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

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Brand Name Generic Name Tier Form AMRIX CYCLOBENZAPRINE HCL 3 Capsule, Sustained Release 24 Hr CYCLOBENZAPRINE HCL CYCLOBENZAPRINE HCL 1 Tablet FEXMID CYCLOBENZAPRINE HCL 3 Tablet FLEXERIL CYCLOBENZAPRINE HCL 3 Tablet DANTRIUM DANTROLENE SODIUM 2 Capsule (Hard, Soft, etc.) DANTROLENE SODIUM DANTROLENE SODIUM 1 Capsule (Hard, Soft, etc.) SKELAXIN METAXALONE 3 Tablet METHOCARBAMOL METHOCARBAMOL 1 Tablet ROBAXIN METHOCARBAMOL 3 Tablet ROBAXIN-750 METHOCARBAMOL 3 Tablet METHOCARBAMOL W/ASPIRIN METHOCARBAMOL/ASPIRIN 1 Tablet ORPHENADRINE CITRATE ORPHENADRINE CITRATE 1 Tablet, Sustained Action ORPHENADRINE COMPOUND ORPHENADRINE/ASPIRIN/CAFFEINE 1 Tablet ORPHENADRINE COMPOUND FORTE ORPHENADRINE/ASPIRIN/CAFFEINE 1 Tablet ZANAFLEX TIZANIDINE HCL 3 Capsule (Hard, Soft, etc.) TIZANIDINE HCL TIZANIDINE HCL 1 Tablet ZANAFLEX TIZANIDINE HCL 3 Tablet SKELETAL MUSCLE RELAXANTS/DIETARY SUPPLEMENT COMB. PRAZOLAMINE CARISOPRODOL/DIET. SUPP 11 3 Combination Package (EA) THERABENZAPRINE-60 CYCLOBENZAPRINE/DIET. SUPP. 11 3 Combination Package (EA) THERABENZAPRINE-90 CYCLOBENZAPRINE/DIET. SUPP. 11 3 Combination Package (EA) PSYCHOTHERAPEUTIC DRUGS ANTI-ANXIETY DRUGS ALPRAZOLAM INTENSOL ALPRAZOLAM 3 Concentrate, Oral ALPRAZOLAM ALPRAZOLAM 1 Tablet XANAX ALPRAZOLAM 3 Tablet NIRAVAM ALPRAZOLAM 3 Tablet, Rapid Dissolve ALPRAZOLAM ER ALPRAZOLAM 1 Tablet, Sustained Release 24 Hr ALPRAZOLAM XR ALPRAZOLAM 1 Tablet, Sustained Release 24 Hr XANAX XR ALPRAZOLAM 3 Tablet, Sustained Release 24 Hr BUSPAR BUSPIRONE HCL 3 Tablet BUSPIRONE HCL BUSPIRONE HCL 1 Tablet VANSPAR BUSPIRONE HCL 3 Tablet CHLORDIAZEPOXIDE HCL CHLORDIAZEPOXIDE HCL 1 Capsule (Hard, Soft, etc.) LIBRIUM CHLORDIAZEPOXIDE HCL 3 Capsule (Hard, Soft, etc.) CLORAZEPATE DIPOTASSIUM CLORAZEPATE DIPOTASSIUM 1 Tablet TRANXENE T-TAB CLORAZEPATE DIPOTASSIUM 3 Tablet TRANXENE SD CLORAZEPATE DIPOTASSIUM 3 Tablet, Sustained Action DIAZEPAM DIAZEPAM 2 Concentrate, Oral DIAZEPAM DIAZEPAM 2 Solution, Oral DIAZEPAM DIAZEPAM 1 Tablet VALIUM DIAZEPAM 3 Tablet LORAZEPAM INTENSOL LORAZEPAM 2 Concentrate, Oral ATIVAN LORAZEPAM 3 Tablet LORAZEPAM LORAZEPAM 1 Tablet MEPROBAMATE MEPROBAMATE 1 Tablet MILTOWN MEPROBAMATE 3 Tablet OXAZEPAM OXAZEPAM 1 Capsule (Hard, Soft, etc.) ANTI-PSYCHOTICS, PHENOTHIAZINES CHLORPROMAZINE HCL CHLORPROMAZINE HCL 1 Concentrate, Oral CHLORPROMAZINE HCL CHLORPROMAZINE HCL 1 Tablet FLUPHENAZINE HCL FLUPHENAZINE HCL 1 Concentrate, Oral FLUPHENAZINE HCL FLUPHENAZINE HCL 1 Elixir FLUPHENAZINE HCL FLUPHENAZINE HCL 1 Tablet PROLIXIN FLUPHENAZINE HCL 3 Tablet PERPHENAZINE PERPHENAZINE 1 Tablet THIORIDAZINE HCL THIORIDAZINE HCL 1 Concentrate, Oral THIORIDAZINE HCL THIORIDAZINE HCL 1 Tablet TRIFLUOPERAZINE HCL TRIFLUOPERAZINE HCL 1 Tablet MONOAMINE OXIDASE (MAO) INHIBITORS EMSAM SELEGILINE 3 Patch, Transdermal 24 Hr ANTI-MANIA DRUGS ESKALITH LITHIUM CARBONATE 1 Capsule (Hard, Soft, etc.) LITHIUM CARBONATE LITHIUM CARBONATE 1 Capsule (Hard, Soft, etc.) LITHIUM CARBONATE LITHIUM CARBONATE 2 Capsule (Hard, Soft, etc.) LITHIUM CARBONATE LITHIUM CARBONATE 1 Tablet LITHIUM CARBONATE LITHIUM CARBONATE 1 Tablet, Sustained Action Page 62
Brand Name Generic Name Tier Form LITHIUM CARBONATE LITHIUM CARBONATE 2 Tablet, Sustained Action LITHOBID LITHIUM CARBONATE 2 Tablet, Sustained Action LITHIUM CITRATE LITHIUM CITRATE 1 Solution, Oral LITHIUM CITRATE LITHIUM CITRATE 2 Solution, Oral TX FOR ATTENTION DEFICIT-HYPERACT(ADHD)/NARCOLEPSY FOCALIN XR DEXMETHYLPHENIDATE HCL 3 Capsule, Multiphasic Release 50-50 DEXMETHYLPHENIDATE HCL DEXMETHYLPHENIDATE HCL 1 Tablet FOCALIN DEXMETHYLPHENIDATE HCL 3 Tablet DAYTRANA METHYLPHENIDATE 3 Patch, Transdermal 24 Hr METADATE CD METHYLPHENIDATE HCL 3 Capsule, Multiphasic Release 30-70 RITALIN LA METHYLPHENIDATE HCL 3 Capsule, Multiphasic Release 50-50 METHYLIN METHYLPHENIDATE HCL 3 Solution, Oral METHYLIN METHYLPHENIDATE HCL 1 Tablet METHYLPHENIDATE HCL METHYLPHENIDATE HCL 1 Tablet RITALIN METHYLPHENIDATE HCL 3 Tablet METHYLIN METHYLPHENIDATE HCL 3 Tablet, Chewable CONCERTA METHYLPHENIDATE HCL 2 Tablet, SR Osmotic Push 24 Hr METADATE ER METHYLPHENIDATE HCL 1 Tablet, Sustained Action METHYLIN ER METHYLPHENIDATE HCL 1 Tablet, Sustained Action METHYLPHENIDATE ER METHYLPHENIDATE HCL 1 Tablet, Sustained Action METHYLPHENIDATE HCL METHYLPHENIDATE HCL 1 Tablet, Sustained Action METHYLPHENIDATE SR METHYLPHENIDATE HCL 1 Tablet, Sustained Action RITALIN-SR METHYLPHENIDATE HCL 3 Tablet, Sustained Action PROVIGIL MODAFINIL 3 Tablet ADRENERGICS, AROMATIC, NON-CATECHOLAMINE VYVANSE LISDEXAMFETAMINE DIMESYLATE 3 Capsule (Hard, Soft, etc.) SSRI & ANTIPSYCH, ATYP, DOPAMINE & SEROTONIN ANTAG COMBINATION SYMBYAX OLANZAPINE/FLUOXETINE HCL 3 Capsule (Hard, Soft, etc.) SELECTIVE SEROTONIN REUPTAKE INHIBITOR (SSRIS) CELEXA CITALOPRAM HYDROBROMIDE 3 Solution, Oral CITALOPRAM CITALOPRAM HYDROBROMIDE 1 Solution, Oral CELEXA CITALOPRAM HYDROBROMIDE 3 Tablet CITALOPRAM HBR CITALOPRAM HYDROBROMIDE 1 Tablet LEXAPRO ESCITALOPRAM OXALATE 2 Solution, Oral LEXAPRO ESCITALOPRAM OXALATE 2 Tablet FLUOXETINE HCL FLUOXETINE HCL 1 Capsule (Hard, Soft, etc.) PROZAC FLUOXETINE HCL 3 Capsule (Hard, Soft, etc.) SARAFEM FLUOXETINE HCL 3 Capsule (Hard, Soft, etc.) PROZAC WEEKLY FLUOXETINE HCL 3 Capsule,Delayed Release (Enteric Coated) FLUOXETINE HCL FLUOXETINE HCL 1 Solution, Oral PROZAC FLUOXETINE HCL 3 Solution, Oral FLUOXETINE HCL FLUOXETINE HCL 1 Tablet RAPIFLUX FLUOXETINE HCL 3 Tablet FLUVOXAMINE MALEATE FLUVOXAMINE MALEATE 1 Tablet PAROXETINE HCL PAROXETINE HCL 1 Suspension, Oral (Final Dose Form) PAXIL PAROXETINE HCL 3 Suspension, Oral (Final Dose Form) PAROXETINE HCL PAROXETINE HCL 1 Tablet PAXIL PAROXETINE HCL 3 Tablet PAXIL CR PAROXETINE HCL 3 Tablet, Sustained Release 24 Hr PEXEVA PAROXETINE MESYLATE 3 Tablet SERTRALINE HCL SERTRALINE HCL 1 Concentrate, Oral ZOLOFT SERTRALINE HCL 3 Concentrate, Oral SERTRALINE HCL SERTRALINE HCL 1 Tablet ZOLOFT SERTRALINE HCL 3 Tablet TRICYCLIC ANTIDEPRESSANTS & REL. NON-SEL. RU-INHIB AMITRIPTYLINE HCL AMITRIPTYLINE HCL 1 Tablet ENDEP AMITRIPTYLINE HCL 1 Tablet AMOXAPINE AMOXAPINE 1 Tablet AMOXAPINE AMOXAPINE 3 Tablet ANAFRANIL CLOMIPRAMINE HCL 3 Capsule (Hard, Soft, etc.) CLOMIPRAMINE HCL CLOMIPRAMINE HCL 1 Capsule (Hard, Soft, etc.) DESIPRAMINE HCL DESIPRAMINE HCL 1 Tablet NORPRAMIN DESIPRAMINE HCL 3 Tablet DOXEPIN HCL DOXEPIN HCL 1 Capsule (Hard, Soft, etc.) DOXEPIN HCL DOXEPIN HCL 1 Capsule (Hard, Soft, etc.) DOXEPIN HCL DOXEPIN HCL 1 Concentrate, Oral IMIPRAMINE HCL IMIPRAMINE HCL 1 Tablet Page 63
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Trustmark/Starmark Formulary Drug List April 2008 - Resource ...

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