FORMULARY: ALPHABETICAL LISTING*
FORMULARY: ALPHABETICAL LISTING*
*Most current Formulary List of Drugs can be found: 1. DUH intranet [click on DRH (Duke Regional Hospital), Departments and Services, Pharmacy, then Lincoln Community Health Center Formulary] () 2. LCHC website (() 3. PADC website (), then click on the Lincoln Pharmacy formulary. 4. LCHC Intranet/ Pharmacy Department/ Formulary of Drugs. Use Ctrl-F to quickly search the listing for a specific item.
Pfizer Institutional Patient Assistance Program Patient Assistance Program
HIV Patient Assistance Program
Project Access Durham County
Lab Monitoring Safety in Lactation Medicaid Preferred Drug List Medicaid Prior Authorizations Hazardous Drugs
Beers List
Pfizer drugs are available to uninsured patients who are at or below 400% of the federal poverty level. Only a dispensing fee is charged. NOTE: These medications are labeled as "IPAP". Patients who meet specific eligibility requirements may receive formulary medications through manufacturer-sponsored patient assistance programs (PAPs). Medications labeled as "PAP" are available to eligible patients through manufacturer-sponsored PAPs. These medications may not be readily available and may require up to an 8-week processing period. EI Clinic may access medications through ADAP for qualified patients. For patients that do not qualify for ADAP, HIV medications may be obtained from manufacturer programs. Project Access Durham County (PADC) serves eligible low-income, uninsured Durham residents who have specialty medical care needs. PADC enrolls members based on referrals from a primary care provider at Lincoln Community Health Center (LCHC). PADC patients are eligible for LCHC formulary medications. Some formulary drugs require laboratory monitoring and are labeled as "LAB" (See Section VII.4. Drugs Requiring Lab Monitoring pg 86) Lactation safety data from American Academy of Pediatrics () Drugs identified by National Institute of Occupational Safety and Health as hazardous are labeled as "HD". Use caution when handling. () 2019 American Geriatrics Society Beers Criteria? Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria? for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019 Jan 29. doi: 10.1111/jgs.15767.
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Medication
Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Crush/ Lactation Split
Acetaminophen/Codeine Tylenol With ANALGESICS AND
Opioid
C
Tab 300mg/30mg
Codeine #3 ANTIPYRETICS
Acetaminophen
Tylenol Susp ANALGESICS AND
Miscellaneous
120 mL
B
Suspension 160mg/5mL
ANTIPYRETICS
Acetaminophen Tablet Tylenol
ANALGESICS AND
Miscellaneous
#100 tabs
B
325mg
ANTIPYRETICS
Acetazolamide Tablet
Diamox
CARDIOVASCULAR Carbonic Anhydrase
C
500mg ER 12hr
Sequels
DRUGS
Inhibitor
Acyclovir Suspension
Zovirax
ANTI-INFECTIVES
Antiviral
B
200mg/5mL
Adalimumab Injection
Humira
RHEUMATOLOGY
Tumor Necrosis
90 day
B
40mg Patient Assistance
Factor Blocking
supply PAP
Program, LAB
Agent
Albendazole Tablet
Albenza
ANTI-INFECTIVES
Antihelmintic
C
200mg
Albuterol MDI
Proventil,
RESPIRATORY
Bronchodilator,
C
Ventolin,
AGENTS
Beta2-Adrenergic
ProAir
Agonist
Albuterol Nebulizer
Proventil,
RESPIRATORY
Bronchodilator,
#25
C
Solution 0.083%
Ventolin
AGENTS
Beta2-Adrenergic
Agonist
Alendronate Tablet 4mg Fosamax
ENDOCRINE AND
Biphosphonates,
#4 tabs
C
METABOLIC AGENTS Osteoporosis
Allopurinol Tablet
Zyloprim
ENDOCRINE AND
Gout, Xanthine
C
100mg, 300 mg
METABOLIC AGENTS Oxidase Inhibitors
-
+
+
+
+
-
+
+
-
-
?
+
?
?
-
-
+
+
Beers List
+
Dose Adjust K=Kidney L=Liver
L
L
L
K/L
K/L
?
K
K K
Amiodarone Tablet
Cordarone CARDIOVASCULAR Antiarrhythmic
D
200mg LAB
DRUGS
Amitriptyline Tablet
Elavil
ANTIDEPRESSANT Tricyclic
D
25mg, 50 mg
AGENTS
7 n:\lchc_pharm\formulary management\formulary of drugs book\2020\7. formulary of drugs (alph) pp6,31.docx
-
+
+
L
See page
120
-
+
+
See page
121
Medication
Amlodipine Tablets 5mg, 10mg Amlodipine-benazepril Capsule 2.5-10mg, 5-20mg, 10-40mg Amoxicillin Capsule 250mg Amoxicillin Suspension 400mg/5mL Amoxicillin/Clavulanic Acid Suspension 600mg/42.9mg Amoxicillin/Clavulanic Acid Tablets 875mg/125mg Apixaban Tablets 2.5mg, 5 mg
(Patient Assistance Program)
Aripiprazole Tablets 5mg, 15mg
Artificial Tear Drops
Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Crush/ Lactation Split
Norvasc Lotrel Amoxil
CARDIOVASCULAR DRUGS CARDIOVASCULAR DRUGS
ANTI-INFECTIVES
Calcium Channel Blocker
Calcium Channel Blocker- ACEInhibitor Penicillin
Amoxil
ANTI-INFECTIVES
Penicillin
Augmentin ES ANTI-INFECTIVES
Penicillin
C
?
+
D
?
-
B
+
-
B
+
B
?
+
Augmentin XR ANTI-INFECTIVES
Penicillin
B
?
+
Eliquis
CARDIOVASCULAR Direct Oral
90 day
B
Anticoagulant
supply PAP
Abilify
ANTIPSYCHOTIC
Second Generation
C
AGENTS
(Atypical)
Antipsychotic
Artificial
EYE, EAR, NOSE, AND Lubricant
15 mL
+
Tears
THROAT
-
+
?
+
+
Beers List
Dose Adjust K=Kidney L=Liver
L
L,K
K K K/L
K/L
+
K
+
Artificial Tear Ointment Duratears
EYE, EAR, NOSE, AND Lubricant THROAT
3.5 gm
+
+
Aspirin Tablet 81mg, 325 mg (enteric coated)
Ecotrin
CARDIOVASCULAR DRUGS
Salicylate
D
?
-
+
K/L
8 n:\lchc_pharm\formulary management\formulary of drugs book\2020\7. formulary of drugs (alph) pp6,31.docx
Medication
Atenolol Tablet 50mg, 100mg
Brand Name Therapeutic Category
Pharmacologic Category
Tenormin
CARDIOVASCULAR DRUGS
Beta Blocker
Package Size Preg Cat Safety in Crush/ Lactation Split
D
-
-
Beers List
Dose Adjust K=Kidney L=Liver
K
Atorvastatin Tablet
Lipitor
CARDIOVASCULAR Antihyperlipidemic,
X
-
+
L
10mg, 20mg, 40mg, 80mg
DRUGS
HMG-CoA Reductase
LAB
Inhibitor
Atropine Ophth Soln 1% Atropine
EYE, EAR, NOSE, AND Mydriatic THROAT
15 mL
C
+
Azithromycin Suspension Zithromax
ANTI-INFECTIVES
Macrolide
B
?
K/L
200mg/5mL
Azithromycin Tablet 250mg
Zithromax
ANTI-INFECTIVES
Macrolide
B
?
+
K/L
Bacitracin Ointment 500 units/gm
SKIN AND MUCOUS Antibiotic, Topical MEMBRANE AGENTS
15 gm
B
?
Baclofen Tablet 10mg
Lioresal
SKELETAL MUSCLE RELAXANT
Skeletal Muscle Relaxant
C
+
+
K
Benzonatate Capsule 100mg
Tessalon Perles
RESPIRATORY AGENTS
Antitussive
#20 caps
C
?
-
Benzoyl Peroxide Gel 5% Panoxyl
SKIN AND MUCOUS Acne MEMBRANE AGENTS
42.5 gm
C
?
Bisacodyl Tablet 5mg
Dulcolax
GASTROINTESTINAL Laxative,
DRUGS
Diphenylmethane
C
?
-
K
Bismuth Subsalicylate
Pepto-Bismol GASTROINTESTINAL Antidiarrheal
#30 tabs
D
?
+
Tablet 262mg
DRUGS
Brimonidine 0.2% ophth Alphagan drops
EYE, EAR, NOSE, AND Antiglaucoma,
THROAT
Alpha2 Agonist
10 mL
B
?
Buprenorphine/Naloxone Zubsolv SL Tablet 2mg/ 0.5mg, 8mg/ 2mg
ANALGESICS AND ANTIPYRETICS
Opioid
C
?
+
K/L
9 n:\lchc_pharm\formulary management\formulary of drugs book\2020\7. formulary of drugs (alph) pp6,31.docx
Medication
Bupropion ER Tablet 150mg, 300 mg Buspirone Tablet 15mg
Butalbital, Acetaminophen and Caffeine Tablet 50mg/325mg/40mg
Calcitriol Capsule 0.5mcg Calcium (elemental) Tablet 500mg
Calcium Acetate Capsule 667mg Capsaicin 0.025% Cream
Carbamazepine Tablet 200mg LAB, HD Carbamide Peroxide Otic Drops 6.5% Carbidopa/Levodopa Tablet 25mg/100mg Carvedilol Tablet 3.125mg, 12.5mg, 25mg
Cefdinir Suspension 250mg/5mL
Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Wellbutrin XL
Buspar
Note: Fioricet changed strength April 2014 and no longer has a generic
ANTIDEPRESSANT AGENTS
ANXIOLYTICS, SEDATIVES, HYPNOTICS MIGRAINE AGENTS
Dopamine Reuptake Inhibitor Antianxiety Agent
Migraine Combinations
C
-
B
-
C
-
Rocaltrol
NEPHROLOGY
Vitamin D Analog
C
?
Calcium PhosLo
NUTRIENTS AND
Calcium Supplement #60 tabs per + (? 1st
?
NUTRITIONAL
bottle
trimester)
AGENTS
NEPHROLOGY
Calcium, Phosphate
C
?
Binder
Capzasin Tegretol
ANALGESICS AND ANTIPYRETICS
ANTICONVULSANT AGENTS
Transient Receptor Potential Vanilloid 1 (TRPV1) Agonist Miscellaneous
60 gm
B
+
D
+
Debrox
EYE, EAR, NOSE, AND Cerumenolytic THROAT
15 mL
?
?
Sinemet
ANTIPARKINSON AGENTS
Dopamine Agonist
C
-
Coreg
CARDIOVASCULAR DRUGS
Beta Blocker w/ alpha blocking activity
C
?
Omnicef
ANTI-INFECTIVES
Cephalosporin, 3rd gen
B
?
Crush/ Split
+ + +
+ -
+
+ +
Beers List
Dose Adjust K=Kidney L=Liver
K/L
K/L
+
K/L
See page
121
K
+
K/L
K/L L
K
10 n:\lchc_pharm\formulary management\formulary of drugs book\2020\7. formulary of drugs (alph) pp6,31.docx
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