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

Tennessee
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 (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- enfuvirtide (Fuzeon).
OI DRUGS
PHS “A1 OI”s- acyclovir (Zovirax), azithromycin (Zithromax), clarithromycin (Biaxin), fluconazole (Diflucan), itraconazole
(Sporonox), leucovorin, pyrimethamine (Daraprim), sulfadiazine, TMP/SMX (Bactrim). Other OIs- adefovir dipivoxil (Hepsera), atovaquone
(Mepron), clindamycin, dapsone, erythropoietin (Procrit), ethambutol (Myambutol), filgrastim (Neupogen), metronidazole
(Flagyl), nystatin, paromomycin (Humatin), pentamidine (IV, NebuPent), promethazine HCI (Phenergan), rifabutin (Mycobutin),
rifampim, valacyclovir (Valtrex), valganciclovir (Valcyte). Hepatitis C- peginterferon Alfa-2a & ribavirin (Pegasys/Copegus), pegylated
interferonAlfa-2b & ribavirin (Peg-Intron/Rebetol).
TREATMENTS FOR METABOLIC DISORDERS
Cardiac- hydrochlorothiazide, losartan, lotensin, quinapril (Accupril). Hyperlipidemia- atorvastatin (Lipitor), fenofibrate
(Tricor), gemfibrozil (Lopid), Prevastatin (Pravachol). Diabetes- rosiglitazone maleate (Avandia), metformin (Glocophage), glipizide
(Glucotrol). Wasting- megestrol acetate (Megace).
ALL OTHERS
albuterol, (Aldactone), amitriptyline (Elavil), betamethasone topical, bupropion (Wellbutrin), fluticasone propionate (Flonase),
gabapentin (Neurontin), hydrocortisone, ibuprofen, lansoprazole (Prevacid), metoprolol (Lopressor; Toprol XL), nasacort,
Paroxetine (Paxil), phenytoin (Dilantin) prednisone, rofecoxib (Vioxx), sertraline (Zolof). Pediatric formulations of HIV drugs
are available for the following: amprenavir (Agenerase), lamivudine (3TC, Epivir), didanosine (ddI, Videx), zidovudine (AZT,
Retrovir), ritonavir (Norvir), lopinavir/ritonavir (Kaletra), atovaquone (Mepron), megestrol acetate (Megace).
Note: In addition, the following medicines are available through the Medical Services Fee Schedule:
amphotericin B, ceftraxione (Rocephin), cosyntropin (Cortrosyn), foscarnet (Foscavir), ganciclovir, vancomycin.
Texas
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).
OI DRUGS
PHS “A1 OI”s- acyclovir (Zovirax), azithromycin (Zithromax), clarithromycin (Biaxin), fluconazole (Diflucan), ganciclovir
(Cytovene), itraconazole (Sporonox), TMP/SMX (Bactrim). Other OIs- amphotericin B, atovaquone (Mepron), dapsone, ethambutol
(Myambutol), IVIG (Pediatric only), pentamidine (Nebupent), rifabutin (Mycobutin), trimethoprim. valganciclovir (Valcyte).
Hepatitis C- none.
TREATMENTS FOR METABOLIC DISORDERS
Wasting- megestrol acetate (Megace).
Utah
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- enfuviritide (Fuzeon)
OI DRUGS
PHS “A1 OI”s- acyclovir (Zovirax), azithromycin (Zithromax), cidofovir (Vistide), clarithromycin (Biaxin), famciclovir
(Famvir), fluconazole (Diflucan), foscavir (Foscarnet), ganciclovir (Cytovene), isoniazid, itraconazole (Sporonox), Leucovorin,
pyrimethamine (Daraprim), sulfadiazine, TMP/SMX (Bactrim) Other OIs- erythropoietin (Epogen), filgrastim (Neupogen),
Hepatitis C- peg-interferon alfa-2a & ribavirin (Pegasys/Copegus), peg-interferon alfa-2b & ribavirin (Peg-Intron/Rebetol).