Preferred Drug List 2013 Standard Formulary (3 ... - Express Scripts
Preferred Drug List 2013 Standard Formulary (3 ... - Express Scripts
Preferred Drug List 2013 Standard Formulary (3 ... - Express Scripts
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DRUG NAME<br />
2.1.5 PENICILLINS<br />
amox tr‐potassium clavulanate X<br />
amoxicillin X<br />
amoxicillin‐clavulanate er X<br />
dicloxacillin sodium X<br />
penicillin v potassium X<br />
2.1.6 SULFONAMIDES<br />
sulfamethoxazole‐trimethoprim X<br />
TIER<br />
1 2 3<br />
SUGGESTED PREFFERED ALTERNATIVES<br />
2.1.7 TETRACYCLINES<br />
doxycycline hyclate X<br />
doxycycline monohydrate X<br />
minocycline hcl X<br />
tetracycline hcl X<br />
DORYX ST X doxycyclne hyclate delayed‐rel<br />
ORACEA ST X doxycycline hyclate<br />
SOLODYN ST X minocycline extended‐release<br />
2.1.8 URINARY ANTIINFECTIVES<br />
nitrofurantoin X<br />
nitrofurantoin mono‐macro X<br />
trimethoprim X<br />
2.1.9 QUINOLONES<br />
ciprofloxacin er X<br />
ciprofloxacin hcl X<br />
levofloxacin X<br />
ofloxacin X<br />
AVELOX/ABC PACK X<br />
FACTIVE X ciproflox,levoflo,oflox,AVELOX<br />
LEVAQUIN X levofloxacin<br />
NOROXIN X ciproflox,levoflo,oflox,AVELOX<br />
2.2 TOPICAL ANTIBACTERIAL DRUGS<br />
gentamicin sulfate X<br />
mupirocin X<br />
silver sulfadiazine X<br />
ALTABAX X<br />
BACTROBAN X<br />
2.3 ORAL ANTIFUNGAL DRUGS<br />
fluconazole X<br />
griseofulvin X<br />
itraconazole ST X<br />
ketoconazole X<br />
nystatin X<br />
terbinafine hcl X<br />
voriconazole X<br />
GRIFULVIN V X
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