Current through Register No. 12, March 21, 2024
Pursuant to
RSA
328-E:16, III, the formulary
for licensees shall be as follows:
(a)
Amino acids and peptides, including but not limited to:
(1) Acetyl Carnitine;
(2) EDTA;
(3) GABA;
(4) Glutathione;
(5) Levocarnitine;
6) Succinic Acid (DMSA); and
(7) Tryptophan;
(b) Animal preparations and their
derivatives, including but not limited to:
(1)
Adrenal;
(2) Thymus;
(3) Thyroid;
(4) Fish oils, including derived mega-3 fatty
acids such as Ethyl eicosapentaenoic acid, docosahexaenoic acid, and omega-3
carboxylic acids;
(5) Hyaluronic
acid; and
(6) Bile acids, including
deoxycholic acid;
(c)
The following anti-gout agents:
(1)
Allopurinol;
(2) Colchicine;
and
(3) Probenecid;
(d) H1 and
H2 antihistamine-class agents;
(e) The following anti-leukotriene agents:
(1) Montelukast; and
(2) Zafirlukast;
(f) The following anti-hyperglycemic agents:
(1) The alpha glucosidase inhibitor
Acarbose;
(2) The biguanide
Metformin;
(3) Sulfonylurea-class
agents;
(4) Thiazolidinedione-class
agents (TZDs);
(5) Sodium-glucose
transport protein 2 (SGLT-2) inhibitors;
(6) Dipeptidyl peptidase 4 (DPP-4)
inhibitors;
(7) Glucagon-like
peptide-1 (GLP-1) receptor agonists; and
(8) Synthetic and human insulin;
(g) The following anti-infective
agents:
(1) The following antibacterial
agents:
a. Aminoglycosides, including but not
limited to:
1. Gentamicin;
2. Kanamycin sulfate; and
3. Tobramycin;
b. The following beta-lactam antibiotics:
1. Cephalosporins, including but not limited
to:
(i) Cefaclor;
(ii) Cefadroxil;
(iii) Cefdinir;
(iv) Ceditoren;
(v) Cefibuten;
(vi) Cefixime;
(vii) Cefonicid sodium;
(viii) Cepodoxime proxetil;
(ix) Cefprozil;
(x) Ceftibuten;
(xi) Cefuroxime;
(xii) Cephalexin; and
(xiii) Cephradine; and
2. Penicillins, including but not limited to:
(i) Amoxicillin and clavulanate;
(ii) Amoxicillin;
(iii) Ampicillin and sulbactam;
(iv) Ampicillin;
(v) Bacampicillin;
(vi) Cloxacillin;
(vii) Dicloxacillin;
(viii) Oxacillin; and
(ix) Penicillin;
c. Macrolides and ketolides,
including but not limited to:
1.
Azithromycin;
2.
Clarithromycin;
3.
Dirithromycin;
4.
Erythromycins;
5. Telithromycin;
and
6. Troleandomycin;
d. Quinolones, including but not
limited to:
1. Ciprofloxacin;
2. Levofloxacin; and
3. Ofloxacin;
e. The following sulfonamides:
1. Sulfonamide;
2. Sofamethoxazole;
2. Trimethoprim; and
3. Dapsone;
f. Tetracyclines, including but not limited
to:
1. Demeclocycline hydrochloride;
2. Doxycycline;
3. Minocycline;
4. Oxytetracycline; and
5. Tetracycline;
g. The following miscellaneous
antibacterials:
1. Bacitracin;
2. Clindamycin;
3. Colistimethate;
4. Lincomycin;
5. Novobiocin;
6. Polymyxin B Sulfate;
7. Spectinomycin;
8. Vancomycin;
9. Daptomycin; and
(2) Antifungals, such as:
a. Polyene;
b. Amphotericin B;
c. Nystatin;
d. Fluconazole;
e. Ketoconazole;
f. Clotrimazole;
g. Terbinafine; and
h. Itraconazole;
(3) The following anti-virals:
a. Valcyclovir;
b. Acyclovir;
c. Famciclovir; and
d. Oseltamivir;
(4) Anti-helmetics, such as:
a. Mebendazole;
b. Thiabendazole;
c. Nitazoxanide;
d. Albendazole;
e. Ivermectin; and
f. Praziquantel;
(5) The following antitubercular and
antimycobacterial agents:
a. Aminosalicylic
acid;
b. Cycloserine;
c. Pyrazinamidel
d. Rifabutin; and
e. Rifampin;
(6) The following antiprotozoal and
antiparasitic agents:
a. The halogenated
8-hydroxyquinoline iodoquinol;
b.
The following nitroimidazoles:
1.
Metronidazole; and
2.
Tinidazole;
c. The
following quinolines:
1.
Chloroquine;
2.
Hydroxychloroquine;
3. Mefloquine;
and
4. Quinine sulfate;
and
d. The
hydroxynaphthoquinone atovaquone; and
(7) The following miscellaneous
anti-infective agents:
a.
Mupirocin;
b. Permethrin;
and
c. Pyrethrins;
(h) The following
anti-thyroid agent thionamides (thioureylenes) :
(1) Methimazole; and
(2) Propylthiouracil;
(i) The following autonomic agents:
(1) The following cholinergic agents:
a. The following antimuscarinic agents:
1. Atropine;
2. Atropine sulfate;
3. Belladonna;
4. Flavoxate;
5. Homatropine hydrobromide;
6. Hyoscyamine;
7. Methscopolamine; and
8. Scopolamine;
b. The muscarinic receptor agonist
pilocarpine;
c. Nicotinic receptor
agonists:
1. Nicotine; and
2. Varenicline; and
d. The following acetylcholinesterase
inhibitors:
1. Donepezil;
2. Galantamine; and
3. Rivastigmine;
(2) The following ergot
derivatives:
a. Ergonovine maleate;
and
b. Methergine;
(3) The following
sympathomimetics:
a. Ephedrine;
b. Epinephrine, including autoinject forms;
c. Pseudoephedrine;
d. Midodrine;
e. Clonidine;
f. Guanfacine;
g. Albuterol;
h. Formoterol; and
i. Salmetrol;
(4) The following sympatholytic agents:
a. The following alpha adrenergic blocking
agents:
1. Yohimbine; and
2. Tamulosin; and
b. Beta adrenergic blocking agents, including
but not limited to:
1. Atenolol;
2. Bisoprolol;
3. Metoprolol;
4. Propranolol; and
5. Timolol; and
(5) The following agents for
ADHD/Narcolepsy treatment:
a.
Methylphenidate;
b.
Dexmethylphenidate;
c.
Amphetamine/dextroamphetamine;
d.
Dextroamphetamine;
e.
Lisdexamfetamine;
f. Atomoxetine;
and
g. Modafinil;
(j) The following
biologicals:
(1) The following biological
response modifiers:
a. Candida and tricophyton
extracts; and
b. Rho(D) immune
globulins;
(2) The
following skin test antigens:
a. Purified
protein derivative tuberculin tests;
b. Candida albicans skin test antigen;
and
c. Coccidioides immitis
spherule derived skin test antigen;
(3) Blood typing serum;
(4) Blood and tissue derived
products;
(5) Enzymes, including
but not limited to:
a. Amylase;
b. Collagenase;
c. Desoxyribonuclease;
d. Fribinolysin;
e. Hyaluronidase;
f. Lipase;
g. Pancrelipase; and
h. Papain;
(6) Electrolytes and fluid replacements,
including but not limited to:
a. Saline
solutions;
b. Sterile
water;
c. D5W;
d. Lactated ringers solution; and
e. Sodium bicarbonate;
(7) Hormones as described in Nat
406.01(p);
(8) Immune
globulins;
(9) Prostaglandins and
prostaglandin analogs, including but not limited to:
a. Alprostadil;
b. Bimatoprost;
c. Dinoprostone;
d. Iloprost; and
e. Misoprostal; and
(10) Botolinum toxin derivatives:
a. Onabotilinumtoxin A;
b. Abobotulinumtoxin A; and
c. Incobotilinumtoxin A;
(k) Botanical preparations, with
the following exceptions::
(1) Legend or
controlled Digitalis species derivatives;
(2) Legend or controlled Coca species
derivatives;
(3) Legend or
controlled Vinca species derivatives;
(4) Legend or controlled Taxus species
derivatives;
(5) Legend or
controlled Rauwolfia species derivatives; and
(6) Derivatives of Papaver somniferum unless
otherwise specified;
(l)
The following cardiovascular agents:
(1) The
following antilipemics:
a. HMG CoA reductase
inhibitors, such as:
1.
Atorvastatin;
2.
Fluvastatin;
3.
Lovastatin;
4. Pravastatin;
and
5. Simvastatin;
b. Cholestyramine; and
c. Colesevelam;
(2) The following anti-angina, piperazine
derivative, metabolism modifiers, or p-FOX inhibitors;
a. Ranolazine; and
b. Trimetazidine;
(3) The following anti-angina nitrates:
a. Nitroglycerin;
b. Isosorbide dinatrate; and
c. Isosobide mononitrate;
(4) Dihydropyridine-class calcium
channel blockers;
(5) The following
non-dihydropyridine calcium channel blockers:
a. Diltiazem; and
b. Verapamil;
(6) Angotensin converting enzyme
inhibitors;
(7) Angiotensin II
receptor blockers;
(8) The
following diuretics:
a.
Chlorthalidone;
b.
Hydrochlorothiazide;
c. Epleronone;
and
d. Spironolactone;
and
(9) The following
anti-coagulant agents:
a. Heparin for
in-office use;
b. Heparin
flushes;
c. Warfarin;
d. Apixaban; and
e. Rivaroxaban;
(m) The following central nervous
system agents:
(1) The following
anticonvulsant and antipeptic agents:
a.
Gabapentin;
b. Tiagabine;
c. Pregabalin;
d. Carbamazepine;
e. Oxcarbazepine;
f. Lamotrigine; and
g. Toiramate;
(2) The following antispasmodics:
a. Baclofen;
b. Cyclobenzaprine;
c. Methocarbamol; and
d. Tizanidine;
(3) The following anxiolytics, sedatives and
hypnotics:
1. The following benzodiazepines;
a. Alprozolam;
b. Chlordiazepoxide;
c. Clobazam;
d. Clonazepam;
e. Diazepam;
f. Lorazepam; and
g. Temazapam;
2. The following non-benzodiazepine
sedative-hypnotic agents:
a. The
imidazopyridine agent Zolpidem;
b.
The cyclopyrrolone agent Eszopiclone;
c. Suvorexant; and
d. Ramelteon;
3. The anti-manic agent Lithium;
and
4. The anxiolytic Buspirone;
and
(4) Antidepressants
for FDA approved age groups:
a. The following
selective serotonin reuptake inhibitors (SSRIs):
1. Citalopram;
2. Escitalopram;
3. Fluoxetine;
4. Paroxetine; and
5. Sertraline;
b. Serotonin-norepinephirene reuptake
inhibitors (SNRIs):
1. Duloxetine;
2. Desvenlafaxine; and
3. Venlafaxine; and
c. The following tricyclic antidepressants
(TCAs):
1. Amitriptyline;
2. Doxepin;
3. Imipramine;
4. Nortriptyline; and
5. Clomipramine;
(n) The following
erectile dysfunction agents:
(1) Tadalafil;
and
(2) Sildenafil;
(o) Homeopathic preparations and
their derivatives including both sterile injectable and non-injectable dosage
forms;
(p) Hormones such as:
(1) Adrenal hormones, such as:
a. Aldosterone;
b. DHEA;
c. Epinephrine;
d. Pregnenalone; and
e. Synthetic glucocorticoids such as:
1. Betamethasone;
2. Cortisone acetate;
3. Dexamethasone;
4. Triamcinolone and Triamcinolone
acetonide;
5. Methylprednisolone
and Prednisolone;
6. Prednisone;
and
7. Hydrocortisone;
(2) Selective
estrogen-receptor modulators (SERMs), and anti-estrogens or estrogen
antagonists, such as:
1.
Clomiphene;
2. Tamoxifen;
3. Toremifene; and
4. Raloxifene; and
(3) Gonadal hormones, such as:
a. Conjugated estrogens;
b. Estrogen;
c. Estradiol;
d. Estriol;
e. Estrone;
f. Estropipate;
g. Ethinyl estradiol;
h. HCG;
i. Progesterone;
j. Quinestrol; and
k. Testosterone;
(4) Thyroid hormones, such as:
a. Levothyroxine;
b. Liothyronine;
c. Natural dessicated thyroid hormones;
and
d. Calcium;
(5) Pituitary hormones, such as:
a. ACTH;
b. Growth hormones; and
c. Oxytocin; and
(6) Hormonal modifiers, such as:
a. Dutasteride;
b. Finasteride; and
c. Anastrazole;
(q) Antitussives, such as:
(1) Codeine for cough;
(2) Guafenesin; and
(3) Benzonatate;
(r) Local anesthetics, including both
injectable and non-injectable dosage form such as:
(1) Amino esters for in-office use:
a. Procaine;
b. Chloroprocaine;
c. Tetracaine; and
d. Benzocaine;
(2) Amino amides, for in-office use:
a. Lidocaine;
b. Mepivocaine;
c. Bupivacaine;
d. Levobupacaine;
e. Etidocaine; and
f. Prilocaine;
(3) The following other topical anesthetics:
a. The ketone Dyclonine, for in-office
use;
b. The ether
Pramoxine;
c. The skin refrigerant
ethyl chloride, also known as chloroethane; and
d. Topical lidocaine; and
(4) The methyl group donor
betaine;
(s)
Anti-psoriatic agents for topical use only:
(1) Dithranol (anthralin);
(2) Calcipotriene;
(3) Fluocinonide; and
(4) Tacrolimus;
(t) Minerals, trace minerals, and their
derivatives, such as super saturated potassium iodine (SSKI);
(u) The following miscellaneous agents:
(1) Acamprosate;
(2) Acetazolamide;
(3) Bee venom;
(4) Crofelemer;
(5) Cromolyn sodium;
(6) DMPS;
(7) DMSO;
(8) Ethyl Chloride spray;
(9) Fluro-ethyl spray;
(10) Fluro-methane spray;
(11) Hydrogen peroxide;
(12) Hydrochloric acid;
(13) Methylsulfonylmethane;
(14) Ondansetron;
(15) Oxygen;
(16) Ozone;
(17) Poly-L-lactic acid and
derivatives;
(18) Salicylates,
propionic acid, and acetic acid derivatives such as:
a. Mesalamine;
b. Topical salicyclic acid
preparations;
c.
Indomethacin;
d.
Ibuprofen;
e. Naproxen;
f. Ketorolac; and
g. Diclofenac; and
(19) Urea;
(v) In-office medical equipment, medical
devices, and therapeutic devices such as:
(1)
Needles;
(2) Syringes;
(3) IV Tubing;
(4) Filters;
(5) The following barrier contraceptives:
a. Cervical caps; and
b. Diaphragms, excluding intrauterine
devices;
(6) Nebulizers,
inhalers, spacers, actuators, and mouthpieces for medication
delivery;
(7) CPAP machies and
medical devices for the treatment and prevention of sleep apnea; and
(8) Auditory devices.
(w) Agents needed to carry out diagnostic
tests or physiological function tests such as:
(1) Mannitol;
(2) Methacholine;
(3) Dexamethasone;
(4) Dyes and contrasts such as:
a. Imaging contrasts;
b. Methylene blue; and
c. Triple dye;
(x) Vaccinations, provided they
are for use and not prescription, including but not limited to:
(1) BCG;
(2) Cholera;
(3) Diphtheria;
(4) DPT;
(5) Haemophilus b Conjugate;
(6) Hepatitus A Virus;
(7) Hepatitus B;
(8) Influenza Virus;
(9) Japanese Encaphalitis Virus;
(10) Measles Virus;
(11) Mumps virus;
(12) Pertussis;
(13) Plague;
(14) Pneumococcal;
(15) Polio virus - inactivated;
(16) Poliovirus - live oral;
(17) Rabies;
(18) Rubella;
(19) Smallpox;
(20) Tetanus IG;
(21) Tetanus Toxoid;
(22) Typhoid;
(23) Varicella;
(24) Yellow fever; and
(25) Covid-19.
(y) All forms of prescription and
non-prescription vitamin preparations and their derivatives, except for
Isotretinoin; and
(z)
Anti-addictive agents:
(1)
Disulfiram;
(2) Naltrexone;
and
(3) Naloxone.
#8679, eff 7-11-06; ss by #9656, eff
2-13-10