Sedative, Misc
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.
To request a Prior Authorization, please use this form.
| NDC | Brand Name | Generic Name | Form | Strength | PDL Status |
Rebate | Current Drug Use Criteria |
|---|---|---|---|---|---|---|---|
| 81092112000 | IGALMI | dexmedetomidine HCl | FILM | 120 mcg | Y | ||
| 81092112001 | IGALMI | dexmedetomidine HCl | FILM | 120 mcg | Y | ||
| 81092112003 | IGALMI | dexmedetomidine HCl | FILM | 120 mcg | Y | ||
| 81092118000 | IGALMI | dexmedetomidine HCl | FILM | 180 mcg | Y | ||
| 81092118001 | IGALMI | dexmedetomidine HCl | FILM | 180 mcg | Y | ||
| 81092118003 | IGALMI | dexmedetomidine HCl | FILM | 180 mcg | Y | ||
| 44567060104 | DEXMEDETOMIDINE HCL | dexmedetomidine HCl | VIAL | 1,000 mcg/10 mL (100 mcg/mL) | Y | ||
| 70069075901 | DEXMEDETOMIDINE HCL | dexmedetomidine HCl | VIAL | 1,000 mcg/10 mL (100 mcg/mL) | Y | ||
| 70069075904 | DEXMEDETOMIDINE HCL | dexmedetomidine HCl | VIAL | 1,000 mcg/10 mL (100 mcg/mL) | Y | ||
| 00143953201 | DEXMEDETOMIDINE HCL | dexmedetomidine HCl | VIAL | 200 mcg/2 mL | Y | ||
| 00143953225 | DEXMEDETOMIDINE HCL | dexmedetomidine HCl | VIAL | 200 mcg/2 mL | Y | ||
| 16729023930 | DEXMEDETOMIDINE HCL | dexmedetomidine HCl | VIAL | 200 mcg/2 mL | Y | ||
| 16729023993 | DEXMEDETOMIDINE HCL | dexmedetomidine HCl | VIAL | 200 mcg/2 mL | Y | ||
| 42023014625 | DEXMEDETOMIDINE HCL | dexmedetomidine HCl | VIAL | 200 mcg/2 mL | Y | ||
| 55150020902 | DEXMEDETOMIDINE HCL | dexmedetomidine HCl | VIAL | 200 mcg/2 mL | Y | ||
| 63323042101 | DEXMEDETOMIDINE HCL | dexmedetomidine HCl | VIAL | 200 mcg/2 mL | Y | ||
| 63323042102 | DEXMEDETOMIDINE HCL | dexmedetomidine HCl | VIAL | 200 mcg/2 mL | Y | ||
| 66794023002 | DEXMEDETOMIDINE HCL | dexmedetomidine HCl | VIAL | 200 mcg/2 mL | Y | ||
| 66794023042 | DEXMEDETOMIDINE HCL | dexmedetomidine HCl | VIAL | 200 mcg/2 mL | Y | ||
| 66794023302 | DEXMEDETOMIDINE HCL | dexmedetomidine HCl | VIAL | 200 mcg/2 mL | Y | ||
| 66794023342 | DEXMEDETOMIDINE HCL | dexmedetomidine HCl | VIAL | 200 mcg/2 mL | Y | ||
| 67457025100 | DEXMEDETOMIDINE HCL | dexmedetomidine HCl | VIAL | 200 mcg/2 mL | Y | ||
| 67457025102 | DEXMEDETOMIDINE HCL | dexmedetomidine HCl | VIAL | 200 mcg/2 mL | Y | ||
| 71288050502 | DEXMEDETOMIDINE HCL | dexmedetomidine HCl | VIAL | 200 mcg/2 mL | Y | ||
| 71288050503 | DEXMEDETOMIDINE HCL | dexmedetomidine HCl | VIAL | 200 mcg/2 mL | Y | ||
| 83634060002 | DEXMEDETOMIDINE HCL | dexmedetomidine HCl | VIAL | 200 mcg/2 mL | Y | ||
| 83634060041 | DEXMEDETOMIDINE HCL | dexmedetomidine HCl | VIAL | 200 mcg/2 mL | Y | ||
| 00409163802 | PRECEDEX | dexmedetomidine HCl | VIAL | 200 mcg/2 mL | Y | ||
| 00409163832 | PRECEDEX | dexmedetomidine HCl | VIAL | 200 mcg/2 mL | Y | ||
| 44567060004 | DEXMEDETOMIDINE HCL | dexmedetomidine HCl | VIAL | 400 mcg/4 mL (100 mcg/mL) | Y | ||
| 70069075801 | DEXMEDETOMIDINE HCL | dexmedetomidine HCl | VIAL | 400 mcg/4 mL (100 mcg/mL) | Y | ||
| 70069075804 | DEXMEDETOMIDINE HCL | dexmedetomidine HCl | VIAL | 400 mcg/4 mL (100 mcg/mL) | Y | ||
| 00409143401 | PRECEDEX | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 1,000 mcg/250 mL (4 mcg/mL) | Y | ||
| 00409281501 | PRECEDEX | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 1,000 mcg/250 mL (4 mcg/mL) | Y | ||
| 00781349491 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 00781349495 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 25021061550 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 42023018601 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 42023018620 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 43598097611 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 43598097658 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 52536012501 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 52536012510 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 63323067105 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 63323067150 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 66794023402 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 66794023444 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 67457092400 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 67457092450 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 68094014701 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 68094014720 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 70121138801 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 70121138808 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 71225012602 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 71225012605 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 71225013201 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 71225013202 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 72572012701 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 72572012710 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 00409145401 | PRECEDEX | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 00409145420 | PRECEDEX | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 00409166050 | PRECEDEX | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 00409166055 | PRECEDEX | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 00409459601 | PRECEDEX | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 00409459620 | PRECEDEX | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 00781349546 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 00781349595 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 25021061551 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 42023018701 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 42023018710 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 43598097511 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 43598097558 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 52536012601 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 52536012608 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 63323067100 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 63323067101 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 66794023502 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 66794023541 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 67457092500 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 67457092510 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 68094024701 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 68094024710 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 70121138901 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 70121138907 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 71225012603 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 71225012606 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 71225013301 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 71225013302 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 72572012801 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 72572012808 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 00409015501 | PRECEDEX | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 00409015502 | PRECEDEX | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 00409117401 | PRECEDEX | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 00409117410 | PRECEDEX | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 00409159601 | PRECEDEX | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 00409159610 | PRECEDEX | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 00409166010 | PRECEDEX | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 00409166035 | PRECEDEX | dexmedetomidine in 0.9 % NaCl | INFUS. BTL | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 00409787501 | PRECEDEX | dexmedetomidine in 0.9 % NaCl | PLAST. BAG | 1,000 mcg/250 mL (4 mcg/mL) | Y | ||
| 00409787512 | PRECEDEX | dexmedetomidine in 0.9 % NaCl | PLAST. BAG | 1,000 mcg/250 mL (4 mcg/mL) | Y | ||
| 00143952601 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | PLAST. BAG | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 00143952610 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | PLAST. BAG | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 00338955524 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | PLAST. BAG | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 43066055524 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | PLAST. BAG | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 43066056124 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | PLAST. BAG | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 55150029601 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | PLAST. BAG | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 55150029610 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | PLAST. BAG | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 70121171101 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | PLAST. BAG | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 70121171109 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | PLAST. BAG | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 00409783801 | PRECEDEX | dexmedetomidine in 0.9 % NaCl | PLAST. BAG | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 00409783824 | PRECEDEX | dexmedetomidine in 0.9 % NaCl | PLAST. BAG | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 00143952501 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | PLAST. BAG | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 00143952510 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | PLAST. BAG | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 00338955712 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | PLAST. BAG | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 25021061782 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | PLAST. BAG | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 43066055712 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | PLAST. BAG | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 43066056512 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | PLAST. BAG | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 55150029701 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | PLAST. BAG | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 55150029710 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | PLAST. BAG | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 70121171201 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | PLAST. BAG | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 70121171202 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | PLAST. BAG | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 70121171203 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | PLAST. BAG | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 00409785301 | PRECEDEX | dexmedetomidine in 0.9 % NaCl | PLAST. BAG | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 00409785324 | PRECEDEX | dexmedetomidine in 0.9 % NaCl | PLAST. BAG | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 00781349380 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | VIAL | 80 mcg/20 mL (4 mcg/mL) | Y | ||
| 00781349395 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | VIAL | 80 mcg/20 mL (4 mcg/mL) | Y | ||
| 63323067102 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | VIAL | 80 mcg/20 mL (4 mcg/mL) | Y | ||
| 63323067120 | DEXMEDETOMIDINE-0.9% NACL | dexmedetomidine in 0.9 % NaCl | VIAL | 80 mcg/20 mL (4 mcg/mL) | Y | ||
| 00409166020 | PRECEDEX | dexmedetomidine in 0.9 % NaCl | VIAL | 80 mcg/20 mL (4 mcg/mL) | Y | ||
| 00409166022 | PRECEDEX | dexmedetomidine in 0.9 % NaCl | VIAL | 80 mcg/20 mL (4 mcg/mL) | Y | ||
| 00409330101 | PRECEDEX | dexmedetomidine in 0.9 % NaCl | VIAL | 80 mcg/20 mL (4 mcg/mL) | Y | ||
| 00409330110 | PRECEDEX | dexmedetomidine in 0.9 % NaCl | VIAL | 80 mcg/20 mL (4 mcg/mL) | Y | ||
| 44567060224 | DEXMEDETOMIDINE-D5W | dexmedetomidine in dextrose 5% | PLAST. BAG | 200 mcg/50 mL (4 mcg/mL) | Y | ||
| 44567060324 | DEXMEDETOMIDINE-D5W | dexmedetomidine in dextrose 5% | PLAST. BAG | 400 mcg/100 mL (4 mcg/mL) | Y | ||
| 00409198503 | LORAZEPAM | lorazepam | CARTRIDGE | 2 mg/mL | Y | ||
| 00409198530 | LORAZEPAM | lorazepam | CARTRIDGE | 2 mg/mL | Y | ||
| 00074198511 | LORAZEPAM | lorazepam | SYRINGE | 2 mg/mL | Y | ||
| 00074198512 | LORAZEPAM | lorazepam | SYRINGE | 2 mg/mL | Y | ||
| 10019010346 | ATIVAN | lorazepam | SYRINGE | 4 mg/mL | Y | ||
| 00074153911 | LORAZEPAM | lorazepam | SYRINGE | 4 mg/mL | Y | ||
| 00641600001 | ATIVAN | lorazepam | VIAL | 2 mg/mL | Y | ||
| 00641600010 | ATIVAN | lorazepam | VIAL | 2 mg/mL | Y | ||
| 00641600101 | ATIVAN | lorazepam | VIAL | 2 mg/mL | Y | ||
| 00641600125 | ATIVAN | lorazepam | VIAL | 2 mg/mL | Y | ||
| 00641604401 | LORAZEPAM | lorazepam | VIAL | 2 mg/mL | Y | ||
| 00641604425 | LORAZEPAM | lorazepam | VIAL | 2 mg/mL | Y | ||
| 00641604601 | LORAZEPAM | lorazepam | VIAL | 2 mg/mL | Y | ||
| 00641604610 | LORAZEPAM | lorazepam | VIAL | 2 mg/mL | Y | ||
| 00641604801 | LORAZEPAM | lorazepam | VIAL | 2 mg/mL | Y | ||
| 00641604825 | LORAZEPAM | lorazepam | VIAL | 2 mg/mL | Y | ||
| 00641605001 | LORAZEPAM | lorazepam | VIAL | 2 mg/mL | Y | ||
| 00641605010 | LORAZEPAM | lorazepam | VIAL | 2 mg/mL | Y | ||
| 00641620701 | LORAZEPAM | lorazepam | VIAL | 2 mg/mL | Y | ||
| 00641620725 | LORAZEPAM | lorazepam | VIAL | 2 mg/mL | Y | ||
| 65219036801 | LORAZEPAM | lorazepam | VIAL | 2 mg/mL | Y | ||
| 65219036802 | LORAZEPAM | lorazepam | VIAL | 2 mg/mL | Y | ||
| 72572038001 | LORAZEPAM | lorazepam | VIAL | 2 mg/mL | Y | ||
| 72572038025 | LORAZEPAM | lorazepam | VIAL | 2 mg/mL | Y | ||
| 76329826100 | LORAZEPAM | lorazepam | VIAL | 2 mg/mL | Y | ||
| 76329826101 | LORAZEPAM | lorazepam | VIAL | 2 mg/mL | Y | ||
| 00641600201 | ATIVAN | lorazepam | VIAL | 4 mg/mL | Y | ||
| 00641600210 | ATIVAN | lorazepam | VIAL | 4 mg/mL | Y | ||
| 00641600301 | ATIVAN | lorazepam | VIAL | 4 mg/mL | Y | ||
| 00641600325 | ATIVAN | lorazepam | VIAL | 4 mg/mL | Y | ||
| 00641604501 | LORAZEPAM | lorazepam | VIAL | 4 mg/mL | Y | ||
| 00641604525 | LORAZEPAM | lorazepam | VIAL | 4 mg/mL | Y | ||
| 00641604701 | LORAZEPAM | lorazepam | VIAL | 4 mg/mL | Y | ||
| 00641604710 | LORAZEPAM | lorazepam | VIAL | 4 mg/mL | Y | ||
| 00641604901 | LORAZEPAM | lorazepam | VIAL | 4 mg/mL | Y | ||
| 00641604925 | LORAZEPAM | lorazepam | VIAL | 4 mg/mL | Y | ||
| 00641605101 | LORAZEPAM | lorazepam | VIAL | 4 mg/mL | Y | ||
| 00641605110 | LORAZEPAM | lorazepam | VIAL | 4 mg/mL | Y |