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 ManagementSumatriptan SuccinateInjectionSumatriptan Succinate TabOralErgot CombinationsErgotamine w/ Caffeine 1-100mg Tab OralImitrexImitrexWigraine, ErcafContingent Therapy: For patient failingtherapy with or intolerant to Cafergot,Midrin, Fioricet, or Fiorinal. Limited to 4packages (8 injections)/monthContingent therapy: For patient failingtherapy with or intolerant to Cafergot,Midrin, Fioricet, or Fiorinal. Limited to 18tablets/month for 25mg & 50mg and 9tablets/month for 100mgGoutAllopurinol Tab OralColchicineOralZyloprimColchicineUricosuricsProbenecid Oral ProbenecidTab 500 mgSulfinpyrazone OralBenemidAnturaneCombination Gout <strong>Drug</strong>sColchicine w/ProbenecidOral Coichicinew/Probenecid Tab 0.5-500mg OralProben-CHydantoinsPhenytoin Chew Tab 50 mgOralDilantinNEUROMUSCULAR AGENTSValproic AcidDivalproex Sodium EC CapOralDivalproex Sodium EC TabOralDivalproex Sodium SR 24 HrTab OralValproic Acid Cap 250mgOralDepakote SprinkleDepakote ECDepakote ERDepakeneJune 2009 Page 20 of 42
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