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The Medical and Dental Staff

Hospital Formulary
2010
AHFS Drug Classification
LSUHSC / E. A. Conway Medical Center
4864 Jackson Street
Monroe, Louisiana

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 2 of 66

04 ANTIHISTAMINE DRUGS
04:04.04 ETHANOLAMINE DERIVATIVES\1
DiphenhydrAMINE HCl 25 mg tab (BENADRYL EQUIV) AutoStop Days: 30
DiphenhydrAMINE HCl 25 mg/10 ml liq 10ml ud (BENADRYL EQUIV) AutoStop Days: 30
DiphenhydrAMINE HCl 50 mg/ml vial (BENADRYL EQUIV) AutoStop Days: 30

04:04.12 PHENOTHIAZINE DERIVATIVES\1


Promethazine 25 mg tab (PHENERGAN EQUIV) AutoStop Days: 30
Promethazine 25 mg supp (PHENERGAN EQUIV) AutoStop Days: 30
Promethazine 50 mg supp (PHENERGAN EQUIV) AutoStop Days: 30
Promethazine Topical 25 mg/0.5 ml gel AutoStop Days: 30
Promethazine 25 mg/ml amp (PHENERGAN EQUIV) AutoStop Days: 30

04:04.20 PROPYLAMINE DERIVATIVES\1


Chlorpheniramine Maleat 12 mg SA TR12cap (CHLOR-TRIMETON SR EQUIV) AutoStop Days: 30
Chlorpheniramine Maleat 4 mg tab (CHLOR-TRIMETON EQUIV) AutoStop Days: 30
Triprolidine/P-ephedrin 1.25-30mg/5ml soln 30ml (ACTIFED SYR EQUIV) AutoStop Days: 30 DEA Sch: V
Triprolidine/P-ephedrin 2.5-60 mg tab (ACTIFED EQUIV) AutoStop Days: 30 DEA Sch: V

04:04.92 FIRST GEN. ANTIHIST. DERIVATIVES, MISC.\1


Cyproheptadine 4 mg tab (PERIACTIN EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 3 of 66

08 ANTI-INFECTIVE AGENTS
08:08.00 ANTHELMINTICS
Mebendazole 100 mg chewtab (VERMOX EQUIV) AutoStop Days: 30

08:12.02 AMINOGLYCOSIDES
Gentamicin 20 mg/2 ml vial (GARAMYCIN EQUIV) AutoStop Days: 30
Gentamicin 80 mg/2 ml vial (GARAMYCIN EQUIV) AutoStop Days: 30
Gentamicin 80 mg/100 ml iso NaCl AutoStop Days: 30
Gentamicin 100 mg/100 ml iso NaCl AutoStop Days: 30
Gentamicin 120 mg/100 ml iso NaCl (GARAMYCIN EQUIV) AutoStop Days: 30
Neomycin Sulfate 500 mg tab AutoStop Days: 30
Streptomycin Sulfate 1 gram vial AutoStop Days: 30

08:12.06 CEPHALOSPORINS
ceFAZolin Sodium 1 gram vial (ANCEF/KEFZOL EQUIV) AutoStop Days: 30
CefOTAXime 1 gram vial (CLAFORAN EQUIV) AutoStop Days: 30
CefOTAXime 2 gram vial (CLAFORAN EQUIV) AutoStop Days: 30
CefTAZIDime Pentahydrat 1 gram vial (FORTAZ/TAZIDIME/TAZICEF EQUIV) AutoStop Days: 30
CefTAZIDime Pentahydrat 2 gram vial (FORTAZ/TAZIDIME/TAZICEF EQUIV) AutoStop Days: 30
cefTRIAXone 250 mg vial (ROCEPHIN EQUIV) AutoStop Days: 30
cefTRIAXone 500 mg vial (ROCEPHIN EQUIV) AutoStop Days: 30
cefTRIAXone 1 gram vial (ROCEPHIN EQUIV) AutoStop Days: 30
cefTRIAXone 2 gram vial (ROCEPHIN EQUIV) AutoStop Days: 30
CefUROXime Axetil 125mg/5ml susp 100ml bt (CEFTIN EQUIV) AutoStop Days: 30
CefUROXime Axetil 250 mg tab (CEFTIN EQUIV) AutoStop Days: 30
CefUROXime Sodium 750 mg vial (ZINACEF EQUIV) AutoStop Days: 30
CefUROXime Sodium 1.5 gram vial (ZINACEF) AutoStop Days: 30
Cephalexin 250 mg cap (KEFLEX EQUIV) AutoStop Days: 30
Cephalexin 250 mg/5 ml susp 100 ml (KEFLEX EQUIV) AutoStop Days: 30

08:12.07 MISCELLANEOUS B-LACTAM ANTIBIOTICS


Cefoxitin 1 gram vial (MEFOXIN EQUIV) AutoStop Days: 30
Cefoxitin 2 gram vial (MEFOXIN EQUIV) AutoStop Days: 30
Ertapenem Sodium 1 gram vial (INVANZ) AutoStop Days: 30
Imipenem/Cilastatin 250 mg vial (PRIMAXIN) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 4 of 66

08 ANTI-INFECTIVE AGENTS
08:12.07 MISCELLANEOUS B-LACTAM ANTIBIOTICS
Imipenem/Cilastatin 500 mg vial (PRIMAXIN) AutoStop Days: 30

08:12.08 CHLORAMPHENICOL
Chloramphenicol 1 gram vial (CHLOROMYCETIN EQUIV) AutoStop Days: 30

08:12.12 MACROLIDES
AZITHromycin 1 gram powder pack (ZITHROMAX EQUIV) AutoStop Days: 30
AZITHromycin 250 mg tab (ZITHROMAX EQUIV) AutoStop Days: 30
AZITHromycin 500 mg vial (ZITHROMAX EQUIV) AutoStop Days: 30
AZITHromycin 600 mg tab (ZITHROMAX EQUIV) AutoStop Days: 30
AZITHromycin 200mg/5ml susp 15ml btl (ZITHROMAX EQUIV) AutoStop Days: 30
AZTIHromycin 200mg/5ml susp 30ml btl (ZITHROMAX EQUIV) AutoStop Days: 30
Clarithromycin 250 mg tab (BIAXIN) AutoStop Days: 30
Clarithromycin 250mg/5ml susp 50 ml bt (BIAXIN EQUIV) AutoStop Days: 30
ERYTHromycin 250 mg enteric-coat tab (ERY-TAB EQUIV) AutoStop Days: 30
ERYTHromycin 333 mg enteric-coat tab (ERY-TAB EQUIV) AutoStop Days: 30
ERYTHromycin Lactobion 500 mg vial (ERYTHROCIN EQUIV) AutoStop Days: 30
ERYTHromycin Stearate 250 mg tab (ERYTHROCIN EQUIV) AutoStop Days: 30
ERYTHromycin-SulfiSOXAZ 200-600mg/5ml sus 100ml (PEDIAZOLE EQUIV) AutoStop Days: 30
ERYTHromycin Ethylsucc 400mg/5ml susp 100ml bt (ERYPED 400 EQUIV) AutoStop Days: 30

08:12.16 PENICILLINS
Amoxicillin 250 mg cap (POLYMOX EQUIV) AutoStop Days: 30
Amoxicillin Trihydrate 125mg/5ml susp 80ml bt (POLYMOX EQUIV) AutoStop Days: 30
Amoxicillin Trihydrate 250mg/5ml susp 100ml bt (POLYMOX EQUIV) AutoStop Days: 30
Amoxicillin-Pot Clavul 250-62.5mg/5ml 75 ml bt (AUGMENTIN EQUIV) AutoStop Days: 30
Amoxicillin-Pot Clavul 250-125 mg tab (AUGMENTIN EQUIV) AutoStop Days: 30
Amoxicillin-Pot Clavul 500-125 mg tab (AUGMENTIN EQUIV) AutoStop Days: 30
Amoxicillin-Pot Clavul 875-125 mg tab (AUGMENTIN EQUIV) AutoStop Days: 30
Amoxicillin-Pot Clavul 1000-62.5 mg XR tab (AUGMENTIN XR 1000-62.5 MG) AutoStop Days: 30
Ampicillin Trihydrate 250 mg cap AutoStop Days: 30
Ampicillin 1 gram vial AutoStop Days: 30
Ampicillin 2 gram vial AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 5 of 66

08 ANTI-INFECTIVE AGENTS
08:12.16 PENICILLINS
Ampicillin 250 mg vial AutoStop Days: 30
Ampicillin 500 mg vial AutoStop Days: 30
Ampicillin Trihydrate 250 mg/5 ml susp 100 ml AutoStop Days: 30
Ampicillin-Sulbactam 1.5 gram vial (UNASYN EQUIV) AutoStop Days: 30
Ampicillin-Sulbactam 3 gram vial (UNASYN EQUIV) AutoStop Days: 30
Dicloxacillin 250 mg cap (DYNAPEN EQUIV) AutoStop Days: 30
Nafcillin 1 gram vial (UNIPEN EQUIV) AutoStop Days: 30
Nafcillin 2 gram vial (UNIPEN EQUIV) AutoStop Days: 30
Penicillin V Potassium 250mg/5ml susp 100ml bt (PEN V K EQUIV) AutoStop Days: 30
Penicillin G Benzathine 1.2 million units/2 ml (BICILLIN L-A) AutoStop Days: 30
Penicillin G Benzathine 2.4 million units/4 ml (BICILLIN L-A) AutoStop Days: 30
Penicillin G Benzathine 600,000 units/ml syr (BICILLIN L-A) AutoStop Days: 30
Penicillin G Potassium 5 million unit vial (PFIZERPEN-G EQUIV) AutoStop Days: 30
Penicillin G Procaine 1.2 million units/2 ml (WYCILLIN EQUIV) AutoStop Days: 30
Penicillin G Procaine 600,000 units/ml syr (WYCILLIN EQUIV) AutoStop Days: 30
Penicillin G Sodium 5 million unit vial (PEN G SOD) AutoStop Days: 30
Penicillin V Potassium 250 mg tab (PEN V K EQUIV) AutoStop Days: 30
PIPERACILL/TAZOBACT/D5W 2.25GM (ZOSYN) AutoStop Days: 30
PIPERACILL/TAZOBACT/D5W 3.375G (ZOSYN) AutoStop Days: 30
PIPERACILL/TAZOBACT/D5W 4.5GM (ZOSYN) AutoStop Days: 30
PIPERACILLIN/TAZOBAC 2.25GM VL (ZOSYN) AutoStop Days: 30
PIPERACILLIN/TAZOBAC 3.375GM (ZOSYN) AutoStop Days: 30
PIPERACILLIN/TAZOBAC 4.5GM VL (ZOSYN) AutoStop Days: 30

08:12.18 QUINOLONES\1
Ciprofloxacin 250 mg tab (CIPRO EQUIV) AutoStop Days: 30
Ciprofloxacin 500 mg tab (CIPRO EQUIV) AutoStop Days: 30
Ciprofloxacin 750 mg tab (CIPRO EQUIV) AutoStop Days: 30
Ciprofloxacin 400 mg/40 ml vial (CIPRO EQUIV) AutoStop Days: 30
Ciprofloxacin in D5W 200 mg/100 ml bag (CIPRO EQUIV) AutoStop Days: 30
Ciprofloxacin in D5W 400 mg/200 ml bag (CIPRO EQUIV) AutoStop Days: 30
MOXIfloxacin 400 mg tab (AVELOX) AutoStop Days: 30
MOXIfloxacin / iso-NaCl 400 mg/250 ml bag (AVELOX IV 400 MG/250 ML NACL) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 6 of 66

08 ANTI-INFECTIVE AGENTS
08:12.20 SULFONAMIDES (SYSTEMIC)\1
SulfaMETHoxazole/Trimet 800-160 mg DS tab (BACTRIM DS EQUIV) AutoStop Days: 30
SulfaMETHoxazole/Trimet susp 800-160mg/20ml ud (BACTRIM SUSP EQUIV) AutoStop Days: 30
SulfaMETHoxazole/Trimet 200-40mg/5ml susp 30 ml (BACTRIM SUSP EQUIV) AutoStop Days: 30
SulfaMETHoxazole/Trimet 800-160mg/10 ml vial (BACTRIM / SEPTRA EQUIV) AutoStop Days: 30
SulfaSALAzine 500mg enteric-coat tab (AZULFIDINE EN-TAB EQUIV) AutoStop Days: 30

08:12.24 TETRACYCLINES
Demeclocycline 150 mg tab (DECLOMYCIN EQUIV) AutoStop Days: 30
Doxycycline 100 mg tab (VIBRAMYCIN EQUIV) AutoStop Days: 30
Doxycycline 100 mg vial (VIBRAMYCIN EQUIV) AutoStop Days: 30
Tetracycline 250 mg cap (ACHROMYCIN V EQUIV) AutoStop Days: 30

08:12.28 ANTIBACTERIALS, MISCELLANEOUS\1


Bacitracin 50,000 unit vial AutoStop Days: 30
Clindamycin 150 mg cap (CLEOCIN EQUIV) AutoStop Days: 30
Clindamycin 300 mg cap (CLEOCIN EQUIV) AutoStop Days: 30
Clindamycin 600 mg/4 ml vial (CLEOCIN EQUIV) AutoStop Days: 30
Clindamycin 900 mg/6 ml vial (CLEOCIN EQUIV) AutoStop Days: 30
Clindamycin in D5W 600 mg/50 ml bag (CLEOCIN IN D5/W EQUIV) AutoStop Days: 30
Clindamycin in D5W 900 mg/50 ml bag (CLEOCIN IN D5/W EQUIV) AutoStop Days: 30
VancoMYCIN 500 mg vial (VANCOCIN EQUIV) AutoStop Days: 30
VancoMYCIN in Dextrose 1 gram/200 ml bag (VANCOCIN HCL EQUIV) AutoStop Days: 30
VancoMYCIN 1 gram vial (VANCOCIN EQUIV) AutoStop Days: 30

08:14.08 AZOLES\1
Fluconazole 100 mg tab (DIFLUCAN EQUIV) AutoStop Days: 30
Fluconazole 150 mg tab (DIFLUCAN EQUIV) AutoStop Days: 30
Fluconazole 40 mg/ml susp 35 ml btl (DIFLUCAN EQUIV) AutoStop Days: 30
Fluconazole in NaCl iso 100 mg/50 ml btl (DIFLUCAN EQUIV) AutoStop Days: 30
Fluconazole in NaCl iso 200 mg/100 ml bag (DIFLUCAN EQUIV) AutoStop Days: 30
Fluconazole in NaCl iso 400 mg/200 ml bag (DIFLUCAN EQUIV) AutoStop Days: 30
Ketoconazole 200 mg tab (NIZORAL EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 7 of 66

08 ANTI-INFECTIVE AGENTS
08:14.28 POLYENES\1
Amphoterecin B 50 mg vial (FUNGIZONE EQUIV) AutoStop Days: 30
Nystatin Oral Susp 500,000 units/5 ml cup (MYCOSTATIN EQUIV) AutoStop Days: 30
Nystatin Oral Susp 100,000 unit/ml 60ml bt (MYCOSTATIN EQUIV) AutoStop Days: 30

08:16.04 ANTITUBERCULOSIS AGENTS\1


Ethambutol 100 mg tab (MYAMBUTOL EQUIV) AutoStop Days: 30
Ethambutol 400 mg tab (MYAMBUTOL EQUIV) AutoStop Days: 30
Isoniazid 100 mg tab (INH) AutoStop Days: 30
Isoniazid 300 mg tab (INH) AutoStop Days: 30
Pyrazinamide 500 mg tab (PZA) AutoStop Days: 30
rifAMPin 150 mg cap (RIFADIN EQUIV) AutoStop Days: 30
rifAMPin 300 mg cap (RIFADIN EQUIV) AutoStop Days: 30

08:18.08 ANTIRETROVIRALS\1
LamiVUDine/ZidovuDINE 150-300 mg tab (COMBIVIR EQUIV) AutoStop Days: 30
Lopinavir/Ritonavir 400-100mg/5ml sol 30 ml (KALETRA) AutoStop Days: 30
Lopinavir/Ritonavir 200-50 mg tab (KALETRA) AutoStop Days: 30
ZidovuDINE 100 mg cap (RETROVIR EQUIV) AutoStop Days: 30
ZidovuDINE 300 mg tab (RETROVIR EQUIV) AutoStop Days: 30
ZidovuDINE 150 mg/5 ml syrup 30 ml (RETROVIR EQUIV) AutoStop Days: 30
ZidovuDINE 200 mg/20 ml vial (RETROVIR EQUIV) AutoStop Days: 30

08:18.28 NEURAMINIDASE INHIBITORS\1


Oseltamivir Phosphate 75 mg GELcap (TAMIFLU) AutoStop Days: 30

08:18.32 NUCLEOSIDES AND NUCLEOTIDES\1


Acyclovir 200 mg cap (ZOVIRAX EQUIV) AutoStop Days: 30
Acyclovir 400 mg tab (ZOVIRAX EQUIV) AutoStop Days: 30
Acyclovir 800 mg tab (ZOVIRAX EQUIV) AutoStop Days: 30
Acyclovir 500 mg vial (ZOVIRAX EQUIV) AutoStop Days: 30
Acyclovir 200 mg/5 ml susp 30 ml (ZOVIRAX EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 8 of 66

08 ANTI-INFECTIVE AGENTS
08:30.08 ANTIMALARIALS\1
CHLOROquine Phosphate 500 mg tab (ARALEN EQUIV) AutoStop Days: 30
HYDROXYCHLOROquine 200 mg tab (PLAQUENIL EQUIV) AutoStop Days: 30
PRIMAquine Phosphate 26.3 mg tab AutoStop Days: 30

08:30.92 ANTIPROTOZOALS, MISCELLANEOUS\1


metroNIDAZOLE 250 mg tab (FLAGYL EQUIV) AutoStop Days: 30
metroNIDAZOLE 500 mg/100 ml NaCl bag (FLAGYL EQUIV) AutoStop Days: 30
Pentamidine Isethionate 300 mg for Inhal vial (NEBUPENT INHAL) AutoStop Days: 30
Pentamidine Isethionate 300 mg for Inj vial (PENTAM) AutoStop Days: 30

08:36.00 URINARY ANTI-INFECTIVES


Nitrofurantion Macro 50 mg cap (MACRODANTIN EQUIV) AutoStop Days: 30
Nitrofurantoin MonMacro 100 mg cap (MACROBID EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 9 of 66

10 ANTINEOPLASTIC AGENTS
10:00.00 ANTINEOPLASTIC AGENTS
BEVACIzumab 100 mg/4 ml vial (AVASTIN) AutoStop Days: 30
BEVACIzumab 400 mg/16 ml vial (AVASTIN) AutoStop Days: 30
Bleomycin Sulfate 15 unit vial (BLENOXANE EQUIV) AutoStop Days: 30
Bleomycin Sulfate 30 unit vial (BLENOXANE EQUIV ) AutoStop Days: 30
CARBOplatin 50 mg/5 ml vial (PARAPLATIN EQUIV) AutoStop Days: 30
CARBOplatin 150 mg/15ml vial (PARAPLATIN EQUIV) AutoStop Days: 30
CARBOplatin 450 mg/45 ml vial (PARAPLATIN EQUIV) AutoStop Days: 30
CARBOplatin 600 mg/60 ml vial (PARAPLATIN EQUIV ) AutoStop Days: 30
Carmustine 100 mg vial (BICNU EQUIV) AutoStop Days: 30
CETUXimab 100 mg/50 ml vial (ERBITUX) AutoStop Days: 30
CETUXimab 200 mg/100 ml vial (ERBITUX ) AutoStop Days: 30
CISplatin 50 mg/50 ml vial (PLATINOL AQ EQUIV) AutoStop Days: 30
CISplatin 100 mg/100 ml vial (PLATINOL AQ EQUIV) AutoStop Days: 30
CISplatin 200 mg/200 ml vial (PLATINOL AQ EQUIV ) AutoStop Days: 30
Cyclophosphamide 25 mg tab (CYTOXAN EQUIV) AutoStop Days: 30
Cyclophosphamide 50 mg tab (CYTOXAN EQUIV) AutoStop Days: 30
Cyclophosphamide 500 mg vial (CYTOXAN EQUIV) AutoStop Days: 30
Cyclophosphamide 1,000 mg vial (CYTOXAN EQUIV ) AutoStop Days: 30
Cyclophosphamide 2 gram vial (CYTOXAN EQUIV) AutoStop Days: 30
Dacarbazine 200 mg vial (DTIC DOME EQUIV) AutoStop Days: 30
DACTINomycin 0.5 mg vial (COSMEGEN) AutoStop Days: 30
DOCEtaxel 20 mg/2 ml vial (TAXOTERE EQUIV) AutoStop Days: 30
Restricted to Hematology / Oncology Only
DOCEtaxel 80 mg/8 ml vial (TAXOTERE EQUIV) AutoStop Days: 30
Restricted to Hematology / Oncology Only
DOXOrubicin 10 mg/5 ml vial (ADRIAMYCIN EQUIV) AutoStop Days: 30
DOXOrubicin 50 mg/25 ml vial (ADRIAMYCIN EQUIV) AutoStop Days: 30
DOXOrubicin 200 mg/100 ml vial (ADRIAMYCIN EQUIV) AutoStop Days: 30
DOXOrubicin Liposomal 20 mg/10 ml vial (DOXIL) AutoStop Days: 30
Restricted to Hematology / Oncology Only
DOXOrubicin Liposomal 50 mg/25 ml vial (DOXIL) AutoStop Days: 30
Restricted to Hematology / Oncology Only
Etoposide (VP16) 50 mg cap (VEPESID EQUIV) AutoStop Days: 30
Etoposide (VP16) 100 mg/5 ml vial (VEPESID EQUIV) AutoStop Days: 30
Fludarabine Phosphate 50 mg vial (FLUDARA EQUIV) AutoStop Days: 30
Fluorouracil 2,500 mg/50 ml vial (ADRUCIL EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 10 of 66

10 ANTINEOPLASTIC AGENTS
10:00.00 ANTINEOPLASTIC AGENTS
Fluorouracil (5-FU) 500 mg/10 ml vial (ADRUCIL EQUIV) AutoStop Days: 30
Fulvestrant 250 mg/5 ml syringe (FASLODEX) AutoStop Days: 30
GemciTABINE 200 mg vial (GEMZAR) AutoStop Days: 30
Restricted to Hematology / Oncology Only
GemciTABINE 1 gram vial (GEMZAR) AutoStop Days: 30
Restricted to Hematology / Oncology Only
Goserelin Acetate 3.6 mg implant (ZOLADEX) AutoStop Days: 30
Goserelin Acetate 10.8 mg implant (ZOLADEX) AutoStop Days: 30
Hydroxyurea 200 mg cap (DROXIA) AutoStop Days: 30
Hydroxyurea 500 mg cap (HYDREA EQUIV) AutoStop Days: 30
Irinotecan 40 mg/2 ml vial (CAMPTOSAR) AutoStop Days: 30
Restricted to Hematology / Oncology Only
Irinotecan 100 mg/5 ml vial (CAMPTOSAR) AutoStop Days: 30
Restricted to Hematology / Oncology Only
Leuprolide Acetate 3.75 mg Adult Depot kit (DEPOT LUPRON) AutoStop Days: 30
Leuprolide Acetate 7.5 mg Adult Depot kit (DEPOT LUPRON) AutoStop Days: 30
Leuprolide Acetate 7.5 mg Ped Depot kit (DEPOT LUPRO) AutoStop Days: 30
Leuprolide Acetate 11.25 mg Ped Depot Kit (DEPOT LUPRO) AutoStop Days: 30
Leuprolide Acetate 11.25mg Adult Depot kit (DEPOT LUPRON) AutoStop Days: 30
Leuprolide Acetate 22.5 mg Adult Depot kit (DEPOT LUPRON) AutoStop Days: 30
Leuprolide Acetate 30 mg 4 month adult kit (DEPOT LUPRON) AutoStop Days: 30
Mechlorethamine 10 mg vial (MUSTARGEN) AutoStop Days: 30
Megestrol Acetate 20 mg tab (MEGACE EQUIV) AutoStop Days: 30
Megestrol Acetate 40 mg tab (MEGACE EQUIV) AutoStop Days: 30
Megestrol Acetate 400mg/10ml susp ud cup (MEGACE EQUIV) AutoStop Days: 30
Melphalan 2 mg tab (ALKERAN) AutoStop Days: 30
Methotrexate 50 mg/2 ml vial (MTX) AutoStop Days: 30
Methotrexate 100 mg/4 ml vial (MTX) AutoStop Days: 30
Methotrexate 1,000 mg/40 ml vial (MTX ) AutoStop Days: 30
Methotrexate 2.5 mg tab (MTX) AutoStop Days: 30
Mitomycin 5 mg vial (MUTAMYCIN EQUIV) AutoStop Days: 30
Mitomycin 20 mg vial (MUTAMYCIN EQUIV) AutoStop Days: 30
Mitomycin 40 mg vial (MUTAMYCIN ) AutoStop Days: 30
OXALIplatin 50 mg/10 ml vial (ELOXATIN) AutoStop Days: 30
Restricted to Use Only After First Line Treatment Failure
OXALIplatin 100 mg/20 ml vial (ELOXATIN) AutoStop Days: 30
Restricted to Use Only After First Line Treatment Failure

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 11 of 66

10 ANTINEOPLASTIC AGENTS
10:00.00 ANTINEOPLASTIC AGENTS
OXALIplatin 200 mg/40 ml vial (ELOXATIN) AutoStop Days: 30
Restricted to Use Only After First Line Treatment Failure
PACLItaxel 30 mg/5 ml vial (TAXOL EQUIV) AutoStop Days: 30
PACLItaxel 100 mg/16.7 ml vial (TAXOL EQUIV) AutoStop Days: 30
PACLItaxel 150 mg/25 ml vial (TAXOL EQUIV ) AutoStop Days: 30
PACLItaxel 300 mg/50 ml vial (TAXOL EQUIV) AutoStop Days: 30
Procarbazine 50 mg cap (MATULANE EQUIV) AutoStop Days: 30
RiTUXimab 100 mg/10 ml vial (RITUXAN) AutoStop Days: 30
Restricted to Hematology / Oncology Attending Only
RiTUXimab 500 mg/50 ml vial (RITUXAN) AutoStop Days: 30
Restricted to Hematology / Oncology Attending Only
taMOXifen Citrate 10 mg tab (NOLVADEX EQUIV) AutoStop Days: 30
Topotecan 4 mg vial (HYCAMTIN) AutoStop Days: 30
Restricted to Hematology / Oncology Only
Trastuzumab 440 mg vial (HERCEPTIN) AutoStop Days: 30
Restricted to Hematology / Oncology Attending Only
VinBLAStine 10 mg/10 ml vial (VELBAN EQUIV) AutoStop Days: 30
VinCRIStine Sulfate 2 mg/2 ml vial (ONCOVIN EQUIV) AutoStop Days: 30
Vinorelbine 10 mg/ml vial (NAVELBINE EQUIV) AutoStop Days: 30
Restricted to Hematology / Oncology Only
Vinorelbine 50 mg/5 ml vial (NAVELBINE EQUIV) AutoStop Days: 30
Restricted to Hematology / Oncology Only

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 12 of 66

12 AUTONOMIC DRUGS
12:04.00 PARASYMPATHOMIMETIC (CHOLINERGIC AGENTS)
Bethanechol 5 mg tab (URECHOLINE EQUIV) AutoStop Days: 30
Bethanechol 25 mg tab (URECHOLINE EQUIV) AutoStop Days: 30
Neostigmine 10 mg/10 ml vial AutoStop Days: 30
Physostigmine 2 mg/2 ml amp (ANTILIRIUM EQUIV) AutoStop Days: 30
Pyridostigmine Bromide 5 mg/ml amp (REGONOL) AutoStop Days: 30
Pyridostigmine Bromide 180 mg timepsan SR tab (MESTINON EQUIV) AutoStop Days: 30
Pyridostigmine Bromide 60 mg tab (MESTINON EQUIV) AutoStop Days: 30

12:08.08 ANTIMUSCARINICS/ANTISPASMODICS
Atropine Sulfate 0.4 mg/ml vial AutoStop Days: 30
Atropine Sulfate 0.4 mg/ml 20 ml vial AutoStop Days: 30
Atropine Sulfate 1 mg/10 ml syringe AutoStop Days: 30
Belladonna Alk/PB 16.2 mg tab (DONNATAL EQUIV) AutoStop Days: 30
Belladonna Alk/PB oral soln 5 ml UD (DONNATAL EQUIV) AutoStop Days: 30
Dicyclomine 20 mg tab (BENTYL EQUIV) AutoStop Days: 30
Dicyclomine 20 mg/2 ml amp (BENTYL EQUIV) AutoStop Days: 30
Dicyclomine 10 mg/5 ml syrup 30 ml (BENTYL EQUIV) AutoStop Days: 30
Glycopyrrolate 0.2 mg/ml vial (ROBINUL EQUIV) AutoStop Days: 30
Ipratropium Bromide 0.02% 0.5mg/2.5ml neb (ATROVENT EQUIV) AutoStop Days: 30
Ipratropium Bromide HFA 17mcg/inh MDI 200 spray (ATROVENT HFA MDI EQUIV) AutoStop Days: 30
Tiotropium Bromide 18mcg/dose inhal 5 dose (SPIRIVA HANDIHALER) AutoStop Days: 30

12:12.04 ALPHA-ADRENERGIC AGONISTS\1


Phenylephrine 10 mg/ml vial (NEO-SYNEPHRINE EQUIV) AutoStop Days: 30

12:12.08 BETA-ADRENERGIC AGONISTS\1


Albuterol Sulfate 0.5% 2.5mg/0.5ml neb (VENTOLIN/PROVENTIL EQUIV) AutoStop Days: 30
Albuterol Sulfate Ped 0.042% 1.25mg/3ml neb (ACCUNEB EQUIV) AutoStop Days: 30
Albuterol Sulfate 2 mg tab (VENTOLIN/PROVENTIL EQUIV) AutoStop Days: 30
Albuterol Sulfate 2 mg/5 ml liq 30 ml bt (VENTOLIN/PROVENTIL EQUIV) AutoStop Days: 30
Albuterol Sulfate 0.083% 2.5mg/3ml neb (VENTOLIN/PROVENTIL EQUIV) AutoStop Days: 30
Albuterol Sulfate HFA 90 mcg/inh 8 gm MDI (VENTOLIN HFA MDI) AutoStop Days: 30
DOBUTamine 250 mg/20 ml vial (DOBUTREX EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 13 of 66

12 AUTONOMIC DRUGS
12:12.08 BETA-ADRENERGIC AGONISTS\1
DOBUTamine 500 mg/250 ml D5/W bag (DOBUTREX EQUIV) AutoStop Days: 30
DOPamine 200 mg/5 ml vial (INTROPIN EQUIV) AutoStop Days: 30
DOPamine 800 mg/500 ml D5/W bag AutoStop Days: 30
Fluticasone/Salmeterol 250-50 diskus 14 dose (ADVAIR DISKUS 250-50) AutoStop Days: 30
Fluticasone/Salmeterol 45-21 mcg/act MDI 12 gm (ADVAIR HFA 45/21 MCG) AutoStop Days: 30
Fluticasone/Salmeterol 100-50 Diskus 14 dose (ADVAIR DISKUS 100-50) AutoStop Days: 30
Fluticasone/Salmeterol 500-50 Diskus 14 dose (ADVAIR DISKUS 500-50) AutoStop Days: 30
Ipratropium/Albuterol 18-103 mcg/act 14gm MDI (COMBIVENT MDI) AutoStop Days: 30
Ipratropium/Albuterol 0.5-2.5 mg/3 ml neb amp (DUONEB EQUIV) AutoStop Days: 30
Isoproterenol 1 mg/5 ml amp (ISUPREL EQUIV) AutoStop Days: 30
Salmeterol powder 50 mcg diskus 28 dose (SEREVENT DISKUS) AutoStop Days: 30
Terbutaline Sulfate 2.5 mg tab (BRETHINE EQUIV) AutoStop Days: 30
Terbutaline 1 mg/ml amp (BRETHINE EQUIV) AutoStop Days: 30

12:12.12 ALPHA- AND BETA-ADRENERGIC AGONISTS\1


ePHEDrine Sulfate 50 mg/ml amp AutoStop Days: 30 DEA Sch: V
EPINEPHrine HCl 1 mg/10 ml leur-lok syr (ADRENALIN EQUIV) AutoStop Days: 30
EPINEPHrine HCl 1 mg/ml amp (ADRENALIN EQUIV) AutoStop Days: 30
EPINEPHrine HCl 1 mg/10 ml intracardiac AutoStop Days: 30
EPINEPHrine HCl 30 mg/30 ml vial (ADRENALIN EQUIV) AutoStop Days: 30
EPINEPHrine Racemic 2.25% Inhal Soln 0.5 ml (S-2 RACE-EPINEPH EQUIV) AutoStop Days: 30
NORepinephrine 4 mg/4 ml amp (LEVOPHED EQUIV) AutoStop Days: 30
Pseudoephedrine 30 mg tab (SUDAFED EQUIV) AutoStop Days: 30 DEA Sch: V
Pseudoephedrine 15 mg/5 ml liq 30 ml bt (SUDAFED EQUIV) AutoStop Days: 30 DEA Sch: V

12:16.00 SYMPATHOLYTIC ADRENERGIC BLOCKING AGENTS


Dihydroergotamine 1 mg/ml amp (D.H.E. 45 EQUIV) AutoStop Days: 30
Phenoxybenzamine 10 mg cap (DIBENZYLINE EQUIV) AutoStop Days: 30
Phentolamine Mesylate 5 mg vial (REGITINE EQUIV) AutoStop Days: 30

12:20.04 CENTRALLY ACTING SKELETAL MUSCLE RELAXNT\1


Cyclobenzaprine 10 mg tab (FLEXERIL EQUIV) AutoStop Days: 30
Methocarbamol 500 mg tab (ROBAXIN EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 14 of 66

12 AUTONOMIC DRUGS
12:20.04 CENTRALLY ACTING SKELETAL MUSCLE RELAXNT\1
Methocarbamol 1000 mg/10 ml vial (ROBAXIN EQUIV) AutoStop Days: 30

12:20.08 DIRECT-ACTING SKELETAL MUSCLE RELAXANTS\1


Dantrolene Sodium 25 mg cap (DANTRIUM EQUIV) AutoStop Days: 30
Dantrolene Sodium 20 mg vial (DANTRIUM) AutoStop Days: 30

12:20.20 NEUROMUSCULAR BLOCKING AGENTS\1


Atracurium Besylate 100 mg/10 ml vial (TRACRIUM EQUIV) AutoStop Days: 30
Atracurium Besylate 50 mg/5 ml vial (TRACRIUM EQUIV) AutoStop Days: 30
Pancuronium Bromide 10 mg/5 ml vial (PAVULON EQUIV) AutoStop Days: 30
Rocuronium Bromide 50 mg/5 ml vial (ZEMURON) AutoStop Days: 30
Succinylcholine 200 mg/10 ml vial (ANECTINE EQUIV) AutoStop Days: 30
VecuroNIUM Bromide 10 mg vial (NORCURON EQUIV) AutoStop Days: 30

12:20.92 SKELETAL MUSCLE RELAXANTS, MISCELLANEOUS\1


Orphenadrine Citrate 60 mg/2 ml amp (NORFLEX EQUIV) AutoStop Days: 30

12:92.00 AUTONOMIC DRUGS, MISCELLANEOUS\1


Nicotine 14 mg/24 hour patch (NICODERM 14 MG/DAY EQUIV) AutoStop Days: 30
Nicotine 21 mg/24 hour patch (NICODERM 21 MG/DAY EQUIV) AutoStop Days: 30
Nicotine 7 mg/24 hour patch (NICODERM 7 MG/DAY EQUIV) AutoStop Days: 30
Nicotine Polacrilex 2 mg gum (NICORETTE EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 15 of 66

16 BLOOD DERIVATIVES
16:00.00 BLOOD DERIVATIVES
Albumin, Human 25% 25 grams/100 ml bt AutoStop Days: 30
Albumin, Human 25% 12.5 grams/50 ml bt AutoStop Days: 30
Albumin, Human 5% 12.5 grams/250 ml bt AutoStop Days: 30
Albumin, Human 5% 25 grams/500 ml bt AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 16 of 66

20 BLOOD FORMATION,COAGULATION & THROMBOSIS\1


20:04.04 IRON PREPARATIONS
Ferrous Gluconate 325 mg tab (FERGON EQUIV) AutoStop Days: 30
Ferrous Sulfate 75mg/0.6ml drops 50 ml (FER-IN-SOL EQUIV) AutoStop Days: 30
Ferrous Sulfate 300 mg tab AutoStop Days: 30
Ferrous Sulfate 325 mg tablet AutoStop Days: 30
Ferrous Sulfate 300 mg/5 ml liq 5ml cup AutoStop Days: 30
Iron Dextran 100 mg/2ml vial (INFED EQUIV) AutoStop Days: 30

20:12.04 ANTICOAGULANTS
Dalteparin Sodium 10,000 units/ml syr (FRAGMIN) AutoStop Days: 5
Dalteparin Sodium 12,500 units/0.5 ml syr (FRAGMIN) AutoStop Days: 5
Dalteparin Sodium 15,000 units/0.6 ml syr (FRAGMIN) AutoStop Days: 5
Dalteparin Sodium 18,000 units/0.72ml syr (FRAGMIN) AutoStop Days: 5
Dalteparin Sodium 2,500 units/0.2 ml syr (FRAGMIN) AutoStop Days: 5
Dalteparin Sodium 5,000 units/0.2 ml syr (FRAGMIN) AutoStop Days: 5
Dalteparin Sodium 7,500 units/0.3 ml syr (FRAGMIN) AutoStop Days: 5
Dalteparin Sodium 95,000 units/3.8ml vial (FRAGMIN) AutoStop Days: 5
Enoxaparin Sodium 30 mg/0.3 ml syringe (LOVENOX) AutoStop Days: 5
Enoxaparin Sodium 40 mg/0.4 ml syringe (LOVENOX) AutoStop Days: 5
Enoxaparin Sodium 60 mg/0.6 ml syringe (LOVENOX) AutoStop Days: 5
Enoxaparin Sodium 80 mg/0.8 ml syringe (LOVENOX) AutoStop Days: 5
Enoxaparin Sodium 100 mg/1 ml syringe (LOVENOX) AutoStop Days: 5
Enoxaparin Sodium 120 mg/0.8 ml syringe (LOVENOX) AutoStop Days: 5
Enoxaparin Sodium 150 mg/ml syringe (LOVENOX) AutoStop Days: 5
HEParin (porcine) 2,000 units/2 ml vial AutoStop Days: 5
HEParin (porcine) 5,000 units/0.5 ml syr AutoStop Days: 5
HEParin (Porcine) 5,000 units/1 ml syr AutoStop Days: 5
HEParin (porcine) 10,000 units/ml vial AutoStop Days: 5
HEParin (porcine) Flush 500 units/5 ml syringe AutoStop Days: 5
HEParin (porcine) Flush Peds 20 units/2 ml syr AutoStop Days: 5
HEParin (porcine) in NS 1,000 units/500 ml bag AutoStop Days: 5
HEParin porcine in D5/W 25,000 units/500 ml bag AutoStop Days: 5
Warfarin 1 mg tab (COUMADIN) AutoStop Days: 5
Warfarin 2 mg tab (COUMADIN) AutoStop Days: 5

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 17 of 66

20 BLOOD FORMATION,COAGULATION & THROMBOSIS\1


20:12.04 ANTICOAGULANTS
Warfarin 2.5 mg tab (COUMADIN) AutoStop Days: 5
Warfarin 5 mg tab (COUMADIN) AutoStop Days: 5
Warfarin 7.5 mg tab (COUMADIN) AutoStop Days: 5

20:12.18 PLATELET-AGGREGATION INHIBITORS\1


Clopidogrel Bisulfate 75 mg tab (PLAVIX EQUIV) AutoStop Days: 30
Clopidogrel Bisulfate 300 mg tab (PLAVIX EQUIV) AutoStop Days: 30
Tirofiban in NS 12.5 mg/250 ml bag (AGGRASTAT 12.5 MG/250 ML) AutoStop Days: 5

20:12.20 THROMBOLYTIC AGENTS\1


Reteplase 10 units/vial 2 vl kit (RETAVASE FULL KIT) AutoStop Days: 5

20:16.00 HEMATOPOIETIC AGENTS


Darbepoetin 25 cmg/0.42 ml syringe (ARANESP) AutoStop Days: 30
Restricted to Hematology / Oncology Outpatients Only
Darbepoetin 40 mcg/0.4 ml syringe (ARANESP ) AutoStop Days: 30
Restricted to Hematology / Oncology Outpatients Only
Darbepoetin 60 mcg/0.3 ml syringe (ARANESP ) AutoStop Days: 30
Restricted to Hematology / Oncology Outpatients Only
Darbepoetin 100 mcg/0.5 ml syringe (ARANESP ) AutoStop Days: 30
Restricted to Hematology / Oncology Outpatients Only
Darbepoetin 200 mcg/0.4 ml syringe (ARANESP ) AutoStop Days: 30
Restricted to Hematology / Oncology Outpatients Only
Darbepoetin 300 mcg/0.6 ml syringe (ARANESP ) AutoStop Days: 30
Restricted to Hematology / Oncology Outpatients Only
Darbepoetin 500 mcg/ml syringe (ARANESP) AutoStop Days: 30
Restricted to Hematology / Oncology Outpatients Only
Epoetin Alfa S2 2,000 units/ml vial (EPOGEN EQUIV) AutoStop Days: 30
Epoetin Alfa S3 3,000 units/ml vial (EPOGEN EQUIV) AutoStop Days: 30
Epoetin Alfa S4 4,000 units/ml vial (EPOGEN EQUIV) AutoStop Days: 30
Epoetin Alfa S10 10,000units/ml vial (EPOGEN EQUIV) AutoStop Days: 30
Epoetin Alfa S40 40,000units/ml vial (EPOGEN EQUIV) AutoStop Days: 30
Pegfilgrastim 6 mg/0.6 ml syringe (NEULASTA ) AutoStop Days: 30
Restricted to Outpatient Use Only

20:28.08 ANTIHEPARIN AGENTS\1


Protamine Sulfate 50 mg/5 ml vial AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 18 of 66

20 BLOOD FORMATION,COAGULATION & THROMBOSIS\1


20:28.16 HEMOSTATICS\1
Aminocaproic Acid 5 grams/20 ml vial (AMICAR EQUIV) AutoStop Days: 30
Aminocaproic Acid 500 mg tab (AMICAR EQUIV) AutoStop Days: 30
Gelatin Hemostat Size 12 (sq cm) sponge (GELFOAM SIZE 12 SPONGE) AutoStop Days: 30
Gelatin Hemostat Size 50 (sq cm) sponge (GELFOAM SIZE 50 SPONGE) AutoStop Days: 30
Gelatin Hemostat 1 gram powder (GELFOAM PWDR 1 GRAM JAR) AutoStop Days: 30
Microfibrillar Collagen 1 gram hemostat flour (AVITENE EQUIV) AutoStop Days: 30
Thrombin Topical 5,000 units vial AutoStop Days: 30
Thrombin Topical 20,000 units vial AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 19 of 66

24 CARDIOVASCULAR DRUGS
24:04.04 ANTIARRHYTHMIC AGENTS\1
Adenosine 6 mg/2 ml vial (ADENOCARD EQUIV) AutoStop Days: 30
Amiodarone 200 mg tab (CORDARONE EQUIV) AutoStop Days: 30
Amiodarone 150 mg/3 ml vial (CORDARONE IV EQUIV) AutoStop Days: 30
Lidocaine in D5/W 1 gram/250 ml bag (XYLOCAINE IN D5W EQUIV) AutoStop Days: 30
Lidocaine 2% 100 mg/5 ml syringe (XYLOCAINE EQUIV) AutoStop Days: 30
Procainamide 250 mg cap (PRONESTYL EQUIV) AutoStop Days: 30
Procainamide 500 mg cap (PRONESTYL EQUIV) AutoStop Days: 30
Procainamide 500 mg SR tab (PROCANBID EQUIV) AutoStop Days: 30
Procainamide 500 mg SA tab (PRONESTYL-SR EQUIV) AutoStop Days: 30
Procainamide 1 gram/10 ml vial (PRONESTYL EQUIV) AutoStop Days: 30
quiNIDine Gluconate 324 mg SR tab (QUINAGLUTE EQUIV) AutoStop Days: 30
quiNIDine Sulfate 200 mg tab AutoStop Days: 30
quiNIDine Sulfate 300 mg SR tab (QUINIDEX EXTENTABS EQUIV) AutoStop Days: 30

24:04.08 CARDIOTONIC AGENTS\1


Digoxin 0.125 mg tab (LANOXIN EQUIV) AutoStop Days: 30
Digoxin 0.25 mg tab (LANOXIN EQUIV) AutoStop Days: 30
Digoxin 50 mcg/ml elixir 60 ml (LANOXIN EQUIV) AutoStop Days: 30
Digoxin 0.5 mg/2 ml amp (LANOXIN EQUIV) AutoStop Days: 30
Digoxin Pediatric 0.1 mg/ml amp (LANOXIN EQUIV) AutoStop Days: 30

24:06.04 BILE ACID SEQUESTRANTS\1


Cholestyramine 4 gram pdr pack (QUESTRAN EQUIV) AutoStop Days: 30

24:06.08 HMG-COA REDUCTASE INHIBITORS\1


Pravastatin 10 mg tab (PRAVACHOL EQUIV) AutoStop Days: 30
Pravastatin 20 mg tab (PRAVACHOL EQUIV) AutoStop Days: 30
Rosuvastatin Calcium 5 mg tab (CRESTOR) AutoStop Days: 30
Rosuvastatin Calcium 10 mg tab (CRESTOR) AutoStop Days: 30
Rosuvastatin Calcium 20 mg tab (CRESTOR) AutoStop Days: 30
Rosuvastatin Calcium 40 mg tab (CRESTOR) AutoStop Days: 30
Simvastatin 5 mg tab (ZOCOR EQUIV) AutoStop Days: 30
Simvastatin 10 mg tab (ZOCOR EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 20 of 66

24 CARDIOVASCULAR DRUGS
24:06.08 HMG-COA REDUCTASE INHIBITORS\1
Simvastatin 20 mg tab (ZOCOR EQUIV) AutoStop Days: 30

24:06.92 ANTILIPEMIC AGENTS, MISCELLANEOUS\1


Niacin 50 mg tab (NICOTINIC ACID) AutoStop Days: 30

24:08.16 CENTRAL ALPHA-AGONISTS\1


CloniDINE 0.1 mg tab (CATAPRES EQUIV) AutoStop Days: 30
CloniDINE 0.2 mg tab (CATAPRES EQUIV) AutoStop Days: 30
CloniDINE 0.3 mg tab (CATAPRES EQUIV) AutoStop Days: 30
CloniDINE 0.1mg/24hr TTS-1 patch (CATAPRES-TTS-1) AutoStop Days: 30
CloniDINE 0.2mg/24hr TTS-2 patch (CATAPRES-TTS-2) AutoStop Days: 30
CloniDINE 0.3mg/24hr TTS-3 patch (CATAPRES-TTS-3) AutoStop Days: 30
Methyldopa 250 mg tab (ALDOMET EQUIV) AutoStop Days: 30
Methyldopate 250 mg/5 ml vial (ALDOMET EQUIV) AutoStop Days: 30

24:08.20 DIRECT VASODILATORS\1


HydrALAZINE 10 mg tab (APRESOLINE EQUIV) AutoStop Days: 30
HydrALAZINE 25 mg tab (APRESOLINE EQUIV) AutoStop Days: 30
HydrALAZINE 20 mg/ml vial (APRESOLINE EQUIV) AutoStop Days: 30
Minoxidil 2.5 mg tab (LONITEN EQUIV) AutoStop Days: 30
Minoxidil 10 mg tab (LONITEN EQUIV) AutoStop Days: 30
Nitroprusside Sodium 50 mg/2 ml vial (NIPRIDE EQUIV) AutoStop Days: 30

24:12.08 NITRATES AND NITRITES\1


Amyl Nitrate 0.3 ml crushable amp AutoStop Days: 30
Isosorbide Dinitrate 10 mg tab (ISORDIL EQUIV) AutoStop Days: 30
Isosorbide Dinitrate 20 mg tablet (ISORDIL EQUIV) AutoStop Days: 30
Isosorbide Dinitrate 40 mg ER tab (ISORDIL TEMBID EQUIV) AutoStop Days: 30
Nitroglycerin 0.3 mg subling tab AutoStop Days: 30
Nitroglycerin 0.4 mg subling tab AutoStop Days: 30
Nitroglycerin 2% oint 1 gram pack (NITROBID OINT EQUIV) AutoStop Days: 30
Nitroglycerin 50 mg/10 ml vial AutoStop Days: 30
Nitroglycerin 0.4mg/spray (oral) 12gm (NITROLINGUAL SPRAY EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 21 of 66

24 CARDIOVASCULAR DRUGS
24:12.08 NITRATES AND NITRITES\1
Nitroglycerin in D5/W 25 mg/250 ml IV bottle AutoStop Days: 30

24:12.92 VASODILATING AGENTS, MISCELLANEOUS\1


Alprostadil 500 mcg/ml amp (PROSTIN VR PED EQUIV) AutoStop Days: 30
Papaverine HCl 300 mg/10 ml vial AutoStop Days: 30

24:20.00 ALPHA-ADRENERGIC BLOCKING AGENTS\1


Doxazosin 2 mg tab (CARDURA EQUIV) AutoStop Days: 30
Prazosin 1 mg cap (MINIPRESS EQUIV) AutoStop Days: 30
Prazosin 2 mg cap (MINIPRESS EQUIV) AutoStop Days: 30
Prazosin 5 mg cap (MINIPRESS EQUIV) AutoStop Days: 30

24:24.00 BETA-ADRENERGIC BLOCKING AGENTS\1


Atenolol 25 mg tab (TENORMIN EQUIV) AutoStop Days: 30
Atenolol 50 mg tab (TENORMIN EQUIV) AutoStop Days: 30
Carvedilol 3.125 mg tab (COREG) AutoStop Days: 30
Carvedilol 6.25 mg tab (COREG) AutoStop Days: 30
Carvedilol 25 mg tab (COREG) AutoStop Days: 30
Carvedilol 20 mg CR TR24cap (COREG CR) AutoStop Days: 30
LaBETalol 100 mg tab (NORMODYNE/TRANDATE EQUIV) AutoStop Days: 30
LaBETalol 100 mg/20 ml vial (NORMODYNE/TRANDATE EQUIV) AutoStop Days: 30
Metoprolol Succinate 25 mg SA TR24tab (TOPROL XL) AutoStop Days: 30
Metoprolol Succinate 50 mg SA TR24tab (TOPROL XL) AutoStop Days: 30
Metoprolol Tartrate 25 mg tab (LOPRESSOR EQUIV) AutoStop Days: 30
Metoprolol Tartrate 50 mg tab (LOPRESSOR EQUIV) AutoStop Days: 30
Metoprolol Tartrate 5 mg/5 ml vial (LOPRESSOR EQUIV) AutoStop Days: 30
Propranolol 10 mg tab (INDERAL EQUIV) AutoStop Days: 30
Propranolol 40 mg tab (INDERAL EQUIV) AutoStop Days: 30
Propranolol 1 mg/ml vial (INDERAL EQUIV) AutoStop Days: 30

24:28.08 DIHYDROPYRIDINES\1
amLODIPine 2.5 mg tab (NORVASC) AutoStop Days: 30
amLODIPine 5 mg tab (NORVASC) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 22 of 66

24 CARDIOVASCULAR DRUGS
24:28.08 DIHYDROPYRIDINES\1
NIFEdipine XL 30 mg ER tab (PROCARDIA XL EQUIV) AutoStop Days: 30
NIFEdipine XL 60 mg ER tab (PROCARDIA XL EQUIV) AutoStop Days: 30
NIFEdipine XL 90 mg ER tab (PROCARDIA XL EQUIV) AutoStop Days: 30

24:28.92 CALCIUM-CHANNEL BLOCKING AGENTS, MISC.\1


Diltiazem 120 mg CD TR24cap (CARDIZEM CD EQUIV) AutoStop Days: 30
Diltiazem 180 mg CD TR24cap (CARDIZEM CD EQUIV) AutoStop Days: 30
Diltiazem 300 mg CD TR24cap (CARDIZEM CD EQUIV) AutoStop Days: 30
Diltiazem 50 mg/10 ml vial (CARDIZEM EQUIV) AutoStop Days: 30
Verapamil 120 mg SR tab (CALAN SR EQUIV) AutoStop Days: 30
Verapamil 180 mg SR tab (CALAN SR EQUIV) AutoStop Days: 30
Verapamil 240 mg SR tab (CALAN SR EQUIV) AutoStop Days: 30
Verapamil 5 mg/2 ml vial (CALAN / ISOPTIN EQUIV) AutoStop Days: 30

24:32.04 ANGIOTENSIN-CONVERTING ENZYME INHIBITORS\1


Captopril 12.5 mg tab (CAPOTEN EQUIV) AutoStop Days: 30
Captopril 25 mg tab (CAPOTEN EQUIV) AutoStop Days: 30
Enalapril 2.5 mg tab (VASOTEC EQUIV) AutoStop Days: 30
Enalapril 5 mg tab (VASOTEC EQUIV) AutoStop Days: 30
Enalapril 2.5 mg/2 ml vial (VASOTEC EQUIV) AutoStop Days: 30
Fosinopril 10 mg tab (MONOPRIL EQUIV) AutoStop Days: 30
Lisinopril 5 mg tab (PRINIVIL EQUIV) AutoStop Days: 30
Lisinopril 10 mg tab (PRINIVIL EQUIV) AutoStop Days: 30
Lisinopril 20 mg tab (PRINIVIL EQUIV) AutoStop Days: 30
Ramipril 1.25 mg cap (ALTACE EQUIV) AutoStop Days: 30
Ramipril 2.5 mg cap (ALTACE EQUIV) AutoStop Days: 30
Ramipril 5 mg cap (ALTACE EQUIV) AutoStop Days: 30
Ramipril 10 mg cap (ALTACE EQUIV) AutoStop Days: 30

24:32.08 ANGIOTENSIN II RECEPTOR ANTAGONISTS\1


Telmisartan 40 mg tab (MICARDIS) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 23 of 66

24 CARDIOVASCULAR DRUGS
24:32.20 MINERALOCORTICOID (ALDOSTERONE) ANTAGNTS\1
Spironolactone 25 mg tab (ALDACTONE EQUIV) AutoStop Days: 30
Spironolactone 100 mg tab (ALDACTONE EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 24 of 66

28 CENTRAL NERVOUS SYSTEM AGENTS


28:04.04 BARBITURATES (GENERAL ANESTHETICS)\1
THIOPENTAL SOD 500 MG SYRINGE (PENTOTHAL EQUIV) AutoStop Days: 3 DEA Sch: III

28:04.16 INHALATION ANESTHETICS\1


DESFLURANE ANESTH BTL 240ML (SUPRANE EQUIV) AutoStop Days: 30
ISOFLURANE SOLN 100 ML (FORANE EQUIV) AutoStop Days: 30
SEVOFLURANE ANETH SOLN 250ML (ULTANE EQUIV) AutoStop Days: 30

28:04.92 GENERAL ANESTHETICS, MISCELLANEOUS\1


Etomidate 40 mg/20 ml syringe (AMIDATE EQUIV) AutoStop Days: 30
Ketamine 1,000 mg/10 ml vial (KETALAR EQUIV) AutoStop Days: 3 DEA Sch: III
Ketamine 500 mg/10 ml vial (KETALAR EQUIV) AutoStop Days: 3 DEA Sch: III
Propofol 200 mg/20 ml amp (DIPRIVAN EQUIV) AutoStop Days: 30
Propofol 1,000 mg/100 ml vial (DIPRIVAN EQUIV) AutoStop Days: 30

28:08.04 NONSTEROIDAL ANTI-INFLAMMATORY AGENTS


Aspirin 300 mg supp AutoStop Days: 30
Aspirin 600 mg supp AutoStop Days: 30
Aspirin 325 mg enteric-coat tab (ECOTRIN EQUIV) AutoStop Days: 30
Aspirin 325 mg tab AutoStop Days: 30
Aspirin 81 mg chewable tab AutoStop Days: 30
Aspirin 81 mg enteric-coat tab AutoStop Days: 30
Ibuprofen 400 mg tab (MOTRIN EQUIV) AutoStop Days: 30
Ibuprofen 600 mg tab (MOTRIN EQUIV) AutoStop Days: 30
Ibuprofen 100 mg/5 ml susp ud cup (MOTRIN EQUIV) AutoStop Days: 30
Indomethacin 25 mg cap (INDOCIN EQUIV) AutoStop Days: 30
Ketorolac TroMETHamine 10 mg tab (TORADOL EQUIV) AutoStop Days: 5
Ketorolac TroMETHamine 30 mg/ml vial (TORADOL EQUIV) AutoStop Days: 5
Ketorolac TroMETHamine 60 mg/2 ml vial (TORADOL EQUIV) AutoStop Days: 5
Naproxen 250 mg tab (NAPROSYN EQUIV) AutoStop Days: 30
Trolamine Salicylate top cream 5 oz. tube (ASPERCREME EQUIV) AutoStop Days: 30

28:08.08 OPIATE AGONISTS


Acetaminophen/CODEine 120-12 mg/5 ml UD cup (TYLENOL/COD LIQ 5ML EQV) AutoStop Days: 3 DEA Sch: V

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 25 of 66

28 CENTRAL NERVOUS SYSTEM AGENTS


28:08.08 OPIATE AGONISTS
Acetaminophen / CODEine #3 300-30 mg tab (TYLENOL #3 EQUIV) AutoStop Days: 3 DEA Sch: III
Alfentanil 1000 mcg/2 ml amp (ALFENTA EQUIV) AutoStop Days: 3 DEA Sch: II
Belladonna Alk-Opium 16.2-60 mg (#16A) supp (B&0 SUP # 16A EQUIV) AutoStop Days: 3 DEA Sch: II
CODEine Phosphate 30 mg/2 ml syringe AutoStop Days: 3 DEA Sch: II
CODEine Sulfate 30 mg tab AutoStop Days: 3 DEA Sch: II
FentaNYL Citrate 100 mcg/2 ml amp (SUBLIMAZE EQUIV) AutoStop Days: 3 DEA Sch: II
FentaNYL Citrate 250 mcg/5 ml amp (SUBLIMAZE EQUIV) AutoStop Days: 3 DEA Sch: II
FentaNYL 25 mcg/hr patch(72hr) (DURAGESIC 25 MCG EQUIV) AutoStop Days: 30 DEA Sch: II
FentaNYL 50 mcg/hr patch(72hr) (DURAGESIC 50 MCG EQUIV) AutoStop Days: 30 DEA Sch: II
FentaNYL 75 mcg/hr patch(72hr) (DURAGESIC 75MCG EQUIV) AutoStop Days: 30 DEA Sch: II
FentaNYL 100 mcg/hr patch(72hr) (DURAGESIC 100 MCG EQUIV) AutoStop Days: 30 DEA Sch: II
hydroCODone/Acetaminoph 5-500 mg tab (LORTAB 5/500 MG EQUIV) AutoStop Days: 3 DEA Sch: III
hydroCODone/Acetaminoph 10-500 mg tab (LORTAB 10/500 EQUIV) AutoStop Days: 3 DEA Sch: III
hydroCODone/Acetaminoph 7.5-500 mg tab (LORTAB 7.5/500 MG EQUIV) AutoStop Days: 3 DEA Sch: III
hydroCODone/Acetaminoph 7.5-500 mg/15 ml liquid (LORTAB EQUIV) AutoStop Days: 3 DEA Sch: III
HYDROmorphone 2 mg tab (DILAUDID EQUIV) AutoStop Days: 3 DEA Sch: II
HYDROmorphone 2 mg/2 ml vial (DILAUDID EQUIV) AutoStop Days: 3 DEA Sch: II
Meperidine 25 mg/ml syringe (DEMEROL EQUIV) AutoStop Days: 3 DEA Sch: II
Meperidine 50 mg/ml syringe (DEMEROL EQUIV) AutoStop Days: 3 DEA Sch: II
Meperidine 75 mg/ml syringe (DEMEROL EQUIV) AutoStop Days: 3 DEA Sch: II
Meperidine 100 mg/ml syringe (DEMEROL EQUIV) AutoStop Days: 3 DEA Sch: II
Meperidine 50 mg tab (DEMEROL EQUIV) AutoStop Days: 3 DEA Sch: II
Meperidine 50 mg/5 ml oral soln UD (DEMEROL EQUIV) AutoStop Days: 3 DEA Sch: II
MethaDONE 5 mg tab (DOLOPHINE EQUIV) AutoStop Days: 3 DEA Sch: II
MorpHINE Sulfate 2 mg/ml syringe AutoStop Days: 3 DEA Sch: II
MorpHINE Sulfate 4 mg/ml syringe AutoStop Days: 3 DEA Sch: II
MorpHINE Sulfate 5 mg/10 ml PF amp (DURAMORPH EQUIV) AutoStop Days: 3 DEA Sch: II
MorpHINE Sulfate 8 mg/ml syringe AutoStop Days: 3 DEA Sch: II
MorpHINE Sulfate 10 mg/ml syringe AutoStop Days: 3 DEA Sch: II
MorpHINE Sulfate 100 mg/10 ml vial AutoStop Days: 3 DEA Sch: II
MorpHINE Sulfate 20 mg Solutab AutoStop Days: 3 DEA Sch: II
MorpHINE Sulfate 10mg/5 ml oral soln cup AutoStop Days: 3 DEA Sch: II
MorpHINE Sulfate 15 mg Immed Release tab AutoStop Days: 3 DEA Sch: II

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 26 of 66

28 CENTRAL NERVOUS SYSTEM AGENTS


28:08.08 OPIATE AGONISTS
MorpHINE Sulfate 15 mg SR tab (MS CONTIN EQUIV) AutoStop Days: 3 DEA Sch: II
MorpHINE Sulfate 30 mg SR tab (MS CONTIN EQUIV) AutoStop Days: 3 DEA Sch: II
MorpHINE Sulfate 100 mg SR tab (MS CONTIN EQUIV) AutoStop Days: 3 DEA Sch: II
Propoxyphene HCl 65 mg cap (DARVON EQUIV) AutoStop Days: 3 DEA Sch: IV
Propoxyphene Naps /APAP 100 mg/650 mg tab (DARVOCET-N 100 EQUIV) AutoStop Days: 3 DEA Sch: IV
traMADol 50 mg tab (ULTRAM EQUIV) AutoStop Days: 30

28:08.92 ANALGESICS AND ANTIPYRETICS, MISC.\1


Acetaminophen 120 mg supp (TYLENOL EQUIV) AutoStop Days: 30
Acetaminophen 650 mg supp (TYLENOL EQUIV) AutoStop Days: 30
Acetaminophen Liq 160 mg/5 ml UD cup (TYLENOL EQUIV) AutoStop Days: 30
Acetaminophen 325 mg tab (TYLENOL EQUIV) AutoStop Days: 30
Butalbital/APAP/Caffein 50-325-40 mg tab (FIORICET EQUIV) AutoStop Days: 3
Isomethep/Dichlphn/APAP 65-100-325 mg cap (MIDRIN EQUIV) AutoStop Days: 3 DEA Sch: IV

28:10.00 OPIATE ANTAGONISTS


Naloxone 0.4 mg/ml amp (NARCAN EQUIV) AutoStop Days: 30

28:12.08 BENZODIAZEPINES (ANTICONVULSANTS)\1


ClonazePAM 0.5 mg tab (KLONOPIN EQUIV) AutoStop Days: 14 DEA Sch: IV
ClonazePAM 1 mg tab (KLONOPIN EQUIV) AutoStop Days: 14 DEA Sch: IV

28:12.12 HYDANTOINS
Fosphenytoin Sodium 100 mg PE/2 ml amp (CEREBYX) AutoStop Days: 30
Fosphenytoin Sodium 500 mg PE/10 ml vial (CEREBYX) AutoStop Days: 30
Phenytoin 50 mg CHEWtab (DILANTIN INFATABS) AutoStop Days: 30
Phenytoin Sodium 100 mg Extended cap (DILANTIN EQUIV) AutoStop Days: 30
Phenytoin Sodium 300 mg Extended cap (PHENYTEK) AutoStop Days: 30
Phenytoin 100 mg/4ml oral susp UD (DILANTIN EQUIV) AutoStop Days: 30
Phenytoin Sodium 100 mg/2 ml vial (DILANTIN EQUIV) AutoStop Days: 30

28:12.92 ANTICONVULSANTS, MISCELLANEOUS\1


carBAMazepine 200 mg tab (TEGRETOL EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 27 of 66

28 CENTRAL NERVOUS SYSTEM AGENTS


28:12.92 ANTICONVULSANTS, MISCELLANEOUS\1
carBAMazepine 200 mg/10ml susp UD cup (TEGRETOL EQUIV) AutoStop Days: 30
Divalproex Sodium 125 mg EC tab (DEPAKOTE) AutoStop Days: 30
Divalproex Sodium 250 mg EC tab (DEPAKOTE) AutoStop Days: 30
Divalproex Sodium 500 mg EC tab (DEPAKOTE) AutoStop Days: 30
Divalproex Sodium 250 mg ER TR24tab (DEPAKOTE ER) AutoStop Days: 30
Divalproex Sodium 500 mg ER TR24tab (DEPAKOTE ER) AutoStop Days: 30
Gabapentin 100 mg cap (NEURONTIN EQUIV) AutoStop Days: 30
Gabapentin 300 mg cap (NEURONTIN EQUIV) AutoStop Days: 30
Gabapentin 400 mg cap (NEURONTIN EQUIV) AutoStop Days: 30
LamoTRIgine 25 mg tab (LAMICTAL EQUIV) AutoStop Days: 30
LamoTRIgine 100 mg tab (LAMICTAL EQUIV) AutoStop Days: 30
leveTIRACetam 500 mg tab (KEPPRA EQUIV) AutoStop Days: 30
leveTIRACetam 500 mg/5 ml vial (KEPPRA) AutoStop Days: 30
leveTIRACetam 500 mg/5 ml liq 30ml bt (KEPPRA ORAL SOLN EQUIV) AutoStop Days: 30
Magnesium Sulfate 1 gram/2 ml vial AutoStop Days: 30
Magnesium Sulfate 5 grams/10 ml vial AutoStop Days: 30
Magnesium Sulfate 25 grams/50 ml vial AutoStop Days: 30
Magnesium Sulfate 4 grams/50 ml bag AutoStop Days: 30
Magnesium Sulfate 20 grams/500 ml bag AutoStop Days: 30
Magnesium Sulfate Crystals 454 gram jar (EPSOM SALT) AutoStop Days: 30
OXcabazepine 150 mg tab (TRILEPTAL EQUIV) AutoStop Days: 30
OXcarbazepine 300 mg tab (TRILEPTAL EQUIV) AutoStop Days: 30
Topiramate 100 mg tab (TOPAMAX EQUIV) AutoStop Days: 30
Topiramate 25 mg tab (TOPAMAX) AutoStop Days: 30
Valproic Acid 250 mg cap (DEPAKENE EQUIV) AutoStop Days: 30
Valproic Acid 250 mg/5 ml liq 5ml UD (DEPAKENE EQUIV) AutoStop Days: 30

28:16.04 ANTIDEPRESSANTS
Amitriptyline 10 mg tab (ELAVIL EQUIV) AutoStop Days: 30
Amitriptyline 25 mg tab (ELAVIL EQUIV) AutoStop Days: 30
Amitriptyline 100 mg tab (ELAVIL EQUIV) AutoStop Days: 30
BuPROPion 100 mg SR tab (WELLBUTRIN SR EQUIV) AutoStop Days: 30
BuPROPion 150 mg SR tab (WELLBUTRIN SR EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 28 of 66

28 CENTRAL NERVOUS SYSTEM AGENTS


28:16.04 ANTIDEPRESSANTS
BuPROPion XL 150 mg ER tab (WELLBUTRIN XL EQUIV) AutoStop Days: 30
Citalopram 20 mg tab (CELEXA EQUIV) AutoStop Days: 30
Desipramine 50 mg tab (NORPRAMIN EQUIV) AutoStop Days: 30
Doxepin 10 mg cap (SINEQUAN EQUIV) AutoStop Days: 30
Doxepin 25 mg cap (SINEQUAN EQUIV) AutoStop Days: 30
DULoxetine 20 mg enteric-coat cap (CYMBALTA) AutoStop Days: 30
DULoxetine 30 mg enteric-coat cap (CYMBALTA) AutoStop Days: 30
Escitalopram Oxylate 10 mg tab (LEXAPRO) AutoStop Days: 30
Escitalopram Oxylate 20 mg tab (LEXAPRO) AutoStop Days: 30
FLUoxetine HCl 10 mg cap (PROZAC EQUIV) AutoStop Days: 30
FLUoxetine HCl 20 mg cap (PROZAC EQUIV) AutoStop Days: 30
FLUvoxamine Maleate 50 mg tab (LUVOX EQUIV) AutoStop Days: 30
FLUvoxamine Maleate 100 mg tab (LUVOX EQUIV) AutoStop Days: 30
Imipramine HCl 10 mg tab (TOFRANIL EQUIV) AutoStop Days: 30
Imipramine HCl 25 mg tab (TOFRANIL EQUIV) AutoStop Days: 30
Mirtazapine 15 mg tab (REMERON EQUIV) AutoStop Days: 30
Mirtazapine 30 mg tab (REMERON EQUIV) AutoStop Days: 30
Mirtazapine 15 mg solutab (REMERON SOLTAB EQUIV) AutoStop Days: 30
Mirtazapine 30 mg solutab (REMERON SOLTAB EQUIV) AutoStop Days: 30
Nortriptyline 25 mg cap (PAMELOR EQUIV) AutoStop Days: 30
PARoxetine HCl 12.5 mg CR tab (PAXIL CR) AutoStop Days: 30
PARoxetine HCl 25 mg CR tab (PAXIL CR) AutoStop Days: 30
PARoxetine HCl 20 mg tab (PAXIL EQUIV) AutoStop Days: 30
SERTraline 50 mg tab (ZOLOFT EQUIV) AutoStop Days: 30
traZODone 50 mg tab (DESYREL EQUIV) AutoStop Days: 30
traZODone 100 mg tab (DESYREL EQUIV) AutoStop Days: 30
Venlafaxine 37.5 mg XR TR24cap (EFFEXOR XR) AutoStop Days: 30
Venlafaxine 75 mg XR TR24cap (EFFEXOR XR) AutoStop Days: 30

28:16.08 ANTIPSYCHOTIC AGENTS


ARIPiprazole 10 mg Solutab (ABILIFY ODT) AutoStop Days: 30
ARIPiprazole 15 mg Solutab (ABILIFY ODT) AutoStop Days: 30
ARIPiprazole 2 mg tab (ABILIFY) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 29 of 66

28 CENTRAL NERVOUS SYSTEM AGENTS


28:16.08 ANTIPSYCHOTIC AGENTS
ARIPiprazole 10 mg tab (ABILIFY) AutoStop Days: 30
ARIPiprazole 15 mg tab (ABILIFY) AutoStop Days: 30
ARIPiprazole 30 mg tab (ABILIFY) AutoStop Days: 30
ARIPiprazole 9.75 mg/1.3 ml vial (ABILIFY) AutoStop Days: 30
chlorproMAZINE 10 mg tab (THORAZINE EQUIV) AutoStop Days: 30
chlorproMAZINE 25 mg tab (THORAZINE EQUIV) AutoStop Days: 30
chlorproMAZINE 100 mg tab (THORAZINE EQUIV) AutoStop Days: 30
chlorproMAZINE 50 mg/2 ml amp (THORAZINE EQUIV) AutoStop Days: 30
Fluphenazine 1 mg tab (PROLIXIN EQUIV) AutoStop Days: 30
Fluphenazine 5 mg tab (PROLIXIN EQUIV) AutoStop Days: 30
Fluphenazine 10 mg tab (PROLIXIN EQUIV) AutoStop Days: 30
Fluphenazine Decanoate 125 mg/5 ml vial (PROLIXIN DECANOATE EQUIV) AutoStop Days: 30
Fluphenazine HCl 25 mg/10 ml vial (PROLIXIN EQUIV) AutoStop Days: 30
Haloperidol Lactate 2 mg/ml oral soln 120ml (HALDOL ORAL CONC EQUIV) AutoStop Days: 30
Haloperidol 1 mg tab (HALDOL EQUIV) AutoStop Days: 30
Haloperidol 5 mg tab (HALDOL EQUIV) AutoStop Days: 30
Haloperidol 10 mg tab (HALDOL EQUIV) AutoStop Days: 30
Haloperidol Decanoate 50 mg/ml vial (HALDOL DECANOATE EQUIV) AutoStop Days: 30
Haloperidol Lactate 5 mg/ml vial (HALDOL EQUIV) AutoStop Days: 30
OLANZapine 5 mg tab (ZYPREXA) AutoStop Days: 30
OLANZapine 7.5 mg tab (ZYPREXA) AutoStop Days: 30
OLANZapine 10 mg tab (ZYPREXA) AutoStop Days: 30
OLANZapine 20 mg tab (ZYPREXA) AutoStop Days: 30
OLANZapine Zydis 10 mg Solutab (ZYPREXA ZYDIS) AutoStop Days: 30
OLANZapine Zydis 15 mg Solutab (ZYPREXA ZYDIS) AutoStop Days: 30
OLANZapine Zydis 5 mg Solutab (ZYPREXA ZYDIS) AutoStop Days: 30
OLANZapine 10 mg vial (ZYPREXA) AutoStop Days: 30
Perphenazine 2 mg tab (TRILAFON EQUIV) AutoStop Days: 30
Perphenazine 4 mg tab (TRILAFON EQUIV) AutoStop Days: 30
QUEtiapine Fumarate 50 mg SR TR24tab (SEROQUEL XR) AutoStop Days: 30
QUEtiapine Fumarate 200 mg SR TR24tab (SEROQUEL XR) AutoStop Days: 30
QUEtiapine Fumarate 300 mg SR TR24tab (SEROQUEL XR) AutoStop Days: 30
QUEtiapine Fumarate 25 mg tab (SEROQUEL) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 30 of 66

28 CENTRAL NERVOUS SYSTEM AGENTS


28:16.08 ANTIPSYCHOTIC AGENTS
QUEtiapine Fumarate 100 mg tab (SEROQUEL) AutoStop Days: 30
QUEtiapine Fumarate 200 mg tab (SEROQUEL) AutoStop Days: 30
QUEtiapine Fumarate 400 mg tab (SEROQUEL) AutoStop Days: 30
Ripseridone 0.5 mg tab (RISPERDAL EQUIV) AutoStop Days: 30
Risperidone 1 mg tab (RISPERDAL EQUIV) AutoStop Days: 30
Risperidone 2 mg tab (RISPERDAL EQUIV) AutoStop Days: 30
Risperidone 3 mg tab (RISPERDAL EQUIV) AutoStop Days: 30
Risperidone 0.5 mg Solutab (RISPERDAL M TAB) AutoStop Days: 30
Risperidone 1 mg Solutab (RISPERDAL M TAB EQUIV) AutoStop Days: 30
Risperidone 1 mg/ml oral sol 30 ml (RISPERDAL) AutoStop Days: 30
Risperidone 2 mg Solutab (RISPERDAL M TAB EQUIV) AutoStop Days: 30
Risperidone Microsphere 12.5 mg/2 ml syringe (RISPERDAL CONSTA) AutoStop Days: 30
Risperidone Microsphere 25 mg syringe (RISPERDAL CONSTA) AutoStop Days: 30
Risperidone Microsphere 37.5 mg syringe (RISPERDAL CONSTA) AutoStop Days: 30
Ziprasidone 20 mg cap (GEODON) AutoStop Days: 30
Ziprasidone 40 mg cap (GEODON) AutoStop Days: 30
Ziprasidone 60 mg cap (GEODON) AutoStop Days: 30
Ziprasidone 20 mg vial (GEODON) AutoStop Days: 30

28:20.92 ANOREX.,RESPIR.,CEREBRAL STIMULANTS,MISC\1


Ammonia, Aromatic 0.33 ml crushable amp AutoStop Days: 30
Caffeine & Sod Benzoate 500 mg/2 ml vial AutoStop Days: 30
Doxapram 400 mg/20 ml vial (DOPRAM) AutoStop Days: 30

28:24.04 BARBITURATES (ANXIOLYTIC, SEDATIVE/HYP)\1


PHENobarbital 16.2 mg tab AutoStop Days: 3 DEA Sch: IV
PHENobarbital 30 mg tab AutoStop Days: 3 DEA Sch: IV
PHENobarbital 97.2 mg tab AutoStop Days: 3 DEA Sch: IV
PHENobarbital Elixir 20mg/5ml UD cup AutoStop Days: 3 DEA Sch: IV
PHENobarbital Sodium 60 mg/ml syringe (LUMINAL EQUIV) AutoStop Days: 3 DEA Sch: IV
PHENobarbital Sodium 130 mg/ml vial (LUMINAL EQUIV) AutoStop Days: 3 DEA Sch: IV

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 31 of 66

28 CENTRAL NERVOUS SYSTEM AGENTS


28:24.08 BENZODIAZEPINES (ANXIOLYTIC,SEDATIV/HYP)\1
ChlordiazePOXIDE HCl 5 mg cap (LIBRIUM EQUIV) AutoStop Days: 14 DEA Sch: IV
ChlordiazePOXIDE HCl 25 mg cap (LIBRIUM EQUIV) AutoStop Days: 14 DEA Sch: IV
Diazepam 2 mg tab (VALIUM EQUIV) AutoStop Days: 14 DEA Sch: IV
Diazepam 5 mg tab (VALIUM EQUIV) AutoStop Days: 14 DEA Sch: IV
Diazepam 10 mg/2 ml syringe (VALIUM EQUIV) AutoStop Days: 14 DEA Sch: IV
LORazepam 0.5 mg tab (ATIVAN EQUIV) AutoStop Days: 14 DEA Sch: IV
LORazepam 1 mg tab (ATIVAN EQUIV) AutoStop Days: 14 DEA Sch: IV
LORazepam 2 mg/ml vial (ATIVAN EQUIV) AutoStop Days: 14 DEA Sch: IV
LORazepam 20 mg/10 ml vial (ATIVAN EQUIV) AutoStop Days: 14 DEA Sch: IV
Midazolam 2 mg/2 ml vial (VERSED EQUIV) AutoStop Days: 14 DEA Sch: IV
Midazolam 5 mg/ml vial (VERSED EQUIV) AutoStop Days: 14 DEA Sch: IV

28:24.92 ANXIOLYTICS, SEDATIVES & HYPNOTICS,MISC.\1


BusPIRone 5 mg tab (BUSPAR EQUIV) AutoStop Days: 30
BusPIRone 15 mg tab (BUSPAR EQUIV) AutoStop Days: 30
Chloral Hydrate 500 mg/5 ml liq UD cup (NOCTEC EQUIV) AutoStop Days: 3 DEA Sch: IV
Droperidol 5 mg/2 ml amp (INAPSINE EQUIV) AutoStop Days: 30
HydrOXYzine HCl 25 mg tab (ATARAX EQUIV) AutoStop Days: 30
HydrOXYzine HCl 50 mg/ml vial (VISTARIL EQUIV) AutoStop Days: 30
HydrOXYzine HCl 10mg/5 ml liq 5 ml UD (ATARAX EQUIV) AutoStop Days: 30
HydrOXYzine Pamoate 25 mg cap (VISTARIL EQUIV) AutoStop Days: 30
Zolpidem Tartrate 10 mg tab (AMBIEN EQUIV) AutoStop Days: 14 DEA Sch: IV

28:28.00 ANTIMANIC AGENTS


Lithium Carbonate 300 mg cap (ESKALITH EQUIV) AutoStop Days: 30
Lithium Carbonate 300 mg ER tab (LITHOBID EQUIV) AutoStop Days: 30
Lithium Carbonate 450 mg ER tab (ESKALITH CR EQUIV) AutoStop Days: 30
Lithium Citrate 300mg/5ml oral sol cup AutoStop Days: 30

28:36.04 ADAMANTANES (CNS)\1


Amantadine 100 mg cap (SYMMETREL EQUIV) AutoStop Days: 30
Amantadine 50 mg/5 ml liq 30ml btl (SYMETREL EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 32 of 66

28 CENTRAL NERVOUS SYSTEM AGENTS


28:36.08 ANTICHOLINERGIC AGENTS (CNS)\1
Benztropine Mesylate 1 mg tab (COGENTIN EQUIV) AutoStop Days: 30
Benztropine Mesylate 2 mg/2 ml amp (COGENTIN EQUIV) AutoStop Days: 30
Trihexyphenidyl 2 mg tab (ARTANE EQUIV) AutoStop Days: 30

28:36.16 DOPAMINE PRECURSORS\1


Carbidopa-Levodopa 10-100 mg tab (SINEMET 10/100 EQUIV) AutoStop Days: 30
Carbidopa-Levodopa 25-100 mg tab (SINEMET 25/100 EQUIV) AutoStop Days: 30
Carbidopa-Levodopa 25-250 mg tab (SINEMET 25/250 EQUIV) AutoStop Days: 30

28:36.20 DOPAMINE RECEPTOR AGONISTS\1


Bromocriptine Mesylate 2.5 mg tab (PARLODEL EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 33 of 66

36 DIAGNOSTIC AGENTS
36:04.00 ADRENOCORTICAL INSUFFICIENCY
Cosyntropin 0.25 mg vial (CORTROSYN) AutoStop Days: 30

36:32.00 FUNGI
Candida Albicans 1 ml vial (CANDIN EQUIV) AutoStop Days: 30

36:40.00 KIDNEY FUNCTION


Indigotindisulfonate Na 0.8% sol 5 ml amp (INDIGO CARMINE) AutoStop Days: 30

36:56.00 MYASTHENIA GRAVIS


Edrophonium 150 mg/15 ml vial (ENLON EQUIV) AutoStop Days: 30

36:58.00 OCULAR DISORDERS\1


Fluorescein Sodium 10% 5 ml vial (AK-FLUOR EQUIV) AutoStop Days: 30
Fluorescein 1 mg oph strip (FLUOR-I-STRIP EQUIV) AutoStop Days: 30
Rose Bengal 1.3 mg oph strip (ROSETS EQUIV) AutoStop Days: 30

36:68.00 ROENTGENOGRAPHY
Barium Sulfate 105% enema kit 650 ml (E-Z-DOSE BARIUM ENEMA KIT) AutoStop Days: 30
Barium Sulfate 2% oral susp 450 ml btl (READI-CAT 2) AutoStop Days: 30
Barium Sulfate 98% rectal susp 135 ml (EZ-HD BARIUM) AutoStop Days: 30
Gastrograffin 120 ml btl (GASTROGRAFIN) AutoStop Days: 30
Iopromide 300 mg/ml 50 ml vial (ULTRAVIST) AutoStop Days: 30
Iopromide 300 mg/ml 100 ml btl (ULTRAVIST) AutoStop Days: 30
Iopramide 370 mg/ml 125 ml btl (ULTRAVIST) AutoStop Days: 30
Conray-60 50 ml vial (CONRAY-60 EQUIV) AutoStop Days: 30
Iothalamate Meglumine 17.2% 250 ml btl (CYSTO-CONRAY II EQUIV) AutoStop Days: 30
Iothalamate Meglumine 17.2% 500 ml btl (CYSTO-CONRAY II EQUIV) AutoStop Days: 30
Gadopentetate Dimeglumn 5 mmol/10ml vial (MAGNEVIST) AutoStop Days: 30
Gadopentetate Dimeglumn 7.5 mmol/15 ml vial (MAGNEVIST) AutoStop Days: 30
Gadopentetate Dimeglumn 10 mmol/20 ml vial (MAGNEVIST) AutoStop Days: 30

36:84.00 TUBERCULOSIS
Tuberculin Skin Test 5 T-units 1 ml vial (TUBERSOL (PER VIAL)) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 34 of 66

36 DIAGNOSTIC AGENTS
36:88.24 PH
PHENAPHTHAZINE TEST STRIP (NITRATEST PAPER EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 35 of 66

38 DISINFECTANTS (FOR NON-DERMATOLOGIC USE)


38:00.00 DISINFECTANTS (FOR NON-DERMATOLOGIC USE)
Sodium Hypochlorite 0.5% top sol 480 ml btl (DAKINS SOLN 0.5% EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 36 of 66

40 ELECTROLYTIC, CALORIC, AND WATER BALANCE


40:04.00 ACIDIFYING AGENTS
Pot & Sod Phosphate 250 mg tab (K PHOS NEUTRAL) AutoStop Days: 30

40:08.00 ALKALINIZING AGENTS


Sodium Bicarbonate 50 mEq/50 ml (8.4%) syr (NAHCO3 8.4% SYR) AutoStop Days: 30
Sodium Bicarbonate 50 mEq/50ml (8.4%) vial (NAHCO3 8.4% VIAL) AutoStop Days: 30
Sodium Bicarbonate 5 mEq/10 ml (4.2%) syr (NAHCO3 4.2% INFANT) AutoStop Days: 30
Sodium Bicarbonate 10mEq/10ml Ped 8.4% syr (NAHCO3 PED 8.4%) AutoStop Days: 30
Sod Citrate/Citric Acid 30 ml cup (BICITRA EQUIV) AutoStop Days: 30

40:10.00 AMMONIA DETOXICANTS


Lactulose 20 grams/30 ml UD cup AutoStop Days: 30

40:12.00 REPLACEMENT PREPARATIONS


Calcium Carbonate 1250 mg tab (OSCAL EQUIV) AutoStop Days: 30
Calcium Chloride 1 gram/10 ml syringe AutoStop Days: 30
Calcium Glubionate 1.8 gram/5 ml sol 30ml (CALCIONATE) AutoStop Days: 30
Calcium Gluconate 1 gram/10 ml vial AutoStop Days: 30
Dextran 40 in D5W 10% sol 500 ml bag (GENTRAN 40 IN D5W EQUIV) AutoStop Days: 30
Dextran 40 in NS 10% sol 500 ml bag (GENTRAN 40 IN NACL EQUIV) AutoStop Days: 30
Dextrose 5%-Lac Ringers 1,000 ml bag AutoStop Days: 30
Electrolytes, TPN Multi (Ac/Ca/Cl/K/Mg/Na) 20ml (NUTRILYTE II) AutoStop Days: 30
KCl in D5/0.45% NaCl 10 mEq in 1,000 ml bag AutoStop Days: 30
KCL in Normal Saline 20 mEq in 1,000 ml bag (NORMAL SALINE/KCL 20MEQ/1000 AutoStop Days: 30
KCl in D5/0.45% NaCl 20 mEq in 1,000 ml bag AutoStop Days: 30
KCl in D5/0.45% NaCl 30 mEq in 1,000 ml bag AutoStop Days: 30
KCl in D5/0.45% NaCl 40 mEq in 1,000 ml bag AutoStop Days: 30
Lactated Ringer's Sol 1,000 ml bag (RINGERS LACTATE 1000ML) AutoStop Days: 30
Lactated Ringer's Sol. 250 ml AVIVA bag (RIGERS LACTATE AVIVA BAG) AutoStop Days: 30
Elements, Multi-Trace (Cr/Cu/Mn/Se/Zn) 10 ml (MTE-5) AutoStop Days: 30
Phosphorous, Na & K 250 mg pack (NEUTRA-PHOS 250MG EQV) AutoStop Days: 30
Normal Saline Nose Drops 30 ml AutoStop Days: 30
Potassium Acetate 40 mEq/20 ml vial AutoStop Days: 30
Potassium Chloride 10 mEq TR tab (K-DUR EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 37 of 66

40 ELECTROLYTIC, CALORIC, AND WATER BALANCE


40:12.00 REPLACEMENT PREPARATIONS
Potassium Chloride 20 mEq TR tab (K-DUR EQUIV) AutoStop Days: 30
Potassium Chloride 20 mEq/10 ml vial (KCL) AutoStop Days: 30
Potassium Chloride 20 mEq/15 ml oral sol (KAOCHLOR 10% EQUIV) AutoStop Days: 30
Potassium Phosphate 66mEq K-45mmol P/15ml (K PHOS EQUIV) AutoStop Days: 30
SALIVA, ARTIFICIAL SOL 240ML (XERO-LUBE EQUIV) AutoStop Days: 30
Sodium Acetate 40 mEq/20 ml vial AutoStop Days: 30
Sodium Chloride 1 gram tab AutoStop Days: 30
SOD CHLORIDE 0.45% 250ML BAG (1/2 NS 250 ML BAG) AutoStop Days: 30
SOD CHLORIDE 0.45% 500 ML BAG (1/2 NS 500ML BAG) AutoStop Days: 30
SOD CHLORIDE 0.45% 1000 ML BAG (1/2 NS 1000 ML BAG) AutoStop Days: 30
SOD CHLORIDE 0.9% 50 ML BAG (NS 50 ML BAG) AutoStop Days: 30
SOD CHLORIDE 0.9% 100 ML BAG (NS 100 ML BAG) AutoStop Days: 30
SOD CHLORIDE 0.9% 250 ML BAG (NS 250 ML BAG) AutoStop Days: 30
SOD CHLORIDE 0.9% 250ML AVIVA (NS AVIVA BAG) AutoStop Days: 30
SOD CHLORIDE 0.9% 250ML GLASS (NS 250ML GLASS BTL) AutoStop Days: 30
SOD CHLORIDE 0.9% 500 ML BAG (NS 500ML BAG) AutoStop Days: 30
SOD CHLORIDE 0.9% 1000 ML BAG (NS 1000 ML BAG) AutoStop Days: 30
Sodium Chloride 0.9% bacterio 30 ml vl (NS BACTERIOSTATIC) AutoStop Days: 30
Sodium Chloride 0.9% flush 3 ml syringe (NORMAL SALINE FLUSH) AutoStop Days: 30
Sodium Chloride 0.9% flush 5 ml syringe (NORMAL SALINE FLUSH) AutoStop Days: 30
Sodium Chloride 0.9% preserv-free 20 ml (NS PF 20 MLVIAL) AutoStop Days: 30
Sodium Chloride 100 mEq/40 ml vial AutoStop Days: 30
SOD CHLORIDE 3% 500 ML BAG AutoStop Days: 30
Sodium Chloride Resp 3% 15 ml neb vial AutoStop Days: 30
Sodium Phosphate 45 mmol/15 ml vial AutoStop Days: 30

40:18.18 POTASSIUM-REMOVING AGENTS\1


Sodium Polystyrene Sulf 15 grams/60 ml susp UD (KAYEXALATE EQUIV) AutoStop Days: 30

40:20.00 CALORIC AGENTS


Amino Acid (Aminosyn) 10 % 500 ml bottle (AMINOSYN 10 %) AutoStop Days: 30
Amino Acid Aminosyn II 8.5% 42.5 grams/500 ml (AMINOSYN II 8.5%) AutoStop Days: 30
Amino Acid (Hepatamine) 8% 500 ml bottle (HEPATAMINE 8%) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 38 of 66

40 ELECTROLYTIC, CALORIC, AND WATER BALANCE


40:20.00 CALORIC AGENTS
Amino Acid Aminosyn RF 5.2% 500 ml bottle (AMINOSYN-RF 5.2%) AutoStop Days: 30
Amino Aicd (Travasol) 10% 500 ml bottle (TRAVASOL 10%) AutoStop Days: 30
Amino Acid (Travasol) 5.5% 500 ml bottle (TRAVASOL 5.5%) AutoStop Days: 30
Amino Acid (Travasol) 8.5% 500 ml bottle (TRAVASOL 8.5%) AutoStop Days: 30
AMINO ACIDS 4.25%/D20W 1000 ML (CLINIMIX 4.25% / 20%) AutoStop Days: 30
AMINO ACIDS 4.25%/D20W 2000 ML (CLINIMIX 4.25% / 20%) AutoStop Days: 30
AMINO ACIDS 4.25%/D5W 2000 ML (CLINIMIX 4.25% / 5%) AutoStop Days: 30
Dextrose in Water 5% 1,000 ml bag AutoStop Days: 30
Dextrose in Water 5% 100 ml bag AutoStop Days: 30
Dextrose in Water 5% 250 ml bag AutoStop Days: 30
Dextrose in Water 5% 50 ml bag AutoStop Days: 30
Dextrose in Water 5% 500 ml bag AutoStop Days: 30
Dextrose in Water 5% 500 ml glass btl AutoStop Days: 30
Dextrose 5%-NaCl 0.2% 1,000 ml bag AutoStop Days: 30
Dextrose 5%-NaCl 0.2% 500 ml bag AutoStop Days: 30
Dextrose 5%-NaCl 0.45% 1,000 ml bag AutoStop Days: 30
Dextrose 5%-NaCl 0.45% 250 ml bag AutoStop Days: 30
Dextrose 5%-NaCl 0.9% 1,000 ml bag AutoStop Days: 30
Dextrose in Water 10% 5 ml amp AutoStop Days: 30
Dextrose in Water 10% 1,000 ml bag AutoStop Days: 30
Dextrose in Water 10% 500 ml TPN bag AutoStop Days: 30
Dextrose 10%-NaCl 0.225 250 ml bag (D10/0.225NACL) AutoStop Days: 30
Dextrose in Water 20% 500 ml TPN bag AutoStop Days: 30
Dextrose in Water 40% 500 ml TPN bag AutoStop Days: 30
Dextrose 5% in Water 500 ml Aviva Bag AutoStop Days: 30
Dextrose 5%-NaCl 0.45% 500 ml bag AutoStop Days: 30
Dextrose in Water 50% 25 grams/50 ml syr AutoStop Days: 30
Dextrose in Water 50% 25 grams/50 ml vial AutoStop Days: 30
Dextrose in Water 50% 500 ml TPN bag AutoStop Days: 30
Dextrose in Water 70% 500 ml TPN bag AutoStop Days: 30
Dextrose 40% oral gel 15 grams (INSTA-GLUCOSE EQUIV) AutoStop Days: 30
Fat Emulsion 10% 250 ml bag (INTRALIPID 10% EQUIV) AutoStop Days: 30
Fat Emulsion 10% 500 ml bag (INTRALIPID 10% EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 39 of 66

40 ELECTROLYTIC, CALORIC, AND WATER BALANCE


40:20.00 CALORIC AGENTS
Fat Emulsion 20% 250 ml bag (INTRALIPID 20% EQUIV) AutoStop Days: 30
Fat Emulsion 20% 500 ml bag (INTRALIPID 20% EQUIV) AutoStop Days: 30
MEDIUM CHAIN TRIGLYC OIL 30 ML (MCT OIL) AutoStop Days: 30

40:28.08 LOOP DIURETICS\1


Bumetanide 1 mg tab (BUMEX EQUIV) AutoStop Days: 30
Bumetanide 1 mg/4 ml vial (BUMEX EQUIV) AutoStop Days: 30
Bumetanide 2.5 mg/10 ml vial (BUMEX EQUIV) AutoStop Days: 30
Ethacrynate Sodium 50 mg vial (EDECRIN SODIUM EQUIV) AutoStop Days: 30
Furosemide 20 mg tab (LASIX EQUIV) AutoStop Days: 30
Furosemide 40 mg tab (LASIX EQUIV) AutoStop Days: 30
Furosemide 40 mg/5 ml soln 5ml cup (LASIX EQUIV) AutoStop Days: 30
Furosemide 10 mg/ml soln 120 ml bt (LASIX EQUIV) AutoStop Days: 30
Furosemide 20 mg/2 ml vial (LASIX EQUIV) AutoStop Days: 30
Furosemide 40 mg/4 ml vial (LASIX EQUIV) AutoStop Days: 30
Furosemide 100 mg/10 ml vial (LASIX EQUIV) AutoStop Days: 30

40:28.12 OSMOTIC DIURETICS\1


Mannitol in Water 20% 100 grams/500ml bag (OSMITROL EQUIV) AutoStop Days: 30
Mannitol 25% 12.5 grams/50 ml vial AutoStop Days: 30

40:28.16 POTASSIUM-SPARING DIURETICS\1


Triamterene - HCTZ 37.5 - 25 mg cap (DYAZIDE EQUIV) AutoStop Days: 30
Triamterene - HCTZ 50 - 25 mg cap (MAXIDE 50/25 EQUIV) AutoStop Days: 30

40:28.20 THIAZIDE DIURETICS\1


ChloroTHIAZIDE Sodium 500 mg vial (DIURIL) AutoStop Days: 30
Hydrochlorothiazide 25 mg tab (HYDRODIURIL/ESIDRIX EQUIV) AutoStop Days: 30

40:28.24 THIAZIDE-LIKE DIURETICS\1


Indapamide 2.5 mg tab (LOZOL EQUIV) AutoStop Days: 30
metoLAZOne 2.5 mg tab (ZAROXOLYN EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 40 of 66

40 ELECTROLYTIC, CALORIC, AND WATER BALANCE


40:36.00 IRRIGATING SOLUTIONS
Acetic Acid in Water 0.25% Irrigation 1000ml (ACETIC ACID 0.25%) AutoStop Days: 30
Acetic Acid in Water 0.5% Irrigation 1000 ml (ACETIC ACID 0.5%) AutoStop Days: 30
SOD CHLORIDE 0.9% 1000 ML IRR (NS IRRIGATION 1000ML BTL) AutoStop Days: 30
SOD CHLORIDE 0.9% 3000ML IRRG (NS GU IRRIGANT 3000 ML) AutoStop Days: 30
Water, Sterile for Irr 1000 ml bottle (STERILE WATER FOR IRRIGATION) AutoStop Days: 30

40:40.00 URICOSURIC AGENTS


Probenecid 500 mg tab (BENEMID EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 41 of 66

44 ENZYMES
44:00.00 ENZYMES
Hyaluronidase 150 units/ml vial (AMPHADASE) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 42 of 66

48 RESPIRATORY TRACT AGENTS\1


48:08.00 ANTITUSSIVES
Benzonatate 100 mg gelcap (TESSALON EQUIV) AutoStop Days: 30
D-methorph/Pe/Chlorphen 15-12.5-4mg/5ml 30ml (RONDEC DM EQUIV) AutoStop Days: 30
guaiFENesin/Dextrometh 100-10 mg/5 ml UD cup (ROBITUSSIN DM EQUIV) AutoStop Days: 30

48:10.32 MAST-CELL STABLILIZERS\1


Cromolyn Sodium 20 mg/2 ml neb vial (INTAL EQUIV) AutoStop Days: 30

48:16.00 EXPECTORANTS
guaiFENesin syrup 200mg/10ml UD cup (ROBITUSSIN EQUIV) AutoStop Days: 30

48:24.00 MUCOLYTIC AGENTS


Acetylcysteine 10% 400mg/4ml inh soln (MUCOMYST-10% EQUIV) AutoStop Days: 30
Acetylcysteine 20% 6gram/30ml inh soln (MUCOMYST-20% EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 43 of 66

52 EYE, EAR, NOSE AND THROAT (EENT) PREPS.


52:04.04 ANTIBACTERIALS (EENT)\1
Bacitracin Ophth 500 unit/gm oint 3.5 gm AutoStop Days: 30
Ciprofloxacin 0.3% oph sol 3.5 ml bt (CILOXAN EQUIV) AutoStop Days: 30
ERYTHromycin 5 mg/gram oph oint AutoStop Days: 30
Gentamicin Sulfate 0.3% oph oint 3.5 grams (GARAMYCIN OPH EQUIV) AutoStop Days: 30
Gentamicin 0.3% oph sol 5 ml btl (GARAMYCIN OPH EQUIV) AutoStop Days: 30
MOXIfloxacin 0.5% oph soln 3 ml btl (VIGAMOX OPH) AutoStop Days: 30
NEOMY-POLYM-DEX 0.1% SUS 5ML (MAXITROL EQUIV) AutoStop Days: 30
NEOMY-POLYM-DEX OPH OIN 3.5GM (MAXITROL EQUIV) AutoStop Days: 30
Neomycin/Polymixin/HC Otic Soln 10 ml btl (CORTISPORIN OTIC SOL EQUIV) AutoStop Days: 30
NEOMY-POLYM-HC 1% OTIC SUSP (CORTISPORIN OTIC SUSP EQUIV) AutoStop Days: 30
NEOMY-POLYM-HC OPH 1% OINT (CORTISPORIN OPH EQUIV) AutoStop Days: 30
NEOMY-POLYM-HC OPH SUSP 7.5ML (CORTISPORIN EQUIV) AutoStop Days: 30
Sulfacetamide Sodium 10% oph oint 3.5 grams (NA SULAMYD 10% OINT EQV) AutoStop Days: 30
Sulfacetamide Sodium 10% oph sol 15 ml btl (NA SULAMYD 10% SOL EQV) AutoStop Days: 30
Sulfacetamide-Prednisol 10-0.2% oph oint 3.5 gm (BLEPHAMIDE S.O.P.) AutoStop Days: 30
Sulfacetamide-Prednisol 10-0.25% oph susp 5 ml (VASOCIDIN SOL EQUIV) AutoStop Days: 30
Tobramycin 0.3% oph oint 3.5 gram (TOBREX OPH OINT EQUIV) AutoStop Days: 30
Tobramycin 0.3% oph sol 5 ml btl (TOBREX OPH SOL EQUIV) AutoStop Days: 30

52:04.16 ANTIFUNGALS (EENT)\1


Natamycin 5% oph susp 15 ml btl (NATACYN) AutoStop Days: 30

52:04.20 ANTIVIRALS (EENT)\1


Trifluridine 1% oph sol 7.5 ml btl (VIROPTIC OPH EQUIV) AutoStop Days: 30

52:04.92 EENT ANTI-INFECTIVES, MISCELLANEOUS\1


Carbamide Peroxide 10% oral sol 60 ml btl (GLY-OXIDE EQUIV) AutoStop Days: 30
Chlorhexidine Gluconate 0.12% oral rinse 473 ml (PERIDEX EQUIV) AutoStop Days: 30

52:08.08 CORTICOSTEROIDS (EENT)\1


Beclomethasone Diprop 42mcg/spy Aq Nasal 25ml (BECONASE AQ EQUIV) AutoStop Days: 30
Dexamethasone 0.1% oph sol 5 ml btl (MAXIDEX OPH EQUIV) AutoStop Days: 30
Fluorometholone 0.1% oph oint 3.5 grams (FML S.O.P EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 44 of 66

52 EYE, EAR, NOSE AND THROAT (EENT) PREPS.


52:08.08 CORTICOSTEROIDS (EENT)\1
Fluorometholone 0.1% oph susp 5 ml btl (FML EQUIV) AutoStop Days: 30
prednisoLONE Acetate 1% oph soln 5 ml btl (PRED FORTE 1% EQUIV) AutoStop Days: 30

52:08.20 EENT NONSTEROIDAL ANTI-INFLAM. AGENTS\1


Flurbiprofen 0.03% oph sol 2.5 ml bt (OCUFEN EQUIV) AutoStop Days: 30
Ketorolac TroMETHamine 0.5% Oph Soln 5 ml btl (ACULAR EQUIV) AutoStop Days: 5

52:16.00 LOCAL ANESTHETICS (EENT)\1


Antipyrine-Benzocaine 5.4-1.4% otic soln 15ml (AURALGAN EQUIV) AutoStop Days: 30
Benzocaine 20% Dental Paste 6 gram (ORABASE-B EQUIV) AutoStop Days: 30
Cocaine 4% top sol 4 ml btl AutoStop Days: 3 DEA Sch: II
Cocaine 10% top sol 4 ml btl AutoStop Days: 3 DEA Sch: II
Fluorescein-Benoxinate 0.25-0.4% oph sol 5 ml (FLURESS EQUIV) AutoStop Days: 30
Lidocaine 2% Viscous soln 15 ml (XYLOCAINE 2% VISCOUS EQUIV) AutoStop Days: 30
Lidocaine 2% Jelly 5 ml tube (XYLOCAINE 2% JELLY EQUIV) AutoStop Days: 30
Lidocaine 2% Jelly 10 ml Urojet (XYLOCAINE 2% UROJET EQUIV) AutoStop Days: 30
Lidocaine 4% topical soln 50 ml (XYLOCAINE 4% TOP EQUIV) AutoStop Days: 30
Lidocaine 2% Viscous soln 100ml (XYLOCAINE 2% VISCOUS EQUIV) AutoStop Days: 30
Proparacaine 0.5% oph sol 15 ml btl (ALCAINE EQUIV) AutoStop Days: 30
Tetracaine 0.5% oph sol 2 ml btl AutoStop Days: 30
THROAT LOZENGE (CEPACOL SORE THROAT EQUIV) AutoStop Days: 30

52:24.00 MYDRIATICS
Atropine Sulfate 1% oph oint 3.5 gram AutoStop Days: 30
Atropine Sulfate 1% oph soln 5 ml bt AutoStop Days: 30
Cyclopentolate 0.5% oph sol 15 ml btl (CYCLOGYL 0.5% EQUIV) AutoStop Days: 30
Cyclopentolate 1% oph sol 2 ml btl (CYCLOGYL 1% EQUIV) AutoStop Days: 30
Cyclopentolate 2% oph sol 2 ml btl (CYCLOGYL 2% EQUIV) AutoStop Days: 30
Homatropine HBr 2% oph sol 5 ml btl (ISOPTO HOMATROPINE EQUIV) AutoStop Days: 30
Homatropine HBr 5% oph sol 5 ml btl (ISOPTO HOMATROPINE EQUIV) AutoStop Days: 30
Scopolamine H-Bromide 0.25% oph sol 5 ml btl (ISOPTO HYOSCINE EQUIV) AutoStop Days: 30
Tropicamide 0.5% oph sol 15 ml btl (MYDRIACIL 0.5% EQUIV) AutoStop Days: 30
Tropicamide 1% oph sol 3 ml btl (MYDRIACYL 1% OPH EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 45 of 66

52 EYE, EAR, NOSE AND THROAT (EENT) PREPS.


52:32.00 VASOCONSTRICTORS
Naphazoline 0.1% oph soln 15 ml btl (VASOCON EQUIV) AutoStop Days: 30
Naphazoline-Pheniramine 0.025-0.3% oph sol 5 ml (VISINE A EQUIV) AutoStop Days: 30
Oxymetazoline 0.05% nasal spray 15 ml (AFRIN EQUIV) AutoStop Days: 30
Phenylephrine 10% oph sol 5 ml btl (NEOSYNEPHRINE 10% OPH EQV) AutoStop Days: 30
Phenylephrine 2.5% oph sol 3 ml btl (NEOSYNEPHRINE 2.5% OPH EQUIV) AutoStop Days: 30

52:40.04 ALPHA-ADRENERGIC AGONISTS (EENT)\1


Brimonidine Tartrate 0.2% oph sol 5 ml bt (ALPHAGAN 0.2% EQUIV) AutoStop Days: 30

52:40.08 BETA-ADRENERGIC BLOCKING AGENTS (EENT)\1


Timolol Maleate 0.25% oph sol 5 ml btl (TIMOPTIC 0.25% OPH EQUIV) AutoStop Days: 30
Timolol Maleate 0.5% oph sol 5 ml btl (TIMOPTIC 0.5% OPH EQUIV) AutoStop Days: 30

52:40.12 CARBONIC ANHYDRASE INHIBITORS (EENT)\1


acetaZOLAMIDE 250 mg tab (DIAMOX EQUIV) AutoStop Days: 30
acetaZOLAMIDE 500 mg SA cap (DIAMOX SEQUELS EQUIV) AutoStop Days: 30
acetaZOLAMIDE Sodium 500 mg vial (DIAMOX EQUIV) AutoStop Days: 30
Dorzolamide 2% oph sol 10 ml bt (TRUSOPT) AutoStop Days: 30
Dorzolamide-Timolol 2-0.5% oph sol 10 ml bt (COSOPT) AutoStop Days: 30

52:40.20 MIOTICS\1
Acetylcholine Chloride 1:100 ophth 2 ml kit (MIOCHOL-E) AutoStop Days: 30
Carbachol 1.5% oph sol 15 ml bt (ISOPTO CARBOCHOL 1.5% EQUIV) AutoStop Days: 30
Carbachol 3% oph sol 15 ml bt (ISOPTO CARBOCHOL 3% EQUIV) AutoStop Days: 30
Pilocarpine 0.5% oph sol 15 ml btl (PILOCAR 0.5% EQUIV) AutoStop Days: 30
Pilocarpine 1% oph sol 2 ml btl (PILOCAR 1% EQUIV) AutoStop Days: 30
Pilocarpine 2% oph sol 2 ml btl (PILOCAR 2% EQUIV) AutoStop Days: 30
Pilocarpine 3% oph sol 15 ml btl (PILOCAR 3% EQUIV) AutoStop Days: 30
Pilocarpine 4% oph gel 4 gram tube (PILOPINE HS EQUIV) AutoStop Days: 30
Pilocarpine 4% oph sol 2 ml btl (PILOCAR 4% EQUIV) AutoStop Days: 30
Pilocarpine 6% oph sol 15 ml btl (ISOPTO CARPINE 6% EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 46 of 66

52 EYE, EAR, NOSE AND THROAT (EENT) PREPS.


52:40.28 PROSTAGLANDIN ANALOGS\1
Latanoprost 0.005% oph sol 2.5 ml (XALATAN) AutoStop Days: 30
Travoprost 0.004% oph sol 2.5ml bt (TRAVATAN 0.004% OPH EQUIV) AutoStop Days: 30

52:92.00 EENT DRUGS, MISCELLANEOUS\1


Apraclonidine 0.5% oph sol 5 ml bt (IOPIDINE EQUIV) AutoStop Days: 30
Apraclonidine 1% Oph 0.1 ml droppette (IOPIDINE EQUIV) AutoStop Days: 30
Artificial Tear oph oint 3.5 gram tube (LACRI-LUBE EQUIV) AutoStop Days: 30
Artificial Tears oph soln 15 ml bt (TEARISOL EQUIV) AutoStop Days: 30
Balanced Salt Sol (BSS) 500 ml oph irrigation (BSS EQUIV) AutoStop Days: 30
Balanced Salt Sol (BSS) 15 ml oph irrigation (BSS EQUIV) AutoStop Days: 30
EYE WASH 4 OZ. (DACRIOSE OPH EQUIV) AutoStop Days: 30
Hydroxypropylmethylcell 2.5% Oph Sol 15 ml btl (GONIOSOL EQUIV) AutoStop Days: 30
Phenol 1.4% Throat Spray 177 ml btl (CHLORASEPTIC SPRAY) AutoStop Days: 30
SALINE NASAL SPRAY 45ML (OCEAN SPY EQUIV) AutoStop Days: 30
Sodium Chloride 2% oph sol 15 ml btl (ADSORBONAC 2% EQUIV) AutoStop Days: 30
Sodium Chloride 5% oph sol 15 ml btl (ADSORBONAC 5% EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 47 of 66

56 GASTROINTESTINAL DRUGS
56:04.00 ANTACIDS AND ADSORBENTS
Aluminum Hydroxide Gel 320 mg/5 ml 30ml UD cup (AMPHOJEL EQUIV) AutoStop Days: 30
Aluminum Hydroxide Gel 600 mg/5 ml 30ml UD cup (ALTERNAGEL EQUIV) AutoStop Days: 30
Mag-Alum Hydroxide 1200-1200 mg/30 ml UD (MAG-AL EQUIV) AutoStop Days: 30
Alum-Mag Hydrox/Simeth 1200-1200-200mg/30ml UD (MYLANTA EQUIV) AutoStop Days: 30
Calcium Carbonate Tums 500 mg antacid tab (TUMS EQUIV) AutoStop Days: 30
Charcoal with Sorbitol 50 grams/240 ml susp (ACTIDOSE WITH SORBITOL EQUIV) AutoStop Days: 30
Charcoal, Aqueous 25 grams/120 ml susp (ACTIDOSE-AQUA EQUIV) AutoStop Days: 30
E-Z Gas II Efferv granules 4gm pak (E-Z-GAS II) AutoStop Days: 30
Magnesium Oxide 400 mg tab (MAG OX 400 EQUIV) AutoStop Days: 30
Sodium Bicarbonate 325 mg tab (NAHCO3) AutoStop Days: 30
Sodium Bicarbonate 650 mg tab (NAHCO3) AutoStop Days: 30

56:08.00 ANTIDIARRHEA AGENTS


Bismuth SubSalicylate 262 mg chew tab (PEPTO-BISMOL EQUIV) AutoStop Days: 30
Bismuth SubSalicylate 262 mg/15 ml susp 30 ml (PEPTO-BISMOL EQUIV) AutoStop Days: 30
Diphenoxylate-Atropine 5 mg-0.05 mg/10ml sol (LOMOTIL EQUIV) AutoStop Days: 3 DEA Sch: V
Diphenoxylate-Atropine 2.5-0.025 mg tab (LOMOTIL EQUIV) AutoStop Days: 3 DEA Sch: V
LACTOBACILLUS ACIDOPHILUS TAB (LACTINEX EQUIV) AutoStop Days: 30
Lactobacillus granules 1 gram/pack (FLORANEX GRANULES) AutoStop Days: 30
Loperamide 2 mg cap (IMODIUM EQUIV) AutoStop Days: 30
Loperamide 2 mg/10 ml oral sol cup (IMODIUM EQUIV) AutoStop Days: 30

56:10.00 ANTIFLATULENTS
Simethicone 80 mg chewtab (MYLICON EQUIV) AutoStop Days: 30
Simethicone 40 mg/0.6 ml drops 30ml (MYLICON EQUIV) AutoStop Days: 30

56:12.00 CATHARTICS AND LAXATIVES


Bisacodyl 5 mg tab (DULCOLAX EQUIV) AutoStop Days: 30
Bisacodyl 10 mg supp (DULCOLAX EQUIV) AutoStop Days: 30
Cascara Sagrada, Aromat 5 ml dose AutoStop Days: 30
Docusate Calcium 240 mg gelcap (SURFAK EQUIV) AutoStop Days: 30
Docusate Sodium 100 mg gelcap (COLACE EQUIV) AutoStop Days: 30
Docusate Sodium 100 mg/10 ml oral sol (COLACE EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 48 of 66

56 GASTROINTESTINAL DRUGS
56:12.00 CATHARTICS AND LAXATIVES
Glycerin Adult Supp AutoStop Days: 30
Glycerin Ped Supp AutoStop Days: 30
Bowel Prep Kit (Lo-So) (Bisacodyl/Mag Citrate) (LO-SO PREP KIT) AutoStop Days: 30
Magnesium Citrate 300 ml bottle AutoStop Days: 30
MAGNESIUM HYDROXIDE SUSP 30 ML (MILK OF MAGNESIA) AutoStop Days: 30
Mineral Oil 30 ml cup AutoStop Days: 30
Mineral Oil Adult Enema 118 ml btl (FLEET MINERAL OIL ENEMA) AutoStop Days: 30
Sod Phosphate (M-B/D-B) Adult Enema 133 ml btl (FLEET ADULT ENEMA) AutoStop Days: 30
Sod Phosphate (M-B/D-B) Ped Enema 66 ml btl (PEDIA-LAX ENEMA) AutoStop Days: 30
PEG-ELECTROLYTE SOLR 4000 ML (GOLYTELY EQUIV) AutoStop Days: 30
Psyllium granules 3.4 gram S-F pack (METAMUCIL S/F ORNG EQUIV) AutoStop Days: 30
SOD & BI PHOSPHATE SOL 45 ML (FLEETS SODA EQUIV) AutoStop Days: 30
SORBITOL 70 % SOLN 30ML AutoStop Days: 30

56:20.00 EMETICS
IPECAC SYRUP 30 ML (SYRUP OF IPECAC) AutoStop Days: 30

56:22.08 ANTIHISTAMINES (GI DRUGS)\1


Meclizine 12.5 mg tab (ANTIVERT EQUIV) AutoStop Days: 30
Prochlorperazine 5 mg tab (COMPAZINE EQUIV) AutoStop Days: 30
Prochlorperazine 10 mg/2 ml vial (COMPAZINE EQUIV) AutoStop Days: 30
Prochlorperazine 25 mg supp (COMPAZINE EQUIV) AutoStop Days: 30

56:22.20 5-HT3 RECEPTOR ANTAGONISTS\1


Dolasetron 100 mg tab (ANZEMET) AutoStop Days: 5
Dolasetron 100 mg/5 ml vial (ANZEMET) AutoStop Days: 5
Dolasetron 12.5 mg/0.625 ml vial (ANZEMET) AutoStop Days: 5
Ondansetron 4 mg tab (ZOFRAN EQUIV) AutoStop Days: 5
Ondansetron 4 mg/2 ml vial (ZOFRAN) AutoStop Days: 5
Ondansetron 40 mg/20 ml vial (ZOFRAN EQUIV) AutoStop Days: 5

56:22.92 ANTIEMETICS, MISCELLANEOUS\1


Aprepitant 80 mg cap (EMEND) AutoStop Days: 30
Restricted to Hematology / Oncology Only

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 49 of 66

56 GASTROINTESTINAL DRUGS
56:22.92 ANTIEMETICS, MISCELLANEOUS\1
Aprepitant 125 mg cap (EMEND) AutoStop Days: 30
Restricted to Hematology / Oncology Only
Aprepitant 125-80-80 mg tri-pack (EMEND TRIPACK 125-80-80 MG) AutoStop Days: 30
Restricted to Hematology / Oncology Only

56:28.12 HISTAMINE H2-ANTAGONISTS\1


Famotidine 20 mg tab (PEPCID EQUIV) AutoStop Days: 30
Famotidine 20 mg/2 ml vial (PEPCID EQUIV) AutoStop Days: 30
Famotidine 20 mg/50 ml NS bag (PEPCID PREMIXED EQUIV) AutoStop Days: 30

56:28.28 PROSTAGLANDINS\1
Misoprostol 100 mcg tab (CYTOTEC) AutoStop Days: 30

56:28.32 PROTECTANTS\1
Sucralfate 1 gram tab (CARAFATE EQUIV) AutoStop Days: 30
Sucralfate 1 gram/10ml susp UD cup (CARAFATE EQUIV) AutoStop Days: 30

56:28.36 PROTON-PUMP INHIBITORS\1


LANSOPrazole 30 mg solutab (PREVACID) AutoStop Days: 30
PANTOPrazole 40 mg enteri-coat tab (PROTONIX) AutoStop Days: 30
PANTOPrazole 40 mg vial (PROTONIX IV) AutoStop Days: 30

56:32.00 PROKINETIC AGENTS\1


metoCLOPramide 10 mg tab (REGLAN EQUIV) AutoStop Days: 30
metoCLOPramide soln 10 mg/10 ml UD cup (REGLAN EQUIV) AutoStop Days: 30
metoCLOPramide 10 mg/2 ml vial (REGLAN EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 50 of 66

60 GOLD COMPOUNDS
60:00.00 GOLD COMPOUNDS
Gold Sodium Thiomalate 50 mg/ml vial (MYOCHRISINE EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 51 of 66

64 HEAVY METAL ANTAGONISTS


64:00.00 HEAVY METAL ANTAGONISTS
CYANIDE ANTIDOTE KIT AutoStop Days: 30
DEFERoxamine Mesylate 500 mg vial (DESFERAL EQUIV) AutoStop Days: 30
Dimercaprol in Oil 300 mg/3 ml amp (BAL-IN-OIL) AutoStop Days: 30
penicillAMINE 250 mg cap (CUPRIMINE EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 52 of 66

68 HORMONES AND SYNTHETIC SUBSTITUTES


68:04.00 ADRENALS
Betamethasone Acet/NaPh 6 mg/ml 5 ml vial (CELESTONE SOLUSPAN EQUIV) AutoStop Days: 30
Cortisone Acetate 25 mg tab (CORTONE EQUIV) AutoStop Days: 30
Dexamethasone 0.75 mg tab (DECADRON EQUIV) AutoStop Days: 30
Dexamethasone 1 mg tab (DECADRON EQUIV) AutoStop Days: 30
Dexamethasone 4 mg tab (DECADRON EQUIV) AutoStop Days: 30
Dexamethasone Sod Phos 4 mg/ml vial (DECADRON EQUIV) AutoStop Days: 30
Dexamethasone Sod Phos 20 mg/5 ml vial (DECADRON EQUIV) AutoStop Days: 30
Dexamethasone 0.5mg/5ml oral sol 30ml (DECADRON EQUIV) AutoStop Days: 30
Fludrocortisone Acetate 0.1 mg tab (FLORINEF EQUIV) AutoStop Days: 30
HydrocorTISone Sod Succ 100 mg/2 ml vial (SOLU-CORTEF EQUIV) AutoStop Days: 30
HydrocorTISone Sod Succ 500 mg/4 ml vial (SOLU-CORTEF EQUIV) AutoStop Days: 30
methylPREDNISolone Ace 40 mg/ml vial (DEPO MEDROL EQUIV) AutoStop Days: 30
methylPREDNISolone Sod Succ 40 mg/ml vial (SOLU-MEDROL EQUIV) AutoStop Days: 30
methylPREDNISolone Sod Succ 125 mg/2 ml vial (SOLU-MEDROL EQUIV) AutoStop Days: 30
methylPREDNISolone Sod Succ 500 mg/4 ml vial (SOLU-MEDROL EQUIV) AutoStop Days: 30
methylPREDNISolone Sod Succ 1,000 mg vial (SOLU-MEDROL EQUIV) AutoStop Days: 30
methylPREDNISolone Sod Succ 2,000 mg vial (SOLU-MEDROL EQUIV) AutoStop Days: 30
predniSONE 5 mg tab AutoStop Days: 30
predniSONE 10 mg tab AutoStop Days: 30
predniSONE 20 mg tab AutoStop Days: 30
predniSONE soln 5 mg/5 ml UD cup AutoStop Days: 30
Triamcinolone Acetonide 10 mg/ml 5 ml vial (KENALOG-10 EQUIV) AutoStop Days: 30
Triamcinolone Acetonide 40 mg/ml vial (KENALOG-40 EQUIV) AutoStop Days: 30
Triamcinolone Acetonide 100 mcg/inhal MDI 20 gm (AZMACORT MDI) AutoStop Days: 30

68:08.00 ANDROGENS
Testosterone Cypionate 200 mg/ml vial (DEPO-TESTOSTERONE EQUIV) AutoStop Days: 3 DEA Sch: III

68:12.00 CONTRACEPTIVES
Norgestrel/Eth Estradol 0.3-0.03 mg tabs 28 day (LO/OVRAL 28 DAY EQUIV) AutoStop Days: 30

68:16.04 ESTROGENS
Estradiol 0.025 mg/day patch (CLIMARA EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 53 of 66

68 HORMONES AND SYNTHETIC SUBSTITUTES


68:16.04 ESTROGENS
Estradiol 0.05 mg/day patch (CLIMARA EQUIV) AutoStop Days: 30
Estradiol 0.1 mg/day patch (CLIMARA EQUIV) AutoStop Days: 30
Estradiol Cypionate 25 mg/5 ml vial (DEPO-ESTRADIOL EQUIV) AutoStop Days: 30
Estradiol Valerate in oil 100 mg/5 ml vial (DELESTROGEN EQUIV) AutoStop Days: 30
Estradiol Valerate in oil 200 mg/5 ml vial (DELESTROGEN EQUIV ) AutoStop Days: 30
Estrogens, Conjugated 0.3 mg tab (PREMARIN EQUIV) AutoStop Days: 30
Estrogens, Conjugated 0.45 mg tab (PREMARIN EQUIV) AutoStop Days: 30
Estrogens, Conjugated 0.625 mg tab (PREMARIN EQUIV) AutoStop Days: 30
Estrogens, Conjugated 25 mg vial (PREMARIN EQUIV) AutoStop Days: 30
Estrogens, Conjugated Vaginal Cream 42.5 gram (PREMARIN EQUIV) AutoStop Days: 30

68:20.04 BIGUANIDES\1
metFORMIN 500 mg tab (GLUCOPHAGE EQUIV) AutoStop Days: 30
metFORMIN 850 mg tab (GLUCOPHAGE EQUIV) AutoStop Days: 30

68:20.08 INSULINS
Insulin Detemir Levemir U-100 3 ml flexpen (LEVEMIR) AutoStop Days: 30
Insulin, Lispro HumaLOG U-100 3 ml vial (HUMALOG) AutoStop Days: 30
Insulin Human Regular U-100 3 ml vial (HUMULIN R) AutoStop Days: 30
Insulin Hum NPH-Reg Mix 70/30 10 ml vial (HUMULIN 70/30 EQUIV) AutoStop Days: 30
Insulin Human Isophane (NPH) U-100 10 ml vial (HUMULIN N) AutoStop Days: 30
Insulin Glargine LanTUS U-100 10 ml vial (LANTUS) AutoStop Days: 30

68:20.20 SULFONYLUREAS
GlipiZIDE 5 mg tab (GLUCOTROL EQUIV) AutoStop Days: 30
GlyBURIDE 2.5 mg tab (DIABETA EQUIV) AutoStop Days: 30
GlyBURIDE 5 mg tab (DIABETA EQUIV) AutoStop Days: 30

68:20.28 THIAZOLIDINEDIONES\1
Rosiglitasone 4 mg tab (AVANDIA) AutoStop Days: 30

68:22.12 GLYCOGENOLYTIC AGENTS\1


Glucagon (RDNA) 1 mg vial AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 54 of 66

68 HORMONES AND SYNTHETIC SUBSTITUTES


68:28.00 PITUITARY
Desmopressin Acetate 4 mcg/ml amp (DDAVP EQUIV) AutoStop Days: 30
Desmopressin Acetate 10 mcg/spy nasal 5ml bt (DDAVP NASAL EQUIV) AutoStop Days: 30
Desmopressin Acetate 10mcg rhinal tube 2.5ml (DDAVP NASAL EQUIV) AutoStop Days: 30
Desmopressin Acetate 1.5 mg/ml Nasal 2.5 ml (STIMATE) AutoStop Days: 30
Vasopressin, Aqueous 20 units/ml vial (PITRESSIN EQUIV) AutoStop Days: 30

68:32.00 PROGESTINS
MedroxyPROGESTERone Ace 150 mg/ml vial (DEPO-PROVERA EQUIV) AutoStop Days: 30
MedroxyPROGESTERone Ace 1,000 mg/2.5 ml vial (DEPO-PROVERA EQUIV) AutoStop Days: 30
MedroxyPROGESTERone Ace 10 mg tab (PROVERA EQUIV) AutoStop Days: 30
MedroxyPROGESTERone Ace 2.5 mg tab (PROVERA EQUIV) AutoStop Days: 30
Progesterone in Oil 500 mg/10 ml vial AutoStop Days: 30

68:36.04 THYROID AGENTS


LevoTHYROXine 25 mcg tab (SYNTHROID EQUIV) AutoStop Days: 30
LevoTHYROXine 50 mcg tab (SYNTHROID EQUIV) AutoStop Days: 30
LevoTHYROXine 88 mcg tab (SYNTHROID EQUIV) AutoStop Days: 30
LevoTHYROXine 100 mcg tab (SYNTHROID EQUIV) AutoStop Days: 30
LevoTHYROXine 112 mcg tab (SYNTHROID EQUIV) AutoStop Days: 30
LevoTHYROXine 125 mcg tab (SYNTHROID EQUIV) AutoStop Days: 30
LevoTHYROXine 150 mcg tab (SYNTHROID EQUIV) AutoStop Days: 30
LevoTHYROXine 200 mcg vial (SYNTHROID EQUIV) AutoStop Days: 30
LevoTHYROXine 500 mcg vial (SYNTHROID EQUIV) AutoStop Days: 30

68:36.08 ANTITHYROID AGENTS


IODine Strong Soln (Lugol's) 30 ml btl AutoStop Days: 30
meTHIMAzole 10 mg tab (TAPAZOLE EQUIV) AutoStop Days: 30
meTHIMAzole 5 mg tablet (TAPAZOLE EQUIV) AutoStop Days: 30
Potassium Iodide 1 gram/ml soln 30 ml (SSKI SOL) AutoStop Days: 30
PROPylthiouracil 50 mg tab AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 55 of 66

72 LOCAL ANESTHETICS (PARENTERAL)\1


72:00.00 LOCAL ANESTHETICS (PARENTERAL)\1
Bupivacaine 0.25% 30 ml SD vial (SENSORCAINE MPF EQUIV) AutoStop Days: 30
Bupivacaine 0.5% 30 ml SD vial (SENSORCAINE MPF EQUIV) AutoStop Days: 30
Bupivacaine 0.75% 30 ml SD vial (SENSORCAINE-MPF EQUIV) AutoStop Days: 30
Bupivacaine in Dextrose 0.75 - 8.25% 2 ml amp (SENSORCAINE-DEX EQUIV) AutoStop Days: 30
Bupivacaine-EPINEPHrine 0.25%-1:200,000 30 ml (SENSORCAINE/EPI EQUIV) AutoStop Days: 30
Bupivacaine-EPINEPHrine 0.5%-1:200,000 30 ml (SENSORCAINE/EPI EQUIV) AutoStop Days: 30
EPIDURAL TRAY AutoStop Days: 30
Lidocaine w/EPINEPHrine 1%-1:100,000 20 ml vial (XYLOCAINE/EPI 1%-1:1 EQUIV AutoStop Days: 30
Lidocaine w/EPINEPHrine 1.5%-1:200,000 5 ml amp (XYLOCAINE/EPI 1.5%-1:200 E AutoStop Days: 30
Lidocaine w/EPINEPHrine 2%-1:100,000 20 ml vial (XYLOCAINE W EPI 2% 1:1 EQU AutoStop Days: 30
Lidocaine w/EPINEPHrine 2%-1:200,000 20 ml MPF (XYLOCAINE-EPI MPF 2%-1:20 AutoStop Days: 30
Lidocaine 0.5% 50 ml vial MPF (XYLOCAINE-MPF 0.5% EQUIV) AutoStop Days: 30
Lidocaine 1% 20 ml MDV (XYLOCAINE 1% EQUIV) AutoStop Days: 30
Lidocaine 1% MPF 5 ml amp (XYLOCAINE-MPF 1% EQUIV) AutoStop Days: 30
Lidocaine 2% 20 ml vial MDV (XYLOCAINE 2% EQUIV) AutoStop Days: 30
Lidocaine 2% MPF 10 ml amp (XYLOCAINE-MPF 2% EQUIV) AutoStop Days: 30
Lidocaine in Dextrose 5%/7.5% 2 ml amp AutoStop Days: 30
Mepivacaine 1% 30 ml vial (CARBOCAINE 1% EQUIV) AutoStop Days: 30
Mepivacaine 1.5% 30 ml vial (CARBOCAINE 1.5% EQUIV) AutoStop Days: 30
Mepivacaine 2% 30 ml vial (CARBOCAINE 2% EQUIV) AutoStop Days: 30
Procaine 10% 2 ml amp (NOVOCAIN 10% EQUIV) AutoStop Days: 30
ROPIvacaine 200 mg/100 ml (0.2%) bt (NAROPIN 0.2%) AutoStop Days: 30
ROPIvacaine 100 mg/20 ml (0.5%) amp (NAROPIN 0.5%) AutoStop Days: 30
SPINAL TRAY AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 56 of 66

76 OXYTOCICS
76:00.00 OXYTOCICS
Carboprost TroMETHamine 250 mcg/ml amp (HEMABATE) AutoStop Days: 30
Methylergonovine 0.2 mg/ml amp (METHERGINE EQUIV) AutoStop Days: 30
Methylergonovine 0.2 mg tab (METHERGINE EQUIV) AutoStop Days: 30
Oxytocin 10 units/ml vial (PITOCIN EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 57 of 66

80 SERUMS, TOXOIDS, AND VACCINES


80:04.00 SERUMS
Antivenin, Black Widow Spider 6,000 unit vial (BLACK WIDOW ANTIV) AutoStop Days: 30
Crotalidae Pol Imm Fab 1 gram vial (CROFAB) AutoStop Days: 30
Hepatitis B Immune Glob 110 units/0.5 ml syr (HYPERHEP B EQUIV) AutoStop Days: 30
Hepatitis B Immune Glob 312 units/ml vial (HYPERHEP B EQUIV) AutoStop Days: 30
Hepatitis B Immune Glob 1560 untis/5 ml vial (HYPERHEP B EQUIV) AutoStop Days: 30
Immun Globulin Gammagrd 10 gram vial (GAMMAGARD S/D ) AutoStop Days: 30
Immun Globulin Gamunex 5 grams/50 ml 10% vial (GAMUNEX) AutoStop Days: 30
Immun Globulin Gamunex 10 grams/100ml 10% vial (GAMUNEX) AutoStop Days: 30
Immun Globulin Gamunex 20 grams/200ml 10% vial (GAMUNEX) AutoStop Days: 30
Immun Globulin Octagam 5 grams/100 ml 5% vial (OCTAGAM) AutoStop Days: 30
Immun Globulin Octagam 10 grams/200 ml 5% vial (OCTAGAM) AutoStop Days: 30
Immun Globulin Carimune 6 gram vial (CARIMUNE (NANOFILTERED)) AutoStop Days: 30
Immun Globulin Panglob 6 gram vial (PANGLOBULIN NF) AutoStop Days: 30
IMMUNE GLOBULIN IM 10 ML VIAL (GAMASTAN EQUIV) AutoStop Days: 30
Rabies Immune Globulin 300 int unit/2 ml vial (HYPERRAB EQUIV) AutoStop Days: 30
Rabies Immune Globulin 1,500 int unit/10 ml vl (HYPERRAB EQUIV) AutoStop Days: 30
Tetanus Immune Globulin 250 units/ml syringe (HYPER-TET EQUIV) AutoStop Days: 30

80:08.00 TOXOIDS
TETANUS-DIPHTH TOX 0.5ML SYR (DECAVAC VACCINE) AutoStop Days: 30

80:12.00 VACCINES
Hepatitis A vaccine 1,440 units/ml vaccine (HAVRIX VACCINE EQUIV) AutoStop Days: 30
Hepatitis A vaccine 720 units/0.5 ml vial (HAVRIX PED VACCINE EQUIV) AutoStop Days: 30
Hepatitis B Vaccine 20 mcg/ml syringe (ENGERIX B VACCINE EQUIV) AutoStop Days: 30
Human Papillomavirus quad-val vaccine 0.5 ml (GARDASIL VACCINE) AutoStop Days: 30
Influenza Virus Vaccine 0.5 ml syringe (FLUZONE VACCINE) AutoStop Days: 30
MEASLES-MUMPS-RUBELLA VACCINE (M-M-R II VACCINE) AutoStop Days: 30
Pneumococcal Vaccine 23-val 25mcg/0.5ml vial (PNEUMOVAX 23 VACCINE) AutoStop Days: 30
Rabies Vaccine, Chicken 2.5 units/ml vial (RABAVERT VACCINE) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 58 of 66

84 SKIN AND MUCOUS MEMBRANE AGENTS


84:04.04 ANTIBACTERIALS (SKIN & MUCOUS MEMBRANE)\1
Bacitracin 500 unit/gm oint 28 gm AutoStop Days: 30
Gentamicin 0.1% top cream 15 gram AutoStop Days: 30
Neomycin/Polymyxin B 40mg/200K unit/ml irrig (NEOSPORIN GU EQUIV) AutoStop Days: 30
Triple Antibiotic top oint 0.9 gm pack (NEOSPORIN PACK EQUIV) AutoStop Days: 30
Triple Antibiotic top oint 30 grams (NEOSPORIN EQUIV) AutoStop Days: 30

84:04.06 ANTIVIRALS (SKIN & MUCOUS MEMBRANE)\1


Acyclovir 5% topical oint 15 gram (ZOVIRAX 5% EQUIV) AutoStop Days: 30

84:04.08 ANTIFUNGALS (SKIN & MUCOUS MEMBRANE)\1


Clotrimazole 1% vaginal cream 45gram (GYNE-LOTRIMIN EQUIV) AutoStop Days: 30
Clotrimazole 1% top cream 15 gram (LOTRIMIN EQUIV) AutoStop Days: 30
Clotrimazole 10 mg troche (MYCELEX EQUIV) AutoStop Days: 30
Gentian Violet 1% top soln 30 ml btl AutoStop Days: 30
Nystatin Topical Powder 15 grams (NYSTOP PWDR EQUIV) AutoStop Days: 30
Nystatin Topical 100.000 unit/gm cream AutoStop Days: 30
TERCONAZOL VAG 0.4% CREAM 45GM (TERAZOL EQUIV) AutoStop Days: 30
TRIPLE DYE 0.5 ML SWAB (KERR TRIPLE DYE EQUIV) AutoStop Days: 30

84:04.12 SCABICIDES AND PEDICULICIDES


Lindane 1% top lotion 60 ml (KWELL LOTION EQUIV) AutoStop Days: 30
Lindane 1% Shampoo 60 ml (KWELL SHAMPOO EQUIV) AutoStop Days: 30
PERMETHRIN 5% CREAM 60 GRAM (ACTICIN 5% CREAM) AutoStop Days: 30
PERMETHRIN LOTION 1% LIQD 60ML (LICE TREATMENT LOTION) AutoStop Days: 30
PYRETRINS BEDDING SPRAY 5OZ AutoStop Days: 30

84:04.92 LOCAL ANTI-INFECTIVES, MISCELLANEOUS\1


Alcohol, Isopropyl 70% (rubbing) 480 ml bt AutoStop Days: 30
Cadexomer IODine 0.9% gel 40 gram tube (IODOSORB EQUIV) AutoStop Days: 30
POVIDONE-IODINE 10% OINT 1 GM (BETADINE PACK EQUIV) AutoStop Days: 30
Selenium Sulfide 2.5% top lotion 4 oz. (SELSUN EQUIV) AutoStop Days: 30
Silver SulfaDIAZINE 1% top cream 400 grams (SILVADENE EQUIV) AutoStop Days: 30
Silver SulfaDIAZINE 1% top cream 50 grams (SILVADENE EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 59 of 66

84 SKIN AND MUCOUS MEMBRANE AGENTS


84:06.00 ANTI-INFLAMMATORY AGENTS (SKIN & MUCOUS)\1
Betamethasone Valerate 0.1% top cream 15 gram (VALISONE 0.1% EQUIV) AutoStop Days: 30
HydrocorTISone Acetate 25 mg rectal supp (ANUSOL-HC EQUIV) AutoStop Days: 30
HydrocorTISone 2.5% rectal cream 28 gm (PROCTOSOL HC EQUIV) AutoStop Days: 30
HydrocorTISone 0.05% Top Oint 28 gram AutoStop Days: 30
HydrocorTISone Acetate 0.5% w/Aloe cream 30 gm AutoStop Days: 30
HydrocorTISone 100 mg/60 ml enema (CORTENEMA EQUIV) AutoStop Days: 30
HydrocorTISone 1% Top Cream 28 grams (HYTONE EQUIV) AutoStop Days: 30
Triamcinolone Acetonide 0.025% top cream 80gram (KENALOG 0.025% CRM EQV) AutoStop Days: 30
Triamcinolone Acetonide 1% Top Cream 15 grams (KENALOG 0.1% CREAM EQUIV) AutoStop Days: 30
Triamcinolone Acetonide 0.1% dental paste 5gram (KENALOG/ORABASE EQUIV) AutoStop Days: 30

84:08.00 ANTIPRURITICS AND LOCAL ANESTHETICS


Benzocaine-Menthol 20-0.5% Top Spray 2 oz (DERMOPLAST) AutoStop Days: 30
Tetracaine/Benzoc/Butam 2-14-2% top spray 56 gm (CETACAINE EQUIV) AutoStop Days: 30
LIDOCAINE TOP 4% LTA KIT (LTA II KIT) AutoStop Days: 30
Lidocaine 5% topical oint 35 gram (XYLOCAINE 5% EQUIV) AutoStop Days: 30
Phenazopyridine 100 mg tab (PYRIDIUM EQUIV) AutoStop Days: 30
PRAMOXINE HCL/CALAMINE LOT 6OZ (CALADRYL EQUIV) AutoStop Days: 30
Tetracaine 2% top sol 30 ml btl (PONTOCAINE 2% TOP EQUIV) AutoStop Days: 30

84:12.00 ASTRINGENTS
Alum Sulfate/Ca Acetate powder pack (DOMEBORO EQUIV) AutoStop Days: 30
Ferric Subsulfate top paste 8 ml (MONSEL'S PASTE EQUIV) AutoStop Days: 30
FLANDER'S BUTT OINT 120 GM AutoStop Days: 30
WITCH HAZEL-GLYCERIN PAD 40EA (TUCKS EQUIV) AutoStop Days: 30

84:24.04 BASIC LOTIONS AND LINIMENTS


Bath Oil (Keri) 240 ml btl (ALPHA KERI EQUIV) AutoStop Days: 30
LUBRIDERM 3.3 OZ LOTION (LUBRIDERM EQUIV) AutoStop Days: 30

84:24.08 BASIC OILS AND OTHER SOLVENTS


Mineral Oil, Light Sterile 30 ml bottle AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 60 of 66

84 SKIN AND MUCOUS MEMBRANE AGENTS


84:24.12 BASIC OINTMENTS AND PROTECTANTS
Benzoin, Compound Tinc 60 ml btl (TIN-CO-BEN EQUIV) AutoStop Days: 30
Calamine top lotion 120 ml btl (CALAMINE LOTION) AutoStop Days: 30
Lanolin top oint 1 lb jar AutoStop Days: 30
VITAMINS A & D OINT 60 GM TUBE AutoStop Days: 30
Zinc Oxide 20% top oint 30 grams AutoStop Days: 30

84:28.00 KERATOLYTIC AGENTS


Silver Nitrate Applicator Stick 100box AutoStop Days: 30

84:92.00 SKIN AND MUCOUS MEMBRANE AGENTS, MISC.\1


Benzoin, Compound Tinc Swabstick AutoStop Days: 30
Fluorouracil (5-FU) 5% top cream 40 grams (EFUDEX EQUIV) AutoStop Days: 30
HEMORRHOIDAL W PHENYLEPH SUPP (ANUSOL / ANUSERT EQUIV) AutoStop Days: 30
PAPAIN/UREA ACCUZYME OINT 6GM (ACCUZYME EQUIV) AutoStop Days: 30
PAPAIN/UREA ACCUZYME OINT 30GM (ACCUZYME EQUIV) AutoStop Days: 30
PAPAIN/UREA/CHLORPH 6 GM TUBE (PANAFIL) AutoStop Days: 30
PAPAIN/UREA/CHLORPH 30 GM TUBE (PANAFIL EQUIV) AutoStop Days: 30
PODOPHYLLIN 25 % SOLN 15ML (PODODERM EQUIV) AutoStop Days: 30
Surgical Lubricant 5 gram tube (SURGILUBE) AutoStop Days: 30
TRYPSIN/CASTOIL/PERUV SPR 56GM (GRANULEX EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 61 of 66

86 SMOOTH MUSCLE RELAXANTS


86:12.00 GENITOURINARY SMOOTH MUSCLE RELAXANTS
Oxybutynin 5 mg tab (DITROPAN EQUIV) AutoStop Days: 30

86:16.00 RESPIRATORY SMOOTH MUSCLE RELAXANTS


Aminophylline 500 mg/20 ml vial AutoStop Days: 30
Theophylline 100 mg SA TR12tab (THEODUR EQUIV) AutoStop Days: 30
Theophylline 200 mg SA TR24cap (THEO-24) AutoStop Days: 30
Theophylline 200 mg ER tab (THEOPHYLLINE ER) AutoStop Days: 30
Theophylline 300 mg SA TR12tab (THEODUR EQUIV) AutoStop Days: 30
Theophylline 80 mg/15ml oral sol cup AutoStop Days: 30
Theophylline in D5/W 800 mg/500 ml bag AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 62 of 66

88 VITAMINS
88:04.00 VITAMIN A
Beta-Carotene (Vit A) 10,000 unit cap AutoStop Days: 30
Beta-Carotene (Vit A) 25,000 unit cap (AQUASOL A EQUIV) AutoStop Days: 30

88:08.00 VITAMIN B COMPLEX


Cyanocobalamin (B12) 1,000 mcg tab (VITAMIN B-12) AutoStop Days: 30
Cyanocobalamin (B12) 1,000 mcg/ml vial (VITAMIN B-12) AutoStop Days: 30
FoLIC Acid 1 mg tab AutoStop Days: 30
FoLIC Acid 50 mg/10 ml vial (FOLVITE EQUIV) AutoStop Days: 30
Pyridoxine (B-6) 50 mg tab (VITAMIN B-6) AutoStop Days: 30
Pyridoxine (B-6) 100 mg/ml vial (VITAMIN B-6) AutoStop Days: 30
Thiamine (B-1) 100 mg tab (VITAMIN B-1) AutoStop Days: 30
Thiamine (B-1) 200 mg/2 ml vial (VITAMIN B-1) AutoStop Days: 30
VITAMIN B COMP WITH C TAB (VITABEE WITH C EQUIV) AutoStop Days: 30

88:12.00 VITAMIN C
Ascorbic Acid (Vit C) 500 mg tab (VITAMIN C) AutoStop Days: 30
Ascorbic Acid (Vit C) 500 mg/ml amp (VITAMIN C) AutoStop Days: 30

88:16.00 VITAMIN D
Calcitriol (Vit D) 0.25 mcg cap (ROCALTROL EQUIV) AutoStop Days: 30
Cholecalciferol (D3) 400 unit cap (VITAMIN D3) AutoStop Days: 30
Ergocalciferol (D2) 50,000 unit gelcap (DRISDOL EQUIV) AutoStop Days: 30
Ergocalciferol (D2) 8,000 units/ml 60 ml bt (CALCIFEROL) AutoStop Days: 30

88:20.00 VITAMIN E
Alpha-Tocopherol (Vit E) 400 unit gelcap (VITAMIN E) AutoStop Days: 30

88:24.00 VITAMIN K ACTIVITY


Phytonadione (Vit K) 5 mg tab (MEPHYTON EQUIV) AutoStop Days: 30
Phytonadione (Vit K) 10 mg/ml amp (AQUA-MEPHYTON EQUIV) AutoStop Days: 30
Phytonadione (Vit K) 1 mg/0.5ml (Neonat) amp (AQUA-MEPHYTON NEONATAL EQ AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 63 of 66

88 VITAMINS
88:28.00 MULTIVITAMIN PREPARATIONS
MULTIVITAMIN ADULT 10 ML VIAL (MVI-12 (ADULT)) AutoStop Days: 30
Multivitamin oral soln 30 ml (THERAGRAN EQUIV) AutoStop Days: 30
Multivitamin pediatric drops 50ml bt (POLY-VI-SOL EQUIV) AutoStop Days: 30
MULTIVITAMIN TABS (THERAGRAN EQUIV) AutoStop Days: 30
Multivitamins + Mineral tab (THERAGRAN-M EQUIV) AutoStop Days: 30
MULTIVITAMINS W-IRON TAB (ONE-TAB-DAILY W/IRON) AutoStop Days: 30
MVI, PEDI NO.1 WITH VIT K (M.V.I. PEDIATRIC) AutoStop Days: 30
PRENATAL MULTIVIT-MIN TAB (PRENATAL/FA/FE EQUIV) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 64 of 66

92 MISCELLANEOUS THERAPEUTIC AGENTS\1


92:00.00 MISCELLANEOUS THERAPEUTIC AGENTS\1
Laminara Japonica Medium stick (DILATERIA MEDIUM THICK) AutoStop Days: 30
Laminara Japonica Thick stick (DILATERIA THICK) AutoStop Days: 30

92:08.00 5-ALPHA-REDUCTASE INHIBITORS\1


Finasteride 5 mg tab (PROSCAR EQUIV) AutoStop Days: 30

92:12.00 ANTIDOTES\1
Leucovorin Calcium 100 mg vial AutoStop Days: 30
Leucovorin Calcium 200 mg vial AutoStop Days: 30
Leucovorin Calcium 350 mg/50 ml vial AutoStop Days: 30
Leucovorin Calcium 500 mg/50 ml vial AutoStop Days: 30
Methylene Blue 1% soln 10 ml vial AutoStop Days: 30
Pralidoxime Chloride 1 gram vial (PROTOPAM EQUIV) AutoStop Days: 30

92:16.00 ANTIGOUT AGENTS\1


Allopurinol 100 mg tab (ZYLOPRIM EQUIV) AutoStop Days: 30
Colchicine 0.6 mg tab AutoStop Days: 30
Colchicine 1 mg/2 ml amp AutoStop Days: 30

92:44.00 IMMUNOSUPPRESSIVE AGENTS\1


azaTHIOprine 50 mg tab (IMURAN EQUIV) AutoStop Days: 30

92:56.00 PROTECTIVE AGENTS\1


Mesna 1000 mg/10 ml vial (MESNEX EQUIV ) AutoStop Days: 30

92:92.00 OTHER MISCELLANEOUS THERAPEUTIC AGENTS\1


Alcohol, Ethyl 98% 1 ml amp (ETHYL ALCOHOL 98%) AutoStop Days: 30
Alcohol, Ethyl 95% 5 gallon (ETHANOL 95%) AutoStop Days: 30
Alcohol, Ethyl 100% 1 gallon (ETHANOL 100%) AutoStop Days: 30
BEER 360ML LIQUID AutoStop Days: 30
Trichophyton Skin Test 1:200 2 ml vial AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 65 of 66

94 DEVICES
94:00.00 DEVICES
DISCOVISC VISCOSURGICAL 1 ML (DISCOVISC) AutoStop Days: 30
DUOVISC VISCOELASTIC KIT (DUOVISC) AutoStop Days: 30
SOD HYALURON 0.55ML 10MG/ML (HEALON 10MG/ML) AutoStop Days: 30
SOD HYALURON GV 0.55ML 14MG/ML (HEALON GV 14MG/ML) AutoStop Days: 30

Revised: April 2010


E. A. Conway Medical Center - 2010 Hospital Formulary by Drug Classification Page 66 of 66

96 PHARMACEUTICAL AIDS
96:00.00 PHARMACEUTICAL AIDS
Collodion, Flexible top sol 120 ml btl (FLEXIBLE COLLODION 120ML) AutoStop Days: 30
GLYCERIN (BULK) LIQD 30 ML AutoStop Days: 30
SYRUP FOR COMPOUNDING 30 ML (SYRPALTA EQUIV) AutoStop Days: 30
Water for Inj Bacteriostatic 30 ml vl (BACTERIOSTATIC WATER) AutoStop Days: 30
WATER FOR INJ STERILE 1000 ML (STERILE WATER ADDITIVE) AutoStop Days: 30
Water for Injection 10 ml vial (STERILE WATERFOR INJ) AutoStop Days: 30

Revised: April 2010

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