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

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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

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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

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