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SAIF Formulary: Extended

Common brand names listed as a convenience.  If generics are available, the prescription will be filled with the generic. Not all strengths/formulations of drugs on this list are on the formulary.

Generic Common Brand
Acetaminophen Tylenol
Alprazolam Niravam, Xanax
Amitripryline HCL Elavil
Amox TR/Potassium Clavulanate Augmentin, INC ES 600, XR
Amoxapine Asendin
Amoxicillin Trihydrate Amoxil, Trimox
Ampicillin Trihydrate Principen
Aspirin Bayer
Azithromycin Zithromax, Zmax
Baclofen Lioresal
Bupropion HCL Wellbutrin, INC SR & XL
Bupropion HCL, SR Budeprion SR
Buspirone HCL Buspar
Carbamazepine Carbatrol
Carisoprodol Soma
Cefadroxil Hydrate Duricef
Celecoxib Celebrex
Cephalexin Monohydrate Keflex
Chlorzoxazone Parafon Forte DSC
Ciprofloxacin Cipro
Ciprofloxacin HCL Ciloxan
Citalopram Hydrobromide Celexa
Clarithromycin Ciaxin, INC. XL
Clomipramine HCL Anafranil
Clonazepam Klonopin
Clorazepate Dipotassium Tranxene SD
Codeine Phos/Acetaminophen Tylenol w/Codeine No. 3
Codeine Sulf Codeine Sulfate
Cyclobenzaprine HCL Flexeril
Dalteparin Sodium, Porcine Fragmin
Demeclocycline HCL Declomycin
Desipramine HCL Norpramin
Diazepam Valium
Diclofenac Potassium Cataflam
Dicloxacillin Sodium Diclox
Diflunisal Dolobid
Diphenhydramine HCL Benadryl
Divalproex Sodium Depakote
Doxephin HCL Sinequan
Doxycycline Calcium Vibramycin
Doxycycline Hyclate Doryx
Doxycycline Monohydrate Adoxa, Adoxa Pak
Duloxetine HCL Cymbalta
Enoxaparin Sodium Lovenox
Erythromycin Base E-mycin, Eryc, Ery-Tab, Romycin
Erythromycin Ethylsuccinate E.E.S.
Erythromycin Lactobionate Erythrocin Lactobionate
Erythromycin Stearate Erythromycin Stearate
Escitalopram Oxalate Lexapro
Estazolam Prosom
Eszopiclone Lunesta
Ethosximide Zarontin
Etodolac Lodine
Felbamate Felbatol
Fenoprofen Calcium Nalfon
Fluoxetine HCL Prozac
Flurazepam HCL Dalmane
Flurbiprofen Ansaid
Fluvoxamine Maleate Luvox
Gabapentin Neurontin
Gentamicin Sulfate Garamycin

Hydrocodone Bit/Acetaminophen
(except 5-300 mg and 7.5-300 mg
discuss with nurse consultant)

Anexsia, Hydrocet
Lorcet, Lortab, Norco
Vicodin
Hydromorphone HCL Dilaudid
Hydroxyzine HCL Atarax
Hydroxyzine Pamoate Vistaril
Ibuprofen Advil
Imipramine HCL Tofranil
Imipramine Pamoate Tofranil-PM
Indomethacin Indocin, Incl SR
Ketoprofen Actron, Orudis, Oruvail
Ketorolac Tromethamine Toradol
Lamotrigine Lamictal
Levetiracetam Keppra
Levofloxacin Levaquin
Levorphanol Tartrate Levo-Dromoran
Lidocaine Lidoderm
Lorazepam Ativan
Meclofenamate Sodium Meclofenamate Sodium
Meloxicam Mobic
Metaxalone Skelaxin
Methadone HCL Dolophine, Methadose
Methocarbamol Robaxin
Methylprednisolone Medrol
Minocycline HCL Dynacin, Minocin, Myrac
Mirtazapine Remeron
Morphine Sulfate Oramorph, Roxanol, MSIR
Morphine Sulfate ER Avinza, Kadian, MS Contin
Moxifloxacin HCL Avelox, Vigamox
Nabumetone Relafen
Naproxen Naprosyn
Naproxen Sodium Aleve
Nitrofurantoin Furadantin
Nitrofurantoin Macrocrystal Macrodantin
Norfloxacin Noroxin
Nortriptyline HCL Pamelor
Ofloxacin Floxin, Ocuflox
Orphenadrine Citrate Norflex
Orphenadrine/Aspirin/Caffeine Norgesic Forte
Oxaprozin Daypro
Oxazepam Serax
Oxcarbazepine Trileptal
Oxycodone HCL Oxyfast, Oxyir, Endocet, Percocet
Roxicet, Tylox
Oxycodone HCL ER Oxycontin
Oxycodone HCL/Aspirin Percodan
Oxymorphone HCL Opana, Incl ER
Paroxetine HCL Paxil
Penicillin V Potassium Veetids
Phenytoin Dilantin
Phenytoin Sodium Extended Phenytek
Piroxicam Feldene
Prednisone Prednisone
Pregabalin Lyrica
Primidone Mysoline
Propoxyphene HCL Darvon, Incl -N
Protriptyline HCL Vivactil
Quazepam Doral
Salsalate Amigesic
Sertraline HCL Zoloft
Silver Sulfadiazine Silvadene
Silver Sulfadiazine SSD
Silver Sulfadiazine Thermazene
Sulfamethoxazole/Trimethoprim Bactrim, Septra, SMZ-TMP,
Sulfatrim, Sultrex
Sulindac Clinoril
Temazepam Restoril
Tetracycline HCL Sumycin
Tiagabine HCL Gabitril
Tizanidine HCL Zanaflex
Tobramycin Sulfate Tobrex
Topiramate Topamax
Tramadol HCL Ultram, Incl ER
Tramadol HCL/Acetaminophen Ultracet
Trazodone HCL Desyrel
Triazolam Halcion
Trimipramine Maleate Surmontil
Vancomycin HCL Vancocin
Venlafaxine HCL Effexor, Incl XR
Warfarin Sodium Coumadin
Zaleplon Sonata
Zolpidem Tartrate Ambien
Zonisamide Zonegran

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