comprehensive medication formulary effective 1 january …1272010103808 am... · 1 comprehensive...

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COMPREHENSIVE MEDICATION FORMULARY Effective 1 January 2010

Please note

• All active ingredients listed in this formulary are subject to the Qualsa medicine reimbursement guidelines and, where applicable, the Qualsa Maximum Price (QMP).

• The examples below serve as a guide for those prescribing and represent the least costly products available. Those prescribing are encouraged to prescribe generically so as to avoid unnecessary co-payments for members.

• This formulary represents drugs covered for the 26 Chronic Disease List (CDL) conditions only. Reimbursement of medication for non-CDL conditions are subject to the Fund’s Rules and Qualsa's medicine reimbursement guidelines.

Key

• Drugs listed as ‘Accepted treatment’ will be reimbursed from the chronic medication benefit subject only to generic reference pricing (i.e. QMP).

• ’Special investigation’ drugs are those that are considered to be agents of choice, however, defined clinical information is required prior to authorisation. Special investigation results e.g. lung function tests or lipogram should accompany the patient.

• ’Motivation required’ drugs are those agents that will only be considered following receipt of either a written or verbal motivation from the prescribing doctor as to why this agent should be funded ahead of other accepted treatment options.

• ‘Motivation required*’ with an asterisk indicates that where clinical criteria have not been met for reimbursement of the requested medication, a co-payment defined by a therapeutic reimbursement limit will be applied.

Abbreviations of dosage form CAP Capsule ENE Enema NAS Nasal spray SUP Suppository CHU Chew tablet FCT Film-coated tablet NOD Nasal drops SUS Suspension CPS Capsule (Inhaler) GEL Topical gel OPD Eye drops SYR Syrup CRM Cream GRA Granules PAD Pad/patch TAB Tablet

DRP Drops IMP Implant SAC Sachet UNG Ointment

DSP Dispersable INH Inhaler SLN Sublingual

ECT Enteric-coated tablet INJ Injection SRC Slow release capsule

EFT Effervescent tablet LOT Lotion SRT Slow release tablet

INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT

Addison's disease

Corticosteroids, oral

Fludrocortisone acetate 0.1mg TAB Florinef acetate Motivation required

Hydrocortisone 10mg TAB Covocort Accepted treatment

Prednisolone 5mg TAB Lenisolone Capsoid Prelone Accepted treatment

Prednisone 5mg TAB Be-tabs prednisone Panafcort Trolic Accepted treatment

2


Asthma

Beta agonists, short-acting

Fenoterol INH Berotec HFA Accepted treatment

Fenoterol and ipratropium bromide 50mcg/20mcg INH Duovent HFA Motivation required

Salbutamol 100mcg INH Venteze Asthavent Accepted treatment

Salbutamol 2.5mg SLN Ventolin nebules Motivation required

Salbutamol 200mcg CPS Asthavent Accepted treatment

Salbutamol 400mcg CPS Ventodisks Motivation required

Terbutaline 0.5mg INH Bricanyl Motivation required*

Beta agonists, long-acting

Formoterol 12mcg CPS/INH Foratec Accepted treatment

Formoterol 9mcg INH Oxis Accepted treatment

Salmeterol 25mcg INH Serevent Accepted treatment

Salmeterol 50mcg INH Serevent Accepted treatment

Corticosteroids, inhaled

Beclometasone 100mcg INH Beclate Accepted treatment



Budesonide 100mcg INH/CPS Inflacor Budeflam Inflammide Accepted treatment

Budesonide 200mcg INH/CPS Inflacor Budeflam Inflammide Accepted treatment

Budesonide 400mcg INH/CPS Inflacor Inflammide Novoliser Accepted treatment

Ciclesonide 80mcg INH Alvesco Motivation required*

Ciclesonide 160mcg INH Alvesco Motivation required*

Fluticasone 100mcg INH Flixotide CFC-free Motivation required*



Fluticasone 500mcg Flixotide accuhaler Motivation required



Prednisolone 15mg/5ml SYR Preflam Motivation required

Prednisone 5mg/ml SYR Pulmison paed Motivation required

Corticosteroids and beta agonists, long-acting

Budesonide and formoterol 160mcg/4.5mcg INH Symbicord 60 dose Symbicord 120 dose Motivation required

Budesonide and formoterol 320mcg/9mcg INH Symbicord 60 dose Motivation required

Budesonide and formoterol 80mcg/4.5mcg INH Symbicord 120 dose Motivation required

Salmeterol and fluticasone 25mcg/125mcg INH Seretide Motivation required




3




Xanthines

Aminophylline 100mg TAB Norstan-ted Accepted treatment


Aminophylline 225mg SRT Phyllocontin Accepted treatment

Theophylline SYR Alcophyllin Nuelin liquid Accepted treatment

Theophylline 200mg SRT Sandoz Theophylline Accepted treatment

Theophylline 250mg SRT Nuelin SA Accepted treatment


Theophylline 400mg SRT Uniphyl Accepted treatment


Theophylline combinations excl. psycholeptics

SYR Solphyllin Theophen Accepted treatment

Leukotriene receptor antagonists

Montelukast 10mg TAB Singulair Motivation required

Montelukast 4mg CHU/SAC Singulair Singulair Sprinkles Motivation required

Montelukast 5mg CHU Singulair Motivation required

Zafirlukast 20mg TAB Accolate Motivation required

Bipolar mood disorder

Heterocyclic antidepressants

Amitriptyline 25mg TAB Trepiline Sandoz-amitriptyline Accepted treatment

Clomipramine 10mg TAB Equinorm Motivation required

Clomipramine 25mg TAB Equinorm Clomidep Motivation required

Dothiepin 25mg CAP Thaden Sandoz-dothiepin Accepted treatment

Dothiepin 75mg TAB Thaden Sandoz-dothiepin Accepted treatment

Imipramine 25mg TAB Ethipramine Accepted treatment

Lofepramine 70mg TAB Emdalen Motivation required

Mainserin 10mg TAB Lantanon Motivation required


Maprotiline 25mg TAB Ludiomil Motivation required


Trimipramine 25mg TAB Tydamine Motivation required*

Trimipramine 50mg CAP Tydamine Motivation required*

Selective serotonin receptor inhibitors

Citalopram 10mg TAB Austell-citalopram Accepted treatment

Citalopram 20mg TAB Austell-citalopram Citalopram-Winthrop Sandoz-citalopram Accepted treatment

Citalopram 40mg TAB Austell-citalopram Citalopram-Winthrop Depramil Accepted treatment

Escitalopram 5mg TAB Lexamil Motivation required*

Escitalopram 10mg TAB Lexamil Citraz Aspen Escitalopram Motivation required*

4


Escitalopram 20mg TAB Lexamil Citraz Motivation required*

Fluoxetine 20mg CAP/TAB A-lennon fluoxetine Zydus-fluoxetine Ranflocs Accepted treatment

Fluoxetine 40mg DSP Prohexal T Motivation required

Fluvoxamine 10mg TAB Faverin Fluvoxamine-hexal Motivation required*

Paroxetine 20mg TAB Serrapress Austell-paroxetine Xet Motivation required*

Paroxetine 30mg TAB Serrapress Austell-paroxetine Motivation required*

Sertraline 50mg TAB Serlife Austell-sertraline Arrow Sertraline Motivation required*

Sertraline 100mg TAB Serlife Austell-sertraline Motivation required*

Serotonin and noradrenaline re-uptake inhibitors

Duloxetine 30mg CAP Cymbalta Motivation required

Duloxetine 60mg CAP Cymgen Cymbalta Motivation required

Venlafaxine 37.5mg CAP Venlor Odiven Motivation required

Venlafaxine 50mg TAB Efexor Motivation required

Venlafaxine 75mg CAP Venlor Sandoz Venlafaxine Odiven Motivation required

Venlafaxine 150mg CAP Venlor Sandoz Venlafaxine Motivation required

Monoamine oxidase type A inhibitors

Moclobemide 150mg TAB Depnil Motivation required*

Moclobemide 300mg TAB Clorix Depnil Motivation required

Other

Bupropion 150mg SRT Wellbutrin Motivation required


Mirtazapine 15mg TAB Sandoz Mirtazapine Adco-mirteron Aspen Mirtazapine Motivation required




Reboxetine 4mg TAB Edronax Motivation required

Sulpiride 200mg TAB Bio-sulpiride Motivation required

Sulpiride 25mg SYR Eglonyl Motivation required

Sulpiride 50mg CAP Espiride Sandoz Sulpiride Motivation required

Trazodone 50mg CAP Molipaxin Motivation required


Mood stabilisers

Lithium 250mg TAB Camcolit Accepted treatment


Lithium 450mg TAB Quilonum Retard Accepted treatment

Carbamazepine 200mg TAB/SRT Sandoz Carbamazepine CR

Degranol CPL-carbamazepine Accepted treatment

Carbamazepine 400mg SRT Sandoz Carbamazepine CR

Accepted treatment

Lamotrigine 100mg TAB Aspen-lamotrigine Lamitor Dyna-Lamotrigine Accepted treatment

5


Lamotrigine 200mg TAB Lamidus Austell-lamotrigine Dyna-Lamotrigine Accepted treatment



Topiramate 100mg TAB Toplep Adco-topiramate Sandoz-topiramate Motivation required




Valproic acid 150mg CAP/SRT Convulex Epilim Accepted treatment

Valproic acid 200mg SRT Epilim Accepted treatment

Valproic acid 300mg CAP Convulex Accepted treatment


Antipsychotics

Chlorpromazine 100mg TAB Largactil Accepted treatment



Haloperidol 0.5mg CAP Serenace Accepted treatment

Haloperidol 1.5mg TAB Serenace Sandoz Haloperidol Accepted treatment

Haloperidol 10mg TAB Serenace Accepted treatment

Haloperidol 5mg TAB Serenace Sandoz Haloperidol Accepted treatment

Trifluoperazine 1mg TAB Stelazine Accepted treatment


Zuclopenthixole 10mg TAB Clopixol Motivation required


Bronchiectasis

Antibiotic treatment will be reimbursed subject to Qualsa Medicine Policy and specific organism sensitivity.

Cardiomyopathy

Aspirin

Acetylsalicylic acid 100mg TAB Bayer aspirin cardio Disprin CV Myoprin Accepted treatment

Acetylsalicylic acid 125mg TAB Lo-aspirin Accepted treatment

Acetylsalicylic acid 300mg TAB Gulf aspirin Be-tabs aspirin Aspirin (Resmed) Accepted treatment

Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin

Accepted treatment

Acetylsalicylic acid 81mg ECT Ecotrin Accepted treatment

Anticoagulants

Warfarin 1mg TAB Cipla-warfarin Accepted treatment


Warfarin 5mg TAB Warfarin Cipla-warfarin Accepted treatment

Diuretics

Bumetanide 1mg TAB Burinex Motivation required*

Bumetanide and potassium 0.5mg/573mg TAB Burinex K Accepted treatment

6


Chlorthalidone 50mg TAB Hygroton Motivation required

Furosemide 10mg/ml SYR Lasix Oral Motivation required

Furosemide 20mg TAB Lasix Accepted treatment

Furosemide 40mg TAB Diuresix Merck-furosemide Beuresis Accepted treatment

Furosemide 500mg TAB Lasix Motivation required*

Furosemide 60mg CAP Lasix Motivation required*


Hydrochlorothiazide 12.5mg TAB Ridaq Accepted treatment

Hydrochlorothiazide 25mg TAB Hexazide Ridaq Accepted treatment

Hydrochlorothiazide and amiloride 25mg/2.5mg TAB Amiloretic HS Accepted treatment

Hydrochlorothiazide and amiloride 50mg/5mg TAB Amiloretic Spec-Co-Amiloride Betaretic Accepted treatment

Hydrochlorothiazide and potassium 50mg/300mg TAB Urirex K Accepted treatment

Indapamide 1.5mg TAB Natrilix SR Accepted treatment

Indapamide 2.5mg TAB Cipla-Indapamide Daptril Merck-indapamide Accepted treatment

Piretanide 3mg TAB Arelix Motivation required*


Spironolactone 100mg TAB Spiractin Accepted treatment

Spironolactone 25mg TAB Spiractin Sandoz Spironolactone Accepted treatment

Torasemide 10mg TAB Torahexal Motivation required*

Torasemide 2.5mg TAB Torahexal Motivation required*


Triamterine and hydrochlorothiazide 50mg/25mg TAB Renezide Accepted treatment

Potassium supplements

Potassium chloride 600mg TAB Plenish-K Sandoz K-600 Accepted treatment

ACE-inhibitors and combinations

Benazepril 10mg TAB Cibace Motivation required*

Benazepril and diuretics 10mg/12.5mg FCT Cibadrex Motivation required

Captopril 12.5mg TAB Captohexal Accepted treatment

Captopril 25mg TAB Captohexal Merck-captopril Bio-captopril Accepted treatment

Captopril 50mg TAB Captohexal Merck-captopril Zapto Accepted treatment

Captopril and diuretic 50mg/25mg TAB Captoretic Zapto-Co Capozide Accepted treatment

Cilazapril 5mg TAB Inhibace Motivation required*

Cilazapril and diuretic 5mg/12.5mg TAB Inhibace Plus Motivation required*

Enalapril 10mg TAB Alapren Ciplatec Pharmapress Accepted treatment

Enalapril 2.5mg TAB Renitec Accepted treatment



Enalapril and diuretic 12.5mg TAB Enap Co Pharmapress Co Accepted treatment

Fosinopril 10mg TAB Merck-fosinopril Motivation required*

7



Lisinopril 10mg TAB Sinopren Simayla-lisinopril Zemax Accepted treatment

Lisinopril 2.5mg TAB Austell-lisinopril Accepted treatment



Lisinopril and diuretic 10mg/12.5mg TAB Lisoretic Lisozide Hexal-lisinopril Co Accepted treatment

Lisinopril and diuretic 20mg/12.5mg TAB Lisoretic Zestozide Hexal-lisinopril Co Accepted treatment

Moexipril 7.5mg TAB Perdix Motivation required*

Perindopril 10mg TAB Coversyl Motivation required

Perindopril 4mg TAB Prexum Vectoryl Cipla-perindopril Accepted treatment

Perindopril 5mg TAB Coversyl Motivation required*

Perindopril 8mg TAB Vectoryl Cipla-perindopril Accepted treatment

Perindopril and indapamide 2mg/0.625mg TAB Preterax Accepted treatment

Perindopril and indapamide 4mg/1.5mg TAB Prexum Plus Vectoryl Plus Accepted treatment

Quinapril 10mg TAB Quinaspen Accumax Quinace Accepted treatment


Quinapril 40mg TAB Quinagen Motivation required

Quinapril 5mg TAB Quinagen Motivation required*

Quinapril and diuretic 10mg/12.5mg TAB Accumax Co Quinace Co Adco-quinaretic Motivation required*


Ramipril 1.25mg TAB/CAP Austell-ramipril Ramiwin Rampil Accepted treatment

Ramipril 10mg CAP Austell-ramipril Ran-ramipril Rampil Motivation required


Ramipril 5mg TAB/CAP Austell-ramipril Ramiwin Rampil Accepted treatment

Ramipril and diuretic 2.5mg/2.5mg TAB Tri-plen Motivation required

Ramipril and diuretic 5mg/5mg TAB Tri-plen Forte Motivation required

Trandolapril 0.5mg/573mg CAP Mavik Accepted treatment

Trandolapril 2mg CAP Mavik Accepted treatment

Trandolapril 4mg CAP Mavik Motivation required

Angiotensin receptor blockers and combinations

Candesartan 16mg TAB Atacand Motivation required*



Candesartan and diuretic 16mg/12.5mg TAB Atacand Plus Motivation required*

Eprosartan 600mg TAB Teveten Motivation required*

Eprosartan and diuretic 600mg/12.5mg TAB Teveten Plus Motivation required*

Irbesartan 150mg TAB Iberwin Aprovel Motivation required*


Irbesartan and diuretic 150mg/12.5mg TAB Co-Iberwin Coaprovel Motivation required*

8



Losartan 50mg TAB Lepitrin Cipla-losartan Los-arb Accepted treatment

Losartan 100mg TAB Zartan Cipla-losartan Accepted treatment

Losartan and diuretic 100mg/25mg TAB Fortzaar Accepted treatment

Losartan and diuretic 50mg/12.5mg TAB Cozaar Comp Accepted treatment

Telmisartan 40mg TAB Micardis Motivation required*


Telmisartan and diuretic 40mg/12.5mg TAB Co-micardis Motivation required*


Valsartan 160mg TAB Tareg Motivation required*

Valsartan 320mg TAB Diovan Motivation required

Valsartan 40mg TAB Diovan Motivation required*


Valsartan and diuretic 160mg/12.5mg TAB Co-diovan Motivation required*

Valsartan and diuretic 160mg/25mg TAB Co-diovan Plus Motivation required*

Valsartan and diuretic 320mg/12.5mg TAB Co-diovan Motivation required

Valsartan and diuretic 320mg/50mg TAB Co-diovan Motivation required

Valsartan and diuretic 80mg/12.5mg TAB Co-tareg Motivation required*

Valsartan and amlodipine 160mg/5mg TAB Exforge Motivation required


Calcium channel blockers and combinations

Amlodipine 10mg TAB Almadin Ciplavasc Amlate Accepted treatment


Felodipine 10mg SRT Felodipine-hexal Accepted treatment

Felodipine 2.5mg SRT Plendil Accepted treatment


Isradipine 2.5mg TAB Dynacirc Motivation required*

Isradipine 5mg CAP Dynacirc SRO Motivation required*

Lercanidipine 10mg TAB Zanidip Motivation required*

Lercanidipine 20mg TAB Zanidip Motivation required

Lercanidipine and enalapril 10mg/10mg TAB Zaneril Motivation required


Beta blockers and combinations

Acebutolol 100mg CAP Sectral Motivation required*


Acebutolol 400mg TAB Butobloc Sectral Motivation required*

Atenolol 100mg TAB Tenopress Sandoz Atenolol B-block Accepted treatment

Atenolol 25mg TAB Tenopress Accepted treatment


9


Atenolol and other diuretics 100mg/25mg TAB Sandoz Co-tenidone Tenchlor Adco-loten Accepted treatment

Atenolol and other diuretics 50mg/12.5mg TAB Sandoz Co-tenidone Tenchlor HS Accepted treatment

Bisoprolol 10mg TAB Cardicor Bilocor Adco-bisocor Accepted treatment

Bisoprolol 2.5mg TAB Cardicor Accepted treatment


Bisoprolol and diuretic 10mg/6.25mg TAB Ziak Accepted treatment

Bisoprolol and diuretic 2.5mg/6.25mg TAB Ziak Accepted treatment


Metoprolol 100mg TAB Lopresor Motivation required*

Nadalol 40mg TAB Corgard HS Motivation required*

Nadalol 80mg TAB Corgard Motivation required*

Nadalol and diuretic 40mg/5mg TAB Corgaretic-40 Motivation required*


Nebivolol 5mg TAB Nebilet Motivation required*

Propranolol 10mg TAB Indoblok Prodorol Purbloka Accepted treatment

Propranolol 160mg CAP Inderal LA Motivation required*



Timolol, thiazides and other diuretics 10/2.5/25mg TAB Servatrin Motivation required*

Alpha/beta blockers

Carvedilol 12.5mg TAB Carloc Carvetrend Vediblok Accepted treatment

Carvedilol 25mg TAB Carloc Carvetrend Vediblok Accepted treatment


Vasodilators

Hydralazine 10mg TAB Hyperphen Accepted treatment

Hydralazine 25mg TAB Sandoz Hydralazine Accepted treatment

Hydralazine 50mg TAB Hyperphen Sandoz Hydralazine Accepted treatment

Cardiac glycosides

Digoxin 0.0625mg TAB Lanoxin Accepted treatment

Digoxin 0.25mg TAB Lanoxin Purgoxin Accepted treatment


Organic nitrates

Isosorbide dinitrate 10mg TAB Sandoz Isosorbide dinitrate Accepted treatment

Isosorbide dinitrate 30mg TAB Sandoz Isosorbide Accepted treatment

Isosorbide dinitrate 40mg TAB Isordil Tembid Accepted treatment


10


Chronic obstructive pulmonary disease

Beta agonists, short-acting

Fenoterol INH Berotec HFA Accepted treatment

Salbutamol 100mcg INH Venteze Asthavent Accepted treatment

Salbutamol 2.5mg SLN Ventolin nebules Motivation required

Salbutamol 200mcg CPS Asthavent Accepted treatment

Salbutamol 400mcg CPS Ventodisks Motivation required

Terbutaline 0.5mg INH Bricanyl Motivation required*

Anticholinergics, inhaled

Ipratropium bromide 20mcg INH Atrovent 20 HFA Accepted treatment

Ipratropium bromide 40mcg INH Ipvent Accepted treatment

Ipratropium bromide and salbutamol 20mcg/100mcg INH Combivent Motivation required

Tiotropium bromide CPS Spiriva Motivation required

Corticosteroids, inhaled

Beclometasone 100mcg INH Beclate Special investigations



Budesonide 100mcg INH/CPS Inflacor Budeflam Inflammide Special investigations

Budesonide 200mcg INH/CPS Inflacor Budeflam Inflammide Special investigations

Budesonide 400mcg INH/CPS Inflacor Inflammide Novoliser Special investigations

Cyclesonide 80mcg/4.5mcg INH Alvesco Special investigations

Cyclesonide 160mcg INH Alvesco Alvesco Special investigations

Fluticasone 100mcg INH Flixotide CFC-free Special investigations



Fluticasone 500mcg INH Flixotide accuhaler Special investigations


Corticosteroids and beta agonists, long-acting







Xanthines



Aminophylline 225mg SRT Phyllocontin Accepted treatment

Theophylline SYR Alcophyllin Nuelin liquid Accepted treatment

11



Theophylline 250mg SRT Nuelin SA Accepted treatment




Theophylline combinations excl. psycholeptics

SYR Solphyllin Theophen Accepted treatment

Chronic renal failure

Diuretics









Furosemide 80mg TAB Lasix Motivation required






Indapamide 1.5mg TAB Natrilix SR Motivation required












ACE inhibitors and combinations


Benazepril and diuretics 10mg/12.5mg FCT Cibadrex Motivation required



12









































13



































Diltiazem 240mg SRT Zildem SR Accepted treatment


Diltiazem 60mg TAB Zildem Accepted treatment




14









Nifedipine 20mg SRT Nifedalat SR Cipalat Retard Accepted treatment

Nifedipine 30mg SRT Adco-Vascard SR Fedaloc Accepted treatment

Nifedipine 60mg SRT Fedaloc Motivation required

Verapamil 240mg SRT Verahexal Calcicard Ravamil Accepted treatment

Verapamil and trandolapril 180mg/2mg SRC Tarka Motivation required


Acebutolol 100mg CAP Sectral Motivation required

Acebutolol 200mg CAP Sectral Motivation required

Acebutolol 400mg TAB Butobloc Sectral Motivation required









Bisoprolol and diuretic 10mg/6.25mg TAB Ziak Motivation required

Bisoprolol and diuretic 2.5mg/6.25mg TAB Ziak Motivation required

Bisoprolol and diuretic 5mg/6.25mg TAB Ziak Motivation required

Metoprolol 100mg TAB Lopresor Motivation required

Nadalol 40mg TAB Corgard HS Motivation required

Nadalol 80mg TAB Corgard Motivation required

Nadalol and diuretic 40mg/5mg TAB Corgaretic-40 Motivation required

Nadalol and diuretic 80mg/5mg TAB Corgaretic-80 Motivation required

Nebivolol 5mg TAB Nebilet Motivation required






15


Erythropoietin and supplements

Alfacalcidol 0.25mg CAP One alpha Accepted treatment

Alfacalcidol 1mg CAP One alpha Accepted treatment

Calcium carbonate TAB Titralac Accepted treatment

Erythropoietin INJ Repotin Recormon Eprex Special investigations

Iron in other combinations INJ Venofer Cosmofer Special investigations

Folic acid 0.5mg TAB Folic acid Accepted treatment

Folic acid 5mg TAB/CAP Be-tabs folic acid Accepted treatment

Folic acid and vitamin B12 CAP Folic Acid Forte Accepted treatment

Iron supplementation subject to Qualsa Medicine Reimbursement Policy.

Coronary artery disease

Aspirin





Accepted treatment


Calcium channel blockers
















Verapamil 40mg TAB Vasomil Accepted treatment


Beta blockers




16
















Alpha/beta blockers




Organic nitrates

Glyceryl trinitrate 0.5mg TAB Angised Accepted treatment





Isosorbide mononitrate 20mg TAB Elantan Accepted treatment

Isosorbide mononitrate 50mg SRC Elantan LA Accepted treatment

Isosorbide mononitrate 60mg SRT Monicor Imdur Accepted treatment

Crohn's disease

Corticosteroids, topical

Budesonide ENE Entocord Motivation required


Betamethasone 0.5mg TAB Betanoid Motivation required

Budesonide 3mg CAP Entocord Motivation required

Methylprednisolone 4mg TAB Medrol Motivation required

Prednisolone 5mg TAB Lenisolone Capsoid Accepted treatment


5-ASA agents

Mesalazine 2g/50ml ENE Asacol Motivation required

Mesalazine 400mg TAB Asacol Motivation required

17



Mesalazine 500mg TAB/SUP Asacol Pentasa Motivation required

Olsalazine 250mg CAP Dipentum Motivation required

Sulfasalazine 500mg TAB Salazopyrin Accepted treatment

Immunosuppressants

Azathioprine 50mg TAB Zaprine Azathioprine 50 PCH Azapress Accepted treatment

Leflunomide 10mg TAB Arava Motivation required


Methotrexate 2.5mg TAB Methotrexate Emthexate Accepted treatment

Diabetes insipidus

Vasopressin analogues

Desmopressin 0.1mg/ml NAS/NOD DDAVP nasal spray 5ml DDAVP 2.5ml Motivation required

Desmopressin 0.1mg TAB DDAVP Motivation required

Desmopressin 0.2mg TAB DDAVP Motivation required

Diabetes mellitus type I

Insulin

Insulin (human) INJ Humulin Actraphane Protaphane Accepted treatment

Insulin aspart INJ Novorapid Novomix Accepted treatment

Insulin detemir INJ Levemir Motivation required

Insulin glargine INJ Lantus Motivation required

Insulin glulisine INJ Apidra Accepted treatment

Insulin lispro INJ Humalog Humalog Mix Accepted treatment

Diabetes mellitus type II

Suphonylureas

Glibenclamide 5mg TAB Sandoz Glibenclamide Diacare Glycomin Accepted treatment

Gliclazide 30mg TAB Diamicron MR Motivation required*

Gliclazide 40mg TAB Austell-gliclazide Accepted treatment

Gliclazide 80mg TAB Austell-gliclazide Merck-gliclazide Sandoz Gliclazide Accepted treatment

Glimepiride 1mg TAB Sulphonur Merck-Glimepiride Sandoz Glimepiride Accepted treatment

Glimepiride 2mg TAB Sulphonur Merck-Glimepiride Sandoz Glimepiride Accepted treatment

Glimepiride 3mg TAB Amaryl Motivation required*

Glimepiride 4mg TAB Sulphonur Merck-Glimepiride Sandoz Glimepiride Motivation required*

Glipizide 5mg TAB Minidiab Motivation required*

Insulin

Insulin (human) INJ Humulin Actraphane Protaphane Accepted treatment

Insulin aspart INJ Novorapid Novomix Accepted treatment

Insulin detemir INJ Levemir Motivation required

Insulin glargine INJ Lantus Motivation required

Insulin glulisine INJ Apidra Accepted treatment

18


Insulin lispro INJ Humalog Humalog Mix Accepted treatment

Biguanides and combinations

Metformin 1000mg TAB Glucophage Bigsens Metored Accepted treatment

Metformin 500mg TAB Austell-metformin Bigsens Forminal Accepted treatment

Metformin 850mg TAB Austell-metformin Bigsens Forminal Accepted treatment

Metformin and glibenclamide 250mg/1.25mg TAB Glucovance Motivation required

Metformin and glibenclamide 500mg/2.5mg TAB Glucovance Motivation required

Metformin and glibenclamide 500mg/5mg TAB Glucovance Motivation required

Thiazolidinediones

Pioglitazone 15mg TAB Cipla-pioglitazine Actos Motivation required

Pioglitazone 30mg TAB Cipla-pioglitazine Actos Motivation required

Rosiglitazone 2mg TAB Avandia Motivation required*

Rosiglitazone 4mg TAB Avandia Motivation required*

Other

Acarbose 50mg TAB Glucobay Motivation required

Acarbose 100mg TAB Glucobay Motivation required

Nateglinide 120mg TAB Starlix Motivation required

Repaglinide 0.5mg TAB Novonorm Motivation required

Repaglinide 1mg TAB Novonorm Motivation required

Repaglinide 2mg TAB Novonorm Motivation required

Dysrhythmias

Aspirin





Accepted treatment


Anticoagulants




Calcium channel blockers






Beta blockers


19










Metoprolol 100mg TAB Lopresor Motivation required







Sotalol 160mg TAB Sotahexal Motivation required

Sotalol 80mg TAB Sotahexal Motivation required

Cardiac glycosides

Digoxin 0.05mg/ml SYR Lanoxin Paed Accepted treatment



Antiarrhythmics

Amiodarone 100mg TAB Arycor Hexarone Accepted treatment

Amiodarone 200mg TAB Arycor Hexarone Bio-Amiodarone Accepted treatment

Disopyramide 100mg CAP Rythmodan Motivation required

Disopyramide 250mg TAB Rythmodan Motivation required

Flecainide 100mg TAB Tambocor Motivation required

Propafenone 150mg TAB Rhythmol Motivation required

Propafenone 300mg TAB Rhythmol Motivation required

Quinidine sulphate 200mg TAB Quinidine Motivation required

Epilepsy

Anticonvulsants

Carbamazepine 100mg/5ml SUS Tegretol S Accepted treatment




Accepted treatment

Ethosuxamide 250mg/5ml SYR Zarontin Accepted treatment

Felbamate 400mg TAB Taloxa Motivation required

Felbamate SUS Taloxa Motivation required

20


Gabapentin 100mg CAP Neurexal Epleptin Ran-gabapentin Motivation required



Gabapentin 600mg TAB Neurontin Motivation required

Gabapentin 800mg TAB Neurontin Motivation required


Lamotrigine 200mg TAB Lamidus Austell-lamotrigine Dyna-Lamotrigine Accepted treatment



Levetiracetam 250mg TAB Keppra Motivation required

Levetiracetam 750mg TAB Keppra Motivation required

Oxcarbazepine 300mg TAB Trileptal Accepted treatment

Oxcarbazepine 600mg TAB Trileptal Accepted treatment

Phenobarbital 30mg TAB Sedabard Lethyl Accepted treatment

Phenobarbital SYR Adco-phenobarb vital Accepted treatment

Phenytoin 100mg TAB/CAP Phenytoin sod Epanutin Accepted treatment

Phenytoin 125mg/5ml SUS Epanutin Accepted treatment





Topiramate 15mg CAP Topamax SC sprinkle Motivation required

Valproic acid 100mg TAB Epilim Accepted treatment


Valproic acid 200mg SRT Epilim Accepted treatment

Valproic acid 200mg/5ml SYR Epilim Accepted treatment

Valproic acid 300mg CAP Convulex Accepted treatment


Valproic acid 50mg/ml SYR Convulex Accepted treatment

Vigabatrin 500mg TAB Sabril Motivation required

Benzodiazepine derivatives

Clonazepam 0.5mg TAB Rivotril Motivation required

Clonazepam 2.5mg DRP Rivotril Motivation required

Clonazepam 2mg TAB Rivotril Motivation required

Glaucoma

Beta blockers

Betoxalol 0.25% OPD Betoptic S 5ml Accepted treatment

Betoxalol 5mg/ml OPD Betoptic 5ml Accepted treatment

Carteolol 2% OPD Teoptic 5ml Accepted treatment

21


Levobunolol 5% OPD Betagan 7.5ml Accepted treatment

Metapranolol 3% OPD Beta-opthiole 5ml Accepted treatment

Metapranolol 6% OPD Beta-opthiole 5ml Accepted treatment

Timolol 1mg/g OPD Nyogel Accepted treatment

Timolol 2.5mg/ml OPD Timoptol Accepted treatment

Timolol 5mg/ml OPD Glaucosan Timoptol Accepted treatment

Parasympathomimetics

Pilocarpine 10mg/ml OPD Isopto-carpine Accepted treatment



Sympathomimetics

Brimonidine OPD Alphagan Purite Motivation required

Dipivefrine 1% OPD Propine Motivation required

Carbonic anhydrase inhibitors

Acetazolamide 250mg TAB Azomid Motivation required

Brinzolamide 1% OPD Azoptic 5ml eye suspension

Motivation required

Dorzolamide 2% OPD Trusopt Motivation required

Prostaglandin analogues

Bimatoprost 0.3mg/3ml OPD Lumigan Motivation required

Latanoprost OPD Xalatan 2.5ml Motivation required

Travoprost 4% OPD Travatan Motivation required

Beta blockers, combinations

Timolol and dordolamide OPD Cosopt Motivation required

Timolol and latanoprost OPD Xalacom Motivation required

Timolol and travoprost OPD DuoTrav Motivation required

Haemophilia

Analgesics and antipyretics

Paracetamol 120mg/5ml SYR Feverpain Napamol Painblok Accepted treatment

Paracetamol 500mg TAB Napamol Gencetamol Antalgic Accepted treatment

Antifibrinolytics

Tranexamic acid 500mg TAB Cyklokapron Special investigations

Heart failure

Aspirin





Accepted treatment


22


Anticoagulants




Diuretics




Eplerenone 25mg TAB Inspra Motivation required

Eplerenone 50mg TAB Inspra Motivation required






























23









































24



























Valsartan and diuretic 80mg/12.5mg TAB Co-tareg Motivation required














25


















Bisoprolol and diuretic 10mg/6.25mg TAB Ziak Motivation required*

Bisoprolol and diuretic 2.5mg/6.25mg TAB Ziak Motivation required*

Bisoprolol and diuretic 5mg/6.25mg TAB Ziak Motivation required*












Alpha/beta blockers




Vasodilators




26


Cardiac glycosides

Digoxin 0.05mg/ml SYR Lanoxin Paed Accepted treatment



Organic nitrates





Hyperlipidaemia

Aspirin

Acetylsalicylic acid 100mg TAB Bayer aspirin cardio Accepted treatment




Accepted treatment


Fibrates

Bezafibrate 200mg TAB Bezalip Special investigations

Bezafibrate 400mg TAB Sandoz bezafibrate Bezachole SR Dyna-Bezafibrate SR Special investigations

Fenofibrate 200mg CAP Lipanthyl Motivation required

Gemfibrozil 600mg TAB Lopid Motivation required

Statins

Atorvastatin 10mg TAB Aspavor Lipitor Motivation required



Atorvastatin 80mg TAB Lipitor Motivation required

Fluvastatin 20mg CAP Lescol Motivation required

Fluvastatin 40mg CAP Lescol Motivation required

Fluvastatin 80mg TAB Lescol Motivation required

Lovastatin 20mg TAB Lovachol Special investigations

Lovastatin 40mg TAB Lovachol Special investigations

Pravastatin 10mg TAB Sandoz Pravastatin Aspen-pravastatin Pranalip Motivation required

Pravastatin 20mg TAB Sandoz Pravastatin Aspen-pravastatin Pranalip Motivation required

Pravastatin 40mg TAB Sandoz Pravastatin Aspen-pravastatin Colite Motivation required

Rosuvastatin 10mg TAB Crestor Motivation required




Simvastatin 10mg TAB Arrow-simvastatin Zocor Michol Special investigations

27




Simvastatin 80mg TAB Zysim Cipla-simvastatin Michol Special investigations

Statins, combinations

Atorvastatin and amlodipine 10mg/5mg TAB Caduet Motivation required








Other

Colestyramine SAC Questran Lite Motivation required

Ezetimibe 10mg TAB Ezetrol Motivation required

Probucol 250mg TAB Lurselle Motivation required

Hypertension

Aspirin






Accepted treatment

Diuretics
















28









































29









































30






























Verapamil and trandolapril 180mg/2mg SRC Tarka Motivation required











31




Bisoprolol and diuretic 2.5mg/6.25mg TAB Ziak Accepted treatment














Alpha/beta blockers




Alpha blockers

Doxazosin 1mg TAB Adco-doxazosin Cardugen Accepted treatment

Doxazosin 2mg TAB Adco-doxazosin Accepted treatment

Doxazosin 4mg TAB Adco-doxazosin Cardugen Accepted treatment

Doxazosin (extended-release) 4mg TAB Cardura XL Motivation required

Doxazosin (extended-release) 8mg TAB Cardura XL Motivation required

Prazosin 1mg TAB Pratsiol Accepted treatment



Terazosin 1mg TAB Hytrin Motivation required




Vasodilators




Minoxidil 10mg TAB Loniten Motivation required

Minoxidil 5mg TAB Loniten Motivation required

32


Antiadrenegic agents, centrally acting

Methyldopa 250mg TAB Hypotone Sandoz Methyldopa Merck-methyldopa Accepted treatment

Methyldopa 500mg TAB Hypotone Accepted treatment

Moxonidine 0.2mg TAB Moxotens Cynt Physiotens Motivation required

Moxonidine 0.3mg TAB Moxotens Physiotens Motivation required

Moxonidine 0.4mg TAB Moxotens Cynt Physiotens Motivation required

Reserpine 0.25mg TAB Reserpine Accepted treatment

Reserpine and diuretics TAB Brinerdin Motivation required

Hypothyroidism

Thyroid hormones

Levothyroxine 100mcg TAB Eltroxin Euthyrox Accepted treatment

Levothyroxine 50mcg TAB Eltroxin Euthyrox Accepted treatment

Levothyroxine 25mcg TAB Euthyrox Accepted treatment

Liothyronine 20mcg TAB Tertroxin Accepted treatment

Thyroxine and liothyronine 90mcg/10mcg TAB Diotroxin Accepted treatment

Multiple sclerosis


Amitriptyline 10mg TAB Trepiline Accepted treatment


Clomipramine 10mg TAB Equinorm Motivation required



Anticonvulsants




Accepted treatment

Immunosuppressants


Cyclophosphamide 50mg TAB Endoxan Motivation required


Muscle relaxants

Baclofen 10mg TAB Bio-baclofen Accepted treatment

Baclofen 25mg TAB Lioresal Motivation required*

Orphenadrine 100mg TAB Norflex Accepted treatment





33


Anticholinergics, oral

Darifenacin 7.5mg TAB Enablex Motivation required

Darifenacin 15mg TAB Enablex Motivation required

Oxybutynin 5mg TAB Lenditro Merck-oxybutynin Urihexal Accepted treatment

Oxybutynin (extended-release) 5mg TAB Lyrinel Motivation required

Oxybutynin (extended-release) 10mg TAB Lyrinel Motivation required

Propiverine 15mg TAB Detrunorm Motivation required

Solifenacin 5mg TAB Vesicare Motivation required

Solifenacin 10mg TAB Vesicare Motivation required

Tolterodine 2mg CAP Detrusitol SR Motivation required

Tolterodine 4mg CAP Detrusitol SR Motivation required

Trospium 20mg TAB Uricon Motivation required

Parkinson's disease

Dopa and dopa derivatives, combinations

Carbidopa and levodopa 25mg/100mg TAB Carbilev Accepted treatment

Carbidopa and levodopa 25mg/250mg TAB Carbilev Accepted treatment

Carbidopa and levodopa 50mg/200mg SRT Sinemet CR Accepted treatment

Levodopa and benserazide 100mg/25mg CAP Madopar HBS Accepted treatment

Levodopa and benserazide 200mg/50mg TAB Madopar Accepted treatment

Levodopa, carbidopa and entecapone 50/12.5/200mg TAB Stalevo Motivation required

Levodopa, carbidopa and entecapone 100/25/200mg TAB Stalevo Motivation required

Levodopa, carbidopa and entecapone 150/37.5/200mg TAB Stalevo Motivation required

Anticholinergics, oral

Biperiden 2mg TAB Akineton Accepted treatment

Orphenadrine 50mg TAB Disipal Accepted treatment


Adamantine derivatives

Amantadine 100mg CAP Symadin Accepted treatment

Dopamine agonists

Bromocriptine 2.5mg TAB Aspen-Bromocriptine Motivation required

Bromocriptine 5mg CAP Parlodel Motivation required

Pramipexole 0.125mg TAB Pexola Motivation required

Pramipexole 0.5mg TAB Pexola Motivation required

Pramipexole 1mg TAB Pexola Motivation required

Ropinirole 0.25mg TAB Requip Motivation required

Ropinirole 0.5mg TAB Requip Motivation required

Ropinirole 1mg TAB Requip Motivation required

Ropinirole 2mg TAB Requip Requip XL Motivation required

Ropinirole 4mg TAB Requip XL Motivation required

34


Ropinirole 5mg TAB Requip Motivation required

Ropinirole 8mg TAB Requip XL Motivation required

Monoamine oxidase type B inhibitors

Selegiline 5mg TAB Parkilyne Accepted treatment

Catechol-O-methyltransferase inhibitors

Entecapone 200mg TAB Comtan Motivation required

Tolcapone 100mg TAB Tasmar Motivation required

Rheumatoid arthritis

Immunosuppressants






Other

Chloroquine 150mg TAB Daramal Accepted treatment

Chloroquine 200mg TAB/CAP Nivaquine Plasmoquine Accepted treatment






Prednisone 20mg TAB Pulmison Accepted treatment

Prednisone 50mg TAB Meticorten Motivation required*

Non-steroidal anti-inflammatory drugs

Diclofenac 100mg SRT/CAP Fortfen SR Sandoz Diclofenac sodium SR Difen SR Accepted treatment

Diclofenac 25mg TAB Merck-diclofenac sodium Diclohexal A-lennon diclofenac Accepted treatment


Diclofenac 75mg CAP/TAB Panamor SR Veltex CR Accepted treatment

Diclofenac and misoprostol 50mg ECT Arthrotec Motivation required

Diclofenac and misoprostol 75mg TAB Arthrotec Motivation required

Flurbiprofen 200mg CAP Froben SR Motivation required

Ibuprofen 100mg/5ml SUS Ibumax Ibugesic Advil paediatric suspension Accepted treatment

Ibuprofen 200mg TAB Ranfen Ibunate Betaprofen Accepted treatment

Ibuprofen 400mg TAB Ranfen Adco-ibuprofen Betaprofen 400 FC Accepted treatment

Ibuprofen 600mg TAB Sandoz Ibuprofen Accepted treatment

Ibuprofen 800mg TAB Brufen Retard Motivation required*

Indomethacin 100mg SUP Arthrexin Accepted treatment

Indomethacin 25mg CAP Betacin Gulf-indomethacin Adco-indomethacin Accepted treatment

35


Indomethacin 50mg CAP Arthrexin Accepted treatment

Ketoprofen 200mg SRT Ketoflam Accepted treatment

Lornoxicam 4mg TAB Xefo Motivation required


Mefenamic acid 250mg CAP Sandoz Mefenamic acid Fenamin Adco-mefenamic acid Motivation required

Mefenamic acid 500mg TAB Ponac Forte Fenamin Ponstel Forte Motivation required

Meloxicam 15mg TAB Zydus-meloxicam Flexocam Loxiflam Accepted treatment

Meloxicam 7.5mg TAB Zydus-meloxicam Flexocam Loxiflam Accepted treatment

Naproxen 250mg TAB/ECT Merck-naproxen Napflam Naprel Accepted treatment

Naproxen 500mg TAB Napflam Accepted treatment

Naproxen 500mg SUP Nafasol Motivation required

Piroxicam 10mg CAP Adco-piroxicam Accepted treatment

Piroxicam 20mg CAP/DSP Xycam Roxifen Pyrocaps Accepted treatment

Tenoxicam 20mg TAB Tilcotil Motivation required

Analgesics and antipyretics

Paracetamol 120mg/5ml SYR Feverpain Napamol Painblok Accepted treatment

Paracetamol 500mg TAB Napamol Gencetamol Antalgic Accepted treatment

Paracetamol combinations excl. psycholeptics

500mg/10mg TAB Napacod Accepted treatment

COX-2 inhibitors

Celecoxib 100mg CAP Celebrex Motivation required


Schizophrenia



Clomipramine 10mg TAB Equinorm Accepted treatment

Clomipramine 25mg TAB Equinorm Clomidep Accepted treatment

Dothiepin 25mg CAP Thaden Sandoz-dothiepin Accepted treatment

Dothiepin 75mg TAB Thaden Sandoz-dothiepin Accepted treatment


Lofepramine 70mg TAB Emdalen Motivation required





Trimipramine 25mg TAB Tydamine Motivation required*

Trimipramine 50mg CAP Tydamine Motivation required*




36



Escitalopram 5mg TAB Lexamil Motivation required*

Escitalopram 10mg TAB Lexamil Citraz Aspen Escitalopram Motivation required*

Escitalopram 20mg TAB Lexamil Citraz Motivation required*



Fluvoxamine 10mg TAB Faverin Fluvoxamine-hexal Motivation required*

Paroxetine 20mg TAB Serrapress Austell-paroxetine Xet Motivation required*

Paroxetine 30mg TAB Serrapress Austell-paroxetine Motivation required*

Sertraline 50mg TAB Serlife Austell-sertraline Arrow Sertraline Motivation required*

Sertraline 100mg TAB Serlife Austell-sertraline Motivation required*

Serotonin and noradrenaline re-uptake inhibitors

Duloxetine 30mg CAP Cymbalta Motivation required

Duloxetine 60mg CAP Cymgen Cymbalta Motivation required

Venlafaxine 37.5mg CAP Venlor Odiven Motivation required

Venlafaxine 50mg TAB Efexor Motivation required

Venlafaxine 75mg CAP Venlor Sandoz Venlafaxine Odiven Motivation required

Venlafaxine 150mg CAP Venlor Sandoz Venlafaxine Motivation required




Other





Reboxetine 4mg TAB Edronax Motivation required






Mood stabilisers




Antipsychotics

Amisulpiride 200mg TAB Solian Motivation required


37


Ariprazole 10mg TAB Abilify Motivation required






Clozapine 100mg TAB Cloment Accepted treatment






Olanzepine 10mg TAB Zyprexa Motivation required

Olanzepine 2.5mg TAB Zyprexa Motivation required

Olanzepine 5mg TAB Zyprexa Motivation required

Pimozide 1mg TAB Orap Motivation required

Pimozide 4mg TAB Orap Motivation required

Quetiapine 25mg TAB Seroquel Motivation required




Risperidone 0.5mg TAB DRL-Risperidone Risperidone-Hexal Merck-Risperidone Motivation required

Risperidone 1mg TAB DRL-Risperidone Risperidone-Hexal Merck-Risperidone Motivation required


Risperidone 3mg TAB DRL-Risperidone Risperidone-Hexal Perizal Motivation required

Risperidone 4mg TAB Aspen Risperidone Risponz Motivation required



Ziprasidone 20mg CAP Geodon Motivation required






Systemic lupus erythematosus

Immunosuppressants


38


Other



Aspirin






Accepted treatment






Non-steroidal anti-inflammatory drugs and combinations

Diclofenac 100mg SRT/CAP Fortfen SR Sandoz Diclofenac sodium SR Difen SR Accepted treatment



Diclofenac 75mg CAP/TAB Panamor SR Veltex CR Accepted treatment

Diclofenac and misoprostol 50mg ECT Arthrotec Motivation required

Diclofenac and misoprostol 75mg TAB Arthrotec Motivation required

Flurbiprofen 200mg CAP Froben SR Motivation required

Ibuprofen 100mg/5ml SUS Ibumax Ibugesic Advil paediatric suspension Accepted treatment

Ibuprofen 200mg TAB Ranfen Ibunate Betaprofen Accepted treatment

Ibuprofen 400mg TAB Ranfen Adco-ibuprofen Betaprofen 400 FC Accepted treatment

Ibuprofen 600mg TAB Sandoz Ibuprofen Accepted treatment

Ibuprofen 800mg TAB Brufen Retard Motivation required

Indomethacin 100mg SUP Arthrexin Accepted treatment

Indomethacin 25mg CAP Betacin Gulf-indomethacin Adco-indomethacin Accepted treatment

Indomethacin 50mg CAP Arthrexin Accepted treatment

Ketoprofen 200mg SRT Ketoflam Accepted treatment



Mefenamic acid 250mg CAP Sandoz Mefenamic acid Fenamin Adco-mefenamic acid Motivation required

Mefenamic acid 500mg TAB Ponac Forte Fenamin Ponstel Forte Motivation required

Meloxicam 15mg TAB Zydus-meloxicam Flexocam Loxiflam Accepted treatment

Meloxicam 7.5mg TAB Zydus-meloxicam Flexocam Loxiflam Accepted treatment

Naproxen 250mg TAB/ECT Merck-naproxen Napflam Naprel Accepted treatment

Naproxen 500mg TAB Napflam Accepted treatment

39


Naproxen 500mg SUP Nafasol Motivation required

Piroxicam 10mg CAP Adco-piroxicam Accepted treatment

Piroxicam 20mg CAP/DSP Xycam Roxifen Pyrocaps Accepted treatment

Tenoxicam 20mg TAB Tilcotil Motivation required

COX-2 inhibitors




Betamethasone 0.10% CRM/UNG Persivate Repivate Vari-betamethasone Accepted treatment

Betamethasone 0.5mg/100g CRM Betnovate Motivation required*

Betamethasone 0.05% CRM/UNG Diprosone Motivation required*

Clobetasol 0.05% LOT Dermovate scalp Motivation required

Clobetasol 0.5mg CRM/UNG Dovate Xenovate Motivation required

Clobetasone CRM/UNG Eumovate Accepted treatment

Diflucortolone 0.1% CRM/UNG Nerisone Motivation required

Diflucortolone 0.3% UNG Nerisone Forte Motivation required

Flucinolone 0.025mg/g CRM/UNG/GEL Cortoderm Synalar Accepted treatment

Fluticasone 0.005% UNG Cutivate Motivation required*

Fluticasone 0.05% CRM Cutivate Motivation required*

Hydrocortisone 0.5mg UNG Dilucort Accepted treatment

Hydrocortisone 10mg/g CRM/UNG Vari-hydrocortisone Biocort (STX) Mylocort Accepted treatment

Hydrocortisone 5mg/g CRM/LOT Dilucort Link mezzoderm Accepted treatment

Hydrocortisone butyrate CRM/UNG/LOT Locoid Motivation required*

Methylprednisolone aceponate CRM/UNG Advantan Motivation required*

Mometasone 0.1% CRM/UNG/LOT Aspen-mometasone Elocon Motivation required

Ulcerative colitis


Budesonide ENE Entocord Motivation required


Betamethasone 0.5mg TAB Betanoid Motivation required

Budesonide 3mg CAP Entocord Motivation required




5-ASA agents

Mesalazine 2g/50ml ENE Asacol Motivation required



Mesalazine 500mg TAB/SUP Asacol Pentasa Motivation required

40


Olsalazine 250mg CAP Dipentum Motivation required


Immunosuppressants


DIAGNOSIS AND TREATMENT PAIRS (DTP) CONDITIONS

Anaemia

Iron supplementation, oral

Ferrous salts TAB/CAP Ferrous sulph co Ferrimed Ferrous Forte Special investigations

Iron and folic acid TAB/CAP Pregamal Fefol Foliglobin Special investigations

Iron supplementation subject to Qualsa Medicine Reimbursement Policy.

Vitamin B

Folic acid 0.5mg TAB Folic acid Special investigations

Folic acid 5mg TAB/CAP Be-tabs folic acid Special investigations

Folic acid and vitamin B12 CAP Folic Acid Forte Special investigations

Cyanocobalamin INJ Cobalatec Vitamin B12 Special investigations

Cushing's syndrome

Growth hormone release inhibitor

Ketoconazole 200mg TAB Sandoz Ketoconazole Ketazol Motivation required

Octreotide 0.05mg INJ Sandostatin Motivation required



Octreotide 10mg INJ Sandostatin Motivation required

Octreotide 20mg INJ Sandostatin Motivation required

Delusional disorders



Dothiepin (dosulepin) 25mg CAP Thaden Sandoz-dothiepin Accepted treatment

Dothiepin (dosulepin) 75mg TAB Thaden Sandoz-dothiepin Accepted treatment










41


Other



Sulpiride 50mg CAP Espiride Sandoz Sulpiride Accepted treatment

Antipsychotics





















Treatment for associated presenting symptoms subject to Qualsa Medicine Reimbursement Policy.

Depression













42





Moclobemide 150mg TAB Depnil Motivation required


Other




Endometriosis

Hormonal preparations, oral

Cyproterone 2mg TAB Diva-35 Claro-35 Ginette Motivation required

Cyproterone 50mg TAB Cyproplex Cipla-Cyproterone Motivation required

Desogestrel and estrogen TAB Mercilon Marvelon Motivation required

Drospirenone and estrogen TAB Triodene Tri-minulet Motivation required

Gestodene and estrogen TAB Femodene Melodene Minulette Motivation required

Levonorgestrel and estrogen TAB Biphasil Triphasil Logynon Motivation required

Medroxyprogesterone TAB Hexal MPA Provera Accepted treatment

Norethisterone 5mg TAB Primolut n Accepted treatment

Norethisterone and estrogen TAB Trinovum Motivation required

Norgestimate and oestrogen TAB Tricilest Motivation required

Antigonadotropins

Danazol 100mg CAP Danogen Motivation required

Danazol 200mg CAP Danogen Motivation required

Hyperparathyroidism

Aminoquinolines



Calcitonin

Calcitonin 200iu NAS Miacalcic Motivation required

Calcitonin 100iu INJ Miacalcic Motivation required

Hyperprolactinaemia

Antiprostaglandins

Bromocriptine 2.5mg TAB Aspen-Bromocriptine Special investigations

Bromocriptine 5mg CAP Parlodel Special investigations

Quinagolide 75mcg TAB Norprolac Special investigations

Quinagolide 150mcg TAB Norprolac Special investigations

43


Hyperthyroidism

Imidazole derivatives

Carbimazole 5mg TAB Neo-Mercazole Motivation required

Beta Blockers



Hypoparathyroidism

Calcium supplementation

Calcium TAB/EFT Fizzical B-cal Caltrate Accepted treatment

Calcium and vitamin D TAB Calpin D B-cal-D Accepted treatment

Calcium supplementation subject to Qualsa Medicine Reimbursement Policy.

Idiopathic thrombocytopaenic purpura

Corticosteroids

Betamethasone 0.5mg TAB Betanoid Celestone Motivation required

Prednisolone 5mg TAB Capsoid Lenisolone Accepted treatment



Alkylating agents


Immunosuppressive agents



Menopause

Hormone replacement therapy

Conjugated estrogen TAB Premarin Accepted treatment

Drospirenone and estrogen 1mg/2mg TAB Angeliq Accepted treatment

Dydrogesterone and estrogen TAB Femoston Accepted treatment

Estradiol PAD/TAB/IMP Estraderm Estrofem Oestradiol Accepted treatment

Medrogestone and estrogen TAB Premelle Prempak Accepted treatment

Medroxyprogesterone TAB Hexal MPA Provera Accepted treatment

Norethisterone and estrogen PAD/TAB Estalis Activelle Accepted treatment

Alpha-2 agonists

Clonidine 0.025mg TAB Menograine Dixarit Accepted treatment

Motor neuron disease

Other nervous system drugs

Riluzole 50mg TAB Rilutek Motivation required


44


Muscular dystrophy

Corticosteroids




Anticonvulsants

Phenytoin 100mg TAB/CAP Phenytoin sod Epanutin Accepted treatment

Phenytoin 125mg/5ml SUS Epanutin Accepted treatment


Myasthenia gravis

Corticosteroids






Parasympathomimetics

Pyridostigmine 10mg TAB Mestinon Motivation required

Pyridostigmine 60mg TAB Mestinon Motivation required

Organ transplant

Corticosteroids






Azathioprine 50mg TAB Zaprine Azathioprine 50 PCH Azapress Motivation required

Ciclosporin 25mg CAP Ciclohexal Motivation required

Ciclosporin 100mg CAP Ciclohexal Motivation required

Ciclosporin 500mg/5ml SYR Sandimmun Neoral Motivation required

Mycophenolate mofetil 250mg CAP Mycophenolate-Hexal Motivation required

Mycophenolate mofetil 500mg CAP Cellcept Motivation required

Mycophenolate mofetil 200mg/ml SUS Cellcept Motivation required

Mycophenolate sodium 180mg TAB Myfortic Motivation required

Mycophenolate sodium 360mg TAB Myfortic Motivation required

Sirolimus 1mg TAB Rapamune Motivation required

Tacrolimus 0.5mg CAP Prograf Motivation required

Tacrolimus 1mg CAP Prograf Motivation required

Tacrolimus 5mg CAP Prograf Motivation required

45


Pemphigus

Corticosteroids





Alkylating agents





Peripheral vascular disease

Aspirin





Accepted treatment


Anticoagulants





Polyarteritis nodosa

Corticosteroids





Alkylating agents





Post-traumatic stress disorder




Clomipramine 75mg SRT Anafranil simple regimen Motivation required

46
















Other




Schizo-affective disorder














Other



Sulpiride 50mg CAP Espiride Sandoz Sulpiride Accepted treatment




47


Mood stabilisers




Antipsychotics





















Spinal cord injuries

Antipropulsives

Loperamide 2mg TAB Prodium Norimode Gastron Accepted treatment

Loperamide 1mg/5ml SYR Loperastat Adco-loperamide Accepted treatment

Laxatives

Bisacodyl 5mg TAB Laxador Bisacodyl Accepted treatment

Glycerol SYR/SUP Glycerine BP Glycerine Adult Glycerine Infant Accepted treatment

Ispaghula and combinations GRA/SAC Fibrelle Ispagel Agiobulk Accepted treatment

Lactulose 3.3g/5ml SYR Aculax Lacson Adco-liquilax Accepted treatment

Lactulose SAC Duphalac dry Accepted treatment

Senna glycosides and combinations TAB/GRA Senokot Soflax Agiolax Accepted treatment


Amitriptyline 10mg TAB Trepiline Accepted treatment


48


Muscle relaxants

Baclofen 10mg TAB Bio-baclofen Accepted treatment

Baclofen 25mg TAB Lioresal Motivation required


Antibiotics, oral

Nitrofurantoin 50mg CAP Macrodantin Accepted treatment

Nitrofurantoin 100mg CAP Macrodantin Accepted treatment

Stroke

Aspirin





Accepted treatment


Anticoagulants





Thromboembolic disease

Aspirin





Accepted treatment


Anticoagulants





Transient ischaemic attack

Aspirin





Accepted treatment


49


Anticoagulants





Valvular disease

Antibiotics

Benzylpenicillin INJ Benzylpenicillin-fresenius Accepted treatment

Phenoxymethylpenicillin 250mg TAB Len-VK Betapen Accepted treatment


comprehensive medication formulary effective 1 january …1272010103808 am... · 1 comprehensive...

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