©2008 Express Scripts, Inc. 16
(10/15/2007)
Nombre del medicamento
|
Composición química
|
Nivel
|
Requisitos/
Límites
|
SUCCINIMIDAS
|
CELONTIN
|
methsuximide
|
2
|
|
ethosuximide
|
|
1
|
|
|
AMINAS TERCIARIAS
|
amitriptyline hcl [CARE]
|
|
1
|
|
clomipramine hcl
|
|
1
|
|
doxepin hcl [CARE]
|
|
1
|
|
imipramine hcl, pamoate
|
|
1
|
|
trimipramine maleate
|
|
1
|
|
|
ÁCIDO VALPROICO Y DERIVADOS
|
DEPAKOTE, ER, SPRINKLE
|
divalproex
|
2
|
|
valproate sodium [INJ]
|
|
1
|
|
valproic acid cap, syrup
|
|
1
|
|
|
MEDICAMENTOS CARDIOVASCULARES
|
AMIODARONAS
|
amiodarone hcl [CARE]
|
|
1
|
|
pacerone tab 200 mg [CARE]
|
|
1
|
|
|
INHIBIDORES DE LA ENZIMA CONVERTIDORA DE ANGIOTENSINA
|
benazepril hcl
|
|
1
|
|
captopril
|
|
1
|
|
enalapril maleate
|
|
1
|
|
enalaprilat [INJ]
|
|
1
|
|
fosinopril sodium
|
|
1
|
|
lisinopril
|
|
1
|
|
moexipril hcl
|
|
1
|
|
quinapril hcl
|
|
1
|
|
trandolapril
|
|
1
|
|
|
ANTAGONISTAS DEL RECEPTOR DE ANGIOTENSINA II
|
DIOVAN
|
valsartan
|
2
|
[ST]
|
MICARDIS
|
telmisartan
|
2
|
[ST]
|
|
MEDICAMENTOS PARA LA DISRRITMIA
|
disopyramide phosphate [CARE]
|
|
1
|
|
ETHMOZINE
|
moricizine
|
2
|
|
flecainide acetate
|
|
1
|
|
mexiletine hcl
|
|
1
|
|
procainamide hcl
|
|
1
|
|
propafenone hcl
|
|
1
|
|
quinidine gluconate, sulfate
|
|
1
|
|
©2008 Express Scripts, Inc. (10/15/2007)
17
Nombre del medicamento
|
Composición química
|
Nivel
|
Requisitos/
Límites
|
MEDICAMENTOS ANTAGONISTAS BETA-ADRENÉRGICOS
|
acebutolol hcl
|
|
1
|
|
atenolol
|
|
1
|
|
betaxolol hcl
|
|
1
|
|
bisoprolol fumarate
|
|
1
|
|
carvedilol
|
|
1
|
|
COREG [G]
|
carvedilol
|
2
|
|
labetalol hcl
|
|
1
|
|
metoprolol succinate, tartrate
|
|
1
|
|
nadolol
|
|
1
|
|
pindolol
|
|
1
|
|
propranolol hcl
|
|
1
|
|
timolol maleate
|
|
1
|
|
TOPROL XL [G]
|
metoprolol succinate
|
2
|
|
|
ANTAGONISTAS DEL CALCIO
|
afeditab cr
|
|
1
|
|
amlodipine besylate
|
|
1
|
|
cartia xt
|
|
1
|
|
dilt-cd
|
|
1
|
|
dilt-xr
|
|
1
|
|
diltia xt
|
|
1
|
|
diltiazem er, hcl
|
|
1
|
|
felodipine er
|
|
1
|
|
isradipine
|
|
1
|
|
nicardipine hcl
|
|
1
|
|
nifediac cc
|
|
1
|
|
nifedical xl
|
|
1
|
|
nifedipine, er
|
|
1
|
|
nimodipine
|
|
3
|
|
NIMOTOP [G]
|
nimodipine
|
3
|
|
SULAR
|
nisoldipine
|
2
|
[ST]
|
taztia xt
|
|
1
|
|
verapamil er, pm
|
|
1
|
|
verapamil hcl
|
|
1
|
|
|
GLICÓSIDOS CARDÍACOS
|
digitek
|
|
1
|
|
digoxin inj, soln, tab (0.125 mg, 0.25 mg)
|
|
1
|
|
milrinone in 5% dextrose, lactate [INJ]
|
|
1
|
|
|
ANTIHIPERTENSIVOS CENTRALES
|
clonidine hcl
|
|
1
|
|
guanabenz acetate
|
|
1
|
|
©2008 Express Scripts, Inc. (10/15/2007)
18
Nombre del medicamento
|
Composición química
|
Nivel
|
Requisitos/
Límites
|
guanfacine hcl
|
|
1
|
|
methyldopa [CARE]
|
|
1
|
|
methyldopate hcl [INJ]
|
|
1
|
|
|
MEDICAMENTOS PARA EL FEOCROMOCITOMA
|
DEMSER
|
metyrosine
|
2
|
|
DIBENZYLINE
|
phenoxybenzamine
|
2
|
|
|
ANTAGONISTAS DEL RECEPTOR DE LA ENDOTELINA
|
LETAIRIS
|
ambrisentan
|
3
|
|
TRACLEER
|
bosentan
|
3
|
|
|
INHIBIDORES DE LA HMG-COA REDUCTASA
|
CRESTOR
|
rosuvastatin calcium
|
2
|
[QLL][ST]
|
lovastatin
|
|
1
|
[QLL]
|
pravastatin sodium
|
|
1
|
[QLL]
|
simvastatin
|
|
1
|
[QLL]
|
VYTORIN
|
ezetimibe/simvastatin
|
2
|
[QLL][ST]
|
|
HIPOLIPROTEINÉMICOS
|
cholestyramine, light
|
|
1
|
|
colestipol hcl
|
|
1
|
|
fenofibrate
|
|
1
|
|
gemfibrozil
|
|
1
|
|
LOVAZA
|
omega-3 acid ethyl esters
|
2
|
|
NIASPAN
|
niacin
|
2
|
|
prevalite
|
|
1
|
|
TRIGLIDE
|
fenofibrate
|
2
|
|
ZETIA
|
ezetimibe
|
2
|
[ST]
|
|
DIURÉTICOS DE ASA
|
bumetanide
|
|
1
|
|
furosemide
|
|
1
|
|
torsemide
|
|
1
|
|
|
NITRATOS
|
amyl nitrite
|
|
1
|
|
isosorbide dinitrate, mononitrate
|
|
1
|
|
nitro-bid
|
|
1
|
|
nitro-time
|
|
1
|
|
nitroglycerin in d5w [INJ]
|
|
1
|
|
nitroglycerin, patch
|
|
1
|
|
nitroquick
|
|
1
|
|
NITROSTAT
|
nitroglycerin
|
2
|
|
©2008 Express Scripts, Inc. (10/15/2007)
19
Nombre del medicamento
|
Composición química
|
Nivel
|
Requisitos/
Límites
|
OTROS ANTIARRÍTMICOS
|
adenosine [INJ]
|
|
1
|
|
CORVERT [INJ]
|
ibutilide fumarate
|
2
|
|
lidocaine hcl [INJ]
|
|
1
|
|
sorine
|
|
1
|
|
sotalol, af
|
|
1
|
|
TIKOSYN
|
dofetilide
|
2
|
|
|
OTROS ANTIHIPERTENSIVOS
|
amlodipine besylate/benazepril
|
|
1
|
|
atenolol/chlorthalidone
|
|
1
|
|
benazepril hcl/hctz
|
|
1
|
|
bisoprolol fumarate/hctz
|
|
1
|
|
captopril/hydrochlorothiazide
|
|
1
|
|
DIOVAN HCT
|
hctz/valsartan
|
2
|
[ST]
|
enalapril maleate/hctz
|
|
1
|
|
EXFORGE
|
amlodipine/valsartan
|
2
|
|
fosinopril/hydrochlorothiazide
|
|
1
|
|
hydra-zide
|
|
1
|
|
lisinopril/hctz
|
|
1
|
|
methyldopa/hydrochlorothiazide [CARE]
|
|
1
|
|
metoprolol/hydrochlorothiazide
|
|
1
|
|
MICARDIS HCT
|
telmisartan/hctz
|
2
|
[ST]
|
moexipril/hydrochlorothiazide
|
|
1
|
|
nadolol/bendroflumethiazide
|
|
1
|
|
propranolol hcl w/hctz
|
|
1
|
|
quinapril/hydrochlorothiazide
|
|
1
|
|
quinaretic
|
|
1
|
|
reserpine
|
|
1
|
|
OTROS MEDICAMENTOS CARDIOVASCULARES
|
alprostadil [INJ]
|
|
1
|
|
dobutamine hcl, in dextrose [INJ]
|
|
1
|
|
dopamine hcl, 5ml in 10ml, additive syringe, in 5% dextrose [INJ]
|
|
1
|
|
isoproterenol hcl [INJ]
|
|
1
|
|
midodrine hcl
|
|
1
|
|
norepinephrine bitartrate [INJ]
|
|
1
|
|
pentoxifylline
|
|
1
|
|
pentoxil
|
|
1
|
|
phenylephrine hcl [INJ]
|
|
1
|
|
RANEXA
|
ranolazine
|
2
|
|
| |
