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

Washington
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- enfuvirtide (Fuzeon
OI DRUGS
PHS “A1 OI”s- acyclovir (Zovirax), azithromycin (Zithromax), cidofovir (Vistide), clarithromycin (Biaxin), fluconazole (Diflucan),
foscarnet (Foscavir), ganciclovir (Cytovene), leucovorin, pyrimethamine (Daraprim, Fansidar), sulfadiazine (Microsulfon), TMP/SMX
(Bactrim, Septra, CoTrim). Other OIs- albendazole, atovaquone (Mepron), ciprofloxacin (Cipro),
clindamycin, clofazimine (Lamprene), clotrimazole (Lotrimin, Mycelex), dapsone, ethambutol (Myambutol), ketoconazole (Nizoral),
metronidazole (Flagyl, Metrogel), miconazole, nystatin, oflaxacin, paromomycin (Humatin), pentamidine (NebuPent), primaquine,
rifabutin (Mycobutin), rifampim (Rifadin), terconazole (Terazol), trimethoprim, valacyclovir (Valtrex), valganciclovir.
Hepatitis C- none.
TREATMENTS FOR METABOLIC DISORDERS
Diabetic- acarbose (Precose), insulin, injection kits, glucose test strips, glipizide (Glucotrol), glyburide (DiaBeta), metformin
(Glucophage), pioglitazone (Actos), repaglinide (Prandin), rosiglitazone (Avandia). Hyperlipidemia- atorvastatin (Lipitor),
cholestyramine (Questran), gemfibrozil (Lopid), lovastatin (Mevacor), niacin, pravastatin (Pravachol), simvastatin (Zocor),
Wasting- dronabinol (Marinol), megestrol acetate (Megace), testosterone.
ALL OTHERS
aciphex (Raberprazole), amoxicillin, amoxicillin/potassium (Augmentin), ampicillin, carbamazepine (Tegretol), cefixime (Suprax),
ceftriaxone, cephalexin (keflex), cimetidine, clotrimazole / betamethasone (Lotrisone cream), clozapine (Clozaril), dicloxacin,
diphenoxylate / atropine (Lomotil), divalproex Sodium (Depakote), doxyclcline, erythromycin, estrogen (Premarin), famotidine
(Pepcid), gabapentin (Neurontin), Hep B Immune Globulin, Imiquimod cream, Immune Globulin IM (IGIM), lamotrigine (Lamictal),
lindane, lithium, loperamide (Imodium), Mediset fills, medroxyprogesterone (Depo-Provera), metoclopramide (Reglan), nexium
(Espmeprazole), nizatidine (Axid), olanzapine (Zyprexa), ondansetron (Zofran) oxcarbazepine (Trileptal), penicillin, peridex,
permethrin, phenazopyridine (Pyridin, Pyridium), podofilox (Condylox), prevacid (Lansoprazole), prilosec (Omeprazole),
prochlorperazine (Compazine), promethazine (Phenergan), protonix (Pantoprazole), ranitidine (Zantac), risperidone (Risperdal),
selenium sulfide, tetracycline, topical steroids -all drugs in the class, topiramate (Topamax), valproic acid (Depakene), vancomycin oral,
VZIG (Varicella Zoster Immune Globulin). The following classes of drugs are covered as groups. A drug’s class is defined by the
medical community and endorsed by the federal Food and Drug Administration. Analgesic - oral only (e.g.) NSAIDs, Narcotics.
Antianxiety - (e.g.)buspirone (Buspar), clonazepam (Klonopin), diazepam (Valium), hydroxyzine (Vistaril), lorazepam (Ativan).
Antidepressant - (e.g.)amitriptyline (Elavil), bupropion (Wellbutrin), citalopram (Celexa), clomipramine (Anafranil), desipramine,
doxepin, fluoxetine (Prozac), fluvoxamine (Luvox), imipramine, nefazodone (Serzone), nortriptyline, paroxetine (Paxil), sertraline
(Zoloft), trazodone, venlafaxine (Effexor). Removed in 2003- itraconazole (Sporonox).
West Virginia
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). NNRTIs- delavirdine (Rescriptor), efavirenz (Sustiva),
nevirapine (Viramune).
OI DRUGS
PHS “A1 OI”s- acyclovir (Zovirax), azithromycin (Zithromax), fluconazole (Diflucan), leucovorin (Wellcovorin), TMP/SMX
(Bactrim). Other OIs- clotrimazole (Mycelex), dapsone, ketoconazole (Nizoral), nystatin (Mucostatin), pentamidine (NebuPent,
Pentam). Hepatitis C- none.