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Illinois Formulary for the Drug Product Selection Program

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<strong>Illinois</strong> <strong>Formulary</strong><br />

<strong>for</strong> <strong>the</strong> <strong>Drug</strong> <strong>Product</strong><br />

<strong>Selection</strong> <strong>Program</strong><br />

Twentieth Edition<br />

Effective April 5, 2002<br />

www.idph.state.il.us<br />

George H. Ryan<br />

Governor<br />

John R. Lumpkin, M.D., M.P.H.<br />

Director


ILLINOIS FORMULARY<br />

FOR THE<br />

DRUG PRODUCT SELECTION PROGRAM<br />

Statutory Authority:<br />

<strong>Illinois</strong> Public Acts 80-976, 82-237, 84-495, 85-451, 91-766, and 92-112<br />

<strong>Illinois</strong> Food, <strong>Drug</strong>s and Cosmetic Act, [410 ILCS 620/2.22 and 620/3.14], (<strong>for</strong>merly Chapter 56 ½,<br />

paragraphs 502.22 and 503.14, <strong>Illinois</strong> Revised Statutes), as amended.<br />

Pharmacy Practice Act of 1987, [225 ILCS 85/25], (<strong>for</strong>merly Chapter 111, paragraphs 4123 and 4145,<br />

<strong>Illinois</strong> Revised Statutes), as amended.<br />

Public Act 80-976 took effect on October 1, 1977. The <strong>Drug</strong> <strong>Product</strong> <strong>Selection</strong> <strong>Program</strong> became<br />

operative July 1, 1978. Public Act 82-237 was effective August 19, 1981. Public Act 84-495 took effect<br />

September 17, 1985. Public Act 85-451 became effective on September 17, 1987. Portions of Public<br />

Act 91-766 took effect on June 9, 2000 and September 1, 2000. Public Act 92-112 became effective on<br />

July 20, 2001.<br />

This Twentieth Edition of <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong>, effective April 5, 2002 replaces all previous editions and<br />

supplements of <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as follows:<br />

First Edition ................... Effective July 1, 1978<br />

Supplemental Update ......... Effective October 1, 1978<br />

Supplemental Update ...... Effective December 31, 1978<br />

Supplemental Update ............Effective April 1, 1979<br />

Second Edition ...............Effective August 1, 1979<br />

Third Edition ............. Effective December 22, 1980<br />

Supplemental Update .............Effective July1, 1981<br />

Supplemental Update ......... Effective October 1, 1981<br />

Supplemental Update ........ Effective February 1, 1982<br />

Fourth Edition .................. Effective July 1, 1982<br />

Supplemental Update ......Effective September 15, 1982<br />

Supplemental Update ...... Effective December 15, 1982<br />

Fifth Edition ................... Effective July 1, 1983<br />

Supplemental Update ......... Effective October 1, 1983<br />

Supplemental Update ......... Effective January 1, 1984<br />

Supplemental Update .......... Effective March 1, 1984<br />

Sixth Edition ................... Effective July 1, 1984<br />

Supplemental Update ....... Effective November 1, 1984<br />

Supplemental Update ............Effective April 1, 1985<br />

Supplemental Update ............ Effective May 1, 1985<br />

Seventh Edition ............. Effective January 1, 1986<br />

Supplemental Update ............ Effective May 1, 1986<br />

Eighth Edition ............. Effective February 23, 1987<br />

Supplemental Update ........... Effective May 15, 1987<br />

Supplemental Update ......... Effective August 15, 1987<br />

Supplemental Update ......... Effective January 1, 1988<br />

Ninth Edition ..................Effective April 15, 1988<br />

Supplemental Update ........... Effective June 2, 1988<br />

Supplemental Update ..........Effective August 5, 1988<br />

Supplemental Update ......... Effective October 7, 1988<br />

Tenth Edition ............. Effective February 28, 1989<br />

Supplemental Update ..........Effective August 1, 1989<br />

Supplemental Update ........ Effective October 13, 1989<br />

Supplemental Update ........ Effective January 12, 1990<br />

Twelfth Edition ............... Effective March 8, 1991<br />

Supplemental Update ........... Effective July 19, 1991<br />

Supplemental Update ........ Effective October 25, 1991<br />

Thirteenth Edition ............ Effective March 14, 1992<br />

Supplemental Update ........... Effective May 15, 1992<br />

Supplemental Update ....... Effective November 9, 1992<br />

Supplemental Update ......... Effective March 29, 1993<br />

Supplemental Update ........... Effective July 26, 1993<br />

Supplemental Update ...... Effective December 20, 1993<br />

Supplemental Update ........... Effective May 27, 1994<br />

Fourteenth Edition ........Effective September 29, 1994<br />

Supplemental Update ...... Effective November 17, 1994<br />

Supplemental Update ....... Effective February 23, 1995<br />

Supplemental Update ........... Effective June 1, 1995<br />

Supplemental Update ......... Effective August 31, 1995<br />

Supplemental Update ....... Effective December 7, 1995<br />

Supplemental Update ....... Effective February 29, 1996<br />

Fifteenth Edition .............. Effective June 15, 1996<br />

Supplemental Update ......... Effective August 22, 1996<br />

Supplemental Update ...... Effective November 21, 1996<br />

Supplemental Update ....... Effective February 27, 1997<br />

Sixteenth Edition .............. Effective May 29, 1997<br />

Supplemental Update ......... Effective August 28, 1997<br />

Supplemental Update ...... Effective November 20, 1997<br />

Supplemental Update ....... Effective February 26, 1998<br />

Seventeenth Edition ............ Effective May 28, 1998<br />

Supplemental Update ......... Effective August 27, 1998<br />

Supplemental Update ...... Effective December 17, 1998<br />

Supplemental Update ....... Effective February 25, 1999<br />

Supplemental Update ........... Effective May 27, 1999<br />

Supplemental Update ......... Effective August 26, 1999<br />

Eighteenth Edition ............. Effective March 2, 2000<br />

Supplemental Update ........... Effective June 1, 2000<br />

Supplemental Update ......... Effective August 31, 2000<br />

Nineteenth Edition ..............Effective April 16, 2001<br />

Supplemental Update ............ Effective July 1, 2001<br />

Supplemental Update ......... Effective October 1, 2001<br />

Supplemental Update ......... Effective January 1, 2002<br />

Updates posted monthly at http://www.idph.state.il.us/about/fdd/<strong>for</strong>mulary.htm<br />

ILLINOIS DEPARTMENT OF PUBLIC HEALTH<br />

OFFICE OF HEALTH PROTECTION<br />

DIVISION OF FOOD, DRUGS AND DAIRIES<br />

525 WEST JEFFERSON STREET<br />

SPRINGFIELD, IL 62761-0001<br />

Printed by <strong>the</strong> Authority of <strong>the</strong> State of <strong>Illinois</strong>


ILLINOIS FORMULARY<br />

<strong>for</strong> <strong>the</strong><br />

DRUG PRODUCT SELECTION PROGRAM<br />

TECHNICAL ADVISORY COUNCIL AND DEPARTMENT STAFF<br />

ROBERT W. BUCKMAN, PH.D.<br />

Chicago, <strong>Illinois</strong><br />

DONALD R. GRONEWOLD, R.PH.<br />

Washington, <strong>Illinois</strong><br />

ALFONSE T. MASI, M.D., DR.P.H.<br />

Peoria, <strong>Illinois</strong><br />

JAMES T. O’DONNELL, PHARM. D., M.S.<br />

Chicago, <strong>Illinois</strong><br />

THERESA MOFFETT WILLIS, R.PH., M.B.A.<br />

Godfrey, <strong>Illinois</strong><br />

RONALD W. GOTTRICH, R.PH., M.S.<br />

Manager,<br />

<strong>Drug</strong>s and Medical Devices <strong>Program</strong>s<br />

Division of Food, <strong>Drug</strong>s and Dairies<br />

Office of Health Protection<br />

Springfield, <strong>Illinois</strong>


ILLINOIS FORMULARY <strong>for</strong> <strong>the</strong> DRUG PRODUCT SELECTION PROGRAM<br />

TABLE OF CONTENTS<br />

GENERAL INSTRUCTIONS AND INFORMATION<br />

I. Application of <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> ................................................ i<br />

II. Prescription Requirements and Interpretation ........................................ i<br />

Prescriptions Written Generically .................................... ii<br />

Prescriptions from Out-of-State Prescribers ........................... ii<br />

Prescriptions Mailed Out-of-State ................................... ii<br />

III. Pharmacy Records ........................................................... ii<br />

IV. Suggested Prescription Labeling ................................................. ii<br />

V. Penalties ................................................................... iv<br />

VI. Relationship to <strong>the</strong> Public Aid <strong>Drug</strong> List ........................................... iv<br />

VII. Liability ..................................................................... iv<br />

VIII. Criteria <strong>for</strong> <strong>Drug</strong> <strong>Product</strong> Inclusion ............................................... iv<br />

IX. Criteria <strong>for</strong> <strong>Drug</strong> <strong>Product</strong> Exclusion ............................................... v<br />

X. Pharmaceutical Equivalence .................................................... v<br />

XI. Therapeutic Equivalence ....................................................... vi<br />

Excerpt from FDA Approved <strong>Drug</strong> <strong>Product</strong> List ........................ vi<br />

XII. <strong>Formulary</strong> Format ............................................................vii<br />

Official <strong>Drug</strong> Name ..............................................vii<br />

Dosage Forms and Strengths ......................................vii<br />

Application Holders, Manufacturers .................................vii<br />

Abbreviations Used ..............................................vii<br />

XIII. Interchange of Prescriptions <strong>for</strong> Nonlegend (OTC) <strong>Drug</strong> <strong>Product</strong>s ......................vii<br />

XIV. Manufacturers’ Petitions <strong>for</strong> <strong>Product</strong> Inclusion; Review of <strong>Product</strong>s .................... viii<br />

XV. FDA MedWatch <strong>Product</strong> Reporting <strong>Program</strong> ...................................... viii<br />

XVI. <strong>Program</strong> In<strong>for</strong>mation .......................................................... ix<br />

XVII. Topical Ocular Pharmaceutical Agents <strong>for</strong> use by Certified Optometrists ................. ix<br />

Therapeutic Ocular Pharmaceutical Agents ........................... ix<br />

“AUTHORIZED GENERIC” PHARMACEUTICAL PRODUCTS ............................... x<br />

SAMPLE PRESCRIPTION FORM ..................................................... xiii<br />

PRESCRIPTION DISPENSING FLOW CHART .......................................... xiv<br />

USFDA MEDWATCH PRODUCT REPORT FORM (per<strong>for</strong>ated, detachable, postage-paid) ........<br />

xv<br />

RULES AND REGULATIONS (77 Ill. Adm. Code 790) ......................................xvii<br />

Section 790.10 - Incorporated Materials ..........................................xvii<br />

Section 790.20 - Introduction ...................................................xvii<br />

Section 790.40 - Consideration of <strong>Drug</strong> <strong>Product</strong>s <strong>for</strong> Inclusion in <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> .....xvii<br />

Section 790.60 - Additional Criteria .............................................. xix<br />

Section 790.80 - Quality Listing ................................................. xix<br />

Section 790.100 - Generic <strong>Drug</strong> Entity Headings ................................... xx<br />

Section 790.120 - Comments and Specific Administration ............................ xx<br />

Section 790.140 - Requests <strong>for</strong> Additional Copies .................................. xx<br />

Section 790.160 - Prescription Use of <strong>Drug</strong> <strong>Product</strong>s ............................... xx<br />

Section 790.180 - FDA <strong>Drug</strong> <strong>Product</strong> Approval and Recommendation .................. xx<br />

Section 790.200 - Availability of <strong>Drug</strong> <strong>Product</strong>s; Pharmaceutical Equivalence ............ xxi<br />

Section 790.220 - Single Source <strong>Drug</strong> <strong>Product</strong>s Exclusion ............................ xxi<br />

Section 790.240 - Criteria <strong>for</strong> Exclusion of <strong>Drug</strong> <strong>Product</strong>s ............................ xxi<br />

Section 790.260 - Inclusion of Controlled Substances ............................... xxi<br />

Section 790.280 - Equivalence of <strong>Product</strong>s Requirements ........................... xxi<br />

Section 790.300 - <strong>Selection</strong> of Equivalent <strong>Drug</strong> <strong>Product</strong>s ............................ xxi<br />

Section 790.320 - Transfer of Prescription Records ................................. xxi<br />

NON-INTERCHANGEABLE DRUG PRODUCTS (partial listing) ..............................xxii<br />

LIST OF PRODUCTS ADDED SINCE PUBLICATION OF THE NINETEENTH EDITION .........<br />

xxv<br />

ALPHABETICAL LISTING OF APPROVED DRUG PRODUCTS FOR DRUG PRODUCT SELECTION 1<br />

ALPHABETICAL INDEX ............................................................ 209


ILLINOIS FORMULARY<br />

FOR THE<br />

DRUG PRODUCT SELECTION PROGRAM<br />

GENERAL INSTRUCTIONS AND INFORMATION<br />

This section provides general in<strong>for</strong>mation and answers questions concerning <strong>the</strong> operation of <strong>the</strong><br />

drug product selection program. For fur<strong>the</strong>r in<strong>for</strong>mation, please review <strong>the</strong> Section on Rules and Regulations<br />

immediately preceding <strong>the</strong> alphabetical drug list, which covers some subjects in greater depth.<br />

I. Application of <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong>:<br />

The <strong>Drug</strong> <strong>Product</strong> <strong>Selection</strong> (DPS) <strong>Program</strong> applies whenever an outpatient or his/her<br />

representative presents a prescription <strong>for</strong> a legend (prescription-requiring) drug to an outpatient pharmacy<br />

(community, clinic, HMO or hospital) or when <strong>the</strong> outpatient pharmacy receives an oral or facsimile<br />

prescription order from <strong>the</strong> prescriber to dispense a drug product to an outpatient. (Note that most home<br />

health care prescriptions are considered outpatient prescriptions under <strong>Illinois</strong> law.) <strong>Drug</strong> <strong>Product</strong> <strong>Selection</strong><br />

is <strong>the</strong> process by which a pharmacist dispenses an approved, equivalent generic or brand name product<br />

of lesser cost than <strong>the</strong> particular brand name product prescribed. <strong>Drug</strong> products selected <strong>for</strong> interchange<br />

must come from among those generically equivalent products approved and listed in <strong>the</strong> current edition of<br />

<strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong>. <strong>Drug</strong> <strong>Product</strong> <strong>Selection</strong> can only occur under <strong>the</strong> following circumstances:<br />

A. The prescriber has not blocked DPS ei<strong>the</strong>r orally or by personally checking or marking<br />

beside <strong>the</strong> “May Not Substitute” choice on a compliant prescription <strong>for</strong>m, and;<br />

B. The drug entity and a pharmaceutically equivalent product are listed in <strong>the</strong> current <strong>Illinois</strong><br />

<strong>Formulary</strong>; and;<br />

C. The in<strong>for</strong>med patient or his/her legal representative (parent, legal guardian, spouse) has<br />

agreed to accept a generically equivalent product.<br />

A flow chart depicting <strong>the</strong> process of drug product selection appears on page xiv.<br />

II.<br />

Prescription Requirements and Interpretation:<br />

Since August 19, 1981, outpatient prescriptions written in <strong>Illinois</strong> have been required to comply with<br />

Public Act 82-237 as follows:<br />

On <strong>the</strong> prescription <strong>for</strong>ms of prescribers, shall be placed a signature line and <strong>the</strong><br />

words “may substitute” and “may not substitute”. The prescriber, in his or her own<br />

handwriting, shall place a mark beside ei<strong>the</strong>r <strong>the</strong> “may substitute” or “may not substitute”<br />

alternatives to guide <strong>the</strong> pharmacist in <strong>the</strong> dispensing of <strong>the</strong> prescription. A prescriber<br />

placing a mark beside <strong>the</strong> “may substitute” alternative or failing in his or her own handwriting<br />

to place a mark beside ei<strong>the</strong>r alternative authorizes drug product selection in accordance<br />

with this Act. Preprinted or rubber stamped marks, or o<strong>the</strong>r deviations from <strong>the</strong> above<br />

prescription <strong>for</strong>mat shall not be permitted. The prescriber shall sign <strong>the</strong> <strong>for</strong>m in his or her<br />

own handwriting to authorize <strong>the</strong> issuance of <strong>the</strong> prescription.<br />

Arrangement of <strong>the</strong> required wording on <strong>the</strong> prescription <strong>for</strong>m is left to <strong>the</strong> prescriber’s perogative. A sample<br />

prescription <strong>for</strong>m is printed on page xiii.<br />

If a prescriber’s dispensing instructions should create a problem of interpretation, <strong>the</strong> pharmacist<br />

should contact <strong>the</strong> prescriber <strong>for</strong> clarification and document <strong>the</strong> instructions received from <strong>the</strong> prescriber.<br />

When a drug entity is not included in <strong>the</strong> <strong>for</strong>mulary, product selection cannot be practiced on brand<br />

name prescriptions, even though <strong>the</strong> prescription may be marked “May Substitute.” This applies to<br />

prescriptions <strong>for</strong> all types of reimbursement: private pay, Public Aid, HMO, and o<strong>the</strong>r third party<br />

prescriptions. In such cases, <strong>the</strong> prescriber must be contacted and permission obtained to dispense<br />

-i-


anything o<strong>the</strong>r than <strong>the</strong> brand originally prescribed. The pharmacist should <strong>the</strong>m properly document his/her<br />

prescription records to indicate that <strong>the</strong> prescriber was notified and that permission to dispense an alternate,<br />

non-<strong>for</strong>mulary drug product was received.<br />

Prescriptions Written Generically - Requirements <strong>for</strong> prescriptions written using <strong>the</strong><br />

generic name of a drug product have not been changed. Any legally marketed product meeting <strong>the</strong> identity<br />

of <strong>the</strong> prescribed drug may be professionally selected irrespective of <strong>the</strong> inclusion or exclusion of <strong>the</strong> entity<br />

in this <strong>for</strong>mulary.<br />

Prescriptions from Out-of-State Prescribers - Prescriptions presented from out-of-state<br />

prescribers should be filled in accordance with <strong>the</strong> intent of <strong>the</strong> <strong>Illinois</strong> statutes. The drug product would be<br />

eligible <strong>for</strong> DPS consideration unless <strong>the</strong> prescriber indicated in a clear manner that interchange was not<br />

desired.<br />

Prescriptions Mailed Out-of-State - Prescriptions dispensed within <strong>the</strong> geographic<br />

boundary of <strong>Illinois</strong> which are to be mailed out-of-state must be filled in compliance with <strong>the</strong> statutes and<br />

regulations of <strong>Illinois</strong> concerning drug product selection.<br />

III.<br />

Pharmacy Records:<br />

When DPS is not prohibited, <strong>the</strong> pharmacist should in<strong>for</strong>m <strong>the</strong> patient of what alternate equivalent<br />

drug product (brand name or generic) <strong>the</strong> pharmacy may have available and of <strong>the</strong> cost savings. If <strong>the</strong><br />

in<strong>for</strong>med patient agrees to an interchange, <strong>the</strong> prescription may be filled with <strong>the</strong> alternate product of a lower<br />

cost and <strong>the</strong> name of <strong>the</strong> product dispensed must be placed on <strong>the</strong> label.<br />

In all cases of drug product selection, <strong>the</strong> identification of <strong>the</strong> product dispensed and its<br />

manufacturer, if different than that prescribed, must be entered on <strong>the</strong> readily retrievable pharmacy record<br />

of <strong>the</strong> filled prescription.<br />

IV.<br />

Suggested Prescription Labeling<br />

Examples of suggested labeling of prescriptions <strong>for</strong> brand name and generic name drug products<br />

are as follows:<br />

A. Brand name (e.g.: HYDRODIURIL 50MG) prescribed and dispensed.<br />

acceptable labeling:<br />

HYDRODIURIL 50MG<br />

or<br />

HYDRODIURIL 50MG (Merck)<br />

B. Generic name (e.g.: HYDROCHLOROTHIAZIDE 50 MG) prescribed and <strong>the</strong> Merck<br />

product is dispensed.<br />

acceptable labeling:<br />

HYDROCHLOROTHIAZIDE 50MG<br />

or<br />

HYDROCHLOROTHIAZIDE 50MG (Merck)<br />

or<br />

HYDROCHLOROTHIAZIDE 50MG (HYDRODIURIL)<br />

or<br />

HYDRODIURIL 50MG<br />

or<br />

HYDRODIURIL 50MG (Merck)<br />

-ii-


3a) Brand name (e.g.: HYDRODIURIL 50MG) prescribed and generically equivalent drug authorized<br />

by physician and patient, generically equivalent drug (e.g.: ESIDRIX 50MG) dispensed.<br />

acceptable labeling:<br />

ESIDRIX 50MG<br />

or<br />

ESIDRIX 50MG (generic equivalent of HYDRODIURIL)<br />

or<br />

ESIDRIX 50MG (generic interchange of HYDRODIURIL)<br />

or<br />

ESIDRIX 50MG (generic <strong>for</strong> HYDRODIURIL)<br />

or<br />

ESIDRIX 50MG (gen. For HYDRODIURIL)<br />

or<br />

ESIDRIX 50MG (sub. For HYDRODIURIL)<br />

non-acceptable labeling:<br />

HYDRODIURIL 50MG<br />

or<br />

HYDRODIURIL 50MG (generic)<br />

or<br />

HYDRODIURIL 50MG (ESIDRIX)<br />

or<br />

ESIDRIX 50MG (HYDRODIURIL)<br />

or<br />

ESIDRIX 50MG (same as HYDRODIURIL)<br />

3b) Brand name (e.g.: DARVON 65MG) prescribed, generically equivalent drug authorized by patient<br />

physician, generic drug (e.g.: PROPOXYPHENE HCL 65MG by ESI/Lederle) dispensed.<br />

`<br />

Acceptable labeling:<br />

PROPOXYPHENE HCL 65MG<br />

or<br />

PROPOXYPHENE HCL 65MG (ESI/Lederle)<br />

or<br />

PROPOXYPHENE HCL 65MG (generic equiv. of DARVON)<br />

or<br />

PROPOXYPHENE HCL 65MG (generic <strong>for</strong> DARVON)<br />

or<br />

PROPOXYPHENE HCL 65MG (gen. <strong>for</strong> DARVON)<br />

or<br />

PROPOXYPHENE HCL 65MG (sub. <strong>for</strong> DARVON)<br />

or<br />

PROPOXYPHENE HCL 65MG (generic interchange of DARVON)<br />

or<br />

ESI/Lederle PROPOXYPHENE HCL 65MG (gen. equiv. of DARVON)<br />

or<br />

ESI/Lederle PROPOXYPHENE HCL 65MG (generic interchange of<br />

DARVON)<br />

non-acceptable labeling:<br />

DARVON 65MG<br />

or<br />

DARVON 65MG (generic)<br />

or<br />

DARVON 65MG (ESI/Lederle)<br />

or<br />

DARVON 65MG (PROPOXYPHENE HCL)<br />

or<br />

DARVON 65MG (Lederle PROPOXYPHENE HCL)<br />

or<br />

PROPOXYPHENE HCL 65MG (Same as DARVON)<br />

-iii-


NOTE: BRAND NAMES AND CORPORATE NAMES ARE USED FOR INFORMATIONAL<br />

PURPOSES ONLY AND DO NOT IMPLY AN ENDORSEMENT BY THE STATE OF ILLINOIS.<br />

In all cases of drug product selection, <strong>the</strong> label must clearly indicate that a product o<strong>the</strong>r than that<br />

prescribed has been dispensed. The examples provided above designated “acceptable” would not render<br />

<strong>the</strong> product misbranded, nor would <strong>the</strong>y infringe <strong>the</strong> trademark of <strong>the</strong> prescribed product.<br />

V. Penalties:<br />

Sections 2 of Public Acts 80-976 and 82-237, dealing with prescription requirements, amend <strong>the</strong><br />

Pharmacy Practice Act of 1987. Penalties as provided in <strong>the</strong> Pharmacy Practice Act thus apply to applicable<br />

portions of <strong>the</strong> <strong>Drug</strong> <strong>Product</strong> <strong>Selection</strong> <strong>Program</strong>. Failure to comply with <strong>Illinois</strong> laws and regulations<br />

concerning drug product selection may result in consideration of pharmacists’ or pharmacies’ license<br />

suspension or revocation actions by <strong>the</strong> State Board of Pharmacy.<br />

VI.<br />

Relationship to <strong>the</strong> Public Aid <strong>Drug</strong> List:<br />

The <strong>Illinois</strong> <strong>Formulary</strong> is not to be confused with <strong>the</strong> <strong>Illinois</strong> Department of Public Aid (IDPA) List of<br />

Reimbursable <strong>Drug</strong> <strong>Product</strong>s, also known as <strong>the</strong> “<strong>Drug</strong> Manual” or <strong>the</strong> “Provider Bulletin.” The list of drug<br />

products reimbursable by <strong>the</strong> Department of Public Aid Medicaid <strong>Drug</strong> <strong>Program</strong> contains many additional<br />

products to those in <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong>. When <strong>the</strong> drug entity is included in <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong>, <strong>the</strong><br />

pharmacist must use <strong>the</strong> <strong>for</strong>mulary when practicing drug product selection <strong>for</strong> prescriptions dispensed to<br />

clients of <strong>the</strong> Department of Public Aid. However, when equivalent products are not in <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong><br />

and <strong>the</strong> pharmacist wishes to dispense a lower cost product than <strong>the</strong> brand prescribed in order to meet<br />

Public Aid’s maximum reimbursement (MAC) limits, <strong>the</strong> permission of <strong>the</strong> prescriber must be obtained to<br />

dispense anything o<strong>the</strong>r than <strong>the</strong> product originally prescribed. As with prescriptions reimbursed from o<strong>the</strong>r<br />

sources, <strong>the</strong> pharmacist must properly document that <strong>the</strong> prescriber has authorized <strong>the</strong> dispensing of a non<strong>for</strong>mulary<br />

generic equivalent.<br />

VII.<br />

Liability:<br />

Many experts have testified that pharmacist and physician liability is not increased by state drug<br />

product selection programs in spite of claims of some major manufacturers. In support of this concept, most<br />

liability insurance rates have not increased due strictly to DPS legislation. The legislation in <strong>Illinois</strong><br />

specifically states that pharmacists and physicians incur no increase in liability <strong>for</strong> permitting or practicing<br />

drug product selection in accordance with applicable statutes and regulations. To date, no pharmacists or<br />

physicians are known to have been involved in litigation pertaining to <strong>the</strong> good faith practice of DPS in<br />

<strong>Illinois</strong>.<br />

VIII.<br />

Criteria <strong>for</strong> <strong>Drug</strong> <strong>Product</strong> Inclusion:<br />

Many factors concerning <strong>the</strong> product, its clinical history, <strong>the</strong> manufacturer, bioequivalence testing,<br />

stability testing, etc., are taken into consideration by <strong>the</strong> program staff and Council in determining <strong>the</strong> listing<br />

of products. In short, a conservative policy is followed in which positive data supporting equivalency is<br />

required <strong>for</strong> listing ra<strong>the</strong>r than simply <strong>the</strong> lack of negative in<strong>for</strong>mation. Some of <strong>the</strong> basic criteria which all<br />

drugs must meet are as follows:<br />

A. Possess a federally approved New <strong>Drug</strong> Application (NDA), Abbreviated New <strong>Drug</strong><br />

Application (ANDA), paper NDA, or Antibiotic Form 5 or 6. (Exception possible via Section<br />

790.60)<br />

B. Safety and Efficacy requirements met.<br />

C. Compendial and Good Manufacturing Practices (GMO) requirements met.<br />

D. Listed or approved <strong>for</strong> listing in <strong>the</strong> “Orange Book” and recommended by <strong>the</strong> FDA <strong>for</strong> DPS<br />

use.<br />

E. Bioequivalency, bioavailability, and stability issues satisfied when known to be a problem<br />

or potential problem. This includes meeting “proposed” bioequivalence standards.<br />

-iv-


F. Classified as prescription-only products.<br />

G. Have pharmaceutically equivalent products available meeting all criteria from two or more<br />

manufacturers or equivalent products available under different names from <strong>the</strong> same<br />

manufacturer.<br />

IX.<br />

Criteria <strong>for</strong> <strong>Drug</strong> <strong>Product</strong> Exclusion:<br />

Basic categories <strong>for</strong> which products have been excluded are as follows:<br />

A. Marketed under “Grandfa<strong>the</strong>r” clauses (i.e., originally marketed be<strong>for</strong>e 1938) without an<br />

approved application or lacking an approved application <strong>for</strong> any o<strong>the</strong>r reason. (Exception<br />

possible via Section 790.60)<br />

B. Under review by <strong>the</strong> <strong>Drug</strong> Efficacy Study Implementation (DESI) program or under <strong>the</strong><br />

“EXEMPT” status of Judge William Bryants’ “Paragraph XIV” decision of October 11, 1972.<br />

C. Not cleared of bioequivalence, bioavailability, or stability issues.<br />

D. Not meeting pharmaceutical equivalence criteria.<br />

E. Available only under one marketing name by a single manufacturer.<br />

F. Enteric coated oral dosage <strong>for</strong>ms subject to absorption difference.<br />

G. Suppositories <strong>for</strong> systemic absorption (vs. local effect).<br />

H. Injectable suspensions o<strong>the</strong>r than antibiotics.<br />

I. Aerosol or nebulizer products with inequivalent delivery systems.<br />

J. <strong>Product</strong>s having drug standards issues.<br />

K. Nonlegend “OTC” products, diagnostic aids, nutritional supplements, and medical devices.<br />

(See page vii <strong>for</strong> an explanation of drug product selection <strong>for</strong> OTC Prescriptions.)<br />

Upon a majority vote of <strong>the</strong> assembled members of <strong>the</strong> Technical Advisory Council, criteria <strong>for</strong><br />

product inclusion or exclusion may be waived. Fur<strong>the</strong>r in<strong>for</strong>mation concerning criteria <strong>for</strong> drug inclusion can<br />

be found in <strong>the</strong> Rules and Regulations section.<br />

X. Pharmaceutical Equivalence:<br />

<strong>Product</strong>s are not listed unless two or more pharmaceutically equivalent products are approved <strong>for</strong><br />

DPS use. Interchange can only take place between pharmaceutically equivalent products. The products<br />

must contain <strong>the</strong> same active ingredients which vary in labeled dosage strength by no more than 1%, must<br />

be identical in dosage <strong>for</strong>m and route of administration, and must be <strong>for</strong>mulated to meet <strong>the</strong> same or<br />

comparable drug standards.<br />

Thus, even though some products may contain <strong>the</strong> same strength of <strong>the</strong> same active ingredient, <strong>the</strong><br />

following pharmaceutical alternatives cannot be interchanged: tab/cap, chew tab/tab, solution/suspension,<br />

ointment/cream, elixir/syrup, etc.<br />

In some cases <strong>the</strong> strengths have not been listed (e.g., antibiotics and multiple strength injectables)<br />

and <strong>the</strong> pharmacist must consider only products of equal strengths. Likewise, injectable oil solutions should<br />

only be interchanged when <strong>the</strong> identical type of oil is used as a vehicle in both products.<br />

Some individual products (especially creams, ointments, ophthalmic solutions) may be excluded if<br />

<strong>the</strong>y contain enough variance in <strong>the</strong>ir vehicle ingredients to cause a potential problem with <strong>the</strong>rapeutic<br />

equivalency.<br />

-v-


XI.<br />

Therapeutic Equivalence:<br />

There have been varying opinions relative to <strong>the</strong> relationship between pharmaceutical and<br />

<strong>the</strong>rapeutic equivalence. Unless <strong>the</strong>re is any research or clinical experience to cause reevaluation of <strong>the</strong><br />

following concept <strong>for</strong> a particular product, <strong>the</strong> policy of <strong>the</strong> federal Food and <strong>Drug</strong> Administration is accepted.<br />

Following is a section entitled “General Policies Governing The List” which is reprinted from <strong>the</strong> preface to<br />

<strong>the</strong> FDA publication, Approved <strong>Drug</strong> <strong>Product</strong>s With Proposed Therapeutic Equivalence Evaluations,<br />

January, 1979:<br />

“The fundamental policy governing this list is that <strong>the</strong> FDA considers<br />

pharmaceutically equivalent drug products to be <strong>the</strong>rapeutically equivalent providing <strong>the</strong>y<br />

are approved <strong>for</strong> both safety and effectiveness, are manufactured in accordance with<br />

Current Good Manufacturing Practice Regulations, meet <strong>the</strong> same or equivalent standards,<br />

and, in those instances where positive evidence of bioavailability is necessary, are shown<br />

to be bioequivalent to an appropriate standard. The Agency believes this policy to be<br />

consistent with <strong>the</strong> prevailing opinion of experts and with general experience in <strong>the</strong><br />

marketplace through <strong>the</strong> years.<br />

“The Agency has considered, and rejected, <strong>the</strong> option of requiring in vivo<br />

bioavailability studies <strong>for</strong> every product. Such a policy would result in <strong>the</strong> testing in humans<br />

of a large number of products <strong>for</strong> which <strong>the</strong>re is no evidence of a bioavailability problem,<br />

and would <strong>the</strong>reby waste <strong>the</strong> nation’s clinical reason, <strong>the</strong> FDA has elected under its<br />

bioavailability and bioequivalence regulations to confine in vivo testing of products <strong>for</strong><br />

bioavailability to those particular drugs <strong>for</strong> which such testing is scientifically and medically<br />

necessary. The FDA has also considered, and rejected, <strong>the</strong> options of evaluating <strong>for</strong><br />

<strong>the</strong>rapeutic equivalence, drugs legally marketed without approved applications and drugs<br />

still under review in <strong>the</strong> DESI process. Although such products are required to be<br />

manufactured under <strong>the</strong> Current Good Manufacturing Practice Regulations and to meet<br />

USP or o<strong>the</strong>r official specifications, <strong>the</strong> effectiveness of <strong>the</strong> active ingredient or combination<br />

of ingredients in <strong>the</strong>se products has not been fully evaluated. The Agency is not proposing<br />

to evaluate <strong>the</strong> <strong>the</strong>rapeutic equivalence of products when <strong>the</strong> basic issue of <strong>the</strong>ir<br />

effectiveness is still in doubt.<br />

“In considering <strong>the</strong> <strong>the</strong>rapeutic equivalence of drugs with known or potential<br />

bioavailability problems, <strong>the</strong> Agency has followed a policy of evaluating as <strong>the</strong>rapeutic<br />

equivalents only those products that have met current requirements (in vivo testing in<br />

humans, in vitro dissolution rate requirement, or both, depending on <strong>the</strong> drug). When<br />

bioavailability or bioequivalence requirements are newly established, <strong>the</strong>re is a transition<br />

period during which all manufacturers are permitted to submit in<strong>for</strong>mation regarding <strong>the</strong>ir<br />

products. For this reason some manufacturers whose products may not have yet met <strong>the</strong><br />

requirement are still legally marketed.<br />

“The FDA emphasizes that <strong>the</strong> decision not to evaluate certain pharmaceutically<br />

equivalent products as <strong>the</strong>rapeutically equivalent does not necessarily imply that such<br />

products are known to be inequivalent. In most cases, lack of necessary in<strong>for</strong>mation<br />

supporting <strong>the</strong>rapeutic equivalence, not positive in<strong>for</strong>mation of inequivalence, is <strong>the</strong><br />

underlying reason <strong>for</strong> <strong>the</strong> decision.”<br />

This federal policy was fur<strong>the</strong>r defined in <strong>the</strong> Third Edition of <strong>the</strong> FDA publication, Approved Prescription<br />

<strong>Drug</strong> <strong>Product</strong>s with Therapeutic Equivalence Evaluations, 4 th Edition, 1983.<br />

“<strong>Drug</strong> products considered to be <strong>the</strong>rapeutic equivalents are pharmaceutical<br />

equivalents and can be expected to have <strong>the</strong> same <strong>the</strong>rapeutic effect when administered<br />

to patients under <strong>the</strong> conditions specified in <strong>the</strong> labeling. The concept of <strong>the</strong>rapeutic<br />

equivalence, as used in developing <strong>the</strong> list, applies only to products containing <strong>the</strong> same<br />

<strong>the</strong>rapeutic agents used <strong>for</strong> <strong>the</strong> same disease (e.g., propoxyphene hydrochloride and<br />

pentazocine hydrochloride <strong>for</strong> <strong>the</strong> treatment of pain). FDA evaluates as <strong>the</strong>rapeutically<br />

equivalent those drug products that meet <strong>the</strong> following general criteria: (1) They are in <strong>the</strong><br />

same dosage <strong>for</strong>m, and (b) meet compendial or o<strong>the</strong>r applicable standards of identity,<br />

-vi-


-viistrength,<br />

quality, and purity; (2) They are bioequivalent in that (a) <strong>the</strong>y do not present a<br />

known or potential bioinequivalence problem, or (b) if <strong>the</strong>y do present such a known or<br />

potential problem, <strong>the</strong>y are shown to meet an appropriate bioequivalence standard; (3)<br />

They are adequately labeled; (4) They are manufactured in compliance with Current Good<br />

Manufacturing Practice regulations.<br />

“FDA considers drug products to be <strong>the</strong>rapeutically equivalent if <strong>the</strong>y meet <strong>the</strong><br />

criteria outlined above, even though <strong>the</strong>y may differ in certain o<strong>the</strong>r characteristics, e.g.,<br />

color, flavor, packaging, preservatives, expiration time and minor aspects of labeling. When<br />

such differences are important in <strong>the</strong> care of a particular patient, it is appropriate <strong>for</strong> <strong>the</strong><br />

prescribing physician to require that a particular brand be dispensed as a medical necessity.<br />

As long as this consideration is met, however, FDA believes that products considered<br />

<strong>the</strong>rapeutically equivalent can be substituted with <strong>the</strong> full expectation that <strong>the</strong> substituted<br />

product will product <strong>the</strong> same <strong>the</strong>rapeutic effect as <strong>the</strong> prescribed product.”<br />

XII.<br />

<strong>Formulary</strong> Format:<br />

Official <strong>Drug</strong> Name - Along <strong>the</strong> left hand margin of te drug list is found each drug entity<br />

indicated b <strong>the</strong> official drug name or generic name in upper case letters, alphabetized and underlined.<br />

Under <strong>the</strong> entity heading is first listed <strong>the</strong> products marketed under <strong>the</strong> generic name followed by <strong>the</strong><br />

products marketed by a brand name. Appropriate cross references have been included <strong>for</strong> multiple active<br />

ingredient drug entities.<br />

Dosage Forms and Strengths - In <strong>the</strong> center column are found <strong>the</strong> dosage <strong>for</strong>ms and<br />

dosage strengths which have been approved <strong>for</strong> drug product selection within that entity grouping. The<br />

dosage <strong>for</strong>m listed is <strong>the</strong> <strong>for</strong>m as received by <strong>the</strong> pharmacist.<br />

Application Holders, Manufacturers - The third column lists <strong>the</strong> approved federal<br />

application holder which, usually, is also <strong>the</strong> manufacturer. In many cases, particularly <strong>for</strong> those<br />

corporations listed in <strong>the</strong> generic section, <strong>the</strong>re will be multiple distributors <strong>for</strong> each manufacturer, who<br />

market <strong>the</strong> product under <strong>the</strong> generic name and/or various trade names. All such distributors and products<br />

are approved by extension provided that <strong>the</strong> manufacturer is approved.<br />

In order to use a product <strong>for</strong> drug product selection, pharmacists must be aware of <strong>the</strong> actual<br />

manufacturer of <strong>the</strong> product ei<strong>the</strong>r through label disclosure or in<strong>for</strong>mation supplied by distributors. The<br />

names of application holders who are known to be solely repackers have been enclosed in paren<strong>the</strong>ses <strong>for</strong><br />

<strong>the</strong> in<strong>for</strong>mation of <strong>the</strong> practitioner.<br />

Abbreviations Used -<br />

equivalent<br />

gram<br />

hydrochloride<br />

International Units<br />

microgram<br />

milligram<br />

milliliter<br />

units<br />

eq<br />

gm<br />

HCI<br />

I.U.<br />

mcg<br />

mg<br />

ml<br />

U<br />

In addition, simplified or abbreviated versions of company names have been used under <strong>the</strong><br />

manufacturing heading.<br />

XIII.<br />

Interchange of Prescriptions <strong>for</strong> Nonlegend (OTC) <strong>Drug</strong> <strong>Product</strong>s:<br />

Public Act 82-237 <strong>for</strong>mally granted <strong>Illinois</strong> pharmacists <strong>the</strong> discretion to interchange prescriptions<br />

<strong>for</strong> nonlegend drug product, provided that <strong>the</strong> same dosage <strong>for</strong>m would be dispensed and <strong>the</strong>re would be<br />

no greater than a 1% variance in <strong>the</strong> labeled amounts of <strong>the</strong> products’ active ingredients. As with any<br />

instance of generic interchange, <strong>the</strong> prescription record should be properly documented tot note <strong>the</strong> name<br />

and manufacturer of <strong>the</strong> product dispensed.


XIV.<br />

Manufacturers’ Petitions <strong>for</strong> <strong>Product</strong> Inclusion; Review of <strong>Product</strong>s:<br />

In accordance with <strong>the</strong> provisions of Public Act 92-112, manufacturers must submit <strong>the</strong>ir products<br />

<strong>for</strong> consideration of inclusion in <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong>. The Department no longer automatically reviews<br />

products subject to a federal NDA or ANDA <strong>for</strong> listing in <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong>. In<strong>for</strong>mation on new<br />

generic products must be provided to <strong>the</strong> Department by <strong>the</strong> pharmaceutical company. Forms and<br />

procedures <strong>for</strong> accurate preparation of <strong>the</strong> detailed in<strong>for</strong>mation may be found at<br />

http://www.idph.state.il.us/about/fdd/submission_<strong>for</strong>m.pdf on <strong>the</strong> Department’s website. Such in<strong>for</strong>mation<br />

is <strong>the</strong>n <strong>for</strong>warded to <strong>the</strong> Technical Advisory Council <strong>for</strong> review and recommendations. From time to time,<br />

it is necessary to request additional supportive in<strong>for</strong>mation from manufacturers to complete <strong>the</strong> review of<br />

a particular product. These requests are handled on a case by case basis by Department staff.<br />

The Technical Advisory Council’s determination of ‘issues’ related to <strong>the</strong> practice of medicine or <strong>the</strong><br />

practice of pharmacy’ temporarily halts a product’s entry into <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> pending a meeting of <strong>the</strong><br />

Council and, if necessary, a hearing be<strong>for</strong>e an Administrative Law Judge in accordance with P.A. 92-112.<br />

Supplements and revisions to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> are printed and distributed to <strong>Illinois</strong>’<br />

pharmacies, as well as o<strong>the</strong>r interested parties in accordance with <strong>the</strong> rules of <strong>the</strong> program. Subscriptions<br />

to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> are also available.<br />

XV.<br />

FDA MedWatch Medical <strong>Product</strong>s Reporting <strong>Program</strong>:<br />

The United State Food and <strong>Drug</strong> Administration coordinates a practitioner reporting system aimed<br />

at improving product quality and voluntarily communicating health hazards and serious adverse events to<br />

industry and government. The reporting program works simply and efficiently. Reporting can be done ei<strong>the</strong>r<br />

by stating <strong>the</strong> problem in writing, by calling <strong>the</strong> toll-free number 1-800-FDA-1088, by facsimile at<br />

1-800-FDA-0178, by modem at 1-800-FDA-7737, or online at www.accessdata.fda.gov/scripts/medwatch/<br />

via <strong>the</strong> Internet.<br />

Reports are acknowledged by <strong>the</strong> FDA. Copies of each report are <strong>for</strong>warded to <strong>the</strong> manufacturer<br />

by <strong>the</strong> FDA. The reporter may be contacted by <strong>the</strong> FDA , <strong>the</strong> manufacturer, or both <strong>for</strong> additional in<strong>for</strong>mation<br />

or with <strong>the</strong>ir respective evaluations of <strong>the</strong> observations.<br />

Basically, anything considered to be a problem should be reported. Because <strong>the</strong> user is <strong>the</strong> best<br />

person to judge what constitutes a product problem in a particular situation, and because <strong>the</strong> type of problem<br />

will vary with <strong>the</strong> user, no attempt is made to limit or define what constitutes a product problem.<br />

<strong>Drug</strong> problems include <strong>the</strong> entire spectrum of problems that might be noted when a drug product<br />

is received, used, or dispensed. Examples of packaging and labeling complaints might be: carton does not<br />

protect <strong>the</strong> inner container; container does not protect <strong>the</strong> product; wrong or deficient label; or inadequate<br />

package insert in<strong>for</strong>mation. Examples of evidence of poor pharmaceutical quality in <strong>the</strong> drug products<br />

<strong>the</strong>mselves might be: broken, crumbling or imperfectly manufactured dosage <strong>for</strong>ms, <strong>for</strong>eign or particulate<br />

matter present; drug solid does not reconstitute properly; off color or off taste; etc. <strong>Product</strong>s having<br />

questionable bioavailability and stability may also be reported. The program is not limited to prescription<br />

drugs, so problems on both prescription and over-<strong>the</strong>-counter drug products can be reported. Regarding<br />

<strong>the</strong> latter, many pharmacists have utilized <strong>the</strong> program to report problems experienced and discussed by<br />

consumers.<br />

Serious adverse events include outcomes involving a patient’s death, life threatening situations,<br />

hospitalization (initial or prolonged), disability, congenital anomalies, or intervention ef<strong>for</strong>ts to prevent<br />

permanent impairment or damage, resulting from <strong>the</strong> use or consumption of a medical product.<br />

In addition, your suggestions <strong>for</strong> improvements indicated by reported problems are always welcome<br />

by FDA.<br />

All reports are computerized <strong>for</strong> trend analysis. The data base created from <strong>the</strong>se reports can be<br />

analyzed by product, manufacturer, or problem. This in<strong>for</strong>mation is utilized by <strong>the</strong> FDA to identify any<br />

industry-wide problems or trends, and to call attention to specific product problems.<br />

-viii-


For fur<strong>the</strong>r in<strong>for</strong>mation concerning <strong>the</strong> MedWatch <strong>Program</strong>, pharmacists and physicians may<br />

contact:<br />

MedWatch <strong>Product</strong> Reporting <strong>Program</strong>, United States Food and <strong>Drug</strong> Administration, 5600 Fishers<br />

Lane, Rockville, MD 20852-9787, Toll-free (800) FDA-1088, facsimile (800) FDA-0178, modem<br />

(800) FDA-7737 or online at www.fda.gov/medwatch/safety.htm via <strong>the</strong> Internet. A sample postage-paid<br />

<strong>for</strong>m <strong>for</strong> use with this program appears on pages xv and xvi.<br />

XVI.<br />

to:<br />

<strong>Program</strong> In<strong>for</strong>mation:<br />

Requests <strong>for</strong> fur<strong>the</strong>r in<strong>for</strong>mation concerning <strong>the</strong> <strong>Drug</strong> <strong>Product</strong> <strong>Selection</strong> <strong>Program</strong> should be directed<br />

Manager, <strong>Drug</strong>s and Medical Devices <strong>Program</strong>s, <strong>Illinois</strong> Department of Public Health, Office of<br />

Health Protection, Division of Food, <strong>Drug</strong>s and Dairies, 525 West Jefferson Street, Springfield, IL<br />

62761-0001, Telephone (217) 782-7532, facsimile (217) 782-0943, or via e-mail to rgottric@idph.state.il.us.<br />

XVII.<br />

Topical Ocular Pharmaceutical Agents <strong>for</strong> use by Certified Optometrists<br />

Effective December 1, 1985, <strong>the</strong> Department of Professional Regulation has designated eight topical<br />

ocular pharmaceutical agents which certified optometrists may use in <strong>the</strong>ir practices <strong>for</strong> examination<br />

purposes. These agents are:<br />

Proparacaine HCI (0.5%)<br />

Benoxinate HCI (0.4%)<br />

Tropicamide (0.5% and 1.0%)<br />

Cyclopentolate HCI (0.5% and 1.0%)<br />

Atropine Sulfate (ointment) (0.5%)<br />

Homatropine (2.0% and 5.0%)<br />

Pheylephrine HCI (2.5%)<br />

Hydroxyamphetamine Hydrobromide (1.0%)<br />

Public Act 89-0140 amended te Optometric Practice Act to allow certified optometrists to prescribe<br />

”<strong>the</strong>rapeutic ocular pharmaceutical agents” effective January 1, 1996. For purposes of <strong>the</strong> Act, “<strong>the</strong>rapeutic<br />

ocular pharmaceutical agents” means <strong>the</strong> following when used <strong>for</strong> diagnostic or <strong>the</strong>rapeutic purposes:<br />

Topical anti-infective agents<br />

Topical anti-allergy agents<br />

Topical anti-glaucoma agents<br />

Topical anti-inflammatory agents<br />

Topical anes<strong>the</strong>tic agents<br />

Over-<strong>the</strong>-counter agents<br />

Non-narcotic oral analgesic agents<br />

Mydriatic reversing agents<br />

To date, many optometrists have met necessary requirements and have been certified to use <strong>the</strong>se<br />

agents and may purchase or prescribe <strong>the</strong>m from any <strong>Illinois</strong> licensed pharmacy. Such certified optometrists<br />

have been issued certification numbers. Pharmacists wishing to confirm an optometrist’s number prior to<br />

filling an order may call <strong>the</strong> Department of Professional Regulation’s In<strong>for</strong>mation Center at (217) 782-8556.<br />

Pharmacists may also soon be able to verify <strong>the</strong> certification of optometrists <strong>for</strong> prescribing of topical ocular<br />

pharmaceutical agents and <strong>the</strong>rapeutic ocular pharmaceutical agents at <strong>the</strong> Internet website of <strong>the</strong><br />

Department of Professional Regulation, www.dpr.state.il.us, utilizing <strong>the</strong> link entitled “License Lookup.”<br />

Additions to this list of approved topical ocular pharmaceutical agents and <strong>the</strong>rapeutic ocular<br />

pharmaceutical agents will be communicated to pharmacists in <strong>Illinois</strong> through future editions and<br />

supplements of <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong>.<br />

-ix-


"AUTHORIZED GENERIC" PHARMACEUTICAL PRODUCTS<br />

An ongoing trend in pharmaceutical marketing has proven to be very confusing to <strong>Illinois</strong> pharmacists,<br />

physicians and consumers: Brand name drug manufacturers have introduced "authorized generic" versions<br />

of <strong>the</strong>ir own branded products prior to or after <strong>the</strong> expiration date of <strong>the</strong> patents of <strong>the</strong>ir brand name<br />

products. These brand name drug manufacturers are not obligated to submit Abbreviated New <strong>Drug</strong><br />

Applications (ANDAs) to <strong>the</strong> FDA in order to market <strong>the</strong>se "authorized generics." These "authorized generic"<br />

products are manufactured under <strong>the</strong> original FDA approved New <strong>Drug</strong> Application (NDA) which <strong>the</strong><br />

manufacturer holds <strong>for</strong> <strong>the</strong>ir innovator branded drug product. In <strong>the</strong>se instances, pharmacists' use of <strong>the</strong><br />

"authorized generic" version is not an issue of drug product selection in that <strong>the</strong> "authorized generic" and<br />

<strong>the</strong> innovator product are, in fact, one and <strong>the</strong> same entity (even though <strong>the</strong>y may have different<br />

appearances). They have exactly <strong>the</strong> same <strong>for</strong>mulation; active ingredients and excipients are identical in<br />

composition and quantity (although, obviously, imprint markings are different). There<strong>for</strong>e, <strong>the</strong>se "authorized<br />

generic" drug products may be dispensed when <strong>the</strong> pharmacist receives a prescription <strong>for</strong> <strong>the</strong>ir innovator<br />

branded counterparts, as soon as <strong>the</strong>y are available, whe<strong>the</strong>r or not <strong>the</strong>y appear in <strong>the</strong> current edition of <strong>the</strong><br />

<strong>Illinois</strong> <strong>Formulary</strong>.<br />

The pharmacist should follow <strong>the</strong> prescriber's intent when determining whe<strong>the</strong>r it is appropriate to dispense<br />

an innovator's "authorized generic" product. If <strong>the</strong> prescription is marked "MAY NOT SUBSTITUTE," <strong>the</strong><br />

pharmacist should proceed to dispense <strong>the</strong> originally prescribed brand name (even though <strong>the</strong> innovator's<br />

"authorized generic" is identical in <strong>for</strong>mulation). Should <strong>the</strong> pharmacist desire to dispense <strong>the</strong> innovator's<br />

"authorized generic" in place of <strong>the</strong> brand name drug product when <strong>the</strong> prescription has been marked "MAY<br />

NOT SUBSTITUTE," <strong>the</strong> prescriber should be contacted to obtain a new prescription and <strong>the</strong> original,<br />

undispensed written prescription should be destroyed. This ensures that <strong>the</strong> prescriber is made aware of<br />

<strong>the</strong> unusual circumstance involving an identical <strong>for</strong>mulation, with identical bioavailability and <strong>the</strong>rapeutic<br />

equivalency, from a product having a different appearance than that of <strong>the</strong> originally prescribed brand name<br />

drug, particularly when <strong>the</strong> prescriber is later inspecting containers of medications dispensed to <strong>the</strong>ir patient.<br />

The <strong>Illinois</strong> <strong>Formulary</strong> only lists actual drug manufacturers and FDA application holders. When a brand<br />

name manufacturer creates a subsidiary or contracts with ano<strong>the</strong>r labeler to market "authorized generic"<br />

versions of <strong>the</strong>ir branded products under ano<strong>the</strong>r name, <strong>the</strong> subsidiary and/or o<strong>the</strong>r labeler are considered<br />

distributors. These "authorized generic" distributors are actually nei<strong>the</strong>r manufacturers, nor FDA application<br />

holders.<br />

The following footnote appears in <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> to assist <strong>the</strong> pharmacist in identifying innovator<br />

companies who market <strong>the</strong>ir own "generic" drug product under a previously FDA approved NDA:<br />

*<strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available<br />

<strong>for</strong> drug product selection under o<strong>the</strong>r brand and/or generic names.<br />

In order <strong>for</strong> <strong>the</strong> pharmacist to correctly understand <strong>the</strong> true source of an "authorized generic" product, it is<br />

<strong>the</strong> brand name pharmaceutical manufacturer's obligation to be candid in <strong>the</strong> identification of <strong>the</strong> product's<br />

manufacturer. Many companies have notified pharmacists that <strong>the</strong>y are <strong>the</strong> actual manufacturer of<br />

"authorized generics" distributed by <strong>the</strong>ir own subsidiaries or o<strong>the</strong>r labelers. Promotional materials,<br />

advertising and product labeling will often identify <strong>the</strong> "authorized generic" product's actual manufacturer.<br />

Some "authorized generic" products are not clearly labeled, however. This omission of full disclosure<br />

creates confusion <strong>for</strong> <strong>the</strong> pharmacist attempting to practice drug product selection in accordance with <strong>the</strong><br />

<strong>Illinois</strong> <strong>Formulary</strong>.<br />

Pharmacists may feel free to use <strong>the</strong> "authorized generics" as soon as <strong>the</strong>y are marketed, since <strong>the</strong> use of<br />

<strong>the</strong>se products does not constitute drug product selection. These products are one and <strong>the</strong> same as <strong>the</strong><br />

innovator. A list of "authorized generics" known to be marketed appears on <strong>the</strong> next page.<br />

- x -


"AUTHORIZED GENERICS"<br />

Actigall<br />

Aldactone<br />

Aldomet<br />

Aldoril<br />

Ansaid<br />

Ativan<br />

Atrovent<br />

Betagan<br />

Blocadren<br />

Calan SR<br />

Calcimar<br />

Carafate<br />

Cardizem<br />

Cataflam<br />

Ceclor<br />

Cleocin T<br />

Clinoril<br />

Clomid<br />

Cordarone<br />

Corgard<br />

Cortisporin<br />

Darvocet-N 100<br />

Darvon<br />

Darvon Compound 65<br />

Daypro<br />

DDAVP nasal spray<br />

Diabeta<br />

Diprolene AF<br />

Ditropan<br />

Diuril<br />

Dolobid<br />

Dyazide (old <strong>for</strong>mula)<br />

Dyazide (new <strong>for</strong>mula)<br />

Econopred Plus<br />

Fiorinal<br />

Fiorinal with Codeine<br />

Fioricet<br />

Flexeril<br />

Flumadine<br />

Fulvicin<br />

Grisactin<br />

Grisactin Ultra<br />

Halcion<br />

Hydrodiuril<br />

Indocin SR<br />

Isopto Carpine<br />

K-Dur<br />

Keflex<br />

Klotrix<br />

Imdur<br />

Isoptin<br />

Lac-Hydrin<br />

Levsin SL<br />

Levsinex<br />

Lopid<br />

Lopressor<br />

Lotrisone<br />

Lozol<br />

- Novartis’ “authorized generic” by Geneva<br />

- Searle/Pharmacia’s “authorized generic” by Greenstone<br />

- Merck's "authorized generic" by West Point<br />

- Merck's "authorized generic" by West Point<br />

- Pharmacia's "authorized generic" by Greenstone<br />

- Wyeth-Ayerst’s “authorized generic” by ESI/Lederle<br />

- Boehringer Ingelheim’s “authorized generic” by Roxane<br />

- Allergan's "authorized generic" by Schein/Pacific<br />

- Merck's "authorized generic" by West Point<br />

- Searle/Pharmacia's "authorized generic" by Zenith (BASF)<br />

- Aventis’ "authorized generic" by Arcola<br />

- Aventis’ “authorized generic” by Blue Ridge/Aventis<br />

- Aventis’ "authorized generic" by Blue Ridge/Aventis<br />

- Ciba/Novartis’ “authorized generic” by Geneva<br />

- Lilly's "authorized generic" by STC/Mylan<br />

- Pharmacia's "authorized generic" by Greenstone<br />

- Merck's "authorized generic" by West Point<br />

- Aventis’ "authorized generic" by Blue Ridge/Aventis<br />

- Novartis’ “authorized generic” by Geneva<br />

- Bristol-Myers Squibb's “authorized generic” by Apo<strong>the</strong>con<br />

- Monarch/King’s “authorized generic” by Falcon<br />

- Lilly's "authorized generic" by STC/Mylan<br />

- Lilly's "authorized generic" by STC/Mylan<br />

- Lilly's "authorized generic" by STC/Mylan<br />

- Searle/Pharmacia’s “authorized generic” by Greenstone<br />

- Aventis’ “authorized generic” by Arcola<br />

- Aventis’ "authorized generic" by Copley<br />

- Schering’s “authorized generic” by Warrick<br />

- Aventis’ “authorized generic” by Blue Ridge/Aventis<br />

- Merck's "authorized generic" by West Point<br />

- Merck's "authorized generic" by West Point<br />

- GlaxoSmithKline’s "authorized generic" by Penn<br />

- GlaxoSmithKline’s "authorized generic" by Penn<br />

- Alcon’s “authorized generic” by Falcon<br />

- Novartis’ “authorized generic” by Creighton<br />

- Novartis’ “authorized generic” by Creighton<br />

- Novartis’ “authorized generic” by Creighton<br />

- Merck's "authorized generic" by West Point<br />

- Forest’s “authorized generic” by Inwood<br />

- Schering’s “authorized generic” by Warrick<br />

- Wyeth Ayerst’s “authorized generic” by ESI/Lederle<br />

- Wyeth Ayerst’s “authorized generic” by ESI/Lederle<br />

- Pharmacia’s “authorized generic” by Greenstone<br />

- Merck's "authorized generic" by West Point<br />

- Merck's "authorized generic" by West Point<br />

- Alcon’s “authorized generic” by Falcon<br />

- Schering’s “authorized generic” by Warrick<br />

- Lilly’s “authorized generic” by STC/Mylan<br />

- Bristol-Myers Squibb’s “authorized generic” by Apo<strong>the</strong>con<br />

- Schering/Key’s “authorized generic” by Warrick<br />

- Knoll/Abbott’s "authorized generic" by Sidmak (BASF)<br />

- Bristol-Myers Squibb’s “authorized generic” by Apo<strong>the</strong>con<br />

- Schwarz’ “authorized generic” by Kremers-Urban<br />

- Schwarz’ “authorized generic” by Kremers-Urban<br />

- Parke-Davis/Pfizer's "authorized generic" by Warner-Chilcott<br />

- Ciba-Geigy's "authorized generic" by Geneva<br />

- Schering’s “authorized generic” by Warrick<br />

- Aventis’ "authorized generic" by Arcola<br />

- xi -


"AUTHORIZED GENERICS"<br />

Maxitrol<br />

Mellaril<br />

Metaprel<br />

Micro-K<br />

Micronase<br />

Moduretic<br />

Motrin<br />

M.S. Contin<br />

Nitro-Bid<br />

Nolvadex<br />

Norflex<br />

Norgesic<br />

Norgesic Forte<br />

Normodyne<br />

Norpramin<br />

Ogen<br />

Oruvail<br />

Pamelor<br />

Parlodel<br />

Percocet<br />

Percodan<br />

Phenergan<br />

Plaquenil<br />

Procardia XL<br />

Propine<br />

Proventil<br />

Provera<br />

Quinidex<br />

Reglan<br />

Restoril<br />

Silvadene<br />

Sinemet<br />

Symmetrel<br />

Tagamet<br />

Tambocor<br />

Tenuate Dospan<br />

Tessalon<br />

Tylenol with Codeine<br />

Theo-Dur<br />

Tylenol with codeine<br />

Ventolin Inhaler<br />

Voltaren ophthalmic<br />

Westcort<br />

Xanax<br />

- Alcon’s “authorized generic” by Falcon<br />

- Novartis’ “authorized generic” by Creighton<br />

- Boehringer's "authorized generic" inhaler by Roxane<br />

- Robins’ “authorized generic” by ESI/Lederle<br />

- Pharmacia's "authorized generic" by Greenstone<br />

- Merck's "authorized generic" by West Point<br />

- Pharmacia’s “authorized generic” by Greenstone<br />

- Purdue Frederick's "authorized generic" by AB Dick/Apotex<br />

- Aventis’ “authorized generic” by Blue Ridge<br />

- AstraZeneca's "authorized generic" by Barr<br />

- 3M’s “authorized generic” by Mylan<br />

- 3M’s “authorized generic” by Mylan<br />

- 3M’s “authorized generic” by Mylan<br />

- Schering’s “authorized generic” by Warrick<br />

- Aventis’ “authorized generic” by Blue Ridge/Aventis<br />

- Ortho/Johnson & Johnson’s “authorized generic” by NorAmCo<br />

- Wyeth-Ayerst’s “authorized generic” by ESI/Lederle<br />

- Novartis’ "authorized generic" by Creighton<br />

- Novartis’ “authorized generic” by Geneva<br />

- DuPont's "authorized generic" by Endo<br />

- DuPont's "authorized generic" by Endo<br />

- Wyeth-Ayerst’s authorized generic by ESI/Lederle<br />

- Sanofi-Syn<strong>the</strong>labo’s “authorized generic” by Kanetta<br />

- Pfizer’s “authorized generic” by Mylan<br />

- Allergan's "authorized generic" by Schein<br />

- Schering's "authorized generic" by Warrick<br />

- Pharmacia’s “authorized generic” by Greenstone<br />

- Robins’ “authorized generic” by ESI/Lederle<br />

- Robins’ “authorized generic” by ESI/Lederle<br />

- Novartis’ “authorized generic” by Creighton<br />

- Aventis’ “authorized generic” by Blue Ridge/Aventis<br />

- DuPont's "authorized generic" by Endo<br />

- DuPont's "authorized generic" by Endo<br />

- GlaxoSmithKline's "authorized generic" by Penn<br />

- 3M’s “authorized generic” by Mylan<br />

- Aventis’ "authorized generic" by Blue Ridge/Aventis<br />

- Forest's "authorized generic" by Inwood<br />

- Johnson & Johnson’s (OMJ’s) “authorized generic” by Purepac<br />

- Schering's "authorized generic" by Warrick<br />

- McNeil’s “authorized” generic by Purepac/OMJ<br />

- GlaxoSmithKline’s “authorized generic” by Dey<br />

- Ciba/Novartis’ “authorized generic” by Geneva<br />

- Bristol-Myers Squibb’s “authorized generic” by Apo<strong>the</strong>con<br />

- Pharmacia's "authorized generic" by Greenstone<br />

Additionally, Bausch & Lomb’s “authorized generics” by Sight<br />

The Department of Public Health, Division of Food, <strong>Drug</strong>s and Dairies, will update this list periodically. If<br />

you have any questions pertaining to drug product selection, please feel free to call (217) 782-7532.<br />

-xii-


____________________ ____________________ ____________________<br />

_________________________<br />

_________________________<br />

____________________ ____________________ ____________________<br />

PATIENT NAME<br />

AGE<br />

ADDRESS<br />

DATE<br />

L<br />

G<br />

G<br />

MAY SUBSTITUTE<br />

MAY NOT SUBSTITUTE<br />

, M.D.<br />

MAY REFILL TIMES DEA<br />

- xiii -


(DAW = DISPENSE AS WRITTEN)


U.S. Department of Health and Human Services<br />

M EDW ATCH<br />

The FDA Safety In<strong>for</strong>mation and<br />

Adverse Event Reporting <strong>Program</strong><br />

A. Patient in<strong>for</strong>mation<br />

1. Patient identifier<br />

In confidence<br />

2. Age at time<br />

of event:<br />

or<br />

Date<br />

of birth:<br />

B. Adverse event or product problem<br />

2. Outcomes attributed to adverse event<br />

(check all that apply)<br />

death __________________<br />

(mo/day/yr)<br />

life-threatening<br />

hospitalization - initial or prolonged<br />

3. Sex<br />

female<br />

male<br />

4. Weight<br />

1. Adverse event and/or <strong>Product</strong> problem (e.g., defects/malfunctions)<br />

3. Date of<br />

event<br />

(mo/day/yr)<br />

5. Describe event or problem<br />

disability<br />

congenital anomaly<br />

required intervention to prevent<br />

permanent impairment/damage<br />

o<strong>the</strong>r: ___________________<br />

4. Date of<br />

this report<br />

(mo/day/yr)<br />

For VOLUNTARYreporting of<br />

adverse events and product problems<br />

Page ____ of ____<br />

or<br />

lbs<br />

kgs<br />

C. Suspect medication(s)<br />

Form Approved:OMB No. 0910-0291 Expires: 04/30/03<br />

See OMB statement on reverse<br />

FDA Use Only<br />

Triage unit<br />

sequence #<br />

1. Name (give labeled strength & mfr/labeler, if known)<br />

#1<br />

#2<br />

2. Dose, frequency & route used 3. Therapy dates (if unknown, give duration)<br />

from/to (or best estimate)<br />

#1<br />

#1<br />

#2<br />

4. Diagnosis <strong>for</strong> use (indication)<br />

#1<br />

#2<br />

6. Lot # (if known)<br />

#1<br />

#2<br />

9. NDC # (<strong>for</strong> product problems only)<br />

- -<br />

#2<br />

7. Exp. date (if known)<br />

#1<br />

#2<br />

5. Event abated after use<br />

stopped or dose reduced<br />

yes no doesn't<br />

apply<br />

8. Event reappeared after<br />

reintroduction<br />

10. Concomitant medical products and <strong>the</strong>rapy dates (exclude treatment of event)<br />

#1<br />

#2 yes no doesn't<br />

apply<br />

#1<br />

yes no doesn't<br />

apply<br />

#2 yes no doesn't<br />

apply<br />

R USE BLACK INK<br />

PLEASE TYPE OR<br />

6. Relevant tests/laboratory data, including dates<br />

D. Suspect medical device<br />

1. Brand name<br />

2. Type of device<br />

3. Manufacturer name & address<br />

6.<br />

model # ________________________________________<br />

catalog # _______________________________________<br />

serial #_________________________________________<br />

lot # ___________________________________________<br />

4. Operator of device<br />

health professional<br />

lay user/patient<br />

o<strong>the</strong>r:<br />

________________<br />

5. Expiration date<br />

(mo/day/yr)<br />

7. If implanted, give date<br />

(mo/day/yr)<br />

8. If explanted, give date<br />

(mo/day/yr)<br />

o<strong>the</strong>r #<br />

9. Device available <strong>for</strong> evaluation? (Do not send to FDA)<br />

yes no returned to manufacturer on __________________<br />

(mo/day/yr)<br />

10. Concomitant medical products and <strong>the</strong>rapy dates (exclude treatment of event)<br />

7. O<strong>the</strong>r relevant history, including preexisting medical conditions (e.g., allergies,<br />

race, pregnancy, smoking and alcohol use, hepatic/renal dysfunction, etc.)<br />

E. Reporter (see confidentiality section on back)<br />

1. Name & address<br />

phone #<br />

FDA Form 3500<br />

Mail to:<br />

MEDWATCH<br />

FAX to:<br />

5600 Fishers Lane 1-800-FDA-0178<br />

Rockville, MD 20852-9787<br />

2. Health professional?<br />

yes<br />

no<br />

3. Occupation<br />

5. If you do NOT want your identity disclosed to<br />

<strong>the</strong> manufacturer, place an " X " in this box.<br />

4. Also reported to<br />

manufacturer<br />

user facility<br />

distributor<br />

Submission of a report does not constitute an admission that medical personnel or <strong>the</strong> product caused or contributed to <strong>the</strong> event.


ADVICE ABOUT VOLUNTARY REPORTING<br />

Report adverse experiences with:<br />

• medications (drugs or biologics)<br />

• medical devices (including in-vitro diagnostics)<br />

• special nutritional products (dietary<br />

supplements, medical foods, infant <strong>for</strong>mulas)<br />

• cosmetics<br />

• medication errors<br />

Report product problems– quality, per<strong>for</strong>mance<br />

or safety concerns such as:<br />

• suspected contamination<br />

• questionable stability<br />

• defective components<br />

• poor packaging or labeling<br />

• <strong>the</strong>rapeutic failures<br />

Report SERIOUS adverse events. An event<br />

is serious when <strong>the</strong> patient outcome is:<br />

• death<br />

• life-threatening (real risk of dying)<br />

• hospitalization (initial or prolonged)<br />

• disability (significant, persistent or permanent)<br />

• congenital anomaly<br />

• required intervention to prevent permanent<br />

impairment or damage<br />

Report even if:<br />

• you’re not certain <strong>the</strong> product caused <strong>the</strong><br />

event<br />

• you don’t have all <strong>the</strong> details<br />

How to report:<br />

• just fill in <strong>the</strong> sections that apply to your report<br />

• use section C <strong>for</strong> all products except<br />

medical devices<br />

• attach additional blank pages if needed<br />

• use a separate <strong>for</strong>m <strong>for</strong> each patient<br />

• report ei<strong>the</strong>r to FDA or <strong>the</strong> manufacturer<br />

(or both)<br />

Confidentiality: The patient’s identity is held in strict<br />

confidence by FDA and protected to <strong>the</strong> fullest extent of<br />

<strong>the</strong> law. FDA will not disclose <strong>the</strong> reporter’s identity in<br />

response to a request from <strong>the</strong> public, pursuant to <strong>the</strong><br />

Freedom of In<strong>for</strong>mation Act. The reporter’s identity,<br />

including <strong>the</strong> identity of a self-reporter, may be shared<br />

with <strong>the</strong> manufacturer unless requested o<strong>the</strong>rwise.<br />

If your report involves a serious adverse event<br />

with a device and it occurred in a facility outside a doctor’s<br />

office, that facility may be legally required to report to<br />

FDA and/or <strong>the</strong> manufacturer. Please notify <strong>the</strong> person in<br />

that facility who would handle such reporting.<br />

Important numbers:<br />

• 1-800-FDA-0178 to FAX report<br />

• 1-800-FDA-1088 to report by phone or <strong>for</strong><br />

more in<strong>for</strong>mation<br />

• 1-800-822-7967 <strong>for</strong> a VAERS <strong>for</strong>m <strong>for</strong> vaccines<br />

To Report via <strong>the</strong> Internet:<br />

https://www.accessdata.fda.gov/scripts/medwatch/<br />

The public reporting burden <strong>for</strong> this collection of in<strong>for</strong>mation<br />

has been estimated to average 30 minutes per response,<br />

including <strong>the</strong> time <strong>for</strong> reviewing instructions, searching existing<br />

data sources, ga<strong>the</strong>ring and maintaining <strong>the</strong> data needed,<br />

and completing and reviewing <strong>the</strong> collection of in<strong>for</strong>mation.<br />

Send comments regarding this burden estimate or any o<strong>the</strong>r<br />

aspect of this collection of in<strong>for</strong>mation, including suggestions<br />

<strong>for</strong> reducing this burden to:<br />

DHHS Reports Clearance Office<br />

Paperwork Reduction Project (0910-0291)<br />

Hubert H. Humphrey Building, Room 531-H<br />

200 Independence Avenue, S.W.<br />

Washington, DC 20201<br />

“An agency may not conduct or sponsor,<br />

and a person is not required to respond to,<br />

a collection of in<strong>for</strong>mation unless it displays<br />

a currently valid OMB control number.”<br />

Please DO NOT<br />

RETURN this <strong>for</strong>m<br />

to this address.<br />

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES<br />

Public Health Service • Food and <strong>Drug</strong> Administration<br />

FDA Form 3500-back<br />

Please Use Address Provided Below – Just Fold In Thirds, Tape and Mail<br />

Department of<br />

Health and Human Services<br />

Public Health Service<br />

Food and <strong>Drug</strong> Administration<br />

Rockville, MD 20857<br />

Official Business<br />

Penalty <strong>for</strong> Private Use $300<br />

BUSINESS REPLY MAIL<br />

FIRST CLASS MAIL PERMIT NO. 946 ROCKVILLE, MD<br />

M EDW ATCH<br />

The FDA Safety In<strong>for</strong>mation and Adverse Event Reporting <strong>Program</strong><br />

Food and <strong>Drug</strong> Administration<br />

5600 Fishers Lane<br />

Rockville, MD 20852-9787


RULES AND REGULATIONS<br />

ILLINOIS FORMULARY <strong>for</strong> <strong>the</strong> DRUG PRODUCT SELECTION PROGRAM<br />

(current through December 8, 2000)<br />

Section 790.10 Incorporated Materials<br />

a) The following materials are incorporated by reference in this Part and include no later amendments<br />

or additions:<br />

1) Section 314.1, Definitions <strong>for</strong> <strong>the</strong> Applications <strong>for</strong> FDA Approval to Market a New <strong>Drug</strong>,<br />

21 CFR 314.3, April 1, 1999.<br />

2) Section 320.1, Definitions <strong>for</strong> <strong>the</strong> Bioavailability and Bioequivalence Requirements,<br />

21 CFR 320.1, April 1, 1999.<br />

b) Incorporations or references refer o <strong>the</strong> materials on <strong>the</strong> date specified and do not include later<br />

amendments or additions.<br />

c) Copies of incorporated or referenced material are available <strong>for</strong> inspection and copying at <strong>the</strong><br />

Department of Public Health, Office of Health Protection, Division of Food, <strong>Drug</strong>s and Dairies, <strong>Drug</strong><br />

<strong>Product</strong> <strong>Selection</strong> <strong>Program</strong>, 525 West Jefferson Street, 2 nd Floor, Springfield, <strong>Illinois</strong> 62761-0001.<br />

Section 790.20 Introduction<br />

a) The <strong>Illinois</strong> Food, <strong>Drug</strong> and Cosmetic Act (Ill. Rev. Stat. 1987, Ch. 56 ½, par. 503.14) allows<br />

interchange of different brands or nonbrands of <strong>the</strong> same generic drug entity <strong>for</strong> a drug product<br />

prescribed by a specific trade name. <strong>Product</strong>s selected <strong>for</strong> interchange must be pharmaceutically<br />

equivalent to <strong>the</strong> prescribed product and must be listed in a positive drug product <strong>for</strong>mulary known<br />

as <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> which has been developed, maintained and issued by <strong>the</strong> <strong>Illinois</strong> Department<br />

of Public Health (hereinafter referred to as <strong>the</strong> "Department"). The practice of selecting an equivalent<br />

drug product from <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> to dispense instead of <strong>the</strong> trade name product prescribed is<br />

known as <strong>Drug</strong> <strong>Product</strong> <strong>Selection</strong> (DPS).<br />

b) The initial issue of <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> <strong>for</strong> use in <strong>Drug</strong> <strong>Product</strong> <strong>Selection</strong> became effective on<br />

July 1, 1978. Periodic updates to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> will be distributed by <strong>the</strong> Department of Public<br />

Health. Single copies of <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> shall be provided to all licensed pharmacies with<br />

<strong>Illinois</strong> addresses. Upon request, single copies of <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> will be provided, at no<br />

charge, to licensed prescribers, pharmacists practicing <strong>the</strong>ir profession in <strong>Illinois</strong>, to pharmacists<br />

seeking reciprocation, students enrolled in a pharmacy curriculum at <strong>the</strong> University of <strong>Illinois</strong> at<br />

Chicago, College of Pharmacy, <strong>the</strong> Chicago College of Pharmacy, St. Louis College of Pharmacy,<br />

students enrolled out-of-state in a college of pharmacy who seek a pharmacist licensure in <strong>the</strong> State<br />

of <strong>Illinois</strong>, or students enrolled in a pharmacy technician program.<br />

c) The Department shall make available to o<strong>the</strong>r interested parties a subscription to <strong>the</strong> <strong>Illinois</strong><br />

<strong>Formulary</strong> and its revisions at a fee of $50.00 per year. All subscription fees collected by <strong>the</strong><br />

Department shall be deposited into <strong>the</strong> Food and <strong>Drug</strong> Safety Fund.<br />

Section 790.40 Consideration of <strong>Drug</strong> <strong>Product</strong>s <strong>for</strong> Inclusion in <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong><br />

a) <strong>Drug</strong> products <strong>for</strong> inclusion in <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> shall be approved and recommended to <strong>the</strong><br />

Director of Public Health, by a Technical Advisory Council according to <strong>the</strong> notice and hearing<br />

provisions of this Section. The Council is composed of 7 members, each of whom has extensive<br />

experience in pharmaceutical affairs. <strong>Product</strong>s <strong>for</strong> Council consideration shall be researched and<br />

presented by Department staff following consideration of recommendations by <strong>the</strong> federal Food and<br />

<strong>Drug</strong> Administration (FDA), of recognized drug reference sources, of published research, and of<br />

qualified consultants.<br />

- xvii -


) No product shall be considered <strong>for</strong> inclusion in <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> unless each individual dosage<br />

<strong>for</strong>m, dosage strength and manufacturer has been recommended <strong>for</strong> drug product selection use by<br />

<strong>the</strong> FDA. Each product considered must be verified by <strong>the</strong> FDA as being marketed under currently<br />

approved drug applications, as meeting required manufacturing standards and chemical identity<br />

standards, and as being cleared of any issues involving <strong>the</strong> bioequivalence or bioavailability of <strong>the</strong><br />

product. Prior to being sanctioned <strong>for</strong> DPS use, <strong>the</strong> product must pass FDA criteria specific <strong>for</strong> DPS<br />

approval which may be more stringent than that required <strong>for</strong> general marketing approval.<br />

“Bioequivalence” and “bioavailability” have <strong>the</strong> meanings prescribed under 21 CFR 320.1,<br />

April 1, 1999.<br />

c) Generic <strong>Drug</strong> <strong>Product</strong>s.<br />

1) <strong>Drug</strong> products previously approved by <strong>the</strong> Technical Advisory Council <strong>for</strong> generic interchange<br />

may be substituted in <strong>the</strong> State of <strong>Illinois</strong> without fur<strong>the</strong>r review subject to <strong>the</strong> conditions of<br />

approval in <strong>the</strong> State be<strong>for</strong>e September 1, 2000 (<strong>the</strong> effective date of Public Act 91-766).<br />

(Section 3.14 of <strong>the</strong> <strong>Illinois</strong> Food, <strong>Drug</strong> and Cosmetic Act [410 ILCS 620/3.14]). <strong>Drug</strong> products<br />

requiring approval by <strong>the</strong> Council on or after September 1, 2000, <strong>for</strong> generic interchange are<br />

subject to <strong>the</strong> notice and hearing provisions of this Section.<br />

2) If not subject to a hearing under subsection (c)(5) or if not specifically prohibited, <strong>the</strong>n generic<br />

drug products determined to be <strong>the</strong>rapeutically equivalent by <strong>the</strong> FDA shall be available <strong>for</strong><br />

substitution in this State no sooner than 60 days after <strong>the</strong> submission of <strong>the</strong> prescribed<br />

notification under subsection (d) to <strong>the</strong> Council. "Therapeutic equivalence" has <strong>the</strong> meaning<br />

prescribed under <strong>the</strong> current edition or supplement of <strong>the</strong> FDA’s "Approved <strong>Drug</strong> <strong>Product</strong>s with<br />

Therapeutic Equivalence Evaluations".<br />

3) Manufacturers of <strong>the</strong> generic drug products shall submit to <strong>the</strong> Council <strong>the</strong> notification<br />

described in subsection (d) at least 60 days be<strong>for</strong>e <strong>the</strong> scheduled substitution of <strong>the</strong> drug<br />

product. During <strong>the</strong> 60-day notification period, <strong>the</strong> Council shall determine, based upon a<br />

preponderance of <strong>the</strong> evidence, whe<strong>the</strong>r <strong>the</strong> generic drug product has issues related to <strong>the</strong><br />

practice of medicine or <strong>the</strong> practice of pharmacy.<br />

4) If <strong>the</strong> Council determines that <strong>the</strong> generic drug product does not have issues related to <strong>the</strong><br />

practice of medicine or pharmacy, <strong>the</strong>n <strong>the</strong> Council shall issue its recommendation of approval<br />

of <strong>the</strong> generic drug product to <strong>the</strong> Director. If included on <strong>the</strong> <strong>Drug</strong> <strong>Product</strong>s <strong>Selection</strong><br />

<strong>Formulary</strong> by <strong>the</strong> Director under subsection (f), <strong>the</strong>n <strong>the</strong> drug product may be substituted in<br />

<strong>the</strong> State after <strong>the</strong> 60-day notification period, <strong>the</strong> date of <strong>the</strong> Director’s approval, or <strong>the</strong> date<br />

of <strong>the</strong> product’s full approval <strong>for</strong> safety and efficacy by <strong>the</strong> FDA, whichever date is later.<br />

5) If <strong>the</strong> Council determines that <strong>the</strong> generic drug product has issues related to <strong>the</strong> practice of<br />

medicine or pharmacy, <strong>the</strong>n:<br />

(A)<br />

(B)<br />

(C)<br />

a hearing on <strong>the</strong> drug product shall be held under subsection (e) at <strong>the</strong> Council’s next<br />

regularly scheduled meeting;<br />

<strong>the</strong> Council’s hearing determination shall be reviewed by <strong>the</strong> Director under subsection<br />

(f); and<br />

<strong>the</strong> drug product may not be substituted in <strong>the</strong> State unless included in <strong>the</strong> <strong>Drug</strong><br />

<strong>Product</strong>s <strong>Selection</strong> <strong>Formulary</strong> by <strong>the</strong> Director.<br />

d) The 60-day notification shall be submitted in writing to <strong>the</strong> Technical Advisory Council at <strong>the</strong> following<br />

address:<br />

Administrator, <strong>Drug</strong> <strong>Product</strong> <strong>Selection</strong> <strong>Program</strong><br />

<strong>Illinois</strong> Department of Public Health<br />

Office of Health Protection<br />

Division of Food, <strong>Drug</strong>s and Dairies<br />

525 W. Jefferson Street<br />

Springfield, <strong>Illinois</strong> 62761-0001<br />

- xviii -


1) The notification to <strong>the</strong> Council shall consist of 9 complete copies of all <strong>the</strong> following items:<br />

(A)<br />

(B)<br />

(C)<br />

All testimony (plus one copy of <strong>the</strong> testimony that has individual identifying in<strong>for</strong>mation<br />

redacted) and data upon which comment or reference to may be made, whe<strong>the</strong>r<br />

published or unpublished.<br />

The drug product’s technical bioequivalence and <strong>the</strong>rapeutic equivalence in<strong>for</strong>mation,<br />

including documentation of <strong>the</strong> required testing to support FDA product approval.<br />

The in<strong>for</strong>mation required in subsection (b).<br />

2) The Department shall notify all o<strong>the</strong>r manufacturers of products within a specific generic entity<br />

that a hearing will be held on <strong>the</strong> drug product. The notification may be posted on <strong>the</strong><br />

Department’s Internet Website at www.idph.state.il.us. These manufacturers shall provide 9<br />

copies of all testimony (plus one copy of <strong>the</strong> testimony that has individual identifying<br />

in<strong>for</strong>mation redacted) and 9 copies of all data upon which comment or reference to may be<br />

made, whe<strong>the</strong>r published or unpublished, in writing to <strong>the</strong> Department within 30 days be<strong>for</strong>e<br />

<strong>the</strong> regularly scheduled meeting should <strong>the</strong>y wish to be heard on <strong>the</strong> specific issue at <strong>the</strong><br />

Council meeting. Nine copies of all rebuttal comments from any concerned manufacturer shall<br />

be submitted in writing to <strong>the</strong> Department within 14 days after <strong>the</strong> regularly scheduled meeting,<br />

should a company wish to respond to its competitor's submission.<br />

e) The Director may designate an individual to conduct <strong>the</strong> hearing and make a recommendation to <strong>the</strong><br />

Council on a generic drug product that has issues related to <strong>the</strong> practice of medicine or pharmacy.<br />

The Council shall make <strong>the</strong> final recommendation. Hearings shall be conducted according to <strong>the</strong><br />

Rules of Practice and Procedure in Administrative Hearings (77 Ill. Adm. Code 100) under Article 10<br />

of <strong>the</strong> <strong>Illinois</strong> Administrative Procedure Act [5 ILCS 100/Art. 10]. Determinations shall be<br />

accompanied by a written detailed explanation of <strong>the</strong> decision’s basis. The Council shall make its<br />

recommendation of approval or disapproval of <strong>the</strong> generic drug product to <strong>the</strong> Director within 20<br />

business days after <strong>the</strong> public hearing.<br />

f) After <strong>the</strong> Council’s recommendation <strong>for</strong> approval or disapproval of <strong>the</strong> drug product is submitted to<br />

<strong>the</strong> Director, <strong>the</strong> Director may approve or prohibit <strong>the</strong> drug product’s inclusion in <strong>the</strong> <strong>Drug</strong> <strong>Product</strong>s<br />

<strong>Selection</strong> <strong>Formulary</strong>. Only if <strong>the</strong> Director decides that, based upon a preponderance of <strong>the</strong> evidence,<br />

<strong>the</strong> generic drug is not bioequivalent, is not <strong>the</strong>rapeutically equivalent, or could cause clinically<br />

significant harm to <strong>the</strong> health or safety of patients, may <strong>the</strong> Director prohibit <strong>the</strong> drug product from<br />

inclusion in <strong>the</strong> <strong>for</strong>mulary. The Director’s decision to prohibit a drug product from inclusion in <strong>the</strong><br />

<strong>for</strong>mulary shall be accompanied by a written detailed explanation of <strong>the</strong> decision’s basis. Decisions<br />

under this subsection constitute a final administrative decision within <strong>the</strong> meaning of Section 22.2 of<br />

<strong>the</strong> <strong>Illinois</strong> Food, <strong>Drug</strong> and Cosmetic Act [410 ILCS 620/22.2] and Section 3-101 of <strong>the</strong> Administrative<br />

Review Law [735 ILCS 5/3-101] and are subject to judicial review under Article III of <strong>the</strong><br />

Administrative Review Law [735 ILCS 5/Art. III].<br />

g) Exclusive indications and unique product packaging, whe<strong>the</strong>r patented or unpatented, do not<br />

constitute criteria <strong>for</strong> inclusion of a drug entity in <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong>.<br />

Section 790.60 Additional Criteria<br />

Additional criteria may be adopted as needed by <strong>the</strong> Department upon <strong>the</strong> recommendation of <strong>the</strong> Technical<br />

Advisory Council to fur<strong>the</strong>r define <strong>the</strong> parameters <strong>for</strong> drug product inclusion. Individual exceptions to any criteria<br />

may be made upon a majority vote of <strong>the</strong> assembled Council members and such exceptions must be noted in <strong>the</strong><br />

<strong>Illinois</strong> <strong>Formulary</strong>.<br />

Section 790.80 Quality Listing<br />

a) The <strong>Illinois</strong> <strong>Formulary</strong> is a quality listing of generically equivalent drug products approved <strong>for</strong><br />

marketing and is based upon <strong>the</strong> criteria as found in <strong>the</strong>se Rules and Regulations. The listing is not<br />

affected by costs or by current or pending litigation against a particular drug product. As an aid to<br />

users of <strong>the</strong> <strong>for</strong>mulary, an in<strong>for</strong>mational footnote will be placed with an entity listing whenever <strong>the</strong><br />

- xix -


Department receives substantive evidence of litigation involving <strong>the</strong> product(s). <strong>Product</strong>s will be<br />

deleted from <strong>the</strong> <strong>for</strong>mulary listing whenever FDA regulatory processes or o<strong>the</strong>r legal action results<br />

in a loss of <strong>the</strong> product's marketing approval or availability.<br />

b) The names of application holders who are known to be solely repackers will be enclosed in<br />

paren<strong>the</strong>ses <strong>for</strong> <strong>the</strong> in<strong>for</strong>mation of <strong>the</strong> practitioner.<br />

c) <strong>Product</strong>s discontinued from marketing or products which have <strong>the</strong>ir approval withdrawn <strong>for</strong> reasons<br />

o<strong>the</strong>r than safety and efficacy, will be noted by <strong>the</strong> symbol "@" preceding <strong>the</strong> dosage <strong>for</strong>m. This<br />

symbol designates <strong>the</strong>ir non-marketed status and notifies practitioners that <strong>the</strong> specific<br />

manufacturer's product may be in short supply. The "@" notation does not change <strong>the</strong> drug product<br />

selection status of <strong>the</strong> drug entity. <strong>Product</strong>s approved and listed <strong>for</strong> interchange may be used until<br />

<strong>the</strong>ir supply is exhausted.<br />

Section 790.100 Generic <strong>Drug</strong> Entity Headings<br />

The <strong>for</strong>mulary consists of generic drug entity headings in alphabetical order. Within <strong>the</strong> entity grouping is indicated<br />

<strong>the</strong> individual product's marketed name, dosage <strong>for</strong>m and dosage strength. The manufacturer listed is <strong>the</strong> firm<br />

holding <strong>the</strong> FDA approved drug application <strong>for</strong> <strong>the</strong> product. Listed products remain approved <strong>for</strong> DPS use when<br />

distributed under <strong>the</strong> label of ano<strong>the</strong>r manufacturer.<br />

Section 790.120 Comments and Specific Administration<br />

Comments and specific in<strong>for</strong>mation regarding drug products ei<strong>the</strong>r listed or under consideration <strong>for</strong> <strong>for</strong>mulary<br />

inclusion will be accepted by <strong>the</strong> Department at any time <strong>for</strong> due consideration. Inquiries or comments should be<br />

directed to:<br />

Section 790.140 Requests <strong>for</strong> Additional Copies<br />

Administrator, <strong>Drug</strong> <strong>Product</strong> <strong>Selection</strong> <strong>Program</strong><br />

<strong>Illinois</strong> Department of Public Health<br />

Office of Health Protection<br />

Division of Food, <strong>Drug</strong>s and Dairies<br />

525 West Jefferson Street<br />

Springfield, <strong>Illinois</strong> 62761<br />

Requests to receive additional copies of <strong>the</strong> <strong>for</strong>mulary or <strong>for</strong> changes to <strong>the</strong> recipient mailing list should be sent to<br />

<strong>the</strong> address in Section 790.120.<br />

Section 790.160 Prescription Use of <strong>Drug</strong> <strong>Product</strong>s<br />

<strong>Drug</strong> products included shall be primarily <strong>for</strong> prescription use outside of <strong>the</strong> inpatient institutional setting. Excluded<br />

are nonprescription drugs, diagnostic aids, nutritional supplements and medical devices.<br />

Section 790.180 FDA <strong>Drug</strong> <strong>Product</strong> Approval and Recommendation<br />

<strong>Drug</strong> products included shall have been approved and recommended <strong>for</strong> DPS use by <strong>the</strong> FDA and listed in a<br />

publication of approved drug products distributed by <strong>the</strong> FDA <strong>for</strong> use in state programs. All products must have<br />

ei<strong>the</strong>r a New <strong>Drug</strong> Application (NDA), Abbreviated New <strong>Drug</strong> Application (ANDA), or Antibiotic Form 5 or 6<br />

Application approved by <strong>the</strong> FDA under <strong>the</strong> provisions of Sections 505 and 507 of <strong>the</strong> Federal Food, <strong>Drug</strong> and<br />

Cosmetic Act (21 U.S.C.A. 301 et seq.). All products have been certified by <strong>the</strong> FDA as safe and effective <strong>for</strong> <strong>the</strong>ir<br />

labeled use, meet current compendial and Good Manufacturing Practices (GMP) requirements, and have met <strong>the</strong><br />

applicable bioavailability and bioequivalence criteria of <strong>the</strong> FDA.<br />

- xx -


Section 790.200 Availability of <strong>Drug</strong> <strong>Product</strong>s; Pharmaceutical Equivalence<br />

<strong>Drug</strong> products included must be available from more than one approved manufacturing source unless o<strong>the</strong>rwise<br />

noted. <strong>Drug</strong> products listed must be pharmaceutically equivalent to at least one o<strong>the</strong>r drug product under <strong>the</strong> same<br />

entity listing. <strong>Drug</strong> products are pharmaceutically equivalent if <strong>the</strong>y contain <strong>the</strong> same active ingredients, are identical<br />

in dosage <strong>for</strong>m and route of administration, are <strong>for</strong>mulated to meet <strong>the</strong> same or comparable standards and vary in<br />

labeled dosage strength by no more than 1%.<br />

Section 790.220 Single Source <strong>Drug</strong> <strong>Product</strong>s Exclusion<br />

Single source drug products which are available only under a single brand name label shall be excluded. <strong>Product</strong>s<br />

which have a single source manufacturer, but which may be distributed under multiple labels are listed with a<br />

warning <strong>for</strong> pharmacists to ascertain that <strong>the</strong> product selected was produced by <strong>the</strong> approved manufacturer.<br />

Section 790.240 Criteria <strong>for</strong> Exclusion of <strong>Drug</strong> <strong>Product</strong>s<br />

<strong>Drug</strong> products of <strong>the</strong> following dosage <strong>for</strong>ms <strong>for</strong> which different brands are not necessarily pharmaceutically and<br />

<strong>the</strong>rapeutically equivalent shall be excluded:<br />

a) Enteric coated tablets<br />

b) Injectable suspensions, o<strong>the</strong>r than antibiotics<br />

c) Suppositories containing active ingredients <strong>for</strong> which systemic absorption is necessary <strong>for</strong> <strong>the</strong>rapeutic<br />

activity<br />

d) Different delivery systems <strong>for</strong> aerosol and nebulizer drugs<br />

Section 790.260 Inclusion of Controlled Substances<br />

Controlled substances listed in Schedule I of <strong>the</strong> <strong>Illinois</strong> Controlled Substances Act, (Ill. Rev. Stat., 1983, ch. 56 1-2,<br />

par. 1100), shall be excluded. <strong>Product</strong>s in Schedules II, III, IV and V are included provided <strong>the</strong>y meet all o<strong>the</strong>r criteria<br />

as set <strong>for</strong>th in subpart A of this Part.<br />

Section 790.280 Equivalence of <strong>Product</strong>s Requirements<br />

All equivalent products selected by <strong>the</strong> pharmacist <strong>for</strong> interchange use must have <strong>the</strong> product's dosage <strong>for</strong>m, <strong>the</strong><br />

dosage strength, and <strong>the</strong> manufacturer listed in <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as revised. <strong>Drug</strong> products recommended by<br />

<strong>the</strong> Technical Advisory Council <strong>for</strong> inclusion in a <strong>for</strong>mulary revision must not be used <strong>for</strong> drug product selection until<br />

<strong>the</strong> effective date of that revision.<br />

Section 790.300 <strong>Selection</strong> of Equivalent <strong>Drug</strong> <strong>Product</strong>s<br />

Even though a prescribed brand name drug product is unlisted, pharmacists may select an equivalent drug product<br />

to dispense under Section 790.280 as long as <strong>the</strong> corresponding generic drug entity with pharmaceutically equivalent<br />

drug products are listed in <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as revised.<br />

Section 790.320 Transfer of Prescription Records<br />

Pharmacists shall be required to designate <strong>the</strong> prescriber's original intent concerning drug product selection on every<br />

prescription record transferred to ano<strong>the</strong>r pharmacy, irrespective of <strong>the</strong> method of transfer. The receiving pharmacy<br />

shall record <strong>the</strong> prescriber's drug product selection intent on <strong>the</strong> original prescription record of <strong>the</strong> transferred<br />

prescription.<br />

- xxi -


NON-INTERCHANGEABLE DRUG PRODUCTS<br />

The following is an incomplete, partial listing of legend multiple-source drug products that are NOT listed in <strong>the</strong> current<br />

edition of <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> <strong>for</strong> <strong>the</strong> <strong>Drug</strong> <strong>Product</strong> <strong>Selection</strong> <strong>Program</strong>. <strong>Illinois</strong> pharmacists may not interchange<br />

prescriptions written <strong>for</strong> <strong>the</strong>se brand-name drug products, even if <strong>the</strong> prescriber has checked <strong>the</strong> “MAY SUBSTITUTE”<br />

box on <strong>the</strong> prescription <strong>for</strong>m, without first obtaining a new prescription from <strong>the</strong> prescriber. This does not apply to<br />

“Authorized Generics” (see page x of <strong>the</strong> 19 th Edition of <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong>) whereby a pharmaceutical labeler<br />

manufactures and markets <strong>the</strong>ir own brand name product under a generic label.<br />

Brand name<br />

ALL Prenatal vitamins with 1mg folic acid<br />

ACT rinse<br />

Aerolate-Jr, -Sr capsules<br />

Anaspaz tablets<br />

Antabuse tablets<br />

Anthra-Derm ointment<br />

Anusol-HC suppositories<br />

Arlidin tablets<br />

Aristocort tablets<br />

Armour Thyroid<br />

Aventyl capsules<br />

Beclovent aerosol<br />

Beconase, Beconase AQ aerosol<br />

Bellergal-S tablets<br />

Berocca tablets<br />

Berocca Plus tablets<br />

Bicillin-LA injection<br />

Bicitra solution<br />

Brethine tablets<br />

Bricanyl tablets<br />

Bontril 105 capsules<br />

Bromfed capsules<br />

Bronkodyl capsules<br />

Butazolidin capsules<br />

Chromagen capsules<br />

Codimal-LA, Codimal-LA Half capsules<br />

Col-Benemid tablets<br />

Constant-T tablets<br />

Cortef tablets<br />

Cortone Acetate tablets<br />

Cotazyme, Cotazyme-S capsules<br />

Creon 10, 20 capsules<br />

Creon, Creon 25 capsules<br />

Cuprimine capsules<br />

Cyclospasmol capsules<br />

Cystospaz tablets, Cystospaz-M capsules<br />

Dallergy caplets<br />

Decadron-LA injection<br />

Deconamine SR capsules<br />

Delta-Cortef tablets<br />

Depen tablets<br />

Deponit patches<br />

Diabeta tablets (not interchangeable with Micronase)<br />

Dilatrate-SR capsules<br />

Dilaudid tablets 2,3,4mg<br />

Dilor tablets<br />

Disalcid capsules, tablets<br />

Diupres-250, -500 tablets<br />

Donnatal tablets<br />

Donnazyme tablets<br />

Drithocreme<br />

Dura-Vent/DA tablets<br />

Duratuss GP tablets<br />

Duratuss-G tablets<br />

Eldoquin-Forte cream<br />

Elixophyllin capsules<br />

Elixophyllin SR capsules<br />

Entex LA tablets<br />

Entex PSE tablets<br />

Entozyme tablets<br />

Epifrin ophthalmic drops<br />

Estraderm patch<br />

Estratabs<br />

Ethatabs<br />

Generic name<br />

sodium fluoride<br />

<strong>the</strong>ophylline extended release<br />

l-hyoscyamine<br />

disulfiram<br />

anthralin<br />

hydrocortisone acetate<br />

nylidrin<br />

triamcinolone<br />

desiccated thyroid<br />

nortriptyline hydrochloride<br />

beclomethasone dipropionate<br />

beclomethasone dipropionate<br />

belladonna alkaloids, ergotamine tartrate and phenobarbital<br />

vitamins B with vitamin C<br />

multivitamins<br />

penicillin G benzathine<br />

citrate and citric acid solutions<br />

terbutaline sulfate<br />

terbutaline sulfate<br />

phendimetrazine tartrate<br />

brompheniramine maleate with pseudoephedrine hydrochloride<br />

<strong>the</strong>ophylline immediate release<br />

phenylbutazone<br />

ascorbic acid, cyanocobalamin, ferrous fumarate, and intrinsic factor<br />

chlorpheniramine maleate with pseudoephedrine hydrochloride<br />

colchicine with probenecid<br />

<strong>the</strong>ophylline extended release<br />

hydrocortisone<br />

cortisone acetate<br />

pancrelipase<br />

amylase, lipase, and protease<br />

amylase, lipase, pancreatin, and protease<br />

penicillamine<br />

cyclandelate<br />

l-hyoscyamine<br />

chlorpheniramine maleate, methscopolamine nitrate, and phenylephrine hydrochloride<br />

dexamethasone acetate<br />

chlorpheniramine maleate with pseudoephedrine hydrochloride<br />

prednisolone<br />

penicillamine<br />

nitroglycerin<br />

glyburide<br />

isosorbide dinitrate<br />

hydromorphone hydrochloride<br />

dyphylline<br />

salsalate<br />

chlorothiazide with reserpine<br />

belladonna alkaloids with phenobarbital<br />

pancreatin<br />

anthralin<br />

chlorpheniramine maleate, methscopolamine nitrate, and phenylephrine hydrochloride<br />

guaifenesin with pseudoephedrine hydrochloride<br />

guaifenesin<br />

hydroquinone<br />

<strong>the</strong>ophylline immediate release<br />

<strong>the</strong>ophylline extended release<br />

guaifenesin with phenylpropanolamine hydrochloride<br />

guaifenesin with pseudoephedrine hydrochloride<br />

pancreatin<br />

epinephrine hydrochloride<br />

estradiol<br />

esterified estrogens<br />

papaverine hydrochloride<br />

- xxii -


Brand name<br />

Etrafon tablets<br />

Extendryl tablets, Extendryl S.R. capsules<br />

Euthroid tablets<br />

Fedahist Timecaps<br />

Florone ointment, Florone, Florone E cream<br />

Fluorigard rinse<br />

Fluorinse<br />

Fluoritabs<br />

Gel-Kam<br />

GenGraf capsules<br />

Glaucon ophthalmic drops<br />

Granulderm aerosol<br />

Granulex aerosol<br />

Guaifed, Guaifed-PD capsules<br />

Guaifenex DX tablets<br />

Guaifenex LA tablets<br />

Guaifenex PSE<br />

Habitrol patch<br />

Halotestin tablets<br />

Humibid L.A. tablets<br />

Hydropres-25, 50 tablets<br />

Infed injection<br />

Isopto Carbachol ophthalmic solution<br />

Isuprel inhaler<br />

Karidium tablets, drops<br />

Karigel, Karigel-N<br />

Klotrix tablets<br />

Kutrase capsules<br />

Ku-Zyme HP capsules<br />

Lasan cream, ointment<br />

Levothroid tablets<br />

Levsin tablets<br />

Levsinex capsules<br />

Librax capsules<br />

Lipram capsules<br />

Lufyllin tablets<br />

Lufyllin-GG tablets, elixir<br />

Luride Lozi-Tabs<br />

Mandelamine tablets<br />

Marax tablets<br />

Maxiflor cream, ointment<br />

Menest tablets<br />

Mescolor tablets<br />

Metahydrin tablets<br />

Micronase tablets (not interchangeable with Diabeta)<br />

Midrin capsules<br />

MSIR tablets<br />

Naldecon tablets<br />

Naqua tablets<br />

Nicoderm patches<br />

Nicotrol patches<br />

Nitro-Bid capsules, ointment<br />

Nitrodisc patch<br />

Nitrostat sublingual<br />

Noctec capsules<br />

Novafed A capsules<br />

Oracit solution<br />

Oramorph SR tablets<br />

Oreton tablets<br />

Pancrease capsules<br />

PanMist LA tablets<br />

Pavabid capsules<br />

Pedameth capsules<br />

Peritrate tablets<br />

Permapen injection<br />

Phenergan tablets (‘authorized generic’ only)<br />

Phenergan suppositories<br />

Point-Two rinse<br />

Poly-Histine elixir<br />

Poly-Vi-Flor tablets<br />

Poly-Vi-Flor with Iron tablets<br />

Polycitra, Polycitra-LC, Polycitra K solutions<br />

Pramosone cream, lotion, ointment<br />

Prevident gel<br />

Probanthine tablets<br />

ProctoCream-HC<br />

Proctofoam-HC<br />

Generic name<br />

amitriptyline hydrochloride with perphenazine<br />

chlorpheniramine maleate, methscopolamine nitrate, and phenylephrine hydrochloride<br />

liotrix<br />

chlorpheniramine maleate with pseudoephedrine hydrochloride<br />

diflorasone diacetate<br />

sodium fluoride<br />

sodium fluoride<br />

sodium fluoride<br />

stannous fluoride<br />

cyclosporine<br />

epinephrine hydrochloride<br />

balsam peru, castor oil and trypsin<br />

balsam peru, castor oil and trypsin<br />

guaifenesin with pseudoephedrine hydrochloride<br />

dextromethorphan hydrobromide with guaifenesin<br />

guaifenesin<br />

guaifenesin with pseudoephedrine hydrochloride<br />

nicotine<br />

fluoxymesterone<br />

guaifenesin<br />

hydrochlorothiazide with reserpine<br />

iron dextran<br />

carbachol<br />

isoproterenol<br />

sodium fluoride<br />

sodium fluoride<br />

potassium chloride<br />

amylase, protease, lipase, cellulase, hyoscyamine sulfate, and phenyltoloxamine citrate<br />

amylase, lipase, and protease<br />

anthralin<br />

levothyroxine sodium<br />

l-hyoscyamine<br />

l-hyoscyamine extended release<br />

chlordiazepoxide hydrochloride with clidinium bromide<br />

amylase, lipase, and protease<br />

dyphylline<br />

dyphylline with guaifenesin<br />

sodium fluoride<br />

me<strong>the</strong>namine mandelate<br />

<strong>the</strong>ophylline, hydroxyzine and ephedrine<br />

diflorasone diacetate<br />

esterified estrogens<br />

chlorpheniramine maleate, methscopolamine nitrate with pseudoephedrine hydrochloride<br />

trichlormethiazide<br />

glyburide<br />

acetaminophen, isome<strong>the</strong>ptene mucate and dichloralphenazone<br />

morphine sulfate immediate release<br />

chlorpheniramine, phenylpropanolamine, phenyltoloxamine, and phenylephrine<br />

trichlormethiazide<br />

nicotine<br />

nicotine<br />

nitroglycerin<br />

nitroglycerin<br />

nitroglycerin<br />

chloral hydrate<br />

chlorpheniramine maleate with pseudoephedrine hydrochloride<br />

citrate and citric acid solutions<br />

morphine sulfate<br />

methyltestosterone<br />

pancreatin<br />

guaifenesin with pseudoephedrine<br />

papaverine hydrochloride<br />

methionine<br />

pentaerythritol tetranitrate<br />

penicillin G benzathine<br />

promethazine hydrochloride<br />

promethazine hydrochloride<br />

sodium fluoride<br />

pheniramine maleate, pyrilamine maleate and phenyltoloxamine citrate<br />

multivitamins with fluoride<br />

multivitamins with fluoride and iron<br />

citrate and citric acid solutions<br />

hydrocortisone with pramoxine<br />

sodium fluoride<br />

propan<strong>the</strong>line bromide<br />

hydrocortisone acetate with pramoxine hydrochloride<br />

hydrocortisone acetate with pramoxine hydrochloride<br />

- xxiii -


Brand name<br />

Prostep patches<br />

Proventil inhaler (not interchangeable with Ventolin inhaler)<br />

Pseudovent PED capsules<br />

Pyridium tablets<br />

Quibron capsules<br />

Quibron-T Dividose<br />

Quibron-T/SR tablets<br />

Quinaglute<br />

Respbid tablets<br />

RMS suppositories<br />

Rondec, Rondec TR tablets<br />

Roxanol SR tablets<br />

Ru-Tuss tablets<br />

Ru-Tuss DE tablets<br />

Rynatan tablets<br />

Salutensin, Salutensin-Demi tablets<br />

Ser-Ap-Es tablets<br />

Slo-Phyllin tablets<br />

Slo-Phyllin Gyrocaps<br />

Solaquin-Forte cream<br />

Sustaire tablets<br />

T-Phyl tablets<br />

Theo-24 capsules<br />

Theo-Sav tablets<br />

Theobid Duracaps<br />

Theoclear L.A. capsules<br />

Theolair-SR tablets<br />

Theospan-SR capsules<br />

Theovent capsules<br />

Thorazine tablets, Spansules<br />

Thyrolar tablets<br />

Tiazac capsules<br />

Tigan capsules, suppositories<br />

Tri-Vi-Flor tablets<br />

Trilisate liquid, tablets<br />

Trinsicon capsules<br />

Tuss-Ornade Spansules<br />

Ultrase capsules<br />

Uni-Dur tablets<br />

Uniphyl tablets<br />

Urised tablets<br />

Vancenase, Vancenase AQ aerosol<br />

Vanceril aerosol<br />

Vasodilan tablets<br />

Ventolin inhaler (not interchangeable with Proventil inhaler)<br />

Vi-Daylin/F tablets<br />

Vi-Daylin/F + Iron tablets<br />

Vio<strong>for</strong>m-Hydrocortisone cream, ointment<br />

Viokase tablets<br />

Wellbutrin SR 150mg tablet<br />

X-Trozine L.A.<br />

Zephrex LA tablets<br />

Zyban 150mg tablet<br />

Generic name<br />

nicotine<br />

albuterol<br />

guaifenesin with pseudoephedrine hydrochloride<br />

phenazopyridine hydrochloride<br />

<strong>the</strong>ophylline with guaifenesin<br />

<strong>the</strong>ophylline immediate release<br />

<strong>the</strong>ophylline extended release<br />

quinidine gluconate<br />

<strong>the</strong>ophylline extended release<br />

morphine sulfate<br />

carbinoxamine maleate with pseudoephedrine hydrochloride<br />

morphine sulfate extended release<br />

belladonna alkaloids, chlorpheniramine, phenylephrine, and phenylpropanolamine<br />

guaifenesin with pseudoephedrine hydrochloride<br />

chlorpheniramine tannate, phenylephrine tannate, and pyrilamine tannate<br />

hydroflumethiazide with reserpine<br />

hydralazine, hydrochlorothiazide and reserpine<br />

<strong>the</strong>ophylline immediate release<br />

<strong>the</strong>ophylline extended release<br />

hydroquinone<br />

<strong>the</strong>ophylline extended release<br />

<strong>the</strong>ophylline extended release<br />

<strong>the</strong>ophylline extended release<br />

<strong>the</strong>ophylline extended release<br />

<strong>the</strong>ophylline extended release<br />

<strong>the</strong>ophylline extended release<br />

<strong>the</strong>ophylline extended release<br />

<strong>the</strong>ophylline extended release<br />

<strong>the</strong>ophylline extended release<br />

chlorpromazine hydrochloride<br />

liotrix<br />

diltiazem hydrochloride<br />

trimethobenzamide hydrochloride<br />

vitamins A, D and C with fluoride<br />

choline salicylate and magnesium salicylate<br />

ascorbic acid, cyanocobalamin, ferrous fumarate, folic acid, and intrinsic factor<br />

caramiphen edisylate with phenylpropanolamine hydrochloride<br />

pancrelipase<br />

<strong>the</strong>ophylline<br />

<strong>the</strong>ophylline extended release<br />

me<strong>the</strong>namine, belladonna alkaloids, benzoic acid, phenylsalicylate and methylene blue<br />

beclomethasone dipropionate<br />

beclomethasone dipropionate<br />

isoxsuprine hydrochloride<br />

albuterol<br />

multivitamins with fluoride<br />

multivitamins with fluoride and iron<br />

clioquinol with hydrocortisone<br />

pancrelipase (amylase, lipase, and protease)<br />

bupropion hydrochloride<br />

phendimetrazine tartrate<br />

guaifenesin with pseudoephedrine hydrochloride<br />

bupropion hydrochloride<br />

- xxiv -


APPROVED DRUG PRODUCTS FOR DRUG PRODUCT SELECTION<br />

Fourth CUMULATIVE Supplement to <strong>the</strong> Nineteenth Edition of <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong><br />

(A compilation of all changes made to <strong>the</strong> 19 th Edition up to <strong>the</strong> April 5, 2002 issuance of <strong>the</strong> 20 th Edition)<br />

(First Supplement issued July 1, 2001; Second Supplement issued October 1, 2001; Third Supplement issued January 1, 2002)<br />

K<br />

PHARMACISTS CAN NOW CHECK THE STATUS OF UPDATES TO THE ILLINOIS FORMULARY ONLINE AT:<br />

http://www.idph.state.il.us/about/fdd/<strong>for</strong>mulary.htm<br />

A REMINDER: Pharmacists may nei<strong>the</strong>r solicit nor receive “blanket” authorizations from<br />

physicians to practice drug product selection on prescriptions issued <strong>for</strong> brand name products.<br />

PAGE DRUG NAME APPLICATION HOLDER,<br />

(19 th Ed.) (EFFECTIVE DATE OF ACTION / SUPPLEMENT) DOSAGE FORM, STRENGTH MANUFACTURER<br />

p. 1 ACETAMINOPHEN; BUTALBITAL; CAFFEINE<br />

Added: (08-12-01 [second supplement]) tablet, oral 325mg;50mg;40mg Able<br />

Added: (08-12-01 [second supplement]) tablet, oral 500mg;50mg;40mg Able<br />

p. 2 ACETAMINOPHEN; CODEINE PHOSPHATE<br />

Added: (10-02-01 [third supplement]) tablet, oral 300mg; 15,30,60mg Mallinckrodt<br />

p. 4 ACETAMINOPHEN; PROPOXYPHENE NAPSYLATE<br />

Added: (08-18-01 [second supplement]) tablet, oral 650mg;100mg Able<br />

Added: (11-13-01 [third supplement]) tablet, oral 650mg;100mg Mallinckrodt<br />

p. 7 ALBUTEROL SULFATE<br />

Added: (05-13-01 [first supplement]) solution <strong>for</strong> inhalation eq 0.083% base Roxane<br />

p. 11 AMIODARONE HYDROCHLORIDE<br />

Added: (06-11-01[first supplement]) tablet, oral 200mg Taro<br />

p. 14 AMPHETAMINE ASPARTAME; AMPHETAMINE SULFATE; DEXTROAMPHETAMINE SACCHARATE;<br />

DEXTROAMPHETAMINE SULFATE (New Entity to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> at <strong>the</strong> Fourth Supplement)<br />

Added: (02-11-02 [fourth supplement]) tablet, oral 2.5mg;2.5mg;2.5mg;2.5mg Barr<br />

Added: (02-11-02 [fourth supplement]) tablet, oral 1.25mg;1.25mg;1.25mg;1.25mg Barr<br />

Added: (02-11-02 [fourth supplement]) tablet, oral 5mg;5mg;5mg;5mg Barr<br />

Added: (02-11-02 [fourth supplement]) tablet, oral 7.5mg;7.5mg;7.5mg;7.5mg Barr<br />

Added: Adderall 5 (02-11-02 [fourth supplement]) tablet, oral 1.25mg;1.25mg;1.25mg;1.25mg Shire<br />

Added: Adderall 10 (02-11-02 [fourth supplement]) tablet, oral 2.5mg;2.5mg;2.5mg;2.5mg Shire<br />

Added: Adderall 20 (02-11-02 [fourth supplement]) tablet, oral 5mg;5mg;5mg;5mg<br />

Shire<br />

Added: Adderall 30 (02-11-02 [fourth supplement]) tablet, oral 7.5mg;7.5mg;7.5mg;7.5mg Shire<br />

p. 23 AZELAIC ACID (New Entity to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> at <strong>the</strong> Third Supplement)<br />

Added: Azelex (12-01-01 [third supplement]) cream, topical 20% Allergan *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product selection under o<strong>the</strong>r<br />

brand and/or generic names.<br />

p. 26 BETAMETHASONE DIPROPIONATE; CLOTRIMAZOLE (New Entity to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> at <strong>the</strong> Second Supplement)<br />

Added: (08-20-01 [second supplement]) cream, topical 0.05%;1% Altana<br />

Added: (07-30-01 [second supplement]) cream, topical 0.05%;1% Taro<br />

Added: Lotrisone (07-30-01 [second supplement]) cream, topical 0.05%; 1% Schering *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product selection under o<strong>the</strong>r<br />

brand and/or generic names.<br />

p. 27 BISOPROLOL FUMARATE<br />

Added: (06-26-01 [first supplement]) tablet, oral 5,10mg Copley/Teva<br />

p. 28 BISOPROLOL FUMARATE; HYDROCHLOROTHIAZIDE<br />

Added: (05-15-01 [first supplement]) tablet, oral 2.5mg;6.25mg Watson<br />

Added: (05-15-01 [first supplement]) tablet, oral 5mg; 6.25mg Watson<br />

Added: (05-15-01 [first supplement]) tablet, oral 10mg;6.25mg Watson<br />

p. 30 BUSPIRONE<br />

Added: (03-01-02 [fourth supplement]) tablet, oral 5,10,15mg IVAX<br />

Added: (02-27-02 [fourth supplement]) tablet, oral 5,10,15mg KV<br />

Added: (09-08-01 [second supplement]) tablet, oral 30mg Mylan<br />

Added: (02-28-02 [fourth supplement]) tablet, oral 5,10,15mg Par<br />

Added: (02-28-02 [fourth supplement]) tablet, oral 5,10,15mg Teva<br />

Added: (04-05-02 [fourth supplement]) tablet, oral 5,10,15mg TorPharm<br />

Added: (05-14-01 [first supplement]) tablet, oral 5,10mg Watson<br />

Added: (03-13-02 [fourth supplement]) tablet, oral 15mg Watson<br />

(continued on <strong>the</strong> next page)<br />

- xxv -


PAGE DRUG NAME APPLICATION HOLDER,<br />

(19 th Ed.) (EFFECTIVE DATE OF ACTION / SUPPLEMENT) DOSAGE FORM, STRENGTH MANUFACTURER<br />

p. 30 BUSPIRONE (continued)<br />

Added: Buspar (09-08-01 [second supplement]) tablet, oral 30mg Bristol-Myers Squibb<br />

Added: Vanspar (06-12-01 [first supplement]) tablet, oral 7.5mg Par *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product selection under o<strong>the</strong>r<br />

brand and/or generic names.<br />

p. 31 BUTORPHANOL TARTRATE<br />

Added: (10-23-01 [third supplement]) injection 1,2mg/ml Apotex/Novex<br />

Added: (10-13-01 [third supplement]) spray, metered, nasal 1mg/ml Lederle/Mylan<br />

Added: (03-12-02 [fourth supplement]) spray, metered, nasal 1mg/ml Roxane<br />

Added: Stadol NS (08-08-01 [second supplement]) spray, metered, nasal 1mg/ml<br />

Bristol-Myers Squibb<br />

p. 32 CALCITRIOL (New Entity to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> at <strong>the</strong> Third Supplement)<br />

Added: (10-12-01 [third supplement]) capsule, oral 0.25,0.5mcg Teva<br />

Added: Rocaltrol (10-12-01 [third supplement]) capsule, oral 0.25,0.5mcg Roche<br />

p. 37 CARBAMAZEPINE<br />

Added: (11-10-01 [third supplement]) tablet, chewable 100mg Caraco<br />

Added: (02-27-02 [fourth supplement]) tablet, oral 200mg Apotex<br />

p. 39 CARISOPRODOL<br />

Added: (08-12-01 [second supplement]) tablet, oral 350mg Able<br />

p. 39 CARTEOLOL HYDROCHLORIDE<br />

Added: (02-06-02 [fourth supplement]) solution, ophthalmic 1% Novex<br />

p. 42 CEPHALEXIN<br />

Added: (12-10-01 [third supplement]) oral suspension 125,250mg/5ml Ranbaxy<br />

p. 51 CLINDAMYCIN PHOSPHATE<br />

Added: (04-03-02 [fourth supplement]) lotion, topical eq 1% base Altana<br />

Added: Cleocin-T (04-03-02 [fourth supplement]) lotion, topical eq 1% base<br />

Pharmacia<br />

p. 53 CLONAZEPAM<br />

Added: (10-17-01 [third supplement]) tablet, oral 0.5,1,2mg Caraco<br />

p. 63 DEXTROAMPHETAMINE SULFATE<br />

Added: (04-01-02 [fourth supplement]) capsule, extended release 5,10,15mg Barr<br />

Added: Dexedrine (04-01-02 [fourth supplement]) capsule, extended release 5,10,15mg<br />

GlaxoSmithKline<br />

p. 71 DICLOFENAC POTASSIUM<br />

Added: (08-11-01 [second supplement]) tablet, oral 50mg Eon<br />

p. 71 DICLOFENAC SODIUM<br />

Added: (12-13-01 [third supplement]) tablet, extended release 100mg Mylan<br />

Added: (01-07-02 [fourth supplement]) tablet, extended release 100mg Purepac<br />

p. 80 ENALAPRIL MALEATE<br />

Added: (08-22-00 [19 th edition]) tablet, oral 20mg Apo<strong>the</strong>con<br />

Added: (08-22-00 [19 th edition]) tablet, oral 20mg Chelsea<br />

Added: (08-22-00 [19 th edition]) tablet, oral 20mg Eon<br />

Added: (08-22-00 [19 th edition]) tablet, oral 20mg ESI Lederle<br />

Added: (08-22-00 [19 th edition]) tablet, oral 20mg Geneva<br />

Added: (08-22-00 [19 th edition]) tablet, oral 20mg GenPharm<br />

Added: (08-22-00 [19 th edition]) tablet, oral 20mg KRKA<br />

Added: (08-22-00 [19 th edition]) tablet, oral 20mg Lek<br />

Added: (08-22-00 [19 th edition]) tablet, oral 20mg Mylan<br />

Added: (08-22-00 [19 th edition]) tablet, oral 20mg Ranbaxy<br />

Added: (09-26-01 [second supplement]) tablet, oral 2.5,5,10,20mg Taro<br />

Added: (08-22-00 [19 th edition]) tablet, oral 20mg Teva<br />

Added: (08-22-00 [19 th edition]) tablet, oral 20mg Wockhardt Americas<br />

Added: (08-22-00 [19 th edition]) tablet, oral 20mg Zenith Goldline<br />

Added: Vasotec (08-22-00 [19 th edition]) tablet, oral 20mg Merck<br />

p. 80 ENALAPRIL MALEATE; HYDROCHLOROTHIAZIDE (New Entity to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> at <strong>the</strong> Second Supplement)<br />

Added: (02-10-02 [fourth supplement]) tablet, oral 5mg;12.5mg, 10mg;25mg Eon<br />

Added: (04-03-02 [fourth supplement]) tablet, oral 5mg;12.5mg, 10mg;25mg Dr. Reddy<br />

Added: (09-18-01 [second supplement]) tablet, oral 5mg;12.5mg, 10mg;25mg Mylan<br />

Added: (09-18-01 [second supplement]) tablet, oral 5mg;12.5mg, 10mg;25mg Taro<br />

Added: (09-18-01 [second supplement]) tablet, oral 5mg;12.5mg, 10mg;25mg Teva<br />

Added: Vaseretic tablet, oral 5mg;12.5mg, 10mg;25mg Merck<br />

(09-18-01 [second supplement])<br />

p. 86 ETHAMBUTOL<br />

Added: (01-29-02 [fourth supplement]) tablet, oral 400mg Barr<br />

- xxvi -


PAGE DRUG NAME APPLICATION HOLDER,<br />

(19 th Ed.) (EFFECTIVE DATE OF ACTION / SUPPLEMENT) DOSAGE FORM, STRENGTH MANUFACTURER<br />

p. 87 ETHINYL ESTRADIOL; LEVONORGESTREL<br />

Added: Alesse (09-01-01 [second supplement]) tablet, oral 0.02mg;0.1mg Wyeth-Ayerst<br />

Added: Aviane (09-01-01 [second supplement]) tablet, oral 0.02mg;0.1mg Duramed<br />

Added: Enpresse (02-21-02 [second supplement]) tablet, oral, triphasic 0.03mg;0.05mg/<br />

Duramed/Barr<br />

0.04mg;0.075mg/0.03mg;0.125mg<br />

p. 87 ETHINYL ESTRADIOL; NORETHINDRONE<br />

Added: Loestrin FE 1/20 tablet, oral 0.02mg; 1mg Parke-Davis<br />

(05-23-01 [first supplement])<br />

Added: Loestrin FE 1.5/30 tablet, oral 0.03mg; 1.5mg Parke-Davis<br />

(05-23-01 [first supplement])<br />

Added: Microgestin FE 1/20 tablet, oral 0.02mg; 1mg Watson<br />

(05-23-01 [first supplement])<br />

Added: Microgestin FE 1.5/30 tablet, oral 0.03mg; 1.5mg Watson<br />

(05-23-01 [first supplement])<br />

p. 88 ETHINYL ESTRADIOL; NORGESTREL<br />

Added: Cryselle (02-20-02 [fourth supplement]) tablet, oral 0.03mg;0.3mg Duramed/Barr<br />

p. 88 ETODOLAC<br />

Added: (11-30-01 [third supplement]) tablet, extended release 400,500mg Andrx<br />

p. 89 ETOPOSIDE<br />

Added: (09-19-01 [second supplement]) capsule, oral 50mg GenPharm<br />

Added: Vepesid (09-19-01 second supplement]) capsule, oral 50mg<br />

Bristol<br />

p. 89 FAMOTIDINE<br />

Added: (09-25-01 [second supplement]) tablet, oral 20,40mg Apotex/TorPharm<br />

Added: (04-14-01 [19 th edition]) tablet, oral 20,40mg Eon<br />

Added: (09-05-01 [second supplement]) tablet, oral 20,40mg Carlsbad<br />

p. 90 FLECAINIDE ACETATE (New Entity to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> at <strong>the</strong> Second supplement)<br />

Added: (07-31-01 [second supplement]) tablet, oral 50,100,150mg Alphapharm<br />

Added: Tambocor (07-31-01[second supplement]) tablet, oral 50,100,150mg 3M *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product selection under o<strong>the</strong>r<br />

brand and/or generic names.<br />

p. 90 FLOXURIDINE<br />

Added: (10-06-01 [third supplement]) injection 500mg/vial American Pharmaceutical<br />

Partners<br />

p. 92 FLUOXETINE HYDROCHLORIDE (New Entity to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> at <strong>the</strong> Second Supplement)<br />

Added: (01-29-02 [fourth supplement]) capsule, oral eq 10,20mg base Alphapharm<br />

Added: (01-30-02 [fourth supplement]) capsule, oral eq 10mg base Barr<br />

Added: (08-02-01 [second supplement]) capsule, oral eq 20mg base Barr<br />

Added: (01-29-02 [fourth supplement]) capsule, oral eq 10,20mg base Chelsea<br />

Added: (01-29-02 [second supplement]) capsule, oral eq 10,20mg base Dr. Reddy’s<br />

Added: (08-02-01 [second supplement]) capsule, oral eq 40mg base Dr. Reddy’s<br />

Added: (01-29-02 [fourth supplement]) capsule, oral eq 10,20mg base Eon<br />

Added: (03-31-02 [fourth supplement]) capsule, oral eq 10,20mg base Ganes/Siegfried<br />

Added: (08-27-01 [second supplement]) capsule, oral eq 10mg base Geneva<br />

Added: (01-29-02 [fourth supplement]) capsule, oral eq 20mg base Geneva<br />

Added: (03-13-02 [fourth supplement]) capsule, oral eq 40mg base Geneva<br />

Added: (01-31-02 [fourth supplement]) capsule, oral eq 10,20mg base IVAX<br />

Added: (01-29-02 [fourth supplement]) capsule, oral eq 10,20mg base Mallinckrodt<br />

Added: (01-30-02 [fourth supplement]) capsule, oral eq 10,20mg base Mylan<br />

Added: (01-29-02 [fourth supplement]) capsule, oral eq 10,20,40mg base Teva<br />

Added: (01-29-02 [fourth supplement]) capsule, oral eq 10,20mg base Watson<br />

Added: (01-29-02 [fourth supplement]) solution, oral eq 20mg base/5ml Mallinckrodt<br />

Added: (02-07-02 [fourth supplement]) solution, oral eq 20mg base/5ml Novex<br />

Added: (08-02-01 [second supplement]) solution, oral eq 20mg base/5ml Teva<br />

Added: (08-02-01 [second supplement]) tablet, oral eq 10mg base Alphapharm/Par<br />

Added: (01-29-02 [fourth supplement]) tablet, oral eq 10mg base Eon<br />

Added: (02-28-02 [fourth supplement]) tablet, oral eq 10mg base IVAX<br />

Added: (01-29-02 [fourth supplement]) tablet, oral eq 10mg base Teva<br />

Added: Prozac (08-27-01) [second supplement]) capsule, oral eq 10mg base<br />

Lilly<br />

Added: Prozac (08-02-01) [second supplement]) capsule, oral eq 20,40mg base<br />

Lilly<br />

Added: Prozac (08-02-01) [second supplement]) solution, oral eq 20 base/5ml<br />

Lilly<br />

Added: Prozac (08-02-01) [second supplement]) tablet, oral eq 10mg base<br />

Lilly<br />

Added: Rapiflux (08-02-01) [second supplement]) tablet, oral eq 20mg base Alphapharm *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product selection under o<strong>the</strong>r<br />

brand and/or generic names.<br />

- xxvii -


PAGE DRUG NAME APPLICATION HOLDER,<br />

(19 th Ed.) (EFFECTIVE DATE OF ACTION / SUPPLEMENT) DOSAGE FORM, STRENGTH MANUFACTURER<br />

p. 92 FLUPHENAZINE DECANOATE<br />

Added: (08-17-01 [second supplement]) injection 25mg/ml Apotex<br />

p. 93 FLUTAMIDE (New Entity to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> at <strong>the</strong> Second Supplement)<br />

Added: (09-18-01 [second supplement]) capsule, oral 125mg Barr<br />

Added: (10-06-01 [third supplement]) capsule, oral 125mg Eon<br />

Added: (09-18-01 [second supplement]) capsule, oral 125mg Teva<br />

Added: (09-19-01 [second supplement]) capsule, oral 125mg Zenith-Goldline<br />

Added: Eulexin (09-18-01 [second supplement]) capsule, oral 125mg<br />

Schering<br />

p. 94 FLUVOXAMINE MALEATE<br />

Added: (07-09-01 [second supplement]) tablet, oral 25,50,100mg Anapharm/Synthon<br />

Added: (10-15-01 [third supplement]) tablet, oral 25,50,100mg GenPharm<br />

p. 97 GLIPIZIDE<br />

Added: (06-13-01 [first supplement]) tablet, oral 5,10mg TorPharm<br />

p. 116 INDOMETHACIN<br />

Added: (02-06-02 [fourth supplement]) capsule, extended release 75mg Able<br />

p. 118 IPRATROPIUM BROMIDE<br />

Added: (05-22-01 [first supplement]) solution <strong>for</strong> inhalation 0.2% Novex<br />

p. 121 KETOCONAZOLE<br />

Added: (01-10-02 [fourth supplement]) tablet, oral 200mg TorPharm<br />

p. 121 KETOPROFEN<br />

Added: (02-20-02 [fourth supplement]) capsule, extended release 100,150,200mg Mylan<br />

p. 121 KETOROLAC TROMETHAMINE<br />

Added: (07-24-01 [second supplement]) injection 15,30mg/ml Apotex/Novex<br />

Added: Ketorolac Tromethamine preservative-free injection 15,30mg/ml<br />

Apotex/Novex<br />

(06-29-01 [second supplement])<br />

p. 122 LACTULOSE<br />

Added: (02-21-01 [fourth supplement]) solution, oral 10gm/15ml Novex<br />

p. 123 LEUCOVORIN CALCIUM<br />

Added: Leucovorin injection preservative-free injection eq 10mg base/ml Luitpold<br />

(09-25-01 [second supplement])<br />

p. 124 LEVOCARNITINE (New Entity to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> at <strong>the</strong> Third Supplement)<br />

Added: (10-10-01 [third supplement]) injection 200mg/ml Bed<strong>for</strong>d<br />

Added: Carnitor (10-10-01 [third supplement]) injection 200mg/ml Sigma Tau<br />

p. 126 LITHIUM CARBONATE<br />

Added: (09-27-01 [second supplement]) capsule, oral 300mg Able<br />

p. 127 LORAZEPAM<br />

Added: (12-09-01 [third supplement]) tablet, oral 0.5,1,2mg Ranbaxy<br />

p. 127 LOVASTATIN (New Entity to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> at <strong>the</strong> Third Supplement)<br />

Added: (12-17-01 [third supplement]) tablet, oral 10,20,40mg Eon<br />

Added: (12-17-01 [third supplement]) tablet, oral 10,20,40mg Geneva<br />

Added: (12-17-01 [third supplement]) tablet, oral 10,20,40mg GenPharm<br />

Added: (12-17-01 [third supplement]) tablet, oral 10,20,40mg Mylan<br />

Added: (12-17-01 [third supplement]) tablet, oral 10,20,40mg Purepac<br />

Added: (12-17-01 [third supplement]) tablet, oral 10,20,40mg Teva<br />

Added: Mevacor (12-17-01 [third supplement]) tablet, oral 10,20,40mg Merck<br />

p. 130 MEFLOQUINE HYDROCHLORIDE (New Entity to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> at <strong>the</strong> Fourth Supplement)<br />

Added: (02-20-02 [fourth supplement]) tablet, oral 250mg Geneva<br />

Added: Lariam (02-20-02 [fourth supplement]) tablet, oral 250mg Roche<br />

p. 130 MEGESTROL ACETATE<br />

Added: (08-02-01 [second supplement]) suspension, oral 40mg/ml Par<br />

Added: (03-31-02 [fourth supplement]) suspension, oral 40mg/ml Roxane<br />

Added: Megace (08-02-01 [second supplement]) suspension, oral 40mg/ml<br />

Bristol-Myers Squibb<br />

p. 132 MESNA (New Entity to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> at <strong>the</strong> Third Supplement)<br />

Added: (10-06-01 [third supplement]) injection 100mg/ml American Pharmaceutical<br />

Partners<br />

Added: Mesnex (10-06-01 [third supplement]) injection 100mg/ml Asta<br />

p. 132 METAPROTERENOL SULFATE<br />

Added: (05-22-01 [first supplement]) solution <strong>for</strong> inhalation 0.4, 0.6% Novex<br />

- xxviii -


PAGE DRUG NAME APPLICATION HOLDER,<br />

(19 th Ed.) (EFFECTIVE DATE OF ACTION / SUPPLEMENT) DOSAGE FORM, STRENGTH MANUFACTURER<br />

p. 133 METFORMIN HYDROCHLORIDE (New Entity to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> at <strong>the</strong> Fourth Supplement)<br />

Added: (01-29-02 [fourth supplement]) tablet, oral 500,850,1000mg Alphapharm<br />

Added: (01-25-02 [fourth supplement]) tablet, oral 500,850,1000mg Andrx<br />

Added: (01-25-02 [fourth supplement]) tablet, oral 500,850,1000mg Barr<br />

Added: (01-25-02 [fourth supplement]) tablet, oral 500,850,1000mg Eon<br />

Added: (01-25-02 [fourth supplement]) tablet, oral 500,850,1000mg Geneva<br />

Added: (01-25-02 [fourth supplement]) tablet, oral 500,850,1000mg GenPharm<br />

Added: (01-24-02 [fourth supplement]) tablet, oral 500,850,1000mg IVAX<br />

Added: (01-24-02 [fourth supplement]) tablet, oral 500,850,1000mg Mylan<br />

Added: (01-24-02 [fourth supplement]) tablet, oral 500,850,1000mg Purepac<br />

Added: (01-25-02 [fourth supplement]) tablet, oral 500,850,1000mg Teva<br />

p. 133 METFORMIN HYDROCHLORIDE (continued)<br />

Added: (01-24-02 [fourth supplement]) tablet, oral 500,850,1000mg Watson<br />

Added: Glucophage (01-24-02 [fourth supplement]) tablet, oral 500,850,1000mg<br />

Bristol-Myers Squibb<br />

p. 134 METHIMAZOLE (New Entity to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> at <strong>the</strong> First Supplement)<br />

Added: (08-03-01 [second supplement]) tablet, oral 5,10mg Eon<br />

Added: (04-10-01 [first supplement]) tablet, oral 5,10mg GenPharm<br />

Added: (02-10-02 [fourth supplement]) tablet, oral 5,10mg Jones<br />

Added: Tapazole (04-10-01 [first supplement]) tablet, oral 5,10mg Lilly<br />

p. 136 METHYLPHENIDATE HYDROCHLORIDE<br />

Added: (08-18-01 [second supplement]) tablet, oral 5,10,20mg Able<br />

Added: (02-05-02 [fourth supplement]) tablet, oral 5,10,20mg Purepac<br />

Added: (08-18-01 [second supplement]) tablet, extended release 20mg Able<br />

Added: (05-14-01 [first supplement]) tablet, extended release 20mg Danbury/Watson<br />

Added: (12-21-01 [third supplement]) tablet, extended release 20mg Purepac<br />

p. 137 METIPRANOLOL HYDROCHLORIDE<br />

Added: (10-10-01 [third supplement]) solution, ophthalmic 0.3% Alcon<br />

p. 139 MINOCYCLINE HYDROCHLORIDE<br />

Added: Minocin (06-04-01 [first supplement]) capsule, oral eq 75mg base ESI Lederle / Wyeth-Ayerst<br />

p. 140 MORPHINE SULFATE<br />

Added: (05-15-01 [first supplement]) tablet, extended release 100mg Watson<br />

p. 141 NABUMETONE<br />

Added: (02-25-02 [fourth supplement]) tablet, oral 500,750mg Geneva<br />

p. 143 NAPROXEN<br />

Added: (03-20-02 [fourth supplement]) tablet, oral 250,375,500mg Interpharm<br />

p. 143 NAPROXEN SODIUM<br />

Added: (07–05-01[second supplement]) tablet, extended release eq 375,500mg base Andrx<br />

Added: Naprelan (07-05-01 [second supplement]) tablet, extended release eq 375,500mg base Élan<br />

p. 147 NORETHINDRONE ACETATE<br />

Added: (05-25-01 [first supplement]) tablet, oral 5mg Barr<br />

p. 149 OMEPRAZOLE (New Entity to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> at <strong>the</strong> Third Supplement)<br />

Added: (11-16-01 [third supplement]) capsule, delayed release, oral 10,20,40mg Andrx<br />

Added: Prilosec (11-16-01 [third supplement]) capsule, delayed release, oral 10,20,40mg AstraZeneca<br />

p. 149 ORPHENADRINE CITRATE<br />

Added: (10-15-01 [third supplement]) tablet, extended release 100mg Impax<br />

p. 150 OXAPROZIN<br />

Added: (11-18-01 [third supplement]) tablet, oral 600mg Dr. Reddy’s<br />

Added: (08-17-01 [second supplement]) tablet, oral 600mg Mylan<br />

Added: (05-15-01 [first supplement]) tablet, oral 600mg Watson<br />

p. 151 PACLITAXEL<br />

Added: (07-23-01 [second supplement]) injection 6mg/ml Mylan<br />

Added: (08-20-01 [second supplement]) injection 6mg/ml Zenith Goldline/SP<br />

p. 152 PEMOLINE<br />

Added: (06-13-01 [first supplement]) tablet, oral 18.75mg Watson<br />

p. 156 PHENTERMINE HYDROCHLORIDE<br />

Added: (08-30-01 [second supplement]) capsule, oral 30mg Able<br />

Added: (08-30-01 [second supplement]) tablet, oral 37.5mg Able<br />

p. 158 PHENYTOIN<br />

Added: (05-08-01 [first supplement]) suspension, oral 125mg/5ml UDL<br />

- xxix -


PAGE DRUG NAME APPLICATION HOLDER,<br />

(19 th Ed.) (EFFECTIVE DATE OF ACTION / SUPPLEMENT) DOSAGE FORM, STRENGTH MANUFACTURER<br />

p. 165 PREDNISOLONE<br />

Added: (01-08-02 [fourth supplement]) syrup, oral 5mg/5ml KV<br />

Added: Prelone (01-08-02 [fourth supplement]) syrup, oral 5mg/5ml Muro<br />

p. 167 PRIMIDONE<br />

Added: (09-02-01 [second supplement]) tablet, oral 50mg Lannett<br />

Added: Mysoline (09-02-01 [second supplement]) tablet, oral 50mg<br />

Xcel<br />

p. 168 PROCHLORPERAZINE<br />

Added: (08-18-01 [second supplement]) suppository, rectal 2.5,5,25mg Able<br />

Added: Compazine (08-18-01 [second supp.]) suppository, rectal 2.5,5mg SmithKline Beecham<br />

p. 169 PROGESTERONE<br />

Added: (10-06-01 [third supplement]) injection 50mg/ml American Pharmaceutical<br />

Partners<br />

p. 170 PROPAPHENONE HYDROCHLORIDE (New Entity to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> at <strong>the</strong> First Supplement)<br />

Added: (03-10-02 [fourth supplement]) tablet, oral 150,225mg Mutual<br />

Added: (05-16-01 [first supplement]) tablet, oral 150,225mg Watson<br />

Added: Rhythmol (05-16-01 [first supplement]) tablet, oral 150,225mg Abbott<br />

p. 174 QUINIDINE GLUCONATE<br />

Deleted: (07-01-01 [first supplement])<br />

ALL LISTINGS<br />

p. 176 RIMANTIDINE HYDROCHLORIDE (New Entity to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> at <strong>the</strong> Third Supplement)<br />

Added: (11-02-01 [third supplement]) tablet, oral 100mg CorePharma<br />

Added: Flumadine (11-02-01 [third supplement]) tablet, oral 100mg Forest<br />

p. 181 SOLTALOL HYDROCHLORIDE<br />

Added: (10-15-01 [third supplement]) tablet, oral 80,120,160,240mg Impax<br />

Added: (03-17-02 [third supplement]) tablet, oral 80,120,160,240mg Mutual<br />

Added: Sorine (07-14-01 [second supplement]) tablet, oral 80,120,160,240mg Upsher-Smith<br />

p. 181 SPIRONOLACTONE<br />

Added: (08-20-01 [second supplement]) tablet, oral 50,100mg Mylan<br />

p. 187 TERBUTALINE SULFATE<br />

Added: (10-15-01 [third supplement]) tablet, oral 2.5,5mg Impax<br />

Added: Brethine (10-15-01 [third supplement]) tablet, oral 2.5,5mg Novartis<br />

p. 190 THIOTEPA<br />

Added: (10-10-01 [third supplement]) injection 15mg/vial Bed<strong>for</strong>d<br />

p. 195 TRIFLURIDINE<br />

Added: (08-04-01 [second supplement]) solution, ophthalmic 1% Alcon<br />

L<br />

L<br />

L<br />

L<br />

L<br />

L<br />

L<br />

L<br />

L<br />

L<br />

L<br />

L<br />

Changed all Camall to ABC (first supplement)<br />

Changed all Chelsea to Watson (fourth supplement)<br />

Changed all Ciba Vision to Novartis (third supplement)<br />

Changed all DuPont to Bristol-Myers Squibb (fourth supplement)<br />

Changed all Knoll to Abbott (second supplement)<br />

Changed all Lotus to New River (fourth supplement)<br />

Changed all Medeva to Celltech (first supplement)<br />

Changed all Novopharm to Teva (first supplement)<br />

Changed all Ohmeda to Baxter (third supplement)<br />

Changed all Roberts to Shire (second supplement)<br />

Changed all Rosemont to USL (fourth supplement)<br />

Changed all Zenith Goldline to IVAX (fourth supplement)<br />

- xxx -


APPROVED DRUG PRODUCTS FOR DRUG PRODUCT SELECTION<br />

APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ACEBUTOLOL HYDROCHLORIDE<br />

Acebutolol Hydrochloride capsule, oral eq 200,400mg base Mylan<br />

capsule, oral eq 200,400mg base Par<br />

capsule, oral eq 200,400mg base Watson<br />

Brand(s)<br />

Sectral capsule, oral eq 200,400mg base Wyeth-Ayerst<br />

ACETAMINOPHEN; BUTALBITAL<br />

Acetaminophen; Butalbital @ tablet, oral 325mg;50mg Danbury<br />

@ tablet, oral 325mg;50mg<br />

Halsey<br />

Brand(s)<br />

Bancap @ capsule, oral 325mg;50mg Forest<br />

Bucet capsule, oral 650mg;50mg Mallinckrodt<br />

Phrenilin Forte capsule, oral 650mg;50mg Amarin<br />

Tencon capsule, oral 650mg;50mg Mallinckrodt<br />

Triaprin @ capsule, oral 325mg;50mg Dunhall<br />

Butapap tablet, oral 325mg;50mg Mikart<br />

Butapap tablet, oral 650mg;50mg Mikart<br />

Phrenilin tablet, oral 325mg;50mg Amarin<br />

Sedapap tablet, oral 650mg;50mg Mayrand<br />

ACETAMINOPHEN; BUTALBITAL; CAFFEINE<br />

Acetaminophen; Butalbital; capsule, oral 325mg;50mg;40mg Gilbert<br />

Caffeine @ capsule, oral 325mg;50mg;40mg Mallinckrodt<br />

capsule, oral 325mg;50mg;40mg Mikart<br />

capsule, oral 500mg;50mg;40mg West-ward<br />

tablet, oral 325mg;50mg;40mg Able<br />

tablet, oral 500mg;50mg;40mg Able<br />

@ tablet, oral 325mg;50mg;40mg Gilbert<br />

tablet, oral 325mg;50mg;40mg Halsey<br />

tablet, oral 325mg;50mg;40mg Mikart<br />

tablet, oral 500mg;50mg;40mg Watson<br />

tablet, oral 325mg;50mg;40mg West-ward<br />

tablet, oral 500mg;50mg;40mg West-ward<br />

Brand(s)<br />

Anoquan @ capsule, oral 325mg;50mg;40mg Roberts and Hauck<br />

Esgic Plus capsule, oral 500mg;50mg;40mg Mikart<br />

Femcet @ capsule, oral 325mg;50mg;40mg Mallinckrodt<br />

Medigesic Plus @ capsule, oral 325mg;50mg;40mg US Chemical<br />

Triad @ capsule, oral 325mg;50mg;40mg Mallinckrodt<br />

Esgic @ tablet, oral 325mg;50mg;40mg Forest<br />

Esgic Plus tablet, oral 500mg;50mg;40mg Mikart<br />

Fioricet tablet, oral 325mg;50mg;40mg Novartis *<br />

Repan tablet, oral 325mg;50mg;40mg Mallinckrodt<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

ACETAMINOPHEN; CAFFEINE; DIHYDROCODEINE BITARTRATE<br />

Acetaminophen; Caffeine; capsule, oral 356.4mg;30mg;16mg Mikart<br />

Dihydrocodeine Bitartrate<br />

Brand(s)<br />

DHC Plus @ capsule, oral 356.4mg;30mg;16mg Purdue Frederick<br />

Synalgos-DC-A @ capsule, oral 356.4mg;30mg;16mg Women First Healthcare<br />

1


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ACETAMINOPHEN; CODEINE PHOSPHATE<br />

Acetaminophen; @ capsule, oral 300mg;15,30,60mg Teva<br />

Codeine Phosphate solution, oral 120mg/5ml; 12mg/5ml Hi-Tech<br />

solution, oral 120mg/5ml; 12mg/5ml Mikart<br />

solution, oral 120mg/5ml; 12mg/5ml Morton Grove<br />

solution, oral 120mg/5ml; 12mg/5ml Mova<br />

solution, oral 120mg/5ml; 12mg/5ml Pharmaceutical Assoc/Beach<br />

solution, oral 120mg/5ml; 12mg/5ml Roxane<br />

suspension, oral 120mg/5ml;12mg/5ml Amarin<br />

@ tablet, oral 300mg;15,30,60mg American Therapeutics<br />

@ tablet, oral 300mg;15,30,60mg Barr<br />

tablet, oral 300mg;15,30,60mg Duramed<br />

@ tablet, oral 300mg;15,30,60mg Eon<br />

@ tablet, oral 325mg;30mg<br />

Everylife<br />

tablet, oral 300mg;30,60mg<br />

Geneva<br />

@ tablet, oral 300mg;15,30,60mg Halsey<br />

@ tablet, oral 300mg;30mg<br />

ICN<br />

tablet, oral 300mg;30,60mg<br />

IVAX<br />

@ tablet, oral 300mg;30,60mg<br />

KV<br />

@ tablet, oral 325mg;15mg<br />

KV<br />

@ tablet, oral 300mg;30mg<br />

Lederle<br />

tablet, oral 300mg;15,30,60mg Mallinckrodt<br />

tablet, oral 300mg;30mg<br />

Mikart<br />

@ tablet, oral 300mg;60mg<br />

Mikart<br />

tablet, oral 650mg;30mg<br />

Mikart<br />

tablet, oral 300mg;15,30,60mg Mutual<br />

tablet, oral 300mg;30mg<br />

Pharmeral<br />

tablet, oral 300mg;30,60mg<br />

Purepac<br />

@ tablet, oral 300mg;15,60mg<br />

Roxane<br />

tablet, oral 300mg;30mg<br />

Roxane<br />

tablet, oral 300mg;15,30,60mg Royce<br />

tablet, oral 300mg;15mg<br />

Superpharm<br />

@ tablet, oral 300mg;30,60mg<br />

Superpharm<br />

tablet, oral 300mg;15,30,60mg Teva<br />

@ tablet, oral 300mg;30,60mg<br />

USL<br />

tablet, oral 300mg;15,30,60mg Vintage<br />

@ tablet, oral 300mg;15,30,60mg Warner Chilcott<br />

@ tablet, oral 300mg;15,30,60mg Watson<br />

@ tablet, oral 300mg;30,60mg<br />

Whiteworth Towne Paulsen<br />

Brand(s)<br />

Phenaphen No. 3 with Codeine capsule, oral 325mg;30mg Robins<br />

Proval No. 3 @ capsule, oral 325mg;30mg Solvay<br />

Tylenol with Codeine #3,#4 @ capsule, oral 300mg;30,60mg RW Johnson<br />

Capital and Codeine solution, oral 120mg/5ml; 12mg/5ml Alpharma<br />

Tylenol with Codeine solution, oral 120mg/5ml; 12mg/5ml RW Johnson<br />

Capital and Codeine<br />

suspension, oral 120mg/5ml;12mg/5ml Alpharma<br />

Capital with Codeine @ tablet, oral 325mg;30mg Carnrick<br />

Empracet with Codeine #3,#4 @ tablet, oral 300mg;30,60mg Glaxo Wellcome<br />

Papa-Deine #3,#4 @ tablet, oral 300mg;30,60mg (Vangard/MWM)<br />

Phenaphen-650 with Codeine @ tablet, oral 650mg;30mg Robins<br />

Tylenol with Codeine No.s 2,3,4 tablet, oral 300mg;15,30,60mg RW Johnson *<br />

Tylenol with Codeine No.s 2,3,4 @ tablet, oral 325mg;15,30,60mg RW Johnson<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

ACETAMINOPHEN; HYDROCODONE BITARTRATE<br />

Acetaminophen; capsule, oral 500mg;5mg Central<br />

Hydrocodone Bitartrate capsule, oral 500mg;5mg Mallinckrodt *<br />

capsule, oral 500mg;5mg<br />

Mikart<br />

(continued on <strong>the</strong> next page)<br />

2


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ACETAMINOPHEN; HYDROCODONE BITARTRATE (continued)<br />

solution, oral 500mg;7.5mg/15ml Mikart<br />

solution, oral 500mg;7.5mg/15ml Pharmaceutical Associates<br />

tablet, oral 500mg;2.5,5,7.5,10mg Barr<br />

tablet, oral 650mg;7.5,10mg<br />

Barr<br />

tablet, oral 750mg;7.5mg<br />

Barr<br />

tablet, oral 400mg;5,7.5,10mg Endo<br />

tablet, oral 500mg;5,7.5mg<br />

Endo<br />

tablet, oral 650mg;7.5,10mg<br />

Endo<br />

tablet, oral 750mg;7.5mg<br />

Endo<br />

tablet, oral 500mg;5mg<br />

Eon<br />

tablet, oral 750mg;7.5mg<br />

Eon<br />

tablet, oral 500mg;5mg<br />

Halsey<br />

tablet, oral 650mg;7.5,10mg<br />

Halsey<br />

tablet, oral 750mg;7.5mg<br />

Halsey<br />

tablet, oral 325mg;5,7.5,10mg Mallinckrodt<br />

tablet, oral 500mg;5,7.5,10mg Mallinckrodt<br />

tablet, oral 650mg;10mg<br />

Mallinckrodt<br />

tablet, oral 750mg;7.5mg<br />

Mallinckrodt<br />

tablet, oral 500mg;2.5,5,7.5mg Mikart<br />

tablet, oral 650mg;7.5,10mg<br />

Mikart<br />

tablet, oral 500mg;5mg<br />

Norton<br />

tablet, oral 500mg;10mg<br />

Peachtree<br />

tablet, oral 500mg;2.5,5,7.5mg Royce<br />

tablet, oral 650mg;7.5,10mg<br />

Royce<br />

tablet, oral 750mg;7.5mg<br />

Royce<br />

tablet, oral 325mg;7.5,10mg<br />

UCB<br />

tablet, oral 650mg;7.5mg<br />

UCB<br />

@ tablet, oral 500mg;5mg<br />

USL<br />

tablet, oral 325mg;10mg<br />

Vintage<br />

tablet, oral 500mg;2.5,5,7.5,10mg Vintage<br />

tablet, oral 650mg;7.5,10mg<br />

Vintage<br />

tablet, oral 660mg;10mg<br />

Vintage<br />

tablet, oral 750mg;7.5mg<br />

Vintage<br />

@ tablet, oral 325mg;7.5mg<br />

Watson<br />

tablet, oral 325mg;10mg<br />

Watson<br />

tablet, oral 500mg;2.5,5,7.5,10mg Watson<br />

tablet, oral 650mg;7.5,10mg<br />

Watson<br />

tablet, oral 660mg;10mg<br />

Watson<br />

tablet, oral 750mg;7.5mg<br />

Watson<br />

Brand(s)<br />

Allay capsule, oral 500mg;5mg IVAX<br />

Bancap HC @ capsule, oral 500mg;5mg Forest<br />

Co-Gesic @ capsule, oral 500mg;5mg Central<br />

Hydrocet capsule, oral 500mg;5mg Mallinckrodt *<br />

Lorcet-HD capsule, oral 500mg;5mg Mallinckrodt *<br />

Anexsia tablet, oral 500mg;5mg Mallinckrodt *<br />

Anexsia 7.5/650 tablet, oral 650mg;7.5mg Mallinckrodt *<br />

Anexsia 10/660 tablet, oral 660mg;10mg Mallinckrodt *<br />

Co-Gesic tablet, oral 500mg;5mg Central<br />

Duradyne DHC @ tablet, oral 500mg;5mg Forest<br />

Hy-Phen tablet, oral 500mg;5mg Ascher<br />

Lortab tablet, oral 325mg;5mg Watson<br />

Lortab tablet, oral 500mg;5mg Mallinckrodt *<br />

Lortab tablet, oral 500mg;10mg UCB<br />

Norcet @ tablet, oral 500mg;5mg Abana<br />

Norco tablet, oral 325mg;10mg Watson<br />

Tycolet @ tablet, oral 500mg;5mg RW Johnson<br />

(continued on <strong>the</strong> next page)<br />

3


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ACETAMINOPHEN; HYDROCODONE BITARTRATE (continued)<br />

Vicodin tablet, oral 500mg;5mg Abbott<br />

Vicodin ES tablet, oral 750mg;7.5mg Abbott<br />

Vicodin HP tablet, oral 660mg;10mg Abbott<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

ACETAMINOPHEN; OXYCODONE HYDROCHLORIDE<br />

Acetaminophen; capsule, oral 500mg;5mg Amide<br />

Oxycodone Hydrochloride capsule, oral 500mg;5mg Barr<br />

capsule, oral 500mg;5mg<br />

Duramed<br />

capsule, oral 500mg;5mg<br />

Endo<br />

capsule, oral 500mg;5mg<br />

Halsey<br />

capsule, oral 500mg;5mg<br />

Mallinckrodt<br />

capsule, oral 500mg;5mg<br />

Royce<br />

capsule, oral 500mg;5mg<br />

Vintage<br />

tablet, oral 325mg;5mg<br />

Amide<br />

tablet, oral 325mg;5mg<br />

Barr<br />

tablet, oral 325mg;5mg<br />

Duramed<br />

tablet, oral 325mg;2.5,5mg<br />

Endo<br />

tablet, oral 500mg;7.5mg<br />

Endo<br />

tablet, oral 325mg;5mg<br />

Royce<br />

tablet, oral 325mg;5mg<br />

Vintage<br />

tablet, oral 500mg;7.5mg<br />

Watson<br />

tablet, oral 650mg;10mg<br />

Watson<br />

Brand(s)<br />

Roxilox capsule, oral 500mg;5mg Roxane<br />

Tylox capsule, oral 500mg;5mg RW Johnson *<br />

Oxycet tablet, oral 325mg;5mg Mallinckrodt<br />

Oxycodone 5/APAP 500 @ tablet, oral 500mg;5mg Bristol-Myers Squibb<br />

Percocet tablet, oral 325mg;5mg Endo *<br />

Percocet tablet, oral 500mg;7.5mg Endo *<br />

Percocet tablet, oral 650mg;10mg Endo *<br />

Roxicet tablet, oral 325mg;5mg Roxane<br />

Roxicet 5/500 tablet, oral 500mg;5mg Roxane<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

ACETAMINOPHEN; PENTAZOCINE HYDROCHLORIDE<br />

Acetaminophen; tablet, oral 650mg;eq 25mg base Watson<br />

Pentazocine Hydrochloride<br />

Brand(s)<br />

Talacen tablet, oral 650mg;eq 25mg base Sanofi Syn<strong>the</strong>labo<br />

ACETAMINOPHEN; PROPOXYPHENE HYDROCHLORIDE<br />

Acetaminophen; tablet, oral 650mg;65mg Geneva<br />

Propoxyphene Hydrochloride tablet, oral 650mg;65mg Mylan<br />

tablet, oral 650mg;65mg<br />

Royce<br />

Brand(s)<br />

Dolene AP-65 @ tablet, oral 650mg;65mg Lederle<br />

Wygesic tablet, oral 650mg;65mg Women First Healthcare<br />

4


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ACETAMINOPHEN; PROPOXYPHENE NAPSYLATE<br />

Acetaminophen; tablet, oral 650mg; 100mg Able<br />

Propoxyphene Napsylate tablet, oral 325mg;50mg Barr<br />

tablet, oral 650mg;100mg<br />

Barr<br />

@ tablet, oral 325mg;50mg<br />

Circa<br />

@ tablet, oral 650mg;100mg<br />

Circa<br />

tablet, oral 650mg;100mg<br />

Geneva<br />

@ tablet, oral 325mg;50mg<br />

Halsey<br />

tablet, oral 650mg;100mg<br />

Halsey<br />

tablet, oral 650mg;100mg<br />

IVAX<br />

tablet, oral 650mg;100mg<br />

Mallinckrodt<br />

tablet, oral 650mg;100mg<br />

Mylan<br />

tablet, oral 650mg;100mg<br />

Purepac<br />

@ tablet, oral 650mg;100mg<br />

Superpharm<br />

tablet, oral 650mg;100mg<br />

Teva<br />

tablet, oral 650mg;100mg<br />

Vintage<br />

Brand(s)<br />

Darvocet-N 50 tablet, oral 325mg;50mg Lilly<br />

Darvocet-N 100 tablet, oral 650mg;100mg Lilly *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

ACETAZOLAMIDE<br />

Acetazolamide @ tablet, oral 250mg (Ascot)<br />

@ tablet, oral 250mg<br />

Circa<br />

tablet, oral 250mg<br />

Danbury<br />

tablet, oral 250mg<br />

Lannett<br />

tablet, oral 125,250mg<br />

Mutual<br />

tablet, oral 125,250mg<br />

Taro<br />

@ tablet, oral 250mg<br />

(Vangard/MWM)<br />

Brand(s)<br />

Diamox tablet, oral 125,250mg Storz<br />

ACETAZOLAMIDE SODIUM<br />

Acetazolamide Sodium injection eq 500mg/vial Abbott<br />

injection eq 500mg/vial<br />

Bed<strong>for</strong>d<br />

@ injection eq 500mg/vial<br />

Quad<br />

Brand(s)<br />

Diamox injection eq 500mg/vial Storz<br />

ACETIC ACID, GLACIAL<br />

Acetic Acid, Glacial solution, irrigation-urethral, in plastic Abbott<br />

container, 250mg/100ml (0.25%)<br />

solution, irrigation-urethral, in plastic Baxter<br />

container, 250mg/100ml (0.25%)<br />

solution, irrigation-urethral, in plastic Braun<br />

container, 250mg/100ml (0.25%)<br />

@ solution, otic 2%<br />

KV<br />

solution, otic 2%<br />

Morton Grove<br />

solution, otic 2%<br />

Thames<br />

Brand(s)<br />

Acetasol solution, otic 2% Alpharma<br />

Orlex @ solution, otic 2% Procter and Gamble<br />

VoSol solution, otic 2% Wallace<br />

5


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ACETIC ACID, GLACIAL; ALUMINUM ACETATE<br />

Acetic Acid, Glacial; @ solution, otic 2%;0.79% Bausch and Lomb<br />

Aluminum Acetate<br />

Brand(s)<br />

Borofair @ solution, otic 2%;0.79% Pharmafair<br />

Domeboro solution, otic 2%;0.79% Bayer<br />

ACETIC ACID, GLACIAL; HYDROCORTISONE<br />

Acetic Acid, Glacial; solution, otic 2%;1% Bausch and Lomb<br />

Hydrocortisone @ solution, otic 2%;1% KV<br />

solution, otic 2%;1%<br />

Morton Grove<br />

solution, otic 2%;1%<br />

Thames<br />

Brand(s)<br />

Acetasol HC solution, otic 2%;1% Alpharma<br />

Orlex HC @ solution, otic 2%;1% Procter and Gamble<br />

VoSol HC solution, otic 2%;1% Wallace<br />

ACETOHEXAMIDE<br />

Acetohexamide tablet, oral 250,500mg Barr<br />

tablet, oral 250,500mg<br />

Danbury<br />

@ tablet, oral 250,500mg<br />

USL<br />

Brand(s)<br />

Dymelor @ tablet, oral 250,500mg Lilly<br />

ACETYLCYSTEINE<br />

Acetylcysteine solution <strong>for</strong> inhalation 10,20% Abbott<br />

solution <strong>for</strong> inhalation 10,20% Bed<strong>for</strong>d<br />

solution <strong>for</strong> inhalation 10,20% Faulding<br />

solution <strong>for</strong> inhalation 10,20% Luitpold<br />

@ solution <strong>for</strong> inhalation 10,20% Quad<br />

solution <strong>for</strong> inhalation 10,20% Roxane<br />

Brand(s)<br />

Mucosil-10,20 solution <strong>for</strong> inhalation 10,20% Dey<br />

Mucomyst solution <strong>for</strong> inhalation 10,20% Apo<strong>the</strong>con<br />

ACYCLOVIR<br />

Acyclovir capsule, oral 200mg Aesgen<br />

capsule, oral 200mg<br />

Apo<strong>the</strong>con<br />

capsule, oral 200mg<br />

Copley<br />

capsule, oral 200mg<br />

ESI Lederle<br />

capsule, oral 200mg<br />

Genpharm<br />

capsule, oral 200mg<br />

IVAX<br />

capsule, oral 200mg<br />

Lek<br />

capsule, oral 200mg<br />

Mylan<br />

capsule, oral 200mg<br />

Purepac<br />

capsule, oral 200mg<br />

Ranbaxy<br />

@ capsule, oral 200mg<br />

Roxane<br />

capsule, oral 200mg<br />

Stason<br />

capsule, oral 200mg<br />

Teva<br />

capsule, oral 200mg<br />

Watson<br />

suspension, oral 200mg/5ml<br />

Alpharma<br />

tablet, oral 400,800mg<br />

Aesgen<br />

tablet, oral 400,800mg<br />

Apo<strong>the</strong>con<br />

tablet, oral 400,800mg<br />

Carlsbad<br />

tablet, oral 400,800mg<br />

Copley<br />

tablet, oral 400,800mg<br />

ESI Lederle<br />

(continued on <strong>the</strong> next page)<br />

6


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ACYCLOVIR (continued)<br />

tablet, oral 400,800mg<br />

tablet, oral 400,800mg<br />

tablet, oral 400,800mg<br />

tablet, oral 400,800mg<br />

tablet, oral 400,800mg<br />

tablet, oral 400,800mg<br />

tablet, oral 400,800mg<br />

GenPharm<br />

IVAX<br />

Lek<br />

Mylan<br />

Purepac<br />

Ranbaxy<br />

Teva<br />

Brand(s)<br />

Zovirax capsule, oral 200mg Glaxo Wellcome<br />

Zovirax suspension, oral 200mg/5ml Glaxo Wellcome<br />

Zovirax tablet, oral 400,800mg Glaxo Wellcome<br />

ACYCLOVIR SODIUM<br />

Acyclovir Sodium injection eq 25mg base/ml Faulding<br />

injection eq 50mg base/ml<br />

Abbott<br />

injection eq 500mg,1gm base/vial Abbott<br />

injection eq 50mg base/ml<br />

American Pharmaceutical<br />

Partners<br />

injection eq 500mg,1gm base/vial American Pharmaceutical<br />

Partners<br />

@ injection eq 500mg,1gm base/vial Apo<strong>the</strong>con<br />

injection eq 500mg,1gm base/vial Bed<strong>for</strong>d<br />

injection eq 500mg,1gm base/vial ESI Lederle<br />

injection eq 500mg,1gm base/vial Gensia Sicor<br />

injection eq 50mg base/ml<br />

Meridian<br />

Brand(s)<br />

Zovirax injection eq 500mg,1gm base/vial Glaxo Wellcome<br />

ALBUTEROL<br />

Albuterol aerosol, metered 0.09mg/inhalation Armstrong ***<br />

aerosol, metered 0.09mg/inhalation GenPharm***<br />

aerosol, metered 0.09mg/inhalation IVAX ***<br />

aerosol, metered 0.09mg/inhalation Sidmak ***<br />

Brands<br />

Proventil aerosol, metered 0.09mg/inhalation Schering * **<br />

Ventolin aerosol, metered 0.09mg/inhalation GlaxoSmithKline * **<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

** Proventil and Ventolin brands of albuterol metered dose inhalers are NOT INTERCHANGEABLE at this time.<br />

Nei<strong>the</strong>r company has to date presented acceptable bioequivalence in<strong>for</strong>mation comparing <strong>the</strong>ir brand of<br />

albuterol metered dose inhaler to <strong>the</strong> o<strong>the</strong>r. Schering, via Warrick Pharmaceuticals, is manufacturing a<br />

generically labeled albuterol metered dose inhaler using <strong>the</strong> Proventil federal new drug application (NDA) while<br />

GlaxoSmithKline is doing <strong>the</strong> same, manufacturing an “authorized generic” <strong>for</strong> distribution under generic<br />

labeling by Dey Laboratories, using <strong>the</strong> Ventolin NDA. Thus, Schering manufactured generically labeled<br />

albuterol metered dose inhalers are NOT INTERCHANGEABLE with GlaxoSmithKline manufactured generically<br />

labeled albuterol metered dose inhalers.<br />

*** Albuterol metered dose inhalers manufactured by Armstrong (<strong>for</strong>merly Celltech or Medeva), GenPharm<br />

(<strong>for</strong>merly Alpharma), Sidmak (<strong>for</strong>merly Medisol), and IVAX (<strong>for</strong>merly Norton Water<strong>for</strong>d) are, at this time, only<br />

interchangeable with albuterol metered dose inhalers manufactured by GlaxoSmithKline.<br />

7


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ALBUTEROL SULFATE<br />

Albuterol Sulfate<br />

solution <strong>for</strong> inhalation eq 0.083% base Alpharma<br />

solution <strong>for</strong> inhalation eq 0.083% base Bausch and Lomb<br />

0.5% base<br />

solution <strong>for</strong> inhalation eq 0.083, Copley<br />

0.5% base<br />

solution <strong>for</strong> inhalation eq 0.083% base Dey<br />

solution <strong>for</strong> inhalation eq 0.083, Hi-Tech<br />

0.5% base<br />

solution <strong>for</strong> inhalation eq 0.083% base Morton Grove<br />

solution <strong>for</strong> inhalation eq 0.083% base Nephron<br />

solution <strong>for</strong> inhalation eq 0.083% base Roxane<br />

solution <strong>for</strong> inhalation eq 0.083% base Steripak<br />

syrup, oral eq 2mg base/5ml<br />

Alpharma<br />

syrup, oral eq 2mg base/5ml<br />

Hi-Tech<br />

@ syrup, oral eq 2mg base/5ml<br />

Mova<br />

syrup, oral eq 2mg base/5ml<br />

Teva<br />

syrup, oral eq 2mg base/5ml<br />

UDL<br />

@ syrup, oral eq 2mg base/5ml<br />

Watson<br />

@ tablet, oral eq 2,4mg base<br />

American Therapeutics<br />

@ tablet, oral eq 2,4mg base<br />

Celltech<br />

@ tablet, oral eq 2,4mg base<br />

Copley<br />

tablet, oral eq 2,4mg base<br />

Danbury<br />

tablet, oral eq 2,4mg base<br />

Geneva<br />

tablet, oral eq 2,4mg base<br />

Lederle<br />

tablet, oral eq 2,4mg base<br />

Mutual<br />

tablet, oral eq 2,4mg base<br />

Mylan<br />

tablet, oral eq 2,4mg base<br />

Sidmak<br />

tablet, oral eq 2,4mg base<br />

Teva<br />

@ tablet, oral eq 2,4mg base<br />

Warner Chilcott<br />

tablet, oral eq 2,4mg base<br />

Watson<br />

Brand(s)<br />

Proventil solution <strong>for</strong> inhalation eq 0.083, Schering *<br />

0.5% base<br />

Ventolin solution <strong>for</strong> inhalation eq 0.083, Glaxo Wellcome<br />

0.5% base<br />

Proventil syrup, oral eq 2mg base/5ml Schering *<br />

Ventolin @ syrup, oral eq 2mg base/5ml Glaxo Wellcome<br />

Proventil tablet, oral eq 2,4mg base Schering *<br />

Ventolin @ tablet, oral eq 2,4mg base Glaxo Wellcome<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

ALCOHOL; DEXTROSE<br />

Alcohol; Dextrose injection 5ml/100ml (5%); Abbott<br />

5gm/100ml (5%)<br />

@ injection 5ml/100ml (5%);<br />

Baxter<br />

5gm/100ml (5%)<br />

injection 5ml/100ml (5%);<br />

Braun<br />

5gm/100ml (5%)<br />

@ injection 5ml/100ml (5%);<br />

Miles<br />

5gm/100ml (5%)<br />

ALCOHOL; MORPHINE<br />

Alcohol; Morphine solution, oral 45% v/v;2mg/5ml Alpharma<br />

solution, oral 45% v/v;2mg/5ml Halsey<br />

(continued on <strong>the</strong> next page)<br />

8


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ALCOHOL; MORPHINE (continued)<br />

Brand(s)<br />

Paregoric Tincture solution, oral 45% v/v;2mg/5ml Cenci<br />

Paregoric Tincture solution, oral 45% v/v;2mg/5ml Lilly<br />

Paregoric Tincture solution, oral 45% v/v;2mg/5ml Morton Grove<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

ALFENTANIL HYDROCHLORIDE<br />

Alfentanil Hydrochloride injection eq 0.5mg base/ml Abbott<br />

Brand(s)<br />

Alfenta injection eq 0.5mg base/ml Akorn<br />

ALLOPURINOL<br />

Allopurinol @ tablet, oral 100,300mg Barr<br />

@ tablet, oral 100,300mg<br />

Circa<br />

tablet, oral 100,300mg<br />

Danbury<br />

tablet, oral 100,300mg<br />

Geneva<br />

tablet, oral 100,300mg<br />

Mutual<br />

tablet, oral 100,300mg<br />

Mylan<br />

tablet, oral 100,300mg<br />

Par<br />

@ tablet, oral 100,300mg<br />

Purepac<br />

@ tablet, oral 100mg<br />

Superpharm<br />

tablet, oral 300mg<br />

Superpharm<br />

@ tablet, oral 100,300mg<br />

Watson<br />

Brand(s)<br />

Lopurin tablet, oral 100,300mg BASF<br />

Zyloprim tablet, oral 100,300mg Prome<strong>the</strong>us<br />

ALPRAZOLAM<br />

Alprazolam tablet, oral 0.25,0.5,1,2mg Alphapharm<br />

tablet, oral 0.25,0.5,1,2mg<br />

Geneva<br />

tablet, oral 0.25,0.5,1,2mg<br />

IVAX<br />

tablet, oral 0.25,0.5,1,2mg<br />

Lederle<br />

tablet, oral 0.25,0.5,1,2mg<br />

Mylan<br />

tablet, oral 0.25,0.5,1,2mg<br />

Purepac<br />

@ tablet, oral 0.25,0.5,1mg<br />

Roxane<br />

tablet, oral 0.25,0.5,1mg<br />

Royce<br />

tablet, oral 0.25,0.5,1,2mg<br />

Teva<br />

tablet, oral 0.25,0.5,1mg<br />

Watson<br />

Brand(s)<br />

Xanax tablet, oral 0.25,0.5,1,2mg Pharmacia & Upjohn *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

ALPROSTADIL<br />

Alprostadil injection 0.5mg/ml Bed<strong>for</strong>d<br />

injection 0.5mg/ml<br />

Gensia Sicor<br />

Brand(s)<br />

Caverject @ injection 0.005mg/vial Pharmacia & Upjohn<br />

Caverject injection 0.01,0.02,0.04mg/vial Pharmacia & Upjohn<br />

Edex injection 0.005,0.01,0.02,0.04mg/vial Schwarz<br />

Prostin VR Pediatric injection 0.5mg/ml Pharmacia & Upjohn<br />

9


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ALUMINUM ACETATE; ACETIC ACID, GLACIAL<br />

See ACETIC ACID, GLACIAL; ALUMINUM ACETATE<br />

AMANTADINE HYDROCHLORIDE<br />

Amantadine Hydrochloride @ capsule, oral 100mg Circa<br />

capsule, oral 100mg<br />

Geneva<br />

capsule, oral 100mg<br />

USL<br />

syrup, oral 50mg/5ml<br />

Alpharma<br />

syrup, oral 50mg/5ml<br />

Copley<br />

syrup, oral 50mg/5ml<br />

Hi-Tech<br />

syrup, oral 50mg/5ml<br />

Mikart<br />

syrup, oral 50mg/5ml<br />

Morton Grove<br />

syrup, oral 50mg/5ml<br />

Pharmaceutical Associates<br />

Brand(s)<br />

Symadine @ capsule, oral 100mg Solvay<br />

Symmetrel capsule, oral 100mg Bristol-Myers Squibb *<br />

Symmetrel syrup, oral 50mg/5ml Endo *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

AMIKACIN SULFATE<br />

Amikacin Sulfate injection eq 50,250mg base/ml Abbott<br />

@ injection eq 50,250mg base/ml Astra Zeneca<br />

injection eq 50,250mg base/ml Bed<strong>for</strong>d<br />

@ injection eq 50,250mg base/ml Elkins-Sinn<br />

injection eq 50,250mg base/ml Faulding<br />

injection eq 50,250mg base/ml Gensia Sicor<br />

Brand(s)<br />

Amikin injection eq 50,250mg base/ml Apo<strong>the</strong>con<br />

AMILORIDE HYDROCHLORIDE<br />

Amiloride Hydrochloride tablet, oral 5mg Par<br />

Brand(s)<br />

Midamor tablet, oral 5mg Merck Sharp and Dohme<br />

AMILORIDE HYDROCHLORIDE; HYDROCHLOROTHIAZIDE<br />

Amiloride Hydrochloride; tablet, oral eq 5mg anhydrous;50mg Barr<br />

Hydrochlorothiazide tablet, oral eq 5mg anhydrous;50mg Geneva<br />

tablet, oral eq 5mg anhydrous;50mg Mylan<br />

tablet, oral eq 5mg anhydrous;50mg Royce<br />

tablet, oral eq 5mg anhydrous;50mg Teva<br />

Brand(s)<br />

Hydro-ride tablet, oral eq 5mg anhydrous;50mg Par<br />

Moduretic tablet, oral eq 5mg anhydrous;50mg Merck Sharp and Dohme *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

AMINOACETIC ACID<br />

See GLYCINE<br />

10


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

AMINOCAPROIC ACID<br />

Aminocaproic Acid injection 250mg/ml Abbott<br />

@ injection 250mg/ml<br />

American Pharmaceutical<br />

Partners<br />

injection 250mg/ml<br />

Elkins-Sinn<br />

injection 250mg/ml<br />

Luitpold<br />

@ injection 250mg/ml<br />

Quad<br />

syrup, oral 1.25gm/5ml<br />

Mikart<br />

Brand(s)<br />

Amicar injection 250mg/ml Immunex<br />

Amicar syrup, oral 1.25gm/5ml Immunex<br />

AMINOHIPPURATE SODIUM<br />

Aminohippurate Sodium injection 20% Merck Sharp and Dohme<br />

@ injection 20%<br />

Quad<br />

AMINOPHYLLINE<br />

Aminophylline injection 25mg/ml Abbott<br />

@ injection 25mg/ml<br />

American Pharmaceutical<br />

Partners<br />

injection 25mg/ml<br />

Elkins-Sinn<br />

injection 25mg/ml<br />

Gensia Sicor<br />

injection 25mg/ml<br />

International Medication<br />

@ injection 25mg/ml<br />

King<br />

injection 25mg/ml<br />

Luitpold<br />

injection 25mg/ml<br />

Pharma Serve<br />

@ injection 25mg/ml<br />

Smith and Nephew<br />

solution, oral 105mg/5ml<br />

Alpharma<br />

@ solution, oral 105mg/5ml<br />

Morton Grove<br />

solution, oral 105mg/5ml<br />

Roxane<br />

@ tablet, oral 100,200mg<br />

Duramed<br />

tablet, oral 100,200mg<br />

Geneva<br />

@ tablet, oral 100,200mg<br />

Impax<br />

tablet, oral 100,200mg<br />

Roxane<br />

@ tablet, oral 100,200mg<br />

(Vangard/MWM)<br />

tablet, oral 100,200mg<br />

West-ward<br />

Brand(s)<br />

Aminophyllin @ injection 25mg/ml Searle<br />

Somophyllin @ solution, oral 105mg/5ml Fisons<br />

Somophyllin-DF @ solution, oral 105mg/5ml Fisons<br />

Aminophyllin tablet, oral 100,200mg Searle<br />

AMIODARONE HYDROCHLORIDE<br />

Amiodarone Hydrochloride tablet, oral 200mg Alphapharm<br />

tablet, oral 200mg<br />

Barr<br />

tablet, oral 200mg<br />

Copley<br />

tablet, oral 200mg<br />

Eon<br />

tablet, oral 200mg<br />

Taro<br />

tablet, oral 200mg<br />

Teva<br />

Brand(s)<br />

Cordarone tablet, oral 200mg Wyeth-Ayerst<br />

Pacerone tablet, oral 200mg Upsher-Smith<br />

AMITRIPTYLINE HYDROCHLORIDE<br />

Amitriptyline Hydrochloride @ injection 10mg/ml Steris<br />

(continued on <strong>the</strong> next page)<br />

11


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

AMITRIPTYLINE HYDROCHLORIDE (continued)<br />

@ tablet, oral 10,25,50,75,100mg American Therapeutics<br />

@ tablet, oral 10,25,50,75,100,150mg Barr<br />

@ tablet, oral 10,25,50,75,100,150mg Celltech<br />

@ tablet, oral 10,25,50,75,100,150mg Danbury<br />

tablet, oral 10,25,50,75,100,150mg Geneva<br />

@ tablet, oral 25mg<br />

Halsey<br />

@ tablet, oral 10,25,50,75,100,150mg Lederle<br />

tablet, oral 10,25,50,75,100,150mg Mutual<br />

tablet, oral 10,25,50,75,100,150mg Mylan<br />

@ tablet, oral 10,25,50,75,100,150mg Par<br />

@ tablet, oral 10,25,50,75,100mg Purepac<br />

@ tablet, oral 10,25,50,75,100mg Roxane<br />

@ tablet, oral 150mg<br />

Roxane<br />

tablet, oral 10,25,50,75,100,150mg Sidmak<br />

tablet, oral 10,25,50,75,100mg Superpharm<br />

tablet, oral 10,25,50,100mg<br />

Teva<br />

@ tablet, oral 75,150mg<br />

Teva<br />

@ tablet, oral 25mg<br />

USL<br />

@ tablet, oral 10,50,75,100mg<br />

(Vangard/MWM)<br />

tablet, oral 10,25,50,75,100,150mg Vintage<br />

@ tablet, oral 10,25,50,75,100,150mg Watson<br />

@ tablet, oral 10,25,50mg<br />

West-ward<br />

Brand(s)<br />

Elavil injection 10mg/ml Zeneca<br />

Amitid @ tablet, oral 10,25,50,75,100mg Squibb<br />

Amitril @ tablet, oral 10,25,50,75,100,150mg Warner Chilcott<br />

Elavil tablet, oral 10,25,50,75,100,150mg Zeneca<br />

Endep @ tablet, oral 10,25,50,75,100mg Roche<br />

Endep @ tablet, oral 150mg Roche<br />

AMITRIPTYLINE HYDROCHLORIDE; CHLORDIAZEPOXIDE<br />

Amitriptyline Hydrochloride; @ tablet, oral eq 12.5mg base;5mg Barr<br />

Chlordiazepoxide @ tablet, oral eq 25mg base;10mg Barr<br />

tablet, oral eq 12.5mg base;5mg Danbury<br />

tablet, oral eq 25mg base;10mg Danbury<br />

tablet, oral eq 12.5mg base;5mg Mylan<br />

tablet, oral eq 25mg base;10mg Mylan<br />

tablet, oral eq 12.5mg base;5mg Par<br />

tablet, oral eq 25mg base;10mg Par<br />

@ tablet, oral eq 12.5mg base;5mg USL<br />

@ tablet, oral eq 25mg base;10mg USL<br />

Brand(s)<br />

Limbitrol tablet, oral eq 12.5mg base;5mg ICN<br />

Limbitrol DS tablet, oral eq 25mg base;10mg ICN<br />

AMITRIPTYLINE HYDROCHLORIDE; PERPHENAZINE<br />

Amitriptyline Hydrochloride; @ tablet, oral 10mg;2mg Barr<br />

Perphenazine @ tablet, oral 25mg;2mg Barr<br />

@ tablet, oral 10mg;4mg<br />

Barr<br />

@ tablet, oral 25mg;4mg<br />

Barr<br />

@ tablet, oral 10mg;2mg<br />

Circa<br />

@ tablet, oral 25mg;2mg<br />

Circa<br />

@ tablet, oral 10mg;4mg<br />

Circa<br />

@ tablet, oral 25mg;4mg<br />

Circa<br />

@ tablet, oral 50mg;4mg<br />

Circa<br />

(continued on <strong>the</strong> next page)<br />

12


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

AMITRIPTYLINE HYDROCHLORIDE; PERPHENAZINE (continued)<br />

@ tablet, oral 10mg;2mg<br />

Danbury<br />

@ tablet, oral 25mg;2mg<br />

Danbury<br />

@ tablet, oral 10mg;4mg<br />

Danbury<br />

@ tablet, oral 25mg;4mg<br />

Danbury<br />

@ tablet, oral 50mg;4mg<br />

Danbury<br />

tablet, oral 10mg;2mg<br />

Geneva<br />

tablet, oral 25mg;2mg<br />

Geneva<br />

tablet, oral 10mg;4mg<br />

Geneva<br />

tablet, oral 25mg;4mg<br />

Geneva<br />

tablet, oral 50mg;4mg<br />

Geneva<br />

@ tablet, oral 10mg;2mg<br />

IVAX<br />

@ tablet, oral 25mg;2mg<br />

IVAX<br />

@ tablet, oral 10mg;4mg<br />

IVAX<br />

@ tablet, oral 25mg;4mg<br />

IVAX<br />

@ tablet, oral 50mg;4mg<br />

IVAX<br />

@ tablet, oral 10mg;2mg<br />

Mylan<br />

@ tablet, oral 25mg;2mg<br />

Mylan<br />

@ tablet, oral 10mg;4mg<br />

Mylan<br />

@ tablet, oral 25mg;4mg<br />

Mylan<br />

@ tablet, oral 50mg;4mg<br />

Mylan<br />

@ tablet, oral 10mg;2mg<br />

Par<br />

@ tablet, oral 25mg;2mg<br />

Par<br />

@ tablet, oral 10mg;4mg<br />

Par<br />

@ tablet, oral 25mg;4mg<br />

Par<br />

@ tablet, oral 50mg;4mg<br />

Par<br />

tablet, oral 10mg;2mg<br />

Royce<br />

tablet, oral 25mg;2mg<br />

Royce<br />

tablet, oral 10mg;4mg<br />

Royce<br />

tablet, oral 25mg;4mg<br />

Royce<br />

@ tablet, oral 50mg;4mg<br />

Watson<br />

Brand(s)<br />

Triavil 2-10 @ tablet, oral 10mg;2mg New River<br />

Triavil 2-25 @ tablet, oral 25mg;2mg New River<br />

Triavil 4-10 @ tablet, oral 10mg;4mg New River<br />

Triavil 4-25 @ tablet, oral 25mg;4mg New River<br />

Triavil 4-50 @ tablet, oral 50mg;4mg New River<br />

AMMONIUM LACTATE<br />

Brand(s)<br />

Lac-Hydrin lotion, topical 12% Bristol-Myers Squibb *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

AMOXAPINE<br />

Amoxapine tablet, oral 25,50,100,150mg Danbury<br />

tablet, oral 25,50,100,150mg Geneva<br />

tablet, oral 25,50,100,150mg Watson<br />

Brand(s)<br />

Asendin @ tablet, oral 25,50,100,150mg Lederle<br />

AMOXICILLIN/AMOXICILLIN TRIHYDRATE<br />

Amoxicillin/ @ capsule, oral 250,500mg Atral<br />

Amoxicillin Trihydrate capsule, oral 250,500mg Biochemie<br />

capsule, oral 250,500mg<br />

Clonmel<br />

capsule, oral 250,500mg<br />

Consolidated<br />

(continued on <strong>the</strong> next page)<br />

13


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

AMOXICILLIN/AMOXICILLIN TRIHYDRATE (continued)<br />

@ capsule, oral 250,500mg<br />

Mylan<br />

capsule, oral 250,500mg<br />

Ranbaxy<br />

capsule, oral 250,500mg<br />

Teva<br />

powder <strong>for</strong> suspension 125,250mg/5ml Clonmel<br />

powder <strong>for</strong> suspension 125,250mg/5ml Consolidated<br />

@ powder <strong>for</strong> suspension 125,250mg/5ml Mylan<br />

powder <strong>for</strong> suspension<br />

Teva<br />

125,250mg/5ml, 50mg/ml<br />

tablet, chewable 125,250mg<br />

Apo<strong>the</strong>con<br />

tablet, chewable 125,250mg<br />

Clonmel<br />

tablet, chewable 125,200,250,400mg Ranbaxy<br />

tablet, chewable 125,250mg<br />

Teva<br />

tablet, oral 500,875mg<br />

Ranbaxy<br />

tablet, oral 500,875mg<br />

Teva<br />

Brand(s)<br />

Amoxil capsule, oral 250,500mg SmithKline Beecham<br />

Trimox capsule, oral 250,500mg Apo<strong>the</strong>con<br />

Utimox @ capsule, oral 250,500mg Parke-Davis<br />

Wymox @ capsule, oral 250,500mg Wyeth-Ayerst<br />

Amoxil powder <strong>for</strong> suspension SmithKline Beecham<br />

125,250mg/5ml, 50mg/ml<br />

Larotid @ powder <strong>for</strong> suspension 50mg/ml SmithKline Beecham<br />

Larotid<br />

powder <strong>for</strong> suspension 125,250mg/5ml SmithKline Beecham<br />

Polymox<br />

@ powder <strong>for</strong> suspension 125,250mg/5ml Apo<strong>the</strong>con<br />

Trimox @ powder <strong>for</strong> suspension 50mg/ml Apo<strong>the</strong>con<br />

Trimox<br />

powder <strong>for</strong> suspension 125,250mg/5ml Apo<strong>the</strong>con<br />

Utimox<br />

@ powder <strong>for</strong> suspension 125,250mg/5ml Parke-Davis<br />

Wymox<br />

powder <strong>for</strong> suspension 125,250mg/5ml Wyeth-Ayerst<br />

Amoxil tablet, chewable 125,200,250,400mg SmithKline Beecham<br />

Amoxil tablet, oral 500,875mg SmithKline Beecham<br />

AMPHETAMINE ASPARTAME; AMPHETAMINE SULFATE; DEXTROAMPHETAMINE SACCHARATE;<br />

DEXTROAMPHETAMINE SULFATE<br />

Amphetamine Aspartame; tablet, oral 2.5mg;2.5mg;2.5mg;2.5mg Barr<br />

Amphetamine Sulfate;<br />

tablet, oral 1.25mg;1.25mg;1.25mg;1.25mg Barr<br />

Dextroamphetamine Saccharate; tablet, oral 5mg;5mg;5mg;5mg Barr<br />

Dextroamphetamine Sulfate tablet, oral 7.5mg;7.5mg;7.5mg;7.5mg Barr<br />

Brand(s)<br />

Adderall 5<br />

tablet, oral 1.25mg;1.25mg;1.25mg;1.25mg Shire<br />

Adderall 10 tablet, oral 2.5mg;2.5mg;2.5mg;2.5mg Shire<br />

Adderall 20 tablet, oral 5mg;5mg;5mg;5mg Shire<br />

Adderall 30 tablet, oral 7.5mg;7.5mg;7.5mg;7.5mg Shire<br />

AMPHETAMINE SULFATE; AMPHETAMINE ASPARTAME; DEXTROAMPHETAMINE SACCHARATE;<br />

DEXTROAMPHETAMINE SULFATE<br />

See AMPHETAMINE ASPARTAME; AMPHETAMINE SULFATE; DEXTROAMPHETAMINE<br />

SACCHARATE; DEXTROAMPHETAMINE SULFATE<br />

AMPHOTERICIN B<br />

Amphotericin B @ injection 50mg/vial Abbott<br />

@ injection 50mg/vial<br />

American Pharmaceutical<br />

Partners<br />

injection 50mg/vial<br />

Gensia Sicor<br />

injection 50mg/vial<br />

Pharma Tek<br />

Brand(s)<br />

Fungizone injection 50mg/vial Apo<strong>the</strong>con<br />

14


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

AMPICILLIN/AMPICILLIN TRIHYDRATE; PROBENECID<br />

Brand(s)<br />

Polycillin-PRB @ powder <strong>for</strong> suspension Apo<strong>the</strong>con<br />

eq 3.5gm base/bottle;1gm/bottle<br />

Probampacin @ powder <strong>for</strong> suspension Teva<br />

eq 3.5gm base/bottle;1gm/bottle<br />

AMPICILLIN SODIUM<br />

Ampicillin Sodium @ injection eq 125,250,500mg, Consolidated<br />

1,2gm base/vial<br />

@ injection eq 125,250,500mg,<br />

Elkins-Sinn<br />

1,2,10gm base/vial<br />

@ injection eq 125,250,500mg,<br />

Han<strong>for</strong>d<br />

1,2,10gm base/vial<br />

@ injection eq 125mg base/vial<br />

IBI<br />

injection eq 250,500mg,<br />

IBI<br />

1,2gm base/vial<br />

@ injection eq 1,2gm base/vial<br />

International Medication<br />

@ injection eq 500mg,1,2gm base/vial Lilly<br />

injection eq 125,250,500mg,<br />

1,2gm base/vial<br />

@ injection eq 10gm base/vial<br />

Marsam<br />

Marsam<br />

Brand(s)<br />

Omnipen-N injection eq 125,250,500mg, Wyeth-Ayerst<br />

1,2gm base/vial<br />

Penbritin-S @ injection eq 125,250,500mg, Wyeth-Ayerst<br />

1,2gm base/vial<br />

Polycillin-N @ injection eq 125,250,500mg, Bristol<br />

1,2gm base/vial<br />

Principen injection eq 125,250,500mg, Apo<strong>the</strong>con<br />

1,2,10gm base/vial<br />

Totacillin-N injection eq 125,250,500mg, SmithKline Beecham<br />

1,10gm base/vial<br />

Totacillin-N @ injection eq 2gm base/vial SmithKline Beecham<br />

AMPICILLIN/AMPICILLIN TRIHYDRATE<br />

Ampicillin Trihydrate @ capsule, oral eq 250,500mg base Biochemie<br />

capsule, oral eq 250,500mg base Clonmel<br />

capsule, oral eq 250,500mg base Consolidated<br />

@ capsule, oral eq 250,500mg base Eon<br />

@ capsule, oral eq 250,500mg base IVAX<br />

@ capsule, oral eq 250,500mg base Lederle<br />

@ capsule, oral eq 250,500mg base Mylan<br />

@ capsule, oral eq 250mg base Purepac<br />

capsule, oral eq 500mg base Purepac<br />

capsule, oral eq 250,500mg base Teva<br />

powder <strong>for</strong> suspension<br />

Clonmel<br />

eq 125,250mg base/5ml<br />

powder <strong>for</strong> suspension<br />

Consolidated<br />

eq 125,250mg base/5ml<br />

@ powder <strong>for</strong> suspension<br />

Mylan<br />

eq 125,250mg base/5ml<br />

powder <strong>for</strong> suspension<br />

Purepac<br />

@ eq 125mg base/5ml<br />

eq 250mg base/5ml<br />

powder <strong>for</strong> suspension<br />

Teva<br />

eq 125,250mg base/5ml<br />

(continued on <strong>the</strong> next page)<br />

15


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

AMPICILLIN/AMPICILLIN TRIHYDRATE (continued)<br />

Brand(s)<br />

Amcill @ capsule, oral eq 250,500mg base Parke-Davis<br />

Omnipen capsule, oral eq 250,500mg base Wyeth-Ayerst<br />

Penbritin @ capsule, oral eq 250,500mg base Wyeth-Ayerst<br />

Pfizerpen-A @ capsule, oral eq 250,500mg base Pfizer<br />

Polycillin @ capsule, oral eq 250,500mg base Bristol<br />

Principen capsule, oral eq 250,500mg base Apo<strong>the</strong>con<br />

Totacillin capsule, oral eq 250,500mg base SmithKline Beecham<br />

Amcill @ powder <strong>for</strong> suspension Parke-Davis<br />

eq 125,250mg base/5ml<br />

Omnipen powder <strong>for</strong> suspension Wyeth-Ayerst<br />

eq 125,250mg base/5ml,<br />

100mg/ml<br />

Penbritin @ powder <strong>for</strong> suspension Wyeth-Ayerst<br />

eq 125,250mg base/5ml,<br />

100mg/ml<br />

Pfizerpen-A @ powder <strong>for</strong> suspension Pfizer<br />

eq 125,250mg base/5ml<br />

Polycillin @ powder <strong>for</strong> suspension Apo<strong>the</strong>con<br />

eq 125,250,500mg base/5ml,<br />

100mg/ml<br />

Principen powder <strong>for</strong> suspension Apo<strong>the</strong>con<br />

eq 125,250mg base/5ml,<br />

100mg/ml<br />

Totacillin @ powder <strong>for</strong> suspension SmithKline Beecham<br />

eq 125,250mg base/5ml<br />

AMRINONE LACTATE<br />

See INAMRINONE LACTATE<br />

ANTAZOLINE PHOSPHATE; NAPHAZOLINE HYDROCHLORIDE<br />

Antazoline Phosphate; solution, ophthalmic 0.5%;0.05% Steris<br />

Naphazoline Hydrochloride<br />

Brand(s)<br />

Albalon A Liquifilm solution, ophthalmic 0.5%;0.05% Allergan<br />

Vasocon-A solution, ophthalmic 0.5%;0.05% Novartis<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

ANTIPYRINE; BENZOCAINE<br />

Antipyrine; Benzocaine solution, otic 54mg/ml(5.4%); Bausch and Lomb<br />

14mg/ml(1.4%)<br />

solution, otic 54mg/ml(5.4%); Hi-Tech<br />

14mg/ml(1.4%)<br />

solution, otic 54mg/ml(5.4%); Thames<br />

14mg/ml(1.4%)<br />

Brand(s)<br />

A/B Otic Drops solution, otic 54mg/ml(5.4%); Clay-Park<br />

14mg/ml(1.4%)<br />

Auralgan solution, otic 54mg/ml(5.4%); Wyeth-Ayerst<br />

14mg/ml(1.4%)<br />

(continued on <strong>the</strong> next page)<br />

16


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ANTIPYRINE; BENZOCAINE (continued)<br />

Auroto Drops solution, otic 54mg/ml(5.4%); Alpharma<br />

14mg/ml(1.4%)<br />

Oto Ear Drops solution, otic 54mg/ml(5.4%); Vortech<br />

14mg/ml(1.4%)<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

ASCORBIC ACID; BIOTIN; CYANOCOBALAMIN; DEXPANTHENOL; ERGOCALCIFEROL; FOLIC ACID;<br />

NIACINAMIDE; PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN PHOSPHATE SODIUM; THIAMINE<br />

HYDROCHLORIDE; VITAMIN A; VITAMIN E<br />

Brand(s)<br />

M.V.C. 9+3 @ injection 10mg/ml;0.006mg/ml; American Pharmaceutical<br />

0.05mg/ml;1.5mg/ml;20IU/ml; Partners<br />

0.04mg/ml;4mg/ml;0.4mg/ml;<br />

0.36mg/ml;0.3mg/ml;330IU/ml;<br />

1IU/ml<br />

MVC Plus injection 10mg/ml;0.006mg/ml; Steris<br />

0.05mg/ml;1.5mg/ml;20IU/ml;<br />

0.04mg/ml;4mg/ml;0.4mg/ml;<br />

0.36mg/ml;0.3mg/ml;330IU/ml;<br />

1IU/ml<br />

M.V.I. - 12 injection 10mg/ml;0.006mg/ml; Neosan<br />

0.05mg/ml;1.5mg/ml;20IU/ml;<br />

0.04mg/ml;4mg/ml;0.4mg/ml;<br />

0.36mg/ml;0.3mg/ml;330IU/ml;<br />

1IU/ml<br />

ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; IRON; NICOTINIC ACID; PYRIDOXINE HYDROCHLORIDE;<br />

RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D; VITAMIN E<br />

Ascorbic Acid; Cyanocobalamin; drops, oral 35mg;2mcg;0.5mg;10mg; Esquire<br />

Fluoride; Iron; Nicotinic Acid; 8mg;0.4mg;0.6mg;0.5mg;<br />

Pyridoxine Hydrochloride; 1500IU;400IU;5IU<br />

Riboflavin; Thiamine Hydrochloride;<br />

Vitamin A; Vitamin D; Vitamin E<br />

Brand(s)<br />

Poly-Vi-Flor with Iron drops, oral 35mg;2mcg;0.5mg;10mg; Mead Johnson/<br />

8mg;0.4mg;0.6mg;0.5mg; Bristol-Myers Squibb<br />

1500IU;400IU;5IU<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; NICOTINIC ACID; PYRIDOXINE HYDROCHLORIDE;<br />

RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D; VITAMIN E<br />

Ascorbic Acid; drops, oral 35mg;2mcg; Alpharma<br />

Cyanocobalamin; Fluoride; 0.25mg;8mg;0.4mg;0.6mg;<br />

Nicotinic Acid; 0.5mg;1500IU;400IU;5IU<br />

Pyridoxine Hydrochloride; drops, oral 35mg;2mcg; Esquire<br />

Riboflavin; 0.25mg;8mg;0.4mg;0.6mg;<br />

Thiamine Hydrochloride; 0.5mg;1500IU;400IU;5IU<br />

Vitamin A; Vitamin D; Vitamin E drops, oral 35mg;2mcg; Alpharma<br />

0.5mg;8mg;0.4mg;0.6mg;<br />

0.5mg;1500IU;400IU;5IU<br />

(continued on <strong>the</strong> next page)<br />

17


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; NICOTINIC ACID; PYRIDOXINE HYDROCHLORIDE;<br />

RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D; VITAMIN E (continued)<br />

drops, oral 35mg;2mcg;<br />

Esquire<br />

0.5mg;8mg;0.4mg;0.6mg;<br />

0.5mg;1500IU;400IU;5IU<br />

drops, oral 35mg;2mcg;<br />

Hi-Tech<br />

0.5mg;8mg;0.4mg;0.6mg;<br />

0.5mg;1500IU;400IU;5IU<br />

Brand(s)<br />

Poly-Vi-Flor drops, oral 35mg;2mcg; Mead Johnson/<br />

0.25mg;8mg;0.4mg;0.6mg; Bristol-Myers Squibb<br />

0.5mg;1500IU;44IU;5IU<br />

Poly Vitamin Drops drops, oral 35mg;2mcg; Hi-Tech<br />

with Fluoride 0.25mg 0.25mg;8mg;0.4mg;0.6mg;<br />

0.5mg;1500IU;44IU;5IU<br />

Poly-Vi-Flor drops, oral 35mg;2mcg; Mead Johnson/<br />

0.5mg;8mg;0.4mg;0.6mg; Bristol-Myers Squibb<br />

0.5mg;1500IU;400IU;5IU<br />

Poly Vitamin Drops drops, oral 35mg;2mcg; Hi-Tech<br />

with Fluoride 0.5mg 0.5mg;8mg;0.4mg;0.6mg;<br />

0.5mg;1500IU;400IU;5IU<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

ASCORBIC ACID; FLUORIDE; IRON; VITAMIN A; VITAMIN D<br />

Ascorbic Acid; Fluoride; drops, oral 35mg;0.25mg; Abbott<br />

Iron; Vitamin A; Vitamin D 10mg;1500IU;400IU<br />

drops, oral 35mg;0.25mg;<br />

Alpharma<br />

10mg;1500IU;400IU<br />

drops, oral 35mg;0.25mg;<br />

Morton Grove<br />

10mg;1500IU;400IU<br />

drops, oral 35mg;0.5mg;<br />

Morton Grove<br />

10mg;1500IU;400IU<br />

Brand(s)<br />

Tri-Vi-Flor with Iron drops, oral 35mg;0.25mg Mead Johnson/<br />

10mg;1500IU;400IU Bristol-Myers Squibb<br />

Tri-Vi-Flor with Iron drops, oral 35mg;0.5mg; Mead Johnson/<br />

10mg;1500IU;400IU Bristol-Myers Squibb<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

ASCORBIC ACID; FLUORIDE; VITAMIN A; VITAMIN D<br />

Ascorbic Acid; Fluoride; drops, oral 35mg;0.25mg; Abbott<br />

Vitamin A; Vitamin D 1500IU;400IU<br />

drops, oral 35mg;0.5mg;1500IU;400IU Alpharma<br />

drops, oral 35mg;0.25mg;<br />

Morton Grove<br />

1500IU;400IU<br />

drops, oral 35mg;0.5mg;1500IU;400IU Morton Grove<br />

Brand(s)<br />

Triple-Vita-Flor 0.25mg drops, oral 35mg;0.25mg; Esquire<br />

1500IU;400IU<br />

Tri-Vi-Flor drops, oral 35mg;0.25mg; Mead Johnson/<br />

1500IU;400IU Bristol-Myers Squibb<br />

TriVitamin Drops drops, oral 35mg;0.25mg; Hi-Tech<br />

with Fluoride 0.25mg 1500IU;400IU<br />

(continued on <strong>the</strong> next page)<br />

18


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ASCORBIC ACID; FLUORIDE; VITAMIN A; VITAMIN D (continued)<br />

Triple-Vita-Flor 0.5mg drops, oral 35mg;0.5mg; Esquire<br />

1500IU;400IU<br />

Tri-Vi-Flor drops, oral 35mg;0.5mg; Mead Johnson/<br />

1500IU;400IU Bristol-Myers Squibb<br />

TriVitamin Drops<br />

drops, oral 35mg;0.5mg;1500IU;400IU Hi-Tech<br />

with Fluoride 0.5mg<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

ASPIRIN; BUTALBITAL; CAFFEINE<br />

Aspirin; Butalbital; Caffeine @ capsule, oral 325mg;50mg;40mg Watson<br />

@ tablet, oral 325mg;50mg;40mg Halsey<br />

tablet, oral 325mg;50mg;40mg Pharmeral<br />

tablet, oral 325mg;50mg;40mg Purepac<br />

@ tablet, oral 325mg;50mg;40mg Quantum<br />

@ tablet, oral 325mg;50mg;40mg Watson<br />

tablet, oral 325mg;50mg;40mg West-ward<br />

Brand(s)<br />

Fiorinal capsule, oral 325mg;50mg;40mg Novartis *<br />

Lanorinal capsule, oral 325mg;50mg;40mg Lannett<br />

Butal Compound tablet, oral 325mg;50mg;40mg Geneva<br />

Butalbital Compound @ tablet, oral 325mg;50mg;40mg IVAX<br />

Fiorinal tablet, oral 325mg;50mg;40mg Novartis *<br />

Lanorinal @ tablet, oral 325mg;50mg;40mg Lannett<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

ASPIRIN; BUTALBITAL; CAFFEINE; CODEINE PHOSPHATE<br />

Aspirin; Butalbital; Caffeine; capsule, oral 325mg;50mg;40mg;30mg Endo<br />

Codeine Phosphate<br />

capsule, oral 325mg;50mg;40mg;30mg Jerome Stevens<br />

capsule, oral 325mg;50mg;40mg;30mg Watson<br />

Brands<br />

Fiorinal with Codeine #3 capsule, oral 325mg;50mg;40mg;30mg Novartis *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

ASPIRIN; CAFFEINE; ORPHENADRINE CITRATE<br />

Aspirin; Caffeine; tablet, oral 385mg;30mg;25mg Eon<br />

Orphenadrine Citrate tablet, oral 770mg;60mg;50mg Eon<br />

tablet, oral 385mg;30mg;25mg Jerome Stevens<br />

tablet, oral 770mg;30mg;25mg Jerome Stevens<br />

Brand(s)<br />

Invagesic tablet, oral 385mg;30mg;25mg Geneva<br />

Invagesic Forte tablet, oral 770mg;60mg;50mg Geneva<br />

Norgesic tablet, oral 385mg;30mg;25mg 3M *<br />

Norgesic Forte tablet, oral 770mg;60mg;50mg 3M *<br />

Orphengesic tablet, oral 385mg;30mg;25mg Par<br />

Orphengesic tablet, oral 385mg;30mg;25mg Par<br />

19


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ASPIRIN; CAFFEINE; PROPOXYPHENE HYDROCHLORIDE<br />

(Propoxyphene Hydrochloride in Powder Form)<br />

Aspirin; Caffeine; @ capsule, oral 389mg;32.4mg;65mg Eon<br />

Propoxyphene Hydrochloride @ capsule, oral 389mg;32.4mg;65mg Geneva<br />

capsule, oral 389mg;32.4mg;65mg Teva<br />

@ capsule, oral 389mg;32.4mg;65mg Watson<br />

Brand(s)<br />

Compound 65 @ capsule, oral 389mg;32.4mg;65mg Alra<br />

Darvon Compound-65 capsule, oral 389mg;32.4mg;65mg Lilly *<br />

Propoxyphene Compound 65 @ capsule, oral 389mg;32.4mg;65mg IVAX<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

ASPIRIN; CARISOPRODOL<br />

Aspirin; Carisoprodol tablet, oral 325mg;200mg Amide<br />

@ tablet, oral 325mg;200mg<br />

Circa<br />

tablet, oral 325mg;200mg<br />

Eon<br />

tablet, oral 325mg;200mg<br />

Par<br />

Brand(s)<br />

Soma Compound tablet, oral 325mg;200mg Wallace<br />

ASPIRIN; CARISOPRODOL; CODEINE PHOSPHATE<br />

Aspirin; Carisoprodol; tablet, oral 325mg;200mg;16mg Amide<br />

Codeine Phosphate tablet, oral 325mg;200mg;16mg Eon<br />

Brand(s)<br />

Soma Compound with Codeine tablet, oral 325mg;200mg;16mg Wallace<br />

ASPIRIN; CODEINE PHOSPHATE<br />

Aspirin; Codeine Phosphate tablet, oral 325mg;15,30,60mg Barr<br />

tablet, oral 325mg;15,30,60mg Geneva<br />

tablet, oral 325mg;30mg<br />

Halsey<br />

tablet, oral 325mg;30,60mg<br />

IVAX<br />

Brand(s)<br />

Empirin #3 tablet, oral 325mg;15,30,60mg Glaxo Wellcome<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Section 790.60.<br />

ASPIRIN; MEPROBAMATE<br />

Aspirin; Meprobamate @ tablet, oral 325mg;200mg Par<br />

Brand(s)<br />

Equagesic tablet, oral 325mg;200mg Women First Healthcare<br />

Mepro-Aspirin @ tablet, oral 325mg;200mg Eon<br />

Micrainin tablet, oral 325mg;200mg Wallace<br />

Q-Gesic @ tablet, oral 325mg;200mg Quantum<br />

ASPIRIN; METHOCARBAMOL<br />

Aspirin; Methocarbamol tablet, oral 325mg;400mg IVAX<br />

@ tablet, oral 325mg;400mg<br />

McNeil<br />

tablet, oral 325mg;400mg<br />

Par<br />

tablet, oral 325mg;400mg<br />

Stevens<br />

Brand(s)<br />

Robaxisal tablet, oral 325mg;400mg Robins<br />

20


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ASPIRIN; OXYCODONE HYDROCHLORIDE: OXYCODONE TEREPHTHALATE<br />

Aspirin; Oxycodone Hydrochloride; tablet, oral 325mg;4.5mg;0.38mg Barr<br />

Oxycodone Terephthalate tablet, oral 325mg;4.5mg;0.38mg Halsey<br />

@ tablet, oral 325mg;2.25mg;0.19mg Roxane<br />

tablet, oral 325mg;4.5mg;0.38mg Watson<br />

Brand(s)<br />

Percodan-Demi tablet, oral 325mg;2.25mg;0.19mg Endo<br />

Codoxy @ tablet, oral 325mg;4.5mg;0.38mg Halsey<br />

Percodan tablet, oral 325mg;4.5mg;0.38mg Endo *<br />

Roxiprin @ tablet, oral 325mg;4.5mg;0.38mg Roxane<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

ATENOLOL<br />

Atenolol @ tablet, oral 50,100mg Apo<strong>the</strong>con<br />

tablet, oral 50,100mg<br />

Copley<br />

tablet, oral 50,100mg<br />

Danbury<br />

tablet, oral 25,50,100mg<br />

Geneva<br />

@ tablet, oral 25,50,100mg<br />

Genpharm<br />

tablet, oral 25,50,100mg<br />

IPR<br />

tablet, oral 25,50,100mg<br />

Lederle<br />

tablet, oral 50,100mg<br />

Martec<br />

tablet, oral 25,50,100mg<br />

Mutual<br />

tablet, oral 25,50,100mg<br />

Mylan<br />

tablet, oral 50,100mg<br />

SCS<br />

tablet, oral 25,50,100mg<br />

Sidmak<br />

tablet, oral 50,100mg<br />

Teva<br />

Brand(s)<br />

Tenormin tablet, oral 25,50,100mg Zeneca<br />

ATENOLOL; CHLORTHALIDONE<br />

Atenolol; Chlorthalidone tablet, oral 50mg;25mg Danbury<br />

tablet, oral 100mg;25mg<br />

Danbury<br />

tablet, oral 50mg;25mg<br />

IPR<br />

tablet, oral 100mg;25mg<br />

IPR<br />

tablet, oral 50mg;25mg<br />

Martec<br />

tablet, oral 100mg;25mg<br />

Martec<br />

tablet, oral 50mg;25mg<br />

Mutual<br />

tablet, oral 100mg;25mg<br />

Mutual<br />

tablet, oral 50mg;25mg<br />

Mylan<br />

tablet, oral 100mg;25mg<br />

Mylan<br />

tablet, oral 50mg;25mg<br />

Sidmak<br />

tablet, oral 100mg;25mg<br />

Sidmak<br />

Brand(s)<br />

Tenoretic 50 tablet, oral 50mg;25mg Zeneca<br />

Tenoretic 100 tablet, oral 100mg;25mg Zeneca<br />

ATRACURIUM BESYLATE<br />

Atracurium Besylate injection 10mg/ml Abbott<br />

injection 10mg/ml<br />

Baxter<br />

injection 10mg/ml<br />

Bed<strong>for</strong>d<br />

injection 10mg/ml<br />

ESI Lederle<br />

injection 10mg/ml<br />

Faulding<br />

injection 10mg/ml<br />

Gensia Sicor<br />

injection 10mg/ml<br />

Marsam<br />

(continued on <strong>the</strong> next page)<br />

21


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ATRACURIUM BESYLATE (continued)<br />

Brand(s)<br />

Atracurium Besylate injection 10mg/ml Abbott<br />

Preservative Free<br />

Atracurium Besylate injection 10mg/ml Baxter<br />

Preservative Free<br />

Atracurium Besylate injection 10mg/ml Bed<strong>for</strong>d<br />

Preservative Free<br />

Atracurium Besylate injection 10mg/ml ESI Lederle<br />

Preservative Free<br />

Atracurium Besylate injection 10mg/ml Faulding<br />

Preservative Free<br />

Atracurium Besylate injection 10mg/ml Marsam<br />

Preservative Free<br />

Tracrium injection 10mg/ml Abbott<br />

Tracrium Preservative Free injection 10mg/ml Abbott<br />

ATROPINE<br />

Atropine @ injection eq 2mg sulfate/0.7ml Solvay<br />

Brand(s)<br />

Atropen injection eq 2mg sulfate/0.7ml Meridian<br />

ATROPINE SULFATE<br />

Atropine Sulfate solution, ophthalmic 1% Allergan<br />

solution, ophthalmic 1%<br />

Alpharma<br />

solution, ophthalmic 1%<br />

Pharmafair<br />

solution, ophthalmic 1%<br />

Steris<br />

Brand(s)<br />

Atropair solution, ophthalmic 1% Balan<br />

Atropine-1 solution, ophthalmic 1% Optopics<br />

Atropine Care solution, ophthalmic 1% Akorn<br />

Atropisol solution, ophthalmic 0.5,1,2% Iolab<br />

I-Tropine solution, ophthalmic 1% Americal<br />

Isopto Atropine solution, ophthalmic 0.5,1,2% Alcon<br />

Ocu-Tropine solution, ophthalmic 1% Ocumed<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

ATROPINE SULFATE; DIPHENOXYLATE HYDROCHLORIDE<br />

Atropine Sulfate; liquid, oral 0.025mg/5ml;2.5mg/5ml Roxane<br />

Diphenoxylate Hydrochloride tablet, oral 0.025mg;2.5mg Able<br />

@ tablet, oral 0.025mg;2.5mg<br />

(Ascot)<br />

@ tablet, oral 0.025mg;2.5mg<br />

Barr<br />

tablet, oral 0.025mg;2.5mg<br />

Eon<br />

@ tablet, oral 0.025mg;2.5mg<br />

Hea<strong>the</strong>r<br />

@ tablet, oral 0.025mg;2.5mg<br />

ICN<br />

@ tablet, oral 0.025mg;2.5mg<br />

Inwood/Forest<br />

tablet, oral 0.025mg;2.5mg<br />

IVAX<br />

@ tablet, oral 0.025mg;2.5mg<br />

KV<br />

tablet, oral 0.025mg;2.5mg<br />

Lannett<br />

@ tablet, oral 0.025mg;2.5mg<br />

Lederle<br />

tablet, oral 0.025mg;2.5mg<br />

Mylan<br />

tablet, oral 0.025mg;2.5mg<br />

Par<br />

@ tablet, oral 0.025mg;2.5mg<br />

Parke-Davis<br />

@ tablet, oral 0.025mg;2.5mg<br />

R and S Pharma<br />

@ tablet, oral 0.025mg;2.5mg<br />

Private Formulations<br />

(continued)<br />

22


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ATROPINE SULFATE; DIPHENOXYLATE HYDROCHLORIDE<br />

@ tablet, oral 0.025mg;2.5mg<br />

Roxane<br />

@ tablet, oral 0.025mg;2.5mg<br />

USL<br />

@ tablet, oral 0.025mg;2.5mg<br />

Watson<br />

@ tablet, oral 0.025mg;2.5mg<br />

West-ward<br />

Brand(s)<br />

Colonaid @ liquid, oral 0.025mg/5ml;2.5mg/5ml Wallace<br />

Lomanate @ liquid, oral 0.025mg/5ml;2.5mg/5ml Alpharma<br />

Lomotil liquid, oral 0.025mg/5ml;2.5mg/5ml Searle<br />

Colonaid @ tablet, oral 0.025mg;2.5mg Wallace<br />

Di-Atro @ tablet, oral 0.025mg;2.5mg MD<br />

Lofene @ tablet, oral 0.025mg;2.5mg Lannett<br />

Logen @ tablet, oral 0.025mg;2.5mg Superpharm<br />

Lomotil tablet, oral 0.025mg;2.5mg Searle<br />

Lonox tablet, oral 0.025mg;2.5mg Geneva<br />

Lo-Trol @ tablet, oral 0.025mg;2.5mg (Vangard/MWM)<br />

Low-Quel @ tablet, oral 0.025mg;2.5mg Halsey<br />

ATROPINE SULFATE; HYOSCYAMINE; PHENOBARBITAL; SCOPOLAMINE HYDROBROMIDE<br />

Atropine Sulfate; Hyoscyamine; elixir, oral 0.0194mg/5ml; Alpharma<br />

Phenobarbital; 0.1037mg/5ml;16.2mg/5ml;<br />

Scopolamine Hydrobromide 0.0065mg/5ml<br />

elixir, oral 0.0194mg/5ml;<br />

Cenci<br />

0.1037mg/5ml;16.2mg/5ml;<br />

0.0065mg/5ml<br />

elixir, oral 0.0194mg/5ml;<br />

Halsey<br />

0.1037mg/5ml;16.2mg/5ml;<br />

0.0065mg/5ml<br />

elixir, oral 0.0194mg/5ml;<br />

Life<br />

0.1037mg/5ml;16.2mg/5ml;<br />

0.0065mg/5ml<br />

elixir, oral 0.0194mg/5ml;<br />

Naska<br />

0.1037mg/5ml;16.2mg/5ml;<br />

0.0065mg/5ml<br />

elixir, oral 0.0194mg/5ml;<br />

Pharmaceutical Associates<br />

0.1037mg/5ml;16.2mg/5ml;<br />

0.0065mg/5ml<br />

elixir, oral 0.0194mg/5ml;<br />

Purepac<br />

0.1037mg/5ml;16.2mg/5ml;<br />

0.0065mg/5ml<br />

Brand(s)<br />

Antispasmodic Elixir elixir, oral 0.0194mg/5ml; Morton Grove<br />

0.1037mg/5ml;16.2mg/5ml;<br />

0.0065mg/5ml<br />

Donnatal elixir, oral 0.0194mg/5ml; Robins<br />

0.1037mg/5ml;16.2mg/5ml;<br />

0.0065mg/5ml<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

ATROPINE SULFATE; MEPERIDINE HYDROCHLORIDE<br />

Atropine Sulfate; @ injection 0.4mg/ml;50mg/ml Wyeth-Ayerst<br />

Meperidine Hydrochloride @ injection 0.4mg/ml;75mg/ml Wyeth-Ayerst<br />

@ injection 0.4mg/ml;100mg/ml Wyeth-Ayerst<br />

Brand(s)<br />

Atropine & Demerol injection 0.4mg/ml;50mg/ml Abbott<br />

Atropine & Demerol injection 0.4mg/ml;75mg/ml Abbott<br />

Atropine & Demerol injection 0.4mg/ml;100mg/ml Abbott<br />

23


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

AZATHIOPRINE<br />

Azathioprine tablet, oral 50mg Applied Analytical Industries<br />

tablet, oral 50mg<br />

GenPharm<br />

tablet, oral 50mg<br />

Roxane<br />

Brand(s)<br />

Imuran tablet, oral 50mg Prome<strong>the</strong>us<br />

AZATHIOPRINE SODIUM<br />

Azathioprine Sodium injection eq 100mg base/vial Bed<strong>for</strong>d<br />

@ injection eq 100mg base/vial<br />

Quad<br />

Brand(s)<br />

Imuran injection eq 100mg base/vial Glaxo Wellcome<br />

AZELAIC ACID<br />

Brand(s)<br />

Azelex cream, topical 20% Allergan *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

BACITRACIN<br />

Bacitracin @ injection 50,000U/vial Pfizer<br />

injection 10,000, 50,000U/vial Pharmacia & Upjohn<br />

@ injection 10,000, 50,000U/vial Quad<br />

ointment, ophthalmic 500U/gm Altana<br />

@ ointment, ophthalmic 500U/gm Lilly<br />

@ ointment, ophthalmic 500U/gm Pharmaderm<br />

@ ointment, ophthalmic 500U/gm Pharmafair<br />

powder <strong>for</strong> compounding<br />

Apo<strong>the</strong>kernes<br />

5,000,000 U/bottle<br />

@ powder <strong>for</strong> compounding<br />

Paddock<br />

5,000,000 U/bottle<br />

Brand(s)<br />

Baciim injection 50,000U/vial Pharma-Tek<br />

Baciguent @ ointment, ophthalmic 500U/gm Pharmacia & Upjohn<br />

Baci-Rx powder <strong>for</strong> compounding Pharma Tek<br />

5,000,000 U/bottle<br />

BACITRACIN; HYDROCORTISONE ACETATE; NEOMYCIN SULFATE; POLYMYXIN B SULFATE<br />

Bacitracin; ointment, ophthalmic 400U/gm;1%; Altana<br />

Hydrocortisone Acetate; eq 3.5mg base/gm;10,000U/gm<br />

Neomycin Sulfate; ointment, ophthalmic 400U/gm;1%; Pharmaderm<br />

Polymyxin B Sulfate eq 3.5mg base/gm;10,000U/gm<br />

BACITRACIN ZINC; HYDROCORTISONE; NEOMYCIN SULFATE; POLYMYXIN B SULFATE<br />

Bacitracin Zinc; ointment, ophthalmic 400U/gm;1%; Bausch and Lomb<br />

Hydrocortisone; eq 3.5mg base/gm;10,000U/gm<br />

Neomycin Sulfate; @ ointment, topical 400U/gm;1%; Pharmafair<br />

Polymyxin B Sulfate eq 3.5mg base/gm;5,000U/gm<br />

Brand(s)<br />

Cortisporin ointment, ophthalmic 400U/gm; 1%; Glaxo Wellcome<br />

eq 3.5mg base/gm;10,000U/gm<br />

Ocutricin HC @ ointment, ophthalmic 400U/gm; 1%; Pharmafair<br />

eq 3.5mg base/gm;10,000U/gm<br />

Cortisporin ointment, topical 400U/gm;1%; Monarch<br />

eq 3.5mg base/gm;5,000U/gm<br />

24


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

BACITRACIN ZINC; NEOMYCIN SULFATE; POLYMYXIN B SULFATE<br />

Bacitracin Zinc; ointment, ophthalmic 400U/gm; Altana<br />

Neomycin Sulfate; eq 3.5mg base/gm;10,000U/gm<br />

Polymyxin B Sulfate ointment, ophthalmic 400U/gm; Bausch and Lomb<br />

eq 3.5mg base/gm;10,000U/gm<br />

Brand(s)<br />

Neosporin ointment, ophthalmic 400U/gm; Monarch<br />

eq 3.5mg base/gm;10,000U/gm<br />

Ocutricin @ ointment, ophthalmic 400U/gm; Pharmafair<br />

eq 3.5mg base/gm;10,000U/gm<br />

BACITRACIN ZINC; POLYMYXIN B SULFATE<br />

Bacitracin Zinc; ointment, ophthalmic 500U/gm; Akorn<br />

Polymyxin B Sulfate 10,000U/gm<br />

ointment, ophthalmic 500U/gm; Bausch and Lomb<br />

10,000U/gm<br />

Brand(s)<br />

Ocumycin @ ointment, ophthalmic 500U/gm; Pharmafair<br />

10,000U/gm<br />

Polysporin ointment, ophthalmic 500U/gm; Monarch<br />

10,000U/gm<br />

BACLOFEN<br />

Baclofen tablet, oral 10,20mg Danbury<br />

tablet, oral 10,20mg<br />

IVAX<br />

tablet, oral 10,20mg<br />

Royce<br />

tablet, oral 10,20mg<br />

Teva<br />

tablet, oral 10,20mg<br />

USL<br />

tablet, oral 10,20mg<br />

Watson<br />

Brand(s)<br />

Lioresal tablet, oral 10,20mg Novartis<br />

BENZATHINE PENICILLIN G<br />

See PENICILLIN G BENZATHINE<br />

BENZOCAINE; ANTIPYRINE<br />

See ANTIPYRINE; BENZOCAINE<br />

BENZONATATE<br />

Benzonatate capsule, oral 100mg Banner Pharmacaps<br />

Brand(s)<br />

Tessalon Perles capsule, oral 100mg Forest *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

BENZOYL PEROXIDE<br />

Benzoyl Peroxide gel, topical 5,10% Balan<br />

gel, topical 5,10%<br />

Bioline<br />

gel, topical 5,10%<br />

CMC<br />

gel, aqueous base 5,10%<br />

Pharmafair<br />

liquid 2.5,5,10%<br />

Stiefel<br />

(continued on <strong>the</strong> next page)<br />

BENZOYL PEROXIDE (continued)<br />

25


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

Brand(s)<br />

Persa-Gel gel, acetone base, topical 5,10% Ortho Derm<br />

Zeroxin -5,-10 gel, acetone base, topical 5,10% Syosset<br />

Benzac 5,10 gel, alcohol base, topical 5,10% Owen/Allercreme<br />

5-Benzagel gel, alcohol base, topical 5% Dermik<br />

10-Benzagel gel, alcohol base, topical 10% Dermik<br />

Panoxyl 5,10 gel, alcohol base, topical 5,10% Stiefel<br />

Ben Aqua 5,10 gel, aqueous base, topical 5,10% Syosset<br />

Benzac W 2.5,5,10 gel, aqueous base, topical 2.5,5,10% Owen/Allercreme<br />

Desquam X 2.5,5,10 gel, aqueous base, topical 2.5,5,10% Westwood<br />

Panoxyl Aq 2.5,5,10 gel, aqueous base, topical 2.5,5,10% Stiefel<br />

Persa-Gel W 5,10% gel, aqueous base, topical 5,10% Ortho Derm<br />

Benzac W Wash 5,10 liquid, topical 5,10% Owen/Allercreme<br />

Desquam X 5 Wash liquid, topical 5% Westwood<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

BENZTROPINE MESYLATE<br />

Benztropine Mesylate tablet, oral 0.5,1,2mg Geneva<br />

tablet, oral 1,2mg<br />

Mutual<br />

tablet, oral 0.5,1,2mg<br />

Par<br />

@ tablet, oral 0.5,1,2mg<br />

Quantum<br />

tablet, oral 0.5,1,2mg<br />

Sidmak<br />

tablet, oral 0.5,1,2mg<br />

USL<br />

Brand(s)<br />

Cogentin tablet, oral 0.5,1,2mg Merck Sharp and Dohme<br />

BEPRIDIL HYDROCHLORIDE<br />

Brand(s)<br />

Bepadin @ tablet, oral 200,300,400mg Wallace<br />

Vascor tablet, oral 200,300mg RW Johnson<br />

Vascor @ tablet, oral 400mg RW Johnson<br />

BETAMETHASONE DIPROPIONATE<br />

Betamethasone Dipropionate @ cream, topical eq 0.05% base Clay-Park<br />

cream, topical eq 0.05% base Fougera/Altana *<br />

cream, topical eq 0.05% base NMC<br />

@ cream, topical eq 0.05% base Pharmaderm<br />

cream, topical eq 0.05% base Taro<br />

cream, topical eq 0.05% base Teva<br />

cream, topical eq 0.05% base Thames<br />

lotion, topical eq 0.05% base Alpharma<br />

lotion, topical eq 0.05% base Clay-Park<br />

lotion, topical eq 0.05% base Copley<br />

lotion, topical eq 0.05% base Fougera/Altana *<br />

@ lotion, topical eq 0.05% base Pharmaderm<br />

lotion, topical eq 0.05% base Taro<br />

lotion, topical eq 0.05% base Teva<br />

lotion, topical eq 0.05% base Thames<br />

@ ointment, topical eq 0.05% base Clay-Park<br />

ointment, topical eq 0.05% base Fougera/Altana *<br />

ointment, topical eq 0.05% base NMC<br />

@ ointment, topical eq 0.05% base Pharmaderm<br />

ointment, topical eq 0.05% base Taro<br />

(continued on <strong>the</strong> next page)<br />

BETAMETHASONE DIPROPIONATE (continued)<br />

ointment, topical eq 0.05% base<br />

26<br />

Teva


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

Brand(s)<br />

Alphatrex cream, topical eq 0.05% base Savage/Altana<br />

Diprosone cream, topical eq 0.05% base Schering<br />

Alphatrex lotion, topical eq 0.05% base Savage/Altana<br />

Diprosone lotion, topical eq 0.05% base Schering<br />

Alphatrex ointment, topical eq 0.05% base Savage/Altana<br />

Diprosone ointment, topical eq 0.05% base Schering<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

BETAMETHASONE DIPROPIONATE, AUGMENTED<br />

Betamethasone Dipropionate, ointment, topical eq 0.05% base Altana<br />

Augmented ointment, topical eq 0.05% base NMC<br />

Brand(s)<br />

Diprolene AF ointment, topical eq 0.05% base Schering *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

BETAMETHASONE DIPROPIONATE; CLOTRIMAZOLE<br />

Betamethasone Dipropionate; cream, topical eq 0.05% base;1% Altana<br />

Clotrimazole cream, topical eq 0.05% base;1% Taro<br />

Brand(s)<br />

Lotrisone cream, topical eq 0.05% base; 1% Schering *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

BETAMETHASONE SODIUM PHOSPHATE<br />

Betamethasone Sodium Phosphate injection eq 3mg base/ml<br />

Steris<br />

Brand(s)<br />

Celestone injection eq 3mg base/ml Schering<br />

BETAMETHASONE VALERATE<br />

Betamethasone Valerate @ cream, topical eq 0.1% base Clay-Park<br />

cream, topical eq 0.1% base<br />

Fougera/Altana<br />

@ cream, topical eq 0.1% base<br />

Pharmaderm<br />

@ cream, topical eq 0.1% base<br />

Pharmafair<br />

cream, topical eq 0.1% base<br />

Thames<br />

lotion, topical eq 0.1% base<br />

Alpharma<br />

lotion, topical eq 0.1% base<br />

Copley<br />

lotion, topical eq 0.1% base<br />

Fougera/Altana<br />

@ lotion, topical eq 0.1% base<br />

Pharmaderm<br />

@ lotion, topical eq 0.1% base<br />

Pharmafair<br />

@ ointment, topical eq 0.1% base Clay-Park<br />

ointment, topical eq 0.1% base Fougera/Altana<br />

ointment, topical eq 0.1% base NMC<br />

@ ointment, topical eq 0.1% base Pharmaderm<br />

@ ointment, topical eq 0.1% base Pharmafair<br />

Brand(s)<br />

Beta-Val cream, topical eq 0.1% base Teva<br />

Betaderm cream, topical eq 0.1% base Roaco<br />

Betatrex cream, topical eq 0.1% base Savage/Altana<br />

Dermabet cream, topical eq 0.1% base Taro<br />

(continued on <strong>the</strong> next page)<br />

BETAMETHASONE VALERATE (continued)<br />

27


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

Valisone @ cream, topical eq 0.1% base Schering<br />

Valnac cream, topical eq 0.1% base NMC<br />

Beta-Val lotion, topical eq 0.1% base Teva<br />

Betatrex lotion, topical eq 0.1% base Savage/Altana<br />

Valisone @ lotion, topical eq 0.1% base Schering<br />

Beta-Val ointment, topical eq 0.1% base Teva<br />

Betatrex ointment, topical eq 0.1% base Savage/Altana<br />

Valisone @ ointment, topical eq 0.1% base Schering<br />

BETAXOLOL HYDROCHLORIDE<br />

Betaxolol Hydrochloride solution, ophthalmic eq 0.5% base Akorn<br />

solution, ophthalmic eq 0.5% base Novex<br />

tablet, oral 10,20mg<br />

Amide<br />

Brand(s)<br />

Betoptic solution, ophthalmic eq 0.5% base Alcon<br />

Kerlone tablet, oral 10,20mg Lorex<br />

BETHANECHOL CHLORIDE<br />

Bethanechol Chloride @ injection 5mg/ml Quad<br />

@ tablet, oral 10,25mg<br />

(Ascot)<br />

@ tablet, oral 5,10,25,50mg<br />

Circa<br />

@ tablet, oral 5,10,25,50mg<br />

Danbury<br />

@ tablet, oral 5,10,25mg<br />

Eon<br />

@ tablet, oral 25mg<br />

IVAX<br />

@ tablet, oral 5,10,25mg<br />

Lannett<br />

tablet, oral 5,10,25,50mg<br />

Odyssey<br />

@ tablet, oral 5,10,25mg<br />

Watson<br />

Brand(s)<br />

Urecholine @ injection 5mg/ml Sidmak<br />

Duvoid @ tablet, oral 5,10,25,50mg Wellspring<br />

Myotonachol @ tablet, oral 5,10,25,50mg Glenwood<br />

Urecholine @ tablet, oral 5,10,25,50mg Sidmak<br />

BIOTIN; ASCORBIC ACID; CYANOCOBALAMIN; DEXPANTHENOL; ERGOCALCIFEROL; FOLIC ACID;<br />

NIACINAMIDE; PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN PHOSPHATE SODIUM; THIAMINE<br />

HYDROCHLORIDE; VITAMIN A; VITAMIN E<br />

See ASCORBIC ACID; BIOTIN; CYANOCOBALAMIN; DEXPANTHENOL; ERGOCALCIFEROL; FOLIC<br />

ACID; NIACINAMIDE; PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN PHOSPHATE SODIUM<br />

HYDROCHLORIDE; VITAMIN A; VITAMIN E<br />

BISOPROLOL FUMARATE<br />

Bisoprolol Fumarate tablet, oral 5,10mg Copley<br />

tablet, oral 5,10mg<br />

Eon<br />

tablet, oral 5,10mg<br />

Mylan<br />

Brand(s)<br />

Zebeta tablet, oral 5,10mg ESI Lederle *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

BISOPROLOL FUMARATE; HYDROCHLOROTHIAZIDE<br />

Bisoprolol Fumarate; @ tablet, oral 2.5,5,10mg;6.25mg Apo<strong>the</strong>con<br />

28


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

Hydrochlorothiazide tablet, oral 2.5,5,10mg;6.25mg Eon<br />

tablet, oral 2.5,5,10mg;6.25mg Geneva<br />

tablet, oral 2.5,5,10mg;6.25mg IVAX<br />

tablet, oral 2.5,5,10mg;6.25mg Mylan<br />

tablet, oral 2.5,5,10mg;6.25mg Purepac<br />

tablet, oral 2.5,5,10mg;6.25mg Teva<br />

tablet, oral 2.5,5,10mg;6.25mg Watson<br />

Brand(s)<br />

Ziac tablet, oral 2.5,5,10mg;6.25mg ESI Lederle *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

BLEOMYCIN SULFATE<br />

Bleomycin Sulfate injection eq 15,30U base/vial Faulding<br />

injection eq 15,30U base/vial Gensia-Sicor<br />

injection eq 15,30U base/vial Pharmacia & Upjohn<br />

Brand(s)<br />

Blenoxane injection eq 15,30U base/vial Bristol-Myers Squibb<br />

BRETYLIUM TOSYLATE<br />

Bretylium Tosylate injection 50mg/ml Abbott<br />

@ injection 50mg/ml<br />

American Pharmaceutical<br />

Partners<br />

@ injection 50mg/ml<br />

AstraZeneca<br />

injection 50mg/ml<br />

Elkins-Sinn<br />

injection 50mg/ml<br />

International Medication<br />

injection 50mg/ml<br />

Luitpold<br />

@ injection 50mg/ml<br />

Quad<br />

Brand(s)<br />

Bretylol @ injection 50mg/ml Faulding<br />

BRETYLIUM TOSYLATE; DEXTROSE<br />

Bretylium Tosylate; Dextrose injection 200mg/100ml;5gm/100ml Abbott<br />

injection 400mg/100ml;5gm/100ml Abbott<br />

@ injection 200mg/100ml;5gm/100ml Baxter<br />

@ injection 400mg/100ml;5gm/100ml Baxter<br />

injection 200mg/100ml;5gm/100ml Braun<br />

injection 400mg/100ml;5gm/100ml Braun<br />

BROMOCRIPTINE MESYLATE<br />

Bromocriptine Mesylate capsule, oral eq 5mg base Lek<br />

tablet, oral eq 2mg base<br />

Lek<br />

Brand(s)<br />

Parlodel capsule, oral eq 5mg base Novartis *<br />

Parlodel tablet, oral eq 2.5mg base Novartis *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

BROMODIPHENHYDRAMINE HYDROCHLORIDE; CODEINE PHOSPHATE<br />

Brand(s)<br />

29


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

Ambenyl syrup, oral 12.5mg/5ml;10mg/5ml Forest<br />

Bromanyl syrup, oral 12.5mg/5ml;10mg/5ml Alpharma<br />

Mybanil syrup, oral 12.5mg/5ml;10mg/5ml Morton Grove<br />

BROMPHENIRAMINE MALEATE<br />

Brompheniramine Maleate @ elixir, oral 2mg/5ml Alpharma<br />

elixir 2mg/5ml<br />

KV<br />

@ elixir 2mg/5ml<br />

Pharmaceutical Associates<br />

@ elixir 2mg/5ml<br />

USL<br />

injection 10mg/ml<br />

Steris<br />

@ tablet, oral 4mg<br />

Anabolic<br />

@ tablet, oral 4mg<br />

Barr<br />

@ tablet, oral 4mg<br />

Danbury<br />

@ tablet, oral 4mg<br />

Eon<br />

@ tablet, oral 4mg<br />

Geneva<br />

@ tablet, oral 4mg<br />

IVAX<br />

@ tablet, oral 4mg<br />

Newtron<br />

tablet, oral 4mg<br />

Nylos<br />

@ tablet, oral 4mg<br />

Par<br />

tablet, oral 4mg<br />

Phoenix<br />

@ tablet, oral 4mg<br />

Pioneer<br />

tablet, oral 4mg<br />

Private Formulations<br />

@ tablet, oral 4mg<br />

Watson<br />

Brand(s)<br />

Dimetane-Ten @ injection 10mg/ml Robins<br />

Dimetane @ tablet, oral 4mg Whitehall Robins<br />

Veltane tablet, oral 4mg Lannett<br />

BROMPHENIRAMINE MALEATE; CODEINE PHOSPHATE; PHENYLPROPANOLAMINE HYDROCHLORIDE<br />

Brand(s)<br />

Bromanate DC syrup, oral 2mg/5ml;10mg/5ml; Alpharma<br />

12.5mg/5ml<br />

Dimetane-DC @ syrup, oral 2mg/5ml;10mg/5ml; Robins<br />

12.5mg/5ml<br />

Myphetane DC syrup, oral 2mg/5ml;10mg/5ml; Morton Grove<br />

12.5mg/5ml<br />

BROMPHENIRAMINE MALEATE; DEXTROMETHORPHAN HYDROBROMIDE; PSEUDOEPHEDRINE<br />

HYDROCHLORIDE<br />

Brand(s)<br />

Bromanate DM syrup, oral 2mg/5ml;10mg/5ml; Alpharma<br />

30mg/5ml<br />

Bromfed-DM syrup, oral 2mg/5ml;10mg/5ml; Muro<br />

30mg/5ml<br />

Dimetane-DX syrup, oral 2mg/5ml;10mg/5ml; Robins<br />

30mg/5ml<br />

Myphetane DX syrup, oral 2mg/5ml;10mg/5ml; Morton Grove<br />

30mg/5ml<br />

BROMPHENIRAMINE MALEATE; PHENYLPROPANOLAMINE HYDROCHLORIDE<br />

Brand(s)<br />

Biphetapp @ elixir, oral 4mg/5ml;25mg/5ml Morton Grove<br />

Bromanate @ elixir, oral 4mg/5ml;25mg/5ml Alpharma<br />

BUMETANIDE<br />

Bumetanide injection 0.25mg/ml Abbott<br />

30


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

injection 0.25mg/ml<br />

Bed<strong>for</strong>d<br />

injection 0.25mg/ml<br />

Gensia Sicor<br />

tablet, oral 0.5,1,2mg<br />

Eon<br />

tablet, oral 0.5,1,2mg<br />

IVAX<br />

Brand(s)<br />

Bumex injection 0.25mg/ml Roche<br />

Bumex tablet, oral 0.5,1,2mg Roche *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

BUPIVACAINE HYDROCHLORIDE<br />

Bupivacaine Hydrochloride injection 0.25,0.5,0.75% Abbott<br />

injection, spinal 0.75%<br />

Abbott<br />

Brand(s)<br />

Marcaine HCl injection 0.25,0.5% Sanofi Syn<strong>the</strong>labo<br />

Marcaine HCl Preservative Free injection 0.25,0.5,0.75% Sanofi Syn<strong>the</strong>labo<br />

Sensorcaine injection 0.25,0.5,0.75% Astra Zeneca<br />

Marcaine injection, spinal 0.75% Sterling Winthrop<br />

Sensorcaine injection, spinal 0.75% Astra Zeneca<br />

BUPIVACAINE HYDROCHLORIDE; EPINEPHRINE BITARTRATE<br />

Brand(s)<br />

Marcaine HCl with Epinephrine injection 0.25%;0.0091mg/ml Sanofi Syn<strong>the</strong>labo<br />

Marcaine HCl with Epinephrine injection 0.5%;0.0091mg/ml Sanofi Syn<strong>the</strong>labo<br />

Marcaine HCl with Epinephrine injection 0.25%;0.0091mg/ml Sanofi Syn<strong>the</strong>labo<br />

Preservative Free<br />

Marcaine HCl with Epinephrine injection 0.5%;0.0091mg/ml Sanofi Syn<strong>the</strong>labo<br />

Preservative Free<br />

Marcaine HCl with Epinephrine injection 0.75%;0.0091mg/ml Sanofi Syn<strong>the</strong>labo<br />

Preservative Free<br />

Sensorcaine injection 0.25%;0.0091mg/ml Astra Zeneca<br />

Sensorcaine injection 0.5%;0.0091mg/ml Astra Zeneca<br />

Sensorcaine injection 0.75%;0.0091mg/ml Astra Zeneca<br />

BUPRENORPHINE HYDROCHLORIDE<br />

Buprenorphine Hydrochloride injection eq 0.3mg base/ml Abbott<br />

Brand(s)<br />

Buprenex injection eq 0.3mg base/ml Reckitt Benckiser<br />

BUPROPION HYDROCHLORIDE<br />

Bupropion Hydrochloride tablet, oral 75,100mg Eon<br />

tablet, oral 75,100mg<br />

ESI Lederle<br />

tablet, oral 75,100mg<br />

Invamed<br />

tablet, oral 75,100mg<br />

Mylan<br />

tablet, oral 75,100mg<br />

Teva<br />

Brand(s)<br />

Wellbutrin tablet, oral 75,100mg Glaxo Wellcome<br />

BUSPIRONE<br />

Buspirone tablet, oral 5,10,15mg Geneva<br />

tablet, oral 5,10,15mg<br />

IVAX<br />

tablet, oral 5,10,15mg<br />

KV<br />

(continued on <strong>the</strong> next page)<br />

BUSPIRONE (continued)<br />

tablet, oral 5,10,15,30mg<br />

Mylan<br />

31


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

tablet, oral 5,10,15mg<br />

Par<br />

tablet, oral 5,10,15mg<br />

Teva<br />

tablet, oral 5,10,15mg<br />

Watson<br />

tablet, oral 5,10,15mg<br />

TorPharm<br />

Brand(s)<br />

Buspar tablet, oral 5,10,15,30mg Bristol-Myers Squibb<br />

Vanspar tablet, oral 7.5mg Par *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

BUTABARBITAL SODIUM<br />

Butabarbital Sodium @ elixir, oral 30mg/5ml Morton Grove<br />

tablet, oral 30mg<br />

Bundy<br />

@ tablet, oral 15,30mg<br />

Eon<br />

@ tablet, oral 15,30mg<br />

Geneva<br />

@ tablet, oral 15,30mg<br />

IVAX<br />

@ tablet, oral 15,30,100mg<br />

Lannett<br />

tablet, oral 16.2,32.4mg<br />

Marshall<br />

@ tablet, oral 16.2,32.4mg<br />

Solvay<br />

@ tablet, oral 15,30mg<br />

Teva<br />

@ tablet, oral 15,30mg<br />

Watson<br />

@ tablet, oral 15,30mg<br />

West-ward<br />

@ tablet, oral 15,30mg<br />

Whiteworth Towne<br />

Brand(s)<br />

Butabarb @ elixir, oral 30mg/5ml Alpharma<br />

Butisol Sodium elixir, oral 30mg/5ml Wallace<br />

Sarisol @ elixir, oral 30mg/5ml Halsey<br />

Butisol Sodium tablet, oral 15,30,100mg Wallace<br />

Sarisol No. 1, No. 2 @ tablet, oral 15,30mg Halsey<br />

BUTALBITAL; ACETAMINOPHEN<br />

See ACETAMINOPHEN; BUTALBITAL<br />

BUTALBITAL; ACETAMINOPHEN; CAFFEINE<br />

See ACETAMINOPHEN; BUTALBITAL; CAFFEINE<br />

BUTALBITAL; ASPIRIN; CAFFEINE<br />

See ASPIRIN; BUTALBITAL; CAFFEINE<br />

BUTORPHANOL TARTRATE<br />

Butorphanol Tartrate injection 1,2mg/ml Abbott<br />

injection 1,2mg/ml<br />

Apotex<br />

injection 1,2mg/ml<br />

Bed<strong>for</strong>d<br />

injection 1,2mg/ml<br />

Faulding<br />

spray, metered, nasal 1mg/spray Lederle/Mylan<br />

spray, metered, nasal 1mg/spray Roxane<br />

Brand(s)<br />

Butorphanol Tartrate injection 1,2mg/ml Apotex<br />

Preservative-Free<br />

Butorphanol Tartrate injection 1,2mg/ml Bed<strong>for</strong>d<br />

Preservative-Free<br />

(continued on <strong>the</strong> next page)<br />

BUTORPHANOL TARTRATE (continued)<br />

Butorphanol Tartrate injection 1,2mg/ml Meridian<br />

32


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

Preservative-Free<br />

Stadol injection 1,2mg/ml Apo<strong>the</strong>con<br />

Stadol Preservative Free injection 1,2mg/ml Apo<strong>the</strong>con<br />

Stadol NS spray, metered, nasal 1mg/spray Bristol-Myers Squibb<br />

CAFFEINE; ACETAMINOPHEN; BUTALBITAL<br />

See ACETAMINOPHEN; BUTALBITAL; CAFFEINE<br />

CAFFEINE; ASPIRIN; BUTALBITAL<br />

See ASPIRIN; BUTALBITAL; CAFFEINE<br />

CAFFEINE; ASPIRIN; ORPHENADRINE CITRATE<br />

See ASPIRIN: CAFFEINE: ORPHENADRINE CITRATE<br />

CAFFEINE; ASPIRIN; PROPOXYPHENE HYDROCHLORIDE;<br />

See ASPIRIN; CAFFEINE; PROPOXYPHENE HYDROCHLORIDE<br />

CAFFEINE; ERGOTAMINE TARTRATE<br />

Brand(s)<br />

Cafergot @ tablet, oral 100mg;1mg Novartis<br />

Ercatab tablet, oral 100mg;1mg Geneva<br />

Wigraine tablet, oral 100mg;1mg Organon/Akzona<br />

CALCITONIN, SALMON<br />

Calcitonin-Salmon @ injection 200IU/ml Astra Zeneca<br />

Brand(s)<br />

Calcimar injection 200IU/ml Aventis *<br />

Miacalcin injection 200IU/ml Novartis<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

CALCITRIOL<br />

Calcitriol capsule, oral 0.25,0.5mcg Teva<br />

Brand(s)<br />

Rocaltrol capsule, oral 0.25,0.5mcg Roche<br />

CALCIUM CHLORIDE; DEXTROSE; GLUTATHIONE DISULFIDE; MAGNESIUM CHLORIDE; POTASSIUM<br />

CHLORIDE; SODIUM BICARBONATE; SODIUM CHLORIDE; SODIUM PHOSPHATE<br />

Brand(s)<br />

BSS Plus solution, irrigation 0.154mg/ml; Alcon<br />

0.92mg/ml;0.184mg/ml;<br />

0.2mg/ml;0.38mg/ml;2.1mg/ml;<br />

7.14mg/ml;0.42mg/ml<br />

Endosol Extra solution, irrigation 0.154mg/ml; Akorn<br />

0.92mg/ml;0.184mg/ml;<br />

0.2mg/ml;0.38mg/ml;2.1mg/ml;<br />

7.14mg/ml;0.42mg/ml<br />

CALCIUM CHLORIDE; DEXTROSE; MAGNESIUM CHLORIDE; SODIUM CHLORIDE; SODIUM LACTATE<br />

Solution; intraperitoneal; in plastic container<br />

33


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

Brand(s)<br />

Delflex with Dextrose 1.5% solution 25.7mg/100ml; Fresenius<br />

(low magnesium) 1.5gm/100ml;5.08mg/100ml;<br />

538mg/100ml;448mg/100ml<br />

Delflex with Dextrose 2.5% solution 25.7mg/100ml; Fresenius<br />

(low magnesium) 2.5gm/100ml;5.08mg/100ml;<br />

538mg/100ml;448mg/100ml<br />

Delflex with Dextrose 3.5% solution 25.7mg/100ml; Fresenius<br />

(low magnesium) 3.5gm/100ml;5.08mg/100ml;<br />

538mg/100ml;448mg/100ml<br />

Delflex with Dextrose 4.25% solution 25.7mg/100ml; Fresenius<br />

(low magnesium) 4.25gm/100ml;5.08mg/100ml;<br />

538mg/100ml;448mg/100ml<br />

Delflex with Dextrose 1.5% solution, 18.4mg/100ml; Fresenius<br />

Low Magnesium 1.5gm/100ml; 5.08mg/100ml;<br />

Low Calcium 538mg/100ml; 448mg/100ml<br />

Delflex with Dextrose 2.5% solution, 18.4mg/100ml; Fresenius<br />

Low Magnesium 2.5gm/100ml; 5.08mg/100ml;<br />

Low Calcium 538mg/100ml; 448mg/100ml<br />

Delflex with Dextrose 4.25% solution, 18.4mg/100ml; Fresenius<br />

Low Magnesium 4.25gm/100ml; 5.08mg/100ml;<br />

Low Calcium 538mg/100ml; 448mg/100ml<br />

Delflex with Dextrose 1.5% solution 25.7mg/100ml; Fresenius<br />

1.5gm/100ml;15.2mg/100ml;<br />

567mg/100ml;392mg/100ml<br />

Delflex with Dextrose 2.5% solution 25.7mg/100ml; Fresenius<br />

2.5gm/100ml;15.2mg/100ml;<br />

567mg/100ml;392mg/100ml<br />

Delflex with Dextrose 3.5% solution 25.7mg/100ml; Fresenius<br />

3.5gm/100ml;15.2mg/100ml;<br />

567mg/100ml;392mg/100ml<br />

Delflex with Dextrose 4.25% solution 25.7mg/100ml; Fresenius<br />

4.25gm/100ml;15.2mg/100ml;<br />

567mg/100ml;392mg/100ml<br />

Dianeal PD-1 solution 25.7mg/100ml; Baxter<br />

with Dextrose 1.5% 1.5gm/100ml;15.2mg/100ml;<br />

567mg/100ml;392mg/100ml<br />

Dianeal PD-1 solution 25.7mg/100ml; Baxter<br />

with Dextrose 2.5% 2.5gm/100ml;15.2mg/100ml;<br />

567mg/100ml;392mg/100ml<br />

Dianeal PD-1 solution 25.7mg/100ml;3.5gm/ Baxter<br />

with Dextrose 3.5% 100ml;15.2mg/100ml;<br />

567mg/100ml;392mg/100ml<br />

Dianeal PD-1 solution 25.7mg/100ml; Baxter<br />

with Dextrose 4.25% 4.25gm/100ml;15.2mg/100ml;<br />

567mg/100ml;392mg/100ml<br />

Dianeal PD-2 solution 25.7mg/100ml; Baxter<br />

with Dextrose 1.5% 1.5gm/100ml;5.08mg/100ml;<br />

538mg/100ml;448mg/100ml<br />

Dianeal PD-2 solution, 18.3mg/100ml; Baxter<br />

with Dextrose 1.5% 1.5gm/100ml; 5.08mg/100ml;<br />

Low Calcium 538mg/100ml; 448mg/100ml<br />

Dianeal PD-2 solution 25.7mg/100ml; Baxter<br />

with Dextrose 2.5% 2.5gm/100ml;5.08mg/100ml;<br />

538mg/100ml;448mg/100ml<br />

Dianeal PD-2 solution 25.7mg/100ml; Baxter<br />

with Dextrose 3.5% 3.5gm/100ml;5.08mg/100ml;<br />

538mg/100ml;448mg/100ml<br />

(continued on <strong>the</strong> next page)<br />

CALCIUM CHLORIDE; DEXTROSE; MAGNESIUM CHLORIDE; SODIUM CHLORIDE; SODIUM LACTATE<br />

(continued)<br />

34


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

Dianeal PD-2 solution 25.7mg/100ml; Baxter<br />

with Dextrose 4.25% 4.25gm/100ml;5.08mg/100ml;<br />

538mg/100ml;448mg/100ml<br />

Dianeal 137 solution 25.7mg/100ml; Baxter<br />

with Dextrose 1.5% 1.5gm/100ml;15.2mg/100ml;<br />

567mg/100ml;392mg/100ml<br />

Dianeal 137 solution 25.7mg/100ml; Baxter<br />

with Dextrose 2.5% 2.5gm/100ml;15.2mg/100ml;<br />

567mg/100ml;392mg/100ml<br />

Dianeal 137 solution 25.7mg/100ml; Baxter<br />

with Dextrose 4.25% 4.25gm/100ml;15.2mg/100ml;<br />

567mg/100ml;392mg/100ml<br />

Dianeal Low Calcium solution, 18.3mg/100ml; Baxter<br />

with Dextrose 1.5% 1.5gm/100ml; 5.08mg/100ml;<br />

538mg/100ml; 448mg/100ml<br />

Dianeal Low Calcium solution, 18.3mg/100ml; Baxter<br />

with Dextrose 2.5% 2.5gm/100ml; 5.08mg/100ml;<br />

538mg/100ml; 448mg/100ml<br />

Dianeal Low Calcium solution, 18.3mg/100ml; Baxter<br />

with Dextrose 3.5% 3.5gm/100ml; 5.08mg/100ml;<br />

538mg/100ml; 448mg/100ml<br />

Dianeal Low Calcium solution, 18.3mg/100ml; Baxter<br />

with Dextrose 4.25% 4.25gm/100ml; 5.08mg/100ml;<br />

538mg/100ml; 448mg/100ml<br />

Inpersol-LC/LM solution, 18.4mg/100ml; Fresenius<br />

with Dextrose 1.5% 1.5gm/100ml; 5.08mg/100ml;<br />

538mg/100ml; 448mg/100ml<br />

Inpersol-LC/LM solution, 18.4mg/100ml; Fresenius<br />

with Dextrose 2.5% 2.5gm/100ml; 5.08mg/100ml;<br />

538mg/100ml; 448mg/100ml<br />

Inpersol-LC/LM solution, 18.4mg/100ml; Fresenius<br />

with Dextrose 3.5% 3.5gm/100ml; 5.08mg/100ml;<br />

538mg/100ml; 448mg/100ml<br />

Inpersol-LC/LM solution, 18.4mg/100ml; Fresenius<br />

with Dextrose 4.25% 4.25gm/100ml; 5.08mg/100ml;<br />

538mg/100ml; 448mg/100ml<br />

CALCIUM CHLORIDE; DEXTROSE; POTASSIUM CHLORIDE; SODIUM CHLORIDE<br />

Injection; in plastic container<br />

Dextrose 5% in Ringer's injection 33mg/100ml;5gm/100ml; Abbott<br />

30mg/100mg;860mg/100ml<br />

Dextrose 5% in Ringer's injection 33mg/100ml;5gm/100ml; Baxter<br />

30mg/100mg;860mg/100ml<br />

Dextrose 5% in Ringer's injection 33mg/100ml;5gm/100ml; Braun<br />

30mg/100mg;860mg/100ml<br />

CALCIUM CHLORIDE; DEXTROSE; POTASSIUM CHLORIDE; SODIUM CHLORIDE; SODIUM LACTATE<br />

Injection; in plastic container<br />

Dextrose 5% in injection 20mg/100ml;5gm/100ml; Abbott<br />

Lactated Ringer's 30mg/100ml;600mg/100ml;<br />

310mg/100ml<br />

Dextrose 5% in injection 20mg/100ml;5gm/100ml; Baxter<br />

Lactated Ringer's 30mg/100ml;600mg/100ml;<br />

310mg/100ml<br />

(continued on <strong>the</strong> next page)<br />

CALCIUM CHLORIDE; DEXTROSE; POTASSIUM CHLORIDE; SODIUM CHLORIDE; SODIUM LACTATE<br />

(continued)<br />

35


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

Dextrose 5% in injection 20mg/100ml;5gm/100ml; Braun<br />

Lactated Ringer's 30mg/100ml;600mg/100ml;<br />

310mg/100ml<br />

Dextrose 5% in @ injection 20mg/100ml;5gm/100ml; Miles<br />

Lactated Ringer's 30mg/100ml;600mg/100ml;<br />

310mg/100ml<br />

Dextrose 5% in @ injection 20mg/100ml;5gm/100ml; Abbott<br />

Lactated Ringer's 104mg/100ml;600mg/100ml;<br />

with 10mEq KCl 310mg/100ml<br />

Dextrose 5% in injection 20mg/100ml;5gm/100ml; Baxter<br />

Lactated Ringer's 105mg/100ml;600mg/100ml;<br />

with 10mEq KCl 310mg/100ml<br />

Dextrose 5% in injection 20mg/100ml;5gm/100ml; Abbott<br />

Lactated Ringer's 179mg/100ml;600mg/100ml;<br />

with 20mEq KCl 310mg/ml<br />

Dextrose 5% in injection 20mg/100ml;5gm/100ml; Baxter<br />

Lactated Ringer's 179mg/100ml;600mg/100ml;<br />

with 20mEq KCl 310mg/ml<br />

Dextrose 5% in @ injection 20mg/100ml;5gm/100ml; Abbott<br />

Lactated Ringer's 254mg/100ml;600mg/100ml;<br />

with 30mEq KCl 310mg/100ml<br />

Dextrose 5% in injection 20mg/100ml;5gm/100ml; Baxter<br />

Lactated Ringer's 254mg/100ml;600mg/100ml;<br />

with 30mEq KCl 310mg/100ml<br />

Dextrose 5% in injection 20mg/100ml;5gm/100ml; Abbott<br />

Lactated Ringer's 328mg/100ml;600mg/100ml;<br />

with 40mEq KCl 310mg/100ml<br />

Dextrose 5% in injection 20mg/100ml;5gm/100ml; Baxter<br />

Lactated Ringer's 328mg/100ml;600mg/100ml;<br />

with 40mEq KCl 310mg/100ml<br />

CALCIUM CHLORIDE; MAGNESIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM CHLORIDE<br />

Brand(s)<br />

Cardioplegic in plastic container solution, perfusion, cardiac<br />

Baxter<br />

17.6mg/100ml; 325.3mg/100mg;<br />

119.3mg/100ml; 643mg/100ml<br />

Plegisol in plastic container solution, perfusion, cardiac Abbott<br />

17.6mg/100ml; 325.3mg/100mg;<br />

119.3mg/100ml; 643mg/100ml<br />

CALCIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM CHLORIDE<br />

Injection; in plastic container<br />

Solution <strong>for</strong> irrigation; in plastic container<br />

Ringer's injection 33mg/100ml;30mg/100ml; Abbott<br />

860mg/100ml<br />

Ringer's injection 33mg/100ml;30mg/100ml; Baxter<br />

860mg/100ml<br />

Ringer's injection 33mg/100ml;30mg/100ml; Braun<br />

860mg/100ml<br />

Ringer's solution <strong>for</strong> irrigation 33mg/100ml; Abbott<br />

30mg/100ml; 860mg/100ml<br />

Ringer's solution <strong>for</strong> irrigation 33mg/100ml; Baxter<br />

30mg/100ml; 860mg/100ml<br />

Ringer's solution <strong>for</strong> irrigation 33mg/100ml; Braun<br />

30mg/100ml; 860mg/100ml<br />

CALCIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM CHLORIDE; SODIUM LACTATE<br />

Injection; in plastic container<br />

36


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

Solution <strong>for</strong> irrigation; in plastic container<br />

Lactated Ringer's injection 20mg/100ml;30mg/100ml; Abbott<br />

600mg/100ml;310mg/100ml<br />

Lactated Ringer's injection 20mg/100ml;30mg/100ml; Baxter<br />

600mg/100ml;310mg/100ml<br />

Lactated Ringer's injection 20mg/100ml;30mg/100ml; Braun<br />

600mg/100ml;310mg/100ml<br />

Lactated Ringer's @ injection 20mg/100ml;30mg/100ml; Miles<br />

600mg/100ml;310mg/100ml<br />

Lactated Ringer's solution 20mg/100ml;30mg/100ml; Abbott<br />

600mg/100ml;310mg/100ml<br />

Lactated Ringer's solution 20mg/100ml;30mg/100ml; Baxter<br />

600mg/100ml;310mg/100ml<br />

Lactated Ringer's solution 20mg/100ml;30mg/100ml; Braun<br />

600mg/100ml;310mg/100ml<br />

CALCIUM GLUBIONATE<br />

Brand(s)<br />

Calciquid solution, oral 1.8gm/5ml Econolab<br />

Neo-Calglucon solution, oral 1.8gm/5ml Novartis<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

CALCIUM GLUCEPTATE<br />

Calcium Gluceptate @ injection 0.09gm/5ml Abbott<br />

(eq 90mg calcium)<br />

@ injection 0.09gm/5ml<br />

American Pharmaceutical<br />

(eq 90mg calcium) Partners<br />

@ injection 0.09gm/5ml<br />

Lilly<br />

(eq 90mg calcium)<br />

CALCIUM GLUCONATE<br />

Calcium Gluconate injection 100mg/ml Astra Zeneca<br />

injection 100mg/ml<br />

American Pharmaceutical<br />

Partners<br />

injection 100mg/ml<br />

Elkins-Sinn<br />

injection 100mg/ml<br />

Pharmacia & Upjohn<br />

injection 100mg/ml<br />

Warner Chilcott<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Section 790.60.<br />

CAPTOPRIL<br />

Captopril tablet, oral 12.5,25,50,100mg Apo<strong>the</strong>con<br />

tablet, oral 12.5,25,50,100mg Copley<br />

tablet, oral 12.5,25,50,100mg Danbury<br />

tablet, oral 12.5,25,50,100mg Egis<br />

tablet, oral 12.5,25,50,100mg Endo<br />

tablet, oral 12.5,25,50,100mg Eon<br />

tablet, oral 12.5,25,50,100mg Geneva<br />

tablet, oral 12.5,25,50,100mg Hallmark<br />

tablet, oral 12.5,25,50,100mg IVAX<br />

tablet, oral 12.5,25,50,100mg Mova<br />

(continued on <strong>the</strong> next page)<br />

CAPTOPRIL (continued)<br />

tablet, oral 12.5,25,50,100mg Mylan<br />

37


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

tablet, oral 12.5,25,50,100mg Par<br />

tablet, oral 12.5,25,50,100mg Purepac<br />

tablet, oral 12.5,25,50,100mg Royce<br />

tablet, oral 12.5,25,50,100mg Stason<br />

tablet, oral 12.5,25,50,100mg Teva<br />

tablet, oral 12.5,25,50,100mg TorPharm<br />

tablet, oral 12.5,25,50,100mg Watson<br />

tablet, oral 12.5,25,50,100mg West-ward<br />

tablet, oral 12.5,25,50,100mg Wockhardt<br />

Brand(s)<br />

Capoten tablet, oral 12.5,25,50,100mg Bristol-Myers Squibb<br />

CAPTOPRIL; HYDROCHLOROTHIAZIDE<br />

Captopril; Hydrochlorothiazide @ tablet, oral 50mg;25mg Danbury<br />

tablet, oral 25mg;15mg, 25mg;25mg, Endo<br />

50mg;15mg, 50mg;25mg<br />

tablet, oral 25mg;15mg, 25mg;25mg, IVAX<br />

50mg;15mg, 50mg;25mg<br />

tablet, oral 25mg;15mg, 25mg;25mg, Mylan<br />

50mg;15mg, 50mg;25mg<br />

tablet, oral 25mg;15mg, 25mg;25mg, Teva<br />

50mg;15mg, 50mg;25mg<br />

Brand(s)<br />

Capozide tablet, oral 25mg;15mg, 25mg;25mg, Bristol-Myers Squibb<br />

50mg;15mg, 50mg;25mg<br />

CARBACHOL<br />

Carbachol @ solution, intraocular 0.01% Pharmafair<br />

Brand(s)<br />

Carbastat solution, intraocular 0.01% Novartis<br />

Miostat solution, intraocular 0.01% Alcon<br />

CARBAMAZEPINE<br />

Carbamazepine suspension, oral 100mg/5ml Taro<br />

tablet, chewable 100mg<br />

Caraco<br />

tablet, chewable 100mg<br />

Taro<br />

tablet, chewable 100mg<br />

Warner Chilcott<br />

tablet, oral 200mg<br />

Apotex<br />

tablet, oral 200mg<br />

Inwood/Forest<br />

tablet, oral 200mg<br />

Purepac<br />

tablet, oral 200mg<br />

Sidmak<br />

tablet, oral 200mg<br />

Taro<br />

@ tablet, oral 200mg<br />

USL<br />

@ tablet, oral 200mg<br />

Warner Chilcott<br />

Brand(s)<br />

Tegretol suspension, oral 100mg/5ml Novartis<br />

Epitol tablet, chewable 100mg Teva<br />

Tegretol tablet, chewable 100mg Novartis<br />

Epitol tablet, oral 200mg Teva<br />

Tegretol tablet, oral 200mg Novartis<br />

CARBENICILLIN, DISODIUM<br />

Brand(s)<br />

Geopen @ injection eq 1,2 5,10gm base/vial Roerig-Pfizer<br />

Pyopen @ injection eq 1,2,5,10gm base/vial SmithKline Beecham<br />

CARBIDOPA; LEVODOPA<br />

Carbidopa; Levodopa tablet, oral 10mg;100mg Geneva<br />

38


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

tablet, oral 25mg;100mg<br />

Geneva<br />

tablet, oral 25mg;250mg<br />

Geneva<br />

tablet, oral 10mg;100mg<br />

Purepac<br />

tablet, oral 25mg;100mg<br />

Purepac<br />

tablet, oral 25mg;250mg<br />

Purepac<br />

@ tablet, oral 10mg;100mg<br />

SCS<br />

@ tablet, oral 25mg;100mg<br />

SCS<br />

@ tablet, oral 25mg;250mg<br />

SCS<br />

tablet, oral 10mg;100mg<br />

Teva<br />

tablet, oral 25mg;100mg<br />

Teva<br />

tablet, oral 25mg;250mg<br />

Teva<br />

@ tablet, oral 10mg;100mg<br />

Watson<br />

@ tablet, oral 25mg;100mg<br />

Watson<br />

@ tablet, oral 25mg;250mg<br />

Watson<br />

tablet, extended release 25mg;100mg Mylan<br />

tablet, extended release 50mg;200mg Mylan<br />

Brand(s)<br />

Sinemet 10/100 tablet, oral 10mg;100mg Bristol-Myers Squibb *<br />

Sinemet 25/100 tablet, oral 25mg;100mg Bristol-Myers Squibb *<br />

Sinemet 25/250 tablet, oral 25mg;250mg Bristol-Myers Squibb *<br />

Sinemet CR 25/100 tablet, extended release 25mg;200mg Bristol-Myers Squibb *<br />

Sinemet CR 50/200 tablet, extended release 50mg;200mg Bristol-Myers Squibb *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

CARBINOXAMINE MALEATE; DEXTROMETHORPHAN HYDROBROMIDE; PSEUDOEPHEDRINE<br />

HYDROCHLORIDE<br />

Carbinoxamine Maleate; syrup, oral 4mg/5ml;15mg/5ml; Geneva<br />

Dextromethorphan Hydrobromide; 60mg/5ml<br />

Pseudoephedrine Hydrochloride syrup, oral 4mg/5ml;15mg/5ml; Morton Grove<br />

60mg/5ml<br />

Brand(s)<br />

Carbofed DM Drops drops, oral 2mg/ml;4mg/ml;25mg/ml Hi-Tech<br />

Cardec DM Drops drops, oral 2mg/ml;4mg/ml;25mg/ml Alpharma<br />

Chemdec DM Drops drops, oral 2mg/ml;4mg/ml;25mg/ml Norton<br />

E-Dec DM Drops drops, oral 2mg/ml;4mg/ml;25mg/ml Esquire<br />

Rondec DM Drops drops, oral 2mg/ml;4mg/ml;25mg/ml Ross/Abbott<br />

Carbofed DM Syrup syrup, oral 4mg/5ml;15mg/5ml; Hi-Tech<br />

60mg/5ml<br />

Cardec DM Syrup syrup, oral 4mg/5ml;15mg/5ml; Alpharma<br />

60mg/5ml<br />

Chemdec DM Syrup syrup, oral 4mg/5ml;15mg/5ml; Norton<br />

60mg/5ml<br />

E-Dec DM Syrup syrup, oral 4mg/5ml;15mg/5ml; Esquire<br />

60mg/5ml<br />

Maldec DM Syrup syrup, oral 4mg/5ml;15mg/5ml; Cenci<br />

60mg/5ml<br />

Rondec DM Syrup syrup, oral 4mg/5ml;15mg/5ml; Ross/Abbott<br />

60mg/5ml<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

CARBINOXAMINE MALEATE; PSEUDOEPHEDRINE HYDROCHLORIDE<br />

Carbinoxamine Maleate; drops, oral 2mg/ml;25mg/ml Alpharma<br />

39


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

Pseudoephedrine Hydrochloride drops, oral 2mg/ml;25mg/ml Morton Grove<br />

syrup, oral 4mg/5ml;60mg/5ml Alpharma<br />

Brand(s)<br />

Rondec Drops drops, oral 2mg/ml;25mg/ml Ross<br />

Chemdec Syrup syrup, oral 4mg/5ml;60mg/5ml Norton<br />

Maldec syrup, oral 4mg/5ml;60mg/5ml Cenci<br />

Rondec Syrup syrup, oral 4mg/5ml;60mg/5ml Ross<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

CARISOPRODOL<br />

Carisoprodol tablet, oral 350mg Able<br />

tablet, oral 350mg<br />

Amide<br />

@ tablet, oral 350mg<br />

Circa<br />

tablet, oral 350mg<br />

CorePharma<br />

tablet, oral 350mg<br />

Danbury<br />

@ tablet, oral 350mg<br />

Eon<br />

tablet, oral 350mg<br />

Geneva<br />

tablet, oral 350mg<br />

Mutual<br />

@ tablet, oral 350mg<br />

Pioneer<br />

tablet, oral 350mg<br />

Royce<br />

tablet, oral 350mg<br />

Vintage<br />

tablet, oral 350mg<br />

Watson<br />

tablet, oral 350mg<br />

West-ward<br />

Brand(s)<br />

Rela @ tablet, oral 350mg Schering<br />

Soma tablet, oral 350mg Wallace<br />

CARISOPRODOL; ASPIRIN<br />

See ASPIRIN; CARISOPRODOL<br />

CARISOPRODOL; ASPIRIN; CODEINE PHOSPHATE<br />

See ASPIRIN; CARISOPRODOL; CODEINE PHOSPHATE<br />

CARTEOLOL HYDROCHLORIDE<br />

Carteolol Hydrochloride solution, ophthalmic 1% Alcon<br />

solution, ophthalmic 1%<br />

Bausch and Lomb<br />

solution, ophthalmic 1%<br />

Novex<br />

Brand(s)<br />

Ocupres solution, ophthalmic 1% Novartis<br />

CEFACLOR<br />

Cefaclor capsule, oral eq 250,500mg base IVAX<br />

@ capsule, oral eq 250,500mg base Lederle<br />

capsule, oral eq 250,500mg base Marsam<br />

capsule, oral eq 250,500mg base Ranbaxy<br />

capsule, oral eq 250,500mg base Teva<br />

@ powder <strong>for</strong> suspension, oral eq 125, IVAX<br />

187,250mg base/5ml<br />

powder <strong>for</strong> suspension, oral eq IVAX<br />

375mg base/5ml<br />

(continued on <strong>the</strong> next page)<br />

CEFACLOR (continued)<br />

@ powder <strong>for</strong> suspension, oral eq 125,<br />

40<br />

Lederle


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

187,250,375mg base/5ml<br />

powder <strong>for</strong> suspension, oral eq 125, Marsam<br />

187,250,375mg base/5ml<br />

powder <strong>for</strong> suspension, oral eq 125, Ranbaxy<br />

187,250,375mg base/5ml<br />

tablet, extended release<br />

IVAX<br />

eq 500mg base<br />

Brand(s)<br />

Ceclor capsule, oral eq 250,500mg base Lilly *<br />

Ceclor powder <strong>for</strong> suspension, eq 125,187, Lilly *<br />

250,375mg base/5ml<br />

Ceclor CD tablet, extended release Lilly<br />

eq 500mg base<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

CEFADROXIL/CEFADROXIL HEMIHYDRATE<br />

Cefadroxil/ capsule, oral eq 500mg base Barr<br />

Cefadroxil Hemihydrate capsule, oral eq 500mg base IVAX<br />

@ capsule, oral eq 500mg base Purepac<br />

@ capsule, oral eq 500mg base Teva<br />

@ powder <strong>for</strong> suspension<br />

Apo<strong>the</strong>con<br />

eq 125,250,500mg base/5ml<br />

@ powder <strong>for</strong> suspension<br />

Teva<br />

eq 125,250,500mg base/5ml<br />

@ tablet, oral eq 1gm base<br />

IVAX<br />

tablet, oral eq 1gm base<br />

Ranbaxy<br />

Brand(s)<br />

Duricef capsule, oral eq 500mg base Bristol-Myers Squibb *<br />

Ultracef capsule, oral eq 500mg base Apo<strong>the</strong>con<br />

Duricef powder <strong>for</strong> suspension Bristol-Myers Squibb<br />

eq 125,250,500mg base/5ml<br />

Duricef tablet, oral eq 1gm base Bristol-Myers Squibb<br />

Ultracef @ tablet, oral eq 1gm base Apo<strong>the</strong>con<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

CEFAZOLIN SODIUM<br />

Cefazolin Sodium injection eq 500mg,1gm base/vial American Pharmaceutical<br />

Partners<br />

@ injection eq 10,20gm base/vial American Pharmaceutical<br />

Partners<br />

@ injection eq 250,500mg,1,5,10gm Bed<strong>for</strong>d<br />

base/vial<br />

@ injection eq 250,500mg,1,5,10,20gm Elkins-Sinn<br />

base/vial<br />

injection eq 500mg,1,10gm base/vial Han<strong>for</strong>d<br />

injection eq 250,500mg,1,5,10,20gm Marsam<br />

base/vial<br />

@ injection eq 250,500mg,1gm<br />

Teva<br />

base/vial<br />

injection eq 5,10gm base/vial Teva<br />

(continued on <strong>the</strong> next page)<br />

CEFAZOLIN SODIUM (continued)<br />

Brand(s)<br />

41


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

Ancef @ injection eq 250mg base/vial SmithKline Beecham<br />

Ancef<br />

injection eq 500mg,1,5,10gm base/vial SmithKline Beecham<br />

Kefzol injection eq 250,500mg,1,10,20gm Lilly<br />

base/vial<br />

Zolicef injection eq 500mg,1,10gm base/vial Apo<strong>the</strong>con<br />

CEFOTAXIME SODIUM<br />

Cefotaxime Sodium injection eq 500mg, American Pharmaceutical<br />

1,2,10,20gm base/vial Partners<br />

Brand(s)<br />

Cla<strong>for</strong>an injection eq 500mg, Aventis<br />

1,2,10,20gm base/vial<br />

CEFOXITIN SODIUM<br />

Cefoxitin Sodium injection eq 1,2,10gm base/vial American Pharmaceutical<br />

Partners<br />

injection eq 1,2,10gm base/vial ESI Lederle<br />

Brand(s)<br />

Mefoxin injection eq 1,2,10gm base/vial Merck<br />

CEFPODOXIME PROXETIL<br />

Brand(s)<br />

Banan @ granules <strong>for</strong> suspension Sankyo<br />

eq 50,100mg base/5ml<br />

Vantin granules <strong>for</strong> suspension Pharmacia & Upjohn<br />

eq 50,100mg base/5ml<br />

Banan @ tablet, oral eq 100,200mg base Sankyo<br />

Vantin tablet, oral eq 100,200mg base Pharmacia & Upjohn<br />

CEFTAZIDIME<br />

Brand(s)<br />

Fortaz injection 500mg,1,2,6gm/vial Glaxo Wellcome<br />

Tazicef injection 500mg,1,2,6gm/vial Abbott<br />

Tazidime injection 500mg,1,2gm/vial Lilly<br />

CEFTAZIDIME (ARGININE FORMULATION)<br />

Brand(s)<br />

Ceptaz injection 1,2,10gm/vial Glaxo Wellcome<br />

Pentacef @ injection 1,2,10gm/vial SmithKline Beecham<br />

CEFTAZIDIME SODIUM<br />

Ceftazidime Sodium injection, in plastic container Baxter<br />

eq 10,20,40mg base/ml<br />

Brand(s)<br />

Fortaz @ injection, in plastic container Glaxo Wellcome<br />

eq 10mg base/ml<br />

Fortaz injection, in plastic container Glaxo Wellcome<br />

eq 20,40mg base/ml<br />

CEFUROXIME SODIUM<br />

Cefuroxime Sodium injection, IM/IV eq 7.5gm base/vial American Pharmaceutical<br />

42


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

Partners<br />

injection, IM/IV eq 7.5gm base/vial Han<strong>for</strong>d<br />

injection, IM/IV eq 7.5gm base/vial Marsam<br />

injection, IM/IV eq 7.5gm base/vial Teva<br />

injection eq 1.5,7.5gm base/vial Han<strong>for</strong>d<br />

injection eq 1.5,7.5gm base/vial Marsam<br />

injection eq 1.5,7.5gm base/vial Teva<br />

Brand(s)<br />

Kefurox injection, IM/IV eq 750mg base/vial Lilly<br />

Kefurox injection eq 1.5,7.5gm base/vial Lilly<br />

Kefurox @ injection, in plastic container Lilly<br />

eq 750mg,1.5gm base/vial<br />

Zinacef injection, IM/IV eq 750mg base/vial Glaxo Wellcome<br />

Zinacef injection eq 1.5,7.5gm base/vial Glaxo Wellcome<br />

CEPHALEXIN<br />

Cephalexin capsule, oral eq 250,500mg base Atral<br />

capsule, oral eq 250,500mg base Barr<br />

capsule, oral eq 250,500mg base IVAX<br />

capsule, oral eq 250,500mg base MJ<br />

@ capsule, oral eq 250,500mg base Purepac<br />

capsule, oral eq 250,500mg base Ranbaxy<br />

capsule, oral eq 250mg base Stevens<br />

@ capsule, oral eq 500mg base Stevens<br />

capsule, oral eq 250,500mg base Teva<br />

@ capsule, oral eq 250,500mg base Yoshitomi<br />

powder <strong>for</strong> suspension<br />

Apo<strong>the</strong>con<br />

eq 125,250mg base/5ml<br />

@ powder <strong>for</strong> suspension<br />

Barr<br />

eq 125mg base/5ml<br />

powder <strong>for</strong> suspension<br />

Barr<br />

eq 250mg base/5ml<br />

@ powder <strong>for</strong> suspension<br />

Eon<br />

eq 125,250mg base/5ml<br />

powder <strong>for</strong> suspension<br />

Ranbaxy<br />

eq 125,250mg base/5ml<br />

powder <strong>for</strong> suspension<br />

Teva<br />

eq 125,250mg base/5ml<br />

@ tablet, oral eq 250,500mg base Barr<br />

@ tablet, oral eq 250,500mg base Eon<br />

tablet, oral eq 250,500mg base Teva<br />

Brand(s)<br />

Cefanex capsule, oral eq 250,500mg base Apo<strong>the</strong>con<br />

Keflex capsule, oral eq 250,500mg base Lilly *<br />

Keflex powder <strong>for</strong> suspension Ceph Intl *<br />

eq 125,250mg base/5ml<br />

Keflet tablet, oral eq 250,500mg base Lilly<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

CEPHALOTHIN SODIUM<br />

Cephalothin Sodium @ injection eq 1,2gm base/vial Abbott<br />

@ injection eq 1,2gm base/vial<br />

American Pharmaceutical<br />

Partners<br />

injection eq 1,2,4gm base/vial Bristol/Bristol-Myers<br />

(continued on <strong>the</strong> next page)<br />

CEPHALOTHIN SODIUM (continued)<br />

@ injection eq 1,2,4gm base/vial International Medication<br />

43


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

Brand(s)<br />

Keflin injection eq 1,2,4gm base/vial Lilly<br />

Seffin @ injection eq 1,2gm base/vial Glaxo Wellcome<br />

CEPHAPIRIN SODIUM<br />

Cephapirin Sodium @ injection eq 500mg,1,2,4, American Pharmaceutical<br />

20gm base/vial Partners<br />

@ injection eq 500mg,1,2,20gm base/vial Elkins-Sinn<br />

Brand(s)<br />

Cefadyl injection eq 500mg,1,2,4gm base/vial Apo<strong>the</strong>con<br />

CEPHRADINE/CEPHRADINE DIHYDRATE<br />

Cephradine/ @ capsule, oral 250,500mg Barr<br />

Cephradine Dihydrate @ capsule, oral 250,500mg Eon<br />

@ capsule, oral 250,500mg<br />

IVAX<br />

capsule, oral 250,500mg<br />

Teva<br />

@ powder <strong>for</strong> suspension 125,250mg/5ml Barr<br />

powder <strong>for</strong> suspension 125,250mg/5ml Teva<br />

Brand(s)<br />

Anspor capsule, oral 250,500mg SmithKline Beecham<br />

Velosef capsule, oral 250,500mg Apo<strong>the</strong>con<br />

Anspor<br />

Velosef "125," "250"<br />

powder <strong>for</strong> suspension 125,250mg/5ml SmithKline Beecham<br />

powder <strong>for</strong> suspension 125,250mg/5ml Apo<strong>the</strong>con<br />

CHLORAL HYDRATE<br />

Chloral Hydrate syrup, oral 500mg/5ml Alpharma<br />

syrup, oral 500mg/5ml<br />

Cenci<br />

syrup, oral 500mg/5ml<br />

Lederle<br />

syrup, oral 500mg/5ml<br />

Morton Grove<br />

@ syrup, oral 500mg/5ml<br />

Purepac<br />

syrup, oral 500mg/5ml<br />

Roxane<br />

syrup, oral 500mg/5ml<br />

Veratex<br />

Brand(s)<br />

Noctec syrup, oral 500mg/5ml Squibb<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

CHLORAMPHENICOL<br />

Chloramphenicol @ capsule, oral 250mg IVAX<br />

ointment, ophthalmic 1%<br />

Altana<br />

@ solution, ophthalmic 0.5%<br />

Alcon<br />

Brand(s)<br />

Amphicol @ capsule, oral 100,250mg Ferrante<br />

Chloromycetin @ capsule, oral 100,250mg Parkdale<br />

Mychel capsule, oral 250mg Armenpharm<br />

Chlorofair @ ointment, ophthalmic 1% Pharmafair<br />

Chloromycetin ointment, ophthalmic 1% Parkedale<br />

Chloroptic S.O.P. ointment, ophthalmic 1% Allergan<br />

Econochlor @ ointment, ophthalmic 1% Alcon<br />

AK-Chlor @ solution, ophthalmic 0.5% Akorn<br />

Chlorofair @ solution, ophthalmic 0.5% Pharmafair<br />

Chloroptic solution, ophthalmic 0.5% Allergan<br />

Econochlor @ solution, ophthalmic 0.5% Alcon<br />

(continued on <strong>the</strong> next page)<br />

CHLORAMPHENICOL (continued)<br />

Ophthochlor @ solution, ophthalmic 0.5% Parkdale<br />

44


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

Optomycin @ solution, ophthalmic 0.5% Optopics<br />

CHLORAMPHENICOL SODIUM SUCCINATE<br />

Chloramphenicol injection eq 1gm base/vial American Pharmaceutical<br />

Sodium Succinate @ injection eq 1gm base/vial Elkins Sinn<br />

injection eq 1gm base/vial<br />

Gruppo Lepetit<br />

Brand(s)<br />

Chloromycetin injection eq 1gm base/vial Parke-Davis<br />

Mychel-S @ injection eq 1gm base/vial Angus<br />

CHLORDIAZEPOXIDE HYDROCHLORIDE<br />

Chlordiazepoxide @ capsule, oral 5,10,25mg (Ascot)<br />

Hydrochloride capsule, oral 5,10,25mg Barr<br />

@ capsule, oral 5,10,25mg<br />

Eon<br />

@ capsule, oral 5,10,25mg<br />

Ferrante<br />

capsule, oral 10mg<br />

Geneva<br />

@ capsule, oral 5,25mg<br />

Geneva<br />

@ capsule, oral 5,10,25mg<br />

Halsey<br />

capsule, oral 10mg<br />

Impax<br />

@ capsule, oral 5,25mg<br />

Impax<br />

@ capsule, oral 5,10,25mg<br />

IVAX<br />

@ capsule, oral 5,10,25mg<br />

Lederle<br />

@ capsule, oral 10mg<br />

Mast<br />

@ capsule, oral 5,10,25mg<br />

Mylan<br />

@ capsule, oral 5,10,25mg<br />

Parke-Davis<br />

@ capsule, oral 10,25mg<br />

Pioneer<br />

@ capsule, oral 5,10,25mg<br />

Purepac<br />

@ capsule, oral 10,25mg<br />

Roxane<br />

@ capsule, oral 5,10,25mg<br />

Superpharm<br />

@ capsule, oral 5,10,25mg<br />

Teva<br />

@ capsule, oral 5,25mg<br />

USL<br />

capsule, oral 10mg<br />

USL<br />

@ capsule, oral 5,10,25mg<br />

(Vangard/MWM)<br />

capsule, oral 5,10,25mg<br />

Watson<br />

@ capsule, oral 5,10,25mg<br />

West-ward<br />

Brand(s)<br />

A-Poxide @ capsule, oral 5,10,25mg Abbott<br />

Chlordiazachel @ capsule, oral 5,10,25mg Rachelle<br />

Librium capsule, oral 5,10,25mg ICN<br />

Lygen @ capsule, oral 5,10,25mg Alra<br />

CHLORDIAZEPOXIDE; AMITRIPTYLINE HYDROCHLORIDE<br />

See AMITRIPTYLINE HYDROCHLORIDE; CHLORDIAZEPOXIDE<br />

CHLORHEXIDINE GLUCONATE<br />

Chlorhexidine Gluconate solution, dental 0.12% Alpharma<br />

solution, dental 0.12%<br />

Hi-Tech<br />

solution, dental 0.12%<br />

Novex<br />

solution, dental 0.12%<br />

Teva<br />

Brand(s)<br />

Peridex solution, dental 0.12% Zila<br />

PerioGard solution, dental 0.12% Colgate-Palmolive<br />

CHLOROPROCAINE HYDROCHLORIDE<br />

Chloroprocaine Hydrochloride injection 2,3% Abbott<br />

45


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

injection 2,3%<br />

Bed<strong>for</strong>d<br />

Brand(s)<br />

Nesacaine-MPF injection 2,3% Astra Zeneca<br />

CHLOROQUINE PHOSPHATE<br />

Chloroquine Phosphate tablet, oral 250mg (eq 150mg base) Danbury<br />

tablet, oral 500mg (eq 300mg base) Danbury<br />

tablet, oral 250mg (eq 150mg base) Impax<br />

@ tablet, oral 250mg (eq 150mg base) MD<br />

@ tablet, oral 250mg (eq 150mg base) Purepac<br />

@ tablet, oral 250mg (eq 150mg base) Teva<br />

tablet, oral 250mg (eq 150mg base) West-ward<br />

tablet, oral 500mg (eq 300mg base) West-ward<br />

Brand(s)<br />

Aralen tablet, oral 500mg (eq 300mg base) Sanofi Syn<strong>the</strong>labo<br />

CHLOROTHIAZIDE<br />

Chlorothiazide @ tablet, oral 250mg ABC<br />

@ tablet, oral 250,500mg<br />

Circa<br />

@ tablet, oral 250mg<br />

Danbury<br />

@ tablet, oral 250,500mg<br />

Eon<br />

@ tablet, oral 250,500mg<br />

Lederle<br />

tablet, oral 250,500mg<br />

Mylan<br />

@ tablet, oral 250,500mg<br />

Watson<br />

tablet, oral 250,500mg<br />

West-ward<br />

Brand(s)<br />

Diuril tablet, oral 250,500mg Merck Sharp and Dohme *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

CHLOROTHIAZIDE; METHYLDOPA<br />

Chlorothiazide; Methyldopa @ tablet, oral 150mg;250mg Par<br />

@ tablet, oral 250mg;250mg<br />

Par<br />

Brand(s)<br />

Aldochlor-150 tablet, oral 150mg;250mg Merck Sharp and Dohme<br />

Aldochlor-250 tablet, oral 250mg;250mg Merck Sharp and Dohme<br />

CHLOROTRIANISENE<br />

Chlorotrianisene @ capsule, oral 12mg Banner Pharmacaps<br />

Brand(s)<br />

TACE capsule, oral 12mg Aventis<br />

CHLORPHENIRAMINE MALEATE<br />

Chlorpheniramine Maleate @ injection 10mg/ml Bel-Mar<br />

@ injection 10mg/ml<br />

Elkins-Sinn<br />

@ injection 10,100mg/ml<br />

Steris<br />

@ tablet, oral 4mg<br />

Danbury<br />

@ tablet, oral 4mg<br />

Geneva<br />

tablet, oral 4mg<br />

ICN<br />

@ tablet, oral 4mg<br />

Impax<br />

@ tablet, oral 4mg<br />

KV<br />

tablet, oral 4mg<br />

Marshall<br />

(continued on <strong>the</strong> next page)<br />

CHLORPHENIRAMINE MALEATE (continued)<br />

@ tablet, oral 4mg<br />

Pharmavite<br />

46


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

tablet, oral 4mg<br />

Phoenix<br />

tablet, oral 4mg<br />

Superpharm<br />

tablet, oral 4mg<br />

Tablicaps<br />

@ tablet, oral 4mg<br />

West-ward<br />

Brand(s)<br />

Chlor-Trimeton @ injection 10,100mg/ml Schering<br />

Pyridamal 100 @ injection 100mg/ml Bel-Mar<br />

Kloromin @ tablet, oral 4mg Halsey<br />

CHLORPHENIRAMINE MALEATE; CODEINE PHOSPHATE; PSEUDOEPHEDRINE HYDROCHLORIDE<br />

Chlorpheniramine Maleate; syrup, oral 2mg/5ml;10mg/5ml; Morton Grove<br />

Codeine Phosphate; 30mg/5ml<br />

Pseudoephedrine Hydrochloride<br />

Brand(s)<br />

Dihistine DH Elixir syrup, oral 2mg/5ml;10mg/5ml; Alpharma<br />

30mg/5ml<br />

Novadyne DH Liquid syrup, oral 2mg/5ml;10mg/5ml; Norton<br />

30mg/5ml<br />

Novahistine DH Liquid syrup, oral 2mg/5ml;10mg/5ml; SmithKline Beecham<br />

30mg/5ml<br />

Phenylhistine DH syrup, oral 2mg/5ml;10mg/5ml; Cenci<br />

30mg/5ml<br />

Ryna C Liquid syrup, oral 2mg/5ml;10mg/5ml; Wallace<br />

30mg/5ml<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

CHLORPHENIRAMINE MALEATE; PHENYLEPHRINE HYDROCHLORIDE; PHENYLPROPANOLAMINE<br />

HYDROCHLORIDE; PHENYLTOLOXAMINE CITRATE<br />

Chlorpheniramine Maleate; drops, oral 0.5mg/ml;1.25mg/ml; Alpharma<br />

Phenylephrine Hydrochloride; 5mg/ml;2mg/ml<br />

Phenylpropanolamine syrup, oral 0.5mg/5ml;1.25mg/5ml; Alpharma<br />

Hydrochloride; 5mg/5ml;2mg/5ml<br />

Phenyltoloxamine Citrate syrup, oral 2.5mg/5ml;5mg/5ml; Alpharma<br />

20mg/5ml;7.5mg/5ml<br />

syrup, oral 2.5mg/5ml;5mg/5ml; Naska<br />

20mg/5ml;7.5mg/5ml<br />

Brand(s)<br />

Naldecon Pediatric Drops drops, oral 0.5mg/ml;1.25mg/ml; Bristol/Bristol-Myers<br />

5mg/ml;2mg/ml<br />

Nalphen Pediatric Drops drops, oral 0.5mg/ml;1.25mg/ml; Hi-Tech<br />

5mg/ml;2mg/ml<br />

Sinucon Pediatric Drops drops, oral 0.5mg/ml;1.25mg/ml; Norton<br />

5mg/ml;2mg/ml<br />

Naldecon Pediatric Syrup syrup, oral 0.5mg/5ml;1.25mg/5ml; Bristol/Bristol-Myers<br />

5mg/5ml;2mg/5ml<br />

Naldecon Syrup syrup, oral 2.5mg/5ml;5mg/5ml; Bristol/Bristol-Myers<br />

20mg/5ml;7.5mg/5ml<br />

Nalphen Pediatric Syrup syrup, oral 0.5mg/5ml;1.25mg/5ml; Hi-Tech<br />

5mg/5ml;2mg/5ml<br />

Nalphen Syrup syrup, oral 2.5mg/5ml;5mg/5ml; Hi-Tech<br />

20mg/5ml;7.5mg/5ml<br />

Sinucon Pediatric Syrup syrup, oral 0.5mg/5ml;1.25mg/5ml; Norton<br />

5mg/5ml;2mg/5ml<br />

(continued on <strong>the</strong> next page)<br />

CHLORPHENIRAMINE MALEATE; PHENYLEPHRINE HYDROCHLORIDE; PHENYLPROPANOLAMINE<br />

HYDROCHLORIDE; PHENYLTOLOXAMINE CITRATE<br />

47


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

Sinucon Syrup syrup, oral 2.5mg/5ml;5mg/5ml; Norton<br />

20mg/5ml;7.5mg/5ml<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Section 790.60.<br />

CHLORPHENIRAMINE MALEATE; PHENYLPROPANOLAMINE HYDROCHLORIDE<br />

Chlorpheniramine Maleate; capsule, extended release 12mg;75mg Geneva<br />

Phenylpropanolamine @ capsule, extended release 12mg;75mg Watson<br />

Hydrochloride<br />

Brand(s)<br />

Ornade<br />

capsule, extended release 12mg;75mg SmithKline Beecham<br />

CHLORPHENIRAMINE TANNATE; PHENYLEPHRINE TANNATE; PYRILAMINE TANNATE<br />

Chlorpheniramine Tannate; suspension, oral 2mg/5ml;5mg/ml; Ferndale<br />

Phenylephrine Tannate; 12.5mg/5ml<br />

Pyrilamine Tannate<br />

Brand(s)<br />

Histatan suspension, oral 2mg/5ml;5mg/5ml; Norton<br />

12.5mg/5ml<br />

R-Tannate suspension, oral 2mg/5ml;5mg/5ml; Copley<br />

12.5mg/5ml<br />

Rynatan Pediatric suspension, oral 2mg/5ml;5mg/5ml; Wallace<br />

12.5mg/5ml<br />

Triotann S suspension, oral 2mg/5ml;5mg/5ml; Duramed<br />

12.5mg/5ml<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Section 790.60.<br />

CHLORPROMAZINE HYDROCHLORIDE<br />

Chlorpromazine Hydrochloride concentrate, oral 100mg/ml Alpharma<br />

@ concentrate, oral 30,100mg/ml Morton Grove<br />

concentrate, oral 30,100mg/ml Pharmaceutical Associates<br />

@ injection 25mg/ml<br />

American Pharmaceutical<br />

Partners<br />

injection 25mg/ml<br />

Elkins-Sinn<br />

injection 25mg/ml<br />

Marsam<br />

@ injection 25mg/ml<br />

Steris<br />

@ injection 25mg/ml<br />

Wyeth-Ayerst<br />

@ syrup, oral 10mg/5ml<br />

Alpharma<br />

Brand(s)<br />

Intensol concentrate, oral 30,100mg/ml Roxane<br />

Sonazine concentrate, oral 30,100mg/ml Geneva<br />

Thorazine concentrate, oral 30,100mg/ml SmithKline Beecham<br />

Thorazine injection 25mg/ml SmithKline Beecham<br />

Sonazine syrup, oral 10mg/5ml Geneva<br />

Thorazine syrup, oral 10mg/5ml SmithKline Beecham<br />

CHLORPROPAMIDE<br />

Chlorpropamide @ tablet, oral 100,250mg Barr<br />

@ tablet, oral 100,250mg<br />

Circa<br />

tablet, oral 100,250mg<br />

Danbury<br />

@ tablet, oral 100,250mg<br />

Duramed<br />

(continued on <strong>the</strong> next page)<br />

CHLORPROPAMIDE (continued)<br />

@ tablet, oral 250mg<br />

Eon<br />

48


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

tablet, oral 100,250mg<br />

Geneva<br />

@ tablet, oral 100,250mg<br />

Halsey<br />

@ tablet, oral 100,250mg<br />

IVAX<br />

tablet, oral 100,250mg<br />

Lederle<br />

tablet, oral 100,250mg<br />

Mylan<br />

tablet, oral 100,250mg<br />

Par<br />

tablet, oral 100,250mg<br />

Sidmak<br />

tablet, oral 100mg<br />

Superpharm<br />

@ tablet, oral 250mg<br />

Superpharm<br />

@ tablet, oral 100mg<br />

Teva<br />

@ tablet, oral 100,250mg<br />

USL<br />

@ tablet, oral 100,250mg<br />

Watson<br />

Brand(s)<br />

Diabinese tablet, oral 100,250mg Pfizer<br />

Glucamide @ tablet, oral 250mg Teva<br />

CHLORTHALIDONE<br />

Chlorthalidone @ tablet, oral 25mg Abbott<br />

@ tablet, oral 50mg<br />

Abbott<br />

@ tablet, oral 25,50mg<br />

(Ascot)<br />

@ tablet, oral 25,50mg<br />

Barr<br />

@ tablet, oral 25,50mg<br />

Circa<br />

@ tablet, oral 25,50mg<br />

Danbury<br />

@ tablet, oral 50mg<br />

Eon<br />

@ tablet, oral 25mg<br />

Geneva<br />

tablet, oral 50mg<br />

Geneva<br />

tablet, oral 25,50mg<br />

IVAX<br />

@ tablet, oral 25,50mg<br />

KV<br />

@ tablet, oral 25,50mg<br />

Lederle<br />

tablet, oral 25,50mg<br />

Mutual<br />

tablet, oral 25,50mg<br />

Mylan<br />

@ tablet, oral 50mg<br />

Pioneer<br />

@ tablet, oral 25,50mg<br />

Purepac<br />

tablet, oral 25,50mg<br />

Sidmak<br />

@ tablet, oral 25,50mg<br />

Superpharm<br />

@ tablet, oral 50mg<br />

Teva<br />

tablet, oral 25mg<br />

USL<br />

@ tablet, oral 50mg<br />

USL<br />

@ tablet, oral 25,50mg<br />

(Vangard/MWM)<br />

@ tablet, oral 25,50mg<br />

Warner Chilcott<br />

tablet, oral 25mg<br />

Watson<br />

@ tablet, oral 50mg<br />

Watson<br />

Brand(s)<br />

Hygroton tablet, oral 25,50mg Aventis<br />

CHLORTHALIDONE; ATENOLOL<br />

See ATENOLOL; CHLORTHALIDONE<br />

CHLORTHALIDONE; CLONIDINE HYDROCHLORIDE<br />

Chlorthalidone; tablet, oral 15mg;0.1mg Mylan<br />

Clonidine Hydrochloride tablet, oral 15mg;0.2mg Mylan<br />

tablet, oral 15mg;0.3mg<br />

Mylan<br />

tablet, oral 15mg;0.1mg<br />

Par<br />

tablet, oral 15mg;0.2mg<br />

Par<br />

tablet, oral 15mg;0.3mg<br />

Par<br />

(continued on <strong>the</strong> next page)<br />

CHLORTHALIDONE; CLONIDINE HYDROCHLORIDE (continued)<br />

Brand(s)<br />

49


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

Combipres tablet, oral 15mg;0.1mg Boehringer Ingelheim<br />

Combipres tablet, oral 15mg;0.2mg Boehringer Ingelheim<br />

Combipres tablet, oral 15mg;0.3mg Boehringer Ingelheim<br />

CHLORZOXAZONE<br />

Chlorzoxazone tablet, oral 250,500mg Amide<br />

tablet, oral 500mg<br />

Barr<br />

@ tablet, oral 250,500mg<br />

Danbury<br />

tablet, oral 250,500mg<br />

Geneva<br />

tablet, oral 500mg<br />

Mutual<br />

tablet, oral 250,500mg<br />

Ohm<br />

tablet, oral 250mg<br />

Par<br />

@ tablet, oral 250,500mg<br />

Pioneer<br />

tablet, oral 500mg<br />

Royce<br />

tablet, oral 500mg<br />

Teva<br />

@ tablet, oral 250mg<br />

Watson<br />

tablet, oral 500mg<br />

Watson<br />

Brand(s)<br />

Paraflex @ tablet, oral 250mg Johnson<br />

Parafon Forte DSC tablet, oral 500mg McNeil<br />

Strifon Forte DSC tablet, oral 500mg Ferndale<br />

CHOLESTYRAMINE<br />

Cholestyramine powder, oral eq 4gm resin/packet Copley<br />

powder, oral eq 4gm resin/scoopful Copley<br />

powder, oral eq 4gm resin/packet IVAX<br />

powder, oral eq 4gm resin/scoopful IVAX<br />

powder, oral eq 4gm resin/packet Teva<br />

powder, oral eq 4gm resin/scoopful Teva<br />

Brand(s)<br />

Cholestyramine Light powder, oral eq 4gm resin/packet Copley<br />

Cholestyramine Light powder, oral eq 4gm resin/scoopful Copley<br />

Cholestyramine Light powder, oral eq 4gm resin/packet Teva<br />

Cholestyramine Light powder, oral eq 4gm resin/scoopful Teva<br />

Locholest powder, oral eq 4gm resin/packet Eon<br />

Locholest powder, oral eq 4gm resin/scoopful Eon<br />

Locholest Light powder, oral eq 4gm resin/packet Eon<br />

Locholest Light powder, oral eq 4gm resin/scoopful Eon<br />

Prevalite powder, oral eq 4gm resin/packet Upsher-Smith *<br />

Prevalite powder, oral eq 4gm resin/scoopful Upsher-Smith *<br />

Questran powder, oral eq 4gm resin/packet Bristol-Myers Squibb *<br />

Questran powder, oral eq 4gm resin/scoopful Bristol-Myers Squibb *<br />

Questran Light powder, oral eq 4gm resin/packet Bristol-Myers Squibb *<br />

Questran Light powder, oral eq 4gm resin/scoopful Bristol-Myers Squibb *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

CHROMIC CHLORIDE<br />

Chromic Chloride injection eq 0.004mg chromium/ml Abbott<br />

@ injection eq 0.004mg chromium/ml American Pharmaceutical<br />

Partners<br />

CIMETIDINE<br />

Cimetidine tablet, oral 200,300,400,800mg Danbury<br />

50


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

tablet, oral 200,300,400,800mg Endo<br />

tablet, oral 200,300,400,800mg Geneva<br />

tablet, oral 200,300,400,800mg IVAX<br />

tablet, oral 200,300,400,800mg Lek<br />

tablet, oral 300,400,800mg<br />

Mova<br />

tablet, oral 200,300,400,800mg Mylan<br />

@ tablet, oral 300,400,800mg<br />

Roxane<br />

tablet, oral 200,300,400,800mg Sidmak<br />

tablet, oral 200,300,400,800mg Teva<br />

tablet, oral 200,300,400,800mg TorPharm<br />

Brand(s)<br />

Tagamet tablet, oral 200,300,400,800mg SmithKline Beecham *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

CIMETIDINE HYDROCHLORIDE<br />

Cimetidine Hydrochloride injection eq 300mg base/2ml Abbott<br />

injection eq 300mg base/2ml Endo<br />

injection eq 300mg base/2ml Gensia Sicor<br />

injection eq 300mg base/2ml Luitpold<br />

injection eq 300mg base/2ml Mova<br />

solution, oral eq 300mg base/5ml Alpharma<br />

solution, oral eq 300mg base/5ml Copley<br />

solution, oral eq 300mg base/5ml Duramed<br />

solution, oral eq 300mg base/5ml Endo<br />

solution, oral eq 300mg base/5ml Hi-Tech<br />

solution, oral eq 300mg base/5ml Morton Grove<br />

solution, oral eq 300mg base/5ml Novex<br />

solution, oral eq 300mg base/5ml Pharmaceutical Associates<br />

solution, oral eq 300mg base/5ml Roxane<br />

solution, oral eq 300mg base/5ml Teva<br />

Brand(s)<br />

Tagamet injection eq 300mg base/2ml SmithKline Beecham<br />

Tagamet solution, oral eq 300mg base/5ml SmithKline Beecham<br />

CIMETIDINE HYDROCHLORIDE; SODIUM CHLORIDE<br />

Cimetidine Hydrochloride; injection eq 600mg base/ml; Abbott<br />

Sodium Chloride 900mg/100ml<br />

Brand(s)<br />

Tagamet injection eq 600mg base/ml; SmithKline Beecham<br />

900mg/100ml<br />

CINOXACIN<br />

Cinoxacin @ capsule, oral 250,500mg Teva<br />

Brand(s)<br />

Cinobac capsule, oral 250,500mg Lilly<br />

CISPLATIN<br />

Cisplatin injection 1mg/ml American Pharmaceutical<br />

Partners<br />

injection 1mg/ml<br />

Bed<strong>for</strong>d<br />

injection 1mg/ml<br />

Gensia-Sicor<br />

(continued on <strong>the</strong> next page)<br />

CISPLATIN<br />

injection 1mg/ml<br />

injection 10,50mg/vial<br />

51<br />

Pharmachemie<br />

Bed<strong>for</strong>d


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

Brand(s)<br />

Platinol-AQ injection 1mg/ml Bristol-Myers Squibb<br />

Platinol injection 10,50mg/vial Bristol-Myers Squibb<br />

CITRIC ACID; MAGNESIUM OXIDE; SODIUM CARBONATE<br />

Solution <strong>for</strong> irrigation; in plastic container<br />

Brand(s)<br />

Irrigating Solution G solution <strong>for</strong> irrigation 3.24gm/100ml; Baxter<br />

380mg/100ml;430mg/100ml<br />

Urologic G solution <strong>for</strong> irrigation 3.24gm/100ml; Abbott<br />

380mg/100ml;430mg/100ml<br />

CLADRIBINE<br />

Cladribine injection 1mg/ml Bed<strong>for</strong>d<br />

Brand(s)<br />

Leustatin injection 1mg/ml RW Johnson<br />

CLEMASTINE FUMARATE<br />

Clemastine Fumarate syrup, oral eq 0.5mg base/5ml Alpharma<br />

syrup, oral eq 0.5mg base/5ml Copley<br />

syrup, oral eq 0.5mg base/5ml Morton Grove<br />

syrup, oral eq 0.5mg base/5ml Novex<br />

syrup, oral eq 0.5mg base/5ml Silarx<br />

syrup, oral eq 0.5mg base/5ml Teva<br />

tablet, oral eq 2.68mg base<br />

Geneva<br />

@ tablet, oral eq 1.34mg base<br />

Teva<br />

tablet, oral eq 2.68mg base<br />

Teva<br />

Brand(s)<br />

Tavist syrup, oral eq 0.5mg base/5ml Novartis *<br />

Tavist 1 @ tablet, oral eq 1.34mg base Novartis<br />

Tavist tablet, oral eq 2.68mg base Novartis<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

CLINDAMYCIN HYDROCHLORIDE<br />

Clindamycin Hydrochloride @ capsule, oral eq 75mg base Danbury<br />

capsule, oral eq 150mg base Danbury<br />

capsule, oral eq 150,300mg base Ranbaxy<br />

capsule, oral eq 75,150mg base Teva<br />

Brand(s)<br />

Cleocin capsule, oral eq 75,150,300mg base Pharmacia & Upjohn *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

CLINDAMYCIN PHOSPHATE<br />

Clindamycin Phosphate injection eq 150mg base/ml Abbott<br />

@ injection eq 150mg base/ml<br />

American Pharmaceutical<br />

Partners<br />

@ injection eq 150mg base/ml<br />

Astra Zeneca<br />

injection eq 150mg base/ml<br />

Bed<strong>for</strong>d<br />

@ injection eq 150mg base/ml<br />

Bristol-Myers Squibb<br />

(continued on <strong>the</strong> next page)<br />

CLINDAMYCIN PHOSPHATE (continued)<br />

@ injection eq 150mg base/ml<br />

Elkins-Sinn<br />

52


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

@ injection eq 150mg base/ml<br />

Gensia Sicor<br />

injection eq 150mg base/ml<br />

Lederle<br />

injection eq 150mg base/ml<br />

Loch<br />

injection eq 150mg base/ml<br />

Marsam<br />

@ injection eq 150mg base/ml<br />

Quad<br />

@ injection eq 150mg base/ml<br />

Solopak<br />

@ injection eq 150mg base/ml<br />

Steris<br />

gel, topical eq 1% base<br />

Altana<br />

lotion, topical eq 1% base<br />

Altana<br />

solution, topical eq 1% base<br />

Alpharma<br />

solution, topical eq 1% base<br />

Clay-Park<br />

@ solution, topical eq 1% base<br />

Copley<br />

solution, topical eq 1% base<br />

Fougera/Altana<br />

solution, topical eq 1% base<br />

Morton Grove<br />

solution, topical eq 1% base<br />

Stiefel<br />

@ solution, topical eq 1% base<br />

Teva<br />

swab, topical eq 1% base<br />

Clay-Park<br />

Brand(s)<br />

Cleocin-T gel, topical eq 1% base Pharmacia & Upjohn *<br />

Cleocin injection eq 150mg base/ml Pharmacia & Upjohn<br />

Cleocin-T lotion, topical eq 1% base Pharmacia & Upjohn<br />

Cleocin T solution, topical eq 1% base Pharmacia & Upjohn *<br />

Clinda-Derm solution, topical eq 1% base Paddock<br />

Cleocin T swab, topical eq 1% base Pharmacia & Upjohn<br />

Clindets swab, topical eq 1% base Stiefel<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

CLINDAMYCIN PHOSPHATE; DEXTROSE<br />

Clindamycin Phosphate; injection eq 900mg base/100ml American Pharmaceutical<br />

Dextrose Partners<br />

in plastic container @ injection eq 12mg base/ml American Pharmaceutical<br />

Partners<br />

injection eq 900mg base/100ml Baxter<br />

injection eq 6,12mg base/ml<br />

Baxter<br />

Brand(s)<br />

Cleocin Phosphate in Dextrose 5% injection eq 6,12,18mg base/ml Pharmacia & Upjohn<br />

CLOBETASOL PROPIONATE<br />

Clobetasol Propionate cream, (AB1) topical 0.05% Altana<br />

cream, (AB1) topical 0.05%<br />

Copley<br />

cream, (AB1) topical 0.05%<br />

Fougera/Altana<br />

cream, (AB1) topical 0.05%<br />

Taro<br />

cream, (AB2) emollient topical 0.05% Altana<br />

cream, (AB2) emollient topical 0.05% Taro<br />

gel, topical 0.05%<br />

Altana<br />

gel, topical 0.05%<br />

Stiefel<br />

gel, topical 0.05%<br />

Taro<br />

ointment, topical 0.05%<br />

Copley<br />

ointment, topical 0.05%<br />

Fougera/Altana<br />

ointment, topical 0.05%<br />

NMC<br />

ointment, topical 0.05%<br />

Stiefel<br />

ointment, topical 0.05%<br />

Taro<br />

solution, topical 0.05%<br />

Altana<br />

solution, topical 0.05%<br />

Morton Grove<br />

(continued on <strong>the</strong> next page)<br />

CLOBETASOL PROPIONATE (continued)<br />

solution, topical 0.05%<br />

NMC<br />

53


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

solution, topical 0.05%<br />

Taro<br />

solution, topical 0.05%<br />

Thames<br />

Brand(s)<br />

Cormax cream, (AB1) topical 0.05% Healthpoint<br />

Temovate cream, (AB1) topical 0.05% Glaxo Wellcome<br />

Embeline E cream, (AB2) emollient topical 0.05% Healthpoint<br />

Temovate E cream, (AB2) emollient topical 0.05% Glaxo Wellcome<br />

Temovate gel, topical 0.05% Glaxo Wellcome<br />

Embeline ointment, topical 0.05% Healthpoint<br />

Temovate ointment, topical 0.05% Glaxo Wellcome<br />

Embeline solution, topical 0.05% DPT<br />

Temovate solution, topical 0.05% Glaxo Wellcome<br />

<strong>Product</strong>s designated “AB1" may only be interchanged with o<strong>the</strong>r products designated as “AB1." <strong>Product</strong>s<br />

designated as “AB2" may only be interchanged with o<strong>the</strong>r products designated as “AB2.” <strong>Product</strong>s<br />

designated as “AB1" MAY NOT BE INTERCHANGED with products designated as “AB2.”<br />

CLOFIBRATE<br />

Clofibrate capsule, oral 500mg Banner Pharmacaps<br />

@ capsule, oral 500mg<br />

Geneva<br />

capsule, oral 500mg<br />

Teva<br />

capsule, oral 500mg<br />

USL<br />

@ capsule, oral 500mg<br />

Watson<br />

Brand(s)<br />

Atromid-S capsule, oral 500mg Wyeth-Ayerst<br />

CLOMIPHENE CITRATE<br />

Clomiphene Citrate tablet, oral 50mg Par<br />

Brand(s)<br />

Clomid tablet, oral 50mg Aventis<br />

Milophene tablet, oral 50mg Milex<br />

Serophene tablet, oral 50mg Serono *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

CLOMIPRAMINE HYDROCHLORIDE<br />

Clomipramine Hydrochloride capsule, oral 25,50,75mg Circa<br />

capsule, oral 25,50,75mg<br />

Geneva<br />

capsule, oral 25,50,75mg<br />

Mylan<br />

capsule, oral 25,50,75mg<br />

Taro<br />

capsule, oral 25,50,75mg<br />

Teva<br />

capsule, oral 25,50,75mg<br />

Watson<br />

Brand(s)<br />

Anafranil capsule, oral 25,50,75mg Tyco<br />

CLONAZEPAM<br />

Clonazepam tablet, oral 0.5,1,2mg Alphapharm<br />

tablet, oral 0.5,1,2mg<br />

Caraco<br />

tablet, oral 0.5,1,2mg<br />

Eon<br />

tablet, oral 0.5,1,2mg<br />

Geneva<br />

tablet, oral 0.5,1,2mg<br />

Mylan<br />

(continued on <strong>the</strong> next page)<br />

CLONAZEPAM (continued)<br />

tablet, oral 0.5,1,2mg<br />

Purepac<br />

tablet, oral 0.5,1,2mg<br />

Teva<br />

54


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

tablet, oral 0.5,1,2mg<br />

TorPharm<br />

tablet, oral 0.5,1,2mg<br />

Watson<br />

Brand(s)<br />

Klonopin tablet, oral 0.5,1,2mg Roche<br />

CLONIDINE HYDROCHLORIDE<br />

Clonidine Hydrochloride @ tablet, oral 0.1,0.2,0.3mg American Therapeutics<br />

tablet, oral 0.1mg<br />

Barr<br />

@ tablet, oral 0.2,0.3mg<br />

Barr<br />

@ tablet, oral 0.1,0.2,0.3mg<br />

Circa<br />

tablet, oral 0.1,0.2,0.3mg<br />

Danbury<br />

@ tablet, oral 0.1,0.2,0.3mg<br />

Duramed<br />

tablet, oral 0.1,0.2,0.3mg<br />

Geneva<br />

@ tablet, oral 0.1,0.2,0.3mg<br />

Interpharm<br />

tablet, oral 0.1,0.2,0.3mg<br />

Lederle<br />

tablet, oral 0.1,0.2,0.3mg<br />

Mylan<br />

@ tablet, oral 0.1,0.2,0.3mg<br />

Par<br />

tablet, oral 0.1,0.2,0.3mg<br />

Purepac<br />

@ tablet, oral 0.1,0.2,0.3mg<br />

Teva<br />

@ tablet, oral 0.1,0.2,0.3mg<br />

Warner-Chilcott<br />

Brand(s)<br />

Catapres tablet, oral 0.1,0.2,0.3mg Boehringer Ingelheim<br />

CLONIDINE HYDROCHLORIDE; CHLORTHALIDONE<br />

See CHLORTHALIDONE; CLONIDINE HYDROCHLORIDE<br />

CLORAZEPATE DIPOTASSIUM<br />

Clorazepate Dipotassium @ capsule, oral 3.75,7.5,15mg Able<br />

@ capsule, oral 3.75,7.5,15mg<br />

American Therapeutics<br />

capsule, oral 3.75,7.5,15mg<br />

Geneva<br />

capsule, oral 3.75,7.5,15mg<br />

Lederle<br />

capsule, oral 3.75,7.5,15mg<br />

Mylan<br />

@ capsule, oral 3.75,7.5,15mg<br />

Purepac<br />

@ capsule, oral 3.75,7.5,15mg<br />

Quantum<br />

@ capsule, oral 3.75,7.5,15mg<br />

Searle<br />

@ capsule, oral 3.75,7.5,15mg<br />

USL<br />

@ capsule, oral 3.75,7.5,15mg<br />

Warner Chilcott<br />

@ capsule, oral 3.75,7.5,15mg<br />

Watson<br />

tablet, oral 3.75,7.5,15mg<br />

Able<br />

@ tablet, oral 3.75,7.5,15mg<br />

American Therapeutics<br />

@ tablet, oral 3.75mg<br />

Geneva<br />

tablet, oral 7.5,15mg<br />

Geneva<br />

@ tablet, oral 3.75,7.5,15mg<br />

Lederle<br />

tablet, oral 3.75,7.5,15mg<br />

Mylan<br />

@ tablet, oral 3.75,7.5,15mg<br />

Purepac<br />

@ tablet, oral 3.75,7.5,15mg<br />

Quantum<br />

tablet, oral 3.75,7.5,15mg<br />

Taro<br />

@ tablet, oral 3.75,7.5,15mg<br />

Warner Chilcott<br />

Brand(s)<br />

Tranxene @ capsule, oral 3.75,7.5,15mg Abbott<br />

Gen-Xene tablet, oral 3.75,7.5,15mg Alra<br />

Tranxene tablet, oral 3.75,7.5,15mg Abbott<br />

CLOTRIMAZOLE<br />

Clotrimazole cream, topical 1% Taro<br />

solution, topical 1%<br />

Taro<br />

55


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

solution, topical 1%<br />

Teva<br />

Brand(s)<br />

Lotrimin cream, topical 1% Schering<br />

Lotrimin solution, topical 1% Schering<br />

Mycelex solution, topical 1% Miles<br />

CLOTRIMAZOLE; BETAMETHASONE DIPROPIONATE<br />

See BETAMETHASONE DIPROPIONATE; CLOTRIMAZOLE<br />

CLOXACILLIN SODIUM MONOHYDRATE<br />

Cloxacillin Sodium Monohydrate capsule, oral eq 250,500mg base Teva<br />

powder <strong>for</strong> solution<br />

Teva<br />

eq 125mg base/5ml<br />

Brand(s)<br />

Cloxapen capsule, oral eq 250,500mg base SmithKline Beecham<br />

Tegopen @ capsule, oral eq 250,500mg base Apo<strong>the</strong>con<br />

Tegopen @ powder <strong>for</strong> solution Apo<strong>the</strong>con<br />

eq 125mg base/5ml<br />

CLOZAPINE<br />

Clozapine @ tablet, oral 25,100mg Geneva<br />

tablet, oral 25,100mg<br />

IVAX<br />

tablet, oral 25,100mg<br />

Mylan<br />

Brand(s)<br />

Clozaril tablet, oral 25,100mg Novartis<br />

CODEINE PHOSPHATE; ACETAMINOPHEN<br />

See ACETAMINOPHEN; CODEINE PHOSPHATE<br />

CODEINE PHOSPHATE; ASPIRIN<br />

See ASPIRIN; CODEINE PHOSPHATE<br />

CODEINE PHOSPHATE; ASPIRIN; CARISOPRODOL<br />

See ASPIRIN; CARISOPRODOL; CODEINE PHOSPHATE<br />

CODEINE PHOSPHATE; BROMODIPHENHYDRAMINE HYDROCHLORIDE<br />

See BROMODIPHENHYDRAMINE HYDROCHLORIDE; CODEINE PHOSPHATE<br />

CODEINE PHOSPHATE; BROMPHENIRAMINE MALEATE; PHENYLPROPANOLAMINE HYDROCHLORIDE<br />

See BROMPHENIRAMINE MALEATE; CODEINE PHOSPHATE; PHENYLPROPANOLAMINE<br />

HYDROCHLORIDE<br />

CODEINE PHOSPHATE; CHLORPHENIRAMINE MALEATE; PSEUDOEPHEDRINE HYDROCHLORIDE<br />

See CHLORPHENIRAMINE MALEATE; CODEINE PHOSPHATE; PSEUDOEPHEDRINE<br />

HYDROCHLORIDE<br />

CODEINE PHOSPHATE; GUAIFENESIN<br />

Codeine Phosphate; syrup, oral 10mg/5ml;100mg/5ml Cenci<br />

Guaifenesin syrup, oral 10mg/5ml;100mg/5ml Halsey<br />

56


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

Brand(s)<br />

Guiatuss AC syrup, oral 10mg/5ml;100mg/5ml Alpharma<br />

Robitussin AC syrup, oral 10mg/5ml;100mg/5ml Robins<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Section 790.60.<br />

CODEINE PHOSPHATE; GUAIFENESIN; PSEUDOEPHEDRINE HYDROCHLORIDE<br />

Codeine Phosphate; Guaifenesin; syrup, oral 10mg/5ml;100mg/5ml; Morton Grove<br />

Pseudoephedrine Hydrochloride 30mg/5ml<br />

Brand(s)<br />

Codafed Expectorant syrup, oral 10mg/5ml;100mg/5ml Hauck<br />

30mg/5ml<br />

Guiatuss DAC syrup, oral 10mg/5ml;100mg/5ml; Alpharma<br />

30mg/5ml<br />

Novadyne Expectorant syrup, oral 10mg/5ml;100mg/5ml Norton<br />

30mg/5ml<br />

Novahistine Expectorant syrup, oral 10mg/5ml;100mg/5ml; Aventis<br />

30mg/5ml<br />

Phenylhistine Expectorant syrup, oral 10mg/5ml;100mg/5ml; Cenci<br />

30mg/5ml<br />

Robitussin DAC Syrup syrup, oral 10mg/5ml;100mg/5ml; Robins<br />

30mg/5ml<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

CODEINE PHOSPHATE; IODINATED GLYCEROL<br />

Codeine Phosphate; @ liquid, oral 10mg/5ml;30mg/5ml Alpharma<br />

Iodinated Glycerol @ liquid, oral 10mg/5ml;30mg/5ml Duramed<br />

@ liquid, oral 10mg/5ml;30mg/5ml Halsey<br />

Brand(s)<br />

Iophen-C @ liquid, oral 10mg/5ml;30mg/5ml Naska<br />

Iotuss-C @ liquid, oral 10mg/5ml;30mg/5ml Cenci<br />

Oridol C @ liquid, oral 10mg/5ml;30mg/5ml Norton<br />

Tussi Organidin @ liquid, oral 10mg/5ml;30mg/5ml Wallace<br />

Tussi-R-Gen Expectorant @ liquid, oral 10mg/5ml;30mg/5ml Goldline<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

CODEINE PHOSPHATE; PHENYLEPHRINE HYDROCHLORIDE; PROMETHAZINE HYDROCHLORIDE<br />

Brand(s)<br />

Phenergan VC with Codeine syrup, oral 10mg/5ml;5mg/5ml; Wyeth-Ayerst<br />

6.25mg/5ml<br />

Pherazine VC with Codeine @ syrup, oral 10mg/5ml;5mg/5ml; Halsey<br />

6.25mg/5ml<br />

Prometh VC with Codeine syrup, oral 10mg/5ml;5mg/5ml; Alpharma<br />

6.25mg/5ml<br />

Promethazine VC with Codeine @ syrup, oral 10mg/5ml;5mg/5ml; Cenci<br />

6.25mg/5ml<br />

Promethazine VC with Codeine syrup, oral 10mg/5ml;5mg/5ml; Morton Grove<br />

6.25mg/5ml<br />

CODEINE PHOSPHATE; PROMETHAZINE HYDROCHLORIDE<br />

Codeine Phosphate; syrup, oral 10mg/5ml;6.25mg/5ml Hi-Tech<br />

57


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

Promethazine Hydrochloride syrup, oral 10mg/5ml;6.25mg/5ml Pharmaceutical Associates<br />

Brand(s)<br />

Phenergan with Codeine syrup, oral 10mg/5ml;6.25mg/5ml Wyeth-Ayerst<br />

Pherazine with Codeine @ syrup, oral 10mg/5ml;6.25mg/5ml Halsey<br />

Prometh with Codeine syrup, oral 10mg/5ml;6.25mg/5ml Alpharma<br />

Promethazine with Codeine @ syrup, oral 10mg/5ml;6.25mg/5ml Cenci<br />

Promethazine with Codeine syrup, oral 10mg/5ml;6.25mg/5ml Morton Grove<br />

CODEINE PHOSPHATE; PSEUDOEPHEDRINE HYDROCHLORIDE; TRIPROLIDINE HYDROCHLORIDE<br />

Codeine Phosphate; @ syrup, oral 10mg/5ml;30mg/5ml; Cenci<br />

Pseudoephedrine Hydrochloride; 1.25mg/5ml<br />

Triprolidine Hydrochloride<br />

Brand(s)<br />

Actifed with Codeine @ syrup, oral 10mg/5ml;30mg/5ml; Glaxo Wellcome<br />

1.25mg/5ml<br />

Pseudodine C syrup, oral 10mg/5ml;30mg/5ml; Morton Grove<br />

1.25mg/5ml<br />

Triacin-C syrup, oral 10mg/5ml;30mg/5ml; Alpharma<br />

1.25mg/5ml<br />

COLISTIMETHATE<br />

Colistimethate injection eq 150mg base/vial Pharma-Tel<br />

Brand(s)<br />

Coly-Mycin M injection eq 150mg base/vial Parkdale<br />

CORTICOTROPIN<br />

Corticotropin @ injection 40U/vial Steris<br />

Brand(s)<br />

ACTH @ injection 25,40U/vial Parkdale<br />

Acthar @ injection 25,40U/vial Aventis<br />

CROMOLYN SODIUM<br />

Cromolyn Sodium solution <strong>for</strong> inhalation 10mg/ml Alpharma<br />

solution <strong>for</strong> inhalation 10mg/ml Bausch and Lomb<br />

solution <strong>for</strong> inhalation 10mg/ml Dey<br />

solution <strong>for</strong> inhalation 10mg/ml Morton Grove<br />

solution <strong>for</strong> inhalation 10mg/ml Roxane<br />

solution <strong>for</strong> inhalation 10mg/ml Steripak<br />

solution <strong>for</strong> inhalation 10mg/ml Warrick<br />

solution, ophthalmic 4%<br />

Akorn<br />

solution, ophthalmic 4% Alcon *<br />

solution, ophthalmic 4%<br />

Novex<br />

Brand(s)<br />

Intal solution <strong>for</strong> inhalation 10mg/ml Aventis *<br />

Crolom solution, ophthalmic 4% Bausch and Lomb<br />

Cromoptic solution, ophthalmic 4% King<br />

Opticrom solution, ophthalmic 4% Allergan<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

CROTAMITON<br />

Brand(s)<br />

58


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

Crotan lotion, topical 10% Summers<br />

Eurax lotion, topical 10% Westwood Squibb<br />

CYANOCOBALAMIN<br />

Cyanocobalamin @ injection 1000mcg/ml Akorn<br />

@ injection 30mcg/ml<br />

American Pharmaceutical<br />

Partners<br />

injection 100mcg/ml<br />

American Pharmaceutical<br />

Partners<br />

@ injection 1000mcg/ml<br />

Aventis<br />

@ injection 30,100,1000mcg/ml Dell<br />

injection 1000mcg/ml<br />

Elkins-Sinn<br />

@ injection 30mcg/ml<br />

Luitpold<br />

injection 1000mcg/ml<br />

Luitpold<br />

injection 1000mcg/ml<br />

Medwick<br />

@ injection 1000mcg/ml<br />

Solopak<br />

Brand(s)<br />

Berubigen @ injection 1000mcg/ml Pharmacia & Upjohn<br />

Betalin 12 @ injection 100,1000mcg/ml Lilly<br />

Cobavite injection 100,1000mcg/ml Steris<br />

Redisol @ injection 1000mcg/ml Merck Sharp Dohme<br />

Rubivite @ injection 30,100,1000mcg/ml Bel-Mar<br />

Rubramin PC @ injection 100mcg/ml Squibb<br />

Rubramin PC injection 1000mcg/ml Squibb<br />

Ruvite @ injection 1000mcg/ml Savage/Altana<br />

Sytobex @ injection 1000mcg/ml Warner Chilcott<br />

Vi-Twel @ injection 1000mcg/ml Berlex<br />

Vibisone injection 1000mcg/ml American Pharmaceutical<br />

Partners<br />

CYANOCOBALAMIN; ASCORBIC ACID; BIOTIN; DEXPANTHENOL; ERGOCALCIFEROL; FOLIC ACID;<br />

NIACINAMIDE; PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN PHOSPHATE SODIUM; THIAMINE<br />

HYDROCHLORIDE; VITAMIN A; VITAMIN E<br />

See ASCORBIC ACID; BIOTIN; CYANOCOBALAMIN; DEXPANTHENOL; ERGOCALCIFEROL; FOLIC<br />

ACID; NIACINAMIDE; PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN PHOSPHATE SODIUM<br />

HYDROCHLORIDE; VITAMIN A; VITAMIN E<br />

CYANOCOBALAMIN; ASCORBIC ACID; FLUORIDE; IRON; NICOTINIC ACID; PYRIDOXINE HYDROCHLORIDE;<br />

RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D; VITAMIN E<br />

See ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; IRON; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D;<br />

VITAMIN E<br />

CYANOCOBALAMIN; ASCORBIC ACID; FLUORIDE; NICOTINIC ACID; PYRIDOXINE HYDROCHLORIDE;<br />

RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D; VITAMIN E<br />

See ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D;<br />

VITAMIN E<br />

CYCLACILLIN<br />

Cyclacillin @ tablet, oral 250,500mg Teva<br />

Brand(s)<br />

Cyclapen W @ tablet, oral 250,500mg Wyeth-Ayerst<br />

CYCLOBENZAPRINE HYDROCHLORIDE<br />

59


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

Cyclobenzaprine Hydrochloride tablet, oral 10mg Barr<br />

tablet, oral 10mg<br />

Danbury<br />

tablet, oral 10mg<br />

Geneva<br />

tablet, oral 10mg<br />

Mylan<br />

tablet, oral 10mg<br />

Royce<br />

tablet, oral 10mg<br />

Sidmak<br />

tablet, oral 10mg<br />

Watson<br />

Brand(s)<br />

Flexeril tablet, oral 10mg Merck Sharp and Dohme *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

CYCLOPENTOLATE HYDROCHLORIDE<br />

Cyclopentolate Hydrochloride solution, ophthalmic 1% Alcon Universal<br />

@ solution, ophthalmic 1%<br />

Sola Barnes Hind<br />

Brand(s)<br />

AK-Pentolate solution, ophthalmic 1,2% Akorn<br />

Cyclogyl solution, ophthalmic 0.5,1,2% Alcon<br />

Pentolair @ solution, ophthalmic 0.5,1% Pharmafair<br />

Pentolair solution, ophthalmic 1% Bausch and Lomb<br />

CYCLOPHOSPHAMIDE<br />

Cyclophosphamide injection 100,200,500mg,1gm Asta<br />

tablet, oral 25,50mg<br />

Roxane<br />

Brand(s)<br />

Cytoxan @ injection 100,200,500mg,1,2gm Bristol-Myers Squibb<br />

Lyophilized Cytoxan injection 100,200,500mg,1,2gm Bristol-Myers Squibb<br />

Neosar injection 100,200,500mg,1,2gm Pharmacia & Upjohn<br />

Cytoxan tablet, oral 25,50mg Bristol-Myers Squibb<br />

CYCLOSPORINE<br />

injection 50mg/ml<br />

Bed<strong>for</strong>d<br />

Brand(s)<br />

Sandimmune injection 50mg/ml Novartis<br />

NOTE: Within 24 hours of any interchange of a patient’s cyclosporine prescription, whe<strong>the</strong>r from a<br />

brand name manufacturer to a generic manufacturer, generic manufacturer to a brand name<br />

manufacturer, or generic manufacturer to a different generic manufacturer, <strong>the</strong> pharmacist must notify<br />

<strong>the</strong> prescriber of <strong>the</strong> interchange, identifying to <strong>the</strong> prescriber <strong>the</strong> name of <strong>the</strong> manufacturer of <strong>the</strong><br />

cyclosporine product dispensed to <strong>the</strong> patient.<br />

CYPROHEPTADINE HYDROCHLORIDE<br />

Cyproheptadine Hydrochloride syrup, oral 2mg/5ml Alpharma<br />

@ syrup, oral 2mg/5ml<br />

Halsey<br />

@ syrup, oral 2mg/5ml<br />

Morton Grove<br />

@ syrup, oral 2mg/5ml<br />

Naska<br />

tablet, oral 4mg<br />

ABC<br />

@ tablet, oral 4mg<br />

American Therapeutics<br />

@ tablet, oral 4mg<br />

(Ascot)<br />

@ tablet, oral 4mg<br />

Circa<br />

(continued on <strong>the</strong> next page)<br />

CYPROHEPTADINE HYDROCHLORIDE (continued)<br />

60


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

@ tablet, oral 4mg<br />

Danbury<br />

@ tablet, oral 4mg<br />

Duramed<br />

@ tablet, oral 4mg<br />

Eon<br />

@ tablet, oral 4mg<br />

Geneva<br />

@ tablet, oral 4mg<br />

Halsey<br />

tablet, oral 4mg<br />

IVAX<br />

@ tablet, oral 4mg<br />

KV<br />

tablet, oral 4mg<br />

MD<br />

@ tablet, oral 4mg<br />

Mylan<br />

tablet, oral 4mg<br />

Par<br />

@ tablet, oral 4mg<br />

Pioneer<br />

tablet, oral 4mg<br />

Sidmak<br />

@ tablet, oral 4mg<br />

Superpharm<br />

@ tablet, oral 4mg<br />

Watson<br />

Brand(s)<br />

Periactin syrup, oral 2mg/5ml Merck Sharp and Dohme<br />

Periactin tablet, oral 4mg Merck Sharp and Dohme<br />

CYTARABINE<br />

Cytarabine injection 100,500mg,1,2gm/vial Bed<strong>for</strong>d<br />

injection 2gm/vial<br />

Faulding<br />

injection 100,500mg,1,2gm/vial Gensia Sicor<br />

@ injection 100,500mg/vial<br />

Quad<br />

Brand(s)<br />

Cytosar-U injection 100,500mg,1,2gm/vial Pharmacia & Upjohn<br />

DACARBAZINE<br />

Dacarbazine injection 100,200mg/vial American Pharmaceutical<br />

Partners<br />

injection 200,500mg/vial<br />

Gensia Sicor<br />

@ injection 100,200mg/vial<br />

Quad<br />

Brand(s)<br />

DTIC-Dome injection 100,200mg/vial Bayer<br />

DANAZOL<br />

Danazol capsule, oral 50,100,200mg Barr<br />

Brand(s)<br />

Danocrine capsule, oral 50,100,200mg Sanofi Syn<strong>the</strong>labo<br />

DAUNORUBICIN HYDROCHLORIDE<br />

Daunorubicin Hydrochloride injection eq 5mg base/ml Bed<strong>for</strong>d<br />

injection eq 20mg base/vial<br />

Bigmar<br />

injection eq 5,20mg base/vial Gensia Sicor<br />

Brand(s)<br />

Cerubidine injection eq 20mg base/vial Bed<strong>for</strong>d<br />

Cerubidine @ injection eq 20mg base/vial Aventis<br />

Cerubidine @ injection eq 20mg base/vial Wyeth-Ayerst<br />

DESIPRAMINE HYDROCHLORIDE<br />

Desipramine Hydrochloride tablet, oral 10,25,50,75,100,150mg Eon<br />

tablet, oral 10,25,50,75,100,150mg Geneva<br />

tablet, oral 25,50,75,100,150mg Sidmak<br />

@ tablet, oral 25,50,75,100mg<br />

USL<br />

Brand(s)<br />

Norpramin tablet, oral 10,25,50,75,100,150mg Aventis<br />

61


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

DESMOPRESSIN ACETATE<br />

Desmopressin Acetate injection 0.004mg/ml Abbott<br />

injection 0.004mg/ml<br />

Bed<strong>for</strong>d<br />

injection 0.004mg/ml<br />

Gensia Sicor<br />

spray, metered, nasal 0.01mg/spray Bausch and Lomb<br />

Brand(s)<br />

Desmopressin Acetate injection 0.004mg/ml Bed<strong>for</strong>d<br />

Preservative-Free<br />

DDAVP injection 0.004mg/ml Aventis *<br />

DDAVP spray, metered, nasal 0.01mg/spray Aventis *<br />

DDAVP (needs no refrigeration) spray, metered, nasal 0.01mg/spray Aventis *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

DESOGESTREL; ETHINYL ESTRADIOL<br />

Brand(s)<br />

Apri tablet, oral 0.15mg;0.03mg Duramed<br />

Desogen tablet, oral 0.15mg;0.03mg Organon<br />

Ortho-Cept tablet, oral 0.15mg;0.03mg RW Johnson<br />

Note: 21 day packs may not be interchanged with 28 day packs.<br />

DESONIDE<br />

Desonide cream, topical 0.05% Copley<br />

cream, topical 0.05%<br />

Taro<br />

ointment, topical 0.05%<br />

Taro<br />

Brand(s)<br />

Desowen cream, topical 0.05% Owen/Galderma<br />

Tridesilon cream, topical 0.05% Clay Park<br />

Desowen ointment, topical 0.05% Owen/Galderma<br />

Tridesilon ointment, topical 0.05% Clay Park<br />

DESOXIMETASONE<br />

Desoximetasone cream, topical 0.05,0.25% Taro<br />

gel, topical 0.05%<br />

Taro<br />

ointment, topical 0.25%<br />

Altana<br />

Brand(s)<br />

Topicort LP cream, topical 0.05% Medicis<br />

Topicort cream, topical 0.25% Medicis<br />

Topicort gel, topical 0.05% Medicis<br />

Topicort @ ointment, topical 0.25% Medicis<br />

DEXAMETHASONE<br />

Dexamethasone elixir, oral 0.5mg/5ml Alpharma<br />

@ suspension, ophthalmic 0.1% Steris<br />

tablet, oral 0.5,0.75,1.5,4mg<br />

Roxane<br />

Brand(s)<br />

Decadron elixir, oral 0.5mg/5ml Merck Sharp and Dohme<br />

Hexadrol elixir, oral 0.5mg/5ml Organon/Akzona<br />

Mymethasone elixir, oral 0.5mg/5ml Morton Grove<br />

Maxidex suspension , ophthalmic 0.1% Alcon<br />

Decadron tablet, oral 0.5,0.75,1.5,4mg Merck Sharp and Dohme<br />

62


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

DEXAMETHASONE; NEOMYCIN SULFATE; POLYMYXIN B SULFATE<br />

Dexamethasone; Neomycin ointment, ophthalmic 0.1%; Fougera/Altana<br />

Sulfate; Polymyxin B Sulfate eq 3.5mg base/gm;10,000U/gm<br />

suspension , ophthalmic 0.1%; Alcon Universal<br />

eq 3.5mg base/ml;10,000u/ml<br />

Brand(s)<br />

Dexacidin @ ointment, ophthalmic 0.1%; Novartis<br />

eq 3.5mg base/gm;10,000U/gm<br />

Dexasporin ointment, ophthalmic 0.1%; Bausch and Lomb<br />

eq 3.5mg base/gm;10,000U/gm<br />

Maxitrol ointment, ophthalmic 0.1%; Falcon *<br />

eq 3.5mg base/gm;10,000U/gm<br />

Dexacidin suspension , ophthalmic 0.1%; Novartis<br />

eq 3.5mg base/ml;10,000U/ml<br />

Dexasporin suspension , ophthalmic 0.1%; Bausch and Lomb<br />

eq 3.5mg base/ml;10,000U/ml<br />

Maxitrol suspension , ophthalmic 0.1%; Falcon *<br />

eq 3.5mg base/ml;10,000U/ml<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

DEXAMETHASONE; TOBRAMYCIN<br />

Dexamethasone; Tobramycin solution, ophthalmic 0.1%; 0.3% Bausch and Lomb<br />

Brand(s)<br />

Tobradex solution, ophthalmic 0.1%; 0.3% Alcon<br />

DEXAMETHASONE SODIUM PHOSPHATE<br />

Dexamethasone Sodium @ injection eq 4mg phosphate/ml Akorn<br />

Phosphate @ injection eq 4mg phosphate/ml American Pharmaceutical<br />

Partners<br />

injection eq 10mg phosphate/ml American Pharmaceutical<br />

Partners<br />

@ injection eq 4mg phosphate/ml Bel-Mar<br />

@ injection eq 4mg phosphate/ml Dell<br />

injection eq 4,10mg phosphate/ml Elkins-Sinn<br />

@ injection eq 4mg phosphate/ml Gensia Sicor<br />

injection eq 10mg phosphate/ml Gensia Sicor<br />

@ injection eq 20mg phosphate/ml International Medication<br />

injection eq 4mg phosphate/ml Luitpold<br />

@ injection eq 4,10,20,<br />

Quad<br />

24mg phosphate/ml<br />

injection eq 4,10mg phosphate/ml Steris<br />

@ injection eq 24mg phosphate/ml Steris<br />

@ injection eq 4mg phosphate/ml Wyeth-Ayerst<br />

solution, ophthalmic-otic<br />

Alcon Universal<br />

eq 0.1% phosphate<br />

solution, ophthalmic<br />

Bausch and Lomb<br />

eq 0.1% phosphate<br />

@ solution, ophthalmic<br />

Sola Barnes Hind<br />

eq 0.1% phosphate<br />

Brand(s)<br />

Dexacen-4 @ injection eq 4mg phosphate/ml Central<br />

Decadron injection eq 4,24mg phosphate/ml Merck Sharp and Dohme<br />

Hexadrol injection eq 4,10mg phosphate/ml Organon/Akzona<br />

Hexadrol @ injection eq 20mg phosphate/ml Organon/Akzona<br />

Decadron @ ointment, ophthalmic Merck Sharp and Dohme<br />

eq 0.05% phosphate<br />

(continued on <strong>the</strong> next page)<br />

63


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

DEXAMETHASONE SODIUM PHOSPHATE (continued)<br />

Dexair @ ointment, ophthalmic Pharmafair<br />

eq 0.05% phosphate<br />

Maxidex ointment, ophthalmic Alcon<br />

eq 0.05% phosphate<br />

AK-Dex @ solution, ophthalmic-otic Akorn<br />

eq 0.1% phosphate<br />

Decadron solution, ophthalmic-otic Merck Sharp and Dohme<br />

eq 0.1% phosphate<br />

Dexair @ solution, ophthalmic Pharmafair<br />

eq 0.1% phosphate<br />

DEXAMETHASONE SODIUM PHOSPHATE; NEOMYCIN SULFATE<br />

Dexamethasone @ solution, ophthalmic Alcon Universal<br />

Sodium Phosphate; eq 0.1% phosphate;eq 3.5mg base/ml<br />

Neomycin Sulfate @ solution, ophthalmic Bausch and Lomb<br />

eq 0.1% phosphate;eq 3.5mg base/ml<br />

Brand(s)<br />

Neodecadron solution, ophthalmic Merck Sharp and Dohme<br />

eq 0.1% phosphate;eq 3.5mg base/ml<br />

Neo-Dexair @ solution, ophthalmic Pharmafair<br />

eq 0.1% phosphate;eq 3.5mg base/ml<br />

DEXCHLORPHENIRAMINE MALEATE<br />

Dexchlorpheniramine Maleate tablet, oral 2mg Sidmak<br />

Brand(s)<br />

Mylaramine syrup, oral 2mg/5ml Morton Grove<br />

Polaramine syrup, oral 2mg/5ml Schering<br />

Polaramine tablet, oral 2mg Schering<br />

DEXPANTHENOL; ASCORBIC ACID; BIOTIN; CYANOCOBALAMIN; ERGOCALCIFEROL; FOLIC ACID;<br />

NIACINAMIDE; PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN PHOSPHATE SODIUM; THIAMINE<br />

HYDROCHLORIDE; VITAMIN A; VITAMIN E<br />

See ASCORBIC ACID; BIOTIN; CYANOCOBALAMIN; DEXPANTHENOL; ERGOCALCIFEROL; FOLIC<br />

ACID; NIACINAMIDE; PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN PHOSPHATE SODIUM<br />

HYDROCHLORIDE; VITAMIN A; VITAMIN E<br />

DEXTROAMPHETAMINE SULFATE<br />

Dextroamphetamine Sulfate capsule, extended release 5,10,15mg Barr<br />

tablet, oral 5,10mg<br />

Barr<br />

tablet, oral 5mg<br />

Endo<br />

@ tablet, oral 5,10mg<br />

Eon<br />

@ tablet, oral 5,10mg<br />

Geneva<br />

@ tablet, oral 10mg<br />

Halsey<br />

@ tablet, oral 5,10mg<br />

Lannett<br />

@ tablet, oral 5mg<br />

Mast<br />

@ tablet, oral 5mg<br />

Purepac<br />

Brand(s)<br />

Dexedrine Spansules capsule, extended release 5,10,15mg GlaxoSmithKline<br />

Dexampex @ tablet, oral 5,10mg Teva<br />

Dexedrine tablet, oral 5mg GlaxoSmithKline<br />

Dextrostat tablet, oral 5,10mg Shire Richwood<br />

Ferndex @ tablet, oral 5mg Ferndale<br />

64


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

DEXTROAMPHETAMINE SACCHARATE; DEXTROAMPHETAMINE SULFATE; AMPHETAMINE ASPARTAME;<br />

AMPHETAMINE SULFATE<br />

See AMPHETAMINE ASPARTAME; AMPHETAMINE SULFATE; DEXTROAMPHETAMINE<br />

SACCHARATE; DEXTROAMPHETAMINE SULFATE<br />

DEXTROAMPHETAMINE SULFATE; DEXTROAMPHETAMINE SACCHARATE; AMPHETAMINE ASPARTAME;<br />

AMPHETAMINE SULFATE<br />

See AMPHETAMINE ASPARTAME; AMPHETAMINE SULFATE; DEXTROAMPHETAMINE<br />

SACCHARATE; DEXTROAMPHETAMINE SULFATE<br />

DEXTROMETHORPHAN HYDROBROMIDE; BROMPHENIRAMINE MALEATE;<br />

PSEUDOEPHEDRINE HYDROCHLORIDE<br />

See BROMPHENIRAMINE MALEATE; DEXTROMETHORPHAN HYDROBROMIDE;<br />

PSEUDOEPHEDRINE HYDROCHLORIDE<br />

DEXTROMETHORPHAN HYDROBROMIDE; CARBINOXAMINE MALEATE; PSEUDOEPHEDRINE<br />

HYDROCHLORIDE<br />

See CARBINOXAMINE MALEATE; DEXTROMETHORPHAN HYDROBROMIDE; PSEUDOEPHEDRINE<br />

HYDROCHLORIDE<br />

DEXTROMETHORPHAN HYDROBROMIDE; IODINATED GLYCEROL<br />

Dextromethorphan @ liquid, oral 10mg/5ml;30mg/5ml Alpharma<br />

Hydrobromide; @ liquid, oral 10mg/5ml;20mg/5ml Duramed<br />

Iodinated Glycerol @ liquid, oral 10mg/5ml;30mg/5ml Halsey<br />

@ liquid, oral 10mg/5ml;30mg/5ml LuChem<br />

Brand(s)<br />

Iogan DM @ liquid, oral 10mg/5ml;30mg/5ml Hi-Tech<br />

Iophen DM @ liquid, oral 10mg/5ml;30mg/5ml Naska<br />

Iotuss DM @ liquid, oral 10mg/5ml;30mg/5ml Cenci<br />

Sil-O-Tuss DM @ liquid, oral 10mg/5ml;30mg/5ml Silarx<br />

Tussi-Organidin DM @ liquid, oral 10mg/5ml;30mg/5ml Wallace<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Section 790.60.<br />

DEXTROMETHORPHAN HYDROBROMIDE; PROMETHAZINE HYDROCHLORIDE<br />

Dextromethorphan Hydrobromide; syrup, oral 15mg/5ml;6.25mg/5ml Hi-Tech<br />

Promethazine Hydrochloride<br />

Brand(s)<br />

Phenergan syrup, oral 15mg/5ml;6.25mg/5ml Wyeth-Ayerst<br />

with Dextromethorphan<br />

Pherazine DM @ syrup, oral 15mg/5ml;6.25mg/5ml Halsey<br />

Prometh syrup, oral 15mg/5ml;6.25mg/5ml Alpharma<br />

with Dextromethorphan<br />

Promethazine syrup, oral 15mg/5ml;6.25mg/5ml Morton Grove<br />

with Dextromethorphan<br />

DEXTROSE<br />

Dextrose injection 5gm/100ml (5%), Abbott<br />

10gm/100ml (10%),<br />

20gm/100ml (20%),<br />

30gm/100ml (30%),<br />

Abbott<br />

40gm/100ml (40%),<br />

(continued on <strong>the</strong> next page)<br />

65


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

DEXTROSE (continued)<br />

50gm/100ml (50%),<br />

60gm/100ml (60%),<br />

70gm/100ml (70%)<br />

injection 5gm/100ml (5%),<br />

10gm/100ml (10%),<br />

20gm/100ml (20%),<br />

30gm/100ml (30%),<br />

40gm/100ml (40%),<br />

50gm/100ml (50%),<br />

60gm/100ml (60%),<br />

70gm/100ml (70%)<br />

injection 5gm/100ml (5%),<br />

10gm/100ml (10%),<br />

@ 60gm/100ml (60%)<br />

injection 10gm/100ml (10%)<br />

@ injection 10gm/100ml (10%),<br />

Abbott<br />

Baxter<br />

Braun<br />

DHL<br />

Miles<br />

DEXTROSE; ALCOHOL<br />

See ALCOHOL; DEXTROSE<br />

DEXTROSE; BRETYLIUM TOSYLATE<br />

See BRETYLIUM TOSYLATE; DEXTROSE<br />

DEXTROSE; CALCIUM CHLORIDE; GLUTATHIONE DISULFIDE; MAGNESIUM CHLORIDE; POTASSIUM<br />

CHLORIDE; SODIUM BICARBONATE; SODIUM CHLORIDE; SODIUM PHOSPHATE<br />

See CALCIUM CHLORIDE; DEXTROSE; GLUTATHIONE DISULFIDE; MAGNESIUM CHLORIDE;<br />

POTASSIUM CHLORIDE; SODIUM BICARBONATE; SODIUM CHLORIDE; SODIUM PHOSPHATE<br />

DEXTROSE; CALCIUM CHLORIDE; MAGNESIUM CHLORIDE; SODIUM CHLORIDE; SODIUM LACTATE<br />

See CALCIUM CHLORIDE; DEXTROSE; MAGNESIUM CHLORIDE; SODIUM CHLORIDE; SODIUM<br />

LACTATE<br />

DEXTROSE; CALCIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM CHLORIDE<br />

See CALCIUM CHLORIDE; DEXTROSE; POTASSIUM CHLORIDE; SODIUM CHLORIDE<br />

DEXTROSE; CALCIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM CHLORIDE; SODIUM LACTATE<br />

See CALCIUM CHLORIDE; DEXTROSE; POTASSIUM CHLORIDE; SODIUM CHLORIDE; SODIUM<br />

LACTATE<br />

DEXTROSE; CLINDAMYCIN PHOSPHATE<br />

See CLINDAMYCIN PHOSPHATE; DEXTROSE<br />

DEXTROSE; DOBUTAMINE HYDROCHLORIDE<br />

Dextrose; Dobutamine injection 5gm/100ml; Abbott<br />

Hydrochloride eq 50mg base/100ml<br />

in plastic container injection 5gm/100ml; Abbott<br />

eq 100mg base/100ml<br />

injection 5gm/100ml;<br />

Abbott<br />

eq 200mg base/100ml<br />

(continued on <strong>the</strong> next page)<br />

66


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

DEXTROSE; DOBUTAMINE HYDROCHLORIDE (continued)<br />

injection 5gm/100ml;<br />

eq 400mg base/100ml<br />

injection 5gm/100ml;<br />

eq 50mg base/100ml<br />

injection 5gm/100ml;<br />

eq 100mg base/100ml<br />

injection 5gm/100ml;<br />

eq 200mg base/100ml<br />

injection 5gm/100ml;<br />

eq 400mg base/100ml<br />

Abbott<br />

Baxter<br />

Baxter<br />

Baxter<br />

Baxter<br />

DEXTROSE; DOPAMINE HYDROCHLORIDE<br />

Dextrose; Dopamine injection 5gm/100ml;80mg/100ml Abbott<br />

Hydrochloride injection 5gm/100ml; 160mg/100ml Abbott<br />

in plastic container injection 5gm/100ml; 320mg/100ml Abbott<br />

injection 5gm/100ml; 400mg/100ml Abbott<br />

injection 5gm/100ml;80mg/100ml Baxter<br />

injection 5gm/100ml; 160mg/100ml Baxter<br />

injection 5gm/100ml; 320mg/100ml Baxter<br />

injection 5gm/100ml;80mg/100ml Braun<br />

injection 5gm/100ml; 160mg/100ml Braun<br />

injection 5gm/100ml; 320mg/100ml Braun<br />

DEXTROSE; GENTAMICIN SULFATE<br />

Dextrose; injection 5gm/100ml; eq 60,70, Abbott<br />

Gentamicin Sulfate 80,90,100mg base/100ml<br />

injection 5gm/100ml; eq 60,70, Baxter<br />

80,90,100mg base/100ml<br />

injection 5gm/100ml; eq 60,70, Braun<br />

80,90,100mg base/100ml<br />

@ injection 5gm/100ml;<br />

International Medication<br />

eq 100mg/100ml<br />

DEXTROSE; HEPARIN SODIUM<br />

Dextrose; Heparin Sodium injection 5gm/100ml; 4,000U/100ml Abbott<br />

in plastic container injection 5gm/100ml; 5,000U/100ml Abbott<br />

injection 5gm/100ml;10,000U/100ml Abbott<br />

injection 5gm/100ml; 4,000U/100ml Baxter<br />

injection 5gm/100ml; 5,000U/100ml Baxter<br />

injection 5gm/100ml;10,000U/100ml Baxter<br />

@ injection 5gm/100ml; 200U/100ml Braun<br />

@ injection 5gm/100ml; 1,000U/100ml Braun<br />

injection 5gm/100ml; 4,000U/100ml Braun<br />

injection 5gm/100ml; 5,000U/100ml Braun<br />

injection 5gm/100ml;10,000U/100ml Braun<br />

DEXTROSE; LIDOCAINE HYDROCHLORIDE<br />

Dextrose; Lidocaine Hydrochloride injection 5gm/100ml;200mg/100ml Abbott<br />

in plastic container injection 5gm/100ml;400mg/100ml Abbott<br />

injection 5gm/100ml;800mg/100ml Abbott<br />

injection 7.5gm/100ml;5gm/100ml Abbott<br />

injection 5gm/100ml;200mg/100ml Baxter<br />

injection 5gm/100ml;400mg/100ml Baxter<br />

injection 5gm/100ml;800mg/100ml Baxter<br />

(continued on <strong>the</strong> next page)<br />

67


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

DEXTROSE; LIDOCAINE HYDROCHLORIDE (continued)<br />

injection 5gm/100ml;200mg/100ml Braun<br />

injection 5gm/100ml;400mg/100ml Braun<br />

injection 5gm/100ml;800mg/100ml Braun<br />

Brand(s)<br />

Xylocaine 5% with Glucose 7.5% injection 7.5gm/100ml;5gm/100ml Astra Zeneca<br />

DEXTROSE; MAGNESIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM ACETATE; SODIUM CHLORIDE;<br />

SODIUM GLUCONATE<br />

Injection; in plastic container<br />

Brand(s)<br />

Isolyte S with Dextrose 5% injection 5gm/100ml;30mg/100ml; Braun<br />

37mg/100ml;370mg/100ml;<br />

530mg/100ml;500mg/100ml<br />

Plasma-Lyte 148 and Dextrose 5% injection 5gm/100ml;30mg/100ml; Baxter<br />

37mg/100ml;368mg/100ml;<br />

526mg/100ml;502mg/100ml<br />

DEXTROSE; MANNITOL<br />

Dextrose; Mannitol injection 5gm/100ml;10gm/100ml Abbott<br />

injection 5gm/100ml;10gm/100ml Braun<br />

DEXTROSE; NITROGLYCERIN<br />

Dextrose; Nitroglycerin injection 5gm/100ml;10mg/100ml Abbott<br />

injection 5gm/100ml;20mg/100ml Abbott<br />

injection 5gm/100ml;40mg/100ml Abbott<br />

injection 5gm/100ml;10mg/100ml Baxter<br />

injection 5gm/100ml;20mg/100ml Baxter<br />

injection 5gm/100ml;40mg/100ml Baxter<br />

DEXTROSE; POTASSIUM CHLORIDE<br />

Injection; in plastic container<br />

Dextrose; Potassium Chloride injection 5gm/100ml (5%); Abbott<br />

224mg/100ml (0.224%)<br />

injection 5gm/100ml (5%);<br />

Baxter<br />

75mg/100ml (0.075%)<br />

5gm/100ml (5%);<br />

Baxter<br />

150mg/100ml (0.15%)<br />

5gm/100ml (5%);<br />

Baxter<br />

224mg/100ml (0.224%)<br />

5gm/100ml (5%);<br />

Baxter<br />

300mg/100ml (0.3%)<br />

injection 5gm/100ml (5%);<br />

Braun<br />

75mg/100ml (0.075%)<br />

5gm/100ml (5%);<br />

Braun<br />

150mg/100ml (0.15%)<br />

5gm/100ml (5%);<br />

Braun<br />

300mg/100ml (0.3%)<br />

DEXTROSE; POTASSIUM CHLORIDE; SODIUM CHLORIDE<br />

Injection; in plastic container<br />

Dextrose; injection 5gm/100ml (5%); Abbott<br />

Potassium Chloride; 74.5mg/100ml (0.075%);<br />

Sodium Chloride 450mg/100ml (0.45%)<br />

(continued on <strong>the</strong> next page)<br />

68


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

DEXTROSE; POTASSIUM CHLORIDE; SODIUM CHLORIDE (continued)<br />

injection 5gm/100ml (5%);<br />

149mg/100ml (0.15%);<br />

450mg/100ml (0.45%)<br />

injection 5gm/100ml (5%);<br />

224mg/100ml (0.224%);<br />

450mg/100ml (0.45%)<br />

injection 5gm/100ml (5%);<br />

298mg/100ml (0.3%);<br />

450mg/100ml (0.45%)<br />

injection 5gm/100ml (5%);<br />

74.5mg/100ml (0.075%);<br />

900mg/100ml (0.9%)<br />

injection 5gm/100ml (5%);<br />

149mg/100ml (0.15%);<br />

900mg/100ml (0.9%)<br />

injection 5gm/100ml (5%);<br />

224mg/100ml (0.224%);<br />

900mg/100ml (0.9%)<br />

injection 5gm/100ml (5%);<br />

298mg/100ml (0.3%);<br />

900mg/100ml (0.9%)<br />

injection 5gm/100ml (5%);<br />

75mg/100ml (0.075%);<br />

200mg/100ml (0.2%)<br />

injection 5gm/100ml (5%);<br />

150mg/100ml (0.15%);<br />

200mg/100ml (0.2%)<br />

injection 5gm/100ml (5%);<br />

224mg/100ml (0.224%);<br />

200mg/100ml (0.2%)<br />

injection 5gm/100ml (5%);<br />

300mg/100ml (0.3%);<br />

200mg/100ml (0.2%)<br />

injection 5gm/100ml (5%);<br />

75mg/100ml (0.075%);<br />

330mg/100ml (0.33%)<br />

injection 5gm/100ml (5%);<br />

150mg/100ml (0.15%);<br />

330mg/100ml (0.33%)<br />

injection 5gm/100ml (5%);<br />

224mg/100ml (0.224%);<br />

330mg/100ml (0.33%)<br />

injection 5gm/100ml (5%);<br />

300mg/100ml (0.3%);<br />

330mg/100ml (0.33%)<br />

injection 5gm/100ml (5%);<br />

75mg/100ml (0.075%);<br />

450mg/100ml (0.45%)<br />

injection 5gm/100ml (5%);<br />

150mg/100ml (0.15%);<br />

450mg/100ml (0.45%)<br />

injection 5gm/100ml (5%);<br />

224mg/100ml (0.224%);<br />

450mg/100ml (0.45%)<br />

injection 5gm/100ml (5%);<br />

300mg/100ml (0.3%);<br />

450mg/100ml (0.45%)<br />

Abbott<br />

Abbott<br />

Abbott<br />

Abbott<br />

Abbott<br />

Abbott<br />

Abbott<br />

Baxter<br />

Baxter<br />

Baxter<br />

Baxter<br />

Baxter<br />

Baxter<br />

Baxter<br />

Baxter<br />

Baxter<br />

Baxter<br />

Baxter<br />

Baxter<br />

(continued on <strong>the</strong> next page)<br />

69


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

DEXTROSE; POTASSIUM CHLORIDE; SODIUM CHLORIDE (continued)<br />

injection 5gm/100ml (5%);<br />

75mg/100ml (0.075%);<br />

900mg/100ml (0.9%)<br />

injection 5gm/100ml (5%);<br />

150mg/100ml (0.15%);<br />

900mg/100ml (0.9%)<br />

injection 5gm/100ml (5%);<br />

224mg/100ml (0.224%);<br />

900mg/100ml (0.9%)<br />

injection 5gm/100ml (5%);<br />

300mg/100ml (0.3%);<br />

900mg/100ml (0.9%)<br />

injection 5gm/100ml (5%);<br />

75mg/100ml (0.075%);<br />

200mg/100ml (0.2%)<br />

injection 5gm/100ml (5%);<br />

150mg/100ml (0.15%);<br />

200mg/100ml (0.2%)<br />

injection 5gm/100ml (5%);<br />

220mg/100ml (0.224%);<br />

200mg/100ml (0.2%)<br />

injection 5gm/100ml (5%);<br />

300mg/100ml (0.3%);<br />

200mg/100ml (0.2%)<br />

injection 5gm/100ml (5%);<br />

75mg/100ml (0.075%);<br />

330mg/100ml (0.33%)<br />

injection 5gm/100ml (5%);<br />

150mg/100ml (0.15%);<br />

330mg/100ml (0.33%)<br />

injection 5gm/100ml (5%);<br />

220mg/100ml (0.22%);<br />

330mg/100ml (0.33%)<br />

injection 5gm/100ml (5%);<br />

300mg/100ml (0.3%);<br />

330mg/100ml (0.33%)<br />

injection 5gm/100ml (5%);<br />

75mg/100ml (0.075%);<br />

450mg/100ml (0.45%)<br />

injection 5gm/100ml (5%);<br />

150mg/100ml (0.15%);<br />

450mg/100ml (0.45%)<br />

injection 5gm/100ml (5%);<br />

300mg/100ml (0.3%);<br />

450mg/100ml (0.45%)<br />

injection 5gm/100ml (5%);<br />

75mg/100ml (0.075%);<br />

900mg/100ml (0.9%)<br />

injection 5gm/100ml (5%);<br />

150mg/100ml (0.15%);<br />

900mg/100ml (0.9%)<br />

injection 5gm/100ml (5%);<br />

300mg/100ml (0.3%);<br />

900mg/100ml (0.9%)<br />

Baxter<br />

Baxter<br />

Baxter<br />

Baxter<br />

Braun<br />

Braun<br />

Braun<br />

Braun<br />

Braun<br />

Braun<br />

Braun<br />

Braun<br />

Braun<br />

Braun<br />

Braun<br />

Braun<br />

Braun<br />

Braun<br />

70


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

DEXTROSE; SODIUM CHLORIDE<br />

Injection; in plastic container<br />

Dextrose; Sodium Chloride injection 2.5gm/100ml (2.5%); Abbott<br />

450mg/100ml (0.45%)<br />

injection 5gm/100ml (5%);<br />

Abbott<br />

300mg/100ml (0.3%)<br />

injection 5gm/100ml (5%);<br />

Abbott<br />

450mg/100ml (0.45%)<br />

injection 5gm/100ml (5%);<br />

Abbott<br />

900mg/100ml (0.9%<br />

injection 2.5gm/100ml (2.5%); Baxter<br />

450mg/100ml (0.45%)<br />

injection 5gm/100ml (5%);<br />

Baxter<br />

200mg/100ml (0.2%)<br />

injection 5gm/100ml (5%);<br />

Baxter<br />

330mg/100ml (0.33%)<br />

injection 5gm/100ml (5%);<br />

Baxter<br />

450mg/100ml (0.45%)<br />

injection 5gm/100ml (5%);<br />

Baxter<br />

900mg/100ml (0.9%)<br />

injection 10gm/100ml (10%)<br />

Baxter<br />

900mg/100ml (0.9%)<br />

injection 2.5gm/100ml (2.5%); Braun<br />

450mg/100ml (0.45%)<br />

injection 5gm/100ml (5%);<br />

Braun<br />

200mg/100ml (0.2%)<br />

injection 5gm/100ml (5%);<br />

Braun<br />

330mg/100ml (0.33%)<br />

injection 5gm/100ml (5%);<br />

Braun<br />

450mg/100ml (0.45%)<br />

injection 5gm/100ml (5%);<br />

Braun<br />

900mg/100ml (0.9%)<br />

injection 10gm/100ml (10%)<br />

Braun<br />

900mg/100ml (0.9%)<br />

@ injection 5gm/100ml (5%);<br />

Miles<br />

200mg/100ml (0.2%)<br />

@ injection 5gm/100ml (5%);<br />

Miles<br />

300mg/100ml (0.3%)<br />

@ injection 5gm/100ml (5%);<br />

Miles<br />

450mg/100ml (0.45%)<br />

@ injection 5gm/100ml (5%);<br />

Miles<br />

900mg/100ml (0.9%)<br />

DEXTROSE; THEOPHYLLINE<br />

Dextrose; Theophylline injection 5gm/100ml (5%); Abbott<br />

40mg/100ml (0.04%)<br />

injection 5gm/100ml (5%);<br />

Abbott<br />

80mg/100ml (0.08%)<br />

injection 5gm/100ml (5%);<br />

Abbott<br />

160mg/100ml (0.16%)<br />

injection 5gm/100ml (5%);<br />

Abbott<br />

200mg/100ml (0.2%)<br />

injection 5gm/100ml (5%);<br />

Abbott<br />

320mg/100ml (0.32%)<br />

injection 5gm/100ml (5%);<br />

Abbott<br />

400mg/100ml (0.4%)<br />

injection 5gm/100ml (5%);<br />

Baxter<br />

40mg/100ml (0.04%)<br />

(continued on <strong>the</strong> next page)<br />

71


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

DEXTROSE; THEOPHYLLINE (continued)<br />

injection 5gm/100ml (5%);<br />

80mg/100ml (0.08%)<br />

injection 5gm/100ml (5%);<br />

160mg/100ml (0.16%)<br />

injection 5gm/100ml (5%);<br />

200mg/100ml (0.2%)<br />

injection 5gm/100ml (5%);<br />

320mg/100ml (0.32%)<br />

injection 5gm/100ml (5%);<br />

400mg/100ml (0.4%)<br />

injection 5gm/100ml (5%);<br />

40mg/100ml (0.04%)<br />

injection 5gm/100ml (5%);<br />

80mg/100ml (0.08%)<br />

injection 5gm/100ml (5%);<br />

160mg/100ml (0.16%)<br />

injection 5gm/100ml (5%);<br />

200mg/100ml (0.2%)<br />

injection 5gm/100ml (5%);<br />

320mg/100ml (0.32%)<br />

injection 5gm/100ml (5%);<br />

400mg/100ml (0.4%)<br />

Baxter<br />

Baxter<br />

Baxter<br />

Baxter<br />

Baxter<br />

Braun<br />

Braun<br />

Braun<br />

Braun<br />

Braun<br />

Braun<br />

DIAZEPAM<br />

Diazepam injection 5mg/ml Abbott<br />

@ injection 5mg/ml<br />

American Pharmaceutical<br />

Partners<br />

injection 5mg/ml<br />

Elkins-Sinn<br />

injection 5mg/ml<br />

Lederle<br />

injection 5mg/ml<br />

Marsam<br />

injection 5mg/ml<br />

Steris<br />

@ injection 5mg/ml<br />

Warner Chilcott<br />

tablet, oral 2,5,10mg<br />

Barr<br />

tablet, oral 2,5,10mg<br />

Danbury<br />

@ tablet, oral 2,5,10mg<br />

Duramed<br />

@ tablet, oral 2,5,10mg<br />

Ferndale<br />

tablet, oral 2,5,10mg<br />

Geneva<br />

@ tablet, oral 2,5,10mg<br />

Halsey<br />

@ tablet, oral 2,5,10mg<br />

IVAX<br />

tablet, oral 2,5,10mg<br />

Lederle<br />

@ tablet, oral 10mg<br />

Martec<br />

tablet, oral 2,5,10mg<br />

Mylan<br />

tablet, oral 2,5,10mg<br />

Par<br />

@ tablet, oral 2,5,10mg<br />

Pioneer<br />

tablet, oral 2,5,10mg<br />

Purepac<br />

@ tablet, oral 2,5,10mg<br />

Roxane<br />

@ tablet, oral 2,5,10mg<br />

Warner Chilcott<br />

@ tablet, oral 2,5,10mg<br />

Watson<br />

Brand(s)<br />

Valium injection 5mg/ml Roche<br />

Q-Pam @ tablet, oral 2,5,10mg Quantum<br />

Valium tablet, oral 2,5,10mg Roche<br />

DIAZOXIDE<br />

Diazoxide @ injection 15mg/ml American Pharmaceutical<br />

Partners<br />

@ injection 15mg/ml<br />

Quad<br />

(continued on <strong>the</strong> next page)<br />

72


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

DIAZOXIDE (continued)<br />

Brand(s)<br />

Hyperstat injection 15mg/ml Schering<br />

DICLOFENAC POTASSIUM<br />

Diclofenac Potassium tablet, oral 50mg Eon<br />

tablet, oral 50mg<br />

Geneva<br />

tablet, oral 50mg<br />

Mylan<br />

tablet, oral 50mg<br />

Teva<br />

tablet, oral 50mg<br />

Watson<br />

Brand(s)<br />

Cataflam tablet, oral 50mg Novartis *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

DICLOFENAC SODIUM<br />

Dicolfenac Sodium @ solution, ophthalmic 0.1% Falcon<br />

tablet, delayed release 15,50,75mg Carlsbad<br />

tablet, delayed release 25,50,75mg Copley<br />

tablet, delayed release 25,50,75mg Geneva<br />

tablet, delayed release 50,75mg Martec<br />

tablet, delayed release 50,75mg Purepac<br />

tablet, delayed release 25,50,75mg Roxane<br />

tablet, delayed release 50,75mg Sidmak<br />

tablet, delayed release 50,75mg Teva<br />

tablet, extended release 100mg Biovail<br />

tablet, extended release 100mg Mylan<br />

tablet, extended release 100ng Purepac<br />

Brand(s)<br />

Voltaren solution, ophthalmic 0.1% Novartis *<br />

Voltaren tablet, delayed release 25,50,75mg Novartis *<br />

Voltaren-XR tablet, extended release 100mg Novartis *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

DICLOXACILLIN SODIUM<br />

Dicloxacillin Sodium capsule, oral eq 250,500mg base Teva<br />

Brand(s)<br />

Dycill @ capsule, oral eq 250,500mg base SmithKline Beecham<br />

Dynapen capsule, oral eq 250,500mg base Apo<strong>the</strong>con<br />

Pathocil capsule, oral eq 250,500mg base Wyeth-Ayerst<br />

Dynapen powder <strong>for</strong> suspension Apo<strong>the</strong>con<br />

eq 62.5mg base/5ml<br />

Pathocil powder <strong>for</strong> suspension Wyeth-Ayerst<br />

eq 62.5mg base/5ml<br />

DICYCLOMINE HYDROCHLORIDE<br />

Dicyclomine Hydrochloride capsule, oral 10mg Barr<br />

@ capsule, oral 10mg<br />

Circa<br />

@ capsule, oral 10mg<br />

Halsey<br />

capsule, oral 10mg<br />

Lannett<br />

capsule, oral 10mg<br />

Mylan<br />

@ capsule, oral 10mg<br />

Pioneer<br />

capsule, oral 10mg<br />

Watson<br />

(continued on <strong>the</strong> next page)<br />

73


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

DICYCLOMINE HYDROCHLORIDE (continued)<br />

capsule, oral 10mg<br />

West-ward<br />

@ injection 10mg/ml<br />

Steris<br />

@ syrup, oral 10mg/5ml<br />

Alpharma<br />

@ tablet, oral 20mg<br />

Barr<br />

@ tablet, oral 20mg<br />

Circa<br />

tablet, oral 20mg<br />

Lannett<br />

tablet, oral 20mg<br />

Mylan<br />

@ tablet, oral 20mg<br />

Pioneer<br />

tablet, oral 20mg<br />

Watson<br />

tablet, oral 20mg<br />

West-ward<br />

Brand(s)<br />

Bentyl capsule, oral 10mg Aventis<br />

Bentyl injection 10mg/ml Aventis<br />

Bentyl Preservative-Free injection 10mg/ml Aventis<br />

Bentyl syrup, oral 10mg/5ml Aventis<br />

Bentyl tablet, oral 20mg Aventis<br />

DIENESTROL<br />

Dienestrol cream, vaginal 0.01% RW Johnson<br />

Brand(s)<br />

DV @ cream, vaginal 0.01% Aventis<br />

Estraguard @ cream, vaginal 0.01% Solvay<br />

DIETHYLPROPION HYDROCHLORIDE<br />

Diethylpropion Hydrochloride tablet, oral 25mg ABC<br />

@ tablet, oral 25mg<br />

Celltech<br />

@ tablet, oral 25mg<br />

Eon<br />

@ tablet, oral 25mg<br />

Teva<br />

@ tablet, oral 25mg<br />

Watson<br />

Brand(s)<br />

Tenuate tablet, oral 25mg Aventis<br />

Tepanil @ tablet, oral 25mg Riker/3M<br />

DIETHYLSTILBESTROL<br />

Diethylstilbestrol @ suppository, vaginal 0.1,0.5mg Lilly<br />

Brand(s)<br />

Stilbestrol @ suppository, vaginal 0.1,0.5mg Squibb<br />

DIFLORASONE DIACETATE<br />

Diflorasone Diacetate cream, topical 0.05% Altana<br />

cream, topical 0.05%<br />

Taro<br />

ointment, topical 0.05%<br />

Altana<br />

ointment, topical 0.05%<br />

Taro<br />

Brand(s)<br />

Psorcon cream, topical 0.05% Dermik<br />

Psorcon ointment, topical 0.05% Pharmacia & Upjohn<br />

DIFLUNISAL<br />

Diflunisal tablet, oral 250,500mg Danbury<br />

tablet, oral 500mg<br />

Geneva<br />

@ tablet, oral 250,500mg<br />

Purepac<br />

tablet, oral 250,500mg<br />

Roxane<br />

tablet, oral 250,500mg<br />

Teva<br />

(continued on <strong>the</strong> next page)<br />

74


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

DIFLUNISAL (continued)<br />

Brand(s)<br />

Dolobid tablet, oral 250,500mg Merck Sharp and Dohme *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

DIGOXIN<br />

Digoxin elixir, oral 0.05mg/ml Halsey<br />

elixir, oral 0.05mg/ml<br />

Pharmafair<br />

elixir, oral 0.05mg/ml<br />

Roxane<br />

injection 0.1,0.25mg/ml<br />

Abbott<br />

@ injection 0.25mg/ml<br />

American Pharmaceutical<br />

Partners<br />

injection 0.25mg/ml<br />

Elkins-Sinn<br />

injection 0.25mg/ml<br />

Wyeth-Ayerst<br />

Brand(s)<br />

Lanoxin Pediatric elixir, oral 0.05mg/ml Glaxo Wellcome<br />

Lanoxin injection 0.1,0.25mg/ml Glaxo Wellcome<br />

Digitek tablet, oral 0.125,0.25mg Amide<br />

Lanoxin tablet, oral 0.125,0.25mg Glaxo Wellcome<br />

* The elixir <strong>for</strong>m of this entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong><br />

<strong>Formulary</strong> as an exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Section 790.60.<br />

DIHYDROCODONE BITARTRATE; ACETAMINOPHEN; CAFFEINE<br />

See ACETAMINOPHEN; CAFFEINE; DIHYDROCODONE BITARTRATE<br />

DIHYDROERGOTOXINE METHANESULFONATE<br />

See ERGOLOID MESYLATES<br />

DILTIAZEM HYDROCHLORIDE<br />

Diltiazem Hydrochloride capsule (AB1), extended release Biovail<br />

60,90,120mg<br />

capsule (AB1), extended release Mylan<br />

60,90,120mg<br />

capsule (AB1), extended release Prographarm<br />

60,90,120mg<br />

capsule (AB1), extended release Teva<br />

60,90,120mg<br />

capsule (AB2), extended release Andrx<br />

120,180,240mg<br />

capsule (AB2), extended release Mylan<br />

120,180,240mg<br />

capsule (AB2), extended release TorPharm<br />

120,180,240mg<br />

capsule (AB3), extended release Biovail<br />

120,180,240,300mg<br />

capsule (AB3), extended release Purepac<br />

120,180,240,300mg<br />

injection 5mg/ml<br />

Abbott<br />

injection 5mg/ml<br />

Apotex<br />

injection 5mg/ml<br />

Bed<strong>for</strong>d<br />

injection 5mg/ml<br />

Gensia Sicor<br />

injection 5mg/ml<br />

Meridian<br />

(continued on <strong>the</strong> next page)<br />

75


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

DILTIAZEM HYDROCHLORIDE (continued)<br />

injection 5mg/ml<br />

Taylor<br />

tablet, oral 30,60,90,120mg<br />

Apo<strong>the</strong>con<br />

tablet, oral 30,60,90,120mg<br />

Copley<br />

tablet, oral 30,60,90,120mg<br />

IVAX<br />

tablet, oral 30,60,90,120mg<br />

Lederle<br />

tablet, oral 30,60,90,120mg<br />

Mylan<br />

tablet, oral 30,60,90,120mg<br />

Teva<br />

Brand(s)<br />

Cardizem SR capsule (AB1), extended release Aventis<br />

60,90,120mg<br />

Dilacor XR capsule (AB2), extended release Aventis *<br />

120,180,240mg<br />

Cardizem CD capsule (AB3), extended release Carderm<br />

120,180,240,300mg<br />

Cartia XT capsule (AB3), extended release Andrx<br />

120,180,240,300mg<br />

Cardizem injection 5mg/ml,100mg/vial Aventis<br />

Cardizem tablet, oral 30,60,90,120mg Aventis *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

<strong>Product</strong>s designated “AB1" may only be interchanged with o<strong>the</strong>r products designated as “AB1.” <strong>Product</strong>s<br />

designated as “AB2" may only be interchanged with o<strong>the</strong>r products designated as “AB2.” <strong>Product</strong>s designated<br />

as “AB3" may only be interchanged with o<strong>the</strong>r products designated as “AB3.” <strong>Product</strong>s designated as “AB1"<br />

MAY NOT BE INTERCHANGED with products designated as “AB2” or “AB3.” <strong>Product</strong>s designated as “AB2"<br />

MAY NOT BE INTERCHANGED with products designated as “AB1” or “AB3.” <strong>Product</strong>s designated as “AB3"<br />

MAY NOT BE INTERCHANGED with products designated as “AB1” or “AB2.”<br />

DIMENHYDRINATE<br />

Dimenhydrinate @ injection 50mg/ml Elkins-Sinn<br />

injection 50mg/ml<br />

Steris<br />

injection 50mg/ml<br />

Wyeth-Ayerst<br />

DIPHENHYDRAMINE HYDROCHLORIDE<br />

Diphenhydramine Hydrochloride @ capsule, oral 25,50mg<br />

capsule, oral 25,50mg<br />

@ capsule, oral 25,50mg<br />

capsule, oral 25,50mg<br />

@ capsule, oral 25,50mg<br />

@ capsule, oral 25,50mg<br />

capsule, oral 25,50mg<br />

@ capsule, oral 50mg<br />

@ capsule, oral 25,50mg<br />

capsule, oral 25,50mg<br />

@ capsule, oral 25,50mg<br />

@ capsule, oral 25,50mg<br />

@ capsule, oral 25,50mg<br />

@ capsule, oral 25,50mg<br />

capsule, oral 25,50mg<br />

capsule, oral 25,50mg<br />

capsule, oral 25,50mg<br />

@ capsule, oral 25,50mg<br />

@ capsule, oral 25,50mg<br />

@ capsule, oral 25,50mg<br />

capsule, oral 25,50mg<br />

@ capsule, oral 25,50mg<br />

(continued on <strong>the</strong> next page)<br />

Anabolic<br />

Barr<br />

Circa<br />

Danbury<br />

Elkins-Sinn<br />

Eon<br />

Geneva<br />

Halsey<br />

Hea<strong>the</strong>r<br />

ICN<br />

IVAX<br />

Impax<br />

Lannett<br />

Lederle<br />

LNK<br />

MK<br />

Mutual<br />

Newtron<br />

Perrigo<br />

Pioneer<br />

Private Formulations<br />

Purepac<br />

76


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

DIPHENHYDRAMINE HYDROCHLORIDE (continued)<br />

@ capsule, oral 50mg<br />

capsule, oral 25mg<br />

@ capsule, oral 50mg<br />

@ capsule, oral 25,50mg<br />

@ capsule, oral 25,50mg<br />

@ capsule, oral 25,50mg<br />

@ capsule, oral 50mg<br />

@ capsule, oral 25,50mg<br />

@ elixir, oral 12.5mg/5ml<br />

@ elixir, oral 12.5mg/5ml<br />

elixir, oral 12.5mg/5ml<br />

@ elixir, oral 12.5mg/5ml<br />

elixir, oral 12.5mg/5ml<br />

@ elixir, oral 12.5mg/5ml<br />

@ elixir, oral 12.5mg/5ml<br />

elixir, oral 12.5mg/5ml<br />

@ elixir, oral 12.5mg/5ml<br />

elixir, oral 12.5mg/5ml<br />

elixir, oral 12.5mg/5ml<br />

@ injection 10mg/ml<br />

@ injection 10mg/ml<br />

injection 50mg/ml<br />

injection 10,50mg/ml<br />

injection 50mg/ml<br />

Brand(s)<br />

Benadryl capsule, oral 25,50mg Parke-Davis<br />

Belix @ elixir, oral 12.5mg/5ml Halsey<br />

Benadryl elixir, oral 12.5mg/5ml Parke-Davis<br />

Dibenil @ elixir, oral 12.5mg/5ml Cenci<br />

Diphen @ elixir, oral 12.5mg/5ml USL<br />

Hydramine @ elixir, oral 12.5mg/5ml Alpharma<br />

Benadryl @ injection 10mg/ml Parke-Davis<br />

Benadryl Preservative-Free injection 50mg/ml Parke-Davis<br />

Diphenhydramine Hydrochloride injection 50mg/ml Abbott<br />

Preservative-Free<br />

Roxane<br />

Superpharm<br />

Superpharm<br />

Teva<br />

(Vangard/MWM)<br />

Watson<br />

West-Ward<br />

Whiteworth Towne<br />

Bundy<br />

KV<br />

Lannett<br />

Lederle<br />

MK<br />

Naska<br />

Perrigo<br />

Pharmaceutical Assoc/Beach<br />

Private Formulations<br />

Purepac<br />

Roxane<br />

American Pharmaceutical<br />

Partners<br />

Bel-Mar<br />

Elkins-Sinn<br />

Steris<br />

Wyeth-Ayerst<br />

Diphenhydramine Hydrochloride @ injection 50mg/ml<br />

American Pharmaceutical<br />

Preservative-Free Partners<br />

Diphenhydramine Hydrochloride injection 50mg/ml International Medication<br />

Preservative-Free<br />

Diphenhydramine Hydrochloride injection 50mg/ml Steris<br />

Preservative-Free<br />

DIPHENOXYLATE HYDROCHLORIDE; ATROPINE SULFATE<br />

See ATROPINE SULFATE; DIPHENOXYLATE HYDROCHLORIDE<br />

DIPIVEFRIN HYDROCHLORIDE<br />

Dipivefrin Hydrochloride solution, ophthalmic 0.1% Bausch and Lomb<br />

solution, ophthalmic 0.1% Falcon *<br />

Brand(s)<br />

AKpro solution, ophthalmic 0.1% Akorn<br />

Propine solution, ophthalmic 0.1% Allergan *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

77


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

DIPYRIDAMOLE<br />

Dipyridamole injection 5mg/ml Abbott<br />

injection 5mg/ml<br />

American Pharmaceutical<br />

Partners<br />

injection 5mg/ml<br />

Bed<strong>for</strong>d<br />

injection 5mg/ml<br />

Elkins-Sinn<br />

injection 5mg/ml<br />

Gensia Sicor<br />

tablet, oral 25,50,75mg<br />

Barr<br />

tablet, oral 25,50,75mg<br />

Geneva<br />

tablet, oral 25,50,75mg<br />

Lederle<br />

@ tablet, oral 25,50,75mg<br />

Purepac<br />

tablet, oral 50mg<br />

Watson<br />

Brand(s)<br />

Persantine injection 5mg/ml Boehringer-Ingelheim<br />

Persantine tablet, oral 25,50,75mg Boehringer-Ingelheim<br />

DISOPYRAMIDE PHOSPHATE<br />

Disopyramide Phosphate @ capsule, oral eq 100,150mg base Barr<br />

@ capsule, oral eq 100,150mg base Circa<br />

capsule, oral eq 100,150mg base Danbury<br />

capsule, oral eq 100,150mg base Geneva<br />

@ capsule, oral eq 100,150mg base Interpharm<br />

capsule, oral eq 100,150mg base IVAX<br />

@ capsule, oral eq 100,150mg base Mylan<br />

capsule, oral eq 100mg base Superpharm<br />

@ capsule, oral eq 150mg base Superpharm<br />

capsule, oral eq 100,150mg base Teva<br />

capsule, controlled release<br />

KV<br />

eq 150mg base<br />

Brand(s)<br />

Norpace capsule, oral eq 100,150mg base Searle<br />

Norpace CR capsule, controlled release Searle<br />

eq 100,150mg base<br />

DOBUTAMINE HYDROCHLORIDE<br />

Dobutamine Hydrochloride injection eq 12.5mg base/ml Abbott<br />

injection eq 12.5mg base/ml<br />

Astra Zeneca<br />

injection eq 12.5mg base/ml<br />

Bed<strong>for</strong>d<br />

injection eq 12.5mg base/ml<br />

Elkins-Sinn<br />

injection eq 12.5mg base/ml<br />

Gensia Sicor<br />

injection eq 12.5mg base/ml<br />

Luitpold<br />

injection eq 12.5mg base/ml<br />

Marsam<br />

injection eq 12.5mg base/ml<br />

Steris<br />

Brand(s)<br />

Dobutrex injection eq 12.5mg base/ml Lilly<br />

DOBUTAMINE HYDROCHLORIDE; DEXTROSE<br />

See DEXTROSE; DOBUTAMINE HYDROCHLORIDE<br />

DOPAMINE HYDROCHLORIDE<br />

Dopamine Hydrochloride injection 40,80mg/ml Abbott<br />

@ injection 40,160mg/ml<br />

American Pharmaceutical<br />

Partners<br />

injection 80mg/ml<br />

American Pharmaceutical<br />

Partners<br />

injection 40,80,160mg/ml<br />

Astra Zeneca<br />

(continued on <strong>the</strong> next page)<br />

78


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

DOPAMINE HYDROCHLORIDE (continued)<br />

injection 40,80mg/ml<br />

Elkins-Sinn<br />

injection 40,80mg/ml<br />

Gensia Sicor<br />

injection 40mg/ml<br />

International Medication<br />

injection 40,80,160mg/ml<br />

Luitpold<br />

injection 40mg/ml<br />

Sanofi Syn<strong>the</strong>labo<br />

@ injection 40,80mg/ml<br />

Smith and Nephew<br />

@ injection 40,80mg/ml<br />

Warner Chilcott<br />

Brand(s)<br />

Dopastat @ injection 40,80mg/ml Parke-Davis<br />

Intropin injection 40,80,160mg/ml Faulding<br />

DOPAMINE HYDROCHLORIDE; DEXTROSE<br />

See DEXTROSE; DOPAMINE HYDROCHLORIDE<br />

DOXAPRAM HYDROCHLORIDE<br />

Doxapram Hydrochloride injection 20mg/ml Steris<br />

Brand(s)<br />

Dopram injection 20mg/ml Robins<br />

DOXAZOSIN MESYLATE<br />

Doxazosin Mesylate tablet, oral eq 1,2,4,8mg base Eon<br />

tablet, oral eq 1,2,4,8mg base ESI Lederle<br />

tablet, oral eq 1,2,4,8mg base Geneva<br />

tablet, oral eq 1,2,4,8mg base GenPharm<br />

tablet, oral eq 1,2,4,8mg base IVAX<br />

tablet, oral eq 1,2,4,8mg base KV<br />

tablet, oral eq 1,2,4,8mg base Mylan<br />

tablet, oral eq 1,2,4,8mg base Purepac<br />

tablet, oral eq 1,2,4,8mg base Teva<br />

tablet, oral eq 1,2,4,8mg base TorPharm<br />

tablet, oral eq 1,2,4,8mg base Watson<br />

Brand(s)<br />

Cardura tablet, oral eq 1,2,4,8mg base Pfizer<br />

DOXEPIN HYDROCHLORIDE<br />

Doxepin Hydrochloride<br />

@ capsule, oral eq 25,50,75,100mg base Barr<br />

capsule, oral eq 10,25,50,75, Danbury<br />

100mg base<br />

capsule, oral eq 10,25,50,75, Geneva<br />

100mg base<br />

capsule, oral eq 10,25,50,75,100, Lederle<br />

150mg base<br />

capsule, oral eq 10,25,50,75, Mylan<br />

100mg base<br />

capsule, oral eq 10,25,50,75,100, Par<br />

150mg base<br />

@ capsule, oral eq 10,25,50,75,100, Purepac<br />

150mg base<br />

@ capsule, oral eq 10,25,50,75,100, Quantum<br />

150mg base<br />

capsule, oral eq 10,25,50mg base Royce<br />

@ capsule, oral eq 10,25,50,75,100, Watson<br />

150mg base<br />

(continued on <strong>the</strong> next page)<br />

79


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

DOXEPIN HYDROCHLORIDE (continued)<br />

concentrate, oral eq 10mg base/ml Copley<br />

concentrate, oral eq 10mg base/ml Morton Grove<br />

concentrate, oral eq 10mg base/ml Silarx<br />

Brand(s)<br />

Adapin @ capsule, oral eq 10,25,50,75,100, New River<br />

150mg base<br />

Sinequan capsule, oral eq 10,25,50,75,100, Pfizer<br />

150mg base<br />

Sinequan concentrate, oral eq 10mg base/ml Pfizer<br />

DOXORUBICIN HYDROCHLORIDE<br />

Doxorubicin Hydrochloride injection 2mg/ml American Pharmaceutical<br />

Partners<br />

injection 2mg/ml,200mg/100ml Bed<strong>for</strong>d<br />

injection 10,20,50mg/vial<br />

Bed<strong>for</strong>d<br />

injection 2mg/ml,200mg/100ml Gensia Sicor<br />

injection 2mg/ml,200mg/100ml Pharmachemie<br />

injection 10,20,50mg/vial<br />

Pharmachemie<br />

Brand(s)<br />

Adriamycin PFS injection 2mg/ml,200mg/100ml Pharmacia & Upjohn<br />

Adriamycin RDF injection 10,20,50mg/vial Pharmacia & Upjohn<br />

Rubex injection 10,50mg/vial Bristol-Myers Squibb<br />

DOXYCYCLINE<br />

Doxycycline capsule, oral eq 50,100mg base Eon<br />

capsule, oral eq 50,100mg base Halsey<br />

capsule, oral eq 50,100mg base Par<br />

capsule, oral eq 50,100mg base Ranbaxy<br />

Brand(s)<br />

Monodox capsule, oral eq 50,100mg base OClassen<br />

Doxychel @ powder <strong>for</strong> suspension Rachelle<br />

eq 25mg base/5ml<br />

Vibramycin powder <strong>for</strong> suspension Pfizer<br />

eq 25mg base/5ml<br />

DOXYCYCLINE HYCLATE<br />

Doxycycline Hyclate capsule, oral eq 50,100mg base Barr<br />

(continued on <strong>the</strong> next page)<br />

capsule, oral eq 50,100mg base Danbury<br />

capsule, oral eq 50,100mg base Halsey<br />

@ capsule, oral eq 50,100mg base Hea<strong>the</strong>r<br />

@ capsule, oral eq 50,100mg base Interpharm<br />

capsule, oral eq 50,100mg base IVAX<br />

capsule, oral eq 50,100mg base Mutual<br />

capsule, oral eq 50,100mg base Mylan<br />

@ capsule, oral eq 50,100mg base Par<br />

@ capsule, oral eq 50,100mg base Private Formulations<br />

@ capsule, oral eq 50,100mg base Ranbaxy<br />

@ capsule, oral eq 50,100mg base Superpharm<br />

@ capsule, oral eq 50,100mg base Warner Chilcott<br />

capsule, oral eq 50,100mg base West-ward<br />

@ capsule, coated pellets eq 100mg base Sidmak<br />

@ capsule, oral eq 50,100mg base Watson<br />

@ injection eq 100,200mg base/vial Bed<strong>for</strong>d<br />

@ injection eq 100,200mg base/vial Elkins-Sinn<br />

@ injection eq 100,200mg base/vial Lederle<br />

80


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

DOXYCYCLINE HYCLATE (continued)<br />

@ injection eq 100,200mg base/vial Quad<br />

tablet, oral eq 100mg base<br />

Barr<br />

tablet, oral eq 100mg base<br />

Danbury<br />

@ tablet, oral eq 50mg base<br />

Halsey<br />

tablet, oral eq 100mg base<br />

Halsey<br />

@ tablet, oral eq 100mg base<br />

Hea<strong>the</strong>r<br />

@ tablet, oral eq 100mg base<br />

Interpharm<br />

tablet, oral eq 100mg base<br />

IVAX<br />

tablet, oral eq 100mg base<br />

Mutual<br />

tablet, oral eq 100mg base<br />

Mylan<br />

@ tablet, oral eq 100mg base<br />

Superpharm<br />

tablet, oral eq 100mg base<br />

Vintage<br />

@ tablet, oral eq 100mg base<br />

Warner Chilcott<br />

@ tablet, oral eq 50,100mg base Watson<br />

Brand(s)<br />

Doxy-Lemmon @ capsule, oral eq 50,100mg base Teva<br />

Doxychel Hyclate capsule, oral eq 50,100mg base Houba<br />

Vibramycin capsule, oral eq 50,100mg base Pfizer<br />

Doryx<br />

capsule, coated pellets eq 100mg base Faulding<br />

Doryx<br />

capsule, coated pellets eq 100mg base Warner-Chilcott<br />

Doxy 100,200 injection eq 100,200mg base/vial American Pharmaceutical<br />

Partners<br />

Doxychel Hyclate @ injection eq 100mg base/vial Rachelle<br />

Vibramycin injection eq 100,200mg base/vial Pfizer<br />

Doxy-Lemmon @ tablet, oral eq 100mg base Teva<br />

Doxy-Tabs @ tablet, oral eq 50,100mg base Houba<br />

Vibra-Tabs tablet, oral eq 100mg base Pfizer<br />

DOXYLAMINE SUCCINATE<br />

Doxylamine Succinate @ tablet, oral 25mg Par<br />

@ tablet, oral 25mg<br />

Quantum<br />

Brand(s)<br />

Decapryn @ tablet, oral 25mg Aventis<br />

DROPERIDOL<br />

Droperidol injection 2.5mg/ml Abbott<br />

@ injection 2.5mg/ml<br />

American Pharmaceutical<br />

Partners<br />

@ injection 2.5mg/ml<br />

Astra Zeneca<br />

injection 2.5mg/ml<br />

Faulding<br />

injection 2.5mg/ml<br />

Luitpold<br />

@ injection 2.5mg/ml<br />

Quad<br />

@ injection 2.5mg/ml<br />

Smith and Nephew<br />

@ injection 2.5mg/ml<br />

Solopak<br />

@ injection 2.5mg/ml<br />

Steris<br />

Brand(s)<br />

Inapsine injection 2.5mg/ml Akorn<br />

DROPERIDOL; FENTANYL CITRATE<br />

Droperidol; Fentanyl Citrate injection 2.5mg/ml;eq 0.05mg base/ml Abbott<br />

injection 2.5mg/ml;eq 0.05mg base/ml Astra Zeneca<br />

Brand(s)<br />

Innovar @ injection 2.5mg/ml;eq 0.05mg base/ml Janssen<br />

81


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

EDETATE DISODIUM<br />

Edetate Disodium injection 150mg/ml Steris<br />

Brand(s)<br />

Endrate injection 150mg/ml Abbott<br />

EDROPHONIUM CHLORIDE<br />

Edrophonium Chloride injection 10mg/ml Abbott<br />

@ injection 10mg/ml<br />

Steris<br />

Brand(s)<br />

Edrophonium Chloride @ injection 10mg/ml Steris<br />

Preservative-Free<br />

Enlon injection 10mg/ml Baxter<br />

Reversol injection 10mg/ml Organon/Akzona<br />

Tensilon injection 10mg/ml ICN<br />

Tensilon Preservative-Free injection 10mg/ml ICN<br />

ENALAPRIL MALEATE<br />

Enalapril Maleate tablet, oral 2.5,5,10,20mg Apo<strong>the</strong>con<br />

tablet, oral 2.5,5,10,20mg<br />

Eon<br />

tablet, oral 2.5,5,10,20mg<br />

Geneva<br />

tablet, oral 2.5,5,10,20mg<br />

GenPharm<br />

tablet, oral 2.5,5,10,20mg<br />

IVAX<br />

tablet, oral 2.5,5,10,20mg<br />

KRKA/Danbury<br />

tablet, oral 2.5,5,10,20mg<br />

Lek<br />

tablet, oral 2.5,5,10,20mg<br />

Mylan<br />

tablet, oral 2.5,5,10,20mg<br />

Ranbaxy<br />

tablet, oral 2.5,5,10,20mg<br />

Taro<br />

tablet, oral 2.5,5,10,20mg<br />

Teva<br />

tablet, oral 2.5,5,10,20mg<br />

Watson<br />

tablet, oral 2.5,5,10,20mg<br />

Wockhardt Americas<br />

Brand(s)<br />

Vasotec tablet, oral 2.5,5,10,20mg Merck *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

ENALAPRIL MALEATE; HYDROCHLOROTHIAZIDE<br />

Enalapril Maleate; tablet, oral 5mg;12.5mg Eon<br />

Hydrochlorothiazide tablet, oral 10mg; 25mg Eon<br />

tablet, oral 5mg;12.5mg<br />

Dr. Reddy<br />

tablet, oral 10mg;25mg<br />

Dr. Reddy<br />

tablet, oral 5mg;12.5mg<br />

Mylan<br />

tablet, oral 10mg;25mg<br />

Mylan<br />

tablet, oral 5mg;12.5mg<br />

Taro<br />

tablet, oral 10mg;25mg<br />

Taro<br />

tablet, oral 5mg;12.5mg<br />

Teva<br />

tablet, oral 10mg;25mg<br />

Teva<br />

Brand(s)<br />

Vaseretic tablet, oral 5mg;12.5mg Merck<br />

Vaseretic tablet, oral 10mg;25mg Merck<br />

ENALIPRILAT<br />

Enaliprilat injection 1.25mg/ml Abbott<br />

injection 1.25mg/ml<br />

Bed<strong>for</strong>d<br />

injection 1.25mg/ml<br />

Faulding<br />

injection 1.25mg/ml<br />

Gensia-Sicor<br />

(continued on <strong>the</strong> next page)<br />

82


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ENALIPRILAT (continued)<br />

Brand(s)<br />

Vasotec injection 1.25mg/ml Merck<br />

ENFLURANE<br />

Enflurane liquid, inhalation 99.9% Abbott<br />

liquid, inhalation 99.9%<br />

Minrad<br />

Brand(s)<br />

Ethrane liquid, inhalation 99.9% Baxter<br />

EPHEDRINE; HYDROXYZINE HYDROCHLORIDE; THEOPHYLLINE<br />

Ephedrine; Hydroxyzine syrup, oral 6.25mg/5ml;2.5mg/5ml; Alpharma<br />

Hydrochloride; Theophylline 32.5mg/5ml<br />

Brand(s)<br />

Marax DF syrup, oral 6.25mg/5ml;2.5mg/5ml; Roerig/Pfizer<br />

32.5mg/5ml<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

EPINEPHRINE BITARTRATE; BUPIVICAINE HYDROCHLORIDE<br />

See BUPIVICAINE HYDROCHLORIDE; EPINEPHRINE BITARTRATE<br />

EPINEPHRINE HYDROCHLORIDE<br />

Epinephrine Hydrochloride solution, ophthalmic 0.1% Iolab<br />

Brand(s)<br />

Adrenalin Chloride solution, ophthalmic 0.1% Parke-Davis<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

EPINEPHRINE; LIDOCAINE HYDROCHLORIDE<br />

Epinephrine; Lidocaine injection 0.005mg/ml;0.5% Abbott<br />

Hydrochloride injection 0.005mg/ml;1% Abbott<br />

injection 0.005mg/ml;1.5%<br />

Abbott<br />

injection 0.005mg/ml;2%<br />

Abbott<br />

injection 0.01mg/ml;1%<br />

Abbott<br />

injection 0.01mg/ml;2%<br />

Abbott<br />

@ injection 0.01mg/ml;1%<br />

Bel-Mar<br />

@ injection 0.01mg/ml;2%<br />

Bel-Mar<br />

injection 0.01mg/ml;1%<br />

Dell<br />

injection 0.01mg/ml;2%<br />

Dell<br />

injection 0.01mg/ml;2%<br />

Eastman Kodak<br />

injection 0.02mg/ml;2%<br />

Eastman Kodak<br />

injection 0.01mg/ml;1%<br />

Elkins-Sinn<br />

injection 0.01mg/ml;2%<br />

Elkins-Sinn<br />

injection 0.01mg/ml;1%<br />

Graham<br />

injection 0.02mg/ml;2%<br />

Graham<br />

@ injection 0.01mg/ml;1%<br />

International Medication<br />

@ injection 0.01mg/ml;1%<br />

Steris<br />

@ injection 0.01mg/ml;2%<br />

Steris<br />

(continued on <strong>the</strong> next page)<br />

83


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

EPINEPHRINE; LIDOCAINE HYDROCHLORIDE (continued)<br />

Brand(s)<br />

Alphacaine Hydrochloride @ injection 0.01mg/ml;2% Carlisle<br />

with Epinephrine<br />

Alphacaine Hydrochloride @ injection 0.02mg/ml;2% Carlisle<br />

with Epinephrine<br />

Lidocaton injection 0.01mg/ml;2% Pharmaton<br />

Lidocaton @ injection 0.02mg/ml;2% Pharmaton<br />

Octocaine injection 0.01mg/ml;2% Novocol<br />

Octocaine injection 0.02mg/ml;2% Novocol<br />

Xylocaine with Epinephrine injection 0.005mg/ml;0.5% Astra Zeneca<br />

Xylocaine with Epinephrine injection 0.005mg/ml;1% Astra Zeneca<br />

Xylocaine with Epinephrine injection 0.005mg/ml;1.5% Astra Zeneca<br />

Xylocaine with Epinephrine injection 0.005mg/ml;2% Astra Zeneca<br />

Xylocaine with Epinephrine injection 0.01mg/ml;1% Astra Zeneca<br />

Xylocaine with Epinephrine injection 0.01mg/ml;2% Astra Zeneca<br />

Xylocaine with Epinephrine @ injection 0.02mg/ml;2% Astra Zeneca<br />

EPOETIN ALPHA<br />

Brand(s)<br />

Epogen injection, preservative free Amgen<br />

2000, 3000, 4000, 10000U<br />

Procrit injection, preservative free Ortho Biotech<br />

2000, 3000, 4000, 10000U<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

ERGOCALCIFEROL (50,000 International Units = 1.25mg)<br />

Vitamin D capsule, oral 50,000IU Banner Pharmacaps<br />

@ capsule, oral 50,000IU<br />

Chase<br />

@ capsule, oral 50,000IU<br />

Eon<br />

@ capsule, oral 50,000IU<br />

Everylife<br />

@ capsule, oral 50,000IU<br />

Impax<br />

@ capsule, oral 50,000IU<br />

Lannett<br />

capsule, oral eq 10,25,50,75,100, Par<br />

150mg base<br />

Brand(s)<br />

Deltalin @ capsule, oral 50,000IU Lilly<br />

Drisdol capsule, oral 50,000IU Sanofi Syn<strong>the</strong>labo<br />

ERGOCALCIFEROL; ASCORBIC ACID; BIOTIN; CYANOCOBALAMIN; DEXPANTHENOL; FOLIC ACID;<br />

NIACINAMIDE; PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN PHOSPHATE SODIUM; THIAMINE<br />

HYDROCHLORIDE; VITAMIN A; VITAMIN E<br />

See ASCORBIC ACID; BIOTIN; CYANOCOBALAMIN; DEXPANTHENOL; ERGOCALCIFEROL; FOLIC<br />

ACID; NIACINAMIDE; PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN PHOSPHATE SODIUM<br />

HYDROCHLORIDE; VITAMIN A; VITAMIN E<br />

ERGOLOID MESYLATES (DIHYDROERGOTOXINE METHANESULFONATE)<br />

Ergoloid Mesylates @ tablet, oral 1.0mg Barr<br />

(Dihydroergotoxine @ tablet, oral 1.0mg Circa<br />

Methanesulfonate) @ tablet, oral 1.0mg Danbury<br />

tablet, oral 1.0mg<br />

Mutual<br />

@ tablet, sublingual 0.5,1.0mg<br />

Barr<br />

@ tablet, sublingual 0.5,1.0mg<br />

Circa<br />

tablet, sublingual 0.5mg<br />

Danbury<br />

(continued on <strong>the</strong> next page)<br />

84


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ERGOLOID MESYLATES (DIHYDROERGOTOXINE METHANESULFONATE) (continued)<br />

@ tablet, sublingual 1.0mg<br />

Danbury<br />

@ tablet, sublingual 0.5mg<br />

IVAX<br />

tablet, sublingual 1.0mg<br />

IVAX<br />

@ tablet, sublingual 0.5,1.0mg<br />

KV<br />

@ tablet, sublingual 0.5,1.0mg<br />

Lederle<br />

@ tablet, sublingual 0.5,1.0mg<br />

Superpharm<br />

Brand(s)<br />

Gerimal @ tablet, oral 1mg Watson<br />

Hydergine tablet, oral 1.0mg Novartis<br />

Alkergot @ tablet, sublingual 0.5,1.0mg Eon<br />

Circanol @ tablet, sublingual 0.5,1.0mg Riker/3-M<br />

Deapril-ST @ tablet, sublingual 1.0mg Bristol-Myers Squibb<br />

Gerimal tablet, sublingual 0.5,1mg Watson<br />

H.E.A. @ tablet, sublingual 0.5,1.0mg (Vangard/MWM)<br />

Hydergine tablet, sublingual 0.5,1.0mg Novartis<br />

ERGOTAMINE TARTRATE<br />

Brand(s)<br />

Ergomar tablet, sublingual 2mg New River<br />

Ergostat @ tablet, sublingual 2mg Parke-Davis<br />

Wigrettes @ tablet, sublingual 2mg Organon/Akzona<br />

ERGOTAMINE TARTRATE; CAFFEINE<br />

See CAFFEINE; ERGOTAMINE TARTRATE<br />

ERYTHROMYCIN<br />

Erythromycin cap, delayed release pellets 250mg Abbott*<br />

cap, delayed release pellets 250mg Barr*<br />

gel, topical 2%<br />

Altana<br />

gel, topical 2%<br />

Stiefel<br />

ointment, ophthalmic 5mg/gm (0.5%) Akorn<br />

ointment, ophthalmic 5mg/gm (0.5%) Bausch and Lomb<br />

ointment, ophthalmic 5mg/gm (0.5%) Fougera/Altana<br />

@ ointment, ophthalmic 5mg/gm (0.5%) Pharmaderm/Altana<br />

@ ointment, ophthalmic 5mg/gm (0.5%) Pharmafair<br />

@ solution, topical 1.5%<br />

Alpharma<br />

solution, topical 2%<br />

Alpharma<br />

solution, topical 2%<br />

Altana<br />

solution, topical 2%<br />

Bausch and Lomb<br />

solution, topical 2%<br />

Clay-Park<br />

@ solution, topical 2%<br />

Lilly<br />

solution, topical 2%<br />

Morton Grove<br />

@ solution, topical 1.5,2%<br />

Pharmafair<br />

solution, topical 2%<br />

Stiefel<br />

swab, topical 2%<br />

Stiefel<br />

Brand(s)<br />

Eryc Sprinkles* @ cap, delayed release pellets 125mg Faulding<br />

Eryc 125* @ cap, delayed release pellets 125mg Parke-Davis<br />

Eryc* cap, delayed release pellets 250mg Faulding<br />

Eryc* @ cap, delayed release pellets 250mg Warner-Chilcott<br />

Emgel gel, topical 2% Glaxo<br />

Erygel gel, topical 2% Allergan Herbert<br />

Ilotycin ointment, ophthalmic 5mg/gm (0.5%) Lilly/Dista<br />

A/T/S solution, topical 2% Aventis<br />

C-Solve-2 solution, topical 2% Bioglan<br />

Eryderm solution, topical 2% Abbott<br />

(continued on <strong>the</strong> next page)<br />

85


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ERYTHROMYCIN (continued)<br />

Erymax solution, topical 2% Allergan Herbert<br />

Erythra-Derm solution, topical 2% Paddock<br />

Erythro-Statin solution, topical 2% Hi-Tech<br />

Sansac solution, topical 2% Healthpoint<br />

Staticin solution, topical 1.5% Westwood Squibb<br />

T-Stat solution, topical 2% Westwood Squibb<br />

C-Solve-2 swab, topical 2% IVAX<br />

Erycette swab, topical 2% J and J<br />

T-Stat swab, topical 2% Westwood Squibb<br />

E-Base* tablet, delayed release 333,500mg Barr<br />

E-Mycin* tablet, delayed release 250,333mg Abbott<br />

Ery-tab *<br />

tablet, delayed release 250,333,500mg Abbott<br />

Ilotycin* @ tablet, delayed release 250mg Dista<br />

R-P Mycin* @ tablet, delayed release 250mg Solvay<br />

Robimycin* @ tablet, delayed release 250mg Robins<br />

* The admission of erythromycin delayed release enteric coated tablets and delayed release capsules<br />

containing enteric coated pellets to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an exception to <strong>the</strong> promulgated criteria was<br />

approved by a majority vote of <strong>the</strong> Technical Advisory Council, pursuant to Rule 790.60.<br />

ERYTHROMYCIN ESTOLATE<br />

Erythromycin Estolate @ capsule, oral eq 125mg base Barr<br />

capsule, oral eq 250mg base Barr<br />

@ capsule, oral eq 250mg base Danbury<br />

@ capsule, oral eq 250mg base IVAX<br />

suspension, oral eq 125,<br />

Alpharma<br />

250mg base/5ml<br />

@ suspension, oral eq 125,<br />

Barr<br />

250mg base/5ml<br />

@ suspension, oral eq 250mg base/5ml Life<br />

Brand(s)<br />

Ilosone @ capsule, oral eq 125,250mg base Lilly/Dista<br />

Ilosone suspension, oral eq 125, Lilly/Dista<br />

250mg base/5ml<br />

ERYTHROMYCIN ETHYLSUCCINATE<br />

Erythromycin Ethylsuccinate granular powder, oral Barr<br />

eq 200mg base/5ml<br />

suspension, oral eq 200,<br />

Alpharma<br />

400mg base/5ml<br />

@ suspension, oral eq 200,<br />

KV<br />

400mg base/5ml<br />

@ suspension, oral eq 200,<br />

Lilly/Dista<br />

400mg base/5ml<br />

@ suspension, oral eq 400mg base/5ml Naska<br />

@ suspension, oral eq 200,<br />

Parke-Davis<br />

400mg base/5ml<br />

@ suspension, oral eq 200,<br />

Pharmafair<br />

400mg base/5ml<br />

@ tablet, oral eq 400mg base<br />

Barr<br />

tablet, oral eq 400mg base<br />

Mylan<br />

Brand(s)<br />

E.E.S. granular powder, oral Abbott<br />

eq 200mg base/5ml<br />

Ery-Ped granular powder, oral Abbott<br />

eq 200mg base/5ml<br />

(continued on <strong>the</strong> next page)<br />

86


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ERYTHROMYCIN ETHYLSUCCINATE (continued)<br />

Pediamycin @ granular powder, oral Ross/Abbott<br />

eq 200mg base/5ml<br />

E.E.S. 200,400 suspension, oral eq 200, Abbott<br />

400mg base/5ml<br />

E-Mycin-E @ suspension, oral eq 200, Pharmacia & Upjohn<br />

400mg base/5ml<br />

Pediamycin suspension, oral eq 200, Ross/Abbott<br />

400mg base/5ml<br />

Wyamycin - E @ suspension, oral eq 200, Wyeth-Ayerst<br />

400mg base/5ml<br />

E.E.S. tablet, chewable eq 200mg base Abbott<br />

Ery-Ped tablet, chewable eq 200mg base Abbott<br />

Pediamycin @ tablet, chewable eq 200mg base Ross/Abbott<br />

E.E.S. 400 tablet, oral eq 400mg base Abbott<br />

ERYTHROMYCIN ETHYLSUCCINATE; SULFISOXAZOLE ACETYL<br />

Erythromycin Ethylsuccinate; suspension, oral eq 200mg base/5ml; Barr<br />

Sulfisoxazole Acetyl eq 600mg base/5ml<br />

Brand(s)<br />

Eryzole suspension, oral eq 200mg base/5ml; Alra<br />

eq 600mg base/5ml<br />

Pediazole suspension, oral eq 200mg base/5ml; Ross/Abbott<br />

eq 600mg base/5ml<br />

ERYTHROMYCIN LACTOBIONATE<br />

Erythromycin Lactobionate @ injection eq 500mg,1gm base/vial American Pharmaceutical<br />

Partners<br />

injection eq 500mg,1gm base/vial Elkins-Sinn<br />

injection eq 500mg,1gm base/vial Gensia Sicor<br />

injection eq 500mg,1gm base/vial Lederle<br />

@ injection eq 500mg,1gm base/vial Quad<br />

Brand(s)<br />

Erythrocin injection eq 500mg,1gm base/vial Abbott<br />

ERYTHROMYCIN STEARATE (Bearing approved labeling which states that <strong>the</strong> tablets should be taken in <strong>the</strong><br />

fasting state or immediately be<strong>for</strong>e meals) **<br />

Erythromycin Stearate tablet, oral eq 250mg base Barr<br />

@ tablet, oral eq 500mg base<br />

Barr<br />

@ tablet, oral eq 250,500mg base Lederle<br />

tablet, oral eq 250,500mg base Mylan<br />

tablet, oral eq 250,500mg base Watson<br />

Brand(s)<br />

Erythrocin Stearate tablet, oral eq 250,500mg base Abbott<br />

Wyamycin-S @ tablet, oral eq 250,500mg base Wyeth-Ayerst<br />

** <strong>Drug</strong> product selection should be made only from products bearing <strong>the</strong> same type of approved labeling<br />

within an entity sub-heading.<br />

ERYTHROMYCIN STEARATE (Bearing approved labeling which states that <strong>the</strong> tablets should be taken on an<br />

empty stomach) **<br />

Erythromycin Stearate @ tablet, oral eq 250,500mg base IVAX<br />

@ tablet, oral eq 250mg base<br />

Purepac<br />

Brand(s)<br />

Bristamycin @ tablet, oral eq 250,500mg base Bristol/Bristol-Myers<br />

Erypar @ tablet, oral eq 250,500mg base Warner Chilcott<br />

Ethril 250,500 @ tablet, oral eq 250,500mg base Squibb<br />

(continued on <strong>the</strong> next page)<br />

87


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ERYTHROMYCIN STEARATE (Bearing approved labeling which states that <strong>the</strong> tablets should be taken on an<br />

empty stomach) ** (continued)<br />

Pfizer-E @ tablet, oral eq 250,500mg base Pfizer<br />

** <strong>Drug</strong> product selection should be made only from products bearing <strong>the</strong> same type of approved labeling<br />

within an entity sub-heading.<br />

ESTAZOLAM<br />

Estazolam tablet, oral 1,2mg IVAX<br />

tablet, oral 1,2mg<br />

Royce<br />

tablet, oral 1,2mg<br />

Teva<br />

Brand(s)<br />

Prosom tablet, oral 1,2mg Abbott<br />

ESTRADIOL<br />

Estradiol film, extended release, transdermal Mylan<br />

0.05,0.1mg/24 hours<br />

tablet, oral 0.5,1,2mg<br />

Applied Analytical Industries<br />

tablet, oral 0.5,1,2mg<br />

Barr<br />

tablet, oral 0.5,1,2mg<br />

Duramed<br />

tablet, oral 0.5,1,2mg<br />

ESI Lederle<br />

tablet, oral 0.5,1,2mg<br />

Mylan<br />

tablet, oral 0.5,1,2mg<br />

Watson<br />

Brand(s)<br />

Climara film, extended release, transdermal Berlex<br />

0.05,0.1mg/24 hours<br />

Vivelle film, extended release, transdermal Novartis<br />

0.0375,0.05,0.075,0.1mg 24 hours<br />

Vivelle-Dot film, extended release, transdermal Novartis<br />

0.0375,0.05,0.075,0.1mg/24 hours<br />

Estrace tablet, oral 0.5,1,2mg Bristol-Myers Squibb *<br />

Innofem tablet, oral 0.5,1,2mg Novo Nordisk<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

ESTRADIOL CYPIONATE<br />

Estradiol Cypionate @ injection 5mg/ml Quad<br />

injection 5mg/ml<br />

Steris<br />

Brand(s)<br />

Depo-Estradiol injection 5mg/ml Pharmacia & Upjohn<br />

ESTRADIOL CYPIONATE; TESTOSTERONE CYPIONATE<br />

Estradiol Cypionate; injection 2mg/ml;50mg/ml Steris<br />

Testosterone Cypionate<br />

Brand(s)<br />

Depo-Testadiol injection 2mg/ml;50mg/ml Pharmacia & Upjohn<br />

ESTRADIOL VALERATE<br />

Estradiol Valerate @ injection 10mg/ml Steris<br />

injection 20,40mg/ml<br />

Steris<br />

Brand(s)<br />

Delestrogen injection 10,20,40mg/ml King<br />

88


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ESTRADIOL VALERATE; TESTOSTERONE ENANTHATE<br />

Estradiol Valerate; injection 4mg/ml;90mg/ml Steris<br />

Testosterone Enanthate @ injection 8mg/ml;180mg/ml Steris<br />

Brand(s)<br />

Deladumone @ injection 4mg/ml;90mg/ml Bristol-Myers Squibb<br />

Deladumone-OB @ injection 8mg/ml;180mg/ml Bristol-Myers Squibb<br />

Ditate-DS injection 8mg/ml;180mg/ml Savage<br />

ESTROPIPATE (PIPERAZINE ESTRONE SULFATE)<br />

Estropipate tablet, oral 0.625,1.25,2.5mg Barr<br />

(Piperazine Estrone Sulfate) (equivalent to 0.75,1.5,3mg estropipate)<br />

tablet, oral 0.625,1.25,2.5,5mg Duramed<br />

(equivalent to 0.75,1.5,3,6mg estropipate)<br />

tablet, oral 0.625,1.25,2.5,5mg Mylan<br />

(equivalent to 0.75,1.5,3,6mg estropipate)<br />

tablet, oral 0.625,1.25,2.5,5mg Watson<br />

(equivalent to 0.75,1.5,3,6mg estropipate)<br />

Brand(s)<br />

Ogen tablet, oral 0.625,1.25,2.5,5mg Pharmacia & Upjohn<br />

(equivalent to 0.75,1.5,3,6mg estropipate)<br />

Ortho-Est tablet, oral 0.625,1.25mg Women First Healthcare*<br />

(equivalent to 0.75,1.5mg estropipate)<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

ETHAMBUTOL HYDROCHLORIDE<br />

Ethambutol Hydrochloride tablet, oral 400mg Barr<br />

tablet, oral 100,400mg<br />

West-ward<br />

Brands(s)<br />

Myambutol tablet, oral 100mg,400mg Lederle<br />

ETHCHLORVYNOL<br />

Ethchlorvynol capsule, oral 100mg Banner Pharmacaps<br />

@ capsule, oral 200,500,750mg Banner Pharmacaps<br />

Brand(s)<br />

Placidyl @ capsule, oral 100mg Abbott<br />

Placidyl capsule, oral 200,500,750mg Abbott<br />

ETHINYL ESTRADIOL; DESOGESTREL<br />

See DESOGESTREL; ETHINYL ESTRADIOL<br />

ETHINYL ESTRADIOL; ETHYNODIOL DIACETATE<br />

Brand(s)<br />

Demulen 1/35 tablet, oral 0.035mg;1mg Searle<br />

Demulen 1/50 tablet, oral 0.05mg;1mg Searle<br />

Zovia 1/35E tablet, oral 0.035mg;1mg Watson<br />

Zovia 1/50E tablet, oral 0.05mg;1mg Watson<br />

NOTE: 21 day packs may not be interchanged with 28 day packs.<br />

89


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ETHINYL ESTRADIOL; LEVONORGESTREL<br />

Brand(s)<br />

Alesse tablet, oral 0.02mg;0.1mg Wyeth-Ayerst<br />

Aviane tablet, oral 0.02mg;0.1mg Duramed<br />

Levora 0.15/30 tablet, oral 0.03mg;0.15mg Watson<br />

Nordette tablet, oral 0.03mg;0.15mg Wyeth-Ayerst *<br />

Enpresse tablet, oral, triphasic 0.03mg;0.05mg/ Duramed/Barr<br />

0.04mg;0.075mg/0.03mg;0.125mg<br />

Triphasil tablet, oral, triphasic 0.03mg;0.05mg/ Wyeth-Ayerst *<br />

0.04mg;0.075mg/0.03mg;0.125mg<br />

Trivora tablet, oral, triphasic 0.03mg;0.05mg/ Watson<br />

0.04mg;0.075mg/0.03mg;0.125mg<br />

NOTE: 21 day packs may not be interchanged with 28 day packs.<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

ETHINYL ESTRADIOL; NORETHINDRONE<br />

Brand(s)<br />

Brevicon tablet, oral 0.035mg;0.5mg Watson<br />

Nortrel 0.5/35 tablet, oral 0.035mg;0.5mg Barr<br />

Genora 0.5/35 tablet, oral 0.035mg;0.5mg Syntex<br />

Modicon tablet, oral 0.035mg;0.5mg Ortho/RW Johnson<br />

Nelova tablet, oral 0.035mg;0.5mg Watson<br />

Nortrel 1/35 tablet, oral 0.035mg;1mg Barr<br />

N.E.E. 1/35 @ tablet, oral 0.035mg;1mg Lexis<br />

Necon 1/35 tablet, oral 0.035mg;1mg Watson<br />

Nelova tablet, oral 0.035mg;1mg Watson<br />

Norcept-E 1/35 tablet, oral 0.035mg;1mg Gynopharma<br />

Norethin 1/35E tablet, oral 0.035mg;1mg Watson<br />

Norinyl 1+35 tablet, oral 0.035mg;1mg Watson<br />

Ortho-Novum 1/35 tablet, oral 0.035mg;1mg Ortho/RW Johnson<br />

Nelova 7/14 tablet, oral 0.035mg;0.5mg and 1mg Watson<br />

Ortho Novum 7/14 tablet, oral 0.035mg;0.5mg and 1mg Ortho/RW Johnson<br />

Gencept 10/11 tablet, oral 0.035mg;0.5mg and 1mg Barr<br />

Nelova 10/11 tablet, oral 0.035mg;0.5mg and 1mg Watson<br />

Ortho Novum 10/11 tablet, oral 0.035mg;0.5mg and 1mg Ortho/RW Johnson<br />

Note: 21 day packs may not be interchanged with 28 day packs.<br />

ETHINYL ESTRADIOL; NORETHINDRONE ACETATE<br />

Brand(s)<br />

Loestrin FE 1/20 tablet, oral 0.02mg;1mg Parke-Davis<br />

Loestrin FE 1.5/30 tablet, oral 0.03mg;1.5mg Parke-Davis<br />

Microgestin FE 1/20 tablet, oral 0.02mg;1mg Watson<br />

Microgestin FE 1.5/30 tablet, oral 0.03mg;1.5mg Watson<br />

Note: 21 day packs may not be interchanged with 28 day packs.<br />

ETHINYL ESTRADIOL; NORGESTREL<br />

Brand(s)<br />

Cryselle tablet, oral 0.03mg;0.3mg Duramed/Barr<br />

Lo/Ovral tablet, oral 0.03mg;0.3mg Wyeth-Ayerst<br />

Low-Ogestrel tablet, oral 0.03mg;0.3mg Watson<br />

Ogestrel tablet, oral 0.05mg;0.5mg SCS<br />

Ovral tablet, oral 0.05mg;0.5mg Wyeth-Ayerst<br />

Note: 21 day packs may not be interchanged with 28 day packs.<br />

90


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ETHOSUXIMIDE<br />

Ethosuximide syrup, oral 250mg/5ml Copley<br />

syrup, oral 250mg/5ml<br />

Pharmaceutical Associates<br />

Brand(s)<br />

Zarontin syrup, oral 250mg/5ml Parke-Davis<br />

ETHYNODIOL DIACETATE; ETHINYL ESTRADIOL<br />

See ETHINYL ESTRADIOL; ETHYNODIOL DIACETATE<br />

ETODOLAC<br />

Etodolac capsule, oral 300mg Aesgen<br />

capsule, oral 200,300mg<br />

Endo<br />

capsule, oral 200,300mg<br />

Geneva<br />

capsule, oral 200,300mg<br />

GenPharm<br />

capsule, oral 200,300mg<br />

IVAX<br />

capsule, oral 200,300mg<br />

Mylan<br />

capsule, oral 200,300mg<br />

Royce<br />

capsule, oral 200,300mg<br />

Taro<br />

capsule, oral 200,300mg<br />

Teva<br />

capsule, oral 200,300mg<br />

TorPharm<br />

capsule, oral 200,300mg<br />

Watson<br />

tablet, oral 400mg<br />

Aesgen<br />

tablet, oral 400mg<br />

Endeavor<br />

tablet, oral 400mg<br />

Endo<br />

tablet, oral 400,500mg<br />

Eon<br />

tablet, oral 400mg<br />

Geneva<br />

tablet, oral 400,500mg<br />

GenPharm<br />

tablet, oral 400,500mg<br />

IVAX<br />

tablet, oral 400,500mg<br />

Mylan<br />

tablet, oral 400,500mg<br />

Purepac<br />

tablet, oral 400,500mg<br />

Ranbaxy<br />

tablet, oral 400mg<br />

Royce<br />

tablet, oral 400,500mg<br />

Taro<br />

tablet, oral 400,500mg<br />

Teva<br />

tablet, oral 400mg<br />

Watson<br />

tablet, extended release 400,500mg Andrx<br />

tablet, extended release<br />

Teva<br />

400,500,600mg<br />

tablet, extended release 400mg Whitney/Point<br />

Brand(s)<br />

Lodine capsule, oral 200,300mg Wyeth-Ayerst *<br />

Lodine tablet, oral 400,500mg Wyeth-Ayerst *<br />

Lodine XL tablet, extended release Wyeth-Ayerst *<br />

400,500,600mg<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

ETOMIDATE<br />

Etomidate injection 2mg/ml Bed<strong>for</strong>d<br />

Brand(s)<br />

Amidate injection 2mg/ml Abbott<br />

ETOPOSIDE<br />

Etoposide capsule, oral 50mg GenPharm<br />

injection 20mg/ml<br />

Abbott<br />

(continued on <strong>the</strong> next page)<br />

91


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ETOPOSIDE (continued)<br />

injection 20mg/ml<br />

American Pharmaceutical<br />

Partners<br />

injection 20mg/ml<br />

Bed<strong>for</strong>d<br />

injection 20mg/ml<br />

Gensia Sicor<br />

injection 20mg/ml<br />

Marsam<br />

injection 20mg/ml<br />

Pharmachemie<br />

injection 20mg/ml<br />

Pierre Fabre Medicament<br />

@ injection 20mg/ml<br />

Steris<br />

injection 20mg/ml<br />

Supergen<br />

Brand(s)<br />

VePesid capsule, oral 50mg Bristol-Myers Squibb<br />

Toposar injection 20mg/ml Pharmacia & Upjohn<br />

VePesid injection 20mg/ml Bristol-Myers Squibb<br />

FAMOTIDINE<br />

Famotidine injection, 10mg/ml American Pharmaceutical<br />

Partners<br />

@ injection, 10mg/ml<br />

Apo<strong>the</strong>con<br />

injection, 10mg/ml<br />

Bed<strong>for</strong>d<br />

injection, 10mg/ml<br />

Ben Venue<br />

injection, 10mg/ml<br />

ESI Lederle<br />

injection, 10mg.ml<br />

Faulding<br />

tablet, oral 20,40mg<br />

Apo<strong>the</strong>con<br />

tablet, oral 20,40mg<br />

Carlsbad<br />

tablet, oral 20,40mg<br />

Danbury<br />

tablet, oral 10,20mg<br />

Eon<br />

tablet, oral 20,40mg<br />

Geneva<br />

tablet, oral 20,40mg<br />

GenPharm<br />

tablet, oral 20,40mg<br />

IVAX<br />

tablet, oral 20,40mg<br />

Mylan<br />

tablet, oral 20,40mg<br />

Purepac<br />

tablet, oral 20,40mg<br />

Reddy-Cheminor<br />

tablet, oral 20,40mg<br />

Teva<br />

tablet, oral 20,40mg<br />

TorPharm<br />

Brand(s)<br />

Famotidine (preservative-free) injection, 10mg/ml American Pharmaceutical<br />

Partners<br />

Famotidine (preservative-free) @ injection, 10mg/ml Apo<strong>the</strong>con<br />

Famotidine (preservative-free) injection, 10mg/ml Bed<strong>for</strong>d<br />

Famotidine (preservative-free) injection, 10mg/ml Ben Venue<br />

Famotidine (preservative-free) injection, 10mg/ml ESI Lederle<br />

Famotidine (preservative-free) injection, 10mg/ml Faulding<br />

Pepcid injection, 10mg/ml Merck<br />

Pepcid (preservative-free) injection, 10mg/ml Merck<br />

Pepcid tablet, oral 20,40mg Merck<br />

FENOPROFEN CALCIUM<br />

Fenoprofen Calcium @ capsule, oral eq 200,300mg base American Therapeutics<br />

@ capsule, oral eq 200,300mg base Danbury<br />

capsule, oral eq 200,300mg base Geneva<br />

@ capsule, oral eq 200,300mg base Halsey<br />

capsule, oral eq 200,300mg base Par<br />

@ capsule, oral eq 200,300mg base Quantum<br />

@ capsule, oral eq 200,300mg base Warner Chilcott<br />

@ capsule, oral eq 200,300mg base Watson<br />

@ tablet, oral eq 600mg base<br />

American Therapeutics<br />

tablet, oral eq 600mg base<br />

Danbury<br />

(continued on <strong>the</strong> next page)<br />

92


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

FENOPROFEN CALCIUM (continued)<br />

tablet, oral eq 600mg base<br />

Geneva<br />

@ tablet, oral eq 600mg base<br />

Halsey<br />

tablet, oral eq 600mg base<br />

IVAX<br />

tablet, oral eq 600mg base<br />

Lederle<br />

tablet, oral eq 600mg base<br />

Mutual<br />

tablet, oral eq 600mg base<br />

Mylan<br />

tablet, oral eq 600mg base<br />

Par<br />

tablet, oral eq 600mg base<br />

Purepac<br />

@ tablet, oral eq 600mg base<br />

Quantum<br />

@ tablet, oral eq 600mg base<br />

USL<br />

tablet, oral eq 600mg base<br />

Watson<br />

Brand(s)<br />

Nalfon capsule, oral eq 200,300mg base Lilly/Dista<br />

Nalfon tablet, oral eq 600mg base Lilly/Dista<br />

FENTANYL CITRATE<br />

Fentanyl Citrate @ injection eq 0.05mg base/ml Steris<br />

Brand(s)<br />

Fentanyl Citrate Preservative-Free injection eq 0.05mg base/ml Abbott<br />

Fentanyl Citrate Preservative-Free injection eq 0.05mg base/ml Elkins-Sinn<br />

Fentanyl Citrate @ injection eq 0.05mg base/ml Marsam<br />

Preservative-Free<br />

Sublimaze Preservative-Free injection eq 0.05mg base/ml Akorn<br />

FENTANYL CITRATE; DROPERIDOL<br />

See DROPERIDOL; FENTANYL CITRATE<br />

FLECAINAIDE ACETATE<br />

Flecainide Acetate tablet, oral 50,100,150mg Alphapharm<br />

Brand(s)<br />

Tambocor tablet, oral 50,100,150mg 3M *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

FLOXURIDINE<br />

Floxuridine injection 500mg/vial American Pharmaceutical<br />

Partners<br />

injection 500mg/vial<br />

Bed<strong>for</strong>d<br />

@ injection 500mg/vial<br />

Quad<br />

Brand(s)<br />

FUDR injection 500mg/vial Roche<br />

FLUOCINOLONE ACETONIDE<br />

Fluocinolone Acetonide @ cream, topical 0.01% Alpharma<br />

@ cream, topical 0.01,0.025%<br />

Clay-Park<br />

cream, topical 0.01,0.025%<br />

Fougera/Altana<br />

cream, topical 0.01,0.025%<br />

G & W<br />

@ cream, topical 0.01,0.025%<br />

Pharmaderm/Altana<br />

@ cream, topical 0.01,0.025%<br />

Pharmafair<br />

cream, topical 0.01,0.025%<br />

Taro<br />

cream, topical 0.01,0.025%<br />

Thames<br />

@ cream, topical 0.01,0.025%<br />

USL<br />

(continued on <strong>the</strong> next page)<br />

93


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

FLUOCINOLONE ACETONIDE (continued)<br />

ointment, topical 0.025%<br />

Fougera/Altana<br />

ointment, topical 0.025%<br />

G & W<br />

@ ointment, topical 0.025%<br />

Pharmaderm/Altana<br />

@ ointment, topical 0.025%<br />

Pharmafair<br />

ointment, topical 0.025%<br />

Taro<br />

@ ointment, topical 0.025%<br />

USL<br />

solution, topical 0.01%<br />

Alpharma<br />

@ solution, topical 0.01%<br />

Bausch and Lomb<br />

solution, topical 0.01%<br />

Fougera/Altana<br />

@ solution, topical 0.01%<br />

Morton Grove<br />

@ solution, topical 0.01%<br />

Pharmaderm<br />

@ solution, topical 0.01%<br />

Pharmafair<br />

solution, topical 0.01%<br />

Thames<br />

Brand(s)<br />

Fluocet cream, topical 0.025% Alpharma<br />

Fluonid @ cream, topical 0.025% Allergan Herbert<br />

Fluotrex @ cream, topical 0.01,0.025% Altana/Savage<br />

Synalar cream, topical 0.01,0.025% Medicis<br />

Fluonid @ ointment, topical 0.025% Allergan Herbert<br />

Fluotrex @ ointment, topical 0.025% Altana/Savage<br />

Synalar ointment, topical 0.025% Medicis<br />

Fluonid solution, topical 0.01% Allergan Herbert<br />

Fluotrex @ solution, topical 0.01% Altana/Savage<br />

Synalar solution, topical 0.01% Medicis<br />

FLUOCINONIDE<br />

Fluocinonide @ cream, topical 0.05% Clay-Park<br />

cream, topical 0.05%<br />

Draxis<br />

cream, topical 0.05%<br />

Fougera/Altana<br />

cream, topical 0.05%<br />

NMC<br />

cream, topical 0.05%<br />

Taro<br />

cream, topical 0.05%<br />

Teva<br />

cream, topical 0.05%<br />

Thames<br />

cream, emulsified base 0.05% NMC<br />

gel, topical 0.05%<br />

Fougera/Altana<br />

gel, topical 0.05%<br />

Taro<br />

gel, topical 0.05%<br />

Teva<br />

ointment, topical 0.05%<br />

Altana<br />

ointment, topical 0.05%<br />

Taro<br />

ointment, topical 0.05%<br />

Teva<br />

solution, topical 0.05%<br />

Alpharma<br />

solution, topical 0.05%<br />

Copley<br />

solution, topical 0.05%<br />

Fougera/Altana<br />

solution, topical 0.05%<br />

Taro<br />

solution, topical 0.05%<br />

Teva<br />

solution, topical 0.05%<br />

Thames<br />

Brand(s)<br />

Lidex cream, topical 0.05% Medicis *<br />

Lidex-E cream, emulsified base 0.05% Medicis *<br />

Lidex gel, topical 0.05% Medicis *<br />

Lidex ointment, topical 0.05% Medicis *<br />

Lidex solution, top 0.05% Medicis *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

94


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

FLUORIDE; ASCORBIC ACID; CYANOCOBALAMIN; IRON; NICOTINIC ACID; PYRIDOXINE HYDROCHLORIDE;<br />

RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D; VITAMIN E<br />

See ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; IRON; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D;<br />

VITAMIN E<br />

FLUORIDE; ASCORBIC ACID; CYANOCOBALAMIN; NICOTINIC ACID; PYRIDOXINE HYDROCHLORIDE;<br />

RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D; VITAMIN E<br />

See ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D;<br />

VITAMIN E<br />

FLUORIDE; ASCORBIC ACID; IRON; VITAMIN A; VITAMIN D<br />

See ASCORBIC ACID; FLUORIDE; IRON; VITAMIN A; VITAMIN D<br />

FLUORIDE; ASCORBIC ACID; VITAMIN A; VITAMIN D<br />

See ASCORBIC ACID; FLUORIDE; VITAMIN A; VITAMIN D<br />

FLUOROMETHOLONE<br />

Brand(s)<br />

Fluor-Op suspension, ophthalmic 0.1% Novartis *<br />

FML suspension, ophthalmic 0.1% Allergan *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

FLUOROURACIL<br />

Fluorouracil @ injection 50mg/ml ABIC<br />

injection 50mg/ml<br />

American Pharmaceutical<br />

Partners<br />

injection 50mg/ml<br />

Bed<strong>for</strong>d<br />

injection 50mg/ml<br />

Bigmar<br />

injection 50mg/ml<br />

Gensia-Sicor<br />

injection 50mg/ml<br />

ICN Puerto Rico<br />

@ injection 50mg/ml<br />

Marchar<br />

@ injection 50mg/ml<br />

Quad<br />

@ injection 50mg/ml<br />

Smith and Nephew<br />

injection 50mg/ml<br />

Steris<br />

Brand(s)<br />

Adrucil injection 50mg/ml Pharmacia & Upjohn<br />

FLUOXETINE HYDROCHLORIDE<br />

Fluoxetine Hydrochloride capsule, oral eq 10,20mg base Alphapharm<br />

capsule, oral eq 10,20mg base Barr<br />

capsule, oral eq 10,20,40mg base Dr. Reddy<br />

capsule, oral eq 10,20mg base Eon<br />

capsule, oral eq 10,20,40mg base Geneva<br />

capsule, oral eq 10,20mg base IVAX<br />

capsule, oral eq 10,20mg base Mallinckrodt<br />

capsule, oral eq 10,20mg base Mylan<br />

capsule, oral eq 10,20mg base Siegfried<br />

capsule, oral eq 10,20,40mg base Teva<br />

capsule, oral eq 10,20mg base Watson<br />

(continued on <strong>the</strong> next page)<br />

95


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

FLUOXETINE HYDROCHLORIDE (continued)<br />

solution, oral eq 20mg base/5ml Mallinckrodt<br />

solution, oral eq 20mg base/5ml Novex<br />

solution, oral eq 20mg base/5ml Teva<br />

tablet, oral eq 10mg base<br />

Alphapharm<br />

tablet, oral eq 10mg base<br />

Eon<br />

tablet, oral eq 10mg base<br />

IVAX<br />

tablet, oral eq 10mg base<br />

Teva<br />

Brand(s)<br />

Prozac capsule, oral eq 10,20,40mg base Lilly<br />

Prozac solution, oral eq 20mg base/5ml Lilly<br />

Prozac tablet, oral eq 10mg base Lilly<br />

Rapiflux tablet, oral eq 20mg base Alphapharm *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

FLUPHENAZINE DECANOATE<br />

Fluphenazine Decanoate injection 25mg/ml American Pharmaceutical<br />

Partners<br />

injection 25mg/ml<br />

Apotex<br />

injection 25mg/ml<br />

Bed<strong>for</strong>d<br />

injection 25mg/ml<br />

Gensia Sicor<br />

injection 25mg/ml<br />

King<br />

@ injection 25mg/ml<br />

Quad<br />

Brand(s)<br />

Prolixin Decanoate injection 25mg/ml Apo<strong>the</strong>con<br />

FLUPHENAZINE HYDROCHLORIDE<br />

Fluphenazine Hydrochloride concentrate, oral 5mg/ml Copley<br />

concentrate, oral 5mg/ml<br />

Pharmaceutical Associates<br />

elixir, oral 2.5mg/5ml<br />

Copley<br />

elixir, oral 2.5mg/5ml<br />

Pharmaceutical Associates<br />

injection 2.5mg/ml<br />

American Pharmaceutical<br />

Partners<br />

@ injection 2.5mg/ml<br />

Quad<br />

@ tablet, oral 1,2.5,5,10mg<br />

Circa<br />

tablet, oral 1,2.5,5,10mg<br />

Geneva<br />

tablet, oral 1,2.5,5,10mg<br />

Mylan<br />

tablet, oral 1,2.5,5,10mg<br />

Par<br />

Brand(s)<br />

Permetil concentrate, oral 5mg/ml Schering<br />

Prolixin concentrate, oral 5mg/ml Apo<strong>the</strong>con<br />

Prolixin elixir, oral 2.5mg/5ml Apo<strong>the</strong>con<br />

Prolixin injection 2.5mg/ml Apo<strong>the</strong>con<br />

Prolixin tablet, oral 1,2.5,5,10mg Apo<strong>the</strong>con<br />

FLURANDRENOLIDE<br />

Flurandrenolide @ lotion, topical 0.05% Alpharma<br />

Brand(s)<br />

Cordran lotion, topical 0.05% Oclassen<br />

FLURAZEPAM HYDROCHLORIDE<br />

Flurazepam Hydrochloride @ capsule, oral 15,30mg Barr<br />

capsule, oral 15,30mg<br />

Danbury<br />

capsule, oral 15,30mg<br />

Geneva<br />

(continued on <strong>the</strong> next page)<br />

96


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

FLURAZEPAM HYDROCHLORIDE (continued)<br />

@ capsule, oral 15,30mg<br />

Halsey<br />

capsule, oral 15,30mg<br />

Mylan<br />

capsule, oral 15,30mg<br />

Par<br />

@ capsule, oral 15,30mg<br />

Purepac<br />

@ capsule, oral 15,30mg<br />

Superpharm<br />

@ capsule, oral 15,30mg<br />

USL<br />

@ capsule, oral 15,30mg<br />

Warner-Chilcott<br />

@ capsule, oral 15mg<br />

Watson<br />

capsule, oral 30mg<br />

Watson<br />

capsule, oral 15,30mg<br />

West-ward<br />

Brand(s)<br />

Dalmane capsule, oral 15,30mg ICN Puerto Rico<br />

FLURBIPROFEN<br />

Flurbiprofen tablet, oral 50,100mg Geneva<br />

tablet, oral 50,100mg<br />

IVAX<br />

tablet, oral 50,100mg<br />

Mylan<br />

tablet, oral 50,100mg<br />

Sidmak<br />

tablet, oral 50,100mg<br />

Teva<br />

tablet, oral 50,100mg<br />

Warner Chilcott<br />

Brand(s)<br />

Ansaid tablet, oral 50,100mg Pharmacia & Upjohn *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

FLURBIPROFEN SODIUM<br />

Flurbiprofen Sodium solution, ophthalmic 0.03% Bausch and Lomb<br />

Brand(s)<br />

Ocufen solution, ophthalmic 0.03% Allergan *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

FLUTAMIDE<br />

Flutamide capsule, oral 125mg Barr<br />

capsule, oral 125mg<br />

Eon<br />

capsule, oral 125mg<br />

IVAX<br />

capsule, oral 125mg<br />

Teva<br />

Brand(s)<br />

Eulexin capsule, oral 125mg Schering<br />

FLUVOXAMINE MALEATE<br />

Fluvoxamine Maleate tablet, oral 25,50,100mg Barr<br />

tablet, oral 25,50,100mg<br />

Eon<br />

tablet, oral 25,50,100mg<br />

Geneva<br />

tablet, oral 25,50,100mg<br />

GenPharm<br />

tablet, oral 25,50,100mg<br />

IVAX<br />

tablet, oral 25,50,100mg<br />

Mylan<br />

tablet, oral 25,50,100mg<br />

Purepac<br />

tablet, oral 25,50,100mg<br />

Synthon<br />

tablet, oral 25,50,100mg<br />

TorPharm<br />

tablet, oral 25,50,100mg<br />

Watson<br />

Brand(s)<br />

Luvox tablet, oral 25,50,100mg Solvay<br />

97


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

FOLIC ACID<br />

Folic Acid injection 5mg/ml American Pharmaceutical<br />

Partners<br />

injection 5mg/ml<br />

Loch<br />

@ tablet, oral 1mg<br />

Anabolic<br />

@ tablet, oral 1mg<br />

Barr<br />

@ tablet, oral 1mg<br />

Circa<br />

tablet, oral 1mg<br />

Danbury<br />

@ tablet, oral 1mg<br />

Eon<br />

@ tablet, oral 1mg<br />

Everylife<br />

@ tablet, oral 1mg<br />

Halsey<br />

tablet, oral 1mg<br />

ICN<br />

@ tablet, oral 1mg<br />

Impax<br />

tablet, oral 1mg<br />

IVAX<br />

@ tablet, oral 1mg<br />

Lannett<br />

@ tablet, oral 1mg<br />

Lilly<br />

tablet, oral 1mg<br />

MK<br />

@ tablet, oral 1mg<br />

Pharmeral<br />

@ tablet, oral 1mg<br />

Pioneer<br />

tablet, oral 1mg<br />

Private Formulations<br />

@ tablet, oral 1mg<br />

Purepac<br />

tablet, oral 1mg<br />

Tablicaps<br />

@ tablet, oral 1mg<br />

(Unit Dose Labs)<br />

@ tablet, oral 1mg<br />

USL<br />

@ tablet, oral 1mg<br />

(Vangard/MWM)<br />

@ tablet, oral 1mg<br />

Vintage<br />

@ tablet, oral 1mg<br />

Watson<br />

tablet, oral 1mg<br />

West-ward<br />

@ tablet, oral 1mg<br />

Whiteworth Towne<br />

Brand(s)<br />

Folvite injection 5mg/ml Lederle<br />

Folicet tablet, oral 1mg Mission<br />

Folvite @ tablet, oral 1mg Lederle<br />

FOLIC ACID; ASCORBIC ACID; BIOTIN; CYANOCOBALAMIN; DEXPANTHENOL; ERGOCALCIFEROL;<br />

NIACINAMIDE; PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN PHOSPHATE SODIUM; THIAMINE<br />

HYDROCHLORIDE; VITAMIN A; VITAMIN E<br />

See ASCORBIC ACID; BIOTIN; CYANOCOBALAMIN; DEXPANTHENOL; ERGOCALCIFEROL; FOLIC<br />

ACID; NIACINAMIDE; PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN PHOSPHATE SODIUM<br />

HYDROCHLORIDE; VITAMIN A; VITAMIN E<br />

FUROSEMIDE<br />

Furosemide injection 10mg/ml Abbott<br />

injection 10mg/ml<br />

American Pharmaceutical<br />

Partners<br />

@ injection 10mg/ml<br />

Astra Zeneca<br />

injection 10mg/ml<br />

Elkins-Sinn<br />

injection 10mg/ml<br />

International Medication<br />

injection 10mg/ml<br />

Lederle<br />

injection 10mg/ml<br />

Luitpold<br />

injection 10mg/ml<br />

Marsam<br />

@ injection 10mg/ml<br />

Organon/Akzona<br />

injection 10mg/ml<br />

Sanofi Syn<strong>the</strong>labo<br />

@ injection 10mg/ml<br />

Smith and Nephew<br />

@ injection 10mg/ml<br />

Steris<br />

@ injection 10mg/ml<br />

Warner Chilcott<br />

@ injection 10mg/ml<br />

Wyeth-Ayerst<br />

(continued on <strong>the</strong> next page)<br />

98


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

FUROSEMIDE (continued)<br />

solution, oral 10mg/ml<br />

solution, oral 10mg/ml<br />

@ tablet, oral 20,40,80mg<br />

Morton Grove<br />

Roxane<br />

Barr<br />

tablet, oral 20,40,80mg<br />

Danbury<br />

@ tablet, oral 40mg<br />

Eon<br />

tablet, oral 20,40,80mg<br />

Geneva<br />

tablet, oral 20,40mg<br />

International Medication<br />

tablet, oral 20,40mg<br />

IVAX<br />

tablet, oral 20,40mg<br />

Kalapharm<br />

tablet, oral 20,40,80mg<br />

Lederle<br />

tablet, oral 20,40,80mg<br />

Mylan<br />

tablet, oral 20,40,80mg<br />

Roxane<br />

@ tablet, oral 20,40mg<br />

Superpharm<br />

@ tablet, oral 20,40,80mg<br />

Warner Chilcott<br />

tablet, oral 20,40,80mg<br />

Watson<br />

Brand(s)<br />

Lasix injection 10mg/ml Aventis<br />

Lasix solution, oral 10mg/ml Aventis<br />

Lasix tablet, oral 20,40,80mg Aventis<br />

GEMFIBROZIL<br />

Gemfibrozil @ capsule, oral 300mg Mylan<br />

@ capsule, oral 300mg<br />

Purepac<br />

tablet, oral 600mg<br />

Geneva<br />

tablet, oral 600mg<br />

Lederle<br />

tablet, oral 600mg<br />

Mylan<br />

@ tablet, oral 600mg<br />

Purepac<br />

tablet, oral 600mg<br />

Teva<br />

tablet, oral 600mg<br />

TorPharm<br />

tablet, oral 600mg<br />

Watson<br />

Brand(s)<br />

Lopid @ capsule, oral 300mg Parke-Davis<br />

Lopid tablet, oral 600mg Parke-Davis *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

GENTAMICIN SULFATE<br />

Gentamicin Sulfate @ cream, topical eq 0.1% base Alpharma<br />

@ cream, topical eq 0.1% base<br />

Bausch and Lomb<br />

cream, topical eq 0.1% base<br />

Clay-Park<br />

cream, topical eq 0.1% base<br />

Fougera/Altana<br />

@ cream, topical eq 0.1% base<br />

Pharmaderm/Altana<br />

cream, topical eq 0.1% base<br />

Thames<br />

injection eq 10,40mg base/ml Abbott<br />

injection eq 10,40mg base/ml American Pharmaceutical<br />

Partners<br />

injection eq 10,40mg base/ml Elkins-Sinn<br />

injection eq 10mg base/ml<br />

Gensia Sicor<br />

@ injection eq 40mg base/ml<br />

Gensia Sicor<br />

@ injection eq 1,40mg base/ml<br />

International Medication<br />

injection eq 40mg base/ml<br />

Kalapharm<br />

injection eq 40mg base/ml<br />

Pharmaceutical Specialties<br />

@ injection eq 10,40mg base/ml Solopak<br />

@ injection eq 10,40mg base/ml Steris<br />

@ injection eq 10,40mg base/ml Wyeth-Ayerst<br />

(continued on <strong>the</strong> next page)<br />

99


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

GENTAMICIN SULFATE (continued)<br />

@ ointment, topical eq 0.1% base<br />

@ ointment, topical eq 0.1% base<br />

ointment, topical eq 0.1% base<br />

ointment, topical eq 0.1% base<br />

@ ointment, topical eq 0.1% base<br />

ointment, topical eq 0.1% base<br />

ointment, ophthalmic eq 0.3% base<br />

@ solution, ophthalmic eq 0.3% base<br />

solution, ophthalmic eq 0.3% base<br />

solution, ophthalmic eq 0.3% base Falcon *<br />

@ solution, ophthalmic eq 0.3% base Paco<br />

Alpharma<br />

Bausch and Lomb<br />

Clay-Park<br />

Fougera/Altana<br />

Pharmaderm/Altana<br />

Thames<br />

Akorn<br />

Alcon Universal<br />

Bausch and Lomb<br />

Brand(s)<br />

Garamycin cream, topical eq 0.1% base Schering<br />

Gentafair @ cream, topical eq 0.1% base Pharmafair<br />

Apogen @ injection eq 10,40mg base/ml King<br />

Bristagen @ injection eq 40mg base/ml Bristol/Bristol-Myers<br />

Garamycin @ injection eq 10mg base/ml Schering<br />

Garamycin injection eq 1,40mg base/ml Schering<br />

Gentafair @ injection eq 40mg base/ml Pharmafair<br />

U-Gencin @ injection eq 10,40mg base/ml Pharmacia & Upjohn<br />

Garamycin ointment, topical eq 0.1% base Schering<br />

Gentafair @ ointment, topical eq 0.1% base Pharmafair<br />

Garamycin ointment, ophthalmic eq 0.3% base Schering<br />

Gentacidin @ ointment, ophthalmic eq 0.3% base Novartis<br />

Gentafair @ ointment, ophthalmic eq 0.3% base Pharmafair<br />

AK-Gentak solution, ophthalmic eq 0.3% base Akorn<br />

Garamycin solution, ophthalmic eq 0.3% base Schering<br />

Genoptic solution, ophthalmic eq 0.3% base Allergan<br />

Gentacidin solution, ophthalmic eq 0.3% base Novartis<br />

Gentafair @ solution, ophthalmic eq 0.3% base Pharmafair<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

GENTAMICIN SULFATE; DEXTROSE<br />

See DEXTROSE; GENTAMICIN SULFATE<br />

GENTAMICIN SULFATE; SODIUM CHLORIDE<br />

Gentamicin Sulfate; injection eq 60mg base/100ml; Abbott<br />

Sodium Chloride 900mg/100ml<br />

injection eq 70mg base/100ml; Abbott<br />

900mg/100ml<br />

injection eq 80mg base/100ml; Abbott<br />

900mg/100ml<br />

injection eq 90mg base/100ml; Abbott<br />

900mg/100ml<br />

injection eq 100mg base/100ml; Abbott<br />

900mg/100ml<br />

injection eq 1.2mg base/ml;9mg/ml Abbott<br />

injection eq 1.4mg base/ml;9mg/ml Abbott<br />

injection eq 1.6mg base/ml;9mg/ml Abbott<br />

injection eq 1.8mg base/ml;9mg/ml Abbott<br />

injection eq 2mg base/ml;9mg/ml Abbott<br />

injection eq 40mg base/100ml; Baxter<br />

900mg/100ml<br />

injection eq 60mg base/100ml; Baxter<br />

900mg/100ml<br />

(continued on <strong>the</strong> next page)<br />

100


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

GENTAMICIN SULFATE; SODIUM CHLORIDE (continued)<br />

injection eq 80mg base/100ml;<br />

900mg/100ml<br />

injection eq 100mg base/100ml;<br />

900mg/100ml<br />

injection eq 120mg base/100ml;<br />

900mg/100ml<br />

injection eq 0.8mg base/ml;9mg/ml<br />

injection eq 1.2mg base/ml;9mg/ml<br />

injection eq 1.6mg base/ml;9mg/ml<br />

injection eq 2mg base/ml;9mg/ml<br />

injection eq 2.4mg base/ml;9mg/ml<br />

injection eq 40mg base/100ml;<br />

900mg/100ml<br />

injection eq 60mg base/100ml;<br />

900mg/100ml<br />

injection eq 70mg base/100ml;<br />

900mg/100ml<br />

injection eq 80mg base/100ml;<br />

900mg/100ml<br />

injection eq 90mg base/100ml;<br />

900mg/100ml<br />

injection eq 100mg base/100ml;<br />

900mg/100ml<br />

injection eq 120mg base/100ml;<br />

900mg/100ml<br />

injection eq 0.8mg base/ml;9mg/ml<br />

injection eq 1.2mg base/ml;9mg/ml<br />

injection eq 1.4mg base/ml;9mg/ml<br />

injection eq 1.6mg base/ml;9mg/ml<br />

injection eq 1.8mg base/ml;9mg/ml<br />

injection eq 2mg base/ml;9mg/ml<br />

injection eq 2.4mg base/ml;9mg/ml<br />

Baxter<br />

Baxter<br />

Baxter<br />

Baxter<br />

Baxter<br />

Baxter<br />

Baxter<br />

Baxter<br />

Braun<br />

Braun<br />

Braun<br />

Braun<br />

Braun<br />

Braun<br />

Braun<br />

Braun<br />

Braun<br />

Braun<br />

Braun<br />

Braun<br />

Braun<br />

Braun<br />

GLIPIZIDE<br />

Glipizide tablet, oral 5,10mg Alphapharm<br />

tablet, oral 5,10mg<br />

Circa<br />

tablet, oral 5,10mg<br />

Duramed<br />

tablet, oral 5,10mg<br />

Endo<br />

tablet, oral 5,10mg<br />

Geneva<br />

tablet, oral 5,10mg<br />

IVAX<br />

tablet, oral 5,10mg<br />

Mylan<br />

tablet, oral 5,10mg<br />

Sidmak<br />

tablet, oral 5,10mg<br />

Teva<br />

tablet, oral 5,10mg<br />

TorPharm<br />

tablet, oral 5,10mg<br />

Watson<br />

Brand(s)<br />

Glucotrol tablet, oral 5,10mg Pfizer<br />

GLUCAGON HYDROCHLORIDE<br />

Glucagon Hydrochloride injection eq 1mg base/vial Lilly<br />

@ injection eq 10mg base/vial<br />

Lilly<br />

@ injection eq 1,10mg base/vial Quad<br />

GLUTATHIONE DISULFIDE; CALCIUM CHLORIDE; DEXTROSE; MAGNESIUM CHLORIDE; POTASSIUM<br />

CHLORIDE; SODIUM BICARBONATE; SODIUM CHLORIDE; SODIUM PHOSPHATE<br />

See CALCIUM CHLORIDE; DEXTROSE; GLUTATHIONE DISULFIDE; MAGNESIUM CHLORIDE;<br />

POTASSIUM CHLORIDE; SODIUM BICARBONATE; SODIUM CHLORIDE; SODIUM PHOSPHATE<br />

101


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

GLUTETHIMIDE<br />

Glutethimide tablet, oral 500mg Danbury<br />

@ tablet, oral 500mg<br />

Eon<br />

tablet, oral 500mg<br />

Geneva<br />

@ tablet, oral 250,500mg<br />

Halsey<br />

@ tablet, oral 250,500mg<br />

Lannett<br />

@ tablet, oral 500mg<br />

Watson<br />

Brand(s)<br />

Doriden @ tablet, oral 250,500mg Aventis<br />

GLYBURIDE<br />

Glyburide tablet, oral 1.25,2.5,5mg Teva ***<br />

Brand(s)<br />

Diabeta tablet, oral 1.25,2.5,5mg Aventis * **<br />

Micronase tablet, oral 1.25,2.5,5mg Pharmacia & Upjohn * **<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

** Diabeta and Micronase are NOT INTERCHANGEABLE at this time. Nei<strong>the</strong>r company has to date presented<br />

acceptable bioequivalence in<strong>for</strong>mation comparing <strong>the</strong>ir brand of glyburide to <strong>the</strong> o<strong>the</strong>r. Aventis, via Copley<br />

(Teva), is manufacturing glyburide <strong>for</strong> o<strong>the</strong>r labelers using <strong>the</strong> Diabeta federal new drug application (NDA) while<br />

Pharmacia & Upjohn is doing <strong>the</strong> same, via Greenstone, <strong>for</strong> at least one labeler using <strong>the</strong> Micronase NDA.<br />

Thus, Aventis manufactured generically labeled glyburide products are NOT INTERCHANGEABLE at this time<br />

with Pharmacia & Upjohn manufactured generically labeled glyburide products.<br />

*** Note: Glyburide by Teva (<strong>for</strong>merly Novopharm) has only been determined, at this time, to be equivalent<br />

to Micronase by Pharmacia & Upjohn. Pharmacists need to be particularly careful when selecting a Teva<br />

product to verify <strong>the</strong> identity of <strong>the</strong> innovator product it is replacing.<br />

GLYBURIDE, MICRONIZED<br />

Glyburide, micronized tablet, oral 1.5,3,6mg Mylan<br />

Brand(s)<br />

Glynase tablet, oral 1.5,3,6mg Pharmacia & Upjohn *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

Note: Prescribers and pharmacists should be aware of <strong>the</strong> differences in scoring mechanisms between<br />

different manufacturers’ tablets and should take <strong>the</strong>se differences into account when writing a prescription or<br />

practicing drug product selection when <strong>the</strong> prescriber’s instructions to <strong>the</strong> patient call <strong>for</strong> <strong>the</strong> use of half tablets.<br />

GLYCINE<br />

Glycine solution 1.5gm/100ml (1.5%) Abbott<br />

(Aminoacetic Acid) solution 1.5gm/100ml (1.5%) Baxter<br />

solution <strong>for</strong> irrigation solution 1.5gm/100ml (1.5%) Braun<br />

GLYCOPYRROLATE<br />

Glycopyrrolate @ injection 0.2mg/ml Abbott<br />

@ injection 0.2mg/ml<br />

American Pharmaceutical<br />

Partners<br />

@ injection 0.2mg/ml<br />

Gensia Sicor<br />

injection 0.2mg/ml<br />

Luitpold<br />

@ injection 0.2mg/ml<br />

Quad<br />

@ injection 0.2mg/ml<br />

Steris<br />

@ tablet, oral 1,2mg<br />

Circa<br />

(continued on <strong>the</strong> next page)<br />

102


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

GLYCOPYRROLATE (continued)<br />

@ tablet, oral 1,2mg<br />

Danbury<br />

@ tablet, oral 1mg<br />

Watson<br />

Brand(s)<br />

Robinul injection 0.2mg/ml Robins<br />

Robinul tablet, oral 1mg First Horizon<br />

Robinul Forte tablet, oral 2mg First Horizon<br />

GONADOTROPIN CHORIONIC<br />

Chorionic Gonadotropin injection 10,000IU/10ml American Pharmaceutical<br />

Partners<br />

@ injection 5,000, 15,000, 20,000IU/10ml American Pharmaceutical<br />

Partners<br />

@ injection 5,000, 10,000IU/10ml Bel-Mar<br />

@ injection 5,000, 10,000, 20,000IU/10ml Quad<br />

injection 5,000, 10,000IU/10ml Steris<br />

@ injection 15,000, 20,000IU/10ml Steris<br />

Brand(s)<br />

A.P.L.<br />

injection 5,000, 10,000, 20,000IU/10ml Wyeth-Ayerst<br />

Follutein @ injection 10,000IU/10ml Squibb<br />

Pregnyl injection 10,000IU/10ml Organon/Akzona<br />

GRAMICIDIN; NEOMYCIN SULFATE; POLYMYXIN B SULFATE<br />

Gramicidin; Neomycin Sulfate; solution, ophthalmic 0.025mg/ml; Bausch and Lomb<br />

Polymyxin B Sulfate eq 1.75mg base/ml; 10,000U/ml<br />

@ solution, ophthalmic 0.025mg/ml; Ipharm<br />

eq 1.75mg base/ml; 10,000U/ml<br />

@ solution, ophthalmic 0.025mg/ml; Steris<br />

eq 1.75mg base/ml; 10,000U/ml<br />

Brand(s)<br />

Neo-Polycin @ solution, ophthalmic 0.025mg/ml; Dow<br />

eq 1.75mg base/ml; 10,000U/ml<br />

Neosporin solution, ophthalmic 0.025mg/ml; Monarch<br />

eq 1.75mg base/ml; 10,000U/ml<br />

Ocutricin @ solution, ophthalmic 0.025mg/ml; Pharmafair<br />

eq 1.75mg base/ml; 10,000U/ml<br />

GRISEOFULVIN MICROCRYSTALLINE<br />

Brand(s)<br />

Fulvicin-U/F tablet, oral 250,500mg Schering<br />

Grifulvin V tablet, oral 250,500mg J & J<br />

Grisactin tablet, oral 500mg Wyeth-Ayerst *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

GRISEOFULVIN ULTRAMICROCRYSTALLINE<br />

Brand(s)<br />

Fulvicin P/G tablet, oral 125,165,250,330mg Schering<br />

Gris-PEG tablet, oral 125,250mg Pedinol<br />

Grisactin Ultra @ tablet, oral 125,250mg Wyeth-Ayerst *<br />

Grisactin Ultra tablet, oral 165,330mg Wyeth-Ayerst *<br />

Ultragris 165, 330 @ tablet, oral 165,330mg Sidmak<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

103


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

GUAIFENESIN; CODEINE PHOSPHATE<br />

See CODEINE PHOSPHATE; GUAIFENESIN<br />

GUAIFENESIN; CODEINE PHOSPHATE; PSEUDOEPHEDRINE HYDROCHLORIDE<br />

See CODEINE PHOSPHATE; GUAIFENESIN; PSEUDOEPHEDRINE HYDROCHLORIDE<br />

GUAIFENESIN; HYDROCODONE BITARTRATE; PSEUDOEPHEDRINE HYDROCHLORIDE<br />

Guaifenesin; syrup, oral 200mg/5ml;5mg/5ml; Morton Grove<br />

Hydrocodone Bitartrate; 60mg/5ml<br />

Pseudoephedrine Hydrochloride<br />

Brand(s)<br />

Detussin Expectorant syrup, oral 200mg/5ml;5mg/5ml; Alpharma<br />

60mg/5ml<br />

Hydrophed Expectorant syrup, oral 200mg/5ml;5mg/5ml; Norton<br />

60mg/5ml<br />

Hytussin Expectorant syrup, oral 200mg/5ml;5mg/5ml; Cenci<br />

60mg/5ml<br />

Tussend Expectorant syrup, oral 200mg/5ml;5mg/5ml; Aventis<br />

60mg/5ml<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

GUAIFENESIN; PHENYLEPHRINE HYDROCHLORIDE; PHENYLPROPANOLAMINE HYDROCHLORIDE<br />

Brand(s)<br />

Entex liquid 100mg/5ml;5mg/5ml;20mg/5ml Procter and Gamble<br />

Sil-Tex liquid 100mg/5ml;5mg/5ml;20mg/5ml Silarx<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

GUAIFENESIN; THEOPHYLLINE<br />

Guaifenesin; Theophylline liquid, oral 90mg/15ml;150mg/15ml Alpharma<br />

liquid, oral 90mg/15ml;150mg/15ml Central<br />

liquid, oral 90mg/15ml;150mg/15ml Forest<br />

liquid, oral 90mg/15ml;150mg/15ml Geneva<br />

liquid, oral 90mg/15ml;150mg/15ml Naska<br />

liquid, oral 90mg/15ml;150mg/15ml Aventis<br />

Brand(s)<br />

Quibron liquid, oral 90mg/15ml;150mg/15ml Bristol-Myers<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

GUANABENZ ACETATE<br />

Guanabenz Acetate tablet, oral eq 4,8mg base Copley<br />

tablet, oral eq 4,8mg base<br />

Eon<br />

tablet, oral eq 4,8mg base<br />

IVAX<br />

tablet, oral eq 4,8mg base<br />

Watson<br />

Brand(s)<br />

Wytensin tablet, oral eq 4,8mg base Wyeth-Ayerst<br />

104


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

GUANETHIDINE MONOSULFATE<br />

Guanethidine Monosulfate @ tablet, oral eq 10,25mg sulfate Circa<br />

Brand(s)<br />

Ismelin tablet, oral eq 10,25mg sulfate Novartis<br />

GUANFACINE HYDROCHLORIDE<br />

Guanfacine Hydrochloride tablet, oral eq 1,2mg base Amide<br />

tablet, oral eq 1,2mg base<br />

GenPharm<br />

tablet, oral eq 1,2mg base<br />

Mylan<br />

tablet, oral eq 1,2mg base<br />

Royce<br />

tablet, oral eq 1,2mg base<br />

Watson<br />

Brand(s)<br />

Tenex tablet, oral eq 1,2mg base Robins<br />

HALOPERIDOL<br />

Haloperidol @ tablet, oral 0.5,1,2,5,10,20mg Barr<br />

@ tablet, oral 0.5,1,1,2,5,10,20mg Circa<br />

tablet, oral 0.5,2,5mg<br />

Danbury<br />

@ tablet, oral 10,20mg<br />

Danbury<br />

@ tablet, oral 0.5,1,2,5,10,20mg Duramed<br />

tablet, oral 0.5,1,2,5,10,20mg Geneva<br />

@ tablet, oral 0.5,1,2,5,10,20mg Lederle<br />

tablet, oral 0.5,1,2,5mg<br />

Mylan<br />

tablet, oral 0.5,1,2,5,10mg<br />

Par<br />

@ tablet, oral 20mg<br />

Par<br />

@ tablet, oral 0.5,1,2,5,20mg<br />

Purepac<br />

tablet, oral 10mg<br />

Purepac<br />

@ tablet, oral 0.5,1,2,5mg<br />

Quantum<br />

@ tablet, oral 0.5,1,2,5,10,20mg Roxane<br />

@ tablet, oral 0.5,1,2,5,10,20mg Royce<br />

@ tablet, oral 0.5,1,2,5,10,20mg SCS<br />

Brand(s)<br />

Haldol tablet, oral 0.5,1,2,5,10,20mg Ortho McNeil<br />

HALOPERIDOL DECANOATE<br />

Haloperidol Decanoate injection eq 50,100mg base/ml American Pharmaceutical<br />

Partners<br />

injection eq 50,100mg base/ml Apotex<br />

injection eq 50,100mg base/ml Bed<strong>for</strong>d<br />

injection eq 50,100mg base/ml Gensia Sicor<br />

injection eq 50,100mg base/ml King<br />

Brand(s)<br />

Haldol Decanoate injection eq 50,100mg base/ml Ortho McNeil<br />

HALOPERIDOL LACTATE<br />

Haloperidol Lactate concentrate, oral eq 2mg base/ml Alpharma<br />

concentrate, oral eq 2mg base/ml Copley<br />

@ concentrate, oral eq 2mg base/ml Morton Grove<br />

concentrate, oral eq 2mg base/ml Pharmaceutical Associates<br />

@ concentrate, oral eq 2mg base/ml Roxane<br />

@ concentrate, oral eq 2mg base/ml SCS<br />

concentrate, oral eq 2mg base/ml Silarx<br />

concentrate, oral eq 2mg base/ml Teva<br />

injection eq 5mg base/ml<br />

American Pharmaceutical<br />

Partners<br />

injection eq 5mg base/ml<br />

Marsam<br />

(continued on <strong>the</strong> next page)<br />

105


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

HALOPERIDOL LACTATE (continued)<br />

@ injection eq 5mg base/ml<br />

Quad<br />

@ injection eq 5mg base/ml<br />

Smith and Nephew<br />

@ injection eq 5mg base/ml<br />

SoloPak<br />

@ injection eq 5mg base/ml<br />

Steris<br />

Brand(s)<br />

Haldol concentrate, oral eq 2mg base/ml Ortho McNeil<br />

Haldol injection eq 5mg base/ml Ortho McNeil<br />

HALOTHANE<br />

Halothane liquid <strong>for</strong> inhalation 99.99% Abbott<br />

@ liquid <strong>for</strong> inhalation 99.99%<br />

BH<br />

liquid <strong>for</strong> inhalation 99.99%<br />

Halocarbon<br />

Brand(s)<br />

Fluothane liquid <strong>for</strong> inhalation 99.99% Wyeth-Ayerst<br />

HEPARIN SODIUM<br />

Heparin Sodium<br />

@ injection 1,000, 5,000, 10,000, 20,000, Akorn<br />

40,000U/ml<br />

injection 1,000, 5,000, 10,000, American Pharmaceutical<br />

20,000U/ml Partners<br />

injection 1,000U/ml<br />

Baxter<br />

@ injection 1,000, 5,000, 10,000, Chamberlin<br />

20,000U/ml<br />

injection 1,000, 5,000, 10,000, 20,000, Dell<br />

40,000U/ml<br />

injection 1,000, 5,000, 10,000U/ml Elkins-Sinn<br />

@ injection 10U/ml<br />

International Medication<br />

@ injection 1,000, 20,000U/ml<br />

Lilly<br />

injection 10,000U/ml<br />

Lilly<br />

@ injection 10, 100, 1,000U/ml<br />

Luitpold<br />

injection 1,000U/ml<br />

Marsam<br />

@ injection 20,000, 40,000U/ml Organon/Akzona<br />

@ injection 10, 1,000, 5,000, 10,000, Parke-Davis<br />

20,000U/ml<br />

@ injection 1,000, 5,000, 10,000, Pharmaceutical Specialties<br />

20,000, 40,000U/ml<br />

@ injection 1,000U/ml<br />

Pharmaserv<br />

@ injection 10, 100, 1,000U/ml<br />

Smith and Nephew<br />

@ injection 10, 100, 1,000, 5,000 Solopak<br />

10,000U/ml<br />

@ injection 10,000U/0.5ml<br />

Solopak<br />

@ injection 100, 1,000, 5,000, 10,000, Steris<br />

20,000, 40,000U/ml<br />

injection 5,000, 10,000U/ml<br />

Sterling Winthrop<br />

injection 1,000, 5,000, 10,000U/ml Pharmacia & Upjohn<br />

injection 10, 100, 1,000, 2,500, 5,000, Wyeth-Ayerst<br />

10,000, 20,000U/ml<br />

Brand(s)<br />

Hep-Flush injection 10, 100U/ml American Pharmaceutical<br />

Partners<br />

Hep-Lock, Hep Lock U/P injection 10, 100U/ml Elkins-Sinn<br />

Heparin Sodium injection 1,000U/ml American Pharmaceutical<br />

Preservative-Free Partners<br />

Lipo-Hepin<br />

@ injection 1,000, 5,000, 10,000, 20,000, Riker/3-M<br />

40,000U/ml<br />

Liquaemin Sodium @ injection 100, 1,000, 5,000, 10,000, Organon/Akzona<br />

20,000, 40,000U/ml<br />

(continued on <strong>the</strong> next page)<br />

106


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

HEPARIN SODIUM (continued)<br />

Panheprin injection 10, 100, 2,500, 5,000U/ml Abbott<br />

Panheprin @ injection 1,000, 20,000, 40,000, Abbott<br />

10,000U/ml<br />

NOTE: Check <strong>for</strong> equivalent strengths prior to drug product selection. <strong>Product</strong>s with preservatives may<br />

not be interchanged with preservative-free products.<br />

HEPARIN SODIUM; DEXTROSE<br />

See DEXTROSE; HEPARIN SODIUM<br />

HEPARIN SODIUM; SODIUM CHLORIDE<br />

Heparin Sodium; injection 200U/100ml;900mg/100ml Abbott<br />

Sodium Chloride @ injection 1000U/100ml;900mg/100ml Abbott<br />

injection 5000U/100ml;450mg/100ml Abbott<br />

@ injection 5000U/100ml;900mg/100ml Abbott<br />

injection 200U/100ml;900mg/100ml Baxter<br />

injection 200U/100ml;900mg/100ml Braun<br />

@ injection 1000U/100ml;900mg/100ml Braun<br />

@ injection 5000U/100ml;450mg/100ml Braun<br />

@ injection 5000U/100ml;900mg/100ml Braun<br />

HEXACHLOROPHENE<br />

Brand(s)<br />

Hexa-Germ @ emulsion, topical 3% Huntington<br />

pHisoHex emulsion, topical 3% Sanofi Syn<strong>the</strong>labo<br />

Soy-Dome @ emulsion, topical 3% Miles<br />

Turgex @ emulsion, topical 3% Xttrium<br />

Dial @ solution, topical 0.25% Dial<br />

Germa-Medica "MG" @ solution, topical 0.25% Huntington<br />

Septisoft @ solution, topical 0.25% Calgon<br />

Septisol @ solution, topical 0.25% Vestal<br />

Hexascrub @ sponge, topical 3% Prof Disposables<br />

pHisoscrub @ sponge, topical 3% Sanofi Syn<strong>the</strong>labo<br />

HOMATROPINE HYDROBROMIDE<br />

Homatropine Methylbromide solution, ophthalmic 2,5% Iolab<br />

solution, ophthalmic 5%<br />

Paco<br />

solution, ophthalmic 5%<br />

Pharmafair<br />

Brand(s)<br />

AK-Homatropine solution, ophthalmic 5% Akorn<br />

I-Homatropine solution, ophthalmic 5% Americal<br />

Isopto Homatropine solution, ophthalmic 2,5% Alcon<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

HOMATROPINE METHYLBROMIDE; HYDROCODONE BITARTRATE<br />

Homatropine Methylbromide; tablet, oral 1.5mg/5mg Amide<br />

Hydrocodone Bitartrate<br />

Brand(s)<br />

Hycodan syrup, oral 1.5mg/5ml;5mg/5ml Endo<br />

Hydrocodone Compound syrup, oral 1.5mg/5ml;5mg/5ml Alpharma<br />

Hydropane syrup, oral 1.5mg/5ml;5mg/5ml Halsey<br />

Mycodone syrup, oral 1.5mg/5ml;5mg/5ml Morton Grove<br />

Hycodan tablet, oral 1.5mg;5mg Endo<br />

Tussigon tablet, oral 1.5mg;5mg Daniels<br />

107


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

HYDRALAZINE HYDROCHLORIDE<br />

Hydralazine Hydrochloride injection 20mg/ml American Pharmaceutical<br />

Partners<br />

injection 20mg/ml<br />

Gensia-Sicor<br />

injection 20mg/ml<br />

Luitpold<br />

@ injection 20mg/ml<br />

Smith and Nephew<br />

@ injection 20mg/ml<br />

Solopak<br />

tablet, oral 10,25,50,100mg<br />

ABC<br />

@ tablet, oral 25,50mg<br />

Amide<br />

@ tablet, oral 25,50mg<br />

(Ascot)<br />

@ tablet, oral 10,25,50,100mg<br />

Barr<br />

tablet, oral 25,50mg<br />

Danbury<br />

@ tablet, oral 25,50mg<br />

Eon<br />

tablet, oral 10,25,50mg<br />

Geneva<br />

@ tablet, oral 10,25,50,100mg<br />

Halsey<br />

@ tablet, oral 25mg<br />

Impax<br />

tablet, oral 50mg<br />

Impax<br />

@ tablet, oral 10,25,50,100mg<br />

IVAX<br />

tablet, oral 25,50mg<br />

Lederle<br />

tablet, oral 10,25,50mg<br />

Mutual<br />

tablet, oral 10,25,50,100mg<br />

Par<br />

@ tablet, oral 25mg<br />

Purepac<br />

@ tablet, oral 50mg<br />

Purepac<br />

@ tablet, oral 10,25,50,100mg<br />

Quantum<br />

tablet, oral 10,25,50,100mg<br />

Sidmak<br />

@ tablet, oral 10,25,50mg<br />

Superpharm<br />

@ tablet, oral 25,50mg<br />

USL<br />

@ tablet, oral 25,50mg<br />

(Vangard/MWM)<br />

@ tablet, oral 25,50mg<br />

Watson<br />

@ tablet, oral 25,50mg<br />

West-ward<br />

Brand(s)<br />

Apresoline @ injection 20mg/ml Novartis<br />

Apresoline tablet, oral 10,25,50,100mg Novartis<br />

Dralzine @ tablet, oral 25mg Teva<br />

HYDRALAZINE HYDROCHLORIDE; HYDROCHLOROTHIAZIDE<br />

Hydralazine Hydrochloride; @ capsule, oral 25mg;25mg, 50mg;50mg, Circa<br />

Hydrochlorothiazide 100mg;50mg<br />

@ capsule, oral 25mg;25mg, 50mg;50mg IVAX<br />

100mg;50mg<br />

@ capsule, oral 25mg;25mg<br />

Superpharm<br />

capsule, oral 50mg;50mg<br />

Superpharm<br />

Brand(s)<br />

Apresazide<br />

capsule, oral 25mg;25mg, 50mg;50mg Novartis<br />

Apresazide @ capsule, oral 100mg;50mg Novartis<br />

Hydra-Zide<br />

capsule, oral 25mg;25mg, 50mg;50mg, Par<br />

100mg;50mg<br />

Hydral<br />

@ capsule, oral 25mg;25mg, 50mg;50mg Solvay<br />

Hydral @ capsule, oral 100mg;50mg Solvay<br />

HYDROCHLOROTHIAZIDE<br />

Hydrochlorothiazide capsule, oral 12.5mg Mylan<br />

@ solution, oral 50mg/5ml<br />

Morton Grove<br />

solution, oral 50mg/5ml<br />

Roxane<br />

tablet, oral 25,50mg<br />

ABC<br />

@ tablet, oral 25,50mg<br />

(Ascot)<br />

tablet, oral 25,50mg<br />

Barr<br />

@ tablet, oral 100mg<br />

Barr<br />

(continued on <strong>the</strong> next page)<br />

108


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

HYDROCHLOROTHIAZIDE (continued)<br />

@ tablet, oral 25,50,100mg<br />

Circa<br />

tablet, oral 25,100mg<br />

Danbury<br />

@ tablet, oral 50mg<br />

Danbury<br />

@ tablet, oral 50mg<br />

Elkins-Sinn<br />

@ tablet, oral 25mg<br />

Eon<br />

tablet, oral 50mg<br />

Eon<br />

tablet, oral 25,50mg<br />

Geneva<br />

@ tablet, oral 25,50mg<br />

Halsey<br />

@ tablet, oral 25,50,100mg<br />

Impax<br />

@ tablet, oral 50mg<br />

Hea<strong>the</strong>r<br />

@ tablet, oral 25,50mg<br />

Inwood/Forest<br />

tablet, oral 25,50,100mg<br />

IVAX<br />

tablet, oral 25,50,100mg<br />

Lederle<br />

@ tablet, oral 25,50mg<br />

Mast<br />

@ tablet, oral 25,50mg<br />

Mylan<br />

@ tablet, oral 25,50mg<br />

Pharmeral<br />

tablet, oral 25,50mg<br />

Private Formulations<br />

tablet, oral 25,50mg<br />

Purepac<br />

@ tablet, oral 25mg<br />

Roxane<br />

tablet, oral 50mg<br />

Roxane<br />

@ tablet, oral 25mg<br />

Solvay<br />

@ tablet, oral 25,50,100mg<br />

Superpharm<br />

@ tablet, oral 25,50mg<br />

Teva<br />

@ tablet, oral 25,50mg<br />

USL<br />

@ tablet, oral 25,50mg<br />

(Vangard/MWM)<br />

@ tablet, oral 25,50mg<br />

Warner-Chilcott<br />

@ tablet, oral 25,50,100mg<br />

Watson<br />

@ tablet, oral 25,50mg<br />

West-ward<br />

@ tablet, oral 25,50,100mg<br />

Whiteworth Towne<br />

Brand(s)<br />

Microzide capsule, oral 12.5mg Watson<br />

Esidrix tablet, oral 25,50,100mg Novartis<br />

Hydro-D @ tablet, oral 25,50mg Halsey<br />

HydroDIURIL tablet, oral 25,50,100mg Merck Sharp and Dohme *<br />

Oretic tablet, oral 25,50mg Abbott<br />

Zide @ tablet, oral 50mg Solvay<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

HYDROCHLOROTHIAZIDE; AMILORIDE HYDROCHLORIDE<br />

See AMILORIDE HYDROCHLORIDE; HYDROCHLOROTHIAZIDE<br />

HYDROCHLOROTHIAZIDE; BISOPROLOL FUMARATE<br />

See BISOPROLOL FUMARATE; HYDROCHLOROTHIAZIDE<br />

HYDROCHLOROTHIAZIDE; CAPTOPRIL<br />

See CAPTOPRIL; HYDROCHLOROTHIAZIDE<br />

HYDROCHLOROTHIAZIDE; ENALAPRIL<br />

See ENALAPRIL; HYDROCHLOROTHIAZIDE<br />

HYDROCHLOROTHIAZIDE; HYDRALAZINE HYDROCHLORIDE<br />

See HYDRALAZINE HYDROCHLORIDE; HYDROCHLOROTHIAZIDE<br />

109


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

HYDROCHLOROTHIAZIDE; LABETALOL<br />

Brand(s)<br />

Normozide @ tablet, oral 25mg;100mg Schering<br />

Normozide @ tablet, oral 25mg;200mg Schering<br />

Normozide @ tablet, oral 25mg;300mg Schering<br />

Normozide @ tablet, oral 25mg;400mg Schering<br />

Trandate-HCT @ tablet, oral 25mg;100mg Glaxo Wellcome<br />

Trandate-HCT @ tablet, oral 25mg;200mg Glaxo Wellcome<br />

Trandate-HCT @ tablet, oral 25mg;300mg Glaxo Wellcome<br />

Trandate-HCT @ tablet, oral 25mg;400mg Glaxo Wellcome<br />

HYDROCHLOROTHIAZIDE; LISINOPRIL<br />

Brand(s)<br />

Prinzide 10-12.5 tablet, oral 12.5mg;10mg Merck Sharp and Dohme *<br />

Prinzide 20-12.5 tablet, oral 12.5mg;20mg Merck Sharp and Dohme *<br />

Prinzide 20-25 tablet, oral 25mg;20mg Merck Sharp and Dohme *<br />

Zestoretic 10-12.5 tablet, oral 12.5mg;10mg Zeneca<br />

Zestoretic 20-12.5 tablet, oral 12.5mg;20mg Zeneca<br />

Zestoretic 20-25 tablet, oral 25mg;20mg Zeneca<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

HYDROCHLOROTHIAZIDE; METHYLDOPA<br />

Hydrochlorothiazide; @ tablet, oral 15mg;250mg Circa<br />

Methyldopa @ tablet, oral 25mg;250mg Circa<br />

@ tablet, oral 30mg;500mg<br />

Circa<br />

@ tablet, oral 50mg;500mg<br />

Circa<br />

tablet, oral 15mg;250mg<br />

Danbury<br />

tablet, oral 25mg;250mg<br />

Danbury<br />

tablet, oral 30mg;500mg<br />

Danbury<br />

tablet, oral 50mg;500mg<br />

Danbury<br />

tablet, oral 15mg;250mg<br />

Geneva<br />

tablet, oral 25mg;250mg<br />

Geneva<br />

tablet, oral 30mg;500mg<br />

Geneva<br />

tablet, oral 50mg;500mg<br />

Geneva<br />

tablet, oral 15mg;250mg<br />

Invamed<br />

tablet, oral 25mg;250mg<br />

Invamed<br />

@ tablet, oral 15mg;250mg<br />

IVAX<br />

@ tablet, oral 25mg;250mg<br />

IVAX<br />

@ tablet, oral 30mg;500mg<br />

IVAX<br />

@ tablet, oral 50mg;500mg<br />

IVAX<br />

tablet, oral 15mg;250mg<br />

Lederle<br />

tablet, oral 25mg;250mg<br />

Lederle<br />

tablet, oral 30mg;500mg<br />

Lederle<br />

tablet, oral 50mg;500mg<br />

Lederle<br />

tablet, oral 15mg;250mg<br />

Mylan<br />

tablet, oral 25mg;250mg<br />

Mylan<br />

tablet, oral 15mg;250mg<br />

Par<br />

tablet, oral 25mg;250mg<br />

Par<br />

tablet, oral 30mg;500mg<br />

Par<br />

tablet, oral 50mg;500mg<br />

Par<br />

@ tablet, oral 15mg;250mg<br />

Parke-Davis<br />

@ tablet, oral 25mg;250mg<br />

Parke-Davis<br />

@ tablet, oral 30mg;500mg<br />

Parke-Davis<br />

@ tablet, oral 50mg;500mg<br />

Parke-Davis<br />

(continued on <strong>the</strong> next page)<br />

110


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

HYDROCHLOROTHIAZIDE; METHYLDOPA (continued)<br />

@ tablet, oral 15mg;250mg<br />

Purepac<br />

@ tablet, oral 25mg;250mg<br />

Purepac<br />

@ tablet, oral 30mg;500mg<br />

Purepac<br />

@ tablet, oral 50mg;500mg<br />

Purepac<br />

@ tablet, oral 15mg;250mg<br />

Teva<br />

@ tablet, oral 25mg;250mg<br />

Teva<br />

@ tablet, oral 30mg;500mg<br />

Teva<br />

@ tablet, oral 50mg;500mg<br />

Teva<br />

@ tablet, oral 15mg;250mg<br />

Watson<br />

@ tablet, oral 25mg;250mg<br />

Watson<br />

@ tablet, oral 30mg;500mg<br />

Watson<br />

@ tablet, oral 50mg;500mg<br />

Watson<br />

Brand(s)<br />

Aldoril 15 tablet, oral 15mg;250mg Merck Sharp and Dohme *<br />

Aldoril 25 tablet, oral 25mg;250mg Merck Sharp and Dohme *<br />

Aldoril D30 tablet, oral 30mg;500mg Merck Sharp and Dohme *<br />

Aldoril D50 tablet, oral 50mg;500mg Merck Sharp and Dohme *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

HYDROCHLOROTHIAZIDE; PROPRANOLOL HYDROCHLORIDE<br />

Hydrochlorothiazide; tablet, oral 25mg;40mg Barr<br />

Propranolol Hydrochloride tablet, oral 25mg;80mg Barr<br />

@ tablet, oral 25mg;40mg<br />

Danbury<br />

@ tablet, oral 25mg;80mg<br />

Danbury<br />

@ tablet, oral 25mg;40mg<br />

Duramed<br />

@ tablet, oral 25mg;80mg<br />

Duramed<br />

tablet, oral 25mg;40mg<br />

Geneva<br />

tablet, oral 25mg;80mg<br />

Geneva<br />

@ tablet, oral 25mg;40mg<br />

IVAX<br />

@ tablet, oral 25mg;80mg<br />

IVAX<br />

tablet, oral 25mg;40mg<br />

Mylan<br />

tablet, oral 25mg;80mg<br />

Mylan<br />

tablet, oral 25mg;40mg<br />

Purepac<br />

tablet, oral 25mg;80mg<br />

Purepac<br />

tablet, oral 25mg;40mg<br />

Sidmak<br />

tablet, oral 25mg;80mg<br />

Sidmak<br />

@ tablet, oral 25mg;40mg<br />

Warner Chilcott<br />

@ tablet, oral 25mg;80mg<br />

Warner Chilcott<br />

tablet, oral 25mg;40mg<br />

Watson<br />

tablet, oral 25mg;80mg<br />

Watson<br />

Brand(s)<br />

Inderide 40/25 tablet, oral 25mg;40mg Wyeth-Ayerst<br />

Inderide 80/25 tablet, oral 25mg;80mg Wyeth-Ayerst<br />

HYDROCHLOROTHIAZIDE; SPIRONOLACTONE<br />

Hydrochlorothiazide; @ tablet, oral 25mg;25mg (Ascot)<br />

Spironolactone tablet, oral 25mg;25mg Barr<br />

@ tablet, oral 25mg;25mg<br />

Circa<br />

tablet, oral 25mg;25mg<br />

Danbury<br />

tablet, oral 25mg;25mg<br />

Geneva<br />

@ tablet, oral 25mg;25mg<br />

IVAX<br />

@ tablet, oral 25mg;25mg<br />

Lederle<br />

tablet, oral 25mg;25mg<br />

Mutual<br />

tablet, oral 25mg;25mg<br />

Mylan<br />

tablet, oral 25mg;25mg<br />

Parke-Davis<br />

(continued on <strong>the</strong> next page)<br />

111


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

HYDROCHLOROTHIAZIDE; SPIRONOLACTONE (continued)<br />

@ tablet, oral 25mg;25mg<br />

Purepac<br />

@ tablet, oral 25mg;25mg<br />

Superpharm<br />

@ tablet, oral 25mg;25mg<br />

Upsher-Smith<br />

@ tablet, oral 25mg;25mg<br />

USL<br />

@ tablet, oral 25mg;25mg<br />

(Vangard/MWM)<br />

@ tablet, oral 25mg;25mg<br />

Watson<br />

Brand(s)<br />

Aldactazide tablet, oral 25mg;25mg Searle<br />

HYDROCHLOROTHIAZIDE; TRIAMTERENE<br />

Hydrochlorothiazide; Triamterene capsule, oral 25mg;37.5mg Barr<br />

capsule, oral 25mg;37.5mg<br />

Duramed<br />

capsule, oral 25mg;37.5mg<br />

Geneva<br />

capsule, oral 25mg;50mg<br />

IVAX<br />

capsule, oral 25mg;37.5mg<br />

Mylan<br />

capsule, oral 25mg;37.5mg<br />

Novartis<br />

capsule, oral 25mg;50mg<br />

Geneva<br />

capsule, oral 25mg;37.5mg<br />

Novartis<br />

@ tablet, oral 50mg;75mg<br />

American Therapeutics<br />

tablet, oral 25mg;37.5mg<br />

Barr<br />

tablet, oral 50mg;75mg<br />

Barr<br />

tablet, oral 50mg;75mg<br />

Danbury<br />

tablet, oral 25mg;37.5mg<br />

Geneva<br />

tablet, oral 50mg;75mg<br />

Geneva<br />

@ tablet, oral 50mg;75mg<br />

Quantum<br />

tablet, oral 25mg;37.5mg<br />

Sidmak<br />

tablet, oral 50mg;75mg<br />

Sidmak<br />

tablet, oral 37.5mg;25mg<br />

Watson<br />

tablet, oral 50mg;75mg<br />

Watson<br />

Brand(s)<br />

Dyazide @ capsule, oral 25mg;50mg SmithKline Beecham *<br />

Dyazide capsule, oral 25mg;37.5mg SmithKline Beecham *<br />

Maxzide-25 tablet, oral 25mg;37.5mg Mylan *<br />

Maxzide tablet, oral 50mg;75mg Mylan *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

HYDROCODONE BITARTRATE; ACETAMINOPHEN<br />

See ACETAMINOPHEN; HYDROCODONE BITARTRATE<br />

HYDROCODONE BITARTRATE; GUAIFENESIN; PSEUDOEPHEDRINE HYDROCHLORIDE<br />

See GUAIFENESIN; HYDROCODONE BITARTRATE; PSEUDOEPHEDRINE HYDROCHLORIDE<br />

HYDROCODONE BITARTRATE; HOMATROPINE METHYLBROMIDE<br />

See HOMATROPINE METHYLBROMIDE; HYDROCODONE BITARTRATE<br />

HYDROCODONE BITARTRATE; PHENYLPROPANOLAMINE HYDROCHLORIDE<br />

Hydrocodone Bitartrate; syrup, oral 2.5mg/5ml;12.5mg/5ml Halsey<br />

Phenylpropanolamine syrup, oral 5mg/5ml;12.5mg/5ml Halsey<br />

Hydrochloride syrup, oral 5mg/5ml;25mg/5ml Morton Grove<br />

(continued on <strong>the</strong> next page)<br />

HYDROCODONE BITARTRATE; PHENYLPROPANOLAMINE HYDROCHLORIDE (continued)<br />

112


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

Brand(s)<br />

Hycophen Pediatric Syrup syrup, oral 2.5mg/5ml;12.5mg/5ml Cenci<br />

Hycomine Pediatric Syrup syrup, oral 2.5mg/5ml;12.5mg/5ml Endo<br />

Codamine Syrup syrup, oral 5mg/5ml;25mg/5ml Alpharma<br />

Hycophen Syrup syrup, oral 5mg/5ml;25mg/5ml Cenci<br />

Hycomine Syrup syrup, oral 5mg/5ml;25mg/5ml Endo<br />

Propachem Syrup syrup, oral 5mg/5ml;25mg/5ml Norton<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

HYDROCODONE BITARTRATE; PSEUDOEPHEDRINE HYDROCHLORIDE<br />

Hydrocodone Bitartrate; liquid, oral 5mg/5ml;60mg/5ml Cenci<br />

Pseudoephedrine Hydrochloride liquid, oral 5mg/5ml;60mg/5ml Morton Grove<br />

Brand(s)<br />

Detussin liquid, oral 5mg/5ml;60mg/5ml Alpharma<br />

Hydrophed liquid, oral 5mg/5ml;60mg/5ml Norton<br />

Tussend liquid, oral 5mg/5ml;60mg/5ml Aventis<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

HYDROCORTISONE<br />

Hydrocortisone cream, topical 2.5% Alpharma<br />

cream, topical 0.5,1%<br />

Altana<br />

@ cream, topical 1,2.5%<br />

Ambix/Organics<br />

@ cream, topical 0.5,1%<br />

Clay-Park<br />

cream, topical 2.5%<br />

Clay-Park<br />

@ cream, topical 0.5%<br />

Everylife<br />

cream, topical 1%<br />

Everylife<br />

cream, topical 1,2.5%<br />

Fougera/Altana<br />

@ cream, topical 1%<br />

G & W<br />

cream, topical 0.5,1%<br />

Ingram<br />

cream, topical 1%<br />

NMC<br />

@ cream, topical 1%<br />

Naska<br />

@ cream, topical 1%<br />

Pharmaderm/Altana<br />

cream, topical 2.5%<br />

Pharmaderm/Altana<br />

@ cream, topical 1%<br />

Pharmafair<br />

@ cream, topical 1%<br />

Stiefel<br />

@ cream, topical 0.5,1,2.5%<br />

Teva<br />

@ cream, topical 0.5%<br />

Thames<br />

cream, topical 1,2.5%<br />

Thames<br />

@ cream, topical 1%<br />

Topiderm<br />

@ cream, topical 1,2.5%<br />

USL<br />

@ cream, topical 1%<br />

Whiteworth Towne<br />

enema, rectal 100mg/60ml<br />

Copley<br />

@ lotion, topical 0.5,1%<br />

Alpharma<br />

lotion, topical 2.5%<br />

Altana<br />

@ lotion, topical 0.5,1%<br />

Clay-Park<br />

@ lotion, topical 0.5,1%<br />

Mericon<br />

@ lotion, topical 1%<br />

Naska<br />

@ lotion, topical 1%<br />

Thames<br />

lotion, topical 2.5%<br />

Thames<br />

@ ointment, topical 0.5%<br />

Altana<br />

ointment, topical 1%<br />

Altana<br />

@ ointment, topical 1,2.5%<br />

Ambix/Organics<br />

@ ointment, topical 0.5,1%<br />

Clay-Park<br />

(continued on <strong>the</strong> next page)<br />

HYDROCORTISONE (continued)<br />

113


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ointment, topical 2.5%<br />

Clay-Park<br />

ointment, topical 2.5%<br />

Fougera/Altana<br />

@ ointment, topical 1%<br />

Naska<br />

@ ointment, topical 1%<br />

Pharmaderm/Altana<br />

@ ointment, topical 0.5%<br />

Thames<br />

ointment, topical 1,2.5%<br />

Thames<br />

@ ointment, topical 1,2.5%<br />

USL<br />

powder <strong>for</strong> compounding 100% Paddock<br />

powder <strong>for</strong> compounding 100% Pharma Tek<br />

Brand(s)<br />

Ala-Cort cream, topical 1% Del Ray<br />

Anusol HC cream, topical 2.5% Parkdale<br />

Cort-Dome @ cream, topical 0.5,1% Bayer<br />

Dermacort cream, topical 1% Monarch<br />

Dermatol HC cream, topical 1% Thames<br />

Eldecort @ cream, topical 1,2.5% ICN<br />

Flexicort @ cream, topical 0.5,1,2.5% Westwood Squibb<br />

H Cort @ cream, topical 0.5% Pharmaceutical Associates<br />

HC @ cream, topical 0.5,1% C & M<br />

HC #1 @ cream, topical 0.5% Bayer<br />

HC #4 @ cream, topical 1% Bayer<br />

HiCor cream, topical 2.5% C & M<br />

Hydrotex cream, topical 0.5% Syosett<br />

Hymac cream, topical 1% NMC<br />

Hytone cream, topical 1,2.5% Dermik/Rorer<br />

Nogenic HC @ cream, topical 1% IVAX<br />

Nutracort @ cream, topical 0.5,1% Healthpoint<br />

Penecort cream, topical 1% Allergan Herbert<br />

Proctocort @ cream, topical 1% Monarch<br />

Synacort @ cream, topical 0.5% Medicis<br />

Synacort cream, topical 1,2.5% Medicis<br />

Colocort enema, rectal 100mg/60ml Paddock<br />

Cortenema enema, rectal 100mg/60ml Solvay<br />

Nutracort @ gel, topical 1% Owen/Galderma<br />

Penecort gel, topical 1% Allergan Herbert<br />

Acticort @ lotion, topical 1% Baker Norton<br />

Ala-Cort lotion, topical 1% Del Ray<br />

Balneol-HC @ lotion, topical 1% Solvay<br />

Beta-HC @ lotion, topical 1% Beta Dermac<br />

Cetacort lotion, topical 0.5,1% Owen/Galderma<br />

Cort-Dome @ lotion, topical 0.5,1% Bayer<br />

Delacort lotion, topical 1% Mericon<br />

Dermacort @ lotion, topical 0.5,1% Solvay<br />

Epicort lotion, topical 0.5% Bluline<br />

Glycort @ lotion, topical 1.0% Heran<br />

H Cort @ lotion, topical 0.5% Pharmaceutical Associates<br />

Hytone lotion, topical 1,2.5% Dermik/Rorer<br />

Nutracort @ lotion, topical 0.5% Healthpoint<br />

Nutracort lotion, topical 1,2/5% Healthpoint<br />

Stie-Cort lotion, topical 1,2.5% Stiefel<br />

Cortril ointment, topical 1,2.5% Pfipharmecs/Pfizer<br />

HC @ ointment, topical 0.5,1% C & M<br />

Hydrocortisone in Absorbase ointment, topical 1% Carolina Medical<br />

Hymac ointment, topical 1% NMC<br />

Hytone @ ointment, topical 1,2.5% Dermik/Rorer<br />

Penecort @ ointment, topical 2.5% Allergan Herbert<br />

Penecort solution, topical 1% Allergan Herbert<br />

Texacort solution, topical 1% Sirius<br />

H-Cort @ powder <strong>for</strong> compounding 100% Torch<br />

114


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

HYDROCORTISONE; ACETIC ACID, GLACIAL<br />

See ACETIC ACID, GLACIAL; HYDROCORTISONE<br />

HYDROCORTISONE; BACITRACIN ZINC; NEOMYCIN SULFATE; POLYMYXIN B SULFATE<br />

See BACITRACIN ZINC; HYDROCORTISONE; NEOMYCIN SULFATE; POLYMYXIN B SULFATE<br />

HYDROCORTISONE; NEOMYCIN SULFATE; POLYMYXIN B SULFATE<br />

Hydrocortisone; solution, otic 1%; eq 3.5mg base/ml; Bausch and Lomb<br />

Neomycin Sulfate; 10,000U/ml<br />

Polymyxin B Sulfate @ suspension, ophthalmic 1%; Alcon Universal<br />

eq 3.5mg base/ml; 10,000U/ml<br />

Brand(s)<br />

Cortisporin solution, otic 1%; eq 3.5mg base/ml; Monarch *<br />

10,000U/ml<br />

Neo-Otosol-HC @ solution, otic 1%; eq 3.5mg base/ml; Alcon<br />

10,000U/ml<br />

Oticair @ solution, otic 1%; eq 3.5mg base/ml; Pharmafair<br />

10,000U/ml<br />

Otocort @ solution, otic 1%; eq 3.5mg base/ml; Steris<br />

10,000U/ml<br />

Cortisporin suspension, ophthalmic 1%; Monarch *<br />

eq 3.5mg base/ml; 10,000U/ml<br />

Ocutricin HC @ suspension, ophthalmic 1%; Pharmafair<br />

eq 3.5mg base/ml; 10,000U/ml<br />

Cortisporin @ suspension, otic 1%; Monarch<br />

eq 3.5mg base/ml; 10,000U/ml<br />

Oticair suspension, otic 1%; Bausch and Lomb<br />

eq 3.5mg base/ml; 10,000U/ml<br />

Otobione @ suspension, otic 1%; Schering<br />

eq 3.5mg base/ml; 10,000U/ml<br />

Otocort @ suspension, otic 1%; Alcon Universal<br />

eq 3.5mg base/ml; 10,000U/ml<br />

Pediotic Cortisporin suspension, otic 1%; Monarch<br />

eq 3.5mg base/ml; 10,000U/ml<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

HYDROCORTISONE; POLYMYXIN B SULFATE<br />

Brand(s)<br />

Otobiotic solution, otic 5mg/ml; Schering<br />

eq 10,000U base/ml<br />

Pyocidin @ solution, otic 5mg/ml; Forest<br />

eq 10,000U base/ml<br />

HYDROCORTISONE; UREA<br />

Brand(s)<br />

Alphaderm @ cream, topical 1%; 10% Bioglan<br />

Calmurid HC @ cream, topical 1%; 10% Pharmacia & Upjohn<br />

HYDROCORTISONE ACETATE<br />

Hydrocortisone Acetate @ cream, topical 1% Cenci<br />

@ cream, topical 1%<br />

Parke Davis<br />

@ cream, topical 1%<br />

Purepac<br />

(continued on <strong>the</strong> next page)<br />

115


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

HYDROCORTISONE ACETATE (continued)<br />

Brand(s)<br />

Hemsol-HC cream, topical 1% Able<br />

Micort-HC @ cream, topical 2.5% Ferndale<br />

HYDROCORTISONE ACETATE; BACITRACIN; NEOMYCIN SULFATE; POLYMYXIN B SULFATE<br />

See BACITRACIN; HYDROCORTISONE ACETATE; NEOMYCIN SULFATE; POLYMYXIN B SULFATE<br />

HYDROCORTISONE ACETATE; NEOMYCIN SULFATE<br />

Brand(s)<br />

Cor-Oticin @ suspension , ophthalmic 1.5%; Akorn<br />

eq. 3.5mg base/ml<br />

Neo-Cortef @ suspension, ophthalmic 1.5%; Pharmacia & Upjohn<br />

eq. 3.5mg base/ml<br />

HYDROCORTISONE ACETATE; UREA<br />

Brand(s)<br />

Carmol HC cream, topical 1%;10% Kenwood<br />

U-Cort cream, topical 1%;10% Thames<br />

HYDROCORTISONE SODIUM PHOSPHATE<br />

Hydrocortisone Sodium @ injection eq 50mg base/ml Quad<br />

Phosphate<br />

Brand(s)<br />

Hydrocortone injection eq 50mg base/ml Merck Sharp and Dohme<br />

HYDROCORTISONE SODIUM SUCCINATE<br />

Hydrocortisone Sodium @ injection eq 100,250,500mg, American Pharmaceutical<br />

Succinate 1gm base/vial Partners<br />

@ injection eq 100,250,500mg,<br />

Elkins-Sinn<br />

1gm base/vial<br />

injection eq 100mg base/vial<br />

International Medication<br />

@ injection eq 100,250,500mg,<br />

Steris<br />

1gm base/vial<br />

Brand(s)<br />

A-Hydrocort injection eq 100,250,500mg, Abbott<br />

1gm base/vial<br />

Solu-Cortef injection eq 100,250,500mg, Pharmacia & Upjohn<br />

1gm base/vial<br />

HYDROCORTISONE VALERATE<br />

Hydrocortisone Valerate cream, topical 0.2% Clay-Park<br />

cream, topical 0.2%<br />

Copley<br />

cream, topical 0.2%<br />

Taro<br />

ointment, topical 0.2%<br />

Taro<br />

Brand(s)<br />

Westcort cream, topical 0.2% Westwood Squibb *<br />

Westcort ointment, topical 0.2% Westwood Squibb *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

116


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

HYDROFLUMETHIAZIDE<br />

Hydroflumethiazide @ tablet, oral 50mg Circa<br />

tablet, oral 50mg<br />

Par<br />

@ tablet, oral 50mg<br />

Watson<br />

Brand(s)<br />

Diucardin tablet, oral 50mg Wyeth-Ayerst<br />

Saluron tablet, oral 50mg Shire<br />

HYDROMORPHONE HYDROCHLORIDE<br />

Hydromorphone Hydrochloride injection 1,2,4,10mg/ml Abbott<br />

injection 2mg/ml<br />

Astra Zeneca<br />

injection 2mg/ml<br />

Elkins-Sinn<br />

injection 2mg/ml<br />

Schein<br />

injection 2,10mg/ml<br />

Steris<br />

injection 1,2,4mg/ml<br />

Wyeth-Ayerst<br />

solution, oral 5mg/5ml<br />

Roxane<br />

tablet, oral 8mg<br />

Roxane<br />

Brand(s)<br />

Dilaudid Hydrochloride injection 1,2,4mg/ml Abbott<br />

Dilaudid-HP injection 10mg/ml Abbott<br />

Dilaudid solution, oral 5mg/5ml Abbott<br />

Dilaudid tablet, oral 8mg Abbott<br />

* Strengths of injections o<strong>the</strong>r than 10mg/ml in this entity were reviewed by <strong>the</strong> Technical Advisory Council<br />

and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to<br />

Rule 790.60.<br />

HYDROXOCOBALAMIN<br />

Hydroxocobalamin @ injection 1000mcg/ml American Pharmaceutical<br />

Partners<br />

injection 1000mcg/ml<br />

Steris<br />

Brand(s)<br />

Alpha Redisol @ injection 1000mcg/ml Merck Sharp and Dohme<br />

Hydroxomin @ injection 1000mcg/ml Bel-Mar<br />

HYDROXYCHLOROQUINE SULFATE<br />

Hydroxychloroquine Sulfate tablet, oral 200mg Copley<br />

tablet, oral 200mg<br />

Geneva<br />

tablet, oral 200mg<br />

Mylan<br />

tablet, oral 200mg<br />

Royce<br />

Brand(s)<br />

Plaquenil tablet, oral 200mg Sanofi *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

HYDROXYPROGESTERONE CAPROATE<br />

Hydroxyprogesterone Caproate @ injection 125mg/ml<br />

Akorn<br />

@ injection 125,250mg/ml<br />

Quad<br />

Brand(s)<br />

Delalutin @ injection 125,250mg/ml Squibb<br />

Dura-Lutin @ injection 125mg/ml Steris<br />

Dura-Lutin injection 250mg/ml Steris<br />

117


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

HYDROXYUREA<br />

Hydroxyurea capsule, oral 500mg Barr<br />

capsule, oral 500mg<br />

Duramed<br />

capsule, oral 500mg<br />

Par<br />

capsule, oral 500mg<br />

Roxane<br />

Brand(s)<br />

Hydrea capsule, oral 500mg Bristol-Myers Squibb<br />

HYDROXYZINE HYDROCHLORIDE<br />

Hydroxyzine Hydrochloride injection 25,50mg/ml Abbott<br />

@ injection 25,50mg/ml<br />

Altana<br />

injection 25,50mg/ml<br />

American Pharmaceutical<br />

Partners<br />

injection 25,50mg/ml<br />

Elkins-Sinn<br />

injection 25,50mg/ml<br />

Luitpold<br />

@ injection 25,50mg/ml<br />

Pharmafair<br />

@ injection 25mg/ml<br />

Smith and Nephew<br />

@ injection 25,50mg/ml<br />

Solopak<br />

@ injection 25mg/ml<br />

Steris<br />

injection 50mg/ml<br />

Steris<br />

@ injection 25,50mg/ml<br />

Wyeth-Ayerst<br />

syrup, oral 10mg/5ml<br />

Alpharma<br />

syrup, oral 10mg/5ml<br />

Hi-Tech<br />

@ syrup, oral 10mg/5ml<br />

KV<br />

syrup, oral 10mg/5ml<br />

Morton Grove<br />

@ tablet, oral 10,25,50mg<br />

Amide<br />

@ tablet, oral 10,25,50,100mg<br />

Barr<br />

tablet, oral 10,25,50mg<br />

Danbury<br />

@ tablet, oral 10,25,50mg<br />

Eon<br />

tablet, oral 10,25,50mg<br />

Geneva<br />

@ tablet, oral 10,25,50mg<br />

Halsey<br />

@ tablet, oral 10,25,50mg<br />

IVAX<br />

@ tablet, oral 10,25,50,100mg<br />

KV<br />

tablet, oral 10,25,50mg<br />

Mutual<br />

@ tablet, oral 10,25,50mg<br />

Par<br />

@ tablet, oral 10,25,50mg<br />

Purepac<br />

@ tablet, oral 10,25,50mg<br />

Quantum<br />

tablet, oral 10,25,50mg<br />

Royce<br />

tablet, oral 10,25,50mg<br />

Sidmak<br />

@ tablet, oral 10,25,50mg<br />

Superpharm<br />

@ tablet, oral 10,25,50mg<br />

USL<br />

@ tablet, oral 10,25,50mg<br />

Watson<br />

Brand(s)<br />

Orgatrax @ injection 25,50mg/ml Organon/Akzona<br />

Vistaril injection 25,50mg/ml Roerig/Pfizer<br />

Atarax syrup, oral 10mg/5ml Roerig/Pfizer<br />

Atarax tablet, oral 10,25,50,100mg Roerig/Pfizer<br />

HYDROXYZINE HYDROCHLORIDE; EPHEDRINE; THEOPHYLLINE<br />

See EPHEDRINE; HYDROXYZINE HYDROCHLORIDE; THEOPHYLLINE<br />

HYDROXYZINE PAMOATE<br />

Hydroxyzine Pamoate capsule, oral eq 25,50,100mg HCl Barr<br />

@ capsule, oral eq 25,50,100mg HCl Circa<br />

capsule, oral eq 25,50,100mg HCl Danbury<br />

@ capsule, oral eq 25,50,100mg HCl Duramed<br />

capsule, oral eq 25,50mg HCl Eon<br />

(continued on <strong>the</strong> next page)<br />

118


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

HYDROXYZINE PAMOATE (continued)<br />

capsule, oral eq 25mg HCl<br />

Geneva<br />

@ capsule, oral eq 50,100mg HCl Geneva<br />

capsule, oral eq 25,50mg HCl IVAX<br />

@ capsule, oral eq 25,50,100mg HCl Par<br />

@ capsule, oral eq 25,50,100mg HCl Superpharm<br />

@ capsule, oral eq 25,50mg HCl (Vangard/MWM)<br />

capsule, oral eq 25,50mg HCl Watson<br />

@ capsule, oral eq 100mg HCl<br />

Watson<br />

Brand(s)<br />

Vistaril capsule, oral eq 25,50,100mg HCl Pfizer<br />

HYOSCYAMINE; ATROPINE SULFATE; PHENOBARBITAL; SCOPALAMINE HYDROBROMIDE<br />

See ATROPINE SULFATE; HYOSCYAMINE; PHENOBARBITAL; SCOPALAMINE HYDROBROMIDE<br />

IBUPROFEN<br />

Ibuprofen suspension, oral 100mg/5ml Alpharma<br />

@ tablet, oral 400,600,800mg<br />

Barr<br />

tablet, oral 400,600,800mg<br />

Danbury<br />

tablet, oral 300,400,600,800mg Geneva<br />

@ tablet, oral 300,400,600,800mg Halsey<br />

tablet, oral 400,600,800mg<br />

Interpharm<br />

tablet, oral 400,600,800mg<br />

Invamed<br />

tablet, oral 400,600,800mg<br />

IVAX<br />

@ tablet, oral 400,600mg<br />

Lederle<br />

@ tablet, oral 400,600mg<br />

McNeil Consumer<br />

tablet, oral 300,400,600,800mg Mutual<br />

tablet, oral 400,600,800mg<br />

Mylan<br />

@ tablet, oral 300mg<br />

Par<br />

tablet, oral 400,600,800mg<br />

Par<br />

tablet, oral 300,400,600,800mg Private Formulations<br />

@ tablet, oral 300,400,600,800mg Purepac<br />

tablet, oral 400,600,800mg<br />

Sidmak<br />

@ tablet, oral 600mg<br />

Superpharm<br />

@ tablet, oral 400,600,800mg<br />

Teva<br />

tablet, oral 400mg<br />

Vintage<br />

@ tablet, oral 300,400,600,800mg Watson<br />

Brand(s)<br />

Motrin suspension, oral 100mg/5ml McNeil Consumer<br />

Ibu tablet, oral 400,600,800mg BASF<br />

Ibu-Tab tablet, oral 400,600mg Alra<br />

Ibu-Tab @ tablet, oral 800mg Alra<br />

Ibuprohm tablet, oral 400mg Ohm<br />

Motrin tablet, oral 300,400,600,800mg McNeil *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

IDOXURIDINE<br />

Brand(s)<br />

Dendrid solution, ophthalmic 0.1% Alcon<br />

Herplex Liquifilm solution, ophthalmic 0.1% Allergan<br />

Stoxil @ solution, ophthalmic 0.1% SmithKline Beecham<br />

119


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

IMIPRAMINE HYDROCHLORIDE<br />

Imipramine Hydrochloride @ tablet, oral 10,25,50mg Circa<br />

@ tablet, oral 10,25,50mg<br />

Eon<br />

tablet, oral 10,25,50mg<br />

Geneva<br />

@ tablet, oral 10,25,50mg<br />

Lederle<br />

tablet, oral 10,25,50mg<br />

Mutual<br />

tablet, oral 10,25,50mg<br />

Par<br />

tablet, oral 10,25,50mg<br />

Roxane<br />

tablet, oral 10,25,50mg<br />

Teva<br />

@ tablet, oral 25mg<br />

USL<br />

@ tablet, oral 10,25,50mg<br />

(Vangard/MWM)<br />

@ tablet, oral 10,25,50mg<br />

Watson<br />

@ tablet, oral 25,50mg<br />

West-ward<br />

Brand(s)<br />

Janimine @ tablet, oral 10,25,50mg Abbott<br />

Presamine @ tablet, oral 10,25,50mg Aventis<br />

Tofranil tablet, oral 10,25,50mg Tyco<br />

INAMRINONE LACTATE<br />

Inamrinone Lactate injection eq 5mg base/ml Abbott<br />

injection eq 5mg base/ml<br />

Baxter<br />

injection eq 5mg base/ml<br />

Bed<strong>for</strong>d<br />

Brand(s)<br />

Inocor injection eq 5mg base/ml Sanofi Syn<strong>the</strong>labo<br />

INDAPAMIDE<br />

Indapamide tablet, oral 2.5mg Akorn<br />

tablet, oral 1.25,2.5mg<br />

Alphapharm<br />

tablet, oral 1.25,2.5mg<br />

Geneva<br />

tablet, oral 1.25,2.5mg<br />

IVAX<br />

tablet, oral 1.25,2.5mg<br />

Mylan<br />

tablet, oral 1.25,2.5mg<br />

Purepac<br />

tablet, oral 1.25,2.5mg<br />

Teva<br />

tablet, oral 1.25,2.5mg<br />

Trigen<br />

tablet, oral 1.25,2.5mg<br />

Watson<br />

Brand(s)<br />

Lozol tablet, oral 1.25,2.5mg Aventis *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

INDOMETHACIN<br />

Indomethacin @ capsule, oral 25,50mg Barr<br />

@ capsule, oral 25,50mg<br />

Circa<br />

@ capsule, oral 25,50mg<br />

Danbury<br />

@ capsule, oral 25,50mg<br />

Duramed<br />

capsule, oral 25,50mg<br />

Geneva<br />

@ capsule, oral 25,50mg<br />

Halsey<br />

capsule, oral 25,50mg<br />

IVAX<br />

capsule, oral 25,50mg<br />

Lederle<br />

capsule, oral 25,50mg<br />

Mutual<br />

capsule, oral 25,50mg<br />

Mylan<br />

capsule, oral 25,50mg<br />

Par<br />

@ capsule, oral 25,50mg<br />

Parke-Davis<br />

@ capsule, oral 25,50mg<br />

Pioneer<br />

@ capsule, oral 25,50mg<br />

Roxane<br />

capsule, oral 25,50mg<br />

Sidmak<br />

(continued on <strong>the</strong> next page)<br />

120


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

INDOMETHACIN (continued)<br />

@ capsule, oral 25,50mg<br />

Superpharm<br />

capsule, oral 25,50mg<br />

Teva<br />

@ capsule, oral 25,50mg<br />

Watson<br />

capsule, extended release 75mg Able<br />

capsule, extended release 75mg Eon<br />

capsule, extended release 75mg Forest/Inwood<br />

suppository, rectal 50mg<br />

G & W<br />

suspension, oral 25mg/5ml<br />

Roxane<br />

Brand(s)<br />

Indo-Lemmon capsule, oral 25,50mg Teva<br />

Indocin capsule, oral 25,50mg Merck Sharp and Dohme *<br />

Indocin-SR @ capsule, extended release 75mg Merck Sharp and Dohme *<br />

Indocin suppository, rectal 50mg G & W<br />

Indocin suspension, oral 25mg/5ml Merck Sharp and Dohme<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

IODINATED GLYCEROL<br />

Iodinated Glycerol @ liquid, oral 60mg/5ml Alpharma<br />

(30mg organically bound iodine)<br />

@ liquid, oral 60mg/5ml<br />

Halsey<br />

(30mg organically bound iodine)<br />

@ liquid, oral 60mg/5ml<br />

Morton Grove<br />

(30mg organically bound iodine)<br />

@ solution, oral 50mg/ml<br />

Alpharma<br />

(25mg organically bound iodine)<br />

Brand(s)<br />

Iogan Elixir @ liquid, oral 60mg/5ml Hi-Tech<br />

(30mg organically bound iodine)<br />

Iophen Elixir @ liquid, oral 60mg/5ml Naska<br />

(30mg organically bound iodine)<br />

Iotuss Elixir @ liquid, oral 60mg/5ml Cenci<br />

(30mg organically bound iodine)<br />

Oridol Elixir @ liquid, oral 60mg/5ml Norton<br />

(30mg organically bound iodine)<br />

Organidin Elixir @ liquid, oral 60mg/5ml Wallace<br />

(30mg organically bound iodine)<br />

Sil-O-Tuss Elixir @ liquid, oral 60mg/5ml Silarx<br />

(30mg organically bound iodine)<br />

Iogan Solution @ solution, oral 50mg/ml Hi-Tech<br />

(25mg organically bound iodine)<br />

Iotuss Solution @ solution, oral 50mg/ml Cenci<br />

(25mg organically bound iodine)<br />

Organidin Drops @ solution, oral 50mg/ml Wallace<br />

(25mg organically bound iodine)<br />

Oridol Solution @ solution, oral 50mg/ml Norton<br />

(25mg organically bound iodine)<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

IODINATED GLYCEROL; CODEINE PHOSPHATE<br />

See CODEINE PHOSPHATE; IODINATED GLYCEROL<br />

IODINATED GLYCEROL; DEXTROMETHORPHAN HYDROBROMIDE<br />

See DEXTROMETHORPHAN HYDROBROMIDE; IODINATED GLYCEROL<br />

121


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

IOPAMIDOL<br />

Iopamidol injection 41,51,61,76% Elkins-Sinn<br />

injection 61,76%<br />

Faulding<br />

Brand(s)<br />

Iopamidol-200 injection 41% Abbott<br />

Iopamidol-250 injection 51% Abbott<br />

Iopamidol-300 injection 61% Abbott<br />

Iopamidol-370 injection 76% Abbott<br />

Iopamidol-250 injection 51% American Pharmaceutical<br />

Partners<br />

Iopamidol-300 injection 61% American Pharmaceutical<br />

Partners<br />

Iopamidol-370 injection 76% American Pharmaceutical<br />

Partners<br />

Iopamidol-200 injection 41% Cook Imaging<br />

Iopamidol-250 injection 51% Cook Imaging<br />

Iopamidol-300 injection 61% Cook Imaging<br />

Iopamidol-370 injection 76% Cook Imaging<br />

Isovue-200 injection 41% Bracco<br />

Isovue-250 injection 51% Bracco<br />

Isovue-300 injection 61% Bracco<br />

Isovue-370 injection 76% Bracco<br />

IPRATROPIUM BROMIDE<br />

Ipratropium Bromide solution <strong>for</strong> inhalation 0.2% Alpharma<br />

solution <strong>for</strong> inhalation 0.2%<br />

Aslung<br />

solution <strong>for</strong> inhalation 0.2%<br />

Dey<br />

solution <strong>for</strong> inhalation 0.2%<br />

Novex<br />

solution <strong>for</strong> inhalation 0.2%<br />

Steripak<br />

Brand(s)<br />

Atrovent solution <strong>for</strong> inhalation 0.2% Boehringer Ingelheim *<br />

Atrovent 0.03% spray, metered; nasal 0.021mg/spray Boehringer Ingelheim *<br />

Atrovent 0.06% spray, metered; nasal 0.042mg/spray Boehringer Ingelheim *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

IRON; ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D; VITAMIN E<br />

See ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; IRON; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D;<br />

VITAMIN E<br />

IRON; ASCORBIC ACID; FLUORIDE; VITAMIN A; VITAMIN D<br />

See ASCORBIC ACID; FLUORIDE; IRON; VITAMIN A; VITAMIN D<br />

ISOETHARINE HYDROCHLORIDE<br />

Isoetharine Hydrochloride @ solution <strong>for</strong> inhalation 1% Alpharma<br />

@ solution <strong>for</strong> inhalation 0.125,0.167,0.2, Astra Zeneca<br />

0.25%<br />

@ solution <strong>for</strong> inhalation 0.08,0.25% Baxter<br />

@ solution <strong>for</strong> inhalation 0.08,0.1,0.17, Dey<br />

0.25%<br />

solution <strong>for</strong> inhalation 1%<br />

Dey<br />

@ solution <strong>for</strong> inhalation 0.08, 0.1,0.167, International Medication<br />

0.2,0.25,1%<br />

(continued on <strong>the</strong> next page)<br />

122


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ISOETHARINE HYDROCHLORIDE (continued)<br />

@ solution <strong>for</strong> inhalation 1%<br />

Parke-Davis<br />

@ solution <strong>for</strong> inhalation 0.1,0.125,0.167, Roxane<br />

0.2,0.25%<br />

solution <strong>for</strong> inhalation 1%<br />

Roxane<br />

Brand(s)<br />

Beta-2 solution <strong>for</strong> inhalation 1% Nephron<br />

Bronkosol @ solution <strong>for</strong> inhalation 0.25,1% Sanofi Syn<strong>the</strong>labo<br />

ISOFLURANE<br />

Isoflurane liquid <strong>for</strong> inhalation 99.9% Abbott<br />

liquid <strong>for</strong> inhalation 99.9%<br />

Halocarbon<br />

liquid <strong>for</strong> inhalation 99.9%<br />

Minrad<br />

liquid <strong>for</strong> inhalation 99.9%<br />

Marsam<br />

liquid <strong>for</strong> inhalation 99.9%<br />

Rhodia<br />

Brand(s)<br />

Forane liquid <strong>for</strong> inhalation 99.9% Baxter<br />

ISONIAZID<br />

Isoniazid @ injection 100mg/ml Quad<br />

syrup, oral 50mg/5ml<br />

Carolina Medical<br />

@ syrup, oral 50mg/5ml<br />

Mikart<br />

@ tablet, oral 100mg<br />

Anabolic<br />

tablet, oral 100,300mg<br />

Barr<br />

@ tablet, oral 100,300mg<br />

Circa<br />

@ tablet, oral 50,100mg<br />

Danbury<br />

tablet, oral 300mg<br />

Danbury<br />

@ tablet, oral 300mg<br />

Dow<br />

@ tablet, oral 100mg<br />

Duramed<br />

tablet, oral 300mg<br />

Duramed<br />

tablet, oral 100,300mg<br />

Eon<br />

@ tablet, oral 50,100mg<br />

Halsey<br />

tablet, oral 300mg<br />

Halsey<br />

@ tablet, oral 100mg<br />

Impax<br />

@ tablet, oral 100,300mg<br />

IVAX<br />

@ tablet, oral 100,300mg<br />

Lilly<br />

@ tablet, oral 100mg<br />

MK<br />

tablet, oral 100,300mg<br />

Mikart<br />

@ tablet, oral 300mg<br />

Novartis<br />

@ tablet, oral 50,100,300mg<br />

Panray/Ormont<br />

@ tablet, oral 100mg<br />

Perrigo<br />

@ tablet, oral 100mg<br />

Pharmavite<br />

@ tablet, oral 50,100mg<br />

Phoenix<br />

@ tablet, oral 50,100mg<br />

Purepac<br />

@ tablet, oral 100,300mg<br />

Watson<br />

tablet, oral 100,300mg<br />

West-ward<br />

@ tablet, oral 100mg<br />

Whiteworth Towne<br />

Brand(s)<br />

Nydrazid injection 100mg/ml Apo<strong>the</strong>con<br />

Rimifon @ injection 100mg/ml Roche<br />

Laniazid @ syrup, oral 50mg/5ml Lannett<br />

Rimifon @ syrup, oral 50mg/5ml Roche<br />

Hyzyd @ tablet, oral 100,300mg Wallace<br />

Laniazid tablet, oral 50,100,300mg Lannett<br />

Nydrazid @ tablet, oral 100mg Squibb<br />

Stanozide @ tablet, oral 100,300mg Everylife<br />

123


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ISOPROTERENOL HYDROCHLORIDE<br />

Isoproterenol Hydrochloride @ injection 0.2mg/ml American Pharmaceutical<br />

Partners<br />

injection 0.2mg/ml<br />

Elkins-Sinn<br />

injection 0.2mg/ml<br />

International Medication<br />

@ solution <strong>for</strong> inhalation 0.5%<br />

Dey<br />

@ solution <strong>for</strong> inhalation 0.25,0.5% Parke-Davis<br />

Brand(s)<br />

Isuprel injection 0.2mg/ml Abbott<br />

Aerolone @ solution <strong>for</strong> inhalation 0.25% Lilly<br />

Isuprel @ solution <strong>for</strong> inhalation 0.5% Sanofi Syn<strong>the</strong>labo<br />

Vapo-ISO @ solution <strong>for</strong> inhalation 0.5% Fisons<br />

ISOSORBIDE DINITRATE<br />

Isosorbide Dinitrate @ tablet, oral 5,10,20,30mg Barr<br />

tablet, oral 5,10mg<br />

Danbury<br />

tablet, oral 5,10,20mg<br />

Geneva<br />

tablet, oral 5,10,20,30mg<br />

Par<br />

@ tablet, oral 5,10,20mg<br />

Superpharm<br />

tablet, oral 5,10,20mg<br />

West-ward<br />

tablet, extended release 40mg Inwood<br />

@ tablet, sublingual 2.5,5,10mg Barr<br />

tablet, sublingual 2.5,5mg<br />

Danbury<br />

tablet, sublingual 2.5,5mg<br />

Geneva<br />

tablet, sublingual 2.5,5mg<br />

West-ward<br />

Brand(s)<br />

Isordil tablet, oral 5,10,20,30,40mg Wyeth-Ayerst<br />

Sorbitrate tablet, oral 20,40mg Zeneca<br />

Sorbitrate @ tablet, oral 30mg Zeneca<br />

Isordil Tembid @ tablet, extended release 40mg Wyeth-Ayerst<br />

Isordil tablet, sublingual 2.5,5,10mg Wyeth-Ayerst<br />

ISOSORBIDE MONONITRATE<br />

Isosorbide Mononitrate tablet, oral 10,20mg Purepac<br />

tablet, oral 20mg<br />

Teva<br />

tablet, oral 20mg<br />

West-ward<br />

tablet, extended release 60mg Brightstone<br />

tablet, extended release 60mg Dexcel<br />

tablet, extended release 60mg Elan<br />

tablet, extended release 30,60,120mg IVAX<br />

tablet, extended release 30,120mg Kremers-Urban<br />

tablet, extended release 30,60,120mg KV<br />

tablet, extended release 30,60mg Purepac<br />

Brand(s)<br />

ISMO tablet, oral 10,20mg Robins<br />

Monoket tablet, oral 10,20mg Schwarz *<br />

Imdur tablet, extended release 30,60,120mg Schering *<br />

* <strong>Product</strong>s manufactured by this brand name drug manufacturer in this drug entity are available <strong>for</strong> drug<br />

product selection under o<strong>the</strong>r brand and/or generic names.<br />

KANAMYCIN SULFATE<br />

Kanamycin Sulfate @ injection eq 75,500mg base/2ml, American Pharmaceutical<br />

1gm base/3ml Partners<br />

@ injection eq 75,500mg base/2ml, Elkins-Sinn<br />

1gm base/3ml<br />

(continued on <strong>the</strong> next page)<br />

124


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

KANAMYCIN SULFATE (continued)<br />

@ injection eq 500mg base/2ml, International Medication<br />

1gm base/3ml<br />

@ injection eq 75,500mg base/2ml, Loch<br />

1gm base/3ml<br />

@ injection eq 75,500mg base/2ml, Pharmafair<br />

1gm base/3ml<br />

@ injection eq 75,500mg base/2ml, Quad<br />

1gm base/3ml<br />

@ injection eq 75,500mg base/2ml, Solopak<br />

1gm base/3ml<br />

@ injection eq 1gm base/3ml<br />

Steris<br />

@ injection eq 1gm base/3ml<br />

Warner Chilcott<br />

Brand(s)<br />

Kantrex injection eq 75,500mg base/2ml, Apo<strong>the</strong>con<br />

1gm base/3ml<br />

Klebcil @ injection eq 75,500mg base/2ml, King<br />

1gm base/3ml<br />

KETAMINE HYDROCHLORIDE<br />

Ketamine Hydrochloride injection eq 50,100mg base/ml Abbott<br />

injection eq 50,100mg base/ml Bed<strong>for</strong>d<br />

@ injection eq 10,50,100mg base/ml Quad<br />

Brand(s)<br />

Ketalar injection eq 10,50,100mg base/ml Parkedale<br />

KETOCONAZOLE<br />

Ketoconazole cream, topical 2% Teva<br />

tablet, oral 200mg<br />

Aesgen<br />

tablet, oral 200mg<br />

Applied Analytical Industries<br />

tablet, oral 200mg<br />

Mutual<br />

tablet, oral 200mg<br />

Mylan<br />

tablet, oral 200mg<br />

Sidmak<br />

tablet, oral 200mg<br />

Taro<br />

tablet, oral 200mg<br />

Teva<br />

tablet, oral 200mg<br />

TorPharm<br />

Brand(s)<br />

Nizoral cream, topical 2% Janssen<br />

Nizoral tablet, oral 200mg Janssen<br />

KETOPROFEN<br />

Ketoprofen capsule, extended release Andrx<br />

100,150,200mg<br />

capsule, extended release 200mg Elan<br />

capsule, extended release<br />

Mylan<br />

100,150,200mg<br />

capsule, oral 50,75mg<br />

Geneva<br />

capsule, oral 25,50,75mg<br />

Lederle<br />

capsule, oral 50,75mg<br />

Mylan<br />

capsule, oral 25,50,75mg<br />

Teva<br />

Brand(s)<br />

Orudis capsule, oral 25,50,75mg Wyeth-Ayerst<br />

Oruvail capsule, extended release Wyeth-Ayerst<br />

100,150,200mg<br />

125


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

KETOROLAC TROMETHAMINE<br />

Ketorolac Tromethamine injection 15,30mg/ml Abbott<br />

injection 30mg/ml<br />

Apotex<br />

@ injection 15,30mg/ml<br />

Apo<strong>the</strong>con<br />

injection 15,30mg/ml<br />

Baxter<br />

injection 15,30mg/ml<br />

Bed<strong>for</strong>d<br />

tablet, oral 10mg<br />

Mylan<br />

@ tablet, oral 10mg<br />

Roxane<br />

tablet, oral 10mg<br />

Sidmak<br />

tablet, oral 10mg<br />

Teva<br />

tablet, oral 10mg<br />

Watson<br />

Brand(s)<br />

Ketorolac preservative-free injection 15,30mg/ml Apotex<br />

Toradol injection 15,30mg Syntex<br />

Toradol tablet, oral 10mg Syntex *<br />

* <strong>Product</strong>s manufactured by this brand name drug manufacturer in this drug entity are available <strong>for</strong> drug<br />

product selection under o<strong>the</strong>r brand and/or generic names.<br />

LABETALOL HYDROCHLORIDE<br />

Labetalol Hydrochloride injection 5mg/ml Abbott<br />

@ injection 5mg/ml<br />

Apo<strong>the</strong>con<br />

injection 5mg/ml<br />

Bed<strong>for</strong>d<br />

injection 5mg/ml<br />

Faulding<br />

injection 5mg/ml<br />

Taylor<br />

tablet, oral 100,200,300mg<br />

Apo<strong>the</strong>con<br />

tablet, oral 100,200,300mg<br />

Eon<br />

tablet, oral 100,200,300mg<br />

IVAX<br />

tablet, oral 100,200,300mg<br />

Mutual<br />

tablet, oral 100,200,300mg<br />

Teva<br />

tablet, oral 100,200,300mg<br />

Watson<br />

Brand(s)<br />

Normodyne injection 5mg/ml Schering<br />

Trandate injection 5mg/ml Prome<strong>the</strong>us<br />

Normodyne tablet, oral 100,200,300mg Schering *<br />

Trandate tablet, oral 100,200,300mg Faro<br />

* <strong>Product</strong>s manufactured by this brand name drug manufacturer in this drug entity are available <strong>for</strong> drug<br />

product selection under o<strong>the</strong>r brand and/or generic names.<br />

LABETALOL HYDROCHLORIDE; HYDROCHLOROTHIAZIDE<br />

See HYDROCHLOROTHIAZIDE; LABETALOL HYDROCHLORIDE<br />

LACTULOSE<br />

Lactulose solution, oral 10gm/15ml Hi-Tech<br />

solution, oral 10gm/15ml<br />

Inalco<br />

solution, oral 10gm/15ml<br />

Morton Grove<br />

solution, oral 10gm/15ml<br />

Novex<br />

@ solution, oral 10gm/15ml<br />

Paco<br />

solution, oral 10gm/15ml<br />

Pharmaceutical Associates<br />

solution, oral 10gm/15ml<br />

Roxane<br />

solution, oral 10gm/15ml<br />

UDL<br />

solution, oral-rectal 10gm/15ml Hi-Tech<br />

@ solution, oral-rectal 10gm/15ml Paco<br />

solution, oral-rectal 10gm/15ml Roxane<br />

(continued on <strong>the</strong> next page)<br />

126


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

LACTULOSE (continued)<br />

Brand(s)<br />

Chronulac solution, oral 10gm/15ml Aventis<br />

Constilac solution, oral 10gm/15ml Alra<br />

Constulose solution, oral 10gm/15ml Alpharma<br />

Duphalac @ solution, oral 10gm/15ml Solvay<br />

Evalose solution, oral 10gm/15ml Copley<br />

Laxilose solution, oral 10gm/15ml Technilab<br />

Acilac solution, oral-rectal 10gm/15ml Technilab<br />

Cephulac solution, oral-rectal 10gm/15ml Aventis<br />

Cholac solution, oral-rectal 10gm/15ml Alra<br />

Enulose solution, oral-rectal 10gm/15ml Alpharma<br />

Generlac solution, oral-rectal 10gm/15ml Morton Grove<br />

Heptalac solution, oral-rectal 10gm/15ml Copley<br />

Portalac @ solution, oral-rectal 10gm/15ml Solvay<br />

LEUCOVORIN CALCIUM<br />

Leucovorin Calcium @ injection eq 3mg base/ml ABIC<br />

@ injection eq 3mg base/ml<br />

Immunex<br />

@ injection eq 5mg base/ml<br />

Quad<br />

injection eq 100,250mg base/vial Abbott<br />

@ injection eq 50mg base/vial<br />

ABIC<br />

@ injection eq 50mg base/vial<br />

American Pharmaceutical<br />

Partners<br />

injection eq 50,100mg base/vial Bed<strong>for</strong>d<br />

injection eq 50,100mg base/vial Elkins-Sinn<br />

injection eq 50,100,350mg base/vial Gensia Sicor<br />

injection eq 50,100,350mg base/vial Immunex<br />

injection eq 50,100,350mg base/vial Pharmachemie<br />

@ injection eq 50,100mg base/vial Quad<br />

tablet, oral eq 5,25mg base<br />

Barr<br />

tablet, oral eq 15mg base<br />

Geneva<br />

tablet, oral eq 10,15mg base<br />

Immunex<br />

tablet, oral eq 15mg base<br />

Invamed<br />

tablet, oral eq 5,25mg base<br />

Par<br />

tablet, oral eq 5,25mg base<br />

Pharmachemie<br />

tablet, oral eq 5,10,15,25mg base Roxane<br />

Brand(s)<br />

Leucovorin Calcium injection eq 10mg base/ml Abbott<br />

Preservative-Free<br />

Leucovorin Calcium injection eq 10mg base/ml Bed<strong>for</strong>d<br />

Preservative-Free<br />

Leucovorin Calcium injection eq 200,350mg base/vial Bed<strong>for</strong>d<br />

Preservative-Free<br />

Leucovorin Calcium injection eq 10mg base/ml Bigmar<br />

Preservative-Free<br />

Leucovorin Calcium injection eq 200mg base/vial Bigmar<br />

Preservative-Free<br />

Leucovorin Calcium injection eq 10mg base/ml Gensia Sicor<br />

Preservative-Free<br />

Leucovorin Calcium injection eq 10mg base/ml Luitpold<br />

Preservative-Free<br />

Wellcovorin injection eq 5mg base/ml Glaxo Wellcome<br />

Wellcovorin @ injection eq 50,100mg base/vial Glaxo Wellcome<br />

Wellcovorin @ tablet, oral eq 5,25mg base Glaxo Wellcome<br />

127


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

LEUPROLIDE ACETATE<br />

Leuprolide Acetate injection 1mg/0.2ml Bed<strong>for</strong>d<br />

injection 1mg/0.2ml<br />

Gensia-Sicor<br />

Brand(s)<br />

Lupron injection 1mg/0.2ml TAP<br />

LEVOBUNOLOL HYDROCHLORIDE<br />

Levobunolol Hydrochloride solution, ophthalmic 0.25,0.5% Alcon<br />

solution, ophthalmic 0.25,0.5% Bausch and Lomb<br />

solution, ophthalmic 0.25,0.5% Novex<br />

Brand(s)<br />

AKbeta solution, ophthalmic 0.25.0.5% Akorn<br />

Betagan solution, ophthalmic 0.25,0.5% Allergan *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

LEVOCARNITINE<br />

Levocarnitine injection 200mg/ml Bed<strong>for</strong>d<br />

Brand(s)<br />

Carnitor injection 200mg/5ml Sigma Tau<br />

LEVODOPA; CARBIDOPA<br />

See CARBIDOPA; LEVODOPA<br />

LEVONORDEFRIN; MEPIVICAINE HYDROCHLORIDE<br />

Levonordefrin; injection 0.05mg/ml;2% Graham<br />

Mepivicaine Hydrochloride<br />

Brand(s)<br />

Arestocaine Hydrochloride @ injection 0.05mg/ml;2% Solvay<br />

with Levonordefrin<br />

Carbocaine Hydrochloride injection 0.05mg/ml;2% Eastman Kodak<br />

with Neo-Cobefrin<br />

Isocaine Hydrochloride injection 0.05mg/ml;2% Novocol<br />

with Levonordefrin<br />

Polocaine with Levonordefrin injection 0.05mg/ml;2% Dentsply<br />

Scandonest L injection 0.05mg/ml;2% Deproco<br />

LEVONORGESTREL; ETHINYL ESTRADIOL<br />

See ETHINYL ESTRADIOL; LEVONORGESTREL<br />

LEVORPHANOL TARTRATE<br />

Levorphanol Tartrate tablet, oral 2mg Roxane<br />

Brand(s)<br />

Levo-Dromoran tablet, oral 2mg ICN<br />

LIDOCAINE<br />

Lidocaine ointment, topical 5% Fougera/Altana<br />

ointment, topical 5%<br />

Graham<br />

ointment, topical 5%<br />

Thames<br />

Brand(s)<br />

Alphacaine ointment, topical 5% Carlisle<br />

Xylocaine ointment, topical 5% Astra Zeneca<br />

128


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

LIDOCAINE HYDROCHLORIDE<br />

Lidocaine Hydrochloride injection 0.5,1,2,20% Abbott<br />

@ injection 10%<br />

Abbott<br />

@ injection 1,2%<br />

Akorn<br />

@ injection 1.5,20%<br />

American Pharmaceutical<br />

Partners<br />

@ injection 1,2%<br />

Bel Mar<br />

@ injection 1,2%<br />

Dell<br />

@ injection 0.5,4%<br />

Elkins-Sinn<br />

injection 1,2%<br />

Elkins-Sinn<br />

injection 2%<br />

Graham<br />

injection 1,2%<br />

International Medication<br />

@ injection 4%<br />

International Medication<br />

injection 1,2%<br />

Luitpold<br />

@ injection 1,2%<br />

Miles<br />

@ injection 1,%<br />

Searle<br />

@ injection 1,2%<br />

Steris<br />

injection 1,2%<br />

Wyeth-Ayerst<br />

jelly, topical 2%<br />

Copley<br />

jelly, topical 2%<br />

International Medication<br />

solution, oral (viscous) 2%<br />

Alpharma<br />

solution, oral (viscous) 2%<br />

Hi-Tech<br />

@ solution, oral (viscous) 2%<br />

International Medication<br />

solution, oral (viscous) 2%<br />

Morton Grove<br />

solution, oral (viscous) 2%<br />

Roxane<br />

solution, topical 4%<br />

Morton Grove<br />

@ solution, topical 4%<br />

Paco<br />

solution, topical 4%<br />

Roxane<br />

Brand(s)<br />

Alphacaine @ injection 2% Carlisle<br />

Lidocaine Hydrochloride injection 1,1.5,4% Abbott<br />

Preservative-Free<br />

Lidocaine Hydrochloride injection 1,2% Abbott<br />

Preservative-Free (in plastic container)<br />

Lidocaine Hydrochloride injection 1,2,4% American Pharmaceutical<br />

Preservative-Free Partners<br />

Lidocaine Hydrochloride injection 1,2% Elkins-Sinn<br />

Preservative-Free<br />

Lidocaine Hydrochloride injection 20% International Medication<br />

Preservative-Free<br />

Lidocaton @ injection 2% Pharmaton<br />

Lidopen injection 10% Meridian<br />

Xylocaine injection 0.5,1,1.5,2% Astra Zeneca<br />

Xylocaine Preservative-Free injection 2,4,10,20% Astra Zeneca<br />

Xylocaine jelly, topical 2% Astra Zeneca<br />

Xylocaine solution, oral (viscous) 2% Astra Zeneca<br />

Anestacon solution, topical 2% Polymedica<br />

Laryng-O-Jet solution, topical 4% International Medication<br />

Laryngotracheal Anes<strong>the</strong>sia Kit @ solution, topical 4% Kendall<br />

LTA II Kit solution, topical 4% Abbott<br />

Pediatric LTA Kit solution, topical 2% Abbott<br />

Xylocaine 4% solution, topical 4% Astra Zeneca<br />

* PRODUCTS LABELED FOR INTRACARDIAC USE MAY NOT BE INTERCHANGED.<br />

LIDOCAINE HYDROCHLORIDE; DEXTROSE<br />

See DEXTROSE; LIDOCAINE HYDROCHLORIDE<br />

129


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

LIDOCAINE HYDROCHLORIDE; EPINEPHRINE<br />

See EPINEPHRINE; LIDOCAINE HYDROCHLORIDE<br />

LINCOMYCIN<br />

Lincomycin @ injection eq 300 base mg/ml Quad<br />

@ injection eq 300 base mg/ml<br />

Steris<br />

Brand(s)<br />

Lincocin injection eq 300 base mg/ml Pharmacia & Upjohn<br />

LINDANE (GAMMA BENZENE HEXACHLORIDE)<br />

Lindane lotion, topical 1% Alpharma<br />

lotion, topical 1%<br />

Morton Grove<br />

shampoo, topical 1%<br />

Alpharma<br />

shampoo, topical 1%<br />

Morton Grove<br />

Brand(s)<br />

Gamene @ lotion, topical 1% Sola Barnes-Hind<br />

Kwell @ lotion, topical 1% Reed and Carnrick<br />

Scabene @ lotion, topical 1% Stiefel<br />

Gamene @ shampoo, topical 1% Sola Barnes-Hind<br />

Kwell @ shampoo, topical 1% Reed and Carnrick<br />

Scabene @ shampoo, topical 1% Stiefel<br />

LIOTHYRONINE SODIUM<br />

Liothyronine Sodium @ tablet, oral 0.025,0.05mg base Circa<br />

Brand(s)<br />

Cytomel tablet, oral 0.025,0.05mg base SmithKline Beecham<br />

LISINOPRIL<br />

Brand(s)<br />

Prinivil tablet, oral 2.5,5,10,20,40mg Merck Sharp and Dohme *<br />

Zestril tablet, oral 2.5,5,10,20,40mg Zeneca<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

LISINOPRIL; HYDROCHLOROTHIAZIDE<br />

See HYDROCHLOROTHIAZIDE; LISINOPRIL<br />

LITHIUM CARBONATE<br />

Lithium Carbonate capsule, oral 300mg Able<br />

@ capsule, oral 300mg<br />

Circa<br />

capsule, oral 300mg<br />

Roxane<br />

@ capsule, oral 300mg<br />

USL<br />

tablet, oral 300mg<br />

Roerig/Pfizer<br />

tablet, oral 300mg<br />

Roxane<br />

Brand(s)<br />

Eskalith capsule, oral 300mg SmithKline Beecham<br />

Lithonate @ capsule, oral 300mg Solvay<br />

Eskalith @ tablet, oral 300mg SmithKline Beecham<br />

Lithane @ tablet, oral 300mg Bayer<br />

Lithotabs @ tablet, oral 300mg Solvay<br />

130


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

LITHIUM CITRATE<br />

Lithium Citrate syrup, oral (eq 300mg carbonate/5ml) Morton Grove<br />

syrup, oral (eq 300mg carbonate/5ml) Roxane<br />

Brand(s)<br />

Lithonate @ syrup, oral (eq 300mg carbonate/5ml) Solvay<br />

LOPERAMIDE HYDROCHLORIDE<br />

Loperamide Hydrochloride capsule, oral 2mg Geneva<br />

capsule, oral 2mg<br />

Mylan<br />

@ capsule, oral 2mg<br />

Roxane<br />

capsule, oral 2mg<br />

Teva<br />

Brand(s)<br />

Imodium capsule, oral 2mg McNeil Consumer<br />

LORAZEPAM<br />

Lorazepam injection 2,4mg/ml Abbott<br />

injection 2mg/ml<br />

Akorn<br />

injection 2,4mg/ml<br />

Elkins-Sinn<br />

injection 2,4mg/ml<br />

Marsam<br />

injection 2,4mg/ml<br />

Mova<br />

injection 2,4mg/ml<br />

Steris<br />

injection 2mg/ml<br />

Taylor<br />

@ tablet, oral 0.5,1,2mg<br />

American Therapeutics<br />

@ tablet, oral 0.5,1,2mg<br />

Barr<br />

tablet, oral 0.5,1,2mg<br />

Danbury<br />

tablet, oral 0.5,1,2mg<br />

Geneva<br />

@ tablet, oral 0.5,1,2mg<br />

Halsey<br />

tablet, oral 0.5,1,2mg<br />

Mutual<br />

tablet, oral 0.5,1,2mg<br />

Mylan<br />

@ tablet, oral 0.5,1,2mg<br />

Par<br />

tablet, oral 0.5,1,2mg<br />

Purepac<br />

tablet, oral 0.5,1,2mg<br />

Ranbaxy<br />

tablet, oral 0.5,1,2mg<br />

Royce<br />

@ tablet, oral 0.5,1,2mg<br />

Superpharm<br />

@ tablet, oral 1,2mg<br />

USL<br />

@ tablet, oral 1,2mg<br />

Warner-Chilcott<br />

tablet, oral 0.5,1,2mg<br />

Watson<br />

Brand(s)<br />

Ativan injection 2,4mg/ml Wyeth-Ayerst<br />

Ativan tablet, oral 0.5,1,2mg Wyeth-Ayerst<br />

Loraz @ tablet, oral 0.5,1,2mg Quantum<br />

LOVASTATIN<br />

Lovastatin tablet, oral 10,20,40mg Eon<br />

tablet, oral 10,20,40mg<br />

Geneva<br />

tablet, oral 10,20,40mg<br />

GenPharm<br />

tablet, oral 10,20,40mg<br />

Mylan<br />

tablet, oral 10,20,40mg<br />

Purepac<br />

tablet, oral 10,20,40mg<br />

Teva<br />

Brand(s)<br />

Mevacor tablet, oral 10,20,40mg Merck<br />

LOXAPINE SUCCINATE<br />

Loxapine Succinate capsule, oral eq 5,10,25,50mg base Watson<br />

Brand(s)<br />

Loxitane capsule, oral eq 5,10,25,50mg base Watson<br />

131


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

MAGNESIUM CHLORIDE; CALCIUM CHLORIDE; DEXTROSE; GLUTATHIONE DISULFIDE; POTASSIUM<br />

CHLORIDE; SODIUM BICARBONATE; SODIUM CHLORIDE; SODIUM PHOSPHATE<br />

See CALCIUM CHLORIDE; DEXTROSE; GLUTATHIONE DISULFIDE; MAGNESIUM CHLORIDE;<br />

POTASSIUM CHLORIDE; SODIUM BICARBONATE; SODIUM CHLORIDE; SODIUM<br />

PHOSPHATE<br />

MAGNESIUM CHLORIDE; CALCIUM CHLORIDE; DEXTROSE; SODIUM CHLORIDE; SODIUM LACTATE<br />

See CALCIUM CHLORIDE; DEXTROSE; MAGNESIUM CHLORIDE; SODIUM CHLORIDE; SODIUM<br />

LACTATE<br />

MAGNESIUM CHLORIDE; DEXTROSE; POTASSIUM CHLORIDE; SODIUM ACETATE;<br />

SODIUM CHLORIDE; SODIUM GLUCONATE<br />

See DEXTROSE; MAGNESIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM ACETATE; SODIUM<br />

CHLORIDE; SODIUM GLUCONATE<br />

132


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

MAGNESIUM CHLORIDE; CALCIUM CHLORIDE; DEXTROSE; GLUTATHIONE DISULFIDE; POTASSIUM<br />

CHLORIDE; SODIUM BICARBONATE; SODIUM CHLORIDE; SODIUM PHOSPHATE<br />

See CALCIUM CHLORIDE; DEXTROSE; GLUTATHIONE DISULFIDE; MAGNESIUM CHLORIDE;<br />

POTASSIUM CHLORIDE; SODIUM BICARBONATE; SODIUM CHLORIDE; SODIUM<br />

PHOSPHATE<br />

MAGNESIUM CHLORIDE; CALCIUM CHLORIDE; DEXTROSE; SODIUM CHLORIDE; SODIUM LACTATE<br />

See CALCIUM CHLORIDE; DEXTROSE; MAGNESIUM CHLORIDE; SODIUM CHLORIDE; SODIUM<br />

LACTATE<br />

MAGNESIUM CHLORIDE; DEXTROSE; POTASSIUM CHLORIDE; SODIUM ACETATE;<br />

SODIUM CHLORIDE; SODIUM GLUCONATE<br />

See DEXTROSE; MAGNESIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM ACETATE; SODIUM<br />

CHLORIDE; SODIUM GLUCONATE<br />

MAGNESIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM ACETATE; SODIUM CHLORIDE;<br />

SODIUM GLUCONATE<br />

Injection; in plastic container<br />

Solution <strong>for</strong> irrigation; in plastic container<br />

Brand(s)<br />

Isolyte S injection 30mg/100ml;37mg/100ml; Braun<br />

370mg/100ml;530mg/100ml;<br />

500mg/100ml<br />

Plasma-Lyte A injection 30mg/100ml;37mg/100ml; Baxter<br />

368mg/100ml;526mg/100ml;<br />

502mg/100ml<br />

Plasma-Lyte 148 injection 30mg/100ml;37mg/100ml; Baxter<br />

368mg/100ml;526mg/100ml;<br />

502mg/100ml<br />

Physiolyte solution, irrigation 30mg/100ml; Braun<br />

37mg/100ml;370mg/100ml;<br />

530mg/100ml;500mg/100ml<br />

Synovalyte @ solution, irrigation 30mg/100ml; Baxter<br />

37mg/100ml;370mg/100ml;<br />

530mg/100ml;500mg/100ml<br />

MAGNESIUM CHLORIDE; CALCIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM CHLORIDE<br />

See CALCIUM CHLORIDE; MAGNESIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM CHLORIDE<br />

MAGNESIUM OXIDE; CITRIC ACID; SODIUM CARBONATE<br />

See CITRIC ACID; MAGNESIUM OXIDE; SODIUM CARBONATE<br />

MAGNESIUM SULFATE<br />

Magnesium Sulfate injection 500mg/ml (50%) Abbott<br />

injection 500mg/ml (50%)<br />

American Pharmaceutical<br />

Partners<br />

MANNITOL<br />

Mannitol injection 5gm/100ml (5%), Abbott<br />

10gm/100ml (10%),<br />

15gm/100ml (15%),<br />

20gm/100ml (20%),<br />

25gm/100ml (25%)<br />

(continued on <strong>the</strong> next page)<br />

132


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

MANNITOL (continued)<br />

injection 25gm/100ml (25%)<br />

injection 12.5gm/50ml (25%),<br />

injection 5gm/100ml (5%),<br />

10gm/100ml (10%),<br />

15gm/100ml (15%),<br />

20gm/100ml (20%),<br />

injection 25gm/100ml (25%)<br />

injection 25gm/100ml (25%)<br />

@ injection 10gm/100ml (10%)<br />

@ injection 15gm/100ml (15%)<br />

@ injection 20gm/100ml (20%)<br />

@ injection 25gm/100ml (25%)<br />

@ injection 25gm/100ml (25%)<br />

Brand(s)<br />

Osmitrol injection 5gm/100ml (5%), Baxter<br />

10gm/100ml (10%),<br />

15gm/100ml (15%),<br />

20gm/100ml (20%)<br />

American Pharmaceutical<br />

Partners<br />

Astra Zeneca<br />

Braun<br />

International Medication<br />

Luitpold<br />

Miles<br />

Miles<br />

Miles<br />

Merck Sharp and Dohme<br />

Steris<br />

MANNITOL; DEXTROSE<br />

See DEXTROSE; MANNITOL<br />

MAPROTILINE HYDROCHLORIDE<br />

Maprotiline Hydrochloride @ tablet, oral 25,50,75mg American Therapeutics<br />

@ tablet, oral 25,50,75mg<br />

Circa<br />

tablet, oral 25,50,75mg<br />

Mylan<br />

tablet, oral 25,50,75mg<br />

Watson<br />

Brand(s)<br />

Ludiomil tablet, oral 25,50,75mg Novartis<br />

MEBENDAZOLE<br />

Mebendazole tablet, chewable 100mg Copley<br />

Brand(s)<br />

Vermox tablet, chewable 100mg McNeil Consumer<br />

MECLIZINE HYDROCHLORIDE<br />

Meclizine Hydrochloride tablet, oral 12.5,25mg ABC<br />

@ tablet, oral 25mg<br />

Anabolic<br />

tablet, oral 12.5,25mg<br />

Bundy<br />

@ tablet, oral 12.5mg<br />

Circa<br />

tablet, oral 12.5,25mg<br />

Geneva<br />

@ tablet, oral 12.5,25mg<br />

IVAX<br />

@ tablet, oral 12.5,25mg<br />

KV<br />

tablet, oral 12.5,25,50mg<br />

Par<br />

tablet, oral 12.5,25mg<br />

Sidmak<br />

@ tablet, oral 12.5,25mg<br />

Superpharm<br />

@ tablet, oral 12.5,25mg<br />

(Unit Dose Labs)<br />

@ tablet, oral 12.5,25mg<br />

(Vangard/MWM)<br />

tablet, oral 12.5,25mg<br />

Vintage<br />

@ tablet, oral 12.5mg<br />

Watson<br />

tablet, oral 25mg<br />

Watson<br />

@ tablet, chewable 25mg<br />

Anabolic<br />

@ tablet, chewable 25mg<br />

IVAX<br />

tablet, chewable 25mg<br />

Sidmak<br />

(continued on <strong>the</strong> next page)<br />

133


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

MECLIZINE HYDROCHLORIDE<br />

Brand(s)<br />

Antivert tablet, oral 12.5,25,50mg Roerig/Pfizer<br />

Antivert tablet, chewable 25mg Roerig/Pfizer<br />

(All products are Rx, although some manufacturers also market an OTC version of <strong>the</strong> product)<br />

MECLOFENAMATE SODIUM<br />

Meclofenamate Sodium @ capsule, oral eq 50,100mg base American Therapeutics<br />

@ capsule, oral eq 50,100mg base Barr<br />

@ capsule, oral eq 50,100mg base Circa<br />

capsule, oral eq 50,100mg base Danbury<br />

@ capsule, oral eq 50,100mg base Eon<br />

capsule, oral eq 50,100mg base Geneva<br />

capsule, oral eq 50,100mg base Mylan<br />

@ capsule, oral eq 50,100mg base Par<br />

@ capsule, oral eq 50,100mg base USL<br />

@ capsule, oral eq 50,100mg base Watson<br />

Brand(s)<br />

Meclomen capsule, oral eq 50,100mg base Parke-Davis<br />

MEDROXYPROGESTERONE ACETATE<br />

Medroxyprogesterone Acetate tablet, oral 2.5,5,10mg Barr<br />

tablet, oral 2.5,5,10mg<br />

Duramed<br />

Brand(s)<br />

Cycrin @ tablet, oral 2.5,5,10mg ESI *<br />

Provera tablet, oral 2.5,5,10mg Pharmacia & Upjohn *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

MEFLOQUINE HYDROCHLORIDE<br />

Mefloquine Hydrochloride tablet, oral 250mg Geneva<br />

Brand(s)<br />

Lariam tablet, oral 250mg Roche<br />

MEGESTROL ACETATE<br />

Megestrol Acetate suspension, oral 40mg/ml Par<br />

suspension, oral 40mg/ml<br />

Roxane<br />

tablet, oral 20,40mg<br />

Barr<br />

tablet, oral 20,40mg<br />

Par<br />

tablet, oral 20,40mg<br />

Roxane<br />

tablet, oral 40mg<br />

Teva<br />

@ tablet, oral 20,40mg<br />

USL<br />

Brand(s)<br />

Megace suspension, oral 40mg/ml Bristol-Myers Squibb<br />

Megace tablet, oral 20,40mg Bristol-Myers Squibb<br />

MENADIOL SODIUM PHOSPHATE<br />

Brand(s)<br />

Kappadione @ injection 10mg/ml Lilly<br />

Synkavite @ injection 10mg/ml Roche<br />

134


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

MENOTROPINS (FSH;LH)<br />

Brand(s)<br />

Humegon @ injection 75IU/vial;75IU/vial Organon<br />

Humegon @ injection 150IU/vial;150IU/vial Organon<br />

Pergonal injection 75IU/vial;75IU/vial Serono<br />

Pergonal injection 150IU/vial;150IU/vial Serono<br />

Repronex @ injection 75IU/vial;75IU/vial Ferring<br />

Repronex @ injection 150IU/vial;150IU/vial Ferring<br />

MEPERIDINE HYDROCHLORIDE<br />

Meperidine Hydrochloride @ injection 25,50,75,100mg/ml Abbott<br />

@ injection 25,50,75,100mg/ml<br />

Astra Zeneca<br />

injection 25,50,75,100mg/ml<br />

Elkins-Sinn<br />

@ injection 50,75,100mg/ml<br />

Parke-Davis<br />

injection 50,100mg/ml<br />

Steris<br />

injection 25,50,75,100mg/ml<br />

Wyeth-Ayerst<br />

syrup, oral 50mg/5ml<br />

Roxane<br />

tablet, oral 50,100mg<br />

Amide<br />

tablet, oral 50,100mg<br />

Barr<br />

tablet, oral 50,100mg<br />

Duramed<br />

tablet, oral 50,100mg<br />

Halsey<br />

tablet, oral 50,100mg<br />

Mallinckrodt<br />

tablet, oral 50,100mg<br />

Roxane<br />

tablet, oral 50,100mg<br />

Royce<br />

tablet, oral 50mg<br />

Wyeth-Ayerst<br />

tablet, oral 50,100mg<br />

Vintage<br />

Brand(s)<br />

Demerol injection 25,50,75,100mg/ml Sanofi Syn<strong>the</strong>labo<br />

Meperidine Hydrochloride injection 10mg/ml Abbott<br />

Preservative-Free<br />

Meperidine Hydrochloride injection 10mg/ml Astra Zeneca<br />

Preservative-Free<br />

Meperidine Hydrochloride injection 10mg/ml Faulding<br />

Preservative-Free<br />

Meperidine Hydrochloride injection 10mg/ml International Medications<br />

Preservative-Free<br />

Meperidine Hydrochloride injection 10mg/ml Mallinckrodt<br />

Preservative-Free<br />

Meperidine Hydrochloride injection 10mg/ml Steris<br />

Preservative-Free<br />

Demerol syrup, oral 50mg/5ml Sanofi Syn<strong>the</strong>labo<br />

Demerol tablet, oral 50,100mg Sanofi Syn<strong>the</strong>labo<br />

MEPERIDINE HYDROCHLORIDE; ATROPINE SULFATE<br />

See ATROPINE SULFATE; MEPERIDINE HYDROCHLORIDE<br />

MEPIVICAINE HYDROCHLORIDE<br />

Mepivicaine Hydrochloride injection 3% Graham<br />

@ injection 1%<br />

International Medication<br />

injection 1,2%<br />

Steris<br />

Brand(s)<br />

Arestocaine HCl @ injection 3% Solvay<br />

Carbocaine injection 1,1.5,2% Sterling Winthrop<br />

Carbocaine injection 3% Eastman Kodak<br />

Isocaine HCl injection 3% Novocol<br />

Polocaine injection 1,2% Astra Zeneca<br />

Polocaine injection 3% Dentsply<br />

(continued on <strong>the</strong> next page)<br />

135


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

MEPIVICAINE HYDROCHLORIDE (continued)<br />

Polocaine-MPF injection 1,1.5,2% Astra Zeneca<br />

Scandonest Plain injection 3% Deproco<br />

MEPIVICAINE HYDROCHLORIDE; LEVONORDEFRIN<br />

See LEVONORDEFRIN; MEPIVICAINE HYDROCHLORIDE<br />

MEPROBAMATE<br />

Meprobamate @ tablet, oral 200,400mg Anabolic<br />

tablet, oral 400mg<br />

Barr<br />

@ tablet, oral 200,600mg<br />

Barr<br />

tablet, oral 200,400mg<br />

Watson<br />

@ tablet, oral 600mg<br />

Watson<br />

tablet, oral 200,400mg<br />

Danbury<br />

@ tablet, oral 600mg<br />

Danbury<br />

@ tablet, oral 200,400mg<br />

Elkins-Sinn<br />

tablet, oral 200,400mg<br />

Eon<br />

@ tablet, oral 200,400mg<br />

Everylife<br />

tablet, oral 400mg<br />

Geneva<br />

@ tablet, oral 400mg<br />

Halsey<br />

@ tablet, oral 400,600mg<br />

Hea<strong>the</strong>r<br />

@ tablet, oral 200,400mg<br />

ICN<br />

@ tablet, oral 200,400mg<br />

Impax<br />

@ tablet, oral 200,400,600mg<br />

IVAX<br />

@ tablet, oral 200,400mg<br />

Lannett<br />

@ tablet, oral 400mg<br />

Lederle<br />

@ tablet, oral 400mg<br />

Lee<br />

@ tablet, oral 400mg<br />

Mallard<br />

@ tablet, oral 200,400mg<br />

MK<br />

tablet, oral 400mg<br />

Mylan<br />

@ tablet, oral 200,400mg<br />

Parke-Davis<br />

@ tablet, oral 200,400mg<br />

Perrigo<br />

@ tablet, oral 400mg<br />

Pharmavite<br />

@ tablet, oral 400mg<br />

Pharmeral<br />

@ tablet, oral 400mg<br />

Private Formulations<br />

@ tablet, oral 200,400mg<br />

Purepac<br />

tablet, oral 600mg<br />

Roxane<br />

tablet, oral 400mg<br />

Scherer<br />

@ tablet, oral 200mg<br />

Solvay<br />

tablet, oral 400mg<br />

Tablicaps<br />

@ tablet, oral 200,400mg<br />

USL<br />

@ tablet, oral 400mg<br />

(Vangard/MWM)<br />

tablet, oral 200,400mg<br />

West-ward<br />

@ tablet, oral 200,400mg<br />

Whiteworth Towne<br />

Brand(s)<br />

Amosene @ tablet, oral 400mg Ferndale<br />

Equanil tablet, oral 200,400mg Wyeth-Ayerst<br />

Mepriam @ tablet, oral 400mg Teva<br />

Miltown tablet, oral 200,400,600mg Wallace<br />

Neuramate @ tablet, oral 200,400mg Halsey<br />

Tranmep tablet, oral 400mg Solvay<br />

MEPROBAMATE; ASPIRIN<br />

See ASPIRIN; MEPROBAMATE<br />

136


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

MESNA<br />

Mesna injection 100mg/ml American Pharmaceutical<br />

Partners<br />

Brand(s)<br />

Mesnex injection 100mg/ml Asta<br />

MESTRANOL; NORETHINDRONE<br />

tablet, oral 0.05mg;1mg<br />

Watson<br />

Brand(s)<br />

Necon 1/50 tablet, oral 0.05mg;1mg Watson<br />

Norethin 1/50M tablet, oral 0.05mg;1mg Watson<br />

Norinyl 1+50 tablet, oral 0.05mg;1mg Watson<br />

Ortho-Novum 1/50 tablet, oral 0.05mg;1mg RW Johnson<br />

Norinyl 1+80 @ tablet, oral 0.08mg;1mg Searle<br />

Ortho-Novum 1/80 @ tablet, oral 0.08mg;1mg RW Johnson<br />

Note: 21 day packs may not be interchanged with 28 day packs.<br />

METAPROTERENOL SULFATE<br />

Metaproterenol Sulfate @ solution <strong>for</strong> inhalation 0.4,0.6% AstraZeneca<br />

@ solution <strong>for</strong> inhalation 5%<br />

Morton Grove<br />

solution <strong>for</strong> inhalation 0.4,0.6% Nephron<br />

solution <strong>for</strong> inhalation 0.4,0.6% Novex<br />

@ syrup, oral 10mg/5ml<br />

Copley<br />

syrup, oral 10mg/5ml<br />

JVL<br />

syrup, oral 10mg/5ml<br />

Morton Grove<br />

syrup, oral 10mg/5ml<br />

Novex<br />

syrup, oral 10mg/ml<br />

Silarx<br />

@ syrup, oral 10mg/5ml<br />

Teva<br />

@ tablet, oral 10,20mg<br />

American Therapeutics<br />

tablet, oral 10,20mg<br />

Danbury<br />

tablet, oral 10,20mg<br />

Par<br />

tablet, oral 10,20mg<br />

Teva<br />

@ tablet, oral 10,20mg<br />

USL<br />

Brand(s)<br />

Alupent aerosol, metered 0.65mg/inhalation Boehringer Ingelheim *<br />

Alupent solution <strong>for</strong> inhalation 0.4,0.6,5% Boehringer Ingelheim *<br />

Dey-Dose @ solution <strong>for</strong> inhalation 5% Dey<br />

Dey-Lute solution <strong>for</strong> inhalation 0.4,0.6% Dey<br />

Prometa @ solution <strong>for</strong> inhalation 5% Muro<br />

Alupent @ syrup, oral 10mg/5ml Boehringer Ingelheim *<br />

Prometa @ syrup, oral 10mg/5ml Muro<br />

Alupent tablet, oral 10,20mg Boehringer Ingelheim *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

METARAMINOL BITARTRATE<br />

Metaraminol Bitartrate injection eq 10mg base/ml American Pharmaceutical<br />

Partners<br />

@ injection eq 10mg base/ml<br />

Elkins-Sinn<br />

@ injection eq 10mg base/ml<br />

Searle<br />

Brand(s)<br />

Aramine injection eq 10mg base/ml Merck Sharp and Dohme<br />

137


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

METFORMIN HYDROCHLORIDE<br />

Met<strong>for</strong>min Hydrochloride tablet, oral 500,850,1000mg Alphapharm<br />

tablet, oral 500,850,1000mg<br />

Andrx<br />

tablet, oral 500,850,1000mg<br />

Barr<br />

tablet, oral 500,850,1000mg<br />

Eon<br />

tablet, oral 500,850,1000mg<br />

Geneva<br />

tablet, oral 500,850,1000mg<br />

GenPharm<br />

tablet, oral 500,850,1000mg<br />

IVAX<br />

tablet, oral 500,850,1000mg<br />

Mylan<br />

tablet, oral 500,850,1000mg<br />

Purepac<br />

tablet, oral 500,850,1000mg<br />

Teva<br />

tablet, oral 500,850,1000mg<br />

Watson<br />

Brand(s)<br />

Glucophage tablet, oral 500,850,1000mg Bristol-Myers Squibb<br />

METHADONE HYDROCHLORIDE<br />

Methadone Hydrochloride concentrate, oral 10mg/ml UDL<br />

injection, preservative-free 1,1.5,4% Abbott<br />

injection, preservative-free 1,2,4% American Pharmaceutical<br />

Partners<br />

injection, preservative-free 1,2% Elkins-Sinn<br />

tablet, oral 5,10mg<br />

Eon<br />

tablet, oral 5,10mg<br />

Roxane<br />

tablet, dispersable 40mg<br />

Eon<br />

tablet, dispersable 40mg<br />

Roxane<br />

Brand(s)<br />

Intensol concentrate, oral 10mg/ml Roxane<br />

Methadose concentrate, oral 10mg/ml Mallinckrodt<br />

Dolophine tablet, oral 5,10mg Lilly<br />

Methadose tablet, oral 5,10mg Mallinckrodt<br />

Methadose tablet, dispersable 40mg Mallinckrodt<br />

METHAMPHETAMINE HYDROCHLORIDE<br />

Methamphetamine @ tablet, oral 5,10mg Rexar<br />

tablet, oral 5,10mg<br />

Shire Richwood<br />

Hydrochloride @ tablet, oral 5mg Teva<br />

Brand(s)<br />

Desoxyn tablet, oral 5mg Abbott<br />

Methampex @ tablet, oral 10mg Teva<br />

METHAZOLAMIDE<br />

Methazolamide @ tablet, oral 25,50mg Applied Analytical Industries<br />

tablet, oral 25,50mg<br />

Copley<br />

tablet, oral 25,50mg<br />

Geneva<br />

tablet, oral 25,50mg<br />

Invamed<br />

tablet, oral 25,50mg<br />

Mikart<br />

Brand(s)<br />

Neptazane tablet, oral 25,50mg Storz<br />

METHENAMINE HIPPURATE<br />

Brand(s)<br />

Hiprex tablet, oral 1gm Aventis<br />

Urex tablet, oral 1gm Riker/3-M<br />

138


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

METHIMAZOLE<br />

Methimazole tablet, oral 5,10mg Eon<br />

tablet, oral 5,10mg<br />

GenPharm<br />

tablet, oral 5,10mg<br />

Jones<br />

Brand(s)<br />

Tapazole tablet, oral 5,10mg Lilly<br />

METHOCARBAMOL<br />

Methocarbamol injection 100mg/ml Marsam<br />

injection 100mg/ml<br />

Steris<br />

@ tablet, oral 500,750mg<br />

American Therapeutics<br />

@ tablet, oral 500,750mg<br />

(Ascot)<br />

@ tablet, oral 500,750mg<br />

Barr<br />

@ tablet, oral 500,750mg<br />

Circa<br />

tablet, oral 500,750mg<br />

Danbury<br />

tablet, oral 500,750mg<br />

Eon<br />

tablet, oral 500,750mg<br />

Geneva<br />

@ tablet, oral 500,750mg<br />

Hea<strong>the</strong>r<br />

tablet, oral 500,750mg<br />

Impax<br />

@ tablet, oral 500mg<br />

Inwood/Forest<br />

@ tablet, oral 500,750mg<br />

IVAX<br />

@ tablet, oral 500,750mg<br />

KV<br />

tablet, oral 750mg<br />

Lannett<br />

tablet, oral 500,750mg<br />

Lederle<br />

@ tablet, oral 500,750mg<br />

Mylan<br />

tablet, oral 750mg<br />

Nylos<br />

tablet, oral 500,750mg<br />

Par<br />

@ tablet, oral 500,750mg<br />

Pharmeral<br />

@ tablet, oral 500,750mg<br />

Pioneer<br />

@ tablet, oral 500,750mg<br />

Purepac<br />

@ tablet, oral 500,750mg<br />

Roxane<br />

@ tablet, oral 500,750mg<br />

Solvay<br />

tablet, oral 500,750mg<br />

Superpharm<br />

tablet, oral 500mg<br />

Tablicaps<br />

@ tablet, oral 500,750mg<br />

Upsher-Smith<br />

tablet, oral 500,750mg<br />

Watson<br />

tablet, oral 500,750mg<br />

West-ward<br />

Brand(s)<br />

Robaxin injection 100mg/ml Schwarz<br />

Delaxin @ tablet, oral 500mg Ferndale<br />

Forbaxin @ tablet, oral 750mg Schwarz<br />

Robaxin tablet, oral 500,750mg Robins<br />

METHOCARBAMOL; ASPIRIN<br />

See ASPIRIN; METHOCARBAMOL<br />

METHOTREXATE SODIUM<br />

Methotrexate Sodium @ injection eq 2.5,25mg base/ml American Pharmaceutical<br />

Partners<br />

injection eq 25mg base/ml<br />

Bed<strong>for</strong>d<br />

injection eq 25mg base/ml<br />

Bigmar<br />

injection eq 25mg base/ml<br />

Norbrook<br />

injection eq 2.5,25mg base/ml Lederle<br />

injection eq 25mg base/ml<br />

Pharmachemie<br />

(continued on <strong>the</strong> next page)<br />

@ injection eq 25mg base/ml<br />

@ injection eq 20,50,100mg base/vial<br />

Quad<br />

American Pharmaceutical<br />

Partners<br />

139


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

METHOTREXATE SODIUM (continued)<br />

injection eq 20,50,100mg base/vial Lederle<br />

@ injection eq 20,50,100,250mg base/vial Quad<br />

tablet, oral eq 2.5mg base<br />

Barr<br />

tablet, oral eq 2.5mg based<br />

Duramed<br />

tablet, oral eq 2.5mg base<br />

Mylan<br />

tablet, oral eq 2.5mg base<br />

Roxane<br />

Brand(s)<br />

Abitrexate @ injection eq 25mg base/ml ABIC<br />

Folex PFS @ injection eq 25mg base/ml Pharmacia & Upjohn<br />

Methotrexate Preservative-Free injection eq 25mg base/ml Bigmar<br />

Mexate-AQ injection eq 25mg base/ml Bristol-Myers Squibb<br />

Mexate-AQ Preserved @ injection eq 25mg base/ml Bristol-Myers Squibb<br />

Abitrexate @ injection eq 50,100,250mg base/vial ABIC<br />

Folex injection eq 50,100,250mg base/vial Pharmacia & Upjohn<br />

Methotrexate Preservative-Free injection eq 1gm base/vial Bigmar<br />

Methotrexate Preservative-Free injection eq 1gm base/vial Lederle<br />

Mexate<br />

@ injection eq 20,50,100,250mg base/vial Bristol-Myers Squibb<br />

Rheumatrex tablet, oral eq 2.5mg base Lederle<br />

METHSCOPOLAMINE BROMIDE<br />

Methscopolamine Bromide @ tablet, oral 2.5mg Private Formulations<br />

Brand(s)<br />

Pamine Bromide tablet, oral 2.5mg Bradley<br />

METHYCLOTHIAZIDE<br />

Methyclothiazide @ tablet, oral 2.5,5mg Circa<br />

tablet, oral 2.5,5mg<br />

Geneva<br />

@ tablet, oral 2.5,5mg<br />

IVAX<br />

@ tablet, oral 2.5mg<br />

Mylan<br />

tablet, oral 5mg<br />

Mylan<br />

@ tablet, oral 2.5,5mg<br />

Par<br />

@ tablet, oral 5mg<br />

USL<br />

@ tablet, oral 2.5mg<br />

Watson<br />

tablet, oral 5mg<br />

Watson<br />

Brand(s)<br />

Aquatensen tablet, oral 5mg Wallace<br />

Enduron tablet, oral 2.5,5mg Abbott<br />

METHYLDOPA<br />

Methyldopa @ tablet, oral 125,250,500mg Barr<br />

@ tablet, oral 125,250,500mg<br />

Circa<br />

tablet, oral 250,500mg<br />

Danbury<br />

@ tablet, oral 250,500mg<br />

Duramed<br />

tablet, oral 125,250,500mg<br />

Geneva<br />

@ tablet, oral 125,250,500mg<br />

Halsey<br />

tablet, oral 250,500mg<br />

IVAX<br />

@ tablet, oral 125mg<br />

Lederle<br />

tablet, oral 250,500mg<br />

Lederle<br />

tablet, oral 250,500mg<br />

Mylan<br />

tablet, oral 125,250,500mg<br />

Par<br />

@ tablet, oral 125,250,500mg<br />

Parke-Davis<br />

@ tablet, oral 125,250,500mg<br />

Purepac<br />

@ tablet, oral 125,250,500mg<br />

Roxane<br />

tablet, oral 125,250,500mg<br />

Sidmak<br />

tablet, oral 250,500mg<br />

Superpharm<br />

(continued on <strong>the</strong> next page)<br />

140


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

METHYLDOPA<br />

@ tablet, oral 125,250,500mg<br />

Teva<br />

@ tablet, oral 125,250,500mg<br />

Watson<br />

Brand(s)<br />

Aldomet tablet, oral 125,250,500mg Merck Sharp and Dohme *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

METHYLDOPA; CHLOROTHIAZIDE<br />

See CHLOROTHIAZIDE; METHYLDOPA<br />

METHYLDOPA; HYDROCHLOROTHIAZIDE<br />

See HYDROCHLOROTHIAZIDE; METHYLDOPA<br />

METHYLDOPATE HYDROCHLORIDE<br />

Methyldopate Hydrochloride injection 50mg/ml Abbott<br />

@ injection 50mg/ml<br />

American Pharmaceutical<br />

Partners<br />

injection 50mg/ml<br />

Elkins-Sinn<br />

injection 50mg/ml<br />

Faulding<br />

injection 50mg/ml<br />

Gensia Sicor<br />

injection 50mg/ml<br />

Luitpold<br />

@ injection 50mg/ml<br />

Marsam<br />

@ injection 50mg/ml<br />

Quad<br />

@ injection 50mg/ml<br />

Smith and Nephew<br />

Brand(s)<br />

Aldomet injection 50mg/ml Merck Sharp and Dohme<br />

METHYLPHENIDATE HYDROCHLORIDE<br />

Methylphenidate Hydrochloride tablet, oral 5,10,20mg Danbury<br />

tablet, oral 5,10,20mg<br />

MD<br />

tablet, oral 5,10,20mg<br />

Purepac<br />

tablet, extended release 20mg Able<br />

tablet, extended release 20mg Danbury<br />

tablet, extended release 20mg Purepac<br />

Brand(s)<br />

Methylin tablet, oral 5,10,20mg Mallinckrodt<br />

Ritalin tablet, oral 5,10,20mg Novartis *<br />

Metadate ER tablet, extended release 10,20mg Celltech<br />

Methylin ER tablet, extended release 10,20mg Mallinckrodt<br />

Ritalin-SR tablet, extended release 20mg Novartis *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

METHYLPREDNISOLONE<br />

Methylprednisolone tablet, oral 4mg Duramed<br />

@ tablet, oral 4mg<br />

Eon<br />

tablet, oral 4mg<br />

Geneva<br />

@ tablet, oral 4mg<br />

Hea<strong>the</strong>r<br />

tablet, oral 16,24,32mg<br />

Par<br />

tablet, oral 4,8mg<br />

Trigen<br />

tablet, oral 4mg<br />

Vintage<br />

(continued on <strong>the</strong> next page)<br />

141


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

METHYLPREDNISOLONE (continued)<br />

tablet, oral 4mg<br />

Watson<br />

@ tablet, oral 16mg<br />

Watson<br />

Brand(s)<br />

Medrol tablet, oral 4,8,16,24,32mg Upjohn *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

METHYLPREDNISOLONE SODIUM SUCCINATE<br />

Methylprednisolone @ injection eq 40,125,500mg, American Pharmaceutical<br />

Sodium Succinate 1gm base/vial Partners<br />

@ injection eq 40,125,500mg,<br />

Elkins-Sinn<br />

1gm base/vial<br />

injection eq 125mg base/vial<br />

Gensia Sicor<br />

@ injection eq 500mg,1gm base/vial Gensia Sicor<br />

@ injection eq 40,125,500mg,<br />

International Medication<br />

1gm base/vial<br />

@ injection eq 500mg,1gm base/vial Organon/Akzona<br />

@ injection eq 40,125,500mg,<br />

Quad<br />

1gm base/vial<br />

@ injection eq 40,125,500mg,<br />

Steris<br />

1gm base/vial<br />

Brand(s)<br />

A-Methapred injection eq 40,125,500mg, Abbott<br />

1gm base/vial<br />

Solu-Medrol injection eq 40,125,500mg, Upjohn<br />

1gm base/vial<br />

METHYLTESTOSTERONE<br />

Brand(s)<br />

Android 10 tablet, oral 10mg ICN<br />

Android 25 tablet, oral 25mg ICN<br />

Metandren @ tablet, oral 10,25mg Novartis<br />

METIPRANOLOL HYDROCHLORIDE<br />

Metipranolol Hydrochloride solution, ophthalmic 0.3% Alcon<br />

Brand(s)<br />

OptiPranolol solution, ophthalmic 0.3% Bausch and Lomb *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

METOCLOPRAMIDE HYDROCHLORIDE<br />

Metoclopramide Hydrochloride injection eq 5mg base/ml Abbott<br />

@ injection eq 5mg base/ml<br />

American Pharmaceutical<br />

Partners<br />

injection eq 5mg base/ml<br />

Bed<strong>for</strong>d<br />

injection eq 5mg base/ml<br />

Faulding<br />

injection eq 5mg base/ml<br />

Gensia Sicor<br />

@ injection eq 5mg base/ml<br />

Norbrook<br />

@ injection eq 5mg base/ml<br />

Quad<br />

@ injection eq 5mg base/ml<br />

Smith and Nephew<br />

solution, oral eq 5mg base/5ml Alpharma<br />

solution, oral eq 5mg base/5ml JVL<br />

@ solution, oral eq 5mg base/5ml Morton Grove<br />

(continued on <strong>the</strong> next page)<br />

142


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

METOCLOPRAMIDE HYDROCHLORIDE (continued)<br />

@ solution, oral eq 5mg base/5ml Paco<br />

solution, oral eq 5mg base/5ml Pharm Ventures<br />

solution, oral eq 5mg base/5ml Pharmaceutical Associates<br />

solution, oral eq 5mg base/5ml Roxane<br />

solution, oral eq 5mg base/5ml Silarx<br />

solution, oral eq 5mg base/5ml Teva<br />

solution, oral eq 5mg base/5ml UDL<br />

@ tablet, oral eq 10mg base<br />

Barr<br />

@ tablet, oral eq 10mg base<br />

Circa<br />

tablet, oral eq 10mg base<br />

Danbury<br />

tablet, oral eq 5,10mg base<br />

Geneva<br />

@ tablet, oral eq 10mg base<br />

Halsey<br />

@ tablet, oral eq 10mg base<br />

Interpharm<br />

tablet, oral eq 10mg base<br />

Lederle<br />

@ tablet, oral eq 5,10mg base<br />

Mutual<br />

@ tablet, oral eq 10mg base<br />

Par<br />

tablet, oral eq 10mg base<br />

Purepac<br />

@ tablet, oral eq 10mg base<br />

Schering<br />

tablet, oral eq 5,10mg base<br />

Sidmak<br />

@ tablet, oral eq 10mg base<br />

Superpharm<br />

tablet, oral eq 5,10mg base<br />

Teva<br />

@ tablet, oral eq 10mg base<br />

USL<br />

@ tablet, oral eq 10mg base<br />

Watson<br />

Brand(s)<br />

Octamide PFS injection eq 5mg base/ml Faulding<br />

Reglan injection eq 5mg base/ml Robins<br />

Reglan solution, oral eq 5mg base/5ml Robins<br />

Clopra @ tablet, oral eq 5,10mg base Quantum<br />

Maxolon @ tablet, oral eq 10mg base King<br />

Reglan tablet, oral eq 5,10mg base Schwarz *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

METOCURINE IODIDE<br />

Metocurine Iodide @ injection 2mg/ml Quad<br />

Brand(s)<br />

Metubine Iodide injection 2mg/ml Lilly<br />

METOLAZONE<br />

Brand(s)<br />

Diulo @ tablet, oral 2.5,5,10mg SCS<br />

Zaroxolyn tablet, oral 2.5,5,10mg Celltech<br />

METOPROLOL TARTRATE<br />

Metoprolol Tartrate injection 1mg/ml Abbott<br />

injection 1mg/ml<br />

Steris<br />

tablet, oral 50,100mg<br />

Apo<strong>the</strong>con<br />

tablet, oral 50,100mg<br />

Caraco<br />

tablet, oral 50,100mg<br />

Copley<br />

tablet, oral 50,100mg<br />

Geneva<br />

tablet, oral 50,100mg<br />

Mutual<br />

tablet, oral 50,100mg<br />

Mylan<br />

tablet, oral 50,100mg<br />

Par<br />

@ tablet, oral 50,100mg<br />

Purepac<br />

(continued on <strong>the</strong> next page)<br />

143


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

METOPROLOL TARTRATE (continued)<br />

tablet, oral 50,100mg<br />

Teva<br />

tablet, oral 50,100mg<br />

Watson<br />

Brand(s)<br />

Lopressor injection 1mg/ml Novartis *<br />

Lopressor tablet, oral 50,100mg Novartis<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

METRONIDAZOLE<br />

Metronidazole injection 500mg/100ml Abbott<br />

@ injection 500mg/100ml<br />

American Pharmaceutical<br />

Partners<br />

@ injection 500mg/100ml<br />

Elkins-Sinn<br />

@ injection 500mg/100ml<br />

International Medication<br />

@ injection 500mg/100ml<br />

Steris<br />

@ tablet, oral 250,500mg<br />

Barr<br />

tablet, oral 250,500mg<br />

Danbury<br />

tablet, oral 250,500mg<br />

Eon<br />

tablet, oral 250,500mg<br />

Geneva<br />

@ tablet, oral 250,500mg<br />

Halsey<br />

tablet, oral 250,500mg<br />

IVAX<br />

tablet, oral 250mg<br />

LNK<br />

tablet, oral 250,500mg<br />

Mutual<br />

tablet, oral 250,500mg<br />

Par<br />

tablet, oral 250,500mg<br />

Sidmak<br />

@ tablet, oral 250,500mg<br />

Superpharm<br />

@ tablet, oral 250,500mg<br />

Watson<br />

Brand(s)<br />

Flagyl I.V. injection 500mg/100ml SCS<br />

Flagyl I.V. RTU injection 500mg/100ml Baxter<br />

Metro I.V. injection 500mg/100ml Braun<br />

Flagyl tablet, oral 250,500mg Searle<br />

Metromidol tablet, oral 250,500mg Laboratorios A.F.<br />

Metryl tablet, oral 250,500mg Teva<br />

Protostat @ tablet, oral 250,500mg RW Johnson<br />

Satric @ tablet, oral 250,500mg Savage<br />

MEXILETINE HYDROCHLORIDE<br />

Mexiletine Hydrochloride capsule, oral 150,200,250mg Danbury<br />

capsule, oral 150,200,250mg Geneva<br />

capsule, oral 150,200,250mg Teva<br />

capsule, oral 150,200,250mg Watson<br />

Brand(s)<br />

Mexetil capsule, oral 150,200,250mg Boehringer Ingelheim *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

MICONAZOLE NITRATE<br />

Miconazole Nitrate suppository, vaginal 200mg Alpharma<br />

Brand(s)<br />

Monistat 3 suppository, vaginal 200mg RW Johnson<br />

144


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

MIDAZOLAM HYDROCHLORIDE<br />

Midazolam Hydrochloride injection eq 1,5mg base/ml Abbott<br />

injection eq 1,5mg base/ml<br />

American Pharmaceutical<br />

Partners<br />

injection eq 1,5gm base/ml<br />

Apotex<br />

@ injection eq 1,5mg base/ml<br />

Apo<strong>the</strong>con<br />

@ injection eq 5mg base/ml<br />

AstraZeneca<br />

injection eq 1,5mg base/ml<br />

Baxter<br />

injection eq 1,5mg base/ml<br />

Bed<strong>for</strong>d<br />

injection eq 1,5mg base/ml<br />

Ben Venue<br />

injection eq 1,5mg base/ml<br />

ESI Lederle<br />

injection eq 1,5mg base/ml<br />

Faulding<br />

injection eq 1,5mg base/ml<br />

Taylor<br />

Brand(s)<br />

Versed injection eq 1,5mg base/ml Roche<br />

MINOCYCLINE HYDROCHLORIDE<br />

Minocycline Hydrochloride capsule, oral eq 50,75,100mg base Danbury<br />

capsule, oral eq 50,100mg base Impax<br />

capsule, oral eq 50,75,100mg base Ranbaxy<br />

capsule, oral eq 50,100mg base Teva<br />

Brand(s)<br />

Minocin capsule, oral eq 50,75,100mg base Lederle<br />

Vectrin capsule, oral eq 50mg base Medicis<br />

Vectrin @ capsule, oral eq 75,100mg base Medicis<br />

MINOXIDIL<br />

Minoxidil tablet, oral 2.5,10mg Danbury<br />

tablet, oral 2.5,10mg<br />

Mutual<br />

tablet, oral 2.5,10mg<br />

Par<br />

@ tablet, oral 2.5,10mg<br />

Royce<br />

@ tablet, oral 2.5mg<br />

USL<br />

Brand(s)<br />

Loniten tablet, oral 2.5,10mg Pharmacia & Upjohn<br />

Minodyl @ tablet, oral 2.5,10mg Quantum<br />

MITOMYCIN<br />

Mitomycin injection 5,20mg/vial Bed<strong>for</strong>d<br />

injection 20mg/vial<br />

Faulding<br />

injection 5,20mg/vial<br />

ESI Lederle<br />

injection 5,20mg/vial<br />

Supergen<br />

Brand(s)<br />

Mutamycin injection 5,20mg/vial Bristol-Myers<br />

MORPHINE; ALCOHOL<br />

See ALCOHOL; MORPHINE<br />

MORPHINE SULFATE<br />

Morphine Sulfate injection 0.5,1mg/ml Abbott<br />

injection 1mg/ml<br />

Mallinckrodt<br />

injection 0.5,1mg/ml<br />

Steris<br />

solution, oral 10mg/5ml Roxane *<br />

solution, oral 20mg/5ml Roxane *<br />

(continued on <strong>the</strong> next page)<br />

145


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

MORPHINE SULFATE (continued)<br />

tablet, extended release<br />

AB Generics<br />

15,30,60,100,200mg<br />

tablet, extended release<br />

Endo<br />

15,30,60,100,200mg<br />

tablet, extended release 15mg ESI Lederle<br />

tablet, extended release 100mg Watson<br />

Brand(s)<br />

Astramorph PF injection 0.5,1mg/ml Astra Zeneca<br />

Duramorph PF injection 0.5,1mg/ml Elkins-Sinn<br />

MSIR solution, oral 20mg/ml Purdue Frederick *<br />

Roxanol solution, oral 20mg/ml Roxane *<br />

MS/L solution, oral 10mg/5ml Liquipharm *<br />

MS/L solution, oral 20mg/5ml Liquipharm *<br />

MSIR solution, oral 10mg/5ml Purdue Frederick *<br />

MSIR solution, oral 20mg/5ml Purdue Frederick *<br />

MS Contin tablet, extended release Purdue Frederick **<br />

15,30,60,100,200mg<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

** <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

NABUMETONE<br />

Nabumetone tablet, oral 750mg Copley<br />

tablet, oral 500,750mg<br />

Geneva<br />

tablet, oral 500mg<br />

Teva<br />

Brand(s)<br />

Relafen tablet, oral 500,750mg SmithKline Beecham<br />

NADOLOL<br />

Nadolol tablet, oral 80,120,160mg Copley<br />

tablet, oral 20,40,80mg<br />

Geneva<br />

tablet, oral 20,40,80,120,160mg IVAX<br />

tablet, oral 20,40,80mg<br />

Mylan<br />

Brand(s)<br />

Corgard tablet, oral 20,40,80,120,160mg Apo<strong>the</strong>con<br />

NAFCILLIN SODIUM<br />

Nafcillin Sodium @ injection eq 500mg,1,2,4,10gm Marsam<br />

base/vial<br />

Brand(s)<br />

Nafcil injection eq 500mg,1,2,4,10gm Apo<strong>the</strong>con<br />

base/vial<br />

Nallpen @ injection eq 500mg,1,2,10gm SmithKline Beecham<br />

base/vial<br />

Unipen @ injection eq 500mg,1,2,4,10gm Wyeth-Ayerst<br />

base/vial<br />

NALBUPHINE HYDROCHLORIDE<br />

Nalbuphine Hydrochloride injection 10,20mg/ml Abbott<br />

@ injection 10,20mg/ml<br />

American Pharmaceutical<br />

Partners<br />

(continued on <strong>the</strong> next page)<br />

146


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

NALBUPHINE HYDROCHLORIDE (continued)<br />

@ injection 10,20mg/ml<br />

Astra Zeneca<br />

injection 10,20mg/ml<br />

King<br />

@ injection 10,20mg/ml<br />

Quad<br />

Brand(s)<br />

Nubain injection 10,20mg/ml Endo<br />

NALIDIXIC ACID<br />

Nalidixic Acid @ tablet, oral 250,500,1000mg Barr<br />

tablet, oral 250,500,1000mg<br />

Danbury<br />

Brand(s)<br />

NegGram tablet, oral 250,500,1000mg Sanofi Syn<strong>the</strong>labo<br />

NALOXONE HYDROCHLORIDE<br />

Naloxone Hydrochloride injection 0.02,0.4mg/ml Abbott<br />

@ injection 0.02,0.4,1mg/ml<br />

American Pharmaceutical<br />

Partners<br />

@ injection 0.02,0.4,1mg/ml<br />

Astra Zeneca<br />

injection 0.02,0.4,1mg/ml<br />

Elkins-Sinn<br />

injection 0.4,1mg/ml<br />

International Medication<br />

@ injection 0.4mg/ml<br />

Marsam<br />

@ injection 0.02,0.4,1mg/ml<br />

Quad<br />

@ injection 0.02,0.4mg/ml<br />

Smith and Nephew<br />

@ injection 0.02,0.4mg/ml<br />

Solopak<br />

@ injection 0.4mg/ml<br />

Steris<br />

@ injection 0.02,0.4mg/ml<br />

Wyeth-Ayerst<br />

Brand(s)<br />

Narcan injection 0.02,0.4,1mg/ml Endo<br />

NALOXONE HYDROCHLORIDE; PENTAZOCINE HYDROCHLORIDE<br />

Naloxone Hydrochloride; tablet, oral eq 0.5mg base; Ranbaxy<br />

Pentazocine Hydrochloride eq 50mg base<br />

tablet, oral eq 0.5mg base;<br />

Royce<br />

eq 50mg base<br />

Brand(s)<br />

Talwin NX tablet, oral eq 0.5mg base; Sanofi Syn<strong>the</strong>labo<br />

eq 50mg base<br />

NALTREXONE HYDROCHLORIDE<br />

Naltrexone Hydrochloride tablet, oral 50mg Amide<br />

tablet, oral 50mg<br />

Barr<br />

tablet, oral 50mg<br />

Eon<br />

Brand(s)<br />

Revia tablet, oral 50mg Bristol-Myers Squibb<br />

NANDROLONE DECANOATE<br />

Nandrolone Decanoate @ injection 100mg/ml Akorn<br />

@ injection 100,200mg/ml<br />

American Pharmaceutical<br />

Partners<br />

@ injection 50,100,200mg/ml<br />

Quad<br />

injection 50,100,200mg/ml<br />

Steris<br />

Brand(s)<br />

Deca-Durabolin injection 50,100,200mg/ml Organon/Akzona<br />

147


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

NANDROLONE PHENPROPIONATE<br />

Nandrolone Phenpropionate @ injection 25,50mg/ml Quad<br />

@ injection 25,50mg/ml<br />

Steris<br />

Brand(s)<br />

Durabolin @ injection 25,50mg/ml Organon/Akzona<br />

NAPHAZOLINE HYDROCHLORIDE<br />

Brand(s)<br />

AK-Con solution, ophthalmic 0.1% Taylor<br />

Albalon solution, ophthalmic 0.1% Allergan<br />

Nafazair solution, ophthalmic 0.1% Bausch and Lomb<br />

Naphcon Forte @ solution, ophthalmic 0.1% Alcon<br />

Opcon @ solution, ophthalmic 0.1% Bausch and Lomb<br />

Vasocon solution, ophthalmic 0.1% Novartis<br />

NAPHAZOLINE HYDROCHLORIDE; ANTAZOLINE PHOSPHATE<br />

See ANTAZOLINE PHOSPHATE; NAPHAZOLINE HYDROCHLORIDE<br />

NAPHAZOLINE HYDROCHLORIDE; PHENIRAMINE MALEATE<br />

Brand(s)<br />

AK-Con-A solution, ophthalmic 0.025%;0.3% Akorn *<br />

Muro's Opcon A solution, ophthalmic 0.025%;0.3% Bausch and Lomb *<br />

Naphcon A solution, ophthalmic 0.025%;0.3% Alcon *<br />

Naphoptic-A solution, ophthalmic 0.025%;0.3% Optopics *<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

NAPROXEN<br />

Naproxen suspension, oral 125mg/5ml Roxane<br />

tablet, delayed release 375,500mg Geneva<br />

tablet, delayed release 375,500mg Purepac<br />

tablet, delayed release 375,500mg Sidmak<br />

tablet, delayed release 375,500mg Teva<br />

tablet, oral 250,375,500mg<br />

Copley<br />

tablet, oral 250,375,500mg<br />

Danbury<br />

tablet, oral 250,375,500mg<br />

Geneva<br />

@ tablet, oral 250,375,500mg<br />

Hamilton<br />

tablet, oral 250,375,500mg<br />

Interpharm<br />

tablet, oral 250,375,500mg<br />

IVAX<br />

tablet, oral 250,375,500mg<br />

Lederle<br />

tablet, oral 250,375,500mg<br />

Mova<br />

tablet, oral 250,375,500mg<br />

Mylan<br />

tablet, oral 250,375,500mg<br />

Purepac<br />

tablet, oral 250,375,500mg<br />

Roxane<br />

tablet, oral 250,375,500mg<br />

Sidmak<br />

tablet, oral 250,375,500mg<br />

Teva<br />

tablet, oral 250,375,500mg<br />

Watson<br />

Brand(s)<br />

Naprosyn suspension, oral 125mg/5ml Syntex<br />

EC-Naprosyn tablet, delayed release 375,500mg Syntex *<br />

Naprosyn tablet, oral 250,375,500mg Syntex<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

148


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

NAPROXEN SODIUM<br />

Naproxen Sodium tablet, oral eq 500mg base Al-Hikma<br />

tablet, oral eq 250,500mg base Copley<br />

tablet, oral eq 250,500mg base Danbury<br />

tablet, oral eq 250,500mg base Geneva<br />

@ tablet, oral eq 250,500mg base Hamilton<br />

tablet, oral eq 250,500mg base IVAX<br />

tablet, oral eq 250,500mg base Mylan<br />

@ tablet, oral eq 250,500mg base Purepac<br />

tablet, oral eq 250,500mg base Roxane<br />

tablet, oral eq 250,500mg base Sidmak<br />

tablet, oral eq 250,500mg base Teva<br />

tablet, oral eq 250,500mg base Watson<br />

Brand(s)<br />

Anaprox tablet, oral eq 250mg base Syntex<br />

Anaprox DS tablet, oral eq 500mg base Syntex<br />

NEOMYCIN SULFATE<br />

Neomycin Sulfate @ injection eq 350mg base/vial Pfizer<br />

@ injection eq 350mg base/vial<br />

Squibb<br />

@ powder <strong>for</strong> compounding 100% Elkins-Sinn<br />

@ powder <strong>for</strong> compounding 100% Paddock<br />

@ tablet, oral eq 350mg base<br />

Eon<br />

@ tablet, oral eq 350mg base<br />

Lannett<br />

@ tablet, oral eq 350mg base<br />

Lilly<br />

@ tablet, oral eq 350mg base<br />

Roxane<br />

@ tablet, oral eq 350mg base<br />

Squibb<br />

tablet, oral eq 350mg base<br />

Teva<br />

Brand(s)<br />

Neo-Rx powder <strong>for</strong> compounding 100% Pharm Tek<br />

Mycifradin @ tablet, oral eq 350mg base Pharmacia & Upjohn<br />

Neobiotic @ tablet, oral eq 350mg base Pfizer<br />

NEOMYCIN SULFATE; BACITRACIN; HYDROCORTISONE ACETATE; POLYMYXIN B SULFATE<br />

See BACITRACIN; HYDROCORTISONE ACETATE; NEOMYCIN SULFATE; POLYMYXIN B SULFATE<br />

NEOMYCIN SULFATE; BACITRACIN ZINC; HYDROCORTISONE; POLYMYXIN B SULFATE<br />

See BACITRACIN ZINC; HYDROCORTISONE; NEOMYCIN SULFATE; POLYMYXIN B SULFATE<br />

NEOMYCIN SULFATE; BACITRACIN ZINC; POLYMYXIN B SULFATE<br />

See BACITRACIN ZINC; NEOMYCIN SULFATE; POLYMYXIN B SULFATE<br />

NEOMYCIN SULFATE; DEXAMETHASONE; POLYMYXIN B SULFATE<br />

See DEXAMETHASONE; NEOMYCIN SULFATE; POLYMYXIN B SULFATE<br />

NEOMYCIN SULFATE; DEXAMETHASONE SODIUM PHOSPHATE<br />

See DEXAMETHASONE SODIUM PHOSPHATE; NEOMYCIN SULFATE<br />

NEOMYCIN SULFATE; GRAMICIDIN; POLYMYXIN B SULFATE<br />

See GRAMICIDIN; NEOMYCIN SULFATE; POLYMYXIN B SULFATE<br />

NEOMYCIN SULFATE; HYDROCORTISONE; POLYMYXIN B SULFATE<br />

See HYDROCORTISONE; NEOMYCIN SULFATE; POLYMYXIN B SULFATE<br />

149


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

NEOMYCIN SULFATE; HYDROCORTISONE ACETATE<br />

See HYDROCORTISONE ACETATE; NEOMYCIN SULFATE<br />

NEOMYCIN SULFATE; POLYMYXIN B SULFATE<br />

Neomycin Sulfate;<br />

@ solution eq 40mg base/ml;200,000U/ml Steris<br />

Polymyxin B Sulfate<br />

Brand(s)<br />

Neosporin G.U. Irrigant<br />

solution eq 40mg base/ml;200,000U/ml Monarch<br />

NIACIN (NICOTINIC ACID)<br />

Niacin @ tablet, oral 500mg Circa<br />

@ tablet, oral 500mg<br />

Danbury<br />

@ tablet, oral 500mg<br />

Everylife<br />

@ tablet, oral 500mg<br />

Geneva<br />

@ tablet, oral 500mg<br />

Halsey<br />

@ tablet, oral 500mg<br />

Impax<br />

@ tablet, oral 500mg<br />

IVAX<br />

tablet, oral 500mg<br />

MK<br />

@ tablet, oral 500mg<br />

Purepac<br />

tablet, oral 500mg<br />

Tablicaps<br />

@ tablet, oral 500mg<br />

Watson<br />

@ tablet, oral 500mg<br />

West-ward<br />

tablet, oral 500mg<br />

Wockhardt<br />

Brand(s)<br />

Niacor tablet, oral 500mg Upsher-Smith<br />

Nicolar tablet, oral 500mg Aventis<br />

NOTE: Dosage strengths less than 500mg are OTC.<br />

NIACINAMIDE; ASCORBIC ACID; BIOTIN; CYANOCOBALAMIN; DEXPANTHENOL; ERGOCALCIFEROL;<br />

FOLIC ACID; PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN PHOSPHATE SODIUM; THIAMINE<br />

HYDROCHLORIDE; VITAMIN A; VITAMIN E<br />

See ASCORBIC ACID; BIOTIN; CYANOCOBALAMIN; DEXPANTHENOL; ERGOCALCIFEROL;<br />

FOLIC ACID; NIACINAMIDE; PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN PHOSPHATE<br />

SODIUM HYDROCHLORIDE; VITAMIN A; VITAMIN E<br />

NICARDIPINE HYDROCHLORIDE<br />

Nicardipine Hydrochloride capsule, oral 20,30mg GenPharm<br />

capsule, oral 20,30mg<br />

IVAX<br />

capsule, oral 20,30mg<br />

Mylan<br />

capsule, oral 20,30mg<br />

Teva<br />

capsule, oral 20,30mg<br />

Watson<br />

Brand(s)<br />

Cardene capsule, oral 20,30mg Roche<br />

NICOTINE<br />

Nicotine film, extended release, transdermal Sano<br />

7,14,21mg/24 hours<br />

Brand(s)<br />

Nicotrol film, extended release, transdermal Novartis<br />

7,14,21mg/24 hours<br />

150


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

NICOTINIC ACID; ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; IRON; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D; VITAMIN E<br />

See ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; IRON; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D;<br />

VITAMIN E<br />

NICOTINIC ACID; ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; PYRIDOXINE HYDROCHLORIDE;<br />

RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D; VITAMIN E<br />

See ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D;<br />

VITAMIN E<br />

NIFEDIPINE<br />

Nifedipine @ capsule, oral 10,20mg Chase<br />

capsule, oral 10mg<br />

Flemington<br />

capsule, oral 10,20mg<br />

Purepac<br />

capsule, oral 10,20mg<br />

Scherer<br />

capsule, oral 10mg<br />

Teva<br />

(AB1) tablet, extended release Biovail<br />

30,60mg<br />

(AB1) tablet, extended release 30mg Elan<br />

@ (AB2) tablet, extended release 30mg Mylan<br />

Brand(s)<br />

Adalat capsule, oral 10,20mg Bayer<br />

Procardia capsule, oral 10,20mg Pfizer<br />

Adalat CC (AB1) tablet, extended release Bayer<br />

30,60mg<br />

Nifedical XL (AB2) tablet, extended release Biovail<br />

30,60mg<br />

Procardia XL (AB2) tablet, extended release Pfizer *<br />

30,60,90mg<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

<strong>Product</strong>s designated “AB1" may only be interchanged with o<strong>the</strong>r products designated as “AB1.” <strong>Product</strong>s<br />

designated as “AB2" may only be interchanged with o<strong>the</strong>r products designated as “AB2.” <strong>Product</strong>s<br />

designated as “AB1" MAY NOT BE INTERCHANGED with products designated as “AB2.” <strong>Product</strong>s<br />

designated as “AB2" MAY NOT BE INTERCHANGED with products designated as “AB1.”<br />

NITROFURANTOIN<br />

Nitrofurantoin tablet, oral 50mg Circa<br />

@ tablet, oral 100mg<br />

Circa<br />

@ tablet, oral 50,100mg<br />

Elkins-Sinn<br />

@ tablet, oral 50,100mg<br />

Eon<br />

@ tablet, oral 50,100mg<br />

IVAX<br />

@ tablet, oral 50,100mg<br />

Watson<br />

tablet, oral 100mg<br />

Whiteworth Towne<br />

Brand(s)<br />

Furadantin tablet, oral 50,100mg Procter and Gamble<br />

Furalan @ tablet, oral 50,100mg Lannett<br />

NITROFURANTOIN, MACROCRYSTALLINE<br />

Nitrofurantoin, Macrocrystalline @ capsule, oral 50,100mg Circa<br />

capsule, oral 25,50,100mg<br />

Danbury<br />

capsule, oral 50,100mg<br />

Geneva<br />

(continued on <strong>the</strong> next page)<br />

151


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

NITROFURANTOIN, MACROCRYSTALLINE (continued)<br />

capsule, oral 50,100mg<br />

IVAX<br />

capsule, oral 50,100mg<br />

Mylan<br />

Brand(s)<br />

Macrodantin capsule, oral 25,50,100mg Procter and Gamble<br />

Note: Nitrofurantoin macrocrystalline extended release capsules are not interchangeable with<br />

nitrofurantoin macrocrystalline capsules.<br />

NITROFURAZONE<br />

Nitrofurazone @ ointment, topical 0.2% Ambix/Organics<br />

@ ointment, topical 0.2%<br />

Clay-Park<br />

@ ointment, topical 0.2%<br />

Lannett<br />

ointment, topical 0.2%<br />

Thames<br />

ointment, topical 0.2%<br />

Wendt<br />

@ solution, topical 0.2%<br />

Clay-Park<br />

solution, topical 0.2%<br />

Wendt<br />

Brand(s)<br />

Actin-H @ ointment, topical 0.2% Sherwood<br />

Furacin ointment, topical 0.2% Shire<br />

NITROGLYCERIN<br />

Nitroglycerin film (AB1), extended release Mylan<br />

transdermal 0.1,0.2,0.4,0.6mg/hour<br />

film (AB2), extended release Hercon<br />

transdermal 0.2,0.4,0.6mg/hour<br />

film (AB2), extended release Mylan<br />

transdermal 0.2,0.4,0.6mg/hour<br />

injection 5mg/ml<br />

Abbott<br />

@ injection 5mg/ml<br />

American Pharmaceutical<br />

Partners<br />

@ injection 5mg/ml<br />

International Medication<br />

injection 5mg/ml<br />

Luitpold<br />

@ injection 5,10mg/ml<br />

Quad<br />

@ injection 5mg/ml<br />

Smith and Nephew<br />

Brand(s)<br />

Nitro-Bid injection 5mg/ml Aventis<br />

Nitro-Bid @ injection 10mg/ml Aventis<br />

Nitrol @ injection 0.8mg/ml Aventis<br />

Nitro I.V. @ injection 5mg/ml Pohl Boskamp<br />

Nitrostat @ injection 0.8,5,10mg/ml Parke-Davis<br />

Tridil injection 5mg/ml Faulding<br />

Minitran film (AB1), extended release 3M<br />

transdermal 0.1,0.2,0.4,0.6mg/hour<br />

Nitro-DUR film (AB1), extended release Schering/Key<br />

transdermal 0.1,0.2,0.4,0.6mg/hour<br />

Transderm-Nitro film (AB2), extended release Novartis<br />

transdermal 0.2,0.4,0.6mg/hour<br />

<strong>Product</strong>s designated “AB1" may only be interchanged with o<strong>the</strong>r products designated as “AB1.” <strong>Product</strong>s<br />

designated “AB2" may only be interchanged with o<strong>the</strong>r products designated as “AB2.” <strong>Product</strong>s<br />

designated as “AB1" MAY NOT BE INTERCHANGED with products designated as “AB2.”<br />

NITROGLYCERIN; DEXTROSE<br />

See DEXTROSE; NITROGLYCERIN<br />

152


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

NORGESTREL; ETHINYL ESTRADIOL<br />

See ETHINYL ESTRADIOL; NORGESTREL<br />

NORETHINDRONE; ETHINYL ESTRADIOL<br />

See ETHINYL ESTRADIOL; NORETHINDRONE<br />

NORETHINDRONE; MESTRANOL<br />

See MESTRANOL; NORETHINDRONE<br />

NORETHINDRONE ACETATE<br />

Norethindrone Acetate tablet, oral 5mg Barr<br />

Brand(s)<br />

Aygestin tablet, oral 5mg Wyeth-Ayerst<br />

Norlutate @ tablet, oral 5mg Parke-Davis<br />

NORTRIPTYLINE HYDROCHLORIDE<br />

Nortriptyline Hydrochloride capsule, oral eq 10,25,50,75mg base Danbury<br />

capsule, oral eq 10,25,50,75mg base Geneva<br />

capsule, oral eq 10,25,50,75mg base Mylan<br />

capsule, oral eq 10,25,50,75mg base Taro<br />

capsule, oral eq 10,25,50,75mg base Teva<br />

solution, oral eq 10mg base/ml Pharmaceutical Associates<br />

Brand(s)<br />

Pamelor capsule, oral eq 10,25,50,75mg base Tyco *<br />

Aventyl HCl solution, oral eq 10mg base/5ml Lilly<br />

Pamelor solution, oral eq 10mg base/5ml Tyco<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

NYSTATIN<br />

Nystatin cream, topical 100,000U/gm Alpharma<br />

cream, topical 100,000U/gm<br />

Altana<br />

cream, topical 100,000U/gm<br />

Clay-Park<br />

cream, topical 100,000U/gm<br />

Taro<br />

@ cream, topical 100,000U/gm<br />

Teva<br />

cream, topical 100,000U/gm<br />

Thames<br />

ointment, topical 100,000U/gm Alpharma<br />

ointment, topical 100,000U/gm Altana<br />

ointment, topical 100,000U/gm Clay-Park<br />

powder, oral 100%<br />

Paddock<br />

suspension, oral 100,000U/ml Alpharma<br />

suspension, oral 100,000U/ml Bausch and Lomb<br />

suspension, oral 100,000U/ml Fougera/Altana<br />

suspension, oral 100,000U/ml Morton Grove<br />

@ suspension, oral 100,000U/ml Pharmaderm/Altana<br />

@ suspension, oral 100,000U/ml Pharmafair<br />

@ suspension, oral 100,000U/ml Roxane<br />

@ suspension, oral 100,000U/ml Teva<br />

@ suspension, oral 100,000U/ml Thames<br />

suspension, oral 100,000U/ml UDL<br />

@ tablet, oral 500,000U<br />

Eon<br />

tablet, oral 500,000U<br />

Mutual<br />

tablet, oral 500,000U<br />

Par<br />

@ tablet, oral 500,000U<br />

Quantum<br />

(continued on <strong>the</strong> next page)<br />

153


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

NYSTATIN (continued)<br />

tablet, oral 500,000U<br />

Teva<br />

@ tablet, oral 500,000U<br />

USL<br />

@ tablet, oral 500,000U<br />

Watson<br />

@ tablet, vaginal 100,000U<br />

Eon<br />

tablet, vaginal 100,000U<br />

Fougera/Altana<br />

tablet, vaginal 100,000U<br />

Odyssey<br />

tablet, vaginal 100,000U<br />

Pharmaderm/Altana<br />

@ tablet, vaginal 100,000U<br />

Quantum<br />

@ tablet, vaginal 100,000U<br />

Teva<br />

@ tablet, vaginal 100,000U<br />

Watson<br />

Brand(s)<br />

Candex @ cream, topical 100,000U/gm Bayer<br />

Mycostatin cream, topical 100,000U/gm Squibb<br />

Mykinac @ cream, topical 100,000U/gm Alpharma<br />

Nilstat @ cream, topical 100,000U/gm Lederle<br />

Mycostatin @ ointment, topical 100,000U/gm Westwood Squibb<br />

Mykinac @ ointment, topical 100,000U/gm Alpharma<br />

Nilstat @ ointment, topical 100,000U/gm Lederle<br />

Barstatin 100 @ powder, oral 100% Barlan<br />

Nilstat powder, oral 100% Lederle<br />

Mycostatin powder, topical 100,000U/gm Westwood Squibb<br />

Nystop powder, topical 100,000U/gm Paddock<br />

Mycostatin suspension, oral 100,000U/ml Apo<strong>the</strong>con<br />

Nilstat suspension, oral 100,000U/ml Lederle<br />

Nystex suspension, oral 100,000U/ml Savage/Altana<br />

Mycostatin tablet, oral 500,000U Apo<strong>the</strong>con<br />

Nilstat tablet, oral 500,000U Lederle<br />

Korostatin @ tablet, vaginal 100,000U Holland-Rantos<br />

Mycostatin tablet, vaginal 100,000U Squibb<br />

Nilstat tablet, vaginal 100,000U Lederle<br />

NYSTATIN; TRIAMCINOLONE ACETONIDE<br />

Nystatin; @ cream, topical 100,000U/gm;0.1% Alpharma<br />

Triamcinolone Acetonide @ cream, topical 100,000U/gm;0.1% Clay-Park<br />

cream, topical 100,000U/gm;0.1% Fougera/Altana<br />

@ cream, topical 100,000U/gm;0.1% Pharmaderm/Altana<br />

@ cream, topical 100,000U/gm;0.1% Pharmafair<br />

cream, topical 100,000U/gm;0.1% Thames<br />

@ ointment, topical 100,000U/gm;0.1% Clay-Park<br />

ointment, topical 100,000U/gm;0.1% Fougera/Altana<br />

@ ointment, topical 100,000U/gm;0.1% Pharmaderm/Altana<br />

@ ointment, topical 100,000U/gm;0.1% Pharmafair<br />

ointment, topical 100,000U/gm;0.1% Taro<br />

Brand(s)<br />

Dermacomb Cream cream, topical 100,000U/gm;0.1% Taro<br />

Myco-Triacet II cream, topical 100,000U/gm;0.1% Teva<br />

Mycolog-II cream, topical 100,000U/gm;0.1% Apo<strong>the</strong>con<br />

Mykacet cream, topical 100,000U/gm;0.1% NMC<br />

Mytrex F cream, topical 100,000U/gm;0.1% Savage/Altana<br />

Myco-Triacet II @ ointment, topical 100,000U/gm;0.1% Teva<br />

Mycolog-II ointment, topical 100,000U/gm;0.1% Apo<strong>the</strong>con<br />

Mykacet ointment, topical 100,000U/gm;0.1% NMC<br />

Mytrex F ointment, topical 100,000U/gm;0.1% Savage/Altana<br />

OMEPRAZOLE<br />

Omeprazole capsule, delayed release 10,20,40mg Andrx<br />

Brand(s)<br />

Prilosec capsule, delayed release 10,20,40mg AstraZeneca<br />

154


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

ORPHENADRINE CITRATE<br />

Orphenadrine Citrate injection 30mg/ml Steris<br />

@ tablet, extended release 100mg (Ascot)<br />

@ tablet, extended release 100mg Circa<br />

tablet, extended release 100mg Eon<br />

tablet, extended release 100mg Geneva<br />

tablet, extended release 100mg Impax<br />

tablet, extended release 100mg Kiel<br />

Brand(s)<br />

Norflex injection 30mg/ml Riker/3-M<br />

Norflex tablet, extended release 100mg Riker/3-M *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

ORPHENADRINE CITRATE; ASPIRIN; CAFFEINE<br />

See ASPIRIN; CAFFEINE; ORPHENADRINE CITRATE<br />

OXACILLIN SODIUM<br />

Oxacillin Sodium capsule, oral eq 250,500mg base Teva<br />

@ injection eq 250,500mg,1,2,4, Elkins-Sinn<br />

10gm base/vial<br />

@ injection eq 250,500mg,<br />

IBI<br />

1,2gm base/vial<br />

injection eq 250,500mg,1,2,4, Marsam<br />

10gm base/vial<br />

powder <strong>for</strong> solution<br />

Teva<br />

eq 250mg base/5ml<br />

Brand(s)<br />

Bactocill capsule, oral eq 250,500mg base SmithKline Beecham<br />

Prostaphlin @ capsule, oral eq 250,500mg base Apo<strong>the</strong>con<br />

Bactocill @ injection eq 500mg,4,10gm base/vial SmithKline Beecham<br />

Bactocill @ injection eq 1,2gm base/vial SmithKline Beecham<br />

Prostaphlin injection eq 250,500mg,1,2, Apo<strong>the</strong>con<br />

10gm base/vial<br />

Prostaphlin @ injection eq 4gm base/vial Apo<strong>the</strong>con<br />

Bactocill powder <strong>for</strong> solution SmithKline Beecham<br />

eq 250mg base/5ml<br />

Prostaphlin powder <strong>for</strong> solution Apo<strong>the</strong>con<br />

eq 250mg base/5ml<br />

OXAPROZIN<br />

Oxaprozin tablet, oral 600mg Dr. Reddy’s<br />

tablet, oral 600mg<br />

Eon<br />

tablet, oral 600mg<br />

Geneva<br />

tablet, oral 600mg<br />

GenPharm<br />

tablet, oral 600mg<br />

IVAX<br />

tablet, oral 600mg<br />

Mylan<br />

tablet, oral 600mg<br />

Purepac<br />

tablet, oral 600mg<br />

Watson<br />

Brand(s)<br />

Daypro tablet, oral 600mg Searle *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

155


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

OXAZEPAM<br />

Oxazepam @ capsule, oral 10,15,30mg American Therapeutics<br />

@ capsule, oral 10,15,30mg<br />

Barr<br />

capsule, oral 10,15,30mg<br />

Danbury<br />

capsule, oral 10,15,30mg<br />

Geneva<br />

capsule, oral 10,15,30mg<br />

IVAX<br />

@ capsule, oral 10,15,30mg<br />

Mylan<br />

capsule, oral 10,15,30mg<br />

Purepac<br />

@ tablet, oral 15mg<br />

Barr<br />

@ tablet, oral 15mg<br />

Danbury<br />

@ tablet, oral 15mg<br />

Parke-Davis<br />

Brand(s)<br />

Serax capsule, oral 10,15,30mg Faulding<br />

Zaxopam @ capsule, oral 10,15,30mg Quantum<br />

Serax tablet, oral 15mg Faulding<br />

OXTRIPHYLLINE<br />

Oxtriphylline @ solution, oral 100mg/5ml Morton Grove<br />

@ syrup, oral 50mg/5ml<br />

Morton Grove<br />

@ tablet, delayed release 100,200mg Circa *<br />

Brand(s)<br />

Choledyl @ solution, oral 100mg/5ml Parke-Davis<br />

Choledyl @ syrup, oral 50mg/5ml Parke-Davis<br />

Choledyl @ tablet, delayed release 100,200mg Parke-Davis *<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

OXYBUTYNIN CHLORIDE<br />

Oxybutynin Chloride syrup, oral 5mg/5ml Mikart<br />

syrup, oral 5mg/5ml<br />

Morton Grove<br />

syrup, oral 5mg/5ml<br />

Novex<br />

syrup, oral 5mg/5ml<br />

Pharmaceutical Associates<br />

syrup, oral 5mg/5ml<br />

Silarx<br />

@ tablet, oral 5mg<br />

Circa<br />

@ tablet, oral 5mg<br />

Quantum<br />

tablet, oral 5mg<br />

Sidmak<br />

tablet, oral 5mg<br />

USL<br />

tablet, oral 5mg<br />

Vintage<br />

Brand(s)<br />

Ditropan syrup, oral 5mg/5ml Alza<br />

Ditropan tablet, oral 5mg Alza<br />

OXYCODONE HYDROCHLORIDE; ACETAMINOPHEN<br />

See ACETAMINOPHEN; OXYCODONE HYDROCHLORIDE<br />

OXYCODONE HYDROCHLORIDE; ASPIRIN; OXYCODONE TEREPHTHALATE<br />

See ASPIRIN; OXYCODONE HYDROCHLORIDE; OXYCODONE TEREPHTHALATE<br />

OXYCODONE TEREPHTHALATE; ASPIRIN; OXYCODONE HYDROCHLORIDE<br />

See ASPIRIN; OXYCODONE HYDROCHLORIDE; OXYCODONE TEREPHTHALATE<br />

156


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

OXYTETRACYCLINE HYDROCHLORIDE<br />

Oxytetracycline Hydrochloride @ capsule, oral eq 250mg base Impax<br />

@ capsule, oral eq 250mg base Proter<br />

@ capsule, oral eq 250mg base Purepac<br />

@ capsule, oral eq 250mg base West-ward<br />

Brand(s)<br />

Oxy-Kesso-Tetra @ capsule, oral eq 250mg base Ferrante<br />

Terramycin capsule, oral eq 250mg base Pfizer<br />

OXYTOCIN<br />

Oxytocin injection 10 USP U/ml American Pharmaceutical<br />

Partners<br />

@ injection 10 USP U/ml<br />

Wyeth-Ayerst<br />

Brand(s)<br />

Pitocin injection 10 USP U/ml Parkdale<br />

Syntocinon injection 10 USP U/ml Novartis<br />

PACLITAXEL<br />

Paclitaxel injection 6mg/ml Baker Norton<br />

injection 6mg/ml<br />

IVAX<br />

injection 6mg/ml<br />

Mylan<br />

Brand(s)<br />

Taxol injection 6mg/ml Bristol-Myers Squibb<br />

PANCURONIUM BROMIDE<br />

Pancuronium Bromide injection 1,2mg/ml Abbott<br />

@ injection 1,2mg/ml<br />

Astra Zeneca<br />

injection 1,2mg/ml<br />

Elkins-Sinn<br />

injection 1,2mg/ml<br />

Gensia Sicor<br />

@ injection 1,2mg/ml<br />

Quad<br />

Brand(s)<br />

Pavulon injection 1,2mg/ml Organon/Akzona<br />

PAROMOMYCIN SULFATE<br />

Paromomycin Sulfate capsule, oral eq 250mg base Caraco<br />

Brand(s)<br />

Humatin capsule, oral eq 250mg base Parkdale<br />

PEMOLINE<br />

Pemoline tablet, chewable 37.5mg Amide<br />

tablet, chewable 37.5mg<br />

Copley<br />

tablet, oral 18.75,37.5,75mg<br />

Amide<br />

tablet, oral 18.75,37.5,75mg<br />

Copley<br />

tablet, oral 18.75,37.5,75mg<br />

Geneva<br />

tablet, oral 18.75,37.5,75mg<br />

Vintage<br />

tablet, oral 18.75,37.5,75mg<br />

Watson<br />

Brand(s)<br />

Cylert tablet, chewable 37.5mg Abbott<br />

Cylert tablet, oral 18.75,37.5,75mg Abbott<br />

PENICILLIN G POTASSIUM<br />

Penicillin G Potassium @ injection 1,000,000, 5,000,000, Apo<strong>the</strong>con<br />

10,000,000, 20,000,000U/vial<br />

(continued on <strong>the</strong> next page)<br />

157


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

PENICILLIN G POTASSIUM (continued)<br />

@ injection 500,000, 1,000,000, Consolidated<br />

5,000,000, 10,000,000U/vial<br />

@ injection 500,000, 1,000,000, Lilly/Dista<br />

5,000,000, 20,000,000U/vial<br />

injection 1,000,000, 5,000,000, Marsam<br />

10,000,000, 20,000,000U/vial<br />

@ injection 1,000,000, 5,000,000U/vial Parke-Davis<br />

@ powder <strong>for</strong> suspension 200,000, Mylan<br />

250,000, 400,000U/5ml<br />

@ powder <strong>for</strong> suspension 250,000, Purepac<br />

400,000U/5ml<br />

@ powder <strong>for</strong> suspension 200,000, Teva<br />

250,000, 400,000U/5ml<br />

@ tablet, oral 400,000U<br />

IVAX<br />

@ tablet, oral 250,000U<br />

Lilly/Dista<br />

@ tablet, oral 200,000, 250,000, 400,000, Mylan<br />

500,000, 800,000U<br />

@ tablet, oral 200,000, 250,000, Purepac<br />

400,000U<br />

@ tablet, oral 200,000, 250,000, 400,000, Teva<br />

500,000U<br />

tablet, oral 200,000, 250,000, Wyeth-Ayerst<br />

400,000U<br />

Brand(s)<br />

Pfizerpen injection 1,000,000, 5,000,000, Pfizer<br />

20,000,000U/vial<br />

Pentids 200 @ powder <strong>for</strong> suspension 200,000U/5ml Apo<strong>the</strong>con<br />

Pentids 400 @ powder <strong>for</strong> suspension 400,000U/5ml Apo<strong>the</strong>con<br />

Pfizerpen-G @ powder <strong>for</strong> suspension 400,000U/5ml Pfizer<br />

Pentids 200 @ tablet, oral 200,000U Apo<strong>the</strong>con<br />

Pentids 250 @ tablet, oral 250,000U Apo<strong>the</strong>con<br />

Pentids 400 @ tablet, oral 400,000U Apo<strong>the</strong>con<br />

Pentids 800 @ tablet, oral 800,000U Apo<strong>the</strong>con<br />

Pfizerpen-G<br />

@ tablet, oral 200,000, 250,000, 400,000, Pfizer<br />

800,000U<br />

PENICILLIN G PROCAINE<br />

Penicillin G Procaine @ injection 300,000U/ml Consolidated<br />

@ injection 300,000U/ml<br />

Parke-Davis<br />

Brand(s)<br />

Duracillin A.S. @ injection 300,000U/ml Lilly<br />

Pfizerpen-AS @ injection 300,000, 600,000U/ml Pfizer<br />

Wycillin injection 300,000, 600,000U/ml King<br />

PENICILLIN V POTASSIUM<br />

Penicillin V Potassium powder <strong>for</strong> solution eq 125, Clonmel<br />

250mg base/5ml<br />

powder <strong>for</strong> solution eq 125,<br />

Consolidated<br />

250mg base/5ml<br />

@ powder <strong>for</strong> solution eq 125,<br />

Mylan<br />

250mg base/5ml<br />

@ powder <strong>for</strong> solution eq 125,<br />

Purepac<br />

250mg base/5ml<br />

powder <strong>for</strong> solution eq 125,<br />

Teva<br />

250mg base/5ml<br />

tablet, oral eq 250,500mg base Biochemie<br />

tablet, oral eq 250,500mg base Clonmel<br />

(continued on <strong>the</strong> next page)<br />

158


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

PENICILLIN V POTASSIUM (continued)<br />

tablet, oral eq 250,500mg base Consolidated<br />

@ tablet, oral eq 125,250,500mg base IVAX<br />

@ tablet, oral eq 250,500mg base Mylan<br />

@ tablet, oral eq 125,250,500mg base Purepac<br />

tablet, oral eq 250,500mg base Teva<br />

Brand(s)<br />

Beepen-VK powder <strong>for</strong> solution eq 125, SmithKline Beecham<br />

250mg base/5ml<br />

Betapen-VK @ powder <strong>for</strong> solution eq 125, Apo<strong>the</strong>con<br />

250mg base/5ml<br />

Ledercillin VK powder <strong>for</strong> solution eq 125, Lederle<br />

250mg base/5ml<br />

Pen-Vee K powder <strong>for</strong> solution eq 125, Wyeth-Ayerst<br />

250mg base/5ml<br />

Penapar-VK @ powder <strong>for</strong> solution eq 125, Parke-Davis<br />

250mg base/5ml<br />

Pfizerpen-VK @ powder <strong>for</strong> solution eq 125, Pfizer<br />

250mg base/5ml<br />

V-Cillin K @ powder <strong>for</strong> solution eq 125, Lilly<br />

250mg base/5ml<br />

Veetids 125 powder <strong>for</strong> solution Apo<strong>the</strong>con<br />

eq 125mg base/5ml<br />

Veetids 250 powder <strong>for</strong> solution Apo<strong>the</strong>con<br />

eq 250mg base/5ml<br />

Beepen-VK tablet, oral eq 250,500mg base SmithKline Beecham<br />

Betapen-VK tablet, oral eq 250,500mg base Bristol<br />

Ledercillin VK tablet, oral eq 250,500mg base Lederle<br />

Pen-Vee K @ tablet, oral eq 125mg base Wyeth-Ayerst<br />

Pen-Vee K tablet, oral eq 250,500mg base Wyeth-Ayerst<br />

Penapar-VK @ tablet, oral eq 250,500mg base Parke-Davis<br />

Pfizerpen-VK @ tablet, oral eq 250,500mg base Pfizer<br />

Uticillin VK tablet, oral eq 250mg base Pharmacia & Upjohn<br />

Uticillin VK @ tablet, oral eq 500mg base Pharmacia & Upjohn<br />

V-Cillin K @ tablet, oral eq 125,250,500mg base Lilly<br />

Veetids 250 tablet, oral eq 250mg base Apo<strong>the</strong>con<br />

Veetids 500 tablet, oral eq 500mg base Apo<strong>the</strong>con<br />

PENTAMIDINE ISETHIONATE<br />

Pentamidine Isethionate injection 300mg/vial Abbott<br />

injection 300mg/vial<br />

Elkins-Sinn<br />

injection 300mg/vial<br />

Steris<br />

Brand(s)<br />

Pentacarinat @ injection 300mg/vial Armour<br />

Pentam 300 injection 300mg/vial American Pharmaceutical<br />

Partners<br />

PENTAZOCINE HYDROCHLORIDE; ACETAMINOPHEN<br />

See NALOXONE HYDROCHLORIDE; ACETAMINOPHEN<br />

PENTAZOCINE HYDROCHLORIDE; NALOXONE HYDROCHLORIDE<br />

See NALOXONE HYDROCHLORIDE; PENTAZOCINE HYDROCHLORIDE<br />

PENTOBARBITAL SODIUM<br />

Pentobarbital Sodium @ capsule, oral 100mg Anabolic<br />

@ capsule, oral 100mg<br />

Elkins-Sinn<br />

(continued on <strong>the</strong> next page)<br />

159


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

PENTOBARBITAL SODIUM (continued)<br />

@ capsule, oral 100mg<br />

Eon<br />

@ capsule, oral 100mg<br />

Everylife<br />

@ capsule, oral 100mg<br />

Halsey<br />

capsule, oral 100mg<br />

ICN<br />

@ capsule, oral 50,100mg<br />

IVAX<br />

@ capsule, oral 50,100mg<br />

Lannett<br />

@ capsule, oral 100mg<br />

Parke-Davis<br />

@ capsule, oral 100mg<br />

Perrigo<br />

@ capsule, oral 100mg<br />

Purepac<br />

@ capsule, oral 100mg<br />

Watson<br />

@ capsule, oral 100mg<br />

Whiteworth Towne<br />

@ capsule, oral 100mg<br />

Wyeth-Ayerst<br />

@ injection 50mg/ml<br />

Elkins-Sinn<br />

injection 50mg/ml<br />

Wyeth-Ayerst<br />

@ tablet, oral 100mg<br />

Anabolic<br />

@ tablet, oral 100mg<br />

Eon<br />

Brand(s)<br />

Nembutal Sodium @ capsule, oral 50mg Abbott<br />

Nembutal Sodium capsule, oral 100mg Abbott<br />

Nembutal Sodium injection 50mg/ml Abbott<br />

PENTOXIFYLLINE<br />

Pentoxifylline tablet, extended release 400mg Biovail<br />

tablet, extended release 400mg ESI-Lederle<br />

tablet, extended release 400mg Impax<br />

tablet, extended release 400mg Mylan<br />

tablet, extended release 400mg Purepac<br />

tablet, extended release 400mg Sidmak<br />

tablet, extended release 400mg Teva<br />

tablet, extended release 400mg TorPharm<br />

tablet, extended release 400mg Watson<br />

tablet, extended release 400mg Upsher-Smith<br />

Brand(s)<br />

Trental tablet, extended release 400mg Aventis *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

PERMETHRIN<br />

Permethrin cream, topical 5% Alpharma<br />

Brand(s)<br />

Elimite cream, topical 5% Glaxo Wellcome<br />

PERPHENAZINE<br />

Perphenazine tablet, oral 2,4,8,16mg Geneva<br />

tablet, oral 2,4,8,16mg<br />

IVAX<br />

tablet, oral 2,4,8,16mg<br />

Vintage<br />

Brand(s)<br />

Trilafon tablet, oral 2,4,8,16mg Schering *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

PERPHENAZINE; AMITRIPTYLINE HYDROCHLORIDE<br />

See AMITRIPTYLINE HYDROCHLORIDE; PERPHENAZINE<br />

160


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

PHENDIMETRAZINE TARTRATE<br />

Phendimetrazine Tartrate capsule, oral 35mg Eon<br />

@ tablet, oral 35mg<br />

Anabolic<br />

@ tablet, oral 35mg<br />

Barr<br />

tablet, oral 35mg<br />

Eon<br />

@ tablet, oral 35mg<br />

Ferndale<br />

@ tablet, oral 35mg<br />

Geneva<br />

@ tablet, oral 35mg<br />

Inwood/Forest<br />

@ tablet, oral 35mg<br />

IVAX<br />

@ tablet, oral 35mg<br />

KV<br />

@ tablet, oral 35mg<br />

Manufacturing Chemists<br />

@ tablet, oral 35mg<br />

Mikart<br />

@ tablet, oral 35mg<br />

Private Formulations<br />

@ tablet, oral 35mg<br />

Solvay<br />

@ tablet, oral 35mg<br />

Watson<br />

Brand(s)<br />

Phenazine @ capsule, oral 35mg Mast<br />

SPRX-3 @ capsule, oral 35mg Solvay<br />

Statobex @ capsule, oral 35mg Teva<br />

X-Trozine capsule, oral 35mg Shire Richwood<br />

Adphen @ tablet, oral 35mg Ferndale<br />

Alphazine @ tablet, oral 35mg Eon<br />

Bontril PDM tablet, oral 35mg Amarin<br />

Cam-Metrazine tablet, oral 35mg ABC<br />

Di-Metrex @ tablet, oral 35mg Private Formulations<br />

Melfiat @ tablet, oral 35mg Numark<br />

Metra @ tablet, oral 35mg Forest<br />

Obezine @ tablet, oral 35mg USL<br />

Phenazine @ tablet, oral 35mg Mast<br />

Phenazine-35 @ tablet, oral 35mg ABC<br />

Plegine @ tablet, oral 35mg Wyeth-Ayerst<br />

Statobex @ tablet, oral 35mg Teva<br />

Statobex-G @ tablet, oral 35mg Teva<br />

X-Trozine tablet, oral 35mg Shire Richwood<br />

PHENIRAMINE MALEATE; NAPHAZOLINE HYDROCHLORIDE<br />

See NAPHAZOLINE HYDROCHLORIDE; PHENIRAMINE MALEATE<br />

PHENOBARBITAL<br />

Phenobarbital elixir, oral 20mg/5ml Alpharma *<br />

elixir, oral 20mg/5ml Cenci *<br />

elixir, oral 20mg/5ml Halsey *<br />

elixir, oral 20mg/5ml Lilly *<br />

elixir, oral 20mg/5ml Naska *<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

PHENOBARBITAL; ATROPINE SULFATE; HYOSCYAMINE; SCOPALAMINE HYDROBROMIDE<br />

See ATROPINE SULFATE; HYOSCYAMINE; PHENOBARBITAL; SCOPALAMINE HYDROBROMIDE<br />

PHENTERMINE HYDROCHLORIDE<br />

Phentermine Hydrochloride capsule, oral 15,30,37.5mg ABC<br />

capsule, oral 30,37.5mg<br />

Amide<br />

@ capsule, oral 30mg<br />

Duramed<br />

capsule, oral 15,30mg<br />

Eon<br />

(continued on <strong>the</strong> next page)<br />

161


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

PHENTERMINE HYDROCHLORIDE (continued)<br />

@ capsule, oral 30mg<br />

IVAX<br />

capsule, oral 30mg<br />

King<br />

@ capsule, oral 30mg<br />

Lannett<br />

@ capsule, oral 30mg<br />

Teva<br />

capsule, oral 30mg<br />

USL<br />

@ capsule, oral 30mg<br />

Watson<br />

tablet, oral 8,37.5mg<br />

ABC<br />

tablet, oral 37.5mg<br />

Amide<br />

@ tablet, oral 8mg<br />

Eon<br />

@ tablet, oral 8mg<br />

IVAX<br />

tablet, oral 37.5mg<br />

Purepac<br />

tablet, oral 8,37.5mg<br />

USL<br />

@ tablet, oral 8mg<br />

Watson<br />

Brand(s)<br />

Adipex P capsule, oral 37.5mg Teva<br />

Dapex-37.5 @ capsule, oral 37.5mg Eon<br />

Fastin @ capsule, oral 30mg SmithKline Beecham<br />

Obestin-30 @ capsule, oral 30mg Ferndale<br />

Oby-Trim @ capsule, oral 30mg Shire Richwood<br />

Ona-Mast capsule, oral 30mg Mast<br />

Adipex P tablet, oral 37.5mg Teva<br />

Ona-Mast tablet, oral 8mg Mast<br />

Tora @ tablet, oral 8mg Solvay<br />

PHENTERMINE RESIN COMPLEX<br />

Phentermine Resin Complex @ capsule, slow release 30mg Quantum<br />

Brand(s)<br />

Ionamin-30 capsule, slow release 30mg Fisons<br />

PHENTOLAMINE MESYLATE<br />

Phentolamine Mesylate injection 5mg/ml Bed<strong>for</strong>d<br />

Brand(s)<br />

Regitine injection 5mg/ml Novartis<br />

PHENYLEPHRINE HYDROCHLORIDE<br />

Phenylephrine Hydrochloride solution, ophthalmic 2.5% Paco *<br />

solution, ophthalmic 10% Iolab *<br />

Brand(s)<br />

AK-Dilate solution, ophthalmic 2.5,10% Akorn *<br />

I-Phrine solution, ophthalmic 2.5,10% International Pharm *<br />

Mydfrin solution, ophthalmic 2.5% Alcon *<br />

Neo-Synephrine solution, ophthalmic 2.5,10% Sterling Winthrop *<br />

Phenoptic solution, ophthalmic 2.5% Optopics *<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

PHENYLEPHRINE HYDROCHLORIDE; CHLORPHENIRAMINE MALEATE; PHENYLPROPANOLAMINE<br />

HYDROCHLORIDE; PHENYLTOLOXAMINE CITRATE<br />

See CHLORPHENIRAMINE MALEATE; PHENYLEPHRINE HYDROCHLORIDE;<br />

PHENYLPROPANOLAMINE HYDROCHLORIDE; PHENYLTOLOXAMINE CITRATE<br />

162


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

PHENYLEPHRINE TANNATE; CHLORPHENIRAMINE TANNATE; PYRILAMINE TANNATE<br />

See CHLORPHENIRAMINE TANNATE; PHENYLEPHRINE TANNATE; PYRILAMINE TANNATE<br />

PHENYLEPHRINE HYDROCHLORIDE; CODEINE PHOSPHATE; PROMETHAZINE HYDROCHLORIDE<br />

See CODEINE PHOSPHATE; PHENYLEPHRINE HYDROCHLORIDE; PROMETHAZINE<br />

HYDROCHLORIDE<br />

PHENYLEPHRINE HYDROCHLORIDE; GUAIFENESIN; PHENYLPROPANOLAMINE HYDROCHLORIDE<br />

See GUAIFENESIN; PHENYLEPHRINE HYDROCHLORIDE; PHENYLPROPANOLAMINE<br />

HYDROCHLORIDE<br />

PHENYLEPHRINE HYDROCHLORIDE; PROMETHAZINE HYDROCHLORIDE<br />

Phenylephrine Hydrochloride; @ syrup, oral 5mg/5ml;6.25mg/5ml Cenci<br />

Promethazine Hydrochloride syrup, oral 5mg/5ml;6.25mg/5ml Morton Grove<br />

Brand(s)<br />

Phenergan VC syrup, oral 5mg/5ml;6.25mg/5ml Wyeth-Ayerst<br />

Pherazine VC @ syrup, oral 5mg/5ml;6.25mg/5ml Halsey<br />

Prometh VC Plain syrup, oral 5mg/5ml;6.25mg/5ml Alpharma<br />

PHENYLPROPANOLAMINE HYDROCHLORIDE; BROMPHENIRAMINE MALEATE<br />

See BROMPHENIRAMINE MALEATE; PHENYLPROPANOLAMINE HYDROCHLORIDE<br />

PHENYLPROPANOLAMINE HYDROCHLORIDE; BROMPHENIRAMINE MALEATE; CODEINE PHOSPHATE<br />

See BROMPHENIRAMINE MALEATE; CODEINE PHOSPHATE; PHENYLPROPANOLAMINE<br />

HYDROCHLORIDE<br />

PHENYLPROPANOLAMINE HYDROCHLORIDE; CHLORPHENIRAMINE MALEATE<br />

See CHLORPHENIRAMINE MALEATE; PHENYLPROPANOLAMINE HYDROCHLORIDE<br />

PHENYLPROPANOLAMINE HYDROCHLORIDE; CHLORPHENIRAMINE MALEATE; PHENYLEPHRINE<br />

HYDROCHLORIDE; PHENYLTOLOXAMINE CITRATE<br />

See CHLORPHENIRAMINE MALEATE; PHENYLEPHRINE HYDROCHLORIDE;<br />

PHENYLPROPANOLAMINE HYDROCHLORIDE; PHENYLTOLOXAMINE CITRATE<br />

PHENYLPROPANOLAMINE HYDROCHLORIDE; GUAIFENESIN; PHENYLEPHRINE HYDROCHLORIDE<br />

See GUAIFENESIN; PHENYLEPHRINE HYDROCHLORIDE; PHENYLPROPANOLAMINE<br />

HYDROCHLORIDE<br />

PHENYLPROPANOLAMINE HYDROCHLORIDE; HYDROCODONE BITARTRATE<br />

See HYDROCODONE BITARTRATE; PHENYLPROPANOLAMINE HYDROCHLORIDE<br />

PHENYLTOLOXAMINE CITRATE; CHLORPHENIRAMINE MALEATE; PHENYLEPHRINE<br />

HYDROCHLORIDE; PHENYLPROPANOLAMINE HYDROCHLORIDE<br />

See CHLORPHENIRAMINE MALEATE; PHENYLEPHRINE HYDROCHLORIDE;<br />

PHENYLPROPANOLAMINE HYDROCHLORIDE; PHENYLTOLOXAMINE CITRATE<br />

163


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

PHENYTOIN<br />

Phenytoin suspension, oral 125mg/5ml Alpharma<br />

suspension, oral 125mg/5ml<br />

UDL<br />

Brand(s)<br />

Dilantin-125 suspension, oral 125mg/5ml Parke-Davis<br />

PHENYTOIN SODIUM<br />

Phenytoin Sodium injection 50mg/ml Abbott<br />

@ injection 50mg/ml<br />

American Pharmaceutical<br />

Partners<br />

injection 50mg/ml<br />

Elkins-Sinn<br />

@ injection 50mg/ml<br />

Marsam<br />

@ injection 50mg/ml<br />

Smith and Nephew<br />

@ injection 50mg/ml<br />

Solopak<br />

@ injection 50mg/ml<br />

Steris<br />

@ injection 50mg/ml<br />

Warner Chilcott<br />

Brand(s)<br />

Dilantin injection 50mg/ml Parke-Davis<br />

PILOCARPINE HYDROCHLORIDE<br />

Pilocarpine Hydrochloride solution, ophthalmic 0.5,1,2,3,4,6% Optopics *<br />

solution, ophthalmic 1,2,4,6% Paco *<br />

solution, ophthalmic 0.5,1,2,4,6% Pharmafair *<br />

solution, ophthalmic 1,2,3,4% Steris *<br />

Brand(s)<br />

Adsorbocarpine solution, ophthalmic 1,2,4,8% Alcon *<br />

AKarpine solution, ophthalmic 1,2,3,4% Akorn *<br />

Isopto Carpine solution, ophthalmic 0.5,1,2,3,4,6,8, Alcon * **<br />

10%<br />

Pilocar solution, ophthalmic 0.5,1,2,4,6% Iolab *<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

** <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

PINDOLOL<br />

Pindolol tablet, oral 5,10mg Geneva<br />

tablet, oral 5,10mg<br />

GenPharm<br />

tablet, oral 5,10mg<br />

IVAX<br />

tablet, oral 5,10mg<br />

Martec<br />

tablet, oral 5,10mg<br />

Mutual<br />

tablet, oral 5,10mg<br />

Mylan<br />

tablet, oral 5,10mg<br />

Purepac<br />

tablet, oral 5,10mg<br />

Royce<br />

tablet, oral 5,10mg<br />

Teva<br />

Brand(s)<br />

Visken tablet, oral 5,10mg Novartis<br />

PIPERAZINE CITRATE<br />

Piperazine Citrate @ syrup, oral eq 500mg base/5ml Alpharma<br />

@ syrup, oral eq 500mg base/5ml Lannett<br />

syrup, oral eq 500mg base/5ml Luitpold<br />

(continued on <strong>the</strong> next page)<br />

164


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

PIPERAZINE CITRATE (continued on <strong>the</strong> next page)<br />

Brand(s)<br />

Antepar @ syrup, oral eq 500mg base/5ml Glaxo Wellcome<br />

Bryrel @ syrup, oral eq 500mg base/5ml Sanofi Syn<strong>the</strong>labo<br />

Multifuge syrup, oral eq 500mg base/5ml Bluline<br />

Vermidol @ syrup, oral eq 500mg base/5ml Solvay<br />

PIROXICAM<br />

Piroxicam capsule, oral 10,20mg Copley<br />

capsule, oral 10,20mg<br />

Danbury<br />

capsule, oral 10,20mg<br />

Egis<br />

capsule, oral 10,20mg<br />

GenPharm<br />

capsule, oral 10,20mg<br />

IVAX<br />

capsule, oral 10,20mg<br />

Mepha<br />

capsule, oral 10,20mg<br />

Mutual<br />

capsule, oral 10,20mg<br />

Mylan<br />

@ capsule, oral 10,20mg<br />

Roxane<br />

capsule, oral 10,20mg<br />

Royce<br />

capsule, oral 10,20mg<br />

SCS<br />

capsule, oral 10,20mg<br />

Teva<br />

Brand(s)<br />

Feldene capsule, oral 10,20mg Pfizer<br />

POLYETHYLENE GLYCOL 3350; POTASSIUM CHLORIDE; SODIUM BICARBONATE; SODIUM<br />

CHLORIDE; SODIUM SULFATE, ANHYDROUS<br />

Brand(s)<br />

Co-Lav powder <strong>for</strong> reconstitution, oral Copley<br />

240gm/bottle;2.98gm/bottle;<br />

6.72gm/bottle;5.84gm/bottle;<br />

22.72gm/bottle<br />

Colovage powder <strong>for</strong> reconstitution, oral Dynapharm<br />

227.1gm/packet;2.82gm/packet;<br />

6.36gm/packet;5.53gm/packet;<br />

21.5gm/packet<br />

Colyte powder <strong>for</strong> reconstitution, oral Schwarz *<br />

227.1gm/bottle;2.82gm/bottle;<br />

6.36gm/bottle;5.53gm/bottle;<br />

21.5gm/bottle<br />

Colyte powder <strong>for</strong> reconstitution, oral Schwarz *<br />

240gm/bottle;2.98gm/bottle;<br />

6.72gm/bottle;5.84gm/bottle;<br />

22.72gm/bottle<br />

Colyte-Flavored powder <strong>for</strong> reconstitution, oral Schwarz *<br />

227.1gm/bottle;2.82gm/bottle;<br />

6.36gm/botlet;5.53gm/bottle;<br />

21.5gm/bottle<br />

Colyte-Flavored powder <strong>for</strong> reconstitution, oral Schwarz *<br />

240gm/bottle;2.98gm/bottle;<br />

6.72gm/bottle;5.84gm/bottle;<br />

22.72gm/bottle<br />

E-Z-EM Prep Lyte powder <strong>for</strong> reconstitution, oral E Z EM<br />

236gm/bottle;2.97gm/bottle;<br />

6.74gm/bottle;5.86gm/bottle;<br />

22.74gm/bottle<br />

Glycoprep powder <strong>for</strong> reconstitution, oral Goldline<br />

236gm/bottle;2.97gm/bottle;<br />

6.74gm/bottle;5.86gm/bottle;<br />

22.74gm/bottle<br />

(continued on <strong>the</strong> next page)<br />

165


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

POLYETHYLENE GLYCOL 3350; POTASSIUM CHLORIDE; SODIUM BICARBONATE; SODIUM<br />

CHLORIDE; SODIUM SULFATE, ANHYDROUS (continued)<br />

Go-Evac powder <strong>for</strong> reconstitution, oral Copley<br />

236gm/bottle;2.97gm/bottle;<br />

6.74gm/bottle;5.86gm/bottle;<br />

22.74gm/bottle<br />

Golytely powder <strong>for</strong> reconstitution, oral Braintree<br />

236gm/bottle;2.97gm/bottle;<br />

6.74gm/bottle;5.86gm/bottle;<br />

22.74gm/bottle<br />

Golytely powder <strong>for</strong> reconstitution, oral Braintree<br />

227.1gm/packet;2.82gm/packet;<br />

6.36gm/packet;5.53gm/packet;<br />

21.5gm/packet<br />

PEG-Lyte powder <strong>for</strong> reconstitution, oral Invamed<br />

236gm/bottle;2.97gm/bottle;<br />

6.74gm/bottle;5.86gm/bottle;<br />

22.74gm/bottle<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

POLYMYXIN B SULFATE<br />

Polymyxin B Sulfate injection eq 500,000 U base/vial Bed<strong>for</strong>d<br />

injection eq 500,000 U base/vial Pharma Tek<br />

@ powder <strong>for</strong> compounding<br />

Paddock<br />

100,000,000U/bottle<br />

Brand(s)<br />

Aerosporin injection eq 500,000 U base/vial Glaxo Wellcome<br />

Poly-Rx powder <strong>for</strong> compounding Pharma Tek<br />

100,000,000U/bottle<br />

POLYMYXIN B SULFATE; BACITRACIN; HYDROCORTISONE ACETATE; NEOMYCIN SULFATE<br />

See BACITRACIN; HYDROCORTISONE ACETATE; NEOMYCIN SULFATE; POLYMYXIN B SULFATE<br />

POLYMYXIN B SULFATE; BACITRACIN ZINC<br />

See BACITRACIN ZINC; POLYMYXIN B SULFATE<br />

POLYMYXIN B SULFATE; BACITRACIN ZINC; HYDROCORTISONE; NEOMYCIN SULFATE<br />

See BACITRACIN ZINC; HYDROCORTISONE; NEOMYCIN SULFATE; POLYMYXIN B SULFATE<br />

POLYMYXIN B SULFATE; BACITRACIN ZINC; NEOMYCIN SULFATE<br />

See BACITRACIN ZINC; NEOMYCIN SULFATE: POLYMYXIN B SULFATE<br />

POLYMYXIN B SULFATE; DEXAMETHASONE; NEOMYCIN SULFATE<br />

See DEXAMETHASONE; NEOMYCIN SULFATE; POLYMYXIN B SULFATE<br />

POLYMYXIN B SULFATE; GRAMICIDIN; NEOMYCIN SULFATE<br />

See GRAMICIDIN; NEOMYCIN SULFATE; POLYMYXIN B SULFATE<br />

POLYMYXIN B SULFATE; HYDROCORTISONE<br />

See HYDROCORTISONE; POLYMYXIN B SULFATE<br />

166


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

POLYMYXIN B SULFATE; HYDROCORTISONE; NEOMYCIN SULFATE<br />

See HYDROCORTISONE; NEOMYCIN SULFATE; POLYMYXIN B SULFATE<br />

POLYMYXIN B SULFATE; NEOMYCIN SULFATE<br />

See NEOMYCIN SULFATE; POLYMYXIN B SULFATE<br />

POLYMYXIN B SULFATE; TRIMETHOPRIM SULFATE<br />

Polymyxin B Sulfate; solution, ophthalmic 10,000U/ml; Falcon *<br />

Trimethoprim Sulfate eq 1mg base/ml<br />

solution, ophthalmic 10,000U/ml; Bausch and Lomb<br />

eq 1mg base/ml<br />

solution, ophthalmic 10,000U/ml; Taylor<br />

eq 1mg base/ml<br />

Brand(s)<br />

Polytrim solution, ophthalmic 10,000U/ml Allergan *<br />

eq 1mg base/ml<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

POTASSIUM BICARBONATE<br />

Potassium Bicarbonate tablet, effervescent 25mEq Bajamar *<br />

tablet, effervescent 25mEq Copley *<br />

Brand(s)<br />

Effer-K tablet, effervescent 25mEq Nomax *<br />

K + Care ET tablet, effervescent 25mEq Alra *<br />

Klor-Con EF tablet, effervescent 25mEq CFH *<br />

K-Lyte tablet, effervescent 25mEq Mead Johnson/Bristol-Myers *<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

POTASSIUM CHLORIDE<br />

Potassium Chloride capsule, extended release KV<br />

10mEq (750mg)<br />

capsule, extended release<br />

Teva<br />

8mEq (600mg),10mEq (750mg)<br />

@ injection 1mEq/ml<br />

Abbott<br />

injection 2mEq/ml<br />

Abbott<br />

@ injection 2mEq/ml<br />

Akorn<br />

injection 2,3mEq/ml<br />

American Pharmaceutical<br />

Partners<br />

injection 2mEq/ml<br />

Baxter<br />

injection 2mEq/ml<br />

Braun<br />

@ injection 2mEq/ml<br />

Elkins-Sinn<br />

injection 2mEq/ml<br />

International Medication<br />

@ injection 2mEq/ml<br />

Lilly<br />

injection 2mEq/ml<br />

Luitpold<br />

@ injection 1,2,3mEq/ml<br />

Miles<br />

injection 4mEq/ml<br />

Miles<br />

injection 2mEq/ml<br />

Pharma Serve<br />

@ injection 1,2,3,4mEq/ml<br />

Searle<br />

@ injection 2,3mEq/ml<br />

Steris<br />

(continued on <strong>the</strong> next page)<br />

167


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

POTASSIUM CHLORIDE (continued)<br />

@ injection, in plastic container<br />

@ 14.9mg/ml (10mEq)<br />

@ 745mg/100ml (10mEq)<br />

29.8mg/ml (20mEq)<br />

@ 1.49gm/100ml (20mEq)<br />

2.24gm/100ml (30mEq)<br />

2.98gm/100ml (40mEq)<br />

injection, in plastic container 2mEq/ml<br />

168<br />

Abbott<br />

American Pharmaceutical<br />

Partners<br />

Baxter<br />

injection, in plastic container<br />

14.9mg/ml (10mEq)<br />

746mg/100ml (10mEq)<br />

1.49gm/100ml (20mEq)<br />

29.8mg/ml (20mEq)<br />

2.24gm/100ml (30mEq)<br />

2.98gm/100ml (40mEq)<br />

powder, oral 20mEq/packet Bajamar *<br />

powder, oral 20mEq/packet Copley *<br />

solution, oral 1500mg/15ml Alpharma *<br />

(20mEq/15ml,10%)<br />

(sugar-free) solution, oral 1500mg/15ml Alpharma *<br />

(20mEq/15ml,10%)<br />

(sugar-free) solution, oral 3000mg/15ml Alpharma *<br />

(40mEq/15ml,20%)<br />

solution, oral 1500mg/15ml Halsey *<br />

(20mEq/15ml,10%)<br />

solution, oral 1500mg/15ml Morton Grove *<br />

(20mEq/15ml,10%)<br />

(sugar free) solution, oral 1500mg/15ml Morton Grove *<br />

(20mEq/15ml,10%)<br />

(sugar free) solution, oral 3000mg/15ml Morton Grove *<br />

(40mEq/15ml,20%)<br />

(sugar-free) solution, oral 1500mg/15ml Naska *<br />

(20mEq/15ml,10%)<br />

(sugar-free) solution, oral 3000mg/15ml Naska *<br />

(40mEq/15ml,20%)<br />

solution, oral 1500mg/15ml Norton *<br />

(20mEq/15ml,10%)<br />

(sugar-free) solution, oral 1500mg/15ml Norton *<br />

(20mEq/15ml,10%)<br />

(sugar-free) solution, oral 3000mg/15ml Norton *<br />

(40mEq/15ml,20%)<br />

tablet, extended release<br />

Copley<br />

8mEq (600mg)<br />

Brand(s)<br />

K Lease @ capsule, extended release Savage<br />

8,10mEq (600,750mg)<br />

Micro-K capsule, extended release KV<br />

8mEq (600mg)<br />

Micro-K 10 capsule, extended release KV<br />

10mEq (750mg)<br />

Gen-K powder, oral 20mEq/packet Howard Food/USA American *<br />

K + Care powder, oral 20mEq/packet Alra *<br />

K-Lor powder, oral 20mEq/packet Abbott *<br />

Kato powder, oral 20mEq/packet ICN *<br />

Kay Ciel powder, oral 20mEq/packet Forest *<br />

Klor-Con powder, oral 20mEq/packet Upsher-Smith *<br />

Cena-K solution, oral 1500mg/15ml Century *<br />

(sugar-free) (20mEq/15ml,10%)<br />

(continued on <strong>the</strong> next page)


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

POTASSIUM CHLORIDE (continued)<br />

EM-K-10% solution, oral 1500mg/15ml Econo Med *<br />

(sugar-free) (20mEq/15ml,10%)<br />

Kaochlor 10% solution, oral 1500mg/15ml Pharmacia & Upjohn *<br />

(20mEq/15ml,10%)<br />

Kaochlor SF solution, oral 1500mg/15ml Pharmacia & Upjohn *<br />

(20mEq/15ml,10%)<br />

Kay Ciel solution, oral 1500mg/15ml Forest/Inwood *<br />

(sugar-free) (20mEq/15ml,10%)<br />

Klor-10% solution, oral 1500mg/15ml Upsher-Smith *<br />

(sugar-free) (20mEq/15ml,10%)<br />

Klorvess 10% solution, oral 1500mg/15ml Novartis *<br />

(20mEq/15ml,10%)<br />

Potsalan solution, oral 1500mg/15ml Pharmacia & Upjohn *<br />

(sugar-free) (20mEq/15ml,10%)<br />

Kaon-Cl 20% solution, oral 3000mg/15ml Pharmacia & Upjohn *<br />

(sugar-free) (40mEq/15ml,20%)<br />

Klor Con 20% solution, oral 3000mg/15ml Upsher-Smith *<br />

(40mEq/15ml,20%)<br />

K + 8 tablet, extended release Alra<br />

8mEq (600mg)<br />

Klor-Con tablet, extended release Upsher-Smith<br />

8mEq (600mg)<br />

Slow K tablet, extended release Novartis<br />

8mEq (600mg)<br />

K-Dur tablet, extended release Schering/Key **<br />

10mEq (750mg)<br />

Klor-Con M10 tablet, extended release Upsher-Smith<br />

10mEq (750mg)<br />

K-Dur tablet, extended release Schering/Key **<br />

20mEq (1500mg)<br />

Klor-Con M20 tablet, extended release Upsher-Smith<br />

20mEq (1500mg)<br />

<strong>Product</strong>s containing sugar shall not be interchanged with sugar-free products without verification of <strong>the</strong><br />

diabetic status of <strong>the</strong> patient.<br />

* Some oral potassium chloride solutions, powders <strong>for</strong> solutions and extended release capsules were reviewed<br />

by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an exception to <strong>the</strong> promulgated<br />

criteria <strong>for</strong> inclusion, pursuant to Section 790.60.<br />

** <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

POTASSIUM CHLORIDE; CALCIUM CHLORIDE; DEXTROSE; GLUTATHIONE DISULFIDE; MAGNESIUM<br />

CHLORIDE; SODIUM BICARBONATE; SODIUM CHLORIDE; SODIUM PHOSPHATE<br />

See CALCIUM CHLORIDE; DEXTROSE; GLUTATHIONE DISULFIDE; MAGNESIUM CHLORIDE;<br />

POTASSIUM CHLORIDE; SODIUM BICARBONATE; SODIUM CHLORIDE; SODIUM<br />

PHOSPHATE<br />

POTASSIUM CHLORIDE; CALCIUM CHLORIDE; DEXTROSE; SODIUM CHLORIDE<br />

See CALCIUM CHLORIDE; DEXTROSE; POTASSIUM CHLORIDE; SODIUM CHLORIDE<br />

POTASSIUM CHLORIDE; CALCIUM CHLORIDE; DEXTROSE; SODIUM CHLORIDE; SODIUM LACTATE<br />

See CALCIUM CHLORIDE; DEXTROSE; POTASSIUM CHLORIDE; SODIUM CHLORIDE; SODIUM<br />

LACTATE<br />

169


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

POTASSIUM CHLORIDE; CALCIUM CHLORIDE; MAGNESIUM CHLORIDE; SODIUM CHLORIDE<br />

See CALCIUM CHLORIDE; MAGNESIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM CHLORIDE<br />

POTASSIUM CHLORIDE; CALCIUM CHLORIDE; SODIUM CHLORIDE<br />

See CALCIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM CHLORIDE<br />

POTASSIUM CHLORIDE; CALCIUM CHLORIDE; SODIUM CHLORIDE; SODIUM LACTATE<br />

See CALCIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM CHLORIDE; SODIUM LACTATE<br />

POTASSIUM CHLORIDE; DEXTROSE<br />

See DEXTROSE; POTASSIUM CHLORIDE<br />

POTASSIUM CHLORIDE; DEXTROSE; MAGNESIUM CHLORIDE; SODIUM ACETATE; SODIUM CHLORIDE;<br />

SODIUM GLUCONATE<br />

See DEXTROSE; MAGNESIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM ACETATE; SODIUM<br />

CHLORIDE; SODIUM GLUCONATE<br />

POTASSIUM CHLORIDE; DEXTROSE; SODIUM CHLORIDE<br />

See DEXTROSE; POTASSIUM CHLORIDE; SODIUM CHLORIDE<br />

POTASSIUM CHLORIDE; MAGNESIUM CHLORIDE; SODIUM ACETATE; SODIUM CHLORIDE;<br />

SODIUM GLUCONATE<br />

See MAGNESIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM ACETATE; SODIUM CHLORIDE;<br />

SODIUM GLUCONATE<br />

POTASSIUM CHLORIDE; SODIUM CHLORIDE<br />

Potassium Chloride; injection 149mg/100ml (0.149%); Abbott<br />

Sodium Chloride 900mg/100ml (0.9%)<br />

injection 298mg/100ml (0.298%); Abbott<br />

900mg/100ml (0.9%)<br />

@ injection 75mg/100ml(0.075%); Baxter<br />

900mg/100ml(0.9%)<br />

injection 150mg/100ml(0.15%); Baxter<br />

900mg/100ml(0.9%)<br />

injection 300mg/100ml(0.3%); Baxter<br />

900mg/100ml(0.9%)<br />

@ injection 75mg/100ml(0.075%); Braun<br />

900mg/100ml(0.9%)<br />

injection 150mg/100ml(0.15%); Braun<br />

900mg/100ml(0.9%)<br />

injection 300mg/100ml(0.3%); Braun<br />

900mg/100ml(0.9%)<br />

POTASSIUM GLUCONATE<br />

Potassium Gluconate elixir, oral 4.68gm/15ml Alpharma *<br />

(20mEq/15ml,10%)<br />

elixir, oral 4.68gm/15ml Naska *<br />

(20mEq/15ml,10%)<br />

elixir, oral 4.68gm/15ml Morton Grove *<br />

(20mEq/15ml,10%)<br />

(continued on <strong>the</strong> next page)<br />

170


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

POTASSIUM GLUCONATE (continued)<br />

elixir, oral 4.68gm/15ml Newton *<br />

(20mEq/15ml,10%)<br />

elixir, oral 4.68gm/15ml Pharmaceutical Associates *<br />

(20mEq/15ml,10%)<br />

elixir, oral 4.68gm/15ml SteriMed *<br />

(20mEq/15ml,10%)<br />

Brand(s)<br />

Kaon 10% elixir, oral 4.68gm/15ml Pharmacia & Upjohn *<br />

(20mEq/15ml,10%)<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

PRALIDOXIME CHLORIDE<br />

Pralidoxime Chloride @ injection 1gm/vial Quad<br />

Brand(s)<br />

Protopam injection 1gm/vial Wyeth-Ayerst<br />

PRAMOXINE HYDROCHLORIDE; HYDROCORTISONE ACETATE<br />

See HYDROCORTISONE ACETATE; PRAMOXINE HYDROCHLORIDE<br />

PRAZOSIN HYDROCHLORIDE<br />

Prazosin Hydrochloride @ capsule, oral eq 1,2,5mg base American Therapeutics<br />

capsule, oral eq 1,2,5mg base Danbury<br />

capsule, oral eq 1,2,5mg base Geneva<br />

capsule, oral eq 1,2,5mg base IVAX<br />

capsule, oral eq 1,2,5mg base Lederle<br />

capsule, oral eq 1,2,5mg base Mylan<br />

@ capsule, oral eq 1,2,5mg base Purepac<br />

Brand(s) base<br />

Minipress capsule, oral eq 1,2,5mg base Pfizer<br />

PREDNISOLONE<br />

Prednisolone syrup, oral 15mg/5ml Copley<br />

syrup, oral 15mg/5ml<br />

Halsey<br />

syrup, oral 5mg/5ml<br />

KV<br />

syrup, oral 15mg/5ml<br />

UDL<br />

Brand(s)<br />

Pre-Pred syrup, oral 15mg/5ml WE<br />

Prelone syrup, oral 5mg/5ml, 15mg/5ml Muro<br />

PREDNISOLONE ACETATE<br />

Brand(s)<br />

Econopred Plus suspension, ophthalmic 1% Falcon *<br />

Pred Forte suspension, ophthalmic 1% Allergan *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

PREDNISOLONE ACETATE; SULFACETAMIDE SODIUM<br />

Brand(s)<br />

Metimyd ointment, ophthalmic 0.5%;10% Schering<br />

Predsulfair @ ointment, ophthalmic 0.5%;10% Pharmafair<br />

(continued on <strong>the</strong> next page)<br />

171


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

PREDNISOLONE ACETATE; SULFACETAMIDE SODIUM (continued)<br />

Vasocidin ointment, ophthalmic 0.5%;10% Novartis<br />

Blephamide suspension, ophthalmic 0.2%;10% Allergan<br />

Metimyd suspension, ophthalmic 0.5%;10% Schering<br />

Predamide @ suspension, ophthalmic 0.5%;10% Akorn<br />

Predsulfair @ suspension, ophthalmic 0.5%;10% Pharmafair<br />

Predsulfair II @ suspension, ophthalmic 0.2%;10% Pharmafair<br />

Sulphrin @ suspension, ophthalmic 0.5%;10% Bausch and Lomb<br />

PREDNISOLONE SODIUM PHOSPHATE<br />

Prednisolone Sodium @ injection eq 20mg phosphate/ml Steris<br />

Phosphate @ solution, ophthalmic 0.125,1% Alcon Universal<br />

(eq 0.11%, 0.9% phosphate)<br />

solution, ophthalmic 0.125,1% Bausch and Lomb<br />

(eq 0.11%, 0.9% phosphate)<br />

@ solution, ophthalmic 0.125,1% Sola Barnes-Hind<br />

(eq 0.11%, 0.9% phosphate)<br />

Brand(s)<br />

Hydeltrasol @ injection eq 20mg phosphate/ml Merck Sharp and Dohme<br />

AK-Pred @ solution, ophthalmic 0.125,1% Akorn<br />

(eq 0.11%, 0.9% phosphate)<br />

Inflamase Mild solution, ophthalmic 0.125% Novartis<br />

(eq 0.11% phosphate)<br />

Inflamase Forte solution, ophthalmic 1% Novartis<br />

(eq 0.9% phosphate)<br />

Predair @ solution, ophthalmic 0.125% Pharmafair<br />

(eq 0.11% phosphate)<br />

Predair Forte @ solution, ophthalmic 1% Pharmafair<br />

(eq 0.9% phosphate)<br />

PREDNISOLONE SODIUM PHOSPHATE; SULFACETAMIDE SODIUM<br />

Prednisolone Sodium Phosphate; solution, ophthalmic eq 0.23% Alcon Universal<br />

Sulfacetamide Sodium phosphate; 10%<br />

solution, ophthalmic eq 0.23% Bausch and Lomb<br />

phosphate; 10%<br />

Brand(s)<br />

Sulster @ solution, ophthalmic eq 0.23% Akorn<br />

phosphate; 10%<br />

Vasocidin solution, ophthalmic eq 0.23% Novartis<br />

phosphate; 10%<br />

PREDNISONE<br />

Prednisone @ solution, oral 5mg/5ml Morton Grove<br />

solution, oral 5mg/5ml<br />

Roxane<br />

@ tablet, oral 5,20,50mg<br />

Barr<br />

tablet, oral 10mg<br />

Barr<br />

tablet, oral 5,10,20mg<br />

Danbury<br />

@ tablet, oral 5,10,20mg<br />

Duramed<br />

@ tablet, oral 50mg<br />

Geneva<br />

tablet, oral 10,20,50mg<br />

Geneva<br />

@ tablet, oral 5,10mg<br />

Halsey<br />

@ tablet, oral 5,10,20,50mg<br />

Hea<strong>the</strong>r<br />

@ tablet, oral 5mg<br />

Impax<br />

@ tablet, oral 5,10,20mg<br />

Interpharm<br />

tablet, oral 5,10,20mg<br />

Mutual<br />

tablet, oral 5mg<br />

Private Formulations<br />

@ tablet, oral 20mg<br />

Private Formulations<br />

(continued on <strong>the</strong> next page)<br />

172


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

PREDNISONE (continued)<br />

@ tablet, oral 5,10,20mg<br />

Purepac<br />

tablet, oral 1,2.5,5,10,20,50mg Roxane<br />

@ tablet, oral 25mg<br />

Roxane<br />

@ tablet, oral 5,10,20mg<br />

Superpharm<br />

@ tablet, oral 50mg<br />

Watson<br />

tablet, oral 10,20,50mg<br />

Watson<br />

tablet, oral 5,10,20,50mg<br />

West-Ward<br />

@ tablet, oral 10mg<br />

Whiteworth Towne<br />

Brand(s)<br />

Deltasone tablet, oral 2.5,5,10,20,50mg Pharmacia & Upjohn<br />

Meticorten @ tablet, oral 1mg Schering<br />

Orasone tablet, oral 1,5,10,20mg Solvay<br />

Orasone @ tablet, oral 50mg Solvay<br />

Prednicen-N @ tablet, oral 5mg Schwarz<br />

PRIMIDONE<br />

Primidone @ tablet, oral 250mg Circa<br />

tablet, oral 250mg<br />

Danbury<br />

tablet, oral 50,250mg<br />

Lannett<br />

Brand(s)<br />

Mysoline tablet, oral 50,250mg Xcel<br />

PROBENECID<br />

Probenecid tablet, oral 500mg Danbury<br />

tablet, oral 500mg<br />

IVAX<br />

@ tablet, oral 500mg<br />

Lederle<br />

tablet, oral 500mg<br />

Mylan<br />

@ tablet, oral 500mg<br />

Watson<br />

Brand(s)<br />

Benemid @ tablet, oral 500mg Merck<br />

Probalan tablet, oral 500mg Lannett<br />

PROBENECID; AMPICILLIN<br />

See AMPICILLIN; PROBENECID<br />

PROCAINAMIDE HYDROCHLORIDE<br />

Procainamide Hydrochloride @ capsule, oral 250,375,500mg (Ascot)<br />

@ capsule, oral 250,500mg<br />

Circa<br />

capsule, oral 250,375,500mg Danbury<br />

capsule, oral 250,375,500mg Geneva<br />

capsule, oral 250,375,500mg IVAX<br />

capsule, oral 250,500mg<br />

Lannett<br />

@ capsule, oral 250,375,500mg Lederle<br />

@ capsule, oral 250,500mg<br />

Roxane<br />

@ capsule, oral 250,500mg<br />

(Vangard/MWM)<br />

@ capsule, oral 250,375,500mg Watson<br />

injection 100,500mg/ml<br />

Abbott<br />

@ injection 100,500mg/ml<br />

American Pharmaceutical<br />

Partners<br />

injection 100,500mg/ml<br />

Elkins-Sinn<br />

injection 100,500mg/ml<br />

International Medication<br />

@ injection 100,500mg/ml<br />

Pharmafair<br />

@ injection 100,500mg/ml<br />

Quad<br />

@ injection 100,500mg/ml<br />

Smith and Nephew<br />

@ injection 500mg/ml<br />

Solopak<br />

(continued on <strong>the</strong> next page)<br />

173


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

PROCAINAMIDE HYDROCHLORIDE (continued)<br />

@ injection 100,500mg/ml<br />

@ injection 100,500mg/ml<br />

@ tablet, extended release<br />

250,500,750,1000mg<br />

tablet, extended release<br />

500,750,1000mg<br />

tablet, extended release<br />

250,500,750mg<br />

@ tablet, extended release 500mg<br />

tablet, extended release<br />

250,500,750mg<br />

tablet, extended release 500mg<br />

Steris<br />

Warner Chilcott<br />

Circa<br />

Copley<br />

Danbury<br />

Forest/Inwood<br />

Geneva<br />

Invamed<br />

Brand(s)<br />

Procan @ capsule, oral 250,375,500mg Parke-Davis<br />

Procapan @ capsule, oral 250mg Panray/Ormont<br />

Pronestyl capsule, oral 250,375,500mg Apo<strong>the</strong>con<br />

Pronestyl injection 100,500mg/ml Apo<strong>the</strong>con<br />

Procan-SR @ tablet, controlled release 250mg Parke-Davis<br />

Procan-SR @ tablet, controlled release Parkdale<br />

500,750,1000mg<br />

Rhythmin @ tablet, controlled release 250mg Sidmak<br />

Rhythmin tablet, controlled release 500mg Sidmak<br />

PROCAINE HYDROCHLORIDE<br />

Procaine Hydrochloride injection 1,2% American Pharmaceutical<br />

Partners<br />

@ injection 1,2%<br />

Bel-Mar<br />

injection 1,2%<br />

Elkins-Sinn<br />

@ injection 1,2%<br />

Miles<br />

@ injection 1,2%<br />

Searle<br />

injection 1,2%<br />

Steris<br />

Brand(s)<br />

Novocain injection 1,2% Abbott<br />

PROCAINE HYDROCHLORIDE; TETRACYCLINE HYDROCHLORIDE<br />

Brand(s)<br />

Achromycin @ injection 40mg/vial;100mg/vial Lederle<br />

@ injection 40mg/vial;250mg/vial Lederle<br />

Tetracyn @ injection 40mg/vial;100mg/vial Pfizer<br />

injection 40mg/vial;250mg/vial Pfizer<br />

PROCHLORPERAZINE<br />

Prochlorperazine suppository, rectal 2.5,5,25mg Able<br />

suppository, rectal 25mg<br />

G&W<br />

Brand(s)<br />

Compazine suppository, rectal 2.5,5,25mg SmithKline Beecham<br />

Compro suppository, rectal 25mg Paddock<br />

PROCHLORPERAZINE EDISYLATE<br />

Prochlorperazine Edisylate @ concentrate, oral eq 10mg base/ml Alpharma<br />

@ concentrate, oral eq 10mg base/ml Morton Grove<br />

injection eq 5mg base/ml<br />

Abbott<br />

injection eq 5mg base/ml<br />

Elkins-Sinn<br />

injection eq 5mg base/ml<br />

Marsam<br />

@ injection eq 5mg base/ml<br />

Quad<br />

(continued on <strong>the</strong> next page)<br />

174


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

PROCHLORPERAZINE EDISYLATE (continued)<br />

@ injection eq 5mg base/ml<br />

Smith and Nephew<br />

injection eq 5mg base/ml<br />

Steris<br />

@ injection eq 5mg base/ml<br />

Wyeth-Ayerst<br />

@ syrup, oral eq 5mg base/5ml<br />

Alpharma<br />

@ syrup, oral eq 5mg base/5ml<br />

Morton Grove<br />

Brand(s)<br />

Compazine @ concentrate, oral eq 10mg base/ml SmithKline Beecham<br />

Compazine injection eq 5mg base/ml SmithKline Beecham<br />

Compazine syrup, oral eq 5mg base/5ml SmithKline Beecham<br />

PROCHLORPERAZINE MALEATE<br />

Prochlorperazine Maleate @ tablet, oral eq 5,10,25mg base Circa<br />

tablet, oral eq 5,10mg base<br />

Copley<br />

tablet, oral eq 5,10mg base<br />

Duramed<br />

tablet, oral eq 5,10,25mg base Geneva<br />

tablet, oral eq 5,10mg base<br />

IVAX<br />

tablet, oral eq 5,10mg base<br />

Mylan<br />

tablet, oral eq 5,10mg base<br />

Trigen<br />

Brand(s)<br />

Compazine tablet, oral eq 5,10,25mg base SmithKline Beecham<br />

PROGESTERONE<br />

Progesterone injection 50mg/ml American Pharmaceutical<br />

Partners<br />

@ injection 50mg/ml<br />

Lilly<br />

injection 50mg/ml<br />

Schein<br />

PROMAZINE HYDROCHLORIDE<br />

Promazine Hydrochloride @ injection 25,50mg/ml Steris<br />

Brand(s)<br />

Sparine @ injection 25mg/ml Wyeth-Ayerst<br />

Sparine injection 50mg/ml Wyeth-Ayerst<br />

PROMETHAZINE HYDROCHLORIDE<br />

Promethazine Hydrochloride injection 25,50mg/ml Abbott<br />

@ injection 25,50mg/ml<br />

Akorn<br />

injection 25,50mg/ml<br />

Elkins-Sinn<br />

injection 25,50mg/ml<br />

Marsam<br />

injection 25,50mg/ml<br />

Steris<br />

@ syrup, oral 6.25mg/5ml<br />

Cenci<br />

syrup, oral 6.25mg/5ml<br />

Hi-Tech<br />

@ syrup, oral 6.25mg/5ml,25mg/5ml KV<br />

syrup, oral 6.25mg/5ml<br />

Morton Grove<br />

@ syrup, oral 6.25mg/5ml<br />

Pharmaceutical Associates<br />

syrup, oral 6.25mg/5ml<br />

Whiteworth Towne<br />

Brand(s)<br />

Phenergan injection 25,50mg/ml Wyeth-Ayerst<br />

Zipan-25,50 @ injection 25,50mg/ml Altana<br />

Mymethazine Fortis @ syrup, oral 25mg/5ml USL<br />

Phenergan syrup, oral 6.25mg/5ml Wyeth-Ayerst<br />

Phenergan Fortis syrup, oral 25mg/5ml Wyeth-Ayerst<br />

Prometh syrup, oral 6.25mg/5ml Alpharma<br />

Prometh Fortis @ syrup, oral 25mg/5ml Alpharma<br />

Phenergan tablet, oral 12.5,25mg Wyeth-Ayerst *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

175


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

PROMETHAZINE HYDROCHLORIDE; CODEINE PHOSPHATE<br />

See CODEINE PHOSPHATE; PROMETHAZINE HYDROCHLORIDE<br />

PROMETHAZINE HYDROCHLORIDE; CODEINE PHOSPHATE; PHENYLEPHRINE HYDROCHLORIDE<br />

See CODEINE PHOSPHATE; PHENYLEPHRINE HYDROCHLORIDE; PROMETHAZINE<br />

HYDROCHLORIDE<br />

PROMETHAZINE HYDROCHLORIDE; DEXTROMETHORPHAN HYDROBROMIDE<br />

See DEXTROMETHORPHAN HYDROBROMIDE; PROMETHAZINE HYDROCHLORIDE<br />

PROMETHAZINE HYDROCHLORIDE; PHENYLEPHRINE HYDROCHLORIDE<br />

See PHENYLEPHRINE HYDROCHLORIDE; PROMETHAZINE HYDROCHLORIDE<br />

PROPAPHENONE HYDROCHLORIDE<br />

Propaphenone Hydrochloride tablet, oral 150,225,300mg Mutual<br />

tablet, oral 150,225mg<br />

Watson<br />

Brand(s)<br />

Rhythmol tablet, oral 150,225,300mg Abbott<br />

PROPARACAINE HYDROCHLORIDE<br />

Proparacaine Hydrochloride solution, ophthalmic 0.5% Bausch and Lomb<br />

@ solution, ophthalmic 0.5%<br />

Sola Barnes-Hind<br />

solution, ophthalmic 0.5%<br />

Taylor<br />

Brand(s)<br />

Alcaine solution, ophthalmic 0.5% Alcon<br />

Kainair @ solution, ophthalmic 0.5% Pharmafair<br />

Ophthaine solution, ophthalmic 0.5% Apo<strong>the</strong>con<br />

Oph<strong>the</strong>tic solution, ophthalmic 0.5% Allergan<br />

Paracaine solution, ophthalmic 0.5% Optopics<br />

PROPOFOL<br />

Propofol injection 10mg/ml Gensia Sicor<br />

Brand(s)<br />

Diprivan injection 10mg/ml Astra Zeneca<br />

Note: Gensia Sicor’s propofol injection utilizes sodium metabisulfite as a preservative while Astra Zeneca’s<br />

Diprivan brand of propofol injection utilizes disodium edetate as a preservative. Patients’ allergy status<br />

should be reviewed prior to <strong>the</strong> interchange of any propofol injection products.<br />

PROPOXYPHENE HYDROCHLORIDE<br />

Propoxyphene Hydrochloride @ capsule, oral 65mg Anabolic<br />

@ capsule, oral 65mg<br />

Barr<br />

@ capsule, oral 65mg<br />

Danbury<br />

@ capsule, oral 32,65mg<br />

Eon<br />

@ capsule, oral 65mg<br />

Geneva<br />

capsule, oral 65mg<br />

ICN<br />

@ capsule, oral 32mg<br />

IVAX<br />

capsule, oral 65mg<br />

IVAX<br />

@ capsule, oral 65mg<br />

Impax<br />

capsule, oral 32mg<br />

Mylan<br />

@ capsule, oral 65mg<br />

Mylan<br />

@ capsule, oral 32,65mg<br />

Private Formulations<br />

capsule, oral 65mg<br />

Purepac<br />

(continued on <strong>the</strong> next page)<br />

176


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

PROPOXYPHENE HYDROCHLORIDE (continued)<br />

@ capsule, oral 32,65mg<br />

Roxane<br />

capsule, oral 65mg<br />

Teva<br />

@ capsule, oral 65mg<br />

Warner Chilcott<br />

@ capsule, oral 65mg<br />

Watson<br />

capsule, oral 65mg<br />

West-Ward<br />

capsule, oral 65mg<br />

Whiteworth Towne<br />

Brand(s)<br />

Darvon capsule, oral 32mg Lilly<br />

Darvon capsule, oral 65mg Lilly *<br />

Dolene capsule, oral 65mg Lederle<br />

Kesso-Gesic capsule, oral 65mg MK<br />

Prophene @ capsule, oral 65mg Halsey<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

PROPOXYPHENE HYDROCHLORIDE; ACETAMINOPHEN<br />

See ACETAMINOPHEN; PROPOXYPHENE HYDROCHLORIDE<br />

PROPOXYPHENE HYDROCHLORIDE; ASPIRIN; CAFFEINE<br />

See ASPIRIN; CAFFEINE; PROPOXYPHENE HYDROCHLORIDE<br />

PROPOXYPHENE HYDROCHLORIDE COMPOUND<br />

PROPOXYPHENE HYDROCHLORIDE; ASPIRIN; CAFFEINE<br />

See ASPIRIN; CAFFEINE; PROPOXYPHENE HYDROCHLORIDE<br />

PROPOXYPHENE NAPSYLATE; ACETAMINOPHEN<br />

See ACETAMINOPHEN; PROPOXYPHENE NAPSYLATE<br />

PROPRANOLOL HYDROCHLORIDE<br />

Propranolol Hydrochloride @ capsule, extended release Inwood<br />

60,80,120,160mg<br />

injection 1mg/ml<br />

Bed<strong>for</strong>d<br />

@ injection 1mg/ml<br />

Smith and Nephew<br />

@ injection 1mg/ml<br />

Solopak<br />

@ solution, oral 20mg/5ml<br />

Morton Grove<br />

@ solution, oral 40mg/5ml<br />

Morton Grove<br />

solution, oral 20mg/5ml<br />

Roxane<br />

solution, oral 40mg/5ml<br />

Roxane<br />

@ tablet, oral 10,20,40,60,80mg Barr<br />

@ tablet, oral 10,20,40,60,80mg Circa<br />

tablet, oral 10,20,40,80mg<br />

Danbury<br />

@ tablet, oral 60,90mg<br />

Danbury<br />

@ tablet, oral 10,20,40,60,80,90mg Duramed<br />

tablet, oral 10,20,40,60,80mg Geneva<br />

@ tablet, oral 10,20,40,80mg<br />

Interpharm<br />

tablet, oral 10,20,40,60,80,90mg Invamed<br />

@ tablet, oral 10,20,40,60,80mg IVAX<br />

@ tablet, oral 10,20mg<br />

Lederle<br />

tablet, oral 40,60,80,90mg<br />

Lederle<br />

tablet, oral 10,20,40,80mg<br />

Mylan<br />

@ tablet, oral 60mg<br />

Mylan<br />

tablet, oral 10,20,40,60,80,90mg Par<br />

tablet, oral 10,20,40,60,80mg Purepac<br />

(continued on <strong>the</strong> next page)<br />

177


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

PROPRANOLOL HYDROCHLORIDE (continued)<br />

@ tablet, oral 10,20,40,60,80,90mg Roxane<br />

@ tablet, oral 10,20,40,60,80mg Schering<br />

tablet, oral 10,20,40,60,80,90mg Sidmak<br />

@ tablet, oral 10,20,40,80mg<br />

Superpharm<br />

@ tablet, oral 10,20mg<br />

Teva<br />

tablet, oral 40mg<br />

Teva<br />

@ tablet, oral 10,20,40,60,80mg Warner Chilcott<br />

@ tablet, oral 20mg<br />

Watson<br />

tablet, oral 10,40,60,80,90mg Watson<br />

Brand(s)<br />

Inderal LA capsule, extended release Wyeth-Ayerst<br />

60,80,120,160mg<br />

Inderal injection 1mg/ml Wyeth-Ayerst<br />

Inderal tablet, oral 10,20,40,60,80mg Wyeth-Ayerst<br />

Inderal @ tablet, oral 90mg Wyeth-Ayerst<br />

PROPRANOLOL HYDROCHLORIDE; HYDROCHLOROTHIAZIDE<br />

See HYDROCHLOROTHIAZIDE; PROPRANOLOL HYDROCHLORIDE<br />

PROTAMINE SULFATE<br />

Protamine Sulfate injection 10mg/ml American Pharmaceutical<br />

Partners<br />

injection 10mg/ml<br />

Elkins-Sinn<br />

injection 10mg/ml<br />

Lilly<br />

@ injection 10mg/ml,50mg/vial<br />

Quad<br />

@ injection 50mg/vial<br />

Upjohn<br />

PROTIRELIN<br />

Brand(s)<br />

Thyrel TRH injection 0.5mg/ml Ferring<br />

Thypinone @ injection 0.5mg/ml Abbott<br />

PROTRIPTYLINE HYDROCHLORIDE<br />

Protriptyline Hydrochloride @ tablet, oral 5,10mg Sidmak<br />

Brand(s)<br />

Vivactil tablet, oral 5,10mg Odyssey<br />

PSEUDOEPHEDRINE HYDROCHLORIDE; BROMPHENIRAMINE MALEATE;<br />

DEXTROMETHORPHAN HYDROBROMIDE<br />

See BROMPHENIRAMINE MALEATE; DEXTROMETHORPHAN HYDROBROMIDE;<br />

PSEUDOEPHEDRINE HYDROCHLORIDE<br />

PSEUDOEPHEDRINE HYDROCHLORIDE; CARBINOXAMINE MALEATE<br />

See CARBINOXAMINE MALEATE; PSEUDOEPHEDRINE HYDROCHLORIDE<br />

PSEUDOEPHEDRINE HYDROCHLORIDE; CARBINOXAMINE MALEATE; DEXTROMETHORPHAN<br />

HYDROBROMIDE<br />

See CARBINOXAMINE MALEATE; DEXTROMETHORPHAN HYDROBROMIDE;<br />

PSEUDOEPHEDRINE HYDROCHLORIDE<br />

178


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

PSEUDOEPHEDRINE HYDROCHLORIDE; CHLORPHENIRAMINE MALEATE; CODEINE PHOSPHATE<br />

See CHLORPHENIRAMINE MALEATE; CODEINE PHOSPHATE; PSEUDOEPHEDRINE<br />

HYDROCHLORIDE<br />

PSEUDOEPHEDRINE HYDROCHLORIDE; CODEINE PHOSPHATE; GUAIFENESIN<br />

See CODEINE PHOSPHATE; GUAIFENESIN; PSEUDOEPHEDRINE HYDROCHLORIDE<br />

PSEUDOEPHEDRINE HYDROCHLORIDE; CODEINE PHOSPHATE; TRIPROLIDINE HYDROCHLORIDE<br />

See CODEINE PHOSPHATE; PSEUDOEPHEDRINE HYDROCHLORIDE;<br />

TRIPROLIDINE HYDROCHLORIDE<br />

PSEUDOEPHEDRINE HYDROCHLORIDE; GUAIFENESIN; HYDROCODONE BITARTRATE<br />

See GUAIFENESIN; HYDROCODONE BITARTRATE; PSEUDOEPHEDRINE HYDROCHLORIDE<br />

PSEUDOEPHEDRINE HYDROCHLORIDE; HYDROCODONE BITARTRATE<br />

See HYDROCODONE BITARTRATE; PSEUDOEPHEDRINE HYDROCHLORIDE<br />

PSEUDOEPHEDRINE HYDROCHLORIDE; TRIPROLIDINE HYDROCHLORIDE<br />

Pseudoephedrine @ tablet, oral 60mg;2.5mg Circa<br />

Hydrochloride; tablet, oral 60mg;2.5mg Eon<br />

Triprolidine Hydrochloride @ tablet, oral 60mg;2.5mg IVAX<br />

tablet, oral 60mg;2.5mg<br />

Superpharm<br />

@ tablet, oral 60mg;2.5mg<br />

West-ward<br />

Brand(s)<br />

Actahist @ syrup, oral 30mg/5ml;1.25mg/5ml Cenci<br />

Histafed @ syrup, oral 30mg/5ml;1.25mg/5ml Cenci<br />

Myfed @ syrup, oral 30mg/5ml;1.25mg/5ml USL<br />

Trilitron @ syrup, oral 30mg/5ml;1.25mg/5ml Newtron<br />

Allerfed @ tablet, oral 60mg;2.5mg Private Formulations<br />

Corphed tablet, oral 60mg;2.5mg Geneva<br />

Trilitron tablet, oral 60mg;2.5mg Newtron<br />

Triphed @ tablet, oral 60mg;2.5mg Teva<br />

PYRAZINAMIDE<br />

Pyrazinamide tablet, oral 500mg Lederle<br />

tablet, oral 500mg<br />

Mikart<br />

PYRIDOSTIGMINE BROMIDE<br />

Brand(s)<br />

Mestinon injection 5mg/ml ICN<br />

Regonol injection 5mg/ml Organon/Akzona<br />

PYRIDOXINE HYDROCHLORIDE<br />

Pyridoxine Hydrochloride @ injection 100mg/ml Akorn<br />

injection 100mg/ml<br />

American Pharmaceutical<br />

Partners<br />

@ injection 100mg/ml<br />

Bel-Mar<br />

@ injection 100mg/ml<br />

Dell<br />

@ injection 100mg/ml<br />

Elkins-Sinn<br />

@ injection 100mg/ml<br />

Luitpold<br />

injection 100mg/ml<br />

Steris<br />

Brand(s)<br />

Hexa-Betalin @ injection 100mg/ml Lilly<br />

179


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

PYRILAMINE MALEATE<br />

Pyrilamine Maleate tablet, oral 25mg Impax<br />

@ tablet, oral 25mg<br />

Watson<br />

PYRILAMINE TANNATE; CHLORPHENIRAMINE TANNATE; PHENYLEPHRINE TANNATE<br />

See CHLORPHENIRAMINE TANNATE; PHENYLEPHRINE TANNATE; PYRILAMINE TANNATE<br />

PYRIDOXINE HYDROCHLORIDE; ASCORBIC ACID; BIOTIN; CYANOCOBALAMIN; DEXPANTHENOL;<br />

ERGOCALCIFEROL; FOLIC ACID; NIACINAMIDE; RIBOFLAVIN PHOSPHATE SODIUM; THIAMINE<br />

HYDROCHLORIDE; VITAMIN A; VITAMIN E<br />

See ASCORBIC ACID; BIOTIN; CYANOCOBALAMIN; DEXPANTHENOL; ERGOCALCIFEROL;<br />

FOLIC ACID; NIACINAMIDE; PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN PHOSPHATE<br />

SODIUM; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN E<br />

PYRIDOXINE HYDROCHLORIDE; ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; IRON; NICOTINIC<br />

ACID; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D; VITAMIN E<br />

See ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; IRON; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D;<br />

VITAMIN E<br />

PYRIDOXINE HYDROCHLORIDE; ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; NICOTINIC ACID;<br />

RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D; VITAMIN E<br />

See ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D;<br />

VITAMIN E<br />

QUINIDINE SULFATE<br />

Quinidine Sulfate @ capsule, oral 200mg Lilly<br />

@ tablet, oral 200mg<br />

Barr<br />

@ tablet, oral 100mg<br />

Danbury<br />

tablet, oral 200,300mg<br />

Danbury<br />

@ tablet, oral 200mg<br />

Elkins-Sinn<br />

tablet, oral 200,300mg<br />

Eon<br />

@ tablet, oral 200mg<br />

Everylife<br />

tablet, oral 200,300mg<br />

Geneva<br />

@ tablet, oral 200mg<br />

Halsey<br />

@ tablet, oral 200mg<br />

ICN<br />

@ tablet, oral 200mg<br />

Impax<br />

@ tablet, oral 200mg<br />

IVAX<br />

tablet, oral 200mg<br />

King<br />

@ tablet, oral 200mg<br />

KV<br />

tablet, oral 200mg<br />

Lannett<br />

tablet, oral 200mg<br />

Lederle<br />

@ tablet, oral 200mg<br />

Lilly<br />

tablet, oral 100,200mg<br />

Mutual<br />

@ tablet, oral 300mg<br />

Mutual<br />

@ tablet, oral 200mg<br />

Perrigo<br />

@ tablet, oral 200mg<br />

Pharmavite<br />

tablet, oral 200mg<br />

Private Formulations<br />

tablet, oral 200mg<br />

Purepac<br />

tablet, oral 200,300mg<br />

Roxane<br />

@ tablet, oral 200mg<br />

Scherer<br />

tablet, oral 200mg<br />

Superpharm<br />

@ tablet, oral 200mg<br />

USL<br />

@ tablet, oral 200mg<br />

(Vangard/MWM)<br />

(continued on <strong>the</strong> next page)<br />

180


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

QUINIDINE SULFATE (continued)<br />

@ tablet, oral 200mg<br />

Vintage<br />

@ tablet, oral 200mg<br />

Warner Chilcott<br />

tablet, oral 200mg<br />

Watson<br />

@ tablet, oral 200mg<br />

West-Ward<br />

@ tablet, oral 200mg<br />

Whiteworth Towne<br />

tablet, extended release 300mg Copley<br />

Brand(s)<br />

Cin-Quin @ capsule, oral 200mg Solvay<br />

Cin-Quin @ tablet, oral 100,200,300mg Solvay<br />

Quinora @ tablet, oral 200,300mg Schering<br />

Quinidex tablet, extended release 300mg Robins *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

RANITIDINE HYDROCHLORIDE<br />

Ranitidine Hydrochloride capsule, oral eq 150,300mg base Geneva<br />

capsule, oral eq 150,300mg base GenPharm<br />

capsule, oral eq 150,300mg base Reddy-Cheminor<br />

capsule, oral eq 150,300mg base Teva<br />

tablet, oral eq 150,300mg base Boehringer Ingelheim<br />

tablet, oral eq 150,300mg base Geneva<br />

tablet, oral eq 150,300mg base GenPharm<br />

tablet, oral eq 150,300mg base IVAX<br />

tablet, oral eq 150,300mg base Mylan<br />

tablet, oral eq 150,300mg base Par<br />

tablet, oral eq 150,300mg base Ranbaxy<br />

tablet, oral eq 150,300mg base Teva<br />

tablet, oral eq 150,300mg base TorPharm<br />

tablet, oral eq 150,300mg base Watson<br />

tablet, oral eq 150,300mg base Wockhardt<br />

Brand(s)<br />

Zantac @ capsule, oral eq 150mg base Glaxo Wellcome<br />

Zantac capsule, oral eq 300mg base Glaxo Wellcome<br />

Zantac tablet, oral eq 150,300mg base Glaxo Wellcome<br />

RESERPINE<br />

Brand(s)<br />

Sandril @ injection 2.5mg/ml Lilly<br />

Serpasil @ injection 2.5mg/ml Novartis<br />

RIBOFLAVIN PHOSPHATE SODIUM; ASCORBIC ACID; BIOTIN; CYANOCOBALAMIN; DEXPANTHENOL;<br />

ERGOCALCIFEROL; FOLIC ACID; NIACINAMIDE; PYRIDOXINE HYDROCHLORIDE; THIAMINE<br />

HYDROCHLORIDE; VITAMIN A; VITAMIN E<br />

See ASCORBIC ACID; BIOTIN; CYANOCOBALAMIN; DEXPANTHENOL; ERGOCALCIFEROL;<br />

FOLIC ACID; NIACINAMIDE; PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN PHOSPHATE<br />

SODIUM; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN E<br />

RIBOFLAVIN; ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; IRON; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D; VITAMIN E<br />

See ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; IRON; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D;<br />

VITAMIN E<br />

181


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

RIBOFLAVIN; ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D; VITAMIN E<br />

See ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D;<br />

VITAMIN E<br />

RIFAMPIN<br />

Rifampin capsule, oral 150,300mg Eon<br />

injection 600mg/vial<br />

Bed<strong>for</strong>d<br />

Brand(s)<br />

Rifadin capsule, oral 150,300mg Aventis<br />

Rimactane capsule, oral 300mg Geneva<br />

Rifadin injection 600mg/vial Aventis<br />

RIMANTIDINE HYDROCHLORIDE<br />

Rimantidine Hydrochloride tablet, oral 100mg CorePharma<br />

Brand(s)<br />

Flumadine tablet, oral 100mg Forest *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

RITODRINE HYDROCHLORIDE<br />

Ritodrine Hydrochloride injection 10,15mg/ml Abbott<br />

@ injection 10,15mg/ml<br />

American Pharmaceutical<br />

Partners<br />

@ injection 10,15mg/ml<br />

Quad<br />

Brand(s)<br />

Yutopar @ injection 10,15mg/ml Astra Zeneca<br />

SCOPALAMINE HYDROBROMIDE; ATROPINE SULFATE; HYOSCYAMINE; PHENOBARBITAL<br />

See ATROPINE SULFATE; HYOSCYAMINE; PHENOBARBITAL; SCOPALAMINE HYDROBROMIDE<br />

SECOBARBITAL SODIUM<br />

Secobarbital Sodium @ capsule, oral 100mg Anabolic<br />

@ capsule, oral 100mg<br />

Barr<br />

@ capsule, oral 100mg<br />

Eon<br />

capsule, oral 100mg<br />

Everylife<br />

@ capsule, oral 100mg<br />

Halsey<br />

@ capsule, oral 100mg<br />

ICN<br />

@ capsule, oral 100mg<br />

IVAX<br />

@ capsule, oral 100mg<br />

KV<br />

@ capsule, oral 50,100mg<br />

Lannett<br />

@ capsule, oral 100mg<br />

Parke-Davis<br />

@ capsule, oral 100mg<br />

Perrigo<br />

@ capsule, oral 100mg<br />

Purepac<br />

@ capsule, oral 100mg<br />

Watson<br />

capsule, oral 100mg<br />

West-Ward<br />

@ capsule, oral 100mg<br />

Whiteworth Towne<br />

@ capsule, oral 100mg<br />

Wyeth-Ayerst<br />

injection 50mg/ml<br />

Wyeth-Ayerst<br />

Brand(s)<br />

Seconal capsule, oral 50,100mg Lilly<br />

Seconal @ injection 50mg/ml Lilly<br />

182


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

SELEGILINE HYDROCHLORIDE<br />

Selegiline Hydrochloride capsule, oral 5mg ESI/Lederle<br />

capsule, oral 5mg<br />

Norton<br />

capsule, oral 5mg<br />

TorPharm<br />

tablet, oral 5mg<br />

Alphapharm<br />

tablet, oral 5mg<br />

Apotex<br />

tablet, oral 5mg<br />

Apo<strong>the</strong>con<br />

tablet, oral 5mg<br />

Endo<br />

tablet, oral 5mg<br />

ESI/Lederle<br />

tablet, oral 5mg<br />

IVAX<br />

tablet, oral 5mg<br />

Stason<br />

tablet, oral 5mg<br />

Teva<br />

Brand(s)<br />

Eldepryl capsule, oral 5mg Somerset<br />

Eldepryl tablet, oral 5mg Somerset<br />

SELENIUM SULFIDE<br />

Selenium Sulfide lotion/shampoo, topical 2.5% Alpharma<br />

lotion/shampoo, topical 2.5% Clay-Park<br />

@ lotion/shampoo, topical 2.5% IVAX<br />

lotion/shampoo, topical 2.5% Morton Grove<br />

@ lotion/shampoo, topical 2.5% Thames<br />

Brand(s)<br />

Exsel lotion/shampoo, topical 2.5% Allergan Herbert<br />

Selsun lotion/shampoo, topical 2.5% Abbott<br />

SILVER SULFADIAZINE<br />

Brand(s)<br />

Silvadene cream, topical 1% Aventis<br />

SSD cream, topical 1% Abbott<br />

Thermazine cream, topical 1% Kendall<br />

SODIUM ACETATE; DEXTROSE; MAGNESIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM CHLORIDE;<br />

SODIUM GLUCONATE<br />

See DEXTROSE; MAGNESIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM ACETATE;<br />

SODIUM CHLORIDE; SODIUM GLUCONATE<br />

SODIUM ACETATE; MAGNESIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM CHLORIDE;<br />

SODIUM GLUCONATE<br />

See MAGNESIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM ACETATE;<br />

SODIUM CHLORIDE; SODIUM GLUCONATE<br />

SODIUM AMINOSALICYLATE<br />

Sodium Aminosalicylate @ powder, oral 100% Hexcel<br />

Brand(s)<br />

P.A.S. Sodium @ powder, oral 4gm/packet Century<br />

Parasal Sodium @ tablet, oral 500mg Panray<br />

Sodium P.A.S. tablet, oral 500mg Lannett<br />

Teebacin @ tablet, oral 500mg Consolidated Midland<br />

SODIUM BICARBONATE; CALCIUM CHLORIDE; DEXTROSE; GLUTATHIONE DISULFIDE; MAGNESIUM<br />

CHLORIDE; POTASSIUM CHLORIDE; SODIUM CHLORIDE; SODIUM PHOSPHATE<br />

See CALCIUM CHLORIDE; DEXTROSE; GLUTATHIONE DISULFIDE; MAGNESIUM CHLORIDE;<br />

POTASSIUM CHLORIDE; SODIUM BICARBONATE; SODIUM CHLORIDE; SODIUM<br />

PHOSPHATE<br />

183


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

SODIUM CARBONATE; CITRIC ACID; MAGNESIUM OXIDE<br />

See CITRIC ACID; MAGNESIUM OXIDE; SODIUM CARBONATE<br />

SODIUM CHLORIDE<br />

Injection; in plastic container<br />

Solution <strong>for</strong> irrigation; in plastic container<br />

Sodium Chloride bacteriostatic injection 9mg/ml Abbott<br />

bacteriostatic injection 9mg/ml American Pharmaceutical<br />

Partners<br />

injection 9mg/ml (0.9%),<br />

Abbott<br />

450mg/100ml (0.45%),<br />

900mg/100ml (0.9%)<br />

injection 9mg/ml (0.9%)<br />

American Pharmaceutical<br />

Partners<br />

injection 9mg/ml (0.9%),<br />

Baxter<br />

450mg/100ml (0.45%),<br />

900mg/100ml (0.9%),<br />

3gm/100ml (3%)<br />

injection 450mg/100ml (0.45%), Braun<br />

900mg/100ml (0.9%),<br />

3gm/100ml (3%)<br />

@ injection 450mg/100ml (0.45%), Miles<br />

@ 900mg/100ml (0.9%)<br />

solution 450mg/100ml (0.45%), Abbott<br />

900mg/100ml (0.9%)<br />

solution 450mg/100ml (0.45%), Baxter<br />

900mg/100ml (0.9%)<br />

solution 900mg/100ml (0.9%) Braun<br />

@ solution 900mg/100ml (0.9%) Miles<br />

SODIUM CHLORIDE; CALCIUM CHLORIDE; DEXTROSE; GLUTATHIONE DISULFIDE; MAGNESIUM<br />

CHLORIDE; POTASSIUM CHLORIDE; SODIUM BICARBONATE; SODIUM PHOSPHATE<br />

See CALCIUM CHLORIDE; DEXTROSE; GLUTATHIONE DISULFIDE; MAGNESIUM CHLORIDE;<br />

POTASSIUM CHLORIDE; SODIUM BICARBONATE; SODIUM CHLORIDE; SODIUM<br />

PHOSPHATE<br />

SODIUM CHLORIDE; CALCIUM CHLORIDE; DEXTROSE; MAGNESIUM CHLORIDE; SODIUM LACTATE<br />

See CALCIUM CHLORIDE; DEXTROSE; MAGNESIUM CHLORIDE; SODIUM CHLORIDE; SODIUM<br />

LACTATE<br />

SODIUM CHLORIDE; CALCIUM CHLORIDE; DEXTROSE; POTASSIUM CHLORIDE<br />

See CALCIUM CHLORIDE; DEXTROSE; POTASSIUM CHLORIDE; SODIUM CHLORIDE<br />

SODIUM CHLORIDE; CALCIUM CHLORIDE; DEXTROSE; POTASSIUM CHLORIDE; SODIUM LACTATE<br />

See CALCIUM CHLORIDE; DEXTROSE; POTASSIUM CHLORIDE; SODIUM CHLORIDE; SODIUM<br />

LACTATE<br />

SODIUM CHLORIDE; CALCIUM CHLORIDE; MAGNESIUM CHLORIDE; POTASSIUM CHLORIDE<br />

See CALCIUM CHLORIDE; MAGNESIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM CHLORIDE<br />

SODIUM CHLORIDE; CALCIUM CHLORIDE; POTASSIUM CHLORIDE<br />

See CALCIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM CHLORIDE<br />

184


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

SODIUM CHLORIDE; CALCIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM LACTATE<br />

See CALCIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM CHLORIDE; SODIUM LACTATE<br />

SODIUM CHLORIDE; CIMETIDINE HYDROCHLORIDE<br />

See CIMETIDINE HYDROCHLORIDE; SODIUM CHLORIDE<br />

SODIUM CHLORIDE; DEXTROSE<br />

See DEXTROSE; SODIUM CHLORIDE<br />

SODIUM CHLORIDE; DEXTROSE; MAGNESIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM ACETATE;<br />

SODIUM GLUCONATE<br />

See DEXTROSE; MAGNESIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM ACETATE; SODIUM<br />

CHLORIDE; SODIUM GLUCONATE<br />

SODIUM CHLORIDE; DEXTROSE; POTASSIUM CHLORIDE<br />

See DEXTROSE; POTASSIUM CHLORIDE; SODIUM CHLORIDE<br />

SODIUM CHLORIDE; GENTAMICIN SULFATE<br />

See GENTAMICIN SULFATE; SODIUM CHLORIDE<br />

SODIUM CHLORIDE; HEPARIN SODIUM<br />

See HEPARIN SODIUM; SODIUM CHLORIDE<br />

SODIUM CHLORIDE; MAGNESIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM ACETATE;<br />

SODIUM GLUCONATE<br />

See MAGNESIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM ACETATE; SODIUM CHLORIDE;<br />

SODIUM GLUCONATE<br />

SODIUM CHLORIDE; POTASSIUM CHLORIDE<br />

See POTASSIUM CHLORIDE; SODIUM CHLORIDE<br />

SODIUM GLUCONATE; DEXTROSE; MAGNESIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM<br />

CHLORIDE; SODIUM ACETATE<br />

See DEXTROSE; MAGNESIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM ACETATE; SODIUM<br />

CHLORIDE; SODIUM GLUCONATE<br />

SODIUM GLUCONATE; MAGNESIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM ACETATE;<br />

SODIUM CHLORIDE<br />

See MAGNESIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM ACETATE; SODIUM CHLORIDE;<br />

SODIUM GLUCONATE<br />

SODIUM LACTATE<br />

Injection; in plastic container<br />

Sodium Lactate injection 1.87gm/100ml (0.167 molar) Abbott<br />

injection 1.87gm/100ml (0.167 molar) Baxter<br />

injection 1.87gm/100ml (0.167 molar) Braun<br />

185


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

SODIUM LACTATE; CALCIUM CHLORIDE; DEXTROSE; MAGNESIUM CHLORIDE; SODIUM CHLORIDE<br />

See CALCIUM CHLORIDE; DEXTROSE; MAGNESIUM CHLORIDE; SODIUM CHLORIDE; SODIUM<br />

LACTATE<br />

SODIUM LACTATE; CALCIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM CHLORIDE<br />

See CALCIUM CHLORIDE; POTASSIUM CHLORIDE; SODIUM CHLORIDE; SODIUM LACTATE<br />

SODIUM NITROPRUSSIDE<br />

Sodium Nitroprusside @ injection 50mg/vial American Pharmaceutical<br />

Partners<br />

injection 50mg/vial<br />

Elkins-Sinn<br />

injection 25mg/ml<br />

Gensia Sicor<br />

Brand(s)<br />

Nipride @ injection 50mg/vial Roche<br />

Nitropress injection 25mg/ml Abbott<br />

Nitropress injection 50mg/vial Abbott<br />

SODIUM POLYSTYRENE SULFONATE<br />

Sodium Polystyrene Sulfonate powder, oral-rectal Carolina Medical<br />

454gm/bottle<br />

@ powder, oral-rectal<br />

Morton Grove<br />

453.6gm bottle<br />

powder, oral-rectal<br />

Paddock<br />

454gm/bottle<br />

suspension, oral-rectal<br />

Carolina Medical<br />

15gm/60ml<br />

@ suspension, oral-rectal<br />

Morton Grove<br />

15gm/60ml<br />

suspension, oral-rectal<br />

Roxane<br />

15gm/60ml<br />

Brand(s)<br />

Kayexalate powder, oral-rectal Sanofi Syn<strong>the</strong>labo<br />

453.6gm bottle<br />

SODIUM PHOSPHATE; CALCIUM CHLORIDE; DEXTROSE; GLUTATHIONE DISULFIDE; MAGNESIUM<br />

CHLORIDE; POTASSIUM CHLORIDE; SODIUM BICARBONATE; SODIUM CHLORIDE<br />

See CALCIUM CHLORIDE; DEXTROSE; GLUTATHIONE DISULFIDE; MAGNESIUM CHLORIDE;<br />

POTASSIUM CHLORIDE; SODIUM BICARBONATE; SODIUM CHLORIDE; SODIUM<br />

PHOSPHATE<br />

SOLTALOL HYDROCHLORIDE<br />

Soltalol Hydrochloride tablet, oral 80,120,160,240mg Eon<br />

tablet, oral 80,120,160,240mg GenPharm<br />

tablet, oral 80,120,160,240mg Impax<br />

tablet, oral 80,120,160,240mg Mutual<br />

tablet, oral 80,120,160,240mg Mylan<br />

tablet, oral 80,120,160,240mg Teva<br />

tablet, oral 80,120,160,240mg Watson<br />

Brand(s)<br />

Betapace tablet, oral 80,120,160,240mg Berlex<br />

Sorine tablet, oral 80,120,160,240mg Upsher-Smith<br />

NOTE: The above products are NOT interchangeable with prescriptions written <strong>for</strong> Betapace AF tablets<br />

from Berlex Laboratories.<br />

186


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

SOYBEAN OIL<br />

Brand(s)<br />

Intralipid 10% injection 10% Fresenius Kabi<br />

Intralipid 20% injection 20% Fresenius Kabi<br />

Intralipid 30% injection 30% Fresenius Kabi<br />

Liposyn III 10% injection 10% Abbott<br />

Liposyn III 20% injection 20% Abbott<br />

Liposyn III 30% injection 30% Abbott<br />

Nutrilipid 10% injection 10% Braun<br />

Nutrilipid 20% injection 20% Braun<br />

Soyacal 10% injection 10% Alpha Therapeutic<br />

Soyacal 20% injection 20% Alpha Therapeutic<br />

Travamulsion 10% @ injection 10% Baxter<br />

Travamulsion 20% @ injection 20% Baxter<br />

SPIRONOLACTONE<br />

Spironolactone @ tablet, oral 25mg (Ascot)<br />

tablet, oral 25mg<br />

Barr<br />

@ tablet, oral 25mg<br />

Circa<br />

tablet, oral 25mg<br />

Geneva<br />

@ tablet, oral 25mg<br />

IVAX<br />

@ tablet, oral 25mg<br />

Lederle<br />

tablet, oral 25,50,100mg<br />

Mutual<br />

tablet, oral 25,50,100mg<br />

Mylan<br />

@ tablet, oral 25mg<br />

Purepac<br />

tablet, oral 50,100mg<br />

Purepac<br />

tablet, oral 25mg<br />

Superpharm<br />

@ tablet, oral 25mg<br />

Upsher-Smith<br />

@ tablet, oral 25mg<br />

(Vangard/MWM)<br />

@ tablet, oral 25mg<br />

Warner Chilcott<br />

@ tablet, oral 25mg<br />

Watson<br />

Brand(s)<br />

Aldactone tablet, oral 25,50,100mg Searle *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

SPIRONOLACTONE; HYDROCHLOROTHIAZIDE<br />

See HYDROCHLOROTHIAZIDE; SPIRONOLACTONE<br />

STREPTOMYCIN SULFATE<br />

Streptomycin Sulfate @ injection eq 1,5gm base/vial Lilly<br />

@ injection eq 1,5gm base/vial<br />

Pfizer<br />

injection eq 1gm base/vial<br />

Pharma-Tex<br />

SUCCINYLCHOLINE CHLORIDE<br />

Succinylcholine Chloride injection 20mg/ml Organon<br />

Brand(s)<br />

Anectine injection 20mg/ml Glaxo Wellcome<br />

Quelicin injection 20mg/ml Abbott<br />

Quelicin Preservative Free injection 20mg/ml Abbott<br />

Sucostrin injection 20mg/ml Apo<strong>the</strong>con<br />

187


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

SUCRALFATE<br />

Sucralfate tablet, oral 1gm Ratiopharm/Martec<br />

tablet, oral 1gm<br />

Teva<br />

Brand(s)<br />

Carafate tablet, oral 1gm Blue Ridge/Aventis<br />

SUFENTANIL CITRATE<br />

Sufentanil Citrate injection eq 0.05mg base/ml Abbott<br />

injection eq 0.05mg base/ml<br />

Elkins-Sinn<br />

@ injection eq 0.05mg base/ml<br />

Steris<br />

Brand(s)<br />

Sufenta injection eq 0.05mg base/ml Akorn<br />

SULFABENZAMIDE; SULFACETAMIDE; SULFATHIAZOLE<br />

Sulfabenzamide; @ tablet, vaginal 184mg; 143.75mg; Fougera/Altana<br />

Sulfacetamide; Sulfathiazole 172.5mg<br />

(Triple Sulfa) @ tablet, vaginal 184mg; 143.75mg; Pharmaderm/Altana<br />

172.5mg<br />

Brand(s)<br />

Gyne-Sulf cream, vaginal 3.7%; 2.86%; 3.42% G & W<br />

Sultrin cream, vaginal 3.7%; 2.86%; 3.42% RW Johnson<br />

Triple Sulfa cream, vaginal 3.7%; 2.86%; 3.42% Alpharma<br />

Triple Sulfa cream, vaginal 3.7%; 2.86%; 3.42% Clay-Park<br />

Triple Sulfa @ cream, vaginal 3.7%; 2.86%; 3.42% Fougera/Altana<br />

Trysul cream, vaginal 3.7%; 2.86%; 3.42% Savage/Altana<br />

Vagilia @ cream, vaginal 3.7%; 2.86%; 3.42% Teva<br />

Sultrin tablet, vaginal 184mg; 143.75mg; RW Johnson<br />

172.5mg<br />

SULFACETAMIDE SODIUM<br />

Sulfacetamide Sodium ointment, ophthalmic 10% Altana<br />

solution, ophthalmic 10%<br />

Alcon Universal<br />

solution, ophthalmic 10%<br />

Bausch and Lomb<br />

@ solution, ophthalmic 10,30%<br />

Sola Barnes-Hind<br />

solution, ophthalmic 30%<br />

Steris<br />

Brand(s)<br />

Bleph-10 @ ointment, ophthalmic 10% Allergan<br />

Cetamide ointment, ophthalmic 10% Alcon<br />

Sodium Sulamyd @ ointment, ophthalmic 10% Schering<br />

Sulfair-10 @ ointment, ophthalmic 10% Pharmafair<br />

AK-Sulf solution, ophthalmic 10,30% Akorn<br />

AK-Sulf @ solution, ophthalmic 15% Akorn<br />

Bleph-10 solution, ophthalmic 10% Allergan<br />

Bleph-30 solution, ophthalmic 10% Allergan<br />

Isopto Cetamide solution, ophthalmic 15% Alcon<br />

Ocusulf-10 solution, ophthalmic 10% Miza<br />

Ocusulf-30 @ solution, ophthalmic 30% Miza<br />

Sodium Sulamyd @ solution, ophthalmic 10,30% Schering<br />

Sulf-10 @ solution, ophthalmic 10% Novartis<br />

Sulf-15 solution, ophthalmic 15% Novartis<br />

Sulfacel-15 solution, ophthalmic 15% Optopics<br />

Sulfair-10 @ solution, ophthalmic 10% Pharmafair<br />

Sulfair-15 @ solution, ophthalmic 15% Pharmafair<br />

Sulfair Forte @ solution, ophthalmic 30% Pharmafair<br />

Sulten-10 @ solution, ophthalmic 10% Bausch and Lomb<br />

188


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

SULFACETAMIDE SODIUM: PREDNISOLONE ACETATE<br />

See PREDNISOLONE ACETATE; SULFACETAMIDE SODIUM<br />

SULFACETAMIDE SODIUM; PREDNISOLONE SODIUM PHOSPHATE<br />

See PREDNISOLONE SODIUM PHOSPHATE; SULFACETAMIDE<br />

SULFADIAZINE<br />

Sulfadiazine tablet, oral 500mg Eon<br />

@ tablet, oral 500mg<br />

Everylife<br />

@ tablet, oral 500mg<br />

Impax<br />

@ tablet, oral 500mg<br />

Lannett<br />

@ tablet, oral 500mg<br />

Lederle<br />

@ tablet, oral 500mg<br />

Lilly<br />

SULFADIAZINE; SULFAMETHAZINE; SULFAMERAZINE<br />

See TRISULFAPYRIMIDINE<br />

SULFAMETHIZOLE<br />

Brand(s)<br />

Proklar @ tablet, oral 500mg Forest<br />

Thiosulfil tablet, oral 500mg Wyeth-Ayerst<br />

SULFAMETHOXAZOLE<br />

Sulfamethoxazole @ tablet, oral 500mg (Ascot)<br />

@ tablet, oral 500mg<br />

Barr<br />

@ tablet, oral 500mg,1gm<br />

Circa<br />

@ tablet, oral 500mg<br />

Geneva<br />

@ tablet, oral 500mg<br />

Hea<strong>the</strong>r<br />

Brand(s)<br />

Gantanol tablet, oral 500mg Roche<br />

Gantanol DS @ tablet, oral 1gm Roche<br />

Urobak @ tablet, oral 500mg Shionogi<br />

SULFAMETHOXAZOLE; TRIMETHOPRIM<br />

Sulfamethoxazole; Trimethoprim injection 80mg/ml;16mg/ml Abbott<br />

@ injection 80mg/ml;16mg/ml<br />

American Pharmaceutical<br />

Partners<br />

@ injection 80mg/ml;16mg/ml<br />

Bed<strong>for</strong>d<br />

injection 80mg/ml;16mg/ml<br />

Elkins-Sinn<br />

injection 80mg/ml;16mg/ml<br />

Gensia Sicor<br />

@ injection 80mg/ml;16mg/ml<br />

Quad<br />

@ injection 80mg/ml;16mg/ml<br />

Steris<br />

suspension, oral 200mg/5ml;40mg/5ml Hi-Tech<br />

@ suspension, oral 200mg/5ml;40mg/5ml Naska<br />

@ tablet, oral 400mg;80mg<br />

Barr<br />

@ tablet, oral 800mg;160mg<br />

Barr<br />

tablet, oral 400mg;80mg<br />

Danbury<br />

tablet, oral 800mg;160mg<br />

Danbury<br />

@ tablet, oral 400mg;80mg<br />

Eon<br />

tablet, oral 800mg;160mg<br />

Eon<br />

tablet, oral 400mg;80mg<br />

Geneva<br />

tablet, oral 800mg;160mg<br />

Geneva<br />

@ tablet, oral 400mg;80mg<br />

Hea<strong>the</strong>r<br />

@ tablet, oral 800mg;160mg<br />

Hea<strong>the</strong>r<br />

(continued on <strong>the</strong> next page)<br />

189


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

SULFAMETHOXAZOLE; TRIMETHOPRIM (continued)<br />

@ tablet, oral 400mg;80mg<br />

Interpharm<br />

@ tablet, oral 800mg;160mg<br />

Interpharm<br />

@ tablet, oral 400mg;80mg<br />

Martec<br />

@ tablet, oral 800mg;160mg<br />

Martec<br />

tablet, oral 400mg;80mg<br />

Mutual<br />

tablet, oral 800mg;160mg<br />

Mutual<br />

tablet, oral 400mg;80mg<br />

Plantex<br />

@ tablet, oral 400mg;80mg<br />

Roxane<br />

tablet, oral 800mg;160mg<br />

Roxane<br />

tablet, oral 400mg;80mg<br />

Sidmak<br />

tablet, oral 800mg;160mg<br />

Sidmak<br />

tablet, oral 800mg;160mg<br />

Teva<br />

@ tablet, oral 400mg;80mg<br />

USL<br />

@ tablet, oral 800mg;160mg<br />

USL<br />

@ tablet, oral 400mg;80mg<br />

Watson<br />

@ tablet, oral 800mg;160mg<br />

Watson<br />

Brand(s)<br />

Bactrim injection 80mg/ml;16mg/ml Women First Healthcare<br />

Septra injection 80mg/ml;16mg/ml Glaxo Wellcome<br />

Sulfamethoprim @ injection 80mg/ml;16mg/ml Quad<br />

Bactrim<br />

suspension, oral 200mg/5ml;40mg/5ml Women First Healthcare<br />

Bactrim Pediatric<br />

suspension, oral 200mg/5ml;40mg/5ml Women First Healthcare<br />

Cotrim Pediatric<br />

suspension, oral 200mg/5ml;40mg/5ml Teva<br />

Septra<br />

suspension, oral 200mg/5ml;40mg/5ml Glaxo Wellcome<br />

Septra Grape<br />

suspension, oral 200mg/5ml;40mg/5ml Glaxo Wellcome<br />

SMZ-TMP<br />

suspension, oral 200mg/5ml;40mg/5ml Teva<br />

SMZ-TMP Pediatric<br />

suspension, oral 200mg/5ml;40mg/5ml Teva<br />

Sulfatrim<br />

suspension, oral 200mg/5ml;40mg/5ml Alpharma<br />

Sulfatrim Pediatric<br />

suspension, oral 200mg/5ml;40mg/5ml Alpharma<br />

Sulmeprim<br />

@ suspension, oral 200mg/5ml;40mg/5ml USL<br />

Sulmeprim Pediatric<br />

@ suspension, oral 200mg/5ml;40mg/5ml USL<br />

Bactrim tablet, oral 400mg;80mg Women First Healthcare<br />

Bactrim DS tablet, oral 800mg;160mg Women First Healthcare<br />

Cotrim tablet, oral 400mg;80mg Teva<br />

Cotrim D.S. tablet, oral 800mg;160mg Teva<br />

Septra tablet, oral 400mg;80mg Glaxo Wellcome<br />

Septra DS tablet, oral 800mg;160mg Glaxo Wellcome<br />

SMZ-TMP tablet, oral 400mg;80mg Teva<br />

SMZ-TMP tablet, oral 800mg;160mg Teva<br />

Sulfamethoprim tablet, oral 400mg;80mg Par<br />

Sulfamethoprim-DS tablet, oral 800mg;160mg Par<br />

Sulfatrim SS @ tablet, oral 400mg;80mg Superpharm<br />

Sulfatrim DS @ tablet, oral 800mg;160mg Superpharm<br />

Uroplus SS @ tablet, oral 400mg;80mg Shionogi<br />

Uroplus DS @ tablet, oral 800mg;160mg Shionogi<br />

SULFANILAMIDE<br />

Brand(s)<br />

AVC cream, vaginal 15% Novavax<br />

Vagitrol cream, vaginal 15% Teva<br />

SULFASALAZINE<br />

Sulfasalazine @ tablet, oral 500mg Circa<br />

tablet, oral 500mg<br />

Danbury<br />

@ tablet, oral 500mg<br />

Eon<br />

@ tablet, oral 500mg<br />

Lederle<br />

tablet, oral 500mg<br />

Mutual<br />

(continued on <strong>the</strong> next page)<br />

190


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

SULFASALAZINE (continued)<br />

@ tablet, oral 500mg<br />

Superpharm<br />

tablet, oral 500mg<br />

Watson<br />

Brand(s)<br />

Azulfidine tablet, oral 500mg Pharmacia & Upjohn<br />

S.A.S.-500 @ tablet, oral 500mg Solvay<br />

SULFATHIAZOLE; SULFACETAMIDE; SULFABENZAMIDE; UREA<br />

See SULFACETAMIDE; SULFABENZAMIDE; SULFATHIAZOLE; UREA<br />

SULFINPYRAZONE<br />

Sulfinpyrazone capsule, oral 200mg Barr<br />

@ capsule, oral 200mg<br />

IVAX<br />

capsule, oral 200mg<br />

Par<br />

@ capsule, oral 200mg<br />

(Vangard/MWM)<br />

tablet, oral 100mg<br />

Barr<br />

@ tablet, oral 100mg<br />

Danbury<br />

@ tablet, oral 100mg<br />

IVAX<br />

tablet, oral 100mg<br />

Par<br />

Brand(s)<br />

Anturane capsule, oral 200mg Novartis<br />

Anturane tablet, oral 100mg Novartis<br />

SULFISOXAZOLE<br />

Sulfisoxazole @ tablet, oral 500mg Barr<br />

@ tablet, oral 500mg<br />

Eon<br />

@ tablet, oral 500mg<br />

Geneva<br />

@ tablet, oral 500mg<br />

Hea<strong>the</strong>r<br />

tablet, oral 500mg<br />

ICN<br />

@ tablet, oral 500mg<br />

Impax<br />

@ tablet, oral 500mg<br />

IVAX<br />

@ tablet, oral 500mg<br />

Lannett<br />

@ tablet, oral 500mg<br />

Lederle<br />

@ tablet, oral 500mg<br />

Pharmeral<br />

@ tablet, oral 500mg<br />

Purepac<br />

tablet, oral 500mg<br />

Roxane<br />

@ tablet, oral 500mg<br />

Watson<br />

@ tablet, oral 500mg<br />

West-Ward<br />

Brand(s)<br />

Gantrisin @ tablet, oral 500mg Roche<br />

Sosol tablet, oral 500mg MK<br />

Sulfalar @ tablet, oral 500mg Parke-Davis<br />

Sulsoxin @ tablet, oral 500mg Solvay<br />

SULFISOXAZOLE ACETYL; ERYTHROMYCIN ETHYLSUCCINATE<br />

See ERYTHROMYCIN ETHYLSUCCINATE; SULFISOXAZOLE<br />

SULINDAC<br />

Sulindac tablet, oral 150,200mg Danbury<br />

tablet, oral 150,200mg<br />

Geneva<br />

tablet, oral 150,200mg<br />

Lederle<br />

tablet, oral 150,200mg<br />

Mutual<br />

tablet, oral 150,200mg<br />

Mylan<br />

tablet, oral 150,200mg<br />

Teva<br />

tablet, oral 150,200mg<br />

Warner Chilcott<br />

(continued on <strong>the</strong> next page)<br />

191


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

SULINDAC (continued)<br />

Brand(s)<br />

Clinoril tablet, oral 150,200mg Merck Sharp and Dohme *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

TAMOXIFEN CITRATE<br />

Tamoxifen Citrate @ tablet, oral eq 10mg base Mylan<br />

@ tablet, oral eq 10mg base<br />

Pharmachemie<br />

Brand(s)<br />

Nolvadex tablet, oral eq 10mg base Zeneca *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

TEMAZEPAM<br />

Temazepam @ capsule, oral 15,30mg Barr<br />

@ capsule, oral 15,30mg<br />

Circa<br />

capsule, oral 15,30mg<br />

Danbury<br />

@ capsule, oral 15,30mg<br />

Duramed<br />

capsule, oral 15,30mg<br />

Geneva<br />

capsule, oral 15,30mg<br />

Mylan<br />

capsule, oral 15,30mg<br />

Par<br />

capsule, oral 15,30mg<br />

Purepac<br />

@ capsule, oral 15,30mg<br />

USL<br />

Brand(s)<br />

Temaz @ capsule, oral 15,30mg Quantum<br />

Restoril capsule, oral 7.5,15,30mg Tyco *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

TERAZOSIN HYDROCHLORIDE<br />

Terazosin Hydrochloride capsule, oral eq 1,2,5,10mg base Geneva<br />

capsule, oral eq 1,2.5,10mg base Invamed<br />

capsule, oral eq 1,2,5,10mg base IVAX<br />

capsule, oral eq 1,2,5,10mg base Mylan<br />

capsule, oral eq 1,2,5,10mg base TorPharm<br />

tablet, oral eq 1,2,5,10mg base Geneva<br />

tablet, oral eq 1,2,5,10mg base Invamed<br />

tablet, oral eq 1,2,5,10mg base IVAX<br />

tablet, oral eq 1,2,5,10mg base Teva<br />

Brand(s)<br />

Hytrin @ tablet, oral eq 1,2,5,10mg base Abbott *<br />

Hytrin capsule, oral eq 1,2,5,10mg base Abbott *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

TERBUTALINE SULFATE<br />

Terbutaline Sulfate tablet, oral 2.5,5mg Impax<br />

Brand(s)<br />

Brethine injection 1mg/ml Novartis<br />

Bricanyl @ injection 1mg/ml Aventis<br />

Brethine tablet, oral 2.5,5mg Novartis<br />

192


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

TESTOSTERONE CYPIONATE<br />

Testosterone Cypionate @ injection 100,200mg/ml Quad<br />

injection 100,200mg/ml<br />

Steris<br />

Brand(s)<br />

Depo-Testosterone injection 100,200mg/ml Pharmacia & Upjohn<br />

TESTOSTERONE CYPIONATE; ESTRADIOL CYPIONATE<br />

See ESTRADIOL CYPIONATE; TESTOSTERONE CYPIONATE<br />

TESTOSTERONE ENANTHATE<br />

Testosterone Enanthate @ injection 100,200mg/ml Quad<br />

@ injection 100mg/ml<br />

Steris<br />

injection 200mg/ml<br />

Steris<br />

Brand(s)<br />

Delatestryl injection 200mg/ml BTG<br />

TESTOSTERONE ENANTHATE; ESTRADIOL VALERATE<br />

See ESTRADIOL VALERATE; TESTOSTERONE ENANTHATE<br />

TESTOSTERONE PROPIONATE<br />

Testosterone Propionate @ injection 25,50,100mg/ml Bel-Mar<br />

@ injection 25mg/ml<br />

Elkins-Sinn<br />

@ injection 50mg/ml<br />

Lilly<br />

@ injection 100mg/ml<br />

Quad<br />

injection 25,50,100mg/ml<br />

Steris<br />

TETRACAINE HYDROCHLORIDE<br />

Tetracaine Hydrochloride solution, ophthalmic 0.5% Optopics *<br />

Brand(s)<br />

Pontocaine solution, ophthalmic 0.5% Sterling Winthrop *<br />

* This entity was reviewed by <strong>the</strong> Technical Advisory Council and admitted to <strong>the</strong> <strong>Illinois</strong> <strong>Formulary</strong> as an<br />

exception to <strong>the</strong> promulgated criteria <strong>for</strong> inclusion, pursuant to Rule 790.60.<br />

TETRACYCLINE HYDROCHLORIDE<br />

Tetracycline Hydrochloride @ capsule, oral 250,500mg Abbott<br />

capsule, oral 250,500mg<br />

Atral<br />

capsule, oral 250,500mg<br />

Barr<br />

@ capsule, oral 250,500mg<br />

Danbury<br />

@ capsule, oral 250mg<br />

Elkins-Sinn<br />

capsule, oral 250mg<br />

Eon<br />

@ capsule, oral 250mg<br />

Ferrante<br />

capsule, oral 250,500mg<br />

Halsey<br />

@ capsule, oral 250,500mg<br />

Hea<strong>the</strong>r<br />

@ capsule, oral 250,500mg<br />

ICN<br />

capsule, oral 250,500mg<br />

Impax<br />

capsule, oral 250,500mg<br />

IVAX<br />

capsule, oral 250mg<br />

Mast<br />

capsule, oral 250,500mg<br />

Mylan<br />

@ capsule, oral 250,500mg<br />

Private Formulations<br />

@ capsule, oral 250,500mg<br />

Purepac<br />

capsule, oral 500mg<br />

Roxane<br />

@ capsule, oral 250,500mg<br />

Superpharm<br />

@ capsule, oral 250,500mg<br />

Warner Chilcott<br />

(continued on <strong>the</strong> next page)<br />

193


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

TETRACYCLINE HYDROCHLORIDE (continued)<br />

@ capsule, oral 250,500mg<br />

Watson<br />

@ capsule, oral 250,500mg<br />

West-ward<br />

@ capsule, oral 250,500mg<br />

Wyeth-Ayerst<br />

@ suspension, oral 125mg/5ml<br />

Ferrante<br />

@ suspension, oral 125mg/5ml<br />

Proter<br />

@ suspension, oral 125mg/5ml<br />

Purepac<br />

Brand(s)<br />

Achromycin V capsule, oral 250,500mg Lederle<br />

Bristacycline capsule, oral 250,500mg Bristol<br />

Cyclopar @ capsule, oral 250,500mg Warner Chilcott<br />

Panmycin @ capsule, oral 250mg Pharmacia & Upjohn<br />

Retet @ capsule, oral 250,500mg Solvay<br />

Robitet @ capsule, oral 250,500mg Wyeth-Ayerst<br />

Sumycin capsule, oral 250,500mg Apo<strong>the</strong>con<br />

Tetrachel @ capsule, oral 250,500mg Angus<br />

Tetracyn @ capsule, oral 250,500mg Pfipharmecs/Pfizer<br />

Achromycin injection 250,500mg/vial Lederle<br />

Tetracyn @ injection 250,500mg/vial Pfizer<br />

Achromycin V suspension, oral 125mg/5ml Lederle<br />

Biocycline @ suspension, oral 125mg/5ml Alpharma<br />

Sumycin suspension, oral 125mg/5ml Apo<strong>the</strong>con<br />

Tetracyn @ suspension, oral 125mg/5ml Pfipharmecs/Pfizer<br />

Tetramed @ suspension, oral 125mg/5ml IVAX<br />

Panmycin @ tablet, oral 500mg Upjohn<br />

Sumycin tablet, oral 500mg Apo<strong>the</strong>con<br />

TETRACYCLINE HYDROCHLORIDE; PROCAINE HYDROCHLORIDE<br />

See PROCAINE HYDROCHLORIDE; TETRACYCLINE HYDROCHLORIDE<br />

THEOPHYLLINE<br />

Theophylline capsule, extended release Inwood/Forest<br />

100,125,200,300mg<br />

elixir, oral 80mg/15ml<br />

Alpharma<br />

@ elixir, oral 80mg/15ml<br />

Halsey<br />

elixir, oral 80mg/15ml<br />

Morton Grove<br />

@ elixir, oral 80mg/15ml<br />

Perrigo<br />

elixir, oral 80mg/15ml<br />

Pharmaceutical Associates<br />

@ elixir, oral 80mg/15ml<br />

Roxane<br />

elixir, oral 80mg/15ml<br />

Thames<br />

solution, oral 80mg/15ml<br />

Roxane<br />

@ syrup, oral 80mg/15ml<br />

Alpharma<br />

@ syrup, oral 150mg/15ml<br />

Alpharma<br />

tablet, extended release<br />

Sidmak<br />

100,200,300,450mg<br />

Brand(s)<br />

Slo-BID capsule, extended release Aventis *<br />

100,125,200,300mg<br />

Elixomin @ elixir, oral 80mg/15ml Cenci<br />

Elixophyllin elixir, oral 80mg/15ml Forest<br />

Lanophyllin @ elixir, oral 80mg/15ml Lannett<br />

Theolixir @ elixir, oral 80mg/15ml Panray/Ormont<br />

Theolair solution, oral 80mg/15ml Riker/3M<br />

Accurbron @ syrup, oral 150mg/15ml Aventis<br />

Aquaphyllin @ syrup, oral 80mg/15ml Ferndale<br />

Slo-Phyllin-80 syrup, oral 80mg/15ml Aventis<br />

Theoclear-80 syrup, oral 80mg/15ml Central<br />

(continued on <strong>the</strong> next page)<br />

194


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

THEOPHYLLINE (continued)<br />

Theocron tablet, extended release Forest/Inwood<br />

100,200,300,450mg<br />

Theo-Dur tablet, extended release Schering *<br />

100,200,300,450mg<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

THEOPHYLLINE; DEXTROSE<br />

See DEXTROSE; THEOPHYLLINE<br />

THEOPHYLLINE; EPHEDRINE; HYDROXYZINE HYDROCHLORIDE<br />

See EPHEDRINE; HYDROXYZINE HYDROCHLORIDE; THEOPHYLLINE<br />

THEOPHYLLINE; GUAIFENESIN<br />

See GUAIFENESIN; THEOPHYLLINE<br />

THIAMINE HYDROCHLORIDE<br />

Thiamine Hydrochloride injection 100mg/ml Abbott<br />

@ injection 100mg/ml<br />

Akorn<br />

injection 100mg/ml<br />

American Pharmaceutical<br />

Partners<br />

@ injection 100,200mg/ml<br />

Bel-Mar<br />

@ injection 100mg/ml<br />

Dell<br />

injection 100mg/ml<br />

Elkins-Sinn<br />

@ injection 100mg/ml<br />

Luitpold<br />

@ injection 100mg/ml<br />

Parke-Davis<br />

injection 100,200mg/ml<br />

Steris<br />

injection 100mg/ml<br />

Wyeth-Ayerst<br />

Brand(s)<br />

Betalin S @ injection 100mg/ml Lilly<br />

THIAMINE HYDROCHLORIDE; ASCORBIC ACID; BIOTIN; CYANOCOBALAMIN; DEXPANTHENOL;<br />

ERGOCALCIFEROL; FOLIC ACID; NIACINAMIDE; PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN<br />

PHOSPHATE SODIUM; VITAMIN A; VITAMIN E<br />

See ASCORBIC ACID; BIOTIN; CYANOCOBALAMIN; DEXPANTHENOL; ERGOCALCIFEROL;<br />

FOLIC ACID; NIACINAMIDE; PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN PHOSPHATE<br />

SODIUM; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN E<br />

THIAMINE HYDROCHLORIDE; ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; IRON; NICOTINIC<br />

ACID; PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN; VITAMIN A; VITAMIN D; VITAMIN E<br />

See ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; IRON; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D;<br />

VITAMIN E<br />

THIAMINE HYDROCHLORIDE; ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; NICOTINIC ACID;<br />

PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN; VITAMIN A; VITAMIN D; VITAMIN E<br />

See ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D;<br />

VITAMIN E<br />

195


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

THIORIDAZINE HYDROCHLORIDE<br />

Thioridazine Hydrochloride @ concentrate, oral 30mg/ml Alpharma<br />

concentrate, oral 100mg/ml<br />

Alpharma<br />

concentrate, oral 30,100mg/ml Copley<br />

@ concentrate, oral 30,100mg/ml Geneva<br />

concentrate, oral 30,100mg/ml Hi-Tech<br />

@ concentrate, oral 30,100mg/ml Morton Grove<br />

concentrate, oral 30,100mg/ml Pharmaceutical Associates<br />

@ tablet, oral 10,15,25,100,150,200mg Barr<br />

tablet, oral 50mg<br />

Barr<br />

@ tablet, oral 10,15,25,50,100,<br />

Circa<br />

150,200mg<br />

tablet, oral 10,15,25,50,100,<br />

Danbury<br />

150,200mg<br />

tablet, oral 10,15,25,50,100,<br />

Geneva<br />

150,200mg<br />

tablet, oral 10,15,25mg<br />

IVAX<br />

@ tablet, oral 50,100mg<br />

IVAX<br />

tablet, oral 10,25,50,100mg<br />

Mutual<br />

tablet, oral 10,25,50,100mg<br />

Mylan<br />

@ tablet, oral 10,15,25,50,100,<br />

Par<br />

150,200mg<br />

@ tablet, oral 10,25,50,100mg<br />

Roxane<br />

@ tablet, oral 10,25,50mg<br />

Superpharm<br />

@ tablet, oral 10mg<br />

Teva<br />

tablet, oral 100mg<br />

Teva<br />

tablet, oral 25,50,100mg<br />

Watson<br />

@ tablet, oral 10,15mg<br />

Watson<br />

@ tablet, oral 10,15,25,50mg<br />

West-Ward<br />

Brand(s)<br />

Intensol concentrate, oral 30,100mg/ml Roxane<br />

Mellaril concentrate, oral 30,100mg/ml Novartis<br />

Mellaril tablet, oral 10,15,25,50,100, Novartis *<br />

150,200mg<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

THIOTEPA<br />

Thiotepa injection 15mg/vial Bed<strong>for</strong>d<br />

injection 15mg/vial<br />

Immunex<br />

Brand(s)<br />

Thioplex injection 15mg/vial Immunex<br />

THIOTHIXENE<br />

Thiothixene @ capsule, oral 1,2,5,10,20mg American Therapeutics<br />

capsule, oral 1,2,5,10mg<br />

Danbury<br />

capsule, oral 1,2,5,10mg<br />

Geneva<br />

capsule, oral 1,2,5,10mg<br />

Mylan<br />

@ capsule, oral 2,5,10mg<br />

Watson<br />

Brand(s)<br />

Navane capsule, oral 1,2,5,10,20mg Roerig/Pfizer<br />

196


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

THIOTHIXENE HYDROCHLORIDE<br />

Thiothixene Hydrochloride @ concentrate, oral eq 5mg base/ml Alpharma<br />

concentrate, oral eq 5mg base/ml Copley<br />

@ concentrate, oral eq 5mg base/ml Paco<br />

@ concentrate, oral eq 5mg base/ml Teva<br />

Brand(s)<br />

Intensol concentrate, oral eq 5mg base/ml Roxane<br />

Navane concentrate, oral eq 5mg base/ml Roerig/Pfizer<br />

TICLOPIDINE HYDROCHLORIDE<br />

Ticlopidine Hydrochloride tablet, oral 250mg Danbury<br />

tablet, oral 250mg<br />

Eon<br />

tablet, oral 250mg<br />

Geneva<br />

tablet, oral 250mg<br />

GenPharm<br />

tablet, oral 250mg<br />

Mylan<br />

tablet, oral 250mg<br />

Purepac<br />

tablet, oral 250mg<br />

Teva<br />

tablet, oral 250mg<br />

TorPharm<br />

Brand(s)<br />

Ticlid tablet, oral 250mg Roche<br />

TIMOLOL MALEATE<br />

Timolol Maleate solution, ophthalmic Akorn<br />

eq 0.25,0.5% base<br />

solution, ophthalmic<br />

Bausch and Lomb<br />

eq 0.25,0.5% base<br />

solution, ophthalmic Falcon *<br />

eq 0.25,0.5% base<br />

solution, ophthalmic<br />

Fougera/Altana<br />

eq 0.25,0.5% base<br />

solution, ophthalmic<br />

Novex<br />

eq 0.25,0.5% base<br />

solution, ophthalmic<br />

Pacific<br />

eq 0.25,0.5% base<br />

solution, gel <strong>for</strong>ming drops, ophthalmic Falcon *<br />

eq 0.25,0.5% base<br />

@ tablet, oral 5,10,20mg<br />

Circa<br />

tablet, oral 5,10,20mg<br />

Danbury<br />

tablet, oral 5,10,20mg<br />

Geneva<br />

tablet, oral 5,10,20mg<br />

Mylan<br />

@ tablet, oral 5,10,20mg<br />

Quantum<br />

@ tablet, oral 5,10,20mg<br />

Teva<br />

@ tablet, oral 5,10,20mg<br />

USL<br />

Brand(s)<br />

Timoptic solution, ophthalmic Merck<br />

eq 0.25,0.5% base<br />

Timoptic-XE<br />

solution, gel <strong>for</strong>ming drops, ophthalmic Merck<br />

eq 0.25,0.5% base<br />

Blocadren tablet, oral 5,10,20mg Merck *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

TOBRAMYCIN<br />

Tobramycin @ solution, ophthalmic 0.3% Alcon Universal<br />

solution, ophthalmic 0.3%<br />

Bausch and Lomb<br />

solution, ophthalmic 0.3%<br />

Steris<br />

(continued on <strong>the</strong> next page)<br />

197


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

TOBRAMYCIN (continued)<br />

Brand(s)<br />

AKtob solution, ophthalmic 0.3% Akorn<br />

Tobrex solution, ophthalmic 0.3% Falcon *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

TOBRAMYCIN; DEXAMETHASONE<br />

See DEXAMETHASONE; TOBRAMYCIN<br />

TOBRAMYCIN SULFATE<br />

Tobramycin Sulfate injection eq 10,40mg base/ml Abbott<br />

injection eq 10,40mg base/ml Apo<strong>the</strong>con<br />

@ injection eq 10mg base/ml<br />

Astra Zeneca<br />

injection eq 40mg base/ml<br />

Astra Zeneca<br />

@ injection eq 10,40mg base/ml Elkins-Sinn<br />

injection eq 40mg base/ml<br />

Gensia Sicor<br />

@ injection eq 10mg base/ml<br />

Lederle<br />

injection eq 40mg base/ml<br />

Lederle<br />

injection eq 10,40mg base/ml Marsam<br />

Brand(s)<br />

Nebcin injection eq 10,40mg base/ml Dista/Lilly<br />

TOLAZAMIDE<br />

Tolazamide @ tablet, oral 100,250,500mg Barr<br />

@ tablet, oral 100,250,500mg<br />

Circa<br />

tablet, oral 100,250,500mg<br />

Danbury<br />

@ tablet, oral 100,250,500mg<br />

Duramed<br />

tablet, oral 100,250,500mg<br />

Geneva<br />

@ tablet, oral 250,500mg<br />

Interpharm<br />

tablet, oral 100,250,500mg<br />

IVAX<br />

tablet, oral 100,250,500mg<br />

Mutual<br />

tablet, oral 250,500mg<br />

Mylan<br />

tablet, oral 100,250,500mg<br />

Par<br />

@ tablet, oral 250,500mg<br />

Superpharm<br />

@ tablet, oral 250,500mg<br />

USL<br />

Brand(s)<br />

Tolinase tablet, oral 100,250,500mg Pharmacia & Upjohn<br />

TOLBUTAMIDE<br />

Tolbutamide @ tablet, oral 500mg (Ascot)<br />

@ tablet, oral 500mg<br />

Barr<br />

@ tablet, oral 250,500mg<br />

Circa<br />

tablet, oral 500mg<br />

Danbury<br />

@ tablet, oral 500mg<br />

Eon<br />

tablet, oral 500mg<br />

Geneva<br />

tablet, oral 500mg<br />

IVAX<br />

tablet, oral 500mg<br />

Lederle<br />

tablet, oral 500mg<br />

Mylan<br />

@ tablet, oral 500mg<br />

Parke-Davis<br />

@ tablet, oral 500mg<br />

Purepac<br />

@ tablet, oral 500mg<br />

Superpharm<br />

@ tablet, oral 500mg<br />

(Vangard/MWM)<br />

tablet, oral 500mg<br />

Watson<br />

Brand(s)<br />

Orinase @ tablet, oral 250,500mg Pharmacia & Upjohn<br />

198


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

TOLMETIN SODIUM<br />

Tolmetin Sodium @ capsule, oral eq 400mg base Geneva<br />

capsule, oral eq 400mg base IVAX<br />

capsule, oral eq 400mg base Mutual<br />

capsule, oral eq 400mg base Mylan<br />

capsule, oral eq 400mg base Purepac<br />

capsule, oral eq 400mg base Teva<br />

tablet, oral eq 200,600mg base Geneva<br />

tablet, oral eq 600mg base<br />

IVAX<br />

tablet, oral eq 200mg base<br />

Mutual<br />

tablet, oral eq 600mg base<br />

Mylan<br />

tablet, oral eq 600mg base<br />

Purepac<br />

@ tablet, oral eq 600mg base<br />

Teva<br />

Brand(s)<br />

Tolectin D.S. capsule, oral eq 400mg base RW Johnson *<br />

Tolectin tablet, oral eq 200mg base RW Johnson *<br />

Tolectin 600 tablet, oral eq 600mg base RW Johnson *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

TRAZODONE HYDROCHLORIDE<br />

Trazodone Hydrochloride @ tablet, oral 50,100mg American Therapeutics<br />

tablet, oral 50,100,150,300mg Barr<br />

@ tablet, oral 50,100mg<br />

Circa<br />

tablet, oral 50,100mg<br />

Danbury<br />

tablet, oral 50,100mg<br />

Geneva<br />

tablet, oral 50,100,150mg<br />

Mutual<br />

tablet, oral 50,100mg<br />

Mylan<br />

tablet, oral 50,100mg<br />

Purepac<br />

@ tablet, oral 100mg<br />

Quantum<br />

tablet, oral 50,100,150mg Sidmak *<br />

tablet, oral 50,100,150mg<br />

Teva<br />

@ tablet, oral 50,100mg<br />

USL<br />

Brand(s)<br />

Desyrel tablet, oral 50,100,150,300mg Apo<strong>the</strong>con **<br />

Trialodine @ tablet, oral 50mg Quantum<br />

*Some manufacturers’ 150mg tablet cannot be broken into three 50mg segments. Prescribers and<br />

pharmacists should be aware of this difference and take it into account when writing a prescription or<br />

practicing drug product selection.<br />

** <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

TRETINOIN<br />

Tretinoin cream, topical 0.025,0.5,1% Spear<br />

gel, topical 0.025%<br />

Spear<br />

solution, topical 0.05%<br />

Copley<br />

solution, topical 0.05%<br />

Morton Grove<br />

Brand(s)<br />

Retin-A cream, topical 0.025,0.5,1% Johnson & Johnson<br />

Avita cream, topical 0.025% Bertek<br />

Retin-A gel, topical 0.025% Johnson & Johnson<br />

Retin-A solution, topical 0.05% Johnson & Johnson<br />

199


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

TRIAMCINOLONE ACETONIDE<br />

Triamcinolone Acetonide cream, topical 0.025,0.1,0.5% Altana<br />

cream, topical 0.025%<br />

Ambix<br />

cream, topical 0.025,0.1,0.5% Clay-Park<br />

cream, topical 0.025,0.1%<br />

G and W<br />

@ cream, topical 0.025,0.1,0.5% Morton Grove<br />

@ cream, topical 0.025,0.1,0.5% Pharmaderm/Altana<br />

@ cream, topical 0.025,0.1,0.5% Pharmafair<br />

@ cream, topical 0.025%<br />

Taro<br />

cream, topical 0.1%<br />

Taro<br />

cream, topical 0.025,0.1,0.5% Thames<br />

@ cream, topical 0.025,0.1,0.5% Topiderm<br />

@ lotion, topical 0.025,0.1%<br />

Alpharma<br />

lotion, topical 0.025,0.1%<br />

Morton Grove<br />

lotion, topical 0.1%<br />

Thames<br />

@ ointment, topical 0.5%<br />

Alpharma<br />

ointment, topical 0.025,0.1,0.5% Altana<br />

ointment, topical 0.025,0.1,0.5% Clay-Park<br />

@ ointment, topical 0.025,0.1%<br />

G & W<br />

@ ointment, topical 0.025,0.1,0.5% Morton Grove<br />

@ ointment, topical 0.025,0.1%<br />

Pharmaderm/Altana<br />

ointment, topical 0.025,0.1%<br />

Taro<br />

ointment, topical 0.1%<br />

Thames<br />

Brand(s)<br />

Aristocort cream, topical 0.025,0.1,0.5% Fujisawa<br />

Flutex @ cream, topical 0.025,0.1,0.5% IVAX<br />

Kenac @ cream, topical 0.025,0.1% Alpharma<br />

Kenalog cream, topical 0.025,0.1,0.5% Apo<strong>the</strong>con<br />

Triacet cream, topical 0.025,0.1,0.5% Teva<br />

Triacort @ cream, topical 0.1% Solvay<br />

Triatex @ cream, topical 0.025,0.1,0.5% IVAX<br />

Triderm cream, topical 0.1% Del-Ray<br />

Trymex cream, topical 0.025,0.1% Altana/Savage<br />

Trymex @ cream, topical 0.5% Altana/Savage<br />

Aristocort A cream, hydrophilic 0.025,0.1,0.5% Fujisawa<br />

Kenalog-H @ cream, hydrophilic 0.1% Apo<strong>the</strong>con<br />

Kenalog lotion, topical 0.025,0.1% Apo<strong>the</strong>con<br />

Aristocort ointment, topical 0.1% Fujisawa<br />

Aristocort @ ointment, topical 0.5% Fujisawa<br />

Flutex @ ointment, topical 0.025,0.1,0.5% IVAX<br />

Kenac ointment, topical 0.1% NMC<br />

Kenalog ointment, topical 0.025,0.1% Apo<strong>the</strong>con<br />

Kenalog @ ointment, topical 0.5% Apo<strong>the</strong>con<br />

Trymex ointment, topical 0.025,0.1% Savage/Altana<br />

Aristocort A ointment, hydrophilic 0.1% Fujisawa<br />

Aristocort A @ ointment, hydrophilic 0.5% Fujisawa<br />

Kenalog in Orabase paste, dental 0.1% Apo<strong>the</strong>con<br />

Oracort paste, dental 0.1% Taro<br />

Oralone paste, dental 0.1% Thames<br />

TRIAMCINOLONE ACETONIDE; NEOMYCIN SULFATE<br />

See NEOMYCIN SULFATE; TRIAMCINOLONE ACETONIDE<br />

TRIAMCINOLONE ACETONIDE; NYSTATIN<br />

See NYSTATIN; TRIAMCINOLONE ACETONIDE<br />

TRIAMTERENE; HYDROCHLOROTHIAZIDE<br />

See HYDROCHLOROTHIAZIDE; TRIAMTERENE<br />

200


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

TRIAZOLAM<br />

Triazolam tablet, oral 0.125,0.25mg Alphapharm<br />

tablet, oral 0.125,0.25mg<br />

Roxane<br />

tablet, oral 0.125,0.25mg<br />

Watson<br />

Brand(s)<br />

Halcion tablet, oral 0.125,0.25mg Pharmacia & Upjohn *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

TRIFLUOPERAZINE HYDROCHLORIDE<br />

Trifluoperazine Hydrochloride @ concentrate, oral eq 10mg base/ml Morton Grove<br />

@ injection eq 2mg base/ml<br />

Quad<br />

@ tablet, oral eq 1,2,5,10mg base Circa<br />

@ tablet, oral eq 1,2,5,10mg base Duramed<br />

tablet, oral eq 1,2,5,10mg base Geneva<br />

@ tablet, oral eq 1,2,5,10mg base IVAX<br />

tablet, oral eq 1,2,5,10mg base Mylan<br />

Brand(s)<br />

Stelazine concentrate, oral eq 10mg base/ml SmithKline Beecham<br />

TFP @ concentrate, oral eq 10mg base/ml Geneva<br />

Stelazine injection eq 2mg base/ml SmithKline Beecham<br />

Stelazine tablet, oral eq 1,2,5,10mg base SmithKline Beecham<br />

TFP tablet, oral eq 1,2,5,10mg base Geneva<br />

TRIFLURIDINE<br />

Trifluridine solution, ophthalmic 1% Alcon<br />

Brand(s)<br />

Viroptic solution, ophthalmic 1% Monarch<br />

TRIHEXYPHENIDYL HYDROCHLORIDE<br />

Trihexyphenidyl Hydrochloride elixir, oral 2mg/5ml Mikart<br />

elixir, oral 2mg/5ml<br />

Pharm Ventures<br />

elixir, oral 2mg/5ml<br />

Pharmaceutical Associates<br />

tablet, oral 2,5mg<br />

Circa<br />

tablet, oral 2,5mg<br />

Danbury<br />

tablet, oral 5mg<br />

Nylos<br />

@ tablet, oral 2mg<br />

(Vangard/MWM)<br />

tablet, oral 2,5mg<br />

Vintage<br />

tablet, oral 2,5mg<br />

West-ward<br />

Brand(s)<br />

Artane elixir, oral 2mg/5ml Lederle *<br />

Artane tablet, oral 2,5mg Lederle<br />

Tremin @ tablet, oral 2,5mg Schering<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

TRIMEPRAZINE TARTRATE<br />

Trimeprazine Tartrate @ syrup, oral 2.5mg/5ml Alpharma<br />

@ syrup, oral 2.5mg/5ml<br />

Morton Grove<br />

Brand(s)<br />

Temaril @ syrup, oral 2.5mg/5ml Allergan Herbert<br />

201


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

TRIMETHOBENZAMIDE HYDROCHLORIDE<br />

Trimethobenzamide Hydrochloride injection 100mg/ml<br />

Abbott<br />

@ injection 100mg/ml<br />

Smith and Nephew<br />

@ injection 100mg/ml<br />

Solopak<br />

injection 100mg/ml<br />

Steris<br />

Brand(s)<br />

Tigan injection 100mg/ml King<br />

TRIMETHOPRIM<br />

Trimethoprim @ tablet, oral 100,200mg Barr<br />

tablet, oral 100mg<br />

Danbury<br />

tablet, oral 100,200mg<br />

Teva<br />

Brand(s)<br />

Proloprim tablet, oral 100,200mg Monarch<br />

Trimpex tablet, oral 100mg Roche<br />

Trimpex @ tablet, oral 200mg Roche<br />

TRIMETHOPRIM; SULFAMETHOXAZOLE<br />

See SULFAMETHOXAZOLE; TRIMETHOPRIM<br />

TRIMETHOPRIM SULFATE; POLYMYXIN B SULFATE<br />

See POLYMYXIN B SULFATE; TRIMETHOPRIM SULFATE<br />

TRIPELENNAMINE HYDROCHLORIDE<br />

Tripelennamine Hydrochloride @ tablet, oral 50mg Anabolic<br />

@ tablet, oral 50mg<br />

Barr<br />

@ tablet, oral 50mg<br />

Circa<br />

tablet, oral 50mg<br />

Danbury<br />

@ tablet, oral 50mg<br />

Hea<strong>the</strong>r<br />

@ tablet, oral 50mg<br />

Impax<br />

tablet, oral 50mg<br />

Lannett<br />

@ tablet, oral 50mg<br />

Parke-Davis<br />

tablet, oral 50mg<br />

Nylos<br />

@ tablet, oral 50mg<br />

Watson<br />

Brand(s)<br />

PBZ tablet, oral 50mg Novartis<br />

TRIPROLIDINE HYDROCHLORIDE<br />

Triprolidine Hydrochloride @ syrup, oral 1.25mg/5ml Alpharma<br />

@ syrup, oral 1.25mg/5ml<br />

Halsey<br />

@ syrup, oral 1.25mg/5ml<br />

Pharmaceutical Associates<br />

@ tablet, oral 2.5mg<br />

Danbury<br />

@ tablet, oral 2.5mg<br />

Eon<br />

Brand(s)<br />

Actidil @ syrup, oral 1.25mg/5ml Glaxo Wellcome<br />

Myidyl @ syrup, oral 1.25mg/5ml USL<br />

Actidil @ tablet, oral 2.5mg Glaxo Wellcome<br />

TRIPROLIDINE HYDROCHLORIDE; CODEINE PHOSPHATE; PSEUDOEPHEDRINE HYDROCHLORIDE<br />

See CODEINE PHOSPHATE; PSEUDOEPHEDRINE HYDROCHLORIDE; TRIPROLIDINE<br />

HYDROCHLORIDE<br />

TRIPROLIDINE HYDROCHLORIDE; PSEUDOEPHEDRINE HYDROCHLORIDE<br />

See PSEUDOEPHEDRINE HYDROCHLORIDE; TRIPROLIDINE HYDROCHLORIDE<br />

202


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

TRISULFAPYRIMIDINE (SULFADIAZINE, SULFAMETHAZINE AND SULFAMERAZINE)<br />

Brand(s)<br />

Lantrisul @ suspension, oral 167mg/5ml; Lannett<br />

167mg/5ml;167mg/5ml (501mg/5ml)<br />

Neotrizine @ suspension, oral 167mg/5ml; Lilly<br />

167mg/5ml;167mg/5ml (501mg/5ml)<br />

Sulfaloid @ suspension, oral 167mg/5ml; Forest<br />

167mg/5ml;167mg/5ml (501mg/5ml)<br />

Sulfose @ suspension, oral 167mg/5ml; Wyeth-Ayerst<br />

167mg/5ml;167mg/5ml (501mg/5ml)<br />

Terfonyl @ suspension, oral 167mg/5ml; Squibb<br />

167mg/5ml;167mg/5ml (501mg/5ml)<br />

Triple Sulfa @ suspension, oral 167mg/5ml; Alpharma<br />

167mg/5ml;167mg/5ml (501mg/5ml)<br />

Triple Sulfas @ suspension, oral 167mg/5ml; Lederle<br />

167mg/5ml;167mg/5ml (501mg/5ml)<br />

Neotrizine @ tablet, oral 167mg;167mg;167mg Lilly<br />

(501mg)<br />

Sulfa-Triple #2 @ tablet, oral 167mg;167mg;167mg Impax<br />

(501mg)<br />

Sulfaloid @ tablet, oral 167mg;167mg;167mg Forest<br />

(501mg)<br />

Sulfose @ tablet, oral 167mg;167mg;167mg Wyeth-Ayerst<br />

(501mg)<br />

Terfonyl @ tablet, oral 167mg;167mg;167mg Squibb<br />

(501mg)<br />

Triple Sulfa @ tablet, oral 167mg;167mg;167mg Purepac<br />

(501mg)<br />

Triple Sulfas @ tablet, oral 167mg;167mg;167mg Lederle<br />

(501mg)<br />

Triple Sulfoid tablet, oral 167mg;167mg;167mg Pal Pak<br />

(501mg)<br />

TROPICAMIDE<br />

Tropicamide @ solution, ophthalmic 0.5% Alcon Universal<br />

solution, ophthalmic 1%<br />

Alcon Universal<br />

solution, ophthalmic 0.5,1%<br />

Bausch and Lomb<br />

solution, ophthalmic 0.5,1%<br />

Miza<br />

Brand(s)<br />

Mydriacil solution, ophthalmic 0.5,1% Alcon<br />

Mydriafair @ solution, ophthalmic 0.5,1% Pharmafair<br />

Tropicacyl solution, ophthalmic 0.5,1% Akorn<br />

TUBOCURARINE CHLORIDE<br />

Tubocurarine Chloride injection 3mg/ml Abbott<br />

injection 3mg/ml<br />

Bristol-Myers Squibb<br />

injection 3mg/ml<br />

Lilly<br />

UREA; HYDROCORTISONE<br />

See HYDROCORTISONE; UREA<br />

UREA; HYDROCORTISONE ACETATE<br />

See HYDROCORTISONE ACETATE; UREA<br />

203


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

URSODIOL<br />

Ursodiol capsule, oral 300mg Amide<br />

capsule, oral 300mg<br />

Copley<br />

Brand(s)<br />

Actigall capsule, oral 300mg Novartis *<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

VALPROIC ACID<br />

Valproic Acid capsule, oral 250mg Banner Pharmacaps<br />

@ capsule, oral 250mg<br />

Par<br />

capsule, oral 250mg<br />

Scherer<br />

capsule, oral 250mg<br />

USL<br />

syrup, oral 250mg/5ml<br />

Copley<br />

syrup, oral 250mg/5ml<br />

Hi-Tech<br />

syrup, oral 250mg/5ml<br />

Pharmaceutical Associates<br />

syrup, oral 250mg/5ml<br />

UDL<br />

Brand(s)<br />

Depakene capsule, oral 250mg Abbott<br />

Depakene syrup, oral 250mg/5ml Abbott<br />

Myproic Acid syrup, oral 250mg/5ml Morton Grove<br />

VANCOMYCIN HYDROCHLORIDE<br />

Vancomycin Hydrochloride injection eq 500mg,1,5gm base/vial Abbott<br />

@ injection eq 500mg,1gm base/vial Elkins-Sinn<br />

@ injection eq 500mg,1gm base/vial Quad<br />

Brand(s)<br />

Lyphocin<br />

injection eq 500mg,1,5,10gm base/vial American Pharmaceutical<br />

Partners<br />

Vancocin injection eq 500mg,1,10gm base/vial Lilly<br />

Vancoled<br />

injection eq 500mg,1,5,10gm base/vial Lederle<br />

Vancor @ injection eq 500mg,1gm base/vial Pharmacia & Upjohn<br />

Vancocin powder <strong>for</strong> reconstitution, oral Lilly<br />

eq 250mg base/5ml<br />

eq 500mg base/6ml<br />

Vancoled powder <strong>for</strong> reconstitution, oral Lederle<br />

eq 250mg base/5ml<br />

@ eq 500mg base/6ml<br />

VECURONIUM BROMIDE<br />

Vecuronium Bromide injection 10,20mg/vial Abbott<br />

injection 10,20mg/vial<br />

Bed<strong>for</strong>d<br />

injection 10,20mg/vial<br />

ESI/Lederle<br />

injection 10,20mg/vial<br />

Gensia Sicor<br />

injection 10,20mg/vial<br />

Steris<br />

Brand(s)<br />

Norcuron injection 10,20mg/vial Organon<br />

VERAPAMIL HYDROCHLORIDE<br />

Verapamil Hydrochloride capsule, extended release Mylan<br />

120,180,240mg<br />

injection 2.5mg/ml<br />

Abbott<br />

@ injection 2.5mg/ml<br />

American Pharmaceutical<br />

Partners<br />

injection 2.5mg/ml<br />

Bed<strong>for</strong>d<br />

(continued on <strong>the</strong> next page)<br />

204


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

VERAPAMIL HYDROCHLORIDE (continued)<br />

injection 2.5mg/ml<br />

injection 2.5mg/ml<br />

injection 2.5mg/ml<br />

@ injection 2.5mg/ml<br />

@ injection 2.5mg/ml<br />

@ injection 2.5mg/ml<br />

@ tablet, oral 80,120mg<br />

tablet, oral 80,120mg<br />

tablet, oral 40,80,120mg<br />

tablet, oral 80,120mg<br />

tablet, oral 80,120mg<br />

tablet, oral 80,120mg<br />

tablet, oral 80,120mg<br />

tablet, oral 40,80,120mg<br />

@ tablet, oral 80,120mg<br />

tablet, oral 40,80,120mg<br />

@ tablet, extended release 120,240mg<br />

tablet, extended release<br />

120,180,240mg<br />

tablet, extended release<br />

120,180,240mg<br />

tablet, extended release 240mg<br />

International Medication<br />

Luitpold<br />

Marsam<br />

Quad<br />

Smith and Nephew<br />

Solopak<br />

Barr<br />

Danbury<br />

Geneva<br />

Lederle<br />

Mutual<br />

Mylan<br />

Purepac<br />

Sidmak<br />

Warner Chilcott<br />

Watson<br />

Barr<br />

IVAX<br />

Mylan<br />

Sidmak<br />

Brand(s)<br />

Verelan capsule, extended release Elan *<br />

120,180,240mg<br />

Calan @ injection 2.5mg/ml Searle<br />

Isoptin injection 2.5mg/ml Abbott<br />

Calan tablet, oral 40,80,120mg Searle<br />

Isoptin tablet, oral 40,80,120mg Abbott<br />

Isoptin SR tablet, extended release Abbott *<br />

120,180,240mg<br />

* <strong>Product</strong>s manufactured by this brand name manufacturer in this drug entity are available <strong>for</strong> drug product<br />

selection under o<strong>the</strong>r brand and/or generic names.<br />

VINBLASTINE SULFATE<br />

Vinblastine Sulfate injection 1mg/ml American Pharmaceutical<br />

Partners<br />

@ injection 1mg/ml<br />

Quad<br />

@ injection 10mg/vial<br />

American Pharmaceutical<br />

Partners<br />

injection 10mg/vial<br />

Bed<strong>for</strong>d<br />

injection 10mg/vial<br />

Faulding<br />

@ injection 10mg/vial<br />

Quad<br />

Brand(s)<br />

Velban @ injection 10mg/vial Lilly<br />

VINCRISTINE SULFATE<br />

Vincristine Sulfate @ injection 1mg/ml ABIC<br />

@ injection 1mg/ml<br />

American Pharmaceutical<br />

Partners<br />

@ injection 1mg/ml<br />

Faulding<br />

@ injection 1mg/ml<br />

Quad<br />

injection 1,2,5mg/vial<br />

Faulding<br />

@ injection 1,2,5mg/vial<br />

Quad<br />

(continued on <strong>the</strong> next page)<br />

205


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

VINCRISTINE SULFATE (continued)<br />

Brand(s)<br />

Oncovin injection 1mg/ml Lilly<br />

Oncovin @ injection 1,5mg/vial Lilly<br />

Vincasar PFS injection 1mg/ml Pharmacia & Upjohn<br />

Vincrex @ injection 5mg/vial Bristol-Myers Squibb<br />

Vincristine Sulfate injection 1mg/ml Gensia Sicor<br />

Preservative-Free<br />

VITAMIN A (50,000 USP Units = 15mg)<br />

Vitamin A @ capsule, oral 50,000 USP Units Banner Pharmacaps<br />

@ capsule, oral 50,000 USP Units Chase<br />

@ capsule, oral 50,000 USP Units Everylife<br />

@ capsule, oral 50,000 USP Units Impax<br />

capsule, oral 50,000 USP Units West-Ward<br />

Brand(s)<br />

Aquasol A @ capsule, oral 50,000 USP Units Astra Zeneca<br />

VITAMIN A; ASCORBIC ACID; BIOTIN; CYANOCOBALAMIN; DEXPANTHENOL; ERGOCALCIFEROL;<br />

FOLIC ACID; NIACINAMIDE; PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN PHOSPHATE SODIUM;<br />

THIAMINE HYDROCHLORIDE; VITAMIN E<br />

See ASCORBIC ACID; BIOTIN; CYANOCOBALAMIN; DEXPANTHENOL; ERGOCALCIFEROL;<br />

FOLIC ACID; NIACINAMIDE; PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN PHOSPHATE<br />

SODIUM; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN E<br />

VITAMIN A; ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; IRON; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN D; VITAMIN E<br />

See ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; IRON; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D;<br />

VITAMIN E<br />

VITAMIN A; ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN D; VITAMIN E<br />

See ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D;<br />

VITAMIN E<br />

VITAMIN A; ASCORBIC ACID; FLUORIDE; IRON; VITAMIN D<br />

See ASCORBIC ACID; FLUORIDE; IRON; VITAMIN A; VITAMIN D<br />

VITAMIN A; ASCORBIC ACID; FLUORIDE; VITAMIN D<br />

See ASCORBIC ACID; FLUORIDE; VITAMIN A; VITAMIN D<br />

VITAMIN A PALMITATE (50,000 Units base = 15mg)<br />

Vitamin A Palmitate capsule, oral 50,000 Units base Arcum<br />

@ capsule, oral 50,000 Units base Banner Pharmacaps<br />

@ capsule, oral 50,000 Units base Chase<br />

@ capsule, oral 50,000 Units base Elkins-Sinn<br />

@ capsule, oral 50,000 Units base Everylife<br />

@ capsule, oral 50,000 Units base Impax<br />

@ capsule, oral 50,000 Units base IVAX<br />

capsule, oral 50,000 Units base MK<br />

(continued on <strong>the</strong> next page)<br />

206


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

VITAMIN A PALMITATE (50,000 Units base = 15mg) (continued)<br />

@ capsule, oral 50,000 Units base Squibb<br />

@ capsule, oral 50,000 Units base Teva<br />

@ capsule, oral 50,000 Units base West-ward<br />

@ capsule, oral 50,000 Units base Wharton<br />

@ injection 50,000 Units base/ml Bel-Mar<br />

Brand(s)<br />

Afaxin @ capsule, oral 50,000 Units base Sterling Winthrop<br />

Alphalin @ capsule, oral 50,000 Units base Lilly<br />

Del-Vi-A @ capsule, oral 50,000 Units base Del-Ray<br />

Vi-Dom-A @ capsule, oral 50,000 Units base Bayer<br />

Aquasol A injection 50,000 Units base/ml Astra Zeneca<br />

VITAMIN D; ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; IRON; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN E<br />

See ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; IRON; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D;<br />

VITAMIN E<br />

VITAMIN D; ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN E<br />

See ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D;<br />

VITAMIN E<br />

VITAMIN D; ASCORBIC ACID; FLUORIDE; IRON; VITAMIN A<br />

See ASCORBIC ACID; FLUORIDE; IRON; VITAMIN A; VITAMIN D<br />

VITAMIN D; ASCORBIC ACID; FLUORIDE; VITAMIN A<br />

See ASCORBIC ACID; FLUORIDE; VITAMIN A; VITAMIN D<br />

VITAMIN E; ASCORBIC ACID; BIOTIN; CYANOCOBALAMIN; DEXPANTHENOL; ERGOCALCIFEROL;<br />

FOLIC ACID; NIACINAMIDE; PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN PHOSPHATE SODIUM;<br />

THIAMINE HYDROCHLORIDE; VITAMIN A<br />

See ASCORBIC ACID; BIOTIN; CYANOCOBALAMIN; DEXPANTHENOL; ERGOCALCIFEROL;<br />

FOLIC ACID; NIACINAMIDE; PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN PHOSPHATE<br />

SODIUM; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN E<br />

VITAMIN E; ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; IRON; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D<br />

See ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; IRON; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D;<br />

VITAMIN E<br />

VITAMIN E; ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D<br />

See ASCORBIC ACID; CYANOCOBALAMIN; FLUORIDE; NICOTINIC ACID; PYRIDOXINE<br />

HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN D;<br />

VITAMIN E<br />

207


APPLICATION HOLDER,<br />

DRUG DOSAGE FORM, STRENGTH MANUFACTURER<br />

WARFARIN SODIUM<br />

Warfarin Sodium tablet, oral 1,2,2.5,3,4,5,6,7.5,10mg Barr<br />

tablet, oral 1,2,2.5,3,4,5,6,7.5,10mg Geneva<br />

tablet, oral 1,2,2.5,4,5,7.5,10mg Taro<br />

Brand(s)<br />

Coumadin tablet, oral 1,2,2.5,3,4,5,6,7.5,10mg Bristol-Myers Squibb<br />

NOTE: Within 24 hours of any interchange of a patient’s warfarin sodium prescription, whe<strong>the</strong>r from a<br />

brand name manufacturer to a generic manufacturer, generic manufacturer to a brand name manufacturer,<br />

or generic manufacturer to a different generic manufacturer, <strong>the</strong> pharmacist must notify <strong>the</strong> prescriber of<br />

<strong>the</strong> interchange, identifying to <strong>the</strong> prescriber <strong>the</strong> name of <strong>the</strong> manufacturer of <strong>the</strong> warfarin sodium tablets<br />

dispensed to <strong>the</strong> patient.<br />

WATER FOR INJECTION, STERILE<br />

Sterile water in plastic container<br />

Water injection 100% Abbott<br />

injection 100%<br />

American Pharmaceutical<br />

Partners<br />

injection 100%<br />

Baxter<br />

injection 100%<br />

Braun<br />

WATER FOR IRRIGATION, STERILE<br />

Sterile water in plastic container<br />

Water liquid 100% Abbott<br />

liquid 100%<br />

Baxter<br />

liquid 100%<br />

Braun<br />

@ liquid 100%<br />

Miles<br />

XYLOSE<br />

Xylose powder, oral 25gm/bottle Lyne<br />

Brand(s)<br />

Xylo-Pfan @ powder, oral 25gm/bottle Savage<br />

208


ILLINOIS FORMULARY<br />

TWENTIETH EDITION<br />

DRUG PRODUCT SELECTION PROGRAM<br />

ALPHABETICAL INDEX<br />

NOTE: Not all dosage <strong>for</strong>ms and/or strengths of <strong>the</strong> drug products listed in this index may actually appear in <strong>the</strong> text. Always<br />

refer to <strong>the</strong> drug's specific page in <strong>the</strong> text to be sure that an approved, generically and pharmaceutically equivalent product is<br />

being dispensed.<br />

Page<br />

Page<br />

A.P.L. 103<br />

A/T/S 85<br />

A-Hydrocort 116<br />

A-Methapred 142<br />

A-Poxide 45<br />

A/B Otic Drops 16<br />

Abitrexate 140<br />

Accurbron 194<br />

ACEBUTOLOL HYDROCHLORIDE 1<br />

ACETAMINOPHEN; BUTALBITAL 1<br />

ACETAMINOPHEN; BUTALBITAL; CAFFEINE 1<br />

ACETAMINOPHEN; CAFFEINE; 1<br />

DIHYDROCODEINE BITARTRATE<br />

ACETAMINOPHEN; CODEINE PHOSPHATE 2<br />

ACETAMINOPHEN; HYDROCODONE 2,3,4<br />

BITARTRATE<br />

ACETAMINOPHEN; OXYCODONE 4<br />

HYDROCHLORIDE<br />

ACETAMINOPHEN; PENTAZOCINE 4<br />

HYDROCHLORIDE<br />

ACETAMINOPHEN; PROPOXYPHENE 4<br />

HYDROCHLORIDE<br />

ACETAMINOPHEN; PROPOXYPHENE 5<br />

NAPSYLATE<br />

Acetasol 5<br />

Acetasol HC 6<br />

ACETAZOLAMIDE 5<br />

ACETAZOLAMIDE SODIUM 5<br />

ACETIC ACID, GLACIAL 5<br />

ACETIC ACID, GLACIAL; ALUMINUM ACETATE 6<br />

ACETIC ACID, GLACIAL; HYDROCORTISONE 6<br />

ACETOHEXAMIDE 6<br />

ACETYLCYSTEINE 6<br />

Achromycin 174,194<br />

Achromycin V 194<br />

Acilac 127<br />

Actahist 179<br />

Actigall 204<br />

ACTH 58<br />

Acthar 58<br />

Acticort 114<br />

Actidil 202<br />

Actifed w/Codeine 58<br />

Actin-H 152<br />

ACYCLOVIR 6,7<br />

ACYCLOVIR SODIUM 7<br />

Adalat 151<br />

Adalat CC 151<br />

Adapin 80<br />

Adderall 14<br />

Adipex-P 162<br />

Adphen 161<br />

Adrenalin Chloride 83<br />

Adriamycin PFS 80<br />

Adriamycin RDF 80<br />

Adrucil 95<br />

Adsorbocarpine 164<br />

Aerolone 124<br />

Aerosporin 166<br />

Afaxin 207<br />

AK-Chlor 44<br />

AK-Con 148<br />

AK-Con A 148<br />

AK-Dex 64<br />

AK-Dilate 162<br />

AK-Gentak 100<br />

AK-Homatropine 106<br />

AK-Pentolate 60<br />

AK-Pred 172<br />

AK-Sulf 188<br />

AKbeta 128<br />

AKarpine 164<br />

AKpro 77<br />

AKtob 198<br />

Ala-Cort 114<br />

Albalon 148<br />

209


Page<br />

Albalon A 16<br />

ALBUTEROL 7<br />

ALBUTEROL SULFATE 7,8<br />

Alcaine 176<br />

ALCOHOL; DEXTROSE 8<br />

ALCOHOL; MORPHINE 8,9<br />

Aldactazide 112<br />

Aldactone 187<br />

Aldochlor 150 46<br />

Aldochlor 250 46<br />

Aldomet 141<br />

Aldoril 15 111<br />

Aldoril 25 111<br />

Aldoril D30 111<br />

Aldoril D50 111<br />

Alesse 90<br />

Alfenta 9<br />

ALFENTANIL HYDROCHLORIDE 9<br />

Alkergot 85<br />

Allay 3<br />

Allerfed 179<br />

ALLOPURINOL 9<br />

Alpha Redisol 117<br />

Alphacaine 128,129<br />

Alphacaine HCl w/Epinephrine 84<br />

Alphaderm 115<br />

Alphalin 207<br />

Alphatrex 27<br />

Alphazine 161<br />

ALPRAZOLAM 9<br />

ALPROSTADIL 9<br />

Alupent 137<br />

AMANTADINE HYDROCHLORIDE 10<br />

Ambenyl 30<br />

Amcill 16<br />

Amicar 11<br />

Amidate 91<br />

AMIKACIN SULFATE 10<br />

Amikin 10<br />

AMILORIDE HYDROCHLORIDE 10<br />

AMILORIDE HYDROCHLORIDE; 10<br />

HYDROCHLOROTHIAZIDE<br />

AMINOACETIC ACID 102<br />

AMINOCAPROIC ACID 11<br />

AMINOHIPPURATE SODIUM 11<br />

Aminophyllin 11<br />

AMINOPHYLLINE 11<br />

AMIODARONE HYDROCHLORIDE 11<br />

Amitid 12<br />

Amitril 12<br />

AMITRIPTYLINE HYDROCHLORIDE 11,12<br />

Page<br />

AMITRIPTYLINE HYDROCHLORIDE; 12<br />

CHLORDIAZEPOXIDE<br />

AMITRIPTYLINE HYDROCHLORIDE; 12,13<br />

PERPHENAZINE<br />

AMMONIUM LACTATE 13<br />

Amosene 136<br />

AMOXAPINE 13<br />

AMOXICILLIN/AMOXICILLIN TRIHYDRATE 13,14<br />

Amoxil 14<br />

AMPHETAMINE ASPARTAME; AMPHETAMINE 14<br />

SULFATE; DEXTROAMPHETAMINE SACCHARATE;<br />

DEXTROAMPHETAMINE SULFATE<br />

Amphicol 44<br />

AMPHOTERICIN B 14<br />

AMPICILLIN/AMPICILLIN TRIHYDRATE; 15<br />

PROBENECID<br />

AMPICILLIN SODIUM 15<br />

AMPICILLIN TRIHYDRATE 15,16<br />

AMRINONE LACTATE see INAMRINONE LACTATE<br />

Anafranil 54<br />

Anaprox 149<br />

Anaprox DS 149<br />

Ancef 42<br />

Android 10 142<br />

Android 25 142<br />

Anectine 187<br />

Anestacon 129<br />

Anexsia 3<br />

Anexsia 7.5/650 3<br />

Anexsia 10/660 3<br />

Anoquan 1<br />

Ansaid 96<br />

ANTAZOLINE PHOSPHATE; 16<br />

NAPHAZOLINE HYDROCHLORIDE<br />

ANTIPYRINE; BENZOCAINE 16,17<br />

Anspor 44<br />

Antepar 165<br />

Antispasmodic Elixir 23<br />

Antivert 134<br />

Anturane 191<br />

Anusol HC 114<br />

Apogen 100<br />

Apresazide 108<br />

Apresoline 108<br />

Apri 62<br />

Aquaphyllin 194<br />

Aquasol A 206,207<br />

Aquatensen 140<br />

Aralen 46<br />

Aramine 137<br />

Arestocaine HCl 135<br />

210


Page<br />

Arestocaine HCl w/Levonordefrin 128<br />

Aristocort 200<br />

Aristocort A 200<br />

Artane 201<br />

ASCORBIC ACID; BIOTIN; 17<br />

CYANOCOBALAMIN; DEXPANTHENOL;<br />

ERGOCALCIFEROL; FOLIC ACID; NIACINAMIDE;<br />

PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN<br />

PHOSPHATE SODIUM; THIAMINE<br />

HYDROCHLORIDE; VITAMIN A; VITAMIN E<br />

ASCORBIC ACID; CYANOCOBALAMIN; 17<br />

FLUORIDE; IRON; NICOTINIC ACID<br />

PYRIDOXINE HYDROCHLORIDE;<br />

RIBOFLAVIN; THIAMINE HYDROCHLORIDE;<br />

VITAMIN A; VITAMIN D; VITAMIN E<br />

ASCORBIC ACID; CYANOCOBALAMIN; 17,18<br />

FLUORIDE; NICOTINIC ACID;<br />

PYRIDOXINE HYDROCHLORIDE;<br />

RIBOFLAVIN; THIAMINE HYDROCHLORIDE;<br />

VITAMIN A; VITAMIN D; VITAMIN E<br />

ASCORBIC ACID; FLUORIDE; IRON; 18<br />

VITAMIN A; VITAMIN D<br />

ASCORBIC ACID; FLUORIDE; 18<br />

VITAMIN A; VITAMIN D<br />

Asendin 13<br />

ASPIRIN; BUTALBITAL; CAFFEINE; 19<br />

ASPIRIN; BUTALBITAL; CAFFEINE; 19<br />

CODEINE PHOSPHATE<br />

ASPIRIN; CAFFEINE; ORPHENADRINE CITRATE 19<br />

ASPIRIN; CAFFEINE; 20<br />

PROPOXYPHENE HYDROCHLORIDE<br />

ASPIRIN; CARISOPRODOL 20<br />

ASPIRIN; CARISOPRODOL; 20<br />

CODEINE PHOSPHATE<br />

ASPIRIN; CODEINE PHOSPHATE 20<br />

ASPIRIN; MEPROBAMATE 20<br />

ASPIRIN; METHOCARBAMOL 20<br />

ASPIRIN; OXYCODONE HYDROCHLORIDE; 21<br />

OXYCODONE TEREPHTHALATE<br />

Astramorph PF 146<br />

Atarax 118<br />

ATENOLOL 21<br />

ATENOLOL; CHLORTHALIDONE 21<br />

Ativan 131<br />

ATRACURIUM BESYLATE 21,22<br />

Atracurium Besylate Preservative-Free 22<br />

Atromid-S 54<br />

Atropair 22<br />

Atropen 22<br />

ATROPINE 22<br />

Atropine Care 22<br />

Page<br />

ATROPINE SULFATE 22<br />

Atropine and Demerol 23<br />

ATROPINE SULFATE; DIPHENOXYLATE 22,23<br />

HYDROCHLORIDE<br />

ATROPINE SULFATE; HYOSCYAMINE; 23<br />

PHENOBARBITAL; SCOPOLAMINE<br />

HYDROBROMIDE<br />

ATROPINE SULFATE; MEPERIDINE 23<br />

HYDROCHLORIDE<br />

Atropine-1 22<br />

Atropisol 22<br />

Atrovent 122<br />

Auralgan 16<br />

Auroto Drops 17<br />

AVC 190<br />

Aventyl HCl 153<br />

Aviane 90<br />

Avita 199<br />

Aygestin 153<br />

AZATHIOPRINE 24<br />

AZATHIOPRINE SODIUM 24<br />

AZELAIC ACID 24<br />

Azelex 24<br />

Azulfidine 191<br />

Baci-Rx 24<br />

Baciguent 24<br />

Baciim 24<br />

BACITRACIN 24<br />

BACITRACIN; HYDROCORTISONE ACETATE; 24<br />

NEOMYCIN SULFATE; POLYMYXIN B SULFATE<br />

BACITRACIN ZINC; HYDROCORTISONE; 24<br />

NEOMYCIN SULFATE; POLYMYXIN B SULFATE<br />

BACITRACIN ZINC; NEOMYCIN SULFATE; 25<br />

POLYMYXIN B SULFATE<br />

BACITRACIN ZINC; POLYMYXIN B SULFATE 25<br />

BACLOFEN 25<br />

Bactocill 155<br />

Bactrim 190<br />

Bactrim DS 190<br />

Bactrim Pediatric 190<br />

Balneol-HC 114<br />

Banan 42<br />

Bancap 1<br />

Bancap HC 3<br />

Barstatin 100 154<br />

Beepen-VK 159<br />

Belix 77<br />

Ben Aqua 5 26<br />

Ben Aqua 10 26<br />

Benadryl 77<br />

Benadryl Preservative-Free 77<br />

211


Page<br />

Benemid 173<br />

Bentyl 74<br />

Bentyl Preservative-Free 74<br />

Benzac 5 26<br />

Benzac 10 26<br />

Benzac W 2.5 26<br />

Benzac W 5 26<br />

Benzac W 10 26<br />

Benzac W Wash 5 26<br />

Benzac W Wash 10 26<br />

BENZONATATE 25<br />

BENZOYL PEROXIDE 25,26<br />

BENZTROPINE MESYLATE 26<br />

Bepadin 26<br />

BEPRIDIL HYDROCHLORIDE 26<br />

Berubigen 59<br />

Beta-2 123<br />

Beta-HC 114<br />

Beta-Val 27,28<br />

Betaderm 27<br />

Betagan 128<br />

Betalin-S 195<br />

Betalin 12 59<br />

BETAMETHASONE DIPROPIONATE 26,27<br />

BETAMETHASONE DIPROPIONATE, 27<br />

AUGMENTED<br />

BETAMETHASONE DIPROPIONATE; 27<br />

CLOTRIMAZOLE<br />

BETAMETHASONE SODIUM PHOSPHATE 27<br />

BETAMETHASONE VALERATE 27,28<br />

Betapace 186<br />

Betapen-VK 159<br />

Betatrex 27,28<br />

BETAXOLOL HYDROCHLORIDE 28<br />

BETHANECHOL CHLORIDE 28<br />

Betoptic 28<br />

Biocycline 194<br />

Biphetap 30<br />

BISOPROLOL FUMARATE 28<br />

BISOPROLOL FUMARATE; 29<br />

HYDROCHLOROTHIAZIDE<br />

Blenoxane 29<br />

BLEOMYCIN SULFATE 29<br />

Bleph-10 188<br />

Bleph-30 188<br />

Blephamide 172<br />

Blocadren 197<br />

Bontril PDM 161<br />

Borofair 6<br />

Brethine 192<br />

BRETYLIUM TOSYLATE 29<br />

Page<br />

BRETYLIUM TOSYLATE; DEXTROSE 29<br />

Bretylol 29<br />

Brevicon 90<br />

Bricanyl 192<br />

Bristacycline 194<br />

Bristagen 100<br />

Bristamycin 87<br />

Bromanate 30<br />

Bromanate DC 30<br />

Bromanate DM 30<br />

Bromanyl 30<br />

Bromfed-DM 30<br />

BROMOCRIPTINE MESYLATE 29<br />

BROMODIPHENHYDRAMINE 30<br />

HYDROCHLORIDE; CODEINE PHOSPHATE<br />

BROMPHENIRAMINE MALEATE 30<br />

BROMPHENIRAMINE MALEATE; CODEINE 30<br />

PHOSPHATE; PHENYLPROPANOLAMINE<br />

HYDROCHLORIDE<br />

BROMPHENIRAMINE MALEATE; 30<br />

DEXTROMETHORPHAN HYDROBROMIDE;<br />

PSEUDOEPHEDRINE HYDROCHLORIDE<br />

BROMPHENIRAMINE MALEATE; 30<br />

PHENYLPROPANOLAMINE HYDROCHLORIDE<br />

Bronkosol 123<br />

Bryrel 165<br />

BSS Plus 33<br />

Bucet 1<br />

BUMETANIDE 31<br />

Bumex 31<br />

BUPIVACAINE HYDROCHLORIDE 31<br />

BUPIVACAINE HYDROCHLORIDE; 31<br />

EPINEPHRINE BITARTRATE<br />

BUPRENORPHINE HYDROCHLORIDE 31<br />

Buprenex 31<br />

BUPROPION HYDROCHLORIDE 31<br />

Buspar 32<br />

BUSPIRONE 31,32<br />

Butabarb 32<br />

BUTABARBITAL SODIUM 32<br />

Butal Compound 19<br />

Butalbital Compound 19<br />

Butapap 1<br />

Butisol Sodium 32<br />

BUTORPHANOL TARTRATE 32,33<br />

Butorphanol Tartrate Preservative-Free 32,33<br />

C-Solve 2 85,86<br />

Cafergot 33<br />

CAFFEINE; ERGOTAMINE TARTRATE 33<br />

Calan 205<br />

Calcimar 33<br />

212


Page<br />

Calciquid 37<br />

CALCITONIN, SALMON 33<br />

CALCITRIOL 33<br />

CALCIUM CHLORIDE; DEXTROSE; 33<br />

GLUTATHIONE DISULFIDE;<br />

MAGNESIUM CHLORIDE; POTASSIUM<br />

CHLORIDE; SODIUM BICARBONATE;<br />

SODIUM CHLORIDE; SODIUM PHOSPHATE<br />

CALCIUM CHLORIDE; DEXTROSE; 34,35<br />

MAGNESIUM CHLORIDE; SODIUM<br />

CHLORIDE; SODIUM LACTATE<br />

CALCIUM CHLORIDE; DEXTROSE; 35<br />

POTASSIUM CHLORIDE; SODIUM CHLORIDE<br />

CALCIUM CHLORIDE; DEXTROSE; 35,36<br />

POTASSIUM CHLORIDE; SODIUM<br />

CHLORIDE; SODIUM LACTATE<br />

CALCIUM CHLORIDE; MAGNESIUM CHLORIDE; 36<br />

POTASSIUM CHLORIDE; SODIUM CHLORIDE<br />

CALCIUM CHLORIDE; POTASSIUM 37<br />

CHLORIDE; SODIUM CHLORIDE<br />

CALCIUM CHLORIDE; POTASSIUM 37<br />

CHLORIDE; SODIUM CHLORIDE;<br />

SODIUM LACTATE<br />

CALCIUM GLUBIONATE 37<br />

CALCIUM GLUCEPTATE 37<br />

CALCIUM GLUCONATE 37<br />

Calmurid HC 115<br />

Cam-Metrazine 161<br />

Candex 154<br />

Capital with Codeine 2<br />

Capoten 38<br />

Capozide 38<br />

CAPTOPRIL 38,39<br />

CAPTOPRIL; HYDROCHLOROTHIAZIDE 38<br />

Carafate 188<br />

CARBACHOL 38<br />

Carbastat 38<br />

CARBAMAZEPINE 38<br />

CARBENICILLIN DISODIUM 38<br />

CARBIDOPA; LEVODOPA 39<br />

CARBINOXAMINE MALEATE; 39<br />

DEXTROMETHORPHAN HYDROBROMIDE;<br />

PSEUDOEPHEDRINE HYDROCHLORIDE<br />

CARBINOXAMINE MALEATE; 40<br />

PSEUDOEPHEDRINE HYDROCHLORIDE<br />

Carbocaine 135<br />

Carbocaine Hydrochloride w/Neocobefrin 128<br />

Carbofed DM 39<br />

Cardec DM 39<br />

Cardene 150<br />

Cardioplegic 36<br />

Page<br />

Cardizem 76<br />

Cardizem CD 76<br />

Cardizem SR 76<br />

Cardura 79<br />

CARISOPRODOL 40<br />

Carmol HC 116<br />

Carnitor 128<br />

CARTEOLOL HYDROCHLORIDE 40<br />

Cartia XT 76<br />

Cataflam 73<br />

Catapres 55<br />

Caverject 9<br />

Ceclor 41<br />

Ceclor CD 41<br />

CEFACLOR 40,41<br />

CEFADROXIL/CEFADROXIL HEMIHYDRATE 41<br />

Cefadyl 44<br />

Cefanex 43<br />

CEFAZOLIN SODIUM 41,42<br />

CEFOTAXIME SODIUM 42<br />

CEFOXITIN SODIUM 42<br />

CEFPODOXIME PROXETIL 42<br />

CEFTAZIDIME 42<br />

CEFTAZIDIME(ARGININE FORMULATION) 42<br />

CEFTAZIDIME SODIUM 42<br />

CEFUROXIME SODIUM 43<br />

Celestone 27<br />

Cena K 168<br />

CEPHALEXIN 43<br />

CEPHALOTHIN SODIUM 43,44<br />

CEPHAPIRIN SODIUM 44<br />

CEPHRADINE/CEPHRADINE DIHYDRATE 44<br />

Cephulac 127<br />

Ceptaz 42<br />

Cerubidine 61<br />

Cetacort 114<br />

Cetamide 188<br />

Chemdec DM 39<br />

Chemdec 40<br />

Chlor-Trimeton 47<br />

CHLORAL HYDRATE 44<br />

CHLORAMPHENICOL 44,45<br />

CHLORAMPHENICOL SODIUM SUCCINATE 45<br />

Chlordiazachel 45<br />

CHLORDIAZEPOXIDE HYDROCHLORIDE 45<br />

Chlorofair 44<br />

CHLORHEXIDINE GLUCONATE 45<br />

Chloromycetin 44,45<br />

CHLOROPROCAINE HYDROCHLORIDE 46<br />

Chloroptic 44<br />

Chloroptic S.O.P. 44<br />

213


Page<br />

CHLOROQUINE PHOSPHATE 46<br />

CHLOROTHIAZIDE 46<br />

CHLOROTHIAZIDE; METHYLDOPA 46<br />

CHLOROTRIANISENE 46<br />

CHLORPHENIRAMINE MALEATE 46,47<br />

CHLORPHENIRAMINE MALEATE; 47<br />

CODEINE PHOSPHATE; PSEUDOEPHEDRINE<br />

HYDROCHLORIDE<br />

CHLORPHENIRAMINE MALEATE; 47,48<br />

PHENYLEPHRINE HYDROCHLORIDE;<br />

PHENYLPROPANOLAMINE HYDROCHLORIDE;<br />

PHENYLTOLOXAMINE CITRATE<br />

CHLORPHENIRAMINE MALEATE; 48<br />

PHENYLPROPANOLAMINE HYDROCHLORIDE<br />

CHLORPHENIRAMINE TANNATE; 48<br />

PHENYLEPHRINE TANNATE;<br />

PYRILAMINE TANNATE<br />

CHLORPROMAZINE HYDROCHLORIDE 48<br />

CHLORPROPAMIDE 48,49<br />

CHLORTHALIDONE 49<br />

CHLORTHALIDONE; CLONIDINE 49,50<br />

HYDROCHLORIDE<br />

CHLORZOXAZONE 50<br />

Cholac 127<br />

Choledyl 156<br />

CHOLESTYRAMINE 50<br />

Cholestyramine Light 50<br />

CHORIONIC GONADOTROPIN 103<br />

CHROMIC CHLORIDE 50<br />

Chronulac 127<br />

CIMETIDINE 51<br />

CIMETIDINE HYDROCHLORIDE 51<br />

CIMETIDINE HYDROCHLORIDE; 51<br />

SODIUM CHLORIDE<br />

Cinobac 51<br />

CINOXACIN 51<br />

Cin-Quin 181<br />

Circanol 85<br />

CISPLATIN 51,52<br />

CITRIC ACID; MAGNESIUM OXIDE; 52<br />

SODIUM CARBONATE<br />

Cla<strong>for</strong>an 42<br />

Cleocin 52,53<br />

Cleocin Phosphate in Dextrose 5% 53<br />

Cleocin T 53<br />

CLADRIBINE 52<br />

CLEMASTINE FUMARATE 52<br />

Climara 88<br />

Clinda-Derm 53<br />

CLINDAMYCIN HYDROCHLORIDE 52<br />

CLINDAMYCIN PHOSPHATE 52,53<br />

Page<br />

CLINDAMYCIN PHOSPHATE; DEXTROSE 53<br />

Clindets 53<br />

Clinoril 192<br />

CLOBETASOL PROPIONATE 53,54<br />

CLOFIBRATE 54<br />

Clomid 54<br />

CLOMIPHENE CITRATE 54<br />

CLOMIPRAMINE HYDROCHLORIDE 54<br />

CLONAZEPAM 54,55<br />

CLONIDINE HYDROCHLORIDE 55<br />

Clopra 143<br />

CLORAZEPATE DIPOTASSIUM 55<br />

CLOTRIMAZOLE 56<br />

CLOXACILLIN SODIUM MONOHYDRATE 56<br />

Cloxapen 56<br />

CLOZAPINE 56<br />

Clozaril 56<br />

Cobavite 59<br />

Codafed 57<br />

Codamine 113<br />

CODEINE PHOSPHATE; GUAIFENESIN 57<br />

CODEINE PHOSPHATE; GUAIFENESIN; 57<br />

PSEUDOEPHEDRINE HYDROCHLORIDE<br />

CODEINE PHOSPHATE; 57<br />

IODINATED GLYCEROL<br />

CODEINE PHOSPHATE; PHENYLEPHRINE 57<br />

HYDROCHLORIDE; PROMETHAZINE<br />

HYDROCHLORIDE<br />

CODEINE PHOSPHATE; PROMETHAZINE 58<br />

HYDROCHLORIDE<br />

CODEINE PHOSPHATE; 58<br />

PSEUDOEPHEDRINE HYDROCHLORIDE;<br />

TRIPROLIDINE HYDROCHLORIDE<br />

Codoxy 21<br />

Cogentin 26<br />

Co-Gesic 3<br />

Co-Lav 165<br />

COLISTIMETHATE 58<br />

Colocort 114<br />

Colovage 165<br />

Colonaid 23<br />

Coly-Mycin M 58<br />

Colyte 165<br />

Colyte-Flavored 165<br />

Combipres 50<br />

Compazine 174,175<br />

Compound 65 20<br />

Compro 174<br />

Constilac 127<br />

Constulose 127<br />

Cor-Oticin 116<br />

214


Page<br />

Cordarone 11<br />

Cordran 96<br />

Corgard 146<br />

Cormax 54<br />

Corphed 179<br />

Cort-Dome 114<br />

Cortenema 114<br />

CORTICOTROPIN 58<br />

Cortisporin ophthalmic ointment 24<br />

Cortisporin ophthalmic suspension 115<br />

Cortisporin otic solution 115<br />

Cortisporin topical ointment 24<br />

Cortril 114<br />

Cotrim 190<br />

Cotrim DS 190<br />

Cotrim Pediatric 190<br />

Coumadin 208<br />

Crolom 58<br />

CROMOLYN SODIUM 58<br />

Cromoptic 58<br />

CROTAMITON 59<br />

Crotan 59<br />

Cryselle 90<br />

CYANOCOBALAMIN 59<br />

CYCLACILLIN 59<br />

Cyclapen W 59<br />

CYCLOBENZAPRINE HYDROCHLORIDE 60<br />

Cyclogyl 60<br />

Cyclopar 194<br />

CYCLOPENTOLATE HYDROCHLORIDE 60<br />

CYCLOPHOSPHAMIDE 60<br />

CYCLOSPORINE 60<br />

Cycrin 134<br />

Cylert 157<br />

CYPROHEPTADINE HYDROCHLORIDE 60,61<br />

CYTARABINE 61<br />

Cytomel 130<br />

Cytosar-U 61<br />

Cytoxan 60<br />

DACARBAZINE 61<br />

Dalmane 97<br />

DANAZOL 61<br />

Danocrine 61<br />

Dapex-37.5 162<br />

Darvocet-N 50 5<br />

Darvocet-N 100 5<br />

Darvon 177<br />

Darvon Compound-65 20<br />

DAUNORUBICIN HYDROCHLORIDE 61<br />

Daypro 155<br />

DDAVP 62<br />

Page<br />

Deapril-ST 85<br />

Decadron 62,63<br />

Deca-Durabolin 147<br />

Decapryn 81<br />

Delacort 114<br />

Delalutin 117<br />

Deladumone 89<br />

Deladumone-OB 89<br />

Delatestryl 193<br />

Delaxin 139<br />

Delestrogen 88<br />

Delflex w/Dextrose 34<br />

Delflex w/Dextrose low magnesium 34<br />

Delflex w/Dextrose low magnesium / low calcium 34<br />

Deltalin 84<br />

Deltasone 173<br />

Del-Vi-A 207<br />

Demerol 135<br />

Demulen 1/35 89<br />

Demulen 1/50 89<br />

Dendrid 119<br />

Depakene 204<br />

Depo-Estradiol 88<br />

Depo-Testadiol 88<br />

Depo-Testosterone 193<br />

Dermabet 27<br />

Dermacomb 154<br />

Dermacort 114<br />

Dermatol HC 114<br />

DESIPRAMINE HYDROCHLORIDE 61<br />

DESMOPRESSIN ACETATE 62<br />

Desmopressin Acetate Preservative-Free 62<br />

Desogen 62<br />

DESOGESTREL; ETHINYL ESTRADIOL 62<br />

DESONIDE 62<br />

Desowen 62<br />

DESOXIMETASONE 62<br />

Desoxyn 138<br />

Desquam X 2.5 26<br />

Desquam X 5 26<br />

Desquam X 10 26<br />

Desquam X 5 Wash 26<br />

Desyrel 199<br />

Detussin Expectorant 104<br />

Detussin Liquid 113<br />

Dexacen-4 63<br />

Dexacidin 63<br />

Dexair 64<br />

DEXAMETHASONE 62<br />

DEXAMETHASONE; NEOMYCIN SULFATE; 63<br />

POLYMYXIN B SULFATE<br />

215


Page<br />

DEXAMETHASONE; TOBRAMYCIN 63<br />

DEXAMETHASONE SODIUM PHOSPHATE 63,64<br />

DEXAMETHASONE SODIUM PHOSPHATE; 64<br />

NEOMYCIN SULFATE<br />

Dexampex 64<br />

Dexasporin 63<br />

DEXCHLORPHENIRAMINE MALEATE 64<br />

Dexedrine 64<br />

DEXTROAMPHETAMINE SULFATE 64<br />

DEXTROMETHORPHAN HYDROBROMIDE; 65<br />

IODINATED GLYCEROL<br />

DEXTROMETHORPHAN HYDROBROMIDE; 65<br />

PROMETHAZINE HYDROCHLORIDE<br />

DEXTROSE 65,66<br />

Dextrose 5% in Lactated Ringers 35,36<br />

Dextrose 5% in Lactated Ringers 36<br />

with Potassium Chloride 10,20,30,40mEq<br />

Dextrose 5% in Ringers 35<br />

DEXTROSE; DOBUTAMINE HYDROCHLORIDE 66,67<br />

DEXTROSE; DOPAMINE HYDROCHLORIDE 67<br />

DEXTROSE; GENTAMICIN SULFATE 67<br />

DEXTROSE; HEPARIN SODIUM 67<br />

DEXTROSE; LIDOCAINE HYDROCHLORIDE 67,68<br />

DEXTROSE; MAGNESIUM CHLORIDE; 68<br />

POTASSIUM CHLORIDE; SODIUM<br />

ACETATE; SODIUM CHLORIDE;<br />

SODIUM GLUCONATE<br />

DEXTROSE; MANNITOL 68<br />

DEXTROSE; NITROGLYCERIN 68<br />

DEXTROSE; POTASSIUM CHLORIDE 68<br />

DEXTROSE; POTASSIUM 68,69,70<br />

CHLORIDE; SODIUM CHLORIDE<br />

DEXTROSE; SODIUM CHLORIDE 69<br />

DEXTROSE; THEOPHYLLINE 71,72<br />

Dextrostat 64<br />

Dey-Dose 137<br />

Dey-Lute 137<br />

DHC Plus 1<br />

Di-Atro 23<br />

Di-Metrex 161<br />

Diabeta 102<br />

Diabinese 49<br />

Dial 106<br />

Diamox 5<br />

Dianeal 137 w/Dextrose 35<br />

Dianeal Low Calcium w/Dextrose 35<br />

Dianeal PD-1 w/Dextrose 34<br />

Dianeal PD-2 w/Dextrose 34,35<br />

Dianeal PD-2 w/Dextrose, Low Calcium 34<br />

DIAZEPAM 72<br />

DIAZOXIDE 72,73<br />

Page<br />

Dibenil 77<br />

DICLOFENAC POTASSIUM 73<br />

DICLOFENAC SODIUM 73<br />

DICLOXACILLIN SODIUM 73<br />

DICYCLOMINE HYDROCHLORIDE 73,74<br />

DIENESTROL 74<br />

DIETHYLPROPION HYDROCHLORIDE 74<br />

DIETHYLSTILBESTROL 74<br />

DIFLORASONE DIACETATE 74<br />

DIFLUNISAL 74,75<br />

Digitek 75<br />

DIGOXIN 75<br />

Dihistine DH 47<br />

DIHYDROERGOTOXINE METHANESULFONATE 84<br />

Dilacor XR 76<br />

Dilantin Injection 164<br />

Dilantin 125 Suspension 164<br />

Dilaudid 117<br />

Dilaudid HP 117<br />

Dilaudid Hydrochloride 117<br />

DILTIAZEM HYDROCHLORIDE 75,76<br />

DIMENHYDRINATE 76<br />

Dimetane 30<br />

Dimetane-DC 30<br />

Dimetane-DX 30<br />

Dimetane-Ten 30<br />

Diphen 77<br />

DIPHENHYDRAMINE HYDROCHLORIDE 76,77<br />

Diphenhydramine Hydrochloride Preservative-Free 77<br />

DIPIVEFRIN HYDROCHLORIDE 77<br />

Diprivan 176<br />

Diprolene AF 27<br />

Diprosone 27<br />

DIPYRIDAMOLE 78<br />

DISOPYRAMIDE PHOSPHATE 78<br />

Ditate-DS 89<br />

Ditropan 156<br />

Diucardin 117<br />

Diulo 143<br />

Diuril 46<br />

DOBUTAMINE HYDROCHLORIDE 78<br />

Dobutrex 78<br />

Dolene 177<br />

Dolene AP-65 4<br />

Dolobid 75<br />

Dolophine 138<br />

Domeboro 6<br />

Donnatal 23<br />

DOPAMINE HYDROCHLORIDE 79<br />

Dopastat 79<br />

Dopram 79<br />

216


Page<br />

Doriden 102<br />

Doryx 81<br />

DOXAPRAM HYDROCHLORIDE 79<br />

DOXAZOSIN MESYLATE 79<br />

DOXEPIN HYDROCHLORIDE 79,80<br />

DOXORUBICIN HYDROCHLORIDE 80<br />

Doxy 100 81<br />

Doxy 200 81<br />

Doxy-Lemmon 81<br />

Doxy-Tabs 81<br />

Doxychel 80<br />

Doxychel Hyclate 81<br />

DOXYCYCLINE 80<br />

DOXYCYCLINE HYCLATE 80,81<br />

DOXYLAMINE SUCCINATE 81<br />

Dralzine 108<br />

Drisdol 84<br />

DROPERIDOL 81<br />

DROPERIDOL; FENTANYL CITRATE 81<br />

DTIC-Dome 61<br />

Duphalac 127<br />

Dura-Lutin 114<br />

Durabolin 148<br />

Duracillin A.S. 158<br />

Duradyne DHC 3<br />

Duramorph PF 146<br />

Duricef 41<br />

Duvoid 28<br />

DV Vaginal Cream 74<br />

Dyazide 112<br />

Dycill 73<br />

Dymelor 6<br />

Dynapen 73<br />

E-Base 86<br />

E-Z-EM Prep Lyte 165<br />

EC-Naprosyn 148<br />

Econochlor 44<br />

Econopred Plus 171<br />

E-Dec DM 39<br />

EDETATE DISODIUM 82<br />

Edex 9<br />

EDROPHONIUM CHLORIDE 82<br />

Edrophonium Chloride Preservative-Free 82<br />

E.E.S. 86,87<br />

E.E.S. 200 87<br />

E.E.S. 400 87<br />

Effer-K 167<br />

Elavil 12<br />

Eldecort 114<br />

Eldepryl 183<br />

Elimite 160<br />

Page<br />

Elixomin 194<br />

Elixophyllin 194<br />

EM-K-10% 169<br />

Embeline 54<br />

Embelene E 54<br />

Emgel 85<br />

Empirin #3 20<br />

Empracet with Codeine #3,4 2<br />

E-Mycin 86<br />

E-Mycin-E 87<br />

ENALAPRIL MALEATE 82<br />

ENALAPRIL MALEATE; HYDROCHLOROTHIAZIDE 82<br />

ENALIPRILAT 82,83<br />

Endep 12<br />

Endosol Extra 33<br />

Endrate 82<br />

Enduron 140<br />

ENFLURANE 83<br />

Enlon 82<br />

Enpresse 90<br />

Entex 104<br />

Enulose 127<br />

EPHEDRINE; HYDROXYZINE 83<br />

HYDROCHLORIDE; THEOPHYLLINE<br />

Epicort 114<br />

EPINEPHRINE HYDROCHLORIDE 83<br />

EPINEPHRINE; LIDOCAINE HYDROCHLORIDE 83,84<br />

Epitol 38<br />

EPOETIN ALPHA 84<br />

Epogen 84<br />

Equagesic 20<br />

Equanil 136<br />

Ercatab 33<br />

ERGOCALCIFEROL 84<br />

ERGOLOID MESYLATES 84,85<br />

Ergomar 85<br />

Ergostat 85<br />

ERGOTAMINE TARTRATE 85<br />

Ery-Ped 86,87<br />

Ery-Tab 86<br />

Eryc 85<br />

Eryc 125 85<br />

Eryc Sprinkles 85<br />

Erycette 86<br />

Eryderm 85<br />

Erygel 85<br />

Erymax 86<br />

Erypar 87<br />

Erythra-Derm 86<br />

Erythro-Statin 86<br />

Erythrocin 87<br />

217


Page<br />

Erythrocin Stearate 87<br />

ERYTHROMYCIN 85,86<br />

ERYTHROMYCIN ESTOLATE 86<br />

ERYTHROMYCIN ETHYLSUCCINATE 86,87<br />

ERYTHROMYCIN ETHYLSUCCINATE; 87<br />

SULFISOXAZOLE ACETYL<br />

ERYTHROMYCIN LACTOBIONATE 87<br />

ERYTHROMYCIN STEARATE 87,88<br />

Eryzole 87<br />

Esgic 1<br />

Esgic Plus 1<br />

Esidrix 109<br />

Eskalith 130<br />

ESTAZOLAM 88<br />

Estrace 88<br />

ESTRADIOL 88<br />

ESTRADIOL CYPIONATE 88<br />

ESTRADIOL CYPIONATE; TESTOSTERONE 88<br />

CYPIONATE<br />

ESTRADIOL VALERATE 88<br />

ESTRADIOL VALERATE; TESTOSTERONE 89<br />

ENANTHATE<br />

Estraguard 74<br />

ESTROPIPATE 89<br />

ETHAMBUTOL HYDROCHLORIDE 89<br />

ETHCHLORVYNOL 89<br />

ETHINYL ESTRADIOL; ETHYNODIOL 89<br />

DIACETATE<br />

ETHINYL ESTRADIOL; LEVONORGESTREL 90<br />

ETHINYL ESTRADIOL; NORETHINDRONE 90<br />

ETHINYL ESTRADIOL: NORETHINDRONE 90<br />

ACETATE<br />

ETHINYL ESTRADIOL; NORGESTREL 90<br />

ETHOSUXIMIDE 91<br />

Ethrane 83<br />

Ethril 250 87<br />

Ethril 500 87<br />

ETODOLAC 91<br />

ETOMIDATE 91<br />

ETOPOSIDE 91,92<br />

Eulexin 97<br />

Eurax 59<br />

Evalose 127<br />

Exsel 183<br />

FAMOTIDINE 92<br />

Famotidine Preservative-Free 92<br />

Fastin 162<br />

Feldene 165<br />

Femcet 1<br />

FENOPROFEN CALCIUM 92,93<br />

FENTANYL CITRATE 93<br />

Page<br />

Fentanyl Citrate Preservative-Free 93<br />

Ferndex 64<br />

Fioricet 1<br />

Fiorinal 19<br />

Fiorinal with Codeine #3 19<br />

Flagyl 144<br />

Flagyl I.V. 144<br />

Flagyl I.V. RTU 144<br />

FLECAINIDE ACETATE 93<br />

Flexeril 60<br />

Flexicort 114<br />

FLOXURIDINE 93<br />

Flumadine 182<br />

Fluocet 94<br />

FLUOCINOLONE ACETONIDE 93,94<br />

FLUOCINONIDE 94<br />

Fluonid 94<br />

FLUOROMETHALONE 95<br />

Fluor-Op 95<br />

FLUOROURACIL 95<br />

Fluothane 106<br />

Fluotrex 94<br />

FLUOXETINE HYDROCHLORIDE 95,96<br />

FLUPHENAZINE DECANOATE 96<br />

FLUPHENAZINE HYDROCHLORIDE 96<br />

FLURANDRENOLIDE 96<br />

FLURAZEPAM HYDROCHLORIDE 96,97<br />

FLURBIPROFEN 97<br />

FLURBIPROFEN SODIUM 97<br />

FLUTAMIDE 97<br />

Flutex 200<br />

FLUVOXAMINE MALEATE 97<br />

FML 95<br />

Folex 140<br />

Folex PFS 140<br />

FOLIC ACID 98<br />

Folicet 98<br />

Follutein 103<br />

Folvite 98<br />

Forane 123<br />

Forbaxin 139<br />

Fortaz 42<br />

FSH; LH 130<br />

FUDR 93<br />

Fulvicin P/G 103<br />

Fulvicin U/F 103<br />

Fungizone 14<br />

Furacin 152<br />

Furadantin 151<br />

Furalan 151<br />

FUROSEMIDE 98,99<br />

218


Page<br />

GAMMA BENZENE HEXACHLORIDE 130<br />

Gamene 130<br />

Gantanol 189<br />

Gantanol DS 189<br />

Gantrisin 191<br />

Garamycin 100<br />

GEMFIBROZIL 99<br />

Gencept 0.5/35 90<br />

Gencept 1/35 90<br />

Gencept 10/11 90<br />

Generlac 127<br />

Genoptic 100<br />

Genora 0.5/35 90<br />

Gentacidin 100<br />

Gentafair 100<br />

GENTAMICIN SULFATE 99,100<br />

GENTAMICIN SULFATE; SODIUM CHLORIDE 100,101<br />

Gen-K 168<br />

Gen-Xene 55<br />

Geopen 38<br />

Gerimal 85<br />

Germa-Medica "MG" 106<br />

GLIPIZIDE 101<br />

GLUCAGON HYDROCHLORIDE 101<br />

Glucamide 49<br />

Glucophage 138<br />

GLUTETHIMIDE 102<br />

Glucotrol 101<br />

GLYBURIDE 102<br />

GLYBURIDE, MICRONIZED 102<br />

GLYCINE 102<br />

Glycoprep 165<br />

GLYCOPYRROLATE 102,103<br />

Glycort 114<br />

Glynase 102<br />

Go-Evac 166<br />

Golytely 166<br />

GONADOTROPIN CHORIONIC 103<br />

GRAMICIDIN; NEOMYCIN SULFATE; 103<br />

POLYMYXIN B SULFATE<br />

Grifulvin V 103<br />

Grisactin 103<br />

Grisactin Ultra 103<br />

GRISEOFULVIN MICROCRYSTALLINE 103<br />

GRISEOFULVIN ULTRAMICROCRYSTALLINE 103<br />

Gris-PEG 103<br />

GUAIFENESIN; HYDROCODONE 104<br />

BITARTRATE; PSEUDOEPHEDRINE<br />

HYDROCHLORIDE<br />

Page<br />

GUAIFENESIN; PHENYLEPHRINE 104<br />

HYDROCHLORIDE; PHENYLPROPANOLAMINE<br />

HYDROCHLORIDE<br />

GUAIFENESIN; THEOPHYLLINE 104<br />

GUANABENZ ACETATE 104<br />

GUANETHIDINE MONOSULFATE 105<br />

GUANFACINE HYDROCHLORIDE 105<br />

Guiatuss AC 57<br />

Guiatus DAC 57<br />

Gyne-Sulf 188<br />

Halcion 201<br />

Haldol 105,106<br />

Haldol Decanoate 105<br />

HALOPERIDOL 105<br />

HALOPERIDOL DECANOATE 105<br />

HALOPERIDOL LACTATE 105,106<br />

HALOTHANE 106<br />

HC 114<br />

HC #1 114<br />

HC #4 114<br />

H Cort 114<br />

H.E.A. 85<br />

Hemsol-HC 116<br />

HEPARIN SODIUM 106,107<br />

Heparin Sodium Preservative-Free 106<br />

HEPARIN SODIUM; SODIUM CHLORIDE 107<br />

Hep Flush 106<br />

Hep-Lock, Hep Lock PF 106<br />

Hep-Lock, Hep Lock U/P 106<br />

Heptalac 127<br />

Herplex Liquifilm 119<br />

Hexa-Betalin 179<br />

HEXACHLOROPHENE 107<br />

Hexadrol 62,63<br />

Hexa-Germ 107<br />

Hexascrub 107<br />

HiCor 114<br />

Hiprex 138<br />

Histafed 179<br />

Histatan 48<br />

HOMATROPINE HYDROBROMIDE 107<br />

HOMATROPINE METHYLBROMIDE; 107<br />

HYDROCODONE BITARTRATE<br />

Humatin 157<br />

Humegon 135<br />

Hycodan 107<br />

Hycomine 113<br />

Hycophen 113<br />

Hydeltrasol 172<br />

Hydergine 85<br />

Hydral 108<br />

219


Page<br />

HYDRALAZINE HYDROCHLORIDE 108<br />

HYDRALAZINE HYDROCHLORIDE; 108<br />

HYDROCHLOROTHIAZIDE<br />

Hydramine 77<br />

Hydra-Zide 108<br />

Hydrea 118<br />

Hydrocet 3<br />

HYDROCHLOROTHIAZIDE 108,109<br />

HYDROCHLOROTHIAZIDE; LABETALOL 110<br />

HYDROCHLOROTHIAZIDE; LISINOPRIL 110<br />

HYDROCHLOROTHIAZIDE; METHYLDOPA 110,111<br />

HYDROCHLOROTHIAZIDE; 111<br />

PROPRANOLOL HYDROCHLORIDE<br />

HYDROCHLOROTHIAZIDE; 111,112<br />

SPIRONOLACTONE<br />

HYDROCHLOROTHIAZIDE; TRIAMTERENE 112<br />

HYDROCODONE BITARTRATE; 112,113<br />

PHENYLPROPANOLAMINE HYDROCHLORIDE<br />

HYDROCODONE BITARTRATE; 113<br />

PSEUDOEPHEDRINE HYDROCHLORIDE<br />

Hydrocodone Compound 107<br />

HYDROCORTISONE 113,114<br />

Hydrocortisone in Adsorbase 114<br />

HYDROCORTISONE; 115<br />

NEOMYCIN SULFATE;<br />

POLYMYXIN B SULFATE<br />

HYDROCORTISONE; POLYMYXIN B SULFATE 115<br />

HYDROCORTISONE; UREA 115<br />

HYDROCORTISONE ACETATE 115,116<br />

HYDROCORTISONE ACETATE; NEOMYCIN 116<br />

SULFATE<br />

HYDROCORTISONE ACETATE; UREA 116<br />

HYDROCORTISONE SODIUM PHOSPHATE 116<br />

HYDROCORTISONE SODIUM SUCCINATE 116<br />

HYDROCORTISONE VALERATE 116<br />

Hydrocortone 116<br />

Hydro-D 109<br />

HydroDIURIL 109<br />

HYDROFLUMETHIAZIDE 117<br />

HYDROMORPHONE HYDROCHLORIDE 117<br />

Hydropane 107<br />

Hydrophed 113<br />

Hydrophed Expectorant 104<br />

Hydro-ride 10<br />

Hydrotex 114<br />

HYDROXOCOBALAMIN 117<br />

Hydroxomin 117<br />

HYDROXYCHLOROQUINE SULFATE 117<br />

HYDROXYPROGESTERONE CAPROATE 117<br />

HYDROXYUREA 118<br />

HYDROXYZINE HYDROCHLORIDE 118<br />

Page<br />

HYDROXYZINE PAMOATE 118,119<br />

Hygroton 49<br />

Hymac 114<br />

Hyperstat 73<br />

Hy-Phen 3<br />

Hytone 114<br />

Hytrin 192<br />

Hytussin 104<br />

Hyzyd 123<br />

Ibu 119<br />

IBUPROFEN 119<br />

Ibuprohm 119<br />

Ibu-Tab 119<br />

IDOXURIDINE 119<br />

I-Homatropine 107<br />

I-Phrine 162<br />

I-Tropine 22<br />

Ilosone 86<br />

Ilotycin 85,86<br />

Imdur 124<br />

IMIPRAMINE HYDROCHLORIDE 120<br />

Imodium 131<br />

Imuran 24<br />

INAMRINONE LACTATE 120<br />

Inapsine 81<br />

INDAPAMIDE 120<br />

Inderal 178<br />

Inderal LA 178<br />

Inderide 40/25 111<br />

Inderide 80/25 111<br />

Indocin 121<br />

Indocin-SR 121<br />

Indo-Lemmon 121<br />

INDOMETHACIN 120,121<br />

Inflamase Mild 172<br />

Inflamase Forte 172<br />

Innofem 88<br />

Innovar 81<br />

Inocor 120<br />

Inpersol-LC/LM with Dextrose 35<br />

Intal 58<br />

Intensol Chlorpromazine 48<br />

Intensol Methadone 138<br />

Intensol Thioridazine 196<br />

Intensol Thiothixene 197<br />

Intralipid 10% 187<br />

Intralipid 20% 187<br />

Intralipid 30% 187<br />

Intropin 79<br />

Invagesic 19<br />

Invagesic Forte 19<br />

220


Page<br />

IODINATED GLYCEROL 121<br />

Iogan 121<br />

Iogan DM 65<br />

Ionamin-30 162<br />

IOPAMIDOL 122<br />

Iopamidol-200 122<br />

Iopamidol-250 122<br />

Iopamidol-300 122<br />

Iopamidol-370 122<br />

Iophen C 57<br />

Iophen DM 65<br />

Iophen Elixir 121<br />

Iotuss-C 57<br />

Iotuss-DM 65<br />

Iotuss Elixir, Solution 121<br />

Iotuss Solution 121<br />

IPRATROPIUM BROMIDE 122<br />

Irrigating Solution G 52<br />

Ismelin 105<br />

ISMO 124<br />

Isocaine HCl 135<br />

Isocaine HCl w/Levonordefrin 128<br />

ISOETHARINE HYDROCHLORIDE 122,123<br />

ISOFLURANE 123<br />

Isolyte S 132<br />

Isolyte S w/Dextrose 5% 68<br />

ISONIAZID 123<br />

ISOPROTERENOL HYDROCHLORIDE 124<br />

Isoptin 205<br />

Isoptin SR 205<br />

Isopto Atropine 22<br />

Isopto Carpine 164<br />

Isopto Cetamide 188<br />

Isopto Homatropine 107<br />

Isordil 124<br />

Isordil Tembid 124<br />

ISOSORBIDE DINITRATE 124<br />

ISOSORBIDE MONONITRATE 124<br />

Isovue-200 122<br />

Isovue-250 122<br />

Isovue-300 122<br />

Isovue-370 122<br />

Isuprel 124<br />

Janimine 120<br />

K + 8 169<br />

K + Care 168<br />

K + Care ET 167<br />

K-Dur 169<br />

Kainair 176<br />

KANAMYCIN SULFATE 124,125<br />

Kantrex 125<br />

Page<br />

Kaochlor 10% 169<br />

Kaochlor SF 169<br />

Kaon 10% 171<br />

Kaon Cl 20% 169<br />

Kappadione 134<br />

Kato 168<br />

Kay Ciel 168,169<br />

Kayexalate 186<br />

Keflet 43<br />

Keflex 43<br />

Keflin 44<br />

Kefurox 43<br />

Kefzol 42<br />

Kenac 200<br />

Kenalog 200<br />

Kenalog-H 200<br />

Kenalog in Orabase 200<br />

Kerlone 28<br />

Kesso-Gesic 177<br />

Ketalar 125<br />

KETAMINE HYDROCHLORIDE 125<br />

KETOCONAZOLE 125<br />

KETOPROFEN 125<br />

KETOROLAC TROMETHAMINE 126<br />

Ketorolac Tromethamine Preservative-Free 126<br />

K-Lease 168<br />

K-Lor 168<br />

K-Lyte 167<br />

Klebcil 125<br />

Klonopin 55<br />

Klor-10% 169<br />

Klor-Con 167,168,169<br />

Klor-Con 20% 169<br />

Klor-Con EF 167<br />

Klor-Con M10 169<br />

Klor-Con M20 169<br />

Kloromin 47<br />

Klorvess 169<br />

Korostatin 154<br />

Kwell 130<br />

LABETALOL HYDROCHLORIDE 126<br />

Lac-Hydrin 13<br />

Lactated Ringer's 37<br />

LACTULOSE 126,127<br />

Laniazid 123<br />

Lanophyllin 194<br />

Lanorinal 19<br />

Lanoxin 75<br />

Lantrisul 203<br />

Lariam 134<br />

Larotid 14<br />

221


Page<br />

Laryng-O-Jet 129<br />

Laryngotracheal Anes<strong>the</strong>sia Kit 129<br />

Lasix 99<br />

Laxilose 127<br />

Ledercillin-VK 159<br />

LEUCOVORIN CALCIUM 127<br />

Leucovorin Calcium Preservative-Free 127<br />

LEUPROLIDE ACETATE 128<br />

Leustatin 52<br />

Levo-Dromoran 128<br />

LEVOBUNOLOL HYDROCHLORIDE 128<br />

LEVOCARNITINE 128<br />

LEVONORDEFRIN; MEPIVICAINE 128<br />

HYDROCHLORIDE<br />

Levora 0.15/30 90<br />

LEVORPHANOL TARTRATE 128<br />

Librium 45<br />

Lidex 94<br />

Lidex-E 94<br />

LIDOCAINE 128<br />

LIDOCAINE HYDROCHLORIDE 129<br />

Lidocaine Hydrochloride Preservative-Free 129<br />

Lidocaton 84,129<br />

Lidopen 129<br />

Limbitrol 12<br />

Limbitrol DS 12<br />

Lincocin 130<br />

LINCOMYCIN 130<br />

LINDANE 130<br />

Lioresal 25<br />

LIOTHYRONINE SODIUM 130<br />

Lipo-Hepin 106<br />

Liposyn III 10% 187<br />

Liposyn III 20% 187<br />

Liposyn III 30% 187<br />

Liquaemin Sodium 106<br />

LISINOPRIL 130<br />

Lithane 130<br />

LITHIUM CARBONATE 130<br />

LITHIUM CITRATE 131<br />

Lithonate 130,131<br />

Lithotabs 130<br />

Lo/Ovral 90<br />

Lo-Trol 23<br />

Locholest 50<br />

Locholest Light 50<br />

Lodine 91<br />

Lodine XL 91<br />

Loestrin FE 1/20 90<br />

Loestrin FE 1.5/30 90<br />

Lofene 23<br />

Page<br />

Logen 23<br />

Lomanate 23<br />

Lomotil 23<br />

Loniten 145<br />

Lonox 23<br />

LOPERAMIDE HYDROCHLORIDE 131<br />

Lopid 99<br />

Lopressor 144<br />

Lopurin 9<br />

Loraz 131<br />

LORAZEPAM 131<br />

Lorcet-HD 3<br />

Lortab 3<br />

Lotrimin 56<br />

Lotrisone 27<br />

LOVASTATIN 131<br />

Low-Ogestrel 90<br />

Low-Quel 23<br />

LOXAPINE SUCCINATE 131<br />

Loxitane 131<br />

Lozol 120<br />

LTA II Kit 129<br />

Ludiomil 133<br />

Lupron 128<br />

Luvox 97<br />

Lygen 45<br />

Lyophilized Cytoxan 60<br />

Lyphocin 204<br />

Macrodantin 152<br />

MAGNESIUM CHLORIDE; POTASSIUM 132<br />

CHLORIDE; SODIUM ACETATE;<br />

SODIUM CHLORIDE; SODIUM GLUCONATE<br />

MAGNESIUM SULFATE 132<br />

Maldec 40<br />

Maldec DM Syrup 39<br />

MANNITOL 132<br />

MAPROTILINE HYDROCHLORIDE 133<br />

Marax DF 83<br />

Marcaine Hydrochloride 31<br />

Marcaine Hydrochloride with Epinephrine 31<br />

Marcaine Hydrochloride Preservative-Free 31<br />

Marcaine HCl with Epinephrine Preservative-Free 31<br />

Maxidex 62,64<br />

Maxitrol 63<br />

Maxolon 143<br />

Maxzide 112<br />

Maxzide-25 112<br />

MEBENDAZOLE 133<br />

MECLIZINE HYDROCHLORIDE 133,134<br />

MECLOFENAMATE SODIUM 134<br />

Meclomen 134<br />

222


Page<br />

Medigesic Plus 1<br />

Medrol 142<br />

MEDROXYPROGESTERONE ACETATE 134<br />

MEFLOQUINE HYDROCHLORIDE 134<br />

Mefoxin 42<br />

MEGESTROL ACETATE 134<br />

Megace 134<br />

Melfiat 161<br />

Mellaril 196<br />

MENADIOL SODIUM PHOSPHATE 134<br />

MENOTROPINS 135<br />

MEPERIDINE HYDROCHLORIDE 135<br />

Meperidine Hydrochloride Preservative-Free 135<br />

MEPIVICAINE HYDROCHLORIDE 135,136<br />

Mepriam 136<br />

Mepro-Aspirin 20<br />

MEPROBAMATE 136<br />

MESNA 137<br />

Mesnex 137<br />

Mestinon 179<br />

MESTRANOL; NORETHINDRONE 137<br />

Metadate ER 141<br />

Metandren 142<br />

METAPROTERENOL SULFATE 137<br />

METARAMINOL BITARTRATE 137<br />

METFORMIN HYDROCHLORIDE 138<br />

METHADONE HYDROCHLORIDE 138<br />

Methadose 138<br />

Methampex 138<br />

METHAMPHETAMINE HYDROCHLORIDE 138<br />

METHAZOLAMIDE 138<br />

METHENAMINE HIPPURATE 138<br />

METHIMAZOLE 139<br />

METHOCARBAMOL 139<br />

METHOTREXATE SODIUM 139,140<br />

Methotrexate Sodium Preservative-Free 140<br />

METHSCOPOLAMINE BROMIDE 140<br />

METHYCLOTHIAZIDE 140<br />

METHYLDOPA 140,141<br />

METHYLDOPATE HYDROCHLORIDE 141<br />

Methylin 141<br />

Methylin ER 141<br />

METHYLPHENIDATE HYDROCHLORIDE 141<br />

METHYLPREDNISOLONE 141,142<br />

METHYLPREDNISOLONE 142<br />

SODIUM SUCCINATE<br />

METHYLTESTOSTERONE 142<br />

Meticorten 173<br />

Metimyd 171,172<br />

METIPRANOLOL HYDROCHLORIDE 142<br />

METOCLOPRAMIDE HYDROCHLORIDE 142,143<br />

Page<br />

METOCURINE IODIDE 143<br />

METOLAZONE 143<br />

METOPROLOL TARTRATE 143,144<br />

Metra 161<br />

Metro I.V. 144<br />

Metromidol 144<br />

METRONIDAZOLE 144<br />

Metryl 144<br />

Metubine Iodide 143<br />

Mevacor 131<br />

Mexate 140<br />

Mexate-AQ 140<br />

Mexate-AQ Preserved 140<br />

Mexetil 144<br />

MEXILETINE HYDROCHLORIDE 144<br />

Miacalcin 33<br />

MICONAZOLE NITRATE 144<br />

Micort HC 116<br />

Micrainin 20<br />

Micro-K 168<br />

Micro-K 10 168<br />

Microgestin FE 1/20 90<br />

Microgestin FE 1.5/30 90<br />

Micronase 102<br />

Microzide 109<br />

Midamor 10<br />

MIDAZOLAM 145<br />

Milophene 54<br />

Miltown 136<br />

Minipress 171<br />

Minitran 152<br />

Minocin 145<br />

MINOCYCLINE HYDROCHLORIDE 145<br />

Minodyl 145<br />

MINOXIDIL 145<br />

Miostat 38<br />

MITOMYCIN 145<br />

Modicon 90<br />

Moduretic 10<br />

Monistat 3 144<br />

Monodox 80<br />

Monoket 124<br />

MORPHINE SULFATE 145,146<br />

Motrin 119<br />

MS Contin 146<br />

MS/L 146<br />

MSIR 146<br />

Mucomyst 6<br />

Mucosil 10 6<br />

Mucosil 20 6<br />

Multifuge 165<br />

223


Page<br />

Muro's Opcon A 148<br />

Mutamycin 145<br />

M.V.C. 9+3 17<br />

M.V.C. Plus 17<br />

M.V.I. - 12 17<br />

Myambutol 89<br />

Mybanil 30<br />

Mycelex 56<br />

Mychel 44<br />

Mychel-S 45<br />

Mycifradin 149<br />

Mycodone 107<br />

Mycolog-II 154<br />

Mycostatin 154<br />

Myco-Triacet II 154<br />

Mydfrin 162<br />

Mydriacil 203<br />

Mydriafair 203<br />

Myfed 179<br />

Myidil 202<br />

Mykacet 154<br />

Mykinac 154<br />

Mylaramine 64<br />

Mymethasone 62<br />

Mymethazine Fortis 175<br />

Myotonachol 28<br />

Myphetane DC 30<br />

Myphetane DX 30<br />

Myproic Acid 204<br />

Mysoline 173<br />

Mytrex F 154<br />

N.E.E. 1/35 90<br />

NABUMETONE 146<br />

NADOLOL 146<br />

Nafazair 148<br />

Nafcil 146<br />

NAFCILLIN SODIUM 146<br />

NALBUPHINE HYDROCHLORIDE 146,147<br />

Naldecon Pediatric Drops 47<br />

Naldecon Pediatric Syrup 47<br />

Naldecon Syrup 47<br />

Nalfon 93<br />

NALIDIXIC ACID 147<br />

Nallpen 146<br />

NALOXONE HYDROCHLORIDE 147<br />

NALOXONE HYDROCHLORIDE; 147<br />

PENTAZOCINE HYDROCHLORIDE<br />

Nalphen 47<br />

Nalphen Pediatric Drops 47<br />

Nalphen Pediatric Syrup 47<br />

NALTREXONE HYDROCHLORIDE 147<br />

Page<br />

NANDROLONE DECANOATE 147<br />

NANDROLONE PHENPROPIONATE 148<br />

NAPHAZOLINE HYDROCHLORIDE 148<br />

NAPHAZOLINE HYDROCHLORIDE; 148<br />

PHENIRAMINE MALEATE<br />

Naphcon A 148<br />

Naphcon Forte 148<br />

Naphoptic A 148<br />

Naprelan 148<br />

Naprosyn 148<br />

NAPROXEN 148<br />

NAPROXEN SODIUM 149<br />

Narcan 147<br />

Navane 196,197<br />

Nebcin 198<br />

Necon 1/35 90<br />

Necon 1/50 137<br />

NegGram 147<br />

Nelova 90<br />

Nelova 7/14 90<br />

Nelova 10/11 90<br />

Nembutal Sodium 160<br />

Neo-Calglucon 37<br />

Neo-Cortef 116<br />

Neo-Dexair 64<br />

Neo-Otosol-HC 115<br />

Neo-Polycin 103<br />

Neo-Rx 149<br />

Neo-Synephrine 162<br />

Neobiotic 149<br />

Neodecadron 64<br />

NEOMYCIN SULFATE 149<br />

NEOMYCIN SULFATE; POLYMYXIN B 150<br />

SULFATE<br />

Neosar 60<br />

Neosporin G.U. Irrigant 150<br />

Neosporin Ophthalmic Ointment 25<br />

Neosporin Ophthalmic Solution 103<br />

Neotrizine 203<br />

Neptazane 138<br />

Nesacaine-MPF 46<br />

Neuramate 136<br />

NIACIN 150<br />

Niacor 150<br />

NICARDIPINE HYDROCHLORIDE 150<br />

Nicolar 150<br />

NICOTINE 150<br />

NICOTINIC ACID 150<br />

Nicotrol 150<br />

Nifedical XL 151<br />

NIFEDIPINE 151<br />

224


Page<br />

Nilstat 154<br />

Nipride 186<br />

Nitro-Bid 152<br />

Nitro-DUR 152<br />

NITROFURANTOIN 151<br />

NITROFURANTOIN MACROCRYSTALLINE 151,152<br />

NITROFURAZONE 152<br />

NITROGLYCERIN 152<br />

Nitro I.V. 152<br />

Nitrol 152<br />

Nitropress 186<br />

Nitrostat Injection 152<br />

Nizoral 125<br />

Noctec 44<br />

Nogenic HC 114<br />

Nolvadex 192<br />

Norcept E 1/35 90<br />

Norcet 3<br />

Norco 3<br />

Norcuron 204<br />

Nordette 90<br />

Norethin 1/35E 90<br />

Norethin 1/50M 137<br />

NORETHINDRONE ACETATE 153<br />

Norflex 155<br />

Norgesic 19<br />

Norgesic Forte 19<br />

Norinyl 1+35 90<br />

Norinyl 1+50 137<br />

Norinyl 1+80 137<br />

Norlutate 153<br />

Normodyne 126<br />

Normozide 110<br />

Norpace 78<br />

Norpace CR 78<br />

Norpramin 61<br />

Nortrel 0.5/35 90<br />

Nortrel 1/35 90<br />

NORTRIPTYLINE HYDROCHLORIDE 153<br />

Novadyne DH Liquid 47<br />

Novadyne Expectorant 57<br />

Novahistine DH Liquid 47<br />

Novahistine Expectorant 57<br />

Novocain 174<br />

Nubain 147<br />

Nutracort 114<br />

Nutrilipid 10% 187<br />

Nutrilipid 20% 187<br />

Nydrazid 123<br />

NYSTATIN 153,154<br />

NYSTATIN; TRIAMCINOLONE ACETONIDE 154<br />

Page<br />

Nystex 154<br />

Nystop 154<br />

Obezine 161<br />

Obestin-30 162<br />

Oby-Trim 162<br />

Octamide PFS 143<br />

Octocaine 84<br />

Ocufen 97<br />

Ocumycin 25<br />

Ocupres 40<br />

Ocusulf-10 188<br />

Ocusulf-30 188<br />

Ocutricin 25,103<br />

Ocutricin HC 25,115<br />

Ocu-Tropine 22<br />

Ogen 89<br />

Ogestrel 90<br />

OMEPRAZOLE 154<br />

Omnipen 16<br />

Omnipen-N 15<br />

Ona-Mast 162<br />

Oncovin 206<br />

Opcon 148<br />

Opcon-A 148<br />

Ophthaine 176<br />

Oph<strong>the</strong>tic 176<br />

Ophthochlor 45<br />

Opticrom 58<br />

Optipranolol 142<br />

Optomycin 45<br />

Oracort 200<br />

Oralone 200<br />

Orasone 173<br />

Oretic 109<br />

Organidin Drops 121<br />

Organidin Elixir 121<br />

Orgatrax 118<br />

Oridol C 57<br />

Oridol Elixir 121<br />

Oridol Solution 121<br />

Orinase 198<br />

Orlex 5<br />

Orlex HC 6<br />

Ornade 48<br />

ORPHENADRINE CITRATE 155<br />

Orphengesic 19<br />

Ortho-Cept 62<br />

Ortho-Est 89<br />

Ortho-Novum 1/35 90<br />

Ortho-Novum 1/50 137<br />

Ortho-Novum 1/80 137<br />

225


Page<br />

Ortho-Novum 7/14 90<br />

Ortho-Novum 10/11 90<br />

Orudis 125<br />

Oruvail 125<br />

Osmitrol 133<br />

Oticair 115<br />

Oto Ear Drops 17<br />

Otobione 115<br />

Otobiotic 115<br />

Otocort 115<br />

Ovral 90<br />

OXACILLIN SODIUM 155<br />

OXAPROZIN 155<br />

OXAZEPAM 156<br />

OXTRIPHYLLINE 156<br />

Oxy-Kesso-Tetra 157<br />

OXYBUTYNIN CHLORIDE 156<br />

Oxycet 4<br />

Oxycodone 5/APAP 500 4<br />

OXYTETRACYCLINE HYDROCHLORIDE 157<br />

OXYTOCIN 157<br />

P.A.S. Sodium 183<br />

Pacerone 11<br />

PACLITAXEL 157<br />

Pamelor 153<br />

Pamine 140<br />

PANCURONIUM BROMIDE 157<br />

Panheprin 107<br />

Panmycin 194<br />

Panoxyl 5 26<br />

Panoxyl 10 26<br />

Panoxyl Aq 2.5 26<br />

Panoxyl Aq 5 26<br />

Panoxyl Aq 10 26<br />

Papa-Deine #3 2<br />

Papa-Deine #4 2<br />

Paracaine 176<br />

Paraflex 50<br />

Parafon Forte DSC 50<br />

Parasal Sodium 183<br />

Paregoric Tincture 9<br />

Parlodel 29<br />

PAROMOMYCIN SULFATE 157<br />

Pathocil 73<br />

Pavulon 157<br />

PBZ 202<br />

Pediamycin 87<br />

Pediatric LTA Kit 129<br />

Pediazole 87<br />

Pediotic Cortisporin 115<br />

PEG-Lyte 166<br />

Page<br />

PEMOLINE 157<br />

Pen-Vee K 159<br />

Penapar-VK 159<br />

Penbritin 16<br />

Penbritin-S 15<br />

Penecort 114<br />

PENICILLIN G POTASSIUM 157,158<br />

PENICILLIN G PROCAINE 158<br />

PENICILLIN V POTASSIUM 158,159<br />

Pentacarinat 159<br />

Pentam 300 159<br />

Pentacef 42<br />

PENTAMIDINE ISETHIONATE 159<br />

Pentids 200 158<br />

Pentids 250 158<br />

Pentids 400 158<br />

Pentids 800 158<br />

PENTOBARBITAL SODIUM 159,160<br />

Pentolair 60<br />

PENTOXIFYLLINE 160<br />

Pepcid 92<br />

Percocet 4<br />

Percodan 21<br />

Percodan-Demi 21<br />

Pergonal 135<br />

Periactin 61<br />

Peridex 45<br />

PerioGard 45<br />

PERMETHRIN 160<br />

Permetil 96<br />

PERPHENAZINE 160<br />

Persa-Gel 26<br />

Persa-Gel W 5% 26<br />

Persa-Gel W 10% 26<br />

Persantine 78<br />

Pfizer-E 88<br />

Pfizerpen 158<br />

Pfizerpen-A 16<br />

Pfizerpen-AS 158<br />

Pfizerpen-G 158<br />

Pfizerpen-VK 159<br />

Phenaphen No. 3 w/Codeine 2<br />

Phenaphen-650 w/Codeine 2<br />

Phenazine 161<br />

Phenazine-35 161<br />

PHENDIMETRAZINE TARTRATE 161<br />

Phenergan Fortis 175<br />

Phenergan Injection 175<br />

Phenergan Syrup 175<br />

Phenergan Tablet 175<br />

Phenergan w/Codeine 58<br />

226


Page<br />

Phenergan VC 163<br />

Phenergan VC w/Codeine 57<br />

Phenergan w/Dextromethorphan 65<br />

PHENOBARBITAL 161<br />

Phenoptic 162<br />

PHENTERMINE HYDROCHLORIDE 161,162<br />

PHENTERMINE RESIN COMPLEX 162<br />

PHENTOLAMINE MESYLATE 162<br />

PHENYLEPHRINE HYDROCHLORIDE 162<br />

PHENYLEPHRINE HYDROCHLORIDE; 163<br />

PROMETHAZINE HYDROCHLORIDE<br />

Phenylhistine DH 47<br />

Phenylhistine Expectorant 57<br />

PHENYTOIN SODIUM INJECTION 164<br />

PHENYTOIN SUSPENSION 164<br />

Pherazine w/Codeine 58<br />

Pherazine DM 65<br />

Pherazine VC 163<br />

Pherazine VC w/Codeine 57<br />

pHisoHex 107<br />

pHisoscrub 107<br />

Phrenilin 1<br />

Phrenilin Forte 1<br />

Physiolyte 132<br />

Pilocar 164<br />

PILOCARPINE HYDROCHLORIDE 164<br />

PINDOLOL 164<br />

PIPERAZINE CITRATE 164,165<br />

PIPERAZINE ESTRONE CITRATE 89<br />

PIROXICAM 165<br />

Pitocin 157<br />

Placidyl 89<br />

Plaquenil 117<br />

Plasma-Lyte 148 132<br />

Plasma-Lyte 148 w/Dextrose 5% 68<br />

Plasma-Lyte A 132<br />

Platinol 52<br />

Platinol-AQ 52<br />

Plegine 161<br />

Plegisol 36<br />

Polaramine 64<br />

Polocaine 135<br />

Polocaine w/ Levonordefrin 128<br />

Polocaine-MPF 136<br />

Poly-Rx 166<br />

Poly-Vi-Flor 18<br />

Poly-Vi-Flor with Iron 17<br />

Poly Vitamin Drops with Fluoride 0.25mg 18<br />

Poly Vitamin Drops with Fluoride 0.5mg 18<br />

Polycillin 16<br />

Polycillin-N 15<br />

Page<br />

Polycillin-PRB 15<br />

POLYETHYLENE GLYCOL 3350; 165,166<br />

POTASSIUM CHLORIDE; SODIUM<br />

BICARBONATE; SODIUM CHLORIDE;<br />

SODIUM SULFATE, ANHYDROUS<br />

Polymox 14<br />

POLYMYXIN B SULFATE 166<br />

POLYMYXIN B SULFATE; 167<br />

TRIMETHOPRIM SULFATE<br />

Polysporin 25<br />

Polytrim 167<br />

Pontocaine 193<br />

Portalac 127<br />

POTASSIUM BICARBONATE 167<br />

POTASSIUM CHLORIDE 167,168,169<br />

POTASSIUM CHLORIDE; SODIUM CHLORIDE 170<br />

POTASSIUM GLUCONATE 170,171<br />

Potsalan 169<br />

PRALIDOXIME CHLORIDE 171<br />

PRAZOSIN HYDROCHLORIDE 171<br />

Pre-Pred 171<br />

Pred Forte 171<br />

Predair 172<br />

Predair Forte 172<br />

Predamide 172<br />

Prednicen-N 173<br />

PREDNISOLONE 171<br />

PREDNISOLONE ACETATE 171<br />

PREDNISOLONE ACETATE; 171<br />

SULFACETAMIDE SODIUM<br />

PREDNISOLONE SODIUM PHOSPHATE 172<br />

PREDNISOLONE SODIUM PHOSPHATE; 172<br />

SULFACETAMIDE SODIUM<br />

PREDNISONE 172,173<br />

Predsulfair 171,172<br />

Predsulfair II 172<br />

Pregnyl 103<br />

Prelone 171<br />

Presamine 120<br />

Prevalite 50<br />

Prilosec 154<br />

PRIMIDONE 173<br />

Principen 15,16<br />

Prinivil 130<br />

Prinzide 10 - 12.5 110<br />

Prinzide 20 - 12.5 110<br />

Prinzide 20 - 25 110<br />

Probalan 173<br />

Probampacin 15<br />

PROBENECID 173<br />

PROCAINAMIDE HYDROCHLORIDE 173,174<br />

227


Page<br />

PROCAINE HYDROCHLORIDE 174<br />

PROCAINE HYDROCHLORIDE; 174<br />

TETRACYCLINE HYDROCHLORIDE<br />

Procan 174<br />

Procan-SR 174<br />

Procapan 174<br />

Procardia 151<br />

Procardia XL 151<br />

PROCHLORPERAZINE 174<br />

PROCHLORPERAZINE EDISYLATE 174,175<br />

PROCHLORPERAZINE MALEATE 175<br />

Procrit 84<br />

Proctocort 114<br />

PROGESTERONE 175<br />

Proklar 189<br />

Prolixin 96<br />

Prolixin Decanoate 96<br />

Proloprim 202<br />

PROMAZINE HYDROCHLORIDE 175<br />

Prometa 137<br />

Prometh 175<br />

Prometh Fortis 175<br />

Prometh w/Codeine 58<br />

Prometh VC Plain 163<br />

Prometh VC w/Codeine 57<br />

Prometh w/Dextromethorphan 65<br />

Promethazine w/Dextromethorphan 65<br />

PROMETHAZINE HYDROCHLORIDE 175<br />

Promethazine with Codeine 58<br />

Promethazine with Dextromethorphan 65<br />

Promethazine VC 163<br />

Promethazine VC w/Codeine 56<br />

Pronestyl 174<br />

Propachem 113<br />

PROPAPHENONE HYDROCHLORIDE 176<br />

PROPARACAINE HYDROCHLORIDE 176<br />

Prophene 177<br />

Propine 77<br />

PROPOFOL 176<br />

Propoxyphene Compound 65 20<br />

PROPOXYPHENE HYDROCHLORIDE 176,177<br />

PROPRANOLOL HYDROCHLORIDE 177,178<br />

Prosom 88<br />

Prostaphlin 155<br />

Prostin VR Pediatric 9<br />

PROTAMINE SULFATE 178<br />

PROTIRELIN 178<br />

Protopam 171<br />

Protostat 144<br />

PROTRIPTYLINE HYDROCHLORIDE 178<br />

Proval No. 3 2<br />

Page<br />

Proventil 7,8<br />

Provera 134<br />

Prozac 96<br />

Pseudodine C 58<br />

PSEUDOEPHEDRINE HYDROCHLORIDE; 179<br />

TRIPROLIDINE HYDROCHLORIDE<br />

Psorcon 74<br />

Pyocidin 115<br />

Pyopen 38<br />

PYRAZINAMIDE 179<br />

Pyribenzamine 202<br />

Pyridamal 100 47<br />

PYRIDOSTIGMINE BROMIDE 179<br />

PYRIDOXINE HYDROCHLORIDE 179<br />

PYRILAMINE MALEATE 180<br />

Q-Gesic 20<br />

Q-Pam 72<br />

Quelicin 187<br />

Quelicin Preservative-Free 187<br />

Questran 50<br />

Questran Light 50<br />

Quibron 104<br />

Quinidex 181<br />

QUINIDINE SULFATE 180,181<br />

Quinora 181<br />

R-P Mycin 86<br />

R-Tannate 48<br />

RANITIDINE HYDROCHLORIDE 181<br />

Rapiflux 96<br />

Redisol 59<br />

Regitine 162<br />

Reglan 143<br />

Regonol 179<br />

Rela 40<br />

Relafen 146<br />

Repan 1<br />

Repronex 135<br />

RESERPINE 181<br />

Restoril 192<br />

Retet 194<br />

Retin-A 199<br />

Reversol 82<br />

Revia 147<br />

Rheumatrex 140<br />

Rhythmin 174<br />

Rifadin 182<br />

RIFAMPIN 182<br />

Rimactane 182<br />

RIMANTIDINE HYDROCHLORIDE 182<br />

Rimifon 123<br />

Ringer's 36<br />

228


Page<br />

Ritalin 141<br />

Ritalin-SR 141<br />

RITODRINE HYDROCHLORIDE 182<br />

Robaxin 139<br />

Robaxisal 20<br />

Robimycin 86<br />

Robinul 103<br />

Robinul Forte 103<br />

Robitet 194<br />

Robitussin AC 57<br />

Robitussin DAC 57<br />

Rocaltrol 33<br />

Rondec Drops 40<br />

Rondec Syrup 40<br />

Rondec DM Drops 39<br />

Rondec DM Syrup 39<br />

Roxanol 146<br />

Roxicet 4<br />

Roxicet 5/500 4<br />

Roxilox 4<br />

Roxiprin 21<br />

Rubex 80<br />

Rubivite 59<br />

Rubramin PC 59<br />

Rufen 119<br />

Ruvite 59<br />

Ryna C Liquid 47<br />

Rynatan Pediatric 48<br />

Rythmol 176<br />

S.A.S.-500 191<br />

Saluron 117<br />

Sandimmune Injection 60<br />

Sandril 181<br />

Sansac 86<br />

Sarisol 32<br />

Sarisol #1 32<br />

Sarisol #2 32<br />

Satric 144<br />

Scabene 130<br />

Scandonest L 128<br />

Scandonest Plain 136<br />

SECOBARBITAL SODIUM 182<br />

Seconal 182<br />

Sectral 1<br />

Sedapap 1<br />

Seffin 44<br />

SELEGILINE HYDROCHLORIDE 183<br />

SELENIUM SULFIDE 183<br />

Selsun 183<br />

Sensorcaine 31<br />

Septisoft 107<br />

Page<br />

Septisol 107<br />

Septra 190<br />

Septra DS 190<br />

Septra Grape 190<br />

Serax 156<br />

Serophene 54<br />

Serpasil 181<br />

Sil-O-Tuss DM 65<br />

Sil-O-Tuss Elixir 121<br />

Sil-Tex 104<br />

Silvadene 183<br />

SILVER SULFADIAZINE 183<br />

Sinemet 10/100 39<br />

Sinemet 25/100 39<br />

Sinemet 25/250 39<br />

Sinemet CR 25/100 39<br />

Sinemet CR 50/200 39<br />

Sinequan 80<br />

Sinucon Pediatric Drops 47<br />

Sinucon Pediatric Syrup 47<br />

Sinucon Syrup 48<br />

Slo-Bid 194<br />

Slo-Phyllin-80 194<br />

Slow K 169<br />

SMZ-TMP 190<br />

SMZ-TMP Pediatric 190<br />

SODIUM AMINOSALICYLATE 183<br />

SODIUM CHLORIDE 184<br />

SODIUM LACTATE 185<br />

SODIUM NITROPRUSSIDE 186<br />

SODIUM POLYSTYRENE SULFONATE 186<br />

SODIUM SULFACETAMIDE 188<br />

Sodium P.A.S. 183<br />

Sodium Sulamyd 188<br />

SOLTALOL HYDROCHLORIDE 186<br />

Solu-Cortef 116<br />

Solu-Medrol 142<br />

Soma 40<br />

Soma Compound 20<br />

Soma Compound with Codeine 20<br />

Somophyllin 11<br />

Somophyllin-DF 11<br />

Sonazine 48<br />

Sorbitrate 124<br />

Sorine 186<br />

Sosol 191<br />

Soy-Dome 107<br />

Soyacal 10% 187<br />

Soyacal 20% 187<br />

SOYBEAN OIL 187<br />

Sparine 175<br />

229


Page<br />

SPIRONOLACTONE 187<br />

SPRX-3 161<br />

SSD 183<br />

Stadol 33<br />

Stadol NS 33<br />

Stadol Preservative-Free 33<br />

Stanozide 123<br />

Staticin 86<br />

Statobex 161<br />

Statobex-G 161<br />

Stelazine 201<br />

Stie-Cort 114<br />

Stilbestrol 74<br />

Stoxil 119<br />

STREPTOMYCIN SULFATE 187<br />

Strifon Forte DSC 50<br />

Sublimaze Preservative-Free 93<br />

SUCCINYLCHOLINE CHLORIDE 187<br />

Sucostrin 187<br />

SUCRALFATE 188<br />

Sufenta 188<br />

SUFENTANIL CITRATE 188<br />

Sulf-10 188<br />

Sulf-15 188<br />

Sulfa-Triple #2 203<br />

SULFABENZAMIDE; SULFACETAMIDE; 188<br />

SULFATHIAZOLE<br />

Sulfacel-15 188<br />

SULFACETAMIDE SODIUM 188<br />

SULFADIAZINE 189<br />

SULFADIAZINE; SULFAMETHAZINE; 203<br />

SULFAMERAZINE<br />

Sulfair-10 188<br />

Sulfair-15 188<br />

Sulfair Forte 188<br />

Sulfalar 191<br />

Sulfaloid 203<br />

SULFAMETHIZOLE 189<br />

Sulfamethoprim 190<br />

Sulfamethoprim-DS 190<br />

SULFAMETHOXAZOLE 189<br />

SULFAMETHOXAZOLE; TRIMETHOPRIM 189,190<br />

SULFANILAMIDE 190<br />

SULFASALAZINE 190,191<br />

Sulfatrim 190<br />

Sulfatrim DS 190<br />

Sulfatrim Pediatric 190<br />

Sulfatrim SS 190<br />

SULFINPYRAZONE 191<br />

SULFISOXAZOLE 191<br />

Sulfose 203<br />

Page<br />

SULINDAC 191,192<br />

Sulmeprim 190<br />

Sulmeprim Pediatric 190<br />

Sulphrin 172<br />

Sulsoxin 191<br />

Sulster 172<br />

Sulten-10 188<br />

Sultrin 188<br />

Sumycin 194<br />

Symadine 10<br />

Symmetrel 10<br />

Synacort 114<br />

Synalar 94<br />

Synalgos-DC-A 1<br />

Synkavite 134<br />

Synovalyte 132<br />

Syntocinon 157<br />

Sytobex 59<br />

T-Stat 86<br />

Tace 46<br />

Tagamet 51<br />

Talacen 4<br />

Talwin NX 147<br />

Tambocor 93<br />

TAMOXIFEN CITRATE 192<br />

Tapazole 139<br />

Taxol 157<br />

Tavist 52<br />

Tavist-1 52<br />

Tazicef 42<br />

Tazidime 42<br />

Teebacin 183<br />

Tegopen 56<br />

Tegretol 38<br />

Temaril 201<br />

Temaz 192<br />

TEMAZEPAM 192<br />

Temovate 54<br />

Temovate E 54<br />

Tencon 1<br />

Tenex 105<br />

Tenoretic 50 21<br />

Tenoretic 100 21<br />

Tenormin 21<br />

Tensilon 82<br />

Tensilon Preservative-Free 82<br />

Tenuate 74<br />

Tepanil 74<br />

TERAZOSIN 192<br />

TERBUTALINE SULFATE 192<br />

Terfonyl 203<br />

230


Page<br />

Terramycin 157<br />

Tessalon Perles 25<br />

TESTOSTERONE CYPIONATE 193<br />

TESTOSTERONE ENANTHATE 193<br />

TESTOSTERONE PROPIONATE 193<br />

TETRACAINE HYDROCHLORIDE 193<br />

Tetrachel 193<br />

TETRACYCLINE HYDROCHLORIDE 193,194<br />

Tetracyn 174,194<br />

Tetramed 194<br />

Texacort 114<br />

TFP 201<br />

Theo-Dur 195<br />

Theoclear-80 194<br />

Theocron 195<br />

Theolair 194<br />

Theolixir 194<br />

THEOPHYLLINE 194,195<br />

Thermazine 183<br />

THIAMINE HYDROCHLORIDE 195<br />

Thioplex 196<br />

THIORIDAZINE HYDROCHLORIDE 196<br />

Thiosulfil 189<br />

THIOTEPA 196<br />

THIOTHIXENE 196<br />

THIOTHIXENE HYDROCHLORIDE 197<br />

Thorazine 48<br />

Thypinone 178<br />

Thyrel TRH 178<br />

Ticlid 197<br />

TICLOPIDINE HYDROCHLORIDE 197<br />

Tigan Injection 202<br />

TIMOLOL MALEATE 197<br />

Timoptic 197<br />

Timoptic XE 197<br />

Tobradex 63<br />

TOBRAMYCIN 197,198<br />

TOBRAMYCIN SULFATE 198<br />

Tobrex 198<br />

Tofranil 120<br />

TOLAZAMIDE 198<br />

TOLBUTAMIDE 198<br />

Tolectin 199<br />

Tolectin 600 199<br />

Tolectin D.S. 199<br />

Tolinase 198<br />

TOLMETIN SODIUM 199<br />

Topicort 62<br />

Toposar 92<br />

Tora 162<br />

Toradol 126<br />

Page<br />

Totacillin 16<br />

Totacillin-N 15<br />

Tracrium 22<br />

Tracrium Preservative-Free 22<br />

Trandate 126<br />

Trandate-HCT 110<br />

Tranmep 136<br />

Transderm-Nitro 152<br />

Tranxene 55<br />

Travamulsion 10% 187<br />

Travamulsion 20% 187<br />

TRAZODONE HYDROCHLORIDE 199<br />

Tremin 201<br />

Trental 160<br />

TRETINOIN 199<br />

Tri-Vi-Flor 18,19<br />

Tri-Vi-Flor w/ Iron 18<br />

Tri-Vitamin Drops w/Fluoride 18,19<br />

Triacet 200<br />

Triacin-C 58<br />

Triacort 200<br />

Triad 1<br />

Trialodine 199<br />

TRIAMCINOLONE ACETONIDE 200<br />

Triaprin 1<br />

Triatex 200<br />

Triavil 2-10 13<br />

Triavil 2-25 13<br />

Triavil 4-10 13<br />

Triavil 4-25 13<br />

Triavil 4-50 13<br />

TRIAZOLAM 201<br />

Triderm 200<br />

Tridesilon 62<br />

Tridil 152<br />

TRIFLUOPERAZINE HYDROCHLORIDE 201<br />

TRIFLURIDINE 201<br />

TRIHEXYPHENIDYL HYDROCHLORIDE 201<br />

Trilafon 160<br />

Trilitron 179<br />

TRIMEPRAZINE TARTRATE 201<br />

TRIMETHOBENZAMIDE HYDROCHLORIDE 202<br />

TRIMETHOPRIM 202<br />

Trimox 14<br />

Trimpex 202<br />

Triotann S 48<br />

TRIPELENNAMINE HYDROCHLORIDE 202<br />

Triphasil 90<br />

Triphed 179<br />

Triple Sulfa 188,203<br />

Triple Sulfas 203<br />

231


Page<br />

Triple Sulfoid 203<br />

Triple-Vita-Flor 0.25mg 18<br />

Triple-Vita-Flor 0.5mg 19<br />

TRIPROLIDINE HYDROCHLORIDE 202<br />

TRISULFAPYRIMIDINE 203<br />

Tri Vitamin Drops w/Fluoride 0.25mg 18<br />

Tri Vitamin Drops w/ Fluoride 0.5mg 19<br />

Trivora 90<br />

Tropicacyl 203<br />

TROPICAMIDE 203<br />

Trymex 200<br />

Trysul 188<br />

TUBOCURARINE CHLORIDE 203<br />

Turgex 107<br />

Tussend 113<br />

Tussend Expectorant 104<br />

Tussi Organidin 57<br />

Tussi-Organidin DM 65<br />

Tussi-R-Gen Expectorant 57<br />

Tussigon 107<br />

Tycolet 3<br />

Tylenol with Codeine 2<br />

Tylox 4<br />

U-Cort 116<br />

U-Gencin 100<br />

Ultracef 41<br />

Ultragris 165 103<br />

Ultragris 330 103<br />

Unipen 146<br />

Urecholine 28<br />

Urex 138<br />

Urobak 189<br />

Urologic G 52<br />

Uroplus SS 190<br />

Uroplus DS 190<br />

URSODIOL 204<br />

Uticillin-VK 159<br />

Utimox 14<br />

Vagilia 188<br />

Vagitrol 190<br />

Valisone 28<br />

Valium 72<br />

Valnac 28<br />

VALPROIC ACID 204<br />

VANCOMYCIN HYDROCHLORIDE 204<br />

Vancocin 204<br />

Vancoled 204<br />

Vancor 204<br />

Vanspar 32<br />

Vantin 42<br />

Vaseretic 82<br />

Page<br />

Vascor 26<br />

Vapo-ISO 124<br />

Vasocidin 172<br />

Vasocon 148<br />

Vasocon A 16<br />

Vasotec 82,83<br />

V-Cillin K 159<br />

Vectrin 145<br />

VECURONIUM BROMIDE 204<br />

Veetids 125 159<br />

Veetids 250 159<br />

Veetids 500 159<br />

Velban 205<br />

Velosef 44<br />

Velosef 125 44<br />

Velosef 250 44<br />

Veltane 30<br />

Ventolin 7,8<br />

VePesid 92<br />

VERAPAMIL HYDROCHLORIDE 204,205<br />

Verelan 205<br />

Vermidol 165<br />

Vermox 133<br />

Versed 145<br />

Vi-Dom-A 207<br />

Vi-Twel 59<br />

Vibisone 59<br />

Vibra-Tabs 81<br />

Vibramycin 80,81<br />

Vicodin 4<br />

Vicodin ES 4<br />

Vicodin HP 4<br />

VINBLASTINE SULFATE 205<br />

Vincasar PFS 206<br />

Vincrex 206<br />

VINCRISTINE SULFATE 205,206<br />

Vincristine Sulfate Preservative-Free 206<br />

Viroptic 201<br />

Visken 164<br />

Vistaril 118,119<br />

VITAMIN A 206<br />

VITAMIN A PALMITATE 206,207<br />

VITAMIN D 82<br />

Vivactil 178<br />

Vivelle 88<br />

Vivelle-Dot 88<br />

Voltaren 73<br />

Voltaren-XR 73<br />

VoSol 5<br />

VoSol HC 6<br />

WARFARIN SODIUM 208<br />

232


Page<br />

Page<br />

WATER FOR INJECTION 208<br />

WATER FOR IRRIGATION 208<br />

Wellbutrin 31<br />

Wellcovorin 127<br />

Westcort 116<br />

Wigraine 32<br />

Wigrettes 85<br />

Wyamycin-E 87<br />

Wyamycin-S 87<br />

Wycillin 158<br />

Wygesic 4<br />

Wymox 14<br />

Wytensin 104<br />

X-Trozine 161<br />

Xanax 9<br />

Xylocaine 128,129<br />

Xylocaine Preservative-Free 129<br />

Xylocaine with Epinephrine 84<br />

Xylocaine with Glucose 68<br />

Xylo-Pfan 208<br />

XYLOSE 208<br />

Yutopar 182<br />

Zantac 181<br />

Zarontin 91<br />

Zaroxolyn 143<br />

Zaxopam 156<br />

Zebeta 28<br />

Zeroxin-5, -10 25<br />

Zestoretic 10 - 12.5 110<br />

Zestoretic 20 - 12.5 110<br />

Zestoretic 20 - 25 110<br />

Zestril 130<br />

Ziac 29<br />

Zide 109<br />

Zinacef 43<br />

Zipan-25 175<br />

Zipan-50 175<br />

Zolicef 42<br />

Zovia 1/35E 89<br />

Zovia 1/50E 89<br />

Zovirax 7<br />

Zyloprim 9<br />

5-Benzagel 26<br />

10-Benzagel 26<br />

233


<strong>Illinois</strong> Department of Public Health<br />

Office of Health Protection<br />

Division of Food, <strong>Drug</strong>s and Dairies<br />

525 W. Jefferson St.<br />

Springfield, IL 62761-0001<br />

Printed by Authority of <strong>the</strong> State of <strong>Illinois</strong><br />

P.O. 522203 4.3M 4/02<br />

PRSRT STD<br />

U.S. POSTAGE<br />

PAID<br />

Springfield, IL<br />

Permit No. 101

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