A A Pharma Inc.Abbott Laboratories LimitedManufacturer name not currently availableAbiogen PharmaManufacturer name not currently availableAlbert Pharma Inc - " DO NOT USE "Accel Pharma Inc.Accord Healthcare Inc.Acon Laboratories IncorporatedActelion Pharmaceutiques Canada Inc.Adria Laboratories of Canada Ltd.Manufacturer name not currently availableAgouron Pharmaceuticals Canada Inc.Actavis Group PTC ehfManufacturer name not currently availableAkorn Pharmaceuticals Canada Inc. - "DO NOT USE"Manufacturer name not currently availableAltana Pharma Inc.Albert Pharma Inc. - "DO NOT USE"Alcon Canada Inc.Alexion Pharmaceuticals Inc.Allergan Inc.AllerPharma Inc.Altimed Pharmaceutical CompanyALZA CanadaAmada (Nutritional Products)Amgen Canada Inc.Manufacturer name not currently availableAPP Pharmaceuticals LLCApotex Inc.Astellas Pharma Canada Inc.Astra Pharma Inc.Astra Zeneca - "DO NOT USE"Aton Pharma Inc.Auro Pharma Inc.Auto Control MedicalAventis PharmaAventis Pasteur Limited (S8)Advanced Vision Research, Inc. (S8)Axcan Pharma Inc.Axxess Pharma Inc.Ayerst Laboratories, Division of Ayerst, McKenna & HarrisonAstraZenecaBaxter Corporation - Clintec Nutrition Division (S8)Bayer Inc., Health Care DivisionBaker Cummins IncBayer Healthcare LLC Subsidiary of Bayer CorporationBarr Laboratories Inc.Bausch & Lomb Canada Inc. - "DO NOT USE"Baxter CorporationBayer Inc., Consumer Care DivisionManufacturer name not currently availableBaker Cummins Inc. - "DO NOT USE"Manufacturer name not currently availableBD Consumer HealthcareManufacturer name not currently availableBerlex Canada Inc. - "DO NOT USE"Berlex Canada IncAxcan Pharma Inc.BiocodexBiogen Idec Canada Inc.Biomed 2002 Inc.BioMarin Pharmaceutical Inc.Biovail Pharmaceuticals CanadaDraxis Health Inc.Bristol-Myers Squibb Canada Inc. - "DO NOT USE"Bioniche Pharma (Canada) Ltd. (S8)Manufacturer name not currently availableBoehringer-Ingelheim (Canada) Ltd./LteeBoehringer - Mannheim CanadaBoots Pharmaceuticals - "DO NOT USE"Bristol Myers Squibb Canada IncB. Braun Medical Inc. (S8)Bristol-Myers Squibb Canada Inc. Nutritional Div. OttawaBausch & Lomb Canada IncBauch & Lomb Surgical Inc. (S8)Burroughs Wellcome Inc.Byk Canada Inc.Manufacturer name not currently availableCIBA VisionCanderm Pharmacal Ltd./Ltee - "DO NOT USE"Canderm Pharmacal LtdCelgeneCentocor Ortho Biotech IncCephalon Inc.Manufacturer name not currently availableCiba-Geigy Self Medication ProductsChurch and Dwight Canada Corp.Ciba Pharmaceuticals, Division of Ciba-Geigy Canada Ltd.Chilcott Laboratories-Division of Warner-Lambert Canada Inc.Clinigen Healthcare Ltd.Clark Laboratory - "DO NOT USE"Clintec (Non-Formulary) - " DO NOT USE"Cosmair Canada Inc.Manufacturer name not currently availableManufacturer name not currently availableConnaught Novo Nordisk Canada Inc. - "DO NOT USE"Cobalt Pharmaceuticals CompanyColumbia LaboratoriesPasteur Merieux Connaught CanadaClay-Park Labs Inc.Crystaal Corp.Custom Pharmaceuticals - "DO NOT USE"Cubist PharmaceuticalsChauvin Pharmaceuticals Limited (S8)Cytex Pharmaceutical Co.David Bull Laboratories - "DO NOT USE"David Bull Laboratories (Canada) Inc.DC LabsDermik Laboratories Canada Inc.Desbergers LimitedDioptic Laboratories, Division of Akorn Pharmaceuticals CanaL. P. Dey (S8)Dupont Merck Pharma (Endo Canada Division) - "DO NOT USE"Dominion PharmacalDPT Laboratories - "DO NOT USE"Dupont Merck Pharma - "DO NOT USE"Dermtek Pharmaceuticals Ltd.Manufacturer Name currently not availableDrug Trading Company Ltd. - "DO NOT USE"Duchesnay Inc.Du Pont PharmaManufacturer name not currently availableEndo Canada Division Du Pont Merck PharmaManufacturer name not currently availableElan Pharmaceuticals, Inc.Manufacturer name not currently availableEMD Serono Canada Inc.Enzon Inc. (S8)Erfa Canada Inc.Ethypharm Inc.Euro-Pharm International CanadaEvans Medical Ltd.Fabrigen Inc.Faulding Canada Inc.Ferring Inc.Manufacturer name not currently availableFisons Corporation LimitedBoots Pharmaceuticals Ltd.Fournier Pharma Inc.Merck Frosst Canada & Cie, Merck Frosst Canada & Co.Fujisawa Canada Inc.Galderma Canada IncGalderma - "DO NOT USE"Manufacturer name not currently availableManufacturer name not currently availableGenDerm Canada Inc. - "DO NOT USE"Geigy Pharmaceuticals,Division of Ciba-Geigy Canada Ltd.Genmed, A Division of Pfizer Canada Inc.Genpharm Inc.Genentech Inc. - "DO NOT USE"Genzyme - "DO NOT USE"Gilead Sciences Inc.Glaxo Canada Inc.Glenwood Laboratories Canada Ltd. - "DO NOT USE"Glades, Division of Stiefel Canada Inc. - "DO NOT USE"Glenwood Laboratories Canada LtdGlaxo Wellcome Inc.Generic Medical Partners.Manufacturer name not currently availableGraceway PharmaceuticalsGlaxoSmithKline Inc., GlaxoSmithKline Consumer Health CareGlaxoSmithKline Shire BiochemGW Pharma LimitedGenzyme Canada Inc.Les Lab Charton, Division of Herdt & Charton - "DO NOT USE"Healthcomm International Inc. (S8)Manufacturer name not currently availableHill Dermaceuticals Inc.Hollister Stier Laboratories LLCHoffmann-La Roche LimitedManufacturer name not currently availableHoechst Marion Roussel Canada Inc.Hoechst Canada Inc.,Pharmaceutical Div.(Hoechst-Roussel CanaManufacturer name not currently availableHome Diagnostics IncFrank W. Horner Inc.Hospira Healthcare Corporation.Hoechst-Roussel Canada Inc.Manufacturer name not currently availableICN Canada LimitedImmunotech Research Ltd.Immunex CorporationInterfalk Canada Inc. - "DO NOT USE"Manufacturer name not currently availableManufacturer name not currently availableIntermune Inc. (S8)Iolab Canada Inc.Manufacturer name not currently availableInsight Pharmaceuticals CorporationIpsen LimitedIvax Laboratories IncorporatedJacobus Pharmaceutical Company Inc.Johnson & Johnson IncJamieson Laboratories Ltd.Janssen Inc.Manufacturer name not currently availableChiron Canada ULC (S8)JHP Pharmaceuticals LLCJanssen-Ortho Inc.Jouveinal Inc.Jamp Pharma CorporationKabi PharmaciaKey Pharmaceuticals,Div.of Schering Canada Inc.Manufacturer name not currently availableKnoll Pharma Inc. - "DO NOT USE"Knoll Pharma Inc.Kenral Inc.,Division of The Upjohn Company of CanadaKremers-Urban (Canada) - "DO NOT USE"Manufacturer name not currently availableLaboratoire Atlas Inc.Labopharm Inc.Laboratoires Fournier S.A.Laboratoires Trianon Inc.Leda Health Innovations Inc.Lee-Adams Lab.Lederle Division-of Cyanamid Canada Inc.Leo Pharma Inc.Lifescan Canada Ltd.Eli Lilly Canada Inc.LIOH Inc.The Liposome Company Inc. (S8)Linson Pharma Inc.Luitpold Pharmaceuticals Inc.Manufacturer name not currently availablePaul Maney Labs., Division of Canapharm Ind. Inc.Marcan Pharmaceuticals Inc.Mayne Pharma (Canada) Inc.McNeil Consumer Products Co.Manufacturer name not currently availableManufacturer name not currently availableManufacturer name not currently availableManufacturer name not currently availableMeta Pharmaceuticals Inc.Medicis Canada Ltd.Medisense Canada Inc.Medican PharmaMerck Canada Inc.MeliaPharm Inc.Medical Mart Supplies - "DO NOT USE"Merrell Dow Pharmaceuticals (Canada) Inc.Medican Technologies Inc.Merz Pharmaceutical GmbhMerck Frosst Canada Ltd.Merck Frosst/Schering Pharma GPMGI Pharma Inc.Mint Pharmaceuticals Inc.Miles Canada Inc Pharmaceutical Division - "DO NOT USE"Miles Canada Inc.Diagnostic Division - "DO NOT USE"Miles Canada Inc., Pharmaceuticals DivisionMead Johnson NutritionalsManufacturer name not currently availableMead Johnson Canada3M Pharmaceuticals, Division 3M Canada Inc.MM Therapeutics Inc.Medical Mart Supplies LtdMed-O-Gen Medical Inc.Mayne Pharma (Canada) Inc. (S8)Merit Pharmaceuticals - "DO NOT USE"Marion Merrell Dow CanadaMerck Sharp & Dohme Canada, Division of Merck Frosst CanadaMylan Pharmaceuticals ULCManufacturer name not currently availableNadeau Laboratory Ltd.Manufacturer name not currently availableNephro-Tech, Inc. (S8)Nestle Clinical NutritionNext Generation Pharma Inc.Nova Biomedical Corporation.Novartis Nutrition CorporationNovo Nordisk Canada IncNovopharm Ltd.Novartis Pharma Canada Inc.Manufacturer name not currently availableNutravite Pharmaceuticals Inc.Nordic Laboratories Inc., Marion Merrell Dow (Canada) Inc.Nutricia North AmericaNu-Pharm Inc.Nycomed Canada Inc.Manufacturer name not currently availableOdan Laboratories Ltd.Organon Teknika Canada IncOrganon Sanofi-Synthelabo CanadaOrtho McNeilOmega Laboratories Ltd.OptimaPharma, a Division of Taro Pharmaceuticals Inc.OPI S.A.Orchid HealthcareOrganon Canada Ltd./LteeOrphan Medical Inc. (S8)Manufacturer name not currently availableOryx Pharmaceuticals Inc.Organon Teknika Inc. - "DO NOT USE"Ovation Pharmaceuticals Inc.Paladin Labs Inc.Patriot, A Division of Janssen Inc.Pathogenesis Canada Ltd.Pharmalab (1982) Inc. (S8)Manufacturer name not currently availableParke-Davis,Division Warner-Lambert Canada Inc.Pro Doc Laboratories - "DO NOT USE"Pendopharm Inc.Perrigo InternationalPfizer Canada Inc.Purdue PharmaPurdue Frederick Inc.Proctor & Gamble Inc.PanGeo Pharma (Canada) Inc.Proctor & Gamble Pharmaceuticals Canada, Inc.Pharmacia Canada Inc.Manufacturer name not currently availablePharmel Inc.Pharmetics (2011) Inc.Pharmaco Canada Inc. - "DO NOT USE"Pharmaco Canada IncPharmacia & UpjohnPharmascience Inc.Pharmetics Inc. (S8)Pharmavite Lab. - "DO NOT USE"Manufacturer name not currently availablePharmaceutical Partners of CanadaPro Doc LimiteePrempharm Inc.Proval Pharma Inc.Pharmavite CorporationManufacturer name not currently availableQuest Vitamins, Division of Pangeo Health Brands Inc. (S8)Ratiopharm Inc. (DO NOT USE)Ranbaxy Pharmaceuticals Canada Inc.Roberts Pharmaceutical of Canada Inc.Reed & Carnrick,Division of Block Drug Company (Canada) Ltd.Reddy-Cheminor Inc.Dr Reddy's Laboratories Inc.Rhoxalpharma Inc.Rhodiapharm Inc.Laboratoire Riva Inc.Richmond Pharmaceuticals Inc.Manufacturer name not currently availableRichmond Pharmaceuticals IncRivex Pharma Inc.Manufacturer name not currently availableManufacturer Name currently not availableRoche Diagnostics, a division of Hoffmann-La Roche LimitedRougier Pharma, Division of Ratiopharm Inc.Roberts Pharmaceutical - "DO NOT USE"Rhone-Poulenc Rorer Consumer Inc. - "DO NOT USE"Ross Laboratories-Abbott (Nutritional Products)Roussel Canada Inc.(Hoechst-Roussel Canada Inc.)C. A. Roy Limited - "DO NOT USE"Ratiopharm Inc.Rhone-Poulenc Rorer-Ethical DivisionRhone-Poulenc Rorer Consumer Inc.Sabex Inc. - "DO NOT USE"Sanis Health Inc.Sandoz Canada Inc. - "DO NOT USE"Sanofi Canada Inc.Sanofi - Synthelabo Canada Inc.Sanofi Aventis PharmaSanofi Winthrop - "DO NOT USE"Shire BioChem Inc.STIEFFEL BCD PHARMAManufacturer name not currently availableSchein PharmaceuticalSchering Canada Inc.Manufacturer name not currently availableManufacturer name not currently availableSchering-Plough Canada Inc.Shoppers Drug MartStanley Pharmaceuticals Ltd.Sandoz Canada Inc.Searle Canada Inc.Sepracor Pharmaceuticals Inc.Manufacturer name not currently availableSepta Pharmaceuticals Inc.Servier Canada Inc.Shire Human Genetic Therapies Inc.Shire Canada Inc.SHS International Ltd.Sherwood Inc.SHS North AmericaSigma-Tau Pharmaceutical Inc.Sabex 2002 IncSmithKline Beecham Consumer Healthcare.Seaford Pharmaceuticals Inc. (S8)Manufacturer name not currently availableSolvay Kingswood Inc. - "DO NOT USE"Smith Kline Beecham Pharma IncSmith & Nephew Inc.Solvay Kingswood Inc. - "DO NOT USE"Sorres Pharma Inc.Solvay Pharma Inc.Squire Pharmaceuticals Inc.Manufacturer name not currently availableSerono Canada Inc.Sterimax Inc.Sterling HealthStiefel Canada Inc.Manufacturer name not currently availableSun Pharmaceutical IncSunovion Pharmaceuticals Canada Inc.Supplements Aromatik Inc.Swiss Herbal Remedies Ltd.Syntex Inc.SynCare Pharmaceutical Inc.Takeda Pharmaceuticals North America Inc.Tanta Pharmaceutical Co.TAP PharmaceuticalsTaro Pharmaceuticals Inc.Trans Canaderm Inc.Technilab Inc.Teva Canada Innovation.Therasense Canada Inc.Teva Canada LimitedTheramed CorporationThermor Ltd.Tican Pharmaceuticals Ltd.TEVA Pharmaceutical Industries Ltd.Laboratory Trianon Inc. - "DO NOT USE"3M Pharmaceuticals/3M Canada Inc. - "DO NOT USE"TaroPharma, a Division of Taro Pharmaceuticals Inc.Manufacturer name not currently availableTremblay Harrison Inc.Trillium Health Care Products Inc.Trophic Canada Ltd.Triton Pharma Inc.UCB Canada Inc.Unimed Canada Inc.The Upjohn Company of CanadaManufacturer name not currently availableManufacturer name not currently availableUnited Therapeutics Corporation (S8)Valeo Pharma Inc.Valeant Canada Ltd.Vita Health Products Inc. (S8)ViiV Healthcare ULCVita Health Products Inc.Viva PharmaceuticalsLundbeck Canada Inc.Virco Pharmaceutical (Canada) Inc.Waymar Pharmaceuticals Inc.Manufacturer name not currently availableWampoleWarner Chilcott Canada Co.Watson Laboratories Inc.Wyeth PharmaceuticalsManufacturer name not currently availableWomen's Capital CorporationWellSpring Pharmaceutical Canada Corp.Whitehall-Robins IncManufacturer name not currently availableWinthrop LaboratoriesWarner-Lambert - "DO NOT USE"Manufacturer name not currently availableWN Pharmaceuticals Ltd.Wockhardt UK Ltd. (S8)Whitehall-Robins Inc. - "DO NOT USE"Manufacturer name not currently availableWestwood Squibb PharmaceuticalsWestcan Pharmaceuticals - "DO NOT USE"Wyeth Ltd.Xenex Laboratories Inc.Manufacturer cannot be identifiedBaxter AG (S8)Manufacturer for Gov't Pharmacy ItemsZeneca Pharma Inc.Zila Pharmaceuticals Inc.Zymcan Pharmaceuticals Inc.ANTIHISTAMINESCETIRIZINE HYDROCHLORIDE000110mgTabReactineMCL2007-12-19Apo-CetirizineAPX2007-12-19Extra Strength Allergy ReliefPEN2009-11-13000220mgTabReactineMCL2008-12-23PMS-CetirizinePMS2008-12-23DIPHENHYDRAMINE HCL000325mgCapBenadrylPDA1996-10-01000450mgCapBenadrylPDA1996-10-01KETOTIFEN00051mgTabZaditenTEV2008-11-04Novo-KetotifenNOP2008-11-04LORATADINE000610mgTabClaritinSCP2007-12-19Apo-LoratadineAPX2007-12-19PROMETHAZINE HCL00072mg/mLO/LPMS-PromethazinePMS1996-10-01PhenerganRPR1996-10-01ANTI-INFECTIVE AGENTSANTHELMINTICSMEBENDAZOLE0008100mgTab4.1800VermoxJAN4.18001996-10-01ANTIBIOTICS ANTIFUNGALSAMPHOTERICIN B0009Inj Pd-50mg Pk72.5472FungizoneBQU72.54721996-10-01FLUCONAZOLE001010mg/mLO/L1.0513Diflucan P.O.S.PFI1.05131999-04-15For the treatment of oral/esophageal candidiasis in immunocompromised patients (e.g. patients with malignancies and transplant patients) who have failed to respond to nystatin or imidazoles and when oral tablets of fluconazole cannot be tolerated. For oral candidiasis, network will limit supply to 2 weeks. For esophageal candidiasis, network will limit supply to 6 weeks.LU Authorization Period: 1 year.For the treatment of patients with disseminated candidiasis when oral tablets of fluconazole cannot be tolerated.For disseminated candidiasis, network will limit supply to 6 weeks.LU Authorization Period: 1 year.For the treatment of patients with cryptococcal meningitis when oral tablets of fluconazole cannot be tolerated.For cryptococcal meningitis (initial treatment), network will limit supply to 12 weeks.LU Authorization Period: 1 year.For the treatment of patients with vulvovaginal candidiasis when oral tablets of fluconazole cannot be tolerated.For vulvovaginal candidiasis, network will limit supply to one dose 150mg (Repeats no more than every 25 days).LU Authorization Period: 1 year.001150mgTab1.29042.5808DiflucanPFI1996-10-01Novo-FluconazoleNOP1.29042.58082003-04-16Apo-FluconazoleAPX1.29042.58081999-09-15Mylan-FluconazoleMYL1.29042.58082003-04-16PMS-FluconazolePMS1.29042.58082003-01-30Taro-FluconazoleTAR2004-12-21Co FluconazoleCOB1.29042.58082008-01-150012100mgTab2.28912.2891DiflucanPFI1996-10-01Novo-FluconazoleNOP2.28912.28912003-04-16Apo-FluconazoleAPX2.28912.28911999-09-15Mylan-FluconazoleMYL2.28912.28912003-04-16PMS-FluconazolePMS2.28912.28912003-01-30Taro-FluconazoleTAR2004-12-21Co FluconazoleCOB2.28912.28912008-01-15For the treatment of thrush in immunocompromised patients (i.e. patients with malignancies and transplant recipients) who are unresponsive to nystatin or imidazole preparations;LU Authorization Period: 1 year.For the treatment of oroesophageal candidiasis in immunocompromised patients (i.e. patients with malignancies and transplant recipients);LU Authorization Period: 1 year.For patients with disseminated candidiasis;LU Authorization Period: 1 year.For the treatment of acute cryptococcal meningitis.LU Authorization Period: 1 year.KETOCONAZOLE0013200mgTab.9393.9393A low pH is necessary for absorption. Antacids, anticholinergics/antispasmodics, H2-blockers, and omeprazole may decrease absorption. Ketoconazole is a potent inhibitor of hepatic oxidation of drugs and may cause significant elevation of blood levels of astemizole, cisapride, cyclosporine, terfenadine, theophylline and warfarin. Potentially fatal arrhythmias (torsade de pointes) can occur with the combination of ketoconazole and astemizole, cisapride or terfenadine. Insulin requirements may be reduced. Hepatotoxicity occurs in approximately 1 in 1500 patients treated with ketoconazole for onychomycosis; female gender, pre-existing disease, alcoholism and greater than 2 weeks of therapy are pre-disposing factors.NizoralJAN1996-10-01Novo-KetoconazoleNOP.9393.93932000-01-17Apo-KetoconazoleAPX.9393.93931999-09-15NYSTATIN0014100000U/mLO/L.0740.2960MycostatinBQU1996-10-01Ratio-NystatinRPH.0740.29601997-10-310015500000UTab.1680.5040MycostatinBQU1996-10-01Ratio-NystatinRPH.1680.50401997-10-31TERBINAFINE HCL0016250mgTabLamisilNOV2007-12-19Apo-TerbinafineAPX2007-12-19Novo-TerbinafineNOP2007-12-19Mylan-TerbinafineMYL2007-12-19Co TerbinafineCOB2007-12-19Sandoz TerbinafineSDZ2007-12-19PMS-TerbinafinePMS2009-09-30Auro-TerbinafineAUR2011-09-15Jamp-TerbinafineJPC2011-12-15VORICONAZOLE001750mgTab12.1300VfendPFI12.13002005-09-270018200mgTab48.5003VfendPFI48.50032005-09-27Outpatient continuation of treatment for documented invasive aspergillosis in patients who have demonstrated a clinical response to either oral or parenteral voriconazole. * The first prescription must be written by a physician based at the hospital where the patient was hospitalized. Note: Limited to 3 months of reimbursement.LU Authorization Period: 1 year.ANTIBIOTICS ERYTHROMYCINSErythromycin alone is not adequate for the treatment of H. influenzae infections. It lacks consistently reliable activity against this organism. Erythromycin is a potent inhibitor of hepatic oxidation of some drugs and may cause significant elevation of blood levels of astemizole, carbamazepine, cyclosporine, digoxin, dihydropyridines, terfenadine, theophylline and warfarin. Potentially fatal arrhythmias (torsade de pointes) can occur with the combination of erythromycin and astemizole or terfenadine.AZITHROMYCIN0019100mg/5mLO/L-15mL Pk5.9347ZithromaxPFI16.95621997-08-28PMS-AzithromycinPMS5.93472007-01-02Novo-Azithromycin PediatricNOP5.93472009-06-23Sandoz AzithromycinSDZ5.93472010-04-230020200mg/5mLO/L-15mL Pk8.4062ZithromaxPFI24.01781997-08-28PMS-AzithromycinPMS8.40622007-01-02Novo-Azithromycin PediatricNOP8.40622009-06-23Sandoz AzithromycinSDZ8.40622010-04-230021200mg/5mLO/L-22.5mL Pk12.6093ZithromaxPFI36.02672009-03-02PMS-AzithromycinPMS12.60932009-03-02Novo-Azithromycin PediatricNOP12.60932009-06-23Sandoz AzithromycinSDZ12.60932010-04-230022250mgTab1.3070ZithromaxPFI5.22811999-04-15Apo-AzithromycinAPX1.30702006-01-24Co AzithromycinCOB1.30702006-01-24PMS-AzithromycinPMS1.30702006-03-01Sandoz AzithromycinSDZ1.30702006-01-24Novo-AzithromycinNOP1.30702006-01-24Gd-AzithromycinGEM1.30702011-05-19Ratio-AzithromycinRPH1.30702006-05-19Mylan-AzithromycinMYL1.30702006-08-24Phl-AzithromycinPHE1.30702010-03-020023600mgTabZithromaxPFI1998-12-31Co AzithromycinCOB2008-06-27PMS-AzithromycinPMS2011-10-25CLARITHROMYCIN0024500mgER Tab2.51445.0288Biaxin XLABB2.51445.02882003-01-300025125mg/5mLPed Gran.28422.8420BiaxinABB.28422.84201997-08-280026250mg/5mLSusp.57125.7120BiaxinABB.57125.71202003-01-300027250mgTab.4122.8244BiaxinABB1.64873.29741996-10-01PMS-ClarithromycinPMS.4122.82442007-10-03Ratio-ClarithromycinRPH.4122.82442007-09-04Mylan-ClarithromycinMYL.4122.82442007-09-04Sandoz ClarithromycinSDZ.4122.82442008-08-28Apo-ClarithromycinAPX.4122.82442007-09-04Ran-ClarithromycinRAN.4122.82442011-08-040028500mgTabBiaxinABB2007-10-03PMS-ClarithromycinPMS2007-10-03Ratio-ClarithromycinRPH2007-10-03Mylan-ClarithromycinMYL2007-10-03Sandoz ClarithromycinSDZ2008-08-28Apo-ClarithromycinAPX2007-10-03Ran-ClarithromycinRAN2011-08-04ERYTHROMYCIN BASE0029250mgEnt Pel Cap.2293.9172ERYCPFI.2293.91721996-10-01Apo-Erythro E-CAPX1996-10-010030250mgTab.1828.7312ErythromidABB1996-10-01Apo-ErythroAPX.1828.73121996-10-01ERYTHROMYCIN ESTOLATE003150mg/mLO/L.07131.4260IlosoneLIL1996-10-01Novo-Rythro EstolateNOP.07131.42601996-10-01ERYTHROMYCIN ETHYLSUCCINATE003240mg/mLO/L.06691.0035EES-200ABB1996-10-01Novo-Rythro Ethyl SuccinateNOP.06691.00351996-10-01003380mg/mLO/L.10131.5195EES-400ABB1996-10-01Novo-Rythro Ethyl SuccinateNOP.10131.51951996-10-010034600mgTab.33631.0089EES-600ABB1996-10-01Erythro-ESAAP.33631.00891996-10-01ERYTHROMYCIN STEARATE0035250mgTab.2118.8472ErythrocinABB1996-10-01Erythro-SAAP.2118.84721996-10-010036500mgTab.54251.0850ErythrocinABB1996-10-01Erythro-SAAP.54251.08501996-10-01ANTIBIOTICS PENICILLINSAMOXICILLINThe activity of amoxicillin is essentially identical to ampicillin. However, amoxicillin is more completely absorbed and causes diarrhea less frequently than ampicillin. The only situation where amoxicillin should not be used to replace oral ampicillin is Shigellosis.0037250mgCap.1750.5250NovamoxinNOP.1750.52501996-10-01Apo-AmoxiAPX.1750.52501996-10-01Nu-AmoxiNXP1996-10-01AmoxilWAY1996-10-01PMS-AmoxicillinPMS.1750.52502004-04-06Mylan-AmoxicillinMYL.1750.52501999-04-150038500mgCap.34171.0251NovamoxinNOP.34171.02511996-10-01Apo-AmoxiAPX.34171.02511996-10-01Nu-AmoxiNXP1996-10-01AmoxilWAY1996-10-01PMS-AmoxicillinPMS.34171.02512004-04-06Mylan-AmoxicillinMYL.34171.02511999-04-150039250mgChew TabNovamoxin ChewableNOP2008-11-04Amoxil ChewableAYE2008-11-04004025mg/mLO/L.0353.5295NovamoxinNOP.0353.52951996-10-01Apo-AmoxiAPX.0353.52951996-10-01Nu-AmoxiNXP1996-10-01Novamoxin (Sugar Reduced)NOP.0353.52951996-10-01AmoxilWAY1996-10-01PMS-AmoxicillinPMS.0353.52952004-04-06004150mg/mLO/L.0540.8100NovamoxinNOP.0540.81001996-10-01Apo-AmoxiAPX.0540.81001996-10-01Nu-AmoxiNXP1996-10-01Novamoxin (Sugar Reduced)NOP.0540.81001996-10-01AmoxilWAY1996-10-01PMS-AmoxicillinPMS.0540.81002004-04-060042125mgTabNovamoxin ChewableNOP2008-11-04Amoxil ChewableAYE2008-11-04AMOXICILLIN & CLAVULANIC ACIDAmoxicillin/clavulanic acid is not recommended as first line treatment for acute otitis media and sinusitis. Antibiotic resistance (H. influenzae, M. catarrhalis) due to B-lactamase production has caused only a minority of treatment failures with amoxicillin. Amoxicillin/clavulanic acid is first line treatment for infected bites of cat, dog or human.004325mg & 6.25mg/mLO/L.0517.7755ClavulinGSK.11701.75501996-10-01Apo-Amoxi ClavAPX.0517.77552003-01-30Ratio-Aclavulanate 125FRPH.0517.77552003-04-16004450mg & 12.5mg/mLO/L.08691.3035ClavulinGSK.20113.01651996-10-01Apo-Amoxi ClavAPX.08691.30352003-01-30Ratio-Aclavulanate 250FRPH.08691.30352003-04-160045200mg & 28.5mg/5mLSusp.1440Clavulin (BID)GSK.14402000-01-170046400mg & 57mg/5mLSusp.2753Clavulin (BID)GSK.27532000-01-17Apo-Amoxi ClavAPX2008-04-090047250mg & 125mgTab.93752.8125ClavulinGSK1996-10-01Apo-Amoxi ClavAPX.93752.81252001-10-110048500mg & 125mgTab.66732.0019ClavulinGSK1.48024.44061996-10-01Apo-Amoxi ClavAPX.66732.00192001-10-11Ratio-AclavulanateRPH.66732.00192001-10-110049875mg & 125mgTab.5551Clavulin (BID)GSK2.22032000-01-17Apo-Amoxi ClavAPX.55512003-09-04Ratio-AclavulanateRPH.55512003-09-04Novo-Clavamoxin 875NOP.55512004-04-06AMPICILLINUse with caution in urinary tract infections as even E. coli is resistant in approximately 20% of cases.0050250mgCap.30711.2284PenbritinAYE1996-10-01Novo-AmpicillinNOP.30711.22841996-10-010051500mgCap.59552.3820PenbritinAYE1996-10-01Novo-AmpicillinNOP.59552.38201996-10-01CLOXACILLIN0052250mgCap.1850.7400OrbeninAYE1996-10-01Novo-CloxinNOP.1850.74001996-10-01Apo-CloxiAPX.1850.74001996-10-010053500mgCap.34981.3992OrbeninAYE1996-10-01Novo-CloxinNOP.34981.39921996-10-01Apo-CloxiAPX.34981.39921996-10-01005425mg/mLO/L.04501.8000Novo-CloxinNOP.04501.80001996-10-01Apo-CloxiAPX.04501.80001996-10-01OrbeninWAY1996-10-01PENICILLIN V (POTASSIUM)005525mg/mLO/L.05351.0700Nadopen-VNDA1996-10-01Apo-Pen V-KAPX.05351.07001996-10-01005660mg/mLO/L.0472.7080VC-K 500LIL2006-06-15Novo-Pen-VK-500NOP.0472.70801996-10-01Apo-Pen V-KAPX.0472.70801996-10-010057300mgTab.0710.2840Novo-Pen-VK-500NOP.0710.28401996-10-01PVF-K 500FRS1996-10-01Apo-Pen V-KAPX.0710.28401996-10-01Nu-Pen VKNXP1996-10-01PIPERACILLIN SODIUM & TAZOBACTAM SODIUM00582g & 250mgInj Pd-Vial PkTazocinWYE2008-12-03Piperacillin & Tazobactam for InjectionAPX2008-12-0300593g & 375mgInj Pd-Vial PkTazocinWYE2008-12-03Piperacillin & Tazobactam for InjectionAPX2008-12-0300604g & 500mgInj Pd-Vial PkTazocinWYE2008-12-03Piperacillin & Tazobactam for InjectionAPX2008-12-03ANTIBIOTICS TETRACYCLINESDOXYCYCLINE HYCLATE0061100mgTabVibra-TabsPFI1996-10-01Apo-Doxy-TabsAPX2009-05-20Novo-Doxylin TabletsNOP2010-12-14MINOCYCLINE HCL006250mgCapRatio-MinocyclineRPH2008-01-15Apo-MinocyclineAPX2008-01-15Novo-MinocyclineNOP2008-11-04MinocinSTI2008-01-15Mylan-MinocyclineMYL2008-01-15Sandoz MinocyclineSDZ2008-01-15PMS-MinocyclinePMS2008-04-090063100mgCapRatio-MinocyclineRPH2008-01-15Apo-MinocyclineAPX2008-01-15Novo-MinocyclineNOP2008-11-04MinocinSTI2008-01-15Mylan-MinocyclineMYL2008-01-15Sandoz MinocyclineSDZ2008-01-15PMS-MinocyclinePMS2008-04-09TETRACYCLINETetracycline use during tooth development (last half of pregnancy and up to age 8) may cause permanent tooth discoloration or enamel hypoplasia. These reactions are more common during long-term use. Tetracyclines should not be used in these groups unless other antibiotics are unlikely to be effective or are contraindicated.0064250mgCap.0657.2628TetracynPFI1996-10-01TetracyclineAAP.0657.26281996-10-01ANTIBIOTICS OTHER ANTIBIOTICSCEFACLOR0065250mgCap.96972.9091CeclorPHE1.02073.06211996-10-01PMS-CefaclorPMS1997-08-28Apo-CefaclorAPX.96972.90911997-08-280066500mgCap1.93005.7900CeclorPHE2.00406.01201996-10-01PMS-CefaclorPMS1997-08-28Apo-CefaclorAPX1.93005.79001997-08-28006725mg/mLOral Susp.10891.6335CeclorPHE.10891.63351996-10-01PMS-CefaclorPMS1999-04-15006850mg/mLOral Susp.19932.9895CeclorPHE.19932.98951996-10-01PMS-CefaclorPMS1999-04-150069375mg/5mLOral Susp.2872CeclorPHE.28721996-12-19PMS-CefaclorPMS1999-04-15CEFADROXIL0070500mgCap.84211.6842DuricefBQU1996-10-01Novo-CefadroxilNOP.84211.68422000-01-17Apo-CefadroxilAPX.84211.68422000-04-17CEFAZOLIN SODIUM00711g/VialInj Pd-Vial PkCefazolin for InjectionNOP2010-06-14Cefazolin for InjectionORC2010-06-14007210g/VialInj Pd-Vial PkCefazolin for InjectionNOP2010-06-14Cefazolin for InjectionORC2010-06-14CEFIXIME007320mg/mLOral Susp.4052SupraxSAV.40521996-10-010074400mgTab3.48403.4840SupraxSAV3.48403.48401996-10-01CEFOXITIN SODIUM00751g/VialInj Pd-1 Vial PkMefoxinMSD2008-06-27Cefoxitin for InjectionORC2008-06-2700762g/VialInj Pd-1 Vial PkMefoxinMSD2008-06-27Cefoxitin for InjectionORC2008-06-27CEFPROZIL0077125mg/5mLOral Susp-100mL Pk5.9255Ran-CefprozilRAN5.92552010-06-14CefzilBQU17.15002010-06-14Apo-CefprozilAPX5.92552010-06-14Sandoz CefprozilSDZ5.92552010-06-140078250mg/5mLOral Susp-100mL Pk11.8475CefzilBQU34.27002010-06-14Apo-CefprozilAPX11.84752010-06-14Sandoz CefprozilSDZ11.84752010-06-14Ran-CefprozilRAN11.84752010-06-14Cefprozil Powder for Oral SuspensionRAN11.84752010-06-140079125mg/5mLOral Susp-75mL Pk4.4441CefzilBQU12.86001996-12-19Apo-CefprozilAPX4.44412007-09-04Sandoz CefprozilSDZ4.44412008-12-03Ran-CefprozilRAN4.44412010-06-140080250mg/5mLOral Susp-75mL Pk8.8856CefzilBQU25.70001996-12-19Ran-CefprozilRAN8.88562007-09-04Apo-CefprozilAPX8.88562007-09-04Sandoz CefprozilSDZ8.88562008-12-03Cefprozil Powder for Oral SuspensionRAN8.88562010-06-140081250mgTab.4332CefzilBQU1.75451996-12-19Apo-CefprozilAPX.43322007-06-06Ran-CefprozilRAN.43322007-06-06Sandoz CefprozilSDZ.43322008-03-25Cefprozil TabletsRAN.43322010-03-020082500mgTab.8494CefzilBQU3.44001996-12-19Apo-CefprozilAPX.84942007-06-06Ran-CefprozilRAN.84942007-06-06Sandoz CefprozilSDZ.84942008-03-25Cefprozil TabletsRAN.84942010-01-05CEFTRIAXONE DISODIUM00830.25g/VialInj Pd-1 Vial Pk3.9501RocephinHLR11.28601996-10-01Ceftriaxone Sodium for Injection, BPMAY3.95012007-09-04Ceftriaxone for Injection USPORC3.95012008-08-2800841g/VialInj Pd-1 Vial Pk12.4950RocephinHLR35.70001996-10-01Ceftriaxone Sodium for Injection, BPMAY12.49502007-09-04Ceftriaxone Sodium for InjectionNOP12.49502008-03-25CeftriaxoneSDZ12.49502007-05-04Ceftriaxone for Injection USPORC12.49502008-01-1500852g/VialInj Pd-1 Vial Pk24.1395RocephinHLR68.97001996-10-01Ceftriaxone Sodium for Injection, BPMAY24.13952007-09-04CeftriaxoneSDZ24.13952007-05-04Ceftriaxone for Injection USPORC24.13952008-01-15008610g/VialInj Pd-1 Vial PkRocephinHLR2008-08-28Ceftriaxone for Injection USPAPX2008-08-28CEFUROXIME AXETIL0087125mg/5mLSusp.1748CeftinGSK.17481998-10-210088250mgTab.72371.4474CeftinGSK1.61873.23741998-10-21Ratio-CefuroximeRPH.72371.44742002-04-04Apo-CefuroximeAPX.72371.44742002-04-040089500mgTab1.43372.8674CeftinGSK3.20676.41341998-10-21Ratio-CefuroximeRPH1.43372.86742002-04-04Apo-CefuroximeAPX1.43372.86742002-04-04CEPHALEXIN MONOHYDRATE0090250mgCap.2250.9000CeporexGLA2006-06-15Novo-LexinNOP.2250.90001996-10-010091500mgCap.45001.8000CeporexGLA2006-06-15Novo-LexinNOP.45001.80001996-10-01009225mg/mLPd for Oral Susp.0457.9140KeflexPHE.0457.91401996-10-01Novo-LexinNOP.0457.91401996-10-01PMS-Cephalexin 125PMS1996-10-01009350mg/mLPd for Oral Susp.09481.8960KeflexPHE.09481.89601996-10-01Novo-LexinNOP.09481.89601996-10-01PMS-Cephalexin 250PMS1996-10-010094250mgTab.2250.9000KeflexPHE.2370.94801996-10-01Novo-LexinNOP1996-10-01Apo-CephalexAPX.2250.90001996-10-01Nu-CephalexNXP1996-10-01PMS-CephalexinPMS1998-12-310095500mgTab.45001.8000KeflexPHE.47401.89601996-10-01Novo-LexinNOP1996-10-01Apo-CephalexAPX.45001.80001996-10-01Nu-CephalexNXP1996-10-01PMS-CephalexinPMS1998-12-31CLINDAMYCIN HCL0096150mgCap.22171.7736Dalacin CPFI.91167.29281996-10-01Novo-ClindamycinNOP.22171.77362000-11-30Apo-ClindamycinAPX.22171.77362002-07-29Mylan-ClindamycinMYL.22171.77362004-10-140097300mgCap.4434Dalacin CPFI1.82331996-12-19Novo-ClindamycinNOP.44342000-11-30Apo-ClindamycinAPX.44342002-07-29Mylan-ClindamycinMYL.44342004-10-14CLINDAMYCIN PALMITATE009815mg/mLPd for Oral Susp.1193Dalacin C Flavoured GranulesPFI.11931996-10-01CLINDAMYCIN PHOSPHATE0099300mg/2mLInj Sol-2mL Pk4.5740Clindamycin is well absorbed by the oral route, therefore stepdown therapy from IV to oral is possible.Dalacin CPFI8.00991996-10-01Clindamycin Phosphate Injection USPSDZ4.57402001-03-07TOBRAMYCIN0100300mg/5mLInh Sol-5mL Pk52.9032TOBINOV52.90322006-10-23TOBRAMYCIN SULFATE010180mg/2mLInj Sol-2mL Pk4.5000NebcinLIL1996-10-01TobramycinSDZ4.50002002-04-04ANTITUBERCULAR AGENTSETHAMBUTOL HCL0102100mgTab.0989MyambutolLED1996-10-01EtibiVAL.09891996-10-010103400mgTab.2757EtibiVAL.27571996-10-01MyambutolWAY1997-02-04PYRAZINAMIDE0104500mgTab.4980TebrazidVAL.49801996-10-01RIFABUTIN0105150mgCap4.0560MycobutinPFI4.05601996-10-01For the prevention of Mycobacterium Avium Intracellular (MAI) in:Patients with a CD4+ cell count less than 200/mm3 with an AIDS-defining diagnosis;LU Authorization Period: 1 year.Patients with a CD4+ cell count less than 100/mm3 without an AIDS-defining diagnosis.LU Authorization Period: 1 year.RIFAMPINExcept when used for prophylaxis in contacts of H. influenzae or N. meningitidis, rifampin should not be used as monotherapy, as bacterial resistance will develop quickly.0106150mgCap.6038RofactVAL.60381996-10-01RifadinSAV.78771996-10-010107300mgCap.9503RofactVAL.95031996-10-01RifadinSAV1.23961999-01-07ANTIVIRALSABACAVIR & LAMIVUDINE & ZIDOVUDINE0108300mg/150mg/300mgTab17.3102For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.TrizivirVIH17.31022003-01-30ABACAVIR SULFATE010920mg/mLO/L.4474For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.ZiagenVIH.44742000-01-170110300mgTab6.8693For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.ZiagenVIH6.86932000-01-17ABACAVIR SULFATE & LAMIVUDINE0111600mg/300mgTab23.2700Note: For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.KivexaVIH23.27002006-06-15ACYCLOVIR200mg/5mLSusp.2450ZoviraxGLW.24501996-10-01200mgTab.9395Nu-AcyclovirNXP.93951997-04-100112200mgTabZoviraxGSK1996-10-01Ratio-AcyclovirRPH1996-10-01Apo-AcyclovirAPX1998-12-31Mylan-AcyclovirMYL2001-06-07Novo-AcyclovirNOP2008-01-15400mgTab1.8555Nu-AcyclovirNXP1.85551997-04-100113400mgTabZoviraxGSK1996-10-01Ratio-AcyclovirRPH1996-10-01Apo-AcyclovirAPX1998-12-31Mylan-AcyclovirMYL2001-06-07Novo-AcyclovirNOP2008-01-150114800mgTab1.2673ZoviraxGSK5.06921996-10-01Ratio-AcyclovirRPH1.26731996-10-01Nu-AcyclovirNXP1.26731996-12-19Apo-AcyclovirAPX1.26731998-12-31Mylan-AcyclovirMYL1.26732001-03-07Novo-AcyclovirNOP1.26732007-01-02In contrast to bacterial infections, viral replication precedes clinical signs and symptoms. Since antiviral agents are only active against replicating viruses, clinical benefit in reducing severity of symptoms and duration of illness is only marginal, at best. Therefore, treatment initiated beyond the stated time frames below is of no value, and treatment of mild cases should be carefully considered, in light of the minimal benefit which will be achieved. In addition, the balance of evidence indicates that the use of acyclovir in normal hosts in an attempt to prevent post-herpetic neuralgia is of no value.Where specified, treatment must begin within the time frames indicated for the product to be reimbursed. There is no benefit from the therapy begun after these time frames.Acyclovir tablets will be reimbursed when prescribed for:Herpes zoster in immunocompetent patients 50 years of age or older, up to 72 hours after appearance of lesions. Dose: 800mg 5 times/day for 7 days.LU Authorization Period: 1 year.Herpes zoster ophthalmicus regardless of age, up to 72 hours after appearance of lesions. Dose: 800mg 5 times/day for 7 days.LU Authorization Period: 1 year.Herpes zoster in immunocompromised patients regardless of age and time elapsed from onset. Dose: 800mg 5 times/day for 7 days.LU Authorization Period: 1 year.Varicella zoster in immunocompetent patients greater than or equal to 12 years of age, up to 24 hours after appearance of lesions. Dose: 20mg/kg/dose (max. 800mg) 4 times/day for 5 days.Network will limit supply up to 7 days and up to 35 tablets.LU Authorization Period: 1 year.ATAZANAVIR SULFATE0115150mgCap10.7076For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.ReyatazBQU10.70762004-11-040116200mgCap10.7442For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.ReyatazBQU10.74422004-11-04DARUNAVIR011775mgTab1.8380Note: For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism. For the treatment of HIV infection in treatment-experienced pediatric patients in combination with ritonavir and an appropriate background regimen, who are resistant to two other protease inhibitors.PrezistaJAN1.83802010-09-090118300mgTab7.2622Note: For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism. In combination with ritonavir, as part of a HIV treatment regimen for treatment-experienced adult and pediatric patients who have demonstrated failure to at least 2 Protease Inhibitors. PrezistaJAN7.26222007-05-040119400mgTab10.5410Note: For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism. In combination with ritonavir, as part of a HIV treatment regimen for treatment-naive adult patients.PrezistaJAN10.54102010-04-230120600mgTab14.9890Note: For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism. In combination with ritonavir, as part of a HIV treatment regimen for treatment-experienced adult and pediatric patients who have demonstrated failure to at least 2 Protease Inhibitors.PrezistaJAN14.98902010-03-02DELAVIRDINE MESYLATE0121100mgTab.7178For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.RescriptorPFI.71781999-04-15DIDANOSINE0122125mgEnteric Coated Cap3.4892Note: For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.Videx ECBQU3.48922006-10-230123200mgEnteric Coated Cap5.5823Note: For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.Videx ECBQU5.58232006-10-230124250mgEnteric Coated Cap6.9779Note: For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.Videx ECBQU6.97792006-10-230125400mgEnteric Coated Cap11.1874Note: For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.Videx ECBQU11.18742006-10-23EFAVIRENZ012650mgCap1.1928For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.SustivaBQU1.19281999-09-150127200mgCap4.7704For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.SustivaBQU4.77041999-09-150128600mgTab14.3113For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.SustivaBQU14.31132003-09-04EFAVIRENZ/TENOFOVIR DISOPROXIL FUMARATE/EMTRICITABINE0129600mg/300mg/200mgTab40.1184For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.AtriplaBQU40.11842008-08-28EMTRICITABINE & TENOFOVIR DISOPROXIL FUMARATE0130200mg & 300mgTab25.8071Note: For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.TruvadaGIL25.80712007-09-04ETRAVIRINE0131100mgTab5.7310Note: For use in combination with an optimized regimen, for the treatment of HIV-1 infection in treatment-experienced adult patients who have failed prior anti-retroviral therapies and have HIV-1 strains resistant to multiple antiretroviral agents, including protease inhibitors (PIs) and other non-nucleoside reverse transcriptase inhibitors (NNRTIs). Note: For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanismIntelenceJAN5.73102009-01-30FAMCICLOVIR0132125mgTabFamvirNOV2007-09-04PMS-FamciclovirPMS2007-10-03Sandoz FamciclovirSDZ2007-09-04Apo-FamciclovirAPX2007-09-04Co FamciclovirCOB2008-12-230133250mgTabFamvirNOV2007-09-04PMS-FamciclovirPMS2007-10-03Sandoz FamciclovirSDZ2007-09-04Apo-FamciclovirAPX2007-09-04Co FamciclovirCOB2008-12-230134500mgTab1.6906FamvirNOV6.93141996-10-01PMS-FamciclovirPMS1.69062007-03-09Sandoz FamciclovirSDZ1.69062007-01-02Apo-FamciclovirAPX1.69062007-04-02Co FamciclovirCOB1.69062008-12-23Herpes zoster in patients 50 years of age or older, up to 72 hours* after appearance of lesions. Dose: 500mg 3 times/day for 7 days.*The patient must begin treatment within the time frame specified for the product to be reimbursed. There is no benefit from the therapy begun after this time frame.Network will limit supply to 7 days and 21 tablets.LU Authorization Period: 1 year.FOSAMPRENAVIR CALCIUM013550mg/mLOral Susp.5790For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.TelzirVIH.57902009-01-300136700mgTab7.9200Note: For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.TelzirVIH7.92002006-01-12GANCICLOVIR SODIUM0137500mg/VialPd Inj-10mL Pk41.2140CytoveneHLR41.21402007-01-02For the treatment of CMV retinitis secondary to AIDS and other immunosuppressive syndromes.LU Authorization Period: 1 year.INDINAVIR0138200mgCap1.3467For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.CrixivanMFC1.34671996-12-190139400mgCap2.6933For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.CrixivanMFC2.69331996-12-19LAMIVUDINE014010mg/mLO/L.3139For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism. Reimbursement will not be provided for the treatment of hepatitis.3TCVIH.31391996-10-010141150mgTab4.8358For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism. Reimbursement will not be provided for the treatment of hepatitis.3TCVIH4.83581996-10-010142300mgTab9.6717For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism. Reimbursement will not be provided for the treatment of hepatitis3TCVIH9.67172004-07-20LAMIVUDINE & ZIDOVUDINE0143150mg & 300mgTab10.4412For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.CombivirVIH10.44121999-09-15LOPINAVIR & RITONAVIR014480mg/mL & 20mg/mLO/L2.1649For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.KaletraABB2.16492001-10-110145100mg & 25mgTab2.7002For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.KaletraABB2.70022009-04-010146200mg & 50mgTab5.4490Note: For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.KaletraABB5.44902007-09-04NELFINAVIR MESYLATE0147250mgTab1.8200For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.ViraceptPFI1.82001999-04-150148625mgTab4.5500For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.ViraceptPFI4.55002005-05-25NEVIRAPINE0149200mgTab1.2346For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.ViramuneBOE4.93831999-04-15Auro-NevirapineAUR1.23462011-05-19Teva-NevirapineTEV1.23462011-05-19OSELTAMIVIR PHOSPHATE015030mgCap1.9500TamifluHLR1.95002011-03-15015145mgCap3.0000TamifluHLR3.00002011-03-15015275mgCap3.9000TamifluHLR3.90002003-04-16For the prophylaxis (max: 75mg daily) of institutionalized individuals during confirmed* outbreaks of Influenza A or Influenza B.Network will limit supply to 6 weeks.LU Authorization Period: 1 year.For the treatment (max: 75mg bid) of institutionalized individuals during confirmed* outbreaks due to: Influenza B or, Influenza A (as an alternative to amantadine) or, Influenza A where new cases have developed despite amantadine prophylaxis.Network will limit supply to 5 days.*The outbreak must be confirmed by Public Health.LU Authorization Period: 1 year.RALTEGRAVIR POTASSIUM0153400mgTab13.5000For use in combination with an optimized regimen, for the treatment of HIV-1 infection in treatment-experienced adult patients who cannot achieve complete viral suppression on multiple prior anti-retroviral regimens AND who have one of the following: . HIV-1 strains with documented resistance to at least one drug in each of the major classes of anti-retrovirals: protease inhibitors (Pls), non-nucleoside reverse transcriptase inhibitors(NNRTIs)and nucleoside reverse transcriptase inhibitors (NRTIs); OR . serious class-effect intolerance to Pls,NNRTIs and/or NRTIs precluding treatment with that antiretroviral class NOTE: For the treatment of HIV/AIDS,the prescriber must be approved for the Facilitated Access mechanism.IsentressMFC13.50002010-04-23RITONAVIR0154100mgCap1.4671For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.Norvir SECABB1.46712000-02-16015580mg/mLO/L1.1839For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.NorvirABB1.18391996-12-19SAQUINAVIR MESYLATE0156200mgCap1.8200For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.InviraseHLR1.82001996-10-010157500mgTab4.2000Note: For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.InviraseHLR4.20002007-01-02STAVUDINE015815mgCap4.2544For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.ZeritBQU4.25441996-12-19015920mgCap4.4231For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.ZeritBQU4.42311996-12-19016030mgCap4.6146For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.ZeritBQU4.61461996-12-19016140mgCap4.7833For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.ZeritBQU4.78331996-12-19TENOFOVIR DISOPROXIL0162300mgTab17.3013Note: For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism.VireadGIL17.30132007-01-02VALACYCLOVIR0163500mgTab.8481ValtrexGSK3.39241996-12-19Apo-ValacyclovirAPX.84812008-08-28PMS-ValacyclovirPMS.84812008-08-28Phl-ValacyclovirPHE.84812010-06-14Co ValacyclovirCOB.84812010-10-28Mylan-ValacyclovirMYL.84812010-07-20Herpes zoster in patients 50 years of age or older, up to 72 hours* after appearance of lesions. Dose: 1 gram 3 times/day for 7 days.*The patient must begin treatment within the time frame specified for the product to be reimbursed. There is no benefit from the therapy begun after this time frame.Network will limit supply to 7 days and 42 capsules.LU Authorization Period: 1 year.01641000mgTabValtrexGSK2010-07-20Mylan-ValacyclovirMYL2010-07-20Apo-ValacyclovirAPX2010-10-28VALGANCICLOVIR0165450mgTab22.4100ValcyteHLR22.41002003-04-16For the treatment of CMV retinitis in patients with AIDS.LU Authorization Period: 1 year.ZANAMIVIR01665mgPd Inh-5 Rotadisks Pk36.5400RelenzaGSK36.54002010-03-02For the treatment or prophylaxis of institutionalized individuals during confirmed outbreaks due to influenza A or Influenza B when the predominant circulating strain is resistant to oseltamivir or for the prophylaxis of influenza A, where new cases have developed despite amantadine prophylaxis. The outbreak must be confirmed by Public Health.For treatment: 2 inhalations of 5mg (10mg) bid for 5 days,LU Authorization Period: 1 year.For prophylaxis: 2 inhalations of 5mg (10mg) once daily for 10 days.LU Authorization Period: 1 year.ZIDOVUDINE0167100mgCapRetrovirVIH2009-06-23Apo-ZidovudineAPX2009-06-23PLASMODICIDES (ANTIMALARIALS)CHLOROQUINE PHOSPHATE0168250mgTab.3208Novo-ChloroquineNOP.32081996-10-01AralenSAO1996-10-01HYDROXYCHLOROQUINE SULFATE0169200mgTab.2620PlaquenilSAV.59871996-10-01Apo-HydroxyquineAPX.26202003-09-04Mylan-HydroxychloroquineMYL.26202004-07-20SULFONAMIDESSULFASALAZINE0170500mgEnt Tab.2816PMS-Sulfasalazine-E.C.PMS.28161996-10-01SalazopyrinPFI.36861996-10-010171500mgTab.1804PMS-SulfasalazinePMS.18041996-10-01SalazopyrinPFI.24201996-10-01TRICHOMONACIDESMETRONIDAZOLE0172500mgCap.70282.1084PMS-MetronidazolePMS1996-10-01FlagylSAV.96522.89561996-10-01MetronidazoleAAP.70282.10842004-07-200173250mgTab.0595.1785MetronidazoleAAP.0595.17851996-10-01FlagylRPP2001-02-28URINARY ANTI-INFECTIVESNITROFURANTOINNitrofurantoin macrocrystals may be better tolerated. Avoid use of nitrofurantoin during the last 6 weeks of pregnancy. Use with caution in patients with renal impairment.017450mgCap.31871.2748MacrodantinPGP1996-10-01Novo-FurantoinNOP.31871.27481998-12-310175100mgCap.61102.4440MacrodantinPGP1996-10-01Novo-FurantoinNOP.61102.44401998-12-31017650mgTab.1670.6680NifuranMAN2006-06-15NitrofurantoinAAP.1670.66801996-10-010177100mgTab.2227.8908NifuranMAN2006-06-15NitrofurantoinAAP.2227.89081996-10-01NITROFURANTOIN MONO/MICRO CRYSTALS0178100mgCap.7040MacroBIDWAR.70401996-12-19MISCELLANEOUS ANTI-INFECTIVESCEFEPIME01791gInj Pd-Vial PkMaxipimeBQU2009-05-20Cefepime for InjectionAPX2009-05-2001802gInj Pd-Vial PkMaxipimeBQU2009-05-20Cefepime for InjectionAPX2009-05-20CIPROFLOXACINCiprofloxacin is not intended for the treatment of asymptomatic bacteriuria in the absence of risk factors. Avoid use in pregnancy and children < 18 years of age. Ciprofloxacin inhibits theophylline clearance and also affects phenytoin kinetics. Theophylline doses should be decreased and blood levels of phenytoin or theophylline monitored when either of these drugs is used concomitantly with ciprofloxacin.018110g/100mLOral Susp.56995.6990CiproBAY.56995.69902001-03-070182250mgTab.61861.2372CiproBAY2.47424.94841996-10-01Novo-CiprofloxacinNOP.61861.23722004-07-20Apo-CiprofloxAPX.61861.23722004-07-20Mylan-CiprofloxacinMYL.61861.23722004-07-20Ratio-CiprofloxacinRPH.61861.23722004-07-20Co CiprofloxacinCOB.61861.23722004-07-20PMS-CiprofloxacinPMS.61861.23722004-07-20Sandoz CiprofloxacinSDZ.61861.23722004-07-20Taro-CiprofloxacinTAR2006-06-14Ran-CiprofloxacinRAN.61861.23722006-01-24Ran-CiprofloxRAN.61861.23722008-03-25Mint-CiprofloxacinMIN.61861.23722009-11-13Ciprofloxacin TabletsRAN.61861.23722010-01-050183500mgTab.69791.3958CiproBAY2.79155.58301996-10-01Novo-CiprofloxacinNOP.69791.39582004-07-20Apo-CiprofloxAPX.69791.39582004-07-20Mylan-CiprofloxacinMYL.69791.39582004-07-20Ratio-CiprofloxacinRPH.69791.39582004-07-20Co CiprofloxacinCOB.69791.39582004-07-20PMS-CiprofloxacinPMS.69791.39582004-07-20Sandoz CiprofloxacinSDZ.69791.39582004-07-20Taro-CiprofloxacinTAR2006-06-14Ran-CiprofloxacinRAN.69791.39582006-01-24Ran-CiprofloxRAN.69791.39582008-03-25Mint-CiprofloxacinMIN.69791.39582009-11-13Ciprofloxacin TabletsRAN.69791.39582010-01-050184750mgTab1.27802.5560CiproBAY5.111810.22361996-10-01Novo-CiprofloxacinNOP1.27802.55602004-07-20Apo-CiprofloxAPX1.27802.55602004-07-20Mylan-CiprofloxacinMYL1.27802.55602004-07-20Ratio-CiprofloxacinRPH1.27802.55602004-07-20Co CiprofloxacinCOB1.27802.55602004-07-20PMS-CiprofloxacinPMS1.27802.55602004-07-20Sandoz CiprofloxacinSDZ1.27802.55602004-07-20Ran-CiprofloxacinRAN1.27802.55602006-01-24Ran-CiprofloxRAN1.27802.55602008-03-25Mint-CiprofloxacinMIN1.27802.55602009-11-13Ciprofloxacin TabletsRAN1.27802.55602010-01-05For the treatment of patients with:SST/BJ (Gram negative bacteria): Skin/soft tissue and bone/joint infection due to gram negative bacteria; severe diabetic foot infection; severe otitis externa; decubitus ulcers.LU Authorization Period: 1 year.GU Tract: Urinary tract infection/prostatitis/epididymitis caused by (suspected or documented) Pseudomonas; sexually transmitted diseases.LU Authorization Period: 1 year.COPD with risk: Acute bacterial exacerbation of chronic obstructive pulmonary disease (COPD) with risk factors*; bronchiectasis; pneumonic illness with cystic fibrosis.*Risk factors include: poor pulmonary lung function (FEV1 below 50% predicted level), age over 65 years, co-morbid medical illness (congestive heart failure, diabetes, chronic renal failure, chronic liver disease), chronic corticosteroid use, malnutrition, prolonged duration of disease or 4 or more exacerbations per year.LU Authorization Period: 1 year.Step-Down: Step-down therapy after parenteral therapy or hospital/emergency department discharge; febrile neutropenia.LU Authorization Period: 1 year.GI: Traveller's diarrhea; enteric fever syndromes; Crohn's disease.LU Authorization Period: 1 year.For the prophylaxis or treatment of B. anthracis exposure.LU Authorization Period: 1 year.Exceptional cases of allergy or intolerance to all other appropriate therapies.LU Authorization Period: 1 year.CIPROFLOXACIN HCL & CIPROFLOXACIN BASE0185500mgER Tab3.0813Cipro XLBAY3.08132005-02-22For patients with uncomplicated urinary tract infections (acute cystitis) who have failure, intolerance or hypersensitivity to all formulary antibiotic alternatives that are listed as General Benefits.LU Authorization Period: 1 year.01861000mgER Tab3.0813Cipro XLBAY3.08132005-02-22For patients with complicated urinary tract infections or acute uncomplicated pyelonephritis who have failure, intolerance or hypersensitivity to all formulary antibiotic alternatives that are listed as General Benefits.LU Authorization Period: 1 year.LEVOFLOXACIN0187250mgTab1.2038LevaquinJAN5.46601999-09-15Novo-LevofloxacinNOP1.20382005-01-25PMS-LevofloxacinPMS1.20382009-09-30Apo-LevofloxacinAPX1.20382009-09-30Sandoz LevofloxacinSDZ1.20382009-09-30Gen-LevofloxacinGEN1.20382009-09-30Co LevofloxacinCOB1.20382009-09-300188500mgTab1.3718LevaquinJAN6.22881999-09-15Novo-LevofloxacinNOP1.37182005-01-25PMS-LevofloxacinPMS1.37182009-09-30Apo-LevofloxacinAPX1.37182009-09-30Sandoz LevofloxacinSDZ1.37182009-09-30Gen-LevofloxacinGEN1.37182009-09-30Co LevofloxacinCOB1.37182009-09-30For the treatment of patients with:CAP with co-morbidity: Community acquired pneumonia with co-morbid illnesses or failure to first-line therapy.LU Authorization Period: 1 year.COPD with risk: Acute bacterial exacerbation of chronic obstructive pulmonary disease (COPD) with risk factors*; bronchiectasis.*Risk factors include: poor pulmonary lung function (FEV1 below 50% predicted level), age over 65 years, co-morbid medical illness (congestive heart failure, diabetes, chronic renal failure, chronic liver disease), chronic corticosteroid use, malnutrition, prolonged duration of disease or 4 or more exacerbations per year.LU Authorization Period: 1 year.Step-Down: Step-down therapy after parenteral therapy or hospital / emergency department discharge.LU Authorization Period: 1 year.Exceptional cases of allergy or intolerance to all other appropriate therapies.LU Authorization Period: 1 year.0189750mgTabLevaquinJAN2009-09-30Novo-LevofloxacinNOP2009-09-30Sandoz LevofloxacinSDZ2009-11-13PMS-LevofloxacinPMS2009-09-30Co LevofloxacinCOB2009-09-30Apo-LevofloxacinAPX2009-09-30LINEZOLID0190600mgTab72.1265ZyvoxamPFI72.12652003-01-30For the treatment of patients with:Methicillin-resistant Staphylococcus species (MRSA, MRSE) infections* in patients who are intolerant or have failed vancomycin therapy, or have contraindications to venous access.LU Authorization Period: 1 year.Vancomycin resistant Enterococcus species (VRE) infections* in patients switching from IV linezolid.LU Authorization Period: 1 year.Step-down therapy for the treatment of methicillin-resistant Staphylococcus species or vancomycin resistant Enterococcus species (VRE) infections* after parenteral therapy or hospital/ emergency department discharge.* Infections must be documented and culture proven. Not approved for colonization (e.g. nares, urine, etc). Maximum 28 days supply.LU Authorization Period: 1 year.MEFLOQUINE HCL0191250mgTabLariamHLR2007-06-06MefloquineAAP2007-06-06MOXIFLOXACIN HYDROCHLORIDE0192400mgTab5.9428AveloxBAY5.94282001-06-07For the treatment of patients with:CAP with co-morbidity: Community acquired pneumonia with co-morbid illnesses or failure to first-line therapy.LU Authorization Period: 1 year.COPD with risk: Acute bacterial exacerbation of chronic obstructive pulmonary disease (COPD) with risk factors*; bronchiectasis.*Risk factors include: poor pulmonary lung function (FEV1 below 50% predicted level), age over 65 years, co-morbid medical illness (congestive heart failure, diabetes, chronic renal failure, chronic liver disease), chronic corticosteroid use, malnutrition, prolonged duration of disease or 4 or more exacerbations per year.LU Authorization Period: 1 year.Step-Down: Step-down therapy after parenteral therapy or hospital / emergency department discharge.LU Authorization Period: 1 year.Exceptional cases of allergy or intolerance to all other appropriate therapies.LU Authorization Period: 1 year.NORFLOXACIN0193400mgTab.54491.0898NoroxinMSD1996-10-01Apo-NorfloxAPX.54491.08981999-04-15Novo-NorfloxacinNOP.54491.08981999-04-15PMS-NorfloxacinPMS.54491.08982003-04-16Co NorfloxacinCOB.54491.08982006-09-06OFLOXACIN0194200mgTab1.30412.6082FloxinJNO1996-10-01Ofloxacin TabletsAAP1.30412.60821998-12-310195300mgTab1.53233.0646FloxinJNO1996-10-01Ofloxacin TabletsAAP1.53233.06461998-12-310196400mgTab1.53233.0646FloxinJNO1996-10-01Ofloxacin TabletsAAP1.53233.06461998-12-31For the treatment of patients with:SST/BJ (Gram negative bacteria): Skin/soft tissue and bone/joint infection due to gram negative bacteria; severe diabetic foot infection..LU Authorization Period: 1 year.GU Tract: Urinary tract infection / prostatitis / epididymitis; sexually transmitted disease.LU Authorization Period: 1 year.COPD with risk: Acute bacterial exacerbation of chronic obstructive pulmonary disease (COPD) with risk factors*; bronchiectasis.*Risk factors include: poor pulmonary lung function (FEV1 below 50% predicted level), age over 65 years, co-morbid medical illness (congestive heart failure, diabetes, chronic renal failure, chronic liver disease), chronic corticosteroid use, malnutrition, prolonged duration of disease or 4 or more exacerbations per year.LU Authorization Period: 1 year.GI: Traveller's diarrhea; enteric fever syndromes.LU Authorization Period: 1 year.Step-Down: Step-down therapy after parenteral therapy or hospital / emergency department discharge.LU Authorization Period: 1 year.Exceptional cases of allergy or intolerance to all other appropriate therapies.LU Authorization Period: 1 year.SULFAMETHOXAZOLE & TRIMETHOPRIMAvoid using sulfamethoxazole/trimethoprim during the last 6 weeks of pregnancy.019740mg & 8mg/mLO/L.0198.1980SeptraBWE1996-10-01Bactrim Sugar FreeHLR1996-10-01Novo-TrimelNOP.0198.19801996-10-010198400mg & 80mgTab.0482.1928SeptraBWE1996-10-01BactrimHLR1996-10-01Apo-SulfatrimAPX.0482.19281996-10-01Novo-TrimelNOP.0482.19281996-10-01Nu-CotrimoxNXP.0482.19281996-10-010199800mg & 160mgTab.1221.2442Septra DSBWE1996-10-01Bactrim-DSHLR1996-10-01Apo-Sulfatrim-DSAPX.1221.24421996-10-01Novo-Trimel DSNOP.1221.24421996-10-01Nu-CotrimoxNXP.1221.24421996-10-01TRIMETHOPRIM0200100mgTab.2566.5132ProloprimBWE1996-10-01TrimethoprimAAP.2566.51322001-06-070201200mgTab.5273.5273ProloprimBWE1996-10-01TrimethoprimAAP.5273.52732001-06-07ANTINEOPLASTIC AGENTSALTRETAMINE020250mgCap3.3600HexalenLIL3.36001996-10-01ANASTROZOLE02031mgTab5.0917ArimidexAZC5.09171996-12-19For the treatment of metastatic breast cancer in hormone receptor positive post-menopausal women.LU Authorization Period: Indefinite.As an alternative to tamoxifen for the adjuvant treatment of postmenopausal women with hormone receptor positive breast cancer.LU Authorization Period: Indefinite.BICALUTAMIDE020450mgTab1.6100CasodexAZC6.62501996-12-19Novo-BicalutamideNOP1.61002006-04-04Co BicalutamideCOB1.61002006-04-04PMS-BicalutamidePMS1.61002006-04-04Sandoz BicalutamideSDZ1.61002006-04-04Ratio-BicalutamideRPH1.61002006-06-14Apo-BicalutamideAPX1.61002008-01-15Mylan-BicalutamideMYL1.61002008-03-25Bicalutamide TabletsACH1.61002010-07-20Jamp-BicalutamideJPC1.61002011-03-15Ran-BicalutamideRAN1.61002011-12-15BUSERELIN ACETATE02056.3mgImplant Kit736.2000Suprefact DepotSAV736.20001997-04-1002069.45mgImplant Kit1087.8200Suprefact DepotSAV1087.82002000-11-3002071mg/mLInj Sol-5.5mL Pk59.6200SuprefactSAV59.62001999-01-0802081mg/mLNas Sp-10mL Pk76.0700SuprefactSAV76.07001999-01-08BUSULFAN02092mgTab1.4376MyleranGSK1.43761996-10-01CAPECITABINE0210150mgTab1.8300XelodaHLR1.83002001-06-070211500mgTab6.1000XelodaHLR6.10002001-06-07For the first-line treatment of patients with metastatic colorectal cancer in whom combination chemotherapy is not recommended.Not to be used in patients who have failed 5-flurouracil.LU Authorization Period: Indefinite.For the treatment of metastatic breast cancer where patients have progressed after prior chemotherapy.LU Authorization Period: Indefinite.For adjuvant treatment of stage 3 or high risk stage 2* colon cancer in patients who have completed surgery (within three months), who would normally be candidates for adjuvant chemotherapy with 5FU/LV. *high risk stage 2 colon cancer is defined as one of the following: - obstruction, - perforation, - poorly differentiated adenocarcinoma, - inadequate lymph node sampling, - T4 tumour. LU Authorization Period: 6 Months.As part of the CAPOX regimen for the first-line and second-line treatment of metastatic colorectal cancerLU Authorization Period: Indefinite.In combination with trastuzumab and cisplatin for the treatment of patients with HER2-positive metastatic adenocarcinoma of the stomach or gastro-esophageal junction who have not received prior anti-cancer treatment for their metastatic disease.LU Authorization Period: Indefinite.For the neo-adjuvant treatment of rectal cancer.LU Authorization Period: Indefinite.CHLORAMBUCIL02122mgTab1.3548LeukeranGSK1.35481996-10-01CLADRIBINE02131mg/mLInj58.5890LeustatinJNO58.58901996-10-01For hairy cell leukemia, as a single 7-day treatment course.LU Authorization Period: 1 year.CYCLOPHOSPHAMIDE0214200mgInj Pd-Vial Pk5.7630ProcytoxBAX5.76302005-05-2502151000mgInj Pd-Vial Pk13.4436ProcytoxBAX13.44362005-05-25021625mgTab.3520ProcytoxBAX.35202005-05-25021750mgTab.4740CytoxanBQU1996-10-01ProcytoxBAX.47402005-05-25CYPROTERONE ACETATE021850mgTab1.4085AndrocurBAY1.40851996-10-01Gen-CyproteroneGEN1.40851998-12-31CyproteroneAAP1.40852004-07-20CYTARABINE0219100mgInj Pd-Vial Pk10.7240CytosarPFI10.72401996-10-01DAUNORUBICIN0220Inj Pd-20mg Pk88.0000CerubidineERF88.00001996-10-01DEGARELIX ACETATE022180mgPd for Inj-Vial Pk255.0000FirmagonFEI255.00002011-03-150222120mgPd for Inj-Vial Pk345.0000FirmagonFEI345.00002011-03-15ESTRAMUSTINE PHOSPHATE DISODIUM0223140mgCap3.0912EmcytPFI3.09122006-10-23ETOPOSIDE022450mgCap33.9998VepesidBQU33.99981996-10-01EXEMESTANE022525mgTab5.0543AromasinPFI5.05432002-07-29For the hormonal treatment of metastatic breast cancer in hormone receptor positive post-menopausal women who have disease progression following tamoxifen therapy.LU Authorization Period: Indefinite.For the sequential treatment of postmenopausal women with estrogen receptor-positive early breast cancer who have received 2-3 years of initial adjuvant tamoxifen therapy. LU Authorization Period: Treatment period required to complete a total of 5 years of adjuvant therapy. FLUDARABINE PHOSPHATE022610mgTab38.9080FludaraGZM38.90802004-04-06For the first-line treatment of chronic lymphocytic leukemia (CLL) in combination with rituximab (with or without cyclophosphamide).LU Authorization Period: Indefinite.For second line therapy of patients with chronic lymphocytic leukemia (CLL) who have failed or are intolerant to chlorambucil.LU Authorization Period: Indefinite.FLUTAMIDE0227250mgTab1.3530EuflexSCH1.42071996-10-01Novo-FlutamideNOP1.35301998-12-31PMS-FlutamidePMS1.35301998-12-31Apo-FlutamideAPX1.35301999-04-15GOSERELIN ACETATE02283.6mgDepot Inj381.7500ZoladexAZC381.75001996-10-01022910.8mgDepot Inj1087.9800Zoladex LAAZC1087.98001996-12-19HYDROXYUREA0230500mgCap1.0203HydreaBQU1.02031996-10-01Mylan-HydroxyureaMYL1.02032002-07-29Apo-HydroxyureaAPX1.02032004-04-06IMATINIB MESYLATE0231100mgTab27.2743These products must be prescribed based on the following criteria: 1) For treatment of Philadelphia chromosome-positive chronic myeloid leukemia (CML) in chronic phase. The initial dose is 400 mg/day. The dose may be increased up to a maximum of 800 mg/day in patients who do not have an adequate hematologic response at 3 months or cytogenetic response at 1 year; or if there has been loss of a previously achieved hematologic and/or cytogenetic response. 2) For treatment of Philadelphia chromosome-positive chronic myeloid leukemia (CML) in blast crisis or accelerated phase. The initial dose is 600 mg/day. The dose may be increased to a maximum of 800 mg/day in patients who do not have an adequate hematologic response at 3 months or cytogenetic response at 1 year; or loss of a previously achieved hematologic and/or cytogenetic response.GleevecNOV27.27432007-01-020232400mgTab109.0970These products must be prescribed based on the following criteria: 1) For treatment of Philadelphia chromosome-positive chronic myeloid leukemia (CML) in chronic phase. The initial dose is 400 mg/day. The dose may be increased up to a maximum of 800 mg/day in patients who do not have an adequate hematologic response at 3 months or cytogenetic response at 1 year; or if there has been loss of a previously achieved hematologic and/or cytogenetic response. 2) For treatment of Philadelphia chromosome-positive chronic myeloid leukemia (CML) in blast crisis or accelerated phase. The initial dose is 600 mg/day. The dose may be increased to a maximum of 800 mg/day in patients who do not have an adequate hematologic response at 3 months or cytogenetic response at 1 year; or loss of a previously achieved hematologic and/or cytogenetic response.GleevecNOV109.09702007-01-02INTERFERON ALFA-2B023315mu/mL18mu MD Pen Kit210.0600Intron ASCH210.06002000-07-17023425mu/mL30mu MD Pen Kit350.1000Intron ASCH350.10002000-07-17023550mu/mL60mu MD Pen Kit700.1900Intron ASCH700.19002000-07-17For hairy cell leukemia.LU Authorization Period: Indefinite.For Kaposi's Sarcoma.LU Authorization Period: Indefinite.LETROZOLE02362.5mgTab1.3780FemaraNOV5.90331998-12-31PMS-LetrozolePMS1.37802010-07-20Med-LetrozoleGMP1.37802010-07-20Letrozole Tablets USPACH1.37802010-07-20Sandoz LetrozoleSDZ1.37802010-06-14LetrozoleTEV1.37802010-07-20LetrozoleCOB1.37802010-07-20Apo-LetrozoleAPX1.37802011-05-19Myl-LetrozoleMYL1.37802012-01-19Ran-LetrozoleRAN1.37802011-12-15Mar-LetrozoleMAR1.37802012-01-19For the treatment of metastatic breast cancer in hormone receptor positive post-menopausal women.LU Authorization Period: Indefinite.For the treatment of hormone receptor positive early breast cancer in postmenopausal women who have received 5 years of adjuvant tamoxifen therapy.LU Authorization Period: 5 years.As an alternative to tamoxifen for the adjuvant treatment of post- menopausal women with hormone receptor positive early breast cancer for a maximum of five years.LU Authorization Period: 5 years.LEUPROLIDE ACETATE02373.75mgInj-Kit337.4000Lupron Depot PDSABB337.40001996-10-0102387.5mgInj-Kit387.9700Lupron Depot PDSABB387.97001996-10-01023911.25mgInj-Kit1005.2600Lupron Depot PDSABB1005.26002000-07-17024022.5mgInj-Kit1071.0000Lupron Depot PDSABB1071.00001997-08-28024130mgInj-Kit1428.0000Lupron Depot PDSABB1428.00002000-04-1702427.5mgPd Susp Inj-Pref Syr Kit343.5800EligardSAV343.58002004-07-20024322.5mgPd Susp Inj-Pref Syr Kit891.0000EligardSAV891.00002004-07-20024430mgPd Susp Inj-Pref Syr Kit1285.2000EligardSAV1285.20002005-05-25024545mgPd Susp Inj-Pref Syr Kit1450.0000EligardSAV1450.00002006-06-15LOMUSTINE (CCNU)024610mgCap6.4500CeeNUBQU6.45001996-10-01024740mgCap11.1200CeeNUBQU11.12001996-10-010248100mgCap18.3600CeeNUBQU18.36001996-10-01MEGESTROL ACETATE024940mgTab1.0073MegaceBQU1996-10-01MegestrolAAP1.00731996-10-010250160mgTab4.2630MegaceBQU1996-10-01MegestrolAAP4.26301996-10-01MELPHALAN02512mgTab1.5672AlkeranGSK1.56721996-10-01MERCAPTOPURINE025250mgTab4.7684Decrease dose of mercaptopurine to 25-33% of initial dose if allopurinol used concomitantly.PurinetholNOP4.76841996-10-01METHOTREXATE025320mg/2mLInj Sol-2mL Pk12.5000Methotrexate SodiumMAY12.50002002-04-04025450mg/2mLInj Sol-2mL Pk12.4800MethotrexateWAY1998-03-17MethotrexateMAY12.48002005-10-0602552.5mgTab.6325MethotrexateWAY.63251997-02-04Apo-MethotrexateAPX.63252001-10-11Ratio-Methotrexate SodiumRPH.63252002-07-29NILUTAMIDE025650mgTab2.0112AnandronSAV2.01121999-01-06PROCARBAZINE HCL025750mgCap.4079Procarbazine inhibits monoamine oxidase. Avoid alcohol and foods with high tyramine content (e.g. aged cheese, red wine, yogurt, etc.)MatulaneSIG.40791996-10-01STREPTOZOCIN0258Inj Pd-1g Pk38.4500ZanosarPFI38.45001996-10-01TAMOXIFEN CITRATE025910mgTab.1750Apo-TamoxAPX.17501996-10-01Novo-TamoxifenNOP.17501996-10-01TamofenSAV.19301996-10-01NolvadexAZC1996-10-01Mylan-TamoxifenMYL.17501996-10-01026020mgTab.3500Apo-TamoxAPX.35001996-10-01Novo-TamoxifenNOP.35001996-10-01TamofenSAV.38591996-10-01Nolvadex DAZC.36001996-10-01Mylan-TamoxifenMYL.35001996-10-01TEMOZOLOMIDE02615mgCap7.4174TemodalSCH7.41742000-07-17026220mgCap29.6694TemodalSCH29.66942000-07-170263100mgCap148.3468TemodalSCH148.34682000-07-170264140mgCap207.6863TemodalSCH207.68632011-09-150265180mgCap267.0238TemodalSCH267.02382011-09-150266250mgCap370.8565TemodalSCH370.85652000-07-17For patients with recurrent or progressive glioblastoma multiforme or anaplastic astrocytoma.LU Authorization Period: Indefinite.For the treatment of newly diagnosed glioblastoma multiforme. Dose: Temozolomide 75 milligrams per square metre daily for up to 6 weeks concomitant with radiotherapy, followed by maintenance treatment of up to 200 milligrams per square metre daily for 5 days for 6 cycles.LU Authorization Period: 1 year.THIOGUANINE026740mgTab4.1888LanvisGSK4.18881996-10-01TRIPTORELIN PAMOATE02683.75mg/VialInj Pd with Sterile Water-Vial Pk314.4100Trelstar (1 Month)PAL314.41002007-01-02026911.25mg/VialInj Pd with Sterile Water-Vial Pk962.6800Trelstar LA (3 Month)PAL962.68002007-01-0202703.75mg/VialInj Pd-Vial Pk314.4100Trelstar (1 Month)PAL314.41002007-01-02027111.25mg/VialInj Pd-Vial Pk962.6800Trelstar LA (3 Month)PAL962.68002007-01-02VINCRISTINE SULFATE02721mg/mLInj Sol7.1300OncovinLIL1996-10-01Vincristine SulfateNOP7.13001996-10-01AUTONOMIC AGENTSPARASYMPATHOMIMETIC (CHOLINERGIC) AGENTSBETHANECHOL CHLORIDE027310mgTab.2802DuvoidPAL.28021996-10-01027425mgTab.4540DuvoidPAL.45401996-10-01027550mgTab.5980DuvoidPAL.59801996-10-01CARBACHOL02762mgTab.3727CarbacholGLA.37271996-10-01DONEPEZIL HCL02775mgTab4.8679AriceptPFI4.86791999-06-01027810mgTab4.8679AriceptPFI4.86791999-06-01Initial Trial: For patients with mild to moderate Alzheimer's Disease (Mini-Mental State Exam [MMSE] 10-26). Patients will be reimbursed for a period of up to 3 months after which continued treatment must be reassessed. Network note: Maximum duration 3 months.LU Authorization Period: 1 year.Continuation: Further reimbursement will be made available to those patients whose disease has not progressed/deteriorated while on this drug. Patients must continue to have a MMSE score of 10-26.LU Authorization Period: 1 year.GALANTAMINE HYDROBROMIDE02798mgER Cap1.2465Reminyl ERJAN5.14602006-01-12Pat-Galantamine ERPAR1.24652011-05-19Mylan-Galantamine ERMYL1.24652011-03-15028016mgER Cap1.2465Reminyl ERJAN5.14602006-01-12Pat-Galantamine ERPAR1.24652011-05-19Mylan-Galantamine ERMYL1.24652011-03-15028124mgER Cap1.2465Reminyl ERJAN5.14602006-01-12Pat-Galantamine ERPAR1.24652011-05-19Mylan-Galantamine ERMYL1.24652011-03-15Initial Trial: For patients with mild to moderate Alzheimer's Disease (Mini-Mental State Exam [MMSE] 10-26). Patients will be reimbursed for a period of up to 3 months after which continued treatment must be reassessed. Network note: Maximum duration 3 months.LU Authorization Period: 1 year.Continuation: Further reimbursement will be made available to those patients whose disease has not progressed/deteriorated while on this drug. Patients must continue to have a MMSE score of 10-26.LU Authorization Period: 1 year.NEOSTIGMINE BROMIDE028215mgTab.4444ProstigminVAL.44441996-10-01PYRIDOSTIGMINE BROMIDE0283180mgLA Tab.9553MestinonVAL.95531996-10-01028460mgTab.4368MestinonVAL.43681996-10-01RIVASTIGMINE02851.5mgCap.6515ExelonNOV2.60592001-03-07Novo-RivastigmineNOP.65152009-11-13PMS-RivastigminePMS.65152009-11-13Ratio-RivastigmineRPH.65152009-11-13Sandoz RivastigmineSDZ.65152009-11-19Apo-RivastigmineAPX.65152010-03-0202863mgCap.6515ExelonNOV2.60592001-03-07Novo-RivastigmineNOP.65152009-11-13PMS-RivastigminePMS.65152009-11-13Ratio-RivastigmineRPH.65152009-11-13Sandoz RivastigmineSDZ.65152009-11-19Apo-RivastigmineAPX.65152010-03-0202874.5mgCap.6515ExelonNOV2.60592001-03-07Novo-RivastigmineNOP.65152009-11-13PMS-RivastigminePMS.65152009-11-13Ratio-RivastigmineRPH.65152009-11-19Sandoz RivastigmineSDZ.65152009-11-19Apo-RivastigmineAPX.65152010-03-0202886mgCap.6515ExelonNOV2.60592001-03-07Novo-RivastigmineNOP.65152009-11-13PMS-RivastigminePMS.65152009-11-13Ratio-RivastigmineRPH.65152009-11-13Sandoz RivastigmineSDZ.65152009-11-19Apo-RivastigmineAPX.65152010-03-02Initial Trial: For patients with mild to moderate Alzheimer's Disease (Mini-Mental State Exam [MMSE] 10-26). Patients will be reimbursed for a period of up to 3 months after which continued treatment must be reassessed. Network note: Maximum duration 3 months.LU Authorization Period: 1 year.Continuation: Further reimbursement will be made available to those patients whose disease has not progressed/deteriorated while on this drug. Patients must continue to have a MMSE score of 10-26.LU Authorization Period: 1 year.PARASYMPATHOLYTIC (CHOLINERGIC BLOCKING) AGENTSAnticholinergic agents should be used with extreme caution in the elderly due to age- related central nervous system adverse effects (e.g., confusion, paranoia, hallucinations). Avoid in patients with dementia as drug-induced memory impairment is common. (This does not apply to ipratropium bromide).BENZTROPINE MESYLATE02892mgTab.0450CogentinMSD1996-10-01Apo-BenztropineAPX.04501996-10-01ETHOPROPAZINE HCL029050mgTab.2255ParsitanERF.22551996-10-01FLAVOXATE HCL0291200mgTabUrispasPAL1996-10-01Apo-FlavoxateAPX2002-07-29PMS-FlavoxatePMS2003-01-30IPRATROPIUM BROMIDE0292250mcg/mLInh Sol-20mL Pk6.3140AtroventBOE1996-10-01Apo-Ipravent Inhalation SolutionAPX6.31402000-11-30Novo-IpramideNOP6.31401999-04-15PMS-IpratropiumPMS6.31401999-04-15Mylan-Ipratropium SolutionMYL6.31402000-04-17For the vast majority of patients, a metered dose inhaler is the preferred therapy. Nebulizer therapy will be reimbursed for patients who are unable to use a metered dose inhaler, including an inhaler with a spacer attachment, or a turbuhaler.Patients who have a tracheostomy;LU Authorization Period: Indefinite.Patients with cystic fibrosis in whom nebulizer therapy is indicated;LU Authorization Period: Indefinite.Patients with severe mental or physical disabilities;LU Authorization Period: Indefinite.Patients who have previously used nebulizer therapy within the last 12 month period.LU Authorization Period: Indefinite.0293125mcg/mLInh Sol-2mL UDV Pk.6590Atrovent UDVBOE1996-10-01Ratio-Ipratropium UDVRPH.65901998-12-31PMS-IpratropiumPMS.65901999-04-150294250mcg/mLInh Sol-2mL UDV Pk1.3180Atrovent UDVBOE1996-10-01Ratio-Ipratropium UDVRPH1.31801996-12-19Mylan-Ipratropium SterinebsMYL1.31801999-09-15PMS-IpratropiumPMS1.31801999-04-15For the vast majority of patients, a metered dose inhaler is the preferred therapy. Nebulizer therapy will be reimbursed for patients who are unable to use a metered dose inhaler, including an inhaler with a spacer attachment, or a turbuhaler.Individuals must have a known hypersensitivity to the preservative in the bulk solution, and have a tracheostomy;LU Authorization Period: Indefinite.Individuals must have a known hypersensitivity to the preservative in the bulk solution, and be patients with cystic fibrosis in whom nebulizer therapy is indicated;.LU Authorization Period: Indefinite.Individuals must have a known hypersensitivity to the preservative in the bulk solution, and have severe mental or physical disabilities;LU Authorization Period: Indefinite.Patients who have previously used nebulizer therapy within the last 12 month period.LU Authorization Period: Indefinite.029520mcg/Metered DoseInh-200 Dose Pk18.3400Atrovent HFABOE18.34002004-11-04IPRATROPIUM BROMIDE/SALBUTAMOL0296500mcg/2.5mg/2.5mLInh Sol-2.5mL Pk.7340Combivent UDVBOE1.50751998-12-31Ratio-IPRA SAL UDVRPH.73402003-01-30Mylan-Combo SterinebsMYL.73402006-01-24For the vast majority of patients, a metered dose inhaler is the preferred therapy. Nebulizer therapy will be reimbursed for patients who are unable to use a metered dose inhaler, including an inhaler with a spacer attachment, or a turbuhaler.Patients who have a tracheostomy;LU Authorization Period: Indefinite.Patients with cystic fibrosis in whom nebulizer therapy is indicated;LU Authorization Period: Indefinite.Patients with severe mental or physical disabilities;LU Authorization Period: Indefinite.Patients who have previously used nebulizer therapy within the last 12 month period.LU Authorization Period: Indefinite.OXYBUTYNIN CHLORIDE02971mg/mLO/L.0444DitropanJNO1996-10-01PMS-OxybutyninPMS.04441998-12-3102985mgTab.0986DitropanPGP1996-10-01Nu-OxybutynNXP.09861996-10-01Apo-OxybutyninAPX.09861996-10-01Novo-OxybutyninNOP.09861998-12-31Mylan-OxybutyninMYL.09861998-12-31PMS-OxybutyninPMS.09862000-07-17PROCYCLIDINE HCL02992.5mgTab.0555PMS-ProcyclidinePMS.05551996-10-0103005mgTab.0255KemadrinBWE1996-10-01PMS-ProcyclidinePMS.02551996-10-01SCOPOLAMINE HYDROBROMIDE03010.4mg/mLInj Sol-1mL PkScopolamine Hydrobromide InjectionHOS2011-05-19Scopolamine Hydrobromide InjectionOMG2011-05-1903020.6mg/mLInj Sol-1mL PkScopolamine Hydrobromide InjectionHOS2011-05-19Scopolamine Hydrobromide InjectionOMG2011-05-19TIOTROPIUM BROMIDE MONOHYDRATE030318mcgCap2.1000SpirivaBOE2.10002003-09-04TRIHEXYPHENIDYL HCL03042mgTab.0369ArtaneLED1996-10-01TrihexyphenidylAAP.03691996-10-0103055mgTab.0668ArtaneLED1996-10-01TrihexyphenidylAAP.06681996-10-01TRIMEBUTINE MALEATE0306100mgTabModulonBFI2008-01-15TrimebutineAAP2008-01-150307200mgTabModulonBFI2008-01-15TrimebutineAAP2008-01-15SYMPATHOMIMETIC (ADRENERGIC) AGENTSSolutions for use in nebulizers are more expensive than metered dose inhalers (MDI) and turbuhalers, and for most patients, there is no significant benefit. The only indication for this mode of administration is for selected patient groups, such as those noted in the Limited Use clinical criteria for solutions for use in nebulizers, who are unable to use other formulations. Even children who are unable to coordinate actuation of a MDI and inhalation can usually use a spacer or turbuhaler. Special fittings are available for patients with severe arthritis who have difficulty using a standard MDI.BUDESONIDE & FORMOTEROL FUMARATE DIHYDRATE0308100mcg/6mcgPd Inh-120 Dose Pk61.7400Symbicort 100 TurbuhalerAZC61.74002003-01-300309200mcg/6mcgPd Inh-120 Dose Pk80.2600Symbicort 200 TurbuhalerAZC80.26002003-01-30For the treatment of asthma in patients who are using optimum anti-inflammatory treatment and are still experiencing breakthrough symptoms.LU Authorization Period: Indefinite.EPINEPHRINE HCL031030mg/30mLInj Sol-30mL Pk21.5800AdrenalinERF21.58001996-10-01FORMOTEROL FUMARATE031112mcg/CapInh Pd-Device Pk48.1200ForadilNOV48.12001998-12-31For the treatment of asthma in patients who are using optimum anti-inflammatory treatment and are still experiencing breakthrough symptoms.This drug is not for relief of acute symptoms.LU Authorization Period: Indefinite.FORMOTEROL FUMARATE DIHYDRATE03126mcg/Metered DosePd Inh-60 Dose Pk33.6500Oxeze TurbuhalerAZC33.65002001-03-07031312mcg/Metered DosePd Inh-60 Dose Pk44.8000Oxeze TurbuhalerAZC44.80001999-04-15For the treatment of asthma in patients who are using optimum anti-inflammatory treatment and are still experiencing breakthrough symptoms.This drug is not for relief of acute symptoms.LU Authorization Period: Indefinite.ORCIPRENALINE SULFATE03142mg/mLO/L.0574AlupentBOE1996-10-01Apo-OrciprenalineAPX.05742001-03-07PSEUDOEPHEDRINE HCL03156mg/mLO/LSudafedBWE1996-10-01031660mgTabSudafedBWE1996-10-01SALBUTAMOL03171mg/mLInh Sol- 2.5mL Pk.3617Mylan-Salbutamol Sterinebs P.F.MYL.36171996-10-01Ratio-Salbutamol Respirator Sol P.F.RPH.36171996-10-01PMS-SalbutamolPMS.36171997-04-10Ventolin Nebules P.F.GSK1.03351998-10-21For the vast majority of patients, a metered dose inhaler is the preferred therapy. Nebulizer therapy will be reimbursed for patients who are unable to use a metered dose inhaler, including an inhaler with a spacer attachment, or a turbuhaler.Individuals must have a known hypersensitivity to the preservative in the bulk solution, and have a tracheostomy;LU Authorization Period: Indefinite.Individuals must have a known hypersensitivity to the preservative in the bulk solution, and be patients with cystic fibrosis in whom nebulizer therapy is indicated;.LU Authorization Period: Indefinite.Individuals must have a known hypersensitivity to the preservative in the bulk solution, and have severe mental or physical disabilities;LU Authorization Period: Indefinite.Patients who have previously used nebulizer therapy within the last 12 month period.LU Authorization Period: Indefinite.03182mg/mLInh Sol- 2.5mL Pk.6871Mylan-Salbutamol Sterinebs P.F.MYL.68711997-04-10PMS-SalbutamolPMS.68711997-04-10Ventolin Nebules P.F.GSK1.96302006-06-15Ratio-SalbutamolRPH.68712001-03-07For the vast majority of patients, a metered dose inhaler is the preferred therapy. Nebulizer therapy will be reimbursed for patients who are unable to use a metered dose inhaler, including an inhaler with a spacer attachment, or a turbuhaler.Individuals must have a known hypersensitivity to the preservative in the bulk solution, and have a tracheostomy;LU Authorization Period: Indefinite.Individuals must have a known hypersensitivity to the preservative in the bulk solution, and be patients with cystic fibrosis in whom nebulizer therapy is indicated;.LU Authorization Period: Indefinite.Individuals must have a known hypersensitivity to the preservative in the bulk solution, and have severe mental or physical disabilities;LU Authorization Period: Indefinite.Patients who have previously used nebulizer therapy within the last 12 month period.LU Authorization Period: Indefinite.03195mg/mLInh Sol-10mL Pk3.5105Ratio-Salbutamol Respirator SolRPH3.51051996-10-01PMS-Salbutamol Respirator SolutionPMS3.51051996-10-01Sandoz SalbutamolSDZ3.51051996-10-01VentolinGSK10.03001998-04-03Gen-SalbutamolGEN3.51051999-04-15For the vast majority of patients, a metered dose inhaler is the preferred therapy. Nebulizer therapy will be reimbursed for patients who are unable to use a metered dose inhaler, including an inhaler with a spacer attachment, or a turbuhaler.Patients who have a tracheostomy;LU Authorization Period: Indefinite.Patients with cystic fibrosis in whom nebulizer therapy is indicated;LU Authorization Period: Indefinite.Patients with severe mental or physical disabilities;LU Authorization Period: Indefinite.Patients who have previously used nebulizer therapy within the last 12 month period.LU Authorization Period: Indefinite.0320100mcg/Metered DoseInh-200 dose Pk6.0000Apo-SalventAPX1996-10-01Ratio-Salbutamol InhalerRPH1996-10-01Novo-SalmolNOP1996-10-01VentolinGLW1997-07-12Airomir HFAGRA6.00001998-12-31Ventolin HFAGSK6.00002009-11-13Apo-Salvent CFC FreeAPX6.00002003-01-01Novo-Salbutamol HFANOP6.00002011-05-1903210.4mg/mLO/L.0476PMS-SalbutamolPMS.04762004-12-21VentolinGSK1998-03-1703222mgTab.1274VentolinGLA1996-10-01Apo-SalventAPX.12741996-10-0103234mgTab.2134VentolinGLA1996-10-01Apo-SalventAPX.21341996-10-01SALMETEROL XINAFOATE032450mcg/BlisterDiskhaler-60 Disk Pk56.1000SereVent Diskhaler DisksGSK56.10001997-07-12032550mcgPd Inh-60 Dose Pk56.1000SereVent DiskusGSK56.10001998-12-31For the treatment of asthma in patients who are using optimum anti-inflammatory treatment and are still experiencing breakthrough symptoms.This drug is not for relief of acute symptoms.LU Authorization Period: Indefinite.For patients with moderate to severe COPD with persistent respiratory symptoms despite an adequate trial of, or an intolerance to, a regularly scheduled short-acting bronchodilator AND a long-acting anticholinergic.LU Authorization Period: Indefinite.SALMETEROL XINAFOATE & FLUTICASONE PROPIONATE032625/125mcg/Metered DoseInh-120 Dose Pk95.9900Advair 125GSK95.99002003-01-30032725/250mcg/Metered DoseInh-120 Dose Pk136.2700Advair 250GSK136.27002003-01-30032850/100mcgInh-60 Dose Pk80.1900Advair DiskusGSK80.19002001-10-11032950/250mcgInh-60 Dose Pk95.9900Advair DiskusGSK95.99002000-07-17033050/500mcgInh-60 Dose Pk136.2700Advair DiskusGSK136.27002000-07-17For the treatment of asthma in patients who are using optimum anti-inflammatory treatment and are still experiencing breakthrough symptoms.LU Authorization Period: Indefinite.TERBUTALINE SULFATE03310.5mg/DoseInh-200 Dose Pk15.1200Bricanyl TurbuhalerAZC15.12001996-10-01SYMPATHOLYTIC (ADRENERGIC BLOCKING) AGENTSErgotamine is the drug of choice in the treatment of acute attacks of migraine. It may also alleviate or prevent acute attacks of cluster headache in some patients. The addition of caffeine or pentobarbital have not been proven to result in greater efficacy.ERGOTAMINE TARTRATE & CAFFEINE03321mg & 100mgTab.8505CafergotNOV.85051996-10-01SKELETAL MUSCLE RELAXANTSMuscle relaxants, other than baclofen and dantrolene sodium, are not indicated for spasticity due to cerebral palsy, multiple sclerosis, spinal cord injury, etc.BACLOFEN033310mgTab.1595LioresalNOV.68651996-10-01PMS-BaclofenPMS.15951996-10-01Mylan-BaclofenMYL.15951996-10-01Nu-BacloNXP.15951996-10-01Apo-BaclofenAPX.15951996-10-01Ratio-BaclofenRPH.15951999-04-15Phl-BaclofenPHE.15952010-06-14033420mgTab.3104Lioresal DSNOV1.33611996-10-01PMS-BaclofenPMS.31041996-10-01Mylan-BaclofenMYL.31041996-10-01Nu-BacloNXP.31041996-10-01Apo-BaclofenAPX.31041996-10-01Ratio-BaclofenRPH.31041999-04-15Phl-BaclofenPHE.31042010-06-14CYCLOBENZAPRINE HCL033510mgTabFlexerilFRS1996-10-01Novo-CycloprineNOP1996-10-01Nu-CyclobenzaprineNXP1996-10-01Apo-CyclobenzaprineAPX1996-10-01PMS-CyclobenzaprinePMS1996-12-19Mylan-CyclobenzaprineMYL1998-12-31Ratio-CyclobenzaprineRPH1999-09-15Phl-CyclobenzaprinePHE2010-06-14Auro-CyclobenzaprineAUR2011-12-15DANTROLENE SODIUM033625mgCap.3780DantriumJHP.37801996-10-010337100mgCap.7684DantriumJHP.76841996-10-01ORPHENADRINE CITRATE033860mg/2mLInj Sol-2mL PkNorflexMMH1996-10-01OrphenadrineCYI1998-12-31TIZANIDINE HCL03394mgTabZanaflexELA2007-06-06Apo-TizanidineAPX2007-06-06Mylan-TizanidineMYL2007-06-06BLOOD FORMATION AND COAGULATIONANTIANEMIA DRUGSFERROUS FUMARATE0340300mgCap.1234PalaferGSK.21141996-10-01Euro-FerEUR.12342006-07-19034160mg/mLO/L.0900PalaferGSK.09001996-10-01FERROUS GLUCONATE0342300mgTab.0212Novo-FerroglucNOP.02121996-10-01Ferrous GluconateJPC1996-10-01Apo-Ferrous GluconateAPX.02121996-10-01FERROUS SULFATE034375mg/mLO/L.2436Fer-In-SolMJS.24361997-01-03COAGULANTS AND ANTI-COAGULANTSDALTEPARIN SODIUM03442500IU/0.2mLInj Pref Syr5.1376FragminPFI5.13761996-10-0103455000IU/0.2mLInj Pref Syr10.2752FragminPFI10.27521997-04-10034610000IU/0.4mLInj Pref Syr20.5504FragminPFI20.55042011-03-15FragminPFI20.55042001-06-07034712500IU/0.5mLInj Pref Syr25.6880FragminPFI25.68802011-03-15FragminPFI25.68802001-06-07034815000IU/0.6mLInj Pref Syr30.8256FragminPFI30.82562011-03-15FragminPFI30.82562001-06-07034918000IU/0.72mLInj Pref Syr36.9907FragminPFI36.99072011-03-15FragminPFI36.99072001-06-07035010000IU/mLInj Sol-1mL Pk16.2240FragminPFI16.22401996-10-01035125000IU/mLMultidose 3.8mL Pk154.1280FragminPFI154.12801998-12-31For acute treatment of deep venous thrombosis (DVT), for a maximum of three weeks;LU Authorization Period: 1 year.For DVT in pregnant or lactating females;LU Authorization Period: 1 year.For DVT in patients whom treatment with warfarin is not tolerated, or contraindicated;LU Authorization Period: 1 year.For DVT in patients who have failed treatment with warfarin.LU Authorization Period: 1 year.ENOXAPARIN0352100mg/mLInj Sol-3mLVial Pk61.5000LovenoxSAV61.50002003-01-30035330mg/0.3mLPref Syr-0.3mL Pk6.1900LovenoxSAV6.19002003-01-30035440mg/0.4mLPref Syr-0.4mL Pk8.2000LovenoxSAV8.20002003-01-30035560mg/0.6mLPref Syr-0.6mL Pk12.3000LovenoxSAV12.30002003-01-30035680mg/0.8mLPref Syr-0.8mL Pk16.4000LovenoxSAV16.40002003-01-300357120mg/0.8mLPref Syr-0.8mL Pk24.6000Lovenox HPSAV24.60002005-02-220358100mg/mLPref Syr-1mL Pk20.5000LovenoxSAV20.50002003-01-300359150mg/mLPref Syr-1mL Pk30.7500Lovenox HPSAV30.75002005-02-22For acute treatment of deep venous thrombosis (DVT), for a maximum of three weeks;LU Authorization Period: 1 year.For DVT in pregnant or lactating females;LU Authorization Period: 1 year.For DVT in patients whom treatment with warfarin is not tolerated, or contraindicated;LU Authorization Period: 1 year.For DVT in patients who have failed treatment with warfarin.LU Authorization Period: 1 year.For the acute treatment of pulmonary embolism, maximum of three weeks.LU Authorization Period: 1 year.FONDAPARINUX SODIUM03602.5mgInj-0.5mL Pk15.4320ArixtraGSK15.43202004-04-06For the post-operative prophylaxis of venous thromboembolic events in patients undergoing orthopedic surgery of the lower limbs such as hip fracture, hip replacement or knee surgery.Limited to 9 days of reimbursement.LU Authorization Period: 1 year.HEPARIN SODIUM036110000USP U/10mLInj Sol-10mL Pk3.5875HepaleanORG3.58751996-10-01036250000USP U/5mLInj Sol-5mL Pk6.0373HepaleanORG6.03731996-10-01NADROPARIN CALCIUM03639500IU/mLPref Syr-0.3mL Pk9.1290FraxiparineGSK9.12901999-04-1503649500IU/mLPref Syr-0.4mL Pk9.1290FraxiparineGSK9.12901999-04-1503659500IU/mLPref Syr-0.6mL Pk9.1290FraxiparineGSK9.12901999-04-15036619000IU/mLPref Syr-0.6mL Pk18.2580Fraxiparine ForteGSK18.25802000-01-1703679500IU/mLPref Syr-0.8mL Pk9.1290FraxiparineGSK9.12901999-04-15036819000IU/mLPref Syr-0.8mL Pk18.2580Fraxiparine ForteGSK18.25802000-01-1703699500IU/mLPref Syr-1.0mL Pk9.1290FraxiparineGSK9.12901999-04-15037019000IU/mLPref Syr-1.0mL Pk18.2580Fraxiparine ForteGSK18.25802000-01-17For acute treatment of deep venous thrombosis (DVT), for a maximum of three weeks;LU Authorization Period: 1 year.For DVT in pregnant or lactating females;LU Authorization Period: 1 year.For DVT in patients whom treatment with warfarin is not tolerated, or contraindicated;LU Authorization Period: 1 year.For DVT in patients who have failed treatment with warfarin.LU Authorization Period: 1 year.RIVAROXABAN037110mgTab8.8598Note: For the prevention of venous thromboembolic events in patients who have undergone elective total hip replacement (THR) or total knee replacement (TKR) surgery. NETWORK NOTE: Limited to 14 days of reimbursement in TKR and limited to 30 days of reimbursement in THR. Both indications are limited to 1 claim in a 120 day period.XareltoBAH8.85982009-06-23TINZAPARIN SODIUM037210000IU/mLInj - 2mL Pk32.7040InnohepLEO32.70401997-04-10037320000IU/mLInj - 2mL Pk66.4300InnohepLEO66.43001998-12-3103742500IU/0.25mLInj Pref Syr4.1250InnohepLEO4.12502010-07-2003753500IU/0.35mLInj Pref Syr5.7700InnohepLEO5.77002011-08-0403764500IU/0.45mLInj Pref Syr7.4200InnohepLEO7.42002011-08-04InnohepLEO7.42001998-12-31037710000IU/0.5mLInj Pref Syr16.8450InnohepLEO16.84501998-12-31037814000IU/0.7mLInj Pref Syr23.5800InnohepLEO23.58002011-08-04InnohepLEO23.58001998-12-31037918000IU/0.9mLInj Pref Syr30.3150InnohepLEO30.31502011-08-04InnohepLEO30.31501998-12-31For acute treatment of deep venous thrombosis (DVT), for a maximum of three weeks;LU Authorization Period: 1 year.For DVT in pregnant or lactating females;LU Authorization Period: 1 year.For DVT in patients whom treatment with warfarin is not tolerated, or contraindicated;LU Authorization Period: 1 year.For DVT in patients who have failed treatment with warfarin.LU Authorization Period: 1 year.For the acute treatment of pulmonary embolism, maximum of three weeks.LU Authorization Period: 1 year.WARFARINThe use of International Normalized Ratio (INR) instead of Prothrombin Time results to control warfarin dosing is strongly recommended. Prothrombin Time results can vary three-fold depending on the reagent used; INR corrects for this and substantially improves safety and efficacy of warfarin therapy.03801mgTab.0796CoumadinBQU.32801996-10-01Taro-WarfarinTAR.14152001-06-07Apo-WarfarinAPX.07962001-06-07Gen-WarfarinGEN.07962003-01-30Novo-WarfarinNOP.07962005-09-1603812mgTab.0841CoumadinBQU.34701996-10-01Taro-WarfarinTAR.14962001-06-07Apo-WarfarinAPX.08412001-06-07Gen-WarfarinGEN.08412003-01-30Novo-WarfarinNOP.08412005-09-1603822.5mgTab.0674CoumadinBQU.27751996-10-01Taro-WarfarinTAR.11982001-06-07Apo-WarfarinAPX.06742001-06-07Gen-WarfarinGEN.06742003-01-30Novo-WarfarinNOP.06742005-09-1603833mgTab.1043CoumadinBQU.43002001-06-07Taro-WarfarinTAR.18552002-04-04Apo-WarfarinAPX.10432003-01-30Novo-WarfarinNOP.10432005-09-16Gen-WarfarinGEN.10432007-03-0903844mgTab.1043CoumadinBQU.43001996-10-01Taro-WarfarinTAR.18552001-06-07Apo-WarfarinAPX.10432001-06-07Gen-WarfarinGEN.10432003-01-30Novo-WarfarinNOP.10432005-09-1603855mgTab.0675CoumadinBQU.27801996-10-01Taro-WarfarinTAR.12002001-06-07Apo-WarfarinAPX.06752001-06-07Gen-WarfarinGEN.06752003-01-30Novo-WarfarinNOP.06752005-09-1603866mgTabCoumadinBQU2008-06-27Taro-WarfarinTAR2008-12-03Gen-WarfarinGEN2008-06-27038710mgTab.1211CoumadinBQU.49901996-10-01Taro-WarfarinTAR.21532001-06-07Apo-WarfarinAPX.12112001-06-07Gen-WarfarinGEN.12112003-01-30HEMATOPOIETIC AGENTSDARBEPOETIN ALFA0388150mcg/0.3mLPref Syr-0.3mL Pk402.0000AranespAMG402.00002007-01-020389200mcg/0.4mLPref Syr-0.4mL Pk546.2400AranespAMG546.24002007-01-020390300mcg/0.6mLPref Syr-0.6mL Pk843.8100AranespAMG843.81002007-01-020391500mcg/1.0mLPref Syr-1.0mL Pk1406.3600AranespAMG1406.36002007-01-02ESAs (Eprex or Aranesp) for patients with: Cancer diagnosis and receiving chemotherapy; AND Presence of anemia caused by chemotherapy with a hemoglobin count less than 100g/L; AND Patient has been informed of the risks and benefits of ESA therapy AND Anemia cannot be managed by use of blood transfusions due to at least one of the following: Religious beliefs do not allow the patient to receive transfusions. Previous severe (potentially life-threatening) reaction to a transfusion or difficulty cross-matching. Myeloid cancers that cannot be managed with blood transfusions Patient lives far away from treatment centre and/or transfusions cannot be coordinated with chemotherapy Patients receiving neoadjuvant chemotherapy with anemia and at risk of high blood losses due to surgery Please refer to the product monograph for starting dose, dose adjustment and discontinuation recommendations. NOTE: Health Canada has issued the following statements regarding ESA therapy for the treatment of anemia due to chemotherapy in patients with non-myeloid malignancies: In patients with a long life expectancy, the decision to administer ESAs should be based on a benefit-risk assessment with the participation of the individual patient. This should take into account the specific clinical context such as (but not limited to) the type of tumor and its stage, the degree of anemia, life expectancy, the environment in which the patient is being treated and known risks of transfusions and ESAs. If appropriate, red blood cell transfusion should be the preferred treatment for the management of anemia in patients with a long life expectancy and who are receiving myelosuppressive chemotherapy. ESAs are not indicated for use in patients receiving hormonal agents, therapeutic biologic products, or radiotherapy unless receiving concomitant myelosuppressive chemotherapy. Health Canada has also issued the following Serious Warnings and Precautions for cancer patients regarding ESAs: ESAs increased the risks for death and serious cardiovascular and thromboembolic events in some controlled clinical trials. ESAs shortened overall survival and/or increased the risk of tumour progression or recurrence in some clinical studies in patients with breast, head and neck, lymphoid, cervical and non-small cell lung cancers when dosed to target a hemoglobin of greater than or equal to 120g/L. To minimize the above risks, use the lowest dose needed to avoid red blood cell (RBC) transfusions. Use ESAs only for treatment of anemia due to concomitant myelosuppressive chemotherapy. If appropriate, red blood cell transfusion should be the preferred treatment for the management of anemia in patients with a long life expectancy and who are receiving myelosuppressive chemotherapy. Discontinue ESAs following completion of a chemotherapy course. LU Authorization Period: 1 year.EPOETIN ALFA039210,000IU/mLPref Syr - 1mL Pk142.5000EprexJAN142.50002007-01-02039340,000IU/mLPref Syr - 1mL Pk428.3900EprexJAN428.39002007-01-02039420,000IU/0.5mLPref Syr-0.5mL Pk285.6000EprexJAN285.60002009-03-02ESAs (Eprex or Aranesp) for patients with: Cancer diagnosis and receiving chemotherapy; AND Presence of anemia caused by chemotherapy with a hemoglobin count less than 100g/L; AND Patient has been informed of the risks and benefits of ESA therapy AND Anemia cannot be managed by use of blood transfusions due to at least one of the following: Religious beliefs do not allow the patient to receive transfusions. Previous severe (potentially life-threatening) reaction to a transfusion or difficulty cross-matching. Myeloid cancers that cannot be managed with blood transfusions Patient lives far away from treatment centre and/or transfusions cannot be coordinated with chemotherapy Patients receiving neoadjuvant chemotherapy with anemia and at risk of high blood losses due to surgery Please refer to the product monograph for starting dose, dose adjustment and discontinuation recommendations. NOTE: Health Canada has issued the following statements regarding ESA therapy for the treatment of anemia due to chemotherapy in patients with non-myeloid malignancies: In patients with a long life expectancy, the decision to administer ESAs should be based on a benefit-risk assessment with the participation of the individual patient. This should take into account the specific clinical context such as (but not limited to) the type of tumor and its stage, the degree of anemia, life expectancy, the environment in which the patient is being treated and known risks of transfusions and ESAs. If appropriate, red blood cell transfusion should be the preferred treatment for the management of anemia in patients with a long life expectancy and who are receiving myelosuppressive chemotherapy. ESAs are not indicated for use in patients receiving hormonal agents, therapeutic biologic products, or radiotherapy unless receiving concomitant myelosuppressive chemotherapy. Health Canada has also issued the following Serious Warnings and Precautions for cancer patients regarding ESAs: ESAs increased the risks for death and serious cardiovascular and thromboembolic events in some controlled clinical trials. ESAs shortened overall survival and/or increased the risk of tumour progression or recurrence in some clinical studies in patients with breast, head and neck, lymphoid, cervical and non-small cell lung cancers when dosed to target a hemoglobin of greater than or equal to 120g/L. To minimize the above risks, use the lowest dose needed to avoid red blood cell (RBC) transfusions. Use ESAs only for treatment of anemia due to concomitant myelosuppressive chemotherapy. If appropriate, red blood cell transfusion should be the preferred treatment for the management of anemia in patients with a long life expectancy and who are receiving myelosuppressive chemotherapy. Discontinue ESAs following completion of a chemotherapy course. LU Authorization Period: 1 year.HEMORRHEOLOGIC AGENTSPENTOXIFYLLINE0395400mgSR Tab.5846TrentalSAV.79181999-01-07Apo-PentoxifyllineAPX.58461997-08-28For the treatment of patients with critical limb ischemia (with arterial ulcers, gangrene and/or rest pain) and documented arterial vascular disease.Limited Use form must specify if arterial ulcers, gangrene and/or rest pain are present.LU Authorization Period: Indefinite.CARDIOVASCULAR DRUGSCARDIAC DRUGSACEBUTOLOL HCL0396100mgTab.0787.1574RhotralSAV.0787.15741996-10-01SectralSAV.3356.67121996-10-01MonitanWAY1996-10-01Apo-AcebutololAPX.0787.15741996-10-01Nu-AcebutololNXP.0787.15741998-12-31Novo-AcebutololNOP.0787.15741998-12-31Mylan-AcebutololMYL.0787.15741999-04-15Mylan-Acebutolol (Type S)MYL.0787.15742000-01-170397200mgTab.1177.2354RhotralSAV.1177.23541996-10-01SectralSAV.50351.00701996-10-01MonitanWAY1996-10-01Apo-AcebutololAPX.1177.23541996-10-01Nu-AcebutololNXP.1177.23541998-12-31Novo-AcebutololNOP.1177.23541998-12-31Mylan-AcebutololMYL.1177.23541999-04-15Mylan-Acebutolol (Type S)MYL.1177.23542000-01-170398400mgTab.2466.4932RhotralSAV.2466.49321996-10-01SectralSAV1.00192.00381996-10-01MonitanWAY1996-10-01Apo-AcebutololAPX.2466.49321996-10-01Nu-AcebutololNXP.2466.49321998-12-31Novo-AcebutololNOP.2466.49321997-08-28Mylan-AcebutololMYL.2466.49321999-04-15Mylan-Acebutolol (Type S)MYL.2466.49322000-01-17AMIODARONE HCL0399200mgTab.5147The manufacturer recommends that treatment with amiodarone be initiated in hospital and continued in a monitored environment under the care of a cardiologist, or internist with equivalent experience in such care.CordaroneWAY2.05891996-10-01Novo-AmiodaroneNOP.51471999-09-15Ratio-AmiodaroneRPH.51472000-01-17Mylan-AmiodaroneMYL.51472000-01-17PMS-AmiodaronePMS.51472001-06-07Sandoz AmiodaroneSDZ.51472002-07-29Phl-AmiodaronePHE.51472010-06-14Apo-AmiodaroneAPX.51472004-04-06AMLODIPINE04005mgTab.3391.3391NorvascPFI1.38091.38091996-10-01Novo-AmlodipineNOP.3391.33912009-09-30Ratio-AmlodipineRPH.3391.33912009-09-30Mylan-AmlodipineMYL.3391.33912009-09-30Apo-AmlodipineAPX.3391.33912009-09-30Gd-AmlodipineGEM.3391.33912009-09-30PMS-AmlodipinePMS.3391.33912009-09-30Sandoz AmlodipineSDZ.3391.33912009-09-30Co AmlodipineCOB.3391.33912009-09-30Ran-AmlodipineRAN.3391.33912009-09-30Phl-AmlodipinePHE.3391.33912009-09-30Jamp-AmlodipineJPC.3391.33912010-04-23Amlodipine TabletsRAN.3391.33912010-01-05Zym-AmlodipineZYN.3391.33912010-07-20Septa-AmlodipineSET.3391.33912011-03-15Mint-AmlodipineMIN.3391.33912011-08-04Mar-Amlodipine TabletsMAR.3391.33912012-01-19040110mgTab.5034.5034NorvascPFI2.04972.04971996-10-01Novo-AmlodipineNOP.5034.50342009-09-30Ratio-AmlodipineRPH.5034.50342009-09-30Mylan-AmlodipineMYL.5034.50342009-09-30Apo-AmlodipineAPX.5034.50342009-09-30Gd-AmlodipineGEM.5034.50342009-09-30PMS-AmlodipinePMS.5034.50342009-09-30Sandoz AmlodipineSDZ.5034.50342009-09-30Co AmlodipineCOB.5034.50342009-09-30Ran-AmlodipineRAN.5034.50342009-09-30Phl-AmlodipinePHE.5034.50342009-09-30Jamp-AmlodipineJPC.5034.50342010-04-23Amlodipine TabletsRAN.5034.50342010-01-05Zym-AmlodipineZYN.5034.50342010-07-20Septa-AmlodipineSET.5034.50342011-03-15Mint-AmlodipineMIN.5034.50342011-08-04Mar-Amlodipine TabletsMAR.5034.50342012-01-19ATENOLOL040250mgTab.1437.1437Apo-AtenolAPX.1437.14371996-10-01Nu-AtenolNXP.1437.14371996-10-01Novo-AtenolNOP.1437.14371996-10-01TenorminAZC.5910.59101996-10-01Mylan-AtenololMYL.1437.14371996-10-01Ratio-AtenololRPH.1437.14371996-10-01Sandoz AtenololSDZ.1437.14372000-01-17PMS-AtenololPMS.1437.14371999-04-15Phl-AtenololPHE.1437.14372010-06-14Co AtenololCOB.1437.14372004-10-14Ran-AtenololRAN.1437.14372006-03-01Jamp-AtenololJPC.1437.14372012-01-19Mint-AtenolMIN.1437.14372012-01-19Mar-AtenololMAR.1437.14372012-01-190403100mgTab.2362.2362Apo-AtenolAPX.2362.23621996-10-01Nu-AtenolNXP.2362.23621996-10-01Novo-AtenolNOP.2362.23621996-10-01TenorminAZC.9717.97171996-10-01Mylan-AtenololMYL.2362.23621996-10-01Ratio-AtenololRPH.2362.23621996-10-01Sandoz AtenololSDZ.2362.23622000-01-17PMS-AtenololPMS.2362.23621999-04-15Phl-AtenololPHE.2362.23622010-06-14Co AtenololCOB.2362.23622004-10-14Ran-AtenololRAN.2362.23622006-03-01Jamp-AtenololJPC.2362.23622012-01-19Mint-AtenolMIN.2429.24292012-01-19Mar-AtenololMAR.2362.23622012-01-19BISOPROLOL FUMARATE04045mgTab.0994MonocorBIO2001-06-07Sandoz BisoprololSDZ.09942003-09-04Apo-BisoprololAPX.09942004-11-16Novo-BisoprololNOP.09942005-08-19PMS-BisoprololPMS.09942008-02-12040510mgTab.1450MonocorCRY2001-06-07Sandoz BisoprololSDZ.14502003-09-04Apo-BisoprololAPX.14502004-11-16Novo-BisoprololNOP.14502005-08-19PMS-BisoprololPMS.14502008-02-12CARVEDILOL04063.125mgTab.3377.6754CoregGSK1997-04-10PMS-CarvedilolPMS.3377.67542004-04-06Apo-CarvedilolAPX.3377.67542004-04-06Phl-CarvedilolPHE.3377.67542010-03-02Ratio-CarvedilolRPH.3377.67542004-07-20Ran-CarvedilolRAN.3377.67542005-12-06Zym-CarvedilolZYN.3377.67542010-04-23Mylan-CarvedilolMYL.3377.67542010-06-1404076.25mgTab.3377.6754CoregGSK1997-04-10PMS-CarvedilolPMS.3377.67542004-04-06Apo-CarvedilolAPX.3377.67542004-04-06Phl-CarvedilolPHE.3377.67542010-03-02Ratio-CarvedilolRPH.3377.67542004-07-20Ran-CarvedilolRAN.3377.67542005-12-06Zym-CarvedilolZYN.3377.67542010-04-23Mylan-CarvedilolMYL.3377.67542010-06-14040812.5mgTab.3377.6754CoregGSK1997-04-10PMS-CarvedilolPMS.3377.67542004-04-06Apo-CarvedilolAPX.3377.67542004-04-06Phl-CarvedilolPHE.3377.67542010-03-02Ratio-CarvedilolRPH.3377.67542004-07-20Ran-CarvedilolRAN.3377.67542005-12-06Zym-CarvedilolZYN.3377.67542010-04-23Mylan-CarvedilolMYL.3377.67542010-06-14040925mgTab.3377.6754CoregGSK1997-04-10PMS-CarvedilolPMS.3377.67542004-04-06Apo-CarvedilolAPX.3377.67542004-04-06Phl-CarvedilolPHE.3377.67542010-03-02Ratio-CarvedilolRPH.3377.67542004-07-20Ran-CarvedilolRAN.3377.67542005-12-06Zym-CarvedilolZYN.3377.67542010-04-23Mylan-CarvedilolMYL.3377.67542010-06-14For patients with:a) NYHA Class II or III Congestive Heart Failure (CHF); and b) Currently being treated with an angiotension converting enzyme (ACE) inhibitor, diuretics with or without digoxin, or previously treated, and failed these agents; and c) An ejection fraction less than or equal to 35%; and d) At least one episode of symptomatic CHF within a 12 month period while receiving optimal management.LU Authorization Period: Indefinite.DIGOXINDigoxin toxicity is common and serious: digoxin levels should be monitored in the elderly, after adding drugs that affect urea clearance including diuretics, particularly spironolactone; verapamil and quinidine also interact significantly with digoxin. Dose should be reduced in renal impairment and in elderly patients. Chronic therapy should be re-evaluated.04100.05mg/mLO/L.3561LanoxinPMS.35612002-04-0404110.0625mgTab.2177ToloxinMMT.21772010-06-1404120.125mgTab.2060Apo-DigoxinAPX2006-08-24ToloxinMMT.20602010-06-1404130.25mgTab.2060Apo-DigoxinAPX2006-08-24ToloxinMMT.20602010-06-14DILTIAZEM HCL0414120mgER Tab.7982Tiazac XCBIO.79822005-05-250415180mgER Tab1.0606Tiazac XCBIO1.06062005-05-250416240mgER Tab1.4096Tiazac XCBIO1.40962005-05-250417300mgER Tab1.4068Tiazac XCBIO1.40682005-05-250418360mgER Tab1.4096Tiazac XCBIO1.40962005-05-250419120mgLA Cap.3634.3634Cardizem CDBIO1.47841.47841996-10-01Ratio-Diltiazem CDRPH.3634.36341997-04-10Apo-Diltiaz CDAPX.3634.36341997-08-28Novo-Diltazem CDNOP.3634.36342001-06-07Sandoz Diltiazem CDSDZ.3634.36342001-10-11PMS-Diltiazem CDPMS.3634.36342011-05-19Co Diltiazem CDCOB.3634.36342012-01-190420180mgLA Cap.4824.4824Cardizem CDBIO1.96251.96251996-10-01Ratio-Diltiazem CDRPH.4824.48241997-04-10Apo-Diltiaz CDAPX.4824.48241997-08-28Novo-Diltazem CDNOP.4824.48242001-06-07Sandoz Diltiazem CDSDZ.4824.48242001-10-11PMS-Diltiazem CDPMS.4824.48242011-05-19Co Diltiazem CDCOB.4824.48242012-01-190421240mgLA Cap.6399.6399Cardizem CDBIO2.60312.60311996-10-01Ratio-Diltiazem CDRPH.6399.63991997-04-10Apo-Diltiaz CDAPX.6399.63991997-08-28Novo-Diltazem CDNOP.6399.63992001-06-07Sandoz Diltiazem CDSDZ.6399.63992001-10-11PMS-Diltiazem CDPMS.6399.63992011-05-19Co Diltiazem CDCOB.6399.63992012-01-190422300mgLA Cap.7999.7999Cardizem CDBIO3.25383.25381996-10-01Apo-Diltiaz CDAPX.7999.79991997-04-10Ratio-Diltiazem CDRPH.7999.79991997-04-10Novo-Diltazem CDNOP.7999.79992001-06-07Sandoz Diltiazem CDSDZ.7999.79992001-10-11PMS-Diltiazem CDPMS.7999.79992011-08-04Co Diltiazem CDCOB.7999.79992012-01-190423120mgSR Cap.2133.2133TiazacBIO.8533.85331998-12-31Sandoz Diltiazem TSDZ.2133.21332006-01-24Novo-Diltiazem HCL ERNOP.2133.21332006-03-01Apo-Diltiaz TZAPX.2133.21332009-01-30Co Diltiazem TCOB.2133.21332012-01-190424180mgSR Cap.2889.2889TiazacBIO1.15561.15561998-12-31Sandoz Diltiazem TSDZ.2889.28892006-01-24Novo-Diltiazem HCL ERNOP.2889.28892006-03-01Apo-Diltiaz TZAPX.2889.28892009-01-30Co Diltiazem TCOB.2889.28892012-01-190425240mgSR Cap.3832.3832TiazacBIO1.53281.53281998-12-31Sandoz Diltiazem TSDZ.3832.38322006-01-24Novo-Diltiazem HCL ERNOP.3832.38322006-03-01Apo-Diltiaz TZAPX.3832.38322009-01-30Co Diltiazem TCOB.3832.38322012-01-190426300mgSR Cap.4720.4720TiazacBIO1.88781.88781998-12-31Sandoz Diltiazem TSDZ.4720.47202006-01-24Novo-Diltiazem HCL ERNOP.4720.47202006-03-01Apo-Diltiaz TZAPX.4720.47202009-01-30Co Diltiazem TCOB.4720.47202012-01-190427360mgSR Cap.5778.5778TiazacBIO2.31122.31121998-12-31Sandoz Diltiazem TSDZ.5778.57782006-01-24Novo-Diltiazem HCL ERNOP.5778.57782006-03-01Apo-Diltiaz TZAPX.5778.57782009-01-30Co Diltiazem TCOB.5778.57782012-01-19042830mgTab.1866Apo-DiltiazAPX.18661996-10-01Novo-DiltazemNOP.18661996-10-01Nu-DiltiazNXP.18661996-10-01CardizemBIO1996-10-01042960mgTab.3273Apo-DiltiazAPX.32731996-10-01Novo-DiltazemNOP.32731996-10-01Nu-DiltiazNXP.32731996-10-01CardizemBIO1996-10-01DISOPYRAMIDE0430100mgCap.2714NorpaceRBT1996-10-01RythmodanSAV.27142004-07-200431150mgCap.3838NorpaceRBT1996-10-01RythmodanSAV.38382004-07-20FLECAINIDE ACETATE043250mgTab.3956TambocorGRA.55561996-10-01FlecainideAAP.39562006-07-190433100mgTab.7912TambocorGRA1.11151996-10-01FlecainideAAP.79122006-07-19METOPROLOL TARTRATE0434100mgLA Tab.1415Lopresor SRNOV.31982001-10-11Apo-Metoprolol SRAPX.14152007-11-10Sandoz Metoprolol SRSDZ.14152008-06-270435200mgLA Tab.2568Lopresor SRNOV.58032001-10-11Apo-Metoprolol SRAPX.25682007-11-10Sandoz Metoprolol SRSDZ.25682008-06-27043650mgTab.0624.1248LopresorNOV.2685.53701996-10-01BetalocAZC1996-10-01Apo-MetoprololAPX.0624.12481996-10-01Novo-MetoprolNOP.0624.12481996-10-01Apo-Metoprolol (Type L)APX.0624.12481996-10-01Novo-Metoprol (Uncoated)NOP.0624.12481996-10-01Nu-MetopNXP.0624.12481996-10-01Mylan-Metoprolol (Type L)MYL.0624.12481996-10-01PMS-Metoprolol-LPMS.0624.12481998-12-31Sandoz Metoprolol (Type L)SDZ.0624.12482004-07-20Metoprolol-LMEL.0624.12482010-12-14Sandoz Metoprolol (Type L)SDZ.0624.12482011-03-15Jamp-Metoprolol-LJPC.0624.12482011-12-150437100mgTab.1361.2722LopresorNOV.58571.17141996-10-01BetalocAZC1996-10-01Apo-MetoprololAPX.1361.27221996-10-01Novo-MetoprolNOP.1361.27221996-10-01Apo-Metoprolol (Type L)APX.1361.27221996-10-01Novo-Metoprol (Uncoated)NOP.1361.27221996-10-01Nu-MetopNXP.1361.27221996-10-01Mylan-Metoprolol (Type L)MYL.1361.27221996-10-01PMS-Metoprolol-LPMS.1361.27221998-12-31Sandoz Metoprolol (Type L)SDZ.1361.27222004-07-20Metoprolol-LMEL.1361.27222010-12-14Sandoz Metoprolol (Type L)SDZ.1361.27222011-03-15Jamp-Metoprolol-LJPC.1361.27222011-12-15MEXILETINE HCL0438100mgCap.8162MexitilBOE1996-10-01Novo-MexiletineNOP.81621998-12-310439200mgCap1.0930MexitilBOE1996-10-01Novo-MexiletineNOP1.09301998-12-31NADOLOL044040mgTab.2465.2465CorgardBQU1996-10-01Apo-NadolAPX.2465.24651996-10-01Novo-NadololNOP.2465.24651996-10-01044180mgTab.3515.7030CorgardBQU1996-10-01Apo-NadolAPX.3515.70301996-10-01Novo-NadololNOP.3515.70301996-10-010442160mgTab1.20461.2046CorgardBQU1996-10-01Apo-NadolAPX1.20461.20461996-10-01NIFEDIPINE04435mgCap.3679NifedipineAAP.36791996-10-01AdalatBAH1996-10-01044410mgCap.4877Rapid absorption of liquid nifedipine from pulvules can cause severe hypotension and aggravation of myocardial or cerebral ischemia.NifedipineAAP.48771996-10-01AdalatBAH1996-10-01PROCAINAMIDE HCL0445250mgLA Tab.4613Procan SRERF.46131996-10-010446500mgLA Tab.6536Procan SRERF.65361996-10-010447750mgLA Tab1.0506Procan SRERF1.05061996-10-01PROPAFENONE HCL0448150mgTab.2966RythmolABB1.20761996-10-01Apo-PropafenoneAPX.29662001-10-11Mylan-PropafenoneMYL.29662003-01-30PMS-PropafenonePMS.29662008-04-090449300mgTab.5227RythmolABB2.12851996-10-01Apo-PropafenoneAPX.52272001-10-11Mylan-PropafenoneMYL.52272003-01-30PMS-PropafenonePMS.52272008-04-09PROPRANOLOL045010mgTab.0172Apo-PropranololAPX.01721996-10-01Novo-PranolNOP.01721996-10-01InderalWAY1996-10-01045120mgTab.0277Apo-PropranololAPX.02771996-10-01Novo-PranolNOP.02771996-10-01InderalWAY1996-10-01045240mgTab.0306.0612Apo-PropranololAPX.0306.06121996-10-01Novo-PranolNOP.0306.06121996-10-01Inderal-40AYE1996-10-01045380mgTab.0509.1018Apo-PropranololAPX.0509.10181996-10-01Novo-PranolNOP.0509.10181996-10-01InderalWAY1997-02-040454120mgTab.3091.6182Apo-PropranololAPX.3091.61821996-10-01InderalWAY1997-02-04SOTALOL HCL045580mgTabSotacorBQU2007-12-19Ratio-SotalolRPH2007-12-19Apo-SotalolAPX2007-12-19Mylan-SotalolMYL2007-12-19Novo-SotalolNOP2007-12-19PMS-SotalolPMS2007-12-19Sandoz SotalolSDZ2007-12-19Co SotalolCOB2007-12-190456160mgTab.1623SotacorBQU1996-10-01Ratio-SotalolRPH.16231996-10-01Nu-SotalolNXP.64921996-10-01Apo-SotalolAPX.64921996-10-01Mylan-SotalolMYL.64921999-04-15Novo-SotalolNOP.16231998-12-31PMS-SotalolPMS.16231999-04-15Sandoz SotalolSDZ.64922005-01-25Co SotalolCOB.64922006-10-23TIMOLOL MALEATE04575mgTab.1649.3298BlocadrenFRS1996-10-01Apo-TimolAPX.1649.32981996-10-01Novo-TimolNOP.1649.32981996-10-01Nu-TimololNXP.1649.32981996-10-01045810mgTab.2572.5144BlocadrenFRS1996-10-01Apo-TimolAPX.2572.51441996-10-01Novo-TimolNOP.2572.51441996-10-01Nu-TimololNXP.2572.51441996-10-01045920mgTab.50051.0010BlocadrenFRS1996-10-01Apo-TimolAPX.50051.00101996-10-01Novo-TimolNOP.50051.00101996-10-01VERAPAMIL HCL046080mgTab.2735.8205IsoptinABB1996-10-01Apo-VerapAPX.2735.82051996-10-01Nu-VerapNXP.2735.82051996-10-01Gen-VerapamilGEN.2735.82051999-04-150461120mgTab.42501.2750IsoptinABB1996-10-01Apo-VerapAPX.42501.27501996-10-01Nu-VerapNXP.42501.27501996-10-01Gen-VerapamilGEN.42501.27501999-04-15ANTILIPEMIC DRUGSNicotinic acid is the most cost-effective therapy for hyperlipidemia and is tolerated in approximately 80% of patients with adequate warning about expected flushing which disappears after five days in most cases; regular ASA will substantially reduce flushing. Bile acid sequestrants are more costly than fibrates or HMG-CoA reductase inhibitors.AMLODIPINE BESYLATE & ATORVASTATIN CALCIUM04625mg & 10mgTab.7551Note: Patients should be stabilized on a statin or a calcium channel blocker before being initiated on Amlodipine Besylate & Atrovastatin Calcium.CaduetPFI2.32062006-10-23Gd-Amlodipine/AtorvastatinGEM.75512011-10-2504635mg & 20mgTab.8591Note: Patients should be stabilized on a statin or a calcium channel blocker before being initiated on Amlodipine Besylate & Atrovastatin Calcium.CaduetPFI2.73662006-10-23Gd-Amlodipine/AtorvastatinGEM.85912011-10-2504645mg & 40mgTab.8981Note: Patients should be stabilized on a statin or a calcium channel blocker before being initiated on Amlodipine Besylate & Atrovastatin Calcium.CaduetPFI2.89262006-10-23Gd-Amlodipine/AtorvastatinGEM.89812011-10-2504655mg & 80mgTab.8981Note: Patients should be stabilized on a statin or a calcium channel blocker before being initiated on Amlodipine Besylate & Atrovastatin Calcium.CaduetPFI2.89262006-10-23Gd-Amlodipine/AtorvastatinGEM.89812011-10-25046610mg & 10mgTab.9194Note: Patients should be stabilized on a statin or a calcium channel blocker before being initiated on Amlodipine Besylate & Atrovastatin Calcium.CaduetPFI2.45002006-10-23Gd-Amlodipine/AtorvastatinGEM.91942011-10-25046710mg & 20mgTab1.0234Note: Patients should be stabilized on a statin or a calcium channel blocker before being initiated on Amlodipine Besylate & Atrovastatin Calcium.CaduetPFI3.05442006-10-23Gd-Amlodipine/AtorvastatinGEM1.02342011-10-25046810mg & 40mgTab1.0624Note: Patients should be stabilized on a statin or a calcium channel blocker before being initiated on Amlodipine Besylate & Atrovastatin Calcium.CaduetPFI3.20002006-10-23Gd-Amlodipine/AtorvastatinGEM1.06242011-10-25046910mg & 80mgTab1.0624Note: Patients should be stabilized on a statin or a calcium channel blocker before being initiated on Amlodipine Besylate & Atrovastatin Calcium.CaduetPFI3.20002006-10-23Gd-Amlodipine/AtorvastatinGEM1.06242011-10-25ATORVASTATIN CALCIUM047010mgTab.4160LipitorPFI1.69401997-08-28Gd-AtorvastatinGEM.41602010-06-18Apo-AtorvastatinAPX.41602010-06-18Novo-AtorvastatinNOP.41602010-06-18Co AtorvastatinCOB.41602010-06-18PMS-AtorvastatinPMS.41602010-06-18Ran-AtorvastatinRAN.41602010-06-18Sandoz AtorvastatinSDZ.41602010-07-20Ratio-AtorvastatinRPH.41602010-06-18Mylan-AtorvastatinMYL.41602012-01-19047120mgTab.5200LipitorPFI2.11741997-08-28Gd-AtorvastatinGEM.52002010-06-18Apo-AtorvastatinAPX.52002010-06-18Novo-AtorvastatinNOP.52002010-06-18Co AtorvastatinCOB.52002010-06-18PMS-AtorvastatinPMS.52002010-06-18Ran-AtorvastatinRAN.52002010-06-18Sandoz AtorvastatinSDZ.52002010-07-20Ratio-AtorvastatinRPH.52002010-06-18Mylan-AtorvastatinMYL.52002012-01-19047240mgTab.5590LipitorPFI2.27621997-08-28Gd-AtorvastatinGEM.55902010-06-18Apo-AtorvastatinAPX.55902010-06-18Novo-AtorvastatinNOP.55902010-06-18Co AtorvastatinCOB.55902010-06-18PMS-AtorvastatinPMS.55902010-06-18Ran-AtorvastatinRAN.55902010-06-18Sandoz AtorvastatinSDZ.55902010-07-20Ratio-AtorvastatinRPH.55902010-06-18Mylan-AtorvastatinMYL.55902012-01-19047380mgTab.5590LipitorPFI2.27622002-04-04Gd-AtorvastatinGEM.55902010-06-18Apo-AtorvastatinAPX.55902010-06-18Novo-AtorvastatinNOP.55902010-06-18Co AtorvastatinCOB.55902010-06-18PMS-AtorvastatinPMS.55902010-06-18Ran-AtorvastatinRAN.55902010-06-18Sandoz AtorvastatinSDZ.55902010-07-20Ratio-AtorvastatinRPH.55902010-06-18Mylan-AtorvastatinMYL.55902012-01-19BEZAFIBRATE0474400mgSR Tab1.9167BezalipAGP1.91671996-10-010475200mgTab.8833BezalipHLR1996-10-01PMS-BezafibratePMS.88332000-07-17CHOLESTYRAMINE RESIN0476Oral Pd-Pouch Pk1.3167Questran 9g PkBQU1996-10-01Olestyr 4g/5g PkMMT1.31671996-10-01Questran Light 4g PkBQU2004-07-20Olestyr 4g/9g PkMMT1.31671997-04-10CLOFIBRATE0477500mgCapAtromid-SAYE1996-10-01Novo-FibrateNOP1996-10-01COLESTIPOL HCLCombining psyllium with Colestid therapy improves the efficacy, and decreases costs, of antilipemic treatment.0478Gran-5g Pk.9097Colestid RegularPFI.90971996-10-010479Gran-7.5g Pk.8837Colestid OrangePFI.88371996-10-01EZETIMIBE048010mgTab1.7507EzetrolMFS1.75072004-04-06For use in combination with a HMG-CoA reductase inhibitor ('statin') in patients with hypercholesterolemia who have not reached target LDL levels despite the use of maximally tolerated doses.LU Authorization Period: Indefinite.For use as monotherapy in the management of hypercholesterolemia in patients who are intolerant to HMG-CoA reductase inhibitors or where HMG-CoA reductase inhibitors are contraindicated.LU Authorization Period: Indefinite.FENOFIBRATE0481100mgCap.6105LipidilJOU1996-10-01Apo-FenofibrateAPX.61051996-12-19048267mgCapLipidil MicroFOU2008-01-15Apo-Feno-MicroAPX2008-01-15Novo-Fenofibrate MicronizedNOP2008-11-040483200mgCap.2723Lipidil MicroSPH1.08901996-10-01Apo-Feno-MicroAPX.27232000-01-17Mylan-Fenofibrate MicroMYL.27232000-01-17Novo-Fenofibrate MicronizedNOP.27232002-04-04Ratio-Fenofibrate MCRPH.27232004-07-20PMS-Fenofibrate MicroPMS.27232007-01-020484100mgTabLipidil SupraLAF2008-11-04Apo-Feno-SuperAPX2008-12-03Sandoz Fenofibrate SSDZ2009-08-18Novo-Fenofibrate-SNOP2008-11-040485160mgTab.3116Lipidil SupraSPH1.24632001-06-07Apo-Feno-SuperAPX.31162006-06-14Sandoz Fenofibrate SSDZ.31162007-03-09Novo-Fenofibrate-SNOP.31162007-06-06048648mgTab.4100Lipidil EZFOU.41002006-10-230487145mgTab1.0500Lipidil EZFOU1.05002006-10-23FLUVASTATIN SODIUM048820mgCap.8723LescolNOV.87231996-10-01048940mgCap1.2248LescolNOV1.22481996-10-01049080mgER Tab1.4775Lescol XLNOV1.47752005-02-22GEMFIBROZIL0491300mgCap.1340LopidPFI.53581996-10-01Apo-GemfibrozilAPX.13401996-10-01Mylan-GemfibrozilMYL.13401997-08-28PMS-GemfibrozilPMS.13402000-01-17Novo-GemfibrozilNOP.13402001-06-070492600mgTabLopidPFI2008-02-12Apo-GemfibrozilAPX2008-02-12Novo-GemfibrozilNOP2008-02-12PMS-GemfibrozilPMS2008-02-12Mylan-GemfibrozilMYL2008-02-12LOVASTATIN049320mgTab.4919MevacorMFC2.16921996-10-01Apo-LovastatinAPX.49191997-08-28Mylan-LovastatinMYL.49192001-06-07Ratio-LovastatinRPH.49192003-01-30PMS-LovastatinPMS.49192003-01-30Novo-LovastatinNOP.49192003-04-16Sandoz LovastatinSDZ.49192003-09-04Co LovastatinCOB.49192004-09-14Ran-LovastatinRAN.49192005-12-06049440mgTab.8985MevacorMFC3.96231996-10-01Apo-LovastatinAPX.89851997-08-28Mylan-LovastatinMYL.89852001-06-07Ratio-LovastatinRPH.89852003-01-30PMS-LovastatinPMS.89852003-01-30Novo-LovastatinNOP.89852003-04-16Sandoz LovastatinSDZ.89852003-09-04Co LovastatinCOB.89852004-09-14Ran-LovastatinRAN.89852005-12-06NIACIN0495500mgER Tab1.2700Note: For the treatment of dyslipidemia in patients who, after an adequate trial of crystalline niacin (defined as at least 1 month duration during which time appropriate dose titration, use of ASA and patient counseling have occurred), are unable to continue taking crystalline niacin because of intractable and intolerable side effects.Niaspan FCTSEP1.27002010-03-020496750mgER Tab1.2700Note: For the treatment of dyslipidemia in patients who, after an adequate trial of crystalline niacin (defined as at least 1 month duration during which time appropriate dose titration, use of ASA and patient counseling have occurred), are unable to continue taking crystalline niacin because of intractable and intolerable side effects.Niaspan FCTSEP1.27002010-03-0204971000mgER Tab1.2700Note: For the treatment of dyslipidemia in patients who, after an adequate trial of crystalline niacin (defined as at least 1 month duration during which time appropriate dose titration, use of ASA and patient counseling have occurred), are unable to continue taking crystalline niacin because of intractable and intolerable side effects.Niaspan FCTSEP1.27002010-03-02PRAVASTATIN SODIUM049810mgTab.4050PravacholBQU.75671996-10-01Apo-PravastatinAPX.40502001-06-07Nu-PravastatinNXP.40502002-07-29Ratio-PravastatinRPH.40502003-09-04Novo-PravastatinNOP.40502003-09-04PMS-PravastatinPMS.40502004-04-06Sandoz PravastatinSDZ.40502004-04-06Co PravastatinCOB.40502004-04-06Mylan-PravastatinMYL.40502005-11-08Ran-PravastatinRAN.40502007-09-04Mint-PravastatinMIN.40502010-04-23Jamp-PravastatinJPC.40502010-04-23Pravastatin TabletsRAN.40502010-01-05049920mgTab.4778PravacholBQU.89251996-10-01Apo-PravastatinAPX.47782001-06-07Nu-PravastatinNXP.47782002-07-29Ratio-PravastatinRPH.47782003-09-04Novo-PravastatinNOP.47782003-09-04PMS-PravastatinPMS.47782004-04-06Sandoz PravastatinSDZ.47782004-04-06Co PravastatinCOB.47782004-04-06Mylan-PravastatinMYL.47782005-11-08Ran-PravastatinRAN.47782007-09-04Mint-PravastatinMIN.47782010-04-23Jamp-PravastatinJPC.47782010-04-23Pravastatin TabletsRAN.47782010-01-05050040mgTab.5755PravacholBQU1.07501997-08-28Apo-PravastatinAPX.57552001-06-07Nu-PravastatinNXP.57552002-07-29Ratio-PravastatinRPH.57552003-09-04Novo-PravastatinNOP.57552003-09-04PMS-PravastatinPMS.57552004-04-06Sandoz PravastatinSDZ.57552004-04-06Co PravastatinCOB.57552004-04-06Mylan-PravastatinMYL.57552005-11-08Ran-PravastatinRAN.57552007-09-04Mint-PravastatinMIN.57552010-04-23Jamp-PravastatinJPC.57552010-04-23Pravastatin TabletsRAN.57552010-01-05ROSUVASTATIN CALCIUM05015mgTab1.2900CrestorAZC1.29002007-01-02050210mgTab1.3600CrestorAZC1.36002003-09-04050320mgTab1.7000CrestorAZC1.70002003-09-04050440mgTab1.9900CrestorAZC1.99002003-09-04SIMVASTATIN05055mgTab.2556ZocorMFC1.08001996-10-01Mylan-SimvastatinMYL.25562003-04-16Apo-SimvastatinAPX.25562003-04-16Co SimvastatinCOB.25562004-04-06Novo-SimvastatinNOP.25562004-07-20PMS-SimvastatinPMS.25562006-04-04Phl-SimvastatinPHE.25562009-11-13Zym-SimvastatinZYN.25562010-06-14Ran-SimvastatinRAN.25562009-11-13Jamp-SimvastatinJPC.25562010-04-23Simvastatin TabletsRAN.25562010-01-05Mint-SimvastatinMIN.25562011-12-15Mar-SimvastatinMAR.25562012-01-19050610mgTab.5058ZocorMFC2.12441996-10-01Mylan-SimvastatinMYL.50582003-04-16Apo-SimvastatinAPX.50582003-04-16Ratio-SimvastatinRPH.50582004-04-06Sandoz SimvastatinSDZ.50582004-04-06Co SimvastatinCOB.50582004-04-06Novo-SimvastatinNOP.50582004-07-20Taro-SimvastatinTAR2005-10-06PMS-SimvastatinPMS.50582006-04-04Phl-SimvastatinPHE.50582009-11-13Zym-SimvastatinZYN.50582010-06-14Ran-SimvastatinRAN.50582009-11-13Jamp-SimvastatinJPC.50582010-04-23Simvastatin TabletsRAN.50582010-01-05Mint-SimvastatinMIN.50582011-12-15Mar-SimvastatinMAR.50582012-01-19050720mgTab.6251ZocorMFC2.62541996-10-01Mylan-SimvastatinMYL.62512003-04-16Apo-SimvastatinAPX.62512003-04-16Ratio-SimvastatinRPH.62512004-04-06Sandoz SimvastatinSDZ.62512004-04-06Co SimvastatinCOB.62512004-04-06Novo-SimvastatinNOP.62512004-07-20Taro-SimvastatinTAR2005-10-06PMS-SimvastatinPMS.62512006-04-04Phl-SimvastatinPHE.62512009-11-13Zym-SimvastatinZYN.62512010-06-14Ran-SimvastatinRAN.62512009-11-13Jamp-SimvastatinJPC.62512010-04-23Simvastatin TabletsRAN.62512010-01-05Mint-SimvastatinMIN.62512011-12-15Mar-SimvastatinMAR.62512012-01-19050840mgTab.6251ZocorMFC2.62541996-12-19Mylan-SimvastatinMYL.62512003-04-16Apo-SimvastatinAPX.62512003-04-16Ratio-SimvastatinRPH.62512004-04-06Sandoz SimvastatinSDZ.62512004-04-06Co SimvastatinCOB.62512004-04-06Novo-SimvastatinNOP.62512004-07-20Taro-SimvastatinTAR2005-10-06PMS-SimvastatinPMS.62512006-04-04Phl-SimvastatinPHE.62512009-11-13Zym-SimvastatinZYN.62512010-06-14Ran-SimvastatinRAN.62512009-11-13Jamp-SimvastatinJPC.62512010-04-23Simvastatin TabletsRAN.62512010-01-05Mint-SimvastatinMIN.62512011-12-15Mar-SimvastatinMAR.62512012-01-19050980mgTab.6251ZocorMFC2.62542000-04-17Mylan-SimvastatinMYL.62512003-04-16Apo-SimvastatinAPX.62512003-04-16Ratio-SimvastatinRPH.62512004-04-06Sandoz SimvastatinSDZ.62512004-04-06Co SimvastatinCOB.62512004-04-06Novo-SimvastatinNOP.62512004-07-20PMS-SimvastatinPMS.62512006-04-04Phl-SimvastatinPHE.62512009-11-13Zym-SimvastatinZYN.62512010-06-14Ran-SimvastatinRAN.62512009-11-13Jamp-SimvastatinJPC.62512010-04-23Simvastatin TabletsRAN.62512010-01-05Mint-SimvastatinMIN.62512011-12-15Mar-SimvastatinMAR.62512012-01-19HYPOTENSIVE DRUGS (FOR DIURETICS SEE 40:28)ALISKIREN0510150mgTab1.2046NOTE: For patients with moderate hypertension who have not achieved blood pressure targets while on maximally optimized therapy with a thiazide-diuretic AND an Angiotensin Converting Enzyme Inhibitor (ACE-I) or a thiazide-diuretic AND Angiotensin II Receptor Blocker (ARB).RasilezNOV1.20462008-12-030511300mgTab1.2046NOTE: For patients with moderate hypertension who have not achieved blood pressure targets while on maximally optimized therapy with a thiazide-diuretic AND an Angiotensin Converting Enzyme Inhibitor (ACE-I) or a thiazide-diuretic AND Angiotensin II Receptor Blocker (ARB).RasilezNOV1.20462008-12-03ATENOLOL & CHLORTHALIDONE051250 & 25mgTab.3195Tenoretic 50/25AZC.65731996-10-01Apo-AtenidoneAPX.31952004-09-14Novo-AtenolthalidoneNOP.31952008-02-120513100 & 25mgTab.5236Tenoretic 100/25AZC1.07701996-10-01Apo-AtenidoneAPX.52362004-09-14Novo-AtenolthalidoneNOP.52362008-02-12BENAZEPRIL05145mgTab.5577.5577LotensinNOV.8004.80041996-10-01BenazeprilAAP.5577.55772007-10-03051510mgTab.6595.6595LotensinNOV.9464.94641996-10-01BenazeprilAAP.6595.65952007-10-03051620mgTab.7567.7567LotensinNOV1.08611.08611996-10-01BenazeprilAAP.7567.75672006-06-14CANDESARTAN CILEXETIL05174mgTab.1700AtacandAZC.70002006-04-19Sandoz CandesartanSDZ.17002011-08-04Apo-CandesartanAPX.17002011-08-04Co CandesartanCOB.17002012-01-1905188mgTab.2850AtacandAZC1.17271999-09-15Sandoz CandesartanSDZ.28502011-08-04Apo-CandesartanAPX.28502011-08-04Co CandesartanCOB.28502012-01-19051916mgTab.2850AtacandAZC1.17271999-09-15Sandoz CandesartanSDZ.28502011-08-04Apo-CandesartanAPX.28502011-08-04Co CandesartanCOB.28502012-01-19052032mgTab1.1727AtacandAZC1.17272009-05-20Co CandesartanCOB2012-01-19CANDESARTAN CILEXETIL & HYDROCHLOROTHIAZIDE052116mg & 12.5mgTab1.1727Atacand PlusAZC1.17272002-07-29052232mg & 12.5mgTab1.1727Atacand PlusAZC1.17272010-07-20052332mg & 25mgTab1.1727Atacand PlusAZC1.17272010-07-20CAPTOPRIL052412.5mgTab.2120.6360CapotenBQU1996-10-01Apo-CaptoAPX.2120.63601996-10-01Nu-CaptoNXP.2120.63601996-10-01Novo-CaptoprilNOP.2120.63601996-10-01Gen-CaptoprilGEN.2120.63601996-10-01052525mgTab.3000.9000CapotenBQU.3000.90001996-10-01Apo-CaptoAPX.3000.90001996-10-01Nu-CaptoNXP.3000.90001996-10-01Novo-CaptoprilNOP.3000.90001996-10-01Gen-CaptoprilGEN.3000.90001996-10-01052650mgTab.55901.6770CapotenBQU.55901.67701996-10-01Apo-CaptoAPX.55901.67701996-10-01Nu-CaptoNXP.55901.67701996-10-01Novo-CaptoprilNOP.55901.67701996-10-01Gen-CaptoprilGEN.55901.67701996-10-010527100mgTab1.0395CapotenBQU1996-10-01Apo-CaptoAPX1.03951996-10-01Nu-CaptoNXP1.03951996-10-01Novo-CaptoprilNOP1.03951996-10-01Gen-CaptoprilGEN1.03951996-10-01CILAZAPRIL05281mgTab.1557InhibaceHLR.62291996-10-01Novo-CilazaprilNOP.15572005-06-13PMS-CilazaprilPMS.15572006-08-24Mylan-CilazaprilMYL.15572006-09-06Apo-CilazaprilAPX.15572007-03-0905292.5mgTab.1795.1795InhibaceHLR.7179.71791996-10-01Novo-CilazaprilNOP.1795.17952005-06-13PMS-CilazaprilPMS.1795.17952006-08-24Mylan-CilazaprilMYL.1795.17952006-09-06Co CilazaprilCOB.3400.34002007-04-02Apo-CilazaprilAPX.1795.17952007-03-0905305mgTab.2085.2085InhibaceHLR.8341.83411996-10-01Novo-CilazaprilNOP.2085.20852005-06-13PMS-CilazaprilPMS.2085.20852006-08-24Mylan-CilazaprilMYL.2085.20852006-09-06Co CilazaprilCOB.3950.39502007-04-02Apo-CilazaprilAPX.2085.20852007-03-09CILAZAPRIL & HYDROCHLOROTHIAZIDE05315mg/12.5mgTab.4170Inhibace PlusHLR.83392000-01-17Apo-Cilazapril/HCTZAPX.41702007-01-02Novo-Cilazapril/HCTZNOP.41702009-05-20CLONIDINE HCLSignificant rebound hypertension can occur after missing even one or two doses; this drug should be avoided in patients with cardiovascular fragility or suspected problems with compliance.05320.025mgTabDixaritBOE2007-06-06Apo-ClonidineAPX2007-06-06Novo-ClonidineNOP2008-05-1605330.1mgTab.1358.5432CatapresBOE.1853.74121996-10-01Apo-ClonidineAPX.1358.54321996-10-01Nu-ClonidineNXP.1358.54321996-10-01Novo-ClonidineNOP.1358.54321996-10-0105340.2mgTab.2424.9696CatapresBOE.33061.32241996-10-01Apo-ClonidineAPX.2424.96961996-10-01Nu-ClonidineNXP.2424.96961996-10-01Novo-ClonidineNOP.2424.96961996-10-01DOXAZOSIN MESYLATE05351mgTab.1416.1416Cardura-1AZC.5784.57841996-10-01Mylan-DoxazosinMYL.1416.14162000-01-17Apo-DoxazosinAPX.1416.14162000-01-17Novo-DoxazosinNOP.1416.14162001-03-07PMS-DoxazosinPMS.1416.14162002-04-0405362mgTab.1699.1699Cardura-2AZC.6938.69381996-10-01Mylan-DoxazosinMYL.1699.16992000-01-17Apo-DoxazosinAPX.1699.16992000-01-17Novo-DoxazosinNOP.1699.16992001-03-07PMS-DoxazosinPMS.1699.16992002-04-0405374mgTab.2209.2209Cardura-4AZC.9022.90221996-10-01Mylan-DoxazosinMYL.2209.22092000-01-17Apo-DoxazosinAPX.2209.22092000-01-17Novo-DoxazosinNOP.2209.22092001-03-07PMS-DoxazosinPMS.2209.22092002-04-04ENALAPRIL MALEATE05382.5mgTab.1863.1863VasotecMFC.8058.8058** Each tablet is made with 2.5mg of enalapril maleate that is equivalent to 2mg of enalapril sodium, in the finished tablets.1996-10-01Apo-EnalaprilAPX.1863.18632007-12-19Co EnalaprilCOB.1863.1863** Each tablet is made with 2.5mg of enalapril maleate that is equivalent to 2mg of enalapril sodium, in the finished tablets.2007-12-19Sandoz EnalaprilSDZ.1863.1863** Each tablet is made with 2.5mg of enalapril maleate that is equivalent to 2mg of enalapril sodium, in the finished tablets.2007-12-19Ratio-EnalaprilRPH.1863.1863** Each tablet is made with 2.5mg of enalapril maleate that is equivalent to 2mg of enalapril sodium, in the finished tablets.2007-12-19Mylan-EnalaprilMYL.1863.1863** Each tablet is made with 2.5mg of enalapril maleate that is equivalent to 2mg of enalapril sodium, in the finished tablets.2007-12-19PMS-EnalaprilPMS** Each tablet is made with 2.5mg of enalapril maleate that is equivalent to 2mg of enalapril sodium, in the finished tablets.2008-02-12Taro-EnalaprilTAR.1863.1863** Each tablet is made with 2.5mg of enalapril maleate that is equivalent to 2mg of enalapril sodium, in the finished tablets.2008-01-15Novo-EnalaprilNOP.1863.1863** Each tablet is made with 2.5mg of enalapril maleate that is equivalent to 2mg of enalapril sodium, in the finished tablets.2008-05-16Ran-EnalaprilRAN.1863.18632011-01-0705395mgTab.2203.2203VasotecMFC.9532.9532** Each tablet is made with 5mg of enalapril maleate that is equivalent to 4mg of enalapril sodium, in the finished tablets.1996-10-01Apo-EnalaprilAPX.2203.22032007-12-19Novo-EnalaprilNOP.2203.2203** Each tablet is made with 5mg of enalapril maleate that is equivalent to 4mg of enalapril sodium, in the finished tablets.2008-05-16Co EnalaprilCOB.2203.2203** Each tablet is made with 5mg of enalapril maleate that is equivalent to 4mg of enalapril sodium, in the finished tablets.2007-12-19Sandoz EnalaprilSDZ.2203.2203** Each tablet is made with 5mg of enalapril maleate that is equivalent to 4mg of enalapril sodium, in the finished tablets.2007-12-19Ratio-EnalaprilRPH.2203.2203** Each tablet is made with 5mg of enalapril maleate that is equivalent to 4mg of enalapril sodium, in the finished tablets.2007-12-19Mylan-EnalaprilMYL.2203.2203** Each tablet is made with 5mg of enalapril maleate that is equivalent to 4mg of enalapril sodium, in the finished tablets.2007-12-19PMS-EnalaprilPMS** Each tablet is made with 5mg of enalapril maleate that is equivalent to 4mg of enalapril sodium, in the finished tablets.2008-02-12Taro-EnalaprilTAR.2203.2203** Each tablet is made with 5mg of enalapril maleate that is equivalent to 4mg of enalapril sodium, in the finished tablets.2008-01-15Ran-EnalaprilRAN.2203.22032011-01-07054010mgTab.2647.2647VasotecMFC1.14531.1453** Each tablet is made with 10mg of enalapril maleate that is equivalent to 8mg of enalapril sodium, in the finished tablets.1996-10-01Apo-EnalaprilAPX.2647.26472007-12-19Novo-EnalaprilNOP.2647.2647** Each tablet is made with 10mg of enalapril maleate that is equivalent to 8mg of enalapril sodium, in the finished tablets.2008-05-16Co EnalaprilCOB.2647.2647** Each tablet is made with 10mg of enalapril maleate that is equivalent to 8mg of enalapril sodium, in the finished tablets.2007-12-19Sandoz EnalaprilSDZ.2647.2647** Each tablet is made with 10mg of enalapril maleate that is equivalent to 8mg of enalapril sodium, in the finished tablets.2007-12-19Ratio-EnalaprilRPH.2647.2647** Each tablet is made with 10mg of enalapril maleate that is equivalent to 8mg of enalapril sodium, in the finished tablets.2007-12-19Mylan-EnalaprilMYL.2647.2647** Each tablet is made with 10mg of enalapril maleate that is equivalent to 8mg of enalapril sodium, in the finished tablets.2007-12-19PMS-EnalaprilPMS** Each tablet is made with 10mg of enalapril maleate that is equivalent to 8mg of enalapril sodium, in the finished tablets.2008-02-12Taro-EnalaprilTAR.2647.2647** Each tablet is made with 10mg of enalapril maleate that is equivalent to 8mg of enalapril sodium, in the finished tablets.2008-01-15Ran-EnalaprilRAN.2647.26472011-01-07054120mgTab.3195.3195VasotecMFC1.38211.3821** Each tablet is made with 20mg of enalapril maleate that is equivalent to 16mg of enalapril sodium, in the finished tablets.1996-10-01Apo-EnalaprilAPX.3195.31952007-12-19Novo-EnalaprilNOP.3195.3195** Each tablet is made with 20mg of enalapril maleate that is equivalent to 16mg of enalapril sodium, in the finished tablets.2008-05-16Co EnalaprilCOB.3195.3195** Each tablet is made with 20mg of enalapril maleate that is equivalent to 16mg of enalapril sodium, in the finished tablets.2007-12-19Sandoz EnalaprilSDZ.3195.3195** Each tablet is made with 20mg of enalapril maleate that is equivalent to 16mg of enalapril sodium, in the finished tablets.2007-12-19Ratio-EnalaprilRPH.3195.3195** Each tablet is made with 20mg of enalapril maleate that is equivalent to 16mg of enalapril sodium, in the finished tablets.2007-12-19Mylan-EnalaprilMYL.3195.3195** Each tablet is made with 20mg of enalapril maleate that is equivalent to 16mg of enalapril sodium, in the finished tablets.2007-12-19PMS-EnalaprilPMS** Each tablet is made with 20mg of enalapril maleate that is equivalent to 16mg of enalapril sodium, in the finished tablets.2008-02-12Taro-EnalaprilTAR.3195.3195** Each tablet is made with 20mg of enalapril maleate that is equivalent to 16mg of enalapril sodium, in the finished tablets.2008-01-15Ran-EnalaprilRAN.3195.31952011-01-07ENALAPRIL MALEATE & HYDROCHLOROTHIAZIDE05425mg & 12.5mgTabVasereticMFC2011-05-19Novo-Enalapril/HCTZNOP2011-08-04Apo-Enalapril Maleate/HCTZAPX2011-05-19054310mg & 25mgTabVasereticMFC2011-05-19Novo-Enalapril/HCTZNOP2011-08-04Apo-Enalapril Maleate/HCTZAPX2011-05-19EPROSARTAN MESYLATE0544400mgTab.7075TevetenSPH.70752002-07-290545600mgTab1.0614TevetenSPH1.06142002-07-29EPROSARTAN MESYLATE & HYDROCHLOROTHIAZIDE0546600mg & 12.5mgTab1.0614Teveten PlusSPH1.06142005-05-25FELODIPINEGrapefruit juice or erythromycin triple the blood levels of felodipine and markedly increase both efficacy and adverse effects. Other dihydropyridines are affected to differing degrees by grapefruit juice.05472.5mgER Tab.5230PlendilAZC.52301996-10-0105485mgER Tab.4620.4620PlendilAZC.6990.69901996-10-01Sandoz FelodipineSDZ.4620.46202007-01-02054910mgER Tab.6925.6925PlendilAZC1.04871.04871996-10-01Sandoz FelodipineSDZ.6925.69252007-01-0205502.5mgSR Tab.5383RenedilSAV.53831999-01-0705515mgSR Tab.4620.4620RenedilSAV.7228.72281999-01-07Sandoz FelodipineSDZ.4620.46202007-01-02055210mgSR Tab.6925.6925RenedilSAV1.08341.08341999-01-07Sandoz FelodipineSDZ.6925.69252007-01-02FOSINOPRIL SODIUM055310mgTab.2178.2178MonoprilBQU.8975.89751996-10-01Novo-FosinoprilNOP.2178.21782004-04-06Mylan-FosinoprilMYL.2178.21782005-01-25Apo-FosinoprilAPX.2178.21782005-07-14Ran-FosinoprilRAN.2178.21782010-03-02Jamp-FosinoprilJPC.2178.21782010-04-23Fosinopril TabletsRAN.2178.21782010-04-23055420mgTab.2619.2619MonoprilBQU1.08001.08001996-10-01Novo-FosinoprilNOP.2619.26192004-04-06Mylan-FosinoprilMYL.2619.26192005-01-25Apo-FosinoprilAPX.2619.26192005-07-14Ran-FosinoprilRAN.2619.26192010-03-02Jamp-FosinoprilJPC.2619.26192010-04-23Fosinopril TabletsRAN.2619.26192010-04-23HYDRALAZINE HCL055520mg/mLInj Sol-1mL Pk11.6500ApresolineSTE11.65001996-10-01055610mgTab.1347.5388ApresolineNOV1996-10-01Apo-HydralazineAPX.1347.53881996-10-01055725mgTab.2314.9256ApresolineSTE1996-10-01Apo-HydralazineAPX.2314.92561996-10-01055850mgTab.36331.4532ApresolineNOV1996-10-01Apo-HydralazineAPX.36331.45321996-10-01IRBESARTAN055975mgTab.3025AvaproSAV1.22781999-04-15Teva-IrbesartanTEV.30252011-08-04Ratio-IrbesartanTEV.30252011-08-04PMS-IrbesartanPMS.30252011-08-04Co IrbesartanCOB.30252011-08-04Sandoz IrbesartanSDZ.30252011-08-04Mylan-IrbesartanMYL.30252012-01-190560150mgTab.3025AvaproSAV1.22781999-04-15Teva-IrbesartanTEV.30252011-08-04Ratio-IrbesartanTEV.30252011-08-04PMS-IrbesartanPMS.30252011-08-04Co IrbesartanCOB.30252011-08-04Sandoz IrbesartanSDZ.30252011-08-04Mylan-IrbesartanMYL.30252012-01-190561300mgTab.3025AvaproSAV1.22781999-04-15Teva-IrbesartanTEV.30252011-08-04Ratio-IrbesartanTEV.30252011-08-04PMS-IrbesartanPMS.30252011-08-04Co IrbesartanCOB.30252011-08-04Sandoz IrbesartanSDZ.30252011-08-04Mylan-IrbesartanMYL.30252012-01-19IRBESARTAN & HYDROCHLOROTHIAZIDE0562150mg & 12.5mgTab.3024AvalideSAV1.22782001-03-07Teva-Irbesartan/HCTZTEV.30252011-08-04PMS-Irbesartan-HCTZPMS.30252011-08-04Ratio-Irbesartan HCTZTEV.30252011-08-04Sandoz Irbesartan HCTSDZ.30242011-08-04Co Irbesartan/HCTCOB.30252011-08-04Ran-Irbesartan HCTZRAN.30252011-08-040563300mg & 12.5mgTab.3024AvalideSAV1.22782001-03-07Teva-Irbesartan/HCTZTEV.30252011-08-04PMS-Irbesartan-HCTZPMS.30252011-08-04Ratio-Irbesartan HCTZTEV.30252011-08-04Sandoz Irbesartan HCTSDZ.30242011-08-04Co Irbesartan/HCTCOB.30252011-08-04Ran-Irbesartan HCTZRAN.30252011-08-040564300mg & 25mgTab.3004AvalideSAV1.21352007-03-09Teva-Irbesartan/HCTZTEV.30042011-08-04PMS-Irbesartan-HCTZPMS.30042011-08-04Ratio-Irbesartan HCTZTEV.30042011-08-04Sandoz Irbesartan HCTSDZ.30042011-08-04Co Irbesartan/HCTCOB.30042011-08-04Ran-Irbesartan HCTZRAN.30042011-08-04LABETALOL HCL0565100mgTab.2875TrandatePAL.28751998-03-170566200mgTab.5083TrandatePAL.50831998-03-17LISINOPRIL05675mgTab.1428.1428PrinivilMFC.6180.61801996-10-01Ratio-Lisinopril PRPH.1428.14282007-12-19Novo-Lisinopril (Type P)NOP.1428.14282007-12-19Apo-LisinoprilAPX.1428.14281999-04-15Sandoz LisinoprilSDZ.1428.14282007-12-19056810mgTab.1716.1716PrinivilMFC.7424.74241996-10-01Ratio-Lisinopril PRPH.1716.17162007-12-19Novo-Lisinopril (Type P)NOP.1716.17162007-12-19Apo-LisinoprilAPX.1716.17162001-06-07Sandoz LisinoprilSDZ.1716.17162007-12-19056920mgTab.2063.2063PrinivilMFC.8926.89261996-10-01Ratio-Lisinopril PRPH.2063.20632007-12-19Novo-Lisinopril (Type P)NOP.2063.20632007-12-19Apo-LisinoprilAPX.2063.20632001-06-07Sandoz LisinoprilSDZ.2063.20632007-12-1905705mgTab.1347.1347ZestrilAZC.5543.55431996-10-01Apo-LisinoprilAPX.1347.13471997-08-28Co LisinoprilCOB.1347.13472007-12-19Mylan-LisinoprilMYL.1347.13472007-12-19Novo-Lisinopril (Type Z)NOP.1347.13472007-12-19Sandoz LisinoprilSDZ.1347.13472007-12-19PMS-LisinoprilPMS.1347.13472007-12-19Ran-LisinoprilRAN.1347.13472007-12-19LisinoprilMEL.1347.13472010-06-14Ratio-Lisinopril ZRPH.1347.13472007-12-19Lisinopril TabletsRAN.1347.13472010-01-05Jamp-LisinoprilJPC.1347.13472012-01-19057110mgTab.1619.1619ZestrilAZC.6660.66601996-10-01Apo-LisinoprilAPX.1619.16192001-06-07Co LisinoprilCOB.1619.16192007-12-19Mylan-LisinoprilMYL.1619.16192007-12-19Novo-Lisinopril (Type Z)NOP.1619.16192007-12-19Sandoz LisinoprilSDZ.1619.16192007-12-19PMS-LisinoprilPMS.1619.16192007-12-19Ran-LisinoprilRAN.1619.16192007-12-19LisinoprilMEL.1619.16192010-06-14Ratio-Lisinopril ZRPH.1619.16192007-12-19Lisinopril TabletsRAN.1619.16192010-01-05Jamp-LisinoprilJPC.1619.16192012-01-19057220mgTab.1945.1945ZestrilAZC.8000.80001996-10-01Apo-LisinoprilAPX.1945.19452001-06-07Co LisinoprilCOB.1945.19452007-12-19Mylan-LisinoprilMYL.1945.19452007-12-19Novo-Lisinopril (Type Z)NOP.1945.19452007-12-19Sandoz LisinoprilSDZ.1945.19452007-12-19PMS-LisinoprilPMS.1945.19452007-12-19Ran-LisinoprilRAN.1945.19452007-12-19LisinoprilMEL.1945.19452010-06-14Ratio-Lisinopril ZRPH.1945.19452007-12-19Lisinopril TabletsRAN.1945.19452010-01-05Jamp-LisinoprilJPC.1945.19452012-01-19LISINOPRIL & HYDROCHLOROTHIAZIDE057310mg & 12.5mgTab.2084ZestoreticAZC.85731996-10-01Apo-Lisinopril/HCTZAPX.20842007-10-03Mylan-Lisinopril HCTZMYL.20842008-01-15Novo-Lisinopril/HCTZ (Type Z)NOP.20842008-01-15Sandoz Lisinopril HCTSDZ.20842008-01-15057410mg & 12.5mgTab.3334PrinzideMFC.76511996-10-01Novo-Lisinopril/HCTZ (Type P)NOP.33342008-01-15057520mg & 12.5mgTab.4006PrinzideMFC.91931996-10-01Novo-Lisinopril/HCTZ (Type P)NOP.40062008-01-15057620mg & 12.5mgTab.2504ZestoreticAZC1.03011996-10-01Apo-Lisinopril/HCTZAPX.25042008-01-15Mylan-Lisinopril HCTZMYL.25042008-01-15Novo-Lisinopril/HCTZ (Type Z)NOP.25042008-01-15Sandoz Lisinopril HCTSDZ.25042008-01-15057720mg & 25mgTabZestoreticAZC2008-08-28Apo-Lisinopril/HCTZAPX2008-08-28Mylan-Lisinopril HCTZMYL2008-08-28Novo-Lisinopril/HCTZ (Type Z)NOP2008-08-28Sandoz Lisinopril HCTSDZ2008-12-23057820mg/25mgTabPrinzideMFC2008-08-28Novo-Lisinopril/HCTZ (Type P)NOP2008-08-28LOSARTAN POTASSIUM057925mgTab1.2590CozaarMFC1.25901996-10-01058050mgTab1.2590CozaarMFC1.25901996-10-010581100mgTab1.2590CozaarMFC1.25901999-04-15LOSARTAN POTASSIUM & HYDROCHLOROTHIAZIDE0582100mg & 12.5mgTab1.2327HyzaarMFC1.23272008-11-04058350mg & 12.5mgTab1.2590HyzaarMFC1.25902000-11-300584100mg & 25mgTab1.2590Hyzaar DSMFC1.25902000-11-30METHYLDOPA0585125mgTab.0989.3956AldometMSD1996-10-01MethyldopaAAP.0989.39561996-10-010586250mgTab.1433.5732AldometMSD2002-11-22MethyldopaAAP.1433.57321996-10-010587500mgTab.2537.5074AldometMSD1996-10-01MethyldopaAAP.2537.50741996-10-01MINOXIDIL05882.5mgTab.3432LonitenPFI.34321996-10-01058910mgTab.7565LonitenPFI.75651996-10-01NIFEDIPINE059020mgER Tab1.26001.2600Adalat XLBAY1.26001.26001999-04-15059130mgER Tab.6171.6171Adalat XLBAY.6171.61711996-10-01Mylan-Nifedipine Extended ReleaseMYL.6171.61712010-07-20059260mgER Tab.9374.9374Adalat XLBAY.9374.93741996-10-01Mylan-Nifedipine Extended ReleaseMYL.9374.93742009-03-02OLMESARTAN MEDOXOMIL059320mgTab.9900OlmetecSCP.99002010-04-23059440mgTab.9900OlmetecSCP.99002010-04-23OLMESARTAN MEDOXOMIL & HYDROCHLOROTHIAZIDE059520mg & 12.5mgTab.9900Olmetec PlusSCP.99002010-04-23059640mg & 12.5mgTab.9900Olmetec PlusSCP.99002010-04-23059740mg & 25mgTab.9900Olmetec PlusSCP.99002010-04-23PERINDOPRIL ERBUMINE05982mgTab.6527CoversylSEV.65271996-10-0105994mgTab.8168CoversylSEV.81681996-10-0106008mgTab1.1325CoversylSEV1.13252004-07-20Apo-PerindoprilAPX2008-03-25PERINDOPRIL ERBUMINE & INDAPAMIDE06012mg & 0.625mgTab.8453Coversyl Plus LDSEV.84532007-04-0206024mg & 1.25mgTab1.0225Coversyl PlusSEV1.02252007-04-0206038mg & 2.5mgTab1.1436Coversyl Plus HDSEV1.14362010-04-23PINDOLOL06045mgTab.1361.2722ViskenNOV.58571.17141996-10-01Apo-PindolAPX.1361.27221996-10-01Novo-PindolNOP.1361.27221996-10-01Nu-PindolNXP.1361.27221996-10-01Gen-PindololGEN.1361.27221996-10-01PMS-PindololPMS.1361.27221999-04-15Sandoz PindololSDZ.1361.27222006-07-19060510mgTab.2323.4646ViskenNOV1.00012.00021996-10-01Apo-PindolAPX.2323.46461996-10-01Novo-PindolNOP.2323.46461996-10-01Nu-PindolNXP.2323.46461996-10-01Gen-PindololGEN.2323.46461996-10-01PMS-PindololPMS.2323.46461999-04-15Sandoz PindololSDZ.2323.46462006-07-19060615mgTab.3370.6740ViskenNOV1.45092.90181996-10-01Apo-PindolAPX.3370.67401996-10-01Novo-PindolNOP.3370.67401996-10-01Nu-PindolNXP.3370.67401996-10-01Gen-PindololGEN.3370.67401996-10-01PMS-PindololPMS.3370.67401999-04-15Sandoz PindololSDZ.3370.67402006-07-19PINDOLOL & HYDROCHLOROTHIAZIDE060710mg & 25mgTab.8977Viskazide 10/25NOV.89771996-10-01060810mg & 50mgTab.8977Viskazide 10/50NOV.89771996-10-01PRAZOSIN HCL06091mgTab.1371.2742MinipressPFI.2743.54861996-10-01Apo-PrazoAPX.1371.27421996-10-01Nu-PrazoNXP.1371.27421996-10-01Novo-PrazinNOP.1371.27421996-10-0106102mgTab.1862.3724MinipressPFI.3725.74501996-10-01Apo-PrazoAPX.1862.37241996-10-01Nu-PrazoNXP.1862.37241996-10-01Novo-PrazinNOP.1862.37241996-10-0106115mgTab.2560.5120MinipressPFI.51211.02421996-10-01Apo-PrazoAPX.2560.51201996-10-01Nu-PrazoNXP.2560.51201996-10-01Novo-PrazinNOP.2560.51201996-10-01QUINAPRIL HCL06125mgTab.8723.8723AccuprilPFI.8723.87231996-10-01061310mgTab.8723.8723AccuprilPFI.8723.87231996-10-01061420mgTab.8723.8723AccuprilPFI.8723.87231996-10-01061540mgTab.8723.8723AccuprilPFI.8723.87231996-10-01QUINAPRIL HCL & HYDROCHLOROTHIAZIDE061610mg & 12.5mgTab.8721AccureticPFI.87212000-07-17061720mg & 12.5mgTab.8721AccureticPFI.87212000-07-17061820mg & 25mgTab.8682AccureticPFI.86822004-04-06RAMIPRIL06191.25mg.1733Altace CapSAV.69331999-01-06Apo-Ramipril CapAPX.17332007-03-09Ratio-Ramipril CapRPH.17332007-03-09Sandoz Ramipril TabSDZ.17332008-04-09PMS-Ramipril CapPMS.17332010-04-23Co Ramipril CapCOB.17332007-11-10Ramipril CapRIA2008-08-28Mylan-Ramipril CapMYL.17332008-08-28Phl-Ramipril CapPHE.17332010-06-14Ran-Ramipril CapRAN.17332008-11-04Jamp-Ramipril CapJPC.17332010-04-23Ramipril CapRAN.17332010-01-0506202.5mg.2000Altace CapSAV.79991999-01-06PMS-Ramipril CapPMS.20002010-04-23Novo-Ramipril CapNOP.20002007-06-06Apo-Ramipril CapAPX.20002007-03-09Ramipril CapRIA2008-08-28Ratio-Ramipril CapRPH.20002007-03-09Phl-Ramipril CapPHE.20002010-06-14Sandoz Ramipril TabSDZ.20002008-04-09Co Ramipril CapCOB.20002007-12-19Mylan-Ramipril CapMYL.20002008-08-28Ran-Ramipril CapRAN.20002008-11-04Jamp-Ramipril CapJPC.20002010-04-23Ramipril CapRAN.20002010-01-0506215mg.2000Altace CapSAV.79991999-01-06PMS-Ramipril CapPMS.20002010-04-23Novo-Ramipril CapNOP.20002007-06-06Apo-Ramipril CapAPX.20002007-03-09Ramipril CapRIA2008-08-28Ratio-Ramipril CapRPH.20002007-03-09Phl-Ramipril CapPHE.20002010-06-14Sandoz Ramipril TabSDZ.20002008-04-09Co Ramipril CapCOB.20002007-12-19Mylan-Ramipril CapMYL.20002008-08-28Ran-Ramipril CapRAN.20002008-11-04Jamp-Ramipril CapJPC.20002010-04-23Ramipril CapRAN.20002010-01-05062210mg.2533Altace CapSAV1.01321999-01-06PMS-Ramipril CapPMS.25332010-04-23Novo-Ramipril CapNOP.25332007-06-06Apo-Ramipril CapAPX.25332007-03-09Ramipril CapRIA2008-08-28Ratio-Ramipril CapRPH.25332007-03-09Phl-Ramipril CapPHE.25332010-06-14Sandoz Ramipril TabSDZ.25332008-04-09Co Ramipril CapCOB.25332007-11-10Mylan-Ramipril CapMYL.25332008-08-28Ran-Ramipril CapRAN.25332008-11-04Jamp-Ramipril CapJPC.25332010-04-23Ramipril CapRAN.25332010-01-05062315mgCapAltaceSAV2009-06-23Ratio-RamiprilRPH2009-06-23Apo-RamiprilAPX2009-06-23PMS-RamiprilPMS2011-03-15RAMIPRIL & HYDROCHLOROTHIAZIDE06242.5mg & 12.5mgTab.2250Altace HCTSAV.29892007-06-06PMS-Ramipril-HCTZPMS.22502011-06-0806255mg & 12.5mgTab.2263Altace HCTSAV.38292007-06-06PMS-Ramipril-HCTZPMS.22632011-06-0806265mg & 25mgTab.2263Altace HCTSAV.38292007-06-06PMS-Ramipril-HCTZPMS.22632011-05-19062710mg & 12.5mgTab.2865Altace HCTSAV.48502007-06-06PMS-Ramipril-HCTZPMS.28652011-03-15062810mg & 25mgTab.2865Altace HCTSAV.48502007-06-06PMS-Ramipril-HCTZPMS.28652011-03-15TELMISARTAN062940mgTab1.1296MicardisBOE1.12962000-04-17063080mgTab1.1296MicardisBOE1.12962000-04-17TELMISARTAN & HYDROCHLOROTHIAZIDE063180mg & 25mgTab1.1296Micardis PlusBOE1.12962009-11-13063280mg/12.5mgTab1.1296Micardis PlusBOE1.12962002-07-29TERAZOSIN HCL06331mgTab.1835.1835HytrinABB.7473.74731996-10-01Ratio-TerazosinRPH.1835.18351998-12-31Novo-TerazosinNOP.1835.18351999-04-15Nu-TerazosinNXP.1835.18351999-04-15Apo-TerazosinAPX.1835.18351998-12-31PMS-TerazosinPMS.1835.18352001-10-1106342mgTab.2333.2333HytrinABB.9499.94991996-10-01Ratio-TerazosinRPH.2333.23331998-12-31Novo-TerazosinNOP.2333.23331999-04-15Nu-TerazosinNXP.2333.23331999-04-15Apo-TerazosinAPX.2333.23331998-12-31PMS-TerazosinPMS.2333.23332001-10-1106355mgTab.3168.3168HytrinABB1.29001.29001996-10-01Ratio-TerazosinRPH.3168.31681998-12-31Novo-TerazosinNOP.3168.31681999-04-15Nu-TerazosinNXP.3168.31681999-04-15Apo-TerazosinAPX.3168.31681998-12-31PMS-TerazosinPMS.3168.31682001-10-11063610mgTab.4637.4637HytrinABB1.88831.88831996-10-01Ratio-TerazosinRPH.4637.46371998-12-31Novo-TerazosinNOP.4637.46371999-04-15Nu-TerazosinNXP.4637.46371999-04-15Apo-TerazosinAPX.4637.46371998-12-31PMS-TerazosinPMS.4637.46372001-10-11TRANDOLAPRIL06371mgCap.6901MavikABB.69011998-12-3106382mgCap.7931MavikABB.79311998-12-3106394mgCap.9785MavikABB.97852004-07-20VALSARTAN064040mgTabDiovanNOV2011-06-08Co ValsartanCOB2011-08-04Teva-ValsartanTEV2011-06-08Sandoz ValsartanSDZ2011-08-04Ran-ValsartanRAN2011-06-08Apo-ValsartanAPX2011-12-15064180mgTab.2958DiovanNOV1.19962003-09-04Co ValsartanCOB.29582011-08-04Teva-ValsartanTEV.29582011-06-08Sandoz ValsartanSDZ.29582011-06-08Ran-ValsartanRAN.29582011-06-08Apo-ValsartanAPX.29582011-12-150642160mgTab.2958DiovanNOV1.19932003-09-04Co ValsartanCOB.29582011-08-04Teva-ValsartanTEV.29582011-06-08Sandoz ValsartanSDZ.29582011-06-08Ran-ValsartanRAN.29582011-06-08Apo-ValsartanAPX.29582011-12-150643320mgTab.2843DiovanNOV1.16572008-02-12Co ValsartanCOB.28432011-08-04Teva-ValsartanTEV.28432011-06-08Sandoz ValsartanSDZ.28432011-06-08Apo-ValsartanAPX.28432011-12-15VALSARTAN & HYDROCHLOROTHIAZIDE064480mg & 12.5mgTab.2958Diovan-HCTNOV1.19392001-03-07Sandoz Valsartan HCTSDZ.29582011-06-08Teva-Valsartan/HCTZTEV.29582011-06-08Mylan-Valsartan HCTZMYL.29582011-12-150645160mg & 12.5mgTab.2958Diovan-HCTNOV1.19712001-03-07Sandoz Valsartan HCTSDZ.29582011-06-08Teva-Valsartan/HCTZTEV.29582011-06-08Mylan-Valsartan HCTZMYL.29582011-12-150646160mg & 25mgTab.2958Diovan-HCTNOV1.20112003-09-04Sandoz Valsartan HCTSDZ.29582011-06-08Teva-Valsartan/HCTZTEV.29582011-06-08Mylan-Valsartan HCTZMYL.29582011-12-150647320mg & 12.5mgTab.2912Diovan-HCTNOV1.19392009-03-02Sandoz Valsartan HCTSDZ.29122011-06-08Teva-Valsartan/HCTZTEV.29122011-06-08Mylan-Valsartan HCTZMYL.29122011-12-150648320mg & 25mgTab.2912Diovan-HCTNOV1.19392009-03-02Sandoz Valsartan HCTSDZ.29122011-06-08Teva-Valsartan/HCTZTEV.29122011-06-08Mylan-Valsartan HCTZMYL.29122011-12-15VERAPAMIL HCL0649120mgLA TabIsoptin SRABB2007-09-04Gen-Verapamil SRGEN2007-10-03Apo-Verap SRAPX2007-09-040650180mgLA Tab.5204.5204Isoptin SRABB1.54961.54961996-10-01Gen-Verapamil SRGEN.5204.52041996-10-01Apo-Verap SRAPX.5204.52042004-04-060651240mgLA Tab.5075.5075Isoptin SRABB2.06652.06651996-10-01Gen-Verapamil SRGEN.5075.50751996-10-01Novo-Veramil SRNOP.5075.50751998-12-31PMS-Verapamil SRPMS.5075.50752000-04-17Apo-Verap SRAPX.5075.50752004-04-06VASODILATING DRUGSPharmacologic tolerance (tachyphylaxis) may lead to loss of efficacy with chronic multiple (qid) daily dosing of nitrates. Continued relief of angina may require adjustment of dosage interval (e.g., tid).BETAHISTINE DIHYDROCHLORIDE06528mgTabSercSPH2011-05-19Novo-BetahistineNOP2011-05-19065316mgTabSercSPH2007-09-04Novo-BetahistineNOP2007-09-04Co BetahistineCOB2012-01-19065424mgTabSercSPH2007-09-04Novo-BetahistineNOP2007-09-04Co BetahistineCOB2012-01-19DIPYRIDAMOLE065525mgTabPersantineBOE2009-03-02Apo-DipyridamoleAPX2009-03-02065650mgTabPersantineBOE2009-03-02Apo-DipyridamoleAPX2009-03-02065775mgTabPersantineBOE2009-03-02Apo-DipyridamoleAPX2009-03-02DIPYRIDAMOLE & ACETYLSALICYLIC ACID0658200mg/25mgCap.8230AggrenoxBOE.82302001-10-11For the secondary prevention of stroke.LU Authorization Period: Indefinite.ISOSORBIDE DINITRATE06595mgSL Tab.0621ISDNAAP.06211996-10-01IsordilWAY1997-02-04066010mgTab.0365ISDNAAP.03651996-10-01IsordilWAY1996-10-01066130mgTab.0857ISDNAAP.08571996-10-01IsordilWAY1996-10-01ISOSORBIDE-5-MONONITRATE066260mgER TabImdurAZC2008-06-27Apo-ISMNAPX2008-06-27PMS-ISMNPMS2008-08-28NIMODIPINE066330mgTab9.8800NimotopBAH9.88002011-10-25As adjunctive therapy to improve the neurologic outcome following subarachnoid haemorrhage during the acute management period (within 4 days of haemorrhage).LU Authorization Period: 1 year.As prophylaxis of ischemia if surgery is delayed.LU Authorization Period: 1 year.NITROGLYCERIN06642%Oint.6420NitrolPAL.64201996-10-0106650.4mg/Hr/20 Sq CmPatch.7673Transderm-NitroNOV.76731996-12-1906660.4mg/Hr/20 Sq CmPatch.6400Nitro-DurSCH.64001996-10-0106670.6mg/Hr/30 Sq CmPatch.7673Transderm-NitroNOV.76731997-04-1006680.6mg/Hr/30 Sq CmPatch.6400Nitro-DurSCH.64001996-10-0106690.4mg/Hr/13.3 Sq CmPatch.6810MinitranGRA.68101996-10-0106700.4mg/Hr/14 Sq CmPatch.6400TrinipatchPAL.64001999-04-1506710.6mg/Hr/20 Sq CmPatch.6813MinitranGRA.68131996-10-0106720.6mg/Hr/21 Sq CmPatch.6400TrinipatchPAL.64001999-04-1506730.3mgSL Tab.1191NitrostatPFI.11911996-10-0106740.6mgSL Tab.1191NitrostatPFI.11911996-10-0106750.4mg/Metered DoseSpray-200 Dose Pk8.4600NitrolingualAVE1996-10-01Mylan-Nitro Sublingual SprayMYL8.46002003-01-3006760.4mg/Metered DoseSpray-200 Dose Pk14.2100Nitrolingual Pump SpraySAV14.21001999-04-15CENTRAL NERVOUS SYSTEM DRUGSANALGESICS NONSTEROIDAL ANTI-INFLAMMATORY AGENTSNSAIDs have a high rate of serious adverse effects in the elderly. When prescribing NSAIDs, the minimal effective dose for the shortest period of time should be used. In nonspecific pain and/or osteoarthritis, in the absence of joint inflammation (swelling), acetaminophen is a better first choice for analgesia. The most effective treatment to prevent NSAID-gastritis is misoprostol; although H-2 antagonists, such as ranitidine or cimetidine, are commonly used, they are not as effective. NSAIDs can significantly aggravate hypertension and congestive heart failure; ASA in doses below 1 gram per day is a better choice than other NSAID options if anti-inflammatory effects are required in patients with these conditions. Low dose ASA has additional benefits for anti-platelet indications that are not provided by other NSAIDs, and should be given in preference or in addition to other NSAIDs for patients with vascular indications.ACETYLSALICYLIC ACID0677325mgEnt Tab.0280EntrophenPEN.02801996-10-01NovasenNOP.02801996-10-010678650mgEnt Tab.0521EntrophenPEN.08621996-10-01NovasenNOP.05211996-10-010679325mgTab.0585ASARPR1996-10-01PMS-ASAPMS.05851996-10-01CELECOXIB0680100mgCap.6637CelebrexPFI.66372000-04-170681200mgCap1.3274CelebrexPFI1.32742000-04-17OsteoarthritisFor patients who have failed an adequate trial of acetaminophen (e.g. acetaminophen 1g QID for several weeks) and have had:History of a documented, clinically significant ulcer or GI bleed; or Failure or intolerance to at least three listed NSAIDS.The maximum daily dose of celecoxib which will be reimbursed for the treatment of osteoarthritis is 200mg.LU Authorization Period: 1 year.Rheumatoid arthritisFor patients who have had:History of a documented, clinically significant ulcer or GI bleed; or Failure or intolerance to at least three listed NSAIDS.The maximum daily dose of celecoxib which will be reimbursed for the treatment of rheumatoid arthritis is 400mg.LU Authorization Period: 1 year.DICLOFENAC POTASSIUM068250mgTabVoltaren RapideNOV2008-01-15Novo-Difenac-KNOP2008-01-15PMS-Diclofenac KPMS2008-02-12Apo-Diclo RapideAPX2008-01-15Sandoz Diclofenac RapideSDZ2008-01-15DICLOFENAC SODIUM068325mgEnt Tab.0781VoltarenGEI1996-10-01Novo-DifenacNOP.07811996-10-01Apo-DicloAPX.07811996-10-01Nu-DicloNXP.07811996-10-01PMS-DiclofenacPMS.07812008-10-01068450mgEnt Tab.2064VoltarenNOV.88851996-10-01Novo-DifenacNOP.20641996-10-01Apo-DicloAPX.20641996-10-01Nu-DicloNXP.20641996-10-01Sandoz DiclofenacSDZ.20642012-01-19PMS-DiclofenacPMS.20642008-10-01068575mgLA Tab.2433Voltaren SRNOV1998-08-26Novo-Difenac SRNOP.24331998-12-31Apo-Diclo SRAPX.24331998-12-31PMS-Diclofenac-SRPMS.24331999-09-15Sandoz Diclofenac SRSDZ.24332008-03-250686100mgLA Tab.4048Voltaren SRNOV1998-08-26Novo-Difenac SRNOP.40481998-12-31Apo-Diclo SRAPX.40481998-12-31PMS-Diclofenac-SRPMS.40481999-09-15Sandoz Diclofenac SRSDZ.40482008-03-25068750mgSup.4339VoltarenNOV1.33431996-10-01PMS-DiclofenacPMS.43392000-01-17Sandoz DiclofenacSDZ.43392009-03-020688100mgSup.5840VoltarenNOV1.79601996-10-01PMS-DiclofenacPMS.58402000-01-17Sandoz DiclofenacSDZ.58402009-03-02DICLOFENAC SODIUM & MISOPROSTOL068950mg & 200mcgTab.5883Arthrotec 50PFI.58831996-10-01069075mg & 200mcgTab.8007Arthrotec 75PFI.80071997-08-28DIFLUNISAL0691250mgTab.5366DolobidFRS1996-10-01Apo-DiflunisalAPX.53661996-10-010692500mgTab.5363DolobidFRS1996-10-01Apo-DiflunisalAPX.53631996-10-01ETODOLAC0693200mgCapUltradolPGP2007-11-10Apo-EtodolacAPX2007-11-100694300mgCapUltradolPGP2007-11-10Apo-EtodolacAPX2007-11-10FLOCTAFENINE0695200mgTab.4175IdaracSAO1996-10-01FloctafenineAAP.41752002-07-290696400mgTab.8123IdaracSAO1996-10-01FloctafenineAAP.81232002-07-29FLURBIPROFEN069750mgTab.2221AnsaidPFI.53291996-10-01Apo-FlurbiprofenAPX.22211996-10-01Nu-FlurbiprofenNXP.22211996-10-01Novo-FlurprofenNOP.22211996-10-010698100mgTab.3039AnsaidPFI.69761996-10-01Apo-FlurbiprofenAPX.30391996-10-01Nu-FlurbiprofenNXP.30391996-10-01Novo-FlurprofenNOP.30391996-10-01IBUPROFEN0699200mgTab.0243MotrinUPJ2006-06-15Apo-IbuprofenAPX.02641996-10-01Novo-ProfenNOP.02431996-10-010700300mgTab.1087MotrinUPJ1996-10-01Apo-IbuprofenAPX.10871996-10-010701400mgTab.0372MotrinUPJ.18711996-10-01Apo-IbuprofenAPX.04681996-10-01Novo-ProfenNOP.03721996-10-010702600mgTab.0465MotrinUPJ1996-10-01Apo-IbuprofenAPX.13131996-10-01Novo-ProfenNOP.04651996-10-01INDOMETHACIN070325mgCap.0871IndocidMSD1996-10-01Novo-MethacinNOP.08711996-10-01Apo-IndomethacinAPX.08711996-10-01Nu-IndoNXP.08711996-10-01070450mgCap.1511IndocidMSD1996-10-01Novo-MethacinNOP.15111996-10-01Apo-IndomethacinAPX.15111996-10-01Nu-IndoNXP.15111996-10-01070550mgSup.8200IndocidMSD1996-10-01Sab-IndomethacinSDZ.82001999-04-150706100mgSup.8919IndocidMSD1996-10-01Ratio-IndomethacinRPH.89191996-10-01Sab-IndomethacinSDZ.89191999-04-15KETOPROFEN070750mgCap.3373Apo-KetoAPX.33731996-10-01OrudisRPP1996-10-01070850mgEnt Tab.3373Apo-Keto-EAPX.33731996-10-01Orudis E-50RPP1996-10-010709100mgEnt Tab.6823Rhodis-ECSAV1996-10-01Apo-Keto-EAPX.68231996-10-01Orudis E-100RPP1996-10-010710200mgLA Tab1.3890Orudis SR-200RPP1996-10-01Apo-Keto SRAPX1.38901998-12-310711100mgSup.9930OrudisAVE1996-10-01PMS-KetoprofenPMS.99301996-10-01KETOROLAC TROMETHAMINE071210mgTabToradolHLR2008-10-01Apo-KetorolacAPX2008-10-01Novo-KetorolacNOP2008-11-04MEFENAMIC ACID0713250mgCap.4988PonstanPFI1996-10-01Apo-MefenamicAPX.49881997-04-10MELOXICAM07147.5mgTab.2003MobicoxBOE.80112001-03-07Ratio-MeloxicamRPH.20032004-04-06PMS-MeloxicamPMS.20032004-04-06Phl-MeloxicamPHE.20032010-06-14Apo-MeloxicamAPX.20032004-07-20Co MeloxicamCOB.20032004-09-14Mylan-MeloxicamMYL.20032004-09-14Novo-MeloxicamNOP.20032004-11-16071515mgTab.2311MobicoxBOE.92432001-03-07Ratio-MeloxicamRPH.23112004-04-06PMS-MeloxicamPMS.23112004-04-06Phl-MeloxicamPHE.23112010-06-14Apo-MeloxicamAPX.23112004-07-20Co MeloxicamCOB.23112004-09-14Mylan-MeloxicamMYL.23112004-09-14Novo-MeloxicamNOP.23112004-11-16NABUMETONE0716500mgTabRelafenGSK2007-07-12Apo-NabumetoneAPX2007-09-04Novo-NabumetoneNOP2007-09-04Sandoz NabumetoneSDZ2007-07-12Mylan-NabumetoneMYL2007-07-120717750mgTabRelafenGSK2007-09-04Novo-NabumetoneNOP2007-09-04NAPROXEN0718250mgEnt TabNaprosyn EHLR2008-01-15Novo-NaproxNOP2008-11-04Gen-Naproxen ECGEN2008-01-15Apo-Naproxen ECAPX2008-01-150719375mgEnt TabNaprosyn EHLR2008-01-15Novo-NaproxNOP2008-11-04Mylan-Naproxen ECMYL2008-01-15Apo-Naproxen ECAPX2008-01-15PMS-Naproxen ECPMS2008-01-150720500mgEnt TabNaprosyn EHLR2008-01-15Mylan-Naproxen ECMYL2008-01-15Novo-NaproxNOP2008-11-04Apo-Naproxen ECAPX2008-01-15PMS-Naproxen ECPMS2008-01-15072125mg/mLO/L.0614NaprosynHLR.06141996-10-010722750mgSR Tab1.0048Naprosyn SRHLR2000-04-17Apo-Naproxen SRAPX1.00481999-04-150723500mgSup.4775PMS-NaproxenPMS.47751996-10-01NaprosynHLR2000-04-170724125mgTab.0781NaprosynSYN2001-02-28Apo-NaproxenAPX.07811996-10-010725250mgTab.1068Apo-NaproxenAPX.10681996-10-01Novo-NaproxNOP.10681996-10-01Nu-NaproxNXP.10681996-10-01NaprosynHLR1996-10-010726375mgTab.1458Apo-NaproxenAPX.14581996-10-01Novo-NaproxNOP.14581996-10-01Nu-NaproxNXP.14581996-10-01NaprosynHLR1996-10-010727500mgTab.2110Novo-NaproxNOP.21101996-10-01Apo-NaproxenAPX.22441996-10-01Nu-NaproxNXP.21101996-10-01NaprosynHLR2000-04-17NAPROXEN SODIUM0728275mgTabApo-Napro-NaAPX2007-12-19AnaproxHLR2007-12-190729550mgTabApo-Napro-Na DSAPX2007-12-19Anaprox DSHLR2007-12-19OXAPROZIN.0730600mgTabDayproHLR2007-07-12Apo-OxaprozinAPX2007-07-12PIROXICAM073110mgCap.2213FeldenePFI1996-10-01Apo-PiroxicamAPX.22131996-10-01Novo-PirocamNOP.22131996-10-01Nu-PiroxNXP.22131996-10-01073220mgCap.3711FeldenePFI1996-10-01Apo-PiroxicamAPX.37111996-10-01Novo-PirocamNOP.37111996-10-01Nu-PiroxNXP.37111996-10-01073320mgSup1.6460FeldenePFI1996-10-01PMS-PiroxicamPMS1.64601996-10-01SULINDAC0734150mgTab.3824ClinorilFRS1996-10-01Novo-SundacNOP.38241996-10-01Apo-SulinAPX.38241996-10-01Nu-SulindacNXP.38241996-10-010735200mgTab.4840ClinorilFRS1996-10-01Novo-SundacNOP.48401996-10-01Apo-SulinAPX.48401996-10-01Nu-SulindacNXP.48401996-10-01TIAPROFENIC ACID0736200mgTab.3437SurgamHRU1996-10-01Apo-TiaprofenicAPX.34371996-10-01Novo-TiaprofenicNOP.34371996-10-010737300mgTab.3258Apo-TiaprofenicAPX.32581996-10-01Novo-TiaprofenicNOP.32581996-10-01SurgamSAV1999-01-07PMS-TiaprofenicPMS1998-12-31ANALGESICS OPIATE AGONISTSNarcotic analgesics can produce dependence and may be abused. Physical dependence, psychological dependence and tolerance may develop. Prescribers are cautioned about ordering these drugs for patients with a history of either emotional disturbances or drug abuse, including alcohol.ACETAMINOPHEN & CAFFEINE & CODEINE PHOSPHATE0738300mg & 15mg & 15mgTab.0476Atasol-15HOR1996-10-01Ratio-Lenoltec No.2RPH.04761996-10-01Tylenol with Codeine No. 2JAN.04761996-10-010739300mg & 15mg & 30mgTab.0524Atasol-30HOR1996-10-01Ratio-Lenoltec No.3RPH.05241996-10-01Tylenol with Codeine No. 3JAN.05241996-10-01ACETAMINOPHEN & CODEINE PHOSPHATE0740160mg & 8mg/5mLO/L.0586PMS-Acetaminophen With CodeinePMS.05861998-12-31Tylenol With Codeine ElixirJAN2007-01-020741300mg & 30mgTab.1300Ratio-EmtecRPH.13001996-10-01Empracet-30BWE1996-10-010742300mg & 60mgTab.1384Ratio-Lenoltec No.4RPH.13841996-10-01Tylenol with Codeine No. 4JAN.13841996-10-01ACETYLSALICYLIC ACID & BUTALBITAL & CAFFEINE0743330mg & 50mg & 40mgCapFiorinalNOV2008-12-23Ratio-TecnalRPH2008-12-23ACETYLSALICYLIC ACID & BUTALBITAL & CAFFEINE & CODEINE PHOSPHATE0744330mg & 50mg & 40mg & 15mgCapFiorinal C1/4NOV2008-12-23Ratio-Tecnal C1/4RPH2008-12-230745330mg & 50mg & 40mg & 30mgCapFiorinal C1/2NOV2008-12-23Ratio-Tecnal C1/2RPH2008-12-23ACETYLSALICYLIC ACID COMPOUND WITH CODEINE074630mgTab.1730292PEN.17302006-10-23CODEINE PHOSPHATE07475mg/mLO/L.0265Ratio-CodeineRPH.02651996-10-01074815mgTab.0542Ratio-CodeineRPH.05421996-10-01CodeineROG.05421996-10-01074930mgTab.0966Ratio-CodeineRPH.09661996-10-01CODEINE SULFATE TRIHYDRATE & MONOHYDRATE075050mgCR Tab.3110Codeine ContinPFP.31102002-04-040751100mgCR Tab.6230Codeine ContinPFP.62302002-04-040752150mgCR Tab.9420Codeine ContinPFP.94202002-04-040753200mgCR Tab1.2460Codeine ContinPFP1.24602002-04-04For the treatment of chronic pain in patients who cannot tolerate, or have failed treatment with a listed long-acting opioid.LU Authorization Period: 1 year.FENTANYL TRANSDERMAL SYSTEM075412mcg/hrTrans PatchDuragesic 12JNO2008-12-23Ratio-FentanylRPH2008-12-23Sandoz Fentanyl PatchSDZ2010-03-02Ran-Fentanyl Matrix PatchRAN2010-03-02PMS-Fentanyl MTXPMS2010-07-20075525mcg/hrTrans Patch3.6582Duragesic 25JNO11.49601996-10-01Ran-FentanylRAN3.65822006-10-23Duragesic MatJNO2010-04-23Ratio-FentanylRPH3.65822007-01-02Novo-FentanylNOP3.65822009-09-30Sandoz Fentanyl PatchSDZ3.65822010-03-02Ran-Fentanyl Matrix PatchRAN3.65822010-03-02PMS-Fentanyl MTXPMS3.65822010-07-20075650mcg/hrTrans Patch6.8838Duragesic 50JNO21.63481996-10-01Ran-FentanylRAN6.88382006-10-23Duragesic MatJNO2010-04-23Ratio-FentanylRPH6.88382007-01-02Novo-FentanylNOP6.88382009-09-30Sandoz Fentanyl PatchSDZ6.88382010-03-02Ran-Fentanyl Matrix PatchRAN6.88382010-03-02PMS-Fentanyl MTXPMS6.88382010-07-20075775mcg/hrTrans Patch9.6817Duragesic 75JNO30.42821996-10-01Ran-FentanylRAN9.68172006-10-23Duragesic MatJNO2010-04-23Ratio-FentanylRPH9.68172007-01-02Novo-FentanylNOP9.68172009-09-30Sandoz Fentanyl PatchSDZ9.68172010-03-02Ran-Fentanyl Matrix PatchRAN9.68172010-03-02PMS-Fentanyl MTXPMS9.68172010-07-200758100mcg/hrTrans Patch12.0512Duragesic 100JNO37.87401996-10-01Ran-FentanylRAN12.05122006-10-23Duragesic MatJNO2010-04-23Ratio-FentanylRPH12.05122007-01-02Novo-FentanylNOP12.05122009-09-30Sandoz Fentanyl PatchSDZ12.05122010-03-02Ran-Fentanyl Matrix PatchRAN12.05122010-03-02PMS-Fentanyl MTXPMS12.05122010-07-20For the treatment of chronic pain in patients who cannot tolerate, or have failed treatment with a listed long-acting opioid.LU Authorization Period: 1 year.HYDROMORPHONE HCL07594.5mgCR Cap.8140Hydromorph ContinPFP.81402012-01-1907609mgCR Cap1.3340Hydromorph ContinPFP1.33402012-01-1907613mgCR Cap.6610Hydromorph ContinPFP.66101998-12-3107626mgCR Cap.9910Hydromorph ContinPFP.99101998-12-31076312mgCR Cap1.7170Hydromorph ContinPFP1.71701998-12-31076418mgCR Cap2.4770Hydromorph ContinPFP2.47702002-04-04076524mgCR Cap3.1700Hydromorph ContinPFP3.17001998-12-31076630mgCR Cap3.7980Hydromorph ContinPFP3.79801999-09-15076720mg/mLInj3.6680Hydromorphone HP-20SDZ3.66801998-12-31Dilaudid-HP-PlusPFP3.66801996-10-0107682mg/mLInj Sol-1mL Pk.9450DilaudidPFP.95001996-10-01HydromorphoneSDZ.94501996-12-19076910mg/mLInj Sol-1mL Pk2.3380Dilaudid-HPPFP2.33801996-10-01Hydromorphone HP-10SDZ2.33801998-12-31077050mg/mLInj-1mL Pk9.7335Dilaudid-XPPFP9.73351996-10-01Hydromorphone HP-50SDZ9.73351998-12-3107711mg/mLOral Sol.0652DilaudidPFP.09311996-10-01PMS-HydromorphonePMS.06522006-01-240772250mgPd Vial Pk67.5750Dilaudid Sterile PowderPFP67.57501996-10-0107731mgTab.0959DilaudidPFP.09591996-10-01PMS-HydromorphonePMS.09592001-10-1107742mgTab.1417DilaudidPFP.14171996-10-01PMS-HydromorphonePMS.14171997-04-1007754mgTab.2240DilaudidPFP.22401996-10-01PMS-HydromorphonePMS.22401999-04-1507768mgTab.3528DilaudidPFP.35281996-10-01PMS-HydromorphonePMS.35282001-10-11MEPERIDINE HCL077750mgTab.1462DemerolSAV.14621996-10-01Limited to 2 weeks supply for acute pain.LU Authorization Period: 1 year.MORPHINE HCL07781mg/mLO/L.0200M.O.S.VAL1996-10-01Ratio-MorphineRPH.02001996-10-0107795mg/mLO/L.0842M.O.S.VAL1996-10-01Ratio-MorphineRPH.08421996-10-01078010mg/mLO/L.1838M.O.S.VAL.18381996-10-01Ratio-MorphineRPH.18381996-10-01078120mg/mLO/L.5241M.O.S.VAL1996-10-01Ratio-MorphineRPH.52411996-10-01078210mgTab.1700M.O.S.-10VAL.17001996-10-01078320mgTab.3243M.O.S.-20VAL.32431996-10-01078460mgTab.5851M.O.S.-60VAL.58511996-10-01MORPHINE SULFATE078510mgER Cap.2900M-EslonETH.29001996-10-01078615mgER Cap.3350M-EslonETH.33501996-12-19078730mgER Cap.5000M-EslonETH.50001996-10-01078860mgER Cap.8875M-EslonETH.88751996-10-010789100mgER Cap1.9100M-EslonETH1.91001996-10-010790200mgER Cap3.8198M-EslonETH3.81981996-12-19079115mg/mLInj Sol Amp.9000Morphine SulfateSDZ.90001996-12-19Morphine Sulfate Injection USPHOS1996-10-01079250mg/mLInj Sol-1mL Pk3.2200Morphine HP-50SDZ3.22001996-10-0107931mg/mLO/L.0200StatexPAL.02001996-10-0107945mg/mLO/L.0803StatexPAL.08031996-10-01079520mg/mLOral Drops.3857StatexPAL.38571996-10-01079610mgSR Cap.3604KadianABB.36042003-01-30079720mgSR Cap.7004KadianABB.70041997-08-28079850mgSR Cap1.3248KadianABB1.32481997-08-280799100mgSR Cap2.3106KadianABB2.31061997-08-28080015mgSR Tab.2317MS ContinPFP.66701996-10-01Sandoz Morphine SRSDZ.23172002-07-29PMS-Morphine SulfatePMS.23172003-01-30Novo-Morphine SRNOP.23172009-04-01080130mgSR Tab.3500MS ContinPFP1.00901996-10-01Sandoz Morphine SRSDZ.35002002-07-29PMS-Morphine SulfatePMS.35002003-01-30Novo-Morphine SRNOP.35002009-06-23080260mgSR Tab.6167MS ContinPFP1.77701996-10-01Sandoz Morphine SRSDZ.61672002-07-29PMS-Morphine SulfatePMS.61672003-01-30Novo-Morphine SRNOP.61672008-04-090803100mgSR Tab.9401MS ContinPFP2.71001996-10-01PMS-Morphine Sulfate SRPMS.94012008-06-27Novo-Morphine SRNOP.94012008-04-090804200mgSR Tab1.7479MS ContinPFP5.03801996-10-01PMS-Morphine Sulfate SRPMS1.74792008-06-27Novo-Morphine SRNOP1.74792008-04-09080520mgTab.3380MS-IRPFP.33801996-10-01080630mgTab.4330MS-IRPFP.43301996-10-0108075mgTab.1100StatexPAL.11001996-10-01080810mgTab.1700StatexPAL.17001996-10-01080925mgTab.2250StatexPAL.22501996-10-01081050mgTab.3450StatexPAL.34501996-10-01OXYCODONE HCL081110mgSR Tab.8780OxycontinPFP.87802000-01-17081220mgSR Tab1.3190OxycontinPFP1.31902000-01-17081340mgSR Tab2.2900OxycontinPFP2.29002000-01-17081480mgSR Tab4.2300OxycontinPFP4.23002000-01-17For the treatment of chronic pain in patients who cannot tolerate, or have failed treatment with a listed long-acting opioid.LU Authorization Period: 1 year.08155mgTabSupeudolSDZ2010-04-23Oxy.IRPFP2009-01-30PMS-OxycodonePMS2009-01-30081610mgTabSupeudolSDZ2010-04-23Oxy.IRPFP2009-01-30PMS-OxycodonePMS2009-01-30081720mgTabOxy.IRPFP2008-10-01SupeudolSDZ2008-10-01PMS-OxycodonePMS2009-01-30OXYCODONE HCL & ACETAMINOPHEN08185mg & 325mgTab.1285Ratio-OxycocetRPH.12851996-10-01PercocetBQU2008-12-23EndocetBQU.12851996-10-01Sandoz Oxycodone/AcetaminophenSDZ.12852008-10-01Apo-Oxycodone/AcetAPX.12852009-09-30OXYCODONE HCL & ACETYLSALICYLIC ACID08195mg & 325mgTab.3220Ratio-OxycodanRPH.32201996-10-01PercodanBQU2008-12-23TRAMADOL HCL & ACETAMINOPHEN082037.5mg & 325mgTabTramacetJAN2010-03-02Apo-Tramadol/AcetAPX2010-03-02ANALGESICS MISCELLANEOUS ANALGESICS AND ANTIPYRETICSACETAMINOPHEN082180mg/mLO/L.1436AtasolHOR1996-10-01TempraMJS1999-01-01PediatrixRPH.14362001-10-110822120mgSup.5367AbenolPEN1996-10-01ACET 120PMS.53671998-03-170823325mgSup.6625AbenolPEN1996-10-01ACET 325PMS.66251998-03-170824650mgSup.7608AbenolPEN2007-01-02ACET 650PMS.76081998-03-170825325mgTab.0114AtasolHOR1996-10-01Novo-GesicNOP.01141996-10-01Apo-AcetaminophenAPX.02451996-10-01AcetaminophenDPC.01141996-10-010826500mgTab.0149Atasol ForteHOR1996-10-01Novo-Gesic ForteNOP.01491996-10-01Apo-AcetaminophenAPX.02851996-10-01ANTICONVULSANTSCARBAMAZEPINE0827100mgChew Tab.0380TegretolNOV.16341996-10-01PMS-CarbamazepinePMS.03802003-04-16Taro-CarbamazepineTAR.06122003-04-16Sandoz Carbamazepine ChewtabsSDZ.03802006-07-190828200mgChew Tab.0749TegretolNOV.32241996-10-01PMS-CarbamazepinePMS.07492003-04-16Taro-CarbamazepineTAR.12072003-04-16Sandoz Carbamazepine ChewtabsSDZ.07492006-07-190829200mgLA Tab.0930Tegretol CRNOV.40021996-10-01PMS-Carbamazepine CRPMS.09301999-04-15Mylan-Carbamazepine CRMYL.09302000-11-30Sandoz Carbamazepine CRSDZ.09302006-07-190830400mgLA Tab.1859Tegretol CRNOV.80021996-10-01PMS-Carbamazepine CRPMS.18591999-04-15Mylan-Carbamazepine CRMYL.18592000-11-30Sandoz Carbamazepine CRSDZ.18592006-07-19For patients who have been tried on conventional carbamazepine with unsatisfactory results due to adverse effects or poor control of symptoms.LU Authorization Period: Indefinite.0831100mg/5mLOral Susp.0772TegretolNOV.07721996-12-190832200mgTab.0795TegretolNOV1996-10-01Apo-CarbamazepineAPX.14761996-10-01Novo-CarbamazNOP.07951996-10-01Nu-CarbamazepineNXP.07951996-10-01CLOBAZAM083310mgTab.1098FrisiumOVA.43931999-01-06Novo-ClobazamNOP.10981999-04-15PMS-ClobazamPMS.10982002-07-29Apo-ClobazamAPX.10982003-01-30As adjunctive therapy in the treatment of seizure disorders where control by other listed anticonvulsants has been unsatisfactory.Because a large number of patients will become refractory to the anticonvulsant effects of the drug over a period of time, the effectiveness of this drug must be re-evaluated after a period of six months.LU Authorization Period: Indefinite.CLONAZEPAM08340.5mgTab.0495RivotrilHLR.19811996-10-01PMS-ClonazepamPMS.04951996-10-01Ratio-ClonazepamRPH.04951996-10-01Phl-ClonazepamPHE.04952010-06-14Nu-ClonazepamNXP.04951996-10-01Apo-ClonazepamAPX.04951996-10-01PMS-Clonazepam-RPMS.04951996-10-01Mylan-ClonazepamMYL.04951997-08-28Sandoz ClonazepamSDZ.04951999-04-15Phl-Clonazepam-RPHE.04952010-06-14Novo-ClonazepamNOP.04952000-04-17Co ClonazepamCOB.09252006-06-14Zym-ClonazepamZYN.04952010-09-0908352mgTab.0854RivotrilHLR.34171996-10-01PMS-ClonazepamPMS.08541996-10-01Ratio-ClonazepamRPH.08541996-10-01Phl-ClonazepamPHE.08542010-06-14Nu-ClonazepamNXP.08541996-10-01Apo-ClonazepamAPX.08541996-10-01Mylan-ClonazepamMYL.08541997-08-28Sandoz ClonazepamSDZ.08541999-04-15Novo-ClonazepamNOP.08542000-04-17Co ClonazepamCOB.15952006-06-14Zym-ClonazepamZYN.08542010-07-20DIVALPROEX SODIUM0836125mgEnt Tab.0724EpivalABB.29481996-10-01Nu-DivalproexNXP.07242000-01-17Apo-DivalproexAPX.07241999-09-15Novo-DivalproexNOP.07242000-01-17Gen-DivalproexGEN.10932005-04-280837250mgEnt Tab.1301EpivalABB.52991996-10-01Nu-DivalproexNXP.13012000-01-17Apo-DivalproexAPX.13011999-09-15Novo-DivalproexNOP.13012000-01-17Gen-DivalproexGEN.19642005-04-280838500mgEnt Tab.2604EpivalABB1.06031996-10-01Nu-DivalproexNXP.26042000-01-17Apo-DivalproexAPX.26041999-09-15Novo-DivalproexNOP.26042000-01-17Gen-DivalproexGEN.39312005-04-28ETHOSUXIMIDE0839250mgCap.3383ZarontinERF.33831996-10-01084050mg/mLO/L.0677ZarontinERF.06771996-10-01GABAPENTIN0841100mgCap.1060NeurontinPFI.42471996-10-01PMS-GabapentinPMS.10602001-10-11Apo-GabapentinAPX.10602002-07-29Novo-GabapentinNOP.10602002-07-29GabapentinMEL.10602009-11-19Mylan-GabapentinMYL.10602004-04-06Co GabapentinCOB.10602005-03-31Ratio-GabapentinRPH.10602005-07-14Gd-GabapentinGEM.10602011-06-08Zym-GabapentinZYN.10602010-04-23Ran-GabapentinRAN.10602010-03-02Auro-GabapentinAUR.10602011-12-15Gabapentin CapsulesRAN.10602010-04-23Jamp-GabapentinJPC.10602012-01-190842300mgCap.2578NeurontinPFI1.03321996-10-01PMS-GabapentinPMS.25782001-10-11Apo-GabapentinAPX.25782002-07-29Novo-GabapentinNOP.25782002-07-29GabapentinMEL.25782009-11-19Mylan-GabapentinMYL.25782004-04-06Co GabapentinCOB.25782005-03-31Ratio-GabapentinRPH.25782005-07-14Gd-GabapentinGEM.25782011-06-08Zym-GabapentinZYN.25782010-04-23Ran-GabapentinRAN.25782010-03-02Auro-GabapentinAUR.25782011-12-15Gabapentin CapsulesRAN.25782010-04-23Jamp-GabapentinJPC.25782012-01-190843400mgCap.3072NeurontinPFI1.23131996-10-01PMS-GabapentinPMS.30722001-10-11Apo-GabapentinAPX.30722002-07-29Novo-GabapentinNOP.30722002-07-29GabapentinMEL.30722009-11-19Mylan-GabapentinMYL.30722004-04-06Co GabapentinCOB.30722005-03-31Ratio-GabapentinRPH.30722005-07-14Gd-GabapentinGEM.30722011-06-08Zym-GabapentinZYN.30722010-04-23Ran-GabapentinRAN.30722010-03-02Auro-GabapentinAUR.30722011-12-15Gabapentin CapsulesRAN.30722010-04-23Jamp-GabapentinJPC.30722012-01-190844600mgTabNeurontinPFI2007-06-06Novo-GabapentinNOP2007-06-06PMS-GabapentinPMS2007-06-06Ratio-GabapentinRPH2007-06-06Apo-GabapentinAPX2008-08-280845800mgTabNeurontinPFI2007-06-06Novo-GabapentinNOP2007-06-06PMS-GabapentinPMS2007-06-06Ratio-GabapentinRPH2007-06-06Apo-GabapentinAPX2008-08-28LAMOTRIGINE084625mgTab.0936LamictalGSK.37421996-10-01Ratio-LamotrigineRPH.09362003-04-16Apo-LamotrigineAPX.09362003-01-30PMS-LamotriginePMS.09362004-04-06Novo-LamotrigineNOP.09362004-04-06Mylan-LamotrigineMYL.09362005-07-140847100mgTab.3735LamictalGSK1.49401996-10-01Ratio-LamotrigineRPH.37352003-04-16Apo-LamotrigineAPX.37352003-01-30PMS-LamotriginePMS.37352004-04-06Novo-LamotrigineNOP.37352004-04-06Mylan-LamotrigineMYL.37352005-07-140848150mgTab.5505LamictalGSK2.20181996-10-01Apo-LamotrigineAPX.55052003-01-30PMS-LamotriginePMS.55052004-04-06Ratio-LamotrigineRPH.55052004-07-20Novo-LamotrigineNOP.55052004-04-06Mylan-LamotrigineMYL.55052005-07-14As adjunctive therapy in the treatment of seizure disorders where control by other listed anticonvulsants has been unsatisfactory.Because a large number of patients may become refractory to the anticonvulsant effects of the drug over a period of time, the effectiveness of this drug must be re-evaluated after a period of six months.LU Authorization Period: Indefinite.LEVETIRACETAM0849250mgTabKeppraVLH2007-11-10Co LevetiracetamCOB2007-12-19Apo-LevetiracetamAPX2007-11-10PMS-LevetiracetamPMS2007-11-100850500mgTabKeppraVLH2007-11-10Co LevetiracetamCOB2007-12-19Apo-LevetiracetamAPX2007-11-10PMS-LevetiracetamPMS2007-11-100851750mgTabKeppraVLH2007-11-10Co LevetiracetamCOB2007-12-19Apo-LevetiracetamAPX2007-11-10PMS-LevetiracetamPMS2007-11-10METHSUXIMIDE0852300mgCap1.0763CelontinERF1.07631996-10-01OXCARBAZEPINE0853150mgTabTrileptalNOV2008-06-27Apo-OxcarbazepineAPX2008-06-270854300mgTabTrileptalNOV2008-06-27Apo-OxcarbazepineAPX2008-06-270855600mgTabTrileptalNOV2008-06-27Apo-OxcarbazepineAPX2008-06-27PHENYTOIN (DIPHENYLHYDANTOIN)08566mg/mLO/L.0406DilantinPFI.04061996-10-01085725mg/mLO/L.0323DilantinPFI.04801996-10-01Taro-PhenytoinTAR.03232005-11-08085850mgTab.0738DilantinPFI.07381996-10-01PHENYTOIN (DIPHENYLHYDANTOIN) SODIUM085930mgCap.0538DilantinPFI.05381996-10-010860100mgCap.0747DilantinPFI.07471996-10-01PRIMIDONE0861125mgTab.0553PrimidoneAAP.05531996-10-01MysolineWAY1996-10-010862250mgTab.0870PrimidoneAAP.08701996-10-01MysolineWAY1996-10-01TOPIRAMATE086315mgSprinkle Cap1.1675Topamax SprinkleJNO1.16752000-11-30086425mgSprinkle Cap1.2255Topamax SprinkleJNO1.22552000-11-30In children age 16 and under, as adjunctive therapy in the treatment of seizure disorders where control by other listed anticonvulsants has been unsatisfactory.LU Authorization Period: Indefinite.086525mgTab.3128TopamaxJNO1.27871998-12-31Novo-TopiramateNOP.31282005-11-08Ratio-TopiramateRPH.31282005-11-08Sandoz TopiramateSDZ.31282005-11-08PMS-TopiramatePMS.31282005-11-08Mylan-TopiramateMYL.31282005-11-08Phl-TopiramatePHE.31282009-11-19Apo-TopiramateAPX.31282006-06-14Co TopiramateCOB.31282007-10-03Mint-TopiramateMIN.31282009-03-02Zym-TopiramateZYN.31282010-04-23Auro-TopiramateAUR.31282011-09-150866100mgTab.5929TopamaxJNO2.42351998-12-31Novo-TopiramateNOP.59292005-11-08Ratio-TopiramateRPH.59292005-11-08Sandoz TopiramateSDZ.59292005-11-08PMS-TopiramatePMS.59292005-11-08Mylan-TopiramateMYL.59292005-11-08Phl-TopiramatePHE.59292009-11-19Apo-TopiramateAPX.59292006-06-14Co TopiramateCOB.59292007-10-03Mint-TopiramateMIN.59292009-03-02Zym-TopiramateZYN.59292010-04-23Auro-TopiramateAUR.59292011-09-150867200mgTab.8854TopamaxJNO3.61901998-12-31Novo-TopiramateNOP.88542005-11-08Ratio-TopiramateRPH.88542005-11-08PMS-TopiramatePMS.88542005-11-08Mylan-TopiramateMYL.88542005-11-08Sandoz TopiramateSDZ.88542005-11-08Phl-TopiramatePHE.88542009-11-19Apo-TopiramateAPX.88542006-06-14Co TopiramateCOB.88542007-10-03Mint-TopiramateMIN.88542009-03-02Zym-TopiramateZYN.88542010-04-23Auro-TopiramateAUR.88542011-09-15As adjunctive therapy in the treatment of seizure disorders where control by other listed anticonvulsants has been unsatisfactory.Because a large number of patients may become refractory to the anticonvulsant effects of the drug over a period of time, the effectiveness of this drug must be re-evaluated after a period of six months.LU Authorization Period: Indefinite.VALPROATE SODIUM086850mg/mLO/L.0398DepakeneABB.11591996-10-01Ratio-ValproicRPH.03981998-12-31PMS-Valproic AcidPMS.03981999-04-15Apo-ValproicAPX.03981999-09-15VALPROIC ACID0869250mgCap.1366DepakeneABB.55621996-10-01Novo-ValproicNOP.13661996-10-01Ratio-ValproicRPH.13661996-10-01Mylan-ValproicMYL.13661996-10-01PMS-Valproic AcidPMS.13661998-12-31Nu-ValproicNXP.13661999-04-15Apo-ValproicAPX.13661999-04-15Sandoz ValproicSDZ.13662000-11-300870500mgEnt Cap.4125DepakeneABB1996-10-01PMS-Valproic AcidPMS.41251997-08-28VIGABATRIN0871500mgTab.9110SabrilOVA.91101996-10-01As adjunctive therapy in the treatment of seizure disorders where control by other listed anticonvulsants has been unsatisfactory.Because a large number of patients may become refractory to the anticonvulsant effects of the drug over a period of time, the effectiveness of this drug must be re-evaluated after a period of six months.LU Authorization Period: Indefinite.PSYCHOTHERAPEUTIC AGENTS ANTIDEPRESSANTSAMITRIPTYLINE087210mgTab.0664ElavilAAP.06641996-10-01087325mgTab.1211ElavilAAP.12111996-10-01087450mgTab.2347ElavilAAP.23471996-10-01BUPROPION HCL0875100mgTab.1547Wellbutrin SRBIO2000-04-17Sandoz Bupropion SRSDZ.15472006-08-24Ratio-Bupropion SRRPH.15472007-03-09PMS-Bupropion SRPMS.15472011-05-190876150mgTab.2298Wellbutrin SRBIO.92472000-04-17Sandoz Bupropion SRSDZ.22982006-08-24Ratio-Bupropion SRRPH.22982007-03-09PMS-Bupropion SRPMS.22982008-12-230877150mgTab.5430Wellbutrin XLBIO.54302007-11-100878300mgTab1.0861Wellbutrin XLBIO1.08612007-11-10For the treatment of depression.LU Authorization Period: Indefinite.CITALOPRAM HYDROBROMIDE087920mgTab.3329CelexaVLH1.33172000-01-17Apo-CitalopramAPX.33292004-07-20Mylan-CitalopramMYL.33292004-07-20PMS-CitalopramPMS.33292004-07-20Co CitalopramCOB.33292004-07-20Sandoz CitalopramSDZ.33292004-07-20Phl-CitalopramPHE.33292009-11-19Ratio-CitalopramRPH.33292004-07-20Ran-CitaloRAN.33292007-05-04Novo-CitalopramNOP.33292007-11-10CitalopramMEL.33292010-06-14Mint-CitalopramMIN.33292008-08-28Citalopram-OdanODN.33292008-10-01Jamp-CitalopramJPC.33292009-01-30Ng-CitalopramNGP.33292009-11-13Citalopram TabletsRAN.33292010-01-05Septa-CitalopramSET.33292011-03-15Mar-CitalopramMAR.33292012-01-19088040mgTab.3329CelexaVLH1.33172000-01-17Apo-CitalopramAPX.33292004-07-20Mylan-CitalopramMYL.33292004-07-20PMS-CitalopramPMS.33292004-07-20Co CitalopramCOB.33292004-07-20Sandoz CitalopramSDZ.33292004-07-20Phl-CitalopramPHE.33292009-11-19Ratio-CitalopramRPH.33292004-07-20Ran-CitaloRAN.33292007-05-04Novo-CitalopramNOP.33292008-01-15CitalopramMEL.33292010-06-14Mint-CitalopramMIN.33292008-08-28Citalopram-OdanODN.33292008-10-01Jamp-CitalopramJPC.33292009-01-30Ng-CitalopramNGP.33292009-11-13Citalopram TabletsRAN.33292010-01-05Septa-CitalopramSET.33292011-03-15Mar-CitalopramMAR.33292012-01-19CLOMIPRAMINE HCL088110mgTab.1290AnafranilORY.25811996-10-01Apo-ClomipramineAPX.12901996-10-01Co ClomipramineCOB.12902003-09-04088225mgTab.1758AnafranilORY.35161996-10-01Apo-ClomipramineAPX.17581996-10-01Co ClomipramineCOB.17582003-09-04088350mgTab.3237AnafranilORY.64741996-10-01Apo-ClomipramineAPX.32371996-10-01Co ClomipramineCOB.32372003-09-04DESIPRAMINE088425mgTab.3804PertofraneGEI1996-10-01NorpraminSAV1999-01-07Apo-DesipramineAPX.38041996-12-19088550mgTab.6704NorpraminSAV1999-01-07Apo-DesipramineAPX.67041996-12-19088675mgTab.8915NorpraminHMR1999-01-07Apo-DesipramineAPX.89151996-12-19DOXEPIN HCL088710mgCap.1889SinequanERF.32921996-10-01Apo-DoxepinAPX.18891996-10-01088825mgCap.2140SinequanERF.40391996-10-01Apo-DoxepinAPX.21401996-10-01088950mgCap.3971SinequanERF.74911996-10-01Apo-DoxepinAPX.39711996-10-01089075mgCap.3916SinequanERF1.07551996-10-01Novo-DoxepinNOP.39161996-10-01Apo-DoxepinAPX.39161996-10-010891100mgCap.5160SinequanERF1.41451996-10-01Novo-DoxepinNOP.51601996-10-01Apo-DoxepinAPX.51601996-10-010892150mgCap.7820SinequanPFI1996-10-01Novo-DoxepinNOP.78201996-10-01DULOXETINE089330mgDR Cap1.8382CymbaltaLIL1.83822009-08-18089460mgDR Cap3.6761CymbaltaLIL3.67612009-08-18ESCITALOPRAM089510mgTab1.6600CipralexVLH1.66002008-11-04089620mgTab1.7673CipralexVLH1.76732008-11-04FLUOXETINE HCLBecause of the long half-life of the fluoxetine metabolite, steady-state concentrations occur only after 4-6 weeks. Use with caution in anorexic patients. Fluoxetine therapy should be discontinued for 5 weeks before starting irreversible monoamine oxidase inhibitors (MAOI). Similarly irreversible MAOI should be discontinued for 2 weeks before starting fluoxetine.089710mgCapProzacLIL2008-02-12PMS-FluoxetinePMS2008-02-12Apo-FluoxetineAPX2008-02-12Novo-FluoxetineNOP2008-02-12Phl-FluoxetinePHE2009-11-19Mylan-FluoxetineMYL2008-02-12Ratio-FluoxetineRPH2008-02-12Sandoz FluoxetineSDZ2008-02-12Zym-FluoxetineZYN2010-06-14089820mgCap.4598ProzacLIL1.83931996-10-01PMS-FluoxetinePMS.45981996-10-01Nu-FluoxetineNXP.45981996-10-01Apo-FluoxetineAPX.45981996-10-01Novo-FluoxetineNOP.45981996-10-01Phl-FluoxetinePHE.45982010-01-05Mylan-FluoxetineMYL.45981999-04-15Ratio-FluoxetineRPH.45982000-07-17Co FluoxetineCOB.45982001-03-07Sandoz FluoxetineSDZ.45982001-10-11Zym-FluoxetineZYN.45982010-06-14FLUVOXAMINE MALEATEFluvoxamine therapy should be discontinued for 2 weeks before starting irreversible monoamine oxidase inhibitors (MAOI). Similarly irreversible MAOI should be discontinued for 2 weeks before starting fluvoxamine.089950mgTab.2105LuvoxSPH.85701996-10-01Ratio-FluvoxamineRPH.21051998-12-31Nu-FluvoxamineNXP.21052001-03-07Apo-FluvoxamineAPX.21051998-12-31Novo-FluvoxamineNOP.21052000-01-17PMS-FluvoxaminePMS.21052000-07-17Sandoz FluvoxamineSDZ.21052003-09-04Co FluvoxamineCOB.21052004-10-140900100mgTab.3783LuvoxSPH1.54071996-10-01Ratio-FluvoxamineRPH.37831998-12-31Nu-FluvoxamineNXP.37832001-03-07Apo-FluvoxamineAPX.37831998-12-31Novo-FluvoxamineNOP.37832000-01-17PMS-FluvoxaminePMS.37832000-07-17Sandoz FluvoxamineSDZ.37832003-09-04Co FluvoxamineCOB.37832004-10-14IMIPRAMINE090110mgTab.1370TofranilNOV1996-10-01ImipramineAAP.13701996-10-01090225mgTab.2471TofranilNOV1996-10-01ImipramineAAP.24711996-10-01090350mgTab.4822TofranilNOV.50761996-10-01ImipramineAAP.48221996-10-01MAPROTILINE HCL090425mgTab.5493LudiomilCIB1996-10-01Novo-MaprotilineNOP.54931996-10-01090550mgTab1.0401LudiomilNOV1996-10-01Novo-MaprotilineNOP1.04011996-10-01090675mgTab1.4204LudiomilNOV1996-10-01Novo-MaprotilineNOP1.42041996-10-01MIRTAZAPINE090715mgOrally Disintegrating Tab.0975Remeron RDORG.40172005-02-22Novo-Mirtazapine ODNOP.19502006-07-19Auro-Mirtazapine ODAUR.09752011-06-08090830mgOrally Disintegrating Tab.1950Remeron RDORG.80342005-02-22Novo-Mirtazapine ODNOP.39002006-07-19Auro-Mirtazapine ODAUR.19502011-06-08090945mgOrally Disintegrating Tab.2925Remeron RDORG1.20512005-02-22Novo-Mirtazapine ODNOP.58502006-07-19Auro-Mirtazapine ODAUR.29252011-06-08091030mgTab.3100RemeronORG1.36712002-07-29PMS-MirtazapinePMS.31002004-07-20Sandoz MirtazapineSDZ.31002004-07-20MirtazapineMEL.31002010-01-05Mylan-MirtazapineMYL.31002004-09-14Novo-MirtazapineNOP.31002004-12-21Ratio-MirtazapineRPH.31002006-01-24Apo-MirtazapineAPX.31002007-01-02Zym-MirtazapineZYN.31002010-04-23MOCLOBEMIDE0911100mgTab.2520ManerixHLR1996-10-01Apo-MoclobemideAPX.25201998-12-31Novo-MoclobemideNOP.25202000-01-170912150mgTab.1515ManerixHLR.60581996-10-01Apo-MoclobemideAPX.15151998-12-31Novo-MoclobemideNOP.15152000-01-170913300mgTab.2974ManerixHLR1.18961997-04-10Novo-MoclobemideNOP.29742000-01-17Apo-MoclobemideAPX.29742000-01-17NORTRIPTYLINE091410mgCap.0500AventylPHE.20001996-10-01PMS-NortriptylinePMS.05001996-12-19Nu-NortriptylineNXP.05001996-12-19Apo-NortriptylineAPX.05001996-12-19Novo-NortriptylineNOP.05001999-04-15091525mgCap.1011AventylPHE.40431996-10-01PMS-NortriptylinePMS.10111996-12-19Nu-NortriptylineNXP.10111996-12-19Apo-NortriptylineAPX.10111996-12-19Novo-NortriptylineNOP.10111999-04-15PAROXETINE HCL091610mgTabPaxilSMJ2007-06-06Apo-ParoxetineAPX2007-06-06PMS-ParoxetinePMS2007-06-06Ratio-ParoxetineRPH2007-07-12Mylan-ParoxetineMYL2007-06-06Phl-ParoxetinePHE2010-01-05Novo-ParoxetineNOP2007-06-06Co ParoxetineCOB2007-06-06Sandoz ParoxetineSDZ2008-08-28091720mgTab.4514PaxilGSK1.80561996-10-01Apo-ParoxetineAPX.45142004-04-06PMS-ParoxetinePMS.45142004-04-06Ratio-ParoxetineRPH.45142004-04-06Mylan-ParoxetineMYL.45142004-04-06ParoxetineMEL.45142010-01-05Novo-ParoxetineNOP.45142004-04-06Co ParoxetineCOB.45142005-04-28Sandoz ParoxetineSDZ.45142008-10-01091830mgTab.4796PaxilGSK1.91831996-10-01Apo-ParoxetineAPX.47962004-04-06PMS-ParoxetinePMS.47962004-04-06Ratio-ParoxetineRPH.47962004-04-06Mylan-ParoxetineMYL.47962004-04-06ParoxetineMEL.47962010-01-05Novo-ParoxetineNOP.47962004-04-06Co ParoxetineCOB.47962005-04-28Sandoz ParoxetineSDZ.47962008-10-01PHENELZINE SULFATE091915mgTab.3758Consult the scientific literature regarding cautions and contraindications prior to prescribing and/or dispensing irreversible monoamine oxidase inhibitors.NardilERF.37581996-10-01SERTRALINE HCLSertraline therapy should be discontinued for 2 weeks before starting irreversible monoamine oxidase inhibitors (MAOI). Similarly irreversible MAOI should be discontinued for 2 weeks before starting sertraline.092025mgCap.2038ZoloftPFI.81851996-10-01Apo-SertralineAPX.20382000-01-17Novo-SertralineNOP.20382000-01-17Mylan-SertralineMYL.20382000-11-30PMS-SertralinePMS.20382003-01-30Sandoz SertralineSDZ.20382003-01-30Ratio-SertralineRPH.20382003-04-16Phl-SertralinePHE.20382009-11-19Gd-SertralineGEM.20382011-05-19Co SertralineCOB.20382007-04-02Zym-SertralineZYN.20382010-06-14Ran-SertralineRAN.20382012-01-19092150mgCap.4000ZoloftPFI1.63041996-10-01Apo-SertralineAPX.40002000-01-17Novo-SertralineNOP.40002000-01-17Mylan-SertralineMYL.40002000-11-30PMS-SertralinePMS.40002003-01-30Sandoz SertralineSDZ.40002003-01-30Ratio-SertralineRPH.40002003-04-16Phl-SertralinePHE.40002009-11-19Gd-SertralineGEM.40002011-05-19Co SertralineCOB.40002007-04-02Zym-SertralineZYN.40002010-06-14Ran-SertralineRAN.40002012-01-190922100mgCap.4458ZoloftPFI1.78331996-10-01Apo-SertralineAPX.44582000-01-17Novo-SertralineNOP.44582000-01-17Mylan-SertralineMYL.44582000-11-30PMS-SertralinePMS.44582003-01-30Sandoz SertralineSDZ.44582003-01-30Ratio-SertralineRPH.44582003-04-16Phl-SertralinePHE.44582009-11-19Gd-SertralineGEM.44582011-05-19Co SertralineCOB.44582007-04-02Zym-SertralineZYN.44582010-06-14Ran-SertralineRAN.44582012-01-19TRANYLCYPROMINE SULFATE092310mgTab.3682Consult the scientific literature regarding cautions and contraindications prior to prescribing and/or dispensing irreversible monoamine oxidase inhibitors.ParnateGSK.36821996-10-01TRAZODONE HYDROCHLORIDE092450mgTab.0554DesyrelBQU1996-10-01PMS-TrazodonePMS.05541996-10-01Novo-TrazodoneNOP.05541996-10-01Apo-TrazodoneAPX.05541996-10-01Mylan-TrazodoneMYL.22141998-12-31Ratio-TrazodoneRPH.05542007-01-020925100mgTab.0989DesyrelBQU.39561996-10-01PMS-TrazodonePMS.09891996-10-01Novo-TrazodoneNOP.09891996-10-01Apo-TrazodoneAPX.09891996-10-01Mylan-TrazodoneMYL.39561998-12-31Ratio-TrazodoneRPH.09892007-01-020926150mgTab.1453Desyrel DividoseBQU1996-10-01Novo-TrazodoneNOP.14531996-10-01Apo-Trazodone DAPX.14531996-10-01Ratio-TrazodoneRPH.14532007-01-02TRIMIPRAMINE092775mgCap.7314RhotrimineSAV1996-10-01SurmontilRPP1996-10-01TrimipramineAAP.73141996-10-01092812.5mgTab.2156Apo-TrimipAPX.21561996-10-01SurmontilRPP1996-10-01092925mgTab.2776Apo-TrimipAPX.27761996-10-01SurmontilRPP1996-10-01093050mgTab.5434Apo-TrimipAPX.54341996-10-01SurmontilRPP1996-10-010931100mgTab.9273Apo-TrimipAPX.92731996-10-01RhotrimineSAV1996-10-01SurmontilRPP1996-10-01VENLAFAXINE HCL093237.5mgER Cap.2206Effexor XRWAY.89922000-01-17Ratio-Venlafaxine XRRPH.22062007-10-03Novo-Venlafaxine XRNOP.22062007-01-02PMS-Venlafaxine XRPMS.22062007-11-10Co Venlafaxine XRCOB.22062008-04-09Mylan-Venlafaxine XRMYL.22062008-08-28Sandoz Venlafaxine XRSDZ.22062008-08-28Apo-Venlafaxine XRAPX.22062010-04-23Gd-Venlafaxine XRGEM.22062012-01-19093375mgER Cap.4412Effexor XRWAY1.79822000-01-17Ratio-Venlafaxine XRRPH.44122007-10-03Novo-Venlafaxine XRNOP.44122007-01-02PMS-Venlafaxine XRPMS.44122007-11-10Co Venlafaxine XRCOB.44122008-04-09Mylan-Venlafaxine XRMYL.44122008-08-28Sandoz Venlafaxine XRSDZ.44122008-08-28Apo-Venlafaxine XRAPX.44122010-04-23Gd-Venlafaxine XRGEM.44122012-01-190934150mgER Cap.4658Effexor XRWAY1.89872000-01-17Ratio-Venlafaxine XRRPH.46582007-10-03Novo-Venlafaxine XRNOP.46582007-01-02PMS-Venlafaxine XRPMS.46582007-11-10Co Venlafaxine XRCOB.46582008-04-09Mylan-Venlafaxine XRMYL.46582008-08-28Sandoz Venlafaxine XRSDZ.46582008-08-28Apo-Venlafaxine XRAPX.46582010-04-23Gd-Venlafaxine XRGEM.46582012-01-19PSYCHOTHERAPEUTIC AGENTS TRANQUILIZERSALPRAZOLAM09350.25mgTab.0633XanaxPFI.25321996-10-01Apo-AlprazAPX.06331996-10-01Nu-AlprazNXP.06331996-10-01Novo-AlprazolNOP.06331996-10-01Gen-AlprazolamGEN.06331996-10-0109360.5mgTab.0757XanaxPFI.30271996-10-01Apo-AlprazAPX.07571996-10-01Nu-AlprazNXP.07571996-10-01Novo-AlprazolNOP.07571996-10-01Gen-AlprazolamGEN.07571996-10-0109371mgTabXanaxPFI2008-03-25Gen-AlprazolamGEN2008-03-25Apo-AlprazAPX2008-03-2509382mgTabXanax TSPFI2008-03-25Gen-AlprazolamGEN2008-03-25Apo-Alpraz TSAPX2008-03-25ARIPIPRAZOLE09392mgTab2.9140Notes: For the treatment of schizophrenia and related psychotic disorders after failure, intolerance or contraindication to at least one less expensive antipsychotic alternative. Not indicated for the treatment of dementia or dementia-related behavioral problems in the elderly.AbilifyBQU2.91402011-10-2509405mgTab3.2800Notes: For the treatment of schizophrenia and related psychotic disorders after failure, intolerance or contraindication to at least one less expensive antipsychotic alternative. Not indicated for the treatment of dementia or dementia-related behavioral problems in the elderly.AbilifyBQU3.28002011-10-25094110mgTab3.8900Notes: For the treatment of schizophrenia and related psychotic disorders after failure, intolerance or contraindication to at least one less expensive antipsychotic alternative. Not indicated for the treatment of dementia or dementia-related behavioral problems in the elderly.AbilifyBQU3.89002011-10-25094215mgTab4.5000Notes: For the treatment of schizophrenia and related psychotic disorders after failure, intolerance or contraindication to at least one less expensive antipsychotic alternative. Not indicated for the treatment of dementia or dementia-related behavioral problems in the elderly.AbilifyBQU4.50002011-10-25094320mgTab5.1100Notes: For the treatment of schizophrenia and related psychotic disorders after failure, intolerance or contraindication to at least one less expensive antipsychotic alternative. Not indicated for the treatment of dementia or dementia-related behavioral problems in the elderly.AbilifyBQU5.11002011-10-25094430mgTab6.3300Notes: For the treatment of schizophrenia and related psychotic disorders after failure, intolerance or contraindication to at least one less expensive antipsychotic alternative. Not indicated for the treatment of dementia or dementia-related behavioral problems in the elderly.AbilifyBQU6.33002011-10-25BROMAZEPAM09451.5mgTab.0515LectopamHLR1996-10-01Apo-BromazepamAPX.05151996-10-01Gen-BromazepamGEN.05151996-10-0109463mgTab.0375LectopamHLR.14991996-10-01Apo-BromazepamAPX.03751996-10-01Gen-BromazepamGEN.07001996-10-01Novo-BromazepamNOP.03751998-12-3109476mgTab.0548LectopamHLR.21901996-10-01Apo-BromazepamAPX.05481996-10-01Gen-BromazepamGEN.10221996-10-01Novo-BromazepamNOP.05481998-12-31CHLORDIAZEPOXIDE09485mgCap.0679LibriumHLR1996-10-01Apo-ChlordiazepoxideAPX.06791996-10-01094910mgCap.1070LibriumHLR1996-10-01Apo-ChlordiazepoxideAPX.10701996-10-01095025mgCap.1658LibriumHLR1996-10-01Apo-ChlordiazepoxideAPX.16581996-10-01CHLORPROMAZINE095125mgTab.1365Novo-ChlorpromazineNOP.13651996-10-01LargactilRPP1999-07-22095250mgTab.1565Novo-ChlorpromazineNOP.15651996-10-01LargactilRPP1999-07-220953100mgTab.3200Novo-ChlorpromazineNOP.32001996-10-01LargactilRPP1999-07-22CLORAZEPATE DIPOTASSIUM09543.75mgCap.1476TranxeneABB1996-10-01Apo-ClorazepateAPX.14761996-10-0109557.5mgCap.1810TranxeneABB1996-10-01Apo-ClorazepateAPX.18101996-10-01095615mgCap.3259TranxeneABB1996-10-01Apo-ClorazepateAPX.32591996-10-01CLOZAPINE095725mgTabClozarilNOV2007-09-04Gen-ClozapineMYL2007-09-04Apo-ClozapineAPX2007-09-040958100mgTabClozarilNOV2007-09-04Gen-ClozapineMYL2007-09-04Apo-ClozapineAPX2007-09-04DIAZEPAM09595mg/mLRect Gel-2x 5mg Pk144.5800DiastatVAL144.58002000-11-3009605mg/mLRect Gel-2x10mg Pk144.5800DiastatVAL144.58002000-11-3009615mg/mLRect Gel-2x15mg Pk144.5800DiastatVAL144.58002000-11-3009622mgTab.0508ValiumHLR2005-02-22Apo-DiazepamAPX.05081996-10-0109635mgTab.0650ValiumHLR1996-10-01Apo-DiazepamAPX.06501996-10-01096410mgTab.0867ValiumHLR1996-10-01Apo-DiazepamAPX.08671996-10-01FLUPENTHIXOL DECANOATE0965200mg/2mLInj Sol-2mL PkFluanxol DepotVLH2010-01-050966200mg/10mLInj Sol-10mL PkFluanxol DepotVLH2010-01-05096720mg/mLInj Sol-1mL Amp Pk7.1860Fluanxol DepotVLH7.18601996-10-010968100mg/mLInj Sol-1mL Amp Pk35.9300Fluanxol DepotVLH35.93001996-10-01FLUPENTHIXOL DIHYDROCHLORIDE09690.5mgTab.2483FluanxolVLH.24831996-10-0109703mgTab.5362FluanxolVLH.53621996-10-01FLUPHENAZINE DECANOATE0971100mg/mLInj Sol-1mL Pk29.7800Modecate ConcentrateBQU29.78001996-10-010972125mg/5mLInj Susp-5mL Pk23.1600ModecateBQU1996-10-01PMS-Fluphenazine DecanoatePMS23.16001999-04-15FLUPHENAZINE HCL09731mgTab.1739Moditen HCLBQU2006-06-15Apo-FluphenazineAPX.17391996-10-0109742mgTab.2252Moditen HCLBQU2006-06-15Apo-FluphenazineAPX.22521996-10-0109755mgTab.1720Moditen HCLBQU1996-10-01Apo-FluphenazineAPX.17201996-10-01HALOPERIDOL09765mg/mLInj Sol-1mL Pk4.0000HaldolOMC1996-10-01HaloperidolSDZ4.00001996-12-1909770.5mgTab.0360HaldolOMC1996-10-01Novo-PeridolNOP.03601996-10-01Apo-HaloperidolAPX.03601996-10-0109781mgTab.0614HaldolOMC1996-10-01Novo-PeridolNOP.06141996-10-01Apo-HaloperidolAPX.06141996-10-0109792mgTab.1050HaldolOMC1996-10-01Novo-PeridolNOP.10501996-10-01Apo-HaloperidolAPX.10501996-10-0109805mgTab.1487HaldolOMC1996-10-01Novo-PeridolNOP.14871996-10-01Apo-HaloperidolAPX.14871996-10-01098110mgTab.1330HaldolOMC1996-10-01Apo-HaloperidolAPX.17921996-10-01Novo-PeridolNOP.13301996-10-01098220mgTab.6304HaldolOMC1996-10-01Novo-PeridolNOP.63041996-10-01HALOPERIDOL DECANOATE0983100mg/mL OilyInj Sol-1mL Pk11.6648Haldol-LAOMC1996-10-01Haloperidol LASDZ11.66481998-12-31098450mg/mL OilyInj Sol-5mL Pk30.2500Haldol-LAOMC1996-10-01Haloperidol LASDZ30.25001998-12-310985100mg/mL OilyInj Sol-5mL Pk58.3240Haldol-LAOMC1996-10-01Haloperidol LASDZ58.32401998-12-31HYDROXYZINE HCL098610mgCapAtaraxPFI1996-10-01Apo-HydroxyzineAPX1996-10-01Novo-HydroxyzinNOP1996-10-01MultipaxRPP1996-10-01098725mgCapAtaraxPFI1996-10-01Apo-HydroxyzineAPX1996-10-01Novo-HydroxyzinNOP1996-10-01MultipaxRPP1996-10-01098850mgCapAtaraxPFI1996-10-01Apo-HydroxyzineAPX1996-10-01Novo-HydroxyzinNOP1996-10-01MultipaxRPP1996-10-01LORAZEPAM09890.5mgTab.0359Apo-LorazepamAPX.03591996-10-01Novo-LorazemNOP.03591996-10-01PMS-LorazepamPMS.03592002-04-04AtivanWAY.03591996-10-0109901mgTab.0447Novo-LorazemNOP.04471996-10-01Apo-LorazepamAPX.04471996-10-01PMS-LorazepamPMS.04472002-04-04AtivanWAY.04471996-10-0109912mgTab.0699Novo-LorazemNOP.06991996-10-01Apo-LorazepamAPX.06991996-10-01PMS-LorazepamPMS.06992002-04-04AtivanWAY.06991996-10-01LOXAPINE SUCCINATE09925mgTab.1500LoxapacWAY1998-03-17XylacMMT.15001999-04-15099310mgTab.2498LoxapacWAY1998-11-19XylacMMT.24981999-04-15099425mgTab.3872LoxapacWAY1998-11-19XylacMMT.38721999-04-15099550mgTab.5162LoxapacWAY1998-03-17XylacMMT.51621999-04-15OLANZAPINE09965mgRapid Dissolve Tab.8937Zyprexa ZydisLIL3.57462001-10-11PMS-Olanzapine ODTPMS.89372010-01-05Phl-Olanzapine ODTPHE.89372010-06-14Novo-Olanzapine ODNOP.89372010-03-02Co Olanzapine ODTCOB.89372010-01-05Sandoz Olanzapine ODTSDZ.89372010-01-05Apo-Olanzapine ODTAPX.89372011-06-08099710mgRapid Dissolve Tab1.7857Zyprexa ZydisLIL7.14292001-10-11PMS-Olanzapine ODTPMS1.78572010-01-05Phl-Olanzapine ODTPHE1.78572010-06-14Novo-Olanzapine ODNOP1.78572010-03-02Co Olanzapine ODTCOB1.78572010-01-05Sandoz Olanzapine ODTSDZ1.78572010-01-05Apo-Olanzapine ODTAPX1.78572011-06-08099815mgRapid Dissolve Tab2.6778Zyprexa ZydisLIL10.71112005-02-22PMS-Olanzapine ODTPMS2.67782010-01-05Phl-Olanzapine ODTPHE2.67782010-06-14Novo-Olanzapine ODNOP2.67782010-03-02Co Olanzapine ODTCOB2.67782010-01-05Sandoz Olanzapine ODTSDZ2.67782010-01-05Apo-Olanzapine ODTAPX2.67782011-06-08099920mgRapid Dissolve TabZyprexa ZydisLIL2010-01-05Novo-Olanzapine ODNOP2010-03-02Co Olanzapine ODTCOB2010-01-05Sandoz Olanzapine ODTSDZ2010-01-05Apo-Olanzapine ODTAPX2011-06-0810002.5mgTab.4493ZyprexaLIL1.79721998-12-31Novo-OlanzapineNOP.44932007-07-12Apo-OlanzapineAPX.44932010-01-05PMS-OlanzapinePMS.44932009-11-19Phl-OlanzapinePHE.44932010-06-14Sandoz OlanzapineSDZ.44932010-10-28Co OlanzapineCOB.44932010-04-23Mylan-OlanzapineMYL.44932011-08-0410015mgTab.8986ZyprexaLIL3.59441997-04-10Novo-OlanzapineNOP.89862007-07-12Apo-OlanzapineAPX.89862010-01-05PMS-OlanzapinePMS.89862009-11-19Phl-OlanzapinePHE.89862010-06-14Sandoz OlanzapineSDZ.89862010-10-28Co OlanzapineCOB.89862010-04-23Mylan-OlanzapineMYL.89862011-08-0410027.5mgTab1.3479ZyprexaLIL5.39161997-04-10Novo-OlanzapineNOP1.34792007-07-12Apo-OlanzapineAPX1.34792010-01-05PMS-OlanzapinePMS1.34792009-11-19Phl-OlanzapinePHE1.34792010-06-14Sandoz OlanzapineSDZ1.34792010-10-28Co OlanzapineCOB1.34792010-04-23Mylan-OlanzapineMYL1.34792011-08-04100320mgTabZyprexaLIL2010-01-05Co OlanzapineCOB2010-01-05Apo-OlanzapineAPX2010-01-05Teva-OlanzapineTEV2011-09-15100410mgTab1.7972ZyprexaLIL7.18881997-04-10Novo-OlanzapineNOP1.79722007-07-12Apo-OlanzapineAPX1.79722010-01-05PMS-OlanzapinePMS1.79722009-11-19Phl-OlanzapinePHE1.79722010-06-14Sandoz OlanzapineSDZ1.79722010-10-28Co OlanzapineCOB1.79722010-04-23Mylan-OlanzapineMYL1.79722011-08-04100515mgTab2.6958ZyprexaLIL10.78312003-09-04Novo-OlanzapineNOP2.69582007-07-12Apo-OlanzapineAPX2.69582010-01-05PMS-OlanzapinePMS2.69582009-11-19Phl-OlanzapinePHE2.69582010-06-14Sandoz OlanzapineSDZ2.69582010-10-28Co OlanzapineCOB2.69582010-04-23Mylan-OlanzapineMYL2.69582011-08-04OXAZEPAM100610mgTab.0350Apo-OxazepamAPX.03501996-10-01SeraxWAY1996-10-01100715mgTab.0550Apo-OxazepamAPX.05501996-10-01SeraxWAY1996-10-01100830mgTab.0750Apo-OxazepamAPX.07501996-10-01SeraxWAY1996-10-01PALIPERIDONE10093mgER Tab3.6210InvegaJAN3.62102009-08-1810106mgER Tab5.4200InvegaJAN5.42002009-08-1810119mgER Tab7.2320InvegaJAN7.23202009-08-18PALIPERIDONE PALMITATE101250mgInj Pref Syr304.1000For the treatment of schizophrenia or schizoaffective disorders in patients who have: A history of non-adherence; AND one of the following: (a) Inadequate control or significant side-effects from two or more formulary oral antipsychotic medications, including at least one atypical agent; OR (b) Inadequate control or significant side-effects from one or more conventional depot antipsychotic agents.Invega SustennaJAN304.10002012-01-19101375mgInj Pref Syr456.1800For the treatment of schizophrenia or schizoaffective disorders in patients who have: A history of non-adherence; AND one of the following: (a) Inadequate control or significant side-effects from two or more formulary oral antipsychotic medications, including at least one atypical agent; OR (b) Inadequate control or significant side-effects from one or more conventional depot antipsychotic agents.Invega SustennaJAN456.18002012-01-191014100mgInj Pref Syr456.1800For the treatment of schizophrenia or schizoaffective disorders in patients who have: A history of non-adherence; AND one of the following: (a) Inadequate control or significant side-effects from two or more formulary oral antipsychotic medications, including at least one atypical agent; OR (b) Inadequate control or significant side-effects from one or more conventional depot antipsychotic agents.Invega SustennaJAN456.18002012-01-191015150mgInj Pref Syr608.2200For the treatment of schizophrenia or schizoaffective disorders in patients who have: A history of non-adherence; AND one of the following: (a) Inadequate control or significant side-effects from two or more formulary oral antipsychotic medications, including at least one atypical agent; OR (b) Inadequate control or significant side-effects from one or more conventional depot antipsychotic agents.Invega SustennaJAN608.22002012-01-19PERICYAZINE10165mgCap.2307NeuleptilERF.23071996-10-01101710mgCap.3952NeuleptilERF.39521996-10-01101810mg/mLO/L.3875NeuleptilERF.38751996-10-01PERPHENAZINE10192mgTab.0626TrilafonSCH1996-10-01PerphenazineAAP.06261996-10-0110204mgTab.0758TrilafonSCH1996-10-01PerphenazineAAP.07581996-10-0110218mgTab.0832TrilafonSCH1996-10-01PerphenazineAAP.08321996-10-01102216mgTab.1274TrilafonSCH1996-10-01PerphenazineAAP.12741996-10-01PIMOZIDE10232mgTab.2279OrapPHE.22791996-10-01Apo-PimozideAPX.30932004-04-0610244mgTab.4136OrapPHE.41361996-10-01Apo-PimozideAPX.41362004-04-06PIPOTIAZINE PALMITATE102525mg/mLInj Sol-1mL Pk15.7400Piportil L4SAV15.74001996-10-01102650mg/mLInj Sol-1mL Pk26.7000Piportil L4SAV26.70001996-10-011027100mg/2mLInj Sol-2mL Pk50.6900Piportil L4SAV50.69001996-10-01PROCHLORPERAZINE102810mg/2mLInj Sol-2mL Pk1.4000Prochlorperazine MesylateSDZ1.40001998-12-31StemetilSAV1996-10-0110295mgTab.1659Apo-ProchlorazineAPX.16592001-06-07StemetilAVE1996-10-01103010mgTab.2025Apo-ProchlorazineAPX.20252001-06-07StemetilAVE1996-10-01QUETIAPINE103150mgER Tab.9800Seroquel XRAZC.98002008-06-271032150mgER Tab1.9300Seroquel XRAZC1.93002010-12-141033200mgER Tab2.6200Seroquel XRAZC2.62002008-06-271034300mgER Tab3.8600Seroquel XRAZC3.86002008-06-271035400mgER Tab5.2400Seroquel XRAZC5.24002008-06-27103625mgTab.1235SeroquelAZC.50831998-12-31Novo-QuetiapineNOP.12352008-12-03PMS-QuetiapinePMS.12352008-12-03Phl-QuetiapinePHE.12352010-06-14Mylan-QuetiapineMYL.12352008-12-03Ratio-QuetiapineRPH.12352008-11-04Apo-QuetiapineAPX.12352008-12-03Sandoz QuetiapineSDZ.12352008-12-03Co QuetiapineCOB.12352008-12-03QuetiapineMEL.12352010-06-14Jamp-QuetiapineJPC.12352010-04-231037100mgTab.3295SeroquelAZC1.35601998-12-31Novo-QuetiapineNOP.32952008-12-03PMS-QuetiapinePMS.32952008-12-03Phl-QuetiapinePHE.32952010-06-14Mylan-QuetiapineMYL.32952008-12-03Ratio-QuetiapineRPH.32952008-11-04Apo-QuetiapineAPX.32952008-12-03Sandoz QuetiapineSDZ.32952008-12-03Co QuetiapineCOB.32952008-12-03QuetiapineMEL.32952010-06-14Jamp-QuetiapineJPC.32952010-04-231038150mgTabSeroquelAZC2002-04-04Novo-QuetiapineNOP2008-12-031039200mgTab.6617SeroquelAZC2.72281998-12-31Novo-QuetiapineNOP.66172008-12-03PMS-QuetiapinePMS.66172008-12-03Phl-QuetiapinePHE.66172010-06-14Mylan-QuetiapineMYL.66172008-12-03Ratio-QuetiapineRPH.66172008-11-04Apo-QuetiapineAPX.66172008-12-03Sandoz QuetiapineSDZ.66172008-12-03Co QuetiapineCOB.66172008-12-03QuetiapineMEL.66172010-06-14Jamp-QuetiapineJPC.66172010-04-231040300mgTab.9656SeroquelAZC3.97302002-07-29Novo-QuetiapineNOP.96562008-12-03PMS-QuetiapinePMS.96562008-12-03Phl-QuetiapinePHE.96562010-06-14Mylan-QuetiapineMYL.96562008-12-03Ratio-QuetiapineRPH.96562008-11-04Apo-QuetiapineAPX.96562008-12-03Sandoz QuetiapineSDZ.96562008-12-03Co QuetiapineCOB.96562008-12-03QuetiapineMEL.96562010-06-14Jamp-QuetiapineJPC.96562010-04-23RISPERIDONE10411mg/mLO/L.4802RisperdalJAN1.41601999-04-15PMS-RisperidonePMS.48022006-09-06Apo-RisperidoneAPX.48022006-09-0610420.5mgOrally Disintegrating Tab.7450Risperdal M-TabJAN.74502004-07-2010431mgOrally Disintegrating Tab.7725Risperdal M-TabJAN1.03002004-07-20PMS-Risperidone ODTPMS.77252011-12-1510442mgOrally Disintegrating Tab1.5281Risperdal M-TabJAN2.03752004-07-20PMS-Risperidone ODTPMS1.52812011-12-1510453mgOrally Disintegrating Tab3.0550Risperdal M-TabJAN3.05502006-04-1910464mgOrally Disintegrating Tab4.0850Risperdal M-TabJAN4.08502006-04-19104725mgPd for Inj-Vial Pk161.5600For the treatment of schizophrenia or schizoaffective disorders in patients who have: A history of non-adherence; AND one of the following: (a) Inadequate control or significant side-effects from two or more formulary oral antipsychotic medications, including at least one atypical agent; OR (b) Inadequate control or significant side-effects from one or more conventional depot antipsychotic agents.Risperdal ConstaJAN161.56002008-08-28104837.5mgPd for Inj-Vial Pk242.3300For the treatment of schizophrenia or schizoaffective disorders in patients who have: A history of non-adherence; AND one of the following: (a) Inadequate control or significant side-effects from two or more formulary oral antipsychotic medications, including at least one atypical agent; OR (b) Inadequate control or significant side-effects from one or more conventional depot antipsychotic agents.Risperdal ConstaJAN242.33002008-08-28104950mgPd for Inj-Vial Pk323.1100For the treatment of schizophrenia or schizoaffective disorders in patients who have: A history of non-adherence; AND one of the following: (a) Inadequate control or significant side-effects from two or more formulary oral antipsychotic medications, including at least one atypical agent; OR (b) Inadequate control or significant side-effects from one or more conventional depot antipsychotic agents.Risperdal ConstaJAN323.11002008-08-2810500.25mgTab.1314RisperdalJAN.54252000-07-17PMS-RisperidonePMS.13142006-09-06Phl-RisperidonePHE.13142009-11-19Ratio-RisperidoneRPH.13142007-01-02Ran-RisperidoneRAN.13142006-09-06Apo-RisperidoneAPX.13142006-09-06Mylan-RisperidoneMYL.13142006-09-06Co RisperidoneCOB.13142006-09-06Novo-RisperidoneNOP.13142006-09-06RisperidoneMEL.13142010-04-23Sandoz RisperidoneSDZ.13142008-08-28Rbx-RisperidoneRAN.13142010-01-05Risperidone TabletsRAN.13142010-04-23Jamp-RisperidoneJPC.13142011-08-04Mint-RisperidonMIN.13142011-08-04Mar-RisperidoneMAR.13142012-01-1910510.5mgTab.2202RisperdalJAN.90882000-07-17PMS-RisperidonePMS.22022006-09-06Phl-RisperidonePHE.22022009-11-19Novo-RisperidoneNOP.22022006-09-06Ratio-RisperidoneRPH.22022007-01-02Ran-RisperidoneRAN.22022006-09-06Apo-RisperidoneAPX.22022006-09-06Mylan-RisperidoneMYL.22022006-09-06Co RisperidoneCOB.22022006-09-06RisperidoneMEL.22022010-04-23Sandoz RisperidoneSDZ.22022008-08-28Rbx-RisperidoneRAN.22022010-01-05Risperidone TabletsRAN.22022010-04-23Jamp-RisperidoneJPC.22022011-08-04Mint-RisperidonMIN.22022011-08-04Mar-RisperidoneMAR.22022012-01-1910521mgTab.3041RisperdalJAN1.25501996-10-01PMS-RisperidonePMS.30412006-09-06Phl-RisperidonePHE.30412009-11-19Novo-RisperidoneNOP.30412006-09-06Ratio-RisperidoneRPH.30412007-01-02Sandoz RisperidoneSDZ.30412006-09-06Ran-RisperidoneRAN.30412006-09-06Apo-RisperidoneAPX.30412006-09-06Mylan-RisperidoneMYL.30412006-09-06Co RisperidoneCOB.30412006-09-06RisperidoneMEL.30412010-04-23Rbx-RisperidoneRAN.30412010-01-05Risperidone TabletsRAN.30412010-04-23Jamp-RisperidoneJPC.30412011-08-04Mint-RisperidonMIN.30412011-08-04Mar-RisperidoneMAR.30412012-01-1910532mgTab.6071RisperdalJAN2.51101996-10-01PMS-RisperidonePMS.60712006-09-06Phl-RisperidonePHE.60712009-11-19Novo-RisperidoneNOP.60712006-09-06Ratio-RisperidoneRPH.60712007-01-02Sandoz RisperidoneSDZ.60712006-09-06Ran-RisperidoneRAN.60712006-09-06Apo-RisperidoneAPX.60712006-09-06Mylan-RisperidoneMYL.60712006-09-06Co RisperidoneCOB.60712006-09-06RisperidoneMEL.60712010-04-23Rbx-RisperidoneRAN.60712010-01-05Risperidone TabletsRAN.60712010-04-23Jamp-RisperidoneJPC.60712011-08-04Mint-RisperidonMIN.60712011-08-04Mar-RisperidoneMAR.60712012-01-1910543mgTab.9108RisperdalJAN3.75961996-10-01PMS-RisperidonePMS.91082006-09-06Phl-RisperidonePHE.91082009-11-19Novo-RisperidoneNOP.91082006-09-06Ratio-RisperidoneRPH.91082007-01-02Sandoz RisperidoneSDZ.91082006-09-06Ran-RisperidoneRAN.91082006-09-06Apo-RisperidoneAPX.91082006-09-06Mylan-RisperidoneMYL.91082006-09-06Co RisperidoneCOB.91082006-09-06RisperidoneMEL.91082010-04-23Rbx-RisperidoneRAN.91082010-01-05Risperidone TabletsRAN.91082010-04-23Jamp-RisperidoneJPC.91082011-08-04Mint-RisperidonMIN.91082011-08-04Mar-RisperidoneMAR.91082012-01-1910554mgTab1.2144RisperdalJAN5.01301996-10-01PMS-RisperidonePMS1.21442006-09-06Phl-RisperidonePHE1.21442009-11-19Novo-RisperidoneNOP1.21442006-09-06Ratio-RisperidoneRPH1.21442007-01-02Sandoz RisperidoneSDZ1.21442006-09-06Ran-RisperidoneRAN1.21442006-09-06Apo-RisperidoneAPX1.21442006-09-06Mylan-RisperidoneMYL1.21442006-09-06Co RisperidoneCOB1.21442006-09-06RisperidoneMEL1.21442010-04-23Rbx-RisperidoneRAN1.21442010-01-05Risperidone TabletsRAN1.21442010-04-23Jamp-RisperidoneJPC1.21442011-08-04Mint-RisperidonMIN1.21442011-08-04Mar-RisperidoneMAR1.21442012-01-19THIOTHIXENE10562mgCap.3178NavaneERF.31781996-10-0110575mgCap.4510NavaneERF.45101996-10-01105810mgCap.5638NavaneERF.56381996-10-01TRIFLUOPERAZINE10591mgTab.1340TrifluoperazineAAP.13401996-10-01StelazineSMJ1996-10-0110602mgTab.1758TrifluoperazineAAP.17581996-10-01StelazineSMJ1996-10-0110615mgTab.2328TrifluoperazineAAP.23281996-10-01StelazineSMJ1996-10-01106210mgTab.2790TrifluoperazineAAP.27901996-10-01StelazineSMJ1996-10-01ZIPRASIDONE HCL MONOHYDRATE106320mgCap1.6500ZeldoxPFI1.65002010-07-20106440mgCap1.8900ZeldoxPFI1.89002010-07-20106560mgCap1.8900ZeldoxPFI1.89002010-07-20106680mgCap1.8900ZeldoxPFI1.89002010-07-20PSYCHOTHERAPEUTIC AGENTS OTHER PSYCHOTROPICSLITHIUM CARBONATE1067150mgCap.0422CarbolithVAL.11411996-10-01PMS-Lithium CarbonatePMS.04221997-04-10Apo-Lithium CarbonateAPX.04222001-10-111068150mgCap.0413LithaneERF.13141996-10-01Apo-Lithium CarbonateAPX.04132003-09-041069300mgCap.0443CarbolithVAL.09011996-10-01PMS-Lithium CarbonatePMS.04431997-04-10Apo-Lithium CarbonateAPX.04432001-10-111070300mgCap.0471LithaneERF.13091996-10-01Apo-Lithium CarbonateAPX.04712003-09-04TRYPTOPHAN1071500mgCapTryptanVAL1996-10-01Ratio-TryptophanRPH2008-12-03PMS-TryptophanPMS2009-04-01Apo-TryptophanAPX2008-06-271072500mgTabTryptanVAL2008-06-27Ratio-TryptophanRPH2008-12-03PMS-TryptophanPMS2009-05-20Apo-TryptophanAPX2008-06-2710731gTabTryptanVAL1996-10-01PMS-TryptophanPMS1999-04-15Ratio-TryptophanRPH2000-04-17Apo-TryptophanAPX2008-06-27C.N.S. STIMULANTSStimulant medication should only be used when diagnostic criteria for narcolepsy or attention deficit disorder have been met and when stimulant medication has been demonstrated to produce clinical benefits. The use of conventional-release medication should almost always precede the use of extended-release preparations.DEXAMPHETAMINE SULFATE10745mgTab.6254DexedrinePAL.62541996-10-01LISDEXAMFETAMINE DIMESYLATE107520mgCap2.5500Notes: Patients greater than or equal to 6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or psychosocial needs, and who meet the following: 1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning; AND 2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner with expertise in ADHD; AND 3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor symptom control, side effects, administrative barriers, or societal barriers. Administrative barriers include: . inability of a school to dose the child at lunch; . the school lunch hour does not coincide with the dosing schedule; . poor compliance with noon or afternoon doses; . the patient is unable to swallow tablets. Societal barriers include: . the patient or patient's caregiver(s) has(have) a history of substance abuse or diversion of listed immediate-release alternatives; . the patient or patient's caregiver(s) is/are at risk of substance abuse or diversion of listed immediate-release alternatives.VyvanseSHI2.55002011-06-08107630mgCap3.0500Notes: Patients > 6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or psychosocial needs, and who meet the following: 1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning; AND 2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner with expertise in ADHD; AND 3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor symptom control, side effects, administrative barriers, or societal barriers. Administrative barriers include: . inability of a school to dose the child at lunch; . the school lunch hour does not coincide with the dosing schedule; . poor compliance with noon or afternoon doses; . the patient is unable to swallow tablets. Societal barriers include: . the patient or patient's caregiver(s) has(have) a history of substance abuse or diversion of listed immediate-release alternatives; . the patient or patient's caregiver(s) is/are at risk of substance abuse or diversion of listed immediate-release alternatives.VyvanseSHI3.05002011-06-08107740mgCap3.5500Notes: Patients > 6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or psychosocial needs, and who meet the following: 1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning; AND 2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner with expertise in ADHD; AND 3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor symptom control, side effects, administrative barriers, or societal barriers. Administrative barriers include: . inability of a school to dose the child at lunch; . the school lunch hour does not coincide with the dosing schedule; . poor compliance with noon or afternoon doses; . the patient is unable to swallow tablets. Societal barriers include: . the patient or patient's caregiver(s) has(have) a history of substance abuse or diversion of listed immediate-release alternatives; . the patient or patient's caregiver(s) is/are at risk of substance abuse or diversion of listed immediate-release alternatives.VyvanseSHI3.55002011-06-08107850mgCap4.0500Notes: Patients > 6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or psychosocial needs, and who meet the following: 1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning; AND 2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner with expertise in ADHD; AND 3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor symptom control, side effects, administrative barriers, or societal barriers. Administrative barriers include: . inability of a school to dose the child at lunch; . the school lunch hour does not coincide with the dosing schedule; . poor compliance with noon or afternoon doses; . the patient is unable to swallow tablets. Societal barriers include: . the patient or patient's caregiver(s) has(have) a history of substance abuse or diversion of listed immediate-release alternatives; . the patient or patient's caregiver(s) is/are at risk of substance abuse or diversion of listed immediate-release alternatives.VyvanseSHI4.05002011-06-08107960mgCap4.5500Notes: Patients > 6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or psychosocial needs, and who meet the following: 1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning; AND 2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner with expertise in ADHD; AND 3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor symptom control, side effects, administrative barriers, or societal barriers. Administrative barriers include: . inability of a school to dose the child at lunch; . the school lunch hour does not coincide with the dosing schedule; . poor compliance with noon or afternoon doses; . the patient is unable to swallow tablets. Societal barriers include: . the patient or patient's caregiver(s) has(have) a history of substance abuse or diversion of listed immediate-release alternatives; . the patient or patient's caregiver(s) is/are at risk of substance abuse or diversion of listed immediate-release alternatives.VyvanseSHI4.55002011-06-08METHYLPHENIDATE HCL108010mgER Cap.6745Note: Patients > 6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or psychosocial needs, and who meet the following: 1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning AND 2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner with expertise in ADHD AND 3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor symptom control, side effects, administrative barriers, or societal barriers. Administrative barriers include: . inability of a school to dose the child at lunch; . the school lunch hour does not coincide with the dosing schedule; . poor compliance with noon or afternoon doses; . the patient is unable to swallow tablets. Societal barriers include: . the patient or patient's caregiver(s) has(have) a history of substance abuse or diversion of listed immediate-release alternatives; . the patient or patient's caregiver(s) is/are at risk of substance abuse or diversion of listed immediate-release alternatives. BiphentinPFP.67452009-08-18108115mgER Cap.9657Note: Patients > 6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or psychosocial needs, and who meet the following: 1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning AND 2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner with expertise in ADHD AND 3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor symptom control, side effects, administrative barriers, or societal barriers. Administrative barriers include: . inability of a school to dose the child at lunch; . the school lunch hour does not coincide with the dosing schedule; . poor compliance with noon or afternoon doses; . the patient is unable to swallow tablets. Societal barriers include: . the patient or patient's caregiver(s) has(have) a history of substance abuse or diversion of listed immediate-release alternatives; . the patient or patient's caregiver(s) is/are at risk of substance abuse or diversion of listed immediate-release alternatives. BiphentinPFP.96572009-08-18108220mgER Cap1.2468Note: Patients > 6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or psychosocial needs, and who meet the following: 1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning AND 2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner with expertise in ADHD AND 3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor symptom control, side effects, administrative barriers, or societal barriers. Administrative barriers include: . inability of a school to dose the child at lunch; . the school lunch hour does not coincide with the dosing schedule; . poor compliance with noon or afternoon doses; . the patient is unable to swallow tablets. Societal barriers include: . the patient or patient's caregiver(s) has(have) a history of substance abuse or diversion of listed immediate-release alternatives; . the patient or patient's caregiver(s) is/are at risk of substance abuse or diversion of listed immediate-release alternatives. BiphentinPFP1.24682009-08-18108330mgER Cap1.7118Note: Patients > 6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or psychosocial needs, and who meet the following: 1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning AND 2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner with expertise in ADHD AND 3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor symptom control, side effects, administrative barriers, or societal barriers. Administrative barriers include: . inability of a school to dose the child at lunch; . the school lunch hour does not coincide with the dosing schedule; . poor compliance with noon or afternoon doses; . the patient is unable to swallow tablets. Societal barriers include: . the patient or patient's caregiver(s) has(have) a history of substance abuse or diversion of listed immediate-release alternatives; . the patient or patient's caregiver(s) is/are at risk of substance abuse or diversion of listed immediate-release alternatives. BiphentinPFP1.71182009-08-18108440mgER Cap2.1815Note: Patients > 6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or psychosocial needs, and who meet the following: 1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning AND 2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner with expertise in ADHD AND 3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor symptom control, side effects, administrative barriers, or societal barriers. Administrative barriers include: . inability of a school to dose the child at lunch; . the school lunch hour does not coincide with the dosing schedule; . poor compliance with noon or afternoon doses; . the patient is unable to swallow tablets. Societal barriers include: . the patient or patient's caregiver(s) has(have) a history of substance abuse or diversion of listed immediate-release alternatives; . the patient or patient's caregiver(s) is/are at risk of substance abuse or diversion of listed immediate-release alternatives. BiphentinPFP2.18152009-08-18108550mgER Cap2.6440Note: Patients > 6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or psychosocial needs, and who meet the following: 1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning AND 2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner with expertise in ADHD AND 3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor symptom control, side effects, administrative barriers, or societal barriers. Administrative barriers include: . inability of a school to dose the child at lunch; . the school lunch hour does not coincide with the dosing schedule; . poor compliance with noon or afternoon doses; . the patient is unable to swallow tablets. Societal barriers include: . the patient or patient's caregiver(s) has(have) a history of substance abuse or diversion of listed immediate-release alternatives; . the patient or patient's caregiver(s) is/are at risk of substance abuse or diversion of listed immediate-release alternatives. BiphentinPFP2.64402009-08-18108660mgER Cap3.0660Note: Patients > 6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or psychosocial needs, and who meet the following: 1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning AND 2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner with expertise in ADHD AND 3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor symptom control, side effects, administrative barriers, or societal barriers. Administrative barriers include: . inability of a school to dose the child at lunch; . the school lunch hour does not coincide with the dosing schedule; . poor compliance with noon or afternoon doses; . the patient is unable to swallow tablets. Societal barriers include: . the patient or patient's caregiver(s) has(have) a history of substance abuse or diversion of listed immediate-release alternatives; . the patient or patient's caregiver(s) is/are at risk of substance abuse or diversion of listed immediate-release alternatives. BiphentinPFP3.06602009-08-18108780mgER Cap4.0572Note: Patients > 6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or psychosocial needs, and who meet the following: 1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning AND 2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner with expertise in ADHD AND 3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor symptom control, side effects, administrative barriers, or societal barriers. Administrative barriers include: . inability of a school to dose the child at lunch; . the school lunch hour does not coincide with the dosing schedule; . poor compliance with noon or afternoon doses; . the patient is unable to swallow tablets. Societal barriers include: . the patient or patient's caregiver(s) has(have) a history of substance abuse or diversion of listed immediate-release alternatives; . the patient or patient's caregiver(s) is/are at risk of substance abuse or diversion of listed immediate-release alternatives. BiphentinPFP4.05722009-08-18108820mgER Tab.2820Ritalin SRNOV.63721996-10-01Apo-Methylphenidate SRAPX.28202006-07-19Sandoz Methylphenidate SRSDZ.28202009-05-20108918mgSR Tab1.0197Notes: Patients > 6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or psychosocial needs, and who meet the following: 1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning; AND 2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner with expertise in ADHD; AND 3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor symptom control, side effects, administrative barriers, or societal barriers. Administrative barriers include: . inability of a school to dose the child at lunch; . the school lunch hour does not coincide with the dosing schedule; . poor compliance with noon or afternoon doses; . the patient is unable to swallow tablets. Societal barriers include: . the patient or patient's caregiver(s) has(have) a history of substance abuse or diversion of listed immediate-release alternatives; . the patient or patient's caregiver(s) is/are at risk of substance abuse or diversion of listed immediate-release alternatives.ConcertaJAN2.09852009-04-01Novo-Methylphenidate ER-CNOP1.01972010-04-23109027mgSR Tab1.1768Notes: Patients > 6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or psychosocial needs, and who meet the following: 1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning; AND 2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner with expertise in ADHD; AND 3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor symptom control, side effects, administrative barriers, or societal barriers. Administrative barriers include: . inability of a school to dose the child at lunch; . the school lunch hour does not coincide with the dosing schedule; . poor compliance with noon or afternoon doses; . the patient is unable to swallow tablets. Societal barriers include: . the patient or patient's caregiver(s) has(have) a history of substance abuse or diversion of listed immediate-release alternatives; . the patient or patient's caregiver(s) is/are at risk of substance abuse or diversion of listed immediate-release alternatives.ConcertaJAN2.42182009-04-01Novo-Methylphenidate ER-CNOP1.17682010-04-23109136mgSR Tab1.3339Notes: Patients > 6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or psychosocial needs, and who meet the following: 1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning; AND 2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner with expertise in ADHD; AND 3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor symptom control, side effects, administrative barriers, or societal barriers. Administrative barriers include: . inability of a school to dose the child at lunch; . the school lunch hour does not coincide with the dosing schedule; . poor compliance with noon or afternoon doses; . the patient is unable to swallow tablets. Societal barriers include: . the patient or patient's caregiver(s) has(have) a history of substance abuse or diversion of listed immediate-release alternatives; . the patient or patient's caregiver(s) is/are at risk of substance abuse or diversion of listed immediate-release alternatives.ConcertaJAN2.74512009-04-01Novo-Methylphenidate ER-CNOP1.33392010-04-23109254mgSR Tab1.6480Notes: Patients > 6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or psychosocial needs, and who meet the following: 1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning; AND 2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner with expertise in ADHD; AND 3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor symptom control, side effects, administrative barriers, or societal barriers. Administrative barriers include: . inability of a school to dose the child at lunch; . the school lunch hour does not coincide with the dosing schedule; . poor compliance with noon or afternoon doses; . the patient is unable to swallow tablets. Societal barriers include: . the patient or patient's caregiver(s) has(have) a history of substance abuse or diversion of listed immediate-release alternatives; . the patient or patient's caregiver(s) is/are at risk of substance abuse or diversion of listed immediate-release alternatives.ConcertaJAN3.39152009-04-01Novo-Methylphenidate ER-CNOP1.64802010-04-23Apo-Methylphenidate ERAPX2010-10-28109310mgTab.0816RitalinNOV.36321996-10-01PMS-MethylphenidatePMS.08161996-10-01Apo-MethylphenidateAPX.08162005-03-31109420mgTabRitalinNOV2008-01-15PMS-MethylphenidatePMS2008-01-15Apo-MethylphenidateAPX2008-01-15MIXED SALT AMPHETAMINE10955mgER Cap2.0655Notes: Patients > 6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or psychosocial needs, and who meet the following: 1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning; AND 2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner with expertise in ADHD; AND 3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor symptom control, side effects, administrative barriers, or societal barriers. Administrative barriers include: . inability of a school to dose the child at lunch; . the school lunch hour does not coincide with the dosing schedule; . poor compliance with noon or afternoon doses; . the patient is unable to swallow tablets. Societal barriers include: . the patient or patient's caregiver(s) has(have) a history of substance abuse or diversion of listed immediate-release alternatives; . the patient or patient's caregiver(s) is/are at risk of substance abuse or diversion of listed immediate-release alternatives.Adderall XRSHI2.06552009-04-01109610mgER Cap2.3473Notes: Patients > 6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or psychosocial needs, and who meet the following: 1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning; AND 2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner with expertise in ADHD; AND 3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor symptom control, side effects, administrative barriers, or societal barriers. Administrative barriers include: . inability of a school to dose the child at lunch; . the school lunch hour does not coincide with the dosing schedule; . poor compliance with noon or afternoon doses; . the patient is unable to swallow tablets. Societal barriers include: . the patient or patient's caregiver(s) has(have) a history of substance abuse or diversion of listed immediate-release alternatives; . the patient or patient's caregiver(s) is/are at risk of substance abuse or diversion of listed immediate-release alternatives.Adderall XRSHI2.34732009-04-01109715mgER Cap2.6291Notes: Patients > 6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or psychosocial needs, and who meet the following: 1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning; AND 2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner with expertise in ADHD; AND 3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor symptom control, side effects, administrative barriers, or societal barriers. Administrative barriers include: . inability of a school to dose the child at lunch; . the school lunch hour does not coincide with the dosing schedule; . poor compliance with noon or afternoon doses; . the patient is unable to swallow tablets. Societal barriers include: . the patient or patient's caregiver(s) has(have) a history of substance abuse or diversion of listed immediate-release alternatives; . the patient or patient's caregiver(s) is/are at risk of substance abuse or diversion of listed immediate-release alternatives.Adderall XRSHI2.62912009-04-01109820mgER Cap2.9110Notes: Patients > 6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or psychosocial needs, and who meet the following: 1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning; AND 2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner with expertise in ADHD; AND 3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor symptom control, side effects, administrative barriers, or societal barriers. Administrative barriers include: . inability of a school to dose the child at lunch; . the school lunch hour does not coincide with the dosing schedule; . poor compliance with noon or afternoon doses; . the patient is unable to swallow tablets. Societal barriers include: . the patient or patient's caregiver(s) has(have) a history of substance abuse or diversion of listed immediate-release alternatives; . the patient or patient's caregiver(s) is/are at risk of substance abuse or diversion of listed immediate-release alternatives.Adderall XRSHI2.91102009-04-01109925mgER Cap3.1928Notes: Patients > 6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or psychosocial needs, and who meet the following: 1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning; AND 2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner with expertise in ADHD; AND 3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor symptom control, side effects, administrative barriers, or societal barriers. Administrative barriers include: . inability of a school to dose the child at lunch; . the school lunch hour does not coincide with the dosing schedule; . poor compliance with noon or afternoon doses; . the patient is unable to swallow tablets. Societal barriers include: . the patient or patient's caregiver(s) has(have) a history of substance abuse or diversion of listed immediate-release alternatives; . the patient or patient's caregiver(s) is/are at risk of substance abuse or diversion of listed immediate-release alternatives.Adderall XRSHI3.19282009-04-01110030mgER Cap3.4748Notes: Patients > 6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or psychosocial needs, and who meet the following: 1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning; AND 2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner with expertise in ADHD; AND 3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor symptom control, side effects, administrative barriers, or societal barriers. Administrative barriers include: . inability of a school to dose the child at lunch; . the school lunch hour does not coincide with the dosing schedule; . poor compliance with noon or afternoon doses; . the patient is unable to swallow tablets. Societal barriers include: . the patient or patient's caregiver(s) has(have) a history of substance abuse or diversion of listed immediate-release alternatives; . the patient or patient's caregiver(s) is/are at risk of substance abuse or diversion of listed immediate-release alternatives.Adderall XRSHI3.47482009-04-01MODAFINIL1101100mgTabAlertecBJH2008-06-27Apo-ModafinilAPX2008-06-27SIBUTRAMINE HCL MONOHYDRATE110210mgCapMeridiaABB2010-03-02Apo-SibutramineAPX2010-03-02110315mgCapMeridiaABB2010-03-02Apo-SibutramineAPX2010-03-02SEDATIVES AND HYPNOTICSSedatives and hypnotics are indicated for short-term therapy only.BUSPIRONE HYDROCHLORIDE110410mgTabBusparBQU2007-11-10Apo-BuspironeAPX2007-11-16Gen-BuspironeGEN2007-11-10PMS-BuspironePMS2007-11-16Novo-BuspironeNOP2007-11-10Ratio-BuspironeRPH2007-11-10FLURAZEPAM110515mgCap.0810DalmaneVAL1996-10-01Apo-FlurazepamAPX.08101996-10-01110630mgCap.0930DalmaneVAL1996-10-01Apo-FlurazepamAPX.09301996-10-01METHOTRIMEPRAZINE110725mg/mLInj Sol-1mL Pk3.2500NozinanSAV3.25001996-10-0111082mgTab.0685NozinanAVE1996-10-01Apo-MethoprazineAPX.06851999-04-1511095mgTab.0991NozinanSAV1996-10-01Apo-MethoprazineAPX.09911999-04-15111025mgTab.2547NozinanSAV1996-10-01Apo-MethoprazineAPX.25471999-04-15111150mgTab.3857NozinanSAV1996-10-01Apo-MethoprazineAPX.38571999-04-15NITRAZEPAM11125mgTab.0357MogadonVAL.14521996-10-01NitrazadonVAL.03571997-08-28Sandoz NitrazepamSDZ.03572007-07-12Apo-NitrazepamAPX.03572003-04-16111310mgTab.0534MogadonVAL.21731996-10-01NitrazadonVAL.05341997-08-28Sandoz NitrazepamSDZ.05342007-07-12Apo-NitrazepamAPX.05342003-04-16TEMAZEPAM111415mgCap.0438RestorilORY.17501996-10-01Nu-TemazepamNXP.04381996-12-19Apo-TemazepamAPX.04381996-12-19Novo-TemazepamNOP.04381999-04-15Ratio-TemazepamRPH.04382001-06-07Co TemazepamCOB.08752003-04-16111530mgCap.0526RestorilORY.21051996-10-01Nu-TemazepamNXP.05261996-12-19Apo-TemazepamAPX.05261996-12-19Novo-TemazepamNOP.05261999-04-15Ratio-TemazepamRPH.05262001-06-07Co TemazepamCOB.10532003-04-16TRIAZOLAM11160.125mgTab.1496HalcionUPJ1996-10-01Apo-TriazoAPX.14961996-10-0111170.25mgTab.2502HalcionPFI1996-10-01Apo-TriazoAPX.25021996-10-01ZOPICLONE11185mgTabImovaneSAV2007-09-04PMS-ZopiclonePMS2007-09-04Apo-ZopicloneAPX2007-09-04Ratio-ZopicloneRPH2007-09-04Novo-ZopicloneNOP2007-09-04Sandoz ZopicloneSDZ2007-09-04Ran-ZopicloneRAN2007-09-04Co ZopicloneCOB2007-09-04Phl-ZopiclonePHE2010-03-02Mylan-ZopicloneMYL2007-09-04ZopicloneMEL2010-06-1411197.5mgTabImovaneSAV2007-09-04RhovaneSAV2007-09-04Apo-ZopicloneAPX2007-09-04Mylan-ZopicloneMYL2007-09-04PMS-ZopiclonePMS2007-09-04Ratio-ZopicloneRPH2007-09-04Novo-ZopicloneNOP2007-09-04Sandoz ZopicloneSDZ2007-09-04Ran-ZopicloneRAN2007-09-04Co ZopicloneCOB2007-09-04Phl-ZopiclonePHE2010-03-02ZopicloneMEL2010-06-14MISCELLANEOUS CENTRAL NERVOUS SYSTEM DRUGSATOMOXETINE HCL112010mgCapStratteraLIL2010-12-14Novo-AtomoxetineNOP2011-03-15Apo-AtomoxetineAPX2010-12-14112118mgCapStratteraLIL2010-12-14Novo-AtomoxetineNOP2011-03-15Apo-AtomoxetineAPX2010-12-14112225mgCapStratteraLIL2010-12-14Novo-AtomoxetineNOP2011-03-15Apo-AtomoxetineAPX2010-12-14112340mgCapStratteraLIL2010-12-14Novo-AtomoxetineNOP2011-03-15Apo-AtomoxetineAPX2010-12-14112460mgCapStratteraLIL2010-12-14Novo-AtomoxetineNOP2011-03-15Apo-AtomoxetineAPX2010-12-14112580mgCapStratteraLIL2010-12-14Apo-AtomoxetineAPX2010-12-141126100mgCapStratteraLIL2010-12-14Apo-AtomoxetineAPX2010-12-14ENTACAPONE1127200mgTab1.6039ComtanNOV1.60392003-04-16For the treatment of patients with Parkinson's disease with 25% of the waking day in the off state despite maximally tolerated doses of levodopa.LU Authorization Period: Indefinite.MEMANTINE HCL112810mgTabEbixaVLH2010-01-05Ratio-MemantineRPH2010-01-05PMS-MemantinePMS2010-01-05Co MemantineCOB2010-06-14Sandoz MemantineSDZ2010-07-20Apo-MemantineAPX2011-12-15NARATRIPTAN HYDROCHLORIDE11291mgTabAmergeGSK2010-03-02Novo-NaratriptanNOP2010-03-0211302.5mgTabAmergeGSK2010-03-02Novo-NaratriptanNOP2010-03-02Sandoz NaratriptanSDZ2010-04-23PIZOTYLINE11310.5mgTab.3894SandomigranPAL.38941996-10-0111321mgTab.6465Sandomigran DSPAL.64651996-10-01PRAMIPEXOLE DIHYDROCHLORIDE MONOHYDRATE11330.25mgTab1.0513NOTE: Mirapex is indicated for both the symptomatic treatment of idiopathic Parkinson's Disease and moderate to severe idiopathic Restless Legs Syndrome under the manufacturer's Drug Identification Number (DIN). Mirapex has also been assigned a Product Identification Number (PIN) for the indication of Parkinson's Disease specifically. Apo-Pramipexole, Novo-Pramipexole, PMS-Pramipexole, Sandoz Pramipexole and Co Pramipexole products are interchangeable with Mirapex for the treatment of Parkinson's Disease.MirapexBOE1.05132000-04-1711340.25mgTab.2628NOTE: Mirapex is indicated for both the symptomatic treatment of idiopathic Parkinson's Disease and moderate to severe idiopathic Restless Legs Syndrome under the manufacturer's Drug Identification Number (DIN). Mirapex has also been assigned a Product Identification Number (PIN) for the indication of Parkinson's Disease specifically. Apo-Pramipexole, Novo-Pramipexole, PMS-Pramipexole Sandoz Pramipexole, Co Pramipexole and Mylan-Pramipexole products are interchangeable with Mirapex for the treatment of Parkinson's Disease.Novo-PramipexoleNOP.26282007-03-09PMS-PramipexolePMS.26282007-03-09Apo-PramipexoleAPX.26282007-04-02Co PramipexoleCOB.26282009-06-23Sandoz PramipexoleSDZ.26282008-11-04Mylan-PramipexoleMYL.26282012-01-19MirapexBOE1.05132007-03-0911350.5mgTabMirapexBOE2007-09-04Novo-PramipexoleNOP2007-09-04PMS-PramipexolePMS2007-10-03Apo-PramipexoleAPX2007-09-04Co PramipexoleCOB2009-06-23Sandoz PramipexoleSDZ2009-05-20Mylan-PramipexoleMYL2012-01-1911361mgTab2.1028NOTE: Mirapex is indicated for both the symptomatic treatment of idiopathic Parkinson's Disease and moderate to severe idiopathic Restless Legs Syndrome under the manufacturer's Drug Identification Number (DIN). Mirapex has also been assigned a Product Identification Number (PIN) for the indication of Parkinson's Disease specifically. Apo-Pramipexole, Novo-Pramipexole, PMS-Pramipexole, Sandoz Pramipexole and Co Pramipexole products are interchangeable with Mirapex for the treatment of Parkinson's Disease.MirapexBOE2.10282000-04-1711371mgTab.5257NOTE: Mirapex is indicated for both the symptomatic treatment of idiopathic Parkinson's Disease and moderate to severe idiopathic Restless Legs Syndrome under the manufacturer's Drug Identification Number (DIN). Mirapex has also been assigned a Product Identification Number (PIN) for the indication of Parkinson's Disease specifically. Apo-Pramipexole, Novo-Pramipexole, PMS-Pramipexole Sandoz Pramipexole, Co Pramipexole and Mylan-Pramipexole products are interchangeable with Mirapex for the treatment of Parkinson's Disease.Novo-PramipexoleNOP.52572007-03-09PMS-PramipexolePMS.52572007-03-09Apo-PramipexoleAPX.52572007-04-02Co PramipexoleCOB.52572009-06-23Sandoz PramipexoleSDZ.52572008-11-04Mylan-PramipexoleMYL.52572012-01-19MirapexBOE2.10282007-03-0911381.5mgTab2.1028NOTE: Mirapex is indicated for both the symptomatic treatment of idiopathic Parkinson's Disease and moderate to severe idiopathic Restless Legs Syndrome under the manufacturer's Drug Identification Number (DIN). Mirapex has also been assigned a Product Identification Number (PIN) for the indication of Parkinson's Disease specifically. Apo-Pramipexole, Novo-Pramipexole, PMS-Pramipexole, Sandoz Pramipexole and Co Pramipexole products are interchangeable with Mirapex for the treatment of Parkinson's Disease.MirapexBOE2.10282000-04-1711391.5mgTab.5257NOTE: Mirapex is indicated for both the symptomatic treatment of idiopathic Parkinson's Disease and moderate to severe idiopathic Restless Legs Syndrome under the manufacturer's Drug Identification Number (DIN). Mirapex has also been assigned a Product Identification Number (PIN) for the indication of Parkinson's Disease specifically. Apo-Pramipexole, Novo-Pramipexole, PMS-Pramipexole Sandoz Pramipexole, Co Pramipexole and Mylan-Pramipexole products are interchangeable with Mirapex for the treatment of Parkinson's Disease.Novo-PramipexoleNOP.52572007-03-09PMS-PramipexolePMS.52572007-03-09Apo-PramipexoleAPX.52572007-04-02Co PramipexoleCOB.52572009-06-23Sandoz PramipexoleSDZ.52572008-11-04Mylan-PramipexoleMYL.52572012-01-19MirapexBOE2.10282007-03-09SUMATRIPTAN SUCCINATE114025mgTabPMS-SumatriptanPMS2007-06-06Co SumatriptanCOB2007-06-06Mylan-SumatriptanMYL2007-06-06ImitrexGSK2007-06-06114125mgTabImitrex DFGSK2007-06-06Novo-Sumatriptan DFNOP2007-06-06114250mgTabImitrexGSK2007-06-06PMS-SumatriptanPMS2007-06-06Co SumatriptanCOB2007-06-06Sandoz SumatriptanSDZ2007-06-06Apo-SumatriptanAPX2007-06-06Mylan-SumatriptanMYL2007-06-06Ratio-SumatriptanRPH2007-06-06114350mgTabImitrex DFGSK2007-06-06Novo-Sumatriptan DFNOP2007-06-061144100mgTabImitrexGSK2007-06-06PMS-SumatriptanPMS2007-06-06Co SumatriptanCOB2007-06-06Sandoz SumatriptanSDZ2007-06-06Apo-SumatriptanAPX2007-06-06Mylan-SumatriptanMYL2007-06-06Ratio-SumatriptanRPH2007-06-061145100mgTabImitrex DFGSK2007-06-06Novo-Sumatriptan DFNOP2007-06-06ZOLMITRIPTAN11462.5mgOrally Disintegrating TabZomig RapimeltAZC2011-09-15PMS-Zolmitriptan ODTPMS2011-09-15Teva-Zolmitriptan ODTEV2011-10-25Sandoz Zolmitriptan ODTSDZ2011-09-1511472.5mgTabZomigAZC2011-09-15Teva-ZolmitriptanTEV2011-10-25PMS-ZolmitriptanPMS2011-09-15Sandoz ZolmitriptanSDZ2011-09-15Mylan-ZolmitriptanMYL2011-09-15DIAGNOSTIC AGENTSADRENAL INSUFFICIENCYCOSYNTROPIN ZINC HYDROXIDE11481mg/mLInj Susp-1mL Pk33.1400Synacthen DepotNOV33.14001996-10-01ELECTROLYTIC, CALORIC AND WATER BALANCEREPLACEMENT AGENTSELECTROLYTE & DEXTROSE1149O/L.0074Pedialyte RegularABB.00741996-10-01Pedialyte FlavoredABB.00741996-10-011150Oral Pd-1 Sach Pk.7950GastrolyteSAV.79501996-10-01PEG-ELECTROLYTES1151Pd-4L Pk16.4500ColyteZYN1996-10-01PegLytePMS16.45001996-10-01POLYETHYLENE GLYCOL & ELECTROLYTES1152Pd-1 Kit16.1700Klean-PrepRIV16.17002003-09-04POTASSIUM CHLORIDE11531.33mEq/mLO/L.0102K-10GSK.01541996-10-01Kaochlor-10PMJ1996-10-01RoychlorWAB1997-01-08PMS-Potassium ChloridePMS.01021999-09-15POTASSIUM-REMOVING RESINSPOLYSTYRENE SODIUM SULFONATE11541mEq/gOral Pd-454g Pk81.0400KayexalateSAV81.04001996-10-01DIURETICSThe Canadian Hypertension Society Consensus Conference recommends lower doses of diuretics for treatment of hypertension, particularly in the elderly, to avoid dose-related adverse effects. Hydrochlorothiazide, 25 to 50mg daily, or other diuretics in equivalent amounts are recommended.AMILORIDE HCL11555mgTab.2717MidamorMSD1996-10-01Apo-AmilorideAPX.27172004-08-11AMILORIDE HCL & HYDROCHLOROTHIAZIDE11565mg & 50mgTab.0838.0419ModuretPRE1996-10-01Apo-AmilzideAPX.0838.04191996-10-01Nu-AmilzideNXP.0838.04191996-10-01NovamilorNOP.0838.04191996-10-01Mylan-AmilazideMYL.0838.04192006-05-19CHLORTHALIDONE115750mgTab.1242.1242HygrotonGEI1996-10-01ChlorthalidoneAAP.1242.12421996-10-01FUROSEMIDE115810mg/mLO/L.2681LasixSAV.26811999-01-07115920mgTab.0373Novo-SemideNOP.03731996-10-01Apo-FurosemideAPX.03731996-10-01LasixSAV.08501999-01-06116040mgTab.0558Novo-SemideNOP.05581996-10-01Apo-FurosemideAPX.05581996-10-01LasixSAV.13071999-01-071161500mgTab2.9330Lasix SpecialSAV2.93301999-01-07For patients with severely impaired renal function refractory to conventional dosages of the drug.LU Authorization Period: Indefinite.HYDROCHLOROTHIAZIDE116212.5mgTabPMS-HydrochlorothiazidePMS2010-04-23Apo-HydroAPX2010-04-23116325mgTab.0157.0157HydroDIURILMSD1996-10-01Novo-HydrazideNOP.0157.01571996-10-01Apo-Hydro 25APX.0157.01571996-10-01PMS-HydrochlorothiazidePMS.0157.01572007-09-04116450mgTab.0217HydroDIURILMSD1996-10-01Novo-HydrazideNOP.02171996-10-01Apo-Hydro 50APX.02171996-10-01PMS-HydrochlorothiazidePMS.02172007-09-04HYDROCHLOROTHIAZIDE & SPIRONOLACTONE116525mg & 25mgTab.1076.0538Aldactazide-25PFI.1331.06651996-10-01Novo-Spirozine-25NOP.1076.05381996-10-01116650mg & 50mgTab.2276Aldactazide-50PFI.28231996-10-01Novo-Spirozine-50NOP.22761996-10-01HYDROCHLOROTHIAZIDE & TRIAMTERENE116725mg & 50mgTab.0608.0608Apo-TriazideAPX.0608.06081996-10-01Novo-TriamzideNOP.0608.06081996-10-01Nu-TriazideNXP1996-10-01DyazideSMJ1996-10-01INDAPAMIDE11681.25mgTab.0745LozideSEV.29791996-10-01Indapamide HemihydrateSEV.18772000-01-17PMS-IndapamidePMS.07451999-09-15Mylan-IndapamideMYL.07451999-09-15Apo-IndapamideAPX.07452003-04-1611692.5mgTab.1182.1182LozideSEV.4727.47271996-10-01IndapamideSEV.2977.29771997-04-10Mylan-IndapamideMYL.1182.11821996-10-01Nu-IndapamideNXP.1182.11821997-04-10Apo-IndapamideAPX.1182.11821996-12-19Novo-IndapamideNOP.1182.11821998-12-31PMS-IndapamidePMS.1182.11821999-09-15METOLAZONE11702.5mgTab.1894ZaroxolynSAV.18941996-10-01MIDODRINE HCL11712.5mgTab.3378AmatineSHI.46101996-10-01MidodrineAAP.33782006-08-2411725mgTab.5630AmatineSHI.76841996-10-01MidodrineAAP.56302006-08-24For the treatment of patients disabled by moderate to severe neurogenic orthostatic hypotension (i.e. drop in systolic BP less than or equal to 20mm Hg from supine to standing position), in whom conventional nonpharmacologic and pharmacologic (i.e. fludrocortisone) therapies have proven ineffective or are poorly tolerated.LU Authorization Period: Indefinite.SPIRONOLACTONESpironolactone can double digoxin blood levels within two weeks, and commonly causes mastalgia and gynaecomastia in men.117325mgTab.1057AldactonePFI.13311996-10-01Novo-SpirotonNOP.10571996-10-011174100mgTab.2461AldactonePFI.31381996-10-01Novo-SpirotonNOP.24611996-10-01URICOSURIC DRUGSPROBENECID1175500mgTab.1884BenemidMSD1996-10-01BenurylVAL.18841996-10-01SULFINPYRAZONE1176200mgTab.2997AnturanGEI1996-10-01SulfinpyrazoneAAP.29971996-10-01COUGH PREPARATIONSANTITUSSIVESDEXTROMETHORPHAN HBR11773mg/mLO/L.0088DM-SyrupPDA2006-06-15Koffex DMROG.00881996-10-01HYDROCODONE BITARTRATE11781mg/mLO/L.1140HycodanBQU.11401996-10-01EXPECTORANTSGUAIFENESIN117920mg/mLO/LRobitussinWHB1996-10-01GuaifenesinROG1996-10-01Guaifenesin Sugar FreeROG1996-10-01EYE, EAR, NOSE AND THROAT PREPARATIONSANTI-INFECTIVES ANTIBIOTICSCHLORAMPHENICOL11800.25%Oph Sol.5280PentamycetinSDZ.52801996-10-01FRAMYCETIN SULFATE11810.5%Oph Oint-5g Pk19.6100SoframycinERF19.61002005-09-2711820.5%Oph Sol1.3400SoframycinERF1.34002005-09-27FRAMYCETIN SULFATE & GRAMICIDIN & DEXAMETHASONE11835mg & 50mcg & 0.5mg/mLOph/Ot Sol.9800The risk of ototoxicity with topical aminoglycoside may increase with prolonged therapy. Topical use of antibiotics increases the likelihood of development of bacterial resistance, especially with prolonged use, sometimes rendering the systemic use of this antibiotic class useless in these patients.SofracortSAV1.81502001-10-11Sandoz OpticortSDZ.98002005-12-06GENTAMICIN & BETAMETHASONE SODIUM PHOSPHATE11843mg & 1mg/mLOph/Ot Drops1.1965The risk of ototoxicity with topical aminoglycoside may increase with prolonged therapy. Topical use of antibiotics increases the likelihood of development of bacterial resistance, especially with prolonged use, sometimes rendering the systemic use of this antibiotic class useless in these patients.GarasoneSCH1.28131996-10-01Sandoz PentasoneSDZ1.19652003-01-30GENTAMICIN SULFATE11850.3%Oph Oint-3.5g Pk4.0000GaramycinSCH4.00001996-10-0111860.3%Oph Sol.4060GaramycinSCH.40601996-10-0111870.3%Ot Sol1.0320GaramycinSCH1.03201996-10-01Sandoz GentamicinSDZ1.03201998-12-31POLYMYXIN B SULFATE & BACITRACIN (ZINC)118810000U & 500U/gOph Oint 3.5g Pk5.5400PolysporinPFI5.54002007-01-02POLYMYXIN B SULFATE & GRAMICIDIN118910000U & 0.025mg/mLOph/Ot Sol.6920PolysporinPFI.69202007-01-02POLYMYXIN B SULFATE & NEOMYCIN SULFATE & HYDROCORTISONE119010000U & 5mg & 10mg/mLOt Sol1.2810CortisporinGSK1.28101996-10-01POLYMYXIN B SULFATE & TRIMETHOPRIM SULFATE119110000U/mL & 1mg/mLOph Sol-10mL PkPolytrimALL2010-06-14PMS-PolytrimethoprimPMS2010-06-14TOBRAMYCIN11920.3%Oph Oint2.4101TobrexALC2.41011996-10-0111930.3%Oph Sol.5831TobrexALC1.69931996-10-01PMS-TobramycinPMS.58311999-09-15Sandoz TobramycinSDZ.83332002-04-04TOBRAMYCIN & DEXAMETHASONE11940.3% & 0.1%Oph Oint2.9726TobraDexALC2.97261996-10-0111950.3% & 0.1%Oph Susp2.0074TobraDexALC2.00741996-10-01ANTI-INFECTIVES OTHER ANTI-INFECTIVESCIPROFLOXACINCiprofloxacin is not intended for the treatment of asymptomatic bacteriuria in the absence of risk factors. Avoid use in pregnancy and children < 18 years of age. Ciprofloxacin inhibits theophylline clearance and also affects phenytoin kinetics. Theophylline doses should be decreased and blood levels of phenytoin or theophylline monitored when either of these drugs is used concomitantly with ciprofloxacin.11960.3%Oph Sol-5mL PkCiloxanALC2009-01-30PMS-CiprofloxacinPMS2009-01-30Apo-CiprofloxAPX2010-06-14OFLOXACIN11970.3%Oph Sol.7080OcufloxALL2.44601996-12-19Apo-OfloxacinAPX.85612006-06-14PMS-OfloxacinPMS.70802007-10-03For the treatment of conjunctivitis caused by susceptible strain(s) of Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae and Hemophilus influenzae which is/are resistant or unresponsive to listed alternative agents.LU Authorization Period: 1 year.TRIFLURIDINE11981%Oph Sol3.0387Administration of trifluridine for periods exceeding 21 days should be avoided because of potential ocular toxicity.ViropticTHE3.03871996-10-01ANTI-INFLAMMATORY AGENTSTopical corticosteroid can reactivate pre-existing viral keratitis. These agents should be used with caution in patients with a history of previous corneal ulceration. In some patients, prolonged use of these agents can result in significant problems such as increased intraocular pressure.BECLOMETHASONE DIPROPIONATE119950mcgNas Sp-200 Dose Pk12.2600Mylan-Beclo AQMYL12.26001996-12-19Beconase AqueousGLW1998-03-17BUDESONIDE1200100mcg/Metered DoseNas Aero 200 Dose23.3500Rhinocort TurbuhalerAZC23.35001996-10-01120164mcg/Metered DoseNas Sp-120 Dose Pk10.5000Rhinocort AquaAZC10.50001998-12-311202100mcg/Metered DoseNas Sp-165 Dose Pk12.7400Rhinocort AquaAST1996-10-01Mylan-Budesonide AQMYL12.74001998-12-31DEXAMETHASONE12030.1%Oph Oint-3.5g Pk8.3500MaxidexALC8.35001996-10-0112040.1%Oph Susp1.5708MaxidexALC1.57081996-10-01FLUMETHASONE PIVALATE & IODOCHLORHYDROXYQUIN12050.02% & 1%Ot Sol1.4860Locacorten-VioformPAL1.48601996-10-01FLUNISOLIDE12060.025%Nas Sp-25mL Pk14.8500RhinalarIVA2000-04-17Apo-FlunisolideAPX14.85002004-08-11FLUOROMETHOLONE12070.1%Oph Susp3.0580FMLALL3.05801996-10-01FLUOROMETHOLONE ACETATE12080.1%Oph Susp1.7748FlarexALC1.77481996-10-01FLUTICASONE PROPIONATE120950mcg/ActuationNas Sp-120 Dose PkFlonaseGSK2007-11-10Apo-FluticasoneAPX2007-11-10Ratio-FluticasoneRPH2007-11-10KETOROLAC TROMETHAMINE12100.5%Oph Sol1.6000AcularALL3.36001996-10-01Apo-KetorolacAPX1.60002004-07-20Ratio-KetorolacRPH1.60002004-04-06LODOXAMIDE TROMETHAMINE12110.1%Oph Sol1.0455AlomideALC1.04551996-10-01PREDNISOLONE ACETATE12120.12%Oph Susp1.7960Pred MildALL1.79601996-10-0112131%Oph Susp1.9400Pred ForteALL1996-10-01Ratio-PrednisoloneRPH1.94001996-10-01DiopredSDZ1.94001996-10-01LOCAL ANESTHETICSBENZYDAMINE HCL12140.15%Oral Rinse.0290TantumGRA.13251996-10-01PMS-BenzydaminePMS.02901998-12-31Novo-BenzydamineNOP.02902000-11-30Apo-BenzydamineAPX.02902000-01-17For the symptomatic relief of treatment induced mucositis in cancer patients.LU Authorization Period: 1 year.LIDOCAINE HCL12152%O/L.0925Xylocaine ViscousAZC.09251996-10-01MIOTICSCARBACHOL12161.5%Oph Sol.6868Isopto CarbacholALC.68681996-10-0112173%Oph Sol.8262Isopto CarbacholALC.82621996-10-01PILOCARPINE HCL12184%Oph Gel2.5480Pilopine HSALC2.54801996-10-0112191%Oph Sol.2088Isopto CarpineALC.20881996-10-01DiocarpineDKT1999-04-1512202%Oph Sol.2407Isopto CarpineALC.24071996-10-01DiocarpineDKT1999-04-1512214%Oph Sol.2720Isopto CarpineALC.27201996-10-01MYDRIATICSATROPINE SULFATE12221%Oph Sol.6120Isopto AtropineALC.61201996-10-01AtropineNOV1996-10-01VASOCONSTRICTORSNAPHAZOLINE HCL12230.1%Oph SolAlbalonALL1996-10-01Naphcon ForteALC1996-10-01VasoconIOB1996-10-01OTHER EYE, EAR, NOSE AND THROAT AGENTSACETAZOLAMIDE1224250mgTab.1237AcetazolamideAAP.12371996-10-01DiamoxWAY2000-11-30BETAXOLOL HCL12250.25%Oph Susp2.2726Betoptic SALC2.27261996-10-01BIMATOPROST12260.03%Oph Sol10.8100LumiganALL10.81002004-04-0612270.01%Oph Sol-3mL Pk32.4300Lumigan RCALL32.43002010-09-0912280.01%Oph Sol-5mL Pk54.0500Lumigan RCALL54.05002010-09-0912290.01%Oph Sol-7.5mL Pk81.0750Lumigan RCALL81.07502012-01-19As first line treatment of elevated intraocular pressure in patients who cannot tolerate an ophthalmic beta-blocking agent or where beta-blocking agents are contraindicated;LU Authorization Period: Indefinite.As second line monotherapy or combination therapy in patients who do not have an adequate intraocular pressure lowering response to ophthalmic beta-blocking agents.LU Authorization Period: Indefinite.For use as adjunctive therapy with an ophthalmic beta-blocking agent in an urgent situation (e.g. patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective..LU Authorization Period: Indefinite.BRIMONIDINE12300.15%Oph Sol1.7325Alphagan PALL2.31002004-11-04Apo-Brimonidine PAPX1.73252008-10-0112310.2%Oph Sol1.1550AlphaganALL3.30001998-12-31Ratio-BrimonidineRPH1.15502003-04-16PMS-BrimonidinePMS1.15502005-12-06Apo-BrimonidineAPX1.15502006-01-24Sandoz BrimonidineSDZ1.15502008-08-28As first line treatment of elevated intraocular pressure in patients who cannot tolerate an ophthalmic beta-blocking agent or where beta-blocking agents are contraindicated;LU Authorization Period: Indefinite.As second line monotherapy or combination therapy in patients who do not have an adequate intraocular pressure lowering response to ophthalmic beta-blocking agents.LU Authorization Period: Indefinite.For use as adjunctive therapy with an ophthalmic beta-blocking agent in an urgent situation (e.g. patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective..LU Authorization Period: Indefinite.BRIMONIDINE TARTRATE & TIMOLOL MALEATE12320.2% & 0.5%Oph Sol-10mL Pk40.1200CombiganALL40.12002008-08-28As second-line therapy for patients who do not have an adequate intraocular pressure lowering response to monotherapy with ophthalmic beta-blocking agents.LU Authorization Period: Indefinite.For use as initial therapy in an urgent situation (e.g. patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective.LU Authorization Period: Indefinite.BRINZOLAMIDE12331%Oph Susp3.2844AzoptALC3.28442000-01-17As first line treatment of elevated intraocular pressure in patients who cannot tolerate an ophthalmic beta-blocking agent or where beta-blocking agents are contraindicated;LU Authorization Period: Indefinite.As second line monotherapy or combination therapy in patients who do not have an adequate intraocular pressure lowering response to ophthalmic beta-blocking agents.LU Authorization Period: Indefinite.For use as adjunctive therapy with an ophthalmic beta-blocking agent in an urgent situation (e.g. patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective..LU Authorization Period: Indefinite.BRINZOLAMIDE & TIMOLOL MALEATE12341% & 0.5%Oph Susp-5mL Pk21.4200AzargaALC21.42002010-06-14As second-line therapy for patients who do not have an adequate intraocular pressure lowering response to monotherapy with ophthalmic beta-blocking agents.LU Authorization Period: Indefinite.For use as initial therapy in an urgent situation (e.g. patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective.LU Authorization Period: Indefinite.DEXTRAN 70 & HYDROXYPROPYL METHYLCELLULOSE12350.1%/0.3%Oph-Sol.2800Tears NaturaleALC.28001996-10-01For patients with objective evidence of keratoconjunctivitis sicca as confirmed by filamentary keratopathy on slit lamp examination or biopsy..LU Authorization Period: Indefinite.DEXTRAN 70 & HYDROXYPROPYL METHYLCELLULOSE & POLYQUAD12360.1%/0.3%/0.001%Oph-Sol.2880Tears Naturale IIALC.28801996-10-01For patients with objective evidence of keratoconjunctivitis sicca as confirmed by filamentary keratopathy on slit lamp examination or biopsy..LU Authorization Period: Indefinite.DICLOFENAC SODIUM12370.1%Oph Sol3.3180Voltaren OphthaNOV3.31801996-10-01DORZOLAMIDE HCL12382%Oph Sol3.7940TrusoptMFC3.79401996-12-19As first line treatment of elevated intraocular pressure in patients who cannot tolerate an ophthalmic beta-blocking agent or where beta-blocking agents are contraindicated;LU Authorization Period: Indefinite.As second line monotherapy or combination therapy in patients who do not have an adequate intraocular pressure lowering response to ophthalmic beta-blocking agents.LU Authorization Period: Indefinite.For use as adjunctive therapy with an ophthalmic beta-blocking agent in an urgent situation (e.g. patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective..LU Authorization Period: Indefinite.DORZOLAMIDE HCL & TIMOLOL MALEATE12392% & 0.5%Oph Sol4.2615CosoptMFC5.74202000-01-17Apo-Dorzo-TimopAPX4.26152011-12-1512402% & 0.5%Oph Sol-0.2mL Pk.4735Cosopt Preservative freeMFC.47352010-04-23As second-line therapy for patients who do not have an adequate intraocular pressure lowering response to monotherapy with ophthalmic beta-blocking agents.LU Authorization Period: Indefinite.For use as initial therapy in an urgent situation (e.g. patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective.LU Authorization Period: Indefinite.IPRATROPIUM BROMIDE12410.03%Nasal Spray.3476AtroventBOE.99301996-10-01PMS-IpratropiumPMS.34762000-07-17For the treatment of non-allergic vasomotor rhinitisLU Authorization Period: 1 year.12420.06%Nasal SprayAtroventBOE2009-06-23Apo-IpraventAPX2009-06-23LATANOPROST12430.005%Oph Sol-2.5mL Pk9.5830XalatanPFI27.38002000-01-17Co LatanoprostCOB9.58302012-01-19Apo-LatanoprostAPX9.58302011-12-15Gd-LatanoprostGEM9.58302011-12-15As first line treatment of elevated intraocular pressure in patients who cannot tolerate an ophthalmic beta-blocking agent or where beta-blocking agents are contraindicated;LU Authorization Period: Indefinite.As second line monotherapy or combination therapy in patients who do not have an adequate intraocular pressure lowering response to ophthalmic beta-blocking agents.LU Authorization Period: Indefinite.For use as adjunctive therapy with an ophthalmic beta-blocking agent in an urgent situation (e.g. patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective..LU Authorization Period: Indefinite.LATANOPROST & TIMOLOL MALEATE124450mcg/mL & 5mg/mLOph Sol-2.5mL Pk30.9900XalacomPFI30.99002004-11-04As second-line therapy for patients who do not have an adequate intraocular pressure lowering response to monotherapy with ophthalmic beta-blocking agents.LU Authorization Period: Indefinite.For use as initial therapy in an urgent situation (e.g. patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective.LU Authorization Period: Indefinite.LEVOBUNOLOL HCL12450.25%Oph Sol.9334BetaganALL1996-10-01Ratio-LevobunololRPH.93341996-10-01Sandoz LevobunololSDZ.93342003-01-3012460.5%Oph Sol1.1515BetaganALL3.29001996-10-01Ratio-LevobunololRPH1.15151996-10-01PMS-LevobunololPMS1.15152000-04-17Sandoz LevobunololSDZ1.15152003-01-30METHAZOLAMIDE124750mgTab.4817NeptazaneWAY1999-12-16MethazolamideAAP.48172003-01-30METHYLCELLULOSE12480.5%Oph-Sol.3407Isopto TearsALC.34071996-10-0112491%Oph-Sol.4220Isopto TearsALC.42201996-10-01For patients with objective evidence of keratoconjunctivitis sicca as confirmed by filamentary keratopathy on slit lamp examination or biopsy..LU Authorization Period: Indefinite.PETROLATUM/MINERAL OIL125055%/42.5%Oph Oint-3.5g Pk6.9800Lacri-LubeALL6.98001996-10-01125180%/20%Oph Oint-3.5g Pk4.5800DuolubeBSH4.58001996-10-01For patients with objective evidence of keratoconjunctivitis sicca as confirmed by filamentary keratopathy on slit lamp examination or biopsy..LU Authorization Period: Indefinite.POLYVINYL ALCOHOL12521%Oph-Sol.3127HypotearsNOV.31271996-10-0112531.4%Oph-Sol.6373Liquifilm TearsALL.63731996-10-01For patients with objective evidence of keratoconjunctivitis sicca as confirmed by filamentary keratopathy on slit lamp examination or biopsy..LU Authorization Period: Indefinite.POLYVINYL ALCOHOL & POLYVINYLPYRROLIDONE1254Oph-Sol.3730Tears PlusALL.37301996-10-01For patients with objective evidence of keratoconjunctivitis sicca as confirmed by filamentary keratopathy on slit lamp examination or biopsy..LU Authorization Period: Indefinite.RANIBIZUMAB125510mg/mLInj Sol-0.23mL Vial Pk1575.0000LucentisNOV1575.00002008-03-25Note: For the treatment of patients with new onset (<3 months) neovascular (wet) age-related macular degeneration (AMD) in a verteporfin PDT (Visudyne)-naive eye. Initial diagnosis should be confirmed by an appropriate diagnostic procedure and administration should be done by a qualified ophthalmologist experienced in Intravitreal injections. Patients receiving concurrent administration of verteporfin PDT (Visudyne) are not eligible for reimbursement. Treatment should be initiated with a loading phase of one injection per month for three consecutive months, followed by a maintenance phase. During the maintenance phase, patients should be monitored for best corrected visual acuity or continued disease activity. If there is clinical or diagnostic evidence of disease activity such as a loss of greater than 5 letters in visual acuity (Early Treatment Diabetic Retinopathy Score (ETDRS) chart or one Snellen line equivalent), Lucentis may be administered. The interval between two doses should not be shorter than one month.LU Authorization Period: 1 year.SODIUM CROMOGLYCATE12562%Oph Sol.9500CromolynPMS.95001996-10-01OpticromALL.99801998-02-17TIMOLOL MALEATE12570.25%Oph Gellan Sol1.9560Timolol maleate can potentiate bronchospasm in asthmatic patients and should not be used in patients with a history of asthma.Timoptic-XEMFC4.08371996-10-01Timolol Maleate-EXALC1.95602006-08-2412580.5%Oph Gellan Sol2.3400Timolol maleate can potentiate bronchospasm in asthmatic patients and should not be used in patients with a history of asthma.Timoptic-XEMFC4.88631996-10-01Timolol Maleate-EXALC2.34002006-08-24Apo-Timop GelAPX2.34002011-03-1512590.25%Oph Sol.9678Timolol maleate can potentiate bronchospasm in asthmatic patients and should not be used in patients with a history of asthma.TimopticMFC1996-10-01Apo-TimopAPX.96781996-10-01Gen-TimololGEN.96781996-10-01PMS-TimololPMS.96782000-07-17Sandoz TimololSDZ.96781999-04-1512600.5%Oph Sol1.2145Timolol maleate can potentiate bronchospasm in asthmatic patients and should not be used in patients with a history of asthma.TimopticMFC3.82571996-10-01Apo-TimopAPX1.21451996-10-01Gen-TimololGEN1.21451996-10-01PMS-TimololPMS1.21452000-07-17Sandoz TimololSDZ1.21451999-04-15TIMOLOL MALEATE & TRAVOPROST12610.5% & 0.004%Oph Sol-2.5mL Pk31.2120DuoTravALC31.21202009-01-3012620.5% & 0.004%Oph Sol-5mL Pk62.4240DuoTravALC62.42402009-11-13As second-line therapy for patients who do not have an adequate intraocular pressure lowering response to monotherapy with ophthalmic beta-blocking agents.LU Authorization Period: Indefinite.For use as initial therapy in an urgent situation (e.g. patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective.LU Authorization Period: Indefinite.TRAVOPROST12630.004%Oph Sol10.8160TravatanALC10.81602002-07-2912640.004%Oph Sol-2.5mL Pk27.5808Travatan ZALC27.58082009-08-1812650.004%Oph Sol-5mL Pk55.1616Travatan ZALC55.16162009-08-18As first line treatment of elevated intraocular pressure in patients who cannot tolerate an ophthalmic beta-blocking agent or where beta-blocking agents are contraindicated;LU Authorization Period: Indefinite.As second line monotherapy or combination therapy in patients who do not have an adequate intraocular pressure lowering response to ophthalmic beta-blocking agents.LU Authorization Period: Indefinite.For use as adjunctive therapy with an ophthalmic beta-blocking agent in an urgent situation (e.g. patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective..LU Authorization Period: Indefinite.GASTROINTESTINAL DRUGSANTACIDS AND ADSORBENTSALUMINUM HYDROXIDE & MAGNESIUM HYDROXIDE126640mg & 40mg/mLO/LNeutralca-SDES1996-10-01MaaloxNOV1998-03-171267120mg & 60mg/mLO/LDiovol EXHOR1996-10-01Maalox TCNOV1998-03-171268400mg & 400mgTabGelusil Extra StrengthPDA1996-10-01MaaloxNOV1998-03-17ANTIDIARRHEA AGENTSDIPHENOXYLATE HYDROCHLORIDE & ATROPINE SULFATE12692.5mg & 0.025mgTab.4532LomotilPFI.45321996-10-01For the treatment of diarrhea associated with:An ileostomy or a colostomy;.LU Authorization Period: 1 year.Bowel resection, including short bowel syndrome;LU Authorization Period: 1 year.Inflammatory Bowel Diseases, i.e. Crohn's Disease and Ulcerative Colitis;LU Authorization Period: 1 year.Cancer, including chemotherapy or radiation therapy;LU Authorization Period: 1 year.HIV/AIDS;LU Authorization Period: 1 year.Acute diarrhea in patients in congregated housing, i.e. Long Term Care Facilities (LTCF), or for patients receiving Home Care;LU Authorization Period: 1 year.Fecal incontinence.LU Authorization Period: 1 year.LOPERAMIDE HCL12702mgCaplet.0952ImodiumJAN.38061996-10-01Novo-LoperamideNOP.09521997-08-28Apo-LoperamideAPX.09521996-12-19PMS-LoperamidePMS.09521998-12-31Diarr-ezePMS1999-04-15Sandoz LoperamideSDZ.09522005-04-28For the treatment of diarrhea associated with:An ileostomy or a colostomy;.LU Authorization Period: 1 year.Bowel resection, including short bowel syndrome;LU Authorization Period: 1 year.Inflammatory Bowel Diseases, i.e. Crohn's Disease and Ulcerative Colitis;LU Authorization Period: 1 year.Cancer, including chemotherapy or radiation therapy;LU Authorization Period: 1 year.HIV/AIDS;LU Authorization Period: 1 year.Acute diarrhea in patients in congregated housing, i.e. Long Term Care Facilities (LTCF), or for patients receiving Home Care;LU Authorization Period: 1 year.Fecal incontinence.LU Authorization Period: 1 year.CATHARTICSCathartics (laxatives) should only be used after failure of simpler measures. A high fibre diet, adequate hydration and a review of potentially constipating drugs is often effective in relieving constipation.BISACODYL12715mgEnt Tab.0450DulcolaxBOE.18601996-10-01Apo-BisacodylAPX.04501996-10-0112725mgSup1.0933DulcolaxBOE1.09331996-10-01127310mgSup.5500DulcolaxBOE1.10001996-10-01Ratio-BisacodylRPH.55001996-10-01DOCUSATE CALCIUM (DIOCTYL CALCIUM SULFOSUCCINATE)1274240mgCap.1287PMS-Docusate CalciumPMS.12871996-10-01SurfakHMR1999-01-07DOCUSATE SODIUM (DIOCTYL SODIUM SULFOSUCCINATE)1275100mgCap.0328Docusate SodiumTAR.03831996-10-01SoflaxPMS.03281996-10-01ColaceWEL.13102006-04-1912764mg/mLO/L.0232Soflax SyrupPMS.02321996-10-01ColaceWEL.02321998-11-19127710mg/mLO/L.1770ColaceWEL.17701998-11-19GRAIN & CITRUS FIBRE1278Tab.0706Novo-FibreNOP.07061996-10-01FibyraxLED1996-10-01LACTULOSE1279667mg/mLO/L.0147PMS-LactulosePMS.01471996-10-01MAGNESIUM OXIDE & CITRIC ACID & SODIUM PICOSULFATE12803.5g & 12g & 10mgPd for Sol-12g Sachet3.0000Pico-SalaxFEI6.00002006-04-19Purg-OdanODN3.00002010-06-14MINERAL OIL1281Enema.0326FleetMFC.03261996-10-01PSYLLIUM MUCILLOID1282Oral Pd.0175MucilliumPMS.01752002-07-29Metamucil Fibre Therapy-Original TexturePGI.02462002-07-29SENNOSIDES A & B12831.7mg/mLSyrup.0318SenokotPFP.03181996-10-0112848.6mgTab.0595SenokotPFP.05951996-10-01GlysennidNOV1996-10-01SODIUM BIPHOSPHATE & SODIUM PHOSPHATE1285160mg & 60mg/mLPed Rect Sol.0440FleetMFC.04401996-10-011286160mg & 60mg/mLRect Sol.0205FleetMFC.02361996-10-01EnemolDPC.02052000-04-17SODIUM CITRATE & SODIUM LAURYL SULFOACETATE1287Micro Enema-5mL Pk.9152MicrolaxPFI.91521996-10-01DIGESTANTSPANCRELIPASE EQUIVALENT TO LIPASE & AMYLASE & PROTEASE12888000 & 30000 & 30000 USP UnitsCap.1866CotazymORG.18661996-10-0112894000 & 11000 & 11000 USP UnitsEnt Microsph Cap.1833Cotazym ECS 4ORG.18331998-12-3112908000 & 30000 & 30000 USP UnitsEnt Microsph Cap.3368Cotazym ECS 8ORG.33681996-10-01129120000 & 55000 & 55000 USP UnitsEnt Microsph Cap.8830Cotazym ECS 20ORG.88301997-04-10Replacement therapy for pancreatic insufficiency secondary to pancreatic surgery (resection);LU Authorization Period: Indefinite.Replacement therapy for pancreatic insufficiency due to chronic pancreatitis;LU Authorization Period: Indefinite.Replacement therapy for pancreatic insufficiency due to carcinoma of the pancreas;LU Authorization Period: Indefinite.Replacement therapy for pancreatic insufficiency due to cystic fibrosis.LU Authorization Period: Indefinite.12924000 & 12000 & 12000 USP UnitsEnt Microsph Cap.4936Pancrease MT4JNO.49361996-10-01Replacement therapy for pancreatic insufficiency secondary to pancreatic surgery (resection);LU Authorization Period: Indefinite.Replacement therapy for pancreatic insufficiency due to chronic pancreatitis;LU Authorization Period: Indefinite.Replacement therapy for pancreatic insufficiency due to carcinoma of the pancreas;LU Authorization Period: Indefinite.12935000 & 16600 & 18750 USP UnitsEnt Minimicrosph Cap.1703Creon 5SPH.17032000-04-17129410000 & 33200 & 37500 USP UnitsEnt Minimicrosph Cap.2723Creon 10SPH.27231998-12-31129520000 & 66400 & 75000 USP UnitsEnt Minimicrosph Cap.7923Creon 20SPH.79232000-04-17129625000 & 74000 & 62500 USP UnitsEnt Minimicrosph Cap.8507Creon 25SPH.85071996-10-01Replacement therapy for pancreatic insufficiency secondary to pancreatic surgery (resection);LU Authorization Period: Indefinite.Replacement therapy for pancreatic insufficiency due to chronic pancreatitis;LU Authorization Period: Indefinite.Replacement therapy for pancreatic insufficiency due to carcinoma of the pancreas;LU Authorization Period: Indefinite.Replacement therapy for pancreatic insufficiency due to cystic fibrosis.LU Authorization Period: Indefinite.129716800 & 70000 & 70000 USP U/0.7gPd-114g Pk38.7700ViokaseBFI38.77001997-03-1412988000 & 30000 & 30000 USP UnitsTab.2249ViokaseBFI.22491997-03-14129916mgTab.3451Viokase 16BFI.34512001-03-07Replacement therapy for pancreatic insufficiency secondary to pancreatic surgery (resection);LU Authorization Period: Indefinite.Replacement therapy for pancreatic insufficiency due to chronic pancreatitis;LU Authorization Period: Indefinite.Replacement therapy for pancreatic insufficiency due to carcinoma of the pancreas;LU Authorization Period: Indefinite.ANTIEMETICS AND ANTINAUSEANTSDELTA-9-TETRAHYDROCANNABINOL13002.5mgCap2.0310MarinolSPH2.03101996-10-0113015mgCap4.0618MarinolSPH4.06181996-10-01For the treatment of emesis associated with cancer chemotherapy in patients who are unresponsive to conventional antiemetic therapy:Initial dose -5mg/m.sq. given 1 to 3 hours before administration of chemotherapy;Repeat doses -5mg/m.sq. every 2 to 4 hours after chemotherapy as needed, usually for 1 to 2 days: no more than 4 to 6 doses should be given in a single day.LU Authorization Period: 1 year.For the treatment of AIDS-related anorexia associated with weight loss and prescription is from a prescriber approved for the Facilitated Access mechanism (see Part VI of the Formulary/CDI binder).LU Authorization Period: 1 year.DIMENHYDRINATE130250mgTabGravol FilmkoteHOR1996-10-01Novo-DimenateNOP1996-10-01Apo-DimenhydrinateAPX1996-10-01PMS-DimenhydrinatePMS1996-10-01DOLASETRON MESYLATE130350mgTab14.2792AnzemetSAV14.27921998-12-311304100mgTab28.5583AnzemetSAV28.55831998-12-31For the treatment of emesis in cancer patients receiving highly emetogenic chemotherapy..LU Authorization Period: 1 year.For patients receiving intravenous chemotherapy who have not experienced adequate control with other available anti-emetics.LU Authorization Period: 1 year.For patients receiving intravenous chemotherapy who experience intolerable side effects with other anti-emetics.The therapeutic value of Anzemet more than 24 hours after the last dose of chemotherapy is unproven.LU Authorization Period: 1 year.DOXYLAMINE SUCCINATE AND PYRIDOXINE HCL130510mg & 10mgSR Tab1.2000DiclectinDUI1.20001996-10-01GRANISETRON HCL13061mgTab13.5000KytrilHLR18.00001996-10-01GranisetronAAP13.50002009-05-20For the treatment of emesis in cancer patients receiving highly emetogenic chemotherapy.LU Authorization Period: 1 year.For patients receiving intravenous chemotherapy or radiation therapy who have not experienced adequate control with other available anti-emetics.LU Authorization Period: 1 year.For patients receiving intravenous chemotherapy or radiation therapy who experience intolerable side effects with other anti- emetics.LU Authorization Period: 1 year.For the treatment of emesis in patients receiving radiation therapy which consists of single fraction treatment to the abdominal cavity, hemi-body irradiation and total body irradiation.The therapeutic value of GRANISETRON HCL more than 24 hours after the last dose of chemotherapy is unproven.LU Authorization Period: 1 year.MECLIZINE HCL130725mgTab.2919BonaminePFI.29191996-10-01NABILONE13080.5mgCap3.1026CesametVAL3.10262005-09-2713091mgCap6.2050CesametVAL6.20501996-10-01ONDANSETRON HCL DIHYDRATE13102mg/mLInj Sol-20mL Vial PkOndansetron InjectionNOP2009-05-20ZofranGSK2009-05-2013112mg/mLInj Sol-2mL Vial PkZofranGSK2009-05-20Ondansetron InjectionNOP2009-05-2013122mg/mLInj Sol-4mL Vial PkOndansetron InjectionNOP2009-05-20ZofranGSK2009-05-20ONDANSETRON HYDROCHLORIDE13134mg/5mLO/L1.4614ZofranGSK2.04421997-08-28OndansetronAAP1.46142009-05-2013144mgTab3.3495ZofranGSK13.39801997-01-20PMS-OndansetronPMS3.34952006-06-14Novo-OndansetronNOP3.34952006-07-19Sandoz OndansetronSDZ3.34952006-07-19Ratio-OndansetronRPH3.34952006-06-14Phl-OndansetronPHE3.34952010-01-05Apo-OndansetronAPX3.34952007-03-09Co OndansetronCOB3.34952009-09-30Mylan-OndansetronMYL3.34952007-09-04Mint-OndansetronMIN3.34952008-12-23Ondansetron-OdanODN3.34952008-10-01Ran-OndansetronRAN3.34952008-12-23Jamp-OndansetronJPC3.34952009-01-30Zym-OndansetronZYN3.34952010-07-20Mar-OndansetronMAR3.34952012-01-1913154mgTab13.0890Zofran ODTGSK13.08902000-04-1713168mgTab5.1110ZofranGSK20.44401997-01-20PMS-OndansetronPMS5.11102006-06-14Novo-OndansetronNOP5.11102006-07-19Sandoz OndansetronSDZ5.11102006-06-14Ratio-OndansetronRPH5.11102006-06-14Phl-OndansetronPHE5.11102010-01-05Apo-OndansetronAPX5.11102007-03-09Co OndansetronCOB5.11102009-09-30Mylan-OndansetronMYL5.11102007-09-04Mint-OndansetronMIN5.11102008-12-23Ondansetron-OdanODN5.11102008-10-01Ran-OndansetronRAN5.11102008-12-23Jamp-OndansetronJPC5.11102009-03-02Zym-OndansetronZYN5.11102010-07-20Mar-OndansetronMAR5.11102012-01-1913178mgTab19.9720Zofran ODTGSK19.97202000-04-17For the treatment of emesis in cancer patients receiving highly emetogenic chemotherapy.LU Authorization Period: 1 year.For patients receiving intravenous chemotherapy or radiation therapy who have not experienced adequate control with other available anti-emetics.LU Authorization Period: 1 year.For patients receiving intravenous chemotherapy or radiation therapy who experience intolerable side effects with other anti- emetics.LU Authorization Period: 1 year.For the treatment of emesis in patients receiving radiation therapy which consists of single fraction treatment to the abdominal cavity, hemi-body irradiation and total body irradiation.The therapeutic value of Ondansetron Hydrochloride more than 24 hours after the last dose of chemotherapy is unproven.LU Authorization Period: 1 year.MISCELLANEOUS G.I. DRUGS5-AMINOSALICYLIC ACID1318500mgDel-Release Tab.5569PentasaFEI.55691996-10-0113191.2gDelayed & ER Tab1.5623MezavantSHI1.56232009-04-0113201g/100mLEnema3.7000PentasaFEI3.70001996-12-1913214g/100mLEnema4.4600PentasaFEI4.46001996-12-191322500mgEnt Tab.5224SalofalkBFI.52241996-10-011323500mgEnt Tab.6145MesasalGSK.61451996-10-0113244gRect Susp-Pk6.3171SalofalkBFI6.31711996-10-011325500mgSup1.1547SalofalkBFI1.15471996-10-0113261gSup1.6000PentasaFEI1.60001996-12-1913271000mgSup1.6960SalofalkBFI1.69602005-09-271328400mgTab.3951AsacolWAR.53001996-10-01Novo-5-ASANOP.39512008-12-231329800mgTab1.0300AsacolWAR1.03002006-04-19BETAMETHASONE DISODIUM PHOSPHATE13305mg/100mLEnema-100mL Pk9.5600BetnesolPAL9.56001998-11-17CIMETIDINECimetidine is less expensive than alternatives, and is effective and well tolerated in most patients. Adequate acid suppression can be achieved by giving cimetidine as opposed to using other longer acting H2-antagonists. Long-term use of these drugs for prevention of recurrent peptic ulcers should be reviewed; specific cure of Helicobacter pylori infection with antibiotics is a more effective and less costly approach.1331200mgTab.0860Apo-CimetidineAPX.08601996-10-01TagametSMJ1996-10-011332300mgTab.0860Apo-CimetidineAPX.08601996-10-01Novo-CimetineNOP.08601996-10-01Nu-CimetNXP.08601996-10-01TagametSMJ1996-10-01Mylan-CimetidineMYL.08601998-12-311333400mgTab.1350Apo-CimetidineAPX.13501996-10-01Novo-CimetineNOP.13501996-10-01Nu-CimetNXP.13501996-10-01TagametSMJ1996-10-01Mylan-CimetidineMYL.13501998-12-311334600mgTab.1702Apo-CimetidineAPX.17021996-10-01Novo-CimetineNOP.17021996-10-01Nu-CimetNXP.17021996-10-01TagametSMJ1996-10-01Mylan-CimetidineMYL.17021998-12-311335800mgTab.2530Apo-CimetidineAPX.25301996-10-01TagametSMJ1996-10-01DOMPERIDONE MALEATE133610mgTab.0594MotiliumJAN1996-10-01Ratio-DomperidoneRPH.05941996-10-01Apo-DomperidoneAPX.05941998-12-31Novo-DomperidoneNOP.05941998-12-31Nu-DomperidoneNXP.05941999-04-15PMS-DomperidonePMS.05941998-12-31Ran-DomperidoneRAN.05942006-03-01Mylan-DomperidoneMYL2008-04-09ESOMEPRAZOLE133720mgDR TabNexiumAZC2011-03-15Apo-EsomeprazoleAPX2011-03-15133840mgDR TabNexiumAZC2011-03-15Apo-EsomeprazoleAPX2011-03-15FAMOTIDINECimetidine is less expensive than alternatives, and is effective and well tolerated in most patients. Adequate acid suppression can be achieved by giving cimetidine as opposed to using other longer acting H2-antagonists. Long-term use of these drugs for prevention of recurrent peptic ulcers should be reviewed; specific cure of Helicobacter pylori infection with antibiotics is a more effective and less costly approach.133920mgTab.2658PepcidMFC1.13181996-10-01Apo-FamotidineAPX.26581996-10-01Novo-FamotidineNOP.26581996-10-01Nu-FamotidineNXP.26581996-10-01Mylan-FamotidineMYL.26581996-10-01134040mgTab.4834PepcidMFC2.09101996-10-01Apo-FamotidineAPX.48341996-10-01Novo-FamotidineNOP.48341996-10-01Nu-FamotidineNXP.48341996-10-01Mylan-FamotidineMYL.48341996-10-01HYDROCORTISONE1341100mg/60mLEnema-60mL Pk5.1429HycortVAL5.14291996-10-01CortenemaBFI6.53001997-05-08HYDROCORTISONE ACETATE134210%Rect Aero-15g Pk83.7900CortifoamPAL83.79001996-10-01LACTULOSE1343666.7mg/mLO/L.0145Ratio-LactuloseRPH.01451996-10-01CephulacMRR1996-10-01Apo-Lactulose SolutionAPX.01452005-03-31LANSOPRAZOLE134415mgDR Cap.5000PrevacidABB2.00001996-10-01Novo-LansoprazoleNOP.50002010-01-05Apo-LansoprazoleAPX.50002009-08-18Mylan-LansoprazoleMYL.50002010-09-09134530mgDR Cap.5000PrevacidABB2.00001996-10-01Novo-LansoprazoleNOP.50002010-01-05Apo-LansoprazoleAPX.50002009-08-18Mylan-LansoprazoleMYL.50002010-09-09Gastroesophageal Reflux Disease (GERD) For the treatment of erosive GERD or upper GI malignancy; OR For the treatment of non-erosive GERD after failure of H2-receptor antagonist therapy. Patients with GERD should be reassessed within 6 months after initial treatment with a PPI. The reassessment could include confirmation of need for PPI with endoscopy, a trial of PPI withdrawal, or step-down therapy to H2-receptor antagonist therapy. Note: There is a lack of published evidence to support double-dose PPI therapy in this setting.LU Authorization Period: 1 year.H. pylori-positive Peptic Ulcers For the treatment of H. pylori-positive peptic ulcers where H. pylori is documented, by serology, urea breath test or endoscopy, for a one-week course in combination with antimicrobial therapy. Retreatment of H. pylori-positive peptic ulcers must be documented by persistent H. pylori infection on urea breath test or endoscopy. Maximum duration: 7 days (for retreatment, a four-week period must elapse since the end of the previous treatment).LU Authorization Period: 1 year.Confirmed Peptic Ulcers or NSAID-induced Ulcer Prophylaxis: For the treatment of confirmed peptic ulcers and NSAID-induced ulcers; OR For the prophylaxis of NSAID-induced ulcers for patients at increased risk of GI bleeding. Note: There is a lack of published evidence to support double-dose PPI therapy in this setting.LU Authorization Period: 1 year.Other Gastrointestinal Disorders For the treatment of gastroduodenal Crohns disease, short-gut syndrome, scleroderma, or pancreatitis. Note: There is a lack of published evidence to support double-dose PPI therapy in these settingsLU Authorization Period: 1 year.Severe Conditions: For the treatment of severe esophagitis, Zollinger-Ellison syndrome, esophageal stricture, persistent symptoms of GERD or persistent erosive esophagitis, or upon hospital discharge following a gastrointestinal bleed. For patients receiving double-dose therapy, the need to continue treatment at higher doses should be reassessed after eight weeks. For re-treatment at higher doses, a four-week period should have elapsed from the end of the previous treatment. Reassessment could include a procedural assessment of the condition or step-down therapy to lower-dose proton pump inhibitor (PPI) therapy.LU Authorization Period: 1 year.LANSOPRAZOLE & CLARITHROMYCIN & AMOXICILLIN134630mg & 500mg & 500mgTab/Cap Pk83.0200Hp-PACABB83.02001999-04-15a) For the treatment of H. pylori-positive peptic ulcers where H. pylori is documented, by serology, breath test or endoscopy, for a one week course. Maximum duration: 7 days.LU Authorization Period: 1 year.b) For the retreatment of H. pylori-positive peptic ulcers where H. pylori recurrence or persistence is documented, by breath test or endoscopy, for a one week course. Maximum duration: 7 days (after a four-week period has elapsed since the end of the previous treatment)Retreatment decisions should be based upon positive symptoms and positive endoscopy or positive urea breath test. Retreatment should not be based on a positive serology test, as serology tests may remain positive indefinitely. An alternative antibiotic regimen is recommended when initial therapy fails due to concerns of antimicrobial resistance.Network will limit supply to 7 days. Network will verify that retreatments are reimbursed only after a four-week period has elapsed since the end of the previous treatment.LU Authorization Period: 1 year.METOCLOPRAMIDE HCL13475mgTab.0556Apo-MetoclopAPX.05561996-10-01MaxeranHMR1996-10-01Nu-MetoclopramideNXP.05561996-10-01PMS-MetoclopramidePMS.05561999-09-15134810mgTab.0583Apo-MetoclopAPX.05831996-10-01MaxeranHMR1996-10-01Nu-MetoclopramideNXP.05831996-10-01PMS-MetoclopramidePMS.05831999-09-15MISOPROSTOL1349100mcgTab.2584CytotecSEA1996-10-01MisoprostolAAP.25842002-04-041350200mcgTab.4303CytotecSEA1996-10-01MisoprostolAAP.43032002-04-04NIZATIDINECimetidine is less expensive than alternatives, and is effective and well tolerated in most patients. Adequate acid suppression can be achieved by giving cimetidine as opposed to using other longer acting H2-antagonists. Long-term use of these drugs for prevention of recurrent peptic ulcers should be reviewed; specific cure of Helicobacter pylori infection with antibiotics is a more effective and less costly approach.1351150mgCap.2098AxidMMT.83921996-10-01PMS-NizatidinePMS.20981999-04-15Apo-NizatidineAPX.20981999-04-15Novo-NizatidineNOP.20982000-01-171352300mgCap.3802AxidPHE1.52061996-10-01PMS-NizatidinePMS.38021999-04-15Apo-NizatidineAPX.38021999-04-15Novo-NizatidineNOP.38022000-01-17Gen-NizatidineGEN.38022003-01-30OLSALAZINE SODIUM1353250mgCap.5125DipentumUCB.51252009-05-20OMEPRAZOLE135410mgLosec DR TabAZC2010-04-23Mylan-Omeprazole DR CapMYL2010-04-23135520mg.5500Losec DR TabAZC2.26331996-10-01Apo-Omeprazole CapAPX.55002004-07-20Ratio-Omeprazole DR TabRPH.55002007-03-09Novo-Omeprazole DR TabNOP.55002011-03-15Sandoz Omeprazole DR CapSDZ.55002007-11-10PMS-Omeprazole DR TabPMS.55002010-10-28Ran-Omeprazole DR TabRAN.55002012-01-19Mylan-Omeprazole DR CapMYL.55002010-01-05PMS-Omeprazole DR CapPMS.55002010-01-05135620mg.5500Losec DR CapAST2004-07-20PMS-Omeprazole DR CapPMS.55002009-06-23Mylan-Omeprazole DR CapMYL.55002009-09-30Apo-Omeprazole CapAPX.55002007-11-10Sandoz Omeprazole DR CapSDZ.55002008-12-03Gastroesophageal Reflux Disease (GERD) For the treatment of erosive GERD or upper GI malignancy; OR For the treatment of non-erosive GERD after failure of H2-receptor antagonist therapy. Patients with GERD should be reassessed within 6 months after initial treatment with a PPI. The reassessment could include confirmation of need for PPI with endoscopy, a trial of PPI withdrawal, or step-down therapy to H2-receptor antagonist therapy. Note: There is a lack of published evidence to support double-dose PPI therapy in this setting.LU Authorization Period: 1 year.Confirmed Peptic Ulcers or NSAID-induced Ulcer Prophylaxis: For the treatment of confirmed peptic ulcers and NSAID-induced ulcers; OR For the prophylaxis of NSAID-induced ulcers for patients at increased risk of GI bleeding. Note: There is a lack of published evidence to support double-dose PPI therapy in this setting.LU Authorization Period: 1 year.Other Gastrointestinal Disorders For the treatment of gastroduodenal Crohns disease, short-gut syndrome, scleroderma, or pancreatitis. Note: There is a lack of published evidence to support double-dose PPI therapy in these settingsLU Authorization Period: 1 year.Severe Conditions: For the treatment of severe esophagitis, Zollinger-Ellison syndrome, esophageal stricture, persistent symptoms of GERD or persistent erosive esophagitis, or upon hospital discharge following a gastrointestinal bleed. For patients receiving double-dose therapy, the need to continue treatment at higher doses should be reassessed after eight weeks. For re-treatment at higher doses, a four-week period should have elapsed from the end of the previous treatment. Reassessment could include a procedural assessment of the condition or step-down therapy to lower-dose proton pump inhibitor (PPI) therapy.LU Authorization Period: 1 year.135710mgDR CapLosecAZC2009-05-20Sandoz OmeprazoleSDZ2009-05-20Mylan-OmeprazoleMYL2009-11-19OMEPRAZOLE MAGNESIUM135820mg.5500Losec DR TabAZC2.26332006-10-23Ratio-Omeprazole DR TabRPH.55002007-03-09Mylan-Omeprazole DR CapMYL.55002010-01-05H. pylori-positive Peptic Ulcers For the treatment of H. pylori-positive peptic ulcers where H. pylori is documented, by serology, urea breath test or endoscopy, for a one-week course in combination with antimicrobial therapy. Retreatment of H. pylori-positive peptic ulcers must be documented by persistent H. pylori infection on urea breath test or endoscopy. Maximum duration: 7 days (for retreatment, a four-week period must elapse since the end of the previous treatment).LU Authorization Period: 1 year.PANTOPRAZOLE MAGNESIUM135940mgEnt Coated Tab.7500TectaNYC.75002010-06-14PANTOPRAZOLE SODIUM136020mgEnt TabPantolocNYC2008-06-27Novo-PantoprazoleNOP2008-08-28Apo-PantoprazoleAPX2008-06-27Sandoz PantoprazoleSDZ2008-11-04Ran-PantoprazoleRAN2008-11-04PMS-PantoprazolePMS2008-12-23Ratio-PantoprazoleRPH2008-08-28136140mgEnt Tab.5054PantolocNYC2.02171997-08-28Novo-PantoprazoleNOP.50542008-06-27Apo-PantoprazoleAPX.50542008-05-16Mylan-PantoprazoleMYL.50542008-08-28Co PantoprazoleCOB.50542008-08-28Sandoz PantoprazoleSDZ.50542008-08-28Ran-PantoprazoleRAN.50542008-04-09PMS-PantoprazolePMS.50542008-08-28Ratio-PantoprazoleRPH.50542008-08-28PantoprazoleMEL.50542010-03-02Gastroesophageal Reflux Disease (GERD) For the treatment of erosive GERD or upper GI malignancy; OR For the treatment of non-erosive GERD after failure of H2-receptor antagonist therapy. Patients with GERD should be reassessed within 6 months after initial treatment with a PPI. The reassessment could include confirmation of need for PPI with endoscopy, a trial of PPI withdrawal, or step-down therapy to H2-receptor antagonist therapy. Note: There is a lack of published evidence to support double-dose PPI therapy in this setting.LU Authorization Period: 1 year.H. pylori-positive Peptic Ulcers For the treatment of H. pylori-positive peptic ulcers where H. pylori is documented, by serology, urea breath test or endoscopy, for a one-week course in combination with antimicrobial therapy. Retreatment of H. pylori-positive peptic ulcers must be documented by persistent H. pylori infection on urea breath test or endoscopy. Maximum duration: 7 days (for retreatment, a four-week period must elapse since the end of the previous treatment).LU Authorization Period: 1 year.Confirmed Peptic Ulcers or NSAID-induced Ulcer Prophylaxis: For the treatment of confirmed peptic ulcers and NSAID-induced ulcers; OR For the prophylaxis of NSAID-induced ulcers for patients at increased risk of GI bleeding. Note: There is a lack of published evidence to support double-dose PPI therapy in this setting.LU Authorization Period: 1 year.Other Gastrointestinal Disorders For the treatment of gastroduodenal Crohns disease, short-gut syndrome, scleroderma, or pancreatitis. Note: There is a lack of published evidence to support double-dose PPI therapy in these settingsLU Authorization Period: 1 year.Severe Conditions: For the treatment of severe esophagitis, Zollinger-Ellison syndrome, esophageal stricture, persistent symptoms of GERD or persistent erosive esophagitis, or upon hospital discharge following a gastrointestinal bleed. For patients receiving double-dose therapy, the need to continue treatment at higher doses should be reassessed after eight weeks. For re-treatment at higher doses, a four-week period should have elapsed from the end of the previous treatment. Reassessment could include a procedural assessment of the condition or step-down therapy to lower-dose proton pump inhibitor (PPI) therapy.LU Authorization Period: 1 year.RABEPRAZOLE SODIUM136210mgTab.1672ParietJAN.68552002-07-29Novo-Rabeprazole ECNOP.16722008-01-15Ran-RabeprazoleRAN.16722008-01-15PMS-Rabeprazole ECPMS.16722008-08-28Sandoz RabeprazoleSDZ.16722008-10-01Rabeprazole ECMEL.16722010-06-14Apo-RabeprazoleAPX.16722010-06-14136320mgTab.3344ParietJAN1.37112007-01-02Novo-Rabeprazole ECNOP.33442008-01-15Ran-RabeprazoleRAN.33442008-01-15PMS-Rabeprazole ECPMS.33442008-08-28Sandoz RabeprazoleSDZ.33442008-10-01Rabeprazole ECMEL.33442010-06-14Apo-RabeprazoleAPX.33442010-06-14RANITIDINE HCLCimetidine is less expensive than alternatives, and is effective and well tolerated in most patients. Adequate acid suppression can be achieved by giving cimetidine as opposed to using other longer acting H2-antagonists. Long-term use of these drugs for prevention of recurrent peptic ulcers should be reviewed; specific cure of Helicobacter pylori infection with antibiotics is a more effective and less costly approach.136450mg/2mLInj Sol-2mL Pk2.7990ZantacGSK2.79901998-03-17136515mg/mLOral Sol.0932ZantacGSK.20851997-01-20Novo-RanidineNOP.09322004-12-21Apo-RanitidineAPX.09322007-09-041366150mgTab.1800Apo-RanitidineAPX.18001996-10-01Novo-RanidineNOP.29921996-10-01Ratio-RanitidineRPH.29921996-10-01Nu-RanitNXP.29921996-10-01Mylan-RanitidineMYL.18001996-10-01ZantacGSK.18001997-07-12PMS-RanitidinePMS.18002001-03-07Sandoz RanitidineSDZ.18002001-10-11Co RanitidineCOB.18002004-07-20Ran-RanitidineRAN.18002010-01-05Myl-RanitidineMYL.18002011-09-151367300mgTab.3600Apo-RanitidineAPX.36001996-10-01Novo-RanidineNOP.56321996-10-01Ratio-RanitidineRPH.56321996-10-01Nu-RanitNXP.56321996-10-01Mylan-RanitidineMYL.36001996-10-01ZantacGSK.36001998-03-17PMS-RanitidinePMS.36002001-03-07Sandoz RanitidineSDZ.36002001-10-11Co RanitidineCOB.36002004-07-20Ran-RanitidineRAN.36002010-01-05Myl-RanitidineMYL.36002011-09-15SUCRALFATE13681g/5mLOral Susp.1008Sulcrate Suspension PlusBFI.10081996-10-0113691gTab.1309Novo-SucralateNOP.13091996-10-01SulcrateBFI.55491996-10-01Apo-SucralfateAPX.13091996-10-01Nu-SucralfateNXP.13091999-04-15GOLD COMPOUNDSAURANOFIN13703mgCap2.0047RidauraPAL2.00471996-10-01SODIUM AUROTHIOMALATE137110mg/mLInj Sol-1mL Pk6.3100MyochrysineSAV11.69001996-10-01Sodium AurothiomalateSDZ6.31002005-09-16137225mg/mLInj Sol-1mL Pk7.6567MyochrysineSAV14.17001996-10-01Sodium AurothiomalateSDZ7.65672005-09-16137350mg/mLInj Sol-1mL Pk11.8900MyochrysineSAV22.02001996-10-01Sodium AurothiomalateSDZ11.89002005-09-16HEAVY METAL ANTAGONISTSDEFEROXAMINE MESYLATE13742g/VialInj Pd-2g Vial PkDesferalNOV2008-01-15PMS-DeferoxaminePMS2008-01-151375500mg/VialInj Pd-500mg Vial PkDesferalNOV2008-01-15PMS-DeferoxaminePMS2008-01-15PENICILLAMINE1376250mgCap3.2965CuprimineATO3.29651996-10-01HORMONES AND SUBSTITUTESCORTICOSTEROIDSThe general direction of the therapy of asthma has been toward the use of anti- inflammatory agents, especially inhaled steroids, which are not associated with systemic side effects to the same degree as oral steroids. The proper technique of inhalation or use of a spacer is very important to the efficacy of these agents. Physicians and pharmacists should ensure that patients are appropriately instructed in the use of these devices.BECLOMETHASONE DIPROPIONATE137750mcg/Metered DoseAero Inh-200 Dose Pk30.0200QVARGRA30.02002001-03-071378100mcg/Metered DoseAero Inh-200 Dose Pk59.8600QVARGRA59.86002001-03-07BUDESONIDE13790.125mg/mLInh Susp.2123Pulmicort NebuampAZC.21231998-12-3113800.25mg/mLInh Susp.4245Pulmicort NebuampAZC.42451996-10-0113810.5mg/mLInh Susp.8490Pulmicort NebuampAZC.84901996-10-01For the vast majority of patients, a metered dose inhaler is the preferred therapy. Nebulizer therapy will be reimbursed for patients who are unable to use a metered dose inhaler, including an inhaler with a spacer attachment, or a turbuhaler.Children aged 6 years or less;LU Authorization Period: Indefinite.Patients who have a tracheostomy;LU Authorization Period: Indefinite.Patients with cystic fibrosis in whom nebulizer therapy is indicated;LU Authorization Period: Indefinite.Patients with severe mental or physical disabilities;LU Authorization Period: Indefinite.Patients who have previously used nebulizer therapy within the last 12 month period.LU Authorization Period: Indefinite.1382100mcg/Metered DosePd Inh-200 Dose Pk31.2700Pulmicort TurbuhalerAZC31.27001996-10-011383200mcg/Metered DosePd Inh-200 Dose Pk62.6000Pulmicort TurbuhalerAZC62.60001996-10-011384400mcg/Metered DosePd Inh-200 Dose Pk112.6500Pulmicort TurbuhalerAZC112.65001996-10-01CICLESONIDE1385100mcg/ActuationInh-120 Dose Pk43.5240AlvescoNYC43.52402007-06-061386200mcg/ActuationInh-120 Dose Pk72.0720AlvescoNYC72.07202007-06-06138750mcg/ActuationMetered Dose Nas Sp-120 Dose Pk24.8880OmnarisNYC24.88802009-09-30DEXAMETHASONE13880.5mgTab.0782DecadronMSD1996-10-01PMS-DexamethasonePMS.07821998-12-31Ratio-DexamethasoneRPH.07822000-07-17Apo-DexamethasoneAPX.07822005-04-2813894mgTab.3046DecadronMSD1996-10-01PMS-DexamethasonePMS.30461998-12-31Ratio-DexamethasoneRPH.30462000-07-17Apo-DexamethasoneAPX.30462004-10-14DEXAMETHASONE 21-PHOSPHATE13904mg/mLInj Sol1.6900DecadronMSD1996-10-01Dexamethasone SodiumSDZ1.69001998-12-31Dexamethasone SodiumCYI1.69001996-12-19FLUDROCORTISONE ACETATE13910.1mgTab.2480FlorinefPAL.24801996-10-01FLUTICASONE PROPIONATE139250mcg/Metered DoseInh-120 Dose Pk23.9292Flovent HFAGSK23.92922002-07-291393125mcg/Metered DoseInh-120 Dose Pk41.2800Flovent HFAGSK41.28002002-07-291394250mcg/Metered DoseInh-120 Dose Pk82.5400Flovent HFAGSK82.54002002-07-291395250mcg/BlisterPd Inh-60 Dose Pk41.2800Flovent DiskusGSK41.28001999-04-151396500mcg/BlisterPd Inh-60 Dose Pk82.5400Flovent DiskusGSK82.54001999-04-15HYDROCORTISONE139710mgTab.1527CortefPFI.15272003-09-04139820mgTab.2756CortefPFI.27561996-10-01METHYLPREDNISOLONE13994mgTab.3407MedrolPFI.34071996-10-01METHYLPREDNISOLONE ACETATE140040mg/mLInj Susp-1mL Pk3.2250Depo-MedrolPFI4.91501996-10-01Methylprednisolone Acetate Inj Susp USPSDZ3.22502010-04-23140180mg/mLInj Susp-1mL Pk6.4500Depo-MedrolPFI9.42601996-10-01Methylprednisolone Acetate Inj Susp USPSDZ6.45002010-04-231402100mg/5mLInj Susp-5mL Pk11.0100Depo-MedrolPFI11.01001996-10-01PREDNISOLONE SODIUM PHOSPHATE14036.7mg/5mLO/L.0671Pediapred Oral LiquidSAV.12432003-01-30PMS-PrednisolonePMS.06712004-07-20PREDNISONE14041mgTab.1035WinpredVAL.10351996-10-01Apo-PrednisoneAPX.10721996-10-0114055mgTab.0220Novo-PrednisoneNOP.02201996-10-01DeltasoneUPJ1996-10-01Apo-PrednisoneAPX.02201996-10-01140650mgTab.0913Novo-PrednisoneNOP.09131996-10-01DeltasoneUPJ1996-10-01Apo-PrednisoneAPX.17351996-10-01TRIAMCINOLONE ACETONIDE140740mg/mLInj Susp-1mL Pk4.7700Kenalog-40BQU7.50001996-10-01Triamcinolone AcetonideSDZ4.77002004-10-14140850mg/5mLInj Susp-5mL Pk10.2800Kenalog-10BQU16.25001996-10-01Triamcinolone AcetonideSDZ10.28002004-10-141409200mg/5mLInj Susp-5mL Pk16.7100Kenalog-40BQU26.40001996-10-01Triamcinolone AcetonideSDZ16.71002004-10-14ANDROGENSDANAZOL141050mgCap.8801CyclomenSAV.88011996-10-011411100mgCap1.3059CyclomenSAV1.30591996-10-011412200mgCap2.0869CyclomenSAV2.08691996-10-01TESTOSTERONE14131%2.5g Foil Packet2.1263AndrogelSPH2.12632005-02-2214141%5.0g Foil Packet3.7600AndrogelSPH3.76002005-02-2214151%Top Gel-5g Pk3.4953TestimPAL3.49532009-09-30141612.2mgTransdermal Patch2.0097AndrodermPAL2.00972005-02-22For male patients with confirmed low morning serum testosterone levels associated with documented, symptomatic hypothalamic, pituitary or testicular disease, or in HIV-infected patients. Note: Older males with nonspecific symptoms of fatigue, malaise, depression who have a low normal random testosterone level do not satisfy these criteria.LU Authorization Period: 1 year.TESTOSTERONE CYPIONATE1417100mg/mL OilyInj Sol-10mL Pk27.4768Depo-TestosteronePFI27.47681996-10-01For male patients with confirmed low morning serum testosterone levels associated with documented, symptomatic hypothalamic, pituitary or testicular disease, or in HIV-infected patients. Note: Older males with nonspecific symptoms of fatigue, malaise, depression who have a low normal random testosterone level do not satisfy these criteria.LU Authorization Period: 1 year.TESTOSTERONE ENANTHATE14181000mg/5mL OilyInj Sol-5mL Pk47.7500DelatestrylTHE47.75001996-10-01For male patients with confirmed low morning serum testosterone levels associated with documented, symptomatic hypothalamic, pituitary or testicular disease, or in HIV-infected patients. Note: Older males with nonspecific symptoms of fatigue, malaise, depression who have a low normal random testosterone level do not satisfy these criteria.LU Authorization Period: 1 year.TESTOSTERONE UNDECANOATE141940mgCap.5640AndriolORG.94001996-10-01PMS-TestosteronePMS.56402010-04-23For male patients with confirmed low morning serum testosterone levels associated with documented, symptomatic hypothalamic, pituitary or testicular disease, or in HIV-infected patients. Note: Older males with nonspecific symptoms of fatigue, malaise, depression who have a low normal random testosterone level do not satisfy these criteria.LU Authorization Period: 1 year.ESTROGENSCONJUGATED ESTROGENS14200.625mgTab.0787C.E.S.VAL.07871996-10-01PremarinWAY1996-10-01For short-term use in women who are experiencing symptoms of menopause. Note: Recent evidence has demonstrated that use of hormone replacement therapy (HRT) increases the rate of coronary events, breast cancer, dementia, stroke, venous thromboembolism and referrals for abnormal vaginal bleeding. These risks should be discussed with patients and reviewed periodically.LU Authorization Period: 1 year.14210.625mg/gVag Cr.6200PremarinWAY.62001996-10-01ESTRADIOL14222mgVag Ring63.3500EstringPFI63.35001996-10-01ESTRADIOL 17-B142325mcgVag Tab3.2133VagifemNOO3.21332005-02-22142410mcgVag Tab with Applicator3.0606Vagifem 10NOO3.06062011-09-15ESTROPIPATE (CALCULATED AS SODIUM ESTRONE SULFATE 1.25MG)14251.5mgTab.2804Ogen 1.25PFI.28041996-10-01For short-term use in women who are experiencing symptoms of menopause. Note: Recent evidence has demonstrated that use of hormone replacement therapy (HRT) increases the rate of coronary events, breast cancer, dementia, stroke, venous thromboembolism and referrals for abnormal vaginal bleeding. These risks should be discussed with patients and reviewed periodically.LU Authorization Period: 1 year.ESTROPIPATE (CALCULATED AS SODIUM ESTRONE SULFATE 2.5MG)14263mgTab.4434Ogen 2.5PFI.44341996-10-01For short-term use in women who are experiencing symptoms of menopause. Note: Recent evidence has demonstrated that use of hormone replacement therapy (HRT) increases the rate of coronary events, breast cancer, dementia, stroke, venous thromboembolism and referrals for abnormal vaginal bleeding. These risks should be discussed with patients and reviewed periodically.LU Authorization Period: 1 year.ANTI-DIABETIC AGENTS ORAL ANTI-DIABETIC AGENTSAn adequate trial of diet and exercise therapy alone is essential before any hypoglycaemic agent is prescribed in non-insulin dependent diabetes mellitus. When indicated (i.e., fasting plasma glucose remains > 10mmol/L), drug therapy should be considered as a supplement to continuing caloric restriction and exercise.ACARBOSE142750mgTab.2642GlucobayBAY.26421996-12-191428100mgTab.3659GlucobayBAY.36591996-12-19For the treatment of non-insulin-dependent diabetes mellitus (NIDDM):In patients who cannot tolerate or have failed treatment with other oral hypoglycemic agents or in whom other oral hypoglycemic agents are contraindicated;LU Authorization Period: Indefinite.In patients who require combination therapy with more than one oral hypoglycemic agent to control their serum glucose concentrations.LU Authorization Period: Indefinite.GLICLAZIDE142960mgER Tab.2529Diamicron MRSEV.25292011-08-04143030mgSR Tab.1405Diamicron MRSEV.14052007-04-02Apo-Gliclazide MRAPX.14052008-08-28143180mgTab.0931DiamicronSEV.37252007-04-02Mylan-GliclazideMYL.09312007-09-04Novo-GliclazideNOP.09312007-06-06Apo-GliclazideAPX.09312007-06-06GLIMEPIRIDE14321mgTabAmarylSAV2007-06-06Sandoz GlimepirideSDZ2007-06-06Ratio-GlimepirideRPH2007-07-12Novo-GlimepirideNOP2007-06-06Apo-GlimepirideAPX2007-11-1014332mgTabAmarylSAV2007-06-06Sandoz GlimepirideSDZ2007-06-06Ratio-GlimepirideRPH2007-07-12Novo-GlimepirideNOP2007-06-06Apo-GlimepirideAPX2007-11-1014344mgTabAmarylSAV2007-06-06Sandoz GlimepirideSDZ2007-06-06Ratio-GlimepirideRPH2007-07-12Novo-GlimepirideNOP2007-06-06Apo-GlimepirideAPX2007-11-10GLYBURIDE14352.5mgTab.0321EugluconPMS.03211996-10-01Mylan-GlybeMYL.03211996-10-01Ratio-GlyburideRPH.03211996-10-01Apo-GlyburideAPX.03211996-10-01Novo-GlyburideNOP.03211996-10-01Nu-GlyburideNXP.03211996-10-01DiabetaSAV.13031999-01-06Sandoz GlyburideSDZ.03212004-07-2014365mgTab.0574EugluconPMS.05741996-10-01Mylan-GlybeMYL.05741996-10-01Ratio-GlyburideRPH.05741996-10-01Apo-GlyburideAPX.05741996-10-01Novo-GlyburideNOP.05741996-10-01Nu-GlyburideNXP.05741996-10-01DiabetaSAV.23331999-01-06PMS-GlyburidePMS.05741999-04-15Sandoz GlyburideSDZ.05742004-07-20METFORMIN HCL1437500mgER TabGlumetzaBIO2010-06-14Apo-Metformin ERAPX2010-06-141438500mgTab.0587Novo-MetforminNOP.05871996-10-01GlucophageSAV.23831996-10-01Mylan-MetforminMYL.05871996-10-01Nu-MetforminNXP.05871996-10-01Apo-MetforminAPX.05871996-10-01PMS-MetforminPMS.05871997-04-10MetforminMEL.05872001-10-11Ratio-MetforminRPH.05872001-06-07Sandoz Metformin FCSDZ.05872003-09-04Co MetforminCOB.05872004-12-21Ran-MetforminRAN.05872006-03-011439850mgTabGlucophageSAV2007-12-19Mylan-MetforminMYL2008-04-09PMS-MetforminPMS2008-04-09Ratio-MetforminRPH2007-12-19Sandoz Metformin FCSDZ2007-12-19MetforminMEL2010-01-05Co MetforminCOB2007-12-19Ran-MetforminRAN2008-04-09PIOGLITAZONE HCL144015mgTabActosTAK2006-10-23Novo-PioglitazoneNOP2008-01-15Sandoz PioglitazoneSDZ2008-01-15Mylan-PioglitazoneMYL2008-01-15Ratio-PioglitazoneRPH2008-01-15Co PioglitazoneCOB2008-01-15Apo-PioglitazoneAPX2008-01-15PMS-PioglitazonePMS2008-02-12Accel PioglitazoneACC2009-09-30Phl-PioglitazonePHE2010-01-05Zym-PioglitazoneZYN2010-04-23Mint-PioglitazoneMIN2009-11-19144130mgTabActosTAK2006-10-23Novo-PioglitazoneNOP2008-01-15Sandoz PioglitazoneSDZ2008-01-15Mylan-PioglitazoneMYL2008-01-15Ratio-PioglitazoneRPH2008-01-15Co PioglitazoneCOB2008-01-15Apo-PioglitazoneAPX2008-01-15PMS-PioglitazonePMS2008-02-12Accel PioglitazoneACC2009-09-30Phl-PioglitazonePHE2010-01-05Zym-PioglitazoneZYN2010-04-23Mint-PioglitazoneMIN2009-11-19Pioglitazone Hydrochloride TabletsACH2011-03-15Jamp-PioglitazoneJPC2011-12-15144245mgTabActosTAK2006-10-23Novo-PioglitazoneNOP2008-01-15Sandoz PioglitazoneSDZ2008-01-15Mylan-PioglitazoneMYL2008-01-15Ratio-PioglitazoneRPH2008-01-15Co PioglitazoneCOB2008-01-15Apo-PioglitazoneAPX2008-01-15PMS-PioglitazonePMS2008-02-12Accel PioglitazoneACC2009-09-30Phl-PioglitazonePHE2009-11-19Zym-PioglitazoneZYN2010-04-23Mint-PioglitazoneMIN2009-11-19Pioglitazone Hydrochloride TabletsACH2011-03-15Jamp-PioglitazoneJPC2011-12-15REPAGLINIDE14430.5mgTabGlucoNormNOO2011-03-15Co RepaglinideCOB2011-03-15PMS-RepaglinidePMS2011-03-15Sandoz RepaglinideSDZ2011-08-0414441mgTabGlucoNormNOO2011-03-15Co RepaglinideCOB2011-03-15PMS-RepaglinidePMS2011-03-15Sandoz RepaglinideSDZ2011-08-0414452mgTabGlucoNormNOO2011-03-15Co RepaglinideCOB2011-03-15PMS-RepaglinidePMS2011-03-15Sandoz RepaglinideSDZ2011-08-04SITAGLIPTIN PHOSPHATE MONOHYDRATE1446100mgTab2.8050Treatment of Type 2 diabetes in patients on maximum doses of metformin (2000mg/day) who have: . Inadequate glycemic control (HbA1c >0.07) and intolerance or contraindication to a sulfonylurea; or . An HbA1c <0.07 and elevated 2 hour post prandial glucose (PPG > 10 mmol/L) or fasting plasma glucose (FPG > 7 mmol/L) levels and intolerance or contraindication to a sulfonylurea.JanuviaMFC2.80502010-06-14ANTI-DIABETIC AGENTS INSULINS (RAPID ACTING)INSULIN (ZINC CRYSTALLINE) HUMAN BIOSYNTHETIC (RDNA ORIGIN)14471000U/10mLInj Sol-10mL Pk21.2200Humulin RegularLIL21.22001996-10-011448100U/mLInj Sol-5x3mL Pk41.6500Humulin RLIL41.65001998-12-15INSULIN ASPART1449100U/mLInj Sol-10mL Pk27.9200NovoRapidNOO27.92002003-09-041450100U/mLInj Sol-5x3mL Pk55.9100NovoRapid PenfillNOO55.91002003-09-04For the treatment of patients with Type 1 diabetes mellitus.LU Authorization Period: Indefinite.For the treatment of patients with Type 2 diabetes mellitus using insulin in an intensive regimen with 3 or more injections per day or an insulin pump.LU Authorization Period: Indefinite.For the treatment of patients with Type 2 diabetes mellitus who are either experiencing recurrent hypoglycemia OR are unable to achieve adequate post-prandial glucose control while on a less intensive regimen of regular insulin (1-2 injections per day).LU Authorization Period: Indefinite.INSULIN GLULISINE (DNA ORIGIN)1451100U/mLInj 5x3mL Cart ClickStar Pen47.4700Note: For the treatment of patients with Type 1 diabetes mellitus. For the treatment of patients with Type 2 diabetes mellitus using insulin in an intensive regimen with 3 or more injections per day or an insulin pump. For the treatment of patients with Type 2 diabetes mellitus who are either experiencing recurrent hypoglycemia OR are unable to achieve adequate post-prandial glucose control while on less intensive regimen of regular insulin (1-2 injections per day).ApidraSAV47.47002010-06-141452100U/mLInj Sol-10mL Vial24.0000Note: For the treatment of patients with Type 1 diabetes mellitus. For the treatment of patients with Type 2 diabetes mellitus using insulin in an intensive regimen with 3 or more injections per day or an insulin pump. For the treatment of patients with Type 2 diabetes mellitus who are either experiencing recurrent hypoglycemia OR are unable to achieve adequate post-prandial glucose control while on less intensive regimen of regular insulin (1-2 injections per day). ApidraSAV24.00002009-08-181453100U/mLInj Sol-5x3mL SoloSTAR Pref Pen48.0000Note: For the treatment of patients with Type 1 diabetes mellitus. For the treatment of patients with Type 2 diabetes mellitus using insulin in an intensive regimen with 3 or more injections per day or an insulin pump. For the treatment of patients with Type 2 diabetes mellitus who are either experiencing recurrent hypoglycemia OR are unable to achieve adequate post-prandial glucose control while on less intensive regimen of regular insulin (1-2 injections per day). ApidraSAV48.00002009-08-18INSULIN HUMAN BIOSYNTHETIC14541000U/10mLInj Sol-10mL Pk20.4000Novolin ge TorontoNOO20.40001996-10-011455100U/mLInj Sol-5x3mL Pk40.0300Novolin ge Toronto PenfillNOO40.03001998-12-15INSULIN LISPRO1456100U/mLInj Sol-10mL Pk27.1100Note: For the treatment of patients with Type 1 diabetes mellitus. For the treatment of patients with Type 2 diabetes mellitus using insulin in an intensive regimen with 3 or more injections per day or an insulin pump. For the treatment of patients with Type 2 diabetes mellitus who are either experiencing recurrent hypoglycemia OR are unable to achieve adequate post-prandial glucose control while on less intensive regimen of regular insulin (1-2 injections per day).HumalogLIL27.11001998-12-311457100U/mLInj Sol-5x3mL Pk54.4500Note: For the treatment of patients with Type 1 diabetes mellitus. For the treatment of patients with Type 2 diabetes mellitus using insulin in an intensive regimen with 3 or more injections per day or an insulin pump. For the treatment of patients with Type 2 diabetes mellitus who are either experiencing recurrent hypoglycemia OR are unable to achieve adequate post-prandial glucose control while on less intensive regimen of regular insulin (1-2 injections per day).HumalogLIL54.45001998-12-311458100U/mLInj Sol-5x3mL Pk54.4500Note: For the treatment of patients with Type 1 diabetes mellitus. For the treatment of patients with Type 2 diabetes mellitus using insulin in an intensive regimen with 3 or more injections per day or an insulin pump. For the treatment of patients with Type 2 diabetes mellitus who are either experiencing recurrent hypoglycemia OR are unable to achieve adequate post-prandial glucose control while on less intensive regimen of regular insulin (1-2 injections per day).Humalog KwikpenLIL54.45002011-05-19ANTI-DIABETIC AGENTS INSULINS (INTERMEDIATE ACTING)INSULIN (ISOPHANE) HUMAN BIOSYNTHETIC14591000U/10mLInj Susp-10mL Pk20.4000Novolin ge NPHNOO20.40001996-10-011460100U/mLInj Susp-5x3mL Pk39.8800Novolin ge NPH PenfillNOO39.88001998-12-15INSULIN (ISOPHANE) HUMAN BIOSYNTHETIC (RDNA ORIGIN)14611000U/10mLInj Susp-10mL Pk21.2200Humulin NPHLIL21.22001996-10-011462100U/mLInj Susp-5x3mL Pk41.6500Humulin NLIL41.65001998-12-15ANTI-DIABETIC AGENTS INSULINS (LONG ACTING)INSULIN DETEMIR1463100U/mLInj Sol-5x3mL Pk99.4600Levemir PenfillNOO99.46002009-06-23INSULIN GLARGINE1464100U/mLInj Sol-10mL Vial Pk58.8900Lantus-(Vial)SAV58.89002008-12-031465100U/mLInj Sol-5x3mL Pk88.7500Lantus-(Cartridge)SAV88.75002008-12-031466100U/mLInj Sol-5x3mL Pk88.7500Lantus SolostarSAV88.75002009-04-01ANTI-DIABETIC AGENTS INSULINS (PRE-MIXED)INSULIN (30% NEUTRAL & 70% ISOPHANE) HUMAN BIOSYNTHETIC14671000U/10mLInj Susp-10mL Pk20.4000Novolin ge 30/70NOO20.40001996-10-011468100U/mLInj Susp-5x3mL Pk39.8400Novolin ge 30/70 PenfillNOO39.84001998-12-15INSULIN (40% NEUTRAL & 60% ISOPHANE) HUMAN BIOSYNTHETIC1469100U/mLInj Susp-5x3mL Pk40.8000Novolin ge 40/60 PenfillNOO40.80001996-10-01INSULIN (50% NEUTRAL & 50% ISOPHANE) HUMAN BIOSYNTHETIC1470100U/mLInj Susp-5x3mL Pk40.8000Novolin ge 50/50 PenfillNOO40.80001996-10-01INSULIN ASPART 30% & INSULIN ASPART PROTAMINE 70%1471100U/mLInj Susp-5x3mL Pk52.5500NovoMix 30 PenfillNOO52.55002007-11-10INSULIN HUMAN BIOSYNTHETIC 30% & ISOPHANE 70%14721000U/10mLInj Susp-10mL Pk21.2200Humulin 30/70LIL21.22001996-10-011473100U/mLInj Susp-5x3mL Pk41.6500Humulin 30/70LIL41.65001998-12-15INSULIN LISPRO & INSULIN LISPRO PROTAMINE147425% & 75%Inj Susp-5x3mL Pk54.4500Humalog Mix25LIL54.45002000-04-17147525% & 75%Inj Susp-5x3mL Pk54.4500Humalog Mix25 KwikpenLIL54.45002011-05-19147650% & 50%Inj Susp-5x3mL Pk53.7500Humalog Mix50LIL53.75002008-08-28147750% & 50%Inj Susp-5x3mL Pk53.7500Humalog Mix50 KwikpenLIL53.75002011-05-19PARATHYROID AGENTSCALCITONIN (SALMON SYNTHETIC)1478100IU/mLInj Sol-1mL Pk7.8200Caltine 100FEI7.82001996-10-011479400IU/2mLInj Sol-2mL Pk54.0300CalcimarSAV54.03001996-10-011480200U/Metered DoseNas Sp-2x14 Dose PkMiacalcinNOV2008-06-27Apo-Calcitonin Nasal SprayAPX2011-05-19Sandoz Calcitonin NSSDZ2008-06-27PITUITARY AGENTSDESMOPRESSIN ACETATE14810.1mg/mLNas Sol-2.5mL Pk47.2000DDAVPFEI47.20001996-10-0114821.5mg/mLNas Sp-2.5mL Pk386.0000OctostimFEI386.00002000-07-17148310mcg/Metered DoseNas Sp-2.5mL Pk35.4000DDAVPFEI47.20001996-10-01Desmopressin SprayAAP35.40002002-07-291484240mcgOrally Disintegrating Tab3.5683DDAVP MeltFEI3.56832010-06-14148560mcgOrally Disintegrating Tab.9913DDAVP MeltFEI.99132007-06-061486120mcgOrally Disintegrating Tab1.9826DDAVP MeltFEI1.98262007-06-0614870.1mgTab.3304DDAVPFEI1.32171997-08-28Apo-DesmopressinAPX.33042007-04-02Novo-DesmopressinNOP.33042007-09-04PMS-DesmopressinPMS.33042010-04-2314880.2mgTab.6609DDAVPFEI2.64341997-08-28Apo-DesmopressinAPX.66092007-04-02Novo-DesmopressinNOP.66092007-09-04PMS-DesmopressinPMS.66092010-04-23THYROTROPIN ALFA14890.9mg/mLInj Pd-2x1.1mg Vial Pk1363.7200ThyrogenGZM1363.72002003-04-16PROGESTOGENS AND ORAL CONTRACEPTIVESCYPROTERONE ACETATE & ETHINYL ESTRADIOL14902mg & 0.035mgTab-21 PkDiane-35BAY2007-12-19Cyestra-35PMS2007-12-19Novo-Cyproterone/Ethinyl EstradiolNOP2008-12-03DESOGESTREL & ETHINYL ESTRADIOL14910.15mg & 0.03mgTab-21 Pk9.1900Marvelon 21ORG15.53961996-10-01Apri 21APX9.19002009-04-0114920.15mg & 0.03mgTab-28 Pk9.1900Marvelon 28ORG15.53961996-10-01Apri 28APX9.19002009-04-0114930.15mg & 0.03mgTab-28 Pk18.5000Ortho-CeptJAN18.50001996-12-19DROSPIRENONE & ETHINYL ESTRADIOL14943.0mg & 0.03mgTab-21 Pk11.8436Yasmin 21BAH11.84362007-06-0614953.0mg & 0.02mgTab-28 Pk15.1516YazBAH15.15162009-09-3014963.0mg & 0.03mgTab-28 Pk11.8436Yasmin 28BAH11.84362007-06-06ETHINYL ESTRADIOL & ETHYNODIOL DIACETATE14970.03mg & 2mgTab-21 Pk12.6152Demulen 30PFI12.61521996-10-0114980.03mg & 2mgTab-28 Pk13.4992Demulen 30PFI13.49921996-10-01ETHINYL ESTRADIOL & LEVONORGESTREL149920mcg & 100mcgTab-21 Pk9.7400AlesseWAY14.21001998-12-31Aviane 21BAR9.74002008-01-1515000.03mg & 0.15mgTab-21 Pk9.7400Min-OvralWAY14.21001996-10-01Portia 21BAR9.74002007-10-0315013 PhaseTab-21 Pk14.6616Triquilar 21BAY14.66161996-10-01150220mcg & 100mcgTab-28 Pk9.7400AlesseWAY14.21001998-12-31Aviane 28BAR9.74002008-01-1515030.03mg & 0.15mgTab-28 Pk9.7400Min-OvralWAY14.21001996-10-01Portia 28BAR9.74002007-10-0315043 PhaseTab-28 Pk14.6616Triquilar 28BAY14.66161996-10-01ETHINYL ESTRADIOL & NORETHINDRONE15050.035mg & 0.5mgTab-21 Pk18.5000Ortho 0.5/35JAN18.50001996-10-0115060.035mg & 1mgTab-21 Pk18.5000Ortho 1/35JAN18.50001996-10-0115073 PhaseTab-21 Pk18.5000Ortho 7/7/7JNO18.50001996-10-0115080.035mg & 0.5mgTab-21 Pk11.5648BreviconPFI11.56481996-10-0115090.035mg & 1mgTab-21 Pk11.5648Brevicon 1/35PFI11.56481996-10-0115103 PhaseTab-21 Pk10.6288SynphasicPFI10.62881996-10-0115110.035mg & 0.5mgTab-28 Pk18.5000Ortho 0.5/35JAN18.50001996-10-0115120.035mg & 1mgTab-28 Pk18.5000Ortho 1/35JAN18.50001996-10-0115133 PhaseTab-28 Pk18.5000Ortho 7/7/7JNO18.50001996-10-0115140.035mg & 0.5mgTab-28 Pk11.5648BreviconPFI11.56481996-10-0115150.035mg & 1mgTab-28 Pk11.5648Brevicon 1/35PFI11.56481996-10-0115163 PhaseTab-28 Pk10.6288SynphasicPFI10.62881996-10-01ETHINYL ESTRADIOL & NORETHINDRONE ACETATE15170.02mg & 1mgTab-21 Pk13.0900Minestrin 1/20PAL13.09001996-10-0115180.03mg & 1.5mgTab-21 Pk13.0900Loestrin 1.5/30PAL13.09001996-10-0115190.02mg & 1mgTab-28 Pk13.0900Minestrin 1/20PAL13.09001996-10-0115200.03mg & 1.5mgTab-28 Pk13.0900Loestrin 1.5/30PAL13.09001996-10-01ETHINYL ESTRADIOL & NORGESTREL15210.05mg & 0.25mgTab-21 Pk13.8200OvralWAY13.82001996-10-01LEVONORGESTREL152252mgInsert329.6094MirenaBAY329.60942001-10-1115230.75mgTab-2 Tabs Pk17.2000Plan BPAL17.20002001-03-07MEDROXYPROGESTERONE ACETATE1524150mg/mLInj18.0000Depo-ProveraPFI27.54001998-12-31Medroxyprogesterone Acetate Inj Susp USPSDZ18.00002009-09-30152550mg/mLInj Sol-5mL Pk25.8600Depo-ProveraPFI25.86001996-10-0115262.5mgTab.0416ProveraPFI.16631996-10-01Novo-MedroneNOP.04161997-08-28Apo-MedroxyAPX.04162003-01-3015275mgTab.0823ProveraPFI.32931996-10-01Novo-MedroneNOP.08231997-08-28Apo-MedroxyAPX.08232003-01-30152810mgTab.1670ProveraPFI.66811996-10-01Novo-MedroneNOP.16701997-08-28Apo-MedroxyAPX.16702007-03-09152910mgTab.6392Provera-PakPFI.63921996-10-011530100mgTab.9153ProveraPFI1.26921996-10-01Apo-MedroxyAPX.91532005-10-06NORETHINDRONE15310.35mgTab-28 Pk18.5000MicronorJAN18.50001996-10-01NORGESTIMATE & ETHINYL ESTRADIOL15323 PhaseTab-21 Pk18.5000Tri-CyclenJAN18.50001996-10-0115333 PhaseTab-21 Pk12.2700Tri-Cyclen LoJAN12.27002008-02-1215340.25mg & 0.035mgTab-21 Pk18.5000CyclenJAN18.50001996-10-0115353 PhaseTab-28 Pk18.5000Tri-CyclenJAN18.50001996-10-0115363 PhaseTab-28 Pk12.2700Tri-Cyclen LoJAN12.27002008-02-1215370.25mg & 0.035mgTab-28 Pk18.5000CyclenJAN18.50001996-10-01THYROIDSLEVOTHYROXINE (SODIUM)15380.025mgTab.0865SynthroidABB.08651996-10-0115390.05mgTab.0280SynthroidABB.05941996-10-01EltroxinTRT.02801997-07-1215400.075mgTab.0935SynthroidABB.09351996-10-0115410.088mgTab.0935SynthroidABB.09351996-12-1915420.1mgTab.0344SynthroidABB.07331996-10-01EltroxinTRT.03441997-07-1215430.112mgTab.0989SynthroidABB.09891996-10-0115440.125mgTab.1000SynthroidABB.10001996-10-0115450.15mgTab.0381SynthroidABB.07881996-10-01EltroxinTRT.03811997-01-2015460.175mgTab.1071SynthroidABB.10711996-10-0115470.2mgTab.0404SynthroidABB.08341996-10-01EltroxinTRT.04041997-01-2015480.3mgTab.1154SynthroidABB.11541996-10-01EltroxinGLW1997-01-20THYROID154930mgTab.0680ThyroidERF.06801996-10-01155060mgTab.0837ThyroidERF.08371996-10-011551125mgTab.1189ThyroidERF.11891996-10-01ANTI-THYROIDSPROPYLTHIOURACIL155250mgTab.2171Propyl-ThyracilPAL.21711996-10-011553100mgTab.3396Propyl-ThyracilPAL.33961996-10-01SKIN AND MUCOUS MEMBRANE PREPARATIONSANTI-INFECTIVES ANTIBIOTICSCLINDAMYCIN PHOSPHATE & BENZOYL PEROXIDE15541% & 5%Gel.8878ClindoxylSTI.88782003-04-1615551% & 5%Top Gel.8676BenzaClinSAV.86762006-01-12FUSIDIC ACID15562%Cr.6070FucidinLEO.60701996-10-01MUPIROCIN15572%Cr.5500BactrobanGSK.55002000-01-1715582%Oint.3556BactrobanGSK.55001996-10-01Taro-MupirocinTAR.35562007-01-02SODIUM FUSIDATE15592%Oint.6070FucidinLEO.60701996-10-01ANTI-INFECTIVES FUNGICIDESDue to its efficacy and significantly lower cost, clotrimazole should be the first line of treatment for Tinea corporis and cruris. In Tinea pedis, topical terbinafine should be considered the first line of treatment due to its efficacy and lower rate of relapse.CLOTRIMAZOLE156010mg/gCr.0884ClotrimadermTAR.08841996-10-01Canesten 1% Topical CreamBAY.09991996-10-011561500mg & 1%Tab & Cr12.0800Canesten 1 Comfortab Combi-PakBAY12.08002007-01-02156210mg/gVag Cr-App.1750Clotrimaderm Vaginal CreamTAR.17501996-10-01Canesten 6 CreamBAY.22121996-10-01156320mg/gVag Cr-App.3500Clotrimaderm Vaginal CreamTAR.35001996-10-01Canesten 3 CreamBAY.44241996-10-01FLUCONAZOLE1564150mgCap3.9424Diflucan-150PFI15.76971998-12-31Apo-Fluconazole-150APX3.94242001-03-07Mylan-FluconazoleMYL3.94242003-04-16PMS-FluconazolePMS3.94242007-07-12For the treatment of vaginal candidiasis. Dose: 150mg orally once daily for 1 day.Repeats within a 25 day period will not be reimbursed.LU Authorization Period: 1 year.KETOCONAZOLE15652%Cr.3167NizoralJAN1996-10-01KetodermTAR.31672004-04-06MICONAZOLE NITRATE15662%Cr.2970MicatinWEL.29701996-10-01NYSTATIN1567100000U/gCr.0700Nystatin is not effective in the treatment of Dermatophyte infections or Tinea versicolor.MycostatinBQU1996-10-01NyadermTAR.07001996-10-01Ratio-NystatinRPH.07001997-10-311568100000U/gOint.1129Nystatin is not effective in the treatment of Dermatophyte infections or Tinea versicolor.MycostatinBQU1996-10-01Ratio-NystatinRPH.11291997-10-31156925000U/gVag Cr.0492MycostatinBQU1996-10-01NyadermTAR.04921996-10-011570100000U/gVag Cr.3191Ratio-NystatinRPH.31911997-10-31TERBINAFINE HCL15711%Cr.5120LamisilNOV.51201996-10-01TERCONAZOLE15720.4%Cr.2726Terazol 7JNO.53111996-10-01Taro-TerconazoleTAR.27262005-06-13ANTI-INFECTIVES PARASITICIDESAll close contacts of patients with scabies should be treated regardless of symptoms to avoid reinfestation and unnecessary repeated treatments. The scabicide should be applied to all the skin from the neck down. Young children, the elderly and immunosuppressed patients may also require treatment of the head and scalp.ISOPROPYL MYRISTATE157350%Top Sol-120mL Pk12.2500ResultzNYC12.25002008-02-12157450%Top Sol-240mL Pk22.4200ResultzNYC22.42002008-02-12LINDANE (GAMMA BENZENE HEXACHLORIDE)15751%ShampooKwelladaRCA1996-10-01PMS-LindanePMS1996-10-01PERMETHRIN15765%Cr.4977Nix Dermal CreamGSK.49771998-10-21For the treatment of patients who have failed on a less costly listed alternative.LU Authorization Period: 1 year.15771%Cr Rinse.0955NixBWE.09551996-10-0115781%Cr Rinse.0930Kwellada-PGSK.09302000-01-1715795%Lot.2688Kwellada-PGSK.26881998-12-31PYRETHRINS PIPERONYL BUTOXIDE & PETROLEUM DISTILLATE15800.3% & 3% & 1.2%Top Sol.0860R & C Shampoo/ConditionerGSK.08601997-04-10ANTI-INFECTIVES OTHER ANTI-INFECTIVESMETRONIDAZOLE15810.75%Cr.6600MetroCreamGAC.66001998-12-3115821%Cr.5083RosasolSTI.50832002-07-2915831%Top Cr.5262NoritateSAV.52621997-04-1015841%Top Gel.6000MetrogelGAC.60002010-03-0215850.75%Top Lot.6600MetroLotionGAC.66002005-02-22158610%Vag Cr-App.2258FlagylSAV.22581996-10-01METRONIDAZOLE & NYSTATIN1587500mg & 100000U/gVag Cr-App.5524FlagystatinSAV.55241996-10-011588500mg & 100000UVag Sup3.0380FlagystatinSAV3.03801996-10-01POVIDONE - IODINE158910%Top SolBetadinePFP1996-10-01ProviodineROG1996-10-01SILVER SULFADIAZINE15901%Cr.1320FlamazineSNE.13201996-10-0115911%Cr-50g Pk10.9600FlamazineSNE10.96001999-09-15ANTI-INFLAMMATORYAMCINONIDE15920.1%Cr.1955CyclocortSTI.41471998-03-17Taro-AmcinonideTAR.19552004-04-06Ratio-AmcinonideRPH.19552004-04-0615930.1%Lot.2611CyclocortSTI.34431998-03-17Ratio-AmcinonideRPH.26112004-07-2015940.1%Oint.3151CyclocortSTI.41471998-03-17Ratio-AmcinonideRPH.31512004-07-20BECLOMETHASONE DIPROPIONATE15950.025%Cr.4371PropadermPAL.43711998-11-1715960.025%Oint.4038PropadermGLA.40381996-10-01BETAMETHASONE DIPROPIONATE15970.05%Cr.2048DiprosoneSCH.20481996-10-01Taro-SoneTAR.20481996-10-0115980.05%Lot.1980DiprosoneSCH.19801996-10-01Ratio-TopisoneRPH.19801996-10-0115990.05%Oint.2152DiprosoneSCH.21521996-10-01Ratio-TopisoneRPH.21521996-10-01BETAMETHASONE DIPROPIONATE IN A BASE CONTAINING PROPYLENE GLYCOL16000.05%Oint.5186No more than 50 grams per week of ultrapotent steroids for a maximum of 2 weeks is recommended.DiproleneSCH.51861996-10-01Ratio-TopileneRPH.51861996-10-01BETAMETHASONE DIPROPIONATE IN PROPYLENE GLYCOL BASE16010.05%Cr.5186No more than 50 grams per week of ultrapotent steroids for a maximum of 2 weeks is recommended.Diprolene GlycolSCH.51861996-10-01Ratio-TopileneRPH.51861996-10-01BETAMETHASONE VALERATE16020.05%Cr.0611Betnovate-1/2GLA1996-10-01Celestoderm-V/2SCH1996-10-01Ratio-Ectosone MildRPH.06111996-10-01BetadermTAR.06111996-10-0116030.1%Cr.0911BetnovateGLA1996-10-01Celestoderm-VSCH1996-10-01Ratio-Ectosone RegularRPH.09111996-10-01BetadermTAR.09111996-10-0116040.05%Lot.1900Ratio-Ectosone MildRPH.19001996-10-01Betnovate-1/2RBT1996-10-0116050.1%Lot.2500Ratio-Ectosone RegularRPH.25001996-10-01BetnovateSHI1996-10-0116060.05%Oint.0606Betnovate-1/2GLA1996-10-01Celestoderm-V/2SCH1996-10-01BetadermTAR.06061996-10-0116070.1%Oint.0903BetnovateGLA1996-10-01Celestoderm-VSCH1996-10-01BetadermTAR.09031996-10-0116080.1%Scalp Lot.0853ValisoneVAE.08531996-10-01Ratio-EctosoneRPH.08531996-10-01BetadermTAR.08531996-10-01CALCIPOTRIOL & BETAMETHASONE DIPROPIONATE160950mcg/g & 0.5mg/gOint1.4146Note: For use in patients with psoriasis who have failed 1st line topical steroids and Dovonex (calcipotriol) therapy.DovobetLEO1.41462008-05-16161050mcg/g & 0.5mg/gTop Gel1.4512Note: For the treatment of moderate to severe scalp psoriasis in patients who have failed first-line topical corticosteroid therapy.XamiolLEO1.45122011-05-19CLOBETASOL PROPIONATENo more than 50 grams per week of ultrapotent steroids for a maximum of 2 weeks is recommended.16110.05%Cr.2279Ratio-ClobetasolRPH.22791996-10-01Mylan-ClobetasolMYL.22791996-10-01Novo-ClobetasolNOP.22791996-12-19DermovateTPH.65121998-05-21PMS-ClobetasolPMS.22791999-04-15Taro-Clobetasol Cream USPTAR.22792003-01-3016120.05%Oint.2279Ratio-ClobetasolRPH.22791996-10-01Mylan-ClobetasolMYL.22791996-10-01Novo-ClobetasolNOP.22791996-12-19DermovateTPH.65121998-05-02PMS-ClobetasolPMS.22791999-04-15Taro-Clobetasol Ointment USPTAR.22792003-01-30PMS-ClobetasolPMS.22792012-01-1916130.05%Scalp Lot.1990Ratio-ClobetasolRPH.19901996-10-01DermovateTPH.56852003-01-30Mylan-Clobetasol Scalp ApplicationMYL.19901996-10-01PMS-ClobetasolPMS.19901999-04-15Taro-Clobetasol Topical Solution USPTAR.19902003-01-30CLOBETASONE BUTYRATE16140.05%Cr.3817EumovateGSK.38171997-01-20DESONIDE16150.05%Cr.2610TridesilonCPL1996-10-01PMS-DesonidePMS.26101997-04-1016160.05%Lot.1667DesocortGAC.16671996-10-0116170.05%Oint.2610DesocortGAC.33331996-10-01TridesilonCPL1996-10-01PMS-DesonidePMS.26101997-04-10DIFLUCORTOLONE VALERATE16180.1%Cr.3853NerisoneSTI.38531996-10-0116190.1%Oily Cr.3853NerisoneSTI.38531996-10-0116200.1%Oint.3853NerisoneSTI.38531996-10-01FLUOCINONIDE16210.05%Cr.2378LydermTAR.26171996-10-01LidexVAE.23781999-01-2016220.05%Emol Cr.1980TiamolTAR.24331996-10-01LidemolVAE.19801996-10-0116230.05%Gel.3076LidexVAE.30761996-10-01LydermTAR.34181999-04-1516240.05%Oint.3035LidexVAE.30351996-10-01LydermTAR.33732000-04-17HYDROCORTISONE16250.5%Cr.1333CortateSCH.13331996-10-0116261%Cr.1678Emo-CortSTI.16781996-10-01CortateSCH1996-10-0116272.5%Cr.1949Emo-CortSTI.19491996-10-0116281%Lot.1550Emo-CortSTI.15501996-10-0116292.5%Lot.2050Emo-CortSTI.20501996-10-0116300.5%Oint.1333CortateSCH.13331996-10-01CortodermTAR.14001996-10-0116311%Oint.0390CortateSCH1996-10-01CortodermTAR.03901996-10-01HYDROCORTISONE ACETATE16321%Cr.0364CorticremeROG1996-10-01HydermTAR.03641996-10-01HYDROCORTISONE ACETATE & UREA16331% & 10%Cr.1627Uremol-HCSTI.16271996-10-0116341% & 10%Lot.0948Uremol-HCSTI.09481996-10-01HYDROCORTISONE VALERATE16350.2%Cr.1212HydrovalTPH.12122001-10-1116360.2%Oint.1212HydrovalTPH.12122001-10-11MOMETASONE FUROATE16370.1%Cr.7518ElocomSCH.75181996-10-0116380.1%Lot.5037ElocomSCH.50371996-10-0116390.1%Oint.2252ElocomSCH.67561996-10-01Ratio-MometasoneRPH.22522004-07-20Taro-MometasoneTAR.27712005-12-06TRIAMCINOLONE ACETONIDE16400.1%Cr.0533KenalogWSQ1996-10-01TriadermTAR.05331996-10-01Aristocort RVAE.05331998-03-1716410.1%Oint.1300KenalogWSQ1996-10-01Aristocort RVAE.13001998-03-17TRIAMCINOLONE ACETONIDE 0.1% IN ORABASE1642Oral Top Oint.9110OracortTAR.91101996-10-01Kenalog-OrabaseBQU1996-10-01KERATOLYTIC AGENTSBENZOYL PEROXIDE16435%Lot.1333BenoxylSTI.13331996-10-01164410%Lot.1812BenoxylSTI.18121996-10-01164520%Lot.2013BenoxylSTI.20131996-10-01BENZOYL PEROXIDE IN ALCOHOL-CONTAINING GEL16465%Gel.1243PanoxylSTI.12431996-10-01164710%Gel.1458PanoxylSTI.14581996-10-01164820%Gel.1900PanoxylSTI.19001996-10-01BENZOYL PEROXIDE IN WATER-BASED GEL16495%Gel.1243Desquam-X5WSQ1996-10-01Benzac W5GAC.15001996-10-01Panoxyl AquagelSTI.12431998-12-31TRETINOIN16500.01%Cr.2924Stieva-ASTI.29241996-10-0116510.025%Cr.2924Stieva-ASTI.29241996-10-0116520.05%Cr.2924Stieva-ASTI.29241996-10-01Vitamin A AcidSAV1996-10-0116530.01%Gel.2884Vitamin A AcidSAV.28841996-10-0116540.025%Gel.2924Stieva-ASTI.29241996-10-0116550.05%Gel.2884Vitamin A AcidSAV.28841996-10-0116560.025%Sol.1832Stieva-ASTI.18321996-10-01For the treatment of acne vulgaris.LU Authorization Period: 1 year.TRETINOIN & ERYTHROMYCIN16570.025% & 4%Top Gel.5356Stievamycin GelSTI.53561996-10-01MISCELLANEOUS SKIN AND MUCOUS MEMBRANE AGENTSACITRETINThis drug should be used with extreme caution in females of childbearing potential due to its teratogenicity. Effective contraception must be practised for at least 2 years following discontinuation.165810mgCap1.9457SoriataneAGP1.94571996-10-01165925mgCap3.4170SoriataneAGP3.41701996-10-01AZELAIC ACID166015%Top Gel.6000FinaceaBAH.60002011-09-15CALCIPOTRIOL166150mcg/gCr.7698DovonexLEO.76981997-04-10166250mcg/gOint.7750DovonexLEO.77501997-04-10For the treatment of psoriasis in patients who have failed topical corticosteroids alone, or are intolerant to topical corticosteroids.LU Authorization Period: Indefinite.CALCITRIOL16633mcg/gOint1.1667SilkisGAC1.16672011-08-04For the treatment of psoriasis in patients who have failed topical corticosteroids alone, or are intolerant to topical corticosteroids.LU Authorization Period: Indefinite.FLUOROURACIL16645%Cr.8135EfudexVAL.81351996-10-01ISOTRETINOINIsotretinoin is indicated for the treatment of severe nodular and/or inflammatory acne, acne conglobata and recalcitrant acne that are unresponsive to conventional therapy including systemic antibiotics. Females of childbearing potential should have a negative pregnancy test within 2 weeks prior to starting treatment. Isotretinoin should be started the second or third day of the next normal menstrual period. Effective contraception should be used for at least 1 month prior to starting isotretinoin, during treatment and for at least 1 month following discontinuation of treatment.166510mgCap.9313AccutaneHLR.93131996-10-01ClarusMYL.93132006-07-19166640mgCap1.9003AccutaneHLR1.90031996-10-01ClarusMYL1.90032006-07-19METHOXSALEN166710mgCap.5436OxsoralenVAL.54361996-10-01166810mgSG Cap.4755UltraMOPCDX.47551996-10-01PIMECROLIMUS16691%Cr2.2100ElidelNOV2.21002004-04-06For use in combination with moisturizers or oral antihistamines in patients with atopic dermatitis who have failed or are intolerant to an 8 week trial of an intermediate potency topical steroid.Therapy should be reassessed at 6 months.LU Authorization Period: 1 year.ZINC SULFATE16700.5%Oint.1033Sandoz AnuzincSDZ.10331996-10-01AnusolPFI.13201996-10-01167110mgSup.3542AnuzincSDZ.35421996-10-01SPASMOLYTICSAMINOPHYLLINE1672225mgSR Tab.2168PhyllocontinPFP.21681996-10-011673350mgSR Tab.2762Phyllocontin-350PFP.27621996-10-01OXTRIPHYLLINE167420mg/mLO/L.0229CholedylERF.03791996-10-01PMS-OxtriphyllinePMS.02291998-12-31THEOPHYLLINE ANHYDROUS1675300mgLA Tab.1750Theo-DurAZC1996-10-01Novo-Theophyl SRNOP.17501999-09-1516765.3mg/mLO/L.0252Theolair Alcohol Free Oral LiquidGRA.02521996-10-011677400mgSR Tab.4980UniphylPFP.49801996-10-011678600mgSR Tab.6032UniphylPFP.60321996-10-01VITAMINSVITAMIN BCYANOCOBALAMIN16791mg/mLInj Sol-10mL Pk3.0600RubraminBQU1996-10-01Vitamin B12-1000mcg/mLSDZ3.06002003-01-30CyanocobalaminCYI3.06001997-04-10FOLIC ACID16805mgTab.0259FolviteLED1996-10-01Apo-FolicAPX.02591996-10-01LEUCOVORIN CALCIUM16815mgTab5.8548Leucovorin CalciumWAY5.85481999-01-07NICOTINIC ACIDNicotinic acid is the most cost-effective therapy for hyperlipidemia and is tolerated in approximately 80% of patients with adequate warning about expected flushing which disappears after 5 days in most cases, and is significantly reduced with regular use of ASA.168250mgTabNiacin-ICNVAL1996-10-01Novo-NiacinNOP1996-10-011683100mgTab.0295Niacin-ICNVAL.02951996-10-01THIAMINE HCL168450mgTabVitamin B1-ICNVAL1996-10-01Vitamin B1LEA1996-10-01VITAMIN CASCORBIC ACID1685500mgTabNovo-CNOP1996-10-01Vitamin CRPR1996-10-01Apo-CAPX1996-10-01VITAMIN DALFACALCIDOL16860.25mcgCap.4349One-AlphaLEO.43491996-10-0116871mcgCap1.3018One-AlphaLEO1.30181996-10-01CALCITRIOL16880.25mcgCap.9280RocaltrolHLR.92801996-10-0116890.5mcgCap1.4758RocaltrolHLR1.47581996-10-01ERGOCALCIFEROL16908288IU/mLO/L.4268DrisdolSAV.42681996-10-01MULTIVITAMINSHEXAVITAMINS USP1691TabHexavitaminsNOP1996-10-01Apo-HexaAPX1996-10-01UNCLASSIFIED THERAPEUTIC AGENTSADALIMUMAB169240mg/0.8mLInj Sol-Pref Pen Pk715.1200HumiraABB715.12002010-09-09169340mg/0.8mLInj Sol-Pref Syr Pk715.1200HumiraABB715.12002010-09-09For the treatment of severe* plaque psoriasis in patients 18 years of age or older who have experienced failure, intolerance, or have a contraindication to adequate trials of several standard therapies**. Claims for the first 6 months must be written by a dermatologist. Monitoring of patients is required to determine if continuation of therapy beyond 12 weeks is required. Patients not responding adequately at 12 weeks should have treatment discontinued. * Definition of severe plaque psoriasis: Body Surface Area (BSA) involvement of at least 10%, or involvement of the face, hands, feet or genital regions, AND Psoriasis Area and Severity Index (PASI) score of at least 10 (not required if there is involvemnet of the face, hands, feet or genital regions), AND Dermatology Life Quality Index (DLQI) score of at least 10. ** Definition of failure, intolerance or contraindication to adequate trials of standard therapies: 6 month trial of at least 3 topical agents including vitamin D analogues and steroids 12 week trial of phototherapy (unless not accessible) 6 month trial of at least 2 systemic, oral agents used alone or in combination Methotrexate 15-30mg per week Acitretin (could have been used with phototherapy) Cyclosporine Maintenance/Renewal: After 3 months of therapy, patients who respond to therapy should have: At least a 50% reduction in PASI, AND at least a 50% reduction in BSA involvement, AND at least a 5 point reduction in DLQI score Approvals will only allow for standard dosing for Humira (adalimumab): the recommended dose is an initial 80mg administered subcutaneously, followed by 40mg subcutaneously given every other week starting one week after the initial dose. The Committee to Evaluate Drugs noted that this is the Manufacturer's recommended dosing regimen, as approved by Health Canada. If the patient has not responded adequately after 12 weeks of treatment at the Health Canada approved dose, higher doses are not recommended and the physician should consider switching to an alternative biologic agent. LU Authorization Period: 1 year.ALENDRONATE16945mgTabFosamaxMFC2007-10-03Novo-AlendronateNOP2007-10-03Apo-AlendronateAPX2007-10-03Sandoz AlendronateSDZ2007-10-03169510mgTab.4987FosamaxMFC2.05362000-11-30Novo-AlendronateNOP.49872003-09-04Apo-AlendronateAPX.49872004-07-20Mylan-AlendronateMYL.49872005-10-06Sandoz AlendronateSDZ.49872007-03-09169640mgTabFosamaxMFC2008-06-27Co AlendronateCOB2008-06-27169770mgTab2.5144FosamaxMFC10.05752003-01-30Apo-AlendronateAPX2.51442005-07-14Co AlendronateCOB2.51442005-08-19Novo-AlendronateNOP2.51442005-08-19PMS-AlendronatePMS2.51442006-01-24Ratio-AlendronateRPH2.51442006-05-19PMS-Alendronate-FCPMS2.51442007-03-09Mylan-AlendronateMYL2.51442007-03-09Sandoz AlendronateSDZ2.51442007-03-09Alendronate-FCMEL2.51442009-11-19ALENDRONATE & CHOLECALCIFEROL169870mg & 70mcgTab4.4250Note: The recommended dose of Vitamin D for osteoporosis prevention and treatment in adults over 50 years old is at least 800 IU/day, in conjunction with calcium. This product does not provide the total recommended daily intake of Vitamin D; supplemental Vitamin D may be required. The appropriate dosage of FOSAVANCE must be determined by the physician based on the patient's vitamin D requirement.FosavanceMFC4.42502007-01-02169970mg & 140mcgTab4.4250FosavanceMFC4.42502009-06-23ALFUZOSIN HYDROCHLORIDE170010mgProlong-Rel Tab.4966XatralSAV1.00912003-01-30Sandoz AlfuzosinSDZ.49662008-11-04Novo-Alfuzosin PRNOP.49662011-05-19Apo-AlfuzosinAPX.49662008-11-04For the management of benign prostatic hyperplasia where six weeks of treatment with other formulary alpha blockers (e.g. doxazosin, terazosin) have been ineffective.LU Authorization Period: Indefinite.For the management of benign prostatic hyperplasia where other formulary alpha blockers have produced intolerable side effects.LU Authorization Period: Indefinite.ALLOPURINOLReduce dose of mercaptopurine or azathioprine if used concomitantly. Adjust dose of allopurinol in patients with renal impairment. Allopurinol should not be used to treat patients with hyperuricemia when decreased uricosuria is the cause.1701100mgTab.0780ZyloprimBWE1996-10-01Novo-PurolNOP.07801996-10-01Apo-AllopurinolAPX.07801996-10-011702200mgTab.1300Apo-AllopurinolAPX.13001996-10-01ZyloprimBWE1996-10-01Novo-PurolNOP.13001996-10-011703300mgTab.2125ZyloprimBWE1996-10-01Novo-PurolNOP.21251996-10-01Apo-AllopurinolAPX.21251996-10-01AMANTADINE HCLAmantadine increases central and peripheral effects of anticholinergic drugs.1704100mgCap.5179SymmetrelBQU1996-10-01PMS-Amantadine HCLPMS.51791999-04-15Mylan-AmantadineMYL.51791996-10-01170510mg/mLO/L.0810SymmetrelBQU1996-10-01PMS-AmantadinePMS.08101997-08-28ANAGRELIDE HCL17060.5mgCap3.3491Sandoz AnagrelideSDZ3.34912005-09-27For the treatment of essential thrombocytosis in patients who are intolerant of or who have failed hydroxyurea therapy.LU Authorization Period: 5 years.AZATHIOPRINE170750mgTab.2405Decrease dose of azathioprine to 25 -33% of initial dose if allopurinol used concomitantly.ImuranTRT.96181996-10-01Mylan-AzathioprineMYL.24051998-12-31Novo-AzathioprineNOP.24051999-04-15Apo-AzathioprineAPX.24052001-10-11BOTULINUM TOXIN TYPE A1708100U/VialPd Inj-100U Vial Pk357.0000BotoxALL357.00001996-10-011709200U/VialPd Inj-200U Vial Pk714.0000BotoxALL714.00002011-08-04171050U/VialPd Inj-50U Vial Pk178.5000BotoxALL178.50002011-08-04For the treatment of strabismus and blepharospasm associated with dystonia, including benign essential blepharospasm or VII nerve disorders in patients 12 years of age or older.LU Authorization Period: 1 year.To reduce the subjective symptoms and objective signs of cervical dystonia (spasmodic torticollis) in adults.LU Authorization Period: 1 year.For the management of focal spasticity, due to stroke or spinal cord injury in adults.LU Authorization Period: 1 year.For the treatment of focal spasticity secondary to cerebral palsy in patients two years of age or older.LU Authorization Period: 1 year.Note: Botox should be administered personally by a pediatrician, neurologist or physical medicine specialist or a physician with equivalent post-graduate training and experience with neuromuscular disorders.BROMOCRIPTINE17115mgCap.7708ParlodelNOV1996-10-01Apo-BromocriptineAPX.77081997-08-28PMS-BromocriptinePMS.77081999-04-1517122.5mgTab.4328ParlodelNOV1996-10-01Apo-BromocriptineAPX.43281996-10-01PMS-BromocriptinePMS.43281999-04-15BUPROPION HCL1713150mgSR Tab.9228ZybanVAL.92282011-08-04For smoking-cessation treatment in adults, in conjunction with smoking-cessation counseling. Network Note: Limited to 12 weeks (168 tablets) of reimbursement per 365 days per patient.LU Authorization Period: 12 Weeks.CABERGOLINE17140.5mgTabDostinexPMJ2008-06-27Co CabergolineCOB2008-06-27CLODRONATE DISODIUM1715400mgCap1.2083OstacHLR1996-10-01ClasteonORY1.20832004-10-14For the control and prophylaxis of hypercalcemia of malignancy.LU Authorization Period: Indefinite.For the treatment of bony metastases in patients with breast cancer.LU Authorization Period: Indefinite.For the prevention and treatment of osteolytic lesions in patients with multiple myeloma.LU Authorization Period: Indefinite.CLODRONATE DISODIUM TETRAHYDRATE1716400mgCap1.9102BonefosBAY1.91021996-10-01For the control and prophylaxis of hypercalcemia of malignancy.LU Authorization Period: Indefinite.For the treatment of bony metastases in patients with breast cancer.LU Authorization Period: Indefinite.For the prevention and treatment of osteolytic lesions in patients with multiple myeloma.LU Authorization Period: Indefinite.CLOPIDOGREL BISULFATE171775mgTab.6576PlavixSAV2.63042003-09-04Apo-ClopidogrelAPX.65762012-01-19Co ClopidogrelCOB.65762012-01-19Mylan-ClopidogrelMYL.65762012-01-19For patients immediately post-hospitalization for Acute Coronary Syndrome (ACS), in combination with ASA. ACS is defined as any myocardial infarction (MI) or unstable angina (UA).LU Authorization Period: Indefinite.For patients immediately pre- or post-percutaneous coronary intervention (PCI).* *Therapy may be initiated up to 10 days prior to PCILU Authorization Period: Indefinite.For patients who experience a stroke or transient ischemic attack (TIA) while taking Aggrenox (dipyridamole and ASA) or ASA alone; or For patients experiencing ongoing severe symptomatic peripheral vascular disease (PVD) (i.e.with Ankle Brachial index <0.5) after a vascular event while on ASA. ASA should not be used concomitantly; or For patients requiring ASA with documented severe allergy to ASA, such as anaphylactic reaction or bronchospasm. Gastrointestinal events (GI), including GI bleeds, are excluded.LU Authorization Period: Indefinite.CLOSTRIDIUM BOTULINUM NEUROTOXIN TYPE A1718100 LD50 UnitsPd for Inj-Vial Pk330.0000XeominMEZ330.00002011-05-19To reduce the subjective symptoms and objective signs of cervical dystonia (spasmodic torticollis) in adults.LU Authorization Period: 1 year.For the treatment of blepharospasm associated with dystonia, including benign essential blepharospasm or VII nerve disorders in adults.LU Authorization Period: 1 year.Xeomin should be administered personally by a neurologist or a physician with equivalent post-graduate training and experience with neuromuscular disorders.CYCLOSPORINE171910mgCap.6238NeoralNOV.62382000-01-17172025mgCap.9952NeoralNOV1.45001996-12-19Sandoz CyclosporineSDZ.99522006-01-24172150mgCap1.9400NeoralNOV2.82701996-12-19Sandoz CyclosporineSDZ1.94002007-01-021722100mgCap3.8815NeoralNOV5.65601996-12-19Sandoz CyclosporineSDZ3.88152003-01-301723100mg/mLO/L3.7707NeoralNOV5.02761996-12-19Apo-Cyclosporine Oral SolutionAPX3.77072003-04-16For the treatment of psoriasis in patients who have failed, or are intolerant to, other systemic therapies, including methotrexate, acitretin or PUVA;LU Authorization Period: Indefinite.For the treatment of rheumatoid arthritis in patients who have failed, or are intolerant to, other systemic therapies, including Disease-Modifying Antirheumatic Drugs (DMARDs).LU Authorization Period: Indefinite.DARIFENACIN17247.5mgER Tab1.5800EnablexNOV1.58002011-12-15172515mgER Tab1.5800EnablexNOV1.58002011-12-15For patients with urinary frequency, urgency or urge incontinence who have: Failed to respond to behavioral techniques AND an adequate trial of oxybutynin with gradual dose escalation has shown to be either ineffective or resulted in unacceptable side effects. NOTE: If after a trial of 2 weeks patients continue to experience similar side effects and no greater efficacy than oxybutynin, continued therapy with this more costly agent should be reassessed. Antimuscarinic agents should be used with caution in the elderly due to potentially serious adverse effects (e.g. confusion, psychosis, acute urinary retention, constipation). Antimuscarinic agents should be avoided in older adults with pre-existing cognitive impairment (e.g. dementia) and those who are already using other drugs with significant anticholinergic effects (e.g. tricyclic antidepressants) in order to avoid a high overall anticholinergic drug burden.LU Authorization Period: Indefinite.DUTASTERIDE17260.5mgCap1.6570AvodartGSK1.65702005-09-27For use in combination with an alpha blocker for the treatment of men with symptomatic* Benign Prostatic Hyperplasia.LU Authorization Period: Indefinite.For monotherapy, as a second line agent in patients with symptomatic* Benign Prostatic Hyperplasia following treatment failure or intolerance to an alpha blocker.* Symptomatic is defined as having moderate (about half the time) to severe (almost always) symptoms related to the prostate in at least 4 of the following domains: 1. feeling of incomplete emptying of the bladder after voiding 2. needing to urinate again less than 2 hours after previous void 3. stopping and starting urine several times while voiding 4. difficulty postponing urination 5. weak urinary stream 6. pushing or straining to begin voiding 7. the need to get up to void at least 3 times in the night.LU Authorization Period: Indefinite.ETANERCEPT172725mg/VialInj Pd-Vial Pk184.4525EnbrelIMU184.45252010-09-09172850mg/mLInj Pref Syr368.9075EnbrelIMU368.90752008-12-03172950mg/mLPref AutoInj368.9075Enbrel SureClickIMU368.90752011-10-25For the treatment of severe* plaque psoriasis in patients 18 years of age or older who have experienced failure, intolerance, or have a contraindication to adequate trials of several standard therapies**. Claims for the first 6 months must be written by a dermatologist. Monitoring of patients is required to determine if continuation of therapy beyond 12 weeks is required. Patients not responding adequately at 12 weeks should have treatment discontinued. * Definition of severe plaque psoriasis: Body Surface Area (BSA) involvement of at least 10%, or involvement of the face, hands, feet or genital regions, AND Psoriasis Area and Severity Index (PASI) score of at least 10 (not required if there is involvemnet of the face, hands, feet or genital regions), AND Dermatology Life Quality Index (DLQI) score of at least 10. ** Definition of failure, intolerance or contraindication to adequate trials of standard therapies: 6 month trial of at least 3 topical agents including vitamin D analogues and steroids, AND 12 week trial of phototherapy (unless not accessible), AND 6 month trial of at least 2 systemic, oral agents used alone or in combination Methotrexate 15-30mg per week Acitretin (could have been used with phototherapy) Cyclosporine Maintenance/Renewal: After 3 months of therapy, patients who respond to therapy should have: At least a 50% reduction in PASI, AND at least a 50% reduction in BSA involvement, AND at least a 5 point reduction in DLQI score Approvals will only allow for standard dosing for Enbrel (Etanercept): the recommended dose is 50mg subcutaneous twice weekly for 12 weeks followed by maintenance therapy at 25-50mg subcutaneous once weekly. The Committee to Evaluate Drugs noted that this is the Manufacturer's recommended dosing regimen, as approved by Health Canada. If the patient has not responded adequately after 12 weeks of treatment at the Health Canada approved dose, higher doses are not recommended and the physician should consider switching to an alternative biologic agent. LU Authorization Period: 1 year.ETIDRONATE DISODIUM1730200mgTab.3569DidronelPGP1996-10-01Mylan-EtidronateMYL.35692004-04-06Co EtidronateCOB.35692005-01-25For the treatment of Paget's disease;LU Authorization Period: Indefinite.For the management of hypercalcemia of malignancy.LU Authorization Period: Indefinite.ETIDRONATE DISODIUM/CALCIUM CARBONATE1731400mg/500mgTab-90 Tablets Kit19.9900DidrocalWAR41.98001996-10-01Mylan-Eti-Cal CarepacMYL19.99002008-06-27Co EtidrocalCOB19.99002008-06-27Novo-EtidronatecalNOP19.99002009-05-20FINASTERIDE17321mgTabPropeciaMFC2010-07-20PMS-FinasteridePMS2010-07-20Sandoz Finasteride ASDZ2010-07-2017335mgTab.4633ProscarMFC1.86602004-07-20Ratio-FinasterideRPH.46332010-06-14PMS-FinasteridePMS.46332010-06-14Sandoz FinasterideSDZ.46332010-04-23Novo-FinasterideTEV.46332010-06-14Co FinasterideCOB.46332011-03-15Finasteride Tablets USPACH.46332010-12-14Mylan-FinasterideMYL.46332010-12-14Jamp-FinasterideJPC.46332011-03-15Apo-FinasterideAPX.46332011-09-15Ran-FinasterideRAN.46332011-12-15For use in combination with an alpha blocker for the treatment of men with symptomatic* Benign Prostatic Hyperplasia.LU Authorization Period: Indefinite.For monotherapy, as a second line agent in patients with symptomatic* Benign Prostatic Hyperplasia following treatment failure or intolerance to an alpha blocker.* Symptomatic is defined as having moderate (about half the time) to severe (almost always) symptoms related to the prostate in at least 4 of the following domains: 1. feeling of incomplete emptying of the bladder after voiding 2. needing to urinate again less than 2 hours after previous void 3. stopping and starting urine several times while voiding 4. difficulty postponing urination 5. weak urinary stream 6. pushing or straining to begin voiding 7. the need to get up to void at least 3 times in the night.LU Authorization Period: Indefinite.FLUNARIZINE HCL17345mgCap.7204SibeliumPMS1996-10-01FlunarizineAAP.72042003-01-30For patients with migraine headaches who have not responded to propranolol.LU Authorization Period: 1 year.For patients who have tried propranolol and experienced significant adverse effects.LU Authorization Period: 1 year.For patients in whom propranolol is contraindicated.Contraindicated in patients with clinical depression and in patients with extrapyramidal disorders.LU Authorization Period: 1 year.GLUCAGON RDNA ORIGIN17351mg/VialInj Pd-Syr Pk77.7150GlucaGen HypoKitNOO77.71502011-12-1517361mg/VialInj Pd-Vial Pk86.3500GlucagonLIL86.35002003-01-3017371mg/VialInj Pd-Vial Pk77.7150GlucaGenNOO77.71502011-12-15LANREOTIDE ACETATE173860mg/0.3mLER Pref Syr-0.3mL Pk1102.0000Somatuline AutogelIPS1102.00002008-11-04173990mg/0.3mLER Pref Syr-0.3mL Pk1470.0000Somatuline AutogelIPS1470.00002008-11-041740120mg/0.5mLER Pref Syr-0.5mL Pk1840.0000Somatuline AutogelIPS1840.00002008-11-04LEFLUNOMIDE174110mgTab2.6433AravaSAV10.74202001-03-07Apo-LeflunomideAPX2.64332004-11-16Novo-LeflunomideNOP2.64332005-01-25Sandoz LeflunomideSDZ2.64332007-01-02PMS-LeflunomidePMS2.64332007-06-06Mylan-LeflunomideMYL2.64332009-01-30174220mgTab2.6433AravaSAV10.74202001-03-07Apo-LeflunomideAPX2.64332004-11-16Novo-LeflunomideNOP2.64332005-01-25Sandoz LeflunomideSDZ2.64332007-01-02PMS-LeflunomidePMS2.64332007-06-06Mylan-LeflunomideMYL2.64332009-01-30LEVODOPA & BENSERAZIDE174350mg & 12.5mgCap.2732Prolopa 50-12.5HLR.27321996-10-011744100mg & 25mgCap.4498Prolopa 100-25HLR.44981996-10-011745200mg & 50mgCap.7551Prolopa 200-50HLR.75511996-10-01LEVODOPA & CARBIDOPA1746100mg & 10mgTab.1877SinemetMFC.47721996-10-01Nu-LevocarbNXP.18771996-12-19Apo-LevocarbAPX.18771996-12-19Novo-LevocarbidopaNOP.18772003-01-301747100mg & 25mgTab.2803SinemetMFC.71261996-10-01Nu-LevocarbNXP.28031996-12-19Apo-LevocarbAPX.28031996-12-19Novo-LevocarbidopaNOP.28032003-01-301748100mg & 25mgTab.5126Sinemet CRMFC.73461996-10-01Apo-Levocarb CRAPX.51262009-08-181749200mg & 50mgTab1.3552Sinemet CRMFC1.35521996-10-01For patients with Parkinson's disease who have been treated with conventional therapy (Prolopa or conventional Sinemet), and experienced adverse effects related to drug level fluctuations, such as ON/OFF or wearing off phenomena.LU Authorization Period: Indefinite.For patients presently requiring anti-parkinsonian drug administration (levodopa/carbidopa) more than three times daily.LU Authorization Period: Indefinite.1750250mg & 25mgTab.3129SinemetMFC.79551996-10-01Nu-LevocarbNXP.31291996-12-19Apo-LevocarbAPX.31291996-12-19Novo-LevocarbidopaNOP.31292002-07-29LEVODOPA & CARBIDOPA & ENTACAPONE175175 & 18.75 & 200mgTab1.5999StalevoNOV1.59992010-10-281752125 & 31.25 & 200mgTab1.5999StalevoNOV1.59992010-10-28175350 & 12.5 & 200mgTab1.5999StalevoNOV1.59992009-03-021754100 & 25 & 200mgTab1.5999StalevoNOV1.59992009-03-021755150 & 37.5 & 200mgTab1.5999StalevoNOV1.59992009-03-02For the treatment of patients with Parkinson's disease with 25% of the waking day in the off state despite maximally tolerated doses of levodopa.LU Authorization Period: Indefinite.MONTELUKAST SODIUM17564mgChew Tab.3646SingulairMFC1.45832004-04-06Sandoz MontelukastSDZ.36462012-01-19PMS-MontelukastPMS.36462012-01-19Teva-MontelukastTEV.36462012-01-19For the treatment of asthma in patients aged 2-5 years old.LU Authorization Period: 1 year.17575mgChew TabSingulairMEK2012-01-19Sandoz MontelukastSDZ2012-01-19PMS-MontelukastPMS2012-01-19Teva-MontelukastTEV2012-01-1917584mgGran PkSingulairMEK2012-01-19Sandoz MontelukastSDZ2012-01-19175910mgTabSingulairMEK2012-01-19Sandoz MontelukastSDZ2012-01-19Teva-MontelukastTEV2012-01-19Mylan-MontelukastMYL2012-01-19PMS-Montelukast FCPMS2012-01-19Apo-MontelukastAPX2012-01-19MYCOPHENOLATE MOFETIL1760250mgCap.5155CellCeptHLR2.06201997-04-10Sandoz MycophenolateSDZ.51552012-01-19Apo-MycophenolateAPX.51552012-01-19Novo-MycophenolateTEV.51552012-01-19Mylan-MycophenolateMYL.51552012-01-191761200mg/mLPd for Oral Susp-175mLPk288.6800CellCeptHLR288.68002005-02-221762500mgTab1.0310CellCeptHLR4.12402000-04-17Sandoz MycophenolateSDZ1.03102012-01-19Novo-MycophenolateTEV1.03102012-01-19Apo-MycophenolateAPX1.03102012-01-19Mylan-MycophenolateMYL1.03102012-01-19For the prophylaxis of organ rejection in patients receiving allogeneic renal, cardiac or hepatic transplants.LU Authorization Period: Indefinite.MYCOPHENOLATE SODIUM1763180mgEnt Coated Tab1.9977MyforticNOV1.99772006-01-121764360mgEnt Coated Tab3.9953MyforticNOV3.99532006-01-12OCTREOTIDE176510mgInj Kit Pk1286.7000Sandostatin LARNOV1286.70002007-01-02176620mgInj Kit Pk1662.3600Sandostatin LARNOV1662.36002007-01-02176730mgInj Kit Pk2132.7900Sandostatin LARNOV2132.79002007-01-02176850mcg/mLInj Sol - 1mL Amp Pk1.7465SandostatinNOV5.09002007-01-02Octreotide Acetate OmegaOMG1.74652008-03-251769100mcg/mLInj Sol - 1mL Amp Pk3.2970SandostatinNOV9.60802007-01-02Octreotide Acetate OmegaOMG3.29702008-03-251770500mcg/mLInj Sol - 1mL Amp Pk15.4945SandostatinNOV45.15602007-01-02Octreotide Acetate OmegaOMG15.49452008-03-251771200mcg/mLInj Sol - 5mL Vial Pk31.7100SandostatinNOV92.41002007-01-02Octreotide Acetate OmegaOMG31.71002008-03-25PAMIDRONATE DISODIUM17723mg/mLInj Sol-10mL VialArediaNOV2007-07-12PMS-PamidronatePMS2008-03-25Pamidronate Disodium OmegaOMG2011-12-15Pamidronate DisodiumSDZ2007-07-1217736mg/mLInj Sol-10mL VialArediaNOV2007-07-12Pamidronate Disodium OmegaOMG2011-12-15Pamidronate DisodiumSDZ2007-07-1217749mg/mLInj Sol-10mL VialArediaNOV2007-07-12PMS-PamidronatePMS2008-03-25Pamidronate Disodium OmegaOMG2011-12-15Pamidronate DisodiumSDZ2007-07-12PHENAZOPYRIDINE HCLThere is no evidence that continuing treatment with phenazopyridine beyond the first 48 hours in urinary tract infections is beneficial.1775200mgTab.1636PhenazoVAL.16361996-10-01PyridiumPDA1996-10-01QUINAGOLIDE HCL17760.075mgTab1.0900NorprolacFEI1.09002006-10-2317770.15mgTab1.6300NorprolacFEI1.63002006-10-23For the treatment of hyperprolactinemia in patients who have: * Failed to respond to a greater than or equal to 3 month trial of bromocriptine; or * Failed to tolerate bromocriptine; or * Failed to shrink a prolactinoma by greater than 1 cm after 12 months of bromocriptine therapyLU Authorization Period: 5 years.RALOXIFENE HCL177860mgTab.9168EvistaLIL1.83362000-11-30Apo-RaloxifeneAPX.91682009-05-20Novo-RaloxifeneNOP.91682009-09-30For the treatment of osteoporosis in postmenopausal women who have:Failed or, experienced intractable side effects, or have a contraindication to, alendronate OR risedronate.Failure is defined as: continued loss of bone mineral density (loss of more than 3%) after two years of therapy; or a new osteoporosis related fracture after one year of therapy.LU Authorization Period: Indefinite.RISEDRONATE SODIUM17795mgTab1.3661ActonelWAR1.82142001-03-07Novo-RisedronateNOP1.36612010-04-23178030mgTab8.8500ActonelWAR11.80002000-04-17Novo-RisedronateNOP8.85002010-04-23178135mgTab2.4893ActonelWAR2003-04-16Novo-RisedronateNOP2.48942010-04-23PMS-RisedronatePMS2.48942010-10-28Ratio-RisedronateRPH2.48942010-10-28Sandoz RisedronateSDZ2.48932010-10-28Apo-RisedronateAPX2.48942010-10-28Mylan-RisedronateMYL2.48932011-09-151782150mgTab43.1500ActonelWAR43.15002009-06-23ROPINIROLE17830.25mgTab.0710ReQuipGSK.28382000-04-17Ran-RopiniroleRAN.07102009-09-30Co RopiniroleCOB.07102009-09-30PMS-RopinirolePMS.07102009-09-30Ropinirole TabletsRAN.07102010-01-05Apo-RopiniroleAPX.07102010-04-23Jamp-RopiniroleJPC.07102010-10-2817841mgTab.2838ReQuipGSK1.13532000-04-17Ran-RopiniroleRAN.28382009-09-30Co RopiniroleCOB.28382009-09-30PMS-RopinirolePMS.28382009-09-30Ropinirole TabletsRAN.28382010-01-05Apo-RopiniroleAPX.28382010-04-23Jamp-RopiniroleJPC.28382010-10-2817852mgTab.3122ReQuipGSK1.24892000-04-17Ran-RopiniroleRAN.31222009-09-30Co RopiniroleCOB.31222009-09-30PMS-RopinirolePMS.31222009-09-30Ropinirole TabletsRAN.31222010-01-05Apo-RopiniroleAPX.31222010-04-23Jamp-RopiniroleJPC.31222010-10-2817865mgTab.8596ReQuipGSK3.43842000-04-17Ran-RopiniroleRAN.85962009-09-30Co RopiniroleCOB.85962009-09-30PMS-RopinirolePMS.85962009-09-30Ropinirole TabletsRAN.85962010-01-05Apo-RopiniroleAPX.85962010-04-23Jamp-RopiniroleJPC.85962010-10-28SELEGILINE HCL17875mgTab.5021Novo-SelegilineNOP.50211996-10-01EldeprylBJH1996-10-01Apo-SelegilineAPX.50211997-08-28Nu-SelegilineNXP.50211999-04-15Mylan-SelegilineMYL.50211998-12-31SILDENAFIL178820mgTabRevatioPFI2010-09-09Ratio-Sildenafil RRPH2010-09-09SIROLIMUS17891mg/mLO/L7.3693RapamuneWAY7.36932005-02-2217901mgTab7.3692RapamuneWAY7.36922005-02-22For the prophylaxis of organ rejection in patients receiving allogeneic renal transplants.LU Authorization Period: Indefinite.SODIUM CROMOGLYCATE17911%Inh Sol-2mL Pk.4846IntalAVE1996-10-01PMS-Sodium CromoglycatePMS.48461996-10-01SOLIFENACIN SUCCINATE17925mgTab1.6400VesicareASE1.64002011-12-15179310mgTab1.6400VesicareASE1.64002011-12-15For patients with urinary frequency, urgency or urge incontinence who have: Failed to respond to behavioral techniques AND an adequate trial of oxybutynin with gradual dose escalation has shown to be either ineffective or resulted in unacceptable side effects. NOTE: If after a trial of 2 weeks patients continue to experience similar side effects and no greater efficacy than oxybutynin, continued therapy with this more costly agent should be reassessed. Antimuscarinic agents should be used with caution in the elderly due to potentially serious adverse effects (e.g. confusion, psychosis, acute urinary retention, constipation). Antimuscarinic agents should be avoided in older adults with pre-existing cognitive impairment (e.g. dementia) and those who are already using other drugs with significant anticholinergic effects (e.g. tricyclic antidepressants) in order to avoid a high overall anticholinergic drug burden.LU Authorization Period: Indefinite.TACROLIMUS17945mg/mLAmp124.5000PrografASE124.50001996-12-1917950.5mgCap1.9700PrografASE1.97002009-04-0117961mgCap2.5200PrografASE2.52001996-12-1917975mgCap12.6200PrografASE12.62001996-12-19For solid organ transplant and bone marrow transplant.LU Authorization Period: Indefinite.17980.5mgER Cap1.9700AdvagrafASE1.97002009-04-0117991mgER Cap2.5200AdvagrafASE2.52002009-04-0118003mgER Cap7.5600AdvagrafASE7.56002011-03-1518015mgER Cap12.6200AdvagrafASE12.62002009-04-01For prophylaxis of organ rejection in adult patients receiving allogeneic kidney transplants LU Authorization Period: Indefinite.18020.03%Oint2.1500ProtopicASE2.15002004-04-0618030.1%Oint2.3000ProtopicASE2.30002004-04-06For use in combination with moisturizers or oral antihistamines in patients with atopic dermatitis who have failed or are intolerant to an 8 week trial of an intermediate potency topical steroid.Therapy should be reassessed at 6 months.LU Authorization Period: 1 year.TAMSULOSIN HCL18040.4mg.1500Note: Randomized controlled trials have shown no significant differences in efficacy between daily doses of 0.4mg and 0.8mg of tamsulosin. Therefore, the daily tamsulosin dose should not exceed 0.4mg.Flomax CR TabBOE.60002006-06-15Sandoz Tamsulosin CR TabSDZ.15002011-05-19Apo-Tamsulosin CR TabAPX.15002011-12-15Teva-Tamsulosin CR TabTEV.15002011-09-15Ratio-Tamsulosin CapRPH.15002009-09-3018050.4mgCap.2375Note: Randomized controlled trials have shown no significant differences in efficacy between daily doses of 0.4mg and 0.8mg of tamsulosin. Therefore, the daily tamsulosin dose should not exceed 0.4mg. FlomaxBOE2002-04-04Novo-Tamsulosin SRNOP.23752007-01-02Ratio-TamsulosinRPH.45002007-06-06Ran-TamsulosinRAN.23752007-12-19Sandoz TamsulosinSDZ.23752007-09-04Gen-TamsulosinGEN.23752007-10-03Tamsulosin CapsulesRAN.23752010-01-05Jamp-TamsulosinJPC.23752010-10-28For the management of benign prostatic hyperplasia where six weeks of treatment with other formulary alpha blockers (e.g. doxazosin, terazosin) have been ineffective.LU Authorization Period: Indefinite.For the management of benign prostatic hyperplasia where other formulary alpha blockers have produced intolerable side effects.LU Authorization Period: Indefinite.TICLOPIDINE HCL1806250mgTab.3141TiclidHLR1996-10-01Novo-TiclopidineNOP.31412003-09-04Nu-TiclopidineNXP.31411999-04-15Apo-TiclopidineAPX.31411999-04-15Mylan-TiclopidineMYL.31411999-09-15Sandoz TiclopidineSDZ.31412002-04-04Ticlopidine is restricted to patients with transient cerebral ischemia. Ticlopidine may be somewhat more effective than ASA in preventing fatal and non-fatal strokes. However, it is associated with neutropenia in 0.8-2.4% of patients, a serious side-effect which may be fatal. Patients on ticlopidine require blood tests every two weeks for the first three months of therapy. There have been more than 60 cases of ticlopidine associated thrombotic thrombocytopenic purpura (TTP) with 33% mortality rate. As well, there are other side-effects such as diarrhea that occurs in 12.5% of patients. Ticlopidine should be used only after careful consideration. The appropriate use of ticlopidine in the management of patients with cerebral ischemic events (TIA or stroke) is based on the following: (a) Determining that the symptoms are due to focal cerebral ischemia, and differentiating the symptoms of dizziness due to vestibular dysfunction, lightheadedness, or syncope from antihypertensive drugs or cardiac dysfunction, and from symptoms due to migraine, epilepsy, hypoglycemia, or other causes, such as tumor. (b) If investigation demonstrates that the events are caused by emboli from the heart, the patient should be treated with anticoagulants, such as warfarin. (c) If the events are due to artery-to-artery emboli from the carotid bifurcation with a severe stenosis, the patient should probably be treated with ASA and offered carotid endarterectomy if medically suitable (70% to 99% stenosis). (d) ASA should be the first line of defense for patients with TIA and threatened stroke, and after an initial stroke of any severity. (e) The only drugs other than ASA that are available as platelet inhibitors and which have been shown to be of value for such patients are ticlopidine and clopidogrel. (f) Before abandoning ASA in favour of ticlopidine, efforts should be made to improve the tolerability of ASA by reducing the dose, taking it with food, and using enteric coated ASA. Ticlopidine will be reimbursed for patients:Who are known to be, or become, intolerant of ASA;LU Authorization Period: Indefinite.Where ASA is contraindicated;LU Authorization Period: Indefinite.Who continue to have TIA or stroke symptoms while being treated with ASA.LU Authorization Period: Indefinite.TOLTERODINE L-TARTRATE18072mgSR Cap1.8546Detrol LAPFI1.85462004-04-0618084mgSR Cap1.8546Detrol LAPFI1.85462004-04-0618091mgTab.9273DetrolPFI.92731999-09-1518102mgTab.9273DetrolPFI.92731999-09-15For patients with urinary frequency, urgency or urge incontinence who have: Failed to respond to behavioral techniques AND an adequate trial of oxybutynin with gradual dose escalation has shown to be either ineffective or resulted in unacceptable side effects. NOTE: If after a trial of 2 weeks patients continue to experience similar side effects and no greater efficacy than oxybutynin, continued therapy with this more costly agent should be reassessed. Antimuscarinic agents should be used with caution in the elderly due to potentially serious adverse effects (e.g. confusion, psychosis, acute urinary retention, constipation). Antimuscarinic agents should be avoided in older adults with pre-existing cognitive impairment (e.g. dementia) and those who are already using other drugs with significant anticholinergic effects (e.g. tricyclic antidepressants) in order to avoid a high overall anticholinergic drug burden.Failed to respond to behavioral techniques ANDAn adequate trial of oxybutynin with gradual dose escalation has shown to be either ineffective or resulted in unacceptable side effects.If after a trial of 2 weeks patients continue to experience similar side effects and no greater efficacy than oxybutynin, continued therapy with this more costly agent should be reassessed.LU Authorization Period: Indefinite.TROSPIUM CHLORIDE181120mgTab.7750TrosecORY.77502011-12-15For patients with urinary frequency, urgency or urge incontinence who have: Failed to respond to behavioral techniques AND an adequate trial of oxybutynin with gradual dose escalation has shown to be either ineffective or resulted in unacceptable side effects. NOTE: If after a trial of 2 weeks patients continue to experience similar side effects and no greater efficacy than oxybutynin, continued therapy with this more costly agent should be reassessed. Antimuscarinic agents should be used with caution in the elderly due to potentially serious adverse effects (e.g. confusion, psychosis, acute urinary retention, constipation). Antimuscarinic agents should be avoided in older adults with pre-existing cognitive impairment (e.g. dementia) and those who are already using other drugs with significant anticholinergic effects (e.g. tricyclic antidepressants) in order to avoid a high overall anticholinergic drug burden.LU Authorization Period: Indefinite.URSODIOL1812250mgTab.8635UrsoBFI1.33152000-01-17PMS-Ursodiol CPMS.86352007-04-02For the treatment of primary biliary cirrhosis.LU Authorization Period: Indefinite.1813500mgTab1.6380Urso DSBFI2.52562004-04-06PMS-Ursodiol CPMS1.63802007-04-02For the treatment of primary biliary cirrhosis.LU Authorization Period: Indefinite.For the treatment of primary sclerosing cholangitis.LU Authorization Period: Indefinite.USTEKINUMAB181445mg/0.5mLInj Sol-Pref Syr Pk4477.4400StelaraJAN4477.44002010-09-09For the treatment of severe* plaque psoriasis in patients 18 years of age or older who have experienced failure, intolerance, or have a contraindication to adequate trials of several standard therapies**. Claims for the first 6 months must be written by a dermatologist. Monitoring of patients is required to determine if continuation of therapy beyond 12 weeks is required. Patients not responding adequately at 12 weeks should have treatment discontinued. * Definition of severe plaque psoriasis: Body Surface Area (BSA) involvement of at least 10%, or involvement of the face, hands, feet or genital regions, AND Psoriasis Area and Severity Index (PASI) score of at least 10 (not required if there is involvement of the face, hands, feet or genital regions), AND Dermatology Life Quality Index (DLQI) score of at least 10. ** Definition of failure, intolerance or contraindication to adequate trials of standard therapies: 6 month trial of at least 3 topical agents including vitamin D analogues and steroids; AND 12 week trial of phototherapy (unless not accessible); AND 6 month trial of at least 2 systemic, oral agents used alone or in combination Methotrexate 15-30mg per week Acitretin (could have been used with phototherapy) Cyclosporine Maintenance/Renewal: After 3 months of therapy, patients who respond to therapy should have: At least a 50% reduction in PASI, AND at least a 50% reduction in BSA involvement, AND at least a 5 point reduction in DLQI score Approvals will only allow for standard dosing for Stelara 45mg to be administered at weeks 0, 4 and every 12 weeks thereafter. If the patient has not responded after 12 weeks of treatment, the physician should consider switching to an alternative biologic agent. LU Authorization Period: 1 year.VARENICLINE TARTRATE18150.5mgTab1.6850ChampixPFI1.68502011-08-0418161.0mgTab1.6850ChampixPFI1.68502011-08-0418170.5mg & 1.0mgTabs (Starter Pack)42.1300ChampixPFI42.13002011-09-15For smoking-cessation treatment in adults, in conjunction with smoking-cessation counseling. Network Note: Limited to 12 weeks (168 tablets) of reimbursement per 365 days per patient.LU Authorization Period: 12 Weeks.ZOLEDRONIC ACID18185mg/100mLInj Sol-100mL Pk670.8000AclastaNOV670.80002006-10-23For the treatment of Paget's disease.LU Authorization Period: Indefinite.MISCELLANEOUSNUTRITION PRODUCTSNUTRITIONAL PRODUCTLiq-1000mL Pk7.9700Compleat ModifiedNON7.97002001-10-11Liq-1000mL Pk11.4800PerativeROS11.48002002-07-291.06kcal/mLLiq-1000mL Pk8.1400Jevity 1 CalABB8.14002003-04-161.2kcal/mLLiq-1000mL Pk9.1300Jevity 1.2 CalABB9.13002003-04-161.5kcal/mLLiq-1000mL Pk41.0400Peptamen 1.5NES41.04002004-11-041.5kcal/mLLiq-1000mL Pk11.5200Jevity 1.5 CalABB11.52002008-12-031kcal/mLLiq-1000mL Pk7.6800Glucerna 1.0 CalABB7.68002002-07-291.06kcal/mLLiq-1500mL Pk8.0100Osmolite 1 CalABB8.01002003-04-161.06kcal/mLLiq-1500mL Pk12.2200Jevity 1 CalABB12.22002003-04-161.2kcal/mLLiq-1500mL Pk9.0700Osmolite 1.2 CalABB9.07002003-04-161.2kcal/mLLiq-1500mL Pk13.7000Jevity 1.2 CalABB13.70002003-04-161.5kcal/mLLiq-1500mL Pk17.2800Jevity 1.5 CalABB17.28002008-12-031kcal/mLLiq-1500mL Pk42.6900Peptamen with PrebioNES42.69002004-07-20Liq-235mL Pk2.0000Ensure with FibreABB2.00001996-10-01Liq-235mL Pk1.7900Ensure PlusABB1.79001996-10-01Liq-235mL Pk1.2600Osmolite 1 CALABB1.26001996-10-01Liq-235mL Pk2.4700PediaSureABB2.47001996-10-01Liq-235mL Pk2.2600NeproABB2.26001998-12-31Liq-235mL Pk2.0900SuplenaABB2.09001998-12-31Liq-235mL Pk1.4400Osmolite 1.2 CALABB1.44002001-10-111.06kcal/mLLiq-235mL Pk1.9200Jevity 1 CalABB1.92001996-10-011.2kcal/mLLiq-235mL Pk2.1700Jevity 1.2 CalABB2.17002000-01-171.5kcal/mLLiq-235mL Pk2.7400Pediasure Plus with FibreROS2.74002003-09-041.5kcal/mLLiq-235mL Pk2.7025Jevity 1.5 CalABB2.70252010-04-231kcal/mLLiq-235mL Pk1.8000Glucerna 1.0 CalABB1.80002002-07-291kcal/mLLiq-235mL Pk2.4700Pediasure with FibreROS2.47002003-01-302kcal/mLLiq-235mL Pk2.3688TwoCal HNROS2.36882003-01-30Liq-237mL Pk1.5300Boost Fruit Flavoured BeverageNES1.53001996-10-01Liq-237mL Pk2.0500Resource 2.0NES2.05002000-07-17Liq-237mL Pk2.0500NovaSource RenalNES2.05002001-10-11Liq-237mL Pk7.3000OptimentalABB7.30002002-04-04Liq-237mL Pk2.7200PerativeROS2.72002002-07-291.06kcal/mLLiq-237mL Pk1.2300Boost 1.0 StandardNES1.23001996-10-011.5kcal/mLLiq-237mL Pk1.5500Boost 1.5 Plus CaloriesNES1.55001996-10-011.5kcal/mLLiq-237mL Pk2.3280Resource Kid Essentials 1.5NES2.32802005-09-271kcal/mLLiq-237mL Pk6.3700E028 Splash (Grape Flavoured)SHL6.37002009-11-131kcal/mLLiq-237mL Pk6.3700E028 Splash (Orange-Pineapple Flavoured)SHL6.37002009-11-131.5kcal/mLLiq-237mL Tetra Pk5.7463KetoCal 4:1NUT5.74632011-08-04Liq-250mL Pk2.0300Compleat ModifiedNES2.03001996-10-01Liq-250mL Pk1.2000IsoSource HNNES1.20001996-10-01Liq-250mL Pk7.1200PeptamenNES7.12001996-10-01Liq-250mL Pk1.2600NuBasicNES1.26001996-10-01Liq-250mL Pk1.8900NuBasic PlusNES1.89001996-10-01Liq-250mL Pk1.2700IsoSource VHNNES1.27001996-10-01Liq-250mL Pk1.2800NuBasic VHPNES1.28001996-10-01Liq-250mL Pk7.1200Peptamen JuniorNES7.12001996-10-01Liq-250mL Pk1.8700IsoSource 1.5 CalNES1.87002001-10-11Liq-250mL Pk1.8300IsoSource HN with FibreNES1.83002002-07-291.06kcal/mLLiq-250mL Pk1.7400Resource DiabeticNES1.74002003-09-041.5kcal/mLLiq-250mL Pk1.8900Nutren 1.5NES1.89001996-10-011.5kcal/mLLiq-250mL Pk10.2600Peptamen 1.5NES10.26002000-07-171kcal/mLLiq-250mL Pk1.2600Nutren 1.0NES1.26001996-10-011kcal/mLLiq-250mL Pk1.6480Nutren JuniorNES1.64802001-10-111kcal/mLLiq-250mL Pk1.6480Nutren Junior FibreNES1.64802001-10-111kcal/mLLiq-250mL Pk7.1200Peptamen with PrebioNES7.12002004-07-201kcal/mLLiq-250mL Pk2.5920Compleat PediatricNES2.59202006-01-12Liq-384mL Pk6.2700RCFABB6.27001996-10-01Liq-4x237mL Pk5.6500AlimentumABB5.65001996-10-010.68kcal/mLLiq-945mL Pk8.4373Nutramigen A+MJN8.43732010-03-027.7kcal/mLLiq-946mL Pk34.4900MCT OilNES34.49001996-10-0122kcal/30mLPd for Liq-363g Pk15.2928Enfamil EnfaCare A+MJS15.29282006-01-12Pd-10g Pouch.6400HMS 90IMM.64002002-04-04Pd-1Kg Pk18.8300CaloreenNES18.83001996-10-017.2kcal/gPd-300g Pk30.0000KetoCalSHS30.00002003-01-30Pd-350g Pk6.2700PolycoseABB6.27001996-10-015.15kcal/gPd-363g Pk14.9900Similac Advance NeoSureABB14.99002004-07-20Pd-400g Pk59.2000NeocateSHS59.20002000-11-301kcal/mLPd-400g Pk64.6800Neocate JuniorSHS64.68002002-04-041kcal/mLPD-400g Pk29.0000Modulen IBDNES29.00002011-09-155kcal/gPd-400g Pk45.7920Nutramigen AAMJN45.79202010-10-28Pd-454g Pk18.3800PregestimilMJN18.38001996-10-011.02kcal/mLPd-454g Pk22.2300PortagenMJN22.23002003-01-305kcal/gPd-454g Pk19.9412Nutramigen A+MJN19.94122010-03-02Pd-48.7g Pk7.0300Vivonex PediatricNES7.03001996-10-01Pd-5Kg Pk81.8500CaloreenNES81.85001996-10-01Pd-79.5g Pk7.0300Vivonex PlusNES7.03001996-10-01Pd-79g Pk7.7700Vital HNABB7.77001996-10-01Pd-80.4g Pk7.0300Vivonex T.E.N.NES7.03001996-10-01Pd-80g Pk4.1700TolerexNES4.17001996-10-01DIABETIC TESTING AGENTSGDH-FAD GLUCOSE DEHYDROGENASEStrip.7290One Touch VerioLIF.72902011-09-15GLUCOSE DEHYDROGENASEStrip.7290ContourBAY.72902004-11-04GLUCOSE OXIDASE REAGENTStrip.7290AccutrendROD.72901996-10-01Strip.7290EncoreBAY.72901996-10-01Strip.7290One TouchLIF.72901996-10-01Strip.7290Precision PlusMED.72901996-10-01Strip.7290Accu-Chek EasyROD.72901996-10-01Strip.7290ExactechMED.72901996-10-01Strip.7193Chemstrip bGROD.71931996-10-01Strip.7290Accu-Chek AdvantageROD.72901996-10-01Strip.7290SurestepLIF.72901996-10-01Strip.6067Prestige Smart SystemTHR.60671997-08-28Strip.7290Ascensia AutodiscBAY.72901998-12-31Strip.7290Advantage ComfortROD.72901999-04-15Strip.7290FastTakeLIF.72901999-04-15Strip.5222Novo-GlucoseNOP.52222000-11-30Strip.7290Precision XtraABB.72902001-10-11Strip.7290Accu-Chek CompactROD.72902002-04-04Strip.7290One Touch UltraLIF.72902002-04-04Strip.7290Sof-TactABB.72902002-07-29Strip.7290FreestyleTER.72902003-09-04Strip.7290Precision EasyABB.72902003-09-04Strip.7290BDBED.72902005-02-22Strip.7290Accu-Chek AvivaROD.72902006-04-19Strip.4000TrueTrack Smart SystemHOM.40002007-12-19Strip.7290Breeze 2BAH.72902008-04-09Strip.7290Nova MaxNOB.72902008-12-23Strip.7290On Call PlusACO.72902010-01-05Strip.6804iTestAUT.68042010-04-23Strip.7290EZ Health OracleTRE.72902010-07-20PQQ GLUCOSE DEHYDROGENASEStrip.7290Freestyle LiteABB.72902008-08-28FACILITATED ACCESS PRODUCTSFACILITATED ACCESS PRODUCTSATOVAQUONE750mg/5mLO/L2.7290MepronGLW2.72901997-04-10DOXYCYCLINE100mgCap.6720Apo-DoxyAPX.67201996-10-01100mgCap1.8442VibramycinPFI1.84421996-10-01100mgCap.6380Novo-DoxylinNOP.63801996-10-01ITRACONAZOLERecommended for the treatment of oral/esophageal candidiasis unresponsive to less expensive alternatives100mgCap3.9747SporanoxJAN3.97471996-10-0110mg/mLOral Sol.8705SporanoxJAN.87051998-12-31PAROMOMYCINRecommended for the treatment of cryptosporidium. Therapy should be discontinued if no benefits are observed after a three week trial.250mgCap2.5872HumatinPDA2.58721996-10-01PNEUMOCOCCAL VACCINEInj-1 Dose Pk15.1400Pneumovax 23MSD15.14001996-10-01POTASSIUM CHLORIDE8meqLA Cap.0944Micro-K ExtencapsWAY.09441996-10-018meqLA Tab.0749Apo-KAPX.07491996-10-018meqLA Tab.1017Slow-KNOV.10171996-10-0110meqLA Tab.0665Kalium DurulesAST.06651996-10-0120meqSR Tab.2660K-DurKEY.26601996-10-01PYRIMETHAMINE25mgTab1.2580DaraprimGLW1.25801996-10-01