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Therapeutic Class

Generic Name

Ezetimbe

Blood Formation &

FERROUS SULFATE

Coagulation

H ti Cardiac Glycosides

DIGOXIN

Coronary

ISOSORBIDE DINITRATE

Vasodilator

NITROGLYCERIN

Diuretics

CHLORTHALIDONE

FUROSEMIDE

Carbonic Hydrase Inhibitors

ACETAZOLAMIDE

Hypotensive Agents

METHAZOLAMIDE MINOXIDIL

HYDROCHLOROTHIAZIDE

METOPROLOL TARTRATE PROPRANOLOL

TRIAMTERENE TRIAMTERENE/ HCTZ

LABETALOL HCL

INDAPAMIDE SPIRONOLACTONE/ HCTZ

Beta Blockers

ACEBUTOLOL ATENOLOL

Potassium Sparing

Amiloride Hydrochloride SPIRONOLACTONE

Calcium Channel Blockers

Amlodipine Besylate

DILTIAZEM HCL

Felodipine

NIFEDIPINE

VERAPAMIL HCL

Ace Inhibitors

BENAZEPRIL HCL

VERSION 05/2004

CHP

Relative Cost

CHP Restrictions

PA

$$$$

Restricted to patients intolerant to statins, or refractory to maximum doses (ie 80mg) of simvastatin or atorvastatin

x

$

Zetia

Tab

10mg.

VARIOUS

Tab

ALL

Brand Name

Form

Strength

LANOXIN

ISORDIL

HYGROTON

LASIX

HYDRODIURIL

LOZOL ALDACTAZIDE

Midamor ALDACTONE

DYRENIUM DYAZIDE, MAXZIDE

DIAMOX

NEPTAZANE LONITEN

Tab, Elixir

Tab, Chew, TabSL,

    • 0.125

      mg,

    • 0.25

      mg,

    • 0.50

      mg,

    • 2.5

      mg, 5mg,

10mg, 20mg,

b Tab, TabSL

,

0 40 1mg, 2mg, 3mg,

Oint

0.3mg, 0.4mg,

Tab

06 % 25mg, 50mg,

Tab, Soln

100mg 20mg, 40mg,

Tab

80mg, 10mg/mL, 25mg, 50mg,

Tab Tab

100mg 1.25mg, 2.5mg

25/25mg,

Tab

50mg/50mg 5mg

Tab

25mg, 50mg,

Cap Tab, Cap

100mg 50mg, 100mg

37.5/25mg,

Tab, CapSR

75/50mg 125mg, 250mg,

Tab Tab

500mg 25mg, 50mg

2.5mg, 10mg

90

$

90

$

x

$

R

$$

90

$

x

$

90

$

x

$$

x

$$$$

x

$$$

NTI

$

x

$

x

$

x

$

90

$

Except Long Acting

Restricted to Gastroenterology Service

Norvasc

Tab

CARDIZEM (CD, SR), DILACOR XR, TIAZAC, CARDIZEM

Tab, CapSR

Plendil

TabER

ADALAT (CC), PROCARDIA (XL)

TabCR, Cap

CALAN (SR), ISOPTIN (SR), COVERA-HS, VERELAN

Tab, TabCR CapSR

SECTRAL TENORMIN

TRANDATE, NORMODYNE

INDERAL

Cap Tab

200mg, 400mg 25mg, 50mg,

x 90

Tab

100mg 100mg, 200mg,

90

Tab

300mg 50mg, 100mg

90 90

Tab, Soln

10mg, 20mg, 40mg, 60mg, 80mg, 4mg/mL, 8mg/mL,

80mg/mL 2.5mg, 5mg,

R

10mg 10mg, 20mg,

30mg, 60mg,

90mg , 40mg, 80mg,

120mg, 180mg, 240mg

90

x

R

90

10mg

30mg, 60mg, 90mg, 120mg, 180mg, 240mg,

300mg, 360mg, 2.5mg, 5mg,

$$ $

$$

$ $

$$$

$$$

$$

$$$

$

Except Long Acting

Restricted to patients w/ hypertension (HTN) + angina or

HTN

CHF

Tab (30mg, 60mg, 90mg): Restricted to Pediatrics, Cardiology, Nephrology, patients

LOTENSIN

Tab

5mg, 10mg, 20mg 40mg

x

$$

Preferred Long- Acting ACE Inhibito

5

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