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Pharmacy

PHARMACY
FORMULARY
Revised 3/05


___________________________________
Dr. Dawn Whelchel, Chairperson
Medication Use Team
___________________________________
Dana Haden, RPh.
Director of Pharmacy

PHARMACY FORMULARY
TABLE OF CONTENTS
ANTI-INFECTIVES…………………………………………………….1
Antibiiotics, Sulfas, Nitrofurans, Antifungals, Antimalarial, Antituberculin,Amebicides, Antivirals, Anthelmintics BIOLOGICALS / IMMUNOLOGICALS…………………………….5
Immune Globulins, Antitoxins & Antivenins, Immunization Agents, Immunologic
Agents
CARDIOVASCULARS…………………………………………………7
Inotropics, Antiarrythmics, Calcium Channel Blockers, Vasodilators, Antiadrenergics &
Sympatholytics, Renin Angiotensin Antagonists, Antihypertensives, Antihyperlipidemics,
Vasopressors
CNS AGENTS………………………………………………………….11
Stimulants, Analgesics, Antiemetics & Antivertigo Agents, Antianxiety, Antidepressants,
Antipsyhotics, Cholinesterase Inhibitors, Sedatives & Hypnotics, Barbiturates, General
Anesthetics, Local Anesthetics (injectable), Anticonvulsants, Muscle Relaxants, Antiparkinson,
Antialcoholic, Smoking deterrents
DERMATOLOGICALS (all topicals)……………………………….18

ENDOCRINE & METABOLIC AGENTS………………………….21
Sex Hormones, Uterine Active Agents, Antidiabetic Agents, Glucose Elevating Agents,
Adrenocortical Steroids, Thyroid Agents, Posterior Pituitary Hormones, Calcitonin, Gout Agents,
Emergency Kits, Antidotes
GASTRO-INTESTINAL AGENTS………………………………….22
H2 Antagonists, Proton Pump Inhibitors, Sucralfate, Antacids, Anticholinergics/Antispasmodics,
Mesalamine, Sulfasalazine, Laxatives, Antidiarrheals, Antiflatulants, GI Stimulants, Digestive
Enzymes, Mouth and Throat products, Anorectal Preparations
HEMATOLOGICAL AGENTS………………………………………27
Hematopoietic Agents, Antiplatelet Agents, Anticoagulants, Coumarin Derivatives, Coagulants,
Thrombolytics, Hemostatics, Plasma Expanders
NUTRITIONALS………………………………………………………28
Vitamins, Minerals, Trace Elements, Electrolytes, Systemic Alkalinizers, Amino Acids,
Lipotropics, Oral Nutritionals, Enteral Nutritionals, Intravenous Nutritionals
OPHTHALMICS & OTICS………………………………………….31
Glaucoma Agents, NSAIDS, Steroids, Decongestants, Antibiotics, Sulfas, Antivirals, Lubricants,
Anesthetics, Surgical Adjuncts, Otics
RENAL/GENITOURINARY………………………………………….34
Interstitial Cystitis Agents, Impotence Agents, GU Irrigants, Urinary Alkalinizers, Urinary
Acidifiers, Anticholinergics, Cholinergics, Vaginal Preparations, Douches, Contraceptives,
Diuretics
RESPIRATORY AGENTS……………………………………………36
Bronchodilators, Leukotriene Receptor Antagonists, Inhalants, Nasal Decongestants,
Antihistamines, Antitussives, Expectorants, Antiasthmatics, Upper Respiratory Combinations
MARSHALL REGIONAL MEDICAL CENTER
PHARMACY FORMULARY
SECTION 1: ANTI-INFECTIVES

PENICILLINS-Injectable
Ampicillin 250mg, 500mg, 1gm, 2gm
Penicillin G Potassium 5 mu
Penicillin G Procaine 1.2 mu (Wycillin)
Penicillin G Benzathine 1.2 mu (Bicillin LA)
Penicillin G Benzathine and Procaine 900/300 1.2 mu (Bicillin CR)
Nafcillin 1gm
Ticarcillin/Clavulanate 3.1gm (Timentin)
PENICILLINS- Oral
Amoxicillin 250mg caps
Amoxicillin 250mg/5ml 100ml susp
Augmentin 250mg, 500mg, 875mg XR 1gm tabs
Augmentin 200mg/5ml 75ml susp
Augmentin 250mg/5ml 50ml susp
Penicillin VK 250mg tabs
Penicillin VK 250mg/5ml 100ml susp
CEPHALOSPORINS-Injectable
First Generation
Cephazolin 1gm (Ancef, Kefzol)
Second Generation
Cefotetan 1gm (Cefotan)
Third Generation
Cefotaxime 500mg (Claforan) ***Restricted to Pediatrics Only
Ceftazidime 1gm (Fortaz, Tazicef)
Ceftriaxone 250mg, 500mg, 1gm (Rocephin)
CEPHALOSPORINS-Oral
First Generation
Cephalexin 250mg caps (Keflex)
Cephalexin 250mg/5ml 100ml susp (Keflex)
Second Generation
Cefaclor 250mg caps (Ceclor)
Cefaclor 125mg/5ml 75ml susp (Ceclor)
Cefprozil 250mg tabs (Cefzil)
Cefprozil 125mg/5ml 100ml susp (Cefzil)
Cefuroxime 250mg tabs (Ceftin)
Cefdinir 300mg caps (Omnicef)
CARBAPENEMS- Injectable
Imipenem-Cilistatin 500mg (Primaxin)
MONOBACTAMS-Injectable
Aztreonam 1gm (Azactam)
CHLORAMPHENICOL 1gm vial
FLUOROQUINOLONES-Injectable
Gatifloxacin 200mg, 400mg premix (Tequin)
FLUOROQUINOLONES-Oral
Gatifloxacin 200mg, 400mg tabs (Tequin)
TETRACYCLINES-Injectable
Doxycycline 100mg
TETRACYCLINES-Oral
Demeclomycin 150mg tabs (Declomycin)
Doxycycline 50mg caps
Tetracycline 250mg caps (Sumycin)
MACROLIDES-Injectable
Azithromycin 500mg (Zithromax)
MACROLIDES-Oral
Azithromycin 250mg tabs (Zithromax)
Azithromycin 200mg/5ml 15ml susp (Zithromax)
Clarithromycin 250mg tabs (Biaxin)
Clarithromycin 125mg/5ml 100ml susp (Biaxin)
Erythromycin 250mg tabs (Ery-tab)
Erythromycin 400mg/5ml susp (EES 400)
STREPTOGRAMINS-Injectable
Quinupristin/dalfopristin 500mg vial (Synercid) Restricted for VREF Only
VANCOMYCIN
500mg vial
VANCOMYCIN 250mg caps (Vancocin)
LINCOSAMIDES-Injectable
Clindamycin 900mg vial, 600mg, 900mg premix (Cleocin)
LINCOSAMIDES-Oral
Clindamycin 150mg caps (Cleocin)
AMINOGLYCOSIDES-Injectable
Gentamicin 80mg vials and 80mg premix
Kanamycin 1gm (Kantrex) ***used in OR Only
AMINOGLYCOSIDES-Oral
Neomycin 500mg tabs
BACITRACIN 50,000u vials
METRONIDAZOLE 500mg Injectable-premix
METRONIDAZOLE 250mg tabs
NITROFURANS
Nitrofurantoin 100mg caps (Macrobid)
METHENAMINE COMBINATION tabs (Urised)
TRIMETHOPRIM 100mg tabs (Trimpex)
COMBINATION PRODUCTS
Erythromycin/Sulfizoxazole susp (Pediazole)
Sulfamethoxazole/Trimethoprim D.S. tabs (Bactrim DS, Septra DS)
Sulfamethoxazole/Trimethoprim liquid (Bactrim, Septra)
Sulfamethoxazole/Trimethoprim injectable (Bactrim, Septra)
ANTIFUNGALS-Injectable
Amphotericin B 50mg
Fluconazole 200mg premix (Diflucan)
ANTIFUNGALS-Oral
Fluconazole 100mg tabs (Diflucan)
Griseofulvin 125mg/5ml susp (Grifulvin V)
Ketoconazole 200mg tabs (Nizoral)
Nystatin 100,000u/ml susp (Mycostatin)
Terbinafine 250mg tabs (Lamisil)
ANTIMALARIALS
Quinine Sulfate 260mg tabs, 325mg caps
ANTITUBERCULOSALS
Cycloserine 250mg caps (Seromycin)
Ethambutol 400mg tabs (Myambutol)
Isoniazid 300mg tabs
Pyrazinamide 500mg tabs
Rifampin 300mg caps
ANTIVIRAL-Injectable
Acyclovir 500mg (Zovirax)
Ribavirin 6gm (Virazole)
ANTIVIRAL-Oral
Amantadine 100mg caps
Amantadine 50mg/5ml Syrup
Oseltamivir 75mg caps (Tamiflu)
Rimantadine 100mg tabs (Flumadine)
Valacyclovir 500mg tabs (Valtrex)
ANTIRETROVIRAL-Oral
Indinavir 200mg caps (Crixivan)
Lamivudine 150mg tabs (Epivir)
Saquinavir 200mg caps (Invirase)
Zalcitabine 0.375mg tabs (Hivid)
Zidovudine 100mg caps (Retrovir)
LEPROSTATICS
Dapsone 25mg caps
ANTHELMINTICS
Ivermectin 6mg tabs (Stromectol)


MARSHALL REGIONAL MEDICAL CENTER
PHARMACY FORMULARY (Cont.)
SECTION 2: BIOLOGICALS/IMMUNOLOGICALS/DIAGNOSTICS

IMMUNE GLOBULINS
Hepatitis B Immune Globulin (HBIG)
Immune Globulin (IM) (Baygam)
Tetanus Immune Globulin (Hypertet)
ANTITOXINS/ANTIVENINS
Antivenin (Crotalidae) Polyvalent
Black Widow Spider Antivenin (Latrodectus mactans)
North American Coral Snake Antivenin (Micrurus fulvius)
ACTIVE IMMUNIZATION
Diphtheria Tetanus Toxoid Pediatric
Hepatitis B Vaccine Adult (Recombivax)
Hepatitis B Vaccine Pediatric (Recombivax)
Influenza Virus Vaccine (Flu Shield, Fluzone, etc.)
Measles Mumps Rubella Virus Vaccine (MMRII)
Pneumococcal Vaccine (Pneumovax)
Rubella Virus Vaccine (Meruvax II)
ANTIRHEUMATIC
Sulfasalazine 500mg tabs
DIAGNOSTICS
Candida Albicans Skin Test
Fluorescein Sodium (Fluor-I-Strips)
Sodium Hyaluronate (Healon)
Sodium Hyaluronate and Chondroitin Sulfate (Viscoat)
Histoplasmin Skin Test
Hydroxyethylcellulose (Gonioscopic)
Indigotindisulfonate Sodium (Indigo Carmine)
Mannitol IV 25% 50ml vials
Mumps Skin Test
Sincalide 5mcg (Kinevac)
Tuberculin Purified Protein Derivative Skin Test (Tubersol)
RADIOPAQUE AGENTS
Barium Sulfate
Gadodiamide (Omniscan)
Iohexol (Omnipaque)
Iothalamate Meglumine (Conray)
Ioversol (Optiray)
MARSHALL REGIONAL MEDICAL CENTER
PHARMACY FORMULARY (Cont.)
SECTION 3: CARDIOVASCULARS

INOTROPICS-Injectable
Digoxin 0.25mg/ml amps
Milrinone Lactate 1mg/ml vials (Primacor)
INOTROPICS-ORAL
Digoxin 0.125mg, 0.25mg tabs
Digoxin Elixir 0.05mg/ml
Lanoxicaps 0.1mg caps
ANTIARRHYTHMICS-Injectable
Adenosine 6mg vials (Adenocard)
Amiodarone 50mg/ml amps (Cordarone)
Bretylium 500mg vials (Bretylol)
Lidocaine 100mg syringes
Lidocaine Drip Premix 4mg/ml
ANTIARRHYTHMICS-Oral
Amiodarone 200mg tabs (Cordarone)
Mexiletine 150mg caps (Mexitil)
Procainamide 250mg caps, 500mg SR tabs
Propafenone 150mg tabs (Rythmol)
Quinidine gluconate 324mg tabs
Quinidine sulfate 200mg tabs, 300mg SR tabs
CALCIUM CHANNEL BLOCKERS-Injectable
Diltiazem 5mg/ml vials (Cardizem)
Nicardipine 25mg/10ml amp (Cardene)
Verapamil 5mg/2ml amps
CALCIUM CHANNEL BLOCKERS-Oral
Amlodipine 5mg tabs (Norvasc)
Diltiazem 30mg tabs (Cardizem)
Diltiazem CD 120mg, 180mg, 300mg caps (Cardizem CD)
Felodipine 2.5mg, 5mg tabs (Plendil)
Isradipine 2.5mg caps, 5mg CR tabs (Dynacirc, Dynacirc CR)
Nicardipine SR 30mg, 45mg caps (Cardene SR)
Nifedipine 10mg caps (Procardia)
Nifedipine XL 30mg tabs (Adalat CC, Procardia XL)
Nisoldipine 10mg tabs (Sular)
NITRATES-Injectable
Nitroglycerin Drip Premix
NITRATES-Oral, Sublingual, Transdermal, Inhalation
Amyl Nitrate Inhalants
Isosorbide dinitrate 10mg, 20mg tabs, 40mg SR tabs (Isordil)
Isosorbide mononitrate 30mg, 60mg tabs (Imdur)
Nitroglycerin 0.4mg SL tabs
Nitroglycerin 2.5mg, 6.5mg caps
Nitroglycerin 0.1mg, 0.2mg patches
Nitroglycerin ointment
PERIPHERAL VASODILATORS-Injectable
Hydralazine 20mg vials (Apresoline)
PERIPHERAL VASODILATORS-Oral
Hydralazine 10mg, 25mg tabs (Apresoline)
Minoxidil 2.5mg tabs (Loniten)
BETA-ADRENERGIC BLOCKERS-Injectable
Esmolol 10mg/ml vials (Brevibloc)
Labetalol 5mg/ml vials (Normodyne, Trandate)
Metoprolol 1mg/ml amps (Lopressor)
Propranolol 1mg/ml amps (Inderal)
BETA-ADRENERGIC BLOCKERS-Oral
Acebutolol 200mg caps (Sectral)
Atenolol 50mg tabs (Tenormin)
Bisoprolol 5mg tabs (Zebeta)
Labetalol 200mg tabs (Normodyne, Trandate)
Metoprolol 50mg tabs (Lopressor)
Metoprolol XL 50mg tabs (Toprol XL)
Nadolol 40mg tabs (Corgard)
Propranolol 20mg tabs, 60mg LA caps, 80mg LA caps (Inderal)
Sotalol 80mg tabs (Betapace)
ALPHA-BETA ADRENERGIC BLOCKERS
Carvedilol 6.25mg tabs (Coreg)
ANTIADRENERGIC AGENTS-Injectable
Methyldopate 50mg/ml vials (Aldomet)
ANTIADRENERGIC AGENTS-Oral and Transdermal
Clonidine 0.1mg tabs (Catapres)
Clonidine TTS 1 Patch (Catapres)
Doxazosin 1mg, 8mg tabs (Cardura)
Guanfacine 1mg tabs (Tenex)
Methyldopa 250mg tabs (Aldomet)
Prazocin 1mg caps (Minipres)
Tamsulosin 0.4mg caps (Flomax)
Terazosin 1mg, 5mg caps (Hytrin)
ACE INHIBITORS-Injectable
Enalapril 1.25mg/ml vials (Vasotec)
ACE INHIBITORS-Oral
Benzapril 5mg, 10mg tabs (Lotensin)
Captopril 12.5mg, 25mg tabs (Capoten)
Enalapril 5mg tabs (Vasotec)
Fosinopril 10mg tabs (Monopril)
Lisinopril 5mg tabs (Prinivil)
Moexipril 7.5mg tabs (Univasc)
Quinapril 10mg tabs (Accupril)
Ramipril 2.5mg caps (Altace)
Trandolapril 1gm tabs (Mavik)
ANGIOTENSIN II RECEPTOR ANTAGONISTS
Candesartan 10mg tabs (Atacand)
Irbesartan 150mg tabs (Avapro)
Losartan 50mg tabs (Cozaar)
Telmisartan 80mg tabs (Micardis)
Valsartan 80mg caps (Diovan)
ANTIHYPERTENSIVE COMBINATIONS
Bisoprolol/Hydrochlorothiazide 2.5mg, 5mg, 10mg tabs (Ziac)
Losartan/Hydrochlorothiazide 50/12.5mg tabs (Hyzaar)
Nadolol/bendroflumethiazide 80/5mg tabs (Corzide)
PHEOCHROMOCYTOMA AGENTS
Phentolamine 5mg vial (Regitine)
Phenoxybenzamine 10mg caps (Dibenzyline)
HYPERTENSIVE EMERGENCIES
Sodium Nitroprusside 50mg vial (Nipride)

ANTIHYPERLIPIDEMICS
Atorvastatin 10mg tabs (Lipitor)
Cholestyramine Powder (Questran)
Colestipol 1gm tabs (Colestid)
Fluvastatin 20mg caps (Lescol)
Gemfibrozil 600mg tabs (Lopid)
Lovastatin 20mg tabs (Mevacor)
Pravastatin 20mg tabs (Pravachol)
Simvastatin 5mg, 40mg tabs (Zocor)
VASOPRESSORS
Dobutamine 12.5mg/ml vial (Dobutrex)
Dopamine 800mg/500ml Drip Premix
Dopamine 40mg/ml 5ml vials ***for Pediatrics
Ephedrine 50mg amps
Epinephrine 1:1000 MDV 30ml, 1ml amps
Epinephrine 1:10,000 10ml syringes
Norepinephrine amps (Levophed)
Phenylephrine 1% amps (Neo-Synephrine)
SCLEROSING AGENTS
Morrhuate Sodium 50mg/ml vial




MARSHALL REGIONAL MEDICAL CENTER
PHARMACY FORMULARY (Cont.)

CNS STIMULANTS
Doxapram 20mg/ml vial (Dopram)
Methylphenidate 5mg tabs (Ritalin)
NARCOTIC AGONIST ANALGESICS-Injectable
Alfentanil 50mcg/ml amps (Alfenta)
Fentanyl 50mcg/ml amps 2ml, 5ml, 20ml (Sublimaze)
Hydromorphone 2mg/ml syringe (Dilaudid)
Meperidine 50mg, 75mg, 100mg syringe, 10mg/ml PCA vial (Demerol)
Morphine 4mg, 10mg syringe, 1mg/ml PCA vial
Sufentanil 50mcg/ml amps (Sufenta)
NARCOTIC AGONIST ANALGESICS-Oral, Transdermal
Codeine 30mg tabs
Fentanyl Patches 25mcg, 50mcg (Duragesic)
Hydromorphone 2mg tabs (Dilaudid)
Meperidine 50mg tabs (Demerol)
Meperidine 50mg/5ml Oral Solution (Demerol)
Methadone 5mg tabs
Morphine SR 15mg, 30mg tabs (MS Contin)
Morphine 10mg/5ml Oral Solution
Oxycodone SR 10mg, 20mg tabs (Oxycontin)
Propoxyphene 65mg caps (Darvon)
NARCOTIC ANALGESIC COMBINATIONS
Acetaminophen 120mg/Codeine 12mg/5ml Elixir
Acetaminophen/Codeine #3 tabs (Tylenol #3)
Belladonna and Opium No.16A suppositories 16.2/60mg (B&O)
Hydrocodone/Acetaminophen 5/500mg, 7.5/500mg, 10/500mg tabs (Lortab, Lorcet)
Oxycodone, Acetaminophen 5/500mg caps (Tylox)
Propoxyphene/Acetaminophen 100/650mg tabs (Darvocet N-100)
NARCOTIC AGONIST-ANTAGONIST ANALGESICS-Injectable
Buprenorphine 0.3mg/ml amps (Buprenex)
Butorphanol 2mg/ml vial (Stadol) ***restricted to L&D Only
Nalbuphine 10mg/ml amps (Nubain)
Pentazocine 30mg/ml amps (Talwin)

NARCOTIC AGONIST-ANTAGONIST ANALGESICS-Oral
Pentazocine/Naloxone 50/0.5mg tabs (Talwin NX)
Pentazocine/Acetaminophen 25/650mg tabs (Talacen)
CENTRAL ANALGESICS
Tramadol 50mg tabs (Ultram)
ACETAMINOPHEN 325mg, 500mg tabs (Tylenol0
ACETAMINOPHEN 120mg, 325mg, 650mg suppositories
ACETAMINOPHEN 80mg/0.8ml drops, 160mg/5ml elixir
SALICYLATES
Aspirin 81mg chewable tabs
Aspirin 325mg tabs
Aspirin Enteric Coated 81mg, 325mg tabs
Aspirin 600mg suppositories
Salsalate 750mg tabs (Disalcid)
NONNARCOTIC ANALGESIC COMBINATIONS
Butalbital/Acetaminophen/Caffeine 50/325/40mg tabs (Fioricet)
Diclofenac/Misoprostol 50/0.2mg tabs (Arthrotec)
NONSTEROIDAL ANTI-INFLAMMATORY AGENTS-Injectable
Ketorolac 30mg, 60mg vials (Toradol)
NONSTEROIDAL ANTI-INFLAMMATORY AGENTS-Oral
Celecoxib 100mg caps (Celebrex)
Etodolac 300mg caps, 400mg tabs (Lodine)
Etodolac XL 400mg, 500mg tabs (Lodine XL)
Ibuprofen 400mg, 600mg tabs, 100mg/5ml liquid (Motrin)
Indomethacin 25mg caps (Indocin)
Ketorolac 10mg tabs (Toradol)
Nabumetone 500mg tabs (Relafen)
Naproxen 250mg tabs (Naprosyn)
Naproxen SR 500mg tabs (Naprelan)
MIGRAINE AGENTS
Dihydroergotamine 1mg/ml amps (D.H.E.)
Isometheptene/Dichloralphenazone/Acetaminophen caps (Midrin)
Rizatriptan 5mg tabs (Maxalt)
Sumatriptan 6mg vials (Imitrex)
ANTIEMETIC/ANTIVERTIGO AGENTS-Injectable
Diphenhydramine 50mg/ml vial (Benadryl)
Metoclopramide 10mg/2ml vials (Reglan)
Ondansetron 2mg/ml vials (Zofran)
Prochlorperazine 5mg/ml vials (Compazine)
Promethazine 25mg/ml amps (Phenergan)
ANTIEMETIC/ANTIVERTIGO AGENTS-Oral, Rectal,Transdermal
Dimenhydrinate 50mg tabs (Dramamine)
Diphenhydramine 25mg caps, 12.5mg/5ml syrup
Meclizine 25mg tabs (Antivert)
Metoclopramide 10mg tabs, 5mg/5ml syrup
Phosphorated Carbohydrate Liquid (Emetrol)
Prochlorperazine 5mg tabs (Compazine)
Promethazine 25mg tabs, (Phenergan)
Promethazine 12.5mg, 25mg, 50mg suppositories
Promethazine 25mg Topical Gel
Scopolamine Patch (Transderm-Scop)
ANTIANXIETY AGENTS-Injectable
Diazepam 10mg/2ml syringes (Valium)
Hydroxyzine HCl 25mg/ml vials (Vistaril)
Lorazepam 2mg/ml syringes (Ativan)
ANTIANXIETY AGENTS-Oral
Alprazolam 0.25mg tabs (Xanax)
Buspirone 5mg tabs (Buspar)
Diazepam 2mg, 5mg tabs (Valium)
Doxepin 10mg, 25mg caps (Sinequan)
Hydroxyzine HCl 10mg/5ml syrup (Atarax)
Hydroxyzine Pamoate 25mg caps (Vistaril)
Lorazepam 1mg tabs (Ativan)
Meprobamate 200mg tabs (Equanil)
Oxazepam 10mg, 15mg caps (Serax)
ANTIDEPRESSANTS
Amitriptyline 10mg, 25mg tabs (Elavil)
Citalopram 20mg tabs (Celexa)
Clomipramine 50mg caps (Anafranil)
Desipramine 25mg tabs (Norpramin)
Escitalopram 10 mg tabs (Lexapro)
Fluoexetine 10mg, 20mg caps (Prozac)
Imipramine 10mg, 25mg tabs (Tofranil)
Mirtazapine 15mg tabs (Remeron)
Nefazodone 150mg tabs (Serzone)
Nortriptyline 25mg caps (Pamelor)
Paroexetine 10mg tabs (Paxil)
Sertraline 50mg tabs (Zoloft)
Trazodone 50mg tabs (Desyrel)
Venlafaxine 25mg 37.5mg tabs (Effexor)
Venlafaxine XR 37.5mg caps (Effexor XR)
ANTIPSYCHOTICS-Injectable
Chlorpromazine 25mg/ml amps (Thorazine)
Haloperidol 5mg/ml amps (Haldol)
Haloperidol 50mg/ml amps (Haldol Decanoate)
Prochlorperazine 5mg/ml vials (Compazine)
Ziprasidone 20mg vial (Geodon) *IV/IM use restricted to monitored beds only

ANTIPSYCHOTICS-Oral
Chlorpromazine 25mg, 100mg tabs, 30mg/ml liquid
Haloperidol 1mg, 5mg tabs (Haldol)
Molindone 10mg, 25mg tabs (Moban)
Lithium 300mg caps
Olanzapine 2.5mg, 10mg tabs (Zyprexa)
Perphenazine 4mg tabs (Trilafon)
Prochlorperazine 5mg tabs (Compazine)
Risperidone 0.25mg, 1mg tabs (Risperdal)
Thioridazine 10mg, 25mg, 100mg tabs, 100mg/ml liquid
Thiothixene 1mg caps (Navane)
Trifluoperazine 5mg tabs (Stelazine)
Ziprasidone 20 mg caps (Geodon)
CHOLINESTERASE INHIBITORS
Donepezil 5mg tabs (Aricept)
NMDA RECEPTOR ANTAGONIST
Memantine 5mg tabs (Namenda)
MISCELLANEOUS PSYCHOTHERAPEUTIC AGENTS
Chlordiazepoxide/Amitriptylene 5/12.5mg tabs (Limbitrol)
SEDATIVE/HYPNOTICS
Chloral Hydrate 500mg/5ml syrup
Phenobarbital 15mg, 60mg, 100mg tabs, 20mg/5ml Elixir
Temazepam 7.5mg, 15mg caps (Restoril)
Triazolam 0.125mg tabs (Halcion)
Zaleplon 5mg caps (Sonata)
Zolpidem 5mg tabs (Ambien)
GENERAL ANESTHETICS
Desflurane 240ml bottle (Suprane)
Droperidol 2.5mg/ml amps (Inapsine)
Etomidate 20mg vial (Amidate)
Isoflurane 100ml bottle (Forane)
Ketamine 500mg vial (Ketalar)
Midazolam 1mg/ml, 5mg/ml vials, 2mg/ml syrup
Propofol 1% 20ml amps, 100ml bottles (Diprivan)
Sevoflurane 250ml bottle (Ultane)
Thiopental Sodium 400mg syringes (Pentothal)
INJECTABLE LOCAL ANESTHETICS
Bupivacaine MPF 0.25%, 0.5% vials (Sensorcaine, Marcaine)
Bupivacaine Spinal amps (Spinal Marcaine)
Bupivacaine 0.25%, 0.5%, 0.75% vials (Sensorcaine, Marcaine)
Bupivacaine w/Epinephrine 0.25%
Lidocaine MPF 0.5%, 1% vials (Xylocaine)
Lidocaine 1%, 2% vials
Lidocaine 2% 10ml syringes
Lidocaine 4% amps
Lidocaine 5% in 7.5%Dextrose amps
Lidocaine w/Epinephrine 1%, 2% vials
Lidocaine w/Epinephrine 2% amps (Xylocaine)
Mepivacaine 1%, 1.5% (Polocaine)
Ropivacaine 0.5%, 1% (Naropin)
ANTICONVULSANTS-Injectable
Diazepam 10mg syringe (Valium)
Phenytoin 100mg syringe (Dilantin)
ANTICONVULSANTS-Oral
Carbamazepine 100mg, 200mg tabs, 100mg/5ml suspension
Clonazepam 0.5mg tabs (Klonopin)
Divalproex Sodium 250mg tabs (Depakote)
Gabapentin 100mg, 300mg caps (Neurontin)
Lamotrigine 25mg tabs (Lamictal)
Levetiracetam 500mg tabs (Keppra)
Magnesium Sulfate 50% syringe, 8meq vials
Mysoline 50mg, 250mg tabs (Primidone)
Phenytoin 50mg tabs, 100mg caps, 125mg/5ml suspension
Sodium Valproate 250mg/5ml syrup (Depakene)

MUSCLE RELAXANTS-ADJUNCTS TO ANESTHESIA
Mivacurium 2mg/ml vials (Mivacron)
Pancuronium 2mg/ml vials (Pavulon)
Rocuronium 10mg/ml vials (Zemuron)
Succinylcholine 20mg/ml vials (Anectine)
Vecuronium 10mg vial (Norcuron)
SKELETAL MUSCLE RELAXANTS-Injectable
Dantrolene 20mg vials (Dantrium) **Is kept in Anesthesia
Diazepam 10mg syringe (Valium)
Methocarbamol 500mg vial (Robaxin)
SKELETAL MUSCLE RELAXANTS-Oral
Carisoprodol 350mg tabs (Soma)
Cyclobenzaprine 10mg tabs (Flexeril)
Dantrolene 25mg caps (Dantrium)
Diazepam 2mg, 5mg tabs (Valium)
Lioresal 10mg tabs (Baclofen)
Methocarbamol 500mg tabs (Robaxin)
Orphenadrine 100mg tabs (Norflex)
Orphenadrine/Aspirin/Caffeine 25mg/385mg/30mg tabs (Norgesic)
ANTIPARKINSON AGENTS
Benztropine mesylate 2mg amps (Cogentin)
Benztropine mesylate 1mg tabs (Cogentin)
Carbidopa/Levodopa 10/100mg, 25/100mg, 25/250mg tabs (Sinemet)
Carbidopa/Levodopa CR 50/200mg tabs (Sinemet CR)
Pergolide mesylate 0.25mg tabs (Permax)
Pramipexole 0.125mg, 0.25mg tabs (Mirapex)
Ropinirole 0.25mg tabs (Requip)
Selegiline 5mg caps (Eldepryl)
CHOLINERGIC MUSCLE STIMULANTS
Edrophonium 10mg/ml vials (Tensilon)
Neostigmine 1:1000 vials (Prostigmine)
SMOKING DETERRENTS
Nicotine Polacrilex 4mg inhalers (Nicotrol Inhalers)
Nicotine Transdermal Patches 14mg (Nicoderm)
MARSHALL REGIONAL MEDICAL CENTER
PHARMACY FORMULARY- CONT.
SECTION 5: DERMATALOGICALS/TOPICALS
ANTIHISTAMINES, TOPICAL
Diphenhydramine 2% Cream (Benadryl)
ANTI-INFECTIVES, TOPICAL
Acyclovir 5% Ointment (Zovirax)
Boric Acid 10% Powder
Clotrimazole 1% Cream (Lotrimin)
Clotrimazole/Betamethasone Cream (Lotrisone)
Gentamicin 0.1% Cream, Ointment
Hexachlorophene 3% Liquid (Phisohex)
Ketoconazole 2% Cream (Nizoral)
Miconazole 2% Cream
Miconazole Powder (Mitrazol)
Mupirocin 2% Cream (Bactroban)
Neomycin/Polymyxin B/Bacitracin Ointment (Triple Antibiotic Ointment)
Neomycin/Polymyxin B/Parmoxine Cream (Neosporin Plus Cream)
Nitrofurazone 0.2% (Furacin Soluble Dressing)
Nystatin 100,000u Cream, Ointment
Nystatin/Triamcinolone Cream, Ointment (Mycolog)
Povidone Iodine 10% Ointment (Betadine)
Povidone Iodine 10% Solution (Betadine Solution)
Povidone Iodine 7.5% Surgical Scrub (Betadine Scrub)
Silver Nitrate Applicators
Silver Sulfadiazine 1% Cream 50gm, 400gm (Silvadene, Thermazene)
Sodium Hypochlorite 0.5% (Dakins Solution)
Terbinafine 1% Cream (Lamisil AT)
Triple Dye Applicators
ANTI-INFLAMMATORY AGENTS
Aclometasone 0.05% Cream (Aclovate)
Betamethasone valerate 0.1% Cream, Ointment (Valisone)
Clobetasol Propionate 0.05% Cream, Ointment (Temovate)
Desonide 0.5% Lotion (DesOwen)
Desoximetasone 0.25% Cream (Topicort)
Fluocinonide 0.05% Cream, Ointment (Lidex)
Halcinonide 0.1% Cream (Halog)
Halobetasol 0.05% Ointment (Ultravate)
Hydrocortisone 0.5% Cream, 1% Cream, Ointment
Hydrocortisone Valerate 0.2% Cream (Westcort)
Mometasone 0.1% Cream (Elocon)
Nystatin/Triamcinolone Cream, Ointment (Mycolog)
Triamcinolone 0.025% Ointment (Kenalog)
Triamcinolone 0.1% Cream (Kenalog)
Triamcinolone 0.1% Dental Paste (Kenalog/Orabase)
ANTI-PSORIATIC AGENTS
Methotrexate 50mg vials
Selenium 2.5% Shampoo (Selsun)
ASTRINGENTS
Aluminum Sulfate/Calcium Acetate Soaks (Bluboro, Domeboro)
DESTRUCTIVE AGENTS
Podophyllum Resin (Podocon)
EMOLLIENTS
Lactic Acid 12% Lotion (Lac-Hydrin)
Lactic
Lanolin Hydrous
Mineral Oil/Hyrdrogenated Castor Oil/Sodium Lactate/Urea (Eucerin Plus)
Mineral Oil/Sorbitan Lotion (Neutraderm)
Oatmeal Bath (Aveno)
ENZYMES
Papin/Urea Ointment (Accuzyme)
Trypsin/Balsam Peru topical (Xenaderm)
Trypsin/Balsam/Castor Oil Spray (Granulex)
Papain/Urea/Chlorophyllin Copper Ointment (Panafil)
IMMUNOMODULATORS
Pimecrolimus 1% Cream (Elidel)
LOCAL ANESTHETICS-TOPICAL
Cocaine 4% Topical Solution
Benzocaine 20% Spray (Dermoplast)
Benzocaine/Tetracaine 14%/2% Spray (Cetacaine) Lidocaine Lidocaine 5% Ointment
Lidocaine/Prilocaine 2.5%/2.5% Cream (Emla)
PROTECTANTS
Benzoin Compound Tincture
Lanolin 50% Skin Cream (Lantiseptic)
New Skin
Zinc Oxide 10% (Dr. Smith’s Diaper Cream)

RUBS AND LINAMENTS
Methyl Salicylate/Menthol Ointment (Ben-Gay)
Trolamine Salicylate 10% Cream (Myoflex)
MISCELLANEOUS
Aloe Vera
Becaplermin 100mcg gel (Regranex) **Special Order Item
Calamine/Zinc Oxide Lotion (Calamine Lotion)
Capsaicin 0.025% Cream (Capsin, Zostrix)
Crotamiton
Permethrin 5% Cream (Elimite), 1% Crème Rinse (Nix)
Petrolatum Jelly (Vaseline)
Petrolatum/Mineral Oil (Aquaphor)
Promethazine Gel 25mg (Phenergan)
RECTAL PREPARATIONS
Benzocaine Hemorrhoid Ointment 20% (Americaine)
Hydrocortisone ½% Cream (Corticaine)
Hydrocortisone 2.5% Cream, suppositories (Anusol HC)
Hydrocortisone/Pramoxine 1%/1% Cream (Proctofoam HC)
Witch Hazel 50% Pads (Tucks)
VAGINAL PREPARATIONS
Clotrimazole 1% Vaginal Cream (Gyne Lotrimin)
Clotrimazole Vaginal Inserts (Gyne Lotrimin)
Estrogens, Conjugated 0.625mg/gm Vaginal Cream (Premarin)
Metronidazole 0.75% Vaginal (Metrogel)
Miconazole Nitrate Vaginal Cream
Povidone Iodine Douche (Betadine)
Sulfanilamide 15% Vaginal Cream (AVC Cream)
Terconazole Vaginal Inserts (Terazol-3)
Vinegar Douche (Summer’s Eve)
MARSHALL REGIONAL MEDICAL CENTER
PHARMACY FORMULARY (Cont.)
SECTION 6: ENDOCRINE/METABOLIC AGENTS
ESTROGENS
Estradiol 1mg tabs (Estrace)
Estradiol cypionate 5mg/ml 10ml vials
Estradiol Transdermal System 0.05mg, 0.1mg patches (Climara) Estradiol valerate 20mg vial (Delestrogen) Estrogens, conjugated 0.3mg, 0.625mg, 1.25mg tabs (Premarin) Estrogens, conjugated 25mg vials (Premarin IV) Estrogens, conjugated Vaginal Cream (Premarin) SELECTIVE ESTROGEN RECEPTOR MODULATORS
Roloxifene 60mg tabs (Evista)
PROGESTINS
Medroxyprogesterone 2.5mg tabs (Provera)
Megestrol acetate 40mg tabs, 40mg/ml suspension

ESTROGEN/ANDROGEN COMBINATIONS
Estrogen/Methyltestosterone 0.625/1.25mg tabs (Estratest H.S.)
CONTRACEPTIVES
Estrogen/Norgestrel tabs (Lo Ovral)
Medroxyprogesterone 150mg vials (Depo Provera)
ANDROGENS
Testosterone 200mg/ml vials (Depo
Finasteride 5mg tabs (Proscar)
ABORTIFACIENTS/PROSTAGLANDINS
Carboprost
Dinoprostone 20mg Vaginal Suppositories (Prostin E2) CERVICAL RIPENING AGENTS
Dinoprostone

OXYTOCICS
Methylergonovine 0.2mg tabs, 0.2mg amps (Methergine)
Oxytocin 10units/ml vials (Pitocin)
BIPHOSPHONATES
Alendronate 10mg tabs (Fosamax)
Pamidronate 30mg vial (Aredia)
ANTIDIABETIC AGENTS
Chlorpropamide 100mg, 250mg tabs (Diabinese)
Glimepiride 2mg tabs (Amaryl)
Glipizide 5mg tabs (Glucotrol)
Glipizide XL 5mg, 10mg tabs (Glucotrol XL)
Glyburide 2.5mg, 5mg tabs (Diabeta)
Glyburide 3mg tabs (Glynase)
Metformin 500mg, 850mg tabs (Glucophage)
Precose 50mg tabs (Acarbose)
Proglitazone 15mg tabs (Actos)
Repaglinide 0.5mg tabs (Prandin)
Rosiglitazone 2mg tabs (Avandia)
Tolazamide 100mg tabs (Tolinase)
Tolbutamide 500mg tabs (Orinase)
Insulin, Human Regular, NPH, 70/30, Lente, Humalog, Lantus
GLUCOSE ELEVATING AGENTS
Glucagon 1mg vials
ADRENOCORTICAL STEROIDS
Betamethasone 6mg syringe (Celestone)
Cosyntropin 0.25mg vials (Cortrosyn)
Dexamethasone 0.5mg, 4mg tabs, 0.5mg/5ml liquid (Decadron)
Dexamethasone 4mg/ml vial (Decadron)
Fludrocortisone acetate 0.1mg tabs (Florinef)
Hydrocortisone enema (Cortenema)
Hydrocortisone sodium succinate 100mg, 250mg, 500mg vials (Solu Cortef)
Methylprednisolone 4mg tabs, 21 tab dospack (Medrol)
Methylprednisolone acetate 40mg/ml vials (Depo Medrol)
Methylprednisolone sodium succinate 40mg, 125mg 500mg vials (Solu Medrol)
Prednisolone 15mg/5ml syrup (Prelone)
Prednisolone sodium phosphate 5mg/5ml liquid (Pediapred)
Prednisone 1mg, 10mg, 50mg tabs, 5mg/5ml oral solution
Triamcinolone acetonide 40mg/ml vials (Kenalog)
THYROID DRUGS
Levothyroxine 0.025mg, 0.075mg, 0.088mg, 0.1mg, 0.112mg tabs, 200mcg vials
(Synthroid)
Thyroid 30mg tabs (Armour Thyroid)

ANTITHYROID AGENTS
Iodine, Strong Solution (Lugol’s)
Propylthiouracil 50mg tabs (PTU)
Methimazole 10mg tabs (Tapazole)
POSTERIOR PITUITARY HORMONES
Vasopressin 20units/ml vials (Pitressin)
CALCITONIN-SALMON 200IU/ml vials, 200IU Nasal spray (Calcimar, Miacalcin)
AGENTS FOR GOUT
Allopurinol 100mg tabs (Zyloprim)
Colchicine 0.6mg tabs
Probenecid 500mg tabs
EMERGENCY KITS
Cyanide Antidote Kit containing Sod nitrate, Sod thiosulfate, amyl nitrate ***In ER
ANTIDOTES
Charcoal, activated liquid (Actidose)
Charcoal, activated w/sorbitol liquid (Actidose w/sorbitol)
Deferoxamine 500mg vials (Desferal)
Digoxin Immune FAB 38mg vials (Digibind)
Dimercaprol 100mg/ml vials (BAL in Oil)
Edetate Calcium Disodium 200mg/ml amps (Calcium EDTA,Calcium Disodium
Versenate)
Flumazenil 0.1mg/ml vials (Romazicon)
Ipecac Syrup
Methylene Blue 10mg/ml amps
Mucomyst 20% solution
Naloxone 1mg/ml amps (Narcan)
Physostigmine 1mg/ml amps (Antilerium)
Pralidoxime 1gm vials (2PAM, Protopam)
Sodium Thiosulfate 250mg/ml vials


MARSHALL REGIONAL MEDICAL CENTER
PHARMACY FORMULARY (Cont.)
SECTION 7: GASTROINTESTINAL AGENTS

HISTAMINE H2 ANTAGONISTS
Cimetidine 200mg, 300mg tabs, 200mg/5ml oral solution (Tagamet)
Famotidine 20mg tabs, 10mg/ml vials, 20mg/50ml premix (Pepcid)
Ranitidine 25mg/ml vials (Zantac)
****Restricted to Continuous Drip Only

PROTON PUMP INHIBITORS
Pantoprazole 20mg, 40mg tabs, 40mg vial (Protonix)
SUCRALFATE 1gm tabs, 1gm/10ml suspension (Carafate)
PROSTAGLANDINS
Misoprostol 25mcg, 200mcg tabs (Cytotec) ****25mcg for L&D Use
ANTACIDS
Aluminum Hydroxide Gel 320mg/5ml suspension (Amphogel)
Aluminum Hydroxide/Magnesium Carbonate liquid (Gaviscon, Genaton)
Aluminum Hydroxide/Magnesium Trisilicate chew tabs (Gaviscon)
Aluminum Hydroxide/Magnesium Hydroxide tabs, liquid (Maalox)
Aluminum Hydroxide/Magnesium Hydroxide/Simethicone (Maalox Plus)
Aluminum Hydroxide/Magnesium Hydroxide/Simethicone (Mylanta D.S.)
Bismuth Subsalicylate chew tabs, liquid (Pepto Bismol)
Calcium Carbonate 500mg chew tabs (Tums)
Calcium Carbonate 420mg tabs (Titralac)
Magaldrate 540mg/5ml (Riopan)
Magnesium Hydroxide 400mg/5ml liquid (Milk of Magnesia, MOM)
Magnesium Oxide 140mg tabs (Uro-Mag)
Sodium
Sodium Citrate/Citric Acid Solution (Bicitra)
ANTICHOLINERGICS/ANTISPASMODICS
Atropine sulfate 0.1mg/ml vials
Atropine/Scopolamine/Hyoscyamine/Phenobarb Elixir (Donnatal)
Belladonna Tincture
Chlordiazepoxide/Clindinium 5mg/2.5mg caps (Librax)
Dicyclomine 20mg tabs, 10mg/5ml syrup, 10mg/ml vials (Bentyl)
Glycopyrolate 0.2mg/ml vials (Robinul)
Hyoscyamine 0.125mg sublingual tabs, 0.125mg/ml 15ml drops (Levsin)
Hyoscyamine Extended Release 0.375mg tabs (Levbid)
MESALAMINE 400mg delayed release tabs (Asacol), 4gm/60ml rectal susp (Rowasa
Rectal Susp)
OLSALAZNE 250mg caps (Dipentum)
SULFASALAZINE 500mg tabs (Azulfidine)
LAXATIVES
Bisacodyl 5mg enteric coated tabs, 10mg suppositories (Dulcolax)
Castor Oil
Docusate Calcium 240mg caps (Surfak)
Docusate Sodium 50mg caps (Colace)
Docusate/Casanthranol 100/30mg caps (Doxidan)
Docusate/Senna tabs (Senokot S)
Fleet Enema
Fleet Pediatric Enema
Fleet Bisacodyl Enema
Fleet Mineral Oil Enema
Fleet Prep Kit #3
Glycerin Suppositories Adult, Pedi
Lactulose 10gm/15ml solution
Magnesium Hydroxide 400mg/5ml liquid (Milk of Magnesia, MOM)
Methylcellulose 2gm powder pkts. (Citrucel)
Mineral Oil
Monobasic Sodium phosphate/dibasic sodium phosphate solution (Fleet Phospho-soda)
Polycarbophil 500mg tabs (Fibercon)
Polyethylene Glycol-electrolyte solution 4 liters (NuLytely, GoLytely, CoLyte)
Polyethylene Glycol-electrolyte 14 oz. Solution (Miralax)
Psyllium 6gm powder pkts (Konsyl)
Psyllium 3.4gm powder pkts (Metamucil)
ANTIDIARRHEALS
Attapulgite 750mg/15ml liquid (Kaopectate)
Bismuth Subsalicylate 262mg chew tabs, 262mg/15ml liquid (Pepto-Bismol)
Diphenoxylate/Atropine 2.5mg/0.025mg tabs, liquid (Lomotil)
Loperamide 2mg caps, 1mg/5ml liquid (Imodium)
ANTIFLATULENTS
Simethicone 80mg chew tabs (Mylicon 80)
Simethicone 40mg/0.6ml drops (Mylicon Drops)
GI STIMULANTS
Metoclopramide 10mg tabs, 10mg/2ml vials, 10mg/5ml liquid (Reglan)
DIGESTIVE ENZYMES
Pancrelipase caps (Pancrease)
GALLBLADDER AGENTS
Ursodiol 300mg caps (Actigall)
MOUTH AND THROAT PRODUCTS
Benzocaine/Menthol lozenges, spray (Chloraseptic)
Cetylpyridinium chloride lozenges (Cepacol Lozenges)
Clotrimazole 10mg troches (Mycelex)
Triamcinolone0.1% dental paste (Kenalog in Orabase)
RECTAL AGENTS
Belladonna/Opium No. 16A suppositories 16.2/60mg (B&O)
Benzocaine 20% Ointment (Americaine Hemorrhoidal Ointment)
Hydrocortisone ½% Cream (Corticaine)
Hydrocortisone acetate 25mg suppositories, 2.5% cream (Anusol HC)
Hydrocortisone acetate/pramoxine 1% aerosol foam (Proctofoam HC)
Pramoxine 1% suppositories (Anusol)
Witch Hazel 50% pads (Tucks)



MARSHALL REGIONAL MEDICAL CENTER
PHARMACY FORMULARY (Cont.)
SECTION 8: HEMATOLOGICAL AGENTS
HEMATOPOIETIC AGENTS
Epoetin Alfa 4000u/ml, 10,000u/ml, 20,000u/ml vials (Epogen)
Filgrastim 300mcg/ml vials (Neupogen)
ANTIPLATELET AGENTS
Cilostazol 50mg tabs (Pletal)
Clopidogrel 75mg tabs (Plavix)
Dipyridamole 25mg tabs (Persantine)
Ticlopidine 250mg tabs (Ticlid)
Tirofiban 250mcg/ml 25 ml vial (Aggrastat)
ANTICOAGULANTS
Enoxaparin 30mg/0.3ml syringe (Lovenox)
Heparin sodium 5000u/ml vials, premix drip
Warfarin 2mg, 2.5mg, 5mg tabs (Coumadin)
COAGULANTS/HEPARIN ANTAGONIST
Protamine 10mg/ml amps
THROMBOLYTIC AGENTS
Alteplase 2mg, 50mg vials (Activase, TPA)
Reteplase Kit 10.8 IU (Retavase)
HEMORRHEOLOGIC AGENTS
Pentoxifylline 400mg tabs (Trental)
HEMOSTATICS
Absorbable Gelatin Sponge (Gelfoam)
Aminocaproic Acid 250mg/ml vials, syrup (Amicar)
Thrombin, topical (Thrombogen, Thrombostat)
PLASMA EXPANDERS
Albumin Human 25% 50ml vials (Albuminar 25)
Hetastarch 6gm/100ml infusion bottles (Hespan) MARSHALL REGIONAL MEDICAL CENTER
PHARMACY FORMULARY (Cont.)
SECTION 9: NUTRITIONALS
VITAMINS
Ascorbic Acid Vitamin C 500mg tabs
Calcitriol 0.25mg caps (Rocaltrol)
Cyanocobalamin Vitamin B12 100mcg/ml vials
Dihydrotachysterol 0.4mg tabs (DHT)
Folic Acid 1mg tabs, 5mg/ml vials (Folvite)
Niacin Vitamin B3 100mg tabs (Nicotinic Acid)
Pyridoxine Vitamin B6 50mg tabs
Thiamin Vitamin B1 100mg tabs, 100mg/ml vials (Thiamine)
Vitamin E 400 IU caps
Vitamin K 5mg tabs, 1mg/ml, 10mg/ml amps (Mephyton, AquaMephyton)
MINERALS
Calcium Carbonate 500mg tabs (Oscal, Oyster Shell Calcium)
Calcium Carbonate/Vitamin D tabs (Oscal D)
Magnesium Oxide 140mg caps, 84.5mg elemental magnesium (Uro-Mag)
Magnesium S.R. tabs, 64mg elemental magnesium (Slow-Mag)
Phosphorus/Potassium/Sodium tablets (K-Phos Neutral)
IRON PRODUCTS
Ferrous Gluconate 300mg tabs (Fergon
Ferrous Sulfate 325mg tabs (Feosol)
Ferrous Sulfate 75mg/0.6ml drops (Fer-In-Sol, Fer-gen-sol)
Ferrous Sulfate Exsiccated 160mg S.R. tabs (Slow FE)
Iron Dextran 50mg/ml amps (InFeD)
Polysaccharide-Iron Complex 150mg caps, 100mg/5ml liquid (Niferex)
MULTIPLE VITAMINS W/IRON
Ferrous Fumarate/Vitamins tabs (Hemocyte Plus)
Iron/Folic Acid/Vitamin B12 Complex Elixir (Hemocyte F)
Iron/B Complex/Intrinsic Factor caps (Trinsicon)
Iron/B Complex/Docusate tabs (Nephron FA)
Multiple Vitamin Liquid (Vidaylin, Dalyvite)
Multiple Vitamin Drops (Vidaylin Drops)
Multiple Vitamin/Iron Drops (Vidaylin w/Iron Drops)
Precare Prenatal Vitamins tabs
Therapeutic M tabs (Theragran M)
Theragran Hematinic tabs
ZINC GLUCONATE 50mg tabs, 220mg caps, 23mg lozenges
POTASSIUM CHLORIDE 20meq tabs (K-Dur), 20meq/15ml liquid

SYSTEMIC ALKALINIZERS
Potassium Citrate 5meq tabs (Urocit-K)
Sodium Citrate/Citric Acid Solution (Bicitra)
Sodium Bicarbonate 648mg tabs
ENZYMES
Lactase tabs (LactAid)
Lactobacillus granules (Lactinex)
ENTERAL/ORAL NUTRITIONAL PRODUCTS
Medium chain triglycerides (MCT Oil)
INTRAVENOUS NUTRITIONAL PRODUCTS
Amino Acid 3.5%, 5%, 8.5%, 10% (Aminosyn)
Amino Acid for peripheral use (ProcalAmine)
Dextrose 10%, 20%, 50%
Lipids 10%, 20% (Liposyn)
Calcium Chloride 10% vial
Calcium Gluconate 10% vial
Folic Acid 1mg/ml vial (Folvite)
Magnesium Sulfate 50% vial
MVI concentrate 5ml vial
Potassium Chloride 20meq vial
Potassium Phosphate 15mm vial
Sodium Acetate 40meq vial
Sodium Bicarbonate 50meq vial
Sodium Chloride 50meq vial
Sodium Phosphate 45mm 15ml vial
Trace Elements 5ml vial
Zinc Sulfate 10mg vial
MARSHALL REGIONAL MEDICAL CENTER
PHARMACY FORMULARY (Cont.)
SECTION 10: OPHTHALMICS & OTICS
AGENTS FOR GLAUCOMA
Acetylcholine chloride, intraocular 1:100 solution (Miochol-E)
Apraclonidine HCl 0.5%, 1% solution (Iopidine)
Betaxolol 0.25% suspension (Betoptic S)
Brimonidine tartrate 0.2% solution (Alphagan)
Carteolol 1% solution (Ocupress)
Dorzolamide 2% solution (Trusopt)
Dorzolamide 2%/Timolol 0.5% 5ml solution (Cosopt)
Ketorolac 0.5% 3ml solution (Acular)
Latanoprost 0.005% solution (Xalatan)
Levobunolol 0.25% solution (Betagan)
Physostigmine 0.25% ointment (Eserine)
Pilocarpine 0.5%, 1%, 2%, 3%, 4% solution (Isopto Carpine)
Timolol 0.25%, 0.5% solution (Timoptic)
Timolol 0.5% gel forming solution (Timoptic XE)
NONSTEROIDAL ANTI-INFLAMMATORY AGENTS
Diclofenac sodium 0.1% solution (Voltaren)
Flurbiprofen 0.03% solution (Ocufen)
CORTICOSTEROIDS
Prednisolone acetate 1% suspension (Pred Forte)
OPHTHALMIC VASOCONSTRICTORS
Phenylephrine HCl 2.5%, 10% solution (Mydfrin, Neo-Synephrine)
OPHTHALMIC DECONGESTANTS
Atropine sulfate 1% solution
Cyclopentolate HCl 1%, 2% solution (Cyclogyl)
Homatropine HBr 2%, 5% solution (Isopto Homatropine)
Naphazoline HCl/Antazoline phosphate 0.05%/0.5% solution (Vasocon A)
Scopolamine HBr 0.25% solution (Isopto Hyoscine)
Tropicamide 0.5%, 1% solution (Mydriacyl)

ANTIBIOTICS
Bacitracin/Polymyxin B ointment (Polysporin)
Ciprofloxacin 3.5mg/ml solution and ointment (Ciloxan)
Erythromycin 5% ointment (Ilotycin)
Gatifloxacin 0.3% 2.5ml solution (Zymar)
Gentamicin 3mg/ml solution, 3mg/gm ointment
Moxifloxacin 0.5% 3ml solution (Vigamox)
Neomycin/Bacitracin/Polymyxin B ointment (Neosporin, Triple Antibiotic)
Neomycin/Polymyxin B/Gramicidin solution (Neosporin, Triple Antibiotic)
Ofloxacin 3mg/ml solution (Ocuflox)
Sulfacetamide sodium 10% ointment (Sodium Sulamyd)
Sulfacetamide Sodium 10% solution (Bleph-10)
Tobramycin 0.3% solution, 3mg/gm ointment (Tobrex)
STEROID/ANTIBIOTIC COMBINATIONS
Neomycin/Polymyxin B/Dexamethasone suspension, ointment (Maxitrol)
Sulfacetamide/Prednisolone suspension (Isopto Cetapred)
Tobramycin/Dexamethasone suspension (Tobradex)
ANTIVIRAL AGENTS
Trifluridine 1% solution (Viroptic)
OCULAR LUBRICANTS/ARTIFICIAL TEARS
Hydroxypropyl methylcellulose solution (Isopto Tears)
Mineral Oil/Petrolatum ointment (Lacri-Lube NP)
LOCAL ANESTHETICS
Proparacaine 0.5% solution (Alcaine)
Tetracaine 0.5% solution
DIAGNOSTICS
Fluorescein sodium strips (Fluor-I-Strip)
SURGICAL ADJUNCTS
Balanced Salt Solution (BSS)
Hydroxyethylcellulose solution (Gonioscopic)
Sodium Hyaluronate (Healon)
Sodium Hyaluronate/Sodium Hyaluronate/Chondroitin Sulfate (DuoVisc)
Sodium Hyaluronate/Chondroitin Sulfate (Viscoat)
NON-SURGICAL IRRIGANTS
Eye Stream 30ml
MISCELLANEOUS OPHTHALMICS
Povidone Iodine 5% solution (Betadine)
Sodium Chloride, hypertonic 5% solution (Adsorbonac)
Sodium Chloride, hypertonic 5% ointment (Muro 128)
OTICS
Antipyrine/Benzocaine otic solution (Aurodex, Auralgan)
Carbamide Peroxide 6.5% otic solution (Debrox)
Neomycin/Polymyxin B/Hydrocortisone otic suspension (Cortisporin Otic Susp)
MARSHALL REGIONAL MEDICAL CENTER
PHARMACY FORMULARY (Cont.)
SECTION 11: RENAL/GENITOURINARY
INTERSTITIAL CYSTITIS AGENTS
Phenazopyridine 100mg tabs (Pyridium)
URINARY ALKALINIZERS
Potassium Citrate 5meq tabs (Urocit-K)
Sodium Bicarbonate 648mg tabs
Sodium Citrate/Citric Acid Solution (Bicitra)
URINARY ACIDIFIERS
Potassium Acid Phosphate 500mg tabs (K-Phos Original)
Potassium Acid Phosphate/Sodium Acid Phosphate tabs (K-Phos Neutral)
ANTICHOLINERGICS
Flavoxate 100mg tabs (Urispas)
Oxybutynin 5mg tabs (Ditropan)
Osybutynin 5mg extended release tabs (Ditropan XL)
Tolterodine 2mg tabs (Detrol)
CHOLINERGICS
Neostigmine 1:1000 10ml vials
VAGINAL PREPARATIONS
Clotrimazole 1% Vaginal Cream (Gyne Lotrimin)
Clotrimazole Vaginal Inserts (Gyne Lotrimin)
Estrogens, Conjugated 0.625mg/gm Vaginal Cream (Premarin)
Metronidazole 0.75% Vaginal (Metrogel)
Miconazole Nitrate Vaginal Cream
Povidone Iodine Douche (Betadine)
Terconazole Vaginal Inserts (Terazol-3)
Vinegar Douche (Summer’s Eve)
DIURETICS
Acetazolamide 250mg tabs, 500mg S.R. caps, 500mg vials (Diamox, Diamox Sequels)
Amiloride/HCTZ 5mg/50mg tabs (Moduretic) Bumetanide 1mg tabs, 0.5mg/2ml vials (Bumex) Chlorthalidone 25mg tabs (Hygroton) Furosemide 20mg, 40mg tabs, 20mg/2ml vials, 40mg/5ml liquid Glycerin 50% 200ml solution (Osmoglyn) Hydrochlorothiazide 25mg tabs (HCTZ) Indapamide 2.5mg tabs (Lozol) Mannitol 25% 50ml vials Metolazone 2.5mg tabs (Zaroxolyn) Spironolactone 25mg tabs (Aldactone) Torsemide 20mg tabs, 10mg/ml amps (Demadex) Triamterine/HCTZ 37.5mg/25mg tabs (Maxzide-25mg) Triamterine/HCTZ 75mg/50mg tabs (Maxzide) MARSHALL REGIONAL MEDICAL CENTER
PHARMACY FORMULARY (Cont.)
SECTION 12: RESPIRATORY AGENTS
BRONCHODILATORS-Oral
Albuterol 2mg tabs, 4mg SR tabs, 2mg/5ml syrup (Proventil, Proventil SR)
Diphylline/Guaifenessin tabs (Dilor G)
Theophylline SR (8-12 hours) 100mg, 200mg, 300mg tabs (Quibron TSR)
Theophylline SR (24 hours) 100mg (Theo 24)
Theophylline 80mg/15ml elixir
BRONCHODILATORS- Injectable
Aminophylline 250mg vials
Isoproterenol 0.2mg/ml amps (Isuprel)
Terbutaline 5mg tabs, 1mg/ml amps (Brethine)
BRONCHODILATORS-Inhalation
Albuterol Inhalant Solution 0.083% 3ml, 0.5% 20ml (Proventil, Ventolin)
Albuterol 90mcg aerosol MDI (Proventil, Ventolin)
Albuterol/Ipratropium aerosol MDI (Combivent)
Epinephrine, racemic 2.25% solution
Formoterol furarate Inhalation Powder (Foradil)
Ipratropium bromide Inhalant Solution 0.02%, 18mcg aerosol MDI (Atrovent)
Levalbuterol Inhalant Solution 0.63mg, 1.25mg (Xopenex)
LEUKOTRIENE RECEPTOR ANTAGONISTS
Montelukast 5mg chewable tabs (Singulair)
Zafirlukast 20mg tabs (Accolate)
CORTICOSTEROIDS-Inhalation
Fluticasone propionate 220mcg aerosol MDI (Flovent)
Triamcinolone acetonide 100mcg aerosol MDI (Azmacort)
MISCELLANEOUS INHALATION PRODUCTS
Acetylcysteine 10%, 20% solution (Mucomyst)
Cromolyn Sodium 20mg/2ml vials for inhalation

NASAL INHALANT PRODUCTS
Azelastine HCl 137mcg spray (Astelin)
Beclomethasone dipropionate 84mcg spray (Vancenase AQ)
Fluticasone propionate 0.05% spray (Flonase)
Ipratropium bromide 0.03% spray (Atrovent)
Mometasone furoate monohydrate 50mcg spray (Nasonex)
Phenylephrine 0.25%, 0.5% spray (Neo-Synephrine)
Oxymetazoline 0.05% spray (Afrin)
Sodium Chloride 0.65% spray (Ocean)
Triamcinolone acetonide 55mcg spray (Nasacort AQ)
ANTIHISTAMINES/DECONGESTANTS
Chlorpheniramine maleate 4mg tabs (Chlor-Trimeton)
Cyproheptadine 4mg tabs, 2mg/5ml syrup (Periactin)
Diphenhydramine 25mg caps, 50mg/ml inj (Benadryl)
Fexofenadine 60mg, 180mg tabs (Allegra)
Fexofenadine/Pseudoephedrine 60/120mg tabs (Allegra D)
Hydroxyzine 10mg tabs, 25mg caps, 50mg/ml vials
Loratadine 10mg tabs (Claritin)
Loratadine/Pseudoephedrine 12 & 24 hour tabs (Claritin D, Claritin D 24)
Promethazine 25mg tabs, 12.5mg, 25mg, 50mg supp, 25mg/ml amps (Phenergan)
Pseudoephedrine 30mg tabs, liquid (Sudafed)
Pseudoephedrine/Dexbrompheniramine tabs (Drixoral, Disobrom)
Pseudoephedrine/Guaifenessin tabs (Entex PSE)
ANTITUSSIVE/EXPECTORANTS
Benzonatate 100mg caps (Tessalon)
Codeine 30mg tabs
Guaifenessin 100mg/5ml syrup (Robitussin)
Guaifenessin 600mg SR tabs (Humibid LA, Fenessin)
Guaifenessin/Dextromethorphan syrup (Robitussin DM)
Guaifenessin/Dextromethorphan tabs (Humibid DM)
Guaifenessin/Codeine syrup (Robitussin AC)
Guaifenessin/Codeine/Pseudoephedrine syrup (Robitussin DAC)
Hydrocodone/Guaifenessin liquid (Hycotuss Exp)
Hydrocodone/Pseudoephedrine liquid (Histussin D, H.C.Tussin)
Pseudoephedrine/Carbinoxamine/Dextromethorphan drops (Cardec DM)

Source: http://marshallortho.net/PharmacyFormulary.pdf

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