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PDL Reference Documents

Drug Use Review Documents

PDL Status Values

Y = preferred
N = non-preferred. Non-preferred drugs listed as N but without clinical drug use criteria are subject to the Non-Preferred Drugs in Select PDL Classes prior authorization criteria. New drugs will be listed as N until reviewed by the P&T Committee and are subject to the New Drug Policy.
V = voluntary non-preferred. Non-preferred mental health drugs are listed as V and prior authorization is not required.
Null (i.e. blank) = indicates the class or specific drug has not been reviewed for PDL placement.

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Generic Name Brand Name Form PDL
Status		 Current Drug Use Criteria Carveout
‐ Bill FFS		 New Drug Evaluation & Updates
codeine phosphate/guaifenesin IOPHEN C-NR LIQUID Y Pharmacy PA N  
codeine phosphate/guaifenesin GUAIFENESIN-CODEINE LIQUID Y Pharmacy PA N  
codeine phosphate/guaifenesin DURAGANIDIN NR LIQUID Y Pharmacy PA N  
codeine phosphate/guaifenesin CODEINE-GUAIFENESIN LIQUID Y Pharmacy PA N  
codeine phosphate/guaifenesin G TUSSIN AC LIQUID Y Pharmacy PA N  
codeine phosphate/guaifenesin VIRTUSSIN AC LIQUID Y Pharmacy PA N  
codeine phosphate/guaifenesin CHERATUSSIN AC SYRUP Y Pharmacy PA N  
codeine phosphate/guaifenesin ALLFEN CDX TABLET Y Pharmacy PA N  
guaifenesin GILTUSS EX LIQUID Y Age Restriction N  
guaifenesin CHILDREN GILTUSS EX LIQUID Y Age Restriction N  
guaifenesin LIQUITUSS GG LIQUID Y Age Restriction N  
guaifenesin TUSSIN SYRUP Y Age Restriction N  
guaifenesin ALTARUSSIN SYRUP Y Age Restriction N  
guaifenesin GUAIFENESIN SYRUP Y Age Restriction N  
guaifenesin MUCUS-ER MAX TAB ER 12H Y Age Restriction N  
guaifenesin MUCUS RELIEF ER TAB ER 12H Y Age Restriction N  
guaifenesin MUCUS ER TAB ER 12H Y Age Restriction N  
guaifenesin MUCINEX TAB ER 12H Y Age Restriction N  
guaifenesin GUAIFENESIN ER TAB ER 12H Y Age Restriction N  
guaifenesin GUAIFENESIN TAB ER 12H Y Age Restriction N  
guaifenesin MUCUS-ER MAX TAB ER 12H Y Age Restriction N  
guaifenesin MUCUS RELIEF ER TAB ER 12H Y Age Restriction N  
guaifenesin GUAIFENESIN ER TAB ER 12H Y Age Restriction N  
guaifenesin GUAIFENESIN TABLET Y Age Restriction N  
guaifenesin CHEST CONGESTION RELIEF TABLET Y Age Restriction N  
guaifenesin TUSSIN TABLET Y Age Restriction N  
guaifenesin G-FENESIN TABLET Y Age Restriction N  
guaifenesin AQUAMIST TABLET ER Y Age Restriction N  
guaifenesin MUCINEX TABLET ER Y Age Restriction N  
guaifenesin/dextromethorphan MUCINEX FAST-MAX CONGEST-COUGH CAPSULE Y Age Restriction N  
guaifenesin/dextromethorphan MUCINEX COUGH-CHEST CONG HBP CAPSULE Y Age Restriction N  
guaifenesin/dextromethorphan CHEST CONGESTION-COUGH HBP CAPSULE Y Age Restriction N  
guaifenesin/dextromethorphan CHILDREN'S COUGH RELIEF LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan TUSSIN DM MAX LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan TUSSIN DM LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan ROBAFEN DM LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan GUAIFENESIN-DM LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan DIABETIC TUSSIN MAX-STRENGTH LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan GERI-TUSSIN DM LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan GILTUSS COUGH-CONGESTION LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan GILTUSS HBP LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan COUGH-CHEST CONGESTION DM LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan GUAIFED-DM LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan CHILDREN'S COUGH LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan MUCINEX FAST-MAX KICK CONG-CGH LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan CHILD MUCUS RELIEF COUGH LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan CHILD ROBITUSSIN ELDERBERRY DM LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan CHILDREN'S GILTUSS COUGH-CHEST LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan CHLD ROBITUSSIN COUGH-CHEST DM LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan CHILD ROBITUSSIN COUGH-CHEST LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan MUCUS RELIEF DM MAX LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan ROBAFEN DM LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan KOLEPHRIN-GG/DM LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan KOSHER CARE DM LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan MAXI-TUSS GMX LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan GUAIFENESIN-DEXTROMETHORPHAN LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan TUSSIN DM LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan ULTRA DM FREE & CLEAR LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan TUSSIN DM CLEAR LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan TUSSIN COUGH LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan ADULT DM MAXIMUM LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan ADULT WAL-TUSSIN DM MAX LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan ALTITUSS LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan BIO-Z-COUGH LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan TRISPEC DMX LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan SORBUGEN NR LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan SCOT-TUSSIN SENIOR LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan SAFE TUSSIN 30 LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan SAFETUSSIN DM LIQUID Y Age Restriction N  
guaifenesin/dextromethorphan DECONGESTANT D SYRUP Y Age Restriction N  
guaifenesin/dextromethorphan EXPECTORANT DM SYRUP Y Age Restriction N  
guaifenesin/dextromethorphan GUAIFENESIN DM SYRUP Y Age Restriction N  
guaifenesin/dextromethorphan COUGH FORMULA DM SYRUP Y Age Restriction N  
guaifenesin/dextromethorphan ROBAFEN DM COUGH-CHEST CONGEST SYRUP Y Age Restriction N  
guaifenesin/dextromethorphan GUAIFENESIN-DEXTROMETHORPHAN SYRUP Y Age Restriction N  
guaifenesin/dextromethorphan GUIATUSS DM SYRUP Y Age Restriction N  
guaifenesin/dextromethorphan TUSSIN DM COUGH-CHEST CONGEST SYRUP Y Age Restriction N  
guaifenesin/dextromethorphan TUSSIN DM SYRUP Y Age Restriction N  
guaifenesin/dextromethorphan WAL-TUSSIN DM SYRUP Y Age Restriction N  
guaifenesin/dextromethorphan ADULT WAL-TUSSIN DM SYRUP Y Age Restriction N  
guaifenesin/dextromethorphan ADULT TUSSIN DM SYRUP Y Age Restriction N  
guaifenesin/dextromethorphan BENYLIN SYRUP Y Age Restriction N  
guaifenesin/dextromethorphan TUSSID DM SYRUP Y Age Restriction N  
guaifenesin/dextromethorphan GUAIBID DM TAB ER 12H Y Age Restriction N  
guaifenesin/dextromethorphan DEX GG TAB ER 12H Y Age Restriction N  
guaifenesin/dextromethorphan MUCUS RELIEF DM MAX ER TAB ER 12H Y Age Restriction N  
guaifenesin/dextromethorphan MUCUS RELIEF DM ER TAB ER 12H Y Age Restriction N  
guaifenesin/dextromethorphan MUCUS DM ER TAB ER 12H Y Age Restriction N  
guaifenesin/dextromethorphan MONAFED DM TAB ER 12H Y Age Restriction N  
guaifenesin/dextromethorphan MUCUS RELIEF DM ER TAB ER 12H Y Age Restriction N  
guaifenesin/dextromethorphan MUCUS DM ER TAB ER 12H Y Age Restriction N  
guaifenesin/dextromethorphan MUCUS RELIEF ER DM-MAX TAB ER 12H Y Age Restriction N  
guaifenesin/dextromethorphan ROBITUSSIN MAX 12H COUGH-MUCUS TAB ER 12H Y Age Restriction N  
guaifenesin/dextromethorphan CHEST CONGESTION RELIEF DM TABLET Y Age Restriction N  
guaifenesin/dextromethorphan GUAIFENESIN-DEXTROMETHORPHAN TABLET Y Age Restriction N  
guaifenesin/dextromethorphan MUCUS RELIEF DM TABLET Y Age Restriction N  
guaifenesin/dextromethorphan MUCUS RELIEF DM TABLET Y Age Restriction N  
guaifenesin/dextromethorphan PHARBINEX-DM TABLET Y Age Restriction N  
guaifenesin/dextromethorphan ZYNCOF TABLET Y Age Restriction N  
pseudoephedrine HCl NASAL DECONGESTANT CAPSULE Y Age Restriction N  
pseudoephedrine HCl SUDOGEST TABLET Y Age Restriction N  
pseudoephedrine HCl PSEUDOEPHEDRINE HCL TABLET Y Age Restriction N  
pseudoephedrine HCl NASAL DECONGESTANT TABLET Y Age Restriction N  
pseudoephedrine HCl SUPHEDRIN TABLET Y Age Restriction N  
pseudoephedrine HCl PSEUDOEPHEDRINE HCL TABLET Y Age Restriction N  
pseudoephedrine HCl WAL-PHED TABLET Y Age Restriction N  
pseudoephedrine HCl SU-PHEDRIN TABLET Y Age Restriction N  
pseudoephedrine HCl SUDAFED TABLET Y Age Restriction N  
pseudoephedrine HCl NEXAFED TABLET Y Age Restriction N  
acetaminophen/guaifenesin CHEST CONGESTION TABLET N Age Restriction N  
bromphenir mal/dextrometh HBr CHILDRENS COLD AND COUGH LIQUID N Age Restriction N  
bromphenir mal/dextrometh HBr CHILDREN'S COLD-COUGH RLF DM LIQUID N Age Restriction N  
brompheniram/phenylephrine/DM LOHIST-DM LIQUID N Age Restriction N  
brompheniram/phenylephrine/DM RYNEX DM SOLUTION N Age Restriction N  
brompheniram/phenylephrine/DM ENDACOF-DM SOLUTION N Age Restriction N  
brompheniram/phenylephrine/DM CHILDREN'S COLD-COUGH RLF DM SOLUTION N Age Restriction N  
brompheniramin/pseudoephedrine RYNEX PSE LIQUID N Age Restriction N  
brompheniramine/phenylephrine CHILDREN'S COLD-ALLERGY SOLUTION N Age Restriction N  
brompheniramine/phenylephrine RU-HIST D TABLET N Age Restriction N  
brompheniramine/pseudoephed/DM BROMPHENIRAMINE-PSEUDOEPHED-DM SYRUP N Age Restriction N  
Car-Pen/Car-Pen Tan/PE Tan/PE CARBATUSS-12 ORAL SUSP N Age Restriction N  
carbinoxamine-pseudoephedrine COLDEC D TABLET ER N Age Restriction N  
cetirizine HCl/pseudoephedrine ALLERGY RELIEF NASAL DECONGEST TAB ER 12H N Age Restriction N  
cetirizine HCl/pseudoephedrine CETIRIZINE-PSEUDOEPHEDRINE ER TAB ER 12H N Age Restriction N  
chlorpheniramine/codeine phos TUXARIN ER TAB ER 12H N Pharmacy PA N Jul 30, 2015
chlorpheniramine/dextromethorp COUGH FORMULA LIQUID N Age Restriction N  
chlorpheniramine/dextromethorp COUGH-COLD HBP TABLET N Age Restriction N  
chlorpheniramine/PE/codeine CAPCOF LIQUID N Pharmacy PA N Jul 30, 2015
chlorpheniramine/phenyleph/DM NOHIST-DM LIQUID N Age Restriction N  
chlorpheniramine/phenyleph/DM ED A-HIST DM TABLET N Age Restriction N  
chlorpheniramine/phenylephrine COLD-ALLERGY PE TABLET N Age Restriction N  
chlorpheniramine/pseudoephed SUDOGEST COLD AND ALLERGY TABLET N Age Restriction N  
d-methorphan/PE/acetaminophen DAY TIME COLD-FLU CAPSULE N Age Restriction N  
d-methorphan/PE/acetaminophen DAY TIME COLD-FLU LIQUID N Age Restriction N  
d-methorphan/PE/acetaminophen DAY MULTI-SYMP FLU-SEVERE COLD POWD PACK N Age Restriction N  
d-methorphan/pe/dexbromphenir WESTUSSIN DM NF LIQUID N Age Restriction N  
d-methorphan/pe/dexbromphenir ALAHIST CF TABLET N Age Restriction N  
dexbromphen/pseudoeph/chlophed CHLO TUSS LIQUID N Age Restriction N  
dexbrompheniramin/phenylephrin ALAHIST PE TABLET N Age Restriction N  
dexbrompheniramine/pseudoephed DURAHIST TABLET N Age Restriction N  
dexbrompheniramine/pseudoephed CONEX TABLET N Age Restriction N  
dexchlorphen/phenylephrine/DM WESTUSSIN DM SYRUP N Age Restriction N  
dexchlorphenir/pse/chlophedian VANACOF LIQUID N Age Restriction N  
dexchlorpheniram/chlophedianol VANACOF-2 LIQUID N Age Restriction N  
dextromethorphan HBr TUSSIN LONG-ACTING LIQUID N Age Restriction N  
dextromethorphan HBr COUGH RELIEF LIQUID N Age Restriction N  
dextromethorphan HBr TUSSIN PEDIATRIC SYRUP N Age Restriction N  
dextromethorphan HBr DIABE-TUSS DM SYRUP N Age Restriction N  
dextromethorphan polistirex DEXTROMETHORPHAN POLISTIREX SUS ER 12H N Age Restriction N  
dextromethorphan polistirex COUGH DM ER SUS ER 12H N Age Restriction N  
dextromethorphan/triprolidine ENDAL SOLUTION N Age Restriction N  
diphenhyd/phenyleph/acetaminop NIGHTTIME SEVERE COUGH-COLD POWD PACK N Age Restriction N  
DM/acetaminophen/doxylamine NIGHTTIME COLD-FLU CAPSULE N Age Restriction N  
DM/acetaminophen/doxylamine NIGHT TIME COLD-FLU CAPSULE N Age Restriction N  
DM/acetaminophen/doxylamine NIGHTTIME COLD-FLU RELIEF CAPSULE N Age Restriction N  
DM/acetaminophen/doxylamine NITE TIME COLD-FLU LIQUID N Age Restriction N  
DM/p-ephed/acetaminoph/doxylam NIGHT TIME COLD CAPSULE N Age Restriction N  
DM/p-ephed/acetaminoph/doxylam NITE TIME LIQUID N Age Restriction N  
DM/pe/acetaminophen/chlorphenr COLD MAX DAY-NIGHT TABLET SEQ N Age Restriction N  
DM/PE/acetaminophen/doxylamine NIGHTTIME MAX COLD-FLU CAPSULE N Age Restriction N  
DM/PE/acetaminophen/doxylamine SEVERE COLD-FLU NIGHTTIME LIQUID N Age Restriction N  
DM/pseudoephed/acetaminoph/cpm FLU/COUGH/COLD POWD PACK N Age Restriction N  
DM/pseudoephed/acetaminophen PSEUDOEPHEDRINE SEVERE COLD TABLET N Age Restriction N  
eucalyptus oil/menthol COUGH DROPS LOZENGE N Age Restriction N  
fexofenadine/pseudoephedrine ALLERGY-CONGESTION-D ER TAB ER 12H N Age Restriction N  
fexofenadine/pseudoephedrine FEXOFENADINE-PSE ER TAB ER 24H N Age Restriction N  
guaifen/dextromethorphan/PE TUSNEL DM PEDIATRIC LIQUID N Age Restriction N  
guaifen/dextromethorphan/PE ROBAFEN CF LIQUID N Age Restriction N  
guaifen/dextromethorphan/PE DEXTROMETHORPH-GUAIF-PHENYLEPH LIQUID N Age Restriction N  
guaifen/dextromethorphan/PE CHILD'S MUCUS RELIEF M-S COLD LIQUID N Age Restriction N  
guaifen/dextromethorphan/PE TUSSIN CF LIQUID N Age Restriction N  
guaifen/dextromethorphan/PE VANACOF DMX LIQUID N Age Restriction N  
guaifen/dextromethorphan/PE AQUANAZ TABLET N Age Restriction N  
guaifen/dextromethorphan/PE VANATAB DM TABLET N Age Restriction N  
guaifen/phenyleph/acetaminophn SINUS SEVERE TABLET N Age Restriction N  
guaifen/phenyleph/acetaminophn MUCUS RELIEF SINUS CONG PAIN TABLET N Age Restriction N  
guaifen/phenyleph/acetaminophn HEAD CONGESTION-MUCUS TABLET N Age Restriction N  
guaifenesin TUSSIN MUCUS-CHEST CONGESTION LIQUID N Age Restriction N  
guaifenesin TUSSIN LIQUID N Age Restriction N  
guaifenesin IOPHEN-NR LIQUID N Age Restriction N  
guaifenesin GUAIFENESIN LIQUID N Age Restriction N  
guaifenesin/DM/pseudoephedrine TUSNEL PEDIATRIC LIQUID N Age Restriction N  
guaifenesin/DM/pseudoephedrine DECONGESTANT D LIQUID N Age Restriction N  
guaifenesin/DM/pseudoephedrine ROLATUSS LIQUID N Age Restriction N  
guaifenesin/phenylephrine HCl ED BRON GP LIQUID N Age Restriction N  
guaifenesin/phenylephrine HCl DECONEX IR TABLET N Age Restriction N  
guaifenesin/phenylephrine HCl PHENYLEPHRINE GG TABLET ER N Age Restriction N  
guaifenesin/pseudoephedrne HCl TUSSIN SEVERE CONGESTION CAPSULE N Age Restriction N  
guaifenesin/pseudoephedrne HCl GUAIFENESIN W/PSEUDOEPHEDRINE CAPSULE ER N Age Restriction N  
guaifenesin/pseudoephedrne HCl COLDMIST S SYRUP N Age Restriction N  
guaifenesin/pseudoephedrne HCl GUAIFEN-PSE TAB ER 12H N Age Restriction N  
guaifenesin/pseudoephedrne HCl COLDMIST LA TAB ER 12H N Age Restriction N  
guaifenesin/pseudoephedrne HCl GUAIFEN PSE TAB ER 12H N Age Restriction N  
guaifenesin/pseudoephedrne HCl MUCUS D TAB ER 12H N Age Restriction N  
guaifenesin/pseudoephedrne HCl MUCUS RELIEF D TAB ER 12H N Age Restriction N  
guaifenesin/pseudoephedrne HCl PSE 60 TAB ER 12H N Age Restriction N  
guaifenesin/pseudoephedrne HCl GUAIFENESIN-PSEUDOEPHEDRINE TABLET N Age Restriction N  
guaifenesin/pseudoephedrne HCl POLY-VENT IR TABLET N Age Restriction N  
hydrocodone bit/homatrop me-br HYDROCODONE-HOMATROPINE MBR TABLET N Age Restriction N  
hydrocodone bit/homatrop me-br HYCODAN TABLET N Age Restriction N  
hydrocodone/cpm/pseudoephed Q-V TUSSIN SYRUP N Age Restriction N  
hydrocodone/guaifenesin MEDCODIN SYRUP N Age Restriction N  
hydrocodone/pseudoephed/guaif DRITUSS HD ELIXIR N Age Restriction N  
hydrocodone/pseudoephed/guaif MEDTUSS HD ELIXIR N Age Restriction N  
ibuprofen/pseudoephedrine HCl COLD-SINUS RELIEF CAPSULE N Age Restriction N  
ibuprofen/pseudoephedrine HCl IBUPROFEN COLD-SINUS TABLET N Age Restriction N  
loratadine/pseudoephedrine ALLERGY-CONGESTION RELIEF 12HR TAB ER 12H N Age Restriction N  
loratadine/pseudoephedrine ALLERGY RELIEF D-12 TAB ER 12H N Age Restriction N  
loratadine/pseudoephedrine ALLERGY RELIEF D-24HR TAB ER 24H N Age Restriction N  
loratadine/pseudoephedrine ALLERGY RELIEF-NASAL DECONGEST TAB ER 24H N Age Restriction N  
loratadine/pseudoephedrine LORATA-DINE D TAB ER 24H N Age Restriction N  
loratadine/pseudoephedrine LORATADINE-D TAB ER 24H N Age Restriction N  
oxymetazoline HCl NASAL SPRAY MIST N Age Restriction N  
oxymetazoline HCl NASAL DECONGESTANT MIST N Age Restriction N  
oxymetazoline HCl SINUS NASAL SPRAY N Age Restriction N  
oxymetazoline HCl NO DRIP SPRAY N Age Restriction N  
oxymetazoline HCl NASAL SPRAY ORIGINAL SPRAY N Age Restriction N  
PE/PE & Pyrilamine Tannate/CPM PHENA-S 12 ORAL SUSP N Age Restriction N  
pheniramine/phenylephrine/DM ALAHIST DM LIQUID N Age Restriction N  
phenyleph/hydrocodon/pyrilamin CODITUSS DH SYRUP N Age Restriction N  
phenylephrine HCl ALCONEFRIN 25 DROPS N Age Restriction N  
phenylephrine HCl ALCONEFRIN 50 DROPS N Age Restriction N  
phenylephrine HCl ALCONEFRIN 12 DROPS N Age Restriction N  
phenylephrine HCl SINUS RELIEF SPRAY N Age Restriction N  
phenylephrine HCl NEO-SYNEPHRINE SPRAY N Age Restriction N  
phenylephrine HCl NASAL SPRAY SPRAY N Age Restriction N  
phenylephrine HCl NASAL DECONGESTANT PE TABLET N Age Restriction N  
phenylephrine HCl/acetaminophn SINUS MAXIMUM STRENGTH TABLET N Age Restriction N  
phenylephrine HCl/acetaminophn SINUS-HEADACHE TABLET N Age Restriction N  
phenylephrine/acetaminophn/cpm ALLERGY MULTI-SYMPTOM TABLET N Age Restriction N  
phenylephrine/DM/acetaminop/GG DAYTIME MAX COLD-FLU CAPSULE N Age Restriction N  
phenylephrine/DM/acetaminop/GG TUSSIN CF MAX SEVERE M-S COLD LIQUID N Age Restriction N  
phenylephrine/DM/acetaminop/GG COLD MULTI-SYMPTOM DAYTIME LIQUID N Age Restriction N  
phenylephrine/DM/acetaminop/GG MUCUS RELIEF SINUS PAIN COUGH TABLET N Age Restriction N  
phenylephrine/DM/acetaminop/GG DAYTIME SEVERE COLD-FLU RELIEF TABLET N Age Restriction N  
phenylephrine/DM/acetaminop/GG SEVERE COLD-FLU TABLET N Age Restriction N  
phenylephrine/hydrocodone/cpm KG-DAL HD SYRUP N Age Restriction N  
phenylephrine/hydrocodone/cpm DURADAL HD PLUS SYRUP N Age Restriction N  
phenylephrine/Pyril Tan/cpm TRIOTANN ORAL SUSP N Age Restriction N  
Phenylephrine/Pyrilamine Tan R-TANNA 12 ORAL SUSP N Age Restriction N  
promethazine HCl/codeine PROMETHAZINE-CODEINE SYRUP N Pharmacy PA N Jul 30, 2015
promethazine/dextromethorphan PROMETHAZINE-DM SYRUP N Age Restriction N  
pseudoeph/DM/guaifen/acetamin MULTI-SYMPTOM LIQUID N Age Restriction N  
pseudoephed/cod/chlorphenir PHENYLHISTINE DH LIQUID N Pharmacy PA N  
pseudoephed/codeine/guaifen PHENYLHISTINE SYRUP N Pharmacy PA N  
pseudoephed/codeine/guaifen KG-FED SYRUP N Pharmacy PA N  
pseudoephed/hydrocodone H-C TUSSIVE-D SOLUTION N Age Restriction N  
pyrilamine/chlophedianol NINJACOF LIQUID N Age Restriction N  
pyrilamine/dextromethorphan hb CAPRON MAX LIQUID N Age Restriction N  
pyrilamine/dextromethorphan hb CAPRON DM LIQUID N Age Restriction N  
pyrilamine/phenylephrine/DM CODIMAL DM LIQUID N Age Restriction N  
pyrilamine/pseudoeph/chlophed NINJACOF-D LIQUID N Age Restriction N  
thonzylamine/phenylephrine/DM POLY-HIST DM LIQUID N Age Restriction N  
triprolidine/phenylephrine/DM HISTEX-DM LIQUID N Age Restriction N  
triprolidine/pseudoephedrin/DM HISTEX-DM LIQUID N Age Restriction N  
triprolidine/pseudoephedrine COLD, ALLERGY & SINUS TABLET N Age Restriction N  
triprolidine/pseudoephedrine APHEDRID TABLET N Age Restriction N  
cpm/PE/DM/acetaminophen/guaifn COLD-FLU SEVERE DAY-NIGHT TABLET SEQ Age Restriction N  
pectin THROAT DROPS LOZENGE Age Restriction N  
phenylephrine HCl PHENYLEPHRINE HCL AMPUL Age Restriction N  
phenylephrine HCl BIORPHEN VIAL Age Restriction N  
pseudoephedrine HCl PSEUDOEPHEDRINE ER TABLET ER Age Restriction N  
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