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AIDS Drug Assistance Program
and HIV Drug Formulary

STATE OF MINNESOTA - (as of 01/05/2010)
Sorted by classification

Nucleoside reverse transcriptase inhibitors
Abacavir (Ziagen)
Didanosine (Videx)
Emtricitabine (Emtriva)
Lamivudine (Epivir)
Stavudine (Zerit)
Zidovudine (Retrovir)
Lamivudine/Zidovudine (Combivir)
Abacavir/Lamivudine/Zidovudine (Trizivir)
Abacavir/Lamivudine (Epzicom) Emtricitabine/Tenofovir (Truvada)
Nucleotide analog
Tenofovir (Viread)
Non-nucleoside reverse transcriptase inhibitors
Delavirdine (Rescriptor)
Nevirapine (Viramune)
Efavirenz (Sustiva)
Etravirine (Intelence)
Efavirenz/Emtricitabine/Tenofovir (Atripla)
Protease inhibitors
Atazanavir sulfate (Reyataz)
Darunavir (Prezista)
Indinavir (Crixivan)
Nelfinavir (Viracept)
Ritonavir (Norvir)
Saquinavir (Invirase)
Tipranavir (Aptivus)
Lopinavir/Ritonavir (Kaletra)
Fosamprenavir calcium (Lexiva)
Cell entry inhibitors
Enfuvirtide/T-20 (Fuzeon)
Maraviroc (Selzentry)
Integrase inhibitor
Raltegravir (Isentress)
Antivirals
Acyclovir (Zovirax)
Famciclovir (Famvir)
Penciclovir (Denavir – topical only)
Valacylovir (Valtrex)
Valganciclovir (Valcyte)
Foscarnet (Foscavir)
Relenza
Tamiflu
Vitamins
Multivitamins (Therapeutic/M, Certagen/ Silver, Cerovite)
Prenatal vitamins (Prenatal Plus, Prenatal Rx)
Colony Stimulating Factors
Epogen/Procrit
Neupogen
Antibiotics/ antiprotozoal- Oral
Penicillins/Cephalosporins
Amoxicillin
Amoxicillin/clavulanic acid (Augmentin)
Cefpodoxime (Vantin)
Cephadroxil (Duricef)
Cephalexin (Keflex)
Dicloxacillin
Penicillin
Macrolides
Azithromycin (Zithromax)
Clarithromycin (Biaxin)
Erythromycin
Tetracyclines
Doxycycline
Minocycline
Tetracycline
Quinolones
Ciprofloxacin (Cipro)
Levofloxacin (Levaquin)
Moxifloxacin (Avelox)
Other Antibiotics
Clindamycin moved from tetracyclines
Isoniazid/Vitamin B6
Metronidazole (Flagyl)
Trimethoprim/Sulfamethoxazole (Septra, Bactrim)
Antibiotics/antiseptics – Topical Rx
Bacitracin
Bacitracin/polymyxin
Clindamycin 1% gel (Cleocin T)
HPV treatment – Topical RX
Imiquimod (Aldara)
Podofilox (Condylox)
Antiparasitics
Pyrimethamine (Daraprim)
Hepatitis B
Lamivudine (Epivir HBV)
Hepatitis C
Pegylated interferon (Pegasys, PegIntron)
Ribavirin (Ribasphere)
Urinary Incontinence
Derafenacin (Enablex)
Oxybutynin (Ditropan/XL)
Triospium (Sanctura)
Desmopressin acetate (DDAVP)
Antidiarrheal
Diphenoxylate/Atropine (Lomotil)
Loperamide (Imodium)
Appetite Stimulants and/or Anti-Nausea
Dronabinol (Marinol)
Megestrol (Megace)
Metoclopramide (Reglan)
Prochlorperazine (Compazine)
Ondansetron (Zofran)
Histamine-2 Receptor Antagonists (H2RA)
Cimetidine (Tagamet)
Ranitidine (Zantac)
Proton Pump Inhibitors (PPI)
Omeprazole (Prilosec)
Lansoprazole (Prevacid)
Pantoprazole (Protonix)
Antidepressants
Buproprion (Wellbutrin/SR/XL)
Citalopram (Celexa)
Duloxetine (Cymbalta)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Mirtazipine (Remeron)
Paroxetine (Paxil)
Quetiapine (Seroquel – used with other antidepressant)
Sertraline (Zoloft)
Trazodone (Desaryl)
Venlafaxine (Effexor/XR)
Tricyclic Antidepressents
Amitriptyline
Doxepin
Imipramine
Nortriptyline
Sleep agents
Zolpidem (Ambien)
Steroid treatment
Testosterone (all dosage forms)
Lipid lowering statins
Atorvastatin (Lipitor)
Fluvastatin (Lescol/XL)
Pravastatin (Pravachol)
Rosuvastatin (Crestor)
Simvastatin (Zocor)
Other lipid lowering agents
Fenofibrate (Tricor)
Gemfibrozil (Lopid )
Niacin (Niaspan)
Antifungals -Oral
Clotrimazole (Mycelex)
Fluconazole (Diflucan)
Itraconazole (Sporanox)
Nystatin (Nilstat)
Voriconazole (Vfend)
Flucytosine (Ancobon)
Antifungals – Topical
Buconazole
Econazole
Ketoconazole
Miconazole
Nystatin
Terconazole
HIV-associated opportunistic infections
Atovaquone (Mepron) for PCP
Dapsone (avlosulfon) for PCP
Ethambutol (Myambutol)
Leucovorin
Rifabutin (Mycobutin) for MAC
Rifampin (Rifadin) for MAC
Anticonvulsants/ Neuropathy
Carbamazepine (Tegretol)
Divalproex Sodium (Depakote/ER)
Gabapentin (Neurontin)
Lamotrigene (Lamictal)
Levetiracetam (Keppra)
Phenytoin (Dilantin)
Anti-inflammatory
Prednisone
Hydrocortisone

Related Pages
•  AIDS Drug Assistance Program (ADAP)
•  Client appeal rights
•  Dental prior authorization
•  Federal Poverty Guidelines
•  HIV/AIDS testing
•  Minnesota HIV/AIDS programs

Related Links
•  Case Management Enrollment form
•  Dental prior authorization form
•  HIV/AIDS application/reapplication
•  Mental Health Prior authorization form
•  MHCP Provider Call Center
•  Six-month client update form

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