Nc Dma Preferred Drug List - Opioid Analgesics And Combination Therapy Page 2

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Medication Name
Mg Strength
DMA/NCTracks
Qty
Days Supply
MME per day*
MME Conversion
Dispensed
Factor
hydrocodone-acetaminophen solution (generic
7.5/500-15ml
1
473ml
10
24
for Hycet®, Lorcet®, Lortab®, Norco®, Vicodin®)
(0.5mg
473ml
30
8
hydrocodone/
ml)
hydrocodone-acetaminophen tablet (generic for
5/325
1
40
10
20
Hycet®, Lorcet®, Lortab®, Norco®, Vicodin®)
10/325
40
10
40
hydrocodone-ibuprofen tablet (generic for Ibudone®,
5/200
1
120
30
20
Repraxin®
10/200
120
30
40
hydromorphone tablet (generic for Dilaudid® Tablet)
2mg
3.75
120
30
30
4mg
120
30
60
morphine solution (generic for MSIR®)
10mg/5ml
1
473ml
8
120
(2mg/ml)
morphine tablet (generic for MSIR®)
15mg
1
60
10
90
30mg
60
10
180
oxycodone concentrated solution (generic for
1.5
Roxicodone® Intensol)
20mg/ml
30ml
7
129
oxycodone solution (generic for Roxicodone®)
5mg/5ml
1.5
500ml
12
63
(1mg/ml)
oxycodone tablet (generic for Roxicodone®)
5mg
1.5
120
30
30
10mg
120
30
60
oxycodone-acetaminophen capsules (generic for Tylox®)
5/500
1.5
20
5
30
120
30
30
2

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