dru g formulary - Kern Health Systems

16GENERIC BRAND FORMSKFHC DRUG FORMULARYCentral Nervous System – Anticonvulsant, continued • SEE PREVIOUS PAGE G Tiagabine Gabitril® 2mg, 4mg, 12mg, 16mg tabletRestriction: Plan neurologists only. G Topiramate Topamax® 15mg, 25mg sprinkle capsule, 25mg, 50mg, 100mg,200mg tabletRestriction: Capsules allowed for children < 10 yo. G Zonisamide Zonegran® 25mg, 50mg, 100mg capsuleCentral Nervous System – Antidepressant – Tricyclics G Amitriptyline10mg, 25mg, 50mg, 75mg, 100mg, 150mg tablet G Clomipramine Anafranil® 25mg, 50mg, 75mg capsule G Desipramine Norpramin® 10mg, 25mg, 50mg, 75mg, 100mg, 150mg tablet G Imipramine Tofranil® 10mg, 25mg, 50mg tablet G Nortriptyline Pamelor® 10mg, 25mg, 50mg, 75mg capsule, 10mg/5ml solnCentral Nervous System – Antidepressant-Serotonin – Norepinephrine Reuptake Inhibitors (SNRIs)Non TricyclicDuloxetine Cymbalta® 20mg, 30mg, 60mgRestriction: Trial and failure of Effexor required. G Venlafaxine Effexor® 25mg, 37.5mg, 50mg, 75mg, 100mg tablet,Effexor XR®37.5mg, 75mg, 150mg cr capsuleRestriction: SSRIs are to be used before consideration. Allowed first line for mental health/psychiatrists.Central Nervous System – Antidepressant – Selective Serotonin Reuptake Inhibitors (SSRIs)Fluoxetine is the least expensive of the SSRIs. KHS recommends the generic Fluoxetine as theeconomic SSRI of choice. Failure of generic medications is necessary before allowing the brandedFormulary SSRIs. Only the 20mg capsules will be covered since they are so inexpensive comparedto the 40mg.KHS formulary requires half tablet dosing for all tablets in this class with the exception ofcitalopram. All generic formulations must be tried and considered before branded, non-formularymedications will be considered.Tablet splitters are covered for KHS patients. G Citalopram Celexa® 10mg, 20mg, 40mg tablets G Escitalopram Lexapro® 10mg, 20mg tabletsRestriction: Trial and failure of citalopram.Continued on next page