Autonomic & CNS Drugs

KP Wellness

2:44 PM  -  Public

3. Autonomic & CNS Drugs, Neurology & Psych
3.6 Anticonvulsants
TIER 1
+ Acetazolamide (Diamox)
+ Carbamazepine (Tegretol)
+ Clonazepam (Klonopin)
+ Diazepam, Rectal (Diastat Acudial)
+ Divalproex Sodium Tablet (Depakote)
+ Divalproex Sodium Tablet,  Sustained-Release (Depakote ER)
+ Ethosuximide (Zarontin)
+ Felbamate (Felbatol)
+ Gabapentin (Neurontin)
+ Lamotrigine 5, 25 mg Chewable Tablet
(Lamictal Chewable)
+ Lamotrigine Tablet (Lamictal)
+ Levetiracetam (Keppra)
+ Oxcarbazepine (Trileptal)
+ Phenobarbital (Phenobarbital)
+ Phenytoin (Dilantin)
+ Phenytoin Sodium (Phenytek)
+ Phenytoin Sodium Extended (Dilantin)
+ Primidone (Mysoline)
+ Topiramate Capsule, Sprinkle (Topamax)
+ Topiramate Tablet (Topamax)
+ Valproic Acid (Depakene)
+ Zonisamide (Zonegran)
TIER 2
+ Carbamazepine Tablet, Sustained-Release  12 Hour (Tegretol XR)**
Celontin (Methsuximide)
Dilantin (Phenytoin)
Dilantin (Phenytoin Sodium Extended)
+ Divalproex Sodium (Depakote Sprinkle)**
Gabitril (Tiagabine HCl)
Mysoline (Primidone)
Peganone (Ethotoin)
Sabril (Vigabatrin)
Tegretol (Carbamazepine)
TIER 3
Banzel + Carbamazepine Capsule,  Extended-Release Multiphase 12 Hour
(Carbatrol)*
Divalproex Sodium Delayed Release Tablets (Depakote ER)
Carbamazepine) Extended-Release Capsules (Equetro)
Levetiracetam (Keppra)
Lamotrigine (Lamictal)
Lamictal Dose Pack
Lamictal ODT
Lamictal XR
Levetiracetam Tablet, Extended-Release  24 Hour (Keppra XR)***
Pregabalin (Lyrica)
Valproic acid delayed release (Stavzor)
Topiramate (Topamax)
Lacosamide (Vimpat)

3.7  Miscellaneous Neurological Therapy
TIER 1
+ Donepezil HCl Tablet (Aricept)
+ Galantamine Capsule 24 Hour  Sustained-Release Pellets
(Razadyne ER)
+ Galantamine Tablet, Solution (Razadyne)
+ Nimodipine (Nimotop)
+ Rivastigmine Tartrate Capsule (Exelon)
TIER 2
Ampyra (Dalfampridine)
Copaxone (Glatiramer Acetate)
+ Donepezil HCl Tablet, Rapid Dissolve (Aricept ODT)**
Mytelase (Ambenonium Chloride)
TIER 3
Donepezil Hydrochloride (Aricept 23 mg)
Rivastigmine Tartrate (Exelon Solution)
Fingolimod (Gilenya)
Memantine HCL (Namenda) 

KP Wellness

2:33 PM  -  Public

3. Autonomic & CNS Drugs, Neurology & Psych

3.8  Muscle Relaxants & Antispasmodic
Therapy
3.8.1  MUSCLE RELAXANTS & ANTISPASMODIC AGENTS
TIER 1
+ Baclofen (Lioresal)
+ Carisoprodol (Soma 350 mg)
+ Chlorzoxazone (Parafon Forte DSC)
+ Cyclobenzaprine HCl (Flexeril)
+ Dantrolene Sodium (Dantrium)
+ Diazepam (Valium)
+ Methocarbamol (Robaxin)
+ Oxybutynin Chloride (Ditropan)
+ Oxybutynin Chloride Tablet,
Sustained-Release (Ditropan XL)
+ Tizanidine HCl (Zanaflex)
TIER 2
Enablex (Darifenacin)
Gelnique (Oxybutynin Chloride)
+ Orphenadrine (Norflex)**
+ Orphenadrine Compound (Norgesic, Norgesic Forte)**
Oxytrol (Oxybutynin Transdermal System)
Skelaxin^^ (Metaxalone)^^
Vesicare (Solifenacin)
TIER 3
+ Carisoprodol (Soma 250 mg)*
+ Cyclobenzaprine Capsule,  Extended-Release 24 Hour (Amrix)*
Tolterodine Tartrate (Detrol LA)
+ Metaxalone (Skelaxin 800 mg)***
Fesoterodine Fumarate Extended-Release Tablets (Toviaz)
Tizanidine (Zanaflex)

3.8.2  MYASTHENIA GRAVIS
TIER 1
+ Pyridostigmine Bromide Tablet (Mestinon 60 mg)
TIER 2
Mestinon (Pyridostigmine Bromide Syrup)
Mestinon 180 mg (Pyridostigmine Bromide Tablet, Sustained-Action)
Prostigmin (Neostigmine Bromide) 

KP Wellness

2:36 PM (edited)  -  Public

3.9  Psychotherapeutic Drugs
3.9.1  HYPNOTIC AGENTS
TIER 1
+ Chloral Hydrate (Chloral Hydrate)
+ Estazolam (ProSom)
+ Flurazepam HCl (Dalmane)
+ Temazepam (Restoril)
+ Triazolam (Halcion)
+ Zaleplon (Sonata)
+ Zolpidem Tartrate (Ambien)
TIER 3
Zolpidem tartrate extended-release (Ambien)
Zolpidem Tartrate Sublingual Tablets (Edluar)
Eszopiclone (Lunesta)
Ramelteon (Rozerem)
Zaleplon (Sonata)
Doxepin Tablets (Silenor)
+ Zolpidem Tartrate Tablet,  Multiphasic-Release (Ambien CR)*  

KP Wellness

2:25 PM (edited)  -  Public

3.9.2  ANTIDEPRESSANT AGENTS
3.9.2.1 TRICYCLICS
TIER 1
+ Amitriptyline HCl (Elavil)
+ Amoxapine (Asendin 50, 100 mg)
+ Clomipramine HCl (Anafranil)
+ Desipramine HCl (Norpramin)
+ Doxepin HCl (Sinequan)
+ Imipramine HCl (Tofranil)
+ Imipramine Pamoate (Tofranil-PM)
+ Nortriptyline HCl (Pamelor)
+ Protriptyline HCl (Vivactil)
+ Trimipramine Maleate (Surmontil)

3.9.2.2 MISCELLANEOUS ANTIDEPRESSANTS
TIER 1
+ Amitriptyline/Perphenazine (Etrafon, Etrafon Forte)
+ Bupropion HCl (Wellbutrin)
+ Bupropion HCl Tablet, Sustained-Action (Wellbutrin SR)
+ Bupropion HCl Tablet, Sustained-Release  24 Hour (Wellbutrin XL)
+ Maprotiline HCl (Ludiomil)
+ Mirtazapine (Remeron)
+ Mirtazapine Dispersible Tablet (Remeron SolTab)
+ Nefazodone HCl (Serzone)
+ Trazodone HCl (Desyrel)
+ Venlafaxine HCl (Effexor)
+ Venlafaxine HCl Capsule,
Sustained-Release 24 Hour (Effexor XR)
TIER 3
Bupropion hydrobromide (Aplenzin)
Duloxetine Hcl (Cymbalta)
Trazodone Hydrochloride Extended-Release Tablets (Oleptro)
Desvenlafaxine Extended-Release Tablets (Pristiq)
+ Venlafaxine HCl Tablet,  Extended-Release 24 Hour
(Venlafaxine HCl ER)*

3.9.2.3 MAO INHIBITORS
TIER 1
+ Phenelzine Sulfate (Nardil)
+ Tranylcypromine Sulfate (Parnate)
TIER 3
Selegiline Transdermal System (Emsam)
Isocarboxazid (Marplan)

3.9.2.4 SELECTIVE SEROTONIN REUPTAKE INHIBITORS
TIER 1
+ Citalopram Hydrobromide (Celexa)
+ Fluoxetine Capsule, Delayed-Release (Prozac Weekly)
+ Fluoxetine HCl Capsule (Prozac)
+ Fluoxetine HCl Tablet (Sarafem)
+ Fluvoxamine Maleate (Luvox)
+ Paroxetine HCl Tablet (Paxil)
+ Sertraline HCl (Zoloft)
TIER 3
Escitalopram (Lexapro)
Fluvoxamine Maleate (Luvox)
+ Paroxetine HCl Sustained-Release,  24 Hour (Paxil CR)*
Paroxetine Mesylate (Pexeva)