Chronic application forms must accompany all first-time … · 2018. 4. 12. · Coveram 5/10mg...

Lancets

Glucose Monitoring

Strips

Needles

Major drug class Generic nameTrade names and

(nappi codes)

Addison's disease

E27.1 Corticosteroids Hydrocortisone 10mg Covocort 10mg 716693

Corticosteroids Fludrocortisone, 0.1mg Florinef 0.1mg 726540

Potassium supplements Potassium chloride 600mg Plenish K 600mg 755753For long term corticosteriod

use

Platelet aggregation

inhibitorsAspirin 100mg Myoprin 845590

Bayer Aspirin Cardio

100mg862304

Loop diuretics Furosemide 20mgAustell Furosemide

20mg 707421

Loop diuretics Furosemide 40mgMylan Furosemide

40mg857769 Sandoz Furosemide 731668

Asthma

J45 Apparatus AerochamberGlaxohaler Spacer

Device666720

Apparatus Aerochamber Huf Puf Kit 125137

Apparatus Aerochamber Zerostat Spacer 454299

Corticosteroids Prednisone 5mg Be-tabs prednisone 788783

Only for severe persistent

asthma (motivation required

from specialist)

Corticosteroids Prednisolone 5mg Aspelone 714552

Only for severe persistent

asthma (motivation required

from specialist)

Sympathomimetics Fenoterol 100mcgBerotec 100 HFA 200

dose706544

Sympathomimetics Salbutamol sulphate 100mcgAsthavent 300dose

ecohaler700715

Limited to 3 inhalers per year if

no inhaled steroid

Sympathomimetics Salbutamol sulphate 2mg Venteze 2mg 775398

Sympathomimetics Salbutamol sulphate 4mg Venteze 4mg 775401

Sympathomimetics Salbutamol sulphate 2mg/5ml Venteze 2mg/5ml 775452

Sympathomimetics Salmeterol xinafoate 25mcgSerevent cfc free

inhaler708289

Only for moderate & severe

persistent asthma

Sympathomimetics Salmeterol xinafoate 25mcg Serevent 120 dose 787302Only for moderate & severe

persistent asthma

Sympathomimetics Salmeterol xinafoate 50mcgSerevent accuhaler 60

dose818496


persistent asthma

Sympathomimetics Salmeterol xinafoate 25mcg Serevent 60 dose 791695Only for moderate & severe

persistent asthma

Sympathomimetics Salmeterol fluticazoneFoxair 25/50mcg 120

dose inh715752

Sereflo 25/50mcg

Synchrobreather 120

dose inh

721412Only for moderate & severe

persistent asthma


dose inh715753

Sereflo 25/125mcg

Synchrobreather 120

dose inh


persistent asthma


dose inh715754

Sereflo 25/250mcg

Synchobreather 120

dose inh


persistent asthma

SympathomimeticsSalmeterol 50ug/Fluticasone

100ug

Foxair 50/100mcg 60

blisters715009


persistent asthma


250ug

Foxair 50/250mcg 60

blisters715008


persistent asthma


500ug

Foxair 50/250mcg 60

blisters715007


persistent asthma

SympathomimeticsBudesonide 160 / formoterol

4.5mcgSymbicord 60 dose 700172


persistent asthma


4.5mcgSymbicord 120 dose 700173 Vannair 160/4.5mcg 720219


persistent asthma


9mcgSymbicord 60 dose 705984


persistent asthma


4.5mcgSymbicord 120 dose 705986 Vannair 80/4.5mcg 720218


persistent asthma

Insulin syringes will only be considered on motivation. Pensets or penfills are recommended.

Inteferons for Multiple Sclerosis will only be considered upon receipt of a clinically relevant motivation including history of therapy and expanded disability

status scale report (EDSS)

Treatment for hyperlipidaemia is subject to criteria for lipid-lowering therapy being met. Assessment required completed Risk Evaluation report as well as

diagnostic and latest lipograms including LDL cholesterol levels.

The formulary is subject to regular review. SCRIPTPHARM RISK MANAGEMENT reserves the right to update and change the formulary when new information becomes available or when

new medicines are released.

Max 30 per month allowed



For diabetic patients, the following limits apply. Please provide a motivation if a higher quantity is required.

NEDGROUP HOSPITAL AND SAVINGS PLAN

A clinically relevant motivation is required when prescribing any product which does not appear on this list.

Chronic application forms must accompany all first-time applications. All applications MUST include valid ICD10 codes.

Risk Equalisation Fund criteria must be met.

Oxygen will only be considered for bronchiectasis and COPD in severe, advanced disease.

PLEASE TAKE NOTE OF THE FOLLOWING:

1

Glucocorticoids Beclomethasone 100ug Beclate 100ug 819638Only for moderate & severe

persistent asthma


persistent asthma


persistent asthma

Glucocorticoids Budesonide 100ugBudeflam 100ug 300

dose897462


persistent asthma

Glucocorticoids Budesonide 200ugBudeflam 200 mg 300

dose897469


persistent asthma

Glucocorticoids Budesonide 200ug Budeflam DP Inh cap 704176Only for moderate & severe

persistent asthma

Glucocorticoids Budesonide 200ugPulmicort Turbohaler

200mcg 200D791423


100mcg 200D791431


400mcg 200D823791

Glucocorticoids Fluticasone 50mcgFlixotide 50 CFC free

inhaler703275


persistent asthma

Glucocorticoids Fluticasone 50mcgFlixotide accuhaler 60

dose818445


dose818453


persistent asthma


inhaler897752


persistent asthma


inhaler897759


persistent asthma


dose818461


persistent asthma


dose818488


persistent asthma

LABA Formoterol 12mcg Foratec hfa 120dose 840246Only for moderate & severe

persistent asthma

Methylxanthine Theophylline 200mgSandoz theophylline

200mg788368 Theoplus 200mg 783005

Methylxanthine Theophylline 300mgSandoz Theophylline

300mg788376 Theoplus 300mg 783013

Inhaled anticholinergics Ipratropium bromideIpvent 40mcg INH

300dose704681

Bipolar depression

F31 Anti-epileptic Valproic acid 150mg Convulex 150mg 715980

Anti-epileptic Valproic acid 300mg Convulex 300mg 715999


Anti-epileptic Valproic acid 250mg/ 5mL Convulex suspension 781541

Anti-epileptic Carbamazepine 200mg Degranol 200mg 712493Therapy must be initiated by a

Psychiatrist

Anti-epileptic Sodium valproateEpilim 200mg/5ml

liquid780545

Therapy must be initiated by a

Psychiatrist

Anti-epileptic Sodium valproate Eprolep cr 200mg 721460 Navalpro cr 200mg 718465



Anti-epileptic Sodium valproateEpilim crushable

100mg821578

Anti-epileptic Lamotrigine 25mg Epitec 25mg TABS 704379Therapy must be initiated by a

Psychiatrist

Anti-epileptic Lamotrigine 50mg Lamidus 50mg 710885 Epitec 50mg TABS 704380Therapy must be initiated by a

Psychiatrist


Psychiatrist


Psychiatrist

Atypical antipsychotic Quetiapine 25mg Dopaquel 25mg 716050 Quetoser 25mg 716635




Benzamides Sulpiride 50mg Espiride 819654Therapy must be initiated by a

Psychiatrist

Butyrephenones Haloperidol 1.5mgSandoz haloperidol

1.5mg 730335


Psychiatrist

Butyrephenones Haloperidol 5mgSandoz haloperidol

5mg 730327


Psychiatrist

Butyrephenones Haloperidol 0.5mg Serenace 0.5mg 763411Therapy must be initiated by a

Psychiatrist

Lithium Lithium carbonate 250mg Camcolit 250mg 712078Therapy must be initiated by a

Psychiatrist

Lithium Lithium carbonate 400mg Camcolit 400mg 712086Therapy must be initiated by a

Psychiatrist

Lithium Lithium carbonate 450mgQuilonum Ret 450mcg

tab758833


Psychiatrist

MAOI Moclobemide 150mg Depnil 897213Therapy must be initiated by a

Psychiatrist


Psychiatrist

Phenothiazines Chlorpromazine 25mg Largactil 25mg 735868Therapy must be initiated by a

Psychiatrist


Psychiatrist


Psychiatrist

SSRI Fluoxetine 20mg Ranflocs 20mg 700686 Deprozan 20mg 894303 1st line agent

SSRI Citalopram 20mg Talomil 20mg 702769 Cilate 20mg 707888 1st line agent

SSRI Paroxetine 20mg Serrapress 20mg 705122 Xet 20mg 705633 1st line agent

SSRI Sertraline 50mg Dyna-Sertraline 50mg 719972 Serlife 50mg 703132

SSRI Sertraline 100mgDyna-Sertraline

100mg 719973 Serlife 100mg 703999

SNRI Venlafaxine 37.5mg Odiven 37.5mg 710972

2

SNRI Venlafaxine Hcl 37.5mgIllovex SR 37.5MG

TABS713648 Venlor XR 37.5 706399

SNRI Venlafaxine 75mg Illovex SR 75MG TABS 713649 Venlor XR 75mg 706402

SNRI Venlafaxine 150mgIllovex SR 150MG

TABS713650 Venlor XR 150mg 706404

Tricyclic antidepressants Dothiepin 25mg Thaden 25mg 800198Therapy must be initiated by a

Psychiatrist


Psychiatrist

Tricyclic antidepressants Amitriptyline 10mg Trepiline 10mg 772003Therapy must be initiated by a

Psychiatrist

Tricyclic antidepressants Amitriptyline 25mg Trepiline 25mg 771996 Gulf Amitripryline 718746Therapy must be initiated by a

Psychiatrist

Anti-cholinergic Orphenadrine 50mg Disipal 50mg 720542

In combination with

antipsychotic for drug-induced

dyskinesias

Beta-receptor blockers Propranolol HCl 10mg Indoblok 10mg 806552

In combination with


dyskinesias


In combination with


dyskinesias

Bronchiectasis

J47 Antibiotics Doxycycline 50mg Dumoxin 50 798401

Antibiotics Amoxycillin 500mg Moxypen 744697

AntibioticsTrimethoprim-

sulfamethoxazole 80/400Durobac 480mg 721751

Antibiotics Doxycycline HCl 100mg Doximal 100mg 883992


Inhaled anti cholinergics Ipratropium bromide 40ug Ipvent-40 300dose 704681

CombinationsIpratropium brom. 20ug;

salbutamol sulph. To Combivent inhaler 824623

Sympathomimetics Formoterol fumerate Foratec HFA 120dose 710307

Sympathomimetics Fenoterol 100mcgBerotec 100 HFA 200

dose706544


dose818496

Sympathomimetics Salmeterol xinafoate 50mcgSerevent Inhaler 60

dose791695

Serevent inhaler 120

dose787302

Inhaled Beta 2-agonists, Salbutamol 100ug inhaler Asthavent 200dose 819603Venteze CFC free

200dose711213


200mg788368 Theoplus 200mg 783005


300mg788376 Theoplus 300mg 783013

Cardiac failure

I50 ACE inhibitors Lisinopril 5mg Sinopren 5mg 700691 Zemax 5mg 703646

ACE inhibitors Lisinopril 10mg Sinopren 10mg 700692Austell Lisinopril

10mg712598


20mg708189

ACE Inhibitors Ramipril 2.5mg Rampil 2.5mg 705427

ACE Inhibitors Ramipril 5mg Rampil 5mg 705428

ACE Inhibitors Ramipril 10mg Rampil10mg 705429

ACE Inhibitors Enalapril 10mg Alapren 10mg 881481



ACE inhibitor combinations Enalapril / hydrochlorthiazide Enap co 20mg/12.5mg 891287

ACE Inhibitors combinationPerindopril 2,5mg/Indapamide

0.625mgPrexum 2.5 Plus 721507

ACE inhibitorsPerindopril tertbutylamine salt

4mgPrexum 4mg 703541 Vectoryl 4mg 710297

ACE Inhibitors Perindopril 5mg Prexum 5mg 720387


8mgPearinda 8mg 714528 Vectoryl 8mg 710925

ACE inhibitor combinationsPerindopril tertbutylamine salt

4mg; Indapamide 1.25mgPrexum Plus 704929 Vectoryl Plus 710298

ACE inhibitor combinationsPerindopril 4mg/Indapamide

1.25mg

Prexum Plus 5/1.25

mg720388


2.5mgBioprexum 10/2.5mg 721508

ACE inhibitor combinationsPerindopril 10mg/Amlodipine

10mg Coveram 10/10mg 719853







Aldosterone antagonist Spirinolactone 25 Spiractin 25mg 765910

Alpha + beta blocker Carvedilol 12.5mg Carloc 12.5mg 700168 Carvetrend 12.5mg 704671


Alpha + beta blocker Carvedilol 25mg Carloc 25mg 897117 Carvetrend 25mg 704672

Cardiac glycosides Digoxin Lanoxin 0.0625mg 735760


Anticoagulant Warfarin 5mg cipla-warfarin 712390

Beta-blockers Atenolol 50mg Tenopress 50mg 705874 Bio-atenolol 50mg 826898


Beta-blockers/diureticAtenolol

100mg/chlorthalidone 25mgTenchlor 786217

3

Beta-blockers/diureticAtenolol 50mg/chlorthalidone

12.5mgTenchlor-HS 807591

Beta-blockers Bisoprolol 5mg Bilocor 5mg 704372


Beta-blockers/diuretic

Bisoprolol

2.5mg/Hydrochlorothiazide

6.25mg

Bisozyd Co

2.5mg/6.25mg718082


Bisoprolol

5mg/Hydrochlorothiazide

6.25mg

Bisozyd Co

5mg/6.25mg718086

Direct acting vasodilators Hydralazine 10mg Hyperphen 10mg 731714





20mg707421

Nitrates Isosorbide dinitrate 10mg Isordil 10mg 734381



Nitrates Isosorbide mononitrate 20mg Ismo 20mg 734055


inhibitorsAspirin 81mg Ecotrin 81mg 823481




100mg862304

Potassium supplements Potassium chloride 600mg Plenish K 600mg 755753

If >120 required, documented

evidence of hypokalaemia must

be provided

Thiazide diuretic Hydrochlorthiazide Hexazide 890470

Calcium channel blockers Amlodipine 10mg Gulf Amlodipine 10mg 712954 Lomanor 10mg 708353

Calcium channel blockers Amlodipine 5mg Amtas 5mg 713971 Lomanor 5mg 708352

Calcium channel blockers Verapamil 240 SR Verahexal 240 sr 700071

Calcium channel blockers Verapamil 40mg Vasomil 40mg 774944


Calcium channel blockers Nifedipine SR 20mg Cipalat Retard 20mg 864153

Calcium channel blockers Nifedipine SR 30mg Cipalat XR 30mg 723283


Angiotensin receptor

blockers (ARBs)Losartan 50mg Ciplazar 50mg 716643

Motivation over ACE-inhibitor,

including history of therapy,

required





required

ARB combinationsLosartan 100mg/

hydrochlorothizide 25mgLosaar Plus 100/25mg 715857



required


hydrochlorothizide 25mg

Losaar Plus

50/12.5mg715856



required

Low ceiling diuretics IndapamideDyna-Indapamide SR

1.5mg716962

Low ceiling diuretics IndapamideMylan-Indapamide

2.5mg703329

Cipla- Indapamide

2.5mg710313

Cardiomyopathy

I42 ACE Inhibitors Enalapril 10mg Alapren 10mg 881481



ACE inhibitor combinations Enalapril / hydrochlorthiazide Enap co 20mg/12.5mg 891287

ACE inhibitors Lisinopril 5mg Sinopren 5mg 700691 Zemax 5mg 703646


10mg712598


20mg708189

ACE inhbitor combinations

Lisinopril


12.5mg

Adco Zetomax-Co

10/12.5mg704597

Hexal-lisinopril co

10/12.5mg704703

ACE inhbitor combinations

Lisinopril


12.5mg

Adco Zetomax-Co

20/12.5mg704598

Hexal-lisinopril co

20/12.5mg704704

ACE inhibitors Ramipril 2.5mg Rampil 2.5mg 705427

ACE inhibitors Ramipril 5mg Rampil 5mg 705428

ACE inhibitors Ramipril 10mg Rampil10mg 705429




4mgPrexum 4mg 703541 Vectoryl 4mg 710297



8mgPearinda 8mg 714528 Vectoryl 8mg 710925

ACE inhibitor combinationsPerindopril tertbutylamine salt

4mg; indapamide 1.25mgPrexum Plus 704929 Vectoryl Plus 710298


1.25mg

Prexum Plus 5/1.25

mg720388


2.5mg

Bioprexum Plus

10/2.5mg721508

4













required





required





required



Losaar Plus

50/12.5mg715856



required

Aldosterone antagonist Spirinolactone 25 Spiractin 25mg 765910
















Bisoprolol


6.25mg

Bisozyd Co

2.5mg/6.25mg718082


Bisoprolol


6.25mg

Bisozyd Co

5mg/6.25mg718086






20mg 707421







Motivation required over

normal aspirin




100mg862304




be provided

Thiazide diuretic Hydrochlorthiazide Hexazide 890470


1.5mg716962


2.5mg703329

Cipla- Indapamide

2.5mg710313

Chronic renal disease

N03 ACE Inhibitors Enalapril 10mg Alapren 10mg 881481



N18 ACE inhbitor combinations Enalapril / hydrochlorthiazide Enap co 891287

N19 ACE inhibitors Ramipril 2.5mg Rampil 2.5mg 705427



ACE Inhibitors Lisinopril 5mg Sinopren 5mg 700691 Zemax 5mg 703646

ACE Inhibitors Lisinopril 10mg Sinopren 10mg 700692Austell Lisinopril

10mg712598

ACE Inhibitors Lisinopril 20mg Sinopren 20mg 700694Austell Lisinopril

20mg708189

ACE inhibitors

Lisinopril


12.5mg

Adco Zetomax-Co

10/12.5mg704597

Hexal-lisinopril co

10/12.5mg704703

ACE inhibitors

Lisinopril


12.5mg

Adco Zetomax-Co

20/12.5mg704598

Hexal-lisinopril co

20/12.5mg704704



ACE Inhibitors Perindopril 4mg Prexum 4mg 703541 Vectoryl 4mg 710297


5

ACE Inhibitors Perindopril 8mg Pearinda 8mg 714528 Vectoryl 8mg 710925

ACE Inhibitors

combinations

Perindopril 4mg/Indapamide

1.25mgPrexum Plus 704929 Vectoryl Plus 710298

ACE Inhibitors

combinations


1.25mg

Prexum Plus 5/1.25

mg720388

ACE Inhibitors

combinations


1.25mg

Bioprexum Plus

10/2.5mg721508









Aldosterone antagonist Spironolactone 25mg Spiractin 25mg 765910









Calciferol Calciferol 5 000u/mlCalciferol Oily solution

5000u/mL 1000-3000 711853

Calciferol Calciferol 50 000IULennon Strong

Calciferol711640



Calcium channel blockers Diltiazem 60mg Zildem 60mg 822213

Calcium channel blockers -

long acting Verapamil 240 SR Verahexal 240 sr 700071


long acting Nifedipine SR 20mg Cipalat Retard 20mg 864153


long acting Nifedipine SR 30mg Cipalat XR 30mg 723283



Calcium supplements Calcium carbonate 500mg Eno Tums 703359

Diuretic-thiazide Hydrochlorothiazide 25mg Hexazide 890470

Haematinics Erythropoietin Repotin 2000iu 839264

Motivation and Haemoglobin

levels required- forward to

Onecare /Medscheme

Haematinics Erythropoietin Repotin 4000iu 839272



Onecare /Medscheme

Other Calcium acetate anhydrous Phosphosorb 660mg 718735

Iron supplementsIron(III)-hydroxide sucrose

complex Venofer 873276



Onecare /Medscheme




20mg 707421




be provided

Vitamins Folic acid 5mg Be-tabs folic 5mg 810967

COPD

J43 Corticosteroids Prednisone 5mgBe-tabs Prednisone

5mg788783

J44 Inhaled anti cholinergics Ipratropium bromide 40ug Ipvent-40 300dose 704681

Sympathomimetics Salbutamol 200ug Asthavent dp 878219 Cybutol 200ug 894397

Sympathomimetics Salbutamol 400ug Cybutol 400ug 894400

Sympathomimetics Salbutamol 100ug inhaler Asthavent 200dose 819603 Venteze 100ug inhaler 775363

Sympathomimetics Salmeterol xinafoate 25mcgSerevent cfc free

inhaler708289

Sympathomimetics Salmeterol xinafoate 25mcg Serevent 120 dose 787302


dose818496

Sympathomimetics Salmeterol xinafoate 25mcg Serevent 60 dose 791695


dose inh715752

Sereflo 25/50mcg

Synchrobreather 120

dose inh

721412


dose inh715753

Sereflo 25/125mcg

Synchrobreather 120

dose inh

721413


dose inh715754

Sereflo 25/250mcg

Synchobreather 120

dose inh

721414


100ug

Foxair 50/100mcg 60

blisters715009


250ug

Foxair 50/250mcg 60

blisters715008


500ug

Foxair 50/250mcg 60

blisters715007

CombinationsIpratropium bromide 40mcg/

Fenoterol 100mcgDuovent HFA 707882

6

Sympathomimetics Formoterol fumarateForatec HFA 12mcg

120 dose710307

Anticholinergics Tiotropium 18mcg Forvent handihaler 714167

Motivation, including history of

therapy, required. FEV1<50

post bronchodilator

Anticholinergics Tiotropium 18mcgForvent 18mcg INH

caps refill714152


therapy, required. FEV1<50

post bronchodilator

GlucocorticoidsBeclomethasone dipropionate

100mcg

Beclate 100mcg

inhaler819638

For Stage ll & lll COPD only.

Script from Pulmonologist or

Specialist Physician

GlucocorticoidsBeclomethasone dipropionate

200mcg

Beclate 200mcg

inhaler820083




Glucocorticoids Budesonide 100ugBudeflam HFA

100mcg 300dose897462




Glucocorticoids Budesonide 200ugBudeflam HFA

200mcg 300dose897469




Glucocorticoids Budesonide 200ugBudeflam DP 200mcg

inh caps704176





200mcg 200D791423


100mcg 200D791431


400mcg 200D823791


200mg788368 Theoplus 200mg 783005


300mg788376 Theoplus 300mg 783013

CombinationsIpratropium/salbutamol

0.5mg/2.5mg per 2.5mlDuolin Respules 703983


therapy, required. From

Pulmonogist or Specialist

Physician

Potassium supplements Potassium chloride 600mg Plenish K 600mg 755753For long term oral

corticosteroid treatment

Coronary Artery

Disease

I20 Anticoagulant Warfarin 5mg cipla-warfarin 712390

I25 Beta blocker Propranolol 10mg Indoblok 10mg 806552

Beta blocker Propranolol 40mg Indoblok 40mg 806560



Beta-blockers Bisoprolol 5mg Bilocor 5mg 704372 Bisbeta 5mg 720659



Bisoprolol


6.25mg

Bisozyd Co

2.5mg/6.25mg718082


Bisoprolol


6.25mg

Bisozyd Co

5mg/6.25mg718086








Calcium channel blockers Amlodipine 10mg Gulf Amlodipine 10mg 712954 Ciplavasc 10mg 708152

Calcium channel blockers Amlodipine 5mg Amtas 5mg 713971 Lomanor 5mg 708352




Calcium channel blockers Nifedipine SR 20mg Cipalat Retard 20mg 864153





Calcium channel blockers Diltiazem SR 180mg Zildem SR 180mg 839183

Calcium channel blockers Diltiazem SR 240mg Zildem SR 240mg 839191

Calcium channel blockers Felodipine 10mgFelodipine-hexal

10mg703902

Calcium channel blockers Felodipine 5mg Felodipine-hexal 5mg 703221

Nitrates Glyceryl trintarate 0.5mg Angised 703605

7





Nitrates Isosorbide dinitrate 40mg Isordil Tembid 40mg 734438




100mg862304




inhibitorsClopidogrel 75mg Plagrol 711423

Detailed clinical motivation

required with stent types and

dates and history of therapy

Fibrates Bezafibrate 400mgDyna-Bezafibrate

400mg710122

From Cardiologist/Specialist

Physician .Need to be loaded

under Hyperlipidaemia

HMG-CoA reductase

inhibitors (statins)Simvastatin 10mg

Adco simvastatin

10mg701276

Austell simvastatin

10mg705464




HMG-CoA reductase


Adco simvastatin

20mg701279

Austell simvastatin

20mg705465




HMG-CoA reductase


Adco simvastatin

40mg701281

Austell simvastatin

40mg705467




Crohn's disease

K505 Aminosalycilic acid

derivativeSulphasalazine 500mg Salazopyrin 500mg 762008

Motivation required -

Treatment to be initiated by

Specialist

5 Aminosalycilic acid

derivativeSulphasalazine 500mg Salazopyrin EN 500 762016



Specialist

Antibiotics Metronidazole 200mgAdco-metronidazole

200mg742872


Specialist


400mg701076


Specialist

Antibiotics Ciprofloxacin 250mg Ciprol 250mg 704777Treatment to be initiated by

Specialist


Specialist

Antibiotics Ciprofloxacin 750mg Cifloc 750mg 893963Treatment to be initiated by

Specialist

Corticosteroids Prednisolone 5mg Lenisolone 5mg 800155



Specialist




Specialist

Cytostatic Methotrexate 2.5 Methotrexate 2.5mg 742465Treatment to be initiated by

Specialist

Immunosuppressive Azathioprine 50mg Azamun 50mg 701252Treatment to be initiated by

Specialist

others Budesonide 2.3mgEntocord 2,3mg

Enema824593



Specialist

others Budesonide 3mg Entocord 3mg cap 838896



Specialist

othersMesalazine [5-aminosalicylic

acid.] rectalAsacol 500mg supp 824135



Specialist


acid.] rectal

Asacol enema

2gm/50ml824127



Specialist


acid.] tabAsacol 400mg tab 783668



Specialist

others Mesalazine 500mg Pentasa 500mg tab 890775Treatment to be initiated by

Specialist

others Olsalazine sod 250mg Dipentum 250mg cap 792519Treatment to be initiated by

Specialist

Prenatal vitamins Folic Acid Be-Tabs Folic acid 810967Treatment to be initiated by

Specialist


corticosteroid treatment

Diabetes insipidus

E23.2 Anti-diuretics Desmopressin DDAVP intranasal sol

0.1mg/ml 717746


Specialist

Anti-diuretics Desmopressin DDAVP nasal spray

0.1mg/ml 837555


Specialist

Anti-Diuretics Desmopressin tab DDAVP 0.1mg 837563Treatment to be initiated by

Specialist

Anti-Diuretics Desmopressin tab DDAVP 0.2mg 703639Treatment to be initiated by

Specialist

Diabetes Mellitus 1

E10 Anti-hypoglycaemic agent Injection GlucaGen - Hypokit 821365

Diabetic consumables LancetsAccu-check pro

lancets616091

Diabetic consumables LancetsAccu-check softclix

lancets616102

Diabetic consumables Lancets Microlet lancets 508771

8

Diabetic consumables Needles Novofine needles 458317

Diabetic consumables Needles BD microfine needles 463822

Diabetic consumables StripsAccu-check advantage

strip891500

Diabetic consumables StripsAccutrend glucose

strips 831743

Diabetic consumables StripsAscensia elite ts

(glucometer)811394

Diabetic consumables StripsAscensia entrust test

strips701260

Diabetic consumables StripsAscensia glucodi

esprit 890752

Diabetic consumables Strips Glucostix coastal 831980

Diabetic consumables Strips Glucostix high altitude 831999

Diabetic consumables Strips Haemo-Glucotest 832014

Diabetic consumables Strips Keto-Diastix 50's 832203

Diabetic consumables StripsMedisense optimum

plus892998

Diabetic consumables StripsMedisense precision

plus electrodes847887

Diabetic consumables StripsOne touch ultra test

strips702690

Diabetic consumables StripsOne touch horizon

test strips704130

Diabetic consumables StripsHomemed blood

glucose strips460628

Insulin Biphasic insulinInsu Actaphane

HM(ge) 3.0ml Penset816213

Insulin Biphasic insulinInsu Actraphane

HM(ge) 10ml vial733512

Insulin Fast acting insulinInsu Apidra 3.0ml

cartridge706039

Motivation required with

treatment history

Insulin Fast acting insulinInsu Apidra I optiset

penset 3ml710367


treatment history

Insulin Fast acting insulininsu Apidra solostar

disposable pens 3ml709861


treatment history

Insulin Fast acting insulin Insu Apidra 10ml vial 706040Motivation required with

treatment history

Insulin Fast acting insulin

Novorapid flexpen

3ml prefilled device

penset

897767

Insulin Fast acting insulin

Novorapid flexpen

3ml solution for inj.

penfill

897775

Insulin Fast acting insulin Novorapid vial 10ml 707927

Insulin InsulinNovomix 30 flexpen

3ml pf device702086

Insulin InsulinNovomix 30 penfill

3ml pf device702089

Insulin Insulin - rapid actinginsulin Humalog 10ml

vial819468

Insulin Insulin - rapid actingInsulin humalog

cartridge 3ml862355

Insulin Insulin - rapid actingInsulin humalog pen

3ml disposable853445

Insulin Insulin premixed biphasicInsulin humalog mix

25 10ml vial853437


25 cartridge 3 ml861782


25 disp pen 3 ml853461


50 cartridge 3ml705074

Insulin Insulin glargine Lantus - 10ml vial 700310Motivation required with

treatment history

Insulin Insulin glargine Optisulin Cartridge

100IU/ml723474

Basaglar Cartridge

100IU/ml722456


treatment history

Insulin Insulin glargine Optisulin pen 100

IU/ml721502

Basaglar Pen

100IU/ml722454


treatment history

Insulin Insulin DetemirLevemir flexpen

prefilled 3ml705312


treatment history

Insulin Insulin DetemirLevemir prefilled

cartridge 3ml705313


treatment history

InsulinInsulin isophane -

intermediateHumulin – N vial 10ml 733458


intermediateBiosulin N 3ml cart 712768


intermediate

Insulin humulin N pen

3ml disposable853453

Insulin Insulin premixed biphasicHumulin 30/70 10ml

vial783811

Insulin Insulin premixed biphasicBiosulin 30/70 3ml

cart712770

Insulin Insulin premixed biphasicHumulin 30/70

disposable pens 3ml704456

Insulin Insulin - short acting Humulin – R 10ml vial 733431

Insulin Insulin - short actingBiosulin R 3ml

cartridge712767

InsulinIntermediate to long acting

insulin

Insu Protaphane

flexpen 3ml pf device700183

9

InsulinIntermediate to long acting

insulin

Insu Protaphane

HM(ge) 10ml vial733482




100mg862304



Diabetes mellitus type

2

E11.9 Biguanides Metformin 850 mg Accord Metformin

850mg714426 Diaphage 850mg 719785

Biguanides Metformin 500mgAccord Metformin

500mg714427 Diaphage 500mg 719784

Biguanides Metformin 1000mg Bigsens 1000mg 709172Mylan Metformin

1000mg721443

Biguanides Metformin 500mg Glucophage XR 500mg 710196



Biguanides Metformin 1000mgGlucophage XR

1000mg 720926

Sulphonylureas Glibenclamide 5mg Bio-glibenclamide 827053

Sulphonylureas Glimepiride 1mgMylan Glimepiride

1mg709984 Sulphonur 1mg 710904

Sulphonylureas Glimepiride 2mgMylan Glimepiride


Sulphonylureas Glimepiride 4mgAustell Glimepiride


Sulphonylureas Gliclazide 30mg MR Diaglucide 30mg MR 714582

Sulphonylureas Gliclazide 60mg MR Diaglucide 60mg MR 718247

Sulphonylureas Gliclazide 80mgSandoz gliclazide

80mg834866

Thiazolidinediones PioglitazoneCipla pioglitazone

30mg707981


treatment history

Thiazolidinediones PioglitazoneCipla pioglitazone

15mg707974


treatment history




100mg862304



Dysrhythmia

I47 Anti-arrhythmic Amiodarone 100mg Hexarone 100mg 863157Treatment to be initiated by

Specialist

I48 Anti-arrhythmic Amiodarone 200mgBio-Amiodarone

200mg707851


Specialist




Beta-blockers Sotalol 160mg Sotahexal 160mg 828009Treatment to be initiated by

Specialist

Beta-blockers Sotalol 80mg Sotahexal 80mg 827991Treatment to be initiated by

Specialist

Beta-blockers Propranolol 10mg Indoblok 10mg 806552







Bisoprolol


6.25mg

Bisozyd Co

2.5mg/6.25mg718082


Bisoprolol


6.25mg

Bisozyd Co

5mg/6.25mg718086














100mg862304



Epilepsy

G40 Anti-epileptic Valproic acid 150mg Convulex 150mg 715980

G41 Anti-epileptic Valproic acid 300mg Convulex 300mg 715999


Anti-epileptic Valproic acid 250mg/ 5mL Convulex suspension 781541

Anti-epileptic Phenytoin 100mg Epanutin 100mg 723525

Anti-epileptic Phenytoin 125mg/5mL susp Epanutin 125mg/5mL 723533

Anti-epileptic Sodium Valproate 100mgEpilim Crushable

100mg821578

10

Anti-epileptic Sodium Valproate 200mg Eprolep cr 200mg 721460 Navalpro cr 200mg 718465



Anti-epileptic Sodium Valproate 200mg/5ml Epilim sugar free 780545

Anti-epileptic Lamotrigine 25mg Epitec 25mg TABS 704379

Anti-epileptic Lamotrigine 50mg Lamidus 50mg 710885 Epitec 50mg TABS 704380



Anti-epileptic Phenobarbitone 30mg Sedabarb 30mg 814946

Anti-epileptic Phenytoin 100mg Phenytoin sod 754870

Anti-epileptic Clonazepam Rivotril 0.5mg 761079

Severe and uncontrolled

epilepsy only, not responding

to first-line agents.Motivation

required - Treatment to be

initiated by Specialist

Anti-epileptic ClonazepamRivotril 2.5mg/ml

drops835129






Anti-epileptic Clonazepam Rivotril 2mg 761087






Anti-epileptic Carbamazepine 100mg/ 5mL Tegretol susp 250mL 769401

Anti-epileptic Carbamazepine 200mg Degranol 200mg 712493

Anti-epileptic Carbamazepine 200mgSandoz

carbamazepine cr705597

Anti-epileptic Carbamazepine 400mgSandoz

carbamazepine cr705602

Anti-epileptic Topiramate 25mg Epitoz 25mg 710899


















Anti-epileptic Oxcarbazepine 300mg Trileptal 300mg 892484






Anti-epileptic Oxcarbazepine 600mg Trileptal 600mg 892491






Anti-epileptic Ethosuximide 250mg/5mlZarontin 250mg/5ml

syrup779105






Prenatal vitamins Folic Acid Be-Tabs Folic acid 810967

Glaucoma

H40 Opthalmics -alpha-2-agonist Brimonidine tartrate Alphagan purite 5ml 709410

Carbonic anhydrase

inhibitorsAcetazolamide Azomid 250mg 789771

Carbonic anhydrase

inhibitorsBrinzolamide

Azoptic eye

suspension 1%701523

Opthalmics -Beta-blockers Timolol 5mg/ml Glaucosan 0.5% 821624

Opthalmics -Beta-blockers Timolol 2.5mg/ml Timoptol 0.25% 770833

Opthalmics -Beta-blockers

combination

Dorzolamide 20mg; timolol

5mg/mlCosopt 0.5% 5ml drp 860379


combination

Brinzolamide 10mg; Timolol

5mg/mlAzarga 5ml 717260


combination

Bimatopost 0.3mg; Timolol

5mg/mlGanfort 3ml 714110

Opthalmics -carbonic

anhydrase inhibitorDorzolamide 20mg Trusopt solution 819832

Opthalmics-prostaglandin

analogue Travoprost 40ug/ml

Travatan eye drop

solution702534


therapy, required


analogue Lantanoprost/timolol Xalacom 702983 Co-Atana 2.5ml 722712


analogue Lantanoprost 1ml/50mcg Xalatan 833223 Atana 50mcg/ml 720971


therapy, required


analogue Bimatropost 0.3mg/ml Lumigan 3ml 703666


therapy, required

Ophthalmic - muscarinic

agonistsPilocarpine 10mg/mL

Isoptocarpine 1% -

15mL734284



Isoptocarpine 2%-

15mL734179

11



Isoptocarpine 4% -

15mL734195

Haemophilia

D66 Anti-diuretics Desmopressin DDAVP intranasal sol

0.1mg/ml 717746


Specialist Haematologist

D67 Anti-diuretics Desmopressin DDAVP nasal spray

0.1mg/ml 837555



Anti-diuretics Desmopressin DDAVP 0.2mg 703639Treatment to be initiated by


Anti-diuretics Desmopressin DDAVP 0.1mg 837563Treatment to be initiated by


Coagulants Tranexamic acid 500mg Cyklokapron 500 717134Treatment to be initiated by


Coagulants Factor VIII 300uHaemosolvate®

Factor VIII841560




Factor VIII800759




Factor VIII813648



Coagulants Factor IX 500uHaemosolvex® Factor

IX800767



Hyperlipidaemia Fibrates Bezafibrate 400mgDyna-bezafibrate SR

400mg710122

E78HMG-CoA reductase


Adco simvastatin

10mg701276

Austell simvastatin

10mg705464

HMG-CoA reductase


Adco simvastatin

20mg701279

Austell simvastatin

20mg705465

HMG-CoA reductase


Adco simvastatin

40mg701281

Austell simvastatin

40mg705467

HMG-CoA reductase

inhibitors (statins)Atorvastatin 10mg Aspavor 10mg 708121

Adco Atorvastatin

10mg718073

Clinical motivation with

treatment history must be

submitted

HMG-CoA reductase

inhibitors (statins)Atorvastatin 20mg Aspavor 20mg 708122

Adco Atorvastatin

20mg718074



submitted

HMG-CoA reductase

inhibitors (statins)Atorvastatin 40mg Astor 40mg 719187

Adco Atorvastatin

40mg718075



submitted

HMG-CoA reductase

inhibitors (statins)Atorvastatin 80mg Lipogen 80mg 714074 Astor 80mg 719189



submitted




100mg862304



Hypertension ACE Inhibitors Captopril 25mg Merck-captopril 25mg 852619

I10 ACE Inhibitors Captopril 50mg Merck-captopril 50mg 899429

ACE Inhibitors combinationCaptopril/hydrochlorothiazide

50mg/25mgCaptoretic 50/25mg 841137




ACE Inhibitors combination Enalapril / hydrochlorthiazide Enap co 891287

ACE inhibitors Ramipril 2.5mg Rampil 2.5mg 705427



ACE inhibitors Perindopril 4mg Prexum 4mg 703541 Vectoryl 4mg 710297


ACE inhibitors Perindopril 8mg Pearinda 8mg 714528 Vectoryl 8mg 710925



ACE Inhibitors combinationPerindopril 4mg/Indapamide

1.25mgPrexum Plus 704929 Vectoryl Plus 710298


1.25mg

Prexum Plus 5/1.25

mg720388


2.5mg

Bioprexum Plus

10/2.5mg721508









ACE inhibitors Lisinopril 5mg Sinopren 5mg 700691 Zemax 5mg 703646


10mg712598


20mg708189

ACE inhibitors

Lisinopril


12.5mg

Adco Zetomax-Co

10/12.5mg704597

Hexal-lisinopril co

10/12.5mg704703

` ACE inhibitors

Lisinopril


12.5mg

Adco Zetomax-Co

20/12.5mg704598

Hexal-lisinopril co

20/12.5mg704704




12

Alpha receptor blockers Prazosin 1mg Pratsiol 1mg 782122 Motivation, including history of

therapy, required

Alpha receptor blockers Prazosin 2mg Pratsiol 2mg 782130Motivation, including history of

therapy, required

Alpha receptor blockers Prazosin 5mg Pratsiol 5mg 782149Motivation, including history of

therapy, required






Bisoprolol


6.25mg

Bisozyd Co

2.5mg/6.25mg718082


Bisoprolol


6.25mg

Bisozyd Co

5mg/6.25mg718086







Calcium channel blocker Amlodipine 10mg Gulf Amlodipine 10mg 712954 Lomanor 10mg 708353

Calcium channel blocker Amlodipine 5mg Amtas 5mg 713971 Lomanor 5mg 708352

Calcium channel blocker Diltiazem 60mg Zildem 60mg 822213

Calcium channel blocker Diltiazem 90mg Zildem 90mg 824364

Calcium channel blocker Diltiazem SR 180mg Zildem SR 180mg 839183

Calcium channel blocker Diltiazem SR 240mg Zildem SR 240mg 839191

Calcium channel blocker Felodopine 5mg Hexal-felodopine 5mg 703221

Calcium channel blocker Felodopine 10mgHexal-felodopine

10mg703902


long acting Verapamil 240 SR Verahexal 240 sr 700071




long acting Nifedipine SR 20mg Cipalat Retard 20mg 864153





Central alpha-2 agonist Methyldopa 250 Hy-po-tone 250mg 732052

Aldosterone antagonist Spironolactone 25mg Spiractin 25mg 765910


2.5mg703329

Cipla- Indapamide

2.5mg710313


1.5mg716962

Diuretic - loop Furosemide 40mgMylan Furosemide



20mg 707421

Diuretic-thiazideHydrochlorthiazide /amiloride

25/2.5mgAmiloretic hs 702811

Diuretic-thiazideHydrochlorthiazide

/triamterene 25/50Renezide 780146

Diuretic-thiazide Hydrochlorothiazide 25mg Hexazide 890470

Diuretic-thiazideHydrochlorthiazide/amiloride

50/5mgSpec -Co - Amiloride 706531

Diuretic-thiazide/K

combination

Hydrochlorthiazide 50mg /

potassium 600mgUrirex K 774057

Direct vasodilator Hydralazine 10mg Hyperphen 10mg 731714

Direct vasodilator Hydralazine 50mg Hyperphen 50mg 731722




be provided


antagonistsLosartan 50mg Ciplazar 50mg 716643



required


antagonistsLosartan 100mg Ciplazar 100mg 716644



required





required



Losaar Plus

50/12.5mg715856



required

Sympathetic nervous

blockersReserpine 0.25mg Reserpine 0.25mg 760048




100mg862304


inhibitorsAspirin Ecotrin 81mg 823481

13

Hypothyroidism

E03 Thyroid preparation levothyroxine 100mcg Euthyrox 100mcg 713169

Thyroid preparation levothyroxine 50mcg Euthyrox 50mcg 713168

Thyroid preparation levothyroxine 25mcg Euthyrox 25mcg 713172

Thyroid preparation levothyroxine 200mcg Eltroxin 200mcg 723172





Thyroid preparation Liothyronine sodium 20mcg Tertroxin 769983

Multiple sclerosis

G35 Anti-epileptic Carbamazepine 200mg Degranol 200mg 712493Treatment to be initiated by

Specialist

Anticholinergics Oxybutinin 5mg Lenditro 5mg 872253Treatment to be initiated by

Specialist

Analgesics Paracetamol 500mg Napamol 745723Treatment to be initiated by

Specialist

Cytostatic Methotrexate 2.5mg Methotrexate 2.5mg 742465Treatment to be initiated by

Specialist

Cytostatic Azathioprine 50mg Azamun 50mg 701252Treatment to be initiated by

Specialist

Corticosteroids Prednisolone 5mg Lenisolone 5mg 800155Treatment to be initiated by

Specialist

Corticosteroids Prednisone 5mg Be-tabs prednisone 788783Treatment to be initiated by

Specialist


Immunosuppressants Cyclophosphamide Endoxan 50mg 723274Treatment to be initiated by

Specialist

Muscle relaxants Baclofen 10 Teva-Baclofen 10mg 712607Treatment to be initiated by

Specialist

NSAID'S Naproxen 250mg Napflam 250mg 806447Treatment to be initiated by

Specialist


Specialist

NSAID'S Diclofenac sod. 25mg tab Panamor 25mg 752371Treatment to be initiated by

Specialist


Specialist

NSAID'S Diclofenac sod. 100mg Panamor sr 827592Treatment to be initiated by

Specialist

Tricyclic antidepressants Amitriptyline 25mg Trepiline 25mg 771996 Gulf Amitripryline 718746Treatment to be initiated by

Specialist

SSRI Fluoxetine 20mg Deprozan 894303Treatment to be initiated by

Specialist

Prenatal vitamins Folic Acid Be-Tabs Folic acid 810967

Immunostimulants inteferon beta-1A Rebif 44mcg/0.5ml 890887

To be reviewed from

Specialised Drug Benefit -

Specialist

Physician/Neurologist must

provide EDSS, relapsing-

remitting history and number

of relapses

Immunostimulants inteferon beta-1A Rebif 22mcg/0.5ml 898891

To be reviewed from

Specialised Drug Benefit -

Specialist

Physician/Neurologist must

provide EDSS, relapsing-

remitting history and number

of relapses

Parkinson's

G20 Central muscarinic blockers Biperiden 2.5mg Lennon - Biperiden 713209 Treatment to be initiated by

Specialist

G21 Beta-blockers Propranolol 10mg Indoblok 10mg 806552Treatment to be initiated by

Specialist

Beta-blockers Propranolol 40mg Indoblok 40mg 806560Treatment to be initiated by

Specialist

dopamine agonists Ropinirole 0.25mg Resure 0.25mg 715081Treatment to be initiated by

Specialist

dopamine agonists Ropinirole 0.5mg Resure 0.5mg 715082Treatment to be initiated by

Specialist

Dopamine agonists Ropinirole 1mg Resure 1mg 715083Treatment to be initiated by

Specialist


Specialist


Specialist

Dopamine agonists Amantadine 100mg Symadin 700500Treatment to be initiated by

Specialist

Levodopa + dopamine

decarboxylase inhibitors

Levodopa/carbidopa

100/25mg

Teva Carbilevo

100/25mg710286 Sinemet 25mg/100mg 764078


Specialist

Levodopa + dopamine

decarboxylase inhibitors

Levodopa/carbidopa

250/25mg

Teva Carbilevo

250/25mg710468 Sinemet 25mg/250mg 764086


Specialist

Anti-cholinergic Orphenadrine 50mg Disipal 50mg 720542Treatment to be initiated by

Specialist

Rheumatoid arthritis

M05 Analgesics Paracetamol 500mg Napamol 500mg 745723Treatment to be initiated by

Specialist

M065 Aminosalycilic acid



Specialist

M085 Aminosalycilic acid

derivativeSulphasalazine 500mg Salazopyrin EN 500 762016


Specialist


Specialist


Specialist


14


Specialist

Cytostatics Cyclophosphamide 50mg Endoxan 50mg 723274 Motivation by Specialist

Immunosuppressive Azathioprine 50mg Azamun 50mg 701252Treatment to be initiated by

Specialist

Immunosuppressive Chloroquine 200mg Plasmoquine 200mg 794333Treatment to be initiated by

Specialist

NSAID'S Indomethacin 100mgArthrexin 100mg

supp.704741

Motivation and relevant lab

results required if prescribed

independently of other Anti-

Rheumatic Agents

NSAID'S Indomethacin 25mg Betacin 25mg 787833 Arthrexin 25mg 704725




Rheumatic Agents

NSAID'S Ibuprofen 200mg Ranfen 200mg 824852




Rheumatic Agents

NSAID'S Ibuprofen 400mg Ranfen 400mg 701654




Rheumatic Agents

NSAID'S Ibuprofen 600mgSandoz ibuprofen 600

mg782807




Rheumatic Agents

Selective COX II inhibitors Meloxicam 15mg Flexocam 15mg 704828Arrow Meloxicam

15mg711325




Rheumatic Agents

Selective COX II inhibitors Meloxicam 7.5mg Flexocam 7.5mg 704829Arrow Meloxicam

7.5mg711324




Rheumatic Agents

NSAID'S Naproxen 250mg Napflam 250mg 806447




Rheumatic Agents

NSAID'S Naproxen 500mg Napflam 500mg 808474




Rheumatic Agents

NSAID'S Diclofenac 25mg Panamor 25mg 752371




Rheumatic Agents

NSAID'S Diclofenac 50mg Panamor 50mg 752398




Rheumatic Agents

NSAID'S Diclofenac SR 100mg Panamor sr 827592




Rheumatic Agents

Specific COX2 inhibitors -

COXIBCelcoxib 100mg

COXLEON 100MG

CAPS723329

Motivation indicating the risk

factors considered for their use

of conventional anti-

inflammatory therapy


COXIBCelcoxib 200mg

COXLEON 200MG

CAPS723330






COXIBEtoricoxib 60mg

SPEC ETORICOXIB

60MG723128





Tricyclic antidepressants Amitriptyline 10mg Trepiline 10mg 772003Treatment to be initiated by

Specialist

Tricyclic antidepressants Amitriptyline 25mg Trepiline 25mg 771996 Gulf Amitripryline 718746Treatment to be initiated by

Specialist

Vitamins Folic acid 5mg Be-tabs folic 5mg 810967Treatment to be initiated by

Specialist

Schizophrenia

F20 Anti-epileptic Carbamazepine 200mg Degranol 200mg 712493Therapy must be initiated by a

Psychiatrist

Anti-epileptic Carbamazepine 200mg cr

Sandoz

carbamazepine cr

200mg

705597Therapy must be initiated by a

Psychiatrist

Anti-epileptic Carbamazepine 400mg cr

Sandoz

carbamazepine cr

400mg

705602Therapy must be initiated by a

Psychiatrist

Anti-epileptic Lamotrigine 25mg Epitec 25mg TABS 704379Therapy must be initiated by a

Psychiatrist


Psychiatrist


Psychiatrist


Psychiatrist


Psychiatrist


Psychiatrist

15


Psychiatrist

SSRI Fluoxetine 20mg Deprozan 20mg 894303Therapy must be initiated by a

Psychiatrist. 1st line therapy

SSRI Citalopram 20mg Cilate 20mg 707888 Talomil 20mg 702769Therapy must be initiated by a

Psychiatrist - 2nd line therapy

SSRI Paroxetine 20mg Serrapress 20mg 705122 Xet 20mg 705633Therapy must be initiated by a


SSRI Escitalopram 10mgMylan Escitalopram

10mg714012 ZYTOMIL 10MG 719547



SSRI Escitalopram 20mgMylan Escitalopram

20mg714013 ZYTOMIL 20MG 719548



SSRI Sertraline 50mg Dyna-Sertraline 50mg 719972 Serlife 50mg 703132

SSRI Sertraline 100mgDyna-Sertraline

100mg 719973 Serlife 100mg 703999


Psychiatrist


Psychiatrist

Tricyclic antidepressants Amitriptyline 10mg Trepiline 10mg 772003Therapy must be initiated by a

Psychiatrist

Tricyclic antidepressants Amitriptyline 25mg Trepiline 25mg 771996 Gulf Amitripryline 718746Therapy must be initiated by a

Psychiatrist

Tricyclic antidepressants Imipramine HCI 10mg Ethipramine 10mg 724661Therapy must be initiated by a

Psychiatrist

Tricyclic antidepressants Imipramine HCI 25mg Ethipramine 25mg 724688Therapy must be initiated by a

Psychiatrist


Psychiatrist


Psychiatrist

ThioxanthinesZuclopenthixol decanoate

200mg/ml

Clopixol Depot

200mg/ml714852

Depot Preparations Only - 2nd

Line

Thioxanthines Flupenthixol decanoate 20mgFluanxol depot 1ml

20mg726672


Line

Thioxanthines Flupenthixol decanoate 40mgFluanxol depot 2ml

40mg726680


Line

Thioxanthines Flupenthixol HCL 0.5mg Fluanxol 0.5mg 726656Therapy must be initiated by a

Psychiatrist

Thioxanthines Flupenthixol HCL 1mg Fluanxol 1mg 726664Therapy must be initiated by a

Psychiatrist

Butyrephenones Haloperidol 0.5mg Serenace 0.5mg 763411Therapy must be initiated by a

Psychiatrist

Butyrephenones Haloperidol 1.5mgSandoz haloperidol

1.5mg 730335


Psychiatrist

Butyrephenones Haloperidol 5mgSandoz haloperidol

5mg 730327


Psychiatrist

Atypical antipsychotic Clozapine 100mg Aspen Clozapine 717082

Motivation Required. Therapy

must be initiated by a

Psychiatrist

Atypical antipsychotic Clozapine 25mg Aspen Clozapine 717081



Psychiatrist

Atypical antipsychotic Risperidone 1mg Zoxadon 1mg 711512 Risnia 1mg 717997



Psychiatrist

Atypical antipsychotic Risperidone 2mg Zoxadon 2mg 711513 Risnia 2mg 717998



Psychiatrist

Atypical antipsychotic Olanzapine 2.5mg Olawin 2.5mg 721385 Olexar 2.5mg 715657



Psychiatrist

Atypical antipsychotic Olanzapine 5mg Olawin 5mg 721388 Olawin 5mg 721388



Psychiatrist

Atypical antipsychotic Olanzapine 10mg Olawin 10mg 721389 Olexar 10mg 715659



Psychiatrist

Benzamides Sulpiride 50mg Espiride 819654Therapy must be initiated by a

Psychiatrist

Anti-cholinergic Orphenadrine 50mg Disipal 50mg 720542

Systemic Lupus

Erythematosus Anti-protozoal agents Chloroquine phosphate Plasmoquine 200mg 794333Treatment to be initiated by

Specialist

M32 Anticoagulant Warfarin 5mg cipla-warfarin 712390Treatment to be initiated by

Specialist

L93 Analgesics Paracetamol 500mg Napamol 500mg tab 745723Treatment to be initiated by

Specialist

Cytostatic Cyclophosphomide 50mg Endoxan 50mg 723274Treatment to be initiated by

Specialist


Specialist

Immunosuppressants Azathioprine 50mg Azamun 701252Treatment to be initiated by

Specialist


Specialist


Specialist

NSAID'S Indomethacin 100mgArthrexin 100mg

supp.704741


Specialist

NSAID'S Indomethacin 25mg Betacin 25mg 787833 Arthrexin 25mg 704725Treatment to be initiated by

Specialist

NSAID'S Aspirin 300mg Be-tabs aspirin 300mg 798533Treatment to be initiated by

Specialist

NSAID'S Ibuprofen 200mg Ranfen 200mg 824852Treatment to be initiated by

Specialist

NSAID'S Ibuprofen 400mg Ranfen 400mg 701654Treatment to be initiated by

Specialist

NSAID'S Ibuprofen 600mgSandoz ibuprofen 600

mg782807


Specialist

16

Selective COX II inhibitors Meloxicam 15mg Flexocam 15mg 704828Arrow Meloxicam

15mg711325


Specialist

Selective COX II inhibitors Meloxicam 7.5mg Flexocam 7.5mg 704829Arrow Meloxicam

7.5mg711324


Specialist

NSAID'S Naproxen 250mg Napflam 250mg 806447 Treatment to be initiated by

Specialist


Specialist


Specialist


Specialist

NSAID'S Diclofenac sod. 100mg Panamor sr 827592Treatment to be initiated by

Specialist

Topical corticosteroids Betamethasone cream Topivate 0.1% cream 833037Treatment to be initiated by

Specialist

Topical corticosteroids Betamethasone lenovateLenovate 0.1%

ointment800171


Specialist

Vitamins Folic acid 5mg Be-tabs folic acid 5mg 810967Treatment to be initiated by

Specialist


corticosteriod use

Ulcerative colitis

K515 Aminosalycilic acid

derivativeMesalazine enema

Asacol 2g/50ml

enema824127


Specialist - motivation required


derivativeMesalazine 400mg Asacol 400mg 783668




derivativeMesalazine supp Asacol 500mg supp 824135








derivativeSulphasalazine 500mg Salazopyrin EN 762016



Aminosalicylates Olsalazine 250mg Dipentum 250mg 792519Treatment to be initiated by


Aminosalicylates Mesalazine 500mg tab Pentasa 500mg 890775Treatment to be initiated by



200mg742872


Specialist


400mg701076


Specialist


Specialist


Specialist

Antibiotics Ciprofloxacin 750mg Cifloc 750mg 893963Treatment to be initiated by

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enema824593



Corticosteroids Budesonide 3mg Entocord 3mg tab 838896Treatment to be initiated by






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required

Immunosuppressive Azathioprine 50mg Azamun 50mg 701252



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Cytostatic Methotrexate 2.5 Methotrexate 2.5mg 742465



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Vitamins Folic acid 5mg Be-tabs folic acid 5mg 810967Treatment to be initiated by

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corticosteriod use

17

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Chronic application forms must accompany all first-time … · 2018. 4. 12. · Coveram 5/10mg...

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