Idea Transcript
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