outpatient formulary afb vandenberg

24 Pages·2016·0.12 MB·English

DoD UNIFORM OUTPATIENT FORMULARY
Alphabetical Listing by Name
This document is current as of July 14, 2021
The availability of formulary items is subject to change.
Basic Core Formulary: MTF must have on formulary
Uniform Formulary: MTF may have on formulary
Nonformulary: MTF must not have on formulary
Extended Core Formulary: MTF must be on formulary
if includes any drugs from that drug class
1
ABACAVIR
Abacavir Capsule,Oral:
DoDUniformFormularyOutpatientDosageForms MapapExtraStrength:500mg
UNIFORMFORMULARY Elixir,Oral:
Solution,Oral: Mapap Children's: 160mg/5 mL (118 mL, 480 mL) [ethanol free; contains
Ziagen: 20mg/mL (240 mL) [contains methylparaben, propylene glycol, benzoicacid,propyleneglycol,sodiumbenzoate;cherryflavor]
propylparaben,saccharinsodium;strawberry-bananaflavor] Injection,Solution[preservativefree]:
Tablet,Oral: Ofirmev:10mg/mL(100mL)
Generic:300mg Liquid,Oral:
Generic:160mg/5mL(120mL,473mL);500mg/5mL(240mL)
AbacavirandLamivudine Solution,Oral:
DoDUniformFormularyOutpatientDosageForms Generic:160mg/5mL(5mL,10mL,20mL)
UNIFORMFORMULARY Suppository,Rectal:
Tablet,Oral: Generic:120mg(12s);325mg(12s)
Generic:Abacavir600mgandlamivudine300mg Suspension,Oral:
Generic:160mg/5mL(5mL,10.15mL,20.3mL)
Abacavir,Dolutegravir,andLamivudine Syrup,Oral:
DoDUniformFormularyOutpatientDosageForms TriaminicChildren'sFeverReducerPainReliever:160mg/5mL(118mL)
UNIFORMFORMULARY Tablet,Oral:
Tablet,Oral: Generic:325mg,500mg
Triumeq:Abacavir600mg,dolutegravir50mg,andlamivudine300mg Tablet,Chewable,Oral:
Generic:80mg
Abacavir,Lamivudine,andZidovudine NOTCOVERED
DoDUniformFormularyOutpatientDosageForms Caplet,ExtendedRelease,Oral:
UNIFORMFORMULARY MapapArthritisPain:650mg
Tablet,Oral: Tylenol8HRArthritisPain:650mg
Generic: Abacavir sulfate 300mg, lamivudine 150mg, and zidovudine Suppository,Rectal:
300mg Generic:650mg(12s)
Abciximab AcetaminophenandCaffeine
DoDUniformFormularyOutpatientDosageForms DoDUniformFormularyOutpatientDosageForms
UNIFORMFORMULARY UNIFORMFORMULARY
Solution,Intravenous: Tablet,Oral:
ReoPro:2mg/mL(5mL)[containspolysorbate80] Excedrin Tension Headache: Acetaminophen 500mg and caffeine 65mg
[containsbenzoicacid]
Abemaciclib
Excedrin Tension Headache: Acetaminophen 500mg and caffeine 65mg
DoDUniformFormularyOutpatientDosageForms [aspirinfree;containsbenzoicacid]
UNIFORMFORMULARY
Tablet,Oral: AcetaminophenandCodeine
Verzenio:50mg,100mg,150mg,200mg DoDUniformFormularyOutpatientDosageForms
BASICCOREFORMULARY
AbirateroneAcetate Tablet,Oral:
DoDUniformFormularyOutpatientDosageForms Acetaminophen300mgandcodeinephosphate30mg
UNIFORMFORMULARY
UNIFORMFORMULARY
Tablet,Oral:
Solution,Oral:
Yonsa:125mg
Generic:Acetaminophen120mgandcodeinephosphate12mgper5mL(5
Zytiga:250mg,500mg
mL,12.5mL,118mL,473mL)
Generic:250mg
Tablet,Oral:
AbobotulinumtoxinA Acetaminophen300mgandcodeinephosphate15mg
DoDUniformFormularyOutpatientDosageForms Acetaminophen300mgandcodeinephosphate60mg
UNIFORMFORMULARY AcetaminophenandDiphenhydramine
SolutionReconstituted,Intramuscular:
DoDUniformFormularyOutpatientDosageForms
Dysport:300units(1ea);500units(1ea)[containsmilkprotein]
UNIFORMFORMULARY
AbsorptionBase Tablet,Oral:
DoDUniformFormularyOutpatientDosageForms Aceta-Gesic: Acetaminophen 325mg and diphenhydramine hydrochloride
UNIFORMFORMULARY 12.5mg
Cream:480g ExcedrinPM:Acetaminophen500mganddiphenhydraminecitrate38mg
Ointment,topical:480g Legatrin PM: Acetaminophen 500mg and diphenhydramine hydrochlor-
ide50mg
Acalabrutinib Percogesic Extra Strength: Acetaminophen 500mg and diphenhydramine
DoDUniformFormularyOutpatientDosageForms hydrochloride12.5mg
UNIFORMFORMULARY Generic:Acetaminophen500mganddiphenhydraminehydrochloride25mg
Capsule,Oral:
AcetaminophenandPamabrom
Calquence:100mg
DoDUniformFormularyOutpatientDosageForms
Acamprosate UNIFORMFORMULARY
DoDUniformFormularyOutpatientDosageForms Caplet,Oral:
UNIFORMFORMULARY MidolTeenFormula:Acetaminophen500mgandpamabrom25mg
TabletDelayedRelease,Oral,ascalcium: Tylenol Women’s Menstrual Relief: Acetaminophen 500mg and pamab-
Generic:333mg rom25mg
Tablet,Oral:
Acarbose CrampTabs:Acetaminophen325mgandpamabrom25mg
DoDUniformFormularyOutpatientDosageForms
AcetaminophenandPhenylephrine
UNIFORMFORMULARY
Tablet,Oral: DoDUniformFormularyOutpatientDosageForms
Generic:25mg,50mg,100mg UNIFORMFORMULARY
Caplet,Oral:
Acebutolol ContacCold+FluMaximumStrengthNonDrowsy:Acetaminophen500mg
DoDUniformFormularyOutpatientDosageForms andphenylephrinehydrochloride5mg
UNIFORMFORMULARY MapapSinusPE,SudafedPEPressure+Pain:Acetaminophen325mgand
Capsule,Oral,ashydrochloride: phenylephrinehydrochloride5mg
Generic:200mg,400mg Tylenol Sinus Congestion & Pain Daytime: Acetaminophen 325mg and
phenylephrinehydrochloride5mg[CoolBurstflavor]
Acetaminophen Capsule,LiquidFilled,Oral:
DoDUniformFormularyOutpatientDosageForms Vicks DayQuil Sinex Daytime Sinus: Acetaminophen 325mg and phenyl-
UNIFORMFORMULARY ephrinehydrochloride5mg
Caplet,Oral: Tablet,Oral:
Generic:500mg CetafenCold:Acetaminophen500mgandphenylephrinehydrochloride5mg
2
ACETAMINOPHEN,DIPHENHYDRAMINE,ANDPHENYLEPHRINE
Robitussin Peak Cold Nasal Relief: Acetaminophen 325mg and phenyl- TylenolColdMax:Acetaminophen325mg,dextromethorphanhydrobromide
ephrinehydrochloride5mg 10mg,andphenylephrinehydrochloride5mg
Sinus Pain & Pressure: Acetaminophen 500mg and phenylephrine hydro- Capsule,Liquidfilled,Oral:
chloride5mg Alka-Seltzer Plus Day Cold: Acetaminophen 325mg, dextromethorphan
hydrobromide10mg,andphenylephrinehydrochloride5mg
AcetaminophenandPhenyltoloxamine
Mucinex Fast-Max Severe Cold & Sinus: Acetaminophen 325mg, dextro-
DoDUniformFormularyOutpatientDosageForms methorphan hydrobromide 10mg, and phenylephrine hydrochloride 5mg
UNIFORMFORMULARY [containssoybeanlecithin]
Tablet,Oral: Vicks DayQuil Cold & Flu Multi-Symptom: Acetaminophen 325mg, dextro-
Dolorex:Acetaminophen325mgandphenyltoloxaminecitrate25mg methorphanhydrobromide10mg,andphenylephrinehydrochloride5mg
Liquid,Oral:
AcetaminophenandPseudoephedrine
TylenolColdMax:Acetaminophen325mg,dextromethorphanhydrobromide
DoDUniformFormularyOutpatientDosageForms
10mg,andphenylephrinehydrochloride5mgper15mL(240mL)[contains
UNIFORMFORMULARY
propyleneglycol,sodium5mg/15mL,sodiumbenzoate;citrusburstflavor]
Caplet,Oral:
Vicks DayQuil Cold & Flu Multi-Symptom: Acetaminophen 325mg, dextro-
Ornex Maximum Strength: Acetaminophen 500mg and pseudoephedrine
methorphan hydrobromide 10mg, and phenylephrine hydrochloride 5mg
hydrochloride30mg
per15mL(180mL,300mL)[ethanolfree,sugarfree;containspropylene
AcetaminophenandTramadol glycol,sodium50mg/15mL,sodiumbenzoate]
DoDUniformFormularyOutpatientDosageForms PowderforSolution,Oral:
Theraflu Daytime Severe Cold & Cough: Acetaminophen 650mg, dextro-
UNIFORMFORMULARY
methorphanhydrobromide20mg,andphenylephrinehydrochloride10mg
Tablet,Oral:
per packet (6s) [contains phenylalanine 14mg/packet, potassium 10mg/
Generic:Acetaminophen325mgandtramadolhydrochloride37.5mg
packet,andsodium20mg/packet;berry-greentea-mentholflavor]
Acetaminophen,Aspirin,andCaffeine TherafluMulti-SymptomSevereCold:Acetaminophen500mg,dextromethor-
DoDUniformFormularyOutpatientDosageForms phan hydrobromide 20mg, and phenylephrine hydrochloride 10mg per
UNIFORMFORMULARY packet(6s)[containsphenylalanine20mg/packet,potassium10mg/packet,
Caplet,Oral: andsodium19mg/packet;Liptongreenteaandhoneylemonflavors]
ExcedrinExtraStrength,ExcedrinMigraine:Acetaminophen250mg,aspirin Syrup,Oral:
250mg,andcaffeine65mg Theraflu ExpressMax Daytime Severe Cold & Cough: Acetaminophen
Vanquish Extra Strength Pain Reliever: Acetaminophen 194mg, aspirin 325mg,dextromethorphanhydrobromide10mg,andphenylephrinehydro-
227mg,andcaffeine33mg chloride5mgper15mL(245.5mL)[containsethanol,potassium12mg/15
Powder,Oral: mL,propyleneglycol,sodium8mg/15mL,sodiumbenzoate;berryflavor]
Goody'sExtraStrengthHeadachePowder:Acetaminophen260mg,aspirin
Acetaminophen,Diphenhydramine,andPhenylephrine
520mg,andcaffeine32.5mg[containslactose]
Tablet,Oral: DoDUniformFormularyOutpatientDosageForms
Anacin Advanced Headache Formula: Acetaminophen 250mg, aspirin UNIFORMFORMULARY
250mg,andcaffeine65mg Caplet,Oral:
Excedrin Extra Strength, Excedrin Migraine, Pain-Off: Acetaminophen OneTabAllergy&Sinus:Acetaminophen650mg,diphenhydraminehydro-
250mg,aspirin250mg,andcaffeine65mg chloride25mg,andphenylephrinehydrochloride10mg[dyefree]
Fem-Prin:Acetaminophen194.4mg,aspirin226.8mg,andcaffeine32.4mg One Tab Cold and Flu: Acetaminophen 650mg, diphenhydramine hydro-
chloride25mg,andphenylephrinehydrochloride10mg[dyefree]
Acetaminophen,Caffeine,andDihydrocodeine Cold Control PE: Acetaminophen 650mg, diphenhydramine hydrochloride
DoDUniformFormularyOutpatientDosageForms 25mg,andphenylephrinehydrochloride10mg
UNIFORMFORMULARY Theraflu ExpressMax Nighttime Severe Cold & Cough: Acetaminophen
Capsule,Oral: 325mg,diphenhydraminehydrochloride12.5mg,andphenylephrinehydro-
Generic: Acetaminophen 320.5mg, caffeine 30mg, and dihydrocodeine chloride5mg
bitartrate16mg Tylenol Allergy Multi-Symptom Nighttime: Acetaminophen 325mg, diphen-
hydramine hydrochloride 25mg, and phenylephrine hydrochloride 5mg
Acetaminophen,Caffeine,andIsomethepteneMucate
[CoolBurstflavor]
DoDUniformFormularyOutpatientDosageForms Liquid,Oral:
UNIFORMFORMULARY DelsymChildren'sCough+ColdNightTime:Acetaminophen325mg,diphen-
Capsule,Oral: hydramine hydrochloride 12.5mg, and phenylephrine hydrochloride 5mg
Generic: Acetaminophen 500mg, caffeine 20mg, isometheptene mucate per10mL(180mL)[containsedetatedisodium,propyleneglycol,sodium
130mg 6mg/10mL,sodiumbenzoate;berryflavor]
DelsymCough+ColdNightTime:Acetaminophen650mg,diphenhydramine
Acetaminophen,Caffeine,andPyrilamine
hydrochloride 25mg, and phenylephrine hydrochloride 10mg per 20 mL
DoDUniformFormularyOutpatientDosageForms
(180 mL) [contains edetate disodium, propylene glycol, sodium 12mg/20
UNIFORMFORMULARY
mL,sodiumbenzoate;mixedberryflavor]
Tablet,Oral,ashydrochloride:
Dimetapp Children's Multi-Symptom Cold & Flu: Acetaminophen 160mg,
Midol Complete: Acetaminophen 500mg, caffeine 60mg, and pyrilamine
diphenhydraminehydrochloride 6.25mg, andphenylephrine hydrochloride
maleate15mg
2.5mgper5mL(118mL)[alcoholfree;containsedetatedisodium,menthol,
Acetaminophen,Dextromethorphan,andDoxylamine polyethylene glycol, propylene glycol, sodium benzoate, sodium 3.5mg/5
DoDUniformFormularyOutpatientDosageForms mL;redgrapeflavor]
Mucinex Sinus-Max Night Time Congestion & Cough: Acetaminophen
UNIFORMFORMULARY
650mg,diphenhydraminehydrochloride25mg,andphenylephrinehydro-
Capsule,LiquidFilled,Oral:
chloride10mgper20mL(180mL)[containsedetatedisodium,propylene
Generic: Acetaminophen 325mg, dextromethorphan hydrobromide 15mg,
glycol,sodium12mg/20mL,sodiumbenzoate]
anddoxylaminesuccinate6.25mg
Liquid,Oral: Theraflu ExpressMax Flu Cough & Sore Throat: Acetaminophen 325mg,
Vicks NyQuil Cold & Flu Nighttime Relief: Acetaminophen 650mg, dextro- diphenhydraminehydrochloride 12.5mg, andphenylephrine hydrochloride
methorphanhydrobromide30mg,anddoxylaminesuccinate12.5mgper30 5mg per 15 mL (245.5 mL) [contains edetate disodium, ethanol 10%,
mL (240 mL, 360 mL) [contains ethanol 10%, propylene glycol, sodium potassium12.5mg/15 mL, propylene glycol,sodium 8mg/15 mL, sodium
benzoate,sodium43mg/30mL] benzoate;berryflavor]
Robitussin Peak Cold Nighttime Multi-Symptom Cold: Acetaminophen
Acetaminophen,Dextromethorphan,andPhenylephrine 160mg,diphenhydraminehydrochloride6.25mg,andphenylephrinehydro-
DoDUniformFormularyOutpatientDosageForms chloride2.5mgper5mL(118mL,237mL)[containsmenthol,propylene
UNIFORMFORMULARY glycol,sodium4mg/5mL,sodiumbenzoate]
Caplet,Oal: RobitussinSevereMulti-SymptomCoughCold+FluNighttime:Acetamino-
Comtrex Maximum Strength, Non-Drowsy Cold & Cough: Acetaminophen phen 650mg, diphenhydramine hydrochloride 25mg, and phenylephrine
325mg,dextromethorphanhydrobromide10mg,andphenylephrinehydro- hydrochloride10mgper20mL(118mL,237mL)[containsedetatediso-
chloride5mg dium,fd&cred#40,polyethyleneglycol,propyleneglycol,sodium12mg/20
Mapap Multi-Symptom Cold: Acetaminophen 325mg, dextromethorphan mL,sodiumbenzoate,sorbitol]
hydrobromide 10mg, and phenylephrine hydrochloride 5mg [cool blast PowderforSolution,Oral:
flavor] Theraflu Nighttime Severe Cold: Acetaminophen 500mg, diphenhydramine
SudafedPEPressure+Pain+Cough:Acetaminophen325mg,dextromethor- hydrochloride 25mg, and phenylephrine hydrochloride 10mg per packet
phanhydrobromide10mg,andphenylephrinehydrochloride5mg (6s)[containsphenylalanine13mg,potassium10mg,andsodium23mg
Theraflu ExpressMax Daytime Severe Cold & Cough: Acetaminophen perpacket;greenteaandcitrusflavor]
325mg,dextromethorphanhydrobromide10mg,andphenylephrinehydro- TherafluNighttimeSevereCold&Cough:Acetaminophen650mg,diphen-
chloride5mg hydraminehydrochloride25mg,andphenylephrinehydrochloride10mgper
3
ACETAMINOPHEN,DIPHENHYDRAMINE,ANDPHENYLEPHRINE
packet(6s)[containsphenylalanine13mg,potassium10mg,andsodium Acetylcholine
23mgperpacket;honeylemonflavor] DoDUniformFormularyOutpatientDosageForms
Theraflu Sugar-Free Nighttime Severe Cold & Cough: Acetaminophen UNIFORMFORMULARY
650mg,diphenhydraminehydrochloride25mg,andphenylephrinehydro- SolutionReconstituted,Intraocular,aschloride:
chloride10mgperpacket(6s)[sugarfree;containsphenylalanine13mg, Miochol-E:20mg(1ea)[containsmannitol]
potassium10mg,andsodium23mgperpacket;honeylemonflavor]
Syrup,Oral: Acetylcysteine
TherafluWarmingReliefFlu&SoreThroat:Acetaminophen325mg,diphen- DoDUniformFormularyOutpatientDosageForms
hydramine hydrochloride 12.5mg, and phenylephrine hydrochloride 5mg UNIFORMFORMULARY
per15mL(245.5mL)[containsethanol,potassium5mg/15mL,propylene Solution,Injection[preservativefree]:
glycol,sodium5mg/15mL,sodiumbenzoate;cherryflavor] Generic:20%(30mL)
Theraflu ExpressMax Nighttime Severe Cold & Cough: Acetaminophen Solution,forInhalation/Oral:
325mg,diphenhydraminehydrochloride12.5mg,andphenylephrinehydro- Generic:10%[100mg/mL](10mL,30mL);20%[200mg/mL](10mL,30mL)
chloride5mgper15mL(245.5mL)[containsethanol,potassium12.5mg/ Solution,forInhalation/Oral[preservativefree]:
15 mL, propylene glycol, sodium 8mg/15 mL, sodium benzoate; cherry Generic:10%[100mg/mL](4mL,10mL,30mL);20%[200mg/mL](4mL,10
flavor] mL,30mL)
TabletEffervescent,Oral:
Acetaminophen,Guaifenesin,andPhenylephrine Cetylev:500mg,2.5g[containsedetatedisodium;lemonmintflavor]
DoDUniformFormularyOutpatientDosageForms
Acitretin
UNIFORMFORMULARY
Liquid,Oral: DoDUniformFormularyOutpatientDosageForms
MucinexFast-Max:Acetaminophen650mg,guaifenesin400mg,andphenyl- UNIFORMFORMULARY
ephrinehydrochloride10mgper20mL(180mL)[containsbrilliantbluefcf Capsule,Oral:
(fd&cblue #1), edetate disodium,fd&c red #40,propylene glycol, sodium Generic:10mg,17.5mg,25mg
benzoate,sorbitol] Aclidinium
Mucinex Fast-Max Cold & Sinus: Acetaminophen 650mg, guaifenesin
DoDUniformFormularyOutpatientDosageForms
400mg, and phenylephrine hydrochloride 10mg per 20 mL (177 mL)
UNIFORMFORMULARY
[containsbrilliantbluefcf(fd&cblue#1),edetatedisodium,fd&cred#40,
AerosolPowderBreathActivated,Inhalation,asbromide:
propyleneglycol,sodiumbenzoate]
TudorzaPressair:400mcg/actuation(1ea)[containsmilkprotein]
MucinexSinus-Max:Acetaminophen650mg,guaifenesin400mg,andphe-
nylephrinehydrochloride10mgper20mL(180mL)[containsbrilliantblue AclidiniumandFormoterol
fcf(fd&cblue#1),edetatedisodium,fd&cred#40,propyleneglycol,sodium DoDUniformFormularyOutpatientDosageForms
benzoate] NOTCOVERED
Theraflu Warming Cold & Chest: Acetaminophen 325mg, guaifenesin AerosolPowderBreathActivated,Inhalation:
200mg, and phenylephrine hydrochloride 5mg per 15 mL (245.5 mL) DuaklirPressair:Aclidiniumbromide400mcgandformoterolfumarate12mcg
[containsbenzylalcohol,edetatedisodium,fd&cyellow#6(sunsetyellow), peractuation(1ea)[containslactose,milkprotein]
propyleneglycol,sodiumbenzoate;orangeflavor]
Tablet,Oral: AcrivastineandPseudoephedrine
Mucinex Sinus-Max Congestion: Acetaminophen 325mg, guaifenesin DoDUniformFormularyOutpatientDosageForms
200mg, and phenylephrine hydrochloride 5mg [contains fd&c red #40 UNIFORMFORMULARY
aluminumlake,fd&cyellow#6aluminumlake] Capsule,Oral:
Sudafed PE Pressure+Pain+Mucus: Acetaminophen 325mg, guaifenesin Semprex-D:Acrivastine8mgandpseudoephedrinehydrochloride60mg
200mg,andphenylephrinehydrochloride5mg
AcyclovirandHydrocortisone
Tylenol Sinus Severe: Acetaminophen 325mg, guaifenesin 200mg, and
DoDUniformFormularyOutpatientDosageForms
phenylephrinehydrochloride5mg
UNIFORMFORMULARY
Acetaminophen,Isometheptene,andDichloralphenazone Cream,External:
DoDUniformFormularyOutpatientDosageForms Xerese:Acyclovir5%andhydrocortisone1%(5g)
UNIFORMFORMULARY Acyclovir(Systemic)
Capsule,Oral:
DoDUniformFormularyOutpatientDosageForms
Generic:Acetaminophen325mg,isometheptenemucate65mg,anddichlor-
BASICCOREFORMULARY
alphenazone100mg
Capsule,Oral:
AcetaZOLAMIDE Zovirax:200mg
DoDUniformFormularyOutpatientDosageForms Generic:200mg
UNIFORMFORMULARY Suspension,Oral:
Zovirax:200mg/5mL(473mL)
CapsuleExtendedRelease12Hour,Oral:
Generic:200mg/5mL(473mL)
Generic:500mg
Tablet,Oral:
SolutionReconstituted,Injection[preservativefree]:
Zovirax:400mg,800mg
Generic:500mg(1ea)
Generic:400mg,800mg
Tablet,Oral:
Generic:125mg,250mg UNIFORMFORMULARY
Solution,Intravenous,assodium[strengthexpressedasbase]:
AceticAcid(Otic)
Generic:50mg/mL(10mL,20mL)
DoDUniformFormularyOutpatientDosageForms SolutionReconstituted,Intravenous,assodium[strengthexpressedasbase]:
UNIFORMFORMULARY Generic:500mg(1ea)
Solution,Otic:
Generic:2%(15mL,60mL) Acyclovir(Topical)
DoDUniformFormularyOutpatientDosageForms
AceticAcid,PropyleneGlycolDiacetate,andHydrocortisone UNIFORMFORMULARY
DoDUniformFormularyOutpatientDosageForms Cream,External:
UNIFORMFORMULARY Zovirax:5%(5g)[containscetostearylalcohol,propyleneglycol]
Solution,Otic[drops]: Ointment,External:
Generic:Aceticacid2%,propyleneglycoldiacetate3%,andhydrocortisone Generic:5%(5g,15g,30g)
1%(10mL) Tablet,Buccal:
Sitavig:50mg[containsmilkproteinconcentrate]
AceticAcid(Topical)
DoDUniformFormularyOutpatientDosageForms Adalimumab
UNIFORMFORMULARY DoDUniformFormularyOutpatientDosageForms
Solution,Irrigation: BASICCOREFORMULARY
Generic:0.25%(250mL,500mL,1000mL) Pen-injectorKit,Subcutaneous[preservativefree]:
Humira Pen: 40mg/0.8 mL (1 ea); 40mg/0.4 mL (1 ea)[contains polysor-
AcetohydroxamicAcid bate80]
DoDUniformFormularyOutpatientDosageForms HumiraPen-CD/UC/HSStarter:40mg/0.8mL(1ea);80mg/0.8mL(1ea)
UNIFORMFORMULARY [containspolysorbate80]
Tablet,Oral: Humira Pen-Pediatric UC Start: 80mg/0.8 mL (1 ea) [latex free; contains
Lithostat:250mg polysorbate80]
4
ALCOHOL(ISOPROPYL)
Humira Pen-Ps/UV/Adol HS Start: 40mg/0.8 mL (1 ea); 80mg/0.8 mL & Albuminar-5:5%(250mL,500mL)
40mg/0.4mL(1ea)[containspolysorbate80] AlbuRx:5%(250mL,500mL)
HumiraPen-Psor/UveitStarter:80MG/0.8ML&40MG/0.4ML(1ea)[contains Buminate:5%(250mL,500mL);25%(20mL)
polysorbate80] Plasbumin-5:5%(50mL,250mL)
PrefilledSyringeKit,Subcutaneous[preservativefree]: Generic:25%(50mL,100mL)
Humira: 10mg/0.2 mL (1 ea); 20mg/0.4 mL (1 ea); 40mg/0.8 mL (1 ea); Solution,Intravenous[preservativefree]:
10mg/0.1mL(1ea);20mg/0.2mL(1ea);40mg/0.4mL(1ea)[contains Albutein:5%(50mL);25%(20mL)
polysorbate80] Plasbumin-5:5%(50mL)
HumiraPediatricCrohnsStart:40mg/0.8mL(1ea);80mg/0.8mL(1ea);
Generic:5%(100mL,250mL,500mL);25%(50mL,100mL)
80mg/0.8mL&40mg0.4mL(1ea)[containspolysorbate80]
Albuterol
Adapalene
DoDUniformFormularyOutpatientDosageForms
DoDUniformFormularyOutpatientDosageForms
BASICCOREFORMULARY
UNIFORMFORMULARY
AerosolSolution,Inhalation:
Cream,External:
ProAirHFA:90mcg/actuation(8.5g)
Generic:0.1%(45g)
NebulizationSolution,Inhalation:
Gel,External:
Generic:0.1%(45g);0.3%(45g) Generic:0.083%[2.5mg/3mL](3mL)
Lotion,External: NebulizationSolution,Inhalation[preservativefree]:
Generic:0.1%(59mL) Generic:0.083%[2.5mg/3mL](3mL)
NONFORMULARY UNIFORMFORMULARY
Pad,Swab,External: AerosolPowderBreathActivated,Inhalation:
Generic:0.1%(30ea)[containsalcohol,usp] ProAirRespiClick:90mcg/actuation(1ea)[containsmilkprotein]
Solution,External: NebulizationSolution,Inhalation:
Generic:0.1%(60mL) Generic:0.63mg/3mL(3mL);0.5%[2.5mg/0.5mL](20mL)
NebulizationSolution,Inhalation[preservativefree]:
Adefovir
Generic:0.63mg/3mL(3mL);1.25mg/3mL(3mL);0.5%[2.5mg/0.5mL]
DoDUniformFormularyOutpatientDosageForms (1ea)
UNIFORMFORMULARY Syrup,Oral:
Tablet,Oral,asdipivoxil: Generic:2mg/5mL(473mL)
Generic:10mg
Tablet,Oral:
Adenosine Generic:2mg,4mg
DoDUniformFormularyOutpatientDosageForms TabletExtendedRelease12Hour,Oral:
UNIFORMFORMULARY Generic:4mg,8mg
Solution,Intravenous: NONFORMULARY
Adenocard:12mg/4mL(4mL) AerosolSolution,Inhalation:
Generic:3mg/mL(20mL,30mL);6mg/2mL(2mL) ProventilHFA:90mcg/actuation(6.7g)
Solution,Intravenous[preservativefree]:
VentolinHFA:90mcg/actuation(8g,18g)
Generic:3mg/mL(20mL,30mL);6mg/2mL(2mL);12mg/4mL(4mL)
Alclometasone
Adenovirus(Types4,7)Vaccine
DoDUniformFormularyOutpatientDosageForms
DoDUniformFormularyOutpatientDosageForms
UNIFORMFORMULARY
UNIFORMFORMULARY
Cream,External,asdipropionate:
Tablet,EntericCoated,Oral[combinationpackage]:
Generic:0.05%(15g,45g,60g)
Adenovirustype4≥4.5log10TCID50[containsalbumin(human);100white Ointment,External,asdipropionate:
tablets]
Adenovirustype7≥4.5log TCID [containsalbumin(human);100white Generic:0.05%(15g,45g,60g)
10 50
tablets] Alcohol(Ethyl)
Ado-TrastuzumabEmtansine DoDUniformFormularyOutpatientDosageForms
DoDUniformFormularyOutpatientDosageForms UNIFORMFORMULARY
UNIFORMFORMULARY Aerosol,Foam,External[instanthandsanitizer]:
SolutionReconstituted,Intravenous[preservativefree]: Epi-Clenz:70%(240mL)[containsaloe,vitaminE]
Kadcyla: 100mg (1 ea); 160mg (1 ea) [contains mouse (murine) and/or Gel,External[foam/instanthandsanitizer]:
hamsterprotein] Epi-Clenz:70%(480mL)[containsaloe,vitaminE]
Gel,External[instanthandsanitizer]:
Aducanumab
GelRite:67%(120mL,480mL)
Afatinib GelRite:67%(800mL)[containsvitaminE]
Isagel:60%(59mL,118mL,621mL,800mL)
DoDUniformFormularyOutpatientDosageForms
Prevacare:60%(120mL,240mL,960mL,1200mL,1500mL)
UNIFORMFORMULARY
Generic:62%(1.5mL,118mL,354mL,473mL)
Tablet,Oral:
Liquid,External[denatured]:
Gilotrif:20mg,30mg,40mg
Generic:70%(480mL,3840mL)
Aflibercept(Ophthalmic) Liquid,External[denatured/rubbingalcohol]:
DoDUniformFormularyOutpatientDosageForms Lavacol:70%(473mL)
UNIFORMFORMULARY Lotion,External[instanthandsanitizer]:
Solution,Intraocular[preservativefree]: Purell2in1:62%(60mL,360mL,1000mL)
Eylea: 2mg/0.05 mL (0.05 mL) [contains mouse (murine) and/or hamster Pad,External[instanthandsanitizer/towelette]:
protein] Isagel:60%(50s,300s)
Purell:62%(24s)[containsaloe,moisturizers,tartrazine,vitaminA,vitaminE]
AgalsidaseBeta
Purell:62%(35s,175s)[containsmoisturizers,vitaminE]
DoDUniformFormularyOutpatientDosageForms Solution,External[instanthandsanitizer]:
UNIFORMFORMULARY ProtectionPlus:62%(800mL)
SolutionReconstituted,Intravenous: Solution,Injection[dehydrated,preservativefree]:
Fabrazyme: 5mg (1 ea); 35mg (1 ea) [contains mouse (murine) and/or
Generic:98%(1mL,5mL)
hamsterprotein]
Alcohol(Isopropyl)
Albendazole
DoDUniformFormularyOutpatientDosageForms
DoDUniformFormularyOutpatientDosageForms
UNIFORMFORMULARY
UNIFORMFORMULARY
Gel,External:
Tablet,Oral:
Generic:70%(118mL)
Albenza:200mg[containssaccharinsodium]
Miscellaneous,External:
Albumin EssentraWipes9x9":70%(30ea,270ea)
DoDUniformFormularyOutpatientDosageForms Pad,External:
UNIFORMFORMULARY PharmacistChoiceAlcohol:70%(100ea)
Solution,Intravenous:
Albumin-ZLB:5%(250mL,500mL)
5
ALDESLEUKIN
Aldesleukin Prolastin-C:1000mg(1ea)
DoDUniformFormularyOutpatientDosageForms
Alpha-Galactosidase
UNIFORMFORMULARY
DoDUniformFormularyOutpatientDosageForms
SolutionReconstituted,Intravenous[preservativefree]:
UNIFORMFORMULARY
Proleukin:22,000,000units(1ea)
Tablet,Chewable,Oral:
Alectinib beano:150Galactosidaseunits[scored]
DoDUniformFormularyOutpatientDosageForms Tablet,OrallyDisintegrating,Oral:
UNIFORMFORMULARY beanoMeltaways:300Galactosidaseunits[strawberryflavor]
Capsule,Oral: ALPRAZolam
Alecensa:150mg
DoDUniformFormularyOutpatientDosageForms
Alemtuzumab UNIFORMFORMULARY
DoDUniformFormularyOutpatientDosageForms Concentrate,Oral:
UNIFORMFORMULARY ALPRAZolamIntensol:1mg/mL(30mL)[unflavoredflavor]
Solution,Intravenous[preservativefree]: Tablet,Oral:
Campath: 30mg/mL (1 mL) [contains edetate disodium dihydrate, mouse Generic:0.25mg,0.5mg,1mg,2mg
(murine)and/orhamsterprotein,polysorbate80] TabletDispersible,Oral:
Lemtrada: 12mg/1.2 mL (1.2 mL) [contains edetate disodium dihydrate, Generic:0.25mg,0.5mg,1mg,2mg
mouse(murine)and/orhamsterprotein,polysorbate80] TabletExtendedRelease24Hour,Oral:
Generic:0.5mg,1mg,2mg,3mg
Alendronate
Alprostadil
DoDUniformFormularyOutpatientDosageForms
BASICCOREFORMULARY DoDUniformFormularyOutpatientDosageForms
Solution,Oral: UNIFORMFORMULARY
Generic:70mg/75mL(75mL) Kit,Intracavernosal:
Tablet,Oral: CaverjectImpulse:10mcg[containsbenzylalcohol]
Generic:5mg,10mg,35mg,40mg,70mg CaverjectImpulse:20mcg
Edex:10mcg,20mcg,40mcg
NONFORMULARY Pellet,Urethral:
TabletEffervescent,Oral: Muse:125mcg(1ea,6ea);250mcg(1ea,6ea);500mcg(1ea,6ea);1000
Binosto:70mg mcg(1ea,6ea)
Solution,Injection:
Alfentanil
Generic:500mcg/mL(1mL)
DoDUniformFormularyOutpatientDosageForms
SolutionReconstituted,Intracavernosal:
UNIFORMFORMULARY Caverject:20mcg(1ea)
Injectable,Injection[preservativefree]: Caverject:20mcg(1ea);40mcg(1ea)[containsbenzylalcohol]
Generic:500mcg/mL(2mL,5mL)
Alteplase
Alfuzosin
DoDUniformFormularyOutpatientDosageForms
DoDUniformFormularyOutpatientDosageForms
UNIFORMFORMULARY
BASICCOREFORMULARY SolutionReconstituted,Injection:
TabletExtendedRelease24Hour,Oral,ashydrochloride: CathfloActivase:2mg(1ea)
Generic:10mg SolutionReconstituted,Intravenous:
AlglucosidaseAlfa Activase:50mg(1ea);100mg(1ea)
DoDUniformFormularyOutpatientDosageForms Altretamine
UNIFORMFORMULARY DoDUniformFormularyOutpatientDosageForms
SolutionReconstituted,Intravenous[preservativefree]: UNIFORMFORMULARY
Lumizyme:50mg(1ea)[containspolysorbate80] Capsule,Oral:
Alirocumab Hexalen:50mg
DoDUniformFormularyOutpatientDosageForms AluminumAcetate
UNIFORMFORMULARY DoDUniformFormularyOutpatientDosageForms
SolutionPen-injector,Subcutaneous[preservativefree]: UNIFORMFORMULARY
Praluent:75mg/mL(1mL);150mg/mL(1mL)[containsmouse(murine)and/ Packet,External:
orhamsterprotein] Boro-Packs:Aluminumsulfate49%andcalciumacetate51%perpacket(14
Alitretinoin(Topical) ea,100ea)
Domeboro:Aluminumsulfatetetradecahydrate1347mgandcalciumacetate
DoDUniformFormularyOutpatientDosageForms
monohydrate952mgperpacket(12s,100s)
UNIFORMFORMULARY
Pedi-Boro Soak: Aluminum sulfate tetradecahydrate 1191mg and calcium
Gel,External:
acetatemonohydrate839mgperpacket(12ea,100ea)
Panretin:0.1%(60g)
Generic: Aluminum sulfate tetradecahydrate 1347mg and calcium acetate
Allopurinol monohydrate952mgperpacket(1ea,12ea)
DoDUniformFormularyOutpatientDosageForms Solution,External:
Generic:(480mL)
BASICCOREFORMULARY
Tablet,Oral,assodium: AluminumAcetateandAceticAcid
Generic:100mg,300mg
DoDUniformFormularyOutpatientDosageForms
UNIFORMFORMULARY UNIFORMFORMULARY
SolutionReconstituted,Intravenous,assodium[strengthexpressedasbase, Solution,Otic:
preservativefree]: Generic:Aluminumacetate10%andaceticacid2%(60mL)
Generic:500mg(1ea)
AluminumChloride
Alosetron DoDUniformFormularyOutpatientDosageForms
DoDUniformFormularyOutpatientDosageForms UNIFORMFORMULARY
UNIFORMFORMULARY Gel,Oral[topical]:
Tablet,Oral: ViscoStatClear:25%(1.2mL,30mL)
Generic:0.5mg,1mg Liquid,Oral[topical]:
Hemoban:25%(30mL)
Alpha1-ProteinaseInhibitor Hemodent:21%(10mL,20mL,40mL)
DoDUniformFormularyOutpatientDosageForms
UNIFORMFORMULARY AluminumChlorideHexahydrate
Solution,Intravenous[preservativefree]: DoDUniformFormularyOutpatientDosageForms
Glassia:1000mg/50mL(1ea)[latexfree] UNIFORMFORMULARY
SolutionReconstituted,Intravenous: Liquid,External:
Zemaira:1000mg(1ea) B+Drier:15%(35mL)
SolutionReconstituted,Intravenous[preservativefree]: Solution,External:
Aralast NP: 500mg (1 ea); 1000mg (1 ea) [contains polyethylene glycol, Drysol:20%(35mL,37.5mL,60mL)
polysorbate80] Hypercare:15%(35mL,60mL)[containssdalcohol40]
6
AMINOLEVULINICACID(TOPICAL)
AluminumHydroxide Amifostine
DoDUniformFormularyOutpatientDosageForms DoDUniformFormularyOutpatientDosageForms
UNIFORMFORMULARY UNIFORMFORMULARY
Ointment,External: SolutionReconstituted,Intravenous:
DermaMed:(113g) Generic:500mg(1ea)
Suspension,Oral:
Amikacin(Systemic)
Generic:320mg/5mL(473mL)
DoDUniformFormularyOutpatientDosageForms
AluminumHydroxideandMagnesiumCarbonate UNIFORMFORMULARY
DoDUniformFormularyOutpatientDosageForms Solution,Injection,assulfate:
UNIFORMFORMULARY Generic:500mg/2mL(2mL);1g/4mL(4mL)
Solution,Injection,assulfate[preservativefree]:
Liquid:
Generic:500mg/2mL(2mL);1g/4mL(4mL)
Acid Gone: Aluminum hydroxide 31.7mg and magnesium carbonate
119.3mgper5mL(360mL) AMILoride
Gaviscon:Aluminumhydroxide31.7mgandmagnesiumcarbonate119.3mg DoDUniformFormularyOutpatientDosageForms
per5mL(355mL)[containsmagnesium38mg/5mL,sodium17mg/5mL UNIFORMFORMULARY
andbenzylalcohol;coolmintflavor] Tablet,Oral,ashydrochloride:
GavisconExtraStrength:Aluminumhydroxide254mgandmagnesiumcar- Generic:5mg
bonate 237.5mg per 5 mL (355 mL) [contains magnesium 80mg/5 mL,
sodium14mg/5mLandbenzylalcohol;coolmintflavor] AmilorideandHydrochlorothiazide
Tablet,chewable: DoDUniformFormularyOutpatientDosageForms
Acid Gone Extra Strength: Aluminum hydroxide 160mg and magnesium UNIFORMFORMULARY
carbonate105mg Tablet,Oral:
GavisconExtraStrength:Aluminumhydroxide160mgandmagnesiumcar- Generic:5/50:Amiloridehydrochloride5mgandhydrochlorothiazide50mg
bonate105mg[containssodium19mg/tablet(1.3mEq/tablet);cherryand
AminoAcidInjection
originalflavors]
DoDUniformFormularyOutpatientDosageForms
AluminumHydroxideandMagnesiumHydroxide UNIFORMFORMULARY
DoDUniformFormularyOutpatientDosageForms Solution,Intravenous:
UNIFORMFORMULARY Aminosyn:8.5%(500mL);10%(500mL,1000mL)[latexfree,sulfitefree]
AminosynII:7%(500mL);8.5%(500mL,1000mL);10%(2000mL)[latex
Liquid,oral:
free,sulfitefree]
Mag-Al:Aluminumhydroxide200mgandmagnesiumhydroxide200mgper5
AminosynII:10%(500mL,1000mL);15%(2000mL)[sulfitefree]
mL(30mL)[dyefree,ethanolfree,sugarfree;containspropyleneglycol,
AminosynII/Electrolytes:8.5%(500mL)[latexfree,sulfitefree]
sodium4mg/5mL;peppermintflavor]
AminosynM:3.5%(1000mL)[latexfree,sulfitefree]
AluminumHydroxide,MagnesiumHydroxide,andSimethicone Aminosyn-HBC:7%(500mL)[latexfree,sulfitefree]
Aminosyn-PF:7%(500mL);10%(1000mL)[latexfree,sulfitefree]
DoDUniformFormularyOutpatientDosageForms
Aminosyn-RF:5.2%(500mL)[latexfree,sulfitefree]
UNIFORMFORMULARY
Aminosyn/Electrolytes:8.5%(500mL,1000mL)[latexfree,sulfitefree]
Liquid,Oral:
ClinimixE/Dextrose(2.75/10):2.75%(1000mL,2000mL)[sulfitefree]
Generic: Aluminum hydroxide 200mg, magnesium hydroxide 200mg, and
ClinimixE/Dextrose(2.75/5):2.75%(1000mL,2000mL)[sulfitefree]
simethicone 20mg per 5 mL (360 mL); aluminum hydroxide 400mg,
ClinimixE/Dextrose(4.25/10):4.25%(1000mL,2000mL)[sulfitefree]
magnesiumhydroxide400mg,andsimethicone40mgper5mL(360mL) ClinimixE/Dextrose(4.25/25):4.25%(1000mL,2000mL)[sulfitefree]
Suspension,Oral: ClinimixE/Dextrose(4.25/5):4.25%(1000mL,2000mL)[sulfitefree]
Generic: Aluminum hydroxide 225mg, magnesium hydroxide 200mg, and ClinimixE/Dextrose(5/15):5%(1000mL,2000mL)[sulfitefree]
simethicone25mgper5mL(360mL) ClinimixE/Dextrose(5/20):5%(1000mL,2000mL)[sulfitefree]
Tablet,Chewable,Oral: ClinimixE/Dextrose(5/25):5%(1000mL,2000mL)[sulfitefree]
Generic: Aluminum hydroxide 200mg, magnesium hydroxide 200mg, and Clinimix/Dextrose(2.75/5):2.75%(1000mL)[sulfitefree]
simethicone25mg Clinimix/Dextrose(4.25/10):4.25%(1000mL,2000mL)[sulfitefree]
Clinimix/Dextrose(4.25/20):4.25%(1000mL,2000mL)[sulfitefree]
Alvimopan
Clinimix/Dextrose(4.25/25):4.25%(1000mL,2000mL)[sulfitefree]
DoDUniformFormularyOutpatientDosageForms Clinimix/Dextrose(4.25/5):4.25%(1000mL,2000mL)[sulfitefree]
UNIFORMFORMULARY Clinimix/Dextrose(5/15):5%(1000mL,2000mL)[sulfitefree]
Capsule,Oral: Clinimix/Dextrose(5/20):5%(1000mL,2000mL)[sulfitefree]
Entereg:12mg Clinimix/Dextrose(5/25):5%(1000mL,2000mL)[sulfitefree]
ClinisolSF:15%(500mL,2000mL)[sulfitefree]
Amantadine
FreAmineHBC:6.9%(750mL)
DoDUniformFormularyOutpatientDosageForms FreAmineIII:3%(1000mL)
BASICCOREFORMULARY FreAmineIII:10%(1000mL)[containssodiumbisulfite]
Capsule,Oral,ashydrochloride: Hepatamine:8%(500mL)
Generic:100mg NephrAmine:5.4%(250mL)
Syrup,Oral,ashydrochloride: Plenamine:15%(1000mL)[containssodiummetabisulfite]
Generic:50mg/5mL(10mL,473mL) Premasol:6%(500mL);10%(500mL,1000mL,2000mL)[sulfitefree]
Prosol:20%(2000mL)
UNIFORMFORMULARY Travasol:10%(500mL,1000mL,2000mL)[sulfitefree]
Tablet,Oral,ashydrochloride: Trophamine:6%(500mL)
Generic:100mg TrophAmine:10%(500mL)
NONFORMULARY AminocaproicAcid
CapsuleExtendedRelease24Hour,Oral,ashydrochloride[strengthexpressed
DoDUniformFormularyOutpatientDosageForms
asbase]:
UNIFORMFORMULARY
Gocovri:68.5mg,137mg
Solution,Intravenous:
TabletExtendedRelease24Hour,Oral,ashydrochloride[strengthexpressed Generic:250mg/mL(20mL)
asbase]: Solution,Oral:
OsmolexER:129mg,193mg,258mg Amicar:25%(236.5mL)[containsedetatedisodium,methylparaben,propyl-
Ambrisentan paraben,saccharinsodium;raspberryflavor]
Tablet,Oral:
DoDUniformFormularyOutpatientDosageForms
Amicar:500mg,1000mg[scored]
UNIFORMFORMULARY
Tablet,Oral: AminolevulinicAcid(Topical)
Letairis:5mg,10mg DoDUniformFormularyOutpatientDosageForms
NOTCOVERED
Amifampridine
Gel,External:
DoDUniformFormularyOutpatientDosageForms Ameluz: 10% (2g) [contains isopropyl alcohol, phosphatidylcholine, soy,
UNIFORMFORMULARY polysorbate80,propyleneglycol,sodiumbenzoate]
Tablet,Oral: SolutionReconstituted,External,ashydrochloride:
Firdapse:10mg[scored] Levulan Kerastick: 20% (1 ea) [contains alcohol, usp, isopropyl alcohol,
Ruzurgi:10mg laureth,polyethyleneglycol]
7
AMINOPHYLLINE
Aminophylline Generic:10/40:Amlodipine10mgandbenazeprilhydrochloride40mg
DoDUniformFormularyOutpatientDosageForms
AmlodipineandCelecoxib
UNIFORMFORMULARY
DoDUniformFormularyOutpatientDosageForms
Solution,Intravenous,asdihydrate:
Generic:25mg/mL(10mL,20mL) Tier4-NOTCOVERED
Tablet,Oral:
AminosalicylicAcid
Consensi:Amlodipinebesylate2.5mgandcelecoxib200mg
DoDUniformFormularyOutpatientDosageForms Consensi:Amlodipinebesylate5mgandcelecoxib200mg
UNIFORMFORMULARY Consensi:Amlodipinebesylate10mgandcelecoxib200mg[scored]
Packet,Oral:
Paser:4g(30ea) AmlodipineandOlmesartan
DoDUniformFormularyOutpatientDosageForms
Amiodarone
UNIFORMFORMULARY
DoDUniformFormularyOutpatientDosageForms Tablet,Oral:
BASICCOREFORMULARY 5/20:Amlodipine5mgandolmesartanmedoxomil20mg
Tablet,Oral,ashydrochloride: 5/40:Amlodipine5mgandolmesartanmedoxomil40mg
Generic:200mg 10/20:Amlodipine10mgandolmesartanmedoxomil20mg
UNIFORMFORMULARY 10/40:Amlodipine10mgandolmesartanmedoxomil40mg
Solution,Intravenous,ashydrochloride:
AmlodipineandValsartan
Nexterone:150mg/100mLinDextrose(100mL);360mg/200mLinDextrose
DoDUniformFormularyOutpatientDosageForms
(200mL)
Generic:150mg/3mL(3mL);450mg/9mL(9mL);900mg/18mL(18mL) UNIFORMFORMULARY
Tablet,Oral,ashydrochloride: Tablet,Oral:
Generic:100mg,400mg Generic:
5/160:Amlodipine5mgandvalsartan160mg
Amitriptyline 5/320:Amlodipine5mgandvalsartan320mg
DoDUniformFormularyOutpatientDosageForms 10/160:Amlodipine10mgandvalsartan160mg
BASICCOREFORMULARY 10/320:Amlodipine10mgandvalsartan320mg
Tablet,Oral,ashydrochloride:
Amlodipine,Valsartan,andHydrochlorothiazide
Generic:10mg,25mg,50mg,75mg
DoDUniformFormularyOutpatientDosageForms
UNIFORMFORMULARY UNIFORMFORMULARY
Tablet,Oral,ashydrochloride: Tablet,Oral:
Generic:100mg,150mg Amlodipine5mg,valsartan160mg,andhydrochlorothiazide12.5mg
Amlodipine5mg,valsartan160mg,andhydrochlorothiazide25mg
AmitriptylineandChlordiazepoxide
Amlodipine10mg,valsartan160mg,andhydrochlorothiazide12.5mg
DoDUniformFormularyOutpatientDosageForms
Amlodipine10mg,valsartan160mg,andhydrochlorothiazide25mg
UNIFORMFORMULARY Amlodipine10mg,valsartan320mg,andhydrochlorothiazide25mg
Tablet,Oral:
12.5/5:Amitriptylinehydrochloride12.5mgandchlordiazepoxide5mg AmmoniaSpirit(Aromatic)
25/10:Amitriptylinehydrochloride25mgandchlordiazepoxide10mg DoDUniformFormularyOutpatientDosageForms
UNIFORMFORMULARY
AmitriptylineandPerphenazine
Solution,forVaporInhalation:
DoDUniformFormularyOutpatientDosageForms
Generic;2%(60mL),15%(0.33mL)
UNIFORMFORMULARY
Tablet,Oral: AmmoniumAlum
Generic: DoDUniformFormularyOutpatientDosageForms
Amitriptylinehydrochloride10mgandperphenazine2mg UNIFORMFORMULARYPowder:454g
Amitriptylinehydrochloride10mgandperphenazine4mg
Amitriptylinehydrochloride25mgandperphenazine2mg Amobarbital
Amitriptylinehydrochloride25mgandperphenazine4mg DoDUniformFormularyOutpatientDosageForms
Amitriptylinehydrochloride50mgandperphenazine4mg UNIFORMFORMULARY
SolutionReconstituted,Injection,assodium:
Amivantamab
AmytalSodium:500mg(1ea)
AmLODIPine Amoxapine
DoDUniformFormularyOutpatientDosageForms DoDUniformFormularyOutpatientDosageForms
BASICCOREFORMULARY UNIFORMFORMULARY
Tablet,Oral: Tablet,Oral:
Generic:2.5mg,5mg,10mg Generic:25mg,50mg,100mg,150mg
NONFORMULARY
Suspension,Oral,asbenzoate: Amoxicillin
Katerzia:1mg/mL(150mL) DoDUniformFormularyOutpatientDosageForms
BASICCOREFORMULARY
AmlodipineandAtorvastatin
Capsule,Oral:
DoDUniformFormularyOutpatientDosageForms
Generic:250mg,500mg
UNIFORMFORMULARY SuspensionReconstituted,Oral:
Tablet,Oral:
Generic:250mg/5mL(80mL,100mL,150mL);400mg/5mL(50mL,75mL,
Generic:
100mL)
2.5/10:Amlodipine2.5mgandatorvastatin10mg
2.5/20:Amlodipine2.5mgandatorvastatin20mg UNIFORMFORMULARY
2.5/40:Amlodipine2.5mgandatorvastatin40mg SuspensionReconstituted,Oral:
5/10:Amlodipine5mgandatorvastatin10mg Generic:125mg/5mL(80mL,100mL,150mL);200mg/5mL(50mL,75mL,
5/20:Amlodipine5mgandatorvastatin20mg 100mL)
5/40:Amlodipine5mgandatorvastatin40mg Tablet,Oral:
5/80:Amlodipine5mgandatorvastatin80mg Generic:500mg,875mg
10/10:Amlodipine10mgandatorvastatin10mg TabletChewable,Oral:
10/20:Amlodipine10mgandatorvastatin20mg Generic:125mg,250mg
10/40:Amlodipine10mgandatorvastatin40mg TabletExtendedRelease24Hour,Oral:
10/80:Amlodipine10mgandatorvastatin80mg Moxatag:775mg
AmlodipineandBenazepril AmoxicillinandClavulanate
DoDUniformFormularyOutpatientDosageForms DoDUniformFormularyOutpatientDosageForms
BASICCOREFORMULARY BASICCOREFORMULARY
Capsule,Oral: PowderforSuspension,Oral:
Generic:2.5/10:Amlodipine2.5mgandbenazeprilhydrochloride10mg Augmentin:125:Amoxicillin125mgandclavulanatepotassium31.25mgper
Generic:5/10:Amlodipine5mgandbenazeprilhydrochloride10mg 5mL(75mL,100mL,150mL)[containspotassium0.16mEq/5mL;banana
Generic:5/20:Amlodipine5mgandbenazeprilhydrochloride20mg flavor]
Generic:5/40:Amlodipine5mgandbenazeprilhydrochloride40mg Generic:200:Amoxicillin200mgandclavulanatepotassium28.5mgper5
Generic:10/20:Amlodipine10mgandbenazeprilhydrochloride20mg mL(50mL,75mL,100mL)
8
ANTIHEMOPHILICFACTOR(RECOMBINANT
Generic:250:Amoxicillin250mgandclavulanatepotassium62.5mgper5 Capsule,Oral:
mL(75mL,100mL,150mL) Generic:0.5mg,1mg
Generic:400:Amoxicillin400mgandclavulanatepotassium57mgper5mL
Anastrozole
(50mL,75mL,100mL)
Generic:600:Amoxicillin600mgandclavulanatepotassium42.9mgper5 DoDUniformFormularyOutpatientDosageForms
mL(75mL,125mL,200mL) UNIFORMFORMULARY
Tablet,Oral: Tablet,Oral:
Generic:250:Amoxicillin250mgandclavulanatepotassium125mg Generic:1mg
Generic:500:Amoxicillin500mgandclavulanatepotassium125mg
Anidulafungin
Generic:875:Amoxicillin875mgandclavulanatepotassium125mg
DoDUniformFormularyOutpatientDosageForms
UNIFORMFORMULARY UNIFORMFORMULARY
Tablet,Chewable,oral: SolutionReconstituted,Intravenous[preservativefree]:
Generic:200:Amoxicillin200mgandclavulanatepotassium28.5mg[con- Eraxis:50mg(1ea);100mg(1ea)[containspolysorbate80]
tainsphenylalanine]
Generic:400:Amoxicillin400mgandclavulanatepotassium57mg[contains Ansuvimab
phenylalanine]
Tablet,ExtendedRelease,Oral: Anthralin
Generic:1000:Amoxicillin1000mgandclavulanateacid62.5mg DoDUniformFormularyOutpatientDosageForms
UNIFORMFORMULARY
Amphetamine Cream,External:
DoDUniformFormularyOutpatientDosageForms Dritho-CremeHP:1%(50g)[containsmethylparaben]
UNIFORMFORMULARY Zithranol-RR:1.2%(45g)[containsbrilliantbluefcf(fd&cblue#1)]
Tablet,Oral,assulfate: Shampoo,External:
Evekeo:5mg,10mg[scored] Zithranol:1%(85g)[containsbrilliantbluefcf(fd&cblue#1)]
TabletDisintegrating,Oral,assulfate:
EvekeoODT:5mg,10mg,15mg,20mg AnthraxVaccineAdsorbed
NONFORMULARY DoDUniformFormularyOutpatientDosageForms
SuspensionExtendedRelease,Oral: UNIFORMFORMULARY
AdzenysER:1.25mg/mL(450mL) Injection,suspension:
SuspensionExtendedRelease,Oral,asbase: BioThrax: Bacillus anthracis proteins (5 mL) [contains aluminum, natural
DyanavelXR:2.5mg/mL(464mL)[containsmethylparaben,polysorbate80, rubber/naturallatexinpackaging]
propylparaben]
TabletExtendedReleaseDispersible,Oral,asbase: AnticoagulantCitrateDextrose
AdzenysXR-ODT:3.1mg,6.3mg,9.4mg,12.5mg,15.7mg,18.8mg DoDUniformFormularyOutpatientDosageForms
UNIFORMFORMULARY
AmphotericinBDeoxycholate Solution,InVitro:
DoDUniformFormularyOutpatientDosageForms ACDFormulaA:Citricacidanhydrous0.73g,dextrosemonohydrate2.45g,
UNIFORMFORMULARY andsodiumcitratedihydrate2.2gper100mL(500mL,1000mL)
SolutionReconstituted,Injection,asdesoxycholate: ACD-A noClot-50: Citric acid anhydrous 0.073g, dextrose monohydrate
Generic:50mg(1ea) 0.245g,andsodiumcitratedihydrate0.22gper10mL(50mL)
Generic: Citric acid Monohydrate 0.8g, dextrose monohydrate 2.45g, and
AmphotericinB(LipidComplex)
sodiumcitratedihydrate2.2gper100mL(750mL)
DoDUniformFormularyOutpatientDosageForms
UNIFORMFORMULARY AnticoagulantCitratePhosphateDextrose
Suspension,Intravenous: DoDUniformFormularyOutpatientDosageForms
Abelcet:5mg/mL(20mL) UNIFORMFORMULARY
AmphotericinB(Liposomal) Injection:63mL
DoDUniformFormularyOutpatientDosageForms AnticoagulantSodiumCitrate
UNIFORMFORMULARY DoDUniformFormularyOutpatientDosageForms
SuspensionReconstituted,Intravenous: UNIFORMFORMULARY
AmBisome: 50mg (1 ea) [contains cholesterol, distearoyl phosphatidylgly- Concentrate,InVitro:
cerol, hydrogenated soy phosphatidylcholine, sodium succinate hexahy- TriCitrasol:46.7%(30mL)
drate,sucrose,tocopherol,dl-alpha] Solution,InVitro:
Ampicillin Generic:4%(250mL,500mL)
DoDUniformFormularyOutpatientDosageForms AntihemophilicFactor(Human)
UNIFORMFORMULARY DoDUniformFormularyOutpatientDosageForms
Capsule,Oral: UNIFORMFORMULARY
Generic:250mg,500mg Kit,Intravenous:
SolutionReconstituted,Injection,assodium[strengthexpressedasbase]:
Monoclate-P: ~1000 units, ~1500 units [contains mouse (murine) and/or
Generic:125mg(1ea);250mg(1ea);500mg(1ea);1g(1ea);2g(1ea);
hamsterprotein]
10g(1ea)
SolutionReconstituted,Intravenous:
Solution Reconstituted, Injection, as sodium [strength expressed as base,
Koate: ~250 units (1 ea); ~500 units (1 ea); ~1000 units (1 ea) [contains
preservativefree]:
albuminhuman,polyethyleneglycol,polysorbate80]
Generic:250mg(1ea);500mg(1ea)
Koate-DVI:~500units(1ea)[containsalbuminhuman,polyethyleneglycol,
SolutionReconstituted,Intravenous,assodium[strengthexpressedasbase]:
polysorbate80]
Generic:1g(1ea);2g(1ea);10g(1ea)
SolutionReconstituted,Intravenous[preservativefree]:
SuspensionReconstituted,Oral:
HemofilM:~250units(1ea)[containsalbuminhuman,mouse(murine)and/or
Generic:125mg/5mL(100mL);250mg/5mL(100mL)
hamsterprotein,polyethyleneglycol]
AmpicillinandSulbactam HemofilM:~500units(1ea)[containsalbuminhuman,mouse(murine)and/or
DoDUniformFormularyOutpatientDosageForms hamsterprotein,polyethyleneglycol]
UNIFORMFORMULARY HemofilM:~1000units(1ea);~1700units(1ea)[containsalbuminhuman,
Injection,powderforreconstitution: mouse(murine)and/orhamsterprotein,polyethyleneglycol]
Generic: Koate-DVI:~250units(1ea);~1000units(1ea)[containsalbuminhuman,
1.5g:Ampicillin1gandsulbactam0.5g polyethyleneglycol,polysorbate80]
3g:Ampicillin2gandsulbactam1g AntihemophilicFactor(Recombinant[FcFusionProtein])
15g:Ampicillin10gandsulbactam5g
DoDUniformFormularyOutpatientDosageForms
AmylNitrite UNIFORMFORMULARY
DoDUniformFormularyOutpatientDosageForms SolutionReconstituted,Intravenous[preservativefree]:
UNIFORMFORMULARY Eloctate:250units(1ea);500units(1ea);750units(1ea);1000units(1ea);
Liquid,forinhalation:USP:85%to103%(0.3mL) 1500units(1ea);2000units(1ea);3000units(1ea)
Anagrelide
DoDUniformFormularyOutpatientDosageForms
UNIFORMFORMULARY
9
ANTIHEMOPHILICFACTOR(RECOMBINANT
AntihemophilicFactor(Recombinant[Pegylated]) FVIII 1000 units and VWF:RCo 1000 units [contains polysorbate 80 (in
DoDUniformFormularyOutpatientDosageForms diluent);packagedwithdiluent]
UNIFORMFORMULARY Anti-inhibitorCoagulantComplex(Human)
SolutionReconstituted,Intravenous:
DoDUniformFormularyOutpatientDosageForms
Adynovate:250units(1ea);500units(1ea);750units(1ea);1000units(1
ea);1500units(1ea);2000units(1ea)[containsmouse(murine)and/or UNIFORMFORMULARY
hamsterprotein,polysorbate80] SolutionReconstituted,Intravenous[preservativefree]:
Esperoct:antihemophilicfactor(recombinant)glycopegylated-exei~500units FEIBA:500units(1ea);1000units(1ea);2500units(1ea)
(1ea);antihemophilicfactor(recombinant)glycopegylated-exei~2000units Antithrombin
(1ea);antihemophilicfactor(recombinant)glycopegylated-exei~1500units
DoDUniformFormularyOutpatientDosageForms
(1ea);antihemophilicfactor(recombinant)glycopegylated-exei~1000units
UNIFORMFORMULARY
(1ea)[containspolysorbate80];antihemophilicfactor(recombinant)glyco-
Injection,powderforreconstitution[human,preservativefree]:
pegylated-exei~3000units(1ea)
Jivi:~500units(1ea);~1000units(1ea);~2000units(1ea);~3000units(1 ThrombateIII:500units,1000units[containsheparin;exactpotencylabeled
ea)[latexfree;containspolysorbate80] oneachvial]
Injection,powderforreconstitution[recombinant,preservativefree]:
AntihemophilicFactor(Recombinant[PorcineSequence]) ATryn:525units,1750units[containsgoatprotein;exactpotencylabeledon
DoDUniformFormularyOutpatientDosageForms eachvial]
UNIFORMFORMULARY
AntithymocyteGlobulin(Equine)
SolutionReconstituted,Intravenous:
Obizur: 500 units (1 ea) [contains mouse (murine) and/or hamster protein, DoDUniformFormularyOutpatientDosageForms
polysorbate80] UNIFORMFORMULARY
Injectable,Intravenous:
AntihemophilicFactor(Recombinant) Atgam:50mg/mL(5mL)[thimerosalfree]
DoDUniformFormularyOutpatientDosageForms
AntithymocyteGlobulin(Rabbit)
ExtendedCoreFormulary
Kit,Intravenous[preservativefree]: DoDUniformFormularyOutpatientDosageForms
Xyntha:250units,500units,1000units,2000units[albuminfree;contains UNIFORMFORMULARY
mouseprotein(murine)(hamster),polysorbate80] SolutionReconstituted,Intravenous:
Thymoglobulin:25mg(1ea)[containsglycine,mannitol,sodiumchloride]
UNIFORMFORMULARY
Kit,Intravenous: Antivenin(Latrodectusmactans)
KogenateFS:250units,500units,1000units[containsmouse(murine)and/ DoDUniformFormularyOutpatientDosageForms
orhamsterprotein] UNIFORMFORMULARY
Kit,Intravenous[preservativefree]: Kit,Injection:
Afstyla: 250 units, 500 units, 1000 units, 2000 units, 3000 units [contains Generic:6000Antiveninunits
polysorbate80]
HelixateFS:250units,500units,1000units,2000units,3000units[contains Antivenin(Micrurusfulvius)
polysorbate80] DoDUniformFormularyOutpatientDosageForms
KogenateFS:2000units,3000units[containsmouse(murine)and/orhamster UNIFORMFORMULARY
protein] SolutionReconstituted,Intravenous:
KogenateFSBio-Set:250units,500units,1000units,2000units,3000units Generic:(1ea)
[containsmouse(murine)and/orhamsterprotein]
Nuwiq:250units,500units,1000units,2000units Apalutamide
Xyntha Solofuse: 250 units, 500 units, 1000 units, 2000 units, 3000 units DoDUniformFormularyOutpatientDosageForms
[albumin free; contains mouse (murine) and/or hamster protein, polysor- UNIFORMFORMULARY
bate80] Tablet,Oral:
SolutionReconstituted,Intravenous: Erleada:60mg
Kovaltry:250units(1ea);500units(1ea);1000units(1ea);2000units(1ea);
3000 units (1 ea) [contains mouse (murine) and/or hamster protein, poly- Apixaban
sorbate80] DoDUniformFormularyOutpatientDosageForms
SolutionReconstituted,Intravenous[preservativefree]: BASICCOREFORMULARY
Advate:250units(1ea);500units(1ea);1000units(1ea);1500units(1ea); Tablet,Oral:
2000units(1ea);3000units(1ea);4000units(1ea)[albuminfree;contains Eliquis:2.5mg,5mg
polysorbate80] EliquisDVT/PEStarterPack:5mg
Novoeight:250units(1ea);500units(1ea);1000units(1ea);1500units(1
ea);2000units(1ea);3000units(1ea)[containsmouse(murine)and/or Apomorphine
hamsterprotein,polysorbate80] DoDUniformFormularyOutpatientDosageForms
Nuwiq:250units(1ea);500units(1ea);1000units(1ea);2000units(1ea) UNIFORMFORMULARY
Recombinate:220-400units(1ea);401-800units(1ea);801-1240units(1 Solution,Subcutaneous,ashydrochloride:
ea); 1241-1800 units (1 ea); 1801-2400 units (1 ea) [contains albumin Apokyn:10mg/mL(3mL)[containsbenzylalcohol,sodiummetabisulfite]
human,polyethyleneglycol,polysorbate80]
Apraclonidine
AntihemophilicFactor/vonWillebrandFactorComplex DoDUniformFormularyOutpatientDosageForms
(Human) UNIFORMFORMULARY
DoDUniformFormularyOutpatientDosageForms Solution,Ophthalmic:
UNIFORMFORMULARY Generic:0.5%(5mL,10mL)
Injection,powderforreconstitution[humanderived]:
Alphanate: Apremilast
250units[FactorVIIIandVWF:RCoratiovariesbylot;containsalbuminand DoDUniformFormularyOutpatientDosageForms
polysorbate80;packagedwithdiluent] UNIFORMFORMULARY
500units[FactorVIIIandVWF:RCoratiovariesbylot;containsalbuminand Tablet,Oral:
polysorbate80;packagedwithdiluent] Otezla:30mg
1000units[FactorVIIIandVWF:RCoratiovariesbylot;containsalbumin TabletTherapyPack,Oral:
andpolysorbate80;packagedwithdiluent] Otezla:10&20&30mg(55ea)
1500units[FactorVIIIandVWF:RCoratiovariesbylot;containsalbumin
andpolysorbate80;packagedwithdiluent] Aprepitant
2000units[FactorVIIIandVWF:RCoratiovariesbylot;containsalbumin DoDUniformFormularyOutpatientDosageForms
andpolysorbate80;packagedwithdiluent] UNIFORMFORMULARY
Humate-P: Capsule,Oral:
FVIII250unitsandVWF:RCo600units[containsalbumin;packagedwith Generic:40mg,80mg,125mg,80mg&125mg
diluent] SuspensionReconstituted,Oral:
FVIII500unitsandVWF:RCo1200units[containsalbumin;packagedwith Emend:125mg(1ea)
diluent]
FVIII1000unitsandVWF:RCo2400units[containsalbumin;packagedwith Arformoterol
diluent] DoDUniformFormularyOutpatientDosageForms
Wilate: UNIFORMFORMULARY
FVIII500unitsandVWF:RCo500units[containspolysorbate80(indiluent); NebulizationSolution,Inhalation:
packagedwithdiluent] Brovana:15mcg/2mL(2mL)
10