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Montana
Nebraska
ADAP FORMULARIES
New drugs added since June 2002 indicated in bold.
ANTIRETROVIRALS
NRTIs- abacavir (Ziagen), abacavir/lamivudine/zidovudine (Trizivir), didanosine (ddI, Videx, Videx EC), emtricitabine (Emtreva),
lamivudine (Epivir, 3TC), lamivudine/zidovudine (Combivir), stavudine (d4T, Zerit), tenofovir (Viread), zalcitabine (ddC, Hivid),
zidovudine (AZT, Retrovir). PIs- amprenavir (Agenerase), atazanivir sufate (Reyataz), fosamprenavir (Lexiva), indinavir (Crixivan),
lopinavir/ritonavir (Kaletra), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Fortovase). NNRTIs- delavirdine (Rescriptor),
efavirenz (Sustiva), nevirapine (Viramune). Other- hydroxyurea (Hydrea).
OI DRUGS
PHS “A1 OI”s- acyclovir (Zovirax), azithromycin (Zithromax), clarithromycin (Biaxin), fluconazole (Diflucan), foscarnet (Foscavir),
ganciclovir (Cytovene), isoniazid (INH), itraconazole (Sporonox), leucovorin (floinic acid), pyrimethamine (Daraprim, Fansidar),
sulfadiazine, TMP/SMX (Bactrim). Other OIs- amphotericin B, atovaquone (Mepron), caspofungin (Cancidas), clotrimazole oral
(Mycolex Troches), dapsone, erythropoietin alpha (Epogen), ethambutol hydrochloride (Myambutol), folinic acid (Leucovorin calcium),
rifabutin (Mycobutin), nystatin (Mycostatin), pentamidine (NebuPent/Pentam), pyrazinamide (Rifater), rifampim (If not covered by
County Health), Valacyclovir (Valtrex), valganciclovir (Valcyte). Hepatitis C- none
TREATMENTS FOR METABOLIC DISORDERS
Wasting- megestroll acetate (Megace), estosterone. Hyperlipidemia- atorvastatin (Lipitor), gemfibrozil (Lopid), pravastatin
(Pravachol). Other- amitriptyline (Elavil), , amoxapine (Ascendin), aripiprazole (Abilify), bupropion (Wellbutrin/Wellbutrin SR),
buspirone (BusPar), carbamazepine (Tegretol/Tegretol XR), chlorpromazine (Thorazine), citalopram (Celexa), clomipramine
(Anafranil), clozapine (Clozaril), desipramine (Norpramin), doxepin (Sinequan), filgrastim (Neupogen), fluoxetine (Prozac),
fluphenazine (Prolixin), fluvoxamine (Luvox), gabapentin (Neurontin), haloperidol (Haldol), hydroxyzine (Atarax/Vistaril),
imipramine (Tofranil), isocarboxazid (Marplan), lamotrigine (Lamictal), lithium (Eskalith), loxapine (Loxitane), maprotiline
(Ludiomil), mesoridazine (Serentil), mirtazapine (Remeron), molindone (Moban), nefazodone (Serzone), nortriptyline (Pamelor),
olanzapine (Zyprexa), oxcarbazepine (Trileptal), paroxetine (Paxil/Paxil CR), perphenazine (Trilafon), phenelzine (Nardil),
pimozide (Orap), promazine (Sparine), protriptyline (Vivactil), quetiapine (Seroquel), risperidone (Risperdal), sertraline
(Zoloft), sodium divalproex (Depakote), thioridazine (Mellaril), thiothixene (Navane), tiagabine (Gabatril), topiramate
(Topamax), tranylcypromine (Parnate), trazodone (Desyrel), trifluoperazine (Stelazine), triflupromazine (Vesprin), trimipramine
(Surmontil), valproic acid (Depakene), venlafaxine (Effexor/Effexor XR), voriconazole (Vfend), ziprasidone (Geodon).
ANTIRETROVIRALS
NRTIs- abacavir (Ziagen), abacavir/lamivudine/zidovudine (Trizivir), didanosine (ddI, Videx,), emcitrabine (Emtriva), lamivudine
(Epivir, 3TC), lamivudine/zidovudine (Combivir), stavudine (d4T, Zerit), tenofovir (Viread), zalcitabine (ddC, Hivid), zidovudine (AZT,
Retrovir). PIs- amprenavir (Agenerase), atazanavir (Reyataz), fosamprenavir (Lexiva), indinavir (Crixivan), lopinavir/ritonavir
(Kaletra), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Fortovase). NNRTIs- delavirdine (Rescriptor), efavirenz (Sustiva),
nevirapine (Viramune). Other- hydroxyurea (Hydrea).
ALL OTHERS
PHS “A1 OI”s- azithromycin (Zithromax), TMP/SMX (Bactrim). Other OIs- atovaquone (Mepron), clarithromycin (Biaxin), dapsone,
rifabutin (Mycobutin).
Nevada
ANTIRETROVIRALS
NRTIs- abacavir (Ziagen), abacavir/lamivudine/zidovudine (Trizivir), didanosine (ddI, Videx), emtricitabine (Emtriva), lamivudine
(Epivir, 3TC), lamivudine/zidovudine (Combivir), stavudine (d4T, Zerit), tenofovir (Viread), zalcitabine (ddC, Hivid), zidovudine (AZT,
Retrovir). PIs- amprenavir (Agenerase), atazanavir sulfate (Reyataz), indinavir (Crixivan), lopinavir/ritonavir (Kaletra), nelfinavir
(Viracept), ritonavir (Norvir), saquinavir (Fortovase, Invirase). NNRTIs- delavirdine (Rescriptor), efavirenz (Sustiva), nevirapine
(Viramune). Other- hydroxyurea (Hydrea).
OI DRUGS
PHS “A1 OI”s- acyclovir, azithromycin (Zithromax), clarithromycin (Biaxin), fluconazole (Diflucan), ganciclovir (Cytovene),
itraconazole (Sporonox), leucovorin, pyrimethamine, sulfadiazine, TMP/SMX (Septra). Other OIs- atovaquone (Mepron), ciprofloxacin
(Cipro), clindamycin (Cleocin), clotrimazole (Mycelex), dapsone, erythropoietin, ethambutol (Myambutol), GCSF (Neupogen), nystatin
(Nilstat), paromomycin (Humatin). Hepatitis C- none.
TREATMENTS FOR METABOLIC DISORDERS
Hyperlipidemia- atorvastatin (Lipitor), fenofibrate (Tricor), gemfibrozil (Lopid), Wasting- dronabinol (Marinol), megestrol acetate
(Megace), oxandrolone (Oxandrin), testosterone.
ALL OTHERS
amitriptyline (Elavil), diphenoxylate/atropine divalproex (Depakote), (Lomotil), gabapentin (Neurontin), loperamide (Imodium),
ondansetron (Zofran), pancreatic enzymes, phenytoin (Dilantin), (Ultrase), prochlorperazine (Compazine), trazadone (Desyrel).