Drug Class
Excluded Medications
Preferred Alternatives
CONZIP, QDOLO, TRAMADOL 25MG & 75MG TABLETS, TRAMADOL ER CAPSULES, TRAMADOL SOLUTION
tramadol 50mg & 100mg tablets, tramadol er tablets
hydromorphone tablets, morphine tablets, oxycodone tablets, oxymorphone tablets hydrocodone/acetaminophen, morphine sulfate, oxycodone, tramadol, tramadol/acetaminophen hydrocodone bitartrate er, hydromorphone er, morphine sulfate er, oxymorphone hcl er, HYSINGLA ER
levorphanol
AUTONOMIC & CENTRAL NERVOUS SYSTEM (continued) Narcotic Analgesics & Combinations
NUCYNTA
NUCYNTA ER, OXYCODONE ER, OXYCONTIN, XTAMPZA ER OXAYDO, OXYCODONE COATED TABLETS, ROXYBOND
oxycodone uncoated tablets
PRIMLEV, PROLATE SOLUTION
oxycodone/acetaminophen
SEGLENTIS
tramadol 50mg tablets plus celecoxib
Narcotic Antagonists Niemann-Pick Disease Type C Agents Rett Syndrome Agents
ZIMHI
naloxone syringes
MIPLYFFA
AQNEURSA
DAYBUE
No alternatives recommended
DORAL, QUAZEPAM
estazolam, lorazepam
Sedative-Hypnotic Agents
ZOLPIDEM 7.5MG CAPSULES
eszopiclone, zaleplon, zolpidem tablets citalopram tablets, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, vilazodone desvenlafaxine er, duloxetine, venlafaxine hcl er, FETZIMA
Selective Serotonin Reuptake Inhibitors (SSRIs) Antidepressants Serotonin/Norepinephrine Reuptake Inhibitor Antidepressants
CITALOPRAM CAPSULES
DRIZALMA SPRINKLE, VENLAFAXINE BESYLATE ER
FENTANYL CITRATE BUCCAL TABLETS, FENTORA
Transmucosal Fentanyl Analgesics
fentanyl citrate lozenges
APLENZIN, BUPROPION XL 450MG, FORFIVO XL bupropion xl 150mg or 300mg RALDESY trazodone tablets
Miscellaneous Antidepressants
olanzapine/fluoxetine, bupropion, desvenlafaxine er, duloxetine, escitalopram, mirtazapine, sertraline tablets
SPRAVATO
CARDIOVASCULAR ACE Inhibitors
QBRELIS
lisinopril
Alpha-Adrenergic Agonists
CLONIDINE ER 0.17MG, NEXICLON XR
clonidine patches, clonidine tablets
candesartan, irbesartan, losartan, olmesartan, telmisartan, valsartan
EDARBI
candesartan/hydrochlorothiazide, irbesartan/hydrochlorothiazide, losartan/hydrochlorothiazide, olmesartan/hydrochlorothiazide, telmisartan/hydrochlorothiazide, valsartan/hydrochlorothiazide, chlorthalidone plus valsartan
Angiotensin Receptor Blockers (ARBs) & Combinations
EDARBYCLOR
(continued)
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CRP1386903A 204612 EXCL-NPF-26 (08/08/2025)
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