North Carol<strong>in</strong>a ADAP FORMULARIES New drugs added s<strong>in</strong>ce June 2002 <strong>in</strong>dicated <strong>in</strong> bold. ANTIRETROVIRALS NRTIs- abacavir (Ziagen), abacavir/lamivud<strong>in</strong>e/zidovud<strong>in</strong>e (Trizivir), didanos<strong>in</strong>e (ddI, Videx), emtricitab<strong>in</strong>e (Emtriva), lamivud<strong>in</strong>e (Epivir, 3TC), lamivud<strong>in</strong>e/zidovud<strong>in</strong>e (Combivir), stavud<strong>in</strong>e (d4T, Zerit), tenofovir (Viread), zalcitab<strong>in</strong>e (ddC, Hivid), zidovud<strong>in</strong>e (AZT, Retrovir). PIs- amprenavir (Agenerase), atazanavir (Reyataz), fosamprenavir (Lexiva), <strong>in</strong>d<strong>in</strong>avir (Crixivan), lop<strong>in</strong>avir/ritonavir (Kaletra), nelf<strong>in</strong>avir (Viracept), ritonavir (Norvir), saqu<strong>in</strong>avir (Fortovase, Invirase). NNRTIs- delavird<strong>in</strong>e (Rescriptor), efavirenz (Sustiva), nevirap<strong>in</strong>e (Viramune). Other- hydroxyurea (Hydrea). Entry Inhibitor- enfufuvirtide (Fuzeon). OI DRUGS PHS “A1 OI”s- acyclovir (Zovirax), azithromyc<strong>in</strong> (Zithromax), clarithromyc<strong>in</strong> (Biax<strong>in</strong>), famciclovir (Famvir), fluconazole (Diflucan), ganciclovir (Cytovene), itraconazole (Sporonox), leucovor<strong>in</strong>, pyrimetham<strong>in</strong>e (Daraprim), sulfadiaz<strong>in</strong>e, TMP/SMX (Bactrim, Cotrim, Septra, Sulfatrim). Other OIs- atovaquone (Mepron), ciprofloxac<strong>in</strong> (Cipro), cl<strong>in</strong>damyc<strong>in</strong> (Cleoc<strong>in</strong>), dapsone, ethambutol (Myambutol), ketoconazole (Nizoral), nystat<strong>in</strong> (Mycostat<strong>in</strong>, Nilstat), paromomyc<strong>in</strong> (Humat<strong>in</strong>), pentamid<strong>in</strong>e (NebuPent), rifabut<strong>in</strong> (Mycobut<strong>in</strong>), valacyclovir (Valtrex), valganciclovir (Valcyte). Hepatitis C- none. ALL OTHERS amitriptyl<strong>in</strong>e (Elavil), diphenoxylate (Lomotil), lansoprazole (Prevacid), loperamide (Imodium), nortriptyl<strong>in</strong>e (Pamelor), omeprazole (Prilosec), ondansetron (Zofran), pancrelipase (Pancreas), prochlorperaz<strong>in</strong>e (Compaz<strong>in</strong>e), promethaz<strong>in</strong>e (Phenergan). North Dakota ANTIRETROVIRALS NRTIs- abacavir (Ziagen), abacavir/lamivud<strong>in</strong>e/zidovud<strong>in</strong>e (Trizivir), didanos<strong>in</strong>e (ddI, Videx), lamivud<strong>in</strong>e (Epivir, 3TC), lamivud<strong>in</strong>e/zidovud<strong>in</strong>e (Combivir), stavud<strong>in</strong>e (d4T, Zerit), tenofovir (Viread), zalcitab<strong>in</strong>e (ddC, Hivid), zidovud<strong>in</strong>e (AZT, Retrovir). PIs- amprenavir (Agenerase), atazanavir (Reyataz), <strong>in</strong>d<strong>in</strong>avir (Crixivan), lop<strong>in</strong>avir/ritonavir (Kaletra), nelf<strong>in</strong>avir (Viracept), ritonavir (Norvir), saqu<strong>in</strong>avir (Fortovase, Invirase). NNRTIs- delavird<strong>in</strong>e (Rescriptor), efavirenz (Sustiva), nevirap<strong>in</strong>e (Viramune). Otherhydroxyurea (Hydrea). OI DRUGS PHS “A1 OI”s- acyclovir (Zovirax), azithromyc<strong>in</strong> (Zithromax), cidofovir (Vistide), clarithromyc<strong>in</strong> (Biax<strong>in</strong>), famciclovir (Famvir), fluconazole (Diflucan), foscarnet (Foscavir), ganciclovir (Cytovene), itraconazole (Sporonox), leucovor<strong>in</strong> (Wellcovor<strong>in</strong>), pyrimetham<strong>in</strong>e (Daraprim), sulfadiaz<strong>in</strong>e, TMP/SMX (Bactrim, Septra). Other OIs- albendazole (Albenza), amphoteric<strong>in</strong> B (Fungizone), amoxicill<strong>in</strong> (Amoxil), atovaquone (Mepron), ciprofloxac<strong>in</strong> (Cipro), cl<strong>in</strong>damyc<strong>in</strong> (Cleoc<strong>in</strong>), clotrimazole (Lotrim<strong>in</strong>, Mycelex), dapsone,erythromyc<strong>in</strong> (Erythroc<strong>in</strong>, Ery-Tab, EES), erythropoiet<strong>in</strong> (Epogen, EPO, Procrit), ethambutol (Myambutol), filgrastim (G-CSF, Neupogen), ketoconazole (Nizoral), nystat<strong>in</strong> (Mycostat<strong>in</strong>), paromomyc<strong>in</strong> (Humat<strong>in</strong>, Am<strong>in</strong>osid<strong>in</strong>e, AMS), pentamid<strong>in</strong>e (NebuPent, Pentam, Pentacar<strong>in</strong>at), prednisone (Deltasone, Meticorten, Orasone), rifabut<strong>in</strong> (Mycobut<strong>in</strong>). valganciclovir (Valcyte). Hepatitis C- none. TREATMENTS FOR METABOLIC DISORDERS Cardiac- doxazosim mesylate (Cardura), lis<strong>in</strong>opril (Zestril). Hyperlipidemia- atorvastat<strong>in</strong> (Lipitor), pravastat<strong>in</strong> (Pravachol). Wast<strong>in</strong>g- dronab<strong>in</strong>ol (Mar<strong>in</strong>ol), megestrol acetate (Megace). ALL OTHERS acetam<strong>in</strong>ophen/cod<strong>in</strong>e (Tylenol #3), amantad<strong>in</strong>e (Symmetrel), amitriptyl<strong>in</strong>e (Elavil), calcium acetate (PhosLo), chlor-hexidene (Peridex), diphenoxylate w/atrop<strong>in</strong>e (Lomotil), etodolac (Lod<strong>in</strong>e), fludrocortisone (Flor<strong>in</strong>ef), fluoxet<strong>in</strong>e (Prozac), gabapent<strong>in</strong> (Neuront<strong>in</strong>), haloperidol (Haldol), hepatitis A vacc<strong>in</strong>e, hepatitis B vacc<strong>in</strong>e, <strong>in</strong>fluenza vacc<strong>in</strong>e, loperamide (Imodium), lorazepam (Ativan), morph<strong>in</strong>e (Duramorph, Oramporph, Roxanol), morph<strong>in</strong>e sulfate (MS Cont<strong>in</strong>), olanzap<strong>in</strong>e (Zyprexa), ondansetron (Zofran), pantoprazole sodium (Protonix), pneumococcal vacc<strong>in</strong>e, prochlorperaz<strong>in</strong>e (Compaz<strong>in</strong>e), propoxyphene N-100 (Darvocet), ranitide<strong>in</strong>e(Zantac), sertral<strong>in</strong>e (Zoloft), trazodone (Desyrel), venlafax<strong>in</strong>e (Effexor), vitam<strong>in</strong> (Nephrocap), zanamivir (Relenza). Northern Mariana Islands ANTIRETROVIRALS NRTIs- abacavir (Ziagen), abacavir/lamivud<strong>in</strong>e/zidovud<strong>in</strong>e (Trizivir), didanos<strong>in</strong>e (ddI, Videx), emtricitab<strong>in</strong>e (Emtriva), lamivud<strong>in</strong>e (3TC, Epivir), lamivud<strong>in</strong>e/zidovud<strong>in</strong>e (Combivir), stavud<strong>in</strong>e (d4T, Zerit), tenofovir (Viread), zalcitab<strong>in</strong>e (ddC, Hivid), zidovud<strong>in</strong>e (AZT, Retrovir). PIs- amprenavir(Agenerase), atazanavir (Reyataz), <strong>in</strong>d<strong>in</strong>avir(Crixivan), lop<strong>in</strong>avir/ritonavir(Kaletra), nelf<strong>in</strong>avir(Viracept), ritonavir(Norvir), saqu<strong>in</strong>avir (Fortovase, Invirase). NNRTIs- delavird<strong>in</strong>e (Rescriptor), efavirenz (Sustiva), nevirap<strong>in</strong>e (Viramune). Other- hydroxyurea (Hydrea). OI DRUGS PHS “A1 OI”s-.acyclovir (Zovirax), azithromyc<strong>in</strong> (Zithromax), cidofovir (Vistide), clarithromyc<strong>in</strong> (Biax<strong>in</strong>), famcyclovir (Famvir), fluconazole (Diflucan), foscarnet (Foscavir), gancyclovir (Cytovene), isoniazid (INH), itraconazole (Sporonox), leucovor<strong>in</strong>, pyrimetham<strong>in</strong>e (Daraprim, Fansidar), sulfadiaz<strong>in</strong>e, TMP/SMX (Bactrim, Septra).Hepatitis C- peg-<strong>in</strong>terferon alfa-2a & ribavir<strong>in</strong> (Pegasys/Copegus). ALL OTHERS Open <strong>Formulary</strong>. all FDA approved drugs are covered.
Ohio TREATMENT FOR METABOLIC DISORDERS Diabetics- acarbose (Precose), glipizide (Glucotrol), metform<strong>in</strong> HCL (Glucophage), rosiglitazone (Avandia). Hyperlipidemia- atorvastat<strong>in</strong> (Lipitor), fenofibrate (Tricor), gemfibrozil (Lopid), pravastat<strong>in</strong> (Pravachol). Wast<strong>in</strong>g- testosterone (Androgel, Testaderm, androderm patches, Testim). ADAP FORMULARIES New drugs added s<strong>in</strong>ce June 2002 <strong>in</strong>dicated <strong>in</strong> bold. ANTIRETROVIRALS NRTIs- abacavir (Ziagen), abacavir/lamivud<strong>in</strong>e/zidovud<strong>in</strong>e (Trizivir), didanos<strong>in</strong>e (ddI, Videx, Videx EC), emtricitab<strong>in</strong>e (Emtriva), lamivud<strong>in</strong>e (Epivir, 3TC),lamivud<strong>in</strong>e/zidovud<strong>in</strong>e (Combivir), stavud<strong>in</strong>e (d4T, Zerit), tenofovir (Viread), zalcitab<strong>in</strong>e (ddC, Hivid), zidovud<strong>in</strong>e (AZT, Retrovir). PIs- amprenavir (Agenerase), atazanavir (Reyataz), fosamprenavir (Lexiva), <strong>in</strong>d<strong>in</strong>avir (Crixivan), lop<strong>in</strong>avir/ritonavir (Kaletra), nelf<strong>in</strong>avir (Viracept), ritonavir (Norvir), saqu<strong>in</strong>avir (Invirase, Fortovase). NNRTIs- delavird<strong>in</strong>e (Rescriptor), efavirenz (Sustiva), nevirap<strong>in</strong>e (Viramune). Other- hydroxyurea (Hydrea). Entry Inhibitor- enfufuvirtide (Fuzeon). OI DRUGS PHS “A1 OI”s- acyclovir (Zovirax), azithromyc<strong>in</strong> (Zithromax), clarithromyc<strong>in</strong> (Biax<strong>in</strong>), famciclovir (Famvir), fluconazole (Diflucan), isoniazid (INH), itraconozole (Sporanox), leucovor<strong>in</strong>, pyrimetham<strong>in</strong>e (Daraprim), sulfadiaz<strong>in</strong>e, TMP/SMX (Bactrim). Other OIs- atovaquone (Mepron), clotrimazole (Mycelex), dapsone, ethambutol (Myambutol), ketoconazole (Nizoral), nystat<strong>in</strong> (Nilstat), pentamid<strong>in</strong>e (Pentam), rifabut<strong>in</strong> (Mycobut<strong>in</strong>), valacyclovir (Valtrex), valganciclovir (Valcyte). Hepatitis C- none. ALL OTHERS amitriptyl<strong>in</strong>e (Elavil), bupropion (Wellbutr<strong>in</strong>), citalopram (Celexa), Depo-Provera (vial), desipram<strong>in</strong>e (Norpram<strong>in</strong>), diphenoxylateatrop<strong>in</strong>e (Lomitil), fluxet<strong>in</strong>e (Prozac), Hep A Vacc<strong>in</strong>e (Havrix),Hep B Vacc<strong>in</strong>e (Engerix, Recombivax, Tw<strong>in</strong>rix), imiquimod (Aldara Cream), mirtazap<strong>in</strong>e (Remeron), nefazodone (Serzone), nizatid<strong>in</strong>e (Axid), loperamide (Immodium), omeprazole (Prilosec), paroxet<strong>in</strong>e (Paxil), prochlorperaz<strong>in</strong>e (Compaz<strong>in</strong>e), promethaz<strong>in</strong>e (Phenergan), ranitid<strong>in</strong>e (Zantac), sertral<strong>in</strong>e (Zoloft), trazadone (Desyrel, Trialod<strong>in</strong>e), venlafax<strong>in</strong>e (Effexor). Oklahoma ANTIRETROVIRALS NRTIs- abacavir (Ziagen), abacavir/lamivud<strong>in</strong>e/zidovud<strong>in</strong>e (Trizivir), didanos<strong>in</strong>e (ddI, Videx), emtricitab<strong>in</strong>e (Emtriva), lamivud<strong>in</strong>e (Epivir, 3TC), lamivud<strong>in</strong>e/zidovud<strong>in</strong>e (Combivir), stavud<strong>in</strong>e (d4T, Zerit), tenofovir (Viread), zalcitab<strong>in</strong>e (ddC, Hivid), zidovud<strong>in</strong>e (AZT, Retrovir). PIs- amprenavir (Agenerase), atazanavir (Reyataz), fosamprenavir (Lexiva), <strong>in</strong>d<strong>in</strong>avir (Crixivan), lop<strong>in</strong>avir/ritonavir (Kaletra), nelf<strong>in</strong>avir (Viracept), ritonavir (Norvir), saqu<strong>in</strong>avir (Fortovase). NNRTIs- delavird<strong>in</strong>e (Rescriptor), efavirenz (Sustiva), nevirap<strong>in</strong>e (Viramune). OI DRUGS PHS “A1 OI”s- acyclovir (Zovirax), azithromyc<strong>in</strong> (Zithromax), cidofovir (Vistide), clarithromyc<strong>in</strong> (Biax<strong>in</strong>), famcyclovir (Famvir), fluconazole (Diflucan), foscarnet (Foscavir), gancyclovir (Cytovene), isoniazid (INH), itraconazole (Sporonox), leucovor<strong>in</strong>, pyrimetham<strong>in</strong>e (Daraprim, Fansidar), sulfadiaz<strong>in</strong>e, TMP/SMX (Bactrim, Septra). Other OIs- clotrimazole torches (Mycelex Torches), dapsone, ethambutol (Myambutol), mycobut<strong>in</strong> (Rifabut<strong>in</strong>), nystat<strong>in</strong> (Mycostat<strong>in</strong>), pentamid<strong>in</strong>e (NebuPent, Pentam), pyraz<strong>in</strong>amide, rifamp<strong>in</strong>, valganciclovir (Valcyte). Hepatitis C- none TREATMENT FOR METABOLIC DISORDERS Wast<strong>in</strong>g- dronab<strong>in</strong>ol (Mar<strong>in</strong>ol), megestrol acetate (Megace), oxandrolone (Oxandr<strong>in</strong>), testosterone. ALL OTHERS Removed <strong>in</strong> 2003- amitriptyl<strong>in</strong>e (Elavil), atorvastat<strong>in</strong> (Lipitor), citalopram (Celexa), clozap<strong>in</strong>e (Clozaril), fenofibrate (Tricor), fluoxet<strong>in</strong>e (Prozac), gabapent<strong>in</strong> (Neuront<strong>in</strong>), gemfibrozil (Lopid), glipizide (Glucotrol), glyburide (Diabeta, Micronase), metform<strong>in</strong> (Glucophage), mirtazap<strong>in</strong>e (Remeron), nefazodone (Serzone), olanzap<strong>in</strong>e (Zyprexa), paroxet<strong>in</strong>e (Paxil), phenyto<strong>in</strong> (Dilant<strong>in</strong>), pioglitazone (Actose), pravastat<strong>in</strong> (Pravachol), risperidone (Risperdal), rosiglitazone (Avandia),sertral<strong>in</strong>e (Zoloft), trazodone (Desyrel), valporic acid (Depakene).
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