dru g formulary - Kern Health Systems

KFHC DRUG FORMULARY 17GENERIC BRAND FORMSCentral Nervous System – Antidepressant – Selective Serotonin Reuptake Inhibitors (SSRIs),continued • SEE PREVIOUS PAGE G Fluoxetine Prozac® 10mg, 20mg capsulesRestriction: Restricted to 10mg NMT 1 daily, 20mg NMT 4 daily. G Fluvoxamine Luvox® 25mg, 50mg, 100mg capsule; 100mg,150mg er capsule G Paroxetine Paxil® 20mg, 30mg, 40mg 100mg tablets, 10mg/5ml susp G Sertraline Zoloft® 50mg, 100mg tabletCentral Nervous System – Antidepressant - Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs) G Bupropion Wellbutrin® 75mg, 100mg tablet, 100mg, 150mg cr tabletRestriction: Restricted to Depression - Not for Smoking Cessation. G Trazodone Desyrel® 50mg, 100mg, 150mg tabletCentral Nervous System – Antidepressant - Norepinephrine Antagonist and Serotonin Antagonists G Mirtazapine Remeron® 15mg, 30mg, 45mg tabletCentral Nervous System – Antidepressant - Antipsychotic G Perphenazine & Amitriptyline Triavil® 2-10mg, 2-25mg, 4-10mg, 4-25mg tabletCentral Nervous System – AnxiolyticThe Benzodiazepine anxiolytic medications are restricted to prevent patients becoming habituatedor addicted to them. Doses for physicians who are not mental health specialists are also restricted.The drugs are restricted to an initial 90 days supply and have the following daily maximums. TheSSRI’s are recommended for long term antianxiety therapy.MedicationDaily Maximum DoseDiazepam10mgLorazepam G Buspirone Buspar® 5mg, 10mg, 15mg, 30mg tabletRestriction: Restricted to pts. w/abuse potential or who have failed lorazepam. Prior authorization required for 30 mg. G Clonazepam Klonopin® 0.5mg, 1mg, 2mg tablet G Diazepam Valium® 2mg, 5mg, 10mg tabletRestriction: Restricted to 90 days therapy and 10mg maximum daily dose - see page 26. G Lorazepam Ativan® 0.5mg, 1mg, 2mg tabletRestriction: Restricted to 90 days therapy and 2mg maximum daily dose.2mg