Respiratory

KP Wellness

12:25 PM  -  Public

13. Respiratory, Allergy, Cough & Cold

13.1  Antihistamine & Antiallergenic Agents
Note: OTC medications are not on the Prescription Drug List,
but are listed for information purposes . If a prescription product
is identical to an OTC product in strength and dosage form, the
prescription product is not included in the drug list .

Claritin (Loratadine Tablet, Syrup) - OTC

13.1.1 ANTIHISTAMINES
TIER 1
Clemastine Fumarate (Tavist)
Cyproheptadine HCl (Periactin)
Hydroxyzine HCl (Atarax)
Hydroxyzine Pamoate Capsule (Vistaril)
Promethazine HCl (Phenergan)
TIER 2
Vistaril Suspension (Hydroxyzine  Pamoate)
TIER 3
Desloratadine (Clarinex)
Levocetirizine Dihydrochloride (Xyzal)  

KP Wellness

12:21 PM  -  Public

13.1.2 ADRENERGICS
TIER 2
Epinephrine Pen Injector (Adrenaclick)
Epipen (Epinephrine Pen Injector)
Epipen Jr (Epinephrine Pen Injector) SL
TIER 3
Epinephrine auto-injector  (Twinject)

13.1.3 CORTICOSTEROIDS
TIER 1
Dexamethasone (Decadron)
Hydrocortisone Tablet (Cortef)
Methylprednisolone Tablet, Dose Pack (Medrol 4, 16 mg)
Orapred (Prednisolone Sodium Phosphate Solution, Oral)
Prednisolone Sodium Phosphate Solution,  Oral (Pediapred)
Prednisolone Syrup (Prelone)
Prednisone (Meticorten)
TIER 2
Medrol 2, 8, 24, 32 mg  (Methylprednisolone Tablet)
Pediapred (Prednisolone Sodium Phosphate  Solution, Oral)
TIER 3
Betamethasone (Celestone Oral Solution)
Prednisolone Sodium Phosphate (Orapred ODT) 

KP Wellness

12:20 PM  -  Public

13.2  Cough & Cold Therapy
Antitussive and Expectorant Drugs
Only prescription antitussive and expectorant drugs are
included in the Prescription Drug List . The use of OTC
antitussive and expectorant products is recommended when
possible . While not all comparable OTC alternatives to
prescription products are provided below, where applicable at
least one is listed for informational purposes .

13.2.1  ANTITUSSIVE COMBINATIONS
TIER 1
Codeine/Promethazine HCl (Phenergan w/Codeine)
Dextromethorphan HBr/Pseudoephedrine  HCl/Brompheniramine (Bromfed-DM)
Guaifenesin/Codeine Phosphate (Robitussin A-C)
Guaifenesin/Pseudoephedrine HCl/ Codeine (Robitussin-DAC)
Phenylephrine HCl/Codeine/ Promethazine (Phenergan VC w/Codeine)
Phenylephrine HCl/Hydrocodone Bit/ Chlorpheniramine (Histussin HC)
TIER 3
Hydrocodone/Chlorpheniramine  Suspension, Sustained-Release 12 Hour (Tussionex)

KP Wellness

12:20 PM  -  Public

Antihistamine/Decongestant Combinations
Only prescription antihistamine/decongestants are included
in the Prescription Drug List . The use of OTC antihistamine/
decongestant products is recommended when possible . While
not all comparable OTC alternatives to prescription products
are provided below, where applicable at least one is listed for
informational purposes . Strength is listed in mg .

Claritin-D (Pseudoephedrine Sulfate/Loratadine) - OTC

13.2.3 DECONGESTANT/ANTIHISTAMINES
TIER 1
Phenylephrine HCl/Promethazine HCl (Phenergan VC)
TIER 3
Desloratadine and Pseudoephedrine Sulfate (Clarinex-D) 

KP Wellness

12:20 PM  -  Public

13.3  Pulmonary Agents

13.3.1 XANTHINES
TIER 1
Guaifenesin/Dyphylline (Difil-G)
Theophylline Anhydrous Tablet,  Extended-Release 12 Hour (Theochron)
TIER 3
Theophylline anhydrous (Elixophyllin Elixir)
Dyphylline (Lufyllin Tablet)
Theophylline Anhydrous Capsule (Theo-24)

13.3.2  BETA AGONISTS ORAL
TIER 1
Albuterol Sulfate (Proventil, Ventolin)
Metaproterenol Sulfate (Alupent)
Terbutaline Sulfate (Brethine)

13.3.3  INHALED BETA AGONISTS
TIER 1
Albuterol Sulfate Solution (Proventil,  Ventolin)
Albuterol Sulfate Solution, Non-Oral (AccuNeb)
Metaproterenol Sulfate Solution,  Non-Oral (Alupent)
Ventolin HFA (Albuterol Sulfate  HFA Aerosol)
TIER 2
Foradil (Formoterol Fumarate Capsule  w/Inhalation Device)
TIER 3
Arformoterol Tartrate Inhalation Solution (Brovana)
Pirbuterol (Maxair Autohaler)
Formoterol Fumarate Inhalation Solution (Perforomist)
Albuterol Sulfate Inhalation Aerosol  (Proair HFA)
Albuterol Inhalation (Proventil HFA)
Salmeterol Xinafoate (Serevent Diskus)
Levalbuterol Tartrate Inhalation Aerosol (Xopenex HFA)
Levalbuterol HCl (Xopenex Vial, Nebulizer) 

KP Wellness

12:20 PM  -  Public

13.3.4  INHALED CORTICOSTEROIDS
TIER 1
Alvesco (Ciclesonide)
Asmanex (Momestasone Furoate Twisthaler)
QVAR (Beclomethasone Dipropionate HFA  Aerosol w/Adapter)
TIER 2
+ Budesonide Inhalation Suspension
(Pulmicort Respules 0 .25 mg/2 ml,  0 .5 mg/2 ml)
Pulmicort Respules 1 mg/2 ml  (Budesonide Inhalation Suspension)
TIER 3
Flunisolide Inhaler (Aerobid M)
Fluticasone Propionate (Flovent Diskus)
Fluticasone Propionate HFA (Flovent HFA)
Budesonide Inhalation Powder (Pulmicort Flexhaler)

13.3.5  INTRANASAL STEROIDS
TIER 1
Flunisolide (Nasarel)
Fluticasone Propionate (Flonase)
TIER 2
Nasonex (Mometasone Furoate Aerosol, Spray)
TIER 3
Beclomethasone Dipropionate, Monohydrate (Beconase-AQ)
Ciclesonide Nasal Spray (Omnaris)
Budesonide (Rhinocort Aqua)
Triamcinolone Acetonide (Nasacort AQ)
Fluticasone Furoate Nasal Spray (Veramyst)  

KP Wellness

12:18 PM  -  Public

13.3.6  MISCELLANEOUS PULMONARY AGENTS
TIER 1
Acetylcysteine Vial, Nebulizer (Mucomyst)
Cromolyn Sodium Ampul for Nebulization (Intal)
+ Ipratropium Bromide Solution, Non-Oral (Atrovent)
+ Zafirlukast (Accolate)
TIER 2
Adcirca (Tadalafil)
Albuterol Sulfate/Ipratropium Solution,  Non-Oral (Duoneb)**
Letairis (Ambrisentan)
Pulmozyme (Dornase Alfa, Solution,  Non-Oral)
Revatio (Sildenafil Citrate)
Singulair (Montelukast Sodium)
Spiriva (Tiotropium)
Tracleer (Bosentan)
Tyvaso (Treprostinil)
Ventavis (Iloprost Ampul for Nebulization)
TIER 3
Fluticasone Propionate (Advair Diskus)
Fluticasone Propionate and Salmeterol (Advair HFA)
Ipratropium bromide inhaler (Atrovent HFA)
Ipratropium Bromide and Albuterol Sulfate (Combivent)
Mometasone Furoate, Formoterol Fumarate Dihydrate (Dulera)
Budesonide and Formoterol Fumarate Dihydrate (Symbicort)
Zileutin (Zyflo)
Zileuton Extended Release Tablets (Zyflo CR)