provincial code list - · pdf filed02ac ø aqueous cream 1 b.p. 100g cream aqueous...

ANNEXURE A

ISSUE No. 02/10

UPDATED: 26-May-11INCLUDES: Supplementary List No: 123 and 124

to access cover sheet on page 1 above - unfreeze panes

*EDL 1= Primary; A= Hospital Level Adult; P = Hospital Level Paediatrics

ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT

CATALOGUE OF APPROVED PHARMACEUTICALS FOR USE

IN THE DEPARTMENT OF HEALTH

PROVINCIAL CODE LIST

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4-epi-doxorubicin: see epirubicin5-fluoro-uracil: see fluorouracil

J05AF 18.12pgwcARV depot

abacavir 20mg/ml 240ml solution ZIAGEN AIDS programmeAvailable through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.

J05AF 18.12pgwcARV depot

abacavir 300mg 60 tablet ZIAGEN AIDS programme As above.

R05CB 28 Supp List 118 N-acetylcysteine1

A P200mg/ml 1 injection PARVOLEX

S01EC 16.1 acetazolamide A 500mg/10ml 1 injection DIAMOX; AZOMID

Specialist: neurologist, neurosurgeon & opthalmologist

S01EC 16.1 Supp List 119 acetazolamide1

A P250mg 100 tablet DIAMOX

General . neurologist, neurosurgeon & ophthalmologist Initiated

General - for Glaucoma emergencies

S02AA Ø Supp List 118 acetic acid 1 1% in aqueous 10ml ear dropsX Ø acetone 500ml liquid ACETONE

S01EB 15.7 acetylcholine + mannitol40mg + 200mg/ 4,5ml

1intraocular injection

COVOCHOLSpecialist: ophthalmologist

acetylsalicylic acid: see aspirinacid citrate monohydrate: see citric acid

D05BB 14.5 acitretin A 10mg 30 capsule NEOTIGASONSpecialist: dermatologist



R02AA Ø acriflavine 0,1% 100ml emulsionACRIFLAVIN EMULSION

R02AA Ø acriflavine 0,1% 500ml emulsionACRIFLAVIN EMULSION

S01AD 15.1.1 acyclovir A 30mg/g 4,5g eye ointment ZOVIRAXSpecialist : ophthalmologist

J05AB 18.12 acyclovir A P 250mg 5 injection ZOVIRAX Specialist J05AB 18.12 acyclovir P 200mg/5ml 125ml suspension ZOVIRAX Specialist

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J05AB 18.12Suppl List 119/122

acyclovir 1 A P 200mg 25 tablet ZOVIRAXGeneral Clinical Nurse Practitioner

General: For Primary Genital Herpes, GUS, Chronic Herpetic Ulcer, Herpes Zoster, Eczema Herpeticum, Herpes Stomatitis and Ophthalmic Zoster: According to H135/2002 Addendum A - Supp List 92. Clinical Nurse Practitioner:Genital Ulcer Syndrome (GUS) according to EDL STG's

J05AB 18.12Suppl List 119/122

acyclovir 1 A P 400mg 70 tablet ZOVIRAXGeneral Clinical Nurse Practitioner

General: For Primary Genital Herpes, GUS, Chronic Herpetic Ulcer, Herpes Zoster, Eczema Herpeticum, Herpes Stomatitis and Ophthalmic Zoster: According to H135/2002 Addendum A - Supp List 92. Clinical Nurse Practitioner:Genital Ulcer Syndrome (GUS) according to EDL STG's

adamson's ointment modified:look under LPC 4% ……..

C01EB 7.2 Supp List 122 adenosine A P 6mg/2ml 1 injection ADENOCORC01CA 7.1.2 adrenaline B.P. 1 A P 1:1000 1mg/ml 1 injection ADRENALINE

P02CA 13Suppl List 119/121

albendazole 1 A P 200mg 2 tablet ZENTEL

For: - Children under two years of age - Neurocysticercosis - Hydatid cysts - Tape worm - Sandworm

P02CA 13Suppl List 119/121

albendazole 1 A P 400mg 2 tablet ZENTEL

For: - Children under two years of age - Neurocysticercosis - Hydatid cysts - Tape worm - Sandworm

B05AA Ø albumin, normal serum P 0.2 50ml infusionSpecialist paediatrician

B05AA Ø albumin, normal serum P 0.2 100ml infusionSpecialist paediatrician

M05BA 4.7.1 alendronate A 10mg 30 tablets OSTEOBONSpecialist endocrinologist initiated

Endocrinologist initiated with 18-month follow-up with endocrinilogist. Restricted to severe osteoporosis with T-score -2,5 or less plus osteoporotic fracture

A11CC 20.1 alfacalcidol P 0,25µg 30 capsule ONE-ALPHA

Specialist physicians and paediatricians initiated

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A11CC 20.1 alfacalcidol P 1µg 30 capsule ONE-ALPHA

Specialist physicians and paediatricians initiated

N01AH 2.1.2 alfentanil A 1mg/2ml 1 injection RAPIFEN SpecialistN01AH 2.1.2 alfentanil A 5mg/10ml 5 injection RAPIFEN Specialist

A02BX 12.4.1

alginic acid + aluminium hydrox. dried gel + magnesium trisil. + sodium bicarb.

924mg + 200mg + 50mg + 340mg/2g

2g sachets GAVISCON INFANTSpecialist: paediatrician

For use in paediatrics for PROVEN reflux oesophagitis.

Supp List 124allergen-skin prick tests for allergy

ALLERGEN SKIN PRICK TESTS

Allergy clinics

M04AA 4.2 allopurinol A P 100mg 500 tablet ZYLOPRIM; PURICOSM04AA 4.2 allopurinol 300mg 30 tablet ZYLOPRIM

C01EA 7.5 alprostadil 0,5mg/ml 1 injection PROSTIN VRSpecialist: paediatrician

G04BE 17.5.2 alprostadil 20µg/ml 1 injection CAVERJECTCentral HospitalsSpecialist: urologist

Urology. Erectile dysfunction. Maximum of 4 doses.Patient name basis.

B01AD 8.3 alteplase 50mg 1 injection ACTILYSE SpecialistFor acute arterial occlusion and deep vein thrombosis.

A02AB 12.4 aluminium hydroxide A 300mg/5ml 350ml suspension AMPHOGELA02AB 12.4 aluminium hydroxide A 300mg/5ml 2 500ml suspension AMPHOGEL

A02AD 12.4aluminium hydrox. + magnesium trisil.

1 A 250mg + 500mg 24 tablet GELUSIL

A02AD 12.4aluminium hydrox. + magnesium trisil.

1 A 250mg + 500mg 96 tablet GELUSIL

A02AD 12.4.1 Supp List 124aluminium hydrox.+ magnesium hydrox. + oxethazaine

291mg + 98mg + 10mg/5ml

500ml suspension MUCAINESpecialist oncologist

For radio-oncology patients only, non-referable. Maximum dose 10ml 4 times daily.

N04BB 1.7.1 amantadine HCl 100mg 20 capsuleSYMMETREL; ANTADINE

Specialist: neurologist

D04AB 2.2.1 amethocaine HCl 0.01 25g cream ANETHAINEamethopterin: See methotrexate

J01GB 18.3 amikacin A P 100mg 1 injection AMIKIN; KACINTH-A SpecialistTo be confirmed on a microbiologist report or requested on the motivation form. Restriction exempted for ICU's.

J01GB 18.3 amikacin P 250mg 1 injection AMIKIN Specialist As aboveJ01GB 18.3 amikacin A 500mg 1 injection AMIKIN Specialist As above

N05AL 1.5.3Suppl List 116

amisulpiride 50mg 30 tablet SOLIAN

Specialist psychiatrist initiated with annual review with psychiatrist

For patients who have not responded to or experienced intolerable side effects with other coded anti-psychotics. To be used in line with the Mental Health protocol

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N05AL 1.5.3Suppl List 116

amisulpiride 200mg 30 tablet SOLIAN

Specialist psychiatrist initiated with annual review with psychiatrist

For patients who have not responded to or experienced intolerable side effects with other coded anti-psychotics. To be used in line with the Mental Health protocol

B02AA 8.1 aminocaproic acid A 250mg/ml 20ml injection AMICARR03DA 10.2.2 aminophylline I.V. 1 A P 250mg/10ml 1 injection PETERPHYLLIN

C01BD 7.2 amiodarone HCl A 150mg/3ml 1 injection CORDARONE X Specialist physician

C01BD 7.2 amiodarone HCl A 200mg 30 tablet CORDARONE X Specialist physician

N06AA 1.4.1 amitriptyline 1 A P 10mg 500 tabletTRYPTANOL; TREPILINE

N06AA 1.4.1 amitriptyline 1 A P 25mg 28 tablet TRYPTANOLN06AA 1.4.1 amitriptyline 1 A P 25mg 56 tablet TRYPTANOLN06AA 1.4.1 amitriptyline 1 A P 25mg 84 tablet TRYPTANOLN06AA 1.4.1 amitriptyline 1 A P 25mg 112 tablet TRYPTANOL

N06AA 1.4.1 amitriptyline 1 A P 25mg 168 tabletTREPILINE-25;ENDEP 25

N06AA 1.4.1 amitriptyline A P 25mg 500 tablet TRYPTANOL

C08CA 7.3.7Supp List 114 and 119

amlodipine1 A

5mg 30 tablet NORVASC

For a maximum daily dose of up to10mg.When initiating a long acting calcium channel blocker in adults, commence with Amlodipine 5mg per day.NB: For complete guidelines on substituting Nifedipine extended release with Amlodipine: See Ci l H5/2006 A d t (S l Li t 104

C08CA 7.3.7 Supp List 120 amlodipine1 A

10mg 30 tabletNORVASC; AMIODAC 10

For a maximum daily dose of up to10mg.When initiating a long acting calcium channel blocker in adults, commence with Amlodipine 5mg per day.NB: For complete guidelines on substituting Nifedipine extended release with Amlodipine: See Ci l H5/2006 A d t (S l Li t 104amoxycillin + clavulanic

acid: see co-amoxyclav

J01CA 18.1.1 amoxycillin 1 A P 250mg 15 capsule AMOXILFor revised Amoxycillin dosage regimen:See Circular H125/2003 (Addendum A - Suppl. List 98).

J01CA 18.1.1 amoxycillin 1 A P 250mg 100 capsule AMOXIL; MOXYPEN As above.J01CA 18.1.1 amoxycillin A P 250mg 500 capsule AMOXIL As above.

J01CA 18.1.1 amoxycillin 1 A 500mg 15 capsule AMOXILFor revised Amoxycillin dosage regimen:See Circular H125/2003 (Addendum A - Suppl. List 98).

J01CA 18.1.1 amoxycillin 1 A 500mg 100 capsule AMOXIL As above.

J01CA 18.1.1 amoxycillin 1 P 125mg/5ml 75ml suspension ZOXIL

For revised Amoxycillin dosage regimen:See Circular H125/2003 (Addendum A - Suppl. List 98).To use cheapest pack size on tender

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J01CA 18.1.1 amoxycillin 1 P 125mg/5ml 100ml suspension AMOXILAs above.To use cheapest pack size on tender.

J01CA 18.1.1 amoxycillin 1 P 250mg/5ml 100ml suspension AMOXILFor revised Amoxycillin dosage regimen:See Circular H125/2003 (Addendum A - Suppl. List 98).

J02AA 18.8 amphotericin-B A P 50mg 1 injection FUNGIZONE

J01CA 18.1.1 ampicillin P 250mg 1 injectionPETERCILLIN; AMPIPEN

J01CA 18.1.1 ampicillin A P 500mg 1 injection PETERCILLIN

S01GA 15.4antazoline + naphazoline

0,5% +0,012% - 0,1%

10ml eye dropsALBALON-AANTISTIN PRIVINE

Maximum one bottle per patient per month.ALTERNATIVE: Next Item Below. Cheapest on tender will be used.

S01GA 15.4antazoline +tetrahydrozoline

0,05% +0,04%

10ml eye drops SPERSALLERGMaximum one bottle per patient per month.ALTERNATIVE: Item Above. Cheapest on tender will be used.

B02AB 27 aprotinin500 000 iu/50ml1 000 000 iu/100ml

1 injection TRASYLOL Central hospitals only, not referable.

D02AC Ø aqueous cream 1 B.P. 100g cream AQUEOUS CREAMD02AC Ø aqueous cream B.P. 500g cream AQUEOUS CREAM

P01BE 18.11 Supp List 120artemether + lumefantrine

1 20mg / 120mg 24 tablets COARTEM

ascorbic acid: See Vitamin C

N02BA 3.2 aspirin soluble 1 A P 300mg 14 tablets DISPRIN

N02BA 3.2 Supp List 115 aspirin soluble1A

300mg 20 tablet DISPRIN Not repeatable for acute conditions (short course)

N02BA 3.2 Supp List 115 aspirin soluble 1 A 300mg 24 tablet DISPRIN Not repeatable for acute conditions (short course)

N02BA 3.2 Supp List 115 aspirin soluble 1 A P 300mg 1 000 tablets DISPRIN Not repeatable for acute conditions (short course)

N02BA 3.3aspirin + codeine phosphate soluble

500mg +8mg

10 tablet CODIS Oncology and facial maxillary surgeons only.

N02BA 3.3aspirin + codeine phosphate soluble

500mg +8mg

30 tablet CODIS As above.

C07AB 7.4 atenolol A 5mg/10ml 5 injection TENORMIN SpecialistC07AB 7.4 atenolol 1 A P 50mg 28 tablet TENORMIN; ATEROL

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C10AA 7.7.2Supp List 116/124

atorvastatin 10mg 28 tablet LIPITOR

General - ARV clinics only Specialist: lipid clinic initiated

General: ARV clinics only, according to Health Programmes' algorithm for the management of dyslipidaemia Specialist lipid clinic initiated:; - For HIV/AIDS patients - Familial heterozygous hypercholesterolaemia and familial homozygous hypercholesterolaemia patients who do not tolerate simvastatin - Familial homozygous hypercholesterolaemia (doses of 40mg and higher)

C10AA 7.7.2Supp List 116/124

atorvastatin 20mg 28 tablet LIPITORSpecialist: lipid clinic initiated


C10AA 7.7.2Supp List 116/124



C10AA 7.7.2Supp List 116/124



M03AC 2.3 atracurium besylate A 25mg/2,5ml 1 injection TRACRIUM For use in liver & kidney impairment onlyM03AC 2.3 atracurium besylate A 50mg/5ml 5 injection TRACRIUM As above.S01FA 15.5 atropine sulphate B.P. 1 1% 5ml eye drops COVAN ATROPINE of 82


S01FA 15.5atropine sulphate + hypromellose

1 1% + 0,5% 5ml eye drops ISOPTO ATROPINE

A03BA 5.4 atropine sulphate 1 A P 0,5mg/ml 1 injection SABAX ATROPINEA03BA 5.4 atropine sulphate 1 1mg/ml 1 injection SABAX ATROPINEL04AX 24.1 azathioprine 50mg/vial 1 injection IMURAN; ASOTRIM Specialist Central hospitals only, not referable.L04AX 24.1 azathioprine A P 50mg 100 tablet IMURAN Specialist

M03BX 4.5 baclofen 10mg 30 tablet LIORESAL

Specialist initiated: neurologists, neurosurgeons, paediatricians, pain clinics and WCRC

M03BX 4.5 baclofen 25mg 30 tabletLIORESAL; NEUROSPAS

Specialist initiated: neurologists, neurosurgeons, paediatricians, pain clinics and WCRC

balanced salt solution (BSS): see salt solution

V08BA 33 barium sulphate 1,2kg powder EZPAQUEV08BA 33 barium sulphate 11,34kg powder EZPAQUE

R01AD 10.4.1beclomethasone dipropionate

50µg/spray 1aqueous nasal spray

BECONASEBECLATE AQUAN.

Maximum: One per month. Two may be dispensed only if prescription is endorsed by an Allergy Clinic.

S01HA 15.7 benoxinate HCl 0,4% 0,5ml x 20 minims MINIM BENOXINATE Cheapest agent on tender to be used

N04AA 1.7.2benzhexol (trihexyphenidyl)

A 2mg 28 tablet ARTANE




2mg 84 tablet ARTANE



D01AE Øbenzoic acid + salicylic acid

1 BPC (6% + 3%) 25g ointment WHITFIELD'S OINT.

R01AX Øbenzoin compound tincture

BP 20ml liquid FRIAR'S BALSEM

R01AX Øbenzoin compound tincture

BP 500ml liquid FRIAR'S BALSEM

D10AE 14.6 benzoyl peroxide 1 A 5g/100g 40g gel PANOXYLD10AE 14.6 benzoyl peroxide A 10g/100g 40g gel PANOXYL SpecialistA01AD 11.3 benzydamine HCl 22,5mg/15ml 200ml solution ANDOLEX Specialist Central hospitals only, not referable.P03AX 14.2 benzyl-benzoate 1 (1/2 strength) 50/100ml emulsionP03AX 14.2 benzyl-benzoate 1 BP 25% 100ml emulsion ASCABIOL

Xberactant: See total phospholipids

H02AB 19.5 betamethasone 4mg/ml I.V./I.M 1 injection CELESTONE of 82


HO2AB 19.5 betamethasone 0,5mg 100 tabletsCELESTONE; BETANOID

D07AC 14.4betamethasone dipropionate

0,5mg/g 20g cream DIPROSONESpecialist dermatologist initiated

Cheapest category IV topical steroid on tender to be used. See Clobetasol

D07AC 14.4betamethasone dipropionate

0,5mg/g 20g ointment DIPROSONESpecialist dermatologist initiated

As above.

M01C 19.5Suppl List

120

betamethasone sodium phosphate + betamethasone acetate

3mg +3mg/ml 1ml

1 injectionCELESTONE SOLUSPAN

Specialist Opthalmology

D07AC 14.4 betamethasone valerate A 0,1% 15g cream BETNOVATECheapest grade III Steroid cream on tender to be used

D07AC 14.4 betamethasone valerate A 0,1% 500g cream LENOVATECheapest grade III Steroid cream on tender to be used

D07AC 14.4 betamethasone valerate A 0,1% 15g ointment BETNOVATECheapest grade III Steroid ointment on tender to be used

D07AC 14.4 betamethasone valerate A 0,1% 500g ointment PERSIVATECheapest grade III Steroid ointment on tender to be used

D07AC 14.4 betamethasone valerate 0,1% 20ml lotion CELESTODERM-VSpecialist dermatologist

Use for a maximum of 3 months at a time.

D05AX 14.4betamethasone + salicylic acid

0,5mg + 30mg/g 20g ointment DIPROSALICSpecialist dermatologist initiated

S01ED 15.6 betaxolol 2,5mg/ml 5ml eye drops BETOPTIC SSpecialist ophthalmology initiated

Only use cheapest beta-blocker ophthalmic solution of appropriate concentration available on tender.

L01DC 23Supp List 121/124

bevacizumab 100mg/4ml 4ml injection AVASTINSpecialist ophthalmologist

C10AB 7.7 Supp List 116 bezafibrate 400mg 30 retard tablet BEZALIPSpecialist physician initiated General

Specialist physician initiated General: ARV clinics only, according to Health Programmes' management algorithm.

S01EE 15.6 bimatoprost 0,03% 3ml eye drops LUMIGANSpecialist ophthalmologist initiated

Cheapest prostaglandin ophthalmic solution to be used. See lantanoprost - see RT280-2009MF

N04AA 1.7.2 biperiden A 5mg/ml 1 injection AKINETONA06AB 12.7 bisacodyl 10mg 10 suppository DULCOLAXA06AB 12.7 bisacodyl 5mg 200 tablet DULCOLAX; PERILAX

C05AX Øbismuth subnitrate & iodoform paste

BPC 100g pasteBISMUTH & IODOFORM PASTE

C05AX 12.10bismuth subgal. + bismuth oxide + zinc oxide

122,5mg + 8,75mg + 107,5mg

25g ointment ANUSOL

C05AX 12.10bismuth subgal. + bismuth oxide + zinc oxide

159mg + 24mg + 296mg

10 suppository ANUSOL of 82


L01DC 23 bleomycin A P 15units/amp 1 injection BLENOXANE Specialist oncologyM03AX 15.7 botulinum toxin type A A 100iu 1 injection BOTOX Specialist Central hospitals only, not referable

S01EA 15.6 brimonidine tartrate 0,2% 1 eye drops ALPHAGANSpecialist ophthalmologist initiated

G02CB 19.8 bromocriptine A 2,5mg 30 tablet PARLODEL SpecialistG02CB 19.8 bromocriptine 5mg 100 capsule PARLODEL Specialist

A07EA 12.10 budesonide 0,02mg/ml7 tabs + 7 bott of vehicle

enema ENTOCORDSpecialist gastroenterologist

R03BA 10.4 budesonide 1 A P 100µg / inhal. 1 MDI complete INFLAMMIDE 100General Code, including Clinical Nurse Practitioners

R03BA 10.4 budesonide 1 A P 200µg / inhal. 1 MDI complete INFLAMMIDE 200 As above.N01BB 2.2 bupivacaine A P 5mg/ml 4ml 10 injection MACAINE SPINALN01BB 2.2 bupivacaine A P 5mg/ml 10ml 1 injection MACAINE; REGIBLOC

N01BB 2.2bupivacaine + adrenaline

5mg + 5µg/ml 20ml

10 injectionMACAINE 0,5% + EPINEPHRINE

Central hospitals only, not referable.

N01BB 2.2 bupivacaine + dextrose A P5mg + 72,7mg/ml 4ml

10 injectionMACAINE SPINAL + DEXTROSE

N02AE 3.4 Supp List 121buprenorphine + naloxone

2mg + 0,5mg 7sublingual tablets

SUBOXONESpecialist psychiatry

Stikland and GSH detoxification unit only

Supp List 121buprenorphine + naloxone

8mg + 0,5mg 7sublingual tablets

SUBOXONESpecialist psychiatry

Stikland and GSH detoxification unit only

L02AE 19.7 Supp List 119 buserelin 9,9mgdepot injection

SUPREFACTSpecialist Urologist and Oncologist

Cheapest similar tropic hormone on tender to be used As single dose for patients with prostatic carcinoma pending orchidectomy / radiotherapy

L01AB 23 busulphan A P 2mg 100 tablet MYLERAN Specialist

J06A Ø button spider antivenom 5ml injection

G02CB 19.8 cabergoline 0,5mg 2 tablet DOSTINEXSpecialist endocrinologist

Not referable.Second line treatment.

G02CB 19.8 cabergoline 0,5mg 4 tablet DOSTINEXSpecialist endocrinologist

Not referable.Second line treatment.

D04AX 31 calamine lotion 1 P BP 100ml lotion CALAMINE LOTIONcalciferol: see ergocalciferol

D05AX 14.5 Supp List 124calcipotriol & betamethasone diprop.

50µg/g 30g ointment DOVONEX

Specialist physician, dermatologist and rheumatologist initiated

D05AX 14.5 calcipotriol 50µg/g 30g cream DOVONEXSpecialist dermatologist

D05AX 14.5 calcipotriol 50µg/g 100g cream DOVONEXSpecialist dermatologist of 82


D05AX 14.5 calcipotriol 50µg/g 30g ointment DOVONEXSpecialist dermatologist

D05AX 14.5 calcipotriol 50µg/g 100g ointment DOVONEXSpecialist dermatologist

H05BA 19.4 calcitonin 100iu/ml 5 injection MIACALCIC Specialist Central hospitals only, not referable.A11CC 20.1 calcitriol A 0,25µg 30 capsule ROCALTROL Specialist

A02AC 12.4calcium carbonate + glycine

A P 420mg + 180mg 300 tablet TITRALAC To be used for calcium supplementation.

A12A 20.2 calcium chloride A P 10% 10ml 1 injection CALCIUM CHLORIDEcalcium folinate: See folinic acid

A12A 20.2 calcium gluconate 1 A P 10% 10ml 1 injection CALCIUM GLUCONATE

L01BC 23 Supp List 121 capecitabine 150mg 60 tablet XELODASpecialist oncologists

Not referable.For colorectal and gastric cancer.

L01BC 23 Supp List 121 capecitabine 500mg 120 tablet XELODASpecialist oncologists

Not referable.For colorectal and gastric cancer.

J04A 18.8.1 capreomycin 1G 1 injection CAPASTAT Specialist As per XDR TB protocol

C09AA 7.3.8 captopril P 25mg 60 tablet CAPOTENSpecialist paediatrician

Only to be used for children under 13 years of age.

N03AF 1.6 carbamazepine 1 A P 100mg/5ml 250ml suspension TEGRETOL-SN03AF 1.6 carbamazepine 1 A P 200mg 56 tablet TEGRETOLN03AF 1.6 carbamazepine 1 A P 200mg 84 tablet TEGRETOLN03AF 1.6 carbamazepine A P 200mg 500 tablet TEGRETOLN04BA 1.7.1 carbidopa + levodopa A 25mg + 100mg 100 tablet SINEMET 25/100N04BA 1.7.1 carbidopa + levodopa 25mg + 250mg 100 tablet SINEMETH03BB 19.3 carbimazole A 5mg 100 tablet NEO-MERCAZOLE

L01DC 23 carboplatin 150mg 1 injection ABIC-CARBOPLATINSpecialist oncologist; haematologist

L01DC 23 carboplatin 450mg 1 injection ABIC-CARBOPLATINSpecialist oncologist; haematologist

L01AD 23 carmustine 100mg 1 injection BiCNUSpecialist oncologist

C07AG 7.3.4 carvedilol 12,5mg 30 tablet DILATREND; CARLOCSpecialist initiated - includes Family Physician initiated

For cardiac failure. NB! For Dosing Schedules refer to Annexure C of Suppl. List 105 (Circular H46/2006) & Addendum D of Suppl. List 106 (Circular H…/2006)

C07AG 7.3.4 carvedilol 25mg 30 tablet DILATREND; CARLOCSpecialist initiated - includes Family Physician initiated

For cardiac failure. NB! For Dosing Schedules refer to Annexure C of Suppl. List 105 (Circular H46/2006) & Addendum D of Suppl. List 106 (Circular H…/2006)

J01DA 18.1.2 cefamandole 1g 1 injection MANDOKEF SpecialistMotivation form to be completed or on mictobiologist report.

J01DA 18.1.2 cefazolin A P 500mg 1 injection KEFZOL; CEFACIDAL SpecialistMotivation form to be completed or on Microbiologist report. Cheapest 1st generation cephalosporin on tender to be used. of 82


J01DA 18.1.2 cefazolin 1g 1 injection CEFACIDAL Specialist As for 500mg injection.

J01DA 18.1.2 cefepime 500mg 1 injection MAXIPIME SpecialistOnly for severe nosocomial infections in ICU's & on a Microbiologist report.

JO1DA 18.1.2 cefixime 400mg 1 tablet FIXIMEGeneral code: per national and provincial STI protocol

J01DA 18.1.2 cefotaxime 500mg 1 injection CLAFORAN SpecialistMotivation form to be completed or on Microbiologist report. Exception in neonatology and meningitis

J01DA 18.1.2 cefotaxime A P 1g 1 injection CLAFORAN Specialist As above

J01DA 18.1.2 cefoxitin A P 1g 1 injection MEFOXIN SpecialistMotivation form to be completed or on Microbiologist report. Exception in surgical prophylaxis & in obstetrics & gynaecology.

J01DA 18.1.2 ceftazidime P 500mg 1 injection FORTUM SpecialistMotivation form to be completed or on Microbiologist report. For pseudomonas infections only.

J01DA 18.1.2 ceftazidime A P 1g 1 injection FORTUM Specialist As for 500mg injection.J01DA 18.1.2 ceftriaxone 1 P 250mg 1 injection ROCEPHIN

J01DA 18.1.2Suppl List 119/124

ceftriaxone 1 P 500mg 1 injection ROCEPHINGeneral Specialist

GENERAL: Meningitis and Neonatology At PHC level, administer as a single dose while awaiting transfer for: Diarrhoea, acute, in children; Dysentry: < 12 months; Septic miscarriage; Acute pyelonephritis; Septic Arthritis; Croup: epiglottitis; Severe pneumonia; Septicaemia in children; Severe malnuntrition; LAP (see 1° EDL pg. 207) SPECIALIST: For other conditions; motivation form to be completed or on micobiologist report Ceftriaxone injection 250mg is on general code

J01DA 18.1.2Suppl List 119/124

ceftriaxone1

A P1g 1 injection ROCEPHIN

General Specialist

GENERAL: Meningitis and Neonatology At PHC level, administer as a single dose while awaiting transfer for: Diarrhoea, acute, in children; Dysentry: < 12 months; Septic miscarriage; Acute pyelonephritis; Septic Arthritis; Croup: epiglottitis; Severe pneumonia; Septicaemia in children; Severe malnuntrition; LAP (see 1° EDL pg. 207) SPECIALIST: For other conditions; motivation form to be completed or on micobiologist report Ceftriaxone injection 250mg is on general code

J01DA 18.1.2 cefuroxime P 250mg 5 injection ZINACEF SpecialistMotivation form to be completed or on Microbiologist report.

J01DA 18.1.2 cefuroxime 750mg 1 injection ZINACEF Specialist As above

J01DA 18.1.2 cefuroxime P 125mg/ml 50ml suspension ZINACEFSpecialist paediatrician

For urinary tract infections

J01DA 18.1.2 cefuroxime P 125mg/ml 100ml suspension ZINACEFSpecialist paediatrician

For urinary tract infections of 82


J01DA 18.1.2 cefuroxime 250mg 10 tablet ZINNAT Specialist As above.J01DA 18.1.2 cefuroxime 500mg 10 tablet ZINNAT Specialist As above.

J01DA 18.1.2Suppl List

119cephalexin 125mg/5ml 100ml suspension

RANCEPH CPL-ALLIANCE CEPHALEXIN

Coded in interim i.p.o. Flucloxacillin syrup To be used where Flucloxacillin is indicated and Flucloxacillin capsules cannot be used

J01DA 18.1.2Suppl List

119cephalexin 250mg/5ml 100ml suspension

RANCEPH CPL-ALLIANCE CEPHALEXIN

Coded in interim i.p.o. Flucloxacillin syrup To be used where Flucloxacillin is indicated and Flucloxacillin capsules cannot be used

R06AE 6.1Suppl List 119/122

cetirizine di-HCl 1 10mg 30 tablet ZYRTECGeneral Clinical Nurse Practitioner

Clinical Nurse Pratitioner: Approved in line with EDL STG's

D08AJ Ø cetrimide conc. 40% 100ml solution CETAVLON

D08AJ 14.1cetrimide + chlorhexidine conc.

15% +1,5% 5 000ml solution SAVLON

D02AC 14.8 cetomacrogol 500g creamCETOMACROGOL CREAM B.P.

D02AC 14.8 cetomacrogol 500g ointmentCETOMACROGOL EMULSIFYING OINTMENT B.P.

A01AB 11.3cetylpyridinium Cl + benzocaine + dibucaine + benzyl alcohol

3,713mg + 30mg +5mg + 60mg

100ml solution CEPACAINE Specialist Oncology patients only

X 31 charcoal, activated 1 A P 25g powderL01AA 23 chlorambucil A 2mg 25 tablet LEUKERAN Specialist

J01BA 18.4.2 chloramphenicol A P 250mg 100 capsuleCHLOROMYCETIN; FENICOL

S01AA 15.1 chloramphenicol A P 0,5% 5ml eye dropsCHLOROMYCETIN REDIDROPS

S01AA 15.1 chloramphenicol1

A P1% 3,5g eye ointment

CHLOROMYCETIN; CHLORAMEX

J01BA 18.4.2 chloramphenicol 1 A P 1g 1 injectionCHLOROMYCETIN; CHLORPHEN

S01CA 15.3chloramphenicol + dexamethasone

P 0,5% + 0,1% 5ml eye drops SPERSADEX CO.Specialist ophthalmologist

D08AC Ø chlorhexidine0,5% 100 x 100mm

10 tulle BACTIGRAS

D08AC Ø chlorhexidine0,5% 100 x 400mm

10 tulle BACTIGRAS

D08AC 14.1chlorhexidine antiseptic cream

A 1% 50g creamHIBITANE ANTISEPTIC CREAM

D08AC 14.1 chlorhexidine obstetric 1% 100ml cream HIBITANED08AC 14.1 chlorhexidine 20% 500ml liquid HIBITANE CONC. Colourless liquid.D08AC 14.1 chlorhexidine gluc. 1 A P 0,05% 50ml solution HIBIDILD08AC 14.1 chlorhexidine gluc. 1 A P 0,05% 100ml solution HIBIDIL

D08AC 14.1chlorhexidine gluc. in 70 % alcohol

0,5% 500ml solution D-GERM

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D08AC 14.1chlorhexidine gluc.0,5% in 70 % alcohol

0,5% 5 000ml solution D-GERM

D08AC 14.1 Supp List 124chlorhexidine gluc.0,5% in 70 % alcohol - skin disinfectant

0,5% 500ml solution BIOTANE

D08AC 14.1 Supp List 124chlorhexidine gluc.0,5% in 70 % alcohol - skin disinfectant

0,5% 5 000ml solution BIOTANE

D08AC 14.1chlorhexidine gluc. surgical scrub

4% 500ml solution HIBISCRUB; BIOSCRUB


4% 5 000ml solution HIBISCRUB; BIOSCRUB


4% 20 000ml solution HIBISCRUB; BIOSCRUB

D08AC 14.1 chlorhexidine conc. 1 5% 5 000ml solution HIBITANEP01BA 18.11 chloroquine phosphate 250mg 100 tablet ANOCLORP01BA 18.11 chloroquine sulphate 1 P 68mg/5ml 100ml syrup NIVAQUINEP01BA 18.11 chloroquine sulphate 1 A P 150mg base 100 tablet NIVAQUINER06AB 6.1 chlorpheniramine 1 2mg/5ml 50ml syrup ALLERGEX CNP may prescribe. For atopic eczema & rhinitisR06AB 6.1 chlorpheniramine 1 2mg/5ml 100ml syrup ALLERGEX CNP may prescribe. For atopic eczema & rhinitisR06AB 6.1 chlorpheniramine 1 A 4 mg 20 tablet ALLERGEX

R06AB 6.1 chlorpheniramine 1 A 4 mg 100 tabletCHLOR-TRIMETON; ALLERGEX

R06AB 6.1 chlorpheniramine A 4 mg 1 000 tabletCHLOR-TRIMETON; ALLERGEX

R06AB 6.1 chlorpheniramine 8 mg 100 tabletCHLOR-TRIMETON REPETABS

R01BA 10.1.3chlorpheniramine + phenylephrine

P 1,25mg + 2,5mg/5ml 50ml syrup DEMAZINSpecialist paediatrician

Only for children up to 5 years old. For blocked nose only. Twice a day dose. Maximum 50ml per prescription.

N05AA 1.5.1 chlorpromazine P 50mg/2ml 1 injection LARGACTILN05AA 1.5.1 chlorpromazine P 25mg/5ml 100ml syrup LARGACTILN05AA 1.5.1 chlorpromazine 1 25mg 28 tablet LARGACTILN05AA 1.5.1 chlorpromazine 25mg 500 tablet LARGACTILN05AA 1.5.1 chlorpromazine 50mg 28 tablet LARGACTILN05AA 1.5.1 chlorpromazine 50mg 50 tablet LARGACTILN05AA 1.5.1 chlorpromazine 50mg 56 tablet LARGACTILN05AA 1.5.1 chlorpromazine 50mg 500 tablet LARGACTILN05AA 1.5.1 chlorpromazine 1 100mg 28 tablet LARGACTILN05AA 1.5.1 chlorpromazine 1 100mg 56 tablet LARGACTILN05AA 1.5.1 chlorpromazine 1 100mg 84 tablet LARGACTILN05AA 1.5.1 chlorpromazine 1 100mg 112 tablet LARGACTILN05AA 1.5.1 chlorpromazine 100mg 500 tablet LARGACTIL

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B04AD 7.7.4 Supp List 121 cholestyramine P 4g 4g sachet powder QUESTRAN

General

Specialist initiated

General: Paediatric use in diarrhoea management

Specialist initiated: Lipid clinics

N02BA 11.3choline salicylate + cetalkonium

8,7% + 0,01% 5g gel TEEJEL

G03GA 19.7 chorionic gonadotropin 1 500u 3 injection PROFASI Specialist Central hospitals only, not referable.G03GA 19.7 chorionic gonadotropin 5 000u 1 injection PROFASI; PREGNYL Specialist As above.

L04AA 24.1 ciclosporin 25mg 50 capsule SANDIMMUN NEORALSpecialist.Not referable.

i) Prescribe only post transplant at academic institutions.ii) Dispense only at academic institutions for patients resident in the metropole.iii) Dispense at non-academic institutions for patients in the rural regions - arrange access to stock with referring Institution

L04AA 24.1 ciclosporin 100mg 50 capsule SANDIMMUN NEORALSpecialistAs above

As above

L04AA 24.1 ciclosporin 250mg/5ml 10 injection SANDIMMUN SpecialistAs above

As above

L04AA 24.1 ciclosporin 100mg/ml 50ml oral solution SANDIMMUN NEORALSpecialistAs above

As above

A02BA 12.4.2Suupl List 119

cimetidine 200mg/2ml 1 injection TAGAMET For inpatient use only

A02BA 12.4.2 cimetidine 200mg/5ml 200ml syrup TAGAMET Specialist

N07CA 1.8 cinnarizine 25mg 100 tabletSTUGERON; ANTIMET; PURAZINE

S01AX 15.1ciprofloxacin/ofloxacin ophthalmic anti-infectives

3mg/ml 5ml eye drops CILOXAN; EXOCINSpecialist ophthalmologist, ENT

Cheapest floroquinolone on tender to be used.

J01MA 18.7 ciprofloxacin A P 2mg/ml 50ml injection CIPROBAY SpecialistMotivation form to be completed or on a Microbiologist report. See also under OFLOXACIN.

J01MA 18.7 ciprofloxacin A P 2mg/ml 100ml injection CIPROBAY Specialist As aboveJ01MA 18.7 Supp List 119 ciprofloxacin 1 250mg 10 tablet CIPROBAY NOT FOR MDR-TB. J01MA 18.7 Supp List 119 ciprofloxacin 1 A 500mg 10 tablet CIPROBAY NOT FOR MDR-TB.

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J01MA 18.7 ciprofloxacin A 750mg 10 tablet CIPROBAY Specialist

Specialist: NOT FOR MDR-TB. Motivation form to be completed or on a Microbiologist report. Cheapest appropriate fluoroquinolone on tender to be bought. See also under OFLOXACIN.

L01XA 23 cisplatin A P 10mg/vial 1 injectionPLATAMINE; ABIPLATIN

Specialist oncologist

L01XA 23 cisplatin A P 25mg/vial 1 injection PLATAMINESpecialist oncologist

L01XA 23 cisplatin A P 50mg/vial 1 injection PLATAMINESpecialist oncologist

N06AB 1.4.4 citalopram 20mg 28 tablet CILIFTSpecialist psychiatrist initiated

A09AB 31 citric acid monohydrate BP 500g powder

J01FA 18.2 clarithromycin 500mg 1 injection KLACID Specialist

1. For use in High Care and ICU's on a Microbiologist report.2. On a patIent name basis in tertiary hospitals for MOTT (Mycobacterium other than tuberculosis).3. As second line agent for specialists to eradicate H. pylori. Refer to: Circular H95/2005 (Addendum B - Suppl. List 102)

J01FA 18.2 clarithromycin 500mg 14 tablet KLACID Specialist As above.

J01FF 18.7 clindamycin A P 150mg 100 capsule DALACIN-C SpecialistMotivation form to be completed or on a microbiologist report.

J01FF 18.7 clindamycin A P 600mg 1 injection DALACIN-C; CLINIDAC Specialist As above.

N05BA 1.3.1 Supp List 118 clobazam 5mg 100 capsule URBANOLSpecialist neurologist Not referable

Central hospitals - not referable. As add on therapy for epilepsy Logistical issues to be managed in the interest of patient care

N05BA 1.3.1 Supp List 118 clobazam 10mg 100 tablet URBANOLSpecialist neurologist Not referable

Central hospitals - not referable. As add on therapy for epilepsy Logistical issues to be managed in the interest of patient care

D07AD 14.4 clobetasol propionate 0,05% 25g cream DERMOVATE; DOVATESpecialist dermatologist initiated

Cheapest category IV topical steroid on tender to be used. See betamethasone dipropionate

D07AD 14.4 clobetasol propionate 0,05% 25g ointment DERMOVATE; DOVATESpecialist dermatologist initiated

As above. of 82


J04BA 18.6.2 clofazimine 50mg 100 capsule LAMPRENE Specialist

J04BA 18.6.2 clofazimine A 100mg 100 capsule LAMPRENESpecialistGeneral - only for MDR TB

G03GB 19.7 clomiphene A 50mg 5 tablet CLOMIDSpecialist gynaecologist

N06AA 1.4.1 clomipramine 10mg 100 tablet ANAFRANILSpecialist psychiatrist & neurologist initiated

N06AA 1.4.1 clomipramine A 25mg 100 tablet ANAFRANILSpecialist psychiatrist & neurologist initiated

N03AE 1.6 clonazepam P 1mg/ml 5 injection RIVOTRILSee guidelines for the treatment of convulsive status epilepticus in paeds: Suppl. List 106 Addendum A

N03AE 1.6 clonazepam P 2,5mg/ml 10ml oral drops RIVOTRIL

Specialist psychiatrist, nuerologist & paediatricians

See guidelines for the use of benzodiazepines: Circular H24/2006. (Addendum I: Suppl List 107). Specialist psychiatrist, neurologist & paediatrician initiated in epilepsy.

N03AE 1.6 clonazepam A 0,5mg 90 tablet RIVOTRIL


As above.

N03AE 1.6 clonazepam A 2mg 90 tablet RIVOTRIL


As above.

C02AC 1.9 clonidine P 0,025mg 100 tablet DIXARIT; MENOGRAINE

B01AC 8.4 Supp List 120 clopidogrel 75mg 28 tablet PLAVIX

Specialist physician initiated Specialist cardiologist

Specialist physician, cardiologist initiated: Life long use in patients with aspirin intolerance Specialist cardiologist: - other indications: 1. Drug eluting stents: Treatment duration - maximum 6 months post stent treatment 2.Metal stents: treatment duration - 4 weeks post stent treatment

N05AX 1.5.3 clothiapine 40mg/4ml 1 injection ETOMINEG01AF 14.3 clotrimazole 1 P 1% 20g cream XERASPOR T Use cheapest imidazole on tender.G01AF 17.2 clotrimazole P 1% 50g vag. cream CLOSCRIPT Use cheapest imidazole on tender.G01AF 17.2 clotrimazole 1 500mg 1 vaginal tablet CANESTEN 1J01CF 18.1.1 cloxacillin A P 250mg 1 injection ORBENINJ01CF 18.1.1 cloxacillin A P 500mg 1 injection ORBENIN; CLOXIN

N05AH 1.5.3 clozapine 25mg 100 tablet LEPONEXSpecialist psychiatrist & neurologist initiated

Psychiatrists and neurologists - for dose titration only. Policy for the use of Clozapine: Circular H117/1997 (Annexure F - Suppl. List 78.)

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As for other pack sizes.Policy for the use of Clozapine: Circular H117/1997 (Annexure F - Suppl. List 78)


As for other pack sizes.Policy for the use of Clozapine: Circular H117/1997 (Annexure F - Suppl. List 78)


Psychiatrists and neurologists.Policy for the use of Clozapine: Circular H117/1997 (Annexure F - Suppl. List 78)

J01CR 18.1.1 Supp List 124 co-amoxiclav 0,6 g 1 injection AUGMENTIN, SANDOZ CO-AMOXYCLAV

SpecialistSpecialist microbiologist report or motivation form to be completed

J01CR 18.1.1 Supp List 124 co-amoxiclav 1,2g 1 injection AUGMENTIN, SANDOZ CO-AMOXYCLAV

SpecialistSpecialist microbiologist report or motivation form to be completed

J01CR 18.1.1Suppl List 119

co-amoxiclav 1 P125mg + 31,25mg/5ml

100ml suspension AUGMENTIN

General

Specialist

GENERAL CODE: - Pneumonia in adults with underlying medical conditions (1 ° EDL pg 287) - Pneumonia: patients > 65 years of age - Complicated cystitis in pregnancy and children as per EDL - Uncomplicated lower UTI in adult females only if stat dose of fluoroquinolone has been unsatisfactory - Complicated UTI in adults - Inpatients in place of IVI - Animal and human bites - Diabetic foot SPECIALIST: Other conditions


co-amoxiclav 1 P 250mg + 62,5mg/5ml 100ml suspension AUGMENTIN

General

Specialist


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co-amoxiclav1 P

A250mg + 125mg 15 tablet AUGMENTIN

General

Specialist



co-amoxiclav1 P

A250mg + 125mg 100 tablet AUGMENTIN

General

Specialist



co-amoxiclav1 P

A875mg + 125mg 10 tablet

AUGMENTIN; AURO-AMOXICLAV

General

Specialist


N01BC Ø cocaine HCl BP 25g powder ENT only.

R05DA 3.1 Supp List 118 codeine phosphate1P

25mg/5ml 500ml syrup CODEINE PHOSPHATEFor hospital use only (in or out-patients) For use in pain as per EDL and IMCI guidelines

R05DA 3.1 Supp List 116 codeine phosphate1P

30mg 100 tablet CODEINE PHOSPHATE Specialist initiated Oncology and GIT clinic initiated

L01XX 23 colaspase A P 10 000u 1 injection LASPARSpecialist oncologist

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M04AC 4.23711048 Supp List 113

colchicine 1 A 0,5mg 50 tablet COLCHICINE

For chronic gout: 0,5mg twice a day for 3 months (up to max of 6 months) For acute attacks: Maximum of 10 tablets of 0.5mg to be prescribed per acute attack with no repeats per prescription

D03 14.9collagenase clostridiopeptidase A + peptidases

1,2units/g +0,24units/g

30g ointment IRUXOL MONO Central HospitalsPatient name basis.Not referable.

J01EE 18.6 co-trimoxazole I.V. 480mg/5ml 1 injection BACTRIMIntra-venous form only to be used if oral form can not be taken.

J01EE 18.6 co-trimoxazole 1 P 240mg/5ml 50ml syrup BACTRIMJ01EE 18.6 co-trimoxazole 1 P 240mg/5ml 100ml syrup BACTRIMJ01EE 18.6 co-trimoxazole 1 A P 480mg 20 tablet BACTRIM; TRIMOKSJ01EE 18.6 co-trimoxazole 1 A P 480mg 56 tablet BACTRIM; TRIMOKS

J01EE 18.6 co-trimoxazole A P 480mg 1 000 tabletTRIMETHOX; MEZENOL; PURBAC

cromoglycate: See sodium cromoglyc…

R06AE 1.8 cyclizine 50mg/ml 1 injection VALOID, TRIAZINE Radiotherapy only.R06AE 1.8 cyclizine 50mg 10 tablet VALOID; NAUZINE Radiotherapy only.

S01FA 15.5 cyclopentolate 1% 15ml eye drops CYCLOGYLSpecialist ophthalmology initiated

S01FA 15.5 cyclopentolate 1%0,5ml x 10 (20)

minimsMINIMS CYCLOPENTOLATE

Specialist ophthalmology initiated

S01FA 15.5cyclopentolate + phenylephrine

A 2mg +10mg/ml 5ml eye drops CYCLOMYDRILSpecialist ophthalmology initiated

L01AA 23 cyclophosphamide A P 200mg 10 injection ENDOXAN

Specialist physicians, oncologists and paediatricians

L01AA 23 cyclophosphamide A P 500mg 1 injection ENDOXAN


L01AA 23 cyclophosphamide A P 1g 5 injection ENDOXAN


L01AA 23 cyclophosphamide A P 50mg 50 tablet ENDOXAN


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L01AA 23 cyclophosphamide A P 50mg 250 tabletENDOXAN; CYCLOBLASTIN


J04AB cycloserine Available from Eli Lilly

MDR patients only, treatment to be initiated in consultation with Brookland Chest hospital

G03HA 19.8 Supp List 114 cyproterone acetate 300mg/3mL 1injection, depot

ANDROCURSpecialist: Psychiatrist APH only

Patient Named Basis Non-Referable

G03HB 14.6cyproterone + ethinyl estradiol

2mg + 0,035mg 28 tablet DIANE-35

Specialist endocrinologist, dermatologist & gynaecologist

L01BC 23 cytarabine A P 100mg 1 injection CYTOSARSpecialist oncologist

L01BC 23 cytarabine A P 500mg 1 injection CYTOSARSpecialist oncologist

X Ø cytological fixative 100g spray

L01AX 23 dacarbazine P 100mg 1 injection D.T.I.C.Specialist oncologist

L01AX 23 dacarbazine P 200mg 1 injection D.T.I.C.Specialist oncologist

L01DA 23 dactinomycin P 0,5mg/3ml 1 injection COSMEGENSpecialist oncologist

B01AB 8.2 dalteparin 5 000iu/0,2ml 1injection: pre-filled syringe

FRAGMIN SpecialistTo be used according to Addendum A: Coding Status protocol for LMWH; Supp List 116

G03XA 19.8 danazol 100mg 60 tablet LADAZOL; LADOGAR Specialist Central hospitals only, not referable.G03XA 19.8 danazol 200mg 60 tablet LADOGAR Specialist As above.

M03CA 2.3 dantroline A P 20mg 1 injection DANTRIUMFor use in malignant hyperthermia only. Contact Regional Chief Pharmacist to ascertain where stocks are kept.

J04BA 18.8.2 dapsone A 100mg 100 tabletLENNON-DAPSONE; MALOPRIM

L01DB 23 daunorubicin A 20mg 1 injection CERUBIDINSpecialist oncologist

V03AC 25 Supp List 120 deferasirox 125mg 28dispersible tablet

EXJADESpecialist paediatrician Non-referable

Patient named basis For treatment of Thalassaemia in paediatrics Paediatric patients initiated on deferasirox may continue treatment when handed to an adult Central hospital

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V03AC 25 desferrioxamine A P 500mg 1 injection DESFERAL Store below 15 degree Celsius.

H01BA8.116.2

desmopressin A P 100µg/ml 2,5mlintranasal solution

DDAVP

Specialist haematologist, endocrinologist & neurosurgeons initiated

H01BA8.116.2

desmopressin A P100µg/ml10µg/spray

5mlintranasal spray

DDAVP


H01BA8.116.2

Supp List 119 desmopressin A P 100µg 30 tablet DDAVP


NOT INTERCHANGEABLE with Desmopressin 200mcg

H01BA8.116.2

Supp List 119 desmopressin A P 200µg 30 tablet DDAVP


NOT INTERCHANGEABLE with Desmopressin 100mcg

H01BA8.116.2

desmopressin A P 4mcg/ml 1ml injection DDAVP

Specialist haematologist, endocrinologist & neurosurgeons

G03AA 17.1.1ex family planning stores

desogestrel + ethinyl oestradiol

0,15mg +0,03mg

28 tablet MARVELON 150/30 Family Planning

Available at Groote Schuur & Tygerberg Hospital Family Planning clinics only. Refer patients to these clinics if unacceptable side effects persist on oral contraceptives.

S01BA 15.2 dexamethasone A 0.1% solution 5ml eye dropsSPERSADEXMAXIDEX

Specialist ophthalmologist initiated

H02AB 19.5 dexamethasone A P 4mg/ml 1 injection DECASONE

S01XA 15.7 Supp List 118dextran 70 + hydroxypropyl methylcellulose

0,3% 15ml eye drops TEARS NATURALE II Specialist initiated

V03AH 22 dextrose 1 50% 20ml 1 injectionV03AH 22 dextrose 50% 50ml 1 injection of 82


V04CA Ø dextrose monohydrate BP 75g powderV04CA 31 dextrose monohydrate BP 50g powder For glucose tolerance test.V04CA 31 dextrose monohydrate BP 500g powder

B05ZA Ødialysis solution for haemodialysis with low magnesium

concentrate 5 000ml solutionSABAX DIASOLFORMULA 16 - AFM 1045

B05DB Ødialysis solution for peritoneal dialysis+ dextrosr 1,5%

1,5%2 000ml in 2 000ml bag

solutionSABAX DIANEAL 1,5AFB 9856

B05DB Ødialysis solution for peritoneal dialysis + dextrose 2,5%

2,5%2 000ml in 2 000ml bag


B05DB Ødialysis solution for peritoneal dialysis+ dextrosr 4,25%

4,25%2 000ml in 2 000ml bag


N05BA 1.3.1 diazepam 1 A P 10mg/2ml 1 injection VALIUM, PAX

N05BA 1.3.1 diazepam A 2mg 14 tablet VALIUM, PAX

No more than 14 days supply, unless when prescribed by a psychiatrist, neurologist or paediatrician, when 28 days supply may be dispensed. See circular H24/2006; Suppl List 107 - addendum I

N05BA 1.3.1 diazepam A 2mg 500 tablet VALIUM; PAX; DIAQUEL As above.



N05BA 1.3.1 diazepam A 5mg 28 tablet VALIUM; PAX


N05BA 1.3.1 diazepam A 5mg 56 tablet VALIUM; PAX




N05BA 1.3.1 diazepam 10mg 90 tablet VALIUM, PAX As above.C02DA 7.3.1 diazoxide P 300mg/20ml 1 injection HYPERSTAT SpecialistM01AB 4.1 diclophenac 75mg/3ml 1 injection VOLTAREN; PANAMOR Specialist To be given as a single dose only.M01AB 4.1 diclophenac 12,5mg 5 suppository VOLTAREN Single dose peri / post operative in paediatricsM01AB 4.1 diclophenac P 25mg 5 suppository VOLTAREN Single dose peri / post operative in paediatrics of 82


M01AB 4.1 Supp List 119 diclophenac 25mg 84 tablet VOLTAREN, PANAMOR

FOR ACUTE CONDITIONS: Not more than 5 days supply. Not repeatable For longer periods, the appropriate diagnosis and quantities to be written on the prescription

M01AB 4.1 Supp List 119 diclophenac 25mg 100 tablet VOLTAREN, PANAMOR


M01AB 4.1 Supp List 119 diclophenac 25mg 500 tabletVOLTAREN; PANAMOR; DIFENAC


J05AB 18.12pgwcARV depot

didanosine 1 25mg 60 tablet VIDEX AIDS programmeAvailable through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.


didanosine 1 50mg 61 tablet VIDEX AIDS programme As above.





C01AA 7.1.1 digoxin P 0,05mg/ml 50mlelixir-paed/geriatr

LANOXIN

C01AA 7.1.1 digoxin A P 0,5mg/2ml 1 injection LANOXIN Specialist For use in ICU's

C01AA 7.1.1 digoxin 0,0625mg 100tablet-paed/geriatr

LANOXIN

C01AA 7.1.1 digoxin 1 A 0,25mg 14 tablet LANOXINC01AA 7.1.1 digoxin 1 A 0,25mg 28 tablet LANOXINC01AA 7.1.1 digoxin A 0,25mg 500 tablet LANOXIN; PURGOXINC02DB 7.3.1 dihydralazine 1 A P 25mg 1 injection NEPRESOLN02AA 3.1 dihydrocodeine 50mg/ml 5 injection DF-118 Specialist Neurology & Radiotherapy only.

G02AD 17.3 dinoprostone 0,5mg/3g 1 gel PREPIDILUse to be controlled in restricted substances register.

G02AD 17.3 dinoprostone 1mg/3g 1 gel PRANDIN E2Use to be controlled in restricted substances register.

G02AD 17.3 dinoprostone 5mg/ml 1 injection PROSTIN F2, ALPHASpecialist gynaecologist

G02AD 17.3 dinoprostoneAP

0,5mg 10 tablet PROSTIN E2 Specialist

In-hospital emergency use only. For off-label Neonatal use in Suspected Congenital Cyanotic heart disease.NOT FOR INDUCTION OF LABOUR

M05BA 4.7.1 Supp List 118 disodium pamidronate 15mg 1 injection AREDIASpecialist Specialist oncologist

For treatment of Hypercalcaemia - refer to Suppl List 118: Addendum A

C01BA 7.2 disopyramide 150mg 100 capsule NORPACE Specialist Central hospitals only, not referable. of 82


V03AA 9 disulfiram A 400mg 50 tablet ANTABUSEAdequate maintenance dose 200mg (1/2 tablet) daily or 400mg (1 tablet)on alternate days.

D05AC ‡dithranol in lygal's base (salicylic acid 3% + sulphur 5%)

1% 200g ointmentSpecialist dermatologist

Not referable

D05AC ‡dithranol in lygal's base (salicylic acid 3% + sulphur 5%)

2% 200g ointmentSpecialist dermatologist

Not referable

D05AC ‡dithranol + salicylic acid in white soft paraffin

1% + 5% 200g ointmentSpecialist dermatologist

Not referable



Not referable



Not referable

C01CA 7.1.2 dobutamine A P 250mg/20ml 1 injection DOBUTREX Specialist For use in cardiac, respiratory & cardio-thoracic ICU's & theatres.

A03FA 1.8 domperidone 1mg/ml 100ml suspension MOTILIUMSpecialist paediatrician

A03FA 1.83714233 Supp List 113

domperidone 10mg 100 tablet MOTILIUMSpecialist initiated Specialist neurologist initiated

Specialist initiated: For use in GIT clinics only and intolerance to metoclopramide. Specialist neurologist initiated: For prevention of dopaminergic side effects

C01CA 7.1.2 dopamine HCl A P 200mg/5ml 1 injectionINTROPIN; DYNOS FOR INFUSION

C02CA 7.3.2Supp List 120/123

doxazosin A P 4mg 30 tablet CARDURA XL

Specialist physician, paediatrician & nephrologist

Specialist physician, paediatrician & nephrologist initiated: For hypertension as 4th line treatment up to max of 8mg daily

X 1.1.2 doxapram 20mg/ml 20ml 1 injection DOPRAM SpecialistFor use in paediatric intensive care and neonatal units

L01DB 23 doxorubicin A P 10mg 1 injection ADRIBLASTINASpecialist oncologist

L01DB 23 doxorubicin A P 50mg 1 injection ADRIBLASTINASpecialist oncologist

J01AA 18.4.1 doxycycline 1 A P 100mg 6 capsule VIBRAMYCIN

J01AA 18.4.1 doxycycline 1 A P 100mg 10 capsuleVIBRAMYCIN; DOXYCLIN

J01AA 18.4.1 doxycycline 1 A P 100mg 14 capsule DOXYCLINJ01AA 18.4.1 doxycycline A P 100mg 100 capsule VIBRAMYCINN01AX 2.1.2 droperidol A 5mg/2ml 1 injection INAPSIN; PAXICALG03DB 19.6.3 dydrogesterone 10mg 30 tablet DUPHASTON Specialist Central hospitals only, not referable.

G01AF 17.2 econazole 150mg 3 ovules GYNO-PEVARYL SpecialistCheapest appropriate imidazole preparation on tender to be used

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D01AC 14.3 econazole 1g/100g 3x10ml foaming soln. PEVARYL Specialist Central hospitals only, not referable.

J05AG 18.12pgwcARV depot Supp List 124

efavirenz 1 50mg 30 capsule STOCRIN

General code: AIDS programme CNP / Professional nurse

General code: AIDS programme: Available through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols. CNP / Professional nurse: Available through HIV / AIDS programme: For first line treatment of adult AIDS patients as per HIV / AIDS guidelines 2010 for treating AIDS patients and per Circular H30/2011: Authorisation of Nurse Prescribing for Antiretroviral Treatment




As above.




As above.

electrolyte & glucose powder for oral rehydration: See sodium chloride + KCl…

emtracitabine / tenofovir: please refer to tenofovir disoproxil fumerate / emtracitabine…

D02AC 31 emulsifying ointment 1 BP 500g ointment EMULSIFYING OINT.X 31 emulsifying wax BP 25kg wax EMULSIFYING WAX

C09AA 7.3.8 Supp List 122 enalapril 1 A P 2,5mg 28 tablet RENITEC

Cheapest ACE inhibitor on tender to be used.For hypertension & cardiac failure: 20mg maximum daily dose.For proteinuria: 40mg maximum daily dose.

C09AA 7.3.8 enalapril 1 A P 5mg 28 tablet RENITEC As aboveC09AA 7.3.8 enalapril 1 A 10mg 28 tablet PHARMAPRESS As aboveC09AA 7.3.8 enalapril 1 A 20mg 28 tablet PHARMAPRESS As above

N01AB 2.1.1 enflurane 250mlinhalation liquid

ETHRANESpecialist aneasthetist

B01AB 8.2 Supp List 124 enoxaparin 40mg/0,4mL 1injection: pre-filled syringe

CLEXANE

Coding Status protocol for use of LMWH per Supp List 116 Addendum A is repealed and replaced by: - General code for indications as stated in the LMWH policy: Supp List 124 Addendum A: Coding Status protocol for use of LMWH Prescription must be endorsed with the diagnosis

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CLEXANE



CLEXANE


X 22enteral nutrients/special foods

ENSUREIntegrated Nutrition Programme

NOT to be issued as a dietary supplement. Supply only on referal by a dietician for use as an enteral feed according to the Provincial Policy for Enteral Feeding.

C01C 7 ephedrine SO4 50mg/ml 10 injection EPHEDRINE SULPHATE

L01DB 23 epirubicin 10mg 1 injection FARMORUBICINSpecialist oncologist

L01DB 23 epirubicin 50mg 1 injection FARMORUBICINSpecialist oncologist

B02BD 8.1eptacog alfa (activated) -See factor VIIa

60 000iu (1,2mg) vial injectionNOVOSEVEN FACTOR VIIa

Central HospitalsHaematology.On a patient name basis only.

A11CC 20.1 ergocalciferol P 5 000u/ml 15ml oily solution VITAMIN D

A11CC 20.1 ergocalciferol A 50 000units 100 tabletSTRONG CALCIFEROL TABLETS

G02AB 17.3 ergometrine P 0,5mg 1 injection ERGOTRATE

N02CA 1.9ergotamine + belladonna + butalbital + caffeine

2mg + 0,25mg + 100mg + 100mg

5 suppository CAFERGOT P-B

N02CA 1.9ergotamine + cyclizine + caffeine

2mg + 50mg + 100mg

10 tablet MIGRIL

J01DH 18.1.3 ertapenem 1g 1 injection INVANZ SpecialistOnly for severe nosocomial infections in ICU's & on a Microbiologist report.

J01FA 18.2 erythromycin A P 1g 1 injection ERYTHROCIN Restricted for use in proven Legionnaires Disease.

J01FA 18.2 erythromycin 1 A P 250mg 20 tablet ERYTHROMIDJ01FA 18.2 erythromycin 250mg 100 tablet/capsule SPECTRASONEJ01FA 18.2 erythromycin A P 250mg 500 tablet ERYTHROMID

J01FA 18.2 erythromycin estolate 1 P 125mg/5ml 100mlgranules/suspension

E-MYCIN As below

J01FA 18.2 erythromycin estolate 1 P 250mg/5ml 100mlgranules/suspension

PURMYCINNot to be used for longer than 5 days. For long term or high dosage, use ethylsuccinate.

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BO3XA 8.6Suppl List 119

erythropoietin 500iupre-filledsyringe

IV/SC injection RECORMON

Specialist nephrology, haematology & neonatology

BO3XA 8.6Suppl List 119

erythropoietin 1 000iupre-filledsyringe

IV/SC injection RECORMON


BO3XA 8.6 erythropoietin 2 000iupre-filledsyringe

IV/SC injection EPREX; RECORMON


BO3XA 8.6 erythropoietin 4 000iupre-filledsyringe

IV/SC injection EPREX; RECORMON


C07AB 5.2 esmolol 100mg/10ml 1 injection BREVIBLOC Use cheapest intravenous beta blocker on tenderJ04AK 18.6.1 ethambutol 25mg/ml 500ml suspension MYAMBUTOLJ04AK 18.6.1 ethambutol 100mg 1 000 tablet MYAMBUTOLJ04AK 18.6.1 ethambutol 1 A 400mg 100 tablet MYAMBUTOL; MYCROLJ04A 18.6.1 ethambutol + isoniazid 300mg + 100mg 500 tablet MYNAH; TUBEROL

C05BB 8.5? ethanolamine oleate 5% 5ml 10 injectionETHANOLAMINE OLEATE

G03CA 19.6.2 ethinyl oestradiol A 0,02mg 100 tablet ESTINYLG03CA 19.6.2 ethinyl oestradiol A 0,05mg 100 tablet ESTINYLJ04AD 18.6.1 ethionamide P 250mg 250 tablet TRESCATYL; ETHATYL

N03AD 1.6 ethosuximide A P 250mg 50 capsule ZARONTIN

Specialist psychiatrists, neurologists and paediatricians

N01BX 31 ethyl chloride 1 BP 100g spray ETHYL CHLORIDEC01CA 7.6 etilefrine A P 10mg/ml 1 injection EFFORTIL SpecialistN01AX 2.1.2 etomidate A P 20mg/10ml 5 injection HYPNOMIDATE Specialist

L01CB 23 etoposide A P 100mg 10 capsule VEPESIDSpecialist oncologist

L01CB 23 etoposide A P 100mg/5ml 1 injection VEPESIDSpecialist oncologist

L02BG 19.8 Supp List 121 exemestane 25mg 30 tablet AROMASINSpecialist oncologist initiated

For second line treatment for Tamoxifen intolerant patients.

C10AB 7.7.3 Supp List 123 ezetimibe 10mg 30 tablet EZETROL Specialist Lipid Clinic only

B02BD 8.1

factor VIIa activated recombinant coagulation (See - eptacog alfa (activated)

60 000iu (1,2mg) vial injectionNOVOSEVEN FACTOR VIIa

Central HospitalsHaematology.On a patient name basis only.

B02BD 8.1 factor VIII Concentrate 300IU 1 injectionHAEMOSOLVATE FACTOR VIII

For use in haemophiliacs only. See provincial haemophilia policy

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B02BD 8.1 factor VIII Concentrate 500IU 1 injectionHAEMOSOLVATE FACTOR VIII


B02BD 8.1 factor VIII Concentrate 2X500IU 1 injectionHAEMOSOLVATE FACTOR VIII


B02BD 8.1factor IX complex human

500IU 1 injectionHAEMOSOLVEX FACTOR IX


B02BD 8.1factor VIII inhibitor bypassing activity complex

500IU 1 injection FEIBA TIM 4 IMMUNOFor use in haemophiliacs only. See provincial haemophilia policy

B02BD 8.1factor VIII inhibitor bypassing activity complex

1000IU 1 injection FEIBA TIM 4 IMMUNOFor use in haemophiliacs only. See provincial haemophilia policy

J05AB 18.1 famciclovir A 250mg 21 tablet FAMVIR SpecialistOnly to be used for registered indications. Motivation form to be completed.

R03AC 10.2.1 fenoterol A 100+F575/inhal 1 x 300 dose MDI complete BEROTEC Use cheapest Beta-stimulant MDI on tender.R03AC 10.2.1 fenoterol A 100µg/inhal 1 x 300 dose MDI refill BEROTEC As above

R03AC 10.2.1 fenoterol 1mg/ml 20mlinhalation solution

BEROTEC

R03AC 10.2.1 fenoterol A 1,25mg/2ml60 x 2ml UDV

inhalation solution in a Unit Dose Vial

BEROTEC U.D.V.

N01AH 2.1.2 fentanyl A P 0,1mg/2ml 1 injection SUBLIMAZEN01AH 2.1.2 fentanyl A P 0,5mg/10ml 5 injection SUBLIMAZE; TANYLB03AA 8.6 ferrous gluconate P 250mg/5ml 100ml syrup KIDDIE VITE Contains 28,5mg elemental iron /5mlB03AA 8.6 ferrous lactate P 25mg/ml Fe++ 10ml oral drops FERRO DROPS Contains 25mg elemental iron /ml

B03AA 8.6 ferrous sulphate co BPC 1 A P

FeSO4: 170mgequiv: 56,67mg Fe++

5H2O.CuSO4: 2.5mg4H2O.MnSO4: 2.5mg

28 tablet FERROUS SULPHATE

B03AA 8.6 ferrous sulphate co BPC A P BPC - as above 5 000 tablet FERROUS SULPHATE

L03AA 26 Supp List 114 filgrastim 300µg (30MU) 1 injection NEUPOGENSpecialist oncologist

For stem cell mobilisation in bone marrow transplant donors For severe congenital neutropenia

J01CG 18.1.1 flucloxacillin 1 A P 250mg 20 capsule FLOXAPEN

Dosing schedule as per 1° EDL 2003. Maximum adult dose: 500mg 6 hourly. Cloxacillin may be used for porphyrics and patients over 50 years of age with cholestatic jaundice. Prescription to be endorsed accordingly.

J01CF 18.1.1 flucloxacillin 1 A P 250mg 100 capsule FLOXAPEN as aboveJ01CF 18.1.1 flucloxacillin 1 P 125mg/5ml 100ml suspension FLOXAPEN

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J02AC 18.10Suppl List 119

fluconazole1 P

50mg 14 capsule DIFLUCAN

For tinea capitis - as per EDL Donated Fluconazole - Manage as a Schedule 6 medicine for Donation Programme - For management of Cryptococcal Meningitis and Candida Oesophagitis in HIV positive patients

J02AC 18.10Suppl List 119

fluconazole1

A P200mg 28 tablet DIFLUCAN

For tinea capitis - as per EDL Donated Fluconazole - Manage as a Schedule 6 medicine for Donation Programme - For management of Cryptococcal Meningitis and Candida Oesophagitis in HIV positive patients

J02AC 18.10 fluconazole 40mg/ml 35ml suspension DIFLUCANDonation drug. Handle as a special buy out

1. Manage as a Schedule 6 drug for Diflucan donation Programme.2. For management of Candida oesophagitis in HIV positive paediatric patients. Use according to treatment guidelines.

L01BB 23.00Suppl List

118fludarabine 10mg 20 tablet FLUDARA

Specialist haemotologist

Haematology.

L01BB 23.00 fludarabine 50mg 1 injection FLUDARASpecialist haemotologist

Haematology. Second line treatment for chronic lymphocytic leukaemia and follicular lymphoma

H02AA 19.5 fludrocortisone A P 0,1mg 100 tablet FLORINEF

V03AB 1.1.3 flumazenil P 0,5mg/5ml 1 injection ANEXATEFor use in ICU's only

V03AB 1.1.3 flumazenil P 1mg/10ml 1 injection ANEXATEFor use in ICU's only

S02C 11.2 flumethasone + cliquinol 0,2mg +10mg/ml 7,5ml ear dropsLOCACORTEN VIOFORM

D07AC 14.4 fluocinolone 0,025% 15g cream SYNALARCheapest grade III Steroid cream on tender to be used

D07AC 14.4 fluocinolone 0,025% 500g cream SYNALARCheapest grade III Steroid cream on tender to be used

D07AC 14.4 fluocinolone 0,025% 15g ointment SYNALARCheapest grade III Steroid ointment on tender to be used

D07AC 14.4 fluocinolone 0,025% 500g ointmentSYNALAR, CORTODERM

Cheapest grade III Steroid ointment on tender to be used

S01JA 15.7 fluorescein 500mg/2ml 12 injection FLUORESCITESpecialist ophthalmologist

S01JA 15.7 fluorescein 1 2% 0,5ml x 20 minims MINIMS FLUORESCEINS01JA 15.7 fluorescein 1mg 100 strips FLUORETS

S01H 15.7 fluorescein + lignocaine1,25mg + 20mg/0,5ml

0,5ml x 20 minimsMINIMS LIGNOCAINE & FLUORESCEIN

Specialist ophthalmologist

S01BA 15.2 fluorometholone 0,1% 5ml eye drops FMLSpecialist ophthalmologist initiated

L01BC 23 fluoro-uracil A P 500mg/10ml 5 injection FLUROBLASTIN Specialist of 82


L01BC 14.9 fluoro-uracil A P 50mg/g 10g ointment EFUDIX SpecialistL01BC 23 fluoro-uracil A P 250mg 30 tablet FLUROBLASTIN Specialist

N06AB 1.4.4 Supp List 123 fluoxetine 1 A 20mg 28 capsule PROZAC; LORIENFor depression (Addendum F of SL 80, Circular H112/1998 is repealed)

N06AB 1.4.4 Supp List 123 fluoxetine A 20mg 100 capsule PROZAC; LORIENFor depression (Addendum F of SL 80, Circular H112/1998 is repealed)

N05AF 1.5.3 flupenthixol A 20mg/ml 1 injection, oily FLUANXOL DEPOTN05AF 1.5.3 flupenthixol A 40mg/2ml 1 injection, oily FLUANXOL DEPOTN05AB 1.5.1 fluphenazine HCl 25mg/10ml 1 injection MODECATE ACUTUMN05AB 1.5.1 fluphenazine decanoate 1 A 25mg/ml 1 injection MODECATEN05AB 1.5.1 fluphenazine decanoate 1 A 250mg/10ml 1 injection MODECATEB03BB 20.1 folic acid 1 A P 5mg 28 tablet FOLIC ACIDB03BB 20.1 folic acid A P 5mg 100 tablet FOLIC ACIDB03BB 20.1 folic acid A P 5mg 1 000 tablet FOLIC ACIDV03AF 20.1 folinic acid P 3mg/ml 10 injection REFOLINON SpecialistV03AF 20.1 folinic acid P 30mg/10ml 10 injection LEUCOVORIN SpecialistV03AF 20.1 folinic acid P 50mg 1 injection LEUCOVORIN SpecialistV03AF 20.1 folinic acid P 15mg 10 tablet ABIC LEUCOVORIN Specialist

R03AC 10.2 Supp List 117 formoterol A 12µg/metered dose 1 inhaler - HFA FORATEC INHALERspecialist physician & paediatrician initiated

For adults and children over the age of 6 - cheapest LABA on tender to be used See Circular H 64/2007 Suppl List 110: Annexure A Note: Formoterol inhaler is not registerd for use in children under the age of six

X Ø formaldehyde liquid 34% - 38% 2 500ml solution FORMALIN

S01CA 15.3framycetin + gramicidin + dexamethasone

8ml ear drops SOFRADEX Specialist ENT

C03CA 16.1 furosemide 1 A P 20mg/2ml 1 injection LASIX

C03CA 16.1 furosemide A P 250mg/25ml 1 injectionLASIX; SABAX FUROSEMIDE

C03CA 16.1 furosemide P 10mg/ml 100ml oral solution LASIXC03CA 16.1 furosemide 1 A P 40mg 28 tablet LASIXC03CA 16.1 furosemide A P 40mg 56 tablet LASIX; PURESISC03CA 16.1 furosemide A P 40mg 250 tablet LASIXC03CA 16.1 furosemide A P 40mg 5 000 tablet LASIXV08AB Ø gadobutrol 1 injection GADOVIST Specialist Radiology

P03AB 14.2gamma benzene hexachloride

1% 100ml lotion GAMBEX LOTION Only for use in children up to the age of 12 years

P03AB 14.2gamma benzene hexachloride

1% 100ml shampooGAMBEX SHAMPOO; QUELLADA

As above

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J05AB 18.12 Supp list 124 ganciclovir 500mg 1 injection CYMEVENE Specialist

Specialist infectious diseases, virologist - for use in life threatening CMV infections: Retinitis / Encephalitis / Pneumonitis / Colitis / Oesophagitis / Cholangitis Ophthalmic use to be approved by ophthalmologist Regional and Central hospitals

L01BC 23 Supp list 124 gemcitabine 200mg 1 injection GEMZAR Specialist Specialist oncologist, for bladder cancerL01BC 23 Supp list 124 gemcitabine 1000mg 1 injection GEMZAR Specialist Specialist oncologist, for bladder cancerJ01GB 18.3 gentamicin P 20mg/2ml 1 injection GARAMYCIN

J01GB 18.3 gentamicin A P 80mg/2ml 1 injectionGARAMYCIN; FERMENTMYCIN

J01GB 18.3gentamycin + methylmethacrylate cement

0,5g + 33,8g2 x 40g pdr2 x 20ml liquid

powderPALACOS R with GARAMYCIN

Specialist orthopaedic surgeon

D07C/X 14.4.1gentamycin + betamethasone + clioquinol + tonaftate

1mg + 0,5mg + 10mg + 10mg per gram

20g cream QUADRIDERM Specialist ENT ENT in-clinic/hospital use only.

D01AE Ø gentian violet medicinal 1 0,5% 20ml paintGENTIAN VIOLET PAINT

G03XA 19.8 gestrinone 2,5mg 10 capsule TRIDOMOSESpecialist gynaecologist

Central hospitals only, not referable.

A10BB 19.1.2 glibenclamide 1 A 5mg 28 tablet DAONILA10BB 19.1.2 glibenclamide 1 A 5mg 56 tablet DAONIL

A10BB 19.1.2 glibenclamide 1 A 5mg 84 tabletDAONIL; EUGLUCON; GLYCOMIN

A10BB 19.1.2 glibenclamide A 5mg 100 tablet DAONILA10BB 19.1.2 glibenclamide A 5mg 500 tablet GLYBEN; GLYCOMINA10BB 19.1.2 gliclazide 1 A 80mg 56 tablet DIAMICRONA10BB 19.1.2 gliclazide A 80mg 504 tablet DIAMICRONH04AA 19.2 glucagon A P 1mg/ml syringe injection GLUCAGON NOVOV07AV Ø glutaraldehyde 2% 1 000ml liquid G-CIDE; GLUTERALV07AV Ø glutaraldehyde 2% 5 000ml liquid G-CIDE; GLUTERALA06A Ø glycerine BP 500ml liquidA06A Ø glycerine BP 5 000ml liquid

A06AG 12.7glycerine + sodium stearate

0,891ml + 0,113g 12 suppository GLYCERINE (PAED.)

A06AG 12.7glycerine + sodium stearate

A 1,698ml + 0,213g 12 suppository GLYCERINE (ADULT)

ØSuppl List 119

glycerine & thymol co 1 BPC 100ml liquidFor dental use only

A03AB 5.4glycopyrrolate (glycopyrronium)

P 0,4mg/2ml 1 injection ROBINUL

D01BA 18.8 griseofulvin 1 125mg 100 tablet FULCIND01BA 18.8 griseofulvin 1 500mg 100 tablet FULCIN; MICROCIDAL

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Growth Stimulating Factor see Filgrastim

N05AD 1.5.2 haloperidol 1 A P 0,5mg 56 capsule SERENACEN05AD 1.5.2 haloperidol 1 A P 0.5mg 60 capsule SERENACEN05AD 1.5.2 haloperidol 1 A P 0,5mg 84 capsule SERENACEN05AD 1.5.2 haloperidol A P 0,5mg 500 capsule SERENACEN05AD 1.5.2 haloperidol 5mg/ml 1 injection SERENACEN05AD 1.5.2 haloperidol 20mg/2ml 6 injection SERENACEN05AD 1.5.2 haloperidol A 1,5mg 100 tablet SERENACEN05AD 1.5.2 haloperidol A 1,5mg 500 tablet HALOPERIDOLN05AD 1.5.2 haloperidol 1 5mg 28 tablet SERENACEN05AD 1.5.2 haloperidol 1 5mg 56 tablet CEREENN05AD 1.5.2 haloperidol A 5mg 100 tablet SERENACEN05AD 1.5.2 haloperidol 5mg 500 tablet SERENACE

N01AB 2.1.1 halothane A P BP 250mlinhalation liquid

FLUOTHANE

B01AB 8.2 heparin sodium A P 1 000u/ml 5ml 1 injection PULARINB01AB 8.2 heparin sodium A 5 000u/ml 5ml 1 injection PULARINB01AB 8.2 heparin sodium A 25 000u/ml 5ml 1 injection PULARIN

S01FA 15.5homatropine + hypromellose

P 2% + 0,5% 5ml eye drops ISOPTO HOMATROPINE

X 19.7human menopausal gonadotrophin

FSH + LH 75iu 1 injection HUMEGON Specialist Central hospitals only, not referable.

human serum albumin: see albumin, normal serum

human serum stabilised: see serum, human stabilised

X 27 Supp List 121 hyaluronidase 1 500iu 1 injection HYALASESpecialist Opthalmologist

C03AA 16.1 hydrochlorothiazide 1 A P 25mg 14 tablet DICHLOTRIDEC03AA 16.1 hydrochlorothiazide 1 A P 25mg 28 tablet DICHLOTRIDEC03AA 16.1 hydrochlorothiazide P 25mg 500 tablet DICHLOTRIDE; RIDAQD07AA 14.4 hydrocortisone 1 A 1% 20g cream MYLOCORTD07AA 14.4 hydrocortisone A 1% 20g ointment MYLOCORT

H02AB 19.5hydrocortisone sodium succinate

1 A P 100mg I.V./I.M. 1 injection SOLU-CORTEF

H02AB 19.5 hydrocortisone A P 10mg 100 tablet COVOCORT

X Ø hydrogen peroxide liquid 20 vol 500ml liquid HYDROGEN PEROXIDE

S01KA 15.7 hydroxypropyl methylcellulose

0.3% - 0.5% 15ml eye dropsVISCOTRAANSPERSATEAR

L01XX 23 hydroxyurea A P 500mg 100 capsule HYDREA Specialist of 82


N05BB 1.3.2 hydroxyzine 10mg/5ml 100ml syrup ATERAXSpecialist paediatrician & dermatologist

N05BB 1.3.2 hydroxyzine 25mg 100 tablet ATERAXSpecialist paediatrician & dermatologist

N05BB 1.3.2 hydroxyzine 100mg 100 tablet ATERAXSpecialist paediatrician & dermatologist

A03BB 12.3hyoscine-N-butyl bromide

A P 20mg/ml 1 injectionBUSCOPAN; HYOSPASMOL


10mg 10 tablet BUSCOPAN





M01AE 4.1 ibuprofen P 100mg/5ml 100ml syrup BRUFENGeneral Code Specialist

General Code: For peri/post operative use in paediatrics Specialist: Other indications

M01AE 4.1Suppl List 119

ibuprofen 1 A P 200mg 15 tablet

For acute conditions: Not more than 5 days supply. Not repeatable for acute conditions (short course). For longer periods, the appropriate diagnosis and quantity to be written on the prescription


ibuprofen 1 A P 200mg 84 tablet BRUFEN



ibuprofen A P 200mg 1 000 tablet BRUFEN


D05A 31 ichthammol ointment BP 500g ointment ICHTHAMMOL OINT.V03A Ø ichthammol glycerin 1 BPC 500ml liquid

J01DH 18.1.3imipenem + cilastatin sodium

A 500mg + 500mg 120ml injection TIENAM 500Specialist ICU & highcare

Use on microbiologist report only.

N06AA 1.4.1 imipramine A P 10mg 100 tablet TOFRANIL Specialist initiatedOpen code for use in children up to a maximum dose of 25mg daily.

N06AA 1.4.1 imipramine A P 25mg 28 tablet MIPRALIN Specialist initiatedN06AA 1.4.1 imipramine A P 25mg 56 tablet MIPRALIN Specialist initiatedN06AA 1.4.1 imipramine A P 25mg 84 tablet MIPRALIN Specialist initiated -------N06AA 1.4.1 imipramine A P 25mg 100 tablet TOFRANIL Specialist initiated -------

N06AA 1.4.1 imipramine A P 25mg 1 000 tabletTOFRANIL; ETHIPRAMINE

Specialist initiated ------- of 82


D06BB 14.9 imiquimod 5% sachet cream ALDARASpecialist dermatologist & oncologist

J06BB 26immunoglobulin anti-D rhesus

1 A 100µg 2ml injection

J06BB 26immunoglobulin anti-hep. B

A P 170 iu 2ml injection

J06BB 26immunoglobulin anti-measles

2ml injection

J06BB 26immunoglobulin anti-rubella

5ml injection

J06BB 26immunoglobulin anti-tetanus

1 A P 250 iu 2ml injection

J06BB 26immunoglobulin anti-varicella zoster

A P 16,5% 2ml injection

J06BA 26 immunoglobulin human P 16% 5ml injection

J06BA 26 immunoglobulin human 5% 0,5g 10ml solvent I.V. infusion POLYGAMSpecialist physician & paediatrician

J06BA 26 immunoglobulin human P 3% 1g 33ml solvent I.V. infusion POLYGAMSpecialist physician & paediatrician

J06BA 26 immunoglobulin human P 3% 3g100ml solvent

I.V. infusion POLYGAMSpecialist physician & paediatrician

J06BA 26 immunoglobulin human P 3% 6g200ml solvent

I.V. infusion POLYGAMSpecialist physician & paediatrician

J06BB 26immunoglobulin, human, anti-rabies

1 A P 150iu/ml 2ml injection RABIGAM IM

M01AB 4.1 indomethacin A 25mg 15 capsuleFor use in obstetrics as a stat dose only

M01AB 4.1 indomethacin A 25mg 84 capsule INDOCIDFor use in obstetrics as a stat dose only

M01AB 4.1 indomethacin A 25mg 1 000 capsule INDOCID; ARTHREXINFor use in obstetrics as a stat dose only

M01AB 4.1 indomethacin A 100mg 10 suppository ARTHREXINFor in-patient use only.

X Øinhaler device with mask

1AEROCHAMBER (NEONATE)

X Øinhaler device with mask

1GLAXOHALER (CHILDREN)

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X Ø Supp List 116 1 re-useable pen BATSWADI AUTOPEN

Specialist physician, paediatrician and endocrinologist

Paediatrics and adolescents only. To be initiated at Central Hospitals only. Autopen: Non-Referable

Supp List 124 1 re-useable pen NOVO RAPID penfillSpecialist paediatrician initiated

For patients under 5 years old. Device to be initiated at central hospitals and is not referable. Cartridges may be accessed at periphery as required i.e. referable. .

A10AA 19.1.1 Supp List 124insulin analogue human, insulin aspart

100units/ml 3mL cartridge NOVO RAPID penfillSpecialist paediatrician initiated

For patients under 5 years old. To be initiated at central hospitals. Cartridges may be accessed at periphery as required i.e. referable. (Insulin device not referable).

A10AA 19.1.1 Supp List 116insulin human soluble biosynthetic 100units/ml 3mL cartridge

HUMULIN R CARTRIDGE


Paediatrics and adolescents only. To be initiated at Central Hospitals only. Referable

A10AA 19.1.1 Supp List 116insulin human soluble/isophane

30% / 70%100units/ml

3mL cartridgeHUMULIN 30/70 CARTRIDGE



A10AA 19.1.1 Supp List 116insulin human isophane biosynthetic

100units/ml 3ml cartridge HUMULIN N



A10AA 19.1.1insulin human soluble biosynthetic 100units/ml 10ml injection

HUMULIN R; ACTRAPID HM(ge)

A10AA 19.1.1insulin human soluble biosynthetic A P 100units/ml 3ml penset ACTRAPID HM(ge)

Pensets to be used only in young patients (juvenile diabetes) and patients not capable of using vials & syringes e.g. impaired vision or the elderly.

A10AA 19.1.1insulin human soluble + isophane 1

30% + 70%100units/ml

10ml injectionACTRAPHANE HM(ge) HUMULIN 30/70

A10AA 19.1.1insulin human soluble + isophane (yeast)

30% / 70%100units/ml

3ml pensetACTRAPHANE HM(ge); HUMULIN 30/70

Pensets to be used only in young patients (juvenile diabetes) and patients not capable of using vials & syringes e.g. impaired vision or the elderly.

A10AA 19.1.1insulin human isophane biosynthetic

1 100units/ml 10ml injectionPROTAPHANE HM(ge); HUMULIN N

A10AA 19.1.1insulin human isophane biosynthetic

100units/ml 3ml penset PROTAPHANE HM(ge)Pensets to be used only in young patients (juvenile diabetes) and patients not capable of using vials & syringes e.g. impaired vision or the elderly.

A10AA 19.1.1 insulin human lispro 100units/ml 10ml injection HUMALOGCentral Hospitals Patient name basis.

Not referable.

A10AA 19.1.1 insulin human lispro 100units/ml 3ml penset HUMALOG Central HospitalsPatient name basis.Not referable.

insulin injection device for use with 3mL insulin cartridge containing 100 units per 1mL (device is colour coded to correspond with insulin type)

insulin injection devise (penfill) for use with 3mL insulin aspart, human cartridge containing 100 units / mL

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X Ø insulin needles 100 needles NOVOFINE NEEDLES

L03AA 23 interferon-alpha 2a A P 3mu/vial 1 injection ROFERON A SpecialistCheapest on tender of alpha 2a or 2b to be bought.For use in hairy-cell leukemia and condyloma acumiata.

L03AA 29 interferon-alpha 2b A P 3mu/vial 1 injection INTRON - A Specialist As aboveV08AB Ø iobitridol 300mg/ml 50ml 1 injection XENETIX Specialist Only for RadiographyD08AG Ø iodine solution BP 500ml liquid WEAK IODINE SOLN. EDL

V08AB Ø iohexol 180mg/ml 10 injection OMNIPAQUE Specialist

Only for use in patients with a history of reaction to contrast media; history of allergy, coronary angiography in high risk patients & children;myelography; certain neuroradiological procedures; peripheral angiography when necessary.

V08AB Ø iohexol 250mg/ml 10ml 10 injection OMNIPAQUE Specialist As aboveV08AB Ø iohexol A 300mg/ml 20ml 20 injection OMNIPAQUE Specialist As aboveV08AB Ø iohexol A 300mg/ml 50ml 10 injection OMNIPAQUE Specialist As aboveV08AB Ø iohexol 350mg/ml 50ml 10 injection OMNIPAQUE Specialist As aboveV08AB Ø iohexol 350mg/ml 100ml 10 injection OMNIPAQUE Specialist As aboveV08AB Ø iopamidol 0,612g/ml 50ml 10 injection JOPAMIRON SpecialistV08AB Ø iopamidol 0,755g/ml 50ml 10 injection JOPAMIRON Specialist As aboveR03BB 10.4 ipratropium bromide 1 A P 0,04mg/inhal. 1 MDI complete ATROVENT

R03BB 10.4 ipratropium bromide A P 0,25mg/ml 2ml 60 UDVinhalation solution in a Unit Dose Vial

ATROVENT

X Ø iron bile salts 300mg 40 capsule BILRON Specialist initiatedLipid clinics only. For use in cerebrotendinous xanthomatosis.

B03AC 8.6 iron sucrose complex 100mg/5ml I.V. 1 injection VENOFER

Specialist physician, paediatrician & gynaecologist

N01AB 2.1.1 isoflurane A P 100ml inhal FORANE; ISOFOR SpecialistJ04AC 18.6.1 isoniazid 1 A P 100mg 1 000 tablet ISONIAZIDC01DA 7.4 isosorbide dinitrate 1 A P 5mg 50 tablet ISORDIL; DILANIDC01DA 7.4 isosorbide dinitrate A P 40mg 30 tembid ISORDIL TEMBIDS As aboveC01DA 7.4 isosorbide dinitrate A P 40mg 100 tembid ISORDIL TEMBIDS MAX. 40mg twice daily with eccentric regimen.

C01DA 7.4isosorbide-5-mononitrate

A P 20mg 60 tablet ELANTAN 20To be used when cost and availability of dinitrate is a problem. 20mg mononitrate is equivalent to 40mg dinitrate.

C01DA 7.4isosorbide-5-mononitrate

A P 20mg 500 tablet ISMO-20To be used when cost and availability of dinitrate is a problem. 20mg mononitrate is equivalent to 40mg dinitrate.

D10BA 14.6 isotretinoin 10mg 60 capsule ROACCUTANE Central HospitalsPatient name basis.Not referable.

D10BA 14.6 isotretinoin 20mg 60 capsule ROACCUTANE Central HospitalsPatient name basis.Not referable. of 82


A06AC 12.7 ispaghula husk P 3,5g 30 sachets FYBOGEL ORANGE Specialist initiatedMaximum: 30 sachets per month. Cheapest bulk forming agent currently on tender to be used.

J02AC 18.10 itraconazole 100mg 4 capsuleSPORANOX/ADCO-SPORAZOLE

Specialist dermatologist

Central hospitals, Patient name basis, Not referable.

J02AC 18.10 itraconazole 100mg 14 capsuleADCO-SPORAZOLE (ON TENDER)


Specialist dermatologist - Central hospitals, patient name basis - Non-referable Specialist - for AIDS & disseminated histoplasmosis following Amphotericin B initial therapy Non referable

J02AC 18.10 Supp List 113 itraconazole 100mg 28 capsuleSPORANOX/ADCO-SPORAZOLE

Specialist dermatologist Specialist

Specialist dermatologist - Central hospitals, patient name basis - Non-referable Specialist - for AIDS & disseminated histoplasmosis following Amphotericin B initial therapy Non referable

J01GB 18.3 kanamycin 1g/3ml 1 injection KANAMYCIN NOVOX Ø kaolin poultice BP 250g poultice KAOLIN POULTICEN01AX 2.1.2 ketamine A P 10mg/ml I.V. 20ml injection KETALARN01AX 2.1.2 ketamine A P 100mg/ml I.V. 10ml injection BREVINAZE

J02AB 18.8 ketoconazole A 200mg 30 tablet NIZORAL SpecialistMotivation form to be completed or on a Microbiologist report.

S01BC 15.7 ketorolac 5mg/ml 5ml eye drops ACULARSpecialist ophthalmologist

R06AX 10.4 ketotifen 1mg/5ml 200ml syrup ZADITENSpecialist paediatrician initiated

To be used in paediatric allergy clinics for children 3 years of age and younger.

C07AG 7.3.1 labetalol 100mg/20ml 1 injection TRANDATE SpecialistG01AD Ø lactic acid 500ml liquidA06AD 12.7 lactulose A P 3.3g/5ml 150ml syrup DUPHALAC; LACSON Hepatic encephalopathy only.A06AD 12.7 lactulose A P 3.3g/5ml 500ml syrup DUPHALAC; LACSON As above.

J05AF 18.12pgwc ARV depot

lamivudine 1 10mg/ml 240ml solution 3-TC AIDS programmeAvailable through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.

J05AF 18.9pgwcARV depot Supp List 124

lamivudine1

A P150mg 60 tablet

3-TC, Adco-Lamivudine, Aspen Lamivudine



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lamivudine1

A P300mg 60 tablet



N03AX 1.6Suppl List 118

lamotrigine 1 25mg 60 tablet LAMICTIN Specialist initiatedFor Mood Disorders: Psychiatrist initiated Patients may only be referred once stabilised on the maintenance dose

N03AX 1.6Supply List 118






S01XA 15.7 lanolin anhydrous liquid A P 30mg/g 3.5g eye ointment DURATEARS Specialist initiated Cheapest eye ointment on tender to be used.

S01XA 15.7lanolin anhydrous derivatives

20mg/g 3,5g eye ointment LACRI-LUBE Specialist initiated Cheapest eye ointment on tender to be used.

A02BC 12.4.4 lansoprazole 30mg 14 capsule LANZORPaediatrician & Endoscopy units initiated

Cheapest PPI on tender to be used. For treatment guidelines refer to: Circular H95/2005 (Addendum B - Suppl. List 102)

A02BC 12.4.4 lansoprazole 30mg 28 capsule LANZORPaediatrician & Endoscopy units initiated

As above.

S01EE 15.6Suppl List

121 latanoprost A 50µg/ml 2,5ml eye drops XALANTAN

Specialist ophthalmologist initiated

Cheapest prostaglandin analogue ophthalmic solution to be used. See bimatoprost - refer RT280-2009MF

S01EE/D 15.6 Supp List 117 latanoprost + timolol 50µg + 5mg/ml 2,5ml eye drops XALACOMSpecialist ophthalmologist

For patients not responding to a single agent

N03AX 1.6 levetiracetam 250mg 30 tablets KEPPRASpecialist neurologist

As third or fourth line therapy. Non-referable. Maximum dose: 2000mg

S01ED 15.6 levobunolol HCl 0,5% 5ml eye drops BETAGANSpecialist ophthalmologist initiated

Only use cheapest beta-blocker drops of appropriate concentration available on tender.

N04BA 1.7.1 levodopa + benserazide A 200mg + 50mg 100 tablet MADOPAR

G03AC 17.1.1ex family planning stores

levonorgestrel 1 0,03mg 28 tablet MICROVAL Family Planning

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G03AB 17.1.1ex family planning stores

levonorgestrel +ethinyl oestradiol

0,1mg +0,02mg

28 tablet LOETTE Family Planning

Not to be prescribed as first line contraceptive. Use according to the Contraceptive Guidelines of the Provincial Reproductive Health Services. See Circular H125/2003 (Addendum F - Suppl. List 98)



1 A0,15mg +0,03mg

28 tablet NORDETTE Family Planning



1 A0,05mg;0,125mg +0,05mg

28 tablet BIPHASIL Family PlanningNot to be prescribed as a contraceptive. Prescribe only for treatment of prolonged bleeding on injectables.



1 A

0,05mg;0,075mg;0,125mg + 0,03mg;0,04mg;0,03mg

28 tablet TRIPHASIL Family Planning

G02BA 17.1.3 Supp List 122levonorgestrel releasing intra uterine system

52mg/system 20µg/24 hours

1intra uterine system

MIRENASpecialist gynaecologist

For women in whom hysterectomy is contra-indicated and/ or who have failed other modalities

N01BB 2.2.1 lidocaine + prilocaine 2,5% + 2,5% 5g cream EMLARestricted to hospital paediatrics for conditions and procedures such as lumbar puncture,oncology, chronic illnesses etc.

D04AB 2.2.1 lignocaine HCl 1 A 2% 20ml gelREMICAINE; PETERKAIEN

N01BB 2.1.1. lignocaine HCl A P10mg per metered spray

475 doses spray XYLOCAINE

N01BB 2.2lignocaine HCl - without adrenaline

A 2% 1,8ml 1dental cartridge

XYLOTOX SE PLAIN

N01BB 2.2lignocaine HCl + nor-adrenaline

2% + 1 : 80 000 1,8ml

1dental cartridge

XYLOTOX L

N01BB 2.2lignocaine HCl + adrenaline

A P2%+ 1 : 80 000 1,8ml

1dental cartridge

XYLOTOX E80-A

N01BB 2.2 lignocaine I.M. 1 A P 1% 20ml 1 injection REMICAINEC01BB 7.2 lignocaine 1 A 2% 5ml 1 injection REMICAINEN01BB 2.2 lignocaine I.M. A P 2% 20ml 1 injection REMICAINEC01BB 7.2 lignocaine I.V. 10% 5ml 1 injection REMICARD Specialist

J01XX 18.9 Supp List 124 linezolid 600mg 10 tablets ZYVOXID Specialist

Infectious disease specialist or microbiologist approval: - vancomycin resistant Staphylococcal or Enterococcal infection - vancomycin intolerant (use excluded in red man syndrome) - methicillin resistant Staphylococcus aureus

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J01XX 18.9 Supp List 124 linezolid 200mg 1 injection ZYVOXID Specialist


J01XX 18.9 Supp List 124 linezolid 600mg 1 injection ZYVOXID Specialist


J01XX 18.9 Supp List 124 linezolid 200mg/ml 150ml suspension ZYVOXID Specialist


H03AA 19.3 liothyronine 20µg 50 tabletTERTROXIN; TRI-IODOTHYRONINE

Specialist endocrinologist

lipid emulsion: see tpn fat emulsion

A06AA Ø liquid paraffin 1 A BP 200ml liquid LIQUID PARAFFIN Maximum 200ml / patient / monthA06AA Ø liquid paraffin A BP 1 000ml liquid LIQUID PARAFFIN Maximum 200ml / patient / month.

N05AN 1.4.5 lithium carbonate A 250mg 56 tablet CAMCOLITSpecialist psychiatrist initiated




N05AN 1.4.5 lithium carbonate A 250mg 1 000 tablet CAMCOLITSpecialist psychiatrist initiated

N05AN 1.4.5 lithium carbonate 400mg 100 tablet CAMCOLITSpecialist psychiatrist initiated

L01AD 23 lomustine A P 10mg 20 tablet CeeNUSpecialist oncologist of 82


L01AD 23 lomustine A P 40mg 20 capsule CeeNUSpecialist oncologist

A07DA 12.8 loperamide A 2mg 6 tablet IMODIUM; GASTRON

A07DA 12.8 loperamide A 2mg 500 tabletIMODIUM; GASTRONPRODIUM

J05AF 18.12

pgwc ARV depot

lopinavir + ritonavir 1 200mg + 50mg 90 capsule ALUVIA

AIDS programme

General Code

Available through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.

Third line agent for needle stick injury post exposure prophylaxis according to the Provincial HIV/AIDS/STI/TB Directorate's protocol. Also refer to Circular H1/2009


lopinavir + ritonavir 1 80mg + 20mg/ml 60ml solution KALETRA AIDS programme As above.

N05BA 1.3.1 lorazepam A 4mg/ml 5 injection ATIVAN; TRANQUIL

N05BA 1.3.1 lorazepam A 1mg 14 tablet TRANQIPAMSpecialist General: for 14 days only & no repeats.

N05BA 1.3.1 lorazepam A 1mg 28 tablet TRANQIPAMSpecialist General: for 14 days only & no repeats.

N05BA 1.3.1 lorazepam A 1mg 100 tablet ATIVANSpecialist General: for 14 days only & no repeats.

N05BA 1.3.1 lorazepam A 1mg 500 tablet ATIVANSpecialist General: for 14 days only & no rep

As above

C09CA 7.3.9Supp List 115/120/121/123/ 124

losartan 50mg 30 tabletLOS-ARB / CIPLA LOSARTAN

Specialist physician, nephrologists, cardiologist and paediatrician initiated

Cheapest angiotensin receptor antagonist (ARB) available on tender to be used. For: ACEI intolerant patients. Maximum dose: 100mg daily Cross contra-indication between ARB & ACEI with relation to angioedema.

D05AA ‡

LPC (liquor picis carbonis - coal tar solution) in aqueous cream

5% 200g cream

D05AA ‡

LPC (liquor picis carbonis - coal tar solution) in emulsifying base

5% 200g ointment

X 14.8 lubricating jelly 1 50ml jelly - sterile K Y JELLY

X 14.8 lubricating jelly 100 x 2,5mlsachets - sterile

K Y JELLY SACHETS

No more than 14 days supply, except when prescribed by a psychiatrist or neurologist when 28 days may be dispensed. See circular H24/2006: Suppl List 107 Addendum I

On General Code ONLY for emergency treatment of aggressive/restless patients in accordance with the applicable protocol - Protocol 1 (2/98).

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H01CA 19.7luteinising hormone-releasing hormone; gonadorelin

0,1mg 1 injection H.R.F. Specialist Central hospitals only, not referable.

H01CA 19.7luteinising hormone-releasing hormone; gonadorelin

0,5mg 1 injection H.R.F. Specialist As above

B05AA 35

lvp [large volume parenteral] dextran 40 in sodium chloride

P 10% + 0,9% 500ml plastic bag RHEOMACRODEX

B05AA 7.8lvp dextran 70 in sodium chloride

P 500mlglass container

MACRODEX

V03AH Ø lvp dextrose 1 A P 10% 1 000ml plastic bagV03AH Ø lvp dextrose A P 20% 1 000ml plastic bagV03AH Ø lvp dextrose A 35% 1 000ml plastic bagV03AH Ø lvp dextrose P 5% 1 000ml plastic bagV03AH Ø lvp dextrose 1 A P 5% 100ml plastic bagV03AH Ø lvp dextrose 1 A P 5% 200ml plastic bagV03AH Ø lvp dextrose 1 A P 5% 50ml plastic bagV03AH Ø lvp dextrose 1 A P 50% 500ml plastic bag

B05AA 7.8

lvp gelatin, degraded, bovine (polygeline) + polypeptides + Na, K, Ca & Cl

3,5% 500ml infusion HAEMACEL

B05AA 7.8lvp hydroxyethyl starch (hetastarch) + sodium chloride

6% + 0,9%

500mlpolyethylene infusion bottle

HAES-STERIL 6%Cheapest colloid to be used For use in ICU, High Care. Theatre & in patients with ongoing massive haemorrhage

B05AA 7.8 Supp List 118lvp hydroxyethyl starch (hetastarch) 130 / 0,4 + sodium chloride

6% + 0,9%

500ml infusion VOLUVENCheapest colloid to be used For use in ICU, High Care. Theatre & in patients with ongoing massive haemorrhage

B05AA 7.8 Supp List 118lvp hydroxyethyl starch (hetastarch) 130 / 0,42 + sodium chloride

6% + 0,9%

500ml infusion VENOFUNDENCheapest colloid to be used For use in ICU, High Care. Theatre & in patients with ongoing massive haemorrhage

B05BC Ølvp mannitol for irrigation

5% 3 000ml plastic bag SABAX OSMITROL

B05BC Ø lvp mannitol infusion 20% 500ml plastic bag

B05BB Ølvp multi-electrolyte inf. with no potassium

P 200ml plastic bagPOT. FREE NEONATAL MAINTENANCE

B05BB Ølvp multi-electrolyte infusion

A 1 000mlREPLACEMENT SOLUTION


A 1 000mlglass container

PLASMALYTE B


A 200mlglass container

PLASMALYTE B


1 P 200ml plastic bagHALF DARROW'S & DEXTROSE 5%

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1 P 500ml palstic bagHALF DARROW'S & DEXTROSE 5%


A 1 000ml plastic bagSUSTENANCE SOLNMAINTELYTE & DEXTROSE 5%


A 1 000ml plastic bag ELECTROLYTE No 2


1 000ml plastic bagMAINTELYTE + GLUCOSE 10%


P 200ml plastic bagNEONATALYTE + GLUCOSE 10%


1 A P 200ml plastic bag RINGER LACTATE

B05BB Ø Supp List 119lvp multi-electrolyte infusion

A P 1 000ml plastic bag RINGER LACTATE

B05BB Ø Supp List 119lvp multi-electrolyte infusion

1 A 1 000ml plastic bagMODIFIED RINGER LACTATE

B05BB Ølvp multi-electrolyte intravenous infusion

P 200ml plastic bagPAED.MAINTENANCE + GLUCOSE 5%

B05BB Ølvp sodium bicarbonate infusion

4,2% 200mlglass container

B05BB Ø lvp sodium chloride 0,9% 200mlglass container

B05BB Ø lvp sodium chloride A P 5% 200mlglass container

B05BB Ø lvp sodium chloride A P 0,45% 1000ml plastic bagB05BB Ø lvp sodium chloride 1 A P 0,9% 1 000ml plastic bagB05BB Ø lvp sodium chloride 1 A P 0,9% 100ml plastic bagB05BB Ø lvp sodium chloride 1 A P 0,9% 200ml plastic bagB05BB Ø lvp sodium chloride 1 A P 0,9% 50ml plastic bag

Ølvp sodium chloride + dextrose

0,45% + 2,5% 1 000ml plastic bag


0,45% + 5% 1 000ml plastic bag REHYDRATION SOLN


0,2% + 5% 200ml plastic bag


A 0,9% + 5% 1 000ml plastic bag


1 A 0,9% + 5% 200ml plastic bag


5% + 0,2% 200ml plastic bag

Ølvp solutionn for irrigation mannitol

5% 3 000ml plastic bagMANNITOL 5% FOR IRRIGATION

Ølvp solution for irrigation multi-electrolyte

3000ml plastic bagRINGER LACTATE INJECTION BP

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Ølvp solution for irrigation purified water

1 1 000ml pour bottleWATER FOR IRRIGATION

Ølvp solution for irrigaationsodium chloride

1 0,9% 3 000ml plastic bagSOD.CHLORIDE 0,9% FOR IRRIGATION

Ølvp solution for irrigationsodium chloride

1 0.9% 1 000ml plastic bagSOD.CHLORIDE 0,9% FOR IRRIGATION

Ølvp solution for irrigation sodium chloride

1 0.9% 1 000ml pour bottleSOD.CHLORIDE FOR IRRIGATION

Ølvp solution for irrigation sodium chloride

1 0.9% 500ml pour bottleSOD.CHLORIDE FOR IRRIGATION

Ølvp solution for irrigation sterile water

1 1 000ml plastic bagSTERILE WATER FOR IRRIGATION

Ølvp solution for irrigation sterile water

1 3 000ml plastic bagSTERILE WATER FOR IRRIGATION

Ø lvp water for injection 1 000mlglass container

Ø lvp water for injection 200mlglass container

A12CC 20.4 magnesium chloride 500mg - 700mg 60 tablet ULTIMAG; SLOW-MAGA12CC 20.4 magnesium chloride 500mg - 700mg 100 tablet ULTIMAG; SLOW-MAG

A02AA 12.4magnesium hydroxide mixture

BP 2 500ml suspension

A12CC 20.4 magnesium sulphate 1 A P 50% 2ml 1 injectionADCO-MAGNESIUM SULPHATE

X Ø magnesium sulphate A P BP 500g powder

A02AA 12.4magnesium trisilicate mixture compound

BPC 500ml suspension MIST MAG TRISIL CO.

A02AA Ø magnesium trisilicate BP 100ml mixtureMIST MAG TRISILICATE BP

D03 14.9

malic acid + benzoic acid + salicylic acid + propylene glycol

0,375% + 0,025% + 0,006% + 1,75%

50g cream ASERBINE

B05BC 16.1 mannitol 1 A P 25% 50ml 1 injection ADCO-MANNITOLP02CA 13 mebendazole 1 A 500mg 1 tablet VERMOX For children over two years of age and for adults.

L02AB 19.6.3 medroxyprogesterone 100mg 100 tablet FARLUTAL

Specialist gynaecologist, obstetrics and oncologist

of 82


L02AB 19.6.3 medroxyprogesterone 500mg 100 tablet FARLUTAL

Specialist gynaecologist, obstetrics and oncologist

G03DA 19.6.3medroxyprogesterone acetate

1 A 150mg/ml 1 injection DEPO PROVERA Available from family planning.

G03DA 19.6.3medroxyprogesterone acetate

5mg 30 tablet PROVERA

V08AA Ømeglumine + sodium diatrizoates

26,1% + 3,9% 250ml

1 injection UROGRAFIN 30%

V08AA Ømeglumine + sodium diatrizoates

A 66% +10% 20ml 10 injection UROGRAFIN 76%

V08AA Ømeglumine + sodium amidotrizoates

A 66% + 10% 100ml 1 injection GASTROGRAFIN

V08AB Ømeglumine + sodium ioxaglate

39,3% + 19,65% 50ml

10 injection HEXABRIX Specialist

Only for use in patients with a history of reaction to contrast media; history of allergy, coronary angiography in high risk patients & children;myelography; certain neuroradiological procedures; peripheral angiography when necessary

V08AA Ø meglumine iothalamate A 60% 50ml 1 injection CONRAY 280V08AA Ø meglumine iothalamate A 70% 50ml 1 injection CONRAY 420

L01AA 23 melphalan A P 100mg 1 injection ALKERANSpecialist oncologist

L01AA 23 melphalan A P 2mg 25 tablet ALKERANSpecialist oncologist

L01AA 23 melphalan A P 5mg 25 tablet ALKERANSpecialist oncologist

L01BB 23 mercaptopurine P 50mg 25 tablet PURI-NETHOLSpecialist oncologist

D08AK Ø mercurochrome 1% 20ml solution MERCUROCHROME

J01DH 18.1.3 meropenem 500mg 1 injection MERONEM SpecialistOnly for severe nosocomial infections in ICU's & on a Microbiologist report.

A07EC 12.10 mesalazine 500mg 20 suppository ASACOLSpecialist gastroenterologist

A07EC 12.10 mesalazine 400mg 90 tablet ASACOLSpecialist gastroenterologist

mesna inhalation solution: see sodium-2-mercapto sulfonate

G03BB 19.6.1 mesterolone 25mg 100 tablet PROVIRONSpecialist endocrinologist

A10BA 19.1.2 metformin 1 A 500mg 56 tablet GLUCOPHAGEA10BA 19.1.2 metformin 1 A 500mg 84 tablet GLUCOPHAGEA10BA 19.1.2 metformin A 500mg 500 tablet GLUCOPHAGEA10BA 19.1.2 metformin 1 A 850mg 56 tablet GLUCOPHAGE FORTEA10BA 19.1.2 metformin A 850mg 300 tablet GLUCOPHAGE FORTE of 82


N02AC 3.1 methadone 10mg/ml 1 injection PHYSEPTONE

N02AC 10.1.1 methadone 2mg/5ml 100ml linctus PHYSEPTONEFor management of opioid withdrawal. To be used according to the Guidelines for the Management of Substance Detoxification.

L01BA 23 Supp List 116methotrexate(amethopterin)

A P 5mg 1 injection METHOBLASTIN

Specialist dermatologist, oncologist, paediatrician and rheumatologist


A P 50mg/2ml 1 injection ABITREXATE 50



A P 500mg 1 injection EMTHEXATE 500mg



A P 1g 1 injection METHOBLASTIN



A P 5g 1 injection METHOBLASTIN


L01BA 23methotrexate(amethopterin)

A P 2,5mg 100 tablet METHOTREXATE

Specialist physician, dermatologist, oncologist, paediatrician & rheumatologist

D05BA 14.7 methoxsalen 10mg 100 capsule OXSORALENSpecialist dermatologist

Not referable.

C02AB 7.3.1 Supp List 123 methyldopa 1 A 250mg 56 tablet ALDOMETGeneral code Clinical Nurse Practitioner

General code: For hypertension in pregnancy Clinical Nurse Practitioner: For hypertension in pregnancy. Nursing to implement an AE reporting system, with 6 month report to District PTC.

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C02AB 7.3.1 Supp List 123 methyldopa 1 A 250mg 84 tablet ALDOMETGeneral code Clinical Nurse Practitioner


C02AB 7.3.1 Supp List 123 methyldopa A 250mg 500 tablet ALDOMETGeneral code Clinical Nurse Practitioner


V03AB Ø methylene blue A P 1% 10 injection METHYLENE BLUEX Ø methylparaben 100g powder

N06BA 1.1.3 Supp List 116 methylphenidate P 10mg 30 tablet RITALIN

Specialist psychiatrists, neurologists, paediatricians and school doctor initiated

N06BA 1.1.3 Supp List 116 methylphenidate P 20mg 30Long -acting tablet

RITALIN LA

Specialist psychiatrists, neurologists, paediatricians and school doctor initiated

For use after trial of the short-acting formulation proved unsuccessful.

N06BA 1.1.3 Supp List 116 methylphenidate P 30mg 30Long -acting tablet

RITALIN LA

Specialist psychiatrists, neurologists, paediatricians initiated

For use after trial of the short-acting formulation proved unsuccessful.

H02AB 19.5 methylprednisolone 125mg 1 injection SOLU-MEDROLH02AB 19.5 methylprednisolone P 500mg injection SOLU-MEDROLH02AB 19.5 methylprednisolone 1g 1 injection SOLU-MEDROL

D07AC 14.4methylprednisolone aceponate

1mg/g 15g cream ADVANTAN CREAMSpecialist dermatologist

Dermatologists only. To be strictly controlled, not to be referred.


1mg/g 30g cream ADVANTAN CREAMSpecialist dermatologist



1mg/g 15g ointment ADVANTAN OINTMENTSpecialist dermatologist



1mg/g 30g ointment ADVANTAN OINTMENTSpecialist dermatologist



1mg/g 15g fatty ointmentADVANTAN FATTY OINTMENT




1mg/g 30g fatty ointmentADVANTAN FATTY OINTMENT



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H02AB 19.5 Supp List 114methylprednisolone acetate

80mg/2ml I.M. 1 injection DEPO-MEDROLFor Intra-lesional, Intra-bursal, Intra-articular and Peri-articular administration only.

D07A 14.4 Supp List 124methylprednisolone acetate

ADVANTANCheapest steroid scalp application on tender to be coded

MA2AB Ø Supp List 119 methyl salicylate 1 10% - 25% 25g ointmentRestricted for use in patients with soft tissue rheumatism

N02CA 1.9 methysergide 1mg 100 tablet DESERILSpecialist neurologist

A03FA 1.8 metoclopramide A P 10mg/2ml 1 injection MAXOLON; CLOPAMONA03FA 1.8 metoclopramide 1 P 5mg/5ml 50ml syrup MAXOLONA03FA 1.8 metoclopramide 1 A P 10mg 10 tablet MAXOLONA03FA 1.8 metoclopramide A P 10mg 100 tablet MAXOLON; PROSTALA03FA 1.8 metoclopramide A P 10mg 500 tablet CLOPAMON-TA03FA 1.8 metoclopramide A P 10mg 1 000 tablet CLOPAMON-T

C03BA 16.1 metolazone P 2,5mg 30 tablet ZAROXOLYNSpecialist nephrologist

For use in renal units & patients with renal failure. Available via Section 21

C03BA 16.1 metolazone 5mg 30 tablet ZAROXOLYNSpecialist nephrologist

As above

P01ABJ01XD

18.9 metronidazole A P 500mg/100ml I.V 1 infusion FLAGYL; TRICHAZOLE SpecialistFirst dose only if necessary, then change to oral or supp. as soon as possible.

P01AB 18.9 metronidazole A 500mg 10 suppository FLAGYLP01AB 18.9 metronidazole 1g 10 suppository FLAGYLP01AB 18.9 metronidazole 1 P 200mg/5ml 50ml suspension FLAGYLP01AB 18.9 metronidazole 1 P 200mg/5ml 100ml suspension FLAGYLP01AB 18.9 metronidazole 1 A P 200mg 21 tablet FLAGYL; ZOLEROLP01AB 18.9 metronidazole A P 200mg 250 tablet FLAGYL; ZOLEROL

P01AB 18.9 metronidazole 400mg 5 tabletFLAGYL; METRAZOLE-400

P01AB 18.9 metronidazole 400mg 15 tablet FLAGYLP01AB 18.9 metronidazole 400mg 21 tablet FLAGYLP01AB 18.9 metronidazole 400mg 100 tablet FLAGYL; ZOLEROLP01AB 18.9 metronidazole 400mg 500 tablet FLAGYL

C01BB 7.2 mexiletine 50mg 100 capsule MEXITILSpecialist cardiologist



C01BB 7.2 mexiletine 250mg/10ml 5 injection MEXITILSpecialist cardiologist

N06AX 1.4.2 mianserin 10mg 28 tablet LANTANON

Specialist psychiatrist & geriatrician initiated

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A01AB 11.3 miconazole 20mg/g 30g oral gel DAKTARIN SpecialistNot to be used as first line treatment. Try nystatin oral drops first.

N05CD 1.2.1 midazolam 15mg/3ml 1 injection DORMICUM Approved for use by paramedics as well.N05CD 1.2.1 midazolam A P 5mg/5ml 1 injection DORMICUM Approved for use by paramedics as well.N05CD 1.2.1 midazolam 7,5mg 20 tablet DORMICUM Pre-med for general paediatric anaesthesia

G03XB 19.8 Supp List 122 mifepristone 200mg 3 tablet MIFEGYNE

General

Specialist Gynaecologist

General: To be used according to Health Programmes' protocol for MTOP in the first trimester (up to 63 days) Specialist Gynaecologist: For TOP in fetal anomalies

C02DC 7.3.1 minoxidil 10mg 100 tablet LONITENSpecialist physician initiated

C02DC 7.3.1 minoxidil 5mg 100 tablet LONITENSpecialist physician initiated

A02BB 12.4.2 misoprostol 200µg 56 tablet CYTOTEC

Specialist gastroenterologist & gynaecologist. TOP clinics as per provincial circular

May be used in casualty for miscarriage without specialist prescription. See EDL warning re uterine rupture

mitomycin-C: See streptomyces caespitosis

L01DB 23 mitoxantrone A P 10mg/5ml 1 injection NOVANTRONE Specialist of 82


L01DB 23 mitoxantrone A P 20mg/10ml 1 injection NOVANTRONE Specialist

N06AG 1.4.6 moclobemide 150mg 60 tablet AURORIXSpecialist psychiatrist

Medicines to be obtained from institution initiating prescription.

A06AD 12.6 Supp List 122

monobasic sodium phosphate anhydrous + dibasic sodium phosphate anhydrous

5g / 10g 2 satchets COLO-PREP For pre-procedure bowel preparation

R03DC 10.4.2 Supp List 117 montelukast 4mg/packet 28 packetssprinkles (granules)

SINGULAIR Specialist

Add-on therapy for patients under 5 years old who remain uncontrolled on appropriate doses of inhaled steroids Allergy and Pulmonary clinics only Not referable

R03DC 10.4.2 Supp List 117 montelukast 5mg 28 chew tablet SINGULAIR Specialist

Add-on therapy for patients under 5 years old who remain uncontrolled on appropriate doses of inhaled steroids Allergy and Pulmonary clinics only Not referable

A06AG 12.7sodium phosphate & sodium acid phosphate

60mg & 160mg/135ml

1 enema - adult LENOLAX; FOSENEMA

P03AA 14.2 monosulfiram 1 5% 75g soap TETMOSOLN02AA 31 morphine HCl 10g powderN02AA 3.1 morphine sulphate 1 A P 10mg/ml 1 injection MORPHINEN02AA 3.1 morphine sulphate 15mg/ml 1 injection MORPHINE

R01AX 11.1 mupirocin A 2% 3gnasal ointment

BACTROBAN NASAL SpecialistOn confirmation of nasal staphylococcus infection from a microbiologist report ONLY.

D06AX 14.1 mupirocin A 2% 15g ointment BACTROBAN TOPICAL Specialist For Staph. resistant infections in burns units only.

L04AA 24.1 mycophenolate mofetil 250mg 100 capsule CELLCEPT

Specialist.Not referable to non-academic institutions in the Metropole. Can be referred to other regions.


L04AA 24.1 Supp List 122 mycophenolate sodium 180mg 120enteric coated tablet

MYFORTIC Specialist

Specialist: For post transplant patients with GIT side effects. Non-referable, central hospitals. Central (tertiary) hospitals to arrange stock with referring institutions for patients in rural areas

L04AA 24.1 Supp List 122 mycophenolate sodium 360mg 120enteric coated tablet

MYFORTIC Specialist

Specialist: For post transplant patients with GIT side effects. Non-referable, central hospitals. Central (tertiary) hospitals to arrange stock with referring institutions for patients in rural areas

J01MB 16.4Supp List 117 and Supp List 119

nalidixic acid 1 A 250mg/5ml 100ml suspension WINLOMYLONAlso to be used for Dysentery, bacillary, instead of Ciprofloxacin suspension as indicated in the EDL

J01MB 16.4 nalidixic acid 1 A 500mg 100 tablet PUROMYLON For infective diarrhoea and food poisoning only. of 82


V03AB 1.1.2 naloxone 1 A P 0,4mg/ml 1 injection NARCAN

A14AB 19.6.1 nandrolone decanoate 25mg/ml 1 injection DECA-DURABOLINSpecialist endocrinologist

A14AB 19.6.1 nandrolone decanoate 50mg/ml 1 injection DECA-DURABOLINSpecialist endocrinologist

J05AE 18.12pgwcARV depot

nelfinavir 50mg/g 144g powder VIRA-CEPT AIDS programmeAvailable through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.

J05AE 19.12pgwcARV depot

nelfinavir 250mg 270 tablet VIRA-CEPT AIDS programme As above.

S02C 15.3neomycin + betamethasone sod. phos

0,00035% + 0,1% 3g eye ointment BETNESOL NSpecialist ophthalmologist

N07AA 5.3 neostigmine A P 0.5mg/ml 1 injection PROSTIGMINN07AA 5.3 neostigmine 2,5mg/ml 1 injection PROSTIGMIN

J05AG 18.12pgwcARV depot

nevirapine 10mg/ml 240ml solutionADCO-NEVIRAPINE, ASPEN NEVIRAPINE, VIRAMUNE

AIDS programme Available through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.


nevirapine 200mg 60 tablet VIRAMUNE



A11HA 20.1? nicotinamide 1 A 100mg 100 tablet NICOTINAMDEB04AE 20.1 nicotinic acid 100mg 100 tablet NICOTINIC ACID

C08CA 7.3.7Supp List 119/122

nifedipine 1 A P 5mg 100 capsuleADALAT; CARDIFEN-5

General Family Physician Specialist physician, paediatrician & gynaecologist

General: hypertensive emergencies in pregnancy and paediatrics Family Physician: For Raynaud's phenomenon

C08CA 7.3..7 Supp List 122 nifedipine 10mg 84 capsuleADALAT; CARDILAT


General: As a tocolytic agent Family Physician: For Raynaud's Syndrome Specialist physician, paediatircian & gynaecologist: For Raynaud's phenomenon, Pulmonary Hypertension, and Pregnancy Induced Hypertension.

C08CA 7.3.7 Supp List 122 nifedipine 10mg 250 capsule ADALAT; CARDILAT


As above

of 82


C08CA 7.3.7 nifedipine 30mg 28 tablet ADALAT XLSpecialist gynaecologist

For hypertension in pregnancy only.

Supp List 123nipastat preservative solution

2,5L liquid

C08CA 7.5 Supp List 122 nimodipine 30mg 100 tablet NIMOTOPSpecialist neurosurgeon

Neurosurgery, central hospitals only Non-referable

C08CA 7.5 Supp List 122 nimodipine 10mg/50ml 1 infusion NIMOTOPSpecialist neurosurgeon

Neurosurgery, central hospitals only Non-referable

G04AC 16.4 nitrofurantoin P 50mg 50 capsuleMACRODANTIN; FURADANTIN

G04AC 16.4 nitrofurantoin 100mg 50 capsule MACRODANTINC01DA 7.5.2 nitroglycerine 50mg/10ml 1 infusion TRIDIL SpecialistC01DA 7.5.2 nitroglycerine starterpack 1 infusion TRIDIL SpecialistG03DC 19.6.3 norethisterone A 5mg 30 tablet PRIMOLUT-N

G03AC 17.1.1ex family planning stores

norethisterone enanthate

1 200mg/ml 1 injection NUR-ISTERATE Family Planning


norethisterone +ethinyl oestradiol

0,5mg;0,75mg;1mg +0,035mg

28 tablet TRINOVUM Family Planning EDL

G03AA 17.1.1norgestrel + ethinyl oestradiol

1 A0,5mg +0,05mg

28 tablet OVRAL Family Planning

G03FB 19.6.4norgestrel + oestradiol

A0,5mg +2mg

28 tablet POSTOVAL

A01AB 18.8 nystatin 1 P 100 000u/ml 20ml suspension NYSTACIDD01AA 18.8 nystatin 1 100 000u/g 15g topical cream NYSTACID ointment/cream: buy cheapest on tender

D01AA 18.8 nystatin 1 100 000u/g 15gtopical ointment

NYSTACID ointment/cream: buy cheapest on tender

G01AA 18.8 nystatin vaginal 1 A 100 000u 15 vaginal tabletsNYSTACID; MYCOSTATIN

G03CA 19.6.2 oestradiol 2mg 28 tablet ESTROFEM

Specialist gynaecologists, obstetricians & endocrinologists initiated.

G03CA 19.6.2 oestradiol valerate A 1mg 21 tabletPROGYNOVAESTRO-PAUSE

G03CA 19.6.2 oestradiol valerate 2mg 21 tablet PROGYNOVA

G03CA 19.6.2 oestradiol implant 20mg 1 pellet OESTRADIOLSpecialist gynaecologist

G03FB 19.6.4oestradiol + norethisterone

A2mg;2mg;1mg + 1mg

28 tablet TRISEQUENS

G03CA 19.6.2oestrogen conjugated I.V./I.M.

A 25mg / 5ml 1 injection PREMARIN

G03CA 19.6.2 oestrogen conjugated 0,3mg 100 tablet PREMARING03CA 19.6.2 oestrogen conjugated A 0,625mg 28 tablet PREMARING03CA 19.6.2 oestrogen conjugated A 0,625mg 500 tablet PREMARIN of 82


G03CA 19.6.2 oestrogen conjugated A 1,25mg 28 tablet PREMARING03CA 19.6.2 oestrogen conjugated A 1,25mg 500 tablet PREMARING03CA 19.6.2 oestrogen conjugated 0,625mg/g 43g vaginal cream PREMARIN

G03FB 19.6.4oestrogens, conjugated +medrogestone

0,625mg +5mg

38 tablet PREMPACK-N

G03FB 19.6.4oestrogens, conjugated +medrogestone

1,25mg +5mg

38 tablet PREMPACK-N

G03DB 19.6.4oestrogens, conjugated +medroxyprogesterone

0,625mg +2,5mg

28 tablet PREMELLEUse according to HRT guidelines. See Circular H95/2005 L1011

S01AX 15.1 ofloxacin 3mg/ml 5ml eye drops EXOCIN; OCTINSpecialist ophthalmologist, paediatrician & ENT

Cheapest fluoroquinolone on tender to be bought.

J01MA 18.7 ofloxacin A 200mg 100ml infusion soln. TARIVID SpecialistMotivation form to be completed or on a microbiologist report.

J01MA 18.7 ofloxacin A 200mg 10 tablet TARIVID Specialist Fluoroquinolone of choice in Multiple Drug Resistant TB.FOR THE exclusive USE IN MDR TB .

J01MA 18.7 ofloxacin A 200mg 100 tablet TARIVID Specialist As aboveJ01MA 18.7 ofloxacin A 400mg 56 tablet TARIVID Specialist As aboveJ01MA 18.7 ofloxacin A 400mg 100 tablet TARIVID Specialist As aboveX Ø olive oil BP 500ml liquid OLIVE OILA02BC 12.4.4 omeprazole 10mg 28 tablet LOSEC MUPS Specialist Paediatricians only

A02BC 12.4.4 omeprazole A P 20mg 14 tablet LOSECPaediatrician & Endoscopy units initiated


A02BC 12.4.4 omeprazole A P 20mg 28 tablet LOSECPaediatrician & Endoscopy units initiated

As above.

Oral Rehydration Salt solutionsee sodium chloride co. below

H01BA 7.6 ornipressin 5iu/ml 1 injection POR 8 SpecialistN04AB 1.7.2 orphenadrine 1 A 50mg 28 tablet DISIPALN04AB 1.7.2 orphenadrine 1 A 50mg 56 tablet DISIPALN04AB 1.7.2 orphenadrine 1 A 50mg 84 tablet PHENERINE; DISIPALN04AB 1.7.2 orphenadrine A 50mg 100 tablet DISIPAL; PHENERINEN04AB 1.7.2 orphenadrine 1 A 50mg 112 tablet PHENERINE; DISIPAL

J05AH 18.12Suppl List 119

oseltamivir 75mg 10 tablet TAMIFLU

For use in prophylaxis and treatment of pandemic H1N1 virus as per national and provincial protocols. Will be made available and accessible when required at strategic sites of 82


J05AH 18.12Suppl List 119

oseltamivir 12mg/ml suspension TAMIFLU

For use in prophylaxis and treatment of pandemic H1N1 virus as per national and provincial protocols. Will be made available and accessible when required at strategic sites

N05BA 1.3.1 oxazepam A 10mg 14 tablet SEREPAX; PURATA

No more than 14 days supply, unless when prescribed by a psychiatrist or neurologist, when 28 days supply may be dispensed. See circular H24/2006; Suppl List 107 - addendum I

N05BA 1.3.1 oxazepam A 10mg 250 tabletSEREPAX; PURATA; OXALINE

No more than 14 days supply, unless when prescribed by a psychiatrist or neurologist, when 28 days supply may be dispensed. See circular H24/2006; Suppl List 107 - addendum I

N05BA 1.3.1 oxazepam A 15mg 14 tablet SEREPAX; PURATASpecialist psychiatrist & neurologist

NO NEW PATIENTS TO BE PRESCRIBED THIS STRENGTH, unless if done by a psychiatrist or neurologist. (Refer to circular H24/2006, SL 107, Addendum 1)

N05BA 1.3.1 oxazepam A 15mg 250 tabletSEREPAX; PURATA; OXALINE

Specialist psychiatrist & neurologist

NO NEW PATIENTS TO BE PRESCRIBED THIS STRENGTH, unless if done by a psychiatrist or neurologist. (Refer to circular H24/2006, SL 107, Addendum 1)

S01HA 15.7 oxybuprocaine 1 A P 0,4% 3ml eye drops NOVESINS01HA 15.7 oxybuprocaine 1 A P 0,4% 0,5ml x 20 minims MINIMS BENOXINATE

G04BD 5.4 oxybutynin A 5mg 100 tabletDITROPAN; SANDOZ OXYBUTYNIN

Specialist neurologist, urologist, gynaecologist, nephrologist, paediatrician & Western Cape Rehab Centre

Maximum dose: 5mg three times a day.

S01GA 15.4 oxymetazoline 1 0,025% 10ml eye drops AFRIN

R01AA 11.1 oxymetazoline 1 P 0.03% 10mlpaed. nose drops

DRIXINE ALTERNATIVE: Xylometazoline when cheaper.

R01AA 11.1 oxymetazoline 1 A 0,05% 10mladult nose drop

DRIXINE/ILIADEN As above.

S01AA 15.1oxytetracycline + polymyxin B

1 A 5mg + 10 000u/g 5g eye ointment TERRAMYCIN

H01BB 17.3 oxytocin A P 5iu/ml 1 injection SYNTOCINONH01BB 17.3 oxytocin 1 A 10iu/ml 1 injection SYNTOCINONG02AB 17.3 oxytocin + ergometrine 5iu + 0,5mg/ml 5 injection SYNTOMETRINE

pamidronate: see disodium-pamidronate

A09 12.1 pancreatin 150mg

amylase 8 000; lipase 10 000; protease 600 FIP units enzyme activity

100 capsule CREONSpecialist physician & paediatrician

of 82


A09 12.1 pancreatin 300mg

amylase 18 000; lipase 25 000; protease 1 000 FIP units enzyme activity

100 capsule CREONSpecialist physician & paediatrician

M03AC 2.3 pancuronium bromide A P 4mg/2ml 1 injection PAVULONA02BC 12.4.4 pantoprazole 40mg/10ml 1 injection PANTOLOC Specialist

A02BC 12.4.4 pantoprazole A P 40mg 14 tablet PANTOLOCPaediatrician & Endoscopy units initiated


A02BC 12.4.4 pantoprazole A P 40mg 28 tablet PANTOLOCPaediatrician & Endoscopy units initiated

As above

J04A 18.8.1 para-aminosalicylic acid 4G 30 powder PASER GRANULES Specialist As per XDR TB protocol

N02BE 3.2 Supp List 123 paracetamol 500mg 1 injection PERFALGAN Specialist

For patients who cannot swallow and safely receive postoperative opioids in : - Obstructive sleep apnoea - Neuromuscular weakness - Respiratory failure Expenditure and usage to be closely monitored.

N02BE 3.2 Supp List 123 paracetamol 1000mg 1 injection PERFALGAN Specialist

For patients who cannot swallow and safely receive postoperative opioids in : - Obstructive sleep apnoea - Neuromuscular weakness - Respiratory failure Expenditure and usage to be closely monitored.

N02BE 3.2 paracetamol 125mg 10 suppository EMPAPED Single, post-operative dose.N02BE 3.2 paracetamol 250mg 10 suppository EMPAPED Single, post-operative dose.

N02BE 3.2 Supp List 119 paracetamol 1 P 120mg 50ml syrup DOLOROL; PAMOL

For acute conditions: Not more than 5 days supply. NOT REPEATABLE FOR ACUTE CONDITIONS. For longer periods, the appropriate diagnosis and quantity to be written on the prescription

N02BE 3.2 Supp List 119 paracetamol 1 P 120mg 100ml syrup DOLOROL; PAMOL


N02BE 3.2 Supp List 119 paracetamol 1 A P 500mg 10 tablet PANADO


of 82


N02BE 3.2 Supp List 119 paracetamol 1 A P 500mg 20 tablet DOLOROL


N02BE 3.2 Supp List 119 paracetamol A P 500mg 100 tablet DOLOROL


N02BE 3.2 Supp List 119 paracetamol A P 500mg 5000 tablet DOLOROL


paraffin soft: see soft paraffin

L03AB 24.2 Supp List 117pegylated interferon alfa-2a

135µg/0,5ml 1pre-filled syringe

PEGASYS Specialist

Central hospitals only. Patient Named Basis. Number of patients to be treated to be decided by local PTC

L03AB 24.2 Supp List 117pegylated interferon alfa-2a

180µg/0,5ml 1pre-filled syringe

PEGASYS Specialist


M01CC 25 penicillamine A 300mg 100 capsule METALCAPTASE Specialist

J01CE 18.1.1 penicillin; benzathine 1 A P 1.2Mu 1 injectionBICILLIN LA; PENILENTE LA

J01CE 18.1.1 penicillin; benzathine 1 2.4Mu 1 injectionBICILLIN LA; PENILENTE LA

J01CE 18.1.1penicillin; benzathine penicillin; procaine penicillin; benzyl sodium

600 000 units300 000 units300 000 units

1single dose

injectionBICILLIN; PENILENTE FORTE 1,2 MU

J01CE 18.1.1penicillin; benzathine penicillin; procainepenicillin; benzyl sodium

600 000 units300 000 units 300 000 units

1 multi-dose

injectionBICILLIN; PENILENTE FORTE 6 MU

J01CE 18.1.1 penicillin; benzyl sodium 1 A P 1Mu (600mg) 1 injectionNOVOPEN; BENZYLPENICILLIN

J01CE 18.1.1 penicillin; benzyl sodium 1 5Mu (3g) 1 injectionNOVOPEN; BENZYLPENICILLIN

J01CE 18.1.1penicillin; phenoxymethyl

1 P 125mg/5ml 100ml suspensionDAROCILLIN; COPEN; BETAPEN


1 P 250mg/5ml 100ml suspensionDAROCILLIN; COPEN; BETAPEN

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1 A P 250mg 20 tablet DELTACILLIN


A P 250mg 100 tablet COPEN; BETAPEN


A P 250mg 500 tablet COPEN; BETAPEN

J01CE 18.1.1 penicillin; procaine A P 0.3Mu/ml 10ml 1 injectionPROCILLIN; NOVOCILLIN

V04CG Ø pentagastrin 250µg/ml 5 injection PEPTAVLON Specialist

N02AB 3.1 pethidine 1 P 25mg/ml 1 injectionPETHIDINE INJ. LABETHICA

Restricted to labour wards, midwife obstetric units, midwifes and patients allergic to morphine.Morphine remains first agent of choice.

N02AB 3.1 pethidine 1 A 50mg/ml 1 injectionPETHIDINE INJ. LABETHICA

As above.

N02AB 3.1 pethidine A 100mg/2ml 1 injectionPETHIDINE INJ. LABETHICA

As above.

petroleum jelly: see soft paraffin

N03AA 1.2.2phenobarbitone + vitamins

1 P 16mg/5ml 100ml elixirADCO-PHENOBARBITONE VITALET

N03AA 1.2.2 phenobarbitone P 200mg/ml 1 injection GARDENALN03AA 1.2.2 phenobarbitone 15mg 1 000 tablet LETHYLN03AA 1.2.2 phenobarbitone 1 A P 30mg 84 tablet LETHYL

N03AA 1.2.2 phenobarbitone A P 30mg 1 000 tabletLETHYLSEDABARB

N03AA 1.2.2 phenobarbitone A P 30mg 5 000 tablet LETHYLC01CA 7.6? phenylephrine A P 10mg/ml 1 injection PHENYLEPHRINE

N03AB 1.6 phenytoin 1 A P 250mg/5ml 1 injection EPANUTINFor use in convulsive status epilepticus and trauma ONLY.

N03AB 1.6 phenytoin 1 A 100mg 56 tablet EPANUTINN03AB 1.6 phenytoin 1 A 100mg 84 tablet EPANUTINN03AB 1.6 phenytoin A 100mg 500 tablet EPANUTINN03AB 1.6 phenytoin A 100mg 5 000 tablet EPANUTIN

X 20.4 phosphate supplement P 100tablet, effervescent

PHOSPHATE SANDOZ Specialist

phospholipid solurion: See total phospholipids

G04BE 17.5.2

phosphodiesterase-5-inhibitors: sildenafil; tadalafil; vardenafil

various various tabletsVIAGRA; CIALIS; LEVITRA

Central HospitalSpecialist

Urology. Not for treatment. To be used only as a dia- gnostic tool in erectile dysfunction - 2 doses maximum. Patient name basis.

B02BA 8.1 phytomenadione (vit K1) 1 P 2mg/0,2ml 1injection for IV & oral

KONAKION MM

B02BA 8.1 phytomenadione (vit K1) A P 10mg/ml 1 injection KONAKIONB02BA 8.1 phytomenadione (vit K1) A P 10mg 10 tablets KONAKION specialist

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S01EB 15.6pilocarpine + hypromellose

1 A P 1% + 0,5% 15ml eye drops ISOPTO-CARPINE

S01EB 15.6 pilocarpine 2% 15ml eye drops ISOPTO-CARPINE

S01EB 15.6 pilocarpine 4% 5g gel PILOGELSpecialist ophthalmologist initiated

N05AG 1.5.1 pimozide 1mg 75 tablet ORAP

Specialist paediatrician, neurologist, psychiatrist

Patient name basis only

N05AG 1.5.1 pimozide 4mg 100 tablet ORAP

Specialist paediatrician, neurologist, psychiatrist

As above

J01CR 18.1.1piperacillin + tazobactam

4g + 500mg 1 injection TAZOCIN SpecialistOnly for severe nosocomial infections in ICU's & on a Microbiologist report.

D06BB 14.9 Supp List 117podophyllotoxin topical solution

A 5mg/ml 3mL liquid WARTECFor genital warts. To be applied by health professional

X 10.5 poractant alfa 80mg/ml vialintratrachial suspension

CUROSURFNeonatal ICU and high care

For use in selected pre-term infants between 700g and 1 000g body weight

A12BA 20.4 potassium chloride A P 15% 10ml 1 injectionSABAX POTASSIUM CHLORIDE INJ.

A12BA 20.4 potassium chloride 600mg 500 tablet SLOW-K 600General

Specialist initiated

For proven hypokalaemia.• For in-patients• For out-patients - maximum of 12 weeks

» For long term use

G04B Øpotassium citrate mixture

A

BP: Citric Acid 5% Pot. Citrate 30%

100ml liquidPOTASSIUM CITRATE MIXTURE

G04B Øpotassium citrate mixture

A

BP: Citric Acid 5% Pot. Citrate 30%

200ml liquidPOTASSIUM CITRATE MIXTURE

D08AX Øpotassium permanganate

500g crystalsPOTASSIUM PERMANGANATE BP

B05XA 20.4 potassium phosphate A P 10ml 10 injectionSABAX POTASSIUM PHOSPHATE

D08AG 14.1 povidone iodine 1 P 5% 25g cream BETADINED08AG 14.1 povidone iodine 1 P 5% 500g cream BETADINE; BIOCREAMD08AG 14.1 povidone iodine 1 10mg/10ml 1 000ml liquid BETADINED08AG 14.1 povidone iodine 1 10mg/10ml 5 000ml liquid BETADINED08AG 14.1 povidone iodine 1 10% 25g ointment BETADINED08AG 14.1 povidone iodine 1 10% 500g ointment BETADINEG01AX 17.2 povidone iodine 200mg 14 pessary BETADINED08AG 14.1 povidone iodine 4g/100ml 150ml shampoo BETADINE

A01 11.3 povidone iodine 1 100mg/10ml 200ml solutionBETADINE ORAL ANTISEPTIC of 82


D08AG 14.1 povidone iodine 75mg/ml 1 litre solution ZEDCHEM PVP-I SCRUB

G01AX 17.2 povidone iodine 100mg/ml 250mlvaginal douche

BETADINE CLEANSER KIT

Specialist gynaecologists

G01AX 17.2 povidone iodine 10% 90g vaginal gel BETADINEP02BA 13 praziquantel 500mg 100 tablet CYSTICIDEP02BA 13 praziquantel 1 A P 600mg 10 tablet

BILTRICIDE; CYSTICIDE

C02CA 7.3.2 prazosin A P 1mg 100 tablet PRATSIOLSpecialist paediatricians

S01BA 15.2 prednisolone 10mg/ml 5ml eye drops PRED FORTESpecialist ophthalmologist.

Alternative: Dexamethasone on Specialist Initiated code

H02AB 19.5 prednisolone P 15mg/5ml 60ml syrup PRELONESpecialist paediatrician

H02AB 19.5 prednisolone 5mg 100 tabletMETICORTELONE; LENISOLONE

H02AB 19.5 prednisone P 1mg 100 tablet METICORTENH02AB 19.5 prednisone 1 A P 5mg 28 tablet METICORTENH02AB 19.5 prednisone 1 A P 5mg 100 tablet METICORTENH02AB 19.5 prednisone 1 A P 5mg 500 tablet METICORTENH02AB 19.5 prednisone 5mg 5 000 tablet METICORTEN

V04CX Ø pregnancy test 25iu/L sensitive25 tests per kit maxinum

dipstick test strip

To detect ectopic pregnancy as well as for routine testing.

NO3AA 1.6 Supp List 113 primidone 250mg 100 tablet MYSOLINESpecialist neurologist initiated

For the management of Essential Tremor only

M04AB 4.2 probenecid A 500mg 100 tablet BENEMID; PROBEN

C01BA 7.2 procainamide P 100mg/ml 1 injection PRONESTYLSpecialist cardiologist

L01XB 23 procarbazine A P 50mg 50 tablet NATULANSpecialist oncologist

N05AB 1.5.1 prochlorperazine 12,5mg/ml 1 injection STEMETILN05AB 1.8 prochlorperazine 5mg 5 suppository STEMETILN05AB 1.8 prochlorperazine 25mg 5 suppository STEMETILN05AB 1.5.1 prochlorperazine 5mg 10 tablet STEMETILN05AB 1.5.1 prochlorperazine 5mg 250 tablet STEMETIL; MITILN05AB 1.5.1 prochlorperazine 5mg 500 tablet STEMETIL; MITILR06AD 6.1 promethazine 1 A P 25mg/ml 1 injection PHENERGANR06AD 6.1 promethazine 50mg/2ml 1 injection PHENERGANR06AD 6.1 promethazine A P 10mg 28 tabletR06AD 6.1 promethazine A P 10mg 500 tablet PHENERGANR06AD 6.1 promethazine A P 25mg 28 tabletR06AD 6.1 promethazine A P 25mg 500 tablet PHENERGAN

A03AB 12.3 Supp List 116 propantheline bromide 15mg 100 tablet PRO-BANTHINEFor Western Cape Rehab Centre only. Not referable

N01AX 2.1.2 propofol A P 200mg/20ml 1 injection DIPRIVAN SpecialistC07AA 7.4 propranolol A P 1mg/ml 1 injection INDERALC07AA 7.4 propranolol A P 10mg 84 tablet INDERALC07AA 7.4 propranolol A P 10mg 250 tablet INDERAL of 82


C07AA 7.4 propranolol A P 10mg 1 000 tablet INDERALC07AA 7.4 propranolol A 40mg 56 tablet INDERAL;REXIGENC07AA 7.4 propranolol A 40mg 84 tablet INDERALC07AA 7.4 propranolol A 40mg 250 tablet INDERALC07AA 7.4 propranolol A 40mg 1 000 tablet INDERALX Ø propylene glycol 2 500ml liquidX Ø propylparaben 100g powder

prostaglandins: see dinoprostone

V03AB 18.1? protamine sulphate P 50mg/5ml 1 injection PROTAMINE SULPHATE

V04CJ 19.3protirelin (thyrotropin releasing hormone, TRF, TRH)

0,2mg/2ml 10 injection TRH-ROCHE Specialist Endocrinologists only.

X Øpump, dispenser, for 500ml bottle bioscrub/hibiscrub

1 plungerUse only on 500ml 4% chlorhexidine gluconate surgical scrub bottles.

A06AC 12.7psyllium hydrophilic muciloid

49g/100g 250g powder METAMUCIL

J04AK 18.6.1 pyrazinamide P 500mg 1 000 tabletISOPAS; CAMIZIDE; ROZIDE

N07AA 5.3 pyridostigmine P 10mg 50 tablet MESTINONN07AA 5.3 pyridostigmine A P 60mg 150 tablet MESTINON

1.5.3 quetiapine 25mg 100 tablet SEROQUELSpecialist psychiatrist initiated

Psychiatrists only. For treatment guidelines refer to Circular H99/2005 (Addendum A - Suppl. List 103).


As above.


As above.


As above.

P01BC 18.11 quinine sulphate 1 A P 300mg 100 tabletP01BC 18.11 quinine sulphate A P 300mg 1 000 tabletP01BC 18.9 quinine dihydrochloride 1 A P 300mg/ml 10 injection ADCO-QUININE

S01AX 15.1

quinolone (ciprofloxacin/ofloxacin) ophthalmic anti-infectives

3mg/ml 5ml eye drops CILOXAN; EXOCINSpecialist: ophthalmologist & ENT

Cheapest on tender to be used.

A02BA 12.4.3 Supp List 120 ranitidine 150mg P 150mg 60 tabletZANTAC; CPL ALLIANCE RANITIDINE

of 82


V04B Øreagent strip - glucose in urine

30 test stripGLUKOTESTTECO-URS 1G

For home monitoring of maturity onset, non-ketotic diabetes mellitus. Recommended 1 container per month.

X Øreagent tablet - glucose in urine

36 reagent tablet CLINITESTRestricted to paediatric wards or on a prescription chart.

V04B Øreagent strip - glucose, ketones in urine

50 reagent strip KETO-DIABURFor home monitoring of juvenile type diabetes mellitus. 1 Bottle per month.

V04B Øreagent strip - glucose, protein in urine

50 reagent strip URICHECK 2(s)

V04B Øreagent strip - 5 diagnosis for urine

100 reagent strip LENSTRIP 5For use in general outpatient departments & wards of larger hospitals. Cheapest on tender will be issued.

V04B Ø

reagent strip - blood, glucose, ketones, protein, nitrite & pH in urine

100 reagent strip URICHECK 5N


100 reagent strip COMBUR 9For use in smaller hospitals; admission wards of larger hospitals and by district surgeons.


100 reagent strip COMBUR 10For use in trauma units and neurosurgery when specific gravity is required.

V04CA Øreagent strip - glucose in blood - visual & meter

50 reagent strip LENSTRIP GLYCO

V04CA Øreagent strip - glucose in blood

50 reagent strip ACCUTREND

Use with Accutrent meter. Can be issued to patients with machines provided by the company. PAWC does not issue Accutrend strips to non-insulin users.Issue up to 100 tests monthly if necessary to patients on multiple daily insulin administration, and up to 50 tests every four months if necessary to patients on a once daily insulin regimen (See Suppl. List 98).


50 reagent strip ACCU-CHECK ACTIVE will replace eventually Accutrend


50 reagent strip ONE TOUCH

Only for clinics with machines and patients with own machines. PAWC does not issue One Touch strips to non-insulin users.Issue up to 100 tests monthly if necessary to patients on multiple daily insulin administration, and up to 50 tests every four months if necessary to patients on a once daily insulin regimen (See Suppl. List 98).

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50 reagent strip GLUCOTREND PLUSTO BE RENAMED TO Accu-Check Active

Use with Glucotrend 2 meter. Can be issued to patients with machines provided by the company. PAWC does not issue Glucotrend Plus strips to non-insulin users.Issue up to 100 tests monthly if necessary to patients on multiple daily insulin administration, and up to 50 tests every four months if necessary to patients on a once daily insulin regimen (See Suppl. List 98).

V04CA Øreagent strip - glucose in blood - visual & meter

50 reagent strip GLUCOSTIX

X Ø

reagent strip - rapid determination of HIV-1/2 antibodies in whole blood

20 reagent strip HIV CHECK 1 + 2For Mother To Child Transmission Project ONLY.

X Øreagent strip - rapid detemination of syphilis

100 reagent strip DETERMINE SYPHILIS

X Øreagent tablet - blood in faeces

50 reagent tablet HEMATEST

N01AH 2.1.2 remifentanyl 1mg 1 injection ULTIVA SpecialistCentral hospitals, For use in endoscopy ENT surgery only



J05AB 18.12 Supp List 117 ribavirin 200mg 42 tablets COPEGUS Specialist


J04AB 18.6.1 rifampicin 1 P 150mg 100 capsule ROLAB RIFAMPICINFor use in tuberculosis or for meningoccocal meningitis prophylaxis.

J04AB 18.6.1 rifampicin 1 P 450mg 100 capsule ROLAB RIFAMPICINJ04AB 18.6.1 rifampicin 1 A P 600mg 100 capsule ROLAB RIFAMPICIN As aboveJ04AB 18.6.1 rifampicin A 300mg 1 injection RIMACTANE

J04AB 18.6.1 rifampicin 1 P 100mg/5ml 180ml suspension RIFADINFor use in tuberculosis or for meningoccocal meningitis prophylaxis.

J04AM 18.6.1 rifampicin + isoniazid P 60mg + 30mg (60; 30) tablet RIMACTACID PAED 60/30

J04AM 18.6.1 rifampicin + isoniazid 1 P 60mg + 60mg 80 tabletRIMACTAZID PAED 60/60

J04AM 18.6.1 rifampicin + isoniazid 1 A 300mg + 150mg 40 tabletRIFINAH 300 RIMACTAZID 300/150

J04AM 18.6.1rifampicin + isoniazid + pyrazinamide

1 P60mg + 30mg + 150mg

80 tablet RIMCURE PAED 3-FDC

J04AM 18.6.1rifampicin + isoniazid + pyrazinamide

1 P60mg + 30mg + 150mg

500 tablet RIMCURE PAED 3-FDC of 82


J04AM 18.6.1rifampicin + ethambutol + isoniazid + pyrazinamide

1 A150mg + 275mg + 75mg + 400mg

28 tabletRIFAFOUR e-275; RIMSTAR 4- FDC


1 A150mg + 275mg + 75mg + 400mg



1 A150mg + 275mg + 75mg + 400mg



1 A150mg + 275mg + 75mg + 400mg



1 A150mg + 275mg + 75mg + 400mg


N05AX 1.5.3 risperidone 1mg 30 tablet RISPERDAL

Specialist & paediatricians psychiatrist initiated

For treatment guidelines refer to Circular H99/2005 (Addendum A - Suppl List 103).



As above.



As above.

N05AX 1.5.3 Supp List 120 risperidone 25mg 1injection IM - prolonged release

RISPERDAL CONSTAPsychiatrist initiated

For: - Specific non-compliant patients - Patients that do not tolerate 1st generation depot anti-psychotics To be used in line with Mental Health Guidelines

N05AX 1.5.3 Supp List 120 risperidone 37,5mg 1injection IM - prolonged release


For: - Specific non-compliant patients - Patients that do not tolerate 1st generation depot anti-psychotics To be used in line with Mental Health Guidelines

N05AX 1.5.3 Supp List 120 risperidone 50mg 1injection IM - prolonged release


For: - Specific non-compliant patients - Patients that do not tolerate 1st generation depot anti-psychotics To be used in line with Mental Health Guidelines of 82


J05AE 18.12pgwc ARV depot

ritonavir 100mg 84 capsule NORVIR AIDS programmeAvailable through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.

J05AE 19.12pgwc ARV depot

ritonavir 80mg/ml 90ml solution NORVIR AIDS programme As above.

M03AC 2.3 rocuronium 50mg/5ml 1 injection ESMERON

N04BC 1.7.1 ropinirole 0,25mg 210 tablet REQUIP Specialist initiatedFor Parkinson Disease patients only. As add-on therapy to Levodopa. May only be referred on maintenance therapy

N04BC 1.7.1 ropinirole 0,5mg 84 tablet REQUIP Specialist initiatedFor Parkinson Disease patients only. As add-on therapy to Levodopa. May only be referred on maintenance therapy

N04BC 1.7.1

Supp List 114

ropinirole 1mg 84 tablet REQUIP Specialist initiatedFor Parkinson Disease patients only. As add-on therapy to Levodopa. May only be referred on maintenance therapy

N04BC 1.7.1 ropinirole 2mg 84 tablet REQUIP Specialist initiatedFor Parkinson Disease patients only. As add-on therapy to Levodopa. May only be referred on maintenance therapy

N04BC 1.7.1 ropinirole 5mg 84 tablet REQUIP Specialist initiatedFor Parkinson Disease patients only. As add-on therapy to Levodopa. May only be referred on maintenance therapy

R03CC 10.2.1 salbutamol P 500µg/ml 1 injection VENTOLINR03CC 10.2.1 salbutamol 5mg/5ml 1 infusion VENTOLIN

R03AC 10.2.1 salbutamol 1 P 5mg/ml 20mlinhalation solution

VENTOLIN; VENTEZE

R03CC 10.2.1 salbutamol P 2mg/5ml 150ml syrup VENTOLIN For use in paediatricsR03CC 10.2.1 salbutamol P 2mg/5ml 500ml syrup VENTOLIN As aboveR03CC 10.2.1 salbutamol P 2mg 500 tablet VENTOLIN; VENTEZE As aboveR03AC 10.2.1 salbutamol 1 A P 100µg/inhalation 1 x 200 dose MDI complete VENTEZE Use cheapest Beta-stimulant MDI on tender.R03AC 10.2.1 salbutamol 1 A P 100µg/inhalation 1 x 200 dose MDI refill VENTEZE As aboveR03AC 10.2.1 salbutamol 1 A P 100µg/inhalation 1 x 300 dose MDI complete VENTOLIN As aboveR03AC 10.2.1 salbutamol 1 A P 100µg/inhalation 1 x 300 dose MDI refill VENTOLIN As above

D05AX ‡salicylic acid in cetomacrogol ointment

2% 200g ointment

D05AX ‡salicylic acid in cetomacrogol ointment

5% 200g ointment

D01AE ‡salicylic acid in soft white paraffin

40% 200g ointment

D01AE ‡salicylic acid + lactic acid in collodion flex

20% + 20% 500ml liquid WART PAINT

R03AC 10.2.1 salmeterol xinafoate 25µg/inhalation 1 x 120 dose MDI complete SEREVENTspecialist physician & paediatrician initiated

For adults and children over the age of 6 - cheapest LABA on tender to be used See Circular H 64/2007 Suppl List 110: Annexure A

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R03AC 10.2.1 salmeterol xinafoate 50µg/inhalation 1 x 120 dose MDI complete SEREVENTspecialist physician & paediatrician initiated

For adults and children over the age of 6 - cheapest LABA on tender to be used See Circular H 64/2007 Suppl List 110: Annexure A

X 15.7 salt solution, balanced 15ml eye soln. B.S.S.Specialist ophthalmologist



J06A Ø scorpion antivenom A P 5ml 1 injectionD01AE 14.3 selenium sulphide 1 2,5% 50ml shampoo SELSUN

A06AB 12.7 senna 1 Aequivalent to 7,5mg sennoside B

12 tablet SENOKOT

A06AB 12.7 senna Aequivalent to 7,5mg sennoside B

48 tablet SENOKOT; SENNALAX


200 tablet SENOKOT


1 000 tablet SENOKOT

A06AB 12.7 sennoside A & B A 142mg/71ml 71ml liquid X-PREPSpecialist radiologist

X serum, human stabilised P 0.05 50ml infusion Specialist

X Ø serum, human stabilised 0.05 250ml infusion Specialist

N01AB 2.1.1 sevoflurane A 250ml liquid ULTANE Central HospitalsPatient name basis.Not referable.

sildenafil: see phosphodiesterase-5-inhibitors

D08AL Ø silver nitrate stick A P 0.95 1 pencil SILVER NITRATE PEN.

D06BA 14.1 silver sulphadiazine A P 1% 50g creamFLAMAZINE; ARGENT-EZE

D06BA 14.1 silver sulphadiazine 1 A P 1% 500g cream FLAMAZINE

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C10AA 7.7.2 Supp List 116 simvastatin 10mg 28 tablet ZOCOR

1. General

2. Specialist physician initiated

Cheapest Statin on tender to be used

1. 10mg daily dose : For secondary prevention of coronary artery disease, thrombotic stroke, peripheral arterial disease, acute coronary syndrome and diabetes.For primary prevention if 10yr risk of CHD greater than 20%.

2. Up to 20mg daily dose if 10yr risk of CHD greater than 20% Up to 40mg daily dose for hyperlipidaemia. For higher doses / inadequate response refer to lipid clinic - See Atorvastatin

C10AA 7.7.2 Supp List 116 simvastatin 20mg 28 tablet ZOCOR As above As above

L04AA 24.1 sirolimus 1mg/ml 60ml solution RAPAMUNE



L04AA 24.1 sirolimus 1mg 30 tablet RAPAMUNE As above As above

J06AA Øsnake bite antivenom, polivalent

1 A P 10ml 1 injection See Circular on availability of antivenom prodicts

B05BB 20.4 sodium bicarbonate 4% 50ml 1 injectionADCO-SODIUM BICARBONATE

B05BB 20.4 sodium bicarbonate 1 A P 8,5% 50ml 1 injectionADCO-SODIUM BICARBONATE

V03AX Ø sodium bicarbonate A BP 500g powderBICARBONATE OF SODA

A12CA 20.4 sodium chloride 1 0,9% 10ml 1 injectionSABAX SODIUM CHLORIDE

EDL

X Ø sodium chloride BP 500g powder

A07CA Ø

sodium chloride + potassium chloride + sodium citrate + dextrose monohydr.

1 P2g + 1,5g + 2,9g + 19,6g = 26g

50 sachetsGASTROLYTESOROL

G04B 16.3sodium citrate co. effervescent

P 60g granulesCITRO-SODA; EFFERSOL

S01GX 15.7 sodium cromoglycate 2% 10ml eye dropsOPTICROM; VISTACROM

Specialist ophthalmologist, paediatrician &allergologist initiated

R03BC 10.4 sodium cromoglycate 20mg 50 inhal. capsule LOMUDALSpecialist paediatrician of 82


X 10.4 sodium cromoglycate 1 spinhaler LOMUDAL SPINHALER

X 4.6sod. fluoride + ascorbic acid

25mg + 200mg 60 tablet OSSIPLEX RETARDSpecialist endocrinologist.

Not referable.

J01XC 18.7 sodium fusidate A 250mg 100capsule / tablet

FUCIDIN Specialist

Recommended to be used in confirmed Staphylococcus infections which have failed to respond to the use of beta-lactam resistant penicillins alone.

J01XC 18.7 sodium fusidate A 500mg 1 infusion I.V. FUCIDIN Specialist As above.J01XC 18.7 sodium fusidate 250mg/5ml 50ml suspension FUCIDIN Specialist As above.

S01KA 15.7 sodium hyaluronate 10mg/ml 0,4ml injection HEALON; AMVISCSpecialist ophthalmologist

S01KA 15.7sodium hyaluronate +sodium chondroitin sulphate

30mg/ml +40mg/ml

0,5ml injection VISCOAT Specialist As above

D08AX Ø sodium hypochlorite 1% 5 000ml liquid MILTOND08AX Ø sodium hypochlorite 1% 500ml liquid MILTONV08AA Ø sodium iothalamate A 20% 300ml injection INFUSO CONRAYV08AA Ø sodium iothalamate 54% 50ml injection CONRAY 325 RadiologyV08AA Ø sodium iothalamate 70% 50ml injection CONRAY 420 Radiology

V08AA Øsodium iothalamate + meglumine iothalamate

52% + 26% 50ml injection CARDIO CONRAY Radiology

V08AC Ø sodium ipodate A 500mg 6 capsule BILOPTIN

R05CB 10.3sodium-2-mercapto sulphonate (MESNA)

P 600mg 3mlinhal. ampoules

MISTABRON Specialist Respiratory specialists & thoracic surgeons. Treatment can not be initiated by physiotherapist.

C02DD 7.3.1 sodium nitroprusside A P 2% 5ml 1 infusion HYPOTEN SpecialistA01AB Ø sodium perborate 162g powder PERASAFE Use as per PGWC Antiseptic Policy.A01AB Ø sodium perborate 810g powder PERASAFE As above

A06AG 12.7sodium phosphate + sodium acid phosphate

A P60mg + 160mg/ml

135ml enema LENOLAX

V03AE 25sodium polystyrene sulphonate

A 454g powder KEXALATE

C05BB 8.5sodium tetradecyl sulphate

30mg/ml 5ml injection STD Specialist

sodium valproate etc. see valproate sodium ….

X 28sodium thiosulphate + sodium nitrite + amyl nitrite inhalaion

kit TRIPAC-CYANO

X Ø soft paraffin, white BP 500g ointment WHITE PARAFFINX Ø soft paraffin, white BP 4kg ointment WHITE PARAFFINX Ø soft paraffin, white BP 15kg ointment WHITE PARAFFIN

X Ø soft paraffin, yellow BP 4kg ointmentYELLOW SOFT PARAFFIN

A06AD Ø sorbitol 1 A 70% 500ml liquidNOT to be used for hepatic encephalopathy. Only as a laxative. of 82


C07AA 7.3.1 sotalol 80mg 100 tablet SOTACORSpecialist cardiologist initiated

C07AA 7.3.1 sotalol 160mg 100 tablet SOTACORSpecialist cardiology initiated

J01XX 18.7 spectinomycin 1 2g 1 injection TROBICINJ06A Ø spider antivenom A P 5ml 1 injection See Circular on antivenom products

C03DA 16.1 spironolactone A P 25mg 200 tabletALDACTONE; TENSIN; SPIRACTIN

stabilised human serum:see serum, human stabilised


stavudine 1 15mg 56 capsuleASPEN STAVUDINE; ZERIT

AIDS programmeAvailable through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.



AIDS programmeAvailable through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.










stavudine 1 1mg/ml 200ml solution ZERIT AIDS programme As above.

A06AC 12.6 sterculia + frangula P 62% + 8% 200g granules NORMACOL PLUS Specialist initiatedMaximum 200g per month. Cheapest bulk forming agent currently on tender to be used.

B01AD 8.3 streptokinase 1 A P 750 000iu 1 injection KABIKINASETo be used according to protocol. See Circular H80/1997 (Addendum 1 - Suppl. List 77)

B01AD 8.3 streptokinase 1 A P 1 500 000iu 1 injectionKABIKINASE; STREPTASE

As above.

L01DC 23streptomyces caespitosis

2mg 1 injection MITOMYCIN - C Specialist of 82


L01DC 23streptomyces caespitosis

10mg 1 injection MITOMYCIN - C Specialist

J01GA 18.3 streptomycin 1 A 1g 1 injectionNOVOSTREP; SOLUSTREP

J01GA 18.3 streptomycin 5g 1 injection NOVOSTREP

A02BX 12.5 sucralfate P 1g/5ml 300ml suspension ULSANIC Specialistendoscopy units - for proven active peptic ulcers - and ICUs only. Also paeds

A02BX 12.5 sucralfate P 1g/5ml 600ml suspension ULSANIC Specialist As above

P01BD 18.9sulfadoxine + pyrimethamine

1 A P 500 + 25mg 3 tablet FANSIDAR Treatment of malaria - 2-3 tablets immediately.

A07EC 12.11 sulphasalazine A P 500mg 100 tabletSALAZOPYRIN

Specialist initiated GIT and Rheumatology clinics only.

D10AB ‡sulphur in soft white paraffin

5% 200g ointment

D10AB 31 sulphur ointment BP 25g ointment SULPHUR OINT.D10AB 31 sulphur ointment BP 500g ointment SULPHUR OINT.

N05AL 1.4.6 sulpiride 50mg 100 capsule EGLONYLSpecialist psychiatrist & neurologist initiated

NOT TO BE USED for lactation as safety in neonates unknown.

N05AL 1.4.7 supp List 116 sulpiride 200mg 50 tabletBIO-SULPIRIDE 200; EGLONYL FORTE

Specialist psychiatrist initiated

D02BA 14.8 sun barrier cream minimum SPF15 50ml cream/lotion DINO-BLOC SPF 15

Specialist dermatologist & rheumatologist initiated

surfactant: See total phospholipids

M03AB 2.3 suxamethonium Cl A P 100mg/2ml 1 injection SCOLINEX Ø syrup simplex BP 2 500ml syrup

L04AA 24.1 tacrolimus 1mg 100 capsule PROGRAF



L04AA 24.1 tacrolimus 5mg 50 capsule PROGRAF


As above

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tadalafil: see phosphodiesterase-5-inhibitors

L02BA 19.8 tamoxifen 10mg 30 tablet NEOPHEDAN-10 Specialist initiatedL02BA 19.8 tamoxifen 10mg 250 tablet NOLVADEX; KESSAR Specialist initiatedL02BA 19.8 tamoxifen 20mg 30 tablet NEOPHEDAN-20 Specialist initiatedL02BA 19.8 tamoxifen 20mg 250 tablet KESSAR Specialist initiated

GO4CA 16.5Supp List 121/124

tamsulosin SR 0,4mg 30slow release capsule

FLOMAX

For BPH and/or LUTS: with referral to a urologist within 6 months for those patients who have not previously been on an alpha-blocker (i.e. referral within 6 months for patients initiated on an alpha-blocker for BPH / LUTS). LUTS = Lower Urinary Tract Symptoms in males

D05AA 14.5? tar extracts125ml / 250ml

shampoo TRITARSpecialist dermatologist initiated

N05CD 1.2.1 temazepam 20mg 100 capsule NORMISON

Maximum dose 20mg/day for 14 days unless prescribed by a psychiatrist, neurologist or paediatrician. See Circular H24/2006 Suppl List 107 Addendum I

L01AX 23 Supp List 121 temozolomide 5mg 5 capsule TEMODALSpecialist oncologist

Limited to patients with malignant glioma with positive status for a methylated promoter for the methylguanine methyl transferase (MGMT) gene.







L01CB 23 teniposide P 50mg/5ml 1 injection VUMONSpecialist oncologist

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J05AF 18.12Supp List 119/124

tenofivir disoproxil funerate

1 300mg 30 tablet VIREAD

General code: AIDS programme CNP / Professional nurse Specialist

GENERAL: Availabe through HIV / AIDS programme for treating AIDS patients according to the appropriate protocols. CNP/ Professional nurse: Available through HIV/ AIDS programme: For first line treatment of adult AIDS patients as per HIV / AIDS guidelines 2010 for treating AIDS patient and per Circular H30/2011 - Authorisation of Nurse Prescribing for Antiretroviral Treatment SPECIALIST: For Liver / GIT clinic for the management of chronic Hepatitis B patients. For this indication Tenofovir must be procured via the Cape Medical Depot and not the ARV Depot

J05AF 18.12 Supp List 122tenofivir disoproxil funerate / emtracitabine

1 300mg / 200mg 30 tabletDIDIVIR / TYRICTEN / TRUVADA

To be used according to Health Programmes' protocol for PMTC

D01BA 18.10 terbinafine 250mg 14 tablets LAMISILSpecialist dermatologist

Patient name basis.Not referable.

J04AK 18.8.1 terizidone 250mg 100 capsules TERIVALIDINSpecial Programmes

Only to be initiated in consultation with MDR TB Referral Centres Brooklyn Chest and Brewelskloof Hospitals. Patients can be referred out and continue treatment on an outpatient basis.

X 19.6.3testosterone + oestradiol

100mg 1 injection PRIMODIAN-DEPOT Specialist

G03BA 19.6.1testosterone cypionate L.A.

A 100mg/ml 10ml injection DEPO-TESTOSTERONE

G03BA 19.6.1

testosterone propionate +testosterone phenylpropionate +testosterone isocaproate +testosterone decanoate

30mg60mg60mg100mg

3 injection SUSTANON 250 Specialist

H01AA 19.7 tetracosactide 1mg/ml 1 injection SYNACTHEN DEPOT Specialist

J01AA 18.4.1 tetracycline A 250mg 100 capsule ROTETCheapest of the hydrochloride or phosphate will be supplied.

J01AA 18.4.1 tetracycline A 250mg 1 000 capsule ROTET As above.R03DA 10.2.2 theophyllin 125mg 60 SR capsule MICRO-PHYLLIN For use in paediatrics only.R03DA 10.2.2 theophyllin P 25mg/5ml 200ml syrup NUELIN For use in paediatrics only.R03DA 10.2.2 theophyllin BP anhydr. 125mg 100 tablet NUELIN

R03DA 10.2.2 Supp List 119 theophyllin anhydr. LA 1 A P 200mg 60 tabletTHEO-DUR; BRONCHOPEN

Not to be used as first line therapy in asthma. Refer to coding guidelines: Suppl List 119 - Addendum A: Amended in 2009: Theophyllin maximum dose increased to 300mg

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R03DA 10.2.2Suppl List 119

theophyllin anhydr. LA 1 A 300mg 60 tabletTHEO-DUR; BRONCHOPEN


R03DA 10.2.2 Supp List 119 theophyllin anhydr. LA A 300mg 500 tablet THEO-DUR


L01BB 23 thioguanine P 40mg 25 tablet LANVISSpecialist oncologist

N01AF 2.1.2 thiopentone A P 0,5g 20ml injection SANDOTHAL

L01AC 23thiotepa(tespa)

A P 15mg 1 injection THIOTEPA Specialist

X ‡ thymol in chloroform 2% 500ml liquidthyrotrop(h)in releasing hormone: See protirelin

H01AB Ø

thyrotrophic hormone (thyroid stimulating hormone, TSH, thyrotrophin)

injection THYTROPARSpecialist endocrinologist

H03AA 19.3 thyroxine A P 0,05mg 100 tablet ELTROXINH03AA 19.3 thyroxine A P 0,1mg 100 tablet ELTROXIN

N02AX 3.1 tilidine P 50mg/0,5ml 10ml oral drops VALORONFor paediatrics ONLY. See protocol on selection of analgesics: Circular H112/1998 (Addendum E - Suppl. List 80)

S01ED 15.6 Supp List 121 timolol maleate A 0.0025 5ml eye drops TIMOPTOLSpecialist ophthalmologist initiated

X ‡

tincture benz. Co in lassar's paste (zinc oxide 2% + salicylic acid 2%)

15% 500ml liquid

G01AF 17.2 tioconazole 100mg 3 vaginal tablets GYNO-TROSYDCheapest appropriate imidazole preparation on tender will be issued.

B01AC 8.4 tirofiban 0,25mg/ml 1 injection AGGRASTETSpecialist cardiologist

Central hospital, Post stent.Patient name basis.

S01AA 15.1 tobramycin 3mg/ml 5ml eye drops TOBREXSpecialist ophthalmologist

Not referable

S01AA 15.1 tobramycin 3mg/g 3,5g eye ointment TOBREXSpecialist ophthalmologist

Not referable

J01GB 18.3 tobramycin 80mg 1 injectionTOBRAMYCIN-FRESENIUS

Specialist Only for severe nosocomial infections in ICU's & on a Microbiologist report.

A11HA 20.1 tocopherol acetate 100mg 100 tablet VITAMIN EA10BB 19.1.2 tolbutamide 1 A 500mg 200 tablet RASTINON; TYDADEX

N03AX 1.6 topiramate 50mg 60 tablet TOPAMAXSpecialist neurologist

For Neurology only at Central Hospitals on a patient name basis and non-referable.

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N03AX 1.6 topiramate 100mg 60 tablet TOPAMAXSpecialist neurologist

As above.

X 10.5 total phospholipids 200mg/8ml 8ml vial SURVANTANeonatal ICU and highcare

For use in selected pre-term infants between 700g and 1 000g body weight

X 10.5 total phospholipids 100mg/4ml 4ml vial SURVANTANeonatal ICU and highcare

As above.

B01BA Øtpn amino acid + electrolytes infusion

1 000ml plastic bagSYNTHAMIN 9 + ELECTROLYTES

B01BA Øtpn amino-acid + electrolytes + glucose

A P 1 000mlglass container

VAMIN + GLUCOSE


A P 100mlglass container

VAMIN + GLUCOSE


A P 500mlglass container

VAMIN + GLUCOSE

B05BA Øtpn amino-acid + electrolytes + glucose + fat

7% + 10% + 20% 1 000mlI.V. infusion solns

VITRIMIX

B01BA Øtpn amino-acid + electrolytes infusion

1 000ml plastic bagSYNTHAMIN 14 + ELECTROLYTES

B01BA Ø tpn amino-acid infusion 500mlglass container

VAMIN 18

B01BA Ø tpn amino-acid infusion 500ml plastic bagSYNTHAMIN 14 WITHOUT ELECT.

B05BA Øtpn electrolytes + trace elements

A P 10ml ampoule ADDAMEL

B05BA Øtpn electrolytes + trace elements

A P 20ml ampoule PED-EL

B01BA Ø tpn fat emulsion A P 20% 500ml I.V. infusion LIPOVENOUS 20%B01BA Ø tpn fat emulsion A P 20% 100ml I.V.infusion LIPOVENOUS 20%

B01BA Ø tpn fat emulsion A P 10% 100mlglass container

LIPOVENOUS 10%

B01BA Ø tpn fat emulsion A P 10% 500mlglass container

LIPOVENOUS 10%

B05BA 22tpn fat emulsion + amino acids + electrolytes

2 000mlIV triple chamber plastic bag

CLINOMEL Specialist For use in central and regional hospitals only.

B05BA Ø tpn vitamins fat soluble P adult 10ml x10 ampoule VITALIPID ADULTB05BA Ø tpn vitamins fat soluble P paediatric 10ml x10 ampoule VITALIPID INFANT

B05BA Øtpn vitamins water soluble

P 10ml x10 vial SOLUVIT

TRH, TRF: See protirelin

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N02AX 3.4Supp List 111/115/119/121/122

tramadol1 A

50mg 100 capsule Tramal; TramazacGeneral Specialist initiated

General: As add-on therapy to paracetamol. Recommended dose 50mg six hourly. Not repeatable for acute conditions (short course) Specialist initiated: For neuropathic pain as second or third line (may be used without paracetamol). Prescription must be endorsed with 'neuropathic pain' NOTE: Refer to Sup List 111 Addendum A: warning - tramadol and serotonin syndrome Refer to Supp List 121: Addendum B: warning - tramadol and amitriptyline interaction

B02AA 8.1 tranexamic acid P 500mg/5ml 1 injection CYKLOKAPRON Specialist

B02AA 8.1 Supp List 114 tranexamic acidAP

500mg 100 tablet CYCLOKAPRON

Specialist physician, oncologist, gynaecologist & paediatrician

In Gynaecology: Second line treatment where NSAID's have failed, max 7 days. May be repeated monthly. In Haematology: For haemophiliacs. May be prescribed for one month. May be repeated

D10AD 14.6 tretinion A P 0,5mg/g 20g cream RETIN A; AIROLSpecialist dermatologist

D10AD 14.6 tretinion A P 0,25mg/g 20g gel RETIN ASpecialist dermatologist

As above.

A01AC 11.3triamcinolone acetonide in orabase

0,1% 5g ointment KENALOG IN ORABASE Specialist

N05AB 15.1 trifluoperazine 1mg 50 tablet STELAZINESpecialist psychiatrist initiated

N05AB 1.5.1 trifluoperazine 2mg 250 tablet STELAZINESpecialist psychiatrist initiated

As above


As above.


As above.


As above.


As above

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S01AD 15.1.1 trifluorothymidine 1% 5ml eye drops T.F.T.Specialist ophthalmologist

trihexiphenidyl: see benzhexol

R06AD 6.1 trimeprazine P 30mg/5ml 100ml syrup VALLERGAN FORTES01FA 15.5 tropicamide 10mg/ml 15ml eye drops MYDRIACILS01FA 15.5 tropicamide 5mg/0,5ml 0,5ml x 20 minims MINIMS TROPICAMIDE SpecialistV04CF 26 tuberculin PPD 2TU/0,1ml 1,5ml vial MANTOUX Freeze dried

V04CF 26 tuberculin PPD test 5TU/applicator 20/25skin prick apparat.

TINE TEST; BIOCINE PPD

EDL

D02AE ‡urea in cetomacrogol cream

10% 200g cream

A05AA ‡ ursodeoxycholic acid 100mg% 100 tablet URSOTANSpecialist GIT clinic, hepatic clinic & liver transplants

Hepatic clinic - only for primary biliary cirrhosis..Central hospitals, non-referable.

J07AN 26 vaccine BCG 1 A 10 doseinjection percutaneous

J07AN 26 vaccine BCG 1 A 20 doseinjection intradermal

J07AF 26vaccine diphtheria, tetanus

1 10ml 20 dose injection

J07AF 26vaccine diphtheria, tetanus, pertussis

1 10ml 20 dose injection D.T.P. MERIEUX

J07AG 26vaccine diphtheria, tetanus, pertussis, HiB & polio

1 0,5ml 1 dose injection PENTAXIM As per EPI immunisation schedule

J07BC 26 vaccine hepatitis B 1 A adult 1 injection ENGERIX-BJ07BC 26 vaccine hepatitis B 1 P paed. 1 dose injection HEPPACINE-BJ07BC 26 vaccine hepatitis B 1 P paed. 10 dose injection HEPPACINE-B

J07BB 26 vaccine influenza 0,5ml single injection MUTAGRIP

Current product on tender to be bought.Use only in the following HIGH RISK CASES:☼ Chronic cardio pulmonary disease - Transplant patients - Patients in nursing homes ☼ Children with: cystic fibrosis, HIV and other immuno compromising conditions☼ PGWC staff working in high risk areas in institutions

J07BB 26 vaccine influenza 5ml multidose injection MUTAGRIP

Use only in the following HIGH RISK CASES:☼ Chronic cardio pulmonary disease - Transplant patients - Patients in nursing homes ☼ Children with: cystic fibrosis, HIV and other immuno compromising conditions☼ PGWC staff working in high risk areas in institutions

J07BD 26 vaccine measles 1 1 dose injection MORBILVAX; ROUVAXJ07BD 26 vaccine measles 1 5ml 10 dose injection MORBILVAX; ROUVAX of 82


J07AL 26vaccine pneumococcal,polivalent

A P 0,5ml 1 injectionPNEUMOVAX 23IMOVAX PNEUMO 23

Specialist

J07AL 26Suppl List 119

vaccine pneumococcal, conjugate 1 0,5ml 1 injection PREVENAR As per EPI immunisation schedule

J07BF 26vaccine poliomyelitis, trivalent, oral

1 10 doseoral preparation

POLIORAL

J07BG 26 vaccine rabies 1 A P 1 dose injection IMOVAX RABIES VERO

J07BH 26Suppl List 119

vaccine rotavirus 1 1ml

1 dose with syringe filled diluent and reconstitution device

oral preparation

ROTARIX As per EPI immunisation schedule

J07BJ 26 vaccine rubella A 0,5ml 1 injection RUBEATEN BERNA

J07AM 26vaccine tetanus adsorbed toxoid

1 A P 40iu/0,5ml 5ml1 multidose

injection TETAVAX

J05AB 18.10 valaciclovir A 500mg 42 tablet ZELITREX 500 SpecialistMicrobiology approval. Motivation form to be completed.

J05AB 18.12 Supp List 122 valganciclovir 450mg 60 tablet VALCYTE Specilaist

For post transplant patients on maintenance therapy on discharge post ganciclovir IV. For adults and children. Non-referable

N03AG 1.6 Supp List 114 valproate sodium P 100mg 100crushable tablets

EPILIM CRUSH TABSUse according to epilepsy treatment guidelines. See Circular H35/2005 (Addendum B - Suppl. List 101)

N03AG 1.6 valproate sodium 400mg 1 injection EPILIMFor status epilepticus only: as third line agent if phenobarbitone injection is not available, otherwise as fourth line agent

N03AG 1.63870928 Supp List 101

valproate sodium P 200mg/5ml 300ml

syrup, sugar free

EPILIMUse according to epilepsy treatment guidelines. See Circular H35/2005 (Addendum B - Suppl. List

N03AG 1.6valproate sodium + valproic acid

AP

133,2mg + 58mg 100 tablet EPILIM CR 200

General code mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm Specialist neurologists, psychiatrists, paediatricians, neurosurgeons and physicians initiated.

For ARV clinics only, in line with Suppl List 112 Addendum A. mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmUse according to epilepsy treatment guidelines. See Circular H35/2005 (Addendum B - Suppl. List 101)

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AP

199,8mg + 87mg 100 tablet EPILIM CR 300

General code mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmSpecialist neurologists, psychiatrists, paediatricians, neurosurgeons and physicians initiated.



AP

333mg + 145mg 100 tablet EPILIM CR 500

General code mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmSpecialist neurologists, psychiatrists, paediatricians, neurosurgeons and physicians initiated.


N03AG 1.6 valproic acid A P 150mg 100 capsule CONVULEX As aboveNo new patients. To be used for patients already on valproic acid only.



N03AG 1.6 valproic acid P 250mg/5ml 100ml suspension CONVULEX As aboveNo new patients. To be used for patients already on valproic acid only.

J01XA 18.7 vancomycin A P 500mg 1 injection VANCOCIN Specialist As above.

J01XA 18.7 vancomycin A P 1g 1 injection VANCOCIN SpecialistMotivation form to be completed or microbiologist report. Cheapest of CP or plain to be bought.

vardenafil: see phosphodiesterase-5-inhibitors

M03AC 2.3 vecuronium A P 4mg 50 injection NORCURON

NO6AX 1.4.5 Supp List 115 venlafaxine 37,5mg 37,5mg 30extended release capsule

VENLOR; EFEXOR Specialist psychiatrist initiated

NO6AX 1.4.5 Supp List 115 venlafaxine 75mg 75mg 30extended release capsule


NO6AX 1.4.5 Supp List 116 venlafaxine 150mg 150mg 30extended release capsule


C08DA 7.3.7 Supp List 124 verapamil A P 5mg/2ml 1 injection ISOPTIN SpecialistCentral Hospitals; Non-referable; for vascular surgery

C08DA 7.3.7 verapamil A 40mg 56 tablet ISOPTINSee protocol on Calcium channel antagonists: Circular H112/1998 (Addendum D - Suppl. List 80) of 82


C08DA 7.3.7 verapamil A 40mg 84 tablet ISOPTIN As above.C08DA 7.3.7 verapamil A 40mg 500 tablet ISOPTIN As above.C08DA 7.3.7 verapamil A 80mg 56 tablet ISOPTIN As above.C08DA 7.3.7 verapamil A 80mg 84 tablet ISOPTIN; BONCEUR As above.C08DA 7.3.7 verapamil A 80mg 250 tablet ISOPTIN As above.

N03AG 1.6 vigabatrin 500mg 100 tablet SABRILSpecialist neurologist

Not referable.

L01CA 23 vinblastine A P 10mg 1 injection VELBESpecialist oncologist

L01CA 23 vincristine A P 1mg 1 injectionONCOVIN; PERICRISTINE

Specialist oncologist

L01CA 23 vincristine A P 1mg + diluent 10 injection ONCOVINSpecialist oncologist



L01CA 23 Supp List 124 vinorelbine 20mg 1 capsules NAVELBINESpecialist oncologist

Patient Name Basis Adjuvant therapy of completed resected NSCLC (stage2 & 3 only) Patient numbers to be decided upon by Central Hospitals







L01CA 23 Supp List 124 vinorelbine 10mg 1 injection NAVELBINESpecialist oncologist


L01CA 23 Supp List 124 vinorelbine 50mg 1 injection NAVELBINESpecialist oncologist

Patient Name Basis Adjuvant therapy of completed resected NSCLC (stage2 & 3 only) Patient numbers to be decided upon by Central Hospitals of 82


A11CA 20.1 vitamin A 50 000iu/ml 2ml 5 injection AROVIT

A11CA 20.1 vitamin A 1 P 50 000iu 50capsule white snip off

VITAFORCE

A11CA 20.1 vitamin A 1 P 50 000iu 200 tablet AROVIT; AVITA

A11CA 20.1 vitamin A 1 P 100 000iu 50capsule blue snip off

VITAFORCE

A11CA 20.1 vitamin A 1 P 200 000iu 50capsule red snip off

VITAFORCE

A11CA 20.1 vitamin A 200 000iu 250 capsule VITAMIN A - Lennons For Nutrition Program Only.A11DA 20.1 vitamin B1 (thiamine) A 100mg/ml 1 injection VITAMIN B 1A11DA 20.1 vitamin B1 (thiamine) 1 A 100mg 100 tablet VITAMIN B 1A11HA 20.1 vitamin B6 (pyridoxine) P 50mg/ml 10 injection VITAMIN B 6A11HA 20.1 vitamin B 6 (pyridoxine) 1 A P 25mg 100 tablet

B03BA 20.1vitamin B12

(cyanocobalamin)A P 1 000µg/ml 1 injection VITAMIN B12

B03BA 20.1vitamin B12

(cyanocobalamin) A P 1 000µg/ml 10ml 1 injection

LABETHICA VITAMIN B 12

A11EA 20.1.1 vitamin B Co A 10ml 1 injection BECOPLEXA11EA 20.1.1 vitamin B Co 1 A 56 tabletA11EA 20.1 vitamin B Co A 1 000 tablet BECOPLEXA11EA 20.1.1 vitamin B Co A 5 000 tabletA11GA 20.1 vitamin C A 500mg/5ml 1 injection VITAMIN CA11GA 20.1 vitamin C A P 100mg 1 000 tablet VITAMIN C

A11BA 20.1.1vitamin Co - multivitamin

10ml 1 injection PANCEBRIN Specialist


P 20ml oral drops VIDAYLIN


1 P 100ml syrup MULTIVITAMIN


2 500ml syrup MULTIVITAMIN

vitamin D: see alfacalcidol, calciferol & ergocalciferolvitamin K: see phytomenadione

B01AA 8.2 warfarin A 5mg 100 tablet COUMADINV07AB Ø water for injection B.P. 1 x 5ml injection

WATER FOR INJECTION

V07AB Ø water for injection B.P. 1 x 10ml injectionWATER FOR INJECTION

V07AB Ø water for injection B.P. 1 x 20ml injectionWATER FOR INJECTION

X Ø wool fat, anhydrous 500g ointment

R01AA 11.1 xylometazoline 1 P 0,05% 10mlnasal drops - paed

OTRIVIN PAED. ALTERNATIVE: Oxymetazoline when cheaper

R01AA 11.1 xylometazoline 1 A 0,1% 10ml nasal drops OTRIVIN As above

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J05AB 18.12 zidovudine 1 A P 100mg 100 capsule RETROVIR

1. For prevention of mother to child transmission of HIV 2. For rape victims. * For other uses: Authority to be obtained from the Regional Drug and Therapeutics Committee.

J05AB 18.12 zidovudine1

A P100mg 14 capsule RETROVIR

1. For prevention of mother to child transmission of HIV 2. For rape victims. * For other uses: Authority to be obtained from the Regional Drug and Therapeutics Committee.

J05AB 18.12 zidovudine1 P

250mg 100 capsule RETROVIR As above

J05AB 18.12 zidovudine 1 50mg/5ml 200ml syrup RETROVIR Special programmeOnly for the treatment of rape survivors (children) & PMCTC according to the provincial protocol.

J05AB 18.12

3797948 &pgwc ARV depot Supp List 124

zidovudine 1 300mg 60 tablet RETROVIR

General code - AIDS programme Clinical Nurse Practitioner CNP / Professional nurse

General: Available through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols. Clinical Nurse Practitioner: According to PMTC policy and guidelines CNP / Professional nurse: Available through HIV AIDS programme: For first line treatment of adult AIDS patients as per HIV / AIDS guidelines 2010 for treating AIDS patients and per Circular H30/2011 - Authorisation of Nurse Prescribing for Antiretroviral Treatment

J05AF 18.12pgwc ARV depot Supp List 124

zidovudine + lamivudine 300mg + 150mg 60 tablet COMBIVIR; LAMZID

General code - AIDS programme Clinical Nurse Practitioner CNP / Professional nurse

General: Available through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols. Clinical Nurse Practitioner: For initiation of therapy for 3 days, according to PGWC PEP protocol. CNP / Professional nurse: Available through HIV AIDS programme: For first line treatment of adult AIDS patients as per HIV / AIDS guidelines 2010 for treating AIDS patients and per Circular H30/2011 - Authorisation of Nurse Prescribing for Antiretroviral Treatment

J05AF 18.12 ------- zidovudine + lamivudineInitiation of therapy extended to Clinical Nurse Practitioner in accordance with the PGWC PEP protocol.

A12CB 20.4 zinc gluconate 417mg 30 tablet LEPPIN ZINC 50mgD02AB Ø zinc oxide 1 BP 500g ointment ZINC OXIDE OINT.

D05AX Øzinc oxide + salicylic acid

BP 500g paste LASSAR'S PASTE

A12CB 20.2 Supp List 120zinc sulphate dispersible tablet

120mg elemental zinc

100dispersible tablet

SMART ZINC 20

A12CB 20.4 zinc sulphate 220mg 100 tablet ZN 220

PEP starting dose: Zidovudine 300mg twice daily for 3 days

+ Lamivudine 150mg twice daily for 3 days

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D01AE 14.3zinc undecenoate + undecenoic acid

20% + 2% 50g powder MYCOTA

D02AB Ø zinc & castor oil 1 BP 25g ointment ZINC & CASTOR OILD02AB Ø zinc & castor oil BP 500g ointment ZINC & CASTOR OIL

N05AF 1.5.3 zuclopenthixol acetate A 50mg/ml 1 injection CLOPIXOL ACUPHASESpecialist psychiatrist

N05AF 1.5.3 zuclopenthixol acetate A 100mg/2ml 1 injection CLOPIXOL ACUPHASESpecialist psychiatrist

N05AF 1.5.3zuclopenthixol decanoate

1 200mg/ml 1 injection CLOPIXOL DEPOT On General Code for continuation of therapy.

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provincial code list - · pdf filed02ac ø aqueous cream 1 b.p. 100g cream aqueous...

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