Lista de medicamentos preferidos

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Lista de medicamentos preferidos aprobado por Medicaid En vigencia desde el 1 de febrero de 2018

Introducción Anthem HealthKeepers Plus es el programa de cuidado administrado ofrecido a las personas elegibles de Virginia Medicaid y FAMIS por medio de la HMO afiliada a Anthem, HealthKeepers, Inc. La Lista de medicamentos preferidos (PDL) de Anthem HealthKeepers Plus incluye los medicamentos disponibles en el beneficio de farmacia. Estos medicamentos preferidos son medicamentos recetados elegidos por su calidad y efectividad. Algunos medicamentos pueden requerir autorización previa. La PDL de Anthem HealthKeepers Plus se actualiza cada tres meses y está sujeta a cambios. Los miembros y sus proveedores recetantes serán informados si un medicamento ya no está en la PDL. Para consultar las actualizaciones regulares a la PDL, visite nuestro sitio web en www.anthem.com/vamedicaid. De forma alternativa, puede ponerse en contacto con la línea gratuita de Servicios al Miembro al 1-800-901-0020 (TTY 711).

HealthKeepers, Inc. es un licenciatario independiente de Blue Cross and Blue Shield Association. ANTHEM es una marca comercial registrada de Anthem Insurance Companies, Inc. Los nombres y símbolos de Blue Cross and Blue Shield son marcas registradas de Blue Cross and Blue Shield Association. WEBPAVA-0250-17

0910 VAW2081 2/1/2018

Medicamentos de marca vs. genéricos Un medicamento de marca es uno desarrollado, patentado y comercializado por el fabricante del medicamento original. Hasta que expire la patente, ninguna otra compañía puede producir ese mismo medicamento de marca. Un medicamento genérico tiene los mismos ingredientes activos que su contraparte de marca. Un medicamento genérico puede ser fabricado por varias compañías farmacéuticas después de que la patente original expire. Un medicamento genérico es idéntico al medicamento de marca en forma de dosificación, concentración, ruta de administración, calidad y usos pretendidos. Los genéricos pueden diferir de su equivalente de marca en color y/o forma. Ambos medicamentos de marca y genéricos deben cumplir los mismos estándares estrictos de seguridad, pureza y rendimiento regulados por la Food and Drug Administration (FDA).

Límite de cantidad de suministro El límite de cantidad de suministro es la cantidad máxima de un medicamento que una farmacia puede despachar en un momento determinado. La PDL de Anthem HealthKeepers Plus cumple con las directrices de dosificación aprobadas por la FDA. Si un proveedor recetante siente que se necesita por motivos médicos una cantidad de suministro mayor a la máxima definida, entonces guiamos al recetante para que envíe una solicitud de autorización previa detallando la necesidad de exceder la cantidad recomendada.

Autorización previa El programa de autorización previa está diseñado para fomentar el uso adecuado de medicamentos. Los medicamentos que requieren autorización previa generalmente son aquellos que son parte de un régimen de terapia escalonada, tienen un alto potencial de efectos secundarios, deben reservarse para indicaciones específicas de la FDA, tienen un alto uso indebido o potencial abuso, o tienen alternativas de menor costo. Los medicamentos de marca con equivalentes genéricos disponibles requieren autorización previa para fomentar la utilización de las alternativas genéricas apropiadas como terapias de primera línea. Antes de recetar algún medicamento de marca, se les recomienda a los médicos que consideren el uso de su alternativa genérica preferida. Algunos medicamentos de la PDL pueden requerir autorización previa. Si un medicamento requiere autorización previa, debe completarse un Formulario de autorización previa por parte del recetante para ser enviado a HealthKeepers, Inc. Para obtener un formulario de autorización previa y una lista de medicamentos que requieren autorización previa, vaya al sitio web, www.anthem.com/vamedicaid. De forma alternativa, puede ponerse en contacto con la línea gratuita de Servicios al Miembro al 1-800-9010020 (TTY 711) para obtener más información. Cómo usar esta guía La PDL de Anthem HealthKeepers Plus lista el nombre de marca o nombre común de un medicamento determinado. Si un medicamento no aparece en esta PDL, el medicamento requerirá autorización previa para ser cubierto bajo el beneficio de farmacia. El recetante debe completar un formulario de autorización previa y enviarlo a HealthKeepers, Inc. antes de que se pueda abastecer la receta. Para obtener un formulario de autorización previa, vaya al sitio web, www.anthem.com/vamedicaid. De forma alternativa, puede ponerse en contacto con la línea gratuita de Servicios al Miembro al 1-800-901-0020 (TTY 711) para obtener más información. Información de contacto Si tiene preguntas acerca de la PDL de Anthem HealthKeepers Plus, póngase en contacto con Servicios al Miembro al 1-800-901-0020 (TTY 711) para obtener más información. El horario de atención es de lunes a viernes de 8:30 a.m. a 6 p.m. hora del Este. Además, hay disponibles actualizaciones regulares a la PDL visitando www.anthem.com/vamedicaid.

Leyenda En cada categoría, los medicamentos se listan en orden alfabético por marca o nombre genérico. Medicamento de marca = Letra mayúscula en negrita Medicamento genérico = Letra minúscula en texto sin formato OTC = Medicamento de venta libre disponible sin receta. (Los recetadores deben incluir la sigla OTC en la receta). PA = REQUIERE AUTORIZACIÓN PREVIA. La autorización previa es el proceso mediante el cual se obtiene la aprobación de los beneficios antes de que se puedan abastecer ciertas recetas. QL = LÍMITES DE CANTIDAD. Ciertos medicamentos recetados tienen límites de cantidad específicos, por receta o por mes. ST = REQUIERE TERAPIA ESCALONADA. Es posible que necesite utilizar un medicamento antes de que los beneficios para el uso de otro medicamento puedan autorizarse

Nombre del medicamento

Reference

Notas

ADJUVANTES QUÍMICOS O FARMACÉUTICOS ADJUVANTE FARMACÉUTICO (INHALADORES) nebusal inhalation solution for nebulization pulmosal inhalation solution for nebulization sodium chloride inhalation solution for nebulization

AGENTES ANORRECTALES AGENTES ANORRECTALES hydrocortisone topical cream with perineal Anusol-HC applicator

QL

proctosol hc topical cream with perineal applicator

QL

proctozone-hc topical cream with perineal applicator

QL

AGENTES ANTI-INFECCIOSOS AGENTES ANTIBACTERIANOS ANTIPROTOZOARIOS ANAEROBIOS metronidazole oral capsule

Flagyl

metronidazole oral tablet

Flagyl

tinidazole oral tablet

QL

AGENTES ANTILATIVOS, OTROS dapsone oral tablet

AGENTES ANTIMICOBACTERIANOS ethambutol oral tablet

Myambutol

isoniazid oral solution isoniazid oral tablet PRIFTIN ORAL TABLET pyrazinamide oral tablet rifabutin oral capsule

Mycobutin

rifampin oral capsule

Rifadin

RIFATER ORAL TABLET

4

Nombre del medicamento

Reference

Notas

Hepsera

PA

AGENTES PARA EL TRATAMIENTO DE HEPATITIS B adefovir oral tablet BARACLUDE ORAL SOLUTION entecavir oral tablet

PA Baraclude

EPIVIR HBV ORAL SOLUTION lamivudine oral tablet

PA PA; QL

Epivir HBV

PA; QL

AGENTES PARA EL TRATAMIENTO DE HEPATITIS C INCIVEK ORAL TABLET

PA

MAVYRET ORAL TABLET

PA

PEGASYS CONVENIENCE PACK SUBCUTANEOUS KIT PEGASYS PROCLICK SUBCUTANEOUS PEN INJECTOR

PA; QL

PEGASYS SUBCUTANEOUS SOLUTION

PA; QL

PEGASYS SUBCUTANEOUS SYRINGE

PA; QL

PEGINTRON REDIPEN SUBCUTANEOUS PEN INJECTOR KIT

PA

PEGINTRON SUBCUTANEOUS KIT

PA

ribavirin oral capsule

Ribasphere

ribavirin oral tablet

Copegus

SOVALDI ORAL TABLET

PA; QL

VICTRELIS ORAL CAPSULE

PA

ZEPATIER ORAL TABLET

PA; QL

AMIBICIDAS paromomycin oral capsule YODOXIN ORAL TABLET

AMINOGLICÓSIDOS neomycin oral tablet

AMINOPENICILINAS amoxicillin oral capsule amoxicillin oral suspension for reconstitution

QL

amoxicillin oral tablet amoxicillin oral tablet,chewable

5

Nombre del medicamento

Reference

Notas

amoxicillin-pot clavulanate oral suspension for reconstitution amoxicillin-pot clavulanate oral tablet 250125 mg amoxicillin-pot clavulanate oral tablet 500Augmentin 125 mg amoxicillin-pot clavulanate oral tablet 875Augmentin 125 mg

QL

amoxicillin-pot clavulanate oral tablet extended release 12 hr

QL

Augmentin XR

amoxicillin-pot clavulanate oral tablet,chewable

QL

ampicillin oral capsule ampicillin oral suspension for reconstitution

ANTIBIÓTICO SULFONAMIDA sulfadiazine oral tablet

ANTIBIÓTICOS ANTIMICÓTICOS fluconazole oral suspension for reconstitution

Diflucan

fluconazole oral tablet

Diflucan

flucytosine oral capsule

Ancobon

griseofulvin microsize oral suspension griseofulvin ultramicrosize oral tablet

Gris-PEG (ultramicrosize)

itraconazole oral capsule

Sporanox

PA

ketoconazole oral tablet nystatin oral powder nystatin oral tablet terbinafine hcl oral tablet

Lamisil

voriconazole intravenous solution

Vfend IV

PA

voriconazole oral suspension for reconstitution

Vfend

PA

voriconazole oral tablet

Vfend

PA

ANTIHELMÍNTICOS ALBENZA ORAL TABLET BILTRICIDE ORAL TABLET ivermectin oral tablet

6

Stromectol

Nombre del medicamento

Reference

Notas

ANTIVIRALES, ESPECÍFICOS DE VIH abacavir oral solution

Ziagen

abacavir oral tablet

Ziagen

abacavir-lamivudine oral tablet

Epzicom

abacavir-lamivudine-zidovudine oral tablet Trizivir APTIVUS ORAL CAPSULE APTIVUS ORAL SOLUTION atazanavir oral capsule

Reyataz

CRIXIVAN ORAL CAPSULE DESCOVY ORAL TABLET didanosine oral capsule,delayed release(dr/ec)

Videx EC

EDURANT ORAL TABLET EMTRIVA ORAL CAPSULE EMTRIVA ORAL SOLUTION EVOTAZ ORAL TABLET FUZEON SUBCUTANEOUS RECON SOLN

PA

GENVOYA ORAL TABLET INTELENCE ORAL TABLET ISENTRESS HD ORAL TABLET ISENTRESS ORAL POWDER IN PACKET ISENTRESS ORAL TABLET ISENTRESS ORAL TABLET,CHEWABLE KALETRA ORAL TABLET lamivudine oral solution

Epivir

lamivudine oral tablet

Epivir

lamivudine-zidovudine oral tablet

Combivir

lopinavir-ritonavir oral solution

Kaletra

nevirapine oral suspension

Viramune

nevirapine oral tablet

Viramune

nevirapine oral tablet extended release 24 Viramune XR hr NORVIR ORAL CAPSULE NORVIR ORAL SOLUTION 7

Nombre del medicamento

Reference

Notas

NORVIR ORAL TABLET PREZCOBIX ORAL TABLET PREZISTA ORAL SUSPENSION PREZISTA ORAL TABLET RESCRIPTOR ORAL TABLET RESCRIPTOR ORAL TABLET, DISPERSIBLE RETROVIR INTRAVENOUS SOLUTION REYATAZ ORAL POWDER IN PACKET SELZENTRY ORAL SOLUTION SELZENTRY ORAL TABLET stavudine oral capsule

Zerit

stavudine oral recon soln

Zerit

STRIBILD ORAL TABLET tenofovir disoproxil fumarate oral tablet

Viread

PA; QL

TIVICAY ORAL TABLET TRIUMEQ ORAL TABLET TRUVADA ORAL TABLET VIDEX 2 GRAM PEDIATRIC ORAL RECON SOLN VIDEX 4 GRAM PEDIATRIC ORAL RECON SOLN VIRACEPT ORAL TABLET VIREAD ORAL POWDER

PA; QL

VIREAD ORAL TABLET

PA; QL

VITEKTA ORAL TABLET zidovudine oral capsule

Retrovir

zidovudine oral syrup

Retrovir

zidovudine oral tablet

ANTIVIRALES, GENERALES acyclovir oral capsule

Zovirax

acyclovir oral suspension

Zovirax

acyclovir oral tablet

Zovirax

famciclovir oral tablet 125 mg, 250 mg, 500 mg

QL

oseltamivir oral capsule 30 mg, 45 mg, 75 Tamiflu mg

QL

8

Nombre del medicamento

Reference

Notas

oseltamivir oral suspension for reconstitution

Tamiflu

QL

RELENZA DISKHALER INHALATION BLISTER WITH DEVICE rimantadine oral tablet

QL Flumadine

TAMIFLU ORAL CAPSULE 30 MG, 45 MG, 75 MG

QL

TAMIFLU ORAL SUSPENSION FOR RECONSTITUTION

QL

valacyclovir oral tablet 1 gram

Valtrex

valacyclovir oral tablet 500 mg

Valtrex

valganciclovir oral recon soln

Valcyte

valganciclovir oral tablet

Valcyte

QL

CEFALOSPORINA, ANTIBIÓTICOS cefaclor oral capsule cefaclor oral suspension for reconstitution cefaclor oral tablet extended release 12 hr cefadroxil oral capsule cefadroxil oral suspension for reconstitution cefadroxil oral tablet cefdinir oral capsule

QL

cefdinir oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml

QL

cefpodoxime oral suspension for reconstitution cefpodoxime oral tablet cefprozil oral suspension for reconstitution cefprozil oral tablet CEFTIN ORAL SUSPENSION FOR RECONSTITUTION ceftriaxone injection recon soln 1 gram, 2 gram, 250 mg, 500 mg

QL

ceftriaxone injection recon soln 10 gram cefuroxime axetil oral suspension for reconstitution

Ceftin

cefuroxime axetil oral tablet 250 mg cefuroxime axetil oral tablet 500 mg cephalexin oral capsule

QL Keflex 9

Nombre del medicamento

Reference

Notas

cephalexin oral suspension for reconstitution cephalexin oral tablet

COMBINACIONES DE PLASMOCIDAS atovaquone-proguanil oral tablet

Malarone Pediatric

LINCOSAMIDAS clindamycin hcl oral capsule

Cleocin HCl

clindamycin palmitate hcl oral recon soln

Cleocin Pediatric

clindamycin pediatric oral recon soln

MACRÓLIDOS azithromycin oral packet

Zithromax

QL

azithromycin oral suspension for reconstitution

Zithromax

QL

azithromycin oral tablet 250 mg, 500 mg, 600 mg

Zithromax

QL

clarithromycin oral suspension for reconstitution clarithromycin oral tablet clarithromycin oral tablet extended release 24 hr e.e.s. 400 oral tablet ery-tab oral tablet,delayed release (dr/ec) erythrocin (as stearate) oral tablet erythromycin ethylsuccinate oral tablet

E.E.S. 400

erythromycin oral capsule,delayed release(dr/ec) erythromycin oral tablet erythromycin stearate oral tablet

Erythrocin (as stearate)

PENICILINAS dicloxacillin oral capsule penicillin v potassium oral recon soln penicillin v potassium oral tablet

PLASMOCIDAS chloroquine phosphate oral tablet hydroxychloroquine oral tablet mefloquine oral tablet PRIMAQUINE ORAL TABLET 10

Plaquenil QL

Nombre del medicamento

Reference

Notas

Cipro

QL

QUINOLONES ciprofloxacin hcl oral tablet levofloxacin oral solution levofloxacin oral tablet

QL Levaquin

ofloxacin oral tablet 300 mg, 400 mg

QL QL

SULFONAMIDAS ABSORBIBLES sulfamethoxazole-trimethoprim oral suspension

Sulfatrim

sulfamethoxazole-trimethoprim oral tablet Bactrim DS trimethoprim oral tablet

TETRACÍLICAS demeclocycline oral tablet doxycycline monohydrate oral capsule

PA

doxycycline monohydrate oral suspension Vibramycin for reconstitution

PA

minocycline oral capsule

Minocin

minocycline oral tablet tetracycline oral capsule

VANCOMICINA Y DERIVADOS linezolid oral suspension for reconstitution Zyvox

PA; QL

linezolid oral tablet

Zyvox

PA; QL

vancomycin oral capsule

Vancocin

PA

AGENTES DE DIAGNÓSTICO DIAGNOSTIC DROGAS GLUCAGEN DIAGNOSTIC KIT INJECTION RECON SOLN

AGENTES DE TERAPIA CARDIOVASCULAR AGENTES BLOQUEADORES ALFA ADRENÉRGICOS doxazosin oral tablet 1 mg, 2 mg, 4 mg, 8 Cardura mg prazosin oral capsule terazosin oral capsule 1 mg, 10 mg, 2 mg, 5 mg

QL

Minipress QL

11

Nombre del medicamento

Reference

Notas

Coreg

QL

AGENTES BLOQUEADORES ALFA/BETA ADRENÉRGICOS carvedilol oral tablet 12.5 mg, 25 mg, 3.125 mg, 6.25 mg labetalol oral tablet

AGENTES BLOQUEADORES BETA ADRENÉRGICOS acebutolol oral capsule atenolol oral tablet

Tenormin

betaxolol oral tablet bisoprolol fumarate oral tablet metoprolol succinate oral tablet extended Toprol XL release 24 hr metoprolol tartrate oral tablet 100 mg, 50 mg

Lopressor

QL

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

Corgard

pindolol oral tablet propranolol oral capsule,extended release Inderal LA 24 hr propranolol oral solution propranolol oral tablet sorine oral tablet sotalol af oral tablet sotalol oral tablet

Betapace

timolol maleate oral tablet

AGENTES BLOQUEADORES DEL CANAL DE CALCIO afeditab cr oral tablet extended release 30 mg

DO; QL

afeditab cr oral tablet extended release 60 mg

QL

amlodipine oral tablet 10 mg

Norvasc

QL

amlodipine oral tablet 2.5 mg, 5 mg

Norvasc

DO; QL

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

DO; QL

cartia xt oral capsule,extended release 24hr 300 mg

QL

12

Nombre del medicamento

Reference

Notas

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

DILT-XR

DO; QL

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

DILT-XR

QL

diltiazem hcl oral capsule,extended release 12 hr

QL

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

Taztia XT

DO; QL

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

Taztia XT

QL

diltiazem hcl oral capsule,extended release 24 hr 420 mg

Tiazac

QL

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

Cardizem CD

DO; QL

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

Cardizem CD

QL

diltiazem hcl oral tablet 120 mg, 30 mg, 60 Cardizem mg

QL

diltiazem hcl oral tablet 90 mg

QL

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

Cardizem LA

DO; QL

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

Cardizem LA

QL

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

DO; QL

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

QL

felodipine oral tablet extended release 24 hr 10 mg

QL

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

DO; QL

isradipine oral capsule 2.5 mg, 5 mg

QL

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

DO; QL

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

QL

nicardipine oral capsule 20 mg, 30 mg

QL

nifedipine oral capsule

Procardia

QL

nifedipine oral tablet extended release 24hr 30 mg

Procardia XL

DO; QL

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

Procardia XL

QL 13

Nombre del medicamento

Reference

Notas

nifedipine oral tablet extended release 30 Adalat CC mg

DO; QL

nifedipine oral tablet extended release 60 Adalat CC mg, 90 mg

QL

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

DO; QL

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

QL

verapamil oral capsule, 24 hr er pellet ct

Verelan PM

DO; QL

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

Verelan

DO; QL

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

Verelan

QL

verapamil oral tablet

Calan

QL

verapamil oral tablet extended release

Calan SR

QL

epinephrine injection auto-injector

Auvi-Q

QL

epinephrine injection solution

Adrenalin

AGENTES DE TERAPIA ANAFILAXIA

AGENTES DIURÉTICOS, OTROS acetazolamide oral capsule, extended release acetazolamide oral tablet methazolamide oral tablet

Neptazane

spironolactone oral tablet

Aldactone

ANTAGONISTAS DEL RECEPTOR DE LA ALDOSTERONA spironolactone oral tablet

Aldactone

ANTIARRÍTMICOS amiodarone oral tablet 200 mg

Pacerone

amiodarone oral tablet 400 mg

Pacerone

disopyramide phosphate oral capsule

Norpace

flecainide oral tablet

QL

QL

mexiletine oral capsule pacerone oral tablet 200 mg

QL

pacerone oral tablet 400 mg propafenone oral capsule,extended release 12 hr propafenone oral tablet 14

Rythmol SR

Nombre del medicamento

Reference

Notas

quinidine gluconate oral tablet extended release quinidine sulfate oral tablet quinidine sulfate oral tablet extended release sorine oral tablet sotalol af oral tablet sotalol oral tablet

Betapace

DIURÉTICOS AHORRADORES DE POTASIO amiloride oral tablet amiloride-hydrochlorothiazide oral tablet spironolacton-hydrochlorothiaz oral tablet Aldactazide triamterene-hydrochlorothiazid oral capsule

Dyazide

triamterene-hydrochlorothiazid oral tablet Maxzide

DIURÉTICOS DE ASA bumetanide oral tablet furosemide oral solution furosemide oral tablet

Lasix

torsemide oral tablet

Demadex

GLUCÓSIDOS DIGITÁLICOS digox oral tablet digoxin oral solution digoxin oral tablet

Digitek

HIPERTENSIÓN ARTERIAL PULMONAR ADCIRCA ORAL TABLET

PA; QL

LETAIRIS ORAL TABLET

PA; QL

sildenafil (antihypertensive) oral tablet

Revatio

PA; QL

Atacand

QL

HIPOTENSIVOS, ANTAGONISTA DE LOS RECEPTORES DE LA ANGIOTENSINA candesartan oral tablet 16 mg, 32 mg, 4 mg, 8 mg

candesartan-hydrochlorothiazid oral tablet Atacand HCT 16-12.5 mg, 32-12.5 mg, 32-25 mg

QL

irbesartan oral tablet 150 mg, 75 mg

Avapro

DO; QL

irbesartan oral tablet 300 mg

Avapro

QL 15

Nombre del medicamento

Reference

Notas

irbesartan-hydrochlorothiazide oral tablet 150-12.5 mg, 300-12.5 mg

Avalide

QL

losartan oral tablet 100 mg, 25 mg, 50 mg Cozaar

QL

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

Hyzaar

QL

losartan-hydrochlorothiazide oral tablet 50-12.5 mg

Hyzaar

DO; QL

valsartan oral tablet 160 mg, 320 mg, 40 mg, 80 mg

Diovan

QL

valsartan-hydrochlorothiazide oral tablet 160-12.5 mg, 80-12.5 mg

Diovan HCT

DO; QL

valsartan-hydrochlorothiazide oral tablet 160-25 mg, 320-12.5 mg, 320-25 mg

Diovan HCT

QL

HIPOTENSIVOS, INHIBIDORES DE LA ECA, COMBINACIONES benazepril oral tablet

QL

benazepril-hydrochlorothiazide oral tablet

QL

captopril oral tablet

QL

captopril-hydrochlorothiazide oral tablet

QL

enalapril maleate oral tablet

Vasotec

QL

enalapril-hydrochlorothiazide oral tablet

QL

fosinopril oral tablet

QL

fosinopril-hydrochlorothiazide oral tablet

QL

lisinopril oral tablet 10 mg, 20 mg, 5 mg

Prinivil

DO; QL

lisinopril oral tablet 2.5 mg

Zestril

DO; QL

lisinopril oral tablet 30 mg, 40 mg

Zestril

QL

lisinopril-hydrochlorothiazide oral tablet 10-12.5 mg

Zestoretic

DO; QL

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

Zestoretic

QL

moexipril oral tablet moexipril-hydrochlorothiazide oral tablet perindopril erbumine oral tablet

QL

quinapril oral tablet

Accupril

QL

quinapril-hydrochlorothiazide oral tablet

Accuretic

QL

ramipril oral capsule

Altace

QL

trandolapril oral tablet

16

Nombre del medicamento

Reference

Notas

Catapres

DO; QL

HIPOTENSIVOS, SIMPATOLÍTICOS clonidine hcl oral tablet 0.1 mg, 0.2 mg, 0.3 mg guanfacine oral tablet

DO; QL

methyldopa oral tablet reserpine oral tablet

HIPOTENSIVOS, VARIOS atenolol-chlorthalidone oral tablet

Tenoretic 50

bisoprolol-hydrochlorothiazide oral tablet

Ziac

methyldopa-hydrochlorothiazide oral tablet metoprolol ta-hydrochlorothiaz oral tablet 100-25 mg, 100-50 mg

QL

metoprolol ta-hydrochlorothiaz oral tablet 50-25 mg

Lopressor HCT

nadolol-bendroflumethiazide oral tablet

Corzide

QL

propranolol-hydrochlorothiazid oral tablet

HIPOTENSIVOS, VASODILATADORES hydralazine oral tablet minoxidil oral tablet

INHIBIDOR DE LA ECA/COMBINACIÓN DEL BLOQUEADOR DEL CANAL DE CALCIO amlodipine-benazepril oral capsule

QL

INHIBIDORES DE LA PCSK-9 REPATHA PUSHTRONEX SUBCUTANEOUS WEARABLE INJECTOR

PA; QL

REPATHA SURECLICK SUBCUTANEOUS PEN INJECTOR

PA; QL

REPATHA SYRINGE SUBCUTANEOUS SYRINGE

PA; QL

LIPOTRÓPICOS atorvastatin oral tablet 10 mg, 20 mg, 40 mg

Lipitor

DO; QL

atorvastatin oral tablet 80 mg

Lipitor

QL

cholestyramine (with sugar) oral powder

Questran 17

Nombre del medicamento

Reference

Notas

cholestyramine (with sugar) oral powder in Questran packet cholestyramine light oral powder cholestyramine light oral powder in packet colestipol oral granules

Colestid

colestipol oral packet

Colestid

colestipol oral tablet

Colestid

fenofibrate micronized oral capsule fenofibrate nanocrystallized oral tablet

QL Tricor

fenofibrate oral tablet

QL QL

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

Trilipix

QL

fenofibric acid oral tablet

Fibricor

QL

gemfibrozil oral tablet

Lopid

lovastatin oral tablet 10 mg, 20 mg

DO; QL

lovastatin oral tablet 40 mg

QL

pravastatin oral tablet 10 mg

DO; QL

pravastatin oral tablet 20 mg, 40 mg

Pravachol

DO; QL

pravastatin oral tablet 80 mg

Pravachol

QL

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

Zocor

DO; QL

simvastatin oral tablet 80 mg

Zocor

PA; QL

Microzide

QL

prevalite oral powder prevalite oral powder in packet

TIAZIDA Y DIURÉTICOS RELACIONADOS chlorothiazide oral tablet chlorthalidone oral tablet hydrochlorothiazide oral capsule hydrochlorothiazide oral tablet 12.5 mg

QL

hydrochlorothiazide oral tablet 25 mg, 50 mg indapamide oral tablet metolazone oral tablet

VASODILATADORES, CORONARIA isosorbide dinitrate oral tablet

Isordil Titradose

isosorbide dinitrate oral tablet extended release

ISOCHRON

18

Nombre del medicamento

Reference

Notas

isosorbide mononitrate oral tablet isosorbide mononitrate oral tablet extended release 24 hr nitro-bid transdermal ointment NITRO-DUR TRANSDERMAL PATCH 24 HOUR nitroglycerin oral capsule, extended release

Nitro-Time

nitroglycerin sublingual tablet

Nitrostat

nitroglycerin transdermal patch 24 hour

Minitran

nitro-time oral capsule, extended release

VASOPRESOR ADRENÉRGICO midodrine oral tablet

AGENTES DE TERAPIA GASTROINTESTINAL AGENTES ANTIEMÉTICOS/ANTIVÉRTIGOS compro rectal suppository ondansetron oral tablet,disintegrating 4 mg, 8 mg

Zofran ODT

phenadoz rectal suppository

PA; QL AL

prochlorperazine edisylate injection solution prochlorperazine maleate oral tablet

Compazine

prochlorperazine rectal suppository

Compazine

promethazine oral syrup

AL

promethazine oral tablet 12.5 mg, 50 mg promethazine oral tablet 25 mg promethazine rectal suppository

QL Phenadoz

AL

promethegan rectal suppository 12.5 mg, 25 mg promethegan rectal suppository 50 mg trimethobenzamide oral capsule

AL Tigan

AGENTES PARA LA ENFERMEDAD INFLAMATORIA INTESTINAL budesonide oral capsule,delayed,extend.release

Entocort EC

QL

colocort rectal enema

19

Nombre del medicamento

Reference

Notas

HUMIRA PEDIATRIC CROHN'S START SUBCUTANEOUS SYRINGE KIT

PA; QL

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

PA; QL

HUMIRA PEN PSORIASIS-UVEITIS SUBCUTANEOUS PEN INJECTOR KIT

PA; QL

HUMIRA PEN SUBCUTANEOUS PEN INJECTOR KIT

PA; QL

HUMIRA SUBCUTANEOUS SYRINGE KIT

PA; QL

hydrocortisone rectal enema

Colocort

ANTIDIARREICOS diphenoxylate-atropine oral liquid diphenoxylate-atropine oral tablet

Lomotil

ANTIESPASMÓDICOS dicyclomine oral capsule dicyclomine oral solution dicyclomine oral tablet glycopyrrolate oral tablet

Robinul

hyoscyamine sulfate oral drops

Hyosyne

hyoscyamine sulfate oral elixir

Hyosyne

hyoscyamine sulfate oral tablet

Levsin

hyoscyamine sulfate oral tablet extended release 12 hr

Levbid

hyoscyamine sulfate oral tablet,disintegrating

Anaspaz

hyoscyamine sulfate sublingual tablet

Levsin/SL

hyosyne oral drops hyosyne oral elixir oscimin oral tablet oscimin oral tablet,disintegrating oscimin sl sublingual tablet oscimin sr oral tablet extended release 12 hr propantheline oral tablet symax fastabs oral tablet,disintegrating symax-sr oral tablet extended release 12 hr

20

Nombre del medicamento

Reference

Notas

ENZIMAS PANCREÁTICAS CREON ORAL CAPSULE,DELAYED RELEASE(DR/EC) pancrelipase 5000 oral capsule,delayed release(dr/ec)

ESTIMULANTES DE MOTILIDAD INTESTINAL metoclopramide hcl oral solution metoclopramide hcl oral tablet

Reglan

INFLAMACIÓN CRÓNICA, ENFERMEDAD DE COLON, 5 AMINOSALICILATOS APRISO ORAL CAPSULE,EXTENDED RELEASE 24HR

QL

balsalazide oral capsule

Colazal

QL

mesalamine rectal enema

sfRowasa

QL

mesalamine with cleansing wipe rectal enema kit

Rowasa

QL

sulfasalazine oral tablet

Azulfidine

QL

sulfasalazine oral tablet,delayed release (dr/ec)

Azulfidine EN-tabs

QL

sulfazine oral tablet

QL

LAXANTES Y CATÁRTICOS constulose oral solution

QL

enulose oral solution gavilyte-c oral recon soln

QL

gavilyte-g oral recon soln

QL

gavilyte-n oral recon soln

QL

generlac oral solution lactulose oral solution 10 gram/15 ml

Constulose

lactulose oral solution 10 gram/15 ml (15 ml)

QL QL

lactulose oral solution 20 gram/30 ml peg 3350-electrolytes oral recon soln

Colyte with Flavor Packs

peg-3350 with flavor packs oral recon soln peg-electrolyte soln oral recon soln trilyte with flavor packets oral recon soln

QL QL

GaviLyte-N

QL QL

21

Nombre del medicamento

Reference

Notas

REDUCTORES DE SECRECIÓN ÁCIDA GÁSTRICA CARAFATE ORAL SUSPENSION famotidine (pf) intravenous solution famotidine oral suspension

Pepcid

famotidine oral tablet

Pepcid

misoprostol oral tablet

Cytotec

nizatidine oral capsule nizatidine oral solution ranitidine hcl oral capsule ranitidine hcl oral syrup ranitidine hcl oral tablet

Zantac

sucralfate oral suspension

Carafate

sucralfate oral tablet

Carafate

SALES BILIARES ursodiol oral capsule

Actigall

ursodiol oral tablet

URSO 250

AGENTES DE TERAPIA RESPIRATORIA AGENTES ALFA/BETA ADRENÉRGICOS epinephrine injection solution

Adrenalin

epinephrine injection syringe

AGENTES BETA ADRENÉRGICOS albuterol sulfate inhalation solution for nebulization 0.63 mg/3 ml, 1.25 mg/3 ml, 2.5 mg /3 ml (0.083 %)

QL

albuterol sulfate inhalation solution for nebulization 2.5 mg/0.5 ml, 5 mg/ml albuterol sulfate oral syrup albuterol sulfate oral tablet albuterol sulfate oral tablet extended release 12 hr metaproterenol oral syrup metaproterenol oral tablet SEREVENT DISKUS INHALATION BLISTER WITH DEVICE terbutaline oral tablet 22

QL

Nombre del medicamento

Reference

VENTOLIN HFA INHALATION HFA AEROSOL INHALER

Notas QL

AGENTES BRONCODILATADORES GENERALES ATROVENT HFA INHALATION HFA AEROSOL INHALER

QL

ipratropium bromide inhalation solution

QL

SPIRIVA RESPIMAT INHALATION MIST

QL

AGENTES PARA EL TRATAMIENTO DEL ASMA AEROSPAN INHALATION HFA AEROSOL INHALER

QL

ARNUITY ELLIPTA INHALATION BLISTER WITH DEVICE

QL

budesonide inhalation suspension for nebulization 0.25 mg/2 ml, 0.5 mg/2 ml, 1 Pulmicort mg/2 ml

PA; AL; QL

cromolyn inhalation solution for nebulization FLOVENT DISKUS INHALATION BLISTER WITH DEVICE 100 MCG/ACTUATION, 250 MCG/ACTUATION, 50 MCG/ACTUATION

PA; AL; Preferred for Members less than 12 years of age. PA required for members greater than 12.; QL

FLOVENT HFA INHALATION HFA AEROSOL INHALER

PA; AL; Preferred for Members less than 12 years of age. PA required for members greater than 12.; QL

AMINOGLICÓSIDOS tobramycin in 0.225 % nacl inhalation solution for nebulization

Tobi

ANTAGONISTAS DEL RECEPTOR DE LEUCOTRIENO montelukast oral granules in packet

Singulair

QL

montelukast oral tablet

Singulair

QL

montelukast oral tablet,chewable

Singulair

QL

zafirlukast oral tablet

Accolate

ANTIBIÓTICOS NASALES BACTROBAN NASAL NASAL OINTMENT 23

Nombre del medicamento

Reference

Notas

ANTICOLINÉRGICOS NASALES ipratropium bromide nasal spray,nonaerosol

QL

ANTICUERPOS DE INMUNOGLOBULINA XOLAIR SUBCUTANEOUS RECON SOLN

PA

ANTIHISTAMÍNICOS NASALES azelastine nasal aerosol,spray azelastine nasal spray,non-aerosol

QL Astepro

QL

ANTIHISTAMÍNICOS arbinoxa oral tablet

AL

carbinoxamine maleate oral liquid

AL

carbinoxamine maleate oral tablet

AL

clemastine oral syrup clemastine oral tablet cyproheptadine oral syrup cyproheptadine oral tablet phenadoz rectal suppository

AL

promethazine oral syrup

AL

promethazine oral tablet 12.5 mg, 50 mg promethazine oral tablet 25 mg promethazine rectal suppository

QL Phenadoz

AL

promethegan rectal suppository 12.5 mg, 25 mg promethegan rectal suppository 50 mg

AL

COMBINACIÓN DE AGENTES BETA ADRENÉRGICOS ANORO ELLIPTA INHALATION BLISTER WITH DEVICE

QL

COMBIVENT RESPIMAT INHALATION MIST

QL

ipratropium-albuterol inhalation solution for nebulization

COMBINACIONES ANTITUSIVAS NO NARCÓTICAS benzonatate oral capsule

Tessalon Perles

centergy dm oral drops

AL

promethazine-dm oral syrup

AL

24

Nombre del medicamento

Reference

Notas

COMBINACIONES DE ANTIHISTAMÍNICOS Y DESCONGESTIVOS centergy oral drops

AL

pcm la oral tablet extended release 12 hr promethazine vc oral syrup promethazine-phenylephrine oral syrup

AL Promethazine VC

r-tanna oral tablet

AL

COMBINACIONES DE ANTITUSIVOS NARCÓTICOS hydrocodone compound oral syrup hydrocodone-chlorpheniramine oral suspension,extended rel 12 hr

Tussionex Pennkinetic ER

hydrocodone-homatropine oral syrup

Hydrocodone Compound

hydrocodone-homatropine oral tablet

Tussigon

AL

hydromet oral syrup promethazine vc-codeine oral syrup

AL

promethazine-codeine oral syrup

AL

promethazine-phenyleph-codeine oral syrup

Promethazine VC-Codeine

COMBINACIONES DE GLUCOCORTICOIDES Y BETAADRENÉRGICOS BREO ELLIPTA INHALATION BLISTER WITH DEVICE

PA; QL

DULERA INHALATION HFA AEROSOL INHALER

PA; QL

MUCOLÍTICOS acetylcysteine solution PULMOZYME INHALATION SOLUTION

PA; QL

XANTINAS ELIXOPHYLLIN ORAL ELIXIR theochron oral tablet extended release 12 hr theophylline oral elixir

Elixophyllin

theophylline oral solution theophylline oral tablet extended release 12 hr

Theochron

25

Nombre del medicamento

Reference

Notas

theophylline oral tablet extended release 24 hr

AGENTES DEL SISTEMA NERVIOSO CENTRAL AGENTES PARA LA FIBROMIALGIA LYRICA ORAL CAPSULE 100 MG, 150 MG, 200 MG, 225 MG, 25 MG, 300 MG, 50 MG, 75 MG

PA; QL

LYRICA ORAL SOLUTION

PA; QL

ANSIOLÍTICOS alprazolam oral tablet

Xanax

QL

alprazolam oral tablet,disintegrating

DO; QL

buspirone oral tablet 10 mg, 15 mg, 30 mg, 5 mg, 7.5 mg

DO; QL

chlordiazepoxide hcl oral capsule

DO; QL

clonazepam oral tablet

Klonopin

QL

clonazepam oral tablet,disintegrating

QL

clorazepate dipotassium oral tablet

DO; QL

diazepam intensol oral concentrate

DO; QL

diazepam oral concentrate

Diazepam Intensol

diazepam oral solution diazepam oral tablet

DO; QL QL

Valium

DO; QL

hydroxyzine hcl oral solution

QL

hydroxyzine hcl oral tablet 10 mg, 25 mg, 50 mg

DO; QL

hydroxyzine pamoate oral capsule

Vistaril

DO; QL

lorazepam oral tablet

Ativan

QL

oxazepam oral capsule

QL

ANTICONVULSIVOS carbamazepine oral capsule, er Carbatrol multiphase 12 hr 100 mg, 200 mg, 300 mg

QL

carbamazepine oral suspension

Tegretol

DO; QL

carbamazepine oral tablet

Epitol

DO; QL

carbamazepine oral tablet extended release 12 hr

Tegretol XR

DO; QL

carbamazepine oral tablet,chewable clonazepam oral tablet clonazepam oral tablet,disintegrating 26

DO; QL Klonopin

QL QL

Nombre del medicamento

Reference

Notas

diazepam rectal kit 12.5-15-17.5-20 mg, 5-7.5-10 mg

Diastat AcuDial

QL

diazepam rectal kit 2.5 mg

Diastat

QL

divalproex oral capsule, delayed rel sprinkle

Depakote Sprinkles

DO; QL

divalproex oral tablet extended release 24 Depakote ER hr 250 mg, 500 mg

DO; QL

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

Depakote

DO; QL

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

Depakote

epitol oral tablet

DO; QL

ethosuximide oral capsule

Zarontin

ethosuximide oral solution

Zarontin

felbamate oral suspension

Felbatol

felbamate oral tablet

Felbatol

gabapentin oral capsule 100 mg, 300 mg, Neurontin 400 mg

QL

gabapentin oral solution

Neurontin

QL

gabapentin oral tablet 600 mg, 800 mg

Neurontin

QL

lamotrigine oral tablet

Lamictal

QL

lamotrigine oral tablet disintegrating, dose Lamictal ODT Starter (Blue) pk lamotrigine oral tablet extended release 24hr 100 mg, 200 mg, 25 mg, 250 mg, 300 mg, 50 mg

Lamictal XR

QL

lamotrigine oral tablet, chewable dispersible 25 mg, 5 mg

Lamictal

QL

lamotrigine oral tablet,disintegrating 100 mg, 200 mg, 25 mg, 50 mg

Lamictal ODT

QL

lamotrigine oral tablets,dose pack

Lamictal Starter (Blue) Kit

levetiracetam oral solution

Keppra

levetiracetam oral tablet

Keppra

levetiracetam oral tablet extended release Keppra XR 24 hr 500 mg, 750 mg

QL

LYRICA ORAL CAPSULE 100 MG, 150 MG, 200 MG, 225 MG, 25 MG, 300 MG, 50 MG, 75 MG

PA; QL

LYRICA ORAL SOLUTION

PA; QL

oxcarbazepine oral suspension

Trileptal

DO; QL 27

Nombre del medicamento

Reference

Notas

oxcarbazepine oral tablet 150 mg, 300 mg Trileptal

QL

oxcarbazepine oral tablet 600 mg

DO; QL

Trileptal

phenobarbital oral elixir

QL

phenobarbital oral tablet 100 mg, 15 mg, 60 mg phenobarbital oral tablet 16.2 mg, 30 mg, 32.4 mg, 64.8 mg, 97.2 mg

QL

phenytoin oral suspension

Dilantin-125

phenytoin oral tablet,chewable

Dilantin Infatabs

phenytoin sodium extended oral capsule

Dilantin Extended

primidone oral tablet

Mysoline

ROWEEPRA ORAL TABLET tiagabine oral tablet

Gabitril

topiramate oral capsule, sprinkle

Topamax

QL

topiramate oral tablet

Topamax

QL

valproic acid (as sodium salt) oral solution Depakene valproic acid (as sodium salt) oral syringe valproic acid oral capsule

Depakene

zonisamide oral capsule

Zonegran

DO; QL

ANTIDEPRESIVOS ANTAGONISTAS DE RECEPTORES ALFA-2 mirtazapine oral tablet

Remeron

DO; QL

mirtazapine oral tablet,disintegrating

Remeron SolTab

DO; QL

ANTIDEPRESIVOS TRICÍCLICOS E INHIBIDORES DE RECAPTACIÓN NO SELECCIONADOS RELACIONADOS amitriptyline oral tablet

DO; QL

amoxapine oral tablet clomipramine oral capsule 25 mg, 50 mg, Anafranil 75 mg

DO; QL

desipramine oral tablet 10 mg, 25 mg

DO; QL

Norpramin

desipramine oral tablet 100 mg, 150 mg, 50 mg, 75 mg

DO; QL

doxepin oral capsule 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg

DO; QL

doxepin oral concentrate

DO; QL

imipramine hcl oral tablet 10 mg, 25 mg, 50 mg 28

Tofranil

DO; QL

Nombre del medicamento

Reference

Notas

imipramine pamoate oral capsule 100 mg, 125 mg, 150 mg, 75 mg

DO; QL

maprotiline oral tablet

DO; QL

nortriptyline oral capsule 10 mg, 25 mg, 50 mg, 75 mg

Pamelor

DO; QL

nortriptyline oral solution

DO; QL

protriptyline oral tablet

DO; QL

trimipramine oral capsule 100 mg, 25 mg, Surmontil 50 mg

DO; QL

ANTIMANIA DROGAS lithium carbonate oral capsule

DO; QL

lithium carbonate oral tablet

DO; QL

lithium carbonate oral tablet extended release

DO; QL

lithium citrate oral solution

ANTIPSICÓTICOS, DOPAMINA ATÍPICA Y ANTAGONISTAS DE SEROTONINA ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON

PA; AL

ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING

PA; AL

aripiprazole oral tablet 10 mg, 2 mg, 5 mg Abilify

PA; DO; AL; QL

aripiprazole oral tablet 15 mg, 20 mg, 30 mg

PA; AL; QL

Abilify

ARISTADA INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING clozapine oral tablet 100 mg, 25 mg

PA; AL Clozaril

PA; DO; AL; QL

clozapine oral tablet 200 mg

PA; AL; QL

clozapine oral tablet 50 mg

PA; DO; AL; QL

INVEGA SUSTENNA INTRAMUSCULAR SYRINGE

PA; AL; QL

INVEGA TRINZA INTRAMUSCULAR SYRINGE

PA; AL; QL

olanzapine intramuscular recon soln

Zyprexa

PA; AL

olanzapine oral tablet 10 mg, 15 mg, 20 mg

Zyprexa

PA; AL; QL

olanzapine oral tablet 2.5 mg, 5 mg, 7.5 mg

Zyprexa

PA; DO; AL; QL

29

Nombre del medicamento

Reference

Notas

paliperidone oral tablet extended release 24hr 1.5 mg

Invega

PA; AL

paliperidone oral tablet extended release 24hr 3 mg

Invega

PA; DO; AL; QL

paliperidone oral tablet extended release 24hr 6 mg, 9 mg

Invega

PA; AL; QL

quetiapine oral tablet 100 mg, 25 mg, 50 mg

Seroquel

PA; DO; AL; QL

quetiapine oral tablet 200 mg, 300 mg, 400 mg

Seroquel

PA; AL; QL

RISPERDAL CONSTA INTRAMUSCULAR SYRINGE risperidone oral solution

PA; AL; QL Risperdal

PA; AL

risperidone oral tablet 0.25 mg, 0.5 mg, 1 Risperdal mg, 2 mg

PA; DO; AL; QL

risperidone oral tablet 3 mg, 4 mg

PA; AL; QL

Risperdal

ziprasidone hcl oral capsule 20 mg, 40 mg Geodon

PA; DO; AL; QL

ziprasidone hcl oral capsule 60 mg, 80 mg Geodon

PA; AL; QL

ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION

PA; AL

ANTIPSICÓTICOS, TÍPICOS chlorpromazine oral tablet 10 mg, 25 mg, 50 mg

PA; DO; QL

chlorpromazine oral tablet 100 mg, 200 mg

PA; QL

fluphenazine decanoate injection solution

PA

fluphenazine hcl injection solution

PA

fluphenazine hcl oral concentrate

PA

fluphenazine hcl oral elixir

PA

fluphenazine hcl oral tablet 1 mg, 2.5 mg

PA; DO; QL

fluphenazine hcl oral tablet 10 mg, 5 mg

PA; QL

haloperidol decanoate intramuscular solution 100 mg/ml

Haldol Decanoate

PA; QL

haloperidol decanoate intramuscular solution 50 mg/ml

Haldol Decanoate

PA

haloperidol lactate injection solution

Haldol

PA

haloperidol lactate oral concentrate

PA

haloperidol oral tablet 0.5 mg, 1 mg, 2 mg

PA; DO; QL

haloperidol oral tablet 10 mg, 20 mg, 5 mg

PA; QL

30

Nombre del medicamento

Reference

Notas

loxapine succinate oral capsule 10 mg, 25 mg, 5 mg

PA; DO; AL; QL

loxapine succinate oral capsule 50 mg

PA; AL; QL

perphenazine oral tablet 16 mg, 4 mg, 8 mg

PA; QL

perphenazine oral tablet 2 mg

PA; DO; QL

pimozide oral tablet 1 mg, 2 mg

Orap

prochlorperazine maleate oral tablet

Compazine

PA; DO; AL; QL

thioridazine oral tablet 10 mg, 25 mg

DO; QL

thioridazine oral tablet 100 mg, 50 mg

QL

thiothixene oral capsule 1 mg, 2 mg, 5 mg

PA; DO; QL

thiothixene oral capsule 10 mg

PA; QL

trifluoperazine oral tablet 1 mg, 2 mg

PA; DO; QL

trifluoperazine oral tablet 10 mg, 5 mg

PA; QL

BARBITÚRICOS phenobarbital oral elixir

QL

phenobarbital oral tablet 100 mg, 15 mg, 60 mg phenobarbital oral tablet 16.2 mg, 30 mg, 32.4 mg, 64.8 mg, 97.2 mg

QL

BENZODIACEPINAS amitriptyline-chlordiazepoxide oral tablet diazepam intensol oral concentrate diazepam oral concentrate

DO; QL Diazepam Intensol

diazepam oral solution

DO; QL QL

diazepam oral tablet

Valium

DO; QL

diazepam rectal kit 12.5-15-17.5-20 mg, 5-7.5-10 mg

Diastat AcuDial

QL

diazepam rectal kit 2.5 mg

Diastat

QL

lorazepam oral tablet

Ativan

QL

COMBINACIONES DE BENZODIACEPINA/ANTIDEPRESIV OS TRICÍCLICOS amitriptyline-chlordiazepoxide oral tablet

COMBINACIONES DE FENOTIAZINA/ANTIDEPRESIVOS TRICÍCLICOS perphenazine-amitriptyline oral tablet 31

Nombre del medicamento

Reference

Notas

DÉFICIT DE ATENCIÓN, HIPERACTIVIDAD (TDAH)/NARCOLEPSIA atomoxetine oral capsule 10 mg, 100 mg, Strattera 18 mg, 25 mg, 40 mg, 60 mg, 80 mg caffeine citrate intravenous solution

PA; DO; QL

Cafcit

caffeine citrate oral solution clonidine hcl oral tablet extended release 12 hr

Kapvay

PA

dexmethylphenidate oral capsule,er biphasic 50-50 10 mg, 15 mg, 20 mg, 5 mg

Focalin XR

PA; DO; QL

dexmethylphenidate oral capsule,er biphasic 50-50 25 mg, 30 mg, 35 mg, 40 mg

Focalin XR

PA; QL

dexmethylphenidate oral tablet 10 mg

Focalin

PA; QL

dexmethylphenidate oral tablet 2.5 mg, 5 mg

Focalin

PA; DO; QL

dextroamphetamine oral capsule, extended release 10 mg, 15 mg

Dexedrine Spansule

PA; QL

dextroamphetamine oral capsule, extended release 5 mg

Dexedrine Spansule

PA; DO; QL

dextroamphetamine oral tablet 10 mg

Zenzedi

PA; QL

dextroamphetamine oral tablet 5 mg

Zenzedi

PA; DO; QL

dextroamphetamine-amphetamine oral capsule,extended release 24hr 10 mg, 15 Adderall XR mg, 5 mg

PA; DO; QL

dextroamphetamine-amphetamine oral capsule,extended release 24hr 20 mg, 25 Adderall XR mg, 30 mg

PA; QL

dextroamphetamine-amphetamine oral tablet 10 mg, 12.5 mg, 15 mg, 5 mg, 7.5 mg

Adderall

PA; DO; QL

dextroamphetamine-amphetamine oral tablet 20 mg, 30 mg

Adderall

PA; QL

metadate er oral tablet extended release

PA; QL

methylphenidate hcl oral capsule, er biphasic 30-70 10 mg, 20 mg, 30 mg

PA; DO; QL

methylphenidate hcl oral capsule, er biphasic 30-70 40 mg, 50 mg, 60 mg

PA; QL

methylphenidate hcl oral capsule,er biphasic 50-50 20 mg 32

Ritalin LA

PA; DO; QL

Nombre del medicamento

Reference

Notas

methylphenidate hcl oral capsule,er biphasic 50-50 30 mg, 40 mg

Ritalin LA

PA; QL

methylphenidate hcl oral capsule,er biphasic 50-50 60 mg

PA; QL

methylphenidate hcl oral solution 10 mg/5 Methylin ml, 5 mg/5 ml

PA; QL

methylphenidate hcl oral tablet 10 mg, 5 mg

Ritalin

PA; DO; QL

methylphenidate hcl oral tablet 20 mg

Ritalin

PA; QL

methylphenidate hcl oral tablet extended release 10 mg

PA; DO; QL

methylphenidate hcl oral tablet extended release 20 mg

Metadate ER

PA; QL

methylphenidate hcl oral tablet extended release 24hr 18 mg, 27 mg

Concerta

PA; DO; QL

methylphenidate hcl oral tablet extended release 24hr 36 mg, 54 mg

Concerta

PA; QL

DIABETIC PERIPHERAL NEUROPATHY AGENTS LYRICA CR ORAL TABLET EXTENDED RELEASE 24 HR

PA

ESTIMULANTES DEL SNC dextroamphetamine oral capsule, extended release 10 mg, 15 mg

Dexedrine Spansule

PA; QL

dextroamphetamine oral capsule, extended release 5 mg

Dexedrine Spansule

PA; DO; QL

dextroamphetamine oral tablet 10 mg

Zenzedi

PA; QL

dextroamphetamine oral tablet 5 mg

Zenzedi

PA; DO; QL

dextroamphetamine-amphetamine oral capsule,extended release 24hr 10 mg, 15 Adderall XR mg, 5 mg

PA; DO; QL

dextroamphetamine-amphetamine oral capsule,extended release 24hr 20 mg, 25 Adderall XR mg, 30 mg

PA; QL

dextroamphetamine-amphetamine oral tablet 10 mg, 12.5 mg, 15 mg, 5 mg, 7.5 mg

Adderall

PA; DO; QL

dextroamphetamine-amphetamine oral tablet 20 mg, 30 mg

Adderall

PA; QL

33

Nombre del medicamento

Reference

Notas

INHIBIDOR SELECTIVO DE RECAPTACIÓN DE SEROTONINA (ISRS) citalopram oral solution

QL

citalopram oral tablet 10 mg, 20 mg

Celexa

DO; QL

citalopram oral tablet 40 mg

Celexa

QL

escitalopram oxalate oral solution

QL

escitalopram oxalate oral tablet 10 mg, 5 mg

Lexapro

DO; QL

escitalopram oxalate oral tablet 20 mg

Lexapro

QL

fluoxetine oral capsule 10 mg, 20 mg

Prozac

DO; QL

fluoxetine oral capsule 40 mg

Prozac

QL

fluoxetine oral capsule,delayed release(dr/ec)

QL

fluoxetine oral solution

QL

fluoxetine oral tablet 10 mg, 20 mg

Sarafem

DO; QL

fluvoxamine oral tablet 100 mg

QL

fluvoxamine oral tablet 25 mg, 50 mg

DO; QL

paroxetine hcl oral tablet 10 mg, 20 mg

Paxil

DO; QL

paroxetine hcl oral tablet 30 mg, 40 mg

Paxil

QL

paroxetine hcl oral tablet extended release 24 hr 12.5 mg

Paxil CR

DO; QL

paroxetine hcl oral tablet extended release 24 hr 25 mg, 37.5 mg

Paxil CR

QL

sertraline oral concentrate

Zoloft

QL

sertraline oral tablet 100 mg

Zoloft

QL

sertraline oral tablet 25 mg, 50 mg

Zoloft

DO; QL

INHIBIDORES DE RECAPTACIÓN DE DOPAMINA Y NOREPINEFRINA (IRND) bupropion hcl oral tablet 100 mg

QL

bupropion hcl oral tablet 75 mg

DO; QL

bupropion hcl oral tablet extended release Wellbutrin SR 12 hr 100 mg

DO; QL

bupropion hcl oral tablet extended release Wellbutrin SR 12 hr 150 mg, 200 mg

QL

bupropion hcl oral tablet extended release Wellbutrin XL 24 hr 150 mg

DO; QL

34

Nombre del medicamento

Reference

bupropion hcl oral tablet extended release Wellbutrin XL 24 hr 300 mg

Notas QL

INHIBIDORES DE RECAPTACIÓN DE SEROTONINA-NOREPINEFRINA (IRSN) duloxetine oral capsule,delayed release(dr/ec) 20 mg, 60 mg

Cymbalta

PA; QL

duloxetine oral capsule,delayed release(dr/ec) 30 mg

Cymbalta

PA; DO; QL

duloxetine oral capsule,delayed release(dr/ec) 40 mg

PA; DO; QL

venlafaxine oral capsule,extended release Effexor XR 24hr 150 mg

QL

venlafaxine oral capsule,extended release Effexor XR 24hr 37.5 mg, 75 mg

DO; QL

venlafaxine oral tablet 100 mg, 25 mg, 37.5 mg, 50 mg

QL

venlafaxine oral tablet 75 mg

DO; QL

venlafaxine oral tablet extended release 24hr 150 mg, 225 mg

QL

venlafaxine oral tablet extended release 24hr 37.5 mg, 75 mg

DO; QL

INHIBIDORES DE REUNIÓN DE ANTAGONISTAS DE SEROTONINA2 (SARIS) nefazodone oral tablet

DO; QL

trazodone oral tablet 100 mg, 150 mg, 300 mg, 50 mg

DO; QL

INHIBIDORES MAO phenelzine oral tablet

Nardil

DO; QL

tranylcypromine oral tablet

Parnate

DO; QL

MEDICAMENTOS PARA EL PARKINSON, ANTICOLINÉRGICO benztropine oral tablet trihexyphenidyl oral elixir trihexyphenidyl oral tablet

MEDICAMENTOS PARA EL PARKINSON, OTRO amantadine hcl oral capsule amantadine hcl oral solution 35

Nombre del medicamento

Reference

Notas

amantadine hcl oral tablet bromocriptine oral capsule

Parlodel

bromocriptine oral tablet

Parlodel

carbidopa-levodopa oral tablet

Sinemet

carbidopa-levodopa oral tablet extended release

Sinemet CR

carbidopa-levodopa oral tablet,disintegrating carbidopa-levodopa-entacapone oral tablet

Stalevo 50

entacapone oral tablet

Comtan

pramipexole oral tablet

Mirapex

ropinirole oral tablet

Requip

selegiline hcl oral capsule

Eldepryl

selegiline hcl oral tablet

NEUROPATHIC PAIN THERAPY LYRICA CR ORAL TABLET EXTENDED RELEASE 24 HR

PA

POSTHERPETIC NEURALGIA AGENTS LYRICA CR ORAL TABLET EXTENDED RELEASE 24 HR

PA

PREPARADOS PARA LA MIGRAÑA divalproex oral tablet extended release 24 Depakote ER hr 250 mg, 500 mg ergotamine-caffeine oral tablet

Cafergot

isometh-dichloral-acetaminophn oral capsule

Nodolor

DO; QL

migergot rectal suppository migragesic ida oral capsule naratriptan oral tablet

Amerge

QL

sumatriptan nasal spray,non-aerosol

Imitrex

PA; QL

sumatriptan succinate oral tablet

Imitrex

QL

sumatriptan succinate subcutaneous cartridge 4 mg/0.5 ml, 6 mg/0.5 ml

Imitrex STATdose Kit Refill

PA; QL

nodolor oral capsule

sumatriptan succinate subcutaneous pen Imitrex STATdose Pen injector 4 mg/0.5 ml, 6 mg/0.5 ml

36

PA; QL

Nombre del medicamento

Reference

Notas

sumatriptan succinate subcutaneous solution

Imitrex

PA; QL

sumatriptan succinate subcutaneous syringe

PA; QL

SEDANTE HIPNÓTICO, NO BARBITÚRICOS estazolam oral tablet

DO; QL

flurazepam oral capsule

DO; QL

temazepam oral capsule

Restoril

triazolam oral tablet

DO; QL DO; QL

zaleplon oral capsule

Sonata

DO; QL

zolpidem oral tablet

Ambien

DO; QL

Lysteda

QL

AGENTES HEMATOLÓGICOS AGENTES ANTIFIBRINOLÍTICOS tranexamic acid oral tablet

AGENTES HEMORREOLÓGICOS pentoxifylline oral tablet extended release

AGENTES PARA LA ANEMIA FALCIFORME DROXIA ORAL CAPSULE

ANTICOAGULANTES ORALES ELIQUIS ORAL TABLET jantoven oral tablet warfarin oral tablet

Coumadin

XARELTO ORAL TABLET XARELTO ORAL TABLETS,DOSE PACK

HEMATÍNICOS, OTRO ARANESP (IN POLYSORBATE) INJECTION SOLUTION

PA

ARANESP (IN POLYSORBATE) INJECTION SYRINGE

PA

EPOGEN INJECTION SOLUTION

PA

PROCRIT INJECTION SOLUTION

PA

HEPARINA Y PREPARADOS RELACIONADOS enoxaparin subcutaneous solution

Lovenox

QL

37

Nombre del medicamento

Reference

enoxaparin subcutaneous syringe 100 mg/ml, 120 mg/0.8 ml, 150 mg/ml, 30 Lovenox mg/0.3 ml, 40 mg/0.4 ml, 60 mg/0.6 ml, 80 mg/0.8 ml

Notas QL

heparin (porcine) injection cartridge heparin (porcine) injection solution heparin (porcine) injection syringe heparin, porcine (pf) injection solution heparin, porcine (pf) injection syringe

INHIBIDORES DE AGREGACIÓN PLAQUETARIA anagrelide oral capsule cilostazol oral tablet clopidogrel oral tablet 300 mg

Plavix

clopidogrel oral tablet 75 mg

Plavix

dipyridamole oral tablet ticlopidine oral tablet

AGENTES INMUNOSUPRESORES INMUNOSUPRESORES azathioprine oral tablet

Imuran

cyclosporine modified oral capsule

Gengraf

cyclosporine modified oral solution

Gengraf

cyclosporine oral capsule

Sandimmune

gengraf oral capsule gengraf oral solution hecoria oral capsule mycophenolate mofetil oral capsule

CellCept

mycophenolate mofetil oral suspension for CellCept reconstitution mycophenolate mofetil oral tablet

CellCept

mycophenolate sodium oral tablet,delayed Myfortic release (dr/ec) RAPAMUNE ORAL SOLUTION SANDIMMUNE ORAL SOLUTION sirolimus oral tablet

Rapamune

tacrolimus oral capsule

Prograf

38

QL

Nombre del medicamento

Reference

Notas

AGENTES OFTÁLMICOS AGENTES ANTIINFLAMATORIOS OFTÁLMICOS dexamethasone sodium phosphate ophthalmic (eye) drops diclofenac sodium ophthalmic (eye) drops fluorometholone ophthalmic (eye) drops,suspension

FML Liquifilm

flurbiprofen sodium ophthalmic (eye) drops prednisolone acetate ophthalmic (eye) drops,suspension

Omnipred

prednisolone sodium phosphate ophthalmic (eye) drops XIIDRA OPHTHALMIC (EYE) DROPPERETTE

PA; QL

ANTIBIÓTICO OFTÁLMICO, COMBINACIONES DE CORTICOESTEROIDES neomycin-bacitracin-poly-hc ophthalmic (eye) ointment

Neo-Polycin HC

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

Maxitrol

neomycin-polymyxin b-dexameth ophthalmic (eye) ointment

Maxitrol

neomycin-polymyxin-hc ophthalmic (eye) drops,suspension neo-polycin hc ophthalmic (eye) ointment sulfacetamide-prednisolone ophthalmic (eye) drops tobramycin-dexamethasone ophthalmic (eye) drops,suspension

QL TobraDex

QL

ANTIBIÓTICOS OFTÁLMICOS ak-poly-bac ophthalmic (eye) ointment bacitracin ophthalmic (eye) ointment

QL

bacitracin-polymyxin b ophthalmic (eye) ointment

Polycin

ciprofloxacin hcl ophthalmic (eye) drops

Ciloxan

erythromycin ophthalmic (eye) ointment garamycin ophthalmic (eye) drops 39

Nombre del medicamento

Reference

gatifloxacin ophthalmic (eye) drops

Zymaxid

Notas

gentak ophthalmic (eye) ointment

QL

gentamicin ophthalmic (eye) drops

QL

gentamicin ophthalmic (eye) ointment

Gentak

QL

levofloxacin ophthalmic (eye) drops moxifloxacin ophthalmic (eye) drops

Vigamox

neomycin-bacitracin-polymyxin ophthalmic Neo-Polycin (eye) ointment

QL

neomycin-polymyxin-gramicidin ophthalmic (eye) drops

QL

neo-polycin ophthalmic (eye) ointment

QL

ofloxacin ophthalmic (eye) drops

Ocuflox

QL

polymyxin b sulf-trimethoprim ophthalmic (eye) drops

Polytrim

QL

sulfacetamide sodium ophthalmic (eye) drops

Bleph-10

QL

polycin ophthalmic (eye) ointment

sulfacetamide sodium ophthalmic (eye) ointment tobramycin ophthalmic (eye) drops

QL Tobrex

QL

ANTIHISTAMÍNICOS OFTÁLMICOS azelastine ophthalmic (eye) drops epinastine ophthalmic (eye) drops

QL Elestat

QL

Viroptic

QL

ANTIVIRALES OFTÁLMICOS trifluridine ophthalmic (eye) drops

DESCONGESTIVOS OFTÁLMICOS naphazoline ophthalmic (eye) drops phenylephrine hcl ophthalmic (eye) drops

ESTABILIZADORES DE CÉLULAS MASTALES OPTÁLMICAS cromolyn ophthalmic (eye) drops

QL

MIDIÁTRICOS atropine ophthalmic (eye) drops

QL

atropine ophthalmic (eye) ointment

QL

atropine-care ophthalmic (eye) drops

MIÓTICOS/OTROS REDUCTORES DE PRESIÓN INTRAOCULAR apraclonidine ophthalmic (eye) drops 40

Iopidine

Nombre del medicamento

Reference

Notas

betaxolol ophthalmic (eye) drops brimonidine ophthalmic (eye) drops

QL

carteolol ophthalmic (eye) drops dorzolamide ophthalmic (eye) drops

Trusopt

QL

dorzolamide-timolol ophthalmic (eye) drops

Cosopt

QL

latanoprost ophthalmic (eye) drops

Xalatan

levobunolol ophthalmic (eye) drops

Betagan

metipranolol ophthalmic (eye) drops pilocarpine hcl ophthalmic (eye) drops

Isopto Carpine

timolol maleate ophthalmic (eye) drops

Timoptic

QL

timolol maleate ophthalmic (eye) gel forming solution

Timoptic-XE

QL

Fiorinal

QL

ANALGÉSICO, ANTIINFLAMATORIO O ANTIPIRÉTICO ANALGÉSICO/ANTIPIRÉTICOS, SALICILATOS butalbital-aspirin-caffeine oral capsule choline,magnesium salicylate oral liquid diflunisal oral tablet salsalate oral tablet

Disalcid

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

QL

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

PA; QL

ascomp with codeine oral capsule

PA; QL

aspirin-caffeine-dihydrocodein oral capsule

PA; QL

BELBUCA BUCCAL FILM 150 MCG, 300 MCG, 450 MCG, 600 MCG, 75 MCG, 750 MCG, 900 MCG

PA; QL

butalbital compound w/codeine oral capsule

PA; QL

butalbital compound-codeine oral capsule

PA; QL

butalbital-acetaminop-caf-cod oral capsule

PA; QL

butorphanol tartrate nasal spray,nonaerosol

PA; QL 41

Nombre del medicamento

Reference

Notas

CODEINE SULFATE ORAL SOLUTION codeine sulfate oral tablet 15 mg, 30 mg, 60 mg codeine-butalbital-asa-caff oral capsule

PA; QL Ascomp with Codeine

PA; QL

diskets oral tablet,soluble

PA; QL

endocet oral tablet 10-325 mg, 5-325 mg, 7.5-325 mg

PA; QL

fentanyl citrate buccal lozenge on a handle

Actiq

PA; QL

fentanyl transdermal patch 72 hour

Duragesic

PA; QL

hydrocodone-acetaminophen oral solution 10-325 mg/15 ml(15 ml), 2.5-167 mg/5 ml hydrocodone-acetaminophen oral solution 5-163 mg/7.5ml(7.5ml)

PA; QL

hydrocodone-acetaminophen oral solution Hycet 7.5-325 mg/15 ml

PA; QL

hydrocodone-acetaminophen oral tablet 10-300 mg

Vicodin HP

PA; QL

hydrocodone-acetaminophen oral tablet 10-325 mg

Lorcet HD

PA; QL

hydrocodone-acetaminophen oral tablet 2.5-325 mg

Verdrocet

QL

hydrocodone-acetaminophen oral tablet 5Vicodin 300 mg

PA; QL

hydrocodone-acetaminophen oral tablet 5Lorcet (hydrocodone) 325 mg

PA; QL

hydrocodone-acetaminophen oral tablet 7.5-300 mg

Vicodin ES

PA; QL

hydrocodone-acetaminophen oral tablet 7.5-325 mg

Lorcet Plus

QL

hydrocodone-ibuprofen oral tablet

PA; QL

hydromorphone oral liquid

Dilaudid

PA; QL

hydromorphone oral tablet 2 mg, 4 mg, 8 mg

Dilaudid

PA; QL

hydromorphone rectal suppository

PA; QL

meperidine oral solution

PA; QL

meperidine oral tablet 100 mg

Demerol

PA; QL

meperidine oral tablet 50 mg

PA; QL

methadone intensol oral concentrate

PA; QL

methadone oral concentrate 42

Methadone Intensol

PA; QL

Nombre del medicamento

Reference

methadone oral solution 10 mg/5 ml, 5 mg/5 ml

Notas PA; QL

methadone oral tablet 10 mg, 5 mg

Dolophine

PA; QL

methadone oral tablet,soluble

Diskets

PA; QL

methadose oral concentrate

PA; QL

methadose oral tablet,soluble

PA; QL

morphine concentrate oral solution

PA; QL

morphine oral solution 10 mg/5 ml, 20 mg/5 ml (4 mg/ml)

PA; QL

morphine oral tablet 15 mg, 30 mg

PA; QL

morphine oral tablet extended release 100 MS Contin mg, 15 mg, 200 mg, 30 mg, 60 mg

PA; QL

morphine rectal suppository

QL

oxycodone oral capsule

PA; QL

oxycodone oral concentrate

PA; QL

oxycodone oral solution

PA; QL

oxycodone oral tablet 10 mg, 20 mg

PA; QL

oxycodone oral tablet 15 mg, 30 mg, 5 mg Roxicodone

PA; QL

oxycodone-acetaminophen oral tablet 10325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 Endocet mg

PA; QL

oxycodone-aspirin oral tablet

PA; QL

pentazocine-naloxone oral tablet

PA; QL

tramadol oral tablet

Ultram

PA; QL

tramadol-acetaminophen oral tablet

Ultracet

PA; QL

vicodin es oral tablet

PA; QL

vicodin hp oral tablet

PA; QL

vicodin oral tablet

PA; QL

zamicet oral solution

QL

ANALGÉSICOS, NO NARCÓTICOS alagesic lq oral solution butalbital-acetaminophen oral tablet

QL Marten-Tab

QL

butalbital-acetaminophen-caff oral capsule Fioricet

QL

butalbital-acetaminophen-caff oral tablet

QL

capacet oral capsule

Esgic

QL

margesic oral capsule marten-tab oral tablet

QL

tencon oral tablet 50-325 mg

QL 43

Nombre del medicamento

Reference

TENCON ORAL TABLET 50-650 MG

Notas QL

ANTIINFLAMATORIO, INHIBIDOR DE LA SÍNTESIS DE PIRIMIDINA leflunomide oral tablet

Arava

RIDAURA ORAL CAPSULE

ENFERMEDADES MODIFICANTES ANTI-REUMATOIDES (DMARD) DEPEN TITRATABS ORAL TABLET

PA

hydroxychloroquine oral tablet

Plaquenil

minocycline oral capsule

Minocin

minocycline oral tablet sulfasalazine oral tablet

Azulfidine

QL

sulfasalazine oral tablet,delayed release (dr/ec)

Azulfidine EN-tabs

QL

sulfazine oral tablet

QL

INHIBIDOR DEL FACTOR DE LA NECROSIS TUMORAL ANTIINFLAMATORIA ENBREL MINI SUBCUTANEOUS CARTRIDGE

PA; QL

ENBREL SUBCUTANEOUS RECON SOLN

PA; QL

ENBREL SUBCUTANEOUS SYRINGE 25 MG/0.5ML (0.51), 50 MG/ML (0.98 ML)

PA; QL

ENBREL SURECLICK SUBCUTANEOUS PEN INJECTOR

PA; QL

HUMIRA PEDIATRIC CROHN'S START SUBCUTANEOUS SYRINGE KIT

PA; QL

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

PA; QL

HUMIRA PEN PSORIASIS-UVEITIS SUBCUTANEOUS PEN INJECTOR KIT

PA; QL

HUMIRA PEN SUBCUTANEOUS PEN INJECTOR KIT

PA; QL

HUMIRA SUBCUTANEOUS SYRINGE KIT

PA; QL

44

Nombre del medicamento

Reference

Notas

INHIBIDOR DEL FACTOR DE NECROSIS TUMORAL ANTIINFLAMATORIO ENBREL MINI SUBCUTANEOUS CARTRIDGE

PA; QL

ENBREL SUBCUTANEOUS RECON SOLN

PA; QL

ENBREL SUBCUTANEOUS SYRINGE 25 MG/0.5ML (0.51), 50 MG/ML (0.98 ML)

PA; QL

ENBREL SURECLICK SUBCUTANEOUS PEN INJECTOR

PA; QL

HUMIRA PEDIATRIC CROHN'S START SUBCUTANEOUS SYRINGE KIT

PA; QL

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

PA; QL

HUMIRA PEN PSORIASIS-UVEITIS SUBCUTANEOUS PEN INJECTOR KIT

PA; QL

HUMIRA PEN SUBCUTANEOUS PEN INJECTOR KIT

PA; QL

HUMIRA SUBCUTANEOUS SYRINGE KIT

PA; QL

INMUNOSUPRESORES azathioprine oral tablet

Imuran

cyclophosphamide oral tablet cyclosporine modified oral capsule

Gengraf

cyclosporine modified oral solution

Gengraf

cyclosporine oral capsule

Sandimmune

gengraf oral capsule gengraf oral solution mycophenolate mofetil oral capsule

CellCept

mycophenolate mofetil oral suspension for CellCept reconstitution mycophenolate mofetil oral tablet

CellCept

SANDIMMUNE ORAL SOLUTION

NSAIDS celecoxib oral capsule 100 mg, 200 mg, 400 mg, 50 mg

Celebrex

PA; QL

diclofenac potassium oral tablet

45

Nombre del medicamento

Reference

diclofenac sodium oral tablet extended release 24 hr

Voltaren-XR

Notas

diclofenac sodium oral tablet,delayed release (dr/ec) diclofenac-misoprostol oral tablet,ir,delayed rel,biphasic

Arthrotec 50

PA

etodolac oral capsule etodolac oral tablet

Lodine

etodolac oral tablet extended release 24 hr fenoprofen oral tablet

ProFeno

flurbiprofen oral tablet ibuprofen oral tablet indomethacin oral capsule indomethacin oral capsule, extended release ketoprofen oral capsule ketoprofen oral capsule,ext rel. pellets 24 hr ketorolac oral tablet

QL

meclofenamate oral capsule mefenamic acid oral capsule

PA

meloxicam oral suspension

QL

meloxicam oral tablet

Mobic

QL

nabumetone oral tablet naproxen oral suspension

Naprosyn

naproxen oral tablet naproxen oral tablet,delayed release (dr/ec)

EC-Naprosyn

PA

naproxen sodium oral tablet, er multiphase 24 hr

Naprelan CR

PA

oxaprozin oral tablet

Daypro

piroxicam oral capsule

Feldene

naproxen sodium oral tablet

sulindac oral tablet tolmetin oral capsule tolmetin oral tablet

46

Nombre del medicamento

Reference

Notas

LTA Pre-Attached

QL

ANESTÉSICOS AGENTES ANESTÉSICOS LOCALES lidocaine hcl laryngotracheal solution lidocaine topical ointment

QL

ANTICONCEPTIVOS ANTICONCEPTIVOS DE EMERGENCIA ELLA ORAL TABLET levonorgestrel oral tablet

ANTICONCEPTIVOS altavera (28) oral tablet

AL

alyacen 1/35 (28) oral tablet

AL

alyacen 7/7/7 (28) oral tablet

AL

amethia lo oral tablets,dose pack,3 month

AL; QL

amethia oral tablets,dose pack,3 month

AL; QL

amethyst oral tablet

AL; QL

apri oral tablet

AL; QL

aranelle (28) oral tablet

AL

ashlyna oral tablets,dose pack,3 month

AL; QL

aubra oral tablet

AL

aviane oral tablet

AL

azurette (28) oral tablet

AL; QL

balziva (28) oral tablet

AL

bekyree (28) oral tablet

AL; QL

blisovi 24 fe oral tablet

AL; QL

blisovi fe 1.5/30 (28) oral tablet

AL; QL

blisovi fe 1/20 (28) oral tablet

AL; QL

briellyn oral tablet

AL

camila oral tablet

AL

camrese lo oral tablets,dose pack,3 month

AL; QL

camrese oral tablets,dose pack,3 month

AL; QL

caziant (28) oral tablet

AL

chateal oral tablet

AL

cryselle (28) oral tablet

AL

cyclafem 1/35 (28) oral tablet

AL

cyclafem 7/7/7 (28) oral tablet

AL

cyred oral tablet

AL; QL 47

Nombre del medicamento

Reference

Notas

dasetta 1/35 (28) oral tablet

AL

dasetta 7/7/7 (28) oral tablet

AL

daysee oral tablets,dose pack,3 month

AL; QL

deblitane oral tablet

AL

delyla (28) oral tablet

AL

desog-e.estradiol/e.estradiol oral tablet

Azurette (28)

AL; QL

desogestrel-ethinyl estradiol oral tablet

Apri

AL; QL

drospirenone-e.estradiol-lm.fa oral tablet

Beyaz

AL

drospirenone-ethinyl estradiol oral tablet 3-0.02 mg

Gianvi (28)

AL; QL

drospirenone-ethinyl estradiol oral tablet 3-0.03 mg

Ocella

AL

elinest oral tablet

AL

emoquette oral tablet

AL; QL

enpresse oral tablet

AL

enskyce oral tablet

AL; QL

errin oral tablet

AL

estarylla oral tablet

AL

ethynodiol diac-eth estradiol oral tablet

Zovia 1/50E (28)

AL

falmina (28) oral tablet

AL

fayosim oral tablets,dose pack,3 month

AL; QL

femynor oral tablet

AL

gianvi (28) oral tablet

AL; QL

gildagia oral tablet

AL

gildess 1.5/30 (21) oral tablet gildess 1/20 (21) oral tablet gildess fe 1.5/30 (28) oral tablet gildess fe 1/20 (28) oral tablet heather oral tablet

AL

introvale oral tablets,dose pack,3 month

AL; QL

jencycla oral tablet

AL

jolessa oral tablets,dose pack,3 month

AL; QL

jolivette oral tablet

AL

juleber oral tablet

AL; QL

junel 1.5/30 (21) oral tablet

AL

junel 1/20 (21) oral tablet

AL

junel fe 1.5/30 (28) oral tablet

AL; QL

48

Nombre del medicamento

Reference

Notas

junel fe 1/20 (28) oral tablet

AL; QL

junel fe 24 oral tablet

AL; QL

kaitlib fe oral tablet,chewable

AL; QL

kariva (28) oral tablet

AL; QL

kelnor 1/35 (28) oral tablet

AL

kimidess (28) oral tablet

AL; QL

kurvelo oral tablet

AL

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

Amethia

AL; QL

larin 1.5/30 (21) oral tablet

AL

larin 1/20 (21) oral tablet

AL

larin 24 fe oral tablet

AL; QL

larin fe 1.5/30 (28) oral tablet

AL; QL

larin fe 1/20 (28) oral tablet

AL; QL

larissia oral tablet

AL

layolis fe oral tablet,chewable

AL; QL

leena 28 oral tablet

AL

lessina oral tablet

AL

levonest (28) oral tablet

AL

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

Aubra

AL

levonorgestrel-ethinyl estrad oral tablet 0.15-0.03 mg

Altavera (28)

AL

levonorgestrel-ethinyl estrad oral tablet 90-20 mcg

Amethyst

AL; QL

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

Introvale

AL; QL

levonorg-eth estrad triphasic oral tablet

Enpresse

AL

levora 0.15/30 (28) oral tablet

AL

levora-28 oral tablet

AL

LILETTA INTRAUTERINE INTRAUTERINE DEVICE lomedia 24 fe oral tablet

AL; QL

loryna (28) oral tablet

AL; QL

low-ogestrel (28) oral tablet

AL

lutera (28) oral tablet

AL

lyza oral tablet

AL 49

Nombre del medicamento

Reference

marlissa oral tablet

Notas AL

medroxyprogesterone intramuscular suspension

Depo-Provera

AL

medroxyprogesterone intramuscular syringe

Depo-Provera

AL

mibelas 24 fe oral tablet,chewable

AL

microgestin 1.5/30 (21) oral tablet

AL

microgestin 1/20 (21) oral tablet

AL

microgestin fe 1.5/30 (28) oral tablet

AL; QL

microgestin fe 1/20 (28) oral tablet

AL; QL

MIRENA INTRAUTERINE INTRAUTERINE DEVICE mono-linyah oral tablet

AL

mononessa (28) oral tablet

AL

myzilra oral tablet

AL

necon 0.5/35 (28) oral tablet

AL

necon 1/50 (28) oral tablet

AL

necon 10/11 (28) oral tablet

AL

necon 7/7/7 (28) oral tablet

AL

NEXPLANON SUBDERMAL IMPLANT nikki (28) oral tablet

AL; QL

nora-be oral tablet

AL

noreth-ethinyl estradiol-iron oral tablet,chewable

Generess Fe

AL; QL

norethindrone (contraceptive) oral tablet

Camila

AL

norethindrone ac-eth estradiol oral tablet

Junel 1/20 (21)

AL

norethindrone-e.estradiol-iron oral tablet

Blisovi Fe 1/20 (28)

AL; QL

norethindrone-e.estradiol-iron oral tablet,chewable

Melodetta 24 Fe

AL

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

Ortho Tri-Cyclen LO (28)

AL; QL

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

Ortho Tri-Cyclen (28)

AL

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

Estarylla

AL

norgestrel-ethinyl estradiol oral tablet

Ogestrel (28)

AL

norlyroc oral tablet

AL

nortrel 0.5/35 (28) oral tablet

AL

nortrel 1/35 (21) oral tablet

AL

50

Nombre del medicamento

Reference

Notas

nortrel 1/35 (28) oral tablet

AL

nortrel 7/7/7 (28) oral tablet

AL

NUVARING VAGINAL RING

AL

ocella oral tablet

AL

ogestrel (28) oral tablet

AL

orsythia oral tablet

AL

PARAGARD T 380A INTRAUTERINE INTRAUTERINE DEVICE philith oral tablet

AL

pimtrea (28) oral tablet

AL; QL

pirmella oral tablet

AL

portia oral tablet

AL

previfem oral tablet

AL

quasense oral tablets,dose pack,3 month

AL; QL

rajani oral tablet

AL

reclipsen (28) oral tablet

AL; QL

RIVELSA ORAL TABLETS,DOSE PACK,3 MONTH

AL; QL

setlakin oral tablets,dose pack,3 month

AL; QL

sharobel oral tablet

AL

SKYLA INTRAUTERINE INTRAUTERINE DEVICE sprintec (28) oral tablet

AL

sronyx oral tablet

AL

syeda oral tablet

AL

tarina fe 1/20 (28) oral tablet

AL; QL

tilia fe oral tablet

AL; QL

tri femynor oral tablet tri-estarylla oral tablet

AL

tri-legest fe oral tablet

AL; QL

tri-linyah oral tablet

AL

tri-lo-estarylla oral tablet

AL; QL

tri-lo-marzia oral tablet

AL; QL

tri-lo-sprintec oral tablet

AL; QL

trinessa (28) oral tablet

AL

trinessa lo oral tablet

AL; QL

tri-previfem (28) oral tablet

AL

tri-sprintec (28) oral tablet

AL 51

Nombre del medicamento

Reference

Notas

trivora (28) oral tablet

AL

velivet triphasic regimen (28) oral tablet

AL

vestura (28) oral tablet

AL; QL

vienva oral tablet

AL

viorele (28) oral tablet

AL; QL

vyfemla (28) oral tablet

AL

wera (28) oral tablet

AL

wymzya fe oral tablet,chewable

AL; QL

xulane transdermal patch weekly

AL; QL

zarah oral tablet

AL

zenchent (28) oral tablet

AL

zeosa oral tablet,chewable zovia 1/35e (28) oral tablet

AL

zovia 1/50e (28) oral tablet

AL

ANTÍDOTOS Y OTROS AGENTES DE REVERSIÓN AGENTES QUELANTES deferoxamine injection recon soln

Desferal

DEPEN TITRATABS ORAL TABLET

PA

SYPRINE ORAL CAPSULE

PA; QL

ANTAGONISTAS DE NARCÓTICOS naloxone injection solution

QL

naloxone injection syringe

QL

naltrexone oral tablet NARCAN NASAL SPRAY,NONAEROSOL

QL

ANTÍDOTOS acetylcysteine solution

ANTINEOPLÁSICOS MEDICAMENTOS ANTINEOPLÁSICOS/INMUNOSUPR ESORES anastrozole oral tablet

Arimidex

bicalutamide oral tablet

Casodex

QL

cyclophosphamide oral tablet EMCYT ORAL CAPSULE exemestane oral tablet 52

PA Aromasin

QL

Nombre del medicamento

Reference

Notas

flutamide oral capsule HEXALEN ORAL CAPSULE

PA

hydroxyurea oral capsule

Hydrea

imatinib oral tablet 100 mg, 400 mg

Gleevec

IRESSA ORAL TABLET letrozole oral tablet

PA; QL PA; QL

Femara

QL

leucovorin calcium oral tablet megestrol oral tablet melphalan oral tablet MESNEX ORAL TABLET

Alkeran PA

MYLERAN ORAL TABLET tamoxifen oral tablet tretinoin (chemotherapy) oral capsule

BIOLÓGICOS INMUNOGLOBULINAS GAMUNEX-C INJECTION SOLUTION

PA

OCTAGAM INTRAVENOUS SOLUTION

PA

VACUNAS INMUNOLÓGICAS AFLURIA 2014-2015 (PF) INTRAMUSCULAR SYRINGE AFLURIA 2014-2015 INTRAMUSCULAR SUSPENSION AFLURIA 2015-2016 (PF) INTRAMUSCULAR SYRINGE AFLURIA 2015-2016 INTRAMUSCULAR SUSPENSION AFLURIA 2016-2017 (PF) INTRAMUSCULAR SYRINGE AFLURIA 2016-2017 INTRAMUSCULAR SUSPENSION AFLURIA 2017-2018 (PF) INTRAMUSCULAR SYRINGE

QL

AFLURIA 2017-2018 INTRAMUSCULAR SUSPENSION

QL

AFLURIA QUAD 2016-2017 (PF) INTRAMUSCULAR SYRINGE AFLURIA QUAD 2017-2018 (PF) INTRAMUSCULAR SYRINGE

QL

53

Nombre del medicamento AFLURIA QUAD 2017-2018 INTRAMUSCULAR SUSPENSION

Reference

Notas QL

EZ FLU 2015-16 (FLUVIRIN) (PF) INTRAMUSCULAR SYRINGE KIT EZ FLU 2015-16(FLUCELVAX)(PF) INTRAMUSCULAR SYRINGE KIT EZ FLU 2016-17 (AFLURIA) (PF) INTRAMUSCULAR SYRINGE KIT EZ FLU 2016-17 (FLUVIRIN) (PF) INTRAMUSCULAR SYRINGE KIT EZ FLU16-17(FLUZON QD PED)(PF) INTRAMUSCULAR SYRINGE KIT FLUAD 2016-2017 (65 YR UP)(PF) INTRAMUSCULAR SYRINGE FLUAD 2017-2018 (65 YR UP)(PF) INTRAMUSCULAR SYRINGE

QL

FLUARIX QUAD 2016-2017 (PF) INTRAMUSCULAR SYRINGE FLUARIX QUAD 2017-2018 (PF) INTRAMUSCULAR SYRINGE

QL

FLUBLOK 2016-2017 (PF) INTRAMUSCULAR SOLUTION FLUBLOK 2017-2018 (PF) INTRAMUSCULAR SOLUTION

QL

FLUBLOK QUAD 2017-2018 (PF) INTRAMUSCULAR SYRINGE

QL

FLUCELVAX QUAD 2016-2017 (PF) INTRAMUSCULAR SYRINGE FLUCELVAX QUAD 2017-2018 (PF) INTRAMUSCULAR SYRINGE

QL

FLUCELVAX QUAD 2017-2018 INTRAMUSCULAR SUSPENSION

QL

FLULAVAL QUAD 2015-2016 INTRAMUSCULAR SUSPENSION FLULAVAL QUAD 2016-2017 (PF) INTRAMUSCULAR SYRINGE FLULAVAL QUAD 2016-2017 INTRAMUSCULAR SUSPENSION FLULAVAL QUAD 2017-2018 (PF) INTRAMUSCULAR SYRINGE

QL

FLULAVAL QUAD 2017-2018 INTRAMUSCULAR SUSPENSION

QL

54

Nombre del medicamento

Reference

Notas

FLUMIST QUAD 2014-2015 NASAL NASAL SPRAY SYRINGE FLUMIST QUAD 2015-2016 NASAL NASAL SPRAY SYRINGE FLUVIRIN 2013-2014 (PF) INTRAMUSCULAR SYRINGE FLUVIRIN 2013-2014 INTRAMUSCULAR SUSPENSION FLUVIRIN 2014-2015 (PF) INTRAMUSCULAR SYRINGE FLUVIRIN 2014-2015 INTRAMUSCULAR SUSPENSION FLUVIRIN 2015-2016 (PF) INTRAMUSCULAR SYRINGE FLUVIRIN 2015-2016 INTRAMUSCULAR SUSPENSION FLUVIRIN 2016-2017 (PF) INTRAMUSCULAR SYRINGE FLUVIRIN 2016-2017 INTRAMUSCULAR SUSPENSION FLUVIRIN 2017-2018 (PF) INTRAMUSCULAR SYRINGE

QL

FLUVIRIN 2017-2018 INTRAMUSCULAR SUSPENSION

QL

FLUZONE 2014-2015 (PF) INTRAMUSCULAR SYRINGE FLUZONE 2014-2015 INTRAMUSCULAR SUSPENSION FLUZONE 2015-2016 INTRAMUSCULAR SUSPENSION FLUZONE HIGH-DOSE 2014-15 (PF) INTRAMUSCULAR SYRINGE FLUZONE HIGH-DOSE 2015-16 (PF) INTRAMUSCULAR SYRINGE FLUZONE HIGH-DOSE 2016-17 (PF) INTRAMUSCULAR SYRINGE FLUZONE HIGH-DOSE 2017-18 (PF) INTRAMUSCULAR SYRINGE

QL

FLUZONE INTRADERM 2014-15 (PF) INTRADERMAL SYRINGE FLUZONE INTRADERM QUAD 2015-16 INTRADERMAL SYRINGE 55

Nombre del medicamento

Reference

Notas

FLUZONE INTRADERM QUAD 2016-17 INTRADERMAL SYRINGE FLUZONE INTRADERM QUAD 2017-18 INTRADERMAL SYRINGE

QL

FLUZONE QUAD 2014-2015 (PF) INTRAMUSCULAR SUSPENSION FLUZONE QUAD 2014-2015 (PF) INTRAMUSCULAR SYRINGE FLUZONE QUAD 2014-2015 INTRAMUSCULAR SUSPENSION FLUZONE QUAD 2015-2016 (PF) INTRAMUSCULAR SUSPENSION FLUZONE QUAD 2015-2016 (PF) INTRAMUSCULAR SYRINGE FLUZONE QUAD 2015-2016 INTRAMUSCULAR SUSPENSION FLUZONE QUAD 2016-2017 (PF) INTRAMUSCULAR SUSPENSION FLUZONE QUAD 2016-2017 (PF) INTRAMUSCULAR SYRINGE FLUZONE QUAD 2016-2017 INTRAMUSCULAR SUSPENSION FLUZONE QUAD 2017-2018 (PF) INTRAMUSCULAR SUSPENSION

QL

FLUZONE QUAD 2017-2018 (PF) INTRAMUSCULAR SYRINGE

QL

FLUZONE QUAD 2017-2018 INTRAMUSCULAR SUSPENSION

QL

FLUZONE QUAD PEDI 2014-15 (PF) INTRAMUSCULAR SYRINGE FLUZONE QUAD PEDI 2015-16 (PF) INTRAMUSCULAR SYRINGE FLUZONE QUAD PEDI 2016-17 (PF) INTRAMUSCULAR SYRINGE FLUZONE QUAD PEDI 2017-18 (PF) INTRAMUSCULAR SYRINGE

QL

GARDASIL (PF) INTRAMUSCULAR SUSPENSION GARDASIL (PF) INTRAMUSCULAR SYRINGE SHINGRIX (PF) INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 56

AL; QL

Nombre del medicamento

Reference

Notas

SINGLE USE EZ FLU 2013-14 (PF) INTRAMUSCULAR KIT SINGLE USE EZ FLU 2013-14 (PF) INTRAMUSCULAR SYRINGE KIT SINGLE USE EZ FLU 2014-15(PF) INTRAMUSCULAR SYRINGE KIT SYNAGIS INTRAMUSCULAR SOLUTION

PA

TWINRIX (PF) INTRAMUSCULAR SUSPENSION TWINRIX (PF) INTRAMUSCULAR SYRINGE ZOSTAVAX (PF) SUBCUTANEOUS SUSPENSION FOR RECONSTITUTION

AL; QL

DEPENDENCIA QUÍMICA, AGENTES PARA TRATAR AGENTES PARA DEJAR DE FUMAR bupropion hcl (smoking deter) oral tablet extended release 12 hr

Zyban

bupropion hcl oral tablet extended release Wellbutrin SR 12 hr

PA; QL QL

ANTAGONISTA DEL ALCOHOL acamprosate oral tablet,delayed release (dr/ec) disulfiram oral tablet

QL Antabuse

ANTAGONISTAS DE NARCÓTICOS buprenorphine hcl sublingual tablet 2 mg, 8 mg

PA; QL

buprenorphine-naloxone sublingual tablet 2-0.5 mg, 8-2 mg

PA; QL

SUBOXONE SUBLINGUAL FILM 12-3 MG, 2-0.5 MG, 4-1 MG, 8-2 MG

PA; QL

DERMATOLÓGICO AGENTES ANTIACNÉ, TÓPICO clindamycin phosphate topical gel

Cleocin T

clindamycin phosphate topical solution

Cleocin T

clindamycin phosphate topical swab

Cleocin T

clindamycin-benzoyl peroxide topical gel

Duac

ery pads topical swab erygel topical gel 57

Nombre del medicamento

Reference

Notas

erythromycin with ethanol topical solution erythromycin with ethanol topical swab

Ery Pads

metronidazole topical cream

MetroCream

metronidazole topical lotion

MetroLotion

rosadan topical cream

QL QL

AGENTES ANTIINFLAMATORIOS ESTEROIDES TÓPICOS amcinonide topical lotion amcinonide topical ointment

QL

betamethasone dipropionate topical lotion

QL

betamethasone valerate topical cream

QL

betamethasone valerate topical ointment

QL

betamethasone, augmented topical cream clobetasol scalp solution

Cormax

QL

clobetasol topical cream

Temovate

QL

Temovate

QL

clobetasol topical gel clobetasol topical ointment clobetasol-emollient topical cream

QL

cormax scalp solution

QL

diflorasone topical cream

Psorcon

QL

fluocinonide-e topical cream fluocinonide-emollient topical cream

Fluocinonide-E

fluticasone topical cream

Cutivate

fluticasone topical ointment

QL QL

halobetasol propionate topical cream

Ultravate

QL

halobetasol propionate topical ointment

Ultravate

QL

hydrocortisone topical cream

Ala-Cort

QL

hydrocortisone topical cream with perineal Anusol-HC applicator

QL

hydrocortisone topical ointment

QL

hydrocortisone-pramoxine topical cream

Mezparox-HC

mometasone topical cream

Elocon

QL

mometasone topical ointment

Elocon

QL

mometasone topical solution prednicarbate topical ointment proctosol hc topical cream with perineal applicator 58

QL Dermatop

PA; QL QL

Nombre del medicamento

Reference

proctozone-hc topical cream with perineal applicator

Notas QL

TEXACORT TOPICAL SOLUTION triamcinolone acetonide topical cream 0.025 %

QL

triamcinolone acetonide topical cream 0.1 Triderm %, 0.5 %

QL

triamcinolone acetonide topical ointment 0.025 %, 0.1 %

QL

triamcinolone acetonide topical ointment 0.5 % trianex topical ointment

QL

triderm topical cream

QL

AGENTES ANTIPSORIÁSICOS calcipotriene scalp solution calcipotriene topical cream

Dovonex

calcipotriene topical ointment

Calcitrene

PA

calcitrene topical ointment

AGENTES CONTRA EL ACNÉ SISTÉMICOS claravis oral capsule

PA

MYORISAN ORAL CAPSULE 10 MG, 30 MG

PA

myorisan oral capsule 20 mg, 40 mg

PA

zenatane oral capsule

PA

AGENTES PARA ROSÁCEA, TÓPICO metronidazole topical gel 0.75 %

Rosadan

metronidazole topical gel 1 %

Metrogel

metronidazole topical gel with pump

Metrogel

QL

rosadan topical gel

AGENTES TÓPICOS, VARIOS aluminum chloride topical solution

Drysol

diclofenac sodium topical drops diclofenac sodium topical gel

PA; QL Voltaren

PA; QL

Lidoderm

PA; QL

hypercare topical solution lidocaine hcl mucous membrane jelly lidocaine topical adhesive patch,medicated

59

Nombre del medicamento

Reference

lidocaine topical ointment

Notas QL

nivatopic plus topical cream PENNSAID TOPICAL SOLUTION IN METERED-DOSE PUMP

PA; QL

podofilox topical solution

PA

prumyx topical cream remeven topical cream salacyn topical cream salacyn topical lotion salicylic acid topical cream

Salimez

salicylic acid topical cream,extended release salicylic acid topical film forming liquid w/appl

Virasal

salicylic acid topical foam

Salvax

salicylic acid topical gel

Keralyt Rx

salicylic acid topical liquid salicylic acid topical lotion salicylic acid topical lotion,extended release salicylic acid topical shampoo

Salex

salvax topical foam selenium sulfide topical lotion selenium sulfide topical shampoo silver sulfadiazine topical cream

Silvadene

ssd topical cream thermazene topical cream urea topical cream urea topical gel urea topical lotion

Uramaxin

x-viate topical cream x-viate topical gel x-viate topical lotion

ANESTÉSICOS TÓPICOS hydrocortisone-pramoxine topical cream lidocaine-prilocaine topical cream

ANTIBIÓTICOS TÓPICOS gentamicin topical cream 60

Mezparox-HC QL

Nombre del medicamento

Reference

Notas

Centany

QL

gentamicin topical ointment mupirocin topical ointment sss 10-5 topical cream sulfacetamide sodium-sulfur topical cream Avar-E virti-sulf topical cream

ANTIMICÓTICOS TÓPICOS ciclopirox topical cream

Ciclodan

ciclopirox topical solution

Ciclodan

ciclopirox topical suspension

Loprox (as olamine)

PA

clotrimazole-betamethasone topical cream Lotrisone

QL

clotrimazole-betamethasone topical lotion

QL

ketoconazole topical cream

QL

ketoconazole topical shampoo

Nizoral

QL

nyamyc topical powder

QL

nyata topical powder

QL

nystatin topical cream

QL

nystatin topical ointment

QL

nystatin topical powder

Nyamyc

nystop topical powder

QL QL

ANTIVIRALES TÓPICOS acyclovir topical ointment

Zovirax

PA; QL

adapalene topical cream

Differin

PA; QL

adapalene topical gel

Differin

PA; QL

tretinoin (emollient) topical cream

Refissa

PA; AL

tretinoin microspheres topical gel

Retin-A Micro

PA

tretinoin topical cream

Avita

PA

tretinoin topical gel

Avita

PA

permethrin topical cream

Elimite

QL

spinosad topical suspension

Natroba

DERIVADOS DE LA VITAMINA A

ESCABICIDAS Y PEDICULICIDAS

INMUNOMODULADORES TÓPICOS imiquimod topical cream in packet

Aldara

PA; QL

tacrolimus topical ointment

Protopic

PA; QL

Efudex

QL

TÓPICO ANTINEOPLÁSICO Y PREMALIGNO fluorouracil topical cream

61

Nombre del medicamento

Reference

fluorouracil topical solution

Notas QL

ENDOCRINO AGENTES ANDRÓGENOS testosterone cypionate intramuscular oil

Depo-Testosterone

testosterone enanthate intramuscular oil

PA PA

testosterone transdermal gel

Testim

PA; QL

testosterone transdermal gel in metereddose pump

Vogelxo

PA; QL

testosterone transdermal gel in packet 1 % (25 mg/2.5gram), 1 % (50 mg/5 gram)

AndroGel

PA; QL

AGENTES ESTROGÉNICOS amabelz oral tablet estradiol oral tablet

Estrace

estradiol transdermal patch transdermal patch weekly

PA; QL

estradiol transdermal patch weekly

Climara

estradiol-norethindrone acet oral tablet

Activella

PA; QL

estropipate oral tablet jinteli oral tablet lopreeza oral tablet mimvey lo oral tablet mimvey oral tablet norethindrone ac-eth estradiol oral tablet

Femhrt Low Dose

PREMPHASE ORAL TABLET PREMPRO ORAL TABLET

AGENTES PARA LA FERTILIDAD MAKENA INTRAMUSCULAR OIL 250 MG/ML, 250 MG/ML (1 ML)

PA; QL

AGENTES PROGESTACIONALES hydroxyprogesterone caproate intramuscular oil

PA; QL

MAKENA INTRAMUSCULAR OIL 250 MG/ML, 250 MG/ML (1 ML)

PA; QL

medroxyprogesterone oral tablet

Provera

norethindrone acetate oral tablet

Aygestin

progesterone micronized oral capsule 100 Prometrium mg, 200 mg

62

QL

QL

Nombre del medicamento

Reference

Notas

AGENTES SUPRESORES HIPOFISARIOS cabergoline oral tablet

QL

ANTIHIPERGLUCÉMICOS, TIPO ANÁLOGO DE AMILINA SYMLINPEN 120 SUBCUTANEOUS PEN INJECTOR

PA

SYMLINPEN 60 SUBCUTANEOUS PEN INJECTOR

PA

CALCITONINAS calcitonin (salmon) nasal spray,nonaerosol

QL

GLUCOCORTICOIDES cortisone oral tablet dexamethasone intensol oral drops dexamethasone oral elixir dexamethasone oral solution dexamethasone oral tablet hydrocortisone oral tablet

Cortef

methylprednisolone oral tablet

Medrol

methylprednisolone oral tablets,dose pack Medrol (Pak) prednisolone oral solution prednisolone sodium phosphate oral solution prednisone intensol oral concentrate prednisone oral solution prednisone oral tablet prednisone oral tablets,dose pack

HIPERGLUCEMIA GLUCAGEN HYPOKIT INJECTION RECON SOLN GLUCAGEN INJECTION RECON SOLN GLUCAGON EMERGENCY KIT (HUMAN) INJECTION KIT

HIPOGLUCEMIA, INSULINA, INTENSIFICADOR DE RESPUESTA pioglitazone oral tablet

Actos

PA; QL

pioglitazone-glimepiride oral tablet

DUETACT

PA; QL

pioglitazone-metformin oral tablet

Actoplus MET

PA; QL 63

Nombre del medicamento

Reference

Notas

HIPOGLUCEMIA, INSULINA, TIPO ESTIMULANTE LIBERADOR glimepiride oral tablet

Amaryl

glipizide oral tablet

Glucotrol

glipizide oral tablet extended release 24hr Glucotrol XL glipizide-metformin oral tablet glyburide micronized oral tablet

Glynase

glyburide oral tablet glyburide-metformin oral tablet nateglinide oral tablet

Starlix

repaglinide oral tablet

PA PA

HIPOGLUCEMIA, TIPO BIGUANIDA metformin oral tablet

Glucophage

metformin oral tablet extended release 24 Glucophage XR hr

HIPOGLUCEMIA, TIPO INHIBIDOR DE LA ALFA GLUCOSIDASA acarbose oral tablet 100 mg

Precose

acarbose oral tablet 25 mg, 50 mg

Precose

QL

HIPOGLUCEMIANTE, MIMÉTICO DE INCRETINA (AGONISTA DEL RECEPTOR GLP-1) TANZEUM SUBCUTANEOUS PEN INJECTOR

PA; QL

VICTOZA 2-PAK SUBCUTANEOUS PEN INJECTOR

PA; QL

VICTOZA 3-PAK SUBCUTANEOUS PEN INJECTOR

PA; QL

HORMONAS ANTIDIURÉTICAS Y VASOPRESORAS desmopressin nasal aerosol,spray

DDAVP

desmopressin nasal solution

DDAVP

desmopressin nasal spray,non-aerosol desmopressin oral tablet

DDAVP

QL

HORMONAS DEL CRECIMIENTO ZOMACTON SUBCUTANEOUS RECON SOLN

PA; QL

HORMONAS TIROIDEAS levothyroxine oral tablet 64

Levo-T

Nombre del medicamento

Reference

Notas

levoxyl oral tablet liothyronine oral tablet

Cytomel

nature-throid oral tablet np thyroid oral tablet thyroid (pork) oral tablet

Armour Thyroid

unithroid oral tablet westhroid oral tablet

INHIBIDOR DE LA DIPEPTIDIL PEPTIDASA IV Y COMBINACIONES JANUMET ORAL TABLET

PA; QL

JANUMET XR ORAL TABLET, ER MULTIPHASE 24 HR 100-1,000 MG, 501,000 MG, 50-500 MG

PA; QL

JANUVIA ORAL TABLET

PA; QL

JENTADUETO ORAL TABLET

PA; QL

JENTADUETO XR ORAL TABLET, IR ER, BIPHASIC 24HR 2.5-1,000 MG, 51,000 MG

PA; QL

TRADJENTA ORAL TABLET

PA; QL

INHIBIDORES DE RESORCIÓN ÓSEA alendronate oral solution alendronate oral tablet 10 mg, 35 mg, 40 mg, 5 mg

QL

alendronate oral tablet 70 mg

Fosamax

raloxifene oral tablet

Evista

QL

INHIBIDORES DE SODIO-GLUCOSA (SGLT2) JARDIANCE ORAL TABLET

PA; QL

SYNJARDY ORAL TABLET

PA; QL

SYNJARDY XR ORAL TABLET, IR - ER, BIPHASIC 24HR 10-1,000 MG, 12.51,000 MG, 25-1,000 MG, 5-1,000 MG

PA; QL

INSULINAS APIDRA SOLOSTAR SUBCUTANEOUS INSULIN PEN

QL

APIDRA SUBCUTANEOUS SOLUTION

QL

BASAGLAR KWIKPEN SUBCUTANEOUS INSULIN PEN

QL 65

Nombre del medicamento

Reference

Notas

HUMALOG MIX 50-50 KWIKPEN SUBCUTANEOUS INSULIN PEN

QL

HUMALOG MIX 50-50 SUBCUTANEOUS SUSPENSION

QL

HUMALOG MIX 75-25 KWIKPEN SUBCUTANEOUS INSULIN PEN

QL

HUMALOG MIX 75-25 SUBCUTANEOUS SUSPENSION

QL

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

QL

HUMULIN R U-500 (CONCENTRATED) SUBCUTANEOUS SOLUTION

QL

NOVOLOG MIX 70-30 FLEXPEN SUBCUTANEOUS INSULIN PEN

QL

NOVOLOG MIX 70-30 SUBCUTANEOUS SOLUTION

QL

MINERALOCORTICOIDES fludrocortisone oral tablet

OXITÓCICOS METHYLERGONOVINE INJECTION SOLUTION methylergonovine oral tablet

Methergine

PREPARADOS ANTITIROIDEOS methimazole oral tablet propylthiouracil oral tablet

EQUILIBRIO ELECTROLÍTICOPRODUCTOS NUTRICIONALES AGENTES CON MINERALES Y ELECTROLITOS phospha 250 neutral oral tablet

MULTIVITAMÍNICOS choice-tabs oral tablet corvita oral tablet purevit dualfe plus oral capsule se-tan plus oral capsule therapeutic formula/hematinics oral tablet v-c forte oral capsule vic-forte oral capsule vit 3 oral capsule 66

Tapazole

Nombre del medicamento

Reference

Notas

PREPARADOS DE VITAMINA B cyanocobalamin (vitamin b-12) injection solution

Vitamin B-12

dialyvite oral tablet folbee plus oral tablet hydroxocobalamin intramuscular solution mynephrocaps oral capsule nephplex rx oral tablet renal caps oral capsule rena-vite rx oral tablet reno caps oral capsule triphrocaps oral capsule vitamin b-12 injection solution vol-care rx oral tablet vp-vite rx oral tablet

PREPARADOS DE VITAMINA D calcitriol oral capsule

Rocaltrol

PA

calcitriol oral solution

Rocaltrol

PA

ergocalciferol (vitamin d2) oral capsule

Vitamin D2

vitamin d2 oral capsule

PREPARADOS DE VITAMINA K MEPHYTON ORAL TABLET vitamin k injection solution vitamin k1 injection solution

PREPARADOS DE VITAMINAS PRENATALES elite-ob oral tablet

QL

MYNATAL ADVANCE ORAL TABLET

QL

mynatal oral capsule

QL

MYNATAL ORAL TABLET

QL

mynatal plus oral tablet

QL

mynatal-z oral tablet

QL

mynate 90 plus oral tablet extended release

QL

prenatal vitamin plus low iron oral tablet

QL

67

Nombre del medicamento

Reference

Notas

RESINAS LIBERADORAS DE POTASIO sodium polystyrene (sorb free) oral suspension sodium polystyrene sulfonate oral suspension

sodium polystyrene (sorb free)

sodium polystyrene sulfonate rectal enema sps (with sorbitol) oral suspension sps (with sorbitol) rectal enema

SOLUCIONES DE RIEGO sodium chloride irrigation solution

Sterile Saline

SUSTITUTO DEL CALCIO calcium acetate oral tablet

Calphron

PA; QL

calcium-folic acid-vitamin d oral wafer

SUSTITUTO DEL HIERRO centratex oral capsule corvita 150 oral tablet elite-ob oral tablet

QL

fe 90 plus oral tablet ferocon oral capsule ferraplus 90 oral tablet ferrex 150 forte oral capsule ferrex 150 forte plus oral capsule ferrex 28 oral tablet ferrocite plus oral tablet ferrogels forte oral capsule folivane-f oral capsule folivane-plus oral capsule hematinic plus vit/minerals oral tablet hematinic/folic acid oral tablet hematogen fa oral capsule hematogen forte oral capsule hematogen oral capsule hemetab oral tablet

QL

iferex 150 forte oral capsule iron aspgly,ps-c-b12-fa-ca-suc oral capsule 68

Ferrex 150 Forte Plus

Nombre del medicamento

Reference

iron fum,ag-c-b12-fa-ca-succ oral tablet

Multigen Plus

Notas

multigen folic oral tablet multigen plus oral tablet myferon 150 forte oral capsule natalvirt flt oral tablet poly-iron 150 forte oral capsule sodium ferric gluconat-sucrose intravenous solution

Ferrlecit

taron forte oral capsule tl icon oral capsule tl-hem 150 oral tablet extended release 24 hr tricon oral capsule trigels-f forte oral capsule

SUSTITUTO DEL POTASIO effer-k oral tablet, effervescent k-effervescent oral tablet, effervescent klor-con 10 oral tablet extended release klor-con 8 oral tablet extended release klor-con m10 oral tablet,er particles/crystals klor-con m15 oral tablet,er particles/crystals klor-con m20 oral tablet,er particles/crystals klor-con oral packet klor-con/ef oral tablet, effervescent potassium bicarb and chloride oral tablet, effervescent potassium bicarb-citric acid oral tablet, effervescent

Effer-K

potassium chloride oral capsule, extended Klor-Con Sprinkle release potassium chloride oral liquid potassium chloride oral packet

Klor-Con

potassium chloride oral tablet extended release

K-Tab

potassium chloride oral tablet,er particles/crystals

Klor-Con M10 69

Nombre del medicamento

Reference

Notas

VITAMINAS PEDIÁTRICAS CON FLÚOR multivitamin with fluoride oral tablet,chewable multi-vitamin with fluoride oral tablet,chewable multivitamins with fluoride oral tablet,chewable multivit-fluor (vit e acetate) oral drops triple vitamin with fluoride oral drops tri-vit with fluoride and iron oral drops tri-vitamin with fluoride oral drops vitamins a,c,d and fluoride oral drops

ESCLEROSIS MÚLTIPLE MEDICAMENTOS PARA TRATAR LA ESCLEROSIS MÚLTIPLE AVONEX (WITH ALBUMIN) INTRAMUSCULAR KIT

PA

AVONEX INTRAMUSCULAR PEN INJECTOR KIT

PA

AVONEX INTRAMUSCULAR SYRINGE AVONEX INTRAMUSCULAR SYRINGE KIT

PA

BETASERON SUBCUTANEOUS KIT

PA

EXTAVIA SUBCUTANEOUS KIT

PA

EXTAVIA SUBCUTANEOUS RECON SOLN

PA

GILENYA ORAL CAPSULE

PA; QL

glatiramer subcutaneous syringe

Copaxone

PA

glatopa subcutaneous syringe

PA

REBIF (WITH ALBUMIN) SUBCUTANEOUS SYRINGE

PA

REBIF REBIDOSE SUBCUTANEOUS PEN INJECTOR

PA

REBIF TITRATION PACK SUBCUTANEOUS SYRINGE

PA

TECFIDERA ORAL CAPSULE,DELAYED RELEASE(DR/EC) 120 MG, 120 MG (14)- 240 MG (46), 240 MG

PA; QL

70

Nombre del medicamento

Reference

Notas

INSUMOS Y PREPARADOS DENTALES AGENTES PARA LA BOCA Y GARGANTA lidocaine hcl mucous membrane jelly lidocaine hcl mucous membrane solution

QL

lidocaine viscous mucous membrane solution

QL

oralone dental paste pilocarpine hcl oral tablet

Salagen (pilocarpine)

triamcinolone acetonide dental paste

Oralone

QL

ANTIBIÓTICOS ANTIMICÓTICOS clotrimazole mucous membrane troche

QL

nystatin oral suspension

ANTISÉPTICOS, GENERALES chlorhexidine gluconate mucous membrane mouthwash

Paroex Oral Rinse

QL

paroex oral rinse mucous membrane mouthwash

QL

periogard mucous membrane mouthwash

QL

PREPARACIONES DE FLUORUROS dentagel dental gel fluor-a-day (with xylitol) oral tablet,chewable fluor-a-day oral drops fluoride (sodium) dental solution

PreviDent

fluoride (sodium) oral drops fluoride (sodium) oral tablet,chewable

QL Fluoritab

fluoritab oral tablet,chewable flura-drops oral drops lozi-flur oral lozenge ludent fluoride oral tablet,chewable sf dental gel

MODIFICADORES METABÓLICOS AGENTES DE DEFICIENCIA METABÓLICA calcitriol oral capsule

Rocaltrol

PA

calcitriol oral solution

Rocaltrol

PA 71

Nombre del medicamento

Reference

Notas

Cetraxal

QL

PHARMACOENHANCER INHIBIDORES DEL CITOCROMO P450 TYBOST ORAL TABLET

ÓTICO PREPARADOS ÓTICOS, MISCELÁNEOS, ANTINFECCIOSOS acetic acid otic (ear) solution acetic acid-aluminum acetate otic (ear) drops antipyrine-benzocaine otic (ear) drops aurodex otic (ear) drops auroguard otic (ear) drops ciprofloxacin hcl otic (ear) dropperette cortane-b aqueous otic (ear) drops exotic-hc otic (ear) drops floxin otic (ear) drops

QL

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

Floxin

QL

oticin hc (bak free) otic (ear) drops otomax-hc otic (ear) drops

PRODUCTOS VAGINALES ANTIBIÓTICOS VAGINALES CLEOCIN VAGINAL SUPPOSITORY clindamycin phosphate vaginal cream

Cleocin

metronidazole vaginal gel

Metrogel Vaginal

vandazole vaginal gel

ANTIMICÓTICOS VAGINALES miconazole-3 vaginal suppository terconazole vaginal cream

PA Terazol 7

terconazole vaginal suppository

PREPARADOS DE ESTRÓGENO VAGINALES estradiol vaginal tablet yuvafem vaginal tablet 72

Vagifem

Nombre del medicamento

Reference

Notas

SISTEMA LOCOMOTOR AGENTES PARA EL TRATAMIENTO DE TRASTORNOS MUSCULOESQUELÉTICOS EUFLEXXA INTRA-ARTICULAR SYRINGE

PA; QL

GELSYN-3 INTRA-ARTICULAR SYRINGE

PA; QL

SUPARTZ FX INTRA-ARTICULAR SYRINGE

PA; QL

OTROS MEDICAMENTOS AUTÓNOMOS/DEL SNC MESTINON ORAL SYRUP pyridostigmine bromide oral tablet

Mestinon

pyridostigmine bromide oral tablet extended release

Mestinon Timespan

RELAJANTES DEL MÚSCULO ESQUELÉTICO baclofen oral tablet carisoprodol oral tablet

Soma

QL

carisoprodol-asa-codeine oral tablet carisoprodol-aspirin oral tablet chlorzoxazone oral tablet cyclobenzaprine oral tablet 10 mg

QL

cyclobenzaprine oral tablet 5 mg dantrolene oral capsule

Dantrium

methocarbamol oral tablet 500 mg

Robaxin

QL

methocarbamol oral tablet 750 mg

Robaxin-750

QL

orphenadrine citrate oral tablet extended release riluzole oral tablet

QL Rilutek

tizanidine oral tablet 2 mg tizanidine oral tablet 4 mg

PA QL

Zanaflex

QL

73

Nombre del medicamento

Reference

Notas

SUMINISTROS MÉDICOS Y EQUIPO MÉDICO DURADERO (DME) AGUJAS, DISPOSITIVOS SIN AGUJAS, JERINGAS Y ACCESORIOS MONOJECT INSULIN SAFETY SYRING SYRINGE MONOJECT SYRINGE SYRINGE pen needle needle

DIAFRAGMAS/CAPUCHÓN CERVICAL WIDE-SEAL DIAPHRAGM 60 VAGINAL DIAPHRAGM WIDE-SEAL DIAPHRAGM 65 VAGINAL DIAPHRAGM

QL

WIDE-SEAL DIAPHRAGM 70 VAGINAL DIAPHRAGM

QL

WIDE-SEAL DIAPHRAGM 75 VAGINAL DIAPHRAGM

QL

WIDE-SEAL DIAPHRAGM 80 VAGINAL DIAPHRAGM

QL

WIDE-SEAL DIAPHRAGM 85 VAGINAL DIAPHRAGM

QL

WIDE-SEAL DIAPHRAGM 90 VAGINAL DIAPHRAGM WIDE-SEAL DIAPHRAGM 95 VAGINAL DIAPHRAGM

EQUIPOS, DISPOSITIVOS, ESPACIADORES Y AUXILIARES RESPIRATORIOS ACE AEROSOL CLOUD ENHANCER SPACER

QL

AEROTRACH PLUS SPACER

QL

AEROVENT PLUS SPACER

QL

BREATHERITE MDI SPACER SPACER

QL

BREATHERITE RIGID SPACER-MASK SPACER

QL

BREATHERITE SPACER-MASK,ADULT SPACER

QL

BREATHERITE SPACER-MASK,CHILD SPACER

QL

74

Nombre del medicamento

Reference

Notas

BREATHERITE SPACER-MASK,INFANT SPACER

QL

BREATHERITE SPACER-MASK,S.CHLD SPACER

QL

BREATHERITE VALVED MDI CHAMBER SPACER

QL

BREATHERITE VALVED MDI SPACER SPACER

QL

BREATHERITE WITH MASK, LARGE SPACER

QL

BREATHERITE WITH MASK, MEDIUM SPACER

QL

BREATHERITE WITH MASK, SMALL SPACER

QL

COMPACT SPACE CHAMBER SPACER

QL

COMPACT SPACE CHAMBER-LRG MASK SPACER

QL

COMPACT SPACE CHAMBER-MED MASK SPACER

QL

COMPACT SPACE CHAMBER-SM MASK SPACER

QL

LITEAIRE MDI CHAMBER SPACER

QL

MICROCHAMBER SPACER

QL

MICROSPACER SPACER

QL

OPTICHAMBER ADULT MASK-LARGE DEVICE

QL

OPTICHAMBER DIAMOND LG MASK SPACER

QL

OPTICHAMBER DIAMOND VHC SPACER

QL

OPTICHAMBER DIAMOND-MED MSK SPACER

QL

OPTICHAMBER DIAMOND-SML MASK SPACER

QL

POCKET CHAMBER SPACER

QL

PRIMEAIRE SPACER

QL

PROCHAMBER SPACER

QL

RITEFLO AEROCHAMBER SPACER

QL

VORTEX HOLDING CHAMBER CHILD SPACER

QL

75

Nombre del medicamento

Reference

Notas

VORTEX HOLDING CHAMBER SPACER

QL

VORTEX HOLDING CHAMBER TODDLER SPACER

QL

VORTEX VHC FROG MASK-CHILD SPACER

QL

VORTEX VHC LADYBUG MASKTODDLR SPACER

QL

MEDIDORES DE FLUJO ESPIRATORIO MÁXIMO Y SUMINISTROS MÉDICOS MINI WRIGHT PEAK FLOW METER DEVICE

QL

TRUZONE PEAK FLOW METER DEVICE

QL

SUMINISTROS MÉDICOS Y EQUIPO MÉDICO DURADERO (DME) ACE AEROSOL CLOUD ENHANCER SPACER

QL

AEROTRACH PLUS SPACER

QL

AEROVENT PLUS SPACER

QL

BREATHERITE MDI SPACER SPACER

QL

BREATHERITE RIGID SPACER-MASK SPACER

QL

BREATHERITE SPACER-MASK,ADULT SPACER

QL

BREATHERITE SPACER-MASK,CHILD SPACER

QL

BREATHERITE SPACER-MASK,INFANT SPACER

QL

BREATHERITE SPACER-MASK,S.CHLD SPACER

QL

BREATHERITE VALVED MDI CHAMBER SPACER

QL

BREATHERITE VALVED MDI SPACER SPACER

QL

BREATHERITE WITH MASK, LARGE SPACER

QL

BREATHERITE WITH MASK, MEDIUM SPACER

QL

76

Nombre del medicamento

Reference

Notas

BREATHERITE WITH MASK, SMALL SPACER

QL

COMPACT SPACE CHAMBER SPACER

QL

COMPACT SPACE CHAMBER-LRG MASK SPACER

QL

COMPACT SPACE CHAMBER-MED MASK SPACER

QL

COMPACT SPACE CHAMBER-SM MASK SPACER

QL

LITEAIRE MDI CHAMBER SPACER

QL

MICROCHAMBER SPACER

QL

MICROSPACER SPACER

QL

MINI WRIGHT PEAK FLOW METER DEVICE

QL

MONOJECT INSULIN SAFETY SYRING SYRINGE MONOJECT SYRINGE SYRINGE OPTICHAMBER ADULT MASK-LARGE DEVICE

QL

OPTICHAMBER DIAMOND LG MASK SPACER

QL

OPTICHAMBER DIAMOND VHC SPACER

QL

OPTICHAMBER DIAMOND-MED MSK SPACER

QL

OPTICHAMBER DIAMOND-SML MASK SPACER

QL

pen needle needle POCKET CHAMBER SPACER

QL

PRIMEAIRE SPACER

QL

PROCHAMBER SPACER

QL

RITEFLO AEROCHAMBER SPACER

QL

TRUZONE PEAK FLOW METER DEVICE

QL

VORTEX HOLDING CHAMBER CHILD SPACER

QL

VORTEX HOLDING CHAMBER SPACER

QL

VORTEX HOLDING CHAMBER TODDLER SPACER

QL

77

Nombre del medicamento

Reference

Notas

VORTEX VHC FROG MASK-CHILD SPACER

QL

VORTEX VHC LADYBUG MASKTODDLR SPACER

QL

WIDE-SEAL DIAPHRAGM 60 VAGINAL DIAPHRAGM WIDE-SEAL DIAPHRAGM 65 VAGINAL DIAPHRAGM

QL

WIDE-SEAL DIAPHRAGM 70 VAGINAL DIAPHRAGM

QL

WIDE-SEAL DIAPHRAGM 75 VAGINAL DIAPHRAGM

QL

WIDE-SEAL DIAPHRAGM 80 VAGINAL DIAPHRAGM

QL

WIDE-SEAL DIAPHRAGM 85 VAGINAL DIAPHRAGM

QL

WIDE-SEAL DIAPHRAGM 90 VAGINAL DIAPHRAGM WIDE-SEAL DIAPHRAGM 95 VAGINAL DIAPHRAGM

TERAPIA DE LA GOTA Y LA HIPERURICEMIA AGENTES URICOSÚRICOS probenecid oral tablet

COMBINADOS DE ALCALOIDE probenecid-colchicine oral tablet

TERAPIA PARA HIPERURICEMIA, INHIBIDORES DE PURINA allopurinol oral tablet

Zyloprim

TERAPIA DEL TRASTORNO COGNITIVO INHIBIDORES DE COLINESTERASA donepezil oral tablet 10 mg, 5 mg

Aricept

DO; QL

donepezil oral tablet 23 mg

Aricept

PA; QL

donepezil oral tablet,disintegrating galantamine oral capsule,ext rel. pellets 24 hr

DO; QL Razadyne ER

galantamine oral solution galantamine oral tablet memantine oral solution 78

DO; QL DO; QL

Razadyne

DO; QL DO; QL

Nombre del medicamento

Reference

Notas

memantine oral tablet

Namenda

DO; QL

memantine oral tablets,dose pack

Namenda Titration Pak

DO; QL

NAMENDA TITRATION PAK ORAL TABLETS,DOSE PACK

DO; QL

rivastigmine tartrate oral capsule

DO; QL

TERAPIA GENITOURINARIA ACIDULANTES URINARIOS (FOSFATOS) phospha 250 neutral oral tablet

AGENTE PARA LA INCONTINENCIA/ANTIESPASMÓDIC O PARA TRACTO URINARIO darifenacin oral tablet extended release 24 hr

Enablex

flavoxate oral tablet oxybutynin chloride oral syrup oxybutynin chloride oral tablet oxybutynin chloride oral tablet extended release 24hr

Ditropan XL

tolterodine oral capsule,extended release Detrol LA 24hr tolterodine oral tablet

Detrol

trospium oral capsule,extended release 24hr trospium oral tablet

AGENTES ANALGÉSICOS/ANESTÉSICOS PARA TRACTO URINARIO phenazopyridine oral tablet

Pyridium

AGENTES PARASIMPÁTICOS bethanechol chloride oral tablet

Urecholine

DESINTOXICANTES DE SANGRE calcium acetate oral capsule calcium acetate oral tablet

PA; QL Calphron

PA; QL

eliphos oral tablet

PA; QL

VELPHORO ORAL TABLET,CHEWABLE

PA; QL

79

Nombre del medicamento

Reference

Notas

alfuzosin oral tablet extended release 24 hr

Uroxatral

QL

finasteride oral tablet

Proscar

QL

tamsulosin oral capsule,extended release Flomax 24hr

QL

HIPERTROFIA PROSTÁTICA BENIGNA/AGENTES MICCIONALES

MODIFICADORES DEL PH URINARIO cytra k crystals oral packet cytra-2 oral solution cytra-3 oral solution cytra-k oral solution potassium citrate oral tablet extended release

Urocit-K 5

potassium citrate-citric acid oral packet

Cytra K Crystals

potassium citrate-citric acid oral solution

Cytra-K

sodium citrate-citric acid oral solution

Cytra-2

tricitrates oral solution

QUIMIOTERAPÉUTICOS, ANTIBACTERIANOS, VARIOS methenamine hippurate oral tablet

Hiprex

methenamine mandelate oral tablet nitrofurantoin macrocrystal oral capsule

Macrodantin

nitrofurantoin monohyd/m-cryst oral capsule

Macrobid

QUINOLONES ciprofloxacin (mixture) oral tablet, er multiphase 24 hr 1,000 mg, 500 mg

TERAPIA PARA TRASTORNOS DE LA ALIMENTACIÓN AGENTES ESTIMULANTES DEL APETITO (PROGESTÁGENO) megestrol oral suspension

AGENTES PARA LA ANOREXIA SUPRENZA ORAL TABLET,DISINTEGRATING

80

Cipro XR

QL

81

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