04 Formulary in pdf format - HIV/AIDS Information provided by ...

North Carolina
ADAP FORMULARIES
New drugs added since June 2002 indicated in bold.
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 (Reyataz), fosamprenavir (Lexiva), indinavir (Crixivan), lopinavir/ritonavir
(Kaletra), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Fortovase, Invirase). NNRTIs- delavirdine (Rescriptor), efavirenz
(Sustiva), nevirapine (Viramune). Other- hydroxyurea (Hydrea). Entry Inhibitor- enfufuvirtide (Fuzeon).
OI DRUGS
PHS “A1 OI”s- acyclovir (Zovirax), azithromycin (Zithromax), clarithromycin (Biaxin), famciclovir (Famvir), fluconazole (Diflucan),
ganciclovir (Cytovene), itraconazole (Sporonox), leucovorin, pyrimethamine (Daraprim), sulfadiazine, TMP/SMX (Bactrim, Cotrim,
Septra, Sulfatrim). Other OIs- atovaquone (Mepron), ciprofloxacin (Cipro), clindamycin (Cleocin), dapsone, ethambutol (Myambutol),
ketoconazole (Nizoral), nystatin (Mycostatin, Nilstat), paromomycin (Humatin), pentamidine (NebuPent), rifabutin (Mycobutin),
valacyclovir (Valtrex), valganciclovir (Valcyte). Hepatitis C- none.
ALL OTHERS
amitriptyline (Elavil), diphenoxylate (Lomotil), lansoprazole (Prevacid), loperamide (Imodium), nortriptyline (Pamelor), omeprazole
(Prilosec), ondansetron (Zofran), pancrelipase (Pancreas), prochlorperazine (Compazine), promethazine (Phenergan).
North Dakota
ANTIRETROVIRALS
NRTIs- abacavir (Ziagen), abacavir/lamivudine/zidovudine (Trizivir), didanosine (ddI, Videx), lamivudine (Epivir, 3TC),
lamivudine/zidovudine (Combivir), stavudine (d4T, Zerit), tenofovir (Viread), zalcitabine (ddC, Hivid), zidovudine (AZT, Retrovir).
PIs- amprenavir (Agenerase), atazanavir (Reyataz), indinavir (Crixivan), lopinavir/ritonavir (Kaletra), nelfinavir (Viracept), ritonavir
(Norvir), saquinavir (Fortovase, Invirase). NNRTIs- delavirdine (Rescriptor), efavirenz (Sustiva), nevirapine (Viramune). Otherhydroxyurea
(Hydrea).
OI DRUGS
PHS “A1 OI”s- acyclovir (Zovirax), azithromycin (Zithromax), cidofovir (Vistide), clarithromycin (Biaxin), famciclovir (Famvir), fluconazole
(Diflucan), foscarnet (Foscavir), ganciclovir (Cytovene), itraconazole (Sporonox), leucovorin (Wellcovorin), pyrimethamine
(Daraprim), sulfadiazine, TMP/SMX (Bactrim, Septra). Other OIs- albendazole (Albenza), amphotericin B (Fungizone), amoxicillin
(Amoxil), atovaquone (Mepron), ciprofloxacin (Cipro), clindamycin (Cleocin), clotrimazole (Lotrimin, Mycelex), dapsone,erythromycin
(Erythrocin, Ery-Tab, EES), erythropoietin (Epogen, EPO, Procrit), ethambutol (Myambutol), filgrastim (G-CSF, Neupogen), ketoconazole
(Nizoral), nystatin (Mycostatin), paromomycin (Humatin, Aminosidine, AMS), pentamidine (NebuPent, Pentam, Pentacarinat),
prednisone (Deltasone, Meticorten, Orasone), rifabutin (Mycobutin). valganciclovir (Valcyte). Hepatitis C- none.
TREATMENTS FOR METABOLIC DISORDERS
Cardiac- doxazosim mesylate (Cardura), lisinopril (Zestril). Hyperlipidemia- atorvastatin (Lipitor), pravastatin (Pravachol).
Wasting- dronabinol (Marinol), megestrol acetate (Megace).
ALL OTHERS
acetaminophen/codine (Tylenol #3), amantadine (Symmetrel), amitriptyline (Elavil), calcium acetate (PhosLo), chlor-hexidene (Peridex),
diphenoxylate w/atropine (Lomotil), etodolac (Lodine), fludrocortisone (Florinef), fluoxetine (Prozac), gabapentin (Neurontin), haloperidol
(Haldol), hepatitis A vaccine, hepatitis B vaccine, influenza vaccine, loperamide (Imodium), lorazepam (Ativan), morphine
(Duramorph, Oramporph, Roxanol), morphine sulfate (MS Contin), olanzapine (Zyprexa), ondansetron (Zofran), pantoprazole sodium
(Protonix), pneumococcal vaccine, prochlorperazine (Compazine), propoxyphene N-100 (Darvocet), ranitideine(Zantac), sertraline
(Zoloft), trazodone (Desyrel), venlafaxine (Effexor), vitamin (Nephrocap), zanamivir (Relenza).
Northern Mariana Islands
ANTIRETROVIRALS
NRTIs- abacavir (Ziagen), abacavir/lamivudine/zidovudine (Trizivir), didanosine (ddI, Videx), emtricitabine (Emtriva), lamivudine
(3TC, Epivir), lamivudine/zidovudine (Combivir), stavudine (d4T, Zerit), tenofovir (Viread), zalcitabine (ddC, Hivid), zidovudine (AZT,
Retrovir). PIs- amprenavir(Agenerase), atazanavir (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 (Zovirax), azithromycin (Zithromax), cidofovir (Vistide), clarithromycin (Biaxin), famcyclovir (Famvir), fluconazole
(Diflucan), foscarnet (Foscavir), gancyclovir (Cytovene), isoniazid (INH), itraconazole (Sporonox), leucovorin, pyrimethamine
(Daraprim, Fansidar), sulfadiazine, TMP/SMX (Bactrim, Septra).Hepatitis C- peg-interferon alfa-2a & ribavirin (Pegasys/Copegus).
ALL OTHERS
Open Formulary. all FDA approved drugs are covered.