(continued)
DRUG CLASS
EXCLUDED MEDICATIONS
PREFERRED ALTERNATIVES
Miscellaneous Antidepressants
APLENZIN, BUPROPION XL 450MG, FORFIVO XL bupropion xl 150mg or 300mg EXXUA ER Generic Antidepressant Agents RALDESY trazodone tablets
Miscellaneous Autonomic Agents
NORTHERA
atomoxetine, dihydroergotamine injection or nasal, fludrocortisone tablets, indomethacin capsules or injection, midodrine tablets, pyridostigmine tablets
CARDIOVASCULAR ACE Inhibitors
QBRELIS
lisinopril
CLONIDINE HCL 0.05MG, CLONIDINE ER 0.17MG, JAVADIN, NEXICLON XR
clonidine patches, clonidine hcl tablets (0.1mg, 0.2mg, 0.3mg)
Alpha-Adrenergic Agonists
Angiotensin Receptor Blockers (ARBs) and Combinations
ARBLI
losartan tablets
EDARBYCLOR
candesartan/hctz, irbesartan/hctz, losartan/hctz, olmesartan/hctz, telmisartan/hctz, valsartan/hctz, chlorthalidone plus valsartan tablets amlodipine/olmesartan, amlodipine/valsartan
telmisartan/amlodipine VALSARTAN SOLUTION
valsartan tablets
WIDAPLIK
amlodipine and indapamide plus candesartan, irbesartan, losartan, olmesartan, telmisartan or valsartan tablets dabigatran, rivaroxaban, ELIQUIS, ELIQUIS SPRINKLE, XARELTO
Anticoagulants
PRADAXA, SAVAYSA
Beta Blockers and Combinations
BISOPROLOL 2.5MG TABLETS
bisoprolol 5mg or 10mg propranolol solution
HEMANGEOL
INDERAL XL, INNOPRAN XL KAPSPARGO SPRINKLE LABETALOL 400MG TABLETS
propranolol er
metoprolol succinate er
labetalol 100mg, 200mg or 300mg tablets metoprolol tartrate (except 12.5mg)
LOPRESSOR SOLUTION, LOPRESSOR 12.5MG TABLETS, METOPROLOL TARTRATE 12.5MG TABLETS
Calcium Channel Blockers
CONJUPRI, LEVAMLODIPINE diltiazem er tablets, CARDIZEM LA KATERZIA, NORLIQVA, SDAMLO
amlodipine, felodipine er, nifedipine er
diltiazem er capsules
amlodipine
nisoldipine, SULAR
amlodipine, felodipine er
verapamil er pm (100 mg, 200mg, 300mg)
verapamil er (120mg, 180mg, 240mg, 360mg)
Diuretics
ENBUMYST, FUROSCIX, LASIX ONYU, SOAANZ bumetanide, ethacrynic acid, furosemide, torsemide HEMICLOR, THALITONE chlorthalidone INZIRQO hydrochlorothiazide capsules or tablets
Endothelin Receptor Antagonists
TRYVIO
Generic Anti-Hypertensive Agents (Categories include: ACE Inhibitors, Alpha- Adrenergic Blockers, Angiotensin Receptor Blockers [ARBs], Beta Blockers, Calcium Channel Blockers, Central Alpha-Adrenergic Agonists, Direct Renin Inhibitors, Direct Vasodilators and Diuretics) fenofibrate capsules (43mg, 67mg, 134mg, 200mg), fenofibrate tablets (48mg, 54mg, 145mg, 160mg), fenofibric acid dr
Fenofibrates
fenofibrate capsules (130mg), fenofibrate tablets (40mg, 120mg), FENOFIBRATE CAPSULES (50MG, 150MG), LIPOFEN
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