San Diego County Medical Services Drug Formulary
San Diego County Medical Services Drug Formulary
San Diego County Medical Services Drug Formulary
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<strong>San</strong> <strong>Diego</strong> <strong>County</strong> <strong>Medical</strong> <strong>Services</strong> <strong>Drug</strong> <strong>Formulary</strong>Generic NameRepresentativeBrand NameUtilization ManagementLovastatin Oral Mevacor Limited to 1 tablet/daySimvastatin Oral Zocor Limited to 1 tablet/dayNicotinic Acid DerivativesNiacin Tab CRNiaspanContingent Therapy: For patient failingtherapy with or intolerant to niacin. Limitedto 1 tablet/dayAntihistamines-AlkylaminesCyproheptadine HCL OralDiphenhydramine HCLcapsule, tablet OralPromethazine HCL OralPromethazine HCL SupposRectalPeriactinRESPIRATORY AGENTSBenadryl, DiphedrylPhenergan,Phenergan FortePhenerganAntihistamines-Non-SedatingLoratadine 10mg Tab Oral(OTC)ClaritinLimited to 1 tablet/dayNasal SteroidsFlunisolide 0.025% NasalFluticasone Propionate NasalExpectorantsGuaifenesin OralNasalideFlonaseOrganidin NR,Diabetic Tus,Robitussin, NaldeconSrCode 1 Restriction: For diagnosis of nasalpolyps, chronic sinusitis, or asthma. Limitedto 1 unit/monthCode 1 Restriction: For diagnosis of nasalpolyps, chronic sinusitis, or asthma. Limitedto 1 unit/monthMiscellaneous RespiratorySodium Chloride Soln Nebu0.9%Broncho SalineDecongestant orDecongestant CombinationsBrompheniramine &Pseudoephedrine Syrup, ElixirOralChlorpheniramine &Phenylephrine Elixir 2-5mg/5ml OralBromfed, Dimetapp,Bromtapp,BromanateNovahistineJune 2009 Page 11 of 42
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