REACHOUT 2018 FORMULARY - daytonreachout.org

1 REACHOUT 2018 FORMULARY - Alpha ListDRUG NAMEDOSAGE FORMDRUG TYPEALT NAMEA cetaminophen 325 mg (MaPap, Q-Pap)TabletAnalgesicTylenolAcyclovir 400 mgTabletAntiviralZoviraxAdvair Diskus 500mcg/50mcg *sample*InhalerRespiratoryFluticasone/ salmeterolAlcaine ophthalmic *sample*SolutionOphthalmic, anestheticProparacaineAlbuterol Soln for Nebulizer 300 mgTabletAnti-GoutZyloprimAmitriptyline 10mgTabletAntidepressantElavilAmitriptyl ine 25 mgTabletAntidepressantElavilAmitriptylin e 50mgTabletAntidepressantElavilAmitriptyl ine 150 mgTabletAntidepressantElavilAmlodipine mgTabletAntihypertensiveNorvascAmlodipin e 5 mgTabletAntihypertensiveNorvascAmlodipin e 10 mgTabletAntihypertensiveNorvascAmitiza 8mcg *sample*CapsuleGI AgentsLubiprostoneAmitiza 24mcg *sample*CapsuleGI AgentsLubiprostoneAmoxicillin 125 mg/5mLSuspensionAnti-InfectiveAmoxilAmox icillin 250 mgCapsulesAnti-infectiveAmoxilAmoxicilli n 250 mg/5mLSuspensionAnti-InfectiveAmoxilAmox icillin 400mg/5mLSuspensionAnti-infectiveAmoxilA moxicillin 500 mgCapsulesAnti-InfectiveAmoxilAmoxicilli n 875 mgTabletAnti-InfectiveAmoxilAmoxicillin/ Clavulanate 400mg/57mg /5mlSuspensionAnti-InfectiveAugmentinAmo xicillin/Clavulanate

2 500mg/125mgTabletAnti-InfectiveAugmentin Amoxicilin/Clavulanate 600 875mg/125mgTabletAnti-InfectiveAugmentin Anoro Ellipta *sample*InhalerRespiratoryumeclindimium /vilanterolAntibiotic Ointment (Bacitracin)OintmentAnti-Infective, Topical (Bacitracin)Antifungal Cream (Clotrimazole 1%)CreamAntifungal, topicalLotriminApidra *sample*VialsInsulinGlulisineAricept 10 mg *sample*TabletAnti-dementiaDonepezilArip iprazole 2mg *sample*TabletAntipsychoticAbilifyrev 2/20/2018 Page 1 REACHOUT 2018 FORMULARY - Alpha ListDRUG NAMEDOSAGE FORMDRUG TYPEALT NAMEA ripiprazole 5mg *sample*TabletAntipsychoticAbilifyArtifi cial Tears ophth ointmentOintmentOTCA rtificial Tears solutionSolutionOTCA smanex HFA 100 mcg *sample*InhalerRespiratoryMometasoneAsma nex HFA 200mcg *sample*InhalerRespiratoryMometasoneAspi rin 325mgTabletAnalgesicAspirin 81mg chewable - clinic use onlyTabletAnalgesicAspirin 81mgTabletAnalgesicAtenolol 25 mgTabletAntihypertensiveTenorminAtorvast atin 20 mg *sample*TabletCholesterol inhibitorLipitorAtorvastatin 80mgTabletCholesterol inhibitorLipitorAyr saline nasal gel *sample*GelRespiratoryAyr saline nasal mist *sample*MistRespiratoryAyr saline nasal rinse kit *sample*RinseRespiratoryAzithromycin

3 100mg/5mlSuspensionAnti-infectiveZithrom axAzithromycin 200mg/5mlSuspensionAnti-infectiveZithrom axAzithromycin 250mg ZpackDose packAnti-infectiveZithromaxAzithromycin 250mgTabletAnti-infectiveZithromaxAzithr omycin 500mgTabletAnti-infectiveZithromaxBaclof en 10mg *sample*TabletMuscle relaxantLioresalBenzonatate 100 mgCapsulesCough SuppressantsTessalon PerlesBetamethasone valerate *sample*OintmentSteroid, TopicalDiproleneBisacodyl 5mgTabletLaxativeDucolaxBoniva 150 mg *sample*TabletOsteoporosisIbandronateBri linta 60mg *sample*TabletAntiplatelet agentTicagrelorBrilinta 90mg *sample*TabletAntiplatelet agentTicagrelorBumetanide 1mgTabletAnti-infectiveBumexBumetanide 2 mgTabletAnti-infectiveBumexBupropion SR 150mg *sample*TabletAntidepressantWellbutrin SRBuspirone 10 mgTabletAnxiolyticsBusparBydureon 2mg penPensAntidiabetic, GLP-1 agonistExenatideBystolic 20 mg *sample*TabletBeta BlockerNebivololBystolic 10 mg *sample*TabletBeta BlockerNebivololrev 2/20/2018 Page 2 REACHOUT 2018 FORMULARY - Alpha ListDRUG NAMEDOSAGE FORMDRUG TYPEALT NAMEB ystolic 5 mg *sample*TabletBeta BlockerNebivololCalamine LotionLotionTopicalCarbamazeprine 200 mgTabletAnticonvulsantTegretolCarvedilol *sample*TabletBeta BlockerCoregCarvedilol mgTabletBeta BlockerCoregCarvedilol mgTabletBeta BlockerCoregCarvedilol 25 mgTabletBeta BlockerCoregCefdinir 125mg/5mlSuspensionAnti-infectiveOmnicef Cefdinir 250mg/5mlSuspensionAnti-infectiveOmnicef Ceftriaxone 250mg injectableInjectableAnti-infectiveRoceph inCeftriaxone 500mg injectableInjectableAnti-infectiveRoceph inCelebrex 100mgCapsuleNSAIDC elecoxibCelecoxib 200mg CapsuleNSAIDC elebrexCephalexin 250 mgCapsulesAnti-infectiveKeflexCephalexin 500 mgCapsulesAnti-infectiveKeflexCetirizine 10mg (All Day Allergy)

4 TabletAntihistimaneZyrtecChlorthalidone 25 mgTabletDiureticHygrotonCiprofloxacin opth solutionSolutionAnti-Infective, TopicalCiloxanCiprofloxacin 250 mgTabletAnti-infectiveCiproCiprofloxacin 500 mgTabletAnti-infectiveCiproCitalopram 20 mgTabletAnti-depressantCelexaCitalopram 40 mgTabletAnti-depressantCelexaClindamycin 150 mgCapsulesAnti-infectiveCleocinClindamyc in/tretinoin *sample*GelTopicalZianaClonidine mgTabletAntihypertensiveCatapresClonidin e mgTabletAntihypertensiveCatapresClopidog rel 75mgTabletAntiplateletPlavixClotrimazole 1%CreamAntifungal, TopicalLotriminClotrimazole & Betamethasone *samp*CreamAntifungal, TopicalLotrisoneCombivent Respimat *sample*InhalerRespiratoryIprat/AlbCyclo benzaprine 5 mgTabletMuscle relaxantFlexerilCyclobenzaprine 10 mgTabletMuscle relaxantFlexerilCrestor 40 mg *sample*TabletCholesterol inhibitorRosuvastatinrev 2/20/2018 Page 3 REACHOUT 2018 FORMULARY - Alpha ListDRUG NAMEDOSAGE FORMDRUG TYPEALT NAMEDepo-Medrol 80mg/mL *sample*InjectableSteroidMethylprednisol oneDepo-ProveraInjectableContraceptiveMe droxy-progesteroneDiclofenac Gel 1%GelNsaid, TopicalVoltarenDicyclomine 10 mgCapsulesGI AgentsBentylDicyclomine 20 mgCapsulesGI AgentsBentylDigoxin mgTabletCardiovascularDigoxDiltiazem 180 mgCapsulesCalcium Channel BlockerCardizemDiphenhydramine (Banophen) BanophenDiphenhydramine (Banophen)

5 25 mgTabletAntihistamineBenadrylDipyridamol e 50 mgTabletAntiplateletPersantineDivalproex DR 250mgCapsulesAnti-ConvulsantDepakoteDiva lproex DR 500mgCapsulesAnti-ConvulsantDepakoteDocu sate Sodium 100 mgCapsulesStool SoftenerColaceDulera 100mcg/5mcg *sample*InhalerRespiratoryMometasone/ formoterolDulera 200mcg/5mcg *sample*InhalerRespiratoryMometasone/ formoterolDoxycycline 100 mgCapsulesAnti-InfectiveVibramycinDuloxe tine 30mgCapsulesAnti-DepressantCymbaltaDulox etine 60mgCapsulesAnti-DepressantCymbaltaDutas teride *sample*CapsulesBPHA vodartEarwax Drops (Debrox)SolutionOTCD ebroxEdarbi 80 mg *sample*TabletAntihypertensiveAzilsartan Eliquis *sample*TabletAnticoagulantApixabanEliqu is 5mg *sample*TabletAnticoagulantApixabanEnala pril 10 mgTabletAce InhibitorVasotecEnoxaparin 40 mlInjectableAnticoagulantLovenoxEnoxapar in 80 mlInjectableAnticoagulantLovenoxEnoxapar in 100mg/1 mlInjectableAnticoagulantLovenoxEnoxapar in 150mg/1 mlInjectableAnticoagulantLovenoxrev 2/20/2018 Page 4 REACHOUT 2018 FORMULARY - Alpha ListDRUG NAMEDOSAGE FORMDRUG TYPEALT NAMEEpi-Pen (pediatric)

6 - clinic use onlySyringeAntidoteEpinephrineEpi-Pen - clinic use onlySyringeAntidoteEpinephrineErythromyc in Ophth , TopicalIlotycinEscitalopram 10 mg *sample*TabletAnti-depressantLexaproEsci talopram 20mg *sample*TabletAnti-depressantLexaproFamo tidine 20 mgTabletGI AgentsPepcidFarxiga 5mg *sample*TabletOral diabetic AgentDapagliflozinFarxiga 10mg *sample*TabletOral diabetic AgentDapagliflozinFenofibrate 160mgTabletLipid Lowering AgentsTricorFerrous Sulfate 325 mgTabletVitamins/MineralsIronFlovent HFA 110mcgInhalerRespiratoryFluticasoneFluco nazole 150 mgTabletAntifungalDiflucanFluconazole 200 mgTabletAntifungalDiflucanFluoxetine 10mgCapsulesAnti-DepressantProzacFluoxet ine 20 mgCapsulesAnti-DepressantProzacFluticaso ne Propionate 50 mcgNasal SprayRespiratoryFlonaseFolic Acid 1 mgTabletVitamins/MineralsVitamin BFurosemide 20 mgTabletDiureticLasixFurosemide 40 mgTabletDiureticLasixGemfibrozil 600 mgTabletLipid Lowering AgentsLopidGentamicin Sulfate Ophth.

7 TopicalGentakGlimepiride 4mgTabletOral Diabetic AgentsAmarylGlipizide 10 mgTabletOral Diabetic AgentsGlucotrolGlipizide 5 mgTabletOral Diabetic AgentsGlucotrolGlyburide 5 mgTabletOral Diabetic AgentsMicronaseGriseofulvin 125mg/5mlSuspensionAnti-InfectiveGris-Pe gHemorrhoidal OintmentOintmentOTCPrep-HHumalogVialsIns ulinLisproHumalog KwikPens 100units/mlPensInsulinLisproHumalog KwikPens 200units/ml *samp*PensInsulinLisproHumalog Mix 75/25 VialsInsulinLisproHumulin 70/30 VialsInsulinNPH/RegularHumulin N VialsInsulinInsulin NPHrev 2/20/2018 Page 5 REACHOUT 2018 FORMULARY - Alpha ListDRUG NAMEDOSAGE FORMDRUG TYPEALT NAMEH umulin RVialsInsulinInsulin RegularHydralazine 10 mgTabletCardiovascularApresolineHydralaz ine 25 mgTabletCardiovascularApresolineHydralaz ine 50 mgTabletCardiovascularApresolineHydralaz ine 100 mgTabletCardiovascularApresolineHydrochl orothiazide mgTabletDiureticMicrozideHydrochlorothia zide 25 mgTabletDiureticMicrozideHydrocortisone 1% OintmentOintmentSteroid, TopicalCortizoneHydrocortisone 1% CreamCreamSteroid, TopicalCortizoneHydrocortisone 1% LotionLotionSteroid, TopicalCortizoneHydrocortisone % OintmentOintmentSteroid, TopicalCortizoneHydrocortisone CreamCreamSteroid, TopicalCortizoneHydrocortisone LotionLotionSteroid.

8 TopicalCortizoneHydroxychloroquine 200mgTabletAnti-malariaPlaquenilHydroxyz ine HCL 25 mgTabletAntihistamineAtaraxHydroxyzine Pamoate 25 mgCapsulesAntihistamineVistarilHydroxyzi ne Pamoate 50 mgCapsulesAntihistamineVistarilIbuprofen Children's Oral Susp 100/5 *samSuspensionNSAIDM otrinIbuprofen 200 mgTabletNSAIDM otrinIbuprofen 400 mgTabletNSAIDM otrinIbuprofen 600 mgTabletNSAIDM otrinIbuprofen 800 mgTabletNSAIDM otrinIndomethacin 25 mgCapsulesAnti-GoutIndocinIndomethacin 50mgCapsulesAnti-GoutIndocinInvokamet XR 50/500 mg *sample*TabletOral-Diabetic AgentsCana+MetInvokamet XR 50/1000 mg *sample*TabletOral-Diabetic AgentsCana+MetInvokamet XR 150/500 mg *sample*TabletOral-Diabetic AgentsCana+MetInvokamet XR 150/1000 mg *sample*TabletOral-Diabetic AgentsCana+MetIpratropium & Albuterol Soln NebulizerVialsRespiratoryDuo-NebIpratrop ium Soln NebulizerVialsRespiratoryIsoniazid 300mgTabletsAnti-Tubercular AgentLaniazidIsosorbide Mononitrate ER 30 mgTabletCardiovascularImdurrev 2/20/2018 Page 6 REACHOUT 2018 FORMULARY - Alpha ListDRUG NAMEDOSAGE FORMDRUG TYPEALT NAMEJ anumet 50/500 *sample*TabletOral Diabetic AgentsSit+ MetforminJanumet 50/1000 *sample*TabletOral Diabetic AgentsSit+ MetforminJanumet XR 50/1000 *sample*TabletOral Diabetic AgentsSit+ MetforminJanumet XR 100/1000 *sample*TabletOral Diabetic AgentsSit+ MetforminJanuvia 100 mg *sample*TabletOral Diabetic AgentsSitagliptinJentadueto mg *sample*TabletOral-Diabetic AgentsLin+MetforminJentadueto 5/1000 XR mg tab *sample*TabletOral-Diabetic AgentsLin+MetforminKetoconazole 2% CreamCreamAntifungal, TopicalXolegelKetoconazole 2% ShampooSolutionAntifungal, TopicalKetotifen 2% ophthalmic (Eye itch relief)

9 SolutionTopicalZaditorLactulose SolnSyrupGI AgentsEnuloseLamotrigine 25mg *sample*TabletAnti-ConvulsantLamictalLam otrigine 100mg *sample*TabletAnti-ConvulsantLamictalLam otrigine 150mg *sample*TabletAnti-ConvulsantLamictalLan tusVialsInsulinGlargineLantus SolostarPensInsulinGlargineLatuda 20mg *sample*TabletAntipsychoticLevemir *sample*VialsInsulinLevemir Flextouch *sample*PensInsulinLevetiracetam 500mg (Keppra)TabletsAnti-ConvulsantKeppraLevo floxacin 500 TabletAnti-infectiveLevaquinLevofloxacin 750 TabletAnti-infectiveLevaquinLevothyroxin e 100 mcgTabletThyroidSynthroidLice Killing Shampoo KitSolutionAnti-parasiticLidocaine Patches 5%PatchesAnalgesicLidodermLidocaine 20mg/2 mL injInjectableAnalgesicLidocaine/prilocai ne - clinic use onlyCreamAnalgesicLinezolid 600mgTabletAnti-infectiveZyvoxLinzess 72mcg *sample*CapsuleGI AgentsLinzess 145mcg *sample*CapsuleGI AgentsLinzess 290mcg *sample*CapsuleGI AgentsLisinopril mgTabletACE InhibitorZestrilLisinopril 5 mgTabletACE InhibitorZestrilrev 2/20/2018 Page 7 REACHOUT 2018 FORMULARY - Alpha ListDRUG NAMEDOSAGE FORMDRUG TYPEALT NAMEL isinopril 10 mgTabletACE InhibitorZestrilLisinopril 20 mgTabletACE InhibitorZestrilLisinopril 40 mgTabletACE InhibitorZestrilLoperamide 2mgTabletAntiDiarrhealImodiumLoratadine 10 mgTabletAntihistamineClaritinLoratadine Children's

10 LiquidSyrupAntihistamineClaritinLosartan K 50 mgTabletAntihypertensiveCozaarLosartan K 100 mgTabletAntihypertensiveCozaarLovastatin 20 mgTabletCholesterol inhibitorMevacorLovastatin 40 mgTabletCholesterol inhibitorMevacorMagnesium Citrate 296 MlSolutionLaxativeMaztim LA 420mg *sample*TabletCalcium Channel BlockerDiltiazem ERMeclizine mgTabletAntihistamineAntivertMeclizine 25mgtabletAntihistamineAntivertMedroxypr ogesterone 10 mgTabletHormoneProveraMeloxicam 500 mgTabletOral Diabetic AgentsGlucophageMetformin 850 mg *sample*TabletOral Diabetic AgentsGlucophageMetformin 1000 mgTabletOral Diabetic AgentsGlucophageMethimazole 10mgTabletThyroidTapazoleMethocarbamol 500mgTabletmuscle relaxantRobaxinMethylprednisolone 4 mgDose PakSteroid MedrolMetoclopramide 10 mgTabletGI AgentsReglanMetoprolol succinate 50mg*sample*TabletBeta BlockerToprol XLMetoprolol succinate 100mg *sample*TabletBeta BlockerToprol XLMetoprolol Tartrate 25 mgTabletBeta BlockerLopressorMetoprolol Tartrate 50 mgTabletBeta BlockerLopressorMetoprolol Tartrate 100mgTabletBeta BlockerLopressorMetronidazole 250 mgTabletAnti-InfectiveFlagylMetronidazol e 500 mgTabletAnti-InfectiveFlagylMinocycline 50mgTabletAnti-InfectiveSolodynMinocycli ne 100mgTabletAnti-InfectiveSolodynMinoxidi l 10 mgTabletAntihypertensiverev 2/20/2018 Page 8 REACHOUT 2018 FORMULARY - Alpha ListDRUG NAMEDOSAGE FORMDRUG TYPEALT NAMEM obisyl pain relieving creamCreamOTCT rolamineMontelukast 10mgTabletRespiratorySingulairMucinex ER 600mgTabletOTCG uaifenesinMucus Relief DMTabletOTCG uaifenesin/ dextromethorphanThera M multivitaminTabletVitamins/MineralsMulti vitaminsMupirocin 2% topicalOintmentAnti-Infective, TopicalBactrobanNaproxen 500 mgTabletNSAIDN aprosynNarcan 4mg - clinic use onlyNasal SprayOpioid antagonistNeomycin & Polymyxin B Sulfate OticSolutionAnti-Infective.