HOLLOMAN AFB FORMULARYDISPENSING POLICIES /                           from the date they were written with up to 5PROCEDUR...
HOLLOMAN AFB FORMULARY                             Amox / Clav (Augmentin)     Griseofulvin (Grifulvin-V) I. Anti-Infectiv...
Nitroglycerin sl Tabs         Ezetimibe (Zetia)                    320mg/12.5mg,    0.3mg, 0.4mg, Pump            Tabs10mg...
HOLLOMAN AFB FORMULARYDoxazosin (Cardura)          Furosemide (Lasix) Tabs    Primidone (Mysoline) Tabs   Tabs 2mg, 4mg, a...
Citalopram (Celexa) Tabs          XR) Tabs 150mg,         Buspirone (Buspar) Tabs    20mg, 40mg                    200mg, ...
HOLLOMAN AFB FORMULARY**Acetaminophen 325 mg /    Nystatin/Triamcinolone    Butalbital 50 mg /          (Mycolog) Cream   ...
Hyoscyamine / Atropine /      Mesalamine (Asacol) Tabs     Doxazosin (Cardura) Tabs    Phenobarbital/               400 mg...
HOLLOMAN AFB FORMULARYInsulin Glargine Pen         Syringes, insulin 0.5mL       Depo-Provera 150mg/ml    (Lantus Solostar...
**Morphine sulfate IR                               (MSIR) 15mg, 30mg        NSAIDS                                       ...
HOLLOMAN AFB FORMULARYCarteolol (Ocupress) Soln     Ciprofloxacin /               Guaifenesin /    1%                     ...
Flunisolide (Aerobid)        Ipratropium (Atrovent)       Cyanocobalamin (Vit B 12)     Inhaler 250mcg / puff       Spray ...
HOLLOMAN AFB FORMULARYSodium Fluoride             Pramozine/Hydrocortisone    (PreviDent) 1.1% gel       (Proctofoam HC)  ...
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Holloman AFB Formulary

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Holloman AFB Formulary

  1. 1. HOLLOMAN AFB FORMULARYDISPENSING POLICIES / from the date they were written with up to 5PROCEDURES refills. Prescriptions for Schedule 2 medications will be honored for 7 days fromMAIN Pharmacy the date they were written with no refills.280 First St, Bldg 15 Providers are reminded to include their DEAHolloman AFB, NM 88330 number on all controlled prescriptions.Open: 0730 – 1630, M-FTEL. NO: (575) 572-2778 - REFILL POLICY: Refills MUST be calledFAX No: (575) 572-5781 in through the automated refill system atREFILL Pharmacy 572-7045. They may be called in 7 daysTEL. NO: (575) 572-7045 / 1-800-843-4682 before the Rx should run out. Please allow for 2 duty days for refills to be ready.The Pharmacy is closed: Saturday, Sunday,all federal holidays and specially designated - Although medications are provided at no ‘down’ days cost to our patients, this service is not free— the American taxpayer pays the bill. Please-The pharmacy must use generic consider less expensive alternativesmedication whenever possible so please whenever possible when prescribing.write all medications generically. TRICARE MAIL ORDER PHARMACY-A prescription written as “Dispense as (EXPRESS SCRIPTS): ContactWritten” may not be accepted. 1-866-363-8667 or www.express- scripts.com/TRICARE for more information.-Drugs with narrow therapeutic margins will 30 or 90 day supply:not be generically substituted. Active duty: No cost All Other Beneficiaries: Generic $0,- TELEPHONE PRESCRIPTIONS: Per Air Formulary Brand-Name: $9; Non-FormularyForce directives, no pharmacy staff member Brand-Name: $25may receive a prescription called in from a Copayments at retail pharmacies are $5 forprovider. This also includes prescription generic drugs, $12 for brand name and $25renewals. The pharmacy can, however, for non-formulary.accept a change or substitution to a non-controlled prescription if the original **The brand name in the listings are forprescription is located within the pharmacy. reference only and do not signify the product dispensed**-Fax’s: New prescriptions for non-controlled substances and controlledsubstances in schedules III-V from providersoffices, hospitals, or nursing homes may befaxed.- NON-CONTROLLED PRESCRIPTIONS:Are honored up to 1 year from the date theprescription was written. Antibioticprescriptions over 10 days old will be filledat the discretion of the pharmacy.Prescriptions for maintenance medicationsmay be written for up to a 90 day supplywith a maximum of 3 refills when requestedby prescriber. All other non-controlledprescriptions may be written for up to 30days supply with a maximum of 11 refills.- CONTROLLED PRESCRIPTIONS(**):Prescriptions for Schedule 3, 4 or 5medications will be honored for 6 months
  2. 2. HOLLOMAN AFB FORMULARY Amox / Clav (Augmentin) Griseofulvin (Grifulvin-V) I. Anti-Infective Agents Tabs 250mg, 500mg, Oral Susp 125mg / 5 875mg mL (microsized)Cephalosporins Amox / Clav (Augmentin) Griseofulvin Ultra (Gris- Susp 125mg/5ml, Peg) Tabs 125mgCefdinir (Omnicef) Caps 400mg/5ml, Ketoconazole (Nizoral)300 mg 600mg/5ml Tabs 200mgCefdinir (Omnicef) Susp Dicloxacillin (Dynapen) Ketoconazole (Nizoral) 2%125mg/5ml, 250mg/5ml Caps 250mg ShampooCefpodoxime (Vantin) Penicillin V Pot (Pen VK) Nystatin (Mycostatin) TabsTabs 100mg, 200 mg Tabs 250mg, 500mg 500,000 unitsCefpodoxime (Vantin) Penicillin V Pot (Pen VK) Terbinafine (Lamisil) TabsSusp 100mg / 5mL Oral Susp 250mg /5mL 250mgCephalexin (Keflex) Caps250mg, 500mg Sulfonamides AntiviralCephalexin (Keflex) Susp250mg / 5mL Sulfamethoxazole 800mg / Amantadine (Symmetrel) Trimethoprim 160mg Caps 100mgFluoroquinolones (Bactrim DS) Tabs Acyclovir (Zovirax) Caps Sulfamethoxazole 200mg/ 200mg, Tabs 800mg,Ciprofloxacin (Cipro) Tabs Trimethoprim 40mg Sus 200mg/5ml 100mg, 250mg, 500 (Bactrim Pediatric) Hydroxychloroquine mg, Susp 250mg/5ml Susp (Plaquenil) TabsLevofloxacin (Levaquin) 200mg Tabs 250mg, 500mg, Tetracyclines Metronidazole (Flagyl) 750mg, Sol 25mg/ml Tabs 250mg Doxycycline (Vibramycin) Valcyclovir (Valtrex) TabsMacrolides Tabs 100mg 500mg Tetracycline (Achromycin) Azithromycin (Zithromax) Caps 250mg Antitubercular Agents Susp 200mg / 5mL Minocycline (Minocin) Azithromycin (Zithromax) Caps 100mg Ethambutol (Myambutol) Susp 100 mg / 5 mL Tabs 100mg, 400mg Azithromycin (Zithromax) Isoniazid (INH) Tabs Other Z-pak Tabs 250mg, 100mg, 300mg Tri-Pak 500mg, 1gm Isoniazid (INH) Syrup packets Clindamycin (Cleocin) 50mg / 5mL Clarithromycin (Biaxin) Caps 150mg, 300 mg Pyrazinamide Tabs 500 Tabs 250mg, 500mg Clindamycin (Cleocin) mg Erythromycin (Ery-Tab) Liquid 75mg/5ml Rifampin (Rifadin) Caps Tabs 250mg, 333mg, Nitrofurantoin 300mg 400mg (Macrodantin) Caps Erythromycin (EryPed) 50mg, 100mg Antihelmintic Agent Susp 200mg/5mL, Nitrofurantoin (Macrobid) 400mg / 5mL Caps 100mg Mebendazole (Vermox) Chew Tab 100mgPenicillins AntifungalsAmoxicillin (Trimox) Susp Fluconazole (Diflucan) II. Cardiovascular 250mg/5ml; Tabs 150mg, Susp Agents 400mg/5mL 10mg/mlAmoxicillin (Trimox) Caps Antianginals/Vasodilator 250, 500mg2
  3. 3. Nitroglycerin sl Tabs Ezetimibe (Zetia) 320mg/12.5mg, 0.3mg, 0.4mg, Pump Tabs10mg 320mg/25mg Spray, Oint 2%, Niacin (Niaspan Extended- Patches 0.1mg/hr, Release) Tabs 500mg, BETA BLOCKERS 0.2mg/hr, 0.3mg/hr, 750mg, and 1,000mg 0.4mg/hr, 0.6mg/hr, Nicotinic Acid (Niacin) Tab Atenolol (Tenormin) Tabs 0.8mg/hr 500mg 25mg, 50mg, 100mgIsosorbide Dinitrate Tabs Carvedilol (Coreg) Tabs 5mg, 10mg, 40mg SR Antihypertensives 3.125mg, 6.25mg, caps 12.5mg, and 25mgIsosorbide Mononitrate ACE Labetalol (Trandate) Tabs (Imdur) Tabs 30mg, INHIBITORS/COMBIN 200mg 60mg, and 120mg ATION PRODUCTS Metoprolol (Lopressor) Tabs 25 mg, 50mg, Amlodipine/Benazepril and 100mgAntihyperlipemics (Lotrel) Caps 2.5/10, Metoprolol XL (Toprol XL) 5/10, 5/20, 10/20, Tabs 25mg, 50mg, 5/40, 10/40 mg 100mg, and 200mg BILE ACID Captopril (Capoten) Tabs SEQUESTRANT 25mg, 50mg, and Propranolol (Inderal) Tabs 100mg 10mg, 40mgColestipol (Colestid) Lisinopril (Prinivil, Zestril) Propranolol (Inderal LA) granules 300gm/box Tabs 2.5mg, 5mg, Caps 60mg, 80mg,Colestipol (Colestid) Tabs 10mg, 20mg, 30mg, and 120mg 1gram and 40mg Lisinopril-HCTZ FIBRIC ACID (Zestoretic) Tabs DERIVATIVES 10-12.5mg, 20-25mg, CALCIUM CHANNEL 20-12.5mg BLOCKERSFenofibrate (TriCor) Tabs Ramipril (Altace) Caps 48mg, 145mg 2.5mg, 5mg, 10mg Amlodipine (Norvasc)Gemfibrozil (Lopid) Tabs Tabs 2.5mg, 5mg, 600mg ANGIOTENSIN II 10mg BLOCKERS/COMBIN Diltiazem (Tiazac) Tabs HMG-CoA REDUCTASE ATION DIURETIC 60mg INHIBITOR Diltiazem (Tiazac SR) Losartan (Cozaar) Tabs Caps 120mg, 180mg,Atorvastatin (Lipitor) Tabs 25mg, 50mg, and 240mg, 300mg, 10mg, 20mg, 40mg, 100mg 360mg, and 420mg 80mg Losartan/HCTZ (Hyzaar) Felodipine (Plendil) TabsPravastatin (Pravachol) Tabs 50/12.5mg, 2.5mg, 5mg, 10mg Tabs 10mg, 20mg, 100/25mg Nifedipine SR (Adalat CC) 40mg, and 80mg Telmisartan (Micardis) Tabs 30g, 60mg, andRosuvastatin(Crestor) Tabs 20mg, 40mg, 90mgTabs 5mg, 10mg, 20mg, and 80mg Verapamil (Calan) Tabs40mg Telmisartan/Hctz (Micardis 80mgSimvastatin (Zocor) Tabs HCT) 80mg/12.5mg, Verapamil (Calan SR)5mg, 10mg, 20mg, 40mg, 80mg/25mg, Tabs 120mg,180mg,and 80mg 40mg/12.5MG 240mgEzetimibe/Simvastatin Valsartan (Diovan) Tabs(Vytorin) Tabs 10/10, 40mg, 80mg, 160mg, ALPHA-ADRENERGIC10/20, 10/40, 10/80 mg 320mg BLOCKERS Valsartan/HCTZ (Diovan MISC HCT) Tabs 80mg/12.5mg, 160mg/ 12.5mg, 160mg/25mg, 3
  4. 4. HOLLOMAN AFB FORMULARYDoxazosin (Cardura) Furosemide (Lasix) Tabs Primidone (Mysoline) Tabs Tabs 2mg, 4mg, and 20mg, 40mg, sol 50mg, 250mg 8mg 10mg/mlPrazosin (Minipress) BENZODIAZEPINE Caps 1mg, 2mg, 5mg THIAZIDE/COMBINATIOTerazosin (Hytrin) Caps N **Clonazepam (Klonopin) 1mg, 2mg, 5mg, 10mg POTASSIUM_SPARIN Tabs 0.5mg G **Diazepam (Valium) Tabs MISC. 5mg ANTIHYPERTENSIVE Chlorthalidone (Hygroton) S Tabs 25mg, 50mg MISC HydrochlorothiazideClonidine (Catapress TT (HCTZ) Caps 12.5mg Carbamazepine (Tegretol) Patches) 0.1 mg, 0.2 Hydrochlorothiazide Chewtabs 100mg; mg, 0.3 mg (HCTZ) Tabs 25mg, Tabs 200mg, SusClonidine (Catapres) 50mg 100mg/5ml Tabs 0.1mg Hydrochlorothiazide Carbamazepine ExtendedHydralazine (Apresoline) 25mg / Triamterene Release (Tegretol XR) Tabs 10mg, 25mg 37.5mg (Maxzide-25) Tabs 400mgMethyldopa (Aldomet) Tabs Divalproex Sodium Tabs 250mg Indapamide (Lozol) Tabs (Depakote) Tabs 2.5mg 125mg, 250mg, CapsAntiplatelets / Metazolone (Zaroxolyn) Sprk 125mg Anticoagulants Tabs 5mg Divalproex Sodium (Depakote ER) Tabs POTASSIUM-SPARING 250mg, 500mgAspirin / Dipyridamole Gabapentin (Neurontin) (Aggrenox) caps Spironolactone Caps100mg 300mg, 5/200mg (Aldactone) Tabs 400mg, 600mg,Aspirin 81 mg Chewable 25mg 800mg Tabs, 325mg Tabs Phenytoin (Dilantin) CapsAspirin (Ecotrin) EC Tabs 100mg 325mg Antiarrhythmics Phenytoin (DilantinDipyridamole Infatabs) Chewtabs (Persantine) Tabs 50mg 25mg Amiodarone (Pacerone) Phenytoin (Dilantin) OralClopidogrel (Plavix) Tabs Tabs 200mg susp 125mg / 5mL 75mg Digoxin (Lanoxin) TabsWarfarin (Coumadin) 0.125mg, 0.25mg, Antidepressants Tabs 1mg, 2mg, Sol 0.05/ml 2.5mg, 3mg, 4mg, Mexiletine (Mexitil) Caps ALPHA-2 ANTAGONISTS 5mg, 6mg, 7.5mg, and 250mg 10mg Mirtazapine (Remeron) Tabs 15mgDiuretics III. Central Nervous DOPAMINE-REUPTAKE CARBONIC ANHYDRASE System Agents INHIBITOR INHIBITOR Anticonvulsants Bupropion (Wellbutrin) Tabs SR 100mg,Acetazolamide (Diamox) BARBITURATE 150mg Tabs 250mg, 500mgCaps **Phenobarbital (Luminal) SELECTIVE SEROTONIN Tabs 30mg; Syrup REUPTAKE LOOP 20mg/5ml INHIBITOR (SSRI)4
  5. 5. Citalopram (Celexa) Tabs XR) Tabs 150mg, Buspirone (Buspar) Tabs 20mg, 40mg 200mg, and 50mg 5mg, 10mgFluoxetine (Prozac) Caps Risperidone (Risperdal) Zolpidem (Ambien) Tabs 10mg, 20mg, Sol Tabs 0.25mg, 0.5mg, 5mg, 10mg 20mg/5ml 1mg, 2mg, 3mg, SolParoxetine (Paxil) Tabs 1mg/ml Central Nervous System 20mg, 40mg Thioridazine (Mellaril) Stimulants/ADHDSertraline (Zoloft) Tabs Tabs 25mg, 100mg Medications 50mg, 100 mg, sol 20mg/ml Atomoxetine (Strattera) 10mg, 18mg, 25mg,SEROTONIN/NOREPINE 40mg, 60mg Caps PHRINE INHIBITOR **Dextroamphetamine (SNRI) Anti- Parkinson’s Agents (Dexedrine) Tabs 5mg; 10mg, 15mg SRVenlafaxine (Effexor) Tabs ANTICHOLINERGIC Caps 75mg, 100mg; **Methylphenidate (Ritalin)XR Caps 37.5mg, 75mg, Benztropine (Cogentin) Tabs 5mg, 10mg 150mg Tabs 0.5mg, 2mg **Methylphenidate LA (Ritalin LA) CapsSEROTONIN REUPTAKE DOPAMINE AGONIST 10mg, 20mg, 30mg, INHIBITOR/ANTAGO 40mg NIST (SNIA) Amantadine (Symmetrel) **Methylphenidate SR Caps 100mg (Ritalin SR) Tabs SRTrazodone (Desyrel) Tabs Carbidopa / Levodopa 20mg 50mg, 100mg (Sinemet) Tabs 25/250 **Methylphenidate mg, 25/100mg, (Concerta) Tabs Ext. TRICYCLIC-(Limit of 30 10/100mg Release 18 mg, 27mg, day supply) Trihexyphenidyl (Artane) 36mg, and 54mg Tabs 2mg, 5mg; Elixir **D, L-amphetamineAmitriptyline (Elavil) Tabs 2mg/5ml (Adderall) Tabs 5mg, 10mg, 25mg, 100mg 10mg, 20mgDoxepin (Sinequan) Caps **D, L-amphetamine 25mg, 100mg, 150mg, (Adderall-XR) Caps sol 10mg/ml 5mg, 10mg, 15mg, Anxiolytics / Sedatives /Imipramine (Tofranil) Tabs 20mg, 25mg, 30mg Hypnotics 10mg, 25mgNortriptyline (Pamelor) Migraine Agents Caps 10mg, 25mg, sol BENZODIAZEPINE 10mg/5ml SEROTONIN 5-HT1D Alprazolam (Xanax) Tabs AGONIST- (LimitMood Stabilizer / 0.5mg Quantities) Antipyscotics Clonazepam (Klonopin) Tabs 0.5mg Sumatriptan (Imitrex) Diazepam (Valium) Tabs Injection 6mgLithium Carbonate Caps 5mg Sumatriptan (Imitrex) Tabs 150mg, Tabs 300 mg, Lorazepam (Ativan) Tabs 25mg, 50mg, and syp 8meq/5ml 1mg 100mgOlanzapine (Zyprexa) Temazepam (Restoril) Sumatriptan (Imitrex) Tabs 2.5mg, 5 mg, Caps 15mg, 30mg Nasal spray 5mg, and 10mg 20mgQuetiapine (Seroquel) Zolmitriptan (Zomig) Tabs Tabs 25mg, 100mg, 2.5mg, 5mg 200mg, and 300mgQuetiapine Extended MISC MISC Release (Seroquel 5
  6. 6. HOLLOMAN AFB FORMULARY**Acetaminophen 325 mg / Nystatin/Triamcinolone Butalbital 50 mg / (Mycolog) Cream Cepacol lozenges Reg Caffeine 40mg 100,000 units/0.1% Lidocaine (Xylocaine) Oint (Fiorcet) Tabs Nystatin (Mycostatin) 5%; Jelly 2%; Visc**Aspirin 325mg / 100,000 units/gm soln 2% Butalbital 50mg / Cream, Oint. Powder Caffeine 40mg Terbinafine (Lamisil) (Fiorinal) Tabs Cream 1%Divalproex Sodium (Depakote ER) Tabs Antiparasitic – Topical 250mg, 500mg Misc-Topical Permethrin (NIX) 1% Cream Rinse Aluminum chlorideIV. Dermatologic Agents Permethrin (Elimite) (Drysol) Soln 20% Cream 5% Amlexanox (Aphthasol)Acne Products Oral Paste 5% Antiseborrheic Agent- Ammonium lactate (Lac-Adapalene (Differin) Topical Hydrin) Lotion12% Cream & Gel 0.1%Benzoyl Peroxide Gel 2.5% Selenium sulfide (Selsun) Fluorouracil (Efudex)Clindamycin/Benzoyl Shampoo 2.5% Cream 5% Peroxide (Benzaclin) Pimecrolimus (Elidel) Gel Corticosteroids-Topical Cream 1%Tretinoin (Retin A) Cream Podofilox (Condylox) Soln 0.025%, 0.05%, 0.1%; 0.5% Betamethasone Valerate Salicylic acid (Duofilm) Gel 0.01%, 0.025% (Valisone) Cream soln 17% (Age limit of 35 or 0.1% Zinc Oxide Oint. 20% younger) Clobetasol PropionateIsotretinoin (Accutane) (Temovate) Cream, Caps 10mg, 20mg, Oint, Soln 0.05% 40mg Fluocinonide (Lidex) Cream, Ointment V. GastrointestinalAntibiotics – Topicals 0.05% Agents Fluocinolone (Derma-Bacitracin oint Smooth/FS) Oil 0.01% H2-ANTAGONISTClindamycin (Cleocin) 1% Flurandrenolide (Cordran) Soln Tape Cimetidine (Tagamet)Erythromycin 2% Soln, Gel Hydrocortisone Cream Tabs 400mg;Metronidazole (Metrogel) 1%, 2.5% 300mg/5ml Syrup 1% Gel Hydrocortisone Valerate Ranitidine (Zantac) TabsMupiricin (Bactroban) 2% (Westcort) Cream0.2% 150mg; Syrup Oint Triamcinolone (Kenalog) 15mg/mLSilver sulfadiazine 0.1%; Cream, Spray (Silvadene) Cream 1% PROTON PUMP ANESTHETIC/CORTICOS INHIBITORSAntifungals – Topicals TEROID COMBINATION Esomeprazole (Nexium)Clotrimazole (Lotrimin) Caps 20mg, 40mg Pramozine/Hydrocortisone Omeprazole (Prilosec) Topical sol 1%, Cream (Proctofoam HC) Caps 10mg, 20mg 1% Foam 1%/1%Ketoconazole (Nizoral) 2% Cream, 2%Shampoo ANTISPASMODIC Local Anesthetics- AGENTSMiconazole (Monistat topical Derm) Cream 2%6
  7. 7. Hyoscyamine / Atropine / Mesalamine (Asacol) Tabs Doxazosin (Cardura) Tabs Phenobarbital/ 400 mg 2mg, 4mg, and 8mg Scopalamine Terazosin (Hytrin) Caps (Donnatal) Tabs 1mg, 2mg, 5mg, 0.1037 mg/0.0194 mg/ Antiemetics 10mg 16.2mg/0.0065mg, Finasteride (Proscar) Tabs Elixir 16.2mg/5ml Meclizine (Antivert) Tabs 5mgBelladonna 0.2 25mg Tamsulosin (Flomax) Cap mg/Phenobarbital 40 Metoclopramide (Reglan) 0.4mg mg/Ergotamine 0.6mg Tabs 10mg; (Bellergal-S) Tabs Syrup 5mg/5mlDicyclomine (Bentyl) Tabs Prochlorperazine VII. Metabolic / 20mg, Caps 10mg sol (Compazine) Tabs Endocrine Agents 10mg/5ml 5mgChlordiazepoxide Prochlorperazine Androgens /Clindinium (Librax) (Compazine) Supps Caps 25mg **Testosterone Cypionate Promethazine Inj 200mg /mL (Phenergan) Tabs LAXATIVE 25mg, Syp Corticosteroids 6.25mg/5ml:Bisacodyl (Dulcolax) Tabs Suppositories 12.5mg, Dexamethasone 5mg; Supps 10mg 25mg (Decadron) Tabs 1mg,Docusate sodium (Colace) Ondansetron (Zofran 4mg Caps 100mg; ODT) 4mg, 8mg Fludrocortisone (Florinef) 150mg/15ml Syrup Ondansetron (Zofran) 2 Tabs 0.1mgFleets Enema mg / mL liquid Hydrocortisone (Cortef)Fleets Oral Saline Laxative Tabs 20mg (PhosphaSoda) MethylprednisoloneGoLytely/CoLytely VI. Genitourinary Agents (Medrol-Dose Pak)Lactulose (Cephulac) Tabs 4mg 21’S Syrup 10mg / 15ml Urinary Tract Agents Prednisolone Oral (Prelone) liquid 15mg / ANTIDIARRHEALS OVERACTIVE BLADDER 5mL AGENTS Prednisone (Deltasone)Bismuth subsalicylate Tabs 1mg, 5mg, (Pepto-Bismol) Oxybutynin (Ditropan) 20mg, sol 5mg/5ml Chewtabs 262mg Tabs 5mg; 5mg/5ml**Diphenoxylate/Atropine Syrup (Lomotil) Tabs 2.5mg/ Oxybutynin ER (Ditropan Diabetic Agents 0.025mg XL) Tabs 5mg,Loperamide (Imodium) 10mg,15mg INSULIN Caps 2mg Tolterodine (Detrol LA) Caps 2mg, 4mg Insulin NPH (Novolin N) MISC 100units/ml 10ml URINARY ANALGESIC Insulin NPH / RegularPancreatic Enzymes 70/30 (Novolin 70/30) (Pancreaze) Phenazopyridine 100units/ml 10mlSimethicone (Mylicon) (Pyridium) Tabs Insulin Regular (Novolin R) Tabs 80mg 100mg 100units/ml 10mlSucralfate (Carafate) Tabs Insulin Glargine (Lantus) 1gm BPH AGENTS 100units/ml 10mlSulfasalazine (Azulfidine) Insulin Aspart (Novolog) Tabs 500mg; Entabs Alfuzosin (Uroxatral) Tabs 100units/ml 10ml 500mg 10mg 7
  8. 8. HOLLOMAN AFB FORMULARYInsulin Glargine Pen Syringes, insulin 0.5mL Depo-Provera 150mg/ml (Lantus Solostar) 15ml (Lo-Dose) 100s; 1mL Demulen 1/35-28 per box 100s Jolessa (genericInsulin Aspart Pen BD Pen Needles Original Seasonale) (Novolog Flex Pen) and Short Levlin 15ml per box Loestrin Fe 1/20, 1.5/30Inusulin Aspart 70/30 Pen Gout Agents Lo-Ovral (Novolog 70/30 Flex Nor QD Pen) Allopurinol (Zyloprim) Tabs Ortho Cyclen(Mononessa) 100mg, 300mg Ortho-Evra Transdermal SULFONYLUREA Probenecid (Benemid) patches AGENTS Tabs 500mg Ortho Tri-cyclen, Ortho Tri- cyclen LOGlipizide (Glucotrol) Tabs Hormone Replacement Ortho Novum 1/35, 1/50 5mg Therapy Ortho Novum 7-7-7Glyburide (Diabeta, Ovral Micronase) Tabs 5mg Estradiol (Estrace) Tabs Triphasil / TrilevlenGlyburide micronized 0.5mg, 1mg, 2mg Desogen/Apri/Ortho-Cept (Glynase) Tabs 1.5mg, Estradiol Trans (Climara) Nuvaring 3mg, and 6mg 0.05mg/day, YasminGlyburide Tabs 1.25mg, 0.1mg)/day Yaz 2.5mg Estrogen Conj (Premarin) Plan B/ Next Choice Tabs 0.3mg, 0.45mg, BIGUANIDE 0.625mg, 0.9mg, Thyroid Agents 1.25mgMetformin (Glucophage) Estrogen Conjugated Levothyroxine (Synthroid) Tabs 500mg, 850mg. (Premarin) vaginal Tabs 0.025, 0.05, 1000mg cream 0.625mg/g 0.075, 0.088, 0.1,Metformin XR Estrogen 0.112, 0.125, 0.15, (Glucophage XR) Conj/Medroxyprogeste 0.175mg Tabs 500mg, 750mg rone (PremPro) Tabs Methimazole (Tapazole) 0.3mg/ 1.5mg Tabs 10 mg Estrogen Propylthiouracil (PTU) Conj/Medroxyprogeste Tabs 50 mgTHIAZOLIDINEDIONE/CO rone (PremPro) Tabs MBINATION 0.45mg/1.5mg EstrogenPioglitazone (Actos) Tabs Conj/Medroxyprogeste LHRH Agonists15mg, 30mg, 45mg rone (PremPro) Tabs 0.625mg /2.5mg Goserelin (Zoladex) MISC Estrogen 3.6mg, 10.8mg Conj/Medroxyprogeste implantsNateglinide (Starlix) Tabs rone (PremPro) Tabs 60mg, 120mg 0.625mg/5mg Estropipate (Ogen) Tabs VIII. MusculoskeletalSitagliptin (Januvia) Tabs 0.625mg, 1.25mg Agents 50 mg, 100 mg MedroxyprogesteroneSitagliptin / Metformin (Provera) Tabs 2.5mg, Analgesics (Janumet) Tabs 10mg 50/500, 50/1000 Raloxifene (Evista) Tabs Acetaminophen (Tylenol) 60mg Tabs 325mgDiabetic Supplies Acetaminophen (Tylenol) Contraceptives Elixir 160mg/5mLGlucose Test Strips **Tramadol (Ultram) Tabs (Precision XTRA) Alesse 50mgLancets8
  9. 9. **Morphine sulfate IR (MSIR) 15mg, 30mg NSAIDS IX. Ophthalmic Agents Antirheumatic AgentsCelecoxib (Celebrex) Anti-Infectives 100mg & 200mg Azathioprine (Imuran)Ibuprofen (Motrin) Tabs Tabs 50mg Bacitracin oint 400mg, 600mg, Hydroxychloroquine Ciprofloxacin (Ciloxin) 800mg (Plaquenil) Tabs 0.3% Soln; Oint 0.3%Ibuprofen (Motrin) Susp 200mg Erythromycin Oint 5mg/gm 100mg / 5mL Methotrexate (Rhematrex) Gentamicin (Garamycin)Indomethacin (Indocin) Tabs 2.5mg Soln 0.3%; Oint 0.3% Caps 25mg Sulfasalazine (Azulfidine) Moxifloxacin (Vigamox)Ketorolac (Toradool) Tabs Tabs 500mg; ENtabs 0.5% Soln 10mg (max 20/month) 500mg Neomycin / Polymyxin B /Meloxicam (Mobic) Tabs Gramicidin 7.5mg, 15mg (Neosporin) SolnNaproxen (Naprosyn) Neomycin / Polymyxin B / Tabs 250mg, 275mg, Osteoporosis Bacitracin (Neosporin) 500mg, 550mg, Agents/Bisphosphon Oint 125/5mlsusp ate Polymyxin B /Oxaprozin (Daypro) Tabs Trimethoprim 600mg Alendronate (Fosamax) (Polytrim) SolnPiroxicam (Feldene) Caps Tabs 5mg, 10mg, Sulfacetamide (Bleph-10) 20mg 35mg, 70mg 10% Soln, OintSalsalate (Disalcid) Tabs Alendronate PlusD Tobramycin/Dexamethaso 500mg, 750mg 70mg/2800IU ne (TobraDex) Susp,Sulindac (Clinoril) Tabs Ibandronate (Boniva) Tabs Oint 200mg 2.5mg, 150mg Tobramycin (Tobrex) Raloxifene (Evista) Tabs 0.03% solnAnalgesics Opioids 60mg Risedronate (Actonel) Anti-Inflammatory /**Acetaminophen 300mg / Tabs 35mg Allergy Codeine 30mg(Tylenol #3) Tabs Skeletal Muscle Fluorometholone(FML)**Acetaminophen 120mg / Relaxant Susp 0.1% Codeine 10mg / 5mL Flurbiprofen (Ocufen) Soln Elixir Baclofen (Lioresal) Tabs Lodoxamide (Alomide)**Acetaminophen 500mg / 10mg Soln 0.1% Hydrocodone 5mg Cyclobenzaprine (Flexeril) Loteprednol (Lotemax) (Lortab/Vicodin) Tabs Tabs 5mg, 10mg Susp 0.5%**Acetaminophen 325mg / Metaxalone (Skelaxin) Olopatadine(Patanol) Soln Oxycodone 5mg Tabs 800mg (limit of 0.1% (Percocet) Tabs 30 day supply) Prednisolone (Pred-Forte)**Acetaminophen 500mg / Methocarbamol (Robaxin) Soln 1% Oxycodone 5mg Tabs 500mg Prednisolone (Pred Mild) (Tylox) Caps Orphenadrine (Norflex) Soln 0.125%**Codeine Tabs 30mg Tabs 100mg**Meperidine (Demerol) Glaucoma Tabs 50mg, Inj. 50mg, 100mg**Methadone Tabs 10mg- BETA_BLOCKERS Misc (For pain only)**Morphine sulfate SR (MS Betaxolol S (Betoptic S) Contin) Tabs 15mg, Pyridostigmine (Mestinon) Susp 0.25% 30mg Tabs 60mg 9
  10. 10. HOLLOMAN AFB FORMULARYCarteolol (Ocupress) Soln Ciprofloxacin / Guaifenesin / 1% Dexamethazone DextromethorphanTimolol (Timoptic) Soln (Ciprodex) (Robitussin DM) Syrup 0.25%, 0.5%Timolol (Timocptic-XE) Gel 0.25% 0.5% XI. Respiratory Agents ALPHA2-ADRENERGIC Antihistamines / DECONGESTANT AGONIST Decongestants / Cough / Cold / **PseudoephedrineBrimonidine (Alphagan-P) Allergy (Sudafed) Tabs 30mg; Drops 0.15% Syrup 30mg / 5mLBrimonidine (Alphagan) ANTIHISTAMINES/ANTIHI Drops 0.2% STAMINE & Asthma MedicationsDipivefrin (Propine) Soln DECONGESTANT 0.1% COMBO ANTICHOLINERGIC AGENTS PROSTAGLANDIN Brompheniramine/Pseudo ephedrine (Dimetapp) Ipratropium BromideLatanoprost (Xalatan) Soln & (Dimetapp DM) Elixir (Atrovent HFA) Inhaler 0.05% Cetirizine (Zyrtec) Tabs 10 17 mcg / puff mg; Syrup 5mg/5mL Ipratropium Bromide CHOLINERGIC AGENT Chlorpheniramine (CTM) (Atrovent) Neb Soln Tabs 4mg for inhalation 0.03%Pilocarpine (Isoptocarpine) Cyproheptadine (Periactin) Tiotropium Bromide Soln 0.5%, 1%, 2%, Tabs 4mg (Spiriva) HandiHaler 4% DiphenhydraminePilocarpine (Pilopine HS) (Benadryl) Caps BETA2- Gel 4% 25mg, Tabs 25mg AGONISTS/COMBINA Diphenhydramine TION PRODUCTS NSAID (Benadryl) Elixir 12.5mg / 5mL Albuterol HFA (Ventolin)Ketorolac (Acular LS) Fexofenadine (Allegra) Inhaler 0.4% Soln Tabs 60mg, 180mg Albuterol (Proventil) Soln Hydroxyzine HCl (Atarax) 0.5%Misc Tabs 10mg, 25mg, Albuterol (Proventil) Soln Syrup 10mg/5ml 0.083%Artificial Tears Loratadine (Claritin) Tabs Albuterol (Proventil) SyrupCelluvisc Drops 10mg, Syrup 5mg/5ml 2mg /5mlGenTeal 0.3% Soln Meclizine (Antivert) Tabs Ipratropium / AlbuterolSodium Chloride 5% 25mg (Combivent) Inhaler (Muro) Ointment **Pseudoephedrine / Salmeterol Triprolidine tabs Xinafoate(Serevent (Actifed) Tabs Diskus) X. Otic Agents ANTITUSSIVEAcetic Acid (Domeboro) Soln 2% Benzonatate (Tessalon) CORTICOSTEROID,Antipyrine/Benzocaine Perles 100mg INHALED/COMBINATI(Auralgan) Soln ON PRODUCTSBacitracin / Neomycin/ EXPECTORANT/COMBIN Polymyxin ATION Budesonide (Pulmicort B/Hydrocortisone Respules) inhalation (Cortisporin) Susp **Guaifenesin / Codeine Susp 0.25mg/2ml,Carbamide(Debrox) Soln 30mg (Robitussin AC) 0.5mg/2ml 6.5% Syrup10
  11. 11. Flunisolide (Aerobid) Ipratropium (Atrovent) Cyanocobalamin (Vit B 12) Inhaler 250mcg / puff Spray 0.3%, 0.6% 1,000mcg Tabs andFluticasone (Flovent HFA) 1mg/ml injection Inhaler 44, 110, 220 ANTIHISTAMINE Ergocalciferol (Vitamin D2) mcg / puff caps 50,000IUFluticasone/Salmeterol Azelastine (Astelin Nasal) Ferrous Sulfate Tabs (Advair Diskus) Spray 137mcg/spray 325mg 100/50, 250/50, Ferrous Sulfate Oral sol 500/50mcg CORTICOSTEROID, 15mg /0.6mLMometasone Furoate INTRANASAL Folic Acid Tabs 1mg (Asmanex Twisthaler) Folic Acid, 110mcg, 220mcg Flunisolide (Nasarel) Cyanocobalamin,Budesonide/Formoterol Spray 25mcg Pyridoxine (Foltx) (Symbicort) Inhaler Fluticasone (Flonase) 2.5mg/1mg/25mg 80/4.5, 160/4.5 Spray Magnesium Gluconate Tabs 500mgMAST CELL STABILIZER SEROTONIN 5-HT1D Poly-Vi Sol Fe (multi- AGONIST vitamin for breastfedCromolyn Sodium (Intal) Sumatriptan (Imitrex) babies) Inhalant Soln 10 mg/ Spray 5mg, 20mg Potassium Chloride Tabs mL 10mEq, 20mEq; VASOCONSTRICTOR 20mEq packets, Liq LEUKOTRIENE 10% RECEPTOR Oxymetazoline (Afrin) Prenatal Vitamins / ANTAGONIST Spray 0.05% Minerals Tabs (Age limit of 45 or younger.)Montelukast (Singulair) MISC Pyridoxine (Vitamin B6) Tabs 4mg, 5mg, Tabs 50mg 10mg; Granules 4mg Desmopressin (DDAVP) Thiamine (Vitamin B1) Spray 0.1% Tabs 50mg MISC Sodium chloride (Ocean) Drops / Spray 0.65% I. Misc AgentsInspirase (drug delivery system for MDI’s) Antineoplastic AgentsAerochamber (drug XII. Vaginal Preparations delivery system for Azathioprine (Imuran) MDI’s) Clotrimazole (Gyne- Tabs 50mgSodium Chloride 5ml Neb Lotrimin) Cream 1% Fluorouracil (Efudex) Soln Clindamycin (Cleocin) Cream 5%Theophylline (Theodur) Cream 2% Methotrexate Tabs 200mg, 300mg Estrogen Conjugated (Rheumatrex) TabsTheophylline Anhydrous (Premarin) Cream 2.5mg (Theo-24) Caps 0.625 mg / gm Tamoxifen (Nolvadex) 300mg, Metronidazole (Metrogel) Tabs 10mgTheophylline Anhydrous Gel 0.75% (Theophylline ER) Terconazole (Terazol 3) Dental Preparations Tabs 400mg SuppsTheophylline (Elixophyllin Chlorhexidine (Peridex / 80mg/15mL Periogard) Oral soln 0.12%Nasal Preparations XIII. Vitamin / Mineral / Sodium Fluoride (Luride) Electrolyte Agents Tabs 1.1mg (0.5mg Fl) ANTICHOLINERGIC Sodium Fluoride Oral soln AGENT Calcium 500mg with Vit D 0.5mg /mL (OsCal) Tabs 11
  12. 12. HOLLOMAN AFB FORMULARYSodium Fluoride Pramozine/Hydrocortisone (PreviDent) 1.1% gel (Proctofoam HC) Clomiphene (Clomid) TabsSodium Flouride Foam 1%/1% 50mg (PreviDent Plus) 1.1% Donepezil (Aricept) Tabs 5 paste mg, 10mgStannous Fluoride Disulfiram (Antabuse) (GelKam) 0.4% gel Tabs 250mgTriamcinolone (Kenalog) Epinephrine (Epipen Jr, Dental Paste 0.1% Epipen) Autoinjector Smoking Deterrents 0.15mg, 0.3mgHemorrhoid Agents Methylergonovine Bupropion SR 150 mg (Methergine) Tabs 0.2mgHemorrhoidal HC Supps Nicotine Patch (Nicoderm) Sodium citrate with citric (Anusol HC) 7mg / day, 14mg/day, acid 480ml (Bicitra)Hemorrhoidal Supps 21mg / day Sildenafil HCL (Viagra) (Anusol) Tabs 25mg, 50mg, 100mgHydrocortisone Cream Other Vitamin D Caps 50,000 IU 2.5%12

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