Title 19/21 Non-SMI & Non-Title 19/21 SMI Behavioral Health Drug List Updated 3/01/2019
Mercy Care RBHA - Behavioral Health Drug List Table of Contents *ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS*...3 *ANALGESICS - OPIOID*... 5 *ANTIANXIETY AGENTS*...5 *ANTICONVULSANTS*...6 *ANTIDEPRESSANTS*...7 *ANTIDOTES*... 11 *ANTIHISTAMINES*... 11 *ANTIHYPERTENSIVES*... 12 *ANTIPARKINSON AGENTS*...13 *ANTIPSYCHOTICS/ANTIMANIC AGENTS*... 13 *BETA BLOCKERS*... 16 *HEMATOPOIETIC AGENTS*...16 *HYPNOTICS*... 17 *LAXATIVES*... 17 *MOUTH/THROAT/DENTAL AGENTS*...20 *MULTIVITAMINS*...20 *NUTRIENTS*...21 *POSTHERPETIC NEURALGIA (PHN)/NEUROPATHIC PAIN AGENTS***...22 *PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.*...22 *THYROID AGENTS*... 22 *URINARY ANTISPASMODICS*...23 *VITAMINS*... 23 1
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Mercy Care RBHA - Behavioral Health Drug List *ADHD/ANTI- NARCOLEPSY/ANTI- OBESITY/ANOREXIANTS* *Adhd Agent - Selective Alpha Adrenergic Agonists*** clonidine hcl er tablet extended release 12 hour 0.1 oral 0.1 guanfacine hcl er oral tablet extended release 24 hour 1, 2, 3, 4 *Adhd Agent - Selective Norepinephrine Reuptake Inhibitor*** atomoxetine hcl oral capsule 10, 100, 18, 25, 40, 60, 80 *Amphetamine Mixtures*** amphetamine-dextroamphetamine oral tablet 10, 12.5, 15, 20, 30, 5, 7.5 ADDERALL ORAL TABLET 10 MG, 12.5 MG, 15 MG, 20 MG, 30 MG, 5 MG, 7.5 MG ADDERALL XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG, 15 MG, 20 MG, 25 MG, 30 MG, 5 MG *Amphetamines*** dextroamphetamine sulfate er oral capsule extended release 24 hour 10, 15, 5 dextroamphetamine sulfate oral tablet 10, 5 VYVANSE ORAL CAPSULE 10 MG, 20 MG, 30 MG, 40 MG, 50 MG, 60 MG, 70 MG VYVANSE ORAL TABLET CHEWABLE 10 MG, 20 MG, 30 MG, 40 MG, 50 MG, 60 MG *Stimulants - Misc.*** methylphenidate hcl er (cd) oral capsule extended release 10, 20, 30, 40, 50, 60 Kapvay Intuniv Strattera Adderall Adderall Amphetamine- Dextroamphet ER Dexedrine Zenzedi 3
methylphenidate hcl er (la) oral capsule extended release 24 hour 10, 20, 30, 40 methylphenidate hcl er (la) oral capsule extended release 24 hour 60 methylphenidate hcl er oral tablet extended release 18, 27, 36, 54 methylphenidate hcl er oral tablet extended release 24 hour 18, 27, 36, 54 methylphenidate hcl oral tablet 10, 20, 5 APTENSIO XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG, 15 MG, 20 MG, 30 MG, 40 MG, 50 MG, 60 MG DAYTRANA TRANSDERMAL PATCH 10 MG/9HR, 15 MG/9HR, 20 MG/9HR, 30 MG/9HR FOCALIN ORAL TABLET 10 MG, 2.5 MG, 5 MG FOCALIN XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG, 15 MG, 20 MG, 25 MG, 30 MG, 35 MG, 40 MG, 5 MG METHYLIN ORAL SOLUTION 10 MG/5ML, 5 MG/5ML QUILLICHEW ER ORAL TABLET CHEWABLE EXTENDED RELEASE 20 MG, 30 MG, 40 MG QUILLIVANT XR ORAL SUSPENSION RECONSTITUTED 25 MG/5ML RITALIN LA ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG Ritalin LA Concerta Ritalin Dexmethylphenidate HCl Dexmethylphenidate HCl ER Methylphenidate HCl Ritalin LA QLL (3 EA per 1 day); QLL (10 ML per 1 day); AL (Min 6 QLL (5 ML per 1 day); 4
*ANALGESICS - OPIOID* *Opioid Partial Agonists*** buprenorphine hcl sublingual tablet sublingual 2, 8 SUBOXONE SUBLINGUAL FILM 12-3 MG, 2-0.5 MG, 4-1 MG, 8-2 MG *ANTIANXIETY AGENTS* *Antianxiety Agents - Misc.*** buspirone hcl oral tablet 10, 15, 5, 7.5 buspirone hcl oral tablet 30 hydroxyzine hcl oral syrup 10 /5ml Buprenorphine HCl- Naloxone HCl PA; PA Required unless the member is pregnant- the prescriber must note the following ICD-10 codes on the prescription: 1. O09.91, 2. O09.92, 3. O09.93, 4. O09.91 QLL (10 ML per 1 day) hydroxyzine hcl oral tablet 10, 25, 50 QLL (8 EA per 1 day) hydroxyzine pamoate oral capsule 100 QLL (4 EA per 1 day) hydroxyzine pamoate oral capsule 25, 50 Vistaril QLL (4 EA per 1 day) *Benzodiazepines*** alprazolam er oral tablet extended release 24 hour 0.5, 1, 2, 3 alprazolam oral tablet 0.25, 0.5, 1 Xanax XR Xanax alprazolam oral tablet 2 Xanax alprazolam oral tablet dispersible 0.25, 0.5, 1 alprazolam oral tablet dispersible 2 chlordiazepoxide hcl oral capsule 10, 25, 5 clorazepate dipotassium oral tablet 15 clorazepate dipotassium oral tablet 3.75 5
clorazepate dipotassium oral tablet 7.5 Tranxene-T diazepam oral concentrate 5 /ml Diazepam Intensol diazepam oral solution 5 /5ml diazepam oral tablet 10, 2, 5 Valium lorazepam oral concentrate 2 /ml LORazepam Intensol lorazepam oral tablet 0.5, 1 Ativan lorazepam oral tablet 2 Ativan oxazepam oral capsule 10, 15, 30 ALPRAZOLAM INTENSOL ORAL CONCENTRATE 1 MG/ML *ANTICONVULSANTS* *Anticonvulsants - Benzodiazepines*** clonazepam oral tablet 0.5, 1 KlonoPIN clonazepam oral tablet 2 KlonoPIN clonazepam oral tablet dispersible 0.125, 0.25, 0.5, 1 clonazepam oral tablet dispersible 2 *Anticonvulsants - Misc.*** carbamazepine er oral capsule extended release 12 hour 100, 200, 300 Carbatrol carbamazepine er oral tablet extended release 12 hour 100, 200, 400 TEGretol-XR carbamazepine oral suspension 100 /5ml TEGretol carbamazepine oral tablet 200 Epitol carbamazepine oral tablet chewable 100 gabapentin oral capsule 100, 300, 400 Neurontin gabapentin oral solution 250 /5ml Neurontin 6 QLL (8 ML per 1 day); QLL (10 ML per 1 day); AL (Min 6 QLL (2 ML per 1 day); QLL (4 ML per 1 day);
gabapentin oral tablet 600, 800 Neurontin lamotrigine er oral tablet extended release 24 hour 100, 200, 25, 250, LaMICtal XR 300, 50 lamotrigine oral tablet 100, 150, 200, 25 LaMICtal lamotrigine oral tablet chewable 25, 5 LaMICtal lamotrigine oral tablet dispersible 100, 200, 25, 50 LaMICtal ODT oxcarbazepine oral suspension 300 /5ml Trileptal oxcarbazepine oral tablet 150, 300, 600 Trileptal topiramate oral capsule sprinkle 15, 25 Topamax Sprinkle topiramate oral tablet 100, 200, 25 Topamax, 50 *Valproic Acid*** divalproex sodium er oral tablet extended release 24 hour 250, 500 Depakote ER divalproex sodium oral capsule delayed release sprinkle 125 Depakote Sprinkles divalproex sodium oral tablet delayed release 125, 250, 500 Depakote valproic acid oral capsule 250 Depakene valproic acid oral solution 250 /5ml Depakene *ANTIDEPRESSANTS* *Alpha-2 Receptor Antagonists (Tetracyclics)*** mirtazapine oral tablet 15, 30 Remeron mirtazapine oral tablet 45, 7.5 mirtazapine oral tablet dispersible 15, 30, 45 *Antidepressants - Misc.*** bupropion hcl er (sr) oral tablet extended release 12 hour 100, 150, 200 bupropion hcl er (xl) oral tablet extended release 24 hour 150, 300 Remeron SolTab Wellbutrin SR Wellbutrin XL 7
bupropion hcl oral tablet 100, 75 maprotiline hcl oral tablet 25, 50, 75 *Modified Cyclics*** nefazodone hcl tablet 100 oral 100 nefazodone hcl tablet 150 oral 150 nefazodone hcl tablet 200 oral 200 nefazodone hcl tablet 250 oral 250 nefazodone hcl tablet 50 oral 50 trazodone hcl tablet 100 oral 100 trazodone hcl tablet 150 oral 150 trazodone hcl tablet 300 oral 300 trazodone hcl tablet 50 oral 50 VIIBRYD ORAL TABLET 10 MG, 20 MG, 40 MG PA VIIBRYD STARTER PACK ORAL KIT 10 & 20 MG PA *Monoamine Oxidase Inhibitors (Maois)*** phenelzine sulfate oral tablet 15 Nardil tranylcypromine sulfate oral tablet 10 Parnate EMSAM TRANSDERMAL PATCH 24 HOUR 12 MG/24HR, 6 MG/24HR, 9 PA MG/24HR MARPLAN ORAL TABLET 10 MG *Selective Serotonin Reuptake Inhibitors (Ssris)*** citalopram hydrobromide oral solution 10 /5ml citalopram hydrobromide oral tablet 10 citalopram hydrobromide oral tablet 20, 40 escitalopram oxalate oral solution 5 /5ml escitalopram oxalate oral tablet 10, 20 CeleXA CeleXA Lexapro QLL (20 ML per 1 day); AL (Min 6 QLL (20 ML per 1 day); AL (Min 6 8
escitalopram oxalate oral tablet 5 Lexapro fluoxetine hcl oral capsule 10, 40 PROzac fluoxetine hcl oral capsule 20 PROzac fluoxetine hcl oral capsule delayed release 90 PA fluoxetine hcl oral solution 20 /5ml QLL (20 ML per 1 day); AL (Min 6 fluvoxamine maleate er oral capsule extended release 24 hour 100 fluvoxamine maleate er oral capsule extended release 24 hour 150 fluvoxamine maleate oral tablet 100 fluvoxamine maleate oral tablet 25 fluvoxamine maleate oral tablet 50 paroxetine hcl er oral tablet extended release 24 hour 12.5, 25, 37.5 paroxetine hcl oral tablet 10, 20, 30 Paxil CR Paxil paroxetine hcl oral tablet 40 Paxil sertraline hcl oral concentrate 20 /ml sertraline hcl oral tablet 100 Zoloft sertraline hcl oral tablet 25 Zoloft sertraline hcl oral tablet 50 Zoloft PAXIL ORAL SUSPENSION 10 MG/5ML PEXEVA ORAL TABLET 10 MG, 20 MG, 30 MG, 40 MG QLL (3 EA per 1 day); QLL (3 EA per 1 day); QLL (6 EA per 1 day); QLL (3 EA per 1 day); QLL (1.5 EA per 1 day) QLL (10 ML per 1 day); AL (Min 6 QLL (3 EA per 1 day); QLL (30 ML per 1 day); AL (Min 6 PA 9
*Serotonin-Norepinephrine Reuptake Inhibitors (Snris)*** desvenlafaxine succinate er oral tablet extended release 24 hour 100, 25, 50 duloxetine hcl oral capsule delayed release particles 20, 30 duloxetine hcl oral capsule delayed release particles 60 venlafaxine hcl er oral capsule extended release 24 hour 150 venlafaxine hcl er oral capsule extended release 24 hour 37.5, 75 venlafaxine hcl oral tablet 100, 37.5, 50 venlafaxine hcl oral tablet 25 venlafaxine hcl oral tablet 75 Pristiq Cymbalta Cymbalta Effexor XR Effexor XR QLL (3 EA per 1 day); QLL (3 EA per 1 day); QLL (5 EA per 1 day); *Tricyclic Agents*** amitriptyline hcl oral tablet 10, 100, 150, 25, 50, 75 amoxapine oral tablet 100, 150, 25, 50 clomipramine hcl oral capsule 25, 50, 75 Anafranil desipramine hcl oral tablet 10, 25 Norpramin desipramine hcl oral tablet 100, 150, 50, 75 doxepin hcl oral capsule 10, 100, 150, 25, 50, 75 doxepin hcl oral concentrate 10 /ml QLL (3 EA per 1 day); QLL (6 ML per 1 day); imipramine hcl oral tablet 10, 25, 50 Tofranil imipramine pamoate oral capsule 100, 125, 150, 75 nortriptyline hcl oral capsule 10, 25, 50, 75 Pamelor nortriptyline hcl oral solution 10 /5ml protriptyline hcl oral tablet 10, 5 trimipramine maleate oral capsule 100, 25, 50 Surmontil 10
*ANTIDOTES* *Opioid Antagonists*** naloxone hcl injection solution 0.4 /ml, 4 /10ml naloxone hcl injection solution cartridge 0.4 /ml naloxone hcl injection solution prefilled syringe 2 /2ml naltrexone hcl oral tablet 50 NARCAN NASAL LIQUID 4 MG/0.1ML VIVITROL INTRAMUSCULAR SUSPENSION RECONSTITUTED 380 MG *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** aler-dryl oral tablet 50 allergy medication capsule 25 oral 25 Banophen allergy medication childrens liquid 12.5 Banophen /5ml oral 12.5 /5ml allergy medication tablet 25 oral 25 Alka-Seltzer Plus Allergy allergy relief nighttime tablet 25 oral Alka-Seltzer Plus Allergy 25 childrens allergy oral liquid 12.5 /5ml Banophen complete allergy medication tablet 25 Alka-Seltzer Plus Allergy oral 25 complete allergy relief tablet 25 oral Alka-Seltzer Plus Allergy 25 cvs allergy liquid 12.5 /5ml oral 12.5 Banophen /5ml cvs allergy relief nighttime tablet 25 Alka-Seltzer Plus Allergy oral 25 cvs dye-free allergy tablet 25 oral 25 Alka-Seltzer Plus Allergy diphenhydramine hcl oral capsule 25, Banophen 50 diphenhydramine hcl oral liquid 6.25 Vanamine PD /ml 11
diphenhydramine hcl oral tablet 25 Alka-Seltzer Plus Allergy eq allergy relief childrens oral elixir 12.5 /5ml gnp allergy relief oral tablet chewable 12.5 hm allergy childrens liquid 12.5 /5ml oral 12.5 /5ml multi-symptom allergy capsule 25 oral 25 Benadryl Allergy Childrens Banophen Banophen q-dryl capsule 25 oral 25 Banophen q-dryl liquid 12.5 /5ml oral 12.5 /5ml Banophen tgt allergy childrens liquid 12.5 /5ml oral 12.5 /5ml Banophen SCOT-TUSSIN ALLERGY RELIEF LIQUID 12.5 MG/5ML ORAL 12.5 Banophen MG/5ML *Antihistamines - Piperidines*** cyproheptadine hcl oral syrup 2 /5ml cyproheptadine hcl oral tablet 4 *ANTIHYPERTENSIVES* *Antiadrenergics - Centrally Acting*** clonidine hcl oral tablet 0.1, 0.2, 0.3 Catapres clonidine hcl patch weekly 0.1 /24hr transdermal 0.1 /24hr clonidine hcl patch weekly 0.2 /24hr transdermal 0.2 /24hr clonidine hcl patch weekly 0.3 /24hr transdermal 0.3 /24hr QLL (4 EA per 28 days); AL (Min 6 QLL (4 EA per 28 days); AL (Min 6 QLL (4 EA per 28 days); AL (Min 6 guanfacine hcl oral tablet 1, 2 *Antiadrenergics - Peripherally Acting*** prazosin hcl oral capsule 1, 2, 5 Minipress 12
*ANTIPARKINSON AGENTS* *Antiparkinson Anticholinergics*** benztropine mesylate oral tablet 0.5, 1, 2 trihexyphenidyl hcl oral elixir 0.4 /ml trihexyphenidyl hcl oral tablet 2, 5 *Antiparkinson Dopaminergics*** amantadine hcl oral capsule 100 amantadine hcl oral syrup 50 /5ml amantadine hcl oral tablet 100 *Antiparkinson Monoamine Oxidase Inhibitors*** selegiline hcl oral capsule 5 selegiline hcl oral tablet 5 *ANTIPSYCHOTICS/ANTIMAN IC AGENTS* *Antimanic Agents*** lithium carbonate er oral tablet extended release 300 Lithobid lithium carbonate er oral tablet extended release 450 lithium carbonate oral capsule 150, 300, 600 lithium carbonate oral tablet 300 lithium oral solution 8 meq/5ml *Antipsychotics - Misc.*** ziprasidone hcl oral capsule 20, 40, 60, 80 EQUETRO ORAL CAPSULE EXTENDED RELEASE 12 HOUR 100 MG, 200 MG, 300 MG LATUDA ORAL TABLET 120 MG, 20 MG, 40 MG, 60 MG, 80 MG *Benzisoxazoles*** risperidone oral solution 1 /ml risperidone oral tablet 0.25, 0.5, 1, 2, 3, 4 Geodon RisperDAL RisperDAL QLL (8 ML per 1 day); 13
risperidone oral tablet dispersible 0.25, 3, 4 risperidone oral tablet dispersible 0.5, 1, 2 INVEGA SUSTENNA INTRAMUSCULAR SUSPENSION 117 MG/0.75ML INVEGA SUSTENNA INTRAMUSCULAR SUSPENSION 156 MG/ML INVEGA SUSTENNA INTRAMUSCULAR SUSPENSION 234 MG/1.5ML INVEGA SUSTENNA INTRAMUSCULAR SUSPENSION 39 MG/0.25ML INVEGA SUSTENNA INTRAMUSCULAR SUSPENSION 78 MG/0.5ML INVEGA TRINZA INTRAMUSCULAR SUSPENSION 273 MG/0.875ML INVEGA TRINZA INTRAMUSCULAR SUSPENSION 410 MG/1.315ML INVEGA TRINZA INTRAMUSCULAR SUSPENSION 546 MG/1.75ML INVEGA TRINZA INTRAMUSCULAR SUSPENSION 819 MG/2.625ML RISPERDAL CONSTA INTRAMUSCULAR SUSPENSION RECONSTITUTED 12.5 MG, 25 MG, 37.5 MG, 50 MG *Butyrophenones*** haloperidol decanoate intramuscular solution 100 /ml, 50 /ml haloperidol lactate injection solution 5 /ml haloperidol lactate oral concentrate 2 /ml haloperidol oral tablet 0.5, 1, 10, 2, 20, 5 RisperiDONE M-TAB QLL (0.75 ML per 28 QLL (1 ML per 28 QLL (1.5 ML per 28 QLL (0.25 ML per 28 QLL (0.5 ML per 28 QLL (0.88 ML per 84 QLL (1.31 ML per 84 QLL (1.75 ML per 84 QLL (2.63 ML per 84 QLL (2 EA per 28 Haldol Decanoate AL (Min 18 Haldol 14
*Dibenzodiazepines*** clozapine oral tablet 100, 25 clozapine oral tablet 200, 50 clozapine oral tablet dispersible 100, 12.5, 150, 200, 25 *Dibenzo-Oxepino Pyrroles*** SAPHRIS SUBLINGUAL TABLET SUBLINGUAL 10 MG, 2.5 MG, 5 MG *Dibenzothiazepines*** quetiapine fumarate oral tablet 100, 200, 25, 300, 400, 50 *Dibenzoxazepines*** loxapine succinate oral capsule 10, 25, 5, 50 *Phenothiazines*** chlorpromazine hcl oral tablet 10, 100, 200, 25, 50 fluphenazine decanoate injection solution 25 /ml Clozaril FazaClo SEROquel QLL (5 EA per 1 day); AL (Min 18 QLL (5 EA per 1 day); AL (Min 18 QLL (5 EA per 1 day); AL (Min 18 AL (Min 18 fluphenazine hcl oral concentrate 5 /ml fluphenazine hcl oral elixir 2.5 /5ml fluphenazine hcl oral tablet 1, 10, 2.5, 5 perphenazine oral tablet 16, 2, 4, 8 prochlorperazine maleate oral tablet 10, 5 prochlorperazine rectal suppository 25 Compro thioridazine hcl oral tablet 10, 100, 25, 50 trifluoperazine hcl oral tablet 1, 10, 2, 5 *Quinolinone Derivatives*** aripiprazole oral solution 1 /ml aripiprazole oral tablet 10, 15, 20, 30, 5 Abilify aripiprazole oral tablet 2 Abilify QLL (5 ML per 1 day); 15
aripiprazole oral tablet dispersible 10, 15 ABILIFY MAINTENA INTRAMUSCULAR PREFILLED SYRINGE 300 MG, 400 MG ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION RECONSTITUTED ER 300 MG, 400 MG ARISTADA INTRAMUSCULAR PREFILLED SYRINGE 1064 MG/3.9ML ARISTADA INTRAMUSCULAR PREFILLED SYRINGE 441 MG/1.6ML ARISTADA INTRAMUSCULAR PREFILLED SYRINGE 662 MG/2.4ML ARISTADA INTRAMUSCULAR PREFILLED SYRINGE 882 MG/3.2ML *Thienbenzodiazepines*** olanzapine oral tablet 10, 2.5, 5, 7.5 olanzapine oral tablet 15, 20 olanzapine oral tablet dispersible 10, 5 olanzapine oral tablet dispersible 15, 20 *Thioxanthenes*** thiothixene oral capsule 1, 10, 2, 5 *BETA BLOCKERS* *Beta Blockers Non-Selective*** ZyPREXA ZyPREXA ZyPREXA Zydis ZyPREXA Zydis nadolol oral tablet 20, 40, 80 Corgard propranolol hcl oral tablet 10, 20, 40, 60, 80 *HEMATOPOIETIC AGENTS* *Cobalamins*** b-12 oral tablet 2000 mcg, 2500 mcg cvs vitamin b-12 tablet 2000 mcg oral 2000 mcg 16 QLL (1 EA per 28 QLL (1 EA per 28 QLL (3.9 ML per 56 QLL (1.6 ML per 28 QLL (2.4 ML per 28 QLL (3.2 ML per 28
cvs vitamin b-12 tablet 500 mcg oral 500 mcg cyanocobalamin solution 1000 mcg/ml injection 1000 mcg/ml vitamin b-12 oral tablet 100 mcg, 1000 mcg, 250 mcg, 50 mcg, 500 mcg vitamin b-12 sublingual tablet sublingual 1000 mcg, 2500 mcg, 3000 mcg, 6000 mcg vitamin b-12 sublingual tablet sublingual 500 mcg B-12 Microlozenge *Folic Acid/Folates*** folic acid oral tablet 1, 400 mcg folic acid oral tablet 800 mcg FA-8 *HYPNOTICS* *Barbiturate Hypnotics*** phenobarbital oral elixir 20 /5ml phenobarbital oral tablet 100, 15, 16.2, 30, 32.4, 60, 64.8, 97.2 *Benzodiazepine Hypnotics*** temazepam oral capsule 15, 30 Restoril *Non-Benzodiazepine - Gaba- Receptor Modulators*** zolpidem tartrate oral tablet 10 Ambien zolpidem tartrate oral tablet 5 Ambien *Selective Melatonin Receptor Agonists*** ROZEREM TABLET 8 MG ORAL 8 MG *LAXATIVES* *Bulk Laxatives*** cvs easy fiber oral powder cvs natural fiber supplement oral packet 58.6 % cvs soluble fiber therapy oral tablet 500 Citrucel eq fiber therapy oral tablet 500 Citrucel ST; QLL (1 EA per 1 day); AL (Min 6 17
eql fiber supplement oral powder eql fiber therapy oral tablet 500 Citrucel fiber (corn dextrin) oral powder fiber therapy oral tablet 500 Citrucel fiber therapy powder 58.6 % oral 58.6 % Metamucil Smooth Texture geri-mucil oral powder 68 % Reguloid gnp fiber therapy oral tablet 500 Citrucel goodsense fiber oral tablet 500 Citrucel hm fiber capsule 0.52 gm oral 0.52 gm Medi-Mucil hm fiber oral tablet 500 Citrucel konsyl daily fiber oral packet 100 % konsyl daily fiber oral powder 60.3 % Konsyl natrul colon care powder 100 % oral 100 % Evac natural fiber capsule 0.52 gm oral 0.52 gm Medi-Mucil natural fiber laxative oral powder 28.3 %, 58.6 % Metamucil Smooth Texture natural fiber laxative oral powder 30.9 % Konsyl natural fiber laxative oral powder 48.57 % Metamucil psyldex oral powder 30 % psyllium fiber oral capsule 0.52 gm Medi-Mucil psyllium husk oral powder 100 % Evac qc natural vegetable oral powder 95 % Hydrocil ra soluble fiber oral tablet 500 Citrucel sb fib lax orange oral powder 33 % sb natural fiber laxative oral powder 49 % sm fiber laxative oral tablet 500 Citrucel sorbulax powder 100 % oral 100 % Evac CITRUCEL ORAL POWDER CITRUCEL ORAL TABLET 500 MG Citrucel KONSYL CAPSULE 520 MG ORAL 520 MG Medi-Mucil KONSYL ORAL POWDER 60.3 % Konsyl KONSYL ORAL POWDER 71.67 % KONSYL-D ORAL POWDER 52.3 % METAMUCIL MULTIHEALTH FIBER ORAL POWDER 63 % 18
METAMUCIL POWDER 28.3 % ORAL 28.3 % REGULOID CAPSULE 0.52 GM ORAL 0.52 GM SOLUBLE FIBER THERAPY ORAL POWDER *Saline Laxatives*** citrate of magnesia oral solution, 1.745 gm/30ml Metamucil Smooth Texture Medi-Mucil Citroma cvs citrate of magnesia oral solution Citroma cvs magnesium citrate oral solution 1.745 Citroma gm/30ml eq magnesium citrate oral solution 1.745 gm/30ml Citroma goodsense magnesium citrate oral solution 1.745 gm/30ml Citroma hm magnesium citrate oral solution 1.745 Citroma gm/30ml magnesium citrate oral solution 1.745 gm/30ml Citroma qc magnesium citrate oral solution 1.745 gm/30ml Citroma ra magnesium citrate oral solution 1.745 gm/30ml Citroma sb magnesium citrate oral solution 1.745 gm/30ml Citroma sm magnesium citrate oral solution 1.745 gm/30ml Citroma CITROMA ORAL SOLUTION 1.745 GM/30ML Citroma *Stimulant Laxatives*** cascara sagrada oral capsule 450 *Surfactant Laxatives*** docusate sodium oral capsule 100 Colace docusate sodium oral capsule 250 DOK docusate sodium oral liquid 150 /15ml docusate sodium oral syrup 60 /15ml docusate sodium oral tablet 100 DOK ENEMEEZ MINI RECTAL ENEMA 283 MG SOF-LAX CAPSULE 100 MG ORAL 100 MG Colace 19
*MOUTH/THROAT/DENTAL AGENTS* *Dry Mouth Agents And Artificial Saliva*** oral relief for dry mouth mouth/throat gel Biotene OralBalance Dry Mouth oral relief for dry mouth mouth/throat lozenge ACT Dry Mouth oral relief spray mouth/throat solution Aquoral AQUORAL AEROSOL SOLUTION MOUTH/THROAT BIOTENE DRY MOUTH MOUTH/THROAT GUM NEUTRASAL MOUTH/THROAT PACKET SALIVATE RX PACKET MOUTH/THROAT *MULTIVITAMINS* *Multiple Vitamins W/ Minerals & Folic Acid*** CORVITA ORAL TABLET 1.25 MG DIALYVITE SUPREME D ORAL TABLET 3 MG *Multiple Vitamins W/ Minerals*** cvs daily multiple fe/ca/zn tablet oral ABC Plus Senior cvs daily multiple for men 50+ tablet oral ABC Plus Senior cvs vision formula tablet oral ABC Plus Senior ecolovit tablet oral ABC Plus Senior eye vitamins & minerals tablet oral ABC Plus Senior gnp century active performance tablet oral ABC Plus Senior hair-vites tablet oral ABC Plus Senior multivitamin & mineral oral liquid Biotect Plus multivitamin gummies adult oral tablet chewable Advanced Multi EA multivitamins plus zinc capsule oral ActivNutrients multivitamins tablet chewable oral Advanced Multi EA natrul-mega-75 tablet oral ABC Plus Senior opti-woman tablet oral ABC Plus Senior 20
qc multi-vite plus tablet oral ABC Plus Senior superb nails tablet oral ABC Plus Senior sure guard anti-oxidant plus tablet oral ABC Plus Senior sure guard multi vit/mineral tablet oral ABC Plus Senior vitamins/minerals oral tablet ABC Plus Senior APATATE FORTE LIQUID ORAL Biotect Plus AQUADEKS CAPSULE ORAL ActivNutrients CEROVITE ADVANCED FORMULA LIQUID ORAL Biotect Plus CERTAVITE/ANTIOXIDANTS LIQUID ORAL Biotect Plus ORTHOVITE TABLET ORAL ABC Plus Senior RENAL TABLET ORAL ABC Plus Senior TAB-A-VITE MAXIMUM TABLET ORAL ABC Plus Senior VITA-BOB CAPSULE ORAL ActivNutrients *Multivitamins*** cvs daily multiple tablet oral Cardenz daily vitamin formula tablet oral Cardenz multiple vitamins oral tablet Cardenz vitamin e/folic acid/b-6/b-12 oral capsule Chlorocaps *NUTRIENTS* *Misc. Nutritional Substances*** fish oil oral capsule 435, 645 fish oil oral capsule delayed release 1200 fish oil oral tablet chewable 875 healthy kids gummies oral tablet chewable 113.5 hm fish oil oral capsule 554 omega-3 fish oil oral capsule 1000 Eskimo PurEFA omega-3 fish oil oral capsule 1200 Sea-Omega 30 omega-3 fish oil oral capsule 300 Fish Oil Pearls omega-3 fish oil oral capsule 500 Ovega-3 omega-3 oral capsule 1400 super omega-epa capsule 1000 oral 1000 Eskimo PurEFA OMEGA-3 IQ ORAL TABLET CHEWABLE 240 MG 21
THEROMEGA SPORT CAPSULE 1000 MG ORAL 1000 MG Eskimo PurEFA *POSTHERPETIC NEURALGIA (PHN)/NEUROPATHIC PAIN AGENTS*** *Postherpetic Neuralgia (Phn)/Neuropathic Pain Agents*** GRALISE ORAL TABLET 300 MG, 600 MG PA GRALISE STARTER ORAL 300 & 600 MG PA *PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.* *Alcohol Deterrents*** acamprosate calcium oral tablet delayed release 333 disulfiram oral tablet 250, 500 Antabuse *Postherpetic Neuralgia (Phn) Agents*** GRALISE ORAL TABLET 300 MG, 600 MG PA GRALISE STARTER ORAL 300 & 600 MG PA *Psychotherapeutic And Neurological Agents - Misc.*** pimozide oral tablet 1, 2 AL (Min 12 *Restless Leg Syndrome (Rls) Agents*** HORIZANT ORAL TABLET EXTENDED RELEASE 300 MG, 600 PA MG *THYROID AGENTS* *Thyroid Hormones*** levothyroxine sodium oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 Euthyrox mcg, 200 mcg, 25 mcg, 50 mcg, 75 mcg, 88 mcg levothyroxine sodium oral tablet 300 mcg Levo-T 22
liothyronine sodium oral tablet 25 mcg, 5 mcg, 50 mcg Cytomel *URINARY ANTISPASMODICS* *Urinary Antispasmodics - Cholinergic Agonists*** bethanechol chloride oral tablet 10, 25 Urecholine, 5, 50 *Urinary Antispasmodics - Cholinergic Agonists*** (New) bethanechol chloride oral tablet 10, 25 Urecholine, 5, 50 *VITAMINS* *Vitamin B-1*** b-1 oral tablet 500 thiamine hcl oral tablet 100 thiamine oral capsule 50 vitamin b-1 oral tablet 250, 50 *Vitamin B-6*** b-6 oral tablet 500 cvs b-6 tablet 100 oral 100 cvs vitamin b-6 oral tablet 100 cvs vitamin b-6 tablet 100 oral 100 pyridoxine hcl oral tablet 100, 25, 50 vitamin b-6 er oral tablet extended release 200 vitamin b6 oral tablet 200, 250 vitamin b-6 tablet 250 oral 250 vitamin b-6 tablet 500 oral 500 *Vitamin E*** natural blend e-400 capsule 400 unit oral 400 unit Ester-E natural vitamin e capsule 200 unit oral 200 unit vitamin e oral capsule 100 unit, 1000 unit, 200 unit, 600 unit vitamin e oral capsule 400 unit Ester-E vitamin e oral tablet chewable 400 unit Key-E vita-plus e capsule 400 unit oral 400 unit Ester-E 23
KEY-E ORAL TABLET CHEWABLE 400 UNIT Key-E 24