ACUTE MEDICINE FORMULARY 2018 - FishMed20180119114048 AM) FINAL_Fish… · 1.3.1 benzo anxiolytics oxazepam tab 30 mg purata 30 mg tabs yes maximum quantity of 90 per annum 1.4 anti-depressants

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ACUTE MEDICINE FORMULARY

2018

NOTE:

Reference pricing is applied. Patients are advised to discuss the availability of less expensive generics with the pharmacist at the point of dispensing.

If a product is dispensed that is more expensive than the reference price, the patient will need to pay the difference in price at the point of dispensing.

Quantity limits apply to some items on this formulary. Quantities in excess of this limit will need to be funded by the member at the point of dispensing, unless an authorisation

has been obtained for a greater quantity.

The formulary is subject to regular review. MMI Health reserves the right to update and change the formulary when new information becomes available, prices change or when

new medicines are released.

While every effort has been made to ensure that products listed are available on the market, it is possible that some products may be discontinued by the manufacturers during

the course of the year. Should this be the case patients are advised to discuss alternatives with the pharmacist or the prescribing doctor.

MIMS CLASS THERAPEUTIC DESCRIPTION ACTIVE INGREDIENT EXAMPLE OF TRADE NAME ACUTE

RESTRICTIONS

FILL AGE GENDER

MIN DAILY DOSE

MAX DAILY DOSE

1 CENTRAL NERVOUS SYSTEM

1.2 SEDATIVE HYPNOTICS

1.2.3 OTHER SEDATIVE HYPNOTICS ZOPICLONE TAB 7.5 MG ALCHERA 7.5MG TAB YES

MAXIMUM QUANTITY OF 90 PER ANNUM

1.3 ANXIOLYTICS

1.3.1 BENZO ANXIOLYTICS ALPRAZOLAM TAB 0.25 MG ZOPAX 0.25MG TAB YES


1.3.1 BENZO ANXIOLYTICS ALPRAZOLAM TAB 0.5 MG ZOPAX 0.5MG TAB YES


1.3.1 BENZO ANXIOLYTICS ALPRAZOLAM TAB 1 MG ZOPAX 1MG TAB YES MAXIMUM QUANTITY OF

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90 PER ANNUM

1.3.1 BENZO ANXIOLYTICS BROMAZEPAM TAB 3 MG SANDOZ BROMAZEPAM 3MG YES


1.3.1 BENZO ANXIOLYTICS BROMAZEPAM TAB 6 MG SANDOZ BROMAZEPAM 6MG YES


1.3.1 BENZO ANXIOLYTICS DIAZEPAM TAB 5 MG BETAPAM 5MG TAB YES


1.3.1 BENZO ANXIOLYTICS OXAZEPAM TAB 10 MG PURATA 10 MG TABS YES






1.4 ANTI-DEPRESSANTS

1.4.1 TRICYCLICS IMIPRAMINE HCL TAB 10 MG ETHIPRAMINE 10MG TAB YES


1.4.1 TRICYCLICS IMIPRAMINE HCL TAB 25 MG ETHIPRAMINE 25MG TAB YES


1.4.1 TRICYCLICS AMITRIPTYLINE HCL TAB 10 MG TREPILINE 10MG TAB YES


1.4.1 TRICYCLICS AMITRIPTYLINE HCL TAB 25 MG TREPILINE 25MG TAB YES


1.5 ANTI-PSYCHOTICS

NO PRODUCTS INCLUDED

1.6 ANTI-EPILEPTICS


1.7 ANTI-PARKINSON AGENTS


1.8 ANTI-VERTIGO AND ANTI-EMETIC AGENTS

1.8 ANTI-VERTIGO AND ANTI-EMETIC AGENTS FRUCTOSE-DEXTROSE-PHOSPHORIC ACID ORAL EMETROL LIQ YES

1.8 ANTI-VERTIGO AND ANTI-EMETIC AGENTS BUCLIZINE-PYRIDOXINE TAB 25-50 MG VOMIFENE TAB YES

MAX AGE = 45

FEMALES ONLY

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1.8 ANTI-VERTIGO AND ANTI-EMETIC AGENTS CYCLIZINE HCL SUPP 50 MG TRIAZINE 50MG SUPP YES

QTY LIMIT = 6 (1 OP). THREE FILLS PER ANNUM

1.8 ANTI-VERTIGO AND ANTI-EMETIC AGENTS CYCLIZINE HCL SUPP 100 MG VALOID 100MG SUPP YES

QTY LIMIT = 6 (1 OP). THREE FILLS PER ANNUM

1.8 ANTI-VERTIGO AND ANTI-EMETIC AGENTS CYCLIZINE HCL SYRUP 12.5 MG/5ML NAUZINE S 12.5MG/5 SYR YES

1.8 ANTI-VERTIGO AND ANTI-EMETIC AGENTS CYCLIZINE HCL TAB 50 MG NAUZINE 50MG TAB YES

1.8 ANTI-VERTIGO AND ANTI-EMETIC AGENTS METOCLOPRAMIDE HCL SYRUP 5 MG/5ML ADCO-CONTROMET 5MG/5ML YES

1.8 ANTI-VERTIGO AND ANTI-EMETIC AGENTS METOCLOPRAMIDE HCL TAB 10 MG ADCO-CONTROMET 10MG TABS YES

1.8 ANTI-VERTIGO AND ANTI-EMETIC AGENTS PHOSPHORATED CARBOHYDRATE SYRUP EMEX SYR YES

1.8 ANTI-VERTIGO AND ANTI-EMETIC AGENTS PROCHLORPERAZINE MALEATE TAB 5 MG SCRIPTO-METIC 5MG TAB YES

1.9 ANTI-MIGRAINE AGENTS

1.9 ANTI-MIGRAINE AGENTS SUMATRIPTAN SUCCINATE TAB 50MG TRIPTAM 50MG TABS YES

1.9 ANTI-MIGRAINE AGENTS SUMATRIPTAN SUCCINATE TAB 100MG TRIPTAM 100MG TABS YES

2 LOCAL ANAESTHETICS

2.2.1 SURFACE ANAESTHETICS TETRACAINE HCL CREAM 1% AMETHOCAINE CREAM YES THREE FILLS PER ANNUM

3 ANALGESICS

3.1 NARCOTIC ANALGESICS

3.2 ANALGESIC AND ANTIPYRETICS

3.2 ANALGESIC AND ANTIPYRETICS ACETAMINOPHEN ELIXIR 120 MG/5ML ADCO-PARACETAMOL ELIX YES

3.2 ANALGESIC AND ANTIPYRETICS ACETAMINOPHEN SUPPOS 125 MG EMPAPED 125MG SUPP YES

LIMIT TO PAEDIATRIC USE. THREE FILLS PER ANNUM

MAX AGE = 6

3.2 ANALGESIC AND ANTIPYRETICS ACETAMINOPHEN SUPPOS 250 MG EMPAPED 250MG SUPP YES


MAX AGE = 6

3.2 ANALGESIC AND ANTIPYRETICS ACETAMINOPHEN SYRUP 120 MG/5ML PANADO SYRP YES

3.2 ANALGESIC AND ANTIPYRETICS ACETAMINOPHEN TAB 500 MG ACTAMOL 500MG TABS YES MAXIMUM 200 PER ANNUM

3.2 ANALGESIC AND ANTIPYRETICS ASPIRIN TAB 300 MG BE-TABS ASPIRIN 300MG TAB YES MAXIMUM QUANTITY OF

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400 PER ANNUM

3.2 ANALGESIC AND ANTIPYRETICS IBUPROFEN SUSP 100 MG/5ML IBUGESIC 100MG/5ML SUSP YES

3.2 ANALGESIC AND ANTIPYRETICS MEFENAMIC ACID CAP 250 MG FENAMIN 250MG CAP YES


3.2 ANALGESIC AND ANTIPYRETICS MEFENAMIC ACID SUSP 50 MG/5ML FENAMIN 50MG/5ML SUSP YES THREE FILLS PER ANNUM

3.2 ANALGESIC AND ANTIPYRETICS MEFENAMIC ACID SUPP 125MG PONSTAN PEAD 125MG SUP YES


MAX AGE = 6

3.3 COMBINATION ANALGESICS

3.3 COMBINATION ANALGESICS ACETAMINOPHEN W/ CODEINE CAP 320-8 MG SPECTRAPAIN CAP YES


3.3 COMBINATION ANALGESICS ACETAMINOPHEN W/ CODEINE TAB 500-10 MG NAPACOD TAB YES


3.3 COMBINATION ANALGESICS ACETAMINOPHEN W/ CODEINE TAB 500-8 MG PAINAMOL PLUS YES


3.3 COMBINATION ANALGESICS ACETAMINOPHEN-MEPROBOMATE-CAFF-COD TAB 320-150-32-8 MG STILPANE TAB YES


3.3 COMBINATION ANALGESICS ACETAMINOPHEN-PROMETHAZINE W/ CODEINE SYRUP 120-6.5-5 MG/5ML STILPANE SYR YES

3.3 COMBINATION ANALGESICS IBUPROFEN-ACETAMINOPHEN TAB 200-250 MG IBUPAIN TABS YES


3.4 OTHER ANALGESICS

4 MUSCULO-SKELETAL AGENTS

4.1 NON-STEROIDAL ANTI-INFLAMMATORY AGENTS

4.1.1 COX INHIBITORS DICLOFENAC SODIUM TAB DELAYED RELEASE 25 DICLOHEXAL 25MG YES


4.1.1 COX INHIBITORS DICLOFENAC SODIUM TAB DELAYED RELEASE 50 ADCO-DICLOFENAC 50MG TAB YES MAXIMUM QUANTITY OF

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200 PER ANNUM

4.1.1 COX INHIBITORS IBUPROFEN TAB 200 MG IBOFLAM 200MG TAB YES


4.1.1 COX INHIBITORS IBUPROFEN TAB 400 MG RANFEN 400MG TAB YES


4.1.1 COX INHIBITORS INDOMETHACIN CAP 25 MG AMDOCIN 25MG CAP YES


4.1.1 COX INHIBITORS NAPROXEN TAB 250 MG NAPROSCRIPT 250MG TAB YES


4.1.1 COX INHIBITORS NAPROXEN TAB 500 MG NAPFLAM 500MG TAB YES


4.1.1 COX INHIBITORS IBUPROFEN GEL 5% IBULEVE GEL YES 2 FILLS PER ANNUM

4.1.1 COX INHIBITORS DICLOFENAC SODIUM SUPPOS 12.5MG PANAMOR 12.5MG SUPP YES


MAX AGE = 6

4.1.2 SELECTIVE COX2 INHIBITORS MELOXICAM TAB 7.5MG FLEXOCAM 7.5MG TABS YES


4.2 ANTI-GOUT

4.2 ANTI-GOUT COLCHICINE TAB 1 MG COLCHICINE HOUDE 1MG TAB YES 3 FILLS PER ANNUM

4.2 ANTI-GOUT COLCHICINE TAB 0.5 MG COLCHICINE 0.5MG TAB YES 3 FILLS PER ANNUM

4.2 ANTI-GOUT ALLOPURINOL 100MG TABS PURICOS 100MG TABS YES

4.2 ANTI-GOUT ALLOPURINOL 300MG TABS PURICOS 300MG TABS YES

4.3 TOPICAL AGENTS

4.5 CENTRALLY ACTING MUSCLE RELAXANTS


4.6 OTHER MUSCULO-SKELETAL AGENTS


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4.7 OSTEOPOROSIS AND OTHER BONE DISORDERS


5 AUTONOMIC


5.3 CHOLINERGICS


5.4 ANTI-CHOLINERGICS


6 AUTACOIDS

6.1 ANTI-HISTAMINES

6.1 ANTI-HISTAMINES CHLORPHENIRAMINE MALEATE SYRUP 2 MG/5ML ALLERGEX 2MG/5ML SYR YES 4 FILLS PER ANNUM

6.1 ANTI-HISTAMINES CHLORPHENIRAMINE MALEATE TAB 4 MG ALLERGEX 4MG TAB YES 4 FILLS PER ANNUM

6.1 ANTI-HISTAMINES PROMETHAZINE HCL SYRUP 5 MG/5ML PROHIST 5MG/5ML SYR YES 4 FILLS PER ANNUM

6.1 ANTI-HISTAMINES PROMETHAZINE HCL TAB 10 MG PHENERGAN 10MG TAB YES 4 FILLS PER ANNUM

6.1 ANTI-HISTAMINES PROMETHAZINE HCL TAB 25 MG PHENERGAN 25MG TAB YES 4 FILLS PER ANNUM

6.1 ANTI-HISTAMINES LORATADINE TAB 10 MG LAURA 10 TABS YES 4 FILLS PER ANNUM

6.1 ANTI-HISTAMINES LORATADINE SYRUP 5 MG/5ML CLARINESE SYRUP YES 4 FILLS PER ANNUM

6.1 ANT-HISTAMINES CETIRIZINE HCL TAB 10 MG ZETOP 10MG TAB YES 4 FILLS PER ANNUM

6.1 ANTI-HISTAMINES CETIRIZINE HCL ORAL SOLUTION 1MG/ML (5MG/5ML) ALLECET 5MG/5ML SYRUP YES 4 FILLS PER ANNUM

7 CARDIO-VASCULAR AGENTS

7.1 POSITIVE INOTROPIC AGENTS


7.2 ANTI-ARRHYTHMICS


7.3 ANTI-HYPERTENSIVES

7.4 ANTI-ANGINAL AGENTS


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7.7 HIPOLIPIDAEMIC AGENTS


8 BLOOD AND HAEMOPOEITIC

8.1 HAEMOSTATICS

8.2 ANTICOAGULANTS


8.6 HAEMATINICS

8.6 HAEMATINICS FERROUS FUMARATE-FOLIC ACID TAB 200-0.1 PREGAMAL TAB YES

LIMIT TO THREE FILLS PER ANNUM

8.6 HAEMATINICS FERROUS SULFATE TAB 30 MG FERROUS SULPHATE 30MG YES


8.6 HAEMATINICS FERROUS SULFATE TAB 75 MG FERROUS SULPHATE 75MG TAB YES


8.6 HAEMATINICS IRON POLYMALTOSE SYRUP 50 MG/5ML (ELEMEN FEROFOLS SYRP YES

8.6 HAEMATINICS FERROUS SULFATE-COPPER-MANGANESE TAB 170-2.5-2.5 MG FOLIGLOBIN TABS YES


8.6 HAEMATINICS FERROUS LACTATE DROPS 25MG/ML FERRO DROPS L

10 RESPIRATORY SYSTEM

10 COUGHS AND COLDS

10.1.1 ANTITUSSIVES AND EXPECTORANTS

AMINOPHYLLINE-DIPHENHYD-AMMON CL SYRUP 32-8-30 MG/5ML LOTUSSIN EXPECT YES

THREE FILLS PER ANNUM


AMINOPHYLLINE-DIPHENHYD-AMMON CL-SOD CITRATE SYRUP DIPHENAMILL SYR YES



AMMONIUM CHLORIDE & IPECAC SYRUP 22-0.24 MG/5ML MIST TUSSI INFANS YES


10.1.1 ANTITUSSIVES AND EXPECTORANTS DEXTROMETHORPHAN-AMCL SYRUP 15-90 MG/5ML BRONCOL YES



DIPHENHYDRAMINE-AMCL-SOD CITRATE SYR 13.33-130-54.17 MG/5ML PHENORANT YES



DIPHENHYDRAMINE-AMCL-SOD CITRATE SYRUP 14.07-137-57 MG/5ML DPH EXPECTORANT SYR YES



DIPHENHYDRAMINE-AMCL-SOD CITRATE-MEN SYR 12.5-125-50-1MG/5ML FAMTUSS SYR YES



DPH-AMCL-SOD CITRATE-MEN SYR 28.1-273.9-113.7-2.5 MG/5ML ALLERGIN EXPECT YES


10.1.1 ANTITUSSIVES AND EXPECTORANTS GUAIFENESIN SYRUP 100 MG/5ML BRONCHOLIN EXPECT YES


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10.1.1 ANTITUSSIVES AND EXPECTORANTS IPECAC-SQUILL SYRUP LINCTUS TUSSI INFANS YES


10.1.1 ANTITUSSIVES AND EXPECTORANTS METAPROTERENOL-BROMHEXINE SYRUP 5-4 MG/5 ADCO-LINCTOPENT SYR YES


10.1.1 ANTITUSSIVES AND EXPECTORANTS THEOPHYLLINE-ETOFYLLINE-DIPHENHYD-AMMON ALCOPHYLLEX SYR YES


10.1.1 ANTITUSSIVES AND EXPECTORANTS THEOPHYLLINE-ETOFYLLINE-DIPHENYLPYRALINE THEOPHEN CO ELIX (UNBOXED YES



EPHEDRINE-PROMETHAZINE-CODEINE SYRUP 7-3-9.2 MG/5ML BRUNACOD SYR YES



EPHEDRINE-PROMETHAZINE-CODEINE SYRUP 7.2-3.6-9 MG/5ML ANTITUSS SYRUP YES


10.1.1 ANTITUSSIVES AND EXPECTORANTS PHOLCODINE SYRUP 4.025 MG/5ML PHOLCOLINCT 4.025 MG/5ML SYR YES



DIPHENHYDRAMINE-PHOLCODINE-GG SYR 15-8-100 MG/5ML FOLCOFEN YES



EPHEDRINE W/DM-AMMONIUM CL SYRUP 7.5-15-125 MG/5ML LINCTODYL SYR YES



EPHEDRINE -CPM-COD-GG-COCILLANA SYRUP 20-2-10-100-5 MG/10ML CORBAR LINCTUS YES



EPHEDRINE-DIPHENHYDRAMINE-DM-GG SYRUP 15-10-12.5-100 MG/10ML LOTUSSIN SYRUP YES



EPHEDRINE-PYRILAMINE-COD-PHOLCODINE SYRUP 8-20-5-5 MG/5ML DOCSED SYRUP YES



PSEUDOEPHEDRINE-TRIPROLIDINE W/COD SYRUP 30-1.25-10 MG/5ML ACTIFED CO LINCTUS YES



PSEUDOEPH-TRIPROLIDINE-DM SYRUP 30-1.25-10 MG/5ML ACTIFED DM DRY COUGH YES


10.1.2 DECONGESTANT, ANALGESIC COMBINATIONS

CHLORPHEN-EPHEDRINE-APAP-CAFFEINE TAB 2-6-200-20 MG COLCLEER TABS YES



CHLORPHEN-PHENYLTOLOX-PE-APAP-CAFF CAP 2-12.5-5-200-30 MG DEQUA-FLU CAPS YES



DM-PHENYLPROPANOLAMINE-APAP SYRUP 15-25-500 MG/20ML SINUSTAT FLU SYR YES



DIPHENHYDRAMINE-PHENYLEPH-APAP-VIT C CAP 10-5-400-50 MG FLUEND CAPS YES



PHENYLEPH-CHLORPHEN-DM W/APAP SYRUP 2.5-0.5-2-120 MG/5ML KIDDYFLU SYR YES


10.1.2 DECONGESTANT, ANALGESIC COMBINATIONS PSEUDOEPHEDRINE W/ ACETAMINOPHEN LIQUID SINUMAX PED SYR YES



PE-CPM-APAP-ATROPINE-CAFF-VIT C CAP 5-2-300-0.125-30-75 MG FAMUCAPS YES



PHENYLPROP-PHENYLTOLOX W/ COD-APAP TAB 25-22-15-300 MG ADCO-SINAL CO YES



PYRILAMINE-PHENYLEPHRINE-ACETAMINOPHEN TAB 5-5-500 MG SINU-FLU TAB YES



CHLORPHEN-PE W/APAP-CAFFEINE SYRUP2-2.5-75-7.5 MG/5ML COLCLEER PAED SYRUP YES


10.1.3 DECONGESTANTS PSEUDOEPHEDRINE HCL SYRUP 30 MG/5ML ADCO-SUFEDRIN 30MG/5ML SY YES THREE FILLS PER ANNUM

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10.1.3 DECONGESTANTS PSEUDOEPHEDRINE HCL TAB 60 MG ADCO-SUFEDRIN 60MG TAB YES THREE FILLS PER ANNUM

10.1.3 DECONGESTANTS TRIPROLIDINE-PSEUDOEPHEDRINE-VIT C SYRUP CORYX PAED SYR YES THREE FILLS PER ANNUM

10 BRONCHODILATORS

10.2.1 SYMPATHOMIMETICS ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT VENTEZE INH COMP 200D YES TWO FILLS PER ANNUM

10.2.1 SYMPATHOMIMETICS ALBUTEROL SULFATE SYRUP 2 MG/5ML ASTHAVENT 2MG/5ML SYR YES THREE FILLS PER ANNUM

MAX AGE = 6

10.2.2 METHYLXANTHINES & COMBINATIONS THEOPHYLLINE TAB 100 MG NORSTAN-TED 100MG TAB YES


10.2.2 METHYLXANTHINES & COMBINATIONS THEOPHYLLINE TAB 200 MG NORSTAN-TED 200MG TAB YES


10 MUCOLYTICS

10.3 MUCOLYTICS CARBOCYSTEINE SYRUP 125 MG/5ML MUCOSPECT PAED SYR YES THREE FILLS PER ANNUM

10.3 MUCOLYTICS CARBOCYSTEINE SYRUP 250 MG/5ML LESSMUSEC 250MG/5ML SYR YES THREE FILLS PER ANNUM

10.3 MUCOLYTICS CARBOCYSTEINE CAP 375MG LESSMUSEC 375MG CAPS YES THREE FILLS PER ANNUM

10 ANTI-ASTHMATICS


11 EAR, NOSE AND THROAT

11 TOPICAL NASAL PREPARATIONS

11.1.2 GLUCOCORTICOSTEROIDS BECLOMETHASONE DIPROPIONATE NASAL SOLN CIPLANAZE MULTICARE YES THREE FILLS PER ANNUM

11.1.2 GLUCOCORTICOSTEROIDS FLUTICASONE PROPIONATE NASAL SUSP 50MCG/ACT FLOMIST AQ NASAL SPRAY YES THREE FILLS PER ANNUM

11.1.4 DECONGESTANTS OXYMETAZOLINE HCL NASAL SOLN 0.025% DRINASAL DROPS 10ML YES TWO FILLS PER ANNUM

11.1.4 DECONGESTANTS OXYMETAZOLINE HCL NASAL SOLN 0.05% DRIXINE 0.05% N/SPRAY 20M YES TWO FILLS PER ANNUM

11.1.4 DECONGESTANTS PHENYLEPHRINE HCL NASAL SOLN 0.25% NAPHENSYL 0.25% DRP 10ML YES TWO FILLS PER ANNUM

11.1.4 DECONGESTANTS PHENYLEPHRINE HCL NASAL SOLN 1% NAPHENSYL 1% DRP 10ML YES TWO FILLS PER ANNUM

11.1.4 DECONGESTANTS PHENYLEPHRINE-NAPHAZOLINE NASAL SOLN 2.5 UNIVERSAL NOSE DROPS 15ML YES TWO FILLS PER ANNUM

11.1.7 OTHER TOPICAL NASAL AGENTS SALINE NASAL SPRAY 0.9% SIMPLY SALINE NASAL SPRAY YES THREE FILLS PER ANNUM

11 EAR DROPS AND OINTMENTS

11.2 EAR DROPS AND OINTMENTS NEOMYCIN-SODIUM PROPIONATE OTIC SOLN 3-5 NEOPAN 15ML EAR DROPS YES ONE FILL PA

11.2 EAR DROPS AND OINTMENTS ANTIPYRINE OTIC SOLN 5% AURONE 15ML EAR DROPS YES ONE FILL PER ANNUM

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11.2 EAR DROPS AND OINTMENTS ANTIPYRINE-BENZOCAINE-EPHEDRINE-POT OXYQUINOLONE OTIC SOLN OTOPHEN FORTE 10ML DRP YES

ONE FILL PER ANNUM

11.2 EAR DROPS AND OINTMENTS BENZOCAINE-ANTIPYRINE OTIC SOLN 1-5% OTISED 15ML EAR DROPS YES ONE FILL PER ANNUM

11 MOUTH AND THROAT PREPARATIONS

11.3 MOUTH AND THROAT PREPARATIONS BENZOCAINE LOZENGE 10 MG TROCHAIN LOZ YES


11.3 MOUTH AND THROAT PREPARATIONS TETRACAINE HCL OINTMENT 0.5% DYNEXAN OINT YES

ONE FILL PER ANNUM

11.3 MOUTH AND THROAT PREPARATIONS POVIDONE-IODINE MOUTHWASH 1% SEPTADINE ORAL ANTISEPTIC YES


12 GASTRO-INTESTINAL TRACT

12 ANTI-SPASMODICS

12.3 ANTI-SPASMODICS SCOPOLAMINE N-BUTYLBROMIDE SYRUP 5 MG/5M HYOSPASMOL 5MG/5ML SYRUP YES

12.3 ANTI-SPASMODICS MEBEVERINE HCL TAB 135 MG BEVISPAS 135MG TAB YES THREE FILLS PER ANNUM

12.3 ANTI-SPASMODICS SCOPOLAMINE N-BUTYLBROMIDE TAB 10 MG HYOSPASMOL 10MG TAB YES

12.3 ANTI-SPASMODICS DIPYRONE-SCOPOLAMINE BUTYLBROMIDE TAB 250-10 MG BUSCOPAN CO TAB YES


12 ACID REDUCERS

12.4.1 ANTACIDS AL HYD-BIS ALUM-CA CARB-MG CARB-MG TRISI BISMA-REX POWDER YES THREE FILLS PER ANNUM

12.4.1 ANTACIDS ALUMINUM HYDROXIDE-MAG OXIDE SUSP 282-120 MG/15ML MAYOGEL SUSP YES


12.4.1 ANTACIDS ALUMINUM HYDROXIDE-MAG OXIDE SUSP 400-200 MG/10ML ALUMAG D SUSP YES


12.4.1 ANTACIDS CAL & MAG CARB-MAG TRISILICATE SUSP 250-250-500 MG/5ML MAG TRISILICATE MIXT YES


12.4.1 ANTACIDS MAG CARB-MAG TRISILICATE-SOD BICARB SUSP 250-250-250 MG/5ML MIST MAG TRISIL YES


12.4.2 ANTACIDS AND COMBINATIONS ALUM OXIDE-MAG OXIDE-DICYCLOMINE GEL 200-200-5 MG/10ML SPASMOGEL YES


12.4.2 ANTACIDS AND COMBINATIONS AL & MG OXIDES-DICYCL-METHYLCELL-SIMETH SUSP MEDIGEL SUSP YES THREE FILLS PER ANNUM

12.4.2 ANTACIDS AND COMBINATIONS ALUM HYDROX-MAG OXIDE-DICYCLOMINE SUSP 400-200-5 MG/10ML AMGEL SUSP YES


12.4.3 HISTAMINE-2 RECEPTOR ANTAGONISTS RANITIDINE HCL TAB 150 MG CPL ALLIANCE RANITIDINE 150MG TAB YES

MAXIMUM OF 90 DAYS SUPPLY PER ANNUM

12.4.3 HISTAMINE-2 RECEPTOR ANTAGONISTS RANITIDINE HCL TAB 300 MG CPL ALLIANCE RANITIDINE 300MG TAB YES


12.4.4 PROTON PUMP INHIBITORS LANSOPRAZOLE CAP DELAYED RELEASE 15 MG ADCO-ROZNAL 15 MG CAPS YES


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13 LAXATIVES

12.6 LAXATIVES BISACODYL SUPPOS 5 MG DULCOLAX 5MG PAED SUPP YES TWO FILLS PER ANNUM

12.6 LAXATIVES BISACODYL SUPPOS 10 MG DULCOLAX 10MG SUPP YES TWO FILLS PER ANNUM

12.6 LAXATIVES BISACODYL TAB DELAYED RELEASE 5 MG LAXADOR BISACODYL 5MG TAB YES TWO FILLS PER ANNUM

12.6 LAXATIVES LACTULOSE SOLUTION 10 GM/15ML LACSON SYR YES TWO FILLS PER ANNUM

12.6 LAXATIVES PEG 3350-KCL-NA BICARB-NACL-NA SULFATE GOLYTELY POWD YES

LIMIT TO ONE FILL PER ANNUM FOR PRE-OPERATIVE USE

12.6 LAXATIVES SODIUM PHOSPHATES - ENEMA LEN-O-LAX ADULT 135ML YES


12.6 LAXATIVES SODIUM PHOSPHATES - ENEMA LEN-O-LAX PAED 64ML YES


12.6 LAXATIVES SENNOSIDES TAB 7.5MG SENOKOT TABS YES

12.6 LAXATIVES SENNOSIDES TAB 13.5MG SOFLAX TABS YES

13 ANTIDIARRHOEALS

12.7 ANTIDIARRHOEALS KAOLIN-PECTIN LIQUID 3-0.15 GM/15ML JP PECT SUSP YES THREE FILLS PER ANNUM

12.7 ANTIDIARRHOEALS KAOLIN-PECTIN SUSP 1-0.05 GM/5ML GASTROPECT SUSP YES THREE FILLS PER ANNUM

12.7 ANTIDIARRHOEALS KAOLIN-PECTIN SUSP 6-0.12 GM/15ML KAOCREAM SUSP YES THREE FILLS PER ANNUM

12.7 ANTIDIARRHOEALS KAOLIN-PECTIN SUSP 6-0.45 GM/30ML PECTIKON SUSP YES THREE FILLS PER ANNUM

12.7 ANTIDIARRHOEALS KAOLIN-PECTIN SUSP 5.5-0.137 GM/30ML KAOPECTIN SUSP YES THREE FILLS PER ANNUM

12.7 ANTIDIARRHOEALS KAOLIN-PECTIN W/ ELECTROLYTES SUSP 6-0.1 ENTEROLYTE SUSP YES THREE FILLS PER ANNUM

12.7 ANTIDIARRHOEALS KAOLIN-PECTIN-BISMUTH CARBONATE SUSP 8-0 BISKAPECT SUSP YES THREE FILLS PER ANNUM

12.7 ANTIDIARRHOEALS LOPERAMIDE HCL TAB 2 MG PRODIUM 2MG TAB YES THREE FILLS PER ANNUM

12.7 ANTIDIARRHOEALS LOPERAMIDE HCL SYRUP 1MG/5ML GASTRON SYR YES THREE FILLS PER ANNUM

13 SUPPOSITORIES AND ANAL OINTMENTS

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13 SUPPOSITORIES AND ANAL OINTMENTS HEMORRHOIDAL ANESTHETIC COMPOUND SUPP ANUSOL SUPP YES


13 SUPPOSITORIES AND ANAL OINTMENTS PRAMOXINE HCL RECTAL OINT 1% ANUGESIC 10MG/GM OINT YES


13 SUPPOSITORIES AND ANAL OINTMENTS

PRAMOXINE/ ZINC OXIDE IN MINERAL OIL RECTAL OINT 1-12.5% ANUSOL OINT YES


12.10 OTHER GASTRO-INTESTINAL TRACT AGENTS


13 ANTIHELMINTICS

13 ANTIHELMINTICS ALBENDAZOLE SUSP 100 MG/5ML ZENTEL 100MG/5ML SUSP YES TWO FILLS PER ANNUM

13 ANTIHELMINTICS ALBENDAZOLE TAB 400 MG BENDEX 400MG TAB YES TWO FILLS PER ANNUM

13 ANTIHELMINTICS MEBENDAZOLE SUSP 20 MG/ML WORMSTOP SUSP YES TWO FILLS PER ANNUM

13 ANTIHELMINTICS MEBENDAZOLE SUSP 50 MG/ML VERMOX SD 500MG/10ML YES TWO FILLS PER ANNUM

13 ANTIHELMINTICS MEBENDAZOLE TAB 100 MG ADCO-WORMEX YES TWO FILLS PER ANNUM

13 ANTIHELMINTICS MEBENDAZOLE TAB 500 MG ADCO-WORMEX 500MG TAB YES TWO FILLS PER ANNUM

13 ANTIHELMINTICS PIPERAZINE CITRATE ELIXIR 500 MG/5ML PIPRINE ELIX YES TWO FILLS PER ANNUM

13 ANTIHELMINTICS PIPERAZINE CITRATE SYRUP 500 MG/5ML SB TOX WORM SYR YES TWO FILLS PER ANNUM

13 ANTIHELMINTICS PRAZIQUANTEL TAB 600 MG BILTRICIDE 600MG TAB YES ONE FILL PER ANNUM

14 DERMATOLOGICALS

14 ANTI-BACTERIAL ANTISEPTIC AGENTS

14.1 ANTI-BACTERIAL ANTISEPTIC AGENTS

IODOQUINOL-CHLOROBUTANOL-BENZOCAINE CREAM 30-10-10 MG/GM VIODOR CREAM YES

ONE FILL PER ANNUM

14.1 ANTI-BACTERIAL ANTISEPTIC AGENTS MUPIROCIN OINT 2% SUPIROBAN 2GM/100GM OINTM YES

ONE FILL PER ANNUM

14 ANTI-BACTERIAL ANTISEPTIC AGENTS MUPIROCIN CREAM 2% BACTROBAN TOPICAL CREAM YES

ONE FILL PER ANNUM

14 ANTI-BACTERIAL ANTISEPTIC AGENTS FUSIDIC ACID CREAM FUCIDIN CREAM YES

ONE FILL PER ANNUM

14 ANTI-BACTERIAL ANTISEPTIC AGENTS FUSIDATE SODIUM OINT 2% FUCIDIN OINTMENT YES

ONE FILL PER ANNUM

14.1 ANTI-BACTERIAL ANTISEPTIC AGENTS POVIDONE-IODINE OINT 10% SEPTADINE ANTISEPT OINT YES

ONE FILL PER ANNUM

14.1 ANTI-BACTERIAL ANTISEPTIC AGENTS NITROFURAZONE OINT 0.2% FUREX OINT YES

ONE FILL PER ANNUM

14 ANTI-PARASITICS

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14.2 ANTI-PARASITICS BENZYL BENZOATE EMULSION 25% BENZYL BENZOATE LOTION YES ONE FILL PER ANNUM

14 ANTI-PARASITICS MONOSULFIRAM SOAP TETMOSOL YES ONE FILL PER ANNUM

14 FUNGICIDES

14.3 FUNGICIDES CLOTRIMAZOLE CREAM 1% CANEX TOPICAL CREAM YES THREE FILLS PER ANNUM

14.3 FUNGICIDES NYSTATIN OINT 100000 UNIT/GM NYSTACID OINT YES THREE FILLS PER ANNUM

14 CORTICO-STEROIDS TOPICAL

14.4 CORTICO-STEROIDS TOPICAL BETAMETHASONE VALERATE CREAM 0.1% TOPIVATE 1MG/GM CREAM YES

THREE FILLS PER ANNUM ON ACUTE

14.4 CORTICO-STEROIDS TOPICAL BETAMETHASONE VALERATE OINT 0.1% LENOVATE 0.1% OINT YES


14.4 CORTICO-STEROIDS TOPICAL CLOBETASOL PROPIONATE CREAM 0.05% DOVATE 0.5MG/GM CREAM YES THREE FILLS PER ANNUM

14.4 CORTICO-STEROIDS TOPICAL CLOBETASOL PROPIONATE OINT 0.05% DOVATE 0.5MG/GM OINT YES THREE FILLS PER ANNUM

14 CORTICO-STEROIDS TOPICAL HYDROCORTIZONE CREAM 1% VARI-HYDROCORTISONE 1% CREAM YES THREE FILLS PER ANNUM

14.4 CORTICO-STEROIDS TOPICAL HYDROCORTISONE CREAM 0.5% SKINCALM CREAM YES THREE FILLS PER ANNUM

14.4 CORTICO-STEROIDS TOPICAL HYDROCORTISONE ACETATE CREAM 0.5% DILUCORT CREAM YES THREE FILLS PER ANNUM

14.4 CORTICO-STEROIDS TOPICAL HYDROCORTISONE ACETATE CREAM 1.0% BIOCORT CREAM YES THREE FILLS PER ANNUM

14.4.1 CORTICO-STEROIDS WITH ANTI-INFECTIVE AGENTS IODOQUINOL-CHLOROBUTANOL-HC CREAM 3-1-0. VIOCORT CREAM YES


14.4.1 CORTICO-STEROIDS WITH ANTI-INFECTIVE AGENTS NEOMYCIN-HC ACE CREAM 1% NEODERM CREAM YES


15 ACNE

14.6 ACNE BENZOYL PEROXIDE GEL 5% CREME CLASSIQUE ACNE 5 GEL YES THREE FILLS PER ANNUM

14.6 ACNE BENZOYL PEROXIDE CREAM 4% BREVOXYL CREAM YES THREE FILLS PER ANNUM

15 OTHER DERMATOLOGICALS

14.9 OTHER DERMATOLOGICALS DIPHENHYDRAMINE-CALAMINE-PHENOL LOTION 1 BIOHIST LOT YES THREE FILLS PER ANNUM

15 OTHER DERMATOLOGICALS PYRILAMINE MALEATE CREAM 2% MEPYRIMAL 2% CREAM YES THREE FILLS PER ANNUM

15 OTHER DERMATOLOGICALS CALAMINE PHENOLATED LOTION CALAMINE - ALCHEMIST LOTN YES THREE FILLS PER ANNUM

15 OTHER DERMATOLOGICALS CALAMINE LOTION CALAMINE LOTION - DAROL LOTION YES THREE FILLS PER ANNUM

Page 14 of 20

15 OTHER DERMATOLOGICALS DIPHENHYDRAMINE-PYRILAMINE CREAM 1-1% HISTODOR CREAM YES THREE FILLS PER ANNUM

15 OPHTHALMICS

15 ANTI-INFECTIVES

15.1 ANTI-INFECTIVES CHLORAMPHENICOL OPHTH OINT 1% CHLORCOL EYE OINT YES THREE FILLS PER ANNUM

15.1 ANTI-INFECTIVES FUSIDIC ACID OPHTH SOLN 10 MG/GM (1%) FUCITHALMIC 5ML DROPS YES THREE FILLS PER ANNUM

15.1 ANTI-INFECTIVES NEOMYCIN-CHLORAMPHENICOL-NAPHAZOLINE OPH COVOMYCIN 7.5ML DROPS YES THREE FILLS PER ANNUM

15.1 ANTI-INFECTIVES SULFACETAMIDE SODIUM OPHTH OINT 10% SULPHACETAMIDE EYE OINT 3 YES THREE FILLS PER ANNUM

15 ANTI-INFECTIVES OFLOXACIN OPHT SOLN 0.3% OCTIN OPHTHALMIC DROPS YES THREE FILLS PER ANNUM

15 CORTICOIDS DEXAMETHASONE SODIUM PHOSPHATE OPHTH SOLN 0.1% SPERSADEX 0.1% 10ML DROPS YES


15 CORTICOIDS PREDNISOLONE ACETATE OPHTH SUSP 0.125% PRED-MILD 5ML DROPS YES THREE FILLS PER ANNUM

15 CORTICOIDS BETAMETHASONE SODIUM PHOSPHATE OPHTH-OTIC-NASAL SOLN 0.1% BETNESOL DROPS YES


15 COMBINATIONS (ANTI-INFECTIVES WITH CORTICOIDS)

15 DECONGESTANTS

15.4 DECONGESTANTS NAPHAZOLINE 0.005% W/ ZINC SULFATE OPHTH OCULOSAN 10ML EYE DROPS YES THREE FILLS PER ANNUM

15.4 DECONGESTANTS PHENYLEPHRINE-BORIC ACID OPHTH SOLN 1.25-20 MG/ML SB UNIVERSAL EYE DROPS 15 YES


15.4 DECONGESTANTS TETRAHYDROZOLINE-ANTAZOLINE OPHTH SOLN 0.04-0.05% OCULERGE 20ML EYE DROPS YES


15.4 DECONGESTANTS AZELASTINE HCL OPHTH SOLN 0.05% OPTILAST YES THREE FILLS PER ANNUM

16 MYDRIATICS

16 GLAUCOMA


16 OTHER OPHTHALMICS

15.7 OTHER OPHTHALMICS CROMOLYN SODIUM OPHTH SOLN 2% CROMOHEXAL EYE DROPS YES THREE FILLS PER ANNUM

16 URINARY SYSTEM

16 DIURETICS


16 ANTI-DIURETICS

Page 15 of 20


16 URINARY ALKALINIZERS

16 URINARY ALKALINIZERS POTASSIUM CITRATE & CITRIC ACID SOLN 45-21 MG/15ML GENCIT SIMPLEX YES


16 URINARY ANTISEPTICS

16.4 URINARY ANTISEPTICS NITROFURANTOIN MACROCRYSTALLINE CAP 50 MG MACRODANTIN 50MG CAP YES THREE FILLS PER ANNUM

16.4 URINARY ANTISEPTICS NITROFURANTOIN MACROCRYSTALLINE CAP 100 MG MACRODANTIN 100MG CAP YES THREE FILLS PER ANNUM

16.4 URINARY ANTISEPTICS NITROFURANTOIN SUSP 25 MG/5ML FURANDANTIN 25MG/5ML YES THREE FILLS PER ANNUM

16.4 URINARY ANTISEPTICS NALIDIXIC ACID SUSP 250MG/5ML WINLOMYLON SUSP YES THREE FILLS PER ANNUM

16.4 URINARY ANTISEPTICS NALIDIXIC ACID TAB 500 MG PUROMYLON 500MG TABS YES THREE FILLS PER ANNUM

17 GENITAL SYSTEM

17 VAGINAL PREPARATIONS

17.2 VAGINAL PREPARATIONS CLOTRIMAZOLE VAGINAL CREAM 1% CANEX VAG CREAM YES 3 FILLS PER ANNUM

FEMALES ONLY

17.2 VAGINAL PREPARATIONS MICONAZOLE NITRATE VAGINAL CREAM 2% GYNO-DAKTARIN VCR YES 3 FILLS PER ANNUM

FEMALES ONLY

18 ANTI-MICROBIALS

18 BETA-LACTAMS

18.1.1 PENICILLINS AMOXICILLIN & K CLAVULANATE FOR SUSP 125-31.25 MG/5ML SANDOZ CO AMOCLAV S YES


18.1.1 PENICILLINS AMOXICILLIN & K CLAVULANATE FOR SUSP 200-28.5 MG/5ML AUGMENTIN BD S YES


18.1.1 PENICILLINS AMOXICILLIN & K CLAVULANATE FOR SUSP 250-62.5 MG/5ML SANDOZ CO AMOCLAV SF YES


18.1.1 PENICILLINS AMOXICILLIN & K CLAVULANATE FOR SUSP 400-57 MG/5ML SANDOZ CO AMOCLAV BD YES


18.1.1 PENICILLINS AMOXICILLIN & K CLAVULANATE TAB 250-125 MG AUSTELL CO-AMOXICLAV 375MG YES THREE FILLS PER ANNUM

18.1.1 PENICILLINS AMOXICILLIN & K CLAVULANATE TAB 500-125 MG AUSTELL CO-AMOXICLAV 625MG YES THREE FILLS PER ANNUM

18.1.1 PENICILLINS AMOXICILLIN & K CLAVULANATE TAB 875-125 MG ADCO-AMOXYCLAV BD 1000MG YES THREE FILLS PER ANNUM

18.1.1 PENICILLINS AMOXICILLIN & K CLAVULANATE TAB DISP 500-125 MG SANDOZ CO-AMOCLAV 625MG DISP YES THREE FILLS PER ANNUM

18.1.1 PENICILLINS AMOXICILLIN & K CLAVULANATE TAB DISP 875-125 MG SANDOZ CO-AMOCLAV 1000MG DISP YES THREE FILLS PER ANNUM

18.1.1 PENICILLINS AMOXICILLIN (TRIHYDRATE) CAP 250 MG IPCAMOX 250MG CAPS YES THREE FILLS ON ACUTE

18.1.1 PENICILLINS AMOXICILLIN (TRIHYDRATE) CAP 500 MG RANMOXY 500MG CAPS YES THREE FILLS ON

Page 16 of 20

ACUTE

18.1.1 PENICILLINS AMOXICILLIN (TRIHYDRATE) FOR SUSP 125 MG PROMOXIL S 125MG/5ML YES THREE FILLS ON ACUTE

18.1.1 PENICILLINS AMOXICILLIN (TRIHYDRATE) FOR SUSP 250 MG PROMOXIL SF 250MG/5ML YES THREE FILLS ON ACUTE

18.1.1 PENICILLINS AMOXICILLIN-FLOXACILLIN CAP 250-250 MG MACROPEN CAP YES THREE FILLS PER ANNUM

18.1.1 PENICILLINS AMOXICILLIN-FLOXACILLIN FOR SUSP 125-125 MACROPEN SUSP YES THREE FILLS PER ANNUM

18.1.1 PENICILLINS CLOXACILLIN SODIUM CAP 250 MG CLOXIN 250MG CAP YES THREE FILLS PER ANNUM

18.1.1 PENICILLINS CLOXACILLIN SODIUM CAP 500 MG CLOXIN 500MG CAPS YES THREE FILLS PER ANNUM

18.1.1 PENICILLINS PENICILLIN V POTASSIUM FOR SOLN 125 MG/5 BETAPEN 125MG/5ML SYR YES THREE FILLS ON ACUTE

18.1.1 PENICILLINS PENICILLIN V POTASSIUM TAB 250 MG BETAPEN 250MG TAB YES THREE FILLS ON ACUTE

18.1.2 CEPHALOSPORINS CEPHALEXIN CAP 250 MG RANCEPH 250MG CAPS YES THREE FILLS PER ANNUM

18.1.2 CEPHALOSPORINS CEPHALEXIN CAP 500 MG RANCEPH 500MG CAPS YES THREE FILLS PER ANNUM

18.1.2 CEPHALOSPORINS CEPHALEXIN FOR SUSP 125 MG/5ML RANCEPH 125MG/5ML SUSP YES THREE FILLS PER ANNUM

18.1.2 CEPHALOSPORINS CEPHALEXIN FOR SUSP 250 MG/5ML RANCEPH 250MG/5ML SUS YES THREE FILLS PER ANNUM

18.1.2 CEPHALOSPORINS CEFIXIME TAB 400MG FIXIME 400MG TABS YES THREE FILLS PER ANNUM

18.1.2 CEPHALOSPORINS CEFTRIAXONE SODIUM FOR INJ 250MG MEDAXONE 250MG INJ YES THREE FILLS PER ANNUM

18.1.2 CEPHALOSPORINS CEFUROXIME AXETIL TAB 250 MG ZEFURIME 250MG TABS YES THREE FILLS PER ANNUM

18.1.2 CEPHALOSPORINS CEFUROXIME AXETIL TAB 500 MG ZEFURIME 500MG TABS YES THREE FILLS PER ANNUM

18.1.2 CEPHALOSPORINS CEFUROXIME AXETIL FOR SUSP 125 MG/5ML SANDOZ CEFUROXIME 125MG/5ML YES THREE FILLS PER ANNUM

18 ERYTHROMYCIN AND OTHER MACROLIDES

18.2 ERYTHROMYCIN AND OTHER MACROLIDES ERYTHROMYCIN ESTOLATE CAP 250 MG ADCO-ERYTHROMYCIN 250 CAP YES


18.2 ERYTHROMYCIN AND OTHER MACROLIDES ERYTHROMYCIN STEARATE TAB 250 MG ERYKO 250MG TABS YES


18.2 ERYTHROMYCIN AND OTHER MACROLIDES ERYTHROMYCIN ESTOLATE SUSP 125 MG/5ML PURMYCIN 125MG/5ML SUSP YES


18.2 ERYTHROMYCIN AND OTHER MACROLIDES ERYTHROMYCIN ESTOLATE SUSP 250 MG/5ML PURMYCIN 250MG/5ML SUSP YES


18.2 ERYTHROMYCIN AND OTHER MACROLIDES AZITHROMYCIN CAP 250MG VARIMAX 250MG CAPS YES

MAXIMUM 12 CAPS P/ANNUM 4 8

18.2 ERYTHROMYCIN AND OTHER MACROLIDES AZITHROMYCIN TAB 600MG ULTREON 600MG YES

MAXIMUM 6 TABS PER 2 4

Page 17 of 20

ANNUM

18.2 ERYTHROMYCIN AND OTHER MACROLIDES CLARITHROMYCIN TAB 250MG KLARIBIN 250MG TABS YES


18.2 ERYTHROMYCIN AND OTHER MACROLIDES CLARITHROMYCIN TAB 500MG KLARIBIN 500MG TABS YES


18.2 ERYTHROMYCIN AND OTHER MACROLIDES CLARITHROMYCIN FOR SUSP 125MG/5ML CLARIHEXAL 125 P SUSP YES


18.2 ERYTHROMYCIN AND OTHER MACROLIDES CLARITHROMYCIN FOR SUSP 250MG/5ML CLARIHEXAL 250 P SUSP YES


18.2 ERYTHROMYCIN AND OTHER MACROLIDES CLARITHROMYCIN TAB SR 24HR 500MG KLARITHRAN MR 500MG TABS YES


18 TETRACYCLINES

18.4 TETRACYCLINES DOXYCYCLINE HYCLATE CAP 50 MG DUMOXIN 50MG CAPS YES


18.4 TETRACYCLINES DOXYCYCLINE HYCLATE CAP 100 MG DOXYTET 100MG CAPS YES


18.4 TETRACYCLINES DOXYCYCLINE HYCLATE CAP DR PARTICLES 50MG CYCLIDOX EC 50MG CAPS YES


18.4 TETRACYCLINES DOXYCYCLINE HYCLATE CAP DR PARTICLES 100MG CYCLIDOX EC 100MG CAPS YES


18.4 TETRACYCLINES OXYTETRACYCLINE HCL CAP 250 MG NUCOTET CAPS YES THREE FILLS PER ANNUM

18.4 TETRACYCLINES TETRACYCLINE HCL TAB 250 MG TETRACYCLINE 250 MG TABS YES THREE FILLS PER ANNUM

19 CHLORAMPHENICOLS

19 SULPHONAMIDES AND COMBINATIONS

18.6 SULPHONAMIDES AND COMBINATIONS SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-4 CO-TRIM SUSP YES


18.6 SULPHONAMIDES AND COMBINATIONS SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 400-80 NUCOTRIM 480MG TABS YES


18.6 SULPHONAMIDES AND COMBINATIONS SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 800-16 SANDOZ CO-TRIMOXAZOLE 800 YES


19 QUINOLONES

18.7 QUINOLONES CIPROFLOXACIN HCL TAB 250 MG CIPROGEN 250MG TABS YES THREE FILLS PER ANNUM

18.7 QUINOLONES CIPROFLOXACIN HCL TAB 500 MG CIFRAN 500MG TABS YES THREE FILLS PER ANNUM

18.7 QUINOLONES CIPROFLOXACIN HCL TAB 750 MG AUSTELL CIPROFLOX 750 MG TAB YES THREE FILLS PER ANNUM

Page 18 of 20

18.8.1 TUBERCULOSTATICS


19 OTHER ANTI-BACTERIAL AGENTS

18.9 OTHER ANTI-BACTERIAL AGENTS CLINDAMYCIN HCL CAP 150 MG CLINDAHEXAL 150MG CAPS YES THREE FILLS PER ANNUM

18.10 ANTI-FUNGAL AGENTS

18.10 ANTI-FUNGAL AGENTS FLUCONAZOLE CAP 150 MG MYCOREST 150MG CAPS YES SIX FILLS PER ANNUM

18.10 ANTI-FUNGAL AGENTS GRISEOFULVIN MICROSIZE TAB 125 MG MICROCIDAL 125MG TAB YES THREE FILLS PER ANNUM

18.10 ANTI-FUNGAL AGENTS GRISEOFULVIN MICROSIZE TAB 500 MG MICROCIDAL 500MG TAB YES THREE FILLS PER ANNUM

18.10 ANTI-FUNGAL AGENTS NYSTATIN SUSP 100000 UNIT/ML CANSTAT ORAL DROPS YES THREE FILLS PER ANNUM

18.11 ANTI-PROTOZOAL AGENTS

18.11 ANTI-PROTOZOAL AGENTS METRONIDAZOLE SUSP 200 MG/5ML FLAGYL 200MG/5ML SUSP YES THREE FILLS PER ANNUM

MAX AGE = 10

18.11 ANTI-PROTOZOAL AGENTS METRONIDAZOLE TAB 200 MG BIO-METRONIDAZOLE TABS YES THREE FILLS PER ANNUM

18.11 ANTI-PROTOZOAL AGENTS METRONIDAZOLE TAB 400 MG METRAZOLE 400MG TABS YES THREE FILLS PER ANNUM

18.12 ANTI-VIRAL AGENTS

18.12 OTHER ANTI-VIRAL AGENTS ACYCLOVIR CREAM 5% ADCO-ACYCLOVIR 50 CREAM YES THREE FILLS PER ANNUM

18.12 OTHER ANTI-VIRAL AGENTS ACYCLOVIR TAB 200 MG ACYCLOVIR BIOTECH 200MG TAB YES THREE FILLS PER ANNUM

18.12 OTHER ANTI-VIRAL AGENTS ACYCLOVIR TAB 400 MG ACICLOVIR SANDOZ 400MG TAB YES THREE FILLS PER ANNUM

18.12 OTHER ANTI-VIRAL AGENTS ACYCLOVIR TAB 200 DISP MG LOVIRE 200MG DISP TABS YES THREE FILLS PER ANNUM

18.12 OTHER ANTI-VIRAL AGENTS ACYCLOVIR TAB 400 DISP MG LOVIRE 400MG DISP TABS YES THREE FILLS PER ANNUM

19 ENDOCRINE SYSTEM

19 ANTI-DIABETIC AGENTS


19 THYROID


20 CORTICOSTEROIDS

19.5 CORTICOSTEROIDS PREDNISOLONE SYRUP 15 MG/5ML ADCO PREDNISOLONE 15MG/5MG SYR YES THREE FILLS PER ANNUM

MAX AGE = 10

Page 19 of 20

19.5 CORTICOSTEROIDS PREDNISOLONE TAB 5 MG CAPSOID 5MG TABS YES THREE FILLS PER ANNUM

19.5 CORTICOSTEROIDS PREDNISONE TAB 5 MG PANAFCORT 5MG TAB YES THREE FILLS PER ANNUM

19.5 CORTICOSTEROIDS BETAMETHASONE SYRUP 0.6MG/5ML BETANOID 0.6MG/5ML SYR YES THREE FILLS PER ANNUM

MAX AGE = 10

20 SEX HORMONES

19.6.3 PROGESTOGENS MEDROXYPROGESTERONE ACETATE TAB 5 MG HEXAL-MPA 5MG TAB YES THREE FILLS PER ANNUM

FEMALES ONLY

19.6.3 PROGESTOGENS MEDROXYPROGESTERONE ACETATE TAB 10 MG HEXAL-MPA 10MG TAB YES THREE FILLS PER ANNUM

FEMALES ONLY

20 HORMONE INHIBITORS


20 VITAMINS, TONICS, MINERALS AND ELECTROLYTES

20 VITAMINS

20.1 PRENATAL VITAMINS FOLIC ACID TAB 5 MG FOLIC ACID 5MG TABS YES TWELVE FILLS PER ANNUM

FEMALES ONLY

20.1 PRENATAL VITAMINS PRENATAL MULTIVITAMINS & MINERALS W/ IRON PROUDLY PREGGY CAPS YES

LIMIT TO 9 CONSECUTIVE MONTHS FOR PREGNANT WOMEN

FEMALES ONLY

20.1 PRENATAL VITAMINS PRENATAL MULTIVITAMINS & MINERALS W/IRON PROUDLY PREGGY TABS YES


FEMALES ONLY

20.1 PRENATAL VITAMINS PRENATAL VIT W/ FE FUMARATE-FA CAP 60-0.8 MG PREGNAVIT M CAPS YES


FEMALES ONLY

20.1 PRENATAL VITAMINS PRENATAL VIT W/ FE FUMARATE-FA CAP 27-0.8 MG PRE-NATAL FORTE CAPS YES


FEMALES ONLY

20.1 PRENATAL VITAMINS PRENATAL VITAMIN TAB PREGWISE TABS YES


FEMALES ONLY

20 VITAMINS WITH MINERALS

20 PEDIATRIC VITAMINS PEDIATRIC VITAMINS WITH IRON DROPS SUPLIMAX VITAMIN B COMPLEX SYR YES

Page 20 of 20

20 VITAMIN MIXTURES VITAMIN MIXTURE SYRUP VITAMINO SYRUP YES

20 MINERALS AND ELECTROLYTES

20 MINERALS AND ELECTROLYTES ORAL ELECTROLYTE PACKET GASTROLYTE 13G YES QTY LIMIT = 6

23 CYTOSTATICS


24 IMMUNOLOGICALS

24 IMMUNOSUPPRESSANTS


24 IMMUNOSTIMULANTS


24 CHELATING AGENTS, ION EXCHANGE PREPARATIONS


26 BIOLOGICALS

26 BIOLOGICALS INFLUENZA VIRUS VACCINE SPLIT INJ VAXIGRIP S/DOSE 0.25ML YES

ONE FILL PER ANNUM FROM ACUTE, PRE-AUTHORISATION REQUIRED FOR PMB

26 BIOLOGICALS INFLUENZA VIRUS VACCINE TYPES A & B SURF MUTAGRIP YES


26 BIOLOGICALS INFLUENZA VIRUS VACCINE WHOLE INJ INFLUVAC YES


OTHER OTHER PRODUCTS

50 HOSPITAL DISINFECTANTS

50 HOSPITAL DISINFECTANTS CHLORHEXIDINE GLUCONATE SOLN 0.2% CORSODYL 2MG/ML SOLN YES ONE FILL PER ANNUM

Documents

ACUTE MEDICINE FORMULARY 2018 - FishMed20180119114048 AM) FINAL_Fish… · 1.3.1 benzo anxiolytics oxazepam tab 30 mg purata 30 mg tabs yes maximum quantity of 90 per annum 1.4 anti-depressants