Programa de Farmacia de Triple-S Salud, Inc. TRIPLE-S SALUD, INC.
Pharmacy Program from Triple-S Salud, Inc. TRIPLE-S SALUD, INC.
Lista de Medicamentos Asegurados y Encargados de Grupo
2013-2014
Drug List Members and Group Administrators
2013-2014
Rev. 12/ 2013
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TABLA DE CONTENIDO TABLE OF CONTENTS
PREFACIO / Preface ..................................................................................................... 3
INTRODUCCIÓN / Introduction ..................................................................................... 5
PARTE I - DISEÑO DE LA LISTA DE MEDICAMENTOS / Part I – Drug List Design ..... 7
Presentación de la Lista de Medicamentos / Drug List Presentation ................. 7
Guías de Referencia / Reference guidelines .................................................... 11
Éditos de análisis de utilización (DUR) / Edits for Utilization Analysis ............... 14
Derechos Reservados / Reserved rights ........................................................ 17
Leyenda para los Símbolos y Abreviaturas / Legend for symbols and
abbreviations ................................................................................................. 18
PARTE II - MEDICAMENTOS POR CLASIFICACIÓN TERAPÉUTICA / Drugs by Therapeutic Class ....................................................................................................... 20
PARTE III – INDICE / Index ....................................................................................... 93
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PREFACIO
Estimado Asegurado y Encargado de Grupo: El costo de los medicamentos tanto en Puerto Rico como en los Estados Unidos continúa registrando un aumento sostenido. Su cubierta de farmacia utiliza una Lista de Medicamentos para ayudar a reducir el continuo aumento en los costos de los medicamentos y a la vez ofrecerle una amplia selección de opciones de tratamiento costo-efectivas. Se ofrece también como una alternativa para continuar ofreciendo a nuestros asegurados planes de farmacia más accesibles. La Lista de Medicamentos es una guía de los medicamentos seleccionados por el Comité de Farmacia y Terapéutica de Triple-S Salud, la cual representa los medicamentos necesarios para un tratamiento de alta calidad. Nuestro Comité de Farmacia y Terapéutica está compuesto por médicos, farmacéuticos clínicos y otros profesionales de la salud, quienes se reúnen periódicamente para evaluar y seleccionar aquellos medicamentos que serán incluidos en esta Lista de Medicamentos. Esta selección se hace a base de la seguridad, efectividad y costo de los medicamentos. De ahí la importancia de que su médico y usted seleccionen los medicamentos en la Lista. El Comité revisa la Lista de Medicamentos dos veces al año, en los meses de febrero y agosto. Los cambios a la Lista de Medicamentos le serán notificados a través de comunicaciones emitidas por Triple-S Salud. Además, puede obtener una copia de nuestra Lista a través de nuestro portal en la Internet www.ssspr.com o nuestro Departamento de Servicio al Cliente, llamando al 787-774-6060. En las páginas a continuación presentamos la Lista de Medicamentos, con toda la información requerida para facilitarle su lectura e interpretación. Le exhortamos a que evalúe con su médico los medicamentos disponibles en nuestra Lista para tratar su condición. Nuestra Lista contiene un sinnúmero de medicamentos por condición, los cuales incluyen medicamentos genéricos y de marca preferidos, entre otros. Al utilizarla, usted contribuye a mantener los costos del beneficio de farmacia en un nivel razonable, además que sus copagos serán menores. Cordialmente, Pablo Almodóvar Presidente y Principal Oficial Ejecutivo Triple-S Salud, Inc.
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PREFACE
Dear Member and Group Administrator: The drugs costs continue recording a continuous increase both in Puerto Rico and the United States. Your plan uses a Drug List to help reduce the continuous increase in drug costs while offering a wide variety of cost-effective medication choices for you treatment. It is also offered as an alternative to continue offering our members accessible prescription drug plans. The Drug List is a guide of prescription drugs selected by the Pharmacy and Therapeutic Committee which represents the drugs necessary for a high quality treatment. Our Pharmacy and Therapeutic Committee is composed of specialized doctors, clinical pharmacists and other health care professionals, who meet periodically and select the prescription drugs to be included in the Drug List. Such selection is made based on security, effectiveness and cost of the drugs. That is why it is so important that you and your doctor choose drugs on the List. The Committee will review the Drug List twice a year, in February and August. The changes to the Drug List will be notified through communications issued by Triple-S Salud. In addition, you can obtain a copy of your Drug List through our web portal at www.ssspr.com or by calling Customer Services at 787- 774-6060. In the pages immediately after, we introduce the Drug List with all the required information to make easy its reading and interpretation. We recommend that you evaluate with your doctor the prescription drugs available in our Drug List to treat your condition. Our List contains a great amount of drugs per condition, which include generic and preferred brand drugs, among others. By using the List, you contribute to maintain pharmacy benefit costs at a reasonable level, and your cost-sharing will be lower. Cordially, Pablo Almodóvar President and Chief Executive Office Triple-S Salud, Inc.
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INTRODUCCIÓN INTRODUCTION
Esta Lista de Medicamentos se divide en tres partes. This Drug List is divided into three parts. La primera parte es un resumen que le provee información sobre la forma en que se diseñó la Lista de Medicamentos. También se incluye una descripción de los éditos de análisis de utilización para validar dosis e identificar terapias duplicadas. Estos éditos están disponibles a través del sistema de procesamiento y adjudicación de reclamaciones de MC-21 Corporation. The first part is a summary that provides with information about the way the Drug List was designed. It includes a description of the utilization analysis edits used to validate dosage and identify duplicate therapies. These edits are available through the claim adjudication and processing system of MC-21 Corporation. La segunda parte contiene los medicamentos por clasificación terapéutica. The second part contains the drugs by therapeutic categories. La tercera parte contiene una lista por orden alfabético (Índice) de los medicamentos de marca y genéricos, disponibles en la Lista de Medicamentos. The third part contains a list in alphabetical order (Index) of brand and generic drugs available in the Drug List. La inclusión de un medicamento a la Lista de Medicamentos no indica que el medicamento es un medicamento cubierto. La cubierta de farmacia es la que determina si el medicamento está cubierto o excluido en la póliza. Por ejemplo, los medicamentos para dejar de fumar, los agentes para la disfunción eréctil, las hormonas de crecimiento y los medicamentos sin leyenda federal (OTC) usualmente están excluidos de la cubierta de farmacia. The inclusion of a drug in the Drug List does not mean that the medication is covered. The pharmacy insurance coverage is the one that determines if the drug is covered or excluded by the policy. For example, the smoking cessation drugs, erectile dysfunction drugs, growth hormones and the medications with no federal legend (OTC) usually are excluded from the pharmacy coverage. El Comité de Farmacia y Terapéutica revisa la Lista de Medicamentos continuamente. The Therapeutics and Pharmacy Committee reviews the Drug List continuously.
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Los cambios a la Lista por medicamentos que se mueven al Nivel 4: No Preferidos serán efectivos a la fecha de revisión, febrero y agosto de cada año. The changes to the Drug List for drugs that are moved to Level 4: Non-Preferred will be effective on the review date; February and August of each year. Para estos medicamentos existirá un período de gracia de 90 días a partir de la fecha de efectividad de los cambios a la Lista. Durante este período de gracia, el asegurado continuará pagando el copago o coaseguro que aplica a los Niveles del 1 al 3 por este medicamento que se mueve al Nivel 4: No Preferido. Una vez terminado el período de gracia, el asegurado pagará el copago o coaseguro que corresponda a su cubierta para los medicamentos No Preferidos (Nivel 4), los cuales son mayores. For these drugs there will be a 90-day grace period which begins on the effective date of the Drug List changes. During this grace period, our insured will continue to pay the copayments or coinsurances applicable to Levels 1 to 3 in the Drug List for the one that has been moved to Level 4 (Non-Preferred). Once the grace period ends, the insured will have to pay the corresponding copayments or coinsurances as indicated in his/her pharmacy benefits coverage for Non-Preferred drugs (Level 4), which are higher.
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PARTE I - DISEÑO DE LA LISTA DE MEDICAMENTOS
PART I- DRUG LIST DESIGN
Presentación de la Lista de Medicamentos
Drug List Presentation En el ejemplo a continuación se ilustra la información que se provee para los medicamentos incluidos en la Lista de Medicamentos. The following example shows the information provided for those drugs included in the Drug List.
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial
Brand Name
Nivel Level
Inst
DERMATOLOGICALS (DERMATOLÓGICOS)
Acne (Acné)
adapalene topical cream 0.1 % DIFFERIN 4
adapalene topical gel 0.3 % DIFFERIN 4 SL AL
adapalene topical gel 0.1 % DIFFERIN 4
azelaic acid topical cream 20 % AZELEX 4
benzoyl peroxide topical gel 2.5 %,
topical liq 5 %
DESQUAM 1
Para cada medicamento incluido en la Lista de Medicamentos aparece su presentación, el nombre comercial, el nivel y si tiene alguna instrucción especial. For every medication included in the Drug List the dosage form, trademark name of the drug, level, and any special instruction will appear.
¿Cómo usar la Lista de Medicamentos? How do I use the Drug List? La manera más fácil en que usted puede conseguir los medicamentos en la Lista de Medicamentos es buscando el medicamento en el Índice que comienza en la página 93. El Índice provee una lista por orden alfabético de todos los medicamentos incluidos en este documento. Ambos, medicamentos de marca como genéricos están incluidos en el Índice. Busque el Índice y encuentre el medicamento. Al lado del medicamento, usted encontrará el número de la página donde encontrará cómo está cubierto. Voltee a la página indicada en el Índice y encuentre el nombre del medicamento en las columnas. The easiest way that you can find the prescription drugs is seeking it in the Index that begins on page 93. The Index provides an alphabetical list of all of the drugs included in this document. Both brand-name drugs and generic drugs are listed in the Index. Look in the Index and find the drug. Next to the drug, you will see the page number where you can find coverage information. Turn to the page listed in the Index and find the name of the drug in the columns.
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¿Cuánto usted paga por los medicamentos cubiertos? How much you will pay for covered drugs? Los medicamentos en la lista de medicamentos se clasifican por niveles. Estos niveles identifican los diferentes niveles de costo compartido, o sea, lo que usted paga por los medicamentos en la receta. Estos niveles son los siguientes:
Nivel 1 – Medicamentos Genéricos
Nivel 2 – Medicamentos Preferidos
Nivel 3 – Medicamentos de Marca
Nivel 4 – Medicamentos No Preferidos
Nivel 5 – Medicamentos Especializados o Biotecnológicos The prescription drugs in the Drug List are classified by levels. These levels identify the different levels of cost-sharing, that is, what you pay, for the drugs in the prescription. These levels are the following:
Level 1 – Generic Drugs Level 2 – Preferred Drugs Level 3 – Brand drugs Level 4 – Non-Preferred Drugs Level 5 – Specialty or Biotech Drugs
El 23 de marzo de 2010, entro en vigor la Affordable Care Act (ACA). Efectivo el 1ro de enero del 2014, como parte de los requisitos de esta ley, y dependiendo de su cubierta, usted tendrá acceso a unos medicamentos preventivos específicos, a los cuales les aplican $0 copago, si son recetados o suministrados por proveedores participantes según requiere el gobierno federal. A continuación los medicamentos incluidos en esta ley:
Anticonceptivos aprobados por la FDA (incluyendo OTC y con receta médica)1 Fluoruro (hasta los 6 años) Aspirina (con límite de cantidad de una 1 tab / diaria; pacientes mayores de 18 años) Hierro (hasta los 12 meses) Ácido fólico (sólo para mujeres)
Este beneficio aplicará a los planes de salud que no tienen estatus protegido (nongrandfather plans). Usted debe comunicarse con nuestro Departamento del Servicio al Cliente al 787-749-4949 para verificar si su cubierta es acreedora de este beneficio. The Affordable Care Act (ACA), entered into force March 23, 2010. Effective January 1, 2014, as part of the requirements of this law, and depending on your pharmacy benefit, you will have access to some specific preventive drugs for which $ 0 copay will apply, if prescribed or provided by participating providers, as required by Federal Law. The following drugs are included in this law:
1 Aplica a los siguientes anticonceptivos: Condón Femenino, Contaceptivos Orales, Dispositivo Intrauterino (IUD),
Diafragma, Mirena IUD®, Plan B
®, Espermicidas (OTC foam), Ortho Evra Patc
®, Nuvaring
®.
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FDA approved contraceptives (including OTC and prescription)2
Fluoride (up to 6 years)
Aspirin (with quantity limit of 1 tab / day; over 18 years)
Iron (up to 12 months)
Folic acid (females only)
This benefit applies to health plans that are not protected status (nongrandfather plans). You must contact our Customer Service Department at 787-749-4949 to see if your pharmacy coverage is deserving of this benefit.
¿Qué son medicamentos genéricos (Nivel 1)? What are generic drugs (Level 1)? Un medicamento genérico tiene el mismo ingrediente activo en la fórmula que un medicamento de marca. Los medicamentos genéricos usualmente cuestan menos que un medicamento de marca y están aprobados por la Administración Federal de Drogas y Alimentos (FDA, por sus siglas en inglés). A generic drug has the same active-ingredient formula as the brand name drug. Generic drugs usually cost less than brand name drugs and are approved by the Food and Drug Administration (FDA). Los medicamentos genéricos están escritos en letras negrillas pequeñas en la Lista de Medicamentos (ejemplo, nabumetone). Medicamentos de marca están escritos en letras mayúsculas (ejemplo, RELAFEN). Generic drugs are listed in bold lower-case (e.g., nabumetone) within the Drug List. Brand-name drugs are capitalized in the Drug List (e.g., RELAFEN). Recomendamos que utilice los medicamentos genéricos. Estos son iguales en potencia y dosis y también son aprobados por la FDA. We recommend that you use generic drugs. They are equal in strength and dosage, are also approved by the FDA.
¿Qué son medicamentos preferidos (Nivel 2)? What are preferred drugs (Level 2)? Hay ciertos medicamentos de marca que han sido seleccionados por el Comité de Farmacia y Terapéutica como agentes preferidos luego de su evaluación de seguridad, eficacia y costo. Los mismos están identificados a la derecha como Nivel 2. En aquellas clases terapéuticas donde no hay genéricos disponibles, les exhortamos a que utilice como primera alternativa aquellos medicamentos identificados como preferidos.
2 Applies to the following contraceptives: Female Condom, Oral Contaceptivos, Intrauterine Device (IUD), Diaphragm,
IUD Mirena ®
, Plan B ®,
Spermicides (Foam OTC), Ortho Evra Patc ®
, NuvaRing ®
.
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There are certain brand name drugs classified by the Therapeutics and Pharmacy Committee as preferred agents after a thorough evaluation in terms of safety, efficiency and cost. These are identified with a Level 2 placed to the right of the name of the drug identifies these as Preferred. In those therapeutic classes where there are no generic drugs available, we urge you to use as first alternative those drugs identified as preferred.
¿Qué son medicamentos de Marca (Nivel 3)? What are Brand drugs (Level 3)? Son los medicamentos que se ofrecen al público bajo un nombre comercial o marca de fábrica. Estos medicamentos están identificados como Nivel 3. Los medicamentos de marca están asociados a un copago mayor que los productos de marca preferidos que son los del Nivel 2 y que los productos genéricos (Nivel 1) incluidos en la Lista de Medicamentos. Those are prescription drugs offered to the public under a commercial name or manufacturing brand. These drugs are identified as Level 3. The brand drugs have a higher copayment than the preferred drugs, which are those in Level 2, and generic drugs (Level 1) included in the Drug List.
¿Qué son medicamentos No Preferidos (Nivel 4)? What are Non-Preferred Drugs (Level 4)? Un medicamento es clasificado como No Preferido porque existen alternativas en los niveles anteriores con menos efectos secundarios o son más costo-efectivos. Si el asegurado obtiene un medicamento de marca del Nivel 4, tendrá que pagar un costo mayor por el medicamento. A drug is classified as Non-preferred because there are other options in previous levels with lesser side effects or are more cost effective. If the insured obtain a brand drug from Level 4, will have to pay more for that drug.
¿Qué son medicamentos Especializados o Biotecnológicos? What are Specialty or Biotech Drugs? Algunos medicamentos para condiciones crónicas y de alto riesgo requieren una administración y/o un manejo especial, por su composición compleja. Estos medicamentos se ofrecen a través de las farmacias de la red o del Programa de Medicamentos para Condiciones Especiales, el cual cuenta con una red de farmacias especializadas dedicadas a que estos medicamentos sean despachados y administrados correctamente. Los mismos se incluyen en este documento al final de la tabla de los medicamentos y en algunas pólizas componen el Nivel 5 de la cubierta de farmacia. Si su beneficio de farmacia no establece un nivel específico para estos productos aplicará el primer nivel indicado en la columna de la tabla de productos especializados (Página 66).
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Certain medications for chronic and high-risk conditions require special administration and/or management, due to their complex composition. These drugs are offer through the pharmacy network or through the Medication Program for Special Conditions, which boasts a network of specialized pharmacies dedicated to ensuring that these medications are dispensed and administered correctly. These drugs are included in this document at the end of the table of medications and they represent Level 5 of the pharmacy coverage in some policies. If your Pharmacy benefit does not establish a specific level for these products, the first level indicated in the column of the Specialty Products table will apply (Page 66).
Guías de Referencia Reference Guidelines
Medicamentos que requieren preautorización (PA) Medications that require pre-authorization (PA) Ciertos medicamentos necesitan una preautorización para ser adquiridos por el paciente. Los mismos se han identificado a la derecha con PA (requiere preautorización), en cuyo caso, la farmacia gestiona la preautorización con MC-21 Corporation previo al despacho del medicamento al asegurado. There are certain drugs that require a preauthorization before being acquired by the patient. A PA (preauthorization is required) placed to the right of the name of the drug identifies them, for which, the pharmacy will process the preauthorization directly to MC-21 Corporation before dispensing it to the insured member. Los medicamentos que requieren preautorización usualmente son aquellos que presentan efectos adversos, son candidatos al uso inapropiado o están relacionados con un costo elevado. The medications that require a preauthorization usually are those that present adverse effects, have a potential for inappropriate use or are related to a higher cost. Aquellos medicamentos que han sido identificados que requieren preautorización deben satisfacer los criterios clínicos establecidos según lo haya determinado el Comité de Farmacia y Terapéutica. Estos criterios clínicos se han desarrollado de acuerdo a la literatura médica actual. Those medications identified as requiring preauthorization must meet the established clinical criteria as determined by the Therapeutics and Pharmacy Committee. These criteria have been developed according to current medical literature. Medicamentos cuyo costo excedan $500.00 requerirán una preautorización para su despacho. La farmacia enviará copia de la receta a MC-21 Corporation a través del fax 1-866-387-3487 ó 1-866-277-6556 para la autorización de la misma.
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Medications whose cost exceeds $500.00 will require a pre-authorization in order to be dispensed. The pharmacy will send MC-21 Corporation a copy of the prescription via fax at 1-866-387-3487 ó 1-866-277-6556 for authorization.
Programa de Terapia Escalonada Step Therapy Program En algunos casos, requerimos que usted utilice primero un medicamento como terapia para su condición antes de que cubramos otro medicamento para esa condición (Terapia Escalonada). Por ejemplo, si el Medicamento A y el Medicamento B se usan ambos para tratar su condición médica, nosotros requerimos que usted utilice primero el Medicamento A. Si el Medicamento A no funciona para usted, entonces cubriremos el Medicamento B. In some cases, we require you to first try one drug to treat your medical condition before we will cover another drug for that condition (Step Therapy). For example, if Drug A and Drug B both treat their medical condition, we may require you use Drug A first. If Drug A does not work for you, then we will cover Drug B. Este programa requiere la utilización de medicamentos sin leyenda federal (OTC, por sus siglas en inglés) o medicamentos genéricos antes de utilizar otros medicamentos para tratar su condición médica. Algunas clasificaciones que requieren un medicamento OTC como primer paso incluyen los inhibidores de la bomba de protón (PPI, por sus siglas en inglés), antihistamínicos no-sedantes y agentes para alergias oculares. Otras clasificaciones que requieren un medicamento genérico como primer paso incluyen las estatinas para el colesterol, los bifosfonatos orales para la osteoporosis y los corticosteroides nasales para las alergias. This program will require the utilization of Over-The-Counter (OTC) drugs or Generic drugs before using other drugs to treat your medical condition. Some of the "OTC First" portion includes Proton Pump Inhibitors (PPI), Non-sedating antihistamines, and Ocular allergies agents. Others in the "Generic First" portion includes Cholesterol drugs-Statins, Osteoporosis-Oral Bisphosphonates, and Allergies-Nasal Corticosteroids.
Límites de cantidad (QL) Limits on the amount to be dispensed Ciertos medicamentos tienen un límite en la cantidad a despacharse. Estas cantidades se establecen de acuerdo a lo sugerido por el manufacturero como la cantidad máxima adecuada que no está asociada a efectos adversos y la cual es efectiva para el tratamiento de una condición. Certain medications have a limit on the amount to be dispensed. These amounts are established according to the manufacturer’s recommendation as to the adequate maximum amount that will not cause adverse effects and which is effective for the treatment of a condition. El Apéndice I contiene la lista de los medicamentos que tienen límites en la cantidad a despacharse. La misma es vigente al momento de imprimirse esta Lista y está sujeta a cambios.
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Appendix I includes a list of the medications that currently have a limit amount for dispensing. The list is effective at the moment of the publication of this List and is subject to changes.
Límites de especialidad médica (SL) Medical specialty limits Algunos medicamentos tienen un límite en la especialidad médica. Estos límites de especialidad se establecen de acuerdo a la literatura médica actual. Some medications have a limit in the medical specialty. These medical specialty limits are established in accordance with the current medical literature. El Apéndice II contiene la lista de los medicamentos que tienen límite de especialidad médica. La misma es vigente al momento de imprimirse esta Lista y está sujeta a cambios. Appendix II contains the list of medications that has a medical specialty limit. The list is effective at the moment of the impression of this List and is subject to changes.
Límites de edad (AL) Age limits Algunos medicamentos tienen un límite de edad. El Apéndice III contiene la lista de los medicamentos que tienen un límite de edad. La misma es vigente al momento de imprimirse esta Lista y está sujeta a cambios. Some medications have a limit due to age. Appendix III contains the list of medications that has an age limit. The list is effective at the moment of the impression of this document and is subject to changes.
Límite de Acceso (LA) Limited Access Algunos medicamentos requieren manejo, seguimientos o dosis especiales, los cuales deben ser monitoreados por un profesional de la salud. Existen un número reducido de medicamentos especializados con acceso limitado o distribución limitada. Debido al seguimiento, monitoreo y observando la seguridad de los pacientes, los manufactureros y la Administración de Drogas y Alimentos (FDA), limitan la obtención de estos medicamentos a uno o un número muy limitado de farmacias. Entre los beneficios de limitar el acceso se encuentran: Some drugs require special handling, tracking or special doses, which should be monitored by a health professional. There are a small number of specialty drugs with limited access or limited distribution. Due to tracking, monitoring and observing the patient safety, manufacturers and the Food and Drug Administration (FDA) limit the acquisition of these drugs to one or a very limited number of pharmacies. Among the benefits of limiting access are:
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Los manufactureros pueden mantener un seguimiento del inventario de medicamentos Manufacturers can keep track of the drug’s inventory
Los profesionales de la salud son educados adecuadamente sobre cualquier monitoreo necesario Health professionals are properly educated about any neccessary monitoring
Educación individualizada del paciente Patient's individualized education
Se asegura de que los riesgos que se asocian con estos medicamentos se reduzcan al mínimo. Ensures that the risks associated with these drugs are minimized.
Uso de medicamentos en investigación o experimentales Use of investigational or experimental medications Los medicamentos recetados para propósitos de investigación, experimentales o no aprobados por la FDA, no se cubren en ningún plan de salud o cubierta de farmacia. Investigational or experimental drugs, or those not approved by the FDA, are not covered by all health plans or pharmacy coverage.
Recetas de compuestos Compounded prescriptions Las recetas de compuestos se consideran medicamentos cubiertos si contienen por lo menos un medicamento de la Lista, siempre y cuando no sea para propósitos cosméticos. Compounded prescriptions are considered covered drugs if they contain at least one of the drugs on this List, as long as they are not for cosmetic purposes.
Éditos de análisis de utilización (DUR) Edits for Drug Utilization Analysis A través del Programa de Beneficio de Farmacia de Triple-S Salud, Inc. se han implantado los siguientes éditos de análisis de utilización (DUR, por sus siglas en inglés) con el propósito de evitar complicaciones a los asegurados, ofreciendo un mejor cuidado. Through the Pharmacy Benefit Management Program, Triple-S Salud has implemented the following edits for drug utilization (DUR) in order to avoid complications to the insured persons while offering a better care. Édito de Validación de Dosis - coteja para dosis máximas diarias usando como
referencia las dosis pediátricas, de adultos y geriátricas de acuerdo a la información suministrada por Medi-Span®. En la mayoría de los casos, la dosis máxima es aquella aprobada por la FDA.
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Dose check edits - verify for daily maximum dosages using as reference the pediatric, adult and geriatric dosages according to Medi-Span®. In the majority of cases, the maximum dosage is the one approved by the FDA.
Édito de Terapia Duplicada - verifica el historial de medicamentos del paciente
asegurado para recetas duplicadas, de dos formas: Duplicate Therapy edits - verify the insured person’s drug history for duplicate prescriptions, in two ways:
1. el paciente asegurado recibe el mismo medicamento (Ej. mismo ingrediente activo)
con dos recetas distintas (Ej. número de receta distinto, puede ser la misma farmacia o farmacias diferentes). The insured person receives the same medication (e.g. same active ingredient) with two different prescriptions (e.g. Prescription number is different; it could be through the same pharmacy or different ones).
2. el paciente asegurado recibe dos medicamentos de la misma clase terapéutica,
como por ejemplo, dos antidepresivos o dos analgésicos, entre otros. The insured person receives two drugs of the same therapeutic class, for example: two anti-depressants or two analgesics.
Hay ciertas excepciones a estos éditos. Para evitar que el sistema rechace servicio a los asegurados, nosotros les solicitamos a los médicos y dentistas que incluyan la siguiente información en la receta del paciente: There are exceptions to these edits. In order to prevent the system from denying the service, we suggest that physicians include the following information in the patient’s prescription:
Cambio en dosis Change in dosage
Si aumentó la dosis y usted necesita más medicamentos antes de tiempo, en este caso se necesitará una carta de justificación de parte del médico indicando el cambio en dosis. La farmacia requerirá una preautorización a MC-21 Corporation, luego de que se reciba la información necesaria de la receta. If the dosage increases and the insured person needs medication right away, a letter from the physician justifying the dosage change will be required. The pharmacy will require a pre-authorization from MC-21 Corporation after receipt of the necessary information regarding that prescription.
- Si la dosis se determina por su peso, el médico debe indicar su peso y estatura en la receta. If the dosage is determined by your weight, the physician must indicate your weight and height in the prescription.
- Cuando la dosis del medicamento se ajuste de acuerdo a los niveles en sangre, el médico debe indicarlo así en la receta (Ej. Ajuste de niveles para tiroides, teofilina, anticonvulsivos, warfarina). When the dosage of the drug is adjusted accordingly to blood levels, the physician must indicate it in the prescription (e.g.: adjustments for thyroid, theophyline, anti-convulsivants, and warfarins).
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- Cuando para la dosis indicada en la receta no existe su presentación farmacéutica.
Por ejemplo, la tableta viene de 25 mg y 50 mg pero el paciente necesita 75 mg (dosis indicada y aceptada). La farmacia requerirá una preautorización a MC-21 Corporation, luego de que se reciba la información necesaria en la receta (se requiere copia de la receta y hoja de preautorizaciones de MC-21). When the dosage indicated in the prescription does not exist in the pharmaceutical dosage form of the medication. For example, the tablet exists in 25 mg and 50 mg, but the patient needs a 75 mg dosage (dose required and accepted). The pharmacy will require a pre-authorization from MC-21 Corporation after the receipt of the necessary information for the prescription (a copy of the prescription will be required and copy of the pre-authorization form from MC-21 Corporation).
Procedimiento para solicitar una Excepción Médica
Procedure to request a Medical Exception
El asegurado o representante legal autorizado podrán solicitar cobertura para un
medicamento que no esté excluido del formulario de forma categórica3 utilizando la forma
que se encuentra en el Apéndice VII (página 85). Esta forma se encuentra disponible
también en nuestra página web www.ssspr.com.
The insured or legally authorized representative may request coverage for a drug that is not
expressly excluded on the form using the form found in Appendix VII (page 85). This form is
also available on our website www.ssspr.com
Las razones por las cuales un asegurado puede solicitar una excepción médica son:
The reasons why an insured may request a medical exception are:
Medicamentos no cubiertos por el formulario Medications not covered by the formulary
Descontinuación de medicamento por motivos que no sean de seguridad o retiro del mercado por su fabricante Drug discontinuation for reasons other than safety or recall by the manufacturer
Excepción al procedimiento de terapia escalonada o limitación de dosis. Exception to the step therapy or dose limitation)
3 Exclusión de forma categórica significa que el nombre científico o comercial del medicamento solicitado no
está en la lista de exclusiones del formulario. 3
Exclusion categorically means that the scientific name or trade name requested drug is not on the exclusion list of the formulary.
2013-2014 | 17
Se requerirá una certificación que incluya la siguiente información:
Certification will be required to include the following information:
Nombre, número de grupo o número de contrato. Name, group or contract number
Historial del paciente. Patient History
Diagnóstico primario relacionado con el medicamento de receta objeto de la solicitud Primary diagnosis related to prescription drug subject of the request
Razón para la solicitud de excepción. Reason for Exception Request
Razón por la cual el medicamento solicitado se necesita, o por la cual la excepción en cuanto al procedimiento de terapia escalonada o limitación de dosis es necesaria para el cuidado del paciente. The reason why the requested drug is needed, or why the exception for the step therapy procedure or dose limitation is necessary for patient care.
Firma del prescribiente. Prescriber signature
La solicitud de excepción médica será revisada por profesionales de la salud con
experiencia en el manejo de medicamentos. Las determinaciones tomadas corresponderán
a los beneficios y exclusiones que se disponen en su cubierta. El asegurado será notificado
de la decisión mediante carta o correo electrónico (según solicitado).
The medical exception request will be reviewed by health professionals with expertise in
medication management. The determinations made will correspond to the benefits and
exclusions that are available in your coverage. The insured will be notified of the decision by
letter or email (as requested).
Derechos Reservados
Reserved Rights La Lista de medicamentos es una propiedad literaria. MC-21 Corporation y Triple-S Salud, Inc. son los propietarios de los derechos de autor. Bajo ninguna circunstancia se podrá copiar o distribuir la Lista de Medicamentos ni cualquier porción de éste sin el consentimiento escrito de MC-21 Corporation y Triple-S Salud, Inc. The Drug List is a literary property. MC-21 Corporation and Triple-S Salud, Inc. are the proprietors of the author’s rights. Under no circumstances may this material be copied or distributed in whole or any part without the written consent of MC-21 Corporation and Triple-S Salud, Inc.
2013-2014 | 18
Leyenda para los Símbolos y Abreviaturas
Legend for Symbols and Abbreviations
Símbolo / Abreviatura
Descripción
AL Identifica aquellos medicamentos para los cuales existe algún límite de edad / Identifies those medications for which an age limit exists
Cap Cápsula / Capsule
Conc Concentrado / Concentrated
Cr Crema / Cream
ER, SR, CR Acción prolongada, acción sostenida, acción controlada / Extended release, sustained release, controlled release
Inh Inhalador / Inhaler
Inj Inyectable / Injectable
QL Identifica aquellos medicamentos para los cuales existe algún límite en la cantidad que la farmacia puede despachar / Identifies those medications for which a dispensing limit exists
SL Identifica aquellos medicamentos para los cuales existe algún límite en la especialidad médica que debe manejar la terapia con estos productos / Identifies those medications for which a limit in the medical specialty exists that must manage the therapy with these products
LA Identifica a aquellos medicamentos con límite de Acceso o Limite de Distribución/ Identify those medications which have a limited access o limited distribution
Lot Loción / Lotion
Negrilla (Bold) Identifica que el medicamento tiene genérico disponible en todas las presentaciones / Identifies if the medication has a generic available in all its dosage forms
Nivel 1 Identifica los medicamentos genéricos / Identifies Generic drugs
Nivel 2 Identifica los medicamentos de marca preferidos / Identifies Preferred drugs
Nivel 3 Identifica los medicamentos de marca / Identifies Brand drugs.
Nivel 4 Identifica los medicamentos no preferidos / Identifies Non-Preferred drugs
Oint Ungüento / Ointment
Oph Oftálmico / Ophthalmic
OTC Medicamentos fuera del Recetario / Over the Counter Drug
PA Preautorización. La farmacia es responsable de solicitar y obtener una preautorización con MC-21 Corporation o Triple-S Salud, Inc., antes de despacharse el medicamento / Preauthorization. The pharmacy is responsible to request and obtain a prior authorization from MC-21 Corporation or Triple-S Salud, Inc., before dispensing the prescription drug.
SHA Champú / Shampoo
Sl Sublingual / Sublingual
SNC Sistema Nervioso Central / Central Nervous System
Soln Solución / Solution
ST Terapia Escalonada / Step Therapy
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Símbolo / Abreviatura
Descripción
Supp Supositorio / Suppository
Susp Suspensión / Suspension
Tab Tableta / Tablet
Td Transdermal / Transdermal
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PARTE II - MEDICAMENTOS POR CLASIFICACIÓN TERAPÉUTICA
PART II - DRUGS BY THERAPEUTIC CATEGORY Medicamentos
Drugs Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
ANESTHETICS (ANESTÉSICOS)
lidocaine inj 1 %, 2 % XYLOCAINE 4
ANTI-ADDICTION/SUBSTANCE AUSE TREATMENT AGENTS (TRATAMIENTO DE ABUSO DE SUSTANCIAS/CONTRA LA ADDICION)
Opioid Antagonist (Antagonista de Opioides)
buprenorphine sl tabs 2 mg, 8 mg SUBUTEX 1 PA
buprenorphine & naloxone
sl film 12-3 mg, 2-0.5 mg, 4-1 mg, 8-2 mg, sl tabs 2-0.5 mg, 8-2 mg
SUBOXONE 3 PA
ANTI-INFECTIVES (ANTI-INFECCIOSOS)
Antifungals (Antifungales)
clotrimazole troche 10 mg MYCELEX 1
fluconazole susp 10 mg/ml, 40 mg/ml, tabs 100 mg, 150 mg, 200 mg, 50 mg
DIFLUCAN 1
flucytosine caps 250 mg, 500 mg ANCOBON 1
griseofulvin microsize susp 125 mg/5ml, tabs 500 mg GRIFULVIN 4
griseofulvin ultramicrosize
tabs 125 mg, tabs 250 mg GRIS-PEG 1
itraconazole caps 100 mg SPORANOX 1
itraconazole soln 10 mg/ml SPORANOX 3
ketoconazole tabs 200 mg NIZORAL 1
nystatin powder , susp 100000 u/ml, tabs 500000 u
NYSTATIN 1
posaconazole susp 40 mg/ml NOXAFIL 4
terbinafine tabs 250 mg LAMISIL 1
voriconazole susp 40 mg/ml VFEND 4
voriconazole tabs 200 mg, 50 mg VFEND 4
Antimarials (Antimaláricos)
artemether & lumefantrine
tabs 20-120 mg COARTEM 4
atovaquone & proguanil tabs 62.5-25 mg MALARONE 4
atovaquone & proguanil tabs 250-100 mg MALARONE 4
chloroquine tabs 250 mg, 500 mg ARALEN 1
hydroxychloroquine tabs 200 mg PLAQUENIL 1
mefloquine tabs 250 mg LARIAM 1
primaquine tabs 26.3 mg PRIMAQUINE 3
pyrimethamine tabs 25 mg DARAPRIM 3
quinine caps 324 mg QUALAQUIN 4
Antiparasitics (Antiparasitarios)
albendazole tabs 200 mg ALBENZA 3
bacitracin inj 50000 u BACITRACIN 1
iodoquinol tabs 210 mg, 650 mg YODOXIN 3
ivermectin tabs 3 mg STROMECTOL 4
2013-2014 | 21
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
mebendazole chew tab 100 mg VERMOX 3
nitazoxanide susp 100 mg/5ml, tabs 500 mg ALINIA 3
praziquantel tabs 600 mg BILTRICIDE 4
Antituberculosis (Antituberculosis)
aminosalicylic acid pack 4 gm PASER 4
cycloserine caps 250 mg SEROMYCIN 3
ethambutol tabs 100 mg, 400 mg MYAMBUTOL 1
ethionamide tabs 250 mg TRECATOR 3
isoniazid tabs 100 mg, 300 mg ISONIAZID 1
isoniazid syrup 50 mg/5ml ISONIAZID 3
isoniazid & pyrazinamide & rifampin
tabs 50-300-120 mg RIFATER 4
isoniazid & rifampin caps 150-300 mg RIFAMATE 4
pyrazinamide tabs 500 mg PYRAZINAMIDE 1
rifabutin caps 150 mg MYCOBUTIN 3
rifampin caps 150 mg, 300 mg RIFADIN 1
rifapentine tabs 150 mg PRIFTIN 4
Antivirals (Antivirales)
Antiherpes Virus (Infecciones Herpéticas)
acyclovir caps 200 mg, susp 200 mg/5ml, tabs 400 mg, 800 mg
ZOVIRAX 1
famciclovir tabs 125 mg, 250 mg, 500 mg FAMVIR 1
valacyclovir tabs 1000 mg, 500 mg VALTREX 1
HIV/AIDS (VIH/SIDA)
Entry Inhibitors (Inhibidores de Entrada)
maraviroc tabs 150 mg, 300 mg SELZENTRY 3 PA SL
raltegravir chew tab 100 mg, 25 mg, tabs 400 mg
ISENTRESS 3
Non-Nucleoside Reverse Transcriptase Inhibitors (Inhibidores No Nucleósidos de la Transcriptasa Reversa)
delavirdine tabs 100 mg, 200 mg RESCRIPTOR 3
efavirenz caps 200 mg, 50 mg, tabs 600 mg SUSTIVA 3
etravirine tabs 100 mg, 200 mg, 25 mg INTELENCE 3 PA SL
nevirapine tabs 200 mg VIRAMUNE 1
nevirapine susp 50 mg/5ml, tab sr 24hr 100 mg, 400 mg
VIRAMUNE/ VIRAMUNE XR
3
rilpivirine tabs 25 mg EDURANT 3
Nucleoside-Nucleotide Reverse Transcriptase Inhibitors (Inhibidores Nucleósidos-Nucleótidos de la Transcriptasa Reversa)
abacavir soln 20 mg/ml, tabs 300 mg ZIAGEN 3
abacavir & lamivudine tabs 600-300 mg EPZICOM 3
abacavir & lamivudine & zidovudine
tabs 300-150-300 mg TRIZIVIR 3
didanosine soln 2 gm, 4 gm
VIDEX 3
didanosine dr caps 125 mg, 200 mg, 250 mg, 400 mg
VIDEX EC 1
efavirenz & emtricitabine & tenofovir
tabs 600-200-300 mg ATRIPLA 3
2013-2014 | 22
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
elvitegravir & cobicistat & emtricitabine & tenofovir
tabs 150-150-200-300 mg STRIBILD 3
emtricitabine caps 200 mg EMTRIVA 3
emtricitabine soln 10 mg/ml EMTRIVA 4
emtricitabine & rilpivirine & tenofovir df
tabs 200-25-300 mg COMPLERA 3
emtricitabine & tenofovir tabs 200-300 mg TRUVADA 3
lamivudine tabs 150 mg, 300 mg EPIVIR 1
lamivudine soln 10 mg/ml EPIVIR 3
lamivudine & zidovudine
tabs 150-300 mg COMBIVIR 1
stavudine caps 15 mg, 20 mg, 30 mg, 40 mg, soln 1 mg/ml
ZERIT 1
tenofovir powder 40 mg/ml, tabs 150 mg, 200 mg, 250 mg
VIREAD 3
tenofovir 300 mg VIREAD 3 PA, SL
zidovudine caps 100 mg, syrup 50 mg/5ml, tabs 300 mg
RETROVIR 1
Protease Inhibitors (Inhibidores de Proteasa)
atazanavir caps 100 mg, 150 mg, 200 mg, 300 mg
REYATAZ 3
darunavir tabs 150 mg, 400 mg, 600 mg, 75 mg, 800 mg
PREZISTA 3
fosamprenavir susp 50 mg/ml, tabs 700 mg LEXIVA 3
indinavir caps 100 mg, 200 mg, 400 mg CRIXIVAN 3
lopinavir & ritonavir soln 400-100 mg/5ml, tabs 100-25 mg, 200-50 mg
KALETRA 3
nelfinavir powder 50 mg/gm, tabs 250 mg, 625 mg
VIRACEPT 3
ritonavir caps 100 mg, soln 80 mg/ml, tabs 100 mg
NORVIR 3
saquinavir caps 200 mg, tabs 500 mg INVIRASE 3
tipranavir caps 250 mg, soln 100 mg/ml APTIVUS 3 PA, SL
Influenza (Influenza)
amantadine caps 100 mg, syrup 50 mg/5ml SYMMETREL 1
amantadine tabs 100 mg AMANTADINE 3
oseltamivir caps 30 mg, 45 mg, 75 mg, susp 12 mg/ml, susp 6 mg/ml
TAMIFLU 4
rimantadine tabs 100 mg FLUMADINE 1
zanamivir inhal 5 mg/blister RELENZA DISKHALER
4
Miscellaneous (Misceláneos)
ganciclovir caps 250 mg, 500 mg CYTOVENE 3
Cephalosporins (Cefalosporinas)
First Generation (Primera Generación)
cefadroxil caps 500 mg, susp 250 mg/5ml, 500 mg/5ml
DURICEF 1
2013-2014 | 23
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
cefadroxil tabs 1 gm DURICEF 4
cephalexin caps 250 mg, 500 mg, susp 125 mg/5ml, 250 mg/5ml
KEFLEX 1
cephalexin tabs 250 mg, 500 mg CEPHALEXIN 4
Second Generation (Segunda Generación)
cefaclor caps 250 mg, 500 mg CECLOR 1
cefaclor sr tabs 12h 500 mg CECLOR CD 4
cefprozil susp 125 mg/5ml, 250 mg/5ml, tabs 250 mg, 500 mg
CEFZIL 1
cefuroxime axetil susp 125 mg/5ml, tabs 250 mg, 500 mg
CEFTIN 1
cefuroxime axetil susp 250 mg/5ml CEFTIN 3
Third Generation (Tercera Generación)
cefdinir caps 300 mg, susp 125 mg/5ml, 250 mg/5ml
OMNICEF 1
cefditoren tabs 200 mg, 400 mg SPECTRACEF 4
cefixime tabs 400 mg SUPRAX 4
cefpodoxime susp 100 mg/5ml, 50 mg/5ml, tabs 100 mg, 200 mg
VANTIN 4
ceftibuten caps 400 mg, susp 90 mg/5ml CEDAX 4
ceftriaxone inj 1 gm, 10 gm, 2 gm, 250 mg, 500 mg
ROCEPHIN 4
Macrolides (Macrólidos)
azithromycin susp 100 mg/5ml, 200 mg/5ml, tabs 250 mg, 500 mg, 600 mg
ZITHROMAX 1
azithromycin pack 1 gm ZITHROMAX 3
azithromycin susp 2 gm ZMAX 4
clarithromycin susp 125 mg/5ml, 250 mg/5ml, tabs 250 mg, 500 mg
BIAXIN 1
clarithromycin sr tabs 24h 500 mg BIAXIN XL 1
erythromycin tabs 250 mg, 500 mg ERYTHROMYCIN 3
erythromycin & sulfisoxazole
susp 200-600 mg/5ml PEDIAZOLE 1
erythromycin dr tabs 250 mg, 333 mg, 500 mg ERY-TAB DR 3
erythromycin dr caps 250 mg ERYTHROMYCIN DR 4
erythromycin ec tabs 333 mg, 500 mg PCE 4
erythromycin ethylsuccinate
tabs 400 mg E.E.S. 1
erythromycin ethylsuccinate
susp 200 mg/5ml, 400 mg/5ml E.E.S./ ERYPED 3
erythromycin stearate tabs 250 mg ERYTHROCIN 3
Miscellaneous (Misceláneos)
atovaquone susp 750 mg/5ml MEPRON 3
cilastatin sodium & imipenem
inj 500-500 mg PRIMAXIN 4
clindamycin caps 150 mg, 300 mg, 75 mg, soln 75 mg/5ml
CLEOCIN 1
dapsone tabs 100 mg, 25 mg DAPSONE 3
fosfomycin pack 5.631 gm MONUROL 4
2013-2014 | 24
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
gentamicin inj 10 mg/ml, 40 mg/ml GENTAMICIN 4
lincomycin inj 300 mg/ml LINCOCIN 4
metronidazole tabs 250 mg, 500 mg FLAGYL 1
metronidazole caps 375 mg FLAGYL 4
metronidazole sr tabs 24h 750 mg FLAGYL ER 4
neomycin tabs 500 mg NEOMYCIN 4
nitrofurantoin susp 25 mg/5ml FURADANTIN 1
nitrofurantoin macrocrystalline
caps 25mg 100 mg, 50 mg MACRODANTIN 1
nitrofurantoin monohydrate macrocrystals
caps 100 mg MACROBID 4
pentamidine neb 300 mg NEBUPENT 3
pentamidine inj 300 mg PENTAM 4
rifaximin tabs 550 mg XIFAXAN 4
streptomycin inj 1 gm STREPTOMYCIN 3
trimethoprim tabs 100 mg PROLOPRIM 4
vancomycin caps 125 mg, 250 mg VANCOCIN 1
Penicillins (Penicilinas)
amoxicillin caps 250 mg, 500 mg, susp 125 mg/5ml, 200 mg/5ml, 250 mg/5ml, 400 mg/5ml, tabs 500 mg, 875 mg
AMOXIL 1
amoxicillin chew tab 125 mg, 250 mg AMOXIL 3
amoxicillin & k clavulanate
chew tab 200-28.5 mg, 400-57 mg, susp 125-31.25 mg/5ml 200- 28.5 mg/5ml, 250-62.5 mg/5ml, 400-57 mg/5ml, 600-42.9 mg/5ml, tabs 250-125 mg, 500-125 mg, 875- 125 mg
AUGMENTIN 1
amoxicillin & k clavulanate sr
tabs 12h 1000-62.5 mg AUGMENTIN XR 4
ampicillin caps 250 mg, 500 mg PRINCIPEN 1
ampicillin susp 125 mg/5ml, 250 mg/5ml AMPICILLIN 3
ampicillin sodium inj 1 gm, 125 mg, 2 gm, 250 mg, 500 mg
AMPICILLIN SODIUM 4
dicloxacillin sodium caps 250 mg, 500 mg DICLOXACILLIN SODIUM
4
nafcillin sodium inj 1 gm, 2 gm NAFCILLIN SODIUM 1
nafcillin sodium inj IV soln 1 gm, 2 gm NAFCILLIN SODIUM 3
penicillin g benzathine inj 1200000 unit/2ml, 2400000 unit/4ml, 600000 u/ml
BICILLIN L-A 3
penicillin g benzathine & penicillin g procaine
inj 1200000 unit/2ml, 300000- 900000 u/ml
BICILLIN C-R 3
penicillin g procaine inj 600000 u/ml PENICILLIN G PROCAINE
4
penicillin v potassium soln 125 mg/5ml, 250 mg/5ml, tabs 250 mg, 500 mg
VEETIDS 1
2013-2014 | 25
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
Quinolones (Quinolonas)
ciprofloxacin tabs 100 mg, 250 mg, 500 mg, 750 mg
CIPRO 1
ciprofloxacin susp 250 mg/5ml, 500 mg/5ml CIPRO 3
ciprofloxacin sr tabs 24h 1000 mg, 500 mg CIPRO XR 4
levofloxacin tabs 250 mg, 500 mg, 750 mg LEVAQUIN 4
moxifloxacin tabs 400 mg AVELOX 2
norfloxacin tabs 400 mg NOROXIN 4
ofloxacin tabs 200 mg, 300 mg, 400 mg FLOXIN 4
Sulfonamides (Sulfonamidas)
sulfadiazine tabs 500 mg SULFADIAZINE 3
sulfamethoxazole & trimethoprim
susp 200-40 mg/5ml, tabs 400-80 mg, 800-160 mg
SEPTRA 1
Tetracyclines (Tetraciclinas)
demeclocycline tabs 150 mg, 300 mg DECLOMYCIN 1
doxycycline calcium syrup 50 mg/5ml VIBRAMYCIN 4
doxycycline hyclate caps 100 mg, 50 mg, tabs 100 mg VIBRAMYCIN/ VIBRATAB
1
doxycycline hyclate caps 50 mg ORAXYL 3
doxycycline hyclate inj 100 mg, tabs 20 mg DOXYCYCLINE 4
doxycycline hyclate dr caps 100 mg DORYX 4
doxycycline monohydrate susp 25 mg/5ml VIBRAMYCIN 4
doxycycline monohydrate
caps 100 mg, 50 mg, tabs 100 mg, 150 mg, 50 mg, 75 mg
MONODOX 4
minocycline caps 100 mg, 50 mg, 75 mg MINOCIN 1
minocycline tabs 100 mg, 50 mg, 75 mg DYNACIN 4
tetracycline caps 250 mg 500 mg ACHROMYCIN V 1
CANCER (CÁNCER)
Alkylating Agents (Agentes Alquilantes)
altretamine caps 50 mg HEXALEN 3
busulfan tabs 2 mg MYLERAN 3
chlorambucil tabs 2 mg LEUKERAN 3
cyclophosphamide tabs 25 mg, 50 mg CYTOXAN 3
lomustine caps 10 mg, 100 mg, 40 mg CEENU 3
melphalan tabs 2 mg ALKERAN 3
Androgens/Estrogens/Progestins (Andrógenos/Estrógenos/Progestinas)
Androgens (Andrógenos)
fluoxymesterone tabs 10 mg ANDROXY 3
methyltestosterone caps 10 mg ANDROID 4
methyltestosterone tabs 10 mg METHITEST 4
Antiandrogens (Antiandrógenos)
bicalutamide tabs 50 mg CASODEX 1
enzalutamide caps 40 mg XTANDI 4
flutamide caps 125 mg EULEXIN 1
nilutamide tabs 150 mg NILANDRON 3
Antiestrogens (Antiestrógenos)
tamoxifen citrate tabs 10 mg, 20 mg NOLVADEX 1
toremifene citrate tabs 60 mg FARESTON 4
2013-2014 | 26
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
Aromatase Inihibitor (Inihibidores de la Aromatasa)
anastrozole tabs 1 mg ARIMIDEX 1
exemestane tabs 25 mg AROMASIN 4
letrozole tabs 2.5 mg FEMARA 1
Progestins (Progestinas)
megestrol acetate susp 40 mg/ml, tabs 20 mg, 40 mg MEGACE 1
Antimetabolites (Antimetabólitos)
mercaptopurine tabs 50 mg PURINETHOL 1
methotrexate tabs 2.5 mg METHOTREXATE 1
methotrexate tabs 10 mg, 15 mg, 2.5 mg, 5 mg, 7.5 mg
TREXALL 3
Immunosuppressives (Inmunosupresores)
azathioprine tabs 50 mg IMURAN 1
mycophenolate mofetil caps 250 mg, tabs 500 mg CELLCEPT 1
mycophenolate mofetil susp 200 mg/ml CELLCEPT 3
Miscellaneous (Misceláneos)
bexarotene caps 75 mg TARGRETIN 4
estramustine phosphate caps 140 mg EMCYT 3
etoposide caps 50 mg VEPESID 3
hydroxyurea caps 500 mg HYDREA 1
hydroxyurea caps 200 mg, 300 mg, 400 mg DROXIA 3
leuprolide inj 5 mg/ml LUPRON 1 PA SL
leuprolide inj 11.25 mg, 15 mg, 22.5 mg, 3.75 mg, 30 mg, 7.5 mg
LUPRON DEPOT 3 PA SL
mitotane tabs 500 mg LYSODREN 3
procarbazine hcl caps 50 mg MATULANE 3
tretinoin caps 10 mg VESANOID 1
CARDIOVASCULARS (CARDIOVASCULARES)
Antiarrhythmics (Antiarrítmicos)
amiodarone tabs 200 mg CORDARONE 1
amiodarone tabs 100 mg PACERONE 3
amiodarone tabs 400 mg CORDARONE 4
disopyramide caps 100 mg, 150 mg NORPACE 1
disopyramide sr caps 12h 100 mg, 150 mg NORPACE CR 3
flecainide tabs 100 mg, 150 mg, 50 mg TAMBOCOR 1
mexiletine caps 150 mg, 200 mg, 250 mg MEXILETINE 3
propafenone tabs 150 mg, 225 mg, 300 mg RYTHMOL 1
propafenone sr caps 12h 225 mg, 325 mg, 425 mg RYTHMOL SR 4
quinidine gluconate cr tabs 324 mg QUINAGLUTE 1
quinidine sulfate tabs 200 mg, 300 mg QUINIDINE SULFATE 4
quinidine sulfate cr tabs 300 mg QUINIDINE SULFATE CR
4
sotalol tabs 120 mg, 160 mg, 240 mg, 80 mg
BETAPACE/BETAPACE AF
1
Antihyperlipidemics (Antihiperlipidémicos)
atorvastatin tabs 10 mg, 20 mg, 40 mg, 80 mg LIPITOR 1
cholestyramine pack 4 gm, powder 4 gm/dose QUESTRAN 1
choline fenofibrate caps dr 135 mg, 45 mg TRILIPIX 3
2013-2014 | 27
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
colesevelam pack 3.75 gm, tabs 625 mg WELCHOL 3
colestipol granules 5 gm, tabs 1 gm COLESTID 1
ezetimibe tabs 10 mg ZETIA 2
ezetimibe & simvastatin tabs 10-10 mg, 10-20 mg, 10-40 mg VYTORIN 2
ezetimibe & simvastatin tabs 10-80 mg VYTORIN 2 PA
fenofibrate caps 134 mg, 200 mg, 67 mg, tabs 160 mg, 54 mg
LOFIBRA 1
fenofibrate tabs 145 mg, 48 mg, 160 mg TRICOR 1
fenofibrate tabs 160 mg, 50 mg TRIGLIDE 4
fluvastatin sodium caps 20 mg, 40 mg LESCOL 4
fluvastatin sr tabs 24h 80 mg LESCOL XL 4
gemfibrozil tabs 600 mg LOPID 1
icosapent ethyl caps 1 gm VASCEPA 3
lovastatin tabs 10 mg, 20 mg, 40 mg MEVACOR 4
lovastatin & niacin sr tabs 24h 20-1000 mg, 20-500 mg, 20-750 mg, 40-1000 mg
ADVICOR 4
lovastatin sr tabs 24h 20 mg ALTOPREV 4
niacin & simvastatin sr tab 24 hr 1000-20 mg, 1000-40 mg, 500-20 mg, 500-40 mg, 750-20 mg
SIMCOR 4
niacin cr tabs 1000 mg, 500 mg, 750 mg NIASPAN 2
omega-3-acid ethyl esters
caps 1 gm LOVAZA 3
pravastatin tabs 10 mg, 20 mg, 40 mg, 80 mg PRAVACHOL 1
rosuvastatin tabs 10 mg, 20 mg, 40 mg, 5 mg CRESTOR 2
simvastatin tabs 10 mg, 20 mg, 40 mg, 5 mg ZOCOR 1
simvastatin tabs 80 mg ZOCOR 1 PA
Antihypertensives (Antihipertensivos)
ACE Inhibitors (Inhibidores de la Enzima Convertidora de Angiotensina)
benazepril tabs 10 mg, 20 mg, 40 mg, 5 mg LOTENSIN 1
captopril tabs 100 mg, 12.5 mg, 25 mg, 50 mg CAPOTEN 1
enalapril tabs 10 mg, 2.5 mg, 20 mg, 5 mg VASOTEC 1
fosinopril tabs 10 mg, 20 mg, 40 mg MONOPRIL 1
lisinopril tabs 10 mg, 2.5 mg, 20 mg, 30 mg, 40 mg, 5 mg
PRINIVIL / ZESTRIL 1
moexipril tabs 15 mg, 7.5 mg UNIVASC 4
perindopril tabs 2 mg, 4 mg, 8 mg ACEON 4
quinapril tabs 10 mg, 20 mg, 40 mg, 5 mg ACCUPRIL 1
ramipril caps 1.25 mg, 10 mg, 2.5 mg, 5 mg ALTACE 4
trandolapril tabs 1 mg, 2 mg, 4 mg MAVIK 4
Alpha-Adrenergic Receptor Blockers (Bloqueadores del Receptor Alfa-Adrenérgico)
doxazosin tabs 1 mg, 2 mg, 4 mg, 8 mg CARDURA 1
prazosin caps 1 mg, 2 mg, 5 mg MINIPRESS 1
terazosin caps 1 mg, 10 mg, 2 mg, 5 mg HYTRIN 1
Angiotensin Receptor Blockers (ARBs) (Bloqueadores del Receptor de la Angiotensina)
candesartan tabs 16 mg, 32 mg, 4 mg, 8 mg ATACAND 4
eprosartan tabs 400mg, 600 mg TEVETEN 4
irbesartan tabs 150 mg, 300 mg, 75 mg AVAPRO 1
losartan tabs 100 mg, 25 mg, 50 mg COZAAR 1
2013-2014 | 28
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
olmesartan tabs 20 mg, 40 mg, 5 mg BENICAR 4
telmisartan tabs 20 mg, 40 mg, 80 mg MICARDIS 3
valsartan tabs 160 mg, 320 mg, 40 mg, 80 mg DIOVAN 2
Beta Blockers (Bloqueadores Beta)
acebutolol caps 200 mg, 400 mg SECTRAL 4
atenolol tabs 100 mg, 25 mg, 50 mg TENORMIN 1
betaxolol tabs 10 mg, 20 mg KERLONE 4
bisoprolol tabs 10 mg, 5 mg ZEBETA 4
carvedilol tabs 12.5 mg, 25 mg, 3.125 mg, 6.25 mg
COREG 1
labetalol tabs 100 mg, 200 mg, 300 mg NORMODYNE 4
metoprolol succinate sr tabs 24h 100 mg, 200 mg, 25 mg, 50 mg
TOPROL XL 1
metoprolol tartrate tabs 100 mg, 25 mg, 50 mg LOPRESSOR 1
nadolol tabs 20 mg, 40 mg, 80 mg CORGARD 4
penbutolol tabs 20 mg LEVATOL 4
pindolol tabs 10 mg, 5 mg VISKEN 4
propranolol tabs 10 mg, 20 mg, 40 mg, 60 mg, 80 mg
INDERAL 1
propranolol soln 20 mg/5ml, 40 mg/5ml INDERAL 3
propranolol sr caps 24h 120 mg, 160 mg, 60 mg, 80 mg
INDERAL LA 1
timolol tabs 10 mg, 20 mg, 5 mg BLOCADREN 4
Calcium Channel Blockers (Antagonistas de los Canales de Calcio)
amlodipine tabs 10 mg, 2.5 mg, 5 mg NORVASC 1
diltiazem tabs 120 mg, 30 mg, 60 mg, 90 mg CARDIZEM 1
diltiazem er beads caps 24h 120 mg, 180 mg, 240 mg, 300 mg, 360 mg, 420 mg
TIAZAC ER 1
diltiazem sr caps 12h 120 mg, 60 mg, 90 mg, caps 24h 120 mg, 180 mg, 240 mg
CARDIZEM SR 1
diltiazem sr coated beads
caps 24h 120 mg, 180 mg, 240 mg, 300 mg, 360 mg
CARDIZEM CD 1
felodipine sr tabs 24h 10 mg, 2.5 mg, 5 mg PLENDIL 1
isradipine caps 2.5 mg 5 mg DYNACIRC 1
isradipine sr tabs 24h 10 mg, 5 mg DYNACIRC-CR 4
nicardipine caps 20 mg, 30 mg CARDENE 1
nicardipine sr caps 12h 30 mg, 45 mg, 60 mg CARDENE SR 4
nifedipine caps 10 mg, 20 mg PROCARDIA 4
nifedipine sr tabs 24h 30 mg, 60 mg, 90 mg ADALAT CC / PROCARDIA XL
1
nimodipine caps 30 mg NIMOTOP 4
nisoldipine sr tabs 24h 20 mg, 30 mg, 40 mg SULAR 3
verapamil tabs 120 mg, 40 mg 80 mg CALAN 1
verapamil cr tabs 120 mg, 180 mg, 240 mg CALAN SR / ISOPTIN SR
1
verapamil sr caps 24h 120 mg, 180 mg, 240 mg, 360 mg
VERELAN 1
verapamil sr tabs 24h 180 mg, 240 mg COVERA-HS 4
2013-2014 | 29
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
verapamil sr caps 24h 100 mg, 200 mg, 300 mg VERELAN PM 4
Centrally Acting Antiadrenergics (Antiadrenérgicos de Acción Central)
clonidine tabs 0.1 mg, 0.2 mg, 0.3 mg, weekly patch 0.1 mg/24hr, 0.2 mg/24hr, 0.3 mg/24hr
CATAPRES 1
guanabenz tabs 4 mg, 8 mg WYTENSIN 4
guanfacine tabs 1 mg, 2 mg TENEX 4
methyldopa tabs 250 mg, 500 mg ALDOMET 1
midodrine tabs 10 mg, 2.5 mg, 5 mg PROAMATINE 4
reserpine tabs 0.1mg, 0.25 mg RESERPINE 4
Combinations (Combinaciones)
amlodipine & atorvastatin tabs 10-10 mg, 10-20 mg, 10-40 mg, 10-80 mg, 2.5-10 mg, 2.5-20 mg, 2.5-40 mg, 5-10 mg, 5-20 mg, 5- 40 mg, 5-80 mg
CADUET 4
amlodipine & benazepril
caps 10-20 mg, 10-40 mg, 2.5- 10 mg, 5-10 mg, 5-20 mg, 5-40 mg
LOTREL 4
amlodipine & olmesartan tabs 10-20 mg, 10-40 mg, 5-20 mg, 5-40 mg
AZOR 2
amlodipine & valsartan tabs 10-160 mg, 10-320 mg, 5-160 mg, 5-320 mg
EXFORGE 4
amlodipine & valsartan & hydrochlorthiazide
tabs 10-160-12.5 mg, 10-160-25 mg, 10-320-25 mg, 5-160-12.5 mg, 5-160-25 mg
EXFORGE HCT 4
atenolol & chlorthalidone
tabs 100-25 mg, 50-25 mg TENORETIC 4
benazepril & hydrochlorothiazide
tabs 10-12.5 mg, 20-12.5 mg, 20-25 mg, 5-6.25 mg
LOTENSIN HCT 4
bisoprolol & hydrochlorothiazide
tabs 10-6.25 mg, 2.5-6.25 mg, 5-6.25 mg
ZIAC 4
candesartan & hydrochlorothiazide
tabs 16-12.5 mg, 32-12.5 mg, 32-25 mg
ATACAND HCT 4
captopril & hydrochlorothiazide
tabs 25-25 mg, 50-25 mg tabs, 25-15 mg, 50-15 mg
CAPOZIDE 1
clonidine & chlorthalidone tabs 0.1-15 mg, 0.2-15 mg, 0.3-15 mg
CLORPRES 4
enalapril & hydrochlorothiazide
tabs 10-25 mg, 5-12.5 mg VASERETIC 4
eprosartan & hydrochlorothiazide
tabs 600-12.5 mg, 600-25 mg TEVETEN HCT 4
fosinopril & hydrochlorothiazide
tabs 10-12.5 mg, 20-12.5 mg MONOPRIL HCT 4
irbesartan & hydrochlorothiazide
tabs 150-12.5 mg, 300-12.5 mg AVALIDE 1
lisinopril & hydrochlorothiazide
tabs 10-12.5 mg, 20-12.5 mg, 20-25 mg
PRINZIDE / ZESTORETIC
1
losartan & hydrochlorothiazide
tabs 100-12.5 mg, 100-25 mg, 50-12.5 mg
HYZAAR 1
methyldopa & hydrochlorothiazide
tabs 250-15 mg, 250-25 mg ALDORIL 4
2013-2014 | 30
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
metoprolol tartrate & hydrochlorothiazide
tabs 100-50 mg, tabs 100-25 mg, 50-25 mg
LOPRESSOR HCT 1
moexipril & hydrochlorothiazide
tabs 15-12.5 mg, 15-25 mg, 7.5-12.5 mg
UNIRETIC 4
nadolol & bendroflumethiazide
tabs 5-40 mg, 5-80 mg CORZIDE 4
olmesartan & hydrochlorothiazide
tabs 20-12.5 mg, 40-12.5 mg, 40-25 mg
BENICAR HCT 4
propranolol & hydrochlorothiazide
tabs 40-25 mg, 80-25 mg INDERIDE 4
quinapril & hydrochlorothiazide
tabs 10-12.5 mg, 20-12.5 mg, 20-25 mg
ACCURETIC 4
telmisartan & hydrochlorothiazide
tabs 40-12.5 mg, 80-12.5 mg, 80-25 mg
MICARDIS HCT 3
trandolapril & verapamil cr
tabs 1-240 mg, 2-180 mg, 2-240 mg, 4-240 mg
TARKA 2
valsartan & hydrochlorothiazide
tabs 160-12.5 mg, 160-25 mg, 320-12.5 mg, 320-25 mg, 80-12.5 mg
DIOVAN HCT 1
Diuretics (Diuréticos)
Carbonic Anhydrase Inhibitors (Inhibidores de la Anhidrasa Carbónica)
acetazolamide tabs 125mg, 250 mg DIAMOX 1
acetazolamide sr caps 12h 500 mg DIAMOX SR 1
methazolamide tabs 25 mg, 50 mg NEPTAZANE 1
Loop Diuretics (Diuréticos del Asa de Henle)
bumetanide tabs 0.5 mg, 1 mg, 2 mg BUMEX 1
ethacrynic acid tabs 25 mg EDECRIN 4
furosemide soln 10 mg/ml, tabs 20 mg, 40 mg, 80 mg
LASIX 1
furosemide soln 8 mg/ml LASIX 3
furosemide inj 10 mg/ml LASIX 4
torsemide tabs 10 mg, 100 mg, 20 mg, 5 mg DEMADEX 4
Miscellaneous (Misceláneos)
eplerenone tabs 25 mg, 50 mg INSPRA 1
indapamide tabs 1.25 mg, 2.5 mg LOZOL 1
Potassium Sparing/Combinations (Conservadores de Potasio/Combinaciones)
amiloride tabs 5 mg MIDAMOR 1
amiloride & hydrochlorothiazide
tabs 5-50 mg MODURETIC 1
spironolactone tabs 100 mg, 25 mg, 50 mg ALDACTONE 1
spironolactone & hydrochlorothiazide
tabs 25-25 mg, 50-50 mg ALDACTAZIDE 1
triamterene caps 100 mg, 50 mg DYRENIUM 4
triamterene & hydrochlorothiazide
caps 37.5-25 mg, tabs 37.5-25 mg, 50-75 mg
DYAZIDE/MAXZIDE 1
Thiazides (Tiazidas)
chlorothiazide tabs 250 mg, 500 mg DIURIL 1
chlorothiazide susp 250 mg/5ml DIURIL 4
chlorthalidone tabs 25 mg CHLORTHALIDONE 1
chlorthalidone tabs 100mg, 15 mg, 50 mg THALITONE 3
2013-2014 | 31
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
hydrochlorothiazide tabs 12.5 mg, 25 mg, 50 mg HYDROCHLOROTHIAZIDE
1
hydrochlorothiazide caps 12.5 mg HYDRODIURIL 4
methyclothiazide tabs 5 mg METHYCLOTHIAZIDE 4
metolazone tabs 10 mg, 2.5 mg, 5 mg ZAROXOLYN 1
Vasodilators (Vasodilatores)
hydralazine tabs 10 mg, 100 mg, 25 mg, 50 mg APRESOLINE 1
isosorbide dinitrate tabs 10 mg, 20 mg, 30 mg, 5 mg ISORDIL 1
isosorbide dinitrate subl 2.5 mg, 5 mg, tabs 40 mg ISORDIL 3
isosorbide dinitrate cr tabs 40 mg ISORDIL 1
isosorbide dinitrate cr caps 40 mg DILATRATE SR 3
isosorbide mononitrate tabs 10 mg, 20 mg ISMO / MONOKET 1
isosorbide mononitrate sr
tabs 24h 120 mg, 30 mg, 60 mg IMDUR 1
isoxsuprine tabs 10 mg VASODILAN 4
minoxidil tabs 10 mg, 2.5 mg LONITEN 1
nitroglycerin topical oint 2 % NITRO-BID 3
nitroglycerin 24h patch 0.1 mg/hr, 0.2 mg/hr, 0.4 mg/hr, 0.6 mg/hr
NITRO-DUR 1
nitroglycerin 24h patch 0.3 mg/hr, 0.8 mg/hr, subl 0.3 mg, 0.4 mg, topical oint 2 %
NITRO-DUR 3
nitroglycerin subl 0.6 mg NITROSTAT 1
nitroglycerin subl 0.3 mg, 0.4 mg NITROSTAT 3
nitroglycerin translingual spray 0.4 mg/spray NITROLINGUAL PUMPSPRAY
4
nitroglycerin cr caps 2.5 mg, 6.5 mg, 9 mg NITRO-TIME 4
papaverine hcl caps 150mg PAPAVERINE 4
ranolazine sr tabs 12h 1000 mg, 500 mg RANEXA 3 PA SL
Glycosides (Glicósidos)
digoxin tabs 0.125 mg, 0.25 mg LANOXIN 1
digoxin soln 0.05 mg/ml DIGOXIN 3
CENTRAL NERVOUS SYSTEM (SISTEMA NERVIOSO CENTRAL)
Alzheimer (Alzheimer)
donepezil odt 10 mg, 5 mg, tabs 10 mg, 5 mg ARICEPT 1
galantamine soln 4 mg/ml, tabs 12mg, 4 mg, 8 mg RAZADYNE 4
galantamine sr caps 24h 16 mg, 24 mg, 8 mg RAZADYNE ER 1
memantine soln 2 mg/ml, tabs 10 mg, 5 mg, 5&10 mg pack
NAMENDA 2
rivastigmine caps 1.5 mg, 3 mg, 4.5 mg, 6 mg EXELON 1
rivastigmine 24h patch 13.3 mg/24hr, 4.6 mg/24hr, 9.5 mg/24hr
EXELON 2
rivastigmine soln 2 mg/ml EXELON 3
Analgesics/Narcotics/Combinations (Analgésicos/Narcóticos/Combinaciones)
acetaminophen & butalbital & caffeine & codeine
caps 325-50-40-30 mg FIORICET/CODEINE 4
acetaminophen & caffeine & dihydrocodeine
caps 356.4-30-16 mg, tabs 712.8-60-32 mg
PANLOR 4
2013-2014 | 32
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
acetaminophen & codeine
soln 120-12 mg/5ml, tabs 300- 15 mg, 300-30 mg, 300-60 mg
TYLENOL/CODEINE 1
acetaminophen & codeine
susp 120-12 mg/5ml CAPITAL/CODEINE 3
acetaminophen & codeine
tabs 650-30 mg VOPAC 4
acetaminophen & hydrocodone
caps 500-5 mg, soln 500- 7.5 mg/15ml, tabs 325-10 mg, 325- 5 mg, 325-7.5 mg, 500-10 mg, 500-2.5 mg, 500-5 mg, 500-7.5 mg, 650-10 mg, 650-7.5 mg, 660-10 mg, 750-10 mg, 750-7.5 mg
LORTAB/VICODIN 1
acetaminophen & hydrocodone
tabs 400-10 mg, 400-5 mg, 400-7.5 mg
ZYDONE 3
acetaminophen & oxycodone
caps 500-5 mg, tabs 325-10 mg, 325-2.5 mg, 325-5 mg, 325-7.5 mg, 500-7.5 mg, 650-10 mg
PERCOCET 1
acetaminophen & oxycodone
soln 325-5 mg/5ml, tabs 500-10 mg, 500-5 mg
ROXICET 4
acetaminophen & tramadol
tabs 325-37.5 mg ULTRACET 4
aspirin & butalbital & caffeine & codeine
caps 325-50-40-30 mg FIORINAL/CODEINE 1
aspirin & meprobamate tabs 325-200 mg EQUAGESIC 4
butalbital & acetaminophen
tabs 50-325 mg PHRENILIN 1
butalbital & acetaminophen
caps 50-650 mg, tabs 50-650 mg PHRENILIN 3
butalbital & acetaminophen & caffeine
caps 50-325-40 mg, 50-500-40 mg, tabs 50-325-40 mg, 50-500-40 mg
FIORICET 1
butalbital & aspirin & caffeine
caps 50-325-40 mg, tabs 50-325- 40 mg
FIORINAL 1
codeine tabs 30 mg, 60 mg CODEINE 3
codeine phosphate inj 15 mg/ml CODEINE PHOSPHATE
4
codeine sulfate tabs 15 mg CODEINE SULFATE 3
fentanyl 72h patch 100 mcg/hr, 12.5 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr
DURAGESIC 1
fentanyl tabs 100 mcg, 200 mcg, 400 mcg, 600 mcg, 800 mcg
FENTORA 4
fentanyl lollipop 1200 mcg, 1600 mcg, 200 mcg, 400 mcg, 600 mcg, 800 mcg
ACTIQ 4
fentanyl citrate inj 0.05 mg/ml FENTANYL 4
hydrocodone & ibuprofen
tabs 5-200 mg VICOPROFEN 1
hydrocodone & ibuprofen
tabs 10-200 mg, 7.5-200 mg IBUDONE 4
2013-2014 | 33
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
hydromorphone inj 1 mg/ml, 10 mg/ml, 2 mg/ml, 4 mg/ml, liq 1 mg/ml, tabs 2 mg, 4 mg, 8 mg
DILAUDID 1
hydromorphone rectal supp 3 mg DILAUDID 3
levorphanol tabs 2 mg LEVORPHANOL 4
meperidine inj 10 mg/ml, 100 mg/ml, 25 mg/ml, 50 mg/ml, tabs 100 mg, 50 mg, 100 mg/2ml , 25 mg/0.5ml , 75 mg/1.5ml , 75 mg/ml, soln 50 mg/5ml
DEMEROL 1
methadone conc 10 mg/ml, soln 10 mg/5ml, 5 mg/5ml, tabs 10 mg, 5 mg
METHADONE 1
methadone inj 10 mg/ml METHADONE 3
morphine inj 0.5 mg/ml, 1 mg/ml, 10 mg/ml, 15 mg/ml, 8 mg/ml, soln 10 mg/5ml, 20 mg/5ml, 20 mg/ml, rectal supp 10 mg, 20 mg, 5 mg
MORPHINE SULFATE 1
morphine inj 1 mg/ml, 2 mg/ml, 25 mg/ml, 4 mg/ml, 5 mg/ml, 50 mg/ml, inj 8 mg/ml, rectal supp 30 mg, tabs 15 mg, 30 mg
MORPHINE SULFATE 3
morphine beads sr caps 24h 120 mg, 30 mg, 60 mg, 90 mg
AVINZA 4
morphine sr tabs 12h 100 mg, 15 mg, 200 mg, 30 mg, 60 mg
MS CONTIN 1
morphine sr caps 24h 10 mg, 100 mg, 130 mg, 20 mg, 200 mg, 30 mg, 50 mg, 60 mg, 70mg, 80 mg
KADIAN SR 4
oxycodone caps 5 mg ROXICODONE 1
oxycodone conc 20 mg/ml OXYCODONE 1
oxycodone tabs 10 mg, 15 mg, 30 mg, 5 mg, 20 mg, soln 5 mg/5ml
ROXICODONE 4
oxycodone sr tabs 12h 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 60 mg, 80 mg
OXYCONTIN 4
oxymorphone inj 1 mg/ml OPANA 4
oxymorphone tabs 10 mg, 5 mg OPANA 4
oxymorphone sr tabs 12h 10 mg, 15 mg, 20 mg, 30 mg, tabs 12h 30 mg, 40 mg, 5 mg, 7.5 mg
OPANA ER 4
tramadol tabs 50 mg ULTRAM 4
Antianxiety/Hypnotics (Ansiolíticos/Hipnóticos)
alprazolam tabs 0.25 mg, 0.5 mg, 1 mg, 2 mg XANAX 1
alprazolam sr tabs 24h 0.5 mg, 1 mg, 2 mg, 3 mg XANAX XR 4
buspirone tabs 7.5 mg, 10 mg, 15 mg, 30 mg, 5 mg
BUSPAR 1
chloral hydrate caps 500 mg, syrup 500 mg/5ml SOMNOTE 4
chlordiazepoxide caps 10 mg, 25 mg, 5 mg LIBRIUM 1
clorazepate tabs 15 mg, 3.75 mg, 7.5 mg TRANXENE T 1
diazepam tabs 10 mg, 2 mg, 5 mg VALIUM 1
diazepam inj 5 mg/ml VALIUM 3
estazolam tabs 1 mg, 2 mg PROSOM 4
2013-2014 | 34
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
flurazepam caps 15 mg, 30 mg DALMANE 1
hydroxyzine hydrochloride
inj 25 mg/ml, 50 mg/ml VISTARIL 4
hydroxyzine pamoate caps 25 mg, 50 mg, 100 mg
VISTARIL 4
lorazepam inj 2 mg/ml, 4 mg/ml, tabs 0.5 mg, 1 mg, 2 mg
ATIVAN 1
meprobamate tabs 200 mg, 400 mg EQUANIL 4
midazolam inj 10 mg/10ml , 10 mg/2ml , 2 mg/2ml , 25 mg/5ml , 5 mg/5ml , 5 mg/ml, 50 mg/10ml , syrup 2 mg/ml
VERSED 4
oxazepam caps 10 mg, 15 mg, 30 mg SERAX 1
quazepam tabs 15 mg DORAL 4
temazepam caps 15 mg, 30 mg, 7.5 mg, 22.5 mg RESTORIL 1
triazolam tabs 0.125 mg, 0.25 mg HALCION 4
zaleplon caps 10 mg, 5 mg SONATA 4
zolpidem tabs 10 mg, 5 mg AMBIEN 1
zolpidem tartrate tabs 12.5 mg, 6.25 mg AMBIEN CR 4
Anticonvulsants (Anticonvulsivos)
carbamazepine chew tab 100 mg, susp 100 mg/5ml, tabs 200 mg
TEGRETOL 1
carbamazepine sr tabs 12h 100 mg, 200 mg, 400 mg TEGRETOL XR 1
carbamazepine sr caps 12h 100 mg, 200 mg, 300 mg CARBATROL SR 4
clonazepam tabs 0.5 mg, 1 mg, 2 mg KLONOPIN 1
clonazepam odt 0.125 mg, 0.25 mg, 0.5 mg, 1 mg, 2 mg
KLONOPIN 4
diazepam rectal gel 10 mg, 2.5 mg, 20 mg DIASTAT 4
divalproex sprinkle caps 125 mg DEPAKOTE 1
divalproex dr tabs 125 mg, 250 mg, 500 mg DEPAKOTE EC 1
divalproex sr tabs 24h 250 mg, 500 mg DEPAKOTE ER 1
ethosuximide caps 250 mg, soln 250 mg/5ml ZARONTIN 1
ethotoin tabs 250 mg PEGANONE 3
ezogabine tabs 200 mg, 300 mg, 400 mg, 50 mg
POTIGA 4 SL
felbamate susp 600 mg/5ml, tabs 400 mg, 600 mg
FELBATOL 1
gabapentin caps 100 mg, 300 mg, 400 mg, soln 250 mg/5ml, tabs 600 mg, 800 mg
NEURONTIN 1
lacosamide soln 10 mg/ml, tabs 100 mg, 150 mg, 200 mg, 50 mg
VIMPAT 4 AL, PA SL
lamotrigine odt 25 mg, 5 mg, tabs 100 mg, 150 mg, 200 mg, 25 mg
LAMICTAL 1
lamotrigine kit 25 mg, 25&100 mg, 25&100 mg LAMICTAL 3
levetiracetam soln 100 mg/ml, tabs 1000 mg, 250 mg, 500 mg, 750 mg
KEPPRA 1
methsuximide
caps 300 mg CELONTIN 3
oxcarbazepine susp 300 mg/5ml, tabs 150 mg, 300 mg, 600 mg
TRILEPTAL 1
2013-2014 | 35
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
phenobarbital elixir 20 mg/5ml, tabs 100 mg, 15 mg, 16.2 mg, 30 mg, 32.4 mg, 60 mg, 64.8 mg, 97.2 mg
PHENOBARBITAL 1
phenytoin caps 30 mg,100 mg, 200 mg, 300 mg, chew tab 50 mg, susp 125 mg/5ml
DILANTIN 1
phenytoin inj 50 mg/ml DILANTIN 4
pregabalin caps 100 mg, 150 mg, 200 mg, 225 mg, 25 mg, 300 mg, 50 mg, 75 mg, soln 20 mg/ml
LYRICA 3
primidone tabs 250 mg, 50 mg MYSOLINE 1
rufinamide susp 40 mg/ml, tabs 200 mg, 400 mg BANZEL 4 PA,SL
tiagabine tabs 2 mg, 4 mg, 12 mg, 16 mg GABITRIL 1
topiramate sprinkle caps 15 mg, 25 mg, tabs 100 mg, 200 mg, 25 mg, 50 mg
TOPAMAX 1
valproate sodium syrup 250 mg/5ml DEPAKENE 1
valproate sodium inj 100 mg/ml DEPACON 4
valproic acid caps 250 mg DEPAKENE 1
zonisamide caps 100 mg, 25 mg, 50 mg ZONEGRAN 1
Antiparkinsons (Antiparkinson)
Anticholinergics (Anticolinérgicos)
benztropine tabs 0.5 mg, 1 mg, 2 mg COGENTIN 1
trihexyphenidyl elixir 0.4 mg/ml, tabs 2 mg, 5 mg ARTANE 1
COMT Inhibitors (Inhibidores de COMT)
entacapone tabs 200 mg COMTAN 1
Dopamine Receptor Agonists (Agonistas del Receptor de Dopamina)
pramipexole tabs 0.125 mg, 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg
MIRAPEX 1
ropinirole tabs 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg
REQUIP 1
rotigotine 24h patch 1 mg/24hr, 2 mg/24hr, 3 mg/24hr, 4 mg/24hr, 6 mg/24hr, 8 mg/24hr
NEUPRO 3
Dopaminergics (Dopaminérgicos)
bromocriptine tabs 2.5 mg PARLODEL 1
bromocriptine caps 5 mg PARLODEL 4
carbidopa tabs 25 mg LODOSYN 4
carbidopa & levodopa tabs 10-100 mg, 25-100 mg, 25-250 mg
SINEMET 1
carbidopa & levodopa cr
tabs 25-100 mg, 50-200 mg SINEMET CR 1
selegiline caps 5 mg, tabs 5 mg ELDEPRYL 4
Dopaminergics - COMT Inhibitors (Dopaminérgicos - Inhibidores de COMT)
carbidopa & entacapone & levodopa
tabs 12.5-50-200 mg, 18.75-75- 200 mg, 25-100-200 mg, 31.25-125-200 mg, 37.5-150-200 mg, 50-200-200 mg
STALEVO 3
Miscellaneous (Misceláneos)
amantadine caps 100 mg, syrup 50 mg/5ml SYMMETREL 1
2013-2014 | 36
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
amantadine tabs 100 mg AMANTADINE 3
Antivertigo/Antiemetic (Antivértigo/Antieméticos)
aprepitant caps 125 mg, 80 mg, pack 80& 125 mg
EMEND 3 PA, QL,SL
dolasetron inj 20 mg/ml, tabs 100 mg, 50 mg ANZEMET 4
dronabinol caps 10 mg, 2.5 mg, 5 mg MARINOL 4
granisetron tabs 1 mg KYTRIL 4
meclizine tabs 12.5 mg, 25 mg, 50 mg ANTIVERT 1
meclizine tabs 32 mg VERTIN-32 4
ondansetron odt 4 mg, 8 mg, tabs 24 mg, 4 mg, 8 mg
ZOFRAN 1
ondansetron inj 4 mg/2ml, soln 4 mg/5ml ZOFRAN 4
prochlorperazine rectal supp 25 mg, tabs 10 mg, 5 mg COMPAZINE 1
promethazine inj 25 mg/ml, 50 mg/ml, rectal supp 12.5 mg, 25 mg, syrup 6.25 mg/5ml, tabs 12.5 mg, 25 mg, 50 mg, rectal supp 50 mg
PHENERGAN 1
scopolamine 72h patch 1.5 mg TRANSDERM-SCOP 4
trimethobenzamide caps 300 mg, inj 100 mg/ml TIGAN 1
Migraine (Migraña)
acetaminophen & butalbital & caffeine & codeine
caps 325-50-40-30 mg FIORICET/CODEINE 4
almotriptan tabs 12.5 mg, 6.25 mg AXERT 4 QL
apap & isometheptene & caffeine
caps 325-65-100 mg MIGRALAM 4
apap & isometheptene & dichloral
caps 325-65-100 mg MIDRIN 4
aspirin & butalbital & caffeine & codeine
caps 325-50-40-30 mg FIORINAL/CODEINE 1
butalbital & acetaminophen
tabs 50-325 mg, 50-650 mg PHRENILIN 1
butalbital & acetaminophen
caps 50-650 mg PHRENILIN 3
butalbital & acetaminophen & caffeine
caps 50-325-40 mg, 50-500-40 mg, tabs 50-325-40 mg, 50-500-40 mg
FIORICET 1
butalbital & aspirin & caffeine
tabs 50-325-40 mg BUTALBITAL & ASPIRIN & CAFFEINE
1
butalbital & aspirin & caffeine
caps 50-325-40 mg FIORINAL 1
dihydroergotamine nasal soln 4 mg/ml MIGRANAL 3
dihydroergotamine
inj 1 mg/ml D.H.E. 45 4
divalproex sprinkle caps 125 mg DEPAKOTE 1
divalproex dr tabs 125 mg, 250 mg, 500 mg DEPAKOTE EC 1
divalproex sr tabs 24h 250 mg, 500 mg DEPAKOTE ER 1
eletriptan tabs 20 mg, 40 mg RELPAX 2 QL
ergotamine subl 2 mg ERGOMAR 3
2013-2014 | 37
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
ergotamine tartrate & caffeine
tabs 1-100 mg CAFERGOT 1
ergotamine tartrate & caffeine
rectal supp 2-100 mg CAFERGOT 3
frovatriptan tabs 2.5 mg FROVA 4 QL
naratriptan tabs 1 mg, 2.5 mg AMERGE 1 QL
rizatriptan odt 10 mg, 5 mg MAXALT 1 QL
rizatriptan tabs 10 mg, 5 mg MAXALT 3 QL
sumatriptan inj 6 mg/0.5ml, tabs 100 mg, 25 mg, 50 mg
IMITREX 1 QL
sumatriptan nasal soln 20 mg/act, 5 mg/act IMITREX 3 QL
sumatriptan inj 4 mg/0.5ml IMITREX 3 QL
zolmitriptan odt 2.5 mg, 5 mg, tabs 2.5 mg, 5 mg ZOMIG 4 QL
Miscellaneous (Misceláneos)
ergoloid mesylates tabs 1 mg HYDERGINE 3
guanidine tabs 125 mg GUANIDINE 4
neostigmine bromide tabs 15 mg PROSTIGMIN 3
pimozide tabs 1 mg, 2 mg ORAP 4
pyridostigmine tabs 60 mg MESTINON 1
pyridostigmine syrup 60 mg/5ml MESTINON 3
pyridostigmine cr tabs 180 mg MESTINON TIMESPAN
3
riluzole tabs 50 mg RILUTEK 4
Psychotropics (Sicotrópicos)
Antidepressants (Antidepresivos)
MAO Inhibitors (Inhibidores de MAO)
isocarboxazid tabs 10 mg MARPLAN 4
phenelzine tabs 15 mg NARDIL 1
tranylcypromine tabs 10 mg PARNATE 1
Miscellaneous (Misceláneos)
bupropion tabs 100 mg, 75 mg WELLBUTRIN 1
bupropion sr tabs 12h 100 mg, 150 mg, 200 mg WELLBUTRIN SR 1
bupropion sr tabs 24h 150 mg, 300 mg WELLBUTRIN XL 4
duloxetine ec caps 20 mg, 30 mg, 60 mg CYMBALTA 3
maprotiline tabs 25 mg, 50 mg, 75 mg LUDIOMIL 4
mirtazapine tabs 15 mg, 30 mg, 45 mg, 7.5 mg REMERON 1
mirtazapine odt 15 mg, 30 mg, 45 mg REMERON 4
nefazodone tabs 100 mg, 150 mg, 200 mg, 250 mg, 50 mg
SERZONE 4
trazodone tabs 100 mg, 150 mg, 300 mg, 50 mg
DESYREL 1
venlafaxine tabs 100 mg, 25 mg, 37.5 mg, 50 mg, 75 mg
EFFEXOR 1
venlafaxine sr caps 24h 150 mg, 37.5 mg, 75 mg EFFEXOR XR 1
Selective Serotonine Reuptake Inhibitors (SSRIs) (Inhibidores Selectivos de la Recaptación de Serotonina)
citalopram tabs 10 mg, 20 mg, 40 mg CELEXA 1
citalopram
soln 10 mg/5ml CELEXA 4
2013-2014 | 38
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
escitalopram soln 5 mg/5ml, tabs 10 mg, 20 mg, 5 mg
LEXAPRO 4
fluoxetine caps 10 mg, 20 mg, 40 mg, soln 20 mg/5ml, tabs 10 mg, 20 mg
PROZAC 1
fluvoxamine tabs 100 mg, 25 mg, 50 mg LUVOX 4
paroxetine hcl tabs 10 mg, 20 mg, 30 mg, 40 mg PAXIL 1
paroxetine hcl susp 10 mg/5ml PAXIL 3
paroxetine hcl sr tabs 24h 12.5 mg, 25 mg, 37.5 mg PAXIL CR 1
sertraline conc 20 mg/ml, tabs 100 mg, 25 mg, 50 mg
ZOLOFT 1
Tricyclics (Tricíclicos)
amitriptyline tabs 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg
ELAVIL 1
amoxapine tabs 100 mg, 150 mg, 25 mg, 50 mg AMOXAPINE 4
clomipramine caps 25 mg, 50 mg, 75 mg ANAFRANIL 1
desipramine tabs 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg
NORPRAMIN 1
doxepin caps 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg
SINEQUAN 1
imipramine hydrochloride
tabs 10 mg, 25 mg, 50 mg TOFRANIL 1
imipramine pamoate caps 100 mg, 125 mg, 150 mg, 75 mg
TOFRANIL-PM 4
nortriptyline caps 10 mg, 25 mg, 50 mg, 75 mg PAMELOR 1
nortriptyline soln 10 mg/5ml PAMELOR 3
protriptyline tabs 10 mg, 5 mg VIVACTIL 4
trimipramine caps 100 mg, 25 mg, 50 mg SURMONTIL 4
Antipsychotics (Antisicóticos)
Atypicals (Atípicos)
aripiprazole tabs 10 mg, 15 mg, 2 mg, 20 mg, 30 mg, 5 mg
ABILIFY 2
clozapine tabs 100 mg, 25 mg, 50 mg CLOZARIL 1
olanzapine odt 10 mg, 15 mg, 20 mg, 5 mg, tabs 10 mg, 15 mg, 2.5 mg, 20 mg, 5 mg, 7.5 mg
ZYPREXA 1
quetiapine tabs 100 mg, 200 mg, 25 mg, 300 mg, 400 mg, 50 mg
SEROQUEL 1
quetiapine fumarate tabs 24h 150 mg, 200 mg, 300 mg, 400 mg, 50 mg
SEROQUEL XR 4 ST
risperidone odt 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, soln 1 mg/ml, tabs 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg
RISPERDAL 1
risperidone inj 12.5 mg, 25 mg, 37.5 mg, 50 mg RISPERDAL CONSTA 4
ziprasidone caps 20 mg, 40 mg, 60 mg, 80 mg GEODON 1
Butyrophenones (Butirofenonas)
haloperidol tabs 0.5 mg, 1 mg, 10 mg, 2 mg, 20 mg, 5 mg
HALDOL 1
2013-2014 | 39
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
haloperidol decanoate inj 100 mg/ml, 50 mg/ml HALDOL DECANOATE
1
haloperidol lactate conc 2 mg/ml HALDOL 1
haloperidol lactate inj 5 mg/ml HALDOL 4
Miscellaneous (Misceláneos)
loxapine caps 10 mg, 25 mg, 5 mg, 50 mg LOXITANE 1
thiothixene caps 1 mg, 10 mg, 2 mg, 5 mg, 20 mg
NAVANE 1
Phenothiazines (Fenotiazinas)
chlorpromazine tabs 10 mg, 100 mg, 200 mg, 25 mg, 50 mg
THORAZINE 1
chlorpromazine inj 25 mg/ml THORAZINE 4
fluphenazine tabs 1 mg, 10 mg, 2.5 mg, 5 mg PROLIXIN 1
fluphenazine conc 5 mg/ml, elixir 2.5 mg/5ml FLUPHENAZINE 3
fluphenazine decanoate inj 25 mg/ml FLUPHENAZINE 3
perphenazine tabs 16 mg, 2 mg, 4 mg, 8 mg TRILAFON 4
thioridazine tabs 10 mg, 100 mg, 25 mg, 50 mg MELLARIL 4
trifluoperazine tabs 1 mg, 10 mg, 2 mg, 5 mg STELAZINE 1
Attention Deficit and Hyperactivity (Déficit de Atención e Hiperactividad)
amphetamine & dextroamphetamine
tabs 10 mg, 12.5 mg, 15 mg, 20 mg, 30 mg, 5 mg, 7.5 mg
ADDERALL 1
amphetamine & dextroamphetamine sr
caps 24h 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 5 mg
ADDERALL XR 1
atomoxetine caps 10 mg, 100 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg
STRATTERA 4 PA ST AL
dexmethylphenidate tabs 10 mg, 2.5 mg, 5 mg FOCALIN 1
dexmethylphenidate sr caps 24h 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg, 5 mg
FOCALIN XR 2
dextroamphetamine sr caps 24h 10 mg, 15 mg, 5 mg DEXEDRINE SR 4
dextroamphetamine sulfate
tabs 5 mg, 10 mg DEXTROSTAT 1
lisdexamfetamine dimesylate
caps 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg
VYVANSE 2
methamphetamine tabs 5 mg DESOXYN 4
methylphenidate tabs 10 mg, 20 mg, 5 mg RITALIN 1
methylphenidate cr caps 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, tabs 20 mg
METADATE CD 1
methylphenidate cr tabs 20 mg RITALIN SR/METADATE ER
1
methylphenidate cr tabs 10 mg RITALIN SR/METADATE ER
3
methylphenidate sa tabs 18 mg, 27 mg, 36 mg, 54 mg CONCERTA 1
methylphenidate sr caps 24h 10 mg, 20 mg, 30 mg, 40 mg
RITALIN LA 1
modafinil tabs 100 mg, 200 mg PROVIGIL 4
Miscellaneous (Misceláneos)
amitriptyline & perphenazine
tabs 10-2 mg, 10-4 mg, 25-2 mg, 25-4 mg, 50-4 mg
PERPHENAZINE/AMITRIPTYLINE
4
2013-2014 | 40
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
chlordiazepoxide & amitriptyline
tabs 10-25 mg, 5-12.5 mg LIMBITROL 4
Mood Stabilizers (Estabilizadores del Ánimo)
divalproex sprinkle caps 125 mg DEPAKOTE 1
divalproex dr tabs 125 mg, 250 mg, 500 mg DEPAKOTE EC 1
divalproex sr tabs 24h 250 mg, 500 mg DEPAKOTE ER 1
lithium carbonate caps 150 mg, 300 mg, 600 mg, tabs 300 mg
LITHIUM CARBONATE
1
lithium carbonate cr tabs 300 mg, 450 mg LITHOBID 1
lithium citrate soln 8 meq/5ml LITHIUM CITRATE 3
valproate sodium syrup 250 mg/5ml DEPAKENE 1
valproic acid caps 250 mg DEPAKENE 1
DERMATOLOGICALS (DERMATOLÓGICOS)
Acne (Acné)
adapalene topical gel 0.3 % DIFFERIN 4 SL AL
adapalene topical cream 0.1 %, topical gel 0.1% DIFFERIN 4
adapalene-benzoyl peroxide
gel 0.1-2.5 % EPIDUO 3 SL AL
azelaic acid topical cream 20 % AZELEX 4
benzoyl peroxide topical liq 2.5 %, 5 % BENZOYL PEROXIDE 1
benzoyl peroxide topical gel 2.5 % BENZOYL PEROXIDE 3
benzoyl peroxide topical liq 4 %, 8%, topical cream 5 %, topical gel 2.75 %, 4 %, 5.25 %, 7 %, 8 %, topical lot 8 %
PANOXYL-8 / BENZASHAVE / BENZIQ
4
benzoyl peroxide liq 5.25 %, topical cream 10 %, topical liq 7 %, topical lot 3 %, 4 %, 6 %, 9 %
BENZIQ WASH 4
benzoyl peroxide & clindamycin
topical gel 5-1 % BENZACLIN 4
benzoyl peroxide & erythromycin
topical gel 5-3 % BENZAMYCIN 1
benzoyl peroxide & urea topical cream 6.5-10 %, 8.5-10 % ZODERM 4
benzoyl peroxide & urea
topical cleanser 4.5-10 %, 5.75- 10 %, 6.5-10 %, 8.5-10 %, topical pads 4.5-10 %
ZODERM 4
clindamycin topical gel 1 %, topical lot 1 %, topical soln 1 %
CLEOCIN 1
clindamycin topical swab 1 % CLEOCIN 4
erythromycin topical gel 2 %, topical soln 2 % ERYGEL 1
erythromycin topical oint 2 % AKNE-MYCIN 3
erythromycin topical pads 2 % ERYTHROMYCIN 4
sulfacetamide sodium topical lot 10 % KLARON 4
sulfacetamide sodium & sulfur
topical cream 10-5 %, topical emulsion 10-5 %, 10-1 %, topical lot 10-5 %
PLEXION 1
sulfacetamide sodium & sulfur
susp 10-5 %, topical gel 10-5 % PLEXION 3
sulfacetamide sodium & sulfur
topical cloth 10-5 % PLEXION 4
2013-2014 | 41
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
sulfacetamide sodium & sulfur & sunscreens
topical cream 10-5 % ROSAC 4
sulfacetamide sodium & sulfur & urea
topical emulsion 10-4 % ROSULA 1
sulfacetamide sodium & sulfur & urea
topical emulsion 10-5 % ROSULA 3
sulfacetamide sodium & sulfur & urea
topical gel 10-5 % ROSULA 4
tretinoin topical cream 0.025 %, 0.05 %, 0.1 %, topical gel 0.01 %, 0.025 %
RETIN-A 1 SL AL
Antibacterials, Topicals (Antibacterianos, Tópicos)
bacitracin & hydrocortisone & neomycin & polymyxin b
topical oint 1 % CORTISPORIN 4
gentamicin topical cream 0.1 %, topical oint 0.1 %
GARAMYCIN 1
hydrocortisone & neomycin & polymyxin b
topical cream 0.5 % CORTISPORIN 4
mupirocin calcium topical cream 2 %, topical oint 2 %, BACTROBAN 1
mupirocin calcium nasal oint 2 % BACTROBAN 4
silver sulfadiazine topical cream 1 % SILVADENE 1
Antifungals, Topical (Antifungales, Tópicos)
butenafine topical cream 1 % MENTAX 4
ciclopirox topical cream 0.77 %, topical gel 0.77 %, topical susp 0.77 %
LOPROX 4
ciclopirox topical nail lacquer 8 % PENLAC 4 QL
clioquinol & hc topical cream 3-0.5 % ALA-QUIN 4
clotrimazole topical cream 1 %, topical soln 1 % LOTRIMIN 1
clotrimazole & betamethasone
topical cream 1-0.05 %, topical lot 1-0.05 %
LOTRISONE 4 AL
doxepin topical cream 5 % ZONALON 4
econazole topical cream 1 % SPECTAZOLE 4
haloprogin topical cream 1% HALOTIN 4
iodoquinol & hydrocortisone
topical cream 1 % VYTONE 4
iodoquinol & hydrocortisone & aloe polysaccharide
topical gel 1-2-1 % ALCORTIN A 4
ketoconazole topical cream 2 %, topical shampoo 2 %
NIZORAL 1
naftifine topical cream 1 %, 2 %, topical gel 1 %
NAFTIN 4
nystatin topical cream 100000 u/gm, topical oint 100000 u/gm
NYSTATIN 1
nystatin topical powder 100000 u/gm MYCOSTATIN 4
nystatin & triamcinolone
topical cream 100000 u/gm-0.1 % MYCOLOG II 1
nystatin & triamcinolone topical oint 100000 u/gm-0.1 % MYCOLOG II 3
oxiconazole topical cream 1 %, topical lot 1 % OXISTAT 3
2013-2014 | 42
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
sodium thiosulfate & salicylic acid
topical lot 25-1 % TINVER 4
sulconazole topical cream 1 %, topical soln 1 % EXELDERM 4
terbinafine topical soln 1 % LAMISIL 3
Antivirals, Topical (Antivirales, Tópicos)
acyclovir topical oint 5 % ZOVIRAX 3
acyclovir topical cream 5 % ZOVIRAX 4
penciclovir topical cream 1 % DENAVIR 4 QL
Corticosteroids, Topical (Corticosteroides, Tópicos)
High Potency (Alta Potencia)
amcinonide topical lot 0.1 %, topical oint 0.1 % AMCINONIDE 4 AL
amcinonide topical cream 0.1 % CYCLOCORT 4 AL
augmented betamethasone dipropionate
topical cream 0.05 %, topical gel 0.05 %, topical lot 0.05 %, topical oint 0.05 %
DIPROLENE 1 AL
betamethasone dipropionate
topical cream 0.05 %, topical lot 0.05 %, topical oint 0.05 %
DIPROSONE 1 AL
diflorasone topical cream 0.05 % PSORCON E 4 AL
diflorasone topical oint 0.05 % PSORCON 4 AL
fluocinonide topical cream 0.05 , topical gel 0.05 %, topical oint 0.05 %, topical soln 0.05 %
LIDEX 4 AL
halcinonide topical cream 0.1 %, topical oint 0.1 %
HALOG 4 AL
Low Potency (Baja Potencia)
alclometasone topical cream 0.05 %, topical oint 0.05 %
ACLOVATE 4
clorcortolone topical cream 0.1 % CLODERM 4
desonide topical cream 0.05 %, topical lot 0.05 %, topical oint 0.05 %
DESOWEN 1
hydrocortisone topical cream 2.5 %, topical lot 2.5 %, topical oint 2.5 %
HYTONE 1
hydrocortisone topical soln 2.5 % TEXACORT 4
hydrocortisone topical cream 1 % PROCTOCORT 4
Medium Potency (Mediana Potencia)
betamethasone valerate topical cream 0.1 %, topical lot 0.1 % VALISONE / BETAVAL
1
betamethasone valerate topical oint 0.1 % VALISONE / BETAVAL
3
betamethasone valerate topical foam 0.12 % LUXIQ 4 AL
desoximetasone topical cream 0.05 % TOPICORT 4
desoximetasone topical cream 0.25 %, topical gel 0.05 %, topical oint 0.25 %
TOPICORT 4 AL
fluocinolone topical oil 0.01 %, topical soln 0.01 % DERMA-SMOOTHE 1
fluocinolone topical shampoo 0.01 % CAPEX 4
fluocinolone topical cream 0.01 %, 0.025 %, topical oint 0.025 %
SYNALAR 4
flurandrenolide topical cream 0.05 %, topical lot 0.05 %, topical tape 4 mcg/sqcm
CORDRAN 4
2013-2014 | 43
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
fluticasone topical cream 0.05 %, topical oint 0.005 %
CUTIVATE 4
hydrocortisone butyrate
topical cream 0.1 %, topical oint 0.1 %, topical soln 0.1 %
LOCOID 1
hydrocortisone butyrate topical cream 0.1 %, topical lot 0.1% LOCOID 4
hydrocortisone probutate
topical cream 0.1 % PANDEL 4 AL
hydrocortisone valerate topical cream 0.2%, topical oint 0.2% WESTCORT 1
mometasone topical cream 0.1 %, topical oint 0.1 %, topical soln 0.1 %
ELOCON 4
prednicarbate topical cream 0.1 %, topical oint 0.1 %
DERMATOP 4
triamcinolone topical aerosol 0.147 mg/gm, topical oint 0.05 %
KENALOG 4
triamcinolone topical oint 0.5 % TRIAMCINOLONE 4 AL
triamcinolone topical cream 0.025 %, 0.1 %, topical lot 0.025 %, 0.1 %, topical oint 0.025 %, 0.1 %
KENALOG 4
triamcinolone topical cream 0.5 % KENALOG 4 AL
Very High Potency (Muy Alta Potencia)
clobetasol topical cream 0.05 %, topical gel 0.05 %, topical oint 0.05 %, topical soln 0.05 %
TEMOVATE 1 AL
clobetasol topical foam 0.05 % OLUX 4 AL
halobetasol topical cream 0.05 %, topical oint 0.05 %
ULTRAVATE 4 AL
Dermatologicals, Orals (Dermatológicos, Orales)
acitretin caps 10 mg, 17.5 mg, 25 mg SORIATANE 3
bexarotene caps 75 mg TARGRETIN 4
isotretinoin caps 10 mg, 20 mg, 40 mg ACCUTANE 1
isotretinoin caps 30 mg CLARAVIS 3
methoxsalen caps 10 mg 8-MOP 3
Miscellaneous (Misceláneos)
aluminum chloride topical soln 6.25 % XERAC-AC 4
aluminum chloride soln 20% DRYSOL 4
anthralin topical cream 0.5 %, 1 % DRITHO-SCALP 3
bexarotene topical gel 1 % TARGRETIN 4
calcipotriene topical soln 0.004 % DOVONEX 1
calcipotriene topical cream 0.004 % DOVONEX 3
calcitriol oint 3 mcg/gm VECTICAL 3
emollient - cream topical cream MIMYX 4
fluorouracil topical cream 5 %, topical soln 2 %, 5 %
EFUDEX 1
fluorouracil topical cream 0.5 %, 1 % CARAC 4
imiquimod topical cream 5 % ALDARA 4
lactic acid (ammonium lactate)
topical cream 12 %, topical lot 12 % LAC-HYDRIN 4
mafenide topical cream 85 mg/gm , topical soln 5% (50 gm)
SULFAMYLON 4
2013-2014 | 44
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
podofilox topical gel 0.5 %, topical soln 0.5 % CONDYLOX 4
salicylic acid topical lot 6 % SALEX 4
tazarotene topical cream 0.05 %, 0.1 %, topical gel 0.05 %, 0.1 %
TAZORAC 4
urea
topical oint 40% GORDON'S UREA/ REMEVEN
4
urea topical cream 40%, topical gel 40%, topical lot 40%, topical soln 50%
CARMOL 40 4
urea & hydrocortisone topical cream 1-10 % CARMOL-HC 4
Rosacea (Rosácea)
azelaic acid kit 15 %, topical gel 15 % FINACEA / FINACEA PLUS
4
metronidazole topical cream 0.75 %, topical gel 0.75 %, topical lot 0.75 %
METROCREAM / METROGEL / METROLOTION
1
metronidazole topical cream 1 %, topical gel 1 % METROGEL/ NORITATE
3
Scabicides/Pediculicides (Escabicidas/Pediculosis)
lindane topical lot 1 %, topical shampoo 1 % LINDANE 1
permethrin topical cream 5 % ELIMITE 1
Topical Anesthetics (Anestésicos Tópicos)
lidocaine patch 5 % LIDODERM 4
lidocaine topical cream 3 %, topical gel 2 %, topical oint 5 %
LIDAMANTLE 4
lidocaine & hydrocortisone
topical cream 3-0.5 %, topical lot 3-0.5 %
LIDAMANTLE 4
lidocaine & prilocaine topical cream 2.5-2.5 % EMLA 4
lidocaine hcl topical lot 3 % LIDAMANTLE 1
pramoxine & hc topical cream 1-1 %, 1-2.5 % PRAMOSONE 1
pramoxine & hc oint 1-1 %, 1-2.5 %, topical lot 1-1 %, 1-2.5 %
PRAMOSONE 3
pramoxine & hc topical foam 1-1 % EPIFOAM 4
Wound Care (Cuidado de Heridas)
becaplermin topical gel 0.01 % REGRANEX 4 PA
collagenase topical oint 250 u/gm SANTYL 4
hexachlorophene topical liq 3 % PHISOHEX 4
physiological irrigation soln PHYSIOLYTE 4
ringer's irrigation soln , RINGER'S 4
water irrigation soln IRRIGATION WATER 4
EAR/NOSE/THROAT (OÍDO/NARIZ/GARGANTA)
Mouth/Throat (Boca/Garganta)
antiseptic products soln , topical spray BUCALSEP 4
benzocaine & menthol & cetylpyridinium cl & tannic acid
soln 2-0.5-0.1 % ORASEP 4
chlorhexidine gluconate
buccal soln 0.12 % PERIDEX 1
lidocaine topical soln 2 %, 4% XYLOCAINE VISCOUS
1
2013-2014 | 45
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
pilocarpine tabs 5 mg, 7.5 mg SALAGEN 4
sodium fluoride buccal soln 0.05%, 0.2% NAFRINSE 4
sodium fluoride dental cream 1.1 %, dental gel 1.1%, dental paste 1.1%, soln 0.2 %
PREVIDENT 4
stannous fluoride
conc 0.63 % GEL-KAM 4
triamcinolone oral paste 0.1 % KENALOG IN ORABASE
1
Otics (Oticos)
acetic acid otic soln 2 % VOSOL 1
acetic acid & aluminum acetate
otic soln 2 % DOMEBORO 1
acetic acid & hydrocortisone
otic soln 2-1 % VOSOL-HC 1
benzocaine & antipyrine
otic soln 1.4-5.4 % BENZOTIC 4
benzocaine-pe-antipyrine otic soln EAR-GESIC 4
ciprofloxacin & dexamethasone
otic susp 0.3-0.1 % CIPRODEX 3
ciprofloxacin & hydrocortisone
otic susp 0.2-1 % CIPRO HC 4
colistin & hydrocortisone & neomycin & thonzonium
otic susp 3-10-3.3-0.5 mg/ml CORTISPORIN-TC 4
cresyl acetate otic soln 25 % CRESYLATE 4
fluocinolone acetonide otic oil 0.01 % DERMOTIC 4
hydrocortisone & neomycin & polymyxin b
otic soln 1 %, otic susp 1 % CORTISPORIN / PEDIOTIC
1
ofloxacin otic soln 0.3 % FLOXIN 1
pramoxine & hc & chloroxylenol aqueous
otic soln 10-10-1 mg/ml CORTANE-B 4
pramoxine & hydrocortisone & chloroxylenol
otic soln 10-10-1 mg/ml OTICIN HC 4
ENDOCRINOLOGY (ENDOCRINOLOGÍA)
Corticosteroids (Corticosteroides)
betamethasone soln 0.6 mg/5ml CELESTONE 4
betamethasone acetate & sod phosphate
inj 3-3 mg/ml CELESTONE 1
cortisone acetate tabs 25 mg CORTONE 3
dexamethasone elixir 0.5 mg/5ml, tabs 0.5 mg, 0.75 mg, 1.5 mg, 4 mg, 6 mg
DEXAMETHASONE 1
dexamethasone tabs 1 mg, 2 mg DEXAMETHASONE 3
dexamethasone conc 1 mg/ml, soln 0.5 mg/5ml, tabs 1.5 mg
DEXAMETHASONE 4
dexamethasone sodium phosphate
inj 10 mg/ml, 4 mg/ml DEXAMETHASONE 1
fludrocortisone tabs 0.1 mg FLORINEF 1
2013-2014 | 46
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
hydrocortisone tabs 10 mg, 20 mg, 5 mg CORTEF 1
hydrocortisone sodium succinate
inj 1000 mg, 250 mg, 500 mg SOLU-CORTEF 4
hydrocortisone sodium succinate
inj 100 mg SOLU-CORTEF 4
methylprednisolone
tabs 2mg, 16 mg, 32 mg, 4 mg, 8 mg MEDROL 1
methylprednisolone acetate
inj 20 mg/ml, 40 mg/ml, 80 mg/ml DEPO-MEDROL 1
methylprednisolone sodium succinate
inj 1000 mg, 2000 mg, 125 mg, 40 mg, 500 mg
SOLU-MEDROL 4
prednisolone syrup 15 mg/5ml PRELONE 1
prednisolone tabs 50 mg PREDNISONE 3
prednisolone conc 5 mg/ml, tabs 5 mg PREDNISONE 4
prednisolone sod phosphate
soln 15 mg/5ml, 5 mg/5ml ORAPRED/PEDIAPRED
1
prednisone tabs 1mg, 10mg, 2.5 mg, 20mg, 5mg PREDNISONE 1
prednisone soln 5 mg/5ml PREDNISONE 4
triamcinolone acetonide
inj 10 mg/ml, 40 mg/ml KENALOG 1
Diabetes (Diabetes)
Antihyperglycemics (Antihiperglicémicos)
Alpha-Glucosidase Inhibitors (Inhibidores de la Alfa-Glucosidasa)
acarbose tabs 100 mg, 25 mg, 50 mg PRECOSE 1
miglitol tabs 100 mg, 25 mg, 50 mg GLYSET 4
Biguanides (Biguanidas)
metformin tabs 1000 mg, 500 mg, 850 mg GLUCOPHAGE 1
metformin sr tabs 24h 500 mg, 750 mg GLUCOPHAGE XR 1
Combinations (Combinaciones)
glipizide & metformin tabs 2.5-250 mg, 2.5-500 mg, 5-500 mg
METAGLIP 1
glyburide & metformin tabs 1.25-250 mg, 2.5-500 mg, 5-500 mg
GLUCOVANCE 1
pioglitazone & glimepiride
tabs 30-2 mg, 30-4 mg DUETACT 4
pioglitazone & metformin
tabs 15-500 mg, 15-850 mg ACTOPLUS MET 4 ST
rosiglitazone & glimepiride
tabs 4-1 mg, 4-2 mg, 4-4 mg, 8-2 mg, 8-4 mg
AVANDARYL 3 ST
rosiglitazone & metformin tabs 2-1000 mg, 2-500 mg, 4-1000 mg, 4-500 mg
AVANDAMET 3 ST
saxagliptin&metfomin hcl tabs 24h 2.5-1000 mg, 5-1000 mg, 5-500 mg
KOMBIGLYZE XR 2 ST
sitagliptin & metformin tabs 50-1000 mg, 50-500 mg JANUMET 2 ST
sitagliptin & metformin tabs 24h 100-1000 mg, 50-1000 mg, 50-500 mg
JANUMET XR 2 ST
sitagliptin & simvastatin tabs 100-10mg, 100-20mg, 100- 40mg, 50-10mg, 50-20 mg, 50-40mg
JUVISYNC 2 ST
2013-2014 | 47
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
Human Insulin (Insulina Humana)
insulin-(pen) inj 70-30, N HUMULIN 2
insulin-(vial) inj 70-30, N, R HUMULIN 2
insulin-(vial) inj R 500 u/ml HUMULIN 3
insulin--(pen) inj 70-30, N, R NOVOLIN 2
insulin--(vial) inj 70-30, N, R NOVOLIN 2
Insulin Analog (Insulinas Análogas)
insulin aspart (pen) inj 100 u/ml NOVOLOG 2
insulin aspart (vial) inj 100 u/ml
NOVOLOG 2
insulin aspart prot & aspart (pen)
inj 70-30 NOVOLOG MIX 2
insulin aspart prot & aspart (vial)
inj 70-30 NOVOLOG MIX 2
insulin detemir (pen) inj 100 u/ml LEVEMIR 2
insulin detemir (vial) inj 100 u/ml LEVEMIR 2
insulin glargine (pen) inj 100 u/ml LANTUS 2
insulin glargine (vial) inj 100 u/ml LANTUS 2
insulin glulisine (pen) inj 100 u/ml APIDRA 3
insulin glulisine (vial) inj 100 u/ml APIDRA 3
insulin lispro (pen) inj 100 u/ml HUMALOG 2
insulin lispro (vial) inj 100 u/ml HUMALOG 2
insulin lispro prot & lispro (pen)
inj 50-50, 75-25 HUMALOG MIX 2
insulin lispro prot & lispro (vial)
inj 50-50, 75-25 HUMALOG MIX 2
Meglitinides (Meglitinidas)
repaglinide tabs 0.5 mg, 1 mg, 2 mg PRANDIN 3
Sulfonylureas (Sulfonilureas)
chlorpropamide tabs 100 mg, 250mg DIABINESE 1
glimepiride tabs 1 mg, 2 mg, 4 mg AMARYL 4
glipizide tabs 10 mg, 5 mg GLUCOTROL 1
glipizide sr tabs 24h 10 mg, 2.5 mg, 5 mg GLUCOTROL XL 1
glyburide tabs 1.25 mg, 2.5 mg, 5 mg MICRONASE 1
glyburide tabs 1.25 mg, 2.5 mg, 5 mg DIABETA 3
glyburide micronized tabs 1.5 mg, 3 mg, 6 mg GLYNASE 1
glyburide micronized tabs 4.5 mg GLYCRON 4
tolazamide tabs 250 mg TOLINASE 1
tolazamide tabs 500 mg TOLAZAMIDE 4
tolbutamide tabs 500 mg TOLBUTAMIDE 4
Thiazolidinediones (Tiazolidinedionas)
pioglitazone tabs 15 mg, 30 mg, 45 mg ACTOS 1 ST
rosiglitazone tabs 2 mg, 4 mg, 8 mg AVANDIA 3 ST
Antihyperglycemics, Others (Antihiperglicémicos, Otros)
exenatide inj 5 mcg/0.02ml , 10 mcg/0.04ml BYETTA 2 ST
exenatide inj 2 mg BYDUREON 2 ST
linagliptin tabs 5 mg
TRADJENTA 3 ST
2013-2014 | 48
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
linagliptin & metformin tabs 2.5-1000 mg, 2.5-500 mg, 2.5-850 mg
JENTADUETO 3 ST
liraglutide inj 18 mg/3ml (6 mg/ml) VICTOZA 2 ST
saxagliptin hcl tabs 2.5 mg, 5 mg ONGLYZA 2 ST
sitagliptin tabs 100 mg, 25 mg, 50 mg JANUVIA 2 ST
Hyperglicemics (Hiperglicémicos)
diazoxide susp 50 mg/ml PROGLYCEM 4
glucagon inj 1 mg GLUCAGON 3
Miscellaneous (Misceláneos)
Androgens (Andrógenos)
danazol caps 100 mg, 200 mg, 50 mg DANOCRINE 1
fluoxymesterone tabs 10 mg ANDROXY 3
methyltestosterone caps 10 mg ANDROID 4
methyltestosterone tabs 10 mg METHITEST 4
testosterone 24h patch 2 mg/24hr, 2.5 mg/24hr, 4 mg/24hr, 5 mg/24hr, transdermal gel 1.25 gm/act , 25 mg/2.5gm, 50 mg/5gm
ANDRODERM / ANDROGEL / TESTIM
3
testosterone transdermal gel 20.25 mg/act (1.62%)
ANDROGEL PUMP 3 QL
testosterone cypionate inj 100 mg/ml, 200 mg/ml DEPO-TESTOSTERONE
1
testosterone enanthate inj 200 mg/ml TESTOSTERONE ENANTHATE
4
Others (Otros)
cabergoline tabs 0.5 mg DOSTINEX 1
calcitonin, salmon inj MIACALCIN 3
desmopressin nasal soln 0.01%, tabs 0.1mg, 0.2mg DESMOPRESSIN 1
desmopressin inj 4 mcg/ml DDAVP 4
etidronate tabs 200 mg, 400 mg DIDRONEL 1
methylergonovine tabs 0.2 mg METHERGINE 4
nafarelin nasal soln 2 mg/ml SYNAREL 4
Thyroid (Tiroides)
Antithyroid (Antitiroideos)
methimazole tabs 10 mg, 5 mg TAPAZOLE 1
propylthiouracil tabs 50 mg PROPYLTHIOURACIL 1
Thyroid Hormones (Hormonas Tiroideas)
levothyroxine tabs 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 300 mcg, 50 mcg, 75 mcg, 88 mcg
LEVOTHYROXINE 1
levothyroxine tabs 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 300 mcg, 50 mcg, 75 mcg, 88 mcg
SYNTHROID 3
liothyronine tabs 25 mcg, 5 mcg, 50 mcg CYTOMEL 1
thyroid tabs 30 mg, 60 mg, 90 mg, 120 mg, 15 mg, 180 mg, 240 mg, 300 mg
ARMOUR THYROID 4
2013-2014 | 49
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
ENZYME REPLACEMENTS/MODIFIERS (REEMPLAZO DE ENZIMAS/MODIFICADORES)
Enzyme Replacements/Modifiers (Reemplazo de Enzimas/Modificadores)
Urea Cycle Disorder Treatment (Desorden del Ciclo de Urea)
mifepristone tabs 300 mg KORLYM 4 PA SL
GASTROENTEROLOGY (GASTROENTEROLOGÍA)
Antidiarrheals (Antidiarreicos)
atropine & difenoxin tabs 1-0.025 mg MOTOFEN 4
diphenoxylate & atropina
tabs 2.5-0.025 mg LOMOTIL 1
diphenoxylate & atropine liq 2.5-0.025 mg/5ml LOMOTIL 3
loperamide caps 2 mg IMODIUM 1
paregoric elixir 2 mg/5ml PAREGORIC 1
Antispasmodics (Antiespasmódicos)
atropine inj 0.05 mg/ml ATROPINE 4
atropine inj 0.1 mg/ml ATROPINE 4
atropine & hyoscyamine & scopolamine & simethicone
elixir 0.0194-0.1037-0.0065- 40 mg/5ml
SIMETYL 4
atropine sulfate inj 0.8 mg/ml ATROPINE 4
atropine sulfate tabs 0.4 mg SAL-TROPINE 4
atropine sulfate inj 0.4 mg/ml, 1 mg/ml ATROPINE 4
belladonna alkaloids & phenobarbital
elixir 16 mg/5ml, tabs 16.2 mg DONNATAL 1
belladonna alkaloids & phenobarbital cr
tabs 48 mg DONNATAL 4
clidinium & chlordiazepoxide
caps 2.5-5 mg LIBRAX 4
dicyclomine caps 10 mg, tabs 20 mg BENTYL 1
dicyclomine inj 10 mg/ml, soln 10 mg/5ml BENTYL 3
glycopyrrolate inj 0.2 mg/ml, 4 mg/20ml (0.2 mg/ml), tabs 1 mg, 2 mg
ROBINUL 1
hyoscyamine elixir 0.125 mg/ml, soln 0.125 mg/ml, subl 0.125 mg, tabs 0.125 mg
LEVSIN 1
hyoscyamine odt 0.125 mg LEVSIN 4
hyoscyamine sulfate sr tabs 12h 0.375 mg LEVSINEX 1
hyoscyamine sulfate inj 0.5 mg/ml LEVSIN 3
methscopolamine tabs 2.5 mg, 5 mg PAMINE 4
propantheline tabs 15 mg PROPANTHINE 3
Antiulcers (Úceras)
H2 Blockers (Antagonistas H2)
cimetidine soln 300 mg/5ml, tabs 300 mg, 400 mg, 800 mg
TAGAMET 1
cimetidine inj 150 mg/ml TAGAMET 4
famotidine inj 10 mg/ml, susp 40 mg/5ml, tabs 20 mg, 40 mg
PEPCID 4
nizatidine
caps 150 mg, 300 mg AXID 4
ranitidine caps 150 mg, 300 mg, syrup 15 mg/ml, tabs 150 mg, 300 mg
ZANTAC 1
2013-2014 | 50
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
ranitidine inj 1000 mg/40ml , 150 mg/6ml , 50 mg/2ml
ZANTAC 4
Miscellaneous (Misceláneos)
amoxicillin & clarithromycin & lansoprazole dr
pack 500&500&30 mg PREVPAC 3
bismuth subsalicylate & metronidazole & tetracycline
pack 262.4&250&500 mg HELIDAC 4
misoprostol tabs 100 mcg, 200 mcg CYTOTEC 1
sucralfate tabs 1 gm CARAFATE 1
sucralfate susp 1 gm/10ml CARAFATE 3
Proton Pump Inhibitors (PPI`s) (Inhibidores de la Bomba de Protónes)
lansoprazole dr caps 1 mg, 30 mg, odt 15 mg, 30 mg
PREVACID 1
lansoprazole dr caps 15 mg PREVACID 24H OTC
omeprazole dr caps 10 mg, 20 mg, 40 mg PRILOSEC 1
omeprazole dr tabs 20 mg PRILOSEC OTC OTC
omeprazole magnesium cpdr 20.6 mg PRILOSEC OTC OTC
omeprazole-sodium bicarbonate
caps 20-1100 mg ZEGERID OTC OTC
pantoprazole ec tabs 20 mg, 40 mg PROTONIX 1
rabeprazole ec tabs 20 mg ACIPHEX 4
Digestive Enzymes (Enzimas Digestivas)
digestive enzymes w/ anticholinergics
caps GASTRINEX 4
pancrelipase (lip-prot-amyl)
caps 12000-38000-60000 u, 24000-76000-120000 u, 3000-9500-15000 u, 36000-114000-180000 u, 6000-19000-30000 u
CREON 2
Laxatives (Laxantes)
lactulose soln 10 gm/15ml ENULOSE 1
lactulose pack 10 gm, 20 gm KRISTALOSE 4
polyethylene glycol pack , powder 17 gm/1.7ml GLYCOLAX 4
polyethylene glycol & potassium chloride & sodium bicarbonate & sodium chloride
soln 420 gm NULYTELY 4
polyethylene glycol & potassium chloride & sodium bicarbonate & sodium chloride & sodium sulfate
soln 227.1 gm GOLYTELY 4
polyethylene glycol & potassium chloride & sodium bicarbonate & sodium chloride & sodium sulfate
soln 236 gm, 240 gm GOLYTELY 4
2013-2014 | 51
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
sodium phosphate, dibasic & monobasic monohydrate
tabs 0.398-1.102 gm VISICOL 4
Miscellaneous (Misceláneos)
alosetron tabs 0.5 mg, 1 mg LOTRONEX 4
balsalazide caps 750 mg COLAZAL 4
budesonide sr caps 24h 3 mg ENTOCORT EC 1 PA SL
cromolyn conc 100 mg/5ml GASTROCROM 4
hydrocortisone enema 100 mg/60ml, rectal cream 2.5 %, rectal supp 25 mg
CORTENEMA 1
hydrocortisone rectal foam 90 mg CORTIFOAM 3
hydrocortisone rectal supp 30 mg PROCTOCORT 4
hydrocortisone acetate & pramoxine
rectal cream 1-1 %, 2.5-1 % ANALPRAM-HC 1
hydrocortisone acetate & pramoxine
rectal foam 1-1 %, rectal lot 2.5-1 % PROCTOFOAM HC 3
lidocaine & hydrocortisone
rectal cream 2-2 % ANAMANTLE HC 4
lidocaine & hydrocortisone
rectal cream 3-0.5 %, 3-0.5 %, 3-1 %, 3-2.5 %
ANAMANTLE HC 4
linaclotide caps 145 mg, 290 mg LINZESS 2
lubiprostone caps 24 mcg, 8 mcg AMITIZA 4 QL SL
mesalamine enema 4 gm ROWASA/ sfROWASA
1
mesalamine rectal supp 1000 mg CANASA 2
mesalamine caps 0.375 gm, 400 mg, enema 4 gm/60ml
APRISO 3
mesalamine cr caps 250 mg, 500 mg PENTASA 2
mesalamine dr tabs 1.2 gm LIALDA 2
mesalamine dr tabs 800 mg ASACOL HD 3
mesalamine dr tabs 400 mg DELZICOL 3
methylnaltrexone inj RELISTOR 4 QL PA
metoclopramide inj 5 mg/ml, soln 5 mg/5ml, tabs 10 mg, 5 mg
REGLAN 1
olsalazine caps 250 mg DIPENTUM 3
sulfasalazine tabs 500 mg AZULFIDINE 1
sulfasalazine dr tabs 500 mg AZULFIDINE EN 1
ursodiol caps 300 mg ACTIGALL 1
ursodiol tabs 250 mg, 500 mg URSO 4
OBSTETRICS/GYNECOLOGY (OBSTETRICIA/GINECOLOGÍA)
Estrogens/Progestins (Estrógenos/Progestinas)
Combinations, Estrogens (Combinaciones, Estrógenos)
esterified estrogens & methyltestosterone
tabs 0.625-1.25 mg, 1.25-2.5 mg ESTRATEST HS 1
estradiol & norethindrone
tabs 0.5-0.1 mg, 1-0.5 mg ACTIVELLA 1
estradiol & norgestimate tabs 1&1-0.09 mg PREFEST 4
estrogens, conjugated & tabs 0.3-1.5 mg, 0.45-1.5 mg, PREMPRO/ 2
2013-2014 | 52
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
medroxyprogesterone 0.625&0.625-5 mg, 0.625-2.5 mg, 0.625-5 mg
PREMPHASE
estrogens, conjugated synthetic b
tabs 0.3 mg, 0.45 mg, 0.625 mg, 0.9 mg, 1.25 mg
ENJUVIA 3
ethinyl estradiol & norethindrone
tabs 2.5-0.5 mg, 5-1 mg FEMHRT 4
Estrogens (Estrógenos)
estradiol tabs 0.5 mg, 1 mg, 2 mg ESTRACE 1
estradiol tabs 0.45 mg, 0.9 mg, 1.8 mg, transdermal gel 0.06 %
FEMTRACE 4
estradiol hemihydrate transdermal emulsion 4.35 mg/1.74gm
ESTRASORB 4
estrogens, conjugated tabs 0.3 mg, 0.45 mg, 0.625 mg, 0.9 mg, 1.25 mg
PREMARIN 2
estrogens, conjugated inj 25 mg PREMARIN 3
estrogens, conjugated synthetic a
tabs 0.3 mg, 0.45 mg, 0.625 mg, 0.9 mg, 1.25 mg
CENESTIN 3
estrogens, esterified tabs 0.3 mg, 0.625 mg, 1.25 mg, 2.5 mg
MENEST 3
estropipate tabs 0.75 mg, 1.5 mg OGEN 1
estropipate tabs 3 mg ESTROPIPATE 3
Progesterones (Progesteronas)
medroxyprogesterone tabs 10 mg, 2.5 mg, 5 mg PROVERA 1
norethindrone tabs 5 mg AYGESTIN 4
progesterone caps 100 mg, 200 mg, inj 50 mg/ml PROMETRIUM 4
Miscellaneous (Misceláneos)
Osteoporosis (Osteoporosis)
Bisphosphonates (Bifosfonatos)
alendronate tabs 10mg, 35mg, 40mg, 5mg, 70mg FOSAMAX 1
alendronate soln 70 mg/75ml FOSAMAX 3
alendronate & cholecalciferol
tabs 70 mg-2800u, 70 mg-5600u FOSAMAX PLUS D 3
ibandronate sodium
tabs 150 mg BONIVA 1
risedronate tabs 150 mg, 30 mg, 35 mg, 5 mg ACTONEL 2
tiludronate tabs 240 mg SKELID 4
Others (Otros)
calcitonin, salmon nasal soln 200 u/act MIACALCIN 1
Selective Estrogen Receptor Modulator (Modulador Selectivo del Receptor de Estrógeno)
raloxifene tabs 60 mg EVISTA 2
Others (Otros)
danazol caps 100 mg, 200 mg, 50 mg DANOCRINE 1
Topicals (Tópicos)
Transdermal Patch (Parchos Transdermales)
estradiol weekly patch 0.025 mg/24hr, 0.0375 mg/24hr, 0.05 mg/24hr, 0.06 mg/24hr, 0.075 mg/24hr, 0.1 mg/24hr
CLIMARA 1
2013-2014 | 53
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
estradiol biweekly patch 0.025 mg/24hr, 0.0375 mg/24hr, 0.05 mg/24hr, 0.05 mg/24hr, 0.075 mg/24hr, 0.1 mg/24hr, 0.1 mg/24hr
VIVELLE-DOT 4
estradiol & levonorgestrel weekly patch 0.045-0.015 mg/day CLIMARA PRO 3
estradiol & norethindrone patch 0.05-0.14 mg/day, 0.05- 0.25 mg/day
COMBIPATCH 4
Vaginal, Topical (Vaginales, Tópicos)
Antifungals (Antifungales)
acetic acid vaginal gel ACID JELLY 4
acetic acid-oxyquinoline vaginal gel RELAGARD 4
clindamycin vaginal cream 2 % CLEOCIN 1
clindamycin vaginal supp 100 mg CLEOCIN 4
metronidazole vaginal gel 0.75 % METROGEL 1
miconazole vaginal supp 200 mg MICONAZOLE 3 3
nystatin tabs 100000 u NYSTATIN 3
sulfanilamide vaginal cream 15 % AVC 4
terconazole vaginal cream 0.4 %, 0.8 %, vaginal supp 80 mg
TERAZOL 1
Hormonal Replacement (Reemplazo Hormonal)
estradiol vaginal tabs 10 mcg VAGIFEM 3
estradiol vaginal cream 0.1 mg/gm, vaginal ring 2 mg
ESTRACE 4
estrogens, conjugated vaginal cream 0.625 mg/gm PREMARIN 3
progesterone vaginal gel 8 % CRINONE 3 QL
Vitamins, Prenatals (Vitaminas, Prenatales)
prenatal vit w/ iron & omega
pack OBTREX DHA 3
prenatal vit w/ iron carbonyl-fa
tabs ATABEX 4
prenatal vitamin tabs NOVASTART 1
prenatal vitamin caps, tabs MATERNA 3
prenatal vitamin pak, tabs Femecal OB Plus DHA 4
OPHTHALMICS (OFTÁLMICOS)
Allergy (Alergia)
Antihistamines (Antihistamínicos)
emedastine ophth soln 0.05 % EMADINE 3
Antihistamines - Mast Cell Stabilizers (Antihistamínicos -Estabilizadores de Mastocitos)
azelastine ophth soln 0.05 % OPTIVAR 1
ketotifen ophth soln 0.025 % KETOTIFEN OTC
olopatadine ophth soln 0.1 %, 0.2 % PATADAY/ PATANOL 2
Mast Cell Stabilizers (Estabilizadores de Mastocitos)
cromolyn ophth soln 4 % CROLOM 1
lodoxamide ophth soln 0.1 % ALOMIDE 4
nedocromil ophth soln 2 % ALOCRIL 3
Antibiotics (Antibióticos)
bacitracin ophth oint 500 u/gm
BACITRACIN 1
2013-2014 | 54
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
bacitracin & hydrocortisone & neomycin & polymyxin b
ophth oint 1 % CORTISPORIN 1
bacitracin & hydrocortisone & neomycin & polymyxin b
topical oint 1 % CORTISPORIN 4
bacitracin & neomycin & polymyxin b
ophth oint 400 u/gm-5 mg/gm-10000u/gm
NEOSPORIN 1
bacitracin & polymyxin b
ophth oint 500-10000 u/gm POLYSPORIN 4
ciprofloxacin ophth soln 0.3 % CILOXAN 1
ciprofloxacin ophth oint 0.3 % CILOXAN 4
dexamethasone & tobramycin
ophth susp 0.1-0.3 % TOBRADEX 1
dexamethasone & tobramycin
ophth oint 0.1-0.3 % TOBRADEX 3
erythromycin ophth oint 5 mg/gm ILOTYCIN 1
gentamicin ophth oint 0.3 %, ophth soln 0.3 % GARAMYCIN 1
gentamicin & prednisolone acetate
ophth oint 0.3-0.6 %, ophth susp 0.3-1 %
PRED-G 4
moxifloxacin ophth soln 0.5 % VIGAMOX 2
moxifloxacin ophth soln 0.5 % MOXEZA 2
natamycin ophth susp 5 % NATACYN 4
neomycin & polymyxin & dexamethasone
ophth oint 0.1 %, ophth susp 0.1 % MAXITROL 4
neomycin & polymyxin & gramicidin
ophth soln NEOSPORIN 1
neomycin & polymyxin & hydrocortisone
ophth susp 1 % CORTISPORIN 3
ofloxacin ophth soln 0.3 % OCUFLOX 1
polymyxin b & trimethoprim
ophth soln 10000 u/ml-0.1 % POLYTRIM 4
sulfacetamide sodium ophth soln 10 % BLEPH-10 4
sulfacetamide sodium & prednisolone
ophth oint 10-0.2 %, ophth susp 10-0.2 %
BLEPHAMIDE 4
sulfacetamide sodium & prednisolone
ophth soln 10-0.23 % VASOCIDIN 4
tobramycin ophth soln 0.3 % TOBREX 1
tobramycin ophth oint 0.3 % TOBREX 3
trifluridine ophth soln 1 % VIROPTIC 1
Corticosteroids (Corticosteroides)
dexamethasone ophth susp 0.1 % MAXIDEX 3
dexamethasone sodium phosphate
ophth soln 0.1 % DECADRON 1
fluorometholone ophth susp 0.1 % FML 1
fluorometholone ophth oint 0.1 %, ophth susp 0.25 % FML 3
fluorometholone acetate ophth susp 0.1 % FLAREX 4
loteprednol ophth susp 0.2 %, 0.5 % ALREX / LOTEMAX 4
2013-2014 | 55
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
prednisolone acetate ophth susp 0.12 % PRED MILD 3
prednisolone sodium phosphate
ophth soln 1 % INFLAMASE 4
rimexolone ophth susp 1 % VEXOL 4
Glaucoma (Glaucoma)
Adrenergic Selective Agonists (Agonistas Adrenérgicos Selectivos)
apraclonidine ophth soln 1 % IOPIDINE 4
apraclonidine ophth soln 0.5 % IOPIDINE 4
brimonidine ophth soln 0.15 %, 0.2 % ALPHAGAN / ALPHAGAN P
1
brimonidine ophth soln 0.1 % ALPHAGAN P 3
Beta Blockers (Bloqueadores Beta)
betaxolol ophth soln 0.5 % BETOPTIC-S / BETAXOLOL
1
betaxolol ophth susp 0.25 % BETOPTIC-S / BETAXOLOL
4
carteolol ophth soln 1 % OCUPRESS 4
levobunolol ophth soln 0.5 %, 0.25 % BETAGAN 4
metipranolol ophth soln 0.3 % OPTIPRANOLOL 4
timolol ophth gel soln 0.25 %, 0.5 %, ophth soln 0.25 %, 0.5 %
TIMOPTIC / TIMOPTIC-XE
1
timolol ophth soln 0.25 %, 0.5 % BETIMOL 3
Carbonic Anhydrase Inhibitors (Inhibidores de la Anhidrasa Carbónica)
brinzolamide ophth susp 1 % AZOPT 2
dorzolamide ophth soln 2 % TRUSOPT 1
Combinations (Combinaciones)
brimonidine & timolol ophth soln 0.2-0.5 % COMBIGAN 2
dorzolamide & timolol ophth soln 2-0.5 % COSOPT 1
dorzolamide & timolol ophth soln 22.3-6.8 % COSOPT PF 2
Miotics (Mióticos)
pilocarpine ophth soln 1 %, 2 %, 4 % ISOPTO CARPINE 1
pilocarpine ophth gel 4 % PILOPINE HS 4
Prostaglandins (Prostaglandinas)
bimatoprost ophth soln 0.01 % LUMIGAN 2
bimatoprost ophth soln 0.03 % LUMIGAN 3
latanoprost ophth soln 0.005 % XALATAN 1
tafluprost ophth soln 0.0015 % ZIOPTAN 3
travoprost ophth soln 0.004 % TRAVATAN Z 2
Miscellaneous (Misceláneos)
atropine ophth soln 1 % ISOPTO ATROPINE 1
cyclopentolate ophth soln 0.5 % CYCLOGYL 4
cyclopentolate ophth soln 1 %, 2 % CYCLOGYL 4
cyclosporine ophth emulsion 0.05 % RESTASIS 4 PA SL
naphazoline ophth soln 0.1 % AK-CON 3
tropicamide ophth soln 0.5 %, 1 % MYDRIACYL 4
Non-Steroidal Anti-Inflammatory Drugs (NSAID`s) (Anti-Inflamatorios No-Esteroidales)
diclofenac ophth soln 0.1 % VOLTAREN 1
flurbiprofen ophth soln 0.03 % OCUFEN 1
2013-2014 | 56
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
ketorolac ophth soln 0.4 %, 0.5 % ACULAR 1
nepafenac ophth susp 0.1 % NEVANAC 2
RESPIRATORY (RESPIRATORIOS)
Antihistamines/Decongestants (Antihistamínicos/Descongestionantes)
Descongestants (Descongestionantes)
acrivastine & pseudoephedrine
caps 8-60 mg SEMPREX-D 4
brompheniramine & phenylephrine
elixir 2-5 mg/5ml, liq 2-7.5 mg/5ml DECON-A 4
brompheniramine & phenylephrine
liq 4-7.5 mg/5ml VAZOL-D 4
brompheniramine & pseudoephedrine
liqd 1-7.5 mg/ml J-TAN 4
brompheniramine & pseudoephedrine sr
tabs 12h 6-45 mg LODRANE 1
brompheniramine & pseudoephedrine sr
caps 12h 9-90 mg BROVEX SR 4
cetirizine & pseudoephedrine sr
tabs 12h 5-120 mg ZYRTEC-D OTC
chlorphen tan & phenyleph tan
tabs 9-25 mg RYNATAN 4
chlorpheniramine & phenylephrine
liq 1-2 mg/ml ED A-HIST 4
chlorpheniramine & phenylephrine
liq 1-3.5 mg/ml RONDEC 4
chlorpheniramine & phenylephrine
liq 4-10 mg/5ml NOHIST-LQ 4
chlorpheniramine & phenylephrine
syrup 4-12.5 mg/5ml RONDEC 4
chlorpheniramine & phenylephrine cr
tabs 8-20 mg ED A-HIST 4
chlorpheniramine & phenylephrine sr
caps 12h 4-20 mg DALLERGY JR 4
chlorpheniramine & pseudoephedrine
liq 2-30 mg/5ml HISTEX 4
chlorpheniramine & pseudoephedrine sr
tabs 12h 12-120 mg BIOHIST LA 4
chlorpheniramine tan & phenylephrine tan
susp 4.5-5 mg/5ml RYNATAN 4
desloratadine & pseudoephedrine sr
tabs 12h 2.5-120 mg, tabs 24h 5-240 mg
CLARINEX-D 2
dexchlorpheniramine syrup 2 mg/5ml DEXCHLORPHENIRAMINE
4
diphenhydramine & phenyleph hcl tannate
tabs chew 12.5-5 mg ALDEX-CT 4
fexofenadine & pseudoephedrine sr
tabs 12h 60-120 mg, tabs 24h 180-240 mg
ALLEGRA-D 4
loratadine & pseudoephedrine sr
tabs 12h 5-120 mg, tabs 24h 10-240 mg
CLARITIN-D OTC
2013-2014 | 57
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
phenylephrine & promethazine
syrup 5-6.25 mg/5ml PROMETHAZINE VC 4
pyrilamine tan & phenyleph tan
tabs 60-25 mg RYNA-12 4
tetrahydrozoline nasal soln 0.05 %, 0.1 % TYZINE 4
Low Sedation Antihistamines (Anti-histamínicos de Baja Sedación)
carbinoxamine liq 4 mg/5ml, tabs 4 mg PALGIC 4
cetirizine syrup 5 mg/5ml, tabs 10 mg, 5 mg ZYRTEC OTC
clemastine syrup 0.67 mg/5ml CLEMASTINE 1
clemastine tabs 2.68 mg CLEMASTINE 4
cyproheptadine syrup 2 mg/5ml, tabs 4 mg CYPROHEPTADINE 1
diphenhydramine caps 50 mg DIPHENHYDRAMINE 1
diphenhydramine inj 50 mg/ml DIPHENHYDRAMINE 4
fexofenadine tabs 60 mg ALLEGRA 1
fexofenadine tabs 180 mg, 30 mg ALLEGRA 4
fexofenadine & pseudoephedrine
tabs 12h 60-120 mg, tabs 24h 180-240 mg
ALLEGRA-D ALLERGY & CONGESTION
OTC
fexofenadine hcl odt 30 mg, susp 30 mg/5ml (6 mg/ml), tabs 30 mg
ALLEGRA ALLERGY CHILDRENS
OTC
fexofenadine hcl tabs 180 mg, 60 mg ALLEGRA ALLERGY OTC
hydroxyzine hydrochloride
syrup 10 mg/5ml, tabs 10 mg, 25 mg, 50 mg
HYDROXYZINE HCL 1
Non-Sedative Antihistamines (Anti-histamínicos No Sedantes)
desloratadine odt 2.5 mg, 5 mg, tabs 5 mg CLARINEX 1
desloratadine syrup 0.5 mg/ml CLARINEX 2
loratadine caps 10 mg, chew tab 5 mg CLARITIN OTC
loratadine odt 10 mg, syrup 10 mg/10ml, tabs 10 mg
CLARITIN OTC
Antitussives/Expectorants (Antitusivos/Expectorantes)
acetylcysteine inhal 10 %, 20 % ACETYLCYSTEINE 4
benzonatate caps 100 mg, 200 mg TESSALON 1
brompheniramine w/ dm-gg
caps 2-15-200 mg, liq 2-15- 200 mg/5ml
TUSNEL 4
carbetapentane & guaifenesin
liq 20-75 mg/5ml EXPECTUSS 4
chlorphen tan & carbetapentane tan
tabs 5-60 mg TUSSIZONE-12 4
chlorphen tan & carbetapentane tan
susp 4-30 mg/5ml TUSSI-12 4
chlorphen-pe-methscopolamine
tabs 12h 8-20-2.5 mg DALLERGY PE 4
codeine & guaifenesin liq 200-10 mg/5ml TUSSO-C 4
codeine & guaifenesin liq 300-10 mg/5ml, syrup 10- 100 mg/5ml
TUSSI-ORGANIDIN NR
4
codeine & guaifenesin syrup 10-100 mg/5ml TUSSI-ORGANIDIN-S NR
4
dextromethorphan & guaifenesin
liq 20-200 mg/5ml, soln 25-225 mg/5ml
NORTUSS-EX 4
2013-2014 | 58
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
dextromethorphan & guaifenesin
liq 10-100 mg/5ml GANI-TUSS DM NR 4
dextromethorphan & guaifenesin sr
tabs 12h 60-1200 mg MUCINEX DM 4
hydrocod polst-chlorphen polst cr
susp 10-8 mg/5ml TUSSIONEX 1
hydrocodone & homatropine
syrup 5-1.5 mg/5ml, tabs 5-1.5 mg HYCODAN 4
phenyleph tan-pyrilamine tan-carbeta tan
susp 5-30-30 mg/5ml, tabs 10-40- 60 mg
TUSSI-12D S 4
phenyleph tan-pyrilamine tan-guaifenesin
tabs 25-60-200 mg RYNA-12X 4
phenyleph-chlorphen w/ dm-gg
liq 5-2-15-150 mg/5ml LARTUS 4
phenyleph-dm-pyril-pot guai-sod cit-cit acid
liq ALBATUSSIN 4
phenyleph-ephed-cpm w/ carbetapentane
tabs 10-10-5-60 mg RYNATUSS 4
phenylephrine & guaifenesin
liq 7.5-200 mg/5ml LUSAIR 4
phenylephrine & guaifenesin
liq 7.5-100 mg/5ml DONATUSSIN 4
phenylephrine & guaifenesin sr
caps 12h 30-400 mg GENEXA LA 4
phenylephrine & guaifenesin sr
tabs 12h 25-1200 mg SIMUC-GP 4
phenylephrine w/ codeine-gg
liq 2.5-3-50 mg/ml GILTUSS PED-C 4
phenylephrine w/ dm-gg liq 10-30-200 mg/5ml TUSSAFED EX 4
phenylephrine w/ dm-gg syrup 10-15-350 mg/5ml BIOBRON SF 4
phenylephrine w/ dm-gg syrup 5-15-100 mg/5ml DESPEC DM 4
phenylephrine w/ dm-gg tabs 12h 20-30-600 mg GILTUSS TR 4
phenylephrine w/ dm-gg
liq 2.5-5-75 mg/5ml TUSSI-PRES 4
phenylephrine-brompheniramine-guaifenesin
liq 2-1-40 mg/ml DECON-G 4
phenylephrine-chlorphen-dihydrocodeine
syrup 7.5-2-3 mg/5ml DESPEC-PD 4
phenylephrine-chlorphen-dm
liq 10-4-15 mg/5ml , 3.5-1-3 mg/ml, syrup 10-2-15 mg/5ml, 12.5-4- 15 mg/5ml, tabs 12h 20-8-30 mg
ED-A-HIST 4
promethazine & codeine
syrup 6.25-10 mg/5ml PROMETHAZINE/ CODEINE
1
promethazine dm syrup 6.25-15 mg/5ml PROMETHAZINE/DEXTROMETHORPHAN
1
promethazine vc & codeine
syrup 5-6.25-10 mg/5ml PROMETHAZINE VC /CODEINE
4
2013-2014 | 59
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
pseudoephed-bromphen-dm
syrup 45-4-15 mg/5ml CARBOFED DM 4
pseudoephed-chlorphen w/ dm-gg
liq 30-2-30-200 mg/5ml NEOTUSS-D 4
pseudoephedrine & guaifenesin sr
tabs 12h 60-550 mg, 75-1200 mg PSEUDOEPHEDRINE-GUAIFENESIN
4
pseudoephedrine w/ cod-gg
syrup 15-5-50 mg/5ml TUSNEL PED-C 4
pseudoephedrine w/ cod-gg
soln 30-10-100 mg/5ml , syrup 30-10-100 mg/5ml
CHERATUSSIN 4
pseudoephedrine w/ dm-gg
liq 15-5-50 mg/5ml TUSNEL PEDIATRIC 4
pseudoephedrine w/ dm-gg
liq 30-15-200 mg/5ml TUSNEL 4
pseudoephedrine-dihydrocodeine-gg
syrup 15-7.5-100 mg/5ml DESPEC-EXP 4
sodium chloride neb 3 % SODIUM CHLORIDE 4
Asthma (Asma)
Anticholinergics (Anticolinérgicos)
aclidinium bromide inhal 400 mcg/act TUDORZA PRESSAIR 2
ipratropium neb 0.02 % ATROVENT 1
ipratropium inhal 17 mcg/act ATROVENT HFA 3
ipratropium nasal soln 0.03 %, 0.06 % ATROVENT 4
tiotropium inhal caps 18 mcg SPIRIVA 2
Beta Agonists, Inhaled (Agonistas Beta, Inhalados)
albuterol neb 0.083 %, 0.5 % PROVENTIL 1
albuterol neb 0.63 mg/3ml, 1.25 mg/3ml ACCUNEB 4
albuterol inhal 108 mcg/act PROAIR HFA 2
albuterol inhal 108 mcg/act PROVENTIL HFA 2
albuterol inhal 108 mcg/act VENTOLIN HFA 3
formoterol inhal caps 12 mcg FORADIL 2
formoterol neb 20 mcg/2ml PERFOROMIST 4
levalbuterol neb 0.31 mg/3ml , neb 0.63 mg/3ml, 1.25 mg/3ml
XOPENEX 1
levalbuterol inhal 45 mcg/act XOPENEX HFA 2
levalbuterol nebu 1.25 mg/0.5ml XOPENEX CONC 4
pirbuterol inhal 200 mcg/inh MAXAIR 4
salmeterol inhal 50 mcg/dose SEREVENT 3
Beta Agonists, Oral (Agonistas Beta, Orales)
albuterol syrup 2 mg/5ml, tabs 2 mg, 4 mg PROVENTIL 1
albuterol sr tabs 12h 4 mg, 8 mg VOSPIRE ER 4
metaproterenol syrup 10 mg/5ml ALUPENT 1
metaproterenol tabs 10 mg, 20 mg METAPROTERENOL 4
terbutaline
tabs 2.5 mg, 5 mg BRETHINE 1
Combinations (Combinaciones)
albuterol & ipratropium inhal 103-18 mcg/act, 20-100 mcg/act
COMBIVENT/ COMBIVENT RESPIMAT
4
2013-2014 | 60
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
budesonide & formoterol inhal 160-4.5 mcg/act, 80-4.5 mcg/act
SYMBICORT 2
fluticasone & salmeterol inhal 100-50 mcg/dose, 115- 21 mcg/act, 230-21 mcg/act, 250- 50 mcg/dose, 45-21 mcg/act, 500- 50 mcg/dose
ADVAIR DISKUS / ADVAIR HFA
2
mometasone & formoterol
inhal 100-5 mcg/act, 200-5 mcg/act DULERA 2
Inhaled Corticosteroids (Corticosteroides Inhalados)
beclomethasone inhal 40 mcg/act, 80 mcg/act QVAR 2
budesonide inhal 0.25 mg/2ml, 0.5 mg/2ml, 1 mg/2ml
PULMICORT 1
budesonide inhal 180 mcg/act, 90 mcg/act PULMICORT FLEXHALER
4
fluticasone inhal 110 mcg/act, 220 mcg/act, 44 mcg/act
FLOVENT HFA 2
fluticasone propionate inhal 100 mcg, 250 mcg, 50 mcg FLOVENT DISKUS 2
mometasone inhal 110 mcg, 220 mcg ASMANEX 2
Miscellaneous (Misceláneos)
cromolyn neb 20 mg/2ml
INTAL 1
montelukast chew tab 4 mg, 5 mg, pack 4 mg, tabs 10 mg
SINGULAIR 1
zafirlukast tabs 10 mg, 20 mg ACCOLATE 4
zileuton tabs 600 mg ZYFLO 4
Xanthines (Xantinas)
aminophylline tabs 100 mg, 200 mg AMINOPHYLLINE 4
dyphylline elixir 100 mg/15ml, tabs 200 mg, 400 mg
DYLIX 4
dyphylline-guaifenesin liq 100-100 mg/15ml BRONDIL 4
dyphylline-guaifenesin elixir 100-100 mg/15ml, tabs 200- 200 mg, 200-400 mg
LUFYLLIN-GG 4
theophylline elixir 80 mg/15ml ELIXOPHYLLIN 3
theophylline sr tabs 12h 100 mg, 200 mg, 300 mg, 450 mg, tabs 24h 400 mg, 600 mg
THEO-DUR 1
theophylline sr caps 24h 100 mg, 200 mg, 300 mg, 400 mg
THEO-24 SR 3
Intranasal Steroids (Esteroides Intranasales)
beclomethasone nasal susp 42 mcg/spray BECONASE AQ 4
budesonide nasal susp 32 mcg/act RHINOCORT AQUA 4
flunisolide nasal soln 0.025 %, 29 mcg/act NASAREL 4
fluticasone furoate nasal susp 27.5 mcg/spray VERAMYST 4
fluticasone propionate nasal susp 50 mcg/act FLONASE 1
mometasone nasal susp 50 mcg/act NASONEX 2
triamcinolone nasal aerosol 55 mcg/act NASACORT AQ 1
Others (Otros)
azelastine nasal soln 137 mcg/spray ASTELIN 4
olopatadine nasal soln 0.6 % PATANASE 3
2013-2014 | 61
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
SKELETAL-MUSCULE SYSTEM/RHEUMATOLOGY (SISTEMA MÚSCULO-ESQUELETAL/REUMATOLOGÍA)
Gout (Gota)
allopurinol tabs 100 mg, 300 mg ZYLOPRIM 1
colchicine tabs 0.6 mg COLCRYS 3
colchicine & probenecid
tabs 0.5-500 mg COLCHICINE/PROBENECID
4
probenecid tabs 500 mg BENEMID 1
Miscellaneous (Misceláneos)
acetaminophen & salicylamide
tabs 250-600 mg FRENADOL 4
acetaminophen & salicylamide & phenyltoloxamine
caps 300-200-20 mg LOBAC 4
choline & magnesium salicylates
liq 500 mg/5ml, tabs 1000 mg, 500 mg, 750 mg
TRILISATE 4
leflunomide tabs 10 mg, 20 mg ARAVA 4
magnesium salicylate tabs 600 mg MST 600 4
phenyltoloxamine & acetaminophen
liq 30-500 mg/15ml, tabs 50-650 mg, 60-500 mg
DOLOGESIC 4
phenyltoloxamine & acetaminophen cr
tabs 30-500 mg, 50-500 mg, 60- 650 mg 66-600 mg
RELAGESIC 4
Rheumatology (Reumatología)
auranofin caps 3 mg RIDAURA 3
azathioprine tabs 50 mg IMURAN 1 SL
methotrexate tabs 2.5 mg METHOTREXATE 1
methotrexate inj 25 mg/ml, 25 mg/ml METHOTREXATE 1 SL
methotrexate tabs 10 mg, 15 mg, 2.5 mg, 5 mg, 7.5 mg
TREXALL 3
penicillamine caps 250 mg, tabs 250 mg CUPRIMINE 3
Muscle Relaxants (Relajantes Musculares)
ambenonium tabs 10 mg MYTELASE 4
baclofen tabs 10 mg, 20 mg LIORESAL 1
carisoprodol tabs 350 mg SOMA 1
carisoprodol & aspirin tabs 200-325 mg SOMA COMPOUND 4
carisoprodol & aspirin & codeine
tabs 200-325-16 mg SOMA COMPOUND/CODEINE
4
chlorzoxazone tabs 500 mg PARAFON 1
cyclobenzaprine tabs 5mg, 10 mg FLEXERIL 1
dantrolene caps 100 mg, 25 mg, 50 mg DANTRIUM 1
metaxalone tabs 800 mg SKELAXIN 4
methocarbamol tabs 500 mg, 750 mg ROBAXIN 1
methocarbamol inj 100 mg/ml ROBAXIN 3
orphenadrine inj 30 mg/ml NORFLEX 4
orphenadrine & aspirin & caffeine
tabs 25-385-30 mg, 50-770-60 mg ORPHENADRINE/ASA/CAFFEINE
4
orphenadrine sr tabs 12h 100 mg NORFLEX 4
tizanidine tabs 2 mg, 4 mg ZANAFLEX 4
2013-2014 | 62
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
Non-Steroidal Anti-Inflammatory Drugs (NSAID`s) (Anti-Inflamatorios No-Esteroidales)
celecoxib caps 100 mg, 200mg, 50 mg, 400mg CELEBREX 2
diclofenac dr tabs 25 mg, 50 mg, 75 mg VOLTAREN DR 1
diclofenac potassium tabs 50 mg CATAFLAM 4
diclofenac sr tabs 24h 100 mg VOLTAREN-XR 4
diflunisal tabs 500mg DIFLUNISAL 1
etodolac caps 200 mg, 300 mg, tabs 400 mg, 500 mg
LODINE 1
etodolac sr tabs 24h 400 mg, 500 mg, 600 mg LODINE XL 4
fenoprofen caps 200 mg, tabs 600 mg NALFON 4
flurbiprofen tabs 100 mg, 50 mg ANSAID 4
ibuprofen tabs 400 mg, 600 mg, 800 mg MOTRIN 1
indomethacin caps 25 mg, 50 mg INDOCIN 1
indomethacin susp 25 mg/5ml INDOCIN 3
indomethacin rectal supp 50 mg INDOCIN 4
indomethacin cr caps 75 mg INDOCIN SR 1
ketoprofen caps 50 mg, 75 mg ORUDIS 4
ketoprofen sr caps 24h 200 mg KETOPROFEN SR 4
ketorolac inj 15 mg/ml, 30 mg/ml, 60 mg/2ml, tabs 10 mg
KETOROLAC 1 QL
meclofenamate caps 100 mg, 50 mg MECLOFENAMATE 4
mefenamic acid caps 250 mg PONSTEL 4
meloxicam tabs 15 mg, 7.5 mg MOBIC 1
meloxicam susp 7.5 mg/5ml MOBIC 4
nabumetone tabs 500 mg, 750 mg RELAFEN 1
naproxen susp 125 mg/5ml, tabs 250 mg, 375 mg, 500 mg
NAPROSYN 1
naproxen ec tabs 375 mg, 500 mg EC-NAPROSYN 1
naproxen sodium tabs 275 mg, 550 mg ANAPROX 1
naproxen sodium sr tabs 24h 375 mg, 500 mg NAPRELAN 4
oxaprozin tabs 600 mg DAYPRO 1
piroxicam caps 10 mg, 20 mg FELDENE 1
salsalate tabs 500 mg, 750 mg DISALCID 1
sulindac tabs 150 mg, 200 mg CLINORIL 1
tolmetin tabs 200 mg, 600 mg TOLMETIN 4
tolmetin caps 400 mg TOLECTIN DS 4
UROLOGY (UROLOGÍA)
5-Alpha Reductase Inhibitors (Inhibidores de la 5-Alpha Reductasa)
dutasteride caps 0.5 mg AVODART 4
finasteride tabs 5 mg PROSCAR 1
Analgesics (Analgésicos)
phenazopyridine tabs 100 mg, 200 mg PYRIDIUM 1
Antispasmodics (Antiespasmódicos)
flavoxate tabs 100 mg URISPAS 1
hyoscyamine tabs 0.15 mg CYSTOSPAZ 1
mirabegron tabs 24h 25 mg, 50 mg MYRBETRIQ 3 ST
oxybutynin syrup 5 mg/5ml, tabs 5 mg DITROPAN 1
oxybutynin sr tabs 24h 10 mg, 15 mg, 5 mg DITROPAN XL 1
2013-2014 | 63
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
tolterodine tabs 1 mg, 2 mg DETROL 1
tolterodine sr caps 24h 2 mg, 4 mg DETROL LA 2
Cholinergics (Colinérgicos)
bethanechol tabs 10 mg, 25 mg, 5 mg, 50 mg URECHOLINE 1
Erectil Dysfunction (Disfunción Eréctil)
sildenafil citrate tabs 100 mg, 25 mg, 50 mg VIAGRA 3 QL SL
tadalafil tabs 10 mg, 2.5 mg, 20 mg, 5 mg CIALIS 3 QL SL
vardenafil hcl odt 10 mg STAXYN 4 QL,SL
vardenafil hcl tabs 10 mg, 2.5 mg, 20 mg, 5 mg LEVITRA 4 QL SL
Miscellaneous (Misceláneos)
acetohydroxamic acid tabs 250 mg LITHOSTAT 4
methenamine & hyosc & meth blue & sod phos
tabs 81.6 mg UROGESIC BLUE 1
methenamine & hyosc & meth blue & sod phos & phenyl sal
tabs 81.6 mg URIN D/S 1
methenamine & hyosc & meth blue & sod phos & phenyl sal
tabs 120 mg URETRON D/S 3
methenamine hippurate tabs 1 gm HIPREX/UREX 4
pentosan caps 100 mg ELMIRON 4
sodium chloride soln 0.9 % SODIUM CHLORIDE 4
tamsulosin sr caps 24h 0.4 mg FLOMAX 1
tiopronin tabs 100 mg THIOLA 4
Renal Disease (Enfermedad Renal)
calcium acetate caps 667 mg PHOSLO 1
cinacalcet tabs 30 mg, 60 mg, 90 mg SENSIPAR 3 PA SL
doxercalciferol caps 0.5 mcg, 1 mcg, 2.5 mcg, inj 2 mcg/ml
HECTOROL 3 PA SL
lanthanum chew tab 1000 mg, 500 mg, 750 mg FOSRENOL 4 PA SL
paricalcitol caps 1 mcg, 2 mcg, 4 mcg ZEMPLAR 2 PA SL
sevelamer tabs 400 mg, 800 mg RENAGEL 3 PA SL
sevelamer carbonate powder pack 0.8 gm, 2.4 gm, tabs 800 mg
RENVELA 2 PA SL
VITAMINS/HEMATINICS/ELECTROLYTES (VITAMINAS/HEMATÍNICOS/ELECTRÓLITOS)
Alkalinizer (Alcalinizantes)
pot & sod citrates & citric acid
syrup 550-500-334 mg/5ml POLYCITRA 4
potassium & sodium citrates
tabs 50-950 mg CITROLITH 4
potassium citrate & citric acid
powder 3300-1002 mg, soln 1100-334 mg/5ml
POLYCITRA 1
potassium citrate cr tabs 10 meq, 5 meq POTASSIUM CITRATE CR
1
sodium citrate & citric acid
soln 500-334 mg/5ml BICITRA 1
sodium citrate & citric acid
soln 490-640 mg/5ml ORACIT 4
2013-2014 | 64
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
Antidotes (Antídotos)
deferasirox susp tab 125 mg, 250 mg, 500 mg EXJADE 3 PA SL
flumazenil inj 0.5 mg/5ml , 1 mg/10ml ROMAZICON 4
naloxone inj 0.4 mg/ml NALOXONE 4
naltrexone tabs 50 mg REVIA 4
sodium polystyrene sulfonate
powder 454 gm, susp 15 gm/60ml KAYEXALATE 1
succimer caps 100 mg CHEMET 4
Coagulant Therapy (Terapia de Coagulación)
Anticoagulant (Anticoagulantes)
apixaban tabs 2.5 mg, 5 mg ELIQUIS 4 PA
dabigatran caps 150 mg, 75 mg PRADAXA 3 PA
dalteparin inj 10000 u/ml , 12500 unit/0.5ml, 15000 unit/0.6ml, 18000 unit/0.72ml, 2500 unit/0.2ml, 25000 unit/ml, 5000 unit/0.2ml, 7500 unit/0.3ml
FRAGMIN 4
enoxaparin inj 150 mg/ml, 300 mg/3ml LOVENOX 1
fondaparinux inj 10 mg/0.8ml, 2.5 mg/0.5ml, 5 mg/0.4ml, 7.5 mg/0.6ml
ARIXTRA 1
heparin sodium (porcine)
inj 20000 u/ml HEPARIN SODIUM 1
heparin sodium (porcine) inj 1000 u/ml, 10000 u/ml, 2000 u/ml, 2500 u/ml, 5000 u/ml
HEPARIN SODIUM 4
rivaroxaban tabs 10 mg XARELTO 3
rivaroxaban tabs 15 mg, 20 mg XARELTO 3 PA
tinzaparin inj 20000 u/ml INNOHEP 4
warfarin tabs 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg
COUMADIN 1
Antiplatelet (Antiplaquetarios)
anagrelide caps 0.5 mg, 1 mg AGRYLIN 4
aspirin & dipyridamole sr caps 12h 25-200 mg AGGRENOX 4
cilostazol tabs 100 mg, 50 mg PLETAL 4
clopidogrel tabs 75 mg PLAVIX 1
dipyridamole tabs 25 mg, 50 mg, 75 mg PERSANTINE 1
prasugrel hcl tabs 10 mg, 5 mg EFFIENT 3 PA SL
ticlopidine tabs 250 mg TICLID 1
Miscellaneous (Misceláneos)
aminocaproic acid tabs 1000 mg AMICAR 4
aminocaproic acid syrup 25 %, tabs 500 mg AMICAR 4
pentoxifylline cr tabs 400 mg TRENTAL 1
Vitamins/Hematinics/Other Supplements (Vitaminas/Hematínicos/Otros Suplementos)
Nutrients (Nutrientes)
dextrose & sodium chloride
inj 5-0.45 %, 5-0.9 % DEXTROSE/SODIUM CHLORIDE
4
levocarnitine soln 1 gm/10ml, tabs 330 mg CARNITOR 1
levocarnitine inj 200 mg/ml CARNITOR 4
pot bicarbonate & chloride
tabs 25 meq K-LYTE 4
2013-2014 | 65
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
pot phos monobasic & sod phos dibasic & monobasic
tabs 155-852-130 mg K-PHOS NEUTRAL 4
potassium & sodium acid phosphates
tabs 155-350 mg, 305-700 mg K-PHOS 4
potassium bicarbonate tabs 25 meq K-LYTE 4
potassium chloride liq 10 %, 2 %, powder 20 meq, 25 meq
KAON 1
potassium chloride cr caps 10 meq, 8 meq, tabs 10 meq, 8 meq
MICRO-K/SLOW-K 1
potassium chloride microencapsulated cr
tabs 10 meq, 20 meq K-DUR 1
potassium chloride microencapsulated cr
tabs 15 meq KLOR-CON 3
sodium chloride inj 0.45 %, 0.9 % SODIUM CHLORIDE 4
sodium fluoride lozenge 1mg, soln 0.25 mg/drop, tabs 0.5 gm, 1 mg
LOZI-FLUR 4
sodium fluoride chew tab 0.25 mg, 0.5 mg, 1 mg, soln 0.125 mg/drop, 0.5 mg/ml
LURIDE 4
Vitamins (Vitaminas)
ascorbic acid inj 500 mg/ml ASCORBIC ACID 1
b-complex & iron inj ALBAFORT S 3
b-complex vitamin inj B-COMPLEX 4
calcitriol caps 0.25 mcg, 0.5 mcg ROCALTROL 1
calcitriol inj 1 mcg/ml, soln 1 mcg/ml CALCITRIOL 4
cyanocobalamin inj 1000 mcg/ml CYANOCOBALAMIN 1
ergocalciferol caps 50000 u DRISDOL 4
ferric ammon cit-vit b12-liver
inj ALBAFORT 3
folic acid tabs 1 mg FOLVITE 1
folic acid inj 5 mg/ml FOLIC ACID 4
hydroxocobalamin inj 1000 mcg/ml HYDROXOCOBALAMIN
4
iron dextran inj 50 mg/ml INFED 4
leucovorin tabs 25 mg, 10 mg, 15 mg, 5 mg LEUCOVORIN 1
multiple vitamin inj M.V.I. PEDIATRIC 4
phytonadione inj 2 mg/ml VITAMIN K1 1
phytonadione inj 10 mg/ml, tabs 5 mg VITAMIN K1 3
potassium aminobenzoate
caps 500 mg, packet 2 gm, tabs 500 mg
POTABA 4 SL
pyridoxine hcl inj 100 mg/ml PYRIDOXINE HCL 1
sodium ascorbate inj 250 mg/ml, 500 mg/ml VITAMIN C 4
thiamine hcl inj 100 mg/ml THIAMINE HCL 1
vitamin a inj 50000/ml AQUASOL A 4
2013-2014 | 66
Condiciones Crónicas y de Alto Riesgo por Clasificación Terapéutica
Chronic and High Risk Conditions by Therapeutic Clasifications Medicamentos
Drugs Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
CHRONIC AND HIGH RISK CONDITIONS (CONDICIONES CRÓNICAS Y DE ALTO RIESGO)
Anti-Infectives (Anti-Infecciosos)
Antifungals (Antifungales)
amphotericin b inj 100 mg, 5 mg/ml, 50 mg, 50 mg, 50 mg
AMPHOTEC 4, 5 *
anidulafungin inj 100 mg, 50 mg ERAXIS 4, 5 * SL
caspofungin inj 50 mg, 70 mg CANCIDAS 4, 5 * SL
fluconazole & dextrose inj 200 mg/100ml, 400 mg/200ml DIFLUCAN 4, 5 * SL
fluconazole & sodium chloride
inj 200 mg/100ml, 400 mg/200ml DIFLUCAN 4, 5 * SL
micafungin inj 100 mg, 50 mg MYCAMINE 4, 5 * SL
voriconazole inj 200 mg VFEND 4, 5 * SL
Miscellaneous (Misceláneos)
tobramycin inj 1.2 gm, 1.2 gm/30ml , 10 mg/ml, 2 gm/50ml , 80 mg/2ml
TOBRAMYCIN 1, 5 *
tobramycin neb 300 mg/5ml TOBI 3, 5 *
Antivirals (Antivirales)
Hepatitis B (Hepatitis B)
adefovir tabs 10 mg HEPSERA 3, 5 * PA SL
entecavir soln 0.05 mg/ml, tabs 0.5 mg, 1mg
BARACLUDE 3, 5 * PA SL
lamivudine soln 5 mg/ml, tabs 100 mg EPIVIR HBV 3, 5 * PA SL
telbivudine tabs 600 mg TYZEKA 3, 5 * PA SL
Hepatitis C (Hepatitis C)
interferon alfacon-1 inj 15 mcg/0.5ml, 9 mcg/0.3ml INFERGEN 3, 5 *
inj 10 mu/0.2ml, 3 mu/0.2ml, 6 mu/ml
inj 10 mu/0.2ml, 3 mu/0.2ml, 6 mu/ml
INTRON-A 4, 5 * PA SL
peginterferon alfa-2a inj 135 mcg/0.5ml, 180 mcg/0.5ml, 180 mcg/ml
PEGASYS PROCLICK 4, 5 * PA SL
peginterferon alfa-2b inj 120 mcg/0.5ml, 150 mcg/0.5ml, 50 mcg/0.5ml, 80 mcg/0.5ml
PEG-INTRON 2, 5 * PA SL
ribavirin inhal 6 gm VIRAZOLE 3, 5 *
ribavirin tabs 400 mg, 600 mg RIBASPHERE 4, 5 * PA SL
ribavirin pack 200 & 400 mg dosepack, 400&600 mg
RIBAPAK 4, 5 * PA SL
ribavirin caps 200 mg, tabs 200 mg COPEGUS/ REBETOL 4, 5 * PA SL
HIV/AIDS (VIH/SIDA)
Fusion Inhibitor (Inhibidores de la Fusión)
enfuvirtide inj 90 mg FUZEON 3, 5 * PA SL
Biotechnology (Biotecnología)
Enzyme Replacement (Remplazo Enzimático)
betain soln CYSTADANE 4, 5 *
cysteamine caps 150 mg, 50 mg CYSTAGON 4, 5 *
2013-2014 | 67
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
imiglucerase inj 200 u, 400 u CEREZYME 4, 5 * PA LA SL
miglustat caps 100 mg ZAVESCA 4, 5 * PA LA SL
pegademase inj 250 u/ml ADAGEN 4, 5 *
proteinase inhibitor inj 1000 mg, 500 mg PROLASTIN 4, 5 *
sodium phenylbutyrate tabs 500 mg BUPHENYL 4, 5 *
sodium phenylbutyrate powder 3 gm/5ml BUPHENYL 4, 5 *
taliglucerase inj 200 u ELELYSO 4, 5 * PA LA SL
velaglucerase inj 400 u VPRIV 4, 5 * PA LA SL
Erythropoiesis Stimulating Proteins (Estimulantes de la Eritopoyesis)
darbepoetin alfa-polysorbate
inj 25 mcg/ml, 25 mcg/0.42ml, 40 mcg/ml, 40 mcg/0.4ml, 60 mcg/ml, 60 mcg/0.3ml, 100 mcg/ml
ARANESP 4, 5 * PA
epoetin alfa inj 10000 u/ml, 2000 u/ml, 20000 u/ml, 3000 u/ml, 4000 u/ml, 40000 u/ml
PROCRIT 2, 5 * PA
epoetin alfa inj 10000 u/ml, 2000 u/ml, 20000 u/ml, 3000 u/ml, 4000 u/ml, 40000 u/ml
EPOGEN 3, 5 * PA
oprelvekin inj 5 mg NEUMEGA 4, 5 *
Multiple Sclerosis (Esclerosis Múltiple)
dalfampridine tab sr 12hr 10 mg AMPYRA 4, 5 * SL
fingolimod caps 0.5 mg GILENYA 4, 5 * PA SL
glatiramer inj 20 mg/ml COPAXONE 2, 5 *
interferon beta-1a inj 30 mcg, 30 mcg/0.5ml AVONEX 2, 5 *
interferon beta-1a inj 22 mcg/0.5ml, 44 mcg/0.5ml, 8.8 mcg/0.2ml&22 mcg/0.5ml
REBIF 3, 5 *
interferon beta-1b inj 0.3 mg EXTAVIA 2, 5 *
interferon beta-1b inj 0.3 mg BETASERON 3, 5 *
natalizumab inj 300 mg/15ml TYSABRI 4, 5 *
teriflunomide tabs 7mg, 14mg AUBAGIO 4, 5 *
Myeloid Stimulating Agents (Estimulantes Mieloides)
filgrastim inj 300 mcg/0.5ml , 300 mcg/ml, 480 mcg/0.8ml , 480 mcg/1.6ml
NEUPOGEN 3, 5 *
pegfilgrastim inj 6 mg/0.6ml NEULASTA 4, 5 *
sargramostim inj 250 mcg LEUKINE 3, 5 *
sargramostim inj 500 mcg/ml LEUKINE 4, 5 *
Cancer (Cáncer)
Alkylating Agents (Agentes Alquilantes)
temozolomide caps 100 mg, 140 mg, 180mg, 20 mg, 250 mg, 5 mg
TEMODAR 4, 5 *
Antimetabolites (Antimetabolitos)
capecitabine tabs 150 mg, 500 mg XELODA 4, 5 *
fludarabine tabs 10 mg OFORTA 4, 5 * PA SL
2013-2014 | 68
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
Miscellaneous (Misceláneos)
axitinib tabs 1mg, 5 mg INLYTA 4, 5 * PA SL AL
bosutinib tabs 100 mg, 500 mg BOSULIF 4, 5 * PA SL AL
crizotinib caps 200 mg, 250 mg XALKORI 4, 5 * PA SL
dasatinib tabs 100 mg, 140 mg, 20 mg, 50 mg, 70 mg, 80 mg
SPRYCEL 4, 5 * PA SL
erlotinib tabs 100 mg, 150 mg, 25 mg TARCEVA 3, 5 * PA SL
everolimus tabs 10 mg, 2.5 mg, 5 mg, 7.5 mg AFINITOR 4, 5 * PA SL
imatinib mesylate tabs 100 mg, 400 mg GLEEVEC 3, 5 * PA SL
lapatinib ditosylate tabs 250 mg TYKERB 3, 5 * PA SL
lenalidomide caps 10 mg, 15 mg, 2.5 mg, 25 mg, 5 mg
REVLIMID 4, 5 * PA SL
mitoxantrone inj 20 mg/10ml , 25 mg/12.5ml , 30 mg/15ml
NOVANTRONE 4, 5 *
nilotinib caps 150 mg, 200 mg TASIGNA 4, 5 * PA SL
pazopanib tabs 200 mg VOTRIENT 4, 5 * PA SL
peginterferon alfa-2b inj 296 mcg, 4 x 296 mcg, 4 x 444 mcg, 4 x 888 mcg, 444 mcg, 888 mcg
SYLATRON 4, 5 * PA, SL
regorafenib tabs 40 mg STIVARGA 4, 5 * PA SL
sorafenib tosylate tabs 200 mg NEXAVAR 4, 5 * PA SL
sunitinib malate caps 12.5 mg, 25 mg, 50 mg SUTENT 4, 5 * PA SL
thalidomide caps 100 mg, 150 mg, 200 mg, 50 mg
THALOMID 4, 5 *
vemurafenib tabs 240 mg ZELBORAF 4, 5 * PA SL AL
vismodegib caps 150 mg ERIVEDGE 4, 5 * PA SL
vorinostat caps 100 mg ZOLINZA 4, 5 * PA SL
Cardiovasculars (Cardiovasculares)
ambrisentan tabs 10 mg, 5 mg LETAIRIS 4, 5 * PA SL
bosentan tabs 125 mg, 62.5 mg TRACLEER 4, 5 * PA SL epoprostenol sodium inj 0.5 mg, 1.5 mg FLOLAN 4, 5 * PA SL iloprost inhal 10 mcg/ml, 20 mcg/ml VENTAVIS 4, 5 * PA SL sildenafil tabs 20 mg REVATIO 4, 5 * AL,
PA SL
treprostinil inj 1 mg/ml, 10 mg/ml, 2.5 mg/ml, 5 mg/ml
REMODULIN 4, 5 * PA SL
Central Nervous System (Sistema Nervioso Central)
sodium oxybate soln 50 mg/5ml XYREM 4, 5 * PA SL
Endocrinology (Endocrinológicos)
Growth Hormones (Hormonas de Crecimiento)
somatropin inj 8.8 mg ZORBTIVE 4, 5 * PA SL
somatropin inj 5 mg, 8.8 mg SAIZEN 3, 5 * PA SL
somatropin inj 0.2 mg, 0.4 mg, 0.6 mg, 0.8 mg, 1 mg, 1.2 mg, 1.4 mg, 1.6 mg, 1.8 mg, 13.8 mg, 2 mg
GENOTROPIN 3, 5 * PA SL
2013-2014 | 69
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
somatropin inj 4 mg, 5 mg, 6 mg SEROSTIM 3, 5 * PA SL
somatropin inj 10 mg, 20 mg/2ml, 5 mg, 5 mg/ml
NUTROPIN 3, 5 * PA SL
somatropin inj 12 mg, 24 mg, 5 mg, 6 mg HUMATROPE 4, 5 * PA SL
somatropin inj 5 mg/1.5ml, 5.8 mg OMNITROPE 3, 5 * PA SL
somatropin inj 5 mg TEV-TROPIN 3, 5 * PA SL
somatropin inj 10 mg/1.5ml, 15 mg/1.5ml, 30 mg/3ml, 5 mg/1.5ml
NORDITROPIN 3, 5 * PA SL
Miscellaneous (Misceláneos)
lanreotide acetate inj 120 mg/0.5ml, 60 mg/0.2ml, 90 mg/0.3ml
SOMATULINE DEPOT 4, 5 * PA SL
octreotide inj 10 mg, 20 mg, 30 mg SANDOSTATIN LAR 3, 5 * PA SL
octreotide inj 0.05 mg/ml, 0.1 mg/ml, 0.2 mg/ml, 0.5 mg/ml, 1 mg/ml
SANDOSTATIN 4, 5 * PA SL
Others (Otros)
desmopressin nasal soln 1.5 mg/ml STIMATE 3, 5 *
Obstetrics/Gynecology (Obstetricia/Ginecología)
Osteoporosis (Osteoporosis)
Biphosphonates (Bifosfonatos)
denosumab inj 60 mg/ml PROLIA 4, 5 * QL PA SL
ibandronate inj 3 mg/3ml BONIVA 4, 5 * PA
pamidronate inj 6 mg/ml AREDIA 4, 5 *
pamidronate inj 3 mg/ml, 30 mg, 9 mg/ml, 90 mg
AREDIA 4, 5 *
zoledronic soln 5 mg/100ml RECLAST 4, 5 * QL PA
Miscellaneous (Misceláneos)
teriparatide inj 750 mcg/3ml FORTEO 3, 5 * PA SL
Respiratory (Respiratorios)
Others (Otros)
dornase alfa inhal 1 mg/ml PULMOZYME 4, 5 *
Skeletal-Muscule System/Rheumatology (Sistema Músculo-Esqueletal/Reumatología)
Miscellaneous (Misceláneos)
abatacept inj 125 mg/1ml, 250 mg ORENCIA 3, 5 * PA SL
adalimumab inj 20 mg/0.4ml, 40 mg/0.8ml HUMIRA 2, 5 * PA SL
etanercept inj 25 mg, 25 mg/0.5ml, 50 mg/ml ENBREL 2, 5 * PA SL
infliximab inj 100 mg REMICADE 4, 5 * PA
tocilizumab inj 200 mg/10ml, 400 mg/20ml, 80 mg/4ml
ACTEMRA 4, 5 * PA, SL
tofacitinib citrate tabs 5 mg XELJANZ 4, 5 * PA, SL
Vitamins/Hematinics/Other Supplements (Vitaminas/Hematínicos/OtrosSuplementos)
Chelating Agents (Agentes Quelantes)
deferiprone tabs 500 mg FERRIPROX 4, 5 * PA SL AL
Coagulant Therapy (Terapia de Coagulación)
Miscellaneous (Misceláneos)
antihemophilic factor inj 401-800 u HEMOFIL M 3, 5 * PA SL
2013-2014 | 70
Medicamentos Drugs
Presentación Dosage Form
Nombre Comercial Brand Name
Nivel Level
Inst
antihemophilic factor inj 500 u KOATE-DVI 4, 5 * PA SL
antihemophilic factor (human)
inj 220-400 u, 4000 u, 401-800 u HEMOFIL M 3, 5 * PA SL
antihemophilic factor (human)
inj 1000 u, 1000-1000 u, 1500 u, 250 u, 450-450 u, 500 u, 500- 500 u, 900-900 u
MONOCLATE-P 4, 5 * PA SL
antihemophilic factor (recombinant)
inj 1241-1800 u, 1801-2400 u, 801-1240 u
RECOMBINATE 3, 5 * PA SL
antihemophilic factor (recombinant)
inj 1000 u, 2000 u, 250 u, 500 u REFACTO 4, 5 * PA, SL
antihemophilic factor (recombinant)
inj 3000 u XYNTHA 4, 5 * PA SL
antihemophilic factor rahf-pfm
inj 1000 u, 1500 u, 2000 u, 250 u, 3000 u, 500 u
ADVATE 3, 5 * PA SL
antihemophilic factor/vwf inj 250-600 u HUMATE-P 4, 5 * PA SL
antihemophilic factor/vwf (human)
inj 1000 u, 1000-2400 u, 1500 u, 250 u, 500 u, 500-1200 u
ALPHANATE 4, 5 * PA SL
antiinhibitor coagulant complex
inj FEIBA VH 4, 5 * PA SL
coagulation factor ix inj , 1000 u, 1500 u, 500 u MONONINE 4, 5 * PA SL
coagulation factor ix (recombinant)
inj 1000 u, 2000 u, 250 u, 3000 u, 500 u
BENEFIX 4, 5 * PA SL
coagulation factor viia (recombinant)
inj 1 mg, 1200 mcg, 2 mg, 2400 mcg, 4800 mcg, 5 mg, 8 mg
NOVOSEVEN 4, 5 * PA SL
factor ix complex inj 1000 u, 1500 u, 200-1200 u, 500 u
PROFILNINE 4, 5 * PA SL
2013-2014 | 71
APENDICE I - LIMITES DE CANTIDAD APPENDIX I - QUANTITY LIMITS
Producto (Product)
Nombre genérico (Generic Name)
Cantidad (Quantity)
Días (Days)
AMERGEf
NARATRIPTAN HCL TAB 1 MG, 2.5MG 9 tab 30
AMITIZA LUBIPROSTONE CAP 8 MCG, 24MCG 60 cap 30
ANDROGEL PUMP
TESTOSTERONE TD GEL 20.25 MG/ACT (1.62%) 75 gm 30
AXERTi
ALMOTRIPTAN MALATE TAB 6.25 MG, 12.5 MG 6 tab 30
CIALIS TADALAFIL TAB 2.5 MG, 5MG, 10MG, 20MG 6 tab 30
CIPRO XR CIPROFLOXACIN-CIPROFLOXACIN HCL TAB SR 24HR 500 MG
** 3
CIPRO XR CIPROFLOXACIN-CIPROFLOXACIN HCL TAB SR 24HR 1000 MG
** 14
COARTEM ARTEMETHER-LUMEFANTRINE TAB 20-120 MG 24 tab 365
CRINONE PROGESTERONE VAGINAL GEL 8% 21.75 gm 15
DENAVIR PENCICLOVIR CREAM 1% 5 gm 15
EMEND APREPITANT CAPSULE 80 MG 2 Cap 7
EMEND APREPITANT CAPSULE 125 MG 1 Cap 7
EMEND APREPITANT CAPSULE THERAPY PACK 80 & 125 MG
3 Cap 7
FROVAj
FROVATRIPTAN SUCCINATE TAB 2.5 MG 9 tab 30
IMITREXb
SUMATRIPTAN NASAL SPRAY 1 caja/ 1 box 30
IMITREXc,d
SUMATRIPTAN SUCCINATE TAB 25 MG, 50MG 18 tab 30
IMITREXc,d
SUMATRIPTAN SUCCINATE TAB 100 MG 9 tab 30
IMITREXa SUMATRIPTAN SUCCINATE INJ 5 ampolletas / 5
ampoule 30
LAMISIL TERBINAFINE HCL TAB 250 MG 84 tab 365
LEVITRA VARDENAFIL HCL TAB 2.5 MG, 5 MG, 10 MG, 20MG
6 tab 30
MALARONE ATOVAQUONE-PROGUANIL HCL TAB 62.5- 25MG 48 tab 365
MARONE ATOVAQUONE-PROGUANIL HCL TAB 250-100MG 12 tab 365
MAXALTg,h
RIZATRIPTAN BENZOATE TAB 5 MG 24 or 12 tab* 30
MAXALTg,h
RIZATRIPTAN BENZOATE TAB 10 MG 12 tab* 30
MAXALTg,h
RIZATRIPTAN BENZOATE ORALLY DISINTEGRATING TAB 5 MG
24 or 12 tab* 30
MAXALTg,h
RIZATRIPTAN BENZOATE ORALLY DISINTEGRATING TAB 10 MG
12 tab* 30
PENLAC CICLOPIROX SOLUTION 8% 1 Botella/Bottle 90
PROLIA DENOSUMAB INJ 60 MG/ML 1 ml 135
Qualaquin QUININE SULFATE CAP 324 MG 42 Cap 365
RECLAST ZOLEDRONIC ACID IV SOLN 5 MG/100ML 100 ml 274
RELISTOR METHYLNALTREXONE BROMIDE INJ 8 MG/0.4ML (20 MG/ML)
2.8 ml 15
2013-2014 | 72
Producto (Product)
Nombre genérico (Generic Name)
Cantidad (Quantity)
Días (Days)
RELISTOR METHYLNALTREXONE BROMIDE INJ 12 MG/0.6ML (20 MG/ML)
4.2 ml 15
RELISTOR METHYLNALTREXONE BROMIDE INJ KIT 12 MG/0.6ML
1 box (7 Inj) 15
RELPAXk
ELETRIPTAN HYDROBROMIDE TAB 20 MG, 40MG 6 tab 30
STAXYN VARDENAFIL HCL ORALLY DISINTEGRATING TAB 10 MG
4 tab 30
TORADOL KETOROLAC TROMETHAMINE ** 5
VIAGRA SILDENAFIL CITRATE TAB 25 MG 2 tab 30
VIAGRA SILDENAFIL CITRATE TAB 50 MG 6 tab 30
VIAGRA SILDENAFIL CITRATE TAB 100 MG 6 tab 30
ZOMIGe
ZOLMITRIPTAN TAB 2.5 MG, 5 MG, ODT 2.5MG, 5MG
6 tab 30
* No se debe utilizar en pacientes que toman propranolol concurrentemente / should not be used concurrently with propranolol
** Se despachará una cantidad máxima de suplido según establecido en la tabla de limites de cantidad / A máximum supply for days of therapy will be dispensed as establish in the table of quantity limits.
Triptanos a. Si no se observa respuesta adecuada, se puede repetir la dosis una vez luego de 2 horas hasta un máximo de 12mg en
24 horas. / If adequate response is not observed, the dose can be repeated once again alter two hours up to a maximum of 12 mg in 24 hours.
b. Si no se observa respuesta adecuada, se puede repetir la dosis una vez luego de 2 horas hasta un máximo de 40mg en 24 horas. /If adequate response is not observed, the dose can be repeated once again alter two hours up to a maximum of 40 mg in 24 hours.
c. Si no se observa respuesta adecuada, se puede repetir la dosis una vez luego de 2 horas hasta un máximo de 200mg en 24 horas. / If adequate response is not observed, the dose can be repeated once again alter two hours up to a maximum of 200 mg in 24 hours.
d. Si el producto inyectable se usa concomitantemente, la dosis oral máxima no debe exceder 100mg / If the injectable product is used jointly, the maximum oral dose should not exceed 100mg.
e. Los estudios clínicos no han establecido la efectividad de una segunda dosis si la primera es inefectiva. Si no se observa respuesta adecuada, se puede repetir la dosis una vez luego de 2 horas hasta un máximo de 10mg en 24 horas. / The clinical studies have not established the effectiveness of a second dose if the first one is ineffective. If adequate response is not observed, the dose can be repeated once again after two hours up to a maximum of 10mg in 24 hours.
f. Si no se observa respuesta adecuada, se puede repetir la dosis una vez luego de 4 horas hasta un máximo de 5mg en 24 horas. / If adequate response is not observed, the dose can be repeated after four hours up to a maximum of 5mg in 24 hours.
g. Si no se observa respuesta adecuada, se puede repetir la dosis luego de 2 horas hasta un máximo de 30mg en 24 horas. / If adequate response is not observed, the dose can be repeated after two hours up to a maximum of 30mg in 24 hours.
h. En pacientes que reciben propranolol concomitantemente, la dosis de 5mg de rizatriptan debe usarse hasta un máximo de 3 dosis (15mg) en 24 horas. / In patients that receive propranolol jointly, the 5mg dose of rizatriptan should be up to a maximum of three doses (15mg) in 24 hours.
i. Si no se observa respuesta adecuada, se puede repetir la dosis una vez luego de 2 horas hasta un máximo de 25mg en 24 horas. / If adequate response is not observed, the dose can be repeated after two hours up to a maximum of 25mg in 24 hours.
j. Si no se observa respuesta adecuada, se puede repetir la dosis en 2 horas hasta un máximo de 7.5mg en 24 horas. / If adequate response is not observed, the dose can be repeated after two hours up to a maximum of 7.5mg in 24 hours.
k. Si no se observa respuesta adecuada, se puede repetir la dosis en 2 horas hasta un máximo de 80mg en 24 horas. No exceder de 40mg por dosis. / If adequate response is not observed, the dose can be repeated after two hours up to a maximum of 80mg in 24 hours. Do not exceed 40mg per dose.
2013-2014 | 73
APENDICE II - LIMITES DE ESPECIALIDAD APPENDIX II - SPECIALTY LIMITS
Dentro del formulario se encuentran incluidos medicamentos asociados a las iniciales SL. SL
significa que estos medicamentos requieren que un especialista evalúe el paciente y los recete. La
siguiente tabla enumera cuales son estos productos y señala el especialista que debe prescribirlos.
The formulary includes drugs associated to the LE initials. LE means that those medications require
that a specialist evaluates the patient and prescribe it. The following table enumerates which are
those products and indicate the specialist that must prescribe it.
Producto (Product)
Especialista (Specialist)
Actemra Reumatólogo / Rheumatologist
Afinitor Hematólogo-Oncólogo, Urólogo, Neurólogo, Neurocirujano / Hematologist-Oncologist, Urologist, Neurologist, Neurosurgeon
Amitiza Gastroenterólogo, Medicina Interna / Gastroenterologist, Internal Medicine
Ampyra Neurólogo, Medicina Física y Rehabilitación / Neurologist, Physical Medicine and Rehabilitation
Antihemophilic & Coagulation Factors
Hematólogo /Hematologist
Aptivus Infectólogo / Infectologist
Banzel Neurólogo, Neurólogo Pediatrico/ Neurologist, Pediatric Neurologist
Baraclude Gastroenterólogo, Infectólogo / Gastroenterologist, Infectologist
Bosulif Hematólogo-Oncológo / Hematologist-Oncologist
Cancidas Infectólogo, Hematólogo-Oncólogo / Infectologist, Hematologist-Oncologist
Cellcept Reumatólogo / Rheumatologist
Cialis Urólogo, Endocrinólogo / Urologist, Endocrinologist
Copegus Gastroenterólogo, Infectólogo / Gastroenterologist, Infectologist
Differin gel 0.3% Dermatólogo/ Dermatologist
Diflucan inj Infectólogo, Hematólogo-Oncólogo / Infectologist, Hematologist-Oncologist
Elelyso Desordenes Genéticos y Metabólicos / Metabolic and Genetic Desorders
Emend Oncólogo / Oncologist
Enbrel Reumatólogo, Dermatólogo / Rheumatologist, Dermatologist
Entocort EC Gastroenterólogo / Gastroenterologist
Epiduo Dermatólogo / Dermatologist
Epivir HBV Gastroenterólogo, Infectólogo / Gastroenterologist, Infectologist
Eraxis Infectólogo, Hematólogo-Oncólogo / Infectologist, Hematologist-Oncologist
Erivedge Hematólogo-Oncológo / Hematologist-Oncologist
Dermatólogo / Dermatologist
Exjade Hematólogo-Oncológo / Hematologist-Oncologist
2013-2014 | 74
Producto (Product)
Especialista (Specialist)
Flolan Cardiólogo, Neumólogo, Intensivista/ Cardiologist, Pneumologist, Intensivist
Forteo Endocrinólogo, Reumatólogo / Endocrinologist, Rheumatologist
Fosrenol Nefrólogo/ Nephrologist
Fuzeon Infectólogo / Infectologist
Gilenya Neurólogo / Neurologist
Gleevec Oncólogo / Oncologist
Hectorol Nefrólogo / Nephrologist
Hepsera Gastroenterólogo, Infectólogo / Gastroenterologist, Infectologist
Hormonas de Crecimiento / Growth Hormone
Endocrinólogo / Endocrinologist
Humira Reumatólogo, Dermatólogo, Gastroenterólogo / Rheumatologist, Dermatologist, Gastroenterologist
Imuran Reumatólogo, Dermatólogo, Nefrólogo, Neumólogo, Gastroenterólogo / Rheumatologist, Dermatologist, Nephrologist, Pneumologist, Gastroenterologist
Inlyta Hematólogo-Oncológo, Urólogo / Hematologist-Oncologist, Urologist
Intelence Infectólogo / Infectologist
Korlym Endocrinólogo / Endocrinologist
Letairis Cardiólogo, Neumólogo, Intensivista/ Cardiologist, Pneumologist, Intensivist
Levitra Urólogo, Endocrinólogo / Urologist, Endocrinologist
Methotrexate inj. Reumatólogo, Gastroenterólogo / Rheumatologist, Gastroenterologist
Mycamine Infectólogo, Hematólogo-Oncólogo / Infectologist, Hematologist-Oncologist
Nexavar Gastroenterólogo, Hematólogo-Oncólogo, Urólogo / Gastroenterologist, Hematologist-Oncologist, Urologist
Noxafil Infectólogo / Infectologist
Oforta Hematólogo-Oncológo / Hematologist-Oncologist
Orencia Reumatólogo / Rheumatologist
Pegasys Gastroenterólogo, Infectólogo / Gastroenterologist, Infectologist
Peg-Intron / Intron-A Gastroenterólogo, Infectólogo / Gastroenterologist, Infectologist
Potaba Reumatólogo, Dermatólogo, Uólogo / Rheumatologist, Dermatologist, Urologist
Potiga Neurólogo, Neurólogo Pediátrico / Neurologist, Pediatric Neurologist
Prolia Endocrinólogo, Reumatólogo / Endocrinologist, Rheumatologist
Ranexa Cardiólogo / Cardiologist
Rebetol Gastroenterólogo, Infectólogo / Gastroenterologist, Infectologist
Remodulin Cardiólogo, Neumólogo, Intensivista/ Cardiologist, Pneumologist, Intensivist
Renagel / Renvela Nefrólogo/ Nephrologist
Restasis Oftalmólogo/ Ophthalmologist
Retin A Dermatólogo / Dermatologist
Revatio Cardiólogo, Neumólogo, Intensivista/ Cardiologist, Pneumologist, Intensivist
2013-2014 | 75
Producto (Product)
Especialista (Specialist)
Revlimid Hematólogo-Oncológo / Hematologist-Oncologist
Ribapak / Ribasphere Gastroenterólogo, Infectólogo / Gastroenterologist, Infectologist
Sandostatin / Sandostatin LAR
Endocrinólogo, Gastroenterólogo, Hematólogo-Oncólogo/ Endocrinologist, Gastroenterologist, Hematologist-Oncologist
Selzentry Infectólogo / Infectologist
Sensipar Nefrólogo / Nephrologist
Somatuline Endocrinólogo/ Endocrinologist
Sprycel Hematólogo-Oncólogo / Hematologist-Oncologist
Staxyn Urólogo, Endocrinólogo / Urologist, Endocrinologist
Stivarga Hematólogo-Oncológo / Hematologist-Oncologist
Sutent Hematólogo-Oncólogo, Gastroenterólogo, Urólogo / Hematologist-Oncologist, Gastroenterologist, Urologist
Sylatron Hematólogo-Oncólogo / Hematologist-Oncologist
Tarceva Oncólogo / Oncologist
Tasigna Hematólogo-Oncológo / Hematologist-Oncologist
Tracleer Cardiólogo, Neumólogo, Intensivista/ Cardiologist, Pneumologist, Intensivist
Tykerb Hematólogo-Oncológo / Hematologist-Oncologist
Tyzeka Gastroenterólogo, Infectólogo / Gastroenterologist, Infectologist
Ventavis Cardiólogo, Neumólogo, Intensivista/ Cardiologist, Pneumologist, Intensivist
Vfend / Voriconazole Infectólogo, Hematólogo-Oncólogo / Infectologist, Hematologist-Oncologist
Viagra Urólogo, Endocrinólogo / Urologist, Endocrinologist
Vimpat Neurólogo, Neurólogo Pediatrico/ Neurologist, Pediatric Neurologist
Viread Gastroenterólogo, Infectólogo / Gastroenterologist, Infectologist
Votrient Hematólogo-Oncológo, Urólogo / Hematologist-Oncologist, Urologist
Vpriv Desordenes Genéticos y Metabólicos / Metabolic and Genetic Desorders
Xalkori Hematólogo-Oncológo / Hematologist-Oncologist
Xtandi Hematólogo-Oncológo / Hematologist-Oncologist
Xeljanz Reumatólogo / Rheumatologist
Xyrem Neumólogo, Neurólogo, Siquiatra / Pneumologist, Neurologist, Psychatrist
Zavesca Desordenes Genéticos y Metabólicos / Metabolic and Genetic Desorders
Zelboraf Hematólogo-Oncológo / Hematologist-Oncologist
Zemplar Nefrólogo / Nephrologist
Zolinza Dermatólogo, Hematólogo-Oncólogo / Dermatologist, Hematologist-Oncologist
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APENDICE III - LIMITES DE EDAD
APPENDIX III - AGE LIMITS Dentro del formulario se encuentran incluidos medicamentos asociados a las iniciales AL. AL
significa que estos medicamentos tienen a un límite de edad.
The formulary includes medications associated to the initials AL. AL means that those medications
have a limit in the age.
Nombre genérico (Generic Name)
Productos (Product)
Límites de Edad (Age Limits)
ADAPALENE GEL DIFFERIN ≤ 25 años/≤ 25 years
ADAPALENE-BENZOYL PEROXIDE GEL
EPIDUO ≤ 24 años/≤ 24 years
AMCINONIDE AMCINONIDE ≥ 12 años/≥ 12 years
AMCINONIDE CREAM CYCLOCORT ≥ 12 años/≥ 12 years
ATOMOXETINE HCL STRATTERA ≥ 6-18 años; ≥ 19 años requiere PA / PA required
AUGMENTED BETAMETHASONE DIPROPIONATE
DIPROLENE ≥ 12 años/≥ 12 years
AXITINIB INLYTA ≥ 18 años/ ≥ 18 years
BETAMETHASONE DIPROPIONATE
DIPROSONE ≥ 12 años/≥ 12 years
BETAMETHASONE VALERATE LUXIQ ≥ 12 años/≥ 12 years
BOSUTINIB BOSULIF ≥ 18 años/ ≥ 18 years
CLOBETASOL PROPIONATE TEMOVATE ≥ 12 años/≥ 12 years
CLOBETASOL PROPIONATE TEMOVATE ≥ 12 años/≥ 12 years
CLOBETASOL PROPIONATE FOAM
OLUX ≥ 12 años/≥ 12 years
CLOTRIMAZOLE W/ BETAMETHASONE
LOTRISONE ≥ 18 años/ ≥ 18 years
DEFERIPRONE FERRIPROX ≥ 18 años/≥ 18 years
DESOXIMETASONE TOPICORT ≥ 12 años/≥ 12 years
DIFLORASONE DIACETATE PSORCON ≥ 12 años/≥ 12 years
FLUOCINONIDE LIDEX ≥ 12 años/≥ 12 years
HALCINONIDE HALOG ≥ 12 años/≥ 12 years
HALOBETASOL PROPIONATE ULTRAVATE ≥ 12 años/≥ 12 years
HYDROCORTISONE PROBUTATE
PANDEL ≥ 18 años/ ≥ 18 years
LACOSAMIDE VIMPAT ≥ 17 años/≥ 17 years
SILDENAFIL CITRATE REVATIO ≥ 18 años/≥ 18 years
TRETINOIN RETIN-A ≤ 24 años/≤ 24 years
TRIAMCINOLONE ACETONIDE KENALOG ≥ 12 años/≥ 12 years
VEMURAFENIB ZELBORAF ≥ 18 años/ ≥ 18 years
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APENDICE IV - PREAUTORIZACION APPENDIX IV- PRIOR AUTHORIZATION
Dentro del formulario se encuentran incluidos medicamentos asociados a las iniciales PA. PA
significa pre-autorización. Triple-S debe aprobar estos medicamentos antes de que sean
despachados. La siguiente tabla enumera cuales son estos productos.
The formulary includes drugs associated to the PA initials. PA means preauthorization. Triple S must
authorize those medications before the pharmacy dispense it. The following table enumerates which
are those products.
Nombre genérico (Generic Name) Producto (Product)
ABATACEPT ORENCIA
ADALIMUMAB HUMIRA
ADEFOVIR HEPSERA
AMBRISENTAN LETAIRIS
ANTIHEMOPHILIC FACTOR HEMOFIL M
ANTIHEMOPHILIC FACTOR KOATE-DVI
ANTIHEMOPHILIC FACTOR KOATE-DVI
ANTIHEMOPHILIC FACTOR HEMOFIL M
ANTIHEMOPHILIC FACTOR MONOCLATE-P
ANTIHEMOPHILIC FACTOR RECOMBINATE
ANTIHEMOPHILIC FACTOR REFACTO
ANTIHEMOPHILIC FACTOR ADVATE
ANTIHEMOPHILIC FACTOR XYNTHA
ANTIHEMOPHILIC FACTOR HUMATE-P
ANTIHEMOPHILIC FACTOR WILATE
ANTIHEMOPHILIC FACTOR HUMATE-P
ANTIHEMOPHILIC FACTOR ALPHANATE
ANTIINHIBITOR COAGULANT COMPLEX FEIBA VH
APIXABAN ELIQUIS
APREPITANT EMEND
ATOMOXETINE HCL STRATTERA
AXITINIB TAB 1 MG INLYTA
AXITINIB TAB 5 MG INLYTA
BECAPLERMIN REGRANEX
BOSENTAN TRACLEER
BOSUTINIB BOSULIF
BUDESONIDE BUDESONIDE
BUPRENORPHINE SUBUTEX
BUPRENORPHINE & NALOXONE SUBOXONE
CINACALCET HCL SENSIPAR
COAGULATION FACTOR IX MONONINE / ALPHANINE / BENEFIX
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Nombre genérico (Generic Name) Producto (Product)
COAGULATION FACTOR VIIA NOVOSEVEN / NOVOSEVEN RT
CRIZOTINIB XALKORI
CYCLOSPORINE RESTASIS
DABIGATRAN ETEXILATE MESYLATE PRADAXA
DARBEPOETIN ALFA-POLYSORBATE ARANESP
DASATINIB SPRYCEL
DEFERASIROX EXJADE
DEFERIPRONE FERRIPROX
DENOSUMAB PROLIA
DOXERCALCIFEROL HECTOROL
ENFUVIRTIDE FOR INJ FUZEON
ENTECAVIR BARACLUDE
ENZALUTAMIDE XTANDI
EPOETIN ALFA EPOGEN/PROCRIT
EPOPROSTENOL SODIUM FLOLAN
ERLOTINIB TARCEVA
ETANERCEPT ENBREL
ETRAVIRINE INTELENCE
EVEROLIMUS AFINITOR
EZETIMIBE & SIMVASTATINA 10/80 mg VYTORIN
FACTOR IX COMPLEX PROFILNINE/PROFILNINE SD / BEBULIN VH
FINGOLIMOD GILENYA
FLUDARABINE PHOSPHATE OFORTA
IBANDRONATE SODIUM IV SOLN BONIVA
ILOPROST INHALATION VENTAVIS
IMATINIB MESYLATE GLEEVEC
INFLIXIMAB REMICADE
INTERFERON ALFA INTRON-A
LACOSAMIDE VIMPAT
LAMIVUDINE EPIVIR HBV
LANREOTIDE ACETATE SOMATULINE DEPOT
LANTHANUM CARBONATE FOSRENOL
LAPATINIB DITOSYLATE TYKERB
LENALIDOMIDE REVLIMID
LEUPROLIDE ACETATE LUPRON DEPOT-PED
LEUPROLIDE ACETATE FOR INJ LUPRON, LUPRON DEPOT
MARAVIROC SELZENTRY
METHYLNALTREXONE BROMIDE RELISTOR
MIFEPRISTONE KORLYM
MIGLUSTAT ZAVESCA
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Nombre genérico (Generic Name) Producto (Product)
NILOTINIB TASIGNA
OCTREOTIDE ACETATE SANDOSTATIN, SANDOSTATIN LAR
PARICALCITOL ZEMPLAR
PAZOPANIB HCL VOTRIENT
PEGINTERFERON ALFA-2A PEGASYS. PEGASYS PROCLICK
PEGINTERFERON ALFA-2B PEG-INTRON
PEGINTERFERON ALFA-2B SYLATRON
PRASUGREL HCL EFFIENT
RANOLAZINE RANEXA
REGORAFENIB STIVARGA
RIBAVIRIN RIBASPHERE
RIBAVIRIN & RIBAVIRIN RIBAPAK
RIBAVIRIN CAP REBETOL
RIBAVIRIN TAB COPEGUS
RIVAROXABAN XARELTO
RUFINAMIDE BANZEL
SEVELAMER CARBONATE RENVELA
SEVELAMER HCL RENAGEL
SILDENAFIL CITRATE SILDENAFIL CITRATE
SIMVASTATINA 80 mg ZOCOR
SODIUM OXYBATE XYREM
SOMATROPIN NUTROPIN
SOMATROPIN OMNITROPE
SOMATROPIN NORDITROPIN FLEXPRO
SOMATROPIN NORDITROPIN
SOMATROPIN NUTROPIN
SOMATROPIN NORDITROPIN NORDIFLEX PEN
SOMATROPIN HUMATROPE
SOMATROPIN GENOTROPIN
SOMATROPIN TEV-TROPIN
SOMATROPIN OMNITROPE
SOMATROPIN HUMATROPE
SOMATROPIN SEROSTIM
SOMATROPIN SAIZEN
SOMATROPIN ZORBTIVE
SORAFENIB TOSYLATE NEXAVAR
SUNITINIB MALATE SUTENT
TALIGLUCERASE ALFA ELELYSO
TELBIVUDINE TYZEKA
TENOFOVIR DISOPROXIL FUMARATE 300MG VIREAD
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Nombre genérico (Generic Name) Producto (Product)
TERIPARATIDE (RECOMBINANT) FORTEO
TIPRANAVIR APTIVUS
TOCILIZUMAB ACTEMRA
TOFACITINIB XELJANZ
TREPROSTINIL SODIUM REMODULIN
VELAGLUCERASE ALFA VPRIV
VEMURAFENIB ZELBORAF
VISMODEGIB ERIVEDGE
VORINOSTAT ZOLINZA
ZOLEDRONIC ACID IV SOLN ZOLEDRONIC ACID
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APENDICE V - TERAPIA ESCALONADA APPENDIX V - STEP THERAPY
Dentro del formulario se encuentran incluidos medicamentos asociados a las iniciales ST. ST
significa terapia escalonada donde el paciente utiliza medicamentos del primer paso antes de utilizar
los medicamentos identificados como segundo paso. En la siguiente tabla se identifican los
medicamentos del primer y segundo paso.
The formulary includes drugs associated to the ST initials. ST means step therapy, where the patient
uses step one drugs before using the drugs identified as second step. The following table identified
the medications used as first and second step.
Nombre de la Terapia
Escalonada (Step Therapy Description)
Medicamentos (Drugs)
Antihypertensive Agents Amlodipine besylate –Valsartan-HCT (Exforge, Exforge HCT) Amlodipine-Olmesartan (Azor)
Paso 1/ Step 1: Alternative #1: Calcium Channel Blockers (CCB)/Angiotensin Converting Enzymes Inhibitors (ACEI) Combinations OR ACEI/HCT Combinations OR CCB/ Angiotensin Receptor Blocker (ARB) Combinations OR ARB/HCT Combinations Alternative #2: Angiotensin Converting Enzymes Inhibitors (ACEI) OR Angiotensin Receptor Blocker (ARB) PLUS Calcium Channel Blocker (CCB) Alternative #3: Angiotensin Converting Enzymes Inhibitors (ACEI) OR Angiotensin Receptor Blocker (ARB) PLUS Diuretic or Diuretic Combination Alternative #4: Angiotensin Converting Enzymes Inhibitors (ACEI) OR Angiotensin Receptor Blocker (ARB) PLUS Diuretic OR Diuretic Combination PLUS Calcium Channel Blockers (CCB) Paso 2/ Step 2: Amlodipine besylate -Valsartan (Exforge), Amlodipine besylate –Valsartan- HCT (Exforge HCT), AmAmlodipine-Olmesartan (Azor)
Biguanides Metformin tab SR osmotic (Fortamet)
Paso 1/ Step 1: metformin immediate release (Glucophage), metformin sustained release (Glucophage XR), metformin combinations Paso 2/ Step 2: Metformin tab SR osmotic (Fortamet)
Dipeptidyl Peptidase-4 (DPP-4) Inhibitors
Paso 1/ Step 1: Biguanides, Biguanides/Combinations, Sulfonylureas, Sulfonylurea/Combinations, Glitazonas, Inhibidores de la enzima dipeptil peptidase-4 (DPP-4), Thiazolidinediones, Combinations Paso 2/ Step 2: Januvia, Janumet XR, Onglyza, Kombiglyze,Tradjenta, Jentadueto
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Nombre de la Terapia
Escalonada (Step Therapy Description)
Medicamentos (Drugs)
Dipeptidyl Peptidase-4 (DPP-4) Inhibitors/ Statin
Paso 1/ Step 1: Biguanides, Biguanides/Combinations, Sulfonylureas, Sulfonylurea/Combinations, Thiazolidinediones, Thiazolidinediones/Combinations, Statins Paso 2/ Step 2: Juvisync
Thiazolidinediones/ Thiazolidinediones Combinations
Paso 1/ Step 1: Biguanides, Biguanides/Combinations, Sulfonylureas, Sulfonylurea/Combinations Paso 2/ Step 2: Rosiglitazone (Avandia), Rosiglitazone-metformin (Avandamet), Rosiglitazone-glimepiride (Avandaryl), Pioglitazone (Actos), Pioglitazone-metformin (Actoplus Met, Actoplus Met XR), Rosiglitazone-glimepiride (Duetact)
Aldosterone Receptor Antagonist Eplerenone (Inspra)
Paso 1/Step 1: Spironolactone (Aldactone), Spironolactone- HCT (Aldactazide) Paso 2/ Step 2: Eplerenone (Inspra)
ADHD Agents Atomoxetine (Strattera)
Paso 1/Step 1: Methylphenidate OR Amphetamines Paso 2/ Step 2: Atomoxetine (Strattera)
Antidepressants Fluoxetine HCl DR (Prozac Weekly)
Paso 1/Step 1: Fluoxetine (Prozac) Paso 2/Step 2: Fluoxetine HCl DR (Prozac Weekly)
Muscle Relaxants Cyclobenzaprine HCl (Amrix, Fexmid)
Paso 1/Step 1: Cyclobenzaprine (Flexeril) Paso 2/Step 2: Cyclobenzaprine HCl (Amrix, Fexmid)
Inhibidores de Calcineurina/ Calcineurin inhibitors
Paso 1/ Step 1: Topical corticosteroids, Lactic acid (ammonium lactate). Paso 2/ Step 2: Elidel, Protopic
Estatinas/Statins Paso 1/ Step 1: Lovastatin (Mevacor), Pravastatin Sodium (Pravachol), Simvastatin (Zocor), Atorvastatin Calcium (Lipitor) Paso 2/ Step 2: Altoprev, Crestor, Lescol, Lescol XR, Vytorin
Corticosteroides Intranasales/ Intranasal Corticosteroids
Paso 1/ Step 1: Fluticasone Propionate-Nasal, Flunisolide Paso 2/ Step 2: Beconase AQ, Rhinocort, Nasarel, Veramyst, Nasacort, Nasonex
Antihistamínicos de Baja o Ninguna Sedación /Histamine1(H1) Blocking Agents, Mildly/Non-sedating
Paso 1/ Step 1: Allegra-OTC, Fexofenadine-OTC, Allegra/D, Allegra/D OTC, Claritin-OTC, Loratadine-OTC, Claritin/D-OTC, Loratadine/D-OTC, Zyrtec-OTC, Cetirizine-OTC, Zyrtec/D-OTC, Cetirizine/D-OTC Paso 2/ Step 2: Clarinex, Clarinex D, Xyzal, Levocetirizine
Alergias Oculares/Ocular Allergies - OTC First
Paso 1/ Step 1: Alaway OTC, Claritin Eye OTC, Zaditor OTC, Zyrtec Itchy OTC. Paso 2/ Step 2: Optivar, Emadine, Elestat, Patanol, Pataday, Alocril.
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Nombre de la Terapia
Escalonada (Step Therapy Description)
Medicamentos (Drugs)
Inhibidores de la Bomba de Protones/ Proton Pump Inhibitors
Paso 1/ Step 1: Prilosec-OTC, Omeprazole-OTC, Omeprazole-RX, Pantoprazole-RX, Prevacid 24HR OTC Zegerid OTC Paso 2/ Step 2: Aciphex, Protonix, Prevacid, Nexium
Bifosfonatos/ Bisphosphonates
Paso 1/ Step 1: Alendronate (Fosamax) Paso 2/ Step 2: Actonel, Actonel with Calcium, Atelvia, Boniva, Fosamax soln, Fosamax Plus D
Bloqueadores del Receptor de Angiotensina (ARBs)/Angiotensin Receptor Blockers (ARB)
Paso 1/ Step 1: Avapro (Irbesartan), (Irbesartan HCT), Avalide, Valsartan (Diovan), Valsartan HCT (Diovan HCT) Losartan (Cozaar), Losartan Potassium (Hyzaar) Paso 2/ Step 2:, Atacand, Atacand HCT, Benicar, Benicar HCT, Micardis, Micardis HCT, Teveten, Teveten HCT
Programa de terapia escalonada aplica a algunas cubiertas. Comuniquese al Departamento de Servicios al Cliente para saber si su cubieta de farmacia tiene este programa. Step therapy program applies to some pharmacy benefit. Communicate to the Customer Service Department to see if your pharmacy benefit applies this program.
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APENDICE VI - PRODUCTOS OTC APPENDIX VI - OTC PRODUCTS
Dentro del formulario se encuentran incluidos medicamentos OTC. La siguiente tabla enumera
cuales son estos productos.
The formulary includes OTC drugs. The following table enumerates which are those products.
Categoria Category
Producto Product
Limitación Limit
H1 BLOCKING AGENTS, MIDLY/NON-SEDATING
ALAVERT® / ALAVERT-D® OTC
ALLEGRA® / ALLEGRA-D® OTC
CETIRIZINE / CETIRIZINE-D OTC
CLARITIN® / CLARITIN-D OTC
FEXOFENADINE / FEXOFENADINE-D OTC
LORATADINE / LORATADINE-D OTC
ZYRTEC® / ZYRTEC-D® OTC
OCULAR ALLERGIES ALAWAY® OTC
ZADITOR® OTC OTC
PROTON PUMP INHIBITORS
LANSOPRAZOLE OTC OTC
OMEPRAZOLE OTC OTC
PREVACID 24H® OTC
PRILOSEC® OTC OTC
ZEGERID® OTC OTC
Nota: Triple-S, Inc., en su programa de cubierta para medicamentos OTC, requiere una receta para el despacho de los mismos. Note: Triple-S, Inc. requires a prescription for dispensing OTC drugs included in their OTC Coverage Program.
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APENDICE VII – SOLICITUD DE EXCEPCION MÉDICA APPENDIX VII – Medical Exception Application
Nombre del Paciente y Representante Personal (si aplica): __________________________________
Núm. Contrato ______________________ Núm. de Grupo: ____________________
Se solicita la aprobación de:
Medicamento no está incluido en el formulario
Cubierta continuada para medicamento que se descontinuar
Excepción a un procedimiento de manejo de medicamento (ei, terapia escalonada)
Excepción a un procedimiento de limitación de dosis
Razones para la solicitud de excepción médica:
En el formulario no figura un medicamento clínicamente aceptable para tratar la condición del
paciente.
El medicamento que procede conforme a la terapia escalonada es ineficaz para la condición o
el paciente, es probable que cause daño al paciente o y ya el paciente se encontraba en un
nivel más avanzado bajo otro plan médico.
La dosis disponible para medicamento probablemente es ineficaz para la condición o el
paciente.
Historial breve del paciente:
Diagnóstico primario relacionado con el medicamento de receta objeto de la solicitud (incluya código y
descripción):
Descripción de la necesidad médica de medicamento para el cual se solicita la excepción:
(Incluya hoja adicional de ser necesario)
____________________________________ __________________________
Nombre de la Persona que expide la receta # de Proveedor (NPI)
____________________________________ __________________________
Firma Fecha
Forma: CSS-AS-04-002
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Tabla de Contenido /Table of Contents
PREFACIO ................................................................................................................... 3
INTRODUCCIÓN ......................................................................................................... 5
DERMATOLOGICALS (DERMATOLÓGICOS) ............................................................ 7
Acne (Acné) ........................................................................................................................... 7
ANESTHETICS (ANESTÉSICOS) ............................................................................. 20
ANTI-ADDICTION/SUBSTANCE AUSE TREATMENT AGENTS (TRATAMIENTO DE ABUSO DE SUSTANCIAS/CONTRA LA ADDICION) ................................................ 20
Opioid Antagonist (Antagonista de Opioides) .................................................................... 20
ANTI-INFECTIVES (ANTI-INFECCIOSOS) ............................................................... 20
Antifungals (Antifungales) .................................................................................................. 20
Antimarials (Antimaláricos) ................................................................................................ 20
Antiparasitics (Antiparasitarios) .......................................................................................... 20
Antituberculosis (Antituberculosis) ..................................................................................... 21
Antivirals (Antivirales) ........................................................................................................ 21
Antiherpes Virus (Infecciones Herpéticas) ...................................................................... 21
HIV/AIDS (VIH/SIDA) ................................................................................................... 21
Influenza (Influenza) ........................................................................................................ 22
Miscellaneous (Misceláneos) ........................................................................................... 22
Cephalosporins (Cefalosporinas) ......................................................................................... 22
First Generation (Primera Generación) ............................................................................ 22
Second Generation (Segunda Generación) ...................................................................... 23
Third Generation (Tercera Generación) ........................................................................... 23
Macrolides (Macrólidos) ..................................................................................................... 23
Miscellaneous (Misceláneos) .............................................................................................. 23
Penicillins (Penicilinas) ....................................................................................................... 24
Quinolones (Quinolonas) ..................................................................................................... 25
Sulfonamides (Sulfonamidas) .............................................................................................. 25
Tetracyclines (Tetraciclinas) ............................................................................................... 25
CANCER (CÁNCER) .................................................................................................. 25
Alkylating Agents (Agentes Alquilantes) ............................................................................ 25
Androgens/Estrogens/Progestins (Andrógenos/Estrógenos/Progestinas) ........................... 25
Androgens (Andrógenos) ................................................................................................. 25
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Antiandrogens (Antiandrógenos) ..................................................................................... 25
Antiestrogens (Antiestrógenos) ........................................................................................ 25
Aromatase Inihibitor (Inihibidores de la Aromatasa) ...................................................... 26
Progestins (Progestinas) ................................................................................................... 26
Antimetabolites (Antimetabólitos) ...................................................................................... 26
Immunosuppressives (Inmunosupresores) .......................................................................... 26
Miscellaneous (Misceláneos) .............................................................................................. 26
CARDIOVASCULARS (CARDIOVASCULARES) ...................................................... 26
Antiarrhythmics (Antiarrítmicos) ........................................................................................ 26
Antihyperlipidemics (Antihiperlipidémicos) ....................................................................... 26
Antihypertensives (Antihipertensivos) ................................................................................ 27
ACE Inhibitors (Inhibidores de la Enzima Convertidora de Angiotensina) .................... 27
Alpha-Adrenergic Receptor Blockers (Bloqueadores del Receptor Alfa-Adrenérgico) .. 27
Angiotensin Receptor Blockers (ARBs) (Bloqueadores del Receptor de la Angiotensina)
.......................................................................................................................................... 27
Beta Blockers (Bloqueadores Beta) ................................................................................. 28
Calcium Channel Blockers (Antagonistas de los Canales de Calcio) .............................. 28
Centrally Acting Antiadrenergics (Antiadrenérgicos de Acción Central) ....................... 29
Combinations (Combinaciones) ....................................................................................... 29
Diuretics (Diuréticos) ....................................................................................................... 30
Vasodilators (Vasodilatores) ............................................................................................ 31
Glycosides (Glicósidos) ....................................................................................................... 31
CENTRAL NERVOUS SYSTEM (SISTEMA NERVIOSO CENTRAL) ........................ 31
Alzheimer (Alzheimer) ........................................................................................................ 31
Analgesics/Narcotics/Combinations (Analgésicos/Narcóticos/Combinaciones) ................ 31
Antianxiety/Hypnotics (Ansiolíticos/Hipnóticos) ............................................................... 33
Anticonvulsants (Anticonvulsivos) ..................................................................................... 34
Antiparkinsons (Antiparkinson) .......................................................................................... 35
Anticholinergics (Anticolinérgicos) ................................................................................. 35
COMT Inhibitors (Inhibidores de COMT) ...................................................................... 35
Dopamine Receptor Agonists (Agonistas del Receptor de Dopamina) ........................... 35
Dopaminergics (Dopaminérgicos) ................................................................................... 35
Dopaminergics - COMT Inhibitors (Dopaminérgicos - Inhibidores de COMT) ............. 35
Miscellaneous (Misceláneos) ........................................................................................... 35
Antivertigo/Antiemetic (Antivértigo/Antieméticos) ........................................................... 36
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Migraine (Migraña) ............................................................................................................. 36
Miscellaneous (Misceláneos) .............................................................................................. 37
Psychotropics (Sicotrópicos) ............................................................................................... 37
Antidepressants (Antidepresivos) .................................................................................... 37
Antipsychotics (Antisicóticos) ......................................................................................... 38
Attention Deficit and Hyperactivity (Déficit de Atención e Hiperactividad) .................. 39
Miscellaneous (Misceláneos) ........................................................................................... 39
Mood Stabilizers (Estabilizadores del Ánimo) ................................................................ 40
DERMATOLOGICALS (DERMATOLÓGICOS) .......................................................... 40
Acne (Acné) ......................................................................................................................... 40
Antibacterials, Topicals (Antibacterianos, Tópicos) ........................................................... 41
Antifungals, Topical (Antifungales, Tópicos) ..................................................................... 41
Antivirals, Topical (Antivirales, Tópicos) ........................................................................... 42
Corticosteroids, Topical (Corticosteroides, Tópicos) .......................................................... 42
High Potency (Alta Potencia)........................................................................................... 42
Low Potency (Baja Potencia) ........................................................................................... 42
Medium Potency (Mediana Potencia) .............................................................................. 42
Very High Potency (Muy Alta Potencia) ......................................................................... 43
Dermatologicals, Orals (Dermatológicos, Orales) .............................................................. 43
Miscellaneous (Misceláneos) .............................................................................................. 43
Rosacea (Rosácea) ............................................................................................................... 44
Scabicides/Pediculicides (Escabicidas/Pediculosis) ............................................................ 44
Topical Anesthetics (Anestésicos Tópicos) ......................................................................... 44
Wound Care (Cuidado de Heridas) ..................................................................................... 44
EAR/NOSE/THROAT (OÍDO/NARIZ/GARGANTA) .................................................... 44
Mouth/Throat (Boca/Garganta) ........................................................................................... 44
Otics (Oticos) ....................................................................................................................... 45
ENDOCRINOLOGY (ENDOCRINOLOGÍA) ............................................................... 45
Corticosteroids (Corticosteroides) ....................................................................................... 45
Diabetes (Diabetes) .............................................................................................................. 46
Antihyperglycemics (Antihiperglicémicos) ..................................................................... 46
Antihyperglycemics, Others (Antihiperglicémicos, Otros) ............................................. 47
Miscellaneous (Misceláneos) .............................................................................................. 48
Androgens (Andrógenos) ................................................................................................. 48
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Others (Otros)................................................................................................................... 48
Thyroid (Tiroides) ............................................................................................................... 48
Antithyroid (Antitiroideos) .............................................................................................. 48
Thyroid Hormones (Hormonas Tiroideas) ....................................................................... 48
ENZYME REPLACEMENTS/MODIFIERS (REEMPLAZO DE ENZIMAS/MODIFICADORES) ................................................................................... 49
Enzyme Replacements/Modifiers (Reemplazo de Enzimas/Modificadores) ...................... 49
Urea Cycle Disorder Treatment (Desorden del Ciclo de Urea) ....................................... 49
GASTROENTEROLOGY (GASTROENTEROLOGÍA) ............................................... 49
Antidiarrheals (Antidiarreicos) ............................................................................................ 49
Antispasmodics (Antiespasmódicos) ................................................................................... 49
Antiulcers (Úceras) .............................................................................................................. 49
H2 Blockers (Antagonistas H2) ....................................................................................... 49
Miscellaneous (Misceláneos) ........................................................................................... 50
Proton Pump Inhibitors (PPI`s) (Inhibidores de la Bomba de Protónes) ......................... 50
Digestive Enzymes (Enzimas Digestivas) ........................................................................... 50
Laxatives (Laxantes) ............................................................................................................ 50
Miscellaneous (Misceláneos) .............................................................................................. 51
OBSTETRICS/GYNECOLOGY (OBSTETRICIA/GINECOLOGÍA) ............................. 51
Estrogens/Progestins (Estrógenos/Progestinas) ................................................................... 51
Combinations, Estrogens (Combinaciones, Estrógenos) ................................................. 51
Estrogens (Estrógenos)..................................................................................................... 52
Progesterones (Progesteronas) ......................................................................................... 52
Miscellaneous (Misceláneos) .............................................................................................. 52
Osteoporosis (Osteoporosis) ............................................................................................ 52
Others (Otros)................................................................................................................... 52
Topicals (Tópicos) ............................................................................................................... 52
Transdermal Patch (Parchos Transdermales) ................................................................... 52
Vaginal, Topical (Vaginales, Tópicos) ................................................................................ 53
Antifungals (Antifungales)............................................................................................... 53
Hormonal Replacement (Reemplazo Hormonal) ............................................................. 53
OPHTHALMICS (OFTÁLMICOS) ............................................................................... 53
Allergy (Alergia) ................................................................................................................. 53
Antihistamines (Antihistamínicos)................................................................................... 53
2013-2014 | 90
Antihistamines - Mast Cell Stabilizers (Antihistamínicos -Estabilizadores de Mastocitos)
.......................................................................................................................................... 53
Mast Cell Stabilizers (Estabilizadores de Mastocitos) ..................................................... 53
Antibiotics (Antibióticos) .................................................................................................... 53
Corticosteroids (Corticosteroides) ....................................................................................... 54
Glaucoma (Glaucoma) ......................................................................................................... 55
Adrenergic Selective Agonists (Agonistas Adrenérgicos Selectivos) ............................. 55
Beta Blockers (Bloqueadores Beta) ................................................................................. 55
Carbonic Anhydrase Inhibitors (Inhibidores de la Anhidrasa Carbónica) ....................... 55
Combinations (Combinaciones) ....................................................................................... 55
Miotics (Mióticos) ............................................................................................................ 55
Prostaglandins (Prostaglandinas) ..................................................................................... 55
Miscellaneous (Misceláneos) .............................................................................................. 55
Non-Steroidal Anti-Inflammatory Drugs (NSAID`s) (Anti-Inflamatorios No-Esteroidales)
............................................................................................................................................. 55
RESPIRATORY (RESPIRATORIOS) ......................................................................... 56
Antihistamines/Decongestants (Antihistamínicos/Descongestionantes) ............................. 56
Descongestants (Descongestionantes) ............................................................................. 56
Low Sedation Antihistamines (Anti-histamínicos de Baja Sedación) ............................. 57
Non-Sedative Antihistamines (Anti-histamínicos No Sedantes) ..................................... 57
Antitussives/Expectorants (Antitusivos/Expectorantes) ...................................................... 57
Asthma (Asma) .................................................................................................................... 59
Anticholinergics (Anticolinérgicos) ................................................................................. 59
Beta Agonists, Inhaled (Agonistas Beta, Inhalados) ........................................................ 59
Beta Agonists, Oral (Agonistas Beta, Orales) .................................................................. 59
Combinations (Combinaciones) ....................................................................................... 59
Inhaled Corticosteroids (Corticosteroides Inhalados) ...................................................... 60
Miscellaneous (Misceláneos) ........................................................................................... 60
Xanthines (Xantinas) ........................................................................................................ 60
Intranasal Steroids (Esteroides Intranasales) ....................................................................... 60
Others (Otros) ...................................................................................................................... 60
SKELETAL-MUSCULE SYSTEM/RHEUMATOLOGY (SISTEMA MÚSCULO-ESQUELETAL/REUMATOLOGÍA) ............................................................................. 61
Gout (Gota) .......................................................................................................................... 61
Miscellaneous (Misceláneos) .............................................................................................. 61
2013-2014 | 91
Rheumatology (Reumatología) ........................................................................................ 61
Muscle Relaxants (Relajantes Musculares) ......................................................................... 61
Non-Steroidal Anti-Inflammatory Drugs (NSAID`s) (Anti-Inflamatorios No-Esteroidales)
............................................................................................................................................. 62
UROLOGY (UROLOGÍA) ........................................................................................... 62
5-Alpha Reductase Inhibitors (Inhibidores de la 5-Alpha Reductasa) ................................ 62
Analgesics (Analgésicos) .................................................................................................... 62
Antispasmodics (Antiespasmódicos) ................................................................................... 62
Cholinergics (Colinérgicos) ................................................................................................. 63
Erectil Dysfunction (Disfunción Eréctil) ............................................................................. 63
Miscellaneous (Misceláneos) .............................................................................................. 63
Renal Disease (Enfermedad Renal) ..................................................................................... 63
VITAMINS/HEMATINICS/ELECTROLYTES (VITAMINAS/HEMATÍNICOS/ELECTRÓLITOS) ........................................................ 63
Alkalinizer (Alcalinizantes) ................................................................................................. 63
Antidotes (Antídotos) .......................................................................................................... 64
Coagulant Therapy (Terapia de Coagulación) ..................................................................... 64
Anticoagulant (Anticoagulantes) ..................................................................................... 64
Antiplatelet (Antiplaquetarios) ........................................................................................ 64
Miscellaneous (Misceláneos) ........................................................................................... 64
Vitamins/Hematinics/Other Supplements (Vitaminas/Hematínicos/Otros Suplementos) .. 64
Nutrients (Nutrientes)....................................................................................................... 64
Vitamins (Vitaminas) ....................................................................................................... 65
CHRONIC AND HIGH RISK CONDITIONS (CONDICIONES CRÓNICAS Y DE ALTO RIESGO) .................................................................................................................... 66
Anti-Infectives (Anti-Infecciosos) ....................................................................................... 66
Antifungals (Antifungales)............................................................................................... 66
Miscellaneous (Misceláneos) ........................................................................................... 66
Antivirals (Antivirales) ........................................................................................................ 66
Hepatitis B (Hepatitis B) .................................................................................................. 66
Hepatitis C (Hepatitis C) .................................................................................................. 66
HIV/AIDS (VIH/SIDA) ................................................................................................... 66
Biotechnology (Biotecnología) ............................................................................................ 66
Enzyme Replacement (Remplazo Enzimático) ................................................................ 66
Erythropoiesis Stimulating Proteins (Estimulantes de la Eritopoyesis) ........................... 67
2013-2014 | 92
Multiple Sclerosis (Esclerosis Múltiple) .......................................................................... 67
Myeloid Stimulating Agents (Estimulantes Mieloides) ................................................... 67
Cancer (Cáncer) ................................................................................................................... 67
Alkylating Agents (Agentes Alquilantes) ........................................................................ 67
Antimetabolites (Antimetabolitos) ................................................................................... 67
Miscellaneous (Misceláneos) ........................................................................................... 68
Cardiovasculars (Cardiovasculares) .................................................................................... 68
Central Nervous System (Sistema Nervioso Central) ......................................................... 68
Endocrinology (Endocrinológicos) ...................................................................................... 68
Growth Hormones (Hormonas de Crecimiento) .............................................................. 68
Miscellaneous (Misceláneos) ........................................................................................... 69
Others (Otros)................................................................................................................... 69
Obstetrics/Gynecology (Obstetricia/Ginecología) .............................................................. 69
Osteoporosis (Osteoporosis) ............................................................................................ 69
Respiratory (Respiratorios) .................................................................................................. 69
Others (Otros)................................................................................................................... 69
Skeletal-Muscule System/Rheumatology (Sistema Músculo-Esqueletal/Reumatología) ... 69
Miscellaneous (Misceláneos) ........................................................................................... 69
Vitamins/Hematinics/Other Supplements (Vitaminas/Hematínicos/OtrosSuplementos) ... 69
Chelating Agents (Agentes Quelantes) ............................................................................ 69
Coagulant Therapy (Terapia de Coagulación) ................................................................ 69
APENDICE I - LIMITES DE CANTIDAD ..................................................................... 71
APENDICE II - LIMITES DE ESPECIALIDAD ........................................................... 73
APENDICE III - LIMITES DE EDAD ........................................................................... 76
APENDICE IV - PREAUTORIZACION ....................................................................... 77
APENDICE V - TERAPIA ESCALONADA .................................................................. 81
APENDICE VI - PRODUCTOS OTC ......................................................................... 84
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PARTE III / PART III
INDICE / INDEX
8
8-MOP, 43
A
A, 55 abacavir, 21 abatacept, 69 ABILIFY, 38 acarbose, 46 ACCOLATE, 60 ACCUNEB, 59 ACCUPRIL, 27 ACCURETIC, 30 ACCUTANE, 43 acebutolol, 28 ACEON, 27 acetaminophen, 31, 32, 36, 61 acetazolamide, 30 acetic, 45, 53 acetohydroxamic, 63 acetylcysteine, 57 ACETYLCYSTEINE, 57 ACHROMYCIN, 25 ACID, 53 ACIPHEX, 50 acitretin, 43 aclidinium, 59 ACLOVATE, 42 acrivastine, 56 ACTEMRA, 69 ACTIGALL, 51 ACTIQ, 32 ACTIVELLA, 51 Actonel, 83 ACTONEL, 52 ACTOPLUS, 46 ACTOS, 47 ACULAR, 56 acyclovir, 21, 42 ADAGEN, 67 ADALAT, 28 adalimumab, 69 adapalene, 7, 40 adapalene-benzoyl, 40 ADDERALL, 39 adefovir, 66 ADVAIR, 60 ADVATE, 70 ADVICOR, 27 AFINITOR, 68
AGGRENOX, 64 AGRYLIN, 64 AK-CON, 55 AKNE-MYCIN, 40 ALA-QUIN, 41 ALAVERT, 84 ALAWAY, 84 Alaway OTC, 82 ALBAFORT, 65 ALBATUSSIN, 58 albendazole, 20 ALBENZA, 20 albuterol, 59 albuterol., 59 albuterol.., 59 albuterol..., 59 alclometasone, 42 ALCORTIN, 41 ALDACTAZIDE, 30 ALDACTONE, 30 ALDARA, 43 ALDEX-CT, 56 ALDOMET, 29 ALDORIL, 29 alendronate, 52 Alendronate, 83 ALINIA, 21 ALKERAN, 25 ALLEGRA, 57, 84 Allegra/D, 82 Allegra/D OTC, 82 ALLEGRA-D, 56, 57 Allegra-OTC, 82 allopurinol, 61 almotriptan, 36 ALOCRIL, 53 ALOMIDE, 53 alosetron, 51 ALPHAGAN, 55 ALPHANATE, 70 alprazolam, 33 ALREX, 54 ALTACE, 27 ALTOPREV, 27 altretamine, 25 aluminum, 43 ALUPENT, 59 amantadine, 22, 35, 36 AMANTADINE, 22, 36 AMARYL, 47 ambenonium, 61 AMBIEN, 34 ambrisentan, 68
amcinonide, 42 AMCINONIDE, 42 AMERGE, 37 AMICAR, 64 amiloride, 30 aminocaproic, 64 aminophylline, 60 AMINOPHYLLINE, 60 aminosalicylic, 21 amiodarone, 26 AMITIZA, 51 amitriptyline, 38, 39 amlodipine, 28, 29 amoxapine, 38 AMOXAPINE, 38 amoxicillin, 24, 50 AMOXIL, 24 amphetamine, 39 AMPHOTEC, 66 amphotericin, 66 ampicillin, 24 AMPICILLIN, 24 AMPYRA, 67 ANAFRANIL, 38 anagrelide, 64 ANALPRAM-HC, 51 ANAMANTLE, 51 ANAPROX, 62 anastrozole, 26 ANCOBON, 20 ANDRODERM, 48 ANDROGEL, 48 ANDROID, 25, 48 ANDROXY, 25, 48 anidulafungin, 66 ANSAID, 62 anthralin, 43 antihemophilic, 69, 70 antiinhibitor, 70 antiseptic, 44 ANTIVERT, 36 ANZEMET, 36 apap, 36 APIDRA, 47 apixaban, 64 apraclonidine, 55 aprepitant, 36 APRESOLINE, 31 APRISO, 51 APTIVUS, 22 AQUASOL, 65 ARALEN, 20 ARANESP, 67
2013-2014 | 94
ARAVA, 61 AREDIA, 69 ARICEPT, 31 ARIMIDEX, 26 aripiprazole, 38 ARIXTRA, 64 ARMOUR, 48 AROMASIN, 26 ARTANE, 35 artemether, 20 ASACOL, 51 ascorbic, 65 ASCORBIC, 65 ASMANEX, 60 aspirin, 32, 36, 64 ASTELIN, 60 ATABEX, 53 Atacand, 83 ATACAND, 27, 29 atazanavir, 22 Atelvia, 83 atenolol, 28, 29 ATIVAN, 34 atomoxetine, 39 atorvastatin, 26 Atorvastatin, 82 atovaquone, 20, 23 ATRIPLA, 21 atropine, 49, 55 ATROPINE, 49 ATROVENT, 59 AUBAGIO, 67 augmented, 42 AUGMENTIN, 24 auranofin, 61 Avalide, 83 AVALIDE, 29 AVANDAMET, 46 AVANDARYL, 46 AVANDIA, 47 Avapro, 83 AVAPRO, 27 AVC, 53 AVELOX, 25 AVINZA, 33 AVODART, 62 AVONEX, 67 AXERT, 36 AXID, 49 axitinib, 68 AYGESTIN, 52 azathioprine, 26, 61 azelaic, 7, 40, 44 azelastine, 53, 60 AZELEX, 7, 40 azithromycin, 23 AZOPT, 55 AZOR, 29
AZULFIDINE, 51
B
bacitracin, 20, 41, 53, 54 BACITRACIN, 20, 53 baclofen, 61 BACTROBAN, 41 balsalazide, 51 BANZEL, 35 BARACLUDE, 66 b-complex, 65 B-COMPLEX, 65 becaplermin, 44 beclomethasone, 60 BECONASE, 60 belladonna, 49 benazepril, 27, 29 BENEFIX, 70 BENEMID, 61 Benicar, 83 BENICAR, 28, 30 BENTYL, 49 BENZACLIN, 40 BENZAMYCIN, 40 BENZIQ, 40 benzocaine, 44, 45 benzocaine-pe-antipyrine, 45 benzonatate, 57 BENZOTIC, 45 benzoyl, 7, 40 BENZOYL, 40 benztropine, 35 BETAGAN, 55 betain, 66 betamethasone, 42, 45 BETAPACE/BETAPACE, 26 BETASERON, 67 betaxolol, 28, 55 bethanechol, 63 BETIMOL, 55 BETOPTIC-S, 55 bexarotene, 26, 43 BIAXIN, 23 bicalutamide, 25 BICILLIN, 24 BICITRA, 63 Biguanides, 81, 82 BILTRICIDE, 21 bimatoprost, 55 BIOBRON, 58 BIOHIST, 56 bismuth, 50 bisoprolol, 28, 29 BLEPH-10, 54 BLEPHAMIDE, 54 BLOCADREN, 28 Boniva, 83
BONIVA, 52, 69 bosentan, 68 BOSULIF, 68 bosutinib, 68 BRETHINE, 59 brimonidine, 55 brinzolamide, 55 bromocriptine, 35 brompheniramine, 56, 57 BRONDIL, 60 BROVEX, 56 BUCALSEP, 44 budesonide, 51, 60 bumetanide, 30 BUMEX, 30 BUPHENYL, 67 buprenorphine, 20, 77 BUPRENORPHINE, 20, 77 buprenorphine&naloxone, 20,
77 bupropion, 37 BUSPAR, 33 buspirone, 33 busulfan, 25 butalbital, 32, 36 BUTALBITAL, 36 butenafine, 41 BYDUREON, 47 BYETTA, 47
C
cabergoline, 48 CADUET, 29 CAFERGOT, 37 CALAN, 28 calcipotriene, 43 calcitonin,, 48, 52 calcitriol, 43, 65 CALCITRIOL, 65 calcium, 63 CANASA, 51 CANCIDAS, 66 candesartan, 27, 29 capecitabine, 67 CAPEX, 42 CAPITAL/CODEINE, 32 CAPOTEN, 27 CAPOZIDE, 29 captopril, 27, 29 CARAC, 43 CARAFATE, 50 carbamazepine, 34 CARBATROL, 34 carbetapentane, 57 carbidopa, 35 carbinoxamine, 57 CARBOFED, 59
2013-2014 | 95
CARDENE, 28 CARDIZEM, 28 CARDURA, 27 carisoprodol, 61 CARMOL, 44 CARMOL-HC, 44 CARNITOR, 64 carteolol, 55 carvedilol, 28 CASODEX, 25 caspofungin, 66 CATAFLAM, 62 CATAPRES, 29 CECLOR, 23 CEDAX, 23 CEENU, 25 cefaclor, 23 cefadroxil, 22, 23 cefdinir, 23 cefditoren, 23 cefixime, 23 cefpodoxime, 23 cefprozil, 23 ceftibuten, 23 CEFTIN, 23 ceftriaxone, 23 cefuroxime, 23 CEFZIL, 23 CELEBREX, 62 celecoxib, 62 CELESTONE, 45 CELEXA, 37 CELLCEPT, 26 CELONTIN, 34 CENESTIN, 52 cephalexin, 23 CEPHALEXIN, 23 CEREZYME, 67 cetirizine, 56, 57 CETIRIZINE, 84 Cetirizine/D-OTC, 82 Cetirizine-OTC, 82
Ch
CHEMET, 64 CHERATUSSIN, 59 chloral, 33 chlorambucil, 25 chlordiazepoxide, 33, 40 chlorhexidine, 44 chloroquine, 20 chlorothiazide, 30 chlorphen, 56, 57 chlorpheniramine, 56 chlorphen-pe-
methscopolamine, 57 chlorpromazine, 39
chlorpropamide, 47 chlorthalidone, 30 CHLORTHALIDONE, 30 chlorzoxazone, 61 cholestyramine, 26 choline, 26, 61
C
CIALIS, 63 ciclopirox, 41 cilastatin, 23 cilostazol, 64 CILOXAN, 54 cimetidine, 49 cinacalcet, 63 CIPRO, 25, 45 CIPRODEX, 45 ciprofloxacin, 25, 45, 54 citalopram, 37 CITROLITH, 63 CLARAVIS, 43 CLARINEX, 57 CLARINEX-D, 56 clarithromycin, 23 CLARITIN, 57, 84 Claritin Eye OTC, 82 Claritin/D-OTC, 82 CLARITIN-D, 56 Claritin-OTC, 82 clemastine, 57 CLEMASTINE, 57 CLEOCIN, 23, 40, 53 clidinium, 49 CLIMARA, 52, 53 clindamycin, 23, 40, 53 CLINORIL, 62 clioquinol, 41 clobetasol, 43 CLODERM, 42 clomipramine, 38 clonazepam, 34 clonidine, 29 clopidogrel, 64 clorazepate, 33 clorcortolone, 42 CLORPRES, 29 clotrimazole, 20, 41 clozapine, 38 CLOZARIL, 38 coagulation, 70 COARTEM, 20 codeine, 32, 57 CODEINE, 32 COGENTIN, 35 COLAZAL, 51 colchicine, 61
COLCHICINE/PROBENECID, 61
COLCRYS, 61 colesevelam, 27 COLESTID, 27 colestipol, 27 colistin, 45 collagenase, 44 COMBIGAN, 55 COMBIPATCH, 53 COMBIVENT/, 59 COMBIVIR, 22 COMPAZINE, 36 COMPLERA, 22 COMTAN, 35 CONCERTA, 39 CONDYLOX, 44 COPAXONE, 67 COPEGUS/, 66 CORDARONE, 26 CORDRAN, 42 COREG, 28 CORGARD, 28 CORTANE-B, 45 CORTEF, 46 CORTENEMA, 51 CORTIFOAM, 51 cortisone, 45 CORTISPORIN, 41, 45, 54 CORTISPORIN-TC, 45 CORTONE, 45 CORZIDE, 30 COSOPT, 55 COUMADIN, 64 COVERA-HS, 28 COZAAR, 27 CREON, 50 CRESTOR, 27 cresyl, 45 CRESYLATE, 45 CRINONE, 53 CRIXIVAN, 22 crizotinib, 68 CROLOM, 53 cromolyn, 51, 53, 60 CUPRIMINE, 61 CUTIVATE, 43 cyanocobalamin, 65 CYANOCOBALAMIN, 65 cyclobenzaprine, 61 CYCLOCORT, 42 CYCLOGYL, 55 cyclopentolate, 55 cyclophosphamide, 25 cycloserine, 21 cyclosporine, 55 CYMBALTA, 37 cyproheptadine, 57
2013-2014 | 96
CYPROHEPTADINE, 57 CYSTADANE, 66 CYSTAGON, 66 cysteamine, 66 CYSTOSPAZ, 62 CYTOMEL, 48 CYTOTEC, 50 CYTOVENE, 22 CYTOXAN, 25
D
D.H.E., 36 dabigatran, 64 dalfampridine, 67 DALLERGY, 56, 57 DALMANE, 34 dalteparin, 64 danazol, 48, 52 DANOCRINE, 48, 52 DANTRIUM, 61 dantrolene, 61 dapsone, 23 DAPSONE, 23 DARAPRIM, 20 darbepoetin, 67 darunavir, 22 dasatinib, 68 DAYPRO, 62 DDAVP, 48 DECADRON, 54 DECLOMYCIN, 25 DECON-A, 56 DECON-G, 58 deferasirox, 64 deferiprone, 69 delavirdine, 21 DELZICOL, 51 DEMADEX, 30 demeclocycline, 25 DEMEROL, 33 DENAVIR, 42 denosumab, 69 DEPACON, 35 DEPAKENE, 35, 40 DEPAKOTE, 34, 36, 40 DEPO-MEDROL, 46 DEPO-TESTOSTERONE, 48 DERMA-SMOOTHE, 42 DERMATOP, 43 DERMOTIC, 45 desipramine, 38 desloratadine, 56, 57 desmopressin, 48, 69 DESMOPRESSIN, 48 desonide, 42 DESOWEN, 42 desoximetasone, 42
DESOXYN, 39 DESPEC, 58 DESPEC-EXP, 59 DESPEC-PD, 58 DESQUAM, 7 DESYREL, 37 DETROL, 63 dexamethasone, 45, 54 DEXAMETHASONE, 45 dexchlorpheniramine, 56 DEXCHLORPHENIRAMINE, 56 DEXEDRINE, 39 dexmethylphenidate, 39 dextroamphetamine, 39 dextromethorphan, 57, 58 dextrose, 64 DEXTROSE/SODIUM, 64 DEXTROSTAT, 39 DIABETA, 47 DIABINESE, 47 DIAMOX, 30 DIASTAT, 34 diazepam, 33, 34 diazoxide, 48 diclofenac, 55, 62 dicloxacillin, 24 DICLOXACILLIN, 24 dicyclomine, 49 didanosine, 21 DIDRONEL, 48 DIFFERIN, 7, 40 diflorasone, 42 DIFLUCAN, 20, 66 diflunisal, 62 DIFLUNISAL, 62 digestive, 50 digoxin, 31 DIGOXIN, 31 dihydroergotamine, 36 DILANTIN, 35 DILATRATE, 31 DILAUDID, 33 diltiazem, 28 Diovan, 83 DIOVAN, 28, 30 DIPENTUM, 51 diphenhydramine, 56, 57 DIPHENHYDRAMINE, 57 diphenoxylate, 49 DIPROLENE, 42 DIPROSONE, 42 dipyridamole, 64 DISALCID, 62 disopyramide, 26 DITROPAN, 62 DIURIL, 30 divalproex, 34, 36, 40 dolasetron, 36
DOLOGESIC, 61 DOMEBORO, 45 DONATUSSIN, 58 donepezil, 31 DONNATAL, 49 DORAL, 34 dornase, 69 DORYX, 25 dorzolamide, 55 DOSTINEX, 48 DOVONEX, 43 doxazosin, 27 doxepin, 38, 41 doxercalciferol, 63 doxycycline, 25 DOXYCYCLINE, 25 DRISDOL, 65 DRITHO-SCALP, 43 dronabinol, 36 DROXIA, 26 DRYSOL, 43 DUETACT, 46 DULERA, 60 duloxetine, 37 DURAGESIC, 32 DURICEF, 22, 23 dutasteride, 62 DYAZIDE/MAXZIDE, 30 DYLIX, 60 DYNACIN, 25 DYNACIRC, 28 DYNACIRC-CR, 28 dyphylline, 60 dyphylline-guaifenesin, 60 DYRENIUM, 30
E
E.E.S., 23 E.E.S./ERYPED, 23 EAR-GESIC, 45 EC-NAPROSYN, 62 econazole, 41 ED, 56 ED-A-HIST, 58 EDECRIN, 30 EDURANT, 21 efavirenz, 21 EFFEXOR, 37 EFFIENT, 64 EFUDEX, 43 ELAVIL, 38 ELDEPRYL, 35 ELELYSO, 67 eletriptan, 36 Elidel, 82 ELIMITE, 44 ELIQUIS, 64
2013-2014 | 97
ELIXOPHYLLIN, 60 ELMIRON, 63 ELOCON, 43 elvitegravir, 22 EMADINE, 53 EMCYT, 26 emedastine, 53 EMEND, 36 EMLA, 44 emollient, 43 emtricitabine, 22 EMTRIVA, 22 enalapril, 27, 29 ENBREL, 69 enfuvirtide, 66 ENJUVIA, 52 enoxaparin, 64 entacapone, 35 entecavir, 66 ENTOCORT, 51 ENULOSE, 50 enzalutamide, 25 EPIDUO, 40 EPIFOAM, 44 EPIVIR, 22, 66 eplerenone, 30 epoetin, 67 EPOGEN, 67 epoprostenol, 68 eprosartan, 27, 29 EPZICOM, 21 EQUAGESIC, 32 EQUANIL, 34 ERAXIS, 66 ergocalciferol, 65 ergoloid, 37 ERGOMAR, 36 ergotamine, 36, 37 ERIVEDGE, 68 erlotinib, 68 ERYGEL, 40 ERY-TAB, 23 ERYTHROCIN, 23 erythromycin, 23, 40, 54 ERYTHROMYCIN, 23, 40 escitalopram, 38 estazolam, 33 esterified, 51 ESTRACE, 52, 53 estradiol, 51, 52, 53 estramustine, 26 ESTRASORB, 52 ESTRATEST, 51 estrogens,, 51, 52, 53 estropipate, 52 ESTROPIPATE, 52 etanercept, 69 ethacrynic, 30
ethambutol, 21 ethinyl, 52 ethionamide, 21 ethosuximide, 34 ethotoin, 34 etidronate, 48 etodolac, 62 etoposide, 26 etravirine, 21 EULEXIN, 25 everolimus, 68 EVISTA, 52 EXELDERM, 42 EXELON, 31 exemestane, 26 exenatide, 47 EXFORGE, 29 EXJADE, 64 EXPECTUSS, 57 EXTAVIA, 67 ezetimibe, 27 Ezetimibe-Simvastatin, 82 ezogabine, 34
F
factor, 70 famciclovir, 21 famotidine, 49 FAMVIR, 21 FARESTON, 25 FEIBA, 70 felbamate, 34 FELBATOL, 34 FELDENE, 62 felodipine, 28 FEMARA, 26 Femecal, 53 FEMHRT, 52 FEMTRACE, 52 fenofibrate, 27 fenoprofen, 62 fentanyl, 32 FENTANYL, 32 FENTORA, 32 ferric, 65 FERRIPROX, 69 fexofenadine, 56, 57 FEXOFENADINE, 84 Fexofenadine-OTC, 82 filgrastim, 67 FINACEA, 44 finasteride, 62 fingolimod, 67 FIORICET, 32, 36 FIORICET/CODEINE, 31, 36 FIORINAL, 32, 36 FIORINAL/CODEINE, 32, 36
FLAGYL, 24 FLAREX, 54 flavoxate, 62 flecainide, 26 FLEXERIL, 61 FLOLAN, 68 FLOMAX, 63 FLONASE, 60 FLORINEF, 45 FLOVENT, 60 FLOXIN, 25, 45 fluconazole, 20, 66 flucytosine, 20 fludarabine, 67 fludrocortisone, 45 FLUMADINE, 22 flumazenil, 64 flunisolide, 60 Flunisolide, 82 fluocinolone, 42, 45 fluocinonide, 42 fluorometholone, 54 fluorouracil, 43 fluoxetine, 38 fluoxymesterone, 25, 48 fluphenazine, 39 FLUPHENAZINE, 39 flurandrenolide, 42 flurazepam, 34 flurbiprofen, 55, 62 flutamide, 25 fluticasone, 43, 60 Fluticasone, 82 fluvastatin, 27 fluvoxamine, 38 FML, 54 FOCALIN, 39 folic, 65 FOLIC, 65 FOLVITE, 65 fondaparinux, 64 FORADIL, 59 formoterol, 59 FORTEO, 69 Fosamax, 83 FOSAMAX, 52 fosamprenavir, 22 fosfomycin, 23 fosinopril, 27, 29 FOSRENOL, 63 FRAGMIN, 64 FRENADOL, 61 FROVA, 37 frovatriptan, 37 FURADANTIN, 24 furosemide, 30 FUZEON, 66
2013-2014 | 98
G
gabapentin, 34 GABITRIL, 35 galantamine, 31 ganciclovir, 22 GANI-TUSS, 58 GARAMYCIN, 41, 54 GASTRINEX, 50 GASTROCROM, 51 GEL-KAM, 45 gemfibrozil, 27 GENEXA, 58 GENOTROPIN, 68 gentamicin, 24, 41, 54 GENTAMICIN, 24 GEODON, 38 GILENYA, 67 GILTUSS, 58 glatiramer, 67 GLEEVEC, 68 glimepiride, 47 glipizide, 46, 47 glucagon, 48 GLUCAGON, 48 GLUCOPHAGE, 46 GLUCOTROL, 47 GLUCOVANCE, 46 glyburide, 46, 47 GLYCOLAX, 50 glycopyrrolate, 49 GLYCRON, 47 GLYNASE, 47 GLYSET, 46 GOLYTELY, 50 GORDON'S, 44 granisetron, 36 GRIFULVIN, 20 griseofulvin, 20 GRIS-PEG, 20 guanabenz, 29 guanfacine, 29 guanidine, 37 GUANIDINE, 37
H
halcinonide, 42 HALCION, 34 HALDOL, 38, 39 halobetasol, 43 HALOG, 42 haloperidol, 38, 39 haloprogin, 41 HALOTIN, 41 HECTOROL, 63 HELIDAC, 50 HEMOFIL, 69, 70
heparin, 64 HEPARIN, 64 HEPSERA, 66 hexachlorophene, 44 HEXALEN, 25 HIPREX/UREX, 63 HISTEX, 56 HUMALOG, 47 HUMATE-P, 70 HUMATROPE, 69 HUMIRA, 69 HUMULIN, 47 HYCODAN, 58 HYDERGINE, 37 hydralazine, 31 HYDREA, 26 hydrochlorothiazide, 31 HYDROCHLOROTHIAZIDE, 31 hydrocod, 58 hydrocodone, 32, 58 hydrocortisone, 41, 42, 43, 45,
46, 51 HYDRODIURIL, 31 hydromorphone, 33 hydroxocobalamin, 65 HYDROXOCOBALAMIN, 65 hydroxychloroquine, 20 hydroxyurea, 26 hydroxyzine, 34, 57 HYDROXYZINE, 57 hyoscyamine, 49, 62 HYTONE, 42 HYTRIN, 27 HYZAAR, 29
I
ibandronate, 52, 69 IBUDONE, 32 ibuprofen, 62 icosapent, 27 iloprost, 68 ILOTYCIN, 54 imatinib, 68 IMDUR, 31 imiglucerase, 67 imipramine, 38 imiquimod, 43 IMITREX, 37 IMODIUM, 49 IMURAN, 26, 61 indapamide, 30 INDERAL, 28 INDERIDE, 30 indinavir, 22 INDOCIN, 62 indomethacin, 62 INFED, 65
INFERGEN, 66 INFLAMASE, 55 infliximab, 69 inj, 66 INLYTA, 68 INNOHEP, 64 INSPRA, 30 insulin, 47 insulin-(pen), 47 insulin--(pen), 47 insulin-(vial), 47 insulin--(vial), 47 INTAL, 60 INTELENCE, 21 interferon, 66, 67 INTRON-A, 66 INVIRASE, 22 iodoquinol, 20, 41 IOPIDINE, 55 ipratropium, 59 irbesartan, 27, 29 Irbesartan, 83 iron, 65 IRRIGATION, 44 ISENTRESS, 21 ISMO, 31 isocarboxazid, 37 isoniazid, 21 ISONIAZID, 21 ISOPTO, 55 ISORDIL, 31 isosorbide, 31 isotretinoin, 43 isoxsuprine, 31 isradipine, 28 itraconazole, 20 ivermectin, 20
J
JANUMET, 46 Januvia, 81 JANUVIA, 48 JENTADUETO, 48 J-TAN, 56 Juvisync, 82 JUVISYNC, 46
K
KADIAN, 33 KALETRA, 22 KAON, 65 KAYEXALATE, 64 K-DUR, 65 KEFLEX, 23 KENALOG, 43, 45, 46 KEPPRA, 34
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KERLONE, 28 ketoconazole, 20, 41 ketoprofen, 62 KETOPROFEN, 62 ketorolac, 56, 62 KETOROLAC, 62 ketotifen, 53 KETOTIFEN, 53 KLARON, 40 KLONOPIN, 34 KLOR-CON, 65 K-LYTE, 64, 65 KOATE-DVI, 70 KOMBIGLYZE, 46 KORLYM, 49 K-PHOS, 65 KRISTALOSE, 50 KYTRIL, 36
L
labetalol, 28 LAC-HYDRIN, 43 lacosamide, 34 lactic, 43 Lactic acid, 82 lactulose, 50 LAMICTAL, 34 LAMISIL, 20, 42 lamivudine, 22, 66 lamotrigine, 34 LANOXIN, 31 lanreotide, 69 lansoprazole, 50 Lansoprazole, 83 LANSOPRAZOLE OTC, 84 lanthanum, 63 LANTUS, 47 lapatinib, 68 LARIAM, 20 LARTUS, 58 LASIX, 30 latanoprost, 55 leflunomide, 61 lenalidomide, 68 LESCOL, 27 LETAIRIS, 68 letrozole, 26 leucovorin, 65 LEUCOVORIN, 65 LEUKERAN, 25 LEUKINE, 67 leuprolide, 26 levalbuterol, 59 LEVAQUIN, 25 LEVATOL, 28 LEVEMIR, 47 levetiracetam, 34
LEVITRA, 63 levobunolol, 55 levocarnitine, 64 Levocetirizine, 82 levofloxacin, 25 levorphanol, 33 LEVORPHANOL, 33 levothyroxine, 48 LEVOTHYROXINE, 48 LEVSIN, 49 LEVSINEX, 49 LEXAPRO, 38 LEXIVA, 22 LIALDA, 51 LIBRAX, 49 LIBRIUM, 33 LIDAMANTLE, 44 LIDEX, 42 lidocaine, 20, 44, 51 LIDODERM, 44 LIMBITROL, 40 linaclotide, 51 linagliptin, 47, 48 LINCOCIN, 24 lincomycin, 24 lindane, 44 LINDANE, 44 LINZESS, 51 LIORESAL, 61 liothyronine, 48 LIPITOR, 26 liraglutide, 48 lisdexamfetamine, 39 lisinopril, 27, 29 lithium, 40 LITHIUM, 40 LITHOBID, 40 LITHOSTAT, 63 LOBAC, 61 LOCOID, 43 LODINE, 62 LODOSYN, 35 lodoxamide, 53 LODRANE, 56 LOFIBRA, 27 LOMOTIL, 49 lomustine, 25 LONITEN, 31 loperamide, 49 LOPID, 27 lopinavir, 22 LOPRESSOR, 28, 30 LOPROX, 41 loratadine, 56, 57 LORATADINE, 84 Loratadine/D-OTC, 82 Loratadine-OTC, 82 lorazepam, 34
LORTAB/VICODIN, 32 losartan, 27, 29 Losartan, 83 LOTENSIN, 27, 29 loteprednol, 54 LOTREL, 29 LOTRIMIN, 41 LOTRISONE, 41 LOTRONEX, 51 lovastatin, 27 LOVAZA, 27 LOVENOX, 64 loxapine, 39 LOXITANE, 39 LOZI-FLUR, 65 LOZOL, 30 lubiprostone, 51 LUDIOMIL, 37 LUFYLLIN-GG, 60 LUMIGAN, 55 LUPRON, 26 LURIDE, 65 LUSAIR, 58 LUVOX, 38 LUXIQ, 42 LYRICA, 35 LYSODREN, 26
M
M.V.I., 65 MACROBID, 24 MACRODANTIN, 24 mafenide, 43 magnesium, 61 MALARONE, 20 maprotiline, 37 maraviroc, 21 MARINOL, 36 MARPLAN, 37 MATERNA, 53 MATULANE, 26 MAVIK, 27 MAXAIR, 59 MAXALT, 37 MAXIDEX, 54 MAXITROL, 54 mebendazole, 21 meclizine, 36 meclofenamate, 62 MECLOFENAMATE, 62 MEDROL, 46 medroxyprogesterone, 52 mefenamic, 62 mefloquine, 20 MEGACE, 26 megestrol, 26 MELLARIL, 39
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meloxicam, 62 melphalan, 25 memantine, 31 MENEST, 52 MENTAX, 41 meperidine, 33 meprobamate, 34 MEPRON, 23 mercaptopurine, 26 mesalamine, 51 MESTINON, 37 METADATE, 39 METAGLIP, 46 metaproterenol, 59 METAPROTERENOL, 59 metaxalone, 61 metformin, 46 methadone, 33 METHADONE, 33 methamphetamine, 39 methazolamide, 30 methenamine, 63 METHERGINE, 48 methimazole, 48 METHITEST, 25, 48 methocarbamol, 61 methotrexate, 26, 61 METHOTREXATE, 26, 61 methoxsalen, 43 methscopolamine, 49 methsuximide, 34 methyclothiazide, 31 METHYCLOTHIAZIDE, 31 methyldopa, 29 methylergonovine, 48 methylnaltrexone, 51 methylphenidate, 39 methylprednisolone, 46 methyltestosterone, 25, 48 metipranolol, 55 metoclopramide, 51 metolazone, 31 metoprolol, 28, 30 METROCREAM, 44 METROGEL, 53 METROGEL/, 44 metronidazole, 24, 44, 53 MEVACOR, 27 mexiletine, 26 MEXILETINE, 26 MIACALCIN, 48, 52 micafungin, 66 Micardis, 83 MICARDIS, 28, 30 miconazole, 53 MICONAZOLE, 53 MICRO-K/SLOW-K, 65 MICRONASE, 47
MIDAMOR, 30 midazolam, 34 midodrine, 29 MIDRIN, 36 mifepristone, 49 miglitol, 46 miglustat, 67 MIGRALAM, 36 MIGRANAL, 36 MIMYX, 43 MINIPRESS, 27 MINOCIN, 25 minocycline, 25 minoxidil, 31 mirabegron, 62 MIRAPEX, 35 mirtazapine, 37 misoprostol, 50 mitotane, 26 mitoxantrone, 68 MOBIC, 62 modafinil, 39 MODURETIC, 30 moexipril, 27, 30 mometasone, 43, 60 MONOCLATE-P, 70 MONODOX, 25 MONONINE, 70 MONOPRIL, 27, 29 montelukast, 60 MONUROL, 23 morphine, 33 MORPHINE, 33 MOTOFEN, 49 MOTRIN, 62 MOXEZA, 54 moxifloxacin, 25, 54 MS, 33 MST, 61 MUCINEX, 58 multiple, 65 mupirocin, 41 MYAMBUTOL, 21 MYCAMINE, 66 MYCELEX, 20 MYCOBUTIN, 21 MYCOLOG, 41 mycophenolate, 26 MYCOSTATIN, 41 MYDRIACYL, 55 MYLERAN, 25 MYRBETRIQ, 62 MYSOLINE, 35 MYTELASE, 61
N
nabumetone, 62
nadolol, 28, 30 nafarelin, 48 nafcillin, 24 NAFCILLIN, 24 NAFRINSE, 45 naftifine, 41 NAFTIN, 41 NALFON, 62 naloxone, 64 NALOXONE, 64 naltrexone, 64 NAMENDA, 31 naphazoline, 55 NAPRELAN, 62 NAPROSYN, 62 naproxen, 62 naratriptan, 37 NARDIL, 37 NASACORT, 60 NASAREL, 60 NASONEX, 60 NATACYN, 54 natalizumab, 67 natamycin, 54 NAVANE, 39 NEBUPENT, 24 nedocromil, 53 nefazodone, 37 nelfinavir, 22 neomycin, 24, 54 NEOMYCIN, 24 NEOSPORIN, 54 neostigmine, 37 NEOTUSS-D, 59 nepafenac, 56 NEPTAZANE, 30 NEULASTA, 67 NEUMEGA, 67 NEUPOGEN, 67 NEUPRO, 35 NEURONTIN, 34 NEVANAC, 56 nevirapine, 21 NEXAVAR, 68 niacin, 27 NIASPAN, 27 nicardipine, 28 nifedipine, 28 NILANDRON, 25 nilotinib, 68 nilutamide, 25 nimodipine, 28 NIMOTOP, 28 nisoldipine, 28 nitazoxanide, 21 NITRO-BID, 31 NITRO-DUR, 31 nitrofurantoin, 24
2013-2014 | 101
nitroglycerin, 31 NITROLINGUAL, 31 NITROSTAT, 31 NITRO-TIME, 31 nizatidine, 49 NIZORAL, 20, 41 NOHIST-LQ, 56 NOLVADEX, 25 NORDITROPIN, 69 norethindrone, 52 NORFLEX, 61 norfloxacin, 25 NORMODYNE, 28 NOROXIN, 25 NORPACE, 26 NORPRAMIN, 38 nortriptyline, 38 NORTUSS-EX, 57 NORVASC, 28 NORVIR, 22 NOVANTRONE, 68 NOVASTART, 53 NOVOLIN, 47 NOVOLOG, 47 NOVOSEVEN, 70 NOXAFIL, 20 NULYTELY, 50 NUTROPIN, 69 nystatin, 20, 41, 53 NYSTATIN, 20, 41, 53
O
OBTREX, 53 octreotide, 69 OCUFEN, 55 OCUFLOX, 54 OCUPRESS, 55 ofloxacin, 25, 45, 54 OFORTA, 67 OGEN, 52 olanzapine, 38 olmesartan, 28, 30 olopatadine, 53, 60 olsalazine, 51 OLUX, 43 omega-3-acid, 27 omeprazole, 50 OMEPRAZOLE OTC, 84 Omeprazole-OTC, 83 omeprazole-sodium, 50 OMNICEF, 23 OMNITROPE, 69 ondansetron, 36 Onglyza, 81 ONGLYZA, 48 OPANA, 33 oprelvekin, 67
OPTIPRANOLOL, 55 OPTIVAR, 53 ORACIT, 63 ORAP, 37 ORAPRED/PEDIAPRED, 46 ORASEP, 44 ORAXYL, 25 ORENCIA, 69 orphenadrine, 61 ORPHENADRINE/ASA/CAFFE
INE, 61 ORUDIS, 62 oseltamivir, 22 OTICIN, 45 oxaprozin, 62 oxazepam, 34 oxcarbazepine, 34 oxiconazole, 41 OXISTAT, 41 oxybutynin, 62 oxycodone, 33 OXYCODONE, 33 OXYCONTIN, 33 oxymorphone, 33
P
PACERONE, 26 PALGIC, 57 PAMELOR, 38 pamidronate, 69 PAMINE, 49 pancrelipase, 50 PANDEL, 43 PANLOR, 31 PANOXYL-8, 40 pantoprazole, 50 Pantoprazole, 83 papaverine, 31 PAPAVERINE, 31 PARAFON, 61 paregoric, 49 PAREGORIC, 49 paricalcitol, 63 PARLODEL, 35 PARNATE, 37 paroxetine, 38 PASER, 21 PATADAY/, 53 PATANASE, 60 Patanol, 82 PAXIL, 38 pazopanib, 68 PCE, 23 PEDIAZOLE, 23 pegademase, 67 PEGANONE, 34 PEGASYS, 66
pegfilgrastim, 67 peginterferon, 66, 68 PEG-INTRON, 66 penbutolol, 28 penciclovir, 42 penicillamine, 61 penicillin, 24 PENICILLIN, 24 PENLAC, 41 PENTAM, 24 pentamidine, 24 PENTASA, 51 pentosan, 63 pentoxifylline, 64 PEPCID, 49 PERCOCET, 32 PERFOROMIST, 59 PERIDEX, 44 perindopril, 27 permethrin, 44 perphenazine, 39 PERPHENAZINE/AMITRIPTYL
INE, 39 PERSANTINE, 64 phenazopyridine, 62 phenelzine, 37 PHENERGAN, 36 phenobarbital, 35 PHENOBARBITAL, 35 phenyleph, 58 phenyleph-chlorphen, 58 phenyleph-dm-pyril-pot, 58 phenyleph-ephed-cpm, 58 phenylephrine, 57, 58 phenylephrine-
brompheniramine-guaifenesin, 58
phenylephrine-chlorphen-dihydrocodeine, 58
phenylephrine-chlorphen-dm, 58
phenyltoloxamine, 61 phenytoin, 35 PHISOHEX, 44 PHOSLO, 63 PHRENILIN, 32, 36 physiological, 44 PHYSIOLYTE, 44 phytonadione, 65 pilocarpine, 45, 55 PILOPINE, 55 pimozide, 37 pindolol, 28 pioglitazone, 46, 47 pirbuterol, 59 piroxicam, 62 PLAQUENIL, 20 PLAVIX, 64 PLENDIL, 28
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PLETAL, 64 PLEXION, 40 podofilox, 44 POLYCITRA, 63 polyethylene, 50 polymyxin, 54 POLYSPORIN, 54 POLYTRIM, 54 PONSTEL, 62 posaconazole, 20 pot, 63, 64, 65 POTABA, 65 potassium, 63, 65 POTASSIUM, 63 POTIGA, 34 PRADAXA, 64 pramipexole, 35 PRAMOSONE, 44 pramoxine, 44, 45 PRANDIN, 47 prasugrel, 64 PRAVACHOL, 27 pravastatin, 27 Pravastatin, 82 praziquantel, 21 prazosin, 27 PRECOSE, 46 PRED, 55 PRED-G, 54 prednicarbate, 43 prednisolone, 46, 55 prednisone, 46 PREDNISONE, 46 PREFEST, 51 pregabalin, 35 PRELONE, 46 PREMARIN, 52, 53 PREMPRO/, 51 prenatal, 53 PREVACID, 50 PREVACID 24H, 84 Prevacid 24HR OTC, 83 PREVIDENT, 45 PREVPAC, 50 PREZISTA, 22 PRIFTIN, 21 PRILOSEC, 50 PRILOSEC OTC, 84 Prilosec-OTC, 83 primaquine, 20 PRIMAQUINE, 20 PRIMAXIN, 23 primidone, 35 PRINCIPEN, 24 PRINIVIL, 27 PRINZIDE, 29 PROAIR, 59 PROAMATINE, 29
probenecid, 61 procarbazine, 26 PROCARDIA, 28 prochlorperazine, 36 PROCRIT, 67 PROCTOCORT, 42, 51 PROCTOFOAM, 51 PROFILNINE, 70 progesterone, 52, 53 PROGLYCEM, 48 PROLASTIN, 67 PROLIA, 69 PROLIXIN, 39 PROLOPRIM, 24 promethazine, 36, 58 PROMETHAZINE, 57, 58 PROMETHAZINE/CODEINE,
58 PROMETHAZINE/DEXTROME
THORPHAN, 58 PROMETRIUM, 52 propafenone, 26 propantheline, 49 PROPANTHINE, 49 Propionate-Nasal, 82 propranolol, 28, 30 propylthiouracil, 48 PROPYLTHIOURACIL, 48 PROSCAR, 62 PROSOM, 33 PROSTIGMIN, 37 proteinase, 67 PROTONIX, 50 Protopic, 82 protriptyline, 38 PROVENTIL, 59 PROVERA, 52 PROVIGIL, 39 PROZAC, 38 pseudoephed-bromphen-dm,
59 pseudoephed-chlorphen, 59 pseudoephedrine, 59 pseudoephedrine-
dihydrocodeine-gg, 59 PSEUDOEPHEDRINE-
GUAIFENESIN, 59 PSORCON, 42 PULMICORT, 60 PULMOZYME, 69 PURINETHOL, 26 pyrazinamide, 21 PYRAZINAMIDE, 21 PYRIDIUM, 62 pyridostigmine, 37 pyridoxine, 65 PYRIDOXINE, 65 pyrilamine, 57 pyrimethamine, 20
Q
QUALAQUIN, 20 quazepam, 34 QUESTRAN, 26 quetiapine, 38 QUINAGLUTE, 26 quinapril, 27, 30 quinidine, 26 QUINIDINE, 26 quinine, 20 QVAR, 60
R
rabeprazole, 50 raloxifene, 52 raltegravir, 21 ramipril, 27 RANEXA, 31 ranitidine, 49, 50 ranolazine, 31 RAZADYNE, 31 REBIF, 67 RECLAST, 69 RECOMBINATE, 70 REFACTO, 70 REGLAN, 51 regorafenib, 68 REGRANEX, 44 RELAFEN, 62 RELAGARD, 53 RELAGESIC, 61 RELENZA, 22 RELISTOR, 51 RELPAX, 36 REMERON, 37 REMICADE, 69 REMODULIN, 68 RENAGEL, 63 RENVELA, 63 repaglinide, 47 REQUIP, 35 RESCRIPTOR, 21 reserpine, 29 RESERPINE, 29 RESTASIS, 55 RESTORIL, 34 RETIN-A, 41 RETROVIR, 22 REVATIO, 68 REVIA, 64 REVLIMID, 68 REYATAZ, 22 RHINOCORT, 60 RIBAPAK, 66 RIBASPHERE, 66 ribavirin, 66
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RIDAURA, 61 rifabutin, 21 RIFADIN, 21 RIFAMATE, 21 rifampin, 21 rifapentine, 21 RIFATER, 21 rifaximin, 24 rilpivirine, 21 RILUTEK, 37 riluzole, 37 rimantadine, 22 rimexolone, 55 ringer's, 44 RINGER'S, 44 risedronate, 52 RISPERDAL, 38 risperidone, 38 RITALIN, 39 ritonavir, 22 rivaroxaban, 64 rivastigmine, 31 rizatriptan, 37 ROBAXIN, 61 ROBINUL, 49 ROCALTROL, 65 ROCEPHIN, 23 ROMAZICON, 64 RONDEC, 56 ropinirole, 35 ROSAC, 41 rosiglitazone, 46, 47 ROSULA, 41 rosuvastatin, 27 rotigotine, 35 ROWASA/, 51 ROXICET, 32 ROXICODONE, 33 rufinamide, 35 RYNA-12, 57 RYNA-12X, 58 RYNATAN, 56 RYNATUSS, 58 RYTHMOL, 26
S
SAIZEN, 68 SALAGEN, 45 SALEX, 44 salicylic, 44 salmeterol, 59 salsalate, 62 SAL-TROPINE, 49 SANDOSTATIN, 69 SANTYL, 44 saquinavir, 22 sargramostim, 67
saxagliptin, 48 saxagliptin&metfomin, 46 scopolamine, 36 SECTRAL, 28 selegiline, 35 SELZENTRY, 21 SEMPREX-D, 56 SENSIPAR, 63 SEPTRA, 25 SERAX, 34 SEREVENT, 59 SEROMYCIN, 21 SEROQUEL, 38 SEROSTIM, 69 sertraline, 38 SERZONE, 37 sevelamer, 63 sildenafil, 63, 68 SILVADENE, 41 silver, 41 SIMCOR, 27 SIMETYL, 49 SIMUC-GP, 58 simvastatin, 27 SINEMET, 35 SINEQUAN, 38 SINGULAIR, 60 sitagliptin, 46, 48 SKELAXIN, 61 SKELID, 52 sodium, 42, 45, 51, 59, 63, 64,
65, 67, 68 SODIUM, 59, 63, 65 SOLU-CORTEF, 46 SOLU-MEDROL, 46 SOMA, 61 somatropin, 68 somatropin., 69 somatropin-., 68 somatropin-.-, 69 somatropin.-, 69 somatropin.., 69 somatropin--.., 68 somatropin..-, 69 somatropin..., 69 SOMATULINE, 69 SOMNOTE, 33 SONATA, 34 sorafenib, 68 SORIATANE, 43 sotalol, 26 SPECTAZOLE, 41 SPECTRACEF, 23 SPIRIVA, 59 spironolactone, 30 SPORANOX, 20 SPRYCEL, 68 STALEVO, 35
stannous, 45 stavudine, 22 STAXYN, 63 STELAZINE, 39 STIMATE, 69 STIVARGA, 68 STRATTERA, 39 streptomycin, 24 STREPTOMYCIN, 24 STRIBILD, 22 STROMECTOL, 20 SUBOXONE, 20, 77 SUBUTEX, 20, 77 succimer, 64 sucralfate, 50 SULAR, 28 sulconazole, 42 sulfacetamide, 40, 41, 54 sulfadiazine, 25 SULFADIAZINE, 25 sulfamethoxazole, 25 SULFAMYLON, 43 sulfanilamide, 53 sulfasalazine, 51 sulindac, 62 sumatriptan, 37 sunitinib, 68 SUPRAX, 23 SURMONTIL, 38 SUSTIVA, 21 SUTENT, 68 SYLATRON, 68 SYMBICORT, 60 SYMMETREL, 22, 35 SYNALAR, 42 SYNAREL, 48 SYNTHROID, 48
T
tadalafil, 63 tafluprost, 55 TAGAMET, 49 taliglucerase, 67 TAMBOCOR, 26 TAMIFLU, 22 tamoxifen, 25 tamsulosin, 63 TAPAZOLE, 48 TARCEVA, 68 TARGRETIN, 26, 43 TARKA, 30 TASIGNA, 68 tazarotene, 44 TAZORAC, 44 TEGRETOL, 34 telbivudine, 66 telmisartan, 28, 30
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temazepam, 34 TEMODAR, 67 TEMOVATE, 43 temozolomide, 67 TENEX, 29 tenofovir, 22 TENORETIC, 29 TENORMIN, 28 TERAZOL, 53 terazosin, 27 terbinafine, 20, 42 terbutaline, 59 terconazole, 53 teriflunomide, 67 teriparatide, 69 TESSALON, 57 testosterone, 48 TESTOSTERONE, 48 tetracycline, 25 tetrahydrozoline, 57 Teveten, 83 TEVETEN, 27, 29 TEV-TROPIN, 69 TEXACORT, 42 thalidomide, 68 THALITONE, 30 THALOMID, 68 THEO-24, 60 THEO-DUR, 60 theophylline, 60 thiamine, 65 THIAMINE, 65 THIOLA, 63 thioridazine, 39 thiothixene, 39 THORAZINE, 39 thyroid, 48 tiagabine, 35 TIAZAC, 28 TICLID, 64 ticlopidine, 64 TIGAN, 36 tiludronate, 52 timolol, 28, 55 TIMOPTIC, 55 TINVER, 42 tinzaparin, 64 tiopronin, 63 tiotropium, 59 tipranavir, 22 tizanidine, 61 TOBI, 66 TOBRADEX, 54 tobramycin, 54, 66 TOBRAMYCIN, 66 TOBREX, 54 tocilizumab, 69 tofacitinib, 69
TOFRANIL, 38 TOFRANIL-PM, 38 tolazamide, 47 TOLAZAMIDE, 47 tolbutamide, 47 TOLBUTAMIDE, 47 TOLECTIN, 62 TOLINASE, 47 tolmetin, 62 TOLMETIN, 62 tolterodine, 63 TOPAMAX, 35 TOPICORT, 42 topiramate, 35 TOPROL, 28 toremifene, 25 torsemide, 30 TRACLEER, 68 Tradjenta, 81 TRADJENTA, 47 tramadol, 33 trandolapril, 27, 30 TRANSDERM-SCOP, 36 TRANXENE, 33 tranylcypromine, 37 TRAVATAN, 55 travoprost, 55 trazodone, 37 TRECATOR, 21 TRENTAL, 64 treprostinil, 68 tretinoin, 26, 41 TREXALL, 26, 61 triamcinolone, 43, 45, 46, 60 TRIAMCINOLONE, 43 triamterene, 30 triazolam, 34 TRICOR, 27 trifluoperazine, 39 trifluridine, 54 TRIGLIDE, 27 trihexyphenidyl, 35 TRILAFON, 39 TRILEPTAL, 34 TRILIPIX, 26 TRILISATE, 61 trimethobenzamide, 36 trimethoprim, 24 trimipramine, 38 TRIZIVIR, 21 tropicamide, 55 TRUSOPT, 55 TRUVADA, 22 TUDORZA, 59 TUSNEL, 57, 59 TUSSAFED, 58 TUSSI-12, 57 TUSSI-12D, 58
TUSSIONEX, 58 TUSSI-ORGANIDIN, 57 TUSSI-ORGANIDIN-S, 57 TUSSI-PRES, 58 TUSSIZONE-12, 57 TUSSO-C, 57 TYKERB, 68 TYLENOL/CODEINE, 32 TYSABRI, 67 TYZEKA, 66 TYZINE, 57
U
ULTRACET, 32 ULTRAM, 33 ULTRAVATE, 43 UNIRETIC, 30 UNIVASC, 27 urea, 44 URECHOLINE, 63 URETRON, 63 URIN, 63 URISPAS, 62 UROGESIC, 63 URSO, 51 ursodiol, 51
V
VAGIFEM, 53 valacyclovir, 21 VALISONE, 42 VALIUM, 33 valproate, 35, 40 valproic, 35, 40 valsartan, 28, 30 Valsartan, 83 VALTREX, 21 VANCOCIN, 24 vancomycin, 24 VANTIN, 23 vardenafil, 63 VASCEPA, 27 VASERETIC, 29 VASOCIDIN, 54 VASODILAN, 31 VASOTEC, 27 VAZOL-D, 56 VECTICAL, 43 VEETIDS, 24 velaglucerase, 67 vemurafenib, 68 venlafaxine, 37 VENTAVIS, 68 VENTOLIN, 59 VEPESID, 26 Veramyst, 82
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VERAMYST, 60 verapamil, 28, 29 VERELAN, 28, 29 VERMOX, 21 VERSED, 34 VERTIN-32, 36 VESANOID, 26 VEXOL, 55 VFEND, 20, 66 VIAGRA, 63 VIBRAMYCIN, 25 VIBRAMYCIN/VIBRATAB, 25 VICOPROFEN, 32 VICTOZA, 48 VIDEX, 21 VIGAMOX, 54 VIMPAT, 34 VIRACEPT, 22 VIRAMUNE, 21 VIRAMUNE/, 21 VIRAZOLE, 66 VIREAD, 22 VIROPTIC, 54 VISICOL, 51 VISKEN, 28 vismodegib, 68 VISTARIL, 34 vitamin, 65 VITAMIN, 65 VIVACTIL, 38 VIVELLE-DOT, 53 VOLTAREN, 55, 62 VOLTAREN-XR, 62 VOPAC, 32 voriconazole, 20, 66 vorinostat, 68 VOSOL, 45 VOSOL-HC, 45 VOSPIRE, 59 VOTRIENT, 68 VPRIV, 67 VYTONE, 41
VYTORIN, 27 VYVANSE, 39
W
warfarin, 64 water, 44 WELCHOLl, 27 WELLBUTRIN, 37 WESTCORT, 43 WYTENSIN, 29
X
XALATAN, 55 XALKORI, 68 XANAX, 33 XARELTO, 64 XELJANZ, 69 XELODA, 67 XERAC-AC, 43 XIFAXAN, 24 XOPENEX, 59 XTANDI, 25 XYLOCAINE, 20, 44 XYNTHA, 70 XYREM, 68
Y
YODOXIN, 20
Z
Zaditor OTC, 82 ZADITOR OTC, 84 zafirlukast, 60 zaleplon, 34 ZANAFLEX, 61 zanamivir, 22 ZANTAC, 49, 50 ZARONTIN, 34
ZAROXOLYN, 31 ZAVESCA, 67 ZEBETA, 28 ZEGERID, 50 Zegerid OTC, 83 ZEGERID® OTC, 84 ZELBORAF, 68 ZEMPLAR, 63 ZERIT, 22 ZETIA, 27 ZIAC, 29 ZIAGEN, 21 zidovudine, 22 zileuton, 60 ZIOPTAN, 55 ziprasidone, 38 ZITHROMAX, 23 ZMAX, 23 ZOCOR, 27 ZODERM, 40 ZOFRAN, 36 zoledronic, 69 ZOLINZA, 68 zolmitriptan, 37 ZOLOFT, 38 zolpidem, 34 ZOMIG, 37 ZONALON, 41 ZONEGRAN, 35 zonisamide, 35 ZORBTIVE, 68 ZOVIRAX, 21, 42 ZYDONE, 32 ZYFLO, 60 ZYLOPRIM, 61 ZYPREXA, 38 ZYRTEC, 57, 84 Zyrtec Itchy OTC, 82 Zyrtec/D-OTC, 82 ZYRTEC-D, 56 Zyrtec-OTC, 82