HUGs Book

Generic Brand/Available Form Dose Max/Day Comments Cost/Day Tier
ProCare HospiceCare Preferred Drug List$3
3.125-25mg Cardiac (continued) Tier 1D
41 BID ¢ CR:Tier 3D
Carvedilol Coreg, Coreg CR 50mg Subcategory: Congestive Heart Failure, Ischemic Patch: (Formerly
Tablet: 3.125, 6.25, 12.5, 25mg 0.1-0.8mg/day Heart Disease, Abdominal Aortic Aneurysm (AAA), $7.73 - Tier 1D)
Capsule, CR (BRAND): 10, 20, 40, 80mg divided into Severe Aortic Stenosis w/Angina $18.13
2 doses Therapeutic Class: Beta Blocker ¢ Tier 1D
May mask symptoms of hypoglycemia, take with Patch:
0.125-1.25mg food. $1 - $2 Tier 3D
daily
Clonidine Catapres 2.4mg Subcategory: Congestive Heart Failure, Tier 1D
Tablet: 0.1, 0.2, 0.3mg 30-90mg PO
Transdermal Patch: 0.1, 0.2, 0.3mg/24h QID AbdominalAortic Aneurysm (AAA) Tier 1D
patch Therapeutic Class: Alpha 2 Agonist Do not

suddenly d/c drug as rebound hypertension may

occur

Digoxin Lanoxin Subcategory: Congestive Heart Failure, Severe
Tablet: 0.125, 0.25mg Aortic Stenosis w/CHF
Elixer: 50mcg/mL Therapeutic Class: Cardiac glycoside
Monitor signs/symptoms bradycardia, maintenance
doses after morning

Diltiazem Cardizem, Cardizem CD, LA, 360mg Subcategory: Ischemic Heart Disease, Abdominal
Cartia XT, Dilt-CD, Diltia XT
Tablet: 30, 60, 90, 120mg Aortic Aneurysm (AAA)
Tablet, 24HR ER: 180, 240, 300, 360, Therapeutic Class: Calcium Channel Blocker
420mg
Capsule, 12HR ER: 60, 90, 120mg May cause constipation
Capsule, 24HR ER: 120, 180, 240, 300,
360, 420mg

Generic ProCare HospiceCare Preferred Drug ListBrand/AvailableDoseMax/DayCommentsCost/Day Tier
Dipyridamole Form
Doxazosin42
Enalapril Cardiac (continued)

Felodipine Persantine 50-100mg 400mg Subcategory: Congestive Heart Failure – Other $2 - $3 Tier 1D
Fosinopril Tablet: 25, 50, 75mg TID Therapeutic Class: Antiplatelet - Give at least 1hr before

Furosemide meals; Give with warfarin or aspirin

Cardura 1-16mg 16mg May cause orthostatic hypotension. Syncope or loss $1 Tier 1D
Tablet: 1, 2, 4, 8mg of consciousness is possible with first dose or dose. $2 Tier 1D
5-40mg daily
Vasotec in 2 divided doses 40mg Subcategory: Congestive Heart Failure, Abdominal
Tablet: 2.5, 5, 10, 20mg Aortic Aneurysm (AAA), Severe Aortic Stenosis
Therapeutic Class: Angiotensin-Converting Enzyme (ACE)
Inhibitors
Monitor for signs/symptoms of angioedema. Cough common.

Plendil 2.5-20mg daily 10mg Subcategory: Abdominal Aortic Aneurysm (AAA) $2 Tier 1D
Therapeutic Class: Calcium Channel Blocker $1 Tier 1D
Tablet, ER: 2.5, 5, 10mg
May cause peripheral edema

Monopril 5-80mg 80mg Subcategory: Congestive Heart Failure, Abdominal
Tablet: 10, 20, 40mg Aortic Aneurysm (AAA), Severe Aortic Stenosis
Therapeutic Class: Angiotensin-Converting Enzyme (ACE)
Inhibitors
Monitor for ACE inhibitor induced cough

Lasix 10-160mg 600mg Subcategory: Congestive Heart Failure, Severe ¢ Tier 1D
Tablet: 20, 40, 80mg daily-BID
Solution, oral: Aortic Stenosis w/CHF, Abdominal Aortic Aneurysm (AAA)
10mgmL, 40mg/5mL Therapeutic Class: Diuretics (loop)

Monitor for hypokalemia. Anuria: contraindicated

Generic Brand/Available Form Dose Max/Day Comments Cost/Day Tier
ProCare HospiceCare Preferred Drug ListHydralazine10-300mg$2Tier 1D
Apresoline Cardiac (continued) $1 Tier 1
43Hydrochlorothiazide Tablet: 10, 25, 50, 100mg 12.5-50mg $1 Tier 1D
Irbesartan daily 300mg Subcategory: Congestive Heart Failure, Abdominal ¢ Tier 1D
Microzide, Hydrodiuril 75-300mg Aortic Aneurysm (AAA) $ Tier 1D
Isosorbide Dinitrate Tablet: 25, 50mg daily Therapeutic Class: Alpha 1 Blocker
Capsule: 12.5mg Monitor for postural hypotension.
Isosorbide 2.5-240mg CrCl 10-50: give Q8h; CrCl <10: give Q8-16h
Mononitrate Avapro
Tablet: 75mg, 150mg, 300mg 10mg BID 200mg Subcategory: Abdominal Aortic Aneurysm (AAA),

Isordil Severe Aortic Stenosis w/CHF, Congestive Heart Failure
Tablet, ER: 5, 10, 20, 30, 40mg Therapeutic Class: Diuretics (thiazide)
Tablet, SL: 2.5, 5mg
Anuria: contraindicated
Imdur
Tablet: 10, 20mg 300mg Subcategory: Congestive Heart Failure, Abdominal
Tablet, ER: 30, 60, 120mg Aortic Aneurysm (AAA), Severe Aortic Stenosis
Therapeutic Class: Angiotensin II Receptor
Blockers (ARBs) – If intolerant to ACE Inhibitors
Monitor for potassium retention and hypotension

480mg Subcategory: Congestive Heart Failure, Ischemic
160mg ER Heart Disease, Severe Aortic Stenosis w/CHF
Therapeutic Class: Nitrates
Short acting vasodilator. Monitor for postural
hypotension.

40mg Subcategory: Congestive Heart Failure, Ischemic
240mg ER
Heart Disease, Severe Aortic Stenosis w/CHF
Therapeutic Class: Nitrates

Long acting vasodilator. Monitor for hypotension

ProCare HospiceCare Preferred Drug ListGenericBrand/Available FormDoseMax/DayCommentsCost/Day Tier
Isradipine
44Labetalol Dynacirc 2.5-5mg Cardiac (continued)
Capsule: 2.5, 5mg BID
Lisinopril 10mg Subcategory: Ischemic Heart Disease, Abdominal $3- $5 Tier 1D
Losartan Trandate, Normodyne 200-400mg
Tablet: 100, 200, 300mg BID Aortic Aneurysm (AAA)
Therapeutic Class: Calcium Channel Blocker May
Prinivil, Zestril 10-40mg
Tablet: 2.5, 5, 10, 20, 30, daily cause constipation and peripheral edema
40mg
25-100mg 2400mg Subcategory: Congestive Heart Failure, Ischemic $1 Tier 1D
Cozaar in 1-2 Heart Disease, Abdominal Aortic Aneurysm (AAA),
Tablet: 25, 50, 100mg divided Severe Aortic Stenosis w/Angina
doses Therapeutic Class: Beta Blocker
May mask symptoms of hypoglycemia.

80mg Subcategory: Congestive Heart Failure, Abdominal $1 Tier 1D
40mg (renal)
Aortic Aneurysm (AAA), Severe Aortic Stenosis
Therapeutic Class: Angiotensin-Converting Enzyme (ACE) Inhibitors

Monitor for cough and postural hypotension

100mg Subcategory: Abdominal Aortic Aneurysm (AAA), $2 - $3 Tier 1D
Congestive Heart Failure, Severe Aortic Stenosis
Therapeutic Class: Angiotensin II Receptor
Blockers (ARBs) – If intolerant to ACE Inhibitors
Monitor for potassium retention

Metolazone Zaroxolyn 2.5-20mg 20mg Subcategory: Congestive Heart Failure, Abdominal $2 Tier 1D
Tablet: 2.5, 5, 10mg daily Aortic Aneurysm (AAA), Severe Aortic Stenosis w/CHF
Therapeutic Class: Diuretics (thiazide)
Not a potent diuretic alone; used in conjunction with Lasix or Bumex;
administer 30min prior to dose of Lasix or Bumex

Generic Brand/Available Form Dose Max/Day Comments Cost/Day Tier
ProCare HospiceCare Preferred Drug List$1 - $2 Tier 1D
50-200mg Cardiac (continued)
45 BID $1 Tier 1D
Metoprolol Lopressor,Toprol XL 450mg Subcategory: Congestive Heart Failure, Ischemic Heart Disease, $3 Tier 1D
Tablet, as tartrate: 25, 50, 20-320mg 400mg XL Abdominal Aortic Aneurysm (AAA), Severe Aortic Stenosis w/ $2 Tier 1D
100mg daily Angina $7 Tier 1D
Tablet, as succinate, XL: 25, Therapeutic Class: Beta Blocker
50, 100, 200mg 20-40mg Sudden discontinuation can cause rebound angina.
TID Monitor for hypotension.

Nadolol Corgard IR: 10-20mg 320mg Subcategory: Congestive Heart Failure, Ischemic Heart Disease,
Tablet: 20, 40, 80, 160mg TID ER: Abdominal Aortic Aneurysm (AAA), Severe Aortic Stenosis w/
30-90mg Angina
daily Therapeutic Class: Beta Blocker
17-34mg Long acting beta blocker. Monitor for hypokalemia.
daily
Nicardipine Cardene 120mg Subcategory: Ischemic Heart Disease, Abdominal
Capsule: 20, 30mg
Aortic Aneurysm (AAA)
Therapeutic Class: Calcium Channel Blocker

Can cause peripheral edema and constipation

Nifedipine Procardia, Adalat IR: 180mg Subcategory: Ischemic Heart Disease, Abdominal
Capsule: 10, 20mg ER: 90mg
Tablet, ER: 30, 60, 90mg Aortic Aneurysm (AAA)
Therapeutic Class: Calcium Channel Blocker

Take ER tablets on empty stomach. May cause constipation.

Nisoldipine Sular 60mg Subcategory: Abdominal Aortic Aneurysm (AAA),
Tablet, ER: 8.5, 10, 17, 20,
25.5, 30, 34, 40mg Ischemic Heart Disease , Abdominal Aortic Aneurysm
Therapeutic Class: Calcium Channel Blocker

Give on empty stomach. May cause constipation & peripheral edema.

Generic ProCare HospiceCare Preferred Drug ListBrand/Available FormDoseMax/DayCommentsCost/Day Tier

Nitroglycerin46 Cardiac (continued)
Ointment
Nitro-Bid 0.5-2 inch 2-5 inch Subcategory: Congestive Heart Failure, Ischemic $2 - $4 Tier 1D
Nitroglycerin Topical: 2% Q4-6h Q4hr
Patch Heart Disease, Severe Aortic Stenosis w/CHF
Therapeutic Class: Nitrates
Nitroglycerin
Sublingual Increase 0.5inch PRN. Include10-12h nitrate free interval

Potassium Nitro-Dur 0.1-0.6mg/ 0.6mg/hr Subcategory: Congestive Heart Failure, Ischemic $2 - $4 Tier 1D
Chloride
Transdermal Patch: 0.1, 0.2, 0.4, hr Heart Disease, Severe Aortic Stenosis w/CHF
Propafenone Therapeutic Class: Nitrates
0.6mg/hr
Propranolol Increase 0.5inch PRN. Include 10-12h nitrate free interval

Nitrostat, NitroMist 0.3-0.6 mg 3 doses in Subcategory: Congestive Heart Failure, Ischemic $2 Tier 1D
Tablet: 0.3, 0.4, 0.6 mg Q5 min 15 min
Spray: 0.4 mg/actuation Heart Disease, Severe Aortic Stenosis w/CHF
Therapeutic Class: Nitrates

Store tablets in original glass container and away from moisture and light

K-Dur, Klor-Con 20meq 100meq May cause diarrhea, nausea, vomiting or abdominal pain $1 Tier 1D
Capsule, XR: 8, 10meq 2-5X daily
Tablet, ER: 8, 10, 15, 20meq 900mg May cause bradycardia. $2 Tier 1D
Solution, oral: 20, 40meq/15mL 150mg TID Use with caution in patients taking methadone. $1 Tier 1D
HTN: Hepatic impairment: decr. dose 70-80%
Rythmol 80-240mg 640mg
Tablet: 150, 225, 300mg BID Angina: Subcategory: Congestive Heart Failure
Capsule, ER: 225, 325, 425mg 320mg Therapeutic Class: Beta Blocker
Effective also for myoclonus.
Inderal
Tablet: 10, 20, 40, 60, 80mg
Capsule, LA: 60, 80, 120, 160mg
Solution, oral: 20, 40mg/5mL

Generic Brand/Available Form Dose Max/Day Comments Cost/Day Tier
Quinapril ProCare HospiceCare Preferred Drug List
Ramipril Cardiac (continued)
47
Accupril 20-80mg HTN: 80mg Long acting ACE inhibitor. $1 - $2 Tier 1D
Tablet: 5, 10, 20 40mg daily CHF: 40mg Cough side effect is common $3 Tier 1D

Altace 5mg BID 20mg Subcategory: Congestive Heart Failure, Abdominal
Capsule: 1.25, 2.5, 5, 10mg 5mg (renal) Aortic Aneurysm (AAA), Severe Aortic Stenosis
Therapeutic Class: Angiotensin-Converting Enzyme
(ACE) Inhibitors
Increase dose Q3 weeks to target dose.
CrCl <40: max 5mg/day

Spironolactone Aldactone 20-200mg 400mg Subcategory: Congestive Heart Failure, Severe $1 Tier 1D
Tablet: 25, 50, 100mg daily Aortic Stenosis w/CHF, Abdominal Aortic Aneurysm (AAA)
Therapeutic Class: Diuretics (potassium sparing)
Especially useful with ascites prevents third spacing;
may cause constipation and hypotension.
CrCl <10: contraindicated;
anuria, acute renal impairment: contraindicated

Terazosin Hytrin 1-5mg QHS 20mg First dose hypotension side effect; give QHS only $2 Tier 1D
Torsemide Capsule: 1, 2, 5, 10 mg $1 - $3 Tier 1D
10-200mg 200mg Subcategory: Congestive Heart Failure, Abdominal
Demadex daily
Tablet: 5, 10, 20, 100mg Aortic Aneurysm (AAA), Severe Aortic Stenosis w/CHF
Therapeutic Class: Diuretics (thiazide)

May cause hypokalemia.

ProCare HospiceCare Preferred Drug ListGenericBrand/Available FormDoseMax/DayCommentsCost/Day Tier
$5 Tier 1D
48 Cardiac (continued)

Valsartan Diovan HTN: 80-320mg 320mg Subcategory: Congestive Heart Failure, Abdominal
Tablet: 40, 80, 160, 320mg daily Aortic Aneurysm (AAA), Severe Aortic Stenosis
CHF: Therapeutic Class: Angiotensin II Receptor
80-160mg daily Blockers (ARBs) – If intolerant to ACE Inhibitors May
be made into a suspension for patients unable to
swallow

Verapamil Calan 240-320mg 480mg Subcategory: Abdominal Aortic Aneurysm (AAA), $2 - $3 Tier 1D
Warfarin Tablet: 40, 80, 120mg 3-4 x day Ischemic Heart Disease
Tablet, ER (12h): 120, 180, 240mg Divide dose Therapeutic Class: Calcium Channel Blocker IR Form:
Capsule, ER (24h AM): 120, 180, BID if >240mg Divide dose BID if >240mg/day. Do not crush ER Tier 2D
240, 360mg daily tablets.
Capsule, ER (24h PM): 100, 200, Hepatic impairment: decr. dose 70%; Consider
300mg alternate dosage form instead of ER

Coumadin Individualized Based upon Subcategory: Cancer with PE/DVT (not preexisting) $1 Tier 1D
Tablet: 1, 2, 2.5, 3, 4, 5, 6, 7.5, 10mg INR level Requires monitoring by INR. Discontinue when oral $4 Tier 2D

intake declines

Olmesartan Benicar 5-40mg daily 40mg Subcategory: Congestive Heart Failure, Abdominal
Tablet: 5, 20, 40mg Aortic Aneurysm (AAA), Severe Aortic Stenosis
Therapeutic Class: Angiotensin II Receptor
Blockers (ARBs) – If intolerant to ACE Inhibitors
May cause potassium retention and hypotension.

Phytonadione Mephyton 2.5-25mg daily 25mg/dose Subcategory: Congestive Heart Failure - Other ¢ Tier 2D
(Tablet only) Tablet: 5mg PRN, PO only Dosage based upon INR (Formerly
Tier 1D

Generic Brand/Available Form Dose Max/Day Comments Cost/Day Tier
Telmisartan ProCare HospiceCare Preferred Drug List$5 Tier 2D
Cardiac (continued)
Triamterene49 (formerly
Micardis 20-80mg 160mg Subcategory: Congestive Heart Failure, Abdominal Tier 1D)
Triamterene/ Tablet: 20, 40, 80mg daily $5 Tier 2D
HCTZ Aortic Aneurysm (AAA), Severe Aortic Stenosis
Clopidogrel Therapeutic Class: Angiotensin II Receptor ¢ Tier 2

Albuterol Blockers (ARBs) – If intolerant to ACE Inhibitors

Dyrenium 100mg BID 300mg Subcategory: Abdominal Aortic Aneurysm (AAA),
Capsule: 50, 100mg Severe Aortic Stenosis w/CHF, Congestive Heart
Failure
Therapeutic Class: Diuretics (potassium sparing)
Anuria: contraindicated

Maxzide/Dyazide 25 mg/37.5mg 75/50mg Triamterene is a potassium sparing diuretic
Tablet: 25/37.5, 50/75mg daily
Capsule: 25/37.5mg 75mg Subcategory: Congestive Heart Failure – Other $7 Tier 3D
75mg daily Therapeutic Class: Antiplatelet Non-preferred $3 Tier 1D
Plavix
Tablet: 75, 300mg

Pulmonary Disease

Proventil,Ventolin Neb: 1 vial Neb: 10mg Subcategory: COPD (Obstructive),
Neb: 2.5mg/3mL (0.083%), via neb Q1-4h MDI: 12 puffs Other (Restrictive/Neoplastic)
5mgmL (0.5%) PRN Monitor for agitation
MDI: 90mcg/spray MDI: 2 puffs May be used to treat hyperkalemia
Q4-6h PRN

Generic ProCare HospiceCare Preferred Drug ListBrand/Available FormDoseMax/DayCommentsCost/DayTier
Ipratropium
50 Atrovent Pulmonary Disease (continued) $5 Neb:Tier 1
Ipratropium/ Neb: 0.5mg/2.5ml (0.02%) MDI:Tier 3
Albuterol MDI: 17mcg/spray Neb: 1 vial Neb: 6 doses Subcategory: COPD (Obstructive) $6 Neb:Tier 1
DuoNeb, Combivent via neb Q6-8h PRN MDI: 12 puffs Neb mixed with albuterol neb is MDI: MDI:Tier 3
NaCl 0.9% sterile Neb: 0.5mg/2.5mg/3mL MDI: 2 puffs inh QID $14.07
for inhalation MDI: 18mcg/90mcg/spray stable for 1 hour.
Theophylline
Bronchosaline Neb: 3mL inh QID Neb: 6 doses Subcategory: COPD (Obstructive),
Beclomethasone Neb: 0.9%
Arformoterol Theo-Dur MDI: 1-2 puffs inh QID MDI: 12 puffs Other (Restrictive/Neoplastic)
Tablet, CR: 400, 600mg
Fluticasone Capsule, ER: 100, 200, 300, 400mg 3mL Q4h 150meq Subcategory: COPD (Obstructive) $1 Tier 1
Elixir: 800mg/15mL PRN 600mg Fluid intake is encouraged $2 Tier 1D
Qvar
MDI: 40, 80mcg/spray 200mg BID Geriatic goal serum concentration is
Brovana 5-7mcg/ml
Neb: 15mcg/2mL
1-4 puffs inh Q12h 640mcg Subcategory: COPD (Obstructive) $8 - $11 Tier 2D
Flovent
DPI: 100, 250mcg/blister 2mL via neb Q12h 30mcq Subcategory: COPD (Obstructive) $17 Tier 3D
MDI: 40, 110, 220mcg/spray Long Acting Beta2 Agonist. (formerly
Tier 2D)
DPI:1-2 puffs inh Q12h DPI: 1000mcg Subcategory: COPD (Obstructive) $11
MDI: 2 puffs inh Q12h MDI: 880mcg Inhaled steroid: Rinse mouth after use Tier 3D
(formerly
Tier 2D)

Generic Brand/Available Form Dose Max/Day Comments Cost/Day Tier
$14 - $22 Tier 3D
ProCare HospiceCare Preferred Drug ListPulmonary Disease (continued)

Fluticasone/51Advair Diskus,Advair HFA 1 puff inh 500/50 1 Subcategory: COPD (Obstructive)
Salmeterol DPI: 100/50, 250/50, 500/50mcg/blister Q12h puff BID Inhaled steroid: Rinse mouth after use
MDI: 45/21, 115/21, 230/21mcg Not for acute attacks; dosage for
COPD

Formoterol Perforomist, Foradil Neb: 2mL via Neb: 40mcg Subcategory: COPD (Obstructive) $16 Tier 3D
Neb: 20mcg/2mL neb inh Q12h DPI: 2 caps Long acting Beta2 agonist (formerly
DPI: 12mcg/cap DPI: 1 cap inh Tier 2D)
Q12h Neb: 6 vials
Levalbuterol Xopenex, HFA MDI: 12 Subcategory: COPD (Obstructive) $8 Tier 3D
Neb: 0.31, 0.63 (0.021%), 1.25mg/3mL (0.042%) Neb: 1-2 vials puffs (nebulizer)
MDI: 45mcg/spray via neb TID $2 (inhaler)
PRN 50mcg inh
Salmeterol Serevent Diskus MDI: 2 puffs Q12h Subcategory: COPD (Obstructive) $13 Tier 3D
Tiotropium DPI: 50mcg/blister inh Q4-6h PRN 1 inhalation Long acting Beta2 Agonist $18 Tier 3D

Spiriva 1 puff inh Avoid combination with Combivent or Tier 1
Q12h DuoNeb

1 cap inh daily

Hepatic Disease

Bumetanide Bumex 0.5-10mg/day 10mg Monitor for hypokalemia; administer ¢ - $1
Tablet: 0.5, 1, 2mg daily BID last dose before 4pm

Generic ProCare HospiceCare Preferred Drug ListBrand/Available FormDoseMax/DayComments Cost/Day Tier
Cholestyramine $1- $2 Tier 1D
Furosemide52 Questran Hepatic Disease (continued) Dissolved in juice or water; ¢ Tier 1
Metolazone Powder, pkt: 4g cholestyramine / 9g powder promotes formed stools; $1 Tier 1
Powder, scoop: 4g cholestyramine / 9g powder 4g 1-4x daily 24g useful in C.diff
Spironolactone Lasix Monitor for hypokalemia $1 Tier 1
Tablet: 20, 40, 80mg 10-160mg 600mg Anuria: contraindicated
Torsemide Solution, oral: 10mg/mL, 40mg/5mL daily-BID 20mg $1- $3 Tier 1
Lactulose Zaroxolyn Not a potent diuretic alone; used in $3 Tier 2
Tablet: 2.5, 5, 10mg 2.5-20mg conjunction with Lasix or Bumex;
Neomycin daily administer 30min prior to dose of $10 - $30 Tier 2D
Lasix or Bumex
Aldactone 20-200mg 400mg Potassium sparing, especially useful with
Tablet: 25, 50, 100mg daily ascites or CHF, prevents third spacing;
may cause constipation and hypotension
Demadex 10-200mg 200mg CrCl <10: contraindicated; anuria,
Tablet: 5, 10, 20, 100mg daily acute renal impairment: contraindicated
60mL Thiazide diuretic. May cause hypokalemia.
Constulose, Enulose, Generlac, Kristalose 15-30mL (constipation)
Solution, oral: 10g/15mL daily BID Reserve for patients with high ammonia
Pwdr Pkt (BRAND): 10g/packet (30s), levels
20g/packet (30s) 1000-3000mg PO 12000mg
Q6h x 5-6 days Renal impairment: Decrease dose
Neo-Fradin
Tablet: 500mg

Generic Brand/Available Form Dose Max/Day Comments Cost/Day Tier
ProCare HospiceCare Preferred Drug List
Hepatic Disease (continued)
53
Aminocaproic Amicar 1-3g Q6hr 30gm May give loading dose $32 - $64 Tier 3D
acid Tablet: 500, 1000mg $50 (formerly
Tier 1D)
Rifaximin Xifaxan 550mg PO BID 1100mg Reduces urease-producing bacterial flora,
Tablet (BRAND): 200, 550mg decreasing ammonia production Tier 3D

Parkinson’s Disease

Amantadine Symmetrel 100mg BID 400mg Anticholinergic side effects $2 Tier 1D
Capsule: 100mg CrCl 30-50: 200mg x1, then 100mg Qday;
Benztropine Tablet: 100mg 1mg BID 6mg CrCl 15-29: 200mg x1, then 100mg Q48h; $1 Tier 1
Bromocriptine Syrup: 50mg/5mL 2.5mg daily 4mg (elderly) CrCl<15: 200mg Q7 days $3 Tier 1D
Anticholinergic side effects
Carbidopa/ Cogentin 100mg
Levodopa Tablet: 0.5, 1, 2mg Give with food
Selegiline
Parlodel 25/100 TID 200/2000 Dyskinesia side effects $2 - $4 Tier 1D
Tablet: 2.5mg 5mg BID 10mg CrCl <50: decr. dose 0-50%
Capsule: 5mg $4 - $5 Tier 1D
Give w/breakfast and lunch
Sinemet
Tablet: 10/100, 25/100, 25/250
Tablet, ER: 25/100, 50/200

Eldepryl
Capsule: 5mg
Tablet: 5mg

Generic ProCare HospiceCare Preferred Drug ListBrand/Available FormDoseMax/DayCommentsCost/DayTier
Carbidopa/ $12 -$20 Tier 2D
Levodopa/54 Parkinson’s Disease (continued)
Entacapone $7 - $15 Tier 2D
Stalevo Based on 8 tabs Swallow tablet whole; do not $6 - $9 (Formerly Tier 1D
Entacapone 12.5: Carbidopa 12.5mg, levodopa 50mg, and therapeutic (6 tabs of crush, chew or break. Tier 2D (Formerly
Pramipexole entacapone 200mg response 200 Separate dosing from iron $7 Tier 1D)
18.75: Carbidopa 18.75mg, levodopa 75mg, and strength) supplements and multivitamins XR: $6 - $12 ER Tablet:Tier 3D
Quetiapine entacapone 200mg with minerals
25: Carbidopa 25mg, levodopa 100mg, and IR:Tier 2
entacapone 200mg XR:Tier 3D
31.25: Carbidopa 31.25mg, Levodopa 125mg,
and entacapone 200mg
37.5: Carbidopa 37.5mg, levodopa 150mg, and
entacapone 200mg
50: Carbidopa 50mg, levodopa 200mg,
and entacapone 200mg

Comtan 200mg 1600mg Give with levo/carbidopa dose
Tablet: 200mg 4x daily

Mirapex 0.125mg 4.5mg Only adjust dosage Q5days
Tablet: 0.125, 0.25, 0.5, 0.75, 1, 1.5mg TID CrCl 35-59: start 0.125mg bid,
Tablet, ER (BRAND): 0.375, 0.75, 1.5, 3, 4.5mg max 1.5mg BID;
CrCl 15-34: start 0.125mg Qday,
max 1.5mg
Qday; CrCl <15: not defined

Seroquel, Seroquel XR 25-50mg 800mg Preferred in Parkinson’s disease
Tablet: 25, 50, 100, 200, 300, 400mg Q8-12h
Tablet, XR: 50, 150, 200, 300, 400mg

Generic Brand/Available Form Dose Max/Day Comments Cost/Day Tier
Ropinirole
Requip
Tablet: 0.25, 0.5, 1, 2, 3, 4, 5mg
Tablet, ER: 2, 3, 4, 6, 8, 12mg
ProCare HospiceCare Preferred Drug ListParkinson’s Disease (continued)

55 3-6mg TID 24mg Give with food $8 - $15 Tier 2D
(Formerly1D)

ER Tablet:
Tier 3D

Cholestyramine Questran Renal Disease Dissolved in juice or water; $3 - $6 Tier 1
Powder, pkt: 4g cholestyramine/9g powder 4g 1-4x daily 24g promotes formed stools; useful in Tier 1
Methadone (CII) Powder, scoop: 4g cholestyramine/9g C.diff Tier 1
powder Tier 3D
Paroxetine Individualized N/A Excellent for nociceptive and ¢ Tier 3D
Dolophine neuropathic pain and for patients $2
Epoetin Solution, oral, as hydrochloride: 5mg/5mL; 10-40mg daily 50mg with renal or hepatic impairment;
Oxycodone SR 10mg/5mL 40mg (elderly, call clinical pharmacist for dosage
(CII) Tablet: 5, 10mg renal/hepatic)
Useful if renal, opioid, or hepatic
Paxil induced itch
Tablet: 10, 20, 30, 40mg
Tablet, ER: 12.5, 25, 37.5mg 50-100 1500 units/kg Monitor for thrombotic side effects $3 - $52
Suspension: 10mg/5mL DO NOT CRUSH; non-preferred $4 - $28
units/kg 3x/wk 3x /week
Procrit, Epogen
Injection: 2000-10000 units/mL Dosed N/A
Q12h
Oxycontin
Tablet, ER/CR: 10, 15, 20, 30,40, 60, 80mg

Generic ProCare HospiceCare Preferred Drug ListBrand/Available FormDose Max/DayCommentsCost/DayTier

56 SYMPTOM MANAGEMENT ¢ - $2 Tier 1
Anorexia
$2 - $3 Tab:Tier 1
Dexamethasone Decadron 2-16mg 40mg GI upset, use with caution for patients with diabetes Soltab: $5 Soltab:Tier 3
Solution, oral: 1mg/mL BID due to resultant hyperglycemia. Give
Mirtazepine Tablet: 0.25, 0.5, 0.75, 1, 1.5, 2, 4, 6mg last dose by 2pm to avoid steroid-induced insomnia.

Prednisone Remeron, Remeron SolTab 7.5-30mg 45mg Also expected to improve sleep and mood
Tablet: 7.5, 15, 30, 45mg QHS
Cyproheptadine SolTab (ODT): 15, 30, 45mg
5-80mg 80mg GI upset, use with caution in patients with diabetes ¢ Tier 1
Megestrol Deltasone 4 x daily
Acetate Solution, oral: 1mg/mL
Tablet: 1, 2.5, 5, 10, 20, 50mg 4mg daily- 16mg Administer at bedtime to start $1.50 Tier 2
4x daily
Periactin
Solution, oral: 2mg/5ml 400- 800mg Promotes clot formation especially in $11 Tier 3
Tablet: 4mg 800mg nonambulatory
daily
Megace
Suspension, oral, as acetate: 40mg/mL
ES (BRAND): 125mg/mL
Tablet: 20, 40mg

Anxiety/Agitation

Alprazolam Xanax 0.25-1mg 4mg May be given PO or SL; avoid or reduce dose in $2 Tier 1
(CIV) Tablet: 0.25, 0.5, 1, 2mg Q4-6h patients with liver disease
Tablet, ER: 0.5, 1, 2, 3mg ODT/ER:
ODT: 0.25, 0.5, 1, 2mg Tier 3
Solution, oral: 1mg/mL

Generic Brand/Available Form Dose Max/Day Comments Cost/Day Tier
ProCare HospiceCare Preferred Drug ListChlorpromazine$4Tier 1
Thorazine Anxiety/Agitation (continued) $2
57Clonazepam Tablet: 10, 25, 50, 100, 200mg $1 Tier 1
(CIV) 10-50mg 1000mg May be given PO, SL, PR; more sedating; avoid in $2 ODT:
Klonopin Q4-6h patients with Parkinson’s disease Tier 3
Diazepam (CIV) Tablet: 0.5, 1, 2mg May cause orthostatic hypotension $1 Tier 1
ODT wafer: 0.125, 0.25, 0.5, 1, 2mg
Divalproex Anxiety: 4mg Long-acting benzodiazepine; should not be used Tier 1
Sodium Valium 1mg/day (anxiety) in combo with short-acting benzodiazepine
Tablet: 2, 5, 10mg Seizure: 0.5mg TID 20mg Tier 1
Haloperidol Solution, oral: 5mg/5mL, 5mg/mL and titrate (seizure)
Depakote, Depakote Sprinkles Tier 1
Hydroxyzine Tablet, DR: 125, 250, 500mg 2-10mg May be given PO, SL, PR; long half-life; use with
Tablet, ER: 250, 500mg Q6-12h caution in elderly w/ liver disease; DIASTAT
Capsule, DR: 125mg RECTAL GEL: NON-FORMULARY

Haldol 15mg/kg/day 60mg/kg/day Give with food; may open and sprinkle capsules
Tablet:0.5, 1, 2, 5, 10, 20mg on food. Divalproex sodium ER and DR tabs not
Solution as lactate, oral: 2mg/mL bioequivalent; incr. total daily dose by 8-20% if
Solution, injection as lactate: 5mg/mL switching from DR tab to ER tab.
Atarax,Vistaril Hepatic dz/significant impairment: contraindicated
Capsule as pamoate:25, 50, 100mg
Tablet, HCl: 10, 25, 50mg 0.5-5mg 100mg Can be given PO, SL, PR, IM; useful when
Solution, oral: 10mg/5mL Q6-12h benzodiazepines fail; do not use in patients with
Parkinson’s; low sedation

10-50mg 600mg May cause drowsiness; use with caution in the $3
Q4-6h elderly; useful in patients with Parkinson’s

ProCare HospiceCare Preferred Drug ListGenericBrand/Available FormDoseMax/DayCommentsCost/DayTier
$2 Tier 1
58 Anxiety/Agitation (continued)

Lorazepam Ativan 0.5-2mg 10mg Intermediate-acting benzodiazepine; may be given
(CIV) Tablet: 0.5, 1, 2mg Q4-6h PO, SL, PR, SQ, IM; reduce dose if liver disease
Solution, oral: 2mg/mL present
Oxazepam Solution, injection: 2mg, 4mg/mL
(CIV) 10mg 60mg/kg/day Intermediate-acting benzodiazepine; may cause $3 Tier 1
Phenobarbital Serax Q8-14h paradoxical reaction in the elderly $1 Tier 1
(CIII) Capsule: 10, 15, 30mg 60-100mg 60mg May be given PO, PR, IM; long half-life allows less
daily BID-TID 800mg frequent dosing $3 Tier 1
Valproic Acid Luminal 16mg CrCl <10: give Q12-16h
Tablet: 15, 16, 30, 32, 60, 65, 97, 100mg 250mg Drug levels required for seizures only; DO NOT $2 - $3 Tier 2
Elixir: 20mg/5mL QHS x 7 days, CRUSH ER FORMS; Depakene may be given $7 IR:Tier 2
then 500mg rectally XR: $6 - XR:Tier 3
Depakene QHS $12 Tier 2
Syrup, as valproic acid: 250mg/5mL 20 - 30mg/day Start: 7.5mg PO BID, then incr. 5mg/day Q2-3 $7 - $21
Capsule, as valproic acid: 250mg BID-TID days; Severe renal/hepatic impairment: Avoid Use
25-50mg Preferred in Parkinson’s disease
Buspirone Buspar Q8-12h
Quetiapine Tablet: 5, 7.5, 10, 15, 30mg Preferred atypical antipsychotic
1-3mg BID
Risperidone Seroquel, Seroquel XR
Tablet: 25, 50, 100, 200, 300, 400mg
Tablet, XR: 50, 150, 200, 300, 400mg

Risperdal
Tablet: 0.25, 0.5, 1, 2, 3, 4mg
Solution, oral: 1mg/mL
ODT: 0.25, 0.5, 1, 2, 3, 4mg

Generic Brand/Available Form Dose Max/Day Comments Cost/Day Tier
Olanzapine
Paliperidone Zyprexa, Zyprexa Zydis Tier 3
Tablet: 2.5, 5, 7.5, 10, 15mg, 20mg (Formerly
ODT: 5, 10, 15, 20mg Tier 2)
Invega Tier 3
Tablet, ER: 1.5, 3, 6, 9mg
ProCare HospiceCare Preferred Drug ListAnxiety/Agitation (continued)

59 2.5-5mg 20mg May cause hyperglycemia; risperidone is $13 - $39
daily preferred ODT:
$21 -$40

6mg daily 12mg Non-preferred, structurally similar to risperidone. $19
CrCl 50-79: start 3mg Qam; max 6mg/day;
CrCl 10-49: start 1.5mg Qam; max 3mg/day

Oxybutynin Ditropan, Ditropan XL IR: 2.5mg Bladder Spasm $2 IR:Tier 1
Tolterodine Syrup: 5mg/5mL Q8-12hr Patch: $10 XL:Tier 2
Tablet, IR: 5mg XL: 5-15mg IR: 20mg Subcategory: Bladder Cancer
Tablet, XL: 5, 10, 15mg daily ER: 30mg Geriatric dose is 2.5mg BID Patch:Tier 3
Transdermal Patch: 3.9mg/day
4mg/day 4mg Subcategory: Bladder Cancer $6 Tier 2
Detrol 2mg (renal) CrCl <30: 1mg BID LA:Tier 3
Tablet: 1, 2mg
Capsule, LA: 2, 4mg

Congestion

Diphenhydramine Benadryl 25-100mg 400mg Use with caution in elderly patients; causes ¢ Tier 1
Capsule/Tablet: 25, 50mg QHS and/or confusion/drowsiness/dizziness; will not affect
Elixir: 12.5mg/5mL Q4-6h PRN blood pressure

Generic ProCare HospiceCare Preferred Drug ListBrand/Available FormDoseMax/DayCommentsCost/Day Tier
Guaifenesin $2 Tier 1
60 Congestion (continued) Subcategory: COPD (Obstructive),
NaCl 0.9% sterile Other (Restrictive/Neoplastic)
for inhalation Robitussin 10-30mL Q4h 2400mg SVN only – No inhalers unless has
Oxymetazoline Tablet: 200, 400mg obstructive component.
Pseudoephedrine Liquid: 100mg/5mL Monitor for agitation and hypokalemia;
Solution, oral: 100mg/5mL, 100mg/6.25mL may be used to treat hyperkalemia.
Guaifenesin LA Solution, oral drops: 50mg/mL Subcategory: COPD (Obstructive)
Bisacodyl Fluid intake is encouraged
Bronchosaline 3mL Q4h 150meq Do not use for more than 3-5 days; $1 Tier 1
Neb: 0.9% PRN 240mg may cause rebound congestion Tier 1
$5 per
Afrin 2-3 sprays May increase blood pressure or cause bottle Tier 1
Solution, intranasal, as hydrochloride each nostril, agitation; do not take at bedtime due
[spray]: 0.05 % Q12h to drug-induced insomnia $1

Sudafed 30-60mg Subcategory: COPD (Obstructive)
Tablet: 30, 60mg Q4-6h Do not crush; encourage fluid intake
Tablet, ER: 120, 240mg
Syrup: 15, 30mg/5mL 1-2 tabs BID 2400mg Can be used daily or PRN ¢ Tier 2

Mucinex Constipation ¢ - $1 Tier 1
Tablet, ER: 600mg 5-10mg QHS 30mg

Dulcolax
Suppository: 10mg
Tablet: 5mg

Generic Brand/Available Form Dose Max/Day Comments Cost/Day Tier
Stool softener only ¢ Tier 1
Docusate Colace May cause “fatty” appearing stool ¢ Tier 1
ProCare HospiceCare Preferred Drug ListCapsule, as sodium: 50, 100, 250mgConstipation (continued)
Glycerin Liquid: 150mg/15mL
61Suppository Sani-Supp 50-500mg
daily in 1-4
Magnesium Magnesium Citrate divided doses
Citrate Bottle: 300mL
1 supp daily 2 supps
Magnesium Milk of Magnesia
Hydroxide Liquid, oral: 400, 800mg/5mL 1 bottle PRN 300mL May keep chilled in refrigerator; $3/bottle Tier 1
Tablet, chewable: 311mg 300mL= 235meq ¢ Tier 1
Mineral Oil Mineral Oil 15-30mL 60mL Magnesium = 2.8g
daily
Caution in patients with renal
impairment

Psyllium (Fiber) Metamucil 15-45mL/day 118mL Given as an enema only; oral use ¢ Tier 1
Powder: 3.4g per dose divided Q8- 30g may cause pneumonitis ¢ Tier 1
24h ¢ - $1 Tier 1
Use with caution in patients
2 Tbsp. daily - with poor fluid intake; may cause
BID obstruction

Senna Senna 2 tabs BID 8 tablets May cause abdominal cramping
Tablet: 8.6mg when used alone

Generic ProCare HospiceCare Preferred Drug ListBrand/Available FormDoseMax/DayComments Cost/Day Tier

Sennosides/62 Constipation (continued) Typically a first line therapy; should
Docusate Sodium be started in all patients on opioids
Sodium Phosphate Senna S, Senokot S, Senna Plus 1-2 tabs daily 8 tablets May cause electrolyte imbalance ¢ Tier 1
Enema/ $3.65 Tier 1
Bisphosphonate Tablet: docusate 50mg and sennosides 8.6mg Osmotic stool softener
Enema Reserve for patients with high
Sorbitol 70% Soln Fleet Enema 1 enema PR daily 1 enema daily ammonia levels

Lactulose Sorbitol 70% Soln 15-30mL daily 150mL Dissolve in 4-8oz of liquid prior to ¢ Tier 1
Solution, oral: 70% (30mL, 480mL, 3840mL) BID admin. $3 Tier 2
Polyethylene Glycol 15-30mL daily 60mL May take 2-4 days to produce BM
(PEG) 3350 Constulose, Enulose, Generlac, BID (constipation)
Kristalose Swallow caps whole
Benzonatate Solution, oral: 10g/15mL 17g daily Contains alcohol $1 Tier 2
Pwdr Pkt (BRAND): 10g/packet (30s),
Dextromethorphan 20g/packet (30s)

MiraLax OTC
1 bottle: 527g

Cough-Dry; Non-Productive

Tessalon Perles 100mg TID 600mg $4 - $6 Tier 1
Capsule: 100, 200mg $2 Tier 1
5-10mL Q4 PRN 120mg
Delsym (ER) Delsym: 10mL
Liquid: 10mg/5mL, 30mg/5mL (ER) Q12 PRN

Generic Brand/Available Form Dose Max/Day Comments Cost/Day Tier
ProCare HospiceCare Preferred Drug List
Cough-Dry; Non-Productive (continued)
63
Hydrocodone/ Hydromet 5mL Q4-6H 30mL $1 - $5 Tier 1
PRN $2 Tier 1
Homatropine (CIII) Syrup, oral; 5-1.5mg/5mL

Paroxetine Paxil 10-40mg 50mg Mechanism for cough unknown;
Tablet: 10, 20, 30, 40mg daily 40mg (elderly, effective for cough after 1-3 doses
Tablet, ER: 12.5, 25, 37.5mg renal/hepatic)
Suspension: 10mg/5mL

Promethazine/ Phenergan with Codeine 5mL PO 30mL Take with food/water to decrease $2 - $3 Tier 1
Codeine (CV) Syrup, oral; 6.25-10mg/5mL GI upset $0.50 - $1 Tier 1
Q4-6H PRN $2 Tier 1

Cough-Wet; Productive

Guaifenesin/ Robitussin AC, Guaiatussin AC, Iophen 10mL Q4H 60mL Encourage fluid intake,
Codeine C-NR, Cheratussin AC PRN recommend diabetic tussin for
patients with DM
Solution/Syrup oral: 100mg/10mg/5mL

Guaifenesin/ Robitussin DM 10mL 2400mg day Encourage fluid intake,
recommend diabetic tussin for
Dextromethorphan Solution, oral: 100mg/10mg/5mL Q4hr PRN guaifenesin patients with DM

Depression

Citalopram Celexa 10-40mg 40mg Preferred over Lexapro (its $2 Tier 1
Tablet: 10, 20, 40mg QAM $1 Tier 1
Solution, oral: 10mg/5mL 20mg (pts >60 yo) isomer)

Desipramine Norpramin 10-150mg 300mg Also expected to improve sleep
Tablet: 10, 25, 50, 75, 100, 150mg QHS and mood; least anticholinergic
effect; max in elderly is 150mg per
day

ProCare HospiceCare Preferred Drug ListGenericBrand/Available FormDose Max/DayCommentsCost/DayTier

64 Depression (continued)

Dexamethasone Decadron 2-16mg 40mg Subcategory: COPD (Obstructive) ¢ - $2 Tier 1
Solution, oral: 1mg/mL BID GI upset, use with caution for patients with
Tablet: 0.25, 0.5, 0.75, 1, 1.5, 2, 4, 6mg diabetes due to resultant hyperglycemia.
Give last dose by 2pm to avoid steroid-
induced insomnia.
Use in patients with CHF or water retention.

Doxepin Sinequan 10-30mg 300mg Caution in elderly; OK if bedbound; causes $1 Tier 1
Fluoxetine Capsule: 10, 25, 50, 75, 100, 150mg QHS drowsiness
Solution, oral: 10mg/mL
Methylphenidate Prozac 20-60mg 80mg Long half-life; increases risk of falls $2 Tier1
(CII) Tablet: 10, 20mg daily
Capsule: 10, 20, 40mg DR Capsule:
Mirtazepine Capsule, DR: 90mg Tier 3
Nortriptyline Solution, oral: 20mg/5mL
Ritalin 5-10mg 60mg May be used alone or in combination with ¢ - $1 Tier 1
Tablet: 5, 10, 20mg Daily-BID (ER tab/ SSRI or TCA; schedule last dose before 2pm
Tablet, 12-24h ER: 10, 20mg to lessen the risk of drug-induced insomnia; $2 - $3 Tab:Tier 1
Capsule, 24h LA (BRAND): 10, 20, 30, 40mg cap) caution in patients with cardiac issues or SolTab: $5 SolTab:Tier 3
Solution, oral: 5, 10mg/5mL uncontrolled HTN
Remeron, Remeron SolTab 7.5-30mg 45mg Also expected to improve sleep and mood
Tablet: 7.5, 15, 30, 45mg QHS
SolTab (ODT): 15, 30, 45mg Also expected to improve sleep and mood; $1 Tier 1
Pamelor 10-150mg 150mg start at lowest dose possible
Capsule: 10, 25, 50, 75mg QHS
Solution, oral: 10mg/5mL

Generic Brand/Available Form Dose Max/Day Comments Cost/Day Tier
Paroxetine $2 Tier 1
ProCare HospiceCare Preferred Drug ListPaxilDepression (continued)
Prednisone Tablet: 10, 20, 30, 40mg
65 Tablet, ER: 12.5, 25, 37.5mg 10-40mg 50mg Mechanism for cough unknown; effective for
Sertraline Suspension: 10mg/5mL daily 40mg (elderly, cough after 1-3 doses
Trazodone Deltasone renal/hepatic)
Amitriptyline Solution, oral: 1mg/mL
Bupropion Tablet: 1, 2.5, 5, 10, 20, 50mg 5-80mg 80mg Subcategory: COPD (Obstructive) ¢ Tier 1
HCl 4x daily GI upset, use with caution in patients with $2 - $4 Tier 1
Zoloft diabetes due to resultant hyperglycemia.
Tablet: 25, 50, 100mg 25-200mg 200mg Give last dose by 2pm to avoid steroid-induced
Solution, oral: 20mg/mL QAM insomnia. Do NOT use in patients with CHF or
Desyrel water retention (use dexamethasone instead).
Tablet: 50, 100, 150, 300mg
Use lower doses in patients with hepatic
Elavil impairment
Tablet: 10, 25, 50, 75, 100, 125, 150mg
Budeprion SR/XL,Wellbutrin 25-100mg 400mg Useful to treat insomnia ¢ - $1 Tier 1
SR/XL, Zyban QHS (depression)
Tablet: 75, 100mg 200mg (insomnia) Also expected to improve sleep and mood; ¢ - $1 Tier 2
Tablet, SR (12H): 100, 150, 200mg 10-15mg increases risk of falls $3 - $4 Tier 2
Tablet, XL (24H): 150, 300mg QHS 300mg ER Form: Do not cut/crush/chew
Severe cirrhosis: max 75mg/day, 100mg ER daily,
IR: 100mg TID IR: 150mg/dose or 150mg ER Q48h
SR, 12H: 450
150mg BID SR: 400mg
XL, 24H: XL: 450mg
300mg QAM

Generic ProCare HospiceCare Preferred Drug ListBrand/Available FormDoseMax/DayCommentsCost/Day Tier
Duloxetine
Venlafaxine66 Cymbalta Depression (continued)
Capsule, DR (BRAND): 20, 30, 60mg
Bismuth 60mg daily 120mg Useful to treat neuropathic pain $6 Tier 2
Subsalicylate Do not cut/crush/chew/sprinkle $3 - $4 Tier 2
Cholestyramine Effexor IR: 37.5 - 75mg IR: 375mg CrCl <30: avoid use
Diphenoxylate/ Tablet: 25, 37.5, 50, 75, 100mg BID-TID ER: 225mg
Atropine (CV) Tablet, ER: 37.5, 75, 150, 225mg ER: 75 - 225mg Give with food
Capsule, ER: 37.5, 75, 150mg daily 8 tabs Do not cut/crush/chew ER form
Loperamide Diarrhea/Gas CrCl 10-70: decr. Dose 25-50%
Pepto Bismol, Kaopectate 524mg Q 30-60 24g CrCl <10: decr. Dose 50%
Tablet, chewable: 262mg min PRN
Liquid, oral: 262mg/15mL 20mg May cause stool to appear ¢ - $2 Tier 1
4g 1-4x daily (diphenoxylate Tier 1
Questran component) black/tarry Tier 1
Powder, pkt: 4g cholestyramine/9g powder 5mg
Powder, scoop: 4g cholestyramine/9g powder (diphenoxylate 16mg Avoid when C.diff infection present
component)
Lomotil 1-4x daily PRN Dissolved in juice or water; $1 - $2
Tablet: Diphenoxylate hydrochloride 2.5mg and promotes formed stools; useful
atropine sulfate 0.025mg 4mg x1 in C.diff
Solution, oral: Diphenoxylate hydrochloride 2.5mg And then
and atropine sulfate 0.025mg/5mL 2mg PRN Avoid when C.diff infection $1 - $5
present
Imodium
Capsule/Tablet: 2mg Avoid when C.diff infection ¢ - $1 Tier 1
Solution, oral, as hydrochloride: 1mg/5mL, 1mg/7.5mL present

Generic ProCare HospiceCare Preferred Drug ListBrand/Available FormDoseMax/DayCommentsCost/Day Tier
Simethicone ¢ Tier 1
67 Mylicon Diarrhea/Gas (continued) Opium Tincture contains 25 times
Opium Tablet, chewable: 80mg, 125mg 40-125mg 4x daily 500mg more morphine than paregoric $3 - $13 Tier 2
Tincture Softgel: 125mg, 166mg, 180mg (Formerly
(CIII) Suspension, oral drops: 40mg/0.6mL (30mL) Doses Subcategory: COPD (Obstructive), Tier 1)
expressed in mg: Other (Restrictive/Neoplastic) Monitor
Thick-It Opium Tincture 6mg of undiluted for agitation
Tincture 10%, oral: w/ anhydrous morphine opium tincture May be used to treat hyperkalemia
Albuterol 10mg/mL [0.6mL = to morphine 6mg; contains (10mg/mL) 4x daily May be given PO or SL; avoid or
ethanol 19%] reduce dose in patients with liver
Alprazolam disease
(CIV) Dysphagia

Thickening Agent 1-4 TBSP None $2 Tier 1
8oz can
$3 Tier 1
Dyspnea/Shortness of Breath
$2 Tier 1
Proventil,Ventolin Neb: 1 vial via Neb: 10mg ODT/ER:
Neb: 2.5mg/3mL (0.083%), 5mg/mL (0.5%) neb Q1-4h PRN MDI: 12 Tier 3
MDI: 90mcg/spray MDI: 2 puffs puffs
Q4-6h PRN
Xanax
Tablet: 0.25, 0.5, 1, 2mg 0.25-1mg 4mg
Tablet, ER: 0.5, 1, 2, 3mg Q4-6h
ODT: 0.25, 0.5, 1, 2mg
Solution, oral: 1mg/mL

Generic ProCare HospiceCare Preferred Drug ListBrand/Available FormDoseMax/DayCommentsCost/Day Tier
Dexamethasone
68 Dyspnea/Shortness of Breath (continued)
Ipratropium
Decadron 2-16mg BID 40mg GI upset, use with caution for patients ¢ - $2 Tier 1
Ipratropium/ Solution, oral: 1mg/mL with diabetes due to resultant
Albuterol Tablet: 0.25, 0.5, 0.75, 1, 1.5, 2, 4, 6mg hyperglycemia. Give last dose by 2pm
to avoid steroid-induced insomnia.

Atrovent Neb: 1 vial via Neb: 6 doses Subcategory: COPD (Obstructive) $5 Neb:Tier 1
Neb: 0.5mg/2.5ml (0.02%) neb MDI: 12 puffs Neb mixed with albuterol neb is stable
MDI: 17mcg/spray Q6-8h PRN MDI:
MDI: 2 puffs for 1 hour. Tier 3
inh QID

DuoNeb, Combivent Neb: 3mL inh Neb: 6 doses Subcategory: COPD (Obstructive), $6 Neb:
Neb: 0.5mg/2.5mg/3mL QID MDI: 12 puffs Other (Restrictive/Neoplastic) TMieDr I1: D
MDI: 18mcg/90mcg/spray MDI: 1-2 puffs MDI: Tier 3
inh QID $14.07

Lorazepam (CIV) Ativan 0.5-2mg 10mg Fear/anxiety-induced n/v Intermediate- $2 Tier 1
Tablet: 0.5, 1, 2mg Q4-6h acting benzodiazepine; may be given $2 Tier 1
Morphine (IR) Solution, oral: 2mg/mL PO, SL, PR, SQ, IM; reduce dose if liver $1 Tier 1
(CII) Solution, injection: 2mg, 4mg/mL Q2h PRN N/A disease present

NaCl 0.9% sterile MSIR, Roxanol 3mL Q4h PRN 150meq Dosage for SOB is 5-10mg Q2h PRN
for inhalation Tablet: 15, 30mg SubQ: 5-15mg SubQ Q2-4h PRN
Solution, oral: 10mg/5mL, 20mg/5mL, 20mg/mL CrCl 10-50: decr. Dose 25%;
Solution, injection as sulfate: 15mg/mL CrCl <10: decr. Dose 50%

Bronchosaline Subcategory: COPD (Obstructive)
Neb: 0.9% Fluid intake is encouraged

ProCare HospiceCare Preferred Drug ListGenericBrand/Available FormDoseMax/DayCommentsCost/Day Tier
$2.50 Tabs Tier 1
69Oxycodone (IR) OxyIR, Oxydose, Dyspnea/Shortness of Breath (continued)
(CII) – (Morphine Roxicodone
intolerant) Tablet: 5, 15, 30mg Dosed Q2hr N/A Dosage for SOB is 5-10mg Q2h PRN; preferred for
Prednisone Capsule: 5mg PRN patients with severe renal impairment
Deltasone
Bumetanide Solution, oral: 1mg/mL 5-80mg 80mg GI upset, use with caution in patients with diabetes ¢ Tier 1
Tablet: 1, 2.5, 5, 10, 20, 50mg 4x daily Tier 1
Tier 1
Bumex Edema Tier 1
Tablet: 0.5, 1, 2mg
0.5-10mg/day 10mg Subcategory: Congestive Heart Failure , Abdominal ¢
daily BID Aortic Aneurysm (AAA), Severe Aortic Stenosis w/CHF ¢
Therapeutic Class: Diuretics (loop) $1
10-160mg Monitor for hypokalemia; administer last dose
daily-BID before 4pm

Furosemide Lasix 12.5-50mg 600mg Subcategory: Congestive Heart Failure, Severe Aortic
Tablet: 20, 40, 80mg daily Stenosis w/CHF, Abdominal Aortic Aneurysm (AAA)
Solution, oral: 10mg/mL, Therapeutic Class: Diuretics (loop)
40mg/5mL Monitor for hypokalemia
Anuria: contraindicated

Hydrochlorothiazide Microzide, Hydrodiuril 200mg Subcategory: Abdominal Aortic Aneurysm (AAA),
Tablet: 25, 50mg
Capsule: 12.5mg Severe Aortic Stenosis w/CHF, Congestive Heart Failure
Therapeutic Class: Diuretics (thiazide)

Anuria: contraindicated

ProCare HospiceCare Preferred Drug ListGenericBrand/Available FormDoseMax/DayCommentsCost/DayTier
Metolazone $2 Tier 1
70 Zaroxolyn Edema (continued)
Tablet: 2.5, 5, 10mg $1 Tier 1
2.5-20mg 20mg Subcategory: Congestive Heart Failure,
daily Abdominal Aortic Aneurysm (AAA), Severe
Aortic Stenosis w/CHF
Therapeutic Class: Diuretics (thiazide)
Not a potent diuretic alone; used in conjunction
with Lasix or Bumex; administer 30min prior to
dose of Lasix or Bumex

Potassium K-Dur, Klor-Con 20meq 100meq May cause diarrhea, nausea, vomiting or abdominal
Chloride Capsule, XR: 8, 10meq 2-5x daily pain
Tablet, ER: 8, 10, 15, 20meq
Spironolactone Solution, oral: 20, 40meq/15mL 20-200mg 400mg Subcategory: Congestive Heart Failure, Severe $1 Tier 1
daily Aortic Stenosis w/CHF, Abdominal Aortic Tier 2
Aldactone Aneurysm (AAA)
Tablet: 25, 50, 100mg Therapeutic Class: Diuretics (potassium
sparing)
Especially useful with ascites, prevents third spacing;
may cause constipation and hypotension
CrCl <10: contraindicated; anuria, acute renal
impairment: contraindicated

Triamterene/ Maxzide, Dyazide 25mg/37.5mg 75/50mg Triamterene is a potassium sparing diuretic ¢
HCTZ Tablet: 25/37.5, 50/75mg daily
Capsule: 25/37.5mg

Generic ProCare HospiceCare Preferred Drug ListBrand/Available FormDoseMax/DayCommentsCost/Day Tier
Benztropine $1 Tier 1
Diphenhydramine71Cogentin Extrapyramidal Symptoms ¢ Tier 1
Acetaminophen Tablet: 0.5, 1, 2mg
0.5-2mg BID 6mg May cause sedation
Aspirin Benadryl
Ibuprofen Capsule/Tablet: 25, 50mg 4mg (elderly)
Elixir: 12.5mg/5mL
25-100mg 400mg Use with caution in elderly patients; causes
Tylenol QHS and/or confusion/drowsiness dizziness; will not affect
Tablet: 325, 500mg Q4-6h PRN blood pressure
Tablet, chewable: 80, 160mg
Caplet/Geltab: 500mg Fever
Caplet/Geltab, extended release: 650mg
Liquid, oral: 500mg/15mL, 160mg/5mL 500-1000mg 4000mg Max of 3000mg for elderly. ¢ - $3 Tier 1
Suppository: 120, 650mg Q4-6h Max of 2000mg for patients with hepatic
impairment.
Bayer, Ecotrin
Tablet: 81, 325, 500, 650mg 325-650mg 4000mg Monitor for antiplatelet effects ¢ Tier 1
Supp: 300, 600mg Q4hr PRN ¢ Tier 1
Take with food/milk; may cause GI
Motrin, Advil 400-800mg 3200mg upset; monitor concomitant use with
Tablet: 200mg [OTC], 400, 600, 800mg Q6h cor ticosteroids
Capsule/Gelcap: 200mg [OTC] Caution if cardiovascular dz, CHF, HTN
Suspension: 100mg/5mL
Drops, oral: 40mg/mL
Chewable: 50, 100mg

Generic ProCare HospiceCare Preferred Drug ListBrand/Available FormDoseMax/DayCommentsCost/Day Tier
Naproxen
72 Fever (continued)
Aluminum/
Magnesium Naprosyn 250-500mg 1500mg 250mg naproxen= 275mg $1 Tier 1
Aluminum/ Tablet: 250, 375, 500mg BID naproxen sodium
Magnesium/ Suspension: 125mg/5mL CrCl <30: avoid use
Simethicone
Gastrointestinal Irritation/Colic
Calcium
Carbonate Gaviscon 5-10mL daily Avoid use in end stage renal disease $1 Tier 1
Aluminum hydroxide 8mg and magnesium trisilicate PRN
Dicyclomine 20mg

Mylanta, Maalox 15-30mL Avoid use in end stage renal disease $2 Tier 1
Liquid: Aluminum hydroxide 200mg, magnesium 4x daily PRN
hydroxide 200mg, and simethicone 20mg per 5mL
(360mL); Aluminum hydroxide 400mg, magnesium
hydroxide 400mg, and simethicone 40mg/5mL (360mL)
Tablet, chewable: Aluminum hydroxide 200mg,
magnesium hydroxide 200mg and simethicone 25mg

Tums, Rolaids 1-2 Qday 7000mg May cause constipation ¢ Tier 1
Tums: 500mg PRN (as an
Tums E-X: 750mg antacid)
Tums Ultra: 1000mg

Bentyl 10-20mg 160mg Anticholinergic; may cause urinary $1 Tier 1
Tablet: 20mg Q6-8h retention or blurry vision
Capsule: 10mg
Solution, oral: 10mg/5mL

Generic ProCare HospiceCare Preferred Drug ListBrand/Available FormDoseMax/DayCommentsCost/DayTier
Famotidine
Nizatidine73 Gastrointestinal Irritation/Colic (continued)
Omeprazole
Ranitidine Pepcid 20mg BID 40mg CrCl <50: decr. dose 50% or give $1 Tier 1
Tablet: 10, 20, 40mg
Sucralfate Suspension: 40mg/5mL 20mg (renal) Q36-48h
Lansoprazole
Axid 150mg BID 300mg CrCl 20-50: 150mg daily 6 Tier 1
Capsule: 150, 300mg CrCl <20: 150mg Q48h
Solution, oral: 15mg/mL

Prilosec 20mg 360mg OTC form is preferred; RX $1 OTC:Tier 1
Tablet and Capsule [OTC], delayed release: 20mg OMEPRAZOLE IS NON- Rx:Tier 3
Capsule, delayed release: 10, 20, 40mg Daily to BID FORMULARY - USE OTC.
$3 Tier 1
Zantac 150mg 300mg Well tolerated; may be crushed
Tablet, as hydrochloride: 75mg [OTC], 150mg [OTC], QHS or BID CrCl <50: 150mg daily
300mg IM/IV: CrCl <10: 75-150mg daily
Solution, oral: 15mg/mL 50mg Q6-8h
Capsule: 150mg, 300mg
Solution, injection: 50mg/2mL

Carafate 1g 4x daily 6g Can be constipating; shake well; $3 Tier 1
Tablet: 1g drug interaction with proton pump
Suspension: 1g/10mL inhibitors and other antacids; Give
1h before meals, bedtime

Prevacid, Prevacid SoluTab, Prevacid OTC 30mg PO 180mg Reserve for patients unable to OTC: OTC:Tier 2
Capsule, delayed release: 15, 30mg daily swallow or NPO $1-$2 Rx:Tier 3
Suspension: 15mg/5mL (150mL, 300mL) Rx: $5
Tablet, ODT: 15, 30mg

ProCare HospiceCare Preferred Drug ListGenericBrand/Available FormDoseMax/DayCommentsCost/Day Tier
Gout
74Allopurinol Zyloprim 100-300mg CrCl 10-20: 200mg daily; CrCl 3-10: 100mg daily or ¢ - $1 Tier 3
Colchicine Tablet: 100, 300mg daily 800mg 300mg 2x/wk $6 - $12 Tier 3
0.6mg daily-BID
Colcrys 1.2mg CrCl less than 30: 0.3mg/day
Tablet: 0.6mg Dialysis: 0.3mg BID

Baclofen Lioresal 5-15mg TID Hiccups May lower seizure threshold $1 - $2 Tier 1
Chlorpromazine Tablet: 10, 20mg 80mg
Thorazine
Metoclopramide Tablet: 10, 25, 50, 100, 200mg 10-50mg 1000mg May be given PO, SL, PR; more sedating; avoid in $4 Tier 1
Q4-6h patients with Parkinson’s disease $1 Tier 1
Reglan 5-10mg May cause orthostatic hypotension
Tablet: 5, 10mg 4x daily $5 Tier 3
Solution, oral: 5mg/5mL 60mg Gastric stasis-induced n/v
BID 30mg (elderly) Avoid in patients with Parkinson’s; monitor for EPS
and agitation; Decr. dose 50% in elderly pts; give
30min before meals.
CrCl 41-50: decr. dose 25%
CrCl 10-40: decr. dose 50%

Hyperglycemia

Intermediate Novolin 70/30, Individualized
Acting Insulin Humulin 70/30
Daily Individualized Basal Insulin $5 Tier 3
Long Acting Insulin Lantus
PRN Individualized BGM divided by 3 minus 3 equals dose for coverage $5 Tier 3
Short Acting Novolin R, Humulin R
Insulin

Generic ProCare HospiceCare Preferred Drug ListBrand/Available FormDoseMax/DayCommentsCost/Day Tier
Clonazepam
(CIV)75 Klonopin Insomnia $2 Tier 1
Tablet: 0.5, 1, 2mg ODT:
Diphenhydramine ODT wafer: 0.125, 0.25, 0.5, 1, 2mg Anxiety: 1mg/day 4mg (anxiety) Long-acting benzodiazepine; should not be used Tier 3

Melatonin Benadryl Seizure: 0.5mg 20mg in combo with short-acting benzodiazepine ¢ Tier 1
Mirtazepine Capsule/Tablet: 25, 50mg
Elixir: 12.5mg/5mL TID and titrate (seizure)
Temazepam Tablet: 1.3mg
(CIV) 25-100mg 400mg Use with caution in elderly patients; causes ¢ Tier 1
Trazodone Remeron, Remeron SolTab QHS and/or 5mg confusion/drowsiness/dizziness; will not affect
Tablet: 7.5, 15, 30, 45mg Q4-6h PRN blood pressure
Triazolam (CIV) SolTab (ODT): 15, 30, 45mg
Zolpidem (CIV) Restoril 0.3-5mg QHS 3 to 4 hours before an imposed sleep period
Capsule: 7.5, 15, 22.5 (BRAND), 30mg over 4 weeks
Desyrel 7.5-30mg 45mg $2-$3 Tab:Tier 1
Tablet: 50, 100, 150, 300mg QHS Also expected to improve sleep and mood Soltab: $5 SolTab:
Tier 3
Halcion 15-30mg QHS 30mg 7.5mg capsule is NON- FORMULARY $1
Tablet: 0.125, 0.25mg Tier 1
Ambien, Ambien CR
Tablet: 5, 10mg 25-100mg QHS 400mg Useful to treat insomnia ¢ - $1 Tier 1
Tablet, CR: 6.25, 12.5mg (depression)
0.125-0.25mg 200mg Short-term use $1 Tier 1
QHS (insomnia) Short half-life; wears off after approximately 5
5-10mg QHS 0.5mg hours. 5mg PO QHS or 6.25mg ER PO QHS in $3-$5 Tier 1
elderly or debilitated pts; give on empty stomach CR: $5 CR:
10mg Tier 3

ProCare HospiceCare Preferred Drug ListGenericBrand/Available FormDoseMax/DayCommentsCost/Day Tier

76 Mucositis/Dry Mouth Generic forms are preferred $1 Tier 1
Should swish for 30 sec prior to $1 Tier 1
Artificial Saliva Artificial Saliva, Salivart Q1-3h PRN none spitting out
$1 Tier 1
Chlorhexidine Peridex 15mL swish/spit BID 30mL For viscous solution 1mL = 20mg of $2 Tier 1
Rinse Solution: 0.12% lidocaine
PRN none Swish and spit out
Dry Mouth Rinse Biotene 0.225mL/kg Q3h PRN Not systemically absorbed
15mL/dose Use x48h after sx resolve
Lidocaine Xylocaine 8 doses
(Viscous) Solution, viscous: 2% Can be constipating; shake well;
drug interaction with proton pump
Nystatin Mycostatin 500,000 - 1,000,000 2.4 million inhibitors and other antacids; Give 1h $3.50 Tier 1
Suspension: 100,000 units/mL units 4x daily x 10-14 units before meals, bedtime
days
Sucralfate Carafate swish +/- swallow 6g May lower seizure threshold $3 Tier 1
Tablet: 1g
Suspension: 1g/10mL 1g 4x daily Long-acting benzodiazepine; should
not be used in combo with short-
Muscle Spasms acting benzodiazepine

Baclofen Lioresal 5-15mg TID 80mg $1 - $2 Tier 1
Tablet: 10, 20mg $2
Clonazepam Anxiety: 1mg/day 4mg (anxiety) Tier 1
(CIV) Klonopin Seizure: 0.5mg TID 20mg (seizure) ODT:
Tablet: 0.5, 1, 2mg and titrate Tier 3
ODT wafer: 0.125, 0.25, 0.5, 1, 2mg

ProCare HospiceCare Preferred Drug ListGenericBrand/Available FormDoseMax/DayCommentsCost/DayTier

77 Muscle Spasms (continued)

Cyclobenzaprine Flexeril 5mg daily 30mg Avoid used in mod-severe hepatic $1 -$4 Tier 1
Carisoprodol Tablet: 5, 10mg impairment

Soma 350mg TID 4x daily May be sedating $2 (350mg) Tier 2
Tablet: 250 (BRAND), 350mg Max x 2-3 weekly
$11 250mg:
(250mg) Tier 3

(Formerly Tier 2)

Tizanidine Zanaflex 8mg 36mg Max: 3 doses/24h; 12mg/dose $3 TABS Tier 2
Tablet: 2, 4mg Q6-8hr Give consistently w/ food or on $7-$14 Tier 1
Capsule: 2, 4, 6mg empty stomach CAPS Tier 1

Diazepam (CIV) Valium Nausea/Vomiting Fear/anxiety-induced n/v $1
Tablet: 2, 5, 10mg
Solution, oral: 5mg/5mL, 5mg/mL 2-10mg May be given PO, SL, PR; long half-
Q6-12h

life; use with caution in elderly w/

liver disease; DIASTAT RECTAL GEL:

NON-FORMULARY

Erythromycin Ery-tab, E.E.S, EryPed 250-500mg 4000mg Gastric stasis-induced n/v $4 - $8
Suspension (BRAND): 200, 400mg/5mL BID 4x daily Useful in pulmonary infections;
Tablet, DR: 250, 333 (BRAND), causes GI upset and diarrhea
500mg (BRAND) Give IR on empty stomach
Tablet, as base/stearate: 250, 500mg
Capsule, as base/stearate: 250mg
Tablet, as ethylsuccinate: 400mg

ProCare HospiceCare Preferred Drug ListGenericBrand/Available FormDoseMax/DayCommentsCost/Day Tier
$1 Tier 1
78 Nausea/Vomiting (continued)
$4 Tier 1
Haloperidol Haldol 0.5-5mg Q6-12h 100mg Drug of choice for opioid-induced n/v
Tablet:0.5, 1, 2, 5, 10, 20mg Can be given PO, SL, PR, IM $2 Tier 1
Solution as lactate, oral: 2mg/mL Useful when benzodiazepines fail $3 - $5 Tier 1
Solution, injection as lactate: 5mg/mL Do not use in patients with Parkinson’s $1 Tier 1
Low sedation

Hyoscyamine Levsin, Levbid 0.125-0.25mg 1.5mg Movement-induced n/v
Solution, oral: 0.125mg/5mL Q4-6h May cause blurred vision, dry mouth, dry eyes
Oral drops: 0.125mg/mL
Tablet: 0.125, 0.15
Tablet, ER: 0.375mg
ODT: 0.125mg

Lorazepam Ativan 0.125-0.25mg 10mg Fear/anxiety-induced n/v-Cerebral Cortex
(CIV) Tablet: 0.5, 1, 2mg Q4-6h Intermediate-acting benzodiazepine; may be
Solution, oral: 2mg/mL given PO, SL, PR, SQ, IM; reduce dose if liver
Solution, injection: 2mg, 4mg/mL disease present

Meclizine Antivert, Bonine, Dramamine 12.5-50mg Movement-induced n/v
Tablet: 12.5, 25, 50mg Q8-12h Anticholinergic; may cause dizziness or
Tablet, chewable: 25mg drowsiness

Metoclopramide Reglan 5-10mg 60mg Gastric stasis-induced n/v
Tablet: 5, 10mg 4x daily 30 mg (elderly) Avoid in patients with Parkinson’s; monitor for
Solution, oral: 5mg/5mL EPS and agitation; Decr. dose 50% in elderly pts;
give 30min before meals.
CrCl 41-50: decr. dose 25%
CrCl 10-40: decr. dose 50%

ProCare HospiceCare Preferred Drug ListGenericBrand/Available FormDoseMax/DayCommentsCost/DayTier
Prochlorperazine $3 - $9 Tier 1
79 Compazine Nausea/Vomiting (continued)
Tablet: 5, 10mg
Suppository, rectal: 25mg 5-10mg PO or 150mg Constant/intermittent/unknown cause n/v
25mg PR Q4-8h Do not use in patients with Parkinson’s
Less sedating than promethazine

Promethazine Phenergan 12.5-25mg Q4-6h 150mg Preferred in patients with Parkinson’s $2 - $14 Tier 1
Tablet: 12.5, 25, 50mg 32mg Use with caution in the Elderly
Ondansetron Solution, oral: 6.25mg/5mL 4-8mg Q8hr More sedating than Prochlorperazine
Suppository, rectal: 25mg 20mg
Trimethobenzamide 250-300mg 8mg Only indicated for chemotherapy indu- $3-$4 Tier 2
Dronabinol Zofran, Zofran ODT Q6-8hr PRN ced nausea/vomiting ODT:
Glycopyrrolate Tablet: 4, 8, 16, 24mg 2.5mg BID $39-$65 ODT:
ODT: 4, 8mg 1-2mg Q4-12h Child-Pugh Class C: max 8mg/24h Tier 3
Solution, oral: 4mg/5mL
Solution, injection: 4mg/2mL Can be given IV, IM

Tigan CrCl <70: consider decr. dose amt or freq Tier 2
Tablet: 250, 300mg
Also indicated as AIDs-related appetite stimulant $12 - $25 Tier 3
Marinol
Capsule: 2.5, 5, 10mg Movement-induced n/v $5 - $8 Tier 3
Reserve for patients who develop confusion on Tier 3
Robinul anticholinergic therapy $3 (per
Tablet: 1, 2mg tablet)
Only indicated for chemotherapy indu-
Granisetron Kytril 2mg Q6-8hr ced nausea/vomiting
Tablet: 1mg Not preferred

ProCare HospiceCare Preferred Drug ListGenericBrand/Available FormDoseMax/DayCommentsCost/Day Tier
$4 Tier 3
80 Nausea/Vomiting (continued)

Scopolamine Transderm Scop 1 patch TD 3 patches May cause blurred vision/confusion; titrate
Patch 1.5mg patch (releases 1mg over 72 hours) Q3d difficult; do not use if phlegm or mucus is
present; may cause mucus plug

Pain - Nociceptive (Mild)

Acetaminophen Tylenol 500-1000mg 4000mg Max of 3000mg for elderly ¢ - $3 Tier 1
Tablet: 325, 500mg Q4-6h Max of 2000mg for patients with hepatic
Tablet, chewable: 80, 160mg impairment
Caplet/Geltab: 500mg
Caplet/Geltab, extended release: 650mg
Liquid, oral: 500mg/15mL, 160mg/5mL
Suppository: 120, 650mg

Aspirin Bayer, Ecotrin 325-650mg 4000mg Monitor for antiplatelet effects ¢ Tier 1
Tablet: 81, 325, 500, 650mg Q4hr PRN
Supp: 300, 600mg 2-16mg BID 40mg GI upset, use with caution for patients with
diabetes due to resultant hyperglycemia. Give
Dexamethasone Decadron 400-800mg 3200mg last dose by 2pm to avoid steroid-induced ¢ - $2 Tier 1
Solution, oral: 1mg/mL Q6h insomnia. May be given SubQ, IM, IV
Tablet: 0.25, 0.5, 0.75, 1, 1.5, 2, 4, 6mg
Take with food/milk; may cause GI upset;
Ibuprofen Motrin, Advil monitor concomitant use with corticosteroids ¢ Tier 1
Tablet: 200mg [OTC], 400, 600, 800mg Caution if cardiovascular dz, CHF, HTN
Capsule/Gelcap: 200mg [OTC]
Suspension: 100mg/5mL
Drops, oral: 40mg/mL
Chewable: 50, 100mg

Generic ProCare HospiceCare Preferred Drug ListBrand/Available FormDoseMax/DayCommentsCost/Day Tier
Indomethacin $2 Tier 1
81 Indocin Pain - Nociceptive (Mild) continued
Meloxicam Capsule: 25, 50mg $3 - $5 Tier 1
Capsule, ER: 75mg 25mg 200mg Only NSAID that can cross blood $1 Tier 1
Naproxen Suppository, rectal: 50mg Q8-12hr brain barrier ¢ Tier 1
Suspension (BRAND): 25mg/5mL $5 Tier 2
Prednisone Mobic 7.5-15mg daily 15mg COX-1 and -2 mixed inhibitor
Tablet: 7.5, 15mg CrCl <15: avoid use $6 - $15 Tier 3
Choline Suspension: 7.5mg/5mL 250-500mg BID 1500mg
Magnesium Naprosyn 250mg naproxen= 275mg naproxen
Trisalicylate Tablet: 250, 375, 500mg 5-80mg 4x daily 80mg sodium.
Celecoxib Suspension: 125mg/5mL CrCl <30: avoid use
Deltasone 1000mg Q12h 4500mg
Solution, oral: 1mg/mL GI upset, use with caution in patients
Tablet: 1, 2.5, 5, 10, 20, 50mg 100-200mg daily 800mg with diabetes
Trilisate
Solution, oral: 500mg/5mL Do not use in salicylate or aspirin
allergy; may cause tinnitus; less GI
Celebrex effects.
Capsule: 50, 100, 200, 400mg Advanced CRI: contraindicated

Caution with sulfa allergy and for
patients who have experienced a
recent GI bleed.
Severe renal impairment: avoid use

Generic ProCare HospiceCare Preferred Drug ListBrand/Available FormDoseMax/DayCommentsCost/Day Tier
$2 Tier 1
Hydrocodone/82 Vicodin, Lortab, Norco Pain - Nociceptive (Moderate)
Acetaminophen Tablet: various, most common: 5mg/500mg,
(CIII) 7.5mg/750mg, 10mg/660mg 1-2 tabs Q4-6h 4000mg of Monitor total acetaminophen intake
Elixir: 7.5mg/500mg/15mL
Oxycodone/ acetamin.
Acetaminophen Percocet,Tylox
(CII) Tablet: various, most common: 5mg/325mg, 3000mg (elderly)
5mg/500mg, 10 mg/325mg
Tramadol (IR) Solution: Roxicet® 5mg/325mg/5mL 1-2 tabs Q4-6h 4000mg of Monitor total acetaminophen intake $2 - $4 Tier 1

Acetaminophen/ Ultram acetamin.
Codeine (CIII) Tablet: 50, 100mg
Tramadol/ Tablet, ER: 100, 200, 300mg 3000mg (elderly)
Acetaminophen
Tylenol #3 50mg 4x daily 400mg May lower seizure threshold $4 Tier 1
Methadone (CII) Tablet: 300mg/30mg 300mg (elderly) CrCl <30: give Q12h, max 200mg/day ER Form:
Cirrhosis: 50mg Q12h, max 100mg/day $4 - $6 Tier 3
Ultracet 1-2 tabs 12 tabs Weak opioid; may be effective for $2 - $7 Tier 2
Tablet: 37.5-325mg Q4-6h PRN diarrhea
Treatment should not exceed 5 days Tier 2
Dolophine 2 tabs Q4-6h 8 tabs
Solution, oral: 5, 10mg/5mL, 10mg/mL PRN pain Excellent for nociceptive and
Tablet: 5, 10mg neuropathic pain and for patients with
Pain - Nociceptive (Severe) renal or hepatic impairment; call clinical
pharmacist for dosage
Individualized N/A ¢ Tier 1

Generic ProCare HospiceCare Preferred Drug ListBrand/Available FormDoseMax/DayCommentsCost/DayTier
Tier 1
Morphine (IR)83 Pain - Nociceptive (Severe) continued Tier 1
(CII) Tier 1
MSIR, Roxanol Q2h PRN N/A Dosage for SOB is 5-10mg Q2h PRN $2 Tier 2
Morphine ER/SR Tablet: 15, 30mg SubQ: 5-15mg SubQ Q2-4h PRN Tier 2
Tablet (CII) Solution, oral: 10mg/5mL, 20mg/5mL, 20mg/mL CrCl 10-50: decr. Dose 25%; Tier 3
CrCl <10: decr. Dose 50%
Oxycodone (IR)
(CII) MS Contin, Oramorph SR Dosed Q12h N/A DO NOT CRUSH; may be given $1 - $10
Tablet, ER, SR: 15, 30, 60, 100, 200mg rectally: CrCl 10-50: decr. dose 25%;
Hydromorphone CrCl <10: decr. dose 50%
(CII)
OxyIR, Oxydose, Roxicodone Dosed Q2hr N/A Dosage for SOB is 5-10mg Q2h $2.50 Tabs
Oxycodone Tablet: 5, 15, 30mg PRN PRN; preferred for patients with
Solution (IR) Capsule: 5mg severe renal impairment
(CII) - (Morphine Solution, oral: 20mg/mL Dosed Q4-6h N/A
Intolerant) Option for patients on high dose $5
Fentanyl (CII) Dilaudid Dosed Q2hr N/A morphine and not able to use
Solution, oral (BRAND): 1mg/mL PRN methadone
Suppository, rectal: 3mg
Tablet: 2, 4, 8mg Dosage for SOB is 5-10mg Q2h $10 - $40
PRN; preferred for patients with Liquid
Oxyfast severe renal impairment
Solution, oral: 20mg/mL

Duragesic Patch, Actiq, Fentora Patch changed Opioid naïve Adequate fat tissue required to $6-$15
Transdermal Patch: 12.5mcg/h, 25mcg/h; 50mcg/h, Q72h 25mcg absorb medication from patch; PATCH
75mcg/h, 100mcg/h Lozenge: 2 difficult to titrate; do NOT cut $33-$98
Transmucosal Lozenge (BRAND): 200, 400, 800, doses/episode; patches. LOZENGE
1200, 1600mcg 4 doses/day Solution, injectable: Liquid given $52-$151
Buccal tablet (BRAND): 100, 200, 400, 600, 800mcg ORALLY for ESRD patients only. BUCCAL

ProCare HospiceCare Preferred Drug ListGenericBrand/Available FormDose Max/DayCommentsCost/Day Tier
$10 - $33 Tier 3
84Morphine SR Pain - Nociceptive (Severe) continued
Capsule (CII)
Avinza Dosed Q24h N/A Avoid in patients with severe renal or hepatic
impairment; do NOT crush; may administer per peg
Capsule, ER (BRAND): 30, 60, 90, 120mg tube or sprinkle on soft food

Oxycodone SR Oxycontin Dosed N/A DO NOT CRUSH; non-preferred $5 - $28 Tier 3
(CII) Tier 1
Carbamazepine Tablet, ER/CR: 10, 15, 20, 30, 40, 60, 80mg Q12hr Tier 1
Tier 1
Desipramine Pain - Neuropathic (Shooting, Stabbing, Burning,Tingling)
Divalproex Tier 1
Sodium Tegretol 100-400mg 1600mg Subcategory: Brain cancer $1 - $2
Tablet, chewable: 100mg BID 4x daily Can be given rectally $1
Gabapentin Tablet, ER: 100, 200, 400mg DO NOT CRUSH ER tablets $2
Suspension, oral: 100mg/5mL Give with food. CrCl <10: decr. dose 25%
$1 - $3
Norpramin 10-150mg 300mg Also expected to improve sleep and mood; least
Tablet: 10, 25, 50, 75, 100, 150mg QHS anticholinergic effect; max in elderly is 150mg per day

Depakote, Depakote Sprinkles 15mg/kg/day 60mg/kg/day Give with food; may open and sprinkle capsules
Tablet, DR: 125, 250, 500mg on food. Divalproex sodium ER and DR tabs not
Tablet, ER: 250, 500mg bioequivalent; incr. total daily dose by 8-20% if
Capsule, DR: 125mg switching from DR tab to ER tab.
Hepatic dz/significant impairment: contraindicated

Neurontin 100mg TID 3600mg Must titrate up and down; may cause memory loss;
Capsule: 100, 300, 400mg and titrate very sedating
Solution, oral: 250mg/ 5mL Q72h CrCl 30-60: 200-700 mg BID; CrCl 16-29: 200-
Tablet: 600, 800mg 700mg daily; CrCl 15: 100-300 mg daily; CrCl <15:
decr. Dose proportionately to CrCl

Generic ProCare HospiceCare Preferred Drug ListBrand/Available FormDoseMax/DayCommentsCost/Day Tier
¢ Tier 1
Methadone85 Dolophine Pain - Neuropathic (continued)
(CII) Solution, oral: 5, 10mg/5mL, 10mg/mL
Tablet: 5, 10mg Individualized N/A Excellent for nociceptive and neuropathic pain and
for patients with renal or hepatic impairment; call
clinical pharmacist for dosage

Nortriptyline Pamelor 10-150mg 150mg Also expected to improve sleep and mood; start at $1 Tier 1
Valproic Acid Capsule: 10, 25, 50, 75mg QHS lowest dose possible Tier 1
Solution, oral: 10mg/5mL
250mg 60mg/kg/day Drug levels required for seizures only; DO NOT $3 Tier 2
Depakene QHS x 7 days, 300mg CRUSH ER FORMS; Depakene may be given rectally Tier 2
Syrup, as valproic acid: 250mg/5mL Then 500mg 120mg ¢ - $1 Tier 3
Capsule, as valproic acid: 250mg QHS Also expected to improve sleep and mood; increases $6 Tier 3
10-150mg 3 patches risk of falls Variable
Amitriptyline Elavil QHS Useful to treat neuropathic pain $16
Duloxetine Tablet: 10, 25, 50, 75, 100, 125, 150mg 60mg daily Do not cut/crush/chew/sprinkle
CrCl <30: avoid use
Cymbalta Consult with Can be given PO/IV;Used for sedation/nerve pain
Capsule, DR (BRAND): 20, 30, 60mg ProCare
Pharmacist May cut patches
Ketamine Ketalar 1 patch up
Solution for Injection; to 12 hrs/day
Lidocaine 10mg/mL, 50mg/mL, 100mg/mL
Patch
Lidoderm Patch
5% patch

Generic ProCare HospiceCare Preferred Drug ListBrand/Available FormDoseMax/DayCommentsCost/Day Tier
Pruritis
Chlorpheniramine86Chlor-Trimeton 4mg Q6hr 24mg Take with full glass of water ¢ Tier 1
Cholestyramine Tablet: 4mg 24g
Questran 4g 1-4x daily Dissolved in juice or water; promotes $1 - $2 Tier 1
Colloidal Powder, pkt: 4g cholestyramine/9g powder 400mg formed stools; useful in C. diff
Oatmeal/ Powder, scoop: 4g cholestyramine/9g powder Apply PRN 300mg
Mineral Oil Aveeno Very good for itchy dry skin; some $8 (8 packet) Tier 1
Diphenhydramine 25-100mg 600mg formulations also contain menthol
Benadryl QHS and/or
Doxepin Capsule/Tablet: 25, 50mg Q4-6h PRN Use with caution in elderly patients; ¢ Tier 1
Elixir: 12.5mg/5mL 10-30mg QHS causes confusion/drowsiness/dizziness; $1 Tier 1
Hydrocortisone Sinequan will not affect blood pressure
Hydroxyzine Capsule: 10, 25, 50, 75, 100, 150mg 1-2% applied
Solution, oral: 10mg/mL Topically BID Caution in elderly; OK if bedbound;
Menthol/Camphor Cortaid, Cortisone 10-50mg causes drowsiness
Lotion Cream: 1%, 2% Q4-6h
Atarax,Vistaril Useful if rash present; do not use on $5 (28 gram) Tier 1
Capsule as pamoate:25, 50, 100mg Apply topically PRN open areas $3 Tier 1
Tablet, HCl: 10, 25, 50mg
Solution, oral: 10mg/5mL May cause drowsiness; use with
Sarna Lotion, Gold Bond Medicated caution in the elderly; useful in
Lotion patients with Parkinson’s

OTC; offers a soothing, cooling effect $11 (222mL) Tier 1

Generic ProCare HospiceCare Preferred Drug ListBrand/Available FormDoseMax/DayCommentsCost/Day Tier
Paroxetine $2 Tier 1
87 Paxil Pruritis (continued)
Diazepam Tablet: 10, 20, 30, 40mg $1 Tier 1
(CIV) Tablet, ER: 12.5, 25, 37.5mg 10-40mg 50mg Mechanism for cough unknown; effective for $2 Tier 1
Lorazepam Suspension: 10mg/5mL daily 40mg (elderly, cough after 1-3 doses
(CIV) renal/hepatic) $1 - $2 Tier 1
Valium
Carbamazepine Tablet: 2, 5, 10mg 2-10mg Seizure - Active May be given PO, SL, PR; long half-life; use with $2 Tier 1
Solution, oral: 5mg/5mL, 5mg/mL Q6-12h 10mg caution in elderly w/ liver disease; DIASTAT ODT:
Clonazepam Ativan RECTAL GEL: NON-FORMULARY Tier 3
(CIV) Tablet: 0.5, 1, 2mg 0.5-2mg
Diazepam Solution, oral: 2mg/mL Q4-6h Intermediate-acting benzodiazepine; may be $1 Tier 1
(CIV) Solution, injection: 2mg, 4mg/mL given PO, SL, PR, SQ, IM; reduce dose if liver
disease present
Tegretol
Tablet, chewable: 100mg Seizure - Maintenance
Tablet, ER: 100, 200, 400mg
Suspension, oral: 100mg/5mL 100-400mg 1600mg Subcategory: Brain cancer
Klonopin BID 4x daily Can be given rectally
Tablet: 0.5, 1, 2mg DO NOT CRUSH ER tablets
ODT wafer: 0.125, 0.25, 0.5, 1, 2mg Give with food. CrCl <10: decr. dose 25%
Valium
Tablet: 2, 5, 10mg Anxiety: 1mg/day 4mg (anxiety) Long-acting benzodiazepine; should not be used
Solution, oral: 5mg/5mL, 5mg/mL Seizure: 0.5mg 20mg (seizure) in combo with short-acting benzodiazepine
TID and titrate

2-10mg May be given PO, SL, PR; long half-life; use with
Q6-12h caution in elderly w/ liver disease; DIASTAT
RECTAL GEL: NON-FORMULARY

Generic ProCare HospiceCare Preferred Drug ListBrand/Available FormDoseMax/DayCommentsCost/Day Tier
Divalproex $2 Tier 1
Sodium88 Depakote, Depakote Sprinkles Seizure - Maintenance (continued)
Tablet, DR: 125, 250, 500mg $2 Tier 1
Lorazepam Tablet, ER: 250, 500mg 15mg/kg/day 60mg/kg/day Give with food; may open and sprinkle capsules $1 Tier 1
(CIV) Capsule, DR: 125mg on food. Divalproex sodium ER and DR tabs not $1 Tier 1
bioequivalent; incr. total daily dose by 8-20% if
Phenobarbital Ativan switching from DR tab to ER tab. $3 Tier 1
(CIII) Tablet: 0.5, 1, 2mg Hepatic dz/significant impairment: contraindicated
Phenytoin Solution, oral: 2mg/mL
Solution, injection: 2mg, 4mg/mL 0.5-2mg 10mg Intermediate-acting benzodiazepine; may be given
Valproic Acid Luminal Q4-6h PO, SL, PR, SQ, IM;
Tablet: 15, 16, 30, 32, 60, 65, 97, 100mg reduce dose if liver disease present
Elixir: 20mg/5mL
Dilantin, Phenytek 60-100 mg 400mg dose May be given PO, PR, IM; long half-life allows less
Capsule, ER: 100, 200, 300mg daily BID-TID 60mg/kg/day frequent dosing
Tablet, chewable (BRAND): 50mg 300mg daily CrCl <10: give Q12-16h
Suspension: 25mg/mL
250mg QHS x 7 Subcategory: Brain cancer
Depakene days, Long half-life allows for once daily dosing;
Syrup, as valproic acid: 250 mg/5mL then 500mg QHS Poor absorption when given rectally;
Capsule, as valproic acid: 250mg Oral suspension binds to tube feeds;
Reduce dose in patients with hypoalbuminemia
ER Capsule: Do not open/crush/chew

Drug levels required for seizures only;
DO NOT CRUSH ER FORMS;
Depakene may be given rectally

ProCare HospiceCare Preferred Drug ListGenericBrand/Available FormDoseMax/DayCommentsCost/Day Tier
$2 - $3 Tier 1
89 Terminal Secretions $4 Tier 1

Atropine 1% Isopto Atropine 1-3gtts SL May cause anticholinergic delirium if used
Opth soln: 5, 15mL Q4-6h PRN too early; not to be used if phlegm or mucus
present as may cause mucus plug

Hyoscyamine Levsin, Levbid 0.125-0.25mg 1.5mg May cause blurred vision, dry mouth, dry eyes
Solution, oral: 0.125mg/5mL Q4-6h
Oral drops: 0.125mg/mL
Tablet: 0.125, 0.15
Tablet, ER: 0.375mg
ODT: 0.125mg

Glycopyrrolate Robinul 1-2mg Q4-12h 8mg Reserve for patients who develop confusion $5 - $8 Tier 3
Tablet: 1, 2mg on anticholinergic therapy $4 Tier 3

Scopolamine Transderm Scop 1 patch TD Q3d 3 patches May cause blurred vision/ confusion; titrate
Patch difficult; do not use if phlegm or mucus is
1.5mg patch (releases 1mg over 72 hours) present; may cause mucus plug

INFECTIONS / ANTIBIOTICS
PO Antibiotics covered for infections related to the terminal diagnosis (for symptom management)

IV / IM Antibiotics - Tier 3

Amoxicillin Trimox, Amoxil 250-500mg TID 4000mg Useful in pulmonary, sinus, and urinary tract $2 - $3 Tier 1
Capsule: 250, 500mg 2000mg infections. May be given with or without food
Suspension: 125, 200, 250, 400mg/5mL (renal) CrCl 10-30: give Q12h;
Tablet: 500, 875mg CrCl <10: give Q24h
Tablet, chewable: 125, 200, 250, 400mg Do not use 875mg tab if CrCl <30

Generic ProCare HospiceCare Preferred Drug ListBrand/Available FormDoseMax/DayCommentsCost/Day Tier
$1 Tier 1
90 Infections / Antibiotics (continued)

Azithromycin Zithromax 500mg day 1, 2000mg Useful in pulmonary infections Severe renal
Tablet: 250, 500, 600mg then 250mg impairment: caution advised
Bacitracin Suspension: 100, 200mg/5mL daily x 4 days
Cefaclor 1g pwdr pkt
Apply topically 5 x day; 7 Useful in optic and pulmonary infections; $3/30g Tier 1
Cefuroxime Baciguent BID-TID day duration May be given with or without food $4 - $7 Tier 1
Cephalexin Ointment: 500 units/g
250-500mg 2000mg
Ciprofloxacin Ceclor daily x 7 days
Capsule: 250, 500mg
Tablet, ER: 375, 500mg 250-500mg Useful for optic and pulmonary infections $4 Tier 1
Suspension: 125, 250, 375mg/5mL BID x 5-10 day Tier 1
Useful in skin and pulmonary infections May be $43 Tier 1
Ceftin 1000-4000mg/day 4000mg given with or without food $2
Tablet: 250, 500mg Divided Q6-Q12h CrCl 50-90: give Q6-8h; CrCl 10-50: give
Suspension: 125, 250mg/5mL Q8-12h; CrCl<10: give Q12-24h
250-750mg
Keflex Q12h x 5-10 days Useful in urinary tract infections
Capsule: 250, 500mg IR Form: CrCl 30-50: 250-500mg Q12h;
Suspension: 125, 250mg/5mL CrCl 5-29:
Tablet: 250mg, 500mg 250-500mg Q18h; CrCl <5: not defined
ER Form: CrCl <30: 500mg Q24h
Cipro
Tablet: 100, 250, 500, 750mg
Tablet, ER: 500, 1000mg
Suspension: 250, 500mg/5mL