DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

Transcription

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
DRUG DESCRIPTION
GENERIC NAME
UNIT PRICE
PK UNIT
NO.
($)
Disclaimer: Please note that this list is not exhaustive and contains certain drugs that may not be covered under the Cathay Pacific
Medical Scheme, e.g. drugs use for psychological conditions, drugs use for management of fertility and contraception. Should you
prescribe item that is not included here or have any queries, please call the CPA Provider Hotline at 2851-3870 or email
cpa@qhms.com
.
ANTACIDS
& ANTIULCERANTS
TAC018
TAI010
TAX010
MBA008
TBU020
TCY040
TDE040
TDE080
TDE081
TGA010
MGA010
MGE016
TGE010
TLO041
TLO042
TLO040
TMA010
MMA010
TMI036
TMU010
MMU010
TMY020
MMY020
TNE050
TNE052
MNE010
TPA044
TPA045
TPA046
ACTAL
AIR-X CHEWABLE 80mg
AXID 150mg
BABCON 20mg/mL
BUWECON 0.125mg
CYTOTEC 200mcg
DENOL
DEXILANT
[DEXLANSOPRAZOLE] MR
DEXILANT
[DEXLANSOPRAZOLE] MR
GAVISCON
GAVISCON ADVANCE
GELUMAG SUSPENSION
GELUSIL
LOSEC CAP 20mg (GE)
LOSEC MUPS 10mg
LOSEC MUPS 20mg
MAALOX PLUS
MAALOX SUSPENSION
(GE) 200mg
MILID
MUCAINE (GE)
MUCAINE SUSPENSION
(GE)
MYLANTA
(GE)
MYLANTA SUSPENSION
(GE)
NEXIUM 20mg
NEXIUM 40mg
NEXIUM GRANULES 10mg
PANTOLOC 20mg (GE) PANTALOC
[PANTOPRAZOLE]
PANTOLOC 40mg
PANTALOC 40mg (GE) TPA047 [PANTOPRAZOLE]
TPA055 GLUCOPHAGE
TPA056 PARIET 20mg
CPA094 PEPCIDINE 20mg
TPE040 PEPCIDINE 20mg (GE)
CPA098 PEPCIDINE 40mg
TPY008 SUCRATE
PYLORID 400mg
GEL 1G/5mL
MSU020 SACHETS
TTA010 TAGAMET 200mg (GE)
TTA012 TAGAMET 400mg (GE)
TTA020 TAKEPRON 30mg
TTA021 TAKEPRON OD 30mg
NA POLYHYDROXYALUMINIUM
MONOCA
SIMETHICONE
NIZATIDINE 150mg
DIMETHYLPOLYSILOXANE 20mg
HYOSCINE/SCOPOLAMINE
MISOPROSTOL 200mcg
COLLOIDAL BISMUTH SUBCITRATE
DEXLANSOPRAZOLE
DEXLANSOPRAZOLE
ALGINIC ACID, AL HYDROXIDE...
SODIUM ALGINATE AND POTASSIUM
BICARBONATE
ALUMINIUM
HYDROXIDE GEL
MG TRISILICATE, AL HYDROXIDE
OMEPRAZOLE 20mg
OMEPRAZOLE 10mg
OMEPRAZOLE 20mg
AL & MG HYDROXIDE,
SIMETHICONE
AL
HYDROXIDE, DIMETHICONE
PROGLUMIDE 200mg
ALUMINA, MGCO3, OXETHAZINE
OXETHAZAINE, AL HYDROXIDE...
AL & MG HYDROXIDE,
DIMETHICONE
AL
HYDROXIDE, MG HYDROXIDE...
ESOMEPRAZOLE 20mg
ESOMEPRAZOLE 40mg
ESOMEPRAZOLE
PANTOPRAZOLE SODIUM 20mg
PANTOPRAZOLE
PANTOPRAZOLE SODIUM 40mg
1.50
1.00
7.00
0.50
0.700
9.00
6.00
16.50
25.00
4.10
1.00
0.00
0.60
10.00
17.50
21.20
0.70
0.17
2.00
0.60
0.18
0.60
0.22
22.90
32.60
22.70
15.50
10.60
22.90
PANTOPRAZOLE
RABEPRAZOLE SODIUM 10mg
RABEPRAZOLE SODIUM 20mg
FAMOTIDINE
FAMOTIDINE
FAMOTIDINE
RANITIDINE BISMUTH CITRATE
400mg
SUCRALFATE
CIMETIDINE 200mg
CIMETIDINE 400mg
LANSOPRAZOLE 30mg
LANSOPRAZOLE 30mg
15.50
8.30
11.00
6.00
2.40
10.00
15.00
5.00
2.00
4.00
22.00
25.10
TAB
TAB
TAB
TAB
TAB
TAB
SACH
TAB
TAB
CAP
TAB
CPA109
LANSOPRAZOLE 15mg
9.00
TAB
TAKEPRON OD 15mg
TAB
TAB
TAB
ML
TAB
TAB
TAB
CAP
CAP
TAB
ML
ML
TAB
CAP
TAB
TAB
TAB
ML
TAB
TAB
ML
TAB
ML
TAB
TAB
SACH
TAB
TAB
TAB
TAB
TUL010 ULSANIC 500 mg
SUCRALFATE 500mg
TUL012 ULSANIC 500mg (GE)
SUCRALFATE 500mg
MUL010 ULSANIC GRANULES 1g
SUCRALFATE 1g
IZA010 ZANTAC [ranitidine]
RANTIDINE
25mg/mL INJ
TZA030 ZANTAC
150 mg
RANITIDINE HCL 150mg
TZA032 ZANTAC 150mg
300 mg(GE)RANITIDINE HCL 300mg
TZA034 [RANITIDINE]
RANITIDINE HCL 150mg
CPA041 ZANTAC SYRUP
RANITIDINE HCL
GIT REGULATORS,ANTIFLATULENTS & ANTI-INFLAMMATORIS
TAS010 ASACOL 400mg
MESALAZINE 400mg
PAS010 ASACOL SUPP 500mg
MESALAZINE
TCE052 CEREKINON 100mg
TRIMEBUTINE MALEATE
TCH010 CHARCOAL 300mg
CHARCOAL 300mg
TCH012 CHARCOAL 200mg
CHARCOAL 200mg
TDI102 DIPENTUM 250mg
OLSALAZINE SODIUM 250mg
TDI106 DISFLATYL 40mg
DIMETHICONE/SILICON DIOXIDE
TEU020 ENTOCORT 3mg
BUDESONIDE 3mg
PEN010 ENTOCORT ENEMA
BUDESONIDE
DIMETHYLPOLYSILOXANE,
2mg/100mL
TGA008 GASTEEL
ALUMINIUM HYDROXIDE
MGA004 GASCON DROP 20mg/mL
DIMETHYLPOLYSILOXANE
300mL
TMA022 MAGESTO
PRECIPITATED CA CARBONATE
200mg/MYLASE 37.5mg/NA
CPA097 MOTILIUM 10mg
DOMPERIDONE
TMO040 MOTILIUM 10mg (GE)
DOMPERIDONE
PMO010 MOTILIUM SUPP 10mg (GE) DOMPERIDONE
PMO012 MOTILIUM SUPP 30mg (GE) DOMPERIDONE
MMO010 MOTILIUM SYRUP 1mg/mL DOMPERIDONE 1mg
TMY030 MYLICON (GASTEEL)
DIMETHICONE 40mg
TPE030 PENTASA 500mg
MESALAZINE 500mg
PPE010 PENTASA
1g 2g
MESALAZINE
PENTASASUPP
SACHET
2.00
1.40
3.70
46.40
7.60
17.80
4.50
0.85
TAB
TAB
SACH
AMP
TAB
TAB
TAB
ML
5.90
20.00
2.00
0.60
0.800
4.50
1.90
27.40
200.00
1.50
2.00
0.60
4.00
1.70
6.00
9.50
1.80
1.00
7.80
26.00
MPE016 (60's/BOX)
MESALAZINE 2g
37.00
TAB
SUPP
TAB
TAB
TAB
TAB
TAB
CAP
TUB
TAB
ML
TAB
TAB
TAB
SUPP
SUPP
ML
TAB
TAB
SUPP
SACH
MPE017
TPR060
TPR062
TSA030
TSA032
PSA010
MESALAZINE 1g
CISAPRIDE 5mg
CISAPRIDE 10mg
MESALAZINE 250mg
MESALAZINE 500mg
Page 1 of 28
MESALAZINE, 5-AMINOSAL. ACID
18.50
3.00
5.30
13.00
15.00
55.00
SACH
TAB
TAB
TAB
CAP
SUPP
PENTASA SCAHET 1g
PREPULSID 5mg
PREPULSID 10mg
SALOFALK 250mg
SALOFALK 500mg
SALOFALK SUPP 250mg
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
DRUG DESCRIPTION
GENERIC NAME
NO.
PSA012 SALOFALK GRANULES
SUPP 500mg
MESALAZINE, 5-AMINOSAL. ACID
MSA008 500mg
MESALAZINE 500mg
MSA010 SALOFALK GRANULES 1G POLYMIGEL
MESALAZINE244mg,
1G
OXETHAZAINE
TST036 STROCAIN
5mg
ANTISPASMODICS
TBU010 BUSCOPAN 10mg (GE)
HYOSCINE-N-BUTYLBROMIDE 10mg
IBU010 BUSCOPAN INJ 20mg/mL
HYOSCINE BUTYLBROMIDE
IBU012 BUSCOPAN INJ 20mg/mL
HYOSCINE BUTYLBROMIDE
10mL
MBU010 BUSCOPAN
LIQUID
HYOSCINE-N-BUTYLBROMIDE
1mg/mL (GE)
TDA040 DARICON
5mg
OXYPHENCYCLIMINE HCL 5mg
MDO010 DONNATAL SYRUP
PHENOBARBITONE, HYOSCYAMINE..
TDU020 DUSPATALIN 135 mg
MEBEVERINE HCL 135mg
TDU021 DUSPATALIN RETARD
MEBEVERINE HCL 200mg
200mg
THO010 HOLOPON
1mg (GE)
SCOPOLAMINE METHYLBROMIDE
1mg
MIN010 INFACOL SUSPENSION
DIMETHICONE
MIN012 (GE)
INFACOL WIND DROPS
DIMETHICONE
TLE016 LEVSIN SL 125mcg
HYOSCYAMINE SULFATE 125mcg
TLI010
LIBRAX (GE)
CHLORDIAZEPOXIDE, CLIDINIUM
TLI020
LIBRIUM 5mg (GE)
CHLORDIAZEPOXIDE
TPR084 PROBANTHINE 15mg (GE) PROPANTHELINE BROMIDE 15mg
TSP012 SPASMOMEN 40mg
OTILONIUM BROMIDE
TSP010 SPASMONAL 60mg (GE)
ALVERINE CITRATE
CPA096 SPASMONAL CAP 60MG
ALVERINE CITRATE
TUR020 URISPAS 100mg
FLAVOXATE HCL 100mg
TUR022 URISPAS 200mg
FLAVOXATE HCL 200mg
TZE007 ZELMAC 6mg
TEGASEROD 6mg
ANTIDIARRHEALS
TAN020 ANTIDIA 200mg
NIFUROXAZIDE 200mg
TER020 ERCEFURYL
200mg
(GE)
NIFUROXAZIDE 200mg
HIDRASEC 10mg
SACHET
MHI010 (INFANTS)
HIDRASEC 30mg SACHET RACECADOTRIL
MHI012 (CHILDREN)
RACECADOTRIL
TIM028 IMODIUM 2mg
LOPERAMIDE HCL 2mg
TIM030 IMODIUM 2mg (G.E.)
LOPERAMIDE HCL 2mg
MIM012 IMODIUM DROPS 2mg/mL LOPERAMIDE HCL
(GE)
MIM010 IMODIUM
SYRUP 2mg/5mL LOPERAMIDE HCL
(GE)
MKA010 KAOPECTATE
(GE)
LIGHT KAOLIN, PECTIN
TLO010 LOMOTIL
DIPHENOXYLATE HCL, ATROPINE
TLO011 LOMOTIL (GE)
DIPHENOXYLATE HCL, ATROPINE
MLO010 LOMOTIL SYRUP
DIPHENOXYLATE, ATROPINE
2.5mg/5mL3g(GE)
MSM010 SMECTA
DIOCTAHEDRAL SMECTITE
LAXATIVES, PURGATIVES
MAG008 AGAROL SUSPENSION
LIQUID PARAFFIN
MAG010 AGAROL SUSPENSION
LIQUID PARAFFIN
(GE)
MAG015 AGIOCUR
GRANULES 250g PLANTAGO SEED, ISPAGHULA
HUSKS
MAG020 AGIOLAX 100g
PLANTAGO
SEED, SENNA PODS...
PBA012 BANDI-ENEMA ADULT
GLYCERIN, MG SULFATE, NACL
PBA010 BANDI-ENEMA PAED
GLYCERIN, MG SULFATE, NACL
MBI008 BISACODYL IN
BISACODYL, POLYETHYLENE
POLYETHYLENE
LIQUID
GLYCOL
TDO006 DOCUSATE
SODIUM
100mg DOCUSATE
Na
TDU010 DULCOLAX 5mg (GE)
BISACODYL 5mg
PDU010 DULCOLAX SUPP 10mg
BISACODYL
MDU010 (GE)
DUPHALAC SYRUP
LACTULOSE
10g/15mL
PFL020 FLEET
ENEMA
NA BIPHOSPHATE, NA PHOSPHATE
PFL010 FLEET ENEMA
NA BIPHOSPHATE, NA PHOSPHATE
(CHILDREN)
MFL006 FLEET
PHOSPHO-SODA
MONOBASIC Na
PHOSPHATE/DIBASIC
MF0010 FORLAX
MACROGOL
4000
MFY010 FYBOGEL
ISPAGHULA HUSK
PGL010 GLYCERINE SUPP
GLYCERIN
(ADULT) (GE)SUPP (PAED) GLYCERIN
PGL012 GLYCERINE
(GE)
MKL020 KLEAN-PREP
POLYETHYLENE
GLYCOL,KCL,NA2CO3
MME010 METAMUCIL POWDER
PSYLLIUM HYDROPHILIC
100g
MUCILLOIDHYDROPHILIC
MME012 METAMUCIL
POWDER
PSYLLIUM
336g
MUCILLOIDHYDROPHILIC
MME013 METAMUCIL
POWDER
PSYLLIUM
504g
MUCILLOIDHYDROPHILIC
MME015 METAMUCIL
POWDER
PSYLLIUM
528g (ORANGE)
MUCILLOIDHYDROPHILIC
MME014 METAMUCIL
POWDER 6g PSYLLIUM
MUCILLOID
PMI010 MICROLAX ENEMA
NA
CITRATE+LAURYL
SULFOACETATE
MMU040 MUCOFALK ORANGE 5g
ISPAGHULA
HUSK 5g
MNA010 NATURLAX POWDER 368g PSYLLIUM HYDROPHILIC
MUCILLOID 62%
MNO010 NORMACOL
STERCULIA
MNO020 NORMACOL PLUS
STERCULIA 62%, FRANGULA 8%
MPA020 PARAFFIN LIQUID (GE)
PARAFFIN LIQUID
MPE005 PEGLYTE POWDER
POLYETHYLENE GLYCOL,
ELECTROLYTES
MPH040 PHOSPHATE SOLUTION
SODIUM
PHOSPHATE
NA
PICOSULFATE
10mg,MG OXIDE
45mL
MPI006 PICOLAX
ORAL SOLUTION 3.5g//CITRIC ACID 12g
MPI008 PICOLAX POWDER 10mg
SODIUM PICOSULFATE
TSE030 SENOKOT
SENNOSIDES B 7.5mg
PSA008 SALOFALK ENEMAS
MESALAZINE, 5-AMINOSAL. ACID
4G/60mL
DIGESTIVES
PANCREATIN, ENZYME
TCO054 COMBIZYM
CONCENTRATE
TCR010 CREON
PANCREATIN/AMYLASE/LIPASE/PRO
T
TEN030 ENZYPLEX
AMYLASE,PROTEASE,LIPASE...
TPA040 PANKREOFLAT
PANCREATIN, SIMETHICONE
CHOLAGOGUES, CHOLELITHOLYTICS & HEPATIC Page
PROTECTORS
2 of 28
TBI008 BILSAN
CHOLINE, DEHYDROCHOLIC ACID,
INOSITOL…
UNIT PRICE
($)
80.00
13.00
26.60
0.95
PK UNIT
0.80
38.00
20.00
0.40
1.10
0.27
5.00
6.80
1.10
0.26
2.30
2.70
1.50
1.00
0.60
4.40
2.20
4.00
1.50
2.70
8.00
TAB
AMP
ML
ML
TAB
ML
TAB
CAP
TAB
ML
ML
TAB
TAB
TAB
TAB
TAB
TAB
CAP
TAB
TAB
TAB
0.80
0.65
4.00
6.00
7.00
1.90
1.00
1.00
0.18
1.00
0.70
0.28
4.40
CAP
CAP
SACH
SACH
CAP
TAB
ML
ML
ML
TAB
TAB
ML
SACH
0.20
0.17
130.00
0.60
3.00
2.50
0.25
1.80
0.80
4.60
0.45
25.00
26.00
0.80
4.70
4.00
6.00
4.20
27.00
0.40
0.45
0.60
0.55
4.00
10.50
5.70
0.40
9.20
9.20
0.30
45.00
0.40
56.00
40.00
0.70
280.00
ML
ML
BOT
g
TUB
TUB
ML
CAP
TAB
SUPP
ML
BOT
BOT
ML
SACH
SACH
SUPP
SUPP
SACH
g
g
g
g
SACH
BOT
SACH
g
SACH
SACH
ML
SACH
ML
SACH
SACH
TAB
PC
2.10
4.70
1.30
2.20
TAB
CAP
TAB
TAB
1.90
TAB
SUPP
SACH
SACH
TAB
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
NO.
TCH020
TLE006
TLE008
CPA088
TUR028
DRUG DESCRIPTION
CHENOFALK 250mg
LEGALON 35mg
LEGALON 70mg
LEGALON 140mg
URSOFALK 250mg
250mg (GE)URSOFALK
GENERIC NAME
CHENODEOXYCHOLIC ACID 250mg
SILYMARIN 35mg
SILYMARIN 70mg
SILYMARIN 140mg
URSODEOXYCHOLIC ACID
TUR029 [URSODEOXYCHOLIC]
URSODEOXYCHOLIC ACID
TUR030 URSOLVAN 200mg
URSODEOXYCHOLIC ACID 200mg
CARDIAC DRUGS
IAD012 ADRENALINE INJ 1:10,000 ADRENALINE
10mL
TCO070 CORDARONE
200 mg
AMIODARONE HCL 200mg
ICO015 CORDARONE INJ
AMIODARONE HCL 150mg
150mg/3mLINJ
(GE)
IDI010
DIGOXIN
0.5mg/2mL
DIGOXIN
TKI010 KINIDIN DURULE 200mg
QUINIDINE BISULFATE 200mg
TLA040 LANITOP 0.1mg
METILDIGOXIN 0.1mg
TLA050 LANOXIN PG 0.0625mg
DIGOXIN 0.0625mg
TLA052 LANOXIN 0.25mg
DIGOXIN 0.25mg
TMU035 MULTAQ FILM-COATED
DRONEDARONE HC1
400 mg
TNO060 NORPACE
100mg
DISOPYRAMIDE PHOSPHATE 100mg
TNO070 NORPACE RETARD 150mg DISOPYRAMIDE PHOSPHATE 150mg
TRY010 RYTMONORM 150mg
PROPAFENONE HCL 150mg
TRY012 <propafenone> 150mg [APOPROPAFENONE
TSL020 SLOW K 600mg
POTASSIUM CHLORIDE 600mg
TSL030 SLOW K 600mg (GE)
POTASSIUM CHLORIDE 600mg
TTA022 TAMBOCOR 100mg
FLECAINIDE ACETATE 100mg
IXY030 XYLOCARD INJ 100mg/5mL LIDOCAINE HCl
ANTI-ANGINAL DRUGS
TCO069 CORALAN 5mg
IVABRADINE
TEL010 ELANTAN 20mg
ISOSORBIDE MONONITRATE 20mg
TIM010 IMDUR 60mg
ISOSORBIDE-5-MONONITRATE 60mg
TIS008
ISO MACK RETARD 40mg ISOSORBIDE DINITRATE 40mg
SIS010
ISOMACK SPRAY
ISOSORBIDE DINITRATE
TIS040
ISORDIL 10mg
ISOSORBIDE DINITRATE 10mg
TIS050
ISORDIL SUBLINGUAL 5mg ISOSORBIDE DINITRATE
TIS060
ISORDIL TEMBIDS 40mg
ISOSORBIDE DINITRATE 40mg
(GE)
CPA150 LOMAKLINE
5 mg
AMLODIPINE BESILATE
CPA151 LOMAKLINE 10 mg
AMLODIPINE BESILATE
ANI020 NITRODERM TTS-10 50mg NITROGLYCERIN
TNI030 NITRODISC 5mg
NITROGLYCERIN
SNI010 NITROLINGUAL SPRAY
NITROGLYCERIN 0.4mg
0.4mg
TNI040 NITROSTAT
500mcg
GLYCERYL TRINITRATE 500mcg
(ANGISED) 25mg (GE)
TPE070 PERSANTIN
DIPYRIDAMOLE 25mg
TPE073 PERSANTIN 75mg
DIPYRIDAMOLE 75mg
TPE072 PERSANTIN 75mg (GE)
DIPYRIDAMOLE 75mg
TPE074 PERSANTIN PLUS
DIPYRIDAMOLE/ACETYSALICYLIC
ACID
TVA030 VASTAREL 20mg
TRIMETAZIDINE
DIHCL 20mg
TVA032 VASTAREL MR
TRIMETAZIDINE
DIHYDROCHLORIDE
35mg
TIS042
ISORDIL 10mg (GE)
ISOSORBIDE
DINITRATE
10mg
ANGIOTENSIN II ANTAGONIST
TCO101 COZAAR <Losartan> 50mg LOSARTAN 50mg
(GE)
TCO111 COZAAR
100mg (GE)-[LOSARTAN]
LOSARTAN 100mg
TCO112 COZAAR [Losartan] 100mg [LOSACOR]
LOSARTAN
THY023 HYZAAR (GE)
LOSARTAN,
THY024 HYZAAR [LOSACOR HCT HYDROCHLOROTHIAZIDE ,
50 mg-12.5mg]
LOSARTAN POTASSIUM
TMI007 MICARDIS
PLUS 80mg
TELMISARTAN/HYDROCHLOROTHIA
ZIDE 12.5mg MEDOXOMIL 40mg
TOL029 OLMETEC 40mg
OLMESARTAN
TOL030 OLMETEC 20mg
OLMESARTAN MEDOXOMIL
OLMESARTAN,
TOL031 OLMETEC PLUS
10mg
OLMESARTAN
TOL032 20mg/12.5mg
HYDROCHLOROTHIAZIDE
ANTIHYPERTENSIVE DRUGS
TAC008 ACCUPRIL 10mg
QUINAPRIL HCL 10mg
TAC007 ACCUPRIL 20mg
QUINAPRIL HCL 20mg
TAC006 ACCUPRIL 5mg
QUINAPRIL HCL 5mg
TAC012 ACERTIL 2mg
PERINDOPRIL 2mg
TAC010 ACERTIL 4mg
PERINDOPRIL 4mg
CPA081 ACERTIL PLUS FILMPERINDOPRIL ARGININE
COATED 5mg
TAC011 ACERTIL
AR 5mg
PERINDOPRIL ARGININE
TAL018 ALDOMET 125mg (GE)
METHYLDOPA 125mg
TAL020 ALDOMET 250mg (GE)
METHYLDOPA 250mg
TAP010 APRESOLINE 10mg
HYDRALAZINE HCL 10mg
TAP012 APRESOLINE 25mg
HYDRALAZINE HCL 25mg
TAP020 APRESOLINE 50mg (GE)
HYDRALAZINE HCL 50mg
TAP040 APROVEL 150mg
IRBESARTAN 150mg
TAP042 APROVEL 300mg
IRBESARTAN 300mg
TBL023 BLOPRESS Plus16mg
CANDESARTAN CILEXETIL 16mg
CANDESARTAN CILEXETIL 8mg
TBL021 BLOPRESS Plus 8mg
TBL022 BLOPRESS 16mg
CANDESARTAN CILEXETIL 16mg
TBL020
TCA050
TCA052
TCA056
TCA054
TCA060
TCA062
TCA064
BLOPRESS 8mg
CAPOTEN 12.5mg
CAPOTEN 25mg (GE)
CAPOTEN 50mg
CAPOTEN 50mg (GE)
CARDURA 1mg
CARDURA 2mg
CARDURA XL 4mg
CANDESARTAN CILEXETIL 8mg
CAPTOPRIL 12.5mg
CAPTOPRIL 25mg
CAPTOPRIL 50mg
CAPTOPRIL 50mg
DOXAZOSIN MESYLATE 1mg
DOXAZOSIN MESYLATE
Page 3 of2mg
28
DOXAZOSIN MESYLATE 4mg
UNIT PRICE
($)
11.60
3.30
4.40
5.00
16.00
PK UNIT
10.50
6.00
CAP
TAB
TAB
TAB
CAP
CAP
TAB
70.00
8.80
85.00
120.00
3.80
1.50
1.20
1.70
17.50
4.40
5.00
11.00
11.000
1.50
0.90
17.00
150.00
AMP
TAB
AMP
AMP
TAB
TAB
TAB
TAB
TAB
CAP
TAB
TAB
TAB
TAB
TAB
TAB
AMP
11.00
7.00
7.10
2.50
130.00
1.00
1.20
2.00
7.00
7.00
30.00
14.30
220.00
1.90
0.80
2.70
2.00
3.50
5.30
9.00
0.60
TAB
TAB
TAB
TAB
BOT
TAB
TAB
TAB
TAB
TAB
PC
DISC
PC
TAB
TAB
TAB
TAB
CAP
TAB
TAB
TAB
7.50
8.50
1.26
8.50
9.90
16.00
13.70
11.70
9.00
11.00
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
7.00
10.00
4.60
3.80
6.70
4.50
7.50
1.10
1.60
1.50
2.00
2.00
8.50
14.00
16.00
9.60
16.00
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
9.60
2.60
2.00
7.70
3.50
6.40
10.30
8.90
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
DRUG DESCRIPTION
GENERIC NAME
UNIT PRICE
NO.
($)
TCA066 CARDURA XL 8mg
DOXAZOSIN MESYLATE 8mg
11.80
ICA030 CATAPRES INJ 150mcg/mL CLONIDINE HCL
50.00
TAP043 CO-APROVEL
IRBESARTAN
8.50
150mg/12.5mg
150mg/HYDROCHLOROTHIAZIDE
TAP044 CO-APROVEL
IRBESARTAN
14.00
300mg/12.5mg 300/25 mg tab 300mg/25mg
300mg/HYDROCHLOROTHIAZIDE
CPA125 CO-APROVEL
IRBESARTAN 300mg /
14.00
HCTZ 25mg
TCO015 CO-DIOVAN 160mg/12.5mg VALSARTAN
15.00
160mg/HYDROCHLOROTHIAZIDE
7.00
TCO016 CO-DIOVAN 80mg/12.5mg (GE)-[VALSARTAN
VALSARTAN, HYDROCHLOROTHIAZIDE
+ HCT]
10.00
TCO017 CO-DIOVAN 160mg/12.5mg (GE)-[VALSARTAN
VALSARTAN, HYDROCHLOROTHIAZIDE
+ HCT]
TCO013 CO-DIOVAN 80mg/12.5mg VALSARTAN
10.70
80mg/HYDROCHLOROTHIAZIDE
TRE018 CO-RENITEC
ENALAPRIL
8.50
20mg/HYDROCHLOROTHIAZIDE
TCO110 COZAAR 100mg
LOSARTAN
POTASSIUM 100mg
10.00
TCO100 COZAAR 50mg
LOSARTAN POTASSIUM 50mg
9.90
TDI050 DIBENYLINE 10mg
PHENOXYBENZAMINE 10mg
8.00
TDI101 DIOVAN 160mg
VALSARTAN 160mg
15.00
6.50
TDI103 DIOVAN 80mg (GE)-[VALSARTAN]
VALSARTAN
9.50
TDI104 DIOVAN 160mg (GE)-[VALSARTAN]
VALSARTAN
TDI100 DIOVAN 80mg
VALSARTAN 80mg
10.70
TDI099 DIOVAN 320mg
VALSARTAN
20.00
TDY020 DYNACIRC 2.5mg
ISRADIPINE 2.5mg
3.50
THY020 HYZAAR
LOSARTAN
9.90
50mg/HYDROCHLOROTHIAZIDE
THY022 HYZAAR FORTE
LOSARTAN
11.50
100mg/HYDROCHLOROTHIAZIDE 25
THY021 HYZAAR PLUS
LOSARTAN,
10.00
HYDROCHLOROTHIAZIDE
TIN060 INHIBACE 2.5mg
CLIAZAPRIL
2.5mg
4.40
TMI005 MICARDIS 40mg
TELMISARTAN 40mg
10.60
TMI006 MICARDIS 80mg
TELMISARTAN 80mg
16.80
TMI004 MICARDIS PLUS
TELMISARTAN
10.00
40mg/12.5mg1mg (GE)
40mg/HYDROCHLOROTHIAZIDE
TMI050 MINIPRESS
PRAZOSIN
HCL 1mg
1.50
TMI052 MINIPRESS 2mg (GE)
PRAZOSIN HCL 2mg
2.00
TMI054 MINIPRESS 5mg
PRAZOSIN HCL 5mg
8.60
TMI053 MINIPRESS 5mg (GE)
PRAZOSIN HCL 5mg
5.00
TMO030 MONOPRIL 10mg
FOSINOPRIL SODIUM 10mg
4.50
TNA020 NATRILIX 2.5mg (GE)
INDAPAMIDE 2.5mg
2.00
TNA021 NATRILIX SR 1.5mg
INDAPAMIDE 1.5mg
5.20
TNI026 NIFTEN
ATENOLOL 50mg/NIFEDIPINE SR
11.90
20mg
TPR026 PREDONIUM
PERINDOPRIL
2mg/INDAPAMIDE
5.00
0.625mg
TPR082 PRINIVIL 5mg
LISINOPRIL
5mg
3.50
ALISKIREN 150mg
TRA005 RASILEZ 150mg
16.00
TRA006 RASILEZ 300mg
20.00
ALISKIREN 300mg
16.000
TRA007 RASILEZ HCT
ALISKIREN 150mg, HCT 12.5mg
20.000
TRA008 RASILEZ HCT
ALISKIREN 300mg, HCT 12.5mg
TRE020 RENITEC 10mg
ENALAPRIL MALEATE 10mg
5.30
TRE021 RENITEC 10mg (GE)
ENALAPRIL MALEATE 10mg
3.20
TRE026 RENITEC 2.5mg
ENALAPRIL MALEATE 2.5mg
3.00
TRE022 RENITEC 20mg
ENALAPRIL MALEATE 20mg
7.00
TRE023 RENITEC 20mg (GE)
ENALAPRIL MALEATE 20mg
4.20
TRE024 RENITEC 5mg
ENALAPRIL MALEATE 5mg
3.70
TRE025 RENITEC 5mg (GE)
ENALAPRIL MALEATE 5mg
2.10
TTA025 TANATRIL 10mg
IMIDAPRIL 10mg
4.00
TTA060 TARKA
VERAPAMIL,TRANDOLAPRIL
7.20
TTE030 TENORET 50mg
ATENOLOL 50mg/CHLORTHALIDONE
7.50
12.5mg
TTE040 TENORETIC
ATENOLOL
10.90
100mg/CHLORTHALIDONE 25mg
TTE042 TENORETIC (GE)
ATENOLOL
5.00
100mg/CHLORTHALIDONE
25mg
TTE080 TEVETEN 600mg
EPROSARTAN
600mg
15.00
TTR010 TRANDATE 100mg
LABETALOL HCL 100mg
7.00
TTR068 TRITACE 2.5mg
RAMIPRIL 2.5mg
2.40
TTR070 TRITACE 5mg
RAMIPRIL 5mg
3.50
TZE010 ZESTORETIC
LISINOPRIL
11.30
20mg/HYDROCHLOROTHIAZIDE
TZE020 ZESTRIL 10mg
LISINOPRIL
DIHYDRATE 10mg
7.20
TZE021 ZESTRIL 10mg (GE)
LISINOPRIL DIHYDRATE 10mg
3.50
TZE022 ZESTRIL 20mg
LISINOPRIL DIHYDRATE 20mg
9.90
TZE023 ZESTRIL 20mg (GE)
LISINOPRIL DIHYDRATE 20mg
5.00
TZE024 ZESTRIL 5mg
LISINOPRIL DIHYDRATE 5mg
4.30
TZE025 ZESTRIL 5mg (GE)
LISINOPRIL DIHYDRATE 5mg
2.00
ANTIGLAUCOMA PREPARATION
DAZ006 AZARGA EYE DROPS
BRINZOLAMIDE 10mg,TIMOLOL 5mg
230
DTA004 TAFLOTAN EYE DROPS
TAFLUPROST
250
2.5mL
DGA008 GANFORT
EYE DROPS
BIMATOPROST,TIMOLOL
320.00
BETA-BLOCKERS
6.20
TBE028 BETALOC 100mg
METOPROLOL 100mg
TBE033 BETALOC 50mg
METOPROLOL TARTRATE 50mg
3.70
TBE032 BETALOC 50mg (GE)
METOPROLOL TARTRATE 50mg
1.50
TBE030 BETALOC 100mg (GE)
METOPROLOL TARTRATE 100mg
2.90
TBE040 BETALOC DURULE 200mg METOPROLOL TARTRATE 200mg
5.50
TBE046 BETALOC ZOK 25mg
METOPROLOL SUCCINATE 25mg
3.80
TBE048 BETALOC ZOK 50mg
METOPROLOL SUCCINATE 50mg
3.70
TBE049 BETALOC ZOK 50mg (GE) METOPROLOL SUCCINATE 50mg
2.00
TBE050 BETALOC ZOK 100mg
METOPROLOL SUCCINATE 100mg
5.90
TBE052 BETALOC ZOK 200mg
METOPROLOL SUCCINATE 200mg
12.50
TBE034 BETALOC COMP 100mg
METOPROLOL
5.40
100mg/HYDROCHLORTHIAZIDE
12.5mg
IBE012 BETALOC INJ 1mg/Ml
METOPROLOL
SUCCINATE
401.30
TBL010 BLOCADREN 10mg
TIMOLOL MALEATE 10mg
3.50
TCO062 CONCOR 2.5mg
BISOPROLOL FUMARATE 2.5mg
3.50
Page 4 of 28
TCO060 CONCOR 5mg
BISOPROLOL FUMARATE
5mg
4.00
PK UNIT
TAB
AMP
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
CAP
TAB
TAB
TAB
CAP
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
CAP
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
CAP
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
BOT
BOT
BOT
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
AMP
TAB
TAB
TAB
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
DRUG DESCRIPTION
NO.
TCO080 CORGARD 80mg
TDI075 DILATREND 6.25mg
TDI076 DILATREND 12.5mg
TDI077 DILATREND 25mg
TIN020 INDERAL 10mg (GE)
CPA148 INDERAL TABLET 10mg
CPA124 INDERAL 20mg (GE)
TIN022 INDERAL 40mg (GE)
TIN030 INDERAL LA 80mg
TIN032 INDERAL LA 160 mg
IIN010
INDERAL INJ 1mg/mL
TLO013 LOGIMAX
TLO006 LODOZ 2.5mg/6.25mg
TLO007 LODOZ 5mg/6.25mg
TSE010 SECTRAL 100mg
TSE012 SECTRAL 200mg
TSE018 SELECTOL 200mg
TSO020 SOTACOR 80mg (GE)TSO022 [SOTALOL]
TTE055 TENORMIN 25mg (GE)
TTE052 TENORMIN 50mg
TTE054 TENORMIN 50mg (GE)
TTE050 TENORMIN 100mg
TTE056 TENORMIN 100mg (GE)
CALCIUM ANTAGONISTS
TAC013 ACERYCAL 5mg/5mg
TAC014 ACERYCAL 5mg/10mg
TAC016 ACERYCAL 10mg/10mg
TAC017 ACERYCAL 10mg/5mg
TAD012 ADALAT 5mg (GE)
TAD010 ADALAT 10mg (GE)
TAD020 ADALAT GITS 30mg
TAD021 ADALAT GITS 30mg (GE)
TAD022 ADALAT GITS 60mg
TAD028 ADALAT RETARD TAB
TAD030 20MG
ADALAT RETARD 20mg
(GE)
TAZ010 AZOREN
20mg/5mg
TAZ012 AZOREN 40mg/5mg
TBA010 BAYPRESS 10mg
TBA020 BAYPRESS 20mg
TEX022 EXFORGE 5mg/160mg
TEX020 EXFORGE 5mg/80mg
EXFORGE HCT
TEX023 5mg/160mg/12.5mg
TEX024 EXFORGE 10mg/160mg
HCT
TEX025 EXFORGE
10mg/160mg/12.5mg
HCT
TEX026 10mg/160mg/25mg
TEX027 EXFORGE HCT
10mg/320mg/25mg
CPA085 EXFORGE
HCT(5mg/160mg/12.5mg)
THE018 HERBESSER
30mg
THE020 HERBESSER 30mg (GE)
THE022 HERBESSER 60mg (GE)
THE024 HERBESSER 60mg
THE034 HERBESSER SR 90mg
THE030 HERBESSER SR 120mg (GE)
THE032 HERBESSER SR 180mg
GENERIC NAME
NADOLOL 80mg
CARVEDILOL 6.25mg
CARVEDILOL 12.5mg
CARVEDILOL 25mg
PROPRANOLOL HCL 10mg
PROPRANOLOL HYDROCHLORIDE
PROPRANOLOL HCL 20mg
PROPRANOLOL HCL 40mg
PROPRANOLOL HCL 80mg
PROPRANOLOL HCL 160mg
PROPRANOLOL HCL
FELODIPINE 5mg,METOPROLOL 50mg
BISOPROLOL
FUMARATE/HYDROCHLOROTHIAZID
BISOPROLOL
FUMARATE/HYDROCHLOROTHIAZID
ACEBUTOLOL
HCL 100mg
ACEBUTOLOL HCL 200mg
CELIPROLOL HCL 200mg
SOTALOL HCL 80mg
SOTALOL
ATENOLOL 25mg
ATENOLOL 50mg
ATENOLOL 50mg
ATENOLOL 100mg
ATENOLOL 100mg
PERINDOPRIL 5mg, AMLODIPINE 5mg
PERINDOPRIL 5mg, AMLODIPINE
10mg
PERINDOPRIL,
AMLODIPINE
PERINDOPRIL, AMLODIPINE
NIFEDIPINE 5mg
NIFEDIPINE 10mg
NIFEDIPINE 30mg
NIFEDIPINE 30mg
NIFEDIPINE 60mg
NIFEDIPINE MODIFIED RELEASE
NIFEDIPINE 20mg
OLMESARTAN
20mg, AMLODIPINE
5mg
OLMESARTAN
40mg, AMLODIPINE
5mg
NITRENDIPINE 10mg
NITRENDIPINE 20mg
AMLODIPINE BESYLATE
VALSARTANABESYLATE
AMLODIPINE
VALSARTANA5mg, VALSARTAN
AMLODIPINE
160mg, HYDROCHLOROTHIAZIDE
AMLODIPINE BESYLATE
10mg, VALSARTAN
VALSARTANA
160mg, HYDROCHLOROTHIAZIDE
AMLODIPINE
10mg, VALSARTAN
160mg, HYDROCHLOROTHIAZIDE
AMLODIPINE 10mg, VALSARTAN
320mg, HYDROCHLOROTHIAZIDE
AMLODIPINE,
VALSARTANA,
HYDROCHLOROTHIAZIDE
DILTIAZEM
DILTIAZEM HCL 30mg
DILTIAZEM HCL 60mg
DILTIAZEM HCL 60mg
DILTIAZEM HCL 90mg
DILTIAZEM HCL 120mg
DILTIAZEM HCL 180mg
UNIT PRICE
($)
5.00
4.00
5.10
5.60
1.00
1.50
1.30
1.50
4.50
6.70
80.00
21.50
3.30
3.30
2.35
4.16
6.00
5.00
2.50
2.00
3.00
2.00
4.00
2.80
PK UNIT
9
12.5
14.3
12.5
2.00
3.00
10.80
5.50
15.90
10.00
4.30
9.90
12.30
8.80
11.00
17.00
14.00
TAB
TAB
TAB
TAB
CAP
CAP
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
AMP
TAB
TAB
TAB
TAB
AMP
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
THE033 HERBESSER R 100mg
DILTIAZEM HCL 100mg
CPA077
IHE050
TIS018
TIS020
TIS022
TIS030
IIS010
TLA018
TLA020
TNO080
TNO081
TNO082
TNO083
TPL022
TPL024
TPL025
TPL020
TTW010
TTW012
TTW014
TTW016
TZA025
DIURET
ICS
TAL012
TAL010
TAL008
TAM018
HERBESSER SR 200mg
HERBESSER INJ 50mg
ISOPTIN 40mg
ISOPTIN 40mg (GE)
ISOPTIN 80mg (GE)
ISOPTIN SR 240mg
ISOPTIN INJ 5mg/2mL
LACIPIL 2mg
LACIPIL 4mg
NORVASC 5mg
NORVASC 5mg [ACTAPIN]
NORVASC 10mg
NORVASC 10mg [ACTAPIN]
PLENDIL 2.5mg
PLENDIL 5mg
PLENDIL 5mg (GE)
PLENDIL 10mg
TWYNSTA 40mg/5mg
TWYNSTA 40mg/10mg
TWYNSTA 80mg/5mg
TWYNSTA 80mg/10mg
ZANIDIP 10mg
DILTIAZEM HCL 200mg
DILTIAZEM
VERAPAMIL HCL 40mg
VERAPAMIL HCL 40mg
VERAPAMIL HCL 80mg
VERAPAMIL HCL 240mg
VERAPAMIL HCL
LACIDIPINE 2mg
LACIDIPINE 4mg
AMLODIPINE BESYLATE 5mg
AMLODIPINE BESYLATE 5mg
AMLODIPINE BESYLATE 10mg
AMLODIPINE BESYLATE 10mg
FELODIPINE 2.5mg
FELODIPINE 5mg
FELODIPINE
FELODIPINE 10mg
TELMISARTAN 40mg, AMLODIPINE
5mg
TELMISARTAN
40mg, AMLODIPINE
10mg
TELMISARTAN
80mg, AMLODIPINE
5mg
TELMISARTAN
80mg, AMLODIPINE
10mg
LERCANIDIPINE HCl 10mg
17.00
20.00
20.00
20.00
21.7
17.60
2.50
1.50
3.00
3.20
5.00
5.50
7.00
4.50
11.00
90.00
3.60
2.50
4.00
12.30
90.00
5.10
7.70
6.50
4.00
11.70
7.50
4.40
6.80
4.00
12.40
11.00
12.00
17.00
18.00
7.20
ALDACTONE 100mg
ALDACTONE 25mg
ALDACTONE 25mg (GE)
AMILORIDE 5mg
SPIRONOLACTONE 25mg
SPIRONOLACTONE 100mg
SPIRONOLACTONE 25mg
AMILORIDE 5mg Page 5 of 28
13.00
5.80
3.70
0.70
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
CAP
CAP
AMP
TAB
TAB
TAB
CAP
CAP
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
DRUG DESCRIPTION
GENERIC NAME
NO.
TDI030 DIAMOX 250mg (GE)
ACETAZOLAMIDE 250mg
IDI006
DIAMOX INJ 500mg (GE)
ACETAZOLAMIDE
TDY008 DYAZIDE
TRIAMTERENE
50mg/HYDROCHLOROTHIAZIDE 25mg
TDY010 DYAZIDE (GE)
TRIAMTERENE
50mg/HYDROCHLOROTHIAZIDE
25mg
TEN020 ENDURON 5mg
METHYCLOTHIAZIDE
5mg
TFR010 FRUMIL
FRUSEMIDE 40mg/AMILORIDE 5mg
THY006 HYDROCHLOROTHIAZIDE HYDROCHLOROTHIAZIDE 25mg
25mg
THY008 HYDROCHLOROTHIAZIDE
HYDROCHLOROTHIAZIDE 50mg
50mg 40mg
TLA078 LASIX
FRUSEMIDE 40mg
TLA080 LASIX 40mg (GE)
FRUSEMIDE 40mg
ILA012 LASIX INJ 20mg/2mL
FRUSEMIDE
TLA090 LASIX SPECIAL TAB 500mg FRUSEMIDE 500mg
TMI028 MIDAMOR 5mg
AMILORIDE 5mg
TMO008 MODURETIC
AMILORIDE
5mg/HYDROCHLOROTHIAZIDE 50mg
TMO010 MODURETIC (GE)
AMILORIDE
5mg/HYDROCHLOROTHIAZIDE
50mg
TNA030 NAVISPARE
CYCLOPENTHIAZIDE
0.25mg/AMILORIDE 2.5mg
TZA050 ZAROXOLYN 5mg
METOLZAONE
CPA076 ZAROXOLYN
METOLAZONE
ANTIDIURETICS
TMI059 MINIRIN 0.1mg
DESMOPRESSION
TMI060 MINIRIN 0.2mg
DESMOPRESSION
TMI061 MINIRIN MELT 60mcg
DESMOPRESSIN ORAL
LYOPHILISATES ACETATE
60mcg
TMI062 MINIRIN MELT 120mcg
DESMOPRESSIN
120mcg
DMI010 MINIRIN DDAVP NASAL
DESMOPRESSION ACETATE
SPRAY
0.01%
PERIPHERAL
VASODILATORS
& CEREBRAL ACTIVATORS
IAT006 ATP INJ 20mg/2mL
ATP
TDO062 DOXIUM 500mg
CA DOBESILATE
TDU030 DUXARIL
AOLMITRINE 30mg,RAUBASINE 10mg
TME040 MERISLON 6mg
BETAHISTINE MESILATE 6mg
TSE056 SERMION 10mg
NICERGOLINE 10mg
CPA101 SERMION 30mg
NICERGOLINE 30mg
CPA078 STUGERON 25mg (JASSEN) CINNARIZINE
TST040 STUGERON 25mg (GE)
CINNARIZINE 25mg
MIGRAI
NE
TCA010 CAFERGOT
ERGOTAMINE TARTRATE
1mg/CAFFEINE
100mg
TDI120 DIXARIT 0.025mg
CLONIDINE
HCL
0.025mg
TGR006 GRAVERGOL
ERGOTAMINE,DIMENHYDRINATE,C
AFFEINE
TIM018 IMIGRAN 50mg
SUMATRIPTAN
SUCCINATE 50mg
IIM010
IMIGRAN INJ 6mg/0.5mL
SUMATRIPTAN SUCCINATE
(REFILL)
TMI030 MIGRIL
ERGOTAMINE,CYCLIZINE,CAFFEINE
TSA040 SANDOMIGRAN 0.5mg
PIZOTIFEN 0.5mg
TSI010
SIBELIUM 5mg (GE)
FLUNARIZINE 5mg
TZO024 ZOMIG 2.5mg
ZOLMITRIPTAN 2.5mg
TZO025 ZOMIG RAPIMELT 2.5mg
ZOLMITRIPTAN 2.5mg
HAEMOSTATICS
TTR020 TRANSAMIN 250mg
TRANEXAMIC ACID 250mg
TTR022 TRANSAMIN 500mg
TRANEXAMIC ACID 500mg
ITR020 TRANSAMIN 5% IV INJ
TRANEXAMIC ACID
(250mg/5mL) 10% IM INJ
ITR010 TRANSAMIN
TRANEXAMIC ACID
(250mg/2.5mL)
TRE050 REVOLADE
25mg
ELTROMBOPAG OLAMINE
TVI060 VITAMIN K-3 10mg
VITAMIN K-3 10mg
ANTICOAGULANTS, ANTITHROMBOTICS & FIBRINOLYTICS
TAG010 AGGRENOX
DIPYRIDAMOLE,ASPIRIN
TBR024 BRILINTA 90mg
TICAGRELOR
TCA070 CARTIA 100mg
ASPIRIN 100mg
ICL010 CLEXANE 40mg/0.4mL
ENOXAPARIN 40mg
ICL012 CLEXANE 60mg/0.6mL
ENOXAPARIN 60mg
ICL013 CLEXANE 80mg/0.8mL
ENOXAPARIN 80mg
TCO067 CO-PLAVIX
CLOPIDOGREL, ASPIRIN
TCO094 COUMADIN 2mg
WARFARIN 2mg
TEL015 ELIQUIS 5mg
APIXABAN
IFR010
FRAGMIN INJ 5,000 IU/2mL DALTEPARIN Na
IFR019
FRAXIPRARINE 2850 AXa NADROPARIN Ca
iu/0.3mL
IFR020
FRAXIPARINE
3,800 AXa
NADROPARIN Ca
IU/0.4mL INJ
IIN018
INNOHEP
20,000 IU/mL
TINZAPARIN
TXA014 2X0.5mL
XARELTO 10mg
RIVAROXABAN
TXA015 XARELTO 20mg
RIVAROXABAN 20mg
TPR005 PRADAXA 75mg
DABIGATRAN 75mg
TPR006 PRADAXA 110mg
DABIGATRAN
TPR007 PRADAXA 150mg
DABIGATRAN 150mg
TPL014 PLAVIX 75mg
CLOPIDOGREL 75mg
TPL015 PLAVIX 75mg (GE)
CLOPIDOGREL
TPL028 PLETAAL 50mg
CILOSTAZOL 50mg
TTI010
TICLID 250mg
TICLOPIDINE 250mg
TWA010 WARFARIN 1mg
WARFARIN 1mg
TWA012 WARFARIN 3mg
WARFARIN 3mg
TWA014 WARFARIN 5mg
WARFARIN 5mg
HAEMORRHOIDAL, PHLEBITIS & VARICOSE PREPARATIONS
CAN028 ANUSOL OINTMENT 25g
BISMUTH SUBGALLATE
CAN030 ANUSOL OINTMENT (GE) BISMUTH SUBGALLATE
30g
PAN010 ANUSOL
SUPP
BALSAM PERU, BISMUTH OXIDE...
CAN040 ANUSOL-HC OINTMENT
HYDROCORTISONE, ZINC SULFATE
(GE) 15g
PAN018 ANUSOL-HC
SUPP
BISMUTH OXIDE,Page
ZINC
OXIDE....
6 of
28
PAN020 ANUSOL-HC SUPP (GE)
BISMUTH OXIDE, ZINC OXIDE....
UNIT PRICE
($)
2.50
480.00
2.00
1.40
2.00
3.60
0.30
0.50
3.00
1.60
42.00
23.00
1.70
2.20
1.40
3.30
8.40
4.95
PK UNIT
13.50
20.00
12.18
30.00
540.00
TAB
TAB
TAB
TAB
BOT
25.00
6.30
8.90
1.20
12.50
33.00
2.70
1.20
AMP
CAP
TAB
TAB
TAB
TAB
TAB
TAB
7.00
2.80
1.65
96.00
440.00
5.50
3.20
3.00
102.40
89.00
TAB
TAB
CAP
TAB
AMP
TAB
TAB
CAP
TAB
TAB
2.30
3.00
80.00
110.00
400.00
1.10
CAP
TAB
AMP
AMP
TAB
TAB
6.90
25.00
1.70
100.00
120.00
150.00
20.00
1.50
17.00
94.00
160.00
156.00
190.00
38.00
40.00
20.00
20.00
20.00
20.00
14.00
6.80
19.50
1.10
1.60
2.00
CAP
TAB
TAB
AMP
AMP
AMP
TAB
TAB
TAB
AMP
AMP
AMP
AMP
TAB
TAB
CAP
CAP
CAP
CAP
TAB
TAB
TAB
TAB
TAB
TAB
2.50
1.00
4.60
2.00
6.00
6.00
g
g
SUPP
g
SUPP
SUPP
TAB
TAB
AMP
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
AMP
TAB
TAB
TAB
TAB
TAB
TAB
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
DRUG DESCRIPTION
GENERIC NAME
NO.
TDA010 DAFLON 500mg
DIOSMIN 450mg, HESPERIDIN 50mg
CFA010 FAKTU OINTMENT 20g
POLICRESULEN, CINCHOCAINE HCL
PFA010 FAKTU SUPP
POLICRESULEN, CINCHOCAINE HCL
CHI031 HIRUDOID CREAM 5g (GE) MUCOPOLYSACCHARIDE
POLYSULFATE
CHI030 HIRUDOID CREAM 14g
MUCOPOLYSACCHARIDE
POLYSULFATE
CHI040 HIRUDOID CREAM 40g
MUCOPOLYSACCHARIDE
CHI032 HIRUDOID FORTE CREAM POLYSULFATE
MUCOPOLYSACCHARIDE
14g
POLYSULFATE
IPH020 PHENOL
IN ALMOND OIL PHENOL
INJ 250mg/5mL
CPH013 PHENOL
5% IN ALMOND PHENOL
OIL
CPR008 PREMARIN
VAGINAL
CONJUGATED ESTROGENS
CREAM 14g
CPR014 PROCTOSEDYL
HYDROCORTISONE, CINCHOCAINE...
OINTMENT 15g SUPP
PRO010 PROCTOSEDYL
HYDROCORTISONE,CINCHOCAINE
HCL
TRE027 REPARIL 20mg
AESCIN
ISO072 SODIUM TETRADECYL
SODIUM TETRADECYL SULPHATE
SULPHATE (FIBRO-VEIN)
ITR040 TROMBOVAR
3% INJ
SODIUM TETRADECYL SULFATE
CUL010 ULTRAPROCT OINTMENT FLUOCORTOLONE, CINCHOCAINE
10g
CUL012 ULTRAPROCT-N
CREAM
FLUOCORTOLONE PIVALATE
10g
PUL010 ULTRAPROCT
SUPP
FLUOCORTOLONE, CINCHOCAINE
HCL
TVE020 VENORUTON 300mg
TRIHYDROXYETHYLRUTOSIDE
300mg
CXY030 XYLOPROCT OINTMENT LIDOCAINE,
HYDROCORTISONE
PXY010 20g
XYLOPROCT SUPP
LIDOCAINE, HYDROCORTISONE
CZI020 ZINC OXIDE OINTMENT
ZINE OXIDE 15%
HAEMATOPOIETIC AGENTS
CPA112 ARANESP 20 mcg/0.5 mL
DARBEPOETIN α
CPA113 ARANESP 40 mcg/0.4 Ml
DARBEPOETIN α
CPA114 ARANESP 100 mcg/0.5 mL DARBEPOETIN α
IAR001 ARANESP [darbepoetin]
DARBEPOETIN
40mcg/0.4ml PRE-FILLED
ILE010
LEUCOMAX
INJ 150mcg
MOLGRAMOSTIM
ILE012
LEUCOMAX INJ 300mcg
MOLGRAMOSTIM
INE005 NEULASTIM
6 mg/0.6 mL
PEGFILGRASTIM
NEUPOGEN 300mcg/0.5mL
INE006 PRE-FILLED
FILGRASTIM
IRE010 RECORMON INJ 5,000IU
ERYTHROPOIETIN
OTHER CARDIOVASCULAR
ADENOSCAN INJ DRUGS
ADENOSINE
IAD005 30mg/10mL
CPA156 EDARBI 40 mg
AZILSARTAN MEDOXOMIL
CPA149 EDARBI 80mg
AZILSARTAN MEDOXOMIL
TEF020 EFFIENT 10mg
PRASUGREL 10mg
CPA045 EIQUINON 10mg
UBIDECARENONE (COENZYME Q10)
TGU010 GUTRON 2.5mg
MIDRODINE HYDROCHOLORIDE
TIM019 IMIGRAN 50mg (GE)
SUMATRIPTAN SUCCINATE 50mg
TIN080 INSPRA 25mg
EPLERENONE 25mg
TIN082 INSPRA 50mg
EPLERENONE 50mg
TPR017 PRAXILENE 100mg
NAFTIDROFURYL 100mg
TTR030 TRENTAL 400mg
PENTOXIFYLLINE 400mg
ANTIASTHMATIC PREPARATIONS
IAD010 ADRENALINE INJ 1:1,000
ADRENALINE
IM (GE) METERED-DOSE CICLESONIDE
CPA074 ALVESCO
INHALER MDI 160
CPA144 ALVESCO
CICLESONIDE
IAM020 mcg/actuation
AMINOPHYLLINE INJ
AMINOPHYLLINE
250mg/10mL IV
IAM010 AMINOPHYLLINE
INJ
AMINOPHYLLINE
250mg/2mL IM
SAT018 ATROVENT
INHALER
IPRATROPIUM BROMIDE
20mcg/puff (200
Doses)
ANHYDROUS BROMIDE
SAT010 ATROVENT
NEB
IPRATROPIUM
SOLUTION10mg
0.25mg/mL
ANHYDROUS HYDROCHLORIDE
TBA004 BAMBEC
BAMBUTEROL
MBA010 BAMBEC SYR.1mg/1ml
BAMBUTEROL HYDROCHLORIDE
SBE006 BECLAZONE INHALER
BECLOMETHASONE DIPROPIONATE
100mcg
SBE010 BECLOFORTE
BECLOMETHASONE DIPROPIONATE
INHALER
(200 Doses)
SBE011 250mcg/puff (GE)
BECLOMETHASONE DIPROPIONATE
SBE020 BECODISK 100mcg x 8
BECLOMETHASONE DIPROPIONATE
Doses
SBE022 BECODISK
200mcg x 8
BECLOMETHASONE DIPROPIONATE
Doses
SBE060 BECOTIDE
DISKHALER
BECODISK DISKHALER
SBE070 BECOTIDE INHALER
BECLOMETHASONE DIPROPIONATE
50mcg/puff (200
Doses)
SBE071 BECOTIDE
INHALER
BECLOMETHASONE DIPROPIONATE
50mcg/puff 2.5mg
(GE)
TBE020 BEROTEC
FENOTEROL HBr 2.5mg
SBE080 BEROTEC INHALER
FENOTEROL HBr
0.2mg/puff 300
puffs
TBR010 BRICANYL
2.5mg
TERBUTALINE SULFATE 2.5mg
TBR012 BRICANYL 2.5mg (GE)
TERBUTALINE SULFATE 2.5mg
TBR020 BRICANYL DURULE 5mg
TERBUTALINE SULFATE 5mg
TBR022 BRICANYL DURULE 7.5mg TERBUTALINE SULFATE 7.5mg
MBR010 BRICANYL SYRUP
TERBUTALINE SULFATE
1.5mg/5mL (GE)
IBR010 BRICANYL
INJ 0.5mg/mL
TERBUTALINE SULFATE
SBR010 BRICANYL INHALER
TERBUTALINE SULPHATE
250mcg/puff NEB
(400 Doses)
SBR020 BRICANYL
SOLUTION TERBUTALINE SULFATE
10mg/mL 50mL/BOT
SBR026 BRICANYL
SPACER
TERBUTALINE SULFATE
INHALER 250mcg/puff
400 TERBUTALINE SULFATE
SBR030 BRICANYL
TURBUHALER
0.5mg/dose (200
Doses)
SBR024 BRINCANYL
RESPULE
TERBUTALINE SULFATE
SCO020 0.5mg/2mL
COMBIVENT INHALER
IPRATROPIUM, SALBUTAMOL
TDA070 DAXAS 500mcg
ROFLUMILAST
SCO010 COMBIVENT
IPRATROPIUM Br
NEB.SOLU.2.5ml/vial
ANHYDROUS/SALBU
CPA137 COMBIVENT
NEBULE
IPRATROPIUM
BR ANHYDROUS
0.5mg, SALBUTAMOL 2.5mg
MDI020 DIPROPHYLLINE
DIPROPHYLLINE
100mg/5mL
IEP002
EPIPEN
AUTO-INJECTOR ADRENALINE
1:1000
SFL024 FLIXOTIDE
ACCUHALER FLUTICASONE PROPIONATE
50mcg
Page 7 of 28
SFL026 FLIXOTIDE
INHALER
FLUTICASONE PROPIONATE
25mcg/puff ( 60 DOSE)
UNIT PRICE
($)
6.00
4.30
6.00
2.30
3.80
2.80
4.64
100.00
3.40
84.00
3.40
4.60
1.75
400.00
60.00
9.00
8.60
9.20
6.00
3.20
5.80
0.80
PK UNIT
500
880
1700
1314
680.00
1280.00
14520.00
1300.00
760.00
AMP
AMP
AMP
SYR
VIA
VIA
AMP
AMP
VIA
210
7.30
8.50
28.00
2.30
3.00
50.00
32.10
51.00
3.70
6.40
AMP
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
70.00
238.00
375.00
50.00
32.00
220.00
150.00
3.50
0.60
255.00
360.00
120.00
18.00
30.00
55.00
110.00
70.00
1.00
120.00
1.00
1.20
2.60
4.20
0.17
77.30
132.00
160.00
130.00
258.00
9.00
200.00
20.500
12.00
9.00
0.17
1500.00
400.00
50.00
AMP
PC
PC
AMP
AMP
PC
BOT
TAB
ML
PC
PC
PC
DISC
DISC
PC
PC
PC
TAB
PC
TAB
TAB
TAB
TAB
ML
AMP
PC
BOT
PC
PC
AMP
PC
TAB
VIA
NEB
ML
AMP
PC
PC
TAB
g
SUPP
g
g
g
g
VIA
ML
TUB
g
SUPP
TAB
AMP
VIA
g
g
SUPP
CAP
g
SUPP
g
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
NO.
SFL028
SFL029
SFL030
SFL032
SFL033
SFL025
CPA138
SIN010
SIN012
SIN030
SIN040
TNU010
TNU012
MNU010
CPA145
CPA146
SOX010
SOX011
SPU012
SPU010
SPU011
SPU040
SPU042
SPU060
SPU062
SPU064
SPU030
SRE010
SSE020
SSE009
SSE022
SSE006
SSE007
SSE008
CPA079
SSE012
SSE010
SSE016
TSI058
TSI060
TSI062
MSI020
TSL012
TSL010
TSL011
TSL014
TSL016
SSP020
CPA089
CPA087
SSY010
SSY012
SSY008
TTE006
TTH010
TTH012
STI010
CPA147
SVE010
SVE020
SVE022
TVE030
TVE032
MVE012
MVE010
IVE010
SVE050
SVE052
SVE030
SVE040
SVE060
SVE070
TVO010
TVO011
TVO012
AVO012
TZA018
TZA020
MZA020
MZA030
DIN010
DRUG DESCRIPTION
GENERIC NAME
FLIXOTIDE INHALER
50mcg/puff (60
Doses)
FLIXOTIDE
INHALER
50mcg/puff (120
Doses)
FLIXOTIDE
INHALER
125mcg/puff INHALER
(60 Doses)
FLIXOTIDE
250mcg/puff INHALER
(120 Doses)
FLIXOTIDE
250mcg/puff ACCUHALER
(60 Doses)
FLIXOTIDE
250mcg
FLIXOTIDE NEBULES 0.5
mg/2 mL
INTAL
INHALER 1mg/puff
(200 Doses)
INTAL
INHALER 5mg/puff
(112 Doses)
INTAL
NEB SOLUTION
20mg/2mL
INTAL
SPINCAP 20mg
NUELIN SR 200mg
NUELIN SR 300mg
NUELIN SYRUP 80mg/15mL
60mL
ONBREZ
BREEZHALER 150
mcg INHALATION POWD
CAP
ONBREZ BREEZHALER 300
mcg INHALATION POWD
CAP
OXIS TURBUHALER
FLUTICASONE PROPIONATE
FLUTICASONE PROPIONATE
FLUTICASONE PROPIONATE
FLUTICASONE PROPIONATE
FLUTICASONE PROPIONATE
FLUTICASONE PROPIONATE
FLUTICASONE PROPIONATE
SODIUM CROMOGLYCATE
SODIUM CROMOGLYCATE
SODIUM CROMOGLYCATE
SODIUM CROMOGLYCATE
ANHYDROUS THEOPHYLLINE 200mg
ANHYDROUS THEOPHYLLINE 300mg
THEOPHYLLINE
INDACATEROL MALEATE
4.5mcg/dose
(60 Doses)
OXIS
TURBUHALER
9mcg/dose (60 INHALER
Doses)
PULMICORT
50mcg/puff (200
Doses)
PULMICORT
INHALER
(100 Dose)
Doses)
200mcg/puff (120
PULMICORT SPACE
INHALER 200mcg/puff
PULMICORT
SPACE (100
INHALER 50mcg/puff (200
PULMICORT
TURBUHALER
PULMICORT 100mcg/dose
TURBUHALER 200mcg/dose
PULMICORT
TURBUHALER
400mcg/dose
PULMICORT
RESPULE
0.5mg/2mL AUTO-HALER
RESPOLIN
100mcg/puffINHALER
(400 Doses)
SERETIDE
25mcg/125mcg
SERETIDE
INHALER
25mcg/50mcg
SERETIDE
INHALER
25mcg/250mcg
SERETIDE
ACCUHALER
50mcg/100mcg
(60 Doses)
SERETIDE
ACCUHALER
50mcg/500mcg
(60 Doses)
SERETIDE ACCUHALER
50mcg/250mcg
(60 Doses)
SERETIDE
ACCUHALER
500mcg
SEREVENT
INHALER
25mcg/puff (120
Doses)
SEREVENT
INHALER
25mcg/puff (60
Doses)
SEREVENT
ACCUHALER
50mcg/dose (60
Doses)
SINGULAIR
4mg
SINGULAIR 5mg
SINGULAIR 10mg
SINGULAIR ORAL
GRANULES
4mg
SLO-BID 50mg
SLO-BID 100mg
SLO-BID 200mg
SLO-THEO 50mg
SLO-THEO 100mg
SPIRIVA 18mcg CAPSULES
FOR INHALATION
SPIRIVA
RESPIMAT
SOLUTION
FOR
SPIRIVA
TURBUHALER
18mcg
SYMBICORT
TURBUHALER 160/4.5mcg
320/9mcg/dose (60 doses)
SYMBICORT
TURBUHALER
TEDRAL
SA
THEODUR 200mg
THEODUR 300mg
TILADE STANDARD
INHALER 2mg/puff,
112MDI
VANNAIR
160/4.5 mcg
VENTIDE INHALER (200
Doses)
VENTODISK
200mcg x 8
Doses
VENTODISK 400mcg x 8
Doses
VENTOLIN
2mg (GE)
VENTOLIN 4mg (GE)
VENTOLIN EXPECTORANT
(G.E)
VENTOLIN
SYRUP
2mg/5mL (GE)
VENTOLIN
INJ 0.5mg/mL
VENTOLIN INHALER
100mcg/puff INHALER
(200 Doses)
VENTOLIN
100mcg/puff ACCUHALER
(GE)
VENTOLIN
200mcg
VENTOLIN DISKHALER
VENTOLIN NEBULE
2.5mg/2.5mLRESP
VENTOLIN
SOLUTION4mg
5mg/mL
VOLMAX
VOLMAX {Salbutamol} 4mg
(GE)
VOLMAX
8mg
VOLUMATIC SOFT
(GLAXO) 1mg
ZADITEN
ZADITEN 1mg (GE)
ZADITEN SYRUP 1mg/5mL
ZANTAC 150mg/10mL
INHALANT 30mL/BOT (GE)
UNIT PRICE
($)
105.00
322.00
340.00
605.00
336.00
442.00
25.00
204.00
170.00
3.00
3.00
1.30
1.60
0.22
384.00
PK UNIT
INDACATEROL MALEATE
637.00
PC
FORMOTEROL FUMARATE 4.5mcg
FORMOTEROL FUMARATE 9 mcg
BUDESONIDE
BUDESONIDE
BUDESONIDE
BUDESONIDE
BUDESONIDE
BUDESONIDE
BUDESONIDE
BUDESONIDE
BUDESONIDE
SALBUTAMOL SULFATE
SALMETEROL, FLUTICASONE
SALMETEROL, FLUTICASONE
SALMETEROL, FLUTICASONE
SALMETEROL, FLUTICASONE
SALMETEROL, FLUTICASONE
SALMETEROL, FLUTICASONE
SALMETEROL, FLUTICASONE
SALMETEROL XINAFOATE
SALMETEROL XINAFOATE
SALMETEROL XINAFOATE
ZINCAPS
MONTELUKAST SODIUM 5mg
MONTELUKAST SODIUM 10mg
MONTELUKAST SODIUM 4mg
THEOPHYLLINE 50mg
THEOPHYLLINE 100mg
THEOPHYLLINE 200mg
ANHYDROUS THEOPHYLLINE 50mg
ANHYDROUS THEOPHYLLINE 100mg
TIOTROPIUM 18 mcg
TIOTROPIUM BR
TIOTROPIUM 18 mcg
BUDESONIDE/FORMOTEROL
FUMARATE
BUDESONIDE 320mcg,FORMOTEROL
FUMARATE DIHYDRATE 9mcg
BUDESONIDE/FORMOTEROL
FUMARATE
THEOPHYLLINE,
EPHEDRINE...
ANHYDROUS THEOPHYLLINE 200mg
ANHYDROUS THEOPHYLLINE 300mg
NEDOCROMIL Na
BUDESONIDE, FORMOTEROL
FUMARATE DIHYDRATE
SALBUTAMOL,
BECLOMETHASONE
SALBUTAMOL SULPHATE
SALBUTAMOL SULPHATE
SALBUTAMOL 2mg
SALBUTAMOL 4mg
SALBUTAMOL SULPHATE
SALBUTAMOL SULPHATE
SALBUTAMOL SULPHATE
SALBUTAMOL SULPHATE
SALBUTAMOL SULPHATE
SALBUTAMOL SULPHATE
SALBUTAMOL SULPHATE
SALBUTAMOL SULPHATE
SALBUTAMOL SULPHATE
SALBUTAMOL SULPHATE 4mg
SALBUTAMOL SULPHATE 4mg
SALBUTAMOL SULPHATE 8mg
173.00
318.00
140.00
210.00
295.00
210.00
140.00
472.00
795.00
1210.00
58.30
260.00
595.00
360.00
825.00
462.00
905.00
755.00
820.00
455.00
275.00
629.00
14.30
14.30
14.30
14.30
0.80
0.70
0.50
0.70
0.90
19.00
600.00
400.00
416.00
PC
PC
PC
PC
PC
PC
PC
PC
PC
PC
AMP
PC
PC
PC
PC
PC
PC
PC
PC
PC
PC
PC
TAB
TAB
TAB
SACH
CAP
CAP
CAP
CAP
CAP
CAP
PC
PC
PC
PC
KETOTIFEN HYDROGEN FUMARATE
1mg
KETOTIFEN
1mg
KETOTIFEN HYDROGEN FUMATATE
RANITIDINE HCLPage 8 of 28
MENTHOL, EUCALYPTUSE
705
285.00
1.10
1.20
1.50
230.00
820.00
200.00
16.00
20.00
0.80
1.30
0.17
0.19
30.00
115.00
56.00
215.00
58.00
6.70
137.00
2.70
2.70
4.50
171.00
5.00
2.60
1.50
2.20
0.33
PC
PC
PC
PC
PC
PC
NEB
PC
PC
AMP
CAP
TAB
TAB
ML
PC
PC
TAB
TAB
TAB
PES
PC
PC
DISC
DISC
TAB
TAB
ML
ML
AMP
PC
PC
PC
PC
AMP
BOT
TAB
TAB
TAB
PC
TAB
TAB
ML
ML
ML
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
DRUG DESCRIPTION
NO.
MME005 MEPTIN SYRUP 5mcg/mL
COUGH & COLD REMEDIES
TAC020 ACTIFED (GE)
MAC008 ACTIFED COMPOUND
LINCTUS CO SYRUP (GE)
MAC010 ACTIFED
MAC012 ACTIFED CO SYRUP (1/2
MAC014 STRENGTH)
ACTIFED CO "UNI-FEDRA
COMPOUND"
SYRUP
MAC020 ACTIFED
SYRUP
(GE)
MBE020 BENADRYL
EXPECTORANT
(GE)
TBI020 BISOLVON
8mg (GE)
MBI020 BISOLVON SYRUP
4mg/5mL (GE)
MBI022 BISOLVON
SYRUP
8mg/5mL (GE)
MBI010 BISOLVON
CO ELIXIR (GE)
TCP010 C.P.P.
MCH010 CHRISTOLIN SYRUP
TCL010 CLARINASE
TCL012 CLARINASE EXTENDED
RELEASE
MCO010 COCILLANA
CO MIXTURE
(GE)
MCO012 COCILLANA
CO MIXTURE
WITH CODEINE
CPA104 CODAPANE
FORTE
CPA157 CO-CODAMOL
MCO020 CODEINE LINCTUS
12.5mg/5mL
(1/2
MCO022 CODEINE
LINCTUS
25mg/5mL PHOSPHATE
(FULL
TCO010 CODEINE
15mg
TCO012 CODEINE
PHOSPHATE
30mg
TCO014 CODIPRONT
TCO020 CODOPLEX
TCO022 CODOPLEX JUNIOR
MCO030 CODOPLEX SYRUP
TCO030 COFREL
MCO060 COSYR
TDA026 DANZEN 5mg
MDE010 DEC SYRUP
MDE050 DEXTROCILLA SYRUP
MDE060 DEXTROMETHORPHAN
15mg/5mL SYRUP
CPA099 DURO-TUSS
FORT
MEX008 EXPECT STIM MIXTURE
(120mL) STIM MIXTURE
MEX010 EXPECT
(3600mL)
MFL020 FLUIMUCIL
100mg
MFL022 FLUIMUCIL 200mg
MFL021 FLUIMUCIL A 100mg
MFL023 FLUIMUCIL A 200mg
CPA090 FLUIMUCIL A
600mg
TFL050 EFFERVESCENT
FLU-OFF
TFL040 FLUCOR DAY
MGE010 GEE'S LINCTUS (GE)
TGE008 GELOMYRTOL FORTE
MGL010 GLYCERYL
GUAIACOLATE100mg/5mL
100mg
MGU010 GUAIFENESIN
TLO012 LOGICIN FLU STRENGTH
CPA111 LOGICIN RAPID RELIEF
LOZ
MME020 METHORSEDYL SYRUP
IME005
TMU020
TMU030
CPA039
MMU024
MMU026
TPA019
TPA034
MPH012
MPH020
TPH026
MPH030
MPI010
MPR030
METHON-S (50'S/BOX)
MUCODYNE 375mg (GE)
MUCOSOLVAN 30mg (GE)
MUCOSOLVAN 30mg
MUCOSPECT SYRUP
100mg/5mL SYRUP
MUCOSPECT
250mg/5mL EXTEND 665mg
PANADOL
PANADOL COLD & FLU
PHENEXPECT SYRUP
PHENSEDYL SYRUP (GE)
PHENSEDYL TAB (GE)
PHOLCODINE SYRUP
5mg/5mL EXPECTORANT
PIRITON
(GE)
PRODEX COUGH SYRUP
GENERIC NAME
PROCATEROL HYDROCHLORIDE
TRIPROLIDINE, PSEUDOEPHEDRINE
CODEINE PSEUDOEPHEDRINE
TRIPROLIDINE
CODEINE,
PSEUDOEPHEDRINE....
CODEINE, PSEUDOEPHEDRINE....
TRIPROLIDINE, CODEINE,
PSEUDOEPHEDRINE
TRIPROLIDINE,
PSEUDOEPHEDRINE
DIPHENHYDRAMINE, AMMONIUM
CL..
BROMHEXINE
8mg
BROMHEXINE HCL
BROMHEXINE HCL
BROMHEXINE,CODEINE
CHLORPHENIRAMINE,PHENYLEHRI
NE
EPHEDRINE/AMMONIUM
CHLORDIE/PO
LORATADINE, PSEUDOEPHEDRINE
LORATADINE, PSEUDOEPHEDRINE
COCILLANA, SENEGA, EUPHORBIA…
COCILLANA, CONDEINE, SENEGA,
EUPHORBIA… CODEINE
PARACETAMOL,
PHOSPHATE
PARACETAMOL, CODEINE
PHOSPHATE
CODEINE
PHOSPHATE
CODEINE PHOSPHATE
CODEINE PHOSPHATE 15mg
CODEINE PHOSPHATE 30mg
CODEINE, PHENYLTOLOXAMINE
CODEINE, CHLORPHENIRAMINE...
CODEINE, CHLORPHENIRAMINE...
CODEINE, CHLORPHENIRAMINE...
BENPROPERINE 20mg
DEXTROMETHORPHAN/CHLORPHEN
IRAM
SERRAPEPTASE
CODEINE,EPHEDRINE,DEXCHLORPH
ENIRAMINE
DEXTROMETHORPHAN,COCILLANA
…
DEXTROMETHORPHAN
PHOLCODINE
AMMONIUM CO3, IPECAUANHA
TINCT
AMMONIUM
CO3, IPECAUAUHA
TINCT
ACETYLCYSTEINE
ACETYLCYSTEINE
ACETYLCYSTEINE
ACETYLCYSTEINE
ACETYLCYSTEINE
PARACETAMOL,
CHLORPHENIRAMINE…
PSEUDOEPHEDRINE,
OPIUM TINCT, SQUIL LIQ EXTRACT
MYRTOL 300mg
GLYCERYL GUAIACOLATE 100mG
GUAIFENESIN 100mg
PARACETAMOL, PSEUDOEPHEDRINE
LIGNOCAINE HCI, BENZYDAMINE
HCI, DICHLOROBENZYL ALCOHOL
1.2
mg
DEXTROMETHORPHAN,PROMETHAZ
CHLORPHENIRAMINE,DEXTROMETHOR
INE
PHAN,GUAIPHENESIN,METHOXPHENAM
CARBOCISTEINE
AMBROXOL HCL 30mg
AMBROXOL HCL 30mg
CARBOCYSTEINE
CARBOCYSTEINE
ACETAMINOPHEN
ACETAMINOPHEN/PHENYLEPHRINE
DIPHENHYDRAMINE/AMMON CL/NA
CI
PROMEHTAZINE,CODEINE,EPHEDRI
NE
PROMETHAZINE,CODEINE,EPHEDRI
NE
PHOLCODINE
CHLORPHENIRAMINE, AMMONIUM
CL
DEXTROMETHORPHAN HBR/
EPHEDRINE HCL/PROMETHAZINE
HCL
MRH008 RHINATHIOL INFANT
CARBOCISTEINE
SYRUP
TRO050 ROMILAR
15mg
DEXTROMETHORPHAN 15mg
(DEXTROMETHORPHAN)
TRO052 ROMILAR
25mg
DEXTROMETHORPHAN 25mg
(DEXTROMETHORPHAN)
TSU010 SUDAFED
60mg (GE)
PSEUDOEPHEDRINE 60mg
MSU010 SUDAFED SYRUP
PSEUDOEPHEDRINE HCL
30mg/5mL (GE)
MCO052 CORYAID
SYRUP (1/2
CHLORPEHNIRAMINE,CODEINE,EPH
STRENGTH)
(GE) (GE)
ED
MCO050 CORYAID
SYRUP
CHLORPEHNIRAMINE,CODEINE,EPH
ED
TCO090 CORYZAC (GE)
CAFFEINE,CHLORPHENIRAMINE,PPA
MDI010 DIMETAPP ELIXIR (GE)
BROMPHENIRAMINE,PPA,PHENYLEP
HR
MMU050 MUCOFLUX
D,L-trans-1
methyl-4-cyclohex-1,2-2n-6-ol
80mg, 60% sucrose syrup
TNE020 NEOZEP
PARACETAMOL,PPA,SALICYLAMIDE.
.
MRH010 RHINOPRONT SYRUP
PPA,
CARBINOXAMINE
MTI010 TIXYLIX SYRUP (GE)
PPA, PHOLCODINE, PROMETHAZINE
TCO008 CODAEWON
DIHYDROCODEINE, GUAIFENESIN,
DECONGESTANTS & OTHER NASALCHLORPHENIRAMINE,
PREPARATIONS
Page 9 of 28
SAF012 AFRIN (PAED) NOSE
OXYMETAZOLINE HCL
DROPS/SPRAY 0.025%
UNIT PRICE
($)
0.79
PK UNIT
2.00
60.00
0.40
0.17
0.32
0.30
0.20
0.85
0.17
0.17
0.17
0.50
0.17
5.50
10.20
0.18
0.42
8.00
2.00
0.23
0.32
1.00
1.50
5.50
1.80
0.50
0.30
2.10
0.17
1.20
0.40
0.22
0.22
0.50
0.17
0.25
2.00
2.50
2.60
3.20
4.00
1.20
2.000
0.18
3.70
0.17
0.17
1.85
1.50
TAB
BOT
ML
ML
ML
ML
ML
TAB
ML
ML
ML
TAB
ML
TAB
TAB
ML
ML
TAB
TAB
ML
ML
TAB
TAB
CAP
TAB
TAB
ML
TAB
ML
TAB
ML
ML
ML
ML
ML
ML
SACH
SACH
SACH
SACH
TAB
CAP
CAP
ML
TAB
ML
ML
TAB
TAB
ML
0.25
ML
35.00
1.50
1.20
1.50
0.23
0.27
1.00
2.00
0.17
0.40
2.00
0.20
0.17
0.20
AMP
TAB
TAB
TAB
ML
ML
TAB
TAB
ML
ML
TAB
ML
ML
ML
0.24
1.10
1.50
2.00
0.30
0.18
0.18
0.60
0.18
1.00
1.20
0.40
0.19
1.20
ML
TAB
TAB
TAB
ML
ML
ML
CAP
ML
ML
TAB
ML
ML
TAB
45.00
BOT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
DRUG DESCRIPTION
NO.
SAF010 AFRIN (ADULT) NASAL
SPRAY 0.05%
15mL/BOT
CPA059 AVAMYS
NASAL
SPRAY
SAV010 AVAMYS NASAL SPRAY
27.5mcg 120 Doses
SBE050 BECONASE
NASAL SPRAY
50mcg
SBE040 BECONASE
AQUEOUS
NASAL SPRAY
50mcg
DCR020 CROMOLYN
NASAL
TDR010 SOLUTION
DRIXORAL 2%
(GE)
DEP010 EPHEDRINE NASAL
DROPS 0.5% NASAL
15mL/BOT
DEP012 EPHEDRINE
DROPS 1% 15AQUEOUS
mL/BOT
SFL010 FLIXONASE
NASAL
SPRAY
CPA105 MAR
PLUS
NASAL SPRAY
(140 SPRAYS)
10NASAL
mg/1 mL x
SNA006 NASACORT
AQ
SPRAY
SNA010 NASONEX
NASAL SPRAY
0.05% 140 Doses
SNA012 NASONEX
NASAL SPRAY
0.05% 60OINTMENT
Doses
CNI006 NISITA
20g
SNI004 NISITA NASAL SPRAY
CPA103 OMNARIS NASAL SPRAY
50MCG CHILDREN
SOT010 OTRIVIN
NASAL DROPS
SOT030 OTRIVIN
ADULTS NASAL
DROPS
SRH010 RHINOCORT
NASAL
50mcgAQUA
(GE) NASAL
SRH008 SPRAY
RHINOCORT
SPRAY 50mcgAQUA NASAL
SRH009 RHINOCORT
SPRAY 64mcg
SRH012 RHINOCORT
TURBUHALER
100mcg/dose
SST010 STERIMAR
MICROSPRAY
50ml
SRY010 RYNACROM
M NASAL
SPRAY 2% ADULTS
DSI020 SINOMARIN
125mL
DSI022 SINOMARIN
CHILDREN/ENFANTS
CVI010 VIBROCIL
GEL 12g
DXY010 XYLOMA NASAL DROPS
0.1%
ANTI-INFLAMMATORY
ENZYMES
TBR030 BROTASE 20mg
TNE040 NEUZYM 30mg
TNE042 NEUZYM 30mg (GE)
TNE044 NEUZYM 60mg (GE)
TPA042 PAPASE
TPA043 PAPASE (GE)
ANALGESICS & ANTIPYRETICS
UNIT PRICE
($)
60.00
120.00
200.00
92.00
175.00
90.00
2.00
0.36
0.45
128.00
30.00
255.00
168.00
135.00
2.00
120.00
315.00
38.00
60
100.00
145.00
147.90
421.80
60.00
70.00
83.00
64.00
3.75
23.00
PK UNIT
BROMELAIN
LYSOZYME HCL 30mg
LYSOZYME HCL 30mg
LYSOZYME HCL 60mg
PROLASE 10,000U
PROLASE 10,000U
0.800
1.00
0.70
0.60
0.70
0.80
TAB
TAB
TAB
TAB
TAB
TAB
TAS050 ASTRIX 100mg
ASPIRIN
TAS034
TAS030
TAS032
TAS033
TAS040
TBE061
MCA010
TDF010
TDI108
TDO020
TDO030
TDO040
TDO038
TDO050
PEP012
PEP010
IFE020
IMO012
IMO030
MMO008
TOX012
TOX013
TOX006
TOX008
CPA043
TPA020
TPA028
TPA018
TPA030
TPA052
PPA010
PPA012
MPA014
MPA010
MPA012
IPE020
IPE022
TPH030
TPO018
TPO020
TPO022
TPO024
TTE028
ITE008
ANO003
ASPIRIN 80mg
ASPIRIN 300mg
ASPIRIN 75mg
ASPIRIN 80mg
ASPIRIN SOLUBLE 300mg
VALDECOXIB 20mg
PARACETAMOL
DIHYDROCODEINE TARTRATE 30mg
ASPIRIN 300mg
DIFLUNISAL 250mg
DEXTROPROPOXYPHENE,PARACET
AMOL
DEXTROPROPOXYPHENE
DEXTROPROPOXYPHENE
DEXTROPROPOXYPHENE,ASA,CAFF
EIN
PARACETAMOL,PROPYPHENAZONE
…
PARACETAMOL,PROPYPHENAZONE
…
FENTANYL
MORPHINE
MORPHINE
MORPHINE
OXYCODONE 5mg
OXYCODONE 10mg
OXYCODONE HYDROCHLORIDE
OXYCODONE HYDROCHLORIDE
PARACETAMOL, CODEINE
PARACETAMOL, CODEINE (500/8mg)
PARACETAMOL 250mg
PARACETAMOL 500mg
PARACETAMOL 500mg
CODEINE PARACETAMOL
PARACETAMOL
PARACETAMOL
PARACETAMOL
PARACETAMOL
PARACETAMOL
PETHIDINE
PETHIDINE
METHADONE HCL 5mg
MEFENAMIC ACID 250mg
MEFENAMIC ACID 250mg
MEFENAMIC ACID 500mg
MEFENAMIC ACID 500mg
BUPRENORPHINE HCL 0.2mg
BUPRENORPHINE HCL
BUPRENORPHINE
Page 10 of 28
1.85
0.50
0.60
0.50
0.70
0.60
10.00
0.25
5.50
1.70
3.20
1.20
2.00
1.00
2.00
5.00
4.80
92.00
50.00
50.00
0.67
26.00
33.00
43.00
54.00
1.60
2.00
0.30
2.00
0.60
3.00
2.80
2.90
0.22
0.17
0.20
60.00
50.00
10.00
1.30
1.05
1.60
1.30
6.20
50.00
820.00
TAB
TAB
TAB
TAB
TAB
TAB
TAB
ML
TAB
TAB
CAP
TAB
CAP
CAP
CAP
SUPP
SUPP
AMP
AMP
AMP
ML
CAP
CAP
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
SUPP
SUPP
ML
ML
ML
AMP
AMP
TAB
CAP
CAP
CAP
TAB
TAB
AMP
BOX
ASPILETS
ASPIRIN 300mg (GE)
ASPIRIN 75mg (GE)
ASPIRIN 80mg (GE)
ASPIRIN SOLUBLE 300mg
(GE)
BEXTRA
20mg
CALPOL SUSPENSION
120mg/5mL
DF
118 30mg
DISPRIN 300mg
DOLOBID 250mg
DOLOGESIC (GE)
DOLOXENE 32mg
DOLOXENE 32mg (GE)
DOLOXENE CO (GE)
EPIZON CHILD RECTOCAP
EPIZON INFANT
RECTOCAP INJ 0.05mg/2mL
FENTANYL
MORPHINE INJ 10mg/mL
MORPHINE INJ 15mg/mL
MORPHINE SYRUP
10mg/5mL [OXYCODONE]
OXYNORM
5mg
OXYNORM
[OXYCODONE]
10mg
OXYCONTIN
5mg
OXYCONTIN 10mg
PANADEINE
PANADEINE (GE)
PANADOL 250mg (GE)
PANADOL 500mg
PANADOL 500mg (GE)
PARCOTEN TAB
PANADOL SUPP 125mg
(GE)
PANADOL
SUPP 250mg
(GE)
PANADOL
SUSPENSION
250mg/5mL SYRUP
(GE)
PANADOL
120mg/5mL SYRUP
(GE)
PANADOL
250mg/5mL (GE)
PETHIDINE
INJ 100mg/2mL
PETHIDINE INJ 50mg/mL
PHYSEPTONE 5mg
PONSTAN 250mg
PONSTAN 250mg (GE)
PONSTAN 500mg
PONSTAN 500mg (GE)
TEMGESIC 0.2mg
TEMGESIC INJ 0.3mg/mL
NORSPAN
[BUPRENORPHINE]
TRANSDERMAL PATCH 5
GENERIC NAME
OXYMETAZOLINE HCL
FLUTICASONE FUROATE
FLUTICASONE FUROATE
BECLOMETHASONE DIPROPIONATE
BECLOMETHASONE DIPROPIONATE
SODIUM CROMOGLYCATE
DEXBROMPHENIRAMINE,
PSEUDOEPHEDRINE
EPHEDRINE
0.5%
EPHEDRINE 1%
FLUTICASONE PROPIONATE
DEXPANTHENOAL 10MG,
SEAWATER 250 mg.ACETONIDE
TRIAMICINOLONE
55mcg
MOMETASONE
FUROATE
MOMETASONE FUROATE
Na Iodide, Na Bromide, Na Cl..
Na IODIDE, Na BROMIDE, NaCl
CICLESONIDE
XYLOMETAZOLINE HCL 0.05%
XYLOMETAZOLINE HCL 0.1%
BUDESONIDE
BUDESONIDE
BUDESONIDE
BUDESONIDE
PHYSIOLOGICAL SEA WATER
SODIUM CROMOGLYCATE
SEA WATER SOLUTION
HYPERTONIC SEA WATER
DIMETHINDENE, PHENYLEPHRINE
XYLOMETAZOLINE HCl
BOT
PC
PC
BOT
BOT
BOT
TAB
ML
ML
BOT
PC
BOT
BOT
BOT
g
BOT
PC
BOT
BOT
BOT
BOT
BOT
PC
BOT
BOT
BOT
BOT
g
BOT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
DRUG DESCRIPTION
GENERIC NAME
NO.
ANO004 NORSPAN
BUPRENORPHINE
[BUPRENORPHINE]
TRANSDERMAL PATCH 10
TTR006 TRAMAL 50mg
TRAMADOL HCL 50mg
<TRAMADOL>
TTR007 50mg [MABRON]
TRAMADOL
ITR006 TRAMAL <TRAMADOL>
INJ 50mg
TRAMADOL
ITR007 INJ 100mg/2mL
TRAMADOL
TTR008 TRAMAL RETARD 100mg TRAMADOL HCL 100mg
TUL030 ULTRACET
TRAMADOL
37.5mg/ACETAMINOPHEN
325mg
ANTIRHEUMATICS, ANTIINFLAMMATORY
ANALGESICS
TAF010 AFLOXAN 150mg
PROGLUMETACIN 150mg
TAR044 ARCOXIA 120mg
ETORICOXIB 120mg
TAR040 ARCOXIA 60mg
ETORICOXIB 60mg
TAR042 ARCOXIA 90mg
ETORICOXIB 90mg
CPA086 ARCOXIA 30mg
ETORICOXIB 30mg
TAR025 ARTRODAR 50mg
DIACEREIN
TAR020 ARTHROTEC
DICLOFENAC NA, MISOPROSTOL
TAS020 ASCRIPTIN A/D
AL & MG HYDROXIDE, ASPIRIN
TBE060 BEXTRA 10mg
VALDECOXIB 10mg
TBE062 BEXTRA 40mg
VALDECOXIB 40mg
TBR120 BRUFEN 200mg (GE)
IBUPROFEN 200mg
TBR122 BRUFEN 400mg
IBUPROFEN
TCA080 CATAFLAM 25mg
DICLOFENAC POTASSIUM 25mg
TCA082 CATAFLAM 50mg
DICLOFENAC POTASSIUM 50mg
TCE034 CELEBREX 100mg
CELECOXIB 100mg
TCE036 CELEBREX 200mg
CELECOXIB 200mg
CPA046 CELEBREX 400mg
CELECOXIB 400mg
CPA054 CLINORIL 200mg
SULINDAC 200mg
TCU010 CUPRIMINE 250mg
PENICILLAMINE 250mg
IDY010 DYNASTAT INJ 40mg
PARECOXIB 40 mg
TEC010 ECOTRIN 650mg
ASPIRIN 650mg
IEN020 ENBREL 25mg
ETANERCEPT 25mg
TFE010 FELDENE 10mg (GE)
PIROXICAM 10mg
IFE010
FELDENE INJ
PIROXICAM
TIN040 INDOCID 25mg (GE)
INDOMETHACIN 25mg
TLO008 LODINE 200mg
ETODOLAC 200mg
TME048 MESULID 100mg
NIMESULIDE 100mg
TMO005 MOBIC 15mg
MELOXICAM 10mg
TMO004 MOBIC 7.5mg
MELOXICAM 7.5mg
AMO010 MOHRUS PATCH
KETOPROFEN
IMY010 MYOCRISIN INJ 20mg
NA AUROTHIOMALATE
TNA010 NAPROSYN 250mg (GE)
NAPROXEN 250mg
TNI024 NIDOL 100mg
NIMESULIDE 100mg
MBR020 BRUFEN SUSPENSION
IBUPROFEN
100MG/5MLSYRUP
90ml
MNU020 NUROFEN
IBUPROFEN
100mg/5mL100mg
60mL (GE)
TOR020 ORUVAIL
KETOPROFEN 100mg
TOR030 ORUVAIL 200mg
KETOPROFEN 200mg
TPL010 PLAQUENIL 200mg
HYDROXYCHLOROQUINE 200mg
MPO020 PONSTAN SUSPENSION
MEFENAMIC ACID
50mg/5mL (GE)
MPO022 250mg/5mL
MEFENAMIC ACID
TRE010 RELIFEX 500mg
NABUMETONE 500mg
TRI008 RIDAURA 3mg
AURANOFIN 3mg
TSA020 SALAZOPYRIN EN 500mg SULFASALAZINE 500mg
CPA110 SIMPONI 50mg/0.5 mL
GOLIMUMAB
TSY010
TTI020
TVI028
TVI029
TVO020
TVO022
TVO021
IVO010
TVO028
TVO031
TVO030
TVO032
TVO034
PVO010
PVO004
PVO006
AVO005
AVO006
GOUT
PREPAR
TBE010
TCO040
SYNFLEX 275mg
TILCOTIL 20mg (GE)
VIOXX 25mg
VIOXX 50mg
VOLTAREN 25mg (GE)
VOLTAREN 50mg
VOLTAREN 50mg (GE)
VOLTAREN INJ 75mg (GE)
VOLTAREN SR 100mg
VOLTAREN SR 100mg CAP
(GE)
VOLTAREN
SR 100mg TAB
(GE)
VOLTAREN
SR 75mg
VOLTAREN SR 75mg (GE)
VOLTAREN SUPP 100mg
(GE)
VOLTAREN
SUPP 12.5mg
VOLTAREN SUPP 25mg
VOLTAREN PATCH 15mg
5's
VOLTAREN
PATCH LARGE
30mg 7's
BENEMID 500mg (GE)
COLCHICINE 0.5mg (GE)
UNIT PRICE
($)
1320.00
PK UNIT
5.00
2.70
40.00
40.00
9.20
5.30
CAP
CAP
AMP
AMP
TAB
TAB
2.50
11.80
10.50
10.40
8.50
10.00
6.30
0.50
10.00
17.00
0.85
1.700
3.50
5.80
8.00
9.20
15.00
4.00
6.50
340.00
1.00
1586.00
3.50
35.00
1.00
6.25
3.00
10.00
7.00
84.00
60.00
2.30
2.80
65.00
0.50
3.30
5.50
14.00
0.17
0.17
8.00
14.00
4.10
12000.00
CAP
TAB
TAB
TAB
TAB
CAP
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
CAP
CAP
CAP
TAB
TAB
VIA
TAB
AMP
CAP
AMP
CAP
CAP
TAB
TAB
TAB
BOX
AMP
TAB
TAB
BOT
ML
CAP
CAP
TAB
ML
ML
TAB
TAB
TAB
UNIT
NAPROXEN SODIUM 275mg
TENOXICAM 20mg
ROFECOXIB 25mg
ROFECOXIB 50mg
DICLOFENAC SODIUM 25mg
DICLOFENAC SODIUM 50mg
DICLOFENAC SODIUM 50mg
DICLOFENAC SODIUM
DICLOFENAC SODIUM 100mg
DICLOFENAC SODIUM 100mg
DICLOFENAC SODIUM 100mg
DICLOFENAC SODIUM 75mg
DICLOFENAC SODIUM 75mg
DICLOFENAC SODIUM
DICLOFENAC SODIUM
DICLOFENAC SODIUM
DICLOFENAC SODIUM
DICLOFENAC SODIUM
2.50
2.50
6.50
9.50
2.00
7.00
4.00
58.00
10.00
4.50
5.00
7.40
4.50
14.00
5.40
7.90
55.00
101.50
TAB
TAB
TAB
TAB
TAB
TAB
TAB
AMP
TAB
CAP
TAB
TAB
TAB
SUPP
SUPP
SUPP
BOX
BOX
PROBENECID 500mg
COLCHICINE 0.5mg
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TFE004 FEBURIC 80mg
FEBUXOSTAT 80mg
TZY010 ZYLORIC 100mg (GE)
TZY012 ZYLORIC 300mg (GE)
TZY014 ZYLORIC 300mg
MINOR TRANQUILLISERS
TAT020 ATIVAN 0.5mg
TAT022 ATIVAN 1mg
TLE032 LEXOTAN 1.5mg
TLE030 LEXOTAN 1.5mg (GE)
ALLOPURINOL 100mg
ALLOPURINOL 300mg
ALLOPURINOL 300mg
3.80
1.00
20.30
1.00
2.80
7.00
LORAZEPAM 0.5mg
LORAZEPAM 1mg
BROMAZEPAM 1.5mg
Page 11 of 28
BROMAZEPAM 1.5mg
2.00
3.00
3.00
3.00
BOX
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
DRUG DESCRIPTION
NO.
TLE034 LEXOTAN 3mg
TVA010 VALIUM 2mg (GE)
TVA012 VALIUM 5mg (GE)
IVA010 VALIUM INJ 10mg/2mL
PVA012 VALIUM RECTAL TUBE
5mg (GE) RECTAL TUBE
PVA010 VALIUM
10mg (GE)
MAJOR TRANQUILLISERS
TLA060 LARGACTIL 25mg
TLA061 LARGACTIL 25mg (GE)
TST008 STELAZINE 2mg (GE)
TST010 STELAZINE 5mg (GE)
HYPNOTICS & SEDATIVES
TDO070 DORMICUM 7.5mg
TDO080 DORMICUM 15mg
IDO010 DORMICUM INJ 5mg/mL
IDO011 DORMICUM INJ 5mg/5mL
IDO012 DORMICUM INJ 15mg/3ml
IGA010 GARDENAL INJ 200mg/mL
(PHENOBARBITONE)
THA010 HALCION
0.25mg
THE010 HEMINEVRIN 300mg
TLO034 LORAMET 1mg
TMO020 MOGADON 5mg (GE)
IPA010 PARALDEHYDE INJ
TRO040 ROHYPNOL 2mg (GE)
TST030 STILNOX 10mg
TST031 STILNOX 10mg (GE)
ANTICONVULSANTS
TDI070 DILANTIN 100mg
TDI072 DILANTIN 30mg
TEP010 EPILIM 200mg
TEP030 EPILIM CHRONO 200mg
TEP028 EPILIM CHRONO 300mg
TEP020 EPILIM CHRONO 500mg
MEP010 EPILIM SF LIQUID
200mg/5mL
300mL
TKE028 KEPPRA
250mg
TKE030 KEPPRA 500mg
TKE032 KEPPRA 1000mg
CPA050 KEPPRA
SYRUP
100mg/ml 5
LAMICTAL
DISPERSIBLE
CPA132 mg
TLA024 LAMICTAL 50mg
TLA026 LAMICTAL 100mg
TLY008 LYRICA 25mg
TLY009 LYRICA 50mg
GENERIC NAME
UNIT PRICE
($)
5.00
1.50
2.00
60.00
80.00
100.00
PK UNIT
CHLORPROMAZINE 25mg
CHLORPROMAZINE 25mg
TRIFLUOPERAZINE 2mg
TRIFLUOPERAZINE 5mg
1.70
1.20
1.50
2.00
TAB
TAB
TAB
TAB
MIDAZOLAM 7.5mg
MIDAZOLAM 15mg
MIDAZOLAM
MIDAZOLAM
MIDAZOLAM
PHENOBARBITONE
TRIAZOLAM 0.25mg
CLOMETHIAZOLE 300mg
LORMETAZEPAM 1mg
NITRAZEPAM 5mg
PARALDEHYDE
FLUNITRAZEPAM 2mg
ZOLPIDEM 10mg
ZOLPIDEM TARTRATE 10mg
4.50
8.00
55.00
55.00
90.00
30.00
5.40
4.30
5.50
4.10
50.00
8.00
4.30
3.10
TAB
TAB
AMP
AMP
AMP
AMP
TAB
CAP
TAB
TAB
AMP
TAB
TAB
TAB
PHENYTOIN SODIUM 100mg
PHENYTOIN SODIUM 30mg
SODIUM VALPROATE 200mg
SODIUM VALPROATE 250mg
SODIUM VALPROATE 300mg
SODIUM VALPROATE 500mg
SODIUM VALPROATE
LEVETIRACETAM
LEVETIRACETAM
LEVETIRACETAM
LEVETIRACETAM 100mg
LAMOTRIGINE 5mg
LAMOTRIGINE 50mg
LAMOTRIGINE 100mg
PREGABALIN 25mg
4.40
4.40
3.50
3.50
4.40
7.00
1.10
11.60
21.30
48.00
4.10
3.80
11.80
19.40
13.20
13.50
13.60
21.90
8.80
5.00
10.50
7.00
1.00
1.50
0.30
2.00
2.00
5.50
0.56
8.00
19.00
12.60
33.50
5.60
19.00
35.00
52.00
CAP
CAP
TAB
TAB
TAB
TAB
ML
TAB
TAB
TAB
ML
TAB
TAB
TAB
CAP
CAP
CAP
TAB
CAP
CAP
CAP
CAP
TAB
TAB
ML
TAB
TAB
TAB
ML
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
4.20
5.00
3.40
2.00
8.20
2.50
4.00
TAB
TAB
TAB
CAP
TAB
CAP
CAP
0.80
1.00
1.00
0.40
25.00
28.00
TAB
TAB
TAB
ML
ML
ML
5.60
121.00
4.40
SUPP
AMP
TAB
BROMAZEPAM
DIAZEPAM 2mg
DIAZEPAM 5mg
DIAZEPAM
DIAZEPAM
DIAZEPAM
PREGABALIN 50mg
TLY010 LYRICA 75mg
PREGABALIN 75mg
TLY011 LYRICA 150mg
PREGABALIN 150mg
TNE034 NEURONTIN 100mg (GE)- GABAPENTIN 100mg
TNE035 [GABAPENTIN]
GABAPENTIN 100mg
TNE036 NEURONTIN 300mg
GABAPENTIN 300mg
TNE037 NEURONTIN 300mg (GE)
GABAPENTIN 300mg
TPH020 PHENOBARBITONE 15mg PHENOBARBITONE SODIUM 15mg
TPH022 PHENOBARBITONE 30mg PHENOBARBITONE SODIUM 30mg
MPH014 PHENOBARBITONE SYRUP PHENOBARBITONE
15mg/5mL 0.5mg
TRI050 RIVOTRIL
CLONAZEPAM 0.5mg
TTE010 TEGRETOL 200mg (GE)
CARBAMAZEPINE 200mg
TTE020 TEGRETOL CR 200mg
CARBAMAZEPINE 200mg
MTE020 TEGRETOL SYRUP 2%
CARBAMAZEPINE
CPA073 250mL
TEGRETOL CR 400MG
CARBAMAZEPINE
CPA056 TOPAMAX 50mg
TOPIRAMATE
TTO030 TOPAMAX 25mg
TOPIRAMATE
TTO032 TOPAMAX 100mg
TOPIRAMATE 100mg
TTR036 TRILEPTAL
300mg
OXCARBAZEPINE 300mg
VIMPAT FILM-COATED
CPA129 VIMPAT
TAB 50 mg
LACOSAMIDE 50mg
FILM-COATED
CPA130 VIMPAT
FILM-COATED
TAB 100 mg
LACOSAMIDE 100mg
LACOSAMIDE 150mg
CPA131 TAB 150 mg
NOOTROPICS & NEUROTONICS
TAR004 ARCALION 200
SULBUTIAMINE 200mg
TME062 METHYCOBAL 500mcg
MECOBALAMIN 500mcg
TME054 METHYCOBAL 500mg
MECOBALAMIN 500mg
TNO030 NOOTROPIL 400mg (GE)
PIRACETAM 400mg
TNO032 NOOTROPIL 800mg
PIRACETAM 800mg
TNO033 NOOTROPIL 800mg (GE)
PIRACETAM
[VICK-TROPIL]
CPA100 PIRACETAM
(GE) 1200mg PIRACETAM
ANTIEMETICS & ANTIVERTIGO DRUGS
TAV010 AVOMINE 25mg
PROMETHAZINE THEOCLATE 25mg
TGR012 GRAVOL 50mg
DIMENHYDRINATE 50mg
TGR010 GRAVOL 50mg (GE)
DIMENHYDRINATE 50mg
MGR010 GRAVOL SYRUP 15mg/5mL DIMENHYDRINATE
(GE)
IGR010 GRAVOL
INJ 50mg/mL
DIMENHYDRINATE
IGR011 GRAVOL
DIMENHYDRINATE
<DIMENHYDRINATE> INJ
50mg/mL10mL
PGR010 GRAVOL SUPP (PAED)
DIMENHYDRINATE
50mg (GE)
IKY010 KYTRIL
[GRANISETRON] GRANISETRON
Page 12 of 28
1mg/mL INJ50mg
TMA034 MARZINE
CYCLIZINE HCL 50mg
TAB
TAB
TAB
AMP
TUB
TUB
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
DRUG DESCRIPTION
GENERIC NAME
NO.
TMA048 MAXOLON 5mg
METOCLOPRAMIDE 5mg
TMA050 MAXOLON 10mg (GE)
METOCLOPRAMIDE 10mg
MMA020 MAXOLON SYRUP
METOCLOPRAMIDE
5mg/5mL (GE)
IMA020 MAXOLON
INJ 10mg/2mL METOCLOPRAMIDE
TNA026 NAVIDOXINE
MECLIZINE HCL, PYRIDOXINE HCL
TNA036 NAVOBAN 5mg
TROPISETRON 5mg
INA010 NAVOBAN INJ 5mg/5mL
TROPISETRON
TST020 STEMETIL 5mg (GE)
PROCHLORPERAZINE 5mg
IST010
STEMETIL INJ 12.5mg/mL
PROCHLORPERAZINE
TZO017 ZOFRAN 4mg
ONDANSETRON HCL DIHYDRATE
4mg
TZO018 ZOFRAN 8mg
ONDANSETRON
HCL DIHYDRATE
8mg
IZO004 ZOFRAN [ondansetron] 4mg ONDANSETRON
INJECTION
IZO006 ZOFRAN
[ondansetron] 8mg ONDANSETRON
INJECTION
NEURODEGENERATIVE
DISEASE DRUGS
TAR006 ARICEPT 5mg
DONEPEZIL 5mg
TEB010 EBIXA 10mg
MEMANTINE HCL 10mg
ANTIPARKINSONIAN DRUGS
TAM010 AMANTADINE SULFATE
AMANTADINE SULFATE 100mg
100mg 2mg (GE)
TAR010 ARTANE
TRIHEXYPHENIDYL HCL 2mg
TAZ004 AZILECT 1mg
RASAGILINE
TCO055 COMTAN 200mg
ENTACAPONE
ICO008 COGENTIN INJ 2mg/2mL
BENZTROPINE MESYLATE
TJU012 JUMEX
SELEGILINE HCL 5mg
TJU010 JUMEX 5mg (GE)
SELEGILINE HCL 5mg
TLE017 LEVOMED 100/25mg
LEVODOPA 100mg
TMA020 MADOPAR 250mg
LEVODOPA, BENSERAZIDE
TMA018 MADOPAR DISPERSIBLE
LEVODOPA, BENSERAZIDE
125mg
TMA019 MADOPAR
HBS 125mg
LEVODOPA, BENSERAZIDE
ANE060 NEUPRO PATCH 2mg
ROTIGOTINE
ANE062 NEUPRO PATCH 4mg
ROTIGOTINE
ANE064 NEUPRO PATCH 6mg
ROTIGOTINE
ANE066 NEUPRO PATCH 8mg
ROTIGOTINE
TPA060 PARLODEL 2.5mg (GE)
BROMOCRIPTINE MESYLATE 2.5mg
TRE028 REQUIP 0.25mg
AMORPHOUS AESCIN
TRE029 REQUIP 1mg
ROPINIROLE
TRE030 REQUIP 2mg
ROPINIROLE
TRE032 REQUIP PD 2mg
ROPINIROLE 2mg
TRE033 REQUIP PD 4mg
ROPINIROLE 4 mg
TSI032
SINEMET 25/100
CARBIDOPA. LEVODOPA (25/100mg)
TSI030
SINEMET 25/250
CARBIDOPA, LEVODOPA (25/250mg)
TSI034
SINEMET CR 50/200
CARBIDOPA, LEVODOPA (50/200mg)
NEUROMUSCULAR DISORDER DRUGS
TME044 MESTINON 10mg
PYRIDOSTIGMINE BROMIDE 10mg
TME046 MESTINON 60mg
PYRIDOSTIGMINE BROMIDE 60mg
TNO040 PYRIDOSTIGMINE>
NORGESIC (GE)
10mg ORPHENADRINE, PARACETAMOL
TME045 [JM-PYRIDOSTIGMINE]
PYRIDOSTIGMINE
ITE010
TENSILON INJ 10mg/mL
EDROPHONIUM CHLORIDE
TRI032
RILUTEK 50mg
RILUZOLE 50mg
TUB010 UBRETID 5mg
DISTIGMINE BROMIDE 5mg
MUSCLE RELAXANTS
TBA002 BACLOFEN 10mg
BACLOFEN 10mg
TCA069 CARISOPRODOL 125mg
TLI024
LIORESAL 10mg (GE)
BACOLFEN 10mg
TMY018 MYDOCALM 50mg
TOLPERISONE HYDROCHLORIDE
50mg
TQU010 QUININE BISULPHATE 300 QUININE
BISULPHATE 300mg
mg
TQU020 QUININE
SULPHATE 200mg QUININIE SULPHATE 200mg
TRO020 ROBAXIN 500mg
METHOCARBAMOL 500mg
ANDROGENS & RELATED SYNTHETIC DRUGS
TAN013 ANDRIOL TESTOCAP 40mg TESTOSTERONE UNDECANOATE
TESTOSTERONE
CAN018 ANDROGEL 50mg
TDA020 DANOCRINE 200mg
DANAZOL 200mg
TDA022 DANOCRINE 200mg (GE)
DANAZOL 200mg
INE004
NEBIDO 25% 1000mg/4mL INJ
TESTOSTERONE UNDECANOATE
TPR140 PROVIRON 25mg
MESTEROLONE 25mg
ISU010 SUSTANON INJ 250mg/mL TESTOSTERONE PROPIONATE 30mg,
DECABIATE 100mg
ITE012
TESTOSTERONE IMPLANT TESTOSTERONE
100mg
ITE020
TESTOVIRON
INJ 250mg
TESTOSTERONE
OESTROGEN & PROGESTERONES & RELATED SYNTHETIC DRUGS
TAC024 ACTIVELLE 28's
ESTRADIOL, NORETHISTERONE
TAN014 ANDROCUR 50mg
CYPROTERONE ACETATE
TAN016 ANGELIQ 28's
ESTRADIOL 1mg, DROSPIRENONE
2mg
TCL024 CLIMEN 28's
ESTRADIOL
VALERATE
PCY010 CYCLOGEST PESSARY
PROGESTERONE
200mg
PCY012 CYCLOGEST
PESSARY
PROGESTERONE
400mg
TCY030 CYCLO-PROGYNOVA
2mg OESTRADIOL
21's
VALERATE,NORGESTREL
TDI074 DILENA
21's
ESTRADIOL,
CPA127 DEPO PROVERA
MEDROXYPROGESTERONE
150MG/ML SUSP.,
ACETATE
TDO056 DOSTINEX
0.5mg 1ML/
CABERGOLINE
TDU018 DUPHASTON 10mg
DYDROGESTERONE 10mg
TES020 ESTRACOMB TTS 50
ESTRADIOL, NORETHISTERONE
TES030 ESTRADERM TTS 25 6'S
17 BETA-ESTRADIOL 2mg
TES032 ESTRADERM TTS 50
17 BETA-ESTRADIOL 4mg
TES034 ESTRADERM TTS 100 (6
17 BETA-ESTRADIOL
8mg
Page 13
of 28
PCs)
CES010 ESTREVA
GEL 0.1% 50g
NATURAL ESTRADIOL 0.1%
UNIT PRICE
($)
1.00
1.00
0.23
30.00
1.50
270.00
350.00
0.50
25.00
52.00
214.00
192.50
140.00
PK UNIT
29.00
15.80
TAB
TAB
5.00
1.50
37.00
14.50
75.00
13.20
6.00
2.20
8.20
5.90
5.70
47.00
51.00
58.50
73.50
6.00
6.80
12.50
14.30
21.70
38.00
5.20
8.90
7.40
TAB
TAB
TAB
TAB
AMP
TAB
TAB
TAB
TAB
TAB
CAP
PC
PC
PC
PC
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
2.60
11.00
1.10
2.30
50.00
100.00
7.90
TAB
TAB
TAB
TAB
AMP
TAB
TAB
2.50
0.60
2.00
1.60
2.50
2.70
3.00
TAB
TAB
TAB
TAB
TAB
TAB
TAB
12.00
25.00
13.00
10.00
1700.00
12.00
205.00
250.00
270.00
CAP
TAB
CAP
CAP
AMP
TAB
AMP
AMP
VIA
5.00
29.00
15.00
3.00
20.00
38.00
5.30
5.00
190.00
132.00
11.00
245.00
170.00
160.00
200.00
2.70
TAB
TAB
TAB
TAB
PES
PES
TAB
TAB
AMP
TAB
TAB
BOX
BOX
BOX
BOX
g
TAB
TAB
ML
AMP
TAB
TAB
AMP
TAB
AMP
TAB
TAB
AMP
AMP
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
NO.
TES040
TFE012
DRUG DESCRIPTION
GENERIC NAME
ESTROFEM 28's
FEMARA 2.5mg
OESTRADIOL 2mg
LETROZOLE
TFE013
FEMOSTON 2/10 28'S
OESTRADIOL +
CPA091 KLIOGEST
ESTRADIOL, NORETHISTERONE
TLI050
LIVIAL 2.5mg 30's
TIBOLONE 2.5mg
TLU010 LUTENYL 5mg
NOMEGESTROL ACETATE 5mg
CPA064 NORCOLUT 5mg
NORETHISTERONE
ESTRADIOL
1mg,NORETHISTERONE
TNO085 NOVOFEM
ACETATE 1mg
IOE012 OESTRADIOL IMPLANT
OESTRADIOL
50mg
IOF010 OESTRADIOL
IMPLANT
OESTRADIOL
100mg
COE010 OESTROGEL
0.06% 80g
NATURAL 17B-ESTRADIOL 0.06%
TOV008 OVESTIN 1mg 30's
ESTRIOL 1mg
TPR030 PREMARIN 0.3mg
CONJUGATED OESTROGENS 0.3mg
TPR032 PREMARIN 0.625mg
CONJUGATED OESTROGENS 0.625mg
TPR034 PREMARIN 1.25mg
CONJUGATED OESTROGENS 1.25mg
TPR036 PREMELLE 0.625mg/2.5mg MEDROXYPROGESTERONE,
28's
OESTROGEN
TPR038 PREMELLE
CYCLE 28's
MEDROXYPROGESTERONE,
OESTROGEN
TPR040 PREMPAK 0.625mg 31's
MEDROGESTONE,
OESTROGENS
TPR050 PREMPAK-C 0.625mg 40's
NORGESTREL, OESTROGENS
TPR052 PREMPAK-C 1.25mg 40's
NORGESTREL, OESTROGENS
TPR080 PRIMOLUT-N 5mg (GE)
NORETHISTERONE 5mg
IPR038 PROGESTERONE INJ 50mg PROGESTERONE
IPR040 PROGESTERONE INJ 50mg PROGESTERONE/ESTRADIOL
+ESTRADIOL BENZOATE
TPR094 PROGYNOVA
2mg 28's
ESTRADIOL VALERATE 2mg
IPR054 PROLUTON DEPOT INJ
HYDROXYPROGESTERONE
250mg
TPR130 PROVERA
5mg
MEDROXYPROGESTERONE
ACETATE
TPR132 PROVERA 10mg
MEDROXYPROGESTERONE
ACETATE
TST022 STILBOESTROL 1mg
DIETHYLSTILBOESTROL
TST024 STILBOESTROL 5mg
DIETHYLSTILBOESTROL
TTR060 TRISEQUENS 28's
ESTRADIOL, NORETHISTERONE
TUT010 UTROGESTAN 100mg
PROGESTERONE MICRONISED 100mg
CPA153 VAGIFEM VAGINAL TAB ESTRADIOL
10mcg
PVA020 VAGIFEM
VAGINAL TAB ESTRADIOL
25mcg
PVA021 VAGIFEM
VAGINAL TAB ESTRADIOL
10mcg 18'S HORMONES
CORTICOSTEROID
CPA093 COLIFOAM ENEMA
HYDROCORTISONE
TCO084 CORTONE 25mg
CORTISONE ACETATE 25mg
TCO095 CORTEF 20mg
HYDROCORTISONE 20mg
TDE020 DECADRON 0.5mg (GE)
DEXAMETHASONE 0.5mg
TDE070 DEXAMETHASONE 4mg
DEXAMETHASONE 4mg
IDE010 DEPO-MEDROL INJ 40
METHYLPREDNISOLONE ACETATE
mg/mL
IDE030 DEPOMETHYLPREDNISOLONE,
MEDROL+LIDOCAINE
LIDOCAINE
IDE038 DEXAMETHASONE
INJINJ DEXAMETHASONE
SODIUM
4mg/mL
PHOSPHATE
IDE040 DEXAMETHASONE
INJ
DEXAMETHASONE
SODIUM
50mg/10mL
PHOSPHATE
CPA155 DEXAMETHASONEDEXAMETHASONE
NA PHOSPHATE
HOSPIRA INJINJ
8 mg/2
IDI020
DIPROSPAN
1mLmL
BETAMETHASONE DIPROPIONATE...
TFL020 FLORINEF 0.1mg
FLUDROCORTISONE ACETATE 0.1mg
IHY010 HYDROCORTISONE INJ
HYDROCORTISONE
100mg/2mL
THY005 HYDROCORTISONE
20mg HYDROCORTISONE 20mg
IKE020 KENACORT-A IA/ID INJ
TRIAMCINOLONE ACETONIDE
10mg/mL 5mL IM INJ 40
IKE010 KENACORT-A
TRIAMCINOLONE ACETONIDE
mg/mL
IKE011 KENACORT-A
IM INJ 40
TRIAMCINOLONE ACETONIDE
mg/mL (GE)
IKE021 KENACORT-A
TRIAMICINOLONE ACETONIDE
{Triamicinolone}
TME010 MEDROL
4mg IA/ID INJ
METHYLPREDNISOLONE 4mg
TPR018 PREDNISOLONE 1mg
PREDNISOLONE 1mg
TPR020 PREDNISOLONE 0.5%
5mg (GE) PREDNISOLONE 5mg
DPR014 MINIMS (20'S/BOX)
PREDNISOLONE
MPR010 PREDNISOLONE
PREDNISOLONE
SUSPENSION 10mg/5mL
IPR010 PREDNISOLONE
INJ
PREDNISOLONE
25mg/mL 20mL
CPA108 REDIPRED
(RASPBERRY
PREDNISOLONE NA
FLAVOUR) ORAL
5 mg/1LIQUID
mL x 30 PREDNISOLONE
MRE020 REDIPRED
5mg/ml
ISO080 SOLU-MEDROL
500mg
METHYLPREDNISOLONE NA
SUCCINATE DRUGS
TROPHIC HORMONES & RELATED SYNTHETIC
CAC020 ACTHAR GEL 40 UNITS
ADRENOCORTICOTROPIC HORMONE
ICO020 CORTROSYN DEPOT INJ
TETRACOSACTIDE HEXAACETATE
1mg/mL
IDE006 DECAPEPTYL
CR INJ
TRIPTORELIN
IDE005 DECAPEPTYL INJ 0.1mg
TRIPTORELIN
IDI016
DIPHERELINE PR INJ
TRIPTORELIN
3.75mg
IEN012 ENANTONE
INJ 11.25mg
LEUPRORELIN ACETATE
IEN010 ENANTONE INJ 3.75mg
LEUPRORELIN ACETATE
IGO012 GONAL-F 150IU/mL
FOLLITROPIN ALFA
IGO010 GONAL-F 1050IU/1.75mL
FOLLITROPIN ALFA
AMI010 MIRENA
LEVONORGESTREL
AMO020 Mona Lisa CU 375
IUD 375
IPR036 PROFASI INJ 10,000IU
HUMAN CHORIONIC
GONADOTROPHIN
IPR034 PROFASI INJ 5,000 IU
HUMAN
CHORIONIC
GONADOTROPHIN
SSU010 SUPRECUR NASAL SPRAY BUSERELIN
ACETATE
SSY020 SYNAREL NASAL SPRAY NAFARELIN ACETATE
2mg/mL
IZO010 ZOLADEX
DEPOT INJ
GOSERELIN ACETATE 3.6mg
3.6mg
IZO012 ZOLADEX
LA DEPOT INJ
GOSERELIN ACETATE 10.8mg
IZO030 10.8mg
ZOMACTON
SOMATROPIN
[SOMATROPIN]
4MG
IPR015 PREGNYL
INJ 5,000iu/mL
HUMAN CHORIONIC
GONADOTROPHIN
CEPHA
Page 14 of 28
LOSPOR
TCE008 CECLOR 250mg (GE)
CEFACLOR MONOPHYDRATE
UNIT PRICE
($)
2.60
61.00
155.00
4.50
14.50
6.00
2.70
4.00
320.00
520.00
1.80
3.80
3.40
4.80
3.50
5.70
3.30
2.74
4.00
4.00
2.90
50.00
110.00
2.70
130.00
3.90
5.70
0.20
0.30
4.80
5.00
18.00
22.00
16.00
PK UNIT
500.00
2.80
3.90
1.20
2.00
145.00
155.00
25.00
25.00
70.00
90.00
2.70
125.00
2.00
37.00
150.00
70.00
57
2.75
0.50
1.20
26.50
0.28
25.00
90.00
100.00
520.00
PC
TAB
TAB
TAB
TAB
VIA
VIA
AMP
ML
AMP
AMP
TAB
VIA
TAB
ML
AMP
AMP
ML
TAB
TAB
TAB
PC
ML
ML
BOT
BOT
VIA
330.00
330.00
1350.00
150.00
1740.00
5240.00
2050.00
700.00
3200.00
2555.00
220.00
280.00
150.00
690.00
2100.00
2500.00
6040.00
1000.00
165.00
VIA
VIA
VIA
VIA
VIA
VIA
VIA
VIA
VIA
SET
PIE
AMP
AMP
BOT
BOT
AMP
AMP
AMP
AMP
4.30
CAP
TAB
TAB
PK
TAB
TAB
TAB
TAB
TAB
AMP
AMP
g
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
AMP
AMP
TAB
AMP
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
PES
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
NO.
TCE009
DRUG DESCRIPTION
GENERIC NAME
UNIT PRICE
($)
7.50
PK UNIT
CEFACLOR MONOHYDRATE 375mg
CEFACLOR MONOHYDRATE
CEFACLOR MONOHYDRATE
CEFTIBUTEN DIHYDRATE 200mg
CEFTIBUTEN DIHYDRATE
CEFOPERAZONE SODIUM
CLOXACILLIN SODIUM 250mg
CEFADROXIL MONOHYDRATE 250mg
CEFADROXIL 500mg
CEPHALEXIN MONOHYDRATE
262.5mg
CEPHALEXIN
MONOHYDRATE 575mg
CEPHALEXIN
CEPHALEXIN
CEFEPIME HCI
LIGNOCAINE CEFTRIAXONE
CEFTRIAXONE DISODIUM
CEFTRIAXONE DISODIUM
CEFTRIAXONE DISODIUM
CEFTRIAXONE DISODIUM
CEFTRIAXONE DISODIUM
CEPHRADINE 250mg
CEPHRADINE NA
CEFUROXIME AXETIL 125mg
CEFUROXIME AXETIL 250mg
CEFUROXIME AXETIL 500mg
CEFUROXIME AXETIL
13.00
1.20
1.10
25.50
4.50
440.00
2.50
3.50
4.00
3.00
5.00
0.90
0.70
350.00
150.00
120.00
105.00
185.00
380.00
330.00
5.90
150.00
9.80
18.00
59.00
2.10
TAB
ML
ML
CAP
ML
VIA
CAP
CAP
CAP
CAP
CAP
ML
ML
VIA
AMP
VIA
VIA
VIA
VIA
VIA
CAP
AMP
TAB
TAB
TAB
ML
ERYTHROMYCIN 250mg
ERYTHROMYCIN ETHYLSUCCINATE
ERYTHROMYCIN
CLARITHROMYCIN 250mg
CLARITHROMYCIN 250mg
CLARITHROMYCIN 500mg
CLARITHROMYCIN 250mg
CLARITHROMYCIN
CLARITHROMYCIN
ROXITHROMYCIN 150mg
AZITHROMYCIN DIHYDRATE 250mg
AZITHROMYCIN
AZITHROMYCIN DIHYDRATE
1.50
0.50
0.33
12.20
6.00
25.00
22.60
1.70
6.50
13.70
22.50
14.00
6.20
TAB
ML
ML
TAB
TAB
TAB
TAB
ML
SACH
TAB
TAB
TAB
ML
DEXAMETHASONE
DOXORUBICIN
OXALIPLATINE
OXALIPLATINE
CYCLOPHOSPHAMIDE
CARBOPLATIN
6-MERCAPTOPURINE 50mg
DOCETAXEL
65.00
983.40
2750.00
5200.00
567.60
1080.00
70.00
2664.000
VIA
VIA
VIA
VIA
VIA
VIA
TAB
VIA
DOCETAXEL
9526.000
VIA
CAPECITABINE
CAPECITABINE
11.00
37.00
TAB
TAB
BICALUTAMIDE
FLUTAMIDE
283.00
11.50
TAB
TAB
8976.00
25740.00
357.00
895.00
435.00
1166.00
VIA
VIA
TAB
TAB
TAB
CAP
AMOXYCILLIN 250mg
AMOXYCILLIN 500mg
AMOXYCILLIN TRIHYDRATE
AMOXYCILLIN
2.20
3.50
0.42
0.49
CAP
CAP
ML
ML
AMPICILLIN 250mg
AMPICILLIN 500mg
AMPICILLIN
AMPICILLIN
AMPICILLIN, CLOXACILLIN
AMPICILLIN, CLOXACILLIN
AMOXYCILLIN, CLAVULANATE K
AMOXYCILLIN, CLAVULANATE K
1.50
2.00
0.25
45.00
4.00
0.50
8.00
CAP
CAP
ML
VIA
CAP
ML
TAB
TAB
CECLOR 500mg (GE)[CEFALOR PLUS]
TCE010 CECLOR MR 375mg
MCE012 CECLOR SUSPENSION
125mg/5mL
(GE)
MCE010 CECLOR
SUSPENSION
125mg/5mL
60mL
TCE020 CEDAX
200mg
MCE020 CEDAX SUSPENSION
180mg/5mLINJ
30mL
ICE010 CEFOBID
1g
TCL040 CLOXACILLIN
TDU019 DURACEF 250mg
CPA047 CEFADROXIL 500mg (GE)
TKE010 KEFLEX 250mg (GE)
TKE020 KEFLEX 500mg (GE)
MKE010 KEFLEX SUSPENSION 125
mg/5mL 60mL
MKE012 KEFLEX
SUSPENSION
125mg/5mL 60mL
CPA084 MAXIPIME
IM/IV (GE)
1g
IRO013 ROCEPHIN IM 500g (GE)
IRO014 ROCEPHIN INJ 250mg
IRO015 ROCEPHIN INJ 250mg (GE)
IRO012 ROCEPHIN INJ 500mg
IRO010 ROCEPHIN INJ 1g
IRO011 ROCEPHIN INJ 1g (GE)
TVE010 VELOSEF 250mg
IZI010
ZINACEF 250mg INJ
TZI010
ZINNAT 125mg
TZI012
ZINNAT 250mg
TZI014
ZINNAT 500mg
MZI006 ZINNAT 125mg/5mL
MACRO SUSPENSION
LIDES
TER010 ERYTHROMYCIN 250mg
MER010 ERYTHROMYCIN
GRANULES 200mg/5mL
MER020 ERYTHROMYCIN
SUSPENSION
125mg/5mL
TKL010 KLACID
250mg
TKL013 KLACID 250mg (GE)
TKL011 KLACID 500mg
TKL012 KLACID MR 500mg
MKL010 KLACID SUSPENSION
125mg/5mL
60mL
MKL012 KLACID
SUSPENSION
125mg (GE)
SACHET
TRU010 RULID
150mg
TZI020
ZITHROMAX 250mg
TZI021
ZITHROMAX 250mg (GE)
MZI010 ZITHROMAX SUSPENSION
200MG/5ML
15ML
CYTOTOXIC
CHEMOTHERAPY
IDE042 DEXAMETHASONE
8mg/2mL INJ
IDO020 DOXORUBICIN-EBEWE
INJ
50MG/25ML
IEL001
ELOXATIN
[OXALIPLATINE] 50mg INJ
IEL002
ELOXATIN
[OXALIPLATINE]
IEN030 ENDOXAN
INJ 1G100mg
IPA020 PARAPLATIN INJ
150mg/15mL 50mg
TPU010 PURI-NETHOL
ITA010 TAXOTERE CONC FOR INF
20mg/0.5ml
ITA012 TAXOTERE CONC FOR
INF. 80mg/2ml
TXE005 XELODA [capecitabine]
150mg
TXE006 XELODA
[capecitabine]
500mg
HORMONAL
CHEMOTHERAPY
TCA075 CASODEX [bicalutamide]
150mg
TFL060 FLUTAMIDE
250mg(G.E)
TARGETED CANCER THERAPY
IHE060 HERCEPTIN 150mg
IHE062 HERCEPTIN 440mg
TJA002 JAKAVI [ruxolitinib] 5mg
TJA003 JAKAVI [ruxolitinib] 20mg
TSP030 SPRYCEL[dasatinib] 50mg
TXA013 XALKORI 250mg 60's
PENICIL
LINS
TAM020 AMOXIL 250mg (GE)
TAM022 AMOXIL 500mg (GE)
MAM010 AMOXIL SYRUP
125mg/5mL
(GE)
MAM012 AMOXIL
SYRUP
125mg/5mL 60mL- NEO
TAM030 CHEM
AMPICILLIN 250mg
TAM032 AMPICILLIN 500mg
MAM020 AMPICILLIN SYRUP
125mg/5mL (GE)
IAM030 AMPICILLIN
INJ 500mg
TAM040 AMPICLOX 500mg (GE)
MAM030 AMPICLOX SYRUP
250mg/5mL (GE)
TAU010 AUGMENTIN
375mg
TAU011 AUGMENTIN 375mg (GE)[AMOXYCILLIN,
CLAVULANIC625mg
ACID]
CPA126 AUGMENTIN
CEFACLOR
AMPICILLIN, CLOXACILLIN
6.000
8.00
TAB
TAU012 AUGMENTIN 1g
TAU014 AUGMENTIN 1g (GE)
AMOXYCILLIN, CLAVULANIC ACID
Page 15 of 28
AMOXYCILLIN CLAVULANIC ACID
11.00
8.00
TAB
TAB
TRASTUZUMAB
TRASTUZUMAB
RUXOLITINIB
RUXOLITINIB
DASATINIB
CRIZOTNIB 250mg
CAP
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
DRUG DESCRIPTION
NO.
MAU010 AUGMENTIN SYRUP
156mg/5mL (60mL)
MAU020 AUGMENTIN
BD
SYRUP
SYRUP
457mg/5mL,
35mL
MAU011 CURAM
156.25mg/5mL
100mLmL
(GE)156.25mg/5
CPA133 CURAM
ORAL SUSP,
60mL xmL
1's
312.5mg/5
CPA134 CURAM
ORAL SUSP,
60mL
x 1's
457mg/5
mL
ORAL
CPA135 SUSP, 35mL x 1's
CPA142 CURAM 375 mg
CPA143 CURAM 1,000 mg
MFL012 FLUCLOXACILLIN ELIXIR
125mg/5mL250mg (GE)
TOR010 ORBENIN
MOR010 ORBENIN SYRUP
125mg/5mL
100mL
(GE)
IPE010
PENADUR LA
INJ 1.2MU
4mL
TPE020 PENGLOBE
400mg
IPE016
PENICILLIN G INJ 600mg
IPE017
PENICILLIN G INJ 1M IU
MPE010 PENICILLIN V
SUSPENSION
125mg/5mL
TPE010 PEN-V
K 250 mg
(GE)
IPR030 PROCAINE PENICILLIN G
QUINOL INJ
ONES
TAV008 AVELOX 400mg
TCI010 CIPROXIN 250mg
TCI008 CIPROXIN 250mg (GE)
TCI009 CIPROXIN 500mg (GE)
TCR006 CRAVIT 100mg
TCR007 CRAVIT 250mg
TCR008 CRAVIT EYE
500mg
DROPS (GE)DCR011 [LEVOFLOXACIN]
TLE020 LEXINOR 100mg
TLE021 LEXINOR 400mg TAB
TTA030 TARIVID 100mg
TTA036 TARIVID 100mg (GE)
TTA032 TARIVID 200mg
TTA034 TARIVID 200mg (GE)
TUR026 UROTRACTIN
TWI012 WINTOMYLON 500mg
TWI010 WINTOMYLON 500mg (GE)
TETRACYCLINES
TMI072 MINOCIN 50mg
TMI074 MINOCIN 50mg (GE)
TMI070 MINOCIN 100mg
TMI080 MINOCIN MR 100mg
TMI076 MINOCIN 100mg (GE)
TOX010 OXY-TETRACYCLINE 250
TTE060 mg
TETRACYCLINE 250 mg
TTE070 TETRALYSAL 300 CAP
TVI018 VIBRAMYCIN 50mg
TVI020 VIBRAMYCIN 100mg (GE)
CPA139 VIBRAMYCIN FILMCOATED TAB 100 mg
ANTIFUNGALS
CPA063 CLOZOLE PESSARY 500MG
TDI058 DIFLUCAN 50mg
TDI059 DIFLUCAN 50mg (GE)
TDI060 DIFLUCAN 150mg
TDI062 DIFLUCAN 150mg (GE)
MDI006 DIFLUCAN SUSPENSION
50mg/5mL
TGR030 GRISEOSTATIN
330mg
TGR020 GRISOVIN 125mg
TGR021 GRISOVIN 125mg (GE)
TGR022 GRISOVIN 500mg
TGR023 GRISOVIN 500mg (GE)
TLA030 LAMISIL 250mg
TLA031 LAMISIL 250mg (GE)
TMY016 MYCOSTATIN 500,000U
(GE)
MMY010 MYCOSTATIN
DROPS
100,000 unit/mL
TNI060 NIZORAL
200mg(GE)
TNI062 NIZORAL 200mg (GE)
TSE040 SEPTRIN (GE)
MSE010 SEPTRIN SUSPENSION (GE)
TSP020 SPORANOX 100mg
TSP022 SPORANOX 100mg (GE)
OTHER ANTIBIOTICS
IAR003 ARANESP [darbepoetin]
100mcg/0.5ml
PRE-FILLED
TDA018 DALACIN
C 150mg
TDA019 DALACIN C 300mg
TDA034 DAPSONE 100mg
TFL010 FLAGYL 200mg (GE)
CPA 079 FLAGYL 200mg
(BRANDED)SUSPENSION
MFL010 FLAGYL-S
200mg/5mL
100mL
TFL011 FLAGYL
250mg(G.E)
TFL012 FLAGYL 400mg
TFU010 FURADANTIN 50mg (GE)
IGE010 GENTAMYCIN INJ
80mg/mL INJ
+ LIDOCAINE
1%
IIN080
INVANZ
1g
ILI020
LINCOCIN INJ 3g/10mL
GENERIC NAME
UNIT PRICE
($)
1.05
2.90
1.00
30.00
50.00
70.00
6.00
11.00
0.50
2.50
0.45
110.00
4.00
35.00
60.00
0.25
1.00
40.00
PK UNIT
MOXIFLOXACIN HCl 400mg
CIPROFLOXACIN 250mg
CIPROFLOXACIN 250mg
CIPROFLOXACIN 500mg
LEVOFLOXACIN 100mg
LEVOFLOXACIN 250mg
LEVOFLOXACIN 500mg
LEVOFLOXACIN
NORFLOXACIN 100mg
NORFLOXACIN 400mg
OFLOXACIN 100mg
OFLOXACIN 100mg
OFLOXACIN 200mg
OFLOXACIN 200mg
PIPEMIDIC ACID 400mg
NALIDIXIC ACID 500mg
NALIDIXIC ACID 500mg
45.00
11.60
7.70
11.27
8.10
16.00
29.00
40.00
4.50
15.00
6.00
4.20
11.00
8.60
8.50
3.10
2.50
TAB
TAB
TAB
CAP
TAB
TAB
TAB
BOT
TAB
TAB
TAB
TAB
TAB
TAB
CAP
TAB
TAB
MINOCYCLINE HCL 50mg
MINOCYCLINE HCL 50mg
MINOCYCLINE HCL 100mg
MINOCYCLINE HCL 100mg
MINOCYCLINE HCL 100mg
OXYTETRACYCLINE HCL 250mg
TETRACYCLINE 250mg
TETRALYSAL 300 CAP
DOXYCYCLINE HYCLATE 50mg
DOXYCYCLINE HYCLATE 100mg
DOXYCYXLINE
5.00
3.50
10.00
13.00
6.00
0.70
0.90
10.00
4.00
3.00
9.00
CAP
CAP
CAP
CAP
CAP
CAP
CAP
CAP
TAB
TAB
TAB
CLOTRIMAZOLE
FLUCONAZOLE 50mg
FLUCONAZOLE 50mg
FLUCONAZOLE 150mg
FLUCONAZOLE 150mg
FLUCONAZOLE
GRISEOFULVIN ULTRAMICROSIZE
GRISEOFULVIN 125mg
GRISEOFULVIN 125mg
GRISEOFULVIN 500mg
GRISEOFULVIN 500mg
TERBINAFINE 250mg
TERBINAFINE 250mg
NYSTATIN 500,000U
NYSTATIN
KETOCONAZOLE 200mg
KETOCONAZOLE 200mg
TRIMETHOPRIM,
SULFAMETHOXAZOLE
TRIMETHOPRIM,
SULFAMETHOXAZOLE
ITRACONAZOLE
100mg
ITRACONAZOLE 100mg
5.00
85.00
40.00
180.00
105.00
16.50
4.30
1.20
1.20
3.00
2.80
21.00
14.00
1.30
4.00
26.00
7.00
1.50
0.27
28.00
17.00
TAB
TAB
CAP
CAP
CAP
ML
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
ML
TAB
TAB
TAB
ML
CAP
CAP
DARBEPOETIN 100mcg
CLINDAMYCIN 150mg
CLINDAMYCIN 300mg
DAPSONE 100mg
METRONIDAZOLE 200mg
METRONIDAZOLE 200mg
METRONIDAZOLE
METRONIDAZOLE
METRONIDAZOLE
NITROFURANTOIN 50mg
GENTAMICIN, LIDOCAINE
ERTAPENEM 1g Page 16 of 28
LINCOMYCIN
1892.00
7.60
10.50
1.50
1.70
3.00
1.80
2.50
7.00
1.30
70.00
525.00
100.00
SYR
CAP
CAP
TAB
TAB
TAB
ML
TAB
TAB
TAB
VIA
VIA
VIA
AMOXYCILLIN, CLAVULANATE K
AMOXYCILLIN, CLAVULANIC ACID
AMOXYCILLIN, CLAVULANIC ACID
AMOXYCILLIN, CLAVULANATE K
AMOXYCILLIN, CLAVULANATE K
AMOXYCILLIN, CLAVULANATE K
POTASSIUM
AMOXYCILLIN,
CLAVULANATE
POTASSIUM
FLUCLOXACILLIN
CLOXACILLIN
CLOXACILLIN
BENZATHINE PENICILLIN G
BACAMPICILLIN 400mg
BENZYLPENICILLIN SODIUM
BENZYLPENICILLIN SODIUM
PHENOXYMETHYLPENICILLIN
PHENOXYMETHYLPENICILLIN 250mg
PROCAINE PENICILLIN
ML
ML
ML
BOT
BOT
BOT
TAB
TAB
ML
CAP
ML
VIA
TAB
VIA
VIA
ML
TAB
VIA
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
DRUG DESCRIPTION
GENERIC NAME
NO.
TLO030 LORABID 200mg
LORACARBEF 200mg
MMO006 MONUROL 3g
FOSFOMYCIN TROMETAMOL
IST020
STREPTOMYCIN INJ 1g
STREPTOMYCIN
CPA 081 TRIMETHOPRIM HCI
TRIMETHOPRIM HCI
ITR030 TROBICIN INJ 2g
SPECTINOMYCIN HCL
IGE008 GENTAMYCIN INJ
GENTAMICIN
CPA057 80mg/2mL
UNASYN 375mg
AMPICILLIN SODIUM / SULBACTAM
SODIUM
CPA100 ZYVOX 600mg
LINZOLID
TZY060 ZYVOX [linezolid] 600mg
LINEZOLID
ANTITUBERCULOUS AGENTS
TIS010
ISONIAZID 100mg (GE)
ISONIAZID 100mg
TIS012
ISONIAZID 50mg (GE)
ISONIAZID 50mg
MRI010 MPR050 100mg/5mL
RIFAMPICIN
TMY010 MYAMBUTOL 100mg
ETHAMBUTOL 100mg
TMY012 MYAMBUTOL 400mg
ETHAMBUTOL 400mg
TMY013 MYAMBUTOL 400mg (GE) ETHAMBUTOL 400mg
TPY010 PYRAMIDE 500mg (GE)
PYRAZINAMIDE 500mg
TRI010 RIFADIN 150mg (GE)
RIFAMPICIN 150mg
TRI012 RIFADIN 300mg (GE)
RIFAMPICIN 300mg
TRI030 RIFADIN 450mg (GE)
RIFAMPICIN 450mg
TRI014 RIFATER
RIFAMPICIN/INH/PYRAZINAMIDE
TRI018 RIFINAH 150mg
RIFAMPICIN,ISONIAZID 150/100mg
TRI020 RIFINAH 300mg
RIFAMPICIN,ISONIAZID 300/150mg
ANTIAMOEBICS
TFA020 FASIGYN 500mg (GE)
TINIDAZOLE 500mg
ANTHELMINTICS
TBI010 BILTRICIDE 600mg
PRAZIQUANTEL 600mg
TCO050 COMBANTRIN 125mg
PYRANTEL PAMOATE 125mg
TCO051 COMBANTRIN 125mg (GE) PYRANTEL PAMOATE 125mg
MCO040 COMBANTRIN
PYRANTEL PAMOATE
SUSPENSION 125mg/5mL
MCO042 COMBANTRIN
PYRANTEL PAMOATE
SUSPENSION
250mg/5mL
TDE030 DECARIS
50mg
LEVAMISOLE 50mg
TVE040 VERMOX 100mg
MEBENDAZOLE 100mg
TVE041 VERMOX 100mg (GE)
MEBENDAZOLE 100mg
CPA080 VERMOX 500mg
MEBENDAZOLE 100mg
(BRANDED)
MVE020 VERMOX
SUSPENSION
MEBENDAZOLE
100mg/5mL 30mL
ANTIVIRALS
MAC005 ACICLOVIR SUSPENSION ACICLOVIR
CAL030 100mg/5mL
ALDARA CREAM 5%
IMIQUIMOD 5% CREAM
TBA007 BARACLUDE 0.5mg
ENTECAVIR
TCO066 COPEGUS (RIBAVIRIN)
RIBAVIRIN 200mg
200mg 125mg
TFA010 FAMVIR
FAMCICLOVIR 125mg
TFA012 FAMVIR 250mg (GE)FAMCICLOVIR 250mg
TFA013 [FAMCICLOVIR]
FAMCICLOVIR
THE016 HEPSERA 10mg
ADEFOVIR DIPIVOXIL 10mg
IPE006
PEG-INTRON REDIPEN INJ RECOMBINANT ALPHA-2B
INTERFERON
IPE004 80mcg
PEGASYS INJ
INTERFERON ALPHA-2A
IPE005
PEGASYS INJ 180mcg/0.5mL ITERFERON ALPHA-2A
IPE007
PEG-INTRON INJ 120mcg
ALPHA-2B INTERFERON
(C.U.)
IPE008
PEG-INTRON
REDIPEN INJ ALPHA-2B INTERFERON
100mcg
SRE006 RELENZA
INHALER
ZANAMIVIR
TSE005 SEBIVO 600mg
TELBIVUDINE 600mg
TTA023 TAMIFLU 75mg
OSELTAMIVIR PHOSPHATE 75mg
MTA010 TAMIFLU SUSPENSION
OSELTAMIVIR
12mg/mL x 500mg
62mL
TVA020 VALTREX
VALACICLOVIR 500mg
TENOFOVIR DISOPROXIL
TVI027 VIREAD 300mg
FUMARATE
TZE004 ZEFFIX 100mg
LAMIVUDINE 100mg
TZO030 ZOVIRAX 200mg
ACYCLOVIR 200mg
TZO031 ZOVIRAX 200mg (GE)
ACYCLOVIR 200mg
TZO032 ZOVIRAX 400mg
ACYCLOVIR 400mg
TZO033 ZOVIRAX 400mg (GE)
ACYCLOVIR 400mg
TZO034 ZOVIRAX 800mg
ACYCLOVIR 800mg
TZO035 ZOVIRAX 800mg (GE)
ACYCLOVIR 800mg
MZO010 ZOVIRAX SUSPENSION
ACYCLOVIR
200mg/5mL 125mL
ANTINEOPLASTICS
TAR030 ARIMIDEX 1mg
ANASTROZOLE
TCA072 CASODEX
BICALUTAMIDE
CEF022 EFUDIX CREAM 5% 20g
5-FLUORO-URACIL
CEF020 EFUDIX OINTMENT 5% 20g 5-FLUORO-URACIL
TEN010 ENDOXAN 50mg
CYCLOPHOSPHAMIDE 50mg
IFL010
FLUORO-URACIL INJ
5-FLUOROURACIL
250mg/5mL
THY004 HYDREA
500mg
HYDROXYUREA 500mg
IIN020
INTRON-A INJ 3MIU +
INTERFERON ALPHA-2b
RIBARIVARIN 200mg
TAB METHOTREXATE 2.5mg
TME050 METHOTREXATE
2.5mg
IME007 METHOTREXATE 10mg INJ METHOTREXATE 10mg
IME009 METHOTREXATE 25mg/mLMETHOTREXATE
INJ
IMI005
MITOMYCIN-C 2mg
MITOMYCIN
TNO010 NOLVADEX 10mg (GE)
TAMOXIFEN CITRATE 10mg
TNO020 NOLVADEX-D 20mg
TAMOXIFEN CITRATE 20mg
TNO022 NOLVADEX-D 20mg (GE)
TAMOXIFEN CITRATE 20mg
IRO016 ROFERON-A INJ 3MIU
INTERFERON ALPHA 2A
ANTIMALARIALS
TLA070 LARIAM 250mg (GE)
MEFLOQUINE 250mg
Page 17 of 28
TMA025 MALARONE
ATOVAQUONE, PROGUANIL HCL
UNIT PRICE
($)
32.00
82.50
40.00
1.50
205.00
50.00
8.60
540.00
517.00
PK UNIT
0.50
0.40
2.00
2.20
4.80
4.40
2.00
4.50
7.00
10.00
7.50
8.60
19.00
TAB
TAB
ML
TAB
TAB
TAB
TAB
CAP
CAP
TAB
TAB
TAB
TAB
12.00
TAB
160.00
6.00
3.00
2.00
5.50
10.00
6.50
4.50
48.00
3.00
TAB
TAB
TAB
ML
ML
TAB
TAB
TAB
TAB
ML
0.25
720.00
90.00
0.00
35.00
38.00
30.00
75.00
1700.00
1680.00
1750.00
450.00
1700.00
320.00
56.50
32.00
5.00
22.00
110.00
35.00
27.60
7.00
16.40
10.00
20.50
13.00
5.40
ML
BOX
TAB
TAB
TAB
TAB
TAB
TAB
PEN
SYR
SYR
VIA
PEN
BOX
TAB
CAP
ML
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
ML
82.00
151.00
12.50
12.50
13.50
80.00
11.80
580.00
8.80
40.00
160.00
130.00
3.50
28.10
6.50
500.00
TAB
TAB
g
g
TAB
VIA
CAP
VIA
TAB
AMP
VIA
AMP
TAB
TAB
TAB
VIA
41.00
73.50
TAB
TAB
CAP
SACH
VIA
ML
VIA
AMP
TAB
TAB
TAB
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
DRUG DESCRIPTION
GENERIC NAME
NO.
TNI050 NIVAQUIN 200mg (GE)
CHLOROQUINE PHOSPHATE 200mg
PREPARATIONS FOR VAGINAL CONDITIONS
PAL010 ALBOTHYL VAGINAL
POLICRESULEN
SUPP 90mg PESSARY
PBE010 BETADINE
POVIDONE IODINE
200mg
PCA010 CANESTEN
PESSARY
CLOTRIMAZOLE
100mg 6'S VAGINAL TAB CLOTRIMAZOLE
PCA011 CANESTEN
PCA012 500MG
CANESTEN PESSARY 500 CLOTRIMAZOLE
mg 1's (GE) PESSARY 500 CLOTRIMAZOLE
CPA154 CANESTEN
mg
PCO010 COLPOSEPTINE
PESSARY PROMESTRIENE, CHLORQUINALDOL
CDI006 DIENOESTROL CREAM
DIENOESTROL 0.01%
0.01% 78g PESSARY
PGI010 GINETRIS
CHLORAMPHENICOL/MYRALACT//C
LOP
PGY020 GYNE-LOTREMIN
CHLORAMPHENICOL/MYRALACT//C
PESSARY 100mg PESSARY ECONAZOLE
LOP
PGY016 GYNO-PEVARYL
NITRATE
150mg
PGY010 GYNO-TRAVOGEN
ISOCONAZOLE NITRATE
PESSARY 300mg
PGY030 GYNOPHILUS
GYNO-TROSYD
PESSARY
TIOCONAZOLE CASEI V.
VAG
CAP
LACTOBACILLUS
CPA140 341 341 mg
RHAMNOSUS DODERLEIN (LCR35)
PMY010 MYCOSTATIN PESSARY
NYSTATIN
100,000U (GE)
CPR010 PREMARIN
VAGINAL
CONJUGATED ESTROGENS
CREAM 42.5g
CPA117 PREMARIN
VAGINAL
CONJUGATED ESTROGENS
0.625
mg/1 gOVULE
x 14 g TETRACYCLINE, AMPHOTERICIN B
PTA010 CREAM
TALSUTIN
PESSARY
ZALAIN
VAGINAL
PZA010 300mg
SERTACONAZOLE
URINARY ANTISEPTICS
MCI010 CITRAVESCENT
SODIUM BICARBONATE, CITRIC
GRANULES
ACID…
TUR024 UROCIT-K
POTASSIUM
CITRATE
MMI010 MIST POTASSIUM
POTASSIUM CITRATE
CITRATE
DRUGS FOR
BLADDER & PROSTATE DISORDERS
TAV009 AVODART 0.5mg
DUTASTERIDE
THA032 HARNAL D 0.2mg
TAMSULOSIN HCl
UNIT PRICE
($)
1.00
PK UNIT
14.50
5.00
17.00
120.00
43.00
85.00
7.00
1.92
7.80
11.00
40.00
35.00
36.00
8.60
3.20
6.00
PES
PES
PES
PES
PES
PES
PES
g
PES
PES
PES
PES
PES
CAP
PES
g
70.00
TUB
4.50
75.00
PES
PES
2.50
6.50
0.40
PK
TAB
ML
14.70
15.00
CAP
TAB
OTHER DRUGS ACTING ON GENITO-URINARY SYSTEM
TCE050 CETIPRIN NOVUM 200mg EMEPRONIUM CARRAGEENATE
4.10
200mg
CPA044 DETRUSITOL 1mg
TOLTERODINE I-TARTRATE 1mg
9.10
TDE044 DETRUSITOL 2mg
TOLTERODINE I-TARTRATE 2mg
10.60
TDI110 DITROPAN 5mg (GE)
OXYBUTYNIN CHLORIDE 5mg
2.00
THA030 HARNAL OCAS 0.4mg
TAMSULOSIN HYDROCHLORIDE
13.50
THY010 HYTRIN 1mg
TERAZOSIN HCL 1mg
5.10
THY012 HYTRIN 2mg
TERAZOSIN HCL 2mg
8.30
THY013 HYTRIN 5mg
TERAZOSIN HCL 5mg
23.00
TPR110 PROSCAR 5mg
FINASTERIDE 5mg
15.00
TPR112 PROSCAR 5mg (GE)
FINASTERIDE 5mg
10.00
TPY020 PYRIDIUM 100mg
PHENAZOPYRIDINE HCL 100mg
1.20
TPY022 PYRIDIUM 100mg (GE)
PHENAZOPYRIDINE HCL 100mg
1.00
TXA016 XATRAL SR 5mg
ALFUZOSIN HCL 5mg
6.00
TXA018 XATRAL XL 10mg
ALFUZOSIN HCL 10mg
8.00
TVE060 VESICARE 5mg
SOLIFENACIN SUCCINATE 5mg
10.50
INSULIN
IAC010 ACTRAPID HM 100IU/mL
INSULIN
355.00
(10mL)
IAC020 ACTRAPID
HM PENFILL
INSULIN
105.00
100IU/mL (3mL) 100IU/mL
IAC030 ACTRAPID-MC
INSULIN
310.00
(10mL) SOLOSTAR
IAP010 APIDRA
INSULIN HUMAN SHORT
140.00
100IU/mL 100U/mL
195.00
IHU006 HUMALOG
MIX 25 100U/mL
INSULIN
KWIPEN LISPRO 25% ,INSULIN LISPRO PROTAMINE
75%
x
IHU007 10mL
INSULIN LISPRO
500.00
IHU008 HUMALOG 100IU/mL
INSULIN
180.00
PENFILL 5x3mL
IHU010 HUMULIN
70/30 100IU/mL INSULIN (SOLUBLE + ISOPHANE)
260.00
IHU020 (10mL)
HUMULIN 70/30 PENFILL INSULIN (SOLUBLE + ISOPHANE)
85.00
100IU/mL (3mL)
IHU030 HUMULIN
L 100IU/mL
LENTE INSULIN
260.00
(10mL)
IHU040 HUMULIN
N 100IU/mL
360.00
(10mL)
IHU042 HUMULIN
N PENFILL
ISOPHANE INSULIN
85.00
100IU/ML (3mL)
IHU050 HUMULIN
R 100IU/mL
INSULIN
260.00
(10mL) 100IU/mL 3mL
ILA020 LANTUS
INSULIN
144.00
ILA022 LANTUS 100IU/mL 10mL
INSULIN GLARGINE
180.00
ILA021 LANTUS OPTISET
INSULIN GLARGINE
144.00
100IU/mLSOLOSTAR
3mL
CPA082 LANTUS
PRE- INSULIN GLARGINE
160.00
FILLED
PEN
ILE020
LEVEMIR
FLEXPEN
INSULIN DETEMIR
198.00
100U/mL HM PENFILL
IMI013
MIXTARD
INSULIN (SOLUBLE + ISOPHANE)
80.00
10/90 100IU/mL
5x3mL
IMI012
MIXTARD
HM PENFILL
INSULIN (SOLUBLE + ISOPHANE)
80.00
20/80 100IU/mL
5x3mL
IMI010
MIXTARD
HM PENFILL
INSULIN (SOLUBLE + ISOPHANE)
105.00
30/70 100IU/mL
5x3mL
IMI014
MIXTARD
HM PENFILL
INSULIN (SOLUBLE + ISOPHANE)
80.00
50/50 100IU/mL 100IU/mL
5X3mL
IMI020
MIXTARD-HM
INSULIN (SOLUBLE + ISOPHANE)
355.00
(10mL)
IMO010 MONOTARD-HM
100IU/mL INSULIN ZINC SUSPENSION
260.00
(10mL)
IMO020 MONOTARD-MC
100IU/mL INSULIN ZN SUSPENSION(PORCINE)
310.00
(10mL)
INO010 NOVOMIX
30 FLEXPEN
INSULIN ASPART
205.00
INO020 100U/mL
NOVORAPID FLEXPEN
PENFILL
INSULIN ASPART
205.00
NOVORAPID
100u/mL 3mL
205.00
INO021 100U/mL
(3mL)
INSULIN ASPART
40.00
TNO050 NORMIX 200mg
RIFAXIMIN
IPR060 PROTAPHANE HM
INSULIN ISOPHANE
105.00
PENFILL 100IU/mL (3mL)
IPR062 PROTAPHANE-HM
INSULIN ISOPHANE
355.00
100IU/mL (10mL)
IPR064 PROTAPHANE-MC
INSULIN
270.00
100IU/mL (10mL)
IUL010 ULTRATARD
HM 100IU/mL INSULIN CRYSTALLINE SUSPENSION
260.00
(10mL)
APE050 PEN
ULTRA 3mL
460.00
ORAL ANTIDIABETIC AGENTS
TAC028 ACTOS 30mg
30mg15MG,
33.00
PIOGLITAZONE HCl
18 of 28
19.00
TAC029 ACTOSMET 15mg/850 28'S METFORMIN HClPage
850MG
TAC031 ACTOS 15mg
PIOGLITAZONE
19.40
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
VIA
AMP
VIA
AMP
AMP
VIA
AMP
VIA
AMP
VIA
VIA
AMP
VIA
AMP
VIA
AMP
PC
AMP
AMP
AMP
AMP
AMP
VIA
VIA
VIA
AMP
AMP
AMP
TAB
AMP
VIA
VIA
VIA
PC
TAB
TAB
TAB
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
DRUG DESCRIPTION
NO.
TAV001 AVANDAMET 1mg/500mg
TAV002 AVANDAMET 2mg/500mg
TAV003 AVANDAMET 4mg/500mg
TAV011 AVANDAMET 4mg/1000mg
CPA102 AMARYL 1mg
TAM014 AMARYL 2mg
TAM016 AMARYL 4mg
TAV004 AVANDIA 2mg
TAV006 AVANDIA 4mg
TAV007 AVANDIA 8mg
TDA030 DAONIL 5mg (GE)
TDI010 DIABINESE 250mg (GE)
TDI018 DIAMICRON MR 30mg
TDI019 DIAMICRON
(GE)-[GLICLAZIDE]
MR 60mg 30'S
TDI017 [GLICLAZIDE]
TDI020 DIAMICRON 80mg (GE)
TGA002 GALVUS MET 50mg/850mg
TGA003 GALVUS MET 50mg/500mg
TGA004 GALVUS MET 50mg/1000mg
TGA005 GALVUS 50mg
TGL012 GLUCOBAY 50mg
TGL010 GLUCOBAY 100mg
TGL020 GLUCOPHAGE 250mg (GE)
TGL022 GLUCOPHAGE 500mg
TGL023 GLUCOPHAGE XR 500mg
TGL025 GLUCOPHAGE XR 750mg
TGL024 GLUCOPHAGE 850mg
TGL030 GLUCOTROL XL 5mg
TGL040 GLUCOVANCE
TGL041 500mg/2.5mg
GLUCOVANCE 500mg/5mg
TJA020 JANUVIA 100mg
TJA022 JANUMET 50mg/500mg
TJA023 JANUMET 50mg/1000mg
TME020 MELBIN 250mg
TMI040 MINIDIAB 5mg
TN0090 NOVONORM 0.5mg
TN0092 NOVONORM 1mg
TNO094 NOVONORM 2mg
TON040 ONGLYZA 5mg
CPA118 ONGLYZA FILM-COATED
TAB
TRA010 RASTINON
500mg (GE)
ANTIDIABETIC AGENTS
IBY010 BYETTA 5mcg/20 microlitre
IBY012 BYETTA 10mcg/20 microlitre
GENERIC NAME
UNIT PRICE
($)
ROSIGLITAZONE 1mg, METFORMIN
5.00
500mg
ROSIGLITAZONE
2mg, METFORMIN
8.60
500mg
4mg, METFORMIN
14.20
ROSIGLITAZONE
MELEATE
500mg
4mg,METFORMIN
1000mg
14.20
GLIMEPIRIDE 1mg
2.50
GLIMEPIRIDE 2mg
5.00
GLIMEPIRIDE 4mg
8.00
ROSIGLITAZONE MALEATE 2mg
9.30
ROSIGLITAZONE MALEATE 4mg
17.60
ROSIGLITAZONE MALEATE 8mg
31.00
GLIBENCLAMIDE 5mg
1.50
CHLORPROPAMIDE 250mg
1.50
GLICLAZIDE MR 30mg
4.80
GLICLAZIDE
3.20
GLICLAZIDE
9.60
GLICLAZIDE 80mg
2.70
7.60
VILDAGLIPTIN 50mg, METFORMIN 850mg
500mg
7.60
VILDAGLIPTIN 50mg, METFORMIN 1000mg 7.60
VILDAGLIPTIN
7.10
ACARBOSE 50mg
3.40
ACARBOSE 100mg
3.50
METFORMIN HCL 250mg
0.50
METFORMIN HCL 500mg
1.00
METFORMIN 500mg
2.50
METFORMIN
3.65
METFORMIN HCL 850mg
2.50
GLIPIZIDE 5mg
4.20
METFORMIN, GLIBENCLAMIDE
2.00
METFORMIN HCL; GLIBENCLAMIDE
2.00
SITAGLIPTIN 100mg
17.50
50mg, METFORMIN
8.75
SITAGLIPTIN PHOSPHATE
50mg,
500mg
METFORMIN
1000mg
8.75
METFORMIN HCL 250mg
2.40
GLIPIZIDE 5mg
4.00
REPAGLINIDE 0.5mg
3.40
REPAGLINIDE 1mg
4.20
REPAGLINIDE 2 mg
5.50
SAXAGLIPTIN
12.000
SAXAGLIPTIN HCI
13.00
TOLBUTAMIDE 500mg
1.00
EXENATIDE
EXENATIDE
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
2400.00
2400.00
1445.00
15.00
BOX
BOX
SYR
TAB
THYROXINE SODIUM 100mcg
THYROXINE 50mcg
THYROXINE 100mcg
1.00
0.60
1.20
TAB
TAB
TAB
IODINE
CARBIMAZOLE 5mg
CARBIMAZOLE 5mg
PROPYLTHIOURACIL 50mg
PROPYLTHIOURACIL 200MG
METHIMAZOLE 5mg
0.60
1.00
0.85
1.20
2.20
5.00
ML
TAB
TAB
TAB
TAB
TAB
CLOFIBRATE 500mg
BEZAFIBRATE 200mg
BEZAFIBRATE 400mg
AMLODIPINE 5mg, ATORVASTATIN
10mg
10mg,ATORVASTATIN
ATORVASTATIN
AMLODIPINE
5mg,
10mg
20mg
AMLODIPINE 10mg, ATORVASTATIN
20mg
ROSUVASTATIN 5mg
ROSUVASTATIN 10mg
ROSUVASTATIN 20mg
THEOFIBRATE 250mg
THEOFIBRATE 500mg
EZETIMIBE 10mg
FLUVASTATIN SODIUM 20mg
FLUVASTATIN SODIUM 40mg
FLUVASTATIN SODIUM 80mg
FENOFIBRATE 300mg
FENOFIBRATE 100mg
FENOFIBRATE 200mg
FENOFIBRATE 300mg
ATORVASTATIN 10mg
ATORVASTATIN CALCIUM
ATORVASTATIN 20mg
ATORVASTATINPage
CALCIUM
19 of 28
ATORVASTATIN 40mg
3.00
5.00
11.60
15.80
18.70
24.50
26.20
12.90
16.50
22.40
2.50
4.80
16.50
4.00
7.00
7.60
8.00
3.00
15.30
12.10
11.80
7.20
17.40
11.00
28.90
CAP
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
CAP
CAP
TAB
TAB
TAB
TAB
CAP
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
IVI004 VICTOZA 6mg/mL PRE-FILLED
LIRAGLUTIDE
PEN
TTR004 TRAJENTA 5mg
LINAGLIPTIN
THYROID PREPARATIONS
TEL020 ELTROXIN 100mcg
TTH030 THYROXINE 50mcg
TTH032 THYROXINE 100mcg
ANTITHYROIDS
MLU010 LUGOL'S IODINE
SOLUTION
TNE010 NEO-MERCARZOLE
5mg
(GE)
TNE012 NEO-MERCAZOL
5mg
TPR100 PROPYLTHIOURACIL 50mg
TPR102 PROPYLTHIOURACIL
200mg
TTA026 TAPAZOLE
5mg
ANTIHYPERLIPIDAEMIC AGENTS
TAT030 ATROMID-S 500mg
TBE070 BEZALIP 200mg
TBE072 BEZALIP RETARD 400mg
TCA067 CADUET 5mg/10mg
TCA068 CADUET 10mg/10mg
TCA073 CADUET 5mg/20mg
TCA074 CADUET 10mg/20mg
TCR028 CRESTOR 5mg
TCR030 CRESTOR 10mg
TCR032 CRESTOR 20mg
TDU014 DUOLIP 250mg
TDU016 DUOLIP 500mg
TEZ010 EZETROL 10mg
TLE010 LESCOL 20mg
TLE012 LESCOL 40mg
TLE014 LIPANTHYL
LESCOL XL 80mg
300mg (GE) TLI027
[FENOFIBRATE]
TLI028
LIPANTHYL 100mg
TLI029
LIPANTHYL 200mg
TLI030
LIPANTHYL 300mg
TLI040
LIPITOR 10mg
TLI041
LIPITOR 10mg [ATACOR]
TLI042
LIPITOR 20mg
TLI043
LIPITOR 20mg [ATACOR]
TLI044
LIPITOR 40mg
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
NO.
TLI045
TLI046
TLI051
DRUG DESCRIPTION
GENERIC NAME
LIPITOR 80mg
ATORVASTATIN 80mg
LIPOBAY 0.2mg
CERIVASTATIN SODIUM 0.2mg
LIPITOR 10mg [LIPISTAD
ATORVASTATIN
10] 30'S
TLI052
LIPITOR 20mg [LIPISTAD
ATORVASTATIN
20] 30'S
TLO020 LOPID 300mg (GE)
GEMFIBROZIL 300mg
TLO021 LOPID 600mg
GEMFIBROZIL 600mg
TLO022 LOPID 600mg (GE)
GEMFIBROZIL 600mg
TLO024 LOPID 900mg
GEMFIBROZIL 900mg
TME060 MEVACOR 20mg
LOVASTATIN 20mg
TME061 MEVACOR 20mg (GE)
LOVASTATIN 20mg
TNI004 NIASPAN 375mg
NICOTINIC ACID 375mg
TNI005 NIASPAN 500mg
NICOTINIC ACID 500mg
TNI006 NIASPAN 1000mg
NICOTINIC ACID 1000mg
TNI010 NICOBID 250mg
NIACIN
TOL010 OLBETAM 250mg
ACIPIMOX 250mg
TPR010 PRAVACHOL 10mg
PRAVASTATIN SODIUM 10mg
TPR012 PRAVACHOL 20mg
PRAVASTATIN SODIUM 20mg
TPR014 PRAVACHOL 40mg
PRAVASTATIN SODIUM 40mg
MQU010 QUESTRAN GRANULES 9g CHOLESTYRAMINE RESIN
TTR028 TREDAPTIVE 1G/20mg
ER NIACIN, LAROPIPRANT
CPA068 TREDAPTIVE
LAROPIPRANT
NICOTINIC ACID
TVY021 VYTORIN 10mg/10mg
EZETIMIBE
/ SIMVASTATIN
TVY022 VYTORIN 10mg/20mg
EZETIMIBE / SIMVASTATIN
TVY024 VYTORIN 10mg/40mg
EZETIMIBE, SIMVASTATIN
TZO010 ZOCOR 10mg
SIMVASTATIN 10mg
TZO011 ZOCOR 10mg (GE)
SIMVASTATIN 10mg
TZO012 ZOCOR 20mg
SIMVASTATIN 20mg
TZO013 ZOCOR 20mg (GE)
SIMVASTATIN 20mg
TZO014 ZOCOR 40mg
SIMVASTATIN 40mg
TZO015 ZOCOR 40mg (GE)
SIMVASTATIN 40mg
TZO016 ZOCOR 80mg
SIMVASTATIN 80mg
OTHER AGENTS
AFFECTING
METABOLISM
ACTONEL
150mg ONCE-ATAC023 MONTH
RISEDRONATE SODIUM 150mg
TAC026 ACTONEL 5mg
RISEDRONATE SODIUM 5mg
TAC027 ACTONEL 35mg
RISEDRONATE SODIUM 35mg
TEV010 EVISTA 60mg
RALOXIFENE HCL 60mg
TFO020 FOSAMAX 10mg
ALENDRONATE SODIUM 10mg
TFO022 FOSAMAX 70mg
ALENDRONATE SODIUM 70mg
TFO023 FOSAMAX 70mg (GE)
ALENDRONATE SODIUM 70mg
TFO024 FOSAMAX PLUS
ALENDRONATE, COLECALCIFEROL
TFO025 FOSAMAX PLUS 5,600IU
ALENDRONATE 70mg,
COLECALCIFEROL
5600IU HCL
IGL010 GLUCAGON INJ 1mg/1mL LYOPHILISED
GLUCAGON
TON010 ONE-ALPHA 0.25mcg
ALFACALCIDOL 0.25mcg
TON012 ONE-ALPHA 1mcg
ALFACALCIDOL 1mcg
TOS030 OSTAC 520mg
CLODRONIC ACID
TRO030 ROCALTROL 0.25mcg
CALCITRIOL 0.25mcg
TRO032 ROCALTROL 0.5mcg
CALCITRIOL 0.5mcg
CSI020
SILKIS OINTMENT 30g
CALCITRIOL 3mcg/g
ELECTROLYTES AND MINERALS
MGE020 GES 45
KCL, NACL, NA2CO3, GLUCOSE
MOR005 ORAL REHYDRATION
KCL, NACL, NA CITRATE
IMA006 SALTS
MAGNESIUM SULPHATE MAGNESIUM SULPHATE
49.3% INJ
MPO030 POTASSIUM CHLORIDE
POTASSIUM CHLORIDE 10%
10%
TPO050 500mg
POTASSIUM CHLORIDE
EYE ANTI-INFECTIVES & ANTISEPTICS
DAZ030 AZYTER 15mg/g EYE
AZITHROMYCIN
DROPS
DCE010 CEBEMYXINE
EYE
NEOMYCIN, POLYMYXIN B
OINTMENT 5g
CCH010 CHLORAMPHENICOL
CHLORAMPHENICOL 2%
OINTMENT 2%
DCH010 CHLORAMPHENICOL
EYE CHLORAMPHENICOL 0.5%
DROPS (GE)
DCH020 CHLORAMPHENICOL
EYE CHLORAMPHENICOL 1%
OINTMENT 1%
DCH022 CHLORAMPHENICOL
CHLORAMPHENICOL 1%
OPTICOPSEYE
EYEDROPS
OINTMENT
DCI010 CILOXAN
0.3% CIPROFLOXACIN HCl
DCR010 CRAVIT OPHTHALMIC
LEVOFLOXACIN
SOLUTION EYE
DCU010 CUSIVIRAL
ACYCLOVIR 3%
OINTMENT
DFU010 FUCITHALMIC
EYE DROPS FUSIDIC ACID 1%
DFL010 FLAREX EYE DROPS
FLUOROMETHOLONE
CGA012 GARAMYCIN CREAM 0.3% GENTAMICIN SULFATE 0.3%
15g (GE)
DGA010 GARAMYCIN
EYE DROPS GENTAMICIN SULFATE 0.3%
(GE)
DGA012 GARAMYCIN
EYE
GENTAMICIN SULFATE 0.3%
OINTMENT
DMU010 MURO
128 5% EYE
SODIUM CHLORIDE HYPERTONICITY
OINTMENT EYE DROPS
DNE010 NEOSPORIN
POLYMYXINB,NEOMYCIN,GRAMICI
DIN
DNE012 NEOSPORIN EYE DROPS
POLYMYXIN
B SULPHATE 5000 U
(GE)
DNE020 NEOSPORIN
EYE
POLYMYXINB,NEOMYCIN,BACITRA
OINTMENTEYE DROPS
CIN
DNE030 NEVANAC
NEPAFENAC
DOK010 OKACIN EYE DROPS
LOMEFLOXACIN 0.3%
DPH020 PHYSIODOSE EYE &
SODIUM CHLORIDE
NASAL DROP
DPO010 POLYFAX
EYE5ml
OINTMENT POLYMYXIN B, BACITRACIN
DSU010 SULPHACETAMIDE EYE
SULFACETAMIDE SODIUM 10%
DROPS 10%
(GE)
DSY010 SYSTANE
EYE
DROPS SDU BORIC ACID, CALCIUM CHLORIDE
15mL
BORIC ACID, CALCIUM
DSY012 (28's)
SYSTANE ULTRA EYE
Page 20 of 28
CHLORIDE,HYDROXPROPYL
GUAR
POLYETHYLENE
DSY013 DROPS 10mL
GLYCOL,PROPYLENE GLYCOL
UNIT PRICE
($)
47.00
12.50
7.20
PK UNIT
11.00
TAB
3.15
8.00
4.40
9.50
11.30
7.00
7.45
9.00
17.10
5.50
9.50
10.00
16.00
18.00
12.00
9.40
20.00
14.30
17.60
26.80
7.80
6.30
8.80
7.10
16.50
11.50
18.00
CAP
CAP
TAB
TAB
TAB
TAB
TAB
TAB
TAB
CAP
CAP
TAB
TAB
TAB
SACH
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
300.00
13.50
75.00
16.90
16.00
81.00
60.00
81.00
81.000
620.00
3.20
8.00
75.00
8.00
13.00
6.90
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
TAB
AMP
CAP
CAP
TAB
CAP
CAP
g
3.00
2.80
70.00
SACH
SACH
AMP
0.50
0.80
ML
TAB
60.000
22.00
0.67
12.50
12.00
2.50
63.00
50.00
175.00
78.50
62.00
2.60
44.00
42.00
54.00
32.00
38.00
50.00
82.00
58.00
5.00
54.00
15.00
70.00
115.00
62.00
BOX
TUB
g
BOT
TUB
CAP
BOT
BOT
TUB
TUB
BOT
g
BOT
TUB
TUB
BOT
BOT
TUB
BOT
BOT
AMP
TUB
BOT
BOT
BOX
BOT
TAB
TAB
TAB
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
DRUG DESCRIPTION
GENERIC NAME
NO.
DTA010 TARIVID EYE DROPS
OFLOXACIN
DTA012 TARIVID EYE DROPS (GE) OFLOXACIN
DTA020 TARIVID EYE OINTMENT OFLOXACIN 3mg/g
DTE020 TERRAMYCIN EYE
OXYTETRACYCLINE, POLYMYXIN B
OINTMENT
DTO010 TOBREX
EYE DROPS (GE) - TOBRAMYCIN 0.3%
DTO011 [TOBRAMYCIN]
TOBRAMYCIN
DTO012 TOBREX EYE OINTMENT TOBRAMYCIN 0.3%
DTR004 TRIHERPINE EYE
TRIFLUOROTHYMIDINE 1%
OINTMENTEYE
2.5g DROPS
DVI008 VIGAMOX
MOXIFLOXACIN HYDROCHLORIDE
5.4
DZO010 ZOVIRAX EYE OINTMENT ACYCLOVIR
3%
ITO010 TOBRAMYCIN 40mg/ml
TOBRAMYCIN
EYE CORTICOSTEROIDS
DEF010 EFEMOLINE EYE DROPS
FLUOROMETHOLONE 0.1%...
DFM010 FML EYE DROPS 0.02%
FLUOROMETHOLONE 0.02%
(GE) EYE DROPS 0.1%
DFM012 FML
FLUOROMETHOLONE 0.1%
DHY006 HYDROCORTISONE EYE
HYDROCORTISONE 1%
OINTMENT
DAL019 ALREX
EYE1%
DROPS 0.2%
LOTEPREDNOL
DLO010 LOTEMAX EYE DROPS
LOTEPREDNOL ETABONATE
DMA014 MAXIDEX EYE DROPS
DEXAMETHASONE 0.1%
DPR010 PRED FORTE EYE DROPS PRENISOLONE ACETATE 1%
DPR012 1%
PRED-MILD EYE DROPS
PRENISOLONE ACETATE 0.12%
DSP048 SPERSADEX 0.1% EYE
DEXAMETHASONE NA PHOSPHATE
DROPS
DUL008 ULTRACORTENOL
EYE
PREDNISOLONE
DROPS
DUL010 ULTRACORTENOL
EYE
PREDNISOLONE ACETATE 5mg/mL
OINT 1% EYE DROPS
DVE010 VEXOL
RIMEXOLONE 1%
DFM013 FML EYE DROPS 0.1% (GE) FLUOROMETHOLONE 0.1%
EYE ANTISEPTICS WITH CORTICOSTEROIDS
DBL010 BLEPHAMIDE EYE DROPS SULFACETAMIDE, PREDNISOLONE..
DCO016 CORTIPHENOL-H EYE
HYDROCORTISONE 1%/CHLORAMPH
1%
DCO020 OINTMET
CORTISON-KEMICETINE
CHLORAMPHENICOL,HYDROCORTIS
EYE OINTMENT
ONE
DDE020 DEXAMETHASONE
0.1% + DEXAMETHASONE,
CHLORAMPHENICOL
CHLORAMPHENICOL NEOMYCIN
DFM020 FML-NEO
EYE DROPS 0.5% FLUOROMETHOLONE,
DGA020 GARASONE EYE DROPS
GENTAMICIN, BETAMETHASONE
DGA030 GARASONE EYE
GENTAMICIN, BETAMETHASONE
OINTMENT EYE DROPS
DMA010 MAXITROL
DEXAMETHASONE, NEOMYCIN...
DMA012 MAXITROL EYE
DEXAMETHASONE, NEOMYCIN...
OINTMENT COMP EYE
DSP050 SPERSADEX
DEXAMETHASONE,
DROP
CHLORAMPHENICOL
DSP010 SPERSADEXOLINE
EYE
DEXAMETHASONE,
CHLORAMPHENICOL
DSP012 DROPS
SPERSADEXOLINE EYE
DEXAMETHASONE,
DROPS (GE) EYE DROPS
CHLORAMPHENICOL
DTO022 TOBRADEX
TOBRAMYCIN,
DEXAMETHASONE
DTO020 TOBRADEX EYE
TOBRAMYCIN, DEXAMETHASONE
OINTMENT
EAR ANTI-INFECTIVES
& ANTISEPTICS
DOT020 OTOZAMBON EAR DROPS LIGNOCAINE NEOMYCIN
POLYMYXIN B
MYDRIATIC DRUGS
DAT010 ATROPINE EYE DROPS 1% ATROPINE SULFATE 1%
DAT012 ATROPINE EYE
ATROPINE SULFATE 1%
OINTMENT
DCY010 CYCLOPENTOLATE
EYE
CYCLOPENTOLATE HCL 0.5%
0.5%
DCY011 DROPS
CYCLOPENTOLATE
EYE
CYCLOPENTOLATE HCL 0.5%
DROPS 0.5% MINIM
DCY012 HOMATRPINE
CYCLOPENTOLATE
EYE
CYCLOPENTOLATE HCL 1%
2% EYE
DHO010 DROPS 1% MINIM
HOMATRPINE
DMY010 MYDFRIN EYE DROPS
PHENYLEPHRINE HCL 2.5%
2.5%
DMY020 MYDRIACYL
EYE DROPS TROPICAMIDE 1%
1%
DMY030 MYDRIN-P
EYE DROPS
TROPICAMIDE,PHENYLEPHERINE
HCL
DNY010 NYOLOL EYE DROPS 0.5% TIMOLOL
MALEATE 0.5%
DPH010 PHENYLEPHERINE
PHENYLEPHERINE 10%
MINIMS 10% EYE
DROPS TROPICAMIDE 0.5%
DTR006 TROPICAMIDE
0.5%
MIOTIC MINIMS
DRUGS
IMI004
MIOCHOL-E 20mg INJ
ACETYLCHOLINE CI
OTHER EYE PREPARATIONS
DAC030 ACULAR 0.5% EYE DROPS KETOROLAC TROMETHAMINE
DAL018 ALCAINE EYE DROPS
PROPARACAINE HCL 0.5%
DAL010 ALOMIDE EYE DROPS
LODOXAMIDE 0.1%
DAL004 ALBALON EYE DROPS
NAPHAZOLINE
DAL020 ALPHAGAN EYE DROPS
BRIMONIDINE TARTRATE
DAL022 ALPHAGAN-P 0.15% EYE
BRIMONIDINE TARTRATE 0.15%
DROPS
DAM010 AMETHOCAINE
EYE
TETRACAINE
DROPS 1% MINIMS
DAZ010 AZOPT
EYE
BRINZOLAMIDE 1%
DBE020 SUSPENSION
BETOPIC-S EYE DROPS
BETAXOLOL 0.25%
DBE010 BETOPTIC EYE DROPS
BETAXOLOL 0.5%
DBI010 BION TEARS EYE DROPS DEXTRAN 70%, HYDROXYPROPYL
0.45mL
MET
DBL006 BLEPHAGEL
POLOXAMER
188/PEG-75/SODIUM BO
DCA010 CATALIN EYE DROPS
PIRENOXINE Na
DCO006 COBAMIN EYE SOLN
CYANOCOBALAMIN
BRIMONIDINE
TARTRATE
0.2mg/mL EYE DROPS
DCO009 COMBIGAN
2mg,TIMOLOL 5mg50mg, CETRIMIDE
DEXPANTHENOL
DCO015 CORNEREGEL EYE GEL
0.1mg, WATER FOR INJ. 945.79mg
DCO030 COSOPT EYE DROPS
DORZOLAMIDE/TIMOLOL MALEATE
DCY004 CYCLOGYL 1% EYE
CYCLOPENTOLATE 1%
DROPS
DDU006 DUOTRAV
EYE DROPS
TRAVOPROST,TIMOLOL
DDU010 DURATEARS EYE
WHITE PETROLATUM, LIQ LANOLIN
OINTMENTEYE DROPS
DEM010 EMADINE
EMEDASTINE DIFUMARATE 0.05%
0.05% 0.1% EYE DROPS
DHI010 HIALID
SODIUM HYALURONATE 0.1%
5mL
DHY010 HYPOTEARS
EYE DROPS POLYVINYL ALCOHOL 1%
DHY011 HYPOTEARS EYE GEL
VIT A PALMITATE/POLYACRYLIC AC
Page 21 of 28
DHY012 HYPOTEARS PLUS EYE
POLYVINYL ALCOHOL 1%
DROPS
UNIT PRICE
($)
50.00
28.00
60.00
38.00
68.00
52.00
83.00
135.00
110.00
355.00
30.00
PK UNIT
60.00
46.00
64.00
22.00
85.00
126.00
60.00
54.00
49.00
54.00
43.00
63.00
133.00
52.00
BOT
BOT
BOT
TUB
BOT
BOT
BOT
BOT
BOT
BOT
BOT
TUB
BOT
BOT
39.00
68.50
32.00
7.00
50.00
55.00
42.00
65.00
72.00
52.00
45.00
34.50
73.00
76.00
BOT
TUB
TUB
BOT
BOT
BOT
TUB
BOT
BOT
BOT
BOT
BOT
BOT
TUB
45.00
BOT
75.00
60.00
45.00
21.00
20.00
100.00
36.00
134.00
94.00
53.00
24.00
21.00
BOT
TUB
BOT
PC
PC
BOT
BOT
BOT
BOT
BOT
PC
PC
200.00
AMP
72.00
52.00
105.00
75.00
207.50
230.00
26.50
180.00
94.00
105.00
108.00
131.00
70.00
60.00
235.00
51.50
280.00
50.00
340.00
55.00
75.00
83.00
67.50
60.00
62.00
BOT
BOT
BOT
BOT
BOT
BOT
PC
BOT
BOT
BOT
BOX
BOX
BOT
BOT
BOT
TUB
BOT
BOT
BOT
TUB
BOT
BOT
BOT
TUB
BOT
BOT
BOT
TUB
TUB
BOT
BOT
BOT
TUB
BOT
TUB
VIA
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
DRUG DESCRIPTION
GENERIC NAME
UNIT PRICE
NO.
($)
DHY014 HYPOTEARS PLUS SDU
POLYVINYL ALCOHOL 1%
3.50
EYE DROPS 0.4mLEYE
DHY020 HYPROMELLOSE
HYPROMELLOSE 0.3%
15.00
DROPS 0.3%
DIO010 IOPIDINE
EYE DROPS 0.5% APRACLONIDINE HCl
115.00
DIS012 ISOPTO CARPINE EYE
PILOCARPINE NITRATE 1%
56.00
DROPS 1%
DIS011 ISOPTO
CARPINE EYE
PILOCARPINE NITRATE 2%
60.00
DROPS 2%
DIS010 ISOPTO
CARPINE EYE
PILOCARPINE NITRATE 4%
88.00
4% EYE DROPS
DKA010 DROPS
KARY UNI
PIRENOXINE
45.00
0.05mg/mL EYE DROPS
DLA010 LARMABAK
SODIUM CHLORIDE 0.9%
95.00
DLU010 LUMIGAN EYE DROPS
BIMATOPROST
390.00
DNA008 NAAXIA EYE DROPS
N-ACETYL ASPARTYLGLUTAMIC
35.00
ACID
DNA010 NAPHCON-A EYE DROPS NAPHAZOLINE
HCL, PHENIRAMINE
54.00
15mL
DNA011 NAPHCON-A
EYE DROPS NAPHAZOLINE HCL 0.025%,
39.00
15mL(GE)- EYE DROPS NAPHAZOLINE
PHENIRAMINE MALEATE
0.3%
DNA012 NAPHCON-A
HCL, PHENIRAMINE
36.00
3mL
DNO010 NOVESIN
EYE DROPS
OXYBUPROCAINE HCL 0.4%
42.00
DOC010 OCULOSAN EYE DROPS
ZINC SULFATE, NAPHAZOLINE
60.00
DOC020 OCUSAN EYE DROPS
SODIUM HYALURONATE 0.15%
50.00
0.35ML(20's/BOX)
DOP010 OPTICROM
EYE DROPS
SODIUM CROMOGLYCATE 2%
55.00
(GE)
DOP012 OPTICROM
4% EYE DROPS SODIUM CROMOGLYCATE
60.00
(GE)
DOP020 OPTIZOLINE
EYE DROPS TETRAHYDROZOLINE HCL 0.05%
32.00
DOP021 OPTIZOLINE EYE DROPS TETRAHYDROZOLINE HCL 0.05%
32.00
DPA008 (GE)
PATADAY EYE DROPS
OLOPATADINE 0.2% HCL
115.00
0.2%
DPA010 PATANOL
EYE DROPS
OLOPATADINE
112.00
0.1%
DPR013 PROPINE
EYE DROPS
DIPIVEFRIN HCL 0.1%
85.00
DPR020 PROTAGENT EYE DROPS POLYVINYL PYRROLIDONE 20mg/mL
38.00
DQU010 QUINAX EYE DROPS
AZAPENTACENE POLYSULFONATE
135.00
Na
DRE010 REFRESH PLUS EYE
CARBOXYMETHCELLULOSE
NA
115.00
DROPS (30pcs)
(PRESE
DRE040 RELESTAT
0.05% EYE
EPINASTINE
78.50
DROPS
DSI010 SICCAPROTECT
EYE
DEXPANTHENOL
29.00
DROPS CHLORIDE EYE
DNO005 SODIUM
SODIUM CHLORIDE
20.00
0.9% EYE GEL
DSO020 DROPS
SOLCOSERYL
HEMODIALYSATE 20%
79.00
DSP040 SPERSACARPINE EYE
PILOCARPINE HCL 1%
40.00
DROPS 1%
DSP044 SPERSACARPINE
EYE
PILOCARPINE HCL 4%
40.00
DROPS 4%
DSP020 SPERSALLERG
EYE DROPS ANTAZOLINE, TETRAHYDROZOLINE
45.00
DSP022 SPERSALLERG SDU EYE
ANTAZOLINE, TETRAHYDROZOLINE
70.00
DROPS
DSP042 SPERSCARPINE
EYE
PILOCARPINE HCL 2%
40.00
DROPS 2% EYE DROPS
DTI010 TIMOPTOL
TIMOLOL MALEATE 0.25%
70.00
0.25%
DTI012 TIMOPTOL
EYE DROPS
TIMOLOL MALEATE 0.5%
85.00
0.5%
DTI013 TIMOPTOL
EYE DROPS
TIMOLOL MALEATE 0.5%
58.00
(GE)
DTI014 0.5%
TIMOPTOL-XE
EYE DROPS TIMOLOL MALEATE 0.5%
85.00
0.5%
DTR003 TRAVATAN
EYE DROPS
TRAVOPROST
365.00
DTR010 TRUSPOT 2% EYE DROPS DORZOLAMIDE HCL
180.00
DVI010 VISCOTEARS EYE GEL
POLYACRYLIC ACID 0.02%
80.00
DVI020 VITREOLENT EYE DROPS NA IODIDE 0.3%, K IODIDE 0.3%
60.00
DVD010 VOLTAREN EYE DROPS
DICLOFENAC SODIUM 0.1%
85.50
DXA006 XALACOM EYE DROPS
LATANOPROST 50mcg,TIMOLOL 5mg
400.00
DXA010 XALATAN EYE DROPS
LATANOPROST 0.005%
385.00
DZA012 ZADITEN (SDU) EYE
KETOTIFEN
58.00
10's
DZA012. DROPS
ZADITEN
(SDU) EYE
KETOTIFEN 0.025%
90.00
DROPS 20's
DZA010 ZADITEN
EYE DROPS
KETOTIFEN 0.025%
100.00
EAR ANTI-INFECTIVES, ANTISEPTICS WITH OR WITHOUT CORTICOSTEROIDS
DAP010 APLOSYN EAR DROPS
NEOMYCIN, POLYMYXIN,
20.00
FLUOCINOLONE
DCH034 CHLORAMPHENICOL EAR CHLORAMPHENICOL
5%
1.00
DROPS 5%
DCH032 CHLORAMPHENICOL
EAR CHLORAMPHENICOL 10%
1.30
DROP 10% 15mL/BOT
DCO018 CORTISON
KEMICETINE
CHLORAMPHENICOL,
49.50
EAR DROPS & NEOMYCIN DEXAMETHASONE,
HYDROCORTISONE NEOMYCIN
DDE010 DECADRON
20.00
EYE/EAR DROPS
DKE010 KENACOMB
EAR DROPS TRIAMCINOLONE, NEOMYCIN...
55.00
DOT010 OTOSPORIN EAR DROPS
POLYMYXIN B, HYDROCORTISONE...
105.00
DOT012 OTOSPORIN EAR DROPS
POLYMYXIN B, HYDROCORTISONE...
22.00
(GE)
DSO010 SOFRADEX
EAR/EYE
DEXAMETHASONE, FRAMYCETIN...
61.00
DROPS (GE)
DTA006 TARIVID
EAR DROPS
OFLOXACIN 3mg/mL
57.00
DTR008 TROPEX EAR DROPS 10mL PHENAZONE 5%, GLYCEROL
75.00
OTHER EAR PREPARATIONS
CAC002 A-CERUMEN EAR DROPS TEA-COCOYL HYDROLYZED
14.00
2ml
COLLAGEN,
DOL010 OLIVE
OIL EAR DROPS
OLIVE
OIL COCO-BETAINE,
0.60
15mL/BOT EAR DROPS
DWA012 WAX-EZE
DOCUSATE SODIUM 0.5%
448.00
DWA010 10mL
WAXSOL EAR DROPS
DOCUSATE SODIUM 0.5%
66.00
MOUTH / THROAT PREPARATION
TCE049 CEPACOL
CETYLPYRIDINIUM CL 0.07%
1.20
CCO040 CORSODYL
CHLORHEXIDINE GLUCONATE 0.2%
0.26
CDA040 DAKTARIN ORAL GEL
MICONAZOLE
4.50
TDE050 DEQUADIN LOZENGES
DEQUALINIUM CHLORIDE 0.25mg
0.60
TDE051 (GE)-[DEQUALINUM]
DEQUALINUM CHLORIDE 0.25mg
0.60
TDI054 DIFFLAM LOZENGES
BENZYDAMINE, CETYLPYRIDINIUM
2.80
ADI020 DIFFLAM SOLUTION
BENZYDAMINE HCL SOLUTION
0.30
ADI022 120mL
DIFFLAM-C SOLUTION BENZYDAMINE HCL, CHLORHEXIDINE 0.60
CEU034 EUROCORT PASTE 5g
TRIAMCINOLONE
5.50
ACETONIDE/LIGNOC
AGL022 GLYCERINE THYMOL
GLYCERIN
THYMOL GARGLE
0.22
GARGLE (GE)THYMOL
"BLUE"
AGL020 GLYCERINE
GLYCERIN THYMOL GARGLE
0.13
GARGLE (GE)
"RED"
CKE030 KENALOG
IN ORABASE
5g TRIAMCINOLONE ACETONIDE 0.1%
8.00
CKE032 (GE)
ORACORT E 5g (GE)
LIGNOCAINE, TRIAMCINOLONE
8.80
COR010 ORAGESIC GEL 5g
TRIAMCINOLONE, CHLORHEXIDINE,
6.50
LIGNOCAINE
COR020 ORAMEDY PASTE 5g
TRIAMCINOLONE
ACETONIDE
7.50
CTR034 TRI-GEL 5g
TRIAMCINOLONE,
LIGNOCAINE
5.00
Page
22 of 28
TTY010 TYROCAINE LOZENGES
TYROTHRICIN, BENZOCAINE
0.52
PK UNIT
PC
BOT
BOT
BOT
BOT
BOT
BOT
BOT
BOT
BOT
BOT
BOT
BOT
BOT
BOT
BOX
BOT
BOT
BOT
BOT
BOT
BOT
BOT
BOT
BOT
BOX
BOT
BOT
BOT
TUB
BOT
BOT
BOT
BOX
BOT
BOT
BOT
BOT
BOT
BOT
BOT
TUB
BOT
BOT
BOT
BOT
BOX
BOX
BOT
BOT
ML
ML
BOT
BOT
BOT
BOT
BOT
BOT
BOT
BOT
AMP
ML
BOT
BOT
TAB
ML
g
TAB
TAB
TAB
ML
ML
g
ML
ML
g
g
g
g
g
TAB
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
DRUG DESCRIPTION
GENERIC NAME
NO.
TOPICAL ANTI-INFECTIVES
CAC010 AUREOMYCIN OINTMENT CHLORTETRACYCLINE HCL OINT 3%
3% 15g
CBA008 BACTROBAN
NASAL
MUPIROCIN
OINTMENT 3gOINTMENT MUPIROCIN
CPA119 BACTROBAN
15g
CBA010 BACTROBAN
OINTMENT MUPIROCIN
15g
CBA012 BACTROBAN
OINTMENT MUPIROCIN 2%
(GE) CREAM 25g
CBU010 15g
BURNOL
AMINACRIEN HCL, CETRIMIDE
CCH008 CHLORAMPHENICOL
CHLORAMPHENICOL 2%
CREAM CREAM
2%
CEL005 ELIDEL
1% 15g
PIMECROLIMUS 1%
CFL008 FLAMAZINE CREAM 25g
SILVER SULFADIAZINE
(GE)
CFL010 FLAMAZINE
CREAM 80g
SILVER SULFADIAZINE
(GE)
CFU030 FUCIDIN
CREAM 15g
FUSIDIC ACID
CFU020 FUCIDIN OINTMENT 5g
FUSIDIC ACID
CGA011 GARAMYCIN CREAM 0.1% GENTAMICIN SULFATE 0.1%
450g (GE)
CGA010 GARAMYCIN
SKIN CREAM GENTAMICIN SULFATE 0.1%
15g (GE)SPRAY
CNE010 0.1%
NEBACETIN
NEOMYCIN SULFATE, BACITRACIN
150mL/BOT CREAM 0.5% NEOMYCIN SULFATE 0.5%
CNE030 NEOMYCIN
(G.E.)
CNO010 NORITATE
CREAM 1% 30g METRONIDAZOLE 1%
CPR028 PROTOPIC OINTMENT
TACROLIMUS
0.03% 30g OINTMENT
CPR030 PROTOPIC
TACROLIMUS
30gGEL 15g
CRO010 0.1%
ROZEX
METRONIDAZOLE 0.75%
CSU010 SULPHADIAZINE CREAM SULPHADIAZINE 5%
5%
CTE010 TETRACYCLINE
TETRACYCLINE
TOPICALOINTMENT
ANTI-INFECTIVES WITH CORTICOSTEROIDS
CBE070 BETNOVATE-C CREAM 15g BETAMETHASONE 0.1%,
CLIOQUINOL
CBE090 BETNOVATE-N CREAM
BETAMETHASONE,
NEOMYCIN
(GE)
CBE080 BETNOVATE-N
CREAM
BETAMETHASONE, NEOMYCIN 0.5%
15g
CPA040 DAKTACORT
CREAM 15g MICONAZOLE 2%,
HYDROCORTISONE
CDA020 DAKTACORT CREAM 15g MICONAZOLE
2%,
CDI016 (GE)
DIPROGENTA CREAM 15g HYDROCORTISONE
BETAMETHASONE DIPROPIONATE
.05
CDI018 DIPROGENTA CREAM 450g BETAMETHASONE
DIP, GENTAMICIN
CDI022 DIPROGENTA OINTMENT BETAMETHASONE DIP, GENTAMICIN
15g
CDI024 DIPROGENTA
OINTMENT BETAMETHASONE DIP, GENTAMICIN
450g
CDI030 DIPROSALIC
LOTION
BETAMETHASONE DIP, SAL. ACID
10mL/BOT OINTMENT
CDI040 DIPROSALIC
BETAMETHASONE DIP, SAL. ACID
15g
CDI042 DIPROSALIC
OINTMENT
BETAMETHASONE DIP, SAL. ACID
450g (GE)
CDI056 DIPROSONE
OINTMENT
BETAMETHASONE DIPROPIONATE
0.05% (GE) 0.5 % x 15 g
0.05%
CPA115 DERMAID
HYDROCORTISONE
CFU010 FUCICORT CREAM 15g
FUSIDIC ACID 2%, BETAMETHASONE
CFU040 FUCIDIN H CREAM 2%
FUSIDIC ACID, HYDROCORTISONE
CHY032 HYDROCORTISONE 1% + HYDROCORTISONE 1%,
MICONAZOLE 2% 1% + HYDROCORTISONE1%,
MICONAZOLE 2%
CHY042 HYDROCORTISONE
NEOMYCIN
NEOMYCIN 1% LOTION
1%
CHY040 HYDROCORTISONEHYDROCORTISONE1%,NEOMYCIN
NEOMYCIN CREAM (GE) HYDROCORTISONE1%,
0.5%
CHY050 HYDROCORTISONEVIOFORM CREAM
(GE)
CLIOQUINOL3% NEOMYCIN...
CKE010 KENACOMB
CREAM
(GE) TRIAMCINOLONE,
CKE011 KENACOMB CREAM 5g
TRIAMCINOLONE, NEOMYCIN...
CNE042 NERISONE C CREAM
DIFLUCORTOLONE,
CHLORQUINALDOL
CPE020 10g/15g
PEVISONE CREAM 15g
ECONAZOLE1%,
TRIAMCINOLONE0.1%
CSI006
SICORTEN CREAM 10g
HALOMETASONE
MONOHYDRATE
0.05%
CSY016 SYNALAR-C CREAM 15g
FLUOCINOLONE,
CLIOQUINOL
CSY018 SYNALAR-C OINTMENT
FLUOCINOLONE, CLIOQUINOL
15g
CSY030 SYNALAR-N
CREAM (GE) FLUOCINOLONE 0.025%,NEOMYCIN
CTR010 TRAVOCORT CREAM 10g ISOCONAZOLE, DIFLUCORTOLONE
CTR032 TRIDERM CREAM 100g
BETAMETHASONE, CLOTRIMAZOLE..
CTR033 TRIDERM CREAM 450g
BETAMETHASONE, CLOTRIMAZOLE..
(GE)
CTR030 TRIDERM
CREAM 5g
BETAMETHASONE, CLOTRIMAZOLE..
CTT010 TTY CREAM
CTcycline/Hydrocortisone/Trav
(CTcycline/Hydrocortisone/Tra
CPA123 ZARICORT
15 g
HYDROCORTISONE 1%, MICONAZLE
NITRATE 2% 2%
TOPICAL CORTICOSTEROIDS
CAD008 ADVANTAN CREAM 0.1% METHYLPREDNISOLONE
10g
ACEPONATE 0
CAD010 ADVANTAN
OINTMENT
METHYLPREDNISOLONE
0.1% 10g
ACEPONATE 0
CAD011 ADVANTAN
OINTMENT
METHYLPREDNISOLONE
0.1% 15g HC LOTION
ACEPONATE 0
CAQ005 AQUANIL
HYDROCORTISONE
CAR010 ARISTOCORT CREAM
TRIAMCINOLONE ACETONIDE
0.02%
CPA058 BEPROSONE
OINTMENT
BETAMETHASONE DIPROPINATE
CBE042 BETNOVATE CREAM (GE) BETAMETHASONE VALERATE 0.1%
CBE040 BETNOVATE CREAM 15g BETAMETHASONE VALERATE 0.1%
CBE052 BETNOVATE OINTMENT BETAMETHASONE VALERATE 0.1%
(GE)
CBE050 BETNOVATE
OINTMENT BETAMETHASONE VALERATE 0.1%
CBE060 15g
BETNOVATE SCALP
BETAMETHASONE VALERATE 0.1%
LOTION 30mLSCALP
CBE064 BETNOVATE
BETAMETHASONE SCALP
LOTION 450mL0.02%
(GE)- & SAL CLOBETASOL/SAL
APPLICATION 0.1%ACID
CCL010 CLOBETASOL
ACID 7.5%
OINTMENT
CCL016 CLOBEX
SHAMPOO
0.05% CLOBETASOL PROPIONATE 0.05%
CCU010 CUTIVATE CREAM 15g
FLUTICASONE PROPIONATE 0.05%
CDE020 DERMOVATE CREAM (GE) CLOBETASOL PROPIONATE 0.05%
CDE022 DERMOVATE CREAM 25g CLOBETASOL PROPIONATE 0.05%
CDE030 DERMOVATE OINTMENT CLOBETASOL PROPIONATE 0.05%
(GE)
CDE032 DERMOVATE
OINTMENT CLOBETASOL PROPIONATE 0.05%
CDE040 25g
DERMOVATE SCALP
CLOBETASOL PROPIONATE 0.05%
APPLICATION
30mL
CDI012 DIPROCEL
CREAM
BETAMETHASONE DIPROPIONATE
CDI014 DIPROCEL OINTMENT
BETAMETHASONE DIPROPIONATE
CDI048 DIPROSONE CREAM
BETAMETHASONE DIPROPIONATE
0.0125% 1/4 STRENGTH
CDI050 DIPROSONE
CREAM
BETAMETHASONE
DIPROPIONATE
Page
23 of 28
1/2 STRENGTH
(GE) BETAMETHASONE DIPROPIONATE
CDI052 0.025%
DIPROSONE
CREAM 0.05%
(FULL STRENGTH)
UNIT PRICE
($)
PK UNIT
7.00
68.00
83.00
5.50
4.50
1.00
0.67
21.50
3.47
3.00
4.90
7.60
2.90
2.70
110.00
0.90
4.00
17.30
19.60
6.30
0.80
0.80
g
g
TUB
g
g
g
g
g
g
g
g
g
g
g
BOT
g
g
g
g
g
g
g
3.13
2.90
4.40
5.63
2.50
7.00
6.00
6.70
6.00
75.70
7.60
4.68
1.90
30.00
5.20
5.20
1.20
1.20
1.20
1.20
4.20
6.00
7.10
14.00
6.00
2.67
2.40
1.65
6.50
6.00
4.00
6.00
3.34
37.00
g
g
g
g
g
g
g
g
g
BOT
g
g
g
TUBE
g
g
g
ML
g
g
g
g
g
g
g
g
g
g
g
g
g
g
g
TUB
8.00
7.00
7.50
1.40
2.00
1.00
1.65
3.90
1.65
3.90
4.80
0.80
2.00
3.50
6.10
1.80
3.80
1.80
3.80
4.90
3.80
4.40
1.34
2.00
2.40
g
g
g
g
g
g
g
g
g
g
ML
ML
g
ML
g
g
g
g
g
ML
g
g
g
g
g
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
DRUG DESCRIPTION
GENERIC NAME
NO.
CDI054 DIPROSONE CREAM 0.05% BETAMETHASONE DIPROPIONATE
(GE)
0.05%
CDI060 DIPROSONE
OINTMENT
BETAMETHASONE
DIPROPIONATE
CEF010 EFCORTELEN LOTION 1% DEXAMETHASONE 1%
30mL/BOTCREAM
(GE) 15g
CEL038 ELOMET
MOMETASONE FUROATE
CEL040 ELOMET OINTMENT 15g
MOMETASONE FUROATE
CEL042 ELOMET SCALP LOTION
MOMETASONE FUROATE 0.1%
CEU010 0.1%
EUMOVATE CREAM 25g
CLOBETASONE BUTYRATE
CEU030 EURAX-HC CREAM 15g
CROTAMITON
(GE)
CHY020 HYDROCORTISONE
HYDROCORTISONE 0.5%
CREAM 0.5% (GE)
CHY022 HYDROCORTISONE
HYDROCORTISONE 1%
CREAM 1% (GE)
CHY024 HYDROCORTISONE
HYDROCORTISONE 1%
CREAM 1% 15g (GE)
CHY030 HYDROCORTISONE
HYDROCORTISONE 1%
OINTMENT 1%CREAM
(GE)
CKE020 KENACORT-A
TRIAMCINOLONE ACETONIDE 0.1%
0.1% 15g
CLA006 LACTICARE-HC
LOTION
HYDROCORTISONE,LACTIC ACID/Na
1%
CME020 METOSYN
CREAM 0.05% FLUOCINONIDE 0.05%
CME040 15g
NERISONE CREAM 0.1%
DIFLUCORTOLONE VALERATE 0.1%
15g
CNE046 NERISONE
FATTY
DIFLUCORTOLONE VALERATE 0.1%
OINTMENTOINTMENT
0.1% 10g
CNE044 NERISONE
DIFLUCORTOLONE VALERATE 0.1%
0.1% 10g CREAM 0.05%
CPE010 PERDERM
ALCLOMETASONE DIPROPION 0.05%
PPR010 PREDENEMA
PREDNISOLONE
PPR020 PREDFOAM
PREDNISOLONE
CQU006 QUADRIDERM CREAM 15g BETAMETHASONE/GENTAMICIN/TO
LNA
CSY008 SYNALAR CREAM 0.005% FLUOCINOLONE
ACETONIDE 0.005%
(GE)
CSY010 SYNALAR
CREAM 0.025% FLUOCINOLONE ACETONIDE 0.025%
(GE)
CSY040 SYNALAR
GEL 30g
FLUOCINOLONE ACETONIDE 0.025%
CSY020 SYNALAR OINTMENT 15g FLUOCINOLONE ACETONIDE 0.025%
CSY022 SYNALAR OINTMENT 450g FLUOCINOLONE ACETONIDE 0.025%
(GE)
ACNE TREATMENT
PREPARATIONS
CAC012 ACNE AID CREAM 40g
SULPHUR 2.5%, RESORCINOL 1.25%
CAC013 ACNE AID LIQUID
SULFONATED OIL
CAC014 ACNEDERM OINTMENT
SULFUR 2.5%, ICHTHAMMOL 1%
25g
CAK010 AKNE-MYCIN
SOLUTION ERYTHROMYCIN SOLUTION 2%
25 mL/BOT (GE)
CBR010 BREVOXYL
CREAM 4%
BENZOYL PEROXIDE 4%
40g
CDA075 DALACIN
T GEL 1% 15g
CLINDAMYCIN PHOSPHATE 1%
(GE)
CDA070 DALACIN
T SOLU.1% ( G. CLINDAMYCIN PHOSPHATE 1%
E.)
CDA074 DALACIN
DALACIN-T
CLINDAMYCIN PHOSPHATE 1%
T GEL 1% 25g
CDA076 [G.E]-[CLINDAMYCIN]
CLINDAMYCIN 1% GEL
CDA072 DALACIN-T LOTION 1%
CLINDAMYCIN PHOSPHATE 1%
TDI040 DIANE 21's
CYPROTERONE,
ETHINYLESTRADIOL
CDI009 DIFFERIN CREAM 30g
ADAPALENE
O.1%
CDI011 DIFFERIN GEL 30g
ADAPALENE O.1%
CDI008 DIFFERIN GEL 15g (GE)
ADAPALENE 0.1%
CDU003 DUAC GEL
CLINDAMYCIN 1%, BENZOYL
PEROXIDE 5%BENZOYL PEROXIDE
CEP010 EPIDUO GEL 15g
ADAPALENE,
CER010 ERYLIK GEL 30g
ERYTHROMYCIN,TRETINOIN
CIS010
ISOTREX 0.05% CREAM
ISOTRETINOIN 0.05%
CIS011
ISOTREX 0.05% GEL
ISOTRETINOIN 0.05%
CIS012
ISOTREX 0.1% CREAM
ISOTRETINOIN 0.1%
CNE020 NEO-MEDROL ACNE
METHYLPREDNISOLONE,
LOTION(GE)
30mL/BOT
NEOMYCINPEROXIDE 5%
COX012 OXY-5
BENZOYL
COX010 PANOXYL GEL 10%
BENZOYL PEROXIDE 10%
CPA012 PANOXYL GEL 2.5% 40g
BENZOYL PEROXIDE 2.5%
CRE020 RETIN-A CREAM 0.025%
TRETINOIN 0.025%
25g (GE) CREAM 0.01% 25g TRETINOIN 0.01%
CRE010 RETIN-A
(GE)
CRE022 RETIN-A
CREAM 0.05% 25g TRETINOIN 0.05%
<Tretinoin>
(GE)
CRE023 CREAM
0.05% 500g [ACTA] TRETINOIN
CRE024 RETIN-A <Tretinoin>
CREAM 0.1% 25g TRETINOIN 0.1%
(GE)
CRE025 CREAM
0.1% 500g [ACTA] TRETINOIN
CRE021 RETIN-A 0.025% GEL 15g
TRETINOIN 0.025%
CRE026 RETIN-A 0.01% GEL 15g
TRETINOIN 0.01%
TRO010 ROACCUTANE 10mg
ISOTRETINOIN 10mg
TRO013 ROACCUTANE 10mg (GE) ISOTRETINOIN 10mg
TRO012 ROACCUTANE 20mg
ISOTRETINOIN 20mg
TRO014 ROACCUTANE 20mg (GE) ISOTRETINOIN 20mg
CSK010 SKINOREN 20% 30g
MCIRONIZED AZELAIC ACID 20%
ANTISEPTICS & DISINFECTANTS
CAL010 ALCOHOL, BURNING
ALCOHOL, BURNING
CBE028 BETADINE CREAM 15g
POVIDONE-IODINE
CBE030 BETADINE SOLUTION
POVIDONE-IODINE
CCA050 CASTELLANI'S
PAINT
CASTELLANI'S PAINT
CHLORHEXIDINE
CCH030 COMPOUND CREAM
CHLORHEXIDINE
CCI022 CIDEX SOLUTION (28
ACTIVATED GLUTARALDHYDE
DAYS)
CCI020 CIDEZYME
LIQ.
CDR010 DRAPOLENE 55g
BENZALKONIUM CL, CETRIMIDE
CET010 ETHER 450mL
ETHER
CEU040 EUSOL 3600mL
CHLORINATED LIME
CHI020 HIBITANE 0.5% IN 70%
CHLORHEXIDINE GLUCONATE
ALCOHOL 5%
CHI018 HIBITANE
CHLORHEXIDINE GLUCONATE
CONCENTRATE
CHI022 HIBITANE
SOLUTION IN
CHLORHEXIDINE ACETATE 0.05%w/v
CHY060 AQ.
HYDROGEN PEROXIDE 6% HYDROGEN PEROXIDE 6%
(20 volume)
CIO010 IODINE
TINTURE
IODINE TINCTURE
CLY010 LYSOL 5000mL
CME010 MERCUOCHROME
MERCUOCHROME
2.5%
Page
24 of 28
SOLUTION CREAM
2.5%
CNA010 NASEPTIN
15g
CHLORHEXIDINE
(GE)
UNIT PRICE
($)
1.90
2.40
60.00
5.60
6.00
4.80
4.40
2.20
1.00
1.20
1.20
1.20
3.33
1.20
3.10
4.80
7.10
5.50
3.70
70.00
430.00
7.50
1.65
1.70
2.60
4.50
2.00
PK UNIT
2.20
0.46
2.00
89.00
2.80
6.00
90.00
160.00
4.00
160.00
7.90
4.40
4.40
3.00
14.64
16.50
2.50
5.80
8.10
7.00
140.00
1.30
2.00
2.00
7.70
7.70
7.70
2.20
9.20
1.50
16.70
18.00
31.80
16.00
40.00
32.00
6.50
g
ML
g
BOT
g
g
BOT
BOT
g
BOT
TAB
g
g
g
g
g
g
g
g
g
BOT
g
g
g
g
g
g
g
g
g
g
g
CAP
CAP
CAP
CAP
g
0.30
3.00
0.35
0.40
0.500
0.10
0.23
1.58
0.275
0.14
0.40
0.20
0.15
1.00
0.28
0.13
0.50
1.00
ML
g
ML
ML
g
ML
ML
g
ML
ML
ML
ML
ML
ML
ML
ML
ML
g
g
g
BOT
g
g
ML
g
g
g
g
g
g
g
ML
g
g
g
g
g
BOT
BOX
g
g
g
g
g
g
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
DRUG DESCRIPTION
NO.
AOP010 OPSITE SPRAY
CPH010 PHENOL SOL 5%
CKM010 POTASSIUM
CKM012 PERMANGANATE SOLN
CSA024 SAVLON CREAM 30g
CPA106 SAVLON CONC SOLUTION
CSU008 (GE)
SULPHACETAMIDE 20% IN
ALCOHOL25mL
50% (HIBITANE)
AUN010 UNISEPT
CVI020 VIOFORM CREAM (GE)
CZI010 ZINC & CASTOR OIL
CREAM
(GE)
FUNGICIDES
& ANTIPARASITES
A-LICES
SCALP HYGIENE
GENERIC NAME
PHENOL 80%
POTASSIUM PERMANGANATE 1%
POTASSIUM PERMANGANATE 4%
CHLORHEXIDINE, CETRIMIDE
CHLORHEXIDINE, CETRIMIDE
SULPHACETAMIDE 20%
CHLORHEXIDINE
CLIOQUINOL 3%
ZINE OXIDE, CASTOR OIL
CAL040 SHAMPOO
MALATHION 1%
CAC008 ACETIC ACID 5%
ACETIC ACID 2%
SOLUTION NAIL
CBA020 BATRAFEN
CICLOPIROX
CBE010 LACQUER
BENZYL BENZOATE
BENZYL BENZOATE 25%
APPLICATION
25% 450mL
CCA038 CANESTEN
CREAM
1%
CLOTRIMAZOLE
CCA040 CANESTEN CREAM
CLOTRIMAZOLE
15g/20g/500gCREAM
(GE) 1% 20g CLOTRIMAZOLE
CPA121 CANESTEN
CDA030 DAKTARIN CREAM 15g
MCIONAZOLE NITRATE 2%
(GE)
CEX010 EXODERIL
CREAM 1% 15g NAFTIFINE HCL
CGA004 GAMMA BENZENE
GAMMA BENZENE HEXACHLORIDE
HEXACHLORIDE
1%
CGE010 GENTIAN
VIOLET1%
(GE)
GENTIAN
VIOLET
CLA010 LAMISIL CREAM
TERBINAFINE 1%
CLA011 LAMISIL CREAM (GE)
TERBINAFINE
CLA012 LAMISIL SPRAY 1% 30mL TERBINAFINE 1%
CLI010 LINDANE LOTION 1%
GAMMA BENZENE HEXACHLORIDE
60mL/BOTSHAMPOO 1%
1%
CLI012 LINDANE
GAMMA
BENZENE HEXACHLORIDE
60mL/BOT 5% NAIL
1%
CLO020 LOCERYL
AMOROLFINE
5%
2.5mL CREAM
CLO022 LACQUER
LOCERYL 0.25%
AMOROLFINE 0.25%
20g
CLO012 LOTREMIN
SOLUTION 1% CLOTRIMAZOLE 1%
10mL/BOT CREAM 1%
CMY010 MYCOSPOR
BIFONAZOLE 1%
15g
CMY020 MYCOSTATIN
CREAM 15g NYSTATIN 100,000u/g
CNI010 NIZORAL CREAM
2% 15g KETOCONAZOLE 2%
SHAMPOO
CNI020 100mL/BOT
KETOCONAZOLE 2%
CNI020 NIZORAL SHAMPOO
KETOCONAZOLE 2%
60mL/BOT HEADLICE
CQU008 QUELLADA
PERMETHRIN 10mg/mL
TREATMENTSCABIES
LIQUID
CQU010 QUELLADA
PERMETHRIN
CSO018 LOTION
SODIUM50mg/mL
THIOSULPHATE SODIUM THIOSULPHATE 10%
10%
CSO020 SODIUM
THIOSULPHATE SODIUM THIOSULPHATE 20%
SOLUTION
CCO030 CORN
PAD 20%
SALICYLIC ACID 40%
CTA020 TARSUM SHAMPOO 120mL COAL TAR, SALICYLIC ACID
CTI010 TINEAFAX POWDER (GE) UNDECENOIC ACID 2%
55g/BOT
CTR020 TRAVOGEN
CREAM 20 g
ISOCONAZOLE NITRATE 1%
CTR040 TROSYD CREAM 1% 30g
TIOCONAZOLE
CTR042 TROSYD NAIL SOLUTION TIOCONAZOLE
CWH010 WHITFIELD OINTMENT
BENZOIC ACID 5%, SAL. ACID 3%
CWH020 (GE)
WHITFIELD'S SOLUTION
BENZOIC ACID 5%, SAL. ACID 3%
(GE)
CPA120 ZALAIN
CREAM 2% 20g
SERTACONAZOLE NITRATE
CNI022 ZORINAX SHAMPOO
KETOCONAZOLE 2%
120mL/BOTSHAMPOO
CNI024 ZORINAX
KETOCONAZOLE 2%
30mL/BOT
PSORIASIS,
SEBORRHEA & ICHTHYOSIS
CCO004 COAL TAR 10% OINTMENT COAL TAR 10%
CCO005 COAL TAR PASTE 5%
COAL TAR 5%
CCO006 COCOIS OINTMENT
COAL TAR SOL.12%, SULPHUR 4%
CDA008 DAIVONEX CREAM 30g
CALCIOTRIOL
CDA010 DAIVONEX OINTMENT 30g CALCIOTRIOL
CDA012 DAIVONEX SCALP LOTION CALCIOTRIOL
30mL
CDA006 DAIVOBET
OINTMENT 15g CALCIPOTRIOL, BETAMETHASONE
CDI070 DITHRANOL 1% IN
DITHRANOL 1%
LASSA'S PASTE
CEG010 EGOPSORYL
TA
SULFUR 0.5%, PHENOL 0.5%, TAR
CEL050 ELOSALIC OINTMENT 15g MOMETASONE, SALICYLIC ACID
CMI004 MICANOL 1% CREAM 50g DITHRANOL 1%
TNE013 NEOTIGASON 10mg
ACITRETIN 10mg
TNE014 NEOTIGASON 25mg
ACITRETIN 25mg
CSA033 SAL. ACID OINTMENT 3% SALICYLIC ACID 3%
CST016 STIEPROX LIQUID 1.5%
CICLOPIROX
CSE010 SELSUN SUSPENSION
SELENIUM SULFIDE 1%
120mL/BOT
CXA010 XAMIOL
GEL 15g
CALCIPOTRIOL, BETAMETHASONE
OTHER DERMOLOGICALS
CAC030 ACTOVEGIN 5% CREAM
HEMODERIVATIVE 2mg/g
20g
CAL020 ALUMINIUM
CHLORIDE
ALUMINIUM CHLORIDE SOLN 20%
SOLUTION 20%
CCL020 CLOTRIMAZOLE+SYNALA
CLOTRIMAZOLE
R+NEOMYCIN
CREAM
/FLUCINOLONE/NEOM
CPA048 DILTIAZEM
Cream
CTR037 TRILUMA CREAM 15g
FLUOCINOLONE,HYDROQUINONE,T
RETINOIN
CTR038 TRILUMA CREAM 30g
FLUOCINOLONE,HYDROQUINONE,T
RETINOIN
CZI040 ZINDACLIN 1% GEL
CLINDAMYCIN,
ZINC ACETARE
TOPICAL ANTIVIRALS
CST020 STOXIL 0.5% 5g
IDOXURUDINE
CVI012 VIRU-MERZ GEL 10g
TROMANTADINE HCL 1%
CZO008 ZOVIRAX COLD SORE
ACYCLOVIR 5%
CREAM 5%COLD
5g (GE)
CZO010 ZOVIRAX
SORE
ACYCLOVIR 5%
CREAM 5%CREAM
4g (GE) 5% 10g ACYCLOVIR 5%
CZO012 ZOVIRAX
KERATOLYTICS
Page 25 of 28
CCO020 COLLOMACK SOLUTION SALICYLIC ACID 2G, LACTIC ACID
10mL
UNIT PRICE
($)
115.00
0.30
0.30
0.50
0.70
0.16
0.39
7.00
0.70
0.80
PK UNIT
2.40
0.16
310.00
0.30
90.00
2.00
60.00
1.50
2.40
0.60
0.17
5.70
3.40
125.00
80.00
0.80
385.00
4.20
70.00
6.70
3.00
10.00
2.20
180.00
2.50
2.20
0.50
0.80
18.00
0.54
50.00
3.70
4.00
308.00
0.67
2.50
60.00
120.00
30.00
ML
ML
BOX
ML
TUB
g
TUB
g
g
ML
ML
g
g
BOT
BOT
ML
BOT
g
BOT
g
g
g
ML
BOT
ML
ML
ML
ML
BOX
ML
BOT
g
g
BOT
g
ML
TUB
BOT
BOT
0.90
0.80
3.20
9.00
9.00
7.50
10.60
1.00
1.30
5.70
2.50
19.00
42.00
1.00
1.30
100.00
175.00
g
g
g
g
g
ML
g
g
g
g
g
CAP
CAP
g
ML
BOT
BOT
2.00
2.00
1.00
200.00
37.80
34.00
5.00
g
ML
g
TUB
g
g
g
11.00
6.50
8.00
8.00
169.00
g
g
g
g
tube
4.00
ML
BOT
ML
ML
ML
g
ML
ML
PK
g
g
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
DRUG DESCRIPTION
GENERIC NAME
NO.
CDU008 DUOFILM GEL
SALICYLIC ACID 27%
CDU012 DUOFILM SOLUTION 14mL SALICYLIC ACID, LACTIC ACID
(GE)
CDU010 DUOFILM
SOLUTION 15mL SALICYLIC ACID, LACTIC ACID
CPO010 PODOPHYLLIN IN SPIRIT TINCT BENZ CO, PODOPHYLLIN
25% 30mL (GE) 5%, SAL.
CPO020 PODOPHYLLIN
TINCT BENZ CO, PODOPHYLLIN
ACID 5% IN COLLODION
CPO050 POSALFILIN
OINTMENT
PODOPHYLLUM, SALICYLIC ACID
CSA004 10g
SALICYLIC ACID 1%
SALICYLIC ACID 1%
OINTMENT ACID 2% IN
CSA006 SALICYLIC
SALICYLIC ACID 2%/SULPHUR 2%
SULPHUR 2%
CREAM
CSA008 SALICYLIC
ACID
5% IN AQ SALICYLIC ACID 5%
CREAM
CSA009 SALICYLIC
ACID 10% IN
SALICYLIC ACID 10%
AQ CREAM ACID IN AQ SALICYLIC ACID 20%
CSA010 SALICYCLIC
CREAM 20% ACID PAINT SALICYLIC ACID 15%
CSA018 SALICYCLIC
15% IN COLLODION
CSA020 SALICYCLIC
ACID PAINT SALICYLIC ACID 15%
15% (GE) ACID 20% IN
CSA023 SALICYLIC
SALICYLIC ACID 20%
COLLODIO
CSA032 SAL.
ACID OINTMENT 6% SALICYLIC ACID 6%
CSA034 SALICYLIC ACID 4% &
SALICYLIC ACID 4%, UREA 20%
UREA 20% CREAM
CSA035 SALICYLIC
ACID 3% IN
SALICYLIC ACID 3%
ALCOHOL
CTR026 TRICHLOROACETIC
ACID TRICHLOROACAETIC ACID 10%
10%
CTR027 TRICHLOROACETIC
ACID TRICHLOROACAETIC ACID 50%
50%
CTR028 TRICHLOROACETIC
ACID TRICHLOROACAETIC ACID 90%
CVE010 90%
VERRUMAL SOLUTION
FLUOROURACIL 0.5%,SAL. ACID10%
13mL/BOT0.15% CREAM 5g PODOPHYLLOTOXIN 0.15%
CWA008 WARTEC
CWA010 WARTEC TOPICAL
PODOPHYLLOTOXIN 0.5%
0.5%
TOPICALSOLUTION
ANTIHISTAMINES
/ ANTIPRURITICS
CAN022 ANTHISAN CREAM 2% 15g MEPYRAMINE
CCA010 CALAMINE CREAM (GE)
CALAMINE 20%
CCA020 CALAMINE LOTION (GE)
CALAMINE 15%
CCA024 CALAMNE-DPH 1%
CALAMINE, DIPHENHYDRAMINE
CREAM
CCA026 CALAMINE
+ DPH 0.2%
CALAMINE, DIPHENHYDRAMINE
CCA028 LOTION
CALAMINE + 0.25%
CALAMINE,MENTHOL 0.25%
MENTHOL + 5%
CCA029 CALAMINE
CALAMINE,SULPHUR 5%
SULPHATE
LOTION
CEU018 EURAX
CREAM
15g (GE)
CROTAMITON
CEU020 EURAX CREAM 450g (GE) CROTAMITON CREAM 10%
CHY031 HYDROCORTISONE 1% IN HYDROCORTISONE 1%/CALAMINE
CALAMINE
LOTION
CST010 STEREX
SHAMPOO
COAL TAR, SAL.ACID, SULPHUR
114mL/BOT
CUR010 UREA
CREAM 10%
UREA 10%
TZY024 ZYRTEC-D
CETIRIZINE 5mg, PSEUDOEPHEDRINE
120mg
CAN020 ANTHISAN CREAM (GE)
MEPYRAIMINE
MALEATE CREAM
TOPICAL ANALGESICS & ANTIINFLAMMATORIES
CAN010 ANALGESIC BALM (GE)
METHYL SALICYLATE
CBE012 BENGAY 28g
METHYL SALICYLATE 30%,
MENTHOL
CBE013 BENGAY 30g (GE) {BAGES METHYL
CREAM} 15g
SALICYLATE,MENTHOL,CAMPHOR
CBO010 BONJELA
CHOLINE
SALICYLATE 8.7%
CDI010 DIFFLAM CREAM 30g
BENZYDAMINE
CDI019 DIPROGENTA CREAM 450g BETAMETHASONE DIPROPIONATE
(GE)
0.05%,GENTAMICIN
CPA141 DUROGESIC
D-TRANS
FENTANYL
BASE SULFATE 0.1%
CFE010 DERMAL
FELDENEPATCH
GEL 25g25 mcg/hr PIROXICAM 0.5%
CIN010 INDOMET GEL 20g
INDOMETHACIN 1%
CRU010 RUBESAL CREAM 25g
DIETHYLAMINE
SALICYLATE/CAMPHO
CSO040 SOLCOSERYL JELLY 20g
METHYL
PARAHYDROXYBENZOATE
CSO042 SOLCOSERYL OINTMENT METHYL PARAHYDROXYBENZOATE
20g
CPA122 OLFEN
GEL 1 % x 20 g
DICLOFENAC NA
CVO006 VOLTAREN EMULGEL 1% DICLOFENAC
CVO010 VOLTAREN EMULGEL 20g DICLOFENAC NA
(GE)
CPA042 VOLTAREN
GEL 1% 20g
DICLOFENAC NA
ANAESTHETICS - LOCAL & GENERAL
DCO014 COCAINE 10% SOLUTION COCAINE
DCO010 COCAINE 10% WITH
COCAINE
ADRENALINE
1:1000
DCO012 COCAINE
5% SOLUTION
COCAINE
CEL003 ELA-MAX CREAM 4%
LIDOCAINE 4%
CEM010 EMLA CREAM 5% 5g
LIDOCAINE 25mg,PRILOCAINE 25mg
CIN018 EMLA
INSTILLAGEL
CREAM11mL
5% 5g (GE) - LIDOCAINE HYDROCHLOREDE
215.7mg,CHLORHEXIDINE
CEM011 [LIDOCAINE +
LIDOCAINE
25mg,PRILOCAINE 25mg
ILI008
LIGNOCAINE INJ 1% 5mL LIGNOCAINE HCL
ILI010
LIGNOCAINE INJ 2% 5mL LIGNOCAINE HCL
IMA009 MARCAINE INJ 0.5% 10mL BUPIVACAINE HCL
IMA010 MARCAINE INJ 0.5% 20mL BUPIVACAINE HCL
IXY004 XYLESTESIN- A 1.8mL
LIDOCAINE HCL 20mg/EPINEPHRINE
HCL 0.015mg ADRENALINE
IXY018 XYLOCAINE 1% +
LIDOCAINE,
INJ+ 20mL
IXY020 ADRENALINE
XYLOCAINE 2%
LIDOCAINE, ADRENALINE
ADRENALINEINJ
INJ1%
20mL
IXY006 XYLOCAINE
5mL
LIDOCAINE HCL
IXY007 XYLOCAINE INJ 2% 5mL
LIDOCAINE HCL
(50'S)
IXY008 XYLOCAINE
INJ 1% 20mL LIDOCAINE HCL
IXY010 XYLOCAINE INJ 2% 20mL LIDOCAINE HCL
CXY010 XYLOCAINE JELLY 2% 30g LIDOCAINE HCl 2%
CXY020 XYLOCAINE OINTMENT
LIDOCAINE HCl 5%
5% 35g
CXY040 XYLOCAINE
SPRAY 10%
LIDOCAINE 10%
80g/BOT & ANTIALLERGICS
ANTIHISTAMINES
TAC030 ACCOLATE 20mg
ZAFIRLUKAST 20mg
TAE010 AERIUS 5mg
DESLORATADINE 5mg
TAT010 ATARAX 10mg
HYDROXYZINE 10mg
TAT012 ATARAX 25mg
HYDROXYZINE 25mg
MAT010 ATARAX SYRUP 0.2%
HYDROXYZINE Page
HCL 26 of 28
200mL
MBE010 BENADRYL
ELIXIR
DIPHENHYDRAMINE HCL
25mg/5mL (GE)
UNIT PRICE
($)
7.40
4.10
6.80
4.50
2.18
11.00
0.33
1.20
0.33
0.60
0.60
1.40
0.83
2.00
1.00
1.00
0.19
5.00
6.00
6.00
80.00
109.00
475.00
PK UNIT
45.00
0.90
0.40
0.80
0.17
0.17
0.30
1.50
1.10
0.60
70.00
1.50
7.50
0.84
TUB
g
ML
g
ML
ML
ML
g
g
ML
BOT
g
TAB
g
0.60
0.60
0.50
1.90
1.83
1.80
340.00
2.50
1.25
0.62
3.50
2.40
46.00
65.00
2.30
2.20
g
g
g
g
g
g
PATCH
g
g
g
g
g
TUB
TUB
g
g
15.00
17.00
10.00
15.00
30.50
55.00
17.00
30.00
62.00
214.00
260.00
4.00
15.00
15.00
26.00
29.40
10.00
10.00
7.10
3.40
489.00
ML
ML
ML
g
g
TUB
g
AMP
AMP
VIA
VIA
AMP
ML
ML
AMP
AMP
ML
ML
g
g
BOT
8.20
5.20
1.80
2.80
0.70
0.17
TAB
TAB
TAB
TAB
ML
ML
g
ML
ML
ML
ML
g
g
g
g
g
g
ML
ML
ML
g
g
ML
ML
ML
ML
BOT
g
BOT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
DRUG DESCRIPTION
GENERIC NAME
NO.
IBE010 BENADRYL INJ
DIPHENHYDRAMINE HCL
500mg/10mL
TCE042 CELESTAMINE
DEXCHLORPHENIRAMINE,
BETAMETHA
TCE040 CELESTAMINE (GE)
DEXCHLORPHENIRAMINE,
BETAMETHA
MCE030 CELESTAMINE SYRUP
DEXCHLORPHENIRAMINE
(GE)
MALEATE.. 10mg
TCL020 CLARITYNE
10mg
LORATADINE
TCL022 CLARITYNE 10mg (GE)
LORATADINE 10mg
MCL010 CLARITYNE SYRUP
LORATADINE
1mg/mL (GE) SYRUP
CPA053 CLARITYNE
LORATADINE
1mg/mL
ICO010 CORAMINE
INJ
NIKETHAMINE
CDI013 DIPHENHYDRAMINE 2%
DIPHENHYDRAMINE 2%
CREAM 450g4mg (GE)
TDI080 DIMETANE
BROMPHENIRAMINE MALEATE 4mg
TEM010 EMEND [APREPITANT]
APREPITANT
TRIPACK
THI010 HISMANAL
ASTEMIZOLE
TIN010 INCIDAL 50 mg
MEBHYDROLIN NAPADISYLATE
TKE050 KESTINE 10mg
EBASTINE 10mg
TPE060 PERIACTIN 4mg (GE)CYPROHEPTADINE 4mg
[CYPROHEPTADINE]
TPH010 PHENERGAN
10mg (GE)
PROMETHAZINE HCL 10mg
TPH012 PHENERGAN 25mg (GE)
PROMETHAZINE HCL 25mg
MPH010 PHENERGAN ELIXIR
PROMETHAZINE HCL 5MG
5mg/5mL (GE) INJ 25mg/mL PROMETHAZINE HCL
IPH010 PHENERGAN
TPI010
PIRITON 2mg (GE)
CHLORPHENIRAMINE MALEATE 2mg
TPI012
PIRITON 4mg (GE)
CHLORPHENIRAMINE MALEATE 4mg
TPI014
PIRITON SR 12mg (GE)
CHLORPHENIRAMINE MALEATE
12mg
MPI020 PIRITON SYRUP 2.5mg/5mL CHLORPHENIRAMINE
MALEATE
(GE)
MPI025 PIRITON
SYRUP 2mg/5mL CHLORPHENIRAMINE MALEATE
(GE)
MPI030 PIRITON
FORTE SYRUP
CHLORPHENIRAMINE MALEATE
4mg/5mL INJ
(GE)10mg/mL (GE) CHLORPHENIRAMINE MALEATE
IPI010
PIRITON
TPL030 PLOKON TAB
PIRINHYDRINATE 3mg
TPO010 POLARAMINE 2mg (GE)
DEXCHLORPHENIRAMINE MALEATE
CPA065 POLARAMINE 6mg
DEXCHLORPHENIRAMINE
TPO012 POLARAMINE SA 6mg (GE) DEXCHLORPHENIRAMINE MALEATE
MPO008 POLARAMINE
DEXCHLORPHENIRAMINE
EXPECTORANTSYRUP
GUAIPHENESIN PSEUDOEPHEDRINE
MPO010 POLARAMINE
DEXCHLORPHENIRAMINE
MALEATE
2mg/5mL (GE)
TSE020 SEMPREX
8mg
ACRIVASTINE 8mg
TTE025 TELDANE (GE)
TERFENADINE 60mg
MTE010 TELDANE SUSPENSION
TERFENADINE
30mg/5mL60mg
120mL
TTE026 TELFAST
FEXOFENADINE HCL 60mg
TTE024 TELFAST 120mg
FEXOFENADINE HCL 120mg
TTE027 TELFAST 180mg
FEXOFENADINE HCL 180mg
TTE029 TELFAST-D
FEXOFENADINE
HCL/PSEUDOEPHEDRI
MVA010 VALLERGEN FORTE
TRIMEPRAZINE
TARTRATE
30mg/5mL
100mL
MXY010 XYZAL
ORAL
DROPS
LEVOCETIRIZINE
5mg/ml 5mg
TXY010 XYZAL
LEVOCETIRIZINE 5mg
CPA052 XYZAL DROPS 20 ml
LEVOCETIRIZINE
TZA010 ZADINE 1mg
AZATADINE MALEATE 1mg
MZA010 ZADINE SYRUP 0.5mg/5mL AZATADINE MALEATE
100mL 10mg
TZY020 ZYRTEC
CETIRIZINE HCL 10mg
TZY022 ZYRTEC 10mg (GE)
CETIRIZINE HCL 10mg
MZY010 ZYRTEC ORAL
CETIRIZINE HCL
SOL.1mg/1ml
MZY008 ZYRTEC
ORAL DROPS 1% CETIRIZINE HCL
(10mL) SYRUP 1mg/mL
MZY012 ZYRTEC
CETIRIZINE HCL
60mL (GE)
TBP010 B.P.P.
PPA,BROMPHENIRAMINE,PHENYLEP
HR
TDI090 DIME-TIME
BROMPHENIRAMINE,PPA,PHENYLEP
HE
IMMUNOLOGICALS & IMMUNOSUPPRESSANTS
CPA152 BENLYSTA POWDER FOR BELIMUMAB
CONCENTRATE FOR
FOR INFUSION MYCOPHENOLATE MOFETIL 250mg
TCE046 SOLUTION
CELLCEPT 250mg
TCE048 CELLCEPT CAP 500mg
MYCOPHENOLATE MOFETIL 500mg
VGA010 GAMMA GLOBULIN 5mL
IMMUNE GLOBULIN IV (HUMAN)
IHU009 HUMIRA 40mg/0.8mL
ADALIMUMAB
TIM048 IMURAN 25mg
AZATHIOPRINE 25mg
TIM050 IMURAN 50mg [APOAZATHIOPRINE 50mg
TIM051 AZATHIOPRINE]
AZATHIOPRINE
TPR091 PROGRAF 1mg
TACROLIMUS 1mg
TPR092 PROGRAF 5mg
TACROLIMUS 5mg
IRE040 REBIF 44mcg
RECOMBINANT HUMAN
INTERFERON
DRE050 RESTASIS 0.05% EYE
CYCLOSPORINE
0.05%
DROPS
TSA034 SANDIMMUN
NEORAL
CYCLOSPORIN A 100mg
100mg
TSA036 SANDIMMUN
NEORAL
CYCLOSPORIN A 25mg
25mg
IST004
STELARA
INJ 45mg
USTEKINUMAB
DISEASE-MODIFYING ANIT-RHEUMATIC DRUGS (DMARDs)
TAR002 ARAVA 10mg
LEFLUNOMIDE
INTRAVENOUS & OTHER STERILE SOLUTIONS
ISO010 SODIUM BICARBONATE
SODIUM BICARBONATE
8.4% 100mL
ISO060 SODIUM
CHLORIDE 0.9% SODIUM CHLORIDE 0.9%
INJ 10mL CHLORIDE 0.9% SODIUM CHLORIDE
ISO061 SODIUM
INJ 20mL BONE METABOLISM
AGENT AFFECTING
TBO010 BONVIVA 150mg
INJ 3mg/3mL (1 IBANDRONIC ACID 150mg
IBO006 SYRING/BOX)
IBANDRONIC ACID 150mg
IPR052 PROLIA 60mg/Ml
DENOSUMAB
MPR050 PROTOS 2g
STRONTIUM RANELATE
CPA128 FORTEO PRE-FILLED PEN TERIPARATIDE
250 mcg/mL,
2.4 mL
1's
ANAESTHETICS
- LOCAL
&xGENERAL
Page 27 of 28
CBE025 BETACAINE GEL 30g
LIDOCAINE 5%
UNIT PRICE
($)
200.00
2.20
1.50
0.19
6.00
3.80
0.50
1.00
50.00
0.70
1.00
1030.00
6.00
2.00
5.00
0.18
1.10
1.10
0.19
25.00
0.40
0.53
1.20
0.17
0.17
0.19
25.00
1.30
0.70
2.50
1.10
50.00
0.17
2.40
2.00
0.80
2.50
5.50
7.50
4.20
1.00
284.00
6.30
105.00
2.50
0.38
4.00
2.40
1.08
8.60
0.60
1.00
2.50
PK UNIT
14000.00
INJ
22.00
41.00
210.00
6052.00
16.50
21.60
18.00
45.00
184.00
870.00
30.00
70.00
18.50
37000.00
CAP
CAP
VIA
SYR
TAB
TAB
TAB
TAB
CAP
AMP
PC
TAB
TAB
VIA
20.00
TAB
90.00
2.90
8.00
BOT
VIA
AMP
320
1650.00
4000.00
15.20
6000.00
TAB
SYR
SYR
SACH
PEN
11.00
g
VIA
TAB
TAB
ML
TAB
TAB
ML
ML
AMP
g
TAB
BOX
TAB
TAB
TAB
TAB
TAB
TAB
ML
AMP
TAB
TAB
CAP
ML
ML
ML
ML
TAB
TAB
TAB
TAB
BOT
ML
CAP
TAB
ML
TAB
TAB
TAB
TAB
ML
BOT
TAB
BOT
TAB
ML
TAB
TAB
ML
ML
ML
TAB
TAB
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ITEM
DRUG DESCRIPTION
GENERIC NAME
NO.
IMI002
MIACALCIC INJ 100 IU/mL SYNTHETIC SALMON CALCITONIN
IMI003
MIACALCIC INJ 50 IU/mL SYNTHETIC SALMON CALCITONIN
IXY019 XYLOCAINE 2% +
LIDOCAINE, ADRENALINE
ADRENALINE
1:80,000
INTRAVENOUS
& OTHER
STERILE SOLUTIONS
IAT010 ATROPINE INJ 0.6mg/mL
ATROPINE SULFATE
(GE)
IDE050 DEXTROSE
INJ 5% 500mL DEXTROSE
IDE060 DEXTROSE INJ 50% 20mL DEXTROSE
IGE020 GELOFUSINE 4% 500mL
SUCCINYLATED GELATIN
NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs)
CPA092 TORADOL 30MG/ML/AMP KETOROLAC TROMETAMOL
MISCELLANEOUS
TRE014 RENAGEL 800mg
SEVELAMER
HCL
SODIUM
CHLORIDE/POTASSIUM
DBS008 BSS SOLUTION 15mL
CHLO
TS0004 SODIUM BICARBONATE
SODIUM BICARBONATE
Page 28 of 28
UNIT PRICE
($)
180.00
150.00
4.00
PK UNIT
30.00
77.00
6.50
100.00
AMP
BOT
AMP
BOT
200
AMP
12.50
111.00
1.10
TAB
BOT
TAB
AMP
AMP
AMP