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VERSION 05/2004

CAPTOPRIL

CAPOTEN

ENALAPRIL MALEATE

VASOTEC

LISINOPRIL

ZESTRIL

Losartan

Cozaar

Guanethidine

Ismelin

Therapeutic Class

Generic Name

Brand Name

Angiotensin II Inhibitors

Sympatholytic Agents

Peripherally Acting PRAZOSIN HCL TERAZOSIN HCL CLONIDINE HCL Centrally Acting

MINIPRESS HYTRIN CATAPRES

NTI

$

x

$$$

Generic Only

x

$$$

Generic Only; Brand Requires PA

PA

$$$

Restricted to ACE induced cough & not treatable with an agent in a non ACE inhibitor class

x

$$$

90 90 90

$ $$$ $

Transdermal patch restricted to Nephrology; patients with chronic renal failure or that are NPO

CHP Restrictions

Tab

12.5mg, 25mg,

Tab

2.5mg, 5mg, 50mg 100mg

Tab

10mg 20mg 2.5mg, 5mg,

10mg,20mg,

Tab

0 40 25mg, 50mg,

100mg

Tab

10mg, 25mg

Cap

1mg, 2mg, 5mg

Tab, Cap

ALL

Tab

0.1mg, 0.2mg,

0.3mg

Form

Strength

CHP

Relative Cost

WYTENSIN TENEX ALDOMET

Tab

Tab Tab

ALDORIL

Tab

APRESOLINE

Tab

SER-AP-ES

Tab

LUMINAL

Tab, Elixir

MYSOLINE

Tab, Susp

KLONOPIN

Tab

VALIUM

Tab

DILANTIN

CapER, Chew, Susp

Zarontin

Cap, Syr

TEGRETOL

Tab, TabER Chew, Susp

Depakote, Depakote Sprinkle, Depakote-ER

Cap, Sprinkle, TabDR, Tab, Chew

Lamictal

DEPAKENE

Cap, Syr

PROZAC

Tab, Liq

LUVOX

Tab

PAXIL

Tab

HCTZ/ Reserpine/ Hydralazine

CENTRAL NERVOUS SYSTEM AGENTS PHENOBARBITAL Anticonvulsants

Lamotrigine

VALPROIC ACID

ANTIDEPRESSANTS FLUOXETINE SSRI

FLUVOXAMINE

PAROXETINE

Barbiturates

PRIMIDONE

Anxiolytics

CLONAZEPAM

DIAZEPAM

Hydantoins

PHENYTOIN

Succinimides

Ethosuximide

Miscellaneous

CARBAMAZEPINE

Anticonvulsants

Divalproex Sodium

x

$$

x

$$

90

$

x

$

90

$

x

$

90

$

NTI

$$

x

$

R

$

NTI

$$

NTI

$$$

NTI

$$

NTI

$$$$

R

$$$$

90

$

xR

$$

x

$$

R

$$$

GUANABENZ ACETATE

GUANFACINE METHYLDOPA

4mg, 8mg

1mg, 2mg 125mg, 250mg,

500mg 250/15mg,

250/25mg, 500/30mg, 10mg, 25mg,

50mg 15/0.1/25mg

8mg, 15mg, 16mg, 30mg, 32mg, 60mg, 65mg, 100mg,

15mg/5mL 50mg, 250mg,

250mg/5mL 0.5mg, 1mg,

2mg 2mg, 5mg, 10mg

30mg, 50mg, 100mg,

1/ 250mg,

250mg/5mL , 100mg, 200mg,

400mg,

100 / 125mg, 250mg,

500mg

5mg, 25mg, 100mg, 150mg,

00 250mg,

250mg/5mL

10mg, 20mg, 20mg/5mL

25mg, 50mg,

100mg 10mg, 20mg,

30mg, 40mg

Restricted to use in Cerebral Palsy, Athetoid States, or Spinal

C

dD

ti

Restricted to Neurology; Pediatrics

GENERIC ONLY; Oral Liq- Restricted to patients unable to

tl

t

l

l

Restricted to Psychiatry, patients with minmal response/contraindications to first line therapy + generic

METHYLDOPA/ HYDROCHLOROTHIAZIDE

Vasodilators

HYDRALAZINE

6

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