1

2011 Table of Drugs

IA - Intra-arterial administration

IV - Intravenous administration

IM - Intramuscular administration

IT - Intrathecal

SC - Subcutaneous administration

INH - Administration by inhaled solution

VAR - Various routes of administration

OTH - Other routes of administration

ORAL - Administered orally

Intravenous administration includes all methods, such as gravity infusion, injections, and timed 

pushes. The ‘VAR’ posting denotes various routes of administration and is used for drugs that are 

commonly administered into joints, cavities, tissues, or topical applications, in addition to other 

parenteral administrations. Listings posted with ‘OTH’ indicate other administration methods, such 

as suppositories or catheter injections.

A

Abatacept 10 mg J0129

Abbokinase, see Urokinase

Abbokinase, Open Cath, see Urokinase

Abciximab 10 mg IV J0130

Abelcet, see Amphotericin B Lipid Complex

ABLC, see Amphotericin B

AbobotulinumtoxintypeA 5 units J0586

Acetazolamide sodium up to 500 mg IM, IV J1120

Acetylcysteine, injection 100 mg J0132

Acetylcysteine, unit dose form per gram INH J7604,J7608

Achromycin, see Tetracycline

Actemra, see Tocilizumab

ACTH, see Corticotropin

Acthar, see Corticotropin
2

Actimmune, see Interferon gamma 1-B

Activase, see Alteplase recombinant

Acyclovir 5 mg J0133

Adalimumab 20 mg J0135

Adenocard, see Adenosine

Adenoscan, see Adenosine

Adenosine 6 mg IV J0150

Adenosine 30 mg IV J0152

Adrenalin Chloride, see Adrenalin, epinephrine

Adrenalin, epinephrine 0.1 mg SC, IM J0171

Adriamycin PFS, see Doxorubicin HCl

Adriamycin RDF, see Doxorubicin HCl

Adrucil, see Fluorouracil

Agalsidase beta 1 mg J0180

Aggrastat, see Tirofiban hydrochloride

A-hydroCort, see Hydrocortisone sodium phosphate

Akineton, see Biperiden

Alatrofloxacin mesylate, injection 100 mg IV J0200

Albuterol 0.5 mg INH J7620

Albuterol, concentrated form 1 mg INH J7610, J7611

Albuterol, unit dose form 1 mg INH J7609, J7613 

Aldesleukin per single use vial IM, IV J9015

Aldomet, see Methyldopate HCl

Alefacept 0.5 mg J0215

Alemtuzumab 10 mg J9010

Alferon N, see Interferon alfa-n3

Alglucerase per 10 units IV J0205

Alglucosidase 10 mg J0220

Alkaban-AQ, see Vinblastine sulfate

Alkeran, see Melphalan, oral

Alpha 1-proteinase inhibitor, human 10 mg IV J0256

Alphanate J7186

Alprostadil, injection 1.25 mcg OTH J0270

injection

Alprostadil, urethral suppository OTH J0275

Alteplase recombinant 1 mg IV J2997

Alupent, see Metaproterenol sulfate or Metaproterenol, compounded

Amcort, see Triamcinolone diacetate

A-methaPred, see Methylprednisolone sodium succinate

Amgen, see Interferon alphacon-1

Amifostine 500 mg IV J0207

Amikacin sulfate 100 mg J0278

Aminolevalinic acid Hcl unit dose (354 mg) OTH J7308

Aminolevulinate 1 gm OTH J7309

Aminophylline/Aminophyllin up to 250 mg IV J0280
3

Amiodarone HCl 30 mg IV J0282

Amitriptyline HCl up to 20 mg IM J1320

Amobarbital up to 125 mg IM, IV J0300

Amphocin, see Amphotericin B

Amphotericin B 50 mg IV J0285

Amphotericin B, lipid complex 10 mg IV J0287-J0289

Ampicillin sodium up to 500 mg IM, IV J0290

Ampicillin sodium/sulbactam sodium per 1.5 gm IM, IV J0295

Amygdalin, see Laetrile, Amygdalin, vitamin B-17

Amytal, see Amobarbital

Anabolin LA 100, see Nandrolone decanoate

Anadulafungin 1 mg J0348

Ancef, see Cefazolin sodium

Andrest 90-4, see Testosterone enanthate and estradiol valerate

Andro-Cyp, see Testosterone cypionate

Andro-Cyp 200, see Testosterone cypionate

Andro L.A. 200, see Testosterone enanthate

Andro-Estro 90-4, see Testosterone enanthate and estradiol valerate

Andro/Fem, see Testosterone cypionate and estradiol cypionate

Androgyn L.A., see Testosterone enanthate and estradiol valerate

Androlone-50, see Nandrolone phenpropionate

Androlone-D 100, see Nandrolone decanoate

Andronaq-50, see Testosterone suspension

Andronaq-LA, see Testosterone cypionate

Andronate-200, see Testosterone cypionate

Andronate-100, see Testosterone cypionate

Andropository 100, see Testosterone enanthate

Andryl 200, see Testosterone enanthate

Anectine, see Succinylcholine chloride

Anergan 25, see Promethazine HCl

Anergan 50, see Promethazine HCl

Anistreplase 30 units IV J0350

Anti-Inhibitor per IU IV J7198

Antispas, see Dicyclomine HCl

Antithrombin III (human) per IU IV J7197

Antithrombin recombinant 50 IU J7196

Anzemet, see Dolasetron mesylate injection

A.P.L., see Chorionic gonadotropin

Apomorphine Hydrochloride 1 mg J0364

Apresoline, see Hydralazine HCl

Aprotinin 10,000 kiu J0365

AquaMEPHYTON, see Vitamin K

Aralen, see Chloroquine HCl

Aramine, see Metaraminol

Aranesp, see Darbepoetin Alfa
4

Arbutamine 1 mg IV J0395

Arcalyst, see Rilanocept

Aredia, see Pamidronate disodium

Arfonad, see Trimethaphan camsylate

Arformoterol tartrate 15 mcg J7605

Aripiprazole 0.25 mg J0400

Aristocort Forte, see Triamcinolone diacetate

Aristocort Intralesional, see Triamcinolone diacetate

Aristospan Intra-Articular, see Triamcinolone hexacetonide

Aristospan Intralesional, see Triamcinolone hexacetonide

Arrestin, see Trimethobenzamide HCl

Arsenic trioxide 1 mg IV J9017

Arzerra, see Ofatumumab

Asparaginase 10,000 units IV, IM J9020

Astramorph PF, see Morphine sulfate

Atgam, see Lymphocyte immune globulin

Ativan, see Lorazepam

Atropine, concentrated form per mg INH J7635

Atropine, unit dose form per mg INH J7636

Atropine sulfate 0.01 mg IV, IM, SC J0461

Atrovent, see Ipratropium bromide

Atryn, see Antithrombin recombinant

Aurothioglucose up to 50 mg IM J2910

Autologous cultured chondrocytes implant J7330

Autoplex T, see Hemophilia clotting factors

Avonex, see Interferon beta-1a

Azacitidine 1 mg J9025

Azathioprine 50 mg ORAL J7500

Azathioprine, parenteral 100 mg IV J7501

Azithromycin, dihydrate 1 gm ORAL Q0144

Azithromycin, injection 500 mg IV J0456

B

Baclofen 10 mg IT J0475

Baclofen for intrathecal trial 50 mcg OTH J0476

Bactocill, see Oxacillin sodium

BAL in oil, see Dimercaprol

Banflex, see Orphenadrine citrate

Basiliximab 20 mg J0480

BCG (Bacillus Calmette and Guérin), live per vial IV J9031 

instillation

Beclomethasone inhalation solution, unit dose form per mg INH J7622

Bena-D 10, see Diphenhydramine HCl

Bena-D 50, see Diphenhydramine HCl
5

Benadryl, see Diphenhydramine HCl

Benahist 10, see Diphenhydramine HCl

Benahist 50, see Diphenhydramine HCl

Ben-Allergin-50, see Diphenhydramine HCl

Bendamustine HCl 1 mg J9033

Benefix, see Factor IX, recombinant

Benoject-10, see Diphenhydramine HCl

Benoject-50, see Diphenhydramine HCl

Bentyl, see Dicyclomine

Benztropine mesylate per 1 mg IM, IV J0515

Berinert, see C-1 esterase inhibitor

Berubigen, see Vitamin B-12 cyanocobalamin

Betalin 12, see Vitamin B-12 cyanocobalamin

Betameth, see Betamethasone sodium phosphate

Betamethasone acetate

& betamethasone sodium phosphate per 3 mg IM J0702

Betamethasone inhalation solution, unit dose form per mg INH J7624

Betaseron, see Interferon beta-1b

Bethanechol chloride up to 5 mg SC J0520

Bevacizumab 10 mg J9035

Bicillin L-A, see Penicillin G benzathine

Bicillin C-R 900/300, see Penicillin G procaine and penicillin G 

 benzathine

Bicillin C-R, see Penicillin G benzathine and penicillin G procaine

BiCNU, see Carmustine 

Biperiden lactate per 5 mg IM, IV J0190

Bitolterol mesylate,concentrated form per mg INH J7628 

Bitolterol mesylate,unit dose form per mg INH J7629

Bivalirudin 1 mg J0583

Blenoxane, see Bleomycin sulfate

Bleomycin sulfate 15 units IM, IV, SC J9040

Bortezomib 0.1 mg J9041

Botox, see OnabotulinumtoxinA

Brethine, see Terbutaline sulfate or Terbutaline, compounded

Bricanyl Subcutaneous, see Terbutaline sulfate

Brompheniramine maleate per 10 mg IM, SC, IV J0945

Bronkephrine, see Ethylnorepinephrine HCl

Bronkosol, see Isoetharine HCl

Budesonide inhalation solution, concentrated form0.25 mg INH J7633, J7634

Budesonide inhalation solution, unit dose form 0.5 mg INH J7626, J7627

Buprenorphine Hydrochloride 0.1 mg J0592

Busulfan 1 mg J0594

Busulfan 2 mg ORAL J8510

Butorphanol tartrate 1 mg J0595

C
6

C1 Esterase Inhibitor 10 units J0597,J0598

Cabergoline .25 mg ORAL J8515

Cafcit, see Caffeine citrate

Caffeine citrate 5 mg IV J0706

Caine-1, see Lidocaine Hcl

Caine-2, see Lidocaine HCl

Calcijex, see Calcitriol

Calcimar, see Calcitonin-salmon

Calcitonin-salmon up to 400 units SC, IM J0630

Calcitriol 0.1 mcg IM J0636

Calcium Disodium Versenate, see Edetate calcium disodium

Calcium gluconate per 10 ml IV J0610

Calcium glycerophosphate & calcium lactate per 10 ml IM, SC J0620

Calphosan, see Calcium glycerophosphate and calcium lactate

Camptosar, see Irinotecan

Canakinumab 1 mg J0638

Capecitabine 150 mg ORAL J8520

500 mg ORAL J8521

Capsaicin patch per 10 sq cm OTH J7335

Carbocaine with Neo-Cobefrin, see Mepivacaine

Carbocaine, see Mepivacaine

Carboplatin 50 mg IV J9045

Carmustine 100 mg IV J9050

Carnitor, see Levocarnitine

Carticel, see Autologous cultured chondrocytes

Caspofungin acetate 5 mg IV J0637

Cayston, see Aztreonam

Cefadyl, see Cephapirin Sodium

Cefazolin sodium 500 mg IV, IM J0690

Cefepime hydrochloride 500 mg IV J0692

Cefizox, see Ceftizoxime sodium

Cefotaxime sodium per 1 g IV, IM J0698

Cefoxitin sodium 1 g IV, IM J0694

Ceftazidime per 500 mg IM, IV J0713

Ceftizoxime sodium per 500 mg IV, IM J0715

Ceftriaxone sodium per 250 mg IV, IM J0696

Cefuroxime sodium, sterile per 750 mg IM, IV J0697

Celestone Soluspan, see Betamethasone acetate 

 and betamethasone sodium phosphate

CellCept, see Mycophenolate mofetil

Cel-U-Jec, see Betamethasone sodium phosphate

Cenacort Forte, see Triamcinolone diacetate

Cenacort A-40, see Triamcinolone acetonide

Cephalothin sodium up to 1 g IM, IV J1890
7

Cephapirin sodium up to 1 g IV, IM J0710

Ceredase, see Alglucerase

Certolizumab pegol 1 mg J0718

Cerubidine, see Daunorubicin HCl

Cetuximab 10 mg J9055

Chealamide, see Endrate ethylenediamine-tetra-acetic acid

Chloramphenicol sodium succinate up to 1 g IV J0720

Chlordiazepoxide HCl up to 100 mg IM, IV J1990

Chloromycetin Sodium Succinate, see Chloramphenicol sodium succinate

Chloroprocaine HCl per 30 ml VAR J2400

Chlorpromazine HCl, oral 10 mg ORAL Q0171

25 mg ORAL Q0172

Chloroquine HCl up to 250 mg IM J0390

Chlorothiazide sodium per 500 mg IV J1205

Chlorpromazine HCl up to 50 mg IM, IV J3230

Chorex-5, see Chorionic gonadotropin

Chorex-10, see Chorionic gonadotropin

Chorignon, see Chorionic gonadotropin

Chorionic gonadotropin per 1,000 USP units IM J0725

Choron 10, see Chorionic gonadotropin

Cidofovir 375 mg IV J0740

Cilastatin sodium, imipenem per 250 mg IV, IM J0743

Cimzia, see Certolizumab pegol

Cinryze, see C1 Esterase Inhibitor

Cipro IV, see Ciprofloxacin

Ciprofloxacin 200 mg IV J0706

Cisplatin, powder or solution per 10 mg IV J9060

Cladribine per mg IV J9065

Claforan, see Cefotaxime sodium

Clofarabine 1 mg J9027

Clonidine Hydrochloride 1 mg epidural J0735

Cobex, see Vitamin B-12 cyanocobalamin

Codeine phosphate per 30 mg IM, IV, SC J0745

Codimal-A, see Brompheniramine maleate

Cogentin, see Benztropine mesylate

Collagenase, Clostridium Histolyticum 0.01 mg J0775

Colchicine per 1 mg IV J0760

Colistimethate sodium up to 150 mg IM, IV J0770

Coly-Mycin M, see Colistimethate sodium

Compa-Z, see Prochlorperazine

Compazine, see Prochlorperazine

Cophene-B, see Brompheniramine maleate

Copper contraceptive, intrauterine OTH J7300

Cordarone, see Amiodarone HCl

Corgonject-5, see Chorionic gonadotropin
8

Corticorelin ovine triflutate 1 mcg J0795

Corticotropin up to 40 units IV, IM, SC J0800

Cortrosyn, see Cosyntropin

Cosmegen, see Dactinomycin

Cosyntropin per 0.25 mg IM, IV J0833, J0834

Cotranzine, see Prochlorperazine

Cromolyn sodium, unit dose form per 10 mg INH J7631, J7632

Crysticillin 300 A.S., see Penicillin G procaine

Crysticillin 600 A.S., see Penicillin G procaine

Cyclophosphamide 100 mg IV J9070

Cyclophosphamide, oral 25 mg ORAL J8530

Cyclosporine, oral 25 mg ORAL J7515

100 mg ORAL J7502

Cyclosporine, parenteral 250 mg IV J7516

Cytarabine 100 mg SC, IV J9100

Cytarabine liposome 10 mg J9098

Cytomegalovirus immune globulin intravenous(human)per vial IV J0850

Cytosar-U, see Cytarabine

Cytovene, see Ganciclovir sodium

Cytoxan, see Cyclophosphamide; cyclophosphamide, lyophilized; and 

 cyclophosphamide, oral

D

D-5-W, infusion 1000 cc IV J7070

Dacarbazine 100 mg IV J9130

Daclizumab 25 mg IV J7513

Dactinomycin 0.5 mg IV J9120

Dalalone, see Dexamethasone sodium phosphate

Dalalone L.A., see Dexamethasone acetate

Dalteparin sodium per 2500 IU SC J1645

Daptomycin 1 mg J0878

Darbepoetin Alfa 1 mcg J0881, J0882

Daunorubicin citrate, liposomal 10 mg IV J9151

 formulation

Daunorubicin HCl 10 mg IV J9150

Daunoxome, see Daunorubicin citrate

DDAVP, see Desmopressin acetate

Decadron Phosphate, see Dexamethasone sodium phosphate

Decadron, see Dexamethasone sodium phosphate

Decadron-LA, see Dexamethasone acetate

Deca-Durabolin, see Nandrolone decanoate

Decaject, see Dexamethasone sodium phosphate

Decaject-L.A., see Dexamethasone acetate

Decitabine 1 mg J0894
9

Decolone-50, see Nandrolone decanoate

Decolone-100, see Nandrolone decanoate

De-Comberol, see Testosterone cypionate and estradiol cypionate

Deferoxamine mesylate 500 mg IM, SC, IV J0895

Degarelix 1 mg J9155

Dehist, see Brompheniramine maleate

Deladumone OB, see Testosterone enanthate and estradiol valerate

Deladumone, see Testosterone enanthate and estradiol valerate

Delatest, see Testosterone enanthate

Delatestadiol, see Testosterone enanthate and estradiol valerate

Delatestryl, see Testosterone enanthate

Delta-Cortef, see Prednisolone, oral

Delestrogen, see Estradiol valerate

Demadex, see Torsemide

Demerol HCl, see Meperidine HCl

Denileukin diftitox 300 mcg J9160

DepAndro 100, see Testosterone cypionate

DepAndro 200, see Testosterone cypionate

DepAndrogyn, see Testosterone cypionate and estradiol cypionate

DepGynogen, see Depo-estradiol cypionate

DepMedalone 40, see Methylprednisolone acetate

DepMedalone 80, see Methylprednisolone acetate

Depo-estradiol cypionate up to 5 mg IM J1000

Depogen, see Depo-estradiol cypionate

Depoject, see Methyprednisolone acetate

Depo-Medrol, see Methylprednisolone acetate

Depopred-40, see Methylprednisolone acetate

Depopred-80, see Methylprednisolone acetate

Depo-Provera, see Medroxyprogesterone acetate

Depotest, see Testosterone cypionate

Depo-Testadiol, see Testosterone cypionate and estradiol cypionate

Depotestogen, see Testosterone cypionate and estradiol cypionate

Depo-Testosterone, see Testosterone cypionate

Desferal Mesylate, see Deferoxamine mesylate

Desmopressin acetate 1 mcg IV, SC J2597

Dexacen LA-8, see Dexamethasone acetate

Dexacen-4, see Dexamethasone sodium phosphate

Dexamethasone, concentrated form per mg INH J7637

Dexamethasone,unit form per mg INH J7638

Dexamethasone, intravitreal implant 0.1 mg OTH J7312

Dexamethasone, oral 0.25 mg J8540

Dexamethasone acetate 1 mg IM J1094

Dexamethasone sodium phosphate 1 mg IM, IV, OTH J1100

Dexasone, see Dexamethasone sodium phosphate

Dexasone L.A., see Dexamethasone acetate
10

Dexferrum, see Iron Dextran

Dexone, see Dexamethasone sodium phosphate

Dexone LA, see Dexamethasone acetate

Dexrazoxane hydrochloride 250 mg IV J1190

Dextran 40 500 ml IV J7100

Dextran 75 500 ml IV J7110

Dextrose 5%/normal saline solution, 500 ml = 1 unit IV J7042

Dextrose/water (5%) 500 ml = 1 unit IV J7060

D.H.E. 45, see Dihydroergotamine

Diamox, see Acetazolamide sodium

Diazepam up to 5 mg IM, IV J3360

Diazoxide up to 300 mg IV J1730

Dibent, see Dicyclomine HCl

Dicyclomine HCl up to 20 mg IM J0500

Didronel, see Etidronate disodium

Diethylstilbestrol diphosphate 250 mg IV J9165

Diflucan, see Fluconazole

Digoxin up to 0.5 mg IM, IV J1160

Digoxin immune fab (ovine) per vial J1162

Dihydrex, see Diphenhydramine Hcl

Dihydroergotamine mesylate per 1 mg IM, IV J1110

Dilantin, see Phenytoin sodium

Dilaudid, see Hydromorphone HCl

Dilocaine, see Lidocaine HCl

Dilomine, see Dicyclomine HCl

Dilor, see Dyphylline

Dimenhydrinate up to 50 mg IM, IV J1240

Dimercaprol per 100 mg IM J0470

Dimethyl sulfoxide, see DMSO, Dimethylsulfoxide

Dinate, see Dimenhydrinate

Dioval, see Estradiol valerate

Dioval 40, see Estradiol valerate

Dioval XX, see Estradiol valerate

Diphenacen-50, see Diphenhydramine HCl

Diphenhydramine HCl, injection up to 50 mg IV, IM J1200

Diphenhydramine HCl, oral 50 mg ORAL Q0163

Dipyridamole per 10 mg IV J1245

Disotate, see Endrate ethylenediamine-tetra-acetic acid

Di-Spaz, see Dicyclomine HCl

Ditate-DS, see Testosterone enanthate and estradiol valerate

Diuril Sodium, see Chlorothiazide sodium

D-Med 80, see Methylprednisolone acetate

DMSO, Dimethyl sulfoxide 50%, 50 ml OTH J1212

Dobutamine HCl per 250 mg IV J1250

Dobutrex, see Dobutamine Hcl
11

Docetaxel 20 mg IV J9170

Dolasetron mesylate, injection 10 mg IV J1260

Dolasetron mesylate, tablets 100 mg ORAL Q0180

Dolophine HCl, see Methadone Hcl

Dommanate, see Dimenhydrinate

Donbax, see Doripenem

Dopamine HCl 40 mg J1265

Doribax, see Doripenem

Doripenem 10 mg J1267

Dornase alpha, unit dose form per mg INH J7639 

Doxercalciferol 1 mcg IV J1270

Doxil, see Doxorubicin HCL, lipid

Doxorubicin HCL 10 mg IV J9000

Doxorubicin HCL, all lipid 10 mg IV J9001

Dramamine, see Dimenhydrinate

Dramanate, see Dimenhydrinate

Dramilin, see Dimenhydrinate

Dramocen, see Dimenhydrinate

Dramoject, see Dimenhydrinate

Dronabinol, oral 2.5 mg ORAL Q0167

Dronabinol, oral 5 mg ORAL Q0168

Droperidol up to 5 mg IM, IV J1790

Drug administered through a metered dose inhaler INH J3535

Droperidol and fentanyl citrate up to 2 ml ampule IM, IV J1810

DTIC-Dome, see Dacarbazine

Dua-Gen L.A., see Testosterone enanthate and estradiol valerate cypionate

Duoval P.A., see Testosterone enanthate and estradiol valerate

Durabolin, see Nandrolone phenpropionate

Duraclon, see Clonidine Hydrochloride

Dura-Estrin, see Depo-estradiol cypionate

Duracillin A.S., see Penicillin G procaine

Duragen-10, see Estradiol valerate

Duragen-20, see Estradiol valerate

Duragen-40, see Estradiol valerate

Duralone-40, see Methylprednisolone acetate

Duralone-80, see Methylprednisolone acetate

Duralutin, see Hydroxyprogesterone Caproate

Duramorph, see Morphine sulfate

Duratest-100, see Testosterone cypionate

Duratest-200, see Testosterone cypionate

Duratestrin, see Testosterone cypionate and estradiol cypionate

Durathate-200, see Testosterone enanthate

Dymenate, see Dimenhydrinate

Dyphylline up to 500 mg IM J1180

Dysport, see AbobotulinumtoxintypeA
12

E

Ecallantide 1 mg J1290

Eculizumab 10 mg J1300

Edetate calcium disodium up to 1000 mg IV, SC, IM J0600

Edetate disodium per 150 mg IV J3520

Elavil, see Amitriptyline HCl

Ellence, see Epirubicin HCl

Elliotts b solution 1 ml OTH J9175

Elspar, see Asparaginase

Emend, see Fosaprepitant

Emete-Con, see Benzquinamide

Eminase, see Anistreplase

Enbrel, see Etanercept

Endrate ethylenediamine-tetra-acetic acid, see Edetate disodium

Enfuvirtide 1 mg J1324

Enovil, see Amitriptyline HCl

Enoxaparin sodium 10 mg SC J1650

Eovist, see Gadoxetate disodium

Epinephrine, adrenalin 0.1 mg SC, IM J0171

Epirubicin hydrochloride 2 mg J9178

Epoetin alfa 1000 units Q4081

Epoprostenol 0.5 mg IV J1325

Eptifibatide, injection 5 mg IM, IV J1327

Ergonovine maleate up to 0.2 mg IM, IV J1330

Ertapenem sodium 500 mg J1335

Erythromycin lactobionate 500 mg IV J1364

Estra-D, see Depo-estradiol cypionate

Estra-L 20, see Estradiol valerate

Estra-L 40, see Estradiol valerate

Estra-Testrin, see Testosterone enanthate and estradiol valerate

Estradiol Cypionate, see Depo-estradiol cypionate

Estradiol L.A., see Estradiol valerate

Estradiol L.A. 20, see Estradiol valerate

Estradiol L.A. 40, see Estradiol valerate

Estradiol valerate up to 10 mg IM J1380

Estro-Cyp, see Depo-estradiol cypionate

Estrogen, conjugated per 25 mg IV, IM J1410

Estroject L.A., see Depo-estradiol cypionate

Estrone per 1 mg IM J1435

Estrone 5, see Estrone

Estrone Aqueous, see Estrone

Estronol, see Estrone

Estronol-L.A., see Depo-estradiol cypionate
13

Etanercept, injection 25 mg IM, IV J1438

Ethanolamine 100 mg J1430

Ethyol, see Amifostine

Etidronate disodium per 300 mg IV J1436

Etonogestrel implant J7307

Etopophos, see Etoposide

Etoposide 10 mg IV J9181

Etoposide, oral 50 mg ORAL J8560

Euflexxa J7323

Everone, see Testosterone Enanthate

F

Factor VIIa (coagulation factor, recombinant) 1 mcg IV J7189

Factor VIII (anti-hemophilic factor, human) per IU IV J7190

Factor VIII (anti-hemophilic factor, porcine) per IU IV J7191

Factor VIII (anti-hemophilic factor, recombinant) per IU IV J7185, J7192

Factor IX (anti-hemophilic factor, purified, per IU IV J7193

 non-recombinant)

Factor IX (anti-hemophilic factor, recombinant) per IU IV J7195

Factor IX, complex per IU IV J7194

Factors, other hemophilia clotting per IU IV J7196

Factrel, see Gonadorelin HCl

Feiba VH Immuno, see Factors, other hemophilia clotting

Fentanyl citrate 0.1 mg IM, IV J3010

Feraheme, see Ferumoxytol

Ferrlecit, see Sodium ferricgluconate complex in sucrose injection

Ferumoxytol 1 mg Q0138, Q0139

Filgrastim (G-CSF) 300 mcg SC, IV J1440

480 mcg SC, IV J1441

Firmagon, see Degarelix

Flebogamma 500 mg IV J1572

Flexoject, see Orphenadrine citrate

Flexon, see Orphenadrine citrate

Flolan, see Epoprostenol

Floxuridine 500 mg IV J9200

Fluconazole 200 mg IV J1450

Fludara, see Fludarabine phosphate

Fludarabine phosphate 1 mg ORAL J8562

50 mg IV J9185

Flunisolide inhalation solution, unit dose form per mg INH J7641

Fluocinolone J7311

Fluorouracil 500 mg IV J9190

Folex, see Methotrexate sodium 

Folex PFS, see Methotrexate sodium 
14

Follutein, see Chorionic gonadotropin

Folotyn, see Pralatrexate

Fomepizole 15 mg J1451

Fomivirsen sodium 1.65 mg Intraocular J1452

Fondaparinux sodium 0.5 mg J1652

Formoterol 12 mcg INH J7640

Formoterol fumarate 20 mcg J7606

Fortaz, see Ceftazidime

Fosaprepitant 1 mg J1453

Foscarnet sodium per 1,000 mg IV J1455

Foscavir, see Foscarnet sodium

Fosphenytoin 50 mg Q2009

FUDR, see Floxuridine

Fulvestrant 25 mg J9395

Fungizone Intravenous, see Amphotericin B

Furomide M.D., see Furosemide

Furosemide up to 20 mg IM, IV J1940

G

Gadoxetate disodium 1 ml A9581

Gallium nitrate 1 mg J1457

Galsulfase 1 mg J1458

Gamastan, see Gamma globulin and Immune globulin

Gammagard Liquid 500 mg J1569

Gamma globulin 1 cc IM J1460

over 10 cc IM J1560

Gammar, see Gamma globulin and Immune globulin

Gammar-IV, see Immune globulin intravenous (human)

Gamulin RH, see Rho(D) immune globulin

Gamunex 500 mg J1561

Ganciclovir, implant 4.5 mg OTH J7310

Ganciclovir sodium 500 mg IV J1570 

Garamycin, gentamicin up to 80 mg IM, IV J1580

Gatifloxacin 10 mg IV J1590

Gefitinib 250 mg J8565

Gemcitabine HCl 200 mg IV J9201

Gemsar, see Gemcitabine Hcl

Gemtuzumab ozogamicin 5 mg IV J9300

Gentamicin Sulfate, see Garamycin, gentamicin

Gentran, see Dextran 40

Gentran 75, see Dextran 75

Gesterol 50, see Progesterone

Glatiramer Acetate 20 mg J1595

Glucagon Hcl per 1 mg SC, IM, IV J1610 
15

Glukor, see Chorionic gonadotropin

Glycopyrrolate, concentrated form per 1 mg INH J7642

Glycopyrrolate, unit dose form per 1 mg INH J7643

Gold sodium thiomalate up to 50 mg IM J1600

Gonadorelin HCl per 100 mcg SC, IV J1620

Gonic, see Chorionic gonadotropin

Goserelin acetate implant per 3.6 mg SC J9202

Granisetron HCl, injection 100 mcg IV J1626

Granisetron HCl, oral 1 mg ORAL Q0166

Gynogen L.A. A10,@ see Estradiol valerate

Gynogen L.A. A20,@ see Estradiol valerate

Gynogen L.A. A40,@ see Estradiol valerate

H

Haldol, see Haloperidol

Haloperidol up to 5 mg IM, IV J1630

Haloperidol decanoate per 50 mg IM J1631

Hectoral, see Doxercalciferol

Hemin 1 mg J1640

Hemofil M, see Factor VIII

Hemophilia clotting factors(e.g., anti-inhibitors) per IU IV J7198

Hemophilia clotting factors, NOC per IU IV J7199

Hepagam B 0.5 ml IM J1571

0.5 ml IV J1573

Hep-Lock, see Heparin sodium (heparin lock flush)

Hep-Lock U/P, see Heparin sodium (heparin lock flush)

Heparin sodium 1,000 units IV, SC J1644

Heparin sodium (heparin lock flush) 10 units IV J1642

Herceptin, see Trastuzumab

Hexadrol Phosphate, see Dexamethasone sodium phosphate

Histaject, see Brompheniramine maleate

Histerone 50, see Testosterone suspension

Histerone 100, see Testosterone suspension

Histrelin acetate 10 mcg J1675

Histrelin implant 50 mg J9225

Hizentra, see Immune globulin

Human fibrinogen concentrate 100 mg J1680

Hyalgan J7321

Hyaluronidase up to 150 units SC, IV J3470

Hyaluronidase, ovine up to 999 units J3471

Hyaluronidase, ovine per 1000 units J3472

Hyaluronidase recombinant 1 usp J3473

Hyate:C, see Factor VIII (anti-hemophilic factor (porcine))

Hybolin Improved, see Nandrolone phenpropionate
16

Hybolin Decanoate, see Nandrolone decanoate

Hycamtin, see Topotecan

Hydralazine HCl up to 20 mg IV, IM J0360

Hydrate, see Dimenhydrinate

Hydrocortisone acetate up to 25 mg IV, IM, SC J1700

Hydrocortisone sodium phosphate up to 50 mg IV, IM, SC J1710

Hydrocortisone succinate sodium up to 100 mg IV, IM, SC J1720

Hydrocortone Acetate, see Hydrocortisone acetate

Hydrocortone Phosphate, see Hydrocortisone sodium phosphate

Hydromorphone HCl up to 4 mg SC, IM, IV J1170

Hydroxyzine HCl up to 25 mg IM J3410

Hydroxyzine Pamoate 25 mg ORAL Q0177

50 mg ORAL Q0178

Hylan G-F 20 J7322

Hyoscyamine sulfate up to 0.25 mg SC, IM, IV J1980

Hyperstat IV, see Diazoxide

Hyper-Tet, see Tetanus immune globulin, human

HypRho-D, see Rho(D) immune globulin

Hyrexin-50, see Diphenhydramine HCl

Hyzine-50, see Hydroxyzine HCl

I

Ibandronate sodium 1 mg J1740

Ibutilide fumarate 1 mg IV J1742

Idamycin, see Idarubicin HCl

Idarubicin HCl 5 mg IV J9211

Idursulfase 1 mg J1743

Ifex, see Ifosfamide

Ifosfamide 1 g IV J9208

Ilaris, see Canakinumab

Iloprost 20 mcg Q4074

Ilotycin, see Erythromycin gluceptate

Imferon, see Iron dextran

Imiglucerase 10 units IV J1786

Imitrex, see Sumatriptan succinate

Immune globulin

 Flebogamma 500 mg IV J1572

 Gammagard Liquid 500 mg IV J1569

 Gamunex 500 mg IV J1561

 HepaGam B 0.5 ml IM J1571

 HepaGam B 0.5 ml IV J1573

 Hizentra 100 mg J1559 

NOS 500 mg IV J1566,J1599
17

 Octagam 500 mg IV J1568

 Privigen 500 mg IV J1459

 Rhophylac 100 IU IM J2791

 Subcutaneous 100 mg J1562

Immunosuppressive drug, not otherwise classified J7599

Imuran, see Azathioprine

Inapsine, see Droperidol

Inderal, see Propranolol HCl

Infed, see Iron Dextran

Infergen, see Interferon alfa-1

Infliximab, injection 10 mg IM, IV J1745

Innohep, see Tinzarparin

Innovar, see Droperidol with fentanyl citrate

Insulin 5 units SC J1815

Insulin lispro 50 units SC J1817

Intal, see Cromolyn sodium or Cromolyn sodium, compounded

Integrilin, injection, see Eptifibatide

Interferon alphacon-1, recombinant 1 mcg SC J9212

Interferon alfa-2a, recombinant 3 million units SC, IM J9213

Interferon alfa-2b, recombinant 1 million units SC, IM J9214

Interferon alfa-n3 (human leukocyte derived) 250,000 IU IM J9215

Interferon beta-1a 30 mcg IM J1826

Interferon beta-1a 11 mcg IM Q3025

Interferon beta-1a 11 mcg SC Q3026

Interferon beta-1b 0.25 mg SC J1830

Interferon gamma-1b 3 million units SC J9216

Intrauterine copper contraceptive, see Copper contraceptive, intrauterine

Invega Sustenna, see Paliperidone Palmitate

Ipratropium bromide, unit dose form per mg INH J7644, J7645

Irinotecan 20 mg IV J9206

Iron dextran 50 mg J1750

Iron sucrose 1 mg IV J1756

Irrigation solution for Tx of bladder calculi per 50 ml OTH Q2004

Isocaine HCl, see Mepivacaine

Isoetharine HCl, concentrated form per mg INH J7647, J7648

Isoetharine Hcl, unit dose form per mg INH J7649, J7650

Isoproterenol HCl, concentrated form per mg INH J7657, J7658

Isoproterenol Hcl, unit dose form per mg INH J7659, J7660

Istodax, see Romidepsin

Isuprel, see Isoproterenol HCl 

Itraconazole 50 mg IV J1835

Ixabepilone 1 mg J9207

Ixempra, see Ixabepilone

J
18

Jenamicin, see Garamycin, gentamicin

K

Kabikinase, see Streptokinase

Kalbitor, see Ecallantide

Kaleinate, see Calcium gluconate

Kanamycin sulfate up to 75 mg IM, IV J1850

Kanamycin sulfate up to 500 mg IM, IV J1840

Kantrex, see Kanamycin sulfate

Keflin, see Cephalothin sodium

Kefurox, see Cufuroxime sodium

Kefzol, see Cefazolin sodium

Kenaject-40, see Triamcinolone acetonide

Kenalog-10, see Triamcinolone acetonide

Kenalog-40, see Triamcinolone acetonide

Keppra, see Levetiracetam

Kestrone 5, see Estrone

Ketorolac tromethamine per 15 mg IM, IV J1885

Key-Pred 25, see Prednisolone acetate

Key-Pred 50, see Prednisolone acetate

Key-Pred-SP, see Prednisolone sodium phosphate

K-Flex, see Orphenadrine citrate

Klebcil, see Kanamycin sulfate

Koate-HP, see Factor VIII

Kogenate, see Factor VIII

Konakion, see Vitamin K, phytonadione, etc.

Konyne-80, see Factor IX, complex

Kytril, see Granisetron HCl

L

L.A.E. 20, see Estradiol valerate

Laetrile, Amygdalin, vitamin B-17 J3570

Lanoxin, see Digoxin

Lanreotide 1 mg J1930

Largon, see Propiomazine HCl

Laronidase 0.1 mg J1931

Lasix, see Furosemide

L-Caine, see Lidocaine HCl

Lepirudin 50 mg J1945

Leucovorin calcium per 50 mg IM, IV J0640

Leukine, see Sargramostim (GM-CSF)

Leuprolide acetate (for depot suspension) per 3.75 mg IM J1950
19

 7.5 mg IM J9217

Leuprolide acetate per 1 mg IM J9218

Leuprolide acetate implant 65 mg J9219

Leustatin, see Cladribine

Levalbuterol HCl, concentrated form 0.5 mg INH J7607, J7612

Levalbuterol HCl, unit dose form 0.5 mg INH J7614, J7615

Levaquin I.U., see Levofloxacin

Levetiracetam 10 mg J1953

Levocarnitine per 1 gm IV J1955

Levo-Dromoran, see Levorphanol tartrate

Levofloxacin 250 mg IV J1956

Levoleucovorin calcium 0.5 mg J0641

Levonorgestrel implant J7306

Levonorgestrel releasing intrauterin contraceptive 52 mg OTH J7302

Levorphanol tartrate up to 2 mg SC, IV J1960

Levsin, see Hyoscyamine sulfate

Levulan Kerastick, see Aminolevulinic acid HCl

Lexiscan, see Regadenoson

Librium, see Chlordiazepoxide HCl

Lidocaine HCl 10 mg IV J2001

Lidoject-1, see Lidocaine HCl

Lidoject-2, see Lidocaine HCl

Lincocin, see Lincomycin HCl

Lincomycin HCl up to 300 mg IV J2010

Linezolid 200 mg IV J2020

Liquaemin Sodium, see Heparin sodium

Lioresal, see Baclofen

LMD (10%), see Dextran 40

Lovenox, see Enoxaparin sodium

Lorazepam 2 mg IM, IV J2060

Lufyllin, see Dyphylline

Luminal Sodium, see Phenobarbitol sodium

Lunelle, see Medroxyprogesterone acetate/estradiol cypionate

Lupron, see Leuprolide acetate

Lymphocyte immune globulin, 

 anti-thymocyte globulin, equine 250 mg IV J7504

 anti-thymocyte globulin, rabbit 25 mg IV J7511

Lyophilized, see Cyclophosphamide, lyophilized

M

Magnesium sulfate 500 mg J3475

Mannitol 25% in 50 ml IV J2150

Marmine, see Dimenhydrinate

Maxipime, see Cefepime hydrochloride
20

Mecasermin 1 mg J2170

Mechlorethamine HCl (nitrogen mustard), HN2 10 mg IV J9230

Medralone 40, see Methylprednisolone acetate

Medralone 80, see Methylprednisolone acetate

Medrol, see Methylprednisolone

Medroxyprogesterone acetate 50 mg IM J1051

150 mg IM J1055

Medroxyprogesterone acetate/estradiol cypionate 5 mg/25 mg IM J1056

Mefoxin, see Cefoxitin sodium

Melphalan HCl 50 mg IV J9245

Melphalan, oral 2 mg ORAL J8600

Menoject LA, see Testosterone cypionate and estradiol cypionate

Mepergan Injection, see Meperdine and promethazine HCl

Meperidine HCl per 100 mg IM, IV, SC J2175

Meperidine and promethazine HCl up to 50 mg IM, IV J2180

Mepivacaine HCL per 10 ml VAR J0670

Meropenem 100 mg J2185

Mesna 200 mg IV J9209

Mesnex, see Mesna

Metaprel, see Metaproterenol sulfate

Metaproterenol sulfate, concentrated form per 10 mg INH J7667, J7668

Metaproterenol sulfate, unit dose form per 10 mg INH J7669, J7670

Metaraminol bitartrate per 10 mg IV, IM, SC J0380

Metastron, see Strontium-89 chloride

Methacholine chloride 1 mg J7674

Methadone HCl up to 10 mg IM, SC J1230

Methergine, see Methylergonovine maleate

Methocarbamol up to 10 ml IV, IM J2800

Methotrexate, oral 2.5 mg ORAL J8610

Methotrexate sodium 5 mg IV, IM, IT, IA J9250

50 mg IV, IM, IT, IA J9260

Methotrexate LPF, see Methotrexate sodium 

Methyldopate HCl up to 250 mg IV J0210

Methylprednisolone, oral per 4 mg ORAL J7509

Methylprednisolone acetate 20 mg IM J1020

40 mg IM J1030

80 mg IM J1040

Methylprednisolone sodium succinate up to 40 mg IM, IV J2920

up to 125 mg IM, IV J2930

Metoclopramide HCl up to 10 mg IV J2765

Metvixia, see Aminolevulinate

Miacalcin, see Calcitonin-salmon

Micafungin sodium 1 mg J2248

Midazolam HCl per 1 mg IM, IV J2250

Milrinone lactate 5 mg IV J2260
21

Mirena, see Levonorgestrel releasing intrauterine contraceptive

Mithracin, see Plicamycin

Mitomycin 5 mg IV J9280

Mitoxantrone HCl per 5 mg IV J9293

Monocid, see Cefonicic sodium

Monoclate-P, see Factor VIII

Monoclonal antibodies, parenteral 5 mg IV J7505

Mononine, see Factor IX, purified, non-recombinant

Morphine sulfate up to 10 mg IM, IV, SC J2270

100 mg IM, IV, SC J2271

Morphine sulfate, preservative-free per 10 mg SC, IM, IV J2275

Moxifloxacin 100 mg J2280

Mozobil, see Plerixafor

M-Prednisol-40, see Methylprednisolone acetate 

M-Prednisol-80, see Methylprednisolone acetate

Mucomyst, see Acetylcysteine or Acetylcysteine, compounded

Mucosol, see Acetylcysteine

Muromonab-CD3 5 mg IV J7505

Muse, see Alprostadil

Mustargen, see Mechlorethamine HCl

Mutamycin, see Mitomycin

Mycophenolic acid 180 mg J7518

Mycophenolate Mofetil 250 mg ORAL J7517

Myleran, see Busulfan

Mylotarg, see Gemtuzumab ozogamicin

Myobloc, see RimabotulinumtoxinB

Myochrysine, see Gold sodium thiomalate

Myolin, see Orphenadrine citrate

N

Nabilone 1 mg ORAL J8650

Nalbuphine HCl per 10 mg IM, IV, SC J2300

Naloxone HCl per 1 mg IM, IV, SC J2310

Naltrexone, depot form 1 mg J2315

Nandrobolic L.A., see Nandrolone decanoate

Nandrolone decanoate up to 50 mg IM J2320

Narcan, see Naloxone HCl

Naropin, see Ropivacaine HCl

Nasahist B, see Brompheniramine maleate

Nasal vaccine inhalation INH J3530

Natalizumab 1 mg J2323

Navane, see Thiothixene

Navelbine, see Vinorelbine tartrate

ND Stat, see Brompheniramine maleate
22

Nebcin, see Tobramycin sulfate

NebuPent, see Pentamidine isethionate

Nelarabine 50 mg J9261

Nembutal Sodium Solution, see Pentobarbital sodium

Neocyten, see Orphenadrine citrate

Neo-Durabolic, see Nandrolone decanoate

Neoquess, see Dicyclomine HCl

Neosar, see Cyclophosphamide

Neostigmine methylsulfate up to 0.5 mg IM, IV, SC J2710

Neo-Synephrine, see Phenylephrine HCl

Nervocaine 1%, see Lidocaine HCl

Nervocaine 2%, see Lidocaine HCl

Nesacaine, see Chloroprocaine HCL

Nesacaine-MPF, see Chloroprocaine HCl

Nesiritide 0.1 mg J2325

Neumega, see Oprelvekin

Neupogen, see Filgrastim (G-CSF)

Neutrexin, see Trimetrexate glucuronate 

Nipent, see Pentostatin

Nordryl, see Diphenhydramine HCl

Norflex, see Orphenadrine citrate

Norzine, see Thiethylperazine maleate

Not otherwise classified drugs J3490

Not otherwise classified drugs other than INH J7799

 administered thru DME

Not otherwise classified drugs INH J7699

 administered thru DME

Not otherwise classified drugs, anti-neoplastic J9999

Not otherwise classified drugs, chemotherapeutic ORAL J8999

Not otherwise classified drugs, immunosuppressive J7599

Not otherwise classified drugs, nonchemotherapeutic ORAL J8499

Novantrone, see Mitoxantrone HCl

Novo Seven, see Factor VIIa

NPH, see Insulin

Nplate, see Romiplostim

Nubain, see Nalbuphine HCl

Nulicaine, see Lidocaine HCl

Numorphan, see Oxymorphone HCl

Numorphan H.P., see Oxymorphone HCl

O

Octagam 500 mg J1568

Octreotide Acetate, injection 1 mg IM J2353

25 mcg IV,SQ J2354
23

Oculinum, see Botulinum toxin type A

Ofatumumab 10 mg J9302

O-Flex, see Orphenadrine citrate

Oforta, see Fludarabine phosphate

Olanzapine 1 mg J2358

Omalizumab 5 mg J2357

Omnipen-N, see Ampicillin

OnabotulinumtoxinA 1 unit J0585

Oncaspar, see Pegaspargase

Oncovin, see Vincristine sulfate

Ondansetron HCI 1 mg IV J2405

Ondansetron HCl, oral 8 mg ORAL Q0179

Oprelvekin 5 mg SC J2355

Oraminic II, see Brompheniramine maleate

Ormazine, see Chlorpromazine HCl

Orphenadrine citrate up to 60 mg IV, IM J2360

Orphenate, see Orphenadrine citrate

Orthovisc J7324

Or-Tyl, see Dicyclomine

Oxacillin sodium up to 250 mg IM, IV J2700

Oxaliplatin 0.5 mg J9263

Oxymorphone HCl up to 1 mg IV, SC, IM J2410

Oxytetracycline HCl up to 50 mg IM J2460

Oxytocin up to 10 units IV, IM J2590

Ozurdex, see Dexamethasone, intravitreal implant

P

Paclitaxel 30 mg IV J9265

Paclitaxel protein-bound particles 1 mg J9264

Palifermin 50 mcg J2425

Paliperidone Palmitate 1 mg J2426

Palonosetron HCl 25 mcg J2469

Pamidronate disodium per 30 mg IV J2430

Panitumumab 10 mg J9303

Papaverine HCl up to 60 mg IV, IM J2440

Paragard T 380 A, see Copper contraceptive, intrauterine

Paraplatin, see Carboplatin

Paricalcitol, injection 1 mcg IV, IM J2501

Pegademase bovine 25 iu J2504

Pegaptinib 0.3 mg J2503

Pegaspargase per single dose vial IM, IV J9266

Pegfilgrastim 6 mg J2505

Pemetrexed 10 mg J9305

Penicillin G benzathine 100,000 units IM J0561
24

Penicillin G benzathine and penicillin G procaine

 100,000 units IM J0558

Penicillin G potassium up to 600,000 units IM, IV J2540

Penicillin G procaine, aqueous up to 600,000 units IM, IV J2510

Pentamidine isethionate per 300 mg INH J2545,J7676

Pentastarch, 10% 100 ml J2513

Pentazocine HCl 30 mg IM, SC, IV J3070

Pentobarbital sodium per 50 mg IM, IV, OTH J2515

Pentostatin per 10 mg IV J9268

Peforomist, see Formoterol fumarate

Permapen, see Penicillin G benzathine

Perphenazine, injection up to 5 mg IM, IV J3310

Perphenazine, tablets 4 mg ORAL Q0175

8 mg ORAL Q0176

Persantine IV, see Dipyridamole

Pfizerpen, see Penicillin G potassium 

Pfizerpen A.S., see Penicillin G procaine

Phenazine 25, see Promethazine HCl

Phenazine 50, see Promethazine HCl

Phenergan, see Promethazine HCl

Phenobarbital sodium up to 120 mg IM, IV J2560

Phentolamine mesylate up to 5 mg IM, IV J2760

Phenylephrine HCl up to 1 ml SC, IM, IV J2370

Phenytoin sodium per 50 mg IM, IV J1165

Photofrin, see Porfimer sodium

Phytonadione (Vitamin K) per 1 mg IM, SC, IV J3430 

Piperacillin/Tazobactam Sodium, injection 1.125 g IV J2543

Pitocin, see Oxytocin

Plantinol AQ, see Cisplatin

Plas+SD, see Plasma, pooled multiple donor

Plasma, cryoprecipitate reduced each unit P9044

Plasma, pooled multiple donor, frozen, each unit IV P9023

Platinol, see Cisplatin

Plerixafor 1 mg J2562

Plicamycin 2,500 mcg IV J9270

Polocaine, see Mepivacaine

Polycillin-N, see Ampicillin

Porfimer Sodium 75 mg IV J9600

Potassium chloride per 2 mEq IV J3480

Pralatrexate 1 mg J9307

Pralidoxime chloride up to 1 g IV, IM, SC J2730

Predalone-50, see Prednisolone acetate

Predcor-25, see Prednisolone acetate

Predcor-50, see Prednisolone acetate

Predicort-50, see Prednisolone acetate
25

Prednisone per 5 mg ORAL J7506

Prednisolone, oral 5 mg ORAL J7510

Prednisolone acetate up to 1 ml IM J2650

Predoject-50, see Prednisolone acetate

Pregnyl, see Chorionic gonadotropin

Premarin Intravenous, see Estrogen, conjugated

Prescription,chemotherapeutic,not otherwise specified ORAL J8999

Prescription,nonchemotherapeutic,not otherwise specified ORAL J8499

Primacor, see Milrinone lactate

Primaxin I.M., see Cilastatin sodium, imipenem

Primaxin I.V., see Cilastatin sodium, imipenem

Priscoline HCl, see Tolazoline HCl

Privigen 500 mg J1459

Pro-Depo, see Hydroxyprogesterone Caproate

Procainamide HCl up to 1 g IM, IV J2690

Prochlorperazine up to 10 mg IM, IV J0780

Prochlorperazine maleate, oral 5 mg ORAL Q0164

10 mg ORAL Q0165

Profasi HP, see Chorionic gonadotropin

Profilnine Heat-Treated, see Factor IX

Progestaject, see Progesterone

Progesterone per 50 mg J2675

Prograf, see Tacrolimus, oral or parenteral

Prokine, see Sargramostim (GM-CSF)

Prolastin, see Alpha 1-proteinase inhibitor, human

Proleukin, see Aldesleukin

Prolixin Decanoate, see Fluphenazine decanoate

Promazine HCl up to 25 mg IM J2950

Promethazine HCl, injection up to 50 mg IM, IV J2550

Promethazine HCl, oral 12.5 mg ORAL Q0169

25 mg ORAL Q0170

Pronestyl, see Procainamide HCl

Proplex T, see Factor IX

Proplex SX-T, see Factor IX

Propranolol HCl up to 1 mg IV J1800

Prorex-25, see Promethazine HCl

Prorex-50, see Promethazine HCl

Prostaphlin, see Procainamide HCl

Prostigmin, see Neostigmine methylsulfate

Protamine sulfate per 10 mg IV J2720

Protein C Concentrate 10 IU J2724

Protirelin per 250 mcg IV J2725

Prothazine, see Promethazine HCl

Protopam Chloride, see Pralidoxime chloride

Proventil, see Albuterol sulfate, compounded
26

Prozine-50, see Promazine HCl

Pulmicort Respules, see Budesonide

Pyridoxine HCl 100 mg J3415

Q

Quelicin, see Succinylcholine chloride

Quinupristin/dalfopristin 500 mg (150/350) IV J2770

Qutenza, see Capsaicin patch

R

Ranibizumab 0.1 mg J2778

Ranitidine HCL, injection 25 mg IV, IM J2780

Rapamune, see Sirolimus

Rasburicase 0.5 mg J2783

Reclast 1 mg J3488

Recombinate, see Factor VIII

Redisol, see Vitamin B-12 cyanocobalamin

Regadenoson 0.1 mg J2785

Regitine, see Phentolamine mesylate

Reglan, see Metoclopramide HCl

Regular, see Insulin

Relefact TRH, see Protirelin

Remicade, see Infliximab, injection

Reo Pro, see Abciximab

Rep-Pred 40, see Methylprednisolone acetate

Rep-Pred 80, see Methylprednisolone acetate

RespiGam, see Respiratory Syncytial Virus 

Retavase, see Reteplase

Reteplase 18.8 mg IV J2993

Retrovir, see Zidovudine

Rheomacrodex, see Dextran 40

Rhesonativ, see Rho(D) immune globulin, human

Rheumatrex Dose Pack, see Methotrexate, oral

Rho(D) immune globulin J2791

Rho(D) immune globulin, human 1 dose package, 300 mcg IM J2790

50 mg J2788

Rho(D)immune globulin, human,solvent detergent 100 IU IV J2792

RhoGAM, see Rho(D) immune globulin, human

Rhophylac 100 IU J2791

Riastap, see Human Fibrinogen concentrate

Rilonacept 1 mg J2793

RimabotulinumtoxinB 100 units J0587

Ringers lactate infusion up to 1,000 cc IV J7120
27

Risperidone 0.5 mg J2794

Rituxan, see Rituximab

Rituximab 100 mg IV J9310

Robaxin, see Methocarbamol

Rocephin, see Ceftriaxone sodium

Roferon-A, see Interferon alfa-2A, recombinant

Romidepsin 1 mg J9315

Romiplostim 10 mcg J2796

Ropivacaine Hydrochloride 1 mg J2795

Rubex, see Doxorubicin HCl

Rubramin PC, see Vitamin B-12 cyanocobalamin

S

Saline solution 5% dextrose, 500 ml IV J7042

infusion, 250 cc IV J7050

infusion, 1,000 cc IV J7030

Saline solution, sterile 500 ml = 1 unit IV, OTH J7040 

Sandimmune, see Cyclosporine

Sandoglobulin, see Immune globulin intravenous (human)

Sandostatin Lar Depot, see Octreotide

Sargramostim (GM-CSF) 50 mcg IV J2820

Selestoject, see Betamethasone sodium phosphate

Sermorelin acetate 1 mcg Q0515

Sincalide 5 mcg J2805

Sinusol-B, see Brompheniramine maleate

Sirolimus 1 mg Oral J7520

Sodium ferricgluconate in sucrose 12.5 mg J2916

Sodium Hyaluronate

 Euflexxa J7323

 Hyalgan J7321

 Orthovisc J7324

 Supartz J7321

Solganal, see Aurothioglucose

Solu-Cortef, see Hydrocortisone sodium phosphate (J1710)

Solu-Medrol, see Methylprednisolone sodium succinate

Solurex, see Dexamethasone sodium phosphate

Solurex LA, see Dexamethasone acetate

Somatrem 1 mg J2940

Somatropin 1 mg J2941

Somatulin Depot, see Lanreotide

Sparine, see Promazine HCl

Spasmoject, see Dicyclomine HCl

Spectinomycin HCl up to 2 g IM J3320
28

Sporanox, see Itraconazole

Staphcillin, see Methicillin sodium

Stelara, see Ustekinumab

Stilphostrol, see Diethylstilbestrol diphosphate

Streptase, see Streptokinase

Streptokinase per 250,000 IU IV J2995

Streptomycin Sulfate, see Streptomycin

Streptomycin up to 1 g IM J3000

Streptozocin 1 gm IV J9320

Strontium-89 chloride per millicurie A9600

Sublimaze, see Fentanyl citrate

Succinylcholine chloride up to 20 mg IV, IM J0330

Sumatriptan succinate 6 mg SC J3030

Supartz J7321

Surostrin, see Succinycholine chloride

Sus-Phrine, see Adrenalin, epinephrine

Synercid, see Quinupristin/dalfopristin

Synkavite, see Vitamin K, phytonadione, etc.

Syntocionon, see Oxytocin

Synvisc and Synvisc-One 1 mg J7325

Sytobex, see Vitamin B-12 cyanocobalamin

T

Tacrolimus, oral per 1 mg ORAL J7507

Tacrolimus, parenteral 5 mg J7525

Talwin, see Pentazocine Hcl

Taractan, see Chlorprothixene

Taxol, see Paclitaxel

Taxotere, see Docetaxel

Tazidime, see Ceftazidime Technetium TC Sestambi per dose A9500

TEEV, see Testosterone enanthate and estradiol valerate

Telavancin 10 mg J3095

Temozolomide 1 mg J9328

5 mg ORAL J8700

Temsirolimus 1 mg J9330

Tenecteplase 1 mg J3101

Teniposide 50 mg Q2017

Tequin, see Gatifloxacin

Terbutaline sulfate up to 1 mg SC, IV J3105

Terbutaline sulfate, concentrated form per 1 mg INH J7680 

Terbutaline sulfate, unit dose form per 1 mg INH J7681 

Teriparatide 10 mcg J3110

Terramycin IM, see Oxytetracycline HCl
29

Testa-C, see Testosterone cypionate

Testadiate, see Testosterone enanthate and estradiol valerate

Testadiate-Depo, see Testosterone cypionate

Testaject-LA, see Testosterone cypionate

Testaqua, see Testosterone suspension

Test-Estro Cypionates, see Testosterone cypionate and estradiol cypionate 

Test-Estro-C, see Testosterone cypionate and estradiol cypionate

Testex, see Testosterone propionate

Testoject-50, see Testosterone suspension

Testoject-LA, see Testosterone cypionate

Testone LA 200, see Testosterone enanthate

Testone LA 100, see Testosterone enanthate

Testosterone Aqueous, see Testosterone suspension

Testosterone enanthate and estradiol valerate up to 1 cc IM J0900

Testosterone enanthate up to 100 mg IM J3120

up to 200 mg IM J3130

Testosterone cypionate up to 100 mg IM J1070

1 cc, 200 mg IM J1080

Testosterone cypionate and estradiol cypionate up to 1 ml IM J1060

Testosterone propionate up to 100 mg IM J3150

Testosterone suspension up to 50 mg IM J3140

Testradiol 90/4, see Testosterone enanthate and estradiol valerate

Testrin PA, see Testosterone enanthate

Tetanus immune globulin, human up to 250 units IM J1670

Tetracycline up to 250 mg IM, IV J0120

Thallous Chloride TL 201 per MCI A9505

Theelin Aqueous, see Estrone

Theophylline per 40 mg IV J2810

TheraCys, see BCG live

Thiamine HCl 100 mg J3411

Thiethylperazine maleate, injection up to 10 mg IM J3280

Thiethylperazine maleate, oral 10 mg ORAL Q0174

Thiotepa 15 mg IV J9340

Thorazine, see Chlorpromazine HCl

Thymoglobulin, see Immune globulin, anti-thymocyte

Thypinone, see Protirelin

Thyrogen, see Thyrotropin Alfa

Thyrotropin Alfa, injection 0.9 mg IM, SC J3240

Tice BCG, see BCG live

Ticon, see Trimethobenzamide HCl

Tigan, see Trimethobenzamide HCl

Tigecycline 1 mg J3243

Tiject-20, see Trimethobenzamide HCl

Tinzaparin 1000 IU SC J1655

Tirofiban Hydrochloride, injection 0.25 mg IM, IV J3246
30

TNKase, see Tenecteplase

Tobi, see Tobramycin, inhalation solution

Tobramycin, inhalation solution 300 mg INH J7682, J7685

Tobramycin sulfate up to 80 mg IM, IV J3260

Tocilizumab 1 mg J3262

Tofranil, see Imipramine HCl

Tolazoline HCl up to 25 mg IV J2670

Topotecan 0.25 mg Oral J8705

0.1 mg IV J9351

Toradol, see Ketorolac tromethamine

Torecan, see Thiethylperazine maleate

Torisel, see Temsirolimus

Tornalate, see Bitolterol mesylate

Torsemide 10 mg/ml IV J3265

Totacillin-N, see Ampicillin

Trastuzumab 10 mg IV J9355

Treanda, see Bendamustine HCl

Treprostinil 1 mg J3285

Tri-Kort, see Triamcinolone acetonide

Triam-A, see Triamcinolone acetonide

Triamcinolone, concentrated form per 1 mg INH J7683

Triamcinolone, unit dose per 1 mg INH J7684 

Triamcinolone acetonide 1 mg J3300

 per 10 mg IM J3301

Triamcinolone diacetate per 5 mg IM J3302

Triamcinolone hexacetonide per 5 mg VAR J3303

Triesence, see Triamcinolone acetonide

Triflupromazine HCl up to 20 mg IM, IV J3400

Trilafon, see Perphenazine

Trilog, see Triamcinolone acetonide

Trilone, see Triamcinolone diacetate

Trimethobenzamide HCl, injection up to 200 mg IM J3250

Trimethobenzamide HCl, oral 250 mg ORAL Q0173

Trimetrexate glucuronate per 25 mg IV J3305

Triptorelin Pamoate 3.75 mg J3315

Trisenox, see Arsenic trioxide

Trobicin, see Spectinomycin HCl

Trovan, see Alatrofloxacin mesylate

Tysabri, see Natalizumab

U

Ultrazine-10, see Prochlorperazine

Unasyn, see Ampicillin sodium/sulbactam sodium

Unclassified drugs (see also Not elsewhere classified) J3490
31

Unspecified oral antiemetic Q0181

Urea up to 40 g IV J3350

Ureaphil, see Urea

Urecholine, see Bethanechol chloride

Urofollitropin 75 iu J3355

Urokinase 5,000 IU vial IV J3364

250,000 IU vial IV J3365

Ustekinumab 1 mg J3357

V

V-Gan 25, see Promethazine HCl

V-Gan 50, see Promethazine HCl

Valergen 10, see Estradiol valerate

Valergen 20, see Estradiol valerate

Valergen 40, see Estradiol valerate

Valertest No. 1, see Testosterone enanthate and estradiol valerate

Valertest No. 2, see Testosterone enanthate and estradiol valerate

Valium, see Diazepam

Valrubicin, intravesical 200 mg OTH J9357

Valstar, see Valrubicin

Vancocin, see Vancomycin HCl

Vancoled, see Vancomycin HCl

Vancomycin HCl 500 mg IV, IM J3370

Vasoxyl, see Methoxamine HCl

Velaglucerase alfa 100 units J3385

Velban, see Vinblastine sulfate

Velsar, see Vinblastine sulfate

Venofer, see Iron sucrose

Ventolin, see Albuterol sulfate

VePesid, see Etoposide and Etoposide, oral

Versed, see Midazolam HCl

Verteporfin 0.1 mg IV J3396

Vesprin, see Triflupromazine HCl

Viadur, see Leuprolide acetate implant

Vibativ, see Telavancin

Vinblastine sulfate 1 mg IV J9360

Vincasar PFS, see Vincristine sulfate

Vincristine sulfate 1 mg IV J9370

Vinorelbine tartrate per 10 mg IV J9390

Vistaject-25, see Hydroxyzine HCl

Vistaril, see Hydroxyzine HCl

Vistide, see cidofovir
32

Visudyne, see Verteporfin

Vitamin K, phytonadione, menadione,

 menadiol sodium diphosphate per 1 mg IM, SC, IV J3430

Vitamin B-12 cyanocobalamin up to 1,000 mcg IM, SC J3420

Von Willebrand Factor Complex, human per IU VWF:RCo IV J7187

Per 100 IU VWF:RCo IV J7184

Voriconazole 10 mg J3465

Vpriv, see Velaglucerase alfa

W

Wehamine, see Dimenhydrinate

Wehdryl, see Diphenhydramine HCl

Wellcovorin, see Leucovorin calcium

Wilate, see Von Willebrand Factor complex (human)

Win Rho SD, see Rho(D)immuglobulin, human, solvent detergent

Wyamine Sulfate, see Mephentermine sulfate

Wycillin, see Penicillin G procaine

Wydase, see Hyaluronidase

X

Xeloda, see Capecitabine

Xiaflex, see Collagenase

Xopenex, see Albuterol

Xylocaine HCl, see Lidocaine HCl

Xyntha, see Factor VIII (anti-hemophilic factor, recombinant)

Z

Zanosar, see Streptozocin

Zantac, see Ranitidine HCL

Zemplar, see Paricalcitol

Zenapax, see Daclizumab

Zetran, see Diazepam

Ziconotide 1 mcg J2278

Zidovudine 10 mg IV J3485

Zinacef, see Cefuroxime sodium

Ziprasidone Mesylate 10 mg J3486

Zithromax, see Azithromycin dihydrate

Zithromax I.V., see Azithromycin, injection

Zofran, see Ondansetron HCl

Zoladex, see Goserelin acetate implant
33

Zoledronic Acid 1 mg J3487

Zolicef, see Cefazolin sodium

Zometa 1 mg J3487

Zosyn, see Piperacillin

Zyprexa Relprevv, see Olanzapine

Zyvox, see Linezolid

Last Updated October 13, 2010