Generic Drugs Are Over Brand Drugs Unless Specified As Brand ANTIDEPRESSANTS ALPHA-2 RECEPTOR ANTAGONIST ANTIDEPRESSANTS MIRTAZAPINE REMERON 30 30 MIRTAZAPINE REMERON SOLTAB 30 30 ISOCARBOXAZID TABLETS MARPLAN PHENELZINE SULFATE TABLETS NARDIL SELIGILENE TD PATCH EMSAM PA Required TRANYLCYPROMINE SULFATE TABLETS PARNATE NOREPINEPHRINE and DOPAMINE REUPTAKE INHIBITORS (NDRIs) BUPROPION HCL IR TABLETS WELLBUTRIN PA Required for ages < 6 years 120 30 BUPROPION HCL TABLET 12-HOUR BUDEPRION SR PA Required for ages < 6 years 60 30 BUPROPION HCL TABLET 24-HOUR WELLBUTRIN XL PA Required for ages < 6 years 30 30 MAPROTILINE HCL TABLETS MAPROTILINE HCL PA Required for ages < 6 years SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) CITALOPRAM HYDROBROMIDE SOLUTION CELEXA 600 ML 30 CITALOPRAM HBR TABLETS 10MG CELEXA 60 30 CITALOPRAM HBR TABLETS 20MG CELEXA 30 30 CITALOPRAM HBR TABLETS 40MG CELEXA 30 30 ESCITALOPRAM OXALATE SOLUTION LEXAPRO 600 ML 30 ESCITALOPRAM OXALATE TABLETS 5MG LEXAPRO 60 30 ESCITALOPRAM OXALATE TABLETS 10MG LEXAPRO 30 30 ESCITALOPRAM OXALATE TABLETS 20MG LEXAPRO 30 30 FLUOXETINE HCL CAPSULES ONLY 10MG PROZAC 60 30 FLUOXETINE HCL CAPSULES ONLY 20MG PROZAC 120 30 FLUOXETINE HCL CAPSULES ONLY 40MG PROZAC 60 30 FLUOXETINE HCL SOLUTION PROZAC 600 ML 30 FLUOXETINE HCL DR CAPSULES - WEEKLY PROZAC WEEKLY PA Required FLUVOXAMINE MALEATE ER CAPSULES 100MG LUVOX CR 90 30 FLUVOXAMINE MALEATE ER CAPSULES 150MG LUVOX CR 60 30 FLUVOXAMINE MALEATE TABLETS 25MG LUVOX 60 30 FLUVOXAMINE MALEATE TABLETS 50MG LUVOX 180 30 FLUVOXAMINE MALEATE TABLETS 100MG LUVOX 90 30 PAROXETINE HCL SUSPENSION PAXIL 900 ML 30 PAROXETINE HCL ER TABLETS 12.5 MG PAXIL CR 90 30 PAROXETINE HCL ER TABLETS 25 MG PAXIL CR 90 30 PAROXETINE HCL ER TABLETS 37.5 MG PAXIL CR 90 30 PAROXETINE HCL TABLETS 10MG PAXIL 30 30 PAROXETINE HCL TABLETS 20MG PAXIL 30 30 PAROXETINE HCL TABLETS 30MG PAXIL 30 30 PAROXETINE HCL TABLETS 40MG PAXIL 45 30 PAROXETINE MESYLATE TABLETS PEXEVA PA Required Page 1 of 9
Generic Drugs Are Over Brand Drugs Unless Specified As Brand LIMITS SERTRALINE HCL CONCENTRATE ZOLOFT 300 ML 30 SERTRALINE HCL TABLETS 25MG ZOLOFT 90 30 SERTRALINE HCL TABLETS 50MG ZOLOFT 120 30 SERTRALINE HCL TABLETS 100MG ZOLOFT 60 30 VILAZODONE HCL TABLETS VIIBRYD PA Required SEROTONIN-2 ANTAGONIST/REUPTAKE INHIBITORS (SARIs) NEFAZODONE TABLETS 50MG 60 30 NEFAZODONE TABLETS 100MG 60 30 NEFAZODONE TABLETS 150MG 120 30 NEFAZODONE TABLETS 200MG 90 30 NEFAZODONE TABLETS 250MG 60 30 TRAZODONE TABLETS 50MG 90 30 TRAZODONE TABLETS 100MG 120 30 TRAZODONE TABLETS 150MG 60 30 TRAZODONE TABLETS 300MG 30 30 SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIs) DESVENLAFAXINE ER TABLETS 25MG PRISTIQ 120 30 DESVENLAFAXINE ER TABLETS 50MG PRISTIQ 120 30 DESVENLAFAXINE ER TABLETS 100MG PRISTIQ 120 30 DULOXETINE CAPSULES 20 MG, 30 MG ONLY CYMBALTA DULOXETINE CAPSULES 60 MG ONLY CYMBALTA 60 30 VENLAFAXINE HCL CAPSULES CONTROLLED RELEASE 37.5MG EFFEXOR XR 90 30 VENLAFAXINE HCL CAPSULES CONTROLLED RELEASE 75MG EFFEXOR XR 90 30 VENLAFAXINE HCL CAPSULES CONTROLLED RELEASE 150MG EFFEXOR XR 30 30 VENLAFAXINE HCL TABLETS (IMMEDIATE RELEASE ONLY) 25MG VENLAFAXINE 120 30 VENLAFAXINE HCL TABLETS (IMMEDIATE RELEASE ONLY) 37.5MG VENLAFAXINE 90 30 VENLAFAXINE HCL TABLETS (IMMEDIATE RELEASE ONLY) 50MG VENLAFAXINE 90 30 VENLAFAXINE HCL TABLETS (IMMEDIATE RELEASE ONLY) 75MG VENLAFAXINE 150 30 VENLAFAXINE HCL TABLETS (IMMEDIATE RELEASE ONLY) 100MG VENLAFAXINE 90 30 TRICYCLIC ANTIDEPRESSANTS & RELATED NON-SELECTIVE REUPTAKE INHIBITORS AMITRIPTYLINE HCL TABLETS ELAVIL PA Required for ages < 6 years AMOXAPINE TABLETS ASENDIN PA Required for ages < 6 years CLOMIPRAMINE HCL TABLETS ANAFRANIL PA Required for ages < 6 years DESIPRAMINE HCL TABLETS NORPRAMIN PA Required for ages < 6 years DOXEPIN HCL CAPSULES SINEQUAN PA Required for ages < 6 years 90 30 DOXEPIN HCL CONCENTRATE SINEQUAN PA Required for ages < 6 years 180 ML 30 IMIPRAMINE HCL CAPSULES TOFRANIL PA Required for ages < 6 years IMIPRAMINE HCL TABLETS TOFRANIL PA Required for ages < 6 years NORTRIPTYLINE HCL CAPSULES PAMELOR PA Required for ages < 6 years NORTRYIPTYLINE HCL SOLUTION PAMELOR PA Required for ages < 6 years PROTRIPTYLINE HCL TABLETS VIVACTIL PA Required for ages < 6 years TRIMIPRAMINE MALEATE CAPSULES TRIMIPRAMINE PA Required for ages < 6 years DAYS SUPPLY Page 2 of 9
Generic Drugs Are Over Brand Drugs Unless Specified As Brand ANTIPSYCHOTICS ANTIPSYCHOTICS - SECOND GENERATION - ATYPICAL ORAL AGENTS ARIPIPRAZOLE TABLETS ABILIFY PA Required for ages < 6 years 30 30 ASENAPINE MALEATE TABLETS SUBLINGUAL SAPHRIS Brand Drug PA Required for ages < 6 years 60 30 CLOZAPINE ORALLY DISINTEGRATING TABLETS FAZACLO Drug PA Required for ages < 18 years 150 30 CLOZAPINE TABLETS CLOZAPINE Drug PA Required for ages < 18 years 150 30 LURASIDONE TABLETS LATUDA Brand Drug PA Required for ages < 6 years 30 30 OLANZAPINE ORALLY DISINTEGRATING TABLETS 5MG ZYPREXA ZYDIS Drug PA Required for ages < 6 years 60 30 OLANZAPINE ORALLY DISINTEGRATING TABLETS 10MG ZYPREXA ZYDIS Drug PA Required for ages < 6 years 60 30 OLANZAPINE ORALLY DISINTEGRATING TABLETS 15MG ZYPREXA ZYDIS Drug PA Required for ages < 6 years 30 30 OLANZAPINE ORALLY DISINTEGRATING TABLETS 20MG ZYPREXA ZYDIS Drug PA Required for ages < 6 years 30 30 OLANZAPINE TABLETS 2.5MG OLANZAPINE Drug PA Required for ages < 6 years 30 30 OLANZAPINE TABLETS 5MG OLANZAPINE Drug PA Required for ages < 6 years 60 30 OLANZAPINE TABLETS 10MG OLANZAPINE Drug PA Required for ages < 6 years 60 30 OLANZAPINE TABLETS 15MG OLANZAPINE Drug PA Required for ages < 6 years 30 30 OLANZAPINE TABLETS 20MG OLANZAPINE Drug PA Required for ages < 6 years 30 30 QUETIAPINE FUMARATE TABLETS SEROQUEL Drug PA Required for ages < 6 years 60 30 RISPERIDONE ORALLY DISPERSABLE TABLETS RISPERIDONE ODT Drug PA Required for ages < 6 years 60 30 RISPERIDONE SOLUTION RISPERDAL Drug PA Required for ages < 6 years 240 ML 30 RISPERIDONE TABLETS RISPERIDONE Drug PA Required for ages < 6 years 60 30 ZIPRASIDONE HCL CAPSULES ZIPRASIDONE Drug PA Required for ages < 6 years 60 30 ANTIPSYCHOTICS - SECOND GENERATION - ATYPICAL LONG-ACTING INJECTABLES ARIPIPRAZOLE LAUROXIL 441MG, 662MG, 882MG ARISTADA Brand Drug PA Required for ages < 18 years 1 30 ARIPIPRAZOLE LAUROXIL 1064MG ARISTADA Brand Drug PA Required for ages < 18 years 1 60 ARIPIPRAZOLE SUSPENSION ABILIFY MAINTENA Brand Drug PA Required for ages < 18 years 1 30 PALIPERIDONE PALMITATE SUSPENSION INVEGA SUSTENNA Brand Drug PA Required for ages < 18 years 1 30 PALIPERIDONE PALMITATE SUSPENSION INVEGA TRINZA Brand Drug PA Required for ages < 18 years 1 90 RISPERIDONE MICROSPHERES SUSPENSION RISPERDAL CONSTA Brand Drug PA Required for ages < 18 years 2 30 ANTIPSYCHOTICS - FIRST GENERATION - TYPICAL ORAL AGENTS CHLORPROMAZINE HCL TABLETS THORAZINE PA Required for ages < 6 years Page 3 of 9
Generic Drugs Are Over Brand Drugs Unless Specified As Brand LIMITS FLUPHENAZINE HCL ELIXIR FLUPHENAZINE PA Required for ages < 6 years FLUPHENAZINE HCL ORAL CONCENTRATE FLUPHENAZINE PA Required for ages < 6 years FLUPHENAZINE HCL TABLETS FLUPHENAZINE PA Required for ages < 6 years HALOPERIDOL LACTATE CONCENTRATE HALDOL PA Required for ages < 6 years HALOPERIDOL TABLETS HALDOL PA Required for ages < 6 years LOXAPINE SUCCINATE CAPSULES LOXITANE PA Required for ages < 6 years PERPHENAZINE TABLETS TRILAFON PA Required for ages < 6 years PIMOZIDE TABLETS ORAP PA Required for ages < 6 years THIORIDAZINE HCL TABLETS MELLARIL PA Required for ages < 6 years THIOTHIXENE CAPSULES NAVANE PA Required for ages < 6 years TRIFLUOPERAZINE HCL TABLETS STELAZINE PA Required for ages < 6 years ANTIPSYCHOTICS - FIRST GENERATION - TYPICAL - LONG ACTING INJECTIONS FLUPHENAZINE DECANOATE SOLUTION FLUPHENAZINE DECANOATE PA Required for ages < 18 years DAYS SUPPLY HALOPERIDOL DECANOATE SOLUTION HALDOL DECANOATE PA Required for ages < 18years ANTICONVULSANTS CARBAMAZEPINE CHEWABLE TABLETS TEGRETOL CARBAMAZEPINE ER CAPSULES CARBATROL CARBAMAZEPINE ER CAPSULES EQUETRO CARBAMAZEPINE SUSPENSION TEGRETOL CARBAMAZEPINE ER TABLETS TEGRETOL XR CARBAMAZEPINE TABLETS TEGRETOL DIVALPROEX CAPSULES SPRINKLE DPAKOTE SPRINKLES DIVALPROEX DR TABLETS DEPAKOTE DIVALPROEX ER TABLETS DEPAKOTE GABAPENTIN CAPSULES 100MG, 300MG, 400MG NEURONTIN GABAPENTIN ER TABLETS HORIZANT PA Required GABAPENTIN ER TABLETS GRALISE PA Required GABAPENTIN SOLUTION NEURONTIN GABAPENTIN TABLETS 600MG, NEURONTIN GABAPENTIN TABLETS 800MG NEURONTIN LAMOTRIGINE CHEW TABLETS LAMICTAL LAMOTRIGINE ER TABLETS LAMICTAL XR LAMOTRIGINE ODT TABLETS 25 MG, 50MG LAMICTAL ODT LAMOTRIGINE ODT TABLETS 100 MG LAMICTAL ODT LAMOTRIGINE ODT TABLETS 200 MG LAMICTAL ODT LAMOTRIGINE TABLETS 25 MG LAMICTAL LAMOTRIGINE TABLETS 100 MG LAMICTAL LAMOTRIGINE TABLETS 150 MG, 200 MG LAMICTAL OXCARBAZEPINE SOLUTON TRILEPTAL OXCABAZEPINE TABLETS TRILEPTAL TOPIRAMATE CAPSULES TOPAMAX Page 4 of 9
Generic Drugs Are Over Brand Drugs Unless Specified As Brand TOPIRAMATE TABLETS TOPAMAX VALPROATE SODIUM CAPSULES DEPAKENE VALPROATE SODIUM SOLUTION DEPAKENE VALPROATE SODIUM SYRUP DEPAKENE ANTIMANIC AGENTS LITHIUM CARBONATE CAPSULES LITHIUM LITHIUM CARBONATE ER TABLETS LITHOBID LITHIUM CITRATE SOLUTION LITHIUM ADHD AGENTS AMPHETAMINES AMPHETAMINE-DEXTROAMPHETAMINE TABLETS ADDERALL Brand and Generic Drug PA Required for ages < 6 years 60 30 AMPHETAMINE-DEXTROAMPHETAMINE CAPSULES 24-HOUR ADDERALL XR Brand Drug PA Required for ages < 6 years 30 30 DEXTROAMPEHTAMINE SULFATE CAPSULE 24-HOUR Drug PA Required for ages < 6 years 60 30 DEXTROAMPHETAMINE SULFATE TABLETS Drug PA Required for ages < 6 years 60 30 LISDEXAMFETAMINE ER CAPSULES VYVANSE Brand Drug PA Required for ages < 6 years 30 30 STIMULANTS DEXMETHYLPHENIDATE HCL ER CAPSULE 24-HOUR FOCALIN XR Brand Drug PA Required for ages < 6 years 60 30 DEXMETHYLPHENIDATE HCL TABLETS FOCALIN Brand Drug PA Required for ages < 6 years 60 30 METHYLPEHNIDATE HCL CHEWABLET TABLET EXTENDED RELEASE QUILLICHEW ER Brand Drug PA Required for ages < 6 years 30 30 METHYLPHENIDATE HCL CHEWABLE TABLETS METHYLIN Brand Drug PA Required for ages < 6 years 90 30 METHYLPHENIDATE HCL CAPSULE 24- HOUR RITALIN LA 10 MG Brand Drug PA Required for ages < 6 years 30 30 METHYLPHENIDATE HCL CAPSULE 24-HOUR APTENSIO XR Brand Drug PA Required for ages < 6 years 30 30 METHYLPHENIDATE HCL CAPSULE CONTROLLED RELEASE METADATE CD Drug PA Required for ages < 6 years 30 30 METHYLPHENIDATE HCL TD PATCH DAYTRANA Brand Drug PA Required for ages < 6 years 30 30 METHYLPHENIDATE HCL SOLUTION METHYLIN Brand Drug PA Required for ages < 6 years 300 ML 30 METHYLPHENIDATE HCL SUSPENSION QUILLIVANT XR Brand Drug PA Required for ages < 6 years 150 ML 30 METHYLPEHNIDATE METHYLPHENIDATE HCL TABLET CONTROLLED RELEASE ER Drug PA Required for ages < 6 years 60 30 METHYLPHENIDATE HCL TABLETS RITALIN Drug PA Required for ages < 6 years 90 30 Page 5 of 9
Generic Drugs Are Over Brand Drugs Unless Specified As Brand METHYLPHENIDATE HCL TABLET 24-HOUR METHYLPHENIDATE ER Drug PA Required for ages < 6 years 60 30 METHYLPHENIDATE HCL TABLET SUSTAINED RELEASE RITALIN SR PA Required for ages < 6 years 60 30 MISCELLANEOUS AGENTS ATOMOXETINE HCL CAPSULES STRATTERA Brand Drug PA Required for ages < 6 years 30 30 CENTRAL ALPHA-AGONISTS CLONIDINE HCL (ADHD) TABLET 12-HOUR KAPVAY Brand Drug PA Required for ages < 6 years 120 30 CLONIDINE HCL TABLETS CATAPRES PA Required for ages < 6 years CLONIDINE HCL TD PATCH CATAPRES PATCH PA Required for ages < 6 years 4 28 GUANFACINE HCL (ADHD)TABLET 24-HOUR GUANFACINE HCL ER Drug PA Required for ages < 6 years 30 30 GUANFACINE HCL TABLETS TENEX PA Required for ages < 6 years SUBSTANCE ABUSE OPIOID AGONISTS/PARTIAL AGONISTS BUPRENORPHINE HCL SL TABLETS SUBUTEX PA Required BUPRENORPHINE HCL / NALOXONE SL FILM SUBOXONE FILM Brand Drug METHADONE * DOLOPHINE* OPIOID AGONISTS NALOXONE NASAL NARCAN NASAL Drug NALOXONE SYRINGE NALOXONE Drug NALOXONE VIAL NALOXONE Drug NALTREXONE TABLETS REVIA Drug NALTREXONE INJECTION VIVITROL Drug MISCELLANEOUS AGENTS ACAMPROSATE TABLET DELAYED RELEASE CAMPRAL DILSULFIRAM TABLETS ANTABUSE ANXIOLYTICS AND HYPNOTICS BENZODIAZEPINES ALPRAZOLAM CONCENTRATE 1 MG/ML ALPRAZOLAM INTENSOL ALPRAZOLAM SR TABLET 24-HOUR ALPRAZOLAM ODT TABLET 0.25MG, 0.5MG, 1MG ALPRAZOLAM ODT TABLET 2MG ALPRAZOLAM TABLET 0.25MG, 0.5MG, 1MG PA Required for > 1 Anxiolytic 60 ML 15 PA Required for > 1 Anxiolytic 30 30 Page 6 of 9
Generic Drugs Are Over Brand Drugs Unless Specified As Brand ALPRAZOLAM TABLET 2MG CHLORDIAZEPOXIDE HCL CAPSULES CLONAZEPAM ODT TABLET 0.125MG, 0.25MG, 0.5MG, 1MG CLONAZEPAM ODT TABLET 2MG CLONAZEPAM TABLETS 0.5MG, 1MG CLONAZEPAM TABLETS 2MG CLORAZEPATE DIPOTASSIUM TAB 15 MG CLORAZEPATE DIPOTASSIUM TAB 3.75 MG CLORAZEPATE DIPOTASSIUM TAB 7.5 MG DIAZEPAM CONCENTRATE 5 MG/ML DIAZEPAM INTENSOL PA Required for > 1 Anxiolytic 60ML 30 DIAZEPAM SOLUTION 1 MG/ML PA Required for > 1 Anxiolytic 300ML 30 DIAZEPAM TABLETS LORAZEPAM CONCENTRATE 2 MG/ML LORAZEPAM TABLETS 0.5MG, 1MG LORAZEPAM TABLETS 2MG OXAZEPAM CAPSULES MISCELLANEOUS ANXIOLYTICS BUSPIRONE HCL TABLETS 5 MG, 7.5 MG, 10 MG, 15 MG BUSPIRONE HCL TABLETS 30 MG HYDROXYZINE HCL SYRUP LORAZEPAM INTENSOL PA Required for > 1 Anxiolytic 60 ML 30 BUSPIRONE HCL BUSPIRONE HCL HYDROXYZINE HCL SYRUP 300 ML 30 HYDROXYZINE HCL TABLETS 240 30 HYDROXYZINE HCL TABLETS HYDROXYZINE PAMOATE CAPSULES VISTARIL 120 30 MISCELLANEOUS SEDATIVE & HYPNOTICS DOXEPIN HCL TABLETS SILENOR PA Required ESZOPICLONE TABLETS LUNESTA Page 7 of 9
Generic Drugs Are Over Brand Drugs Unless Specified As Brand ESTAZOLAM TABLETS FLURAZEPAM HCL CAPSULES DALMANE MEPROBAMATE TABLETS RAMELTEON TABLETS ROZEREM PA Required TEMAZEPAM CAPSULES 15MG, 30MG RESTORIL TRIAZOLAM TABLETS HALCION ZALEPLON CAPSUELS SONATA ZOLPIDEM CAPSULES 5MG AMBIEN PA Required for > 1 Hypnotic 60 30 ZOLPIDEM CAPSULES 10MG AMBIEN ZOLPIDEM ER TABLETS AMBIEN CR PA Required ZOLPIDEM SL TABLETS INTERMEZZO SL PA Required ZOLPIDEM SL TABLETS EDULAR PA Required ZOLPIDEM SOLUTION ZOLPIMIST PA Required ANTIHISTAMINES CYPROHEPTADINE HCL TABLETS DIPHENHYDRAMINE HCL CAPSULES DIPHENHYDRAMINE HCL CHEWABLE TABLETS DIPHENHYDRAMINE HCL ELIXIR DIPHENHYDRAMINE HCL LIQUID DIPHENHYDRAMINE HCL SYRUP DIPHENHYDRAMINE HCL TABLETS HYDROXYZINE HCL TABLETS ATARAX HYDROXYZINE PAMOATE CAPSULES VISTARIL DOPAMINE AGONISTS AMANTADINE HCL CAPSULES SYMMETREL AMANTADINE HCL TABLETS SYMMETREL AUTONOMIC AGONISTS PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS BETHANECHOL CHLORIDE TABLETS URECHOLINE ANTICHOLINERGIC AGENTS BENZTROPINE MESYLATE TABLETS COGENTIN TRIHEXPHENIDYL HCL TABLETS ARTANE CARDIOVASCULAR DRUGS ALPHA-1 ADRENERGIC BLOCKING AGENTS PRAZOSIN HCL CAPSULES MINIPRESS BETA-ADRENERGIC BLOCKING AGENTS NADOLOL TABLETS CORGARD Page 8 of 9
Generic Drugs Are Over Brand Drugs Unless Specified As Brand LIMITS PROPRANOLOL HCL TABLETS INDERAL THRYOID AGENTS LEVOTHROID / LEVOTHYROXINE SODIUM TABLETS SYNTHROID LIOTHYRONINE TABLETS CYTOMEL THRYOID TABLETS ARMOUR THYROID VITAMINS AND OTHER MISCELLANEOUS AGENTS DAYS SUPPLY ALPHA-TOCOPHEROL CAPSULES VITAMIN E - VITAMIN B12 - CYANOCOBALAMIN TABLETS FOLIC ACID TABLETS OMEGA 3 FATTY ACID CAPSULES VITAMIN B6 - PYRIDOXINE HCL TABLETS VITAMIN B1 - THIAMINE HCL TABLETS MULTIPLE VITAMIN TABLETS MULTIPLE VITAMIN W/ MINERAL TABLETS SALIVA SUBSTITUTE SPRAY SALIVART DOCUSATE SODIUM CAPSULES COLACE PSYLLIUM METAMUCIL KEY: Drugs listed in Bold/Italic CAPITAL LETTERS indicate the medication is only available as a brand name product. (*) Indicates that medication can only be obtained from an Opioid Treatment Program (OTP) provider. (X) Indicates that the medication requires prior authorization. Abbreviations: Cap = capsule HCL = hydrochloride SOLN = solution Chew = chewable IM = intramuscular SR = sustained release Conc = concentrate Inj = injectable Susp = suspension DR = Delayed Release IR = Immediate release Syr = Syrup Elix = Elixir LA = long acting Tab = tablet ER = extended release ODT = orally disintegrating tablet TD = transdermal hbr = hydrobromide SL = sublingual XL = extended release Page 9 of 9