Download **Please note that generic and Medicaid covered over-the

ALABAMA MEDICAID AGENCY
1st Generation Antihistamines
Preferred Status
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Effective July 1, 2010, the 1 generation antihistamines were included in the Alabama Medicaid Preferred Drug Program. The list below
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includes the current preferred status of the covered 1 generation antihistamines. Preferred drugs are available without prior approval. The
list is subject to change. For additional PDL and coverage information, visit our drug look-up site at
https://www.medicaid.alabamaservices.org/ALPortal/NDC%20Look%20Up/tabId/39/Default.aspx.
NDC Code
65224054201
65224055016
65224054501
63717087001
63717087116
51991033404
51991033416
64376061216
64376061240
51991033301
64376060501
23359001430
00093030912
60505035700
00093030801
00781135901
00121048905
00121048910
00409229031
00641037625
63323066401
Brand Name
ALDEX AN 5 MG CHEWABLE TABLET
ALDEX D SUSPENSION
ALDEX-CT TABLET CHEWABLE
ARBINOXA 4 MG TABLET
ARBINOXA 4 MG/5 ML LIQUID
CARBINOXAMINE 4 MG/5 ML LIQUID
CARBINOXAMINE 4 MG/5 ML LIQUID
CARBINOXAMINE 4 MG/5 ML LIQUID
CARBINOXAMINE 4 MG/5 ML LIQUID
CARBINOXAMINE MALEATE 4 MG TAB
CARBINOXAMINE MALEATE 4 MG TAB
CENTERGY PEDIATRIC DROPS
CLEMASTINE 0.5 MG/5 ML SYRUP
CLEMASTINE 0.67 MG/5 ML SYRUP
CLEMASTINE FUM 2.68 MG TAB
CLEMASTINE FUM 2.68 MG TAB
DIPHENHYDRAMINE 12.5 MG/5 ML
DIPHENHYDRAMINE 12.5 MG/5 ML
DIPHENHYDRAMINE 50 MG/ML
SYRNG
DIPHENHYDRAMINE 50 MG/ML VIAL
DIPHENHYDRAMINE 50 MG/ML VIAL
Generic Name
DOXYLAMINE SUCCINATE ORAL 5 MG TAB CHEW
PHENYLEPHRINE/PYRILAMINE ORAL 5-16MG/5ML ORAL SUSP
PHENYLEPHRINE/DIPHENHYDRAMINE ORAL 5MG-12.5MG TAB CHEW
CARBINOXAMINE MALEATE ORAL 4 MG TABLET
CARBINOXAMINE MALEATE ORAL 4 MG/5 ML LIQUID
CARBINOXAMINE MALEATE ORAL 4 MG/5 ML LIQUID
CARBINOXAMINE MALEATE ORAL 4 MG/5 ML LIQUID
CARBINOXAMINE MALEATE ORAL 4 MG/5 ML LIQUID
CARBINOXAMINE MALEATE ORAL 4 MG/5 ML LIQUID
CARBINOXAMINE MALEATE ORAL 4 MG TABLET
CARBINOXAMINE MALEATE ORAL 4 MG TABLET
PHENYLEPHRINE/CHLORPHENIRAMINE ORAL 2MG-1MG/ML DROPS
CLEMASTINE FUMARATE ORAL 0.67MG/5ML SYRUP
CLEMASTINE FUMARATE ORAL 0.67MG/5ML SYRUP
CLEMASTINE FUMARATE ORAL 2.68 MG TABLET
CLEMASTINE FUMARATE ORAL 2.68 MG TABLET
DIPHENHYDRAMINE HCL ORAL 12.5MG/5ML ELIXIR
DIPHENHYDRAMINE HCL ORAL 12.5MG/5ML ELIXIR
PDL Status
Non-Preferred
Non-Preferred
Non-Preferred
Non-Preferred
Non-Preferred
Preferred
Preferred
Preferred
Preferred
Preferred
Preferred
Preferred
Preferred
Preferred
Preferred
Preferred
Preferred
Preferred
DIPHENHYDRAMINE HCL INJECTION 50 MG/ML SYRINGE
Preferred
DIPHENHYDRAMINE HCL INJECTION 50 MG/ML VIAL
DIPHENHYDRAMINE HCL INJECTION 50 MG/ML VIAL
Preferred
Preferred
1
Effective 01/01/2015