Trustmark/Starmark Formulary Drug List April 2008 - Resource ...

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Brand Name Generic Name Tier Form HYDROXYZINE HCL HYDROXYZINE HCL 1 Tablet HYDROXYZINE PAMOATE HYDROXYZINE PAMOATE 1 Capsule (Hard, Soft, etc.) HYDROXYZINE PAMOATE HYDROXYZINE PAMOATE 1 Capsule (Hard, Soft, etc.) VISTARIL HYDROXYZINE PAMOATE 3 Capsule (Hard, Soft, etc.) PROMETHAZINE HCL PROMETHAZINE HCL 1 Syrup PROMETHAZINE HCL PROMETHAZINE HCL 1 Tablet PROMETHAZINE HCL PROMETHAZINE HCL 2 Tablet POLY TAN PYRILAMINE MAL/DEXBROMPHEN TAN 3 Suspension, Oral (Final Dose Form) PYRLEX PYRILAMINE TANNATE 3 Suspension, Oral (Final Dose Form) TRIPOHIST TRIPROLIDINE HCL 1 Syrup TRIPROLIDINE HCL TRIPROLIDINE HCL 1 Syrup ZYMINE TRIPROLIDINE HCL 3 Syrup ZYMINE XR TRIPROLIDINE TANNATE 3 Suspension, Oral (Final Dose Form) EYE ANTIHISTAMINES OPTIVAR AZELASTINE HCL 3 Drops EMADINE EMEDASTINE DIFUMARATE 3 Drops ELESTAT EPINASTINE HCL 3 Drops KETOTIFEN FUMARATE KETOTIFEN FUMARATE 1 Drops PATADAY OLOPATADINE HCL 3 Drops PATANOL OLOPATADINE HCL 2 Drops ANTIHISTAMINES – 2ND GENERATION ZYRTEC CETIRIZINE HCL 3 Syrup ZYRTEC CETIRIZINE HCL 3 Tablet ZYRTEC CETIRIZINE HCL 3 Tablet, Chewable CLARINEX DESLORATADINE 3 Syrup CLARINEX DESLORATADINE 3 Tablet CLARINEX DESLORATADINE 3 Tablet, Rapid Dissolve ALLEGRA FEXOFENADINE HCL 3 Suspension, Oral (Final Dose Form) ALLEGRA FEXOFENADINE HCL 3 Tablet FEXOFENADINE HCL FEXOFENADINE HCL 1 Tablet ALLEGRA ODT FEXOFENADINE HCL 3 Tablet, Rapid Dissolve XYZAL LEVOCETIRIZINE DIHYDROCHLORIDE 3 Tablet ANTIHISTAMINE AND DECONGESTANT COMBINATION 1ST GEN ANTIHISTAMINE & DECONGESTANT COMBINATIONS ALA-HIST D BROMPHENIR/DIPHENHYD/PHENYLEPH 3 Tablet, Sustained Release 12 Hr POLY TAN D PE TAN/PYRIL MAL/DEXBROMPH TAN 3 Suspension, Oral (Final Dose Form) PHENA-S 12 PE/PE & PYRILAMINE TANNATE/CPM 3 Suspension, Oral (Final Dose Form) BROVEX PD P-EPD TAN/BROMPHENIRAMIN 3 Suspension, Oral (Final Dose Form) B-VEX PD P-EPD TAN/BROMPHENIRAMIN 1 Suspension, Oral (Final Dose Form) LODRANE D P-EPD TAN/BROMPHENIRAMIN 3 Suspension, Oral (Final Dose Form) C-PHED TANNATE P-EPD TAN/CHLOR-TAN 1 Suspension, Oral (Final Dose Form) DICEL P-EPD TAN/CHLOR-TAN 3 Suspension, Oral (Final Dose Form) SUDAL 12 P-EPD TAN/CHLOR-TAN 3 Tablet, Chewable BROMFENEX P-EPHED HCL/BROMPHENIRAMIN 1 Capsule, Sustained Action BROMFENEX-PD P-EPHED HCL/BROMPHENIRAMIN 1 Capsule, Sustained Action PSEUBROM P-EPHED HCL/BROMPHENIRAMIN 1 Capsule, Sustained Action PSEUBROM-PD P-EPHED HCL/BROMPHENIRAMIN 1 Capsule, Sustained Action RESPAHIST P-EPHED HCL/BROMPHENIRAMIN 1 Capsule, Sustained Action TOURO ALLERGY P-EPHED HCL/BROMPHENIRAMIN 3 Capsule, Sustained Action ULTRABROM P-EPHED HCL/BROMPHENIRAMIN 1 Capsule, Sustained Action ULTRABROM PD P-EPHED HCL/BROMPHENIRAMIN 1 Capsule, Sustained Action BROMPHENIRAMINE-PSEUDOEPHEDR P-EPHED HCL/BROMPHENIRAMIN 1 Capsule, Sustained Release 12 Hr BROVEX SR P-EPHED HCL/BROMPHENIRAMIN 3 Capsule, Sustained Release 12 Hr HISTEX SR P-EPHED HCL/BROMPHENIRAMIN 1 Capsule, Sustained Release 12 Hr LODRANE 24D P-EPHED HCL/BROMPHENIRAMIN 3 Capsule, Sustained Release 24 Hr BROMHIST P-EPHED HCL/BROMPHENIRAMIN 1 Drops BROMHIST-NR P-EPHED HCL/BROMPHENIRAMIN 1 Drops J-TAN D PD P-EPHED HCL/BROMPHENIRAMIN 3 Drops LOHIST-PD P-EPHED HCL/BROMPHENIRAMIN 1 Drops LODRANE P-EPHED HCL/BROMPHENIRAMIN 3 Liquid (ml) PSE BPM P-EPHED HCL/BROMPHENIRAMIN 1 Liquid (ml) ANDEHIST P-EPHED HCL/BROMPHENIRAMIN 1 Syrup BROFED P-EPHED HCL/BROMPHENIRAMIN 3 Syrup SILDEC P-EPHED HCL/BROMPHENIRAMIN 1 Syrup BPM PSEUDO P-EPHED HCL/BROMPHENIRAMIN 1 Tablet, Sustained Release 12 Hr HISTEX SR P-EPHED HCL/BROMPHENIRAMIN 3 Tablet, Sustained Release 12 Hr LODRANE P-EPHED HCL/BROMPHENIRAMIN 1 Tablet, Sustained Release 12 Hr Page 10
Brand Name Generic Name Tier Form LOHIST 12D P-EPHED HCL/BROMPHENIRAMIN 1 Tablet, Sustained Release 12 Hr SINUHIST P-EPHED HCL/BROMPHENIRAMIN 1 Tablet, Sustained Release 12 Hr TOURO ALLERGY P-EPHED HCL/BROMPHENIRAMIN 1 Tablet, Sustained Release 12 Hr DISOPHROL P-EPHED HCL/D-BROMP MAL 3 Tablet TRIPOHIST D P-EPHED HCL/TRIPROLIDINE HCL 1 Liquid (ml) ZYMINE-D P-EPHED HCL/TRIPROLIDINE HCL 3 Liquid (ml) PREHIST PHENYLEPHRINE HCL/CHLOR-MAL 3 Capsule, Sustained Action DALLERGY-JR PHENYLEPHRINE HCL/CHLOR-MAL 3 Capsule, Sustained Release 12 Hr PHENYLEPHRINE HCL-CHLOR-MAL PHENYLEPHRINE HCL/CHLOR-MAL 1 Capsule, Sustained Release 12 Hr CARDEC PHENYLEPHRINE HCL/CHLOR-MAL 1 Drops CERON PHENYLEPHRINE HCL/CHLOR-MAL 1 Drops CP DEC PHENYLEPHRINE HCL/CHLOR-MAL 1 Drops C-PHEN DROPS PHENYLEPHRINE HCL/CHLOR-MAL 1 Drops DALLERGY PHENYLEPHRINE HCL/CHLOR-MAL 1 Drops NASOHIST PHENYLEPHRINE HCL/CHLOR-MAL 3 Drops PD-HIST D PHENYLEPHRINE HCL/CHLOR-MAL 1 Drops RONDEC PHENYLEPHRINE HCL/CHLOR-MAL 3 Drops RONDEX PHENYLEPHRINE HCL/CHLOR-MAL 1 Drops SILDEC-PE PHENYLEPHRINE HCL/CHLOR-MAL 1 Drops ED A-HIST PHENYLEPHRINE HCL/CHLOR-MAL 1 Liquid (ml) TUSSANIL PHENYLEPHRINE HCL/CHLOR-MAL 1 Liquid (ml) CARDEC PHENYLEPHRINE HCL/CHLOR-MAL 1 Syrup CERON PHENYLEPHRINE HCL/CHLOR-MAL 1 Syrup CP DEC PHENYLEPHRINE HCL/CHLOR-MAL 1 Syrup C-PHEN Syrup PHENYLEPHRINE HCL/CHLOR-MAL 1 Syrup PD-HIST D PHENYLEPHRINE HCL/CHLOR-MAL 1 Syrup RONDEC PHENYLEPHRINE HCL/CHLOR-MAL 3 Syrup RONDEX PHENYLEPHRINE HCL/CHLOR-MAL 1 Syrup SILDEC-PE PHENYLEPHRINE HCL/CHLOR-MAL 1 Syrup ALERSULE PHENYLEPHRINE HCL/CHLOR-MAL 1 Tablet, Sustained Action ED A-HIST PHENYLEPHRINE HCL/CHLOR-MAL 1 Tablet, Sustained Action NOHIST PHENYLEPHRINE HCL/CHLOR-MAL 1 Tablet, Sustained Action PHENABID PHENYLEPHRINE HCL/CHLOR-MAL 3 Tablet, Sustained Action RESCON-JR PHENYLEPHRINE HCL/CHLOR-MAL 3 Tablet, Sustained Action PROMETHAZINE VC PHENYLEPHRINE HCL/PROMETH HCL 1 Syrup PROMETHAZINE VC PHENYLEPHRINE HCL/PROMETH HCL 3 Syrup BROM TANN-PE TANN PHENYLEPHRINE/BROMPHENIRAMIN 1 Suspension, Oral (Final Dose Form) BROMAPHEDRINE D PHENYLEPHRINE/BROMPHENIRAMIN 1 Suspension, Oral (Final Dose Form) BROMPHENIRAMINE-PHENYLEPHRINE PHENYLEPHRINE/BROMPHENIRAMIN 1 Suspension, Oral (Final Dose Form) BROVEX ADT PHENYLEPHRINE/BROMPHENIRAMIN 3 Suspension, Oral (Final Dose Form) BROVEX-D PHENYLEPHRINE/BROMPHENIRAMIN 3 Suspension, Oral (Final Dose Form) B-VEX D PHENYLEPHRINE/BROMPHENIRAMIN 1 Suspension, Oral (Final Dose Form) C-TAN D PHENYLEPHRINE/BROMPHENIRAMIN 1 Suspension, Oral (Final Dose Form) J-TAN D PHENYLEPHRINE/BROMPHENIRAMIN 3 Suspension, Oral (Final Dose Form) TANABID DA PHENYLEPHRINE/BROMPHENIRAMIN 1 Suspension, Oral (Final Dose Form) VAZOBID PHENYLEPHRINE/BROMPHENIRAMIN 1 Suspension, Oral (Final Dose Form) BROMFED PHENYLEPHRINE/BROMPHENIRAMINE 3 Capsule, Sustained Release 12 Hr BROMFED-PD PHENYLEPHRINE/BROMPHENIRAMINE 3 Capsule, Sustained Release 12 Hr PHENYLEPHRINE-BROMPHENIRAMIN PHENYLEPHRINE/BROMPHENIRAMINE 1 Capsule, Sustained Release 12 Hr ALACOL PHENYLEPHRINE/BROMPHENIRAMINE 3 Drops ALENAZE-D NR PHENYLEPHRINE/BROMPHENIRAMINE 1 Liquid (ml) BPM PE PHENYLEPHRINE/BROMPHENIRAMINE 1 Liquid (ml) VAZOL-D PHENYLEPHRINE/BROMPHENIRAMINE 3 Liquid (ml) ALACOL PHENYLEPHRINE/BROMPHENIRAMINE 3 Syrup RESPAHIST-II PHENYLEPHRINE/BROMPHENIRAMINE 3 Tablet, Sustained Release 12 Hr ED CHLORPED D PHENYLEPHRINE/CHLOR-TAN 1 Suspension, Drops(Final Dosage Form)(ml) MYCI CHLORPED D PHENYLEPHRINE/CHLOR-TAN 3 Suspension, Drops(Final Dosage Form)(ml) TANAHIST D PHENYLEPHRINE/CHLOR-TAN 1 Suspension, Drops(Final Dosage Form)(ml) ALLANTAN PHENYLEPHRINE/CHLOR-TAN 1 Suspension, Oral (Final Dose Form) ALLERX PHENYLEPHRINE/CHLOR-TAN 3 Suspension, Oral (Final Dose Form) BP ALLERGY JUNIOR PHENYLEPHRINE/CHLOR-TAN 1 Suspension, Oral (Final Dose Form) CHLORTAN D PHENYLEPHRINE/CHLOR-TAN 1 Suspension, Oral (Final Dose Form) DALLERGY-JR PHENYLEPHRINE/CHLOR-TAN 3 Suspension, Oral (Final Dose Form) NUHIST PHENYLEPHRINE/CHLOR-TAN 1 Suspension, Oral (Final Dose Form) PE TANN-CP TANN PHENYLEPHRINE/CHLOR-TAN 1 Suspension, Oral (Final Dose Form) PEDIAPHYL D PHENYLEPHRINE/CHLOR-TAN 1 Suspension, Oral (Final Dose Form) PEDIATAN D PHENYLEPHRINE/CHLOR-TAN 3 Suspension, Oral (Final Dose Form) PHENYL CHLOR-TAN PHENYLEPHRINE/CHLOR-TAN 1 Suspension, Oral (Final Dose Form) Page 11
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Trustmark/Starmark Formulary Drug List April 2008 - Resource ...

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