chronic medication comprehensive formulary effective …

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CHRONIC MEDICATION COMPREHENSIVE FORMULARY

Effective 1 January 2011 • This formulary represents drugs covered for chronic use for 25 Chronic Disease List (CDL) conditions and individual Diagnosis and Treatment Pairs (DTP) conditions, where

applicable for each scheme. • Reimbursement of medication for non-CDL and non-DTP conditions is subject to Scheme Rules and Qualsa’s medicine reimbursement policy. • Unless otherwise stipulated, all active ingredients listed in this formulary are subject to the Qualsa Maximum Price (QMP). • The examples below serve as a guide on the trade names available for the active ingredients listed and not for marketing a specific brand. Any product within the QMP

category may be used, however, a co-payment may be attracted if the product selected is above the generic reference threshold. • The dispensing pharmacist may make a generic substitution to assist members in avoiding a co-payment, where necessary. • Treatment designated as “Accepted treatment” indicates that this is a medication covered as first line, according to the Qualsa medicine reimbursement policy. • For treatment designated as “Motivation required”, certain criteria as specified in the Qualsa medicine reimbursement policy should be met. • For treatment designated as “Special investigation”, the relevant clinical investigation reports as specified in the Qualsa medicine reimbursement policy are required.

Abbreviations of dosage form

CAP Capsule ECT Enteric-coated tablet NAS Nasal spray SRT Slow release tablet

CHU Chew tablet ENE Enema NOD Nasal drops SUP Suppository

CPS Capsule (Inhaler) FCT Film-coated tablet OPD Eye drops SUS Suspension

CRM Cream INH Inhaler SAC Sachet SYR Syrup

DRP Drops INJ Injection SLN Sublingual TAB Tablet

DSP Dispersable LOT Lotion SRC Slow release capsule UNG Ointment

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INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT

Addison's disease

Corticosteroids, oral

Fludrocortisone acetate 0.1mg TAB Florinef acetate Motivation required

Hydrocortisone 10mg TAB Covocort Accepted treatment

Prednisolone 5mg TAB Lenisolone Capsoid Prelone Accepted treatment

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

Asthma

Beta agonists, short-acting

Fenoterol INH Berotec HFA Accepted treatment

Fenoterol and ipratropium bromide 50mcg/20mcg INH Duovent HFA Accepted treatment

Salbutamol 100mcg INH Venteze Asthavent Accepted treatment

Salbutamol 2.5mg SLN Ventolin nebules Motivation required

Salbutamol 200mcg CPS Asthavent Accepted treatment

Salbutamol 200mcg CPS Ventodisks Accepted treatment

Salbutamol 400mcg CPS Ventodisks Motivation required

Terbutaline 0.5mg INH Bricanyl Motivation required

Beta agonists, long-acting

Formoterol 12mcg CPS/INH Foratec Accepted treatment

Formoterol 9mcg INH Oxis Motivation required

Salmeterol 25mcg INH Serevent Motivation required

Salmeterol 50mcg INH Serevent Motivation required

Corticosteroids, inhaled

Beclometasone 100mcg INH/ATH Beclate Qvar Accepted treatment

Beclometasone 200mcg INH Beclate Accepted treatment

Beclometasone 50mcg INH/ATH Beclate Qvar Accepted treatment

Budesonide 100mcg INH/CPS Inflacor Budeflam Inflammide Accepted treatment

Budesonide 200mcg INH/CPS Inflacor Budeflam Inflammide Accepted treatment

Budesonide 400mcg INH/CPS Inflacor Inflammide Novoliser Accepted treatment

Ciclesonide 80mcg INH Alvesco Motivation required

Ciclesonide 160mcg INH Alvesco Motivation required

Fluticasone 100mcg INH Flixotide CFC-free Motivation required



Fluticasone 500mcg INH Flixotide accuhaler Motivation required

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Corticosteroids and beta agonists, long-acting

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

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

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

Salmeterol and fluticasone 25mcg/125mcg INH Sereflo Seretide Accepted treatment



Salmeterol and fluticasone 50mcg/100mcg INH Foxair Seretide Accepted treatment



Xanthines

Aminophylline 225mg SRT Phyllocontin Motivation required

Theophylline 200mg SRT Sandoz Theophylline Motivation required Theophylline 250mg SRT Nuelin SA Motivation required Theophylline 300mg SRT Sandoz Theophylline Motivation required Theophylline 400mg SRT Uniphyl Motivation required Theophylline 600mg SRT Uniphyl Motivation required Leukotriene receptor antagonists

Montelukast 10mg TAB Singulair Motivation required

Montelukast 4mg CHU/SAC Singulair Singulair Sprinkles Motivation required

Montelukast 5mg CHU Singulair Motivation required

Zafirlukast 20mg TAB Accolate Motivation required

Other

Ketotifen 1mg/2mg TAB Zaditen Motivation required

Ketotifen 1mg SYR Zetofen Motivation required

Bipolar mood disorder

Heterocyclic antidepressants

Amitriptyline 25mg TAB Sandoz-amitriptyline Trepiline Tryptanol Accepted treatment

Clomipramine 10mg TAB Anafranil Equinorm Accepted treatment Clomipramine 25mg TAB Anafranil Clomidep Equinorm Accepted treatment Clomipramine 75mg TAB Anafranil Motivation required

Dothiepin 25mg CAP Thaden Prothiaden Sandoz-dothiepin Accepted treatment Dothiepin 75mg TAB Thaden Sandoz-dothiepin Accepted treatment

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Imipramine 25mg TAB Ethipramine Tofranil Accepted treatment

Lofepramine 70mg TAB Emdalen Motivation required

Mianserin 10mg TAB Lantanon Motivation required


Maprotiline 25mg TAB Ludiomil Motivation required


Trimipramine 25mg TAB Tydamine Motivation required

Trimipramine 50mg CAP Tydamine Motivation required

Selective serotonin receptor inhibitors

Citalopram 10mg TAB Austell-citalopram Accepted treatment

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

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

Escitalopram 5mg TAB Lexamil Motivation required

Escitalopram 10mg TAB Citraz Lexamil Aspen Escitalopram Motivation required

Escitalopram 20mg TAB Citraz Lexamil Zytomil Motivation required

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

Fluoxetine 40mg DSP Prohexal T Accepted treatment

Fluvoxamine 10mg TAB Faverin Fluvoxamine-hexal Luvox Motivation required Paroxetine 20mg TAB Serrapress Austell-paroxetine Xet Motivation required Paroxetine 30mg TAB Serrapress Austell-paroxetine Motivation required Sertraline 50mg TAB Serlife Austell-sertraline Arrow Sertraline Motivation required Sertraline 100mg TAB Serlife Austell-sertraline Motivation required Serotonin and noradrenaline re-uptake inhibitors

Duloxetine 30mg CAP Cymgen Cymbalta Motivation required


Venlafaxine 37.5mg CAP Venlor Odiven Motivation required

Venlafaxine 50mg TAB Efexor Motivation required

Venlafaxine 75mg CAP Venlor Sandoz Venlafaxine Odiven Motivation required

Venlafaxine 150mg CAP Venlor Sandoz Venlafaxine Efegen Motivation required

Monoamine oxidase type A inhibitors

Moclobemide 150mg TAB Depnil Motivation required

Moclobemide 300mg TAB Clorix Depnil Motivation required

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Other

Bupropion 150mg SRT Wellbutrin Motivation required


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




Reboxetine 4mg TAB Edronax Motivation required

Sulpiride 200mg TAB Bio-sulpiride Eglonyl Accepted treatment

Sulpiride 25mg SYR Eglonyl Accepted treatment Sulpiride 50mg CAP Espiride Eglonyl Sandoz Sulpiride Accepted treatment Trazodone 50mg CAP Molipaxin Aspen Trazodone Motivation required

Trazodone 100mg CAP Molipaxin Aspen Trazodone Motivation required

Mood stabilisers

Lithium 250mg TAB Camcolit Accepted treatment


Lithium 450mg TAB Quilonum Retard Accepted treatment

Carbamazepine 200mg TAB/SRT Sandoz Carbamazepine CR Degranol CPL-carbamazepine Accepted treatment

Carbamazepine 400mg SRT Sandoz Carbamazepine CR Accepted treatment

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

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



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




Valproic acid 150mg CAP/SRT Convulex Epilim Accepted treatment

Valproic acid 100mg TAB Epilim Accepted treatment

Valproic acid 200mg SRT Epilim Accepted treatment

Valproic acid 300mg CAP Convulex Accepted treatment


Antipsychotics

Chlorpromazine 100mg TAB Largactil Accepted treatment

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Haloperidol 0.5mg CAP Serenace Accepted treatment

Haloperidol 1.5mg TAB Serenace Sandoz Haloperidol Accepted treatment

Haloperidol 10mg TAB Serenace Accepted treatment

Haloperidol 5mg TAB Serenace Sandoz Haloperidol Accepted treatment

Risperidone 0.5mg TAB Auropidone DRL-Risperidone Mylan Risperidone Accepted treatment Risperidone 1mg TAB Auropidone DRL-Risperidone Mylan Risperidone Accepted treatment Risperidone 2mg TAB Auropidone DRL-Risperidone Mylan Risperidone Accepted treatment Risperidone 3mg TAB Auropidone DRL-Risperidone Perizal Accepted treatment Risperidone 4mg TAB Auropidone Aspen Risperidone Risponz Accepted treatment Risperidone 1mg/ml SLN Auropidone Risperdal Motivation required

Quetiapine 25mg TAB Seroquel Motivation required


Quetiapine 200mg TAB Seroquel Seroquel XR Motivation required


Quetiapine 400mg TAB Seroquel XR Motivation required


Trifluoperazine 1mg TAB Stelazine Accepted treatment


Zuclopenthixole 10mg TAB Clopixol Motivation required


Bronchiectasis

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

Cardiomyopathy/Heart failure

Aspirin

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

Acetylsalicylic acid 125mg TAB Lo-aspirin Accepted treatment

Acetylsalicylic acid 300mg TAB Be-tabs aspirin Disprin Gulf aspirin Accepted treatment

Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment (in children)

Acetylsalicylic acid 81mg ECT Ecotrin Coprin Accepted treatment

Anticoagulants

Warfarin 1mg TAB Cipla-warfarin Accepted treatment


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Diuretics

Bumetanide 1mg TAB Burinex Motivation required

Chlortalidone 50mg TAB Hygroton Motivation required

Furosemide 10mg/ml SYR Lasix Oral Motivation required

Furosemide 20mg TAB Lasix Accepted treatment

Furosemide 40mg TAB Beuresis Diuresix Mylan Furosemide Accepted treatment

Furosemide 500mg TAB Lasix Motivation required

Furosemide 60mg CAP Lasix Motivation required


Hydrochlorothiazide 12.5mg TAB Ridaq Accepted treatment

Hydrochlorothiazide 25mg TAB Hexazide Ridaq Accepted treatment

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

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

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

Indapamide 1.5mg TAB Natrilix SR Accepted treatment

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

Piretanide 3mg TAB Arelix Motivation required


Spironolactone 100mg TAB Aldactone Spiractin Accepted treatment

Spironolactone 25mg TAB Spiractin Sandoz Spironolactone Accepted treatment

Torasemide 10mg TAB Unat Torahexal Motivation required

Torasemide 2.5mg TAB Unat Torahexal Motivation required


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

Potassium supplements

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

ACE-inhibitors and combinations

Benazepril 10mg TAB Cibace Motivation required

Benazepril and diuretics TAB Cibadrex Accepted treatment

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

Captopril 12.5mg TAB Captohexal Accepted treatment

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

Captopril 50mg TAB Captohexal Mylan-captopril Zapto Accepted treatment

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

Cilazapril 5mg TAB Inhibace Motivation required

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

Enalapril 10mg TAB Alapren Ciplatec Pharmapress Accepted treatment

Enalapril 2.5mg TAB Renitec Accepted treatment



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

Fosinopril 10mg TAB Mylan-fosinopril Motivation required


Lisinopril 10mg TAB Sinopren Simayla-lisinopril Zemax Accepted treatment

Lisinopril 2.5mg TAB Austell-lisinopril Accepted treatment



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

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

Moexipril 7.5mg TAB Perdix Motivation required

Perindopril 10mg TAB Prexum Coversyl Accepted treatment

Perindopril 4mg TAB Prexum Vectoryl Cipla-perindopril Accepted treatment

Perindopril 8mg TAB Vectoryl Cipla-perindopril Accepted treatment

Perindopril and indapamide 2mg/0.625mg TAB Preterax Spec-Perindopril Plus Accepted treatment

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

Quinapril 10mg TAB Quinaspen Accumax Quinace Accepted treatment


Quinapril 40mg TAB Accupril Quinagen Motivation required


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


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

Ramipril 10mg CAP Austell-ramipril Ran-ramipril Rampil Accepted treatment

Ramipril 2.5mg TAB/CAP Austell-ramipril Ramiwin Rampil Accepted treatment

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

Ramipril and calcium channel blocker 2.5mg/2.5mg TAB Tri-plen Motivation required

Ramipril and calcium channel blocker 5mg/5mg TAB Tri-plen Forte Motivation required

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Trandolapril 0.5mg CAP Mavik Accepted treatment

Trandolapril 2mg CAP Mavik Accepted treatment

Angiotensin receptor blockers and combinations

Candesartan 16mg TAB Atacand Motivation required



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

Eprosartan 600mg TAB Teveten Motivation required

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

Irbesartan 150mg TAB Iberwin Aprovel Motivation required


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


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

Losartan 100mg TAB Zartan Cipla-losartan Accepted treatment

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

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

Telmisartan 40mg TAB Micardis Pritor Motivation required


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


Valsartan 160mg TAB Tareg Zomevek Motivation required

Valsartan 320mg TAB Diovan Motivation required



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

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

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

Valsartan and diuretic 320mg/25mg TAB Co-diovan Motivation required

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

Valsartan and amlodipine 160mg/5mg TAB Exforge Accepted treatment Valsartan and amlodipine 160mg/10mg TAB Exforge Accepted treatment

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Calcium channel blockers and combinations

Amlodipine 10mg TAB Almadin Ciplavasc Amlate Accepted treatment


Diltiazem 240mg SRT Zildem SR Accepted treatment


Diltiazem 60mg TAB Zildem Accepted treatment


Felodipine 10mg SRT Felodipine-hexal Plendil Accepted treatment

Felodipine 2.5mg SRT Plendil Accepted treatment


Isradipine 2.5mg TAB Dynacirc Motivation required

Isradipine 5mg CAP Dynacirc SRO Motivation required

Lercanidipine 10mg TAB Zanidip Motivation required


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


Nifedipine 20mg SRT Nifedalat SR Cipalat Retard Accepted treatment

Nifedipine 30mg SRT Adco-Vascard SR Fedaloc Macorel Accepted treatment

Nifedipine 60mg SRT Fedaloc Macorel Motivation required

Verapamil 240mg SRT Verahexal Calcicard Ravamil Accepted treatment

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

Verapamil 40mg TAB Vasomil Accepted treatment


Beta blockers and combinations

Acebutolol 100mg CAP Sectral Motivation required


Acebutolol 400mg TAB Butobloc Sectral Motivation required

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

Atenolol 25mg TAB Tenopress Tenormin Accepted treatment


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

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

Bisoprolol 10mg TAB Cardicor Bilocor Adco-bisocor Accepted treatment

Bisoprolol 2.5mg TAB Cardicor Accepted treatment

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

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


Metoprolol 100mg TAB Lopresor Motivation required

Nebivolol 5mg TAB Nebilet Motivation required

Propranolol 10mg TAB Indoblok Prodorol Purbloka Accepted treatment

Propranolol 160mg CAP Inderal LA Motivation required



Propranolol and thiazides 80mg/2.5mg CAP Inderetic Motivation required

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

Alpha/beta blockers

Carvedilol 12.5mg TAB Carloc Carvetrend Vediblok Accepted treatment

Carvedilol 25mg TAB Carloc Carvetrend Vediblok Accepted treatment


Vasodilators

Hydralazine 10mg TAB Hyperphen Accepted treatment

Hydralazine 25mg TAB Sandoz Hydralazine Accepted treatment

Hydralazine 50mg TAB Hyperphen Sandoz Hydralazine Accepted treatment

Cardiac glycosides

Digoxin 0.0625mg TAB Lanoxin Accepted treatment

Digoxin 0.25mg TAB Lanoxin Purgoxin Accepted treatment

Digoxin 0.05mg/ml SYR Lanoxin Paed Motivation required in adults

Organic nitrates

Isosorbide dinitrate 10mg TAB Sandoz Isosorbide dinitrate Isordil Accepted treatment

Isosorbide dinitrate 30mg TAB Sandoz Isosorbide Accepted treatment

Isosorbide dinitrate 40mg TAB Isordil Tembid Accepted treatment

Isosorbide dinitrate 5mg TAB Sandoz Isosorbide dinitrate Accepted treatment

Chronic Obstructive Pulmonary Disease

Beta agonists, short-acting

Fenoterol INH Berotec HFA Accepted treatment

Fenoterol and ipratropium bromide 50mcg/20mcg INH Duovent HFA Accepted treatment

Salbutamol 100mcg INH Venteze Asthavent Accepted treatment

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Salbutamol 2.5mg SLN Ventolin nebules Motivation required

Salbutamol 200mcg CPS Asthavent Accepted treatment

Salbutamol 200mcg CPS Ventodisks Accepted treatment

Salbutamol 400mcg CPS Ventodisks Motivation required

Terbutaline 0.5mg INH Bricanyl Motivation required

Beta agonists, long-acting

Formoterol 12mcg CPS/INH Foratec Accepted treatment

Formoterol 9mcg INH Oxis Accepted treatment

Salmeterol 25mcg INH Serevent Accepted treatment

Salmeterol 50mcg INH Serevent Accepted treatment

Anticholinergics, inhaled

Ipratropium bromide 20mcg INH Atrovent 20 HFA Accepted treatment

Ipratropium bromide 40mcg INH Ipvent Accepted treatment

Ipratropium bromide and salbutamol 20mcg/100mcg INH Combivent Accepted treatment

Tiotropium bromide 18mcg CPS Spiriva Forvent Motivation required

Corticosteroids, inhaled

Beclometasone 100mcg INH Beclate Special investigations



Budesonide 100mcg INH/CPS Inflacor Budeflam Inflammide Special investigations

Budesonide 200mcg INH/CPS Inflacor Budeflam Inflammide Special investigations

Budesonide 400mcg INH/CPS Inflacor Inflammide Novoliser Special investigations

Cyclesonide 80mcg INH Alvesco Special investigations

Cyclesonide 160mcg INH Alvesco Special investigations

Fluticasone 100mcg INH Flixotide CFC-free Special investigations



Fluticasone 500mcg INH Flixotide accuhaler Special investigations


Corticosteroids and beta agonists, long-acting

Salmeterol and fluticasone 25mcg/125mcg INH Seretide Sereflo Special investigations



Salmeterol and fluticasone 50mcg/100mcg INH Seretide Foxair Special investigations

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Xanthines

Aminophylline 100mg TAB Norstan-ted Accepted treatment

Aminophylline 200mg TAB Norstan-ted Accepted treatment

Aminophylline 225mg SRT Phyllocontin Accepted treatment

Theophylline SYR Alcophyllin Nuelin liquid Accepted treatment

Theophylline 200mg SRT Sandoz Theophylline Accepted treatment

Theophylline 250mg SRT Nuelin SA Accepted treatment

Theophylline 300mg SRT Sandoz Theophylline Accepted treatment

Theophylline 400mg SRT Uniphyl Accepted treatment

Theophylline 600mg SRT Uniphyl Accepted treatment

Theophylline combinations excl. psycholeptics SYR Solphyllin Theophen Accepted treatment

Chronic kidney failure

Diuretics




















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


























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

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























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Valsartan and amlodipine 160mg/5mg TAB Exforge Accepted treatment Valsartan and amlodipine 160mg/10mg TAB Exforge Accepted treatment Calcium channel blockers and combinations



Diltiazem 240mg SRT Zildem SR Tilazem Accepted treatment














Nifedipine 30mg SRT Adco-Vascard SR Fedaloc Accepted treatment

Nifedipine 60mg SRT Fedaloc Motivation required





17

























Alpha/beta blockers




Vasodilators


Hydralazine 25mg TAB Sandoz Hydralazine Accepted treatment

Hydralazine 50mg TAB Hyperphen Sandoz Hydralazine Accepted treatment

Erythropoietin and supplements

Alfacalcidol 0.25mg CAP One alpha Accepted treatment

Alfacalcidol 1mg CAP One alpha Accepted treatment

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Calcitriol 0.25mg CAP Rocaltrol Accepted treatment Ergocalciferol 50,000u TAB Calciferol Accepted treatment Calcium carbonate TAB Titralac Accepted treatment Erythropoietin INJ Repotin Recormon Eprex Special investigations

Methoxy polyethhylene glycol- epoetin beta INJ Mircera Special investigations& motivation

Iron in other combinations INJ Venofer Cosmofer Special investigations

Folic acid 0.5mg TAB Folic acid Accepted treatment Folic acid 5mg TAB/CAP Be-tabs folic acid Accepted treatment Folic acid and vitamin B12 CAP Folic Acid Forte Accepted treatment Phosphate binders

Sevelamer hydrochloride 800mg TAB Renagel Special investigations& motivation

Lanthanum carbonate 750mg TAB Fosrenol Special investigations& motivation

Lanthanum carbonate 500mg TAB Fosrenol Special investigations& motivation

Hormone Inhibitors

Cinacalcet 30mg TAB Sensipar Special investigations & Motivation

Cinacalcet 60mg TAB Sensipar Special investigations& Motivation

Iron supplementation subject to Qualsa’s Medicine Reimbursement Policy

Coronary Artery Disease

Aspirin






Calcium channel blockers








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Nifedipine 60mg SRT Fedaloc Accepted treatment






Beta blockers














20











Alpha/beta blockers




Organic nitrates

Glyceryl trinitrate 0.5mg TAB Angised Accepted treatment


Isosorbide dinitrate 30mg TAB Sandoz Isosorbide Accepted treatment

Isosorbide dinitrate 40mg TAB Isordil Tembid Accepted treatment


Isosorbide mononitrate 20mg TAB Elantan Accepted treatment

Isosorbide mononitrate 50mg SRC Elantan LA Accepted treatment

Isosorbide -5 -mononitrate 60mg SRT Monicor Imdur Accepted treatment

Anticoagulants




Dipyridimole 200mg SRC Persantin Motivation required

Dipyridimole 100mg TAB Plato Motivation requred

Dipyridimole 25mg TAB Plato Motivation required

Clopidogrel 75mg TAB Clopivas Mistro Pharma Dynamics Clopidogrel Motivation required

IF-Channel blockers

Ivabradine 5mg TAB Coralan Motivation required

Ivabradine 7.5mg TAB Coralan Motivation required

21


Crohn's disease

Corticosteroids, topical

Budesonide ENE Entocord Motivation required


Budesonide 3mg CAP Entocord Motivation required

Hydrocortisone 10mg TAB Covocort Motivation required

Methylprednisolone 4mg TAB Medrol Motivation required


Prednisolone 5mg TAB Lenisolone Capsoid Accepted treatment


5-ASA agents

Mesalazine 2g/50ml ENE Asacol Motivation required

Mesalazine 400mg TAB Asacol Motivation required


Mesalazine 500mg TAB/SUP Asacol Pentasa Motivation required

Mesalazine 1000mg SUP Pentasa Motivation required

Olsalazine 250mg CAP Dipentum Motivation required

Sulfasalazine 500mg TAB Salazopyrin Accepted treatment Immunosuppressants

Azathioprine 50mg TAB Zaprine Azathioprine 50 PCH Azapress Accepted treatment

Leflunomide 10mg TAB Arava Motivation required


Methotrexate 2.5mg TAB Methotrexate Emthexate Accepted treatment

Biologicals will be reimbursed subject to Qualsa’s Medicine Policy and special investigations.

Supplements

Folic acid 0.5mg TAB Folic acid Accepted treatment Folic acid 5mg TAB/CAP Be-tabs folic acid Accepted treatment Folic acid and vitamin B12 CAP Folic Acid Forte Accepted treatment Diabetes insipidus

Vasopressin analogues

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

Desmopressin 0.1mg TAB DDAVP Motivation required

Desmopressin 0.2mg TAB DDAVP Motivation required

22


Diabetes mellitus, type 1

Insulin

Insulin (human) INJ Humulin Actraphane Protaphane Accepted treatment

Insulin aspart INJ Novorapid Novomix Accepted treatment

Insulin detemir INJ Levemir Accepted treatment

Insulin glargine INJ Lantus Accepted treatment

Insulin glulisine INJ Apidra Accepted treatment

Insulin lispro INJ Humalog Humalog Mix Accepted treatment

Diabetes mellitus, type 2

Suphonylureas

Glibenclamide 5mg TAB Sandoz Glibenclamide Diacare Glycomin Accepted treatment

Gliclazide 30mg TAB Diaran MR Diamicron MR Motivation required

Gliclazide 40mg TAB Austell-gliclazide Accepted treatment

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

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

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

Glimepiride 3mg TAB Amaryl Aspen-Glimepiride Motivation required

Glimepiride 4mg TAB Sulphonur Mylan-Glimepiride Sandoz Glimepiride Motivation required

Glipizide 5mg TAB Minidiab Motivation required

Insulin

Insulin (human) INJ Humulin Actraphane Protaphane Accepted treatment

Insulin aspart INJ Novorapid Novomix Accepted treatment

Insulin detemir INJ Levemir Accepted treatment Insulin glargine INJ Lantus Accepted treatment Insulin glulisine INJ Apidra Accepted treatment

Insulin lispro INJ Humalog Humalog Mix Accepted treatment

Biguanides and combinations

Metformin 1000mg TAB Glucophage Bigsens Metored Accepted treatment

Metformin 500mg TAB Austell-metformin Bigsens Forminal Accepted treatment

Metformin 850mg TAB Austell-metformin Bigsens Forminal Accepted treatment

Metformin 500mg XR TAB Glucophage XR Accepted treatment

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

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

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

23


Thiazolidinediones

Pioglitazone 15mg TAB Cipla-pioglitazine Actos Motivation required

Pioglitazone 30mg TAB Cipla-pioglitazine Actos Motivation required

Rosiglitazone 2mg TAB Avandia Motivation required

Rosiglitazone 4mg TAB Avandia Motivation required

Other

Acarbose 50mg TAB Glucobay Motivation required

Acarbose 100mg TAB Glucobay Motivation required

Nateglinide 120mg TAB Starlix Motivation required

Repaglinide 0.5mg TAB Novonorm Motivation required

Repaglinide 1mg TAB Novonorm Motivation required

Repaglinide 2mg TAB Novonorm Motivation required

Dysrhythmias

Aspirin






Anticoagulants




Calcium channel blockers






Beta blockers




24



Atenolol 25mg TAB Tenopress Accepted treatment










Sotalol 160mg TAB Sotahexal Motivation required


Cardiac glycosides

Digoxin 0.05mg/ml SYR Lanoxin Paed Accepted treatment in children



Anti-arrhythmics

Amiodarone 100mg TAB Arycor Hexarone Cordarone X Accepted treatment

Amiodarone 200mg TAB Arycor Hexarone Bio-Amiodarone Accepted treatment

Disopyramide 100mg CAP Rythmodan Motivation required

Disopyramide 250mg TAB Rythmodan Motivation required

Flecainide 100mg TAB Tambocor Motivation required

Propafenone 150mg TAB Rythmol Motivation required


Quinidine sulphate 200mg TAB Quinidine Motivation required

Epilepsy

Anticonvulsants

Carbamazepine 100mg/5ml SUS Tegretol S Accepted treatment



Ethosuxamide 250mg/5ml SYR Zarontin Accepted treatment

Felbamate 400mg TAB Taloxa Motivation required

Felbamate 600mg/5ml SUS Taloxa Motivation required

25


Gabapentin 100mg CAP Neurexal Epleptin Ran-gabapentin Motivation required



Gabapentin 600mg TAB Neurontin Motivation required

Gabapentin 800mg TAB Neurontin Motivation required


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



Levetiracetam 250mg TAB Keppra Redilev Motivation required

Levetiracetam 500mg TAB Redilev Motivation required

Levetiracetam 750mg TAB Keppra Redilev Motivation required

Oxcarbazepine 300mg TAB Trileptal Motivation required Oxcarbazepine 600mg TAB Trileptal Motivation required Phenobarbital 30mg TAB Sedabarb Lethyl Accepted treatment

Phenobarbital SYR Adco-phenobarb vital Accepted treatment

Phenytoin 100mg TAB/CAP Phenytoin sod Epanutin Accepted treatment

Phenytoin 125mg/5ml SUS Epanutin Accepted treatment

Phenytoin 250mg/5ml SUS Epanutin Accepted treatment in children





Topiramate 15mg CAP Topamax SC sprinkle Motivation required



Valproic acid 100mg TAB Epilim Accepted treatment

Valproic acid 150mg CAP/SRT Convulex Accepted treatment

Valproic acid 200mg SRT Epilim Accepted treatment

Valproic acid 200mg/5ml SYR Epilim Accepted treatment



Valproic acid 50mg/ml SYR Convulex Accepted treatment

Vigabatrin 500mg TAB Sabril Motivation required

26


Benzodiazepine derivatives

Clonazepam 0.5mg TAB Rivotril Motivation required

Clonazepam 2.5mg DRP Rivotril Motivation required

Clonazepam 2mg TAB Rivotril Motivation required

Glaucoma

Beta blockers

Betoxalol 0.25% OPD Betoptic S 5ml Accepted treatment

Betoxalol 5mg/ml OPD Betoptic 5ml Accepted treatment

Carteolol 2% OPD Teoptic 5ml Accepted treatment

Levobunolol 5% OPD Betagan 7.5ml Accepted treatment

Metapranolol 3% OPD Beta-opthiole 5ml Accepted treatment

Metapranolol 6% OPD Beta-opthiole 5ml Accepted treatment

Timolol 1mg/g OPD Nyogel Accepted treatment

Timolol 2.5mg/ml OPD Timoptol Accepted treatment

Timolol 5mg/ml OPD Glaucosan Timoptol Accepted treatment

Parasympathomimetics

Pilocarpine 10mg/ml OPD Isopto-carpine Accepted treatment



Sympathomimetics

Brimonidine OPD Alphagan Purite Motivation required

Dipivefrine 1% OPD Propine Motivation required

Carbonic anhydrase inhibitors

Acetazolamide 250mg TAB Azomid Diamox Motivation required

Brinzolamide 1% OPD Azoptic 5ml eye suspension Motivation required

Dorzolamide 2% OPD Trusopt Motivation required

Prostaglandin analogues

Bimatoprost 0.3mg/3ml OPD Lumigan Accepted treatment Latanoprost OPD Xalatan 2.5ml Accepted treatment Travoprost 4% OPD Travatan Accepted treatment Beta blockers, combinations

Timolol and dordolamide OPD Cosopt Motivation required

Timolol and latanoprost OPD Xalacom Motivation required

27


Timolol and travoprost OPD DuoTrav Motivation required

Haemophilia

Analgesics and antipyretics

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

Paracetamol 500mg TAB Napamol Gencetamol Antalgic Accepted treatment

Antifibrinolytics

Tranexamic acid 500mg TAB Cyklokapron Tranexamic acid Medwich Special investigations

Blood coagulation factors will be reimbursed subject to Qualsa’s Medicine Policy and pathology report.

Hyperlipidaemia

Aspirin






Fibrates

Bezafibrate 200mg TAB Bezalip Special investigations

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

Fenofibrate 200mg CAP Lipanthyl Special investigations & Motivation

Gemfibrozil 600mg TAB Lopid Special investigations & Motivation

Statins

Atorvastatin 10mg TAB Aspavor Lipitor Ran-Atorvastatin Special investigations & Motivation



Atorvastatin 80mg TAB Lipitor Ran-Atorvastatin Special investigations & Motivation

Fluvastatin 20mg CAP Lescol Special investigations & Motivation

Fluvastatin 40mg CAP Lescol Special investigations & Motivation

Fluvastatin 80mg TAB Lescol Special investigations & Motivation

Lovastatin 20mg TAB Lovachol Special investigations

Lovastatin 40mg TAB Lovachol Special investigations

Pravastatin 10mg TAB Sandoz Pravastatin Aspen-pravastatin Pranalip Special investigations & Motivation

28


Pravastatin 20mg TAB Sandoz Pravastatin Aspen-pravastatin Pranalip Special investigations & Motivation

Pravastatin 40mg TAB Sandoz Pravastatin Aspen-pravastatin Colite Special investigations & Motivation

Rosuvastatin 10mg TAB Crestor Special investigations & Motivation




Simvastatin 10mg TAB Arrow-simvastatin Zocor Michol Special investigations



Simvastatin 80mg TAB Zysim Cipla-simvastatin Michol Special investigations

Statins, combinations

Atorvastatin and amlodipine 10mg/5mg TAB Caduet Special investigations & Motivation








Other

Colestyramine SAC Questran Lite Special investigations & Motivation

Ezetimibe 10mg TAB Ezetrol Special investigations & Motivation

Ezetimibe/simvastatin 10/10mg TAB Inegy Special investigations & Motivation



Probucol 250mg TAB Lurselle Special investigations & Motivation

Hypertension

Aspirin

29







Diuretics




























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

30




































31




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































Valsartan and amlodipine 160mg/5mg TAB Exforge Accepted treatment

32


Valsartan and amlodipine 160mg/10mg TAB Exforge Accepted treatment Calcium channel blockers and combinations

















Nifedipine 30mg SRT Adco-Vascard SR Fedaloc Macorel Accepted treatment

Nifedipine 60mg SRT Fedaloc Macorel Motivation required















33















Alpha/beta blockers




Alpha blockers

Doxazosin 1mg TAB Adco-doxazosin Cardugen Accepted treatment

Doxazosin 2mg TAB Adco-doxazosin Accepted treatment

Doxazosin 4mg TAB Adco-doxazosin Cardugen Accepted treatment

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

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

Prazosin 1mg TAB Pratsiol Accepted treatment



Terazosin 1mg TAB Hytrin Motivation required




Vasodilators


Hydralazine 25mg TAB Sandoz Hydralazine Accepted treatment Hydralazine 50mg TAB Hyperphen Sandoz Hydralazine Accepted treatment

34


Minoxidil 10mg TAB Loniten Motivation required

Minoxidil 5mg TAB Loniten Motivation required

Antiadrenegic agents, centrally acting

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

Methyldopa 500mg TAB Hypotone Accepted treatment

Moxonidine 0.2mg TAB Moxotens Cynt Physiotens Motivation required

Moxonidine 0.3mg TAB Moxotens Physiotens Motivation required

Moxonidine 0.4mg TAB Moxotens Cynt Physiotens Motivation required

Reserpine 0.25mg TAB Reserpine Accepted treatment

Reserpine and diuretics TAB Brinerdin Motivation required

Hypothyroidism

Thyroid hormones

Levothyroxine 100mcg TAB Eltroxin Euthyrox Accepted treatment


Levothyroxine 25mcg TAB Euthyrox Accepted treatment

Liothyronine 20mcg TAB Tertroxin Accepted treatment

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

Multiple sclerosis


Amitriptyline 10mg TAB Trepiline Accepted treatment


Clomipramine 10mg TAB Equinorm Motivation required

Clomipramine 25mg TAB Equinorm Motivation required

Imipramine 10mg TAB Ethipramine Accepted treatment


Anticonvulsants



Carbamazepine 100mg/5ml SUS Tegretol S Motivation required in adults

Immunosuppressants


Cyclophosphamide 50mg TAB Endoxan Motivation required


Muscle relaxants

35


Baclofen 10mg TAB Bio-baclofen Accepted treatment

Baclofen 25mg TAB Lioresal Motivation required

Orphenadrine 100mg TAB Norflex Accepted treatment





Anticholinergics, oral

Darifenacin 7.5mg TAB Enablex Motivation required

Darifenacin 15mg TAB Enablex Motivation required

Oxybutynin 5mg TAB Lenditro Mylan-oxybutynin Urihexal Accepted treatment

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

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

Propiverine 15mg TAB Detrunorm Motivation required

Solifenacin 5mg TAB Vesicare Motivation required

Solifenacin 10mg TAB Vesicare Motivation required

Tolterodine 2mg CAP Detrusitol SR Motivation required

Tolterodine 4mg CAP Detrusitol SR Motivation required

Trospium 20mg TAB Uricon Motivation required

Supplements

Folic acid 0.5mg TAB Folic acid Accepted treatment+ Folic acid 5mg TAB/CAP Be-tabs folic acid Accepted treatment+ Folic acid and vitamin B12 CAP Folic Acid Forte Accepted treatment+ Inteferons will be reimbursed for Relapsing-Remitting Multiple Sclerosis (RRMS) subject to Qualsa’s Medicine Policy and EDSS score.

Parkinson's disease

Dopa and dopa derivatives, combinations

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

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

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

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

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

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

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

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

36


Anticholinergics, oral

Biperiden 2mg TAB Akineton Accepted treatment

Orphenadrine 50mg TAB Disipal Accepted treatment


Trihexyphenidyl 2mg TAB Benzhexol Accepted treatment

Adamantine derivatives

Amantadine 100mg CAP Symadin Symmetrel Accepted treatment

Dopamine agonists

Bromocriptine 2.5mg TAB Aspen-Bromocriptine Parlodel Motivation required

Pramipexole 0.125mg TAB Pexola Motivation required

Pramipexole 0.5mg TAB Pexola Motivation required

Pramipexole 1mg TAB Pexola Motivation required

Ropinirole 0.25mg TAB Requip Motivation required

Ropinirole 0.5mg TAB Requip Motivation required

Ropinirole 1mg TAB Requip Motivation required

Ropinirole 2mg TAB Requip Requip XL Motivation required

Ropinirole 4mg TAB Requip XL Motivation required

Ropinirole 5mg TAB Requip Motivation required

Ropinirole 8mg TAB Requip XL Motivation required

Monoamine oxidase type B inhibitors

Selegiline 5mg TAB Parkilyne Accepted treatment

Rasagiline 1mg TAB Azilect Motivation required

Catechol-O-methyltransferase inhibitors

Entecapone 200mg TAB Comtan Motivation required

Tolcapone 100mg TAB Tasmar Motivation required

Rheumatoid arthritis

Immunosuppressants





Sulfasalazine 500mg TAB Salazopyrin Accepted treatment

37


Other

Chloroquine 150mg TAB Daramal Accepted treatment

Chloroquine 200mg TAB/CAP Nivaquine Plasmoquine Accepted treatment



Methylprednisolone 4mg TAB Medrol Accepted treatment



Non-steroidal anti-inflammatory drugs

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

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


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

Diclofenac 100mg SRC Veltex CR Motivation required

Diclofenac and misoprostol 50mg ECT Arthrotec Motivation required

Diclofenac and misoprostol 75mg TAB Arthrotec Motivation required

Flurbiprofen 200mg CAP Froben SR Motivation required

Ibuprofen 200mg TAB Ranfen Ibunate Betaprofen Accepted treatment

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

Ibuprofen 600mg TAB Sandoz Ibuprofen Accepted treatment

Ibuprofen 800mg TAB Brufen Retard Motivation required

Indomethacin 100mg SUP Arthrexin Accepted treatment

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

Indomethacin 50mg CAP Arthrexin Accepted treatment

Ketoprofen 200mg SRT Ketoflam Accepted treatment

Lornoxicam 4mg TAB Xefo Motivation required


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

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

Meloxicam 15mg TAB Zydus-meloxicam Flexocam Loxiflam Accepted treatment

Meloxicam 7.5mg TAB Zydus-meloxicam Flexocam Loxiflam Accepted treatment

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

Naproxen 500mg TAB Napflam Accepted treatment

38


Naproxen 500mg SUP Nafasol Motivation required

Piroxicam 10mg CAP Adco-piroxicam Accepted treatment

Piroxicam 20mg CAP/DSP Xycam Roxifen Pyrocaps Accepted treatment

Analgesics and antipyretics

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

Paracetamol 500mg TAB Napamol Gencetamol Antalgic Accepted treatment

COX-2 inhibitors

Celecoxib 100mg CAP Celebrex Motivation required


Supplements

Folic acid 0.5mg TAB Folic acid Accepted treatment+ Folic acid 5mg TAB/CAP Be-tabs folic acid Accepted treatment+ Folic acid and vitamin B12 CAP Folic Acid Forte Accepted treatment+ Biologicals will be reimbursed subject to Qualsa’s Medicine Policy and special investigations in combination with methotrexate.

Schizophrenia



Clomipramine 10mg TAB Anafranil Equinorm Accepted treatment Clomipramine 25mg TAB Anafranil Clomidep Equinorm Accepted treatment Clomipramine 75mg TAB Anafranil Motivation required

Dothiepin 25mg CAP Thaden Sandoz-dothiepin Accepted treatment Dothiepin 75mg TAB Thaden Sandoz-dothiepin Accepted treatment Imipramine 25mg TAB Ethipramine Tofranil Accepted treatment






Trimipramine 25mg TAB Tydamine Motivation required

Trimipramine 50mg CAP Tydamine Motivation required





39



Escitalopram 10mg TAB Citraz Lexamil Aspen Escitalopram Motivation required

Escitalopram 20mg TAB Citraz Lexamil Zytomil Motivation required

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

Fluoxetine 40mg DSP Prohexal T Accepted treatment

Fluvoxamine 10mg TAB Faverin Fluvoxamine-hexal Luvox Motivation required

Paroxetine 20mg TAB Serrapress Austell-paroxetine Xet Motivation required

Paroxetine 30mg TAB Serrapress Austell-paroxetine Motivation required

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

Sertraline 100mg TAB Serlife Austell-sertraline Motivation required



Venlafaxine 37.5mg CAP Venlor Odiven Motivation required

Venlafaxine 50mg TAB Efexor Motivation required

Venlafaxine 75mg CAP Venlor Sandoz Venlafaxine Odiven Motivation required

Venlafaxine 150mg CAP Venlor Sandoz Venlafaxine Efegen Motivation required




Other








Sulpiride 200mg TAB Bio-sulpiride Eglonyl Accepted treatment

Sulpiride 25mg SYR Eglonyl Accepted treatment

Sulpiride 50mg CAP Espiride Eglonyl Sandoz Sulpiride Motivation required



Mood stabilisers

40




Lithium 450mg TAB Quilonum Retard Accepted treatment

Antipsychotics

Amisulpiride 200mg TAB Solian Motivation required


Ariprazole 10mg TAB Abilify Motivation required






Clozapine 100mg TAB Cloment Leponex Accepted treatment

Clozapine 25mg TAB Cloment Leponex Accepted treatment


Haloperidol 1.5mg TAB Sandoz Haloperidol Accepted treatment



Olanzepine 10mg TAB Zyprexa Motivation required

Olanzepine 2.5mg TAB Zyprexa Motivation required

Olanzepine 5mg TAB Zyprexa Motivation required

Pimozide 1mg TAB Orap Motivation required

Pimozide 4mg TAB Orap Motivation required







Risperidone 0.5mg TAB DRL-Risperidone Mylan-Risperidone Risperidone-Hexal Accepted treatment

Risperidone 1mg TAB DRL-Risperidone Mylan-Risperidone Risperidone-Hexal Accepted treatment

Risperidone 2mg TAB DRL-Risperidone Mylan-Risperidone Risperidone-Hexal Accepted treatment

Risperidone 3mg TAB DRL-Risperidone Risperidone-Hexal Perizal Accepted treatment

Risperidone 4mg TAB Aspen Risperidone Auropidone Risponz Accepted treatment

41


Risperidone 1mg/ml SLN Auropidone Risperdal Motivation required



Ziprasidone 20mg CAP Geodon Motivation required






Systemic lupus erythematosus

Immunosuppressants




Ciclosporin 25mg CAP Ciclohexal Sandimmun neoral Motivation required

Ciclosporin 100mg CAP Ciclohexal Sandimmun neoral Motivation required

Mycophenolate 250mg CAP Mycophenolate-Hexal Cellcept Motivation required

Other



Aspirin










Non-steroidal anti-inflammatory drugs and combinations

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



42


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

Diclofenac 75mg SRC Veltex CR Accepted treatment

Diclofenac and misoprostol 50mg ECT Arthrotec Motivation required

Diclofenac and misoprostol 75mg TAB Arthrotec Motivation required

Flurbiprofen 200mg CAP Froben SR Motivation required

Ibuprofen 200mg TAB Ranfen Ibunate Betaprofen Accepted treatment

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

Ibuprofen 600mg TAB Sandoz Ibuprofen Accepted treatment

Ibuprofen 800mg TAB Brufen Retard Motivation required

Indomethacin 100mg SUP Arthrexin Accepted treatment

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

Indomethacin 50mg CAP Arthrexin Accepted treatment

Ketoprofen 200mg SRT Ketoflam Accepted treatment



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

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

Meloxicam 15mg TAB Zydus-meloxicam Flexocam Loxiflam Accepted treatment

Meloxicam 7.5mg TAB Zydus-meloxicam Flexocam Loxiflam Accepted treatment

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

Naproxen 500mg TAB Napflam Accepted treatment

Naproxen 500mg SUP Nafasol Motivation required

Piroxicam 10mg CAP Adco-piroxicam Accepted treatment

Piroxicam 20mg CAP/DSP Xycam Roxifen Pyrocaps Accepted treatment

COX-2 inhibitors




Beclometasone CRE Beclate Accepted treatment

Betamethasone 0.5mg/100g CRM Betnovate Motivation required

Betamethasone 0.05% CRM/UNG Diprosone Motivation required

Clobetasol 0.05% LOT Dermovate scalp Motivation required

Clobetasol 0.5mg CRM/UNG Dovate Xenovate Motivation required

Clobetasone CRM/UNG Eumovate Accepted treatment

43


Diflucortolone 0.1% CRM/UNG Nerisone Motivation required

Diflucortolone 0.3% UNG Nerisone Forte Motivation required

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

Fluticasone 0.005% UNG Cutivate Motivation required

Fluticasone 0.05% CRM Cutivate Motivation required

Hydrocortisone 0.5mg UNG Dilucort Accepted treatment

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

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

Hydrocortisone butyrate CRM/UNG/LOT Locoid Motivation required

Methylprednisolone aceponate CRM/UNG Advantan Motivation required

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

Supplements

Folic acid 0.5mg TAB Folic acid Accepted treatment Folic acid 5mg TAB/CAP Be-tabs folic acid Accepted treatment Folic acid and vitamin B12 CAP Folic Acid Forte Accepted treatment Ulcerative colitis


Budesonide ENE Entocord Motivation required


Betamethasone 0.5mg TAB Betanoid Motivation required

Budesonide 3mg CAP Entocord Motivation required


Methylprednisolone 4mg TAB Medrol Accepted treatment




5-ASA agents

Mesalazine 2g/50ml ENE Asacol Motivation required



Mesalazine 500mg TAB/SUP Asacol Pentasa Motivation required

Mesalazine 1000mg SUP Pentasa Motivation required

Olsalazine 250mg CAP Dipentum Motivation required

Sulfasalazine 500mg TAB Salazopyrin Accepted treatment

44


Immunosuppressants



Supplements

Folic acid 0.5mg TAB Folic acid Accepted treatment Folic acid 5mg TAB/CAP Be-tabs folic acid Accepted treatment Folic acid and vitamin B12 CAP Folic Acid Forte Accepted treatment Biologicals will be reimbursed subject to Qualsa’s Medicine Policy and special investigations.

45

DIAGNOSIS AND TREATMENT PAIRS (DTP) CONDITIONS


Adrenocortical Hypersecretion

Diuretics

Hydrochlorothiazide and potassiumsparing agents TAB Urirex k Amiloretic Betaretic Accepted treatment

Spironolactone 100mg TAB Spiractin Accepted treatment


Eplerenone 25mg TAB Inspra Motivation required

Eplerenone 50mg TAB Inspra Motivation required

Adrenocortical Insufficiency

Corticosteroids Oral


Prednisone 5mg TAB Be-tabs prednisone Panafcort Accepted treatment


Fludrocortisone 0.1mg TAB Florinef acetate Motivation required

Anaemia

Iron supplementation, oral

Ferrous salts TAB / CAP Ferrous Sulphate Special investigations

Ferric oxide polymaltose complex TAB/CAP Ferrimed Special investigations

Iron and folic acid TAB / CAP Ferofolic Special investigations

Iron multivitamins and folic acid 100mg TAB Autrin Ferograd Foliferr Special investigations

Iron vitamin B12 and folic acid TAB Foliglobin Special investigations

Vitamin B

Folic acid 0.5mg TAB Folic acid Special investigations

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

Cyanocobalamin INJ Vitamin B12 Special investigations Arrhythmias Aspirin

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


46


Acetylsalicylic acid 300mg TAB Gulf aspirin Be-tabs aspirin Accepted treatment

Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment in children

Acetylsalicylic acid 81mg ECT Ecotrin Accepted treatment

Antiarrythmics

Amiodarone 100mg TAB Arycor Hexarone Cordarone x Accepted treatment

Amiodarone 200mg TAB Arycor Hexarone Cordarone x Accepted treatment

Quinidine 200mg TAB Quinadine Motivation required

Disopyramide 100mg CAP Rythmodan Motivation required

Propafenone 150mg TAB Rhythmol Motivation required

Flecainide 100mg TAB Tambocor Motivation required

Betablockers




Acebutalol 100mg TAB Sectral Motivation required

Acebutalol 200mg TAB Sectral Motivation required Acebutalol 400mg TAB Sectral Motivation required Bisoprolol 10mg TAB Cardicor Bilocor Adco-Bisocor Accepted treatment

Bisoprolol 5mg TAB Cardicor Bilocor Adco-Bisocor Accepted treatment


Metoprolol 100mg TAB Lopressor Motivation required

Propranolol 10mg TAB Indoblock Prodolol Purbloka Accepted treatment

Propronalol 40mg TAB Indoblock Prodolol Purbloka Accepted treatment

Propronalol 160mg TAB Inderal LA Motivation required Propronalol 80mg TAB Inderal LA Motivation required Sotalol 160mg TAB Sotahexal Motivation required


Cardiac Glycosides

Digoxin 0.05mg/ml SYR Lanoxin Paed Accepted treatment



47


Calcium Channel Blockers

Diltiazem 180mg SRC Zildem SR Accepted treatment







Anti-coagulants

Clopidrogel 75mg TAB Pharma Dynamics Clopidogrel Plagrol Mistro Motivation required

Dipyridamole 25mg TAB Plato Motivation required

Dipyridamole 100mg TAB Plato Motivation required Dipyridamole 200mg SRT Persantin Motivation required Warfarin 5mg TAB Cipla-Warfarin Accepted treatment

Warfarin 3mg TAB Cipla-Warfarin Accepted treatment


Benign Prostatic Hypertrophy

Alfuzosin 10mg TAB Xatral XL Motivation required

Doxazosin 1mg TAB Adco-Doxazosin Cardugen Accepted treatment

Doxazosin 2mg TAB Adco-Doxazosin Accepted treatment

Doxazosin 4mg TAB Adco-Doxazosin Cardugen Accepted treatment

Doxazosin (Extended Release) 4mg TAB Carzin XL Cardura XL Motivation required

Doxazosin (Extended Release) 8mg TAB Cardura XL Motivation required




Tamsulosin 0.4mg SRC Uromax Tamsul Flomax sr Accepted treatment

Terazosin 1mg TAB Hytrin Motivation required Terazosin 2mg TAB Hytrin Motivation required Terazosin 5mg TAB Hytrin Motivation required Terazosin 10mg TAB Hytrin Motivation required Finasteride 5mg TAB Fincar Finpro Proscar Motivation required

Dutasteride 0.5mg CAP Avodart Motivation required

48


Chronic Kidney Failure

Ace Inhibitor and Combinations


Benazepril and diuretic TAB Cibadrex Accepted treatment

Benazepril and diuretic 10mg/12.5mg TAB Cibadrex FCT Motivation required


Captopril 25mg TAB Captohexal Mylan Captopril Bio-Captopril Accepted treatment

Captopril 50mg TAB Captohexal Mylan Captopril Zapto Accepted treatment

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






Enalapril 20mg TAB Alapren Ciplatec Pharmaperss Accepted treatment

Enalaprin and diuretics 20mg/12.5mg TAB Enap Co Pharmapress Co Accepted treatment







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

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


Perindopril 4mg TAB Prexum Vectoryl Cipla-Perindopril Accepted treatment

Perindopril 8mg TAB Vectoryl Cipla-Perindopril Accepted treatment


Perindopril and diuretics 4mg/1.25mg TAB Prexum Plus Vectoryl Plus Accepted treatment


Perindopril and indapamide 4mg/1.5mg TAB Pearinda plus Prexum plus Vectoryll plus Accepted treatment


Quinapril 20mg TAB Quinaspen Accumax Quinace Accepted treatment Quinapril 40mg TAB Accupril Quinagen Motivation required

49



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


Ramipril 2.5mg TAB/CAP Austell-ramipril Ran-ramipril Rampil Accepted treatment


Ramipril 10mg TAB/CAP Austell-ramipril Ran-ramipril Rampil Accepted treatment

Ramipril and calcium channel blocker 2.5mg/2.5mg TAB Tri-plen Motivation required

Ramipril and calcium channel blocker 5mg/5mg TAB Tri-plen forte Motivation required



Angiotensin Receptor Blockers




Candesartan and diuretic 16mg/12.5mg TAB Atacand plus Motivation required



Irbesartan 150mg TAB Iberwin Motivation required Irbesartan 300mg TAB Iberwin Motivation required Irbesartan and diuretic 150mg/12.5mg TAB Co-Iberwin Coaprovel Motivation required Irbesartan and diuretic 300mg/12.5mg TAB Co-Iberwin Coaprovel Motivation required Losartan 100mg TAB Zartan Cipla-Losartan Accepted treatment

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

Losartan and diuretics 100mg/12.5mg TAB Fortzaar Accepted treatment

Losartan and diuretics 50mg/12.5mg TAB Cozaar Comp Sartoc Accepted treatment

Telmisartan 40mg TAB Micardis Pritor Motivation required Telmisartan 80mg TAB Micardis Pritor Motivation required Telmisartan and diuretic 40mg/12.5mg TAB Co-micardis Co-Pritor Motivation required Telmisartan and diuretic 80mg/12.5mg TAB Co-micardis Co-Pritor Motivation required Valsartan 320mg TAB Diovan Motivation required

Valsartan 160mg TAB Tareg Zomevak Motivation required

Valsartan 80mg TAB Tareg Zomevak Motivation required


Valsartan and diuretics 320mg/50mg TAB Co-diovan Co-Zomevak Co-Microben Motivation required

50


Valsartan and diuretics 160mg/25mg TAB Co-diovan Plus Co-Zomevak Co-Microben Motivation required

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

Valsartan and diuretics 80mg/12.5mg TAB Co-tareg Co-Zomevak Co-Microben Motivation required Valsartan and amlodipine 160mg/5mg TAB Exforge Accepted treatment Valsartan and amlodipine 160mg/10mg TAB Exforge Accepted treatment

Beta Blockers and Combinations






Atenolol and thiazides 100mg/25mg TAB Adco-loten Accepted treatment

Acebutalol 100mg TAB Sectral Motivation required

Acebutalol 200mg TAB Sectral Motivation required Acebutalol 400mg TAB Sectral Motivation required Bisoprolol 10mg TAB Cardicor Bilocor Adco-bisocor Accepted treatment




Bisoprolol and diuretic 5mg/6.25mg TAB Ziak Accepted treatment Bisoprolol and diuretic 2.5mg/6.25mg TAB Ziak Accepted treatment Metoprolol 100mg TAB Lopressor Motivation required


Propranolol 10mg TAB Indoblock Prodorol Purbloka Accepted treatment





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

Alpha/beta blockers

Carvedilol 12.5mg TAB Carloc Carvetrend Vediblock Accepted treatment

Carvedilol 25mg TAB Carloc Carvetrend Vediblock Accepted treatment Carvedilol 6.25mg TAB Carloc Carvetrend Vediblock Accepted treatment

51


Vasodilators

Hydralazine 10mg TAB Hyperphen Accepted treatment Hydralazine 25mg TAB Sandoz Hydralazine Accepted treatment Hydralazine 50mg TAB Hyperphen Sandoz Hydralazine Accepted treatment Calcium Channel Blockers











Isradipine 5mg CAP Dynacirc SRC Motivation required

Lercandipine 10mg TAB Zanidip Motivation required

Lercandipine 20mg TAB Zanidip Motivation required

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

Lercandipine and enalapril 10mg/20mg TAB Zaneril Motivation required

Nifedipine 60mg TAB Fedaloc Accepted treatment



Nifedipine 20mg SRT Nifedalat SR Cipalat retard Accepted treatment

Verapamil TAB Vasomil Accepted treatment

Diuretics





Hydrochlorothiazide and potassium 50mg/300mg TAB Urirek-k Accepted treatment

Hydrochlorothiazide and potassium-sparing agents 25mg/2.5mg TAB Amiloretic hs Moduretic HS Accepted treatment

Hydrochlorothiazide and potassium-sparing agents 50mg/25mg TAB Dyazide Accepted treatment

Hydrochlorothiazide and potassium-sparing agents 50mg/5mg TAB Amiloretic Betaretic Spec-Co-Amiloride Accepted treatment

52





Furosemide 40mg TAB/CAP Diuresix Mylan-Furosemide Accepted treatment




Furosemide 10mg/ml SYR Lasix Oral Motivation required in adults









Erythropoetin and Supplements

Alfacalcidol 0.25mcg TAB One Alpha Special investigation

Alfacalcidol 1mcg TAB One Alpha Special investigation

Ferrous fumarate TAB Pregamal Special investigation

Ferrous sulfate 30mg TAB Ferrous sulfate Special investigation


Ferric oxide polymaltose complex TAB/CAP Ferrimed Special investigations

Folic acid 0.5mg TAB Folic acid Special investigation

Folic acid 5mg TAB Be-tabs folic acid Special investigation

Iron and multivitamins TAB Ferograd Special investigation

Iron multivitamins and folic acid TAB Foliferr Autrin Special investigation

Erythropoetin INJ Repotin Recormon Eprex Special investigation

Dextraferron INJ Cosmofer Special investigation and motivation

Darbepoetin alpha INJ Aranesp Special investigation and motivation

Iron vitamin B12 and folic acid TAB Foliglobin Special investigations

Iron in other combinations INJ Ferofolic Special investigation

Calcium carbonate 300mg CHU Caltrate 300 Special investigation

53


Calcium carbonate 500mg CHU Virtual care Calcium Special investigation

Calcium carbonate 500mg EFT Sandoz Calcium Forte Fizzical Special investigation

Calcium carbonate 500mg TAB Caltrate d Special investigation

Potassium Supplement

Potassium chloride 600mg TAB Plenish-K Accepted treatment

Hormone inhibitors

Cinacalcet 30mg TAB Senispar Motivation required

Cinacalcet 60mg TAB Senispar Motivation required

Complications of Hypertension

Calcium Channel Blockers








Isradipine 5mg CAP Dynacirc sro Motivation required




Felodipine 10mg SRT Felodipine -hexal Accepted treatment





Cardiac Glycosides




Diuretics

Bumetanide TAB Burinex Motivation required

54


Hydrochlorothiazide and potassium-sparing agents TAB Aldazide Accepted treatment

Furosemide 40mg TAB/CAP Diuresix Mylan-furosemide Beuresis Accepted treatment




Spironolactone 100mg TAB Spiractin Accepted treatment

Torasemide 2.5mg TAB Torahexal Motivation required Torasemide 5mg TAB Torahexal Motivation required Torasemide 10mg TAB Torahexal Motivation required Piretanide 3mg TAB Arelix Motivation required


Anticoagulants


Dypiridamole 100mg TAB Plato Accepted treatment

Dypiridamole 200mg SRC Persantin retard Accepted treatment

Dypiridamole 200mg/25mg CAP Asasantin Retard Accepted treatment


Warfarin 5mg TAB Cipla-Warfarin Lennon warfarin Accepted treatment



Vasodilators

Sildenafil 20mg TAB Revatio Motivation required

Cushing’s syndrome

Growth hormone release inhibitor

Ketoconazole 200mg TAB Ketazol Nizoral Motivation required

Octreotide 0.05mg INJ Sandostatin Motivation required



Octreotide 10mg INJ Sandostatin LAR pre-filled Motivation required

Octreotide 20mg INJ Sandostatin LAR pre-filled Motivation required

Delusional disorders


Amitriptyline 25mg TAB Trepiline Sandoz-Amitryptyline Accepted treatment

55


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

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

Imipramine 25mg TAB Ethipramine Tofranil Accepted treatment




Mianserin 10mg TAB Lantonon Motivation required

Mianserin 30mg TAB Lantonon Motivation required

Mirtazapine 15mg TAB Beron Sandoz Mirtazapine Aspen Mirtazapine Motivation required Mirtazapine 30mg TAB Beron Sandoz Mirtazapine Aspen Mirtazapine Motivation required Selective serotonin receptor inhibitors

Citalopram 10mg TAB Austell-Citalopram Accepted treatment

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

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


Escitalopram 10mg TAB Citraz Zytomil Mylan Escitalopram Motivation required Escitalopram 20mg TAB Citraz Zytomil Mylan Escitalopram Motivation required Fluoxetine 20mg CAP / TAB A-lennon fluoxetine Zydus Fluoxetine Ranflocs Accepted treatment

Fluoxetine 40mg DSP Prohexal T Motivation required

Paroxetine 20mg TAB Austell Paroxetine Serrapress Xet Motivation required Paroxetine 30mg TAB Austell Paroxetine Serrapress Motivation required Sertraline 50mg TAB Austell Sertraline Sertzol Serdep Motivation required

Sertraline 100mg TAB Austell Sertraline Serlife Sertzol Motivation required

Serotonin and noadrenalin reuptake inhibitors

Duloxetine 30mg CAP Cymgen Motivation required


Venlafaxine 37.5mg CAP Venlor XR Motivation required Venlafaxine 75mg CAP Illovex SR Efegen XR Sandoz Venlafaxine XL Motivation required Venlafaxine 150mg CAP Illovex SR Efegen XR Sandoz Venlafaxine XL Motivation required Monoamine oxidase inhibitor



Other antidepressants

Edronax 4mg TAB Edronax Motivation required

56


Sulpiride 200mg TAB Bio-Sulpiride Motivation required

Sulpiride 25mg SYR Eglonyl Motivation required

Sulpiride 50mg CAP Espiride Accepted treatment

Bupropion 150mg SRT Wellbutrin XL Motivation required

Bupropion 300mg SRT Wellbutrin XL Motivation required

Trazodone 50mg CAP Aspen Trazodone Molipaxin Motivation required

Trazodone 100mg CAP Aspen Trazodone Molipaxin Motivation required

Antipsychotics



Aripiprazole 5mg TAB Abilify Motivation required

Aripiprazole 10mg TAB Abilify Motivation required Aripiprazole 15mg TAB Abilify Motivation required Chlorpromazine 100mg TAB Largactil Accepted treatment



Clozapine 100mg TAB Cloment Accepted treatment






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

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


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

Risperidone 4mg TAB Aspen Risperidone Risponz Motivation required



Zuclopenthixole 10mg TAB Clopixal Motivation required

Zuclopenthixole 2mg TAB Clopixal Motivation required

Endometriosis

Hormonal preparations, oral

Cyproterone and estrogen 2mg TAB Diva -35 Ginette Minerva Motivation required

57


Cyproterone acetate 50mg TAB Cipla-Cyproterone Acetate Cyproplex Androcur Motivation required

Desogestrel and estrogen TAB Mercilon Marvelon Motivation required

Drospirenone and estrogen TAB Yasmin Yaz Motivation required

Gestodene and estrogen TAB Minulette Melodene Femodene ed Motivation required

Levonorgestrel and estrogen TAB Biphasil Triphasil Motivation required

Medroxyprogesterone 5mg TAB Hexal-PMA Provera Accepted treatment

Norethisterone 5mg TAB Primulot n Accepted treatment

Norethisterone and estrogen TAB Trinovum Motivation required

Norgestimate & oestrogen TAB Tricilest Motivation required

Antigonadotropins

Danazol 100mg CAP Danogen Ladazol Motivation required

Danazol 200mg CAP Danogen Ladazol Motivation required Gonadotrophin Releasing Hormones and analogues

Goserelin 3.6mg INJ Zoladex Motivation required

Nafarelin 2 mg/mL NAS Synarel Motivation required

Leuprorelin 11.25mg INJ Lucrin Depot Motivation required

Hyperparathyroidism

Aminoquinolines



Calcitonin

Calcitonin 200iu NAS Miacalcic nasal spray Motivation required

Calcitonin 100iu INJ Miacalcic Motivation required

Hormone inhibitors

Cinacalcet 30mg TAB Sensipar Motivation required

Cinacalcet 60mg TAB Sensipar Motivation required

Hyperthyroidism

Imidazole derivatives

Carbimazole 5mg TAB Neo-mercazole Motivation required

Beta blockers



58


Hypoparathyroidism

Calcium supplementation

Calcium TAB/EFT B-cal Accepted treatment

Calcium and vitamin D TAB B-cal d Caltrate d Accepted treatment

Idiopathic thrombocytopaenic purpura

Corticosteroids –Oral

Betamethasone 0.5mg TAB Betanoid Celestone Motivation required


Prednisone 5mg TAB Be-tabs prednisone Panafcort Accepted treatment

Prednisone 20mg TAB Pulmison Accepted treatment

Alkylating agents


Immunosuppressive agents


Methotrexate 2.5mg TAB Methotrexate Accepted treatment

Ischaemic Heart Disease

Aspirin

Acetylsalicylic acid 100mg TAB Bayer Aspirin Cardio Disprin CV Myoprin Accepted treatment

Acetylsalicylic acid 125mg TAB Lo-Aspirin Accepted treatment

Acetylsalicylic acid 300mg TAB Gulf Aspirin Be-Tabs Aspirin Aspirin (Resmed) Accepted treatment in children

Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment


Anticoagulants

Warfarin 5mg TAB Cipla-Warfarin Lennon Warfarin Accepted treatment




Dypiridamole 200mg SRC Persantin Accepted treatment



Menopause

Hormone replacement therapy

Conjugated estrogen TAB Premarin Accepted treatment

Cyproterone and estrogen TAB Claro 35 Diva 35 Accepted treatment

59


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

Dydrogesterone and estrogen TAB Femoston conti Accepted treatment

Dydrogesterone 10mg TAB Duphaston Accepted treatment

Dydrogesterone CRM Progesterone cream Motivation required

Estradiol PAD/TAB/IMP Evorel Accepted treatment

Estradiol CRM Vagifem Motivation required

Estradiol combinations TAB Menoflush Accepted treatment

Estriol 2mg TAB Synapause e3 Accepted treatment

Estriol CRM Synapause Vag Motivation required

Estrone 0.0625mg TAB Ortho est Accepted treatment

Medrogestone and estrogen TAB Premelle Accepted treatment

Medroxyprogesterone TAB Hexal PMA Provera Accepted treatment

Norethisterone and estrogen PAD/TAB Trinovum Accepted treatment

Norgestimate and estrogen TAB Cilest Accepted treatment

Norgestral and estrogen TAB Tricilest Accepted treatment

Progesterone 100mg CAP Utrogestan Accepted treatment

Tibolone 2.5mg TAB Livifem Motivation required

Alpha-2 agonists

Clonidine 0.025mg TAB Dixarit Menograine Accepted treatment Mycobacterial Infections (Excluding TB)

Pulmonary Disease & Others

Isoniazid 100mg TAB Be-tabs Isoniazid Special Investigations

Pyrazinamide 500mg TAB Sandoz Pyrazinamide Special Investigations

Rifampicin 100mg/5ml SUS R-Cin rifampicin Special Investigations

Rifampicin 600mg TAB Rimactane Special Investigations

Rifampicin & isoniazid 150/75mg TAB Rimactazid Special investigations


Rifampicin & isoniazid 60/30mg TAB Rimactazid Paed Special investigations

Rifampicin, isoniazid & pyrazinamide 60/30/150mg TAB Rimcure Paed 3 FDC Special investigations

Rifampicin, isoniazid, pyrazinamide & ethambutol 150/75/400/275mg TAB Rifafour E- 275 Rimstar 4 -FDC Special investigations

Ethambutol 400mg TAB Sandoz Ethambutol Special Investigations

Clarithromycin 250mg TAB Clacee Special Investigations

Clarithromycin 500mg TAB Clacee Clarihexal Special Investigations

Clarithromycin 250mg/5ml SUS Clarihexal Ran-Clarithromycin Special Investigations

60


Clarithromycin 125mg/5ml SUS Clarihexal Ran-Clarithromycin Special Investigations

Tetracycline 250mg TABS/CAPS Be-oxytet Oxypan Special Investigations

Neonatal Cardiac Dysrhythmia

Antiarrhythmics

Amiodarone 100mg TAB Arycor Cordarone X Motivation required

Amiodarone 150mg/3ml INJ Cordarone X Motivation required

Quinidine 200mg TAB Quinidine Sulphate Motivation required

Disopyramide 100mg CAP Rhythmodan Motivation required


Flecainide 100mg TAB Rythmol Motivation required





Cardiac Glycosides

Digoxin 0.05mg/ml SYR Lanoxin Paed Accepted treatment Neonatal Cardiac Failure Cardiac Glycosides


Diuretics

Furosemide 10mg/ml SYR Lasix Oral Accepted treatment Nephritic Syndrome Calcium Channel Blockers







Felodipine 10mg SRT Felodipine-hexal Accepted treatment

Felodipine 5mg SRT Felodipine-hexal Accepted treatment



Lercanidipine 10mg TAB Zanidip Motivation required Lercanidipine 20mg TAB Zanidip Motivation required

61


Nifedipine 60mg SRT Fedaloc Motivation required



Diuretics

Bumetanide 1mg TAB Burinex k Motivation required





Hydrochlorothiazide and potassium-sparing agents 25mg/2.5mg TAB Amiloretic hs Accepted treatment

Hydrochlorothiazide and potassium-sparing agents 50mg/25mg TAB Dyazide Accepted treatment

Hydrochlorothiazide and potassium-sparing agents 50mg/5mg TAB Amiloretic Accepted treatment

Indapamide 2.5mg TAB Cipla-Indapamide Daptril Accepted treatment

Furosemide 40mg TAB/CAP Diuresix Mylan-Furosemide Beuresis Accepted treatment









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

Beta Blocker and Combinations

Acebutolol 100mg TAB Sectral Motivation required

Acebutolol 200mg TAB Sectral Motivation required

Acebutolol 400mg TAB Butoblok Sectral Motivation required




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

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

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


62




Metoprolol 100mg TAB Lopressor Motivation required





Propranolol and thiazide 80mg/2.5mg CAP Inderetic Motivation required


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

Ace Inhibitor And Combinations

Benzepril 10mg TAB Cibace Motivation required

Benzepril 10mg/12.5mg TAB Cibadrex Motivation required


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


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


Cilazapril and diuretic 5mg/12.5mg TAB Inhibace plus Motivation required





Enalaprin and diuretics 20mg/12.5mg TAB Enap-Co Pharmapress co Accepted treatment

Enalapril and Lercadapine 10mg/10mg TAB Zaneril Motivation required

Enalapril and Lercadapine 10mg/20mg TAB Zaneril Motivation required

Fosinopril 10mg TAB Mylan fosinopril Motivation required





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

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


63


Perindopril 4mg TAB Prexum Vectoryl Cipla-Perindopril Accepted treatment


Perindopril 10mg TAB Prexum Coversyl Motivation required

Perindopril and diuretics 4mg/1.25mg TAB Prexum plus Coversyl Plus Accepted treatment

Quinapril 5mg TAB Quinagen Accupril Motivation required

Quinapril 10mg TAB Accumax Quinace Quinaspen Accepted treatment

Quinapril 20mg TAB Accumax Quinace Quinaspen Accepted treatment







Ramipril 10mg TAB/CAP Austell-ramipril Ran-ramipril Rampil Accepted treatment






Candesartan 16mg TAB Atacand Motivation required Candesartan 32mg TAB Atacand Motivation required Candesartan and diuretic 16mg/12.5mg TAB Atacand Plus Motivation required Eprosartan 600mg TAB Teveten Motivation required

Losartan 100mg TAB Zartan Cipla-Losartan Accepted treatment

Losartan 50mg TAB Lepitrin Cipla-Losartan Los-Arb Accepted treatment

Losartan and diuretics 100mg/12.5mg TAB Fortzaar Accepted treatment

Losartan and diuretics 50mg/12.5mg TAB Cozaar-comp Accepted treatment

Irbesartan 150mg TAB Iberwin Motivation required

Irbesartan 300mg TAB Iberwin Motivation required

Irbesartan and diuretic 150mg/12.5mg TAB Co-Iberwin Motivation required Irbesartan and diuretic 300mg/12.5mg TAB Co-Iberwin Motivation required Telmisartan 40mg TAB Pritor Motivation required Telmisartan 80mg TAB Pritor Motivation required Telmisartan and diuretic 40mg/12.5mg TAB Co-Pritor Motivation required

64


Telmisartan and diuretic 80mg/12.5mg TAB Co-Pritor Motivation required Valsartan 320mg TAB Diovan Motivation required

Valsartan 160mg TAB Tareg Motivation required

Valsartan 80mg TAB Tareg Motivation required



Valsartan and diuretics 320mg/25mg TAB Co-diovan Motivation required

Valsartan and diuretics 160mg/25mg TAB Co-diovan plus Motivation required


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

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

Valsartan and amlodipine 160mg/10mg TAB Exforge Motivation required

Potassium Supplements

Potassium chloride 600mg TAB Plenish-k Accepted treatment

Erythropoetin and Supplements

Alfacalcidol 0.25mcg TAB One Alpha Special investigation

Alfacalcidol 1mcg TAB One Alpha Special investigation

Ferrous fumarate TAB Pregamal Special investigation



Ferric oxide and polymaltose complex TAB Ferrimed Special investigation

Folic acid 0.5mg TAB Folic acid Special investigation

Folic acid 5mg TAB Be-tabs folic acid Special investigation

Iron multivitamins and folic acid 100mg TAB Autrin Ferograd Foliferr Special investigation

Erythropoetin INJ Repotin Recormon Eprex Special investigation

Dextriferron 50mg/ml INJ Cosmofer Special investigation

Methoxy polyethylene glycol-epoetin beta INJ Mircera Special investigation

Darbepoetin INJ Aranesp Special investigation

Iron in other combinations INJ Ferofolic Special investigation

Calcium carbonate 300mg CHU Caltrate 300 Special investigation

Calcium carbonate 500mg CHU Virtual care Calcium Special investigation

Calcium carbonate 500mg EFT Sandoz Calcium Forte Fizzical Special investigation

Calcium carbonate 500mg TAB Caltrate d Special investigation

65


Hormone inhibitors

Cinacalcet 30mg TAB Senispar Specail investigations*

Cinacalcet 60mg TAB Senispar Specail investigations* Nephrogenic Diabetes Insipidus Thiazide diuretic



Neurological abnormalities of the newborn - Spasticity

Muscle relaxants

Baclofen 10mg TAB Bio-baclofen Teva-baclofen Lioresal Accepted treatment

Dantrolene 20mg/70ml INJ Dantrium Motivation required Diabetes Mellitus – Complications Neurological

Tricyclic antidepressants

Amitryptiline 10mg TAB Trepiline Accepted treatment

Amitryptiline 25mg TAB Trepiline Sandoz Amitriptyline Accepted treatment

Anti-convulsants

Carbamazepine 200mg TAB Degranol CPL-carbamazepine Accepted treatment

Phenytoin 100mg TAB Epanutin Accepted treatment

Other

Gabapentin 100mg CAP Ran Gabapentin Neurexal Epleptin Accepted treatment

Gabapentin 300mg CAP Ran Gabapentin Neurexal Epleptin Accepted treatment Gabapentin 400mg CAP Ran Gabapentin Neurexal Epleptin Accepted treatment Ovarian dysfunction Hormonal preparations, oral Cyproterone 2mg TAB Diva -35 Ginette Minerva Motivation required

Cyproterone 50mg TAB Cipla-Cyproterone Acetate Cyproplex Androcur Motivation required

Desogestrel and estrogen TAB Mercilon Marvelon Motivation required

Drospirenone and estrogen TAB Yasmin Yaz Motivation required

Gestodene and estrogen TAB Minulette Melodene Femodene ed Motivation required

Levonorgestrel and estrogen TAB Biphasil Triphasil Motivation required

Norethisterone and estrogen TAB Trinovum Motivation required

Norgestimate & oestrogen TAB Tricilest Motivation required

66


Pemphigus and other disseminated bullous skin disease

Immuosuppressants

Azathioprine 50mg TAB Zaprine Azapress Azathioprine 50 PCH Accepted treatment

Methotrexate 2.5mg TAB Methotrexate Accepted treatment

Ciclosporin 25mg CAP Sandimmun neural soft gel Motivation required

Ciclosporin 100mg CAP Sandimmun neural soft gel Motivation required

Corticosteroids oral

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


Alkylating agents

Cyclophosphamide 50mg TAB Endoxan Motivation required Peptic Ulcer Disease H2-receptor antagonists

Cimetidine 200mg TAB Bio-Cimetidine Cimlok Lenamet Accepted treatment

Cimetidine 400mg TAB Bio-Cimetidine Cimlok Lenamet Accepted treatment

Ranitidine 150mg TAB Ranihexal Ranit Histak Accepted treatment

Ranitidine 300mg TAB Ranihexal Ranit Histak Accepted treatment

Ranitidine 150mg/10ml SYR Zantac Motivation required

Proton Pump Inhibitors

Omeprazole 10mg CAP Omez Altosec DRL-omeprazole Accepted treatment

Omeprazole 20mg CAP Nozer Altosec Omez Accepted treatment

Omeprazole 40mg TAB/CAP Omez Losec mups DRL-omeprazole Accepted treatment

Pantoprazole 20mg TAB Topzole Pantoloc Controloc Motivation required

Pantoprazole 40mg TAB Topzole Pantoloc Controloc Motivation required

Esomeprazole 20mg TAB Nexiam Motivation required

Esomeprazole 40mg TAB Nexiam Motivation required

Lansoprazole 15mg TAB/CAP Lansoloc Lancap Aspen Lansoprazole Motivation required

Lansoprazole 30mg TAB/CAP Lansoloc Lancap Aspen Lansoprazole Motivation required

Rabeprazole 10mg TAB Pariet Motivation required

Rabeprazole 20mg TAB Pariet Motivation required

Peripheral vascular disease

Aspirin



67


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







Anticoagulants





Pituitary hyperfunction Dopamine Agonists

Carbergoline 0.5mg TAB Dostinex Special investigations & motivation

Quinagolide 75mg TAB Norprolac Special investigations & motivation Quinagolide 150mg TAB Norprolac Special investigations & motivation Growth Hormone Release Inhibitors

Octreotide 0.05mg/ml INJ Sandostatin Special investigations Pituitary hypofunction Thyroid Hormones



Levothyroxine 25mcg TAB Euthyrox Accepted treatment

Liothyronine 20mcg TAB Tertroxin Accepted treatment

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

Growth Hormone

Humatrope 6mg INJ Isopto homotropine Motivation required

Sex Hormones

Depo- Testosterone 100mg/ml INJ Depot testosterone Motivation required

Conjugated oestrogens 0.625 mg TAB Premarin Accepted treatment

Conjugated oestrogens 0.3mg TAB Premarin Accepted treatment

Glucocorticoids,oral


68


Schizo-affective disorder



Clomipramine 25mg TAB Clomidep Equinorm Motivation required

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

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





Mianserin 10mg TAB Lantanon Motivation required Mianserin 30mg TAB Lantanon Motivation required Mirtazapine 15mg TAB Beron Mylan Mirtazapine Sandoz Mirtazaopine Motivation required

Mirtazapine 30mg TAB Beron Mylan Mirtazapine Sandoz Mirtazaopine Motivation required





Escitalopram 5mg TAB Lexamil Motivation required Escitalopram 10mg TAB Aspen Escitalopram Zytomil Citraz Motivation required Escitalopram 20mg TAB Zytomil Citraz Motivation required Fluoxetine 20mg CAP / TAB A-lennon fluoxetine Zydus-fluoxetine Ranflocs Accepted treatment

Fluoxetine 40mg DSP Prohexal T Motivation required

Fluvoxamine 100mg TAB Faverin Fluvoxamine-hexal Motivation required

Paroxetine 20mg TAB Serrapress Austell Paroxetine Xydus Paroxetine Motivation required Paroxetine 25mg TAB Aropax CR Motivation required Paroxetine 30mg TAB Serrapress Austell Paroxetine Motivation required Sertraline 50mg TAB Austell-Sertraline Zolid Sertzol Motivation required Sertraline 100mg TAB Austell-Sertraline Serlife Motivation required Serotonin and noradrenalin reuptake inhibitors



Venlafaxine 37.5mg TAB/CAP Venlor XR Motivation required

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Venlafaxine 50mg TAB Efexor Motivation required Venlafaxine 75mg TAB/CAP Ilovex SR Sandoz Venlafaxine Efegen XR Motivation required Venlafaxine 150mg TAB/CAP Efegen XR Ilovex SR Sandoz Venlafaxine Motivation required Other

Bupropion 150mg SRT Wellbutrin Motivation required Bupropion 300mg SRT Wellbutrin XL Motivation required Sulpiride 200mg TAB Bio-Sulpiride Motivation required

Sulpiride 25mg SYR Eglonyl Motivation required

Sulpiride 50mg CAP Espiride Sandoz Sulpiride Accepted treatment

Trazadone 50mg CAP Aspen Trazadone Molipaxin Motivation required

Trazadone 100mg CAP Aspen Trazadone Molipaxin Motivation required





Mood stabilisers



Lithium 450mg TAB Quinolum Retard Accepted treatment

Antipsychotics















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Olanzapine 2.5mg TAB Olexar Zyprexa Motivation required

Olanzapine 5mg TAB Olexar Zyprexa Motivation required Olanzapine 10mg TAB Olexar Zyprexa Motivation required Quetiapine 25mg TAB Seroquel Motivation required Quetiapine 50mg TAB Seroquel XR Motivation required Quetiapine 100mg TAB Seroquel Motivation required Quetiapine 200mg TAB Seroquel Motivation required Quetiapine 300mg TAB Seroquel Seroquel XR Motivation required Quetiapine 400mg TAB Seroquel XR Motivation required Risperidone 0.5mg TAB DRL-Risperidone Risperidone-Hexal Mylan-Risperidone Motivation required



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

Risperidone 4mg TAB Aspen Risperidone Risponz Motivation required



Ziprasidone 20mg CAP Geodon Motivation required Ziprasidone 40mg CAP Geodon Motivation required Ziprasidone 60mg CAP Geodon Motivation required Ziprasidone 80mg CAP Geodon Motivation required Zuclopenthixole 10mg TAB Clopixol Motivation required


Spinal cord injuries

Antipropulsives

Loperamide 2mg TAB/CAP Adco loperamide Gastron Imodium Accepted treatment

Loperamide 1mg/5ml SYR Adco loperamide Imodium Accepted treatment

Laxatives

Bisacodyl 5mg TAB Dulcolax Accepted treatment

Glycerol SYR / SUP Glycerine Accepted treatment

Ispaghula and combinations GRA / SAC Fybogel Agiolax Accepted treatment

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

Lactulose SAC Duphalac dry Laxette dry Accepted treatment

Laurisulfate including combinations ENE Microlax Accepted treatment

Osmotically acting laxatives SAC Movicol Accepted treatment

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Sterculia GRA Normacol Accepted treatment

Sterculia, combinations GRA Normacol plus Accepted treatment

Senna glycosides and combinations TAB / GRA Senokot Soflax Accepted treatment

Heterocyclic Antidepressants


Amitriptyline 25mg TAB Trepiline Sandoz-amitriptyline Accepted treatment

Muscle Relaxants

Baclofen 10mg TAB Bio-baclofen Accepted treatment

Baclofen 25mg TAB Lioresal Motivation required

Dantrolene 25mg CAP Dantrium Motivation required


Antibiotics, oral

Nalidixic acid 500mg TAB Puromylon Motivation required

Nalidixic acid SUS Winlomylin Mtoivation required

Nitrofurantoin 50mg CAP Macrodantin Accepted treatment

Nitrofurantoin 100mg CAP Macrodantin Accepted treatment

Nitrofurantoin 25mg/5ml SUS Furadantin Accepted treatment

Pipemidic Acid CAP Deblaston Motivation required

Stroke

Aspirin

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


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



Anticoagulants



Warfarin 5mg TAB Cipla-warfarin Lennon warfarin Accepted treatment


Thalassemia Supplemments

Folic acid 0.5mg TAB Folic Acid Accepted treatment

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Chelating agents

Deferasirox 125mg DSP Exjade Special investigation

Deferasirox 250mg DSP Exjade Special investigation

Deferasirox 500mg DSP Exjade Special Investigation

Deferoxamine 500mg INJ Desferal Special investigation Thromboembolic disease Aspirin










Anticoagulants



Warfarin 5mg TAB Cipla-warfarin Lennon warfarin Accepted treatment


Transient Ischaemic Attack

Aspirin






Anticoagulants




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Tuberculosis

Drugs

Ethambutol 400mg TAB Sandoz ethambutol Special investigations

Isoniazid 100mg TAB Be-tabs Isoniazid Special investigations (also prophylaxis)

Pyrazinamide 500mg TAB Sandoz Pyrazinamide

Special investigations

Rifampicin 450mg TAB Rimactane Special investigations

Rifampicin 600mg TAB Rimactane Special investigations

Rifampicin 150mg CAP Rimactane Special investigations

Rifampicin 300mg CAP Rimactane Special investigations

Rifampicin 100mg/5ml SUS R-cin Special investigations



Rifampicin & isoniazid 60/30mg TAB Rimactazid Paed Special investigations

Rifampicin, isoniazid & pyrazinamide 60/30/150mg TAB Rimcure Paed 3 FDC Special investigations

Rifampicin, isoniazid, pyrazinamide & ethambutol 150/75/400/275mg TAB Rifafour E- 275 Rimstar 4 -FDC Special investigations

Streptomycin 1g/3ml INJ Bio-strep Special investigations

Pyridoxine 25mg TAB Pyridoxine Be-tabs Pyridoxine Accepted treatment Multi Drug-Resistant TB and Extensively Drug-Resistant TB

Pyrazinamide 500mg TAB Sandoz Pyrazinamide Special investigations

Ethambutol 400mg TAB Sandoz ethambutol Special investigations

Ethionamide 250mg TAB Ethatyl Special investigations

Ofloxacin 200mg TAB Zanocin Tafloc Special investigations

Ofloxacin 400mg TAB Zanocin Tafloc Special investigations

Ciprofloxacin 250mg TAB Ciplox Special investigations

Ciprofloxacin 500mg TAB Ciplox Special investigations

Kanamycin 1g/3ml INJ Bio-kanamycin Special investigations

Amikacin 100mg INJ Amikacin-fresenius Special investigations




Terizidone 250mg CAP Terivalidin Special investigations

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Cycloserine 250mg CAP Aspen Cycloserine Special investigations

Tuberculoid Leprosy

Rifampicin 450mg TAB Rimactane Special Investigation


Rifampicin 150mg CAP Rimactane Special Investigation

Rifampicin 300mg CAP Rimactane Special Investigation


Dapsone 100mg TAB Dapsone Special Investigation

Valvular heart disease

Antibiotics

Benzylpenicillin INJ Bio-pen Accepted treatment

Phenoxymethylpenicillin 250mg TAB Betapen Pen VK Accepted treatment

Erythromycin 250mg CAP Adco-erythromycin Betamycin Accepted treatment

chronic medication comprehensive formulary effective …

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