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California
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), cidofovir (Vistide), clarithromycin (Biaxin), famciclovir (Famvir),
fluconazole (Diflucan), foscarnet (Foscavir), ganciclovir (Cytovene), isoniazid (generic), itraconazole (Sporonox), leucovorin calcium
(Wellcovorin), pyrimethamine (Daraprim), sulfadiazine (oral generic), TMP/SMX (Bactrim, Septra). Other OIs- albendazole (Albenza),
amikacin sulphate (generic injection), amoxicillin trihydrate (oral generic), amphotericin B (Fungizone), atovaquone (Mepron),
bleomycin sulfate (Blenoxane), ciprofloxacin (Cipro), clindamycin (Cleocin), clofazimine (Lamprene), clotrimazole (Lotrimin,
Mycelex), cyclophosphamide (Cytoxan), dapsone (Avlosulfon), dexamethasone (Decadron), doxorubicin (Adriamycin), epoetin alpha
(Procrit), ethambutol (Myambutol), filgrastim (Neupogen), flucytosine (5FC, Ancobon), fomivirsen (Vitravene), ketoconazole (Nizoral),
isoniazid/rifampin (generic), liposomal duanorubicin (DaunoXome), methotrexate (oral, injection), metronidazole (oral generic), nystatin
(Mycostatin), paclitaxel (Taxol), paromomycin (Humatin), pentamidine (Nebupent, Pentam), prednisone (oral generic), pyrazinamide
(generic), rifabutin (Mycobutin), rifampim (generic), trimethoprim (Trimpex, Proloprim), trimetrexate glucuronate (NeuTrexin),
valganciclovir (Valcyte), valacyclovir (Valtrex), vinblastine sulfate (Velban), vincristine sulfate (Oncovin). Hepatitis C- interferon
alfacon 1 (Infergen), interferon A-2A (Intron-A, Roferon-A), ribavirin (generic), ribavirin/interferon alfa 2B (Rebetron).
TREATMENTS FOR METABOLIC DISORDERS
Diabetic- glipizide (Glucotrol), rosiglitazone maleate (Avandia). Hyperlipidemia- atorvastatin (Lipitor), gemfibrozil (generic only),
pravastatin (Pravachol), simvastatin (Zocor). Wasting- dronabinol (Marinol), megestrol acetate (Megace), nandrolone (Durabolin,
Deca-Duranbolin), oxandrolone (Oxandrin), somatropin (Serostim), testosterone (generic injection, transdermal).
ALL OTHERS
alitretinoin gel (Panretin Gel), alprazolam (Xanax), amitriptyline hydrochloride (generic), bupropion HCL (Wellbutrin), buspiron HCL
(BuSpar), cephalexin (oral generic), citalopram hydrobromide (Celexa), codeine w/wo ASA, APAP (oral generic), desipramine HCL
(oral generic), dicloxacillin sodium (oral generic), diphenoxylate HCL (Lomotil), divalproex sodium (Depakote), doxycycline hyclate
(oral generic), erythromycin (oral generic), famotidine (generic), fenoprofen calcium (oral generic), fentanyl (Duragesic, hospice clients
only), fluoxetine HCL (Prozac), gabapentin (Neurontin), hepatitis A vaccine, hepatitis B vaccine, hydrocodone w/wo APAP
(oral generic), ibuprofen-prescription strength (generic), imiquimod (Aldara), indomethacin (oral generic), ketoprofen (oral generic),
ketorolac tromethamine (Toradol injection), lamotrigine (Lamictal), lansoprazole (Prevacid), levorphenol tartrate (Levo-Dromoran),
loperamide HCL (generic), lorazepam (oral generic), methadone HCL (oral generic), metoclopramide (Reglan, Clopra), minocycline
HCL (oral generic), morphine sulfate (oral generic), naproxen (oral generic), nefazodone HCL (Serzone), neomycin sulfate (oral
generic), nortriptyline HCL (oral generic), olanzapine (Zyprexa), omeprazole (Prilosec), opium, tincture of, oxycodone w/wo ASA,
APAP (oral generic), pancrelipase (Ultrase), paroxetine HCL (Paxil), penicillin V potassium (oral generic), pneumococcal vaccine
(Pneumovax, Pnu-Immune), probenecid (generic), prochlorperazine (Compazine), promethazine (Phenergan), quetiapine fumarate
(Seroquel), ranitidine HCL (prescription strength generic), risperidone (Risperdal), sertraline (Zoloft), sulindac (oral generic),
tetracycline HCL (oral generic), trazodone HCL (oral generic), vancomycin HCL (oral generic), venlafaxine HCL (Effexor).
Colorado
ANTIRETROVIRALS
NRTIs- abacavir (Ziagen), abacavir/lamivudine/zidovudine (Trizivir), didanosine (ddI, Videx, Videx EC), lamivudine (Epivir, 3TC),
lamivudine/zidovudine (Combivir), stavudine (d4T, Zerit), tenofovir (Viread), zalcitabine (ddC, Hivid), zidovudine (AZT, Retrovir).
PIs- amprenavir (Agenerase), indinavir (Crixivan), lopinavir/ritonavir (Kaletra), nelfinavir (Viracept), ritonavir (Norvir), saquinavir
(Fortovase, Invirase). NNRTIs- delavirdine (Rescriptor), efavirenz (Sustiva), nevirapine (Viramune).
ALL OTHERS
Removed 2003- acyclovir (Zovirax), azithromycin (Zithromax), cidofovir (Vistide), clarithromycin (Biaxin), famciclovir (Famvir), fluconazole
(Diflucan), foscarnet (Foscavir), ganciclovir (Cytovene), itraconazole (Sporonox), pyrimethamine (Daraprim), sulfadiazine,
TMP/SMX (Bactrim,Septra), amphotericin (Fungizone), atovaquone (Mepron), clindamycin (Cleocin), clotrimazole (Mycelex), dapsone,
ethambutol (Myambutol), pentamidine (Nebupent), rifabutin (Mycobutin), valacyclovir (Valtrex), valganciclovir (Valcyte).