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

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Brand Name Generic Name Tier Form GILTUSS GUAIFENESIN/D-METHORPHAN HB/PE 1 Liquid (ml) TUSSI-PRES GUAIFENESIN/D-METHORPHAN HB/PE 3 Liquid (ml) TUSSI-PRES PEDIATRIC GUAIFENESIN/D-METHORPHAN HB/PE 1 Liquid (ml) TUSSI-PRES PEDIATRIC GUAIFENESIN/D-METHORPHAN HB/PE 3 Liquid (ml) Z-TUSS DM GUAIFENESIN/D-METHORPHAN HB/PE 3 Liquid (ml) BRONCOTRON-D GUAIFENESIN/D-METHORPHAN HB/PE 3 Suspension, Oral (Final Dose Form) DACEX-DM GUAIFENESIN/D-METHORPHAN HB/PE 1 Syrup DYNATUSS-EX GUAIFENESIN/D-METHORPHAN HB/PE 1 Syrup PDM GG GUAIFENESIN/D-METHORPHAN HB/PE 1 Syrup TRITUSS GUAIFENESIN/D-METHORPHAN HB/PE 3 Syrup Z-DEX Syrup GUAIFENESIN/D-METHORPHAN HB/PE 1 Syrup ZOTEX GUAIFENESIN/D-METHORPHAN HB/PE 3 Syrup ZOTEX-G GUAIFENESIN/D-METHORPHAN HB/PE 3 Syrup SINUTUSS DM GUAIFENESIN/D-METHORPHAN HB/PE 1 Tablet CARBATUSS-CL POT GUAIACO/CAR-B-PENTANE/PE 3 Liquid (ml) ALBATUSSIN CF POT GUAIACO/D-METHORPHAN HB/PE 3 Drops ALBATUSSIN SR POT GUAIACO/D-METHORPHAN HB/PE 3 Tablet, Sustained Release 12 Hr ALBATUSSIN SR F POT GUAIACO/D-METHORPHAN HB/PE 3 Tablet, Sustained Release 12 Hr NON-NARCOTIC ANTITUSS-DECONGESTANT-EXPECTORANT COMBINATION DEX-TUSS GUAIFENESIN/CODEINE PHOS 1 Liquid (ml) GANI-TUSS NR GUAIFENESIN/CODEINE PHOS 1 Liquid (ml) GUAIFENESIN-CODEINE GUAIFENESIN/CODEINE PHOS 1 Liquid (ml) GUAL-CO GUAIFENESIN/CODEINE PHOS 1 Liquid (ml) IOPHEN-C NR GUAIFENESIN/CODEINE PHOS 1 Liquid (ml) MYCI-GC GUAIFENESIN/CODEINE PHOS 1 Liquid (ml) TUSSIDEN C GUAIFENESIN/CODEINE PHOS 1 Liquid (ml) TUSSI-ORGANIDIN NR GUAIFENESIN/CODEINE PHOS 2 Liquid (ml) TUSSI-ORGANIDIN-S NR GUAIFENESIN/CODEINE PHOS 2 Liquid (ml) TUSSO-C GUAIFENESIN/CODEINE PHOS 1 Liquid (ml) GUAIFENESIN-CODEINE GUAIFENESIN/CODEINE PHOS 1 Syrup ROBAFEN AC GUAIFENESIN/CODEINE PHOS 1 Syrup ALLFEN CD GUAIFENESIN/CODEINE PHOS 3 Tablet ALLFEN CDX GUAIFENESIN/CODEINE PHOS 3 Tablet BRONTEX GUAIFENESIN/CODEINE PHOS 3 Tablet GUAIFENESIN/CODEINE PHOSPHATE GUAIFENESIN/CODEINE PHOS 1 Tablet A-COF DH GUAIFENESIN/HYDROCODONE BIT 1 Liquid (ml) CODICLEAR DH GUAIFENESIN/HYDROCODONE BIT 3 Liquid (ml) HC-GUAI GUAIFENESIN/HYDROCODONE BIT 1 Liquid (ml) CONDASIN GUAIFENESIN/HYDROCODONE BIT 1 Syrup ENDACOF-XP GUAIFENESIN/HYDROCODONE BIT 1 Syrup EXECLEAR GUAIFENESIN/HYDROCODONE BIT 1 Syrup EXECOF-XP GUAIFENESIN/HYDROCODONE BIT 1 Syrup HYDROCODONE GF GUAIFENESIN/HYDROCODONE BIT 1 Syrup HYDROCODONE-GUAIFENESIN GUAIFENESIN/HYDROCODONE BIT 1 Syrup KWELCOF GUAIFENESIN/HYDROCODONE BIT 1 Syrup MAXI-TUSS HCG GUAIFENESIN/HYDROCODONE BIT 3 Syrup NARCOF GUAIFENESIN/HYDROCODONE BIT 1 Syrup PNEUMOTUSSIN GUAIFENESIN/HYDROCODONE BIT 3 Syrup TUSSICLEAR DH GUAIFENESIN/HYDROCODONE BIT 1 Syrup VITUSSIN GUAIFENESIN/HYDROCODONE BIT 1 Syrup ENDACOF GUAIFENESIN/HYDROCODONE BIT 1 Tablet HY-KXP POT GUAIACO/HYDROCODONE BIT 1 Syrup MARCOF POT GUAIACO/HYDROCODONE BIT 1 Syrup MC COUGH POT GUAIACO/HYDROCODONE BIT 3 Syrup MC JR COUGH POT GUAIACO/HYDROCODONE BIT 3 Syrup M-CLEAR POT GUAIACO/HYDROCODONE BIT 1 Syrup MINTUSS NX POT GUAIACO/HYDROCODONE BIT 1 Syrup PRO-CLEAR POT GUAIACO/HYDROCODONE BIT 3 Syrup DECONGESTANT-ANTICHOLINERGIC COMBINATIONS ALLERX-D P-EPHED HCL/METHSCOPOLAMN 3 Tablet, Sustained Release 12 Hr EXTENDRYL PSE P-EPHED HCL/METHSCOPOLAMN 1 Tablet, Sustained Release 12 Hr SUDATRATE P-EPHED HCL/METHSCOPOLAMN 1 Tablet, Sustained Release 12 Hr AMDRY-D P-EPHED HCL/SCOP ME-NITRATE 1 Tablet, Sustained Release 12 Hr PSE 120/MSC 2.5 P-EPHED HCL/SCOP ME-NITRATE 1 Tablet, Sustained Release 12 Hr DECONGESTANT-EXPECTORANT COMBINATIONS VITA-NUMONYL GUAIFEN/PHENYLEPHRINE/K CIT 3 Solution, Oral BRONCHOLATE GUAIFENESIN/EPHEDRINE HCL 3 Syrup PSEUDOVENT GUAIFENESIN/P-EPHED HCL 1 Capsule, Multiphasic Release 12 Hr Page 40
Brand Name Generic Name Tier Form PSEUDOVENT 400 GUAIFENESIN/P-EPHED HCL 1 Capsule, Multiphasic Release 12 Hr PSEUDOVENT PED GUAIFENESIN/P-EPHED HCL 1 Capsule, Multiphasic Release 12 Hr NALEX JR GUAIFENESIN/P-EPHED HCL 1 Capsule, Sustained Action TUSNEL PEDIATRIC GUAIFENESIN/P-EPHED HCL 1 Drops PSEUDOEPHEDRINE GG GUAIFENESIN/P-EPHED HCL 1 Syrup SUDATEX GUAIFENESIN/P-EPHED HCL 1 Syrup AMBI 60-580 GUAIFENESIN/P-EPHED HCL 1 Tablet MAXIFED GUAIFENESIN/P-EPHED HCL 3 Tablet MAXIFED-G GUAIFENESIN/P-EPHED HCL 3 Tablet MAXIFED-G GUAIFENESIN/P-EPHED HCL 3 Tablet CONPEC L.A. GUAIFENESIN/P-EPHED HCL 3 Tablet, Sustained Release 12 Hr EUDAL-SR GUAIFENESIN/P-EPHED HCL 1 Tablet, Sustained Release 12 Hr GP-500 GUAIFENESIN/P-EPHED HCL 1 Tablet, Sustained Release 12 Hr PROFED GUAIFENESIN/P-EPHED HCL 1 Tablet, Sustained Release 12 Hr SINA-12X GUAIFENESIN/PHENYLEPHRINE 3 Suspension, Oral (Final Dose Form) SINA-12X GUAIFENESIN/PHENYLEPHRINE 3 Tablet PHENAVENT GUAIFENESIN/PHENYLEPHRINE HCL 1 Capsule, Multiphasic Release 12 Hr PHENAVENT LA GUAIFENESIN/PHENYLEPHRINE HCL 1 Capsule, Multiphasic Release 12 Hr PHENAVENT PED GUAIFENESIN/PHENYLEPHRINE HCL 1 Capsule, Multiphasic Release 12 Hr DONATUSSIN GUAIFENESIN/PHENYLEPHRINE HCL 3 Drops NUMONYL PEDIATRIC GUAIFENESIN/PHENYLEPHRINE HCL 3 Drops PE-GUAI GUAIFENESIN/PHENYLEPHRINE HCL 1 Drops DESPEC GUAIFENESIN/PHENYLEPHRINE HCL 3 Liquid (ml) NARIZ GUAIFENESIN/PHENYLEPHRINE HCL 3 Liquid (ml) NAZARIN GUAIFENESIN/PHENYLEPHRINE HCL 1 Liquid (ml) NUMONYL GUAIFENESIN/PHENYLEPHRINE HCL 3 Liquid (ml) SITREX PD GUAIFENESIN/PHENYLEPHRINE HCL 3 Liquid (ml) ZYRPHEN GUAIFENESIN/PHENYLEPHRINE HCL 1 Liquid (ml) CONPEC GUAIFENESIN/PHENYLEPHRINE HCL 3 Solution, Oral CRANTEX GUAIFENESIN/PHENYLEPHRINE HCL 1 Syrup J-MAX GUAIFENESIN/PHENYLEPHRINE HCL 3 Syrup QUINTEX GUAIFENESIN/PHENYLEPHRINE HCL 1 Syrup SIL-TEX GUAIFENESIN/PHENYLEPHRINE HCL 1 Syrup SINUVENT PE GUAIFENESIN/PHENYLEPHRINE HCL 1 Tablet ZOTEX-GP GUAIFENESIN/PHENYLEPHRINE HCL 3 Tablet DYNEX LA GUAIFENESIN/PHENYLEPHRINE HCL 3 Tablet, Multiphasic Release 12 Hr LUSONAL POT GUAIACO/PHENYLEPHRINE HCL 3 Liquid (ml) 1ST GENERATION ANTIHISTAMINE-ANTICHOLINERGIC COMBINATIONS ALLERX DF CHLOR-MAL/METHSCOPOLAMINE NIT 3 Tablet, Sequential ALLERX DF 30 CHLOR-MAL/METHSCOPOLAMINE NIT 3 Tablet, Sequential AEROHIST CHLOR-MAL/METHSCOPOLAMINE NIT 3 Tablet, Sustained Release 12 Hr NOHIST-EXT CHLOR-MAL/METHSCOPOLAMINE NIT 1 Tablet, Sustained Release 12 Hr RYNEZE CHLOR-MAL/METHSCOPOLAMINE NIT 1 Tablet, Sustained Release 12 Hr DEXODRYL CHLORPHENIRAMINE TAN/METHSCOP 3 Suspension, Oral (Final Dose Form) DEXODRYL CHLORPHENIRAMINE TAN/METHSCOP 3 Tablet, Chewable NON-NARC ANTITUSS-1ST GEN ANTIHIST-ANTICHOLINERGIC EXTENDRYL DM D-METHORPHAN HB/CHLOR-MAL/SCOP 3 Tablet, Sustained Release 12 Hr 1ST GEN ANTIHISTAMINE-DECONGESTANT WITH ZINC COMBINATIONS ZINX PE/CHLORPHEN/METHSCOP/ZINC AC 3 Kit ZINX P-EPHED HCL/CHLOR-MAL/ZINC AC 3 Combination Package, CAP 12HR & Lozenge 1ST GEN. ANTIHIST-DECONG-ANTICHOLIN-EXPECT COMBINATIONS SYMPAK GUAIFEN/PE/CHLORPH/METHSCOP 3 Tablet, Sustained Action Sequential NARCOTIC ANTITUSS-DECONGESTANT-ANALGESIC-EXPECT CB PHENFLU CD PHENYLEPH/CODEINE/ACET/GUAIFEN 3 Tablet MAXIFLU CD PSEUDOEPH/CODEINE/ACET/GUAIFEN 3 Tablet NARC ANTITUSS-1ST GEN ANTIHISTAMINE-ANALG, N-SAL CB COTABFLU CHLOR-MAL/CODEINE/ACETAMINOPHN 3 Tablet NON-NARC ANTITUSS-1ST GEN ANTIHIS-DECON-EXP-ANTICHO SYMPAK DM GUAIFEN/DM/PE/CPM/METHSCOPOLAM 3 Tablet,Sustained Release 12 Hr Sequential DIAGNOSTIC GASTROINTESTINAL RADIOPAQUE DIAGNOSTICS E-Z-PASTE BARIUM SULFATE 3 Cream (Grams) E-Z-DOSE BARIUM SULFATE 3 Enema (ml) E-Z-CAT BARIUM SULFATE 3 Suspension, Oral (Final Dose Form) LIQUID E-Z PAQUE BARIUM SULFATE 3 Suspension, Oral (Final Dose Form) LIQUID POLIBAR PLUS BARIUM SULFATE 3 Suspension, Oral (Final Dose Form) Page 41
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Trustmark/Starmark Formulary Drug List April 2008 - Resource ...

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