ALABAMA MEDICAID AGENCY Cough and Cold List
ALABAMA MEDICAID AGENCY Cough and Cold List
ALABAMA MEDICAID AGENCY Cough and Cold List
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<strong>ALABAMA</strong> <strong>MEDICAID</strong> <strong>AGENCY</strong><br />
<strong>Cough</strong> <strong>and</strong> <strong>Cold</strong> <strong>List</strong><br />
by Generic Name<br />
In accordance with the Omnibus Budget Reconciliation Act of 1990 (OBRA 90), agents used for the symptomatic relief of<br />
cough <strong>and</strong> cold are an optional coverage class of drugs for the Alabama Medicaid Agency. Effective November 1, 2005,<br />
the Alabama Medicaid Agency covers generic <strong>and</strong> OTC cough <strong>and</strong> cold products; br<strong>and</strong> name cough <strong>and</strong> cold products are<br />
non‐covered. The list below contains products which are currently covered by the Alabama Medicaid Agency. The list is<br />
subject to change. For additional information <strong>and</strong> updates, please see the Agency website at www.medicaid.alabama.gov.<br />
Br<strong>and</strong> Name Generic Name Dosage Form<br />
BENZONATATE 100 MG CAPSULE BENZONATATE ORAL 100MG CAPSULE CAPSULE<br />
BENZONATATE 200 MG CAPSULE BENZONATATE ORAL 200MG CAPSULE CAPSULE<br />
M‐END WC LIQUID BROMPHENIRA/PSEUDOEPHED/CODEIN ORAL 1.3‐10‐6.3 LIQUID LIQUID<br />
POLY‐TUSSIN DHC LIQUID BROMPHENIRAM/PE/DIHYDROCODEINE ORAL 4‐7.5‐3/5 LIQUID LIQUID<br />
POLY‐TUSSIN AC LIQUID BROMPHENIRAMIN/PE/CODEINE PHOS ORAL 4‐7.5‐10/5 LIQUID LIQUID<br />
CHILDS COLD & COUGH DM ELIXIR BROMPHENIRAMIN/PE/DEXTROMETHOR ORAL 1‐2.5‐5/5 SOLUTION SOLUTION<br />
DIMETAPP COLD & COUGH LIQUID BROMPHENIRAMIN/PE/DEXTROMETHOR ORAL 1‐2.5‐5/5 SOLUTION SOLUTION<br />
BPM PE DM SYRUP BROMPHENIRAMIN/PE/DEXTROMETHOR ORAL 2‐5‐10MG/5 LIQUID LIQUID<br />
BROM‐PE‐DM 2‐5‐10 MG/ML SYRUP BROMPHENIRAMIN/PE/DEXTROMETHOR ORAL 2‐5‐10MG/5 LIQUID LIQUID<br />
LOHIST‐DM SYRUP BROMPHENIRAMIN/PE/DEXTROMETHOR ORAL 2‐5‐10MG/5 LIQUID LIQUID<br />
TUSDEC‐DM LIQUID BROMPHENIRAMIN/PE/DEXTROMETHOR ORAL 2‐7.5‐15/5 LIQUID LIQUID<br />
ALA‐HIST DM LIQUID BROMPHENIRAMIN/PE/DEXTROMETHOR ORAL 4‐7.5‐15/5 LIQUID LIQUID<br />
ENDACOF AC SYRUP BROMPHENIRAMINE/CODEINE PHOS ORAL 2MG‐10MG/5 LIQUID LIQUID<br />
J‐COF DHC LIQUID BROMPHENRM/PSEUDOEPH/DIHYDROCD ORAL 3‐15‐7.5/5 LIQUID LIQUID<br />
D‐TANN AT SUSPENSION CARBETAPENT TAN/DIPHENHYDR TAN ORAL 30‐25MG/5 ORAL SUSP SUSPENSION<br />
C‐TANNA 12 SUSPENSION CAR‐B‐PEN TA/CHLOR‐TAN ORAL 30‐4MG/5ML ORAL SUSP SUSPENSION<br />
TANNATE 12 S SUSPENSION CAR‐B‐PEN TA/CHLOR‐TAN ORAL 30‐4MG/5ML ORAL SUSP SUSPENSION<br />
TUSTAN 12S SUSPENSION CAR‐B‐PEN TA/CHLOR‐TAN ORAL 30‐4MG/5ML ORAL SUSP SUSPENSION<br />
CARBETAPENTANE‐CHLORPHENIR TAB CAR‐B‐PEN TA/CHLOR‐TAN ORAL 60‐5MG TABLET TABLET<br />
TANNIC‐12 TABLET CAR‐B‐PEN TA/CHLOR‐TAN ORAL 60‐5MG TABLET TABLET<br />
QUAD‐TUSS TANNATE PED SUSP CAR‐B‐PEN TA/EPHED TAN/PE/CP ORAL 30‐5‐5‐4/5 ORAL SUSP SUSPENSION<br />
D‐TANN CT TABLET CAR‐B‐PEN TA/PE/DP‐HYDRAMINE ORAL 30‐10‐25MG TABLET TABLET<br />
D‐TANN CD SUSPENSION CAR‐B‐PEN TA/PE/DP‐HYDRAMINE ORAL 30‐15‐25/5 ORAL SUSP SUSPENSION<br />
D‐TANN CT SUSPENSION CAR‐B‐PEN TA/PE/DP‐HYDRAMINE ORAL 30‐7.5‐25 ORAL SUSP SUSPENSION<br />
ALLRES D SUSPENSION CAR‐B‐PEN TA/P‐EPD TAN ORAL 20‐30(75) ORAL SUSP SUSPENSION<br />
ALLRES PD SUSPENSION CAR‐B‐PEN TA/P‐EPD TAN ORAL 7.5‐30MG/5 ORAL SUSP SUSPENSION<br />
L‐ALL 12 NF SUSPENSION CAR‐B‐PEN TA/PHENYLEPHRINE ORAL 30‐25MG/5 ORAL SUSP SUSPENSION<br />
RE ALL 12 SUSPENSION CAR‐B‐PEN TA/PHENYLEPHRINE ORAL 30‐30MG/5 ORAL SUSP SUSPENSION<br />
NOHIST‐EXT CAPLET CHLOR‐MAL/METHSCOPOLAMINE NIT ORAL 8‐2.5MG TAB.SR 12H TABLET 12H<br />
NOHIST‐PE SYRUP CHLOR‐MAL/PHENYLEPH/METHSCOP ORAL 2‐10‐0.75 LIQUID LIQUID<br />
EXTENDRYL SR TABLET CHLOR‐MAL/PHENYLEPH/METHSCOP ORAL 8‐20‐2.5MG TAB.SR 12H TABLET 12H<br />
HISTA‐VENT DA TABLET SA CHLOR‐MAL/PHENYLEPH/METHSCOP ORAL 8‐20‐2.5MG TAB.SR 12H TABLET 12H<br />
NOHIST‐PLUS TABLET SA CHLOR‐MAL/PHENYLEPH/METHSCOP ORAL 8‐20‐2.5MG TAB.SR 12H TABLET 12H<br />
PREHIST D TABLET SA CHLOR‐MAL/PHENYLEPH/METHSCOP ORAL 8‐20‐2.5MG TAB.SR 12H TABLET 12H<br />
PRO‐CLEAR AC SYRUP CODEINE PHOS/PYRIL MAL ORAL 9‐8.33MG/5 LIQUID LIQUID<br />
PROMETHAZINE‐CODEINE SYRUP CODEINE/PROMETHAZINE HCL ORAL 10‐6.25/5 SYRUP SYRUP<br />
COUGH RELIEF LIQUID DEXTROMETHORPHAN HBR ORAL 15MG/5ML LIQUID LIQUID<br />
DELSYM 30 MG/5 ML LIQUID DEXTROMETHORPHAN HBR ORAL 30MG/5ML LIQUID LIQUID<br />
ROBITUSSIN PEDIATRIC COUGH SYP DEXTROMETHORPHAN HBR ORAL 7.5MG/5ML SYRUP SYRUP<br />
AMBI 20DM‐4CPM TABLET DEXTROMETHORPHAN HBR/CHLOR‐MAL ORAL 20MG‐4MG TABLET TABLET<br />
DELSYM 30 MG/5 ML SUSPENSION DEXTROMETHORPHAN POLISTIREX ORAL 30MG/5ML SUS.12H SR SUSPENSION<br />
SM COLD & COUGH LIQUID DEXTROMETHORPHAN/PHENYLEPHRINE ORAL 5‐2.5MG/5 LIQUID LIQUID<br />
1 Effective 7/1/09
<strong>ALABAMA</strong> <strong>MEDICAID</strong> <strong>AGENCY</strong><br />
<strong>Cough</strong> <strong>and</strong> <strong>Cold</strong> <strong>List</strong><br />
by Generic Name (continued)<br />
Br<strong>and</strong> Name Generic Name Dosage Form<br />
J‐MAX DHC LIQUID DIHYDROCODEINE/GUAIFENESIN ORAL 7.5‐100/5 LIQUID LIQUID<br />
DM‐PE‐DEXCHLORPHEN TANN SUSP DM TAN/PE TAN/DEXCHLORPHEN TAN ORAL 30‐20‐2/5 ORAL SUSP SUSPENSION<br />
D‐TANN DM SUSPENSION DM/PHENYLEPH/DIPHENHYDRAM TANN ORAL 75‐7.5‐25 ORAL SUSP SUSPENSION<br />
CORYZA‐DM SYRUP DM/PHENYLEPH/PYRIL/DEXCHLROPHE ORAL 5‐5‐5‐1.25 SOLUTION SOLUTION<br />
P‐HIST SYRUP DM/PHENYLEPH/PYRIL/DEXCHLROPHE ORAL 5‐5‐5‐1.25 SOLUTION SOLUTION<br />
RESPERAL SYRUP DM/PHENYLEPH/PYRIL/DEXCHLROPHE ORAL 5‐5‐5‐1.25 SOLUTION SOLUTION<br />
DM‐PE‐BROM TAN 30‐25‐10 MG SUS D‐METHORP TAN/PE/BR‐PHENIR ORAL 30‐25‐10/5 ORAL SUSP SUSPENSION<br />
BROM‐DM‐PSE TAN 8‐60‐90 MG SUS D‐METHORP TAN/P‐EPD TAN/BPM ORAL 60‐90‐8/5 ORAL SUSP SUSPENSION<br />
TANNATE DMP‐DEX SUSPENSION D‐METHORP TAN/P‐EPD TAN/D‐CP ORAL 25‐75‐2.5 ORAL SUSP SUSPENSION<br />
SUTAN‐DM SUSPENSION D‐METHORP TAN/P‐EPD TAN/D‐CP ORAL 27.5‐50‐3 ORAL SUSP SUSPENSION<br />
TANNATE PD‐DM SUSPENSION D‐METHORP TAN/P‐EPD TAN/D‐CP ORAL 27.5‐50‐3 ORAL SUSP SUSPENSION<br />
BROMATAN PLUS SUSPENSION D‐METHORP TAN/P‐EPD TAN/D‐CP ORAL 30‐45‐3.5 ORAL SUSP SUSPENSION<br />
MAXIPHEN ADT TABLET D‐METHORP TAN/PHENYLEPHRINE/CP ORAL 30‐20‐2MG TABLET TABLET<br />
DM‐CHLORPHEN‐METHSCOP TABLET D‐METHORPHAN HB/CHLOR‐MAL/SCOP ORAL 30‐8‐2.5MG TAB.SR 12H TABLET 12H<br />
DE‐CHLOR DM LIQUID D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 15‐10‐2/5 SYRUP SYRUP<br />
DMETHORPHAN‐PE‐CHLORPHENIR LIQ D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 15‐10‐2/5 SYRUP SYRUP<br />
CORFEN‐DM LIQUID D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 15‐10‐4/5 SOLUTION SOLUTION<br />
DEXTROMETHORPHAN‐CP‐PHENYL LIQ D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 15‐10‐4/5 SOLUTION SOLUTION<br />
ED‐A‐HIST DM LIQUID D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 15‐10‐4/5 SOLUTION SOLUTION<br />
TRITAL DM LIQUID D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 15‐10‐4/5 SOLUTION SOLUTION<br />
CARDEC DM SYRUP D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 15‐12.5‐4 SYRUP SYRUP<br />
CERON‐DM SYRUP D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 15‐12.5‐4 SYRUP SYRUP<br />
CP DEC‐DM SYRUP D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 15‐12.5‐4 SYRUP SYRUP<br />
C‐PHEN DM SYRUP D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 15‐12.5‐4 SYRUP SYRUP<br />
SILDEC PE‐DM SYRUP D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 15‐12.5‐4 SYRUP SYRUP<br />
PE‐HIST DM SYRUP D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 15‐5‐2MG/5 SYRUP SYRUP<br />
REME TUSSIN DM SYRUP D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 15‐5‐2MG/5 SYRUP SYRUP<br />
DE‐CHLOR DR LIQUID D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 15‐6‐2MG/5 SYRUP SYRUP<br />
DEX PC SYRUP D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 15‐6‐2MG/5 SYRUP SYRUP<br />
MINTUSS DR SYRUP D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 15‐6‐2MG/5 SYRUP SYRUP<br />
TRI‐VENT DPC SYRUP D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 15‐6‐2MG/5 SYRUP SYRUP<br />
RE DCP DROPS D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 2.75MG/ML DROPS DROPS<br />
AMBI 10PEH‐4CPM‐20DM TABLET D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 20‐10‐4MG TABLET TABLET<br />
NOHIST DMX SR TABLET D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 30‐20‐8MG TAB.SR 12H TABLET 12H<br />
DONATUSSIN DM DROPS D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 3‐1.5‐1/ML DROPS DROPS<br />
RELAHIST‐DM PEDIATRIC DROPS D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 3‐2‐1MG/ML DROPS DROPS<br />
SONAHIST DM PEDIATRIC DROPS D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 3‐2‐1MG/ML DROPS DROPS<br />
CARDEC DM DROPS D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 3‐3.5‐1/ML DROPS DROPS<br />
CERON‐DM ORAL DROPS D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 3‐3.5‐1/ML DROPS DROPS<br />
CP DEC‐DM ORAL DROPS D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 3‐3.5‐1/ML DROPS DROPS<br />
C‐PHEN DM DROPS D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 3‐3.5‐1/ML DROPS DROPS<br />
SILDEC PE‐DM ORAL DROPS D‐METHORPHAN HB/PE/CHLORPHENIR ORAL 3‐3.5‐1/ML DROPS DROPS<br />
TUSSALL SYRUP D‐METHORPHAN HB/PE/D‐BP ORAL 20‐10‐2/5 SYRUP SYRUP<br />
TUSSALL‐ER TABLET D‐METHORPHAN HB/PE/D‐BP ORAL 30‐20‐6MG TAB.SR 12H TABLET 12H<br />
Y‐COF DM TABLET D‐METHORPHAN HB/PE/D‐BP ORAL 30‐20‐6MG TAB.SR 12H TABLET 12H<br />
BROMETANE DX SYRUP D‐METHORPHAN HB/P‐EPD HCL/BPM ORAL 10‐30‐2/5 SYRUP SYRUP<br />
MYPHETANE DX COUGH SYRUP D‐METHORPHAN HB/P‐EPD HCL/BPM ORAL 10‐30‐2/5 SYRUP SYRUP<br />
PBM ALLERGY SYRUP D‐METHORPHAN HB/P‐EPD HCL/BPM ORAL 15‐30‐3/5 LIQUID LIQUID<br />
2 Effective 7/1/09
<strong>ALABAMA</strong> <strong>MEDICAID</strong> <strong>AGENCY</strong><br />
<strong>Cough</strong> <strong>and</strong> <strong>Cold</strong> <strong>List</strong><br />
by Generic Name (continued)<br />
Br<strong>and</strong> Name Generic Name Dosage Form<br />
ANDEHIST‐DM NR SYRUP D‐METHORPHAN HB/P‐EPD HCL/BPM ORAL 15‐45‐4/5 SYRUP SYRUP<br />
CARBOFED DM SYRUP D‐METHORPHAN HB/P‐EPD HCL/BPM ORAL 15‐45‐4/5 SYRUP SYRUP<br />
SILDEC‐DM SYRUP D‐METHORPHAN HB/P‐EPD HCL/BPM ORAL 15‐45‐4/5 SYRUP SYRUP<br />
NEO DM SYRUP D‐METHORPHAN HB/P‐EPD HCL/BPM ORAL 30‐50‐3MG LIQUID LIQUID<br />
BROMPHENEX DM SYRUP D‐METHORPHAN HB/P‐EPD HCL/BPM ORAL 30‐60‐4/5 SYRUP SYRUP<br />
BROMPHENEX DM SYRUP D‐METHORPHAN HB/P‐EPD HCL/BPM ORAL 30‐60‐4/5 SYRUP SYRUP<br />
BROMPLEX DM SYRUP D‐METHORPHAN HB/P‐EPD HCL/BPM ORAL 30‐60‐4/5 SYRUP SYRUP<br />
ENDACOF‐DM SYRUP D‐METHORPHAN HB/P‐EPD HCL/BPM ORAL 30‐60‐4/5 SYRUP SYRUP<br />
PSE BROM DM SYRUP D‐METHORPHAN HB/P‐EPD HCL/BPM ORAL 30‐60‐4/5 SYRUP SYRUP<br />
ALLANHIST PDX DROPS D‐METHORPHAN HB/P‐EPD HCL/BPM ORAL 3‐12.5‐1/1 DROPS DROPS<br />
BROMHIST PDX DROPS D‐METHORPHAN HB/P‐EPD HCL/BPM ORAL 3‐12.5‐1/1 DROPS DROPS<br />
ENDACOF‐PD DROPS D‐METHORPHAN HB/P‐EPD HCL/BPM ORAL 3‐12.5‐1/1 DROPS DROPS<br />
BROMHIST‐DM DROPS D‐METHORPHAN HB/P‐EPD HCL/BPM ORAL 4‐15‐1MG/1 DROPS DROPS<br />
PEDIAHIST DM DROPS D‐METHORPHAN HB/P‐EPD HCL/BPM ORAL 4‐15‐1MG/1 DROPS DROPS<br />
P‐HIST DM DROPS D‐METHORPHAN HB/P‐EPD HCL/BPM ORAL 5‐12‐1MG/1 DROPS DROPS<br />
TRIAMINIC COUGH LIQUID D‐METHORPHAN HB/P‐EPHED HCL ORAL 5‐15MG/5ML SYRUP SYRUP<br />
PEDIACARE LONG‐ACTING LIQ D‐METHORPHAN HB/P‐EPHED HCL ORAL 7.5‐15MG/5 SYRUP SYRUP<br />
TRIAMINIC COUGH‐NASAL CONG LIQ D‐METHORPHAN HB/P‐EPHED HCL ORAL 7.5‐15MG/5 SYRUP SYRUP<br />
AMBI 60PSE‐4CPM‐20DM TABLET D‐METHORPHAN HB/P‐EPHED HCL/CP ORAL 20‐60‐4MG TABLET TABLET<br />
NEUTRAHIST PDX DROPS D‐METHORPHAN HB/P‐EPHED HCL/CP ORAL 3‐9‐0.8/ML DROPS DROPS<br />
KIDCARE COUGH & COLD LIQUID D‐METHORPHAN HB/P‐EPHED HCL/CP ORAL 5‐15‐1MG/5 LIQUID LIQUID<br />
PEDIA RELIEF COUGH‐COLD LIQUID D‐METHORPHAN HB/P‐EPHED HCL/CP ORAL 5‐15‐1MG/5 LIQUID LIQUID<br />
PEDIATRIC COUGH‐COLD LIQUID D‐METHORPHAN HB/P‐EPHED HCL/CP ORAL 5‐15‐1MG/5 LIQUID LIQUID<br />
TRIAMINIC COLD & COUGH LIQUID D‐METHORPHAN HB/P‐EPHED HCL/CP ORAL 5‐15‐1MG/5 LIQUID LIQUID<br />
PROMETHAZINE‐DM SYRUP D‐METHORPHAN HB/PROMETH HCL ORAL 15‐6.25/5 SYRUP SYRUP<br />
ALLANVAN‐DM SUSPENSION DM‐PE‐PYRILAMINE TANNATES ORAL 25‐12.5‐30 ORAL SUSP SUSPENSION<br />
TANNATE‐V‐DM SUSPENSION DM‐PE‐PYRILAMINE TANNATES ORAL 25‐12.5‐30 ORAL SUSP SUSPENSION<br />
VIRATAN‐DM SUSPENSION DM‐PE‐PYRILAMINE TANNATES ORAL 25‐12.5‐30 ORAL SUSP SUSPENSION<br />
DM‐PE‐PYRILAMINE TANN SUSP DM‐PE‐PYRILAMINE TANNATES ORAL 25‐15.5/5 ORAL SUSP SUSPENSION<br />
VIRATAN‐DM TABLET CHEWABLE DM‐PE‐PYRILAMINE TANNATES ORAL 25‐25‐30MG TAB CHEW CHEW TAB<br />
PSEUDO DM GG SYRUP GUAIFEN/DM HB/P‐EPHEDRINE ORAL 100‐15‐40 SYRUP SYRUP<br />
RU‐TUSS DM LIQUID GUAIFEN/DM HB/P‐EPHEDRINE ORAL 100‐15‐45 LIQUID LIQUID<br />
DONATUSSIN DM SYRUP GUAIFEN/DM HB/P‐EPHEDRINE ORAL 150‐15‐30 LIQUID LIQUID<br />
EXECLEAR‐DM SYRUP GUAIFEN/DM HB/P‐EPHEDRINE ORAL 150‐15‐30 LIQUID LIQUID<br />
PSEUDO COUGH LIQUID GUAIFEN/DM HB/P‐EPHEDRINE ORAL 175‐15‐32 SOLUTION SOLUTION<br />
AMBI 40PSE‐400GFN‐20DM TABLET GUAIFEN/DM HB/P‐EPHEDRINE ORAL 400‐20‐40 TABLET TABLET<br />
AMBI 60PSE‐400GFN‐20DM TABLET GUAIFEN/DM HB/P‐EPHEDRINE ORAL 400‐20‐60 TABLET TABLET<br />
EXEFEN DMX TABLET GUAIFEN/DM HB/P‐EPHEDRINE ORAL 400‐20‐60 TABLET TABLET<br />
BROMHIST‐DM PEDIATRIC SYRUP GUAIFEN/DM HB/P‐EPHEDRINE/BPM ORAL 50‐5‐30‐2 SYRUP SYRUP<br />
HISTACOL DM PEDIATRIC SYRUP GUAIFEN/DM HB/P‐EPHEDRINE/BPM ORAL 50‐5‐30‐2 SYRUP SYRUP<br />
PEDIAHIST DM SYRUP GUAIFEN/DM HB/P‐EPHEDRINE/BPM ORAL 50‐5‐30‐2 SYRUP SYRUP<br />
HYDRO‐TUSSIN EXP SYRUP GUAIFEN/P‐EPHED HCL/DIHY‐COD ORAL 100‐15‐7.5 SYRUP SYRUP<br />
ADULT MUCUS RELIEF LIQ GUAIFENESIN ORAL 100MG/5ML LIQUID LIQUID<br />
CHILD MUCUS RELIEF LIQUID GUAIFENESIN ORAL 100MG/5ML LIQUID LIQUID<br />
CHILD'S MUCINEX 100 MG/5 ML LQ GUAIFENESIN ORAL 100MG/5ML LIQUID LIQUID<br />
DIABETIC TUSSIN EX LIQUID GUAIFENESIN ORAL 100MG/5ML LIQUID LIQUID<br />
GUAIFENESIN 100 MG/5 ML SYRUP GUAIFENESIN ORAL 100MG/5ML LIQUID LIQUID<br />
GUAIFENESIN NR 100 MG/5 ML GUAIFENESIN ORAL 100MG/5ML LIQUID LIQUID<br />
3 Effective 7/1/09
<strong>ALABAMA</strong> <strong>MEDICAID</strong> <strong>AGENCY</strong><br />
<strong>Cough</strong> <strong>and</strong> <strong>Cold</strong> <strong>List</strong><br />
by Generic Name (continued)<br />
Br<strong>and</strong> Name Generic Name Dosage Form<br />
GUAIFENESIN SYRUP GUAIFENESIN ORAL 100MG/5ML LIQUID LIQUID<br />
GUIATUSS 100 MG/5 ML SYRUP GUAIFENESIN ORAL 100MG/5ML LIQUID LIQUID<br />
IOPHEN NR LIQUID GUAIFENESIN ORAL 100MG/5ML LIQUID LIQUID<br />
MEDI‐TUSSIN 100 MG/5 ML SYRUP GUAIFENESIN ORAL 100MG/5ML LIQUID LIQUID<br />
MUCUS RELIEF 100 MG/5 ML LIQ GUAIFENESIN ORAL 100MG/5ML LIQUID LIQUID<br />
MUCUS RELIEF LIQUID GUAIFENESIN ORAL 100MG/5ML LIQUID LIQUID<br />
Q‐TUSSIN 100 MG/5 ML SYRUP GUAIFENESIN ORAL 100MG/5ML LIQUID LIQUID<br />
ROBAFEN 100 MG/5 ML SYRUP GUAIFENESIN ORAL 100MG/5ML LIQUID LIQUID<br />
ROBITUSSIN CHEST CONGEST LIQ GUAIFENESIN ORAL 100MG/5ML LIQUID LIQUID<br />
ROBITUSSIN CHEST CONGEST SYRUP GUAIFENESIN ORAL 100MG/5ML LIQUID LIQUID<br />
SB COUGH CONTROL SYRUP GUAIFENESIN ORAL 100MG/5ML LIQUID LIQUID<br />
SILTUSSIN DAS LIQUID GUAIFENESIN ORAL 100MG/5ML LIQUID LIQUID<br />
SUNMARK TUSSIN ORIGINAL SYRUP GUAIFENESIN ORAL 100MG/5ML LIQUID LIQUID<br />
TUSSIN 100 MG/5 ML SYRUP GUAIFENESIN ORAL 100MG/5ML LIQUID LIQUID<br />
TUSSIN EXPECTORANT GUAIFENESIN ORAL 100MG/5ML LIQUID LIQUID<br />
TUSSIN HONEY SYRUP GUAIFENESIN ORAL 100MG/5ML LIQUID LIQUID<br />
TUSSIN SYRUP GUAIFENESIN ORAL 100MG/5ML LIQUID LIQUID<br />
COUGHTAB 200 MG TABLET GUAIFENESIN ORAL 200MG TABLET TABLET<br />
GUAIFENESIN 200 MG TABLET GUAIFENESIN ORAL 200MG TABLET TABLET<br />
ORGAN‐I NR 200 MG TABLET GUAIFENESIN ORAL 200MG TABLET TABLET<br />
ALLFEN 400 MG TABLET GUAIFENESIN ORAL 400MG TABLET TABLET<br />
COUGHTAB 400 MG TABLET GUAIFENESIN ORAL 400MG TABLET TABLET<br />
GUAIFENESIN 400 MG TABLET GUAIFENESIN ORAL 400MG TABLET TABLET<br />
MUCUS RELIEF 400 MG TABLET GUAIFENESIN ORAL 400MG TABLET TABLET<br />
MUCINEX 600 MG TABLET GUAIFENESIN ORAL 600MG TABLET SA TABLET SA<br />
GANI‐TUSS NR LIQUID GUAIFENESIN/CODEINE PHOS ORAL 100‐10MG/5 LIQUID LIQUID<br />
IOPHEN‐C NR LIQUID GUAIFENESIN/CODEINE PHOS ORAL 100‐10MG/5 LIQUID LIQUID<br />
MYCI‐GC LIQUID GUAIFENESIN/CODEINE PHOS ORAL 100‐10MG/5 LIQUID LIQUID<br />
CHERATUSSIN AC SYRUP GUAIFENESIN/CODEINE PHOS ORAL 100‐10MG/5 SYRUP SYRUP<br />
GUAIFENESIN‐CODEINE SYRUP GUAIFENESIN/CODEINE PHOS ORAL 100‐10MG/5 SYRUP SYRUP<br />
ROBAFEN AC SYRUP GUAIFENESIN/CODEINE PHOS ORAL 100‐10MG/5 SYRUP SYRUP<br />
M‐CLEAR WC LIQUID GUAIFENESIN/CODEINE PHOS ORAL 100‐6.3/5 LIQUID LIQUID<br />
CODEINE‐GUAIFEN 10MG‐200MG LIQ GUAIFENESIN/CODEINE PHOS ORAL 200‐10MG/5 LIQUID LIQUID<br />
EXECLEAR‐C SYRUP GUAIFENESIN/CODEINE PHOS ORAL 200‐10MG/5 LIQUID LIQUID<br />
CODEINE 10 MG‐GUAI 300 MG LIQ GUAIFENESIN/CODEINE PHOS ORAL 300‐10MG/5 LIQUID LIQUID<br />
DEX‐TUSS LIQUID GUAIFENESIN/CODEINE PHOS ORAL 300‐10MG/5 LIQUID LIQUID<br />
GUAIFENESIN‐CODEINE TABLET GUAIFENESIN/CODEINE PHOS ORAL 300MG‐10MG TABLET TABLET<br />
CHERACOL D COUGH FORMULA GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 LIQUID LIQUID<br />
DIABETIC TUSSIN DM LIQUID GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 LIQUID LIQUID<br />
GANI‐TUSS‐DM NR LIQUID GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 LIQUID LIQUID<br />
GUAIFENESIN‐DM NR LIQUID GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 LIQUID LIQUID<br />
IOPHEN DM LIQUID GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 LIQUID LIQUID<br />
MEDI‐TUSSIN DM DIABETIC LIQ GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 LIQUID LIQUID<br />
PV TUSSIN DM CLEAR LIQUID GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 LIQUID LIQUID<br />
SILTUSSIN DM DAS LIQUID GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 LIQUID LIQUID<br />
TUSNEL DIABETIC LIQUID GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 LIQUID LIQUID<br />
TUSSIN DM LIQUID GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 LIQUID LIQUID<br />
GENATUSS DM SYRUP GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 SYRUP SYRUP<br />
4 Effective 7/1/09
<strong>ALABAMA</strong> <strong>MEDICAID</strong> <strong>AGENCY</strong><br />
<strong>Cough</strong> <strong>and</strong> <strong>Cold</strong> <strong>List</strong><br />
by Generic Name (continued)<br />
Br<strong>and</strong> Name Generic Name Dosage Form<br />
GUAIFENESIN DM SYRUP GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 SYRUP SYRUP<br />
GUIATUSS DM SYRUP GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 SYRUP SYRUP<br />
Q‐TUSSIN DM SYRUP GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 SYRUP SYRUP<br />
Q‐TUSSIN‐DM SYRUP GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 SYRUP SYRUP<br />
ROBAFEN‐DM CLEAR SYRUP GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 SYRUP SYRUP<br />
ROBAFEN‐DM SYRUP GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 SYRUP SYRUP<br />
ROBITUSSIN‐COUGH‐CHEST‐CONG LQ GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 SYRUP SYRUP<br />
ROBITUSSIN‐DM COUGH SYRUP GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 SYRUP SYRUP<br />
ROBITUSSIN‐DM SYRUP GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 SYRUP SYRUP<br />
SB COUGH CONTROL DM SYRUP GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 SYRUP SYRUP<br />
SILTUSSIN DM COUGH SYRUP GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 SYRUP SYRUP<br />
SM TUSSIN CLEAR SYRUP GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 SYRUP SYRUP<br />
SM TUSSIN DM GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 SYRUP SYRUP<br />
TUSSIN DM CLEAR SYRUP GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 SYRUP SYRUP<br />
TUSSIN DM COUGH SYRUP GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 SYRUP SYRUP<br />
TUSSIN DM SYRUP GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 SYRUP SYRUP<br />
VICKS PEDIATRIC 44E LIQUID GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐10MG/5 SYRUP SYRUP<br />
CHILD MUCUS RELIEF COUGH LIQ GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐5MG/5 LIQUID LIQUID<br />
CHILDREN'S MUCINEX COUGH LIQ GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐5MG/5 LIQUID LIQUID<br />
MUCUS RELIEF COUGH LIQUID GUAIFENESIN/D‐METHORPHAN HB ORAL 100‐5MG/5 LIQUID LIQUID<br />
DIABETIC TUSSIN MAX‐STR LIQ GUAIFENESIN/D‐METHORPHAN HB ORAL 200‐10MG/5 LIQUID LIQUID<br />
HT‐TUSS DM ELIXIR GUAIFENESIN/D‐METHORPHAN HB ORAL 200‐20/5ML ELIXIR ELIXIR<br />
HYDRO‐TUSSIN DM LIQUID GUAIFENESIN/D‐METHORPHAN HB ORAL 200‐20/5ML ELIXIR ELIXIR<br />
SU‐TUSS DM ELIXIR GUAIFENESIN/D‐METHORPHAN HB ORAL 200‐20/5ML ELIXIR ELIXIR<br />
SIMUC‐DM ELIXIR GUAIFENESIN/D‐METHORPHAN HB ORAL 225‐25MG/5 SOLUTION SOLUTION<br />
DEX‐TUSS DM LIQUID GUAIFENESIN/D‐METHORPHAN HB ORAL 300‐10MG/5 LIQUID LIQUID<br />
DM 10 MG‐GUAI 300 MG LIQUID GUAIFENESIN/D‐METHORPHAN HB ORAL 300‐10MG/5 LIQUID LIQUID<br />
CHEST CONGEST‐COUGH RELIEF TAB GUAIFENESIN/D‐METHORPHAN HB ORAL 400MG‐20MG TABLET TABLET<br />
MUCUS RELIEF DM TABLET GUAIFENESIN/D‐METHORPHAN HB ORAL 400MG‐20MG TABLET TABLET<br />
MUCINEX DM TABLET GUAIFENESIN/D‐METHORPHAN HB ORAL 600MG‐30MG TAB.SR 12H TABLET 12H<br />
PV TUSSIN CF LIQUID GUAIFENESIN/D‐METHORPHAN HB/PE ORAL 100‐10‐5MG LIQUID LIQUID<br />
ROBITUSSIN COUGH‐COLD CF SYR GUAIFENESIN/D‐METHORPHAN HB/PE ORAL 100‐10‐5MG LIQUID LIQUID<br />
TUSSIN CF LIQUID GUAIFENESIN/D‐METHORPHAN HB/PE ORAL 100‐10‐5MG LIQUID LIQUID<br />
Z‐DEX SYRUP GUAIFENESIN/D‐METHORPHAN HB/PE ORAL 100‐20‐10 SYRUP SYRUP<br />
DYNATUSS‐EX SYRUP GUAIFENESIN/D‐METHORPHAN HB/PE ORAL 200‐30‐10 SYRUP SYRUP<br />
PDM GG SYRUP GUAIFENESIN/D‐METHORPHAN HB/PE ORAL 200‐30‐10 SYRUP SYRUP<br />
DACEX‐DM SYRUP GUAIFENESIN/D‐METHORPHAN HB/PE ORAL 25‐12.5/5 SYRUP SYRUP<br />
TRITUSS SYRUP GUAIFENESIN/D‐METHORPHAN HB/PE ORAL 25‐12.5/5 SYRUP SYRUP<br />
Z‐DEX PEDIATRIC DROPS GUAIFENESIN/D‐METHORPHAN HB/PE ORAL 35‐3‐2.5/1 DROPS DROPS<br />
AMBI 10PEH‐400GFN‐20DM TABLET GUAIFENESIN/D‐METHORPHAN HB/PE ORAL 400‐20‐10 TABLET TABLET<br />
SINUTUSS DM TABLET SA GUAIFENESIN/D‐METHORPHAN HB/PE ORAL 600‐30‐15 TABLET TABLET<br />
PSEUDOEPHEDRINE GG SYRUP GUAIFENESIN/P‐EPHED HCL ORAL 200‐40MG/5 LIQUID LIQUID<br />
PSEUDOVENT CAPSULE SA GUAIFENESIN/P‐EPHED HCL ORAL 250‐120MG CPMP 12HR CAPSULE<br />
PSEUDOVENT PED CAPSULE SA GUAIFENESIN/P‐EPHED HCL ORAL 300MG‐60MG CPMP 12HR CAPSULE<br />
PSEUDOVENT 400 CAPSULE GUAIFENESIN/P‐EPHED HCL ORAL 400‐120MG CPMP 12HR CAPSULE<br />
AMBI 40PSE‐400GFN TABLET GUAIFENESIN/P‐EPHED HCL ORAL 400MG‐40MG TABLET TABLET<br />
SUDATEX G TABLET GUAIFENESIN/P‐EPHED HCL ORAL 400MG‐40MG TABLET TABLET<br />
AMBI 60PSE‐400GFN TABLET GUAIFENESIN/P‐EPHED HCL ORAL 400MG‐60MG TABLET TABLET<br />
5 Effective 7/1/09
<strong>ALABAMA</strong> <strong>MEDICAID</strong> <strong>AGENCY</strong><br />
<strong>Cough</strong> <strong>and</strong> <strong>Cold</strong> <strong>List</strong><br />
by Generic Name (continued)<br />
Br<strong>and</strong> Name Generic Name Dosage Form<br />
MUCINEX D TABLET GUAIFENESIN/P‐EPHED HCL ORAL 600MG‐60MG TAB.SR 12H TABLET 12H<br />
CRANTEX LIQUID GUAIFENESIN/PHENYLEPHRINE HCL ORAL 100‐7.5/5 SYRUP SYRUP<br />
QUINTEX LIQUID GUAIFENESIN/PHENYLEPHRINE HCL ORAL 100‐7.5/5 SYRUP SYRUP<br />
GUAIFENESIN‐PHENYLEPHRINE SYR GUAIFENESIN/PHENYLEPHRINE HCL ORAL 200‐5MG/5 SYRUP SYRUP<br />
DONATUSSIN DROPS GUAIFENESIN/PHENYLEPHRINE HCL ORAL 20‐1.5/ML DROPS DROPS<br />
RE PHENYLEPHRINE‐GUAIFEN DROPS GUAIFENESIN/PHENYLEPHRINE HCL ORAL 20‐1.5/ML DROPS DROPS<br />
AMBI 10PEH‐400GFN TABLET GUAIFENESIN/PHENYLEPHRINE HCL ORAL 400MG‐10MG TABLET TABLET<br />
GUAIFENESIN‐PHENYLEPHRINE TAB GUAIFENESIN/PHENYLEPHRINE HCL ORAL 400MG‐10MG TABLET TABLET<br />
LIQUIBID D‐R TABLET GUAIFENESIN/PHENYLEPHRINE HCL ORAL 400MG‐10MG TABLET TABLET<br />
TUSSIGON TABLET HYDROCODONE BIT/HOMATROPINE ORAL 5‐1.5MG TABLET TABLET<br />
HYDROCODONE‐HOMATROPINE SYRUP HYDROCODONE BIT/HOMATROPINE ORAL 5‐1.5MG/5 SYRUP SYRUP<br />
HYDROMET SYRUP HYDROCODONE BIT/HOMATROPINE ORAL 5‐1.5MG/5 SYRUP SYRUP<br />
REDUR‐PCM SUSPENSION PE & CPM TANNATES/METHSCOP NT ORAL 10‐2‐1.5/5 ORAL SUSP SUSPENSION<br />
AH‐CHEW ULTRA SUSPENSION PE,CHLORPHEN,&METHSCOP TANNATS ORAL 10‐2‐1.5/5 ORAL SUSP SUSPENSION<br />
CHERATUSSIN DAC SYRUP P‐EPHED HCL/CODEINE/GUAIFEN ORAL 30‐10‐100 SYRUP SYRUP<br />
PHENYLHISTINE EXPECTORANT P‐EPHED HCL/CODEINE/GUAIFEN ORAL 30‐10‐100 SYRUP SYRUP<br />
STAHIST TABLET P‐EPHED HCL/CPMM/ATP/SCOP/HYOS ORAL 90‐8‐0.04 TAB.SR 12H TABLET 12H<br />
CORYZA‐D TABLET P‐EPHED HCL/DEXCHLORPHEN/SCOP ORAL 45‐3.5‐1MG TAB.SR 12H TABLET 12H<br />
D‐HIST D CAPLET P‐EPHED HCL/DEXCHLORPHEN/SCOP ORAL 45‐3.5‐1MG TAB.SR 12H TABLET 12H<br />
COLDCOUGH SYRUP P‐EPHED HCL/DHCODEINE BT/CP ORAL 15‐7.5‐2/5 SYRUP SYRUP<br />
DIHYDRO‐CP SYRUP P‐EPHED HCL/DHCODEINE BT/CP ORAL 15‐7.5‐2/5 SYRUP SYRUP<br />
HYDRO‐TUSSIN DHC SYRUP P‐EPHED HCL/DHCODEINE BT/CP ORAL 15‐7.5‐2/5 SYRUP SYRUP<br />
AMDRY‐D TABLET P‐EPHED HCL/METHSCOPOLAMN ORAL 120‐2.5MG TAB.SR 12H TABLET 12H<br />
SUDATRATE TABLET P‐EPHED HCL/METHSCOPOLAMN ORAL 120‐2.5MG TAB.SR 12H TABLET 12H<br />
NOREL SR TABLET PHENYLEPH/ACETAMINOP/P‐TLOX/CP ORAL 40‐325‐8MG TAB.SR 12H TABLET 12H<br />
DEXPHEN M SOLUTION PHENYLEPH/DEXCHLOR/METHSCOPOL ORAL 10‐1‐1.25 SOLUTION SOLUTION<br />
RE‐DRYLEX SYRUP PHENYLEPH/DEXCHLOR/METHSCOPOL ORAL 10‐1‐1.25 SOLUTION SOLUTION<br />
CHILDREN'S SUDAFED PE LIQUID PHENYLEPHRINE HCL ORAL 2.5MG/5ML SOLUTION SOLUTION<br />
LUSONAL LIQUID PHENYLEPHRINE HCL ORAL 7.5MG/5ML LIQUID LIQUID<br />
PROMETHAZINE VC‐CODEINE SYRUP PHENYLEPHRINE HCL/COD/PROMETH ORAL 5‐10‐6.25 SYRUP SYRUP<br />
ALA‐HIST AC LIQUID PHENYLEPHRINE HCL/CODEINE PHOS ORAL 7.5‐10MG/5 LIQUID LIQUID<br />
PHENYL‐T SUSPENSION PHENYLEPHRINE TANNATE ORAL 7.5MG/5ML ORAL SUSP SUSPENSION<br />
PHENCARB GG SYRUP PHENYLEPHRINE/CARBETAPENTAN/GG ORAL 10‐20‐100 LIQUID LIQUID<br />
CHLOR‐MES D LIQUID PHENYLEPHRINE/CHLOR‐MAL/SCOP ORAL 10‐2‐0.625 SYRUP SYRUP<br />
DEHISTINE SYRUP PHENYLEPHRINE/CHLOR‐MAL/SCOP ORAL 10‐2‐1.25 SOLUTION SOLUTION<br />
NOHIST‐PLUS TABLET CHEWABLE PHENYLEPHRINE/CHLOR‐MAL/SCOP ORAL 10‐2‐1.25 TAB CHEW CHEW TAB<br />
PCM CHEWABLE TABLET PHENYLEPHRINE/CHLOR‐MAL/SCOP ORAL 10‐2‐1.25 TAB CHEW CHEW TAB<br />
NOHIST‐PLUS JR TABLET SA PHENYLEPHRINE/CHLOR‐MAL/SCOP ORAL 10‐4‐1.25 TABLET SA TABLET SA<br />
RE‐DRYLEX JR TABLET PHENYLEPHRINE/CHLOR‐MAL/SCOP ORAL 10‐4‐1.25 TABLET SA TABLET SA<br />
CHLOR‐MES CAPLET SA PHENYLEPHRINE/CHLOR‐MAL/SCOP ORAL 20‐12‐2.5 TAB.SR 12H TABLET 12H<br />
CPM 8‐PE 20‐MSC 1.25 MG TAB PHENYLEPHRINE/CHLOR‐MAL/SCOP ORAL 20‐8‐1.25 TAB.SR 12H TABLET 12H<br />
HISTATAB PH TABLET PHENYLEPHRINE/CHLOR‐MAL/SCOP ORAL 20‐8‐1.25 TAB.SR 12H TABLET 12H<br />
SCOPOHIST‐PE TABLET PHENYLEPHRINE/CHLOR‐MAL/SCOP ORAL 20‐8‐1.25 TAB.SR 12H TABLET 12H<br />
PHENYLEPHRINE CM TABLET PHENYLEPHRINE/CHLOR‐MAL/SCOP ORAL 40‐8‐2.5MG TAB.SR 12H TABLET 12H<br />
SCOPOHIST SYRUP PHENYLEPHRINE/CHLOR‐MAL/SCOP ORAL 8‐2‐0.75/5 SYRUP SYRUP<br />
COLDCOUGH PD SYRUP PHENYLEPHRINE/DHCODEINE BT/CP ORAL 7.5‐3‐2/5 SYRUP SYRUP<br />
DIHYDRO‐PE SYRUP PHENYLEPHRINE/DHCODEINE BT/CP ORAL 7.5‐3‐2/5 SYRUP SYRUP<br />
CARBATUSS‐CL LIQUID POT GUAIACO/CAR‐B‐PENTANE/PE ORAL 100‐20‐10 LIQUID LIQUID<br />
6 Effective 7/1/09
<strong>ALABAMA</strong> <strong>MEDICAID</strong> <strong>AGENCY</strong><br />
<strong>Cough</strong> <strong>and</strong> <strong>Cold</strong> <strong>List</strong><br />
by Generic Name (continued)<br />
Br<strong>and</strong> Name Generic Name Dosage Form<br />
GUIADEX DM LIQUID POT GUAIACO/D‐METHORPHAN HB ORAL 300‐15MG/5 LIQUID LIQUID<br />
12 HOUR DECONGEST 120 MG CAPLT PSEUDOEPHEDRINE HCL ORAL 120MG TABLET SA TABLET SA<br />
12 HOUR DECONGESTANT CAPLET PSEUDOEPHEDRINE HCL ORAL 120MG TABLET SA TABLET SA<br />
MEDI‐PHEDRINE 120 MG CAPLET PSEUDOEPHEDRINE HCL ORAL 120MG TABLET SA TABLET SA<br />
SM 12 HOUR SINUS DECONG CAPLET PSEUDOEPHEDRINE HCL ORAL 120MG TABLET SA TABLET SA<br />
SUNMARK SINUS 12 HOUR CAPLET PSEUDOEPHEDRINE HCL ORAL 120MG TABLET SA TABLET SA<br />
SUPHEDRIN 12 HOUR CAPLET SA PSEUDOEPHEDRINE HCL ORAL 120MG TABLET SA TABLET SA<br />
CHILDREN'S SILFEDRINE LIQ PSEUDOEPHEDRINE HCL ORAL 15MG/5ML LIQUID LIQUID<br />
GENAPHED 30 MG TABLET PSEUDOEPHEDRINE HCL ORAL 30MG TABLET TABLET<br />
MEDI‐PHEDRINE 30 MG TABLET PSEUDOEPHEDRINE HCL ORAL 30MG TABLET TABLET<br />
NASAL DECONGESTANT 30 MG TAB PSEUDOEPHEDRINE HCL ORAL 30MG TABLET TABLET<br />
NASAL DECONGESTANT TABLET PSEUDOEPHEDRINE HCL ORAL 30MG TABLET TABLET<br />
PSEUDOEPHEDRINE 30 MG TABLET PSEUDOEPHEDRINE HCL ORAL 30MG TABLET TABLET<br />
QC SUPHEDRINE TABLET PSEUDOEPHEDRINE HCL ORAL 30MG TABLET TABLET<br />
SM NASAL DECONGEST 30 MG TAB PSEUDOEPHEDRINE HCL ORAL 30MG TABLET TABLET<br />
SUDOGEST 30 MG TABLET PSEUDOEPHEDRINE HCL ORAL 30MG TABLET TABLET<br />
SUNMARK NASAL DECONGESTANT TAB PSEUDOEPHEDRINE HCL ORAL 30MG TABLET TABLET<br />
SUPHEDRIN 30 MG TABLET PSEUDOEPHEDRINE HCL ORAL 30MG TABLET TABLET<br />
PSEUDOEPHED 30 MG/5 ML SYRUP PSEUDOEPHEDRINE HCL ORAL 30MG/5ML SYRUP SYRUP<br />
PSEUDOEPHEDRINE 60 MG TABLET PSEUDOEPHEDRINE HCL ORAL 60MG TABLET TABLET<br />
PSEUDOEPHEDRINE 60 MG TABLET PSEUDOEPHEDRINE HCL ORAL 60MG TABLET TABLET<br />
SUDOGEST 60 MG TABLET PSEUDOEPHEDRINE HCL ORAL 60MG TABLET TABLET<br />
KIDCARE DECONGESTANT DROPS PSEUDOEPHEDRINE HCL ORAL 9.4MG/ML DROPS DROPS<br />
VALU‐TAPP DECONGESTANT DROP PSEUDOEPHEDRINE HCL ORAL 9.4MG/ML DROPS DROPS<br />
V‐R PEDIA RELIEF DROPS PSEUDOEPHEDRINE HCL ORAL 9.4MG/ML DROPS DROPS<br />
VISRX DOSE PACK TABLET PSEUDOEPHEDRINE/CPM/METHSCOPOL ORAL 120‐2.5MG TABLET SEQ TABLET<br />
AMDRY‐C TABLET PSEUDOEPHEDRINE/CPM/METHSCOPOL ORAL 120‐8‐2.5 TAB.SR 12H TABLET 12H<br />
HISTA‐VENT PSE TABLET PSEUDOEPHEDRINE/CPM/METHSCOPOL ORAL 120‐8‐2.5 TAB.SR 12H TABLET 12H<br />
PCM LA TABLET PSEUDOEPHEDRINE/CPM/METHSCOPOL ORAL 60‐8‐1.25 TAB.SR 12H TABLET 12H<br />
SCOPOHIST TABLET PSEUDOEPHEDRINE/CPM/METHSCOPOL ORAL 60‐8‐1.25 TAB.SR 12H TABLET 12H<br />
COLDAMINE TABLET SA PSEUDOEPHEDRINE/CPM/METHSCOPOL ORAL 90‐8‐2.5MG TAB.SR 12H TABLET 12H<br />
PRO‐RED AC SYRUP PYRIL MA/PE/CODEINE PHOS ORAL 8.33‐5‐9/5 LIQUID LIQUID<br />
MYHIST‐DM LIQUID PYRILAMINE/PE/DEXTROMETHORPHAN ORAL 12.5‐7.5/5 LIQUID LIQUID<br />
REME HIST DM LIQUID PYRILAMINE/PE/DEXTROMETHORPHAN ORAL 12.5‐7.5/5 LIQUID LIQUID<br />
7 Effective 7/1/09
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