Formulary 50th Edition - Drug Plan

Transcription

Saskatchewan
Health
Formulary
Fiftieth Edition
Drug Plan
July 2000 - July 2001
Updated quarterly
Inquiries should be directed to:
Pharmaceutical Services Division
Drug Plan & Extended Benefits Branch
Saskatchewan Health
2nd Floor, 3475 Albert Street
Regina, Saskatchewan
S4S 6X6
Telephone inquiries should be directed as follows:
Pricing, Contract Inquiries……………………………………….
(306) 787-3326
Product Submission Inquiries………………………….………..
(306) 933-5599
EDS, Palliative Care, "No Substitution" Inquiries…….……….
(306) 787-8744
EDS Requests (24-hour message system)…..Toll Free……..
1-800-667-2549
Special Support Program Inquiries……………Toll Free……..
1-800-667-7581
…………………………………………….……....Regina….…..
(306) 787-3317
Research and Utilization Inquiries……………………………...
(306) 787-3305
Profile Release Program………………………………………...
(306) 787-1661
Consumer Inquiries………………..……………Toll Free……..
1-800-667-7581
…………………………………………….……....Regina….…..
(306) 787-3317
Pharmacy Inquiries………………………………Toll Free…….
1-800-667-7578
………………………………………………..……Regina………
(306) 787-3315
Hospital Benefit List Inquiries………………………….………..
(306) 787-3224
FAX………………………………………………………………...
(306) 787-8679
Copyright - 2000
Her Majesty the Queen in right of
the Dominion of Canada, as
represented by the Minister of
Health of the Province of
Saskatchewan.
ISSN 0701-9823
Printed in Canada
Saskatchewan Health
Government of Saskatchewan
Minister,
The Honourable Pat Atkinson
Associate Minister,
The Honourable Judy Junor
TABLE OF CONTENTS
The Saskatchewan Formulary Is Now
Published Annually
Quarterly Updates will be provided:
Fall 2000
Winter 2001
Spring 2001
Please insert sticker updates in the section
provided at the back of the Formulary.
TABLE OF CONTENTS
MEMBERSHIP OF SASKATCHEWAN FORMULARY COMMITTEE...................................................................
.
iv
MEMBERSHIP OF SASKATCHEWAN DRUG QUALITY ASSESSMENT COMMITTEE ..............................
.
iv
PREFACE........................................................................................................................................................................
.
v
NOTES CONCERNING THE FORMULARY.......................................................................................................
.
ix
LEGEND..........................................................................................................................................................................
. xvii
PHARMACOLOGICAL - THERAPEUTIC CLASSIFICATION OF DRUGS
08:00 ANTI-INFECTIVE AGENTS...........................................................................................................
2
.
10:00 ANTINEOPLASTIC AGENTS........................................................................................................
26
.
12:00 AUTONOMIC DRUGS..................................................................................................................
30
.
20:00 BLOOD FORMATION AND COAGULATION..................................................................................
42
.
24:00 CARDIOVASCULAR DRUGS.......................................................................................................
48
.
28:00 CENTRAL NERVOUS SYSTEM DRUGS.......................................................................................
80
.
36:00 DIAGNOSTIC AGENTS................................................................................................................
. 128
40:00 ELECTROLYTIC, CALORIC AND WATER BALANCE.....................................................................
. 132
48:00 COUGH PREPARATIONS...........................................................................................................
. 138
52:00 EYE, EAR, NOSE AND THROAT PREPARATIONS.......................................................................
. 140
56:00 GASTROINTESTINAL DRUGS.....................................................................................................
. 154
60:00 GOLD COMPOUNDS..................................................................................................................
. 164
64:00 METAL ANTAGONISTS...............................................................................................................
. 166
68:00 HORMONES AND SUBSTITUTES................................................................................................
. 168
84:00 SKIN AND MUCOUS MEMBRANE PREPARATIONS.....................................................................
. 190
86:00 SMOOTH MUSCLE RELAXANTS......................................................................................................................................
. 214
88:00 VITAMINS...................................................................................................................................................
. 218
92:00 UNCLASSIFIED THERAPEUTIC AGENTS.....................................................................................
. 222
APPENDICES
APPENDIX A - EXCEPTION DRUG STATUS PROGRAM...................................................................
. 232
APPENDIX B - HOSPITAL BENEFIT DRUG LIST...................................................................................................
. 261
APPENDIX C - TIPS ON PRESCRIPTION WRITING...................................................................
. 292
PRESCRIPTION REGULATIONS...................................................................
. 294
APPENDIX D - GUIDELINES FOR REPORTING ADVERSE DRUG REACTIONS........................................
. 296
APPENDIX E - SPECIAL COVERAGES.....................................................................................................
. 301
APPENDIX F - TRIPLICATE PRESCRIPTION PROGRAM.........................................................................
. 306
APPENDIX G - CODES FOR PHARMACY ON-LINE CLAIMS PROCESSING.............................................
. 309
APPENDIX H - MAINTENANCE DRUG SCHEDULE....................................................................
. 311
APPENDIX I - TRIAL PRESCRIPTION PROGRAM MEDICATION LIST...................................................................
. 312
APPENDIX J - SASKATCHEWAN MS DRUGS PROGRAM....................................................................
. 313
INDICES
INDEX
INDEX
INDEX
INDEX
A - PHARMACEUTICAL MANUFACTURERS LIST.........................................................................
. 318
B - THERAPEUTIC CLASSIFICATION LIST...................................................................................
. 320
C - NUMERICAL LIST OF DRUG IDENTIFICATION NUMBERS.......................................................
. 322
D - ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCT NAMES...........................................
. 340
FORMULARY UPDATES...................................................................................................................
. 362
ii
INTRODUCTION
COMMITTEES
SASKATCHEWAN FORMULARY
COMMITTEE
SASKATCHEWAN DRUG QUALITY
ASSESSMENT COMMITTEE
Dr. B.R. Schnell
Chairperson
Dr. John Tuchek
Chairperson
Dr. M. Caughlin
Saskatchewan Medical Association
Ms Barb Evans
College of Pharmacy
Dr. Johann De La Rey Nel
College of Physicians & Surgeons
Dr. Ian Holmes
College of Medicine
Mr. Michael Gaucher
Saskatchewan Association of
Health Care Organizations
Dr. Paul Peloso
College of Medicine
Dr. D. Quest
Department of Pharmacology,
College of Medicine
Ms Cintra Kanhai
Saskatchewan Pharmaceutical
Association
Dr. A. Kumar Ramlall
College of Medicine
Mr. George Peters
Saskatchewan Health
Dr. B.R. Schnell
Ex-officio
Dr. D. Seibel
Member at Large
Dr. Y. Shevchuk
College of Pharmacy
Dr. Y. Shevchuk
College of Pharmacy
University of Saskatchewan
Dr. Thomas W. Wilson
Departments of Medicine &
Pharmacology,
College of Medicine
Ms Marilyn Smith
Saskatchewan Registered Nurses
Association
Dr. G. Tompkins
Member at Large
Dr. John Tuchek
College of Medicine
STAFF ASSISTANCE
Ms Gail Bradley
Pharmacist, Drug Plan &
Extended Benefits Branch
Ms Barbara J. Shea
Executive Director, Drug Plan &
Dr. L. Davis
Pharmacologist, Drug Plan &
Mr. Kevin B. Wilson
Director, Pharmaceutical Services
iv
PREFACE
OBJECTIVES
The Drug Plan has been established to:
• provide coverage to Saskatchewan residents for quality pharmaceutical products of
proven therapeutic effectiveness;
• reduce the direct cost of prescription drugs to Saskatchewan residents;
• reduce the cost of drug materials;
• encourage the rational use of prescription drugs.
THE FORMULARY
The Saskatchewan Formulary is a listing of the therapeutically effective drugs of proven
high quality that have been approved for coverage under the Drug Plan. It is compiled by
the Minister of Health with the advice of the Saskatchewan Formulary Committee (SFC).
The SFC is advised and assisted by the Drug Quality Assessment Committee (DQAC).
Members of both committees are appointed by the Minister of Health.
The Saskatchewan Formulary is published annually in July, with quarterly updates.
The ongoing work of the SFC includes the evaluation of new drug products as they are
introduced, and the periodic re-evaluation of all products. The goal is to list a range and
variety of drugs that will enable prescribers to select an effective course of therapy for
most patients.
THE DRUG REVIEW PROCESS
When a new drug is introduced to the Canadian market, the manufacturer submits a
request to the Drug Plan so that it can be considered for possible coverage. The request
must be supported by scientific reports and manufacturing documents to show that the
product meets accepted standards of quality, effectiveness and safety.
The DQAC carries out an initial evaluation of the submission, with emphasis on clinical
documents, such as reports of scientific studies comparing the new product with existing
therapeutic alternatives. In the case of new brands of currently listed products, the
DQAC evaluates comparative bioavailability studies and/or comparative clinical studies in
order to determine compliance with accepted standards for interchangeability.
The DQAC reports its findings to the SFC. Using this information, along with additional
details of anticipated cost and impact on patterns of practice, the SFC makes a
recommendation to the Minister of Health. These recommendations reflect the "Policy for
Inclusion of Products in the Saskatchewan Formulary" (see pages ix-xii).
The membership on the two Committees reflects their unique but complementary
mandate. The DQAC is composed of clinical specialists in internal medicine and/or
pharmacology, clinical pharmacists, pharmacologists, and pharmacists with special
interest in pharmaceutics and pharmaceutical chemistry. The SFC is made up of
representatives of the associations or institutions related to the regulation, education,
delivery and payment of the cost of drug therapy in Saskatchewan.
v
PRODUCT SUBMISSION PROCESS
MANUFACTURER
SUBMISSION
MANUFACTURER
SUBMISSION
ONCOLOGY INDICATION
DRUG QUALITY
ASSESSMENT COMMITTEE
(DQAC)
The DQAC reviews the clinical
and pharmaceutical aspects of
the submission and makes a
recommendation to the
Formulary Committee or the
Advisory Committee on
Institutional Pharmacy Practice.
AMBULATORY CARE INDICATION
INSTITUTIONAL INDICATION
SASKATCHEWAN
CANCER AGENCY
PHARMACY & THERAPEUTICS
COMMITTEE 2
SASKATCHEWAN
FORMULARY COMMITTEE
(SFC) 1
SASKATCHEWAN
CANCER AGENCY
BENEFIT DRUG LIST
ADVISORY COMMITTEE
ON INSTITUTIONAL
PHARMACY PRACTICE 3
HOSPITAL BENEFIT
DRUG LIST
SASKATCHEWAN
FORMULARY
1
2
3
Considers pharmacoeconomic impact in addition to the clinical and pharmaceutical aspects reviewed
by the DQAC.
DQAC advises the Saskatchewan Cancer Agency Pharmacy & Therapeutics Committee regarding
interchangeability and product quality issues.
All products listed in the Saskatchewan Formulary are benefits when used in the hospital setting.
Note: All committee recommendations are subject to approval by the Minister of Health.
vi
REQUEST FOR PRODUCT ASSESSMENT
Submission Process
Any supplier wishing to have products listed in the Saskatchewan Formulary, the Hospital
Benefits List or the Saskatchewan Cancer Agency Benefit List may submit requests for
product assessment. The route a submission follows is determined by the indication of
the products. There is no deadline date for submissions for listing in the Formulary. In
general, submissions are reviewed in order of receipt.
Clinical Documentation
Single-Supplier Product Submissions
Clinical documentation in support of products to be reviewed may be submitted at any
time. The committees meet on a regular basis and will review submissions as quickly as
possible upon receipt. Details of the criteria for product listings are published in each
edition of the Formulary.
Clinical information should clearly illustrate the efficacy of the drug. Comparative studies
against listed products demonstrating specific advantages of the drug should be included.
Clinical data is not usually required for additional strengths of a dosage form unless the
additional strength is intended for different indications, than listed products. Rationale for
the additional strength should be included.
Notification is required whenever there is a change in formulation or in the clinical
information published in the product monograph, for any listed product as well as for any
product under review.
Interchangeable Product Submissions
Comprehensive clinical data may not be required for new brands of drugs already listed
in the Formulary. When a product may be considered as interchangeable with a listed
product, the submission should include documentation to demonstrate bioequivalence.
Comparative bioavailability data for one strength will apply to other strengths of the same
product if they are dose proportionate.
For solid oral dosage forms, comparative dissolution rate studies should be submitted.
For topical preparations, oral liquids and injectable drug products, comparative physical
parameters (e.g. viscosity, homogeneity, specific gravity, particle size distribution, pH,
osmolarity, drop size, drug content per drop, surface tension, etc.) to demonstrate
pharmaceutical equivalence.
For a cross-referenced product, letters dated and signed by a senior company official
from both the manufacturer making the submission, and the manufacturer of the crossreferenced product, should be submitted to confirm that the product is identical in all
aspects, except for embossing and labelling.
Manufacturing Documentation
Manufacturing documentation should be submitted with the clinical documentation if
possible, but will be accepted at a later date.
vii
Economic Evaluation
Price information including catalogue or estimated prices should be provided at the time
of product submission.
Submission of pharmacoeconomic analyses are encouraged.
The National
Pharmacoeconomic Guidelines serve as a guide. The Formulary Committee will
routinely consider direct “medical” costs such as:
impact on laboratory test for monitoring, evaluation or diagnosis
impact on physician office visits
impact on hospitalization or institutionalization
impact on surgical procedures
increased or decreased incidence and severity of side effects.
The availability of quality-of-life analyses is encouraged.
Market Information
To allow for an accurate projection of the impact of a new product, expected market
share information is requested.
Patent Status
Product patent expiration date is requested to allow for consideration of the potential
long-term economic impact of the product.
Promotion Material
Copies of the initial product launch material, and any subsequent material sent to
physicians and pharmacists, are requested.
Submission Procedure
Requests for product assessment, together with supporting clinical (including
notice of compliance and product monograph) and manufacturing documentation
should be sent to:
Dr. Lorne Davis, Pharmacologist
Department of Pharmacology, College of Medicine
University of Saskatchewan, 107 Wiggins Road
Saskatoon, Saskatchewan S7N 5E5
Copies of the covering letter, the product monograph, notice of compliance,
pricing information and economic analysis should be sent to:
Mr. Kevin Wilson, Director, Pharmaceutical Services Division
Drug Plan and Extended Benefits Branch, Saskatchewan Health
2nd Floor , 3475 Albert Street
Regina, Saskatchewan S4S 6X6
viii
NOTES CONCERNING THE FORMULARY
Benefits
The Saskatchewan Formulary lists the drugs which are covered by the Drug Plan. A
prescription is required for all drugs dispensed under the Drug Plan with the exception of
insulin, blood-testing agents, and urine-testing agents used by diabetic patients. Drugs
not listed in the Formulary will not be covered by the Drug Plan except when approved for
coverage under the Exception Drug Status Program. See Appendix A for more
information regarding the Exception Drug Status Program.
Eligibility
With a few exceptions, all Saskatchewan residents with a valid Saskatchewan Health
Services card are eligible for coverage under the Drug Plan. The exceptions include
those who have prescription costs paid by another agency. For example:
•
•
•
•
•
Health Canada-Medical Services Branch
Workers' Compensation Board
Veterans Affairs Canada
members of the Royal Canadian Mounted Police
members of the Canadian Forces
Policy for Inclusion of Products in the Saskatchewan Formulary
1.
Only products produced by manufacturers approved as acceptable suppliers by the
SFC will be considered.
Companies without their own manufacturing facilities may be recognized as
approved suppliers if, in addition to meeting all other criteria outlined herein, they
provide adequate assurance that the product supplied is made under an acceptable
contractual arrangement which is approved by the SFC.
The procedures used to evaluate a drug manufacturer include:
• review of manufacturing facilities and procedures by:
• manufacturers' reports to the Committee;
• evaluation of selected documents pertaining to individual products;
• laboratory analysis of products selected for testing;
• exchange of information and views with Health Canada, and the Food and Drug
Administration (Washington), on products and manufacturers, as well as studies
relating to particular problems such as dissolution and bioavailability;
• reference to experience and knowledge available to the Committee with relation to
manufacturing practices and drug usage at the clinical level.
The review of drug manufacturers is ongoing to ensure that the quality of products
listed in the Saskatchewan Formulary is maintained.
2.
Only drug products formulated and produced in accordance with sound
manufacturing principles and found to comply with official standards will be
considered.
The official standards include:
• regulations under the Food and Drugs Act pertaining to drug manufacturing;
ix
• Good Manufacturing Practices for Drug Manufacturers and Importers, 3rd Edition,
1989- Health Canada;
• official compendia-B.P., U.S.P., N.F. and/or appropriate in-house standards;
• similar criteria, where applicable, as defined by International (WHO), U.S., and
British authorities.
3.
Only drug products which are valid therapeutic agents, with proven clinical
effectiveness, for the diagnosis, prevention or treatment of mental or physical
disorders will be listed. The availability of suitable alternative agents, and potential
for undesirable effects will be considered.
The medical literature and clinical studies, supplied by the manufacturers or
Committee members, are reviewed and evaluated to determine if the drug product is
therapeutically effective for the treatment of the condition(s) for which the drug is
indicated.
The clinical literature is also reviewed to determine the therapeutic advantages or
disadvantages in relation to alternative agents, which may or may not be listed in the
Saskatchewan Formulary.
The rate and severity of potential undesirable effects are reviewed and compared
with those for alternative products.
In reviewing products for which suitable alternatives are listed in the Formulary,
consideration will be given to the following additional criteria:
• clinical documentation must clearly demonstrate therapeutic advantages such as:
• more effective for treatment of the condition(s) for which the drug is intended;
• increased safety as shown by reduced toxicity and reduced incidence of
adverse reactions and/or side effects;
• improved dosing schedule;
• reduced potential for abuse or inappropriate use;
OR
• anticipated cost of a product of equivalent therapeutic effectiveness must offer a
potential economic advantage over listed alternatives.
4.
The cost of therapy relative to the clinical efficacy is reviewed and compared to the
cost of therapy relative to the clinical efficacy of alternative agents.
An increased cost may be justified if the drug product produces better clinical results
in a significant portion of the patient population, demonstrates fewer or less severe
undesirable effects, or has a dosage regime which improves patient compliance.
The cost of oral combination products relative to the combined costs of the single
entities, the cost of the various doage strengths relative to therapeutic advantages,
and the cost of additional dosage forms relative to the therapeutic advantages will be
considered when reviewing such products.
5.
Some drug products will not be listed, but may be made available on Exception Drug
Status for treatment of selected clinical indications. (See Appendix A)
6.
Oral combination products are required to meet the following additional criteria:
• each component must make a contribution to the claimed effect;
x
• the dosage of each component (amount, frequency, duration of therapeutic effect)
must be such that the combination is safe and effective for a significant patient
population, requiring such concurrent therapy as defined in the labelling;
• a component may be added to:
• enhance safety or effectiveness of the principal active ingredient;
• minimize the potential for abuse of the principal active ingredient.
• combination fixed ratio must be "right" for:
• significant portion of patients;
• significant amount of natural history of disease.
• the manufacturer must provide the standards he has adopted for the product (inhouse or other) and these standards must be acceptable to the DQAC;
• the manufacturer must provide evidence that he can consistently meet these
standards.
7.
Sustained, prolonged or delayed release dosage forms are required to meet the
following additional criteria:
• clinical studies have demonstrated the sustained, prolonged or delayed action of
the active ingredient;
• the dosage form possesses therapeutic advantages in the treatment of the
disease entity for which the product is indicated;
• the manufacturer must provide the standards he has adopted for the product (inhouse or other) and these standards must be acceptable to the DQAC;
• the manufacturer must provide evidence that he can consistently meet these
standards.
8.
The various strengths of one dosage form will be considered if they possess
therapeutic advantages and meet the required standards for quality and cost.
9.
The various dosage forms of a drug product will be evaluated individually.
10. Drug products not listed in the Schedules of the Food and Drugs Act, Narcotic
Control Act or the Saskatchewan Pharmacy Act, but usually sold on prescription, will
be considered for inclusion.
11. Products which contain the same amount of the same active ingredient in an
equivalent dosage form and are of acceptable equivalent therapeutic effectiveness
will be listed as interchangeable.
12. The following will not be listed:
•
•
•
•
•
fertility agents;
drugs used in erectile dysfunction;
certain over-the-counter preparations;
drugs used primarily in hospitals;
antineoplastic agents (these are provided to patients through the Saskatchewan
Cancer Agency);
• anti-tuberculosis drugs;
xi
• blood derivatives-immune serum globulin for prophylaxis against infectious
hepatitis or measles or for treatment of immune deficiency disease is available
from the Health Offices.
• vaccines and sera-most immunological agents are available from the Health
Offices.
13. Drug products identified by trade names deemed to be inappropriate, confusing
and/or misleading may not be listed. Some examples include:
• products with similar or identical trade names but containing different active
ingredients;
• products with a different strength of ingredient, manufactured by the same
supplier, but with a different trade name.
Policy for Formulary Deletion
The Minister of Health may delete any product from the Saskatchewan Formulary under
the following circumstances:
1. Upon the recommendation of the SFC:
• where the standards of quality and/or production have altered and are not
considered to meet accepted standards;
• where new information demonstrates that the product does not have adequate
therapeutic benefit;
• where undesirable effects of the product make the continued listing of the product
inappropriate;
• where new products possessing clearly demonstrated therapeutic advantages
have been listed, thereby making the continued listing of the product unnecessary.
2. Upon the recommendation of the Drug Plan where there are undesirable financial,
supply or administrative implications to continued listing of a product, the Drug Plan
will consult with the SFC prior to making a recommendation. The comments of the
Committee will be brought to the attention of the Minister.
3. Where the Minister of Health believes a product should be deleted, the Minister will
consult with the SFC before making a final decision.
Exception Drug Status
Certain drug products may be considered for Exception Drug Status coverage under one
or more of the following circumstances:
• the drug is ordinarily administered only to hospital inpatients and is being
administered outside of a hospital because of unusual circumstances;
• the drug is not ordinarily prescribed or administered in Saskatchewan but is being
prescribed because it is required in the diagnosis or treatment of a patient having
an illness, disability or condition rarely found in this province;
• the drug is infrequently used since therapeutic alternatives listed in the Formulary
are usually effective but are contraindicated or found to be ineffective because of
the clinical condition of the patient;
• the drug has been deleted from the Formulary, but is required by patients who
were previously stabilized on the drug;
• the drug has potential for use in other than approved indications;
• the drug has potential for the development of widespread inappropriate use;
xii
• the drug is more expensive than listed alternatives and offers an advantage in only
a limited number of indications.
The following information is required to process Exception Drug Status requests:
•
patient name
•
patient Health Services Number (9 digits)
•
name of drug
•
diagnosis relevant to use of drug
•
prescriber name
•
prescriber phone number
Saskatchewan Prescription Drug Plan policy does not allow a fee to be charged to clients
for Exception Drug Status applications made to the Drug Plan on the client's behalf.
See Appendix A for further details regarding Exception Drug Status.
"No Substitution" Prescriptions
Drug Plan benefits, as well as credits to deductibles, will be based only on the lowest
priced interchangeable brand as listed in the Formulary. Although the Formulary will
continue to list all approved brands, patients will, in addtion to their normal share of cost,
be responsible for any incremental cost associated with the selection of a higher cost
brand.
It is important to note that both generic and brand name products are manufactured
under the same standards of good manufacturing practice, and that only those brands
which meet the SFC's standards for bioequivalence are accepted as interchangeable in
Saskatchewan.
In cases where a patient experiences problems with a specific brand of a medication, a
prescriber may make application for exemption from the cost of the "no sub" brand. (See
Appendix E for details.)
Adverse Drug Reactions
The Health Protection Branch encourages the reporting of suspected adverse drug
reactions. In Saskatchewan, prescribers, pharmacists, and other health professionals
are encouraged to participate in the Sask ADR Program.
Suspected adverse reactions are reported by the observers to this program, which in
turn, will send the original report to the Health Protection Branch in Ottawa.
See Appendix D for forms and guidelines.
Index
Drug products are listed numerically by DIN (drug identification number) as well as
alphabetically by official name and brand name at the back of the Formulary.
xiii
Pharmacologic-Therapeutic Classification of Drugs
The drugs are classified according to the pharmacologic-therapeutic classification
developed by the American Society of Hospital Pharmacists for the purpose of the
American Hospital Formulary Service.
Permission to use this system has been granted by the American Society of Hospital
Pharmacists. The Society is not responsible for the accuracy of transpositions or
excerpts from the original content.
Within each therapeutic classification the drugs are listed alphabetically according to their
official names. Under each drug, acceptable products are listed. Drugs with multiple
uses may be listed in one or more classes.
Prescription Quantities
The Drug Plan places no limitation on the quantities of drugs that may be prescribed.
Prescribers shall exercise their professional judgment in determining the course and
duration of treatment for their patients. However, in most cases, the Drug Plan will not
pay benefits or credit deductibles for more than a 3-month supply of a drug at one time.
The quantity dispensed for one dispensing fee shall be determined by the terms of the
contract in force when the prescription was dispensed. For drugs listed on the Two
Month and 100 Day maintenance drug lists, refer to Appendix H. Because of possible
waste and the potential danger of storing large quantities of potent drugs in the home, the
Drug Plan does not encourage the dispensing of unreasonably large quantities of
prescription drugs.
Release of Patient Drug Profiles
Saskatchewan prescribers or pharmacists wishing to obtain a drug profile for patients in
their care may do so by submitting a written request, stating the patient's name, address,
date of birth and Health Services Number to the address below. The drug profile will
include all claims for Formulary and Exception Drug Status drugs submitted to the Drug
Plan on behalf of the patient in the previous 9-12 months.
Please submit written request to:
Executive Director
Saskatchewan Health
2nd Floor, 3475 Albert Street
Regina, S4S 6X6
FAX: (306) 787-8679
xiv
LEGEND
LEGEND
1
Pharmacological-Therapeutic classification.
2
Pharmacological-Therapeutic sub-classification.
3
Nonproprietary or generic name of the drug.
4
An asterisk (*) to the left of a drug strength and dosage form indicates that the
products listed below are interchangeable.
5
An asterisk (*) to the right of a price indicates that the Drug Plan has
negotiated a contract price for that product.
Pharmacists will dispense these products except where a prescriber indicates
"no substitution" for a product in an interchangeable category (see page xii).
In cases where contracts have been negotiated with two suppliers of an
interchangeable product, either brand may be used. The prices are expressed
as decimal dollars.
6
The following symbol: , to the left of a drug strength and dosage form
indicates that the products listed below are NOT interchangeable.
7
Drug strength and dosage form.
8
The Drug Identification Number (DIN), which has been assigned by Health
Canada, uniquely identifies the drug product and its manufacturer, name and
strength of active ingredients, route of administration, and pharmaceutical
dosage form.
9
This product requires Exception Drug Status (EDS) approval (see Appendix A
for EDS criteria).
10
All active ingredients of combination products are listed.
11
Strengths of active ingredients are listed in the same order as the ingredients.
This example indicates that the tablet contains 300mg of acetaminophen and
30mg of codeine.
12
Brand name of drug.
13
Three letter identification code assigned to each manufacturer. The codes are
listed in Index A near the back of the Formulary.
14
The size of vials or ampoules of injectables is listed in brackets.
15
The size of a tube of ophthalmic ointments is listed in brackets.
1 8
08:00 ANTI-INFECTIVE AGENTS
2 8
08:12.16 ANTIBIOTICS (PENICILLINS)
3 8
AMOXICILLIN (AMOXYCILLIN)
* 250MG CAPSULE
4 8
NU-AMOXI
NOVAMOXIN
APO-AMOXI
LIN-AMOX
PENTA-AMOXICILLIN
GEN-AMOXICILLIN
MED-AMOXICILLIN
AMOXIL-250
NXP
NOP
APX
LIN
PEN
GPM
MED
WYA
$
0.0837 * 7 5
0.1120
0.1120
0.1120
0.1120
0.1120
0.1120
0.2051
00010308
WARFILONE
MSD
$
0.1917
01918354
COUMADIN
DUP
00865567
00406724
00628115
02181487
02229584
02238171
02239761
02041294
WARFARIN
6 8
x
5MG TABLET
0.3150
CIPROFLOXACIN
500MG TABLET
7 8
8 8
10 8
11 8
02155966
CIPRO (EDS) 7 9
BAY
$
2.7188
TCH
$
0.0494
ACETAMINOPHEN/CODEINE
* 300MG/30MG TABLET
00608882
EMTEC-30 7 12
00666130
EMPRACET-30
13
8 GLA
0.0494
FLUPENTHIXOL DECANOATE
20MG/ML INJECTION SOLUTION (10ML) 7 14
02156032
FLUANXOL DEPOT
LUD
$
73.1900
SCH
SAB
$
4.3400
4.3400
GENTAMICIN SO4
* 5MG/G OPHTHALMIC OINTMENT (3.5G)
00028339
02230888
GARAMYCIN
GENTAMICIN SULFATE
xvii
7 15
ANTI-INFECTIVE AGENTS
8:00
08:04.00 AMEBICIDES
DIIODOHYDROXYQUIN
650MG TABLET
01997750
DIODOQUIN
GLW
$
0.6578
JAN
$
3.1592
RBP
$
0.9700
RBP
$
0.0629
BAY
$
5.7510
PFI
$
0.7840
PFI
$
0.1882
WLA
$
0.1721
08:08.00 ANTHELMINTICS
MEBENDAZOLE
100MG TABLET
00556734
VERMOX
PIPERAZINE ADIPATE
2G/PKG GRANULES
02100215
ENTACYL
120MG/ML ORAL SUSPENSION
02100223
ENTACYL
PRAZIQUANTEL
600MG TABLET
02230897
BILTRICIDE
PYRANTEL PAMOATE
125MG TABLET
01944363
COMBANTRIN
01944355
COMBANTRIN
PYRVINIUM PAMOATE
02019809
VANQUIN
2
Saskatchewan
Health
SELECTION
OF
ANTIMICROBIAL
DRUGS
November 1999
Special Review Committee
on
Antibiotics
Ms. B. Evans, BSP, MSc; Dr. R.J. Herman, M.D., FRCP (C); Dr. I.H. Holmes, MD, FRCP (C);
Dr. P.M. Peloso, M.D.,M.Sc, FRCP (C); Dr. D. Quest, Ph.D; Dr. A.K. Ramlall, BSc, MD, FAAP, FRCP (C);
Dr. B.R. Schnell, B.S.P., Ph.D.; Dr. Y.M. Shevchuk, Pharm.D., FCSHP; Dr. B.J. K.Tan, MD, FRCP (C);
Dr. J.M. Tuchek, Ph.D; Dr. K. E. Williams, MD, FRCP (C)
PRINCIPLES OF ANTIMICROBIAL DRUG SELECTION
There is national and international concern regarding the rising incidence
of resistance to antimicrobial agents.
Strategies to combat this problem include:
??
??
??
??
community-based monitoring of resistance;
avoiding antimicrobial agents to treat viral infections;
use of narrow spectrum antimicrobial agents;
encouraging patient compliance.
The determination of rational and effective antimicrobial therapy involves
the consideration of:
?? Focus of infection The possible causative organisms and most effective
classes of antimicrobial agents can then be identified. Gram stains and
culture and sensitivity data should be obtained if possible.
?? Local susceptibility patterns of the possible organisms involved. The
incidence of antibiotic resistance in the community setting helps determine
the antibiotic of choice.
?? Host factors or the variations in patient response These include the
patient’s history of allergy or adverse reactions, immunologic status, age,
pregnancy, underlying disease states and hepatic or renal function.
?? Treatment setting In the ambulatory setting low toxicity and ease of
administration (usually the oral route) are the most important factors to
consider. As well, using drugs which require less frequent administration
may improve compliance.
?? Cost This is important when efficacy and toxicity issues are equivalent.
ANTIBIOTIC CHOICES FOR
CLINICAL
S
K
I
N
MODIFYING
CIRCUMSTANCES
ADULT
& CHILD
Strep. pyogenes
S. aureus
BOILS
S. aureus
COMPLICATED
ECTHYMA
Switch to penicillin V if culture shows S.
pyogenes . Topical treatment if not
widespread
Mupirocin 2% ?
Fusidic acid 2% ?
S. aureus
Polymicrobial
Cloxacillin
Cephalexin
Clindamycin
Erythromycin
Clarithromycin *
ADULT
Strep Grp A
Penicillin V
Cefazolin iv
ERYSIPELAS
ADULT
& CHILD
CELLULITIS
ADULT & CHILD
>5yoa
uncomplicated
Strep group A
S. aureus
H. influenzae (child)
Strep. Grp A
S. aureus
Penicillin V
Cefazolin iv
CEPH2* (children)
Cloxacillin
Cephalexin
Penicillin V
Amoxicillin
TMP/SMX and
Metronidazole
CEPH2 *
Azithromycin *
Clarithromycin *
Vancomycin iv
AM/CL *
Vancomycin iv
Folliculitis due to S. aureus can be
treated topically. Pseudomonas
folliculitis occurs in contaminated hot
tubs. Carbuncles are deeper requiring
drainage. No need to remove crust.
Systemic therapy does not always
shorten treatment.
Systemic treatment preferred.
Debridement & cleansing of lesions
indicated
DOG BITES
T
R
A
C
T
SINUSITIS
(acute)
ADULT & CHILD
S. aureus
Strep. Grp A & B
Enterococci
Mixed aerobic &
anaerobes
P. multocida
S. aureus
Strep Grp A,
oral anaerobes
P. multocida
Strep viridans
Others
Common:
S. pneumoniae
H. influenzae
M. catarrhalis
Strep. Grp A
OTITIS MEDIA
PHARYNGITIS
TONSILLITIS
(acute)
AM/CL *
AM/CL *
Amoxicillin (adult &
child)
TMP/SMX (adult)
ACUTE
ADULT & CHILD
Common:
S. pneumoniae
H. influenzae
M. catarrhalis
Strep. grp A
S. aureus
Adult:
Amox
CHRONIC
ADULT & CHILD
Polymicrobial
S. aureus
Proteus sp.
Klebsiella sp.
E.coli
B. fragilis
Ps. aeruginosa
Viral
Strep. grp A
Sofracort drops
Garasone drops
80-90%
CHILD 5-15 yoa
ADULTS
AM/CL
= Amoxicillin/Clavulanate
TMP/SMX = Trimethoprim/Sulfamethoxazole
nd
CEPH2
= 2 generation cephalosporin
Strep grp A
M. pneumoniae
C. pneumoniae
Viral
None
Penicillin V
Amoxicillin
Penicillin V
None
Debride lesions. 10 day treatment
Erythromycin
Clarithromycin *
Clindamycin
AM/CL *
TMP/SMX &
Clindamycin
If Pseudomonas , use Ciprofloxacin.
Minimum 10 day treatment. For severe
cellulitis, DO NOT use Cipro alone; add
Metronidazole or Clindamycin
Clindamy cin &
Ciprofloxacin *
TCN
Doxycycline
Erythromycin
Clarithromycin*
TCN
Doxycycline
Less Common:
S. aureus
Gram( -) bacilli
Anaerobes
(use 2nd line agents)
Resp viruses
LARYNGITIS
Key:
COMMENTS
Erythromycin
Clarithromycin *
Clindamycin
CAT BITES
R
E
S
P
I
R
A
T
O
R
Y
ANTIBIOTIC SELECTION
First line
Second line
Mupirocin 2%?
Fusidic acid 2%?
Cloxac illin
Cephalexin
No treatment
Self limiting
IMPETIGO
Bullous and nonbullous
FOLLICULITIS
FURUNCULOSIS
CARBUNCLES
DIABETIC FOOT
U
P
P
E
R
PROBABLE
ORGANISMS
Ped:
Amox
AM/CL *
Doxycycline
CEPH2*
Cefixime*
Clarithromycin *
Azithromycin *
ER/SX (child)
Erythromycin
Treat 10-14 days.
Treat with decongestant for < 5 days.
Sinuses fully developed at 5-7 years.
40% spontaneously cure. If > 10-30
days, then look at structural defects.
CHRONIC SINUSITIS-may need 2-4wk
treatment
Adult:
Ped:
TMP/SMX
AM/CL *
AM/CL *
CEPH2*
Doxycycline
Cefixime *
CEPH2*
ER/SX
Cefixime *
Clarith *
Clarith *
Azith *
Azith *
Cortisporin drops
TMP/SMX
Cephalexin
AM/CL *
Erythromycin not to be used alone
None
Erythromycin
Cephalexin
Erythromycin
Cephalexin
Clarithromycin *
Azithromycin *
None
CFX-AX = Cefuroxime axetil
TCN
= Tetracycline
?
= Topical
In patients at high risk of drug-resistant
Streptococcus pneumoniae the
Amoxicillin dose should be 80-90mg/kg
per day.
Topical treatment unsuccessful without
careful cleaning of external canal.
83 % bacterial caus es due to
streptococci.
ER/SX
FQ
*
= Erythromycin/Sulfisoxazole
= Fluoroquinolone
= Exception Drug Status
COMMON INFECTIOUS DISEASES
CLINICAL
U
R
I
N
A
R
Y
T
R
A
C
T
G
E
N
I
T
A
L
COMMENTS
Purulent sputum or
symptoms > 2 weeks
(bacterial)
Child
10 months to 2 years
S. pneumoniae
C. pneumoniae
M. pneumoniae
TCN
Erythromycin
RSV ( 50%)
None
Mild to moderate
Adult
50% of acute
exacerbation of
chronic bronchitis is
non-bacterial.
Severe Clinical
Presentation
S. pneumoniae
H. influenzae
M. catarrhalis
M. pneumoniae
TCN
TMP/SMX
Amoxicillin
Doxycycline
AM/CL *
CEPH2*
Clarithromycin *
Azithromycin *
TCN & erythromycin effective against mycoplasma.
DO NOT use erythromycin alone in H. influenzae.
S. pneumoniae
H. influenzae
M. catarrhalis
M. pneumoniae
TMP/SMX
AM/CL*
CEPH2*
above with or
without
Erythromycin
Levofloxacin*
DO NOT use erythromycin alone in H. influenzae.
WHOOPING
COUGH
Adult & Child
Bordetella
pertussis
Erythromycin
PNEUMONIA
COMMUNITY
(Mild to moderate, no
comorbidity)
S. pneumoniae
C. pneumoniae
M. pneumoniae
H. influenzae
Erythromycin
Tetracycline
TMP/SMX
TCN
Amoxicillin
Ampicillin
Clarithromycin *
Azithromycin *
Doxycycline
Clarithromycin *
Azithromycin *
Levofloxacin*
NURSING HOME
OR COMMUNITY
(Mild to moderate with
comorbidity)
Above plus:
Legionella sp.
Oral anaerobes
Gram(-) bacilli
S. aureus
Acute Normal Urinary
Tract – females
E.coli
S. saprophyticus
Gram( -) bacilli
TMP/SMX
CEPH2*
AM/CL*
(aspiration)
PLUS macrolide
antibiotic
TMP/SMX
Trimethoprim
Nitrofurantoin
Macrobid
Acute pregnant
women
E. coli
Klebsiella
Proteus
Enterococci
E. coli
S. saprophyticus
Gram( -) bacilli
ACUTE
EXACERBATION
OF CHRONIC
BRONCHITIS
CYSTITIS
(acute)
PYELONEPHRITIS
Recurrence < 1
month
Recurrence > 3
episodes/year
NON –
OBSTRUCTIVE
PROSTATITIS
ACUTE BACTERIAL
mild to moderate
EPIDIDYMOORCHITIS
< 35 yoa sexually
transmitted
> 35 yoa non-sexually
transmitted
GONORRHEA
T
R
A
C
T
ANTIBIOTIC SELECTION
First line
Second line
None
L
O
W
E BRONCHIOLITIS
R
T
R
A
C
T
PROBABLE
ORGANISMS
Viral (80%)
ACUTE
BRONCHITIS
R
E
S
P
I
R
A
T
O
R
Y
MODIFYING
CIRCUMSTANCES
Adult or Child
SYPHILIS
NONGONOCOCCAL
URETHRITIS/
CERVICITIS
Uncomplicated
cervicitis, urethritis,
vaginitis, anorectal
infection
Early, primary,
secondary latent < 1yr
E. coli
K. pneumoniae
Gram( -) bacilli
E. faecalis
Enterobacter
S. saprophyticus
P. mirabilis
Amoxicillin
Cephalexin
Nitrofurantoin
Macrobid
TMP/SMX
Trimethoprim
Nitrofurantoin
Macrobid
TMP/SMX
Trimethoprim
Norfloxacin *
Ciprofloxacin *
Gent & Amp iv
Doxycycline
Clarithromycin *
Azithromycin *
Current literature does not support the use of
antibiotics to treat
Doxycycline may benefit those with acute cough
and purulent sputum, especially those over 55 yoa
Use Ribavirin for in-patients who are
immunocompromised or have birth defects.
Other: stop smoking, vaccinate against S.
pneumoniae.
Levofloxacin*
Amoxicillin
Norfloxacin *
Ciprofloxacin *
Cephalexin
AM/CL *
TMP/SMX
Trimethoprim
Norfloxacin *
Ciprofloxacin *
Cephalexin
AM/CL *
E. coli
S. aureus
Gram( -) bacilli
Enterococcus
faecalis
Gonococcus
C. trachomatis
TMP/SMX
Trimethoprim
Norfloxacin *
Ciprofloxacin *
Erythromycin
Clarithromycin *
E. coli
Other Gram( -)
bacilli
TMP/SMX
Cephalexin
Ciprofloxacin *
Norfloxacin *
N. gonorrhea
Cefixime*
Ceftriaxone im.
Ciprofloxacin*
Norfloxacin *
Treponema
pallidum
Benzathine
penicillin G
Doxycycline
C. trachomatis
Doxycycline
Tetracycline
Azithromycin *
Erythromycin
Contact public health
Treatment for 10 days
Must start within 3 weeks of symptoms onset
Cleared from nasopharynx after 3 weeks
10% pneumoncocci resist TCN. If legionella, add
erythromycin or use clarithromycin or azithromycin
alone.
For severe infections or comorbidity (ie: COPD,
diabetes mellitus, renal insufficiency, heart failure),
may require combination treatment with a
cephalosporin and a macrolide antibiotic.
Expensive agents only when conventional agents
contraindicated because of resistant organisms,
side effects or allergies
3 days treatment adequate EXCEPT with
amoxicillin
AVOID TMP/SMX in last 6 weeks because
displacement of bilirubin.
NO Fluoroquinolones
3 day treatment, with follow-up cultures.
Retreat for 10-14 days based on cultures
Reassess at 6 months
Longterm lowdose TMP/SMX will not cause
resistance
Macrobid better tolerated than Nitrofurantoin
Treat for 14 days
Use ampicillin if enterococci
Treat for 4 – 6 weeks. Reassess if no improvement
after 2 weeks. Chronic infection may also be due
to Pseudomonas.
as for gonorrhea
Diagnosis based on laboratory investigations. All
patients with N. gonorrhea should be treated for
presumptive co-existing Chlamydia (Doxycycline or
Azithromycin).
ANTIBIOTIC SELECTION WITHIN THERAPEUTIC CLASSES
In many cases antibiotics within therapeutic classes have similar antimicrobial spectra and
provide equivalent therapeutic results. The differences between them are often
pharmacokinetic in nature.
Penicillins – Ampicillin and amoxicillin have similar antimicrobial spectra. Amoxicillin is
generally preferred over ampicillin because it is better absorbed, requires fewer doses per
day, can be taken with meals and may cause less diarrhea. It is similarly priced.
Amoxicillin in combination with ? -lactamase inhibitors markedly enhances its use in
penicillin resistant infections.
Macrolides – A number of different formulations of erythromycin are listed which have
been designed to reduce acid degradation and increase absorption. Gastrointestinal
intolerance is a problem with erythromycin. The newer macrolides, clarithromycin and
azithromycin, have somewhat improved chemical, antimicrobial, safety and
pharmacokinetic features over erythromycin. These products are administered once or
twice daily but are significantly more expensive.
Tetracyclines – The tetracyclines all have similar antimicrobial activity. Minocycline
causes a high incidence of vestibular toxicity which has limited its use. Doxycycline has
better gastrointestinal absorption, and higher tissue concentrations than tetracycline. It
has a mechanism of elimination that is independent of renal function and causes less
diarrhea. Doxycycline is preferred in patients with renal dysfunction. It (like minocycline)
can be taken without regard to meals, whereas tetracycline should be taken on a empty
stomach.
Oral Cephalosporins – There are now first (cephalexin), second (cefaclor, cefprozil,
cefuroxime) and third (cefixime) generation cephalosporins listed in the Saskatchewan
Formulary. Spectrum of activity and pharmacokinetic characteristics of the cephalosporins
vary considerably. These drugs should be considered individually and selected on the
basis of their spectrum of activity and route of administration. Generally the
cephalosporins are well tolerated and have a wide spectra of activity with overall safety.
Fluoroquinolones – The fluoroquinolones (norfloxacin, ciprofloxacin, levofloxacin)
provide oral therapy for gram-negative infections which previously required parenteral
therapy. They are effective against more gram-negative organisms including Ps.
aeruginosa, although culture and sensitivity testing should be done as there is some
resistance in Saskatchewan. The newer compound (levofloxacin) has enhanced activity
against streptococci (pneumococci). The quinolones have reasonably long elimination
half-lives and acceptable bioavailability. Differences between the quinolones exist in their
tolerability profiles and potential for various drug interactions. World wide development of
resistance to quinolones is a concern due to their escalating use.
08:12.00 ANTIBIOTICS
ANTIBIOTIC ASSOCIATED COLITIS OR PSEUDOMEMBRANOUS ENTEROCOLITIS
IS A SEVERE POTENTIALLY FATAL COLITIS WHICH MAY FOLLOW THE
ADMINISTRATION OF ANTIBIOTICS, MOST COMMONLY CLINDAMYCIN.
THE SYNDROME IS CAUSED BY A BACTERIAL TOXIN.
PATIENTS FOR WHOM ANTIBIOTICS ARE PRESCRIBED SHOULD BE ADVISED
TO DISCONTINUE THERAPY AND REPORT TO THE PHYSICIAN IF A
PERSISTANT DIARRHEA DEVELOPS AND/OR IF BLOOD OR MUCUS APPEARS
IN THE STOOL, AND SHOULD BE ADVISED NOT TO USE ANTIDIARRHEAL
PREPARATIONS WHILE ON THESE DRUGS AS THEY MAY EXACERBATE THE
CONDITION.
RECOMMENDED TREATMENT INCLUDES STOPPING ANTIBIOTICS AS SOON AS
POSSIBLE, CAREFUL ATTENTION TO FLUIDS AND ELECTROLYTES AND THE
USE OF AN APPROPRIATE ANTIBIOTIC (SUCH AS ORALLY ADMINISTERED
METRONIDAZOLE OR VANCOMYCIN) DIRECTED AGAINST THE TOXIN
PRODUCING ORGANISM.
08:12.02 ANTIBIOTICS (AMINOGLYCOSIDES)
GENTAMICIN SO4
* 40MG/ML INJECTION SOLUTION (2ML)
00223824
02145758
GARAMYCIN
GENTAMICIN SULPHATE
SCH
NOP
$
4.3000
4.3000
PCL
$
54.9575
APX
PFI
$
11.0779
15.1868
APX
PFI
$
3.7693
5.0581
TOBRAMYCIN
SEE APPENDIX A FOR EDS CRITERIA
60MG/ML INHALATION SOLUTION
02239630
TOBI (EDS)
08:12.04 ANTIBIOTICS (ANTIFUNGALS)
FLUCONAZOLE
* 150MG CAPSULE
02241895
02141442
APO-FLUCONAZOLE
DIFLUCAN
* 50MG TABLET
02237370
00891800
APO-FLUCONAZOLE (EDS)
DIFLUCAN (EDS)
3
08:12.04 ANTIBIOTICS (ANTIFUNGALS)
* 100MG TABLET
02237371
00891819
DIFLUCAN (EDS)
APX
PFI
$
6.6867
8.5699
PFI
$
1.0126
SCH
$
0.2775
SCH
$
0.4697
JAN
$
3.7975
JAN
$
0.8075
NXP
NOP
APX
JAN
$
1.2841
1.2841
1.2841
2.0383
TCH
$
0.0858
TAR
DOM
TCH
FTP
NDA
PMS
PPZ
$
0.0566
0.0566
0.0566
0.0566
0.0641
0.0643
0.2103
PMS
NVR
$
2.7393
3.8712
10MG/ML POWDER FOR ORAL SUSPENSION
02024152
DIFLUCAN P.O.S. (EDS)
GRISEOFULVIN (ULTRA-FINE)
250MG TABLET
00028274
FULVICIN U/F
500MG TABLET
00028282
FULVICIN U/F
ITRACONAZOLE
100MG CAPSULE
02047454
SPORANOX (EDS)
10MG/ML ORAL SOLUTION
02231347
SPORANOX (EDS)
KETOCONAZOLE
* 200MG TABLET
02122197
02231061
02237235
00633836
NU-KETOCON (EDS)
NOVO-KETOCONAZOLE (EDS)
APO-KETOCONAZOLE (EDS)
NIZORAL (EDS)
NYSTATIN
500,000U TABLET
02194198
NILSTAT
* 100,000U/ML ORAL SUSPENSION
00779121
02125145
02194201
02238544
00282219
00792667
00248169
NYADERM
DOM-NYSTATIN
NILSTAT
FTP-NYSTATIN
NADOSTINE
PMS-NYSTATIN
MYCOSTATIN
TERBINAFINE HCL
* 250MG TABLET
02240807
02031116
PMS-TERBINAFINE
LAMISIL
4
08:12.06 ANTIBIOTICS (CEPHALOSPORINS)
CEFACLOR
* 250MG CAPSULE
02185830
02230263
02231432
02231691
02237729
02177633
PMS-CEFACLOR (EDS)
APO-CEFACLOR (EDS)
NU-CEFACLOR (EDS)
NOVO-CEFACLOR (EDS)
SCHEINPHARM CEFACLOR(EDS)
DOM-CEFACLOR (EDS)
PMS
APX
NXP
NOP
SCN
DOM
$
0.6977
0.6977
0.6977
0.6977
0.6977
0.8722
PMS
APX
NXP
NOP
SCN
DOM
$
1.3699
1.3699
1.3699
1.3699
1.3699
1.7124
PMS
APX
DOM
LIL
$
0.0827
0.0827
0.0930
0.1183
PMS
APX
DOM
LIL
$
0.1514
0.1514
0.1702
0.2164
PMS
APX
DOM
LIL
$
0.2181
0.2181
0.2450
0.3117
AVT
$
3.3570
AVT
$
0.3598
* 500MG CAPSULE
02185849
02230264
02231433
02231693
02237730
02177641
PMS-CEFACLOR (EDS)
APO-CEFACLOR (EDS)
NU-CEFACLOR (EDS)
NOVO-CEFACLOR (EDS)
DOM-CEFACLOR (EDS)
* 25MG/ML ORAL SUSPENSION
02185857
02237500
02177668
00465208
PMS-CEFACLOR (EDS)
APO-CEFACLOR (EDS)
DOM-CEFACLOR (EDS)
CECLOR (EDS)
02185865
02237501
02177676
00465216
PMS-CEFACLOR (EDS)
APO-CEFACLOR (EDS)
DOM-CEFACLOR (EDS)
CECLOR (EDS)
02185873
02237502
02177684
00832804
PMS-CEFACLOR (EDS)
APO-CEFACLOR (EDS)
DOM-CEFACLOR (EDS)
CECLOR BID (EDS)
CEFIXIME
400MG TABLET
02195984
SUPRAX (EDS)
02195992
SUPRAX (EDS)
5
CEFPROZIL
250MG TABLET
02163659
CEFZIL (EDS)
BMY
$
1.6601
BMY
$
3.2550
BMY
$
0.1622
BMY
$
0.3245
GLA
$
1.5705
GLA
$
3.1112
GLA
$
0.1736
NOP
$
0.1620
NOP
$
0.3240
PEN
NOP
APX
NXP
PMS
DOM
LIL
$
0.1140 *
0.1620
0.1620
0.1620
0.1620
0.1966
0.3468
500MG TABLET
02163667
CEFZIL (EDS)
02163675
CEFZIL (EDS)
02163683
CEFZIL (EDS)
CEFUROXIME AXETIL
250MG TABLET
02212277
CEFTIN (EDS)
500MG TABLET
02212285
CEFTIN (EDS)
02212307
CEFTIN (EDS)
CEPHALEXIN MONOHYDRATE
250MG CAPSULE
00342084
NOVO-LEXIN
500MG CAPSULE
00342114
NOVO-LEXIN
* 250MG TABLET
02229587
00583413
00768723
00865877
02177781
02177846
00403628
PENTA-CEPHALEXIN
NOVO-LEXIN
APO-CEPHALEX
NU-CEPHALEX
PMS-CEPHALEXIN
DOM-CEPHALEXIN
KEFLEX
6
* 500MG TABLET
02229588
00583421
00768715
00865885
02177803
02177854
00244392
PENTA-CEPHALEXIN
NOVO-LEXIN
APO-CEPHALEX
NU-CEPHALEX
PMS-CEPHALEXIN
DOM-CEPHALEXIN
KEFLEX
PEN
NOP
APX
NXP
PMS
DOM
LIL
$
0.2216 *
0.3240
0.3240
0.3240
0.3240
0.3871
0.6954
NOP
PMS
DOM
LIL
$
0.0352
0.0352
0.0409
0.0486
NOP
PMS
DOM
LIL
$
0.0712
0.0712
0.0829
0.0980
00342106
02177811
02177862
00015547
NOVO-LEXIN
PMS-CEPHALEXIN
DOM-CEPHALEXIN
KEFLEX
00342092
02177838
02177870
00035645
NOVO-LEXIN
PMS-CEPHALEXIN
DOM-CEPHALEXIN
KEFLEX
08:12.12 ANTIBIOTICS (MACROLIDES)
PRESCRIPTIONS FOR SOLID DOSAGE FORMS OF ERYTHROMYCIN SHOULD BE
FILLED WITH AN ERYTHROMYCIN BASE PREPARATION OF THE STRENGTH
PRESCRIBED; DISPENSE THE STEARATE AND ESTOLATE ONLY WHEN
SPECIFICALLY PRESCRIBED.
AZITHROMYCIN
250MG CAPSULE
02091291
ZITHROMAX (EDS)
PFI
$
5.1386
PFI
$
5.1386
PFI
$
12.3326
PFI
$
1.1111
PFI
$
1.5740
250MG TABLET
02212021
ZITHROMAX (EDS)
600MG TABLET
02231143
ZITHROMAX (EDS)
02223716
ZITHROMAX (EDS)
02223724
ZITHROMAX (EDS)
7
CLARITHROMYCIN
250MG TABLET
01984853
BIAXIN (EDS)
ABB
$
1.6048
ABB
$
3.2095
ABB
$
0.2817
ABB
$
0.0492
ABB
$
0.5137
NOP
PDA
$
0.2301
0.5024
PDA
$
0.5581
NOP
$
0.0297
NOP
$
0.0598
NOP
ABB
$
0.0671
0.0748
NOP
ABB
$
0.0899
0.1133
500MG TABLET
02126710
BIAXIN (EDS)
02146908
BIAXIN (EDS)
ERYTHROMYCIN BASE
250MG TABLET
00244635
ERYTHROMID
333MG PARTICLE COATED TABLET
00769991
PCE
* 250MG CAPSULE (ENTERIC COATED PELLETS)
00878669
00607142
NOVO-RYTHRO-ENCAP
ERYC
333MG CAPSULE (ENTERIC COATED PELLETS)
00873454
ERYC
ERYTHROMYCIN ESTOLATE
00021172
NOVO-RYTHRO ESTOLATE
00262595
ERYTHROMYCIN ETHYLSUCCINATE
00605859
00000299
NOVO-RYTHRO ETHYLSUCC.
EES 200
00652318
00453617
EES 400
8
ERYTHROMYCIN STEARATE
* 250MG TABLET
00545678
02051850
APO-ERYTHRO-S
NU-ERYTHROMYCIN-S
APX
NXP
$
0.0940
0.0940
ABB
$
0.0440
ABB
$
0.0782
NXP
NOP
APX
LIN
PEN
GPM
MED
WYA
$
0.0810 *
0.1120
0.1120
0.1120
0.1120
0.1120
0.1120
0.2051
NXP
NOP
APX
LIN
PEN
GPM
MED
WYA
$
0.1578 *
0.2181
0.2181
0.2181
0.2181
0.2181
0.2181
0.4181
NOP
WYA
$
0.2512
0.3138
NOP
WYA
$
0.3700
0.4770
25MG/ML ORAL LIQUID
00000302
ERYTHROCIN
50MG/ML ORAL LIQUID
00273023
ERYTHROCIN
* 250MG CAPSULE
00865567
00406724
00628115
02181487
02229584
02238171
02239761
02041294
NU-AMOXI
NOVAMOXIN
APO-AMOXI
LIN-AMOX
PENTA-AMOXICILLIN
GEN-AMOXICILLIN
MED-AMOXICILLIN
AMOXIL-250
* 500MG CAPSULE
00865575
00406716
00628123
02181495
02233017
02238172
02239762
02041308
NU-AMOXI
NOVAMOXIN
APO-AMOXI
LIN-AMOX
PENTA-AMOXICILLIN
GEN-AMOXICILLIN
MED-AMOXICILLIN
AMOXIL
* 125MG CHEWABLE TABLET
02036347
00714887
NOVAMOXIN
AMOXIL
* 250MG CHEWABLE TABLET
02036355
02041286
NOVAMOXIN
AMOXIL
9
00865540
00452149
00628131
02181509
02229582
02041316
NU-AMOXI
NOVAMOXIN
APO-AMOXI
LIN-AMOX
PENTA-AMOXICILLIN
AMOXIL-125
NXP
NOP
APX
LIN
PEN
WYA
$
0.0149 *
0.0217
0.0217
0.0217
0.0217
0.0393
NXP
NOP
APX
LIN
PEN
WYA
$
0.0223 *
0.0326
0.0326
0.0326
0.0326
0.0637
00865559
00452130
00628158
02181517
02229583
02042592
NU-AMOXI
NOVAMOXIN
APO-AMOXI
LIN-AMOX
PENTA-AMOXICILLIN
AMOXIL-250
AMOXICILLIN TRIHYDRATE/POTASSIUM CLAVULANATE
250MG/125MG TABLET
01916866
CLAVULIN-250 (EDS)
SMJ
$
0.9654
SMJ
$
1.4481
SMJ
$
2.1721
SMJ
$
0.1144
SMJ
$
0.1410
SMJ
$
0.1922
SMJ
$
0.2633
NOP
APX
NXP
$
0.0889
0.0889
0.0889
NOP
APX
NXP
$
0.1723
0.1723
0.1723
500MG/125MG TABLET
01916858
CLAVULIN-500 (EDS)
875MG/125MG TABLET
02238829
CLAVULIN-875 (EDS)
25MG/6.25MG/ML ORAL SUSPENSION
01916882
CLAVULIN-125F (EDS)
02238831
CLAVULIN-200 (EDS)
01916874
CLAVULIN-250F (EDS)
02238830
CLAVULIN-400 (EDS)
AMPICILLIN
* 250MG CAPSULE
00020877
00603279
00717657
NOVO-AMPICILLIN
APO-AMPI
NU-AMPI
* 500MG CAPSULE
00020885
00603295
00717673
NOVO-AMPICILLIN
APO-AMPI
NU-AMPI
10
00021121
00603260
00717495
NOVO-AMPICILLIN
APO-AMPI
NU-AMPI
NOP
APX
NXP
$
0.0174
0.0174
0.0174
NOP
APX
NXP
$
0.0285
0.0285
0.0285
BRI
$
2.0700
NOP
APX
NXP
$
0.1078
0.1078
0.1078
NOP
APX
NXP
$
0.2112
0.2112
0.2112
NOP
APX
NXP
$
0.0259
0.0259
0.0259
LIH
$
0.0537
NOP
APX
NXP
LIH
$
0.0407
0.0407
0.0407
0.0407
APX
NDA
$
0.0266
0.0288
00021148
00603287
00717649
NOVO-AMPICILLIN
APO-AMPI
NU-AMPI
500MG INJECTION POWDER
00004057
AMPICIN
CLOXACILLIN
* 250MG CAPSULE
00337765
00618292
00717584
NOVO-CLOXIN
APO-CLOXI
NU-CLOXI
* 500MG CAPSULE
00337773
00618284
00717592
NOVO-CLOXIN
APO-CLOXI
NU-CLOXI
* 25MG/ML ORAL LIQUID
00337757
00644633
00717630
NOVO-CLOXIN
APO-CLOXI
NU-CLOXI
PENICILLIN V (BENZATHINE)
02229617
PEN-VEE
PENICILLIN V (POTASSIUM)
* 300MG TABLET
00021202
00642215
00717568
02232391
NOVO-PEN-VK
APO-PEN-VK
NU-PEN-VK
PVF-K 500
* 25MG/ML ORAL SOLUTION
00642223
00018635
APO-PEN-VK
NADOPEN-V 200
11
08:12.24 ANTIBIOTICS (TETRACYCLINES)
THE USE OF TETRACYCLINES DURING TOOTH DEVELOPMENT (LAST HALF
OF PREGNANCY, INFANCY AND CHILDHOOD TO THE AGE OF 8 YEARS)
MAY CAUSE PERMANENT TOOTH DISCOLORATION (YELLOW-GRAY-BROWN).
THIS REACTION IS MORE COMMON DURING LONG-TERM USE OF
TETRACYCLINES, BUT HAS BEEN OBSERVED FOLLOWING SHORT-TERM
COURSES. ENAMEL HYPOPLASIA HAS ALSO BEEN REPORTED.
TETRACYCLINE DRUGS, THEREFORE, SHOULD NOT BE USED IN THIS
AGE GROUP UNLESS OTHER DRUGS ARE NOT LIKELY TO BE EFFECTIVE
OR ARE CONTRAINDICATED.
DOXYCYCLINE
* 100MG CAPSULE
02044668
00740713
00817120
02093103
02140039
00024368
NU-DOXYCYCLINE
APO-DOXY
DOXYCIN
DOXYTEC
ALTI-DOXYCYCLINE
VIBRAMYCIN
NXP
APX
GPM
TCH
ALT
PFI
$
0.4346 *
0.6359
0.6359
0.6359
0.6359
1.7703
NXP
GPM
APX
TCH
ALT
NOP
PEN
PFI
$
0.4346 *
0.6359
0.6359
0.6359
0.6359
0.6359
0.6359
1.7702
ALT
APX
NOP
GPM
MED
WYA
$
0.5805
0.5805
0.5805
0.5805
0.5805
0.6456
* 100MG TABLET
02044676
00860751
00874256
02091232
02142058
02158574
02231771
00578452
NU-DOXYCYCLINE
DOXYCIN
APO-DOXY
DOXYTEC
ALTI-DOXYCYCLINE
NOVO-DOXYLIN
PENTA-DOXYCYCLINE
VIBRA-TABS
MINOCYCLINE HCL
* 50MG CAPSULE
01914138
02084090
02108143
02230735
02237875
02173514
ALTI-MINOCYCLINE (EDS)
APO-MINOCYCLINE (EDS)
NOVO-MINOCYCLINE (EDS)
GEN-MINOCYCLINE (EDS)
MED-MINOCYCLINE (EDS)
MINOCIN (EDS)
12
08:12.24 ANTIBIOTICS (TETRACYCLINES)
* 100MG CAPSULE
01914146
02084104
02108151
02230736
02237876
02239982
02173506
SCHEIN MINOCYCLINE (EDS)
MINOCIN (EDS)
ALT
APX
NOP
GPM
MED
SCN
WYA
$
1.1211
1.1211
1.1211
1.1211
1.1211
1.1211
1.2456
NOP
APX
NXP
$
0.0207
0.0207
0.0207
NOP
$
0.0237
TETRACYCLINE
* 250MG CAPSULE
00021059
00580929
00717606
NOVO-TETRA
APO-TETRA
NU-TETRA
25MG/ML ORAL LIQUID
00151416
NOVO-TETRA
08:12.28 ANTIBIOTICS (MISCELLANEOUS ANTIBIOTICS)
CLINDAMYCIN HCL
SEE NOTE ON PAGE 3
* 150MG CAPSULE
02130033
02241709
00030570
ALTI-CLINDAMYCIN
NOVO-CLINDAMYCIN
DALACIN C
ALT
NOP
PHU
$
0.5895
0.5895
0.8896
ALT
NOP
PHU
$
1.1791
1.1791
1.7792
PHU
$
0.1197
* 300MG CAPSULE
02192659
02241710
02182866
ALTI-CLINDAMYCIN
NOVO-CLINDAMYCIN
DALACIN C
CLINDAMYCIN PALMITATE HCL
SEE NOTE ON PAGE 3
00225851
DALACIN C
13
08:12.28 ANTIBIOTICS (MISCELLANEOUS ANTIBIOTICS)
VANCOMYCIN HCL
125MG CAPSULE
00800430
VANCOCIN (EDS)
LIL
$
7.1133
LIL
$
14.2266
LIL
$
28.4600
LIL
$
55.4500
NXP
TCH
APX
ALT
GLA
$
0.7734 *
0.9530
0.9530
0.9530
1.2706
TCH
NXP
APX
ALT
GLA
$
1.8758
1.8758
1.8758
1.8758
2.5010
NXP
APX
ALT
TCH
GLA
$
3.0985
3.0985
3.0985
3.0986
4.9181
250MG CAPSULE
00788716
VANCOCIN (EDS)
500MG INJECTION
00015423
VANCOCIN (EDS)
1GM INJECTION
00722146
VANCOCIN (EDS)
08:18.00 ANTIVIRALS
ACYCLOVIR
* 200MG TABLET
02197405
02078627
02207621
02229707
00634506
NU-ACYCLOVIR
AVIRAX
APO-ACYCLOVIR
ALTI-ACYCLOVIR
ZOVIRAX
* 400MG TABLET
02078635
02197413
02207648
02229708
01911627
AVIRAX
NU-ACYCLOVIR
APO-ACYCLOVIR
ALTI-ACYCLOVIR
ZOVIRAX WELLSTAT PAC
* 800MG TABLET
02197421
02207656
02229709
02078651
01911635
NU-ACYCLOVIR
APO-ACYCLOVIR
ALTI-ACYCLOVIR
AVIRAX
ZOVIRAX ZOSTAB PAC
14
08:18.00 ANTIVIRALS
AMANTADINE
* 100MG CAPSULE
02199289
01990403
02034468
02139200
02130963
01914006
MED-AMANTADINE
PMS-AMANTADINE
ENDANTADINE
GEN-AMANTADINE
DOM-AMANTADINE
SYMMETREL
MED
PMS
END
GPM
DOM
DUP
$
0.2306 *
0.5620
0.5620
0.5620
0.6324
1.0703
DUP
PMS
DOM
$
0.0879
0.0879
0.0924
SMJ
$
2.7451
SMJ
$
3.6890
SMJ
$
6.5534
HLR
$
4.5028
GLA
$
3.2767
* 10MG/ML SYRUP
01913999
02022826
02130971
SYMMETREL
PMS-AMANTADINE
DOM-AMANTADINE
FAMCICLOVIR
125MG TABLET
02229110
FAMVIR
250MG TABLET
02229129
FAMVIR
500MG TABLET
02177102
FAMVIR
GANCICLOVIR SO4
250MG CAPSULE
02186802
CYTOVENE (EDS)
VALACYCLOVIR
500MG CAPLET
02219492
VALTREX
15
08:18.08 ANTIRETROVIRAL AGENTS (NONNUCLEOSIDE
REVERSE TRANSCRIPTASE INHIBITORS)
DELAVIRDINE MESYLATE
100MG TABLET
02238348
RESCRIPTOR (EDS)
AGR
$
0.7789
DUP
$
1.2019
DUP
$
2.4033
DUP
$
4.7634
BOE
$
5.0453
EFAVIRENZ
50MG CAPSULE
02239886
SUSTIVA (EDS)
100MG CAPSULE
02239887
SUSTIVA (EDS)
200MG CAPSULE
02239888
SUSTIVA (EDS)
NEVIRAPINE
200MG TABLET
02238748
VIRAMUNE (EDS)
08:18.08 ANTIRETROVIRAL AGENTS (NUCLEOSIDE REVERSE
TRANSCRIPTASE INHIBITORS)
ABACAVIR SO4
300MG TABLET
02240357
ZIAGEN (EDS)
GLA
$
6.7500
GLA
$
0.4522
02240358
ZIAGEN (EDS)
16
DIDANOSINE
SEE APPENDIX A FOR EDS CITERIA
25MG CHEWABLE TABLET
01940511
VIDEX (EDS)
BMY
$
0.4178
BMY
$
0.8365
BMY
$
1.6728
BMY
$
2.5091
BMY
$
73.6200
GLA
$
4.7740
GLA
$
4.7740
GLA
$
0.3184
GLA
$
10.0000
BRI
$
4.1013
BRI
$
4.2641
BRI
$
4.4485
BRI
$
4.6113
01940538
VIDEX (EDS)
01940546
VIDEX (EDS)
01940554
VIDEX (EDS)
4G POWDER FOR ORAL SOLUTION (PACKAGE)
01940635
VIDEX (EDS)
LAMIVUDINE
100MG TABLET
02239193
HEPTOVIR (EDS)
150MG TABLET
02192683
3TC (EDS)
02192691
3TC (EDS)
LAMIVUDINE/ZIDOVUDINE
150MG/300MG TABLET
02239213
COMBIVIR (EDS)
STAVUDINE
15MG CAPSULE
02216086
ZERIT (EDS)
20MG CAPSULE
02216094
ZERIT (EDS)
30MG CAPSULE
02216108
ZERIT (EDS)
40MG CAPSULE
02216116
ZERIT (EDS)
17
ZALCITABINE
0.375MG TABLET
01990918
HIVID (EDS)
HLR
$
1.8662
HLR
$
2.3328
APX
NOP
GLA
$
1.3020
1.3020
1.8445
GLA
$
5.5335
GLA
$
0.1962
GLA
$
17.5500
0.75MG TABLET
01990896
HIVID (EDS)
ZIDOVUDINE
* 100MG CAPSULE
01946323
01953877
01902660
APO-ZIDOVUDINE (EDS)
NOVO-AZT (EDS)
RETROVIR (EDS)
300MG TABLET
02238699
RETROVIR (EDS)
10MG/ML SOLUTION
01902652
RETROVIR (EDS)
10MG/ML INJECTION SOLUTION
01902644
RETROVIR (EDS)
08:18.08 ANTIRETROVIRAL AGENTS (PROTEASE INHIBITORS)
INDINAVIR SO4
200MG CAPSULE
02229161
CRIXIVAN (EDS)
MSD
$
1.4300
MSD
$
2.9224
AGR
$
1.9312
AGR
$
0.3951
400MG CAPSULE
02229196
CRIXIVAN (EDS)
NELFINAVIR MESYLATE
250MG TABLET
02238617
VIRACEPT (EDS)
50MG/G ORAL POWDER
02238618
VIRACEPT (EDS)
18
08:18.08 ANTIRETROVIRAL AGENTS (PROTEASE INHIBITORS)
RITONAVIR
100MG CAPSULE
02229137
NORVIR (EDS)
ABB
$
1.4491
ABB
$
1.4491
ABB
$
1.1590
HLR
$
1.9312
HLR
$
1.1067
NOP
SAW
$
0.0865
0.3481
SAW
$
0.5686
GLA
$
1.2882
100MG SOFT ELASTIC CAPSULE
02241480
NORVIR SEC (EDS)
02229145
NORVIR (EDS)
SAQUINAVIR
200MG CAPSULE
02216965
INVIRASE (EDS)
200MG SOFT GELATIN CAPSULE
02239083
FORTOVASE (EDS)
08:20.00 ANTIMALARIAL AGENTS
CHLOROQUINE PHOSPHATE
* 250MG TABLET
00021261
02017539
NOVO-CHLOROQUINE
ARALEN
HYDROXYCHLOROQUINE SO4
200MG TABLET
02017709
PLAQUENIL
PYRIMETHAMINE
25MG TABLET
00004774
DARAPRIM
19
08:20.00 ANTIMALARIAL AGENTS
QUININE SO4
* 200MG CAPSULE
00021008
00695440
NOVO-QUININE
QUININE-ODAN
NOP
ODN
$
0.1156
0.1156
NOP
ODN
$
0.1802
0.1802
HLR
$
1.1610
BAY
$
2.4098
BAY
$
2.7188
BAY
$
5.1284
BAY
$
0.5438
JAN
$
4.8174
JAN
$
5.4359
APX
NOP
MSD
$
1.6554
1.6554
2.4120
* 300MG CAPSULE
00021016
00695459
NOVO-QUININE
QUININE-ODAN
SULFADOXINE/PYRIMETHAMINE
500MG/25MG TABLET
00692719
FANSIDAR
08:22.00 QUINOLONES
CIPROFLOXACIN
250MG TABLET
02155958
CIPRO (EDS)
500MG TABLET
02155966
CIPRO (EDS)
750MG TABLET
02155974
CIPRO (EDS)
02237514
CIPRO (EDS)
LEVOFLOXACIN
250MG TABLET
02236841
LEVAQUIN (EDS)
500MG TABLET
02236842
LEVAQUIN (EDS)
NORFLOXACIN
* 400MG TABLET
02229524
02237682
00643025
APO-NORFLOX (EDS)
NOVO-NORFLOXACIN (EDS)
NOROXIN (EDS)
20
08:24.00 SULFONAMIDES
SULFISOXAZOLE
500MG TABLET
00021792
NOVO-SOXAZOLE
NOP
$
0.0507
WYA
$
0.2496
PDA
$
0.1825
NOP
ALZ
$
0.2470
0.3771
NOP
APX
$
0.0245
0.0559
NOP
APX
$
0.0266
0.0765
NOP
$
0.0292
ALZ
$
0.6700
08:26.00 SULFONES
DAPSONE
100MG TABLET
02041510
AVLOSULFON
08:36.00 URINARY ANTI-INFECTIVES
METHENAMINE SALTS ARE EFFECTIVE ONLY IN ACIDIC URINE AND
ACIDIFICATION OF URINE TO PH 5.5 OR LESS IS RECOMMENDED.
METHENAMINE MANDELATE
500MG ENTERIC TABLET
00499013
MANDELAMINE
NITROFURANTOIN
50MG CAPSULE (MACROCRYSTALS)
02231015
01997637
NOVO-FURANTOIN
MACRODANTIN
* 50MG TABLET
00021563
00319511
NOVO-FURAN
APO-NITROFURANTOIN
* 100MG TABLET
00021571
00312738
NOVO-FURAN
APO-NITROFURANTOIN
00232971
NOVO-FURAN
NITROFURANTOIN MONOHYDRATE
100MG CAPSULE (MACROCRYSTALS)
02063662
MACROBID
21
08:36.00 URINARY ANTI-INFECTIVES
TRIMETHOPRIM
100MG TABLET
00675229
PROLOPRIM
GLA
$
0.3174
GLA
$
0.6022
GLA
$
2.4199
ABB
$
0.1136
PMS
ROP
$
0.9223
0.9223
NOP
PMS
APX
$
0.0353
0.0364
0.0554
NXP
GLA
APX
NOP
$
0.0412 *
0.0523
0.0523
0.0523
200MG TABLET
00677590
PROLOPRIM
08:40.00 MISCELLANEOUS ANTI-INFECTIVES
ATOVAQUONE
150MG/ML SUSPENSION
02217422
MEPRON (EDS)
ERYTHROMYCIN ETHYLSUCCINATE/
SULFISOXAZOLE ACETATE
40MG(BASE)/120MG(BASE) PER ML ORAL SOLUTION
00583405
PEDIAZOLE
METRONIDAZOLE
* 500MG CAPSULE
00783137
01926853
TRIKACIDE
FLAGYL
* 250MG TABLET
00021555
00584339
00545066
NOVO-NIDAZOL
PMS-METRONIDAZOLE
APO-METRONIDAZOLE
SULFAMETHOXAZOLE/TRIMETHOPRIM
(CO-TRIMOXAZOLE)
* 400MG/80MG TABLET
00865710
00270636
00445274
00510637
NU-COTRIMOX
SEPTRA
APO-SULFATRIM
NOVO-TRIMEL
22
* 800MG/160MG TABLET
00865729
00445282
00510645
00368040
00371823
NU-COTRIMOX DS
APO-SULFATRIM DS
NOVO-TRIMEL DS
SEPTRA D.S.
BACTRIM D.S.
NXP
APX
NOP
GLA
HLR
$
0.1038 *
0.1325
0.1325
0.1326
0.2827
APX
$
0.0955
NOP
APX
NXP
GLA
HLR
$
0.0215
0.0215
0.0215
0.0216
0.0216
100MG/20MG PEDIATRIC TABLET
00445266
APO-SULFATRIM
* 40MG/8MG PER ML ORAL SUSPENSION
00726540
00846465
00865753
00270644
00272485
NOVO-TRIMEL
APO-SULFATRIM
NU-COTRIMOX
SEPTRA
BACTRIM
23
24
ANTINEOPLASTIC AGENTS
10:00
10:00 ANTINEOPLASTIC AGENTS
10:00.00 ANTINEOPLASTIC AGENTS
CYPROTERONE ACETATE
* 50MG TABLET
00704431
02229449
02229723
02232872
ANDROCUR (EDS)
ALTI-CPA (EDS)
GEN-CYPROTERONE (EDS)
NOVO-CYPROTERONE (EDS)
BEX
ALT
GPM
NOP
$
1.6375
1.6375
1.6375
1.6375
BEX
$
79.1100
HLR
$
36.8900
HLR
$
73.7800
HLR
$
110.6700
HLR
$
221.3400
SCH
$
38.2900
SCH
SCH
$
61.4700
63.6400
SCH
$
36.8800
100MG/ML INJECTION
00704423
ANDROCUR (EDS)
INTERFERON ALFA-2A
3 MILLION IU/1ML INJECTION SOLUTION
ALBUMIN (HUMAN) FREE (1ML)
02217015
ROFERON-A (EDS)
02217031
ROFERON-A (EDS)
02217058
ROFERON-A (EDS)
02217066
ROFERON-A (EDS)
INTERFERON ALFA-2B
3 MILLION IU POWDER FOR INJECTION
02223384
INTRON-A (EDS)
5 MILLION IU POWDER FOR INJECTION (ML)
02223414
02223392
INTRON-A PREMIX (EDS)
INTRON-A (EDS)
6 MILLION IU/ML INJECTION SOLUTION
ALBUMIN (HUMAN) FREE (0.5ML)
02238674
INTRON-A (EDS)
26
10:00 ANTINEOPLASTIC AGENTS
10:00.00 ANTINEOPLASTIC AGENTS
10 MILLION IU POWDER FOR INJECTION
02223406
INTRON-A (EDS)
SCH
$
127.2600
SCH
$
122.9400
SCH
$
221.2800
SCH
$
368.8000
SCH
$
709.8000
GLA
$
38.3100
GLA
$
127.2800
LIN
NXP
APX
BMY
$
0.9824
0.9824
0.9824
1.4572
APX
NXP
LIN
BMY
$
3.9267
3.9350
3.9353
5.8302
BMY
$
1.1653
GLA
$
1.9899
ALBUMIN (HUMAN) FREE (0.5ML, 1ML)
02238675
INTRON-A (EDS)
18 MILLION IU/PEN MULTI-DOSE PEN (KIT)
ALBUMIN (HUMAN) FREE
02240693
INTRON-A (EDS)
02240694
INTRON-A (EDS)
02240695
INTRON-A (EDS)
INTERFERON ALPHA-N1
01959077
WELLFERON (EDS)
01959069
WELLFERON (EDS)
MEGESTROL
* 40MG TABLET
02176092
02185415
02195917
00386391
LIN-MEGESTROL (EDS)
NU-MEGESTROL (EDS)
APO-MEGESTROL (EDS)
MEGACE (EDS)
* 160MG TABLET
02195925
02185423
02176106
00731323
APO-MEGESTROL (EDS)
NU-MEGESTROL (EDS)
LIN-MEGESTROL (EDS)
MEGACE (EDS)
02168979
MEGACE OS (EDS)
MERCAPTOPURINE
50MG TABLET
00004723
PURINETHOL (EDS)
27
28
AUTONOMIC DRUGS
12:00
12:00 AUTONOMIC DRUGS
12:04.00 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
BETHANECHOL CHLORIDE
10MG TABLET
01947958
DUVOID
RBP
$
0.2512
RBP
MSD
$
0.4069
0.6847
RBP
$
0.5344
ICN
$
0.4742
ICN
$
0.4660
ICN
$
1.0196
PMS
APX
MSD
$
0.0191 *
0.0402
0.1558
MSD
$
5.1400
AVT
$
0.2013
* 25MG TABLET
01947931
00349739
DUVOID
URECHOLINE
50MG TABLET
01947923
DUVOID
NEOSTIGMINE BROMIDE
15MG TABLET
00869945
PROSTIGMIN
PYRIDOSTIGMINE BROMIDE
60MG TABLET
00869961
MESTINON
180MG LONG ACTING TABLET
00869953
MESTINON
12:08.04 ANTIPARKINSONIAN AGENTS
BENZTROPINE MESYLATE
* 2MG TABLET
00587265
00426857
00016357
PMS-BENZTROPINE
APO-BENZTROPINE
COGENTIN
1MG/ML INJECTION SOLUTION (2ML)
00016128
COGENTIN
ETHOPROPAZINE
50MG TABLET
01927744
PARSITAN
30
12:08.04 ANTIPARKINSONIAN AGENTS
ORPHENADRINE HCL
50MG TABLET
01966146
DISIPAL
MDA
$
0.4490
GLA
PMS
DOM
ICN
$
0.0277
0.0277
0.0291
0.0771
GLA
PMS
$
0.0333
0.0333
NOP
APX
$
0.0113
0.0228
NOP
APX
$
0.0157
0.0358
ICN
$
0.0992
AVT
$
0.2157
AVT
$
0.0612
PROCYCLIDINE HCL
* 5MG TABLET
00004758
00587354
02125102
00306290
KEMADRIN
PMS-PROCYCLIDINE
DOM-PROCYCLIDINE
PROCYCLID
* 0.5MG/ML ELIXIR
00004405
00587362
KEMADRIN
PMS-PROCYCLIDINE
TRIHEXYPHENIDYL HCL
* 2MG TABLET
00021911
00545058
NOVO-HEXIDYL
APO-TRIHEX
* 5MG TABLET
00021938
00545074
NOVO-HEXIDYL
APO-TRIHEX
12:08.08 ANTIMUSCARINICS/ANTISPASMODICS
DICYCLOMINE HCL
10MG CAPSULE
00361933
FORMULEX
20MG TABLET
02103095
BENTYLOL
2MG/ML SYRUP
02102978
BENTYLOL
31
GLYCOPYRROLATE
1MG TABLET
02043602
ROBINUL
WYA
$
0.1510
WYA
$
0.2508
BOE
$
0.2323
2MG TABLET
02043629
ROBINUL
HYOSCINE BUTYLBROMIDE
10MG TABLET
00363812
BUSCOPAN
HYOSCYAMINE/ATROPINE/HYOSCINE/PHENOBARBITAL
0.021MG/3.88UG/1.3UG/3.24MG PER ML ELIXIR
02042894
DONNATAL
WYA
$
0.0572
IPRATROPIUM BROMIDE
NOTE: WHEN USING THE INHALATION SOLUTION CARE MUST BE TAKEN
TO PREVENT CONTACT WITH EYES. A WELL FITTED NEBULIZER MASK
MUST BE USED.
INHALER AEROSOL (PACKAGE)
00576158
ATROVENT
BOE
$
17.0900
ALT
PMS
BOE
$
0.8200
0.8200
1.4301
ALT
APX
NOP
PMS
GPM
BOE
$
0.6000
0.6000
0.6000
0.6000
0.6000
0.9532
NXP
ALT
GPM
PMS
APX
BOE
$
1.2010 *
1.6390
1.6390
1.6390
1.6390
2.8610
* 0.0125% INHALATION SOLUTION (2ML)
02097176
02231135
02026759
ALTI-IPRATROPIUM UDV
PMS-IPRATROPIUM
ATROVENT
* 0.025% INHALATION SOLUTION
02097141
02126222
02210479
02231136
02239131
00731439
ALTI-IPRATROPIUM
APO-IPRAVENT
NOVO-IPRAMIDE
PMS-IPRATROPIUM
GEN-IPRATROPIUM
ATROVENT
* 0.025% INHALATION SOLUTION (2ML)
02231785
02097168
02216221
02231245
02231494
01950681
NU-IPRATROPIUM
GEN-IPRATROPIUM
PMS-IPRATROPIUM
APO-IPRAVENT
ATROVENT
32
IPRATROPIUM BROMIDE/SALBUTAMOL SO4
NOTE: SALBUTAMOL STRENGTHS ARE EXPRESSED IN TERMS OF SALBUTAMOL
BASE EQUIVALENT.
20UG/100UG INHALER AEROSOL (PACKAGE)
02163721
COMBIVENT
BOE
$
20.2400
BOE
$
1.5930
RBP
$
0.2038
ICN
RBP
$
0.1807
0.2257
0.5MG/2.5MG INHALATION SOLUTION (2.5ML)
02231675
COMBIVENT (EDS)
PROPANTHELINE BROMIDE
7.5MG TABLET
02030829
PRO-BANTHINE
* 15MG TABLET
00294837
02030837
PROPANTHEL
PRO-BANTHINE
12:12.00 SYMPATHOMIMETIC (ADRENERGIC) AGENTS
EPINEPHRINE HCL
00155357
ADRENALIN
PDA
$
1.5700
BOE
$
10.6700
BOE
$
0.7628
BOE
$
1.5256
BOE
$
0.7628
FENOTEROL HYDROBROMIDE
100UG INHALER AEROSOL (PACKAGE)
02006383
BEROTEC
0.025% INHALATION SOLUTION (2ML)
02056712
BEROTEC UDV
0.0625% INHALATION SOLUTION (2ML)
02056704
BEROTEC UDV
0.1% INHALATION SOLUTION
00541389
BEROTEC
33
FORMOTEROL FUMARATE
12UG/INHALATION POWDER CAPSULE
02230898
FORADIL (EDS)
NVR
$
0.7650
$
34.4500
AST
$
45.9000
RBP
$
0.5290
RBP
$
0.8935
ALT
APX
BOE
$
0.0415
0.0415
0.0656
BRI
$
1.5310
6UG/DOSE POWDER FOR INHALATION (PACKAGE)
02237225
OXEZE TURBUHALER (EDS)
AST
02237224
MIDODRINE HCL
2.5MG TABLET
01934392
AMATINE (EDS)
5MG TABLET
01934406
AMATINE (EDS)
ORCIPRENALINE SO4
* 2MG/ML SYRUP
02152568
02236783
00249920
ALTI-ORCIPRENALINE
APO-ORCIPRENALINE
ALUPENT
RITODRINE HCL
10MG TABLET
00550159
YUTOPAR
SALBUTAMOL SO4
NOTE: PRODUCT STRENGTHS ARE EXPRESSED IN TERMS OF SALBUTAMOL
BASE EQUIVALENT.
* 2MG TABLET
00620955
02146843
02165368
NOVO-SALMOL
APO-SALVENT
NU-SALBUTAMOL
NOP
APX
NXP
$
0.0705
0.0705
0.0705
NOP
APX
NXP
$
0.1164
0.1164
0.1164
GLA
$
0.1846
* 4MG TABLET
00620963
02146851
02165376
NOVO-SALMOL
APO-SALVENT
NU-SALBUTAMOL
200UG/AEROSOL POWDER CAPSULE
02212315
VENTOLIN ROTACAPS
34
200UG/DOSE AEROSOL POWDER DISK (8)
02214997
VENTODISK
GLA
$
1.4764
GLA
$
0.2565
GLA
$
2.0514
GLA
$
0.0738
APX
ALT
NOP
MDA
GLA
$
5.0500
5.0500
5.0500
5.0500
13.3200
$
0.4047
0.5398
400UG/AEROSOL POWDER CAPSULE
02212323
VENTOLIN ROTACAPS
02215004
VENTODISK
0.4MG/ML ORAL LIQUID
02212390
VENTOLIN
* 100UG/DOSE INHALER AEROSOL (PACKAGE)
00790419
00851841
00874086
02232570
02213478
APO-SALVENT
ALTI-SALBUTAMOL
NOVO-SALMOL
AIROMIR (CFC-FREE)
VENTOLIN
* 0.5MG/ML INHALATION SOLUTION PRESERVATIVE
FREE (2.5ML)
02208245
02022125
PMS-SALBUTAMOL
VENTOLIN NEBULES P.F.
PMS
GLA
* 1MG/ML INHALATION SOLUTION PRESERVATIVE FREE
(2.5ML)
02231783
01926934
01986864
02084333
02208229
02231430
02231488
02216949
02213419
NU-SALBUTAMOL
GEN-SALBUTAMOL STERINEB
SALBUTAMOL SULPHATE
MED-SALBUTAMOL
PMS-SALBUTAMOL
ASMAVENT
APO-SALVENT
DOM-SALBUTAMOL
NXP
GPM
ALT
MED
PMS
TCH
APX
DOM
GLA
$
0.3370 *
0.6610
0.6610
0.6610
0.6610
0.6610
0.6610
0.7410
1.0480
* 2MG/ML INHALATION SOLUTION PRESERVATIVE FREE
(2.5ML)
02173360
02208237
02231678
02231784
01945203
PMS-SALBUTAMOL
APO-SALVENT
NU-SALBUTAMOL
35
GPM
PMS
APX
NXP
GLA
$
1.2538
1.2538
1.2538
1.2538
1.9905
* 5MG/ML INHALATION SOLUTION
00860808
02046741
02048760
02069571
02154412
02232987
02139324
02213486
ALTI-SALBUTAMOL RESP.SOL.
APO-SALVENT
ASMAVENT RESPIRATOR SOL
PMS-SALBUTAMOL RESPIR.SOL
RHOXAL-SALBUTAMOL RES.SOL
GEN-SALBUTAMOL RESPIR.SOL
DOM-SALBUTAMOL RESPIR.SOL
VENTOLIN RESPIRATOR SOLN.
ALT
APX
TCH
PMS
RHO
GPM
DOM
GLA
$
0.6402
0.6402
0.6402
0.6402
0.6402
0.6402
0.7205
1.0167
GLA
$
54.0400
GLA
$
3.6022
$
54.0400
SALMETEROL XINAFOATE
25UG/DOSE INHALER AEROSOL (PACKAGE)
02211742
SEREVENT (EDS)
02214261
SEREVENT (EDS)
02231129
SEREVENT DISKUS (EDS)
GLA
SALMETEROL XINAFOATE/FLUTICASONE PROPIONATE
50UG/100UG POWDER FOR INHALATION (PACKAGE)
02240835
ADVAIR DISKUS (EDS)
GLA
$
77.8000
$
93.1000
GLA
$
132.1600
AST
$
0.1633
AST
$
0.2132
$
15.5200
02240836
ADVAIR DISKUS (EDS)
GLA
02240837
ADVAIR DISKUS (EDS)
TERBUTALINE SO4
2.5MG TABLET
00335355
BRICANYL
5MG TABLET
00335363
BRICANYL
0.5MG/DOSE POWDER FOR INHALATION (PACKAGE)
00786616
BRICANYL TURBUHALER
36
AST
12:16.00 SYMPATHOLYTIC AGENTS (ANTIMIGRAINE DRUGS)
DIHYDROERGOTAMINE MESYLATE
02241163
00027243
DIHYDROERGOTAMINE MESYL.
DIHYDROERGOTAMINE-SANDOZ
SAB
NVR
$
4.0300
4.5800
NVR
$
9.8200
AVT
$
0.7958
$
2.3735
GLA
$
0.6489
PMS
$
0.8229
NVR
$
0.6961
4MG/ML NASAL SPRAY
02228947
MIGRANAL (EDS)
ERGOTAMINE TARTRATE
2MG SUBLINGUAL TABLET
00328952
ERGOMAR
ERGOTAMINE TARTRATE/CAFFEINE/
BELLADONNA ALKALOIDS/PENTOBARBITAL
2MG/100MG/0.25MG/60MG SUPPOSITORY
00176214
CAFERGOT-PB
NVR
ERGOTAMINE TARTRATE/CYCLIZINE/CAFFEINE
2MG/50MG/100MG TABLET
00068586
MEGRAL
FLUNARIZINE HCL
5MG CAPSULE
00846341
SIBELIUM (EDS)
METHYSERGIDE MALEATE
2MG TABLET
00027499
SANSERT (EDS)
NARATRIPTAN HCL
THE MAXIMUM QUANTITY THAT CAN BE CLAIMED THROUGH THE DRUG PLAN
IS LIMITED TO 6 DOSES PER 30 DAYS WITHIN A 60 DAY PERIOD.
SEE APPENDIX A FOR EDS CRITERIA.
1MG TABLET
02237820
AMERGE (EDS)
GLA
$
13.3350
GLA
$
14.0600
2.5MG TABLET
02237821
AMERGE (EDS)
37
PIZOTYLINE HYDROGEN MALATE
0.5MG TABLET
00329320
SANDOMIGRAN
NVR
$
0.3771
NVR
$
0.6261
1MG TABLET
00511552
SANDOMIGRAN DS
PROPRANOLOL
SEE SECTION 24:04.00 (CARDIAC DRUGS) PAGE 57
RIZATRIPTAN BENZOATE
5MG TABLET
02240520
MAXALT (EDS)
MSD
$
14.0508
MSD
$
14.0508
MSD
$
14.0508
10MG TABLET
02240521
MAXALT (EDS)
10MG WAFER
02240519
MAXALT RPD (EDS)
SUMATRIPTAN
25MG TABLET
02239738
IMITREX (EDS)
GLA
$
13.3347
GLA
$
14.0508
GLA
$
15.4785
GLA
$
41.7400
GLA
$
13.3400
GLA
$
14.0600
50MG TABLET
02212153
IMITREX (EDS)
100MG TABLET
02212161
IMITREX (EDS)
6MG/0.5ML INJECTION SOLUTION
02212188
IMITREX (EDS)
5MG NASAL SPRAY
02230418
IMITREX (EDS)
20MG NASAL SPRAY
02230420
IMITREX (EDS)
38
ZOLMITRIPTAN
2.5MG TABLET
02238660
ZOMIG (EDS)
AST
$
14.0510
MED
PMS
GPM
NXP
APX
NOP
TCH
FTP
DOM
NVR
$
0.1227 *
0.3159
0.3159
0.3159
0.3159
0.3159
0.3159
0.3159
0.3373
0.5014
MED
PMS
GPM
NXP
APX
NOP
TCH
FTP
DOM
NVR
$
0.2399 *
0.6149
0.6149
0.6149
0.6149
0.6149
0.6149
0.6149
0.6591
0.9760
NVR
$
9.8800
NVR
$
142.3500
12:20.00 SKELETAL MUSCLE RELAXANTS
BACLOFEN
* 10MG TABLET
02084449
02063735
02088398
02136090
02139332
02229936
02236507
02238445
02138271
00455881
MED-BACLOFEN
PMS-BACLOFEN
GEN-BACLOFEN
NU-BACLO
APO-BACLOFEN
NOVO-BACLOFEN
LIOTEC
FTP-BACLOFEN
DOM-BACLOFEN
LIORESAL
* 20MG TABLET
02084457
02063743
02088401
02136104
02139391
02229937
02236508
02238446
02138298
00636576
MED-BACLOFEN
PMS-BACLOFEN
GEN-BACLOFEN
NU-BACLO
APO-BACLOFEN
NOVO-BACLOFEN
LIOTEC
FTP-BACLOFEN
DOM-BACLOFEN
LIORESAL-DS
0.05MG/ML INJECTION (1ML)
02131048
LIORESAL INTRATHECAL(EDS)
0.5MG/ML INJECTION (20ML)
02131056
39
12:20.00 SKELETAL MUSCLE RELAXANTS
2MG/ML INJECTION (5ML)
02131064
NVR
$
142.3500
NOP
NXP
ALT
APX
PMS
GPM
TCH
MED
DOM
MSD
$
0.4085
0.4085
0.4085
0.4085
0.4085
0.4085
0.4085
0.4085
0.4289
0.6159
PGA
$
0.3955
PGA
$
0.7650
CYCLOBENZAPRINE HCL
* 10MG TABLET
02080052
02171848
02174618
02177145
02212048
02231353
02236506
02237275
02238633
00782742
NOVO-CYCLOPRINE (EDS)
NU-CYCLOBENZAPRINE (EDS)
ALTI-CYCLOBENZAPRINE(EDS)
APO-CYCLOBENZAPRINE (EDS)
PMS-CYCLOBENZAPRINE (EDS)
GEN-CYCLOBENZAPRINE (EDS)
FLEXITEC (EDS)
MED-CYCLOBENZAPRINE (EDS)
DOM-CYCLOBENZAPRINE (EDS)
FLEXERIL (EDS)
DANTROLENE SODIUM
25MG CAPSULE
01997602
DANTRIUM
100MG CAPSULE
01997653
DANTRIUM
40
BLOOD FORMATION AND COAGULATION
20:00
20:00 BLOOD FORMATION AND COAGULATION
20:04.04 IRON PREPARATIONS
IRON DEXTRAN
02221780
INFUFER (EDS)
SAB
$
28.6300
AST
$
2.8800
NVR
$
0.1343
NVR
$
0.4221
PHU
$
16.2800
PHU
$
5.1600
PHU
$
10.2600
PHU
$
16.2800
PHU
$
154.6200
IRON SORBITOL
00001910
JECTOFER (EDS)
20:12.04 ANTICOAGULANTS
ACENOCOUMAROL
1MG TABLET
00010383
SINTROM
4MG TABLET
00010391
SINTROM
DALTEPARIN SODIUM
2,500IU/ML INJECTION SOLUTION (4ML)
02132656
FRAGMIN (EDS)
2,500IU SYRINGE (0.2ML)
02132621
FRAGMIN (EDS)
5,000IU SYRINGE (0.2ML)
02132648
FRAGMIN (EDS)
02132664
FRAGMIN (EDS)
25,000IU/ML INJECTION SOLUTION (3.8ML)
02231171
FRAGMIN (EDS)
42
ENOXAPARIN
30MG/0.3ML SYRINGE (0.3ML)
02012472
LOVENOX (EDS)
AVT
$
6.5600
AVT
$
21.7000
AVT
$
65.1000
OTK
$
5.8600
SAW
$
9.7200
SAW
$
19.4300
LEO
$
34.7200
LEO
$
7.8800
LEO
$
69.4400
LEO
$
31.2500
100MG/ML SYRINGE (0.4ML, 0.6ML, 0.8ML, 1ML)
02236883
LOVENOX (EDS)
02236564
LOVENOX (EDS)
HEPARIN
10,000 USP U/ML INJECTION SOLUTION (5ML)
00740497
HEPALEAN
NADROPARIN CALCIUM
9,500IU/ML SYRINGE (0.2ML, 0.3ML, 0.4ML,
0.6ML, 0.8ML, 1ML)
02236913
FRAXIPARINE (EDS)
19,000IU/ML SYRINGE (0.6ML, 0.8ML, 1ML)
02240114
FRAXIPARINE FORTE (EDS)
TINZAPARIN SODIUM
02167840
INNOHEP (EDS)
10,000IU/ML SYRINGE (0.35ML, 0.45ML)
02229755
INNOHEP (EDS)
02229515
INNOHEP (EDS)
20,000IU/ML SYRINGE (0.5ML, 0.7ML, 0.9ML)
02231478
INNOHEP (EDS)
43
WARFARIN
WHEN ADMINISTERING WARFARIN IT IS ADVISABLE TO MAINTAIN THE
PATIENT ON THE SAME DRUG PRODUCT.
1MG TABLET
01918311
COUMADIN
DUP
$
0.3466
DUP
$
0.3666
DUP
$
0.3466
DUP
$
0.4542
DUP
$
0.4542
MSD
DUP
$
0.1917
0.3605
DUP
$
0.6041
2MG TABLET
01918338
COUMADIN
2.5MG TABLET
01918346
COUMADIN
3MG TABLET
02240205
COUMADIN
4MG TABLET
02007959
x
COUMADIN
5MG TABLET
00010308
01918354
WARFILONE
COUMADIN
10MG TABLET
01918362
COUMADIN
20:12.20 ANTIPLATELET DRUGS
SULFINPYRAZONE
SEE SECTION 40:40:00 (URICOSURIC DRUGS) PAGE 135
44
20:16.00 HEMATOPOIETIC AGENTS
EPOETIN ALFA
1000IU/0.5ML PRE-FILLED SYRINGE
02231583
EPREX (EDS)
JAN
$
15.4700
JAN
$
30.9300
JAN
$
46.3900
JAN
$
61.8500
JAN
$
138.9500
JAN
$
290.6800
AMG
$
234.2700
SAW
$
2.6057
ALT
APX
NXP
AVT
$
0.4164
0.4164
0.4164
0.6629
02231584
EPREX (EDS)
02231585
EPREX (EDS)
02231586
EPREX (EDS)
10000IU/ML PRE-FILLED SYRINGE
02231587
EPREX (EDS)
20000IU STERILE SOLUTION FOR INJECTION
02206072
EPREX (EDS)
FILGRASTIM
300UG/ML INJECTION SOLUTION
01968017
NEUPOGEN (EDS)
20:24.00 HEMORRHEOLOGIC AGENTS
CLOPIDOGREL BISULFATE
75MG TABLET
02238682
PLAVIX (EDS)
PENTOXIFYLLINE
* 400MG SUSTAINED RELEASE TABLET
01968432
02230090
02230401
02221977
ALBERT PENTOXIFYLLINE
APO-PENTOXIFYLLINE SR
NU-PENTOXIFYLLINE-SR
TRENTAL
45
20:24.00 HEMORRHEOLOGIC AGENTS
TICLOPIDINE HCL
* 250MG TABLET
02237560
02237701
02194422
02239744
02162776
NU-TICLOPIDINE (EDS)
APO-TICLOPIDINE (EDS)
SYN-TICLOPIDINE (EDS)
GEN-TICLOPIDINE (EDS)
TICLID (EDS)
46
NXP
APX
ALT
GPM
HLR
$
0.5865 *
0.7471
0.7472
0.7472
1.2982
CARDIOVASCULAR DRUGS
24:00
24:00 CARDIOVASCULAR DRUGS
24:04.00 CARDIAC DRUGS
ACEBUTOLOL HCL
* 100MG TABLET
02165546
01910140
02147602
02204517
02231251
02237721
02237885
02239754
02239758
01926543
02036290
NU-ACEBUTOLOL
RHOTRAL
APO-ACEBUTOLOL
NOVO-ACEBUTOLOL
PENTA-ACEBUTOLOL
GEN-ACEBUTOLOL
GEN-ACEBUTOLOL (TYPE S)
MED-ACEBUTOLOL (TYPE S)
MED-ACEBUTOLOL
SECTRAL
MONITAN
NXP
ROP
APX
NOP
PEN
GPM
GPM
MED
MED
AVT
WYA
$
0.0954 *
0.1769
0.1769
0.1769
0.1769
0.1769
0.1769
0.1769
0.1769
0.2949
0.2949
NXP
ROP
APX
NOP
PEN
GPM
GPM
MED
MED
AVT
WYA
$
0.1325 *
0.2648
0.2648
0.2648
0.2648
0.2648
0.2648
0.2648
0.2648
0.4424
0.4424
ROP
APX
NXP
NOP
PEN
GPM
GPM
MED
MED
AVT
WYA
$
0.5260
0.5260
0.5260
0.5260
0.5260
0.5260
0.5260
0.5260
0.5260
0.8803
0.8803
* 200MG TABLET
02165554
01910159
02147610
02204525
02231252
02237722
02237886
02239755
02239759
01926551
02036436
NU-ACEBUTOLOL
RHOTRAL
APO-ACEBUTOLOL
NOVO-ACEBUTOLOL
PENTA-ACEBUTOLOL
GEN-ACEBUTOLOL
MED-ACEBUTOLOL
SECTRAL
MONITAN
* 400MG TABLET
01910167
02147629
02165562
02204533
02231253
02237723
02237887
02239756
02239760
01926578
02036444
RHOTRAL
APO-ACEBUTOLOL
NU-ACEBUTOLOL
NOVO-ACEBUTOLOL
PENTA-ACEBUTOLOL
GEN-ACEBUTOLOL
MED-ACEBUTOLOL
SECTRAL
MONITAN
48
AMIODARONE
AMIODARONE IS INDICATED IN TREATMENT OF SEVERE CARDIAC
ARRHYTHMIAS. THIS DRUG SHOULD ONLY BE USED UNDER THE
SUPERVISION OF A CARDIOLOGIST OR AN INTERNIST WITH EQUIVALENT
EXPERIENCE IN CARDIOLOGY.
* 200MG TABLET
02240071
02036282
ALTI-AMIODARONE
CORDARONE
ALT
WYA
$
1.4074
2.4661
PFI
$
1.3333
PFI
$
1.9791
DOM
APX
NXP
NOP
GPM
TCH
MED
SCN
PEN
RHO
PMS
FTP
FCP
AST
$
0.0947 *
0.3814
0.3814
0.3814
0.3814
0.3814
0.3814
0.3814
0.3814
0.3814
0.3814
0.3814
0.4139
0.6054
AMLODIPINE BESYLATE
5MG TABLET
00878928
NORVASC
10MG TABLET
00878936
NORVASC
ATENOLOL
* 50MG TABLET
02229467
00773689
00886114
01912062
02146894
02171791
02188961
02220679
02229585
02231731
02237600
02238569
02239749
02039532
DOM-ATENOLOL
APO-ATENOL
NU-ATENOL
NOVO-ATENOL
GEN-ATENOLOL
TENOLIN
MED-ATENOLOL
ATENOLOL
PENTA-ATENOLOL
RHOXAL-ATENOLOL
PMS-ATENOLOL
FTP-ATENOLOL
FC PHARMA ATENOLOL
TENORMIN
49
* 100MG TABLET
02229468
00773697
00886122
01912054
02147432
02171805
02188988
02220687
02229586
02237601
02238570
02231733
02239750
02039540
DOM-ATENOLOL
APO-ATENOL
NU-ATENOL
NOVO-ATENOL
GEN-ATENOLOL
TENOLIN
MED-ATENOLOL
ATENOLOL
PENTA-ATENOLOL
PMS-ATENOLOL
FTP-ATENOLOL
RHOXAL-ATENOLOL
FC PHARMA ATENOLOL
TENORMIN
DOM
APX
NXP
NOP
GPM
TCH
MED
SCN
PEN
PMS
FTP
RHO
FCP
AST
$
0.1710 *
0.6268
0.6268
0.6268
0.6268
0.6268
0.6268
0.6268
0.6268
0.6268
0.6268
0.6270
0.6903
0.9952
HLR
$
1.3780
HLR
$
1.3780
HLR
$
1.3780
HLR
$
1.3780
GLA
$
0.1026
GLA
$
0.1026
GLA
$
0.1026
GLA
$
0.1685
CAPTOPRIL
SEE SECTION 24:08.00 (HYPOTENSIVE DRUGS) PAGE 64
CARVEDILOL
3.125MG TABLET
02240808
COREG (EDS)
6.25MG TABLET
02240809
COREG (EDS)
12.5MG TABLET
02240810
COREG (EDS)
25MG TABLET
02240811
COREG (EDS)
DIGOXIN
O.0625MG TABLET
00731269
LANOXIN
0.125MG TABLET
00035319
LANOXIN
O.25MG TABLET
00004685
LANOXIN
0.05MG/ML ELIXIR
00242713
LANOXIN
50
DILTIAZEM HCL
* 30MG TABLET
00886068
00771376
00862924
00888524
02146916
02189038
02229593
02097370
NU-DILTIAZ
APO-DILTIAZ
NOVO-DILTAZEM
SYN-DILTIAZEM
GEN-DILTIAZEM
MED-DILTIAZEM
PENTA-DILTIAZEM
CARDIZEM
NXP
APX
NOP
ALT
GPM
MED
PEN
AVT
$
0.0795 *
0.2252
0.2252
0.2252
0.2252
0.2252
0.2252
0.4031
NXP
APX
NOP
ALT
GPM
MED
PEN
AVT
$
0.1378 *
0.3947
0.3947
0.3947
0.3947
0.3947
0.3947
0.7070
APX
NOP
GPM
AVT
$
0.3944
0.3944
0.3944
0.7274
APX
NOP
GPM
AVT
$
0.5919
0.5919
0.5919
0.9656
APX
NOP
GPM
AVT
$
0.7888
0.7888
0.7888
1.2808
ALT
APX
NXP
AVT
$
0.9324
0.9324
0.9324
1.3093
BVL
$
0.8773
* 60MG TABLET
00886076
00771384
00862932
00888532
02146924
02189046
02229594
02097389
NU-DILTIAZ
APO-DILTIAZ
NOVO-DILTAZEM
SYN-DILTIAZEM
GEN-DILTIAZEM
MED-DILTIAZEM
PENTA-DILTIAZEM
CARDIZEM
* 60MG SUSTAINED-RELEASE CAPSULE
02222957
02229406
02231743
02097214
APO-DILTIAZ SR
NOVO-DILTAZEM SR
GEN-DILTIAZEM SR
CARDIZEM-SR
02222965
02229407
02231744
02097222
APO-DILTIAZ SR
NOVO-DILTAZEM SR
GEN-DILTIAZEM SR
CARDIZEM-SR
02222973
02229408
02231745
02097230
APO-DILTIAZ SR
NOVO-DILTAZEM SR
GEN-DILTIAZEM SR
CARDIZEM-SR
* 120MG CONTROLLED DELIVERY CAPSULE
02229781
02230997
02231052
02097249
ALTI-DILTIAZEM CD
APO-DILTIAZ CD
NU-DILTIAZ-CD
CARDIZEM CD
120MG EXTENDED RELEASE CAPSULE
02231150
TIAZAC
51
02229782
02230998
02231053
02097257
ALTI-DILTIAZEM CD
APO-DILTIAZ CD
NU-DILTIAZ-CD
CARDIZEM CD
ALT
APX
NXP
AVT
$
1.2377
1.2377
1.2377
1.7380
BVL
$
1.1645
ALT
APX
NXP
AVT
$
1.6416
1.6416
1.6416
2.3053
BVL
$
1.5445
APX
ALT
AVT
$
2.1608
2.1608
2.8816
BVL
$
1.9307
BVL
$
2.3289
AVT
$
0.2273
AVT
$
0.3212
RBP
$
0.5787
AVT
$
0.7617
MDA
$
0.5344
MDA
$
1.0688
02231151
TIAZAC
02229783
02230999
02231054
02097265
ALTI-DILTIAZEM CD
APO-DILTIAZ CD
NU-DILTIAZ-CD
CARDIZEM CD
02231152
TIAZAC
02229526
02229784
02097273
APO-DILTIAZ CD
ALTI-DILTIAZEM CD
CARDIZEM CD
02231154
TIAZAC
02231155
TIAZAC
DISOPYRAMIDE
100MG CAPSULE
01989553
RYTHMODAN
150MG CAPSULE
01989561
RYTHMODAN
150MG CONTROLLED RELEASE TABLET
02030810
NORPACE-CR
250MG SUSTAINED RELEASE TABLET
01989545
RYTHMODAN-LA
FLECAINIDE ACETATE
50MG TABLET
01966197
TAMBOCOR
100MG TABLET
01966200
TAMBOCOR
52
METOPROLOL TARTRATE
* 50MG TABLET
02172550
00618632
00648035
00749354
00842648
00865605
02145413
02174545
02230448
02230803
02232546
02239771
02231121
00397423
00402605
DOM-METOPROLOL
APO-METOPROLOL
NOVO-METOPROL
APO-METOPROLOL-TYPE L
NOVO-METOPROL (UNCOATED)
NU-METOP
PMS-METOPROLOL-B
GEN-METOPROLOL (TYPE L)
GEN-METOPROLOL
PMS-METOPROLOL-L
PENTA-METOPROLOL
MED-METOPROLOL
DOM-METOPROLOL-L
LOPRESOR
BETALOC
DOM
APX
NOP
APX
NOP
NXP
PMS
GPM
GPM
PMS
PEN
MED
DOM
NVR
AST
$
0.0423 *
0.1330
0.1330
0.1330
0.1330
0.1330
0.1330
0.1330
0.1330
0.1330
0.1330
0.1330
0.1397
0.2232
0.2442
DOM
APX
NOP
APX
NOP
NXP
PMS
GPM
GPM
PMS
PEN
MED
DOM
AST
NVR
$
0.0647 *
0.2412
0.2412
0.2412
0.2412
0.2412
0.2412
0.2412
0.2412
0.2412
0.2412
0.2412
0.2533
0.4178
0.4579
NVR
$
0.2659
AST
NVR
$
0.4824
0.4824
* 100MG TABLET
02172569
00618640
00648043
00751170
00842656
00865613
02145421
02174553
02230449
02230804
02232547
02239772
02231122
00402540
00397431
DOM-METOPROLOL
APO-METOPROLOL
NOVO-METOPROL
NU-METOP
PMS-METOPROLOL-B
GEN-METOPROLOL
PMS-METOPROLOL-L
PENTA-METOPROLOL
MED-METOPROLOL
DOM-METOPROLOL-L
BETALOC
LOPRESOR
00658855
x
LOPRESOR-SR
00497827
00534560
BETALOC DURULES
LOPRESOR-SR
53
MEXILETINE HCL
* 100MG CAPSULE
02230359
02231690
00599956
NOVO-MEXILETINE
ALTI-MEXILETINE
MEXITIL
NOP
ALT
BOE
$
0.3785
0.3785
0.5407
NOP
ALT
BOE
$
0.5068
0.5068
0.7241
PPZ
APX
ALT
NOP
$
0.2675
0.2675
0.2675
0.2675
PPZ
APX
ALT
NOP
$
0.3814
0.3814
0.3814
0.3814
PPZ
APX
ALT
$
0.7156
0.7156
0.7156
HLR
$
0.5208
HLR
$
0.7378
* 200MG CAPSULE
02230360
02231692
00599964
NOVO-MEXILETINE
ALTI-MEXILETINE
MEXITIL
NADOLOL
* 40MG TABLET
00607126
00782505
00851663
02126753
CORGARD
APO-NADOL
ALTI-NADOLOL
NOVO-NADOLOL
* 80MG TABLET
00463256
00782467
00851671
02126761
CORGARD
APO-NADOL
ALTI-NADOLOL
NOVO-NADOLOL
* 160MG TABLET
00523372
00782475
00851698
CORGARD
APO-NADOL
ALTI-NADOLOL
NICARDIPINE HCL
20MG CAPSULE
02162741
CARDENE (EDS)
30MG CAPSULE
02162733
CARDENE (EDS)
54
NIFEDIPINE
* 5MG CAPSULE
00725110
02047462
02235897
APO-NIFED
NOVO-NIFEDIN
PMS-NIFEDIPINE
APX
NOP
PMS
$
0.2648
0.2648
0.2648
APX
NOP
NXP
PMS
DOM
$
0.2016
0.2016
0.2016
0.2016
0.2117
SCN
APX
NXP
BAY
$
0.2436
0.2436
0.2436
0.5569
SCN
APX
NXP
BAY
$
0.4232
0.4232
0.4232
0.8708
BAY
$
0.8138
BAY
$
1.0091
BAY
$
1.5831
DOM
APX
NOP
NXP
GPM
MED
PMS
NVR
$
0.0870 *
0.2477
0.2477
0.2477
0.2477
0.2477
0.2477
0.4492
* 10MG CAPSULE
00755907
00756830
00865591
02235898
02236758
APO-NIFED
NOVO-NIFEDIN
NU-NIFED
PMS-NIFEDIPINE
DOM-NIFEDIPINE
02154390
02197448
02212102
02155885
NIFEDIPINE PA
APO-NIFED PA
NU-NIFEDIPINE-PA
ADALAT PA
02154404
02181525
02200937
02155893
NIFEDIPINE PA
APO-NIFED PA
NU-NIFEDIPINE-PA
ADALAT PA
20MG EXTENDED-RELEASE TABLET
02237618
ADALAT XL
02155907
ADALAT XL
02155990
ADALAT XL
PINDOLOL
* 5MG TABLET
02231650
00755877
00869007
00886149
02057808
02084376
02231536
00417270
DOM-PINDOLOL
APO-PINDOL
NOVO-PINDOL
NU-PINDOL
GEN-PINDOLOL
MED-PINDOLOL
PMS-PINDOLOL
VISKEN
55
* 10MG TABLET
02238046
00755885
00869015
00886009
02057816
02084384
02231537
00443174
DOM-PINDOLOL
APO-PINDOL
NOVO-PINDOL
NU-PINDOL
GEN-PINDOLOL
MED-PINDOLOL
PMS-PINDOLOL
VISKEN
DOM
APX
NOP
NXP
GPM
MED
PMS
NVR
$
0.1600 *
0.4302
0.4302
0.4302
0.4302
0.4302
0.4302
0.7671
APX
NOP
NXP
GPM
MED
PMS
DOM
NVR
$
0.6321
0.6321
0.6321
0.6321
0.6321
0.6321
0.6636
1.1127
SQU
APX
$
0.1913
0.1913
SQU
APX
$
0.2497
0.2497
SQU
APX
$
0.3321
0.3321
PDA
$
0.1628
PDA
SQU
$
0.3255
0.5122
PDA
$
0.4883
KNO
$
0.9246
KNO
$
1.6297
* 15MG TABLET
00755893
00869023
00886130
02057824
02084392
02231539
02238047
00417289
APO-PINDOL
NOVO-PINDOL
NU-PINDOL
GEN-PINDOLOL
MED-PINDOLOL
PMS-PINDOLOL
DOM-PINDOLOL
VISKEN
PROCAINAMIDE HCL
* 250MG CAPSULE
00029076
00713325
PRONESTYL
APO-PROCAINAMIDE
* 375MG CAPSULE
00296031
00713333
PRONESTYL
APO-PROCAINAMIDE
* 500MG CAPSULE
00353523
00713341
PRONESTYL
APO-PROCAINAMIDE
00638692
x
PROCAN-SR
00638676
00639885
PROCAN-SR
PRONESTYL-SR
00638684
PROCAN-SR
PROPAFENONE HCL
150MG TABLET
00603708
RYTHMOL
300MG TABLET
00603716
RYTHMOL
56
PROPRANOLOL
* 10MG TABLET
02137313
00582255
00496480
00402788
02042177
DOM-PROPRANOLOL
PMS-PROPRANOLOL
NOVO-PRANOL
APO-PROPRANOLOL
INDERAL
DOM
PMS
NOP
APX
WYA
$
0.0164 *
0.0209
0.0261
0.0304
0.0883
NOP
NXP
APX
$
0.0376
0.0500
0.0500
DOM
NOP
PMS
NXP
APX
WYA
$
0.0292 *
0.0378
0.0378
0.0498
0.0597
0.1574
NOP
PMS
DOM
APX
WYA
$
0.0635
0.0635
0.0667
0.0950
0.2207
NOP
APX
WYA
$
0.1149
0.1492
0.3531
WYA
$
0.4532
WYA
$
0.6066
WYA
$
0.8685
WYA
$
1.1001
AST
$
0.4449
* 20MG TABLET
00740675
02044692
00663719
NOVO-PRANOL
NU-PROPRANOLOL
APO-PROPRANOLOL
* 40MG TABLET
02137321
00496499
00582263
02044706
00402753
02042207
DOM-PROPRANOLOL
NOVO-PRANOL
PMS-PROPRANOLOL
NU-PROPRANOLOL
APO-PROPRANOLOL
INDERAL
* 80MG TABLET
00496502
00582271
02137348
00402761
02042215
NOVO-PRANOL
PMS-PROPRANOLOL
DOM-PROPRANOLOL
APO-PROPRANOLOL
INDERAL
* 120MG TABLET
00549657
00504335
02042223
NOVO-PRANOL
APO-PROPRANOLOL
INDERAL
60MG LONG ACTING CAPSULE
02042231
INDERAL-LA
02042258
INDERAL-LA
02042266
INDERAL-LA
02042274
INDERAL-LA
QUINIDINE BISULFATE
00249580
BIQUIN DURULES
57
QUINIDINE SO4
200MG TABLET
00021733
NOVO-QUINIDIN
NOP
$
0.0641
WYA
$
0.5525
MED
ALT
LIN
NXP
APX
GPM
NOP
RHO
PMS
TCH
DOM
BRI
$
0.2576 *
0.6437
0.6437
0.6437
0.6437
0.6437
0.6437
0.6437
0.6437
0.6437
0.6759
0.9538
MED
ALT
NXP
APX
LIN
GPM
NOP
RHO
PMS
TCH
DOM
BRI
$
0.2819 *
0.7044
0.7044
0.7044
0.7044
0.7044
0.7044
0.7044
0.7044
0.7044
0.7924
1.1181
02043505
QUINIDEX EXTENTABS
SOTALOL HCL
* 80MG TABLET
02237269
02084228
02170833
02200996
02210428
02229778
02231181
02234008
02238326
02238417
02238634
00897272
MED-SOTALOL
ALTI-SOTALOL
LINSOTALOL
NU-SOTALOL
APO-SOTALOL
GEN-SOTALOL
NOVO-SOTALOL
RHO-SOTALOL
PMS-SOTALOL
SOTAMOL
DOM-SOTALOL
SOTACOR
* 160MG TABLET
02237270
02084236
02163772
02167794
02170841
02229779
02231182
02234013
02238327
02238415
02238635
00483923
MED-SOTALOL
ALTI-SOTALOL
NU-SOTALOL
APO-SOTALOL
LINSOTALOL
GEN-SOTALOL
NOVO-SOTALOL
RHO-SOTALOL
PMS-SOTALOL
SOTAMOL
DOM-SOTALOL
SOTACOR
58
TIMOLOL MALEATE
* 5MG TABLET
00755842
01947796
02044609
APO-TIMOL
NOVO-TIMOL
NU-TIMOLOL
APX
NOP
NXP
$
0.1790
0.1790
0.1790
APX
NOP
NXP
$
0.2791
0.2791
0.2791
APX
NOP
$
0.5431
0.5431
AST
$
0.7633
PDA
$
1.7360
PDA
$
2.1700
PDA
$
2.3328
* 10MG TABLET
00755850
01947818
02044617
APO-TIMOL
NOVO-TIMOL
NU-TIMOLOL
* 20MG TABLET
00755869
01947826
APO-TIMOL
NOVO-TIMOL
TOCAINIDE HCL
400MG TABLET
00598941
TONOCARD (EDS)
VERAPAMIL HCL
SEE SECTION 24:08.00 (HYPOTENSIVE DRUGS) PAGE 75
24:06.00 ANTILIPEMIC DRUGS
ATORVASTATIN CALCIUM
10MG TABLET
02230711
LIPITOR
20MG TABLET
02230713
LIPITOR
40MG TABLET
02230714
LIPITOR
59
BEZAFIBRATE
* 200MG TABLET
02240331
02084082
PMS-BEZAFIBRATE (EDS)
BEZALIP (EDS)
PMS
HLR
$
0.6710
0.9585
HLR
$
1.7360
BAY
$
1.3020
BAY
$
1.5733
BAY
$
1.7360
BRI
NOP
PMS
$
0.6952
0.6952
0.6952
PMS
BRI
ALT
NOP
$
0.6952
0.6952
0.6952
0.6952
NOP
WYA
$
0.0613
0.1267
PHU
$
0.8880
COLESTID
PHU
$
0.8880
COLESTID
PHU
$
0.2533
02083523
BEZALIP SR (EDS)
CERIVASTATIN SODIUM
0.2MG TABLET
02237325
BAYCOL
0.3MG TABLET
02237326
BAYCOL
0.4MG TABLET
02241466
BAYCOL
CHOLESTYRAMINE RESIN
* 444MG/G ORAL POWDER (9G)
00464880
02139189
02210320
QUESTRAN
NOVO-CHOLAMINE
PMS-CHOLESTYRAMINE
* 800MG/G ORAL POWDER (5G)
00890960
01918486
02054825
02139197
PMS-CHOLESTYRAMINE LIGHT
QUESTRAN LIGHT
SYN-CHOLESTYRAMINE LIGHT
NOVO-CHOLAMINE LIGHT
CLOFIBRATE
* 500MG CAPSULE
00337382
02041480
NOVO-FIBRATE
ATROMID-S
COLESTIPOL HCL RESIN
5G GRANULES
00642975
COLESTID
7.5G GRANULES
02132699
1G TABLET
02132680
60
FENOFIBRATE
* 100MG CAPSULE
02223600
02225980
NU-FENOFIBRATE (EDS)
APO-FENOFIBRATE (EDS)
NXP
APX
$
0.4693
0.4693
PMS
APX
GPM
DOM
FFR
$
1.3129
1.3129
1.3129
1.3785
1.8771
NVR
$
0.8138
NVR
$
1.1393
NXP
ALT
APX
GPM
PMS
DOM
NOP
PDA
$
0.1908 *
0.3216
0.3216
0.3216
0.3216
0.3377
0.3783
0.5375
NXP
ALT
APX
NOP
PEN
PMS
GPM
MED
DOM
PDA
$
0.2650 *
0.8160
0.8160
0.8160
0.8160
0.8160
0.8160
0.8160
0.8568
1.0760
* 200MG CAPSULE
02231780
02239864
02240210
02240337
02146959
PMS-FENOFIBR. MICRO (EDS)
APO-FENO-MICRO (EDS)
GEN-FENOFIBR. MICRO (EDS)
DOM-FENOFIBR. MICRO (EDS)
LIPIDIL-MICRO (EDS)
FLUVASTATIN SODIUM
20MG CAPSULE
02061562
LESCOL
40MG CAPSULE
02061570
LESCOL
GEMFIBROZIL
* 300MG CAPSULE
02058456
00851922
01979574
02185407
02239951
02241608
02241704
00599026
NU-GEMFIBROZIL
GEMFIBROZIL
APO-GEMFIBROZIL
GEN-GEMFIBROZIL
PMS-GEMFIBROZIL
DOM-GEMFIBROZIL
NOVO-GEMFIBROZIL
LOPID
* 600MG TABLET
02058464
00851930
01979582
02142074
02229604
02230183
02230476
02237292
02230580
00659606
NU-GEMFIBROZIL
GEMFIBROZIL
APO-GEMFIBROZIL
NOVO-GEMFIBROZIL
PENTA-GEMFIBROZIL
PMS-GEMFIBROZIL
GEN-GEMFIBROZIL
MED-GEMFIBROZIL
DOM-GEMFIBROZIL
LOPID
61
LOVASTATIN
* 20MG TABLET
02220172
00795860
APO-LOVASTATIN
MEVACOR
APX
MSD
$
1.5028
1.8786
APX
MSD
$
2.7717
3.4649
* 40MG TABLET
02220180
00795852
APO-LOVASTATIN
MEVACOR
PRAVASTATIN
10MG TABLET
00893749
PRAVACHOL
SQU
1.6421
SQU
1.9368
SQU
2.3328
20MG TABLET
00893757
PRAVACHOL
40MG TABLET
02222051
PRAVACHOL
SIMVASTATIN
5MG TABLET
00884324
ZOCOR
MSD
$
0.9765
MSD
$
1.9313
MSD
$
2.3870
MSD
$
2.3870
MSD
$
2.3870
10MG TABLET
00884332
ZOCOR
20MG TABLET
00884340
ZOCOR
40MG TABLET
00884359
ZOCOR
80MG TABLET
02240332
ZOCOR
24:08.00 HYPOTENSIVE DRUGS
ANTIHYPERTENSIVE COMBINATION PRODUCTS:
FIXED COMBINATION DRUGS ARE NOT INDICATED FOR INITIAL THERAPY
OF HYPERTENSION. HYPERTENSION REQUIRES THERAPY TO BE TITRATED
TO THE INDIVIDUAL PATIENT. IF THE FIXED COMBINATION
REPRESENTS THE DOSAGE SO DETERMINED, ITS USE MAY BE MORE
CONVENIENT IN PATIENT MANAGEMENT. THE TREATMENT OF
HYPERTENSION IS NOT STATIC, BUT MUST BE RE-EVALUATED AS
CONDITIONS IN EACH PATIENT WARRANT.
62
ACEBUTOLOL HCL
AMILORIDE HCL/HYDROCHLOROTHIAZIDE
SEE NOTE ON PAGE 62
* 5MG/50MG TABLET
00886106
00784400
01937219
02174596
02231254
00487813
NU-AMILZIDE
APO-AMILZIDE
NOVAMILOR
ALTI-AMILORIDE HCTZ
PENTA-AMILORIDE HCTZ
MODURET
NXP
APX
NOP
ALT
PEN
MSD
$
0.1458 *
0.2080
0.2080
0.2080
0.2080
0.3816
AST
$
0.6732
AST
$
1.1033
NVR
$
0.6239
NVR
$
0.7378
NVR
$
0.8463
AST
$
1.1718
AST
$
1.1718
ATENOLOL
ATENOLOL/CHLORTHALIDONE
SEE NOTE ON PAGE 62
50MG/25MG TABLET
02049961
TENORETIC
100MG/25MG TABLET
02049988
TENORETIC
BENAZEPRIL HCL
5MG TABLET
00885835
LOTENSIN
10MG TABLET
00885843
LOTENSIN
20MG TABLET
00885851
LOTENSIN
CANDESARTAN CILEXETIL
8MG TABLET
02239091
ATACAND
16MG TABLET
02239092
ATACAND
63
CAPTOPRIL
6.25MG TABLET
01999559
APO-CAPTO
APX
$
0.1297
NXP
SQU
ALT
APX
NOP
GPM
MED
PMS
PEN
TCH
FTP
DOM
$
0.0562 *
0.2301
0.2301
0.2301
0.2301
0.2301
0.2301
0.2301
0.2301
0.2301
0.2301
0.2416
NXP
SQU
ALT
APX
NOP
GPM
MED
PMS
PEN
TCH
FTP
DOM
$
0.0742 *
0.3255
0.3255
0.3255
0.3255
0.3255
0.3255
0.3255
0.3255
0.3255
0.3255
0.3418
* 12.5MG TABLET
01913824
00695661
00851639
00893595
01942964
02163551
02188929
02230203
02234254
02237861
02238449
02238551
NU-CAPTO
CAPOTEN
SYN-CAPTOPRIL
APO-CAPTO
NOVO-CAPTORIL
GEN-CAPTOPRIL
MED-CAPTOPRIL
PMS-CAPTOPRIL
PENTA-CAPTOPRIL
CAPTRIL
FTP-CAPTOPRIL
DOM-CAPTOPRIL
* 25MG TABLET
01913832
00546283
00851833
00893609
01942972
02163578
02188937
02230204
02234255
02237862
02238450
02238552
NU-CAPTO
CAPOTEN
SYN-CAPTOPRIL
APO-CAPTO
NOVO-CAPTORIL
GEN-CAPTOPRIL
MED-CAPTOPRIL
PMS-CAPTOPRIL
PENTA-CAPTOPRIL
CAPTRIL
FTP-CAPTOPRIL
DOM-CAPTOPRIL
64
* 50MG TABLET
01913840
00546291
00851647
00893617
01942980
02163586
02188945
02230205
02234256
02237863
02238451
02238553
NU-CAPTO
CAPOTEN
SYN-CAPTOPRIL
APO-CAPTO
NOVO-CAPTORIL
GEN-CAPTOPRIL
MED-CAPTOPRIL
PMS-CAPTOPRIL
PENTA-CAPTOPRIL
CAPTRIL
FTP-CAPTOPRIL
DOM-CAPTOPRIL
NXP
SQU
ALT
APX
NOP
GPM
MED
PMS
PEN
TCH
FTP
DOM
$
0.1484 *
0.6066
0.6066
0.6066
0.6066
0.6066
0.6066
0.6066
0.6066
0.6066
0.6066
0.6369
SQU
ALT
APX
NXP
NOP
GPM
MED
PMS
PEN
TCH
DOM
$
1.1279
1.1279
1.1279
1.1279
1.1279
1.1279
1.1279
1.1279
1.1279
1.1279
1.1843
HLR
$
0.6402
HLR
$
0.7378
HLR
$
0.8572
HLR
$
0.8572
* 100MG TABLET
00546305
00851655
00893625
01913859
01942999
02163594
02188953
02230206
02234257
02237864
02238554
CAPOTEN
SYN-CAPTOPRIL
APO-CAPTO
NU-CAPTO
NOVO-CAPTORIL
GEN-CAPTOPRIL
MED-CAPTOPRIL
PMS-CAPTOPRIL
PENTA-CAPTOPRIL
CAPTRIL
DOM-CAPTOPRIL
CILAZAPRIL
1MG TABLET
01911465
INHIBACE
2.5MG TABLET
01911473
INHIBACE
5MG TABLET
01911481
INHIBACE
CILAZAPRIL/HYDROCHLOROTHIAZIDE
SEE NOTE ON PAGE 62
5MG/12.5MG TABLET
02181479
INHIBACE PLUS
65
CLONIDINE HCL
0.025MG TABLET
00519251
DIXARIT (EDS)
BOE
$
0.2017
BOE
APX
NXP
NOP
$
0.1915
0.1915
0.1915
0.1915
BOE
APX
NXP
NOP
$
0.3417
0.3417
0.3417
0.3417
* 0.1MG TABLET
00259527
00868949
01913786
02046121
CATAPRES
APO-CLONIDINE
NU-CLONIDINE
NOVO-CLONIDINE
* 0.2MG TABLET
00291889
00868957
01913220
02046148
CATAPRES
APO-CLONIDINE
NU-CLONIDINE
NOVO-CLONIDINE
DILTIAZEM HCL
NOTE: THE SUSTAINED RELEASE DOSAGE FORMS ARE APPROVED AS
ANTIHYPERTENSIVE AGENTS.
(SEE SECTION 24:04.00)
DOXAZOSIN MESYLATE
* 1MG TABLET
02240498
02240588
01958100
GEN-DOXAZOSIN
APO-DOXAZOSIN
CARDURA-1
GPM
APX
AST
$
0.4178
0.4178
0.5968
GPM
APX
AST
$
0.5013
0.5013
0.7161
GPM
APX
AST
$
0.6516
0.6516
0.9310
* 2MG TABLET
02240499
02240589
01958097
GEN-DOXAZOSIN
APO-DOXAZOSIN
CARDURA-2
* 4MG TABLET
02240500
02240590
01958119
GEN-DOXAZOSIN
APO-DOXAZOSIN
CARDURA-4
66
ENALAPRIL MALEATE
2.5MG TABLET
00851795
VASOTEC
MSD
$
0.7327
MSD
$
0.8666
MSD
$
1.0416
MSD
$
1.2568
MSD
$
1.0416
AVT
AST
$
0.5357
0.5359
AST
AVT
$
0.7161
0.7161
AVT
AST
$
1.0735
1.0742
BMY
$
0.8572
BMY
$
1.0308
5MG TABLET
00708879
VASOTEC
10MG TABLET
00670901
VASOTEC
20MG TABLET
00670928
VASOTEC
ENALAPRIL MALEATE/HYDROCHLOROTHIAZIDE
SEE NOTE ON PAGE 62
10MG/25MG TABLET
00657298
VASERETIC
FELODIPINE
* 2.5MG SUSTAINED RELEASE TABLET
02221985
02057778
RENEDIL
PLENDIL
00851779
02221993
PLENDIL
RENEDIL
02222000
00851787
RENEDIL
PLENDIL
FOSINOPRIL
10MG TABLET
01907107
MONOPRIL
20MG TABLET
01907115
MONOPRIL
67
HYDRALAZINE HCL
* 10MG TABLET
00441619
00759465
01913204
00005525
APO-HYDRALAZINE
NOVO-HYLAZIN
NU-HYDRAL
APRESOLINE
APX
NOP
NXP
NVR
$
0.1001
0.1001
0.1001
0.1539
APX
NOP
NXP
NVR
$
0.1784
0.1784
0.1784
0.2643
APX
NOP
NXP
NVR
$
0.2742
0.2742
0.2742
0.4149
BMY
$
1.1718
BMY
$
1.1718
BMY
$
1.1718
BMY
$
1.1718
BMY
$
1.1718
RBP
$
0.2553
RBP
$
0.4515
* 25MG TABLET
00441627
00759473
02004828
00005533
APO-HYDRALAZINE
NOVO-HYLAZIN
NU-HYDRAL
APRESOLINE
* 50MG TABLET
00441635
00759481
02004836
00005541
APO-HYDRALAZINE
NOVO-HYLAZIN
NU-HYDRAL
APRESOLINE
IRBESARTAN
75MG TABLET
02237923
AVAPRO
150MG TABLET
02237924
AVAPRO
300MG TABLET
02237925
AVAPRO
IRBESARTAN/HYDROCHLOROTHIAZIDE
SEE NOTE ON PAGE 62
150MG/12.5MG TABLET
02241818
AVALIDE
300MG/12.5MG TABLET
02241819
AVALIDE
LABETALOL HCL
100MG TABLET
02106272
TRANDATE
200MG TABLET
02106280
TRANDATE
68
LISINOPRIL
* 5MG TABLET
02217481
00839388
02049333
APO-LISINOPRIL
PRINIVIL
ZESTRIL
APX
MSD
AST
$
0.6576
0.7308
0.7308
APX
MSD
AST
$
0.8246
0.8780
0.8780
MSD
AST
$
1.0551
1.0551
AST
MSD
$
0.8782
0.8782
MSD
AST
$
1.0551
1.0551
MSD
AST
$
1.0551
1.0551
MSD
$
1.1940
MSD
$
1.1940
MSD
$
1.1940
* 10MG TABLET
02217503
00839396
02049376
APO-LISINOPRIL
PRINIVIL
ZESTRIL
* 20MG TABLET
00839418
02049384
PRINIVIL
ZESTRIL
LISINOPRIL/HYDROCHLOROTHIAZIDE
SEE NOTE ON PAGE 62
* 10MG/12.5MG TABLET
02103729
02108194
ZESTORETIC
PRINZIDE
* 20MG/12.5MG TABLET
00884413
02045737
PRINZIDE
ZESTORETIC
* 20MG/25MG TABLET
00884421
02045729
PRINZIDE
ZESTORETIC
LOSARTAN POTASSIUM
25MG TABLET
02182815
COZAAR
50MG TABLET
02182874
COZAAR
100MG TABLET
02182882
COZAAR
LOSARTAN POTASSIUM/HYDROCHLOROTHIAZIDE
SEE NOTE ON PAGE 62
50MG/12.5MG TABLET
02230047
HYZAAR
MSD
$
1.1940
MSD
$
1.1935
100MG/25MG TABLET
02241007
HYZAAR DS
69
METHYLDOPA
* 125MG TABLET
00337463
00717517
00360252
NOVO-MEDOPA
NU-MEDOPA
APO-METHYLDOPA
NOP
NXP
APX
$
0.0369
0.0369
0.0543
NOP
NXP
APX
MSD
$
0.0629
0.0879
0.0879
0.1999
NOP
NXP
APX
$
0.1248
0.1709
0.1709
NOP
APX
$
0.0736
0.1075
NOP
APX
$
0.0761
0.1221
PHU
$
0.3431
PHU
$
0.7564
* 250MG TABLET
00337471
00717509
00360260
00016578
NOVO-MEDOPA
NU-MEDOPA
APO-METHYLDOPA
ALDOMET
* 500MG TABLET
00337498
00717576
00426830
NOVO-MEDOPA
NU-MEDOPA
APO-METHYLDOPA
METHYLDOPA/HYDROCHLOROTHIAZIDE
SEE NOTE ON PAGE 62
* 250MG/15MG TABLET
00363642
00441708
NOVO-DOPARIL
APO-METHAZIDE-15
* 250MG/25MG TABLET
00363634
00441716
NOVO-DOPARIL
APO-METHAZIDE-25
METOPROLOL TARTRATE
MINOXIDIL
2.5MG TABLET
00514497
LONITEN (EDS)
10MG TABLET
00514500
LONITEN (EDS)
NADOLOL
NIFEDIPINE
70
OXPRENOLOL HCL
40MG TABLET
00402575
TRASICOR
NVR
$
0.2804
NVR
$
0.4249
NVR
$
0.4248
NVR
$
0.8496
SEV
$
0.6510
SEV
$
0.8138
NVR
$
0.7513
NVR
$
0.7513
APX
NXP
NOP
ALT
PFI
$
0.1683
0.1683
0.1683
0.1683
0.2960
APX
NXP
NOP
ALT
PFI
$
0.2275
0.2275
0.2275
0.2275
0.4021
80MG TABLET
00402583
TRASICOR
80MG SLOW RELEASE TABLET
00534579
SLOW TRASICOR
160MG SLOW RELEASE TABLET
00534587
SLOW TRASICOR
PERINDOPRIL ERBUMINE
2MG TABLET
02123274
COVERSYL
4MG TABLET
02123282
COVERSYL
PINDOLOL
PINDOLOL/HYDROCHLOROTHIAZIDE
SEE NOTE ON PAGE 62
10MG/25MG TABLET
00568627
VISKAZIDE
10MG/50MG TABLET
00568635
VISKAZIDE
PRAZOSIN
* 1MG TABLET
00882801
01913794
01934198
02139979
00560952
APO-PRAZO
NU-PRAZO
NOVO-PRAZIN
ALTI-PRAZOSIN
MINIPRESS
* 2MG TABLET
00882828
01913808
01934201
02139987
00560960
APO-PRAZO
NU-PRAZO
NOVO-PRAZIN
ALTI-PRAZOSIN
MINIPRESS
71
* 5MG TABLET
00882836
01913816
01934228
02139995
00560979
APO-PRAZO
NU-PRAZO
NOVO-PRAZIN
ALTI-PRAZOSIN
MINIPRESS
APX
NXP
NOP
ALT
PFI
$
0.3284
0.3284
0.3284
0.3284
0.5527
WYA
$
0.5672
WYA
$
0.8781
PDA
$
0.8915
PDA
$
0.8915
PDA
$
0.8915
PDA
$
0.8915
PDA
$
0.8914
PDA
$
0.8914
AVT
$
0.7053
AVT
$
0.8138
AVT
$
0.8138
AVT
$
1.0308
PROPRANOLOL
PROPRANOLOL/HYDROCHLOROTHIAZIDE
SEE NOTE ON PAGE 62
40MG/25MG TABLET
02042282
INDERIDE-40
80MG/25MG TABLET
02042290
INDERIDE-80
QUINAPRIL HCL
5MG TABLET
01947664
ACCUPRIL
10MG TABLET
01947672
ACCUPRIL
20MG TABLET
01947680
ACCUPRIL
40MG TABLET
01947699
ACCUPRIL
QUINAPRIL HCL/HYDROCHLOROTHIAZIDE
SEE NOTE ON PAGE 62
10MG/12.5MG TABLET
02237367
ACCURETIC
20MG/12.5MG TABLET
02237368
ACCURETIC
RAMIPRIL
1.25MG CAPSULE
02221829
ALTACE
2.5MG CAPSULE
02221837
ALTACE
5MG CAPSULE
02221845
ALTACE
10MG CAPSULE
02221853
ALTACE
72
RESERPINE/HYDRALAZINE HCL/HYDROCHLOROTHIAZIDE
SEE NOTE ON PAGE 62
0.1MG/25MG/15MG TABLET
00074608
SER-AP-ES
NVR
$
0.4058
SEA
NOP
$
0.0934
0.0934
SEA
NOP
$
0.2426
0.2426
BOE
$
1.6254
BOE
$
1.6254
ALT
NOP
NXP
APX
ABB
$
0.3787
0.3787
0.3787
0.3787
0.6011
ALT
NOP
NXP
APX
ABB
$
0.4813
0.4813
0.4813
0.4813
0.7641
ALT
NOP
NXP
APX
ABB
$
0.6538
0.6538
0.6538
0.6538
1.0377
SPIRONOLACTONE/HYDROCHLOROTHIAZIDE
SEE NOTE ON PAGE 62
* 25MG/25MG TABLET
00180408
00613231
ALDACTAZIDE-25
NOVO-SPIROZINE
* 50MG/50MG TABLET
00594377
00657182
ALDACTAZIDE-50
NOVO-SPIROZINE
TELMISARTAN
40MG TABLET
02240769
MICARDIS
80MG TABLET
02240770
MICARDIS
TERAZOSIN HCL
* 1MG TABLET
02218941
02230805
02233047
02234502
00818658
ALTI-TERAZOSIN
NOVO-TERAZOSIN
NU-TERAZOSIN
APO-TERAZOSIN
HYTRIN
* 2MG TABLET
02218968
02230806
02233048
02234503
00818682
ALTI-TERAZOSIN
NOVO-TERAZOSIN
NU-TERAZOSIN
APO-TERAZOSIN
HYTRIN
* 5MG TABLET
02218976
02230807
02233049
02234504
00818666
ALTI-TERAZOSIN
NOVO-TERAZOSIN
NU-TERAZOSIN
APO-TERAZOSIN
HYTRIN
73
* 10MG TABLET
02218984
02230808
02233050
02234505
00818674
ALTI-TERAZOSIN
NOVO-TERAZOSIN
NU-TERAZOSIN
APO-TERAZOSIN
HYTRIN
ALT
NOP
NXP
APX
ABB
$
0.9570
0.9570
0.9570
0.9570
1.5190
ABB
$
24.0900
MSD
$
0.4654
KNO
$
0.6727
KNO
$
0.7812
KNO
$
0.8897
NXP
APX
NOP
SMJ
PEN
$
0.0318 *
0.0518
0.0518
0.0518
0.0518
NVR
$
1.1393
NVR
$
1.1393
1MG TABLET (7) 2MG TABLET (7) 5MG TABLET (14 )
(PACKAGE)
02187876
HYTRIN STARTER PACK
TIMOLOL MALEATE
TIMOLOL/HYDROCHLOROTHIAZIDE
SEE NOTE ON PAGE 62
10MG/25MG TABLET
00509353
TIMOLIDE
TRANDOLAPRIL
0.5MG CAPSULE
02231457
MAVIK
1MG CAPSULE
02231459
MAVIK
2MG CAPSULE
02231460
MAVIK
TRIAMTERENE/HYDROCHLOROTHIAZIDE
SEE NOTE ON PAGE 62
* 50MG/25MG TABLET
00865532
00441775
00532657
01919547
02238638
NU-TRIAZIDE
APO-TRIAZIDE
NOVO-TRIAMZIDE
DYAZIDE
PENTA-TRIAMTERENE HCTZ
VALSARTAN
80MG CAPSULE
02236808
DIOVAN
160MG CAPSULE
02236809
DIOVAN
74
VERAPAMIL HCL
* 80MG TABLET
02239769
00782483
00812331
00867365
00886033
02229597
02237921
00554316
MED-VERAPAMIL
APO-VERAP
NOVO-VERAMIL
ALTI-VERAPAMIL
NU-VERAP
PENTA-VERAPAMIL
GEN-VERAPAMIL
ISOPTIN
MED
APX
NOP
ALT
NXP
PEN
GPM
KNO
$
0.1655 *
0.2968
0.2968
0.2968
0.2968
0.2968
0.2968
0.3043
MED
APX
NOP
ALT
NXP
PEN
GPM
KNO
$
0.2569 *
0.4612
0.4612
0.4612
0.4612
0.4612
0.4612
0.4728
WYA
$
0.7487
GPM
KNO
$
0.7487
1.0769
SEA
$
0.8463
WYA
$
0.8463
GPM
KNO
$
0.8463
1.2162
SEA
$
0.9462
WYA
$
0.9462
* 120MG TABLET
02239770
00782491
00812358
00867373
00886041
02229598
02237922
00554324
MED-VERAPAMIL
APO-VERAP
NOVO-VERAMIL
ALTI-VERAPAMIL
NU-VERAP
PENTA-VERAPAMIL
GEN-VERAPAMIL
ISOPTIN
120MG SUSTAINED RELEASE CAPSULE
02100479
VERELAN
02210347
01907123
GEN-VERAPAMIL SR
ISOPTIN SR
180MG CONTROLLED-ONSET EXTENDED-RELEASE
TABLET
02231676
CHRONOVERA
02100487
VERELAN
02210355
01934317
GEN-VERAPAMIL SR
ISOPTIN SR
240MG CONTROLLED-ONSET EXTENDED-RELEASE
TABLET
02231677
CHRONOVERA
02100495
VERELAN
75
02210363
02211920
02237791
02240321
00742554
GEN-VERAPAMIL SR
NOVO-VERAMIL SR
PMS-VERAPAMIL SR
DOM-VERAPAMIL SR
ISOPTIN SR
GPM
NOP
PMS
DOM
KNO
$
0.9462
0.9462
0.9462
0.9935
1.6218
SLV
$
0.1384
SLV
$
0.2546
BOE
$
0.3008
BOE
$
0.4008
BOE
$
0.5398
BOE
$
0.6325
APX
NOP
WYA
$
0.0174
0.0174
0.0565
APX
NOP
WYA
$
0.0375
0.0375
0.1324
APX
WYA
$
0.0363
0.0403
24:12.00 VASODILATING DRUGS
BETAHISTINE HCL
4MG TABLET
02222035
SERC
8MG TABLET
02240601
SERC
DIPYRIDAMOLE
25MG TABLET
00067385
PERSANTINE (EDS)
50MG TABLET
00067393
PERSANTINE (EDS)
75MG TABLET
00452092
PERSANTINE (EDS)
100MG TABLET
00452106
PERSANTINE (EDS)
ISOSORBIDE DINITRATE
* 10MG TABLET
00441686
00458686
02042622
APO-ISDN
NOVO-SORBIDE
ISORDIL
* 30MG TABLET
00441694
00458694
02042614
APO-ISDN
NOVO-SORBIDE
ISORDIL
* 5MG SUBLINGUAL TABLET
00670944
02042606
APO-ISDN
ISORDIL
76
ISOSORBIDE-5 MONONITRATE
20MG TABLET
02058472
ISMO
WYA
$
0.5154
AST
$
0.6944
BAY
$
5.7574
02126559
IMDUR
NIMODIPINE
30MG CAPSULE
02155923
NIMOTOP (EDS)
NITROGLYCERIN
NOTE: TO PREVENT DEVELOPMENT OF TOLERANCE, PATCHES SHOULD BE
REMOVED AFTER 12-14 HOURS TO PROVIDE DAILY NITRATE-FREE PERIODS
OF 10-12 HOURS. THE NITRATE-FREE PERIOD SHOULD BE TIMED TO
COINCIDE WITH THE PERIOD IN WHICH ANGINA IS LEAST LIKELY TO OCCUR
(USUALLY AT NIGHT).
x
0.2MG/HR. TRANSDERMAL THERAPEUTIC SYSTEM
00584223
01911910
02162806
02230732
x
NVR
KEY
MDA
SAW
$
0.6149
0.6149
0.6149
0.6149
$
0.6944
0.6944
0.6944
0.6944
$
0.6944
0.6944
0.6944
0.6944
KEY
$
1.2044
PDA
$
0.0290
PDA
$
0.0302
PMS
$
0.2105
00852384
01911902
02163527
02230733
x
TRANSDERM-NITRO 0.2
NITRO-DUR 0.2
MINITRAN 0.2
TRINIPATCH 0.2
TRANSDERM-NITRO 0.4
NITRO-DUR 0.4
MINITRAN 0.4
TRINIPATCH 0.4
NVR
KEY
MDA
SAW
01911929
02046156
02163535
02230734
NITRO-DUR 0.6
TRANSDERM-NITRO 0.6
MINITRAN 0.6
TRINIPATCH 0.6
KEY
NVR
MDA
SAW
02011271
NITRO-DUR 0.8
0.3MG SUBLINGUAL TABLET
00037613
NITROSTAT
0.6MG SUBLINGUAL TABLET
00037621
NITROSTAT
2% OINTMENT
01926454
NITROL
77
0.4MG/DOSE METERED DOSE LINGUAL SPRAY
(PACKAGE)
01926721
NITROLINGUAL SPRAY
AVT
$
13.1200
AVT
$
13.1200
0.4MG/DOSE LINGUAL SPRAY (PACKAGE)
02231441
NITROLINGUAL PUMPSPRAY
78
CENTRAL NERVOUS SYSTEM DRUGS
28:00
28:00 CENTRAL NERVOUS SYSTEM DRUGS
28:08.04 NON-STEROIDAL ANTI-INFLAMMATORY AGENTS
ACETYLSALICYLIC ACID
* 325MG ENTERIC TABLET
00216666
02046253
00010332
NOVASEN
MSD ENTERIC-COATED ASA
ENTROPHEN
NOP
JJM
JJM
$
0.0160
0.0160
0.0526
NOP
JJM
JJM
$
0.0263
0.0263
0.0900
SEA
$
0.6782
SEA
$
1.3563
DOM
PMS
NOP
APX
NXP
PEN
NVR
$
0.0784 *
0.2065
0.2137
0.2137
0.2137
0.2137
0.3391
DOM
NOP
APX
NXP
PEN
PMS
NVR
$
0.1452 *
0.4272
0.4272
0.4272
0.4272
0.4272
0.7155
00229296
02046261
00010340
NOVASEN
ENTROPHEN
CELECOXIB
100MG CAPSULE
02239941
CELEBREX (EDS)
200MG CAPSULE
02239942
CELEBREX (EDS)
DICLOFENAC SODIUM
02231662
02231502
00808539
00839175
00886017
02229591
00514004
DOM-DICLOFENAC
PMS-DICLOFENAC
NOVO-DIFENAC
APO-DICLO
NU-DICLO
PENTA-DICLOFENAC EC
VOLTAREN
02231663
00808547
00839183
00886025
02229592
02231503
00514012
DOM-DICLOFENAC
NOVO-DIFENAC
APO-DICLO
NU-DICLO
PENTA-DICLOFENAC EC
PMS-DICLOFENAC
VOLTAREN
80
02228203
02158582
02162814
02231504
02231664
00782459
NU-DICLO-SR
NOVO-DIFENAC SR
APO-DICLO SR
PMS-DICLOFENAC-SR
DOM-DICLOFENAC SR
VOLTAREN-SR
NXP
NOP
APX
PMS
DOM
NVR
$
0.2915 *
0.6191
0.6191
0.6191
0.6877
1.0055
NXP
NOP
APX
PMS
DOM
NVR
$
0.4028 *
0.8544
0.8544
0.8544
0.9169
1.4332
NOP
PMS
TCH
SAB
NVR
$
0.6768
0.6768
0.6768
0.7248
1.0742
NOP
PMS
TCH
SAB
NVR
$
0.9111
0.9111
0.9111
0.9762
1.4463
SEA
$
0.6011
SEA
$
0.8181
APX
NOP
NXP
$
0.4595
0.4595
0.4595
APX
NOP
NXP
$
0.5621
0.5621
0.5621
02228211
02048698
02091194
02231505
02231665
00590827
NU-DICLO-SR
NOVO-DIFENAC SR
APO-DICLO SR
PMS-DICLOFENAC-SR
DOM-DICLOFENAC SR
VOLTAREN-SR
* 50MG SUPPOSITORY
02174677
02231506
02237786
02241224
00632724
NOVO-DIFENAC
PMS-DICLOFENAC
DICLOTEC
SAB-DICLOFENAC
VOLTAREN
* 100MG SUPPOSITORY
02174685
02231508
02237787
02241225
00632732
NOVO-DIFENAC
PMS-DICLOFENAC
DICLOTEC
SAB-DICLOFENAC
VOLTAREN
DICLOFENAC SODIUM/MISOPROSTOL
50MG/200UG ENTERIC TABLET
01917056
ARTHROTEC
75MG/200UG ENTERIC TABLET
02229837
ARTHROTEC 75
DIFLUNISAL
* 250MG TABLET
02039486
02048493
02058405
APO-DIFLUNISAL
NOVO-DIFLUNISAL
NU-DIFLUNISAL
* 500MG TABLET
02039494
02048507
02058413
APO-DIFLUNISAL
NOVO-DIFLUNISAL
NU-DIFLUNISAL
81
ETODOLAC
* 200MG CAPSULE
02232317
02239319
02142023
APO-ETODOLAC (EDS)
GEN-ETODOLAC (EDS)
ULTRADOL (EDS)
APX
GPM
PGA
$
0.6510
0.6510
0.8680
APX
GPM
PGA
$
0.6510
0.6510
0.8680
LIL
$
0.5628
ALT
APX
NXP
NOP
PHU
$
0.2782
0.2782
0.2782
0.2782
0.5346
ALT
APX
NXP
NOP
PHU
$
0.3807
0.3807
0.3807
0.3807
0.6999
APX
NXP
NOP
MCL
$
0.0309
0.0309
0.0316
0.1646
* 300MG CAPSULE
02232318
02239320
02142031
APO-ETODOLAC (EDS)
GEN-ETODOLAC (EDS)
ULTRADOL (EDS)
FENOPROFEN
600MG TABLET
00345504
NALFON
FLURBIPROFEN
* 50MG TABLET
00675202
01912046
02020661
02100509
00647942
ALTI-FLURBIPROFEN
APO-FLURBIPROFEN
NU-FLURBIPROFEN
NOVO-FLURPROFEN
ANSAID
* 100MG TABLET
00675199
01912038
02020688
02100517
00600792
ALTI-FLURBIPROFEN
APO-FLURBIPROFEN
NU-FLURBIPROFEN
NOVO-FLURPROFEN
ANSAID
IBUPROFEN
* 300MG TABLET
00441651
02020696
00629332
00327794
APO-IBUPROFEN
NU-IBUPROFEN
NOVO-PROFEN
MOTRIN
82
* 400MG TABLET
00506052
02020718
00629340
00364142
APO-IBUPROFEN
NU-IBUPROFEN
NOVO-PROFEN
MOTRIN
APX
NXP
NOP
MCL
$
0.0404
0.0404
0.0412
0.2106
APX
NOP
NXP
MCL
$
0.0505
0.0505
0.0505
0.2959
NOP
APX
NXP
TCH
ROP
FTP
$
0.0945
0.0945
0.0945
0.0945
0.0945
0.0945
NOP
APX
NXP
TCH
ROP
FTP
$
0.1640
0.1640
0.1640
0.1640
0.1640
0.1640
RHO
NOP
SAB
MSD
$
0.7194
0.7194
0.7194
1.1430
RHO
NOP
SAB
MSD
$
0.9668
0.9668
0.9668
1.5361
* 600MG TABLET
00585114
00629359
02020726
00484911
APO-IBUPROFEN
NOVO-PROFEN
NU-IBUPROFEN
MOTRIN
INDOMETHACIN
* 25MG CAPSULE
00337420
00611158
00865850
02143364
02204541
02238442
NOVO-METHACIN
APO-INDOMETHACIN
NU-INDO
INDOTEC
RHODACINE
FTP-INDOMETHACIN
* 50MG CAPSULE
00337439
00611166
00865869
02143372
02204568
02238443
NOVO-METHACIN
APO-INDOMETHACIN
NU-INDO
INDOTEC
RHODACINE
FTP-INDOMETHACIN
* 50MG SUPPOSITORY
02146932
02176130
02231799
00594466
RHODACINE
NOVO-METHACIN
SAB-INDOMETHACIN
INDOCID
* 100MG SUPPOSITORY
02146940
02176149
02231800
00016233
RHODACINE
NOVO-METHACIN
SAB-INDOMETHACIN
INDOCID
83
KETOPROFEN
* 50MG CAPSULE
00790427
02150808
01926403
APO-KETO
PMS-KETOPROFEN
ORUDIS
APX
PMS
AVT
$
0.1804
0.1804
0.3853
ROP
PMS
AVT
$
0.1804
0.1804
0.3853
ROP
PMS
AVT
$
0.3340
0.3340
0.7793
ROP
APX
AVT
$
0.6680
0.6680
1.5864
AVT
$
0.7831
PMS
NOP
TCH
AVT
$
1.0774
1.0774
1.0774
1.5947
DOM
APX
NXP
PMS
PDA
$
0.2242 *
0.3590
0.3590
0.3590
0.6115
APX
NOP
SMJ
$
0.5453
0.5453
0.7270
* 50MG ENTERIC COATED TABLET
00761672
02150816
01926381
RHODIS EC
PMS-KETOPROFEN-EC
ORUDIS-E
00761680
02150824
01926365
RHODIS EC
PMS-KETOPROFEN-EC
ORUDIS-E
02031175
02172577
01926373
RHODIS SR
APO-KETOPROFEN SR
ORUDIS SR
50MG SUPPOSITORY
01931512
ORUDIS
* 100MG SUPPOSITORY
02015951
02156083
02165481
01926411
PMS-KETOPROFEN
NOVO-KETO
ORAFEN
ORUDIS
MEFENAMIC ACID
* 250MG CAPSULE
02237826
02229452
02229569
02231208
00155225
DOM-MEFENAMIC ACID
APO-MEFENAMIC
NU-MEFENAMIC
PMS-MEFENAMIC ACID
PONSTAN
NABUMETONE
* 500MG TABLET
02238639
02240867
02083531
APO-NABUMETONE (EDS)
NOVO-NABUMETONE (EDS)
RELAFEN (EDS)
84
NAPROXEN
* 125MG TABLET
00522678
00565369
00865621
APO-NAPROXEN
NOVO-NAPROX
NU-NAPROX
APX
NOP
NXP
$
0.0590
0.0590
0.0590
NXP
APX
NOP
ALT
HLR
$
0.0958 *
0.1159
0.1159
0.1159
0.4256
NXP
APX
ALT
NOP
HLR
$
0.1306 *
0.1582
0.1582
0.1582
0.5550
NXP
NOP
APX
ALT
HLR
$
0.1888 *
0.2290
0.2290
0.2290
1.0067
APX
NOP
HLR
$
0.9168
0.9168
1.3778
ALT
RHO
SAB
PMS
HLR
$
0.8601
0.8601
0.8601
0.8604
1.1935
HLR
$
0.0622
NOP
APX
$
0.0212
0.0261
* 250MG TABLET
00865648
00522651
00565350
00615315
02162474
NU-NAPROX
APO-NAPROXEN
NOVO-NAPROX
NAXEN
NAPROSYN
* 375MG TABLET
00865656
00600806
00615323
00627097
02162482
NU-NAPROX
APO-NAPROXEN
NAXEN
NOVO-NAPROX
NAPROSYN
* 500MG TABLET
00865664
00589861
00592277
00615331
02162490
NU-NAPROX
NOVO-NAPROX
APO-NAPROXEN
NAXEN
NAPROSYN
02177072
02231327
02162466
APO-NAPROXEN SR
NOVO-NAPROX SR
NAPROSYN-S.R.
* 500MG SUPPOSITORY
00756814
02229690
02230477
02017237
02162458
NAXEN
RHODIAPROX
NAPROXEN
PMS-NAPROXEN
NAPROSYN
25MG/ML SUSPENSION
02162431
NAPROSYN
PHENYLBUTAZONE
* 100MG TABLET
00021660
00312789
NOVO-BUTAZONE
APO-PHENYLBUTAZONE
85
PIROXICAM
* 10MG CAPSULE
00642886
00695718
00836249
00865761
02139952
02171813
00525596
APO-PIROXICAM
NOVO-PIROCAM
PMS-PIROXICAM
NU-PIROX
PIROXICAM
GEN-PIROXICAM
FELDENE
APX
NOP
PMS
NXP
ALT
GPM
PFI
$
0.4500
0.4500
0.4500
0.4500
0.4500
0.4500
0.9554
APX
NOP
PMS
NXP
ALT
GPM
PFI
$
0.7767
0.7767
0.7767
0.7767
0.7767
0.7767
1.6019
PMS
$
0.8040
PMS
TCH
PFI
$
1.3400
1.3400
1.8634
MSD
$
1.3563
MSD
$
1.3563
MSD
$
0.2713
* 20MG CAPSULE
00642894
00695696
00836230
00865788
02139960
02171821
00525618
APO-PIROXICAM
NOVO-PIROCAM
PMS-PIROXICAM
NU-PIROX
PIROXICAM
GEN-PIROXICAM
FELDENE
10MG SUPPOSITORY
02154420
PMS-PIROXICAM
* 20MG SUPPOSITORY
02154463
02238028
00632716
PMS-PIROXICAM
FEXICAM
FELDENE
ROFECOXIB
12.5MG TABLET
02241107
VIOXX (EDS)
25MG TABLET
02241108
VIOXX (EDS)
2.5MG/ML ORAL SUSPENSION
02241109
VIOXX (EDS)
86
SULINDAC
* 150MG TABLET
00745588
00778354
02042576
NOVO-SUNDAC
APO-SULIN
NU-SULINDAC
NOP
APX
NXP
$
0.4149
0.4149
0.4149
NXP
NOP
APX
PEN
$
0.4333 *
0.5252
0.5252
0.5252
ALT
APX
NOP
PMS
PEN
$
0.3730
0.3730
0.3730
0.3730
0.3730
DOM
NXP
ALT
APX
NOP
PMS
PEN
AVT
$
0.2398 *
0.3147
0.4453
0.4453
0.4453
0.4453
0.4453
0.7069
NOP
$
0.4611
JAN
$
0.4293
JAN
$
0.8722
* 200MG TABLET
02042584
00745596
00778362
02239164
NU-SULINDAC
NOVO-SUNDAC
APO-SULIN
PENTA-SULINDAC
TIAPROFENIC ACID
* 200MG TABLET
01924613
02136112
02179679
02230827
02231249
ALBERT-TIAFEN
APO-TIAPROFENIC
NOVO-TIAPROFENIC
PMS-TIAPROFENIC
PENTA-TIAPROFENIC
* 300MG TABLET
02231060
02146886
01924621
02136120
02179687
02230828
02231250
02221950
DOM-TIAPROFENIC
NU-TIAPROFENIC
ALBERT-TIAFEN
APO-TIAPROFENIC
NOVO-TIAPROFENIC
PMS-TIAPROFENIC
PENTA-TIAPROFENIC
SURGAM
TOLMETIN
400MG CAPSULE
02076233
NOVO-TOLMETIN
200MG TABLET
00364126
TOLECTIN
600MG TABLET
00632740
TOLECTIN
87
28:08.08 OPIATE AGONISTS (NARCOTIC ANALGESICS)
ACETAMINOPHEN/CAFFEINE/CODEINE
* WITH 15MG CODEINE/TABLET
00653241
02163934
00687200
00293504
LENOLTEC NO.2
TYLENOL WITH CODEINE NO.2
NOVO-GESIC C15
ATASOL-15
TCH
JAN
NOP
HOR
$
0.0537
0.0537
0.0835
0.0876
TCH
JAN
NOP
HOR
LIH
$
0.0603
0.0603
0.0867
0.1270
0.1730
TCH
GLA
$
0.0494
0.0494
TCH
JAN
GLA
$
0.1502
0.1502
0.1537
JAN
$
0.0835
LIH
$
0.1834
MSD
$
0.3697
* WITH 30MG CODEINE/TABLET
00653276
02163926
00687219
00293512
02232389
LENOLTEC NO.3
NOVO-GESIC C30
ATASOL-30
EXDOL-30
* 300MG/30MG TABLET
00608882
00666130
EMTEC-30
EMPRACET-30
* 300MG/60MG TABLET
00621463
02163918
00666149
LENOLTEC #4
EMPRACET-60
32MG/1.6MG/ML ELIXIR
02163942
TYLENOL WITH CODEINE ELX
ACETYLSALICYLIC ACID/CAFFEINE/CODEINE
375MG/30MG/30MG TABLET
02238645
292
ANILERIDINE HCL
25MG TABLET
00010014
LERITINE
88
CODEINE
02230302
CODEINE CONTIN (EDS)
PFR
$
0.2442
PFR
$
0.4883
PFR
$
0.7378
PFR
$
0.9765
TCH
$
0.0832
TCH
$
0.1080
ROG
$
0.0266
JAN
$
9.2225
JAN
$
17.3600
JAN
$
24.4125
JAN
$
30.3800
KNO
$
0.1288
KNO
PMS
$
0.1538
0.1538
02163748
02163780
02163799
CODEINE PHOSPHATE
15MG TABLET
00593435
CODEINE
30MG TABLET
00593451
CODEINE
5MG/ML SYRUP
00779474
CODEINE
FENTANYL
25UG/HR TRANSDERMAL SYSTEM
01937383
DURAGESIC (EDS)
01937391
DURAGESIC (EDS)
01937405
DURAGESIC (EDS)
01937413
DURAGESIC (EDS)
HYDROMORPHONE HCL
1MG TABLET
00705438
DILAUDID
* 2MG TABLET
00125083
00885436
DILAUDID
PMS-HYDROMORPHONE
89
* 4MG TABLET
00125121
00885401
DILAUDID
PMS-HYDROMORPHONE
KNO
PMS
$
0.2431
0.2431
KNO
$
0.4735
PFR
$
0.6510
PFR
$
0.9765
PFR
$
1.6926
PFR
$
3.1248
PFR
$
3.7433
KNO
PMS
$
0.0859
0.0860
KNO
SAB
$
1.2400
1.2400
KNO
SAB
$
3.0300
3.0300
KNO
SAB
$
4.8200
4.9000
KNO
SAB
$
10.8000
11.1000
KNO
$
76.1100
KNO
$
2.3979
SAW
$
0.1285
SAB
ABB
ABB
$
0.2800
0.8300
0.8300
8MG TABLET
00786543
DILAUDID
3MG CONTROLLED-RELEASE CAPSULE
02125323
HYDROMORPH CONTIN
6MG CONTROLLED RELEASE CAPSULE
02125331
HYDROMORPH CONTIN
02125366
HYDROMORPH CONTIN
02125382
HYDROMORPH CONTIN
02125390
HYDROMORPH CONTIN
* 1MG/ML ORAL LIQUID
00786535
01916386
DILAUDID
PMS-HYDROMORPHONE
00627100
02145901
DILAUDID
HYDROMORPHONE HCL
00622133
02145928
DILAUDID-HP
HYDROMORPHONE HP 10
02146118
02145936
DILAUDID HP-PLUS
HYDROMORPHONE HP 20
02145863
02146126
DILAUDID-XP
HYDROMORPHONE HP 50
250MG STERILE POWDER
02085895
DILAUDID
3MG SUPPOSITORY
00125105
DILAUDID
MEPERIDINE HCL
50MG TABLET
02138018
DEMEROL
00725765
02242003
00497452
MEPERIDINE HYDROCHLORIDE
DEMEROL
PETHIDINE
90
00725749
02242005
00497479
DEMEROL
PETHIDINE
SAB
ABB
ABB
$
0.3200
0.8700
0.8700
MORPHINE
ORAL FORMS CONTAIN MORPHINE HYDROCHLORIDE OR SULFATE,
INJECTABLE FORMS CONTAIN MORPHINE SULFATE.
* 5MG TABLET
00594652
02009773
02014203
STATEX
MOS-SULFATE
MSIR
PMS
ICN
PFR
$
0.1194
0.1194
0.1194
PMS
ICN
ICN
PFR
$
0.1845
0.1845
0.1845
0.1856
PFR
ICN
$
0.3275
0.3519
PMS
ICN
$
0.2442
0.2442
PFR
$
0.4206
ICN
$
0.4573
PMS
ICN
$
0.3744
0.3744
ICN
$
0.6349
AVT
$
0.3147
AVT
$
0.3852
PFR
$
0.6460
KNO
$
0.8173
AVT
$
0.7439
* 10MG TABLET
00594644
00690198
02009765
02014211
STATEX
M.O.S.
MOS-SULFATE
MSIR
* 20MG TABLET
02014238
00690201
MSIR
M.O.S.
* 25MG TABLET
00594636
02009749
STATEX
MOS-SULFATE
30MG TABLET
02014254
MSIR
40MG TABLET
00690228
M.O.S.
* 50MG TABLET
00675962
02009706
STATEX
MOS-SULFATE
60MG TABLET
00690244
M.O.S.
10MG EXTENDED-RELEASE CAPSULE
02019930
M-ESLON
02177749
M-ESLON
02015439
MS CONTIN
20MG SUSTAINED-RELEASE CAPSULE
02184435
KADIAN
02019949
M-ESLON
91
x
01988727
00776181
02014297
ORAMORPH SR
M.O.S.-S.R.
MS CONTIN
BOE
ICN
PFR
$
0.7437
0.7439
0.9755
KNO
$
1.4940
AVT
$
1.3057
BOE
ICN
PFR
$
1.3056
1.3057
1.7195
KNO
$
2.6218
AVT
$
2.0724
BOE
PFR
$
2.1806
2.6218
AVT
$
4.1447
PFR
$
4.8739
ICN
PMS
TCH
$
0.0217
0.0217
0.0217
PMS
TCH
ICN
$
0.0873
0.0873
0.0914
ICN
TCH
$
0.1995
0.1995
PMS
TCH
ICN
$
0.5404
0.5404
0.5686
SAB
ABB
$
0.5700
0.6600
02184443
KADIAN
02019957
x
M-ESLON
01988735
00776203
02014300
ORAMORPH SR
M.O.S.-S.R.
MS CONTIN
02184451
KADIAN
02019965
x
M-ESLON
01988743
02014319
ORAMORPH SR
MS CONTIN
02177757
M-ESLON
02014327
MS CONTIN
00486582
00591467
00607762
M.O.S.
STATEX
MORPHITEC-1
00591475
00607770
00514217
STATEX
MORPHITEC-5
M.O.S.
00632503
00690783
M.O.S.
MORPHITEC-10
00621935
00690791
00632481
STATEX
MORPHITEC-20
M.O.S.
00392588
00850322
MORPHINE SO4
MORPHINE SO4
92
00392561
00850330
MORPHINE SO4
MORPHINE SO4
SAB
ABB
$
0.5700
0.6700
SAB
$
3.4100
KNO
$
96.5700
PMS
$
1.4485
PMS
ICN
PFR
$
1.6080
1.8988
1.9422
PMS
ICN
PFR
$
1.9020
2.2605
2.3274
PMS
ICN
PFR
$
2.1125
2.4865
2.5796
PFR
$
2.5823
PFR
$
3.2659
PFR
$
4.1773
PFR
$
6.4558
PFR
$
0.8680
PFR
$
1.3020
PFR
$
2.2568
PFR
$
4.1664
00617288
MORPHINE HP 50
50MG/ML INJECTION SOLUTION (50ML SYRINGE)
02137267
MORPHINE SULPHATE
5MG SUPPOSITORY
00632228
STATEX
* 10MG SUPPOSITORY
00632201
00624268
02014246
STATEX
M.O.S.
MSIR
* 20MG SUPPOSITORY
00596965
00624276
02014262
STATEX
M.O.S.
MSIR
* 30MG SUPPOSITORY
00639389
00636681
02014173
STATEX
M.O.S.
MSIR
30MG SUSTAINED RELEASE SUPPOSITORY
02146827
MS CONTIN
02145944
MS CONTIN
02145952
MS CONTIN
02145960
MS CONTIN
OXYCODONE HCL
02202441
OXYCONTIN (EDS)
02202468
OXYCONTIN (EDS)
02202476
OXYCONTIN (EDS)
02202484
OXYCONTIN (EDS)
OXYMORPHONE HCL
5MG SUPPOSITORY
93
01916513
NUMORPHAN
DUP
94
$
4.2210
PROPOXYPHENE
SEVERE TOXIC INTERACTION BETWEEN PROPOXYPHENE AND CENTRAL
NERVOUS SYSTEM DEPRESSANTS, PARTICULARLY ALCOHOL AND DIAZEPAM,
HAS BEEN NOTED. IT IS RECOMMENDED THAT ALL PRODUCTS WHICH
CONTAIN PROPOXYPHENE SHOULD BE USED ONLY WITH EXTREME CAUTION
AND WITH FULL PATIENT AWARENESS OF THE SERIOUS POTENTIAL FOR
INTERACTION.
PROPOXYPHENE NAPSYLATE 100MG IS EQUIVALENT IN
ANALGESIC ACTIVITY TO PROPOXYPHENE HCL 65MG.
* CAPSULE
00151351
00261432
NOVO-PROPOXYN
DARVON-N
NOP
LIL
$
0.0505
0.2332
LIH
$
0.1359
SAW
$
0.3708
65MG TABLET
00010081
642
28:08.12 OPIATE PARTIAL AGONISTS
PENTAZOCINE
50MG TABLET
02137984
TALWIN
28:08.92 MISCELLANEOUS ANALGESICS AND ANTIPYRETICS
FLOCTAFENINE
200MG TABLET
02017628
IDARAC
SAW
$
0.3939
SAW
$
0.6859
400MG TABLET
02017636
IDARAC
95
28:12.04 ANTICONVULSANTS (BARBITURATES)
PHENOBARBITAL
* 15MG TABLET
00023795
00178799
PHENOBARBITAL
PHENOBARBITAL
PDA
SDR
$
0.0059
0.0060
PDA
SDR
$
0.0063
0.0064
PDA
SDR
$
0.0147
0.0148
SDR
$
0.0199
SDR
$
0.0139
APX
DPY
$
0.0516
0.0632
APX
DPY
$
0.0814
0.1222
* 30MG TABLET
00023809
00178802
PHENOBARBITAL
PHENOBARBITAL
* 60MG TABLET
00023817
00178810
PHENOBARBITAL
PHENOBARBITAL
100MG TABLET
00178829
PHENOBARBITAL
5MG/ML ELIXIR
00645575
PHENOBARBITAL
PRIMIDONE
* 125MG TABLET
00399310
02042363
APO-PRIMIDONE
MYSOLINE
* 250MG TABLET
00396761
02042355
APO-PRIMIDONE
MYSOLINE
96
28:12.08 ANTICONVULSANTS (BENZODIAZEPINES)
CLONAZEPAM
* 0.5MG TABLET
02130998
02224100
02103656
02173344
02177889
02207818
02230366
02230950
02233960
02237277
02239024
00382825
DOM-CLONAZEPAM
DOM-CLONAZEPAM-R
SYN-CLONAZEPAM
NU-CLONAZEPAM
APO-CLONAZEPAM
PMS-CLONAZEPAM-R
CLONAPAM
GEN-CLONAZEPAM
RHO-CLONAZEPAM
MED-CLONAZEPAM
NOVO-CLONAZEPAM
RIVOTRIL
DOM
DOM
ALT
NXP
APX
PMS
ICN
GPM
RHO
MED
NOP
HLR
$
0.0470 *
0.0470 *
0.1266
0.1266
0.1266
0.1266
0.1266
0.1266
0.1266
0.1266
0.1266
0.2008
PMS
ICN
RHO
$
0.2019
0.2019
0.2019
DOM
PMS
ALT
NXP
APX
ICN
GPM
RHO
MED
NOP
HLR
$
0.0805 *
0.2181
0.2181
0.2181
0.2181
0.2181
0.2181
0.2181
0.2181
0.2181
0.3462
ICN
RHO
ICN
$
0.0996
0.0996
0.1476
ICN
RHO
ICN
$
0.1490
0.1490
0.2208
* 1MG TABLET
02048728
02230368
02233982
PMS-CLONAZEPAM
CLONAPAM
RHO-CLONAZEPAM
* 2MG TABLET
02131013
02048736
02103737
02173352
02177897
02230369
02230951
02233985
02237278
02239025
00382841
DOM-CLONAZEPAM
PMS-CLONAZEPAM
SYN-CLONAZEPAM
NU-CLONAZEPAM
APO-CLONAZEPAM
CLONAPAM
GEN-CLONAZEPAM
RHO-CLONAZEPAM
MED-CLONAZEPAM
NOVO-CLONAZEPAM
RIVOTRIL
NITRAZEPAM
* 5MG TABLET
02229654
02234003
00511528
NITRAZADON
RHO-NITRAZEPAM
MOGADON
* 10MG TABLET
02229655
02234007
00511536
NITRAZADON
RHO-NITRAZEPAM
MOGADON
97
28:12.12 ANTICONVULSANTS (HYDANTOINS)
PHENYTOIN
30MG CAPSULE
00022772
DILANTIN
PDA
$
0.0540
PDA
$
0.0674
PDA
$
0.0740
PDA
$
0.0408
PDA
$
0.0482
PDA
$
0.3051
PDA
$
0.0610
PDA
$
0.3375
100MG CAPSULE
00022780
DILANTIN
50MG TABLET
00023698
DILANTIN
00023442
DILANTIN
00023450
DILANTIN
28:12.20 ANTICONVULSANTS (SUCCINIMIDES)
ETHOSUXIMIDE
250MG CAPSULE
00022799
ZARONTIN
50MG/ML ORAL SYRUP
00023485
ZARONTIN
METHSUXIMIDE
300MG CAPSULE
00022802
CELONTIN
98
28:12.92 MISCELLANEOUS ANTICONVULSANTS
CARBAMAZEPINE
00369810
TEGRETOL
NVR
$
0.1327
APX
NOP
NXP
NVR
$
0.0863
0.0863
0.0863
0.3164
PMS
TAR
GPM
DOM
NVR
$
0.2276
0.2276
0.2276
0.2560
0.3251
PMS
TAR
GPM
DOM
NVR
$
0.4551
0.4551
0.4551
0.5121
0.6502
NVR
$
0.0628
NOP
ALT
AVT
$
0.2598
0.2598
0.3708
NXP
APX
NOP
ABB
$
0.1584
0.1660
0.1660
0.2372
* 200MG TABLET
00402699
00782718
02042568
00010405
APO-CARBAMAZEPINE
NOVO-CARBAMAZ
NU-CARBAMAZEPINE
TEGRETOL
* 200MG CONTROLLED RELEASE TABLET
02231543
02237907
02241882
02238222
00773611
PMS-CARBAMAZEPINE CR(EDS)
TARO-CARBAMAZEPINE (EDS)
GEN-CARBAMAZEPINE CR(EDS)
DOM-CARBAMAZEPINE CR(EDS)
TEGRETOL CR (EDS)
* 400MG CONTROLLED RELEASE TABLET
02231544
02237908
02241883
02238223
00755583
TEGRETOL CR (EDS)
02194333
TEGRETOL
CLOBAZAM
* 10MG TABLET
02238334
02238797
02221799
NOVO-CLOBAZAM
ALTI-CLOBAZAM
FRISIUM
DIVALPROEX SODIUM
02239517
02239698
02239701
00596418
NU-DIVALPROEX
APO-DIVALPROEX
NOVO-DIVALPROEX
EPIVAL
99
02239518
02239699
02239702
00596426
NU-DIVALPROEX
APO-DIVALPROEX
NOVO-DIVALPROEX
EPIVAL
NXP
APX
NOP
ABB
$
0.2847
0.2984
0.2984
0.4262
NXP
APX
NOP
ABB
$
0.5696
0.5971
0.5971
0.8530
PDA
$
0.4340
PDA
$
1.0557
PDA
$
1.2581
GLA
$
0.1551
GLA
$
0.3597
GLA
$
1.4388
GLA
$
2.1581
JAN
$
1.1393
JAN
$
2.1592
JAN
$
3.4178
JAN
$
1.0850
JAN
$
1.1393
02239519
02239700
02239703
00596434
NU-DIVALPROEX
APO-DIVALPROEX
NOVO-DIVALPROEX
EPIVAL
GABAPENTIN
100MG CAPSULE
02084260
NEURONTIN
300MG CAPSULE
02084279
NEURONTIN
400MG CAPSULE
02084287
NEURONTIN
LAMOTRIGINE
5MG CHEWABLE TABLET
02240115
LAMICTAL
25MG TABLET
02142082
LAMICTAL
100MG TABLET
02142104
LAMICTAL
150MG TABLET
02142112
LAMICTAL
TOPIRAMATE
25MG TABLET
02230893
TOPAMAX
100MG TABLET
02230894
TOPAMAX
200MG TABLET
02230896
TOPAMAX
15MG SPRINKLE CAPSULE
02239907
TOPAMAX
25MG SPRINKLE CAPSULE
02239908
TOPAMAX
100
VALPROATE SODIUM
* 50MG/ML ORAL SYRUP
02140063
02236807
02238042
02238370
02238817
00443832
ALTI-VALPROIC
PMS-VALPROIC ACID
DEPROIC
APO-VALPROIC
DOM-VALPROIC ACID
DEPAKENE
ALT
PMS
TCH
APX
DOM
ABB
$
0.0626
0.0626
0.0626
0.0628
0.0732
0.0995
DOM
NOP
ALT
GPM
TCH
MED
PMS
PEN
NXP
APX
FTP
RHO
ABB
$
0.1079 *
0.2804
0.2804
0.2804
0.2804
0.2804
0.2804
0.2804
0.2804
0.2804
0.2804
0.2804
0.4475
ALT
NOP
PMS
TCH
RHO
ABB
$
0.5639
0.5639
0.5639
0.5639
0.5639
0.8951
AVT
$
0.9624
AVT
$
0.9624
VALPROIC ACID
* 250MG CAPSULE
02231030
02100630
02140047
02184648
02217414
02230663
02230768
02231248
02237830
02238048
02238448
02239714
00443840
DOM-VALPROIC ACID
NOVO-VALPROIC
ALTI-VALPROIC
GEN-VALPROIC
DEPROIC
MED-VALPROIC
PMS-VALPROIC
PENTA-VALPROIC
NU-VALPROIC
APO-VALPROIC
FTP-VALPROIC ACID
RHOXAL-VALPROIC
DEPAKENE
* 500MG ENTERIC COATED CAPSULE
02140055
02218321
02229628
02231489
02239713
00507989
ALTI-VALPROIC
NOVO-VALPROIC
PMS-VALPROIC ACID E.C.
DEPROIC
RHOXAL-VALPROIC
DEPAKENE
VIGABATRIN
500MG TABLET
02065819
SABRIL
500MG SACHET
02068036
SABRIL
101
28:16.04 PSYCHOTHERAPEUTIC AGENTS (ANTIDEPRESSANTS)
PHENELZINE AND TRANYLCYPROMINE:
MONOAMINE OXIDASE INHIBITORS INTERACT WITH SYMPATHOMIMETIC
DRUGS, FOODS AND ALCOHOLIC BEVERAGES CONTAINING TYRAMINE OR
OTHER PRESSOR AMINES (EG. CHEESE, HERRING, CHICKEN LIVERS,
BROAD BEANS, CHIANTI WINE, ETC.) AND MAY EVOKE HYPERTENSION.
THESE DRUGS ARE CONTRAINDICATED IN PATIENTS WITH
CEREBROVASCULAR AND CARDIOVASCULAR DISEASE. THE MANUFACTURERS'
LITERATURE REGARDING PRECAUTIONS AND CONTRAINDICATIONS
SHOULD BE CONSULTED PRIOR TO PRESCRIBING THESE DRUGS.
AMITRIPTYLINE
* 10MG TABLET
00037400
00335053
00016322
NOVO-TRIPTYN
APO-AMITRIPTYLINE
ELAVIL
NOP
APX
MSD
$
0.0163
0.0196
0.0787
NOP
APX
MSD
$
0.0086
0.0179
0.1500
NOP
APX
MSD
$
0.0277
0.0434
0.2785
WYA
$
0.3505
WYA
$
0.6865
GLA
$
0.5788
GLA
$
0.8680
LUD
$
1.3563
LUD
$
1.3563
* 25MG TABLET
00037419
00335061
00016330
NOVO-TRIPTYN
APO-AMITRIPTYLINE
ELAVIL
* 50MG TABLET
00037427
00335088
00016349
NOVO-TRIPTYN
APO-AMITRIPTYLINE
ELAVIL
AMOXAPINE
50MG TABLET
02169894
ASENDIN
100MG TABLET
02169908
ASENDIN
BUPROPION HCL
100MG TABLET
02237824
WELLBUTRIN SR (EDS)
150MG TABLET
02237825
WELLBUTRIN SR (EDS)
CITALOPRAM HYDROBROMIDE
20MG TABLET
02239607
CELEXA
40MG TABLET
02239608
CELEXA
102
CLOMIPRAMINE HCL
* 10MG TABLET
02040786
02139340
02188996
02230256
00330566
APO-CLOMIPRAMINE
GEN-CLOMIPRAMINE
MED-CLOMIPRAMINE
NOVO-CLOPAMINE
ANAFRANIL
APX
GPM
MED
NOP
NVR
$
0.1765
0.1765
0.1765
0.1765
0.2801
MED
APX
NOP
GPM
PEN
NVR
$
0.1204 *
0.2404
0.2404
0.2404
0.2404
0.3815
MED
APX
NOP
GPM
PEN
NVR
$
0.2216 *
0.4425
0.4425
0.4425
0.4425
0.7025
PMS
ALT
NXP
APX
NOP
DOM
AVT
$
0.2067
0.2067
0.2067
0.2067
0.2067
0.2395
0.3067
DOM
PMS
ALT
NXP
APX
NOP
PEN
AVT
$
0.1245 *
0.2761
0.2761
0.2761
0.2761
0.2761
0.2761
0.3752
* 25MG TABLET
02189003
02040778
02130165
02139359
02229589
00324019
MED-CLOMIPRAMINE
APO-CLOMIPRAMINE
NOVO-CLOPAMINE
GEN-CLOMIPRAMINE
PENTA-CLOMIPRAMINE
ANAFRANIL
* 50MG TABLET
02189011
02040751
02130173
02139367
02229590
00402591
MED-CLOMIPRAMINE
APO-CLOMIPRAMINE
NOVO-CLOPAMINE
GEN-CLOMIPRAMINE
PENTA-CLOMIPRAMINE
ANAFRANIL
DESIPRAMINE HCL
* 10MG TABLET
01946250
01948776
02211939
02216248
02223341
02130084
02103583
PMS-DESIPRAMINE
ALTI-DESIPRAMINE
NU-DESIPRAMINE
APO-DESIPRAMINE
NOVO-DESIPRAMINE
DOM-DESIPRAMINE
NORPRAMIN
* 25MG TABLET
02130092
01946269
01948784
02211947
02216256
02223325
02232561
02099128
DOM-DESIPRAMINE
PMS-DESIPRAMINE
ALTI-DESIPRAMINE
NU-DESIPRAMINE
APO-DESIPRAMINE
NOVO-DESIPRAMINE
PENTA-DESIPRAMINE
NORPRAMIN
103
* 50MG TABLET
02130106
01946277
01948792
02211955
02216264
02223333
02232562
02099136
DOM-DESIPRAMINE
PMS-DESIPRAMINE
ALTI-DESIPRAMINE
NU-DESIPRAMINE
APO-DESIPRAMINE
NOVO-DESIPRAMINE
PENTA-DESIPRAMINE
NORPRAMIN
DOM
PMS
ALT
NXP
APX
NOP
PEN
AVT
$
0.1955 *
0.4460
0.4460
0.4460
0.4460
0.4460
0.4460
0.6615
PMS
ALT
NXP
APX
NOP
$
0.6873
0.6873
0.6873
0.6873
0.6873
PMS
NXP
APX
AVT
$
0.9342
0.9342
0.9342
1.2456
NOP
APX
ALT
PFI
$
0.1286
0.1286
0.1286
0.2588
NOP
NOP
APX
ALT
PFI
$
0.1552
0.1552
0.1552
0.1552
0.3174
NOP
NOP
APX
ALT
PFI
$
0.2418
0.2418
0.2418
0.2418
0.5889
* 75MG TABLET
01946242
01948806
02211963
02216272
02223368
PMS-DESIPRAMINE
ALTI-DESIPRAMINE
NU-DESIPRAMINE
APO-DESIPRAMINE
NOVO-DESIPRAMINE
* 100MG TABLET
02168952
02211971
02216280
02103591
PMS-DESIPRAMINE
NU-DESIPRAMINE
APO-DESIPRAMINE
NORPRAMIN
DOXEPIN HCL
* 10MG CAPSULE
00842745
02049996
02140071
00024325
TRIADAPIN
APO-DOXEPIN
ALTI-DOXEPIN
SINEQUAN
* 25MG CAPSULE
00842753
01913425
02050005
02140098
00024333
TRIADAPIN
NOVO-DOXEPIN
APO-DOXEPIN
ALTI-DOXEPIN
SINEQUAN
* 50MG CAPSULE
00842761
01913433
02050013
02140101
00024341
TRIADAPIN
NOVO-DOXEPIN
APO-DOXEPIN
ALTI-DOXEPIN
SINEQUAN
104
* 75MG CAPSULE
00842788
01913441
02050021
02140128
00400750
TRIADAPIN
NOVO-DOXEPIN
APO-DOXEPIN
ALTI-DOXEPIN
SINEQUAN
NOP
NOP
APX
ALT
PFI
$
0.5180
0.5180
0.5180
0.5180
0.8454
NOP
NOP
APX
PFI
$
0.6803
0.6803
0.6803
1.1137
NOP
APX
$
1.0280
1.0280
DOM
PMS
NXP
APX
NOP
PEN
GPM
MED
ALT
LIL
$
0.5910 *
1.2774
1.2774
1.2774
1.2774
1.2774
1.2774
1.2774
1.2774
1.7035
NXP
PMS
APX
NOP
PEN
GPM
MED
ALT
DOM
LIL
$
0.3710 *
1.0972
1.0972
1.0972
1.0972
1.0972
1.0972
1.0972
1.4802
1.7415
PMS
APX
LIL
$
0.5019
0.5019
0.6692
* 100MG CAPSULE
00842796
01913468
02050048
00326925
TRIADAPIN
NOVO-DOXEPIN
APO-DOXEPIN
SINEQUAN
* 150MG CAPSULE
01913476
02050056
NOVO-DOXEPIN
APO-DOXEPIN
FLUOXETINE
* 10MG CAPSULE
02177617
02177579
02192756
02216353
02216582
02229819
02237813
02239751
02241371
02018985
DOM-FLUOXETINE
PMS-FLUOXETINE
NU-FLUOXETINE
APO-FLUOXETINE
NOVO-FLUOXETINE
PENTA-FLUOXETINE
GEN-FLUOXETINE
MED FLUOXETINE
ALTI-FLUOXETINE
PROZAC
* 20MG CAPSULE
02192764
02177587
02216361
02216590
02229820
02237814
02239752
02241374
02177625
00636622
NU-FLUOXETINE
PMS-FLUOXETINE
APO-FLUOXETINE
NOVO-FLUOXETINE
PENTA-FLUOXETINE
GEN-FLUOXETINE
MED FLUOXETINE
ALTI-FLUOXETINE
DOM-FLUOXETINE
PROZAC
02177595
02231328
01917021
PMS-FLUOXETINE
APO-FLUOXETINE
PROZAC
105
FLUVOXAMINE MALEATE
* 50MG TABLET
02218453
02231192
02231329
02239953
02240682
02240849
02241347
01919342
ALTI-FLUVOXAMINE
NU-FLUVOXAMINE
APO-FLUVOXAMINE
NOVO-FLUVOXAMINE
PMS-FLUVOXAMINE
GEN-FLUVOXAMINE
DOM-FLUVOXAMINE
LUVOX
ALT
NXP
APX
NOP
PMS
GPM
DOM
SLV
$
0.5373
0.5373
0.5373
0.5373
0.5373
0.5373
0.5641
0.8529
ALT
NXP
APX
NOP
PMS
GPM
DOM
SLV
$
0.9659
0.9659
0.9659
0.9659
0.9659
0.9659
1.0142
1.5331
NOP
APX
NVR
$
0.0196
0.0217
0.1565
NOP
APX
NVR
$
0.0196
0.0375
0.2485
NOP
APX
NVR
$
0.0250
0.0565
0.4619
* 100MG TABLET
02218461
02231193
02231330
02239954
02240683
02240850
02241348
01919369
ALTI-FLUVOXAMINE
NU-FLUVOXAMINE
APO-FLUVOXAMINE
NOVO-FLUVOXAMINE
PMS-FLUVOXAMINE
GEN-FLUVOXAMINE
DOM-FLUVOXAMINE
LUVOX
IMIPRAMINE
* 10MG TABLET
00021504
00360201
00010464
NOVO-PRAMINE
APO-IMIPRAMINE
TOFRANIL
* 25MG TABLET
00021512
00312797
00010472
NOVO-PRAMINE
APO-IMIPRAMINE
TOFRANIL
* 50MG TABLET
00021520
00326852
00010480
NOVO-PRAMINE
APO-IMIPRAMINE
TOFRANIL
106
MAPROTILINE
* 10MG TABLET
02158604
00641855
NOVO-MAPROTILINE
LUDIOMIL
NOP
NVR
$
0.1644
0.2255
NOP
NVR
$
0.2241
0.2992
NOP
NVR
$
0.4243
0.5659
NOP
NVR
$
0.5794
0.7729
APX
NXP
NOP
$
0.2735
0.2735
0.2735
ALT
APX
NXP
NOP
HLR
$
0.3965
0.3965
0.3965
0.3965
0.6444
ALT
NOP
APX
HLR
$
0.8651
0.8651
0.8651
1.2655
BMY
$
0.8680
BMY
$
0.8680
BMY
$
1.0128
* 25MG TABLET
02158612
00360481
NOVO-MAPROTILINE
LUDIOMIL
* 50MG TABLET
02158620
00360503
NOVO-MAPROTILINE
LUDIOMIL
* 75MG TABLET
02158639
00360511
NOVO-MAPROTILINE
LUDIOMIL
MOCLOBEMIDE
* 100MG TABLET
02232148
02237111
02239746
APO-MOCLOBEMIDE
NU-MOCLOBEMIDE
NOVO-MOCLOBEMIDE
* 150MG TABLET
02218410
02232150
02237112
02239747
00899356
ALTI-MOCLOBEMIDE
APO-MOCLOBEMIDE
NU-MOCLOBEMIDE
NOVO-MOCLOBEMIDE
MANERIX
* 300MG TABLET
02218429
02239748
02240456
02166747
ALTI-MOCLOBEMIDE
NOVO-MOCLOBEMIDE
APO-MOCLOBEMIDE
MANERIX
NEFAZODONE
100MG TABLET
02087375
SERZONE
150MG TABLET
02087383
SERZONE
200MG TABLET
02087391
SERZONE
107
NORTRIPTYLINE
* 10MG CAPSULE
02177692
02223139
02223511
02230361
02231686
02231781
02240789
02178729
00015229
PMS-NORTRIPTYLINE
NU-NORTRIPTYLINE
APO-NORTRIPTYLINE
NORVENTYL
GEN-NORTRIPTYLINE
NOVO-NORTRIPTYLINE
ALTI-NORTRIPTYLINE
DOM-NORTRIPTYLINE
AVENTYL
PMS
NXP
APX
ICN
GPM
NOP
ALT
DOM
LIL
$
0.1368
0.1368
0.1368
0.1368
0.1368
0.1368
0.1368
0.1709
0.2170
NOP
PMS
NXP
APX
ICN
GPM
ALT
DOM
LIL
$
0.2763
0.2764
0.2764
0.2764
0.2764
0.2764
0.2764
0.3455
0.4387
SMJ
$
1.7252
SMJ
$
1.8337
PDA
$
0.3633
MSD
$
0.3769
* 25MG CAPSULE
02231782
02177706
02223147
02223538
02230362
02231687
02240790
02178737
00015237
NOVO-NORTRIPTYLINE
PMS-NORTRIPTYLINE
NU-NORTRIPTYLINE
APO-NORTRIPTYLINE
NORVENTYL
GEN-NORTRIPTYLINE
ALTI-NORTRIPTYLINE
DOM-NORTRIPTYLINE
AVENTYL
PAROXETINE HCL
20MG TABLET
01940481
PAXIL
30MG TABLET
01940473
PAXIL
PHENELZINE SO4
SEE NOTE ON PAGE 101
15MG TABLET
00476552
NARDIL
PROTRIPTYLINE
10MG TABLET
00322741
TRIPTIL
108
SERTRALINE HYDROCHLORIDE
* 25MG CAPSULE
02238280
02240485
02132702
APO-SERTRALINE
NOVO-SERTRALINE
ZOLOFT
APX
NOP
PFI
$
0.6076
0.6076
0.8698
APX
NOP
PFI
$
1.2152
1.2152
1.7395
APX
NOP
PFI
$
1.3292
1.3292
1.8228
SMJ
$
0.3625
DOM
BRI
PMS
ALT
NOP
APX
NXP
ICN
GPM
PEN
$
0.1264 *
0.2403
0.2403
0.2403
0.2403
0.2403
0.2403
0.2403
0.2403
0.2403
* 50MG CAPSULE
02238281
02240484
01962817
APO-SERTRALINE
NOVO-SERTRALINE
ZOLOFT
* 100MG CAPSULE
02238282
02240481
01962779
APO-SERTRALINE
NOVO-SERTRALINE
ZOLOFT
TRANYLCYPROMINE SO4
SEE NOTE ON PAGE 101
10MG TABLET
01919598
PARNATE
TRAZODONE
* 50MG TABLET
02128950
00579351
01937227
02053187
02144263
02147637
02165384
02230284
02231683
02232543
DOM-TRAZODONE
DESYREL
PMS-TRAZODONE
SYN-TRAZODONE
NOVO-TRAZODONE
APO-TRAZODONE
NU-TRAZODONE
TRAZOREL
GEN-TRAZODONE
PENTA-TRAZODONE
109
* 100MG TABLET
02128969
00579378
01937235
02053195
02144271
02147645
02165392
02230285
02231684
02232544
DOM-TRAZODONE
DESYREL
PMS-TRAZODONE
SYN-TRAZODONE
NOVO-TRAZODONE
APO-TRAZODONE
NU-TRAZODONE
TRAZOREL
GEN-TRAZODONE
PENTA-TRAZODONE
DOM
BRI
PMS
ALT
NOP
APX
NXP
ICN
GPM
PEN
$
0.2207 *
0.4293
0.4293
0.4293
0.4293
0.4293
0.4293
0.4293
0.4293
0.4293
APX
AVT
$
0.5639
0.8354
APX
ROP
NXP
AVT
$
0.0890
0.0890
0.0890
0.2462
APX
ROP
NOP
NXP
AVT
$
0.1129
0.1129
0.1129
0.1129
0.3171
APX
ROP
NOP
NXP
AVT
$
0.2169
0.2169
0.2169
0.2169
0.6207
APX
ROP
NOP
NXP
AVT
$
0.3709
0.3709
0.3709
0.3709
1.0591
TRIMIPRAMINE
* 75MG CAPSULE
02070987
01926349
APO-TRIMIP
SURMONTIL
* 12.5MG TABLET
00740799
00761605
02020599
01926357
APO-TRIMIP
RHOTRIMINE
NU-TRIMIPRAMINE
SURMONTIL
* 25MG TABLET
00740802
00761613
01940430
02020602
01926322
APO-TRIMIP
RHOTRIMINE
NOVO-TRIPRAMINE
NU-TRIMIPRAMINE
SURMONTIL
* 50MG TABLET
00740810
00761621
01940449
02020610
01926330
APO-TRIMIP
RHOTRIMINE
NOVO-TRIPRAMINE
NU-TRIMIPRAMINE
SURMONTIL
* 100MG TABLET
00740829
00761648
01940457
02020629
01926284
APO-TRIMIP
RHOTRIMINE
NOVO-TRIPRAMINE
NU-TRIMIPRAMINE
SURMONTIL
110
VENLAFAXINE HCL
37.5MG TABLET
02103680
EFFEXOR
WYA
$
0.8463
WYA
$
1.6926
WYA
$
0.8463
WYA
$
1.6926
WYA
$
1.7903
NOP
$
0.0174
NOP
$
0.0364
NOP
$
0.0416
NOP
$
0.0695
ROP
$
0.0259
TCH
ROP
$
0.0376
0.0376
TCH
ROP
$
0.2932
0.2932
SAB
ROP
$
1.0600
1.0600
75MG TABLET
02103702
EFFEXOR
37.5MG EXTENDED-RELEASE CAPSULE
02237279
EFFEXOR XR
02237280
EFFEXOR XR
02237282
EFFEXOR XR
28:16.08 PSYCHOTHERAPEUTIC AGENTS
(ANTIPSYCHOTIC AGENTS)
CHLORPROMAZINE
10MG TABLET
00232157
NOVO-CHLORPROMAZINE
25MG TABLET
00232823
NOVO-CHLORPROMAZINE
50MG TABLET
00232807
NOVO-CHLORPROMAZINE
100MG TABLET
00232831
NOVO-CHLORPROMAZINE
01929968
LARGACTIL
00580988
01929976
CHLORPROMANYL
LARGACTIL
00690805
01929992
CHLORPROMANYL-40
LARGACTIL
00743518
01929984
CHLORPROMAZINE
LARGACTIL
111
CLOZAPINE
25MG TABLET
00894737
CLOZARIL (EDS)
NVR
$
1.0221
NVR
$
4.0780
LUD
$
73.1900
LUD
$
73.1900
LUD
$
0.2528
LUD
$
0.5461
SQU
PMS
ROP
$
26.4600
26.4600
26.4600
SQU
ROP
$
32.3200
32.3200
SQU
$
47.2600
100MG TABLET
00894745
CLOZARIL (EDS)
02156032
FLUANXOL DEPOT
02156040
FLUANXOL DEPOT
FLUPENTHIXOL DIHYDROCHLORIDE
0.5MG TABLET
02156008
FLUANXOL
3MG TABLET
02156016
FLUANXOL
FLUPHENAZINE DECANOATE
00349917
02091275
02211157
MODECATE
PMS-FLUPHENAZINE DECAN.
RHO-FLUPHENAZINE
00755575
02211165
MODECATE CONCENTRATE
RHO-FLUPHENAZINE
FLUPHENAZINE ENANTHATE
00029173
MODITEN ENANTHATE
112
FLUPHENAZINE HCL
1MG TABLET
00405345
APO-FLUPHENAZINE
APX
$
0.1498
APX
$
0.1807
APX
$
0.2420
SQU
$
0.9559
NOP
APX
TCH
$
0.0391
0.0391
0.0391
NOP
APX
TCH
$
0.0667
0.0667
0.0667
NOP
APX
$
0.1140
0.1140
NOP
APX
TCH
$
0.1614
0.1614
0.1614
APX
NOP
$
0.1443
0.1443
TCH
PMS
APX
$
0.1165
0.1165
0.1274
SAB
$
3.3800
2MG TABLET
00410632
APO-FLUPHENAZINE
5MG TABLET
00405361
APO-FLUPHENAZINE
10MG TABLET
00582514
MODITEN
HALOPERIDOL
* 0.5MG TABLET
00363685
00396796
00552135
NOVO-PERIDOL
APO-HALOPERIDOL
PERIDOL
* 1MG TABLET
00363677
00396818
00552143
NOVO-PERIDOL
APO-HALOPERIDOL
PERIDOL
* 2MG TABLET
00363669
00396826
NOVO-PERIDOL
APO-HALOPERIDOL
* 5MG TABLET
00363650
00396834
00647969
NOVO-PERIDOL
APO-HALOPERIDOL
PERIDOL
* 10MG TABLET
00463698
00713449
APO-HALOPERIDOL
NOVO-PERIDOL
00552429
00759503
00587702
PERIDOL
PMS-HALOPERIDOL
APO-HALOPERIDOL
00808652
HALOPERIDOL
113
HALOPERIDOL DECANOATE
02130297
02211130
00599085
HALOPERIDOL LA
RHO-HALOPERIDOL
HALDOL-LA
SAB
ROP
JAN
$
32.0100
32.0100
45.7600
SAB
ROP
$
63.2600
63.2600
PMS
NXP
APX
DOM
WYA
$
0.1628
0.1628
0.1628
0.1709
0.2326
PMS
NXP
APX
DOM
WYA
$
0.2711
0.2711
0.2711
0.2846
0.3872
PMS
NXP
APX
DOM
WYA
$
0.4202
0.4202
0.4202
0.4412
0.6002
PMS
NXP
APX
DOM
WYA
$
0.5601
0.5601
0.5601
0.5881
0.8002
NVR
$
0.3950
NVR
$
0.5420
02130300
02211149
HALOPERIDOL LA
RHO-HALOPERIDOL
LOXAPINE SUCCINATE
* 5MG TABLET
02230837
02237534
02237651
02239918
02170019
PMS-LOXAPINE
NU-LOXAPINE
APO-LOXAPINE
DOM-LOXAPINE
LOXAPAC
* 10MG TABLET
02230838
02237535
02237652
02239919
02170027
PMS-LOXAPINE
NU-LOXAPINE
APO-LOXAPINE
DOM-LOXAPINE
LOXAPAC
* 25MG TABLET
02230839
02237536
02237653
02239920
02170132
PMS-LOXAPINE
NU-LOXAPINE
APO-LOXAPINE
DOM-LOXAPINE
LOXAPAC
* 50MG TABLET
02230840
02237537
02237654
02239921
02170035
PMS-LOXAPINE
NU-LOXAPINE
APO-LOXAPINE
DOM-LOXAPINE
LOXAPAC
MESORIDAZINE
25MG TABLET
00027456
SERENTIL
50MG TABLET
00027464
SERENTIL
114
OLANZAPINE
2.5MG TABLET
02229250
ZYPREXA (EDS)
LIL
$
1.8310
LIL
$
3.6619
LIL
$
5.4929
LIL
$
7.2500
AVT
$
0.1817
AVT
$
0.2796
AVT
$
0.4413
AVT
$
0.3076
APX
SCH
$
0.0239
0.0626
APX
$
0.0348
APX
$
0.0456
APX
$
0.0565
PMS
$
0.1727
PMS
$
0.3533
PMS
$
0.6411
5MG TABLET
02229269
ZYPREXA (EDS)
7.5MG TABLET
02229277
ZYPREXA (EDS)
10MG TABLET
02229285
ZYPREXA (EDS)
PERICYAZINE
5MG CAPSULE
01926780
NEULEPTIL
10MG CAPSULE
01926772
NEULEPTIL
20MG CAPSULE
01926764
NEULEPTIL
10MG/ML ORAL DROPS
01926756
NEULEPTIL
PERPHENAZINE
* 2MG TABLET
00335134
00028290
APO-PERPHENAZINE
TRILAFON
4MG TABLET
00335126
APO-PERPHENAZINE
8MG TABLET
00335118
APO-PERPHENAZINE
16MG TABLET
00335096
APO-PERPHENAZINE
3.2MG/ML SYRUP
00751898
PMS-PERPHENAZINE CONC.
PIMOZIDE
2MG TABLET
00313815
ORAP
4MG TABLET
00313823
ORAP
115
PIPOTIAZINE PALMITATE
01926667
PIPORTIL L4
AVT
$
13.1800
AVT
$
42.4300
ROP
NXP
$
0.1145
0.1145
ROP
NXP
$
0.1400
0.1400
ROP
$
0.0552
SAB
ROP
$
1.0800
1.0800
ROP
$
0.9006
AST
$
0.5208
AST
$
1.3888
AST
$
2.7885
JAN
$
0.4503
JAN
$
0.7541
JAN
$
1.0416
01926675
PIPORTIL L4
PROCHLORPERAZINE
* 5MG TABLET
01927752
01964399
STEMETIL
NU-PROCHLOR
* 10MG TABLET
01927760
01964402
STEMETIL
NU-PROCHLOR
01927787
STEMETIL
00789747
01927779
PROCHLORPERAZINE MESYLATE
STEMETIL
10MG SUPPOSITORY
01927795
STEMETIL
QUETIAPINE
25MG TABLET
02236951
SEROQUEL (EDS)
100MG TABLET
02236952
SEROQUEL (EDS)
200MG TABLET
02236953
SEROQUEL (EDS)
RISPERIDONE
0.25MG TABLET
02240551
RISPERDAL
0.5MG TABLET
02240552
RISPERDAL
1MG TABLET
02025280
RISPERDAL
116
2MG TABLET
02025299
RISPERDAL
JAN
$
2.0797
JAN
$
3.1194
JAN
$
4.1593
JAN
$
1.1979
NOP
PMS
APX
$
0.0156
0.0179
0.0272
NOP
PMS
APX
$
0.0291
0.0353
0.0483
NOP
PMS
APX
$
0.0528
0.0635
0.0820
NOP
PMS
APX
$
0.1057
0.1213
0.1465
PMS
NVR
$
0.1133
0.1619
NVR
$
0.0374
PFI
$
0.2005
PFI
$
0.3447
PFI
$
0.4438
3MG TABLET
02025302
RISPERDAL
4MG TABLET
02025310
RISPERDAL
02236950
RISPERDAL
THIORIDAZINE
* 10MG TABLET
00037508
00575119
00360228
NOVO-RIDAZINE
PMS-THIORIDAZINE
APO-THIORIDAZINE
* 25MG TABLET
00037494
00575127
00360198
NOVO-RIDAZINE
PMS-THIORIDAZINE
APO-THIORIDAZINE
* 50MG TABLET
00037486
00575135
00360236
NOVO-RIDAZINE
PMS-THIORIDAZINE
APO-THIORIDAZINE
* 100MG TABLET
00037478
00575143
00360244
NOVO-RIDAZINE
PMS-THIORIDAZINE
APO-THIORIDAZINE
00775320
00027359
PMS-THIORIDAZINE
MELLARIL
00027375
MELLARIL
THIOTHIXENE
2MG CAPSULE
00024430
NAVANE
5MG CAPSULE
00024449
NAVANE
10MG CAPSULE
00024457
NAVANE
117
TRIFLUOPERAZINE
* 1MG TABLET
00345539
01918206
APO-TRIFLUOPERAZINE
STELAZINE
APX
SMJ
$
0.0217
0.1530
NOP
APX
SMJ
$
0.0169
0.0288
0.2008
NOP
APX
SMJ
$
0.0197
0.0441
0.2659
NOP
APX
SMJ
$
0.0299
0.0679
0.3187
PMS
$
0.2700
LUD
$
15.1900
LUD
$
151.9000
LUD
$
0.3906
LUD
$
0.9765
LUD
$
1.5624
* 2MG TABLET
00021865
00312754
01918214
NOVO-TRIFLUZINE
APO-TRIFLUOPERAZINE
STELAZINE
* 5MG TABLET
00021873
00312746
01918222
NOVO-TRIFLUZINE
APO-TRIFLUOPERAZINE
STELAZINE
* 10MG TABLET
00021881
00326836
01918230
NOVO-TRIFLUZINE
APO-TRIFLUOPERAZINE
STELAZINE
00751871
PMS-TRIFLUOPERAZINE
ZUCLOPENTHIXOL ACETATE
02230405
CLOPIXOL ACUPHASE (EDS)
ZUCLOPENTHIXOL DECANOATE
02230406
CLOPIXOL DEPOT (EDS)
ZUCLOPENTHIXOL DIHYDROCHLORIDE
10MG TABLET
02230402
CLOPIXOL (EDS)
25MG TABLET
02230403
CLOPIXOL (EDS)
40MG TABLET
02230404
CLOPIXOL (EDS)
118
28:20.00 RESPIRATORY AND CEREBRAL STIMULANTS
DEXTROAMPHETAMINE SO4
5MG TABLET
01924516
DEXEDRINE
SMJ
$
0.2992
SMJ
$
0.4292
SMJ
$
0.5247
PMS
$
0.1028
PMS
TCH
NVR
$
0.1726
0.1726
0.2831
PMS
TCH
NVR
$
0.3958
0.3958
0.4948
NVR
$
0.5215
PMS
$
0.1042
PMS
$
0.2294
ABB
$
0.2212
10MG SPANSULE CAPSULE
01924559
DEXEDRINE
15MG SPANSULE CAPSULE
01924567
DEXEDRINE
METHYLPHENIDATE HCL
5MG TABLET
02234749
PMS-METHYLPHENIDATE
* 10MG TABLET
00584991
02230321
00005606
PMS-METHYLPHENIDATE
RIFENIDATE
RITALIN
* 20MG TABLET
00585009
02230322
00005614
PMS-METHYLPHENIDATE
RIFENIDATE
RITALIN
00632775
RITALIN SR
28:24.04 ANXIOLYTICS,SEDATIVES AND HYPNOTICS
(BARBITURATES)
AMOBARBITAL SODIUM
60MG CAPSULE
00015148
AMYTAL SODIUM
200MG CAPSULE
00015156
AMYTAL SODIUM
PENTOBARBITAL SODIUM
100MG CAPSULE
00000086
NEMBUTAL
PHENOBARBITAL
SEE SECTION 28:12.04 (ANTICONVULSANTS) PAGE 95
119
(BARBITURATES)
SECOBARBITAL SODIUM
100MG CAPSULE
00015288
SECONAL
PMS
$
0.1160
NXP
ALT
APX
NOP
GPM
MED
PHU
$
0.0552 *
0.0825
0.0825
0.0825
0.0825
0.0825
0.2540
NXP
ALT
APX
NOP
GPM
MED
PHU
$
0.0663 *
0.0999
0.0999
0.0999
0.0999
0.0999
0.3037
ALT
NXP
APX
GPM
MED
HLR
$
0.0752
0.0752
0.0752
0.0752
0.0752
0.1118
(BENZODIAZEPINES)
ALPRAZOLAM
* 0.25MG TABLET
01913239
00677485
00865397
01913484
02137534
02237264
00548359
NU-ALPRAZ
ALTI-ALPRAZOLAM
APO-ALPRAZ
NOVO-ALPRAZOL
GEN-ALPRAZOLAM
MED-ALPRAZOLAM
XANAX
* 0.5MG TABLET
01913247
00677477
00865400
01913492
02137542
02237265
00548367
NU-ALPRAZ
ALTI-ALPRAZOLAM
APO-ALPRAZ
NOVO-ALPRAZOL
GEN-ALPRAZOLAM
MED-ALPRAZOLAM
XANAX
BROMAZEPAM
* 1.5MG TABLET
02167808
02171858
02177153
02192705
02230666
00682314
SYN-BROMAZEPAM
NU-BROMAZEPAM
APO-BROMAZEPAM
GEN-BROMAZEPAM
MED-BROMAZEPAM
LECTOPAM
120
(BENZODIAZEPINES)
* 3MG TABLET
02232556
02167816
02171864
02177161
02192713
02230584
02230667
00518123
PENTA-BROMAZEPAM
SYN-BROMAZEPAM
NU-BROMAZEPAM
APO-BROMAZEPAM
GEN-BROMAZEPAM
NOVO-BROMAZEPAM
MED-BROMAZEPAM
LECTOPAM
PEN
ALT
NXP
APX
GPM
NOP
MED
HLR
$
0.0700 *
0.0957
0.0957
0.0957
0.0957
0.0957
0.0957
0.1519
ALT
NXP
APX
GPM
NOP
MED
HLR
$
0.1398
0.1398
0.1398
0.1398
0.1398
0.1398
0.2219
NOP
APX
$
0.0163
0.0239
NOP
APX
$
0.0196
0.0320
NOP
APX
$
0.0255
0.0413
NOP
APX
ABB
$
0.0753
0.0753
0.1686
NOP
APX
ABB
$
0.1662
0.1662
0.2067
NOP
APX
$
0.2840
0.2840
* 6MG TABLET
02167824
02171872
02177188
02192721
02230585
02230668
00518131
SYN-BROMAZEPAM
NU-BROMAZEPAM
APO-BROMAZEPAM
GEN-BROMAZEPAM
NOVO-BROMAZEPAM
MED-BROMAZEPAM
LECTOPAM
CHLORDIAZEPOXIDE
* 5MG CAPSULE
00020915
00522724
NOVO-POXIDE
APO-CHLORDIAZEPOXIDE
* 10MG CAPSULE
00020923
00522988
NOVO-POXIDE
* 25MG CAPSULE
00020931
00522996
NOVO-POXIDE
CLORAZEPATE DIPOTASSIUM
* 3.75MG CAPSULE
00628190
00860689
00264938
NOVO-CLOPATE
APO-CLORAZEPATE
TRANXENE
* 7.5MG CAPSULE
00628204
00860700
00264946
NOVO-CLOPATE
APO-CLORAZEPATE
TRANXENE
* 15MG CAPSULE
00628212
00860697
NOVO-CLOPATE
APO-CLORAZEPATE
121
00264911
TRANXENE
ABB
122
0.3722
(BENZODIAZEPINES)
DIAZEPAM
* 2MG TABLET
00272434
00405329
00013757
NOVO-DIPAM
APO-DIAZEPAM
VIVOL
NOP
APX
HOR
$
0.0130
0.0228
0.0662
NOP
APX
HOR
HLR
$
0.0067
0.0183
0.0915
0.1552
NOP
APX
HOR
HLR
$
0.0207
0.0358
0.1501
0.1568
NOP
PMS
APX
ICN
$
0.0400
0.0479
0.0679
0.1330
NOP
PMS
APX
ICN
$
0.0455
0.0548
0.0776
0.1557
APX
NOP
NXP
WYA
$
0.0507
0.0507
0.0507
0.0814
NOP
APX
NXP
WYA
$
0.0517
0.0517
0.0517
0.1009
* 5MG TABLET
00272442
00362158
00013765
00013285
NOVO-DIPAM
APO-DIAZEPAM
VIVOL
VALIUM
* 10MG TABLET
00272450
00405337
00013773
00013293
NOVO-DIPAM
APO-DIAZEPAM
VIVOL
VALIUM
FLURAZEPAM HCL
* 15MG CAPSULE
00496545
00667102
00521698
00012696
NOVO-FLUPAM
PMS-FLURAZEPAM
APO-FLURAZEPAM
DALMANE
* 30MG CAPSULE
00496553
00667099
00521701
00012718
NOVO-FLUPAM
PMS-FLURAZEPAM
APO-FLURAZEPAM
DALMANE
LORAZEPAM
* 0.5MG TABLET
00655740
00711101
00865672
02041413
APO-LORAZEPAM
NOVO-LORAZEM
NU-LORAZ
ATIVAN
* 1MG TABLET
00637742
00655759
00865680
02041421
NOVO-LORAZEM
APO-LORAZEPAM
NU-LORAZ
ATIVAN
123
(BENZODIAZEPINES)
* 2MG TABLET
00637750
00655767
00865699
02041448
NOVO-LORAZEM
APO-LORAZEPAM
NU-LORAZ
ATIVAN
NOP
APX
NXP
WYA
$
0.0840
0.0840
0.0840
0.1585
NOP
APX
WYA
$
0.0139
0.0228
0.0573
NOP
APX
WYA
$
0.0169
0.0358
0.0718
NOP
APX
WYA
$
0.0199
0.0489
0.1040
DOM
NXP
APX
PMS
NOP
GPM
MED
PEN
NVR
$
0.0544 *
0.1196
0.1196
0.1196
0.1196
0.1196
0.1196
0.1196
0.1899
DOM
NXP
APX
PMS
NOP
GPM
MED
PEN
NVR
$
0.0683 *
0.1439
0.1439
0.1439
0.1439
0.1439
0.1439
0.1439
0.2284
OXAZEPAM
* 10MG TABLET
00500852
00402680
02043653
NOVOXAPAM
APO-OXAZEPAM
SERAX
* 15MG TABLET
00496529
00402745
02043661
NOVOXAPAM
APO-OXAZEPAM
SERAX
* 30MG TABLET
00496537
00402737
02043688
NOVOXAPAM
APO-OXAZEPAM
SERAX
TEMAZEPAM
* 15MG CAPSULE
02229756
02223570
02225964
02229455
02230095
02231615
02237294
02239071
00604453
DOM-TEMAZEPAM
NU-TEMAZEPAM
APO-TEMAZEPAM
PMS-TEMAZEPAM
NOVO-TEMAZEPAM
GEN-TEMAZEPAM
MED-TEMAZEPAM
PENTA-TEMAZEPAM
RESTORIL
* 30MG CAPSULE
02229758
02223589
02225972
02229456
02230102
02231616
02237295
02239072
00604461
DOM-TEMAZEPAM
NU-TEMAZEPAM
APO-TEMAZEPAM
PMS-TEMAZEPAM
NOVO-TEMAZEPAM
GEN-TEMAZEPAM
MED-TEMAZEPAM
PENTA-TEMAZEPAM
RESTORIL
124
(BENZODIAZEPINES)
TRIAZOLAM
* 0.125MG TABLET
00614351
00808563
01995227
00872423
ALTI-TRIAZOLAM
APO-TRIAZO
GEN-TRIAZOLAM
NOVO-TRIOLAM
ALT
APX
GPM
NOP
$
0.0604
0.0604
0.0604
0.0606
ALT
APX
NOP
GPM
PHU
$
0.0760
0.0760
0.0760
0.0760
0.2199
* 0.25MG TABLET
00614378
00808571
00872431
01913506
00443158
ALTI-TRIAZOLAM
APO-TRIAZO
NOVO-TRIOLAM
GEN-TRIAZOLAM
HALCION
28:24.92 MISCELLANEOUS ANXIOLYTICS,SEDATIVES AND
HYPNOTICS
BUSPIRONE
5MG TABLET
02230941
PMS-BUSPIRONE
PMS
$
0.4323
DOM
LIN
NXP
APX
GPM
PMS
NOP
MED
TCH
FTP
PEN
BRI
$
0.2602 *
0.7076
0.7076
0.7076
0.7076
0.7076
0.7076
0.7076
0.7076
0.7076
0.7076
1.0498
PMS
$
0.0471
* 10MG TABLET
02232564
02176122
02207672
02211076
02230874
02230942
02231492
02237268
02237858
02238447
02238613
00603821
DOM-BUSPIRONE
LIN-BUSPIRONE
NU-BUSPIRONE
APO-BUSPIRONE
GEN-BUSPIRONE
PMS-BUSPIRONE
NOVO-BUSPIRONE
MED-BUSPIRONE
BUSPIREX
FTP-BUSPIRONE
PENTA-BUSPIRONE
BUSPAR
CHLORAL HYDRATE
100MG/ML SYRUP
00792659
PMS-CHLORAL HYDRATE SYRUP
125
28:24.92 MISCELLANEOUS ANXIOLYTICS,SEDATIVES AND
HYPNOTICS
HYDROXYZINE
* 10MG CAPSULE
00738824
00646059
00024376
NOVO-HYDROXYZIN
APO-HYDROXYZINE
ATARAX
NOP
APX
PFI
$
0.0361
0.0532
0.1672
NOP
APX
PFI
$
0.0584
0.0798
0.2513
NOP
APX
$
0.0814
0.1069
PMS
PFI
$
0.0422
0.0515
ROP
APX
$
0.0548
0.0548
ROP
NOP
PMS
APX
$
0.0573
0.0573
0.0573
0.0573
ROP
NOP
PMS
APX
$
0.1228
0.1228
0.1228
0.1228
ROP
NOP
PMS
APX
$
0.1672
0.1672
0.1672
0.1672
ROP
$
0.0609
ROP
$
0.4451
* 25MG CAPSULE
00738832
00646024
00024384
NOVO-HYDROXYZIN
APO-HYDROXYZINE
ATARAX
* 50MG CAPSULE
00738840
00646016
NOVO-HYDROXYZIN
APO-HYDROXYZINE
* 2MG/ML ORAL SYRUP
00741817
00024694
PMS-HYDROXYZINE
ATARAX
METHOTRIMEPRAZINE
* 2MG TABLET
01927647
02238403
NOZINAN
APO-METHOPRAZINE
* 5MG TABLET
01927655
01964909
02232903
02238404
NOZINAN
NOVO-MEPRAZINE
PMS-METHOTRIMEPRAZINE
APO-METHOPRAZINE
* 25MG TABLET
01927663
01964925
02232904
02238405
NOZINAN
NOVO-MEPRAZINE
APO-METHOPRAZINE
* 50MG TABLET
01927671
01964933
02232905
02238406
NOZINAN
NOVO-MEPRAZINE
APO-METHOPRAZINE
01927728
NOZINAN
01927701
NOZINAN
126
28:28.00 ANTIMANIC AGENTS
LITHIUM CARBONATE
* 150MG CAPSULE
02216132
00461733
PMS-LITHIUM CARBONATE
CARBOLITH
PMS
ICN
$
0.0687
0.1238
PMS
ICN
$
0.0721
0.1017
PMS
ICN
$
0.1476
0.1845
JAN
$
0.2068
* 300MG CAPSULE
02216140
00236683
CARBOLITH
* 600MG CAPSULE
02216159
02011239
CARBOLITH
00590665
DURALITH
127
128
DIAGNOSTIC AGENTS
36:00
36:00 DIAGNOSTIC AGENTS
36:04.00 ADRENAL INSUFFICIENCY
COSYNTROPIN ZINC HYDROXIDE
SEE SECTION 68:28.00 (PITUITARY AGENTS) PAGE 184
36:26.00 DIABETES MELLITUS
NOTE: THE IDENTIFICATION NUMBERS LISTED IN THIS SECTION
HAVE BEEN GENERATED BY THE PRESCRIPTION DRUG PLAN FOR
BILLING PURPOSES ONLY.
GLUCOSE OXIDASE/PEROXIDASE REAGENT
x
STRIP
00950889
00950432
00950505
00950599
00950068
00950408
00950378
00950300
00950878
00950882
00950122
00950459
00950734
00950661
00950883
00950572
NOVO-GLUCOSE
ACCUTREND
ENCORE
ACCU-CHEK EASY
CHEMSTRIP BG
GLUCOSTIX
GLUCOFILM
PRECISION PLUS
GLUCOMETER DEX
FASTTAKE
EXACTECH
ONE TOUCH
SURESTEP
ADVANTAGE
ADVANTAGE COMFORT
ELITE
NOP
BOM
AME
BOM
BOM
AME
AME
MDS
BAY
LSN
MDS
LSN
LSN
BOM
BOM
AME
$
0.6011
0.7324
0.7324
0.7335
0.7834
0.7904
0.8394
0.8626
0.8626
0.8626
0.8637
0.8663
0.8663
0.8680
0.8680
0.9388
AME
$
0.0998
36:88.00 URINE CONTENTS
NOTE: THE IDENTIFICATION NUMBERS LISTED IN THIS SECTION
HAVE BEEN GENERATED BY THE PRESCRIPTION DRUG PLAN FOR
BILLING PURPOSES ONLY.
CUPRIC SO4 REAGENT
TABLET
00035122
CLINITEST
128
36:00 DIAGNOSTIC AGENTS
36:88.00 URINE CONTENTS
GLUCOSE OXIDASE/PEROXIDASE REAGENT
x
STICK
00035114
00035130
CLINISTIX
DIASTIX
AME
AME
$
0.1129
0.1129
BOM
$
0.1389
AME
$
0.1354
KETOSTIX
AME
$
0.1259
ACETEST
AME
$
0.1728
LIL
$
14.0600
GLUCOSE OXIDASE/PEROXIDASE/SODIUM
NITROFERRICYANIDE/GLYCINE REAGENT
STICK
00950238
CHEMSTRIP UG 5000K
GLUCOSE OXIDASE/PEROXIDASE/SODIUM
NITROPRUSSIDE REAGENT
STICK
00035149
KETO DIASTIX
SODIUM NITROPRUSSIDE REAGENT
STICK
00035092
TABLET
00035106
URINE-SUGAR ANALYSIS PAPER
STRIP
00035653
TES-TAPE
129
130
ELECTROLYTIC, CALORIC AND
WATER BALANCE
40:00
40:00 ELECTROLYTIC, CALORIC AND WATER BALANCE
40:12.00 REPLACEMENT AGENTS
POTASSIUM CHLORIDE
8MMOL LONG ACTING CAPSULE
02042304
MICRO-K EXTENCAPS
WYA
$
0.0971
WYA
$
0.1030
APX
NVR
$
0.0489
0.0736
KEY
$
0.2887
PMS
SMJ
$
0.0139
0.0152
ABB
$
0.3165
RBP
$
0.5191
SAW
$
0.3031
PMS
$
0.1027
PMS
SAW
$
0.1172
0.1569
PMS
$
14.8000
10MMOL LONG ACTING CAPSULE
02042312
x
MICRO-K 10 EXTENCAPS
8MMOL LONG ACTING TABLET
00602884
00074225
APO-K
SLOW-K
20MMOL LONG ACTING TABLET
00713376
K-DUR
* 1.33MMOL/ML ORAL SOLUTION
02238604
01918303
PMS-POTASSIUM CHLORIDE
K-10
20MMOL/PACKAGE POWDER (3G)
00481211
K-LOR
25MMOL/PACKAGE POWDER (7.8G)
02089580
K-LYTE/CL
40:18.00 POTASSIUM-REMOVING RESINS
CALCIUM POLYSTYRENE SULFONATE
POWDER (1G BINDS WITH APPROX. 1.6MMOL. K)
02017741
RESONIUM CALCIUM
SODIUM POLYSTYRENE SULFONATE
00769541
PMS-SOD POLYSTYRENE SULF
* POWDER (1G BINDS WITH APPROX.1MMOL K IN VIVO)
00755338
02026961
KAYEXALATE
250MG/ML RETENTION ENEMA
00769533
PMS-SOD POLY SULF (120ML)
132
40:28.00 DIURETICS
ACETAZOLAMIDE
SEE SECTION 52:10.00 (CARBONIC ANHYDRASE INHIBITORS) PAGE 146
BUMETANIDE
1MG TABLET
00728284
BURINEX (EDS)
LEO
$
0.4340
LEO
$
0.8680
LEO
$
1.6818
NOP
APX
$
0.0209
0.0434
NOP
APX
$
0.0431
0.0695
MSD
$
0.3440
NOP
APX
AVT
$
0.0158
0.0320
0.0749
NOP
APX
AVT
$
0.0082
0.0283
0.1147
AVT
$
0.2356
2MG TABLET
02176076
BURINEX (EDS)
5MG TABLET
00728276
BURINEX (EDS)
CHLORTHALIDONE
* 50MG TABLET
00337447
00360279
NOVO-THALIDONE
APO-CHLORTHALIDONE
* 100MG TABLET
00337455
00360287
NOVO-THALIDONE
APO-CHLORTHALIDONE
ETHACRYNIC ACID
50MG TABLET
00016497
EDECRIN (EDS)
FUROSEMIDE
* 20MG TABLET
00337730
00396788
02224690
NOVO-SEMIDE
APO-FUROSEMIDE
LASIX
* 40MG TABLET
00337749
00362166
02224704
NOVO-SEMIDE
APO-FUROSEMIDE
LASIX
02224720
LASIX
133
40:28.00 DIURETICS
HYDROCHLOROTHIAZIDE
* 25MG TABLET
00021474
00326844
00016500
NOVO-HYDRAZIDE
APO-HYDRO
HYDRODIURIL
NOP
APX
MSD
$
0.0223
0.0228
0.0795
NOP
APX
$
0.0250
0.0293
PRO
PMS
GPM
DOM
SEV
$
0.2037
0.2037
0.2037
0.2139
0.3234
GPM
NXP
APX
NOP
PMS
PRO
DOM
SEV
$
0.3230
0.3230
0.3230
0.3230
0.3230
0.3232
0.3392
0.5289
AVT
$
0.1585
AVT
$
0.2024
MSD
$
0.3104
* 50MG TABLET
00021482
00312800
NOVO-HYDRAZIDE
APO-HYDRO
INDAPAMIDE HEMIHYDRATE
* 1.25MG TABLET
02227339
02239619
02240067
02239913
02179709
INDAPAMIDE
PMS-INDAPAMIDE
GEN-INDAPAMIDE
DOM-INDAPAMIDE
LOZIDE
* 2.5MG TABLET
02153483
02223597
02223678
02231184
02239620
02049341
02239917
00564966
GEN-INDAPAMIDE
NU-INDAPAMIDE
APO-INDAPAMIDE
NOVO-INDAPAMIDE
PMS-INDAPAMIDE
INDAPAMIDE
DOM-INDAPAMIDE
LOZIDE
METOLAZONE
2.5MG TABLET
00888400
ZAROXOLYN
5MG TABLET
00888419
ZAROXOLYN
40:28.10 POTASSIUM SPARING DIURETICS
AMILORIDE HCL
5MG TABLET
00487805
MIDAMOR
134
40:28.10 POTASSIUM SPARING DIURETICS
SPIRONOLACTONE
* 25MG TABLET
00028606
00613215
ALDACTONE
NOVO-SPIROTON
SEA
NOP
$
0.0751
0.0751
SEA
NOP
$
0.2301
0.2301
SMJ
$
0.1963
SMJ
$
0.2539
ICN
$
0.2045
NOP
NXP
APX
$
0.0858
0.1080
0.1080
NOP
NXP
APX
$
0.1650
0.2062
0.2062
* 100MG TABLET
00285455
00613223
ALDACTONE
NOVO-SPIROTON
TRIAMTERENE
50MG TABLET
01919563
DYRENIUM
100MG TABLET
01919571
DYRENIUM
40:40.00 URICOSURIC DRUGS
PROBENECID
500MG TABLET
00294926
BENURYL
SULFINPYRAZONE
* 100MG TABLET
00475068
02045680
00441759
NOVO-PYRAZONE
NU-SULFINPYRAZONE
APO-SULFINPYRAZONE
* 200MG TABLET
00475076
02045699
00441767
NOVO-PYRAZONE
NU-SULFINPYRAZONE
APO-SULFINPYRAZONE
135
136
COUGH PREPARATIONS
48:00
48:00 COUGH PREPARATIONS
48:24.00 MUCOLYTIC AGENTS
ACETYLCYSTEINE
20% AEROSOL SOLUTION (30ML)
02091526
MUCOMYST
RBP
$
19.1600
HLR
$
36.0000
DORNASE ALFA
1MG/ML INHALATION SOLUTION (2.5ML)
02046733
PULMOZYME (EDS)
138
EYE, EAR, NOSE AND THROAT
PREPARATIONS
52:00
52:00 EYE, EAR, NOSE AND THROAT PREPARATIONS
52:04.04 ANTI-INFECTIVES (ANTIBIOTICS)
GENTAMICIN SO4
TOPICAL GENTAMICIN SHOULD BE RESERVED FOR THERAPY OF SERIOUS
INFECTIONS INSUSCEPTIBLE TO OTHER AGENTS SINCE RESISTANT
ORGANISMS CAN DEVELOP.
GENTAMICIN SO4 5MG/ML IS EQUIVALENT TO 3MG/ML GENTAMICIN BASE.
* 5MG/ML OPHTHALMIC SOLUTION
00512192
00776521
00880191
02219581
02229440
02133245
02212927
00436771
GARAMYCIN
PMS-GENTAMYCIN
GARATEC
GENTAMICIN SULFATE
GENTAMICIN SULFATE
GENTACIDIN
GENTAMICIN
ALCOMICIN
SCH
PMS
TCH
SCN
SAB
CBV
RVX
ALC
$
0.4406
0.4406
0.4406
0.4406
0.4406
0.4449
0.4644
0.5187
PMS
SCH
SAB
$
1.1198
1.1998
1.1998
SCH
SAB
$
4.3400
4.3400
* 5MG/ML OTIC SOLUTION
02230889
00512184
02229441
PMS-GENTAMICIN
GARAMYCIN
GENTAMICIN SO4
* 5MG/G OPHTHALMIC OINTMENT (3.5G)
00028339
02230888
GARAMYCIN
GENTAMICIN SULFATE
POLYMYXIN B SO4/NEOMYCIN SO4/BACITRACIN(ZINC)
10,000U/5MG/400U PER G OPHTHALMIC OINTMENT
(3.5G)
00694398
NEOSPORIN
GLA
$
8.1400
SAB
GLA
$
0.6782
0.7975
PMS
ALL
$
0.7194
0.9592
POLYMYXIN B SO4/NEOMYCIN SO4/GRAMICIDIN
x
10,000U/2.5MG/0.025MG PER ML EYE/EAR SOLUTION
00807435
00694371
OPTIMYXIN PLUS
NEOSPORIN
POLYMYXIN B SO4/TRIMETHOPRIM SO4
* 10,000U/1MG PER ML OPHTHALMIC SOLUTION
02240363
02011956
PMS-POLYTRIMETHOPRIM
POLYTRIM
140
TOBRAMYCIN
* 0.3% OPHTHALMIC SOLUTION
02238708
02239148
02239577
00513962
TOMYCINE (EDS)
TOBRAMYCIN (EDS)
PMS-TOBRAMYCIN (EDS)
TOBREX (EDS)
CBV
RVX
PMS
ALC
$
1.2652
1.2652
1.2652
1.8077
ALC
$
8.9800
ALL
$
1.1002
GLA
$
30.1700
ALL
AKN
SCH
$
0.0789
0.0789
0.0876
ALC
SCH
$
3.1000
4.1900
0.3% OPHTHALMIC OINTMENT (3.5G)
00614254
TOBREX (EDS)
52:04.06 ANTI-INFECTIVES (ANTIVIRALS)
IDOXURIDINE
0.1% OPHTHALMIC SOLUTION
00001120
HERPLEX
TRIFLURIDINE
1% OPHTHALMIC SOLUTION (7.5ML)
00687456
VIROPTIC
52:04.08 ANTI-INFECTIVES (SULFONAMIDES)
SULFACETAMIDE (SODIUM)
* 10% OPHTHALMIC SOLUTION
00001287
02023830
00028053
BLEPH-10
DIOSULF
SODIUM SULAMYD
* 10% OPHTHALMIC OINTMENT (3.5G)
00252522
00028347
CETAMIDE
SODIUM SULAMYD
141
52:04.12 ANTI-INFECTIVES (MISCELLANEOUS)
ALUMINUM ACETATE/BENZETHONIUM CHLORIDE
0.5%/0.03% OTIC SOLUTION
00674222
BURO-SOL-OTIC
STI
$
0.2170
ALC
$
2.1049
ALC
$
10.5300
MSD
$
1.7686
ALL
$
1.5364
SCH
$
8.1400
ALT
GPM
MED
NXP
APX
$
13.3100
13.3100
13.3100
13.3100
13.3100
RBP
$
3.2724
CIPROFLOXACIN
01945270
CILOXAN (EDS)
02200864
CILOXAN (EDS)
NORFLOXACIN
01908294
NOROXIN (EDS)
OFLOXACIN
02143291
OCUFLOX (EDS)
52:08.00 ANTI-INFLAMMATORY AGENTS
BECLOMETHASONE DIPROPIONATE
50UG/DOSE NASAL SPRAY (PACKAGE)
00422053
VANCENASE
* 50UG/DOSE AQUEOUS NASAL SPRAY (PACKAGE)
00872318
02172712
02237379
02238577
02238796
ALTI-BECLOMETHASONE AQ.
GEN-BECLO AQ.
MED-BECLOMETHASONE AQ
NU-BECLOMETHASONE
APO-BECLOMETHASONE
BETAMETHASONE DISODIUM PHOSPHATE
0.1% OPHTHALMIC/OTIC SOLUTION
02060868
BETNESOL
142
BUDESONIDE
* 64UG/DOSE NASAL SPRAY (PACKAGE)
02241003
02231923
GEN-BUDESONIDE AQ
RHINOCORT AQUA
GPM
AST
$
9.1500
10.7700
GPM
$
13.8300
AST
$
23.9300
ALC
$
1.6709
SAB
PMS
RVX
AKN
$
0.7335
0.7335
0.7335
0.9071
ALC
$
9.0600
ALT
NOP
APX
HLR
$
15.0400
16.1200
16.1200
21.4900
ALL
$
2.1939
ALC
$
1.8879
ALL
$
5.0062
02230648
GEN-BUDESONIDE AQ
100UG POWDER FOR INHALATION (PACKAGE)
02035324
RHINOCORT TURBUHALER
DEXAMETHASONE
0.1% OPHTHALMIC SUSPENSION
00042560
MAXIDEX
* 0.1% OPHTHALMIC/OTIC SOLUTION
00739839
00785261
02212978
02023865
DEXAMETHASONE SODIUM PHO
PMS-DEXAMETHASONE SOD PHO
DEXAMETHASONE
DIODEX
00042579
MAXIDEX
FLUNISOLIDE
* 0.025% NASAL SOLUTION (PACKAGE)
00878790
02230306
02239288
02162687
ALTI-FLUNISOLIDE
NOVO-FLUNISOLIDE
APO-FLUNISOLIDE
RHINALAR
FLUOROMETHOLONE
00247855
FML
FLUOROMETHOLONE ACETATE
00756784
FLAREX
FLURBIPROFEN SODIUM
00766046
OCUFEN (EDS)
143
FLUTICASONE PROPIONATE
50UG/DOSE AQUEOUS NASAL SPRAY (PACKAGE)
02213672
FLONASE
GLA
$
24.0500
ALL
$
3.4720
SCH
$
22.7400
SAB
ALL
$
1.1501
1.5473
ALT
SAB
AKN
ALL
$
0.6293
0.6293
0.6293
2.5303
CBV
$
1.6731
CBV
RVX
$
1.5190
1.5190
AVT
$
21.7000
AVT
$
23.3900
KETOROLAC TROMETHAMINE
01968300
ACULAR (EDS)
MOMETASONE FUROATE MONOHYDRATE
0.05% AQUEOUS NASAL SPRAY
02238465
NASONEX
PREDNISOLONE ACETATE
* 0.12% OPHTHALMIC SUSPENSION
01916181
00299405
PREDNISOLONE
PRED MILD
* 1.0% OPHTHALMIC SUSPENSION
00700401
01916203
02023768
00301175
OPHTHO-TATE
PREDNISOLONE
DIOPRED
PRED FORTE
PREDNISOLONE SODIUM PHOSPHATE
02133296
INFLAMASE
02133318
02213079
INFLAMASE FORTE
PREDNISOLONE
TRIAMCINOLONE ACETONIDE
01913328
NASACORT
AQUEOUS NASAL SPRAY (PACKAGE)
02213834
NASACORT AQ
144
52:08.00 COMBINATION ANTI-INFECTIVE/
ANTI-INFLAMMATORY AGENTS
CIPROFLOXACIN/HYDROCORTISONE
0.2%/1% OTIC SUSPENSION
02240035
CIPRO HC (EDS)
ALC
$
2.2790
FRAMYCETIN SO4/GRAMICIDIN/DEXAMETHASONE BASE
5MG/50UG/0.5MG PER ML EYE/EAR SOLUTION
01987712
SOFRACORT
AVT
$
1.5190
$
10.4200
5MG/50UG/0.5MG PER G EYE/EAR OINTMENT (5G)
02224631
SOFRACORT
AVT
GENTAMICIN SO4/BETAMETHASONE SODIUM PHOSPHATE
0.3%/0.1% OPHTHALMIC OINTMENT (3.5G)
00586706
GARASONE
SCH
$
11.0000
SCH
$
1.9872
0.3%/0.1% OTIC/OPHTHALMIC SOLUTION
00682217
GARASONE
IODOCHLORHYDROXYQUIN/FLUMETHASONE PIVALATE
1%/0.02% OTIC SOLUTION
00074454
LOCACORTEN-VIOFORM
NVR
$
1.3346
PHU
$
1.4279
GLA
$
10.5200
NEOMYCIN SO4/HYDROCORTISONE ACETATE
5MG/15MG PER ML EYE/EAR SUSPENSION
00194948
NEO-CORTEF
POLYMYXIN B SO4/BACITRACIN (ZINC)/
NEOMYCIN SO4/HYDROCORTISONE
10000U/400U/5MG/10MG PER G OPHTHALMIC
OINTMENT (3.5G)
00701904
CORTISPORIN
POLYMYXIN B SO4/NEOMYCIN SO4/DEXAMETHASONE
6,000U/5MG/1MG PER ML OPHTHALMIC SOLUTION
00042676
MAXITROL
ALC
$
2.0659
$
10.0800
6,000U/5MG/1MG PER G OPHTHALMIC OINTMENT
(3.5G)
00358177
MAXITROL
ALC
145
POLYMYXIN B SO4/NEOMYCIN SO4/HYDROCORTISONE
10,000U/5MG/10MG PER ML EYE/EAR SUSPENSION
02025736
CORTISPORIN
GLA
$
1.2424
SAB
GLA
$
1.0004
1.2424
* 10,000U/5MG/10MG PER ML OTIC SOLUTION
02230386
01912828
CORTIMYXIN
CORTISPORIN
SULFACETAMIDE SODIUM/PREDNISOLONE ACETATE
100MG/2.5MG PER ML OPHTHALMIC SOLUTION
02133342
VASOCIDIN
CBV
$
2.2460
AKN
$
1.2478
ALL
$
12.3200
ALC
$
2.1353
ALC
$
11.0700
NOP
APX
WYA
$
0.0353
0.0467
0.1413
WYA
$
0.7567
ALC
$
3.4069
100MG/5MG PER ML OPHTHALMIC SUSPENSION
02023814
DIOPTIMYD
100MG/2MG PER G OPHTHALMIC OINTMENT
(3.5G)
00307246
BLEPHAMIDE S.O.P.
TOBRAMYCIN/DEXAMETHASONE
0.3%/0.1% OPHTHALMIC SUSPENSION
00778907
TOBRADEX (EDS)
0.3%/0.1% OPHTHALMIC OINTMENT (3.5G)
00778915
TOBRADEX (EDS)
52:10.00 CARBONIC ANHYDRASE INHIBITORS
ACETAZOLAMIDE
* 250MG TABLET
00488275
00545015
02238072
NOVO-ZOLAMIDE
APO-ACETAZOLAMIDE
DIAMOX
02238073
DIAMOX SEQUELS
BRINZOLAMIDE
1% OPHTHALMIC SUSPENSION
02238873
AZOPT
146
52:10.00 CARBONIC ANHYDRASE INHIBITORS
DORZOLAMIDE HCL
2% OPHTHALMIC SOLUTION
02216205
TRUSOPT
MSD
$
3.5805
WYA
$
0.2707
WYA
$
0.4231
ALC
$
0.7307
ALC
$
0.8789
WYA
$
4.9737
WYA
$
5.7006
WYA
$
6.4558
ALC
$
0.3328
METHAZOLAMIDE
25MG TABLET
02238070
NEPTAZANE
50MG TABLET
02238071
NEPTAZANE
52:20.00 MIOTICS
CARBACHOL
00000655
ISOPTO CARBACHOL
00000663
ISOPTO CARBACHOL
ECHOTHIOPHATE IODIDE
02238075
PHOSPHOLINE IODIDE
02238076
PHOSPHOLINE IODIDE
02217139
PHOSPHOLINE IODIDE
PILOCARPINE HCL
00000833
ISOPTO CARPINE
147
52:20.00 MIOTICS
02134861
02229393
02229556
02213036
00000841
02023725
MIOCARPINE
PILOCARPINE
SCHEINPHARM PILOCARPINE
PILOCARPINE
ISOPTO CARPINE
DIOCARPINE
CBV
TCH
SCN
RVX
ALC
AKN
$
0.1888
0.1888
0.1888
0.2026
0.2221
0.2221
CBV
TCH
SCN
RVX
ALC
AKN
$
0.2099
0.2099
0.2099
0.2251
0.2561
0.2561
CBV
TCH
SCN
RVX
ALC
AKN
$
0.2395
0.2395
0.2395
0.2561
0.2894
0.2894
CBV
ALC
$
0.3661
0.4883
ALC
$
13.5600
CBV
$
1.3020
ALC
CBV
CBV
$
0.5100
0.5534
0.6185
02134888
02229394
02229555
02213044
00000868
02023741
MIOCARPINE
PILOCARPINE
PILOCARPINE
ISOPTO CARPINE
DIOCARPINE
02134896
02229395
02229554
02213052
00000884
02023733
MIOCARPINE
PILOCARPINE
PILOCARPINE
ISOPTO CARPINE
DIOCARPINE
02133334
00000892
MIOCARPINE
ISOPTO CARPINE
4% OPHTHALMIC GEL (5G)
00575240
PILOPINE-HS
PILOCARPINE HCL/EPINEPHRINE BITARTRATE
4%/1% OPHTHALMIC SOLUTION
02133202
E-PILO 4
52:24.00 MYDRIATICS
ATROPINE SO4
00035017
02134853
01948598
ISOPTO ATROPINE
ATROPISOL
ATROPINE
148
52:24.00 MYDRIATICS
DIPIVEFRIN HCL
02032376
02237868
02152525
00529117
OPHTHO-DIPIVEFRIN
PMS-DIPIVEFRIN
DPE
PROPINE
ALT
PMS
ALC
ALL
$
1.0807
1.0807
1.2858
1.7154
ALC
$
0.6293
ALC
$
0.7487
ALC
$
23.0800
ALC
$
11.9200
ALC
$
2.4456
ALL
$
3.5810
CBV
$
2.5715
MSD
$
5.4250
HOMATROPINE HYDROBROMIDE
00000779
ISOPTO HOMATROPINE
00000787
ISOPTO HOMATROPINE
52:36.00 MISCELLANEOUS E.E.N.T. DRUGS
APRACLONIDINE HCL
0.5% OPHTHALMIC SOLUTION (5ML)
02076306
IOPIDINE
1% OPHTHALMIC SOLUTION (1 TREATMENT)
00888354
IOPIDINE
BETAXOLOL HCL
01908448
BETOPTIC S
BRIMONIDINE TARTRATE
02236876
ALPHAGAN
DICLOFENAC SODIUM
0.1% OPHTHALMIC SOLUTION (ML)
01940414
VOLTAREN OPTHA (EDS)
DORZOLAMIDE HCL/TIMOLOL MALEATE
2%/0.5% OPHTHALMIC SOLUTION
02240113
COSOPT
149
IPRATROPIUM BROMIDE
* 21UG/DOSE NASAL SPRAY (PACKAGE)
02239627
02240072
02240508
02163705
PMS-IPRATROPIUM
ALTI-IPRATROPIUM
DOM-IPRATROPIUM
ATROVENT NASAL SPRAY
PMS
ALT
DOM
BOE
$
21.1500
21.1500
22.2000
30.2100
PHU
$
28.2100
ALT
NOP
RVX
APX
ALL
$
1.2760
1.2760
1.2760
1.2760
2.3078
PMS
ALT
NOP
RVX
APX
ALL
$
1.6872
1.6883
1.6883
1.6883
1.6883
2.8341
ALL
$
3.2008
CBV
$
18.3100
ALC
$
1.1122
LATANOPROST
50UG/ML OPHTHALMIC SOLUTION (2.5ML)
02231493
XALATAN
LEVOBUNOLOL HCL
02031159
02197456
02231714
02241575
00751286
OPHTHO-BUNOLOL
NOVO-LEVOBUNOLOL
LEVOBUNOLOL HYDROCHLORIDE
APO-LEVOBUNOLOL
BETAGAN
02237991
02031167
02197464
02231715
02241574
00637661
PMS-LEVOBUNOLOL
OPHTHO-BUNOLOL
NOVO-LEVOBUNOLOL
APO-LEVOBUNOLOL
BETAGAN
LEVOBUNOLOL HCL/DIPIVEFRIN HCL
0.5%/0.1% OPHTHALMIC SOLUTION
02209071
PROBETA
LEVOCABASTINE HYDROCHLORIDE
0.5MG PER ML OPHTHALMIC SUSPENSION (5ML)
02131625
LIVOSTIN
LODOXAMIDE TROMETHAMINE
00893560
ALOMIDE
150
SODIUM CROMOGLYCATE
* 2% NASAL METERED DOSE MIST (PACKAGE)
01950541
02231390
CROMOLYN
APO-CROMOLYN
PMS
APX
$
14.9300
14.9300
APX
GPM
NOP
PMS
MED
SAB
DOM
MSD
$
1.6818
1.6818
1.6818
1.6818
1.6818
1.6818
1.7664
2.7733
APX
GPM
NOP
PMS
MED
SAB
DOM
MSD
$
2.0181
2.0181
2.0181
2.0181
2.0181
2.0181
2.1190
3.3874
MSD
$
3.5371
MSD
$
4.2315
TIMOLOL MALEATE
00755826
00893773
02048523
02083353
02084317
02166712
02238770
00451193
APO-TIMOP
GEN-TIMOLOL
NOVO-TIMOL
PMS-TIMOLOL
MED-TIMOLOL
TIMOLOL MALEATE
DOM-TIMOLOL
TIMOPTIC
00755834
00893781
02048515
02083345
02084325
02166720
02238771
00451207
APO-TIMOP
GEN-TIMOLOL
NOVO-TIMOL
PMS-TIMOLOL
MED-TIMOLOL
TIMOLOL MALEATE
DOM-TIMOLOL
TIMOPTIC
0.25% OPHTHALMIC GELLAN SOLUTION
02171880
TIMOPTIC-XE
0.5% OPHTHALMIC GELLAN SOLUTION
02171899
TIMOPTIC-XE
TIMOLOL MALEATE/PILOCARPINE HYDROCHLORIDE
0.5%/2% OPHTHALMIC SOLUTION
01905082
TIMPILO
MSD
$
3.3874
MSD
$
3.3874
0.5%/4% OPHTHALMIC SOLUTION
01905090
TIMPILO
151
152
GASTROINTESTINAL DRUGS
56:00
56:00 GASTROINTESTINAL DRUGS
56:08.00 ANTIDIARRHEA AGENTS
DIPHENOXYLATE HCL
2.5MG TABLET
00036323
LOMOTIL
SEA
$
0.4548
NOP
APX
ICN
PMS
RHO
PMS
MCL
$
0.2676
0.2676
0.2676
0.2676
0.2676
0.2684
0.7234
PMS
PMS
$
0.0912
0.0912
PMS
TCH
$
0.0158
0.0158
JAN
$
0.3733
JAN
$
0.3727
LOPERAMIDE HCL
* 2MG CAPLET
02132591
02212005
02228343
02228351
02233998
02229552
00860743
NOVO-LOPERAMIDE
APO-LOPERAMIDE
LOPERACAP
PMS-LOPERAMIDE
RHO-LOPERAMIDE
DIARR-EZE
IMODIUM
* 0.2MG/ML ORAL SOLUTION
02016095
02192667
PMS-LOPERAMIDE HCL
DIARR-EZE
56:12.00 CATHARTICS AND LAXATIVES
LACTULOSE
x
667MG/ML SYRUP
00703486
00854409
PMS-LACTULOSE (EDS)
ACILAC (EDS)
56:16.00 DIGESTANTS
PANCRELIPASE (LIPASE/AMYLASE/PROTEASE)
4000U/12000U/12000U CAPSULE CONTAINING
ENTERIC COATED PARTICLES
00789445
PANCREASE MT 4
00591548
PANCREASE
154
56:16.00 DIGESTANTS
02203324
ULTRASE MS4
AXC
$
0.2214
SLV
$
0.1812
ORG
$
0.2670
ORG
$
0.3662
JAN
$
0.9329
SLV
$
0.2897
AXC
$
0.4330
JAN
$
1.4925
ORG
$
0.9456
AXC
$
0.7069
SLV
$
0.8597
SLV
$
0.9049
02239007
CREON 5
8000U/30000U/30000U CAPSULE
00263818
COTAZYM
00502790
COTAZYM ECS 8
00789437
PANCREASE MT 10
02200104
CREON 10
02045834
ULTRASE MT12
00789429
PANCREASE MT 16
00821373
COTAZYM ECS 20
02045869
ULTRASE MT20
02239008
CREON 20
01985205
CREON 25
155
56:16.00 DIGESTANTS
8000U/30000U/30000U TABLET
02230019
VIOKASE
AXC
$
0.2303
AXC
$
0.4951
APX
PMS
NOP
HOR
$
0.0138
0.0138
0.0408
0.1313
HOR
$
0.0725
SAB
HOR
$
3.2600
4.2800
HOR
$
0.5002
HOR
$
0.5219
DUI
$
0.8896
PFI
$
0.2873
NVR
$
3.8000
24000U/100000U/100000U POWDER
02230020
VIOKASE
56:22.00 ANTI-EMETICS
DIMENHYDRINATE
* 50MG TABLET
00363766
00586331
00021423
00013803
APO-DIMENHYDRINATE
PMS-DIMENHYDRINATE
NOVO-DIMENATE
GRAVOL
3MG/ML ORAL LIQUID
00230197
GRAVOL
00392537
00013579
DIMENHYDRINATE IM
GRAVOL
50MG SUPPOSITORY
00013595
GRAVOL
100MG SUPPOSITORY
00013609
GRAVOL
DOXYLAMINE SUCCINATE/PYRIDOXINE HCL
10MG/10MG DELAYED RELEASE TABLET
00609129
DICLECTIN
MECLIZINE HCL
25MG TABLET
00220442
BONAMINE
SCOPOLAMINE
1.5MG TRANSDERMAL THERAPEUTIC SYSTEM
00550094
TRANSDERM-V
156
56:40.00 MISCELLANEOUS GASTROINTESTINAL DRUGS
BUDESONIDE
3MG CONTROLLED ILEAL RELEASE CAPSULE
02229293
ENTOCORT (EDS)
AST
$
1.6058
TCH
NOP
APX
NXP
GPM
PMS
$
0.0800
0.0800
0.0800
0.0800
0.0800
0.0800
DOM
APX
TCH
NOP
NXP
GPM
PMS
SMJ
$
0.0530 *
0.0934
0.0934
0.0934
0.0934
0.0934
0.0934
0.3887
DOM
TCH
APX
NOP
NXP
GPM
PMS
SMJ
$
0.0831 *
0.1465
0.1465
0.1465
0.1465
0.1465
0.1465
0.6357
DOM
TCH
APX
NOP
NXP
GPM
PMS
SMJ
$
0.1060 *
0.1867
0.1867
0.1867
0.1867
0.1867
0.1867
0.7388
SMJ
$
0.1743
CIMETIDINE
* 200MG TABLET
00546232
00582409
00584215
00865796
02227436
02229717
PEPTOL
NOVO-CIMETINE
APO-CIMETIDINE
NU-CIMET
GEN-CIMETIDINE
PMS-CIMETIDINE
* 300MG TABLET
02231287
00487872
00546240
00582417
00865818
02227444
02229718
01916815
DOM-CIMETIDINE
APO-CIMETIDINE
PEPTOL
NOVO-CIMETINE
NU-CIMET
GEN-CIMETIDINE
PMS-CIMETIDINE
TAGAMET
* 400MG TABLET
02231288
00568449
00600059
00603678
00865826
02227452
02229719
01916785
DOM-CIMETIDINE
PEPTOL
APO-CIMETIDINE
NOVO-CIMETINE
NU-CIMET
GEN-CIMETIDINE
PMS-CIMETIDINE
TAGAMET
* 600MG TABLET
02231290
00584282
00600067
00603686
00865834
02227460
02229720
01916777
DOM-CIMETIDINE
PEPTOL
APO-CIMETIDINE
NOVO-CIMETINE
NU-CIMET
GEN-CIMETIDINE
PMS-CIMETIDINE
TAGAMET
60MG/ML ORAL LIQUID
01916750
TAGAMET
157
CISAPRIDE MONOHYDRATE
5MG TABLET
00836311
PREPULSID
JAN
$
0.3080
JAN
$
0.6017
JAN
$
1.1890
DOM
ALT
APX
NOP
TCH
NXP
PMS
FTP
JAN
$
0.0846 *
0.1624
0.1624
0.1624
0.1624
0.1624
0.1624
0.1624
0.2578
NXP
APX
NOP
GPM
ICN
PEN
RHO
MSD
$
0.3710 *
0.6398
0.6398
0.6398
0.6398
0.6398
0.6398
1.0153
NXP
APX
NOP
GPM
ICN
PEN
RHO
MSD
$
0.6360 *
1.1514
1.1514
1.1514
1.1514
1.1514
1.1514
1.8461
10MG TABLET
00836338
PREPULSID
20MG TABLET
02054817
PREPULSID
DOMPERIDONE MALEATE
* 10MG TABLET
02238315
01912070
02103613
02157195
02230473
02231477
02236466
02238444
00855820
DOM-DOMPERIDONE
ALTI-DOMPERIDONE MALEATE
APO-DOMPERIDONE
NOVO-DOMPERIDONE
MOTILIDONE
NU-DOMPERIDONE
PMS-DOMPERIDONE
FTP-DOMPERIDONE MALEATE
MOTILIUM
FAMOTIDINE
* 20MG TABLET
02024195
01953842
02022133
02196018
02237148
02238342
02240622
00710121
NU-FAMOTIDINE
APO-FAMOTIDINE
NOVO-FAMOTIDINE
GEN-FAMOTIDINE
ULCIDINE
PENTA-FAMOTIDINE
RHOXAL-FAMOTIDINE
PEPCID
* 40MG TABLET
02024209
01953834
02022141
02196026
02237149
02238343
02240623
00710113
NU-FAMOTIDINE
APO-FAMOTIDINE
NOVO-FAMOTIDINE
GEN-FAMOTIDINE
ULCIDINE
PENTA-FAMOTIDINE
RHOXAL-FAMOTIDINE
PEPCID
158
LANSOPRAZOLE
15MG DELAYED RELEASE CAPSULE
02165503
PREVACID (EDS)
ABB
$
2.1700
ABB
$
2.1700
30MG DELAYED RELEASE CAPSULE
02165511
PREVACID (EDS)
LANSOPRAZOLE/CLARITHROMYCIN/AMOXICILLIN
30MG/500MG/500MG 7-DAY PACKAGE
02238525
HP-PAC (EDS)
ABB
$
79.8600
PMS
$
0.0604
APX
NXP
PMS
WYA
$
0.0633
0.0633
0.0633
0.1845
PMS
WYA
$
0.0291
0.0324
SEA
$
0.2952
SEA
$
0.4914
PMS
APX
NOP
LIL
$
0.5737
0.5737
0.5737
0.9106
PMS
APX
NOP
LIL
$
1.0395
1.0395
1.0395
1.6499
METOCLOPRAMIDE HCL
5MG TABLET
02230431
PMS-METOCLOPRAMIDE
* 10MG TABLET
00842834
02143283
02230432
02043521
APO-METOCLOP
NU-METOCLOPRAMIDE
PMS-METOCLOPRAMIDE
REGLAN
02230433
02043548
PMS-METOCLOPRAMIDE
REGLAN
MISOPROSTOL
100UG TABLET
00813966
CYTOTEC
200UG TABLET
00632600
CYTOTEC
NIZATIDINE
* 150MG CAPSULE
02177714
02220156
02240457
00778338
PMS-NIZATIDINE
APO-NIZATIDINE
NOVO-NIZATIDINE
AXID
* 300MG CAPSULE
02177722
02220164
02240458
00778346
PMS-NIZATIDINE
APO-NIZATIDINE
NOVO-NIZATIDINE
AXID
159
OLSALAZINE SODIUM
250MG CAPSULE
02063808
DIPENTUM
PHU
$
0.5176
AST
$
1.8988
AST
$
2.3870
SLV
$
2.0615
NXP
APX
NOP
ALT
GPM
MED
SCN
GLA
$
0.1166 *
0.4386
0.4386
0.4386
0.4386
0.4386
0.4386
1.1885
NXP
APX
NOP
ALT
GPM
MED
SCN
GLA
$
0.2650 *
0.8449
0.8449
0.8449
0.8449
0.8449
0.8449
2.2373
GLA
$
0.2023
OMEPRAZOLE
10MG DELAYED RELEASE TABLET
02230737
LOSEC (EDS)
02190915
LOSEC (EDS)
PANTOPRAZOLE
40MG ENTERIC TABLET
02229453
PANTOLOC (EDS)
RANITIDINE
* 150MG TABLET
00865737
00733059
00828564
00828823
02207761
02219077
02241598
02212331
NU-RANIT
APO-RANITIDINE
NOVO-RANIDINE
ALTI-RANITIDINE
GEN-RANITIDINE
MED-RANITIDINE
SCHEINPHARM RANITIDINE
ZANTAC
* 300MG TABLET
00865745
00733067
00828556
00828688
02207788
02219085
02241599
00641790
NU-RANIT
APO-RANITIDINE
NOVO-RANIDINE
ALTI-RANITIDINE
GEN-RANITIDINE
MED-RANITIDINE
ZANTAC
02212374
ZANTAC
160
RANITIDINE BISMUTH CITRATE
400MG TABLET
02231831
PYLORID (EDS)
GLA
$
1.3997
NXP
NOP
APX
PMS
AVT
$
0.1590 *
0.3192
0.3192
0.3192
0.5578
AVT
$
0.1014
PMS
ALT
PHU
$
0.0907
0.0907
0.2383
PMS
ALT
ICN
PHU
$
0.1177
0.1177
0.2643
0.3752
FEI
$
0.3338
NOP
PGA
$
0.4297
0.5371
FEI
$
0.6043
AXC
SMJ
$
0.5252
0.5762
FEI
$
4.0300
SUCRALFATE
* 1G TABLET
02134829
02045702
02125250
02238209
02100622
NU-SUCRALFATE
NOVO-SUCRALATE
APO-SUCRALFATE
PMS-SUCRALFATE
SULCRATE
02103567
SULCRATE SUSPENSION PLUS
SULFASALAZINE (SALICYLAZOSULFAPYRIDINE)
* 500MG TABLET
00598461
00685933
02064480
PMS-SULFASALAZINE
ALTI-SULFASALAZINE
SALAZOPYRIN
00598488
00685925
00445126
02064472
PMS-SULFASALAZINE
ALTI-SULFASALAZINE
S.A.S. 500
SALAZOPYRIN
5-AMINOSALICYLIC ACID
02099675
x
PENTASA
400MG ENTERIC COATED TABLET
02171929
01997580
NOVO-5-ASA
ASACOL
02099683
x
PENTASA
500MG ENTERIC COATED TABLET
02112787
01914030
SALOFALK
MESASAL
1.0G/100ML RETENTION ENEMA
02153521
QUINTASA
161
2.0G/60G RETENTION ENEMA
02112795
SALOFALK RETENTION ENEMA
AXC
$
3.8100
FEI
$
4.4200
AXC
$
6.4700
FEI
$
4.8400
AXC
$
0.8348
AXC
$
1.1820
FEI
$
1.7686
02153548
QUINTASA
4.0G/60G RETENTION ENEMA
02112809
02153556
QUINTASA
250MG SUPPOSITORY
02112752
SALOFALK
500MG SUPPOSITORY
02112760
SALOFALK
1.0G SUPPOSITORY
02153564
QUINTASA
162
GOLD COMPOUNDS
60:00
60:00 GOLD COMPOUNDS
60:00.00 GOLD COMPOUNDS
AURANOFIN
AURANOFIN SHOULD BE CONSIDERED ONLY WHEN SALICYLATES OR OTHER
NON-STEROIDAL ANTI-INFLAMMATORY DRUGS, AND, WHEN APPROPRIATE,
STEROIDS, HAVE PROVEN TO BE INADEQUATE FOR CONTROLLING THE
SYMPTOMS OF RHEUMATOID ARTHRITIS. PHYSICIANS PLANNING TO USE
AURANOFIN SHOULD BE EXPERIENCED WITH CHRYSOTHERAPY AND SHOULD
THOROUGHLY FAMILIARIZE THEMSELVES WITH THE TOXICITY AND BENEFITS
OF AURANOFIN. ADVERSE REACTIONS WERE REPORTED IN 62% OF 4,784
PATIENTS TREATED WITH AURANOFIN. MOST COMMON WERE DIARRHEA (47%),
RASH (24%), PRURITIS (17%), ABDOMINAL PAIN (14%), AND STOMATITIS (13%).
POTENTIALLY SERIOUS ADVERSE REACTIONS WERE ANEMIA (1.6%),
LEUKOPENIA (1.9%), THROMBOCYTOPENIA (0.9%) AND PROTEINUREA (5.0%).
3MG CAPSULE
01916823
RIDAURA
PMS
$
1.3652
SAW
$
116.2100
AVT
$
9.7800
AVT
$
11.8700
AVT
$
18.4400
AUROTHIOGLUCOSE
50MG/ML INJECTION SUSPENSION (10ML)
00855774
SOLGANAL
SODIUM AUROTHIOMALATE
01927620
MYOCHRYSINE
01927612
MYOCHRYSINE
01927604
MYOCHRYSINE
164
METAL ANTAGONISTS
64:00
64:00 METAL ANTAGONISTS
64:00.00 METAL ANTAGONISTS
PENICILLAMINE
125MG CAPSULE
00497894
CUPRIMINE
MSD
$
0.5315
MSD
$
0.7968
HOR
$
0.6838
250MG CAPSULE
00016055
CUPRIMINE
250MG TABLET
00511641
DEPEN
166
HORMONES AND SUBSTITUTES
68:00
68:00 HORMONES AND SUBSTITUTES
68:04.00 ADRENAL CORTICOSTEROIDS
COMPARABLE ANTI-INFLAMMATORY ACTIVITY OF ORAL
CORTICOSTEROIDS
(MINERALCORTICOID ACTIVITY NOT COMPARABLE)
DURATION OF
ACTION
PRODUCT
COMPARABLE
ANTI-INFLAMMATORY
DOSE
SHORT ACTING
- CORTISONE
- HYDROCORTISONE
- PREDNISONE
- METHYLPREDNISOLONE
INTERMEDIATE ACTING
- TRIAMCINOLONE
LONG ACTING
- DEXAMETHASONE
- BETAMETHASONE
25 mg
20 mg
5 mg
4 mg
4 mg
0.75 mg
0.60 mg
THESE CLASSIFICATIONS ARE IMPORTANT CONSIDERATIONS IN ALTERNATE
DAY STEROID THERAPY.
COMPARABLE ANTI-INFLAMMATORY ACTIVITY OF SOLUBLE
INJECTABLE CORTICOSTEROIDS
PRODUCT
HYDROCORTISONE
SODIUM SUCCINATE
DEXAMETHASONE
21 PHOSPHATE
% ACTIVE
BASE
74.8
76.1
168
COMPARABLE
ANTI-INFLAMMATORY
DOSE
100 mg
4 mg
* 50UG/INHALATION AEROSOL (PACKAGE)
00374407
00872334
VANCERIL INHALER
ALTI-BECLOMETHASONE
SCH
ALT
$
8.1400
8.1400
SCH
SAB
$
4.2900
4.2900
AST
$
0.4340
AST
$
0.8680
AST
$
1.7360
AST
$
32.0700
AST
$
64.1300
AST
$
115.3900
MSD
$
0.1220
ICN
MSD
$
0.3327
0.4557
BETAMETHASONE ACETATE/
BETAMETHASONE SODIUM PHOSPHATE
* 3MG/3MG PER ML INJECTION SUSPENSION (1ML)
00028096
02237835
CELESTONE SOLUSPAN
BETAJECT
BUDESONIDE
0.125MG/ML INHALATION SOLUTION (2ML)
02229099
PULMICORT NEBUAMP
01978918
PULMICORT NEBUAMP
01978926
PULMICORT NEBUAMP
00852074
PULMICORT TURBUHALER
00851752
00851760
CORTISONE ACETATE
5MG TABLET
00016438
CORTONE
* 25MG TABLET
00280437
00016446
CORTISONE
CORTONE
169
DEXAMETHASONE
* 0.5MG TABLET
00295094
01964976
02240684
00016462
DEXASONE
PMS-DEXAMETHASONE
ALTI-DEXAMETHASONE
DECADRON
ICN
PMS
ALT
MSD
$
0.2138
0.2138
0.2138
0.3393
ICN
PMS
ALT
$
0.4883
0.4883
0.4883
PMS
ICN
ALT
MSD
$
0.8326
0.8329
0.8329
1.3220
SAB
CYT
PMS
MSD
$
9.1700
9.1700
16.2800
19.6800
RBP
$
0.2355
GLA
$
14.3300
GLA
$
23.7700
GLA
$
39.0600
GLA
$
78.1200
$
14.3300
* 0.75MG TABLET
00285471
01964968
02240685
DEXASONE
PMS-DEXAMETHASONE
ALTI-DEXAMETHASONE
* 4MG TABLET
01964070
00489158
02240687
00354309
PMS-DEXAMETHASONE
DEXASONE
ALTI-DEXAMETHASONE
DECADRON
DEXAMETHASONE 21-PHOSPHATE
00664227
01977547
00751863
00213624
DEXAMETHASONE SOD PHO INJ
DECADRON
FLUDROCORTISONE ACETATE
0.1MG TABLET
02086026
FLORINEF
25UG/INHALATION AEROSOL (PACKAGE)
02213583
FLOVENT
02213591
FLOVENT
02213605
FLOVENT
02213613
FLOVENT
02237244
FLOVENT DISKUS
GLA
170
02237245
FLOVENT DISKUS
GLA
$
23.7700
$
39.0600
GLA
$
78.1200
PHU
$
0.1468
PHU
$
0.2653
PHU
$
3.4800
PHU
$
6.0500
PHU
$
0.3529
PHU
$
1.0182
PHU
$
5.1000
PHU
$
9.7700
AVT
$
0.1041
02237246
FLOVENT DISKUS
GLA
02237247
FLOVENT DISKUS
HYDROCORTISONE
10MG TABLET
00030910
CORTEF
20MG TABLET
00030929
CORTEF
HYDROCORTISONE SODIUM SUCCINATE
00030600
SOLU-CORTEF
00030619
SOLU-CORTEF
METHYLPREDNISOLONE
4MG TABLET
00030988
MEDROL
16MG TABLET
00036129
MEDROL
METHYLPREDNISOLONE ACETATE
00030759
DEPO-MEDROL
00030767
DEPO-MEDROL
PREDNISOLONE SODIUM PHOSPHATE
1MG/ML ORAL LIQUID
02230619
PEDIAPRED
171
PREDNISONE
* 1MG TABLET
00271373
00598194
WINPRED
APO-PREDNISONE
ICN
APX
$
0.1123
0.1123
NOP
APX
PHU
$
0.0162
0.0163
0.0451
APX
NOP
PHU
$
0.1091
0.1760
0.2107
STI
$
0.3041
STI
$
0.5246
AVT
$
17.3600
SAB
WSD
$
13.5700
15.9400
CYT
SCN
SAB
WSD
$
5.5600
5.5600
6.3147
7.4000
* 5MG TABLET
00021695
00312770
00210188
NOVO-PREDNISONE
APO-PREDNISONE
DELTASONE
* 50MG TABLET
00550957
00232378
00252417
APO-PREDNISONE
NOVO-PREDNISONE
DELTASONE
TRIAMCINOLONE
2MG TABLET
02194082
ARISTOCORT
4MG TABLET
02194090
ARISTOCORT
200UG/DOSE INHALATION AEROSOL (PACKAGE)
01926314
AZMACORT
* 10MG/ML INJECTION SUSPENSION (5ML)
02229540
01999761
KENALOG 10
* 40MG/ML INJECTION SUSPENSION (1ML)
01977563
02219271
02229550
01999869
TRIAMCINE-A
KENALOG 40
172
68:08.00 ANDROGENS
DANAZOL
50MG CAPSULE
02018144
CYCLOMEN
SAW
$
0.7733
SAW
$
1.1474
SAW
$
1.8336
NVR
$
0.4029
NVR
$
1.0128
SCN
CYT
PHU
$
16.2300
18.4000
25.1900
THM
$
4.9590
ORG
$
1.0199
STI
$
6.7000
100MG CAPSULE
02018152
CYCLOMEN
200MG CAPSULE
02018160
CYCLOMEN
METHYLTESTOSTERONE
10MG TABLET
00005622
METANDREN
25MG TABLET
00005630
METANDREN
TESTOSTERONE CYPIONATE
* 100MG/ML OILY INJECTION SOLUTION (10ML)
02220318
01977601
00030783
TESTONE-CYP
DEPO-TESTOSTERONE
TESTOSTERONE ENANTHATE
200MG/ML OILY INJECTION SOLUTION (ML)
00029246
DELATESTRYL
TESTOSTERONE UNDECANOATE
40MG CAPSULE
00782327
ANDRIOL
TRIAMCINOLONE HEXACETONIDE
20MG/ML INJECTION SUSPENSION
02194155
ARISTOSPAN (EDS)
173
68:12.00 CONTRACEPTIVES
ETHINYL ESTRADIOL/D-NORGESTREL
0.05MG/0.25MG (21 TABLET)
02043033
OVRAL
WYA
$
12.6900
WYA
$
12.6900
ORG
JAN
$
12.7300
12.7300
ORG
JAN
$
12.7300
12.7300
SEA
$
12.2700
SEA
$
13.1200
WYA
$
12.4800
WYA
$
12.4800
BEX
WYA
$
11.7000
12.4200
BEX
WYA
$
11.7000
12.4200
WYA
$
12.3600
WYA
$
12.3600
02043041
OVRAL
ETHINYL ESTRADIOL/DESOGESTREL
x
02042487
02042541
x
MARVELON
ORTHO-CEPT
02042479
02042533
MARVELON
ORTHO-CEPT
ETHINYL ESTRADIOL/ETHYNODIOL DIACETATE
0.03MG/2MG (21 TABLET)
00469327
DEMULEN 30
00471526
DEMULEN 30
ETHINYL ESTRADIOL/L-NORGESTREL
02236974
ALESSE
02236975
x
0.03MG/0.05MG(6)0.04MG/0.075MG(5)
0.03MG/0.125MG(10) (21 TABLET)
00707600
02043726
x
ALESSE
TRIQUILAR
TRIPHASIL
0.03MG/0.05MG(6)0.04MG/0.075MG(5)
0.03MG/0.125MG(10) INERT TABLETS (7)
(28 TABLET)
00707503
02043734
TRIQUILAR
TRIPHASIL
02042320
MIN-OVRAL
02042339
MIN-OVRAL
174
ETHINYL ESTRADIOL/NORETHINDRONE
x
02187086
00317047
x
BREVICON
ORTHO 0.5/35
SEA
JAN
$
11.2500
11.9300
SEA
JAN
$
11.2500
12.2100
JAN
$
11.4200
JAN
$
11.2300
JAN
$
11.9300
SEA
$
11.0900
SEA
$
11.0900
SEA
SEA
JAN
$
7.6000
11.2500
11.9300
SEA
SEA
JAN
$
7.6000
11.2500
12.2100
02187094
00340731
BREVICON
ORTHO 0.5/35
0.035MG/0.5MG (7) 0.035MG/0.75MG (7)
0.035/1.0MG (7) (21 TABLET)
00602957
ORTHO 7/7/7
0.035MG/0.5MG (7) 0.035MG/0.75MG (7)
0.035MG/1.0MG (7) INERT TABLETS (7)
(28 TABLET)
00602965
ORTHO 7/7/7
0.035MG/0.5MG(10) 0.035MG/1MG(11) (21 TABLET )
00538590
ORTHO 10/11
0.035MG/0.5MG(7)0.035MG/1.0MG(9)
0.035MG/0.5MG(5) (21 TABLET)
02187108
SYNPHASIC
0.035MG/0.5MG(7)0.035MG/1.0MG(9)
0.035MG/0.5MG(5) INERT TABLETS (7)
(28 TABLET)
02187116
x
02197502
02189054
00372846
x
SYNPHASIC
SELECT 1/35
BREVICON 1/35
ORTHO 1/35
02199297
02189062
00372838
SELECT 1/35
BREVICON 1/35
ORTHO 1/35
175
ETHINYL ESTRADIOL/NORETHINDRONE ACETATE
00315966
MINESTRIN 1/20
PDA
$
12.6800
PDA
$
12.6800
PDA
$
12.6800
PDA
$
12.6800
JAN
$
11.4200
JAN
$
11.2400
JAN
$
12.9000
JAN
$
12.9000
WYA
$
480.0000
JAN
SEA
$
11.7000
11.8100
SEA
JAN
$
11.8100
12.2100
JAN
$
13.2500
00343838
MINESTRIN 1/20
00297143
LOESTRIN 1.5/30
00353027
LOESTRIN 1.5/30
ETHINYL ESTRADIOL/NORGESTIMATE
0.035MG/0.180MG (7) 0.35MG/0.215MG (7)
0.035MG/0.250MG (7) (21 TABLET)
02028700
TRI-CYCLEN
0.035MG/0.180MG (7) 0.35MG/0.215MG (7)
0.035MG/0.250MG (7) (28 TABLET)
02029421
TRI-CYCLEN
0.035MG/0.25MG (21 TABLET)
01968440
CYCLEN
0.035MG/0.25MG (28 TABLET)
01992872
CYCLEN
LEVONORGESTREL
36MG SUBDERMAL IMPLANTS
02060590
NORPLANT
MESTRANOL/NORETHINDRONE
x
00022608
02188724
x
ORTHO-NOVUM 1/50
NORINYL 1+50
02188732
00340758
NORINYL 1+50
ORTHO-NOVUM 1/50
NORETHINDRONE
0.35MG (28 TABLET)
00037605
MICRONOR
176
68:16.00 ESTROGENS
CONJUGATED ESTROGENS
x
0.3MG TABLET
02230891
02043394
x
$
0.0862
0.1151
C.E.S.
PREMARIN
ICN
WYA
$
0.1055
0.1321
ICN
WYA
$
0.2061
0.2750
ICN
WYA
$
0.1877
0.2348
WYA
$
0.3783
RBP
$
0.1113
RBP
$
0.2149
RBP
$
0.3792
SCH
$
19.4800
PHU
$
65.1000
$
19.8000
22.1200
$
19.8000
$
21.1600
21.1600
21.1600
22.1200
$
22.7100
0.9MG TABLET
02230892
02043416
x
ICN
WYA
0.625MG TABLET
00265470
02043408
x
C.E.S.
PREMARIN
C.E.S.
PREMARIN
1.25MG TABLET
00265489
02043424
C.E.S.
PREMARIN
0.625MG/G VAGINAL CREAM
02043440
PREMARIN
ESTRADIOL
0.5MG TABLET
02225190
ESTRACE
1MG TABLET
02148587
ESTRACE
2MG TABLET
02148595
ESTRACE
0.06% TRANSDERMAL GEL SPRAY (PACKAGE)
02238704
ESTROGEL (EDS)
2MG VAGINAL RING (7.5UG/24 HOURS)
02168898
x
ESTRING
25UG TRANSDERMAL THERAPEUTIC SYSTEM (PKG)
00756849
02237807
ESTRADERM (EDS)
OESCLIM (EDS)
NVR
FFR
37.5UG TRANSDERMAL THERAPEUTIC SYSTEM (PKG)
02204401
x
VIVELLE (EDS)
NVR
00756857
02204428
02231509
02237808
ESTRADERM (EDS)
VIVELLE (EDS)
CLIMARA 50 (EDS)
OESCLIM (EDS)
NVR
NVR
BEX
FFR
02204436
VIVELLE (EDS)
NVR
177
68:16.00 ESTROGENS
x
00756792
02204444
02231510
ESTRADERM (EDS)
VIVELLE (EDS)
CLIMARA 100 (EDS)
NVR
NVR
BEX
$
23.8700
23.8700
23.8700
ESTRADIOL & NORETHINDRONE ACETATE/ESTRADIOL
50UG & 250UG/50UG TRANSDERMAL THERAPEUTIC
SYSTEM (8)
02108186
ESTRACOMB (EDS)
NVR
$
22.4100
THM
$
16.7100
PHU
$
0.1704
PHU
$
0.3043
PHU
$
0.4811
SCH
$
0.1496
SCH
$
0.3255
RBP
$
0.2329
RBP
$
0.2821
RBP
$
0.3069
HOR
$
1.0364
ESTRADIOL VALERATE
10MG/ML OILY INJECTION SUSPENSION (5ML)
00029238
DELESTROGEN
ESTROPIPATE (CALCULATED AS SODIUM
ESTRONE SULFATE)
0.625MG TABLET
02089793
OGEN
1.25MG TABLET
02089769
OGEN
2.5MG TABLET
02089777
OGEN
ETHINYL ESTRADIOL
0.05MG TABLET
00028223
ESTINYL
0.5MG TABLET
00028231
ESTINYL
STILBOESTROL
0.1MG TABLET
02091488
STILBESTROL
0.5MG TABLET
02100304
STILBESTROL
1MG TABLET
02091461
STILBESTROL
STILBOESTROL SODIUM DIPHOSPHATE
100MG TABLET
00013781
HONVOL
178
68:18.00 GONADOTROPINS
CHORIONIC GONADOTROPIN
10000IU/VIAL INJECTION (10ML)
02168936
APL (EDS)
WYA
$
81.3800
SRO
$
55.9900
LIL
$
19.7300
LIL
$
19.7300
LIL
$
19.7300
LIL
NOO
$
16.2900
16.8400
NOO
LIL
$
33.6700
33.7700
LIL
NOO
$
16.2900
16.8400
10000IU/VIAL INJECTION
01925679
PROFASI HP (EDS)
68:20.08 ANTI-DIABETIC DRUGS (INSULINS-PORK)
INSULIN (ISOPHANE) PORK
100U/ML INJECTION SUSPENSION (10ML)
00514551
NPH ILETIN II PORK
INSULIN (LENTE) PORK
00514535
LENTE ILETIN II, PORK
INSULIN (REGULAR) PORK
100U/ML INJECTION SOLUTION (10ML)
00513644
REGULAR ILETIN II, PORK
68:20.08 ANTI-DIABETIC DRUGS
(INSULINS-HUMAN BIOSYNTHETIC)
INSULIN (ISOPHANE) HUMAN BIOSYNTHETIC
x
00587737
02024225
x
HUMULIN-N
NOVOLIN GE NPH
100U/ML INJECTION SUSPENSION (5X3ML)
02024268
01959239
NOVOLIN GE NPH PENFILL
HUMULIN-N CARTRIDGE
INSULIN (LENTE) HUMAN BIOSYNTHETIC
x
00646148
02024241
HUMULIN-L
NOVOLIN GE LENTE
179
x
00586714
02024233
x
HUMULIN-R
NOVOLIN GE TORONTO
LIL
NOO
$
16.2900
16.8400
NOO
LIL
$
33.6700
33.7700
LIL
$
24.1500
LIL
$
48.3000
100U/ML INJECTION SOLUTION (5X3ML)
02024284
01959220
NOVOLIN GE TORONTO PENFIL
HUMULIN-R CARTRIDGE
INSULIN (REGULAR) LISPRO
02229704
HUMALOG (EDS)
100U/ML INJECTION SOLUTION (5X3ML)
02229705
HUMALOG CARTRIDGE (EDS)
INSULIN (REGULAR/ISOPHANE) HUMAN BIOSYNTHETIC
100U/ML INJECTION SUSPENSION 10%/90% (10ML)
00889113
x
HUMULIN 10/90
LIL
$
16.2900
NOO
LIL
$
33.6700
33.7700
LIL
$
16.2900
NOO
LIL
$
33.6700
33.7700
LIL
NOO
$
16.2900
16.8400
NOO
LIL
$
33.6700
33.7700
LIL
$
16.2900
NOO
LIL
$
33.6700
33.7700
100U/ML INJECTION SUSPENSION 10%/90%
(5X3ML)
02024292
01962639
NOVOLIN GE 10/90 PENFILL
HUMULIN 10/90 CARTRIDGE
00889105
x
02024306
01962655
x
00795879
02024217
x
HUMULIN 20/80
(5X3ML)
HUMULIN 30/70
NOVOLIN GE 30/70
(5X3ML)
02025248
01959212
00889091
x
HUMULIN 40/60
(5X3ML)
02024314
01962647
180
00889121
x
HUMULIN 50/50
LIL
$
16.2900
NOO
LIL
$
33.6700
33.7700
LIL
$
48.3000
$
16.2900
16.8400
(5X3ML)
02024322
01962663
INSULIN (REGULAR/PROTAMINE) LISPRO
(5X3ML)
02240294
HUMALOG MIX25 (EDS)
INSULIN (ULTRALENTE) HUMAN BIOSYNTHETIC
x
00733075
02024276
HUMULIN-U
NOVOLIN GE ULTRALENTE
LIL
NOO
68:20.20 ANTI-DIABETIC DRUGS (ORAL HYPOGLYCEMICS)
ACARBOSE
50MG TABLET
02190885
PRANDASE
BAY
$
0.2453
BAY
$
0.3390
APX
PFI
$
0.0684
0.1021
NOP
APX
PFI
$
0.0454
0.0809
0.2063
100MG TABLET
02190893
PRANDASE
CHLORPROPAMIDE
* 100MG TABLET
00399302
00024708
APO-CHLORPROPAMIDE
DIABINESE
* 250MG TABLET
00021350
00312711
00024716
NOVO-PROPAMIDE
APO-CHLORPROPAMIDE
DIABINESE
181
GLYBURIDE
* 2.5MG TABLET
02020734
00720933
00808733
01913654
01913670
02084341
02229595
02236733
01900927
02234513
02224550
NU-GLYBURIDE
EUGLUCON
GEN-GLYBE
APO-GLYBURIDE
NOVO-GLYBURIDE
MED-GLYBURIDE
PENTA-GLYBURIDE
PMS-GLYBURIDE
ALBERT-GLYBURIDE
DOM-GLYBURIDE
DIABETA
NXP
PMS
GPM
APX
NOP
MED
PEN
PMS
ALT
DOM
AVT
$
0.0159 *
0.0427
0.0427
0.0427
0.0427
0.0427
0.0427
0.0427
0.0428
0.0449
0.1144
NXP
PMS
GPM
APX
NOP
MED
PEN
PMS
ALT
DOM
AVT
$
0.0223 *
0.0741
0.0741
0.0741
0.0741
0.0741
0.0741
0.0741
0.0743
0.0778
0.2051
NXP
NOP
GPM
APX
PMS
ICN
MED
RHO
DOM
AVT
$
0.0530 *
0.1320
0.1320
0.1320
0.1320
0.1320
0.1320
0.1320
0.1504
0.2387
* 5MG TABLET
02020742
00720941
00808741
01913662
01913689
02085887
02229596
02236734
01900935
02234514
02224569
NU-GLYBURIDE
EUGLUCON
GEN-GLYBE
APO-GLYBURIDE
NOVO-GLYBURIDE
MED-GLYBURIDE
PENTA-GLYBURIDE
PMS-GLYBURIDE
ALBERT-GLYBURIDE
DOM-GLYBURIDE
DIABETA
METFORMIN
* 500MG TABLET
02162822
02045710
02148765
02167786
02223562
02229516
02230670
02233999
02229994
02099233
NU-METFORMIN
NOVO-METFORMIN
GEN-METFORMIN
APO-METFORMIN
PMS-METFORMIN
GLYCON
MED-METFORMIN
RHO-METFORMIN
DOM-METFORMIN
GLUCOPHAGE
182
* 850MG TABLET
02229517
02229656
02229785
02230475
02162849
NU-METFORMIN
GEN-METFORMIN
APO-METFORMIN
NOVO-METFORMIN
GLUCOPHAGE
NXP
GPM
APX
NOP
AVT
$
0.1484 *
0.2268
0.2268
0.2268
0.3025
NOO
$
0.2713
NOO
$
0.2821
NOO
$
0.2930
NOP
APX
$
0.0304
0.0462
FEI
$
4.2500
FEI
$
8.4900
AVT
$
45.2200
REPAGLINIDE
0.5MG TABLET
02239924
GLUCONORM (EDS)
1MG TABLET
02239925
GLUCONORM (EDS)
2MG TABLET
02239926
GLUCONORM (EDS)
TOLBUTAMIDE
* 500MG TABLET
00021849
00312762
NOVO-BUTAMIDE
APO-TOLBUTAMIDE
68:24.00 PARATHYROID
CALCITONIN SALMON
100IU/ML INJECTION (0.5ML)
01940376
CALTINE 50 (EDS)
100IU/ML INJECTION (1ML)
02007134
CALTINE 100 (EDS)
200IU/ML INJECTION
01926691
CALCIMAR (EDS)
183
68:28.00 PITUITARY AGENTS
COSYNTROPIN ZINC HYDROXIDE
00253952
SYNACTHEN DEPOT
NVR
$
23.0900
FEI
$
2.0485
FEI
$
4.0970
FEI
$
10.5300
FEI
$
51.2200
$
102.4300
FEI
$
416.0000
HLR
$
205.9000
HLR
$
396.8000
SRO
$
136.7100
HLR
LIL
$
195.8400
238.3500
LIL
$
303.8300
HLR
HLR
$
386.8000
386.8000
LIL
$
590.0400
DESMOPRESSIN
0.1MG TABLET
00824305
D.D.A.V.P. (EDS)
0.2MG TABLET
00824143
D.D.A.V.P. (EDS)
4UG/ML INJECTION (1ML)
00873993
D.D.A.V.P. (EDS)
10UG/DOSE INTRANASAL SOLUTION
00402516
D.D.A.V.P. (EDS)
10UG/DOSE INTRANASAL SOLUTION (SPRAY PUMP)
00836362
D.D.A.V.P. (EDS)
FEI
150UG/DOSE INTRANASAL SOLUTION (SPRAY PUMP)
02237860
OCTOSTIM (EDS)
SOMATREM
5MG INJECTION (VIAL)
02204584
PROTROPIN (EDS)
02204576
PROTROPIN (EDS)
SOMATROPIN
3.33MG INJECTION (VIAL)
02215136
x
SAIZEN (EDS)
02216183
00745626
NUTROPIN (EDS)
HUMATROPE (EDS)
6MG INJECTION (CARTRIDGE)
02229692
x
HUMATROPE CARTRIDGE (EDS)
02216191
02229722
NUTROPIN (EDS)
NUTROPIN AQ (EDS)
12MG INJECTION (CARTRIDGE)
02229693
184
68:32.00 PROGESTINS
MEDROXYPROGESTERONE ACETATE
* 2.5MG TABLET
02231768
02148552
02221284
02229838
02239825
00708917
PENTA-MEDROXYPROGESTERONE
KENRAL-MPA
NOVO-MEDRONE
GEN-MEDROXY
PROCLIM
PROVERA
PEN
ALT
NOP
GPM
FFR
PHU
$
0.0674 *
0.0862
0.0862
0.0862
0.0862
0.1670
PEN
ALT
NOP
GPM
FFR
PHU
$
0.1264 *
0.1703
0.1703
0.1703
0.1704
0.3303
PEN
ALT
NOP
GPM
FFR
PHU
$
0.2553 *
0.3439
0.3439
0.3439
0.3440
0.6702
PHU
$
25.2400
PHU
$
27.0800
SCH
$
0.4640
* 5MG TABLET
02231769
02148560
02221292
02229839
02239826
00030937
KENRAL-MPA
NOVO-MEDRONE
GEN-MEDROXY
PROCLIM
PROVERA
* 10MG TABLET
02231770
02148579
02221306
02229840
02239827
00729973
KENRAL-MPA
NOVO-MEDRONE
GEN-MEDROXY
PROCLIM
PROVERA
00030848
DEPO-PROVERA
00585092
DEPO-PROVERA
PROGESTERONE (MICRONIZED)
100MG CAPSULE
02166704
PROMETRIUM (EDS)
185
68:36.04 THYROID AGENTS
LEVOTHYROXINE (SODIUM)
0.025MG TABLET
02172062
SYNTHROID
KNO
$
0.0703
GLA
KNO
$
0.0431
0.0574
KNO
$
0.0748
KNO
$
0.0763
GLA
KNO
$
0.0332
0.0708
KNO
$
0.0786
KNO
$
0.0824
GLA
KNO
$
0.0369
0.0758
KNO
$
0.0876
GLA
KNO
$
0.0391
0.0809
GLA
KNO
$
0.0934
0.1116
THM
$
0.0961
THM
$
0.1167
* 0.05MG TABLET
02213192
02172070
ELTROXIN
SYNTHROID
0.075MG TABLET
02172089
SYNTHROID
0.088MG TABLET
02172097
SYNTHROID
* 0.1MG TABLET
02213206
02172100
ELTROXIN
SYNTHROID
0.112MG TABLET
02171228
SYNTHROID
0.125MG TABLET
02172119
SYNTHROID
* 0.15MG TABLET
02213214
02172127
ELTROXIN
SYNTHROID
0.175MG TABLET
02172135
SYNTHROID
* 0.2MG TABLET
02213222
02172143
ELTROXIN
SYNTHROID
* 0.3MG TABLET
02213230
02172151
ELTROXIN
SYNTHROID
LIOTHYRONINE (SODIUM)
5UG TABLET
01919458
CYTOMEL
25UG TABLET
01919466
CYTOMEL
186
68:36.04 THYROID AGENTS
THYROID
30MG TABLET
00023949
THYROID
PDA
$
0.0384
PDA
$
0.0478
PDA
$
0.0609
LIL
$
0.1243
MSD
$
0.1243
MSD
$
0.1945
60MG TABLET
00023957
THYROID
125MG TABLET
00023965
THYROID
68:36.08 ANTITHYROID AGENTS
METHIMAZOLE
5MG TABLET
00015741
TAPAZOLE
PROPYLTHIOURACIL
50MG TABLET
00010200
PROPYL-THYRACIL
100MG TABLET
00010219
PROPYL-THYRACIL
187
188
SKIN AND MUCOUS MEMBRANE
PREPARATIONS
84:00
84:00 SKIN AND MUCOUS MEMBRANE PREPARATIONS
CLINDAMYCIN PHOSPHATE
1% TOPICAL SOLUTION
00582301
DALACIN T
PHU
$
0.3068
WSD
$
0.1666
GAC
$
0.1549
WSD
$
0.1666
WSD
$
0.1666
AVT
$
1.0254
AVT
$
2.9784
FUCIDIN
LEO
$
0.6258
BACTROBAN
SMJ
$
0.5354
SMJ
$
0.5354
ERYTHROMYCIN/ETHYL ALCOHOL
1.5%/55% TOPICAL LOTION
01910086
STATICIN
2%/44% TOPICAL LOTION
01902628
SANS-ACNE
2%/71.2% TOPICAL LOTION
02047802
T-STAT
2%/71.2% TOPICAL LOTION/PRE-MOISTENED PADS
02047799
T-STAT
FRAMYCETIN SO4
1% GAUZE (10CM X 10CM)
01988840
SOFRA-TULLE
1% GAUZE (30CM X 10CM)
01987682
SOFRA-TULLE
FUSIDIC ACID
2% TOPICAL CREAM
00586668
MUPIROCIN
2% CREAM
02239757
2% OINTMENT
01916947
BACTROBAN
POLYMYXIN B SO4/NEOMYCIN SO4/BACITRACIN(ZINC)
* 5,000U/5MG/400U PER G TOPICAL OINTMENT
00653268
00666122
NEOTOPIC
NEOSPORIN
TCH
GLA
$
0.3502
0.4449
$
0.4449
POLYMYXIN B SO4/NEOMYCIN SO4/GRAMICIDIN
10,000U/5MG/0.25MG PER G TOPICAL CREAM
00666203
NEOSPORIN
GLA
190
SODIUM FUSIDATE
2% TOPICAL OINTMENT
00586676
FUCIDIN
LEO
$
0.6258
LEO
$
0.6326
AVT
$
0.5968
AVT
$
0.5498
BCD
$
12.2300
BOE
SCN
TAR
BCD
$
0.1943
0.1943
0.1953
0.3458
BCD
$
0.2092
TAR
BCD
$
0.1899
0.2240
TAR
BCD
$
0.3798
0.4479
$
12.2300
2% GAUZE PADS
00586684
FUCIDIN
84:04.08 ANTI-INFECTIVES (ANTI-FUNGALS)
CICLOPIROX OLAMINE
1% TOPICAL CREAM
02221802
LOPROX
1% TOPICAL LOTION
02221810
LOPROX
CLOTRIMAZOLE
200MG VAGINAL TABLET
02150921
CANESTEN-3-COMBI-PAK
* 1% TOPICAL CREAM
02131676
02230447
00812382
02150867
MYCLO-DERM
SCHEINPHARM CLOTRIMAZOLE
CLOTRIMADERM
CANESTEN
1% TOPICAL SOLUTION
02150875
CANESTEN
* 1% VAGINAL CREAM
00812366
02150891
CLOTRIMADERM
CANESTEN-6
* 2% VAGINAL CREAM
00812374
02150905
CLOTRIMADERM
CANESTEN-3
500MG VAGINAL SUPPOSITORY/1% TOPICAL CREAM
(COMBINATION PACKAGE)
02150948
191
BCD
ECONAZOLE NITRATE
150MG VAGINAL SUPPOSITORY
02010267
ECOSTATIN
WSD
$
6.0689
WSD
$
0.4630
JAN
$
0.4915
MCL
$
1.5299
MCL
$
12.2500
SDR
MCL
$
1.7940
3.5697
MCL
$
12.2500
TCH
MCL
$
0.1595
0.3060
MCL
$
0.3422
TCH
NDA
$
0.1519
0.1643
TAR
NDA
TCH
PPZ
$
0.0760
0.1269
0.1269
0.3364
1% TOPICAL CREAM
02011948
ECOSTATIN
KETOCONAZOLE
2% TOPICAL CREAM
00703974
NIZORAL
MICONAZOLE NITRATE
02084295
MONISTAT-7
100MG VAGINAL SUPPOSITORY/2% TOPICAL CREAM
02126257
MONISTAT 7 COMBINATION
* 400MG VAGINAL OVULES
02171775
02126605
MICONAZOLE 3 DAY OVULE
MONISTAT-3
400MG VAGINAL OVULES/2% TOPICAL CREAM
02126249
* 2% VAGINAL CREAM
02219476
02084309
MONAZOLE 7
MONISTAT-7
2% TOPICAL CREAM
02085852
MICATIN
NYSTATIN
* 100,000U VAGINAL TABLET
02194171
00270091
NILSTAT
NADOSTINE
* 100,000U/G TOPICAL CREAM
00716871
00288217
02194236
00029092
NYADERM
NADOSTINE
NILSTAT
MYCOSTATIN
192
* 100,000U/G TOPICAL OINTMENT
00288195
00716898
02194228
00029556
NADOSTINE
NYADERM
NILSTAT
MYCOSTATIN
NDA
TAR
TCH
PPZ
$
0.1556
0.1556
0.1556
0.3038
NDA
TAR
PPZ
$
0.0498
0.0498
0.0955
TCH
$
0.2771
WSD
$
0.4022
NVR
$
0.4883
NVR
$
0.4883
JAN
$
6.3364
JAN
$
19.0100
JAN
$
19.0100
JAN
$
19.0100
* 25,000U/G VAGINAL CREAM
00288209
00716901
00295973
NADOSTINE
NYADERM
MYCOSTATIN
100,000U/G VAGINAL CREAM
02194163
NILSTAT
100,000U/G TOPICAL POWDER
02195704
CANDISTATIN
TERBINAFINE HCL
1% TOPICAL CREAM
02031094
LAMISIL
1% TOPICAL SPRAY SOLUTION
02238703
LAMISIL
TERCONAZOLE
80MG VAGINAL OVULES
00894710
TERAZOL-3
80MG VAGINAL OVULES/0.8% CREAM (DUAL-PAK)
02130874
TERAZOL-3 DUAL-PAK
0.4% VAGINAL CREAM (PKG)
00894729
TERAZOL-7
0.8% VAGINAL CREAM (PKG)
01934155
TERAZOL-3
84:04.12 ANTI-INFECTIVES (SCABICIDES AND PEDICULICIDES)
CROTAMITON
10% TOPICAL CREAM
00623377
EURAX
NVC
$
0.4297
MED
$
17.3600
ESDEPALLATHRIN/PIPERONYL BUTOXIDE
0.63%/5.04% AEROSOL
02229874
SCABENE
193
84:04.12 ANTI-INFECTIVES (SCABICIDES AND PEDICULICIDES)
GAMMA-BENZENE HEXACHLORIDE
1% TOPICAL LOTION
00703591
PMS-LINDANE
PMS
$
0.0792
PMS
ODN
$
0.0792
0.0999
RCA
WLA
$
0.1129
0.1185
GLA
$
0.4991
RCA
$
0.2843
RCA
$
0.1027
SAW
$
0.0620
GAC
$
0.6304
GAC
$
0.5354
DER
$
0.5357
* 1% SHAMPOO
00703605
00430617
PMS-LINDANE
HEXIT SHAMPOO
PERMETHRIN
* 1% CREME RINSE
02231480
00771368
KWELLADA-P CREME RINSE
NIX CREME RINSE
5% TOPICAL CREAM
02219905
NIX DERMAL CREAM
5% TOPICAL LOTION
02231348
KWELLADA-P LOTION
PYRETHINS/PIPERONYL BUTOXIDE/
PETROLEUM DISTILLATE
0.33%/3.0%/1.2% SHAMPOO/CONDITIONER
02125447
R&C SHAMPOO/CONDITIONER
HEXACHLOROPHENE
3% TOPICAL EMULSION
02017733
PHISOHEX
METRONIDAZOLE
0.75% TOPICAL GEL
02013223
METROGEL
0.75% TOPICAL CREAM
02226839
METROCREAM
1% TOPICAL CREAM
02156091
NORITATE
194
500MG VAGINAL TABLET
01926888
FLAGYL
ROP
$
0.4796
MDA
$
0.2752
ROP
$
0.2189
PFR
$
0.7441
PFR
ROG
$
0.1016
0.1177
PFR
$
0.0434
0.75% VAGINAL GEL
02125226
NIDAGEL
10% VAGINAL CREAM
01926861
FLAGYL
POVIDONE-IODINE
00026050
BETADINE
* 10% VAGINAL GEL
00026034
00026611
BETADINE
PROVIODINE
10% VAGINAL SOLUTION
00026093
BETADINE
SULFACETAMIDE (SODIUM)/COLLOIDAL SULPHUR
02220407
SULFACET-R
DER
$
0.5074
$
0.2743
STI
$
0.5585
STI
$
0.5585
STI
$
0.4693
SULFANILAMIDE/AMINACRINE HCL/ALLANTOIN
15%/0.2%/2% VAGINAL CREAM
02103036
AVC
AVT
SEE INSERT THIS SECTION FOR TABLES SHOWING APPROXIMATE
RELATIVE POTENCIES OF TOPICAL STEROID PREPARATIONS, RELATIVE
RATES OF PENETRATION IN DIFFERENT ANATOMICAL SITES AND
SUGGESTED GUIDELINES FOR TOPICAL STEROID THERAPY
AMCINONIDE
0.1% TOPICAL CREAM
02192284
CYCLOCORT
0.1% TOPICAL OINTMENT
02192268
CYCLOCORT
0.1% TOPICAL LOTION
02192276
CYCLOCORT
195
0.025% TOPICAL CREAM
02089602
PROPADERM
RBP
$
0.6431
RBP
$
0.3961
0.025% TOPICAL LOTION
02089610
PROPADERM
BETAMETHASONE DIPROPIONATE
PENETRATION OF ACTIVE DRUG THROUGH THE EPIDERMIS IS ENHANCED
BY THE PROPYLENE GLYCOL BASE, RESULTING IN INCREASED POTENCY,
BECAUSE OF THE DIFFERENCE IN POTENCY YET SIMILARITY OF THE NAMES
(DIPROSONE-DIPROLENE) EXTRA CAUTION IS ADVISED.
* 0.05% TOPICAL CREAM
01925350
00323071
TARO-SONE
DIPROSONE
TAR
SCH
$
0.2222
0.2337
SCH
TCH
TAR
$
0.2337
0.2337
0.2337
SCH
TCH
TAR
$
0.2149
0.2149
0.2149
SCH
TCH
$
0.5628
0.5628
SCH
TCH
$
0.5628
0.5628
SCH
TCH
$
0.5083
0.5083
SCH
$
0.7697
SCH
$
0.6507
* 0.05% TOPICAL OINTMENT
00344923
00805009
01944436
DIPROSONE
TOPISONE
TARO-SONE
* 0.05% TOPICAL LOTION
00417246
00809187
01944444
DIPROSONE
TOPISONE
TARO-SONE
* 0.05% TOPICAL GLYCOL CREAM
00688622
00849650
DIPROLENE
TOPILENE GLYCOL
* 0.05% TOPICAL GLYCOL OINTMENT
00629367
00849669
DIPROLENE
TOPILENE GLYCOL
* 0.05% TOPICAL GLYCOL LOTION
00862975
01927914
DIPROLENE
TOPILENE GLYCOL
BETAMETHASONE DIPROPIONATE/
SALICYLIC ACID
0.05%/3% TOPICAL OINTMENT
00578436
DIPROSALIC
0.05%/2% TOPICAL LOTION
00578428
DIPROSALIC
196
GUIDELINES FOR TOPICAL STEROID THERAPY
1.
Apply an appropriately potent compound to bring
the condition under control.
2.
Continue treatment, with a less potent preparation
after control is achieved.
3.
Reduce the frequency of application.
4.
If required, continue application with the weakest
preparation that will control the condition.
5.
Once healed, "tail off" treatment.
6.
Use special care in treating children, the elderly,
and in certain anatomical sites (e.g. face and
flexures).
7.
Use combination products (those containing antiinfective agents) only for short periods of time.
197
APPROXIMATE
RELATIVE POTENCIES
of
TOPICAL STEROID
PREPARATIONS
The classification of products in this table is based on 'WHO Model
Prescribing Information: Drugs Used in Dermatology (1995)'. Comments
from Saskatchewan Dermatologists have been incorporated.
In general, ointments, as a result of their more occlusive property, tend to
exhibit higher potency than creams of the same strength. Cream
formulations, in turn, appear to be more potent than lotions containing the
same concentration of the same anti-inflammatory agent.
198
ULTRA
HIGH
POTENCY
GROUP
I
Betamethasone dipropionate 0.05% glycol cream, ointment, lotion
Betamethasone dipropionate 0.05%/salicylic acid 3% ointment
Clobetasol propionate 0.05% cream, ointment, scalp lotion
Diflorasone diacetate 0.05% ointment
Halobetasol propionate 0.05% ointment
GROUP
II
Amcinonide 0.1% ointment
Betamethasone dipropionate 0.05% ointment
Desoximetasone 0.25% cream, ointment
Desoximetasone 0.5% gel
Fluocinonide 0.05% cream, ointment, gel, emollient base
Halcinonide 0.1% cream, ointment, solution
Halobetasol propionate 0.05% cream
GROUP
III
Betamethasone dipropionate 0.05% cream
Betamethasone valerate 0.1% ointment
Diflorasone diacetate 0.05% cream
Triamcinolone acetonide 0.1% ointment
HIGH
POTENCY
GROUP
IV
MID
POTENCY
GROUP
V
GROUP
VI
LOW
POTENCY
GROUP
VII
Amcinonide 0.1% cream, lotion
Beclomethasone dipropionate 0.025% cream, lotion
Desoximetasone 0.05% cream
Fluocinolone acetonide 0.025% ointment
Hydrocortisone valerate 0.2% ointment
Mometasone furoate 0.1% cream, ointment, lotion
Triamcinolone acetonide 0.1% cream
Betamethasone benzoate 0.025% gel
Betamethasone valerate 0.1% cream, lotion
Betamethasone valerate 0.05% cream, ointment, lotion
Fluocinolone acetonide 0.01% cream, ointment, solution
Fluocinolone acetonide 0.025% cream
Hydrocortisone valerate 0.2% cream
Triamcinolone acetonide 0.025% cream, ointment
Desonide 0.05% cream, ointment, lotion
Hydrocortisone
0.5% lotion
1% cream, ointment, lotion
2.5% cream, lotion, scalp solution
Methylprednisolone 0.25% ointment
199
RELATIVE RATES OF PERCUTANEOUS PENETRATION IN
DIFFERENT ANATOMICAL SITES
(Based on hydrocortisone/forearm = 1)
RELATIVE
PENETRATION
0.14
0.83
1.0
1.7
3.5
6.0
13.0
42.0
SITE
Foot (plantar)
Palm
Forearm
Back
Scalp
Forehead
Jaw angle/cheeks
Scrotum
Arndt, K.A., Manual of Dermatological
nd
Therapeutics, 2 Edition, p. 293
GUIDE TO TOPICAL QUANTITIES IN DERMATOLOGY
Amount used three times daily for one week, average adult.
SITE
% BODY
SURFACE
VANISHING
CREAM
GREASE
BASE
SHAKE
LOTION
THIN
(NON SHAKE
LOTION)
PROPYLENE
GLYCOL
ONE WHOLE
HAND or
FOOT
2%
7.5g
10g
20mL
5mL
15mL
ONE WHOLE
ARM
9%
30g
45g
90mL
24mL
60mL
TRUNK
36%
120g
180g
360mL
90mL
240mL
GENITAL
AREA
1%
7.5g
5g
not used
here
5mL
7.5mL
ONE TOTAL
LEG
18%
60g
90g
180mL
45mL
120mL
TOTAL FACE
4.5%
15g
20g
40mL
10mL
30mL
BODY
100%
375g
500g
1000mL
240mL
750mL
200
BETAMETHASONE DISODIUM PHOSPHATE
5MG/100ML ENEMA (100ML)
02060884
BETNESOL ENEMA
RBP
$
8.6300
SCH
TCH
TAR
$
0.0167
0.0167
0.0167
SCH
TCH
TAR
$
0.0248
0.0248
0.0248
SCH
TAR
$
0.0167
0.0167
SCH
TAR
$
0.0248
0.0248
TCH
$
0.2062
TCH
RBP
$
0.2713
0.2713
SCH
TCH
TAR
$
0.0927
0.0927
0.0927
AST
$
8.3600
BETAMETHASONE VALERATE
00027898
00535427
00716618
CELESTODERM-V/2
ECTOSONE MILD
BETADERM
00027901
00535435
00716626
CELESTODERM-V
ECTOSONE REGULAR
BETADERM
00028355
00716642
CELESTODERM-V/2
BETADERM
00028363
00716650
CELESTODERM-V
BETADERM
00653209
ECTOSONE MILD
* 0.1% TOPICAL LOTION
00750050
02100193
ECTOSONE
BETNOVATE
* 0.1% SCALP LOTION
00027944
00653217
00716634
VALISONE
ECTOSONE
BETADERM
BUDESONIDE
0.02MG/ML ENEMA (100ML)
02052431
ENTOCORT
201
CLOBETASOL PROPIONATE
00878723
01910272
02024187
02093162
02232191
02213265
DERMASONE
GEN-CLOBETASOL
NOVO-CLOBETASOL
PMS-CLOBETASOL
DERMOVATE
ALT
TCH
GPM
NOP
PMS
GLA
$
0.4414
0.4414
0.4414
0.4414
0.4414
0.8131
NOP
ALT
GPM
PMS
GLA
$
0.4413
0.4414
0.4414
0.4414
0.8131
ALT
GPM
PMS
TCH
GLA
$
0.3868
0.3868
0.3868
0.3871
0.7834
GLA
$
0.4774
GLA
$
0.4774
SCN
GAC
BAY
$
0.2832
0.3147
0.4210
SCN
GAC
BAY
$
0.2832
0.3147
0.4196
GAC
$
0.1574
02126192
00881678
02026767
02232193
00359726
NOVO-CLOBETASOL
GEN-CLOBETASOL
PMS-CLOBETASOL
DERMOVATE
* 0.05% SCALP APPLICATION
00878707
02216213
02232195
01910299
02213281
GEN-CLOBETASOL
PMS-CLOBETASOL
DERMASONE
DERMOVATE
CLOBETASONE BUTYRATE
0.05% TOPICAL CREAM
02214415
EUMOVATE
00456551
EUMOVATE
DESONIDE
02229315
02048639
02154862
SCHEINPHARM DESONIDE
DESOCORT
TRIDESILON
02229323
02115522
02154870
DESOCORT
TRIDESILON
02115514
DESOCORT
202
DESOXIMETASONE
02239068
02221918
TARO-DESOXIMETASONE
TOPICORT MILD
TAR
AVT
$
0.3022
0.4530
TAR
AVT
$
0.4549
0.6538
AVT
$
0.5371
AVT
$
0.6538
PHU
$
0.3325
STI
$
0.3943
STI
$
0.3943
STI
$
0.3943
TAR
$
0.0703
TAR
$
0.3364
TAR
MDC
$
0.4676
0.4676
MDC
$
0.4440
HDI
$
0.2250
HDI
$
0.1656
02239069
02221896
TARO-DESOXIMETASONE
TOPICORT
0.05% TOPICAL GEL
02221926
TOPICORT
02221934
TOPICORT
DIFLORASONE DIACETATE
00481793
FLORONE
DIFLUCORTOLONE VALERATE
0.1% TOPICAL CREAM
00587826
NERISONE
0.1% TOPICAL OILY CREAM
00587818
NERISONE
00587834
NERISONE
FLUOCINOLONE ACETONIDE
0.01% TOPICAL CREAM
00716782
FLUODERM
00716790
FLUODERM
00716812
02162512
FLUODERM
SYNALAR REGULAR
0.01% TOPICAL SOLUTION
02162504
SYNALAR
0.01% TOPICAL OIL
00873292
DERMA-SMOOTHE/FS
0.01% SHAMPOO
02129078
FS SHAMPOO
203
FLUOCINONIDE
00716863
02161923
LYDERM
LIDEX
TAR
MDC
$
0.5007
0.5010
TAR
MDC
$
0.3711
0.5561
MDC
$
0.5489
MDC
$
0.6041
WSD
$
0.5650
WSD
$
0.5180
WSD
$
0.4356
WSD
$
0.7986
WSD
$
0.7986
SDR
TAR
SCH
$
0.1310
0.1628
0.2301
SCH
TAR
SDR
STI
$
0.0198
0.0198
0.0222
0.1718
* 0.05% TOPICAL GEL
02236997
02161974
LYDERM
TOPSYN
02161966
LIDEX
0.05% IN EMOLLIENT BASE
02163152
LIDEMOL
HALCINONIDE
0.1% TOPICAL CREAM
02011921
HALOG
02010283
HALOG
02010291
HALOG
HALOBETASOL PROPIONATE
0.05% CREAM
01962701
ULTRAVATE (EDS)
0.05% OINTMENT
01962728
ULTRAVATE (EDS)
HYDROCORTISONE
00228079
00716820
00513288
HYDROCORTISONE CREAM
HYDERM
CORTATE
* 1% TOPICAL CREAM
00502200
00716839
00228087
00192597
CORTATE
HYDERM
EMO-CORT
204
2.5% TOPICAL CREAM
00595799
EMO-CORT
STI
$
0.2344
TAR
SCH
$
0.1628
0.2301
SCH
TAR
$
0.0212
0.0212
SCH
$
0.1817
STI
STI
$
0.0938
0.1587
STI
STI
$
0.1812
0.2099
STI
$
0.1985
ICN
AXC
$
5.5800
6.5700
RCA
$
80.5400
WSD
$
0.2583
WSD
$
0.2583
STI
$
0.1747
STI
$
0.0970
PHU
$
0.2257
00716685
00513261
CORTODERM
CORTATE
* 1% TOPICAL OINTMENT
00502197
00716693
CORTATE
CORTODERM
0.5% TOPICAL LOTION
00513253
x
00578541
00192600
x
CORTATE
1% TOPICAL LOTION
SARNA HC
EMO-CORT
2.5% TOPICAL LOTION
00856711
00595802
SARNA HC
EMO-CORT
2.5% SCALP SOLUTION
00641154
EMO-CORT
* 100MG/60ML ENEMA (60ML)
00230316
02112736
HYCORT
CORTENEMA
HYDROCORTISONE ACETATE
10% RECTAL AEROSOL FOAM (15G)
00579335
CORTIFOAM
HYDROCORTISONE VALERATE
0.2% TOPICAL CREAM
01910124
WESTCORT
01910132
WESTCORT
HYDROCORTISONE/UREA
1%/10% TOPICAL CREAM
00503134
UREMOL-HC
00560022
UREMOL-HC
METHYLPREDNISOLONE
00031062
MEDROL
205
MOMETASONE FUROATE
0.1% TOPICAL CREAM
00851744
ELOCOM
SCH
$
0.6938
SCH
$
0.6938
SCH
$
0.5397
TAR
$
0.0504
TAR
STI
WSD
$
0.1411
0.1411
0.3260
TAR
$
0.1173
TAR
STI
WSD
$
0.1411
0.1411
0.3260
TAR
WSD
$
1.2556
1.4122
00851736
ELOCOM
0.1% TOPICAL LOTION
00871095
ELOCOM
00716952
TRIADERM
00716960
02194058
01999818
TRIADERM
ARISTOCORT R
KENALOG
00716979
TRIADERM
00716987
02194031
01999796
TRIADERM
ARISTOCORT R
KENALOG
* 0.1% ORAL TOPICAL OINTMENT
01964054
01999788
ORACORT DENTAL PASTE
KENALOG-ORABASE
BETAMETHASONE DIPROPIONATE/CLOTRIMAZOLE
0.05%/1% TOPICAL CREAM
00611174
LOTRIDERM
SCH
$
0.6706
$
0.7595
FUSIDIC ACID/HYDROCORTISONE ACETATE
2%/1% TOPICAL CREAM
02238578
FUCIDIN H
LEO
206
NEOMYCIN/GRAMICIDIN/NYSTATIN/
2.5MG/0.25MG/100,000U/0.25MG PER G
TOPICAL CREAM
01999842
KENACOMB MILD
WSD
$
0.5614
TAR
WSD
$
0.4594
0.7943
WSD
$
0.5614
TAR
WSD
$
0.4594
0.7943
$
0.7487
* 2.5MG/0.25MG/100,000U/1MG PER G
TOPICAL CREAM
00717002
01999850
VIADERM-KC
KENACOMB
2.5MG/0.25MG/100,000U/0.25MG PER G
TOPICAL OINTMENT
01999834
KENACOMB MILD
* 2.5MG/0.25MG/100,000U/1MG PER G
TOPICAL OINTMENT
00717029
01999826
VIADERM-KC
KENACOMB
POLYMYXIN B SO4/BACITRACIN (ZINC)/
NEOMYCIN SO4/HYDROCORTISONE
5000U/400U/5MG/10MG PER G TOPICAL OINTMENT
00666246
CORTISPORIN
GLA
84:08.00 ANTIPRURITICS AND LOCAL ANAESTHETICS
PHENAZOPYRIDINE
* 100MG TABLET
00271489
00476714
PHENAZO
PYRIDIUM
ICN
PDA
$
0.1281
0.1281
ICN
PDA
$
0.1598
0.1775
* 200MG TABLET
00454583
00476722
PHENAZO
PYRIDIUM
207
84:12.00 ASTRINGENTS
ALUMINUM ACETATE/BENZETHONIUM CHLORIDE
0.35%/0.023% POWDER (2.36G PACKAGE)
00579947
BURO-SOL
STI
$
0.7216
GAC
$
0.6149
STI
$
0.5968
STI
DER
JAN
$
0.3082
0.3082
0.3863
STI
DER
JAN
$
0.3082
0.3082
0.3748
STI
DER
PMS
JAN
$
0.3082
0.3082
0.3082
0.3863
STI
DER
PMS
JAN
$
0.3082
0.3082
0.3082
0.3748
STI
$
0.1932
84:16.00 CELL STIMULANTS AND PROLIFERANTS
CONDITIONS OTHER THAN ACNE VULGARIS ARE NOT APPROVED
INDICATIONS FOR THE USE OF TOPICAL RETINOIDS.
ADAPALENE
0.1% TOPICAL GEL
02148749
DIFFERIN
ISOTRETINOIN
0.05% TOPICAL GEL
00784338
ISOTREX
TRETINOIN
00657204
01926497
00897329
STIEVA-A
VITAMIN A ACID
RETIN A
* 0.01% TOPICAL GEL
00587958
01926462
00870013
STIEVA-A
VITAMIN A ACID
RETIN A
00578576
01926500
02125293
00897310
STIEVA-A
VITAMIN A ACID
VITINOIN
RETIN A
* 0.025% TOPICAL GEL
00587966
01926470
02069598
00443816
STIEVA-A
VITAMIN A ACID
VITINOIN
RETIN A
00578568
STIEVA-A
208
84:16.00 CELL STIMULANTS AND PROLIFERANTS
00518182
01926519
02125307
00443794
STIEVA-A
VITAMIN A ACID
VITINOIN
RETIN A
STI
DER
PMS
JAN
$
0.3082
0.3082
0.3082
0.3748
STI
DER
$
0.3082
0.3082
STI
$
0.1932
STI
DER
PMS
JAN
$
0.3082
0.3082
0.3082
0.3863
STI
$
9.1400
ICN
STI
$
0.1677
0.1910
BENOXYL
OXYDERM
STI
ICN
$
0.2122
0.2176
DESQUAM-X
BENZAC W
WSD
GAC
$
0.0543
0.0547
STI
$
0.1492
STI
DER
$
0.1492
0.1511
WSD
GAC
STI
GAC
$
0.1068
0.1453
0.1492
0.1519
* 0.05% TOPICAL GEL
00641863
01926489
STIEVA-A
VITAMIN A ACID
00518174
STIEVA-A
00662348
01926527
02125315
00870021
STIEVA-A FORTE (EDS)
VITAMIN A ACID (EDS)
VITINOIN (EDS)
RETIN A (EDS)
84:28.00 KERATOLYTIC AGENTS
BENZOYL PEROXIDE
10% BAR
00527661
PANOXYL
* 10% TOPICAL LOTION
00432938
00370568
OXYDERM
BENOXYL
* 20% TOPICAL LOTION
00187585
00374318
x
10% WASH
01908901
01925199
10% TOPICAL GEL (ACETONE BASE)
00406848
x
00263699
02220385
x
ACETOXYL
10% TOPICAL GEL (ALCOHOL BASE)
PANOXYL-10
BENZAGEL
10% TOPICAL GEL (AQUEOUS BASE)
01908871
01925997
02223856
01912437
DESQUAM-X
BENZAC-W
PANOXYL AQUAGEL
BENZAC AC
209
84:28.00 KERATOLYTIC AGENTS
00403571
PANOXYL-15
STI
$
0.1806
STI
$
0.1945
STI
$
0.1945
MED
$
0.2437
MED
$
0.2570
MED
$
0.2687
MED
$
0.3038
MED
$
0.3290
MED
$
0.3501
PMS
CDX
$
34.4000
40.1500
00373036
PANOXYL-20
20% TOPICAL GEL (AQUEOUS BASE)
02223864
PANOXYL AQUAGEL
DITHRANOL
0.1% TOPICAL CREAM
00537594
ANTHRANOL
0.2% TOPICAL CREAM
00537608
ANTHRANOL
0.4% TOPICAL CREAM
00537616
ANTHRANOL
0.4% TOPICAL LOTION
00695351
ANTHRASCALP
1% TOPICAL OINTMENT
00566756
ANTHRAFORTE-1
2% TOPICAL OINTMENT
00566748
ANTHRAFORTE-2
PODOFILOX
x
0.5% TOPICAL SOLUTION (PACKAGE)
02074788
01945149
WARTEC
CONDYLINE
84:36.00 MISCELLANEOUS SKIN & MUCOUS MEMBRANE
AGENTS
ACITRETIN
10MG CAPSULE
02070847
SORIATANE (EDS)
HLR
$
1.6782
HLR
$
2.9477
DBU
WYA
$
0.7747
1.0908
25MG CAPSULE
02070863
SORIATANE (EDS)
AMETHOPTERIN
* 2.5MG TABLET
02182963
02170698
METHOTREXATE
METHOTREXATE
210
84:36.00 MISCELLANEOUS SKIN & MUCOUS MEMBRANE
AGENTS
CALCIPOTRIOL
50UG/G TOPICAL CREAM
02150956
DOVONEX
LEO
$
0.7568
LEO
$
0.7568
LEO
$
0.7568
50UG/G TOPICAL OINTMENT
01976133
DOVONEX
50UG/ML SCALP SOLUTION
02194341
DOVONEX
CYCLOSPORINE
NOTE: THE IDENTIFICATION NUMBERS LISTED FOR THIS PRODUCT HAVE
BEEN GENERATED BY THE PRESCRIPTION DRUG PLAN FOR BILLING
PURPOSES ONLY.
10MG CAPSULE
00950792
NEORAL (EDS)
NVR
$
0.6637
NVR
$
1.5426
NVR
$
3.0073
NVR
$
6.0164
NVR
$
5.3480
ICN
$
0.4601
HLR
$
1.7903
HLR
$
3.6529
ALL
$
1.2695
ALL
$
1.2695
25MG CAPSULE
00950793
NEORAL (EDS)
50MG CAPSULE
00950807
NEORAL (EDS)
100MG CAPSULE
00950815
NEORAL (EDS)
100MG/ML LIQUID
00950823
NEORAL (EDS)
FLUOROURACIL
5% TOPICAL CREAM
00330582
EFUDEX
ISOTRETINOIN
10MG CAPSULE
00582344
ACCUTANE
40MG CAPSULE
00582352
ACCUTANE
TAZAROTENE
0.05% TOPICAL GEL
02230784
TAZORAC
0.1% TOPICAL GEL
02230785
TAZORAC
211
84:50.06 DEPIGMENTING & PIGMENTING AGENTS
(PIGMENTING AGENTS)
METHOXSALEN
x
10MG CAPSULE
00252654
00646237
01946374
x
OXSORALEN ULTRA (EDS)
ULTRAMOP (EDS)
OXSORALEN (EDS)
ICN
CDX
ICN
$
0.4666
0.5160
0.8181
ULTRAMOP (EDS)
OXSORALEN (EDS)
CDX
ICN
$
1.1198
1.5939
1% LOTION
00698059
01907476
212
SMOOTH MUSCLE RELAXANTS
86:00
86:00 SMOOTH MUSCLE RELAXANTS
86:12.00 GENITOURINARY SMOOTH MUSCLE RELAXANTS
FLAVOXATE HCL
200MG TABLET
00728179
URISPAS (EDS)
PMS
$
0.5360
NXP
APX
ICN
ALT
NOP
GPM
PEN
PMS
DOM
ALZ
$
0.1325 *
0.2697
0.2697
0.2697
0.2697
0.2697
0.2697
0.2697
0.2831
0.4281
PMS
APX
ALZ
$
0.0675
0.0675
0.0964
PHU
$
0.9494
PHU
$
0.9494
OXYBUTYNIN CHLORIDE
* 5MG TABLET
02158590
02163543
02220059
02220067
02230394
02230800
02239073
02240550
02241285
01924761
NU-OXYBUTYN
APO-OXYBUTYNIN
OXYBUTYN
ALBERT OXYBUTYNIN
NOVO-OXYBUTYNIN
GEN-OXYBUTYNIN
PENTA-OXYBUTYNIN CHLORIDE
PMS-OXYBUTYNIN
DOM-OXYBUTYNIN
DITROPAN
* 1MG/ML SYRUP
02223376
02231089
01924753
PMS-OXYBUTYNIN
APO-OXYBUTYNIN
DITROPAN
TOLTERODINE L-TARTRATE
1MG TABLET
02239064
DETROL (EDS)
2MG TABLET
02239065
DETROL (EDS)
86:16.00 RESPIRATORY SMOOTH MUSCLE RELAXANTS
AMINOPHYLLINE
02014270
PHYLLOCONTIN
PFR
$
0.2158
PFR
$
0.2751
02014289
PHYLLOCONTIN-350
214
OXTRIPHYLLINE
100MG TABLET
00441724
APO-OXTRIPHYLLINE
APX
$
0.0272
APX
NOP
$
0.0337
0.0337
APX
$
0.0345
PDA
$
0.2453
PDA
$
0.2911
ROG
$
0.0112
PMS
PDA
$
0.0249
0.0363
AVT
$
0.1826
AVT
$
0.2048
AVT
$
0.2374
AVT
$
0.2850
APX
NOP
RIV
AST
$
0.1411
0.1411
0.1888
0.2073
APX
NOP
RIV
AST
$
0.1465
0.1465
0.1823
0.2404
MDA
$
0.3551
* 200MG TABLET
00441732
00458716
APO-OXTRIPHYLLINE
NOVO-TRIPHYL
300MG TABLET
00511692
APO-OXTRIPHYLLINE
00503436
CHOLEDYL-SA
00536709
CHOLEDYL-SA
10MG/ML SYRUP
00405310
ROUPHYLLINE
* 20MG/ML ELIXIR
00792942
00476366
PMS-OXTRIPHYLLINE
CHOLEDYL
THEOPHYLLINE (ANHYDROUS)
01926616
SLO-BID
01926586
SLO-BID
01926594
SLO-BID
01926608
x
00692689
02230085
00631698
00460982
x
SLO-BID
APO-THEO-LA
NOVO-THEOPHYL SR
THEOCHRON
THEO-DUR
00692697
02230086
00631701
00460990
APO-THEO-LA
NOVO-THEOPHYL SR
THEOCHRON
THEO-DUR
01966251
THEOLAIR-SR
215
x
00692700
01926640
02230087
01966278
00599905
00556742
00461008
APO-THEO-LA
THEO-SR
NOVO-THEOPHYL SR
THEOLAIR-SR
THEOCHRON
QUIBRON-T/SR
THEO-DUR
APX
AVT
NOP
MDA
RIV
BRI
AST
$
0.1519
0.1519
0.1519
0.1747
0.2040
0.2811
0.2892
PFR
$
0.4959
AST
$
0.3505
PFR
$
0.6005
TCH
PMS
$
0.0038
0.0038
MDA
$
0.0208
02014165
UNIPHYL
00722065
THEO-DUR
02014181
UNIPHYL
* 5.33MG/ML ELIXIR
00532223
00575151
THEOPHYLLINE
PMS-THEOPHYLLINE
5.33MG/ML SOLUTION
01966219
THEOLAIR LIQUID
216
VITAMINS
88:00
88:00 VITAMINS
88:04.00 VITAMIN A
VITAMIN A IS TOXIC IN EXCESSIVE DOSES.
VITAMIN A
25,000IU CAPSULE
00021067
VITAMIN A
NOP
$
0.0586
NOP
$
0.0961
SAB
CYT
SCN
$
3.3700
3.3700
3.3700
NOP
SDR
APX
$
0.0147
0.0147
0.0196
WYA
$
5.4873
ICN
$
0.0154
ICN
LEA
$
0.0317
0.0352
ODN
ICN
LEA
$
0.0456
0.0495
0.0546
50,000IU CAPSULE
00021075
VITAMIN A
88:08.00 VITAMINS B
CYANOCOBALAMIN
00521515
01987003
02229972
VITAMIN B12
CYANOCOBALAMIN
SCHEINPHARM B12
FOLIC ACID
* 5MG TABLET
00021466
00179493
00426849
NOVO-FOLACID
FOLIC ACID
APO-FOLIC
LEUCOVORIN CALCIUM (FOLINIC ACID)
5MG TABLET
02170493
LEUCOVORIN (EDS)
NIACIN
50MG TABLET
00268593
NIACIN
* 100MG TABLET
00268585
00232459
NIACIN
NIACIN
* 500MG TABLET
01939130
00294950
00232440
NIACIN
NIACIN
NIACIN
218
88:00 VITAMINS
88:08.00 VITAMINS B
PYRIDOXINE HCL
* 25MG TABLET
00232475
00268607
01943200
PYRIDOXINE HCL
VITAMIN B6
VITAMIN B6
LEA
ICN
ODN
$
0.0234
0.0280
0.0283
LEA
ICN
$
0.0192
0.0620
SAB
ABB
$
13.5700
14.9800
LEO
$
0.4438
LEO
$
1.3284
LEO
$
0.5075
SAW
$
0.4202
HLR
$
0.9538
HLR
$
1.5169
HLR
$
3.0380
THIAMINE HCL
* 50MG TABLET
00610267
00268631
VITAMIN B1
VITAMIN B1
00816078
02241983
VITAMIN B1
BETAXIN
88:16.00 VITAMIN D
VITAMIN D IS TOXIC IN EXCESSIVE DOSES.
ALFACALCIDOL
0.25UG CAPSULE
00474517
ONE-ALPHA (EDS)
1.0UG CAPSULE
00474525
ONE ALPHA (EDS)
0.2UG/ML ORAL SOLUTION
00759546
ONE ALPHA (EDS)
CALCIFEROL
8,288IU/ML ORAL SOLUTION
02017598
DRISDOL
CALCITRIOL
0.25UG CAPSULE
00481823
ROCALTROL (EDS)
0.5UG CAPSULE
00481815
ROCALTROL (EDS)
1UG/ML ORAL SOLUTION
00824291
ROCALTROL (EDS)
219
88:00 VITAMINS
88:16.00 VITAMIN D
VITAMIN D
50,000IU CAPSULE
00009830
OSTOFORTE
MSD
220
$
0.2177
UNCLASSIFIED THERAPEUTIC AGENTS
92:00
92:00 UNCLASSIFIED THERAPEUTIC AGENTS
92:00.00 UNCLASSIFIED THERAPEUTIC AGENTS
ALENDRONATE SODIUM
10MG TABLET
02201011
FOSAMAX (EDS)
MSD
$
1.9042
MSD
$
3.8898
NOP
APX
GLA
$
0.0207
0.0207
0.1102
APX
NOP
GLA
$
0.0363
0.0363
0.1829
NOP
APX
GLA
$
0.0446
0.0446
0.2988
RBP
$
5.0845
GPM
ALT
NOP
GLA
$
0.5879
0.5879
0.5879
0.9331
ORP
$
1.4046
40MG TABLET
02201038
FOSAMAX (EDS)
ALLOPURINOL
* 100MG TABLET
00364282
00402818
00004588
NOVO-PUROL
APO-ALLOPURINOL
ZYLOPRIM
* 200MG TABLET
00479799
00565342
00506370
APO-ALLOPURINOL
NOVO-PUROL
ZYLOPRIM
* 300MG TABLET
00363693
00402796
00294322
NOVO-PUROL
APO-ALLOPURINOL
ZYLOPRIM
ANAGRELIDE HCL
0.5MG CAPSULE
02236859
AGRYLIN
AZATHIOPRINE
* 50MG TABLET
02231491
02236799
02236819
00004596
GEN-AZATHIOPRINE
ALTI-AZATHIOPRINE
NOVO-AZATHIOPRINE
IMURAN
BETAINE ANHYDROUS
1G/SCOOP POWDER FOR ORAL SOLUTION
02238526
CYSTADANE
222
BOTULINUM TOXIN TYPE A
100IU STERILE LYOPHILIZED POWDER (IU)
01981501
BOTOX (EDS)
ALL
$
3.6890
APX
PMS
NVR
$
1.0537
1.0537
1.6726
APX
PMS
NVR
$
0.5917
0.5917
0.9391
AVT
$
101.7200
AVT
$
68.1400
ROG
ODN
$
0.0722
0.0722
ROG
ODN
$
0.2051
0.2051
NVR
$
0.6637
NVR
$
1.5426
NVR
$
3.0073
BROMOCRIPTINE MESYLATE
* 5MG CAPSULE
02230454
02236949
00568643
APO-BROMOCRIPTINE
PMS-BROMOCRIPTINE
PARLODEL
* 2.5MG TABLET
02087324
02231702
00371033
APO-BROMOCRIPTINE
PMS-BROMOCRIPTINE
PARLODEL
BUSERELIN ACETATE
1.05MG/ML INJECTION (2)
02225166
SUPREFACT (EDS)
1.05MG/ML INTRANASAL SOLUTION
02225158
SUPREFACT (EDS)
COLCHICINE
* 0.6MG TABLET
00287873
00572349
COLCHICINE
COLCHICINE-ODAN
* 1MG TABLET
00206032
00621374
COLCHICINE
COLCHICINE-ODAN
CYCLOSPORINE (TRANSPLANT)
10MG CAPSULE
02237671
NEORAL (EDS)
25MG CAPSULE
02150689
NEORAL (EDS)
50MG CAPSULE
02150662
NEORAL (EDS)
223
100MG CAPSULE
02150670
NEORAL (EDS)
NVR
$
6.0164
NVR
$
5.3480
WYA
$
0.4180
WYA
$
0.7947
PGA
$
1.4224
PGA
$
39.8200
MSD
$
1.7686
TVM
$
34.6900
LIL
$
35.6500
AST
$
411.7500
100MG/ML LIQUID
02150697
NEORAL (EDS)
DISULFIRAM
250MG TABLET
02041375
ANTABUSE
500MG TABLET
02041391
ANTABUSE
ETIDRONATE DISODIUM
200MG TABLET
01997629
DIDRONEL (EDS)
ETIDRONATE DISODIUM/CALCIUM CARBONATE
400MG/1250MG TABLET (PACKAGE)
02176017
DIDROCAL
FINASTERIDE
5MG TABLET
02010909
PROSCAR
GLATIRAMER ACETATE
SEE APPENDIX H FOR EDS CRITERIA
02233014
COPAXONE (EDS)
GLUCAGON
00015377
GLUCAGON
GOSERELIN ACETATE
3.6MG/SYRINGE
02049325
ZOLADEX (EDS)
224
INTERFERON ALFA-2B/RIBAVIRIN
6 MILLION IU/ML (0.5ML) INJECTION SOLUTION
ALBUMIN (HUMAN) FREE/200MG CAPSULE (PACKAGE)
02239730
REBETRON (EDS)
SCH
$
861.1800
SCH
$
861.1800
SRO
$
59.1400
SRO
$
118.2700
SRO
$
145.0000
BGN
$
330.5800
BEX
$
96.0000
NOP
PMS
NVR
$
0.6874
0.6874
0.8594
NOP
NXP
APX
PMS
NVR
$
0.1443
0.1443
0.1443
0.1443
0.1925
15 MILLION IU/ML MULTI-DOSE PEN
ALBUMIN (HUMAN) FREE/200MG CAPSULE (PACKAGE)
02241159
REBETRON (EDS)
INTERFERON BETA-1A
11UG (3 MILLION IU) POWDER FOR INJECTION
(VIAL)
02237317
REBIF (EDS)
22UG (6 MILLION IU) PRE-FILLED SYRINGE
02237319
REBIF (EDS)
44UG (12 MILLION IU) PRE-FILLED SYRINGE
02237320
REBIF (EDS)
30UG POWDER FOR IM INJECTION (VIAL)
02237770
AVONEX (EDS)
INTERFERON BETA-1B
0.3MG POWDER FOR INJECTION (3ML)
02169649
BETASERON (EDS)
KETOTIFEN FUMARATE
* 1MG TABLET
02230730
02231680
00577308
NOVO-KETOTIFEN (EDS)
PMS-KETOTIFEN (EDS)
ZADITEN (EDS)
* 0.2MG/ML SYRUP
02176084
02218305
02221330
02231679
00600784
NU-KETOTIFEN (EDS)
APO-KETOTIFEN (EDS)
PMS-KETOTIFEN (EDS)
ZADITEN (EDS)
225
LEUPROLIDE ACETATE
3.75MG/ML INJECTION
00884502
LUPRON DEPOT (EDS)
ABB
$
330.3900
ABB
$
417.9700
ABB
$
943.5000
NOP
JAN
$
3.6077
5.1538
HLR
$
0.2767
HLR
$
0.4557
HLR
$
0.7650
ALT
NXP
APX
DUP
$
0.2745
0.2745
0.2745
0.4580
ALT
NXP
APX
DUP
$
0.4107
0.4107
0.4107
0.6839
ALT
NXP
APX
DUP
$
0.4585
0.4585
0.4585
0.7634
7.5MG/ML INJECTION
00836273
LUPRON DEPOT (EDS)
11.25MG (3-MONTH SR) DEPOT INJECTION
02239834
LUPRON DEPOT (EDS)
LEVAMISOLE
* 50MG TABLET
02234217
00846368
NOVO-LEVAMISOLE (EDS)
ERGAMISOL (EDS)
LEVODOPA/BENZERAZIDE
50MG/12.5MG CAPSULE
00522597
PROLOPA
100MG/25MG CAPSULE
00386464
PROLOPA
200MG/50MG CAPSULE
00386472
PROLOPA
LEVODOPA/CARBIDOPA
* 100MG/10MG TABLET
02126176
02182831
02195933
00355658
ENDO-LEVODOPA/CARBIDOPA
NU-LEVOCARB
APO-LEVOCARB
SINEMET
* 100MG/25MG TABLET
02126168
02182823
02195941
00513997
NU-LEVOCARB
APO-LEVOCARB
SINEMET
* 250MG/25MG TABLET
02126184
02182858
02195968
00328219
NU-LEVOCARB
APO-LEVOCARB
SINEMET
226
100MG/25MG CONTROLLED RELEASE TABLET
02028786
SINEMET CR
DUP
$
0.6746
DUP
$
1.2443
MSD
$
1.5190
MSD
$
2.2351
HLR
$
2.1620
HLR
$
4.4746
ICN
$
6.7325
FEI
$
303.8000
AVT
$
27.9700
200MG/50MG CONTROLLED RELEASE TABLET
00870935
SINEMET CR
MONTELUKAST SODIUM
5MG CHEWABLE TABLET
02238216
SINGULAIR (EDS)
10MG TABLET
02238217
SINGULAIR (EDS)
MYCOPHENOLATE MOFETIL
250MG CAPSULE
02192748
CELLCEPT (EDS)
500MG TABLET
02237484
CELLCEPT (EDS)
NABILONE
1MG CAPSULE
00548375
CESAMET (EDS)
NAFARELIN ACETATE
2MG/ML NASAL SOLUTION
02188783
SYNAREL (EDS)
NEDOCROMIL SO4
2MG/DOSE INHALATION AEROSOL (PACKAGE)
02230543
TILADE
OCTREOTIDE
WHEN BILLING LAR FORM, SUBMIT QUANTITY IN TERMS OF MILLIGRAMS.
50UG INJECTION (1ML)
00839191
SANDOSTATIN (EDS)
NVR
$
5.4200
NVR
$
10.2300
00839205
SANDOSTATIN (EDS)
227
200UG/ML INJECTION (5ML)
02049392
SANDOSTATIN (EDS)
NVR
$
98.3100
NVR
$
48.0400
NVR
$
113.2000
NVR
$
75.0000
NVR
$
62.3400
ALZ
$
1.2912
DPY
$
0.2696
DPY
$
0.9883
DPY
$
3.3690
BOE
$
1.0742
BOE
$
2.1483
BOE
$
2.1483
BOE
$
2.1483
PHU
$
4.0500
PGA
$
11.6638
00839213
SANDOSTATIN (EDS)
10MG/VIAL POWDER FOR INJECTION (MG)
02239323
SANDOSTATIN LAR (EDS)
02239324
02239325
PENTOSAN POLYSULFATE SO4
100MG CAPSULE
02029448
ELMIRON (EDS)
PERGOLIDE MESYLATE
0.05MG TABLET
02123320
PERMAX
0.25MG TABLET
02123339
PERMAX
1MG TABLET
02123347
PERMAX
PRAMIPEXOLE DIHYDROCHLORIDE
0.25MG TABLET
02237145
MIRAPEX
0.5MG TABLET
02241594
MIRAPEX
1MG TABLET
02237146
MIRAPEX
1.5MG TABLET
02237147
MIRAPEX
RIFABUTIN
150MG CAPSULE
02063786
MYCOBUTIN (EDS)
RISEDRONATE SODIUM
30MG TABLET
02239146
ACTONEL (EDS)
228
ROPINIROLE HCL
0.25MG TABLET
02232565
REQUIP
SMJ
$
0.2713
SMJ
$
1.0850
SMJ
$
1.1935
SMJ
$
3.3635
NXP
NOP
APX
GPM
MED
DOM
DPY
$
0.5830 *
1.3726
1.3726
1.3726
1.3726
1.5445
2.1793
AVT
$
0.5007
AVT
$
1.1621
AVT
PMS
GPM
APX
NXP
DOM
$
0.5258
0.5258
0.5258
0.5258
0.5258
0.6562
AVT
$
42.8600
AVT
$
44.9200
1MG TABLET
02232567
REQUIP
2MG TABLET
02232568
REQUIP
5MG TABLET
02232569
REQUIP
SELEGILINE HCL
* 5MG TABLET
02230717
02068087
02230641
02231036
02237289
02238340
02123312
NU-SELEGILINE (EDS)
NOVO-SELEGILINE (EDS)
APO-SELEGILINE (EDS)
GEN-SELEGILINE (EDS)
MED-SELEGILINE (EDS)
DOM-SELEGILINE (EDS)
ELDEPRYL (EDS)
SODIUM CROMOGLYCATE
20MG/CAPSULE AEROSOL POWDER
00261238
INTAL SPINCAPS
100MG CAPSULE
00500895
NALCROM (EDS)
* 10MG/ML INHALATION SOLUTION (2ML)
00534609
02046113
02219468
02231431
02231671
02145448
INTAL NEBULIZER SOLUTION
PMS-SODIUM CROMOGLYCATE
GEN-CROMOGLYCATE
APO-CROMOLYN
NU-CROMOLYN
DOM-SODIUM CROMOGLYCATE
1MG/DOSE PRESSURIZED AEROSOL (PACKAGE)
00555649
INTAL
1MG/DOSE PRESSURIZED AEROSOL
WITH SPECIAL MOUTH PIECE (PACKAGE)
00638641
INTAL SYNCRONER
229
SODIUM FLUORIDE
20MG TABLET
02099225
FLUOTIC
AVT
$
0.3521
FUJ
$
2.6583
FUJ
$
12.5500
FUJ
$
127.5000
BOE
$
1.0308
HLR
$
2.1700
AVT
$
0.2256
AVT
$
0.2805
AVT
$
0.0681
AXC
$
1.3385
AST
$
0.7595
TACROLIMUS
1MG CAPSULE
02175991
PROGRAF (EDS)
5MG CAPSULE
02175983
PROGRAF (EDS)
5MG/ML AMPOULE
02176009
PROGRAF (EDS)
TAMSULOSIN HCL
0.4MG SUSTAINED RELEASE CAPSULE
02238123
FLOMAX
TETRABENAZINE
25MG TABLET
02199270
NITOMAN
TRIMEPRAZINE TARTRATE
2.5MG TABLET
01926306
PANECTYL
5MG TABLET
01926292
PANECTYL
0.5MG/ML ORAL LIQUID
01926446
PANECTYL
URSODIOL
250MG TABLET
02238984
URSO (EDS)
ZAFIRLUKAST
20MG TABLET
02236606
ACCOLATE (EDS)
230
APPENDICES
APPENDIX A - EXCEPTION DRUG STATUS PROGRAM
APPENDIX B - HOSPITAL BENEFIT DRUG LIST
APPENDIX C - TIPS ON PRESCRIPTION WRITING AND
PRESCRIPTION REGULATIONS
APPENDIX D - GUIDELINES FOR REPORTING ADVERSE
DRUG REACTIONS
APPENDIX E - SPECIAL COVERAGES
APPENDIX F - TRIPLICATE PRESCRIPTION PROGRAM
APPENDIX G - CODES FOR PHARMACY ON-LINE CLAIMS
PROCESSING
APPENDIX H - MAINTENANCE DRUG SCHEDULE
APPENDIX I - TRIAL PRESCRIPTION PROGRAM
MEDICATION LIST
APPENDIX J - SASKATCHEWAN MS DRUGS PROGRAM
APPENDIX A
EXCEPTION DRUG STATUS PROGRAM
NOTES REGARDING THE EXCEPTION DRUG STATUS (EDS) PROGRAM
• Physicians, dentists, duly qualified optometrists (or authorized office staff) and
•
•
•
•
•
•
•
•
pharmacists may apply for EDS.
Requests can be submitted by telephone, by mail or by fax. A toll-free line with an
electronic message system is available exclusively for requests on a 24-hour basis.
The telephone number to access this line is 1-800-667-2549, the Drug Plan fax
number is (306) 787-8679.
Requests are processed daily on a continuous basis. Please allow Drug Plan staff
24 hours to process requests.
Patients and prescribers are notified by letter if coverage has been approved and the
time period for which coverage has been approved.
If a request has been denied, letters are sent to the patient and prescriber notifying
them of the reason for the denial. In most cases, the Drug Plan requires more
information to determine the patient's eligibility for coverage, and will reconsider
coverage at such time as further information is received.
If the drug requested is not a benefit under the Drug Plan, the patient and prescriber
are notified. Payment for the medication is the responsibility of the patient in these
cases. It is important to note that not all medications currently available on the
market in Canada are benefits under the Saskatchewan Drug Plan or under the
Exception Drug Status Program of the Drug Plan.
The majority of EDS requests are routinely backdated 30 days from the time the
Drug Plan receives the request. Provision can be made for further backdating of
EDS coverage on a case-by-case basis. However, the Drug Plan cannot backdate
further than one year from the current date.
Saskatchewan Prescription Drug Plan policy does not allow a fee to be charged to
clients for Exception Drug Status applications made to the Drug Plan on the client's
behalf.
See NOTES CONCERNING THE FORMULARY, pages xii-xiii for additional general
information regarding Exception Drug Status coverage
CRITERIA FOR COVERAGE UNDER EXCEPTION DRUG STATUS
Following are the criteria for coverage of certain drugs under Exception Drug Status.
Coverage may be provided for other products in certain instances. Further information
can be provided by professional staff at the Drug Plan.
Certain products may be granted Exception Drug Status for non-approved indications.
This is the case only when the Saskatchewan Formulary Committee has reviewed
evidence to demonstrate safety and efficacy and the prescriber is aware the drug is
being prescribed for a non-approved indication.
The following information is required to process all Exception Drug Status requests:
• patient name
• patient Health Services Number (9 digits)
• name of drug
• diagnosis relevant to use of drug
• prescriber name and phone number
232
_____________________________________________
abacavir SO4, oral solution, 20mg/mL; tablet, 300mg (Ziagen-GLA)
For management of HIV disease. This drug, as with other antivirals in treatment of
HIV, should be used under the direction of an infectious disease specialist
Acilac - see lactulose
acitretin, capsule, 10mg, 25mg (Soriatane-HLR)
For treatment of severe intractable psoriasis, Darier's Disease, ichthyosiform
dermatoses, palmoplantar pustulosis and other disorders of keratinization. For
detailed patient information see page 260.
Accolate - see zafirlukast
Actonel - see risedronate sodium
Acular - see ketorolac tromethamine
Advair Diskus - see salmeterol xinafoate/fluticasone propionate
alendronate sodium, tablet, 10mg, 40mg (Fosamax-MSD)
(a) For treatment of osteoporosis in patients unable to tolerate or who do not
respond to etidronate disodium/calcium (Didrocal) after receiving it for one year.
(b) For treatment of osteoporosis in patients who have fresh fractures.
(c) For treatment of symptomatic Paget's Disease of the bone.
alfacalcidol, capsule, 0.25ug, 1ug; oral solution, 0.2ug/mL (One-Alpha-LEO)
For management of hypocalcemia and osteodystrophy in chronic renal disease
patients prior to initiation of dialysis. Note: Coverage for dialysis patients is provided
under the Saskatchewan Aids to Independent Living (S.A.I.L.) Program. Exception
Drug Status coverage is not required for S.A.I.L. patients.
Alti-CPA - see cyproterone acetate
Alti-Minocycline - see minocycline HCl
Amatine - see midodrine HCl
Amerge – see naratriptan HCl
amoxicillin trihydrate/potassium clavulanate, tablet, 250mg/125mg, 500mg/125mg,
875mg/125mg; oral suspension, 25mg/6.25mg/mL, 50mg/12.5mg/mL,
40mg/5.3mg/mL, 80mg/11.4mg/mL (Clavulin-SMJ)
(a) For treatment of infections in patients with underlying lung disease not
responding to first-line antibiotics.
(b) For treatment of patients with infections caused by organisms known to be
resistant to alternative antibiotics.
(c) For step-down care following hospital separation in patients treated with
intravenous antibiotics.
(d) For treatment of respiratory tract infections in nursing home patients.
(e) For treatment of pneumonia in patients in the community with comorbidity (ie.
COPD, diabetes mellitus, renal insufficiency, heart failure).
Androcur - see cyproterone acetate
APL - see chorionic gonadotropin
Apo-Cefaclor - see cefaclor
Apo-Cyclobenzaprine - see cyclobenzaprine HCl
233
Apo-Etodolac - see etodolac
Apo-Fenofibrate - see fenofibrate
Apo-Feno-Micro - see fenofibrate (micronized)
Apo-Fluconazole – see fluconazole
Apo-Ketoconazole - see ketoconazole
Apo-Ketotifen - see ketotifen fumarate
Apo-Megestrol - see megestrol acetate tablet
Apo-Minocycline - see minocycline HCl
Apo-Nabumetone – see nabumetone
Apo-Norflox – see norfloxacin
Apo-Selegiline - see selegiline HCl
Apo-Ticlopidine - see ticlopidine HCl
Apo-Zidovudine – see zidovudine
Aristospan - see triamcinolone/hexacetonide
atovaquone, suspension, 150mg/mL (Mepron-GLA)
For treatment of pneumocystis carinii pneumonia (PCP) in patients who are intolerant
to trimethoprim/sulfamethoxazole.
Avonex – see Appendix J
azithromycin, tablet, 250mg; capsule, 250mg; oral suspension, 20mg/mL, 40mg/mL
(Zithromax-PFI)
(b) For treatment of infections caused by organisms known to be resistant to
alternative antibiotics.
(c) For treatment of infections in patients allergic to alternative antibiotics.
(f) For treatment of chlamydia trachomatis infections.
azithromycin, tablet, 600mg (Zithromax-PFI)
For prevention of disseminated Mycobacterium avium complex (MAC) disease in
patients with advanced HIV infections.
baclofen, injection, 0.05mg/mL, 0.5mg/mL, 2mg/mL (Lioresal Intrathecal-NVR)
For treatment of severe spastic conditions in patients who do not respond or cannot
tolerate oral baclofen.
Betaseron - see Appendix J
*bezafibrate, tablet, 200mg (Bezalip-HLR) (pms-Bezafibrate-PMS); sustained
release tablet, 400mg (Bezalip SR-HLR)
For treatment of patients with hyperlipidemia who have failed to respond to
gemfibrozil or have experienced side effects with it.
Bezalip - see bezafibrate
Biaxin - see clarithromycin
Botox - see botulinum toxin type A
234
botulinum toxin type A, sterile lyophilized powder, 100IU (Botox-ALL)
(a) For treatment of eye dystonias, that is, blepharospasm and strabismus.
(b) For treatment of cervical dystonia, that is, torticollis.
(c) For treatment of other forms of severe spasticity.
budesonide, controlled ileal release capsule, 3mg (Entocort-AST)
(a) For treatment of patients with mild to moderate Crohn's Disease affecting the
ileum and/or ascending colon. Coverage will be provided for up to 8 weeks.
(b) Maintenance treatment will be approved for patients unresponsive or intolerant
to other agents.
bumetanide, tablet, 2mg (Burinex-LEO)
For treatment of patients unable to tolerate furosemide.
bupropion HCl, tablet, 100mg, 150mg (Wellbutrin SR-GLA)
For treatment of depression.
Burinex - see bumetanide
buserelin acetate, intranasal solution, 1.05mg/mL; injection, 1.05mg/mL
(Suprefact-HRU)
(a) For treatment of endometriosis, for a maximum of 6 months. Coverage may be
repeated after a six month lapse, for another 6 month course.
(b) For pre-treatment of uterine fibroids prior to surgical removal, for a maximum of
6 months.
(c) For treatment of menorrhagia in preparation for endometrial ablation, for a
maximum of 6 months.
Calcimar - see calcitonin salmon
+calcitonin salmon, injection, 100IU/mL (Caltine-FEI), 200IU/mL (Calcimar-AVT)
(a) For symptomatic treatment of Paget's Disease of the bone.
(b) For treatment of crush fracture with bone pain. Coverage will be provided for a
(c) For treatment of osteogenesis imperfecta.
calcitriol, capsule, 0.25ug, 0.5ug (Rocaltrol-HLR)
For management of hypocalcemia and clinical manifestations associated with
postsurgical hypoparathyroidism, pseudohypoparathyroidism or Vitamin D resistant
rickets.
Caltine - see calcitonin salmon
*carbamazepine, controlled release tablet, 200mg, 400mg (Tegretol CR-NVR)
(pms-Carbamazepine-CR-PMS) (Dom-Carbamazepine CR-DOM)
(Taro-Carbamazepine CR-TAR) (Gen-Carbamazepine CR-GPM)
For treatment in patients experiencing inadequate control or occurrence of
unacceptable adverse reactions using the regular tablet dosage form.
Cardene - see nicardipine HCl
235
carvedilol, tablet, 3.125mg, 6.25mg, 12.5mg, 25mg (Coreg-HLR)
For treatment of patients with stable symptomatic congestive heart failure taking
diuretics and ACE inhibitors, with or without digoxin.
Ceclor - see cefaclor
*cefaclor, suspension, 25mg/mL, 50mg/mL, 75mg/mL (Ceclor-LIL) (Apo-CefaclorAPX) (Dom-Cefaclor-DOM) (pms-Cefaclor-PMS); capsule, 250mg, 500mg (pmsCefaclor-PMS) (Apo-Cefaclor-APX) (Dom-Cefaclor-DOM) (Nu-Cefaclor-NXP)
(Scheinpharm Cefaclor-SCN) (Novo-Cefaclor-NOP)
(b) For treatment of infections in patients allergic to alternative antibiotics (Note:
patients with immediate hypersensitivity to penicillin should not receive
cephalosporins.)
(c) For treatment of infections caused by organisms known to be resistant to
(f) For step-down care following hospital separation in patients treated with
intravenous antibiotics (guided by culture and sensitivity results).
cefixime, tablet, 400mg; oral suspension, 20mg/mL (Suprax-AVT)
cephalosporins.)
(g) For treatment of uncomplicated gonorrhea.
cefprozil, tablet, 250mg, 500mg; suspension, 25mg/mL, 50mg/mL (Cefzil-BMY)
cephalosporins.)
236
Ceftin - see cefuroxime axetil
cefuroxime axetil, tablet, 250mg, 500mg; suspension, 25mg/mL (Ceftin-GLA)
cephalosporins.)
Cefzil - see cefprozil
Celebrex - see celecoxib
celecoxib, capsule, 100mg, 200mg (Celebrex-SEA)
(a) For treatment of rheumatoid arthritis and osteoarthritis in patients who have one
or more of the following factors:
age 65 years or over;
•
past history of ulcers;
•
concurrent prednisone therapy;
•
concurrent warfarin therapy.
•
(b) For treatment of patients with an intolerance to other NSAIDs listed in the
Formulary.
CellCept - see mycophenolate mofetil
Cesamet - see nabilone
+chorionic gonadotropin, injection, 10,000IU/vial (Profasi HP-SRO) (APL-WYA)
(a) For treatment of habitual abortion.
(b) For treatment of delayed puberty.
Ciloxan - see ciprofloxacin
Cipro - see ciprofloxacin tablet
Cipro HC - see ciprofloxacin/hydrocortisone
ciprofloxacin, ophthalmic solution, 0.3%; ophthalmic ointment, 0.3% (Ciloxan-ALC)
For treatment of ophthalmic infections caused by gram-negative organisms or those
not responding to alternative agents.
ciprofloxacin, tablet, 250mg, 500mg, 750mg; oral suspension, 100mg/mL
(Cipro-BAY)
(a) For treatment of infections caused by pseudomonas aeruginosa.
(b) For treatment of infections in patients allergic to alternative antibiotics.
(c) For treatment of infections with organisms known to be resistant to alternative
antibiotics.
(d) For step-down care following hospital separation in patients treated with
(e) For prophylaxis of infection in immunocompromised patients.
(f) For treatment of genitourinary tract infections unresponsive to first-line antibiotics
or based on culture and sensitivity results.
(g) For treatment of gonorrhea.
237
ciprofloxacin/hydrocortisone, otic suspension, 0.2%/1% (Cipro HC-ALC)
For treatment of otitis externa in patients who have failed previous treatment with
listed combination anti-infective/anti-inflammatory agents.
clarithromycin, tablet, 250mg, 500mg; oral suspension, 25mg/mL (Biaxin-ABB)
(f) For treatment and prophylaxis of Mycobacterium avium complex (MAC) in HIV
positive patients.
(g) For one week for eradication of H. pylori-related infections when used in
combination treatment regimens for the treatment of peptic ulcer disease.
Clavulin - see amoxicillin trihydrate/potassium clavulanate
Climara - see estradiol-17β
clonidine HCl, tablet, 0.025mg (Dixarit-BOE)
(a) For treatment of menopausal flushing in patients unable to tolerate estrogen
therapy.
(b) For treatment of Attention Deficit Disorder.
clopidogrel bisulfate, tablet, 75mg (Plavix-SAW)
(a) For treatment of patients who have experienced a recurrent vascular episode
while on acetylsalicylic acid.
(b) For treatment of patients who have a clearly demonstrated allergy to
acetylsalicylic acid (manifested by asthma or nasal polyps).
(c) For treatment of patients with an intolerance of acetylsalicylic acid (manifested
by gastrointestinal hemorrhage).
(d) For a period of 4 weeks when prescribed following intracoronary stent
placement.
Clopixol - see zuclopenthixol
clozapine, tablet, 25mg, 100mg (Clozaril-NVR)
For treatment of patients with schizophrenia who are either treatment resistant or
treatment intolerant and have no other medical contraindications.
Clozaril - see clozapine
codeine, controlled release tablet, 50mg, 100mg, 150mg, 200mg (Codeine ContinPFR)
(a) For treatment of palliative and chronic pain patients as an alternative to
ASA/codeine combination products or acetaminophen/codeine combination
products.
(b) For treatment of palliative and chronic pain patients as an alternative to the
regular release tablet when large doses are required.
In non-palliative patients, coverage will only be approved for a 6 month course of
therapy, subject to review.
238
Codeine Contin - see codeine
Combivent - see ipratropium bromide/salbutamol SO4
Combivir – see lamivudine/zidovudine
Copaxone - see Appendix J
Coreg - see carvedilol
Crixivan - see indinavir SO4
*cyclobenzaprine HCl, tablet, 10mg (Flexeril-MSD) (Apo-Cyclobenzaprine-APX)
(Novo-Cycloprine-NOP) (Nu-Cyclobenzaprine-NXP) (pms-Cyclobenzaprine-PMS)
(Syn-Cyclobenzaprine-ALT) (Gen-Cyclobenzaprine-GPM) (Med-CyclobenzaprineMED) (Flexitec-TCH) (Dom-Cyclobenzaprine-DOM)
As an adjunct to rest and physical therapy for relief of muscle spasm associated with
acute, painful musculoskeletal conditions not responding or experiencing severe
adverse reactions to alternative therapy. Coverage will be provided for up to a 3 week
period.
cyclosporine, capsule, 10mg, 25mg, 50mg, 100mg; liquid, 100mg/mL (Neoral-NVR)
(a) For induction and maintenance of remission of severe psoriasis in patients for
whom conventional therapy is ineffective or inappropriate.
(b) For treatment of patients with severe active rheumatoid arthritis for whom
classical slow-acting anti-rheumatic agents are inappropriate or ineffective.
(c) For treatment of nephrotic syndrome.
For the above indications prescriptions are subject to deductible and co-payment as
for other drugs covered under the Drug Plan. Pharmacies note: claims on behalf
of these patients must use the following identifying numbers (not the DIN):
10mg – 00950792
100mg – 00950815
25mg – 00950793
100mg/mL - 00950823
50mg – 00950807
cyclosporine, capsule, 10mg, 25mg, 50mg, 100mg; liquid, 100mg/mL (Neoral-NVR)
For prophylaxis of graft rejection following solid organ transplant and bone marrow
transplant procedures. In such cases, the cost is covered at 100% and the deductible
does not apply.
cyproterone acetate, injection, 100mg/mL (Androcur Depot-BEX);
*tablet, 50mg (Androcur-BEX) (Alti-CPA-ALT) (Gen-Cyproterone-GPM) (NovoCyproterone-NOP)
For treatment of hirsuitism.
Cytovene - see ganciclovir sodium
dalteparin sodium, syringe, 2,500IU (0.2mL), 5,000IU (0.2mL); injection solution,
2,500IU/mL (4mL), 10,000IU/mL (1mL), 25,000IU/mL (3.8mL) (Fragmin-PHU)
(a) For treatment of venous thromboembolism for up to 10 days.
(b) For prophylaxis following total knee arthroplasty and major orthopedic trauma for
up to 10 days (treatment duration may be reassessed).
(c) For longterm outpatient prophylaxis in patients who are pregnant.
(d) For longterm outpatient prophylaxis in patients who are intolerant to, or have
failed, warfarin therapy.
(e) For longterm outpatient prophylaxis in patients who have lupus anticoagulant
syndrome.
239
DDAVP - see desmopressin acetate
delavirdine mesylate, tablet, 100mg (Rescriptor-PHU)
HIV, should be used under the direction of an infectious disease specialist.
desmopressin, intranasal solution, 10ug/dose; tablet, 0.1mg, 0.2mg (DDAVP-FEI)
(a) For treatment of diabetes insipidus.
(b) For treatment of enuresis in children over 5 years of age refractory to bedwetting alarms or alternative agents listed in the Formulary.
desmopressin, injection, 4ug/mL (DDAVP-FEI); intranasal solution, 150ug/dose
(Octostim-FEI)
For prophylaxis of mild hemophilia A and mild von Willebrand's Disease.
Detrol - see tolterodine l-tartrate
diclofenac sodium, ophthalmic solution, 0.1% (Voltaren Ophtha-CBV)
(a) For treatment of post-operative ocular inflammation in patients undergoing
cataract surgery.
(b) For prophylaxis of aphakic macular edema following cataract surgery.
(c) For treatment of long-term inflammatory conditions not responding to short-term
topical steroids.
didanosine, powder for oral solution (package), 4g; chewable tablet, 25mg, 50mg,
100mg, 150mg (Videx-BMY)
Didronel - see etidronate disodium
Diflucan - see fluconazole
dihydroergotamine mesylate, nasal spray, 4mg/mL (Migranal-NVR)
For treatment of migraines where standard therapy such as an analgesic or oral
ergotamine product has failed or cannot be tolerated.
dipyridamole, tablet, 25mg, 50mg, 75mg, 100mg (Persantine-BOE)
(a) Following transluminal angioplasty, for a maximum of 6 months.
(b) Following bypass surgery, for a maximum of 12 months.
(c) Following prosthetic heart valve replacement, for 12 months. This is renewable
on a yearly basis.
Dixarit - see clonidine HCl
Dom-Carbamazepine CR – see carbamazepine
Dom-Cefaclor - see cefaclor
Dom-Cyclobenzaprine – see cyclobenzaprine HCl
Dom-Fenofibrate Micro - see fenofibrate (micronized)
Dom-Selegiline – see selegiline HCl
240
dornase alfa, inhalation solution, 1mg/mL (Pulmozyme-HLR)
For treatment of cystic fibrosis patients who meet the following criteria:
(a) at least 5 years of age
(b) Lung function greater than 40% (as measured by FVC)
(c) Physicians will be requested to provide evidence of the beneficial effect of this
drug in their patients after 6 months of therapy before additional coverage is
granted.
Renewal of coverage will be provided for a 6 month period if any of the following
criteria are met:
(a) FEV1 has improved by 10% from pre-treatment value
(b) decreased antibiotic utilization
(c) decreased hospitalizations
(d) decreased absenteeism from school or work
(e) if the individual deteriorates upon discontinuation of Pulmozyme therapy.
Physicians must provide appropriate documentation to establish benefit.
Duragesic - see fentanyl
Edecrin - see ethacrynic acid
efavirenz, capsule, 50mg, 100mg, 200mg (Sustiva-DUP)
Eldepryl - see selegiline HCl
Elmiron - see pentosan polysulfate sodium
enoxaparin, syringe, 100mg/mL (0.3mL, 0.4mL, 0.6mL, 0.8mL, 1mL); injection
solution, 100mg/mL (3mL) (Lovenox-AVT)
syndrome.
(f) For treatment of pediatric patients where anticoagulant therapy is required and
warfarin cannot be administered.
Entocort - see budesonide
epoetin alfa, pre-filled syringe, 1,000 IU/0.5mL, 2,000IU/0.5mL, 3,000IU/0.3mL,
4,000IU/0.4mL, 10,000IU/Ml (Eprex-JAN)
(a) For treatment of anemia in chronic renal disease patients prior to initiation of
dialysis. Note: Coverage for dialysis patients is provided under the
Saskatchewan Aids to Independent Living (S.A.I.L.) Program. Exception Drug
Status coverage is not required for S.A.I.L. patients.
(b) For treatment of anemia in AIDS patients.
Eprex - see epoetin alfa
Ergamisol - see levamisole
Estracomb - see estradiol-17β & norethindrone acetate/estradiol-17β
241
Estraderm - see estradiol-17β
+estradiol-17β
β , transdermal gel (metered dose pump), 0.06% (Estrogel-SCH;
transdermal therapeutic system, 25ug, 50ug, 100ug (Estraderm-NVR), 37.5ug,
50ug, 75ug, 100ug (Vivelle-NVR), 50ug, 100ug (Climara-BEX), 25ug, 50ug (OesclimFFR)
For treatment in patients who are unable to tolerate oral estrogen.
estradiol-17β
β & norethindrone acetate/estradiol-17β
β , transdermal therapeutic
system, 50ug & 250ug/50ug (Estracomb-NVR)
For treatment in patients who are unable to tolerate oral estrogen.
Estrogel – see estradiol-17β
ethacrynic acid, tablet, 50mg (Edecrin-MSD)
For treatment of patients refractory to furosemide.
etidronate disodium, tablet, 200mg (Didronel-PGA)
(a) For treatment of symptomatic Paget's Disease of the bone for a 6 month period.
Coverage can be renewed after a drug holiday of at least 90 days.
(b) For treatment of heterotopic calcification.
(c) For symptomatic management of bone pain due to cancer in the palliative care
patient.
(d) For treatment of osteoporosis in patients who are intolerant to the calcium in
Didrocal.
*etodolac, capsule, 200mg, 300mg (Ultradol-PGA) (Apo-Etodolac-APX) (GenEtodolac-GPM)
For treatment of patients with an intolerance to other NSAIDS listed in the Formulary.
*fenofibrate, capsule, 100mg (Apo-Fenofibrate-APX) (Nu-Fenofibrate-NXP)
*fenofibrate (micronized), capsule, 200mg (Lipidil Micro-FFR) (Apo-Feno-MicroAPX) (Gen-Fenofibrate Micro-GPM) (pms-Fenofibrate Micro-PMS) (Dom-Fenofibrate
Micro-DOM)
fentanyl, transdermal system, 25ug/hr., 50ug/hr., 75ug/hr., 100ug/hr. (DuragesicJAN)
For treatment of patients who cannot tolerate, or are unable to take oral sustainedrelease morphine, or as an alternative to subcutaneous narcotic infusion therapy. In
non-palliative patients, coverage will only be approved for a 6 month course of
therapy.
filgrastim, injection solution, 300ug/mL (Neupogen-AMG)
(a) For treatment of patients with congenital, cyclic or idiopathic neutropenia with
absolute neutrophil counts of less than or equal to 500.
(b) For treatment of non-cancer patients who have undergone bone marrow
transplantation.
(c) For treatment of AIDS patients with absolute neutrophil counts of less than 500.
242
flavoxate HCl, tablet, 200mg (Urispas-PMS)
For treatment of spasms in the urinary tract in patients unresponsive or intolerant to
listed alternatives.
Flexeril - see cyclobenzaprine HCl
Flexitec - see cyclobenzaprine HCl
fluconazole, powder for oral suspension, 10mg/mL (Diflucan-PFI);
*tablet, 50mg, 100mg (Diflucan-PFI) (Apo-Fluconazole-APX)
(a) For treatment of fungal meningitis in immunocompromised patients.
(b) For treatment of severe or life-threatening fungal infections.
(c) For treatment of severe dermatophytoses not responding to other forms of
therapy including ketoconazole.
Note: the 150mg capsule form of fluconazole is listed in the Saskatchewan
Formulary.
flunarizine HCl, capsule, 5mg (Sibelium-JAN)
For prophylaxis of migraines in cases where alternative prophylactic agents have not
been effective.
flurbiprofen sodium, ophthalmic solution, 0.03% (Ocufen-ALL)
cataract surgery.
topical steroids.
Foradil - see formoterol fumarate
+formoterol fumarate, powder for inhalation (capsule), 12ug (Foradil-NVR); powder
for inhalation (package), 6ug/dose, 12ug/dose (Oxeze Turbuhaler-AST)
(a) For treatment of asthma when used in patients on concurrent steroid therapy. It
is important that these patients also have access to a short-acting beta-2 agonist
for symptomatic relief.
(b) For treatment of chronic obstructive pulmonary disease (COPD).
Fortovase – see saquinavir
Fosamax - see alendronate sodium
Fragmin – see dalteparin sodium
Fraxiparine – see nadroparin calcium
Fraxiparine Forte – see nadroparin calcium
ganciclovir sodium, capsule, 250mg (Cytovene-HLR)
(a) For treatment of CMV retinitis and other CMV infections in immunocompromised
patients.
(b) For prevention of CMV in solid organ transplant recipients who are considered at
risk of developing CMV disease. Coverage will be granted for a period of 3
months.
Gen-Carbamazepine CR - see carbamazepine
Gen-Cycloprine - see cyclobenzaprine HCl
Gen-Cyproterone - see cyproterone acetate
243
Gen-Etodolac – see etodolac
Gen-Fenofibrate Micro - see fenofibrate (micronized)
Gen-Minocycline - see minocycline HCl
Gen-Selegiline - see selegiline HCl
Gen-Ticlopidine – see ticlopidine HCl
glatiramer acetate, injection, 20mg (vial) (Copaxone-TVM)
See Appendix J
GlucoNorm - see repaglinide
goserelin acetate, 3.6mg/syringe (Zoladex-AST)
6 months.
halobetasol propionate, cream, 0.05%; ointment, 0.05% (Ultravate-WSD)
For treatment of patients refractory to or intolerant of other listed products.
Heptovir – see lamivudine
Hivid - see zalcitabine
Hp-PAC – see lansoprazole/clarithromycin/amoxicillin
Humalog - see insulin lispro
Humalog Mix25 - see insulin (regular/protamine) lispro
Humatrope - see somatropin
Imitrex - see sumatriptan
indinavir SO4, capsule, 200mg, 400mg (Crixivan-MSD)
Infufer - see iron dextran
Innohep - see tinzaparin sodium
insulin lispro, injection, 100U/mL, vial (10mL), cartridge (5 x 1.5mL, 5 x 3mL)
(Humalog-LIL)
(a) For treatment of patients using insulin pumps.
(b) For treatment of patients with difficult to control diabetes.
insulin (regular/protamine) lispro, injection suspension, 100U/mL, 25%/75%
(5x3mL) (Humalog Mix25-LIL)
For treatment of patients with difficult to control diabetes.
interferon alfa-2a, injection solution albumin (human) free, 3 million IU/1mL, 6
million IU/1mL, 9 million IU/1mL , 18 million IU/3mL (Roferon-A-HLR)
(a) For treatment of chronic active hepatitis B for a period of up to 6 months.
(b) For treatment of chronic active hepatitis C. Coverage will be provided for an
initial 6 month period with potential renewal for 2 additional 6 month periods.
Note: Interferons are not interchangeable. Pharmacists should dispense the product
specified by the physician.
244
interferon alfa-2b, powder for injection, 3 million IU, 5 million IU, 10 million IU;
injection solution albumin (human) free, 6 million IU/mL (0.5mL), 10 million IU/mL
(0.5mL, 1mL); multi-dose pen (kit) albumin (human) free, 18 million IU/pen, 30
million IU/pen, 60 million IU/pen (Intron-A-SCH)
(a) For treatment of chronic active hepatitis B for a period of up to 6 months.
(b) For treatment of chronic active hepatitis C. Coverage will be provided for an
initial 6 month period with potential renewal for 2 additional 6 month periods.
interferon alfa-2b/Ribavirin, injection solution albumin (human) free/capsule
(package), 6 million IU/mL(0.5mL)/200mg; multi-dose pen albumin (human)
free/capsule (package), 15 million IU/mL/200mg (Rebetron-SCH)
For treatment of hepatitis C. Coverage will be provided for an initial 6 month period
with potential renewal for 2 additional 6 month periods.
interferon alpha-n1, injection solution, 3 million IU/mL, 10 million IU/mL (WellferonGLA)
(a) For treatment of juvenile laryngeal papillomatosis (JLP) and condylomata
acuminata unresponsive to other therapy.
(b) For treatment of chronic active hepatitis C in individuals refractory to
recombinant forms of interferon. Coverage will be provided for an initial 6 month
period with potential renewal for 2 additional 6 month periods.
Intron A - see interferon alfa-2b
interferon beta-1a, powder for IM injection, 30ug (Avonex-BGN)
See Appendix J
interferon beta-1a, powder for injection, 11ug (3 million IU); pre-filled syringe, 22ug
(6 million IU), 44ug (12 million IU) (Rebif-SRO)
See Appendix J
interferon beta-1b, powder for injection, 0.3ng (3mL) (Betaseron-BEX)
See Appendix J
Intron A - see interferon alfa-2b
Invirase - see saquinavir
ipratropium bromide/salbutamol SO4, inhalation solution, 0.5mg/3.0mg (2.5mL)
(Combivent-BOE)
For treatment of patients who have difficulty administering a dose from a multi-dose
vial.
iron dextran, injection, 50mg/mL (Infufer-SAB)
For treatment of iron deficiency when patients are intolerant to oral iron replacement
products. Note: Coverage for dialysis patients is provided under the Saskatchewan
Aids to Independent Living (S.A.I.L.) Program. Exception Drug Status coverage is not
required for S.A.I.L. patients.
245
iron sorbitol, injection, 50mg/mL (Jectofer-AST)
For treatment of iron deficiency when patients are intolerant to oral iron replacement
products.
itraconazole, capsule, 100mg; oral solution, 10mg/mL (Sporanox-JAN)
(a) For treatment of severe or life-threatening fungal infections.
(b) For treatment of severe dermatophytoses not responding to other forms of
therapy.
(c) For treatment of onychomycosis.
Jectofer - see iron sorbitol
*ketoconazole, tablet, 200mg (Nizoral-JAN) (Apo-Ketoconazole-APX) (Nu-KetoconNXP) (Novo-Ketoconazole-NOP)
(a) For treatment of severe or life-threatening fungal infections.
(b) For treatment of severe dermatophytoses not responding to other forms of
therapy.
ketorolac tromethamine, ophthalmic solution, 0.5% (Acular-ALL)
cataract surgery.
topical steroids.
*ketotifen fumarate, tablet, 1mg (Zaditen-NVR) (Novo-Ketotifen-NOP) (pmsKetotifen-PMS); syrup, 0.2mg/mL (Zaditen-NVR) (Novo-Ketotifen-NOP) (NuKetotifen-NXP) (Apo-Ketotifen-APX) (pms-Ketotifen-PMS)
For treatment of pediatric patients with asthma who are unresponsive to or unable to
administer alternative prophylactic agents listed in the Formulary.
+lactulose, syrup, 667mg/mL (Acilac-TCH) (pms-Lactulose-PMS)
For treatment of portal systemic encephalopathy.
lamivudine, tablet, 100mg (Heptovir-GLA)
For management of hepatitis B.
lamivudine, tablet, 150mg; oral solution, 10mg/mL (3TC-GLA)
lamivudine/zidovudine, tablet, 150mg/300mg (Combivir-GLA)
246
lansoprazole, delayed release capsule, 15mg, 30mg (Prevacid-ABB)
(a) For a maximum of 8 weeks in treatment of peptic ulcer disease, which includes
gastric and duodenal ulcers, in patients not responding or experiencing unusual
or severe adverse reactions to a reasonable trial with H2 blockers, sucralfate or
misoprostol. Coverage for a repeat treatment will be approved only after a 3-6
month period of no treatment or prophylaxis with an H2 blocker, sucralfate or
misoprostol.
(b) For one year in treatment of symptoms of gastroesophageal reflux disease
(GERD). It was noted that patients with non-erosive GERD could potentially be
reduced to step-down therapy with an H2 antagonist depending on symptom
resolution.
(c) For one year in treatment of severe erosive esophagitis and Zollinger-Ellison
Syndrome. This is renewable on a yearly basis.
(d) For one week for eradication of H. pylori-related infections in individuals with
peptic ulcer disease. Provision will be made for additional coverage in treatment
failures.
lansoprazole/clarithromycin/amoxicillin, 7 day package, 30mg/500mg/500mg (HpPAC-ABB)
For one week for eradication of H. pylori-related infections in individuals with peptic
ulcer disease. Provision will be made for additional coverage in treatment failures.
Leucovorin - see leucovorin calcium
leucovorin calcium, tablet, 5mg (Leucovorin-WYA)
For treatment of folic acid deficiency in patients who have been on long-term therapy
with trimethoprim/sulfamethoxazole.
leuprolide acetate, injection, 3.75mg/mL, 7.5mg/mL; depot injection, 11.25mg (3month SR) (Lupron Depot-ABB)
6 months.
*levamisole, tablet, 50mg (Ergamisol-JAN) (Novo-Levamisole-NOP)
For treatment of high-dose steroid-dependent nephrotic syndrome in children as
adjunct therapy following relapse on corticosteroids.
Levaquin – see levofloxacin
levofloxacin, tablet, 250mg, 500mg (Levaquin-JAN)
Lin-Megestrol - see megestrol acetate tablet
247
Lioresal Intrathecal - see baclofen
Lipidil Micro - see fenofibrate (micronized)
Loniten - see minoxidil
Losec - see omeprazole
Lovenox - see enoxaparin
Lupron Depot - see leuprolide acetate
Maxalt - see rizatriptan benzoate
Maxalt RPD - see rizatriptan benzoate
Med-Cyclobenzaprine - see cyclobenzaprine HCl
Med-Minocycline - see minocycline HCl
Med-Selegiline - see selegiline HCl
Megace - see megestrol acetate tablet
Megace OS - see megestrol acetate oral suspension
*megestrol acetate, tablet, 40mg, 160mg (Megace-BRI) (Lin-Megestrol-LIN) (ApoMegestrol-APX) (Nu-Megestrol-NXP)
For treatment of anorexia, cachexia or an unexplained weight loss in patients with a
diagnosis of acquired immunodeficiency (AIDS).
megestrol acetate, oral suspension (Megace OS-BRI)
For treatment of anorexia, cachexia or an unexplained weight loss in patients with a
diagnosis of acquired immunodeficiency syndrome (AIDS) who are unable to tolerate
tablets.
Mepron - see atovaquone
mercaptopurine, tablet, 50mg (Purinethol-GLA)
(a) For treatment of Crohn's Disease.
(b) For treatment of rheumatoid arthritis.
+methoxsalen, capsule, 10mg (Oxsoralen-ICN) (Oxsoralen Ultra-ICN) (UltramopCDX); lotion, 1% (Oxsoralen-ICN) (Ultramop-CDX)
For treatment of psoriasis, for use prior to PUVA therapy.
methysergide maleate, tablet, 2mg (Sansert-NVR)
For prophylaxis of recurrent vascular headaches. Coverage will be provided for up to
6 months at a time with a 3-4 week medication free interval between courses of
therapy.
midodrine HCl, tablet, 2.5mg, 5mg (Amatine-RBP)
For treatment of orthostatic hypotension.
Migranal - see dihydroergotamine mesylate
Minocin - see minocycline HCl
*minocycline HCl, capsule, 50mg (Minocin-WYA) (Apo-Minocycline-APX) (NovoMinocycline-NOP) (Alti-Minocycline-ALT) (Gen-Minocycline-GPM) (MedMinocycline-MED); 100mg (Minocin-WYA) (Apo-Minocycline-APX) (NovoMinocycline-NOP) (Alti-Minocycline-ALT) (Gen-Minocycline-GPM) (MedMinocycline-MED) (Scheinpharm Minocycline-SCN)
For treatment of acne unresponsive to tetracycline.
248
minoxidil, tablet, 2.5mg, 10mg (Loniten-PHU)
For control of hypertension unresponsive to all other listed therapeutic agents.
montelukast sodium, chewable tablet, 5mg; tablet, 10mg (Singulair-MSD)
(a) For treatment of asthma when used in patients on concurrent steroid therapy.
(b) For treatment of asthma in patients not well controlled with inhaled
corticosteroids.
Mycobutin - see rifabutin
mycophenolate mofetil, capsule, 250mg; tablet, 500mg (CellCept-HLR)
(a) For prevention of acute rejection in renal and cardiac transplant patients, in
combination with cyclosporine. This is renewable on a yearly basis.
(b) For treatment of patients unable to tolerate cyclosporine.
nabilone, capsule, 1mg (Cesamet-LIL)
For treatment of nausea and anorexia in AIDS patients.
*nabumetone, tablet, 500mg (Relafen-SMJ) (Apo-Nabumetone-APX) (NovoNabumetone-NOP)
For treatment of patients with an intolerance to other NSAIDs listed in the Formulary.
nadroparin calcium, syringe, 9,500IU/mL (0.2mL, 0.3mL, 0.4mL, 0.6mL, 0.8mL,
1.0mL) (Fraxiparine-SAW); syringe, 19,000IU/mL (0.6mL, 0.8mL, 1mL) (Fraxiparine
Forte-SAW)
syndrome.
nafarelin acetate, intranasal solution, 2mg/mL (Synarel-HLR)
6 months.
Nalcrom - see sodium cromoglycate
naratriptan HCl, tablet, 1mg, 2.5mg (Amerge-GLA)
For treatment of migraine headaches where other standard therapy such as an
analgesic and/or an ergotamine product have failed. Eligibility will be restricted to
beneficiaries over 18 and under 65 years of age.
The maximum quantity that can be claimed through the Drug Plan is limited to
6 doses per 30 days within a 60 day period. Patients requiring more than 12 doses
in a consecutive 60 day period should be considered for migraine prophylaxis
therapy if they are not already receiving such therapy.
249
nelfinavir mesylate, tablet, 250mg; oral powder, 50mg/g (Viracept-AGR)
Neoral - see cyclosporine
Neupogen - see filgrastim
nevirapine, tablet, 200mg (Viramune-BOE)
nicardipine HCl, capsule, 20mg, 30mg (Cardene-WYA)
For treatment of hypertension and angina in patients who have left ventricular
dysfunction.
nimodipine, capsule, 30mg (Nimotop-BAY)
For treatment of subarachnoid hemorrhage to complete a 3 week course of treatment
in cases where a patient is discharged from hospital before completion of the
treatment period.
Nimotop - see nimodipine
Nizoral - see ketoconazole
norfloxacin, ophthalmic solution, 0.3% (Noroxin Ophthalmic Solution-MSD)
For treatment of ophthalmic infections caused by gram-negative organisms or those
not responding to alternative agents.
*norfloxacin, tablet, 400mg (Noroxin-MSD) (Apo-Norflox-APX) (Novo-NorfloxacinNOP)
(a) For treatment of genitourinary tract infections caused by pseudomonas
aeruginosa.
(b) For treatment of genitourinary tract infections in adults with gonoccoccal
urethritis or cervicitis.
(c) For treatment of genitourinary tract infections in patients allergic to alternative
agents.
(d) For treatment of genitourinary tract infections with organisms known to be
resistant to alternative antibiotics.
Noroxin - see norfloxacin
Norvir - see ritonavir
Norvir SEC - ritonavir
Novo-AZT – see zidovudine
Novo-Cefaclor - see cefaclor
Novo-Cycloprine - see cyclobenzaprine HCl
Novo-Cyproterone - see cyproterone acetate
Novo-Ketoconazole - see ketoconazole
Novo-Ketotifen - see ketotifen fumarate
Novo-Levamisole - see levamisole
Novo-Minocycline - see minocycline HCl
250
Novo-Nabumetone - see nabumetone
Novo-Norfloxacin – see norfloxacin
Novo-Selegiline - see selegiline HCl
Nu-Cefaclor - see cefaclor
Nu-Cyclobenzaprine - see cyclobenzaprine HCl
Nu-Fenofibrate - see fenofibrate
Nu-Ketocon – see ketoconazole
Nu-Ketotifen - see ketotifen fumarate
Nu-Megestrol - see megestrol acetate tablet
Nu-Selegiline - see selegiline HCl
Nu-Ticlopidine - see ticlopidine HCl
Nutropin - see somatropin
Nutropin AQ - see somatropin
Octostim – see desmopressin
octreotide, injection, 50ug/mL (1mL), 100ug/mL (1mL), 200ug/mL (5mL),
500ug/mL (1mL) (Sandostatin-NVR); powder for injection, 10mg/vial, 20mg/vial,
30mg/vial (Sandostatin LAR-NVR)
(a) For management of terminal malignant bowel obstruction in palliative patients.
(b) For treatment of acromegaly.
Note: Coverage for federally approved cancer indications is provided under the
Saskatchewan Cancer Foundation according to their guidelines.
Ocufen - see flurbiprofen sodium
Ocuflox - see ofloxacin ophthalmic solution
Oesclim - see estradiol-17β
ofloxacin, ophthalmic solution, 0.3% (Ocuflox-ALL)
(a) For treatment of ophthalmic infections caused by gram-negative organisms or
those not responding to alternative agents.
(b) For treatment of infiltrative corneal infections.
olanzapine, tablet, 2.5mg, 5mg, 7.5mg, 10mg (Zyprexa-LIL)
(a) For treatment of schizophrenia.
(b) For treatment of other conditions where there has been treatment failure or
intolerance to other atypical anti-psychotic agents.
(c) For treatment of psychosis caused by drugs used in the treatment of Parkinson's
Disease.
omeprazole, delayed release tablet, 10mg (Losec-AST)
(a) For maintenance therapy of healed reflux esophagitis. This is renewable on a
yearly basis.
resolution.
251
omeprazole, enteric coated tablet, 20mg (Losec-AST)
misoprostol.
resolution.
failures.
One-Alpha - see alfacalcidol
Oxeze Turbuhaler - see formoterol fumarate
Oxsoralen - see methoxsalen
oxycodone HCl, controlled release tablet, 10mg, 20mg, 40mg, 80mg (OxyContinPFR)
For treatment of palliative and chronic pain patients as an alternative to ASA/codeine
combination products or acetaminophen/codeine combination products. In nonpalliative patients, coverage will only be approved for a 6 month course of therapy,
subject to review.
OxyContin - see oxycodone HCl
pantoprazole, enteric coated tablet, 40mg (Pantoloc-SLV)
misoprostol.
resolution.
failures.
Pantoloc - see pantoprazole
pentosan polysulfate sodium, capsule, 100mg (Elmiron-ALZ)
For treatment of interstitial cystitis where other treatments have failed.
252
Persantine - see dipyridamole
Plavix – see clopidogrel bisulfate
pms-Bezafibrate - see bezafibrate
pms-Carbamazepine-CR – see carbamazepine
pms-Cefaclor - see cefaclor
pms-Cyclobenzaprine - see cyclobenzaprine HCl
pms-Fenofibrate Micro - see fenofibrate (micronized)
pms-Ketotifen – see ketotifen
pms-Lactulose - see lactulose
pms-Tobramycin – see tobramycin
Prevacid - see lansoprazole
Profasi HP - see chorionic gonadotropin
progesterone (micronized), capsule, 100mg (Prometrium-SCH)
(a) For treatment of patients unable to tolerate medroxyprogesterone acetate
(Provera).
(b) For treatment of patients having low high-density lipoproteins.
Prograf - see tacrolimus
Prometrium - see progesterone (micronized)
Protropin - see somatrem
Pulmozyme - see dornase alfa
Purinethol - see mercaptopurine
Pylorid – see ranitidine bismuth citrate
quetiapine, tablet, 25mg, 100mg, 200mg (Seroquel-AST)
(a) For treatment of schizophrenia.
(b) For treatment of other conditions where there has been treatment failure or
intolerance to other atypical anti-psychotic agents.
ranitidine bismuth citrate, tablet, 400mg (Pylorid-GLA)
For one week for eradication of H. pylori-related infections in patients with an active
duodenal ulcer. It was noted that this product, when combined with two antibiotics
for 7 days, is an effective regimen for H. pylori eradication.
Rebetron – see interferon alfa-2b/Ribavirin
Rebif - see Appendix J
Relafen - see nabumetone
repaglinide, tablet, 0.5mg, 1mg, 2mg (GlucoNorm-NOO)
For treatment of patients intolerant or refractory to sulfonylureas and metformin.
Rescriptor – see delavirdine mesylate
Retin A - see tretinoin
Retrovir - see zidovudine
rifabutin, capsule, 150mg (Mycobutin-PHU)
For prevention of disseminated Mycobacterium avium complex (MAC) disease in
patients with advanced human immunodeficiency virus (HIV) infection.
risedronate sodium, tablet, 30mg (Actonel-PGA)
253
For treatment of symptomatic Paget's Disease of the bone.
ritonavir, oral solution, 80mg/mL; capsule, 100mg (Norvir-ABB); soft elastic
capsule, 100mg (Norvir SEC-ABB)
rizatriptan benzoate, tablet, 5mg, 10mg (Maxalt-MSD); wafer, 10mg
(Maxalt RPD-MSD)
Rocaltrol - see calcitriol
rofecoxib, tablet, 12.5mg, 25mg; oral suspension, 2.5mg/mL (Vioxx-MSD)
(a) For treatment of rheumatoid arthritis and osteoarthritis in patients who have one
or more of the following factors:
age 65 years or over;
•
past history of ulcers;
•
concurrent prednisone therapy;
•
concurrent warfarin therapy.
•
(b) For treatment of patients with an intolerance to other NSAIDs listed in the
Formulary.
Roferon-A - see interferon alfa-2a
Saizen - see somatropin
salmeterol xinafoate, metered dose inhaler, 25ug/actuation; powder disk,
50ug/blister (Serevent-GLA); powder for inhalation (package), 50ug/dose
(Serevent Diskus-GLA)
(a) For treatment of asthma when used in patients on concurrent steroid therapy. It
is important that these patients also have access to a short-acting beta-2 agonist
for symptomatic relief.
(b) For treatment of chronic obstructive pulmonary disease (COPD).
salmeterol xinafoate/fluticasone propionate, powder for inhalation (package),
50ug/100ug, 50ug/250ug, 50ug/500ug (Advair Diskus-GLA)
For treatment of asthma when used in patients on concurrent steroid therapy. It is
important that these patients also have access to a short-acting beta-2 agonist for
symptomatic relief.
Sandostatin - see octreotide
Sandostatin LAR - see octreotide
Sansert - see methysergide maleate
254
saquinavir, capsule, 200mg (Invirase-HLR); soft gelatin capsule, 200mg
(Fortovase-HLR)
Scheinpharm Cefaclor – see cefaclor
Scheinpharm Minocycline - see minocycline
*selegiline HCl, tablet, 5mg (Eldepryl-DPY) (Novo-Selegiline-NOP)
(Apo-Selegiline-APX) (Gen-Selegiline-GPM) (Med-Selegiline-MED)
(Nu-Selegiline-NXP) (Dom-Selegiline-DOM)
(a) For use as an adjunct in cases of Parkinson's Disease being treated with
levodopa, levodopa/benzerazide, levodopa/carbidopa, or bromocriptine.
(b) For prophylaxis in early Parkinsonism.
Serevent - see salmeterol xinafoate
Serevent Diskus - see salmeterol xinafoate
Seroquel – see quetiapine
Sibelium - see flunarizine HCl
Singulair – see montelukast sodium
sodium cromoglycate, capsule, 100mg (Nalcrom-AVT)
(a) For treatment of patients who experience severe reactions to foods which cannot
be avoided.
(b) For treatment of patients with Crohn's Disease or ulcerative colitis not
responding to traditional therapy.
somatrem, injection, 5mg, 10mg (Protropin-HLR)
For treatment of children who have growth failure due to inadequate secretion of
normal endogenous growth hormone.
+somatropin, injection, 3.33mg (Saizen-SRO), 5mg (Humatrope-LIL), 6mg, 12mg
(Humatrope Cartridge-LIL)
normal endogenous growth hormone.
+somatropin, injection, 5mg/vial, 10mg/vial (Nutropin-HLR), 10mg/vial (Nutropin
AQ-HLR)
normal endogenous growth hormone, and who have growth failure associated with
chronic renal insufficiency. Note: Exception Drug Status coverage is not required for
S.A.I.L. patients, coverage is provided under the Saskatchewan Aids to Independent
Living (S.A.I.L.) Program.
Soriatane - see acitretin
Sporanox - see itraconazole
stavudine, capsule, 15mg, 20mg, 30mg, 40mg (Zerit-BRI)
Stieva-A Forte - see tretinoin
255
sumatriptan, tablet, 25mg, 50mg, 100mg; injection solution, 6mg/0.5mL; nasal
spray, 5mg, 20mg (Imitrex-GLA)
Suprax - see cefixime
Suprefact - see buserelin acetate
Sustiva - see efavirenz
Synarel - see nafarelin acetate
Syn-Cyclobenzaprine - see cyclobenzaprine HCl
Syn-Ticlopidine - see ticlopidine HCl
3TC - see lamivudine
tacrolimus, capsule, 1mg, 5mg; ampoule, 5mg/mL (Prograf-FUJ)
For prophylaxis of graft rejection.
Taro-Carbamazepine CR – see carbamazepine
Tegretol CR - see carbamazepine
Ticlid - see ticlopidine HCl
*ticlopidine HCl, tablet, 250mg (Ticlid-HLR) (Apo-Ticlopidine-APX) (Nu-TiclopidineNXP) (Gen-Ticlopidine-GPM) (Syn-Ticlopidine-ALT)
(a) For treatment of patients who have experienced a recurrent vascular episode
while on acetylsalicylic acid.
(b) For treatment of patients who have a clearly demonstrated allergy to
acetylsalicylic acid (manifested by asthma or nasal polyps).
(c) For treatment of patients with an intolerance of acetylsalicylic acid (manifested
by gastrointestinal hemorrhage).
(d) For a period of 4 weeks when prescribed following intracoronary stent
placement.
tinzaparin sodium, syringe, 10,000IU/mL (0.35mL, 0.45mL), 20,000IU/mL (0.5mL,
0.7mL, 0.9mL); injection solution, 10,000IU/mL (2mL), 20,000IU/mL (2mL) (InnohepLEO)
syndrome.
TOBI - see tobramycin inhalation solution
Tobradex - see tobramycin/dexamethasone
Tobramycin - see tobramycin ophthalmic solution
256
tobramycin, inhalation solution, 60mg/mL (TOBI-PCL)
For treatment of cystic fibrosis patients who do not tolerate injectable tobramycin
when used for inhalation.
tobramycin, ophthalmic ointment, 0.3% (Tobrex-ALC);
*ophthalmic solution, 0.3% (Tobrex-ALC) (Tomycine-CBV) (pms-Tobramycin-PMS)
(Tobramycin-RVX)
For treatment of ophthalmic infections in cases not responding to gentamicin
ophthalmic.
tobramycin/dexamethasone, ophthalmic suspension, 0.3%/0.1%; ophthalmic
ointment, 0.3%/0.1% (Tobradex-ALC)
(a) For treatment of ophthalmic infections in cases not responding to therapeutic
alternatives.
(b) For post-operative long-term (>7days) use.
Tobrex - see tobramycin
tocainide HCl, tablet, 400mg (Tonocard-AST)
For treatment of cardiac arrhythmias in patients previously stabilized on this
medication.
tolterodine l-tartrate, tablet, 1mg, 2mg (Detrol-PHU)
For treatment of patients unable to tolerate oxybutynin chloride.
Tomycine - see tobramycin
Tonocard - see tocainide HCl
*tretinoin, cream, 0.1% (Stieva-A Forte-STI) (Retin A-JAN) (Vitamin A Acid-DER)
(Vitinoin-PMS)
For treatment of acne not responding to alternative topical therapy.
triamcinolone hexacetonide, injection suspension, 20mg/mL (Aristospan-STI)
For intra-articular injection in the management of pediatric chronic inflammatory
arthropathies.
Ultradol - see etodolac
Ultramop - see methoxsalen
Ultravate - see halobetasol propionate
Urispas - see flavoxate HCl
Urso - see ursodiol
ursodiol, tablet, 250mg (Urso-AXC)
(a) For treatment of radiolucent gallstones.
(b) For management of cholestatic liver diseases such as primary biliary cirrhosis.
Vancocin - see vancomycin HCl
vancomycin HCl, capsule, 125mg, 250mg; injection, 500mg, 1g (Vancocin-LIL)
For treatment of pseudomembranous colitis for up to two consecutive two week
periods after no response to a course of metronidazole. Repeat approvals will only
be granted with laboratory evidence of c. difficile toxin.
257
Videx - see didanosine
Vioxx - see rofecoxib
Viracept – see nelfinavir mesylate
Viramune – see nevirapine
Vitamin A Acid - see tretinoin
Vitinoin - see tretinoin
Vivelle - see estradiol-17β
Voltaren Ophtha - see diclofenac sodium
Wellbutrin SR – see bupropion HCl
Wellferon - see interferon alpha-n1
Zaditen - see ketotifen fumarate
zafirlukast, tablet, 20mg (Accolate-AST)
(a) For treatment of asthma when used in patients on concurrent steroid therapy.
(b) For treatment of asthma in patients not well controlled with inhaled
corticosteroids.
zalcitabine, tablet, 0.375mg, 0.750mg (Hivid-HLR)
Zerit - see stavudine
Ziagen - see abacavir SO4
zidovudine, tablet, 300mg; syrup, 10mg/mL; injection, 10mg/mL
(Retrovir-GLA)
*capsule, 100mg (Retrovir-GLA) (Apo-Zidovudine-APX) (Novo-AZT-NOP)
Zithromax - see azithromycin
Zoladex - see goserelin acetate
zolmitriptan, tablet, 2.5mg (Zomig-AST)
Zomig - see zolmitriptan
258
zuclopenthixol, acetate injection, 50mg/mL (Clopixol-Acuphase-AVT); decanoate
injection, 200mg/mL (Clopixol-Depot-AVT); dihydrochloride tablet, 10mg, 25mg,
40mg (Clopixol-AVT)
For treatment of patients with schizophrenia not responding to other neuroleptic
medications.
Zyprexa – see olanzapine
LEGEND:
*These brands of products have been approved as interchangeable.
+These brands of products have NOT been approved as interchangeable.
259
SORIATANE
Important Information for Female Patients:
Soriatane can cause deformed babies if it is taken by a female before or during
pregnancy.
•
Do not take Soriatane if you are or may become pregnant during treatment or for an
undetermined period of time* after treatment has stopped.
•
You must avoid becoming pregnant while you are taking Soriatane and for an
undetermined period of time* after you stop taking Soriatane.
•
You must discuss effective birth control with your doctor before beginning treatment
and you must use effective birth control: for at least 1 month before you start
Soriatane; while you are taking Soriatane; and for an undetermined period of time*
after you stop taking Soriatane, bearing in mind that any method of birth control can
fail.
•
It is recommended that you either abstain from sexual intercourse or use 2 reliable
methods of birth control at the same time.
•
Do not take Soriatane until you are sure that you are not pregnant: you must have a
serum pregnancy test within 2 weeks before you start Soriatane; you must wait until
the second or third day of your next menstrual period before you start Soriatane.
•
Contact your doctor immediately if you do become pregnant while taking Soriatane or
after treatment has stopped. You should discuss with your doctor the serious risk of
your baby having severe birth deformities because you are taking or have taken
Soriatane. You should also discuss the desirability of continuing your pregnancy.
•
Do not breast feed while taking Soriatane or for an extended period of time after
treatment has stopped.
*
Soriatane remains in your body for prolonged periods of time after you have
stopped treatment. It is not known exactly how long you must avoid pregnancy
after Soriatane is stopped. The drug has been found in the blood of some
patients for at least 2 years following treatment. Discuss this with your doctor.
Talk with your doctor before you stop birth control.
Important Information for All Patients:
Soriatane can cause deformed babies if taken by a female before or during
pregnancy.
•
Do not give Soriatane to anyone else who has similar symptoms.
•
Do not donate blood, while you are taking Soriatane or for an extended period of time
after treatment has stopped. This is because your blood should not be given to a
pregnant female.
•
Do not consume alcohol while taking Soriatane.
260
APPENDIX B
HOSPITAL BENEFIT DRUG LIST
JULY 1, 2000
NOTIFICATION OF UPDATES TO THE HOSPITAL BENEFIT DRUG LIST
WILL BE PROVIDED IN THE DRUG PLAN QUARTERLY UPDATE
BULLETINS
PLEASE DIRECT INQUIRIES REGARDING THIS LIST TO:
(306) 787- 3224
261
1.
This list of drug benefits under Saskatchewan Health is supplementary to the annual
Saskatchewan Formulary (50th Edition, July 1, 2000). It is intended to expand on
the Formulary as required to meet the special requirements of hospitals.
2.
The Benefit Drug List is updated semi-annually by the Advisory Committee on
Institutional Pharmacy Practice. This committee is composed of representatives of:
the Canadian Society of Hospital Pharmacists (Saskatchewan Branch); the Drug
Quality Assessment Committee; the Association of Saskatchewan Health Services
Executives and officials of the Department of Health. The new additions to the list
are presented in bold type.
3.
In summary, the government is accepting the following items as insured benefits
under The Saskatchewan Hospitalization Act when administered to patients in
hospital. Institutional formularies put in place by District Health Boards may affect
the availability of some insured drugs:
(a)
"All products listed in the Saskatchewan Formulary." (Brands other than
those listed are not considered as interchangeable.)
(b)
Unlisted strengths of products included in the Saskatchewan Formulary or
approved for Exception Drug Status coverage (see item 5). [This applies
only to brands manufactured by the same supplier(s).]
(c)
Generally accepted nursing treatments, agents such as antiseptics,
disinfectants, mouthwashes, lozenges, lubricants, soaps and emollients.
(d)
All diagnostic agents.
(e)
All irrigating solutions.
(f)
All radioactive agents.
(g)
All injectable vitamins and injectable multivitamin preparations when used
to maintain or attain nutritional status.
(h)
Alcoholic beverages such as beer, stout, brandy and whiskey.
(i)
All dietary supplements.
(j)
All antacids and laxatives marketed by approved manufacturers.
(k)
All hemostatic agents.
(l)
All agents appearing on the attached supplemental list including all dosage
forms and strengths unless otherwise indicated in the list. Prolonged
release, sustained release, and delayed release dosage forms are benefits
only when specifically listed.
(m) New dosage forms, drug entities and other products released on the
market after the effective date of this list are not insured hospital benefits.
They may be charged to hospital clients until reviewed and approved as
an insured benefit by the Saskatchewan Formulary Committee or the
Advisory Committee on Institutional Pharmacy Practice.
262
4.
Formularies established by health facilities or District Health Boards may not include
all insured items. If an insured drug is not included in a facility or Health District
formulary, its provision will be subject to facility or District Health Board policy.
5.
Only drugs listed in the Saskatchewan Formulary, and not those on the Benefit Drug
List, are an insured benefit when dispensed to ambulatory patients, i.e. through retail
pharmacies or an organized hospital dispensing service.
6.
For certain patients, the Prescription Drug Services Branch may approve/has
approved Exception Drug Status coverage, on an outpatient basis, for certain
products which are not listed in the Saskatchewan Formulary or the Benefit Drug
List. Patients with such coverage have been issued a letter of authorization which,
upon presentation in a hospital, also entitles the beneficiary to receive the specified
drug as an inpatient benefit (notwithstanding Statement 4 above).
In cases where treatment with a product known to be eligible for Exception Drug
Status Coverage is initiated in the hospital, it will be recognized as an inpatient
benefit providing the patient's case meets the eligibility criteria listed in the
Saskatchewan Formulary. The drugs eligible for such coverage and the criteria for
patient eligibility are published in the Saskatchewan Formulary as Appendix A.
7.
Certain products are benefits only when used according to specific criteria. The
usage criteria or restrictions that apply are shown for each product. When these
products are ordered, the ordering physician and/or the pharmacist must determine if
the conditions for coverage have been met. When the conditions are met, the
patient receives the drug as a benefit. The cost is absorbed by the health district.
The district may choose to charge the patient for administration of drugs in this
section that fails to meet the criteria/restrictions listed.
8.
Combination products are only benefits if they are specifically included in the Benefit
Drug List. Listing of one ingredient included in a combination product does not make
that product a benefit.
9.
Products that are not listed in either the Saskatchewan Formulary or this
supplementary benefit drug list, or which have not received special approval, are not
insured and therefore chargeable to a patient in accordance with instructions
included in Statement 137.
10. Certain products may be granted Restricted Coverage status for non-approved
indications. This is the case only when the Advisory Committee for Institutional
Pharmacy Practice has reviewed evidence to demonstrate safety and efficacy and
the prescriber is aware the drug is being prescribed for a non-approved indication.
263
TABLE OF CONTENTS
04:00.00
ANTIHISTAMINE DRUGS
268
08:00.00
ANTI INFECTIVE AGENTS
268
08:12.00
ANTIBIOTICS
08:12.02
AMINOGLYCOSIDES
08:12.04
ANTIFUNGALS
08:12.06
CEPHALOSPORINS
08:12.07
MISCELLANEOUS BETA LACTAM ANTIBIOTICS
08:12.08
CHLORAMPHENICOL
08:12.12
ERYTHROMYCINS
08:12.16
PENICILLINS
08:12.28
MISCELLANEOUS ANTIBIOTICS
268
268
268
268
269
269
269
269
269
08:16.00
ANTITUBERCULOSIS AGENTS
269
08:18.00
ANTIVIRALS
270
08:22.00
QUINOLONES
270
08:40.00
MISCELLANEOUS ANTI INFECTIVES
270
10:00.00
ANTINEOPLASTIC AGENTS (AGENTS USED FOR NON-CANCER
INDICATIONS. SEE FORMULARY OF THE SASKATCHEWAN CANCER
FOUNDATION FOR A COMPLETE LISTING OF ANTINEOPLASTIC AGENTS.)
270
12:00.00
271
12:04.00
AUTONOMIC DRUGS
PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
271
12:08.00
ANTICHOLINERGIC AGENTS
12:08.08
ANTIMUSCARINIC/ANTISPASMODICS
271
271
12:12.00
SYMPATHOMIMETIC (ADRENERGIC) AGENTS
271
12:16.00
SYMPATHOLYTICS
272
12:20.00
SKELETAL MUSCLE RELAXANTS
272
20:00.00
272
20:04.00
ANTIANEMIA DRUGS
272
20:04.04
IRON PREPARATIONS
272
20:12.00
COAGULANTS AND ANTICOAGULANTS
20:12.04
ANTICOAGULANTS
20:12.08
ANTIHEPARIN AGENTS
264
272
272
273
20:12.16
20:40.00
24:00.00
HEMOSTATICS
273
THROMBOLYTIC AGENTS
273
273
24.04.00
CARDIAC DRUG
273
24:08.00
HYPOTENSIVE AGENTS
274
24:12.00
VASODILATING AGENTS
274
28:00.00
28:04.00
CENTRAL NERVOUS SYSTEM AGENTS
GENERAL ANESTHETICS
274
274
28:08.00
ANALGESICS AND ANTIPYRETICS
28:08.04
NON-STEROIDAL ANTI-INFLAMMATORY AGENTS
28:08.08
OPIATE AGONISTS
28:08.12
OPIATE PARTIAL AGONISTS
28:08.92
MISCELLANEOUS ANALGESICS AND ANTIPYRETICS
275
275
275
275
275
28:10.00
OPIATE ANTAGONISTS
275
28:12.00
ANTICONVULSANTS
275
28:16.00
PSYCHOTHERAPEUTIC AGENTS
28:16.08
TRANQUILIZERS
275
275
28:20.00
276
RESPIRATORY AND CEREBRAL STIMULANTS
28:24.00
ANXIOLYTICS, SEDATIVES AND HYPNOTICS
276
28:24.04
BARBITURATES
276
28:24.08
BENZODIAZEPINES
276
28:24.92
MISCELLANEOUS ANXIOLYTICS, SEDATIVES AND HYPNOTICS276
36:00.00
36:56.00
40:00.00
DIAGNOSTIC AGENTS
276
MYASTHENIA GRAVIS
276
ELECTROLYTIC, CALORIC AND WATER BALANCE
276
40:08.00
ALKALINIZING AGENTS
276
40:20.00
CALORIC AGENTS
277
40:28.00
DIURETICS
277
44:00.00
ENZYMES
278
265
48:00.00
ANTITUSSIVES, EXPECTORANTS AND MUCOLYTIC AGENTS
278
48:08.00
ANTITUSSIVES
278
48:16.00
EXPECTORANTS
278
52:00.00
EYE, EAR, NOSE AND THROAT PREPARATIONS
278
52:04.00
ANTI-INFECTIVES
52:04.04
ANTIBIOTICS
278
278
52:16.00
LOCAL ANESTHETICS
278
52:20.00
MIOTICS
279
52:24.00
MYDRIATICS
279
52:32.00
VASOCONSTRICTORS
279
52:36.00
MISCELLANEOUS EYE, EAR, NOSE AND THROAT DRUGS
279
56:00.00
279
56:04.00
ANTACIDS AND ADSORBENTS
279
56:08.00
ANTIDIARRHEA AGENTS
279
56:12.00
CATHARTICS AND LAXATIVES
279
56:20.00
EMETICS
280
56:22.00
ANTIEMETICS
280
64:00.00
HEAVY METAL ANTAGONISTS
280
68:00.00
HORMONES AND SYNTHETIC SUBSTITUTES
280
68:04.00
ADRENALS
280
68:08.00
ANDROGENS
280
68:28.00
PITUITARY
281
72:00.00
LOCAL ANESTHETICS
281
76:00.00
OXYTOCICS
281
80:00.00
SERUMS, TOXOIDS AND VACCINES
282
266
80:04.00
SERUMS
282
80:08.00
TOXOIDS
282
80:12.00
VACCINES
283
84:00.00
SKIN AND MUCOUS MEMBRANE AGENTS
283
84:04.00
ANTI INFECTIVES
84:04.04
ANTIBIOTICS
84:04.16
MISCELLANEOUS LOCAL ANTI-INFECTIVES
283
283
283
84:08.00
ANTI PRURITICS AND LOCAL ANESTHETICS
284
84:24.00
EMOLLIENTS, DEMULCENTS ANDPROTECTANTS
284
84:40:00 HEMORRHOID PREPARATIONS
88:00.00
88:16.00
92:00.00
VITAMINS
284
284
VITAMIN D
284
267
284
04:00.00
ANTIHISTAMINE DRUGS
CYPROHEPTADINE
Tablet 4mg
Syrup 0.4mg/mL
DIPHENHYDRAMINE (injection only)
Injection 50mg/mL
PROMETHAZINE
Injection 25mg/mL
08:00.00
ANTI INFECTIVE AGENTS
08:12.00
ANTIBIOTICS
08:12.02
AMINOGLYCOSIDES
AMIKACIN
Injection 250mg/mL
TOBRAMYCIN
Injection 10mg/mL, 40mg/mL
Powder 1.2g
08:12.04
ANTIFUNGALS
AMPHOTERICIN B
Injection 50mg
FLUCONAZOLE
Restricted Coverage: Injection
Injection 2mg/mL
FLUCYTOSINE (HPB – Emergency Drug Release)
Injection 1g, 5g, 10g
Capsules 500mg
08:12.06
CEPHALOSPORINS
CEFAZOLIN
Injection 500mg, 1g
CEFOTAXIME
Restricted Coverage: Benefit status is automatic for first 72 hours in severe
infections. Long term use is covered when supported by sensitivity tests.
Injection 500mg, 1g, 2g
CEFOTETAN
Injection 1g, 2g
CEFOXITIN SODIUM
Injection 1g, 2g
CEFTAZIDIME
Restricted Coverage: Benefit status is automatic for first 72 hours in severe
infections. Long term use is covered when supported by sensitivity tests.
CEFTRIAXONE
Restricted Coverage:
a) Benefit status is automatic for first 72 hours in severe infections.
Long term use is covered when supported by sensitivity tests.
268
b) Treatment of uncomplicated gonococcal infections in adults when administered
as a single, 250mg, intramuscular dose (250mg vials are available without
charge from the Laboratory and Disease Control Services Branch,
Saskatchewan Health.)
CEFUROXIME (see Appendix A – Saskatchewan Health Formulary)
Tablet (axetil) 125mg
Injection 750mg, 1.5g
CEPHALOTHIN injection
08:12.07
MISCELLANEOUS BETA LACTAM ANTIBIOTICS
IMIPENEM/CILASTATIN
Restricted Coverage: For the treatment of severe infections on the recommendation
of an infectious disease specialist; internist or medical microbiologist.
Injection 250mg/250mg; 500mg/500mg
08:12.08
CHLORAMPHENICOL
CHLORAMPHENICOL
Injection 1g
08:12.12
ERYTHROMYCINS
ERYTHROMYCIN
Injection (lactobionate) 500mg, 1g
08:12.16
PENICILLINS
AMPICILLIN
Injection 125mg, 250mg, 500mg, 1g, 2g
PIPERACILLIN
Injection 2g, 3g, 4g
Piperacillin/Tazobactam
Restricted Coverage: For the treatment of severe infections on the
recommendation of an infectious disease specialist; internist or medical
microbiologist.
Injection 2g/0.25g; 3g/0.375g; 4g/0.5g
TICARCILLIN
Injection 3g
08:12.28
MISCELLANEOUS ANTIBIOTICS
BACITRACIN STERILE
Vial 50,000 units
POLYMYXIN B SULFATE (injection only) (HPB – Special Access)
VANCOMYCIN
Injection
08:16.00
ANTITUBERCULOSIS AGENTS
ETHAMBUTOL
Tablet 100mg, 400mg
ISONIAZID
269
Tablet 50mg, 100mg, 300mg
Syrup 10mg/mL
PYRAZINAMIDE
Tablet 500mg
RIFAMPIN
Capsule 150mg, 300mg
08:18.00
ANTIVIRALS
ACYCLOVIR
a) IV form only when used for treatment of initial and recurrent mucosal and
cutaneous herpes simplex infections in immunocompromised patients and;
b) IV form when used for severe initial episodes of herpes simplex infections in
patients who may not be immunocompromised.
Suspension 40mg/mL
Injection 500mg, 1g
FOSCARNET
Injection 24mg/mL
GANCICLOVIR (see Appendix A - Saskatchewan Health Formulary)
Vial 500mg
RIBAVIRIN
Restricted Coverage: When used in a Pediatric Intensive Care Unit,
preferably on the basis of consultation with an infectious disease specialist, and
for proven or seriously ill cases during an outbreak of the Respiratory Syncytial
Virus (RSV).
Powder for inhalation solution 6g
08:22.00
QUINOLONES
CIPROFLOXACIN
Injection 10mg/mL
LEVOFLOXACIN
08:40.00
MISCELLANEOUS ANTI INFECTIVES
PENTAMIDINE ISETHIONATE
Injection 300mg
Oral inhalation solution 300mg
10:00.00
ANTINEOPLASTIC AGENTS (Agents used for non-cancer indications.
See Formulary of the Saskatchewan Cancer Foundation for a complete listing of
antineoplastic agents.)
BLEOMYCIN
Injection 15 unit
CYCLOPHOSPHAMIDE
Tablet 25mg, 50mg
Injection 200mg, 1g
DAUNORUBICIN
Injection 20mg
DOXORUBICIN
Injection 2mg/mL
270
FLUOROURACIL
Injection 50mg/mL
METHOTREXATE
Injection 10mg/mL (2mL), 25mg/mL (2mL, 4mL, 8mL, 20mL, 40mL,
200mL)
Powder for injection 20mg
12:00.00
AUTONOMIC DRUGS
12:04.00
PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
EDROPHONIUM
Injection 10mg/mL
NEOSTIGMINE
Injection 0.5mg/mL (1:2000), 1mg/mL (1:1000)
Injection 2.5mg/mL (5mL)
PHYSOSTIGMINE (HPB - Emergency Drug Release)
Injection 1mg/mL
12:08.00
ANTICHOLINERGIC AGENTS
12:08.08
ANTIMUSCARINIC/ANTISPASMODICS
- Also known as SCOPOLAMINE BUTYLBROMIDE
Injection 20mg/mL
HYOSCINE HYDROBROMIDE
- Also known as SCOPOLAMINE HYDROBROMIDE
Injection 0.4mg/mL, 0.6mg/mL
12:12.00
SYMPATHOMIMETIC (ADRENERGIC) AGENTS
DOBUTAMINE
Injection 12.5mg/mL
DOPAMINE
Injection 40mg/mL (20mL)
IV premixed bag 0.8mg/mL (250mL, 500mL) D5W
EPHEDRINE
Injection 50mg/1mL
Tablet 8mg, 15mg, 25mg, 30mg
Capsule 25mg
ISOPROTERENOL
Injection 0.2mg/mL (1:5000)
METHOXAMINE
Aqueous solution 20mg/mL (1mL)
NOREPINEPHRINE
Injection 1mg/mL
PHENYLEPHRINE
Injection 10mg/mL
PSEUDOEPHEDRINE
Tablet 60mg
Syrup 6mg/mL
271
12:16.00
SYMPATHOLYTICS
PHENTOLAMINE MESYLATE
Injection 5mg vial
12:20.00
SKELETAL MUSCLE RELAXANTS
ATRACURIUM BESYLATE
Injection 10mg/mL (5mL, 10mL)
GALLAMINE TRIETHIODIDE
PANCURONIUM
Injection 2mg/mL
ROCURONIUM
SUCCINYLCHOLINE
Injection 20mg/mL
TUBOCURARINE
VECURONIUM
Injection 10mg
20:00.00
20:04.00
ANTIANEMIA DRUGS
20:04.04
IRON PREPARATIONS
FERROUS FUMARATE
Capsule
FERROUS GLUCONATE
Tablet
FERROUS SULPHATE
Tablet
Syrup
Oral drops
Oral solution
IRON DEXTRAN
Injection 50mg elemental iron/mL
IRON-SORBITOL
Injection 50mg iron/mL
20:12.00
COAGULANTS AND ANTICOAGULANTS
20:12.04
ANTICOAGULANTS
ANCROD
Injection 70 IU/mL
HEPARIN (not including low molecular weight formulations)
Injection 1,000 IU/mL (1mL, 10mL, 30mL)
Injection (subcutaneous) 25000 IU/mL (0.2mL, 2mL)
Injection (heparin lock flush) 100 IU/mL (2mL, 10mL)
IV premixed bags all strengths mixed in D5W and 0.9% NaCl
272
20:12.08
ANTIHEPARIN AGENTS
PROTAMINE SULPHATE
Injection 10mg/mL
20:12.16
HEMOSTATICS
AMINOCAPROIC ACID
Tablet 500mg
Syrup 250mg/mL
Injection 250mg/mL
ANTIHEMOPHILIC FACTOR VIII (HUMAN)
APROTININ
Injection 10,000 Kallikrein Inhibitory Units/mL
FACTOR IX
THROMBIN
Powder 5000 unit, 10000 unit vials
20:20.00
SKELETAL MUSCLE RELAXANT
ATRACURIUM BESYLATE
Ampoules 10mg
Injection 10mg/mL (single use 5mL vials)
Injection 10mg/mL (multi-use 10mL vials)
20:40.00
THROMBOLYTIC AGENTS
STREPTOKINASE
Injection 250,000 IU, 750000 IU, 1.5 million IU
TISSUE PLASMINOGEN ACTIVATOR (tPA)
Restricted Coverage: Streptokinase is the drug of choice when thrombolytic
therapy in myocardial infarction is indicated. R-tPA should be used instead of
streptokinase under the following circulstances:
• patients with larger acute myocardial infarction and presenting within four
(4) hours.
• high risk inferior wall myocardial infarctions.
• known allergy to streptokinase.
• received streptokinase in the past (5 days – 3 years).
• patients with significant hypotension or cardiogenic shock.
Injection 50mg, 100mg
24:00.00
24.04.00
CARDIAC DRUG
ADENOSINE
Restricted Coverage: When used as an antiarrhythmic – for conversion to sinus
rhythm of paroxysmal supraventricular tachycardia, including those associated with
accessory bypass tracts (Wolf-Parkinson-White Syndrome).
Injection 3mg/mL
BRETYLIUM TOSYLATE
Injection 50mg/mL
DIGOXIN
Injection 0.05mg/mL (1mL), 0.25mg/mL (2mL)
273
DILTIAZEM
ESMOLOL
Restricted Coverage: For use in Operating Room or Critical Care Areas only for: the
perioperative management of tachycardia and hypertension in patients with atrial
fibrillation or atrial flutter in acute situations.
MILRINONE
a) When used in the short term management of ventricular dysfunction
unresponsive to digitalis, diuretics and vasodilators or as an aid to weaning off
an intra-aortic balloon pump when other inotropes have failed.
b) Must be administered in a critical care setting capable of invasive cardiac
monitoring including cardiac output, pulmonary capillary wedge
pressures and systemic vascular resistance.
PROCAINAMIDE
24:08.00
HYPOTENSIVE AGENTS
DIAZOXIDE
LABETALOL
Injection 5mg/mL
SODIUM NITROPRUSSIDE
Injection 50mg
24:12.00
VASODILATING AGENTS
NIMODIPINE
NITROGLYCERIN
PAPAVERINE
28:00.00
CENTRAL NERVOUS SYSTEM AGENTS
28:04.00
GENERAL ANESTHETICS
DESFLURANE
Inhalation solution 1mL/mL (240mL)
ENFLURANE
Solution 250mL
HALOTHANE
Solution 250mL
ISOFLURANE
Solution 100mL
KETAMINE
PROPOFOL
Injection 10mg/mL (20mL, 50mL, 100mL)
SEVOFLURANE
Solution 250mL
274
THIOPENTAL
Injection kit 1g, 2.5g
28:08.00
28:08.04
NON-STEROIDAL ANTI-INFLAMMATORY AGENTS
Tablet
Enteric coated tablet
Suppository
28:08.08
OPIATE AGONISTS
ALFENTANIL
FENTANYL
Injection 50ug/mL
METHADONE
Powder for oral solution
(Use of methadone is restricted to Health Protection Branch authorized
prescribers)
SUFENTANIL
Injection 50ug/mL
28:08.12
OPIATE PARTIAL AGONISTS
NALBUPHINE
Ampoule 10mg/mL
28:08.92
MISCELLANEOUS ANALGESICS AND ANTIPYRETICS
ACETAMINOPHEN
Tablet (chewable)
Tablet
Oral liquid
Elixir
Suppository
28:10.00
OPIATE ANTAGONISTS
NALOXONE
28:12.00
ANTICONVULSANTS
28:12.92
MISCELLANEOUS ANTICONVULSANTS
MAGNESIUM SULFATE
Injection 50mg/mL
28:16.00
PSYCHOTHERAPEUTIC AGENTS
28:16.08
TRANQUILIZERS
275
LOXAPINE
Oral solution 25mg/mL
28:20.00
RESPIRATORY AND CEREBRAL STIMULANTS
DOXAPRAM
Restricted Coverage: When used for approved indications.
28:24.00
ANXIOLYTICS, SEDATIVES AND HYPNOTICS
28:24.04
BARBITURATES
METHOHEXITAL
Injection 500mg
28:24.08
BENZODIAZEPINES
MIDAZOLAM
Injection 1mg/mL (2mL, 5mL, 10mL), 5mg/mL (1mL, 2mL, 10mL)
28:24.92
MISCELLANEOUS ANXIOLYTICS, SEDATIVES AND HYPNOTICS
DROPERIDOL
Injection 2.5mg/mL
PARALDEHYDE
Injection 5mL ampoule (1mL is equivalent to approximately 1g)
36:00.00
DIAGNOSTIC AGENTS
36:56.00
MYASTHENIA GRAVIS
EDROPHONIUM
Injection 10mg/mL
40:00.00
ELECTROLYTIC, CALORIC AND WATER BALANCE
40:08.00
ALKALINIZING AGENTS
SODIUM BICARBONATE injectable preparations
Injection 0.5mEq/mL (4.2%), 1mEq/mL (8.4%) pre-load syringe
Injection 5g/100mL (5%) (500mL)
Injection 75mg/mL (7.5%)
Injection 1mEq/mL (8.4%)
TROMETHAMINE injection
Injection 36mg/mL (0.3 Molar)
40:12.00
ELECTROLYTE AND FLUID REPLACEMENT
CALCIUM CHLORIDE
Injection 10% - 100mg/mL (27mg elemental calcium/mL)
CALCIUM GLUCONATE
Injection 10% - 100mg/mL (9mg elemental calcium/mL)
276
CALCIUM ORAL DOSAGE FORMS
Note:
500mg elemental calcium = 12.5mmol or 25mEq elemental calcium
DEXTRAN 40
Solution 10% in D5W 500mL
Solution 10% in Saline 0.9% 500mL
DEXTRAN 70
Solution 6% in Saline 0.9% 500mL
MAGNESIUM ORAL DOSAGE FORMS
MAGNESIUM SULPHATE
Injection 50% - 500mg/mL (50mg elemental magnesium/mL)
Note:
5mg elemental magnesium = 0.2mmol or 0.4mEq elemental magnesium
PHOSPHATE
Injection potassium phosphate dibasic 236mg/mL
Injection potassium phosphate monobasic 224mg/mL
Effervescent tablet 500mg
POTASSIUM ACETATE
Injection 392mg/mL
POTASSIUM CHLORIDE
Injection 2mEq elemental potassium/mL
POTASSIUM PHOSPHATE
Vial 3mmol/mL
SODIUM CHLORIDE
Injection 2.5mEq/mL
Injection 4mEq/mL
SODIUM PHOSPHATE
Injection 3 mmol/mL
ZINC ORAL DOSAGE FORMS
40:20.00
CALORIC AGENTS
ABSOLUTE ALCOHOL INJECTION (dehydrated alcohol)
Injection 100% (10mL)
AMINO ACIDS SOLUTIONS (with or without electrolytes)
Includes all single substrate formulations
AMINO ACIDS / DEXTROSE SOLUTIONS (with or without electrolytes)
Includes all multisubstrate formulations
DEXTROSE
Injection 5%, 10%, 50%
FAT EMULSION PREPARATIONS
Injection 10%, 20%, 30%
40:28.00
DIURETICS
MANNITOL
277
44:00.00
ENZYMES
CHYMOPAPAIN
Restricted Coverage: When recommended by an authorized orthopaedic surgeon or
neurosurgeon.
Injection, intradiscal 4NKAT Units/2mL
HYALURONIDASE
Injection 150 USP units/mL (1mL, 10mL)
48:00.00
ANTITUSSIVES, EXPECTORANTS AND MUCOLYTIC AGENTS
48:08.00
ANTITUSSIVES
DEXTROMETHORPHAN
Syrup 3mg/mL
48:16.00
EXPECTORANTS
GUAIFENESIN
48:24.00
MUCOLYTIC AGENTS
ACETYLCYSTEINE INJECTION
Antidote for acetaminophen poisoning
20% solution
52:00.00
EYE, EAR, NOSE AND THROAT PREPARATIONS
52:04.00
ANTI-INFECTIVES
52:04.04
ANTIBIOTICS
POLYMYXIN B/GRAMICIDIN or BACITRACIN
Ophthalmic/otic solution, each mL: 10,000 units/0.25mg (gramicidin)
Ophthalmic ointment, each g: 10,000 units/500 units (bacitacin)
52:16.00
LOCAL ANESTHETICS
BENZOCAINE
Gel, topical 7.5%
Spray, 20%
Gel, topical 20%
COCAINE
Topical solution 100mg/mL: 4% (4mL), 10% (5mL)
LIDOCAINE (except for lozenges and suppositories)
Aerosol, endotracheal
Liquid (viscous), topical 2%
PROPARACAINE
Ophthalmic solution 0.5%
TETRACAINE
Ophthalmic solution minums 0.5%
Aerosol 754 mg / 65g (oral)
278
52:20.00
MIOTICS
ACETYLCHOLINE
Solution, intraocular irrigation 10mg/mL
52:24.00
MYDRIATICS
PHENYLEPHRINE
Ophthalmic solution minums 10%
TROPICAMIDE
Ophthalmic solution 0.5%, 1%
52:32.00
VASOCONSTRICTORS
NAPHAZOLINE
XYLOMETAZOLINE
Nasal spray 0.05%, 0.1%
Nasal solution 0.05%, 0.1%
52:36.00
MISCELLANEOUS EYE, EAR, NOSE AND THROAT DRUGS
ALUMINUM ACETATE
Solution, otic 0.5%
ARTIFICIAL TEARS
Ophthalmic solution
FLUORESCEIN SODIUM
Ophthalmic solution 2%, 10%
Strip, ophthalmic 1mg
56:00.00
56:04.00
ANTACIDS AND ADSORBENTS
ACTIVATED CHARCOAL
Suspension (aqueous), oral - 200mg/mL
Suspension (in sorbitol), oral - 200mg/mL
56:08.00
ANTIDIARRHEA AGENTS
ATTAPULGITE
Tablet 300mg, 600mg, 750mg
Suspension 40mg/mL, 50mg/mL
56:12.00
CATHARTICS AND LAXATIVES
CASTOR OIL
36.4% (115mL)
FLEET
Enema with monobasic sodium phosphate 16g/100mL, dibasic sodium
phosphate 6g/100mL
279
Enema with monobasic sodium phosphate 16g/100mL, dibasic sodium
phosphate 6g/100mL, & mineral oil
FLEET PHOSPHO - SODA BUFFERED SALINE
Oral solution with sodium biphosphate 900mg/5mL, sodium phosphate
monobasic 2.4g/5mL
GLYCERIN
Suppository - infant 1.63g, adult 2.67g
SENNOSIDES (Standardized)
Liquid 119mg/70mL
Powder 157.5mg/21g pouch
Tablet 8.6mg, 12mg, 15mg, 25mg
Granules 15mg/3g=1tsp
Syrup 1.7mg/mL (70mL, 100mL, 250mL, 500mL)
Suppository 30mg
56:20.00
EMETICS
IPECAC
Syrup
56:22.00
ANTIEMETICS
DROPERIDOL
Injection 2.5mg/mL
64:00.00
HEAVY METAL ANTAGONISTS
CALCIUM DISODIUM EDETATE
Restricted Coverage: Used in the treatment of lead poisonings and other select
heavy metal poisonings (zinc, manganese, nickel, chromium and certain
radioisotopes). (Coverage not provided for chelation therapy.)
Injection 200mg/mL
DEFEROXAMINE MESYLATE
Injection 500mg, 2g vial
DIMERCAPROL
Injection 100mg/mL
68:00.00
HORMONES AND SYNTHETIC SUBSTITUTES
68:04.00
ADRENALS
METHYLPREDNISOLONE
Plain
Injection 40mg, 50mg, 125mg, 500mg, 1g
Injection (depot) 20mg/mL, 40mg/mL, 80mg/mL (5mL)
With Lidocaine
Injection 10mg/mL, 40mg/mL (1mL, 2mL, 5mL)
68:08.00
ANDROGENS
FLUOXYMESTERONE
Tablet 5mg
280
68:28.00
PITUITARY
ACTH (adrenocorticotropic hormone / corticotropin)
Jelly 80 unit/mL (5mL)
Powder 80 unit
VASOPRESSIN
Injection (aqueous) 20 units/mL
68:36.00 THYROID AND ANTITHYROID AGENTS
POTASSIUM IODIDE
Tablet 130mg
72:00.00
LOCAL ANESTHETICS
ARTICAINE
Cartridge 4% (5ug/mL epinephrine) (1.7mL)
BUPIVACAINE
Injection 0.25%, 0.5%, 0.75%
Injection 0.25% with epinephrine 1:200,000
Injection, spinal 0.75% with dextrose 8.25% (2mL)
CHLOROPROCAINE
Injection, caudal-epidural 2%, 3%
LIDOCAINE (with the exception of lozenges or suppositories)
Injection 0.5%, 1%, 2%
Injection 1% with epinephrine 1:100,000
Injection, epidural 1.5%, 2%
Injection, epidural 1.5% with epinephrine 1:200,000
Injection, epidural 2% with carbon dioxide
Injection, spinal 5% with glucose 7.5% - 2mL vial
MEPIVACAINE
Injection 1%
Injection, caudal-epidural 1%, 2%
PRILOCAINE
Solution 4%
PROCAINE
Vial 2%
TETRACAINE
Injection 20mg ampoule
76:00.00
OXYTOCICS
ALPROSTADIL
Injection 0.5mg/mL
CARBOPROST
Injection 250mg/mL
DINOPROSTONE
Tablet 0.5mg
Gel 0.5mg/2.5mL, 1mg/2.5mL, 2mg/2.5mL syringe
Vaginal insert 10mg
281
DINOPROST TROMETHAMINE
Injection 5mg/mL
ERGOMETRINE MALEATE
Injection 0.25mg/mL
OXYTOCIN
Injection 10 units/mL
80:00.00
SERUMS, TOXOIDS AND VACCINES
Note:
* indicates the product is supplied to health districts by Saskatchewan Health
**indicates the product is supplied to health districts by the Canadian Blood Services
80:04.00
SERUMS
DIGOXIN IMMUNE FAB
a) When used for the treatment of severe, life threatening digoxin toxicity as
defined by: (1) severe ventricular tachy or bradyarrhythmias and/or (2)
progressive hyperkalemia of greater then 5mmol/L in the setting of severe
digoxin toxicity.
b) It is recommended one of the following medical specialties be consulted before
this agent is administered: cardiologist; internist; or pediatrician.
Injection 38mg
DIPHTHERIA ANTITOXIN*
Injection 20,000 IU vial
HEPATITIS B IMMUNE GLOBULIN (HUMAN)**
IMMUNE GLOBULIN (HUMAN IV)**
Injection 0.5%, 10% solution
IMMUNE SERUM GLOBULIN (HUMAN IM)
Injection 18%
TETANUS IMMUNE GLOBULIN (HUMAN)
Injection 250 unit
80:08.00
TOXOIDS
DIPHTHERIA TOXOID*
50Lf/mL (1mL, 10mL)
DIPHTHERIA TETANUS TOXOIDS*
Injection (2Lf / 0.5mL diphtheria toxoid and 5Lf/0.5mL tetanus toxoid)
(5mL – adult adsorbed)
Injection (25Lf/0.5mL diphtheria toxoid and 5Lf/0.5mL tetanus toxoid) (0.5mL,
5mL)
DIPHTHERIA TOXOID/PERTUSSIS VACCINE/TETANUS TOXOID (DPT
Adsorbed)*
Injection (diphtheria toxoid 25Lf/0.5mL, tetanus toxoid 5Lf/0.5mL, pertussis
vaccine 4 to 12 PU/0.5mL)
TETANUS DIPHTHERIA TOXOIDS/POLIOMYELITIS VACCINE*
Injection (diphtheria toxoid 2Lf/0.5mL, poliamyelitis vaccine (inactivated)
NIL/0.5mL, tetanus toxoid
5Lf/0.5mL)
DIPHTHERIA TOXOID/PERTUSSIS/TETANUS/POLIOVIRUS VACCINE/
HAEMOPHILUS INFLUENZA TYPE B (PENTA VACCINE)
282
80:12.00
VACCINES
HEPATITIS B IMMUNE GLOBULIN**
Injection 217 IU/mL
HEPATITIS B VACCINE*
Injection 20ug/mL
INFLUENZA VIRUS VACCINE*
Injection 5mL
MEASLES/MUMPS/RUBELLA VACCINE*
Injection NIL/0.5mL
PNEUMOCOCCAL VACCINE*
Injection 50ug/0.5mL
POLIOMYELITIIS VACCINE*
Injection 0.5mL
RUBELLA VIRUS VACCINE*
Injection 31000 TCID50/0.5mL
BCG VACCINE*
Injection 0.1mg/0.1mL
HAEMOPHILUS INFLUENZAE TYPE B VACCINE*
84:00.00
SKIN AND MUCOUS MEMBRANE AGENTS
84:04.00
ANTI INFECTIVES
84:04.04
ANTIBIOTICS
BACITRACIN
Ointment 500 IU/g
84:04.08
ANTIFUNGALS
TOLNAFTATE
Aerosol liquid 0.72mg/g (70g)
Aerosol powder 10mg/g
Cream 10mg/g
Powder 10mg/g
Solution 10mg/mL
84:04.16MISCELLANEOUS LOCAL ANTI-INFECTIVES
CHLORHEXIDINE
Alcoholic scrub
Cleanser 4%
Gauze 0.5%
Jelly 2%, 4%
Liquid 2%, 4%, 20%
Ointment 1%
Soap 2%
MAFENIDE
Cream 8.5%
SILVER SULFADIAZINE
Cream 1% w/w
283
Cream 1% with chlorhexidine 0.2%
84:08.00
ANTI PRURITICS AND LOCAL ANESTHETICS
CALCIUM FOLINATE (folinic acid)
Powder 50mg, 350mg
Tablets 5mg
Injection 10mg/mL
DIBUCAINE
Cream 0.5% (30g)
Ointment 1% (30g)
LIDOCAINE/PRILOCAINE
Topical cream 2.5%/2.5%
Patch
LIDOCAINE (except lozenges and suppositories)
Jelly 2%
Jelly (urojet) 2%
Ointment 5%
Topical solution 4%
PRAMOXINE
Cream, rectal 1%
84:24.00
EMOLLIENTS, DEMULCENTS AND PROTECTANTS
84:24.12
BASIC CREAMS, OINTMENTS AND PROTECTANTS
ZINC OXIDE
Ointment 15%
84:24.16
BASIC POWDERS AND DEMULCENTS
GELATIN, PECTIN, SODIUM CARBOXYMETHYLCELLULOSE
Paste 13.3% gelatin, 13.3% pectin, 13.3% sodium carboxymethylcellulose
84:40:00
HEMORRHOID PREPARATIONS
PRAMOXINE
Ointment, rectal 1%, with zinc sulphate 0.5%
Suppository 20MG, with zinc sulphate 10mg
88:00.00
VITAMINS
88:16.00
VITAMIN D
CALCITRIOL
-also known as 1,25-DIHYDROXYCHOLECALCIFEROL
Injection 1ug/mL
DIHYDROTACHYSTEROL
Capsule 0.125mg
92:00.00
ABCIXMAB INJECTION
Restricted Coverage: For use in high risk angioplasties carried out in a cardiac
284
catheterization laboratory as per approved health district protocols.
Injection 2 mg/mL (5mL)
ACTHAR GEL 80IU/5mL (Emergency Drug Release from HPB for infantile spasms)
BERACTANT
Restricted Coverage: When administered in a Neonatal Intensive Care Unit.
Powder (reconstituted) 25mg phospholipids/mL
COLFOSCERIL PALMITATE
Restricted Coverage: When administered in a Neonatal Intensive Care Unit.
Powder for tracheal suspension
CYANIDE ANTIDOTE KIT
With sodium nitrate injection 30mg/mL (2 x 10mL ampoules), sodium thiosulfate
injection 250mg/mL (2 x 50mL ampoules), amyl nitrate inhalant solution (12 x
0.3mL crushable ampoules)
CYCLOSPORINE (see Appendix A - Saskatchewan Health Formulary)
Restricted Coverage: Injection
Injection 50mg/mL
DIMETHYL SULFOXIDE
Solution 500mg/g (50mL)
LEVOCARNITINE
Restricted Coverage: For the treatment of metabolic disorders with carnitine
deficiency and neonates who will be on long term Total Parenteral Nutrition (greater
than 14 days).
Injection 200mg/mL
Tablet 330mg
OCTREOTIDE
a) For the treatment of acute variceal bleeds in patients with acute portal
hypertension.
b) For the prevention of pancreatic resection to a maximum of 7 days.
Injection 50ug, 100ug, 500ug (1mL)
Injection 200ug (5mL)
Injection 10mg, 20mg, 30mg (powder for injection)
PRALIDOXIME CHLORIDE
Injection, 1g vial
SOMATOSTATIN
Restricted Coverage: For the treatment of acute variceal bleeds.
Powder 205ug, 3mg
TRACE ELEMENTS
Chromium 4ug/mL
Copper 0.4mg/mL
Manganese 0.1mg/mL, 0.5mg/mL
Selenium 40ug/mL
Zinc 1mg/mL, 5mg/mL
Note: May come as cocktails.
(M.T.E.-4 contains: 4.0ug/mL chromium, 0.4mg/mL copper, 0.1mg/mL
manganese, and 1.0mg/mL zinc)
(Micro 5 contains: 10ug/mL chromium, 1mg/mL copper, 0.5mg/mL manganese,
60ug/mL selenium, 5mg/mL zinc)
285
APPENDIX I: Products included in the Hospital Benefit List, and as referred to in 3
(a), (b), and (c) are approved for use and are benefits only when manufactured by
approved suppliers as listed in the Saskatchewan Formulary or included below:
Adria
Anaquest
Cutter
IMS
Johnson & Johnson-Merck
Lyphomed
Mallinkrodt
Metapharma
Smith & Nephew
APPENDIX II: PROCEDURES FOR OBTAINING DRUGS PROVIDED UNDER
PROVINCIAL PROGRAMS
Drugs Used for the Treatment of Tuberculosis:
The following drugs can be obtained for use in the treatment of tuberculosis by contacting
the Clinical Director for Tuberculosis Control (933-6166). The drugs will be sent from the
TB Pharmacy in Ellis Hall at the Royal University Hospital in Saskatoon.
Amikacin injection 500mg/2mL
Cycloserine capsules 250mg
Ethambutol tablets, 100mg, 400mg
Ethionamide tablets 250mg
Isoniazide syrup 10mg/mL, tablets 100mg, 300mg
Pyrazinamide tablet 500mg
Rifabutin capsule 150mg
Rifampin capsule 150mg, 300mg, suspension 25mg/mL
Streptomycin injection 1 gram/2.5mL
Drugs Used for the Treatment of Sexually Transmitted Diseases:
•
The following drugs can be obtained from Saskatchewan Health – Communicable
Disease Control at (306) 787-7104 for the treatment of sexually transmitted
diseases:
Azithromycin 1g
Erythromycin PCE 333mg or 250mg
Cefixime 400mg
•
The following medication/vaccines are available on special request from
Saskatchewan Health – Communicable Disease Control (306) 787-1460:
Benzathine Penicillin 2.4 MU IM injection
Ciprofloxacin 500mg
286
INDEX
ANXIOLYTICS, SEDATIVES AND
HYPNOTICS................................276
ARVIN..............................................272
ASA .................................................275
ATTAPULGITE ................................279
BACIGUENT....................................283
BACITRACIN ...................................283
BACITRACIN STERILE ...................269
BAL IN OIL.......................................280
BARBITURATES .............................276
BENADRYL .....................................268
BENYLIN DM...................................278
BENZOCAINE .................................278
BENZODIAZEPINES.......................276
BERACTANT ...................................285
BETA LACTAM ANTIBIOTICS .......269
BLENOXANE...................................270
BLEOMYCIN....................................270
BRETYLIUM ....................................273
BREVIBLOC ....................................274
BRIETAL..........................................276
BUPIVACAINE.................................281
BURO SOL ......................................279
CALCITRIOL....................................284
CALCIUM CHLORIDE .....................276
CALCIUM DISODIUM EDETATE ....280
CALCIUM GLUCONATE .................276
CALORIC AGENTS.........................277
CARBOCAINE .................................281
CARDIZEM ......................................274
CARNITOR ......................................285
CATHARTICS AND LAXATIVES....279
CEFAZOLIN.....................................268
CEFOTAXIME .................................268
CEFOTETAN ...................................268
CEFOXITIN......................................268
CEFTAZIDIME.................................268
CEFTIN............................................269
CEFTRIAXONE ...............................268
CEFUROXIME.................................269
CEPHALOSPORINS .......................268
CHLORAMPHENICOL.....................269
CHLORHEXIDINE ...........................283
CHLOROMYCETIN .........................269
CHLOROPROCAINE.......................281
CHOLINERGIC AGENTS................271
CIPRO .............................................270
CIPROFLOXACIN ...........................270
CLAFORAN .....................................268
COCAINE ........................................278
COLFOSCERIL PALMITATE...........285
CYANIDE ANTIDOTE KIT ...............285
CYCLOPHOSPHAMIDE ..................270
CYCLOSPORINE ............................285
1,25-DIHYDROXYCHOLECALCIFEROL.................. 284
ACEBUTOLOL ................................ 273
ACETAMINOPHEN ......................... 275
ACETYLCHOLINE........................... 279
ACETYLSALICYLIC ACID............... 275
ACTIVASE....................................... 273
ACTIVATED CHARCOAL................ 279
ACYCLOVIR .................................... 270
ADENOCARD.................................. 273
ADENOSINE ................................... 273
ADRENALS ..................................... 280
ADRIAMYCIN .................................. 270
ALCAINE ......................................... 278
ALCOHOL (ETHYL) DRESSING ..... 283
ALFENTA ........................................ 275
ALFENTANIL................................... 275
ALKALINIZING AGENTS ............... 276
ALPROSTADIL ................................ 281
ALUMINUM ACETATE .................... 279
AMICAR........................................... 273
AMIKACIN ....................................... 268
AMIKIN ............................................ 268
AMINOCAPROIC ACID ................... 273
AMINOGLYCOSIDES ..................... 268
AMPHOTERICIN B.......................... 268
AMPICILLIN..................................... 269
..................................................... 275
ANCEF ............................................ 268
ANCROD ......................................... 272
ANDROGENS.................................. 280
ANECTINE ...................................... 272
ANTACIDS AND ADSORBENTS ... 279
ANTIANEMIA DRUGS .................... 272
ANTICHOLINERGIC AGENTS ....... 271
ANTICOAGULANTS ....................... 272
ANTICONVULSANTS ..................... 275
ANTIDIARRHEA AGENTS ............. 279
ANTIEMETICS ................................ 280
ANTIFUNGALS ............................... 268
ANTIHEMOPHILIC FACTOR VIII.... 273
ANTIHEPARIN AGENTS ................ 273
ANTIHISTAMINE DRUGS............... 268
ANTILIRIUM .................................... 271
ANTIMUSCARINIC/ANTISPASMODICS............................. 271
ANTINEOPLASTIC AGENTS ......... 270
ANTIPRURITICS AND LOCAL
ANESTHETICS ........................... 284
ANTITUBERCULOSIS AGENTS .... 269
ANTITUSSIVES............................... 278
ANTIVIRALS ................................... 270
ANUSOL.......................................... 284
287
CYPROHEPTADINE ....................... 268
CYTOXAN ....................................... 270
DEFEROXAMINE ............................ 280
DEPO MEDROL .............................. 280
DESFERAL...................................... 280
DEXTRAN 40 .................................. 277
DEXTRAN 70 .................................. 277
DEXTROMETHORPHAN ................ 278
DEXTROSE..................................... 277
DIAGNOSTIC AGENTS .................. 276
DIAZOXIDE ..................................... 274
DIFLUCAN....................................... 268
DIGIBIND......................................... 282
DIGOXIN ......................................... 273
DIGOXIN IMMUNE FAB .................. 282
DILTIAZEM...................................... 274
DIMERCAPROL .............................. 280
DINOPROSTONE............................ 281
DIPHENHYDRAMINE...................... 268
DIPHTHERIA ANTITOXIN............... 282
DIPHTHERIA TETANUS TOXOIDS 282
DIURETICS ..................................... 277
DOBUTAMINE................................. 271
DOBUTREX..................................... 271
DOPAMINE ..................................... 271
DOPRAM......................................... 276
DOXAPRAM .................................... 276
DOXORUBICIN ............................... 270
DROPERIDOL ......................... 276, 280
DT ADSORBED............................... 282
DURAGESIC ................................... 275
EDROPHONIUM ..................... 271, 276
EFUDEX .......................................... 271
ELECTROLYTE AND FLUID
REPLACEMENT ......................... 276
EMETICS......................................... 280
ENLON ............................................ 276
ENTROPHEN .................................. 275
ENZYMES ....................................... 278
ERGOMETRINE MALEATE ............ 282
ERGONOVINE ................................ 282
ERYTHROMYCIN............................ 269
ESMOLOL HYDROCHLORIDE ....... 274
ETHAMBUTOL ................................ 269
EXOSURF ....................................... 285
EXPECTORANTS ........................... 278
EYE, EAR, NOSE AND THROAT
PREPARATIONS ........................ 278
FACTOR IX COMPLEX ................... 273
FENTANYL...................................... 275
FERGON ......................................... 272
FERROUS GLUCONATE................ 272
FERROUS SULPHATE ................... 272
FLAMAZINE .................................... 283
FLAMAZINE-C................................. 284
FLEET ............................................. 279
FLEET PHOSPHO SODA BUFFERED
SALINE ........................................280
FLUCONAZOLE ..............................268
FLUOR I STRIP ...............................279
FLUORESCEIN SODIUM ................279
FLUORESCITE................................279
FLUOROURACIL.............................271
FLUOXYMESTERONE....................280
FORTAZ ..........................................268
FUNGIZONE....................................268
GENERAL ANESTHETICS .............274
GLYCERIN ......................................280
GUAIFENESIN ................................278
HALOTESTIN ..................................280
HEAVY METAL ANTAGONISTS ....280
HEMORRHOID PREPARATIONS ..284
HEMOSTATICS...............................273
HEPARIN.........................................272
HEPATITIS B IMMUNE GLOBULIN 282
HEPATITIS B VACCINE ..................283
HIBITANE ........................................283
HORMONES AND SYNTHETIC
SUBSTITUTES............................280
HYALURONIDASE ..........................278
HYDROCONTIN ..............................275
HYOSCINE BUTYLBROMIDE.........271
HYOSCINE HYDROBROMIDE .......271
HYPERSTAT ...................................274
HYPOTENSIVE AGENTS ...............274
HYSKON..........................................277
IMIPENEM CILASTATIN .................269
IMMUNE GLOBULIN .......................282
IMMUNE SERUM GLOBULIN .........282
INAPSINE ................................276, 280
INFLUENZA VIRUS VACCINE ........283
INH ..................................................269
INTROPIN........................................271
IPECAC ...........................................280
IRON PREPARATIONS ..................272
ISOFLURANE..................................274
ISONIAZID.......................................269
ISOPROTERENOL ..........................271
ISUPREL .........................................271
KAOPECTATE.................................279
KEFZOL...........................................268
LABETALOL ....................................274
LANOXIN .........................................273
LEVARTERENOL ............................271
LEVOCARNITINE ............................285
LEVOPHED .....................................271
LIDOCAINE ..................... 278, 281, 284
LOCAL ANESTHETICS ..........278, 281
LOXAPAC........................................276
LOXAPINE.......................................276
M M R II ...........................................283
MAFENIDE ......................................283
288
MAGNESIUM SULPHATE............... 277
MANNITOL ...................................... 277
MARCAINE...................................... 281
MCT OIL .......................................... 277
MEASLES/MUMPS/RUBELLA
VACCINE..................................... 283
MEDIUM CHAIN TRIGLYCERIDES OIL
..................................................... 277
MEFOXIN ........................................ 268
MEPIVACAINE ................................ 281
METHADONE.................................. 275
METHOHEXITAL............................. 276
METHOTREXATE ........................... 271
METHYLPREDNISOLONE ACETATE
..................................................... 280
MIDAZOLAM ................................... 276
MIOCHOL........................................ 279
MIOTICS.......................................... 279
MYAMBUTOL .................................. 269
MYDFRIN ........................................ 279
MYDRIACYL.................................... 279
MYDRIATICS .................................. 279
NALBUPHINE.................................. 275
NALOXONE..................................... 275
NAPHAZOLINE ............................... 279
NARCAN ......................................... 275
NEO SYNEPHRINE......................... 271
NEOSTIGMINE................................ 271
NESACAINE CE .............................. 281
NIPRIDE .......................................... 274
NITROGLYCERIN ........................... 274
NITROPRUSSIDE ........................... 274
NON STEROIDAL ANTI
INFLAMMATORY AGENTS........ 275
NORCURON ................................... 272
NOREPINEPHRINE ........................ 271
NOVOCAINE ................................... 281
NUBAIN ........................................... 275
OPIATE AGONISTS........................ 275
OPIATE ANTAGONISTS ................ 275
OPIATE PARTIAL AGONISTS ....... 275
ORAJEL........................................... 278
OTRIVIN .......................................... 279
OXYTOCICS ................................... 281
OXYTOCIN...................................... 282
PANCURONIUM.............................. 272
PAPAVERINE.................................. 274
PARALDEHYDE .............................. 276
PAVULON ....................................... 272
PENBRITIN ..................................... 269
PENICILLINS .................................. 269
PENTACARINAT ............................. 270
PENTAMIDINE ISETHIONATE ....... 270
PERIACTIN ..................................... 268
PHENERGAN .................................. 268
PHENTOLAMINE ............................ 272
PHENYLEPHRINE ..................271, 279
PHOSPHATE...................................277
PHOSPHATE SANDOZ...................277
PHYSOSTIGMINE ...........................271
PIPERACILLIN ................................269
PIPRACIL ........................................269
PITRESSIN......................................281
PITUITARY ......................................281
PNEUMOCOCCAL VACCINE .........283
PNEUMOVAX 23.............................283
POLYSPORIN .................................278
PONTOCAINE .........................278, 281
POTASSIUM ACETATE ..................277
POTASSIUM CHLORIDE ................277
POTASSIUM PHOSPHATE.............277
PRALIDOXIME CHLORIDE.............285
PRAMOXINE ...................................284
PRIMAXIN .......................................269
PROCAINAMIDE .............................274
PROCAINE ......................................281
PROMETHAZINE ............................268
PRONESTYL ...................................274
PROPARACAINE ............................278
PROSTIN E2 ...................................281
PROSTIN VR...................................281
PROTAMINE SULPHATE................273
PROTOPAM ....................................285
PSEUDOEPHEDRINE.....................271
QUINOLONES.................................270
RESPIRATORY AND CEREBRAL
STIMULANTS..............................276
RHEOMACRODEX..........................277
RIBAVIRIN.......................................270
RIFADIN ..........................................270
RIFAMPIN........................................270
RIMSO .............................................284
ROCALTROL...................................284
ROCEPHIN......................................268
ROGITINE .......................................272
SCOPOLAMINE BUTYLBROMIDE .271
SCOPOLAMINE HYDROBROMIDE 271
SENSORCAINE...............................281
SERUMS .........................................282
SILVER SULFADIAZINE .................283
SKELETAL MUSCLE RELAXANTS 272
SKIN AND MUCOUS MEMBRANE
AGENTS......................................283
SLOW-K ..........................................277
SODAMINT......................................276
SODIUM BICARBONATE................276
SODIUM CHLORIDE .......................277
SODIUM PHOSPHATE ...................277
STREPTOKINASE...........................273
SUBLIMAZE ....................................275
SUCCINYLCHOLINE.......................272
SUDAFED........................................271
289
SUFENTA........................................ 275
SUFENTANIL .................................. 275
SULFAMYLON ................................ 283
SURVANTA ..................................... 285
SYMPATHOLYTICS ........................ 272
SYNTOCINON................................. 282
TAZOCIN......................................... 269
TENSILON............................... 271, 276
TETANUS DIPHTHERIA
TOXOIDS/POLIOMYELITIS
VACCINE..................................... 282
TETANUS IMMUNE GLOBULIN ..... 282
TETRACAINE .......................... 278, 281
THROMBIN TOPICAL ..................... 273
THROMBOLYTIC AGENTS............ 273
THROMBOSTAT ............................. 273
TICAR.............................................. 269
TICARCILLIN................................... 269
TOBRAMYCIN................................. 268
TOXOIDS ........................................ 282
TRANQUILIZERS............................ 275
TRASYLOL...................................... 273
TRIMETHOPRIM .............................270
TROMETHAMINE............................276
TRONOTHANE................................284
TROPICAMIDE................................279
TYLENOL ........................................275
VACCINES ......................................283
VASOCON.......................................279
VASOCONSTRICTORS ..................279
VASODILATING AGENTS..............274
VASOPRESSIN ...............................281
VECURONIUM ................................272
VERSED ..........................................276
VIRAZOLE .......................................270
VITAMIN D.......................................284
WYDASE .........................................278
X PREP............................................280
XYLOCAINE ....................................281
XYLOMETAZOLINE ........................279
ZINACEF .........................................269
ZINC OXIDE ....................................284
ZINCOFAX.......................................284
ZOVIRAX .........................................270
290
APPENDIX C
TIPS ON PRESCRIPTION WRITING
(Adapted from "Tips on Prescription Writing", a pamphlet available from the
Saskatchewan Pharmaceutical Association.)
Properly issued prescriptions are in the best interest of the patient, the pharmacist and
the prescriber. This information is designed to assist prescribers to issue prescriptions
most effectively. These guidelines will help to reduce the time involved in the prescription
process, increase patient safety and maximize patient compliance.
PRESCRIPTION CONTENT
Prescriptions need to be issued clearly and completely to minimize errors.
pronunciation or legible writing with accurate spelling is essential.
Clear
The prescription may be written, or verbal for certain classes of drugs, (refer to chart on
pages 294 and 295) and must include the following information:
•
•
•
•
•
•
date
patient's name and address
name, strength and quantity of drug
complete directions for use
repeat authorization (if appropriate)
prescriber's signature
The prescriber's name, address and telephone number should be preprinted on the
prescription form, or hand printed beneath the signature.
VERBAL PRESCRIPTIONS
Federal and Provincial legislation states that a verbal prescription or refill authority must
be given by a medical practitioner, duly qualified optometrist, dentist or veterinary
surgeon directly to a pharmacist. Having a receptionist or nurse assume this
responsibility is contrary to the law.
Direct prescriber/pharmacist communication is necessary to provide the best quality of
care for the patient. The pharmacist may wish to discuss an aspect of the drug therapy
prior to dispensing the medication. As well, the prescriber may wish to ask the
pharmacist about a particular medication, or a patient's medication history, compliance,
or pattern of drug use. Both the professionals and the patient will benefit from this direct
communication.
MEDICATION DIRECTIONS
Pharmacists maintain patient profiles which contain information concerning prescriptions
dispensed, directions for use, drug allergies, medical conditions, and other pertinent
information. These profiles are used to monitor the patient's drug usage and compliance,
and drug interactions. Thus, it is very important that directions on the prescription be
consistent with verbal instructions given to the patient. Clear directions enable the
pharmacist to effectively counsel the patient and reinforce the prescriber's instructions.
Prescriptions with closing instructions written "As Directed" create problems for the
patient, particularly the elderly or those assisting them. Patients taking more than one
medication may become confused if all instructions read "As Directed". Such labelling
also makes it impossible for pharmacists to monitor compliance, or assist patients with
medication concerns.
292
It is helpful for a patient taking more than one medication, or for the caregiver, to know
what the medication is used for. The prescriber may wish to indicate the use of the
medication on the prescription (e.g. for heart), to enable the pharmacist to include this
information on the label.
REFILLS
When a patient is stabilized on medication, refills, where permitted by law, should be
indicated on the prescription. Authorization should allow for sufficient refills until the
patient's next appointment, to a maximum of one year. If refills are not properly indicated
on the prescription, the pharmacist must by law, contact the prescriber for refill
authorization.
Specific regulations apply to various categories of prescription drugs. Your pharmacist
would be pleased to review the regulations with you. Please refer to the following chart
for a summary of requirements.
SUBSTITUTION
Unless the prescriber directs otherwise, the pharmacist may select and dispense an
interchangeable pharmaceutical product, other than the one prescribed, according to the
Saskatchewan Prescription Drug Plan Formulary. An interchangeable pharmaceutical
product is a product containing a drug or drugs in the same amounts, of the same active
ingredients, in the same dosage form as that directed by the prescription. Those which
conform to the criteria for interchangeability determined by the Saskatchewan Formulary
Committee are designated as "interchangeable" in the Saskatchewan Formulary Listing.
A prescriber may request that a specific brand of a drug be dispensed by indicating in his
own handwriting at the time of issuing a written prescription, or verbally at the time of
giving a verbal prescription, No Substitution, No Sub, or N/S. In most cases, the patient
is responsible for the incremental cost of "No Sub" prescriptions.
TRANSFER OF PRESCRIPTIONS
Only prescriptions for Schedule F drugs may be transferred from one pharmacist to
another at the request of a patient. Prescriptions for Schedule 2 and 3 drugs and
Narcotic and Controlled Drugs may NOT be transferred.
When a prescription is transferred, the original prescription shall remain on file, and on it
shall be entered:
1. the date of the transfer;
2. an indication that no further sales nor transfers may be made under the prescription
(i.e. the word "VOID");
3. the name of the pharmacy and pharmacist to whom the prescription was transferred;
4. the patient profile, manual or electronic, must also indicate the prescription is "VOID".
The pharmacist receiving the transferred prescription shall indicate:
1.
2.
3.
4.
the name of the pharmacist transferring the prescription;
the name and address of the pharmacy transferring the prescription;
the number of authorized repeats remaining, if any;
the date of the last fill or refill.
293
Saskatchewan Pharmaceutical Association
PRESCRIPTION REGULATIONS
A synopsis* of Federal and Provincial Acts and Regulations Governing the
Distribution of Drugs by Prescription in Saskatchewan
CLASS
NARCOTIC DRUG**
Examples: Codeine, Demerol, Morphine,
Novahistex DH, Percodan, Tussionex,
Tylenol #4, Lomotil, Darvon-N, Talwin,
642's, etc.
DESCRIPTION
REQUIREMENTS
All straight narcotics, all narcotic drugs or compounds for
parenteral use. Compounds containing more than one
narcotic or compounds with less than two non-narcotic
ingredients. All products containing diacetylmorphine,
oxycodone, hydrocodone, methadone, or pentazocine.
Written prescription signed and
dated by a practitioner.
**Refer to Triplicate
Prescription Program.
Refer to the Schedule to the Narcotic Control Regulations.
VERBAL PRESCRIPTION NARCOTIC**
Examples: A.C. with Codeine 15, 30, 60
mg, Fiorinal C 1/4, C1/2, Tylenol #2 and
#3, Darvon-N Compound, 692's, 292's,
etc.
A combination product not intended for parenteral use,
containing one narcotic (only) and two or more non-narcotic
drugs in therapeutic dose, except products containing
diacetylmorphine, oxycodone, hyrocodone, methadone, or
pentazocine.
Refer to the Schedule to the Narcotic Control Regulations.
CONTROLLED DRUGS - LEVEL I**
Examples: Dexedrine, Ritalin, Seconal,
Tuinal, etc.
Those drugs listed in Part I of the Schedule to Part G of the
Food and Drug Regulations. They include amphetamines,
methaqualone, methylphenidate, phendimetrazine,
phenmetrazine, pentobarbital, secobarbital.
CONTROLLED DRUG PREPARATION LEVEL I**
Examples: Carbrital, Mandrax, etc.
A combination containing a controlled drug - Level 1 - as
described above, and one or more active medicinal
ingredients, in a recognized therapeutic dose, other than a
narcotic or controlled drug.
CONTROLLED DRUGS - LEVEL II**
Examples: Phenobarb, Amytal, Butisol,
Tenuate, Ionamin, Anabolic Steriods, etc.
Those drugs listed in Parts II & III of the Schedule to Part G
of the Food and Drug Regulations. They include: barbituric
acid and its salts and derivatives (except secobarbital and
pentobarbital), butorphanol, chlorphentermine,
diethylpropion, nalbuphine, phentermine, thiobarbituric acid.
CONTROLLED DRUG PREPARATION LEVEL II**
Examples: Donnatal, Fiorinal, Tedral,
Anabolic Steroids, etc.
A combination containing controlled drug - Level II - as
described above, and one or more active medicinal
ingredients, in a recognized therapeutic dose, other than a
narcotic or controlled drug.
PRESCRIPTION DRUGS
Those drugs listed in Schedule I of the Bylaws to the
Pharmacy Act, 1996, including drugs listed in Schedule F to
the Food and Drug Regulations.
TRANSFER OF PRESCRIPTIONS
Only prescriptions for Schedule I
drugs may be transferred from one
pharmacist to another at the request
of a patient. Prescriptions for
Narcotic and Controlled Drugs may
NOT be transferred.
294
Written or verbal prescription**
from a practitioner. Verbal
prescription must be reduced to
writing by a pharmacist showing:
- name and address of patient;
- name, initials and address of
prescriber;
- name, quantity, and form of
drug(s);
- directions for use;
- date;
- prescription number;
- name or initials of pharmacist
**Refer to Triplicate
Prescription Program
As immediately above, plus, in
the case of verbal prescriptions:
- number and frequency of refills
(if any) authorized.
Written or verbal prescription from
practitioner. Verbal prescriptions must
be reduced to writing by a pharmacist
showing date, prescription number,
patient's name and address, name and
quantity of drug(s), directions for use,
prescriber's name, name and initials or
pharmacist, and number of refills (if
any).
The pharmacist receiving the transferred prescription shall
indicate:
1. the name of the pharmacist transferring the prescription;
2. the name and address of the pharmacy transferring the
prescription;
3. the number of authorized repeats remaining, if any;
4. the date of the last fill or refill.
* This synopsis is a condensation of some of the pertinent Acts and Regulations. Users of the chart are reminded that it has been compiled for
convenient reference only and that the official legislation should always be consulted for the purposes of interpreting and applying the laws.
** Triplicate Prescription Program: Effective August 1, 1988, a specially designed prescription form must be used by a prescriber to write a
prescription for any of the medications on the panel of monitored drugs. Pharmacists may not fill a prescription for any of these drugs written
on any other form. Verbal prescriptions may not be accepted for any of the drugs listed on this panel of drugs. Please refer to the Triplicate
Prescription Program Newsletter for details.
*** RECORDS - Narcotic Register includes either the approved manual or electronic (i.e. pharmacy computer) version.
Source: Saskatchewan Pharmaceutical Association
REPEATS
RECORDS***
No Repeats.
All re-orders must be new, written
prescriptions. However, a prescription may
be dispensed in divided portions, subject to
professional discretion.
All receipts and all sales (except prescription sales of dextropropoxyphene) entered in
Narcotic Register. Prescriptions filed in order of date and number in a special file designated
for Narcotics and Controlled Drugs. If a part-fill is made, all records, including the
prescription itself, and the Narcotic Register, must reflect the actual amount dispensed.
Further part-fills must be documented and cross-referenced to the original prescription.
No Repeats.
All orders must be new, written
prescriptions. However, a prescription
may be dispensed in divided portions,
subject to professional discretion.
Receipts - entry required in Narcotic Register.
Sales - no entry required for sales pursuant to prescriptions, but emergency supplies provided
to another pharmacist and returns to licensed dealers must be recorded in sales portion of
Register. Prescriptions filed in order of date and number in a special file designated for
Narcotics and Controlled Drugs.
No repeats are allowed if original
prescription is verbal. If written, the original
prescription may be repeated if the
prescriber has indicated in writing the
number and frequency of repeats.
All receipts and all sales entered in Narcotic Register.
Prescriptions filed in order of date and number in a special file designated for Narcotics and
Controlled Drugs.
**Refer to the Triplicate Prescription
Program.
Receipts - entry required in Narcotic Register.
Sales - no entry required in Narcotic Register for sales pursuant to prescriptions, but
emergency supplies provided to another pharmacist and returns to licensed dealers must be
recorded in sales portion of Register. Prescriptions filed in order of date and number in a
special file designated for Narcotics and Controlled Drugs.
Repeats may be authorized on original
prescription whether written or verbal, but
authorization must indicate number and
frequency of repeats.
Receipts - entry required in Narcotic Register or invoices must be available to substantiate
receipt.
Repeats may be authorized on original
prescription whether written or verbal, but
authorization must be for a specific number
of refills.
No entries required in Narcotic Register. Prescriptions filed in regular file and must be
retained for at least two years from date of last fill or refill.
Sales - no entry required in Narcotic Register for sales pursuant to prescriptions, but
emergency supplies provided to another pharmacist and returns to licensed dealers must be
recorded in sales portion of Register. Prescriptions filed in order of date and number in
special file designated for Narcotics and Controlled Drugs.
"PRN" is not valid authority for repeats.
When a prescription is transferred, the original prescription shall remain on file, and on it shall be entered:
1. the date of the transfer;
2. an indication that no further sales nor transfers may be made under the prescription (i.e. the word "VOID");
3. the name of the pharmacy and pharmacist to whom the prescription was transferred;
4. the patient profile, manual or electronic, must also indicate the prescription is "VOID".
295
APPENDIX D
GUIDELINES FOR REPORTING ADVERSE DRUG REACTIONS
DEFINITION OF AN ADVERSE DRUG REACTION (ADR):
"Any undesirable patient effect suspected to be associated with drug use."
WHICH ADVERSE DRUG REACTIONS SHOULD BE REPORTED?
Proof a drug caused an undesirable patient effect (causality) is NOT a requirement for
reporting an adverse drug reaction. If an adverse event is suspected of being drugrelated, particularly if the event is unusual in the context of the illness, it should be
reported.
Practitioners should report to SaskADR:
•
all suspected adverse drug reactions which are unexpected. An unexpected
adverse drug reaction is an undesirable patient effect which is not consistent with
product information or labelling;
•
all suspected adverse drug reactions which are serious. A serious adverse drug
reaction is an undesirable patient effect which contributes to significant disability or
illness. All adverse drug reactions which result in, or prolong hospitalization or
require significant medical intervention should be considered serious;
•
all suspected adverse reactions to recently marketed drugs regardless of their
nature or severity. A recently marketed drug is considered to be commercially
available for 5 (five) years or less.
HOW TO REPORT A SUSPECTED ADVERSE DRUG REACTION TO SaskADR:
Adverse drug reaction reports from Saskatchewan practitioners should be sent to the
Saskatchewan Adverse Drug Reaction Reporting Centre (SaskADR) located at the Dial
Access Drug Information Service, College of Pharmacy, University of Saskatchewan.
Please report suspected adverse drug reactions as soon as possible after detection
even if all details are not known at the time of the report. Staff at SaskADR will follow-up
for further information if required.
•
Complete a written ADR report form (next page). Record all information that is
available and mail to SaskADR. Information may be attached to the report form if
insufficient space is available for complete documentation. Additional forms may be
obtained from SaskADR at the following address:
SaskADR Centre
Dial Access Drug Information Service
College of Pharmacy & Nutrition
110 Science Place
Saskatoon, S7N 5C9
OR
•
provide a verbal report to SaskADR by phoning Dial Access Drug Information at tollfree 1-800-667-3425 or (in Saskatoon) at 966-6340 or 966-6329. Office hours are
9:00 a.m. to 5:00 p.m., Monday to Friday, excluding statutory holidays.
296
Health
Canada
l
l
Santé
Canada
Canadian Adverse Drug Reaction Monitoring Program
See reverse for return address.
La version française de ce document
est disponible sur demande. Voir au
verso pour connaître le centre à contacter.
A. Patient Information
1. Patient identifier
Chart Number
DD
2. Age at time of
reaction
__________ or
Date of birth
MM
YYYY
3. Sex
Male
Female
4. Height
5. Weight
_____ feet
_____ lbs
or
or
_____ cm
_____ kgs
B. Adverse Reaction
1. Outcome attributed to adverse reaction (check all that apply)
Death ____________ (dd / mm / yyyy)
Disability
Life-threatening
Congenital malformation
Hospitalization
Hospitalization - prolonged
2.
Date and time of reaction
DD
MM
YYYY
Required intervention to prevent
damage / permanent impairment
Other: ____________________
3.
DD
Therapeutic
Products
Programme
Report of suspected adverse reaction
due to drug products marketed in Canada
(Vaccines excluded)
Date of this report
MM
YYYY
PROTECTED
C. Suspected drug product(s)
(See "How to report" section on reverse)
1. Name (give labelled strength & manufacturer, if known).
#1
____________________________________________________________________
#2
____________________________________________________________________
2. Dose, frequency & route used
#1
3. Therapy dates (if unknown, give duration)
#1 From (dd / mm / yyyy) - To (dd / mm / yyyy)
#2
#2
4. Indication for use of suspected drug
product
#1
5. Reaction abated after use
stopped or dose reduced
#1
Yes
No
Doesn't apply
#2
Yes
No
Doesn't apply
#2
4. Describe reaction or problem
6. Lot # (if known)
#1
_______________
#2
7. Exp. date (if known) 8. Reaction reappeared after
reintroduction
#1 (dd / mm / yyyy)
_______________
#1
Yes
No
Doesn't apply
#2
#2
Yes
No
Doesn't apply
9. Concomitant drugs (name, dose, frequency and route used) and therapy dates
(dd / mm / yyyy) (exclude treatment of reaction)
10. Treatment of adverse reaction (drugs and / or therapy), including dates
(dd / mm / yyyy)
5. Relevant tests / laboratory data (including dates (dd / mm / yyyy)
D. Reporter
(See "Confidentiality" section on reverse)
1. Name, address & phone number.
6. Other relevant history, including preexisting medical conditions
(e.g. allergies, pregnancy, smoking and alcohol use, hepatic / renal dysfunction)
2. Health professional? 3.Occupation
Yes
Submission of a report does not constitute an admission that medical
personnel or the product caused or contributed to the adverse reaction.
HC/SC 4016 (12-98)
No
For TPP use only
4. Also reported to
manufacturer?
Yes
No
Return this form to the address listed for your region
ADVERSE DRUG REACTION REPORTING GUIDELINES
What to report?
An adverse drug reaction (ADR) is a noxious and unintended response to a drug which occurs with use or testing for the diagnosis, treatment or prevention of a disease or the
modification of an organic function. This includes any undesirable patient effect suspected to be associated with drug use. ADRs as a result of prescription, non-prescription,
biological (including blood products), complementary medicines (including herbals) and radiopharmaceutical drug products are monitored. Drug abuse, drug overdoses, drug
interactions and unusual lack of therapeutic efficacy are also considered to be reportable as ADRs.
ADR reports are, for the most part, only suspected associations. A temporal or possible association is sufficient for a report to be made. Reporting an ADR does not imply a
causal link.
ADRs that should be reported include all suspected adverse drug reactions which are:
"
unexpected, regardless of their severity i.e. not consistent with product information or labelling; or
"
serious, whether expected or not; or
"
reactions to recently marketed drugs (on the market for less than five years) regardless of their nature or severity.
The Canadian Regulations pertaining to reporting ADRs for marketed drug products define a serious adverse drug reaction as "a noxious and unintended response to a drug,
which occurs at any dose and requires in-patient hospitalization or prolongation of existing hospitalization, causes congenital malformation, results in persistent or significant
disability or incapacity, is life-threatening or results in death".
Confidentiality of ADR Information
Any information related to the reporter and patient identifiers is kept confidential.
How to report?
To report a suspected ADR for drug products marketed in Canada, health professionals should complete a copy of the ADR Reporting Form (Report of suspected adverse
reaction due to drug products marketed in Canada (Vaccines excluded) (HC/SC 4016 (12-98)). This form may be obtained from your Regional Centre or from the
National ADR Unit (see addresses below), and is included in the Canadian Compendium of Pharmaceuticals and Specialities (CPS).
Fill in the sections that apply to the report as completely as possible, using a separate form for each patient. Additional pages may be attached if additional space is required.
The success of the program depends on the quality and accuracy of the information sent in by the reporter.
Up to two (2) suspected drug products may be reported on one form (#1 = first suspected drug product, #2 = second suspected drug product). Attach an additional form if
there are more than two suspected drug products for the reported adverse reaction.
How to deal with follow-up information for an ADR that has already been reported?
Any follow-up information for an ADR that has already been reported can be sent on another ADR form, or it can be communicated by telephone, fax or e-mail if convenient to
the appropriate address for your region (see addresses below). So that this information can be matched with the original report, indicate that it is follow-up information, the
date of the original report and the report case number if known. It is very important that follow-up reports are identified and linked to the original report.
What about reporting ADRs to the Manufacturer?
Health professionals may also report ADRs to the manufacturer. Indicate on your ADR report sent to Health Canada if a case was also reported to the manufacturer.
For more information on the ADR monitoring program, additional copies of ADR reporting forms or to report an ADR, physicians, pharmacists and other health professionals
are invited to contact the addresses listed for your region.
British Columbia
Ontario
BC Regional ADR Centre
c/o BC Drug and Poison Information Centre
1081 Burrard St.
Vancouver, British Columbia V6Z 1Y6
Tel: (604) 631-5625
Fax: (604) 631-5262
adr@dpic.bc.ca
Ontario Regional ADR Centre
LonDIS Drug Information Centre
London Health Sciences Centre
339 Windermere Road
London, Ontario N6A 5A5
Tel: (519) 663-8801 Fax: (519) 663-2968
adr@lhsc.on.ca
Saskatchewan
Québec
All other provinces and territories
Sask ADR Regional Centre
College of Pharmacy and Nutrition
110 Science Place
Saskatoon, Saskatchewan S7N 5C9
Tel: (306) 966-6340 or (800) 667-3425
Fax: (306) 966-6377
vogt@duke.usask.ca
Québec Regional ADR Centre
Drug Information Centre
Hôpital du Sacré-Coeur de Montréal
5400, boul. Gouin ouest
Montréal, Québec H4J 1C5
Tel: (514) 338-2961 or (888) 265-7692
Fax: (514) 338-3670
cip.hscm@sympatico.ca
National ADR Unit
Continuing Assessment Division
Bureau of Drug Surveillance
Therapeutic Products Programme
Finance Building
Tunney's Pasture
AL 0201C2
Ottawa, Ontario K1A 1B9
Tel: (613) 957-0337 Fax: (613) 957-0335
cadrmp@hc-sc.gc.ca
For Therapeutic Products Programme Use Only
New Brunswick, Nova Scotia
Prince Edward Island and Newfoundland
Atlantic Regional ADR Centre
c/o Queen Elizabeth II Health Sciences Centre
1796 Summer Street, Rm 2421
Halifax, Nova Scotia B3H 3A7
Tel: (902) 473-7171 Fax: (902) 473-8612
rxkls1@qe2-hsc.ns.ca
Health
Canada
l
l
Santé
Canada
Canadian Adverse Drug Reaction Monitoring Program
See reverse for return address.
La version française de ce document
est disponible sur demande. Voir au
verso pour connaître le centre à contacter.
A. Patient Information
1. Patient identifier
Chart Number
DD
2. Age at time of
reaction
__________ or
Date of birth
MM
YYYY
3. Sex
Male
Female
4. Height
5. Weight
_____ feet
_____ lbs
or
or
_____ cm
_____ kgs
B. Adverse Reaction
1. Outcome attributed to adverse reaction (check all that apply)
Death ____________ (dd / mm / yyyy)
Disability
Life-threatening
Congenital malformation
Hospitalization
Hospitalization - prolonged
2.
Date and time of reaction
DD
MM
YYYY
Required intervention to prevent
damage / permanent impairment
Other: ____________________
3.
DD
Therapeutic
Products
Programme
Report of suspected adverse reaction
due to drug products marketed in Canada
(Vaccines excluded)
Date of this report
MM
YYYY
PROTECTED
C. Suspected drug product(s)
(See "How to report" section on reverse)
1. Name (give labelled strength & manufacturer, if known).
#1
____________________________________________________________________
#2
____________________________________________________________________
2. Dose, frequency & route used
#1
3. Therapy dates (if unknown, give duration)
#1 From (dd / mm / yyyy) - To (dd / mm / yyyy)
#2
#2
4. Indication for use of suspected drug
product
#1
5. Reaction abated after use
stopped or dose reduced
#1
Yes
No
Doesn't apply
#2
Yes
No
Doesn't apply
#2
4. Describe reaction or problem
6. Lot # (if known)
#1
_______________
#2
7. Exp. date (if known) 8. Reaction reappeared after
reintroduction
#1 (dd / mm / yyyy)
_______________
#1
Yes
No
Doesn't apply
#2
#2
Yes
No
Doesn't apply
9. Concomitant drugs (name, dose, frequency and route used) and therapy dates
(dd / mm / yyyy) (exclude treatment of reaction)
10. Treatment of adverse reaction (drugs and / or therapy), including dates
(dd / mm / yyyy)
5. Relevant tests / laboratory data (including dates (dd / mm / yyyy)
D. Reporter
(See "Confidentiality" section on reverse)
1. Name, address & phone number.
6. Other relevant history, including preexisting medical conditions
(e.g. allergies, pregnancy, smoking and alcohol use, hepatic / renal dysfunction)
2. Health professional? 3.Occupation
Yes
Submission of a report does not constitute an admission that medical
personnel or the product caused or contributed to the adverse reaction.
HC/SC 4016 (12-98)
No
For TPP use only
4. Also reported to
manufacturer?
Yes
No
Return this form to the address listed for your region
ADVERSE DRUG REACTION REPORTING GUIDELINES
What to report?
An adverse drug reaction (ADR) is a noxious and unintended response to a drug which occurs with use or testing for the diagnosis, treatment or prevention of a disease or the
modification of an organic function. This includes any undesirable patient effect suspected to be associated with drug use. ADRs as a result of prescription, non-prescription,
biological (including blood products), complementary medicines (including herbals) and radiopharmaceutical drug products are monitored. Drug abuse, drug overdoses, drug
interactions and unusual lack of therapeutic efficacy are also considered to be reportable as ADRs.
ADR reports are, for the most part, only suspected associations. A temporal or possible association is sufficient for a report to be made. Reporting an ADR does not imply a
causal link.
ADRs that should be reported include all suspected adverse drug reactions which are:
"
unexpected, regardless of their severity i.e. not consistent with product information or labelling; or
"
serious, whether expected or not; or
"
reactions to recently marketed drugs (on the market for less than five years) regardless of their nature or severity.
The Canadian Regulations pertaining to reporting ADRs for marketed drug products define a serious adverse drug reaction as "a noxious and unintended response to a drug,
which occurs at any dose and requires in-patient hospitalization or prolongation of existing hospitalization, causes congenital malformation, results in persistent or significant
disability or incapacity, is life-threatening or results in death".
Confidentiality of ADR Information
Any information related to the reporter and patient identifiers is kept confidential.
How to report?
To report a suspected ADR for drug products marketed in Canada, health professionals should complete a copy of the ADR Reporting Form (Report of suspected adverse
reaction due to drug products marketed in Canada (Vaccines excluded) (HC/SC 4016 (12-98)). This form may be obtained from your Regional Centre or from the
National ADR Unit (see addresses below), and is included in the Canadian Compendium of Pharmaceuticals and Specialities (CPS).
Fill in the sections that apply to the report as completely as possible, using a separate form for each patient. Additional pages may be attached if additional space is required.
The success of the program depends on the quality and accuracy of the information sent in by the reporter.
Up to two (2) suspected drug products may be reported on one form (#1 = first suspected drug product, #2 = second suspected drug product). Attach an additional form if
there are more than two suspected drug products for the reported adverse reaction.
How to deal with follow-up information for an ADR that has already been reported?
Any follow-up information for an ADR that has already been reported can be sent on another ADR form, or it can be communicated by telephone, fax or e-mail if convenient to
the appropriate address for your region (see addresses below). So that this information can be matched with the original report, indicate that it is follow-up information, the
date of the original report and the report case number if known. It is very important that follow-up reports are identified and linked to the original report.
What about reporting ADRs to the Manufacturer?
Health professionals may also report ADRs to the manufacturer. Indicate on your ADR report sent to Health Canada if a case was also reported to the manufacturer.
For more information on the ADR monitoring program, additional copies of ADR reporting forms or to report an ADR, physicians, pharmacists and other health professionals
are invited to contact the addresses listed for your region.
British Columbia
Ontario
BC Regional ADR Centre
c/o BC Drug and Poison Information Centre
1081 Burrard St.
Vancouver, British Columbia V6Z 1Y6
Tel: (604) 631-5625
Fax: (604) 631-5262
adr@dpic.bc.ca
Ontario Regional ADR Centre
LonDIS Drug Information Centre
London Health Sciences Centre
339 Windermere Road
London, Ontario N6A 5A5
Tel: (519) 663-8801 Fax: (519) 663-2968
adr@lhsc.on.ca
Saskatchewan
Québec
All other provinces and territories
Sask ADR Regional Centre
College of Pharmacy and Nutrition
110 Science Place
Saskatoon, Saskatchewan S7N 5C9
Tel: (306) 966-6340 or (800) 667-3425
Fax: (306) 966-6377
vogt@duke.usask.ca
Québec Regional ADR Centre
Hôpital du Sacré-Coeur de Montréal
5400, boul. Gouin ouest
Montréal, Québec H4J 1C5
Tel: (514) 338-2961 or (888) 265-7692
Fax: (514) 338-3670
cip.hscm@sympatico.ca
National ADR Unit
Continuing Assessment Division
Bureau of Drug Surveillance
Therapeutic Products Programme
Finance Building
Tunney's Pasture
AL 0201C2
Ottawa, Ontario K1A 1B9
Tel: (613) 957-0337 Fax: (613) 957-0335
cadrmp@hc-sc.gc.ca
For Therapeutic Products Programme Use Only
New Brunswick, Nova Scotia
Prince Edward Island and Newfoundland
Atlantic Regional ADR Centre
c/o Queen Elizabeth II Health Sciences Centre
1796 Summer Street, Rm 2421
Halifax, Nova Scotia B3H 3A7
Tel: (902) 473-7171 Fax: (902) 473-8612
rxkls1@qe2-hsc.ns.ca
APPENDIX E
SPECIAL COVERAGES
SPECIAL SUPPORT PROGRAM
An expanded safety net program, called the Special Support Program, has been
designed to help those whose drug costs are high in relation to their income. Based
on the information provided on the application form along with Drug Plan records, the
Drug Plan may lower the deductible and give the consumer a lower co-payment to
reduce the consumer's share of drug costs.
Benefits are determined by family income (adjusted for number of dependents) and
actual benefit drug costs. Residents must apply for Special Support annually.
Residents can call the Drug Plan at 787-3317 (in Regina) or toll-free at 1-800-667-7581
and request an application form be sent to them or they may pick up a form at their
community pharmacy. Coverage will be backdated 30 days from the date the application
is received by the Drug Plan.
If the family income or medication costs change during the coverage period, the
consumer may wish to contact the Drug Plan for a reassessment of coverage.
Income Supplement Recipients
Families receiving Family Health Benefits, and seniors receiving the Saskatchewan
Income Plan supplement (S.I.P.) or receiving the federal Guaranteed Income Supplement
(G.I.S.) and residing in a special care home will pay a $100 semi-annual deductible.
Other seniors receiving G.I.S. (ie. living in the community) have a $200 semi-annual
deductible. (If these patients have high drug costs they may also apply for Special
Support.) Other seniors are treated the same as non-seniors, based on their income and
drug cost.
Children under 18 years of age of families receiving Family Health Benefits are eligible
for the same benefits as Supplementary Health beneficiaries with Plan Two coverage.
This means all covered drugs will be provided at no charge. Also certain dental services,
medical supplies and appliances, optical services, chiropractic services, and emergency
medical transportation costs will be covered.
Adults receiving Family Health Benefits are eligible for chiropractic services and an eye
examination every two years.
Inquiries regarding benefits, contact the Supplementary Health Program:
Regina: 787-3125
Toll-free: 1-800-266-0695
Inquiries regarding prescription drugs should be directed to the Drug Plan:
Regina: 787-3317
Toll-free: 1-800-667-7581
301
SUMMARY OF FAMILY HEALTH BENEFITS FOR FAMILIES RECEIVING
SASKATCHEWAN CHILD BENEFIT AND/OR
SASKATCHEWAN EMPLOYMENT SUPPLEMENT
HEALTH BENEFITS
CHILDREN
PARENTS OR
GUARDIANS
Dental Coverage
Coverage of most services
Coverage not provided
Optometric Services
Eye examinations once a
year
Eye examinations covered
once every two years
Basic Eyeglasses
Emergency Ambulance
Covered
Medical Supplies
Basic coverage, some
items require prior approval
Chiropractic Services
Covered
Covered
Drug Coverage
No charge for Formulary
drugs
$100 semi-annual family
deductible; 35% consumer
co-payment there after
Drug Plan Special Support
Program available if
provides better coverage
(Consumer must apply)
EMERGENCY ASSISTANCE
Eligibility
Residents who require immediate treatment with covered prescription drugs and are
unable to cover their share of the cost, may access emergency assistance. An eligible
beneficiary may obtain a limited supply of covered prescription drug(s) at a reduced cost.
The level of assistance provided will be in accordance with the consumer's ability to pay.
Request Process
During regular office hours, the patient's pharmacy may call the Drug Plan at 787-3317
(Regina) or toll-free at 1-800-667-7578 to provide the information needed to support the
request, as follows:
•
•
•
patient identification (health services number);
pharmacy identification (name, number);
name and cost of the drug(s) required immediately;
302
•
reason for the request, including evidence that other sources of credit or assistance
have been explored and are not available.
Following approval by the Drug Plan, the claims may be submitted via the on-line system.
The patient may obtain up to a one month supply of covered drug product(s) included in
the request. A completed "Request for Special Support" form must be submitted for
future assistance.
Outside regular office hours, the pharmacy may provide up to a four day supply of
benefit drug products in an emergency situation. The paper claim will be honoured by
the Drug Plan at the rate of payment specified by the pharmacist. A completed "Request
for Special Support" form must be submitted for future assistance.
EXCEPTION DRUG STATUS PROGRAM
Please refer to Appendix A for detailed information and criteria for coverage of
medications under the Exception Drug Status Program. For general information
regarding Exception Drug Status, see "Notes Concerning the Formulary".
PALLIATIVE CARE COVERAGE
Definition of Palliative Care
Patients who are in the late stages of a terminal illness, where life expectancy is
measured in months, and for whom treatment aimed at cure or prolongation of life is no
longer deemed appropriate, but for whom care is aimed at improving or maintaining the
quality of remaining life (eg. management of symptoms such as pain, nausea and stress),
will be eligible for Drug Plan Palliative Care drug benefits. The patient's physician must
submit a completed Drug Plan" Request for Palliative Care Coverage" form to the Drug
Plan in order to register a patient for this program.
Drug Benefits under Palliative Care
A palliative care patient who is registered with the Drug Plan is entitled to receive
prescription drugs listed in the Saskatchewan Formulary at no charge to them. The
patient's pharmacy will bill the Drug Plan for 100% of the cost of benefit medications.
Coverage is also provided for some commonly used laxatives, on prescription request, to
patients registered under this program.
Exception Drug Status Drugs for Palliative Care Patients
Drugs listed under the Exception Drug Status program still require a separate physician
request on behalf of the patient. To be eligible for approval of Exception Drug Status
drugs, palliative care patients must meet the criteria as outlined in Appendix A of the
current Saskatchewan Formulary. The Drug Plan must be provided with all relevant
information to determine if the patient meets the criteria for the Exception Drug Status
drug being requested on the patient's behalf.
Provisional Approval of Palliative Care Coverage
Provisional approval may be granted in response to a telephoned request from the
pharmacy, the physician or social worker involved in the patient's care. At the time of the
request, the pharmacy or social worker must be in possession of a signed Palliative Care
form. After provisional coverage has been granted, the pharmacy or social worker must
forward the signed form to the Drug Plan. Provisional approval may be withheld by the
Drug Plan if the pharmacy or social worker is not in receipt of a signed form. All
303
physicians requesting provisional approval must provide the Drug Plan with a signed form
on the patient's behalf in a timely manner.
For provisional approval of Palliative Care, please contact the Drug Plan at 787-8744 to
arrange coverage.
Notification of Physician and Patient
Upon receipt of a signed Palliative Care form, notification letters are generated by the
Drug Plan, to the patient and the requesting physician.
Backdating of Palliative Care Coverage
Palliative Care coverage is routinely backdated 30 days from the date the form is
received by the Drug Plan. In certain cases where a patient is eligible for coverage but
application is inadvertently not made, the Drug Plan will consider backdating at the
physician's request, beyond this period.
Palliative Care Benefits under Health Districts
Patients, pharmacists or physicians should contact the home care office in their health
district to inquire about coverage provided by the district for dietary supplements and
other basic supplies.
"NO SUB" PRESCRIPTION DRUG COVERAGE
It is recognized that extremely rare cases may exist in which a person is not able to use a
particular brand of product. In such cases, the prescriber may request exemption from
full payment of incremental cost when a specific brand of drug in an interchangeable
category is found to be essential for a particular patient. There is no provision for
"blanket" exemptions. Each request must be patient and product specific.
The request may be submitted in writing or by telephone (787-8744 or toll-free
1-800-667-2549) and must provide sufficient details to permit thorough, objective
assessment.
S.A.I.L. COVERAGE (SASKATCHEWAN AIDS TO INDEPENDENT LIVING)
S.A.I.L. beneficiaries include persons with cystic fibrosis, chronic end-stage renal disease
and paraplegics. S.A.I.L. provides coverage for Formulary and non-Formulary diseaserelated drugs used by these beneficiaries. For general inquiries regarding this program,
telephone (306) 787-7121. For drug inquiries, telephone (306) 787-3314.
SASKATCHEWAN CANCER AGENCY
Prescriptions for drugs covered by the Saskatchewan Cancer Agency are provided free
of charge to registered cancer patients by either the Allan Blair Cancer Centre Pharmacy
in Regina (telephone: (306) 766-2816) or the Saskatoon Cancer Centre Pharmacy
(telephone: (306) 655-2680). These drugs would be provided when requested by a
clinic oncologist or a physician working in association with the Cancer Agency. These
drugs are not covered by the Drug Plan. Examples are flutamide, cyproterone and
ondansetron. Please note that dexamethasone 4mg when used in the treatment of
registered cancer patients would be provided by the Saskatchewan Cancer Agency
through the 2 cancer centre pharmacies. When dexamethasone 4mg is used for control
of symptoms in the palliative patient, the cost is covered by the Drug Plan, when the
patient has been registered under the Drug Plan Palliative Care program.
304
SOCIAL ASSISTANCE BENEFICIARIES
Plan One Drug Coverage
Holders of Supplementary Health cards designated as "Plan One" may obtain
prescriptions for Formulary drugs at a nominal consumer charge, currently no more than
$2.00 per prescription. In addition, they may obtain the following prescribed drugs
without charge:
insulin, oral hypoglycemics, injectable Vitamin B12, oral contraceptives, allergenic
extracts, and products used in megavitamin therapy.
Beneficiaries under the age of 18 may obtain Formulary drugs or approved Exception
Drug Status drugs without charge.
Cost of allergenic extracts and products used in megavitamin therapy are covered by the
Supplementary Health Program of Saskatchewan Health. All of the other products listed
above are covered and processed through the Drug Plan.
Plan Two Drug Coverage
Beneficiaries requiring several Formulary drugs on a regular basis can be considered for
"Plan Two" drug coverage. Plan Two coverage may be initiated by contacting the Drug
Plan at 787-8744 or (toll-free) 1-800-667-7581. The request can be made by the patient
or a health professional (ie. physician, social worker).
Holders of Supplementary Health cards designated as "Plan Two" may obtain the
products available under "Plan One" together with any Formulary drugs or approved
Exception Drug Status drugs, without charge.
Plan Three Drug Coverage
Holders of Supplementary Health cards designated as "Plan Three" may obtain, in
addition to drugs available under the Drug Plan, certain other prescribed drugs at no
charge. The cost of such drugs is covered by the Supplementary Health Program of
Saskatchewan Health. All pharmacy claims are processed by the Drug Plan.
Pharmacies may contact the Drug Plan at 787-3314 (Regina) or
1-800-667-7578 with inquires regarding Plan Three drug coverage.
(toll-free)
Special Drug Authorization
In addition to Formulary and Exception Drug Status benefits, Social Assistance
beneficiaries (Plan One and Plan Two) may be eligible for coverage of a selected panel
of products under the Supplementary Health Program through the Special Drug
Authorization process. Selected over-the-counter (OTC) products which are currently
benefits for Plan Three beneficiaries could be considered for coverage for Plan One and
Plan Two beneficiaries on a case-by-case basis. The prescriber must submit a request
on the patient's behalf. Requests may be submitted in writing or by telephone at
(306) 787-8744 or (toll-free) 1-800-667-2549.
305
APPENDIX F
TRIPLICATE PRESCRIPTION PROGRAM
PARTICIPANTS:
• Saskatchewan Pharmaceutical Association
• College of Physicians & Surgeons of Saskatchewan
• College of Dental Surgeons of Saskatchewan
OBJECTIVE:
To reduce the abuse and diversion of a select panel of prescription drugs.
PROGRAM CAPABILITY
The Triplicate Prescription program provides the College of Physicians & Surgeons with
the ability to:
•
•
•
•
•
•
identify patients who may be double doctoring or drug shopping;
upon request from the prescriber or pharmacist, provide accurate and up-to-date
prescribing information;
detect changing trends among the drug shopping patient population;
observe the prescribing practices of physicians and dentists and the dispensing
activities of pharmacies and provide advice to prevent serious problems from
developing;
generate prescriber, patient and pharmacy profiles relevant to the panel of monitored
drugs;
generate statistics and reports relevant to the panel of monitored drugs.
PROCESS
A specially designed prescription form must be used to write a prescription for any of the
medications included on the appended list. Pharmacists cannot fill a prescription for any
of these drugs written on any other form. Verbal prescriptions cannot be accepted for
any of these products. Faxed prescriptions are acceptable if done according to published
guidelines for faxing prescriptions.
PRESCRIBER PARTICIPATION
Physicians and dentists who wish to prescribe any of the medications on the panel of
monitored drugs must subscribe to the program by ordering their triplicate prescription
forms from the College of Physicians & Surgeons. Prescribers without these forms
cannot prescribe the monitored drugs.
GENERAL INFORMATION
The prescriber will complete the prescription form according to instructions. The patient
will receive the original prescription plus one copy. The patient will present the original
and copy to the pharmacist for dispensing. Upon receiving the medication, the patient or
the patient's agent will sign the form in the space provided. The pharmacist completes
the lower portion of the forms, retains the original and sends the copy to the College of
Physicians & Surgeons. This is done at least once per week. (The Saskatchewan
Pharmaceutical Association distributes self-addressed envelopes for this purpose.)
Upon receipt of the prescription copy, the College of Physicians & Surgeons enters the
information into their computer system.
306
DISPENSING INFORMATION
Prescriptions for the listed drugs must be written on a triplicate prescription form.
Prescriptions that are issued incompletely or inaccurately or are issued in any manner
which is contrary to the requirements of the Triplicate Prescription Program are rejected.
The following information must be complete on the prescription presented at the
pharmacy:
•
•
•
•
date (the prescription is valid for only 3 days from date of issue);
patient's name and address;
personal health number;
printed name of the prescriber.
The pharmacist enters the following information before sending the copy to the College:
•
•
•
•
•
prescription number;
date of filling the prescription;
price charged (optional);
dispensing pharmacist's signature or initials;
dispensing pharmacist's certificate (i.e. membership) number.
The prescription form must be signed by the patient (or agent) upon receipt of the
dispensed prescription. The signature must appear on the College copy.
ADDITIONAL INFORMATION
The Triplicate Prescription Program does not apply to orders issued in licensed special
care homes.
Only those products included in the panel of monitored drugs can be prescribed on the
triplicate form, and only one of those medications can be prescribed per form.
Refills are not allowed.
Part-fills are not encouraged but are acceptable subject to the usual legal and recordkeeping requirement. Under the program, every part-fill must be documented with the
original prescription number and the form number (upper right hand corner). The College
copy of the original prescription must be sent to the College of Physicians & Surgeons
immediately after the first fill. No subsequent refill information is required by the College.
The prescriber number imprinted on the prescription blank is a program identity number
specifically assigned for purpose of the Triplicate Prescription Program. Prescription
pads are personalized and numerically recorded and cannot be exchanged between
subscribers.
If a prescriber or pharmacist is concerned about a patient's drug history, he/she may
contact the College personally for confidential information at (306) 244-8778.
Prescriptions written at hospital emergency outpatient departments must be written on a
triplicate form if one of the monitored products is prescribed for an outpatient.
If a patient does not have the personal health number available and cannot readily obtain
it, the prescriber is expected to ask for identification and accurately fill in the remaining
identifiers on the form. Under these circumstances the pharmacist may fill the
prescription if this number is absent, but the remaining identifiers are in place.
307
DRUGS ON THE TRIPLICATE PRESCRIPTION PROGRAM:
NOTE: Trade names are included as examples only. Any brands or dosage forms of products
within a particular category are subject to the program. The list is subject to change from time to
time. Prescribers and pharmacists will be advised directly of the effective date of any additions or
deletions. Questions should be directed to the College of Physicians & Surgeons at (306) 244-8778,
or to the Saskatchewan Pharmaceutical Association at (306) 584-2292.
THE TRIPLICATE PRESCRIPTION PROGRAM PANEL OF DRUGS
(by product categories with examples)
ACETAMINOPHEN WITH CODEINE-in all dosage forms except
those containing 8mg or less of codeine (for example*)
Atasol 15, 30
Empracet 30, 60
Emtec-30
Exdol 15, 30
Lenoltec with Codeine #2, #3, #4
Novogesic C-15, C-30
Tylenol with Codeine #2, #3, #4
Tylenol with Codeine Elixir
ACETYLSALICYLIC ACID (ASA) WITH CODEINE- in all
dosage forms except those containing 8mg of codeine (for
example*)
282, 292, 293
Anacasal 15, 30
Phenaphen #2, #3, #4
282 Meps
Robaxisal C¼, C½
HYDROCODONE-DIHYDROCODEINONE-continued
Robidone
Triaminic Expectorant DH
Tussaminic DH Forte
Tussaminic DH Pediatric
Tussionex Suspension, Tablets
HYDROMORPHINE-DIHYDROMORPHONE-in all dosage forms
(for example*)
Dilaudid, all strengths
Dilaudid HP Parenteral
Hydromorphone, all strengths
LEVORPHANOL-in all dosage forms (for example*)
Levo-Dromoran
MEPERIDINE-PETHIDINE-in all dosage forms (for example*)
Demerol Injectable, Tablets
Meperidine HCl Injectable
ANILERIDINE-in all dosage forms (for example*)
Leritine
METHADONE-in all dosage forms
METHYLPHENIDATE-in all dosage forms (for example*)
Ritalin
Ritalin SR
BUTALBITAL -in all dosage forms (for example*)
Fiorinal Pl ain
Tecnal
MORPHINE- in all dosage forms (for example*)
M.O.S., all strengths
Morphine Injectable
Morphine HP
Morphine LP
Morphitec, all strengths
MS Contin, all strengths
MSIR, all strengths
Oramorph SR, all strengths
Statex, all strengths
BUTALBITAL WITH CODEINE-in all dosage forms (for
example*)
Fiorinal C¼, C½
Tecnal C¼, C½
BUTORPHANOL
Stadol Nasal Spray
COCAINE-in all dosage forms
CODEINE- as the single active ingredient, or in combination with
other active ingredients in all dosage forms except those
containing 20mg per 30mL or less of codeine in liquid for oral
administration (for example*)
Codeine Tablets, all strengths
Codeine Syrup, all strengths
Codeine Injectable, all strengths
Co-Actifed Syrup, Tablets
CoSudafed Syrup, Tablets
CoSudafed Expectorant
Cotridine
Novahistex C
Omni-Tuss
Pentuss
Robitussin AC
Tussaminic C Forte and C Pediatric
NORMETHADONE-P-HYDROXYEPHEDRINE-in all dosage
forms (for example*)
Cophylac
Cophylac Expectorant
DEXTROAMPHETAMINE-in all dosage forms (for example*)
Dexedrine
PANTOPON-in all dosage forms
DIETHYLPROPION-in all dosage forms (for example*)
Tenuate
Tenuate Dospan
FENTANYL-transdermal system (for example*)
Duragesic, all strengths
HYDROCODONE-DIHYDROCODEINONE-in all dosage forms
(for example*)
Dimetane Expectorant-C
Hycodan Syrup, Tablets
Hycomine Syrup
Hycomine-S Pediatric Syrup
Mercodol with Decapryn
Novahistex DH
Novahistex DH Expectorant
Novahistine DH
OXYCODONE-as a single active ingredient, or in combination
with other active ingredients in all dosage forms (for example*)
Endocet
Endodan
Oxycocet
Ocyocodan
Oxycontin, all strengths
Percocet
Percocet-Demi
Percodan
Percodan-Demi
PENTAZOCINE-in all dosage forms (for example*)
Talwin
Talwin Compound-50
PHENTERMINE-in all dosage forms (for example*)
Fastin
Ionamin
PROPOXYPHENE-in all dosage forms (for example*)
642, 692
Darvon-N
Darvon-N Compound
Darvon-N with ASA
Novo-Proxyphene
Novo-Proxyphene Compound
*DISCLAIMER-The product names listed with each drug
category are for example only, and are not intended to be
inclusive.
308
APPENDIX G
CODES FOR PHARMACY ON-LINE CLAIMS PROCESSING
The following is a list of error and warning codes that may appear when processing
claims on the on-line system. The error codes are highlighted.
CODE
DESCRIPTION
AA
AI
AR
CA
CB
CC
CD
CE
CF
CO
CP
CR
CS
CT
FC
GA
GB
GC
GE
GG
GH
GI
GJ
GK
GL
GM
GN
GO
GP
GQ
GR
GT
GU
GW
GX
GY
GZ
HA
HB
HSN not on file
Registered Indian
HSN no coverage
Prescription number required
Prescriber ineligible
Prescriber required
Prescriber inactive
Prescriber not on file
Prescriber inactive
Pharmacy not on file
Dispensing date no contract
Dispensing date over 62 days
Dispensing date invalid
Invalid prescription number
Formulary Clearance
Possible duplicate same pharmacy
Possible duplicate same pharmacy
Verify quantity & unit cost
Unit drug cost exceeded
Non-formulary drug cost exceeded
Non-formulary drug cost exceeded
Dispense SOC for payment
Verify quantity & unit cost & possible duplicate
Total prescription cost exceeded(memory claim)
Patient paid exceeded(memory claim)
Verify quantity & possible duplicate
Verify unit cost & possible duplicate
Dispensing fee exceeds maximum
Possible duplicate different pharmacy
Possible duplicate different pharmacy
Age inconsistent with drug
Total prescription cost invalid(memory claim)
Patient paid invalid(mem ory claim)
Verify compound unit cost and compound fee
Compound quantity must be 1
Verify compound unit cost
Verify compound fee
Non-benefit DIN
DIN not on file
309
CODE
DESCRIPTION
HC
HD
HE
HF
HG
HH
HI
HJ
IP
IS
IT
MA
MB
NA
RC
RD
RE
SA
SF
TA
TB
TC
TD
TE
TF
TG
TH
TJ
TK
TL
TM
TN
TP
TQ
YI
YK
YL
YM
Three month supply exceeded
Three month supply exceeded; another pharmacy
Possible benefit under Exception Drug Status
Three submissions exceeded for Palliative Care
Three submissions exceeded for Palliative Care; another pharmacy
Verify quantity & three submissions exceeded for Palliative Care
Verify unit cost & three submissions exceeded for Palliative Care
Verify quantity & unit cost & three submissions exceeded for Palliative Care
Alternative Reimbursement not allowed
Alternative Reimbursement Fee exceeds maximum allowable
Alternative Reimbursement Type (Quantity) invalid
Mark-up percentage exceeds the maximum allowable
Discount percentage exceeds 100% (PC interfaced)
Transmission error - re-send
Void - original claim not found
Void - original claim already voided
Void not allowed - claim paid to family
Not authorized for PC interface - contact the Drug Plan Help Desk
File error - contact the Drug Plan Help Desk
Trial/Remainder/Alternative Reimbursement prior to April 1, 1996
Product not eligible for Trial Prescription Program
Trial not allowed - not a new medication
Trial not allowed - not a new medication; another pharmacy
Duplicate Trial prescription same pharmacy
Duplicate Trial prescription different pharmacy
Remainder not allowed - trial not found
Duplicate Remainder prescription same pharmacy
Remainder not allowed - dispensed to soon after trial
Remainder not allowed - regular prescription found same pharmacy
Remainder not allowed - regular prescription found different pharmacy
Dispensing Fee not allowed on Remainder
Regular prescription not allowed - trial found
Alternative Reimbursement not allowed - trial not found
Duplicate Alternative Reimbursement
Quantity exceeds maximum
Quantity exceeds the recommended quantity
Quantity exceeds the authorized limit
Quantity lower than minimum
310
APPENDIX H
MAINTENANCE DRUG SCHEDULE
The following lists of drugs are appended to the contract between Saskatchewan Health
and each Saskatchewan pharmacy. Prescribing and dispensing should be in these
quantities once the medical therapy of a patient is in the maintenance stage, unless there
are unusual circumstances that require these quantities not be dispensed.
100 DAY LIST (by product categories)
DIGITALIS PREPARATIONS
digoxin
PHENOBARBITAL
phenobarbital
ANTICONVULSANTS
carbamazepine
clobazam
clonazepam
divalproex sodium
ethosuximide
gabapentin
lamotrigine
methsuximide
nitrazepam
phenytoin
primidone
topiramate
valproate sodium
valproic acid
vigabatrin
ORAL HYPOGLYCEMICS
acarbose
chlorpropamide
glyburide
metformin
repaglinide
tolbutamide
THYROID PREPARATIONS
thyroid
levothyroxine (sodium)
ANTI-THYROIDS
methimazole
propylthiouracil
TWO MONTH DRUG LIST (by product categories)
ORAL CONTRACEPTIVES
ESTROGENS
conjugated estrogens
estradiol
estropipate
ethinyl estradiol
piperazine estrone sulfate
stilboestrol
stilboestrol sodium diphosphate
311
APPENDIX I
TRIAL PRESCRIPTION PROGRAM MEDICATION LIST
A trial prescription provides a patient with a 7 or 10 day supply of new medication to
determine if it will be tolerated.
The following list of drugs is appended to the contract between Saskatchewan Health and
each Saskatchewan pharmacy. These medications are eligible for reimbursement under
the Trial Prescription Program.
ALPHA ADRENERGIC BLOCKERS
doxazosin
prazosin
terazosin
ANTIDEPRESSANT AGENTS
fluoxetine
fluvoxamine
moclobemide
nefazodone
paroxetine
sertraline
ANTILIPEMIC AGENTS
cholestyramine
colestipol
gemfibrozil
CALCIUM CHANNEL BLOCKERS
amlodipine
diltiazem
felodipine
nifedipine
verapamil
GASTROINTESTINAL AGENTS
misoprostol
HEMORRHELOGIC AGENTS
pentoxifylline
NONSTEROIDAL ANTI-INFLAMMATORY AGENTS
diclofenac
diclofenac/misoprostol
flurbiprofen
indomethacin
ketoprofen
piroxicam
sulindac
tiaprofenic acid
tolmetin
312
APPENDIX J
SASKATCHEWAN MS DRUGS PROGRAM
CRITERIA FOR COVERAGE OF MS DRUGS
Approval for coverage will be given to patients who are assessed and meet the following
criteria:
•
have clinical definite relapsing and remitting multiple sclerosis;
•
have had at least two attacks of MS during the previous two years (an attack is
defined as the appearance of new symptoms or worsening of old symptoms, lasting
at least 24 hours in the absence of fever, preceded by stability for at least one
month);
•
are fully ambulatory 100 meters without aids (canes, walkers or wheelchairs)Extended Disability Status Scale (EDSS) 5.5 or less;
•
are age 18 or older.
Contraindications to Treatment
•
concurrent illness likely to alter compliance or substantially reduce life expectancy;
•
pregnancy is planned or occurs;
•
nursing women;
•
active, severe depression.
Physicians should also forward the following information:
•
documentation of attacks, date of onset, date of diagnosis;
•
neurological findings, Extended Disability Status Scale (EDSS)-if known;
•
MRI reports or other significant information;
•
list of current medications.
PROCEDURE FOR OBTAINING COVERAGE OF MS DRUGS UNDER DRUG PLAN
•
Requests are initiated by a physician. The patient and physician complete the
application form and the physician forwards any relevant information to the
Saskatchewan MS Drugs Program. A copy of the application form appears in this
appendix.
•
The MS Drug Advisory Panel reviews the application form and relevant
documentation and renders a decision. Note: A patient's eligibility for coverage
is determined by the MS Drug Advisory Panel. The Drug Plan is notified of the
decision and communicates the results to the patient and the physician.
•
Questions regarding eligibility should be directed to:
Saskatchewan MS Drugs Program
Suite 7703-7th Floor
Saskatoon City Hospital
Saskatoon, S7K 0M7
Telephone: (306) 655-8400
FAX:
(306) 655-8404
•
Upon approval of coverage, patients are encouraged to apply for assistance with
the cost of these medications under the Drug Plan Special Support Program. For
more detailed information regarding this program, see Appendix E.
313
MS DRUG APPROVAL PROCESS
Fax #: (306) 655-8404
Physician
EDS
Application
(Patient consent)
MS Drug
Advisory
Panel
Not
Approved
Approved
Patient
Education
Schedule
Response to
Physician
&
Patient
Drug Plan
On-line Update
Physician
Letter
(Special Support Approval)
Patient
Letter
Follow-up
On-going
Assessment
MS Drug
Advisory
Panel
314
Saskatchewan
Health
Drug Plan &
Extended Benefits
Branch
MS DRUGS EXCEPTION DRUG STATUS APPLICATION
DATE: ___________________________
NAME: _______________________________________________ B/D: ______________________
(D/M/Y)
ADDRESS: _______________________________________________________________________
______________________________________________________ PHONE: __________________
NEUROLOGIST: __________________________________________________________________
DATE OF LAST CONSULTATION: ______________________
FAMILY PHYSICIAN: __________________________________ HSN: ____________________
Drug Requested:
Betaseron
Copaxone
Rebif
Avonex
Exception Drug Status approval will be given to patients who are assessed and meet the following
criteria:
Yes
No
1. Have clinical definite relapsing and remitting multiple sclerosis
2. Have had at least two attacks of MS during the previous two
years (an attack is defined as the appearance of new symptoms
or worsening of old symptoms, lasting at least 24 hours in the
absence of fever, preceded by stability for at least one month)
3. Are fully ambulatory 100 meters without aids (canes, walkers
or wheelchairs) – EDSS 5.5 or less
4. Are age 18 or older
Contraindications to Treatment
1. Concurrent illness likely to alter compliance or substantially
reduce life expectancy
2. Pregnancy is planned or occurs, nursing women
3. Active, severe depression
I, (patient signature) ____________________________________________, give my permission for any
health care provider involved in my care to release to the Advisory Panel any information that may be deemed
necessary in assessing my application for coverage and subsequent monitoring.
MD Signature: ___________________________ Address: ____________________________________
Telephone: ______________________________ Fax: _________________________________
Please Forward:
- clinical history including:
a) documentation of attacks, date of onset, date of diagnosis
b) neurological findings, Extended Disability Status Scale (EDSS) - if known
c) MRI reports or other significant information
d) list current medications
Mail to:
Saskatchewan MS Drugs Program
Suite 7703 - 7th Floor
Saskatoon City Hospital
SASKATOON, Saskatchewan S7K 0M7
OR
Fax:
(306) 655-8404
For clinical program information: Phone (306) 655-8400 For reimbursement information: Phone 1-800-667-7578.
315
INDICES
INDEX A - PHARMACEUTICAL MANUFACTURERS LIST
INDEX B - THERAPEUTIC CLASSIFICATION LIST
INDEX C - NUMERICAL LIST OF DRUG IDENTIFICATION
NUMBERS
INDEX D - ALPHABETICAL LIST OF PHARMACEUTICAL
PRODUCT NAMES
INDEX A
PHARMACEUTICAL MANUFACTURERS LIST
ABB
AGR
AKN
ALC
ALL
ALT
ALZ
AME
AMG
APX
AST
AVT
AXC
BAY
BCD
BEX
BGN
BMY
BOE
BOM
BRI
BVL
CBV
CDX
CYT
DBU
DER
DOM
DPY
DUI
DUP
END
FCP
FEI
FFR
FTP
FUJ
GAC
GLA
GLW
GPM
HDI
HLR
HOR
ICN
JAN
JJM
KEY
KNO
LEA
LEO
LIH
LIL
LIN
LSN
LUD
MCL
MDA
MDC
MDS
Abbott Laboratories Ltd.
Agouron Pharmaceuticals Canada Inc.
Dioptic Laboratories, Division of Akorn Pharmaceuticals Canada Ltd.
Alcon Canada Inc.
Allergan Inc.
Altimed Pharmaceutical Company
Alza Canada
Diagnostic Division - Bayer Corp.
Amgen Canada Inc.
Apotex Inc.
AstraZeneca
Aventis Pharma Inc.
Axcan Pharma
Bayer Inc. - Healthcare Division
Bayer Inc. - Consumer Care Division
Berlex Canada Inc.
Biogen Canada Inc.
Bristol-Myers Squibb Canada Inc.
Boehringer Ingelheim (Canada) Ltd.
Roche Diagnostics, Division of Hoffmann-LaRoche Limited
Bristol Pharmaceutical Products - Bristol-Myers Squibb
Biovail Pharma
Ciba Vision
Canderm Pharmacal Ltd.
Cytex Pharmaceuticals Inc.
Faulding (Canada) Inc.
Dermik Laboratories Canada Inc.
Dominion Pharmacal
Draxis Health Inc.
Duchesnay Inc.
DuPont Pharma Inc.
Endo Canada Inc., Subsidiary of DuPont Pharma
FC Pharma Inc.
Ferring Inc.
Fournier Pharma Inc.
FTP Pharmacal Inc.
Fujisawa Canada Inc.
Galderma Canada Inc.
Glaxo Wellcome Inc.
Glenwood Laboratories Canada Ltd.
Genpharm Inc.
Hill Dermaceuticals, Inc.
Hoffmann-LaRoche Ltd.
Carter-Horner Inc.
ICN Canada Ltd.
Janssen-Ortho Inc.
Johnson & Johnson - Merck
Key, Division of Schering Canada Inc.
Knoll Pharma Inc.
Lee-Adams Laboratories, Division of Pharmascience Inc.
Leo Pharma Inc.
Lioh Inc.
Eli Lilly Canada Inc.
Linson Pharma Inc.
Lifescan Canada Ltd.
Lundbeck Canada Inc
McNeil Consumer Products
3M Pharmaceuticals, 3M Canada Company
Medicis Canada Ltd.
Medisense, Canada Inc.
318
MED
MSD
NDA
NOO
NOP
NVC
NVR
NXP
ODN
ORG
ORP
OTK
PCL
PDA
PEN
PFI
PFR
PGA
PHU
PMS
PPZ
PRO
RBP
RCA
RHO
RIV
ROG
ROP
RVX
SAB
SAW
SCH
SCN
SDR
SEA
SEV
SLV
SMJ
SQU
SRO
STI
TAR
TCH
THM
TVM
WLA
WSD
WYA
Medican Pharma Inc.
Merck Frosst Canada & Co.
Lab Nadeau Ltd., Division of Technilab
Novo Nordisk Canada Inc.
Novopharm Ltd.
Novartis Consumer Health Canada Inc.
Novartis Pharmaceuticals Canada Inc.
Nu-Pharm Inc.
Odan Laboratories Limited
Organon Canada Ltd.
Orphan Medical Inc.
Organon Teknika
Pathogenesis Canada Limited
Parke-Davis Canada Inc.
Pentapharm Limited
Pfizer Canada Inc.
Purdue Frederick
Procter & Gamble Pharm. Canada, Inc.
Pharmacia & Upjohn Inc.
Pharmascience Inc.
Princeton Pharmaceutical Products - Bristol-Myers Squibb
Proval Pharma Inc.
Shire Canada Inc.
Reed & Carnrick, Division of Block Drug Company (Canada) Ltd.
Rhoxalpharma Inc.
Riva Laboratories Ltd.
Rougier Pharma Inc., Division of Technilab
Rhodiapharm
Rivex Pharma Inc.
Sabex Inc.
Sanofi-Synthelabo Canada Inc.
Schering Canada Inc.
Schein Pharmaceutical Canada Inc.
Stanley Pharmaceuticals Ltd.
Searle Canada, Unit of Monsanto Canada Inc.
Servier Canada Inc.
Solvay Pharma Inc.
SmithKline Beecham Pharma Inc.
Squibb Pharmaceutical Products - Bristol-Myers Squibb
Serono Canada Inc.
Stiefel Canada Inc.
Taro Pharmaceuticals Inc.
Technilab Inc.
Theramed Corporation
Teva Marion Partners Canada
Warner-Lambert Consumer Health Care - Div. of Warner-Lambert Canada Inc.
Westwood Squibb Canada
Wyeth-Ayerst Inc.
319
INDEX B
THERAPEUTIC CLASSIFICATION LIST
2
08:00 ANTI-INFECTIVE AGENTS..........................................................................................................
.
08:04.00 AMEBICIDES.........................................................................................................................
2
.
08:08.00 ANTHELMINTICS......................................................................................................................
2
.
08:12.00 ANTIBIOTICS..........................................................................................................................
3
.
08:12.02 ANTIBIOTICS (AMINOGLYCOSIDES).......................................................................................
3
.
08:12.04 ANTIBIOTICS (ANTIFUNGALS)................................................................................................
3
.
08:12.06 ANTIBIOTICS (CEPHALOSPORINS)........................................................................................
5
.
08:12.12 ANTIBIOTICS (MACROLIDES)...........................................................................................
7
.
08:12.16 ANTIBIOTICS (PENICILLINS)......................................................................................................
9
.
08:12.24 ANTIBIOTICS (TETRACYCLINES)............................................................................................
. 12
08:12.28 ANTIBIOTICS (MISCELLANEOUS ANTIBIOTICS).......................................................................................
. 13
08:18.00 ANTIVIRALS..........................................................................................................................
. 14
08:18.08 ANTIRETROVIRAL AGENTS (NONNUCLEOSIDE REVERSE
TRANSCRIPTASE INHIBITORS).................................................................................
. 16
TRANSCRIPTASE INHIBITORS).................................................................................
. 16
08:18.08 ANTIRETROVIRAL AGENTS (PROTEASE INHIBITORS).....................................................
. 18
08:20.00 ANTIMALARIAL AGENTS........................................................................................................
. 19
08:22.00 QUINOLONES........................................................................................................................
. 20
08:24.00 SULFONAMIDES...................................................................................................................
. 21
08:26.00 SULFONES...........................................................................................................................
. 21
08:36.00 URINARY ANTI-INFECTIVES.........................................................................................................
. 21
08:40.00 MISCELLANEOUS ANTI-INFECTIVES......................................................................................
. 22
10:00 ANTINEOPLASTIC AGENTS........................................................................................................
. 26
10:00.00 ANTINEOPLASTIC AGENTS...................................................................................................
. 26
12:00 AUTONOMIC DRUGS..................................................................................................................
. 30
12:04.00 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS.............................................................
. 30
12:08.04 ANTIPARKINSONIAN AGENTS...............................................................................................
. 30
12:08.08 ANTIMUSCARINICS/ANTISPASMODICS..................................................................................
. 31
12:12.00 SYMPATHOMIMETIC (ADRENERGIC) AGENTS.......................................................................
. 33
12:16.00 SYMPATHOLYTIC AGENTS (ANTIMIGRAINE DRUGS).............................................................
. 37
12:20.00 SKELETAL MUSCLE RELAXANTS..........................................................................................
. 39
20:00 BLOOD FORMATION AND COAGULATION..................................................................................
. 42
20:04.04 IRON PREPARATIONS...........................................................................................................
. 42
20:12.04 ANTICOAGULANTS................................................................................................................
. 42
20:12.20 ANTIPLATELET DRUGS.........................................................................................................
. 44
20:16.00 HEMATOPOIETIC AGENTS....................................................................................................
. 45
20:24.00 HEMORRHEOLOGIC AGENTS................................................................................................
. 45
24:00 CARDIOVASCULAR DRUGS.......................................................................................................
. 48
24:04.00 CARDIAC DRUGS..................................................................................................................
. 48
24:06.00 ANTILIPEMIC DRUGS.............................................................................................................
. 59
24:08.00 HYPOTENSIVE DRUGS.........................................................................................................
. 62
24:12.00 VASODILATING DRUGS.........................................................................................................
. 76
28:00 CENTRAL NERVOUS SYSTEM DRUGS.......................................................................................
. 80
. 80
28:08.04 NON-STEROIDAL ANTI-INFLAMMATORY AGENTS............................................................................................
28:08.08 OPIATE AGONISTS (NARCOTIC ANALGESICS).......................................................................
. 88
28:08.12 OPIATE PARTIAL AGONISTS.................................................................................................
. 94
28:08.92 MISCELLANEOUS ANALGESICS AND ANTIPYRETICS............................................................
. 94
28:12.04 ANTICONVULSANTS (BARBITURATES)..................................................................................
. 95
28:12.08 ANTICONVULSANTS (BENZODIAZEPINES).............................................................................
. 96
28:12.12 ANTICONVULSANTS (HYDANTOINS)......................................................................................
. 97
28:12.20 ANTICONVULSANTS (SUCCINIMIDES)....................................................................................
. 97
28:12.92 MISCELLANEOUS ANTICONVULSANTS.................................................................................
. 98
28:16.04 PSYCHOTHERAPEUTIC AGENTS (ANTIDEPRESSANTS)........................................................
. 101
28:16.08 PSYCHOTHERAPEUTIC AGENTS (ANTIPSYCHOTIC AGENTS)...............................................................
. 110
28:20.00 RESPIRATORY AND CEREBRAL STIMULANTS.......................................................................
. 118
28:24.04 ANXIOLYTICS,SEDATIVES AND HYPNOTICS (BARBITURATES)..............................................
. 118
28:24.08 ANXIOLYTICS,SEDATIVES AND HYPNOTICS (BENZODIAZEPINES).........................................
. 119
28:24.92 MISCELLANEOUS ANXIOLYTICS,SEDATIVES AND HYPNOTICS............................................
. 123
28:28.00 ANTIMANIC AGENTS.............................................................................................................
. 125
36:00 DIAGNOSTIC AGENTS................................................................................................................
. 128
36:04.00 ADRENAL INSUFFICIENCY....................................................................................................
. 128
36:26.00 DIABETES MELLITUS............................................................................................................
. 128
36:88.00 URINE CONTENTS.................................................................................................................
. 128
40:00 ELECTROLYTIC, CALORIC AND WATER BALANCE.....................................................................
. 132
320
40:12.00 REPLACEMENT AGENTS......................................................................................................
. 132
40:18.00 POTASSIUM-REMOVING RESINS..........................................................................................
. 132
40:28.00 DIURETICS............................................................................................................................
. 133
40:28.10 POTASSIUM SPARING DIURETICS.........................................................................................
. 134
40:40.00 URICOSURIC DRUGS.............................................................................................................
. 135
48:00 COUGH PREPARATIONS...........................................................................................................
. 138
48:24.00 MUCOLYTIC AGENTS............................................................................................................
. 138
52:00 EYE, EAR, NOSE AND THROAT PREPARATIONS.......................................................................
. 140
52:04.04 ANTI-INFECTIVES (ANTIBIOTICS)............................................................................................
. 140
52:04.06 ANTI-INFECTIVES (ANTIVIRALS).............................................................................................
. 141
52:04.08 ANTI-INFECTIVES (SULFONAMIDES)......................................................................................
. 141
52:04.12 ANTI-INFECTIVES (MISCELLANEOUS)....................................................................................
. 142
52:08.00 ANTI-INFLAMMATORY AGENTS.............................................................................................
. 142
52:08.00 COMBINATION ANTI-INFECTIVE/ ANTI-INFLAMMATORY AGENTS...........................................
. 145
52:10.00 CARBONIC ANHYDRASE INHIBITORS....................................................................................
. 146
52:20.00 MIOTICS................................................................................................................................
. 147
52:24.00 MYDRIATICS.........................................................................................................................
. 148
52:36.00 MISCELLANEOUS E.E.N.T. DRUGS.......................................................................................
. 149
56:00 GASTROINTESTINAL DRUGS.....................................................................................................
. 154
56:08.00 ANTIDIARRHEA AGENTS.......................................................................................................
. 154
56:12.00 CATHARTICS AND LAXATIVES...............................................................................................
. 154
56:16.00 DIGESTANTS.........................................................................................................................
. 154
56:22.00 ANTI-EMETICS.......................................................................................................................
. 156
56:40.00 MISCELLANEOUS GASTROINTESTINAL DRUGS....................................................................
. 157
60:00 GOLD COMPOUNDS..................................................................................................................
. 164
60:00.00 GOLD COMPOUNDS..............................................................................................................
. 164
64:00 METAL ANTAGONISTS...............................................................................................................
. 166
64:00.00 METAL ANTAGONISTS..........................................................................................................
. 166
68:00 HORMONES AND SUBSTITUTES................................................................................................
. 168
68:04.00 ADRENAL CORTICOSTEROIDS..............................................................................................
. 169
68:08.00 ANDROGENS........................................................................................................................
. 173
68:12.00 CONTRACEPTIVES................................................................................................................
. 174
68:16.00 ESTROGENS.........................................................................................................................
. 177
68:18.00 GONADOTROPINS.................................................................................................................
. 179
68:20.08 ANTI-DIABETIC DRUGS (INSULINS-PORK)..............................................................................
. 179
68:20.08 ANTI-DIABETIC DRUGS (INSULINS-HUMAN BIOSYNTHETIC)...................................................
. 179
68:20.20 ANTI-DIABETIC DRUGS (ORAL HYPOGLYCEMICS).................................................................
. 181
68:24.00 PARATHYROID......................................................................................................................
. 183
68:28.00 PITUITARY AGENTS..............................................................................................................
. 184
68:32.00 PROGESTINS......................................................................................................................
. 185
68:36.04 THYROID AGENTS.................................................................................................................
. 186
68:36.08 ANTITHYROID AGENTS..........................................................................................................
. 187
84:00 SKIN AND MUCOUS MEMBRANE PREPARATIONS.....................................................................
. 190
84:04.04 ANTI-INFECTIVES (ANTIBIOTICS)............................................................................................
. 190
84:04.08 ANTI-INFECTIVES (ANTI-FUNGALS)........................................................................................
. 191
84:04.12 ANTI-INFECTIVES (SCABICIDES AND PEDICULICIDES)...........................................................
. 193
84:04.16 MISCELLANEOUS ANTI-INFECTIVES......................................................................................
. 194
84:06.00 ANTI-INFLAMMATORY AGENTS.............................................................................................
. 195
84:06.00 COMBINATION ANTI-INFECTIVE/ ANTI-INFLAMMATORY AGENTS...........................................
. 206
84:08.00 ANTIPRURITICS AND LOCAL ANAESTHETICS........................................................................
. 207
84:12.00 ASTRINGENTS......................................................................................................................
. 208
84:16.00 CELL STIMULANTS AND PROLIFERANTS...............................................................................
. 208
84:28.00 KERATOLYTIC AGENTS.........................................................................................................
. 209
84:36.00 MISCELLANEOUS SKIN & MUCOUS MEMBRANE AGENTS.......................................................
. 210
84:50.06 DEPIGMENTING & PIGMENTING AGENTS (PIGMENTING AGENTS).........................................
. 212
86:00 SMOOTH MUSCLE RELAXANTS.................................................................................................................................................
. 214
86:12.00 GENITOURINARY SMOOTH MUSCLE RELAXANTS.................................................................
. 214
86:16.00 RESPIRATORY SMOOTH MUSCLE RELAXANTS.........................................................................
. 214
88:00 VITAMINS..................................................................................................................................
. 218
88:04.00 VITAMIN A.............................................................................................................................
. 218
88:08.00 VITAMINS B...........................................................................................................................
. 218
88:16.00 VITAMIN D.................................................................................................................................
. 219
92:00 UNCLASSIFIED THERAPEUTIC AGENTS.....................................................................................
. 222
92:00.00 UNCLASSIFIED THERAPEUTIC AGENTS................................................................................
. 222
321
INDEX C
NUMERICAL LIST OF DRUG IDENTIFICATION NUMBERS
DIN
00000086
00000299
00000302
00000655
00000663
00000779
00000787
00000833
00000841
00000868
00000884
00000892
00001120
00001287
00001910
00004057
00004405
00004588
00004596
00004685
00004723
00004758
00004774
00005525
00005533
00005541
00005606
00005614
00005622
00005630
00009830
00010014
00010081
00010200
00010219
00010308
00010332
00010340
00010383
00010391
00010405
00010464
00010472
00010480
00012696
00012718
00013285
00013293
00013579
00013595
00013609
00013757
00013765
00013773
00013781
00013803
00015148
00015156
00015229
00015237
00015288
00015377
00015423
PAGE
118
8
9
147
147
149
149
147
148
148
148
148
141
141
42
11
31
222
222
50
27
31
19
68
68
68
118
118
173
173
220
88
94
187
187
44
80
80
42
42
98
105
105
105
121
121
121
121
156
156
156
121
121
121
178
156
118
118
107
107
119
224
14
DIN
PAGE
00015547
00015741
00016055
00016128
00016233
00016322
00016330
00016349
00016357
00016438
00016446
00016462
00016497
00016500
00016578
00018635
00020877
00020885
00020915
00020923
00020931
00021008
00021016
00021059
00021067
00021075
00021121
00021148
00021172
00021202
00021261
00021350
00021423
00021466
00021474
00021482
00021504
00021512
00021520
00021555
00021563
00021571
00021660
00021695
00021733
00021792
00021849
00021865
00021873
00021881
00021911
00021938
00022608
00022772
00022780
00022799
00022802
00023442
00023450
00023485
00023698
00023795
00023809
322
7
187
166
30
83
101
101
101
30
169
169
170
133
134
70
11
10
10
120
120
120
20
20
13
218
218
11
11
8
11
19
181
156
218
134
134
105
105
105
22
21
21
85
172
58
21
183
117
117
117
31
31
176
97
97
97
97
97
97
97
97
95
95
DIN
00023817
00023949
00023957
00023965
00024325
00024333
00024341
00024368
00024376
00024384
00024430
00024449
00024457
00024694
00024708
00024716
00026034
00026050
00026093
00026611
00027243
00027359
00027375
00027456
00027464
00027499
00027898
00027901
00027944
00028053
00028096
00028223
00028231
00028274
00028282
00028290
00028339
00028347
00028355
00028363
00028606
00029076
00029092
00029173
00029238
00029246
00029556
00030570
00030600
00030619
00030759
00030767
00030783
00030848
00030910
00030929
00030937
00030988
00031062
00035017
00035092
00035106
00035114
PAGE
95
187
187
187
103
103
103
12
124
124
116
116
116
124
181
181
195
195
195
195
37
116
116
113
113
37
201
201
201
141
169
178
178
4
4
114
140
141
201
201
135
56
192
111
178
173
193
13
171
171
171
171
173
185
171
171
185
171
205
148
129
129
129
DIN
00035122
00035130
00035149
00035319
00035645
00035653
00036129
00036323
00037400
00037419
00037427
00037478
00037486
00037494
00037508
00037605
00037613
00037621
00042560
00042579
00042676
00067385
00067393
00068586
00074225
00074454
00074608
00125083
00125105
00125121
00151351
00151416
00155225
00155357
00176214
00178799
00178802
00178810
00178829
00179493
00180408
00187585
00192597
00192600
00194948
00206032
00210188
00213624
00216666
00220442
00223824
00225851
00228079
00228087
00229296
00230197
00230316
00232157
00232378
00232440
00232459
00232475
00232807
00232823
00232831
00232971
00236683
00242713
PAGE
128
129
129
50
7
129
171
154
101
101
101
116
116
116
116
176
77
77
143
143
145
76
76
37
132
145
73
89
90
90
94
13
84
33
37
95
95
95
95
218
73
209
204
205
145
223
172
170
80
156
3
13
204
204
80
156
205
110
172
218
218
219
110
110
110
21
125
50
DIN
PAGE
00244392
00244635
00247855
00248169
00249580
00249920
00252417
00252522
00252654
00253952
00259527
00261238
00261432
00262595
00263699
00263818
00264911
00264938
00264946
00265470
00265489
00268585
00268593
00268607
00268631
00270091
00270636
00270644
00271373
00271489
00272434
00272442
00272450
00272485
00273023
00280437
00282219
00285455
00285471
00287873
00288195
00288209
00288217
00291889
00293504
00293512
00294322
00294837
00294926
00294950
00295094
00295973
00296031
00297143
00299405
00301175
00306290
00307246
00312711
00312738
00312746
00312754
00312762
00312770
00312789
00312797
00312800
00313815
323
7
8
143
4
57
34
172
141
212
184
66
229
94
8
209
155
120
120
120
177
177
218
218
219
219
192
22
23
172
207
121
121
121
23
9
169
4
135
170
223
193
193
192
66
88
88
222
33
135
218
170
193
56
176
144
144
31
146
181
21
117
117
183
172
85
105
134
114
DIN
00313823
00315966
00317047
00319511
00322741
00323071
00324019
00326836
00326844
00326852
00326925
00327794
00328219
00328952
00329320
00330566
00330582
00335053
00335061
00335088
00335096
00335118
00335126
00335134
00335355
00335363
00337382
00337420
00337439
00337447
00337455
00337463
00337471
00337498
00337730
00337749
00337757
00337765
00337773
00340731
00340758
00342084
00342092
00342106
00342114
00343838
00344923
00345504
00345539
00349739
00349917
00353027
00353523
00354309
00355658
00358177
00359726
00360198
00360201
00360228
00360236
00360244
00360252
00360260
00360279
00360287
00360481
00360503
PAGE
114
176
175
21
107
196
102
117
134
105
104
82
226
37
38
102
211
101
101
101
114
114
114
114
36
36
60
83
83
133
133
70
70
70
133
133
11
11
11
175
176
6
7
7
6
176
196
82
117
30
111
176
56
170
226
145
202
116
105
116
116
116
70
70
133
133
106
106
DIN
00360511
00361933
00362158
00362166
00363634
00363642
00363650
00363669
00363677
00363685
00363693
00363766
00363812
00364126
00364142
00364282
00368040
00369810
00370568
00371033
00371823
00372838
00372846
00373036
00374318
00374407
00382825
00382841
00386391
00386464
00386472
00392537
00392561
00392588
00396761
00396788
00396796
00396818
00396826
00396834
00397423
00397431
00399302
00399310
00400750
00402516
00402540
00402575
00402583
00402591
00402605
00402680
00402699
00402737
00402745
00402753
00402761
00402788
00402796
00402818
00403571
00403628
00405310
00405329
00405337
00405345
00405361
00406716
PAGE
106
31
121
133
70
70
112
112
112
112
222
156
32
87
83
222
23
98
209
223
23
175
175
210
209
169
96
96
27
226
226
156
93
92
95
133
112
112
112
112
53
53
181
95
104
184
53
71
71
102
53
122
98
122
122
57
57
57
222
222
210
6
215
121
121
112
112
9
DIN
PAGE
00406724
00406848
00410632
00417246
00417270
00417289
00422053
00426830
00426849
00426857
00430617
00432938
00436771
00441619
00441627
00441635
00441651
00441686
00441694
00441708
00441716
00441724
00441732
00441759
00441767
00441775
00443158
00443174
00443794
00443816
00443832
00443840
00445126
00445266
00445274
00445282
00451193
00451207
00452092
00452106
00452130
00452149
00453617
00454583
00455881
00456551
00458686
00458694
00458716
00460982
00460990
00461008
00461733
00463256
00463698
00464880
00465208
00465216
00469327
00471526
00474517
00474525
00475068
00475076
00476366
00476552
00476714
00476722
324
9
209
112
196
55
56
142
70
218
30
194
209
140
68
68
68
82
76
76
70
70
215
215
135
135
74
123
56
209
208
100
100
161
23
22
23
151
151
76
76
10
10
8
207
39
202
76
76
215
215
215
216
125
54
112
60
5
5
174
174
219
219
135
135
215
107
207
207
DIN
00479799
00481211
00481793
00481815
00481823
00483923
00484911
00486582
00487805
00487813
00487872
00488275
00489158
00496480
00496499
00496502
00496529
00496537
00496545
00496553
00497452
00497479
00497827
00497894
00499013
00500852
00500895
00502197
00502200
00502790
00503134
00503436
00504335
00506052
00506370
00507989
00509353
00510637
00510645
00511528
00511536
00511552
00511641
00511692
00512184
00512192
00513253
00513261
00513288
00513644
00513962
00513997
00514004
00514012
00514217
00514497
00514500
00514535
00514551
00518123
00518131
00518174
00518182
00519251
00521515
00521698
00521701
00522597
PAGE
222
132
203
219
219
58
83
92
134
63
157
146
170
57
57
57
122
122
121
121
90
91
53
166
21
122
229
205
204
155
205
215
57
83
222
100
74
22
23
96
96
38
166
215
140
140
205
205
204
179
141
226
80
80
92
70
70
179
179
120
120
209
209
66
218
121
121
226
DIN
00522651
00522678
00522724
00522988
00522996
00523372
00525596
00525618
00527661
00529117
00532223
00532657
00534560
00534579
00534587
00534609
00535427
00535435
00536709
00537594
00537608
00537616
00538590
00541389
00545015
00545058
00545066
00545074
00545678
00546232
00546240
00546283
00546291
00546305
00548359
00548367
00548375
00549657
00550094
00550159
00550957
00552135
00552143
00552429
00554316
00554324
00555649
00556734
00556742
00560022
00560952
00560960
00560979
00564966
00565342
00565350
00565369
00566748
00566756
00568449
00568627
00568635
00568643
00572349
00575119
00575127
00575135
00575143
PAGE
85
85
120
120
120
54
86
86
209
149
216
74
53
71
71
229
201
201
215
210
210
210
175
33
146
31
22
31
9
157
157
64
65
65
119
119
227
57
156
34
172
112
112
112
75
75
229
2
216
205
71
71
72
134
222
85
85
210
210
157
71
71
223
223
116
116
116
116
DIN
PAGE
00575151
00575240
00576158
00577308
00578428
00578436
00578452
00578541
00578568
00578576
00579335
00579351
00579378
00579947
00580929
00580988
00582255
00582263
00582271
00582301
00582344
00582352
00582409
00582417
00582514
00583405
00583413
00583421
00584215
00584223
00584282
00584339
00584991
00585009
00585092
00585114
00586331
00586668
00586676
00586684
00586706
00586714
00587265
00587354
00587362
00587702
00587737
00587818
00587826
00587834
00587958
00587966
00589861
00590665
00590827
00591467
00591475
00591548
00592277
00593435
00593451
00594377
00594466
00594636
00594644
00594652
00595799
00595802
325
216
148
32
225
196
196
12
205
208
208
205
108
109
208
13
110
57
57
57
190
211
211
157
157
112
22
6
7
157
77
157
22
118
118
185
83
156
190
191
191
145
180
30
31
31
112
179
203
203
203
208
208
85
125
81
92
92
154
85
89
89
73
83
91
91
91
205
205
DIN
00596418
00596426
00596434
00596965
00598194
00598461
00598488
00598941
00599026
00599085
00599905
00599956
00599964
00600059
00600067
00600784
00600792
00600806
00602884
00602957
00602965
00603260
00603279
00603287
00603295
00603678
00603686
00603708
00603716
00603821
00604453
00604461
00605859
00607126
00607142
00607762
00607770
00608882
00609129
00610267
00611158
00611166
00611174
00613215
00613223
00613231
00614254
00614351
00614378
00615315
00615323
00615331
00617288
00618284
00618292
00618632
00618640
00620955
00620963
00621374
00621463
00621935
00622133
00623377
00624268
00624276
00627097
00627100
PAGE
98
99
99
93
172
161
161
59
61
113
216
54
54
157
157
225
82
85
132
175
175
11
10
11
10
157
157
56
56
123
122
122
8
54
8
92
92
88
156
219
83
83
206
135
135
73
141
123
123
85
85
85
93
11
11
53
53
34
34
223
88
92
90
193
93
93
85
90
DIN
00628115
00628123
00628131
00628158
00628190
00628204
00628212
00629332
00629340
00629359
00629367
00631698
00631701
00632201
00632228
00632481
00632503
00632600
00632716
00632724
00632732
00632740
00632775
00633836
00634506
00636576
00636622
00636681
00637661
00637742
00637750
00638641
00638676
00638684
00638692
00639389
00639885
00641154
00641790
00641855
00641863
00642215
00642223
00642886
00642894
00642975
00643025
00644633
00645575
00646016
00646024
00646059
00646148
00646237
00647942
00647969
00648035
00648043
00652318
00653209
00653217
00653241
00653268
00653276
00655740
00655759
00655767
00657182
PAGE
9
9
10
10
120
120
120
82
83
83
196
215
215
93
93
92
92
159
86
81
81
87
118
4
14
39
104
93
150
121
122
229
56
56
56
93
56
205
160
106
209
11
11
86
86
60
20
11
95
124
124
124
179
212
82
112
53
53
8
201
201
88
190
88
121
121
122
73
DIN
PAGE
00657204
00657298
00658855
00659606
00662348
00663719
00664227
00666122
00666130
00666149
00666203
00666246
00667099
00667102
00670901
00670928
00670944
00674222
00675199
00675202
00675229
00675962
00677477
00677485
00677590
00682217
00682314
00685925
00685933
00687200
00687219
00687456
00688622
00690198
00690201
00690228
00690244
00690783
00690791
00690805
00692689
00692697
00692700
00692719
00694371
00694398
00695351
00695440
00695459
00695661
00695696
00695718
00698059
00700401
00701904
00703486
00703591
00703605
00703974
00704423
00704431
00705438
00707503
00707600
00708879
00708917
00710113
00710121
326
208
67
53
61
209
57
170
190
88
88
190
207
121
121
67
67
76
142
82
82
22
91
119
119
22
145
119
161
161
88
88
141
196
91
91
91
91
92
92
110
215
215
216
20
140
140
210
20
20
64
86
86
212
144
145
154
194
194
192
26
26
89
174
174
67
185
158
158
DIN
00711101
00713325
00713333
00713341
00713376
00713449
00714887
00716618
00716626
00716634
00716642
00716650
00716685
00716693
00716782
00716790
00716812
00716820
00716839
00716863
00716871
00716898
00716901
00716952
00716960
00716979
00716987
00717002
00717029
00717495
00717509
00717517
00717568
00717576
00717584
00717592
00717606
00717630
00717649
00717657
00717673
00720933
00720941
00722065
00722146
00725110
00725749
00725765
00726540
00728179
00728276
00728284
00729973
00731269
00731323
00731439
00733059
00733067
00733075
00738824
00738832
00738840
00739839
00740497
00740675
00740713
00740799
00740802
PAGE
121
56
56
56
132
112
9
201
201
201
201
201
205
205
203
203
203
204
204
204
192
193
193
206
206
206
206
207
207
11
70
70
11
70
11
11
13
11
11
10
10
182
182
216
14
55
91
90
23
214
133
133
185
50
27
32
160
160
181
124
124
124
143
43
57
12
109
109
DIN
00740810
00740829
00741817
00742554
00743518
00745588
00745596
00745626
00749354
00750050
00751170
00751286
00751863
00751871
00751898
00755338
00755575
00755583
00755826
00755834
00755842
00755850
00755869
00755877
00755885
00755893
00755907
00756784
00756792
00756814
00756830
00756849
00756857
00759465
00759473
00759481
00759503
00759546
00761605
00761613
00761621
00761648
00761672
00761680
00766046
00768715
00768723
00769533
00769541
00769991
00771368
00771376
00771384
00773611
00773689
00773697
00775320
00776181
00776203
00776521
00778338
00778346
00778354
00778362
00778907
00778915
00779121
00779474
PAGE
109
109
124
76
110
87
87
184
53
201
53
150
170
117
114
132
111
98
151
151
59
59
59
55
56
56
55
143
178
85
55
177
177
68
68
68
112
219
109
109
109
109
84
84
143
7
6
132
132
8
194
51
51
98
49
50
116
92
92
140
159
159
87
87
146
146
4
89
DIN
PAGE
00782327
00782459
00782467
00782475
00782483
00782491
00782505
00782718
00782742
00783137
00784338
00784400
00785261
00786535
00786543
00786616
00788716
00789429
00789437
00789445
00789747
00790419
00790427
00792659
00792667
00792942
00795852
00795860
00795879
00800430
00805009
00807435
00808539
00808547
00808563
00808571
00808652
00808733
00808741
00809187
00812331
00812358
00812366
00812374
00812382
00813966
00816078
00817120
00818658
00818666
00818674
00818682
00821373
00824143
00824291
00824305
00828556
00828564
00828688
00828823
00832804
00836230
00836249
00836273
00836311
00836338
00836362
00839175
327
173
81
54
54
75
75
54
98
40
22
208
63
143
90
90
36
14
155
155
154
115
35
84
123
4
215
62
62
180
14
196
140
80
80
123
123
112
182
182
196
75
75
191
191
191
159
219
12
73
73
74
73
155
184
219
184
160
160
160
160
5
86
86
226
158
158
184
80
DIN
00839183
00839191
00839205
00839213
00839388
00839396
00839418
00842648
00842656
00842745
00842753
00842761
00842788
00842796
00842834
00846341
00846368
00846465
00849650
00849669
00850322
00850330
00851639
00851647
00851655
00851663
00851671
00851698
00851736
00851744
00851752
00851760
00851779
00851787
00851795
00851833
00851841
00851922
00851930
00852074
00852384
00854409
00855774
00855820
00856711
00860689
00860697
00860700
00860743
00860751
00860808
00862924
00862932
00862975
00865397
00865400
00865532
00865540
00865559
00865567
00865575
00865591
00865605
00865613
00865621
00865648
00865656
00865664
PAGE
80
227
227
228
69
69
69
53
53
103
103
103
104
104
159
37
226
23
196
196
92
93
64
65
65
54
54
54
206
206
169
169
67
67
67
64
35
61
61
169
77
154
164
158
205
120
120
120
154
12
36
51
51
196
119
119
74
10
10
9
9
55
53
53
85
85
85
85
DIN
00865672
00865680
00865699
00865710
00865729
00865737
00865745
00865753
00865761
00865788
00865796
00865818
00865826
00865834
00865850
00865869
00865877
00865885
00867365
00867373
00868949
00868957
00869007
00869015
00869023
00869945
00869953
00869961
00870013
00870021
00870935
00871095
00872318
00872334
00872423
00872431
00873292
00873454
00873993
00874086
00874256
00878669
00878707
00878723
00878790
00878928
00878936
00880191
00881678
00882801
00882828
00882836
00884324
00884332
00884340
00884359
00884413
00884421
00884502
00885401
00885436
00885835
00885843
00885851
00886009
00886017
00886025
00886033
PAGE
121
121
122
22
23
160
160
23
86
86
157
157
157
157
83
83
6
7
75
75
66
66
55
56
56
30
30
30
208
209
227
206
142
169
123
123
203
8
184
35
12
8
202
202
143
49
49
140
202
71
71
72
62
62
62
62
69
69
226
90
89
63
63
63
56
80
80
75
DIN
PAGE
00886041
00886068
00886076
00886106
00886114
00886122
00886130
00886149
00888354
00888400
00888419
00888524
00888532
00889091
00889105
00889113
00889121
00890960
00891800
00891819
00893560
00893595
00893609
00893617
00893625
00893749
00893757
00893773
00893781
00894710
00894729
00894737
00894745
00897272
00897310
00897329
00899356
00950068
00950122
00950238
00950300
00950378
00950408
00950432
00950459
00950505
00950572
00950599
00950661
00950734
00950792
00950793
00950807
00950815
00950823
00950878
00950882
00950883
00950889
01900927
01900935
01902628
01902644
01902652
01902660
01905082
01905090
01907107
328
75
51
51
63
49
50
56
55
149
134
134
51
51
180
180
180
181
60
3
4
150
64
64
65
65
62
62
151
151
193
193
111
111
58
208
208
106
128
128
129
128
128
128
128
128
128
128
128
128
128
211
211
211
211
211
128
128
128
128
182
182
190
18
18
18
151
151
67
DIN
01907115
01907123
01907476
01908294
01908448
01908871
01908901
01910086
01910124
01910132
01910140
01910159
01910167
01910272
01910299
01911465
01911473
01911481
01911627
01911635
01911902
01911910
01911929
01912038
01912046
01912054
01912062
01912070
01912437
01912828
01913204
01913220
01913239
01913247
01913328
01913425
01913433
01913441
01913468
01913476
01913484
01913492
01913506
01913654
01913662
01913670
01913689
01913786
01913794
01913808
01913816
01913824
01913832
01913840
01913859
01913999
01914006
01914030
01914138
01914146
01916181
01916203
01916386
01916513
01916750
01916777
01916785
01916815
PAGE
67
75
212
142
149
209
209
190
205
205
48
48
48
202
202
65
65
65
14
14
77
77
77
82
82
50
49
158
209
146
68
66
119
119
144
103
103
104
104
104
119
119
123
182
182
182
182
66
71
71
72
64
64
65
65
15
15
161
12
13
144
144
90
93
157
157
157
157
DIN
01916823
01916858
01916866
01916874
01916882
01916947
01917021
01917056
01918206
01918214
01918222
01918230
01918303
01918311
01918338
01918346
01918354
01918362
01918486
01919342
01919369
01919458
01919466
01919547
01919563
01919571
01919598
01924516
01924559
01924567
01924613
01924621
01924753
01924761
01925199
01925350
01925679
01925997
01926284
01926292
01926306
01926314
01926322
01926330
01926349
01926357
01926365
01926373
01926381
01926403
01926411
01926446
01926454
01926462
01926470
01926489
01926497
01926500
01926519
01926527
01926543
01926551
01926578
01926586
01926594
01926608
01926616
01926640
PAGE
164
10
10
10
10
190
104
81
117
117
117
117
132
44
44
44
44
44
60
105
105
186
186
74
135
135
108
118
118
118
87
87
214
214
209
196
179
209
109
230
230
172
109
109
109
109
84
84
84
84
84
230
77
208
208
209
208
208
209
209
48
48
48
215
215
215
215
216
DIN
PAGE
01926667
01926675
01926691
01926721
01926756
01926764
01926772
01926780
01926853
01926861
01926888
01926934
01927604
01927612
01927620
01927647
01927655
01927663
01927671
01927701
01927728
01927744
01927752
01927760
01927779
01927787
01927795
01927914
01929968
01929976
01929984
01929992
01931512
01934155
01934198
01934201
01934228
01934317
01934392
01934406
01937219
01937227
01937235
01937383
01937391
01937405
01937413
01939130
01940376
01940414
01940430
01940449
01940457
01940473
01940481
01940511
01940538
01940546
01940554
01940635
01942964
01942972
01942980
01942999
01943200
01944355
01944363
01944436
329
115
115
183
78
114
114
114
114
22
195
195
35
164
164
164
124
124
124
124
124
124
30
115
115
115
115
115
196
110
110
110
110
84
193
71
71
72
75
34
34
63
108
109
89
89
89
89
218
183
149
109
109
109
107
107
17
17
17
17
17
64
64
65
65
219
2
2
196
DIN
01944444
01945149
01945203
01945270
01946242
01946250
01946269
01946277
01946323
01946374
01947664
01947672
01947680
01947699
01947796
01947818
01947826
01947923
01947931
01947958
01948598
01948776
01948784
01948792
01948806
01950541
01950681
01953834
01953842
01953877
01958097
01958100
01958119
01959069
01959077
01959212
01959220
01959239
01962639
01962647
01962655
01962663
01962701
01962728
01962779
01962817
01964054
01964070
01964399
01964402
01964909
01964925
01964933
01964968
01964976
01966146
01966197
01966200
01966219
01966251
01966278
01968017
01968300
01968432
01968440
01976133
01977547
01977563
PAGE
196
210
35
142
103
102
102
103
18
212
72
72
72
72
59
59
59
30
30
30
148
102
102
103
103
151
32
158
158
18
66
66
66
27
27
180
180
179
180
180
180
181
204
204
108
108
206
170
115
115
124
124
124
170
170
31
52
52
216
215
216
45
144
45
176
211
170
172
DIN
01977601
01978918
01978926
01979574
01979582
01981501
01984853
01985205
01986864
01987003
01987682
01987712
01988727
01988735
01988743
01988840
01989545
01989553
01989561
01990403
01990896
01990918
01992872
01995227
01997580
01997602
01997629
01997637
01997653
01997750
01999559
01999761
01999788
01999796
01999818
01999826
01999834
01999842
01999850
01999869
02004828
02004836
02006383
02007134
02007959
02009706
02009749
02009765
02009773
02010267
02010283
02010291
02010909
02011239
02011271
02011921
02011948
02011956
02012472
02013223
02014165
02014173
02014181
02014203
02014211
02014238
02014246
02014254
PAGE
173
169
169
61
61
223
8
155
35
218
190
145
92
92
92
190
52
52
52
15
18
18
176
123
161
40
224
21
40
2
64
172
206
206
206
207
207
207
207
172
68
68
33
183
44
91
91
91
91
192
204
204
224
125
77
204
192
140
43
194
216
93
216
91
91
91
93
91
DIN
PAGE
02014262
02014270
02014289
02014297
02014300
02014319
02014327
02015439
02015951
02016095
02017237
02017539
02017598
02017628
02017636
02017709
02017733
02017741
02018144
02018152
02018160
02018985
02019809
02019930
02019949
02019957
02019965
02020599
02020602
02020610
02020629
02020661
02020688
02020696
02020718
02020726
02020734
02020742
02022125
02022133
02022141
02022826
02023725
02023733
02023741
02023768
02023814
02023830
02023865
02024152
02024187
02024195
02024209
02024217
02024225
02024233
02024241
02024268
02024276
02024284
02024292
02024306
02024314
02024322
02025248
02025280
02025299
02025302
330
93
214
214
92
92
92
92
91
84
154
85
19
219
94
94
19
194
132
173
173
173
104
2
91
91
92
92
109
109
109
109
82
82
82
83
83
182
182
35
158
158
15
148
148
148
144
146
141
143
4
202
158
158
180
179
180
179
179
181
180
180
180
180
181
180
115
116
116
DIN
02025310
02025736
02026759
02026767
02026961
02028700
02028786
02029421
02029448
02030810
02030829
02030837
02031094
02031116
02031159
02031167
02031175
02032376
02034468
02035324
02036282
02036290
02036347
02036355
02036436
02036444
02039486
02039494
02039532
02039540
02040751
02040778
02040786
02041286
02041294
02041308
02041316
02041375
02041391
02041413
02041421
02041448
02041480
02041510
02042177
02042207
02042215
02042223
02042231
02042258
02042266
02042274
02042282
02042290
02042304
02042312
02042320
02042339
02042355
02042363
02042479
02042487
02042533
02042541
02042568
02042576
02042584
02042592
PAGE
116
146
32
202
132
176
227
176
228
52
33
33
193
4
150
150
84
149
15
143
49
48
9
9
48
48
81
81
49
50
102
102
102
9
9
9
10
224
224
121
121
122
60
21
57
57
57
57
57
57
57
57
72
72
132
132
174
174
95
95
174
174
174
174
98
87
87
10
DIN
02042606
02042614
02042622
02042894
02043033
02043041
02043394
02043408
02043416
02043424
02043440
02043505
02043521
02043548
02043602
02043629
02043653
02043661
02043688
02043726
02043734
02044609
02044617
02044668
02044676
02044692
02044706
02045680
02045699
02045702
02045710
02045729
02045737
02045834
02045869
02046113
02046121
02046148
02046156
02046253
02046261
02046733
02046741
02047454
02047462
02047799
02047802
02048493
02048507
02048515
02048523
02048639
02048698
02048728
02048736
02048760
02049325
02049333
02049341
02049376
02049384
02049392
02049961
02049988
02049996
02050005
02050013
02050021
PAGE
76
76
76
32
174
174
177
177
177
177
177
58
159
159
32
32
122
122
122
174
174
59
59
12
12
57
57
135
135
161
182
69
69
155
155
229
66
66
77
80
80
138
36
4
55
190
190
81
81
151
151
202
81
96
96
36
224
69
134
69
69
228
63
63
103
103
103
104
DIN
PAGE
02050048
02050056
02051850
02052431
02053187
02053195
02054817
02054825
02056704
02056712
02057778
02057808
02057816
02057824
02058405
02058413
02058456
02058464
02058472
02060590
02060868
02060884
02061562
02061570
02063662
02063735
02063743
02063786
02063808
02064472
02064480
02065819
02068036
02068087
02069571
02069598
02070847
02070863
02070987
02074788
02076233
02076306
02078627
02078635
02078651
02080052
02083345
02083353
02083523
02083531
02084082
02084090
02084104
02084228
02084236
02084260
02084279
02084287
02084295
02084309
02084317
02084325
02084333
02084341
02084376
02084384
02084392
02084449
331
104
104
9
201
108
109
158
60
33
33
67
55
56
56
81
81
61
61
77
176
142
201
61
61
21
39
39
228
160
161
161
100
100
229
36
208
210
210
109
210
87
149
14
14
14
40
151
151
60
84
60
12
13
58
58
99
99
99
192
192
151
151
35
182
55
56
56
39
DIN
02084457
02085852
02085887
02085895
02086026
02087324
02087375
02087383
02087391
02088398
02088401
02089580
02089602
02089610
02089769
02089777
02089793
02091194
02091232
02091275
02091291
02091461
02091488
02091526
02093103
02093162
02097141
02097168
02097176
02097214
02097222
02097230
02097249
02097257
02097265
02097273
02097370
02097389
02099128
02099136
02099225
02099233
02099675
02099683
02100193
02100215
02100223
02100304
02100479
02100487
02100495
02100509
02100517
02100622
02100630
02102978
02103036
02103095
02103567
02103583
02103591
02103613
02103656
02103680
02103702
02103729
02103737
02106272
PAGE
39
192
182
90
170
223
106
106
106
39
39
132
196
196
178
178
178
81
12
111
7
178
178
138
12
202
32
32
32
51
51
51
51
52
52
52
51
51
102
103
230
182
161
161
201
2
2
178
75
75
75
82
82
161
100
31
195
31
161
102
103
158
96
110
110
69
96
68
DIN
02106280
02108143
02108151
02108186
02108194
02112736
02112752
02112760
02112787
02112795
02112809
02115514
02115522
02122197
02123274
02123282
02123312
02123320
02123339
02123347
02125102
02125145
02125226
02125250
02125293
02125307
02125315
02125323
02125331
02125366
02125382
02125390
02125447
02126168
02126176
02126184
02126192
02126222
02126249
02126257
02126559
02126605
02126710
02126753
02126761
02128950
02128969
02129078
02130033
02130084
02130092
02130106
02130165
02130173
02130297
02130300
02130874
02130963
02130971
02130998
02131013
02131048
02131056
02131064
02131625
02131676
02132591
02132621
PAGE
68
12
13
178
69
205
162
162
161
162
162
202
202
4
71
71
229
228
228
228
31
4
195
161
208
209
209
90
90
90
90
90
194
226
226
226
202
32
192
192
77
192
8
54
54
108
109
203
13
102
102
103
102
102
113
113
193
15
15
96
96
39
39
40
150
191
154
42
DIN
PAGE
02132648
02132656
02132664
02132680
02132699
02132702
02133202
02133245
02133296
02133318
02133334
02133342
02134829
02134853
02134861
02134888
02134896
02136090
02136104
02136112
02136120
02137267
02137313
02137321
02137348
02137534
02137542
02137984
02138018
02138271
02138298
02139189
02139197
02139200
02139324
02139332
02139340
02139359
02139367
02139391
02139952
02139960
02139979
02139987
02139995
02140039
02140047
02140055
02140063
02140071
02140098
02140101
02140128
02141442
02142023
02142031
02142058
02142074
02142082
02142104
02142112
02143283
02143291
02143364
02143372
02144263
02144271
02145413
332
42
42
42
60
60
108
148
140
144
144
148
146
161
148
148
148
148
39
39
87
87
93
57
57
57
119
119
94
90
39
39
60
60
15
36
39
102
102
102
39
86
86
71
71
72
12
100
100
100
103
103
103
104
3
82
82
12
61
99
99
99
159
142
83
83
108
109
53
DIN
02145421
02145448
02145758
02145863
02145901
02145928
02145936
02145944
02145952
02145960
02146118
02146126
02146827
02146843
02146851
02146886
02146894
02146908
02146916
02146924
02146932
02146940
02146959
02147432
02147602
02147610
02147629
02147637
02147645
02148552
02148560
02148579
02148587
02148595
02148749
02148765
02150662
02150670
02150689
02150697
02150808
02150816
02150824
02150867
02150875
02150891
02150905
02150921
02150948
02150956
02152525
02152568
02153483
02153521
02153548
02153556
02153564
02154390
02154404
02154412
02154420
02154463
02154862
02154870
02155885
02155893
02155907
02155923
PAGE
53
229
3
90
90
90
90
93
93
93
90
90
93
34
34
87
49
8
51
51
83
83
61
50
48
48
48
108
109
185
185
185
177
177
208
182
223
224
223
224
84
84
84
191
191
191
191
191
191
211
149
34
134
161
162
162
162
55
55
36
86
86
202
202
55
55
55
77
DIN
02155958
02155966
02155974
02155990
02156008
02156016
02156032
02156040
02156083
02156091
02157195
02158574
02158582
02158590
02158604
02158612
02158620
02158639
02161923
02161966
02161974
02162431
02162458
02162466
02162474
02162482
02162490
02162504
02162512
02162687
02162733
02162741
02162776
02162806
02162814
02162822
02162849
02163152
02163527
02163535
02163543
02163551
02163578
02163586
02163594
02163659
02163667
02163675
02163683
02163705
02163721
02163748
02163772
02163780
02163799
02163918
02163926
02163934
02163942
02165368
02165376
02165384
02165392
02165481
02165503
02165511
02165546
02165554
PAGE
20
20
20
55
111
111
111
111
84
194
158
12
81
214
106
106
106
106
204
204
204
85
85
85
85
85
85
203
203
143
54
54
46
77
81
182
183
204
77
77
214
64
64
65
65
6
6
6
6
150
33
89
58
89
89
88
88
88
88
34
34
108
109
84
159
159
48
48
DIN
PAGE
02165562
02166704
02166712
02166720
02166747
02167786
02167794
02167808
02167816
02167824
02167840
02168898
02168936
02168952
02168979
02169649
02169894
02169908
02170019
02170027
02170035
02170132
02170493
02170698
02170833
02170841
02171228
02171775
02171791
02171805
02171813
02171821
02171848
02171858
02171864
02171872
02171880
02171899
02171929
02172062
02172070
02172089
02172097
02172100
02172119
02172127
02172135
02172143
02172151
02172550
02172569
02172577
02172712
02173344
02173352
02173360
02173506
02173514
02174545
02174553
02174596
02174618
02174677
02174685
02175983
02175991
02176009
02176017
333
48
185
151
151
106
182
58
119
120
120
43
177
179
103
27
225
101
101
113
113
113
113
218
210
58
58
186
192
49
50
86
86
40
119
120
120
151
151
161
186
186
186
186
186
186
186
186
186
186
53
53
84
142
96
96
35
13
12
53
53
63
40
81
81
230
230
230
224
DIN
02176076
02176084
02176092
02176106
02176122
02176130
02176149
02177072
02177102
02177145
02177153
02177161
02177188
02177579
02177587
02177595
02177617
02177625
02177633
02177641
02177668
02177676
02177684
02177692
02177706
02177714
02177722
02177749
02177757
02177781
02177803
02177811
02177838
02177846
02177854
02177862
02177870
02177889
02177897
02178729
02178737
02179679
02179687
02179709
02181479
02181487
02181495
02181509
02181517
02181525
02182815
02182823
02182831
02182858
02182866
02182874
02182882
02182963
02184435
02184443
02184451
02184648
02185407
02185415
02185423
02185830
02185849
02185857
PAGE
133
225
27
27
123
83
83
85
15
40
119
120
120
104
104
104
104
104
5
5
5
5
5
107
107
159
159
91
92
6
7
7
7
6
7
7
7
96
96
107
107
87
87
134
65
9
9
10
10
55
69
226
226
226
13
69
69
210
91
92
92
100
61
27
27
5
5
5
DIN
02185865
02185873
02186802
02187086
02187094
02187108
02187116
02187876
02188724
02188732
02188783
02188929
02188937
02188945
02188953
02188961
02188988
02188996
02189003
02189011
02189038
02189046
02189054
02189062
02190885
02190893
02190915
02192268
02192276
02192284
02192659
02192667
02192683
02192691
02192705
02192713
02192721
02192748
02192756
02192764
02194031
02194058
02194082
02194090
02194155
02194163
02194171
02194198
02194201
02194228
02194236
02194333
02194341
02194422
02195704
02195917
02195925
02195933
02195941
02195968
02195984
02195992
02196018
02196026
02197405
02197413
02197421
02197448
PAGE
5
5
15
175
175
175
175
74
176
176
227
64
64
65
65
49
50
102
102
102
51
51
175
175
181
181
160
195
195
195
13
154
17
17
119
120
120
227
104
104
206
206
172
172
173
193
192
4
4
193
192
98
211
46
193
27
27
226
226
226
5
5
158
158
14
14
14
55
DIN
PAGE
02197456
02197464
02197502
02199270
02199289
02199297
02200104
02200864
02200937
02200996
02201011
02201038
02202441
02202468
02202476
02202484
02203324
02204401
02204428
02204436
02204444
02204517
02204525
02204533
02204541
02204568
02204576
02204584
02206072
02207621
02207648
02207656
02207672
02207761
02207788
02207818
02208229
02208237
02208245
02209071
02210320
02210347
02210355
02210363
02210428
02210479
02211076
02211130
02211149
02211157
02211165
02211742
02211920
02211939
02211947
02211955
02211963
02211971
02212005
02212021
02212048
02212102
02212153
02212161
02212188
02212277
02212285
02212307
334
150
150
175
230
15
175
155
142
55
58
222
222
93
93
93
93
155
177
177
177
178
48
48
48
83
83
184
184
45
14
14
14
123
160
160
96
35
35
35
150
60
75
75
76
58
32
123
113
113
111
111
36
76
102
102
103
103
103
154
7
40
55
38
38
38
6
6
6
DIN
02212315
02212323
02212331
02212374
02212390
02212927
02212978
02213036
02213044
02213052
02213079
02213192
02213206
02213214
02213222
02213230
02213265
02213281
02213419
02213478
02213486
02213583
02213591
02213605
02213613
02213672
02213834
02214261
02214415
02214997
02215004
02215136
02216086
02216094
02216108
02216116
02216132
02216140
02216159
02216183
02216191
02216205
02216213
02216221
02216248
02216256
02216264
02216272
02216280
02216353
02216361
02216582
02216590
02216949
02216965
02217015
02217031
02217058
02217066
02217139
02217414
02217422
02217481
02217503
02218305
02218321
02218410
02218429
PAGE
34
35
160
160
35
140
143
148
148
148
144
186
186
186
186
186
202
202
35
35
36
170
170
170
170
144
144
36
202
35
35
184
17
17
17
17
125
125
125
184
184
147
202
32
102
102
103
103
103
104
104
104
104
35
19
26
26
26
26
147
100
22
69
69
225
100
106
106
DIN
02218453
02218461
02218941
02218968
02218976
02218984
02219077
02219085
02219271
02219468
02219476
02219492
02219581
02219905
02220059
02220067
02220156
02220164
02220172
02220180
02220318
02220385
02220407
02220679
02220687
02221284
02221292
02221306
02221330
02221780
02221799
02221802
02221810
02221829
02221837
02221845
02221853
02221896
02221918
02221926
02221934
02221950
02221977
02221985
02221993
02222000
02222035
02222051
02222957
02222965
02222973
02223139
02223147
02223325
02223333
02223341
02223368
02223376
02223384
02223392
02223406
02223414
02223511
02223538
02223562
02223570
02223589
02223597
PAGE
105
105
73
73
73
74
160
160
172
229
192
15
140
194
214
214
159
159
62
62
173
209
195
49
50
185
185
185
225
42
98
191
191
72
72
72
72
203
203
203
203
87
45
67
67
67
76
62
51
51
51
107
107
102
103
102
103
214
26
26
27
26
107
107
182
122
122
134
DIN
PAGE
02223600
02223678
02223716
02223724
02223856
02223864
02224100
02224550
02224569
02224631
02224690
02224704
02224720
02225158
02225166
02225190
02225964
02225972
02225980
02226839
02227339
02227436
02227444
02227452
02227460
02228203
02228211
02228343
02228351
02228947
02229099
02229110
02229129
02229137
02229145
02229161
02229196
02229250
02229269
02229277
02229285
02229293
02229315
02229323
02229393
02229394
02229395
02229406
02229407
02229408
02229440
02229441
02229449
02229452
02229453
02229455
02229456
02229467
02229468
02229515
02229516
02229517
02229524
02229526
02229540
02229550
02229552
02229554
335
61
134
7
7
209
210
96
182
182
145
133
133
133
223
223
177
122
122
61
194
134
157
157
157
157
81
81
154
154
37
169
15
15
19
19
18
18
114
114
114
114
157
202
202
148
148
148
51
51
51
140
140
26
84
160
122
122
49
50
43
182
183
20
52
172
172
154
148
DIN
02229555
02229556
02229569
02229582
02229583
02229584
02229585
02229586
02229587
02229588
02229589
02229590
02229591
02229592
02229593
02229594
02229595
02229596
02229597
02229598
02229604
02229617
02229628
02229654
02229655
02229656
02229690
02229692
02229693
02229704
02229705
02229707
02229708
02229709
02229717
02229718
02229719
02229720
02229722
02229723
02229755
02229756
02229758
02229778
02229779
02229781
02229782
02229783
02229784
02229785
02229819
02229820
02229837
02229838
02229839
02229840
02229874
02229936
02229937
02229972
02229994
02230019
02230020
02230047
02230085
02230086
02230087
02230090
PAGE
148
148
84
10
10
9
49
50
6
7
102
102
80
80
51
51
182
182
75
75
61
11
100
96
96
183
85
184
184
180
180
14
14
14
157
157
157
157
184
26
43
122
122
58
58
51
52
52
52
183
104
104
81
185
185
185
193
39
39
218
182
156
156
69
215
215
216
45
DIN
02230095
02230102
02230183
02230203
02230204
02230205
02230206
02230256
02230263
02230264
02230284
02230285
02230302
02230306
02230321
02230322
02230359
02230360
02230361
02230362
02230366
02230368
02230369
02230386
02230394
02230401
02230402
02230403
02230404
02230405
02230406
02230418
02230420
02230431
02230432
02230433
02230447
02230448
02230449
02230454
02230473
02230475
02230476
02230477
02230543
02230580
02230584
02230585
02230619
02230641
02230648
02230663
02230666
02230667
02230668
02230670
02230711
02230713
02230714
02230717
02230730
02230732
02230733
02230734
02230735
02230736
02230737
02230768
PAGE
122
122
61
64
64
65
65
102
5
5
108
109
89
143
118
118
54
54
107
107
96
96
96
146
214
45
117
117
117
117
117
38
38
159
159
159
191
53
53
223
158
183
61
85
227
61
120
120
171
229
143
100
119
120
120
182
59
59
59
229
225
77
77
77
12
13
160
100
DIN
PAGE
02230784
02230785
02230800
02230803
02230804
02230805
02230806
02230807
02230808
02230827
02230828
02230837
02230838
02230839
02230840
02230874
02230888
02230889
02230891
02230892
02230893
02230894
02230896
02230897
02230898
02230941
02230942
02230950
02230951
02230997
02230998
02230999
02231015
02231030
02231036
02231052
02231053
02231054
02231060
02231061
02231089
02231121
02231122
02231129
02231135
02231136
02231143
02231150
02231151
02231152
02231154
02231155
02231171
02231181
02231182
02231184
02231192
02231193
02231208
02231245
02231248
02231249
02231250
02231251
02231252
02231253
02231254
02231287
336
211
211
214
53
53
73
73
73
74
87
87
113
113
113
113
123
140
140
177
177
99
99
99
2
34
123
123
96
96
51
52
52
21
100
229
51
52
52
87
4
214
53
53
36
32
32
7
51
52
52
52
52
42
58
58
134
105
105
84
32
100
87
87
48
48
48
63
157
DIN
02231288
02231290
02231327
02231328
02231329
02231330
02231347
02231348
02231353
02231390
02231430
02231431
02231432
02231433
02231441
02231457
02231459
02231460
02231477
02231478
02231480
02231488
02231489
02231491
02231492
02231493
02231494
02231502
02231503
02231504
02231505
02231506
02231508
02231509
02231510
02231536
02231537
02231539
02231543
02231544
02231583
02231584
02231585
02231586
02231587
02231615
02231616
02231650
02231662
02231663
02231664
02231665
02231671
02231675
02231676
02231677
02231678
02231679
02231680
02231683
02231684
02231686
02231687
02231690
02231691
02231692
02231693
02231702
PAGE
157
157
85
104
105
105
4
194
40
151
35
229
5
5
78
74
74
74
158
43
194
35
100
222
123
150
32
80
80
81
81
81
81
177
178
55
56
56
98
98
45
45
45
45
45
122
122
55
80
80
81
81
229
33
75
75
35
225
225
108
109
107
107
54
5
54
5
223
DIN
02231714
02231715
02231731
02231733
02231743
02231744
02231745
02231768
02231769
02231770
02231771
02231780
02231781
02231782
02231783
02231784
02231785
02231799
02231800
02231831
02231923
02232148
02232150
02232191
02232193
02232195
02232317
02232318
02232389
02232391
02232543
02232544
02232546
02232547
02232556
02232561
02232562
02232564
02232565
02232567
02232568
02232569
02232570
02232872
02232903
02232904
02232905
02232987
02233014
02233017
02233047
02233048
02233049
02233050
02233960
02233982
02233985
02233998
02233999
02234003
02234007
02234008
02234013
02234217
02234254
02234255
02234256
02234257
PAGE
150
150
49
50
51
51
51
185
185
185
12
61
107
107
35
35
32
83
83
161
143
106
106
202
202
202
82
82
88
11
108
109
53
53
120
102
103
123
229
229
229
229
35
26
124
124
124
36
224
9
73
73
73
74
96
96
96
154
182
96
96
58
58
226
64
64
65
65
DIN
PAGE
02234502
02234503
02234504
02234505
02234513
02234514
02234749
02235897
02235898
02236466
02236506
02236507
02236508
02236564
02236606
02236733
02236734
02236758
02236783
02236799
02236807
02236808
02236809
02236819
02236841
02236842
02236859
02236876
02236883
02236913
02236949
02236950
02236951
02236952
02236953
02236974
02236975
02236997
02237111
02237112
02237145
02237146
02237147
02237148
02237149
02237224
02237225
02237235
02237244
02237245
02237246
02237247
02237264
02237265
02237268
02237269
02237270
02237275
02237277
02237278
02237279
02237280
02237282
02237289
02237292
02237294
02237295
02237317
337
73
73
73
74
182
182
118
55
55
158
40
39
39
43
230
182
182
55
34
222
100
74
74
222
20
20
222
149
43
43
223
116
115
115
115
174
174
204
106
106
228
228
228
158
158
34
34
4
170
171
171
171
119
119
123
58
58
40
96
96
110
110
110
229
61
122
122
225
DIN
02237319
02237320
02237325
02237326
02237367
02237368
02237370
02237371
02237379
02237484
02237500
02237501
02237502
02237514
02237534
02237535
02237536
02237537
02237560
02237600
02237601
02237618
02237651
02237652
02237653
02237654
02237671
02237682
02237701
02237721
02237722
02237723
02237729
02237730
02237770
02237786
02237787
02237791
02237807
02237808
02237813
02237814
02237820
02237821
02237824
02237825
02237826
02237830
02237835
02237858
02237860
02237861
02237862
02237863
02237864
02237868
02237875
02237876
02237885
02237886
02237887
02237907
02237908
02237921
02237922
02237923
02237924
02237925
PAGE
225
225
60
60
72
72
3
4
142
227
5
5
5
20
113
113
113
113
46
49
50
55
113
113
113
113
223
20
46
48
48
48
5
5
225
81
81
76
177
177
104
104
37
37
101
101
84
100
169
123
184
64
64
65
65
149
12
13
48
48
48
98
98
75
75
68
68
68
DIN
02237991
02238028
02238042
02238046
02238047
02238048
02238070
02238071
02238072
02238073
02238075
02238076
02238123
02238171
02238172
02238209
02238216
02238217
02238222
02238223
02238280
02238281
02238282
02238315
02238326
02238327
02238334
02238340
02238342
02238343
02238348
02238370
02238403
02238404
02238405
02238406
02238415
02238417
02238442
02238443
02238444
02238445
02238446
02238447
02238448
02238449
02238450
02238451
02238465
02238525
02238526
02238544
02238551
02238552
02238553
02238554
02238569
02238570
02238577
02238578
02238604
02238613
02238617
02238618
02238633
02238634
02238635
02238638
PAGE
150
86
100
56
56
100
147
147
146
146
147
147
230
9
9
161
227
227
98
98
108
108
108
158
58
58
98
229
158
158
16
100
124
124
124
124
58
58
83
83
158
39
39
123
100
64
64
65
144
159
222
4
64
64
65
65
49
50
142
206
132
123
18
18
40
58
58
74
DIN
PAGE
02238639
02238645
02238660
02238674
02238675
02238682
02238699
02238703
02238704
02238708
02238748
02238770
02238771
02238796
02238797
02238817
02238829
02238830
02238831
02238873
02238984
02239007
02239008
02239024
02239025
02239064
02239065
02239068
02239069
02239071
02239072
02239073
02239083
02239091
02239092
02239131
02239146
02239148
02239164
02239193
02239213
02239288
02239319
02239320
02239323
02239324
02239325
02239517
02239518
02239519
02239577
02239607
02239608
02239619
02239620
02239627
02239630
02239698
02239699
02239700
02239701
02239702
02239703
02239713
02239714
02239730
02239738
02239744
338
84
88
39
26
27
45
18
193
177
141
16
151
151
142
98
100
10
10
10
146
230
155
155
96
96
214
214
203
203
122
122
214
19
63
63
32
228
141
87
17
17
143
82
82
228
228
228
98
99
99
141
101
101
134
134
150
3
98
99
99
98
99
99
100
100
225
38
46
DIN
02239746
02239747
02239748
02239749
02239750
02239751
02239752
02239754
02239755
02239756
02239757
02239758
02239759
02239760
02239761
02239762
02239769
02239770
02239771
02239772
02239825
02239826
02239827
02239834
02239864
02239886
02239887
02239888
02239907
02239908
02239913
02239917
02239918
02239919
02239920
02239921
02239924
02239925
02239926
02239941
02239942
02239951
02239953
02239954
02239982
02240035
02240067
02240071
02240072
02240113
02240114
02240115
02240205
02240210
02240294
02240321
02240331
02240332
02240337
02240357
02240358
02240363
02240456
02240457
02240458
02240481
02240484
02240485
PAGE
106
106
106
49
50
104
104
48
48
48
190
48
48
48
9
9
75
75
53
53
185
185
185
226
61
16
16
16
99
99
134
134
113
113
113
113
183
183
183
80
80
61
105
105
13
145
134
49
150
149
43
99
44
61
181
76
60
62
61
16
16
140
106
159
159
108
108
108
DIN
02240498
02240499
02240500
02240508
02240519
02240520
02240521
02240550
02240551
02240552
02240588
02240589
02240590
02240601
02240622
02240623
02240682
02240683
02240684
02240685
02240687
02240693
02240694
02240695
02240769
02240770
02240789
02240790
02240807
02240808
02240809
02240810
02240811
02240835
02240836
02240837
02240849
02240850
02240867
02241003
02241007
02241107
02241108
02241109
02241159
02241163
02241224
02241225
02241285
02241347
02241348
02241371
02241374
02241466
02241480
02241574
02241575
02241594
02241598
02241599
02241608
02241704
02241709
02241710
02241818
02241819
02241882
02241883
PAGE
66
66
66
150
38
38
38
214
115
115
66
66
66
76
158
158
105
105
170
170
170
27
27
27
73
73
107
107
4
50
50
50
50
36
36
36
105
105
84
143
69
86
86
86
225
37
81
81
214
105
105
104
104
60
19
150
150
228
160
160
61
61
13
13
68
68
98
98
DIN
PAGE
02241895
02241983
02242003
02242005
339
3
219
90
91
INDEX D
ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCT NAMES
PRODUCT NAME
292
3TC (EDS)
5-AMINOSALICYLIC ACID
642
ABACAVIR SO4
ACARBOSE
ACCOLATE (EDS)
ACCU-CHEK EASY
ACCUPRIL
ACCURETIC
ACCUTANE
ACCUTREND
ACEBUTOLOL HCL
"
ACENOCOUMAROL
ACETAMINOPHEN/CAFFEINE/
CODEINE
ACETAZOLAMIDE
"
ACETEST
ACETOXYL
ACETYLCYSTEINE
ACETYLSALICYLIC ACID/
CAFFEINE/CODEINE
ACILAC (EDS)
ACITRETIN
ACTONEL (EDS)
ACULAR (EDS)
ACYCLOVIR
ADALAT PA
ADALAT XL
ADAPALENE
ADRENALIN
ADVAIR DISKUS (EDS)
ADVANTAGE
ADVANTAGE COMFORT
AGRYLIN
AIROMIR (CFC-FREE)
ALBERT OXYBUTYNIN
ALBERT PENTOXIFYLLINE
ALBERT-GLYBURIDE
ALBERT-TIAFEN
ALCOMICIN
ALDACTAZIDE-25
ALDACTAZIDE-50
ALDACTONE
ALDOMET
ALENDRONATE SODIUM
ALESSE
ALFACALCIDOL
ALLOPURINOL
ALOMIDE
ALPHAGAN
ALPRAZOLAM
ALTACE
ALTI-ACYCLOVIR
ALTI-ALPRAZOLAM
ALTI-AMILORIDE HCTZ
ALTI-AMIODARONE
ALTI-AZATHIOPRINE
ALTI-BECLOMETHASONE
Page
88
17
161
94
16
181
230
128
72
72
211
128
48
63
42
88
88
133
146
129
209
138
80
88
154
210
228
144
14
55
55
208
33
36
128
128
222
35
214
45
182
87
140
73
73
135
70
222
174
219
222
150
149
119
72
14
119
63
49
222
169
PRODUCT NAME
ALTI-BECLOMETHASONE AQ.
ALTI-CLINDAMYCIN
ALTI-CLOBAZAM
ALTI-CPA (EDS)
ALTI-CYCLOBENZAPRINE(EDS)
ALTI-DESIPRAMINE
"
ALTI-DEXAMETHASONE
ALTI-DILTIAZEM CD
"
ALTI-DOMPERIDONE MALEATE
ALTI-DOXEPIN
"
ALTI-DOXYCYCLINE
ALTI-FLUNISOLIDE
ALTI-FLUOXETINE
ALTI-FLURBIPROFEN
ALTI-FLUVOXAMINE
ALTI-IPRATROPIUM
"
ALTI-MEXILETINE
"
ALTI-MOCLOBEMIDE
ALTI-NADOLOL
ALTI-NORTRIPTYLINE
ALTI-ORCIPRENALINE
ALTI-PRAZOSIN
"
ALTI-RANITIDINE
ALTI-SALBUTAMOL
ALTI-SALBUTAMOL RESP.SOL.
ALTI-SOTALOL
ALTI-SULFASALAZINE
ALTI-TERAZOSIN
"
ALTI-TRIAZOLAM
ALTI-VALPROIC
ALTI-VERAPAMIL
ALUMINUM ACETATE/
BENZETHONIUM CHLORIDE
"
ALUPENT
AMANTADINE
AMATINE (EDS)
AMCINONIDE
AMERGE (EDS)
AMETHOPTERIN
AMILORIDE HCL
AMILORIDE HCL/
HYDROCHLOROTHIAZIDE
AMINOPHYLLINE
AMIODARONE
AMITRIPTYLINE
AMLODIPINE BESYLATE
AMOBARBITAL SODIUM
AMOXAPINE
AMOXICILLIN TRIHYDRATE/
POTASSIUM CLAVULANATE
AMOXIL
AMOXIL-125
340
Page
142
13
98
26
40
102
103
170
51
52
158
103
104
12
143
104
82
105
32
150
32
54
12
13
106
54
107
34
71
72
160
35
36
58
161
73
74
123
100
75
142
208
34
15
34
195
37
210
134
63
214
49
101
49
118
101
9
10
9
10
PRODUCT NAME
AMOXIL-250
"
AMPICILLIN
AMPICIN
AMYTAL SODIUM
ANAFRANIL
ANAGRELIDE HCL
ANDRIOL
ANDROCUR (EDS)
ANILERIDINE HCL
ANSAID
ANTABUSE
ANTHRAFORTE-1
ANTHRAFORTE-2
ANTHRANOL
ANTHRASCALP
APL (EDS)
APO-ACEBUTOLOL
APO-ACETAZOLAMIDE
APO-ACYCLOVIR
APO-ALLOPURINOL
APO-ALPRAZ
APO-AMILZIDE
APO-AMITRIPTYLINE
APO-AMOXI
"
APO-AMPI
"
APO-ATENOL
"
APO-BACLOFEN
APO-BECLOMETHASONE
APO-BENZTROPINE
APO-BROMAZEPAM
"
APO-BROMOCRIPTINE
APO-BUSPIRONE
APO-CAPTO
"
APO-CARBAMAZEPINE
APO-CEFACLOR (EDS)
APO-CEPHALEX
"
APO-CHLORPROPAMIDE
APO-CHLORTHALIDONE
APO-CIMETIDINE
APO-CLOMIPRAMINE
APO-CLONAZEPAM
APO-CLONIDINE
APO-CLORAZEPATE
APO-CLOXI
APO-CROMOLYN
"
APO-CYCLOBENZAPRINE (EDS)
APO-DESIPRAMINE
"
APO-DIAZEPAM
APO-DICLO
APO-DICLO SR
APO-DIFLUNISAL
APO-DILTIAZ
APO-DILTIAZ CD
"
APO-DILTIAZ SR
APO-DIMENHYDRINATE
APO-DIVALPROEX
"
Page
9
10
10
11
118
102
222
173
26
88
82
224
210
210
210
210
179
48
146
14
222
119
63
101
9
10
10
11
49
50
39
142
30
119
120
223
123
64
65
98
5
6
7
120
181
133
157
102
96
66
120
11
151
229
40
102
103
121
80
81
81
51
51
52
51
156
98
99
PRODUCT NAME
APO-DOMPERIDONE
APO-DOXAZOSIN
APO-DOXEPIN
"
APO-DOXY
APO-ERYTHRO-S
APO-ETODOLAC (EDS)
APO-FAMOTIDINE
APO-FENOFIBRATE (EDS)
APO-FENO-MICRO (EDS)
APO-FLUCONAZOLE
"
APO-FLUNISOLIDE
APO-FLUOXETINE
APO-FLUPHENAZINE
APO-FLURAZEPAM
APO-FLURBIPROFEN
APO-FLUVOXAMINE
APO-FOLIC
APO-FUROSEMIDE
APO-GEMFIBROZIL
APO-GLYBURIDE
APO-HALOPERIDOL
APO-HYDRALAZINE
APO-HYDRO
APO-HYDROXYZINE
APO-IBUPROFEN
"
APO-IMIPRAMINE
APO-INDAPAMIDE
APO-INDOMETHACIN
APO-IPRAVENT
APO-ISDN
APO-K
APO-KETO
APO-KETOCONAZOLE (EDS)
APO-KETOPROFEN SR
APO-KETOTIFEN (EDS)
APO-LEVOBUNOLOL
APO-LEVOCARB
APO-LISINOPRIL
APO-LOPERAMIDE
APO-LORAZEPAM
"
APO-LOVASTATIN
APO-LOXAPINE
APO-MEFENAMIC
APO-MEGESTROL (EDS)
APO-METFORMIN
"
APO-METHAZIDE-15
APO-METHAZIDE-25
APO-METHOPRAZINE
APO-METHYLDOPA
APO-METOCLOP
APO-METOPROLOL
APO-METRONIDAZOLE
"
APO-MOCLOBEMIDE
APO-NABUMETONE (EDS)
APO-NADOL
APO-NAPROXEN
APO-NAPROXEN SR
APO-NIFED
APO-NIFED PA
341
Page
158
66
103
104
12
9
82
158
61
61
3
3
4
143
104
112
121
82
105
218
133
61
182
112
68
134
124
82
83
105
134
83
32
76
132
84
4
84
225
150
226
69
154
121
122
62
113
84
27
182
183
70
70
124
70
159
53
53
22
12
13
106
84
54
85
85
55
55
PRODUCT NAME
APO-NITROFURANTOIN
APO-NIZATIDINE
APO-NORFLOX (EDS)
APO-NORTRIPTYLINE
APO-ORCIPRENALINE
APO-OXAZEPAM
APO-OXTRIPHYLLINE
APO-OXYBUTYNIN
APO-PENTOXIFYLLINE SR
APO-PEN-VK
APO-PERPHENAZINE
APO-PHENYLBUTAZONE
APO-PINDOL
"
APO-PIROXICAM
APO-PRAZO
"
APO-PREDNISONE
APO-PRIMIDONE
APO-PROCAINAMIDE
APO-PROPRANOLOL
APO-RANITIDINE
APO-SALVENT
"
"
APO-SELEGILINE (EDS)
APO-SERTRALINE
APO-SOTALOL
APO-SUCRALFATE
APO-SULFATRIM
"
APO-SULFATRIM DS
APO-SULFINPYRAZONE
APO-SULIN
APO-TEMAZEPAM
APO-TERAZOSIN
"
APO-TETRA
APO-THEO-LA
"
APO-THIORIDAZINE
APO-TIAPROFENIC
APO-TICLOPIDINE (EDS)
APO-TIMOL
APO-TIMOP
APO-TOLBUTAMIDE
APO-TRAZODONE
"
APO-TRIAZIDE
APO-TRIAZO
APO-TRIFLUOPERAZINE
APO-TRIHEX
APO-TRIMIP
APO-VALPROIC
APO-VERAP
APO-ZIDOVUDINE (EDS)
APRACLONIDINE HCL
APRESOLINE
ARALEN
ARISTOCORT
ARISTOCORT R
ARISTOSPAN (EDS)
ARTHROTEC
ARTHROTEC 75
ASACOL
ASENDIN
ASMAVENT
ASMAVENT RESPIRATOR SOL
Page
21
159
20
107
34
122
215
214
45
11
114
85
55
56
86
71
72
172
95
56
57
160
34
35
36
229
108
58
161
22
23
23
135
87
122
73
74
13
215
216
116
87
46
59
151
183
108
109
74
123
117
31
109
100
75
18
149
68
19
172
206
173
81
81
161
101
35
36
PRODUCT NAME
ATACAND
ATARAX
ATASOL-15
ATASOL-30
ATENOLOL
"
ATENOLOL
"
ATENOLOL/CHLORTHALIDONE
ATIVAN
"
ATORVASTATIN CALCIUM
ATOVAQUONE
ATROMID-S
ATROPINE
ATROPINE SO4
ATROPISOL
ATROVENT
ATROVENT NASAL SPRAY
AURANOFIN
AUROTHIOGLUCOSE
AVALIDE
AVAPRO
AVC
AVENTYL
AVIRAX
AVLOSULFON
AVONEX (EDS)
AXID
AZATHIOPRINE
AZITHROMYCIN
AZMACORT
AZOPT
BACLOFEN
BACTRIM
BACTRIM D.S.
BACTROBAN
BAYCOL
BECLOMETHASONE
DIPROPIONATE
"
"
BENAZEPRIL HCL
BENOXYL
BENTYLOL
BENURYL
BENZAC AC
BENZAC W
BENZAC-W
BENZAGEL
BENZOYL PEROXIDE
BENZTROPINE MESYLATE
BEROTEC
BEROTEC UDV
BETADERM
BETADINE
BETAGAN
BETAHISTINE HCL
BETAINE ANHYDROUS
BETAJECT
BETALOC
BETALOC DURULES
BETAMETHASONE ACETATE/
BETAMETHASONE SODIUM
PHOSPHATE
BETAMETHASONE
DIPROPIONATE
BETAMETHASONE
342
Page
63
124
88
88
49
63
49
50
63
121
122
59
22
60
148
148
148
32
150
164
164
68
68
195
107
14
21
225
159
222
7
172
146
39
23
23
190
60
142
169
196
63
209
31
135
209
209
209
209
209
30
33
33
201
195
150
76
222
169
53
53
169
196
PRODUCT NAME
DIPROPIONATE/
SALICYLIC ACID
BETAMETHASONE
DIPROPIONATE/CLOTRIMAZOLE
BETAMETHASONE DISODIUM
PHOSPHATE
"
BETAMETHASONE VALERATE
BETASERON (EDS)
BETAXIN
BETAXOLOL HCL
BETHANECHOL CHLORIDE
BETNESOL
BETNESOL ENEMA
BETNOVATE
BETOPTIC S
BEZAFIBRATE
BEZALIP (EDS)
BEZALIP SR (EDS)
BIAXIN (EDS)
BILTRICIDE
BIQUIN DURULES
BLEPH-10
BLEPHAMIDE S.O.P.
BONAMINE
BOTOX (EDS)
BOTULINUM TOXIN TYPE A
BREVICON
BREVICON 1/35
BRICANYL
BRICANYL TURBUHALER
BRIMONIDINE TARTRATE
BRINZOLAMIDE
BROMAZEPAM
BROMOCRIPTINE MESYLATE
BUDESONIDE
"
"
"
BUMETANIDE
BUPROPION HCL
BURINEX (EDS)
BURO-SOL
BURO-SOL-OTIC
BUSCOPAN
BUSERELIN ACETATE
BUSPAR
BUSPIREX
BUSPIRONE
C.E.S.
CAFERGOT-PB
CALCIFEROL
CALCIMAR (EDS)
CALCIPOTRIOL
CALCITONIN SALMON
CALCITRIOL
CALCIUM POLYSTYRENE
SULFONATE
CALTINE 100 (EDS)
CALTINE 50 (EDS)
CANDESARTAN CILEXETIL
CANDISTATIN
CANESTEN
CANESTEN-3
CANESTEN-6
CAPOTEN
Page
196
206
142
201
201
225
219
149
30
142
201
201
149
60
60
60
8
2
57
141
146
156
223
223
175
175
36
36
149
146
119
223
143
157
169
201
133
101
133
208
142
32
223
123
123
123
177
37
219
183
211
183
219
132
183
183
63
193
191
191
191
191
191
64
PRODUCT NAME
CAPOTEN
CAPTOPRIL
"
CAPTRIL
"
CARBACHOL
CARBAMAZEPINE
CARBOLITH
CARDENE (EDS)
CARDIZEM
CARDIZEM CD
"
CARDIZEM-SR
CARDURA-1
CARDURA-2
CARDURA-4
CARVEDILOL
CATAPRES
CECLOR (EDS)
CECLOR BID (EDS)
CEFACLOR
CEFIXIME
CEFPROZIL
CEFTIN (EDS)
CEFUROXIME AXETIL
CEFZIL (EDS)
CELEBREX (EDS)
CELECOXIB
CELESTODERM-V
CELESTODERM-V/2
CELESTONE SOLUSPAN
CELEXA
CELLCEPT (EDS)
CELONTIN
CEPHALEXIN MONOHYDRATE
CERIVASTATIN SODIUM
CESAMET (EDS)
CETAMIDE
CHEMSTRIP BG
CHEMSTRIP UG 5000K
CHLORAL HYDRATE
CHLORDIAZEPOXIDE
CHLOROQUINE PHOSPHATE
CHLORPROMANYL
CHLORPROMANYL-40
CHLORPROMAZINE
CHLORPROMAZINE
CHLORPROPAMIDE
CHLORTHALIDONE
CHOLEDYL
CHOLEDYL-SA
CHOLESTYRAMINE RESIN
CHORIONIC GONADOTROPIN
CHRONOVERA
CICLOPIROX OLAMINE
CILAZAPRIL
CILAZAPRIL/
HYDROCHLOROTHIAZIDE
CILOXAN (EDS)
CIMETIDINE
CIPRO (EDS)
CIPRO HC (EDS)
CIPROFLOXACIN
"
CIPROFLOXACIN/
HYDROCORTISONE
CISAPRIDE MONOHYDRATE
CITALOPRAM HYDROBROMIDE
343
Page
65
50
64
64
65
147
98
125
54
51
51
52
51
66
66
66
50
66
5
5
5
5
6
6
6
6
80
80
201
201
169
101
227
97
6
60
227
141
128
129
123
120
19
110
110
110
110
181
133
215
215
60
179
75
191
65
65
142
157
20
145
20
142
145
158
101
PRODUCT NAME
CLARITHROMYCIN
CLAVULIN-125F (EDS)
CLAVULIN-200 (EDS)
CLAVULIN-250 (EDS)
CLAVULIN-250F (EDS)
CLAVULIN-400 (EDS)
CLAVULIN-500 (EDS)
CLAVULIN-875 (EDS)
CLIMARA 100 (EDS)
CLIMARA 50 (EDS)
CLINDAMYCIN HCL
CLINDAMYCIN PALMITATE HCL
CLINDAMYCIN PHOSPHATE
CLINISTIX
CLINITEST
CLOBAZAM
CLOBETASONE BUTYRATE
CLOFIBRATE
CLOMIPRAMINE HCL
CLONAPAM
CLONAZEPAM
CLONIDINE HCL
CLOPIDOGREL BISULFATE
CLOPIXOL (EDS)
CLOPIXOL ACUPHASE (EDS)
CLOPIXOL DEPOT (EDS)
CLORAZEPATE DIPOTASSIUM
CLOTRIMADERM
CLOTRIMAZOLE
CLOXACILLIN
CLOZAPINE
CLOZARIL (EDS)
CODEINE
CODEINE
CODEINE PHOSPHATE
COGENTIN
COLCHICINE
COLCHICINE
COLCHICINE-ODAN
COLESTID
COLESTIPOL HCL RESIN
COMBANTRIN
COMBIVENT
COMBIVENT (EDS)
COMBIVIR (EDS)
CONDYLINE
CONJUGATED ESTROGENS
COPAXONE (EDS)
CORDARONE
COREG (EDS)
CORGARD
CORTATE
"
CORTEF
CORTENEMA
CORTIFOAM
CORTIMYXIN
CORTISONE
CORTISONE ACETATE
CORTISPORIN
"
"
CORTODERM
CORTONE
COSOPT
Page
8
10
10
10
10
10
10
10
178
177
13
13
190
129
128
98
202
202
202
60
102
96
96
66
45
117
117
117
120
191
191
11
111
111
89
89
89
89
30
223
223
223
60
60
2
33
33
17
210
177
224
49
50
54
204
205
171
205
205
146
169
169
145
146
207
205
169
149
PRODUCT NAME
COSYNTROPIN ZINC
HYDROXIDE
"
COTAZYM
COTAZYM ECS 20
COTAZYM ECS 8
COUMADIN
COVERSYL
COZAAR
CREON 10
CREON 20
CREON 25
CREON 5
CRIXIVAN (EDS)
CROMOLYN
CROTAMITON
CUPRIC SO4 REAGENT
CUPRIMINE
CYANOCOBALAMIN
CYANOCOBALAMIN
CYCLEN
CYCLOBENZAPRINE HCL
CYCLOCORT
CYCLOMEN
CYCLOSPORINE
CYCLOSPORINE (TRANSPLANT)
CYPROTERONE ACETATE
CYSTADANE
CYTOMEL
CYTOTEC
CYTOVENE (EDS)
D.D.A.V.P. (EDS)
DALACIN C
DALACIN T
DALMANE
DALTEPARIN SODIUM
DANAZOL
DANTRIUM
DANTROLENE SODIUM
DAPSONE
DARAPRIM
DARVON-N
DECADRON
DELATESTRYL
DELAVIRDINE MESYLATE
DELESTROGEN
DELTASONE
DEMEROL
"
DEMULEN 30
DEPAKENE
DEPEN
DEPO-MEDROL
DEPO-PROVERA
DEPO-TESTOSTERONE
DEPROIC
DERMA-SMOOTHE/FS
DERMASONE
DERMOVATE
DESIPRAMINE HCL
DESMOPRESSIN
DESOCORT
DESONIDE
DESOXIMETASONE
DESQUAM-X
DESYREL
"
DETROL (EDS)
344
Page
128
184
155
155
155
44
71
69
155
155
155
155
18
151
193
128
166
218
218
176
40
195
173
211
223
26
222
186
159
15
184
13
190
121
42
173
40
40
21
19
94
170
173
16
178
172
90
91
174
100
166
171
185
173
100
203
202
202
102
184
202
202
203
209
108
109
214
PRODUCT NAME
DEXAMETHASONE
"
DEXAMETHASONE
DEXAMETHASONE
21-PHOSPHATE
DEXAMETHASONE SODIUM PHO
DEXASONE
DEXEDRINE
DEXTROAMPHETAMINE SO4
DIABETA
DIABINESE
DIAMOX
DIAMOX SEQUELS
DIARR-EZE
DIASTIX
DIAZEPAM
DICLECTIN
DICLOFENAC SODIUM
"
DICLOFENAC SODIUM/
MISOPROSTOL
DICLOTEC
DICYCLOMINE HCL
DIDANOSINE
DIDROCAL
DIDRONEL (EDS)
DIFFERIN
DIFLORASONE DIACETATE
DIFLUCAN
DIFLUCAN (EDS)
"
DIFLUCAN P.O.S. (EDS)
DIFLUCORTOLONE VALERATE
DIFLUNISAL
DIGOXIN
DIHYDROERGOTAMINE MESYL.
DIHYDROERGOTAMINE
MESYLATE
DIHYDROERGOTAMINE-SANDOZ
DIIODOHYDROXYQUIN
DILANTIN
DILAUDID
"
DILAUDID HP-PLUS
DILAUDID-HP
DILAUDID-XP
DILTIAZEM HCL
"
DIMENHYDRINATE
DIMENHYDRINATE IM
DIOCARPINE
DIODEX
DIODOQUIN
DIOPRED
DIOPTIMYD
DIOSULF
DIOVAN
DIPENTUM
DIPHENOXYLATE HCL
DIPIVEFRIN HCL
DIPROLENE
DIPROSALIC
DIPROSONE
DIPYRIDAMOLE
DISIPAL
DISOPYRAMIDE
DISULFIRAM
Page
143
170
143
170
170
143
170
118
118
182
181
146
146
154
129
121
156
80
149
81
81
31
17
224
224
208
203
3
3
4
4
203
81
50
37
37
37
2
97
89
90
90
90
90
51
66
156
156
148
143
2
144
146
141
74
160
154
149
196
196
196
76
31
52
224
PRODUCT NAME
DITHRANOL
DITROPAN
DIVALPROEX SODIUM
DIXARIT (EDS)
DOM-AMANTADINE
DOM-ATENOLOL
"
DOM-BACLOFEN
DOM-BUSPIRONE
DOM-CAPTOPRIL
"
DOM-CEFACLOR (EDS)
DOM-CEPHALEXIN
"
DOM-CIMETIDINE
DOM-CLONAZEPAM
DOM-CLONAZEPAM-R
DOM-CYCLOBENZAPRINE (EDS)
DOM-DESIPRAMINE
"
DOM-DICLOFENAC
DOM-DICLOFENAC SR
DOM-DOMPERIDONE
DOM-FENOFIBR. MICRO (EDS)
DOM-FLUOXETINE
DOM-FLUVOXAMINE
DOM-GEMFIBROZIL
DOM-GLYBURIDE
DOM-INDAPAMIDE
DOM-IPRATROPIUM
DOM-LOXAPINE
DOM-MEFENAMIC ACID
DOM-METFORMIN
DOM-METOPROLOL
DOM-METOPROLOL-L
DOM-NIFEDIPINE
DOM-NORTRIPTYLINE
DOM-NYSTATIN
DOM-OXYBUTYNIN
DOMPERIDONE MALEATE
DOM-PINDOLOL
"
DOM-PROCYCLIDINE
DOM-PROPRANOLOL
DOM-SALBUTAMOL
DOM-SALBUTAMOL RESPIR.SOL
DOM-SELEGILINE (EDS)
DOM-SODIUM CROMOGLYCATE
DOM-SOTALOL
DOM-TEMAZEPAM
DOM-TIAPROFENIC
DOM-TIMOLOL
DOM-TRAZODONE
"
DOM-VALPROIC ACID
DOM-VERAPAMIL SR
DONNATAL
DORNASE ALFA
DORZOLAMIDE HCL
DORZOLAMIDE HCL/TIMOLOL
MALEATE
DOVONEX
DOXAZOSIN MESYLATE
DOXEPIN HCL
DOXYCIN
DOXYCYCLINE
DOXYLAMINE SUCCINATE/
345
Page
210
214
98
66
15
49
50
39
123
64
65
98
5
6
7
157
96
96
40
102
103
80
81
158
61
104
105
61
182
134
150
113
84
182
53
53
55
107
4
214
158
55
56
31
57
35
36
229
229
58
122
87
151
108
109
100
76
32
138
147
149
211
66
103
12
12
PRODUCT NAME
PYRIDOXINE HCL
DOXYTEC
DPE
DRISDOL
DURAGESIC (EDS)
DURALITH
DUVOID
DYAZIDE
DYRENIUM
ECHOTHIOPHATE IODIDE
ECONAZOLE NITRATE
ECOSTATIN
ECTOSONE
ECTOSONE MILD
ECTOSONE REGULAR
EDECRIN (EDS)
EES 200
EES 400
EFAVIRENZ
EFFEXOR
EFFEXOR XR
EFUDEX
ELAVIL
ELDEPRYL (EDS)
ELITE
ELMIRON (EDS)
ELOCOM
ELTROXIN
EMO-CORT
"
EMPRACET-30
EMPRACET-60
EMTEC-30
ENALAPRIL MALEATE
ENALAPRIL MALEATE/
HYDROCHLOROTHIAZIDE
ENCORE
ENDANTADINE
ENOXAPARIN
ENTACYL
ENTOCORT
ENTOCORT (EDS)
ENTROPHEN
E-PILO 4
EPINEPHRINE HCL
EPIVAL
"
EPOETIN ALFA
EPREX (EDS)
ERGAMISOL (EDS)
ERGOMAR
ERGOTAMINE TARTRATE
ERGOTAMINE TARTRATE/
CAFFEINE/
BELLADONNA ALKALOIDS/
PENTOBARBITAL
ERGOTAMINE TARTRATE/
CYCLIZINE/CAFFEINE
ERYC
ERYTHROCIN
ERYTHROMID
ERYTHROMYCIN BASE
ERYTHROMYCIN ESTOLATE
ERYTHROMYCIN
ETHYLSUCCINATE
ERYTHROMYCIN
ETHYLSUCCINATE/
Page
156
12
149
219
89
125
30
74
135
147
192
192
201
201
201
133
8
8
16
110
110
211
101
229
128
228
206
186
204
205
88
88
88
67
67
128
15
226
43
2
201
157
80
148
33
98
99
45
45
226
37
37
37
37
8
9
8
8
8
8
PRODUCT NAME
SULFISOXAZOLE ACETATE
ERYTHROMYCIN STEARATE
ERYTHROMYCIN/ETHYL
ALCOHOL
ESDEPALLATHRIN/PIPERONYL
BUTOXIDE
ESTINYL
ESTRACE
ESTRACOMB (EDS)
ESTRADERM (EDS)
"
ESTRADIOL
ESTRADIOL & NORETHINDRONE
ACETATE/ESTRADIOL
ESTRADIOL VALERATE
ESTRING
ESTROGEL (EDS)
ESTROPIPATE
ETHACRYNIC ACID
ETHINYL ESTRADIOL
ETHINYL ESTRADIOL/
DESOGESTREL
ETHINYL ESTRADIOL/
D-NORGESTREL
ETHINYL ESTRADIOL/
ETHYNODIOL DIACETATE
ETHINYL ESTRADIOL/
L-NORGESTREL
ETHINYL ESTRADIOL/
NORETHINDRONE
ETHINYL ESTRADIOL/
NORETHINDRONE ACETATE
ETHINYL ESTRADIOL/
NORGESTIMATE
ETHOPROPAZINE
ETHOSUXIMIDE
ETIDRONATE DISODIUM
ETIDRONATE DISODIUM/
CALCIUM CARBONATE
ETODOLAC
EUGLUCON
EUMOVATE
EURAX
EXACTECH
EXDOL-30
FAMCICLOVIR
FAMOTIDINE
FAMVIR
FANSIDAR
FASTTAKE
FC PHARMA ATENOLOL
"
FELDENE
FELODIPINE
FENOFIBRATE
FENOPROFEN
FENOTEROL HYDROBROMIDE
FENTANYL
FEXICAM
FILGRASTIM
FINASTERIDE
FLAGYL
"
FLAREX
FLAVOXATE HCL
FLECAINIDE ACETATE
FLEXERIL (EDS)
FLEXITEC (EDS)
346
Page
22
9
190
193
178
177
178
177
178
177
178
178
177
177
178
133
178
174
174
174
174
175
176
176
30
97
224
224
82
182
202
193
128
88
15
158
15
20
128
49
50
86
67
61
82
33
89
86
45
224
22
195
143
214
52
40
40
PRODUCT NAME
FLOCTAFENINE
FLOMAX
FLONASE
FLORINEF
FLORONE
FLOVENT
FLOVENT DISKUS
"
FLUANXOL
FLUANXOL DEPOT
FLUCONAZOLE
FLUDROCORTISONE ACETATE
FLUNARIZINE HCL
FLUNISOLIDE
FLUOCINOLONE ACETONIDE
FLUOCINONIDE
FLUODERM
FLUOROMETHOLONE
FLUOROMETHOLONE ACETATE
FLUOROURACIL
FLUOTIC
FLUOXETINE
FLUPENTHIXOL
DIHYDROCHLORIDE
FLUPHENAZINE DECANOATE
FLUPHENAZINE ENANTHATE
FLUPHENAZINE HCL
FLURAZEPAM HCL
FLURBIPROFEN
FLURBIPROFEN SODIUM
"
FLUVASTATIN SODIUM
FLUVOXAMINE MALEATE
FML
FOLIC ACID
FOLIC ACID
FORADIL (EDS)
FORMOTEROL FUMARATE
FORMULEX
FORTOVASE (EDS)
FOSAMAX (EDS)
FOSINOPRIL
FRAGMIN (EDS)
FRAMYCETIN SO4
FRAMYCETIN SO4/
GRAMICIDIN/DEXAMETHASONE
FRAXIPARINE (EDS)
FRAXIPARINE FORTE (EDS)
FRISIUM
FS SHAMPOO
FTP-ATENOLOL
"
FTP-BACLOFEN
FTP-BUSPIRONE
FTP-CAPTOPRIL
"
FTP-DOMPERIDONE MALEATE
FTP-INDOMETHACIN
FTP-NYSTATIN
FTP-VALPROIC ACID
FUCIDIN
"
FUCIDIN H
FULVICIN U/F
FUROSEMIDE
FUSIDIC ACID
Page
94
230
144
170
203
170
170
171
111
111
3
170
37
143
203
204
203
143
143
211
230
104
111
111
111
111
112
121
82
143
144
170
61
105
143
218
218
34
34
31
19
222
67
42
190
145
43
43
98
203
49
50
39
123
64
65
158
83
4
100
190
191
206
4
133
190
PRODUCT NAME
FUSIDIC ACID/
GABAPENTIN
GAMMA-BENZENE
HEXACHLORIDE
GANCICLOVIR SO4
GARAMYCIN
"
GARASONE
GARATEC
GEMFIBROZIL
GEMFIBROZIL
GEN-ACEBUTOLOL
GEN-ALPRAZOLAM
GEN-AMANTADINE
GEN-AMOXICILLIN
GEN-ATENOLOL
"
GEN-AZATHIOPRINE
GEN-BACLOFEN
GEN-BECLO AQ.
GEN-BROMAZEPAM
"
GEN-BUDESONIDE AQ
GEN-BUSPIRONE
GEN-CAPTOPRIL
"
GEN-CIMETIDINE
GEN-CLOBETASOL
GEN-CLOMIPRAMINE
GEN-CLONAZEPAM
GEN-CROMOGLYCATE
GEN-CYCLOBENZAPRINE (EDS)
GEN-CYPROTERONE (EDS)
GEN-DILTIAZEM
GEN-DILTIAZEM SR
GEN-DOXAZOSIN
GEN-ETODOLAC (EDS)
GEN-FAMOTIDINE
GEN-FENOFIBR. MICRO (EDS)
GEN-FLUOXETINE
GEN-FLUVOXAMINE
GEN-GEMFIBROZIL
GEN-GLYBE
GEN-INDAPAMIDE
GEN-IPRATROPIUM
GEN-MEDROXY
GEN-METFORMIN
"
GEN-METOPROLOL
"
GEN-NORTRIPTYLINE
GEN-OXYBUTYNIN
GEN-PINDOLOL
"
GEN-PIROXICAM
GEN-RANITIDINE
GEN-SALBUTAMOL RESPIR.SOL
GEN-SELEGILINE (EDS)
GEN-SOTALOL
GENTACIDIN
GENTAMICIN
GENTAMICIN SO4
347
Page
206
99
194
15
3
140
145
140
61
61
48
48
119
15
9
49
50
222
39
142
119
120
143
123
64
65
98
157
202
102
96
229
40
26
51
51
66
82
158
61
104
105
61
182
134
32
185
182
183
53
53
12
13
107
214
55
56
86
160
36
35
229
58
140
140
3
PRODUCT NAME
GENTAMICIN SO4
GENTAMICIN SO4
GENTAMICIN SO4/
BETAMETHASONE SODIUM
PHOSPHATE
GENTAMICIN SULFATE
GENTAMICIN SULPHATE
GEN-TEMAZEPAM
GEN-TICLOPIDINE (EDS)
GEN-TIMOLOL
GEN-TRAZODONE
"
GEN-TRIAZOLAM
GEN-VALPROIC
GEN-VERAPAMIL
GEN-VERAPAMIL SR
"
GLATIRAMER ACETATE
GLUCAGON
GLUCAGON
GLUCOFILM
GLUCOMETER DEX
GLUCONORM (EDS)
GLUCOPHAGE
"
GLUCOSE OXIDASE/
PEROXIDASE REAGENT
"
GLUCOSE OXIDASE/
PEROXIDASE/SODIUM
NITROFERRICYANIDE/
GLYCINE REAGENT
GLUCOSE OXIDASE/
PEROXIDASE/SODIUM
NITROPRUSSIDE REAGENT
GLUCOSTIX
GLYBURIDE
GLYCON
GLYCOPYRROLATE
GOSERELIN ACETATE
GRAVOL
GRISEOFULVIN (ULTRA-FINE)
HALCINONIDE
HALCION
HALDOL-LA
HALOBETASOL PROPIONATE
HALOG
HALOPERIDOL
HALOPERIDOL
HALOPERIDOL DECANOATE
HALOPERIDOL LA
HEPALEAN
HEPARIN
HEPTOVIR (EDS)
HERPLEX
HEXACHLOROPHENE
HEXIT SHAMPOO
HIVID (EDS)
HOMATROPINE HYDROBROMIDE
HONVOL
HP-PAC (EDS)
HUMALOG (EDS)
HUMALOG CARTRIDGE (EDS)
HUMALOG MIX25 (EDS)
HUMATROPE (EDS)
HUMULIN 10/90
Page
140
140
145
140
3
122
46
151
108
109
123
100
75
75
76
224
224
224
128
128
183
182
183
128
129
129
129
128
182
182
32
224
156
4
204
123
113
204
204
112
112
113
113
43
43
17
141
194
194
18
149
178
159
180
180
181
184
184
180
180
PRODUCT NAME
HUMULIN 20/80
HUMULIN 30/70
HUMULIN 40/60
HUMULIN 50/50
HUMULIN-L
HUMULIN-N
HUMULIN-N CARTRIDGE
HUMULIN-R
HUMULIN-R CARTRIDGE
HUMULIN-U
HYCORT
HYDERM
HYDRALAZINE HCL
HYDROCHLOROTHIAZIDE
HYDROCORTISONE
"
HYDROCORTISONE SODIUM
SUCCINATE
HYDROCORTISONE VALERATE
HYDROCORTISONE/UREA
HYDRODIURIL
HYDROMORPH CONTIN
HYDROMORPHONE HCL
HYDROMORPHONE HCL
HYDROMORPHONE HP 10
HYDROMORPHONE HP 20
HYDROMORPHONE HP 50
HYDROXYCHLOROQUINE SO4
HYDROXYZINE
HYOSCYAMINE/ATROPINE/
HYOSCINE/PHENOBARBITAL
HYTRIN
"
HYTRIN STARTER PACK
HYZAAR
HYZAAR DS
IBUPROFEN
IDARAC
IDOXURIDINE
IMDUR
IMIPRAMINE
IMITREX (EDS)
IMODIUM
IMURAN
INDAPAMIDE
INDAPAMIDE HEMIHYDRATE
INDERAL
INDERAL-LA
INDERIDE-40
INDERIDE-80
INDINAVIR SO4
INDOCID
INDOMETHACIN
INDOTEC
INFLAMASE
INFLAMASE FORTE
INFUFER (EDS)
INHIBACE
INHIBACE PLUS
INNOHEP (EDS)
INSULIN (ISOPHANE) HUMAN
348
Page
180
180
180
180
180
180
181
181
179
179
179
180
180
181
205
204
68
134
171
204
205
204
171
205
205
134
90
89
90
90
90
90
19
124
32
32
73
74
74
69
69
82
94
141
77
105
38
154
222
134
134
57
57
72
72
18
83
83
83
144
144
42
65
65
43
PRODUCT NAME
BIOSYNTHETIC
INSULIN (ISOPHANE) PORK
INSULIN (LENTE) HUMAN
BIOSYNTHETIC
INSULIN (LENTE) PORK
INSULIN (REGULAR) LISPRO
INSULIN (REGULAR) PORK
INSULIN (REGULAR/ISOPHANE)
HUMAN BIOSYNTHETIC
INSULIN (REGULAR/
PROTAMINE) LISPRO
INSULIN (ULTRALENTE)
HUMAN BIOSYNTHETIC
INTAL
INTAL NEBULIZER SOLUTION
INTAL SPINCAPS
INTAL SYNCRONER
INTERFERON ALFA-2A
INTERFERON ALFA-2B
INTERFERON ALFA-2B/
RIBAVIRIN
INTERFERON ALPHA-N1
INTERFERON BETA-1A
INTERFERON BETA-1B
INTRON-A (EDS)
"
INTRON-A PREMIX (EDS)
INVIRASE (EDS)
IODOCHLORHYDROXYQUIN/
FLUMETHASONE PIVALATE
IOPIDINE
IPRATROPIUM BROMIDE
"
IPRATROPIUM BROMIDE/
SALBUTAMOL SO4
IRBESARTAN
IRBESARTAN/
HYDROCHLOROTHIAZIDE
IRON DEXTRAN
IRON SORBITOL
ISMO
ISOPTIN
ISOPTIN SR
"
ISOPTO ATROPINE
ISOPTO CARBACHOL
ISOPTO CARPINE
"
ISOPTO HOMATROPINE
ISORDIL
ISOSORBIDE DINITRATE
ISOSORBIDE-5 MONONITRATE
ISOTRETINOIN
"
ISOTREX
ITRACONAZOLE
JECTOFER (EDS)
K-10
KADIAN
"
KAYEXALATE
K-DUR
KEFLEX
"
KEMADRIN
KENACOMB
KENACOMB MILD
KENALOG
Page
179
179
179
179
180
179
180
181
181
229
229
229
229
26
26
225
27
225
225
26
27
26
19
145
149
32
150
33
68
68
42
42
77
75
75
76
148
147
147
148
149
76
76
77
208
211
208
4
42
132
91
92
132
132
6
7
31
207
207
206
PRODUCT NAME
KENALOG 10
KENALOG 40
KENALOG-ORABASE
KENRAL-MPA
KETO DIASTIX
KETOCONAZOLE
"
KETOPROFEN
KETOROLAC TROMETHAMINE
KETOSTIX
KETOTIFEN FUMARATE
K-LOR
K-LYTE/CL
KWELLADA-P CREME RINSE
KWELLADA-P LOTION
LABETALOL HCL
LACTULOSE
LAMICTAL
LAMISIL
"
LAMIVUDINE
LAMIVUDINE/ZIDOVUDINE
LAMOTRIGINE
LANOXIN
LANSOPRAZOLE
LANSOPRAZOLE/
CLARITHROMYCIN/
AMOXICILLIN
LARGACTIL
LASIX
LATANOPROST
LECTOPAM
"
LENOLTEC #4
LENOLTEC NO.2
LENOLTEC NO.3
LENTE ILETIN II, PORK
LERITINE
LESCOL
LEUCOVORIN (EDS)
LEUCOVORIN CALCIUM
(FOLINIC ACID)
LEUPROLIDE ACETATE
LEVAMISOLE
LEVAQUIN (EDS)
LEVOBUNOLOL HCL
LEVOBUNOLOL HCL/
DIPIVEFRIN HCL
LEVOCABASTINE
HYDROCHLORIDE
LEVODOPA/BENZERAZIDE
LEVODOPA/CARBIDOPA
LEVOFLOXACIN
LEVONORGESTREL
LEVOTHYROXINE (SODIUM)
LIDEMOL
LIDEX
LIN-AMOX
"
LIN-BUSPIRONE
LIN-MEGESTROL (EDS)
LINSOTALOL
LIORESAL
"
LIORESAL-DS
LIOTEC
349
Page
172
172
206
185
129
4
192
84
144
129
225
132
132
194
194
68
154
99
4
193
17
17
99
50
159
159
110
133
150
119
120
88
88
88
179
88
61
218
218
226
226
20
150
150
150
150
226
226
20
176
186
204
204
9
10
123
27
58
39
39
40
39
39
PRODUCT NAME
LIOTHYRONINE (SODIUM)
LIPIDIL-MICRO (EDS)
LIPITOR
LISINOPRIL
LISINOPRIL/
HYDROCHLOROTHIAZIDE
LITHIUM CARBONATE
LIVOSTIN
LOCACORTEN-VIOFORM
LODOXAMIDE TROMETHAMINE
LOESTRIN 1.5/30
LOMOTIL
LONITEN (EDS)
LOPERACAP
LOPERAMIDE HCL
LOPID
LOPRESOR
LOPRESOR-SR
LOPROX
LORAZEPAM
LOSARTAN POTASSIUM
LOSARTAN POTASSIUM/
HYDROCHLOROTHIAZIDE
LOSEC (EDS)
LOTENSIN
LOTRIDERM
LOVASTATIN
LOVENOX (EDS)
LOXAPAC
LOXAPINE SUCCINATE
LOZIDE
LUDIOMIL
LUPRON DEPOT (EDS)
LUVOX
LYDERM
M.O.S.
"
"
M.O.S.-S.R.
MACROBID
MACRODANTIN
MANDELAMINE
MANERIX
MAPROTILINE
MARVELON
MAVIK
MAXALT (EDS)
MAXALT RPD (EDS)
MAXIDEX
MAXITROL
MEBENDAZOLE
MECLIZINE HCL
MED FLUOXETINE
MED-ACEBUTOLOL
MED-ALPRAZOLAM
MED-AMANTADINE
MED-AMOXICILLIN
MED-ATENOLOL
"
MED-BACLOFEN
MED-BECLOMETHASONE AQ
MED-BROMAZEPAM
"
MED-BUSPIRONE
MED-CAPTOPRIL
"
MED-CLOMIPRAMINE
Page
186
61
59
69
69
125
150
145
150
176
154
70
154
154
61
53
53
191
121
69
69
160
63
206
62
43
113
113
134
106
226
105
204
91
92
93
92
21
21
21
106
106
174
74
38
38
143
145
2
156
104
48
48
119
15
9
49
50
39
142
119
120
123
64
65
102
PRODUCT NAME
MED-CLONAZEPAM
MED-CYCLOBENZAPRINE (EDS)
MED-DILTIAZEM
MED-GEMFIBROZIL
MED-GLYBURIDE
MED-METFORMIN
MED-METOPROLOL
"
MED-PINDOLOL
"
MED-RANITIDINE
MEDROL
"
MEDROXYPROGESTERONE
ACETATE
MED-SALBUTAMOL
MED-SELEGILINE (EDS)
MED-SOTALOL
MED-TEMAZEPAM
MED-TIMOLOL
MED-VALPROIC
MED-VERAPAMIL
MEFENAMIC ACID
MEGACE (EDS)
MEGACE OS (EDS)
MEGESTROL
MEGRAL
MELLARIL
MEPERIDINE HCL
"
MEPRON (EDS)
MERCAPTOPURINE
MESASAL
M-ESLON
"
MESORIDAZINE
MESTINON
MESTRANOL/NORETHINDRONE
METANDREN
METFORMIN
METHAZOLAMIDE
METHENAMINE MANDELATE
METHIMAZOLE
METHOTREXATE
METHOTRIMEPRAZINE
METHOXSALEN
METHSUXIMIDE
METHYLDOPA
METHYLDOPA/
HYDROCHLOROTHIAZIDE
METHYLPHENIDATE HCL
METHYLPREDNISOLONE
"
METHYLPREDNISOLONE
ACETATE
METHYLTESTOSTERONE
METHYSERGIDE MALEATE
METOCLOPRAMIDE HCL
METOLAZONE
METOPROLOL TARTRATE
"
METROCREAM
METROGEL
METRONIDAZOLE
"
MEVACOR
350
Page
96
40
51
61
182
182
53
12
13
55
56
160
171
205
185
35
229
58
122
151
100
75
84
27
27
27
37
116
90
90
91
22
27
161
91
92
113
30
176
173
182
147
21
187
210
124
212
97
70
70
118
171
205
171
173
37
159
134
53
70
194
194
22
194
62
PRODUCT NAME
MEXILETINE HCL
MEXITIL
MICARDIS
MICATIN
MICONAZOLE 3 DAY OVULE
MICONAZOLE NITRATE
MICRO-K 10 EXTENCAPS
MICRO-K EXTENCAPS
MICRONOR
MIDAMOR
MIDODRINE HCL
MIGRANAL (EDS)
MINESTRIN 1/20
MINIPRESS
"
MINITRAN 0.2
MINITRAN 0.4
MINITRAN 0.6
MINOCIN (EDS)
"
MINOCYCLINE HCL
MIN-OVRAL
MINOXIDIL
MIOCARPINE
MIRAPEX
MISOPROSTOL
MOCLOBEMIDE
MODECATE
MODECATE CONCENTRATE
MODITEN
MODITEN ENANTHATE
MODURET
MOGADON
MOMETASONE FUROATE
MOMETASONE FUROATE
MONOHYDRATE
MONAZOLE 7
MONISTAT-3
MONISTAT-7
MONITAN
MONOPRIL
MONTELUKAST SODIUM
MORPHINE
MORPHINE HP 50
MORPHINE SO4
"
MORPHINE SULPHATE
MORPHITEC-1
MORPHITEC-10
MORPHITEC-20
MORPHITEC-5
MOS-SULFATE
MOTILIDONE
MOTILIUM
MOTRIN
"
MS CONTIN
"
"
MSIR
"
MUCOMYST
MUPIROCIN
MYCLO-DERM
MYCOBUTIN (EDS)
Page
54
54
73
192
192
192
132
132
176
134
34
37
176
71
72
77
77
77
12
13
12
174
70
148
228
159
106
111
111
112
111
63
96
206
144
192
192
192
192
192
48
67
227
91
93
92
93
93
92
92
92
92
91
158
158
82
83
91
92
93
80
91
93
138
190
191
228
PRODUCT NAME
MYCOPHENOLATE MOFETIL
MYCOSTATIN
"
"
MYOCHRYSINE
MYSOLINE
NABILONE
NABUMETONE
NADOLOL
"
NADOPEN-V 200
NADOSTINE
"
"
NADROPARIN CALCIUM
NAFARELIN ACETATE
NALCROM (EDS)
NALFON
NAPROSYN
NAPROSYN-S.R.
NAPROXEN
NAPROXEN
NARATRIPTAN HCL
NARDIL
NASACORT
NASACORT AQ
NASONEX
NAVANE
NAXEN
NEDOCROMIL SO4
NEFAZODONE
NELFINAVIR MESYLATE
NEMBUTAL
NEO-CORTEF
NEOMYCIN SO4/
NEOMYCIN/
GRAMICIDIN/NYSTATIN/
NEORAL (EDS)
"
"
NEOSPORIN
"
NEOSTIGMINE BROMIDE
NEOTOPIC
NEPTAZANE
NERISONE
NEULEPTIL
NEUPOGEN (EDS)
NEURONTIN
NEVIRAPINE
NIACIN
NIACIN
NICARDIPINE HCL
NIDAGEL
NIFEDIPINE
"
NIFEDIPINE PA
NILSTAT
"
"
NIMODIPINE
NIMOTOP (EDS)
NITOMAN
NITRAZADON
NITRAZEPAM
NITRO-DUR 0.2
351
Page
227
4
192
193
164
95
227
84
54
70
11
4
192
193
43
227
229
82
85
85
85
85
37
107
144
144
144
116
85
227
106
18
118
145
145
207
211
223
224
140
190
30
190
147
203
114
45
99
16
218
218
54
195
55
70
55
4
192
193
77
77
230
96
96
77
PRODUCT NAME
NITRO-DUR 0.4
NITRO-DUR 0.6
NITRO-DUR 0.8
NITROFURANTOIN
NITROFURANTOIN
MONOHYDRATE
NITROGLYCERIN
NITROL
NITROLINGUAL PUMPSPRAY
NITROLINGUAL SPRAY
NITROSTAT
NIX CREME RINSE
NIX DERMAL CREAM
NIZATIDINE
NIZORAL
NIZORAL (EDS)
NORETHINDRONE
NORFLOXACIN
"
NORINYL 1+50
NORITATE
NOROXIN (EDS)
"
NORPACE-CR
NORPLANT
NORPRAMIN
"
NORTRIPTYLINE
NORVASC
NORVENTYL
NORVIR (EDS)
NORVIR SEC (EDS)
NOVAMILOR
NOVAMOXIN
"
NOVASEN
NOVO-5-ASA
NOVO-ACEBUTOLOL
NOVO-ALPRAZOL
NOVO-AMPICILLIN
"
NOVO-ATENOL
"
NOVO-AZATHIOPRINE
NOVO-AZT (EDS)
NOVO-BACLOFEN
NOVO-BROMAZEPAM
NOVO-BUSPIRONE
NOVO-BUTAMIDE
NOVO-BUTAZONE
NOVO-CAPTORIL
"
NOVO-CARBAMAZ
NOVO-CEFACLOR (EDS)
NOVO-CHLOROQUINE
NOVO-CHLORPROMAZINE
NOVO-CHOLAMINE
NOVO-CHOLAMINE LIGHT
NOVO-CIMETINE
NOVO-CLINDAMYCIN
NOVO-CLOBAZAM
NOVO-CLOBETASOL
NOVO-CLONAZEPAM
NOVO-CLONIDINE
NOVO-CLOPAMINE
NOVO-CLOPATE
NOVO-CLOXIN
NOVO-CYCLOPRINE (EDS)
Page
77
77
77
21
21
77
77
78
78
77
194
194
159
192
4
176
20
142
176
194
20
142
52
176
102
103
107
49
107
19
19
63
9
10
80
161
48
119
10
11
49
50
222
18
39
120
123
183
85
64
65
98
5
19
110
60
60
157
13
98
202
96
66
102
120
11
40
PRODUCT NAME
NOVO-CYPROTERONE (EDS)
NOVO-DESIPRAMINE
"
NOVO-DIFENAC
"
NOVO-DIFENAC SR
NOVO-DIFLUNISAL
NOVO-DILTAZEM
NOVO-DILTAZEM SR
NOVO-DIMENATE
NOVO-DIPAM
NOVO-DIVALPROEX
"
NOVO-DOMPERIDONE
NOVO-DOPARIL
NOVO-DOXEPIN
"
NOVO-DOXYLIN
NOVO-FAMOTIDINE
NOVO-FIBRATE
NOVO-FLUNISOLIDE
NOVO-FLUOXETINE
NOVO-FLUPAM
NOVO-FLURPROFEN
NOVO-FLUVOXAMINE
NOVO-FOLACID
NOVO-FURAN
NOVO-FURANTOIN
NOVO-GEMFIBROZIL
NOVO-GESIC C15
NOVO-GESIC C30
NOVO-GLUCOSE
NOVO-GLYBURIDE
NOVO-HEXIDYL
NOVO-HYDRAZIDE
NOVO-HYDROXYZIN
NOVO-HYLAZIN
NOVO-INDAPAMIDE
NOVO-IPRAMIDE
NOVO-KETO
NOVO-KETOCONAZOLE (EDS)
NOVO-LEVAMISOLE (EDS)
NOVO-LEVOBUNOLOL
NOVO-LEXIN
"
NOVOLIN GE 30/70
NOVOLIN GE LENTE
NOVOLIN GE NPH
NOVOLIN GE NPH PENFILL
NOVOLIN GE TORONTO
NOVOLIN GE TORONTO PENFIL
NOVOLIN GE ULTRALENTE
NOVO-LOPERAMIDE
NOVO-LORAZEM
"
NOVO-MAPROTILINE
NOVO-MEDOPA
NOVO-MEDRONE
NOVO-MEPRAZINE
NOVO-METFORMIN
"
NOVO-METHACIN
352
Page
26
102
103
80
81
81
81
51
51
156
121
98
99
158
70
103
104
12
158
60
143
104
121
82
105
218
21
21
61
88
88
128
182
31
134
124
68
134
32
84
4
225
226
150
6
7
180
180
180
180
180
181
179
179
179
180
180
181
154
121
122
106
70
185
124
182
183
83
PRODUCT NAME
NOVO-METOPROL
NOVO-MEXILETINE
"
NOVO-MOCLOBEMIDE
NOVO-NABUMETONE (EDS)
NOVO-NADOLOL
NOVO-NAPROX
NOVO-NAPROX SR
NOVO-NIDAZOL
NOVO-NIFEDIN
NOVO-NIZATIDINE
NOVO-NORFLOXACIN (EDS)
NOVO-NORTRIPTYLINE
NOVO-OXYBUTYNIN
NOVO-PEN-VK
NOVO-PERIDOL
NOVO-PINDOL
"
NOVO-PIROCAM
NOVO-POXIDE
NOVO-PRAMINE
NOVO-PRANOL
NOVO-PRAZIN
"
NOVO-PREDNISONE
NOVO-PROFEN
"
NOVO-PROPAMIDE
NOVO-PROPOXYN
NOVO-PUROL
NOVO-PYRAZONE
NOVO-QUINIDIN
NOVO-QUININE
NOVO-RANIDINE
NOVO-RIDAZINE
NOVO-RYTHRO-ENCAP
NOVO-SALMOL
"
NOVO-SELEGILINE (EDS)
NOVO-SEMIDE
NOVO-SERTRALINE
NOVO-SORBIDE
NOVO-SOTALOL
NOVO-SOXAZOLE
NOVO-SPIROTON
NOVO-SPIROZINE
NOVO-SUCRALATE
NOVO-SUNDAC
NOVO-TEMAZEPAM
NOVO-TERAZOSIN
"
NOVO-TETRA
NOVO-THALIDONE
NOVO-THEOPHYL SR
"
NOVO-TIAPROFENIC
NOVO-TIMOL
"
NOVO-TOLMETIN
NOVO-TRAZODONE
"
NOVO-TRIAMZIDE
NOVO-TRIFLUZINE
NOVO-TRIMEL
Page
53
53
54
12
13
106
84
54
85
85
22
55
159
20
107
214
11
112
55
56
86
120
105
57
71
72
172
82
83
181
94
222
135
58
20
160
116
8
8
8
34
35
229
133
108
76
58
21
135
73
161
87
122
73
74
13
133
215
216
87
59
151
87
108
109
74
117
22
PRODUCT NAME
NOVO-TRIMEL
NOVO-TRIMEL DS
NOVO-TRIOLAM
NOVO-TRIPHYL
NOVO-TRIPRAMINE
NOVO-TRIPTYN
NOVO-VALPROIC
NOVO-VERAMIL
NOVO-VERAMIL SR
NOVOXAPAM
NOVO-ZOLAMIDE
NOZINAN
NPH ILETIN II PORK
NU-ACEBUTOLOL
NU-ACYCLOVIR
NU-ALPRAZ
NU-AMILZIDE
NU-AMOXI
"
NU-AMPI
"
NU-ATENOL
"
NU-BACLO
NU-BECLOMETHASONE
NU-BROMAZEPAM
"
NU-BUSPIRONE
NU-CAPTO
"
NU-CARBAMAZEPINE
NU-CEFACLOR (EDS)
NU-CEPHALEX
"
NU-CIMET
NU-CLONAZEPAM
NU-CLONIDINE
NU-CLOXI
NU-COTRIMOX
"
NU-COTRIMOX DS
NU-CROMOLYN
NU-CYCLOBENZAPRINE (EDS)
NU-DESIPRAMINE
"
NU-DICLO
NU-DICLO-SR
NU-DIFLUNISAL
NU-DILTIAZ
NU-DILTIAZ-CD
"
NU-DIVALPROEX
"
NU-DOMPERIDONE
NU-DOXYCYCLINE
NU-ERYTHROMYCIN-S
NU-FAMOTIDINE
NU-FENOFIBRATE (EDS)
NU-FLUOXETINE
NU-FLURBIPROFEN
NU-FLUVOXAMINE
NU-GEMFIBROZIL
NU-GLYBURIDE
NU-HYDRAL
NU-IBUPROFEN
"
NU-INDAPAMIDE
NU-INDO
353
Page
23
23
123
215
109
101
100
75
76
122
146
124
179
48
14
119
63
9
10
10
11
49
50
39
142
119
120
123
64
65
98
5
6
7
157
96
66
11
22
23
23
229
40
102
103
80
81
81
51
51
52
98
99
158
12
9
158
61
104
82
105
61
182
68
82
83
134
83
PRODUCT NAME
NU-IPRATROPIUM
NU-KETOCON (EDS)
NU-KETOTIFEN (EDS)
NU-LEVOCARB
NU-LORAZ
"
NU-LOXAPINE
NU-MEDOPA
NU-MEFENAMIC
NU-MEGESTROL (EDS)
NU-METFORMIN
"
NU-METOCLOPRAMIDE
NU-METOP
NU-MOCLOBEMIDE
NUMORPHAN
NU-NAPROX
NU-NIFED
NU-NIFEDIPINE-PA
NU-NORTRIPTYLINE
NU-OXYBUTYN
NU-PENTOXIFYLLINE-SR
NU-PEN-VK
NU-PINDOL
"
NU-PIROX
NU-PRAZO
"
NU-PROCHLOR
NU-PROPRANOLOL
NU-RANIT
NU-SALBUTAMOL
"
NU-SELEGILINE (EDS)
NU-SOTALOL
NU-SUCRALFATE
NU-SULFINPYRAZONE
NU-SULINDAC
NU-TEMAZEPAM
NU-TERAZOSIN
"
NU-TETRA
NU-TIAPROFENIC
NU-TICLOPIDINE (EDS)
NU-TIMOLOL
NU-TRAZODONE
"
NU-TRIAZIDE
NU-TRIMIPRAMINE
NUTROPIN (EDS)
NUTROPIN AQ (EDS)
NU-VALPROIC
NU-VERAP
NYADERM
"
"
NYSTATIN
"
OCTOSTIM (EDS)
OCTREOTIDE
OCUFEN (EDS)
OCUFLOX (EDS)
OESCLIM (EDS)
OFLOXACIN
OGEN
OLANZAPINE
OLSALAZINE SODIUM
OMEPRAZOLE
Page
32
4
225
226
121
122
113
70
84
27
182
183
159
53
106
93
85
55
55
107
214
45
11
55
56
86
71
72
115
57
160
34
35
229
58
161
135
87
122
73
74
13
87
46
59
108
109
74
109
184
184
100
75
4
192
193
4
192
184
227
143
142
177
142
178
114
160
160
PRODUCT NAME
ONE ALPHA (EDS)
ONE TOUCH
ONE-ALPHA (EDS)
OPHTHO-BUNOLOL
OPHTHO-DIPIVEFRIN
OPHTHO-TATE
OPTIMYXIN PLUS
ORACORT DENTAL PASTE
ORAFEN
ORAMORPH SR
ORAP
ORCIPRENALINE SO4
ORPHENADRINE HCL
ORTHO 0.5/35
ORTHO 1/35
ORTHO 10/11
ORTHO 7/7/7
ORTHO-CEPT
ORTHO-NOVUM 1/50
ORUDIS
ORUDIS SR
ORUDIS-E
OSTOFORTE
OVRAL
OXAZEPAM
OXPRENOLOL HCL
OXSORALEN (EDS)
OXSORALEN ULTRA (EDS)
OXTRIPHYLLINE
OXYBUTYN
OXYBUTYNIN CHLORIDE
OXYCODONE HCL
OXYCONTIN (EDS)
OXYDERM
OXYMORPHONE HCL
PANCREASE
PANCREASE MT 10
PANCREASE MT 16
PANCREASE MT 4
PANCRELIPASE (LIPASE/
AMYLASE/PROTEASE)
PANECTYL
PANOXYL
PANOXYL AQUAGEL
"
PANOXYL-10
PANOXYL-15
PANOXYL-20
PANTOLOC (EDS)
PANTOPRAZOLE
PARLODEL
PARNATE
PAROXETINE HCL
PARSITAN
PAXIL
PCE
PEDIAPRED
PEDIAZOLE
PENICILLAMINE
PENICILLIN V (BENZATHINE)
PENICILLIN V (POTASSIUM)
PENTA-ACEBUTOLOL
PENTA-AMILORIDE HCTZ
PENTA-AMOXICILLIN
"
PENTA-ATENOLOL
"
354
Page
219
128
219
150
149
144
140
206
84
92
114
34
31
175
175
175
175
174
176
84
84
84
220
174
122
34
71
212
212
215
214
214
93
93
209
93
154
155
155
154
154
230
209
209
210
209
210
210
160
160
223
108
107
30
107
8
171
22
166
11
11
48
63
9
10
49
50
PRODUCT NAME
PENTA-BROMAZEPAM
PENTA-BUSPIRONE
PENTA-CAPTOPRIL
"
PENTA-CEPHALEXIN
"
PENTA-CLOMIPRAMINE
PENTA-DESIPRAMINE
"
PENTA-DICLOFENAC EC
PENTA-DILTIAZEM
PENTA-DOXYCYCLINE
PENTA-FAMOTIDINE
PENTA-FLUOXETINE
PENTA-GEMFIBROZIL
PENTA-GLYBURIDE
PENTA-METOPROLOL
PENTA-OXYBUTYNIN CHLORIDE
PENTASA
PENTA-SULINDAC
PENTA-TEMAZEPAM
PENTA-TIAPROFENIC
PENTA-TRAZODONE
"
PENTA-TRIAMTERENE HCTZ
PENTA-VALPROIC
PENTA-VERAPAMIL
PENTAZOCINE
PENTOBARBITAL SODIUM
PENTOSAN POLYSULFATE SO4
PENTOXIFYLLINE
PEN-VEE
PEPCID
PEPTOL
PERGOLIDE MESYLATE
PERICYAZINE
PERIDOL
PERINDOPRIL ERBUMINE
PERMAX
PERMETHRIN
PERPHENAZINE
PERSANTINE (EDS)
PETHIDINE
"
PHENAZO
PHENAZOPYRIDINE
PHENELZINE SO4
PHENOBARBITAL
"
PHENOBARBITAL
PHENYLBUTAZONE
PHENYTOIN
PHISOHEX
PHOSPHOLINE IODIDE
PHYLLOCONTIN
PHYLLOCONTIN-350
PILOCARPINE
PILOCARPINE HCL
PILOCARPINE HCL/
EPINEPHRINE BITARTRATE
PILOPINE-HS
PIMOZIDE
PINDOLOL
"
PINDOLOL/
HYDROCHLOROTHIAZIDE
PIPERAZINE ADIPATE
Page
120
123
64
65
6
7
102
102
103
80
51
12
158
104
61
182
185
53
214
161
87
122
87
108
109
74
100
75
94
118
228
45
11
158
157
228
114
112
71
228
194
114
76
90
91
207
207
107
95
118
95
85
97
194
147
214
214
148
147
148
148
114
55
71
71
2
PRODUCT NAME
PIPORTIL L4
PIPOTIAZINE PALMITATE
PIROXICAM
PIROXICAM
PIZOTYLINE HYDROGEN
MALATE
PLAQUENIL
PLAVIX (EDS)
PLENDIL
PMS-AMANTADINE
PMS-ATENOLOL
"
PMS-BACLOFEN
PMS-BENZTROPINE
PMS-BEZAFIBRATE (EDS)
PMS-BROMOCRIPTINE
PMS-BUSPIRONE
PMS-CAPTOPRIL
"
PMS-CEFACLOR (EDS)
PMS-CEPHALEXIN
"
PMS-CHLORAL HYDRATE SYRUP
PMS-CHOLESTYRAMINE
PMS-CHOLESTYRAMINE LIGHT
PMS-CIMETIDINE
PMS-CLOBETASOL
PMS-CLONAZEPAM
PMS-CLONAZEPAM-R
PMS-CYCLOBENZAPRINE (EDS)
PMS-DESIPRAMINE
"
PMS-DEXAMETHASONE
"
PMS-DICLOFENAC
"
PMS-DICLOFENAC-SR
PMS-DIMENHYDRINATE
PMS-DIPIVEFRIN
PMS-DOMPERIDONE
PMS-FENOFIBR. MICRO (EDS)
PMS-FLUOXETINE
PMS-FLUPHENAZINE DECAN.
PMS-FLURAZEPAM
PMS-FLUVOXAMINE
PMS-GEMFIBROZIL
PMS-GENTAMICIN
PMS-GENTAMYCIN
PMS-GLYBURIDE
PMS-HALOPERIDOL
PMS-HYDROMORPHONE
"
PMS-HYDROXYZINE
PMS-INDAPAMIDE
PMS-IPRATROPIUM
"
PMS-KETOPROFEN
PMS-KETOPROFEN-EC
PMS-KETOTIFEN (EDS)
PMS-LACTULOSE (EDS)
PMS-LEVOBUNOLOL
PMS-LINDANE
PMS-LOPERAMIDE
PMS-LOPERAMIDE HCL
PMS-LOXAPINE
355
Page
115
115
86
86
38
19
45
67
15
49
50
39
30
60
223
123
64
65
98
5
6
7
123
60
60
157
202
96
96
40
102
103
170
143
170
80
81
81
156
149
158
61
104
111
121
105
61
140
140
182
112
89
90
124
134
32
150
84
84
225
154
150
194
125
154
154
113
PRODUCT NAME
PMS-MEFENAMIC ACID
PMS-METFORMIN
PMS-METHYLPHENIDATE
PMS-METOCLOPRAMIDE
PMS-METOPROLOL-B
PMS-METOPROLOL-L
PMS-METRONIDAZOLE
PMS-NAPROXEN
PMS-NIFEDIPINE
PMS-NIZATIDINE
PMS-NORTRIPTYLINE
PMS-NYSTATIN
PMS-OXTRIPHYLLINE
PMS-OXYBUTYNIN
PMS-PERPHENAZINE CONC.
PMS-PINDOLOL
"
PMS-PIROXICAM
PMS-POLYTRIMETHOPRIM
PMS-POTASSIUM CHLORIDE
PMS-PROCYCLIDINE
PMS-PROPRANOLOL
PMS-SALBUTAMOL
PMS-SALBUTAMOL RESPIR.SOL
PMS-SOD POLY SULF (120ML)
PMS-SODIUM CROMOGLYCATE
PMS-SOTALOL
PMS-SUCRALFATE
PMS-SULFASALAZINE
PMS-TEMAZEPAM
PMS-TERBINAFINE
PMS-THEOPHYLLINE
PMS-THIORIDAZINE
PMS-TIAPROFENIC
PMS-TIMOLOL
PMS-TOBRAMYCIN (EDS)
PMS-TRAZODONE
"
PMS-TRIFLUOPERAZINE
PMS-VALPROIC
PMS-VALPROIC ACID
PMS-VALPROIC ACID E.C.
PMS-VERAPAMIL SR
PODOFILOX
POLYMYXIN B SO4/
BACITRACIN (ZINC)/
NEOMYCIN SO4/
HYDROCORTISONE
"
POLYMYXIN B SO4/NEOMYCIN
SO4/BACITRACIN(ZINC)
"
SO4/DEXAMETHASONE
SO4/GRAMICIDIN
"
SO4/HYDROCORTISONE
POLYMYXIN B SO4/
TRIMETHOPRIM SO4
POLYTRIM
PONSTAN
POTASSIUM CHLORIDE
POVIDONE-IODINE
PRAMIPEXOLE
Page
84
182
124
118
159
53
53
22
85
55
159
107
4
215
214
114
55
56
86
140
132
31
57
35
36
132
132
229
58
161
161
122
4
216
116
87
151
141
108
109
117
100
100
100
76
210
145
207
140
190
145
140
190
146
140
140
84
132
195
PRODUCT NAME
DIHYDROCHLORIDE
PRANDASE
PRAVACHOL
PRAVASTATIN
PRAZIQUANTEL
PRAZOSIN
PRECISION PLUS
PRED FORTE
PRED MILD
PREDNISOLONE
PREDNISOLONE SODIUM
PHOSPHATE
"
PREDNISONE
PREMARIN
PREPULSID
PREVACID (EDS)
PRIMIDONE
PRINIVIL
PRINZIDE
PRO-BANTHINE
PROBENECID
PROBETA
PROCAINAMIDE HCL
PROCAN-SR
PROCHLORPERAZINE
PROCHLORPERAZINE MESYLATE
PROCLIM
PROCYCLID
PROCYCLIDINE HCL
PROFASI HP (EDS)
PROGESTERONE (MICRONIZED)
PROGRAF (EDS)
PROLOPA
PROLOPRIM
PROMETRIUM (EDS)
PRONESTYL
PRONESTYL-SR
PROPADERM
PROPAFENONE HCL
PROPANTHEL
PROPANTHELINE BROMIDE
PROPINE
PROPOXYPHENE
PROPRANOLOL
"
"
PROPRANOLOL/
HYDROCHLOROTHIAZIDE
PROPYLTHIOURACIL
PROPYL-THYRACIL
PROSCAR
PROSTIGMIN
PROTRIPTYLINE
PROTROPIN (EDS)
PROVERA
PROVIODINE
PROZAC
PULMICORT NEBUAMP
PULMOZYME (EDS)
PURINETHOL (EDS)
PVF-K 500
PYLORID (EDS)
PYRANTEL PAMOATE
PYRETHINS/PIPERONYL
BUTOXIDE/
356
Page
228
181
62
62
2
71
128
144
144
144
144
144
171
172
177
158
159
95
69
69
33
135
150
56
56
115
115
185
31
31
179
185
230
226
22
185
56
56
196
56
33
33
149
94
38
57
72
72
187
187
224
30
107
184
185
195
104
169
169
138
27
11
161
2
PRODUCT NAME
PETROLEUM DISTILLATE
PYRIDIUM
PYRIDOSTIGMINE BROMIDE
PYRIDOXINE HCL
PYRIDOXINE HCL
PYRIMETHAMINE
PYRVINIUM PAMOATE
QUESTRAN
QUESTRAN LIGHT
QUETIAPINE
QUIBRON-T/SR
QUINAPRIL HCL
QUINAPRIL HCL/
HYDROCHLOROTHIAZIDE
QUINIDEX EXTENTABS
QUINIDINE BISULFATE
QUINIDINE SO4
QUININE SO4
QUININE-ODAN
QUINTASA
"
R&C SHAMPOO/CONDITIONER
RAMIPRIL
RANITIDINE
RANITIDINE BISMUTH
CITRATE
REBETRON (EDS)
REBIF (EDS)
REGLAN
REGULAR ILETIN II, PORK
RELAFEN (EDS)
RENEDIL
REPAGLINIDE
REQUIP
RESCRIPTOR (EDS)
RESERPINE/HYDRALAZINE
HCL/HYDROCHLOROTHIAZIDE
RESONIUM CALCIUM
RESTORIL
RETIN A
"
RETIN A (EDS)
RETROVIR (EDS)
RHINALAR
RHINOCORT AQUA
RHINOCORT TURBUHALER
RHO-CLONAZEPAM
RHODACINE
RHODIAPROX
RHODIS EC
RHODIS SR
RHO-FLUPHENAZINE
RHO-HALOPERIDOL
RHO-LOPERAMIDE
RHO-METFORMIN
RHO-NITRAZEPAM
RHO-SOTALOL
RHOTRAL
RHOTRIMINE
RHOXAL-ATENOLOL
"
RHOXAL-FAMOTIDINE
RHOXAL-SALBUTAMOL RES.SOL
RHOXAL-VALPROIC
RIDAURA
RIFABUTIN
RIFENIDATE
RISEDRONATE SODIUM
Page
194
207
30
219
219
19
2
60
60
115
216
72
72
58
57
58
20
20
161
162
194
72
160
161
225
225
159
179
84
67
183
229
16
73
132
122
208
209
209
18
143
143
143
96
83
85
84
84
111
113
154
182
96
58
48
109
49
50
158
36
100
164
228
118
228
PRODUCT NAME
RISPERDAL
"
RISPERIDONE
RITALIN
RITALIN SR
RITODRINE HCL
RITONAVIR
RIVOTRIL
RIZATRIPTAN BENZOATE
ROBINUL
ROCALTROL (EDS)
ROFECOXIB
ROFERON-A (EDS)
ROPINIROLE HCL
ROUPHYLLINE
RYTHMODAN
RYTHMODAN-LA
RYTHMOL
S.A.S. 500
SAB-DICLOFENAC
SAB-INDOMETHACIN
SABRIL
SAIZEN (EDS)
SALAZOPYRIN
SALBUTAMOL SO4
SALBUTAMOL SULPHATE
SALMETEROL XINAFOATE
SALMETEROL XINAFOATE/
SALOFALK
"
SANDOMIGRAN
SANDOMIGRAN DS
SANDOSTATIN (EDS)
"
SANS-ACNE
SANSERT (EDS)
SAQUINAVIR
SARNA HC
SCABENE
SCHEIN MINOCYCLINE (EDS)
SCHEINPHARM B12
SCHEINPHARM CLOTRIMAZOLE
SCOPOLAMINE
SECOBARBITAL SODIUM
SECONAL
SECTRAL
SELECT 1/35
SELEGILINE HCL
SEPTRA
"
SEPTRA D.S.
SER-AP-ES
SERAX
SERC
SERENTIL
SEREVENT (EDS)
SEREVENT DISKUS (EDS)
SEROQUEL (EDS)
SERTRALINE HYDROCHLORIDE
SERZONE
SIBELIUM (EDS)
357
Page
115
116
115
118
118
34
19
96
38
32
219
86
26
229
215
52
52
56
161
81
83
100
184
161
34
35
36
36
161
162
162
38
38
227
228
228
190
37
19
205
193
13
218
5
191
202
148
160
156
119
119
48
175
229
22
23
23
73
122
76
113
36
36
115
108
106
37
PRODUCT NAME
SIMVASTATIN
SINEMET
SINEMET CR
SINEQUAN
"
SINGULAIR (EDS)
SINTROM
SLO-BID
SLOW TRASICOR
SLOW-K
SODIUM AUROTHIOMALATE
SODIUM CROMOGLYCATE
"
SODIUM FLUORIDE
SODIUM FUSIDATE
SODIUM NITROPRUSSIDE
REAGENT
SODIUM POLYSTYRENE
SULFONATE
SODIUM SULAMYD
SOFRACORT
SOFRA-TULLE
SOLGANAL
SOLU-CORTEF
SOMATREM
SOMATROPIN
SORIATANE (EDS)
SOTACOR
SOTALOL HCL
SOTAMOL
SPIRONOLACTONE
SPIRONOLACTONE/
HYDROCHLOROTHIAZIDE
SPORANOX (EDS)
STATEX
"
"
STATICIN
STAVUDINE
STELAZINE
STEMETIL
STIEVA-A
"
STIEVA-A FORTE (EDS)
STILBESTROL
STILBOESTROL
STILBOESTROL SODIUM
DIPHOSPHATE
SUCRALFATE
SULCRATE
SULCRATE SUSPENSION PLUS
SULFACETAMIDE (SODIUM)
SULFACETAMIDE (SODIUM)/
COLLOIDAL SULPHUR
SULFACETAMIDE SODIUM/
SULFACET-R
SULFADOXINE/PYRIMETHAMINE
SULFAMETHOXAZOLE/
TRIMETHOPRIM
SULFANILAMIDE/AMINACRINE
HCL/ALLANTOIN
SULFASALAZINE
(SALICYLAZOSULFAPYRIDINE)
SULFINPYRAZONE
"
SULFISOXAZOLE
SULINDAC
Page
62
226
227
103
104
227
42
215
71
132
164
151
229
230
191
129
132
141
145
190
164
171
184
184
210
58
58
58
135
73
4
91
92
93
190
17
117
115
208
209
209
178
178
178
161
161
161
141
195
146
195
20
22
195
161
44
135
21
87
PRODUCT NAME
SUMATRIPTAN
SUPRAX (EDS)
SUPREFACT (EDS)
SURESTEP
SURGAM
SURMONTIL
SUSTIVA (EDS)
SYMMETREL
SYNACTHEN DEPOT
SYNALAR
SYNALAR REGULAR
SYNAREL (EDS)
SYN-BROMAZEPAM
"
SYN-CAPTOPRIL
"
SYN-CHOLESTYRAMINE LIGHT
SYN-CLONAZEPAM
SYN-DILTIAZEM
SYNPHASIC
SYNTHROID
SYN-TICLOPIDINE (EDS)
SYN-TRAZODONE
"
TACROLIMUS
TAGAMET
TALWIN
TAMBOCOR
TAMSULOSIN HCL
TAPAZOLE
TARO-DESOXIMETASONE
TARO-SONE
TAZAROTENE
TAZORAC
TEGRETOL
TEGRETOL CR (EDS)
TELMISARTAN
TEMAZEPAM
TENOLIN
"
TENORETIC
TENORMIN
"
TERAZOL-3
TERAZOL-3 DUAL-PAK
TERAZOL-7
TERAZOSIN HCL
TERBINAFINE HCL
"
TERBUTALINE SO4
TERCONAZOLE
TES-TAPE
TESTONE-CYP
TESTOSTERONE ENANTHATE
TESTOSTERONE UNDECANOATE
TETRABENAZINE
TETRACYCLINE
THEOCHRON
"
THEO-DUR
"
THEOLAIR LIQUID
THEOLAIR-SR
"
THEOPHYLLINE
358
Page
38
5
223
128
87
109
16
15
184
203
203
227
119
120
64
65
60
96
51
175
186
46
108
109
230
157
94
52
230
187
98
203
196
211
211
98
98
73
122
49
50
63
49
50
193
193
193
73
4
193
36
193
129
173
173
173
173
173
230
13
215
216
215
216
216
215
216
216
PRODUCT NAME
THEOPHYLLINE (ANHYDROUS)
THEO-SR
THIAMINE HCL
THIORIDAZINE
THIOTHIXENE
THYROID
THYROID
TIAPROFENIC ACID
TIAZAC
"
TICLID (EDS)
TICLOPIDINE HCL
TILADE
TIMOLIDE
TIMOLOL MALEATE
"
"
TIMOLOL MALEATE
TIMOLOL MALEATE/
PILOCARPINE
HYDROCHLORIDE
TIMOLOL/
HYDROCHLOROTHIAZIDE
TIMOPTIC
TIMOPTIC-XE
TIMPILO
TINZAPARIN SODIUM
TOBI (EDS)
TOBRADEX (EDS)
TOBRAMYCIN
"
TOBRAMYCIN (EDS)
TOBRAMYCIN/DEXAMETHASONE
TOBREX (EDS)
TOCAINIDE HCL
TOFRANIL
TOLBUTAMIDE
TOLECTIN
TOLMETIN
TOLTERODINE L-TARTRATE
TOMYCINE (EDS)
TONOCARD (EDS)
TOPAMAX
TOPICORT
TOPICORT MILD
TOPILENE GLYCOL
TOPIRAMATE
TOPISONE
TOPSYN
TRANDATE
TRANDOLAPRIL
TRANSDERM-NITRO 0.2
TRANSDERM-NITRO 0.4
TRANSDERM-NITRO 0.6
TRANSDERM-V
TRANXENE
TRANYLCYPROMINE SO4
TRASICOR
TRAZODONE
TRAZOREL
"
TRENTAL
TRETINOIN
TRIADAPIN
"
TRIADERM
TRIAMCINE-A
TRIAMCINOLONE
Page
215
216
219
116
116
187
187
87
51
52
46
46
227
74
59
74
151
151
151
74
151
151
151
43
3
146
3
141
141
146
141
59
105
183
87
87
214
141
59
99
203
203
196
99
196
204
68
74
77
77
77
156
120
108
71
108
108
109
45
208
103
104
206
172
172
PRODUCT NAME
"
"
TRIAMCINOLONE
HEXACETONIDE
TRIAMTERENE
TRIAMTERENE/
HYDROCHLOROTHIAZIDE
TRIAZOLAM
TRI-CYCLEN
TRIDESILON
TRIFLUOPERAZINE
TRIFLURIDINE
TRIHEXYPHENIDYL HCL
TRIKACIDE
TRILAFON
TRIMEPRAZINE TARTRATE
TRIMETHOPRIM
TRIMIPRAMINE
TRINIPATCH 0.2
TRINIPATCH 0.4
TRINIPATCH 0.6
TRIPHASIL
TRIPTIL
TRIQUILAR
TRUSOPT
T-STAT
TYLENOL WITH CODEINE ELX
ULCIDINE
ULTRADOL (EDS)
ULTRAMOP (EDS)
ULTRASE MS4
ULTRASE MT12
ULTRASE MT20
ULTRAVATE (EDS)
UNIPHYL
URECHOLINE
UREMOL-HC
URINE-SUGAR ANALYSIS
PAPER
URISPAS (EDS)
URSO (EDS)
URSODIOL
VALACYCLOVIR
VALISONE
VALIUM
VALPROATE SODIUM
VALPROIC ACID
VALSARTAN
VALTREX
VANCENASE
VANCERIL INHALER
VANCOCIN (EDS)
VANCOMYCIN HCL
VANQUIN
VASERETIC
VASOCIDIN
VASOTEC
VENLAFAXINE HCL
VENTODISK
VENTOLIN
VENTOLIN RESPIRATOR SOLN.
VENTOLIN ROTACAPS
359
Page
144
172
206
172
173
135
74
123
176
202
117
141
31
22
114
230
22
109
77
77
77
174
107
174
147
190
88
88
88
88
158
82
212
155
155
155
204
216
30
205
129
214
230
230
15
201
121
100
100
74
15
142
169
14
14
2
67
146
67
110
35
35
35
36
34
PRODUCT NAME
VENTOLIN ROTACAPS
VERAPAMIL HCL
"
VERELAN
VERMOX
VIADERM-KC
VIBRAMYCIN
VIBRA-TABS
VIDEX (EDS)
VIGABATRIN
VIOKASE
VIOXX (EDS)
VIRACEPT (EDS)
VIRAMUNE (EDS)
VIROPTIC
VISKAZIDE
VISKEN
"
VITAMIN A
VITAMIN A
VITAMIN A ACID
"
VITAMIN A ACID (EDS)
VITAMIN B1
VITAMIN B12
VITAMIN B6
VITAMIN D
VITINOIN
"
VITINOIN (EDS)
VIVELLE (EDS)
"
VIVOL
VOLTAREN
"
VOLTAREN OPTHA (EDS)
VOLTAREN-SR
WARFARIN
WARFILONE
WARTEC
WELLBUTRIN SR (EDS)
WELLFERON (EDS)
WESTCORT
WINPRED
XALATAN
XANAX
YUTOPAR
ZADITEN (EDS)
ZAFIRLUKAST
ZALCITABINE
ZANTAC
ZARONTIN
ZAROXOLYN
ZERIT (EDS)
ZESTORETIC
ZESTRIL
ZIAGEN (EDS)
ZIDOVUDINE
ZITHROMAX (EDS)
ZOCOR
ZOLADEX (EDS)
ZOLMITRIPTAN
ZOLOFT
ZOMIG (EDS)
ZOVIRAX
ZOVIRAX WELLSTAT PAC
ZOVIRAX ZOSTAB PAC
ZUCLOPENTHIXOL ACETATE
Page
35
59
75
75
2
207
12
12
17
100
156
86
18
16
141
71
55
56
218
218
208
209
209
219
218
219
220
208
209
209
177
178
121
80
81
149
81
44
44
210
101
27
205
172
150
119
34
225
230
18
160
97
134
17
69
69
16
18
7
62
224
39
108
39
14
14
14
117
PRODUCT NAME
ZUCLOPENTHIXOL DECANOATE
ZUCLOPENTHIXOL
DIHYDROCHLORIDE
ZYLOPRIM
ZYPREXA (EDS)
360
Page
117
117
222
114
FORMULARY UPDATES
Formulary Updates
1
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Formulary Updates
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Formulary Updates
Formulary Updates
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Formulary Updates
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Formulary 50th Edition - Drug Plan

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