lista de medicamentos preferidos aprobado por...

Louisiana Healthy Blue

Lista de medicamentos preferidos aprobada por Medicaid En vigencia desde el 1 de mayo de 2018

Leyenda

En cada categoría, los medicamentos se listan en orden alfabético por marca o nombre genérico.

Medicamento de marca: letra mayúscula en negrita

Medicamento genérico: letra minúscula en texto sin formato

AL: restricción de límite de edad

DO: programa de optimización de dosis

GR: restricción de género

OTC: medicamento de venta libre disponible con receta. (Los recetadores deben incluir la sigla OTC en la

receta).

PA: requiere autorización previa. La autorización previa es el proceso mediante el cual se obtiene la aprobación

de los beneficios antes de que se puedan abastecer ciertas recetas.

QL: límites de cantidad. Ciertos medicamentos recetados tienen límites de cantidad específicos, por receta o por

mes.

SP: farmacia de medicamentos especiales ST: requiere terapia escalonada. Es posible que necesite utilizar un medicamento antes de que los beneficios

para el uso de otro medicamento puedan autorizarse.

Nombre del medicamento Referencia Notas

ADJUVANTES QUÍMICOS O FARMACÉUTICOS

ADJUVANTE FARMACÉUTICO (INHALADORES)

NEBUSAL INHALATION SOLUTION FOR NEBULIZATION

pulmosal inhalation solution for nebulization

sodium chloride inhalation solution for nebulization

NebuSal

AGENTES ANORRECTALES

AGENTES ANORRECTALES

hydrocortisone topical cream with perineal applicator

Anusol-HC QL

proctosol hc topical cream with perineal applicator

QL

proctozone-hc topical cream with perineal applicator

QL

AGENTES ANTI-INFECCIOSOS

AGENTES ANTIBACTERIANOS ANTIPROTOZOARIOS

metronidazole oral capsule Flagyl

metronidazole oral tablet Flagyl

tinidazole oral tablet QL

AGENTES ANTILEPROSOS, DAPSONA

dapsone oral tablet

AGENTES ANTIMICOBACTERIANOS

ethambutol oral tablet Myambutol

isoniazid oral solution

isoniazid oral tablet

PRIFTIN ORAL TABLET

pyrazinamide oral tablet

rifabutin oral capsule Mycobutin

rifampin oral capsule Rifadin

RIFATER ORAL TABLET

2


AGENTES PARA EL TRATAMIENTO DE HEPATITIS B

adefovir oral tablet Hepsera PA; QL

BARACLUDE ORAL SOLUTION PA; QL

entecavir oral tablet Baraclude PA; QL

EPIVIR HBV ORAL SOLUTION PA; QL

lamivudine oral tablet Epivir HBV PA; QL

AGENTES PARA EL TRATAMIENTO DE HEPATITIS C

MAVYRET ORAL TABLET PA; QL

PEGASYS PROCLICK SUBCUTANEOUS PEN INJECTOR

PA

PEGASYS SUBCUTANEOUS SOLUTION

PA; QL

PEGASYS SUBCUTANEOUS SYRINGE PA

PEGINTRON REDIPEN SUBCUTANEOUS PEN INJECTOR KIT

PA

PEGINTRON SUBCUTANEOUS KIT PA

ribavirin oral capsule Ribasphere QL

ribavirin oral tablet Moderiba QL

ZEPATIER ORAL TABLET PA; QL

AMIBICIDAS

paromomycin oral capsule

AMINOGLICÓSIDOS

gentamicin in nacl (iso-osm) intravenous piggyback

gentamicin injection solution

gentamicin sulfate (ped) (pf) injection solution

gentamicin sulfate (pf) intravenous solution

neomycin oral tablet

AMINOPENICILINAS

amoxicillin oral capsule

amoxicillin oral suspension for reconstitution

QL

amoxicillin oral tablet

amoxicillin oral tablet,chewable

3


amoxicillin-pot clavulanate oral suspension for reconstitution

Augmentin ES-600

amoxicillin-pot clavulanate oral tablet

amoxicillin-pot clavulanate oral tablet extended release 12 hr

Augmentin XR QL

amoxicillin-pot clavulanate oral tablet,chewable

ampicillin oral capsule

ampicillin oral suspension for reconstitution

ANTIBIÓTICO SULFONAMIDA

sulfadiazine oral tablet

ANTIBIÓTICOS ANTIMICÓTICOS

fluconazole oral suspension for reconstitution

Diflucan QL

fluconazole oral tablet Diflucan QL

flucytosine oral capsule Ancobon

griseofulvin microsize oral suspension

griseofulvin ultramicrosize oral tablet Gris-PEG (ultramicrosize)

itraconazole oral capsule Sporanox PA

ketoconazole oral tablet QL

nystatin oral powder

nystatin oral tablet

terbinafine hcl oral tablet QL

voriconazole intravenous solution Vfend IV PA

voriconazole oral suspension for reconstitution

Vfend PA

voriconazole oral tablet 200 mg Vfend PA; QL

voriconazole oral tablet 50 mg Vfend PA

ANTIHELMÍNTICOS

ALBENZA ORAL TABLET

ivermectin oral tablet Stromectol

praziquantel oral tablet Biltricide

ANTIRETROVIRAL - ANTI-CD4 DOMAIN 2 MONOCLONAL ANTIBODY

TROGARZO INTRAVENOUS SOLUTION

4


ANTIRETROVIRAL COMBINATIONS - INTEGRASE INHIBITOR AND NNRTI

JULUCA ORAL TABLET

ANTIVIRALES, ESPECÍFICOS DE VIH

abacavir oral solution Ziagen

abacavir oral tablet Ziagen

abacavir-lamivudine oral tablet Epzicom

abacavir-lamivudine-zidovudine oral tablet Trizivir

APTIVUS ORAL CAPSULE

APTIVUS ORAL SOLUTION

atazanavir oral capsule Reyataz

BIKTARVY ORAL TABLET

CRIXIVAN ORAL CAPSULE

DESCOVY ORAL TABLET

didanosine oral capsule,delayed release(dr/ec)

Videx EC

EDURANT ORAL TABLET

EMTRIVA ORAL CAPSULE

EMTRIVA ORAL SOLUTION

EVOTAZ ORAL TABLET

FUZEON SUBCUTANEOUS RECON SOLN

GENVOYA ORAL TABLET

INTELENCE ORAL TABLET AL

ISENTRESS HD ORAL TABLET

ISENTRESS ORAL POWDER IN PACKET

ISENTRESS ORAL TABLET

ISENTRESS ORAL TABLET,CHEWABLE

KALETRA ORAL TABLET

lamivudine oral solution Epivir AL

lamivudine oral tablet Epivir

lamivudine-zidovudine oral tablet Combivir

lopinavir-ritonavir oral solution Kaletra

nevirapine oral suspension Viramune

5


nevirapine oral tablet Viramune

nevirapine oral tablet extended release 24 hr

Viramune XR

NORVIR ORAL CAPSULE

NORVIR ORAL SOLUTION

PREZCOBIX ORAL TABLET

PREZISTA ORAL SUSPENSION

PREZISTA ORAL TABLET

RESCRIPTOR ORAL TABLET

RESCRIPTOR ORAL TABLET, DISPERSIBLE

RETROVIR INTRAVENOUS SOLUTION

REYATAZ ORAL POWDER IN PACKET

ritonavir oral tablet Norvir

SELZENTRY ORAL SOLUTION

SELZENTRY ORAL TABLET

stavudine oral capsule Zerit

stavudine oral recon soln Zerit

STRIBILD ORAL TABLET

SYMFI ORAL TABLET

tenofovir disoproxil fumarate oral tablet Viread PA; QL

TIVICAY ORAL TABLET

TRIUMEQ ORAL TABLET

TRUVADA ORAL TABLET

VIDEX 2 GRAM PEDIATRIC ORAL RECON SOLN

VIDEX 4 GRAM PEDIATRIC ORAL RECON SOLN

VIRACEPT ORAL TABLET

VIREAD ORAL POWDER PA; QL

VIREAD ORAL TABLET PA; QL

zidovudine oral capsule Retrovir

zidovudine oral syrup Retrovir

zidovudine oral tablet

ANTIVIRALES, GENERALES

acyclovir oral capsule Zovirax

acyclovir oral suspension Zovirax

acyclovir oral tablet Zovirax

6


cidofovir intravenous solution

famciclovir oral tablet QL

oseltamivir oral capsule Tamiflu QL

oseltamivir oral suspension for reconstitution

Tamiflu QL

RELENZA DISKHALER INHALATION BLISTER WITH DEVICE

QL

rimantadine oral tablet Flumadine

TAMIFLU ORAL SUSPENSION FOR RECONSTITUTION

QL

valacyclovir oral tablet Valtrex QL

valganciclovir oral recon soln Valcyte

valganciclovir oral tablet Valcyte

CEFALOSPORINA, ANTIBIÓTICOS

cefaclor oral capsule

cefaclor oral suspension for reconstitution

cefaclor oral tablet extended release 12 hr

cefadroxil oral capsule

cefadroxil oral suspension for reconstitution

cefadroxil oral tablet

cefdinir oral capsule QL

cefdinir oral suspension for reconstitution QL

cefpodoxime oral suspension for reconstitution

cefpodoxime oral tablet

cefprozil oral suspension for reconstitution

cefprozil oral tablet

CEFTIN ORAL SUSPENSION FOR RECONSTITUTION

ceftriaxone injection recon soln 1 gram, 2 gram, 250 mg, 500 mg

QL

ceftriaxone injection recon soln 10 gram, 100 gram

ceftriaxone intravenous recon soln

cefuroxime axetil oral suspension for reconstitution

cefuroxime axetil oral tablet

cephalexin oral capsule Keflex

7


cephalexin oral suspension for reconstitution

cephalexin oral tablet

COMBINACIONES DE PLASMOCIDAS

atovaquone-proguanil oral tablet Malarone Pediatric

LINCOSAMIDAS

clindamycin hcl oral capsule Cleocin HCl

clindamycin palmitate hcl oral recon soln Cleocin Pediatric

clindamycin pediatric oral recon soln

MACRÓLIDOS

azithromycin oral packet Zithromax QL

azithromycin oral suspension for reconstitution

Zithromax QL

azithromycin oral tablet Zithromax QL

clarithromycin oral suspension for reconstitution

clarithromycin oral tablet

clarithromycin oral tablet extended release 24 hr

e.e.s. 400 oral tablet

ery-tab oral tablet,delayed release (dr/ec)

erythrocin (as stearate) oral tablet

erythromycin ethylsuccinate oral tablet E.E.S. 400

erythromycin oral capsule,delayed release(dr/ec)

erythromycin oral tablet

erythromycin stearate oral tablet Erythrocin (as stearate)

PENICILINAS

BICILLIN L-A INTRAMUSCULAR SYRINGE

dicloxacillin oral capsule

penicillin v potassium oral recon soln

penicillin v potassium oral tablet

PLASMOCIDAS

chloroquine phosphate oral tablet

hydroxychloroquine oral tablet Plaquenil

mefloquine oral tablet QL

8


PRIMAQUINE ORAL TABLET

QUINOLONES

ciprofloxacin hcl oral tablet QL

levofloxacin oral solution QL

levofloxacin oral tablet Levaquin QL

ofloxacin oral tablet QL

SULFONAMIDAS ABSORBIBLES

sulfamethoxazole-trimethoprim oral suspension

Sulfatrim

sulfamethoxazole-trimethoprim oral tablet Bactrim

sulfatrim oral suspension

trimethoprim oral tablet

TETRACICLINA

demeclocycline oral tablet

doxycycline monohydrate oral capsule 100 mg, 50 mg

Mondoxyne NL QL

doxycycline monohydrate oral capsule 150 mg

doxycycline monohydrate oral capsule 75 mg

Mondoxyne NL

doxycycline monohydrate oral suspension for reconstitution

Vibramycin

minocycline oral capsule Minocin

minocycline oral tablet

tetracycline oral capsule

VANCOMICINA Y DERIVADOS

linezolid oral suspension for reconstitution Zyvox PA; QL

linezolid oral tablet Zyvox PA; QL

vancomycin oral capsule Vancocin PA

AGENTES DE DIAGNÓSTICO

AGENTES DE DIAGNÓSTICO: COMPLEMENTO RADIOLÓGICO GASTROINTESTINAL

GLUCAGEN DIAGNOSTIC KIT INJECTION RECON SOLN

QL

AGENTES DE DIAGNÓSTICO: FUNCIÓN DE LA HIPÓFISIS

cosyntropin injection recon soln Cortrosyn QL

9


cosyntropin intravenous solution

AGENTES DE TERAPIA CARDIOVASCULAR

AGENTES BLOQUEADORES ALFA ADRENÉRGICOS

doxazosin oral tablet Cardura QL

prazosin oral capsule Minipress

terazosin oral capsule QL

AGENTES BLOQUEADORES ALFA/BETA ADRENÉRGICOS

carvedilol oral tablet Coreg QL

labetalol oral tablet

AGENTES BLOQUEADORES BETA ADRENÉRGICOS

acebutolol oral capsule

atenolol oral tablet Tenormin

betaxolol oral tablet

bisoprolol fumarate oral tablet

metoprolol succinate oral tablet extended release 24 hr

Toprol XL

metoprolol tartrate oral tablet 100 mg, 50 mg

Lopressor QL

metoprolol tartrate oral tablet 25 mg, 37.5 mg, 75 mg

nadolol oral tablet 20 mg, 40 mg Corgard

nadolol oral tablet 80 mg Corgard PA

pindolol oral tablet

propranolol oral capsule,extended release 24 hr

Inderal LA

propranolol oral solution

propranolol oral tablet

sorine oral tablet QL

sotalol af oral tablet QL

sotalol oral tablet Betapace QL

timolol maleate oral tablet

AGENTES BLOQUEADORES DEL CANAL DE CALCIO

afeditab cr oral tablet extended release 30 mg

DO; QL

10


afeditab cr oral tablet extended release 60 mg

QL

amlodipine oral tablet 10 mg Norvasc QL

amlodipine oral tablet 2.5 mg, 5 mg Norvasc DO; QL

cartia xt oral capsule,extended release 24hr 120 mg, 180 mg, 240 mg

DO; QL

cartia xt oral capsule,extended release 24hr 300 mg

QL

diltiazem hcl oral capsule,ext.rel 24h degradable 120 mg, 180 mg

DILT-XR DO; QL

diltiazem hcl oral capsule,ext.rel 24h degradable 240 mg

DILT-XR QL

diltiazem hcl oral capsule,extended release 12 hr

QL

diltiazem hcl oral capsule,extended release 24 hr 120 mg, 180 mg

Taztia XT DO; QL

diltiazem hcl oral capsule,extended release 24 hr 240 mg, 300 mg, 360 mg

Taztia XT QL

diltiazem hcl oral capsule,extended release 24 hr 420 mg

Tiazac QL

diltiazem hcl oral capsule,extended release 24hr 120 mg, 180 mg, 240 mg

Cardizem CD DO; QL

diltiazem hcl oral capsule,extended release 24hr 300 mg, 360 mg

Cardizem CD QL

diltiazem hcl oral tablet Cardizem QL

diltiazem hcl oral tablet extended release 24 hr 180 mg, 240 mg

Cardizem LA DO; QL

diltiazem hcl oral tablet extended release 24 hr 300 mg, 360 mg, 420 mg

Cardizem LA QL

dilt-xr oral capsule,ext.rel 24h degradable 120 mg, 180 mg

DO; QL

dilt-xr oral capsule,ext.rel 24h degradable 240 mg

QL

felodipine oral tablet extended release 24 hr 10 mg

QL

felodipine oral tablet extended release 24 hr 2.5 mg, 5 mg

DO; QL

isradipine oral capsule QL

matzim la oral tablet extended release 24 hr 180 mg, 240 mg

DO; QL

matzim la oral tablet extended release 24 hr 300 mg, 360 mg, 420 mg

QL

11


nicardipine oral capsule QL

nifedipine oral capsule QL

nifedipine oral tablet extended release 24hr 30 mg

Procardia XL DO; QL

nifedipine oral tablet extended release 24hr 60 mg, 90 mg

Procardia XL QL

nifedipine oral tablet extended release 30 mg

Adalat CC DO; QL

nifedipine oral tablet extended release 60 mg, 90 mg

Adalat CC QL

taztia xt oral capsule,extended release 24 hr 120 mg, 180 mg

DO; QL

taztia xt oral capsule,extended release 24 hr 240 mg, 300 mg, 360 mg

QL

verapamil oral capsule, 24 hr er pellet ct Verelan PM DO; QL

verapamil oral capsule,ext rel. pellets 24 hr 120 mg, 180 mg

Verelan DO; QL

verapamil oral capsule,ext rel. pellets 24 hr 240 mg, 360 mg

Verelan QL

verapamil oral tablet QL

verapamil oral tablet extended release Calan SR QL

AGENTES DE TERAPIA ANAFILAXIA

epinephrine injection auto-injector EpiPen Jr QL

epinephrine injection solution Adrenalin

AGENTES DIURÉTICOS, OTROS

acetazolamide oral capsule, extended release

acetazolamide oral tablet

methazolamide oral tablet

spironolactone oral tablet Aldactone

ANTAGONISTAS DEL RECEPTOR DE LA ALDOSTERONA

spironolactone oral tablet Aldactone

ANTIARRÍTMICOS

amiodarone oral tablet 200 mg Pacerone QL

amiodarone oral tablet 400 mg Pacerone

disopyramide phosphate oral capsule Norpace

flecainide oral tablet QL

12


mexiletine oral capsule

pacerone oral tablet 200 mg QL

pacerone oral tablet 400 mg

propafenone oral capsule,extended release 12 hr

Rythmol SR

propafenone oral tablet

quinidine gluconate oral tablet extended release

quinidine sulfate oral tablet

sorine oral tablet QL

sotalol af oral tablet QL

sotalol oral tablet Betapace QL

DIURÉTICOS AHORRADORES DE POTASIO

amiloride oral tablet

amiloride-hydrochlorothiazide oral tablet

spironolacton-hydrochlorothiaz oral tablet Aldactazide

triamterene-hydrochlorothiazid oral capsule

triamterene-hydrochlorothiazid oral tablet Maxzide-25mg

DIURÉTICOS DE ASA

bumetanide oral tablet

furosemide oral solution

furosemide oral tablet Lasix

torsemide oral tablet Demadex

GLUCÓSIDOS DIGITÁLICOS

digitek oral tablet

digox oral tablet

digoxin oral solution

digoxin oral tablet Digitek

HIPERTENSIÓN ARTERIAL PULMONAR

ADCIRCA ORAL TABLET PA; QL

LETAIRIS ORAL TABLET PA; QL

sildenafil (antihypertensive) oral tablet Revatio PA; QL

13


HIPOTENSIVOS, ANTAGONISTA DE LOS RECEPTORES DE LA ANGIOTENSINA

candesartan oral tablet Atacand

candesartan-hydrochlorothiazid oral tablet Atacand HCT

irbesartan oral tablet 150 mg, 75 mg Avapro DO; QL

irbesartan oral tablet 300 mg Avapro QL

irbesartan-hydrochlorothiazide oral tablet Avalide QL

losartan oral tablet Cozaar QL

losartan-hydrochlorothiazide oral tablet 100-12.5 mg, 100-25 mg

Hyzaar QL

losartan-hydrochlorothiazide oral tablet 50-12.5 mg

Hyzaar DO; QL

valsartan oral tablet Diovan QL

valsartan-hydrochlorothiazide oral tablet Diovan HCT QL

HIPOTENSIVOS, INHIBIDORES DE LA ECA, COMBINACIONES

benazepril oral tablet QL

benazepril-hydrochlorothiazide oral tablet QL

captopril oral tablet QL

captopril-hydrochlorothiazide oral tablet QL

enalapril maleate oral tablet Vasotec QL

enalapril-hydrochlorothiazide oral tablet QL

fosinopril oral tablet QL

fosinopril-hydrochlorothiazide oral tablet QL

lisinopril oral tablet 10 mg, 20 mg, 5 mg Prinivil DO; QL

lisinopril oral tablet 2.5 mg Zestril DO; QL

lisinopril oral tablet 30 mg, 40 mg Zestril QL

lisinopril-hydrochlorothiazide oral tablet 10-12.5 mg

Zestoretic DO; QL

lisinopril-hydrochlorothiazide oral tablet 20-12.5 mg, 20-25 mg

Zestoretic QL

moexipril oral tablet

moexipril-hydrochlorothiazide oral tablet

perindopril erbumine oral tablet QL

quinapril oral tablet Accupril QL

quinapril-hydrochlorothiazide oral tablet Accuretic QL

ramipril oral capsule Altace QL

14


trandolapril oral tablet

HIPOTENSIVOS, SIMPATOLÍTICOS

clonidine hcl oral tablet Catapres

guanfacine oral tablet

methyldopa oral tablet

reserpine oral tablet

HIPOTENSIVOS, VARIOS

atenolol-chlorthalidone oral tablet Tenoretic 100

bisoprolol-hydrochlorothiazide oral tablet Ziac

methyldopa-hydrochlorothiazide oral tablet

metoprolol ta-hydrochlorothiaz oral tablet Lopressor HCT QL

nadolol-bendroflumethiazide oral tablet Corzide QL

propranolol-hydrochlorothiazid oral tablet

HIPOTENSIVOS, VASODILATADORES

hydralazine oral tablet

minoxidil oral tablet

INHIBIDOR DE LA ECA/COMBINACIÓN DEL BLOQUEADOR DEL CANAL DE CALCIO

amlodipine-benazepril oral capsule QL

INHIBIDORES DE LA PCSK-9

REPATHA PUSHTRONEX SUBCUTANEOUS WEARABLE INJECTOR

PA; QL

REPATHA SURECLICK SUBCUTANEOUS PEN INJECTOR

PA; QL

REPATHA SYRINGE SUBCUTANEOUS SYRINGE

PA; QL

LIPOTRÓPICOS

atorvastatin oral tablet 10 mg, 20 mg, 40 mg

Lipitor DO; QL

atorvastatin oral tablet 80 mg Lipitor QL

cholestyramine (with sugar) oral powder Questran

cholestyramine (with sugar) oral powder in packet

Questran

cholestyramine light oral powder

15


cholestyramine light oral powder in packet

colestipol oral granules Colestid

colestipol oral packet Colestid

colestipol oral tablet Colestid

fenofibrate micronized oral capsule 130 mg, 200 mg, 43 mg

QL

fenofibrate micronized oral capsule 134 mg

fenofibrate micronized oral capsule 67 mg PA; QL

fenofibrate nanocrystallized oral tablet Tricor QL

fenofibrate oral tablet QL

fenofibric acid (choline) oral capsule,delayed release(dr/ec) 135 mg

Trilipix QL

fenofibric acid (choline) oral capsule,delayed release(dr/ec) 45 mg

Trilipix PA; QL

fenofibric acid oral tablet Fibricor PA; QL

fish oil oral capsule,delayed release(dr/ec) OTC

gemfibrozil oral tablet Lopid

lovastatin oral tablet QL

pravastatin oral tablet Pravachol QL

prevalite oral powder

prevalite oral powder in packet

simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg

Zocor DO; QL

simvastatin oral tablet 80 mg Zocor PA; QL

TIAZIDA Y DIURÉTICOS RELACIONADOS

chlorothiazide oral tablet

chlorthalidone oral tablet

hydrochlorothiazide oral capsule Microzide QL

hydrochlorothiazide oral tablet 12.5 mg QL

hydrochlorothiazide oral tablet 25 mg, 50 mg

indapamide oral tablet

metolazone oral tablet

VASODILATADORES, CORONARIA

isosorbide dinitrate oral tablet

isosorbide dinitrate oral tablet extended release

ISOCHRON

16


isosorbide mononitrate oral tablet

isosorbide mononitrate oral tablet extended release 24 hr

nitro-bid transdermal ointment

NITRO-DUR TRANSDERMAL PATCH 24 HOUR

nitroglycerin oral capsule, extended release

Nitro-Time

nitroglycerin sublingual tablet Nitrostat

nitroglycerin transdermal patch 24 hour Minitran

nitro-time oral capsule, extended release

VASOPRESOR ADRENÉRGICO

midodrine oral tablet

AGENTES DE TERAPIA GASTROINTESTINAL

AGENTES ANTIEMÉTICOS/ANTIVÉRTIGOS

compro rectal suppository

meclizine oral tablet Dramamine Less Drowsy OTC

ondansetron oral tablet,disintegrating Zofran ODT QL

phenadoz rectal suppository

prochlorperazine edisylate injection solution

prochlorperazine maleate oral tablet Compazine

prochlorperazine rectal suppository Compazine

promethazine rectal suppository Phenadoz AL

promethegan rectal suppository AL

trimethobenzamide oral capsule Tigan

AGENTES PARA LA ENFERMEDAD INFLAMATORIA INTESTINAL

budesonide oral capsule,delayed,extend.release

Entocort EC QL

colocort rectal enema

HUMIRA PEDIATRIC CROHN'S START SUBCUTANEOUS SYRINGE KIT

PA; QL

HUMIRA PEN CROHN'S-UC-HS START SUBCUTANEOUS PEN INJECTOR KIT

PA; QL

HUMIRA PEN PSORIASIS-UVEITIS SUBCUTANEOUS PEN INJECTOR KIT

PA; QL

17


HUMIRA PEN SUBCUTANEOUS PEN INJECTOR KIT

PA; QL

HUMIRA SUBCUTANEOUS SYRINGE KIT

PA; QL

hydrocortisone rectal enema Colocort

ANTIDIARREICOS

diphenoxylate-atropine oral liquid

diphenoxylate-atropine oral tablet Lomotil

loperamide oral capsule Anti-Diarrheal (loperamide) OTC; QL

ANTIESPASMÓDICOS

dicyclomine oral capsule

dicyclomine oral solution

dicyclomine oral tablet

glycopyrrolate oral tablet Robinul

hyoscyamine sulfate oral drops Hyosyne

hyoscyamine sulfate oral elixir Hyosyne

hyoscyamine sulfate oral tablet Levsin

hyoscyamine sulfate oral tablet extended release 12 hr

Levbid

hyoscyamine sulfate oral tablet,disintegrating

Anaspaz

hyoscyamine sulfate sublingual tablet Levsin/SL

hyosyne oral drops

hyosyne oral elixir

oscimin oral tablet

oscimin oral tablet,disintegrating

oscimin sl sublingual tablet

oscimin sr oral tablet extended release 12 hr

propantheline oral tablet

symax fastabs oral tablet,disintegrating

symax-sr oral tablet extended release 12 hr

ENZIMAS PANCREÁTICAS

CREON ORAL CAPSULE,DELAYED RELEASE(DR/EC) 12,000-38,000 -60,000 UNIT, 24,000-76,000 -120,000 UNIT, 6,000-19,000 -30,000 UNIT

QL

18


CREON ORAL CAPSULE,DELAYED RELEASE(DR/EC) 3,000-9,500- 15,000 UNIT, 36,000-114,000- 180,000 UNIT

ESTIMULANTES DE MOTILIDAD INTESTINAL

metoclopramide hcl oral solution

metoclopramide hcl oral tablet Reglan

INFLAMACIÓN CRÓNICA, ENFERMEDAD DE COLON, 5 AMINOSALICILATOS

APRISO ORAL CAPSULE,EXTENDED RELEASE 24HR

QL

balsalazide oral capsule Colazal QL

mesalamine rectal enema Rowasa QL

mesalamine with cleansing wipe rectal enema kit

Rowasa QL

sulfasalazine oral tablet Azulfidine QL

sulfasalazine oral tablet,delayed release (dr/ec)

Azulfidine EN-tabs QL

LAXANTES Y CATÁRTICOS

constulose oral solution QL

enulose oral solution

gavilyte-c oral recon soln QL

gavilyte-g oral recon soln QL

gavilyte-n oral recon soln QL

generlac oral solution

lactulose oral solution Constulose QL

peg 3350-electrolytes oral recon soln GaviLyte-G QL

peg-3350 with flavor packs oral recon soln QL

peg-electrolyte soln oral recon soln GaviLyte-N QL

polyethylene glycol 3350 oral powder ClearLax OTC

polyethylene glycol 3350 oral powder in packet

ClearLax OTC; QL

trilyte with flavor packets oral recon soln QL

REDUCTORES DE SECRECIÓN ÁCIDA GÁSTRICA

CARAFATE ORAL SUSPENSION

famotidine (pf) intravenous solution

famotidine 20 mg tablet (rx) Acid Controller OTC; QL

19


famotidine 20 mg tablet f/c (rx) Acid Controller OTC; QL

famotidine 20 mg tablet u-d,10x10,inner (rx)

Acid Controller OTC; QL

famotidine 20 mg tablet u-d,10x10,outer (rx)


famotidine 20 mg tablet u-d,robot ready,innr (rx)


famotidine 20 mg tablet u-d,robot ready,outr (rx)


famotidine oral suspension Pepcid AL

famotidine oral tablet 40 mg Pepcid QL

misoprostol oral tablet Cytotec

nizatidine oral capsule

nizatidine oral solution

pantoprazole oral tablet,delayed release (dr/ec)

Protonix QL

ranitidine 150 mg tablet (rx) Acid Control (ranitidine) OTC; QL

ranitidine 150 mg tablet f/c (rx) Acid Control (ranitidine) OTC; QL

ranitidine 150 mg tablet federal supply (rx) Acid Control (ranitidine) OTC; QL

ranitidine 150 mg tablet inner (rx) Acid Control (ranitidine) OTC; QL

ranitidine 150 mg tablet outer (rx) Acid Control (ranitidine) OTC; QL

ranitidine 150 mg tablet u-d,10x10,inner (rx)

Acid Control (ranitidine) OTC; QL

ranitidine 150 mg tablet u-d,10x10,outer (rx)

Acid Control (ranitidine) OTC; QL

ranitidine hcl oral capsule 150 mg

ranitidine hcl oral capsule 300 mg QL

ranitidine hcl oral syrup

ranitidine hcl oral tablet 300 mg Zantac QL

sucralfate oral suspension Carafate

sucralfate oral tablet Carafate

SALES BILIARES

ursodiol oral capsule Actigall

ursodiol oral tablet URSO 250

AGENTES DE TERAPIA RESPIRATORIA

AGENTES ALFA/BETA ADRENÉRGICOS

epinephrine injection solution Adrenalin

20


epinephrine injection syringe

AGENTES BETA ADRENÉRGICOS

albuterol sulfate inhalation solution for nebulization

QL

albuterol sulfate oral syrup

albuterol sulfate oral tablet

albuterol sulfate oral tablet extended release 12 hr

metaproterenol oral syrup

metaproterenol oral tablet

PROVENTIL HFA INHALATION HFA AEROSOL INHALER

PA; QL

SEREVENT DISKUS INHALATION BLISTER WITH DEVICE

QL

terbutaline oral tablet

VENTOLIN HFA INHALATION HFA AEROSOL INHALER

QL

AGENTES BRONCODILATADORES GENERALES

ATROVENT HFA INHALATION HFA AEROSOL INHALER

QL

ipratropium bromide inhalation solution QL

SPIRIVA RESPIMAT INHALATION MIST QL

AGENTES PARA EL TRATAMIENTO DE LA FIBROSIS QUÍSTICA

tobramycin in 0.225 % nacl inhalation solution for nebulization

Tobi QL

AGENTES PARA EL TRATAMIENTO DEL ASMA

ARNUITY ELLIPTA INHALATION BLISTER WITH DEVICE

QL

budesonide inhalation suspension for nebulization

Pulmicort PA; AL; QL

cromolyn inhalation solution for nebulization

FLOVENT DISKUS INHALATION BLISTER WITH DEVICE

QL

FLOVENT HFA INHALATION HFA AEROSOL INHALER

QL

montelukast oral granules in packet Singulair QL

21


montelukast oral tablet Singulair

montelukast oral tablet,chewable Singulair

PULMICORT FLEXHALER INHALATION AEROSOL POWDR BREATH ACTIVATED

PA; QL

zafirlukast oral tablet Accolate QL

ANTIBIÓTICOS NASALES

BACTROBAN NASAL NASAL OINTMENT

QL

ANTICOLINÉRGICOS NASALES

ipratropium bromide nasal spray,non-aerosol

ANTICUERPOS DE INMUNOGLOBULINA

XOLAIR SUBCUTANEOUS RECON SOLN

PA

ANTIHISTAMÍNICOS NASALES

azelastine nasal aerosol,spray QL

azelastine nasal spray,non-aerosol Astepro QL

ANTIHISTAMÍNICOS

carbinoxamine maleate oral liquid

carbinoxamine maleate oral tablet

clemastine oral tablet Allergy Relief (clemastine)

cyproheptadine oral tablet

diphenhydramine hcl oral capsule Banophen OTC

diphenhydramine hcl oral elixirChildren's Allergy (diphenhyd)

OTC; QL

fexofenadine oral tablet Allegra Allergy OTC; QL

promethazine oral syrup AL

promethazine oral tablet 12.5 mg, 50 mg AL

promethazine oral tablet 25 mg AL; QL

UNISOM (DIPHENHYDRAMINE) ORAL LIQUID

OTC

COMBINACIÓN DE AGENTES BETA ADRENÉRGICOS

ANORO ELLIPTA INHALATION BLISTER WITH DEVICE

COMBIVENT RESPIMAT INHALATION MIST

QL

22


ipratropium-albuterol inhalation solution for nebulization

COMBINACIONES ANTITUSIVAS NO NARCÓTICAS

benzonatate oral capsule

chlorpheniramine-phenyleph-dm oral liquid

OTC

promethazine-dm oral syrup AL; QL

COMBINACIONES DE ANTIHISTAMÍNICOS Y DESCONGESTIVOS

fexofenadine-pseudoephedrine oral tablet extended release 12 hr

Allegra-D 12 Hour OTC; QL

hist-pse oral liquid OTC

promethazine vc oral syrup AL; QL

promethazine-phenylephrine oral syrup Promethazine VC AL; QL

r-tanna oral tablet

COMBINACIONES DE ANTITUSIVOS NARCÓTICOS

cheratussin ac oral liquid AL; OTC; QL

guaiatussin ac oral liquid AL; OTC; QL

guaifenesin ac oral liquid AL; OTC; QL

guaifenesin dac oral syrup AL; OTC

hydrocodone compound oral syrup

hydrocodone-homatropine oral syrup Hydrocodone Compound

hydrocodone-homatropine oral tablet Tussigon

hydromet oral syrup

m-clear wc oral liquid AL; OTC

promethazine vc-codeine oral syrup AL; QL

promethazine-codeine oral syrup AL; QL

promethazine-phenyleph-codeine oral syrup

Promethazine VC-Codeine AL; QL

relcof c oral liquid AL; OTC

REZIRA ORAL SOLUTION

tusnel c oral syrup AL; OTC

virtussin ac oral liquid AL; OTC; QL

23


COMBINACIONES DE DESCONGESTIVOS Y EXPECTORANTES

TRIAMINIC CHEST-NASAL CONGEST ORAL LIQUID

OTC

COMBINACIONES DE GLUCOCORTICOIDES Y BETA-ADRENÉRGICOS

BREO ELLIPTA INHALATION BLISTER WITH DEVICE 100-25 MCG/DOSE

PA; QL

BREO ELLIPTA INHALATION BLISTER WITH DEVICE 200-25 MCG/DOSE

PA

DULERA INHALATION HFA AEROSOL INHALER

PA; QL

COMBINACIONES DESCONGESTIVAS

pain reliever pm oral tablet OTC

DESCONGESTIVOS SIMPATICOMIMÉTICOS SISTÉMICOS

pseudoephedrine hcl oral tablet Sudogest AL; OTC

MUCOLÍTICOS

acetylcysteine solution

PULMOZYME INHALATION SOLUTION PA; QL

XANTINAS

THEO-24 ORAL CAPSULE,EXTENDED RELEASE 24HR

QL

theochron oral tablet extended release 12 hr

theophylline oral elixir Elixophyllin

theophylline oral solution

theophylline oral tablet extended release 12 hr

Theochron

theophylline oral tablet extended release 24 hr

AGENTES DEL SISTEMA NERVIOSO CENTRAL

ANSIOLÍTICOS

alprazolam intensol oral concentrate

alprazolam oral tablet Xanax

24


alprazolam oral tablet,disintegrating

buspirone oral tablet

chlordiazepoxide hcl oral capsule

clonazepam oral tablet Klonopin

clonazepam oral tablet,disintegrating

clorazepate dipotassium oral tablet

diazepam intensol oral concentrate

diazepam oral concentrate Diazepam Intensol

diazepam oral solution

diazepam oral tablet Valium

hydroxyzine hcl oral solution

hydroxyzine hcl oral tablet

hydroxyzine pamoate oral capsule

lorazepam oral tablet Ativan

oxazepam oral capsule

ANTICONVULSIVOS

carbamazepine oral capsule, er multiphase 12 hr

Carbatrol QL

carbamazepine oral suspension Tegretol

carbamazepine oral tablet Epitol

carbamazepine oral tablet extended release 12 hr

Tegretol XR

carbamazepine oral tablet,chewable



diazepam rectal kit Diastat QL

divalproex oral capsule, delayed rel sprinkle

Depakote Sprinkles QL

divalproex oral tablet extended release 24 hr

Depakote ER QL

divalproex oral tablet,delayed release (dr/ec) 125 mg, 250 mg

Depakote QL

divalproex oral tablet,delayed release (dr/ec) 500 mg

Depakote

epitol oral tablet

ethosuximide oral capsule Zarontin

ethosuximide oral solution Zarontin

felbamate oral suspension Felbatol

25


felbamate oral tablet Felbatol

gabapentin oral capsule Neurontin QL

gabapentin oral solution Neurontin QL

gabapentin oral tablet Neurontin QL

lamotrigine oral tablet Lamictal

lamotrigine oral tablet disintegrating, dose pk

Lamictal ODT Starter (Orange)

lamotrigine oral tablet extended release 24hr

Lamictal XR

lamotrigine oral tablet, chewable dispersible

Lamictal

lamotrigine oral tablet,disintegrating 100 mg, 50 mg

Lamictal ODT QL

lamotrigine oral tablet,disintegrating 200 mg, 25 mg

Lamictal ODT

lamotrigine oral tablets,dose pack Lamictal Starter (Blue) Kit

levetiracetam oral solution Keppra

levetiracetam oral tablet Keppra QL

levetiracetam oral tablet extended release 24 hr

Keppra XR QL

oxcarbazepine oral suspension Trileptal

oxcarbazepine oral tablet Trileptal

phenobarbital oral elixir

phenobarbital oral tablet 100 mg, 15 mg, 16.2 mg, 30 mg, 60 mg, 64.8 mg, 97.2 mg

phenobarbital oral tablet 32.4 mg QL

phenytoin oral suspension Dilantin-125

phenytoin oral tablet,chewable Dilantin Infatabs

phenytoin sodium extended oral capsule Phenytek

primidone oral tablet Mysoline

ROWEEPRA ORAL TABLET QL

roweepra xr oral tablet extended release 24 hr

QL

tiagabine oral tablet Gabitril

topiramate oral capsule, sprinkle Topamax

topiramate oral tablet Topamax

valproic acid (as sodium salt) oral solution Depakene

valproic acid oral capsule Depakene QL

zonisamide oral capsule 100 mg Zonegran

26


zonisamide oral capsule 25 mg Zonegran QL

zonisamide oral capsule 50 mg QL

ANTIDEPRESIVOS ANTAGONISTAS DE RECEPTORES ALFA-2

mirtazapine oral tablet Remeron

mirtazapine oral tablet,disintegrating Remeron SolTab

ANTIDEPRESIVOS TRICÍCLICOS E INHIBIDORES DE RECAPTACIÓN NO SELECCIONADOS RELACIONADOS

amitriptyline oral tablet

amoxapine oral tablet

clomipramine oral capsule Anafranil

desipramine oral tablet Norpramin

doxepin oral capsule

doxepin oral concentrate

imipramine hcl oral tablet Tofranil

imipramine pamoate oral capsule

maprotiline oral tablet

nortriptyline oral capsule Pamelor

nortriptyline oral solution

protriptyline oral tablet

trimipramine oral capsule Surmontil

ANTIDEPRESIVOS, OTROS

perphenazine-amitriptyline oral tablet

ANTIPSICÓTICOS, DOPAMINA ATÍPICA Y ANTAGONISTAS DE SEROTONINA

ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON

AL; QL

ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING

AL

aripiprazole oral tablet Abilify AL; QL

ARISTADA INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING

PA; AL

clozapine oral tablet Clozaril AL; QL

INVEGA SUSTENNA INTRAMUSCULAR SYRINGE

PA; AL; QL

27


INVEGA TRINZA INTRAMUSCULAR SYRINGE

PA; AL; QL

olanzapine intramuscular recon soln Zyprexa AL

olanzapine oral tablet Zyprexa AL; QL

paliperidone oral tablet extended release 24hr

Invega AL

quetiapine oral tablet Seroquel AL; QL

RISPERDAL CONSTA INTRAMUSCULAR SYRINGE

PA; AL; QL

risperidone oral solution Risperdal AL; QL

risperidone oral tablet Risperdal AL; QL

ziprasidone hcl oral capsule Geodon AL; QL

ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION

PA; AL

ANTIPSICÓTICOS, TÍPICOS

chlorpromazine oral tablet AL

fluphenazine decanoate injection solution AL

fluphenazine hcl injection solution AL

fluphenazine hcl oral concentrate AL

fluphenazine hcl oral elixir AL

fluphenazine hcl oral tablet AL

haloperidol decanoate intramuscular solution 100 mg/ml

Haldol Decanoate AL; QL

haloperidol decanoate intramuscular solution 50 mg/ml

Haldol Decanoate AL

haloperidol lactate injection solution Haldol AL

haloperidol lactate intramuscular syringe AL

haloperidol lactate oral concentrate AL

haloperidol oral tablet AL

loxapine succinate oral capsule AL

perphenazine oral tablet AL

pimozide oral tablet Orap PA

prochlorperazine maleate oral tablet Compazine

thioridazine oral tablet

thiothixene oral capsule AL

trifluoperazine oral tablet AL

BENZODIACEPINAS

alprazolam intensol oral concentrate

28


alprazolam oral tablet Xanax

alprazolam oral tablet,disintegrating

chlordiazepoxide hcl oral capsule



clorazepate dipotassium oral tablet

estazolam oral tablet

flurazepam oral capsule QL

oxazepam oral capsule

temazepam oral capsule Restoril QL

triazolam oral tablet Halcion QL

COMBINACIONES DE BENZODIACEPINA/ANTIDEPRESIVOS TRICÍCLICOS

amitriptyline-chlordiazepoxide oral tablet

DÉFICIT DE ATENCIÓN, HIPERACTIVIDAD (TDAH)/NARCOLEPSIA

atomoxetine oral capsule Strattera DO; AL; QL

caffeine citrate intravenous solution Cafcit

caffeine citrate oral solution

clonidine hcl oral tablet extended release 12 hr

Kapvay AL; QL

dexmethylphenidate oral capsule,er biphasic 50-50

Focalin XR AL; QL

dexmethylphenidate oral tablet 10 mg, 2.5 mg

Focalin AL

dexmethylphenidate oral tablet 5 mg Focalin PA; QL

dextroamphetamine oral capsule, extended release

Dexedrine Spansule AL; QL

dextroamphetamine oral tablet Zenzedi AL; QL

dextroamphetamine-amphetamine oral capsule,extended release 24hr

Adderall XR AL; QL

dextroamphetamine-amphetamine oral tablet

Adderall AL

metadate er oral tablet extended release AL; QL

methylphenidate hcl oral capsule, er biphasic 30-70

AL; QL

29


methylphenidate hcl oral capsule,er biphasic 50-50

Ritalin LA AL; QL

methylphenidate hcl oral solution Methylin AL

methylphenidate hcl oral tablet Ritalin AL

methylphenidate hcl oral tablet extended release 10 mg

AL

methylphenidate hcl oral tablet extended release 20 mg

Metadate ER AL; QL

methylphenidate hcl oral tablet extended release 24hr

Concerta AL; QL

ESTIMULANTES DEL SNC

dextroamphetamine oral capsule, extended release

Dexedrine Spansule AL; QL

dextroamphetamine oral tablet Zenzedi AL; QL

dextroamphetamine-amphetamine oral capsule,extended release 24hr

Adderall XR AL; QL

dextroamphetamine-amphetamine oral tablet

Adderall AL

INHIBIDOR SELECTIVO DE RECAPTACIÓN DE SEROTONINA (ISRS)

citalopram oral solution QL

citalopram oral tablet 10 mg, 40 mg Celexa

citalopram oral tablet 20 mg Celexa QL

escitalopram oxalate oral solution

escitalopram oxalate oral tablet Lexapro QL

fluoxetine oral capsule Prozac QL

fluoxetine oral capsule,delayed release(dr/ec)

fluoxetine oral solution

fluoxetine oral tablet Sarafem QL

fluvoxamine oral tablet

paroxetine hcl oral tablet Paxil QL

paroxetine hcl oral tablet extended release 24 hr 12.5 mg, 37.5 mg

Paxil CR

paroxetine hcl oral tablet extended release 24 hr 25 mg

Paxil CR QL

sertraline oral concentrate Zoloft QL

sertraline oral tablet Zoloft QL

30


INHIBIDORES DE RECAPTACIÓN DE ANTAGONISTAS DE SEROTONINA-2 (SARIS)

nefazodone oral tablet

trazodone oral tablet

INHIBIDORES DE RECAPTACIÓN DE DOPAMINA Y NOREPINEFRINA (IRND)

bupropion hcl oral tablet

bupropion hcl oral tablet extended release 12 hr

Wellbutrin SR


Wellbutrin XL QL

INHIBIDORES DE RECAPTACIÓN DE SEROTONINA-NOREPINEFRINA (IRSN)

venlafaxine oral capsule,extended release 24hr

Effexor XR QL

venlafaxine oral tablet QL

venlafaxine oral tablet extended release 24hr

QL

INHIBIDORES MAO

phenelzine oral tablet Nardil

tranylcypromine oral tablet Parnate

MEDICAMENTOS ANTIMANÍACOS

lithium carbonate oral capsule

lithium carbonate oral tablet

lithium carbonate oral tablet extended release

Lithobid

lithium citrate oral solution 8 meq/5 ml AL

lithium citrate oral solution 8 meq/5 ml (5 ml)

MEDICAMENTOS PARA EL PARKINSON, ANTICOLINÉRGICO

benztropine oral tablet

trihexyphenidyl oral elixir

trihexyphenidyl oral tablet

31


MEDICAMENTOS PARA EL PARKINSON, OTROS

amantadine hcl oral capsule QL

amantadine hcl oral solution

amantadine hcl oral tablet

bromocriptine oral capsule Parlodel

bromocriptine oral tablet Parlodel

carbidopa-levodopa oral tablet Sinemet

carbidopa-levodopa oral tablet extended release

Sinemet CR

carbidopa-levodopa oral tablet,disintegrating

carbidopa-levodopa-entacapone oral tablet

Stalevo 50 QL

entacapone oral tablet Comtan

pramipexole oral tablet Mirapex QL

ropinirole oral tablet Requip

selegiline hcl oral capsule

selegiline hcl oral tablet

PREPARADOS PARA LA MIGRAÑA

divalproex oral tablet extended release 24 hr

Depakote ER QL

ergotamine-caffeine oral tablet Cafergot

isometh-dichloral-acetaminophn oral capsule

migergot rectal suppository

naratriptan oral tablet Amerge QL

nodolor oral capsule

sumatriptan nasal spray,non-aerosol Imitrex PA; QL

sumatriptan succinate oral tablet Imitrex QL

sumatriptan succinate subcutaneous cartridge

Imitrex STATdose Kit Refill PA; QL

sumatriptan succinate subcutaneous pen injector

Imitrex STATdose Pen PA; QL

sumatriptan succinate subcutaneous solution

Imitrex PA; QL

sumatriptan succinate subcutaneous syringe

PA; QL

32


SEDANTE HIPNÓTICO, BARBITÚRICOS

phenobarbital oral elixir

phenobarbital oral tablet 100 mg, 15 mg, 16.2 mg, 30 mg, 60 mg, 64.8 mg, 97.2 mg

phenobarbital oral tablet 32.4 mg QL

SEDANTE HIPNÓTICO, NO BARBITÚRICOS

diphenhydramine hcl oral capsule Banophen OTC

estazolam oral tablet

flurazepam oral capsule QL

temazepam oral capsule Restoril QL

triazolam oral tablet Halcion QL

UNISOM (DIPHENHYDRAMINE) ORAL LIQUID

OTC

zaleplon oral capsule Sonata QL

zolpidem oral tablet Ambien QL

AGENTES HEMATOLÓGICOS

AGENTES ANTIFIBRINOLÍTICOS

tranexamic acid oral tablet Lysteda QL

AGENTES HEMORREOLÓGICOS

pentoxifylline oral tablet extended release

AGENTES INHIBIDORES DE C1 ESTERASA

BERINERT INTRAVENOUS RECON SOLN

PA

AGENTES PARA LA ANEMIA FALCIFORME

DROXIA ORAL CAPSULE

ANTICOAGULANTES ORALES

ELIQUIS ORAL TABLET

ELIQUIS ORAL TABLETS,DOSE PACK QL

jantoven oral tablet

warfarin oral tablet Coumadin

FORMULACIONES DE COLORACIÓN CON HEPARINA

heparin lock flush (porcine) intravenous syringe

33


HEMATÍNICOS, OTRO

ARANESP (IN POLYSORBATE) INJECTION SOLUTION

PA; QL

ARANESP (IN POLYSORBATE) INJECTION SYRINGE 10 MCG/0.4 ML, 100 MCG/0.5 ML, 200 MCG/0.4 ML, 25 MCG/0.42 ML, 300 MCG/0.6 ML, 40 MCG/0.4 ML, 60 MCG/0.3 ML

PA

ARANESP (IN POLYSORBATE) INJECTION SYRINGE 150 MCG/0.3 ML, 500 MCG/ML

PA; QL

EPOGEN INJECTION SOLUTION PA

PROCRIT INJECTION SOLUTION PA

HEPARINA Y PREPARADOS RELACIONADOS

enoxaparin subcutaneous solution Lovenox QL

enoxaparin subcutaneous syringe Lovenox QL

heparin (porcine) injection cartridge

heparin (porcine) injection solution

heparin (porcine) injection syringe

heparin lock flush (porcine) intravenous syringe

heparin, porcine (pf) injection solution

heparin, porcine (pf) injection syringe

INHIBIDORES DE AGREGACIÓN PLAQUETARIA

anagrelide oral capsule Agrylin

cilostazol oral tablet

clopidogrel oral tablet 300 mg Plavix

clopidogrel oral tablet 75 mg Plavix QL

dipyridamole oral tablet

ticlopidine oral tablet

AGENTES INMUNOSUPRESORES

INMUNOSUPRESORES

azathioprine oral tablet Imuran

cyclosporine modified oral capsule Gengraf

cyclosporine modified oral solution Gengraf

cyclosporine oral capsule Sandimmune

gengraf oral capsule

34


gengraf oral solution

mycophenolate mofetil oral capsule CellCept

mycophenolate mofetil oral suspension for reconstitution

CellCept

mycophenolate mofetil oral tablet CellCept

mycophenolate sodium oral tablet,delayed release (dr/ec)

Myfortic

RAPAMUNE ORAL SOLUTION

SANDIMMUNE ORAL SOLUTION

sirolimus oral tablet Rapamune

tacrolimus oral capsule Prograf

AGENTES OFTÁLMICOS

AGENTES ANTINFLAMATORIOS OFTÁLMICOS

dexamethasone sodium phosphate ophthalmic (eye) drops

diclofenac sodium ophthalmic (eye) drops

fluorometholone ophthalmic (eye) drops,suspension

FML Liquifilm

flurbiprofen sodium ophthalmic (eye) drops

prednisolone acetate ophthalmic (eye) drops,suspension

Omnipred

prednisolone sodium phosphate ophthalmic (eye) drops

XIIDRA OPHTHALMIC (EYE) DROPPERETTE

PA; QL

ANTIBIÓTICO OFTÁLMICO, COMBINACIONES DE CORTICOESTEROIDES

neomycin-bacitracin-poly-hc ophthalmic (eye) ointment

Neo-Polycin HC

neomycin-polymyxin b-dexameth ophthalmic (eye) drops,suspension

Maxitrol

neomycin-polymyxin b-dexameth ophthalmic (eye) ointment

Maxitrol

neomycin-polymyxin-hc ophthalmic (eye) drops,suspension

neo-polycin hc ophthalmic (eye) ointment

35


sulfacetamide-prednisolone ophthalmic (eye) drops

QL

tobramycin-dexamethasone ophthalmic (eye) drops,suspension

TobraDex QL

ANTIBIÓTICOS OFTÁLMICOS

bacitracin ophthalmic (eye) ointment QL

bacitracin-polymyxin b ophthalmic (eye) ointment

Polycin

ciprofloxacin hcl ophthalmic (eye) drops Ciloxan

erythromycin ophthalmic (eye) ointment

gatifloxacin ophthalmic (eye) drops Zymaxid

gentak ophthalmic (eye) ointment QL

gentamicin ophthalmic (eye) drops QL

gentamicin ophthalmic (eye) ointment Gentak QL

levofloxacin ophthalmic (eye) drops

moxifloxacin ophthalmic (eye) drops Vigamox QL

neomycin-bacitracin-polymyxin ophthalmic (eye) ointment

Neo-Polycin QL

neomycin-polymyxin-gramicidin ophthalmic (eye) drops

QL

neo-polycin ophthalmic (eye) ointment QL

ofloxacin ophthalmic (eye) drops Ocuflox QL

polycin ophthalmic (eye) ointment

polymyxin b sulf-trimethoprim ophthalmic (eye) drops

Polytrim QL

sulfacetamide sodium ophthalmic (eye) drops

Bleph-10 QL

sulfacetamide sodium ophthalmic (eye) ointment

QL

tobramycin ophthalmic (eye) drops Tobrex QL

ANTIHISTAMÍNICOS OFTÁLMICOS

azelastine ophthalmic (eye) drops QL

epinastine ophthalmic (eye) drops Elestat QL

ANTIVIRALES OFTÁLMICOS

trifluridine ophthalmic (eye) drops Viroptic QL

DESCONGESTIVOS OFTÁLMICOS

phenylephrine hcl ophthalmic (eye) drops

36


ESTABILIZADORES DE MASTOCITOS OFTÁLMICOS

cromolyn ophthalmic (eye) drops QL

LÁGRIMAS ARTIFICIALES

hypotears ophthalmic (eye) drops OTC

lubricant eye(dextran70-hypml) ophthalmic (eye) dropperette

OTC

MIDRIÁTRICOS

atropine ophthalmic (eye) drops QL

atropine ophthalmic (eye) ointment QL

MIÓTICOS/OTROS REDUCTORES DE PRESIÓN INTRAOCULAR

apraclonidine ophthalmic (eye) drops Iopidine

betaxolol ophthalmic (eye) drops

brimonidine ophthalmic (eye) drops QL

carteolol ophthalmic (eye) drops QL

dorzolamide ophthalmic (eye) drops Trusopt QL

dorzolamide-timolol ophthalmic (eye) drops

Cosopt QL

latanoprost ophthalmic (eye) drops Xalatan QL

levobunolol ophthalmic (eye) drops Betagan

metipranolol ophthalmic (eye) drops QL

pilocarpine hcl ophthalmic (eye) drops Isopto Carpine

timolol maleate ophthalmic (eye) drops Timoptic QL

timolol maleate ophthalmic (eye) gel forming solution

Timoptic-XE QL

ANALGÉSICO, ANTINFLAMATORIO O ANTIPIRÉTICO

ANALGÉSICO/ANTIPIRÉTICOS, SALICILATOS

butalbital-aspirin-caffeine oral capsule Fiorinal QL

butalbital-aspirin-caffeine oral tablet

choline,magnesium salicylate oral liquid

diflunisal oral tablet

salsalate oral tablet Disalcid

ANALGÉSICOS, NARCÓTICOS

acetaminophen-codeine oral solution 120 mg-12 mg /5 ml (5 ml), 120-12 mg/5 ml

PA; AL; QL

37


acetaminophen-codeine oral solution 240 mg-24 mg /10 ml (10 ml), 300 mg-30 mg /12.5 ml

PA; AL

acetaminophen-codeine oral tablet PA; AL; QL

ascomp with codeine oral capsule AL

aspirin-caffeine-dihydrocodein oral capsule

QL

butalbital compound w/codeine oral capsule

AL

butalbital compound-codeine oral capsule AL

butalbital-acetaminop-caf-cod oral capsule AL; QL

butorphanol tartrate nasal spray,non-aerosol

PA; QL

codeine sulfate oral tablet 15 mg, 30 mg AL

codeine sulfate oral tablet 60 mg AL; QL

codeine-butalbital-asa-caff oral capsule Ascomp with Codeine AL

diskets oral tablet,soluble QL

endocet oral tablet 10-325 mg, 5-325 mg

endocet oral tablet 7.5-325 mg QL

fentanyl citrate buccal lozenge on a handle

Actiq PA; QL

fentanyl transdermal patch 72 hour Duragesic PA; QL

hydrocodone-acetaminophen oral solution Hycet PA; QL

hydrocodone-acetaminophen oral tablet Lorcet (hydrocodone) PA; QL

hydrocodone-ibuprofen oral tablet PA; QL

hydromorphone oral liquid Dilaudid QL

hydromorphone oral tablet 2 mg, 4 mg Dilaudid

hydromorphone oral tablet 8 mg Dilaudid QL

hydromorphone rectal suppository QL

meperidine oral solution QL

meperidine oral tablet 100 mg Demerol QL

meperidine oral tablet 50 mg

methadone intensol oral concentrate PA; QL

methadone oral concentrate Methadone Intensol PA; QL

methadone oral solution PA; QL

methadone oral tablet Dolophine PA; QL

methadone oral tablet,soluble Diskets PA; QL

methadose oral concentrate PA; QL

38


methadose oral tablet,soluble PA; QL

morphine concentrate oral solution QL

morphine oral solution QL

morphine oral tablet QL

morphine oral tablet extended release MS Contin PA; QL

morphine rectal suppository QL

oxycodone oral capsule QL

oxycodone oral concentrate QL

oxycodone oral solution QL

oxycodone oral tablet Roxicodone QL

oxycodone-acetaminophen oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg

Endocet

oxycodone-acetaminophen oral tablet 7.5-325 mg

Endocet QL

oxycodone-aspirin oral tablet QL

pentazocine-naloxone oral tablet QL

tramadol oral tablet Ultram PA; AL; QL

tramadol-acetaminophen oral tablet Ultracet PA; AL; QL

vicodin es oral tablet PA; QL

vicodin hp oral tablet PA; QL

vicodin oral tablet PA; QL

zamicet oral solution QL

ANALGÉSICOS, NO NARCÓTICOS

acetaminophen oral liquid OTC

acetaminophen oral tablet,disintegrating Children's Pain-Fever Relief OTC

butalbital-acetaminophen oral tablet Tencon QL

butalbital-acetaminophen-caff oral capsule Capacet QL

butalbital-acetaminophen-caff oral tablet Esgic QL

capacet oral capsule QL

marten-tab oral tablet QL

non-aspirin pain relief oral tablet OTC

tencon oral tablet QL

ANTINFLAMATORIO, INHIBIDOR DE LA SÍNTESIS DE PIRIMIDINA

leflunomide oral tablet Arava

RIDAURA ORAL CAPSULE

39


FÁRMACOS ANTIRREUMÁTICOS MODIFICADORES DE LA ENFERMEDAD (FARME)

DEPEN TITRATABS ORAL TABLET PA

minocycline oral capsule Minocin

minocycline oral tablet

sulfasalazine oral tablet Azulfidine QL

sulfasalazine oral tablet,delayed release (dr/ec)

Azulfidine EN-tabs QL

INHIBIDOR DEL FACTOR DE LA NECROSIS TUMORAL ANTINFLAMATORIA

ENBREL MINI SUBCUTANEOUS CARTRIDGE

PA; QL

ENBREL SUBCUTANEOUS RECON SOLN

PA; QL

ENBREL SUBCUTANEOUS SYRINGE PA; QL

ENBREL SURECLICK SUBCUTANEOUS PEN INJECTOR

PA; QL


PA; QL


PA; QL


PA; QL


PA; QL


PA; QL

INHIBIDOR DEL FACTOR DE NECROSIS TUMORAL ANTINFLAMATORIO

ENBREL MINI SUBCUTANEOUS CARTRIDGE

PA; QL

ENBREL SUBCUTANEOUS RECON SOLN

PA; QL

ENBREL SUBCUTANEOUS SYRINGE PA; QL

ENBREL SURECLICK SUBCUTANEOUS PEN INJECTOR

PA; QL


PA; QL

40



PA; QL


PA; QL


PA; QL


PA; QL

INMUNOSUPRESORES

cyclosporine modified oral capsule Gengraf

cyclosporine modified oral solution Gengraf

cyclosporine oral capsule Sandimmune

gengraf oral capsule

gengraf oral solution

mycophenolate mofetil oral suspension for reconstitution

CellCept

SANDIMMUNE ORAL SOLUTION

NSAIDS

diclofenac potassium oral tablet

diclofenac sodium oral tablet extended release 24 hr

Voltaren-XR PA

diclofenac sodium oral tablet,delayed release (dr/ec)

etodolac oral capsule

etodolac oral tablet Lodine

etodolac oral tablet extended release 24 hr

fenoprofen oral tablet ProFeno QL

flurbiprofen oral tablet

ibu oral tablet

ibuprofen oral suspension Child Ibuprofen OTC; QL

ibuprofen oral tablet IBU

indomethacin oral capsule

indomethacin oral capsule, extended release

ketoprofen oral capsule

ketoprofen oral capsule,ext rel. pellets 24 hr

QL

ketorolac oral tablet QL

41


meclofenamate oral capsule QL

meloxicam oral suspension

meloxicam oral tablet 15 mg Mobic

meloxicam oral tablet 7.5 mg Mobic PA

nabumetone oral tablet

naproxen oral suspension Naprosyn PA

naproxen oral tablet

naproxen oral tablet,delayed release (dr/ec)

EC-Naprosyn PA

naproxen sodium oral tablet Anaprox DS

oxaprozin oral tablet Daypro

piroxicam oral capsule Feldene PA

profeno oral tablet QL

sulindac oral tablet

tolmetin oral capsule

tolmetin oral tablet

ANESTÉSICOS

ANESTÉSICOS LOCALES

lidocaine hcl laryngotracheal solution LTA Pre-Attached QL

lidocaine topical ointment QL

ANTICONCEPTIVOS

ANTICONCEPTIVOS DE EMERGENCIA

ELLA ORAL TABLET

ANTICONCEPTIVOS

altavera (28) oral tablet AL; QL

alyacen 1/35 (28) oral tablet AL

alyacen 7/7/7 (28) oral tablet AL

amethia lo oral tablets,dose pack,3 month AL; QL

amethia oral tablets,dose pack,3 month AL; QL

amethyst oral tablet AL

apri oral tablet AL

aranelle (28) oral tablet AL

ashlyna oral tablets,dose pack,3 month AL; QL

aubra oral tablet AL

aviane oral tablet AL

azurette (28) oral tablet AL

42


balziva (28) oral tablet AL

bekyree (28) oral tablet AL

blisovi 24 fe oral tablet AL

blisovi fe 1.5/30 (28) oral tablet AL

blisovi fe 1/20 (28) oral tablet AL

briellyn oral tablet AL

camila oral tablet AL

camrese lo oral tablets,dose pack,3 month AL; QL

camrese oral tablets,dose pack,3 month AL; QL

caziant (28) oral tablet AL

chateal oral tablet AL; QL

cryselle (28) oral tablet AL

cyclafem 1/35 (28) oral tablet AL

cyclafem 7/7/7 (28) oral tablet AL

cyred oral tablet AL

dasetta 1/35 (28) oral tablet AL

dasetta 7/7/7 (28) oral tablet AL

daysee oral tablets,dose pack,3 month AL; QL

deblitane oral tablet AL

delyla (28) oral tablet AL

desog-e.estradiol/e.estradiol oral tablet Azurette (28) AL

desogestrel-ethinyl estradiol oral tablet Apri AL

drospirenone-e.estradiol-lm.fa oral tablet Beyaz AL

drospirenone-ethinyl estradiol oral tablet Ocella AL

elinest oral tablet AL

emoquette oral tablet AL

enpresse oral tablet AL

enskyce oral tablet AL

errin oral tablet AL

estarylla oral tablet AL

ethynodiol diac-eth estradiol oral tablet Kelnor 1/35 (28) AL

falmina (28) oral tablet AL

fayosim oral tablets,dose pack,3 month AL; QL

femynor oral tablet AL

gianvi (28) oral tablet AL

gildagia oral tablet AL

heather oral tablet AL

43


introvale oral tablets,dose pack,3 month AL; QL

isibloom oral tablet AL

jencycla oral tablet AL

jolessa oral tablets,dose pack,3 month AL; QL

jolivette oral tablet AL

juleber oral tablet AL

junel 1.5/30 (21) oral tablet AL

junel 1/20 (21) oral tablet AL

junel fe 1.5/30 (28) oral tablet AL

junel fe 1/20 (28) oral tablet AL

junel fe 24 oral tablet AL

kaitlib fe oral tablet,chewable AL

kariva (28) oral tablet AL

kelnor 1/35 (28) oral tablet AL

kelnor 1-50 oral tablet

kimidess (28) oral tablet AL

kurvelo oral tablet AL; QL

KYLEENA INTRAUTERINE INTRAUTERINE DEVICE

l norgest/e.estradiol-e.estrad oral tablets,dose pack,3 month

Amethia AL; QL

larin 1.5/30 (21) oral tablet AL

larin 1/20 (21) oral tablet AL

larin 24 fe oral tablet AL

larin fe 1.5/30 (28) oral tablet AL

larin fe 1/20 (28) oral tablet AL

larissia oral tablet AL

layolis fe oral tablet,chewable AL

leena 28 oral tablet AL

lessina oral tablet AL

levonest (28) oral tablet AL

levonorgestrel-ethinyl estrad oral tablet 0.1-20 mg-mcg

Aubra AL

levonorgestrel-ethinyl estrad oral tablet 0.15-0.03 mg

Altavera (28) AL; QL

levonorgestrel-ethinyl estrad oral tablet 90-20 mcg

Amethyst AL

44


levonorgestrel-ethinyl estrad oral tablets,dose pack,3 month

Introvale AL; QL

levonorg-eth estrad triphasic oral tablet Enpresse AL

levora 0.15/30 (28) oral tablet AL; QL

levora-28 oral tablet AL; QL

LILETTA INTRAUTERINE INTRAUTERINE DEVICE

lillow oral tablet AL; QL

lomedia 24 fe oral tablet AL

loryna (28) oral tablet AL

low-ogestrel (28) oral tablet AL

lutera (28) oral tablet AL

lyza oral tablet AL

marlissa oral tablet AL; QL

medroxyprogesterone intramuscular suspension

Depo-Provera AL; QL

medroxyprogesterone intramuscular syringe

Depo-Provera AL; QL

melodetta 24 fe oral tablet,chewable AL

mibelas 24 fe oral tablet,chewable AL

microgestin 1.5/30 (21) oral tablet AL

microgestin 1/20 (21) oral tablet AL

microgestin fe 1.5/30 (28) oral tablet AL

microgestin fe 1/20 (28) oral tablet AL

MIRENA INTRAUTERINE INTRAUTERINE DEVICE

mono-linyah oral tablet AL

mononessa (28) oral tablet AL

myzilra oral tablet AL

necon 0.5/35 (28) oral tablet AL

necon 1/50 (28) oral tablet AL

necon 10/11 (28) oral tablet AL

necon 7/7/7 (28) oral tablet AL

NEXPLANON SUBDERMAL IMPLANT

nikki (28) oral tablet AL

nora-be oral tablet AL

noreth-ethinyl estradiol-iron oral tablet,chewable

Wymzya Fe AL

45


norethindrone (contraceptive) oral tablet Camila AL

norethindrone ac-eth estradiol oral tablet Junel 1/20 (21) AL

norethindrone-e.estradiol-iron oral tablet Blisovi Fe 1/20 (28) AL

norethindrone-e.estradiol-iron oral tablet,chewable

Melodetta 24 Fe AL

norgestimate-ethinyl estradiol oral tablet 0.18/0.215/0.25 mg-25 mcg

Ortho Tri-Cyclen LO (28) AL; QL

norgestimate-ethinyl estradiol oral tablet 0.18/0.215/0.25 mg-35 mcg (28)

Ortho Tri-Cyclen (28) AL

norgestimate-ethinyl estradiol oral tablet 0.25-35 mg-mcg

Estarylla AL

norgestrel-ethinyl estradiol oral tablet Ogestrel (28) AL

norlyda oral tablet AL

norlyroc oral tablet AL

nortrel 0.5/35 (28) oral tablet AL

nortrel 1/35 (21) oral tablet AL

nortrel 1/35 (28) oral tablet AL

nortrel 7/7/7 (28) oral tablet AL

NUVARING VAGINAL RING AL; QL

ocella oral tablet AL

ogestrel (28) oral tablet AL

orsythia oral tablet AL

PARAGARD T 380A INTRAUTERINE INTRAUTERINE DEVICE

philith oral tablet AL

pimtrea (28) oral tablet AL

pirmella oral tablet AL

portia oral tablet AL; QL

previfem oral tablet AL

quasense oral tablets,dose pack,3 month AL; QL

rajani oral tablet AL

reclipsen (28) oral tablet AL

RIVELSA ORAL TABLETS,DOSE PACK,3 MONTH

AL; QL

setlakin oral tablets,dose pack,3 month AL; QL

sharobel oral tablet AL

SKYLA INTRAUTERINE INTRAUTERINE DEVICE

sprintec (28) oral tablet AL

46


sronyx oral tablet AL

syeda oral tablet AL

tarina fe 1/20 (28) oral tablet AL

tilia fe oral tablet AL; QL

tri femynor oral tablet AL

tri-estarylla oral tablet AL

tri-legest fe oral tablet AL; QL

tri-linyah oral tablet AL

tri-lo-estarylla oral tablet AL; QL

tri-lo-marzia oral tablet AL; QL

tri-lo-sprintec oral tablet AL; QL

trinessa (28) oral tablet AL

trinessa lo oral tablet AL; QL

tri-previfem (28) oral tablet AL

tri-sprintec (28) oral tablet AL

trivora (28) oral tablet AL

tri-vylibra oral tablet AL

tydemy oral tablet AL

velivet triphasic regimen (28) oral tablet AL

vestura (28) oral tablet AL

vienva oral tablet AL

viorele (28) oral tablet AL

vyfemla (28) oral tablet AL

vylibra oral tablet AL

wera (28) oral tablet AL

wymzya fe oral tablet,chewable AL

xulane transdermal patch weekly AL; QL

zarah oral tablet AL

zenchent (28) oral tablet AL

zenchent fe oral tablet,chewable AL

zovia 1/35e (28) oral tablet AL

zovia 1/50e (28) oral tablet AL

ANTÍDOTOS Y OTROS AGENTES DE REVERSIÓN

AGENTES QUELANTES

deferoxamine injection recon soln Desferal

DEPEN TITRATABS ORAL TABLET PA

47


trientine oral capsule Syprine PA; QL

ANTAGONISTAS DE NARCÓTICOS

naloxone injection solution QL

naloxone injection syringe QL

naltrexone oral tablet

NARCAN NASAL SPRAY,NON-AEROSOL

QL

ANTÍDOTOS

acetylcysteine solution

ANTINEOPLÁSICOS

MEDICAMENTOS ANTINEOPLÁSICOS/INMUNOSUPRESORES

anastrozole oral tablet Arimidex QL

bicalutamide oral tablet Casodex

EMCYT ORAL CAPSULE PA

exemestane oral tablet Aromasin QL

flutamide oral capsule

HEXALEN ORAL CAPSULE PA

hydroxyurea oral capsule Hydrea

imatinib oral tablet Gleevec PA; QL

IRESSA ORAL TABLET PA; QL

letrozole oral tablet Femara QL

leucovorin calcium injection recon soln

leucovorin calcium oral tablet

megestrol oral tablet

melphalan oral tablet Alkeran

MESNEX ORAL TABLET PA

MYLERAN ORAL TABLET

PROLEUKIN INTRAVENOUS RECON SOLN

tamoxifen oral tablet

tretinoin (chemotherapy) oral capsule

VANTAS IMPLANT KIT PA

VELCADE INJECTION RECON SOLN PA

48


BIOLÓGICOS

INMUNOGLOBULINAS

GAMUNEX-C INJECTION SOLUTION PA

OCTAGAM INTRAVENOUS SOLUTION PA

VACUNAS INMUNOLÓGICAS

AFLURIA 2016-2017 (PF) INTRAMUSCULAR SYRINGE

AFLURIA 2016-2017 INTRAMUSCULAR SUSPENSION

AFLURIA 2017-2018 (PF) INTRAMUSCULAR SYRINGE

QL

AFLURIA 2017-2018 INTRAMUSCULAR SUSPENSION

QL

AFLURIA QUAD 2016-2017 (PF) INTRAMUSCULAR SYRINGE

AFLURIA QUAD 2017-2018 (PF) INTRAMUSCULAR SYRINGE

QL

AFLURIA QUAD 2017-2018 INTRAMUSCULAR SUSPENSION

QL

CERVARIX VACCINE (PF) INTRAMUSCULAR SYRINGE

EZ FLU 2016-17 (AFLURIA) (PF) INTRAMUSCULAR SYRINGE KIT

EZ FLU 2016-17 (FLUVIRIN) (PF) INTRAMUSCULAR SYRINGE KIT

EZ FLU16-17(FLUZON QD PED)(PF) INTRAMUSCULAR SYRINGE KIT

FLUAD 2016-2017 (65 YR UP)(PF) INTRAMUSCULAR SYRINGE

FLUAD 2017-2018 (65 YR UP)(PF) INTRAMUSCULAR SYRINGE

QL

FLUARIX QUAD 2016-2017 (PF) INTRAMUSCULAR SYRINGE

FLUARIX QUAD 2017-2018 (PF) INTRAMUSCULAR SYRINGE

QL

FLUBLOK 2016-2017 (PF) INTRAMUSCULAR SOLUTION

FLUBLOK 2017-2018 (PF) INTRAMUSCULAR SOLUTION

QL

FLUBLOK QUAD 2017-2018 (PF) INTRAMUSCULAR SYRINGE

QL

49


FLUCELVAX QUAD 2016-2017 (PF) INTRAMUSCULAR SYRINGE

FLUCELVAX QUAD 2017-2018 (PF) INTRAMUSCULAR SYRINGE

QL

FLUCELVAX QUAD 2017-2018 INTRAMUSCULAR SUSPENSION

QL

FLULAVAL QUAD 2016-2017 (PF) INTRAMUSCULAR SYRINGE

FLULAVAL QUAD 2016-2017 INTRAMUSCULAR SUSPENSION

FLULAVAL QUAD 2017-2018 (PF) INTRAMUSCULAR SYRINGE

QL

FLULAVAL QUAD 2017-2018 INTRAMUSCULAR SUSPENSION

QL

FLUVIRIN 2016-2017 (PF) INTRAMUSCULAR SYRINGE

FLUVIRIN 2016-2017 INTRAMUSCULAR SUSPENSION

FLUVIRIN 2017-2018 (PF) INTRAMUSCULAR SYRINGE

QL

FLUVIRIN 2017-2018 INTRAMUSCULAR SUSPENSION

QL

FLUZONE HIGH-DOSE 2016-17 (PF) INTRAMUSCULAR SYRINGE

FLUZONE HIGH-DOSE 2017-18 (PF) INTRAMUSCULAR SYRINGE

QL

FLUZONE INTRADERM QUAD 2016-17 INTRADERMAL SYRINGE

FLUZONE INTRADERM QUAD 2017-18 INTRADERMAL SYRINGE

QL

FLUZONE QUAD 2016-2017 (PF) INTRAMUSCULAR SUSPENSION

FLUZONE QUAD 2016-2017 (PF) INTRAMUSCULAR SYRINGE

FLUZONE QUAD 2016-2017 INTRAMUSCULAR SUSPENSION

FLUZONE QUAD 2017-2018 (PF) INTRAMUSCULAR SUSPENSION

QL

FLUZONE QUAD 2017-2018 (PF) INTRAMUSCULAR SYRINGE

QL

FLUZONE QUAD 2017-2018 INTRAMUSCULAR SUSPENSION

QL

50


FLUZONE QUAD PEDI 2016-17 (PF) INTRAMUSCULAR SYRINGE

FLUZONE QUAD PEDI 2017-18 (PF) INTRAMUSCULAR SYRINGE

QL

GARDASIL (PF) INTRAMUSCULAR SUSPENSION

GARDASIL 9 (PF) INTRAMUSCULAR SUSPENSION

GARDASIL 9 (PF) INTRAMUSCULAR SYRINGE

PREVNAR 13 (PF) INTRAMUSCULAR SYRINGE

SYNAGIS INTRAMUSCULAR SOLUTION

PA

DEPENDENCIA QUÍMICA, AGENTES PARA TRATAMIENTO

AGENTES PARA DEJAR DE FUMAR

bupropion hcl (smoking deter) oral tablet extended release 12 hr

Zyban QL


Wellbutrin SR

ANTAGONISTA DEL ALCOHOL

acamprosate oral tablet,delayed release (dr/ec)

QL

disulfiram oral tablet Antabuse

ANTAGONISTAS DE NARCÓTICOS

buprenorphine hcl sublingual tablet QL

buprenorphine-naloxone sublingual tablet PA; QL

SUBOXONE SUBLINGUAL FILM PA; QL

DERMATOLÓGICO

AGENTES ANTIACNÉ, TÓPICOS

benzoyl peroxide topical cleanser OTC; QL

clindamycin phosphate topical gel Cleocin T

clindamycin phosphate topical solution Cleocin T QL

clindamycin phosphate topical swab Cleocin T QL

clindamycin-benzoyl peroxide topical gel Duac QL

ery pads topical swab QL

erygel topical gel QL

erythromycin with ethanol topical solution QL

51


erythromycin with ethanol topical swab Ery Pads QL

metronidazole topical cream MetroCream QL

metronidazole topical lotion MetroLotion

rosadan topical cream QL

AGENTES ANTINFLAMATORIOS ESTEROIDES TÓPICOS

amcinonide topical lotion

amcinonide topical ointment QL

betamethasone dipropionate topical lotion QL

betamethasone valerate topical cream QL

betamethasone valerate topical ointment QL

betamethasone, augmented topical cream

clobetasol scalp solution Cormax QL

clobetasol topical cream Temovate QL

clobetasol topical gel

clobetasol topical ointment Temovate QL

clobetasol-emollient topical cream QL

cormax scalp solution QL

CORTAID TOPICAL CREAM OTC; QL

diflorasone topical cream Psorcon QL

fluocinonide-e topical cream

fluocinonide-emollient topical cream Fluocinonide-E

fluticasone topical cream Cutivate QL

fluticasone topical ointment QL

halobetasol propionate topical cream Ultravate QL

halobetasol propionate topical ointment Ultravate QL

hydrocortisone 1% ointment (rx) Anti-Itch (HC) OTC

hydrocortisone topical cream 1 % Ala-Cort PA; OTC; QL

hydrocortisone topical cream 2.5 % Ala-Cort QL

hydrocortisone topical cream with perineal applicator

Anusol-HC QL

hydrocortisone topical ointment 2.5 % QL

hydrocortisone-pramoxine topical cream Pramosone

mometasone topical cream Elocon QL

mometasone topical ointment Elocon QL

mometasone topical solution QL

prednicarbate topical ointment Dermatop QL

52


proctosol hc topical cream with perineal applicator

QL

proctozone-hc topical cream with perineal applicator

QL

TEXACORT TOPICAL SOLUTION

triamcinolone acetonide topical cream Triderm QL

triamcinolone acetonide topical ointment QL

trianex topical ointment QL

triderm topical cream QL

AGENTES ANTIPSORIÁSICOS

calcipotriene scalp solution QL

calcipotriene topical cream Dovonex QL

calcipotriene topical ointment Calcitrene

calcitrene topical ointment

AGENTES PARA ROSÁCEA, TÓPICOS

metronidazole topical gel 0.75 % Rosadan

metronidazole topical gel 1 % Metrogel QL

metronidazole topical gel with pump Metrogel QL

rosadan topical gel

AGENTES SISTÉMICOS CONTRA EL ACNÉ

claravis oral capsule PA

myorisan oral capsule PA

zenatane oral capsule PA

AGENTES TÓPICOS, VARIOS

aluminum chloride topical solution Drysol

ammonium lactate topical cream Geri-Hydrolac OTC; QL

ammonium lactate topical lotion AmLactin OTC

diclofenac sodium topical drops PA; QL

lidocaine hcl mucous membrane jelly

lidocaine topical adhesive patch,medicated

Lidoderm PA; QL

lidocaine topical ointment QL

nivatopic plus topical cream

podofilox topical solution PA

prumyx topical cream

remeven topical cream

53


salacyn topical cream

salacyn topical lotion

salicylic acid topical cream Salimez

salicylic acid topical cream,extended release

salicylic acid topical film forming liquid w/appl

Virasal

salicylic acid topical film-forming soln er w/ appl

UltraSal-ER

salicylic acid topical foam Salvax

salicylic acid topical gel Keralyt Rx

salicylic acid topical liquid

salicylic acid topical lotion

salicylic acid topical lotion,extended release

salicylic acid topical shampoo Salex

salvax topical foam

selenium sulfide topical lotion QL

selenium sulfide topical shampoo

silver sulfadiazine topical cream Silvadene

ssd topical cream

thermazene topical cream

urea topical cream 40 % QL

urea topical cream 45 % Uramaxin QL

urea topical cream 50 % Ure-K

urea topical gel 40 % QL

urea topical gel 45 % CEM-Urea

urea topical lotion Uramaxin

ANESTÉSICOS TÓPICOS

hydrocortisone-pramoxine topical cream Pramosone

lidocaine-prilocaine topical cream QL

ANTIBIÓTICOS TÓPICOS

gentamicin topical cream

gentamicin topical ointment

mupirocin topical ointment Centany QL

sss 10-5 topical cream

sulfacetamide sodium-sulfur topical cream Avar-E

54


ANTIMICÓTICOS TÓPICOS

ciclopirox topical cream Ciclodan PA; QL

ciclopirox topical solution Ciclodan PA; QL

ciclopirox topical suspension Loprox (as olamine) QL

clotrimazole topical cream Antifungal (clotrimazole) OTC; QL

clotrimazole topical solution OTC

clotrimazole-betamethasone topical cream Lotrisone QL

clotrimazole-betamethasone topical lotion QL

FUNGI-NAIL TOPICAL TINCTURE OTC

ketoconazole topical cream QL

ketoconazole topical shampoo Nizoral QL

nyamyc topical powder QL

nyata topical powder QL

nystatin topical cream QL

nystatin topical ointment QL

nystatin topical powder Nyamyc QL

nystop topical powder QL

ANTIVIRALES TÓPICOS

acyclovir topical ointment Zovirax PA; QL

DERIVADOS DE LA VITAMINA A

adapalene topical cream Differin PA; QL

adapalene topical gel Differin PA; QL

tretinoin (emollient) topical cream Refissa PA; AL

tretinoin microspheres topical gel Retin-A Micro PA; AL; QL

tretinoin topical cream Retin-A PA

tretinoin topical gel Retin-A PA; QL

ESCABICIDAS Y PEDICULICIDAS

permethrin topical cream Elimite QL

spinosad topical suspension Natroba

INMUNOMODULADORES TÓPICOS

imiquimod topical cream in packet Aldara PA; QL

tacrolimus topical ointment Protopic PA; QL

TÓPICO ANTINEOPLÁSICO Y PREMALIGNO

fluorouracil topical cream Efudex QL

fluorouracil topical solution QL

55


DISPOSITIVOS CON Y SIN AGUJAS, JERINGAS Y ACCESORIOS

AGUJAS, DISPOSITIVOS SIN AGUJAS, JERINGAS Y ACCESORIOS

ADVOCATE SYRINGES SYRINGE OTC; QL

ASSURE ID INSULIN SAFETY SYRINGE OTC; QL

BD ECLIPSE LUER-LOK SYRINGE OTC; QL

BD INSULIN SYRINGE HALF UNIT SYRINGE

OTC; QL

BD INSULIN SYRINGE MICRO-FINE SYRINGE

OTC; QL

BD INSULIN SYRINGE SAFETY-LOK SYRINGE

OTC; QL

BD INSULIN SYRINGE SYRINGE OTC; QL

BD INSULIN SYRINGE ULTRA-FINE SYRINGE

OTC; QL

BD LO-DOSE MICRO-FINE IV SYRINGE OTC; QL

BD LO-DOSE ULTRA-FINE SYRINGE OTC; QL

BD SAFETYGLIDE INSULIN SYRINGE SYRINGE

OTC; QL

BD SAFETYGLIDE SYRINGE SYRINGE OTC; QL

BD ULTRA-FINE SHORT PEN NEEDLE NEEDLE

OTC; QL

BD VEO INSULIN SYR HALF UNIT SYRINGE

OTC

BD VEO INSULIN SYRINGE UF SYRINGE

OTC

COMFORT EZ SYRINGE SYRINGE OTC; QL

EASY COMFORT INSULIN SYRINGE SYRINGE

OTC; QL

EASY TOUCH INSULIN SAFETY SYR SYRINGE

OTC; QL

EASY TOUCH INSULIN SYRINGE SYRINGE

OTC; QL

EXEL INSULIN SYRINGE OTC; QL

FREESTYLE PRECISION SYRINGE OTC; QL

insulin syringe microfine syringe OTC; QL

insulin syringe needleless syringe BD Insulin Syringe Slip Tip OTC; QL

insulin syringe syringe OTC; QL

56


insulin syringe-needle u-100 syringe Advocate Syringes OTC; QL

insulin syringes (disposable) syringe Monoject Insulin Syringe OTC; QL

LITE TOUCH INSULIN SYRINGE SYRINGE

OTC; QL

MAXI-COMFORT INSULIN SYRINGE SYRINGE

OTC; QL

MONOJECT INSULIN SAFETY SYRING SYRINGE 0.3 ML 29 GAUGE X 1/2"

OTC; QL

MONOJECT INSULIN SAFETY SYRING SYRINGE 0.3 ML 30 GAUGE X 5/16, 0.5 ML 29 GAUGE X 1/2", 1/2 ML 30 GAUGE X 5/16

QL

MONOJECT INSULIN SYRINGE SYRINGE

OTC; QL

MONOJECT SAFETY SYRINGES SYRINGE

OTC

MONOJECT SYRINGE SYRINGE QL

pen needle 31g x 3/16" (rx) OTC; QL

PEN NEEDLE 31G X 5/16" (RX) OTC; QL

pen needle needle 30 gauge x 5/16" QL

PRODIGY INSULIN SYRINGE SYRINGE OTC; QL

SURE COMFORT INS. SYR. U-100 SYRINGE

OTC; QL

SURE COMFORT INSULIN SYRINGE SYRINGE

OTC; QL

SURE-JECT INSULIN SYRINGE SYRINGE

OTC; QL

TERUMO INSULIN SYRINGE SYRINGE OTC; QL

THINPRO INSULIN SYRINGE SYRINGE OTC; QL

TOPCARE ULTRA COMFORT SYRINGE OTC; QL

TRUEPLUS INSULIN SYRINGE OTC; QL

ULTICARE SYRINGE OTC; QL

ULTILET INSULIN SYRINGE SYRINGE OTC; QL

ULTRA CMFT INS SYR HALF UNIT SYRINGE

OTC; QL

ULTRA COMFORT INSULIN SYRINGE SYRINGE

OTC; QL

ULTRA-THIN II (SHORT) INS SYR SYRINGE

OTC; QL

ULTRA-THIN II INSULIN SYRINGE SYRINGE

OTC; QL

57


VANISHPOINT SYRINGE SYRINGE OTC; QL

DIAFRAGMAS/CAPUCHÓN CERVICAL

WIDE-SEAL DIAPHRAGM 60 VAGINAL DIAPHRAGM








DISPOSITIVOS CON Y SIN AGUJAS, JERINGAS Y ACCESORIOS

ACE AEROSOL CLOUD ENHANCER SPACER

QL

ADVOCATE SYRINGES SYRINGE OTC; QL

AEROTRACH PLUS SPACER QL

AEROVENT PLUS SPACER QL

ASSURE ID INSULIN SAFETY SYRINGE OTC; QL

BD ECLIPSE LUER-LOK SYRINGE OTC; QL

BD INSULIN SYRINGE HALF UNIT SYRINGE

OTC; QL

BD INSULIN SYRINGE MICRO-FINE SYRINGE

OTC; QL

BD INSULIN SYRINGE SAFETY-LOK SYRINGE

OTC; QL

BD INSULIN SYRINGE SYRINGE OTC; QL

BD INSULIN SYRINGE ULTRA-FINE SYRINGE

OTC; QL

BD LO-DOSE MICRO-FINE IV SYRINGE OTC; QL

BD LO-DOSE ULTRA-FINE SYRINGE OTC; QL

BD SAFETYGLIDE INSULIN SYRINGE SYRINGE

OTC; QL

58


BD SAFETYGLIDE SYRINGE SYRINGE OTC; QL

BD ULTRA-FINE SHORT PEN NEEDLE NEEDLE

OTC; QL

BD VEO INSULIN SYR HALF UNIT SYRINGE

OTC

BD VEO INSULIN SYRINGE UF SYRINGE

OTC

BREATHERITE MDI SPACER SPACER QL

BREATHERITE SPACER-MASK, NEO. SPACER

QL

BREATHERITE SPACER-MASK,ADULT SPACER

QL

BREATHERITE SPACER-MASK,CHILD SPACER

QL

BREATHERITE SPACER-MASK,INFANT SPACER

QL

BREATHERITE SPACER-MASK,S.CHLD SPACER

QL

BREATHERITE VALVED MDI CHAMBER SPACER

QL

BREATHERITE VALVED MDI SPACER SPACER

QL

BREATHERITE WITH MASK, LARGE SPACER

QL

BREATHERITE WITH MASK, MEDIUM SPACER

QL

BREATHERITE WITH MASK, SMALL SPACER

QL

COMFORT EZ SYRINGE SYRINGE OTC; QL

COMPACT SPACE CHAMBER SPACER QL

COMPACT SPACE CHAMBER-LRG MASK SPACER

QL

COMPACT SPACE CHAMBER-MED MASK SPACER

QL

COMPACT SPACE CHAMBER-SM MASK SPACER

QL

EASIVENT MASK LARGE DEVICE QL

EASIVENT MASK MEDIUM DEVICE QL

EASIVENT MASK SMALL DEVICE QL

EASY COMFORT INSULIN SYRINGE SYRINGE

OTC; QL

59


EASY TOUCH INSULIN SAFETY SYR SYRINGE

OTC; QL

EASY TOUCH INSULIN SYRINGE SYRINGE

OTC; QL

EXEL INSULIN SYRINGE OTC; QL

FREESTYLE PRECISION SYRINGE OTC; QL

insulin syringe microfine syringe OTC; QL

insulin syringe needleless syringe BD Insulin Syringe Slip Tip OTC; QL

insulin syringe syringe OTC; QL

insulin syringe-needle u-100 syringe Advocate Syringes OTC; QL

insulin syringes (disposable) syringe Monoject Insulin Syringe OTC; QL

LITE TOUCH INSULIN SYRINGE SYRINGE

OTC; QL

LITEAIRE MDI CHAMBER SPACER QL

MAXI-COMFORT INSULIN SYRINGE SYRINGE

OTC; QL

MICROCHAMBER SPACER QL

MICROSPACER SPACER QL

MINI WRIGHT PEAK FLOW METER DEVICE

MONOJECT INSULIN SAFETY SYRING SYRINGE 0.3 ML 29 GAUGE X 1/2"

OTC; QL

MONOJECT INSULIN SAFETY SYRING SYRINGE 0.3 ML 30 GAUGE X 5/16, 0.5 ML 29 GAUGE X 1/2", 1/2 ML 30 GAUGE X 5/16

QL

MONOJECT INSULIN SYRINGE SYRINGE

OTC; QL

MONOJECT SAFETY SYRINGES SYRINGE

OTC

MONOJECT SYRINGE SYRINGE QL

OPTICHAMBER ADULT MASK-LARGE DEVICE

QL

OPTICHAMBER DIAMOND LG MASK SPACER

QL

OPTICHAMBER DIAMOND VHC SPACER

QL

OPTICHAMBER DIAMOND-MED MSK SPACER

QL

OPTICHAMBER DIAMOND-SML MASK SPACER

QL

60


pen needle 31g x 3/16" (rx) OTC; QL

PEN NEEDLE 31G X 5/16" (RX) OTC; QL

pen needle needle 30 gauge x 5/16" QL

POCKET CHAMBER SPACER QL

PRIMEAIRE SPACER QL

PROCHAMBER SPACER QL

PRODIGY INSULIN SYRINGE SYRINGE OTC; QL

RITEFLO AEROCHAMBER SPACER QL

SURE COMFORT INS. SYR. U-100 SYRINGE

OTC; QL

SURE COMFORT INSULIN SYRINGE SYRINGE

OTC; QL

SURE-JECT INSULIN SYRINGE SYRINGE

OTC; QL

TERUMO INSULIN SYRINGE SYRINGE OTC; QL

THINPRO INSULIN SYRINGE SYRINGE OTC; QL

TOPCARE ULTRA COMFORT SYRINGE OTC; QL

TRUEPLUS INSULIN SYRINGE OTC; QL

TRUZONE PEAK FLOW METER DEVICE

ULTICARE SYRINGE OTC; QL

ULTILET INSULIN SYRINGE SYRINGE OTC; QL

ULTRA CMFT INS SYR HALF UNIT SYRINGE

OTC; QL

ULTRA COMFORT INSULIN SYRINGE SYRINGE

OTC; QL

ULTRA-THIN II (SHORT) INS SYR SYRINGE

OTC; QL

ULTRA-THIN II INSULIN SYRINGE SYRINGE

OTC; QL

UNISTIK 2 EXTRA KIT OTC; QL

VANISHPOINT SYRINGE SYRINGE OTC; QL

VORTEX HOLDING CHAMBER CHILD SPACER

QL

VORTEX HOLDING CHAMBER SPACER

QL

VORTEX HOLDING CHAMBER TODDLER SPACER

QL

VORTEX VHC FROG MASK-CHILD SPACER

QL

61


VORTEX VHC LADYBUG MASK-TODDLR SPACER

QL









EQUIPOS, DISPOSITIVOS, ESPACIADORES Y AUXILIARES RESPIRATORIOS

ACE AEROSOL CLOUD ENHANCER SPACER

QL

AEROTRACH PLUS SPACER QL

AEROVENT PLUS SPACER QL

BREATHERITE MDI SPACER SPACER QL

BREATHERITE SPACER-MASK, NEO. SPACER

QL

BREATHERITE SPACER-MASK,ADULT SPACER

QL

BREATHERITE SPACER-MASK,CHILD SPACER

QL

BREATHERITE SPACER-MASK,INFANT SPACER

QL

BREATHERITE SPACER-MASK,S.CHLD SPACER

QL

BREATHERITE VALVED MDI CHAMBER SPACER

QL

BREATHERITE VALVED MDI SPACER SPACER

QL

BREATHERITE WITH MASK, LARGE SPACER

QL

62


BREATHERITE WITH MASK, MEDIUM SPACER

QL

BREATHERITE WITH MASK, SMALL SPACER

QL

COMPACT SPACE CHAMBER SPACER QL

COMPACT SPACE CHAMBER-LRG MASK SPACER

QL

COMPACT SPACE CHAMBER-MED MASK SPACER

QL

COMPACT SPACE CHAMBER-SM MASK SPACER

QL

EASIVENT MASK LARGE DEVICE QL

EASIVENT MASK MEDIUM DEVICE QL

EASIVENT MASK SMALL DEVICE QL

LITEAIRE MDI CHAMBER SPACER QL

MICROCHAMBER SPACER QL

MICROSPACER SPACER QL

OPTICHAMBER ADULT MASK-LARGE DEVICE

QL

OPTICHAMBER DIAMOND LG MASK SPACER

QL

OPTICHAMBER DIAMOND VHC SPACER

QL

OPTICHAMBER DIAMOND-MED MSK SPACER

QL

OPTICHAMBER DIAMOND-SML MASK SPACER

QL

POCKET CHAMBER SPACER QL

PRIMEAIRE SPACER QL

PROCHAMBER SPACER QL

RITEFLO AEROCHAMBER SPACER QL

VORTEX HOLDING CHAMBER CHILD SPACER

QL

VORTEX HOLDING CHAMBER SPACER

QL

VORTEX HOLDING CHAMBER TODDLER SPACER

QL

VORTEX VHC FROG MASK-CHILD SPACER

QL

VORTEX VHC LADYBUG MASK-TODDLR SPACER

QL

63


SUMINISTROS MÉDICOS Y DME PARA EL ANÁLISIS Y MONITOREO DE LA GLUCOSA EN SANGRE

UNISTIK 2 EXTRA KIT OTC; QL

SUMINISTROS MÉDICOS Y DME: ESPIRÓMETRO

MINI WRIGHT PEAK FLOW METER DEVICE

TRUZONE PEAK FLOW METER DEVICE

ENDOCRINO

AGENTES ANDRÓGENOS

testosterone cypionate intramuscular oil Depo-Testosterone PA

testosterone enanthate intramuscular oil PA

testosterone transdermal gel Testim PA; QL

testosterone transdermal gel in metered-dose pump

Vogelxo PA; QL

testosterone transdermal gel in packet AndroGel PA; QL

AGENTES DE PROGESTERONA PARA LA FERTILIDAD: PREVENCIÓN DE NACIMIENTOS PREMATUROS

MAKENA (PF) SUBCUTANEOUS AUTO-INJECTOR

MAKENA INTRAMUSCULAR OIL QL

AGENTES ESTROGÉNICOS

amabelz oral tablet

estradiol oral tablet Estrace

estradiol transdermal patch transdermal patch weekly

QL

estradiol transdermal patch weekly Climara QL

estradiol-norethindrone acet oral tablet Activella

estropipate oral tablet

fyavolv oral tablet

jevantique lo oral tablet

jinteli oral tablet

lopreeza oral tablet

mimvey lo oral tablet

mimvey oral tablet

64


norethindrone ac-eth estradiol oral tablet Fyavolv

PREMARIN ORAL TABLET QL

PREMPHASE ORAL TABLET

PREMPRO ORAL TABLET

AGENTES PROGESTACIONALES

hydroxyprogesterone caproate intramuscular oil

QL

MAKENA (PF) SUBCUTANEOUS AUTO-INJECTOR

MAKENA INTRAMUSCULAR OIL QL

medroxyprogesterone oral tablet Provera QL

norethindrone acetate oral tablet Aygestin

progesterone micronized oral capsule Prometrium QL

AGENTES SUPRESORES HIPOFISARIOS

cabergoline oral tablet QL

ANTIHIPERGLICÉMICO, MIMÉTICO DE INCRETINA (AGONISTA DEL RECEPTOR GLP-1)

OZEMPIC SUBCUTANEOUS PEN INJECTOR

PA; QL

TANZEUM SUBCUTANEOUS PEN INJECTOR

PA; QL

VICTOZA 2-PAK SUBCUTANEOUS PEN INJECTOR

QL

VICTOZA 3-PAK SUBCUTANEOUS PEN INJECTOR

QL

ANTIHIPERGLUCÉMICOS, TIPO ANÁLOGO DE AMILINA

SYMLINPEN 120 SUBCUTANEOUS PEN INJECTOR

PA; QL

SYMLINPEN 60 SUBCUTANEOUS PEN INJECTOR

PA; QL

CALCITONINAS

calcitonin (salmon) nasal spray,non-aerosol

GLUCOCORTICOIDES

cortisone oral tablet

dexamethasone intensol oral drops

65


dexamethasone oral elixir Decadron

dexamethasone oral solution

dexamethasone oral tablet Decadron

dexamethasone sodium phosphate injection solution

DEXPAK 10 DAY ORAL TABLETS,DOSE PACK



hydrocortisone oral tablet Cortef

MEDROL ORAL TABLET

methylprednisolone acetate injection suspension

Depo-Medrol

methylprednisolone oral tablet Medrol

methylprednisolone oral tablets,dose pack Medrol (Pak)

millipred oral tablet

prednisolone oral solution

prednisolone sodium phosphate oral solution

prednisone intensol oral concentrate

prednisone oral solution

prednisone oral tablet

prednisone oral tablets,dose pack

HIPERGLUCEMIA

GLUCAGEN HYPOKIT INJECTION RECON SOLN

QL

GLUCAGON EMERGENCY KIT (HUMAN) INJECTION KIT

QL

glucose oral tablet,chewable OTC

HIPOGLUCEMIA, INSULINA, INTENSIFICADOR DE RESPUESTA

pioglitazone oral tablet Actos PA; QL

pioglitazone-glimepiride oral tablet DUETACT PA

pioglitazone-metformin oral tablet Actoplus MET PA

HIPOGLUCEMIA, INSULINA, TIPO ESTIMULANTE LIBERADOR

glimepiride oral tablet Amaryl

66


glipizide oral tablet Glucotrol

glipizide oral tablet extended release 24hr Glucotrol XL

glipizide-metformin oral tablet

glyburide micronized oral tablet Glynase

glyburide oral tablet

glyburide-metformin oral tablet

nateglinide oral tablet Starlix PA; QL

repaglinide oral tablet Prandin PA

HIPOGLUCEMIA, TIPO BIGUANIDA

metformin oral tablet Glucophage

metformin oral tablet extended release 24 hr

Glucophage XR

HIPOGLUCEMIA, TIPO INHIBIDOR DE LA ALFA GLUCOSIDASA

acarbose oral tablet 100 mg Precose

acarbose oral tablet 25 mg, 50 mg Precose QL

HORMONAS ANTIDIURÉTICAS Y VASOPRESORAS

DDAVP NASAL SOLUTION

desmopressin nasal solution DDAVP

desmopressin nasal spray with pump DDAVP

desmopressin nasal spray,non-aerosol

desmopressin oral tablet DDAVP QL

HORMONAS DEL CRECIMIENTO

ZOMACTON SUBCUTANEOUS RECON SOLN

PA; QL

HORMONAS TIROIDEAS

levothyroxine oral tablet Levo-T

levoxyl oral tablet

liothyronine oral tablet Cytomel

nature-throid oral tablet QL

np thyroid oral tablet QL

thyroid (pork) oral tablet Armour Thyroid QL

unithroid oral tablet

westhroid oral tablet QL

INHIBIDOR DE LA DIPEPTIDIL PEPTIDASA IV Y COMBINACIONES

JANUMET ORAL TABLET PA; QL

67


JANUMET XR ORAL TABLET, ER MULTIPHASE 24 HR

PA; QL

JANUVIA ORAL TABLET PA; QL

JENTADUETO ORAL TABLET PA; QL

JENTADUETO XR ORAL TABLET, IR - ER, BIPHASIC 24HR

PA; QL

TRADJENTA ORAL TABLET PA; QL

INHIBIDORES DE RESORCIÓN ÓSEA

alendronate oral solution QL

alendronate oral tablet QL

raloxifene oral tablet Evista

INHIBIDORES DE SODIO-GLUCOSA (SGLT2)

JARDIANCE ORAL TABLET PA; QL

SYNJARDY ORAL TABLET PA; QL

SYNJARDY XR ORAL TABLET, IR - ER, BIPHASIC 24HR

PA; QL

INSULINAS

APIDRA SOLOSTAR U-100 INSULIN SUBCUTANEOUS INSULIN PEN

QL

APIDRA U-100 INSULIN SUBCUTANEOUS SOLUTION

QL

BASAGLAR KWIKPEN U-100 INSULIN SUBCUTANEOUS INSULIN PEN

QL

HUMALOG MIX 50-50 INSULN U-100 SUBCUTANEOUS SUSPENSION

QL

HUMALOG MIX 50-50 KWIKPEN SUBCUTANEOUS INSULIN PEN

QL

HUMALOG MIX 75-25 KWIKPEN SUBCUTANEOUS INSULIN PEN

QL

HUMALOG MIX 75-25(U-100)INSULN SUBCUTANEOUS SUSPENSION

QL

HUMULIN 70/30 U-100 KWIKPEN SUBCUTANEOUS INSULIN PEN

OTC; QL

HUMULIN N NPH INSULIN KWIKPEN SUBCUTANEOUS INSULIN PEN

OTC; QL

HUMULIN N NPH U-100 INSULIN SUBCUTANEOUS SUSPENSION

OTC; QL

68


HUMULIN R REGULAR U-100 INSULN INJECTION SOLUTION

OTC; QL

HUMULIN R U-500 (CONC) INSULIN SUBCUTANEOUS SOLUTION

QL

HUMULIN R U-500 (CONC) KWIKPEN SUBCUTANEOUS INSULIN PEN

QL

LANTUS SOLOSTAR U-100 INSULIN SUBCUTANEOUS INSULIN PEN

PA; AL; QL

LANTUS U-100 INSULIN SUBCUTANEOUS SOLUTION

PA; QL

NOVOLIN R REGULAR U-100 INSULN INJECTION SOLUTION

OTC; QL

NOVOLOG MIX 70-30 U-100 INSULN SUBCUTANEOUS SOLUTION

QL

NOVOLOG MIX 70-30FLEXPEN U-100 SUBCUTANEOUS INSULIN PEN

QL

MINERALOCORTICOIDES

fludrocortisone oral tablet

OXITÓCICOS

methylergonovine injection solution

PREPARADOS ANTITIROIDEOS

methimazole oral tablet Tapazole

propylthiouracil oral tablet

EQUILIBRIO ELECTROLÍTICO, PRODUCTOS NUTRICIONALES

AGENTES CON MINERALES Y ELECTROLITOS

av-phos 250 neutral oral tablet

k-phos-neutral oral tablet

phospha 250 neutral oral tablet

virt-phos 250 neutral oral tablet

MULTIVITAMÍNICOS

central vite with lutein oral tablet OTC

central-vite cardio oral tablet OTC; QL

corvita oral tablet

ICAPS PLUS ORAL TABLET OTC; QL

m.v.i. adult intravenous solution

multi-vite (with folic acid) oral tablet OTC; QL

multi-vite 50 and over oral tablet OTC; QL

69


one daily mens 50 plus(ginkgo) oral tablet OTC

purevit dualfe plus oral capsule

se-tan plus oral capsule

v-c forte oral capsule

vic-forte oral capsule

vit 3 oral capsule

VITAMAX ORAL TABLET,CHEWABLE

women's daily multivitamin oral tablet OTC; QL

PREPARADOS DE VITAMINA B

b complex 100 injection solution

cyanocobalamin (vitamin b-12) injection solution

Vitamin B-12

DIALYVITE ORAL TABLET

folbee oral tablet

folbee plus oral tablet

folbic oral tablet QL

folic acid-vit b6-vit b12 oral tablet Folplex 2.2

folplex 2.2 oral tablet

hydroxocobalamin intramuscular solution

mynephrocaps oral capsule

mynephron oral capsule

nephplex rx oral tablet

NEPHRO-VITE RX ORAL TABLET OTC

pyridoxine (vitamin b6) injection solution

renal caps oral capsule

rena-vite rx oral tablet

reno caps oral capsule OTC

thiamine hcl (vitamin b1) injection solution

tl gard rx oral tablet

triphrocaps oral capsule

virt-gard oral tablet

virt-vite forte oral tablet QL

virt-vite oral tablet

vitamin b-12 injection solution

vol-care rx oral tablet

vp-vite rx oral tablet

70


PREPARADOS DE VITAMINA C

ascorbic acid (vitamin c) injection solution

vitamin c oral lozenge OTC

PREPARADOS DE VITAMINA D

calcitriol oral capsule Rocaltrol PA

calcitriol oral solution Rocaltrol PA

ergocalciferol (vitamin d2) oral capsule Drisdol

vitamin d2 oral capsule

PREPARADOS DE VITAMINA K

MEPHYTON ORAL TABLET

vitamin k injection solution

vitamin k1 injection solution

PREPARADOS DE VITAMINAS PRENATALES

dothelle dha oral capsule AL; QL

elite-ob oral tablet AL; QL

mynatal advance oral tablet AL; QL

mynatal oral capsule AL; QL

mynatal oral tablet AL; QL

mynatal plus oral tablet AL; QL

mynatal-z oral tablet AL; QL

mynate 90 plus oral tablet extended release

AL; QL

prena1 true oral combo pack AL; QL

prenatal vitamin plus low iron oral tablet AL; QL

thrivite-19 oral tablet AL; QL

virt-nate dha oral capsule AL; QL

vol-plus oral tablet AL; QL

RESINAS LIBERADORAS DE POTASIO

sodium polystyrene (sorb free) oral suspension

sodium polystyrene sulfonate oral suspension

sodium polystyrene (sorb free)

sodium polystyrene sulfonate rectal enema

sps (with sorbitol) oral suspension

sps (with sorbitol) rectal enema

71


SOLUCIONES DE IRRIGACIÓN

sodium chloride irrigation solution Sterile Saline

SUSTITUTO DEL CALCIO

calcium 500 oral tablet OTC; QL

calcium acetate oral tablet Calphron PA

calcium-folic acid-vitamin d oral wafer

tl g-fol os oral tablet

SUSTITUTO DEL HIERRO

centratex oral capsule

corvita 150 oral tablet

elite-ob oral tablet AL; QL

ferocon oral capsule QL

ferraplus 90 oral tablet

ferrex 150 forte oral capsule

ferrex 150 forte plus oral capsule

ferrex 28 oral tablet

ferrocite plus oral tablet

folivane-f oral capsule

folivane-plus oral capsule

hematinic plus vit/minerals oral tablet

hematinic/folic acid oral tablet

hematogen fa oral capsule

hematogen forte oral capsule

hematogen oral capsule

hemetab oral tablet QL

iferex 150 forte oral capsule

infed injection solution

multigen folic oral tablet

multigen plus oral tablet

myferon 150 forte oral capsule

poly-iron 150 forte oral capsule

sodium ferric gluconat-sucrose intravenous solution

Ferrlecit

taron forte oral capsule

tl icon oral capsule QL

tl-hem 150 oral tablet extended release 24 hr

72


tricon oral capsule QL

trigels-f forte oral capsule

SUSTITUTO DEL POTASIO

effer-k oral tablet, effervescent

k-effervescent oral tablet, effervescent

klor-con 10 oral tablet extended release

klor-con 8 oral tablet extended release

klor-con m10 oral tablet,er particles/crystals



klor-con oral packet

klor-con/ef oral tablet, effervescent

k-tab oral tablet extended release

potassium bicarb and chloride oral tablet, effervescent

potassium bicarb-citric acid oral tablet, effervescent

Effer-K

potassium chloride oral capsule, extended release

Klor-Con Sprinkle

potassium chloride oral liquid

potassium chloride oral packet Klor-Con

potassium chloride oral tablet extended release

K-Tab

potassium chloride oral tablet,er particles/crystals

Klor-Con M20

VITAMINAS PEDIÁTRICAS CON FLÚOR

multi-vit with fluoride-iron oral drops OTC

multi-vitamin with fluoride oral drops OTC

multivitamin with fluoride oral tablet,chewable

multi-vitamin with fluoride oral tablet,chewable

multivitamins with fluoride oral tablet,chewable

multivit-fluor (vit e acetate) oral drops

mvc-fluoride oral tablet,chewable

73


triple vitamin with fluoride oral drops

tri-vit with fluoride and iron oral drops

tri-vitamin with fluoride oral drops

vitamins a,c,d and fluoride oral drops

VITAMINAS PEDIÁTRICAS

children's chewable oral tablet,chewable OTC

VITAMINAS

folbee oral tablet

folbic oral tablet QL

folic acid injection solution

folic acid oral tablet OTC

folic acid-vit b6-vit b12 oral tablet Folplex 2.2

folplex 2.2 oral tablet

tl gard rx oral tablet

virt-gard oral tablet

virt-vite forte oral tablet QL

virt-vite oral tablet

ESCLEROSIS MÚLTIPLE

MEDICAMENTOS PARA TRATAR LA ESCLEROSIS MÚLTIPLE

AVONEX (WITH ALBUMIN) INTRAMUSCULAR KIT

PA; QL

AVONEX INTRAMUSCULAR PEN INJECTOR KIT

PA; QL

AVONEX INTRAMUSCULAR SYRINGE KIT

PA; QL

BETASERON SUBCUTANEOUS KIT PA; QL

EXTAVIA SUBCUTANEOUS KIT PA; QL

EXTAVIA SUBCUTANEOUS RECON SOLN

PA

GILENYA ORAL CAPSULE PA; QL

glatiramer subcutaneous syringe Copaxone PA; QL

glatopa subcutaneous syringe PA; QL

REBIF (WITH ALBUMIN) SUBCUTANEOUS SYRINGE

PA

REBIF REBIDOSE SUBCUTANEOUS PEN INJECTOR

PA

REBIF TITRATION PACK SUBCUTANEOUS SYRINGE

PA

74


TECFIDERA ORAL CAPSULE,DELAYED RELEASE(DR/EC)

PA; QL

INSUMOS Y PREPARADOS DENTALES

AGENTES PARA LA BOCA Y GARGANTA

clotrimazole mucous membrane troche QL

lidocaine hcl mucous membrane jelly

lidocaine hcl mucous membrane solution QL

lidocaine viscous mucous membrane solution

QL

nystatin oral suspension

oralone dental paste

pilocarpine hcl oral tablet Salagen (pilocarpine) QL

triamcinolone acetonide dental paste Oralone

ANTISÉPTICOS, OTROS

chlorhexidine gluconate mucous membrane mouthwash

Paroex Oral Rinse QL

paroex oral rinse mucous membrane mouthwash

QL

periogard mucous membrane mouthwash QL

PREPARACIONES DE FLUORUROS

dentagel dental gel

fluor-a-day (with xylitol) oral tablet,chewable

FLUOR-A-DAY ORAL DROPS

fluoride (sodium) dental solution PreviDent

fluoride (sodium) oral drops QL

fluoride (sodium) oral tablet,chewable Fluoritab

fluoritab oral tablet,chewable

FLURA-DROPS ORAL DROPS

ludent fluoride oral tablet,chewable

sf dental gel

MODIFICADORES METABÓLICOS

AGENTES DE DEFICIENCIA METABÓLICA

calcitriol oral capsule Rocaltrol PA

calcitriol oral solution Rocaltrol PA

75


levocarnitine oral tablet Carnitor OTC

sodium phenylbutyrate oral powder Buphenyl PA

sodium phenylbutyrate oral tablet Buphenyl PA

PHARMACOENHANCER - INHIBIDORES DEL CITOCROMO P450

TYBOST ORAL TABLET

ÓTICO

PREPARADOS ÓTICOS, MISCELÁNEOS, ANTINFECCIOSOS

acetic acid otic (ear) solution

acetic acid-aluminum acetate otic (ear) drops

ciprofloxacin hcl otic (ear) dropperette Cetraxal QL

floxin otic (ear) drops QL

neomycin-polymyxin-hc otic (ear) drops,suspension

neomycin-polymyxin-hc otic (ear) solution

ofloxacin otic (ear) drops QL

PRODUCTOS VAGINALES

ANTIBIÓTICOS VAGINALES

CLEOCIN VAGINAL SUPPOSITORY

clindamycin phosphate vaginal cream Cleocin

metronidazole vaginal gel Metrogel Vaginal

vandazole vaginal gel

ANTIMICÓTICOS VAGINALES

miconazole-3 vaginal suppository PA

terconazole vaginal cream Terazol 7 QL

terconazole vaginal suppository QL

PREPARADOS DE ESTRÓGENO VAGINALES

estradiol vaginal tablet Vagifem

yuvafem vaginal tablet

76


SISTEMA LOCOMOTOR

AGENTES PARA EL TRATAMIENTO DE TRASTORNOS MUSCULOESQUELÉTICOS

EUFLEXXA INTRA-ARTICULAR SYRINGE

PA; QL

GELSYN-3 INTRA-ARTICULAR SYRINGE

PA; QL

SUPARTZ FX INTRA-ARTICULAR SYRINGE

PA; QL

OTROS MEDICAMENTOS AUTÓNOMOS/DEL SNC

MESTINON ORAL SYRUP

pyridostigmine bromide oral tablet Mestinon

pyridostigmine bromide oral tablet extended release

Mestinon Timespan

RELAJANTES DEL MÚSCULO ESQUELÉTICO

baclofen oral tablet

carisoprodol oral tablet Soma QL

carisoprodol-asa-codeine oral tablet AL; QL

carisoprodol-aspirin oral tablet QL

chlorzoxazone oral tablet

cyclobenzaprine oral tablet 10 mg QL

cyclobenzaprine oral tablet 5 mg

dantrolene oral capsule Dantrium

methocarbamol oral tablet Robaxin QL

orphenadrine citrate oral tablet extended release

QL

riluzole oral tablet Rilutek PA

tizanidine oral tablet QL

TERAPIA ALTERNATIVA

TERAPIA ALTERNATIVA

SYSTANE VITAMIN ORAL CAPSULE OTC

TERAPIA DE LA GOTA Y LA HIPERURICEMIA

AGENTES URICOSÚRICOS

probenecid oral tablet

77


COMBINADOS DE COLQUICINA

probenecid-colchicine oral tablet

TERAPIA PARA HIPERURICEMIA, INHIBIDORES DE PURINA

allopurinol oral tablet Zyloprim

TERAPIA DEL TRASTORNO COGNITIVO

INHIBIDORES DE LA COLINESTERASA

donepezil oral tablet 10 mg, 5 mg Aricept QL

donepezil oral tablet 23 mg Aricept PA; QL

donepezil oral tablet,disintegrating QL

galantamine oral capsule,ext rel. pellets 24 hr

Razadyne ER

galantamine oral solution

galantamine oral tablet Razadyne QL

memantine oral solution

memantine oral tablet Namenda QL

memantine oral tablets,dose pack Namenda Titration Pak QL

NAMENDA TITRATION PAK ORAL TABLETS,DOSE PACK

QL

rivastigmine tartrate oral capsule

TERAPIA GENITOURINARIA

ACIDULANTES URINARIOS

av-phos 250 neutral oral tablet

k-phos-neutral oral tablet

phospha 250 neutral oral tablet

virt-phos 250 neutral oral tablet

AGENTE PARA LA INCONTINENCIA/ANTIESPASMÓDICO PARA TRACTO URINARIO

darifenacin oral tablet extended release 24 hr

Enablex

flavoxate oral tablet QL

oxybutynin chloride oral syrup QL

oxybutynin chloride oral tablet

oxybutynin chloride oral tablet extended release 24hr

Ditropan XL QL

78


tolterodine oral capsule,extended release 24hr

Detrol LA

tolterodine oral tablet Detrol

trospium oral capsule,extended release 24hr

trospium oral tablet

AGENTES ANALGÉSICOS/ANESTÉSICOS PARA TRACTO URINARIO

phenazopyridine oral tablet Pyridium

urinary tract oral tablet OTC; QL

AGENTES ANTIBACTERIANOS URINARIOS

ciprofloxacin (mixture) oral tablet, er multiphase 24 hr

Cipro XR

methenamine hippurate oral tablet Hiprex

methenamine mandelate oral tablet

nitrofurantoin macrocrystal oral capsule Macrodantin

nitrofurantoin monohyd/m-cryst oral capsule

Macrobid

nitrofurantoin oral suspension Furadantin

AGENTES PARASIMPÁTICOS

bethanechol chloride oral tablet Urecholine QL

DESINTOXICANTES DE SANGRE

calcium acetate oral capsule PA

calcium acetate oral tablet Calphron PA

eliphos oral tablet PA

VELPHORO ORAL TABLET,CHEWABLE

PA

HIPERTROFIA PROSTÁTICA BENIGNA/AGENTES MICCIONALES

alfuzosin oral tablet extended release 24 hr

Uroxatral QL

finasteride oral tablet Proscar QL

tamsulosin oral capsule,extended release 24hr

Flomax QL

MODIFICADORES DEL PH URINARIO

cytra k crystals oral packet

79


cytra-2 oral solution

cytra-3 oral solution

cytra-k oral solution

potassium citrate oral tablet extended release

Urocit-K 10

potassium citrate-citric acid oral packet Cytra K Crystals

potassium citrate-citric acid oral solution Cytra-K

sodium citrate-citric acid oral solution Cytra-2

tricitrates oral solution

virtrate-k oral solution

TERAPIA PARA TRASTORNOS DE LA ALIMENTACIÓN

AGENTES ESTIMULANTES DEL APETITO

megestrol oral suspension

80

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