new brunswick prescription drug program formulary

Transcription

NEW BRUNSWICK
PRESCRIPTION DRUG PROGRAM
FORMULARY
FORMULAIRE DU PLAN DE
MÉDICAMENTS SUR ORDONNANCE
DU NOUVEAU-BRUNSWICK
FEBRUARY 2014
FÉVRIER 2014
NEW BRUNSWICK
PRESCRIPTION DRUG PROGRAM
FORMULARY
Copyright - 2014
HM The Queen
in Right of
The Province of New Brunswick
as represented by
The Honourable Hugh J. Flemming, Q.C.
Minister of Health
ADMINISTERED BY MEDAVIE BLUE CROSS
ON BEHALF OF THE GOVERNMENT OF NEW BRUNSWICK
TABLE OF CONTENTS
Page
Introduction
I
New Brunswick Prescription Drug Program Plans
II - III
Exclusions
IV - V
Drug Review Process
VI
ACDR Drug Requirements
VII
Legend
VIII
Comment Sheet
IX
Anatomical Therapeutic Chemical Classification of Drugs
A
B
C
D
G
H
J
L
M
N
P
R
S
V
Appendices
I-A
I-B
I-C
I-D
II
III
IV
IV
Alimentary Tract and Metabolism
Blood and Blood Forming Organs
Cardiovascular System
Dermatologicals
Genito Urinary System and Sex Hormones
Systemic Hormonal Preparations, Excluding Sex Hormones
Antiinfectives for Systemic Use
Antineoplastic and Immunomodulating Agents
Musculo-Skeletal System
Nervous System
Antiparasitic Products, Insecticides and Repellants
Respiratory System
Sensory Organs
Various
Abbreviations of Dosage Forms
Abbreviations of Routes
Abbreviations of Units
Abbreviations of Manufacturers' Names
Placebos
Extemporaneous Preparations
Special Authorization
Special Authorization Drug Criteria
1
18
26
67
79
88
94
118
126
135
182
184
192
201
A-1 - A-4
A-5 - A-6
A-7 - A-8
A-9 - A-10
A-11
A-12
A-13 - A-14
A-15
NEW BRUNSWICK PRESCRIPTION
DRUG PROGRAM FORMULARY
Introduction
The New Brunswick Prescription Drug Program (NBPDP) provides prescription drug coverage to eligible New
Brunswick residents (see pages II and III).
The New Brunswick Prescription Drug Program (NBPDP) Formulary is a list of the drugs which are eligible benefits
under the Program. All drugs considered for listing as benefits must be reviewed according to the drug review
process.
Most drugs listed in the NBPDP Formulary are “regular” benefits which are reimbursed with no criteria or prior
approval requirements. Some drugs require special authorization in order to be reimbursed. Certain drug products
are not eligible benefits and are identified on the exclusion list (see Formulary pages IV and V).
An electronic copy of the Formulary is updated monthly on the NBPDP web page. To have your name added to the email mailing list to receive notification of monthly updates and Formulary Update Bulletins, please sign up online at
NBPDP Email Announcements.
February 2014
I
Plans
Participating
Beneficiaries
Fees
A
$9.05 per prescription up to an
annual copay ceiling of $500 for
GIS recipients.
$15.00 per prescription with no
annual ceiling for non-GIS
recipients
B
Legislative
Authority
Eligible residents of the province
who are sixty-five years of age or
older
Prescription Drug
Payment Act and
Regulations
$50 per year registration fee ;
20% of cost of prescription to a
maximum of $20 per prescription
up to an annual ceiling of $500 per
family unit
Persons with cystic fibrosis who are
eligible residents and registered with
the Department of Health
Prescription Drug
Payment Act and
Regulations
E
$4 per prescription; up to an annual
(2)
copay ceiling of $250 per person
Persons in licensed residential
facilities who are in receipt of
financial assistance from the
Department of Social Development
and hold a valid health card issued
by the Department of Social
Development
Health Services Act
and Regulations
F
$4 per prescription for adults (18
years and over)
$2 per prescription for children
(under 18 years);
up to an annual copay ceiling of
(2)
$250 per family unit
Department of Social Development
clients
Health Services Act
and Regulations
G
None
Children in care of the Minister of
the Department of Social
Development and special needs
children
Health Services Act
and Regulations
H
$50 per year premium; copay
ranges from zero to 100 per cent
for each prescription
Persons with multiple sclerosis who
are eligible residents and registered
with the Department of Health
Prescription Drug
Payment Act and
Regulations
R
family unit
Solid organ transplant recipients
who are eligible residents and
registered with the Department of
Health
Prescription Drug
Payment Act and
Regulations
(1)
Persons with growth
hormone deficiency who are
eligible residents and
registered with the
Department of Health
Prescription Drug
Payment Act and
Regulations
(1)
HIV-infected persons who
are eligible residents and
registered with the
Prescription Drug
Payment Act and
Regulations
(1)
(1)
T
family unit
U
family unit
February 2014
II
Plans
V
Special
Authorization
None
Plan dependent
Non-NBPDP
Plan
W
Participating
Beneficiaries
Fees
(3)
Eligible residents of Nursing Homes
as defined in the Nursing Home Act
operated by a licensee under the
Act
Prescription Drug
Payment Act and
Regulations
Persons approved to have payment
made for certain drugs following
medical consultation
Prescription Drug
Payment Act
Participating
Beneficiaries
Fees
$9.05 per prescription
Extra Mural Hospital patients who
are in possession of a Prescription
Drug Authorization Form
(1) Family and Community Services clients are exempted from these fees.
(2) Exempted from these fees for contraceptives.
(3) See Appendix IV.
February 2014
III
Legislative
Authority
Legislative
Authority
Hospital Services Act
Exclusions
Exclusions are items that are not eligible benefits under the New Brunswick Prescription Drug Program. These items
fall outside of the program’s mandate or are excluded based on the recommendation of an expert advisory committee
and are not considered for coverage.
1.
Patent medicines such as Jack and Jill Cough Syrup, Extract of Wild Strawberry, etc.
2.
Non-prescription acetylsalicylic acid (ASA) preparations except enteric coated ASA products designated as
benefits.
3.
Non-prescription mouth, throat and nasal preparations, including decongestants.
4.
Prescription and non-prescription, cough and cold products (e.g. antitussives, expectorants and
decongestants) except those listed as benefits for children in care (Plan G).
5.
(a) Non-prescription adult vitamins with or without iron supplements (Plans A, E, F
[over 18 years of age]) as a dietary supplement.
(b) Multivitamins (prescription and non-prescription) as a dietary supplement.
6.
Non-prescription tonics and compounded iron preparations (except single entity iron preparations designated
as benefits).
7.
Dietary/nutritional supplements and food products.
8.
Artificial sweetening agents.
9.
Weight loss products (prescription and non-prescription).
10.
Calcium preparations (prescription and non-prescription) as a dietary supplement.
11.
Laxatives (Plans A, E,F and G) .
12.
Antacids (Plans A only).
13.
Smoking cessation products.
14.
Ergoloid mesylates, oral, (Hydergine).
15.
Potassium supplements, oral, when supplied as K-Lyte effervescent tablets, lime or orange flavoured.
16.
Retinoic acid (eg. Tretinoin) topical and oral preparations (Plan A only).
17.
Cosmetic, health, dental and beauty aids, and cosmetic drugs.
18.
Soaps, cleansers and shampoos, medicated or otherwise.
19.
Appliances, devices and medical supplies including prostheses, first aid supplies and syringes.
20.
Diagnostic agents and point-of-care testing kits.
21.
Household remedies e.g. calamine lotion, iodine, hydrogen peroxide, antiseptics
and disinfectants.
22.
Injectables or other products normally administered in a hospital setting or requiring a health care professional
for administration and/or monitoring to ensure the appropriate standard of patient care is provided.
23.
Any insured service for which the resident is entitled to benefit under Department of Veterans Affairs,
Workplace Health & Safety Compensation Commission or other legislation.
24.
Delivery, postal or C.O.D. charges.
25.
Refills in excess of the number specified by the physician or any refill of a prescription older than one year
unless approved for refill by the prescriber.
February 2014
IV
26.
Antihistamines (Plans A, E, F, and V)
27.
Benzoyl Peroxide preparations in strengths of 5% or less.
28.
Lactase Enzyme products.
29.
All drug products used for the treatment of infertility.
30.
Products for the treatment of impotence and sexual dysfunction.
31.
Butorphanol nasal spray.
32.
Drugs excluded as eligible benefits further to the expert advisory committee’s review and recommendation that
they not be listed.
33.
Medications for the prevention of travel acquired diseases (eg. malaria, gastrointestinal illnesses and other
potential conditions)
February 2014
V
Drug Review Process
All drugs considered for benefit status in the New Brunswick Prescription Drug Program (NBPDP) Formulary are
subject to a standard review process. Drugs are reviewed by an expert advisory committee that evaluates the
available clinical and cost-effectiveness information and makes a recommendation to drug plans on whether it should
be listed as a benefit.
The New Brunswick Prescription Drug Program receives formulary listing recommendations from the following three
common drug review processes. Formulary listing decisions are based on the expert advisory committee’s
recommendation, along with other factors, including the budget impact analysis and the program’s mandate, priorities
and resources.
National Common Drug Review
The Common Drug Review (CDR) provides participating federal, provincial and territorial drug benefit plans with a
systematic review of the best available clinical evidence, a critique of manufacturer-submitted
pharmacoeconomic studies and a formulary listing recommendation made by the Canadian Drug Expert Committee
(CDEC).
Eligible submissions from manufacturers include those for new drugs, new combination products and drugs with new
indications. Information on the CDR submission requirements and procedures is posted at: www.cadth.ca.
pan-Canadian Oncology Drug Review
The pan-Canadian Oncology Drug Review (pCODR) is an evidence-based cancer drug review process. The pCODR
Expert Review Committee (pERC) assesses the clinical evidence and cost effectiveness of new cancer drugs and
provides a listing recommendation to the participating provinces and territories. Information on the pCODR
submission requirements and procedures is posted at: www.pcodr.ca
Atlantic Common Drug Review
The Atlantic Common Drug Review (ACDR) assesses the clinical and cost effectiveness of drugs that do not fall
under the mandates of the national Common Drug Review (CDR) or the pan-Canadian Oncology Drug Review
(pCODR). Formulary listing recommendations are made by the Atlantic Expert Advisory Committee (AEAC) to the
Atlantic provincial drug plans.
Information on the ACDR submission requirements and procedures is posted at:
http://novascotia.ca/dhw/pharmacare/atlantic-common-drug-review.asp
Manufacturers' Drug Submissions
Drug submission requirements and timelines are outlined in the procedures of the respective common drug review
processes. Please send a copy of each submission in the specified format to:
Director, NB Prescription Drug Program
Phone: (506) 453-8266
Fax:
(506) 453-3983
th
520 King Street, 6 Floor HSBC Place
[email protected]
PO Box 5100
Fredericton, NB E3B 5G8
The NBPDP may charge manufacturers for costs associated with the review of drug submissions and resubmissions;
however, this occurs infrequently.
ACDR Drug Submission Requirements
•
All documents must be provided to each participating province in electronic format on compact disc accompanied
by a cover letter.
•
One complete hard copy submission must be sent to the ACDR coordinator.
•
Receipt of submissions is acknowledged by the ACDR secretariat by e-mail. Please include a contact email address in the submission.
February 2014
VI
New drug products not eligible for review by CDR
1.
Executive Summary
2.
Notice of Compliance (NOC)
3.
Product Monograph
4.
Therapeutic classifications:
•
American Hospital Formulary Service, Pharmacologic-Therapeutic Classification (PTC) and
•
World Health Organization's Anatomical Therapeutic Chemical (ATC) classification
5.
Clinical evidence on efficacy, effectiveness and safety.
•
Double-blind, randomized, controlled trials (RCTs) published in peer-reviewed journals are given the most
weight
•
If unpublished/abstract data is submitted, it must be indicated why it is unpublished
•
List all studies submitted in one table and specify the study name, date, authors and whether it is published
or unpublished
•
Published articles supporting the validity of outcome measures in studies (if available)
6.
Economic Information
a. A pharmacoeconomic evaluation is required for most new chemical entities. Studies should follow current
guidelines from the Canadian Agency for Drugs and Technologies in Health (CADTH)
b. Budget impact analysis
7.
Pricing and availability
a. Current price for all strengths and dosage forms
b. Method of distribution to pharmacies (wholesale, direct or other arrangements)
c. Evidence of ability to supply anticipated demand
8.
A letter authorizing unrestricted communication regarding the drug product between the New Brunswick
Prescription Drug Program and
a. Other federal, provincial and territorial (F/P/T) drug programs
b. F/P/T health authorities and related facilities
c. Health Canada
d. Patented Medicine Prices Review Board (PMPRB)
e. Canadian Agency for Drugs and Technologies in Health (CADTH)
9.
A letter specifying the current or intended Compendium of Pharmaceuticals and Specialties (CPS) listing status.
10. A copy of the Pharmaceutical Advertising Advisory Board (PAAB) approved promotional materials
11. Manufacturers will be invoiced for any costs associated with the review of a drug submission or re-submission.
Drug submission requirements for line extensions and resubmissions are posted at:
http://www.gov.ns.ca/health/Pharmacare/committees/acdr.asp
February 2014
VII
Legend
1.
2.
3.
4.
5.
6.
7.
ATC-Therapeutic subgroup
ATC- Pharmacological subgroups
ATC- Chemical Substance
Dosage form, route and strength. Strength represents
the amount of ingredients present in a solid dose form
(Tablet) or in one gram or one millilitre of a preparation
(Cream, Liquid, etc.)
Brand or manufacturers' product name
Drug Identification Number (DIN)
Manufacturers' identification code. See Appendix I-D for
an explanation of codes
February 2014
VIII
8.
Drug program plans for which the product is
considered to be a benefit
9. Indicates that the products are interchangeable
10. Manufacturer has discontinued this product it will
be deleted from the list as a benefit on the date
indicated
11. Indicates that the copay is waived for Plan ‘E’
and Plan “F’ prescriptions
12. Date of publication
Your comments please.....
______________________________________________________________________
The New Brunswick Prescription Drug Program would like to offer you the opportunity to provide your comments. If
you have any concerns and/or suggestions concerning the formulary, product listings, etc., please let us know.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Please return to:
NB Prescription Drug Program
P.O. Box 5100
Fredericton, New Brunswick
E3B 5G8
or FAX to:
(506) 453-3983
February 2014
IX
A01
STOMATOLOGICAL PREPARATIONS
PRODUITS STOMATOLOGIQUES
A01A
STOMATOLOGICAL PREPARATIONS
PRODUITS STOMATOLOGIQUES
A01AA
CARIES PROPHYLACTIC AGENTS
AGENTS PROPHYLACTIQUES DES CARIES
A01AA01
SODIUM FLUORIDE
FLUORURE DE SODIUM
Liq
Liq
A01AC
Den
Fluorinse
00782882
MLA
EF-18G
01964054
TAR
AEFGVW
PMS
APX
TEV
AEFGVW
AEFGVW
AEFGVW
CORTICOSTEROIDS FOR LOCAL ORAL TREATMENT
CORTICOSTÉROÏDES POUR TRAITEMENT BUCCAL LOCALISÉ
A01AC01
TRIAMCINOLONE
TRIAMCINOLONE
Pst
Pst
A01AD
0.2%
Den
0.1%
Oracort
OTHER AGENTS FOR LOCAL ORAL TREATMENT
AUTRES MÉDICAMENTS POUR TRAITEMENT BUCCAL LOCALISÉ
A01AD02
BENZYDAMINE
BENZYDAMINE
Liq
Liq
Buc
0.15%
Pharixia
Apo-Benzydamine (Disc/non disp Mar 30/14)
Novo-Benzydamine (Disc/non disp Feb 15/15)
02229777
02239044
02310422
A02
DRUGS FOR ACID RELATED DISORDERS
MÉDICAMENTS CONTRE LES TROUBLES DUS À L'HYPERACIDITÉ
A02A
ANTACIDS
ANTIACIDES
A02AD
COMBINATIONS AND COMPLEXES OF ALUMINIUM, CALCIUM AND MAGNESIUM COMPOUNDS
COMBINAISON DE COMPOSÉS DE MAGNÉSIUM, D'ALUMINIUM ET DE CALCIUM
A02AD01
ORDINARY SALT COMBINATIONS
COMPOSES DE SEL ORDINAIRE
ALUMINUM / MAGNESIUM
ALUMINUM / MAGNÉSIUM
Sus Orl
Susp
45.6mg/40mg
Diovol
01966529
CHU
G
Sus
Susp
120mg/60mg
Diovol EX
00491217
CHU
G
Orl
February 2014 / février 2014
Page 1
A02B
DRUGS FOR PEPTIC ULCER AND GASTRO-OESOPHAGEAL REFLUX DISEASE (GORD)
MÉDICAMENTS CONTRE L'ULCÈRE GASTRODUODÉNAL ET LE REFLUX GASTRO-OESOPHAGIEN
A02BA
H2-RECEPTOR ANTAGONISTS
ANTAGONISTES DES RÉCEPTEURS H2
A02BA01
CIMETIDINE
CIMETIDINE
Tab
Co.
Orl
200mg
Apo-Cimetidine
00584215
APX
f
ABEFGVW
Tab
Co.
Orl
300mg
Apo-Cimetidine
Mylan-Cimetidine
00487872
02227444
APX
MYL
f
f
ABEFGVW
ABEFGVW
Tab
Co.
Orl
400mg
Apo-Cimetidine
Mylan-Cimetidine
00600059
02227452
APX
MYL
f
f
ABEFGVW
ABEFGVW
Tab
Co.
Orl
600mg
Apo-Cimetidine
Mylan-Cimetidine
00600067
02227460
APX
MYL
f
f
ABEFGVW
ABEFGVW
Tab
Co.
Orl
800mg
Apo-Cimetidine
00749494
APX
f
ABEFGVW
A02BA02
RANITIDINE
RANITIDINE
Liq
Liq
Inj
25mg
Zantac
02212366
GSK
Liq
Liq
Orl
15mg
Teva-Ranidine
Apo-Ranitidine
02242940
02280833
TEV
APX
f
f
EFGVW
EFGVW
Tab
Co.
Orl
150mg
Apo-Ranitidine
Teva-Ranidine
ratio-Ranitidine (Disc/non disp Jun 29/14)
Mylan-Ranitidine
Zantac
pms-Ranitidine
Sandoz Ranitidine
Co Ranitidine
Ran-Ranitidine
Ranitidine
Myl-Ranitidine
00733059
00828564
00828823
02207761
02212331
02242453
02243229
02248570
02336480
02353016
02367378
APX
TEV
RPH
MYL
GSK
PMS
SDZ
COB
RAN
SAS
MYL
f
f
f
f
f
f
f
f
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
Tab
Co.
Orl
300mg
Apo-Ranitidine
Teva-Ranidine
Mylan-Ranitidine
Zantac
pms-Ranitidine
Sandoz Ranitidine
Co Ranitidine
Ran-Ranitidine
Ranitidine
Myl-Ranitidine
00733067
00828556
02207788
02212358
02242454
02243230
02248571
02336502
02353024
02367386
APX
TEV
MYL
GSK
PMS
SDZ
COB
RAN
SAS
MYL
f
f
f
f
f
f
f
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
Page 2
W
A02BB
PROSTAGLANDINS
PROSTAGLANDINES
A02BB01
A02BC
Tab
Co.
Orl
100mcg
Misoprostol
02244022
AAP
f
AEFGVW
Tab
Co.
Orl
200mcg
Misoprostol
02244023
AAP
f
AEFGVW
PROTON PUMP INHIBITORS
INHIBITEURS DE LA POMPE À PROTONS
A02BC01
OMEPRAZOLE
OMÉPRAZOLE
SRC Orl 20mg
Caps.L.L
Losec
1
Apo-Omeprazole
1
Sandoz Omeprazole
1
pms-Omeprazole
1
Mylan-Omeprazole
1
Omeprazole
1
Ran-Omeprazole
1
00846503
02245058
02296446
02320851
02329433
02348691
02403617
AZE
APX
SDZ
PMS
MYL
SAS
RAN
f
f
f
f
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
SRT Orl 20mg
Co.L.L.
Losec
1
ratio-Omeprazole(Disc/non disp July 24/15)
1
Teva-Omeprazole
1
pms-Omeprazole DR
1
Ran-Omeprazole
1
02190915
02260867
02295415
02310260
02374870
AZE
TEV
TEV
PMS
RAN
f
f
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
Tecta
02267233
TAK
A02BC02
Tab
Co.
A02BC04
1
MISOPROSTOL
MISOPROSTOL
PANTOPRAZOLE
PANTOPRAZOLE
Orl
40mg
ABEFGVW
RABEPRAZOLE
RABÉPRAZOLE
ECT
Orl
Co.Ent
10mg
Pariet
Teva-Rabeprazole EC
Ran-Rabeprazole
pms-Rabeprazole EC
Sandoz Rabeprazole
Apo-Rabeprazole
Rabeprazole EC
Pat-Rabeprazole
Mylan-Rabeprazole
02243796
02296632
02298074
02310805
02314177
02345579
02356511
02381737
02408392
JAN
TEV
RAN
PMS
SDZ
APX
SAS
PAT
MYL
f
f
f
f
f
f
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ECT Orl
Co.Ent.
20mg
Pariet
Teva-Rabeprazole EC
Ran-Rabeprazole
02243797
02296640
02298082
JAN
TEV
RAN
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
Omeprazole prescribed in doses higher than 20mg daily will require special authorization. Please refer to Appendix IV for
the criteria. For plans ABEFGV, a bi-annual quantity limit has been established for this drug.
La couverture d’omeprazole au doses supérieures à 20mg par jour exige une autorisation spéciale. Veuillez consulter
l’annexe IV pour critéres. Pour les régimes ABEFGV, une quantité limite semestrielle à été établie pour ce médicament.
Page 3
A02BC04
RABEPRAZOLE
RABÉPRAZOLE
ECT Orl
Co.Ent.
A02BX
20mg
pms-Rabeprazole EC
Sandoz Rabeprazole
Apo-Rabeprazole
Rabeprazole EC
Pat-Rabeprazole
Mylan-Rabeprazole
02310813
02314185
02345587
02356538
02381745
02408406
PMS
SDZ
APX
SAS
PAT
MYL
f
f
f
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
OTHER DRUGS FOR PEPTIC ULCER AND GASTROESOPHAGEAL REFLUX DISEASE (GORD)
AUTRES MÉDICAMENTS CONTRE L'ULCÈRE GASTRODUODÉNAL ET LE REFLUX GASTROOESOPHAGIEN
A02BX02
SUCRALFATE
SUCRALFATE
Sus Orl 200mg
Susp.
Tab Orl
Co.
1gm
Sulcrate Plus
02103567
AXC
Teva-Sulcralfate
Sulcrate
Apo-Sucralfate
02045702
02100622
02125250
TEV
AXC
APX
AEFGVW
f
f
f
A03
DRUGS FOR FUNCTIONAL GASTROINTESTINAL DISORDERS
MÉDICAMENTS CONTRE LES TROUBLES GASTROINTESTINAUX FONCTIONNELS
A03A
DRUGS FOR FUNCTIONAL GASTROINTESTINAL DISORDERS
MÉDICAMENTS CONTRE LES TROUBLES FONCTIONNELS DE L'INTESTIN
A03AA
SYNTHETIC ANTICHOLINERGICS, ESTERS WITH TERTIARY AMINO GROUP
ANTICHOLINERGIQUES SYNTHÉTIQUES A ESTERS AVEC GROUPE AMINO TERTIAIRE
A03AA05
AEFGVW
AEFGVW
AEFGVW
TRIMEBUTINE
TRIMEBUTINE
Tab Orl 100mg
Co.
Trimebutine
02245663
AAP
f
AEFGVW
Tab Orl 200mg
Co.
Modulon
Trimebutine
00803499
02245664
AXC
AAP
f
f
AEFGVW
AEFGVW
10mg
Protylol
00287709
PDL
AEFGVW
A03AA07
DICYCLOVERINE (DICYCLOMINE)
DICYCLOVERINE (DICYCLOMINE)
Cap Orl
Caps
Syr
Sir.
Orl
2mg
Bentylol
02102978
AXC
AEFGVW
Tab
Co.
Orl
10mg
Bentylol
02103087
AXC
AEFGVW
Tab
Co.
Orl
20mg
Protylol-20
Bentylol
00513059
02103095
PDL
AXC
AEFGVW
AEFGVW
Page 4
A03AB
SYNTHETIC ANTICHOLINERGICS, QUATERNARY AMMONIUM COMPOUNDS
ANTICHOLINERGIQUES SYNTHÉTIQUES, ESTERS, COMPOSES D'AMMONIUM QUATERNAIRE
A03AB02
Liq
Liq
A03AX
GLYCOPYRRONIUM (GLYCOPYRROLATE)
GLYCOPYRRONIUM (GLYCOPYRROLATE)
Inj
0.2mg
Glycopyrrolate
02039508
SDZ
AEFVW
OTHER DRUGS FOR FUNCTIONAL GASTROINTESTINAL DISORDERS
AUTRES MÉDICAMENTS POUR LES TROUBLES FONCTIONNELS DE L'INTESTIN
A03AX04
PINAVERIUM
PINAVERIUM
Tab
Tab
Orl
50mg
Dicetel
01950592
ABB
AEFGVW
Tab
Tab
Orl
100mg
Dicetel
02230684
ABB
AEFGVW
A03C
ANTISPASMODICS IN COMBINATION WITH PSYCHOLEPTICS
ANTISPASMODIQUES EN COMBINAISON AVEC DES PSYCHOLEPTIQUES
A03CA
SYNTHETIC ANTICHOLINERGIC AGENTS IN COMBINATION WITH PSYCHOLEPTICS
AGENTS ANTICHOLINERGIQUES SYNTHÉTIQUES EN COMBINAISON AVEC DES PSYCHOLEPTIQUES
A03CA02
CLINIDIUM AND PSYCHOLEPTICS
CLINIDIUM ET PSYCHOLEPTIQUES
CHLORDIAZEPOXIDE / CLINIDIUM
CHLORDIAZEPOXIDE / CLINIDIUM
Cap Orl
Caps
5mg/2.5mg
Librax
Apo-Chlorax
00115630
00618454
VLN
APX
AEFGVW
AEFGVW
A03E
ANTISPASMODICS AND ANTICHOLINERGICS IN COMBINATION WITH OTHER DRUGS
ANTISPASMODIQUES ET ANTICHOLINERGIQUES EN COMBINAISON AVEC D'AUTRES MÉDICAMENTS
A03ED
ANTISPASMODICS IN COMBINATION WITH OTHER DRUGS
ANTISPASMODIQUES EN COMBINAISON AVEC D'AUTRES MÉDICAMENTS
A03ED99
ANTISPASMODICS, COMBINATIONS
ANTISPASMODIQUES, COMBINAISONS
PHENOBARBITAL / ERGOTAMINE / BELLADONNA
PHÉNOBARBITAL / ERGOTAMINE / BELLADONNA
SRT Orl 40mg/0/6mg/0.2mg
Co.L.L.
A03F
PROPULSIVES
PROPULSIFS
A03FA
PROPULSIVES
PROPULSIVES
A03FA01
Liq
Liq
Bellergal spacetabs
00176141
TRI
AEFGVW
Metoclopramide HCL
02185431
SDZ
W
Metonia
02230433
PDP
METOCLOPRAMIDE
MÉTOCLOPRAMIDE
Inj
5mg
Syr
Orl
1mg
Sir.
Page 5
f
AEFGVW
A03FA01
METOCLOPRAMIDE
MÉTOCLOPRAMIDE
Tab
Co.
Orl
5mg
Apo-Metoclop (Disc/non disp Mar 30/14)
Metonia
00842826
02230431
APX
PDP
f
f
AEFGVW
AEFGVW
Tab
Co.
Orl
10mg
Apo-Metoclop (Disc/non disp Mar 30/14)
Metonia
00842834
02230432
APX
PDP
f
f
AEFGVW
AEFGVW
ratio-Domperidone
Apo-Domperidone
Teva-Domperidone
pms-Domperidone
Ran-Domperidone
Mylan-Domperidone
Domperidone
Jamp-Domperidone
Mar-Domperidone
01912070
02103613
02157195
02236466
02268078
02278669
02350440
02369206
02403870
RPH
APX
TEV
PMS
RAN
MYL
SAS
JPC
MAR
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
A03FA03
Tab
Co.
DOMPERIDONE
DOMPÉRIDONE
Orl
10mg
A04
ANTIEMETICS AND ANTINAUSEANTS
ANTIEMÉTIQUES ET ANTINAUSÉEUX
A04A
ANTIEMETICS AND ANTINAUSEANTS
ANTIEMÉTIQUES ET ANTINAUSÉEUX
A04AA
SEROTONIN (5HT3) ANTAGONISTS
ANTAGONISTES DE LA SÉROTONINE (5HT3)
A04AA01
Liq
Liq
Tab
Co.
ONDANSETRON
ONDANSÉTRON
Inj
Orl
2mg
Zofran
Ondansetron preservative free
Ondansetron with preservative
AJ-Ondansetron
02213745
02265524
02265532
02390019
GSK
TEV
TEV
AJP
f
f
f
f
W
W
W
W
4mg
Zofran
Zofran
2
pms-Ondansetron
pms-Ondansetron
Teva-Ondansetron
2
Teva-Ondansetron
Sandoz Ondansetron
2
Sandoz Ondansetron
2
Ratio-Ondansetron
Ratio-Ondansetron
2
Phl-Ondansetron
Phl-Ondansetron
2
Apo-Ondansetron
Apo-Ondansetron
Co Ondansetron
2
Co Ondansetron
2
Mylan-Ondansetron
Mylan-Ondansetron
2
Mint-Ondansetron
2
02213567
02213567
02258188
02258188
02264056
02264056
02274310
02274310
02278529
02278529
02278618
02278618
02288184
02288184
02296349
02296349
02297868
02297868
02305259
GSK
GSK
PMS
PMS
TEV
TEV
SDZ
SDZ
RPH
RPH
PHL
PHL
APX
APX
COB
COB
MYL
MYL
MNT
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGV
W
AEFGV
W
W
AEFGV
W
AEFGV
AEFGV
W
AEFGV
W
AEFGV
W
W
AEFGV
AEFGV
W
AEFGV
Page 6
A04AA01
ONDANSETRON
ONDANSÉTRON
Tab
Co.
Orl
4mg
Mint-Ondansetron
2
Ondansetron-Odan
Ondansetron-Odan
2
Ran-Ondansetron
Ran-Ondansetron
Jamp-Ondansetron
2
Jamp-Ondansetron
Mar-Ondansetron
2
Mar-Ondansetron
Septa-Ondansetron
2
Septa-Ondansetron
02305259
02306212
02306212
02312247
02312247
02313685
02313685
02371731
02371731
02376091
02376091
MNT
ODN
ODN
RAN
RAN
JPC
JPC
MAR
MAR
SPT
SPT
f
f
f
f
f
f
f
f
f
f
f
W
AEFGV
W
AEFGV
W
W
AEFGV
W
AEFGV
W
AEFGV
Tab
Co.
Orl
8mg
Zofran
Zofran
pms-Ondansetron
2
pms-Ondansetron
2
Teva-Ondansetron
Teva-Ondansetron
2
Sandoz Ondansetron
Sandoz Ondansetron
ratio-Ondansetron
2
ratio-Ondansetron
2
Phl-Ondansetron
Phl-Ondansetron
Apo-Ondansetron
2
Apo-Ondansetron
2
Co Ondansetron
Co Ondansetron
Mylan-Ondansetron
2
Mylan-Ondansetron
Mint-Ondansetron
2
Mint-Ondansetron
2
Ondansetron-Odan
Ondansetron-Odan
2
Ran-Ondansetron
Ran-Ondansetron
Jamp-Ondansetron
2
Jamp-Ondansetron
2
Mar-Ondansetron
Mar-Ondansetron
Septa-Ondansetron
2
Septa-Ondansetron
2
02213575
02213575
02258196
02258196
02264064
02264064
02274329
02274329
02278537
02278537
02278626
02278626
02288192
02288192
02296357
02296357
02297876
02297876
02305267
02305267
02306220
02306220
02312255
02312255
02313693
02313693
02371758
02371758
02376105
02376105
GSK
GSK
PMS
PMS
TEV
TEV
SDZ
SDZ
RPH
RPH
PHL
PHL
APX
APX
COB
COB
MYL
MYL
MNT
MNT
ODN
ODN
RAN
RAN
JPC
JPC
MAR
MAR
SPT
SPT
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGV
W
W
AEFGV
AEFGV
W
AEFGV
W
W
AEFGV
AEFGV
W
W
AEFGV
AEFGV
W
W
AEFGV
W
AEFGV
AEFGV
W
AEFGV
W
W
AEFGV
AEFGV
W
W
AEFGV
2
Requests for coverage of ondansetron (Zofran and generics) will be considered under special authorization, see Appendix
IV. Prescriptions written by oncologists or oncology clinical associates/general practitioners-oncology for a maximum of 12
tablets every 28 days do not require special authorization.
Les demandes de protection pour l'ondansétron (Zofran et génériques) seront examinées sur autorisation spéciale. Veuillez
consulter l'annexe IV. Les ordonnances des oncologues ou des cliniciens adjoint/omnipraticiens en oncologie pour un
maximum de 12 comprimées chaque 28 jours ne nécessitent pas une authorisation spéciale.
Page 7
A04AA02
GRANISETRON
GRANISÉTRON
Tab
Co.
A04AA04
Orl
Kytril
Kytril
3
Granisetron
Granisetron
3
02185881
02185881
02308894
02308894
HLR
HLR
AAP
AAP
Anzemet
Anzemet
4
02231379
02231379
SAV
SAV
AEFGV
W
f
f
f
f
AEFGV
W
AEFGV
W
DOLASETRON
DOLASETRON
Tab
Co.
A04AD
1mg
Orl
100mg
OTHER ANTIEMETICS
AUTRES ANTIEMÉTIQUES
A04AD01
SCOPOLAMINE
SCOPOLAMINE
Liq
Liq
Inj
20mg
Buscopan
Hyoscine Butylbromide
00363839
02229868
BOE
SDZ
W
VW
Tab
Co.
Orl
10mg
Buscopan
00363812
BOE
AEFGVW
Liq
Liq
Inj
0.4mg
Scopolamine Hydrobromide
00541869
HOS
AEFVW
Liq
Liq
Inj
0.6mg
Scopolamine Hydrobromide
00541877
HOS
AEFVW
Srd
Srd
Trd
1.5mg
Transderm-V
80024336
NVR
AEFGVW
A04AD12
APREPITANT
APRÉPITANT
Orl
80mg
Emend
Emend
5
02298791
02298791
FRS
FRS
AEFGV
W
Cap Orl
Caps
125mg
Emend
5
Emend
02298805
02298805
FRS
FRS
W
AEFGV
Cap
Caps
3
Requests for coverage of Kytril (Granisetron) will be considered under special authorization. See Appendix IV. Prescriptions
written by oncologists or oncology clinical associates/general practitioners-oncology for a maximum of 2 tablets every 28
days do not require special authorization.
Les demandes de protection pour le Kytril (Granisétron) seront examinées sur autorisation spéciale. Veuillez consulter
l’annexe IV. Les ordonnances des oncologues ou des cliniciens adjoint/amnipraticiens en oncologie pour un maximum de 2
comprimées chaque 28 jours ne nécessitent pas d’autorisation spéciale.
4
Requests for coverage of Anzemet (Dolasetron) will be considered under special authorization. See Appendix IV.
Prescriptions written by oncologists or oncology clinical associates/general practitioners-oncology for a maximum of 2 tablets
every 28 days do not require special authorization.
Les demandes de protection pour le Anzemet (Dolasetron) seront examinées sur autorisation spéciale. Veuillez consulter
comprimées chaque 28 jours ne nécessitent pas d’autorisation spéciale.
Page 8
A04AD12
APREPITANT
APRÉPITANT
Cap
Caps
Orl
85mg
Emend-Tri-Pack Cap
5
Emend-Tri-Pack Cap
02298813
02298813
FRS
FRS
W
AEFGV
Gravol
00013579
CHU
W
A04AD99
DIMENHYDRINATE
DIMENHYDRINATE
Liq
Inj
50mg
Liq
Syr
Sir.
Orl
3mg
Gravol
00230197
CHU
G
Tab
Co.
Orl
15mg
Gravol
00511196
CHU
G
A07
ANTIDIARRHEALS, INTESTINAL ANTIINFLAMMATORY/ANTIINFECTIVE AGENTS
ANTIDIARRHÉIQUES, AGENTS ANTI-INFECTIEUX/ANTI-INFLAMMATOIRES POUR L’INTESTIN
A07A
INTESTINAL ANTIINFECTIVES
ANTI-INFECTIEUX INTESTINAUX
A07AA
ANTIBIOTICS
ANTIBIOTIQUES
A07AA02
NYSTATIN
NYSTATINE
Susp Orl 100000IU
Susp.
Tab Orl 500000IU
Co.
A07D
ANTIPROPULSIVES
ANTIPROPULSIFS
A07DA
ANTIPROPULSIVES
ANTIPROPULSIFS
A07DA01
pms-Nystatin Oral
Ratio-Nystatin
00792667
02194201
PMS
RPH
ABEFGVW
ABEFGVW
ratio-Nystatin (Disc/non disp Jan. 21/15)
02194198
RPH
ABEFGVW
Lomotil
00036323
PFI
AEFGVW
pms-Loperamide Hydrochloride
02016095
PMS
DIPHENOXYLATE
DIPHÉNOXYLATE
DIPHENOXYLATE / ATROPINE
DIPHÉNOXYLATE / ATROPINE
Tab Orl 2.5mg/0.025mg
Co.
A07DA03
LOPERAMIDE
LOPÉRAMIDE
Liq Orl 0.2mg/mL
Liq
5
f
AEFGVW
Requests for coverage of Emend (Aprepitant) will be considered under special authorization. See Appendix IV.
Prescriptions written by oncologists or oncology clinical associates/general practitioners-oncology for a maximum of 2 Tripacks or 6 capsules every 28 days do not require special authorization.
Les demandes de protection pour le Emend (Aprépitant) seront examinées sur autorisation spéciale. Veuillez consulter
emballages de trois ou 6 capsules chaque 28 jours ne nécessitent pas d’autorisation spéciale.
Page 9
A07DA03
LOPERAMIDE
LOPÉRAMIDE
Tab Orl 2mg
Co.
Novo-Loperamide
Imodium (Disc/non disp Aug 01/15)
Apo-Loperamide
pms-Loperamide
Sandoz-Loperamide (Disc/non disp Nov 15/15)
Loperamide
A07E
INTESTINAL ANTIINFLAMMATORY AGENTS
AGENTS ANTI-INFLAMMATOIRES INTESTINAUX
A07EA
CORTICOSTEROIDS ACTING LOCALLY
CORTICOSTÉROÏDES AGISSANT LOCALEMENT
A07EA02
Rt
Enm
Lav.
Rt 1.66666mg
10%
Cortifoam
00579335
PAL
AEFGVW
Hycort
Cortenema
00230316
02112736
VLN
AXC
AEFGVW
AEFGVW
Rt
0.05mg
Betnesol
02060884
PAL
AEFGVW
Orl
3mg
Entocort
02229293
AZE
AEFGVW
00500895
SAV
AEFGVW
ANTIALLERGIC AGENTS, EXCL. CORTICOSTEROIDS
AGENTS ANTIALLERGIQUES, À L’EXCLUSION DES CORTICOSTÉROÏDES
A07EB01
CROMOGLICIC ACID
CROMOGLYCATE DISODIQUE
Cap Orl
Caps
A07EC
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
BUDESONIDE
BUDÉSONIDE
Cap
Caps
A07EB
f
f
f
f
f
BETAMETHASONE
BÉTAMÉTHASONE
Enm
Lav.
A07EA06
TEV
JNJ
APX
PMS
SDZ
JPC
HYDROCORTISONE
HYDROCORTISONE
Aer
Aér
A07EA04
02132591
02183862
02212005
02228351
02257564
02256452
100mg
Nalcrom
AMINOSALICYLIC ACID AND SIMILAR AGENTS
ACIDE AMINOSALICYLIQUE ET AGENTS SEMBLABLES
A07EC01
SULFASALAZINE
SULFASALAZINE
ECT Orl
Co.Ent
500mg
Salazopyrin EN
pms-Sulfasalazine EC
02064472
00598488
PFI
PMS
f
AEFGVW
AEFGVW
Tab
Co.
500mg
Salazopyrin
pms-Sulfasalazine
02064480
00598461
PFI
PMS
f
AEFGVW
AEFGVW
Orl
Page 10
A07EC02
MESALAZINE
MÉSALAZINE
ECT Orl
Co.Ent
500mg
Mesasal
Salofalk
01914030
02112787
GSK
AXC
AEFGVW
AEFGVW
SRT Orl
Co.L.L.
500mg
Pentasa
02099683
FEI
AEFGVW
Sup
Rt
Supp.
1gm
Pentasa
Salofalk
02153564
02242146
FEI
AXC
AEFGVW
AEFGVW
Sup
Rt
Supp.
500mg
Salofalk
02112760
AXC
AEFGVW
Sus
Susp
Rt
1gm
Pentasa
02153521
FEI
AEFGVW
Sus
Rt
Susp.
2gm
Salofalk
02112795
AXC
AEFGVW
Sus
Rt
Susp.
4gm
Pentasa
02153556
FEI
AEFGVW
Salofalk
02112809
AXC
AEFGVW
Sus Rt 66.66666mg
Susp.
ECT Orl
Co.Ent
400mg
Asacol
01997580
WNC
AEFGVW
ECT Orl
Co.Ent.
800mg
Asacol
02267217
WNC
AEFGVW
Tab
Co.
1.2gm
Mezavant
02297558
SHI
AEFGVW
Dipentum
02063808
UCB
AEFGVW
80017987
ERF
AEFGVW
A07EC03
Orl
OLSALAZINE
OLSALAZINE
Cap
Caps
Orl 250mg
A07F
ANTIDIARRHEAL MICROORGANISMS
MICRO-ORGANISMES ANTIDIARRHÉIQUES
A07FA
ANTIDIARRHEAL MICROORGANISMS
MICRO-ORGANISMES ANTIDIARRHÉIQUES
A07FA01
LACTIC ACID PRODUCING ORGANISMS
ORGANISMES PRODUISANT DE L’ACIDE LACTIQUE
Cap
Caps
Orl
1b
Bacid
Page 11
A09
DIGESTIVES, INCLUDING ENZYMES
AGENTS DIGESTIFS, Y COMPRIS LES ENZYMES
A09A
DIGESTIVES, INCLUDING ENZYMES
AGENTS DIGESTIFS, Y COMPRIS LES ENZYMES
A09AA
ENZYME PREPARATIONS
PRÉPARATIONS D’ENZYMES
A09AA02
MULTIENZYMES (LIPASE, PROTEASE ETC)
MULTIENZYMES (LIPASE, PROTÉASE ETC)
Cap Orl 4500U/ 20000U/20000U
Caps.
Ultrase MS 4
02203324
AXC
BEFG
Cap Orl 8000IU/30000IU/30000IU
Caps.
Cotazym
00263818
FRS
BEFG
Cap Orl 12000U/39000U/39000U
Caps.
Ultrase MT 12
02045834
AXC
BEFG
Cap Orl 20000U/ 65000U/65000U
Caps.
Ultrase MT 20
02045869
AXC
BEFG
ECC Orl 4000U/12000U/12000U
Caps.Ent.
Pancrease MT 4
00789445
JAN
BEFG
ECC Orl 5000U/16600U/18750U
Caps.Ent.
Creon 5 Minimicrospheres
02239007
ABB
BEFG
ECC Orl 6000U/30000U/19000U
Caps.Ent.
Creon 6 Minimicrospheres
02415194
ABB
BEFG
ECC Orl 8000U/30000U/30000U
Caps.Ent.
Cotazym ECS 8
00502790
SCH
BEFG
Creon10 Minimicrospheres
02200104
ABB
BEFG
ECC Orl 1000U/30000U/30000U
Caps.Ent.
Pancrease MT 10
00789437
JAN
BEFG
ECC Orl 16000U/48000U/48000U
Caps.Ent.
Pancrease MT 16
00789429
JAN
BEFG
ECC Orl 20000U/55000U/55000U
Caps.Ent.
Cotazym ECS 20
00821373
SCH
BEFG
Creon25 Minimicrospheres
01985205
ABB
BEFG
ECC Orl 10000U/33200U/37500U
Caps.Ent.
ECC Orl25000U/ 74000U/62500U
Caps.Ent.
Tab
Co.
Orl 8000U/ 30000U/30000U
Viokase 8
02230019
AXC
BEFG
Tab
Co.
Orl 16000U/ 60000U/60000U
Viokase 16
02241933
AXC
BEFG
Page 12
A10
DRUGS USED IN DIABETES
MÉDICAMENTS UTILISÉS CHEZ LES DIABÉTIQUES
A10A
INSULINS AND ANALOGUES
INSULINES ET ANALOGUES
A10AB
INSULINS & ANALOGUES FOR INJECTION, FAST-ACTING
INSULINES ET ANALOGUES POUR L’INJECTION, À ACTION RAPIDE
A10AB01
INSULIN (HUMAN); FAST-ACTING
INSULINE (HUMAINE); ACTION RAPIDE
Liq
Liq
A10AB04
Inj
Inj
A10AC
00586714
01959220
02024233
02024284
LIL
LIL
NNO
NNO
AEFGVW
AEFGVW
AEFGVW
AEFGVW
100IU
Humalog*
6
Humalog (cartridge)*
6
Humalog (kwikpen)*
6
02229704
02229705
02403412
LIL
LIL
LIL
AEFGV
AEFGV
AEFGV
Novorapid (penfill) (3ml)*
6
Novorapid*
6
02244353
02245397
NNO
NNO
AEFGV
AEFGV
INSULIN ASPART
INSULINE ASPART
Liq
Liq
A10AB06
Humulin R*
Humulin R (cartridge)*
Novolin GE Toronto*
Novolin GE Toronto(penfill) (3ml)*
INSULIN LISPRO; FAST-ACTING
INSULINE LISPRO; ACTION RAPIDE
Liq
Liq
A10AB05
100IU
Inj
100IU
INSULIN GLULISINE
INSULINE GLULISINE
Liq
Liq
Inj
3mL
Apidra (cartridge)
Apidra (cartridge)
6
Apidra Solostar
Apidra Solostar
6
02279479
02279479
02294346
02294346
SAV
SAV
SAV
SAV
AVW
EFG-18
AVW
EFG-18
Liq
Liq
Inj
10mL
Apidra
Apidra 6
02279460
02279460
SAV
SAV
EFG-18
AVW
LIL
LIL
LIL
NNO
NNO
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
INSULINS & ANALOGUES FOR INJECTION, INTERMEDIATE-ACTING
INSULINES ET ANALOGUES POUR INJECTION, ACTION INTERMÉDIAIRE
A10AC01 INSULIN (HUMAN); INTERMEDIATE-ACTING
INSULINE (HUMAINE); ACTION INTERMÉDIAIRE
Sus
Susp.
Inj
100IU
Humulin N *
Humulin N (cartridge) *
Humulin N (kwikpen) *
Novolin GE NPH*
Novolin GE NPH (penfill) (3ml) *
6
00587737
01959239
02403447
02024225
02024268
Prescriptions written by New Brunswick endocrinologists and internists do not require special authorization. Subsequent
refills by other practitioners will not require special authorization.
Les ordonnances rédigées par des endocrinologues et des internists du Nouveau-Brunswick ne requièrent pas d’autorisation
spéciale. Les renouvellements prescrits par d’autres practiciens ne nécessiteront pas d’autorisation spéciale.
Page 13
A10AD
INSULINS & ANALOGUES FOR INJECTION INTERMEDIATE-ACTING, FAST-ACTING
INSULINES ET ANALOGUES POUR INJECTION, ACTION INTERMÉDIAIRE, À ACTION RAPIDE
A10AD01
INSULIN (HUMAN), INTERMEDIATE-ACTING IN COMBINATION
INSULINE (HUMAINE); ACTION INTERMÉDIAIRE, COMBINASON
Sus
Susp.
Inj
30 IU/70IU
Humulin 30/70*
Humulin 30/70 (cartridge) *
Novolin GE 30/70*
Novolin GE 30/70 (penfill) (3ml) *
00795879
01959212
02024217
02025248
LIL
LIL
NNO
NNO
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Sus
Susp.
Inj
40 IU/60IU
Novolin GE 40/60 (Penfill) *
02024314
NNO
AEFGVW
Sus
Susp.
Inj
50 IU/50IU
Novolin GE 50/50 (Penfill) *
02024322
NNO
AEFGVW
A10B
BLOOD GLUCOSE LOWERING DRUGS, EXCLUDING INSULINS
MÉDICAMENTS HYPOGLYCÉMIANTS, À L’EXCLUSION DES INSULINES
A10BA
BIGUANIDES
BIGUANIDES
A10BA02
METFORMIN
METFORMINE
Tab
Co.
Orl
500mg
Teva-Metformin *
Glucophage *
Mylan-Metformin *
Apo-Metformin *
pms-Metformin *
Metformin *
ratio-Metformin *
Sandoz Metformin FC *
Co-Metformin *
Ran-Metformin *
Metformin *
Metformin*
Mar-Metformin*
Jamp-Metformin*
Jamp-Metformin Blackberry*
Septa-Metformin*
Mint-Metformin*
02045710
02099233
02148765
02167786
02223562
02242794
02242974
02246820
02257726
02269031
02353377
02378841
02378620
02380196
02380722
02379767
02388766
TEV
SAV
MYL
APX
PMS
MEL
RPH
SDZ
COB
RAN
SAS
MAR
MAR
JPC
JPC
SPT
MNT
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
850mg
Glucophage *
Mylan-Metformin *
Apo-Metformin *
Teva-Metformin *
pms-Metformin *
ratio-Metformin *
Sandoz Metformin FC *
Co-Metformin *
Ran-Metformin *
Metformin *
Metformin*
Mar-Metformin*
02162849
02229656
02229785
02230475
02242589
02242931
02246821
02257734
02269058
02353385
02378868
02378639
SAV
MYL
APX
TEV
PMS
RPH
SDZ
COB
RAN
SAS
MAR
MAR
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Page 14
A10BA02
Tab
Co.
A10BB
METFORMIN
METFORMINE
Orl
850mg
Jamp-Metformin*
Jamp-Metformin Blackberry*
Septa-Metformin*
Mint-Metformin*
02380218
02380730
02379775
02388774
JPC
JPC
SPT
MNT
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
SULFONAMIDES, UREA DERIVATIVES
SULFONAMIDES, DÉRIVÉS DE L’URÉE
A10BB01
GLIBENCLAMIDE (GLYBURIDE)
GLIBENCLAMIDE (GLYBURIDE)
Tab
Co.
Orl
2.5mg
Mylan-Glybe *
ratio-Glyburide *
Apo-Glyburide *
Teva-Glyburide *
Diabeta *
Sandoz Glyburide *
Glyburide *
00808733
01900927
01913654
01913670
02224550
02248008
02350459
MYL
RPH
APX
TEV
SAV
SDZ
SAS
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
5mg
Mylan-Glybe *
ratio-Glyburide *
Apo-Glyburide *
Teva-Glyburide *
Diabeta *
Sandoz Glyburide *
Glyburide *
00808741
01900935
01913662
01913689
02224569
02248009
02350467
MYL
RPH
APX
TEV
SAV
SDZ
SAS
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
A10BB02
CHLORPROPAMIDE
CHLORPROPAMIDE
Tab
Co.
Orl
100mg
Apo-Chlorpropamide *
00399302
APX
f
AEFGVW
Tab
Co.
Orl
250mg
Apo-Chlorpropamide *
00312711
APX
f
AEFGVW
Tolbutamide *
00312762
AAP
f
AEFGVW
Diamicron MR *
Gliclazide MR *
02242987
02297795
SEV
AAP
f
f
ABEFGVW
ABEFGVW
A10BB03
TOLBUTAMIDE
TOLBUTAMIDE
Tab Orl 500mg
Co.
A10BB09
GLICLAZIDE
GLICLAZIDE
ECT Orl 30mg
Co.Ent.
ECT Orl
Co.Ent.
60mg
Diamicron MR
02356422
SEV
Tab
Co.
80mg
Diamicron *
Mylan-Gliclazide *
Novo-Gliclazide *
Apo-Gliclazide *
Gliclazide *
Page 15
00765996
02229519
02238103
02245247
02287072
SEV
MYL
TEV
APX
SAS
Orl
ABEFGVW
f
f
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
A10BB12
GLIMEPIRIDE
GLIMÉPIRIDE
Tab
Co.
Orl
1mg
Amaryl *
Sandoz Glimepiride *
Ratio-Glimepiride *
Novo-Glimepiride *
Apo-Glimepiride *
02245272
02269589
02273101
02273756
02295377
SAV
SDZ
TEV
TEV
APX
f
f
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
Tab
Co.
Orl
2mg
Amaryl *
Ratio-Glimepiride *
Novo-Glimepiride *
Apo-Glimepiride *
02245273
02269597
02273128
02273764
02295385
SAV
SDZ
TEV
TEV
APX
f
f
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
Tab
Co.
Orl
4mg
Amaryl *
Ratio-Glimepiride *
Novo-Glimepiride *
Apo-Glimepiride *
02245274
02269619
02273136
02273772
02295393
SAV
SDZ
TEV
TEV
APX
f
f
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
A11
VITAMINS
VITAMINES
A11A
MULTIVITAMINS, COMBINATIONS
MULTIVITAMINES, EN COMBINAISON
A11AA
MULTIVITAMINS WITH MINERALS
MULTIVITAMINES ET MINÉRAUX
A11AA03
Tab
Co.
MULTIVITAMIN AND OTHER MINERALS, INCLUDING COMBINATIONS
MULTIVITAMINE ET AUTRES MINÉRAUX, Y COMPRIS LES COMBINAISONS
Orl
02246236
WCH
G
D-Forte
Osto-D2
02237450
02301911
EUR
TRI
AEFGVW
AEFGVW
Centrum Junior
A11C
VITAMIN A AND D, INCLUDING COMBINATIONS OF THE TWO
VITAMINE A ET D, Y COMPRIS LES COMBINAISONS DES DEUX
A11CC
VITAMIN D AND ANALOGUES
VITAMINE D ET ANALOGUES
A11CC01
ERGOCALCIFEROL
ERGOCALCIFEROL
Cap Orl 50000IU
Caps
Dps Orl
Gttes
8288IU
Drisdol (Disc/non disp Feb. 4/15)
Erdol (Drisodan)
02017598
80003615
SAV
ODN
Tab
Co.
1000IU
Vitamin D
80000436
JAM
EF-18G
One-Alpha
00474517
LEO
AEFGVW
A11CC03
Orl
f
f
AEFGVW
AEFGVW
ALFACALCIDOL
ALFACALCIDOL
Cap Orl 0.25mcg
Caps
Page 16
A11CC03
ALFACALCIDOL
ALFACALCIDOL
Cap Orl
Caps
One-Alpha
00474525
LEO
AEFGVW
Cap Orl 0.25mcg
Caps
Rocaltrol
00481823
HLR
AEFGVW
Cap Orl
Caps
Rocaltrol
00481815
HLR
AEFGVW
Pyridoxine
00463469
KRI
W
200IU
Vitamin E
02041073
VTH
BEF-18G
50IU
Aquasol E
02162075
CLC
BEF-18G
100IU
Vitamin E Natural
Vitamin E
00122823
00189227
JAM
JAM
BEF-18G
BEF-18G
A11CC04
1mcg
CALCITRIOL
CALCITRIOL
0.5mcg
A11H
OTHER PLAIN VITAMIN PREPARATIONS
AUTRES PRÉPARATIONS VITAMINIQUES ORDINAIRES
A11HA
OTHER PLAIN VITAMIN PREPARATIONS
AUTRES PRÉPARATIONS VITAMINIQUES ORDINAIRES
A11HA02
PYRIDOXINE (VIT B6)
PYRIDOXINE (VIT B6)
Liq
Liq
A11HA03
Inj
100mg
TOCOPHEROL (VIT E)
TOCOPHÉROL (VIT E)
Cap Orl
Caps
Dps
Gttes
Orl
Cap Orl
Caps
Cap Orl
Caps
200IU
Vitamin E Natural
Vitamin E
00122831
00189235
JAM
SWS
BEF-18G
BEF-18G
Cap Orl
Caps
400IU
Vitamin E Natural
Vitamin E Natural
Vitamin E
Vitamin E Synthetic
Vitamin E
Vitamin E
00122858
00201995
00266108
00274259
02040816
02247190
JAM
JPC
PMT
WAM
PMT
HHC
BEF-18G
BEF-18G
BEF-18G
BEF-18G
BEF-18G
BEF-18G
00558079
CHU
BEFG
A11J
OTHER VITAMIN PRODUCTS, COMBINATIONS
AUTRES PRODUITS VITAMINIQUES, EN COMBINAISON
A11JA
COMBINATIONS OF VITAMINS
COMBINAISONS DE VITAMINES
Liq
Liq
Orl
Infantol
Page 17
A12
MINERAL SUPPLEMENTS
SUPPLÉMENTS DE MINÉRAUX
A12B
POTASSIUM
POTASSIUM
A12BA
POTASSIUM
POTASSIUM
A12BA01
Liq
Liq
POTASSIUM CHLORIDE
CHLORURE DE POTASSIUM
Orl
100mg
pms-Potassium
K-10(Disc/non disp Jul 31/14)
K-10
02238604
01918303
80024360
PMS
GSK
GSK
SRC Orl
Caps.L.L.
600mg
Micro-K
02042304
PAL
AEFGVW
SRT Orl
Co.L.L.
600mg
Slow-K
Apo-K
Jamp-K8
80040226
00602884
80013005
NVR
APX
JPC
AEFGVW
AEFGVW
AEFGVW
SRT Orl 1500mg
Co.L.L.
Odan K-20
K-Dur 20(Disc/non disp Dec 1/14)
Jamp-K20
80004415
00713376
80013007
ODN
FRS
JPC
AEFGVW
AEFGVW
AEFGVW
Fluor-a-Day
00610100
PDP
EF-18G
Fluor-a-Day
00575569
PDP
EF-18G
Coumadin
Taro-Warfarin
Apo-Warfarin
Mylan-Warfarin
Novo-Warfarin (Disc/non disp Jun 4/15)
Warfarin
01918311
02242680
02242924
02244462
02265273
02344025
BRI
TAR
APX
MYL
TEV
SAS
A12C
OTHER MINERAL SUPPLEMENTS
AUTRES SUPPLÉMENTS MINÉRAUX
A12CD
FLUORIDE
FLUORURE
A12CD01
AEFGVW
AEFGVW
AEFGVW
SODIUM FLUORIDE
FLUORURE DE SODIUM
Dps Orl
Gttes
Tab
Co.
f
5.56mg
Orl 2.21mg
B01
ANTITHROMBOTIC AGENTS
AGENTS ANTITHROMBOTIQUES
B01A
ANTITHROMBOTIC AGENTS
AGENTS ANTITHROMBOTIQUES
B01AA
VITAMIN K ANTAGONISTS
ANTAGONISTES DE LA VITAMINE K
B01AA03
WARFARIN
WARFARINE
Tab
Orl
1mg
Co.
Page 18
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
B01AA03
WARFARIN
WARFARINE
Tab
Co.
Orl
2mg
Coumadin
Taro-Warfarin
Apo-Warfarin
Mylan-Warfarin
Novo-Warfarin
Warfarin
01918338
02242681
02242925
02244463
02265281
02344033
BRI
TAR
APX
MYL
TEV
SAS
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
2.5mg
Coumadin
Taro-Warfarin
Apo-Warfarin
Mylan-Warfarin
Novo-Warfarin
Warfarin
01918346
02242682
02242926
02244464
02265303
02344041
BRI
TAR
APX
MYL
TEV
SAS
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
3mg
Coumadin
Taro-Warfarin
Apo-Warfarin
Mylan-Warfarin
Warfarin
02240205
02242683
02245618
02287498
02265311
02344068
BRI
TAR
APX
MYL
TEV
SAS
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
4mg
Coumadin
Taro-Warfarin
Apo-Warfarin
Mylan-Warfarin
Warfarin
02007959
02242684
02242927
02244465
02265338
02344076
BRI
TAR
APX
MYL
TEV
SAS
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
5mg
Coumadin
Taro-Warfarin
Apo-Warfarin
Mylan-Warfarin
Novo-Warfarin
Warfarin
01918354
02242685
02242928
02244466
02265346
02344084
BRI
TAR
APX
MYL
TEV
SAS
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
6mg
Coumadin
Taro-Warfarin
Mylan-Warfarin
Warfarin (Disc/non disp Jan 1/15)
02240206
02242686
02287501
02344092
BRI
TAR
MYL
SAS
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
10mg
Coumadin
Taro-Warfarin
Apo-Warfarin
Mylan-Warfarin
Warfarin
01918362
02242687
02242929
02244467
02344114
BRI
TAR
APX
MYL
SAS
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Sintrom
00010383
PAL
B01AA07
Tab
Co.
ACENOCOUMAROL (NICOUMALONE)
Orl
1mg
Page 19
AEFGVW
B01AA07
Tab
Co.
B01AB
Orl
4mg
Sintrom
00010391
PAL
AEFGVW
HEPARIN GROUP
GROUPE DE L’HÉPARINE
B01AB01
HEPARIN
HÉPARINE
Liq
Liq
Inj
100IU
Heparin
00727520
LEO
W
Liq
Liq
Inj 10,000IU
Heparin *
00579718
LEO
AEFGV
B01AB04
DALTEPARIN
DALTÉPARINE
Liq
Liq
Inj
5,000IU
Fragmin (prefilled syringe)
02132648
PFI
W
Liq
Liq
Inj
7,500IU
02352648
PFI
W
Liq
Liq
Inj 10,000IU
Fragmin (prefilled syringe) *
7
02352656
02352656
PFI
PFI
AEF18+V
W
Liq
Liq
Inj 12,500IU
Fragmin (prefilled syringe)*
7
02352664
02352664
PFI
PFI
AEF18+V
W
Liq
Liq
Inj 15,000IU
7
02352672
02352672
PFI
PFI
W
AEF18+V
Liq
Liq
Inj 18,000IU
7
02352680
02352680
PFI
PFI
W
AEF18+V
Liq
Liq
Inj 25,000IU
Fragmin *
Fragmin
7
02231171
02231171
PFI
PFI
AEF18+V
W
B01AB05
ENOXAPARIN
ÉNOXAPARINE
Liq
Liq
Inj
30mg/0.3mL
Lovenox (prefilled syringe)
02012472
SAV
W
Liq
Liq
Inj
40mg/0.4mL
02236883
SAV
W
Liq
Liq
Inj
60mg/0.6mL
02378426
SAV
W
Liq
Liq
Inj
80mg/0.8mL
02378434
SAV
W
Page 20
B01AB05
02378442
SAV
W
300mg/3mL
Lovenox
7
Lovenox *
02236564
02236564
SAV
SAV
W
AEF18+V
Liq
Liq
Inj 120mg/0.8mL
Lovenox HP (prefilled syringe)
7
Lovenox HP (prefilled syringe) *
02242692
02242692
SAV
SAV
W
AEF18+V
Liq
Liq
Inj
Lovenox HP (prefilled syringe)
7
Lovenox HP (prefilled syringe) *
02378469
02378469
SAV
SAV
W
AEF18+V
Fraxiparin Forte (prefilled syringe) *
Fraxiparin Forte (prefilled syringe)
7
02240114
02240114
GSK
GSK
AEF18+V
W
Liq
Liq
Inj
100mg/mL
Liq
Liq
Inj
B01AB06
Liq
Liq
B01AB10
B01AC
150mg/mL
NADROPARIN
NADROPARINE
Inj 19000IU
TINZAPARIN
TINZAPARINE
Liq
Liq
Inj 10000IU/mL
Innohep *
Innohep
Innohep (prefilled syringe)
7
02167840
02167840
02229755
LEO
LEO
LEO
AEF18+V
W
W
Liq
Liq
Inj 20000IU/mL
Innohep *
Innohep
Innohep (prefilled syringe)
7
Innohep (prefilled syringe) *
7
02229515
02229515
02231478
02231478
LEO
LEO
LEO
LEO
AEF18+V
W
W
AEF18+V
PLATELET AGGREGATION INHIBITORS EXCLUDING HEPARIN
INHIBITEURS D’AGRÉGATION PLAQUETTAIRE, À L’EXCLUSION DE HÉPARINE
B01AC04
Tab
Co.
B01AC05
Tab
Co.
7
ENOXAPARIN
ÉNOXAPARINE
CLOPIDOGREL
CLOPIDOGREL
Orl
75mg
Plavix
Apo-Clopidogrel
Teva-Clopidogrel
Co-Clopidogrel
pms-Clopidogrel
Mylan-Clopidogrel
Sandoz Clopidogrel
Ran-Clopidogrel
Clopidogrel
Mint-Clopidogrel
02238682
02252767
02293161
02303027
02348004
02351536
02359316
02379813
02400553
02408910
SAV
APX
TEV
COB
PMS
MYL
SDZ
RAN
SAS
MNT
f
f
f
f
f
f
f
f
f
f
W
W
W
W
W
W
W
W
W
W
Teva-Ticlopidine
Apo-Ticlopidine
02236848
02237701
TEV
APX
f
f
AEFVW
AEFVW
TICLOPIDINE
TICLOPIDINE
Orl
250mg
For the treatment of DVT. Annual quantity limits applied.
Pour le traitment initial de la thrombose veineuse profonde. Des limites quantitatives annuelles s’appliquent.
Page 21
B01AC05
TICLOPIDINE
TICLOPIDINE
Tab
Co.
B01AC07
B01AX
Orl
Mylan-Ticlopidine
Ticlopidine
02239744
02343045
MYL
SAS
f
f
AEFVW
AEFVW
DIPYRIDAMOLE
DIPYRIDAMOLE
Tab
Co.
Orl
25mg
Apo-Dipyridamole FC/FE
00895644
APX
f
AEFGVW
Tab
Co.
Orl
50mg
00895652
APX
f
AEFGVW
Tab
Co.
Orl
75mg
00895660
APX
f
AEFGVW
8
02316986
BAY
Cyklokapron
Tranexamic Acid
02064405
02401231
PFI
STR
OTHER ANTITHROMBOTIC AGENTS
AUTRES AGENTS ANTITHROMBOTIQUES
B01AX06
RIVAROXABAN
RIVAROXABAN
Tab
Co.
Orl
10mg
B02
ANTIHAEMORRHAGICS
ANTIHÉMORRAGIQUES
B02A
ANTIFIBRINOLYTICS
ANTIFIBRINOLYTIQUES
B02AA
AMINO ACIDS
ACIDES AMINÉS
B02AA02
B02AA03
Xarelto
AEFVW
TRANEXAMIC ACID
ACIDE TRANEXAMIQUE
Tab
Co.
8
250mg
Orl
500mg
f
f
AEFGVW
AEFGVW
AMINOMETHYLBENZOIC ACID
ACIDE AMINOMETHYLBENZOIQUE
Cap
Caps
Orl 500mg
Potaba
00611271
GLE
AEFGVW
Pwr
Pd.
Orl 2000mg
Potaba (Disc/non disp Jul 24/14)
00611298
GLE
AEFGVW
Tab
Co.
Orl
Potaba
00550175
GLE
AEFGVW
500mg
For prophylaxis of VTE following total knee replacement surgery. A bi-annual quiantity limit has been establisted. Please
refer to Appendix IV for the criteria.
Pour la prévention des ETEV chez les patients qui ont subi une arthroplastic totale de la hauche ou du genou. Une quantité
limite semestrielle a été établie. Veuillez consulter l’annexe IV pour les critères.
Page 22
B03
ANTIANAEMIC PREPARATIONS
PRÉPARATIONS ANTIANÉMIQUES
B03A
IRON PREPARATIONS
PRÉPARATIONS DE FER
B03AA
IRON BIVALENT, ORAL PREPARATIONS
FER BIVALENT, PRÉPARATIONS ORALES
B03AA02
FERROUS FUMARATE
FUMARATE FERREUX
Cap
Caps
Orl
18mg
Iron
00808954
BIF
AEFGVW
Cap
Caps
Orl 300mg
Neo-Fer
Palafer
00482064
01923420
NEO
MVL
AEFGVW
AEFGVW
60mg
Palafer
01923439
MVL
AEFGVW
300mg
Ferrous Fumarate
00031089
JPC
AEFGVW
Chelated Iron
00633666
RHG
AEFGVW
Fer
00832677
NSE
AEFGVW
Ferrous Gluconate
Apo-ferrous Gluconate
Ferrous Gluconate
pms-ferrous Gluconate
Novo-Ferrogluc
00031097
00545031
00582727
00743976
80000435
JPC
APX
VTH
PVR
TEV
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Sus
Orl
Susp.
Tab
Co.
B03AA03
Orl
FERROUS GLUCONATE
GLUCONATE FERREUX
Tab
Co.
Orl 37.5mg
Tab
Co.
Orl
50mg
Tab
Co.
Orl
300mg
B03AA07
FERROUS SULPHATE
SULFATE FERREUX
Cap
Caps
Orl
45mg
Mega SR Iron
Iron Formula
00362727
00647454
KRI
GNC
AEFGVW
AEFGVW
Dps
Gttes
Orl
75mg
pms-Ferrous Sulfate
02222574
PMS
AEFGVW
ECT Orl
Co.Ent.
300mg
Apo-Ferrous Sulfate-FC
01912518
APX
AEFGVW
Liq
Liq
Orl
15mg
Fer-In-Sol
Ferodan
Jamp Ferrous Sulfate
00762954
02237385
80008309
MJO
ODN
JPC
Liq
Liq
Orl
30mg
Jamp Ferrous Sulfate
80008295
JPC
Page 23
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
B03AA07
FERROUS SULPHATE
SULFATE FERREUX
SRT Orl
Co.L.L
B03AC
160mg
Slow-Fe
00623520
NNC
G
Syr
Sir.
Orl
30mg
Fer-In-Sol
Ferodan
pms-Ferrous Sulfate
00017884
00758469
00792675
MJO
ODN
PMS
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 300mg
Ferrous Sulfate
Ferrous Sulfate
pms-Ferrous Sulfate
00031100
00346918
00586323
JPC
PMT
PMS
AEFGVW
AEFGVW
AEFGVW
02205963
02221780
MYL
SDZ
AEFGVW
AEFGVW
Vitamin B12 *
Cyanocobalamin *
00521515
01987003
SDZ
CYI
Apo-Folic Acid
Euro-Folic
Jamp-Folic
00426849
02285673
02366061
APX
EUR
JPC
AEFGVW
AEFGVW
AEFGVW
IRON TRIVALENT, PARENTERAL PREPARATIONS
FER TRIVALENT, PRÉPARATIONS PARENTÉRALES
B03AC01
Liq
Liq
FERRIC OXIDE POLYMALTOSE COMPLEXES
FERRIC OXIDE POLYMALTOSE COMPLEXES
Inj
50mg
Dexiron *
Infufer *
B03B
VITAMIN B12 AND FOLIC ACID
VITAMINE B12 ET ACIDE FOLIQUE
B03BA
VITAMIN B12 (CYANOCOBALAMIN AND DERIVATIVES)
VITAMINE B12 (CYANOCOBALAMINE ET DÉRIVÉS)
B03BA01
Liq
Liq
B03BB
CYANOCOBALAMIN
CYANOCOBALAMINE
Inj 1000mcg
f
f
AEFGVW
AEFGVW
FOLIC ACID AND DERIVATIVES
ACIDE FOLIQUE ET DÉRIVÉS
B03BA01
Tab
Co.
FOLIC ACID
ACIDE FOLIQUE
Orl
5mg
B03X
OTHER ANTIANEMIC PREPARATIONS
AUTRES PRÉPARATIONS ANTIANÉMIQUES
B03XA
OTHER ANTIANEMIC PREPARATIONS
AUTRES PRÉPARATIONS ANTIANÉMIQUES
B03XA01
ERYTHROPOIETIN
ÉRYTHROPOIETINE
Liq
Liq
Inj
1000IU
Eprex
02231583
JAN
W
Liq
Liq
Inj
2000IU
Eprex
02231584
JAN
W
Liq
Liq
Inj
3000IU
Eprex
02231585
JAN
W
Page 24
B03XA01
ERYTHROPOIETIN
ÉRYTHROPOIETINE
Liq
Liq
Inj
4000IU
Eprex
02231586
JAN
W
Liq
Liq
Inj
6000IU
Eprex
02243401
JAN
W
Liq
Liq
Inj
8000IU
Eprex
02243403
JAN
W
Liq
Liq
Inj 100000IU
Eprex
02231587
JAN
W
Liq
Liq
Inj
Eprex
02240722
JAN
W
B03XA02
40000IU
DARBEPOETIN ALFA
DARBÉPOÉTINE ALFA
Liq
Liq
Inj
10mcg/0.4mL
Aranesp
02392313
AGA
W
Liq
Liq
Inj
20mcg/0.5mL
Aranesp
02246355
AGA
W
Liq
Liq
Inj
30mcg
Aranesp
02246357
AGA
W
Liq
Liq
Inj
40mcg
Aranesp
02391740
AGA
W
Liq
Liq
Inj
50mcg
Aranesp
02246357
AGA
W
Liq
Liq
Inj
60mcg
Aranesp
02246358
AGA
W
Liq
Liq
Inj
80mcg
Aranesp
02246358
AGA
W
Liq
Liq
Inj
100mcg
Aranesp
02246358
AGA
W
Liq
Liq
Inj
130mcg
Aranesp
02246358
AGA
W
Liq
Liq
Inj
150mcg
Aranesp (Disc/non disp Nov. 04/15)
02391821
AGA
W
Page 25
B05
BLOOD SUBSTITUTES AND PERFUSION SOLUTIONS
PRODUITS DE REMPLACEMENT DU SANG ET SOLUTIONS POUR PERFUSION
B05C
IRRIGATING SOLUTIONS
SOLUTIONS POUR IRRIGATION
B05CA
ANTIINFECTIVES
ANTI-INFECTIEUX
B05CA10
COMBINATIONS
COMBINAISONS
POLYMYXIN B / NEOMYCIN
POLYMYXINE B / NÉOMYCINE
Liq Urh 200000IU/40mg
Liq
C01
CARDIAC THERAPY
CARDIOTHÉRAPIE
C01A
CARDIAC GLYCOSIDES
GLUCOSIDES CARDIOTONIQUES
C01AA
DIGITALIS GLYCOSIDES
GLUCOSIDES DIGITALIQUE
Neosporin Irrigating Sol.
00666157
GSK
AEFGVW
Toloxin
02242320
PDP
AEFGVW
C01AA05
DIGOXIN
DIGITOXINE
Liq Orl 0.05mg
Liq
Tab
Co.
Orl
0.0625mg
Toloxin
02335700
PDP
AEFGVW
Tab
Co.
Orl
0.125mg
Toloxin
02335719
PDP
AEFGVW
Tab
Co.
Orl
0.25mg
Toloxin
02335727
PDP
AEFGVW
C01B
ANTIARRHYTHMICS, CLASS I AND III
ANTIARHYTHMIQUES, CATÉGORIES I ET III
C01BA
ANTIARRHYTHMICS, CLASS IA
ANTIARHYTHMIQUES, CATÉGORIE IA
C01BA02
PROCAINAMIDE
PROCAINAMIDE
SRT Orl
Co.L.L.
250mg
Procan SR
00638692
ERF
AEFGVW
SRT Orl
Co.L.L.
500mg
Procan SR
00638676
ERF
AEFGVW
SRT Orl
Co.L.L.
750mg
Procan SR
00638684
ERF
AEFGVW
Page 26
C01BA03
C01BB
Cap Orl
Caps
100mg
Rythmodan
02224801
SAV
AEFGVW
Cap Orl
Caps
150mg
Rythmodan (Disc/non disp July 1/14)
02224828
SAV
AEFGVW
ANTIARRHYTHMICS, CLASS IB
ANTIARHYTHMIQUES, CATÉGORIE IB
C01BB02
C01BC
MEXILETINE
MEXILÉTINE
Cap Orl
Caps
100mg
Novo-Mexiletine
02230359
TEV
f
AEFGVW
Cap Orl
Caps
200mg
Novo-Mexiletine
02230360
TEV
f
AEFGVW
ANTIARRHYTHMICS, CLASS IC
ANTIARHYTHMIQUES, CATÉGORIE IC
C01BC03
PROPAFENONE
PROPAFÉNONE
Tab
Co.
Orl
150mg
Rythmol
Apo-Propafenone
Mylan-Propafenone
pms-Propafenone
Propafenone
00603708
02243324
02245372
02294559
02343053
ABB
APX
MYL
PMS
SAS
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
300mg
Rythmol
Apo-Propafenone
Mylan-Propafenone
pms-Propafenone
Propafenone
00603716
02243325
02245373
02294575
02343061
ABB
APX
MYL
PMS
SAS
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
C01BC04
C01BD
DISOPYRAMIDE
DISOPYRAMIDE
FLECAINIDE
FLÉCAÏNIDE
Tab
Co.
Orl
50mg
Tambocor (Disc/non disp Sep 1/14)
Flecainide
01966197
02275538
VLN
AAP
f
f
AEFGVW
AEFGVW
Tab
Co.
Orl
100mg
Tambocor (Disc/non disp Nov 1/14)
Flecainide
01966200
02275546
VLN
AAP
f
f
AEFGVW
AEFGVW
02292173
PMS
ANTIARRHYTHMICS, CLASS III
ANTIARHYTHMIQUES, CATÉGORIE III
C01BD01
Tab
Co.
AMIODARONE
AMIODARONE
Orl
100mg
pms-Amiodarone
Page 27
AEFGVW
C01BD01
AMIODARONE
AMIODARONE
Tab
Co.
Orl
200mg
Cordarone
Teva-Amiodarone
ratio-Amiodarone (Disc/non disp Jun 29/14)
Mylan-Amiodarone
pms-Amiodarone
Sandoz Amiodarone
Phl-Amiodarone
Apo-Amiodarone
Amiodarone
02036282
02239835
02240071
02240604
02242472
02243836
02245781
02246194
02364336
C01C
CARDIAC STIMULANTS EXCLUDING CARDIAC GLYCOSIDES
CARDIOTONIQUES À L’EXCLUSION DES GLYCOSIDES CARDIOTONIQUES
C01CA
ADRENERGIC AND DOPAMINERGIC AGENTS
AGENTS ADRÉNERGIQUES ET DOPAMINERGIQUES
C01CA24
PFI
TEV
RPH
MYL
PMS
SDZ
PHL
APX
SAS
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
EPINEPHRINE (CARDIAC STIMULANTS)
ÉPINEPHRINE (STIMULANTS CARDIAQUES)
Liq
Liq
Inj
0.15mg
Twinject *
Allerject
02268205
02382059
PAL
SAV
AEFGVW
AEFGVW
Liq
Liq
Inj
0.3mg
Twinject *
Allerject
02247310
02382067
PAL
SAV
AEFGVW
AEFGVW
Liq
Liq
Inj
0.5mg
Epi Pen Jr *
00578657
KNG
AEFGVW
Liq
Liq
Inj
1mg
Epi Pen *
00509558
KNG
AEFGVW
Liq
Liq
Inj
1mg
Adrenalin *
00155357
ERF
AEFGVW
C01D
VASODILATORS USED IN CARDIAC DISEASES
VASODILATATEURS UTILISÉS POUR LES MALADIES CARDIAQUES
C01DA
ORGANIC NITRATES
NITRATES ORGANIQUES
C01DA02
NITROGLYCERIN (GLYCERYL TRINITRATE)
NITROGLYCERINE (TRINITRATE DE GLYCERYLE)
Aem
Aém
Slg 0.4mg
Ont
Ont
Top
Pth
Pth
Nitrolingual
Rho-Nitro
Mylan-Nitro SL
Apo-Nitroglycerin
02231441
02238998
02243588
02393433
SAV
SDZ
MYL
APX
2%
Nitrol
01926454
PAL
Trd 0.2mg/hr
Nitro-Dur
Mylan-Nitro Patch
Minitran
Trinipatch
01911910
02407442
02162806
02230732
FRS
MYL
VLN
PAL
Page 28
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
f
f
AEFVW
AEFVW
AEFVW
AEFV
C01DA02
NITROGLYCERIN (GLYCERYL TRINITRATE)
NITROGLYCERINE (TRINITRATE DE GLYCERYLE)
Pth
Pth
Trd 0.4mg/hr
Nitro-Dur
Mylan-Nitro Patch
Minitran
Trinipatch
01911902
02407450
02163527
02230733
FRS
MYL
VLN
PAL
f
f
AEFVW
AEFVW
AEFVW
AEFV
Pth
Pth
Trd 0.6mg/hr
Nitro-Dur
Mylan-Nitro Patch
Minitran
Trinipatch
01911929
02407469
02163535
02230734
FRS
MYL
VLN
PAL
f
f
AEFVW
AEFVW
AEFVW
AEFV
Pth
Pth
Trd 0.8mg/hr
Nitro-Dur
Mylan-Nitro Patch
02011271
02407477
FRS
MYL
f
f
AEFVW
AEFVW
Slt
Slg
Co.S.L.
0.3mg
Nitrostat
00037613
PFI
AEFGVW
Slt
Slg
Co.S.L.
0.6mg
Nitrostat
00037621
PFI
AEFGVW
Srd
Srd
Trd
0.2mg
Transderm-Nitro
00584223
NVR
AEFVW
Srd
Srd
Trd
0.4mg
Transderm-Nitro
00852384
NVR
AEFVW
Srd
Srd
Trd
0.6mg
Transderm-Nitro
02046156
NVR
AEFVW
5mg
ISDN S/L
00670944
AAP
f
AEFGVW
Tab Orl 10mg
Co.
ISDN
00441686
AAP
f
AEFGVW
Tab Orl 30mg
Co.
ISDN
00441694
AAP
f
AEFGVW
Imdur
Apo-ISMN
pms-ISMN
02126559
02272830
02301288
AZE
APX
PMS
f
f
f
AEFGVW
AEFGVW
AEFGVW
C01DA08
ISOSORBIDE DINITRATE
DINITRATE D’ISOSORBIDE
Slt Slg
Co.S.L.
C01DA14
ISOSORBIDE MONONITRATE
MONONITRATE D’ISOSORBIDE
SRT Orl 60mg
Co.L.L.
Page 29
C02
ANTIHYPERTENSIVES
ANTIHYPERTENSEURS
C02A
ANTIADRENERGIC AGENTS, CENTRALLY ACTING
AGENTS ANTIADRÉNERGIQUES, AGISSANT CENTRALEMENT
C02AB
METHYLDOPA
METHYLDOPA
C02AB02
C02AC
METHYLDOPA (RACEMIC)
METHYLDOPA (RACEMIQUE)
Tab Orl 125mg
Co.
Methyldopa
00360252
AAP
f
AEFGVW
Tab Orl 250mg
Co.
Methyldopa
00360260
AAP
f
AEFGVW
Tab Orl 500mg
Co.
Methyldopa
00426830
AAP
f
AEFGVW
Tab Orl 0.025mg
Co.
Dixarit
Novo-Clonidine
00519251
02304163
BOE
TEV
f
f
AEFGVW
AEFGVW
Tab Orl 0.1mg
Co.
Catapres
Novo-Clonidine
00259527
02046121
BOE
TEV
f
f
AEFGVW
AEFGVW
Tab Orl 0.2mg
Co.
Catapres
Apo-Clonidine (Disc/non disp Mar 30/14)
Novo-Clonidine
00291889
00868957
02046148
BOE
APX
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
IMIDAZOLINE RECEPTOR AGONISTS
AGONISTES DU RÉCEPTEUR IMIDAZOLINE
C02AC01
CLONIDINE
CLONIDINE
C02C
ANTIADRENERGIC AGENTS, PERIPHERALLY ACTING
AGENTS ANTIADRÉNERGIQUES, AGISSANT EN PÉRIPHÉRIE
C02CA
ALPHA-ADRENOCEPTOR ANTAGONISTS
ALPHABLOQUANT DE L’ADRÉNOCEPTEUR
C02CA01
PRAZOSIN
PRAZOSIN
Tab Orl 1mg
Co.
Apo-Prazo
Teva-Prazin
00882801
01934198
APX
TEV
f
f
AEFGVW
AEFGVW
Tab Orl 2mg
Co.
Apo-Prazo
Teva-Prazin
00882828
01934201
APX
TEV
f
f
AEFGVW
AEFGVW
Tab Orl 5mg
Co.
Apo-Prazo
Teva-Prazin
00882836
01934228
APX
TEV
f
f
AEFGVW
AEFGVW
Cardura-1
Mylan-Doxazosin
Apo-Doxazosin
01958100
02240498
02240588
PFI
MYL
APX
f
f
f
AEF18+V
AEF18+V
AEF18+V
C02CA04
DOXAZOSIN
DOXAZOSIN
Tab Orl 1mg
Co.
Page 30
C02CA04
DOXAZOSIN
DOXAZOSIN
Tab Orl 1mg
Co.
Novo-Doxazosin
pms-Doxazosin
02242728
02244527
TEV
PMS
f
f
AEF18+V
AEF18+V
Tab Orl 2mg
Co.
Cardura-2
Mylan-Doxazosin
Apo-Doxazosin
Novo-Doxazosin
pms-Doxazosin
01958097
02240499
02240589
02242729
02244528
PFI
MYL
APX
TEV
PMS
f
f
f
f
f
AEF18+V
AEF18+V
AEF18+V
AEF18+V
AEF18+V
Tab Orl 4mg
Co.
Cardura-4
Mylan-Doxazosin
Apo-Doxazosin
Novo-Doxazosin
pms-Doxazosin
01958119
02240500
02240590
02242730
02244529
PFI
MYL
APX
TEV
PMS
f
f
f
f
f
AEF18+V
AEF18+V
AEF18+V
AEF18+V
AEF18+V
C02D
ARTERIOLAR SMOOTH MUSCLE, AGENTS ACTING ON
MUSCLES LISSES ARTÉRIOLAIRES, AGENTS AGISSANT SUR LES
C02DB
HYDRAZINOPHTHALAZINE DERIVATIVES
DÉRIVÉS DU HYDRAZINOPHTHALAZINE
C02DB02
HYDRALAZINE
HYDRALAZINE
Tab Orl 10mg
Co.
C02DC
Hydralazine
00441619
AAP
f
AEFGVW
Tab Orl 25mg
Co.
Hydralazine
00441627
AAP
f
AEFGVW
Tab Orl 50mg
Co.
Hydralazine
00441635
AAP
f
AEFGVW
Loniten
00514497
PFI
AEFGVW
Loniten
00514500
PFI
AEFGVW
pms-Hydrochlorothiazide
Apo-Hydro
02274086
02327856
PMS
APX
PYRIMIDINE DERIVATIVES
DÉRIVÉS DU PYRIMIDINE
C02DC01
MINOXIDIL
MINOXIDIL
Tab Orl 2.5mg
Co.
Tab Orl 10mg
Co.
C03
DIURETICS
DIURÉTIQUES
C03A
LOW-CEILING DIURETICS, THIAZIDES
DIURÉTIQUES DE PLAFOND BAS, THIAZIDES
C03AA
THIAZIDES, PLAIN
THIAZIDES, ORDINAIRE
C03AA03
HYDROCHLOROTHIAZIDE
HYDROCHLOROTHIAZIDE
Tab Orl 12.5mg
Co.
Page 31
f
f
AEFGVW
AEFGVW
C03AA03
HYDROCHLOROTHIAZIDE
HYDROCHLOROTHIAZIDE
Tab Orl 25mg
Co.
Teva-Hydrochlorothiazide
Apo-Hydro
00021474
00326844
02247386
TEV
APX
PMS
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab Orl 50mg
Co.
Teva-Hydrazide
Apo-Hydro
Hydrochlorothiazide
00021482
00312800
02247387
02360608
TEV
APX
PMS
SAS
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Apo-Hydro
00644552
APX
Tab Orl 100mg
Co.
C03B
LOW-CEILING DIURETICS, EXCLUDING THIAZIDES
DIURÉTIQUES DE PLAFOND BAS, À L’EXCLUSION DES THIAZIDES
C03BA
SULFONAMIDES, PLAIN
SULFONAMIDES, ORDINAIRES
C03BA04
AEFGVW
CHLORTHALIDONE
CHLORTHALIDONE
Tab Orl 50mg
Co.
Chlorthalidone
00360279
AAP
Zaroxolyn
00888400
SAV
Tab Orl 1.25mg
Co.
Lozide
Mylan-Indapamide
Apo-Indapamide
pms-Indapamide
Jamp-Indapamide
02179709
02240067
02245246
02239619
02373904
SEV
MYL
APX
PMS
JPC
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 2.5mg
Co.
Lozide
Mylan-Indapamide
Apo-Indapamide
Novo-Indapamide
pms-Indapamide
Jamp-Indapamide
00564966
02153483
02223678
02231184
02239620
02373912
SEV
MYL
APX
TEV
PMS
JPC
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Furosemide
Furosemide
00527033
02382539
SDZ
SDZ
f
VW
VW
C03BA08
HIGH-CEILING DIURETICS
DIURÉTIQUES À PLAFOND ÉLEVÉ
C03CA
SULFONAMIDES, PLAIN
SULFONAMIDES, ORDINAIRES
Liq
Liq
AEFGVW
INDAPAMIDE
INDAPAMIDE
C03C
C03CA01
AEFGVW
METOLAZONE
MÉTOLAZONE
Tab Orl 2.5mg
Co.
C03BA11
f
FUROSEMIDE
FUROSEMIDE
Inj
10mg
Page 32
C03CA01
Liq
Liq
C03CC
FUROSEMIDE
FUROSEMIDE
Orl
10mg
Lasix
02224720
SAV
Tab
Co.
Orl
20mg
Teva-Furosemide
Apo-Furosemide
Lasix (Disc/non disp Jun 30/14)
pms-Furosemide
Furosemide
00337730
00396788
02224690
02247493
02351420
TEV
APX
SAV
PMS
SAS
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
40mg
Lasix (Disc/non disp Apr 1/14)
pms-Furosemide
Furosemide
02224704
02247494
02351439
SAV
PMS
SAS
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
80mg
Apo-Furosemide
Teva-Furosemide
Furosemide
00707570
00765953
02351447
APX
TEV
SAS
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
500mg
Lasix Special
02224755
SAV
Edecrin
02258528
VLN
AEFGVW
ARYLOXYACETIC ACID DERIVATIVES
DÉRIVÉS DE L’ACIDE ARYLOXYACÉTIQUE
C03CC01
Tab
Co.
ETHACRYNIC ACID
ACIDE ETHACRYNIQUE
Orl
25mg
C03D
POTASSIUM-SPARING DRUGS
MÉDICAMENTS D’ÉPARGNE DE POTASSIUM
C03DA
ALDOSTERONE ANTAGONISTS
ANTAGONISTES DE L’ALDOSTÉRONE
C03DA01
C03DB
AEFGVW
AEFGVW
SPIRONOLACTONE
SPIRONOLACTONE
Tab
Co.
Orl
25mg
Aldactone
Teva-Spiroton
00028606
00613215
PFI
TEV
f
f
AEFGVW
AEFGVW
Tab
Co.
Orl
100mg
Aldactone
Teva-Spiroton
00285455
00613223
PFI
TEV
f
f
AEFGVW
AEFGVW
02249510
AAP
f
AEFGVW
OTHER POTASSIUM-SPARING AGENTS
AUTRES MÉDICAMENTS D’ÉPARGNE DE POTASSIUM
C03DB01
Tab
Co.
AMILORIDE
AMILORIDE
Orl
5mg
Midamor
Page 33
C03E
DIURETICS AND POTASSIUM-SPARING AGENTS IN COMBINATION
DIURÉTIQUES ET MÉDICAMENTS D’ÉPARGNE DE POTASSIUM EN COMBINAISON
C03EA
LOW-CEILING DIURETICS AND POTASSIUM-SPARING AGENTS
DIURÉTIQUES DE PLAFOND BAS ET MÉDICAMENTS D’ÉPARGNE DE POTASSIUM EN COMBINAISON
C03EA01
HYDROCHLOROTHIAZIDE AND POTASSIUM-SPARING DRUGS
HYDROCHLOROTHIAZIDE ET MÉDICAMENTS D’ÉPARGNE DE POTASSIUM
HYDROCHLOROTHIAZIDE / AMILORIDE
HYDROCHLOROTHIAZIDE / AMILORIDE
Tab
Co.
Apo-Amilzide
Novamilor
Mylan-Amilazide (Disc/non disp Jun 5/14)
Orl
50mg/5mg
00784400
01937219
02257378
APX
TEV
MYL
f
f
f
AEFGVW
AEFGVW
AEFGVW
HYDROCHLOROTHIAZIDE / SPIRONOLACTONE
HYDROCHLOROTHIAZIDE / SPIRONOLACTONE
Tab
Co.
Orl
25mg/25mg
Aldactazide-25
Teva-Spirozine-25
00180408
00613231
PFI
TEV
f
f
AEFGVW
AEFGVW
Tab
Co.
Orl
50mg/50mg
Aldactazide-50
Teva-Spirozine-50
00594377
00657182
PFI
TEV
f
f
AEFGVW
AEFGVW
00441775
00532657
APX
TEV
f
f
AEFGVW
AEFGVW
TRIAMTERENE / HYDROCHLOROTHIAZIDE
TRIAMTERENE / HYDROCHLOROTHIAZIDE
Tab
Co.
Orl
50mg/25mg
Apo-Triazide
Teva-Triamterene/HCTZ
C04
PERIPHERAL VASODILATORS
VASODILATATEURS PÉRIPHÉRIQUES
C04A
PERIPHERAL VASODILATORS
VASODILATATEURS PÉRIPHÉRIQUES
C04AA
2-AMINO-1-PHENYLETHANOL DERIVATIVES
DÉRIVÉS DU 2-AMINO-1 PHÉNYLÉTHANOL
C04AA02
Tab
Co.
BUPHENINE (HYLIDRIN)
BUPHENINE (HYLIDRINE)
Orl
6mg
Arlidin
01926713
ERF
AEFGVW
C05
VASOPROTECTIVES
VASOPROTECTEURS
C05A
AGENTS FOR TREATMENT OF HEMORRHOIDS & ANAL FISSURES FOR TOPICAL USE
AGENTS POUR LE TRAITEMENT DES HÉMORROÏDES ET FISSURES ANALES / USAGE TOPIQUE
C05AA
CORTICOSTEROIDS
CORTICOSTÉROÏDES
C05AA01
HYDROCORTISONE
HYDROCORTISONE
HYDROCORTISONE / ZINC
Ont
Ont
Rt
0.5%/0.5%
Anusol-HC
Anodan HC
Sandoz Anuzinc HC
Ratio-Hemcort HC
Page 34
00505773
02128446
02247691
00607789
JNJ
ODN
SDZ
RPH
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
C05AA01
HYDROCORTISONE
HYDROCORTISONE
Sup
Rt
Supp.
Aer
Aér
Rt
0.5%/0.5%
Anusol-HC
Anodan HC
Sab-Anuzinc HC
Ratio-Hemcort HC
00476285
02236399
02242798
00607797
JNJ
ODN
SDZ
RPH
Proctofoam HC
00363014
DUI
1%/1%
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
FRAMYCETIN / ESCULIN / DIBUCAINE / HYDROCORTISONE
FRAMYCÉTINE / ESCULINE / DIBUCAINE / HYDROCORTISONE
Ont Rt 10mg/10mg/5mg/5mg
Ont.
Proctosedyl
Sandoz Proctomyxin HC
Proctol Ointment
02223252
02242527
02247322
AXC
SDZ
ODN
f
f
f
AEFGVW
AEFGVW
AEFGVW
Sup Rt 10mg/10mg/5mg/5mg
Supp.
Proctosedyl
Sandoz Proctomyxin HC Supp
Proctol Suppositories
02223260
02242528
02247882
AXC
SDZ
ODN
f
f
f
AEFGVW
AEFGVW
AEFGVW
Anugesic-HC
Proctodan-HC Suppositories
Sandoz-Anuzinc HC Plus (Disc/non disp Mar 21/14)
00505781
02234466
02247692
JNJ
ODN
SDZ
f
f
f
AEFGVW
AEFGVW
AEFGVW
10mg/20mg/10mg
00476242
02240851
02242797
JNJ
ODN
SDZ
f
f
f
AEFGVW
AEFGVW
AEFGVW
HYDROCORTISONE / PRAMOXINE / ZINC
HYDROCORTISONE / PRAMOXINE / ZINC
Ont
Ont
Rt
Sup Rt
Supp.
0.5%/1%/0.5%
Anugesic-HC
Proctodan-HC Suppositories
Sab-Anuzinc HC Plus
C07
BETA BLOCKING AGENTS
BETA-BLOQUANTS
C07A
BETA BLOCKING AGENTS, PLAIN
BETA-BLOQUANTS, ORDINAIRES
C07AA
BETA BLOCKING AGENTS, NON-SELECTIVE
BETA-BLOQUANTS, NON SÉLECTIFS
C07AA03
PINDOLOL
PINDOLOL
Tab Orl 5mg
Co.
Visken
Apo-Pindol
Teva-Pindol
pms-Pindolol
Sandoz Pindolol
00417270
00755877
00869007
02231536
02261782
NVR
APX
TEV
PMS
SDZ
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 10mg
Co.
Visken
Apo-Pindol
Teva-Pindol
pms-Pindolol
Sandoz Pindolol
00443174
00755885
00869015
02231537
02261790
NVR
APX
TEV
PMS
SDZ
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Page 35
C07AA03
PINDOLOL
PINDOLOL
Tab Orl 15mg
Co.
C07AA05
Visken
Apo-Pindol
Teva-Pindol
pms-Pindolol
Sandoz Pindolol
00417289
00755893
00869023
02231539
02261804
NVR
APX
TEV
PMS
SDZ
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
PROPRANOLOL
PROPRANOLOL
Tab
Co.
Orl 10mg
Apo-Propranolol (Disc/non disp Apr 10/15)
Novo-Pranol
00402788
00496480
APX
TEV
f
f
AEFGVW
AEFGVW
Tab
Co.
Orl 20mg
Apo-Propranolol (Disc/non disp Oct 22/15)
Novo-Pranol
00663719
00740675
APX
TEV
f
f
AEFGVW
AEFGVW
Tab
Co.
Orl 40mg
Novo-Pranol
00402753
00496499
APX
TEV
f
f
AEFGVW
AEFGVW
Tab
Co.
Orl 80mg
Novo-Pranol
00402761
00496502
APX
TEV
f
f
AEFGVW
AEFGVW
Tab
Co.
Orl 120mg
Apo-Propranolol
00504335
APX
f
AEFGVW
Orl 5mg
Apo-Timol
Teva-Timol
00755842
01947796
APX
TEV
f
f
AEFGVW
AEFGVW
Tab Orl 10mg
Co.
Apo-Timol
Teva-Timol
00755850
01947818
APX
TEV
f
f
AEFGVW
AEFGVW
Tab
Co.
Apo-Timol
Teva-Timol
00755869
01947826
APX
TEV
f
f
AEFGVW
AEFGVW
C07AA06
Tab
Co.
C07AA07
TIMOLOL
TIMOLOL
Orl
20mg
SOTALOL
SOTALOL
Tab
Co.
Orl
80mg
Apo-Sotalol
Mylan-Sotalol
Novo-Sotalol
pms-Sotalol
Sandoz Sotalol
Co-Sotalol (Disc/non disp Dec 12/14)
Jamp-Sotalol
ratio-Sotalol
02210428
02229778
02231181
02238326
02257831
02270625
02368617
02084228
APX
MYL
TEV
PMS
SDZ
COB
JPC
TEV
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 160mg
ratio-Sotalol
Apo-Sotalol
Mylan-Sotalol
Novo-Sotalol
pms-Sotalol
Sandoz Sotalol
02084236
02167794
02229779
02231182
02238327
02257858
TEV
APX
MYL
TEV
PMS
SDZ
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Page 36
C07AA07
Tab
Co.
C07AA12
C07AB
SOTALOL
SOTALOL
Orl 160mg
Co-Sotalol (Disc/non disp Dec 12/14)
Jamp-Sotalol
02270633
02368625
COB
JPC
f
f
AEFGVW
AEFGVW
NADOLOL
NADOLOL
Tab
Co.
Orl
40mg
Apo-Nadol
Teva-Nadolol (Disc/non disp Oct 25/14)
00782505
02126753
APX
TEV
f
f
AEFGVW
AEFGVW
Tab
Co.
Orl
80mg
Apo-Nadol
Teva- Nadolol (Disc/non disp Oct 25/14)
00782467
02126761
APX
TEV
f
f
AEFGVW
AEFGVW
Tab
Co.
Orl 160mg
Apo-Nadol
00782475
APX
f
AEFGVW
BETA BLOCKING AGENTS, SELECTIVE
BETA-BLOQUANTS, SÉLECTIFS
C07AB02
METOPROLOL
MÉTOPROLOL
SRT Orl
Co.L.L.
100mg
Lopresor SR
Apo-Metoprolol SR
Sandoz Metoprolol SR
00658855
02285169
02303396
NVR
APX
SDZ
f
f
f
AEFGVW
AEFGVW
AEFGVW
SRT Orl
Co.L.L.
200mg
Lopresor SR
Apo-Metoprolol SR
Sandoz Metoprolol SR
00534560
02285177
02303418
NVR
APX
SDZ
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
25mg
Apo-Metoprolol
pms-Metoprolol-L
Mylan-Metoprolol (type L)
Jamp-Metoprolol-L
02246010
02248855
02302055
02356813
APX
PMS
MYL
JPC
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
50mg
Lopresor (coated)
Apo-Metoprolol (uncoated)
Teva-Metoprolol (coated)
Apo-Metoprolol type “L”
Teva-Metoprolol (uncoated)
pms-Metoprolol-L
Sandoz Metoprolol (type L) (Disc/non disp Feb 22/14)
Metoprolol
Sandoz Metoprolol
Jamp-Metoprolol-L
00397423
00618632
00648035
00749354
00842648
02174545
02230803
02247875
02350394
02354187
02356821
NVR
APX
TEV
APX
TEV
MYL
PMS
SDZ
SAS
SDZ
JPC
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
100mg
00397431
00618640
00648043
00751170
00842656
02174553
02230804
02247876
NVR
APX
TEV
APX
TEV
MYL
PMS
SDZ
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Lopresor (coated)
Apo-Metoprolol (uncoated)
Teva-Metoprolol (coated)
Apo-Metoprolol type “L”
Teva-Metoprolol (uncoated)
pms-Metoprolol-L
Sandoz Metoprolol (type L) (Disc/non disp Feb 22/14)
Page 37
C07AB02
Tab
Co.
C07AB03
METOPROLOL
MÉTOPROLOL
Orl
100mg
Metoprolol
Sandoz Metoprolol
Jamp-Metoprolol-L
02350408
02354195
02356848
SAS
SDZ
JPC
f
f
f
AEFGVW
AEFGVW
AEFGVW
ATENOLOL
ATÉNOLOL
Tab
Co.
Orl
25mg
pms-Atenolol
Atenolol
Teva-Atenolol
Mylan-Atenolol
Jamp-Atenolol
Mint-Atenolol
Mar-Atenolol
Ran-Atenolol
02246581
02247182
02266660
02303647
02367556
02368013
02371979
02373963
PMS
SIV
TEV
MYL
JPC
MNT
MAR
RAN
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
50mg
Apo-Atenol
Tenormin
Mylan-Atenolol-50
ratio-Atenolol
Sandoz Atenolol
pms-Atenolol
Atenolol
Co Atenolol
Ran-Atenolol
Jamp-Atenolol
Mint-Atenolol
Septa-Atenolol
Mar-Atenolol
00773689
02039532
02146894
02171791
02231731
02237600
02238316
02255545
02267985
02367564
02368021
02368641
02371987
APX
AZE
MYL
TEV
SDZ
PMS
SIV
COB
RAN
JPC
MNT
SPT
MAR
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
100mg
Apo-Atenol
Teva-Atenolol
Tenormin
Mylan-Atenolol-100
ratio-Atenolol
Sandoz Atenolol
pms-Atenolol
Atenolol
Co Atenolol
Ran-Atenolol
Jamp-Atenolol
Mint-Atenolol
Septa-Atenolol
Mar-Atenolol
00773697
01912054
02039540
02147432
02171805
02231733
02237601
02238318
02255553
02267993
02367572
02368048
02368668
02371995
APX
TEV
AZE
MYL
TEV
SDZ
PMS
SIV
COB
RAN
JPC
MNT
SPT
MAR
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Sectral (Disc/non disp Jun 30/14)
Apo-Acebutolol
Teva-Acebutolol
Mylan-Acebutolol
Mylan-Acebutolol Type S
Acebutolol
Page 38
01926543
02147602
02204517
02237721
02237885
02286246
SAV
APX
TEV
MYL
MYL
SAS
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
C07AB04
ACEBUTOLOL
ACÉBUTOLOL
Tab Orl 100mg
Co.
C07AB04
ACEBUTOLOL
ACÉBUTOLOL
Tab Orl 200mg
Co.
Tab
Co.
C07AB07
C07AG
Orl
400mg
Sectral
Apo-Acebutolol
Teva-Acebutolol
Mylan-Acebutolol
Acebutolol
01926551
02147610
02204525
02237722
02237886
02286254
SAV
APX
TEV
MYL
MYL
SAS
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Sectral
Apo-Acebutolol
Teva-Acebutolol
Mylan-Acebutolol
Acebutolol
01926578
02147629
02204533
02237723
02237887
02286262
SAV
APX
TEV
MYL
MYL
SAS
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
BISOPROLOL
BISOPROLOL
Tab
Co.
Orl
5mg
Sandoz Bisoprolol
Apo-Bisoprolol
Novo-Bisoprolol
pms-Bisoprolol
Mylan-Bisoprolol
Bisoprolol
02247439
02256134
02267470
02302632
02384418
02391589
SDZ
APX
TEV
PMS
MYL
SAS
f
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
Tab
Co.
Orl
10mg
Sandoz Bisoprolol
Apo-Bisoprolol
Novo-Bisoprolol
pms-Bisoprolol
Mylan-Bisoprolol
Bisoprolol
02247440
02256177
02267489
02302640
02384426
02391597
SDZ
APX
TEV
PMS
MYL
SAS
f
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
ALPHA AND BETA BLOCKING AGENTS
ALPHA-BLOQUANTS ET BETA-BLOQUANTS
C07AG01
LABETALOL
LABÉTALOL
Tab
Co.
Orl 100mg
Trandate
02106272
PAL
f
AEFGVW
Tab
Co.
Orl
Trandate
02106280
PAL
f
AEFGVW
9
02245914
02247933
02248752
02252309
02268027
02338068
02347512
02364913
02368897
PMS
APX
SIV
TEV
RAN
ZYM
MYL
SAS
JPC
f
f
f
f
f
f
f
f
f
AEFV
AEFV
AEFV
AEFV
AEFV
AEFV
AEFV
AEFV
AEFV
C07AG01
Tab
Co.
200mg
CARVEDILOL
CARVÉDILOL
Orl
3.125mg
pms-Carvedilol
9
Apo-Carvedilol
9
Carvedilol
9
ratio-Carvedilol
9
Ran-Carvedilol
9
Zym-Carvedilol
9
Mylan-Carvedilol
9
Carvidilol
9
Jamp-Carvedilol
Page 39
C07AG01
CARVEDILOL
CARVÉDILOL
Tab
Co.
Orl
6.25mg
pms-Carvedilol
9
Apo-Carvedilol
9
Carvedilol
9
ratio-Carvedilol
9
Ran-Carvedilol
9
Zym-Carvedilol
9
Mylan-Carvedilol
9
Carvidilol
9
Jamp-Carvedilol
9
02245915
02247934
02248753
02252317
02268035
02338092
02347520
02364921
02368900
PMS
APX
SIV
TEV
RAN
ZYM
MYL
SAS
JPC
f
f
f
f
f
f
f
f
f
AEFV
AEFV
AEFV
AEFV
AEFV
AEFV
AEFV
AEFV
AEFV
Tab
Co.
Orl
12.5mg
pms-Carvedilol
9
Apo-Carvedilol
9
Carvedilol
9
ratio-Carvedilol
9
Ran-Carvedilol
9
Zym-Carvedilol
9
Mylan-Carvedilol
9
Carvidilol
9
Jamp-Carvedilol
9
02245916
02247935
02248754
02252325
02268043
02338106
02347555
02364948
02368919
PMS
APX
SIV
TEV
RAN
ZYM
MYL
SAS
JPC
f
f
f
f
f
f
f
f
f
AEFV
AEFV
AEFV
AEFV
AEFV
AEFV
AEFV
AEFV
AEFV
Tab
Co.
Orl
25mg
pms-Carvedilol
9
Apo-Carvedilol
9
Carvedilol
9
ratio-Carvedilol
9
Ran-Carvedilol
9
Zym-Carvedilol
9
Mylan-Carvedilol
9
Carvedilol
9
Jamp-Carvedilol
9
02245917
02247936
02248755
02252333
02268051
02338114
02347571
02364956
02368927
PMS
APX
SIV
TEV
RAN
ZYM
MYL
SAS
JPC
f
f
f
f
f
f
f
f
f
AEFV
AEFV
AEFV
AEFV
AEFV
AEFV
AEFV
AEFV
AEFV
C07C
BETA BLOCKING AGENTS AND OTHER DIURETICS
BETA-BLOQUANTS ET AUTRES DIURÉTIQUES
C07CA
BETA BLOCKING AGENTS, NON-SELECTIVE, OTHER DIURETICS
BETA-BLOQUANTS, NON SÉLECTIFS, AUTRES DIURÉTIQUES
C07CA03
PINDOLOL AND OTHER DIURETICS
PINDOLOL ET AUTRE DIURÉTIQUES
PINDOLOL / HYDROCHLOROTHIAZIDE
PINDOLOL / HYDROCHLOROTHIAZIDE
9
Tab
Co.
Orl
10mg/25mg
Viskazide
00568627
NVR
AEFGVW
Tab
Co.
Orl
10mg/50mg
Viskazide
00568635
NVR
AEFGVW
Requests for coverage of Carvedilol will be considered under special authorization. Please refer to
Appendix IV. Prescriptions written by cardiologists or internists do not require special authorization. Subsequent
refills by other practitioners will not require special authorization.
Les demandes de protection pour le Carvedilol seront examinées sur autorisation spéciale. Veuillez consulter l'annexe IV.
Les ordonnances des cardiologistes ou des internistes ne nécessitent pas une autorisation spéciale. Les renouvellements
prescrits par d'autres practiciens ne nécessiteront pas d'autorisation spéciale.
Page 40
C07CB
BETA BLOCKING AGENTS, SELECTIVE, AND OTHER DIURETICS
BETA-BLOQUANTS, SÉLECTIFS, ET AUTRES DIURÉTIQUES
C07CB03
ATENOLOL AND OTHER DIURETICS
ATÉNOLOL ET AUTRE DIURÉTIQUES
ATENOLOL / CHLORTHALIDONE
ATÉNOLOL / CHLORTHALIDONE
Tab
Co.
Orl 50mg/25mg
Tenoretic
Apo-Atenidone
Teva-Atenolol/Chlorthalidone
02049961
02248763
02302918
AZE
APX
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 100mg/25mg
Tenoretic
Apo-Atenidone
Teva-Atenolol/Chlorthalidone
02049988
02248764
02302926
AZE
APX
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
C08
CALCIUM CHANNEL BLOCKERS
ANTAGONISTES DU CALCIUM
C08C
SELECTIVE CALCIUM CHANNEL BLOCKERS WITH MAINLY VASCULAR EFFECTS
ANTAGONISTES DU CALCIUM SÉLECTIFS AVEC PRINCIPALEMENT DES EFFETS VASCULAIRES
C08CA
DIHYDROPYRIDINE DERIVATIVES
DÉRIVÉS DU DIHYDROPYRIDINE
C08CA01
AMLODIPINE
AMLODIPINE
Tab Orl
Co.
2.5mg
Tab Orl
Co.
5mg
pms-Amlodipine
Co Amlodipine
Amlodipine
Sandoz Amlodipine
Jamp-Amlodipine
Mar-Amlodipine
Septa-Amlodipine
Ran-Amlodipine
02295148
02297477
02326795
02330474
02357186
02371707
02357704
02398877
PMS
COB
PDL
SDZ
JPC
MAR
SPT
RAN
f
f
f
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
Norvasc
Teva-Amlodipine
ratio-Amlodipine
Mylan-Amlodipine
Apo-Amlodipine
GD-Amlodipine
pms-Amlodipine
Sandoz Amlodipine
Co Amlodipine
Ran-Amlodipine
Phl-Amlodipine
Amlodipine
Jamp-Amlodipine
Amlodipine
Jamp-Amlodipine (new formulation)
Septa-Amlodipine
Mint-Amlodipine
Mar-Amlodipine
Amlodipine-Odan
Auro-Amlodipine
00878928
02250497
02259605
02272113
02273373
02280132
02284065
02284383
02297485
02321858
02326779
02326809
02331071
02331284
02357194
02357712
02362651
02371715
02378760
02397072
PFI
TEV
RPH
MYL
APX
GMD
PMS
SDZ
COB
RAN
PHL
PDL
JPC
SAS
JPC
SPT
MNT
MAR
ODN
ARO
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
Page 41
C08CA01
Tab
Co.
AMLODIPINE
AMLODIPINE
Norvasc
Teva-Amlodipine
ratio-Amlodipine
Mylan-Amlodipine
Apo-Amlodipine
GD-Amlodipine
pms-Amlodipine
Sandoz Amlodipine
Co Amlodipine
Ran-Amlodipine
Phl-Amlodipine
Amlodipine
Jamp-Amlodipine
Amlodipine
Jamp-Amlodipine (new formulation)
Septa-Amlodipine
Mar-Amlodipine
Amlodipine-Odan
Auro-Amlodipine
Mint-Amlodipine
00878936
02250500
02259613
02272121
02273381
02280140
02284073
02284391
02297493
02321866
02326787
02326817
02331098
02331292
02357208
02357720
02371723
02378779
02397080
02362678
PFI
TEV
RPH
MYL
APX
GMD
PMS
SDZ
COB
RAN
PHL
PDL
JPC
SAS
JPC
SPT
MAR
ODN
ARO
MNT
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
Plendil
Renedil (Disc/non disp Sep 18/15)
02057778
02221985
AZE
SAV
f
f
AEFVW
AEFVW
Plendil
Renedil (Disc/non disp Aug 6/15)
Sandoz Felodipine
00851779
02221993
02280264
AZE
SAV
SDZ
f
f
f
AEFVW
AEFVW
AEFVW
Plendil
Renedil (Disc/non disp Apr 29/15)
Sandoz Felodipine
00851787
02222000
02280272
AZE
SAV
SDZ
f
f
f
AEFVW
AEFVW
AEFVW
Cap Orl 5mg
Caps
Nifedipine
00725110
AAP
f
AEFGVW
Cap Orl 10mg
Caps
Nifedipine
00755907
AAP
f
AEFGVW
ERT Orl 20mg
Co.L.P.
Adalat XL
02237618
BAY
f
AEFGVW
ERT Orl 30mg
Co.L.P.
Adalat XL
Mylan-Nifedipine Extended Release
02155907
02349167
BAY
MYL
f
f
AEFGVW
AEFGVW
ERT Orl 60mg
Co.L.P.
Adalat XL
Mylan-Nifedipine Extended Release
02155990
02321149
BAY
MYL
f
f
AEFGVW
AEFGVW
C08CA02
Orl
10mg
FELODIPINE
FÉLODIPINE
SRT Orl 2.5mg
Co.L.L.
SRT Orl 5mg
Co.L.L.
SRT Orl 10mg
Co.L.L.
C08CA05
NIFEDIPINE
NIFÉDIPINE
Page 42
C08D
SELECTIVE CALCIUM CHANNEL BLOCKERS WITH DIRECT CARDIAC EFFECTS
ANTAGONISTES DU CALCIUM SÉLECTIFS AVEC EFFETS CARDIAQUES DIRECTS
C08DA
PHENYLALKYLAMINE DERIVATIVES
DÉRIVÉS DU PHÉNYLALKYLAMINE
C08DA01
C08DB
VERAPAMIL
VÉRAPAMIL
SRT Orl 180mg
Co.L.L.
Isoptin SR
Mylan-Verapamil
Apo-Verap SR
Covera-HS
01934317
02210355
02246894
02231676
ABB
MYL
APX
PFI
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFVW
SRT Orl 240mg
Co.L.L.
Isoptin SR
Mylan-Verapamil
pms-Verapamil SR
Apo-Verap SR
Novo-Veramil SR
Covera-HS
00742554
02210363
02237791
02246895
02211920
02231677
ABB
MYL
PMS
APX
TEV
PFI
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGV
Tab Orl 80mg
Co.
Apo-Verap
Mylan-Verapamil
00782483
02237921
APX
MYL
f
f
AEFGVW
AEFGVW
Tab Orl 120mg
Co.
Apo-Verap
Mylan-Verapamil
00782491
02237922
APX
MYL
f
f
AEFGVW
AEFGVW
CD Orl 120mg
Caps.L.C.
Cardizem CD
Apo-Diltiaz CD
ratio-diltiazem CD (Disc/non disp Jun 29/14)
Teva-Diltazem CD
Sandoz Diltiazem CD
pms-Diltiazem CD
Co Diltiazem CD
Diltiazem CD
02097249
02230997
02229781
02242538
02243338
02355752
02370611
02400421
VLN
APX
RPH
TEV
SDZ
PMS
COB
SAS
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
CD Orl 180mg
Caps.L.C.
Cardizem CD
Apo-Diltiaz CD
ratio-diltiazem CD (Disc/non disp June 29/14)
Teva-Diltazem CD
Sandoz Diltiazem CD
pms-Diltiazem CD
Co Diltiazem CD
Diltiazem CD
02097257
02230998
02229782
02242539
02243339
02355760
02370638
02400448
VLN
APX
RPH
TEV
SDZ
PMS
COB
SAS
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
CD Orl 240mg
Caps.L.C.
Cardizem CD
Apo-Diltiaz CD
Teva-Diltazem CD
Sandoz Diltiazem CD
02097265
02230999
02229783
02242540
02243340
VLN
APX
RPH
TEV
SDZ
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
BENZOTHIAZEPINE DERIVATIVES
DÉRIVÉS DU BENZOTHIAZÉPINE
C08DB01
DILTIAZEM
DILTIAZEM
Page 43
C08DB01
DILTIAZEM
DILTIAZEM
CD Orl 240mg
Caps.L.C.
pms-Diltiazem CD
Co Diltiazem CD
Diltiazem CD
02355779
02370646
02400456
PMS
COB
SAS
f
f
f
AEFGVW
AEFGVW
AEFGVW
CD Orl 300mg
Caps.L.C.
Cardizem CD
Apo-Diltiaz CD
Teva-Diltazem CD
Sandoz Diltiazem CD
pms-Diltiazem CD
Co Diltiazem CD
Diltiazem CD
02097273
02229526
02229784
02242541
02243341
02355787
02370654
02400464
VLN
APX
RPH
TEV
SDZ
PMS
COB
SAS
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
ERC Orl 120mg
Caps.L.P
Tiazac
Sandoz Diltiazem T
Teva-Diltiazem ER
Apo-Diltiaz TZ
Co Diltiazem T
02231150
02245918
02271605
02291037
02370441
VLN
SDZ
TEV
APX
COB
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
ERC Orl 180mg
Caps.L.P
Tiazac
Sandoz Diltiazem T
Teva-Diltiazem ER
Apo-Diltiaz TZ
Co Diltiazem T
02231151
02245919
02271613
02291045
02370492
VLN
SDZ
TEV
APX
COB
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
ERC Orl 240mg
Caps.L.P
Tiazac
Sandoz Diltiazem T
Teva-Diltiazem ER
Apo-Diltiaz TZ
Co Diltiazem T
02231152
02245920
02271621
02291053
02370506
VLN
SDZ
TEV
APX
COB
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
ERC Orl 300mg
Caps.L.P
Tiazac
Sandoz Diltiazem T
Teva-Diltiazem ER
Apo-Diltiaz TZ
Co Diltiazem T
02231154
02245921
02271648
02291061
02370514
VLN
SDZ
TEV
APX
COB
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
ERC Orl 360mg
Caps.L.P
Tiazac
Sandoz Diltiazem T
Teva-Diltiazem ER
Apo-Diltiaz TZ
Co Diltiazem T
02231155
02245922
02271656
02291088
02370522
VLN
SDZ
TEV
APX
COB
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
ERT Orl 120mg
Co.L.P.
Tiazac XC
02256738
VLN
AEFGVW
ERT Orl 180mg
Co.L.P.
Tiazac XC
02256746
VLN
AEFGVW
ERT Orl 240mg
Co.L.P.
Tiazac XC
02256754
VLN
AEFGVW
Page 44
C08DB01
DILTIAZEM
DILTIAZEM
ERT Orl 300mg
Co.L.P.
Tiazac XC
02256762
VLN
AEFGVW
ERT Orl 360mg
Co.L.P.
Tiazac XC
02256770
VLN
AEFGVW
Tab Orl
Co.
30mg
Apo-Diltiaz
Teva-Diltiazem
00771376
00862924
APX
TEV
f
f
AEFGVW
AEFGVW
Tab Orl
Co.
60mg
Apo-Diltiaz
Teva-Diltiazem
00771384
00862932
APX
TEV
f
f
AEFGVW
AEFGVW
C09
AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM
AGENTS AGISSANT SUR LE SYSTÈME RÉNINE-ANGIOTENSINE
C09A
ACE INHIBITORS, PLAIN
INHIBITEUR DE L’ENZYME CONVERTISSANT L’ANGIOTENSINE, ORDINAIRE
C09AA
ACE INHIBITORS, PLAIN
INHIBITEUR DE L’ENZYME CONVERTISSANT L’ANGIOTENSINE, ORDINAIRE
C09AA01
CAPTOPRIL
CAPTOPRIL
Tab Orl 12.5mg
Co.
Apo-Capto
Teva-Captoril
Mylan-Captopril
00893595
01942964
02163551
APX
TEV
MYL
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab Orl 25mg
Co.
Apo-Capto
Teva-Captoril
Mylan-Captopril
00893609
01942972
02163578
APX
TEV
MYL
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab Orl 50mg
Co.
Apo-Capto
Teva-Captoril
Mylan-Captopril
00893617
01942980
02163586
APX
TEV
MYL
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab Orl 100mg
Co.
Apo-Capto
Teva-Captoril
Mylan-Captopril
00893625
01942999
02163594
APX
TEV
MYL
f
f
f
AEFGVW
AEFGVW
AEFGVW
10
00851795
02020025
02291878
02299933
02300036
02300680
02352230
02300079
02400650
FRS
APX
COB
SDZ
MYL
TEV
RAN
PMS
SAS
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
C09AA02
ENALAPRIL
ÉNALAPRIL
Tab Orl 2.5mg
Co.
Vasotec
10
Apo-Enalapril
10
Co Enalapril
10
Sandoz Enalapril
10
Mylan-Enalapril
10
Teva-Enalapril
10
Ran-Enalapril
10
pms-Enalapril
10
Enalapril
Page 45
C09AA02
ENALAPRIL
ÉNALAPRIL
Tab Orl 5mg
Co.
Vasotec
10
Apo-Enalapril
10
Co Enalapril
10
Sandoz Enalapril
10
Mylan-Enalapril
10
Teva-Enalapril
10
Ran-Enalapril
10
pms-Enalapril
10
Enalapril
10
00708879
02019884
02291886
02299941
02300044
02233005
02352249
02300087
02400669
FRS
APX
COB
SDZ
MYL
TEV
RAN
PMS
SAS
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 10mg
Co.
Vasotec
10
Apo-Enalapril
10
Co Enalapril
10
Sandoz Enalapril
10
Mylan-Enalapril
10
Teva-Enalapril
10
Ran-Enalapril
10
pms-Enalapril
10
Enalapril
10
00670901
02019892
02291894
02299968
02300052
02233006
02352257
02300095
02400677
FRS
APX
COB
SDZ
MYL
TEV
RAN
PMS
SAS
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 20mg
Co.
Vasotec
10
Apo-Enalapril
10
Co Enalapril
10
Sandoz Enalapril
10
Mylan-Enalapril
10
Teva-Enalapril
10
Ran-Enalapril
10
pms-Enalapril
10
Enalapril
10
00670928
02019906
02291908
02299976
02300060
02233007
02352265
02300109
02400685
FRS
APX
COB
SDZ
MYL
TEV
RAN
PMS
SAS
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Prinivil
Zestril
Apo-Lisinopril
ratio-Lisinopril P (Disc/non disp Jun 29/14)
Co Lisinopril
Mylan-Lisinopril
Teva-Lisinopril P
Teva-Lisinopril Z
Sandoz Lisinopril
pms-Lisinopril
Ran-Lisinopril
ratio-Lisinopril Z (Disc/non disp Jun 29/14)
Jamp-Lisinopril
Auro-Lisinopril
00839388
02049333
02217481
02256797
02271443
02274833
02285061
02285118
02289199
02292203
02294230
02299879
02361531
02394472
FRS
AZE
APX
RPH
COB
MYL
TEV
TEV
SDZ
PMS
RAN
RPH
JPC
ARO
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
C09AA03
LISINOPRIL
LISINOPRIL
Tab Orl 5mg
Co.
10
Each tablet is made with 2.5mg, 5mg, 10mg or 20mg of enalapril maleate that appears as 2mg, 4mg, 8mg, 16mg of
enalapril sodium, respectively, in the finished tablets.
Chaque comprimé est compose de 2,5mg, 5mg, 10mg ou 20mg de maleate d’énalapril contenant respectivement 2mg, 4mg,
8mg ou 16mg de sodium d’énalapril, dans les comprimés en version finale.
Page 46
C09AA03
LISINOPRIL
LISINOPRIL
Tab Orl 10mg
Co.
Prinivil
Zestril
Apo-Lisinopril
Co Lisinopril
Mylan-Lisinopril
Teva-Lisinopril P
Teva-Lisinopril Z
Sandoz Lisinopril
pms-Lisinopril
Ran-Lisinopril
Jamp-Lisinopril
Auro-Lisinopril
00839396
02049376
02217503
02256800
02271451
02274841
02285088
02285126
02289202
02292211
02294249
02299887
02361558
02394480
FRS
AZE
APX
RPH
COB
MYL
TEV
TEV
SDZ
PMS
RAN
RPH
JPC
ARO
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 20mg
Co.
Prinivil
Zestril
Apo-Lisinopril
Co Lisinopril
Mylan-Lisinopril
Teva-Lisinopril P
Teva-Lisinopril Z
Sandoz Lisinopril
pms-Lisinopril
Ran-Lisinopril
Jamp-Lisinopril
Auro-Lisinopril
00839418
02049384
02217511
02256819
02271478
02274868
02285096
02285134
02289229
02292238
02294257
02299895
02361566
02394499
FRS
AZE
APX
RPH
COB
MYL
TEV
TEV
SDZ
PMS
RAN
RPH
JPC
ARO
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 2mg
Co.
Coversyl
02123274
SEV
AEFGVW
Tab Orl 4mg
Co.
Coversyl
02123282
SEV
AEFGVW
Tab Orl 8mg
Co.
Coversyl
02246624
SEV
f
AEFGVW
Altace
Apo-Ramipril
ratio-Ramipril
pms-Ramipril
Co Ramipril
Mylan-Ramipril
02221829
02251515
02287692
02295369
02295482
02301148
SAV
APX
RPH
PMS
COB
MYL
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
C09AA04
C09AA05
PERINDOPRIL
PERINDOPRIL
RAMIPRIL
RAMIPRIL
Cap Orl 1.25mg
Caps
Page 47
C09AA05
RAMIPRIL
RAMIPRIL
Cap Orl 1.25mg
Caps
Ran-Ramipril
Jamp-Ramipril
Auro-Ramipril
02310503
02331101
02387387
RAN
JPC
ARO
f
f
f
AEFGVW
AEFGVW
AEFGVW
Cap Orl 2.5mg
Caps
Altace
pms-Ramipril
Teva-Ramipril
Apo-Ramipril
ratio-Ramipril
Co Ramipril
Mylan-Ramipril
Ran-Ramipril
Jamp-Ramipril
Ramipril
Auro-Ramipril
02221837
02247917
02247945
02251531
02287706
2295490
02301156
02310511
02331128
02374846
02387395
SAV
PMS
TEV
APX
RPH
COB
MYL
RAN
JPC
SAS
ARO
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Cap Orl 5mg
Caps
Altace
pms-Ramipril
Teva-Ramipril
Apo-Ramipril
Co Ramipril
Mylan-Ramipril
Ran-Ramipril
Jamp-Ramipril
Ramipril
Auro-Ramipril
02221845
02247918
02247946
02251574
02295504
02301164
02310538
02331136
02374854
02387409
SAV
PMS
TEV
APX
COB
MYL
RAN
JPC
SAS
ARO
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Cap Orl 10mg
Caps
Altace
pms-Ramipril
Teva-Ramipril
Apo-Ramipril
Co Ramipril
Mylan-Ramipril
Ran-Ramipril
Jamp-Ramipril
Ramipril
Auro-Ramipril
02221853
02247919
02247947
02251582
02295512
02301172
02310546
02331144
02374862
02387417
SAV
PMS
TEV
APX
COB
MYL
RAN
JPC
SAS
ARO
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Cap Orl 15mg
Caps
Altace
Apo-Ramipril
02281112
02325381
SAV
APX
f
f
AEFGVW
AEFGVW
Tab Orl 1.25mg
Co.
Sandoz Ramipril
02291398
SDZ
AEFGVW
Tab Orl 2.5mg
Co.
Sandoz Ramipril
02291401
SDZ
AEFGVW
Tab Orl 5mg
Co.
Sandoz Ramipril
02291428
SDZ
AEFGVW
Tab Orl 10mg
Co.
Sandoz Ramipril
02291436
SDZ
AEFGVW
Page 48
C09AA06
QUINAPRIL
QUINAPRIL
Tab Orl 5mg
Co.
Accupril
Apo-Quinapril
01947664
02248499
PFI
APX
f
f
AEFGVW
AEFGVW
Tab Orl 10mg
Co.
Accupril
Apo-Quinapril
01947672
02248500
PFI
APX
f
f
AEFGVW
AEFGVW
Tab Orl 20mg
Co.
Accupril
Apo-Quinapril
01947680
02248501
PFI
APX
f
f
AEFGVW
AEFGVW
Tab Orl 40mg
Co.
Accupril
Apo-Quinapril
01947699
02248502
PFI
APX
f
f
AEFGVW
AEFGVW
Lotensin
Benazapril
00885835
02290332
NVR
AAP
f
f
AEFGVW
AEFGVW
Tab Orl 10mg
Co.
Lotensin (Disc/non disp Apr 3/14)
Benazapril
00885843
02290340
NVR
AAP
f
f
AEFGVW
AEFGVW
Tab Orl 20mg
Co.
Lotensin
Benazapril
00885851
02273918
NVR
AAP
f
f
AEFGVW
AEFGVW
Novo-Cilazapril
pms-Cilazapril
Mylan-Cilazapril
Apo-Cilazapril
Cilazapril (Disc/non disp Jan 1/15)
02266350
02280442
02283778
02291134
02350963
TEV
PMS
MYL
APX
SAS
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 2.5mg
Co.
Inhibace
Novo-Cilazapril
pms-Cilazapril
Mylan-Cilazapril
Co-Cilazapril
Apo-Cilazapril
Cilazapril
01911473
02266369
02280450
02283786
02285215
02291142
02350971
HLR
TEV
PMS
MYL
COB
APX
SAS
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 5mg
Co.
Inhibace
Novo-Cilazapril
pms-Cilazapril
Mylan-Cilazapril
Co-Cilazapril
Apo-Cilazapril
Cilazapril
01911481
02266377
02280469
02283794
02285223
02291150
02350998
HLR
TEV
PMS
MYL
COB
APX
SAS
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Monopril (Disc/non disp Jun 17/15)
Teva-Fosinopril
01907107
02247802
BRI
TEV
f
f
AEFGVW
AEFGVW
C09AA07
BENAZEPRIL
BÉNAZÉPRIL
Tab Orl 5mg
Co.
C09AA08
CILAZAPRIL
CILAZAPRIL
Tab Orl 1mg
Co.
C09AA09
FOSINOPRIL
FOSINOPRIL
Tab Orl 10mg
Co.
Page 49
C09AA09
FOSINOPRIL
FOSINOPRIL
Tab Orl 10mg
Co.
Mylan-Fosinopril
Apo-Fosinopril
Ran-Fosinopril
Jamp-Fosinopril
02262401
02266008
02294524
02331004
MYL
APX
RAN
JPC
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 20mg
Co.
Monopril (Disc/non disp Jun 17/15)
Teva-Fosinopril
Mylan-Fosinopril
Apo-Fosinopril
Ran-Fosinopril
Jamp-Fosinopril
01907115
02247803
02262428
02266016
02294532
02331012
BRI
TEV
MYL
APX
RAN
JPC
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Cap Orl 1mg
Caps
Mavik
02231459
ABB
AEFGVW
Cap Orl 2mg
Caps
Mavik
02231460
ABB
AEFGVW
Cap Orl 4mg
Caps
Mavik
02239267
ABB
AEFGVW
C09AA09
TRANDOLAPRIL
TRANDOLAPRIL
C09B
ACE-INHIBITORS, COMBINATIONS
INHIBITEUR DE L’ENZYME CONVERTISSANT L’ANGIOTENSINE, COMBINAISONS
C09BA
ACE-INHIBITORS AND DIURETICS
INHIBITEUR DE L’ENZYME CONVERTISSANT L’ANGIOTENSINE, ET DIURÉTIQUES
C09BA02
ENALAPRIL AND DIURETICS
ÉNALAPRIL ET DIURÉTIQUES
ENALAPRIL / HYDROCHLOROTHIAZIDE
ÉNALAPRIL / HYDROCHLOROTHIAZIDE
Tab Orl 5mg/12.5mg
Co.
Novo-Enalapril/HCT
11
Apo-Enalapril/HCTZ
11
02300222
02352923
TEV
APX
f
f
AEFGVW
AEFGVW
Tab Orl 10mg/25mg
Co.
Vaseretic
11
Novo-Enalapril/HCT
11
Apo-Enalapril/HCTZ
11
00657298
02300230
02352931
FRS
TEV
APX
f
f
f
AEFGVW
AEFGVW
AEFGVW
Zestoretic
Apo-Lisinopril/HCTZ
Mylan-Lisinopril HCTZ
02103729
02261979
02297736
AZE
APX
MYL
f
f
f
AEFGVW
AEFGVW
AEFGVW
C09BA03
LISINOPRIL AND DIURETICS
LISINOPRIL ET DIURÉTIQUES
LISINOPRIL / HYDROCHLOROTHIAZIDE
Tab Orl 10mg/12.5mg
Co.
11
Each tablet is made with 5mg or 10mg of enalapril maleate that appears as 4mg or 8mg of enalapril sodium, respectively,
in the finished tablets.
Chaque comprimé est compose de 5mg ou 10mg de maleate d’énalapril contenant respectivement 4mg ou 8mg de sodium
d’énalapril, dans les comprimés en version finale.
Page 50
C09BA03
LISINOPRIL AND DIURETICS
LISINOPRIL ET DIURÉTIQUES
Tab Orl 10mg/12.5mg
Co.
Teva-Lisinopril HCTZ (Type Z)
Teva-Lisinopril HCTZ (Type P)
Sandoz Lisinopril HCT
Lisinopril HCTZ (Type Z)
02301768
02302136
02302365
02362945
TEV
TEV
SDZ
SAS
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 20mg/12.5mg
Co.
Zestoretic
Prinzide
Apo-Lisinopril/HCTZ
02045737
00884413
02261987
02297744
02301776
02302144
02302373
02362953
AZE
FRS
APX
MYL
TEV
TEV
SDZ
SAS
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 20mg/25mg
Co.
Zestoretic
Apo-Lisinopril/HCTZ
02045729
02261995
02297752
02301784
02302152
02302381
02362961
AZE
APX
MYL
TEV
TEV
SDZ
SAS
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
C09BA04
PERINDOPRIL AND DIURETICS
PERINDOPRIL ET DIURÉTIQUES
PERINDOPRIL / INDAPAMIDE
PERINDOPRIL / INDAPAMIDE
Tab Orl 4mg/1.25mg
Co.
Tab Orl 8mg/2.5mg
Co.
C09BA05
Coversyl Plus
02246569
SEV
AEFGVW
Coversyl Plus HD
02321653
SEV
AEFGVW
RAMIPRIL AND DIURETICS
RAMIPRIL ET DIURÉTIQUES
RAMIPRIL / HYDROCHLOROTHIAZIDE
Co.
Altace HCT
pms–Ramipril-HCTZ
Teva-Ramipril/HCTZ
02283131
02342138
02388332
SAV
PMS
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab Orl 5mg/12.5mg
Co.
Altace HCT
pms–Ramipril-HCTZ
Teva-Ramipril/HCTZ
02283158
02342146
02388340
SAV
PMS
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab Orl 5mg/25mg
Co.
Altace HCT
pms–Ramipril-HCTZ
Teva-Ramipril/HCTZ
02283174
02342162
02388367
SAV
PMS
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
Page 51
C09BA05
RAMIPRIL AND DIURETICS
RAMIPRIL ET DIURÉTIQUES
Tab Orl 10mg/12.5mg
Co.
Altace HCT
pms–Ramipril-HCTZ
Teva-Ramipril/HCTZ
02283166
02342154
02388359
SAV
PMS
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab Orl 10mg/25mg
Co.
Altace HCT
pms–Ramipril-HCTZ
Teva-Ramipril/HCTZ
02283182
02342170
02388375
SAV
PMS
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
C09BA06
QUINAPRIL AND DIURETICS
QUINAPRIL ET DIURÉTIQUES
QUINAPRIL / HYDROCHLOROTHIAZIDE
QUINAPRIL / HYDROCHLOROTHIAZIDE
Tab Orl 10mg/12.5mg
Co.
Accuretic
Apo-Quinapril/HCTZ
02237367
02408767
PFI
APX
f
f
AEFGVW
AEFGVW
Tab Orl 20mg/12.5mg
Co.
Accuretic
Apo-Quinapril/HCTZ
02237368
02408775
PFI
APX
f
f
AEFGVW
AEFGVW
Tab Orl 20mg/25mg
Co.
Accuretic
Apo-Quinapril/HCTZ
02237369
02408783
PFI
APX
f
f
AEFGVW
AEFGVW
02181479
02284987
02313731
HLR
APX
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
02182815
02309750
02313332
02354829
02368277
02379058
02380838
02388863
02398834
02403323
02404451
FRS
PMS
SDZ
COB
MYL
APX
TEV
SAS
JPC
ARO
RAN
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
C09BA08
CILAZAPRIL AND DIURETICS
CILAZAPRIL ET DIURÉTIQUES
CILAZAPRIL / HYDROCHLOROTHIAZIDE
CILAZAPRIL / HYDROCHLOROTHIAZIDE
Tab Orl 5mg/12.5mg
Co.
Inhibace Plus
Apo-Cilazapril/HCTZ
Novo-Cilazapril/HCTZ
C09C
ANGIOTENSIN II ANTAGONISTS, PLAIN
ANTAGONISTES DE L’ANGIOTENSINE II, ORDINAIRE
C09CA
ANGIOTENSIN II ANTAGONISTS, PLAIN
ANTAGONISTES DE L’ANGIOTENSINE II, ORDINAIRE
C09CA01
LOSARTAN
LOSARTAN
Tab Orl 25mg
Co.
Cozaar
pms-Losartan
Sandoz Losartan
Co Losartan
Mylan-Losartan
Apo-Losartan
Teva-Losartan
Losartan
Jamp-Losartan
Auro-Losartan
Ran-Losartan
Page 52
C09CA01
LOSARTAN
LOSARTAN
Tab Orl 50mg
Co.
Cozaar
pms-Losartan
Sandoz Losartan
Co Losartan
Mylan-Losartan
Apo-Losartan
Teva-Losartan
Losartan
Jamp-Losartan
Auro-Losartan
Ran-Losartan
02182874
02309769
02313340
02354837
02368285
02353504
02357968
02388871
02398842
02403331
02404478
FRS
PMS
SDZ
COB
MYL
APX
TEV
SAS
JPC
ARO
RAN
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 100mg
Co.
Cozaar
pms-Losartan
Sandoz Losartan
Co Losartan
Mylan-Losartan
Apo-Losartan
Teva-Losartan
Losartan
Jamp-Losartan
Auro-Losartan
Ran-Losartan
02182882
02309777
02313359
02354845
02368293
02353512
02357976
02388898
02398850
02403358
02404486
FRS
PMS
SDZ
COB
MYL
APX
TEV
SAS
JPC
ARO
RAN
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 400mg
Co.
Teveten
02240432
ABB
AEFGVW
Tab Orl 600mg
Co.
Teveten
02243942
ABB
AEFGVW
Tab Orl 40mg
Co.
Diovan
pms-Valsartan
Co Valsartan
Teva-Valsartan
Sandoz Valsartan
Ran-Valsartan
Mylan- Valsartan
Apo-Valsartan
Valsartan
02270528
02312999
02337487
02356643
02356740
02363062
02383527
02371510
02366940
NVR
PMS
COB
TEV
SDZ
RAN
MYL
APX
SAS
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 80mg
Co.
Diovan
pms-Valsartan
Co Valsartan
Teva-Valsartan
Sandoz Valsartan
Ran-Valsartan
02244781
02313006
02337495
02356651
02356759
02363100
NVR
PMS
COB
TEV
SDZ
RAN
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
C09CA02
C09CA03
EPROSARTAN
ÉPROSARTAN
VALSARTAN
VALSARTAN
Page 53
C09CA03
VALSARTAN
VALSARTAN
Tab Orl 80mg
Co.
Mylan- Valsartan
Apo-Valsartan
Valsartan
02383535
02371529
02366959
MYL
APX
SAS
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab Orl 160mg
Co.
Diovan
pms-Valsartan
Co Valsartan
Teva-Valsartan
Sandoz Valsartan
Ran-Valsartan
Mylan- Valsartan
Apo-Valsartan
Valsartan
02244782
02313014
02337509
02356678
02356767
02363119
02383543
02371537
02366967
NVR
PMS
COB
TEV
SDZ
RAN
MYL
APX
SAS
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 320mg
Co.
Diovan
pms-Valsartan
Co Valsartan
Teva-Valsartan
Sandoz Valsartan
Mylan- Valsartan
Apo-Valsartan
Valsartan
02289504
02344564
02337517
02356686
02356775
02383551
02371545
02366975
NVR
PMS
COB
TEV
SDZ
MYL
APX
SAS
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 75mg
Co.
Avapro
Teva-Irbesartan
ratio-Irbesartan
pms-Irbesartan
Co Irbesartan
Sandoz Irbesartan
Mylan-Irbesartan
Irbesartan
Apo-Irbesartan
Auro-Irbesartan
Ran-Irbesartan
02237923
02315971
02316390
02317060
02328070
02328461
02347296
02372347
02386968
02406098
02406810
SAV
TEV
TEV
PMS
COB
SDZ
MYL
SAS
APX
ARO
RAN
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 150mg
Co.
Avapro
Teva-Irbesartan
ratio-Irbesartan
pms-Irbesartan
Co Irbesartan
Sandoz Irbesartan
Mylan-Irbesartan
Irbesartan
Apo-Irbesartan
Auro-Irbesartan
Ran-Irbesartan
02237924
02315998
02316404
02317079
02328089
02328488
02347318
02372371
02386976
02406101
02406829
SAV
TEV
TEV
PMS
COB
SDZ
MYL
SAS
APX
ARO
RAN
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 300mg
Co.
Avapro
Teva-Irbesartan
ratio-Irbesartan
Page 54
02237925
02316005
02316412
SAV
TEV
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
C09CA04
IRBESARTAN
IRBESARTAN
C09CA04
IRBESARTAN
IRBESARTAN
Tab Orl 300mg
Co.
pms-Irbesartan
Co Irbesartan
Sandoz Irbesartan
Mylan-Irbesartan
Irbesartan
Apo-Irbesartan
Auro-Irbesartan
Ran-Irbesartan
02317087
02328100
02328496
02347326
02372398
02386984
02406128
02406837
PMS
COB
SDZ
MYL
SAS
APX
ARO
RAN
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 4mg
Co.
Atacand
Sandoz Candesartan
Apo-Candesartan
Co Candesartan
Mylan-Candesartan
pms-Candesartan
Jamp-Candesartan
Candesartan Cilexetil
Candesartan
Ran-Candesartan
02239090
02326957
02365340
02376520
02379120
02391171
02386496
02379260
02388901
02380684
AZE
SDZ
APX
COB
MYL
PMS
JPC
AHI
SAS
RAN
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 8mg
Co.
Atacand
Sandoz Candesartan
Apo-Candesartan
Teva-Candesartan
Co Candesartan
Mylan-Candesartan
pms-Candesartan
Candesartan
Jamp-Candesartan
Ran-Candesartan
02239091
02326965
02365359
02366312
02376539
02379139
02391198
02388928
02386518
02379279
02380692
AZE
SDZ
APX
TEV
COB
MYL
PMS
SAS
JPC
AHI
RAN
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 16mg
Co.
Atacand
Sandoz Candesartan
Apo-Candesartan
Teva-Candesartan
Co Candesartan
Mylan-Candesartan
pms-Candesartan
Candesartan
Jamp-Candesartan
Ran-Candesartan
02239092
02326973
02365367
02366320
02376547
02379147
02391201
02388936
02386526
02379287
02380706
AZE
SDZ
APX
TEV
COB
MYL
PMS
SAS
JPC
AHI
RAN
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 32mg
Co.
Atacand
Teva-Candesartan
Co Candesartan
Mylan-Candesartan
pms-Candesartan
Sandoz Candesartan
Page 55
02311658
02366339
02376555
02379155
02391228
02392267
AZE
TEV
COB
MYL
PMS
SDZ
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
C09CA06
CANDESARTAN
CANDÉSARTAN
C09CA06
CANDESARTAN
CANDÉSARTAN
Tab Orl 32mg
Co.
Jamp-Candesartan
Apo-Candesartan
Ran-Candesartan
02386534
02379295
02399105
02380714
JPC
AHI
APX
RAN
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 40mg
Co.
Micardis
Teva-Telmisartan
Sandoz Telmisartan
Mylan-Telmisartan
pms-Telmisartan
Telmisartan
Co-Telmisartan
02240769
02320177
02375958
02376717
02391236
02388944
02393247
BOE
TEV
SDZ
MYL
PMS
SAS
COB
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 80mg
Co.
Micardis
Teva-Telmisartan
Sandoz Telmisartan
Mylan-Telmisartan
pms-Telmisartan
Telmisartan
Co-Telmisartan
02240770
02320185
02375966
02376725
02391244
02388952
02393255
BOE
TEV
SDZ
MYL
PMS
SAS
COB
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 20mg
Co.
Olmetec
02318660
FRS
AEFGVW
Tab Orl 40mg
Co.
Olmetec
02318679
FRS
AEFGVW
02230047
02313375
02358263
02371235
02378078
02392224
02388251
02389657
FRS
SDZ
TEV
APX
MYL
PMS
COB
MNT
C09CA07
C09CA08
TELMISARTAN
TELMISARTAN
OLMESARTAN MEDOXOMIL
OLMÉSARTAN MÉDOXOMIL
C09D
ANGIOTENSIN II ANTAGONISTS, COMBINATIONS
ANTAGONISTES DE L’ANGIOTENSINE II, EN COMBINAISON
C09DA
ANGIOTENSIN II ANTAGONISTS AND DIURETICS
ANTAGONISTES DE L’ANGIOTENSINE II ET DIURÉTIQUES
C09DA01
LOSARTAN AND DIURETICS
LOSARTAN ET DIURÉTIQUES
LOSARTAN / HYDROCHLOROTHIAZIDE
Tab Orl 50mg/12.5mg
Co.
Hyzaar
Sandoz Losartan HCT
Teva-Losartan HCTZ
Apo-Losartan HCTZ
Mylan-Losartan HCTZ
pms-Losartan-HCTZ
Co-Losartan/HCT
Mint-Losartan/HCTZ
Page 56
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
C09DA01
LOSARTAN AND DIURETICS
LOSARTAN ET DIURÉTIQUES
Tab Orl 100mg/12.5mg
Co.
Hyzaar
Sandoz Losartan HCT
Teva-Losartan HCTZ
Apo-Losartan HCTZ
Mylan-Losartan HCTZ
pms-Losartan-HCTZ
Co-Losartan/HCT
Mint-Losartan/HCTZ
02297841
02362449
02377144
02371243
02378086
02392232
02388278
02389665
FRS
SDZ
TEV
APX
MYL
PMS
COB
MNT
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 100mg/25mg
Co.
Hyzaar DS
Sandoz Losartan HCT
Teva-Losartan HCTZ
Apo-Losartan HCTZ
Mylan-Losartan HCTZ
pms-Losartan-HCTZ
Co-Losartan/HCT
Mint-Losartan/HCTZ DS
02241007
02313383
02377152
02371251
02378094
02392240
02388286
02389673
FRS
SDZ
TEV
APX
MYL
PMS
COB
MNT
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Teveten Plus
02253631
ABB
VALSARTAN / HYDROCHLOROTHIAZIDE
Tab Orl 80mg/12.5mg
Diovan HCT
Co.
Sandoz Valsartan HCT
Teva-Valsartan/ HCTZ
Mylan-Valsartan HCTZ
Apo-Valsartan/HCTZ
Valsartan/HCTZ
02241900
02356694
02356996
02373734
02382547
02367009
NVR
SDZ
TEV
MYL
APX
SAS
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
02241901
02356708
02357003
02373742
02382555
02367017
02246955
02356716
02357011
02373750
02382563
02367025
NVR
SDZ
TEV
MYL
APX
SAS
NVR
SDZ
TEV
MYL
APX
SAS
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
C09DA02
EPROSARTAN AND DIURETICS
ÉPROSARTAN ET DIURÉTIQUES
EPROSARTAN / HYDROCHLOROTHIAZIDE
ÉPROSARTAN / HYDROCHLOROTHIAZIDE
Co.
C09DA03
AEFGVW
VALSARTAN AND DIURETICS
VALSARTAN ET DIURÉTIQUES
Co.
Diovan HCT
Apo-Valsartan/HCTZ
Valsartan/HCTZ
Diovan HCT
Apo-Valsartan/HCTZ
Valsartan/HCTZ
Page 57
C09DA03
VALSARTAN AND DIURETICS
VALSARTAN ET DIURÉTIQUES
Co.
Diovan HCT
Apo-Valsartan/HCTZ
Valsartan/HCTZ
02308908
02356724
02357038
02373769
02382571
02367033
NVR
SDZ
TEV
MYL
APX
SAS
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 320mg/25mg
Co.
Diovan HCT
Apo-Valsartan/HCTZ
Valsartan/HCTZ
02308916
02356732
02357046
02373777
02382598
02367041
NVR
SDZ
TEV
MYL
APX
SAS
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
C09DA04
IRBESARTAN AND DIURETICS
IRBESARTAN ET DIURÉTIQUES
IRBESARTAN / HYDROCHLOROTHIAZIDE
IRBESARTAN / HYDROCHLOROTHIAZIDE
Co.
Avalide
Teva-Irbesartan HCTZ
pms-Irbesartan HCTZ
ratio-Irbesartan HCTZ
Sandoz Irbesartan HCT
Co Irbesartan HCT
Ran-Irbesartan HCTZ
Irbesartan/HCTZ
Apo-Irbesartan/HCTZ
Mint-Irbesartan/HCTZ
02241818
02316013
02328518
02330512
02337428
02357399
02363208
02372886
02387646
02392992
SAV
TEV
PMS
TEV
SDZ
COB
RAN
SAS
APX
MNT
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Co.
Avalide
pms-Irbesartan HCTZ
Co Irbesartan HCT
Ran-Irbesartan HCTZ
Irbesartan/HCTZ
Apo-Irbesartan/HCTZ
02241819
02316021
02328526
02330520
02337436
02357402
02363216
02372894
02387654
02393018
SAV
TEV
PMS
TEV
SDZ
COB
RAN
SAS
APX
MNT
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 300mg/25mg
Co.
pms-Irbesartan HCTZ
Co Irbesartan HCT
Ran-Irbesartan HCTZ
Irbesartan/HCTZ
Apo-Irbesartan/HCTZ
02316048
02328534
02330539
02337444
02357410
02363224
02372908
02387662
02393026
TEV
PMS
TEV
SDZ
COB
RAN
SAS
APX
MNT
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Page 58
C09DA06
CANDESARTAN AND DIURETICS
CANDÉSARTAN ET DIURÉTIQUES
CANDESARTAN / HYDROCHLOROTHIAZIDE
CANDÉSARTAN / HYDROCHLOROTHIAZIDE
Tab Orl 16mg/12.5mg
Co.
Atacand Plus
Apo-Candesartan/HCTZ
Co-Candesartan/HCT
Mylan-Candesartan HCTZ
pms-Candesartan-HCTZ
Sandoz Candesartan Plus
Candesartan/HCTZ
Teva-Candesartan/HCTZ
02244021
02367866
02388650
02374897
02391295
02327902
02394804
02395541
AZE
APX
COB
MYL
PMS
SDZ
SAS
TEV
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 32mg/12.5mg
Co.
Atacand Plus
Teva-Candesartan/HCTZ
02332922
02395126
02395568
AZE
APX
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
Atacand Plus
02332957
02395134
AZE
APX
f
f
AEFGVW
AEFGVW
Tab Orl 32mg/25mg
Co.
C09DA07
TELMISARTAN AND DIURETICS
TELMISARTAN ET DIURÉTIQUES
TELMISARTAN / HYDROCHLOROTHIAZIDE
TELMISARTAN / HYDROCHLOROTHIAZIDE
Tab Orl 80mg/12.5mg
Co.
Micardis Plus
Teva-telmisartan HCTZ
Mylan-telmisartan HCTZ
Sandoz Telmisartan HCT
Telmisartan/HCTZ
Co-Telmisartan/HCT
pms-Telmisartan/HCTZ
02244344
02330288
02373564
02393557
02395355
02393263
02401665
BOE
TEV
MYL
SDZ
SAS
COB
PMS
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 80mg/25mg
Co.
Micardis Plus
Teva-telmisartan HCTZ
Mylan-telmisartan HCTZ
Sandoz Telmisartan HCT
Telmisartan/HCTZ
Co-Telmisartan/HCT
pms-Telmisartan/HCTZ
02318709
02379252
02373572
02393565
02395363
02393271
02401673
BOE
TEV
MYL
SDZ
SAS
COB
PMS
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
C09DA08
OLMESARTAN AND DIURETICS
OLMÉSARTAN ET DIURÉTIQUES
OLMESARTAN / HYDROCHLOROTHIAZIDE
OLMÉSARTAN / HYDROCHLOROTHIAZIDE
Tab Orl 20mg/12.5mg
Co.
Olmetec Plus
02319616
FRS
f
AEFGVW
Tab Orl 40mg/12.5mg
Co.
Olmetec Plus
02319624
FRS
f
AEFGVW
Tab Orl 40mg/25mg
Co.
Olmetec Plus
02319632
FRS
f
AEFGVW
Page 59
C09DB
ANGIOTENSIN II ANTAGONISTS AND CALCIUM CHANNEL BLOCKERS
ANTAGONISTES DE L’ANGIOTENSINE II ET ANTAGONISTES DU CALCIUM
C09DB04
TELMISARTAN AND AMLODIPINE
TELMISARTAN ET AMLODIPINE
Tab Orl 40mg/5mg
Co.
Twynsta
02371022
BOE
AEFGVW
Tab Orl 40mg/10mg
Co.
Twynsta
02371030
BOE
AEFGVW
Tab Orl 80mg/5mg
Co.
Twynsta
02371049
BOE
AEFGVW
Tab Orl 80mg/10mg
Co.
Twynsta
02371057
BOE
AEFGVW
C10
LIPID MODIFYING AGENTS
AGENTS RÉDUISANT LES LIPIDES SÉRIQUES
C10A
LIPID MODIFYING AGENTS, PLAIN
AGENTS RÉDUISANT LES LIPIDES SÉRIQUES, ORDINAIRES
C10AA
HMG COA REDUCTASE INHIBITORS
INHIBITEURS DU HMG COA-REDUCTASE
C10AA01
SIMVASTATIN
SIMVASTATINE
Tab Orl 5mg
Co.
Zocor
Mylan-Simvastatin
Apo-Simvastatin
Co Simvastatin
Teva-Simvastatin
pms-Simvastatin
Phl-Simvastatin
Simvastatin
Ran-Simvastatin
Jamp-Simvastatin (Disc/non disp Jul 8/15)
Mint-Simvastatin
Mar-Simvastatin
Jamp-Simvastatin
Simvastatin-Odan
00884324
02246582
02247011
02248103
02250144
02269252
02281546
02284723
02329131
02331020
02372932
02375036
02375591
02378884
FRS
MYL
APX
COB
TEV
PMS
PHL
SAS
RAN
JPC
MNT
MAR
JPC
ODN
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 10mg
Co.
Zocor
Mylan-Simvastatin
Apo-Simvastatin
Sandoz Simvastatin
Co Simvastatin
Teva-Simvastatin
pms-Simvastatin
Phl-Simvastatin
Simvastatin
Ran-Simvastatin
Mint-Simvastatin
Mar-Simvastatin
00884332
02246583
02247012
02247828
02248104
02250152
02269260
02281554
02284731
02329158
02331039
02372940
02375044
FRS
MYL
APX
SDZ
COB
TEV
PMS
PHL
SAS
RAN
JPC
MNT
MAR
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Page 60
C10AA01
SIMVASTATIN
SIMVASTATINE
Tab Orl 10mg
Co.
Jamp-Simvastatin
Simvastatin-Odan
02375605
02378892
JPC
ODN
f
f
AEFGVW
AEFGVW
Tab Orl 20mg
Co.
Zocor
Mylan-Simvastatin
Apo-Simvastatin
Sandoz Simvastatin
Co Simvastatin
Teva-Simvastatin
pms-Simvastatin
Phl-Simvastatin
Simvastatin
Ran-Simvastatin
Mint-Simvastatin
Mar-Simvastatin
Jamp-Simvastatin
Simvastatin-Odan
00884340
02246737
02247013
02247830
02248105
02250160
02269279
02281562
02284758
02329166
02331047
02372959
02375052
02375613
02378906
FRS
MYL
APX
SDZ
COB
TEV
PMS
PHL
SAS
RAN
JPC
MNT
MAR
JPC
ODN
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 40mg
Co.
Zocor
Mylan-Simvastatin
Apo-Simvastatin
Sandoz Simvastatin
Co Simvastatin
Teva-Simvastatin
pms-Simvastatin
Phl-Simvastatin
Simvastatin
Ran-Simvastatin
Mint-Simvastatin
Mar-Simvastatin
Jamp-Simvastatin
Simvastatin-Odan
00884359
02246584
02247014
02247831
02248106
02250179
02269287
02281570
02284766
02329174
02331055
02372967
02375060
02375621
02378914
FRS
MYL
APX
SDZ
COB
TEV
PMS
PHL
SAS
RAN
JPC
MNT
MAR
JPC
ODN
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 80mg
Co.
Zocor
Mylan-Simvastatin
Apo-Simvastatin
Sandoz Simvastatin
Co Simvastatin
Teva-Simvastatin
pms-Simvastatin
Phl-Simvastatin
Simvastatin
Ran-Simvastatin
Mint-Simvastatin
Mar-Simvastatin
Jamp-Simvastatin
Simvastatin-Odan
02240332
02246585
02247015
02247833
02248107
02250187
02269295
02281589
02284774
02329182
02331063
02372975
02375079
02375648
02378922
FRS
MYL
APX
SDZ
COB
TEV
PMS
PHL
SAS
RAN
JPC
MNT
MAR
JPC
ODN
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Page 61
C10AA02
LOVASTATIN
LOVASTATINE
Tab Orl 20mg
Co.
Mevacor
Apo-Lovastatin
Mylan-Lovastatin
ratio-Lovastatin (Disc/non disp Jun 29/14)
pms-Lovastatin
Teva-Lovastatin
Sandoz Lovastatin (Disc/non disp Nov 15/15)
Co Lovastatin
Lovastatin
00795860
02220172
02243127
02245822
02246013
02246542
02247056
02248572
02353229
FRS
APX
MYL
RPH
PMS
TEV
SDZ
COB
SAS
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 40mg
Co.
Mevacor
Apo-Lovastatin
Mylan-Lovastatin
ratio-Lovastatin (Disc/non disp Jun 29/14)
pms-Lovastatin
Teva-Lovastatin
Sandoz Lovastatin (Disc/non disp Nov 15/15)
Co Lovastatin
Lovastatin
00795852
02220180
02243129
02245823
02246014
02246543
02247057
02248573
02353237
FRS
APX
MYL
RPH
PMS
TEV
SDZ
COB
SAS
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
C10AA03
PRAVASTATIN
PRAVASTATINE
Tab Orl 10mg
Co.
Pravachol (Disc/non disp Sep 14/14)
Apo-Pravastatin
Teva-Pravastatin
pms-Pravastatin
Sandoz Pravastatin
Co Pravastatin
Mylan-Pravastatin
Ran-Pravastatin
Mint-Pravastatin
Jamp-Pravastatin
Pravastatin
00893749
02243506
02247008
02247655
02247856
02248182
02257092
02284421
02317451
02330954
02356546
BRI
APX
TEV
PMS
SDZ
COB
MYL
RAN
MNT
JPC
SAS
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 20mg
Co.
Pravachol
Apo-Pravastatin
Teva-Pravastatin
pms-Pravastatin
Sandoz Pravastatin
Co Pravastatin
Mylan-Pravastatin
Ran-Pravastatin
Mint-Pravastatin
Jamp-Pravastatin
Pravastatin
00893757
02243507
02247009
02247656
02247857
02248183
02257106
02284448
02317478
02330962
02356554
BRI
APX
TEV
PMS
SDZ
COB
MYL
RAN
MNT
JPC
SAS
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 40mg
Co.
Pravachol
Apo-Pravastatin
Teva-Pravastatin
pms-Pravastatin
Sandoz Pravastatin
02222051
02243508
02247010
02247657
02247858
BRI
APX
TEV
PMS
SDZ
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Page 62
C10AA03
PRAVASTATIN
PRAVASTATINE
Tab Orl 40mg
Co.
Co Pravastatin
Mylan-Pravastatin
Ran-Pravastatin
Mint-Pravastatin
Jamp-Pravastatin
Pravastatin
02248184
02257114
02284456
02317486
02330970
02356562
COB
MYL
RAN
MNT
JPC
SAS
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Cap Orl 20mg
Caps
Lescol
Teva-Fluvastatin
Sandoz Fluvastatin
02061562
02299224
02400235
NVR
TEV
SDZ
f
f
f
AEFGVW
AEFGVW
AEFGVW
Cap Orl 40mg
Caps
Lescol
Teva-Fluvastatin
Sandoz Fluvastatin
02061570
02299232
02400243
NVR
TEV
SDZ
f
f
f
AEFGVW
AEFGVW
AEFGVW
SRT Orl 80mg
Co.L.L
Lescol XL
02250527
NVR
Tab Orl 10mg
Co.
Lipitor
GD-Atorvastatin
Apo-Atorvastatin
Novo-Atorvastatin
Co Atorvastatin
pms-Atorvastatin
Ran-Atorvastatin
Sandoz Atorvastatin
Atorvastatin
ratio-Atorvastatin
Mylan-Atorvastatin
pms-Atorvastatin
02230711
02288346
02295261
02302675
02310899
02313448
02313707
02324946
02348705
02350297
02373203
02399377
PFI
GMD
APX
TEV
COB
PMS
RAN
SDZ
SAS
TEV
MYL
PMS
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 20mg
Co.
Lipitor
GD-Atorvastatin
Apo-Atorvastatin
Novo-Atorvastatin
Co Atorvastatin
pms-Atorvastatin
Ran-Atorvastatin
Sandoz Atorvastatin
Atorvastatin
ratio-Atorvastatin
Mylan-Atorvastatin
pms-Atorvastatin
02230713
02288354
02295288
02302683
02310902
02313456
02313715
02324954
02348713
02350319
02373211
02399385
PFI
GMD
APX
TEV
COB
PMS
RAN
SDZ
SAS
TEV
MYL
PMS
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 40mg
Co.
Lipitor
GD-Atorvastatin
Apo-Atorvastatin
02230714
02288362
02295296
PFI
GMD
APX
f
f
f
AEFGVW
AEFGVW
AEFGVW
C10AA04
C10AA05
FLUVASTATIN
FLUVASTATINE
AEFGVW
ATORVASTATIN
ATORVASTATINE
Page 63
C10AA05
ATORVASTATIN
ATORVASTATINE
Tab Orl 40mg
Co.
Novo-Atorvastatin
Co Atorvastatin
pms-Atorvastatin
Ran-Atorvastatin
Sandoz Atorvastatin
Atorvastatin
ratio-Atorvastatin
Mylan-Atorvastatin
pms-Atorvastatin
02302691
02310910
02313464
02313723
02324962
02348721
02350327
02373238
02399393
TEV
COB
PMS
RAN
SDZ
SAS
TEV
MYL
PMS
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 80mg
Co.
Lipitor
GD-Atorvastatin
Apo-Atorvastatin
Novo-Atorvastatin
Co Atorvastatin
pms-Atorvastatin
Ran-Atorvastatin
Sandoz Atorvastatin
Atorvastatin
ratio-Atorvastatin
Mylan-Atorvastatin
pms-Atorvastatin
02243097
02288370
02295318
02302713
02310929
02313472
02313758
02324970
02348748
02350335
02373246
02399407
PFI
GMD
APX
TEV
COB
PMS
RAN
SDZ
SAS
TEV
MYL
PMS
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 5mg
Co.
Crestor
Apo-Rosuvastatin
Sandoz Rosuvastatin
Co Rosuvastatin
Teva-Rosuvastatin
pms-Rosuvastatin
Mylan-Rosuvastatin
Ran-Rosuvastatin
Rosuvastatin
Mint-Rosuvastatin
Jamp-Rosuvastatin
02265540
02337975
02338726
02339765
02354608
02378523
02381265
02382644
02405628
02397781
02391252
AZE
APX
SDZ
COB
TEV
PMS
MYL
RAN
SAS
MNT
JPC
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 10mg
Co.
Crestor
Apo-Rosuvastatin
Sandoz Rosuvastatin
Co Rosuvastatin
Teva-Rosuvastatin
pms-Rosuvastatin
Mylan-Rosuvastatin
Ran-Rosuvastatin
Jamp-Rosuvastatin
Rosuvastatin
Mint-Rosuvastatin
02247162
02337983
02338734
02339773
02354616
02378531
02381273
02382652
02391260
02405636
02397803
AZE
APX
SDZ
COB
TEV
PMS
MYL
RAN
JPC
SAS
MNT
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 20mg
Co.
Crestor
Apo-Rosuvastatin
Sandoz Rosuvastatin
Page 64
02247163
02337991
02338742
AZE
APX
SDZ
f
f
f
AEFGVW
AEFGVW
AEFGVW
C10AA07
ROSUVASTATIN
ROSUVASTATINE
C10AA07
C10AB
ROSUVASTATIN
ROSUVASTATINE
Tab Orl 20mg
Co.
Co Rosuvastatin
Teva-Rosuvastatin
pms-Rosuvastatin
Mylan-Rosuvastatin
Ran-Rosuvastatin
Jamp-Rosuvastatin
Rosuvastatin
Mint-Rosuvastatin
02339781
02354624
02378558
02381281
02382660
02391279
02405644
02397811
COB
TEV
PMS
MYL
RAN
JPC
SAS
MNT
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 40mg
Co.
Crestor
Apo-Rosuvastatin
Sandoz Rosuvastatin
Co Rosuvastatin
Teva-Rosuvastatin
pms-Rosuvastatin
Mylan-Rosuvastatin
Ran-Rosuvastatin
Jamp-Rosuvastatin
Rosuvastatin
Mint-Rosuvastatin
02247164
02338009
02338750
02339803
02354632
02378566
02381303
02382679
02391287
02405652
02397838
AZE
APX
SDZ
COB
TEV
PMS
MYL
RAN
JPC
SAS
MNT
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 300mg
Co.
Apo-Gemfibrozil
Mylan-Gemfibrozil
pms-Gemfibrozil
Novo-Gemfibrozil
01979574
02185407
02239951
02241704
APX
MYL
PMS
TEV
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 600mg
Co.
Apo-Gemfibrozil
Mylan-Gemfibrozil
pms-Gemfibrozil (Disc/non disp Jan 31/16)
Novo-Gemfibrozil
01979582
02230476
02230183
02142074
APX
MYL
PMS
TEV
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Apo-Fenofibrate
02225980
APX
f
AEFGVW
Lipidil Micro
Apo-Feno-Micro
Mylan-Fenofibrate Micro
Novo-Fenofibrate Micro
ratio-Fenofibrate MC
pms-Fenofibrate Micro (Disc/non disp Apr 1/16)
Fenofibrate Micro
02146959
02239864
02240210
02243552
02250039
02273551
02286092
ABB
APX
MYL
TEV
TEV
PMS
SAS
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
02241601
02246859
ABB
APX
f
f
AEFGVW
AEFGVW
FIBRATES
FIBRATES
C10AB04
C10AB05
GEMFIBROZIL
GEMFIBROZIL
FENOFIBRATE
FÉNOFIBRATE
Cap Orl 100mg
Caps
Cap Orl 200mg
Caps
Tab Orl 100mg
Co.
Lipidil Supra
Apo-Feno-Super
Page 65
C10AB05
C10AC
FENOFIBRATE
FÉNOFIBRATE
Tab Orl 100mg
Co.
Sandoz Fenofibrate S
Teva-Fenofibrate-S
Fenofibrate S
02288044
02289083
02356570
SDZ
TEV
SAS
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab Orl 160mg
Co.
Lipidil Supra
Apo-Feno-Super
Sandoz Fenofibrate S
Teva-Fenofibrate-S
Fenofibrate S
02241602
02246860
02288052
02289091
02356589
ABB
APX
SDZ
TEV
SAS
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Olestyr
00890960
PDP
f
AEFGVW
Olestyr
02210320
PDP
f
AEFGVW
Tab Orl 1g
Co.
Colestid
02132680
PFI
AEFGVW
Pws Orl 5g
Pds.
Colestid
00642975
PFI
AEFGVW
Colestid (Orange)
02132699
PFI
AEFGVW
BILE ACID SEQUESTRANTS
SEQUESTRANTS DE L’ACIDE BILIAIRE
C10AC01
COLESTYRAMINE
COLESTYRAMINE
Pws Orl 4g Packets/sachets
Pds.
Pws Orl 4g Packets/sachets
Pds.
C10AC02
COLESTIPOL
COLESTIPOL
Pws Orl 7.5g
Pds.
C10B
LIPID MODIFYING AGENTS, COMBINATIONS
AGENTS RÉDUISANT LES LIPIDES SÉRIQUES, EN COMBINAISON
C10BA
HMG COA REDUCTASE INHIBITORS IN COMBINATION WITH OTHER LIPID MODIFYING AGENTS
INHIBITEURS DE LA HMG COA RÉDUCTASE EN COMBINAISON AVEC D’AUTRES AGENTS DE
MODIFICATION DES LIPIDES
C10BA01
C10BX
LOVASTATIN AND NICOTINIC ACID
LOVASTATINE ET ACIDE NICOTINIQUE
SRT Orl 20mg/500mg
Co.L.L.
Advicor (Disc/non disp Jun 27/14)
02270439
SNV
AEFGVW
SRT Orl 20mg/1000mg
Co.L.L.
Advicor (Disc/non disp Jun 27/14)
02270447
SNV
AEFGVW
HMG COA REDUCTASE INHIBITORS, OTHER COMBINATIONS
INHIBITEURS DE LA HMG COA RÉDUCTASE, AUTRES COMBINAISONS
C10BX03
ATORVASTATIN AND AMLODIPINE
ATORVASTATINE ET AMLODIPINE
Tab Orl 5mg/10mg
Co.
12
Caduet
12
GD-Amlodipine/Atorvastatin
Page 66
02273233
02362759
PFI
GMD
f
f
AEFV
AEFV
C10BX03
ATORVASTATIN AND AMLODIPINE
ATORVASTATINE ET AMLODIPINE
12
Tab Orl 5mg/10mg
pms-Amlodipine/Atorvastatin
12
Co.
Apo-Amlodipine-Atorvastatin
02404222
02411253
PMS
APX
f
f
AEFV
AEFV
Tab Orl 5mg/20mg
Co.
Caduet
12
12
12
12
02273241
02362767
02404230
02411261
PFI
GMD
PMS
APX
f
f
f
f
AEFV
AEFV
AEFV
AEFV
Tab Orl 5mg/40mg
Co.
Caduet
12
12
12
02273268
02362775
02411288
PFI
GMD
APX
f
f
f
AEFV
AEFV
AEFV
Tab Orl 5mg/80mg
Co.
Caduet
12
12
12
02273276
02362783
02411296
PFI
GMD
APX
f
f
f
AEFV
AEFV
AEFV
Tab Orl 10mg/10mg
Co.
Caduet
12
12
12
12
02273284
02362791
02404249
02411318
PFI
GMD
PMS
APX
f
f
f
f
AEFV
AEFV
AEFV
AEFV
Tab Orl 10mg/20mg
Co.
Caduet
12
12
12
12
02273292
02362805
02404257
02411326
PFI
GMD
PMS
APX
f
f
f
f
AEFV
AEFV
AEFV
AEFV
Tab Orl 10mg/40mg
Co.
Caduet
12
12
12
02273306
02362813
02411334
PFI
GMD
APX
f
f
f
AEFV
AEFV
AEFV
Tab Orl 10mg/80mg
Co.
Caduet
12
12
12
02273314
02362821
02411342
PFI
GMD
APX
f
f
f
AEFV
AEFV
AEFV
Nyaderm
Ratio-Nystatin
00716871
02194236
TAR
RPH
AEFGVW
AEFGVW
Ratio-Nystatin
02194228
RPH
AEFGVW
D01
ANTIFUNGALS FOR DERMATOLOGICAL USE
ANTIFONGIQUES À USAGE DERMATOLOGIQUE
D01A
ANTIFUNGALS FOR TOPICAL USE
ANTIFONGIQUES POUR USAGE TOPIQUE
D01AA
ANTIBIOTICS
ANTIBIOTIQUES
D01AA01
NYSTATIN
NYSTATINE
Crm Top 100000IU
Cr.
Ont
Ont
12
Top 100000IU
If the beneficiary has had a claim for both amlodipine and atorvastatin reimbursed by NBPDP in the previous 6 months, the
claim for Caduet will automatically be reimbursed without requiring special authorization.
Si le bénéficiaire a fait une demande de remboursement au PMONB pour l’amlodipine et l’atorvastatine au cours des six
derniers mois, la demande pour Caduet sera automatiquement remboursée sans autorisation spéciale.
Page 67
D01AC
IMIDAZOLE AND TRIAZOLE DERIVATIVES
DÉRIVÉS DE L’IMIDAZOLE ET TRIAZOLE
D01AC01
CLOTRIMAZOLE
CLOTRIMAZOLE
Crm Top
Cr.
D01AC02
1%
2%
YNO
TAR
Micatin
Monistat Derm
02085852
02126567
WLS
JNJ
Ketoderm
02245662
TPH
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
KETOCONAZOLE
KÉTOCONAZOLE
Crm Top
Cr.
D01AC20
02150867
00812382
MICONAZOLE
MICONAZOLE
Crm Top
Cr.
D01AC08
Canesten
Clotrimaderm
2%
f
AEFGVW
COMBINATION, TOPICAL ANTIFUNGALS (IMIDAZOLE DERVATIVES)
COMBINAISON, ANTIFONGIQUES TOPIQUES (DÉRIVÉS DE L’IMIDAZOLE)
CLOTRIMAZOLE / BETAMETHASONE
CLOTRIMAZOLE / BETAMETHASONE
Crm Top
Cr.
D01AE
1%/0.05%
Lotriderm
00611174
FRS
AEFGVW
Loprox
02221802
VLN
AEFGVW
Loprox
02221810
VLN
AEFGVW
Lamisil
02031094
NVR
AEFGVW
Odans LCD
00358495
ODN
AEFGV
OTHER ANTIFUNGALS FOR TOPICAL USE
AUTRES ANTIFONGIQUES POUR USAGE TOPIQUE
D01AE14
CICLOPIROX
CICLOPIROX
Crm Top
Cr.
Lot Top
Lot
D01AE15
1%
1%
TERBINAFINE
TERBINAFINE
Crm Top
Cr.
1%
D05
ANTIPSORIATICS
TRAITEMENT DU PSORIASIS
D05A
ANTIPSORIATICS FOR TOPICAL USE
TRAITEMENT DU PSORIASIS, POUR USAGE TOPIQUE
D05AA
TARS
GOUDRONS
D05AA99
TARS
GOUDRONS
Liq Top
Liq
20%
Page 68
D05AX
OTHER ANTISPORIATICS FOR TOPICAL USE
AUTRES TRAITEMENTS DU PSORIASIS POUR USAGE TOPIQUE
D05AX02
CALCIPOTRIOL
CALCIPOTRIOL
Crm Top
Cr.
50mcg
Dovonex
02150956
LEO
AEFV
Ont Top
Ont
50mcg
Dovonex
01976133
LEO
AEFV
Liq Top
Liq
50mcg
Dovonex Scalp Solution
02194341
LEO
AEFV
01946374
VLN
AEFGVW
D05B
ANTIPSORIATICS FOR SYSTEMIC USE
TRAITEMENT DU PSORIASIS, POUR USAGE SYSTÉMIQUE
D05BA
PSORALENS FOR SYSTEMIC USE
PSORALENES, POUR USAGE SYSTÉMIQUE
D05BA02
METHOXSALEN
MÉTHOXSALENE
Cap Orl
Caps
D05BB
10mg
Oxsoralen
RETINOIDS FOR TREATMENT OF PSORIASIS
RÉTINOÏDES POUR LE TRAITEMENT DU PSORIASIS
D05BB02
ACITRETIN
ACITRÉTINE
Cap Orl
Caps
10mg
Soriatane
02070847
TRB
AEFGVW
Cap Orl
Caps
25mg
Soriatane
02070863
TRB
AEFGVW
D06
ANTIBIOTICS AND CHEMOTHERAPEUTICS FOR DERMATOLOGICAL USE
ANTIBIOTIQUES ET AGENTS CHIMIOTHÉRAPEUTIQUES ET DERMATOLOGIQUES
D06A
ANTIBIOTICS FOR TOPICAL USE
ANTIBIOTIQUES POUR USAGE TOPIQUE
D05AX
OTHER ANTIBIOTICS FOR TOPICAL USE
AUTRES ANTIBIOTIQUES POUR USAGE TOPIQUE
D06AX01
FUSIDIC ACID
ACIDE FUSIDIQUE
Ont Top
Ont
2%
Fucidin
00586676
LEO
AEFGVW
Crm Top
Cr.
2%
Fucidin
00586668
LEO
AEFGVW
ratio-Gentamicin Sulfate
00805386
RPH
AEFGVW
D06AX07
GENTAMICIN
GENTAMICINE
Crm Top
Cr.
0.1%
Page 69
D06AX07
GENTAMICIN
GENTAMICINE
Ont Top
Ont
D06AX09
0.1%
ratio-Gentamicin Sulfate
00805025
RPH
Bactroban
Taro-Mupirocin
01916947
02279983
GCH
TAR
Flamazine
00323098
SNE
Sandoz Idoxuridine(Disc/non disp Mar 21/14)
02237187
SDZ
Zovirax
00569771
VLN
AEFGVW
Podofilm
00598208
PAL
AEFGV
Metrocream
02226839
GAC
AEFV
MUPROCIN
MUPROCINE
Ont Top
Ont
2%
D06B
CHEMOTHERAPEUTICS FOR TOPICAL USE
AGENTS CHIMIOTHÉRAPEUTIQUES POUR USAGE TOPIQUE
D06BA
SULFONAMIDES
SULFONAMIDES
D06BA01
AEFGVW
AEFGVW
1%
AEFGVW
ANTIVIRALS
ANTIVIRAUX
D06BB01
IDOXURIDINE
IDOXURIDINE
Liq Top
Liq
D06BB03
D06BB04
0.1%
f
AEFGVW
ACYCLOVIR
ACYCLOVIR
Ont Top
Ont
5%
PODOPHYLLOTOXIN
PODOPHYLLOTOXINE
Liq Top
Liq
D06BX
f
f
SILVER SULFADIAZINE
SULFADIAZINE D’ARGENT
Crm Top
Cr.
D06BB
AEFGVW
250mg
OTHER CHEMOTHERAPEUTICS
AUTRES AGENTS DE CHIMOTHÉRAPIE
D06BX01
METRONIDAZOLE
MÉTRONIDAZOLE
Crm Top
Cr.
0.75%
Crm Top
Cr.
1%
Noritate
Rosasol cream
02156091
02242919
VLN
GSK
AEFV
AEFV
Gel Top
Gel
1%
Metrogel
02297809
GAC
AEFGVW
Lot Top
Lot
0.75%
Metrolotion
02248206
GAC
AEFGVW
Page 70
D07
CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS
CORTICOSTÉROÏDES, PRÉPARATIONS DERMATOLOGIQUES
D07A
CORTICOSTEROIDS, PLAIN
CORTICOSTÉROÏDES, ORDINAIRES
D07AA
CORTICOSTEROIDS, WEAK (GROUP I)
CORTICOSTÉROÏDES, FAIBLES (GROUPE I)
D07AA02
D07AB
HYDROCORTISONE
HYDROCORTISONE
Crm Top
Cr.
0.5%
Hydrosone
Cortate
Hyderm
00564281
80021088
00716820
ROG
SCO
TAR
AEFGVW
AEFGVW
AEFGVW
Crm Top
Cr.
1%
Emo-Cort
Prevex HC
Hyderm
00192597
00804533
00716839
GSK
GSK
TAR
AEFGVW
AEFGVW
AEFGVW
Crm Top
Cr.
2.5%
Emo-Cort
00595799
GSK
AEFGVW
Lot Top 1%
Lot
Emo-Cort
Sarna HC
00192600
00578541
GSK
GSK
AEFGVW
AEFGVW
Lot Top 2.5%
Lot
Emo-Cort
Sarna HC
00595802
00856711
GSK
GSK
AEFGVW
AEFGVW
Cortoderm
00716693
TAR
AEFGVW
Ont Top
Ont
1%
Crm Top
Cr.
0.2%
Hydroval
02242984
TPH
f
AEFGVW
Ont Top
Ont
0.2%
Hydroval
02242985
TPH
f
AEFGVW
Spectro Eczemacare
02214415
GCH
pms-Desonide
02229315
PMS
f
AEFGVW
pms-Desonide
Desocort (Disc/non disp Apr 30/14)
02229323
02115522
PMS
GAC
f
AEFGVW
AEFGVW
CORTICOSTEROIDS, MODERATELY POTENT (GROUP II)
CORTICOSTÉROÏDES, MOYENNEMENT PUISSANT (GROUPE II)
D07AB01
CLOBETASONE
CLOBÉTASONE
Crm Top
Cr.
0.05%
DESONIDE
DÉSONIDE
Crm Top 0.05%
Cr.
AEFGVW
D07AB08
Ont Top 0.05%
Ont
Page 71
D07AB09
TRIAMCINOLONE
TRIAMCINOLONE
Crm Top 0.1%
Cr.
D07AC
Aristocort R
02194058
VAL
AEFGVW
Crm Top
Cr.
0.5%
Aristocort C
02194066
VAL
AEFGVW
Ont Top
Ont
0.1%
Aristocort R
02194031
VAL
AEFGVW
ratio-Ectosone Mild
Betaderm
Celestoderm V/2
00535427
00716618
02357860
RPH
TAR
VAL
f
f
AEFGVW
AEFGVW
AEFGVW
ratio-Ectosone
Betaderm
Celestoderm V
00535435
00716626
02357844
RPH
TAR
VAL
f
f
AEFGVW
AEFGVW
AEFGVW
ratio-Ectosone Mild
00653209
RPH
AEFGVW
Valisone
ratio-Ectosone Scalp
Betaderm
ratio-Ectosone
00027944
00653217
00716634
00750050
VAL
RPH
TAR
RPH
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Betaderm
Celestoderm V/2
00716642
02357879
TAR
VAL
f
f
AEFGVW
AEFGVW
Betaderm
Celestoderm V
00716650
02357852
TAR
VAL
f
f
AEFGVW
AEFGVW
Diprosone
Diprolene Glycol
ratio-Topisone
ratio-Topilene
00323071
00688622
00804991
00849650
FRS
FRS
RPH
RPH
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Lot Top 0.05%
Lot
Diprosone
Diprolene Glycol
ratio-Topisone
ratio-Topilene Glycol
00417246
00862975
00809187
01927914
FRS
FRS
RPH
RPH
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Ont Top 0.05%
Ont
Diprosone
Diprolene Glycol
ratio-Topilene Glycol
ratio-Topisone
00344923
00629367
00849669
00805009
FRS
FRS
RPH
RPH
CORTICOSTEROIDS, POTENT (GROUP III)
CORTICOSTÉROÏDES, PUISSANT (GROUPE III)
D07AC01
BETAMETHASONE
BÉTAMÉTHASONE
Crm Top
Cr.
0.05%
Crm Top
Cr.
0.1%
Lot Top 0.05%
Lot
Lot Top 0.1%
Lot
Ont Top 0.05%
Ont
Ont Top 0.1%
Ont
Crm Top
Cr.
0.05%
Page 72
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
D07AC03
DESOXIMETASONE
DÉSOXIMÉTASONE
Crm Top
Cr.
0.05%
Topicort Mild
02221918
VLN
f
AEFGVW
Crm Top
Cr.
0.25%
Topicort
02221896
VLN
f
AEFGVW
Gel Top
Gel
0.05%
Topicort
02221926
VLN
f
AEFGVW
D07AC06
DIFLUCORTOLONE
DIFLUCORTOLONE
Crm Top
Cr.
0.1%
Nerisone Oily
Nerisone
00587818
00587826
GSK
GSK
AEFGVW
AEFGVW
Ont Top
Ont
0.1%
Nerisone (Disc/non disp Mar 15/14)
00587834
GSK
AEFGVW
AEFGVW
AEFGVW
D07AC08
FLUOCINONIDE
FLUOCINONIDE
Crm Top
Cr.
0.05%
Lyderm
Lidemol
00716863
02163152
TPH
VAL
Gel Top
Gel
0.05%
Lidex Gel
Lyderm
02161974
02236997
VAL
TPH
f
f
AEFGVW
AEFGVW
Ont Top
Ont
0.05%
Lidex
Lyderm
02161966
02236996
VAL
TPH
f
f
AEFGVW
AEFGVW
Cyclocort
Taro-Amcinonide
ratio-Amcinonide
02192284
02246714
02247098
GSK
TAR
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
Lot Top 0.1%
Lot
Cyclocort
ratio-Amcinonide
02192276
02247097
GSK
TEV
f
f
AEFGVW
AEFGVW
Ont Top
Ont
Cyclocort
ratio-Amcinonide
02192268
02247096
GSK
TEV
f
f
AEFGVW
AEFGVW
0.1%
Elocom
Taro-Mometasone
00851744
02367157
FRS
TAR
f
f
ABEFGVW
ABEFGVW
Lot
Lot
Top 0.1%
Elocom
Taro-Mometasone
00871095
02266385
FRS
TAR
f
f
ABEFGVW
ABEFGVW
Ont
Ont
Top
Elocom
ratio-Mometasone
00851736
02248130
FRS
TEV
f
f
ABEFGVW
ABEFGVW
D07AC11
AMCINONIDE
AMCINONIDE
Crm Top 0.1%
Cr.
D07AC13
0.1%
MOMETASONE
MOMÉTASONE
Crm Top
Cr.
0.1%
Page 73
D07AD
CORTICOSTEROIDS, VERY POTENT (GROUP IV)
CORTICOSTÉROÏDES, TRÈS PUISSANT (GROUPE IV)
D07AD01
CLOBETASOL
CLOBÉTASOL
Crm Top
Cr.
0.05%
Lot Top 0.05%
Lot
Ont Top
Ont
0.05%
ratio-Clobetasol
Dermovate
Taro-Clobetasol Cream
Mylan-Clobetasol
Novo-Clobetasol
01910272
02213265
02245523
02024187
02093162
TEV
TPH
TAR
MYL
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
ratio-Clobetasol
Dermovate
Taro-Clobetasol Topical Sol’n
Mylan-Clobetasol Propionate
01910299
02213281
02245522
02216213
TEV
TPH
TAR
MYL
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
ratio-Clobetasol
Dermovate
Taro-Clobetasol Ointment
Mylan-Clobetasol
Novo-Clobetasol
01910280
02213273
02245524
02026767
02126192
TEV
TPH
TAR
MYL
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
D07C
CORTICOSTEROIDS, COMBINATIONS WITH ANTIBIOTICS
CORTICOSTÉROÏDES, EN COMBINAISON AVEC DES ANTIBIOTIQUES
D07CA
CORTICOSTEROIDS, WEAK, COMBINATIONS WITH ANTIBIOTICS
CORTICOSTÉROÏDES, FAIBLES, EN COMBINAISON AVEC DES ANTIBIOTIQUES
D07CA02
HYDROCORTISONE AND ANTIBIOTICS
HYDROCORTISONE ET ANTIBIOTIQUES
IODOCHLORHYDROXYQUINE / HYDROCORTISONE
IODOCHLORHYDROXYQUINE / HYDROCORTISONE
Crm
Cr.
Top
3%/1%
Vioform HC
00074500
PAL
AEFGVW
POLYMYXIN B SULFATE / BACITRACIN ZINC / HYDROCORTISONE / NEOMYCIN
POLYMYXINE B (SULFATE DE) / BACITRACINE / HYDROCORTISONE / NÉOMYCINE
Ont Top 5000IU/400IU/10mg/5mg
Cortisporin
00666246 GSK
AEFGVW
Ont
FUSIDIC ACID / HYDROCORTISONE
ACIDE FUSIDIQUE / HYDROCORTISONE
Crm Top
Cr.
D07CB
2%/1%
Fucidin H
02238578
LEO
AEFGVW
CORTICOSTEROIDS, MODERATELY POTENT, COMBINATIONS WITH ANTIBIOTICS
CORTICOSTÉROÏDES, MOYENNEMENT PUISSANTS, EN COMBINAISON AVEC DES ANTIBIOTIQUES
D07CB01
TRIAMCINOLONE AND ANTIBIOTICS
TRIAMCINOLONE ET ANTIBIOTIQUES
TRIAMCINOLONE / NEOMYCIN / NYSTATIN / GRAMICIDIN
TRIAMCINOLONE / NÉOMYCINE / NYSTATINE / GRAMICIDINE
Crm Top
Cr.
100000IU/2.5mg/1mg/0.25mg
Viaderm K-C
Page 74
00717002
TAR
AEFGVW
D07CB01
TRIAMCINOLONE AND ANTIBIOTICS
TRIAMCINOLONE ET ANTIBIOTIQUES
TRIAMCINOLONE / NEOMYCIN / NYSTATIN / GRAMICIDIN
TRIAMCINOLONE / NÉOMYCINE / NYSTATINE / GRAMICIDINE
Ont
Ont
D07CB05
Top
Viaderm K-C
00717029
TAR
Locacorten-Vioform
00074462
PAL
100000IU/2.5mg/1mg/0.25mg
AEFGVW
FLUMETASONE AND ANTIBIOTICS
FLUMETASONE ET ANTIBIOTIQUES
CLIOQUINO/FLUMETHASONE
CLIOQUINO/FLUMÉTHASONE
Crm
Cr.
D07CC
Top
3%/0.02%
AEFGVW
CORTICOSTEROIDS, POTENT, COMBINATIONS WITH ANTIBIOTICS
CORTICOSTÉROÏDES, PUISSANT, EN COMBINAISON AVEC DES ANTIBIOTIQUES
D07CC01
BETAMETHASONE AND ANTIBIOTICS
BÉTAMETHASONE ET ANTIBIOTIQUES
BETAMETHASONE / GENTAMICIN
BÉTAMETHASONE / GENTAMICINE
Ont
Ont
Top
0.1%/0/1%
Valisone G
00232351
VAL
AEFGVW
Crm Top
Cr.
0.1%/0.1%
Valisone G
00177016
VAL
AEFGVW
Pramox HC
00770957
DPT
AEFGVW
Crm Top 10%/1%
Cr.
Uremol HC
00503134
GSK
AEFGVW
Lot Top
Lot
Uremol HC
00560022
GSK
AEFGVW
D07X
CORTICOSTEROIDS, OTHER COMBINATIONS
CORTICOSTÉROÏDES, AUTRES COMBINAISONS
D07XA
CORTICOSTEROIDS, WEAK, OTHER COMBINATIONS
CORTICOSTÉROÏDES, FAIBLES, AUTRES COMBINAISONS
D07XA01
HYDROCORTISONE, OTHER COMBINATIONS
HYDROCORTISONE, AUTRES COMBINAISONS
HYDROCORTISONE / PRAMOXINE
HYDROCORTISONE / PRAMOXINE
Crm Top
Cr.
1%/1%
HYDROCORTISONE / UREA
HYDROCORTISONE / URÉA
10%/1%
Page 75
D07XC
CORTICOSTEROIDS, POTENT, OTHER COMBINATIONS
CORTICOSTÉROÏDES, PUISSANTS, AUTRES COMBINAISONS
D07XC01
BETAMETHASONE, OTHER COMBINATIONS
BETAMETHASONE, AUTRES COMBINAISONS
BETAMETHASONE / SALICYLIC ACID
BETAMETHASONE / ACIDE SALICYLIQUE
Lot Top
Lot
20mg/0.5mg
Diprosalic
ratio-Topisalic
00578428
02245688
FRS
TEV
Ont Top
Ont
30mg/0.5mg
Diprosalic
00578436
FRS
Nerisalic Oily (Disc/non disp Feb 21/14)
02028719
GSK
00579947
TCD
AEFGVW
01987682
01988840
ERF
ERF
AEFGVW
AEFGVW
D07XC04
f
f
AEFGVW
AEFGVW
AEFGVW
DIFLUCORTOLONE, OTHER COMBINATIONS
DIFLUCORTOLONE, AUTRES COMBINAISONS
DIFLUCORTOLONE / SALICYLIC ACID
DIFLUCORTOLONE / ACIDE SALICYLIQUE
Crm Top 3%/0.02%
Cr.
D08
ANTISEPTICS AND DISINFECTANTS
ANTISEPTIQUES ET AGENTS STÉRILISANTS
D08A
ANTISEPTICS AND DISINFECTANTS
ANTISEPTIQUES ET AGENTS STÉRILISANTS
D08AJ
QUATERNARY AMMONIUM COMPOUNDS
COMPOSÉS D’AMMONIUM QUATERNAIRE
D08AJ58
f
AEFGV
BENZETHONIUM CHLORIDE, COMBINATIONS
COMBINATION DE BENZETHONIUM CHLORIDE
ALUMINUM ACETATE / BENZETHONIUM CHLORIDE
ACÉTATE D’ALUMINIUM / CHLORURE DE BENZÉTHONIUM
Pwr Top
Pds.
0.35%
Buro Sol
D09
MEDICATED DRESSINGS
PANSEMENTS MÉDICAMENTEUX
D09A
MEDICATED DRESSINGS
PANSEMENTS MÉDICAMENTEUX
D09AA
MEDICATED DRESSINGS WITH ANTIINFECTIVES
PANSEMENTS MÉDICAMENTEUX ET ANTI-INFECTIEUX
D09AA01
FRAMYCETIN
FRAMYCÉTINE
Dre Top
Dre
1%
Sofra-Tulle (10cm x 30cm)
Sofra-Tulle (10cm x 10cm)
Page 76
D10
ANTI-ACNE PREPARATIONS
PRÉPARATIONS CONTRE L’ACNÉ
D10A
ANTI-ACNE PREPARATIONS FOR TOPICAL USE
PRÉPARATIONS TOPIQUES CONTRE L’ACNÉ
D10AA
CORTICOSTEROIDS, COMBINATIONS FOR TREATMENT OF ACNE
CORTICOSTÉROÏDES, COMBINAISON CONTRE L’ACNÉ
D10AA02
METHYLPREDNISONE, COMBINATION
METHYLPREDNISONE, COMBINAISON
ALUMINUM CHLORHYDROXIDE / SULPHUR / METHYLPREDNISOLONE / NEOMYCIN
ALUMINUM (CHLORHYDROXIDE D’) / SOUFRE / MÉTHYLPREDNISOLONE / NÉOMYCINE
Lot Top
Lot
D10AB
100mg/50mg/2.5mg/2.5mg
Neo-Medrol Acne
00195057
PFI
EFGW
Sulfacet R
02220407
VLN
AEFGVW
PREPARATIONS CONTAINING SULPHUR
PRÉPARATIONS CONTENANT DU SOUFRE
D10AB02
SULPHUR
SOUFRE
SULFACETAMIDE SODIUM/SULPHUR
SULFACÉTAMIDE SODIQUE/SOUFRE
Lot Top
Lot
D10AD
10%/5%
RETINOIDS FOR TOPICAL USE IN ACNE
RÉTINOÏDES POUR USAGE TOPIQUE CONTRE L’ACNÉ
D10AD01
TRETINOIN
TRÉTINOINE
Crm Top
Cr.
0.01%
Stieva-A
00657204
GSK
EFG
Crm Top
Cr.
0.025%
Stieva-A
00578576
GSK
EFG
Crm Top
Cr.
0.05%
Retin-A
Stieva-A
00443794
00518182
VLN
GSK
EFG
EFG
Crm Top
Cr.
0.1%
Retin-A (Disc/non disp Jun 1/14)
Stieva-A Forte
00870021
00662348
VLN
GSK
EFG
EFG
Gel Top 0.01%
Gel
Vitamin A Acid
01926462
VLN
EFG
Stieva-A (Disc/non Disp Jul 3/14)
Vitamin A Acid
00587966
01926470
GSK
VLN
EFG
EFG
Vitamin A Acid
01926489
VLN
EFG
Gel Top 0.025%
Gel
Gel Top 0.05%
Gel
Page 77
D10AE
PEROXIDES
PEROXIDES
D10AE01
BENZOYL PEROXIDE
PEROXYDE DE BENZOYLE
BENZOYL PEROXIDE / POLYOXYETHYLENE LAURYL ETHER
PEROXYDE DE BENZOYLE / LAURYL ETHER DE POLYOXYÉTHYLÈNE
D10AF
Gel Top 10%/6%
Gel
Panoxyl
00263699
GSK
AEFGVW
Gel Top 20%/6%
Gel
Panoxyl
00373036
GSK
AEFGVW
Dalacin T
Taro-Clindamycin
00582301
02266938
PFI
TAR
Stievamycin
01905112
GSK
EFG
02270811
BAY
AEFGVW
ANTIINFECTIVES FOR TREATMENT OF ACNE
ANTI-INFECTIEUX POUR LE TRAITEMENT DE L’ACNEÉ
D10AF01
CLINDAMYCIN
CLINDAMYCINE
Liq Top
Liq
D10AF52
1%
f
f
AEFGV
AEFGV
ERYTHROMYCIN COMBINATIONS
ÉRYTHROMYCINE, EN COMBINAISON
ERYTHROMYCIN BASE / TRETINOIN
ÉRYTHROMYCINE BASE / TRÉTINOÏNE
Gel Top
Gel
D10AX
4%/0.025%
OTHER ANTI ACNE PREPARATIONS FOR TOPICAL USE
AUTRES PRÉPARATIONS CONTRE L’ACNÉ POUR USAGE TOPIQUE
D10AX03
AZELAIC ACID
ACIDE AZÉLAIQUE
Gel Top
Gel
15%
Finacea
D10B
ANTI ACNE PREPARATIONS FOR SYSTEMIC USE
PRÉPARATIONS CONTRE L’ACNÉ POUR USAGE SYSTÉMIQUE
D10BA
RETINOIDS FOR TREATMENT OF ACNE
RÉTINOÏDES POUR LE TRAITEMENT DE L’ACNÉ
D10BA01
ISOTRETINOIN
ISOTRÉTINOINE
Cap Orl
Cap
10mg
Accutane Roche
Clarus
00582344
02257955
HLR
MYL
f
f
EFG
EFG
Cap Orl
Cap
40mg
Accutane Roche
Clarus
00582352
02257963
HLR
MYL
f
f
EFG
EFG
Page 78
G01
GYNECOLOGICAL ANTIINFECTIVES AND ANTISEPTICS
ANTI-INFECTIEUX ET ANTISEPTIQUES GYNÉCOLOGIQUES
G01A
ANTIINFECTIVES AND ANTISEPTICS, EXCLUDING COMBINATIONS WITH CORTICOSTEROIDS
ANTI-INFECTIEUX ET ANTISEPTIQUES, SAUF LES ASSOCIATIONS AVEC DES CORTICOSTÉROÏDES
G01AA
ANTIBIOTICS
ANTIBIOTIQUES
G01AA01
NYSTATIN
NYSTATINE
Crm Vag
Cr.
25000IU
Crm Vag
Cr.
100000IU
G01AA51
Nyaderm
00716901
TAR
AEFGVW
Ratio-Nystatin
02194163
RPH
AEFGVW
Flagystatin
01926829
SAV
AEFGVW
Diodoquin
01997750
GLE
AEFGVW
Flagyl
01926861
AVE
AEFGVW
NYSTATIN, COMBINATIONS
COMBINATION NYSTATINE
NYSTATIN / METRONIDAZOLE
NYSTATINE / METRONIDAZOLE
Sup Vag
Supp.
G01AC
QUINOLINE DERIVATIVES
DÉRIVÉS DE LA QUINOLEINE
G01AC01
DIIODOHYDROXYQUINOLINE
QUINOLEINE DIIODOHYDROXYLE
Tab Orl
Co.
G01AF
100000IU/500mg
650mg
IMIDAZOLE DERIVATIVES
DÉRIVÉS DE L’IMIDAZOLE
G01AF01
METRONIDAZOLE
MÉTRONIDAZOLE
Crm Vag
Cr.
G01AF02
10%
CLOTRIMAZOLE
CLOTRIMAZOLE
Crm Vag
Cr.
1%
Canesten
02150891
YNO
AEFGVW
Crm Vag
Cr.
2%
Canesten 3
02150905
YNO
AEFGVW
Crm Vag
Cr.
500mg/1%
Canesten 3 Comfortab Combi-Pak
Canesten 1 Comfortab
02264099
02264102
YNO
YNO
AEFGVW
AEFGVW
Monistat 7
Micozole Vaginal 2%
02084309
02231106
JNJ
TAR
G01AF04
MICONAZOLE
MICONAZOLE
Crm Vag
Cr.
2%
Page 79
f
f
AEFGVW
AEFGVW
G01AF04
G01AG
MICONAZOLE
MICONAZOLE
Sup Vag
Supp.
400mg
Crm Vag
Cr.
1200mg/2%
02126605
JNJ
AEFGVW
Monistat 3 Dual Pak
02126249
JNJ
AEFGVW
Terazol 7
Taro-Terconazole
00894729
02247651
JAN
TAR
TRIAZOLE DERIVATIVES
DÉRIVÉS DU TRIAZOLE
G01AG02
TERCONAZOLE
TERCONAZOLE
Crm Vag
Cr.
0.4%
G02
OTHER GYNECOLOGICALS
AUTRES AGENTS GYNÉCOLOGIQUES
G02B
CONTRACEPTIVES FOR TOPICAL USE
CONTRACEPTIFS TOPIQUES
G02BA
INTRAUTERINE CONTRACEPTIVES
CONTRACEPTIFS INTRA-UTÉRINS
G02BA03
f
f
AEFGVW
AEFGVW
PLASTIC IUD WITH PROGESTERONE AND LEVONORGESTREL
DIU EN PLASTIQUE AVEC LA PROGESTÉRONE ET DE LÉVONORGESTREL
Ins Vag
Ins
52mg
Mirena
02243005
BAY
Bromocriptine
pms-Bromocriptine (Disc/non disp Feb 16/14)
02087324
02231702
AAP
PMS
f
f
AEFGVW
AEFGVW
Cap Orl 5mg
Bromocriptine
02230454
Cap
pms-Bromocriptine (Disc/non disp Feb 16/14)
02236949
SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM
HORMONES SEXUELLES ET MODULATEURS DE L’APPAREIL GÉNITAL
AAP
PMS
f
f
AEFGVW
AEFGVW
G02C
OTHER GYNECOLOGICALS
AUTRES AGENTS GYNÉCOLOGIQUES
G02CB
PROLACTINE INHIBITORS
INHIBITEURS DE LA PROLACTINE
G02CB01
G03A
HORMONAL CONTRACEPTIVES FOR SYSTEMIC USE
CONTRACEPTIFS HORMONAUX, SYSTÉMIQUES
G03AA
PROGESTOGENS AND ESTROGENS, FIXED COMBINATIONS
PROGESTOGÈNES ET OESTROGÈNES, COMBINAISONS FIXES
G03AA01
EFG
BROMOCRIPTINE
BROMOCRIPTINE
Tab Orl 2.5mg
Co.
G03
Monistat-3
ETYNODIOL AND ETHINYLESTRADIOL
ETYNODIOL ET ÉTHINYLOESTRADIOL
Tab Orl 320mcg/2mg
Co.
Demulen 30 (21) *
Demulen 30 (28) *
Page 80
00469327
00471526
PFI
PFI
EFGV
EFGV
G03AA05
NORETHISTERONE AND ETHINYLESTRADIOL
NORÉTHISTERONE ET ÉTHINYLOESTRADIOL
Tab Orl 20mcg/1mg
Co.
Co.
Co.
Tab Orl 1mg/0.035mg
Co.
G03AA07
Minestrin 1/20 (21) *
Minestrin 1/20 (28) *
00315966
00343838
WNC
WNC
EFGV
EFGV
Loestrin 1.5/30 (21) *
Loestrin 1.5/30 (28) *
00297143
00353027
WNC
WNC
EFGV
EFGV
Ortho 0.5/35 (21) *
Ortho 0.5/35 (28) *
Brevicon (21) *
Brevicon (28) *
00317047
00340731
02187086
02187094
JAN
JAN
PFI
PFI
EFGV
EFGV
EFGV
EFGV
Ortho 1/35 (21) *
Ortho 1/35 (28) *
Brevicon 1/35 (21) *
Brevicon 1/35 (28) *
Select 1/35 (21) *
Select 1/35 (28) *
00372846
00372838
02189054
02189062
02197502
02199297
JAN
JAN
PFI
PFI
PFI
PFI
EFGV
EFGV
EFGV
EFGV
EFGV
EFGV
Min-Ovral (21) *
Min-Ovral (28) *
Portia 21 *
Portia 28 *
Ovima 21 *
Ovima 28 *
02042320
02042339
02295946
02295954
02387085
02387093
PFI
PFI
TEV
TEV
APX
APX
f
f
f
f
f
f
EFGV
EFGV
EFGV
EFGV
EFGV
EFGV
Alesse (21) *
Alesse (28) *
Aviane 21 *
Aviane 28 *
Esme (21) *
Esme (28) *
Alysena 21 *
Alysena 28 *
Lutera 21 *
Lutera 28 *
02236974
02236975
02298538
02298546
02388138
02388146
02387875
02387883
02401185
02401207
PFI
PFI
TEV
TEV
MYL
MYL
APX
APX
COB
COB
f
f
f
f
f
f
f
f
f
f
EFGV
EFGV
EFGV
EFGV
EFGV
EFGV
EFGV
EFGV
EFGV
EFGV
Marvelon (21) *
Marvelon (28) *
Apri 21 *
Apri 28 *
Freya 21 *
Freya 28 *
Linessa 21 *
Linessa 28 *
02042487
02042479
02317192
02317206
02396491
02396610
02272903
02257238
FRS
FRS
TEV
TEV
TEV
TEV
FRS
FRS
f
f
f
f
f
f
EFGV
EFGV
EFGV
EFGV
EFGV
EFGV
EFGV
EFGV
LEVONORGESTREL AND ETHINYLESTRADIOL
LÉVONORGESTREL ET ÉTHINYLOESTRADIOL
Co.
Co.
G03AA09
DESORGESTREL AND ETHINYLESTRADIOL
DÉSORGESTREL ET ÉTHINYLOESTRADIOL
Co.
Page 81
G03AA12
DROSPIRENONE AND ETHINYLESTRADIOL
DROSPIRÉNONE ET ÉTHINYLOESTRADIOL
Tab
Co.
G03AB
Orl 3mg/0.03mg
Yasmin 21 *
Zarah 21 *
Yasmin 28 *
Zarah 28 *
02261723
02385058
02261731
02385066
BAY
COB
BAY
COB
f
f
f
f
EFGV
EFGV
EFGV
EFGV
PROGESTOGENS AND ESTROGENS, SEQUENTIAL PREPARATIONS
PROGESTOGÈNES ET OESTROGÈNES, PRÉPARATION SÉQUENTIELLE
G03AB03
LEVONORGESTREL AND ETHINYLESTRADIOL
LÉVONORGESTREL ET ÉTHINYLOESTRADIOL
Tab Orl
50mcg/75mcg/125mcg/30mcg/40mcg/30mcg
Co.
Triquilar (21) *
Triquilar (28) *
00707600
00707503
BAY
BAY
EFGV
EFGV
NORETHISTERONE AND ETHINYLESTRADIOL
NORÉTHISTERONE ET ÉTHINYLOESTRADIOL
Tab
Orl 1mg/0.5mg/0.035mg
Synphasic (21) *
Co.
Synphasic (28) *
02187108
02187116
PFI
PFI
EFGV
EFGV
Tab
Co.
00602957
00602965
JAN
JAN
EFGV
EFGV
Tri-Cyclen lo (21) *
Tri-Cyclen lo (28) *
02258560
02258587
JAN
JAN
EFGV
EFGV
Tri-Cyclen (21) *
Tri-Cyclen (28) *
02028700
02029421
JAN
JAN
EFGV
EFGV
Micronor (28) *
00037605
JAN
EFGV
Depo-Provera
00030848
PFI
W
Depo-Provera *
Medroxyprogesterone Acetate *
00585092
02322250
PFI
SDZ
G03AB04
G03AB11
Orl
1mg/0.75mg/0.5mg/0.035mg
NORGESTIMATE AND ETHINYLESTRADIOL
NORGÉSTIMATE ET ÉTHINYLOESTRADIOL
Tab Orl
0.215mg/0.18mg/0.025mg/0.025mg
Co.
Tab Orl
0.25mg/0.215mg/0.18mg/0.035mg
Co.
G03AC
Ortho 7/7/7 (21) *
Ortho 7/7/7 (28) *
PROGESTOGENS
PROGESTOGÈNES
G03AC01
NORGESTIMATE
NORGÉSTIMATE
Tab Orl 0.35mg
Co.
G03AC06
MEDROXYPROGESTERONE
MÉDROXYPROGESTÉRONE
Sus Inj 50mg
Susp.
Sus Inj 150mg/mL
Susp.
Page 82
f
f
EFGV
EFGV
G03AD
EMERGENCY CONTRACEPTIVES
CONTRACEPTIFS D’URGENCE
G03AD01
LEVONORGESTREL (EMERGENCY CONTRACEPTIVE)
LÉVONORGESTREL (CONTRACEPTIF D’URGENCE)
Tab Orl 0.75mg
Co.
Plan B *
Next Choice *
02241674
02364905
PAL
COB
Liq Inj 100mg
Liq
Depo-Testosterone
00030783
PFI
W
Liq Inj 200mg
Liq
Delatestryl
00029246
VLN
W
G03B
ANDROGENS
ANDROGÈNES
G03BA
3-OXOANDROSTEN (4) DERIVATIVES
DÉRIVÉS DU 3-OXOANDROSTENE (4)
G03BA03
EFG
EFG
TESTOSTERONE
TESTOSTÉRONE
G03C
ESTROGENS
OESTROGÈNES
G03CA
NATURAL AND SEMISYNTHETIC ESTROGENS, PLAIN
OESTROGÈNES NATURELS ET SEMI-SYNTHÉTIQUES, ORDINAIRES
G03CA03
f
f
ESTRADIOL
ESTRADIOL
Tab Vag 10mcg
Co.
Vagifem 10
02325462
NNO
AEFGVW
Estrogel
02238704
FRS
AEFV
Estring
02168898
PAL
AEFV
Pth Trd 25mcg
Pth
Climara 25
02247499
BAY
AEFVW
Pth Trd 50mcg
Pth
Climara 50
02231509
BAY
AEFV
Pth Trd 75mcg
Pth
Climara 75
02247500
BAY
AEFVW
Pth Trd 100mcg
Pth
Climara 100
02231510
BAY
AEFV
Srd Trd 25mcg
Srd
Estraderm-25 (Disc/non disp Nov 7/14)
00756849
NVR
AEFGVW
Srd Trd 100mcg
Srd
Estraderm-100(Disc/non disp Jan 8/15)
00756792
NVR
AEFGVW
Gel Trd
Gel
0.06%
Ins Vag 2mg
Ins
Page 83
G03CA03
ESTRADIOL
ESTRADIOL
Tab Orl
Co.
0.5mg
Estrace
02225190
SHI
AEFGVW
Tab Orl
Co.
1mg
Estrace
02148587
SHI
AEFGVW
Tab Orl
Co.
2mg
Estrace
02148595
SHI
AEFGVW
Crm Vag 0.625mg
Cr.
Premarin
02043440
PFI
AEFGVW
Tab Orl 0.3g
Co.
Premarin
02043394
PFI
AEFGVW
Tab Orl 0.625g
Co.
Premarin
CES (Disc/non disp Jan 4/15)
02043408
00265470
PFI
VLN
AEFGVW
AEFGVW
Tab Orl 1.25mg
Co.
Premarin
02043424
PFI
AEFGVW
Tab Orl 2.5mg
Co.
Provera
Teva-Medrone
Apo-Medroxy
00708917
02221284
02244726
PFI
TEV
APX
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab Orl 5mg
Co.
Provera
Teva-Medrone
Apo-Medroxy
00030937
02221292
02244727
PFI
TEV
APX
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab Orl 10mg
Co.
Provera
Teva-Medrone
Apo-Medroxy
00729973
02221306
02277298
PFI
TEV
APX
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab Orl 100mg
Co.
Apo-Medroxy
02267640
APX
f
AEFGVW
G03CA57
CONJUGATED ESTROGENS
OESTROGÈNES CONJUGUÉS
G03D
PROGESTOGENS
PROGESTOGÈNES
G03DA
PREGNEN (4) DERIVATIVES
DÉRIVÉS DU PREGNEN (4)
G03DA02
MEDROXYPROGESTERONE
MÉDROXYPROGESTÉRONE
Page 84
G03H
ANTIANDROGENS
ANTIANDROGÈNES
G03HA
ANTIANDROGENS, PLAIN
ANTIANDROGÈNES, ORDINAIRES
G03HA01
CYPROTERONE
CYPROTÉRONE
Tab Orl 50mg
Co.
Androcur
Cyproterone
Med-Cyproterone
00704431
02245898
02390760
PMS
AAP
GMP
G03X
OTHER SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM
AUTRES HORMONES SEXUELLES ET MODULATEURS DE L’APPAREIL GÉNITAL
G03XA
ANTIGONADOTROPHINS AND SIMILAR AGENTS
ANTIGONADOTROPHINES ET AGENTS SIMILAIRES
G03XA01
f
f
f
AEFVW
AEFVW
AEFVW
DANAZOL
DANAZOL
Cap Orl 100mg
Caps
Cyclomen
02018152
SAV
AEFVW
Cap Orl 200mg
Caps
Cyclomen
02018160
SAV
AEFVW
G04
UROLOGICALS
MÉDICAMENTS UROLOGIQUES
G04B
UROLOGICALS
MÉDICAMENTS UROLOGIQUES
G04BD
DRUGS FOR URINARY FREQUENCY AND INCONTINENCE
MÉDICAMENTS POUR LA FRÉQUENCE URINAIRE ET INCONTINENCE
G04BD04
OXYBUTYNIN
OXYBUTYNINE
Syr Orl 1mg
Sir.
pms-Oxybutynin
02223376
PMS
Tab Orl 2.5mg
Co.
pms-Oxybutynin
02240549
PMS
Apo-Oxybutynin
Novo-Oxybutynin
Mylan-Oxybutynin
pms-Oxybutynin
Oxybutynin
02163543
02230394
02230800
02240550
02350238
APX
TEV
MYL
PMS
SAS
Tab Orl 5mg
Co.
G04BD07
f
AEFGVW
AEFGVW
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
TOLTERODINE
TOLTÉRODINE
Tab Orl 1mg
Co.
Detrol
Detrol
13
02239064
02239064
PFI
PFI
AEFGV
W
Tab Orl 2mg
Co.
Detrol
Detrol
13
02239065
02239065
PFI
PFI
AEFGV
W
Page 85
G04BD07
SOLIFENACIN
SOLIFÉNACINE
Tab Orl 5mg
Co.
Vesicare
Vesicare
13
02277263
02277263
ASL
ASL
AEFGV
W
Tab Orl 10mg
Co.
Vesicare
Vesicare
13
02277271
02277271
ASL
ASL
AEFGV
W
Trosec
Trosec
13
02275066
02275066
SNV
SNV
AEFGV
W
G04BD09
TROSPIUM
TROSPIUM
Tab Orl 20mg
Co.
G04BD10
ERT Orl 7.5mg
Co.L.P
Enablex
Enablex
13
02273217
02273217
MRS
MRS
AEFGV
W
ERT Orl 15mg
Co.L.P
Enablex
Enablex
13
02273225
02273225
MRS
MRS
AEFGV
W
13
02380021
PFI
AEFGV
13
02380048
PFI
AEFGV
Rimso-50 *
Dimethyl Sulfoxide Irr. *
00493392
02243231
BCH
SDZ
G04BD11
G04BX
DARIFENACIN
DARIFÉNACINE
FESOTERODINE
FÉSOTÉRODINE
ERT Orl 4mg
Co.L.P
Toviaz
ERT Orl 8mg
Co.L.P
Toviaz
OTHER UROLOGICAL
AUTRES MÉDICAMENTS UROLOGIQUES
G04BX13
DIMETHYL SULFOXIDE
SULFOXYDE DE DIMÉTHYLE
Liq Itv 500mg
Liq
13
f
f
AEFGVW
AEFGVW
Requests for coverage of regular Tolterodine (1mg and 2mg), Darifenacin, Solifenacin, Trospium or Fesoterodine will be
considered under special authorization, see Appendix IV. If the beneficiary has had a claim for oxybutynin in the previous 24
months the adjudication system will recognize this information and the claim for regular Tolterodine (1mg and 2mg),
Darifenacin, Solifenacin, Trospium or Fesoterodine will be automatically reimbursed without the need for a written special
authorization request. Written special authorization will continue to be available as an option for beneficiaries who may not
have the relevant first line agent on history due to changes in drug coverage or other factors.
Les demandes de protection pour du Toltérodine régulier (1mg and 2mg), Darifnacine, Solifénacinr, Trospium ou
Fesoterodine seront examinees sur autorisation spéciale. Veuillez consulter l’annexe IV. Si le bénéficiare a fait une demande
de réglement pour de l’oxybutynine dans le précédents 24 mois, le systeme pour la soumission en ligne des a fait une
demandes de réglement reconnaîtra cette information et la demande pour du Toltérodine régulier (1mg and 2mg),
Darifnacine, Solifénacinr, Trospium ou Fesoterodine sera remboursée automatiquement sans avoir à faire une demande
écrite d’autorisation spéciale. Les autorisation spéciales écrites continueront d’ être offertes à titre optionnel pour les
bénéficiares qui n’ont peut-être pas utilize d’agent de premiére ligne en raison des changements à l’assurance-médicaments
our d’autres facteurs.
Page 86
G04C
DRUGS USED IN BENIGN PROSTATIC HYPERTROPHY
MÉDICAMENTS UTILISÉS POUR LE TRAITEMENT DE L’HYPERTROPHIE BÉNIGNE DE LA PROSTATE
G04CA
ALPHA-ADRENORECEPTOR ANTAGONISTS
ANTAGONISTES DE L’ALPHA-ADRÉNORÉCEPTEUR
G04CA02
TAMSULOSIN
TAMSULOSINE
ERT Orl 0.4mg
Co.L.P
Flomax CR
Sandoz Tamsulosin CR
Apo-Tamsulosin CR
Teva-Tamsulosin CR
02270102
02340208
02362406
02368242
BOE
SDZ
APX
TEV
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
Teva-Tamsulosin
ratio-Tamsulosin
Ran-Tamsulosin (Disc/non disp Jun 13/14)
Sandoz Tamsulosin
Mylan-Tamsulosin
Jamp-Tamsulosin (Disc/non disp Jul 5/14)
02281392
02294265
02294885
02295121
02298570
02352419
TEV
TEV
RAN
SDZ
MYL
JPC
f
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
Tab Orl 1mg
Co.
Hytrin
ratio-Terazosin
Teva-Terazosin
Apo-Terazosin
pms-Terazosin
Terazosin
Mylan-Terazosin
00818658
02218941
02230805
02234502
02243518
02350475
02396289
ABB
RPH
TEV
APX
PMS
SAS
MYL
f
f
f
f
f
f
f
AEF18+VW
AEF18+VW
AEF18+VW
AEF18+VW
AEF18+VW
AEF18+VW
AEF18+VW
Tab Orl 2mg
Co.
Hytrin
ratio-Terazosin
Teva-Terazosin
Apo-Terazosin
pms-Terazosin
Terazosin
Mylan-Terazosin
00818682
02218968
02230806
02234503
02243519
02350483
02396297
ABB
RPH
TEV
APX
PMS
SAS
MYL
f
f
f
f
f
f
f
AEF18+VW
AEF18+VW
AEF18+VW
AEF18+VW
AEF18+VW
AEF18+VW
AEF18+VW
Tab Orl 5mg
Co.
Hytrin
ratio-Terazosin
Teva-Terazosin
Apo-Terazosin
pms-Terazosin
Terazosin
Mylan-Terazosin
00818666
02218976
02230807
02234504
02243520
02350491
02396300
ABB
RPH
TEV
APX
PMS
SAS
MYL
f
f
f
f
f
f
f
AEF18+VW
AEF18+VW
AEF18+VW
AEF18+VW
AEF18+VW
AEF18+VW
AEF18+VW
Tab Orl 10mg
Co.
Hytrin
ratio-Terazosin
Teva-Terazosin
Apo-Terazosin
pms-Terazosin
Terazosin
Mylan-Terazosin
00818674
02218984
02230808
02234505
02243521
02350505
02396319
ABB
RPH
TEV
APX
PMS
SAS
MYL
f
f
f
f
f
f
f
AEF18+VW
AEF18+VW
AEF18+VW
AEF18+VW
AEF18+VW
AEF18+VW
AEF18+VW
SRC Orl 0.4mg
Caps.L.L.
G04CA03
TERAZOSIN
TÉRAZOSINE
Page 87
H01
PITUITARY AND HYPOTHALAMIC HORMONES AND ANALOGUES
HORMONES HYPOPHYSAIRES ET HYPOTHALAMIQUES
H01A
ANTERIOR PITUITARY LOBE HORMONES AND ANALOGUES
HORMONES DU LOBE ANTEHYPOPHYSAIRE
H01AC
SOMATROPIN AND SOMATROPIN AGONISTS
SOMATROPINE ET AGONISTES DE LA SOMATROPINE
H01AC01
SOMATROPIN
SOMATROPINE
Ctg Inj 6mg
Cart
Humatrope
02243077
LIL
T
Ctg Inj 12mg
Cart
Humatrope
02243078
LIL
T
Ctg Inj 24mg
Cart
Humatrope
02243079
LIL
T
Liq
Liq
Inj 3.33mg
Omnitrope
02325063
SDZ
T
Liq
Liq
Inj 6.70mg
Omnitrope
02325071
SDZ
T
Liq
Liq
Inj 5mg/mL
Nutropin AQ (Disc/non disp Apr 16/15)
02229722
HLR
T
Liq
Liq
Inj 5mg/mL
Nutropin AQ NuSpin
®
02376393
HLR
T
Liq Inj 10mg/2mL
Liq
Nutropin AQ Pen
02249002
HLR
T
Liq
Liq
Inj
6mg
Saizen
02350122
EMD
T
Liq
Liq
Inj
12mg
Saizen
02350130
EMD
T
Liq
Liq
Inj
20mg
Saizen
02350149
EMD
T
Humatrope
Nutropin (Disc/non disp Dec 02/15)
00745626
02216191
LIL
HLR
T
T
Pws Inj 3.33mg
Pds.
Saizen
02215136
EMD
T
Pws Inj 5mg
Pds.
Saizen
02237971
EMD
T
Pws Inj 8.8mg
Pds.
Saizen
02272083
EMD
T
Pws Inj 1mg
Pds.
Page 88
H01B
POSTERIOR PITUITARY LOBE HORMONES
HORMONES DU LOBE POSTHYPOPHYSAIRE
H01BA
VASOPRESSIN AND ANALOGUES
VASOPRESSINE ET ANALOGUES
H01BA02
DESMOPRESSIN
DESMOPRESSINE
DDAVP*
00873993
FEI
AEFGVW
Nas 0.1mg
DDAVP
00402516
FEI
AEFGVW
ODT Slg 60mg
Co.D.O.
DDAVP Melt
02284995
FEI
EFG-18
ODT Slg 120mg
Co.D.O.
DDAVP Melt
02285002
FEI
EFG-18
ODT Slg 240mg
Co.D.O.
DDAVP Melt
02285010
FEI
EFG-18
Tab Orl 0.1mg
Co.
DDAVP
Apo-Desmopressin
Novo-Desmopressin
pms-Desmopressin
00824305
02284030
02287730
02304368
FEI
APX
TEV
PMS
f
f
f
f
EF-18G
EF-18G
EF-18G
EF-18G
Tab Orl 0.2mg
Co.
DDAVP
Apo-Desmopressin
Novo-Desmopressin
pms-Desmopressin
00824143
02284049
02287749
02304376
FEI
APX
TEV
PMS
f
f
f
f
EF-18G
EF-18G
EF-18G
EF-18G
Liq Inj 0.05mg/mL
Liq
Sandostatin
Octreotide Acetate Omega
00839191
02248639
NVR
OMG
f
f
W
W
Liq Inj 0.1mg/mL
Liq
Sandostatin
00839205
02248640
NVR
OMG
f
f
W
W
Liq Inj 0.2mg/mL
Liq
Sandostatin (vial)
02049392
02248642
NVR
OMG
f
f
W
W
Liq Inj 0.5mg/mL
Liq
Sandostatin
00839213
02248641
NVR
OMG
f
f
W
W
Sandostatin LAR
02239323
NVR
Liq
Liq
Inj 4mg
Liq
Liq
H01C
HYPOTHALAMIC HORMONES
HORMONES HYPOTHALAMIQUES
H01CB
SOMATOSTATIN AND ANALOGUES
SOMATOSTATINE ET ANALOGUES
H01CB02
OCTREOTIDE
OCTRÉOTIDE
Pws Inj 10mg
Pds.
Page 89
W
H01CB02
OCTREOTIDE
OCTRÉOTIDE
Pws Inj
Pds.
20mg
Sandostatin LAR
02239324
NVR
W
Pws Inj 30mg
Pds.
Sandostatin LAR
02239325
NVR
W
Florinef
02086026
PAL
AEFGVW
Celestone Soluspan
00028096
FRS
AEFGVW
Betnesol
02063190
SHI
AEFGVW
Tab Orl 0.5mg
Co.
pms-Dexamethasone
ratio-Dexamethasone
Apo-Dexamethasone
01964976
02240684
02261081
PMS
RPH
APX
Tab Orl 2mg
Co.
pms-Dexamethasone
02279363
PMS
Tab Orl 4mg
Co.
pms-Dexamethasone
ratio-Dexamethasone
Apo-Dexamethasone
Dexasone
01964070
02240687
02250055
00489158
PMS
RPH
APX
VLN
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Dexamethasone sodium phosphate
Dexamethasone sodium phosphate
Dexamethasone-Omega
00664227
01977547
02204266
SDZ
CYI
OMG
f
f
AEFGVW
AEFGVW
AEFGVW
00030988
PFI
H02
CORTICOSTEROIDS FOR SYSTEMIC USE
CORTICOSTÉROÏDES SYSTÉMIQUES
H02A
CORTICOSTEROIDS FOR SYSTEMIC USE, PLAIN
CORTICOSTÉROÏDES SYSTÉMIQUES, ORDINAIRES
H02AA
MINERALOCORTICOIDS
MINÉRALOCORTICOÏDES
H02AA02
FLUDROCORTISONE
FLUDROCORTISONE
Tab
Co.
H02AB
Orl 0.1mg
GLUCOCORTICOIDS
GLUCOCORTICOÏDES
H02AB01
BETAMETHASONE
BÉTAMÉTHASONE
Sus Ia 3mg/3mg
Susp.
Tab Orl 0.5mg
Co.
H02AB02
DEXAMETHASONE
DEXAMÉTHASONE
Liq Inj 4mg
Liq
H02AB04
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
METHYLPREDNISOLONE
MÉTHYLPREDNISOLONE
Tab Orl 4mg
Co.
Medrol
Page 90
AEFGVW
H02AB04
METHYLPREDNISOLONE
MÉTHYLPREDNISOLONE
Tab Orl 16mg
Co.
Medrol
00036129
PFI
AEFGVW
Sus Ia 20mg
Susp.
Depo-Medrol *
01934325
PFI
AEFGVW
Sus Ia 80mg
Susp.
Depo-Medrol *
Depo-Medrol *
00030767
01934341
PFI
PFI
AEFGVW
AEFGVW
Sus Ibu 40mg
Susp.
Depo-Medrol *
Depo-Medrol *
00030759
01934333
PFI
PFI
AEFGVW
AEFGVW
Pws Inj 125mg
Pds.
Solu-Medrol
02367955
PFI
W
Pws Inj 500mg
Pds.
Solu-Medrol
02367963
PFI
W
Solu-Medrol (Disc/non disp Jun 7/14)
02063697
PFI
W
Pediapred
pms-Prednisolone
02230619
02245532
SAV
PMS
Tab Orl 1mg
Co.
Winpred
Apo-Prednisone (Disc/non disp Jan 9/16)
00271373
00598194
AAP
APX
Tab Orl 5mg
Co.
Novo-Prednisone
Apo-Prednisone
00021695
00312770
TEV
APX
f
f
ABEFGVW
ABEFGVW
Tab Orl 50mg
Co.
Novo-Prednisone
Apo-Prednisone
00232378
00550957
TEV
APX
f
f
AEFGVW
AEFGVW
Tab Orl 10mg
Co.
Cortef
00030910
PFI
AEFGVW
Tab Orl 20mg
Co.
Cortef
00030929
PFI
AEFGVW
Pws Inj 100mg
Pds.
Solu-Cortef
00030600
PFI
W
Cortisone
00280437
VLN
Pws Inj 1g
Pds.
H02AB06
PREDNISOLONE
PREDNISOLONE
Liq Orl 1mg
Liq
H02AB09
H02AB10
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
HYDROCORTISONE
HYDROCORTISONE
CORTISONE
CORTISONE
Tab Orl 25mg
Co.
Page 91
f
AEFGVW
H02B
CORTICOSTEROIDS FOR SYSTEMIC USE, COMBINATIONS
CORTICOSTÉROÏDES SYSTÉMIQUES, EN COMBINAISON
H02BX
CORTICOSTEROIDS FOR SYSTEMIC USE, COMBINATIONS
CORTICOSTÉROÏDES SYSTEMIQUES, EN COMBINAISON
H02BX01
METHYLPREDNISOLONE, COMBINATIONS
MÉTHYLPREDNISOLONE, EN COMBINAISON
METHYLPREDNISOLONE / LIDOCAINE
MÉTHYLPREDNISOLONE / LIDOCAINE
Sus Ia 40mg/10mg
Susp.
Depo-Medrol (Disc/non disp Jun 8/14) *
H03
THYROID THERAPY
TRAITEMENT DE LA THYROÏDE
H03A
THYROID PREPARATIONS
PRÉPARATIONS POUR LA THYROÏDE
H03AA
THYROID HORMONES
HORMONES POUR LA THYROÏDE
H03AA01
00260428
PFI
AEFGVW
LEVOTHYROXINE SODIUM
LÉVOTHYROXINE SODIQUE
Tab
Co.
Orl 0.025mg
Synthroid
02172062
ABB
AEFGVW
Tab
Co.
Orl 0.05mg
Synthroid
Eltroxin
02172070
02213192
ABB
TRI
AEFGVW
AEFGVW
Tab
Co.
Orl 0.075mg
Synthroid
02172089
ABB
AEFGVW
Tab
Co.
Orl 0.088mg
Synthroid
02172097
ABB
AEFGVW
Tab
Co.
Orl 0.1mg
Synthroid
Eltroxin
02172100
02213206
ABB
TRI
AEFGVW
AEFGVW
Tab Orl 0.112mg
Co.
Synthroid
02171228
ABB
AEFGVW
Tab
Co.
Orl 0.125mg
Synthroid
02172119
ABB
AEFGVW
Tab
Co.
Orl 0.137mg
Synthroid
02233852
ABB
AEFGVW
Tab
Co.
Orl 0.15mg
Synthroid
Eltroxin
02172127
02213214
ABB
TRI
AEFGVW
AEFGVW
Tab
Co.
Orl 0.175mg
Synthroid
02172135
ABB
AEFGVW
Tab
Co.
Orl 0.2mg
Synthroid
Eltroxin
02172143
02213222
ABB
TRI
AEFGVW
AEFGVW
Page 92
H03AA02
LIOTHYRONINE SODIUM
LIOTHYRONINE SODIQUE
Tab Orl 0.3mg
Co.
Synthroid
Eltroxin
02172151
02213230
ABB
TRI
AEFGVW
AEFGVW
Tab
Co.
Orl 5mcg
Cytomel
01919458
PFI
AEFGVW
Tab
Co.
Orl 25mcg
Cytomel
01919466
PFI
AEFGVW
H03AA05
THYROID GLAND PREPARATIONS
PRÉPARATIONS POUR LA GLANDE THYROÏDE
DESICCATED THYROID
EXTRAIT THYROÏDIEN LYOPHILISÉ
Tab
Co.
Orl 30mg
Thyroid
00023949
ERF
AEFGVW
Tab
Co.
Orl 60mg
Thyroid
00023957
ERF
AEFGVW
Tab
Co.
Orl 125mg
Thyroid
00023965
ERF
AEFGVW
H03B
ANTITHYROID PREPARATIONS
PRÉPARATIONS ANTI-THYROÏDIENNES
H03BA
THIOURACILS
THIOURACILES
H03BA02
H03BB
PROPYLTHIOURACIL
PROPYLTHIOURACILE
Tab
Co.
Orl 50mg
Propyl-Thyracil
00010200
PAL
AEFGVW
Tab
Co.
Orl 100mg
Propyl-Thyracil
00010219
PAL
AEFGVW
SULPHUR-CONTAINING IMIDAZOLE DERIVATIVES
DÉRIVÉS DE L’IMIDAZOLE CONTENANT DU SOUFRE
H03BB02
THIAMAZOLE
THIAMAZOLE
Tab
Co.
Orl 5mg
Tapazole
00015741
PAL
AEFGVW
Tab
Co.
Orl 10mg
Tapazole
02296039
PAL
AEFGVW
Page 93
H04
PANCREATIC HORMONES
HORMONES PANCRÉATIQUES
H04A
GLYCOGENOLYTIC HORMONES
HORMONES GLYCOGÉNOLYTIQUES
H04AA
GLYCOGENOLYTIC HORMONES
HORMONES GLYCOGENOLYTIQUES
H04AA01
GLUCAGON
GLUCAGON
Pws Inj 1mg
Pds.
H05
CALCIUM HOMEOSTASIS
HOMÉOSTASIE DU CALCIUM
H05B
ANTI-PARATHYROID AGENTS
AGENTS ANTI-PARATHYROÏDES
H05BA
CALCITONIN PREPARATIONS
PRÉPARATIONS DU CALCITONINE
H05BA01
Glucagon *
Glucagen
Glucagen Hypokit
02243297
02333619
02333627
LIL
NNO
NNO
AEFGVW
AEFGVW
AEFGVW
AEFGVW
CALCITONIN (SALMON SYNTHETIC)
CALCITONINE (SAUMON, SYNTHETIQUE)
Liq Inj 100IU
Liq
Caltine *
02007134
FEI
Liq Inj 200IU
Liq
Calcimar *
01926691
SAV
f
AEFGVW
Vibramycin
Novo-Doxylin
Apo-Doxy
Doxycycline
00024368
00725250
00740713
02351234
PFI
TEV
APX
SAS
f
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
Apo-Doxy
Novo-Doxylin
Doxycycline
00874256
02158574
02351242
APX
TEV
SAS
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
Tetra
00580929
AAP
f
AEFGVW
J01
ANTIBACTERIALS FOR SYSTEMIC USE
ANTIBACTÉRIENS POUR USAGE SYSTÉMIQUE
J01A
TETRACYCLINES
TÉTRACYCLINES
J01AA
TETRACYCLINES
TÉTRACYCLINES
J01AA02
DOXYCYCLINE
DOXYCYCLINE
Cap Orl 100mg
Caps
Tab Orl 100mg
Co.
J01AA07
TETRACYCLINE
TÉTRACYCLINE
Cap Orl 250mg
Caps
Page 94
J01AA08
MINOCYCLINE
MINOCYCLINE
Cap Orl 50mg
Caps
Cap Orl 100mg
Caps
Apo-Minocycline
Novo-Minocycline
Mylan-Minocycline
Sandoz Minocycline
Minocycline
pms-Minocycline
02084090
02108143
02230735
02237313
02287226
02294419
APX
TEV
MYL
SDZ
SAS
PMS
f
f
f
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
Apo-Minocycline
Novo-Minocycline
Mylan-Minocycline
Sandoz Minocycline
Minocycline
Minocycline
pms-Minocycline
02084104
02108151
02230736
02237314
02239982
02287234
02294427
APX
TEV
MYL
SDZ
IVX
SAS
PMS
f
f
f
f
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
J01C
BETA LACTAM ANTIBACTERIALS, PENICILLINS
ANTIBACTÉRIEN BETA-LACTAME, PÉNICILLINES
J01CA
PENICILLIN WITH EXTENDED SPECTRUMS
PÉNICILLINE AVEC SPECTRUMS ÉTENDUS
J01CA01
AMPICILLIN
AMPICILLINE
Cap Orl 250mg
Caps
Teva-Ampicillin
00020877
TEV
f
AEFGVW
Cap Orl 500mg
Caps
Teva-Ampicillin
00020885
TEV
f
AEFGVW
Pws Inj 500mg
Pds.
Teva-Ampicillin
00872652
TEV
W
Pws Inj 1g
Pds.
Teva-Ampicillin
01933345
TEV
W
Pws Inj 2g
Pds.
Ampicillin Sodium
01933353
TEV
W
Cap Orl 250mg
Caps
Novamoxin
Apo-Amoxi
pms-Amoxicillin
Mylan-Amoxicillin
Amoxicillin
Amoxicillin
Auro-Amoxicillin
00406724
00628115
02230243
02238171
02241826
02352710
02388073
TEV
APX
PMS
MYL
NUM
SAS
ARO
f
f
f
f
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
Cap Orl 500mg
Caps
Novamoxin
Apo-Amoxi
pms-Amoxicillin
Mylan-Amoxicillin
00406716
00628123
02230244
02238172
TEV
APX
PMS
MYL
f
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
J01CA04
AMOXICILLIN
AMOXICILLINE
Page 95
J01CA04
AMOXICILLIN
AMOXICILLINE
Cap Orl 500mg
Caps
Amoxicillin
Amoxicillin
Auro-Amoxicillin
02241827
02352729
02388081
NUM
SAS
ARO
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
Pws Orl 25mg
Pds.
Novamoxin
Apo-Amoxi
Novamoxin 125 (sugar-reduced)
pms-Amoxicillin
Amoxicillin
Amoxicillin (sugar-reduced)
00452149
00628131
01934171
02230245
02352745
02352761
TEV
APX
TEV
PMS
SAS
SAS
f
f
f
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
Pws Orl 50mg
Pds.
Novamoxin
Apo-Amoxi
Novamoxin 125 (sugar-reduced)
pms-Amoxicillin
Amoxicillin
Amoxicillin (sugar-reduced)
00452130
00628158
01934163
02230246
02352753
02352788
TEV
APX
TEV
PMS
SAS
SAS
f
f
f
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
TabC Orl 125mg
Co.C
Novamoxin chew
02036347
TEV
f
ABEFGVW
TabC Orl 250mg
Co.C
Novamoxin chew
02036355
TEV
f
ABEFGVW
Piperacillin
02246641
HOS
f
W
J01CA12
PIPERACILLIN
PIPÉRACILLINE
Pws Inj 3g
Pds.
J01CE
BETA-LACTAMASE SENSITIVE PENICILLINS
PÉNICILLINES SENSIBLES AUX BETA-LACTAMASES
J01CE01
BENZYLPENICILLIN (PENICILLIN G)
BENZYLPÉNICILLINE (PÉNICILLINE G)
Liq Inj 1000000IU
Liq
Penicillin G Sodium
01930672
TEV
W
Liq Inj 5000000IU
Liq
Penicillin G Sodium
00883751
TEV
W
Liq Inj 10000000IU
Liq
Penicillin G Sodium
01930680
TEV
W
Pws Inj 1000000IU
Pds.
Crystapen
02060086
BCH
W
Pws Inj 10000000IU
Pds.
Crystapen
02060108
BCH
W
Page 96
J01CE02
PHENOXYMETHYLPENICILLIN (PENICILLIN V)
PHENOXYMETHYLPÉNICILLINE (PÉNICILLINE V)
Pws Orl 25mg
Pds.
Apo-Pen VK
00642223
APX
AEFGVW
Pws Orl 60mg
Pds.
Novo-Pen-VK (Disc/non disp Feb 26/15)
Apo-Pen VK
00391603
00642231
TEV
APX
AEFGVW
AEFGVW
Tab Orl 300mg
Co.
Novo-Pen-VK (Disc/non disp Feb 26/15)
Apo-Pen VK
00021202
00642215
TEV
APX
J01CE08
Bicillin L-A
02291924
KNG
AEFGVW
BETA-LACTAMASE RESISTANT PENICILLINS
PÉNICILLINES RÉSISTANT AUX BETA-LACTAMASE
J01CF02
CLOXACILLIN
CLOXACILLINE
Cap Orl 250mg
Caps
Novo-Cloxin
00337765
TEV
f
ABEFGVW
Cap Orl 500mg
Caps
Novo-Cloxin
00337773
TEV
f
ABEFGVW
Cloxacillin Sodium *
01912429
TEV
BEFGW
Pws Inj 1g
Pds.
Cloxacillin Sodium
01975447
TEV
BEFGW
Pws Inj 2g
Pds.
Cloxacillin Sodium
01912410
TEV
BEFGW
Novo-Cloxin
00337757
TEV
Pws Inj
Pds.
500mg
Pws Orl 25mg
Pds.
J01CR
AEFGVW
AEFGVW
BENZATHINE BENZYLPENICILLIN (PENICILLIN G BENZATHINE)
BENZATHINE BENZYLPÉNICILLINE (PÉNICILLINE G BENZATHINE)
Sus Inj 6000000IU
Susp.
J01CF
f
f
f
ABEFGVW
COMBINATIONS PENICILLINS INCLUDING BETA LACTAMASE INHIBITORS
COMBINAISON DE PÉNICILLINES, Y COMPRIS LES INHIBITEURS DE BETA-LACTAMASE
J01CR02
AMOXICILLIN AND ENZYME INHIBITOR
AMOXICILLINE ET INHIBITEURS D’ENZYMES
AMOXICILLIN / CLAVULANIC ACID
AMOXICILLINE / ACIDE CLAVULANIQUE
Pws Orl 25mg/6.25mg
Clavulin
Pds.
Apo-Amoxi clav
Ratio-Aclavulanate 125 F
Pws Orl 50mg/12.5mg
Pds.
Clavulin-250 F
Apo-Amoxi clav
Ratio-Aclavulanate 250 F
Page 97
01916882
02243986
02244646
GSK
APX
TEV
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
01916874
02243987
02244647
GSK
APX
TEV
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
J01CR02
AMOXICILLIN AND ENZYME INHIBITOR
AMOXICILLINE ET INHIBITEURS D’ENZYMES
AMOXICILLIN / CLAVULANIC ACID
AMOXICILLINE / ACIDE CLAVULANIQUE
Pws Orl 200mg/28.5mg/5mL
Pds.
Clavulin 200
02238831
GSK
Pws Orl 400mg/57mg/5mL
Pds.
Clavulin 400
Apo-Amoxi Clav
02238830
02288559
GSK
APX
f
f
ABEFGVW
ABEFGVW
Tab Orl 250mg/125mg
Co.
Apo-Amoxi Clav
02243350
APX
f
ABEFGVW
Tab Orl 500mg/125mg
Co.
Clavulin-500 F
Apo-Amoxi Clav
ratio-Aclavulanate
01916858
02243351
02243771
GSK
APX
TEV
f
f
ABEFGVW
ABEFGVW
ABEFGVW
Tab Orl 875mg/125mg
Co.
Clavulin
Apo-Amoxi Clav
ratio-Aclavulanate
Novo-Clavamoxin
02238829
02245623
02247021
02248138
GSK
APX
TEV
TEV
f
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
Timentin
01916939
GSK
Pws Inj 2g/0.25g
Pds.
Tazocin
Piperacillin & Tazobactam
02170817
02308444
02299623
PFI
APX
SDZ
f
f
W
W
W
Pws Inj 3g/0.375g
Pds.
Tazocin
Piperacillin/Tazobactam
02170795
02308452
02299631
02370166
PFI
APX
SDZ
TEV
f
f
W
W
W
W
Tazocin
AJ-Pip/Taz
Piperacillin/Tazobactam
02170809
02308460
02299658
02391546
02370174
PFI
APX
SDZ
AJP
TEV
f
f
J01CR03
ABEFGVW
TICARICILLIN AND ENZYME INHIBITOR
TICARICILLINE ET INHIBITEURS D’ENZYMES
TICARICILLIN / POTASSIUM CLAVULANATE
TICARICILLINE / CLAVULANATE DE POTASSIUM
Pws
Pds.
J01CR05
Inj
3g
W
PIPERACILLIN AND ENZYME INHIBITOR
PIPÉRACILLINE ET INHIBITEURS D’ENZYMES
PIPERACILLIN / TAZOBACTAM
PIPÉRACILLINE / TAZOBACTAM
Pws Inj 4g/0.5g
Pds.
Page 98
f
f
f
W
W
W
W
W
J01D
OTHER BETA LACTAM ANTIBACTERIALS
AUTRES ANTIBACTERIEN BETA-LACTAM
J01DB
FIRST GENERATION CEPHALOSPORINS
CÉPHALOSPORINES DE PREMIÈRE GÉNÉRATION
J01DB01
CEPHALEXIN
CÉPHALEXINE
Cap Orl 250mg
Caps
Novo-Lexin
00342084
TEV
ABEFGVW
Cap Orl 500mg
Caps
Novo-Lexin
00342114
TEV
ABEFGVW
Pws Orl 25mg
Pds.
Novo-Lexin
00342106
TEV
f
ABEFGVW
Pws Orl 50mg
Pds.
Novo-Lexin
00342092
TEV
f
ABEFGVW
Tab Orl 250mg
Co.
Novo-Lexin
Apo-Cephalex
00583413
00768723
TEV
APX
f
f
ABEFGVW
ABEFGVW
Tab Orl 500mg
Co.
Novo-Lexin
Apo-Cephalex
00583421
00768715
TEV
APX
f
f
ABEFGVW
ABEFGVW
Pws Inj 500mg
Pds.
Cefazolin Sodium
Cefazolin Sodium
02108119
02308932
TEV
SDZ
f
f
BEFGW
BEFGW
Pws Inj 1g
Pds.
Cefazolin Sodium
Cefazolin
Cefazolin Sodium
02108127
02297205
02308959
TEV
HOS
SDZ
f
f
f
BEFGW
BEFGW
BEFGW
Teva-Cefadroxil
Apo-Cefadroxil
02235134
02240774
TEV
APX
f
f
AEFGVW
AEFGVW
J01DB04
J01DB05
CEFAZOLIN
CÉFAZOLINE
CEFADROXIL
CÉFADROXIL
Cap Orl 500mg
Caps
J01DC
SECOND GENERATION CEPHALOSPORINS
CÉPHALOSPORINES DE DEUXIÈME GÉNÉRATION
J01DC01
CEFOXITIN
CÉFOXITINE
Pws Inj 1g
Pds.
Cefoxitin Sodium
Cefoxitin for Injection
02128187
02291711
TEV
APX
f
f
W
W
Pws Inj 2g
Pds.
Cefoxitin Sodium
Cefoxitin for Injection
02128195
02291738
TEV
APX
f
f
W
W
Novo-Cefoxitin
02240773
TEV
Pws Inj 10g
Pds.
Page 99
W
J01DC02
Liq
Liq
CEFUROXIME
CÉFUROXIME
Ceftin
02212307
GSK
Tab Orl 250mg
Co.
Ceftin
ratio-Cefuroxime
Apo-Cefuroxime
Auro-Cefuroxime
02212277
02242656
02244393
02344823
GSK
TEV
APX
ARO
f
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
Tab Orl 500mg
Co.
Ceftin
ratio-Cefuroxime
Apo-Cefuroxime
Auro-Cefuroxime
02212285
02242657
02244394
02344831
GSK
TEV
APX
ARO
f
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
Pws. Inj 750mg
Pds.
Cefuroxime *
02241638
PPC
f
BEFGW
Pws. Inj 1.5g
Pds.
Cefuroxime *
02241639
PPC
f
BEFGW
Cap Orl 250mg
Caps
Ceclor
00465186
PDP
f
ABEFGVW
Cap Orl 500mg
Caps
Ceclor
00465194
PDP
f
ABEFGVW
Pws. Orl 25mg
Pds.
Ceclor
00465208
PDP
f
ABEFGVW
Pws. Orl 50mg
Pds.
Ceclor
00465216
PDP
f
ABEFGVW
Pws. Orl 75mg
Pds.
Ceclor B.I.D.
00832804
PDP
f
ABEFGVW
Tab Orl 250mg
Co.
Cefzil
Apo-Cefprozil
Ran-Cefprozil
Sandoz Cefprozil
Auro-Cefprozil
02163659
02292998
02293528
02302179
02347245
BRI
APX
RAN
SDZ
ARO
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 500mg
Co.
Cefzil
Apo-Cefprozil
Ran-Cefprozil
Sandoz Cefprozil
Auro-Cefprozil
02163667
02293005
02293536
02302187
02347253
BRI
APX
RAN
SDZ
ARO
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
J01DC04
J01DC10
Orl 25mg
ABEFGVW
CEFACLOR
CÉFACLOR
CEFPROZIL
CEFPROZIL
Page 100
J01DC10
J01DD
CEFPROZIL
CEFPROZIL
Pws. Orl 25mg
Pds.
Cefzil
Apo-Cefprozil
Ran-Cefprozil
Sandoz Cefprozil
Auro-Cefprozil
02163675
02293943
02329204
02303426
02347261
BRI
APX
RAN
SDZ
ARO
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Pws. Orl 50mg
Pds.
Cefzil
Apo-Cefprozil
Ran-Cefprozil
Sandoz Cefprozil
Auro-Cefprozil
02163683
02293951
02293579
02303434
02347288
BRI
APX
RAN
SDZ
ARO
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Claforan (Disc/non disp Apr 1/14)
02225085
SAV
W
THIRD GENERATION CEPHALOSPORINS
CÉPHALOSPORINES DE TROISIÈME GÉNÉRATION
J01DD01
CEFOTAXIME
CÉFOTAXIME
Pws Inj
Pds.
500mg
Pws Inj
Pds.
1g
Claforan
02225093
SAV
W
Pws Inj
Pds.
2g
Claforan
02225107
SAV
W
Fortaz
02212196
GSK
BEFGW
J01DD02
CEFTAZIDIME
CEFTAZIDIME
Pws Inj
Pds.
500mg
Pws Inj
Pds.
1g
Ceftazidime
Fortaz
00886971
02212218
PPC
GSK
BEFGW
BEFGW
Pws Inj
Pds.
2g
Ceftazidime
Fortaz
00886955
02212226
PPC
GSK
BEFGW
BEFGW
Rocephin (Disc/non disp Jun 20/14)
Ceftriaxone
Ceftriaxone Sodium
00657387
02292866
02325594
HLR
APX
STR
f
f
f
BEFGVW
BEFGVW
BEFGVW
Ceftriaxone
Ceftriaxone
Ceftriaxone Sodium
Ceftriaxone Sodium
02292270
02292874
02325616
2287633
SDZ
APX
STR
TEV
f
f
f
f
BEFGVW
BEFGVW
BEFGVW
BEFGVW
J01DD04
CEFTRIAXONE
CEFTRIAXONE
Pws Inj
Pds.
250mg
Pws Inj
Pds.
1g
Page 101
J01DD04
CEFTRIAXONE
CEFTRIAXONE
Pws Inj
Pds.
J01DD08
J01DE
Ceftriaxone
Ceftriaxone
Ceftriaxone Sodium
02292289
02292882
02325624
SDZ
APX
STR
f
f
f
BEFGVW
BEFGVW
BEFGVW
CEFIXIME
CÉFIXIME
Pws Orl
Pds.
20mg
Suprax
00868965
SAV
ABEFGVW
Tab
Co.
400mg
Suprax
00868981
SAV
ABEFGVW
W
Orl
FOURTH GENERATION CEPHALOSPORINS
CÉPHALOSPORINES DE QUATRIÈME GÉNÉRATION
J01DE01
J01DH
2g
CEFEPIME
CÉFEPIME
Pws Inj
Pds.
1g
Maxipime
02163632
BRI
Pws Inj
Pds.
2g
Maxipime
Cefepime
02163640
02319039
BRI
APX
f
f
W
W
CARBAPENEMS
CARBAPENEMS
J01DH02
MEROPENEM
MÉROPÉNEM
Pws Inj
Pds.
500mg
Merrem
02218488
AZE
W
Pws Inj
Pds.
1g
Merrem
02218496
AZE
W
Invanz
02247437
FRS
W
J01DH03
ERTAPENEM
ERTAPÉNEM
Pws Inj
Pds.
J01DH51
1g
IMIPENEM AND ENZYME INHIBITOR
IMIPENEM ET INHIBITEURS D’ENZYMES
IMIPENEM / CILASTATIN
IMIPÉNEM / CILASTATINE
Pws Inj
Pds.
250mg
Primaxin(Disc/non disp Oct 1/14)
Ran-Imipenem-Cilastatin
00717274
02351692
FRS
OMG
W
W
Pws Inj
Pds.
500mg
Primaxin
Ran-Imipenem-Cilastatin
00717282
02351706
FRS
OMG
W
W
Page 102
J01E
SULFONAMIDES AND TRIMETHOPRIM
SULFONAMIDES ET TRIMÉTHOPRIME
J01EA
TRIMETHOPRIM AND DERIVATIVES
TRIMÉTHOPRIME ET DÉRIVÉS
J01EA01
TRIMETHOPRIM
TRIMÉTHOPRIME
Tab Orl 100mg
Co.
Tab
Co.
J01EE
Orl 200mg
Trimethoprim
02243116
AAP
f
AEFGVW
Trimethoprim
02243117
AAP
f
AEFGVW
COMBINATIONS OF SULFONAMIDES AND TRIMETHOPRIM, INCLUDING DERIVATIVES
COMBINAISON DE SULFONAMIDES ET DE TRIMÉTHOPRIME, INCLUANT LES DÉRIVÉS
J01EE01
SULFAMETHOXASOLE AND TRIMETHOPRIM
SULFAMÉTHOXASOLE ET TRIMÉTHOPRIME
Sus
Orl 8mg/40mg
Susp.
Novo-Trimel
00726540
TEV
f
ABEFGVW
Tab
Co.
Orl 20mg/100mg
Apo-Sulfatrim
00445266
APX
Tab
Co.
Orl 80mg/400mg
Apo-Sulfatrim
Novo-Trimel
00445274
00510637
APX
TEV
f
f
ABEFGVW
ABEFGVW
Tab
Co.
Orl 160mg/800mg
Apo-Sulfatrim DS
Novo-Trimel DS
00445282
00510645
APX
TEV
f
f
ABEFGVW
ABEFGVW
J01F
MACROLIDES, LINCOSAMIDES AND STREPTOGRAMINS
MACROLIDES, LINCOSAMIDES ET STREPTOGRAMINES
J01FA
MACROLIDES
MACROLIDES
J01FA01
ABEFGVW
ERYTHROMYCIN
ÉRYTHROMYCINE
ECC Orl
Caps.Ent.
250mg
Eryc
Erythro E-C
00607142
00726672
PFI
AAP
f
f
ABEFGVW
ABEFGVW
ECC Orl
Caps.Ent.
333mg
Eryc
Erythro E-C
00873454
01925938
PFI
AAP
f
f
ABEFGVW
ABEFGVW
Erythro
00682020
AAP
f
ABEFGVW
Tab Orl
Co.
250mg
Liq
Liq
Orl
50mg
Novo-Rythro Estolate
00262595
TEV
f
ABEFGVW
Pws Orl
Pds.
40mg
Novo-Rythro
00605859
TEV
f
ABEFGVW
Pws Orl
Pds.
80mg
Novo-Rythro
00652318
TEV
f
ABEFGVW
Page 103
J01FA01
ERYTHROMYCIN
ÉRYTHROMYCINE
Tab
Co.
Orl 600mg
Erythro-ES
00637416
AAP
f
ABEFGVW
Tab
Co.
Orl 250mg
Erythro-S
00545678
AAP
f
ABEFGVW
Tab
Co.
Orl 500mg
Erythro-S
00688568
AAP
ABEFGVW
J01FA02
SPIRAMYCIN
SPIRAMYCINE
Cap Orl
Caps
750000IU
Rovamycine 250
01927825
ODN
AEFGVW
Cap Orl
Caps
1500000IU
Rovamycine 500
01927817
ODN
AEFGVW
Biaxin XL
02244756
ABB
ABEFGVW
J01FA09
CLARITHROMYCIN
CLARITHROMYCINE
ERT Orl 500mg
Co.L.P.
Pws Orl
Pds.
25mg
Biaxin
Accel-Clarithromycin
Clarithromycin
02146908
02390442
02408988
ABB
ACC
SAS
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
Pws Orl
Pds.
50mg
Biaxin
Accel-Clarithromycin
Clarithromycin
02244641
02390450
02408996
ABB
ACC
SAS
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
Orl 250mg
Biaxin BID
pms-Clarithromycin
ratio-Clarithromycin(Disc/non disp Apr 12/15)
Mylan-Clarithromycin
Sandoz Clarithromycin
Apo-Clarithromycin
Ran-Clarithromycin
Teva-Clarithromycin
01984853
02247573
02247818
02248856
02266539
02274744
02361426
02248804
ABB
PMS
RPH
MYL
SDZ
APX
RAN
TEV
f
f
f
f
f
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
Tab Orl 500mg
Co.
Biaxin BID
pms-Clarithromycin
Mylan-Clarithromycin
ratio-Clarithromycin (Disc/non disp Apr 12/15)
Sandoz Clarithromycin
Apo-Clarithromycin
Ran-Clarithromycin
Teva-Clarithromycin
02126710
02247574
02248857
02247819
02266547
02274752
02361434
02248805
ABB
PMS
MYL
RPH
SDZ
APX
RAN
TEV
f
f
f
f
f
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
Tab
Co.
Page 104
J01FA10
AZITHROMYCIN
AZITHROMYCINE
Pws Inj
Pds.
500mg
Zithromax
02239952
PFI
Pws Orl
Pds.
20mg
Zithromax
Pms-Azithromycin
Novo-Azithromycin pediatric
Sandoz Azithromycin
Phl-Azithromycin
GD-Azithromycin
02223716
02274388
02315157
02332388
02282380
02274566
PFI
PMS
TEV
SDZ
PHL
GMD
f
f
f
f
Zithromax
Pms-Azithromycin
Novo-Azithromycin pediatric
Sandoz Azithromycin
Phl-Azithromycin
GD-Azithromycin
02223724
02274396
02315165
02332396
02282410
02274574
PFI
PMS
TEV
SDZ
PHL
GMD
f
f
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
Tab Orl 250mg
Co.
Zithromax
Apo-Azithromycin
Co Azithromycin
pms-Azithromycin
Sandoz-Azithromycin
Novo-Azithromycin
GD-Azithromycin
ratio-Azithromycin
Mylan-Azithromycin
Azithromycin
02212021
02247423
02255340
02261634
02265826
02267845
02274531
02275287
02278359
02330881
PFI
APX
COB
PMS
SDZ
TEV
GMD
RPH
MYL
SAS
f
f
f
f
f
f
f
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
Tab Orl 600mg
Co.
Zithromax
Co Azithromycin
pms-Azithromycin
Azithromycin
02231143
02256088
02261642
02330911
PFI
COB
PMS
SAS
f
f
f
f
W
W
W
W
Dalacin C
Teva-Clindamycin
Apo-Clindamycin
Mylan-Clindamycin
00030570
02241709
02245232
02258331
PFI
TEV
APX
MYL
f
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
Dalacin C
Teva-Clindamycin
Apo-Clindamycin
Mylan-Clindamycin
02182866
02241710
02245233
02258358
PFI
TEV
APX
MYL
f
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
Dalacin C Phosphate
Clindamycin (bulk vials)
Clindamycin (2ml, 4ml, 6ml vials)
00260436
02230535
02230540
PFI
SDZ
SDZ
f
f
f
W
W
W
Pws Orl
Pds.
J01FF
40mg
W
f
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
ABEFGVW
LINCOSAMIDES
LINCOSAMIDES
J01FF01
CLINDAMYCIN
CLINDAMYCINE
Cap Orl 150mg
Caps
Cap Orl
Caps
Liq
Liq
Inj
300mg
150mg
Page 105
J01FF01
CLINDAMYCIN
CLINDAMYCINE
Pws Orl 15mg
Pds.
J01G
AMINOGLYCOSIDE ANTIBACTERIALS
ANTIBACTÉRIENS AMINOGLYCOSIDES
J01GB
OTHER AMINOGLYCOSIDES
AUTRES AMINOGLYCOSIDES
J01GB01
Liq
Liq
J01GB03
Liq
Liq
J01GB06
Liq
Liq
Inj
40mg
PFI
AEFGVW
Tobramycin *
Tobramycin *
02241210
02382814
SDZ
AJP
f
f
BEFGVW
BEFGVW
Gentamicin
02242652
SDZ
f
BEFGVW
Amikacin
02242971
SDZ
GENTAMICIN
GENTAMICINE
Inj
40mg
AMIKACIN
AMIKACINE
Inj
250mg
QUINOLONE ANTIBACTERIALS
ANTIBACTÉRIENS QUINOLONES
J01MA
FLOUROQUINOLONES
FLOUROQUINOLONES
W
OFLOXACIN
OFLOXACINE
Tab Orl 200mg
Co.
Ofloxacin
14
02231529
AAP
f
EF18+
Tab Orl 300mg
Co.
Ofloxacin
14
02231531
AAP
f
EF18+
Tab Orl 400mg
Co.
Ofloxacin
14
02231532
AAP
f
EF18+
Cipro XL
15
02251787
BAY
J01MA02
CIPROFLOXACIN
CIPROFLOXACINE
ERT Orl
Co.L.P.
14
00225851
TOBRAMYCIN
TOBRAMYCINE
J01M
J01MA01
Dalacin C
1000mg
ABEFGV
The use of Quinolones in children < 18 years of age is generally contraindicated.
Les quinolones sont habituellement contre-indiquées pour les enfants.
15
Prescriptions written by New Brunswick urologists, infectious disease specialists and medical microbiologists do not require
special authorization.
Les ordonnances provenant d’urologues, spécialistes en maladies infectieuses, ou microbiologists du Nouveau-Brunswick ne
nécessiteront pa une autorisation special.
Page 106
J01MA02
CIPROFLOXACIN
CIPROFLOXACINE
Liq
Liq
Inj
2mg
Ciprofloxacin I.V.
02267462
TEV
Liq
Liq
Inj
10mg
Ciprofloxacin
02204398
PDL
W
Liq
Liq
Orl
100mg
16
02237514
BAY
ABEFGV
Tab Orl 250mg
Co.
Cipro
16
Cipro
Novo-Ciprofloxacin
16
Novo-Ciprofloxacin
Apo-Ciproflox
16
Apo-Ciproflox
Mylan-Ciprofloxacin
16
Mylan-Ciprofloxacin
ratio-Ciprofloxacin (Disc/non disp Nov.29/15)
16
Co Ciprofloxacin
16
Co Ciprofloxacin
pms-Ciprofloxacin
16
pms-Ciprofloxacin
Sandoz Ciprofloxacin
16
Ran-Ciproflox
16
Ran-Ciproflox
Mint-Ciprofloxacin
16
Mint-Ciprofloxacin
Ciprofloxacin
16
Ciprofloxacin
Septa-Ciprofloxacin
16
Septa-Ciprofloxacin
Jamp-Ciprofloxacin
16
Jamp-Ciprofloxacin
Mar-Ciprofloxacin
16
Mar-Ciprofloxacin
Auro-Ciprofloxacin
16
Auro-Ciprofloxacin
02155958
02155958
02161737
02161737
02229521
02229521
02245647
02245647
02246825
02246825
02247339
02247339
02248437
02248437
02248756
02248756
02303728
02303728
02317427
02317427
02353318
02353318
02379627
02379627
02380358
02380358
02379686
02379686
02381907
02381907
BAY
BAY
TEV
TEV
APX
APX
MYL
MYL
TEV
TEV
COB
COB
PMS
PMS
SDZ
SDZ
RAN
RAN
MNT
MNT
SAS
SAS
SPT
SPT
JPC
JPC
MAR
MAR
ARO
ARO
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
Tab Orl 500mg
Co.
Cipro
16
Cipro
Novo-Ciprofloxacin
16
Novo-Ciprofloxacin
Apo-Ciproflox
16
Apo-Ciproflox
Mylan-Ciprofloxacin
16
Mylan-Ciprofloxacin
ratio-Ciprofloxacin (Disc/non disp Jul 24/15)
16
ratio-Ciprofloxacin (Disc/non disp Jul 24/15)
Co Ciprofloxacin
16
Co Ciprofloxacin
02155966
02155966
02161745
02161745
02229522
02229522
02245648
02245648
02246826
02246826
02247340
02247340
BAY
BAY
TEV
TEV
APX
APX
MYL
MYL
TEV
TEV
COB
COB
f
f
f
f
f
f
f
f
f
f
f
f
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
Cipro Oral Suspension
Page 107
f
W
J01MA02
CIPROFLOXACIN
CIPROFLOXACINE
Tab Orl 500mg
Co.
pms-Ciprofloxacin
16
pms-Ciprofloxacin
16
Ran-Ciproflox
16
Ran-Ciproflox
Mint-Ciprofloxacin
16
Mint-Ciprofloxacin
Ciprofloxacin
16
Ciprofloxacin
Septa-Ciprofloxacin
16
Septa-Ciprofloxacin
Jamp-Ciprofloxacin
16
Jamp-Ciprofloxacin
Mar-Ciprofloxacin
16
Mar-Ciprofloxacin
Auro-Ciprofloxacin
16
Auro-Ciprofloxacin
02248438
02248438
02248757
02248757
02303736
02303736
02317435
02317435
02353326
02353326
02379635
02379635
02380366
02380366
02379694
02379694
02381923
02381923
PMS
PMS
SDZ
SDZ
RAN
RAN
MNT
MNT
SAS
SAS
SPT
SPT
JPC
JPC
MAR
MAR
ARO
ARO
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
Tab Orl 750mg
Co.
Cipro
16
Cipro
Novo-Ciprofloxacin
16
Novo-Ciprofloxacin
Apo-Ciproflox
16
Apo-Ciproflox
Mylan-Ciprofloxacin
16
Mylan-Ciprofloxacin
16
Co Ciprofloxacin
16
Co Ciprofloxacin
pms-Ciprofloxacin
16
pms-Ciprofloxacin
16
Ran-Ciproflox
16
Ran-Ciproflox
Mint-Ciprofloxacin
16
Mint-Ciprofloxacin
Ciprofloxacin
16
Ciprofloxacin
Septa-Ciprofloxacin
16
Septa-Ciprofloxacin
Jamp-Ciprofloxacin
16
Jamp-Ciprofloxacin
02155974
02155974
02161753
02161753
02229523
02229523
02245649
02245649
02246827
02246827
02247341
02247341
02248439
02248439
02248758
02248758
02303744
02303744
02317443
02317443
02353334
02353334
02379643
02379643
02380374
02380374
BAY
BAY
TEV
TEV
APX
APX
MYL
MYL
TEV
TEV
COB
COB
PMS
PMS
SDZ
SDZ
RAN
RAN
MNT
MNT
SAS
SAS
SPT
SPT
JPC
JPC
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
BW
AEFGV
Page 108
J01MA02
CIPROFLOXACIN
CIPROFLOXACINE
Tab Orl 750mg
Co.
Mar-Ciprofloxacin
16
Mar-Ciprofloxacin
Auro-Ciprofloxacin
16
Auro-Ciprofloxacin
02379708
02379708
02381931
02381931
MAR
MAR
ARO
ARO
f
f
f
f
BW
AEFGV
BW
AEFGV
Apo-Norflox
Novo-Norfloxacin
pms-Norfloxacin (Disc/non disp Oct 29/15)
Co Norfloxacin
02229524
02237682
02246596
02269627
APX
TEV
PMS
COB
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
Levaquin
02236839
JAN
Tab Orl 250mg
Co.
Levaquin
17
Levaquin
Novo-Levofloxacin
17
Novo-Levofloxacin
pms-Levofloxacin
17
pms-Levofloxacin
Apo-Levofloxacin
17
Apo-Levofloxacin
Sandoz Levofloxacin
17
Sandoz Levofloxacin
Mylan-Levofloxacin
17
Mylan-Levofloxacin
Co Levofloxacin
17
Co Levofloxacin
02236841
02236841
02248262
02248262
02284677
02284677
02284707
02284707
02298635
02298635
02313979
02313979
02315424
02315424
JAN
JAN
TEV
TEV
PMS
PMS
APX
APX
SDZ
SDZ
MYL
MYL
COB
COB
f
f
f
f
f
f
f
f
f
f
f
f
f
f
VW
ABEFG
VW
ABEFG
VW
ABEFG
VW
ABEFG
VW
ABEFG
VW
ABEFG
VW
ABEFG
Tab Orl 500mg
Co.
Levaquin
17
Levaquin
Novo-Levofloxacin
17
Novo-Levofloxacin
pms-Levofloxacin
17
pms-Levofloxacin
Apo-Levofloxacin
17
Apo-Levofloxacin
Sandoz Levofloxacin
17
Sandoz Levofloxacin
Mylan-Levofloxacin
17
Mylan-Levofloxacin
Co Levofloxacin
17
Co Levofloxacin
02236842
02236842
02248263
02248263
02284685
02284685
02284715
02284715
02298643
02298643
02313987
02313987
02315432
02315432
JAN
JAN
TEV
TEV
PMS
PMS
APX
APX
SDZ
SDZ
MYL
MYL
COB
COB
f
f
f
f
f
f
f
f
f
f
f
f
f
f
VW
ABEFG
VW
ABEFG
VW
ABEFG
VW
ABEFG
VW
ABEFG
VW
ABEFG
VW
ABEFG
J01MA06
NORFLOXACIN
NORFLOXACINE
Tab Orl 400mg
Co.
J01MA12
LEVOFLOXACIN
LÉVOFLOXACINE
Liq Inj 5mg
Liq
16
W
Requests for coverage of Cipro (Ciprofloxacin) will be considered under special authorization (see Appendix IV).
Prescriptions written by New Brunswick urologists, infectious disease specialists, medical oncologists, hematologists,
respiratory medicine specialists or medical microbiologists do not require special authorization.
Les demandes de protection pour le Cipro (Ciprofloxacin) seront examinees sur autorisation special. Veuillez consulter
l’annexe IV. Les ordonnances rédigées par leurologues, spécialistes en maladies infectieuses, oncologues, hématologues,
inhalothérapeutes ou microbiologists du Nouveau-Brunswick ne nécessiteront pa une autorisation special.
Page 109
J01MA12
LEVOFLOXACIN
LÉVOFLOXACINE
Tab Orl 750mg
Co.
Levaquin
Novo-Levofloxacin
Sandoz Levofloxacin
pms-Levofloxacin
Co Levofloxacin
Apo-Levofloxacin
02246804
02285649
02298651
02305585
02315440
02325942
JAN
TEV
SDZ
PMS
COB
APX
400mg
Avelox I.V.
02246414
BAY
W
Tab Orl 400mg
Co.
Avelox
17
Avelox
02242965
02242965
BAY
BAY
VW
ABEFG
J01MA14
Liq
Liq
Inj
OTHER ANTIBACTERIALS
AUTRES ANTIBACTÉRIENS
J01XA
GLYCOPEPTIDE ANTIBACTERIALS
ANTIBACTÉRIENS GLYCOPEPTIDES
J01XD
W
W
W
W
W
W
MOXIFLOXACIN
MOXIFLOXACINE
J01X
J01XA01
f
f
f
f
f
f
VANCOMYCIN
VANCOMYCINE
Cap Orl
Caps
125mg
Vancocin
Vancomycin Hydrochloride
00800430
02377470
MRS
PPC
f
f
AEFGVW
AEFGVW
Cap Orl
Caps
250mg
Vancocin
Vancomycin Hydrochloride
00788716
02377489
MRS
PPC
f
f
AEFGVW
AEFGVW
Pws Inj
Pds.
1g
pms-Vancomycin
Vancomycin HCL
Val-Vancomycin
02241821
02139383
02342863
PMS
PPC
VAL
f
ABEFGW
ABEFGW
ABEFGW
Pws Inj
Pds.
500mg
pms-Vancomycin
Sterile Vancomycin HCL
Val-Vancomycin
Sterile Vancomycin
02241820
02139375
02342855
02230191
PMS
PPC
VAL
HOS
f
ABEFGW
ABEFGW
ABEFGW
ABEFGW
Metronidazole
Metronidazole
00649074
00870420
HOS
BAX
Metronidazole
00545066
AAP
J01XD01
METRONIDAZOLE
MÉTRONIDAZOLE
Liq Inj 0.50%
Liq
Tab
Co.
Orl
250mg
17
W
W
f
AEFGVW
Prescriptions written by New Brunswick infectious disease specialists, medical microbiologists, medical oncologists,
respirologists and internal medicine specialists do not require special authorization.
Les ordonnances rédigées par les infectologues, les microbiologistesmédicaux, oncologues, les spécialistes de medicine
interne ou le pneumologues du Nouveau-Brunswick ne nécessiteront pa une autorisation special.
Page 110
J01XE
NITROFURAN DERIVATIVES
DÉRIVÉS DU NITROFURANE
J01XE01
J01XX
NITROFURANTOIN
NITROFURANTOÏNE
Cap Orl
Caps
50mg
Teva-Furantoin
02231015
TEV
Cap Orl
Caps
100mg
Tab
Co.
Orl
Tab
Co.
Orl
Tab
Co.
Macrobid
02063662
WNC
AEFGVW
50mg
Nitrofurantoin
00319511
AAP
AEFGVW
100mg
Nitrofurantoin
00312738
AAP
AEFGVW
Mandelamine
00499013
ERF
AEFGVW
Fungizone IV
00029149
BRI
W
Novo-Ketoconazole
Apo-Ketoconazole
02231061
02237235
TEV
APX
f
f
AEFGVW
AEFGVW
Apo-Fluconazole
pms-Fluconazole
02241895
02282348
APX
PMS
f
f
AEFGVW
AEFGVW
Diflucan
Fluconazole (Disc/non disp Jun 4/15)
00891835
02247922
PFI
TEV
f
f
W
W
METHENAMINE
MÉTHÉNAMINE
Orl
500mg
J02
ANTIMYCOTICS FOR SYSTEMIC USE
ANTIMYCOTIQUES POUR USAGE SYSTÉMIQUE
J02A
J02AA
ANTIBIOTICS
ANTIBIOTIQUES
J02AA01
AMPHOTERICIN B
AMPHOTÉRICINE B
Pws Inj
Pds.
50mg
J02AB02
Tab
Co.
J02AC
AEFGVW
OTHER ANTIBACTERIALS
AUTRES ANTIBACTÉRIENS
J01XX05
J02AB
f
KETOCONAZOLE
KÉTOCONAZOLE
Orl
200mg
TRIAZOLE DERIVATIVES
DÉRIVÉS DE TRIAZOLE
J02AC01
FLUCONAZOLE
FLUCONAZOLE
Cap Orl
Caps
Liq
Liq
150mg
Inj
2mg
Page 111
J02AC01
J02AX
FLUCONAZOLE
FLUCONAZOLE
Tab
Co.
Orl
50mg
Novo-Fluconazole
Apo-Fluconazole
Mylan-Fluconazole
pms-Fluconazole
Co Fluconazole
02236978
02237370
02245292
02245643
02281260
TEV
APX
MYL
PMS
COB
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
100mg
Novo-Fluconazole
Apo-Fluconazole
Mylan-Fluconazole
pms-Fluconazole
Co Fluconazole
02236979
02237371
02245293
02245644
02281279
TEV
APX
MYL
PMS
COB
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
02244265
FRS
W
J02AX04
CASPOFUNGIN
CASPOFUNGIN
Pwd Inj
Pws.
50mg
Cancidas IV
J04
ANTIMYCOBACTERIALS
ANTIFONGIQUES BACTÉRIENS
J04A
DRUGS FOR TREATMENT OF TUBERCULOSIS
MÉDICAMENTS POUR LE TRAITEMENT DE LA TUBERCULOSE
J04AB
ANTIBIOTICS
ANTIBIOTIQUES
J04AB02
RIFAMPICIN
RIFAMPICINE
Cap Orl
Caps
150mg
Rofact
Rifadin
00393444
02091887
VLN
SAV
ABEFGVW
ABEFGVW
Cap Orl
Caps
300mg
Rofact
Rifadin
00343617
02092808
VLN
SAV
ABEFGVW
ABEFGVW
Dapsone
02041510
JCB
AEFGVW
J04B
DRUGS FOR TREATMENT OF LEPRA
MÉDICAMENTS POUR LE TRAITEMENT DE LA LÈPRE
J04BA
DRUGS FOR TREATMENT OF LEPRA
MÉDICAMENTS POUR LE TRAITEMENT DE LA LEPRE
J04BA02
Tab
Co.
DAPSONE
DAPSONE
Orl
100mg
Page 112
J05
ANTIVIRALS FOR SYSTEMIC USE
ANTIVIRAUX SYSTÉMIQUES
J05A
DIRECT ACTING ANTIVIRALS
AGENTS AGISSANT DIRECTEMENT SUR LE VIRUS
J05AB
NUCLEOSIDES AND NUCLEOTIDES EXCLUDING REVERSE TRANSCRIPTASE INHIBITORS
NUCLÉOSIDES ET NUCLÉOTIDES, À L’EXCLUSION DES INHIBITEURS LA TRANSCRIPTASE
INVERSÉE
J05AB01
ACYCLOVIR
ACYCLOVIR
Tab
Co.
Orl 200mg
Zovirax
ratio-Acyclovir
Apo-Acyclovir
Mylan-Acyclovir
Teva-Acyclovir
Acyclovir
00634506
02078627
02207621
02242784
02285959
02286556
GSK
TEV
APX
MYL
TEV
SAS
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 400mg
Zovirax
ratio-Acyclovir (Disc/non disp Nov.29/15)
Apo-Acyclovir
Mylan-Acyclovir
Teva-Acyclovir
Acyclovir
01911627
02078635
02207648
02242463
02285967
02286564
GSK
TEV
APX
MYL
TEV
SAS
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
ratio-Acyclovir (Disc/non disp Jul 24/15)
Apo-Acyclovir
Mylan-Acyclovir
Teva-Acyclovir
Acyclovir
02078651
02207656
02242464
02285975
02286572
TEV
APX
MYL
TEV
SAS
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl 800mg
Co.
Liq
Liq
Inj 25mg
Acyclovir Sodium
02236916
HOS
W
Liq
Liq
Inj 50mg
Acyclovir Sodium
02236926
PPC
W
Cytovene
02162695
HLR
W
J05AB06
GANCICLOVIR
GANCICLOVIR
Pws Inj 500mg
Pds.
J05AB09
FAMCICLOVIR
FAMCICLOVIR
Tab
Co.
Orl 125mg
Famvir
pms-Famciclovir
Sandoz Famciclovir
Apo-Famciclovir
Co Famciclovir
02229110
02278081
02278634
02292025
02305682
NVR
PMS
SDZ
APX
COB
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 250mg
Famvir
pms-Famciclovir
Sandoz Famciclovir
02229129
02278103
02278642
NVR
PMS
SDZ
f
f
f
AEFGVW
AEFGVW
AEFGVW
Page 113
J05AB09
Tab
Co.
Orl 250mg
Apo-Famciclovir
Co Famciclovir
02292041
02305690
APX
COB
f
f
AEFGVW
AEFGVW
Tab
Co.
Orl 500mg
Famvir
pms-Famciclovir
Sandoz Famciclovir
Apo-Famciclovir
Co Famciclovir
02177102
02278111
02278650
02292068
02305704
NVR
PMS
SDZ
APX
COB
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Valtrex
Apo-Valacyclovir
pms-Valacyclovir
Co Valacyclovir
Mylan-Valacyclovir
Auro-Valacyclovir
02219492
02295822
02298457
02331748
02351579
02405040
GSK
APX
PMS
COB
MYL
ARO
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Cap Orl 200mg
Caps
Invirase
02216965
HLR
U
Tab
Co.
Invirase
02279320
HLR
U
Cap Orl 200mg
Caps
Crixivan
02229161
FRS
U
Cap Orl 400mg
Caps
Crixivan
02229196
FRS
U
Norvir
02357593
ABV
U
J05AB11
Tab
Co.
J05AE
FAMCICLOVIR
FAMCICLOVIR
VALACYCLOVIR
VALACYCLOVIR
Orl 500mg
PROTEASE INHIBITORS
INHIBITEURS DE PROTÉASE
J05AE01
J05AE02
J05AE03
Tab
Co.
J05AE04
SAQUINAVIR
SAQUINAVIR
Orl 300mg
INDINAVIR
INDINAVIR
RITONAVIR
RITONAVIR
Orl 100mg
NELFINAVIR
NELFINAVIR
Tab
Co.
Orl 250mg
Viracept
02238617
VIV
U
Tab
Co.
Orl 625mg
Viracept
02248761
VIV
U
Page 114
J05AE07
FOSAMPRENAVIR
FOSAMPRÉNAVIR
Sus Orl 50mg
Susp.
Telzir
02261553
VIV
U
Tab
Co.
Telzir
02261545
VIV
U
Cap Orl 150mg
Caps
Reyataz
02248610
BRI
U
Cap Orl 200mg
Caps
Reyataz
02248611
BRI
U
Cap Orl 300mg
Caps
Reyataz
02294176
BRI
U
Kaletra Oral Solution
02243644
ABV
U
J05AE08
J05AE30
Orl 700mg
ATAZANAVIR
ATAZANAVIR
COMBINATIONS OF PROTEASE INHIBITORS
COMBINAISONS D’INHIBITEURS DE PROTÉASE
LOPINAVIR / RITONAVIR
LOPINAVIR / RITONAVIR
J05AF
Liq
Liq
Orl
80mg
Tab
Co.
Orl 100mg/25mg
Kaletra
02312301
ABV
U
Tab
Co.
Orl 200mg/50mg
Kaletra Tab
02285533
ABB
U
NUCLEOSIDE AND NUCLEOTIDE REVERSE TRANSCRIPTASE INHIBITORS
INHIBITEURS NUCLÉOSIDIQUES ET NUCLÉOTIDIQUES DE LA TRANSCRIPTASE
J05AF01
ZIDOVUDINE
ZIDOVUDINE
Cap Orl 100mg
Caps
Retrovir
Apo-Zidovudine
01902660
01946323
VIV
APX
Retrovir
01902644
VIV
U
Retrovir
01902652
VIV
U
ECC Orl 125mg
Caps.Ent.
Videx EC
02244596
BRI
U
ECC Orl 200mg
Caps.Ent.
Videx EC
02244597
BRI
U
Liq
Liq
Inj 100mg
Syr Orl 10mg
Sir.
J05AF02
f
f
U
U
DIDANOSINE
DIDANOSINE
Page 115
J05AF02
DIDANOSINE
DIDANOSINE
ECC Orl 250mg
Caps.Ent.
Videx EC
02244598
BRI
U
ECC Orl 400mg
Caps.Ent.
Videx EC
02244599
BRI
U
Cap Orl 15mg
Caps
Zerit
02216086
BRI
U
Cap Orl 20mg
Caps
Zerit
02216094
BRI
U
Cap Orl 30mg
Caps
Zerit
02216108
BRI
U
Cap Orl 40mg
Caps
Zerit
02216116
BRI
U
18
02239194
GSK
AEFV
3TC
02192691
VIV
U
Tab Orl 100mg
Co.
Heptovir
Apo-Lamivudine HBV
02239193
02393239
GSK
APX
f
f
AEFGVW
AEFGVW
Tab Orl 150mg
Co.
3TC
Apo-Lamivudine
02192683
02369052
VIV
APX
f
f
U
U
Tab Orl 300mg
Co.
3TC
Apo-Lamivudine
02247825
02369060
VIV
APX
f
f
U
U
Ziagen
02240358
VIV
U
Ziagen
02240357
VIV
U
J05AF04
J05AF05
STAVUDINE
STAVUDINE
LAMIVUDINE
LAMIVUDINE
Liq
Liq
Orl 5mg
Liq
Liq
Orl 10mg
J05AF06
Liq
Liq
ABACAVIR
ABACAVIR
Orl 20mg
Tab Orl 300mg
Co.
18
Heptovir
Prescriptions written by certified New Brunswick internal medicine specialists do not require special authorization.
Les ordonnances rédigées par les spécialistes en medicine interne du Nouveau-Brunswick ne requiérent pas d’autorisation
special.
Page 116
J05AG
NON-NUCLEOSIDES REVERSE TRANSCRIPTASE INHIBITORS
INHIBITEURS NON NUCLÉOSIDIQUES DE LA TRANSCRIPTASE INVERSÉE
J05AG01
NEVIRAPINE
NÉVIRAPINE
ERT Orl 400mg
Co. L.P.
Viramune XR
02367289
BOE
Viramune
Auro-Nevirapine
Teva-Nevirapine
Mylan-Nevirapine
pms-Nevirapine
02238748
02318601
02352893
02387727
02405776
BOE
ARO
TEV
MYL
PMS
Cap Orl 20mg
Caps
Sustiva
02239886
BRI
U
Cap Orl 200mg
Caps
Sustiva
02239888
BRI
U
Sustiva
Mylan-Efavirenz
Teva-Efavirenz
02246045
02381524
02389762
BRI
MYL
TEV
Edurant
02370603
JAN
Tab
Co.
J05AG03
Tab
Co.
J05AG05
Tab
Co.
J05AR
Orl 200mg
U
f
f
f
f
f
U
U
U
U
U
EFAVIRENZ
ÉFAVIRENZ
Orl 600mg
f
f
f
U
U
U
RILPIVIRINE
RILPIVIRINE
Orl 25mg
U
ANTIVIRALS FOR TREATMENT OF HIV INFECTIONS, COMBINATIONS
ANTIVIRAUX POUR LE TRAITEMENT DES INFECTIONS AU VIH, COMBINAISONS
J05AR02
Tab
Co.
J05AR02
Tab
Co.
J05AR03
Tab
Co.
J05AR04
Tab
Co.
LAMIVUDINE AND ZIDOVUDINE
LAMIVUDINE ET ZIDOVUDINE
Orl 300mg/150mg
Combivir
Apo-Lamivudine/Zidovudine
Teva-Lamivudine/Zidovudine
02239213
02375540
02387247
VIV
APX
TEV
f
f
f
U
U
U
Kivexa
02269341
VIV
U
Truvada
02274906
GIL
U
Trizivir
02244757
VIV
U
LAMIVUDINE AND ABACAVIR
LAMIVUDINE ET ABACAVIR
Orl 600mg/300mg
TENOFOVIR DISOPROXIL AND EMTRICITABINE
TENOFOVIR DISOPROXIL ET EMTRICITABINE
Orl 300mg/200mg
ZIDOVUDINE, LAMIVUDINE AND ABACAVIR
ZIDOVUDINE, LAMIVUDINE ET ABACAVIR
Orl 300mg
Page 117
J05AR06
Tab
Co.
J05AR08
Tab
Co.
J05AX
EMTRICITABINE, TENOFOVIR DISOPROXIL AND EFAVIRENZ
EMTRICITABINE, TÉNOFOVIR DISOPROXIL ET ÉFAVIRENZ
Orl 600mg/300mg/200mg
Atripla
GIL
U
EMTRICITABINE, TENOFOVIR DISOPROXIL AND RILPIVIRINE
EMTRICITABINE, TÉNOFOVIR DISOPROXIL ET RILPIVIRINE
Complera
02374129
GIL
U
Orl 25mg/200mg/300mg
Isentress
02301881
FRS
U
Tab Orl 25mg
Co.
Procytox
02241795
BAX
AEFGVW
Tab Orl 50mg
Co.
Procytox
02241796
BAX
AEFGVW
Leukeran
00004626
TRI
AEFGVW
Alkeran
00004715
TRI
AEFGVW
Myleran
00004618
TRI
AEFGVW
OTHER ANTIVIRALS
AUTRES ANTIVIRAUX
J05AX08
Tab
Co.
RALTEGRAVIR
RALTÉGRAVIR
Orl 400mg
L01
ANTINEOPLASTIC AGENTS
AGENTS ANTINÉOPLASIQUES
L01A
ALKYLATING AGENTS
AGENTS ALKYLANTS
L01AA
NITROGEN MUSTARD ANALOGUES
ANALOGUES, MOUTARDE AZOTÉE
L01AA01
L01AA02
CYCLOPHOSPHAMIDE
CYCLOPHOSPHAMIDE
CHLORAMBUCIL
CHLORAMBUCIL
Tab Orl 2mg
Co.
L01AA03
MELPHALAN
MELPHALAN
Tab Orl 2mg
Co.
L01AB
02300699
ALKYL SULPHONATES
SULFONATES D’ALKYLE
L01AB01
BUSULFAN
BUSULFAN
Tab Orl 2mg
Co.
Page 118
L01B
ANTIMETABOLITES
ANTIMÉTABOLITES
L01BA
FOLIC ACID ANALOGUES
ANALOGUES DE L’ACIDE FOLIQUE
L01BA01
L01BB
METHOTREXATE
MÉTHOTREXATE
Liq
Liq
Inj 10mg
Methotrexate Inj USP *
02182947
HOS
AEFGVW
Liq
Liq
Inj 25mg
02099705
02182777
02182955
TEV
HOS
HOS
AEFGVW
AEFGVW
AEFGVW
Tab Orl 2.5mg
Co.
Methotrexate
Ratio-methotrexate
Methotrexate
02170698
02244798
02182963
PFI
TEV
APX
Tab Orl 10mg
Co.
Methotrexate
02182750
HOS
AEFGVW
Purinethol
00004723
TEV
AEFGVW
Lanvis
00282081
TRI
AEFGVW
Efudex
00330582
VLN
AEFGVW
00616192
BRI
AEFGVW
AEFGVW
AEFGVW
AEFGVW
PURINE ANALOGUES
ANALOGUES PURINE
L01BB02
MERCAPTOPURINE
MERCAPTOPURINE
Tab Orl 50mg
Co.
L01BB03
TIOGUANINE
TIOGUANINE
Tab Orl 40mg
Co.
L01BC
f
f
PYRIMIDINE ANALOGUES
ANALOGUES PYRIMIDIQUES
L01BC02
FLUOROURACIL
FLUOROURACILE
Crm Top 5%
Cr.
L01C
PLANT ALKALOIDS AND OTHER NATURAL PRODUCTS
ALCALOIDES DE PLANTES ET AUTRES PRODUITS NATURELS
L01CB
PODOPHYLLOTOXIN DERIVATIVES
DÉRIVÉS DE LA PODOPHYLLOTOXINE
L01CB01
ETOPOSIDE
ÉTOPOSIDE
Cap Orl 50mg
Caps
Vepesid
Page 119
L01X
OTHER ANTINEOPLASTIC AGENTS
AUTRES AGENTS ANTINÉOPLASIQUES
L01XB
METHYLHYDRAZINES
MÉTHYLHYDRAZINES
L01XB01
PROCARBAZINE
PROCARBAZINE
Cap Orl 50mg
Caps
L01XX
Matulane
00012750
QGT
Hydrea
Mylan-Hydroxyurea
Hydroxyurea
00465283
02242920
02343096
BRI
MYL
SAS
Emcyt
02063794
PFI
Tab Orl 40mg
Co.
Megestrol
02195917
AAP
f
AEFGVW
Tab Orl 160mg
Co.
Megestrol
02195925
AAP
f
AEFGVW
OTHER ANTINEOPLASTIC AGENTS
AUTRES AGENTS ANTINÉOPLASIQUES
L01XX05
HYDROXYCARBAMIDE (HYDROXYUREA)
HYDROXYCARBAMIDE (HYDROXYURÉE)
Cap Orl 500mg
Caps
L01XX11
L02
ENDOCRINE THERAPY
TRAITEMENT ENDOCRINIEN
L02A
HORMONES AND RELATED AGENTS
HORMONES ET AGENTS APPARENTÉS
L02AB
PROGESTOGENS
PROGESTOGÉNES
L02AB01
f
f
f
AEFGVW
AEFGVW
AEFGVW
ESTRAMUSTINE
ESTRAMUSTINE
Cap Orl 140mg
Caps
L02AE
AEFGVW
AEFGVW
MEGESTROL
MÉGESTROL
GONADOTROPHIN RELEASING HORMONE ANALOGUES
ANALOGUES DE L’HORMONE LIBÉRANT DE LA GONADOTROPHINE
L02AE01
BUSERELIN
BUSÉRÉLINE
Asp
Asp
Nas
1mg
Suprefact
02225158
SAV
AVW
Imp
Imp
Inj
6.3mg
Suprefact Depot
02228955
SAV
AEF18+VW
Imp
Imp
Inj
9.45mg
Suprefact Depot
02240749
SAV
AEF18+VW
Page 120
L02AE02
LEUPRORELIN
LEUPRORÉLINE
Liq
Liq
Inj
5mg
Lupron *
00727695
ABV
AVW
Pws
Pds.
Inj
7.5mg
Lupron Depot *
00836273
ABB
AVW
Pws
Pds.
Inj
22.5mg
Lupron Depot *
02230248
ABB
AEF18+VW
Pws
Pds.
Inj
30mg
Lupron Depot *
02239833
ABB
AEF18+VW
Sus Inj
Susp.
22.5mg
Eligard *
02248240
SAV
AEFVW
Sus Inj
Susp.
45mg
Eligard *
02268892
SAV
AEFVW
Zoladex
02049325
AZE
AVW
Zoladex LA
02225905
AZE
AEF18+VW
L02AE02
GOSERELIN
GOSÉRÉLINE
Imp
Imp
Inj
3.6mg
Imp
Imp
Inj
10.8mg
L02AE04
TRIPTORELIN
TRIPTORÉLINE
Pws
Pds.
Inj
3.75mg
Trelstar *
02240000
PAL
AEFVW
Pws
Pds.
Inj 11.25mg
Trelstar *
02243856
PAL
AEFVW
L02B
HORMONE ANTAGONISTS AND RELATED AGENTS
ANTAGONISTES D’HORMONES ET AGENTS CONNEXES
L02BA
ANTI-ESTROGENS
ANTI-OESTROGÈNES
L02BA01
TAMOXIFEN
TAMOXIFÉNE
Tab Orl 10mg
Co.
Apo-Tamox
Teva-Tamoxifen
Mylan-Tamoxifen
00812404
00851965
02088428
APX
TEV
MYL
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab Orl 20mg
Co.
Apo-Tamox
Teva-Tamoxifen
Mylan-Tamoxifen
Nolvadex-d
00812390
00851973
02089858
02048485
APX
TEV
MYL
AZE
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Page 121
L02BB
ANTI-ANDROGENS
ANTI-ANDROGÉNES
L02BB01
FLUTAMIDE
FLUTAMIDE
Tab Orl 250mg
Co.
L02BB02
Euflex
Teva-Flutamide
pms-Flutamide
Apo-Flutamide
00637726
02230089
02230104
02238560
FRS
TEV
PMS
APX
Anandron
02221861
SAV
Casodex
Novo-Bicalutamide
Co Bicalutamide
pms-Bicalutamide
Sandoz Bicalutamide
ratio-Bicalutamide (Disc/non disp Feb 22/15)
Apo-Bicalutamide
Mylan-Bicalutamide
Bicalutamide
Jamp-Bicalutamide
Ran-Bicalutamide
02184478
02270226
02274337
02275589
02276089
02277700
02296063
02302403
02325985
02357216
02371324
AZE
TEV
COB
PMS
SDZ
RPH
APX
MYL
AHI
JPC
RAN
f
f
f
f
f
f
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
Arimidex
Sandoz Anastrozole
Apo-Anastrozole
Co-Anastrozole
Jamp-Anastrozole
Mar-Anastrozole
Med-Anastrozole
Anastrozole
Mylan-Anastrozole
pms-Anastrozole
Ran-Anastrozole
Taro-Anastrozole
Teva-Anastrozole
Mint-Anastrozole
02224135
02338467
02374420
02394898
02339080
02379562
02379104
02351218
02361418
02320738
02328690
02365650
02313049
02393573
AZE
SDZ
APX
COB
JPC
MAR
GMP
AHI
MYL
PMS
RAN
TAR
TEV
MNT
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
Femara
pms-Letrozole
Med-Letrozole
02231384
02309114
02322315
NVR
PMS
GMP
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
BICALUTAMIDE
BICALUTAMIDE
Tab Orl 50mg
Co.
L02BG
AEFVW
AEFVW
AEFVW
AEFVW
NILUTAMIDE
NILUTAMIDE
Tab Orl 50mg
Co.
L02BB03
f
f
f
f
AROMATASE INHIBITORS
INHIBITEURS AROMATASES
L02BG03
ANASTROZOLE
ANASTROZOLE
Tab Orl 1mg
Co.
L02BG04
LETROZOLE
LÉTROZOLE
Tab Orl 2.5mg
Co.
Page 122
L02BG04
LETROZOLE
LÉTROZOLE
Tab Orl 2.5mg
Co.
L02BG06
02338459
02344815
02347997
02348969
02358514
02372169
02372282
02373009
02373424
02343657
AHI
SDZ
TEV
COB
APX
MYL
RAN
JPC
MAR
TEV
f
f
f
f
f
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
Aromasin
Co-Exemestane
02242705
02390183
PFI
COB
f
f
AEFVW
AEFVW
EXEMESTANE
EXÉMESTANE
Tab Orl 25mg
Co.
L02BX
Letrozole tablets usp
Sandoz Letrozole
Letrozole (Disc/non disp Jul 24/15)
Letrozole
Apo-Letrozole
Myl-Letrozole
Ran-Letrozole
Jamp-Letrozole
Mar-Letrozole
Teva-Letrozole
OTHER HORMONE ANTAGONISTS AND RELATED AGENTS
AUTRES ANTAGONISTES D’HORMONES ET AGENTS CONNEXES
L02BX02
DEGARELIX
DEGARELIX
Pws
Pds.
Inj
80mg/vial
Firmagon
02337029
FEI
AEF+18VW
Pws
Pds.
Inj
120mg/vial
Firmagon
02337037
FEI
AEF+18VW
Neupogen (1.6 mL size only)
Neupogen
00999001
01968017
AGA
AGA
W
W
L03
IMMUNOSTIMULANTS
IMMUNOSTIMULANTS
L03A
IMMUNOSTIMULANTS
IMMUNOSTIMULANTS
L03AA
COLONY STIMULATING FACTORS
FACTEURS DE CROISSANCE DES GLOBULES BLANCS
L03AA02
Liq
Liq
L03AB
FILGRASTIM
FILGRASTIM
Inj
0.3mg
INTERFERONS
INTERFÉRONS
L03AB05
INTERFERON ALFA-2B
INTERFÉRON ALFA-2B
Liq
Liq
Inj
6000000IU
Intron A *
02238674
SCH
AEFGVW
Liq
Liq
Inj
10000000IU
Intron A *
Intron A *
02223406
02238675
SCH
SCH
AEFGVW
AEFGVW
Liq Inj 15000000IU
Liq
Intron A *
02240693
SCH
AEFGVW
Page 123
L03AB05
Liq
Liq
Inj
25000000IU
Intron A *
02240694
FRS
AEFGVW
Liq
Liq
Inj
50000000IU
Intron A *
02240695
SCH
AEFGVW
L03AB07
INTERFERON BETA-1A
INTERFÉRON BÊTA-1A
Liq
Liq
Inj
22mcg
Rebif
Rebif Initiation Pack (Disc/non disp May 1/14)
Rebif Cartridge
02237319
02281708
02318253
EMD
EMD
EMD
H
H
H
Liq
Liq
Inj
44mcg
Rebif
Rebif Cartridge
02237320
02318261
EMD
EMD
H
H
Liq
Liq
Inj
30mcg
Avonex PS
02269201
BIG
H
Betaseron
Extavia
02169649
02337819
BAY
NVR
H
H
Copaxone
02245619
SAV
H
Cap Orl 250mg
Caps
Cellcept
Sandoz Mycophenolate
Apo-Mycophenolate
Novo-Mycophenolate
Mylan-Mycophenolate
Mycophenolate Mofetil
Jamp-Mycophenolate
02192748
02320630
02352559
02364883
02371154
02383780
02386399
HLR
SDZ
APX
TEV
MYL
AHI
JPC
f
f
f
f
f
f
f
R
R
R
R
R
R
R
Tab
Co.
Cellcept
Sandoz Mycophenolate
Apo-Mycophenolate
02237484
02313855
02348675
HLR
SDZ
APX
f
f
f
R
R
R
L03AB08
Liq
Liq
L03AX
INTERFERON ALFA-2B
INTERFÉRON ALFA-2B
INTERFERON BETA-1B
INTERFÉRON BÊTA-1B
Inj
0.3mg
OTHER IMMUNOSTIMULANTS
AUTRES IMMUNOSTIMULANTS
L03AX13
Liq
Liq
GLATIRAMER ACETATE
GLATIRAMÉRE ACETATE
Inj
20mg
L04
IMMUNOSUPPRESSANTS
AGENTS IMMUNOSUPPRESSEURS
L04A
IMMUNOSUPPRESSANTS
AGENTS IMMUNOSUPPRESSEURS
L04AA
SELECTIVE IMMUNOSUPPRESSANTS
IMMUNOSUPPRESSEURS SÉLECTIFS
L04AA06
MYCOPHENOLIC ACID
ACIDE MYCOPHÉNOLIQUE
Orl 500mg
Page 124
L04AA06
MYCOPHENOLIC ACID
ACIDE MYCOPHÉNOLIQUE
Tab
Co.
Orl 500mg
TEV
MYL
COB
JPC
AHI
f
f
f
f
f
R
R
R
R
R
180mg
Myfortic
02264560
NVR
R
ECT Orl
Co.Ent.
360mg
Myfortic
02264579
NVR
R
Rapamune
02243237
PFI
R
Rapamune
02247111
PFI
R
SIROLIMUS
SIROLIMUS
Liq
Liq
Orl
Tab
Co.
Orl
1mg
1mg
TUMOR NECROSIS FACTOR ALPHA (TNF-A) INHIBITORS
INHIBITEURS DU FACTEUR DE NÉCROSE TUMORALE ALPHA (TNF-A)
L04AB01
ETANERCEPT
ÉTANERCEPT
Pws
Pds.
L04AD
02352567
02370549
02379996
02380382
02378574
ECT Orl
Co.Ent.
L04AA10
L04AB
Novo-Mycophenolate
Mylan-Mycophenolate
Co Mycophenolate
Jamp-Mycophenolate
Mycophenolate Mofetil
Inj
25mg
Enbrel
02242903
AGA
W
Cap Orl 10mg
Caps
Neoral
02237671
NVR
R
Cap Orl 25mg
Caps
Neoral
Sandoz Cyclosporine
02150689
02247073
NVR
SDZ
f
f
R
R
Cap Orl 50mg
Caps
Neoral
Sandoz Cyclosporine
02150662
02247074
NVR
SDZ
f
f
R
R
Cap Orl 100mg
Caps
Neoral
Sandoz Cyclosporine
02150670
02242821
NVR
SDZ
f
f
R
R
Neoral
Apo-Cyclosporine
02150697
02244324
NVR
APX
f
f
R
R
Prograf
02243144
ASL
CALCINEURIN INHIBITORS
INHIBITEURS DE LA CALCINEURINE
L04AD01
Liq
Liq
L04AD02
CYCLOSPORINE
CYCLOSPORINE
Orl 100mg
TACROLIMUS
TACROLIMUS
Cap Orl 0.5mg
Caps
Page 125
R
L04AD02
L04AX
TACROLIMUS
TACROLIMUS
Cap Orl 1mg
Caps
Prograf
Sandoz Tacrolimus
02175991
02416824
ASL
SDZ
f
f
R
R
Cap Orl 5mg
Caps
Prograf
Sandoz Tacrolimus
02175983
02416832
ASL
SDZ
f
f
R
R
ERC Orl 0.5mg
Caps.L.P.
Advagraf
02296462
ASL
R
ERC Orl 1mg
Caps.L.P.
Advagraf
02296470
ASL
R
ERC Orl 3mg
Caps.L.P.
Advagraf
02331667
ASL
R
ERC Orl 5mg
Caps.L.P.
Advagraf
02296489
ASL
R
Imuran
Mylan-Azathioprine
Teva-Azathioprine
Apo-Azathioprine
Azathioprine
00004596
02231491
02236819
02242907
02343002
TRI
MYL
TEV
APX
SAS
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
OTHER IMMUNOSUPPRESSANTS
AUTRES AGENTS IMMUNOSUPPRESSEURS
L04AX01
Tab
Co.
AZATHIOPRINE
AZATHIOPRINE
Orl 50mg
M01
ANTIINFLAMMATORY AND ANTIRHEUMATIC PRODUCTS
ANTI-INFLAMMATOIRES ET ANTIRHUMATISMAUX
M01A
ANTIINFLAMMATORY AND ANTIRHEUMATIC PRODUCTS, NON-STEROIDS
ANTI-INFLAMMATOIRES ET ANTIRHUMATISMAUX, NON STÉROIDÏENS
M01AB
ACETIC ACID DERIVATIVES AND RELATED SUBSTANCES
ACIDE ACÉTIQUE ET SUBSTANCES APPARENTÉES
M01AB01
INDOMETHACIN
INDOMÉTHACINE
Cap Orl 25mg
Caps
Novo-Methacin
Apo-Indomethacin (Disc/non disp Mar 30/14)
00337420
00611158
TEV
APX
f
f
AEFGVW
AEFGVW
Cap Orl 50mg
Caps
Novo-Methacin
Apo-Indomethacin (Disc/non disp Mar 30/14)
00337439
00611166
TEV
APX
f
f
AEFGVW
AEFGVW
Sup Rt
Supp.
50mg
Sab-Indomethacin
02231799
SDZ
f
AEFGVW
Sup Rt
Supp.
100mg
Sab-Indomethacin
Ratio-Indomethacin
02231800
01934139
SDZ
TEV
f
f
AEFGVW
AEFGVW
Page 126
M01AB02
SULINDAC
SULINDAC
Tab
Co.
Orl 150mg
Teva-Sundac
Apo-Sulin
00745588
00778354
TEV
APX
f
f
AEFGVW
AEFGVW
Tab
Co.
Orl 200mg
Teva-Sundac
Apo-Sulin
00745596
00778362
TEV
APX
f
f
AEFGVW
AEFGVW
M01AB05
DICLOFENAC
DICLOFÉNAC
ECT Orl
Co.Ent.
25mg
Teva-Difenac
Apo-Diclo
Sandoz Diclofenac
pms-Diclofenac
00808539
00839175
02261952
02302616
TEV
APX
SDZ
PMS
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
ECT Orl
Co.Ent.
50mg
Voltaren
Teva-Difenac
Apo-Diclo
Sandoz Diclofenac
pms-Diclofenac
Diclofenac EC
00514012
00808547
00839183
02261960
02302624
02352397
NVR
TEV
APX
SDZ
PMS
SAS
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
SRT Orl
Co.L.L.
75mg
Voltaren SR
Teva-Difenac SR
Apo-Diclo SR
Sandoz Diclofenac SR
pms-Diclofenac SR
Diclofenac SR
00782459
02158582
02162814
02261901
02231504
02352400
NVR
TEV
APX
SDZ
PMS
SAS
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
SRT Orl
Co.L.L.
100mg
Voltaren SR
Teva-Difenac SR
Apo-Diclo SR
Sandoz Diclofenac SR
pms-Diclofenac SR
00590827
02048698
02091194
02261944
02231505
NVR
TEV
APX
SDZ
PMS
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Sup Rt
Supp.
50mg
Voltaren
Pms-Difenac
Sandoz Diclofenac
00632724
02231506
02261928
NVR
PMS
SDZ
f
f
f
AEFGVW
AEFGVW
AEFGVW
Sup Rt
Supp.
100mg
Voltaren
Pms-Difenac
Sandoz Diclofenac
00632732
02231508
02261936
NVR
PMS
SDZ
f
f
f
AEFGVW
AEFGVW
AEFGVW
Toradol
02162644
HLR
Toradol
Ketorolac
Novo-Ketorolac (Disc/non disp Feb 26/15)
02162660
02229080
02230201
HLR
AAP
TEV
M01AB15
Liq
Liq
Tab
Co.
KETOROLAC
KÉTOROLAC
Inj
10mg
Orl 10mg
Page 127
W
f
f
f
W
W
W
M01AB55
DICLOFENAC COMBINATIONS
DICLOFENAC, EN COMBINAISON
DICLOFENAC / MISOPROSTOL
DICLOFÉNAC / MISOPROSTOL
M01AC
Tab
Co.
Orl 50mg/200mcg
Arthrotec
01917056
PFI
AEFGVW
Tab
Co.
Orl 75mg/200mcg
Arthrotec
02229837
PFI
AEFGVW
Cap Orl 10mg
Caps
Apo-Piroxicam
Novo-Pirocam
00642886
00695718
APX
TEV
f
f
AEFGVW
AEFGVW
Cap Orl 20mg
Caps
Apo-Piroxicam
Novo-Pirocam
00642894
00695696
APX
TEV
f
f
AEFGVW
AEFGVW
Sup Rt
Supp.
pms-Piroxicam
02154463
PMS
f
AEFGVW
OXICAMS
OXICAMS
M01AC01
M01AC06
M01AE
PIROXICAM
PIROXICAM
20mg
MELOXICAM
MELOXICAM
Tab
Co.
Orl 7.5mg
Mobicox
pms-Meloxicam
Phl-Meloxicam
Apo-Meloxicam
Co Meloxicam
Mylan-Meloxicam
Teva-Meloxicam
Meloxicam
Auro-Meloxicam
02242785
02248267
02248607
02248973
02250012
02255987
02258315
02353148
02390884
BOE
PMS
PHL
APX
COB
MYL
TEV
SAS
ARO
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 15mg
Mobicox
pms-Meloxicam
Phl-Meloxicam
Apo-Meloxicam
Co Meloxicam
Mylan-Meloxicam
Teva-Meloxicam
Meloxicam
Auro-Meloxicam
02242786
02248268
02248608
02248974
02250020
02255995
02258323
02353156
02390892
BOE
PMS
PHL
APX
COB
MYL
TEV
SAS
ARO
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Apo-Ibuprofen
00441651
APX
f
AEFGVW
PROPIONIC ACID DERIVATIVES
DÉRIVÉS DE L’ACIDE PROPIONIQUE
M01AE01
Tab
Co.
IBUPROFEN
IBUPROFÉNE
Orl 300mg
Page 128
M01AE01
IBUPROFEN
IBUPROFÉNE
Tab
Co.
Orl 400mg
Apo-Ibuprofen
Novo-Profen
pms-Ibuprofen
Motrin IB
00506052
00629340
00836133
02242658
APX
TEV
PMS
JNJ
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 600mg
Apo-Ibuprofen
Novo-Profen
00585114
00629359
APX
TEV
f
f
AEFGVW
AEFGVW
f
AEFGVW
M01AE02
NAPROXEN
NAPROXÉNE
Sup Rt
Supp.
500mg
pms-Naproxen
02017237
PMS
Sus Orl
Susp.
25mg
Naprosyn
02162431
HLR
Tab
Co.
Orl 125mg
Apo-Naproxen
00522678
APX
f
AEFGVW
Tab
Co.
Orl 250mg
Apo-Naproxen
Teva-Naproxen
Naproxen
00522651
00565350
02350750
APX
TEV
SAS
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 375mg
Apo-Naproxen
Teva-Naproxen
Naproxen
00600806
00627097
02350769
APX
TEV
SAS
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 500mg
Apo-Naproxen
Teva-Naproxen
Naproxen
00589861
00592277
02350777
APX
TEV
SAS
f
f
f
AEFGVW
AEFGVW
AEFGVW
ECT Orl 250mg
Co.Ent.
Naprosyn E
Apo-Naproxen EC
Naproxen EC
Teva-Naprox EC
02162792
02246699
02350785
02243312
HLR
APX
SAS
TEV
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
ECT Orl 375mg
Co.Ent.
Naprosyn E
Apo-Naproxen EC
Naproxen EC
Teva-Naprox EC
Mylan-Naproxen EC
pms-Naproxen EC
02162415
02246700
02350793
02243313
02243432
02294702
HLR
APX
SAS
TEV
MYL
PMS
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
ECT Orl 500mg
Co.Ent.
Naprosyn E
Apo-Naproxen EC
Naproxen EC
Teva-Naprox EC
Mylan-Naproxen EC
pms-Naproxen EC
02162423
02246701
02350807
02243314
02241024
02294710
HLR
APX
SAS
TEV
MYL
PMS
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Page 129
AEFGVW
M01AE02
NAPROXEN
NAPROXÉNE
Tab
Co.
Orl
275mg
Anaprox
Apo-Napro-Na
Naproxen Sodium
Teva-Naproxen Sodium
02162725
00784354
02351013
00778389
HLR
APX
SAS
TEV
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
550mg
Anaprox DS
Apo-Napro-Na DS
Naproxen Sodium DS
Teva-Naproxen Sodium DS
02162717
01940309
02351021
02026600
HLR
APX
SAS
TEV
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Cap Orl 50mg
Caps
Keto
00790427
AAP
f
AEFGVW
ECT Orl 50mg
Co.Ent.
Keto-E
00790435
AAP
f
AEFGVW
ECT Orl 100mg
Co.Ent.
Keto-E
00842664
AAP
f
AEFGVW
SRT Orl 100mg
Co.L.L.
Keto SR
02172577
AAP
f
AEFGVW
pms-Ketoprofen
02015951
PMS
M01AE03
KETOPROFEN
KÉTOPROFÉNE
Sup Rt
Supp.
M01AE09
AEFGW
FLURBIPROFEN
FLURBIPROFÉNE
Tab
Co.
Orl 50mg
Apo-Flurbiprofen
Novo-Flurprofen
01912046
02100509
APX
TEV
f
f
AEFGVW
AEFGVW
Tab
Co.
Orl 100mg
Apo-Flurbiprofen
Novo-Flurprofen
01912038
02100517
APX
TEV
f
f
AEFGVW
AEFGVW
M01AE11
M01AG
100mg
TIAPROFENIC ACID
ACIDE TIAPROFÉNIQUE
Tab
Co.
Orl 200mg
Apo-Tiaprofenic (Disc/non disp Apr 10/14)
Teva-Tiaprofenic
02136112
02179679
APX
TEV
f
f
AEFGVW
AEFGVW
Tab
Co.
Orl 300mg
Apo-Tiaprofenic (Disc/non disp Apr 10/14)
Teva-Tiaprofenic
02136120
02179687
APX
TEV
f
f
AEFGVW
AEFGVW
02229452
AAP
f
AEFGVW
FENEMATES
FENEMATES
M01AG01
MEFENAMIC ACID
ACIDE MÉFÉNAMIQUE
Cap Orl 250mg
Caps
Mefenamic
Page 130
M01AH
COXIBS
COXIBS
M01AH01
CELECOXIB
CÉLÉCOXIB
PFI
AEFVW
19
02239942
PFI
AEFVW
Cap Orl 200mg
Caps
Celebrex
SPECIFIC ANTIRHEUMATIC AGENTS
AGENTS ANTIRHUMATISMAUX SPÉCIFIQUES
M01CB
GOLD PREPARATIONS
PRÉPARATIONS D’OR
M01CB01
SODIUM AUROTHIOMALATE
AUROTHIOMALATE SODIQUE
Liq
Liq
Inj
10mg
Myochrysine *
Sodium Aurothiomalate *
01927620
02245456
SAV
SDZ
f
f
AEFGVW
AEFGVW
Liq
Liq
Inj
25mg
Myochrysine *
01927612
02245457
SAV
SDZ
f
f
AEFGVW
AEFGVW
Liq
Liq
Inj
50mg
Myochrysine *
01927604
02245458
SAV
SDZ
f
f
AEFGVW
AEFGVW
Riduara*
01916823
XPI
AEFGVW
Cuprimine
00016055
VLN
AEFGVW
01930990
WCH
AEFGVW
M01CB03
AURANOFIN
AURANOFINE
Cap Orl
Caps
3mg
PENICILLAMINE AND SIMILAR AGENTS
PÉNICILLAMINE ET AGENTS SEMBLABLES
M01CC01
PENICILLAMINE
PÉNICILLAMINE
Cap Orl 250mg
Caps
M03
MUSCLE RELAXANTS
MYORELAXANTS
M03B
MUSCLE RELAXANTS, CENTRALLY ACTING AGENTS
MYORELAXANTS, AGENTS AGISSANT CENTRALEMENT
M03BA
CARBAMIC ACID ESTERS
ESTERS DE L’ACIDE CARBAMIQUE
M03BA03
Tab
Co.
19
02239941
Celebrex
M01C
M01CC
19
Cap Orl 100mg
Caps
METHOCARBAMOL
MÉTHOCARBAMOL
Orl 500mg
Robaxin
Celecoxib is a regular benefit for beneficiaries age 65 and over. Please refer to Appendix IV.
Les Celecoxib est le service assure habituel pour le bénéficiares de 65 ans et plus. Veuillez consulter l’annexe IV.
Page 131
M03BA03
Tab
Co.
M03BA53
METHOCARBAMOL
MÉTHOCARBAMOL
Orl 750mg
Robaxin
01932187
WCH
AEFGVW
METHOCARBAMOL, COMBINATIONS EXCLUDING PSYCHOLEPTICS
MÉTHOCARBAMOL, EN COMBINAISON, A L’EXCLUSION DES PSYCHOLEPTIQUES
METHOCARBAMOL / ACETYLSALICYLIC ACID / CODEINE PHOSPHATE
MÉTHOCARBAMOL / ACIDE ACETYLSALICYLIC / PHOSPHATE DE CODÉINE
M03BC
Tab
Co.
Orl 400mg/325mg/16.2mg
Robaxisal C-1/4
01934783
WCH
W
Tab
Co.
Orl 400mg/325mg/32.4mg
Robaxisal C-1/2
01934791
WCH
W
01966154
02243559
MDS
SDZ
f
f
AEFGVW
AEFGVW
ETHERS, CHEMICALLY CLOSE TO ANTIHISTAMINES
ÉTHERS, CHIMIQUEMENT PRÈS DES ANTIHISTAMINES
M03BC01
ORPHENADRINE
ORPHÉNADRINE
SRT Orl 100mg
Co.L.L.
M03BX
Norflex (Disc/non disp Sep 1/14)
Sandoz Orphenadrine Citrate
OTHER CENTRALLY ACTING AGENTS
AUTRES AGENTS AGISSANT CENTRALEMENT
M03BX01
BACLOFEN
BACLOFÉNE
Tab
Co.
Orl 10mg
Lioresal
pms-Baclofen
Mylan-Baclofen
Apo-Baclofen
ratio-Baclofen
Phl-Baclofen
Baclofen
00455881
02063735
02088398
02139332
02236507
02236963
02287021
NVR
PMS
MYL
APX
TEV
PHL
SAS
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 20mg
Lioresal D.S.
pms-Baclofen
Mylan-Baclofen
Apo-Baclofen
ratio-Baclofen
Phl-Baclofen
Baclofen
00636576
02063743
02088401
02139391
02236508
02236964
02287048
NVR
PMS
MYL
APX
TEV
PHL
SAS
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Novo-Cycloprine
Apo-Cycloprine
pms-Cyclobenzaprine
Mylan-Cyclobenzaprine
Cyclobenzaprine
Auro-Cyclobenzaprine
Jamp-Cyclobenzaprine
02080052
02177145
02212048
02231353
02287064
02348853
02357127
TEV
APX
PMS
MYL
SAS
ARO
JPC
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
M03BX08
Tab
Co.
CYCLOBENZAPRINE
CYCLOBENZAPRINE
Orl 10mg
Page 132
M03C
MUSCLE RELAXANTS, DIRECTLY ACTING AGENTS
MYORELAXANTS, AGENTS AGISSANT DIRECTEMENT
M03CA
DANTROLENE AND DERIVATIVES
DANTROLENE ET DÉRIVÉS
M03CA01
DANTROLENE
DANTROLÉNE
Cap Orl 25mg
Caps
Dantrium
01997602
MTP
AEFGVW
Cap Orl 100mg
Caps
Dantrium
01997653
MTP
AEFGVW
M04
ANTIGOUT PREPARATIONS
PRÉPARATIONS ANTI-GOUTTE
M04A
ANTIGOUT PREPARATIONS
PRÉPARATIONS ANTI-GOUTTE
M04AA
PREPARATIONS INHIBITING URIC ACID PRODUCTION
PRÉPARATIONS INHIBANT LA PRODUCTION D’ACIDE URIQUE
M04AA01
M04AB
Tab
Co.
Orl 100mg
Zyloprim
Mar-Allopurinol
Apo-Allopurinol
00402818
02396327
02402769
AAP
MAR
APX
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 200mg
Zyloprim
Mar-Allopurinol
Apo-Allopurinol
00479799
02396335
02402777
AAP
MAR
APX
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 300mg
Zyloprim
Mar-Allopurinol
Apo-Allopurinol
00402796
02396343
02402785
AAP
MAR
APX
f
f
f
AEFGVW
AEFGVW
AEFGVW
Benuryl (Disc/non disp Nov 29/14)
00294926
VLN
Sulfinpyrazone
00441767
AAP
PREPARATIONS INCREASING URIC ACID EXCRETION
PRÉPARATIONS AUGMENTANT L’EXCRÉTION D’ACIDE URIQUE
M04AB01
Tab
Co.
M04AB02
Tab
Co.
M04AC
ALLOPURINOL
ALLOPURINOL
PROBENECID
PROBÉNÉCIDE
Orl 500mg
AEFGVW
SULFINPYRAZONE
SULFINPYRAZONE
Orl 200mg
f
AEFGVW
PREPARATION WITH NO EFFECT ON URIC ACID METABOLISM
PRÉPARATION SANS EFFET SUR LE MÉTABOLISME DE L’ACIDE URIQUE
M04AC01
Tab
Co.
COLCHICINE
COLCHICINE
Orl 0.6mg
Colchicine
Colchicine
Page 133
00287873
00572349
EUR
ODN
AEFGVW
AEFGVW
M04AC01
Tab
Co.
COLCHICINE
COLCHICINE
Orl 1mg
Colchicine (Disc/non disp Mar 6/15)
00621374
ODN
M05
DRUGS FOR TREATMENT OF BONE DISEASES
MÉDICAMENTS POUR LE TRAITEMENT DES MALADIES OSSEUSES
M05B
DRUGS AFFECTING BONE STRUCTURE AND MINERALIZATION
MÉDICAMENTS AGISSANT SUR LA STRUCTURE OSSEUSE ET LA MINÉRALISATION
M05BA
BIPHOSPHONATES
BIPHOSPHONATES
M05BA02
CLODRONIC ACID
ACIDE CLODRONIQUE
Cap Orl 400mg
Caps
M05BA04
M05BB
AEFGVW
Bonefos
01984845
BAY
AEFGVW
ALENDRONIC ACID
ACIDE ALENDRONIQUE
Tab
Co.
Orl 10mg
Teva-Alendronate
Apo-Alendronate
Mylan-Alendronate
Sandoz Alendronate
Alendronate Sodium
Ran-Alendronate
Mint-Alendronate
Auro-Alendronate
02247373
02248728
02270129
02288087
02381486
02384701
02394863
02388545
TEV
APX
MYL
SDZ
AHI
RAN
MNT
ARO
f
f
f
f
f
f
f
f
W
W
W
W
W
W
W
W
Tab
Co.
Orl 40mg
Fosamax (Disc/non disp Jun 1/15)
Co Alendronate
02201038
02258102
FRS
COB
f
f
W
W
Tab
Co.
Orl 70mg
Fosamax
Apo-Alendronate
Co Alendronate
Teva-Alendronate
pms-Alendronate FC
Mylan-Alendronate
Sandoz Alendronate
Alendronate FC
Alendronate
Alendronate Sodium
Ran-Alendronate
Jamp-Alendronate
Mint-Alendronate
Auro-Alendronate
02245329
02248730
02258110
02261715
02284006
02286335
02288109
02299712
02352966
02381494
02384728
02385031
02394871
02388553
FRS
APX
COB
TEV
PMS
MYL
SDZ
SIV
SAS
AHI
RAN
JPC
MNT
ARO
f
f
f
f
f
f
f
f
f
f
f
f
f
f
W
W
W
W
W
W
W
W
W
W
W
W
W
W
02314940
02403641
FRS
TEV
f
f
W
W
BIPHOSPHONATES, COMBINATIONS
BIPHOSPHONATES EN COMBINAISON
M05BB03
Tab
Co.
ALENDRONIC ACID AND COLECALCIFEROL
ACIDE ALENDRONIQUE ET COLÉCALCIFÉROL
Orl 70mg/5600mg
Fosavance
Teva-Alendronate/Cholecalciferol
Page 134
N01
ANAESTHETICS
ANESTHÉSIQUES
N01B
LOCAL ANAESTHETICS
ANESTHÉSIQUES LOCAUX
N01BX
OTHER LOCAL ANAESTHETICS
AUTRES ANESTHÉSIQUES LOCAUX
N01BX04
CAPSAICIN
CAPSAÏCINE
Crm
Cr.
Top 0.025%
Zostrix
Capsaicin
00740306
02157101
MDS
VAL
AEFGVW
AEFGVW
Crm
Cr.
Top 0.075%
Zostrix H.P.
Capsaicin Crm
02004240
02157128
MDS
VAL
AEFGVW
AEFGVW
SRT Orl 30mg
Co.L.L.
M.O.S.SR
00776181
VLN
AEFGVW
SRT Orl 60mg
Co.L.L.
M.O.S.SR
00776203
VLN
AEFGVW
N02
ANALGESICS
ANALGÉSIQUES
N02A
OPIOIDS
OPIOÏDES
N02AA
NATURAL OPIUM ALKALOIDS
ALKALOÏDES D’OPIUM NATUREL
N02AA01
MORPHINE
MORPHINE
Syr
Sir.
Orl 1mg
ratio-Morphine
00607762
RPH
AEFGVW
Syr
Sir.
Orl 5mg
ratio-Morphine
00607770
RPH
AEFGVW
Syr
Sir.
Orl 10mg
ratio-Morphine
00690783
RPH
AEFGVW
Syr
Sir.
Orl 20mg
ratio-Morphine
00690791
RPH
AEFGVW
Dps
Gtts
Orl 20mg
Statex
00621935
PAL
AEFGVW
Dps
Gtts
Orl 50mg
Statex
00705799
PAL
AEFGVW
Liq
Liq
Inj
10mg
Morphine Sulfate*
00392588
SDZ
AEFGVW
Liq
Liq
Inj
15mg
Morphine Sulfate*
00392561
SDZ
AEFGVW
Page 135
N02AA01
MORPHINE
MORPHINE
Liq
Liq
Inj
25mg
Morphine HP 25*
00676411
SDZ
AEFGVW
Liq
Liq
Inj
50mg
Morphine HP 50*
00617288
SDZ
AEFGVW
M-Eslon
Kadian
02019930
02242163
SAV
ABB
AEFGVW
AEFGVW
SRC Orl 15mg
Caps.L.L.
M-Eslon 15
02177749
SAV
AEFGVW
SRC Orl 20mg
Caps.L.L.
Kadian
02184435
ABB
AEFGVW
SRC Orl 30mg
Caps.L.L.
M-Eslon
02019949
SAV
AEFGVW
SRC Orl 50mg
Caps.L.L.
Kadian
02184443
ABB
AEFGVW
SRC Orl 60mg
Caps.L.L.
M-Eslon
02019957
SAV
AEFGVW
SRC Orl 100mg
Caps.L.L.
M-Eslon
Kadian
02019965
02184451
SAV
ABB
AEFGVW
AEFGVW
SRC Orl 200mg
Caps.L.L.
Kadian
02177757
ABB
AEFGVW
SRT Orl 15mg
Co.L.L.
MS Contin
Sandoz Morphine SR
Teva-Morphine SR
Morphine SR
02015439
02244790
02302764
02350815
PFR
SDZ
TEV
SAS
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
SRT Orl 30mg
Co.L.L.
MS Contin
Sandoz Morphine SR
Teva-Morphine SR
Morphine SR
02014297
02244791
02302772
02350890
PFR
SDZ
TEV
SAS
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
SRT Orl 60mg
Co.L.L.
MS Contin
Sandoz Morphine SR
Teva-Morphine SR
Morphine SR
02014300
02244792
02302780
02350912
PFR
SDZ
TEV
SAS
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
MS Contin
Teva-Morphine SR
Morphine SR (Disc/non disp Apr 22/15)
02014319
02302799
02350920
PFR
TEV
SAS
f
f
f
AEFGVW
AEFGVW
AEFGVW
SRC Orl
Caps.L.L.
10mg
SRT Orl 100mg
Co.L.L.
Page 136
N02AA01
MORPHINE
MORPHINE
SRT Orl 200mg
MS Contin
Co.L.L.
pms-Morphine sulfate (Disc/non disp Apr 1/14)
Teva-Morphine SR
Morphine SR (Disc/non disp Apr 22/15)
02014327
02245288
02302802
02350947
PFR
PMS
TEV
SAS
Sup Rt
Supp.
5mg
Statex
00632228
PAL
AEFGVW
Sup Rt
Supp.
10mg
Statex
00632201
PAL
AEFGVW
Sup Rt
Supp.
20mg
Statex
00596965
PAL
AEFGVW
Sup Rt
Supp.
30mg
Statex
00639389
PAL
AEFGVW
Syr
Sir.
Orl
1mg
Statex
00591467
PAL
AEFGVW
Syr
Sir.
Orl
5mg
Statex
00591475
PAL
AEFGVW
Tab
Co.
Orl
5mg
Statex
MS IR
00594652
02014203
PAL
PFR
AEFGVW
AEFGVW
Tab
Co.
Orl
10mg
Statex
MS IR
00594644
02014211
PAL
PFR
AEFGVW
AEFGVW
Tab
Co.
Orl
20mg
MS IR
02014238
PFR
AEFGVW
Tab
Co.
Orl
25mg
Statex
00594636
PAL
AEFGVW
Tab
Co.
Orl
30mg
MS IR
02014254
PFR
AEFGVW
Tab
Co.
Orl
50mg
Statex
00675962
PAL
AEFGVW
N02AA03
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
HYDROMORPHONE
HYDROMORPHONE
Liq
Liq
Inj
2mg
Dilaudid *
Hydromorphone hcl *
00627100
02145901
PFR
SDZ
f
f
AEFGVW
AEFGVW
Liq
Liq
Inj
10mg
Dilaudid HP *
Hydromorphone HP *
00622133
02145928
PFR
SDZ
f
f
AEFGVW
AEFGVW
Liq
Liq
Inj
20mg
Hydromorphone HP *
02145936
SDZ
f
AEFGVW
Page 137
N02AA03
Liq
Liq
HYDROMORPHONE
HYDROMORPHONE
Inj
50mg
Hydromorphone HP *
02146126
SDZ
f
AEFGVW
Cap Orl 4.5mg
Caps.
Hydromorph Contin
02359502
PFR
AEFGVW
Cap Orl 9mg
Caps.
Hydromorph Contin
02359510
PFR
AEFGVW
SRC Orl 3mg
Caps.L.L.
Hydromorph Contin SR
02125323
PFR
AEFGVW
SRC Orl 6mg
Caps.L.L.
02125331
PFR
AEFGVW
SRC Orl 12mg
Caps.L.L.
02125366
PFR
AEFGVW
SRC Orl 18mg
Caps.L.L.
02243562
PFR
AEFGVW
SRC Orl 24mg
Caps.L.L.
02125382
PFR
AEFGVW
SRC Orl 30mg
Caps.L.L.
02125390
PFR
AEFGVW
Syr
Sir.
Orl
1mg
Dilaudid
Pms-Hydromorphone
00786535
01916386
PFR
PMS
f
f
AEFGVW
AEFGVW
Tab
Co.
Orl
1mg
Dilaudid
pms-Hydromorphone
Teva-Hydromorphone
00705438
00885444
02319403
PFR
PMS
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
2mg
Dilaudid
pms-Hydromorphone
Teva-Hydromorphone
00125083
00885436
02319411
PFR
PMS
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab
Orl
4mg
Dilaudid
pms-Hydromorphone
Teva-Hydromorphone
00125121
00885401
02319438
PFR
PMS
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
8mg
Dilaudid
pms-Hydromorphone
Teva-Hydromorphone
00786543
00885428
02319446
PFR
PMS
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
Oxyneo
02372525
PFR
N02AA05
OXYCODONE
OXYCODONE
ERT Orl 10mg
Co.L.P.
Page 138
W
N02AA05
OXYCODONE
OXYCODONE
ERT Orl 15mg
Co.L.P.
Oxyneo
02372533
PFR
W
ERT Orl
Co.L.P.
20mg
Oxyneo
02372797
PFR
W
ERT Orl
Co.L.P.
30mg
Oxyneo
02372541
PFR
W
ERT Orl
Co.L.P.
40mg
Oxyneo
02372568
PFR
W
ERT Orl
Co.L.P.
60mg
Oxyneo
02372576
PFR
W
ERT Orl
Co.L.P.
80mg
Oxyneo
02372584
PFR
W
Sup Rt
Supp.
10mg
Supeudol
00392480
SDZ
AEFGVW
Tab
Co.
Orl
5mg
Oxy-IR
pms-Oxycodone IR
02231934
02319977
PFR
PMS
f
f
W
W
Tab
Co.
Orl
10mg
Supeudol
Oxy-IR
pms-Oxycodone IR
00443948
02240131
02319985
SDZ
PFR
PMS
f
f
f
W
W
W
Tab
Co.
Orl
20mg
Supeudol
Oxy-IR
pms-Oxycodone IR
02262983
02240132
02319993
SDZ
PFR
PMS
f
f
f
W
W
W
N02AA59
CODEINE, COMBINATIONS, EXCLUDING PSYCHOLEPTICS
CODÉINE, EN COMBINAISON, À L’EXCLUSION DES PSYCHOLEPTIQUES
ACETAMINOPHEN / CAFFEINE / CODEINE
ACÉTAMINOPHÈNE / CAFÉINE / CODÉINE
Tab
Co.
Orl
300mg/30mg/15mg
ratio-Lenoltec #3
Tylenol No.3
00653276
02163926
RPH
JAN
AEFGVW
AEFGVW
Tab
Co.
Orl
300mg/30mg/30mg
Atasol-30
00293512
CHU
AEFGVW
ratio-Emtec-30
00608882
RPH
AEFGVW
ratio-Lenoltec #4
Tylenol No.4
00621463
02163918
RPH
JAN
AEFGVW
AEFGVW
ACETAMINOPHEN / CODEINE
ACÉTAMINOPHÈNE / CODÉINE
Tab Orl 300mg/30mg
Co.
Tab
Co.
Orl
300mg/60mg
Page 139
N02AA59
CODEINE, COMBINATIONS, EXCLUDING PSYCHOLEPTICS
CODÉINE, EN COMBINAISON, À L’EXCLUSION DES PSYCHOLEPTIQUES
ACETYLSALICYTIC ACID / CAFFEINE / CODEINE
ACETYLSALICYTIC ACIDE / CAFÉINE / CODÉINE
Tab
Co.
N02AB
Orl
375mg/30mg/30mg
292
02238645
PDP
AEFGVW
Demerol
02138018
SAV
W
PHENYLPIPERIDINE DERIVATIVES
DÉRIVÉS DU PHENYLPIPERDINE
N02AB02
Tab
Co.
N02AB03
PETHIDINE (MEPERIDINE)
PÉTHIDINE (MÉPÉRIDINE)
Orl
50mg
FENTANYL
FENTANYL
Pth
Pth
Trd
12mcg
Teva-Fentanyl
Sandoz Fentanyl patch
Ran-Fentanyl Matrix
Duragesic Mat
pms-Fentanyl MTX
Mylan-Fentanyl Matrix
Co-Fentanyl
02311925
02327112
02330105
02334186
02341379
02396696
02386844
TEV
SDZ
RAN
JAN
PMS
MYL
COB
f
f
f
f
f
f
f
W
W
W
W
W
W
W
Pth
Pth
Trd
25mcg
Duragesic Mat
Teva-Fentanyl
Apo-Fentanyl
Sandoz Fentanyl
Ran-Fentanyl Matrix
pms-Fentanyl MTX
Co-Fentanyl
02275813
02282941
02314630
02327120
02330113
02341387
02396718
02386852
JAN
TEV
APX
SDZ
RAN
PMS
MYL
COB
f
f
f
f
f
f
f
f
W
W
W
W
W
W
W
W
Pth
Pth
Trd
37mcg
Sandoz Fentanyl
02327139
SDZ
Pth
Pth
Trd
50mcg
Duragesic Mat
Teva-Fentanyl
Apo-Fentanyl
Sandoz Fentanyl
Ran-Fentanyl Matrix
pms-Fentanyl MTX
Co-Fentanyl
02275821
02282968
02314649
02327147
02330121
02341395
02396726
02386879
JAN
TEV
APX
SDZ
RAN
PMS
MYL
COB
f
f
f
f
f
f
f
f
W
W
W
W
W
W
W
W
Pth
Pth
Trd
75mcg
Duragesic Mat
Teva-Fentanyl
Apo-Fentanyl
Sandoz Fentanyl
Ran-Fentanyl Matrix
pms-Fentanyl MTX
Co-Fentanyl
02275848
02282976
02314657
02327155
02330148
02341409
02396734
02386887
JAN
TEV
APX
SDZ
RAN
PMS
MYL
COB
f
f
f
f
f
f
f
f
W
W
W
W
W
W
W
W
Page 140
W
N02AB03
Pth
Pth
N02AD
FENTANYL
FENTANYL
Trd
100mcg
Duragesic Mat
Teva-Fentanyl
Apo-Fentanyl
Sandoz Fentanyl
Ran-Fentanyl Matrix
pms-Fentanyl MTX
Co-Fentanyl
02275856
02282984
02314665
02327163
02330156
02341417
02396742
02386895
JAN
TEV
APX
SDZ
RAN
PMS
MYL
COB
f
f
f
f
f
f
f
f
W
W
W
W
W
W
W
W
Talwin
02137984
SNS
W
ASA daily low dose (Disc/non disp Jun 5/14)
Equate daily low-dose EC
Rexall Coated low dose ASA
Exact Coated daily low dose ASA
ASA ECT (Disc/non disp Jun 5/14)
Praxis ASA
02243101
02243801
02243802
02243896
02244993
02283700
PMS
PMS
PMS
PMS
PMS
PDP
V
V
V
V
V
V
ECT Orl 325mg
Co.Ent.
Entrophen
Novasen
Enteric Coated ASA
EC ASA
pms-ASA EC
ASATAB EC
00010332
00216666
02010526
02245443
02284529
02352427
PDP
TEV
VTH
JPC
PMS
ODN
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
ECT Orl 650mg
Co.Ent.
Entrophen
Novasen
Jamp-ASA EC
00010340
00229296
00794244
PDP
TEV
JPC
AEFGVW
AEFGVW
AEFGVW
BENZOMORPHAN DERIVATIVES
DÉRIVÉS DU BENZOMORPHANE
N02AD01
Tab
Co.
PENTAZOCINE
PENTAZOCINE
Orl
50mg
N02B
OTHER ANALGESICS AND ANTIPYRETICS
AUTRES ANALGÉSIQUES ET ANTIPYRÉTIQUES
N02BA
SALICYLIC ACID AND DERIVATIVES
ACIDE SALICYLIQUE ET DÉRIVÉS
N02BA01
ACETYLSALICYLIC ACID
ACIDE ACÉTYLSALICYLIQUE
ECT Orl 81mg
Co.Ent.
N02BA11
DIFLUNISAL
DIFLUNISAL
Tab
Co.
Orl 250mg
Apo-Diflunisal
Novo-Diflunisal
02039486
02048493
APX
TEV
f
f
AEFGVW
AEFGVW
Tab
Co.
Orl 500mg
Apo-Diflunisal
02039494
APX
f
AEFGVW
Page 141
N02BA51
ACETYLSALICYLIC ACID, COMBINATIONS EXCLUDING PSYCHOLEPTICS
ACIDE ACÉTYLSALICYLIQUE, EN COMBINAISON, À L’EXCLUSION DES PSYCHOLEPTIQUES
ACETYLSALICYLIC ACID / OXYCODONE
ACIDE ACÉTYLSALICYLIQUE / OXYCODONE
Tab
Co.
N02BA71
Orl 325mg/5mg
ratio-Oxycodan
00608157
RPH
AEFGVW
ACETYLSALICYLIC ACID COMBNATIONS WITH PSYCHOLEPTICS
ACIDE ACÉTYLSALICYLIQUE, EN COMBINAISON AVEC DES PSYCHOLEPTIQUES
BUTALBITAL / ACETYLSALICYLIC ACID / CAFFEINE
BUTALBITAL / ACIDE ACÉTYLSALICYLIQUE / CAFÉINE
Cap Orl 50mg/330mg/40mg
Caps
Fiorinal
ratio-Tecnal
00226327
00608238
NVR
RPH
Tab
Co.
ratio-Tecnal
00608211
RPH
Orl 50mg/330mg/40mg
f
f
W
W
W
BUTALBITAL / ACETYLSALICYLIC ACID / CAFFEINE / CODEINE
BUTALBITAL / ACIDE ACÉTYLSALICYLIQUE / CAFÉINE/ CODÉINE
N02BE
Cap Orl 50mg/330mg/40mg/15mg
Caps
Fiorinal C ¼
ratio-Tecnal C ¼
00176192
00608203
NVR
RPH
f
f
W
W
Cap Orl 50mg/330mg/40mg/30mg
Caps
Fiorinal C ½
ratio-Tecnal C ½
00176206
00608181
NVR
RPH
f
f
W
W
f
f
G
G
ANILIDES
ANILIDES
N02BE01
PARACETAMOL (ACETAMINOPHEN)
PARACETAMOL (ACÉTAMINOPHÉNE)
Sup Rt
Supp.
120mg
Abenol
Acet – 120
01919385
02230434
PDP
PDP
Sup Rt
Supp.
325mg
Abenol
01919393
PDP
G
Tab
Co.
Orl 325mg
Novo-Gesic
Apo-Acetaminophen
Acetaminophen
00389218
00544981
01938088
TEV
APX
JPC
G
G
G
Tab
Co.
Orl 500mg
Novo-Gesic
Apo-Acetaminophen
Acetaminophen
00482323
00545007
01939122
TEV
APX
JPC
G
G
G
N02BE51
PARACETAMOL (ACETAMINOPHEN), COMBINATIONS EXCLUDING PSYCHOLEPTICS
PARACETAMOL (ACÉTAMINOPHÉNE), EN COMBINAISONS, À L’EXCLUSION DES
PSYCHOLEPTIQUES
Tab
Co.
Orl 300mg/30mg/15mg
Atasol-15
Page 142
00293504
CHU
AEFGVW
N02BE51
PARACETAMOL (ACETAMINOPHEN), COMBINATIONS EXCLUDING PSYCHOLEPTICS
PARACETAMOL (ACÉTAMINOPHÉNE), EN COMBINAISONS, À L’EXCLUSION DES
PSYCHOLEPTIQUES
Tab
Co.
Orl 300mg/15mg/15mg
ratio-Lenoltec #2
Tylenol No.2
00653241
02163934
RPH
JAN
AEFGVW
AEFGVW
Tylenol w Codeine (Disc/non
disp Jul 2/15)
02163942
JAN
AEFGVW
Percocet Demi
01916491
BRI
AEFGVW
ratio-Oxycocet
Percocet
Endocet
Sandoz Oxycodone/Acetaminophen
Apo-Oxycodone/Acet
Oxycodone/Acet
00608165
01916475
01916548
02307898
02324628
02361361
RPH
BRI
BRI
SDZ
APX
SAS
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
ACETAMINOPHEN / CODEINE
ACÉTAMINOPHÈNE / CODÉINE
Elx
Elx
Orl
32mg/1.6mg
ACETAMINOPHEN / OXYCODONE
ACÉTAMINOPHÈNE / OXYCODONE
N02BG
Tab
Co.
Orl 325mg/2.5mg
Tab
Co.
Orl 325mg/5mg
OTHER ANALGESICS AND ANTIPYRETICS
AUTRE ANALGÉSIQUES ET ANTIPYRÉTIQUES
N02BG04
FLOCTAFENINE
FLOCTAFÉNINE
Tab
Co.
Orl 200mg
Floctafenine
02244680
AAP
f
AEFGVW
Tab
Co.
Orl 400mg
Floctafenine
02244681
AAP
f
AEFGVW
Dihydroergotamine *
Dihydroergotamine *
02241163
00027243
SDZ
STR
f
f
AEFGVW
AEFGVW
Migranal
02228947
STR
N02C
ANTIMIGRAINE PREPARATIONS
PRÉPARATIONS ANTI-MIGRAINES
N02CA
ERGOT ALKALOIDS
ALKALOÏDES DE L’ERGOT
N02CA01
DIHYDROERGOTAMINE
DIHYDROERGOTAMINE
Liq
Liq
Inj
1mg
Liq
Liq
Nas 4mg
Page 143
AEFGVW
N02CA52
ERGOTAMINE, COMBINATIONS EXCLUDING PSYCHOLEPTICS
ERGOTAMINE, EN COMBINAISON, À L’EXCLUSION DES PSYCHOLEPTIQUES
ERGOTAMINE / CAFFEINE
ERGOTAMINE / CAFÉINE
Tab
Co.
Orl 1mg/100mg
Cafergot
00176095
NVR
AEFGVW
Ergodryl (Disc/non disp
Jul 9/15)
00156086
ERF
AEFGVW
Sandomigran
00329320
PAL
AEFGVW
Sandomigran DS
00511552
PAL
AEFGVW
Phenobarbital
00645575
PMS
AEFGVW
ERGOTAMINE / CAFFEINE / DIMENHYDRINATE
ERGOTAMINE / CAFÉINE / DIMENHYDRINATE
Cap Orl 1mg/100mg/25mg
Caps
N02CX
OTHER ANTIMIGRAINE PREPARATIONS
AUTRES PRÉPARATIONS ANTI-MIGRAINE
N02CX01
PIZOTIFEN
PIZOTIFÉNE
Tab
Co.
Orl 0.5mg
Tab
Co.
Orl 1mg
N03
ANTIEPILEPTICS
ANTIÉPILEPTIQUES
N03A
ANTIEPILEPTICS
ANTIÉPILEPTIQUES
N03AA
BARBITURATES AND DERIVATIVES
BARBITURIQUES ET DÉRIVÉS
N03AA02
PHENOBARBITAL
PHÉNOBARBITOL
Elx Orl 5mg
Elx
Tab
Co.
Orl 15mg
Phenobarbital
00178799
PDP
AEFGVW
Tab
Co.
Orl 30mg
Phenobarbital
00178802
PDP
AEFGVW
Tab
Co.
Orl 60mg
Phenobarbital
00178810
PDP
AEFGVW
Tab
Co.
Orl 100mg
Phenobarbital
00178829
PDP
AEFGVW
N03AA03
PRIMIDONE
PRIMIDONE
Tab
Co.
Orl 125mg
Primidone
00399310
AAP
AEFGVW
Tab
Co.
Orl 150mg
Primidone
00396761
AAP
AEFGVW
Page 144
N03AB
HYDANTOIN DERIVATIVES
DÉRIVÉS DE L’HYDANTOÏNE
N03AB02
Sus Orl
Susp.
6mg
Dilantin 30
00023442
PFI
Sus Orl
Susp.
25mg
Dilantin 125
Taro-Phenytoin
00023450
02250896
PFI
TAR
Tab
Co.
Orl
50mg
Dilantin infatabs
00023698
PFI
AEFGVW
Cap Orl
Caps
30mg
Dilantin
00022772
PFI
AEFGVW
Cap Orl 100mg
Caps
Dilantin
00022780
PFI
AEFGVW
Phenytoin Sodium
00780626
SDZ
V
Cap Orl 250mg
Caps
Zarontin
00022799
ERF
AEFGVW
Syr
Sir.
Zarontin
00023485
ERF
AEFGVW
Celontin
00022802
ERF
AEFGVW
Rivotril
Apo-Clonazepam
pms-Clonazepam R
Mylan-Clonazepam
Sandoz Clonazepam
Phl-Clonazepam
Teva-Clonazepam
Co Clonazepam
Zym-Clonazepam
00382825
02177889
02207818
02230950
02233960
02236948
02239024
02270641
02345676
HLR
APX
PMS
MYL
SDZ
PHL
TEV
COB
ZYM
Liq
Liq
N03AD
PHENYTOIN
PHÉNYTOINE
Orl
50mg
f
f
AEFGVW
AEFGVW
SUCCINIMIDE DERIVATIVES
DÉRIVÉS DU SUCCINIMIDE
N03AD01
N03AD03
ETHOSUXIMIDE
ÉTHOSUXIMIDE
Orl 50mg
MESUXIMIDE
MÉSUXIMIDE
Cap Orl 300mg
Caps
N03AE
AEFGVW
BENZODIAZEPINE DERIVATIVES
DÉRIVÉS DU BENZODIAZÉPINES
N03AE01
Tab
Co.
CLONAZEPAM
CLONAZÉPAM
Orl 0.5mg
Page 145
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
N03AE01
N03AF
CLONAZEPAM
CLONAZÉPAM
Tab
Co.
Orl 1mg
pms-Clonazepam
Sandoz Clonazepam
Phl-Clonazepam
Co Clonazepam (Disc/non disp Jan 11/15)
Zym-Clonazepam
02048728
02233982
02145235
02270668
02303329
PMS
SDZ
PHL
COB
ZYM
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
Rivotril
Apo-Clonazepam
pms-Clonazepam
Mylan-Clonazepam
Sandoz Clonazepam
Phl-Clonazepam
Teva-Clonazepam
Co Clonazepam
Zym-Clonazepam
00382841
02177897
02048736
02230951
02233985
02145243
02239025
02270676
02303337
HLR
APX
PMS
MYL
SDZ
PHL
TEV
COB
ZYM
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
SRT Orl 200mg
Co.L.L.
Tegretol CR
pms-Carbamazepine
Taro-Carbamazepine CR
Mylan-Carbamazepine
Sandoz-Carbamazepine CR
00773611
02231543
02237907
02241882
02261839
NVR
PMS
TAR
MYL
SDZ
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
SRT Orl 400mg
Co.L.L.
Tegretol CR
pms-Carbamazepine
Taro-Carbamazepine CR
Mylan-Carbamazepine
Sandoz-Carbamazepine CR
00755583
02231544
02237908
02241883
02261847
NVR
PMS
TAR
MYL
SDZ
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
2mg
CARBOXAMIDE DERIVATIVES
DÉRIVÉS DU CARBOXAMIDE
N03AF01
CARBAMAZEPINE
CARBAMAZÉPINE
Sus Orl
Susp.
20mg
Tegretol
Taro-Carbamazepine
02194333
02367394
NVR
TAR
f
f
AEFGVW
AEFGVW
Tab
Co.
200mg
Tegretol
Apo-Carbamazepine (Disc/non disp Apr 30/14)
Teva-Carbamazepine
00010405
00402699
00782718
NVR
APX
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
Orl
TabC Orl 100mg
Co.C..
Tegretol Chew
pms-Carbamazepine
Sandoz-Carbamazepine Chewtabs
00369810
02231542
02261855
NVR
PMS
SDZ
f
f
f
AEFGVW
AEFGVW
AEFGVW
TabC Orl 200mg
Co.C..
Tegretol Chew
pms-Carbamazepine
Sandoz-Carbamazepine Chewtabs
00665088
02231540
02261863
NVR
PMS
SDZ
f
f
f
AEFGVW
AEFGVW
AEFGVW
Page 146
N03AG
FATTY ACID DERIVATIVES
DÉRIVÉS DES ACIDES GRAS
N03AG01
ECT Orl 125mg
Co.Ent.
Epival
Apo-Divalproex
Novo-Divalproex
Divalproex
00596418
02239698
02239701
02400499
ABB
APX
TEV
SAS
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
ECT Orl 250mg
Co.Ent.
Epival
Apo-Divalproex
Novo-Divalproex
Divalproex
00596426
02239699
02239702
02400502
ABB
APX
TEV
SAS
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
ECT Orl 500mg
Co.Ent.
Epival
Apo-Divalproex
Novo-Divalproex
Divalproex
00596434
02239700
02239703
02400510
ABB
APX
TEV
SAS
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Cap Orl 250mg
Caps
Depakene
Novo-Valproic
Mylan-Valproic(Disc/non disp Jul 4/15)
pms-Valproic Acid
Apo-Valproic
Sandoz Valproic (Disc/non disp Nov 15/15)
00443840
02100630
02184648
02230768
02238048
02239714
ABB
TEV
MYL
PMS
APX
SDZ
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
ECC Orl 500mg
Caps.Ent..
pms-Valproic Acid
02229628
PMS
f
AEFGVW
Depakene
Ratio-Valproic (Disc/non disp Feb 22/15)
pms-Valproic
Apo-Valproic Acid
00443832
02140063
02236807
02238370
ABB
RPH
PMS
APX
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Syr
Sir.
N03AX
VALPROIC ACID
ACIDE VALPROIQUE
Orl
50mg
OTHER ANTIEPILEPTICS
AUTRE ANTIÉPILEPTIQUES
N03AX09
LAMOTRIGINE
LAMOTRIGINE
Tab
Co.
Orl 25mg
Lamictal
ratio-Lamotrigine (Disc/non disp Feb 22/15)
Apo-Lamotrigine
pms-Lamotrigine
Teva-Lamotrigine
Mylan-Lamotrigine
Lamotrigine
Auro-Lamotrigine
02142082
02243352
02245208
02246897
02248232
02265494
02343010
02381354
GSK
TEV
APX
PMS
TEV
MYL
SAS
ARO
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 100mg
Lamictal
Apo-Lamotrigine
pms-Lamotrigine
02142104
02243353
02245209
02246898
GSK
TEV
APX
PMS
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Page 147
N03AX09
LAMOTRIGINE
LAMOTRIGINE
Tab
Co.
Orl 100mg
Teva-Lamotrigine
Mylan-Lamotrigine
Lamotrigine
Auro-Lamotrigine
02248233
02265508
02343029
02381362
TEV
MYL
SAS
ARO
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 150mg
Lamictal
Apo-Lamotrigine
pms-Lamotrigine
Teva-Lamotrigine
Mylan-Lamotrigine
Lamotrigine
Auro-Lamotrigine
02142112
02246963
02245210
02246899
02248234
02265516
02343037
02381370
GSK
TEV
APX
PMS
TEV
MYL
SAS
ARO
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
TabC
Co.C
Orl 2mg
Lamictal Chewtabs
02243803
GSK
AEFGVW
TabC
Co.C
Orl 5mg
Lamictal Chewtabs
02240115
GSK
AEFGVW
Cap Orl 100mg
Caps
Neurontin
pms-Gabapentin
Apo-Gabapentin
Teva-Gabapentin
Gabapentin
Mylan-Gabapentin
Co-Gabapentin
GD-Gabapentin
Ran-Gabapentin
Auro-Gabapentin
Gabapentin
Jamp-Gabapentin
Mar-Gabapentin
02084260
02243446
02244304
02244513
02246314
02248259
02256142
02285819
02319055
02321203
02353245
02361469
02391473
PFI
PMS
APX
TEV
SIV
MYL
COB
GMD
RAN
ARO
SAS
JPC
MAR
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Cap Orl 300mg
Caps
Neurontin
pms-Gabapentin
Apo-Gabapentin
Teva-Gabapentin
Gabapentin
Mylan-Gabapentin
Co-Gabapentin
GD-Gabapentin
Ran-Gabapentin
Auro-Gabapentin
Gabapentin
Jamp-Gabapentin
Mar-Gabapentin
02084279
02243447
02244305
02244514
02246315
02248260
02256150
02285827
02319063
02321211
02353253
02361485
02391481
PFI
PMS
APX
TEV
SIV
MYL
COB
GMD
RAN
ARO
SAS
JPC
MAR
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
N03AX12
GABAPENTIN
GABAPENTINE
Page 148
N03AX12
GABAPENTIN
GABAPENTINE
Cap Orl 400mg
Caps
Neurontin
pms-Gabapentin
Apo-Gabapentin
Teva-Gabapentin
Gabapentin
Mylan-Gabapentin
Co-Gabapentin
ratio-Gabapentin
GD-Gabapentin
Ran-Gabapentin
Auro-Gabapentin
Gabapentin
Jamp-Gabapentin
Mar-Gabapentin
02084287
02243448
02244306
02244515
02246316
02248261
02256169
02260905
02285835
02319071
02321238
02353261
02361493
02391503
PFI
PMS
APX
TEV
SIV
MYL
COB
RPH
GMD
RAN
ARO
SAS
JPC
MAR
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
600mg
Neurontin
pms-Gabapentin
Apo-Gabapentin
Teva-Gabapentin
GD-Gabapentin
Gabapentin
Mylan-Gabapentin
Jamp-Gabapentin
02239717
02255898
02293358
02248457
02285843
02392526
02397471
02402289
PFI
PMS
APX
TEV
GMD
AHI
MYL
JPC
f
f
f
f
f
f
f
F
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
800mg
Neurontin
pms-Gabapentin
Apo-Gabapentin
Teva-Gabapentin
GD-Gabapentin
Gabapentin
Mylan-Gabapentin
Jamp-Gabapentin
02239718
02255901
02293366
02247346
02285851
02392534
02397498
02402297
PFI
PMS
APX
TEV
GMD
AHI
MYL
JPC
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
N03AX16
PREGABALIN
PREGABALIN
Cap Orl
Caps
25mg
Lyrica
Co-Pregabalin
pms-Pregabalin
Ran-Pregabalin
Sandoz Pregabalin
Teva-Pregabalin
Apo-Pregabalin
GD-Pregabalin
Pregabalin
02268418
02402912
02359596
02392801
02390817
02361159
02394235
02360136
02405539
PFI
COB
PMS
RAN
SDZ
TEV
APX
GMD
SAS
f
f
f
f
f
f
f
f
f
W
W
W
W
W
W
W
W
W
Cap Orl
Caps
50mg
Lyrica
Co-Pregabalin
pms-Pregabalin
Ran-Pregabalin
Sandoz Pregabalin
Teva-Pregabalin
Apo-Pregabalin
GD-Pregabalin
Pregabalin
02268426
02402920
02359618
02392828
02390825
02361175
02394243
02360144
02405547
PFI
COB
PMS
RAN
SDZ
TEV
APX
GMD
SAS
f
f
f
f
f
f
f
f
f
W
W
W
W
W
W
W
W
W
Page 149
N03AX16
PREGABALIN
PREGABALIN
Cap Orl
Caps
75mg
Lyrica
Co-Pregabalin
pms-Pregabalin
Ran-Pregabalin
Sandoz Pregabalin
Teva-Pregabalin
Apo-Pregabalin
GD-Pregabalin
Pregabalin
02268434
02402939
02359626
02392836
02390833
02361183
02394251
02360152
02405555
PFI
COB
PMS
RAN
SDZ
TEV
APX
GMD
SAS
f
f
f
f
f
f
f
f
f
W
W
W
W
W
W
W
W
W
Cap Orl
Caps
150mg
Lyrica
Co-Pregabalin
pms-Pregabalin
Ran-Pregabalin
Sandoz Pregabalin
Teva-Pregabalin
Apo-Pregabalin
GD-Pregabalin
Pregabalin
02268450
02402955
02359634
02392844
02390841
02361205
02394278
02360179
02405563
PFI
COB
PMS
RAN
SDZ
TEV
APX
GMD
SAS
f
f
f
f
f
f
f
f
f
W
W
W
W
W
W
W
W
W
Cap Orl
Caps
225mg
Lyrica
Co-Pregabalin
Teva-Pregabalin
pms-Pregabalin
Ran-Pregabalin
Apo-Pregabalin
GD-Pregabalin
02268477
02402971
02361221
02398079
02392852
02394286
02360195
PFI
COB
TEV
PMS
RAN
APX
GMD
f
f
f
f
f
f
f
W
W
W
W
W
W
W
Cap Orl
Caps
300mg
Lyrica
Co-Pregabalin
pms-Pregabalin
Sandoz Pregabalin
Ran-Pregabalin
Teva-Pregabalin
Apo-Pregabalin
GD-Pregabalin
Pregabalin
02268485
02402998
02359642
02390868
02392860
02361248
02394294
02360209
02405598
PFI
COB
PMS
SDZ
RAN
TEV
APX
GMD
SAS
f
f
f
f
f
f
f
f
f
W
W
W
W
W
W
W
W
W
N04
ANTI-PARKINSON DRUGS
MÉDICAMENTS ANTI-PARKINSON
N04A
ANTI-CHOLINERGIC AGENTS
AGENTS ANTI-CHOLINERGIQUES
N04AA
TERTIARY AMINES
AMINES TERTIAIRES
N04AA01
TRIHEXYPHENIDYL
TRIHEXYPHÉNIDYLE
Tab
Co.
Orl 2mg
Trihex
00545058
AAP
f
AEFGVW
Tab
Co.
Orl 5mg
Trihex
00545074
AAP
f
AEFGVW
Page 150
N04AA04
Elx Orl 0.5mg
Elx.
pms-Procyclidine
00587362
PMS
AEFGVW
Tab
Co.
Orl 2.5mg
pms-Procyclidine
00649392
PMS
AEFGVW
Tab
Co.
Orl 5mg
pms-Procyclidine
00587354
PMS
AEFGVW
Parsitan
01927744
ERF
AEFGVW
Benztropine Omega
02238903
OMG
VW
pms-Benztropine
00706531
PMS
AEFGVW
Benztropine
pms-Benztropine (Disc/non disp Sep 24/14)
00426857
00587265
PMS
PMS
Prolopa
00522597
HLR
AEFGVW
Cap Orl 100mg/25mg
Caps
Prolopa
00386464
HLR
AEFGVW
Cap Orl 200mg/50mg
Caps
Prolopa
00386472
HLR
AEFGVW
Sinemet CR
Levocarb CR
02028786
02272873
FRS
AAP
f
f
AEFVW
AEFVW
Sinemet CR
Levocarb CR
Page 151
00870935
02245211
FRS
AAP
f
f
AEFVW
AEFVW
N04AA05
Tab
Co.
N04AC
PROCYCLIDINE
PROCYCLIDINE
PROFENAMINE (ETHOPROPAZINE)
PROFÉNAMINE (ÉTHOPROPAZINE)
Orl 50mg
ETHERS OF TROPINE OR TROPINE DERIVATIVES
ÉTHERS DE TROPINE OU DÉRIVÉS DU TROPINE
N04AC01
Liq
Liq
BENZYTROPINE
BENZYTROPINE
Inj
1mg
Tab
Co.
Orl 1mg
Tab
Co.
Orl
2mg
N04B
DOPAMINERGIC AGENTS
AGENTS DOPAMINERGIQUES
N04BA
DOPA AND DOPA DERIVATIVES
DOPA ET DÉRIVÉS DU DOPA
N04BA02
f
AEFGVW
AEFGVW
LEVODOPA AND DECARBOXYLASE INHIBITOR
LÉVODOPA ET INHIBITEUR DU DÉCARBOXYLASE
LEVODOPA / BENSERAZIDE
LÉVODOPA / BÉNSERAZIDE
Cap Orl 50mg/12.5mg
Caps
LEVODOPA / CARBIDOPA
LÉVODOPA / CARBIDOPA
SRT Orl 100mg/25mg
Co.L.L.
SRT Orl 200mg/50mg
Co.L.L.
N04BA02
LEVODOPA AND DECARBOXYLASE INHIBITOR
LÉVODOPA ET INHIBITEUR DU DÉCARBOXYLASE
LEVODOPA / CARBIDOPA
LÉVODOPA / CARBIDOPA
Tab
Co.
Orl 100mg/10mg
Sinemet
Apo-Levocarb
Teva-Levocarbidopa
00355658
02195933
02244494
FRS
APX
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 100mg/25mg
Sinemet
Apo-Levocarb
Teva-Levocarbidopa
00513997
02195941
02244495
FRS
APX
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 250mg/25mg
Sinemet
Apo-Levocarb
Teva-Levocarbidopa
00328219
02195968
02244496
FRS
APX
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
pms-Amantadine Hydrochloride
Mylan-Amantadine (Disc/non disp Jul 4/15)
01990403
02139200
PMS
MYL
f
f
AEFGVW
AEFGVW
pms-Amantadine
02022826
PMS
f
AEFGVW
N04BB
ADAMANTINE DERIVATIVES
DÉRIVÉS DE L’ADAMANTINE
N04BB01 AMANTADINE
AMANTADINE
Cap Orl 100mg
Caps
Syr
Sir.
Orl
10mg
N04BC
DOPAMINE AGONISTS
AGONISTES DE LA DOPAMINE
N04BC04 ROPINIROLE
ROPINIROLE
Tab
Co.
Orl 0.25mg
Requip
Ran-Ropinirole
Co Ropinirole
pms-Ropinirole
Jamp-Ropinirole
Ropinirole
02232565
02314037
02316846
02326590
02352338
02353040
GSK
RAN
COB
PMS
JPC
SAS
f
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
Tab
Co.
Orl 1mg
Requip
Ran-Ropinirole
Co Ropinirole
pms-Ropinirole
Jamp-Ropinirole
Ropinirole
02232567
02314053
02316854
02326612
02352346
02353059
GSK
RAN
COB
PMS
JPC
SAS
f
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
Tab
Co.
Orl 2mg
Requip
Ran-Ropinirole
Co Ropinirole
pms-Ropinirole
Jamp-Ropinirole
Ropinirole
02232568
02314061
02316862
02326620
02352354
02353067
GSK
RAN
COB
PMS
JPC
SAS
f
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
Page 152
N04BC04
Tab
Co.
N04BC05
N04BD
ROPINIROLE
ROPINIROLE
Orl 5mg
Requip
Ran-Ropinirole
Co Ropinirole
pms-Ropinirole
Jamp-Ropinirole
Ropinirole
02232569
02314088
02316870
02326639
02352362
02353075
GSK
RAN
COB
PMS
JPC
SAS
f
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
PRAMIPEXOLE
PRAMIPEXOLE
Tab
Co.
Orl 0.25mg
Mirapex
Teva-Pramipexole
pms-Pramipexole
Apo-Pramipexole
Co Pramipexole
Sandoz Pramipexole
Mylan-Pramipexole
02237145
02269309
02290111
02292378
02297302
02315262
02376350
BOE
TEV
PMS
APX
COB
SDZ
MYL
f
f
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
Tab
Co.
Orl 0.5mg
Mirapex
Teva-Pramipexole
pms-Pramipexole
Apo-Pramipexole
Co Pramipexole
Sandoz Pramipexole
Mylan-Pramipexole
02241594
02269317
02290138
02292386
02297310
02315270
02376369
BOE
TEV
PMS
APX
COB
SDZ
MYL
f
f
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
Tab
Co.
Orl 1mg
Mirapex
Teva-Pramipexole
pms-Pramipexole
Apo-Pramipexole
Co Pramipexole
Sandoz Pramipexole
Mylan-Pramipexole
02237146
02269325
02290146
02292394
02297329
02315289
02376377
BOE
TEV
PMS
APX
COB
SDZ
MYL
f
f
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
Tab
Co.
Orl 1.5mg
Mirapex
Teva-Pramipexole
pms-Pramipexole
Apo-Pramipexole
Co Pramipexole
Sandoz Pramipexole
Mylan-Pramipexole
02237147
02269333
02290154
02292408
02297337
02315297
02376385
BOE
TEV
PMS
APX
COB
SDZ
MYL
f
f
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
02068087
02230641
02231036
TEV
APX
MYL
f
f
f
AEFVW
AEFVW
AEFVW
MONOAMINE OXIDASE TYPE B INHIBITORS
OXIDASE DE MONOAMINE, INHIBITEURS DE TYPE B
N04BD01
Tab
Co.
SELEGILINE
SÉLÉGILINE
Orl 5mg
Novo-Selegiline
Apo-Selegiline
Mylan-Selegiline
Page 153
N05
PSYCHOLEPTICS
PSYCHOLEPTIQUES
N05A
ANTIPSYCHOTICS
ANTIPSYCHOTIQUES
N05AA
PHENOTHIAZINE WITH ALIPHATIC SIDE CHAIN
PHÉNOTHIAZINE AVEC CHAÎNE LATÉRALE ALIPHATIQUE
N05AA01
Tab
Co.
Orl 25mg
Teva-Chlorpromazine
00232823
TEV
AEFGVW
Tab
Co.
Orl 50mg
Teva-Chlorpromazine
00232807
TEV
AEFGVW
Tab
Co.
Orl 100mg
Teva-Chlorpromazine
00232831
TEV
AEFGVW
AEFVW
N05AA02
Liq
Liq
N05AB
CHLORPROMAZINE
CHLORPROMAZINE
LEVOMEPROMAZINE (METHOTRIMEPRAZINE)
LÉVOMÉPROMAZINE (MÉTHOTRIMÉPRAZINE)
Inj
25mg
Nozinan
01927698
SAV
Tab
Co.
Orl 2mg
Methoprazine
02238403
AAP
f
AEFGVW
Tab
Co.
Orl 5mg
Methoprazine
02238404
AAP
f
AEFGVW
Tab
Co.
Orl 25mg
Methoprazine
02238405
AAP
f
AEFGVW
Tab
Co.
Orl 50mg
Methoprazine
02238406
AAP
f
AEFGVW
PHENOTHIAZINE WITH PIPERAZINE STRUCTURE
PHÉNOTHIAZINE À STRUCTURE DE PIPÉRAZINE
N05AB02
FLUPHENAZINE
FLUPHÉNAZINE
Liq
Liq
Inj 25mg
Fluphenazine (Disc/non disp Nov 20/14) *
02239636
OMG
Liq
Liq
Inj 100mg
Modecate conc *
Fluphenazine (Disc/non disp Nov 20/14) *
00755575
02242570
BRI
OMG
Fluphenazine
00405345
AAP
Tab Orl
Co.
1mg
Page 154
AEFGVW
f
AEFGVW
AEFGVW
AEFGVW
N05AB02
FLUPHENAZINE
FLUPHÉNAZINE
Tab
Co.
Orl 2mg
Fluphenazine
00410632
AAP
AEFGVW
Tab
Co.
Orl 5mg
Fluphenazine
00405361
AAP
AEFGVW
N05AB03
PERPHENAZINE
PERPHÉNAZINE
Tab Orl
Co.
2mg
Perphenazine
00335134
AAP
f
AEFGVW
Tab Orl
Co.
4mg
Perphenazine
00335126
AAP
f
AEFGVW
Tab
Co.
Orl 8mg
Perphenazine
00335118
AAP
f
AEFGVW
Tab
Co.
Orl 16mg
Perphenazine
00335096
AAP
f
AEFGVW
pms-Prochlorperazine
00753688
PMS
AEFGVW
Prochlorazine
pms-Prochlorperazine (Disc/non disp Feb 7/14)
00886440
00753661
AAP
PMS
AEFGVW
AEFGVW
Prochlorazine
pms-Prochlorperazine (Disc/non disp Feb 7/14)
00886432
00753637
AAP
PMS
AEFGVW
AEFGVW
Trifluoperazine
00345539
AAP
f
AEFGVW
2mg
Trifluoperazine
00312754
AAP
f
AEFGVW
Tab
Co.
Orl 5mg
Trifluoperazine
00312746
AAP
f
AEFGVW
Tab
Co.
Orl 10mg
Trifluoperazine
00326836
AAP
f
AEFGVW
01926780
ERF
N05AB04
PROCHLORPERAZINE
PROCHLORPÉRAZINE
Sup Rt 10mg
Supp
Tab Orl
Co.
Tab
Co.
5mg
Orl 10mg
N05AB06
TRIFLUOPERAZINE
TRIFLUOPÉRAZINE
Tab Orl 1mg
Co.
Tab Orl
Co.
N05AC
PHENOTHIAZINE WITH PIPERIDINE STRUCTURE
PHÉNOTHIAZINES À STRUCTURE DE PIPÉRIDINE
N05AC01
PERICYAZINE
PÉRICYAZINE
Cap Orl 5mg
Caps
Neuleptil
Page 155
AEFGVW
N05AC01
Cap Orl 10mg
Caps
Neuleptil
01926772
ERF
AEFGVW
Cap Orl 20mg
Caps
Neuleptil
01926764
ERF
AEFGVW
Dps Orl
Gttes
Neuleptil
01926756
ERF
AEFGVW
N05AC04
N05AD
PERICYAZINE
PÉRICYAZINE
10mg
PIPOTIAZINE
PIPOTIAZINE
Liq
Liq
Inj 25mg
Piportil L4 *
01926667
SAV
AEFGVW
Liq
Liq
Inj 50mg
Piportil L4 *
01926675
SAV
AEFGVW
Haloperidol *
00808652
SDZ
AEFGVW
Novo-Peridol
Apo-Haloperidol (Disc/non disp Dec 09/15)
00363685
00396796
TEV
APX
f
f
AEFGVW
AEFGVW
BUTYROPHENONE DERIVATIVES
DÉRIVÉS DU BUTYROPHÉNONE
N05AD01
Liq
Liq
HALOPERIDOL
HALOPÉRIDOL
Inj
5mg
Tab
Co.
Orl 0.5mg
Tab
Co.
Orl 1mg
Novo-Peridol
Apo-Haloperidol
00363677
00396818
TEV
APX
f
f
AEFGVW
AEFGVW
Tab
Co.
Orl 2mg
Novo-Peridol
Apo-Haloperidol (Disc/non disp Apr 10/15)
00363669
00396826
TEV
APX
f
f
AEFGVW
AEFGVW
Tab
Co.
Orl 5mg
Novo-Peridol
Apo-Haloperidol (Disc/non disp Apr 10/15)
00363650
00396834
TEV
APX
f
f
AEFGVW
AEFGVW
Tab
Co.
Orl 10mg
Novo-Peridol
Apo-Haloperidol
00713449
00463698
TEV
APX
f
f
AEFGVW
AEFGVW
Liq
Liq
Inj 50mg
Haloperidol LA *
Haloperidol (Disc/non disp Nov 20/14)*
02130297
02239639
SDZ
OMG
f
AEFGVW
AEFGVW
Liq
Liq
Inj 100mg
Haloperidol LA *
Haloperidol (Disc/non disp Nov 20/14) *
02130300
02239640
SDZ
OMG
f
AEFGVW
AEFGVW
Page 156
N05AE
INDOLE DERIVATIVES
DÉRIVÉS DE L’INDOLE
N05AE04
N05AF
Cap Orl 20mg
Caps
Zeldox
02298597
PFI
AEFGVW
Cap Orl 40mg
Caps
Zeldox
02298600
PFI
AEFGVW
Cap Orl 60mg
Caps
Zeldox
02298619
PFI
AEFGVW
Cap Orl 80mg
Caps
Zeldox
02298627
PFI
AEFGVW
THIOXANTHENE DERIVATIVES
DÉRIVÉS DU THIOXANTHÉNE
N05AF01
FLUPENTHIXOL
FLUPENTHIXOL
Tab
Co.
Orl 0.5mg
Fluanxol
02156008
VLH
AEFGVW
Tab
Co.
Orl 3mg
Fluanxol
02156016
VLH
AEFGVW
Liq Inj 20mg
Liq
Fluanxol Depot*
02156032
VLH
AEFGVW
Liq Inj 100mg
Liq
Fluanxol Depot*
02156040
VLH
Cap Orl 2mg
Caps
Navane
00024430
ERF
AEFGVW
Cap Orl 5mg
Caps
Navane
00024449
ERF
AEFGVW
Cap Orl 10mg
Caps
Navane
00024457
ERF
AEFGVW
N05AF04
N05AG
ZIPRASIDONE
ZIPRASIDONE
f
AEFGVW
THIOTHIXENE
THIOTHIXÉNE
DIPHENYLBUTYLPIPERIDINE DERIVATIVES
DÉRIVÉS DE LA DIPHÉNYLBUTYLPIPÉRIDINE
N05AG02
PIMOZIDE
PIMOZIDE
Tab
Co.
Orl 2mg
Orap
Apo-Pimozide
00313815
02245432
PDP
APX
f
f
AEFGVW
AEFGVW
Tab
Co.
Orl 4mg
Orap
Apo-Pimozide
00313823
02245433
PDP
APX
f
f
AEFGVW
AEFGVW
Page 157
N05AH
DIAZEPINES, OXAZEPINES, THIAZEPINES AND OXEPINES
DIAZÉPINES, OXAZÉPINES, THIAZÉPINES ET OXÉPINNES
N05AH01
LOXAPINE
LOXAPINE
Tab
Co.
Orl 2.5mg
Xylac
02242868
PDP
Tab
Co.
Orl 5mg
Xylac
02230837
PDP
f
AEFGVW
Tab
Co.
Orl 10mg
Xylac
02230838
PDP
f
AEFGVW
Tab
Co.
Orl 25mg
Xylac
02230839
PDP
f
AEFGVW
Tab
Co.
Orl 50mg
Xylac
02230840
PDP
f
AEFGVW
N05AH02
AEFGVW
CLOZAPINE
CLOZAPINE
Tab
Co.
Orl 25mg
Clozaril
20
Gen-Clozapine
20
Apo-Clozapine
20
00894737
02247243
02248034
NVR
MYL
APX
f
f
f
AEFGV
AEFGV
AEFGV
Tab
Co.
Orl 100mg
Clozaril
20
Gen-Clozapine
20
Apo-Clozapine
20
00894745
02247244
02248035
NVR
MYL
APX
f
f
f
AEFGV
AEFGV
AEFGV
21
02243086
02243086
02303191
02303191
02321343
02321343
02327562
02327562
02327775
02327775
02352974
02352974
02360616
02360616
02382709
02382709
LIL
LIL
PMS
PMS
TEV
TEV
COB
COB
SDZ
SDZ
SAS
SAS
APX
APX
MYL
MYL
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
N05AH03
OLANZAPINE
OLANZAPINE
ODT Orl 5mg
Co.D.O.
20
Zyprexa Zydis
Zyprexa Zydis
21
pms-Olanzapine ODT
pms-Olanzapine ODT
21
Teva-Olanzapine ODT
Teva-Olanzapine ODT
21
Co Olanzapine ODT
Co Olanzapine ODT
21
Sandoz Olanzapine ODT
21
Olanzapine ODT
Olanzapine ODT
21
Apo-Olanzapine ODT
Apo-Olanzapine ODT
21
Mylan-Olanzapine ODT
Requests for coverage of Clozaril (Clozapine) will be considered under special authorization, see Appendix IV.
Prescriptions written by Psychiatrists do not require special authorization. Subsequent refills may be ordered by other
practitioners.
Les demandes de protection pour le Clozaril (Clozapine) seront examinees sur atorisation special. Veuillez consulter
l’annexe IV. Les ordonnances des psychiatres ne nécessitent pas une autorisation spéciale. Une autorisation special ne sera
pas nécessaire pour les renovellements subséquents prescripts pas les autres pratciens.
Page 158
N05AH03
OLANZAPINE
OLANZAPINE
ODT Orl 5mg
Co.D.O.
Mar-Olanzapine ODT
Mar-Olanzapine ODT
21
02389088
02389088
MAR
MAR
f
f
AEFGV
W
ODT Orl
Co.D.O.
10mg
Zyprexa Zydis
Zyprexa Zydis
21
pms-Olanzapine ODT
pms-Olanzapine ODT
21
Teva-Olanzapine ODT
Teva-Olanzapine ODT
21
Co Olanzapine ODT
Co Olanzapine ODT
21
21
Olanzapine ODT
Olanzapine ODT
21
Apo-Olanzapine ODT
Apo-Olanzapine ODT
21
21
Mar-Olanzapine ODT
Mar-Olanzapine ODT
21
02243087
02243087
02303205
02303205
02321351
02321351
02327570
02327570
02327783
02327783
02352982
02352982
02360624
02360624
02382717
02382717
02389096
02389096
LIL
LIL
PMS
PMS
TEV
TEV
COB
COB
SDZ
SDZ
SAS
SAS
APX
APX
MYL
MYL
MAR
MAR
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
ODT Orl
Co.D.O.
15mg
Zyprexa Zydis
Zyprexa Zydis
21
pms-Olanzapine ODT
pms-Olanzapine ODT
21
Teva-Olanzapine ODT
Teva-Olanzapine ODT
21
Co Olanzapine ODT
Co Olanzapine ODT
21
21
Olanzapine ODT
Olanzapine ODT
21
Apo-Olanzapine ODT
Apo-Olanzapine ODT
21
21
Mar-Olanzapine ODT
Mar-Olanzapine ODT
21
02243088
02243088
02303213
02303213
02321378
02321378
02327589
02327589
02327791
02327791
02352990
02352990
02360632
02360632
02382725
02382725
02389118
02389118
LIL
LIL
PMS
PMS
TEV
TEV
COB
COB
SDZ
SDZ
SAS
SAS
APX
APX
MYL
MYL
MAR
MAR
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
ODT Orl
Co.D.O.
20mg
Zyprexa Zydis
Zyprexa Zydis
21
Teva-Olanzapine ODT
Teva-Olanzapine ODT
21
Co Olanzapine ODT
Co Olanzapine ODT
21
21
Apo-Olanzapine ODT
Apo-Olanzapine ODT
21
21
02243089
02243089
02321386
02321386
02327597
02327597
02327805
02327805
02360640
02360640
02382733
LIL
LIL
TEV
TEV
COB
COB
SDZ
SDZ
APX
APX
MYL
f
f
f
f
f
f
f
f
f
f
f
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
Page 159
N05AH03
OLANZAPINE
OLANZAPINE
ODT Orl 20mg
Co.D.O.
21
Mar-Olanzapine ODT
Mar-Olanzapine ODT
02382733
02389126
02389126
MYL
MAR
MAR
f
f
f
W
AEFGV
W
Tab
Co.
Orl 2.5mg
Zyprexa
Zyprexa
21
Teva-Olanzapine
Teva-Olanzapine
21
Apo-Olanzapine
Apo-Olanzapine
21
pms-Olanzapine
pms-Olanzapine
21
Sandoz Olanzapine
Sandoz Olanzapine
21
Co Olanzapine
Co Olanzapine
21
Mylan-Olanzapine
Mylan-Olanzapine
21
Olanzapine
Olanzapine
21
Ran-Olanzapine
Ran-Olanzapine
21
02229250
02229250
02276712
02276712
02281791
02281791
02303116
02303116
02310341
02310341
02325659
02325659
02337878
02337878
02372819
02372819
02403064
02403064
LIL
LIL
TEV
TEV
APX
APX
PMS
PMS
SDZ
SDZ
COB
COB
MYL
MYL
SAS
SAS
RAN
RAN
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
Tab
Co.
Orl 5mg
Zyprexa
Zyprexa
21
Teva-Olanzapine
Teva-Olanzapine
21
Apo-Olanzapine
Apo-Olanzapine
21
pms-Olanzapine
pms-Olanzapine
21
Sandoz Olanzapine
Sandoz Olanzapine
21
Co Olanzapine
Co Olanzapine
21
Mylan-Olanzapine
Mylan-Olanzapine
21
Olanzapine
Olanzapine
21
Ran-Olanzapine
Ran-Olanzapine
21
02229269
02229269
02276720
02276720
02281805
02281805
02303159
02303159
02310368
02310368
02325667
02325667
02337886
02337886
02372827
02372827
02403072
02403072
LIL
LIL
TEV
TEV
APX
APX
PMS
PMS
SDZ
SDZ
COB
COB
MYL
MYL
SAS
SAS
RAN
RAN
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
Tab
Co.
Orl 7.5mg
Zyprexa
Zyprexa
21
Teva-Olanzapine
Teva-Olanzapine
21
Apo-Olanzapine
Apo-Olanzapine
21
pms-Olanzapine
pms-Olanzapine
21
Sandoz Olanzapine
Sandoz Olanzapine
21
02229277
02229277
02276739
02276739
02281813
02281813
02303167
02303167
02310376
02310376
LIL
LIL
TEV
TEV
APX
APX
PMS
PMS
SDZ
SDZ
f
f
f
f
f
f
f
f
f
f
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
Page 160
N05AH03
OLANZAPINE
OLANZAPINE
Tab Orl 7.5mg
Co.
Co Olanzapine
Co Olanzapine
21
Mylan-Olanzapine
Mylan-Olanzapine
21
Olanzapine
Olanzapine
21
Ran-Olanzapine
Ran-Olanzapine
21
02325675
02325675
02337894
02337894
02372835
02372835
02403080
02403080
COB
COB
MYL
MYL
SAS
SAS
RAN
RAN
f
f
f
f
f
f
f
f
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
Tab
Co.
Orl 10mg
Zyprexa
Zyprexa
21
Teva-Olanzapine
Teva-Olanzapine
21
Apo-Olanzapine
Apo-Olanzapine
21
pms-Olanzapine
pms-Olanzapine
21
Sandoz Olanzapine
Sandoz Olanzapine
21
Co Olanzapine
Co Olanzapine
21
Mylan-Olanzapine
Mylan-Olanzapine
21
Olanzapine
Olanzapine
21
Ran-Olanzapine
Ran-Olanzapine
21
02229285
02229285
02276747
02276747
02281821
02281821
02303175
02303175
02310384
02310384
02325683
02325683
02337908
02337908
02372843
02372843
02403099
02403099
LIL
LIL
TEV
TEV
APX
APX
PMS
PMS
SDZ
SDZ
COB
COB
MYL
MYL
SAS
SAS
RAN
RAN
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
Tab
Co.
Orl 15mg
Zyprexa
Zyprexa
21
Teva-Olanzapine
Teva-Olanzapine
21
Apo-Olanzapine
Apo-Olanzapine
21
pms-Olanzapine
pms-Olanzapine
21
Sandoz Olanzapine
Sandoz Olanzapine
21
Co Olanzapine
Co Olanzapine
21
Mylan-Olanzapine
Mylan-Olanzapine
21
Ran-Olanzapine
Ran-Olanzapine
21
02238850
02238850
02276755
02276755
02281848
02281848
02303183
02303183
02310392
02310392
02325691
02325691
02337916
02337916
02403102
02403102
LIL
LIL
TEV
TEV
APX
APX
PMS
PMS
SDZ
SDZ
COB
COB
MYL
MYL
RAN
RAN
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
AEFGV
W
Page 161
N05AH03
OLANZAPINE
OLANZAPINE
Tab Orl 15mg
Co.
N05AH04
21
Olanzapine
Olanzapine
21
02372851
02372851
SAS
SAS
f
f
AEFGV
W
QUETIAPINE
QUÉTIAPINE
ERT Orl
Co.L.P.
50mg
Seroquel XR
Teva-Quetiapine XR
Sandoz Quetiapine XR
02300184
02395444
02407671
AZE
TEV
SDZ
f
f
f
AEFGVW
AEFGVW
AEFGVW
ERT Orl
Co.L.P.
150mg
Seroquel XR
Teva-Quetiapine XR
02321513
02395452
02407698
AZE
TEV
SDZ
f
f
f
AEFGVW
AEFGVW
AEFGVW
ERT Orl
Co.L.P.
200mg
Seroquel XR
Teva-Quetiapine XR
02300192
02395460
02407701
AZE
TEV
SDZ
f
f
f
AEFGVW
AEFGVW
AEFGVW
ERT Orl
Co.L.P.
300mg
Seroquel XR
Teva-Quetiapine XR
02300206
02395479
02407728
AZE
TEV
SDZ
f
f
f
AEFGVW
AEFGVW
AEFGVW
ERT Orl
Co.L.P.
400mg
Seroquel XR
Teva-Quetiapine XR
02300214
02395487
02407736
AZE
TEV
SDZ
f
f
f
AEFGVW
AEFGVW
AEFGVW
Seroquel
Teva-Quetiapine
pms-Quetiapine
Phl-Quetiapine
Mylan-Quetiapine
Apo-Quetiapine
Sandoz Quetiapine
Co Quetiapine
Jamp-Quetiapine
Quetiapine
Auro-Quetiapine
Quetiapine
Ran-Quetiapine
Mar-Quetiapine
02236951
02284235
02296551
02299054
02307804
02313901
02313995
02316080
02330415
02353164
02390205
02387794
02397099
02399822
AZE
TEV
PMS
PHL
MYL
APX
SDZ
COB
JPC
SAS
ARO
AHI
RAN
MAR
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Seroquel
Teva-Quetiapine
pms-Quetiapine
Phl-Quetiapine
Mylan-Quetiapine
02236952
02284243
02296578
02299062
02307812
AZE
TEV
PMS
PHL
MYL
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 25mg
Tab
Co.
Orl 100mg
Requests for coverage of Zyprexa (Olanzapine) and Zyprexa Zydis (Olanzapine ODT) will be considered under special
authorization, see Appendix IV. Prescriptions written by New Brunswick psychiatrists do not require special authorization.
Subsequent refills ordered by other practitioners will not require special authorization.
Les demandes de protection pour le Zyprexa (Olanzapine) et le Zyprexa Zydis (Olanzapine ODT) seront examineées sur
autorisation spéciale. Veuillez consulter l’annexe IV. Les ordonnances rédigées par les psychiatres du Nouveau-Brunswick
ne requiérent pa d’autorisation spéciale. Les renouvellements precrits par d’autre praticiens ne nécessiteront pa
d’autorisation spéciale.
Page 162
N05AH04
N05AN
QUETIAPINE
QUÉTIAPINE
Tab
Co.
Orl 100mg
Apo-Quetiapine
Sandoz Quetiapine
Co Quetiapine
Jamp-Quetiapine
Quetiapine
Auro-Quetiapine
Quetiapine
Ran-Quetiapine
Mar-Quetiapine
02313928
02314002
02316099
02330423
02353172
02390213
02387808
02397102
02399830
APX
SDZ
COB
JPC
SAS
ARO
AHI
RAN
MAR
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 150mg
Teva-Quetiapine
02284251
TEV
f
AEFGVW
Tab
Co.
Orl
200mg
Seroquel
Teva-Quetiapine
pms-Quetiapine
Phl-Quetiapine
Mylan-Quetiapine
Apo-Quetiapine
Sandoz Quetiapine
Co Quetiapine
Jamp-Quetiapine
Quetiapine
Auro-Quetiapine
Quetiapine
Ran-Quetiapine
Mar-Quetiapine
02236953
02284278
02296594
02299089
02307839
02313936
02314010
02316110
02330458
02353199
02390248
02387824
02397110
02399849
AZE
TEV
PMS
PHL
MYL
APX
SDZ
COB
JPC
SAS
ARO
AHI
RAN
MAR
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 300mg
Seroquel
Teva-Quetiapine
pms-Quetiapine
Phl-Quetiapine
Mylan-Quetiapine
Apo-Quetiapine
Sandoz Quetiapine
Co Quetiapine
Jamp-Quetiapine
Quetiapine
Auro-Quetiapine
Quetiapine
Ran-Quetiapine
Mar-Quetiapine
02244107
02284286
02296608
02299097
02307847
02313944
02314029
02316129
02330466
02353202
02390256
02387832
02397129
02399857
AZE
TEV
PMS
PHL
MYL
APX
SDZ
COB
JPC
SAS
ARO
AHI
RAN
MAR
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Lithane
Apo-Lithium Carbonate
Carbolith
pms-Lithium Carbonate
02013231
02242837
00461733
02216132
ERF
APX
VLN
PMS
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
LITHIUM
LITHIUM
N05AN01
LITHIUM
LITHIUM
Cap Orl 150mg
Caps
Page 163
N05AN01
Cap Orl 300mg
Caps
Lithane
Apo-Lithium Carbonate
Carbolith
pms-Lithium Carbonate
00406775
02242838
00236683
02216140
ERF
APX
VLN
PMS
Cap Orl 600mg
Caps
Carbolith
02011239
VLN
SRT Orl 300mg
Co.L.L.
Lithmax SR
02266695
AAP
pms-Lithium Citrate
02074834
PMS
Risperdal
pms-Risperidone
Apo-Risperidone
02236950
02279266
02280396
JAN
PMS
APX
Risperdal M
22
Risperdal M
02247704
02247704
JAN
JAN
Liq
Liq
N05AX
LITHIUM
LITHIUM
Orl
8mmol/5mL
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
f
AEFGVW
AEFGVW
OTHER ANTIPSYCHOTICS
AUTRES ANTIPSYCHOTIQUES
N05AX08
Liq
Liq
RISPERIDONE
RISPÉRIDONE
Orl
1mg
f
f
f
AEFGVW
AEFGVW
AEFGVW
ODT Orl
Co.D.O.
0.5mg
ODT Orl
Co.D.O.
1mg
Risperdal M
22
Risperdal M
pms-Risperidone ODT
22
pms-Risperidone ODT
02247705
02247705
02291789
02291789
JAN
JAN
PMS
PMS
f
f
f
f
W
AEFGV
W
AEFGV
ODT Orl
Co.D.O.
2mg
Risperdal M
22
Risperdal M
pms-Risperidone ODT
22
pms-Risperidone ODT
02247706
02247706
02291797
02291797
JAN
JAN
PMS
PMS
f
f
f
f
W
AEFGV
W
AEFGV
ODT Orl
Co.D.O.
3mg
Risperdal M
22
Risperdal M
pms-Risperidone ODT
22
pms-Risperidone ODT
02268086
02268086
02370697
02370697
JAN
JAN
PMS
PMS
f
f
f
f
W
AEFGV
W
AEFGV
ODT Orl
Co.D.O.
4mg
Risperdal M
22
Risperdal M
pms-Risperidone ODT
22
pms-Risperidone ODT
02268094
02268094
02370700
02370700
JAN
JAN
PMS
PMS
f
f
f
f
W
AEFGV
W
AEFGV
22
W
AEFGV
Requests for coverage of Risperdal M (Risperidone ODT) will be considered under special authorization, see Appendix IV.
Prescriptions written by New Brunswick psychiatrists do not require special authorization. Subsequent refills ordered by other
practitioners will not require special authorization.
Les demandes de protection pour le Risperdal M (Risperidone ODT) seront examineées sur autorisation spéciale. Veuillez
consulter l’annexe IV. Les ordonnances rédigées par les psychiatres du Nouveau-Brunswick ne requiérent pa d’autorisation
spéciale. Les renouvellements precrits par d’autre praticiens ne nécessiteront pa d’autorisation spéciale
Page 164
N05AX08
RISPERIDONE
RISPÉRIDONE
Tab
Co.
Orl
0.25mg
Risperdal
pms-Risperidone
Phl-Risperidone
ratio-Risperidone(Disc/non disp Jul 2/15)
Ran-Risperidone (Disc/non disp Jun 13/14)
Apo-Risperidone
Mylan-Risperidone
Co Risperidone
Teva-Risperidone
Sandoz Risperidone
Ran-Risperidone
Risperidone
Jamp-Risperidone
Mint-Risperidone
Mar-Risperidone
02240551
02252007
02258439
02264757
02280906
02282119
02282240
02282585
02282690
02303655
02328305
02356880
02359529
02359790
02371766
JAN
PMS
PHL
RPH
RAN
APX
MYL
COB
TEV
SDZ
RAN
SAS
JPC
MNT
MAR
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
0.5mg
Risperdal
pms-Risperidone
Phl-Risperidone
ratio-Risperidone (Disc/non disp Jul 2/15)
Apo-Risperidone
Mylan-Risperidone
Co Risperidone
Teva-Risperidone
Sandoz Risperidone
Ran-Risperidone
Risperidone
Jamp-Risperidone
Mint-Risperidone
Mar-Risperidone
02240552
02252015
02258447
02264765
02280914
02282127
02282259
02282593
02264188
02303663
02328313
02356899
02359537
02359804
02371774
JAN
PMS
PHL
RPH
RAN
APX
MYL
COB
TEV
SDZ
RAN
SAS
JPC
MNT
MAR
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
1mg
Risperdal
pms-Risperidone
Phl-Risperidone
Apo-Risperidone
Mylan-Risperidone
Co Risperidone
Teva-Risperidone
Sandoz Risperidone
Ran-Risperidone
Risperidone
Jamp-Risperidone
Mint-Risperidone
Mar-Risperidone
02025280
02252023
02258455
02264773
02280922
02282135
02282267
02282607
02264196
02279800
02328321
02356902
02359545
02359812
02371782
JAN
PMS
PHL
RPH
RAN
APX
MYL
COB
TEV
SDZ
RAN
SAS
JPC
MNT
MAR
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
2mg
Risperdal
pms-Risperidone
Phl-Risperidone
02025299
02252031
02258463
02264781
JAN
PMS
PHL
RPH
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Page 165
N05AX08
RISPERIDONE
RISPÉRIDONE
Tab
Co.
Orl
2mg
Apo-Risperidone
Mylan-Risperidone
Co Risperidone
Teva-Risperidone
Sandoz Risperidone
Ran-Risperidone
Risperidone
Jamp-Risperidone
Mint-Risperidone
Mar-Risperidone
02280930
02282143
02282275
02282615
02264218
02279819
02328348
02356910
02359553
02359820
02371790
RAN
APX
MYL
COB
TEV
SDZ
RAN
SAS
JPC
MNT
MAR
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
3mg
Tab
Co.
Orl
3mg
Risperdal
pms-Risperidone
Phl-Risperidone
Apo-Risperidone
Mylan-Risperidone
Co Risperidone
Teva-Risperidone
Sandoz Risperidone
Ran-Risperidone
Risperidone
Jamp-Risperidone
Mint-Risperidone
Mar-Risperidone
02025302
02252058
02258471
02264803
02280949
02282151
02282283
02282623
02264226
02279827
02328364
02356929
02359561
02359839
02371804
JAN
PMS
PHL
RPH
RAN
APX
MYL
COB
TEV
SDZ
RAN
SAS
MPC
MNT
MAR
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
4mg
Risperdal
pms-Risperidone
Phl-Risperidone
Apo-Risperidone
Mylan-Risperidone
Co Risperidone
Teva-Risperidone
Sandoz Risperidone
Ran-Risperidone
Risperidone
Jamp-Risperidone
Mint-Risperidone
Mar-Risperidone
02025310
02252066
02258498
02264811
02282178
02282291
02282631
02264234
02279835
02328372
02356937
02359588
02359847
02371812
JAN
PMS
PHL
RPH
APX
MYL
COB
TEV
SDZ
RAN
SAS
MPC
MNT
MAR
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
00399728
SDZ
N05B
ANXIOLYTICS
ANXIOLYTIQUES
N05BA
DÉRIVÉS DU BENZODIAZEPINE
N05BA01
Liq
Liq
DIAZEPAM
DIAZÉPAM
Inj
5mg
Diazepam
Page 166
VW
N05BA01
DIAZEPAM
DIAZÉPAM
Tab
Co.
Orl 2mg
Apo-Diazepam
pms-Diazepam
00405329
02247490
APX
PMS
f
f
AEFGVW
AEFGVW
Tab
Co.
Orl 5mg
Valium
Apo-Diazepam
pms-Diazepam
00013285
00362158
02247491
HLR
APX
PMS
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 10mg
Apo-Diazepam
pms-Diazepam
00405337
02247492
APX
PMS
f
f
AEFGVW
AEFGVW
N05BA02
CHLORDIAZEPOXIDE
CHLORDIAZÉPOXIDE
Cap Orl
Cap
5mg
Chlordiazepoxide
00522724
AAP
f
AEFGVW
Cap Orl
Cap
10mg
Chlordiazepoxide
00522988
AAP
f
AEFGVW
Cap Orl
Cap
25mg
Chlordiazepoxide
00522996
AAP
f
AEFGVW
N05BA04
OXAZEPAM
OXAZÉPAM
Tab
Co.
Orl 10mg
Apo-Oxazepam
00402680
APX
f
AEFGVW
Tab
Co.
Orl 15mg
Apo-Oxazepam
00402745
APX
f
AEFGVW
Tab
Co.
Orl 30mg
Apo-Oxazepam
00402737
APX
f
AEFGVW
N05BA05
CLORAZEPATE DIPOTASSIUM
CLORAZÉPATE DIPOTASSIQUE
Cap Orl
Cap
3.75mg
Clorazepate
00860689
AAP
f
AEFGVW
Cap Orl
Cap
7.5mg
Clorazepate
00860700
AAP
f
AEFGVW
Cap Orl
Cap
15mg
Clorazepate
00860697
AAP
f
AEFGVW
Lorazepam
02243278
SDZ
AEFVW
Ativan SL
02041456
PFI
AEFGVW
N05BA06
Liq
Liq
LORAZEPAM
LORAZÉPAM
Inj
Slt Orl
Co.S.L.
4mg
0.5mg
Page 167
N05BA06
LORAZEPAM
LORAZÉPAM
Slt Orl
Co.S.L.
1mg
Ativan SL
02041464
PFI
AEFGVW
Slt Orl
Co.S.L.
2mg
Ativan SL
02041472
PFI
AEFGVW
Tab
Co.
Orl 0.5mg
Ativan
Novo-Lorazepam
pms-Lorazepam
Apo-Lorazepam
Lorazepam
02041413
00711101
00728187
00655740
02351072
PFI
TEV
PMS
APX
SAS
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 1mg
Ativan
Novo-Lorazepam
pms-Lorazepam
Apo-Lorazepam
Lorazepam
02041421
00637742
00728195
00655759
02351080
PFI
TEV
PMS
APX
SAS
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 2mg
Ativan
Novo-Lorazepam
pms-Lorazepam
Apo-Lorazepam
Lorazepam
02041448
00637750
00728209
00655767
02351099
PFI
TEV
PMS
APX
SAS
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Apo-Bromazepam
02177153
APX
f
AEFGVW
N05BA08
BROMAZEPAM
BROMAZÉPAM
Tab
Co.
Orl 1.5mg
Tab
Co.
Orl 3mg
Lectopam
Apo-Bromazepam
Novo-Bromazepam
00518123
02177161
02230584
HLR
APX
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 6mg
Lectopam
Apo-Bromazepam
Novo-Bromazepam
00518131
02177188
02230585
HLR
APX
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
Frisium
Novo-Clobazam
pms-Clobazam
Apo-Clobazam
02221799
02238334
02244474
02244638
LBK
TEV
PMS
APX
f
f
f
f
AEFGV
AEFGV
AEFGV
AEFGV
Xanax
Apo-Alpraz
Teva-Alprazolam
Mylan-Alprazolam
Alprazolam
00548359
00865397
01913484
02137534
02349191
PFI
APX
TEV
MYL
SAS
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
N05BA09
Tab
Co.
N05BA12
Tab
Co.
CLOBAZAM
CLOBAZAM
Orl 10mg
ALPRAZOLAM
ALPRAZOLAM
Orl 0.25mg
Page 168
N05BA12
Tab
Co.
N05BB
Orl 0.5mg
00548367
00865400
01913492
02137542
02349205
PFI
APX
TEV
MYL
SAS
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
HYDROXYZINE
HYDROXYZINE
Cap Orl
Cap
10mg
Apo-Hydroxyzine
Novo-Hydroxyzine
00646059
00738824
APX
TEV
f
f
AEFGVW
AEFGVW
Cap Orl
Cap
25mg
Apo-Hydroxyzine
Novo-Hydroxyzine
00646024
00738832
APX
TEV
f
f
AEFGVW
AEFGVW
Cap Orl
Cap
50mg
Apo-Hydroxyzine
Novo-Hydroxyzine
00646016
00738840
APX
TEV
f
f
AEFGVW
AEFGVW
Syr
Sir.
2mg
Atarax
pms-Hydroxyzine
00024694
00741817
ERF
PMS
Apo-Buspirone
pms-Buspirone
Novo-Buspirone
02211076
02230942
02231492
APX
PMS
TEV
pms-Chloral Hydrate
Chloral Hydrate Syrup Odan
00792659
02247621
PMS
ODN
Orl
AEFGVW
AEFGVW
AZASPIRODECANEDIONE DERIVATIVES
DÉRIVÉS DE L'AZASPIRODECANEDIONE
N05BE01
Tab
Co.
BUSPIRONE
BUSPIRONE
Orl 10mg
N05C
HYPNOTICS AND SEDATIVES
HYPNOTIQUES ET SEDATIFS
N05CC
ALDEHYDES AND DERIVATIVES
ALDEHYDES ET DÉRIVÉS
N05CC01
Syr
Sir.
N05CD
Xanax
Apo-Alpraz
Teva-Alprazolam
Mylan-Alprazolam
Alprazolam
DIPHENYLMETHANE DERIVATIVES
DÉRIVÉS DU DIPHENYLMETHANE
N05BB01
N05BE
ALPRAZOLAM
ALPRAZOLAM
f
f
f
AEFGVW
AEFGVW
AEFGVW
CHLORAL HYDRATE
CHLORAL (HYDRATE DE)
Orl 100mg
AEFGVW
AEFGVW
DÉRIVÉS DU BENZODIAZEPINE
N05CD01
FLURAZEPAM
FLURAZÉPAM
Cap Orl
Cap
15mg
Apo-Flurazepam
00521698
APX
f
AEFGVW
Cap Orl
Cap
30mg
Apo-Flurazepam
00521701
APX
f
AEFGVW
Page 169
N05CD02
NITRAZEPAM
NITRAZÉPAM
Tab
Co.
Orl 5mg
Mogadon
Nitrazadon
Sandoz Nitrazepam
Apo-Nitrazepam
00511528
02229654
02234003
02245230
AAP
VLN
SDZ
APX
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 10mg
Mogadon
Nitrazadon
Sandoz Nitrazepam
Apo-Nitrazepam
00511536
02229655
02234007
02245231
AAP
VLN
SDZ
APX
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Triazolam
00808563
AAP
f
AEFGVW
Triazolam
00808571
AAP
f
AEFGVW
Restoril
Apo-Temazepam
Novo-Temazapam
Co-Temazepam
00604453
02225964
02230095
02244814
SNV
APX
TEV
COB
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Restoril
Apo-Temazepam
Novo-Temazapam
Co-Temazepam
00604461
02225972
02230102
02244815
SNV
APX
TEV
COB
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Midazolam
02240285
SDZ
AEFVW
Midazolam
02240286
SDZ
AEFVW
Imovane
pms-Zopiclone
Apo-Zopiclone
ratio-Zopiclone
Novo-Zopiclone
Sandoz Zopiclone
Ran-Zopiclone
Co Zopiclone
Phl-Zopiclone
02216167
02243426
02245077
02246534
02251450
02257572
02267918
02271931
02294052
SAV
PMS
APX
TEV
TEV
SDZ
RAN
COB
PHL
N05CD05
TRIAZOLAM
TRIAZOLAM
Tab Orl 0.125mg
Co.
Tab
Co.
Orl 0.25mg
N05CD07
TEMAZEPAM
TÉMAZÉPAM
Cap Orl 15mg
Cap
Cap Orl
Cap
30mg
N05CD08
MIDAZOLAM
MIDAZOLAM
Liq Inj 1mg
Liq
Liq
Liq
Inj
5mg
N05CF
BENZODIAZEPINE RELATED DRUGS
MÉDICAMENTS LIÉS AU BENZODIAZÉPINE
N05CF01 ZOPICLONE
ZOPICLONE
Tab Orl 5mg
Co.
Page 170
f
f
f
f
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
N05CF01
ZOPICLONE
ZOPICLONE
Tab Orl 5mg
Co.
Tab
Co.
Orl 7.5mg
Mylan-Zopiclone
Zopiclone
Mar-Zopiclone
Mint-Zopiclone
Septa-Zopiclone
02296616
02344122
02386771
02391716
02386909
MYL
SAS
MAR
MNT
SPT
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
Imovane
Rhovane
pms-Zopiclone
Apo-Zopiclone
ratio-Zopiclone
Novo-Zopiclone
Sandoz Zopiclone
Ran-Zopiclone
Co Zopiclone
Phl-Zopiclone
Mylan-Zopiclone
Zopiclone
Jamp-Zopiclone
Mar-Zopiclone
Mint-Zopiclone
Septa-Zopiclone
01926799
02008203
02240606
02218313
02242481
02251469
02257580
02267926
02271958
02294060
02238596
02282445
02356805
02386798
02391724
02386917
SAV
SAV
PMS
APX
TEV
TEV
SDZ
RAN
COB
PHL
MYL
SAS
JPC
MAR
MNT
SPT
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
N06
PSYCHOANALEPTICS
PSYCHOANALEPTIQUES
N06A
ANTIDEPRESSANTS
ANTIDEPRESSIFS
N06AA
NON-SELECTIVE MONOAMINE REUPTAKE INHIBITORS
INHIBITEURS DE LA MONOAMINE NON SÉLECTIFS DU RECAPTAGE
N06AA01
DESIPRAMINE
DÉSIPRAMINE
Tab
Co.
Orl 10mg
Desipramine
02216248
AAP
f
AEFGVW
Tab
Co.
Orl 25mg
Desipramine
02216256
AAP
f
AEFGVW
Tab
Co.
Orl 50mg
Desipramine
02216264
AAP
f
AEFGVW
Tab
Co.
Orl 75mg
Desipramine
02216272
AAP
f
AEFGVW
Tab
Co.
Orl 100mg
Desipramine
02216280
AAP
f
AEFGVW
Imipramine
00360201
AAP
f
AEFGVW
N06AA02
Tab
Co.
IMIPRAMINE
IMIPRAMINE
Orl 10mg
Page 171
N06AA02
IMIPRAMINE
IMIPRAMINE
Tab
Co.
Orl 25mg
Imipramine
00312797
AAP
f
AEFGVW
Tab
Co.
Orl 50mg
Imipramine
00326852
AAP
f
AEFGVW
Tab
Co.
Orl 75mg
Imipramine
00644579
AAP
f
AEFGVW
N06AA04
CLOMIPRAMINE
CLOMIPRAMINE
Tab
Co.
Orl 10mg
Anafranil
Apo-Clomipramine
00330566
02040786
SNV
APX
f
f
AEFGVW
AEFGVW
Tab
Co.
Orl 25mg
Anafranil
Apo-Clomipramine
Co-Clomipramine
00324019
02040778
02244817
SNV
APX
COB
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 50mg
Anafranil
Apo-Clomipramine
Co-Clomipramine
00402591
02040751
02244818
SNV
APX
COB
f
f
f
AEFGVW
AEFGVW
AEFGVW
N06AA06
TRIMIPRAMINE
TRIMIPRAMINE
Tab
Co.
Orl 12.5mg
Trimipramine
00740799
AAP
f
AEFGVW
Tab
Co.
Orl
25mg
Trimipramine
00740802
AAP
f
AEFGVW
Tab
Co.
Orl
50mg
Trimipramine
00740810
AAP
f
AEFGVW
Cap
Cap
Orl
75mg
Trimipramine
02070987
AAP
f
AEFGVW
Tab
Co.
Orl 100mg
Trimipramine
00740829
AAP
f
AEFGVW
N06AA09
AMITRIPTYLINE
AMITRIPTYLINE
Tab
Co.
Orl 10mg
Elavil
Apo-Amitriptyline
Amitriptyline
00335053
02403137
00370991
AAP
APX
PDL
f
f
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 25mg
Elavil
Apo-Amitriptyline
Amitriptyline
00335061
02403145
00371009
AAP
APX
PDL
f
f
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl 50mg
Elavil
Apo-Amitriptyline
00335088
02403153
AAP
APX
f
f
AEFGVW
AEFGVW
Page 172
N06AA09
Tab
Co.
N06AA10
AMITRIPTYLINE
AMITRIPTYLINE
Orl 75mg
Elavil
Apo-Amitriptyline
00754129
02403161
AAP
APX
f
f
AEFGVW
AEFGVW
NORTRIPTYLINE
NORTRIPTYLINE
Cap Orl
Cap
10mg
Aventyl
pms-Nortriptyline
Apo-Nortriptyline
Teva-Nortriptyline
00015229
02177692
02223511
02231781
PDP
PMS
APX
TEV
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Cap Orl
Cap
25mg
Aventyl
pms-Nortriptyline
Apo-Nortriptyline
Teva-Nortriptyline
00015237
02177706
02223538
02231782
PDP
PMS
APX
TEV
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Sinequan
Doxepin
00024325
02049996
ERF
AAP
f
f
AEFGVW
AEFGVW
N06AA12
DOXEPIN
DOXÉPINE
Cap Orl 10mg
Cap
Cap Orl
Cap
25mg
Sinequan
Doxepin
Novo-Doxepin (Disc/non disp Oct 18/15)
00024333
02050005
01913425
ERF
AAP
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
Cap Orl
Cap
50mg
Sinequan
Doxepin
00024341
02050013
01913433
ERF
AAP
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
Cap Orl
Cap
75mg
Sinequan
Doxepin
00400750
02050021
01913441
ERF
AAP
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
Cap Orl
Cap
100mg
Sinequan
Doxepin
00326925
02050048
01913468
ERF
AAP
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
Cap Orl
Cap
150mg
01913476
TEV
f
AEFGVW
N06AA21
MAPROTILINE
MAPROTILINE
Tab
Co.
Orl 25mg
Teva-Maprotiline
02158612
TEV
f
AEFGVW
Tab
Co.
Orl 50mg
Teva-Maprotiline
02158620
TEV
f
AEFGVW
Tab
Co.
Orl 75mg
Teva-Maprotiline
02158639
TEV
f
AEFGVW
Page 173
N06AB
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI'S)
INHIBITEURS SPECIFIQUES DU RECAPTAGE DE LA SEROTONINE
N06AB03
FLUOXETINE
FLUOXÉTINE
Cap Orl
Cap
10mg
Prozac
pms-Fluoxetine
Apo-Fluoxetine
Teva-Fluoxetine
Phl-Fluoxetine
Mylan-Fluoxetine
ratio-Fluoxetine (Disc/non disp Feb 22/15)
Co Fluoxetine
Sandoz Fluoxetine
Fluoxetine
Zym-Fluoxetine
Mint-Fluoxetine
Auro-Fluoxetine
Fluoxetine
Mar-Fluoxetine
Jamp-Fluoxetine
Ran-Fluoxetine
02018985
02177579
02216353
02216582
02223481
02237813
02241371
02242177
02243486
02286068
02302659
02380560
02385627
02393441
02392909
02401894
02405695
LIL
PMS
APX
TEV
PHL
MYL
RPH
COB
SDZ
SAS
ZYM
MNT
ARO
AHI
MAR
JPC
RAN
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Cap Orl
Cap
20mg
Prozac
pms-Fluoxetine
Apo-Fluoxetine
Teva-Fluoxetine
Phl-Fluoxetine
Mylan-Fluoxetine
ratio-Fluoxetine (Disc/non disp Feb 22/15)
Co Fluoxetine
Sandoz Fluoxetine
Fluoxetine
Zym-Fluoxetine
Mint-Fluoxetine
Fluoxetine
Jamp-Fluoxetine
Auro-Fluoxetine
Mar-Fluoxetine
Ran-Fluoxetine
00636622
02177587
02216361
02216590
02223503
02237814
02241374
02242178
02243487
02286076
02302667
02380579
02383241
02386402
02385635
02392917
02405709
LIL
PMS
APX
TEV
PHL
MYL
RPH
COB
SDZ
SAS
ZYM
MNT
AHI
JPC
ARO
MAR
RAN
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
N06AB04
CITALOPRAM
CITALOPRAM
Tab Orl
Co.
10mg
pms-Citalopram
Phl-Citalopram
Teva-Citalopram
Mint-Citalopram
Jamp-Citalopram
Mar-Citalopram
02270609
02273543
02312336
02370077
02370085
02371871
PMS
PHL
TEV
MNT
JPC
MAR
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl
Co.
20mg
Celexa
Apo-Citalopram
Mylan-Citalopram
pms-Citalopram
02239607
02246056
02246594
02248010
VLH
APX
MYL
PMS
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Page 174
N06AB04
CITALOPRAM
CITALOPRAM
Tab Orl
Co.
20mg
Co Citalopram
Sandoz Citalopram
Phl-Citalopram
ratio-Citalopram (Disc/non disp Dec 21/14)
Ran-Citalo
Teva-Citalopram
Mint-Citalopram
Citalopram-odan
Jamp-Citalopram
Citalopram
Septa-Citalopram
Mar-Citalopram
Auro-Citalopram
02248050
02248170
02248944
02252112
02285622
02293218
02304686
02306239
02313405
02353660
02355272
02371898
02275562
COB
SDZ
PHL
TEV
RAN
TEV
MNT
ODN
JPC
SAS
SPT
MAR
ARO
Tab Orl
Co.
30mg
CTP 30
02296152
SNV
Tab Orl
Co.
40mg
Celexa
Apo-Citalopram
Mylan-Citalopram
pms-Citalopram
Co Citalopram
Sandoz Citalopram
Phl-Citalopram
ratio-Citalopram (Disc/non disp Dec 21/14)
Ran-Citalo
Teva-Citalopram
Mint-Citalopram
Citalopram-odan
Auro-Citalopram
Jamp-Citalopram
Citalopram
Septa-Citalopram
Mar-Citalopram
02239608
02246057
02246595
02248011
02248051
02248171
02248945
02252120
02285630
02293226
02304694
02306247
02275570
02313413
02353679
02355280
02371901
VLH
APX
MYL
PMS
COB
SDZ
PHL
TEV
RAN
TEV
MNT
ODN
ARO
JPC
SAS
SPT
MAR
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
N06AB05
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
PAROXETINE
PAROXÉTINE
Tab Orl
Co.
20mg
Paxil
Apo-Paroxetine
pms-Paroxetine
ratio-Paroxetine (Disc/non disp Feb 22/15)
Mylan-Paroxetine
Teva-Paroxetine
Co Paroxetine
Sandoz Paroxetine
Paroxetine
Jamp-Paroxetine
Auro-Paroxetine
01940481
02240908
02247751
02247811
02248013
02248557
02262754
02269430
02282852
02368870
02383284
GSK
APX
PMS
RPH
MYL
TEV
COB
SDZ
SAS
JPC
ARO
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl
Co.
30mg
Paxil
Apo-Paroxetine
pms-Paroxetine
Page 175
01940473
02240909
02247752
GSK
APX
PMS
f
f
f
AEFGVW
AEFGVW
AEFGVW
N06AB05
PAROXETINE
PAROXÉTINE
Tab Orl
Co.
30mg
ratio-Paroxetine (Disc/non disp Feb 22/15)
Mylan-Paroxetine
Teva-Paroxetine
Co Paroxetine
Sandoz Paroxetine
Paroxetine
Jamp-Paroxetine
Auro-Paroxetine
02247812
02248014
02248558
02262762
02269449
02282860
02368889
02383292
RPH
MYL
TEV
COB
SDZ
SAS
JPC
ARO
Tab Orl
Co.
40mg
pms-Paroxetine
02293749
PMS
N06AB06
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
SERTRALINE
SERTRALINE
Cap Orl
Caps
25mg
Zoloft
Apo-Sertraline
Teva-Sertraline
Mylan-Sertraline
pms-Sertraline
Sandoz Sertraline
Phl-Sertraline
GD-Sertraline
Co Sertraline
Sertraline
Jamp-Sertraline
Ran-Sertraline
Auro-Sertraline
Mar-Sertraline
Mint-Sertraline
02132702
02238280
02240485
02242519
02244838
02245159
02245824
02273683
02287390
02353520
02357143
02374552
02390906
02399415
02402378
PFI
APX
TEV
MYL
PMS
SDZ
PHL
GMD
COB
SAS
JPC
RAN
ARO
MAR
MNT
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Cap Orl
Caps
50mg
Zoloft
Apo-Sertraline
Teva-Sertraline
Mylan-Sertraline
pms-Sertraline
Sandoz Sertraline
Phl-Sertraline
GD-Sertraline
Co Sertraline
Sertraline
Jamp-Sertraline
Ran-Sertraline
Auro-Sertraline
Mar-Sertraline
Mint-Sertraline
01962817
02238281
02240484
02242520
02244839
02245160
02245825
02273691
02287404
02353539
02357151
02374560
02390914
02399423
02402394
PFI
APX
TEV
MYL
PMS
SDZ
PHL
GMD
COB
SAS
JPC
RAN
ARO
MAR
MNT
f
f
f
f
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Cap Orl
Caps
100mg
Zoloft
Apo-Sertraline
Teva-Sertraline
Mylan-Sertraline
pms-Sertraline
Sandoz Sertraline
Page 176
01962779
02238282
02240481
02242521
02244840
02245161
PFI
APX
TEV
MYL
PMS
SDZ
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
N06AB06
SERTRALINE
SERTRALINE
Cap Orl
Caps
N06AB06
N06AF
Phl-Sertraline
GD-Sertraline
Co Sertraline
Sertraline
Jamp-Sertraline
Ran-Sertraline
Auro-Sertraline
Mar-Sertraline
Mint-Sertraline
02245826
02273705
02287412
02353547
02357178
02374579
02390922
02399431
02402408
PHL
GMD
COB
SAS
JPC
RAN
ARO
MAR
MNT
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
FLUVOXAMINE
FLUVOXAMINE
Tab Orl
Co.
50mg
Luvox
Ratio-Fluvoxamine
Apo-Fluvoxamine
Novo-Fluvoxamine
pms-Fluvoxamine (Disc/non disp Sep 13/15)
Co Fluvoxamine
01919342
02218453
02231329
02239953
02240682
02255529
ABB
TEV
APX
TEV
PMS
COB
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl
Co.
100mg
Luvox
Ratio-Fluvoxamine
Apo-Fluvoxamine
Novo-Fluvoxamine
pms-Fluvoxamine (Disp/non disp Sep 13/15)
Co Fluvoxamine
01919369
02218461
02231330
02239954
02240683
02255537
ABB
TEV
APX
TEV
PMS
COB
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Nardil
00476552
ERF
AEFGVW
Parnate
01919598
GSK
AEFGVW
MONOAMINE OXIDASE INHIBITORS, NON-SELECTIVE
INHIBITEURS DE LA MONOAMINE OXYDASE, NON SELECTIFS
N06AF03
PHENELZINE
PHÉNELZINE
Tab Orl
Co.
N06AF04
15mg
TRANYLCYPROMINE
TRANYLCYPROMINE
Tab Orl
Co.
N06AG
100mg
10mg
MONOAMINE OXIDASE TYPE A INHIBITORS
INHIBITEURS DE LA MONOAMINE OXYDASE DE TYPE A
N06AG02
MOCLOBEMIDE
MOCLOBÉMIDE
Tab Orl
Co.
100mg
Apo-Moclobemide
Teva-Moclobemide
02232148
02239746
APX
TEV
f
f
AEFGVW
AEFGVW
Tab Orl
Co.
150mg
Manerix
Apo-Moclobemide
Teva-Moclobemide
00899356
02232150
02239747
MVL
APX
TEV
f
f
f
AEFGVW
AEFGVW
AEFGVW
Page 177
N06AG02
MOCLOBEMIDE
MOCLOBÉMIDE
Tab Orl
Co.
N06AX
300mg
Manerix
Apo-Moclobemide
Teva-Moclobemide
02166747
02240456
02239748
MVL
TEV
APX
f
f
f
AEFGVW
AEFGVW
AEFGVW
OTHER ANTIDEPRESSANTS
AUTRES ANTIDEPRESSIFS
N06AX05
TRAZODONE
TRAZODONE
Tab Orl
Co.
50mg
pms-Trazodone
Teva-Trazodone
Apo-Trazodone
Mylan-Trazodone
Phl-Trazodone
Trazodone
01937227
02144263
02147637
02231683
02236941
02348772
PMS
TEV
APX
MYL
PHL
SAS
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl
Co.
100mg
pms-Trazodone
Teva-Trazodone
Apo-Trazodone
Mylan-Trazodone
Phl-Trazodone
Trazodone
01937235
02144271
02147645
02231684
02236942
02348780
PMS
TEV
APX
MYL
PHL
SAS
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab Orl
Co.
150mg
Teva-Trazodone
Apo-Trazodone
Trazodone
02144298
02147653
02348799
TEV
APX
SAS
f
f
f
AEFGVW
AEFGVW
AEFGVW
Remeron RD
Novo-Mirtazapine OD
Auro-Mirtazapine OD
GD-Mirtazapine OD (Disc/non disp Nov 30/15)
02248542
02279894
02299801
02352826
FRS
TEV
ARO
GMD
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
N06AX11
MIRTAZAPINE
MIRTAZAPINE
ODT Orl
Co.D.O.
15mg
ODT Orl
Co.D.O.
30mg
Remeron RD
Novo-Mirtazapine OD
Auro-Mirtazapine OD
02248543
02279908
02299828
02352834
FRS
TEV
ARO
GMD
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
ODT Orl
Co.D.O.
45mg
Remeron RD
Novo-Mirtazapine OD
Auro-Mirtazapine OD
02248544
02279916
02299836
02352842
FRS
TEV
ARO
GMD
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
15mg
Sandoz Mirtazapine
pms-Mirtazapine
Mirtazapine
Apo-Mirtazapine
Zym-Mirtazapine
Mylan-Mirtazapine
02250594
02273942
02281732
02286610
02325179
02256096
SDZ
PMS
MEL
APX
ZYM
MYL
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Orl
Page 178
N06AX11
Tab
Co.
N06AX12
MIRTAZAPINE
MIRTAZAPINE
Orl
30mg
Remeron
pms-Mirtazapine
Sandoz Mirtazapine
Mirtazapine
Mylan-Mirtazapine
Novo-Mirtazapine
Apo-Mirtazapine
Zym-Mirtazapine
Mirtazapine
02243910
02248762
02250608
02252279
02256118
02259354
02286629
02325187
02370689
FRS
PMS
SDZ
MEL
MYL
TEV
APX
ZYM
SAS
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
BUPROPION
BUPROPION
SRT Orl
Co.L.L.
100mg
Sandoz Bupropion SR
ratio-Bupropion SR
pms-Bupropion
Bupropion SR
02275074
02285657
02325373
02391562
SDZ
TEV
PMS
SAS
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
SRT Orl
Co.L.L.
150mg
Wellbutrin SR
Sandoz Bupropion SR
ratio-Bupropion SR
pms-Bupropion
Bupropion SR
02237825
02275082
02285665
02313421
02391570
VLN
SDZ
TEV
PMS
SAS
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
SRT Orl
Co.L.L.
150mg
Wellbutrin XL
Mylan-Bupropion XL
02275090
02382075
VLN
MYL
f
f
AEFGVW
AEFGVW
SRT Orl
Co.L.L.
300mg
Wellbutrin XL
Mylan-Bupropion XL
02275104
02382083
VLN
MYL
f
f
AEFGVW
AEFGVW
N06AX16
VENLAFAXINE
VENLAFAXINE
SRC Orl
Caps.L.L.
37.5mg
Effexor XR
Venlafaxine XR (Disc/non disp May 6/14)
Teva-Venlafaxine XR
pms-Venlafaxine XR
Co Venlafaxine XR
Mylan-Venlafaxine XR
Sandoz Venlafaxine XR
Venlafaxine XR
GD-Venlafaxine XR
Ran-Venlafaxine XR
Apo-Venlafaxine XR
02237279
02273969
02275023
02278545
02304317
02310279
02310317
02354713
02360020
02380072
02331683
PFI
TEV
TEV
PMS
COB
MYL
SDZ
SAS
GMD
RAN
APX
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
SRC Orl
Caps.L.L.
75mg
Effexor XR
Teva-Venlafaxine XR
pms-Venlafaxine XR
Co Venlafaxine XR
Venlafaxine XR
02237280
02273977
02275031
02278553
02304325
02310287
02310325
02354721
PFI
TEV
TEV
PMS
COB
MYL
SDZ
SAS
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Page 179
N06AX16
VENLAFAXINE
VENLAFAXINE
SRC Orl
Caps.L.L.
75mg
SRC Orl
Caps.L.L.
150mg
GD-Venlafaxine XR
Ran-Venlafaxine XR
Apo-Venlafaxine XR
02360039
02380080
02331691
GMD
RAN
APX
f
f
f
AEFGVW
AEFGVW
AEFGVW
Effexor XR
Teva-Venlafaxine XR
pms-Venlafaxine XR
Co Venlafaxine XR
Venlafaxine XR
GD-Venlafaxine XR
Ran-Venlafaxine XR
Apo-Venlafaxine XR
02237282
02273985
02275058
02278561
02304333
02310295
02310333
02354748
02360047
02380099
02331705
PFI
TEV
TEV
PMS
COB
MYL
SDZ
SAS
GMD
RAN
APX
f
f
f
f
f
f
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
N06B
PSYCHOSTIMULANTS, AGENTS USED FOR ADHD AND NOOTROPICS
PSYCHOSTIMULANTS, AGENTS UTILISÉS POUR ADHD ET NOOTROPIQUES
N06BA
CENTRALLY ACTING SYMPATHOMIMETICS
ADRENERGIQUES AGISSANT CENTRALEMENT
N06BA02
Tab
Co.
DEXAMPHETAMINE
DEXAMPHÉTAMINE
Orl
5mg
Dexedrine
01924516
PAL
EF-18G
SRC Orl
Caps.L.L.
10mg
Dexedrine
01924559
PAL
EF-18G
SRC Orl
Caps.L.L.
15mg
Dexedrine
01924567
PAL
EF-18G
Ritalin SR
Apo-Methylphenidate SR
Sandoz Methylphenidate SR
00632775
02266687
02320312
NVR
APX
SDZ
f
f
f
AEFGVW
AEFGVW
AEFGVW
N06BA04
METHYLPHENIDATE
MÉTHYLPHÉNIDATE
SRT Orl
Co.L.L.
20mg
Tab
Co.
Orl
5mg
Apo-Methylphenidate
pms-Methylphenidate
02273950
02234749
APX
PMS
f
AEFGVW
AEFGVW
Tab
Co.
Orl
10mg
Ritalin
pms-Methylphenidate
Apo-Methylphenidate
00005606
00584991
02249324
NVR
PMS
APX
f
f
f
AEFGVW
AEFGVW
AEFGVW
Tab
Co.
Orl
20mg
Ritalin
pms-Methylphenidate
Apo-Methylphenidate
00005614
00585009
02249332
NVR
PMS
APX
f
f
f
AEFGVW
AEFGVW
AEFGVW
Page 180
N07
OTHER NERVOUS SYSTEM DRUGS
AUTRES MÉDICAMENTS DU SYSTEME NERVEUX
N07A
PARASYMPATHOMIMETICS
PARAADRENERGIQUES
N07AA
ANTICHOLINESTERASES
ANTICHOLINESTERASES
N07AA02
PYRIDOSTIGMINE
PYRIDOSTIGMINE
SRT Orl 180mg
Co.L.L.
Tab
Co.
N07AB
Orl
Mestinon SR
00869953
VLN
AEFGVW
Mestinon
00869961
VLN
AEFGVW
60mg
CHOLINE ESTERS
ESTERS DE CHOLINE
N07AB02
BETHANECHOL
BÉTHANÉCHOL
Tab
Co.
Orl 10mg
Duvoid
01947958
PAL
AEFGVW
Tab
Co.
Orl
25mg
Duvoid
01947931
PAL
AEFGVW
Tab
Co.
Orl
50mg
Duvoid
01947923
PAL
AEFGVW
Flunarizine
02246082
AAP
f
EF
Nitoman
pms-Tetrabenazine
Apo-Tetrabenazine
02199270
02402424
02407590
VLN
PMS
APX
f
f
f
AEFGVW
AEFGVW
AEFGVW
N07C
ANTIVERTIGO PREPARATIONS
PRÉPARATIONS ANTIVERTIGINEUX
N07CA
ANTIVERTIGO PREPARATIONS
PRÉPARATIONS ANTIVERTIGINEUX
N07CA03
FLUNARIZINE
FLUNARIZINE
Cap Orl
Caps
5mg
N07X
N07XX
N07XX06
Tab
Co
TETRABENAZINE
TÉTRABENAZINE
Orl
25mg
Page 181
P01
ANTIPROTOZOALS
ANTIPROTOZOAIRES
P01B
ANTIMALARIALS
ANTIPALUDIQUES
P01BA
AMINOQUINOLINES
AMINOQUINOLINES
P01BA01
Tab
Co.
P01BA02
Tab
Co.
P01BC
Orl
250mg
Teva-Chloroquine
00021261
TEV
f
AEFGVW
Plaquenil
Apo-Hydroxyquine
Mylan-Hydroxychloroquine
02017709
02246691
02252600
SAV
APX
MYL
f
f
f
AEFGVW
AEFGVW
AEFGVW
HYDROXYCHLOROQUINE
HYDROXYCHLOROQUINE
Orl
200mg
METHANOLQUINOLINES
METHANOLQUINOLINES
P01BC01
P01BD
CHLOROQUINE
CHLOROQUINE
QUININE
QUININE
Cap Orl
Caps
200mg
Apo-Quinine
Novo-Quinine
Quinine Sulfate
02254514
00021008
00695440
APX
TEV
ODN
f
AEFGV
AEFGVW
AEFGV
Cap Orl
Caps
300mg
Apo-Quinine
Novo-Quinine
Quinine Sulfate
02254522
00021016
00695459
APX
TEV
ODN
f
AEFGV
AEFGVW
AEFGV
Tab
Co.
300mg
Quinine Sulfate
00695432
ODN
AEFGVW
Daraprim (Disc/non disp Jun 1/15)
00004774
TRB
AEFGVW
00556734
JAN
AEFGVW
Orl
DIAMINOPYRIMIDINES
DIAMINOPYRIMIDINES
P01BD01
Tab
Co.
PYRIMETHAMINE
PYRIMÉTHAMINE
Orl
25mg
P02
ANTHELMINTICS
ANTHELMINTIQUES
P02C
ANTINEMATODAL AGENTS
AGENTS ANTINEMATODAUX
P02CA
BENZIMIDAZOLE AGENTS
AGENTS DU BENZIMIDAZOLE
P02CA01
Tab
Co.
MEBENDAZOLE
MÉBENDAZOLE
Orl
100mg
Vermox
Page 182
P02CC
TETRAHYDROPIRIMIDINE DERIVATIVES
DÉRIVÉS DU TETRAHYDROPIRIMIDINE
P02CC01
PYRANTEL
PYRANTEL
Tab
Co.
Orl
125mg
Combantrin
01944363
JNJ
EF-18G
P03
ECTOPARASITICIDES, INCLUDING SCABICIDES, INSECTICIDES & REPELLANTS
ECTOPARASITICIDES, Y COMPRIS LES SCABICIDES, LES INSECTICIDES ET REPULSIFS
P03A
ECTOPARASITICIDES, INCLUDING SCABICIDES
ECTOPARASITICIDES, Y COMPRIS LES SCABICIDES
P03AB
CHLORINE CONTAINING PRODUCTS
PRODUITS CONTENANT DU CHLORE
P03AB02
P03AC
LINDANE
LINDANE
Lot
Lot
Top
1%
pms-Lindane (Disc/non disp Jun 1/14)
00703591
PDP
EFGV
Shp
Shp
Top
1%
Hexit (Disc/non disp Dec 31/14)
pms-Lindane (Disc/non disp Jun 1/14)
00430617
00703605
ODN
PDP
EFGV
EFGV
PYRETHRINES, INCLUDING SYNTHETIC COMPOUNDS
PYRETHRINES, Y COMPRIS LES COMPOSÉS SYNTHÉTIQUES
P03AC04
PERMETHRIN
PERMÉTHRINE
Crm
Cr.
Top
1%
Nix Creme
Kwellada-P Creme Rinse 1%
00771368
02231480
INP
MDI
EFGV
EFGV
Crm
Cr.
Top
5%
Nix Dermal
02219905
GCH
EFGV
Lot
Lot
Top
5%
Kwellada-P
02231348
MDI
EFGV
R & C Shampoo and Conditioner
02125447
MDI
EFGV
00623377
CLC
EF-18G
P03AC51
PYRETHRUM, COMBINATIONS
PYRETHRUM, EN COMBINAISON
PYRETHRINS / PIPERONYL BUTOXIDE
PYRETHRINS / BUTOXIDE DE PIPÉRONYL
Shp
Shp
P03AX
Top
3%
OTHER ECTOPARACITICIDES, INCLUDING SCABICIDES
AUTRES ECTOPARASITICIDES, Y COMPRIS LES SCABICIDES
CROTAMITON
CROTAMITON
Crm
Cr.
Top
10%
Eurax
Page 183
ISOPROPYL MYRISTATE
MYRISTATE D'ISOPROPYLE
Liq
Liq
Top
50%
Resultz
02279592
MDF
R01
NASAL PREPARATIONS
PRÉPARATIONS NASALES
R01A
DECONGESTANTS AND OTHER NASAL PREPARATIONS FOR TOPICAL USE
DÉCONGESTIONNANTS ET AUTRES PRÉPARATIONS NASALES, UTILISATION TOP
R01AC
ANTIALLERGIC AGENTS, EXCLUDING CORTICOSTEROIDS
AGENTS ANTI-ALLERGIQUES, A L'EXCLUSION DES CORTICOSTÉROÏDES
R01AC01
CROMOGLICIC ACID
ACIDE CROMOGLICIQUE
Aem
Aém
R01AD
EFGV
Nas 2%
Rhinaris-CS Anti-Allergic Nsl
01950541
PDP
Mylan-Beclo AQ
Apo-Beclomethasone AQ
02172712
02238796
MYL
APX
f
f
ABEFGVW
ABEFGVW
Apo-Flunisolide (Disc/non disp Sep 4/14)
02239288
APX
f
AEFGVW
AEFGVW
CORTICOSTEROIDS
CORTICOSTÉROÏDES
R01AD01
BECLOMETHASONE
BÉCLOMÉTHASONE
Aem
Aém
R01AD04
Nas 50mcg
FLUNISOLIDE
FLUNISOLIDE
Asp Nas 0.025%
Asp
R01AD05
BUDESONIDE
BUDÉSONIDE
Aem
Aém
Inh 100mcg
Rhinocort
02035324
AZE
Aem
Aém
Nas 64mcg
Rhinocort Aqua
Mylan-Budesonide
02231923
02241003
AZE
MYL
f
f
AEFVW
AEFVW
Aem
Aém
Nas 100mcg
Mylan-Budesonide
02230648
MYL
f
AEFGVW
Flonase AQ
Apo-Fluticasone
ratio-Fluticasone
02213672
02294745
02296071
GSK
APX
TEV
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
Nasonex Aqueous
Apo-Mometasone
02238465
02403587
FRS
APX
f
f
EFG-12
EFG-12
R01AD08
FLUTICASONE
FLUTICASONE
Aem
Aém
R01AD09
Asp
Asp
AEFVW
Nas 50mcg
MOMETASONE
MOMÉTASONE
Nas 0.1%
Page 184
R01AX
OTHER NASAL PREPARATIONS
AUTRES PRÉPARATIONS NASALES
R01AX03
IPRATROPIUM BROMIDE
BROMURE D'IPRATROPIUM
Spr
Spr
Nas 0.03%
Atrovent Nasal
pms-Ipratropium
R01B
NASAL DECONGESTANTS FOR SYSTEMIC USE
DÉCONGESTIONNANT NASAL POUR USAGE SYSTEMIQUE
R01BA
SYMPATHOMIMETICS
ADRENERGIQUES
R01BA52
02163705
02239627
BOE
PMS
01944711
JNJ
f
f
AEFGVW
AEFGVW
PSEUDOEPHEDRINE, COMBINATIONS
PSEUDOEPHEDRINE, EN COMBINAISON
PSEUDOEPHEDRINE /DEXTROMETHORPHAN
PSEUDOÉPHÉDRINE /DEXTROMÉTHORPHANE
Syr
Sir.
Orl 6mg/3mg
Benylin DM-D (Disc/non disp Nov 16/14)
R03
DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES
MÉDICAMENTS CONTRE LES BRONCHOPNEUMOPATHIES OBSTRUCTIVES
R03A
ADRENERGICS, INHALANTS
ADRENERGIQUES, INHALANTS
R03AC
SELECTIVE BETA2-ADRENOCEPTOR AGONISTS
AGONISTES DES RECEPTEURS ADRENERGIQUES BETA2 SELECTIFS
R03AC02
G
SALBUTAMOL
SALBUTAMOL
Airomir
Ventolin
Apo-Salvent CFC Free
02232570
02241497
02245669
VLN
GSK
APX
f
f
f
ABEFGVW
ABEFGVW
ABEFGVW
1mg
Teva-Salbutamol Sterinebs
ratio-Salbutamol unit/dose PF
pms-Salbutamol
Ventolin Nebules P.F.
Med-Salbutamol
01926934
01986864
02208229
02213419
02237414
TEV
TEV
PMS
GSK
MED
f
f
f
f
BEF-18GVW
BEF-18GVW
BEF-18GVW
BEF-18GVW
BEF-18GVW
Inh
2mg
Teva-Salbutamol
pms-Salbutamol
Ventolin Nebules PF
ratio-Salbutamol (Disc/non disp Aug 26/15)
02173360
02208237
02213427
02239366
TEV
PMS
GSK
TEV
f
f
f
f
G
G
G
G
Liq
Liq
Inh
5mg
Inh
200mcg
00860808
02069571
02154412
02213486
02243115
TEV
PMS
SDZ
GSK
GSK
f
f
f
f
Pwr
Pd.
ratio-Salbutamol
pms-Salbutamol
Sandoz-Salbutamol
Ventolin
Ventolin Diskus
BEF-18GVW
BEF-18GVW
BEF-18GVW
BEF-18GVW
AEFGVW
Aem
Aém
Inh 100mcg
Liq
Liq
Inh
Liq
Liq
Page 185
R03AC03
TERBUTALINE
TERBUTALINE
Aem
Aém
R03AC12
00786616
AZE
AEFGVW
Inh 50mcg
23
02231129
GSK
ABEFGV
23
02237225
AZE
ABEFGV
Serevent Diskus
FORMOTEROL
FORMOTÉROL
Aem
Aém
Inh 6mcg
Oxeze
Aem
Aém
Inh 12mcg
Foradil
23
Oxeze
23
02230898
02237224
NVR
AZE
ABEFGV
ABEFGV
23
02376938
NVR
ABEFGV
R03AC18
INDACATEROL
INDACATÉROL
Cap Inh 75mcg
Cap.
R03AK
Bricanyl Turbuhaler
SALMETEROL
SALMÉTÉROL
Pwr
Pd.
R03AC13
Inh 0.5mg
Onbrez
ADRENERGICS AND OTHER DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES
ADRÉNERGIQUES ET AUTRES MÉDICAMENTS CONTRE LES BRONCHOPNEUMOPATHIES
R03AK06
SALMETEROL AND OTHER DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES
SALMÉTÉROL ET AUTRES MÉDICAMENTS CONTRE LES BRONCHOPNEUMOPATHIES
SALMETEROL/FLUTICASONE
SALMÉTÉROL/FLUTICASONE
23
Pwr
Pd.
Inh 25mcg/125mcg
Advair 125
02245126
GSK
W
Pwr
Pd.
Inh
25mcg/250mcg
Advair 250
02245127
GSK
W
Pwr
Pd.
Inh
50mcg/100mcg
Advair Diskus
02240835
GSK
W
Pwr
Pd.
Inh
50mcg/250mcg
Advair Diskus
02240836
GSK
W
Pwr
Pd.
Inh
50mcg/500mcg
Advair Diskus
02240837
GSK
W
Prescriptions written by certified New Brunswick respirologists do not require special authorization. Subsequent refills
ordered by other practitioners will not require special authorization.
Les ordonnances rédigées par les pneumologues diplômés du Nouveau-Brunswick ne requiérent pas d’autorisation special.
Les renouvellements precrits par d’autres praticiens ne nécessiteront pas d’autorisation special.
Page 186
R03B
OTHER DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES, INHALANTS
AUTRES MÉDICAMENTS CONTRE LES BRONCHOPNEUMOPATHIES OBSTRUCTIVES, INHALANTS
R03BA
GLUCOCORTICOIDS
GLUCOCORTICOÏDES
R03BA01
BECLOMETHASONE
BÉCLOMÉTHASONE
Aem Inh 50mcg
Aém
Aem
Aém
Qvar
02242029
VLN
ABEFGVW
Qvar
02242030
VLN
ABEFGVW
Pulmicort Turbuhaler
00852074
AZE
ABEFGVW
Inh 100mcg
R03BA02
BUDESONIDE
BUDÉSONIDE
Aem Inh 100mcg
Aém
Aem
Aém
Inh 200mcg
00851752
AZE
ABEFGVW
Aem
Aém
Inh 400mcg
00851760
AZE
ABEFGVW
Sus Inh 0.125mg
Susp.
Pulmicort Nebuamp
02229099
AZE
W
Sus Inh
Susp.
0.25mg
Pulmicort Nebuamp
01978918
AZE
ABEFGVW
Sus Inh
Susp.
0.5mg
Pulmicort Nebuamp
01978926
AZE
ABEFGVW
R03BA05
FLUTICASONE
FLUTICASONE
Aem
Aém
Inh 50mcg
Flovent Metered Dose HFA
02244291
GSK
ABEFGVW
Aem
Aém
Inh 125mcg
02244292
GSK
ABEFGVW
Aem
Aém
Inh 250mcg
02244293
GSK
ABEFGVW
Pwr
Pd.
Inh
250mcg
Flovent Diskus
02237246
GSK
ABEFGVW
Pwr
Pd.
Inh
500mcg
Flovent Diskus
02237247
GSK
ABEFGVW
Page 187
R03BA07
Pwr
Pd.
Inh
200mcg
Asmanex Twisthaler
02243595
MSD
AEFGVW
Pwr
Pd.
Inh
400mcg
Asmanex Twisthaler
02243596
MSD
AEFGVW
R03BA08
R03BB
MOMETASONE
MOMÉTASONE
CICLESONIDE
CICLÉSONIDE
Aem
Aém
Inh 100mcg
Alvesco
02285606
NYC
ABEFGVW
Aem
Aém
Inh 200mcg
Alvesco
02285614
NYC
ABEFGVW
Atrovent HFA
02247686
BOE
ABEFGVW
ANTICHOLINERGICS
ANTICHOLINERGIQUES
R03BB01
IPRATROPIUM BROMIDE
BROMURE D'IPRATROPIUM
Aem
Aém
R03BC
Liq
Liq
Inh
250mcg
Apo-Ipravent
Novo-Ipramide
pms-Ipratropium
Mylan-Ipratropium Soln
02126222
02210479
02231136
02239131
APX
TEV
PMS
MYL
f
f
f
f
BEF-18GVW
BEF-18GVW
BEF-18GVW
BEF-18GVW
Liq
Liq
Inh
250mcg
ratio-Ipratropium UDV
Teva-Ipratropium
pms-Ipratropium (1ml nebules)
pms-Ipratropium (2ml nebules)
02097168
02216221
02231244
02231245
TEV
TEV
PMS
PMS
f
f
f
f
BEF-18GVW
BEF-18GVW
BEF-18GVW
BEF-18GVW
PMS
f
ABEFGVW
ANTIALLERGIC AGENTS, EXCLUDING CORTICOSTEROIDS
AGENTS ANTIALLERGIQUES, A L'EXCLUSION DES CORTICOSTÉROÏDES
R03BC01
Liq
Liq
R03BX
Inh 20mcg
CROMOGLICIC ACID
ACIDE CROMOGLICIQUE
Inh
10mcg
pms-Sodium Cromoglycate
02046113
OTHER DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES, INHALANTS
AUTRES MÉDICAMENTS CONTRE LES BRONCHOPNEUMOPATHIES OBSTRUCTIVES, INHALANTS
R03BX99
Liq
Liq
HYPERTONIC SODIUM CHLORIDE
CHLORURE DE SODIUM, HYPERTONIQUE
Inh
7%
Hyper-Sal
Page 188
80029414
KEG
BEFG
R03C
ADRENERGICS FOR SYSTEMIC USE
ADRENERGIQUES, PRÉPARATIONS SYSTEMIQUES
R03CB
NON-SELECTIVE BETA-ADRENOCEPTOR AGONISTS
AGONISTES DES RECEPTEURS ADRENERGIQUES BETA NON SELECTIFS
R03CB03
Syr
Sir.
R03CC
APX
f
AEFGVW
APX
f
AEFGVW
Tab Orl 4mg
Apo-Salvent
02146851
APX
f
Co.
OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES
AUTRES MÉDICAMENTS CONTRE LES BRONCHOPNEUMOPATHIES OBSTRUCTIVES
AEFGVW
Tab
Co.
R03DA
Orl 2mg
Apo-Orciprenaline
02236783
SELECTIVE BETA2-ADRENOCEPTOR AGONISTS
AGONISTES DES RECEPTEURS ADRENERGIQUES BETA2 SELECTIFS
R03CC02
R03D
ORCIPRENALINE
ORCIPRÉNALINE
SALBUTAMOL
SALBUTAMOL
Orl 2mg
Apo-Salvent
02146843
XANTHINES
XANTHINES
R03DA02
Elx
Elx
R03DA04
Liq
Liq
CHOLINE THEOPHYLLINATE (OXTRIPHYLLINE)
THÉOPHYLLINATE CHOLINE (OXTRIPHYLLINE)
Orl
20mg
Choledyl
00476366
ERF
AEFGVW
Theolair
01966219
VLN
AEFGVW
THEOPHYLLINE
THÉOPHYLLINE
Orl
5.33333mg
SRT Orl
Co.L.L.
100mg
Teva-Theophylline
Apo-Theo LA
02230085
00692689
TEV
APX
f
ABEFGVW
ABEFGVW
SRT Orl
Co.L.L.
200mg
Teva-Theophylline SR
Apo-Theo LA
02230086
00692697
TEV
APX
f
ABEFGVW
ABEFGVW
SRT Orl
Co.L.L.
300mg
Teva-Theophylline SR
Apo-Theo LA
02230087
00692700
TEV
APX
f
ABEFGVW
ABEFGVW
SRT Orl
Co.L.L.
400mg
Uniphyl
Theo ER
02014165
02360101
PFR
AAP
f
f
ABEFGVW
ABEFGVW
SRT Orl
Co.L.L.
600mg
Uniphyl
Theo ER
02014181
02360128
PFR
AAP
f
f
ABEFGVW
ABEFGVW
Tab
Co.
125mg
Theolair
01966235
RIK
Orl
Page 189
AEFGVW
R05
COUGH AND COLD PREPARATIONS
PRÉPARATIONS CONTRE LA TOUX ET LE RHUME
R05C
EXPECTORANTS, EXCLUDING COMBINATIONS WITH COUGH SUPPRESSANTS
EXPECTORANTS, A L'EXCLUSION D'UNE COMBINAISON AVEC UN ANTITUSSIF
R05CA
EXPECTORANTS
EXPECTORANTS
R05CA03
Syr
Sir
R05CB
GUAIFENESIN
GUAIFÉNÉSINE
Orl 20mg
Balminil
Balminil Expect Sans Sucrose
Robitussin
00608920
00609951
01931032
ROG
ROG
WCH
G
G
G
Mucomyst
Parvolex
Acetylcysteine
02091526
02181460
02243098
WLS
BCH
SDZ
W
W
W
MUCOLYTICS
MUCOLYTIQUES
R05CB01
ACETYLCYSTEINE
ACÉTYLCYSTÉINE
Liq Inh 200mg
Liq
R05D
COUGH SUPPRESSANTS, EXCLUDING COMBINATIONS WITH EXPECTORANTS
ANTITUSSIFS, A L'EXCLSION D'UNE COMBINAISON AVEC UN EXPECTORANT
R05DA
OPIUM ALKALOIDS AND DERIVATIVES
ALKALOIDES D'OPIUM ET DÉRIVÉS
R05DA04
CODEINE
CODÉINE
Liq Inj 30mg
Liq
Codeine Phosphate
00544884
SDZ
W
Codeine Phosphate
00050024
ATL
AEFGVW
Syr
Sir
Orl
4.76666mg
Syr
Sir
Orl
5mg
ratio-Codeine
00779474
RPH
AEFGVW
Tab
Co.
Orl
15mg
ratio-Codeine
Codeine
00593435
00779458
RPH
ROG
AEFGVW
AEFGVW
Tab
Co.
Orl
30mg
ratio-Codeine
00593451
RPH
AEFGVW
SRT Orl
Co.L.L.
50mg
Codeine Contin
02230302
PFR
W
SRT Orl
Co.L.L.
100mg
Codeine Contin
02163748
PFR
W
SRT Orl
Co.L.L.
150mg
Codeine Contin
02163780
PFR
W
SRT Orl
Co.L.L.
200mg
Codeine Contin
02163799
PFR
W
Page 190
R05DA09
Liq
Liq
DEXTROMETHORPHAN
DEXTROMÉTHORPHANE
3mg
Koffex Sugar Free Clear
01928791
ROG
G
Sus Orl 6mg
Susp.
Delsym
02018403
NNC
G
Balminil DM
Koffex DM
Benylin DM
00436895
01928783
01944738
ROG
ROG
JNJ
G
G
G
WCH
G
Syr
Sir
Orl
Orl 3mg
R05F
COUGH SUPPRESSANTS AND EXPECTORANTS, COMBINATIONS
ANTITUSSIFS ET EXPECTORANTS, EN COMBINAISON
R05FA
OPIUM DERIVATIVES AND EXPECTORANTS
DÉRIVÉS DE L'OPIUM ET EXPECTORANTS
R05FA02
OPIUM DERIVATIVES AND EXPECTORANTS
DÉRIVÉS DE L'OPIUM ET EXPECTORANTS
GUAIFENESIN / DEXTROMETHORPHAN
GUAIFÉNÉSINE / DEXTROMÉTHORPHANE
Liq
Liq
Orl
20mg/3mg
Robitussin DM Exp
01931024
GUAIFENESIN / DEXTROMETHORPHAN / PSEUDOEPHEDRINE
GUAIFÉNÉSINE / DEXTROMÉTHORPHANE / PSEUDOÉPHÉDRINE
Syr
Sir
Orl 100mg/50mg/30mg
R06
ANTIHISTAMINES FOR SYSTEMIC USE
ANTIHISTAMINIQUES SYSTEMIQUES
R06A
ANTIHISTAMINES FOR SYSTEMIC USE
ANTIHISTAMINIQUES SYSTEMIQUES
R06AA
AMINOALKYL ETHERS
AMINOALKYLETHERS
R06AA02
Benylin DM-D-E
01944673
JNJ
G
Dimenhydrinate IM
00392537
SDZ
W
DIPHENHYDRAMINE
DIPHENHYDRAMINE
Liq
Liq
Inj
Tab
Co.
Orl
25mg
Diphenhydramine
02257548
JPC
G
Tab
Co.
Orl
50mg
Diphenhydramine
02257556
JPC
G
Cap Orl
Caps
50mg
Benadryl (Disc/non disp Nov 16/14)
02019671
JNJ
G
2.5mg
Benadryl
02019736
JNJ
G
Elx
Elx
Orl
50mg
Page 191
R06AA02
Tab
Co.
R06AA09
DIPHENHYDRAMINE
DIPHENHYDRAMINE
Orl
Tab
Co.
JNJ
G
Diclectin
00609129
DUI
EF
Novo-Pheniram
Chlor-Tripolon
00021288
00738972
TEV
SCO
G
G
Reactine
Apo-Cetirizine
Extra Strength Allergy Relief
02223554
02231603
02315955
JNJ
APX
PDP
f
f
f
G
G
G
Claritin
Apo-Loratadine
00782696
02243880
SCO
APX
f
f
G
G
10mg/10mg
CHLORPHENAMINE
CHLORPHÉNAMINE
Orl
4mg
PIPERAZINE DERIVATIVES
DÉRIVÉS DU PIPERAZINE
R06AE07
Tab
Co.
R06AX
02017849
SUBSTITUTED ALKYL AMINES
AMINO-ALKYLES SUBSTITUTES
R06AB04
R06AE
Benadryl
DOXYLAMINE
DOXYLAMINE
SRT Orl
Co.L.L.
R06AB
25mg
CETIRIZINE
CÉTIRIZINE
Orl
10mg
OTHER ANTIHISTAMINES FOR SYSTEMIC USE
DIVERS ANTIHISTAMINIQUES SYSTEMIQUES
R06AX13
Tab
Co.
R06AX17
LORATADINE
LORATADINE
Orl
10mg
KETOTIFEN
KÉTOTIFÉNE
Syr
Sir
Orl 0.2mg
Novo-Ketotifen (Disc/non disp Sep 11/15)
Zaditen
02176084
00600784
TEV
TEV
f
f
EFG
EFG
Tab
Co.
Orl
Zaditen
Novo-Ketotifen (Disc/non disp Aug 10/14)
00577308
02230730
TEV
TEV
f
f
EFG
EFG
01980556
SDZ
1mg
S01
OPHTHALMOLOGICALS
AGENTS OPHTHALMOLOGIQUES
S01A
ANTIINFECTIVES
ANTIINFECTIEUX
S01AA
ANTIBIOTICS
ANTIBIOTIQUES
S01AA01
CHLORAMPHENICOL
CHLORAMPHÉNICOL
Dps Oph
Gttes
0.25%
Pentamycetin (Disc/non disp Mar 21/14)
Page 192
AEFGVW
S01AA01
CHLORAMPHENICOL
CHLORAMPHÉNICOL
Dps Oph
Gttes
0.5%
02164051
SDZ
AEFGVW
Ont
Ont
1%
01980564
SDZ
AEFGVW
Garamycin
00512192
FRS
Sandoz Gentamicin(Disc/non disp Mar21/14)
02230888
SDZ
S01AA11
Oph
GENTAMICIN
GENTAMICINE
Dps Oph
Gttes
Ont
Ont
S01AA12
0.3%
Oph 0.3%
f
AEFGVW
AEFGVW
TOBRAMYCIN
TOBRAMYCINE
Liq
Liq
Oph
0.3%
Tobrex
pms-Tobramycin (Disc/non disp Jun 1/16)
Sandoz Tobramycin
00513962
02239577
02241755
ALC
PMS
SDZ
Ont
Ont
Oph
0.3%
Tobrex
00614254
ALC
AEFGVW
pms-Erythromycin
Erythromycin
01912755
02326663
PMS
SGQ
AEFGVW
AEFGVW
Polysporin
02239157
JNJ
G
Sodium Sulamyd
00028053
SDZ
AEFGVW
Viroptic
Sandoz Trifluridine (Disc/non disp Mar 21/14)
00687456
02248529
VLN
SDZ
S01AA17
Ont
Ont
S01AA30
f
f
f
AEFGVW
AEFGVW
AEFGVW
ERYTHROMYCIN
ÉRYTHROMYCINE
Oph
0.5%
COMBINATIONS OF DIFFERENT ANTIBIOTICS
EN COMBINAISON AVEC DIFFERENTS ANTIBIOTIQUES
POLYMYXIN B SULFATE/BACITRACIN ZINC
POLYMYXINE B (SULFATE DE)/BACITRACINE
Ont
Ont
S01AB
Oph
SULFONAMIDES
SULFONAMIDES
S01AB04
SULFACETAMIDE
SULFACETAMIDE
Dps Oph
Gttes
S01AD
10000IU/500IU
10%
ANTIVIRALS
ANTIVIRAUX
S01AD02
Liq
Liq
TRIFLURIDINE
TRIFLURIDINE
Oph
1%
Page 193
f
f
AEFGVW
AEFGVW
S01AX
OTHER ANTIINFECTIVES
AUTRES ANTIINFECTIEUX
S01AX11
Liq
Liq
S01AX13
Liq
Liq
OFLOXACIN
OFLOXACINE
Oph
0.3%
02143291
02248398
02252570
02247189
ALL
APX
PMS
SDZ
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
25
01945270
02253933
02387131
ALC
PMS
SDZ
f
f
f
AEFGVW
AEFGVW
AEFGVW
CIPROFLOXACIN
CIPROFLOXACINE
Oph
0.3%
Ciloxan
25
pms-Ciprofloxacin (Disc/non disp Mar 4/15)
25
S01B
ANTIINFLAMMATORY AGENTS
AGENTS ANTIINFLAMMATOIRES
S01BA
CORTICOSTEROIDS, PLAIN
CORTICOSTÉROÏDES, ORDINAIRES
S01BA01
24
Ocuflox
24
Apo-Ofloxacin
24
pms-Ofloxacin (Disc/non disp Jan 8/15)
24
Sandoz Ofloxacin
DEXAMETHASONE
DEXAMÉTHASONE
Dps Oph
Gttes
0.1%
Maxidex
00042560
ALC
AEFGVW
Ont
Ont
0.1%
Maxidex
00042579
ALC
AEFGVW
Cortamed (Disc/non disp Mar 21/14)
01980661
SDZ
AEFGVW
Pred Mild
00299405
ALL
AEFGVW
Pred Forte
ratio-Prednisolone
Diopred (Disc/non disp Mar 21/14)
00301175
00700401
02023768
ALL
RPH
SDZ
S01BA02
Ont
Ont
S01BA04
Liq
Liq
Oph
HYDROCORTISONE
HYDROCORTISONE
Oph
2.5%
PREDNISOLONE
PREDNISOLONE
Oph
Sus Oph
Susp.
0.12%
1%
f
f
AEFGVW
AEFGVW
AEFGVW
24
Requests for coverage of Ocuflox (Ofloxacin) will be considered under special authorization. Prescriptions written by
ophthalmologists or optometrists do not require special authorization.
Les demandes de protection pour le Ocuflox (Ofloxacine) seront examinees sur authorisation spéciale. Les ordonnances des
ophtalmologistes ou optometristes ne necessitent pas une authorisation spéciale.
25
Requests for coverage of Ciloxan (Ciprofloxacin) will be considered under special authorization. Prescriptions written by
ophthalmologists or optometrists do not require special authorization.
Les demandes de protection pour le Ciloxan (ciprofloxacine) seront examinees sur authorisation spéciale. Les ordonnances
des ophtalmologistes ou optometrisets ne necessitent pas une authorisation spéciale.
Page 194
S01BA07
S01BC
FLUOROMETHOLONE
FLUOROMÉTHOLONE
Dps Oph
Gttes
0.1%
Sus Oph
Susp.
0.25%
Sus Oph
Susp.
0.1%
FML
pms-Fluorometholone
00247855
02238568
ALL
PMS
AEFGVW
AEFGVW
FML Forte
00707511
ALL
AEFGVW
Flarex
00756784
ALC
AEFGVW
Voltaren
01940414
ALC
AEFGVW
Acular
Ketorolac
ratio-Ketorolac (Disc/non disp Feb 26/15)
01968300
02245821
02247461
ALL
AAP
TEV
ANTIINFLAMMATORY AGENTS, NON STEROIDS
AGENTS ANTIINFLAMMATOIRES, NON STEROIDIENS
S01BC03
Liq
Liq
S01BC05
Liq
Liq
DICLOFENAC
DICLOFÉNAC
Oph
0.1%
KETOROLAC
KÉTOROLAC
Oph
0.5%
S01C
ANTIINFLAMMATORY AGENTS & ANTIINFECTIVES IN COMBINATION
AGENTS ANTIINFLAMMATOIRES ET ANTIINFECTIEUX EN COMBINAISON
S01CA
CORTICOSTEROIDS AND ANTIINFECTIVES IN COMBINATION
CORTICOSTÉROÏDES ET ANTIINFECTIEUX EN COMBINAISON
S01CA01
f
f
f
AEFGVW
AEFGVW
AEFGVW
DEXAMETHASONE AND ANTIINFECTIVES
DEXAMÉTHASONE ET ANTIINFECTIEUX
DEXAMETHASONE / NEOMYCIN / POLYMYXIN B
DEXAMÉTHASONE / NÉOMYCINE / POLYMYXINE B
Sus Oph
Susp.
6000IU/3.5mg/1mg
Ont
Ont
Oph
Sus Oph
Susp.
S01CA02
Maxitrol
00042676
ALC
AEFGVW
0.3%/0.1%
Tobradex
00778915
ALC
AEFGVW
0.3%/0.1%
Tobradex
00778907
ALC
AEFGVW
Blephamide
00807788
ALL
AEFGVW
PREDNISOLONE AND ANTIINFECTIVES
PREDNISOLONE ET ANTIINFECTIEUX
PREDNISOLONE / SULFACETAMIDE
PREDNISOLONE / SULFACÉTAMIDE
Dps Oph
Gttes
10%/0.2%
Page 195
S01CA02
PREDNISOLONE AND ANTIINFECTIVES
PREDNISOLONE ET ANTIINFECTIEUX
PREDNISOLONE / SULFACETAMIDE
PREDNISOLONE / SULFACÉTAMIDE
Ont
Ont
Oph
10%/0.2%
Blephamide S.O.P.
00307246
ALL
AEFGVW
Iopidine
02076306
ALC
AEFVW
S01E
ANTIGLAUCOMA PREPARATIONS AND MIOTICS
PRÉPARATIONS ANTIGLAUCOME ET MIOTIQUES
S01EA
SYMPATHOMIMETICS IN GLAUCOMA THERAPY
ADRENERGIQUES POUR LE TRAITEMENT DU GLAUCOME
S01EA03
Liq
Liq
S01EA05
S01EB
APRACLONIDINE
APRACLONIDINE
Oph
0.5%
BRIMONIDINE
BRIMONIDINE
Liq
Liq
Oph
0.15%
Alphagan P
Apo-Brimonidine P
02248151
02301334
ALL
APX
f
f
AEFVW
AEFVW
Liq
Liq
Oph
0.2%
Alphagan
ratio-Brimonidine
pms-Brimonidine
Apo-Brimonidine
Sandoz Brimonidine
02236876
02243026
02246284
02260077
02305429
ALL
TEV
PMS
APX
SDZ
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
PARASYMPATHOMIMETICS
PARA-ADRENERGIQUES
S01EB01
PILOCARPINE
PILOCARPINE
Dps Oph
Gttes
1%
Isopto Carpine
Pilocarpine
00000841
02229556
ALC
IVX
f
f
AEFGVW
AEFGVW
Dps Oph
Gttes
2%
Isopto Carpine
00000868
ALC
f
AEFGVW
Dps Oph
Gttes
4%
Isopto Carpine
00000884
ALC
f
AEFGVW
Dps Oph
Gttes
6%
Pilocarpine
02230239
IVX
f
AEFGVW
Gel
Gel
4%
Pilocarpine HS (Disc/non disp Sept. 6/14)
00575240
ALC
AEFGVW
Isopto Carbachol (Disc/non disp Aug 14/14)
00000655
ALC
AEFGVW
S01EB02
Oph
CARBACHOL
CARBACHOL
Liq Oph 1.5%
Liq
Page 196
S01EB02
CARBACHOL
CARBACHOL
Liq Oph 3%
Liq
S01EC
00000663
ALC
AEFGVW
Acetazolamide
00545015
AAP
f
AEFGVW
Trusopt
Sandoz Dorzolamide
02216205
02316307
FRS
SDZ
f
f
AEF18+VW
AEF18+VW
Azopt
02238873
ALC
Methazolamide
02245882
AAP
f
AEFGVW
CARBONIC ANHYDRASE INHIBITORS
INHIBITEURS DE L'ANHYDRASE CARBONIQUE
S01EC01
Tab
Co.
S01EC03
Liq
Liq
S01EC04
Liq
Liq
S01EC05
Tab
Co.
S01ED
Isopto Carbachol (Disc/non disp Dec 31/14)
ACETAZOLAMIDE
ACÉTAZOLAMIDE
Orl
250mg
DORZOLAMIDE
DORZOLAMIDE
Oph
2%
BRINZOLAMIDE
BRINZOLAMIDE
Oph
1%
AEF18+V
METHAZOLAMIDE
MÉTHAZOLAMIDE
Orl
50mg
BETA BLOCKING AGENTS
BETA-BLOQUANTS
S01ED01
TIMOLOL
TIMOLOL
Dps Oph
Gttes
0.25%
Apo-Timop
Sandoz Timolol Maleate
Mylan-Timolol (Disc/non disp Jun 5/14)
pms-Timolol
00755826
02166712
00893773
02083353
APX
SDZ
MYL
PMS
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Dps Oph
Gttes
0.5%
Timoptic Oph
Apo-Timop
Sandoz Timolol Maleate
Mylan-Timolol (Disc/non disp Jun 5/14)
pms-Timolol
00451207
00755834
02166720
00893781
02083345
FRS
APX
SDZ
MYL
PMS
f
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Liq
Liq
Oph
0.25%
Timoptic-XE Oph
Timolol Maleate-EX
02171880
02242275
FRS
SDZ
f
f
AEFGVW
AEFGVW
Liq
Liq
Oph
0.5%
Timoptic-XE Oph
Timolol Maleate-EX
Apo-Timop
02171899
02242276
02290812
FRS
SDZ
APX
f
f
f
AEFGVW
AEFGVW
AEFGVW
Page 197
S01ED02
BETAXOLOL
BÉTAXOLOL
Sus Oph
Susp.
S01ED03
0.25%
01908448
ALC
AEFVW
ratio-Levobunolol
02031159
TEV
f
AEFGVW
Betagan
ratio-Levobunolol
pms-Levobunolol
Sandoz Levobunolol
00637661
02031167
02237991
02241716
ALL
TEV
PMS
SDZ
f
f
f
f
AEFGVW
AEFGVW
AEFGVW
AEFGVW
Azarga
02331624
ALC
Cosopt
Apo-Dorzo-Timop
Sandoz Dorzolamide/Timolol
Teva-Dorzotimol
Co-Dorzotimolol
02240113
02299615
02344351
02320525
02404389
FRS
APX
SDZ
TEV
COB
f
f
f
f
f
AEFVW
AEFVW
AEFVW
AEFVW
AEFVW
Xalacom
GD-Latanoprost/Timolol
Sandoz Latanoprost/Timolol
02246619
02373068
02394685
PFI
GMD
SDZ
f
f
f
AEFGVW
AEFGVW
AEFGVW
Combigan
02248347
ALL
AEFGVW
Duo Trav
02278251
ALC
AEFVW
LEVOBUNOLOL
LÉVOBUNOLOL
Liq
Liq
Oph
0.25%
Liq
Liq
Oph
0.5%
S01ED51
Betoptic S
TIMOLOL COMBINATIONS
TIMOLOL EN COMBINAISON
TIMOLOL / BRINZOLAMIDE
TIMOLOL / BRINZOLAMIDE
Sus Oph
Susp.
0.5%/1%
AEF18+VW
TIMOLOL / DORZOLAMIDE
TIMOLOL / DORZOLAMIDE
Liq
Liq
Oph
2%/0.5%
TIMOLOL / LATANOPROST
TIMOLOL / LATANOPROST
Liq
Liq
Oph
0.005%/0.5%
TIMOLOL / BRIMONIDINE
TIMOLOL / BRIMONIDINE
Liq
Liq
Oph
0.5%/0.2%
TIMOLOL / TRAVOPROST
TIMOLOL / TRAVOPROST
Liq
Liq
Oph
0.5%/0.004%
Page 198
S01EE
PROSTAGLANDIN ANALOGUES
ANALOGUES DE LA PROSTAGLANDINE
S01EE01
Liq
Liq
S01EE03
Liq
Liq
S01EE04
Liq
Liq
LATANOPROST
LATANOPROST
Oph
0.005%
Oph
Oph
Lumigan RC
02324997
ALL
AEFGVW
Travatan Z
02318008
ALC
AEFGVW
Isopto Atropine
00035017
ALC
AEFGVW
Cyclogyl
00252506
ALC
AEFGVW
0.004%
ANTICHOLINERGICS
ANTICHOLINERGIQUES
AEFGVW
AEFGVW
AEFGVW
AEFGVW
AEFGVW
ATROPINE
ATROPINE
Dps Oph
Gttes
S01FA05
f
f
f
f
f
TRAVOPROST
TRAVOPROST
S01FA
Liq
Liq
PFI
COB
APX
GMD
SDZ
0.01%
MYDRIATICS AND CYCLOPLEGICS
MYDRIATIQUES ET CYCLOPLEGIQUES
S01FA04
02231493
02254786
02296527
02373041
02367335
BIMATOPROST
BIMATOPROST
S01F
S01FA01
Xalatan
Co Latanoprost
Apo-Latanoprost
GD-Latanoprost
Sandoz Latanoprost
1%
CYCLOPENTOLATE
CYCLOPENTOLATE
Oph
1%
HOMATROPINE
HOMATROPINE
Liq
Liq
Oph
2%
Isopto Homatropine
00000779
ALC
AEFGVW
Liq
Liq
Oph
5%
Isopto Homatropine
00000787
ALC
AEFGVW
02009277
02230621
PDP
ALL
S01G
DECONGESTANTS AND ANTIALLERGICS
DÉCONGESTIONNANTS ET ANTIALLERGIQUES
S01GX
OTHER ANTIALLERGICS
AUTRES ANTIALLERGIQUES
S01GX01
CROMOGLICIC ACID
ACIDE CROMOGLICIQUE
Liq Oph 2%
Liq
Cromolyn Ophthalmic Solution
Opticrom
Page 199
f
f
AEFGVW
AEFGVW
S01GX09
Liq
Liq
OLOPATADINE
OLOPATADINE
Oph
0.2%
S01X
OTHER OPTHALMOLOGICALS
AUTRES OPTHALMOLOGIQUES
S01XA
OTHER OPTHALMOLOGICALS
AUTRES OPTHALMOLOGIQUES
S01XA03
Pataday
02362171
ALC
AEFGVW
SODIUM CHLORIDE, HYPERTONIC
CHLORURE DE SODIUM, HYPERTONIQUE
Dps Oph
Gttes
5%
Muro 128
00750824
BSH
Ont
Ont
5%
Muro 128
00750816
BSH
Garamycin
Sandoz Gentamicin
00512184
02229441
FRS
SDZ
00674222
TCD
AEFGVW
00074454
PAL
AEFGVW
Oph
S02
OTOLOGICALS
AGENTS OTOLOGIQUES
S02A
ANTIINFECTIVES
ANTIINFECTIEUX
S02AA
ANTIINFECTIVES
ANTIINFECTIEUX
S02AA14
AEFGVW
AEFGVW
GENTAMICIN
GENTAMICINE
Dps Ot
Gttes
S02AA30
f
0.3%
f
f
AEFGVW
AEFGVW
ANTIINFECTIVES, COMBINATIONS
ANTIINFECTIEUX, EN COMBINAISON
ALUMINUM ACETATE/BENZETHONIUM CHLORIDE
ACÉTATE D'ALUMINIUM/CHLORURE DE BENZÉTHONIUM
Liq
Liq
Ot
0.5%/0.03%
Buro-Sol Otic
S02C
S02CA
S02CA02
FLUMETASONE AND ANTIINFECTIVES
FLUMETASONE ET ANTIINFECTIEUX
FLUMETASONE / CLIOQUINOL
FLUMÉTASONE / CLIOQUINOL
Dps Ot
Gttes
1%/0.02%
Locacorten-Vioform
Page 200
S02CA03
HYDROCORTISONE AND ANTIINFECTIVES
HYDROCORTISONE ET ANTIINFECTIEUX
HYDROCORTISONE / NEOMYCIN / POLYMYXIN B
HYDROCORTISONE / NÉOMYCINE / POLYMYXIN B
Liq Ot 10000unit/10mg/3.5mg
Sandoz Cortimyxin
Liq
(Disc/non disp Mar 27/15)
Cortisporin (Disc/non disp Dec 10/14)
S03
OPHTHALMOLOGICAL AND OTOLOGICAL PREPARATIONS
PRÉPARATIONS OPHTHALMOLOGIQUES ET OTOLOGIQUES
S03C
S03CA
S03CA01
02230386
SDZ
f
AEFGVW
01912828
GSK
f
AEFGVW
02224623
02247920
SAV
SDZ
f
f
AEFGV
AEFGV
DEXAMETHASONE AND ANTIINFECTIVES
DEXAMÉTHASONE ET ANTIINFECTIEUX
DEXAMETHASONE / FRAMYCETIN / GRAMICIDIN
DEXAMÉTHASONE / FRAMYCÉTINE / GRAMICIDINE
Dps Oph
Gttes
S03CA04
5mg/0.5mg/0.05mg
Sofracort E/E
Sandoz Opticort (Disc/non disp Mar 21/14)
HYDROCORTISONE AND ANTIINFECTIVES
HYDROCORTISONE ET ANTIINFECTIEUX
HYDROCORTISONE / CHLORAMPHENICOL
HYDROCORTISONE / CHLORAMPHÉNICOL
Ont Oph 1%/1%
Ont
Pentamycetin/HC(Disc/non disp Mar 21/14)
01980580
SDZ
AEFGVW
Sus Oph 0.2%/1%
Susp.
Pentamycetin/HC(Disc/non disp Mar 21/14)
01980572
SDZ
AEFGVW
Garasone
Sandoz Pentasone
00682217
02244999
FRS
SDZ
Allergy Sera *
00999938
HJM
S03CA06
BETAMETHASONE AND ANTIINFECTIVES
BÉTAMÉTHASONE ET ANTIINFECTIEUX
BETAMETHASONE / GENTAMICIN
BÉTAMÉTHASONE / GENTAMICINE
Liq
Liq
Oph
0.3%/0.1%
V01
ALLERGENS
ALLERGENES
V01A
ALLERGENS
ALLERGENES
V01AA
ALLERGEN EXTRACTS
EXTRAITS D'ALLERGENES
V01AA20
Liq
Liq
f
f
AEFGVW
AEFGVW
VARIOUS ALLERGEN EXTRACTS
DIVERS EXTRAITS D'ALLERGENE
Inj
Page 201
EF-18G
V03
ALL OTHER THERAPEUTIC PRODUCTS
TOUS LES AUTRES PRODUITS THERAPEUTIQUES
V03A
ALL OTHER THERAPEUTIC PRODUCTS
TOUS LES AUTRES PRODUITS THERAPEUTIQUES
V03AC
IRON CHELATING AGENTS
AGENTS CHÉLATEURS DE FER
V03AC01
V03AE
Pws Inj
Pds.
2g
Desferal *
pms-Deferoxamine *
Deferoxamine Mesilate *
01981250
02243450
02247022
NVR
PMS
HOS
f
f
f
AEFGVW
AEFGVW
AEFGVW
Pws Inj
Pds.
500mg
Desferal *
pms-Deferoxamine *
Deferoxamine Mesilate *
01981242
02242055
02241600
NVR
PMS
HOS
f
f
f
AEFGVW
AEFGVW
AEFGVW
f
f
AEFGVW
AEFGVW
FOR TREATMENT OF HYPERKALEMIA AND HYPERPHOSPHATEMIA
POUR LE TRAITEMENT DE HYPERKALEMIA ET HYPERPHOSPHATEMIA
V03AE01
V03AF
POLYSTYRENE SULPHONATE
POLYSTYRÉNE SULPHONATE
Pws Inj
Pds.
100%
Sus Orl
Susp.
250mg
pms-Sodium Polystyrene
Kayexalate
00755338
02026961
PMS
SAV
Solystat
00769541
PDP
W
PFI
AEFGVW
DETOXIFYING AGENTS FOR ANTINEOPLASTIC TREATMENT
AGENTS DÉTOXIFIANTS POUR TRAITEMENT ANTINÉOPLASIQUE
V03AF03
Tab
Co.
V03AG
DEFEROXAMINE
DÉFÉROXAMINE
CALCIUM FOLINATE
FOLINATE DE CALCIUM
Orl
5mg
Leucovorin Calcium
02170493
DRUGS FOR TREATMENT OF HYPERCALCEMIA
MÉDICAMENTS POUR LE TRAITEMENT DE L' HYPERCALCEMIE
V03AG99
DRUGS FOR TREATMENT OF HYPERCALCEMIA
MÉDICAMENTS POUR LE TRAITEMENT DE L' HYPERCALCEMIE
SODIUM ACID PHOSPHATE / SODIUM BICARBONATE / POTASSIUM
PHOSPHATE ACIDE DE SODIUM / SODIUM (BICARBONATE DE) / POTASSIUM
Evt Orl
Co.Eff.
356mg/350mg/315mg
Phosphate Novartis
Page 202
80027202
NVR
G
V07
ALL OTHER NON-THERAPEUTIC PRODUCTS
TOUS LES AUTRES PRODUITS NON THERAPEUTIQUES
V07A
ALL OTHER NON-THERAPEUTIC PRODUCTS
TOUS LES AUTRES PRODUITS NON THERAPEUTIQUES
V07AY
OTHER NON-THERAPEUTIC AUXILLIARY PRODUCTS
AUTRES PRODUITS AUXILIAIRES NON THERAPEUTIQUES
V07AY90
PLACEBO
PLACEBO
Cap Orl
Caps
100mg
Placebo
Page 203
00501190
ODN
AEFGVW
APPENDIX I-A / ANNEXE I-A
ABBREVIATIONS OF DOSAGE FORMS / ABRÉVIATIONS DES FORMES POSOLOGIQUES
FORM
CODE
FORME
Metered-Dose Aerosol
AEM/AÉM.
Aérosol-dose mesurée
Aerosol (with propellants)
AER/AÉR.
Aérosol (avec agents de propulsion)
Aerosol (without propellants)
ASP
Aérosol (sans agents de propulsion)
Blood Collection
BCL
Sang prélevé
Biscuit
BIS
Biscuit
BLK/VRC
En vrac
Capsule
CAP/CAPS
Capsule
Chewable Tablets
TABC/CO.C.
Comprimés à croquer
Bulk
Controlled Delivery Capsules
CDC/CAPS.L.C.
Capsules à libération contrôlée
Cigarette
CIG
Cigarette
Cleanser
CLR/NET
Nettoyant
Cement
CMT
Ciment
Condom
CON
Condom
Cream
Cartridge
CRM/CR.
CTG/CART
Crème
Cartouche
Cube
CUB
Cube
Douche
DCH
Douche
Delayed Action (Injectables)
DLA
Soluté injectable-retard
Drop
DPS/GTTES
Dressing
Enteric Coated Capsule
Each
DRE
ECC/CAPS.ENT
ECH/CH
Enteric Coated Granule
Enteric Coated Tablet
ECP
ECT/CO.ENT.
Gouttes
Pansement
Capsule entérique
Chacun
Granule entérique
Comprimés entérique
Elixir
ELX/ÉLIXIR
Élixir
Emulsion
EML/ÉMULS
Émulsion
ENM/LAV.
Lavement
Enema
Extended Release Capsules
ERC/CAPS.L.P.
Capsules à libération prolongée
Extended Release Tablets
ERT/CO.L.P.
Comprimés à libération prolongée
Effervescent Granule
EVG/GEV
Granule effervescente
February 2014
A-1
FORM
Effervescent Powder
Effervescent Tablet
Feed Mix
Gas
CODE
EVP/PEV
EVT/CO.EFF.
FMX/MÉLF
GAS
FORME
Poudre effervescente
Comprimé effervescent
Mélange de fourrage
Gaz
Jelly
GEL
Gelée
Graft
`
Gum
GRT
Greffon
GUM/GOM
Gomme
Hypodermic Tablet
HYT/CO.HYP.
Comprimé hypodermique
Implant
IMP
Implant
Insert
INS
Pièce à insérer
Jam
JAM
Confiture
Kit
KIT
Trousse
Leaf
LEF
Feuille
Liniment
LIN
Liniment
Liquid
LIQ
Liquide
Lente Suspension
LLA/SUSP.
Suspension
Lotion
LOT
Lotion
Lozenge
LOZ
Tablette
Lubricant
LUB
Lubrifiant
Miscellaneous
MIS
Divers
Mist, Aerosol
MST/BAÉR
Bruine en aérosol
Mouthwash
MWH/R.-B.
Gargarisme, rnce-bouche, élizir dentifrice
Needle
NDL/AIG
Aiguille
Orally Disintegrating Tablet
ODT
Comprimés à désintégration orale
Ointment
ONT
Onguent, pommade
Ostomy
OST
Ostomie
Pad
PAD/GAZE
Compresse
Paper
PAP
Papier
Placebo
PCB
Placebo
Package
PCK/EMB.
February 2014
A-2
Paquet, emballage
FORM
CODE
FORME
Pencil
PEN
Crayon
Plaster
PLS
Emplâtre
Poultice
PLT/CAT
Cataplasme
Paint
PNT
Badigeon
Paste
PST
Pâte
Patch
PTH
Timbre cutané
Powder
PWR/PD.
Poudre
Powder For Solution
PWS/PDS.
Poudre pour solution
Sequential
SEQ
Séquentiel (le)
Shampoo
SHP
Shampooing
Semi-Lente Suspension
SLA
Suspension semi-lente
Sublingual Tablet
SLT/CO.S.L.
Comprimé sublingual
Soap (Bar, Cake)
SOP/SAVON
Savon (Pain)
Sponge
Spray
Sustained-Released Capsule
SPG
SPR/VAPO
Éponge
Vaporisateur
SRC/CAPS.L.L.
Capsule à liberation lente
Sustained-Release Disc
SRD
Disque à action soutenue
Sustained-Release Syrup
SRS
Sirop à action soutenue
Sustained-Release Tablet
SRT/CO.L.L.
Comprimé à liberation lente
Stick
STK
Bâton
Strip
STP
Bande, plaque, plaquette
Suppository
SUP/SUPP.
Suppositoire
Suspension
SUS/SUSP.
Suspension
Suture
SUT
Swab
SWB/TMP
Tampon
Syrup
SYR/SIR.
Sirop
Tablet
TAB/CO.
Comprimé
Tape
TAP/RUBAN
Tincture
Teat Dilator
February 2014
TCT
TDL/DIL
A-3
Suture
Sparadrap, diachylon
Teinture
Dilatateur de trayon
FORM
Top Dressing (VET)
Herbal Tea
CODE
TDR/PAN
TEA/TIS
FORME
Pansement (vét.)
Tisane
Tampon
TMP
Tampon
Tooth Powder
TPR
Poudre dentifrice
Tooth Paste
TPT
Pâte dentifrice
Ultra-Lente Suspension
ULA
Suspension ultra-lente
Wafer
WAF
Cachet
Wire
WIR
Fil
February 2014
A-4
APPENDIX I-B / ANNEXE I-B
ABBREVIATIONS OF ROUTES / ABRÉVIATIONS DES VOIES D'AMINISTRATION
ROUTE
Block or Infiltration
Barn
CODE
BIN
BRN/ÉTA
VOIE
Infiltration
Étable
Buccal
BUC
Buccale, orale
Caudal Block
CAU
Anesthésie caudale
Dental
DEN
Dentaire
Dialysis
DIS
Dialyse
Epidural
EPD
Épidural
Disinfectant (Food Premises)
HOM
Désinfectant (locaux alimentaires)
Hospital Disinfectant (Area)
HOS
Désinfectant de locaux hospitaliers
Intra Articular
IA
Intra-articulaire
Intra Amniotic
IAM
Intra-amniotique
Intrabursal
IBU
Intrabursique
Intracardiac
ICD
Intracardiaque
Intracranial
ICR
Intracrânienne
Intracavity
ICV
Intra-cavitaire
Intradermal
ID
Intradermique
Intra-Mammary (INF)
IMM
Intra-mammaire (bébé)
Intervertebral
IND
Intervertébrale
Intrafollicular
INF
Intra-folliculaire
Inhalation
INH
Inhalation
Injectable
INJ
Injectable
Instrument(s)
INS
Instrument(s)
Intrathecal
INT
Intra-thécale
Intraocular
IO
Intraoculaire
Intraperitoneal
IP
Intrapéritonéale
Intrapleural
IPL
Intrapleurale
Intrapulmonary
IPU
Intrapulmonaire
Irrigation
IR
Irrigation
Intrasinal
ISI
Intra-sinusiennne, intra-sinusale
Instillation
ISL
Instillation
February 2014
A-5
APPENDIX I-B / ANNEXE I-B
ABBREVIATIONS OF ROUTES / ABRÉVIATIONS DES VOIES D'AMINISTRATION
ROUTE
CODE
VOIE
Intrasynovial
ISY
Intra-synoviale
Intrathoracic
IT
Intrathoracique
Intubing
ITB
Intubation
Intratracheal
ITR
Intratrachéal(e)
Intratesticular
ITS
Intratesticulaire
Intravesicular
ITV
Intra-vésiculaire
Intrauterine
IU
Intra-utérin(e)
Intraventicular
IVR
Intraventriculaire
Laboratory Test
LAB
Essai, analyse de laboratoire
Miscellaneous
MIS
Divers
Nasal
NAS
Nasale
Nil
NIL
Néant
Ophthalmic
OPH
Ophtalmique
Oral
ORL
Orale
Otic
OT
Otique
Periosteal
PRS
Périostale
Parenteral (Unspecified)
PRT
Parentérale (non spécifiée)
Retrobulbar
Refer (See Dosage Form)
Rectal
RB
REF
RT
Rétrobulbaire
Voir forme posologique
Rectale
Subarachnoidal
SAR
Sous-arachnoïdienne
Sublingual
SLG
Sublinguale
Surgical
SUR
Chirurgicale
Topical
TOP
Topique
Transdermal
TRD
Transdermique
Urethral
URH
Urétrale
Vaginal
VAG
Vaginale
February 2014
A-6
APPENDIX I-C / ANNEXE I-C
ABBREVIATIONS OF UNITS / ABRÉVIATIONS DES UNITÉS DE MESURE
UNIT
Ampoule
CODE
AMP
Billion
B
Bottle
BOTTL
Box
BOX
Centesimal Scale
C
UNITE
Ampoule
Milliard
Flacon, bouteille
Boîte
Échelle centésimale
Can
CAN
Boîte métallique
Capsule
CAP
Capsule
Cubic Centimetre
CC
Centimètre cube
Dilution - 1/10 Centesimal Scale
CH
Dilution - 1/10 échelle centésimale
Centimetre
CM
Centimètre
Decimal Scale
D/M
Échelle métrique
Disk
DISC
Disque
Dessert Spoon
DSP
Cuillerée à dessert
Fluid Dram
FL DR
Drachme liquide
Fluid Ounce
FL OZ
Once liquide
Gallon
GAL
Gallon
Gram
GM
Gramme
Grain
GR
Grain
Kilogram
KG
Kilogramme
Kit
KIT
Trousse
Litre
L
Litre
Pound
LB
Livre
Limit Flocculation Unit
LF
Dose LF ou LF
Lozenge
Million
Millicurie
LOZ
Pastille
M
Million
MC
Millicurie
Microcurie
MCC
Microcurie
Microgram
MCG
Microgramme
Milliequivalent
MEQ
Milliéquivalent
Milligram
MG
Milligramme
Minim, Drop
MIN
Goutte
February 2014
A-7
APPENDIX I-C / ANNEXE I-C
ABBREVIATIONS OF UNITS / ABRÉVIATIONS DES UNITÉS DE MESURE
UNIT
Millitre
Millimole
Nil
CODE
ML
MMO
NIL
Nanokat
NKAT
UNITE
Millilitre
Millimole
Néant
Nanokat
Non-standard
NS
Non normalisé
Ounce
OZ
Once
Package
Percentage
Piece
PCK
%
PIECE
Quantity Sufficient
QS
Paquet, emballage
Pourcentage
Pièce
En quantité suffisante
Strip
STRIP
Bande
Square Centimetre
SQ CM
Centimètre carré
Square Inch
SQ IN
Pouce carré
Syringe
SYR
Seringue
Tablet
TAB
Comprimé
Tablespoon
TBS
Cuillerée à soupe
Mother-Tincture
TM
Teinture-mère
Trace
TRACE
Trace
Turbidity Reducing Unit
TRU
Unité de réduction de la turbidité
Teaspoon
TSP
Cuillerée à thé
Tuberculin Unit
TUB
Unité de tuberculine
Tube
TUBE
Tube
International Unit
UNIT
Unité internationale
Protein Nitrogen Unit (PNU)
UNIT
Unité d'azote protéique
TCID 50 Unit
UNIT
Dict 50
Unit (General Unspecified)
UNIT
Unité (en général, non précisée)
Vial
VIAL
Fiole
Homeopathic Unit
February 2014
X
A-8
Unité homéopathique
APPENDIX I-D / ANNEXE I-D
ABBREVIATIONS OF MANUFACTURER'S NAMES/ABRÉVIATIONS DES NOMS DE FABRICANTS
AAP
ABB
AGA
AHI
AJP
ALC
ALL
APX
ARO
ASL
ATL
AVE
AXC
AXS
AZE
BAX
BAY
BCH
BIF
BIG
BOE
BRI
BSH
CDX
CHU
CLC
COB
CYI
DCL
DPT
DUI
EMD
ERF
EUR
FEI
FRS
GAC
GCH
GIL
GLE
GMD
GMP
GNC
GND
GSK
HAL
HHC
HJM
HLR
HOS
INP
IVX
JAM
JAN
JCB
JNJ
JPC
KNG
KRI
LBK
LEO
LIL
MAR
AA Pharma Inc.
Abbott Laboratories, Ltd.
Amgen Canada Inc.
Accord Healthcare Inc.
Agila-Jamp Canada Inc.
Alcon Canada Inc.
Allergan Inc.
Apotex Inc.
Auro Pharma Inc.
Astellas Pharma Canada Inc.
Laboratoire Atlas Inc.
Aventis Pharma Inc.
Aptalis
Axxess Pharma Inc.
Astra Zeneca Pharma
Baxter Corporation
Bayer Inc., HealthCare Division
Bioniche Inc.
Bioforce Canada Ltd/Ltee.
Biogen Idec Canada, Inc.
Boehringer Ingelheim (Canada) Ltd.
Bristol-Myers Squibb Canada Inc.
Baush & Lomb Canada Inc.
Canderm Pharma Inc.
Church and Dwight Canada Corp.
Columbia Laboratories Canada Inc.
Cobalt Pharmaceuticals Company
Cytex Pharmaceuticals Inc.
D.C. Labs Limited
Dermtek Pharmaceuticals Ltd
Duchesnay
EMD Serono Canada Inc.
Erfa Canada Inc.
Europharm International Canada Inc.
Ferring Inc.
Merck Canada Inc.
Galderma Canada Inc.
GlaxoSmithKline Consumer Healthcare Inc.
Gilead Sciences Inc.
Glenwood Laboratories Canada Ltd.
GenMed, a division of Pfizer Canada Inc.
Generic Medical Partners
General Nutrition Canada Inc.
Golden Neo-Life Diamite International Lt
GlaxoSmithKline
Hall Laboratories Ltd.
Holista Health Corporation
Medavie Blue Cross
Hoffmann-La Roche Ltd/Ltee.
Hospira Healthcare Corporation
Insight Pharmaceuticals Corp.
Ivax Pharmaceuticals Canada Inc.
Jamieson Laboratories Ltd.
Janssen Inc.
Jacobus Pharmaceutical Company Inc.
Johnson & Johnson Consumer Group
Jamp Pharma Corporation
King Pharmaceuticals Canada
Kripps Pharmacy Ltd
Lundbeck Inc.
Leo Pharma Inc.
Eli Lilly Canada Inc.
Marcan Pharmaceuticals Inc
February 2014
A-9
MDI
MDS
MED
MEL
MJO
MLA
MNT
MRS
MTP
MVL
MYL
NEO
NGP
NNC
NNO
NOP
NSE
NUM
NVO
NVR
NYC
ODN
OMG
PAL
PAT
PDL
PDP
PFI
PFR
PHL
PMS
PMT
PPC
PVR
QGT
RAN
RHG
RIK
ROG
RPH
SAS
SAV
SCH
SCO
SDZ
SEP
SEV
SHI
SIV
SNE
SNS
SNV
SPH
SPT
STR
SWS
TAR
TCD
TCH
TEV
Medtech Products Inc.
Medicis Canada LTD./LTEE.
Medican Pharma Inc.
Meliapharm Inc.
Mead Johnson Canada
Proctor & Gamble Healthcare
Mint Pharmaceuticals Inc.
Merus Labs Inc.
Methapharm Inc.
Meda Valeant Pharma Canada Inc.
Mylan Pharmaceuticals ULC
Neo Lab Inc.
Next Generation Pharma Inc.
Novartis Consumer Health Canada Inc.
Novo Nordisk Canada Inc.
Novopharm Ltd.
Nutri Souce Inc Les Aliments
4349121 Canada Inc.
Novartis Ophthalmics
Novartis Pharmaceuticals Canada Inc.
Nycomed Canada Inc.
Odan Laboratories Ltd.
Omega Laboratories Limited
Paladin Labs Inc.
Pathogenesis Canada Ltd
Pro Doc Laboratories Ltd
PendoPharm, a Division of Pharmascience
Inc.
Pfizer Canada Inc.
Purdue Pharma
Pharmel Inc (Div of PMS/Price D.Shipp)
Pharmascience Inc.
Pharmetics Inc.
Pharmaceutical Partners of Canada
Pharmavite Corporation
Sigma-Tau
Ranbaxy Pharmaceuticals Canada Inc.
Rheningold Food International Ltd.
3M Pharmaceuticals
Rougier Pharma Inc, Div of Ratiopharm
Ratiopharm Inc.
Sanis Health Inc.
Sanofi-Aventis Canada Inc.
Schering-Plough Canada Inc.
Schering-Plough (Canada) Inc.
Sandoz Canada Incorporated
Sepracor Pharmaceuticals Inc.
Servier Canada Inc.
Shire Canada Inc.
Sivem Pharmaceuticals
Smith & Nephew, Inc.
Sanofi-Synthelabo Canada Inc.
Sunovion Pharmaceuticals Canada Inc
Solvay Pharma Inc.
Septa Pharmaceuticals Inc.
Sterimax Inc.
Swiss Herbal Remedies Ltd
Taro Pharmaceuticals Inc.
Trans Canaderm Inc.
Technilab, Inc.
Teva Canada Limited
APPENDIX I-D / ANNEXE I-D
ABBREVIATIONS OF MANUFACTURER'S NAMES/ABRÉVIATIONS DES NOMS DE FABRICANTS
TPH
TRB
TRI
UCB
VAL
VIV
VLH
VLN
TaroPharma, Divison of Taro
Pharmaceuticals
Tribute Pharmaceuticals
Triton Pharma Inc.
UCB Canada Inc.
Valeo Pharma Inc.
ViiV Healthcare ULC
Lundbeck Canada Inc.
Valeant Canada Ltd.
February 2014
VTH
WAM
WCH
WLS
WNC
XPI
YNO
ZYM
A - 10
Vita Health Company (1985) Ltd
Wampole Brands
Wyeth Consumer Healthcare Inc.
Wellspring Pharmaceutical Cananda Corp.
Warner Chilcott Canada Co.
Xediton Pharmaceuticals Inc.
Bayer Inc. Consumer Care Division
Zymcan Pharmaceuticals Inc.
APPENDIX II
Placebos
Placebos, when prescribed as substitutes for benefit products, are normally payable under these programs. This
applies particularly to the extemporaneous substitution of inert substances for active ingredients for therapeutic
purposes, for example the content of capsules, without the patient's knowledge. In such cases, the pharmacist's
claim is to be based on the original product.
When a lower-priced manufactured product is substituted which does not require special preparation, the lowerpriced drug becomes the basis for the pharmacist's claim.
No claim may be made if the purpose of a prescription is obviously to substitute a dosage or formulation which is not
itself covered by the program; such formulations cannot properly be called placebos.
Claims for placebos must be submitted for reimbursement on the Special Claim Form using the DIN "999008". The
Program also requires the name, quantity and strength of all the ingredients used in the preparation of each placebo.
February 2014
A - 11
APPENDIX III
Extemporaneous Preparations
Extemporaneous preparations are defined as a drug or mixture of drugs prepared or compounded in a pharmacy
according to the order of a prescriber.
To be eligible as a benefit, extemporaneous preparations must be in the list below or:
1.
2.
3.
4.
be specifically tailored to a physician's prescription and
contain one or more drugs presently considered a benefit and
not duplicate the formulation of a manufactured drug product and
not contain drugs in the exclusion list
Claims for Extemporaneous Preparations listed below are to be submitted electronically using the PIN assigned to
the product. Claims for Extemporaneous Preparations not listed below are to be submitted electronically using the
DIN of at least one ingredient which is a program benefit. This claim must be identified by entering the appropriate
CPhA version 3 code.
Note: When there is a shortage or no supply of a commercially available product and the healthcare professional has
determined a medical need for this product, the product may be compounded during the period of shortage or no
supply only. (Health Products and Food Branch Inspectorate Policy on Manufacturing and Compounding Drug
Products in Canada)
Regular Benefits
Product Name
PIN Plans
Anthralin Ointment 0.4%
Anthralin Soft Paste 0.05%
Anthralin Weak Ointment 0.2%
Disulfiram powder
Hydrochlorothiazide powders and suspensions for oral use
Hydrocortisone powder for topical applications >0.5%
LCD (Coal Tar Solution) in compounds for topical applications
Meclizine Powder
Prednisone powders and suspension for oral use
Progesterone powder in compounds for topical application
Propylene Glycol Liquid in compounds for topical applications
Salicylic Acid in compounds for topical applications
Saturated Solution Potassium Iodide
Spironolactone powders and suspensions for oral use
Sulphur in compounds for topical applications
00901113
00902063
00900907
00900915
00901105
00999087
00999106*
00990841*
00358495*
00903076
00999108*
00990876*
00990884*
00900788*
00999105*
00999107*
00900826*
* This PIN must be used to submit claims for any strength of this extemporaneous preparation.
February 2014
A - 12
AEFGV
AEFGV
AEFGV
AEFGV
AEFGV
AEFG
AEFGV
AEFGV
AEFGV
AEFGV
AEFGV
AEFGV
ABEFGV
AEFGV
AEFGV
AEFGV
AEFGV
APPENDIX IV
Special Authorization
Certain drugs are only eligible for coverage under New Brunswick Prescription Drug Program (NBPDP) through
special authorization. The criteria are developed by the Atlantic and Canadian Expert Advisory Committees.
Drugs eligible for consideration through special authorization:
• Drugs listed as special authorization benefits have specific criteria which must be met in order to be approved.
These drugs are listed alphabetically by generic name in the following section.
• Under exceptional circumstances, requests for drugs without specific criteria may be reviewed case-by-case and
assessed based on the published medical evidence.
Drugs not eligible for consideration through special authorization:
• New drugs not yet reviewed by the expert advisory committee
• Drugs excluded as eligible benefits further to the expert advisory committee’s review and recommendation
• Drugs not licensed or marketed in Canada (e.g. drugs obtained through Health Canada’s Special Access
Program)
• Products specifically excluded as benefits as identified on the exclusion list (Formulary pages IV and V).
Reimbursement of brand name products when generics exist
When interchangeable generic products are available for a brand name drug, the New Brunswick Prescription Drug
Program (NBPDP) will only reimburse pharmacies for the lowest cost generic product. Beneficiaries, who choose to
receive a brand name product when a generic product exists, are responsible for paying any difference in price.
The NBPDP will consider requests for reimbursement of brand name drugs when a beneficiary has had a
hypersensitivity reaction (e.g. edema, respiratory distress, serum sickness, anaphylaxis) to a non-medicinal ingredient
contained in the interchangeable generic product. Requests may be made by submitting a completed Special
Authorization Request Form and providing details of the hypersensitivity reaction.
Information on the safety and effectiveness of generic drugs is available on Health Canada’s website at http://www.hcsc.gc.ca/hl-vs/iyh-vsv/med/med-gen-eng.php.
February 2014
A - 13
Special authorization requests must be submitted in writing by the prescriber and include the following information:
Patient Identification
• Name of patient
• NB Medicare number
• Date of birth
Prescriber Identification
• Name, address, telephone number and FAX number (if applicable) of prescriber
Drug Requested
• Drug name, strength and dosage form
• Dosage schedule
• Expected duration of therapy
Reason for the Request
• Diagnosis and/or indication for which the drug is being used
• Information regarding previous drugs which have been used and the patient’s response to therapy where
appropriate
• Any additional information that may assist in making a decision on the request for special authorization.
Special authorization requests for beneficiaries of Plans A,B,E,F,G,R,V should be sent by mail or FAX to:
Special Authorization Unit
New Brunswick Prescription Drug Program
P.O. Box 690
Moncton, NB E1C 8M7
Local Fax: 506-867-4872
Toll Free Fax: 1-888-455-8322
NBPDP Inquiry Line: 1-800-332-3691
Plan U (HIV - Infected Persons) special authorization requests should be sent by mail or FAX to:
Special Authorization Unit – Plan U
P.O. Box 690
Moncton, NB E1C 8M7
Local fax: 506-867-4339
Toll Free Fax: 1-866-770-7746
Toll Free Telephone: 1-800-332-3691
February 2014
A - 14
Special Authorization Criteria
ABATACEPT (ORENCIA)
250mg vial for intravenous injection
• For the treatment of Juvenile Rheumatoid Arthritis:
o In children (age 6-17) with moderate to severe active polyarticular juvenile idiopathic arthritis/juvenile
rheumatoid arthritis who are intolerant to, or who have not had an adequate response from etanercept.
o Initial treatment is limited to a maximum of 16 weeks. Retreatment is permitted for children who demonstrated
an adequate initial treatment response and who are experiencing a disease flare.
o Must be prescribed by a rheumatologist.
• For patients with moderate to severe active rheumatoid arthritis who:
o Have not responded to, or have had intolerable side-effects with, an adequate trial of combination therapy of
at least two traditional DMARDs (disease modifying antirheumatic drugs). Combination DMARD therapy must
include methotrexate unless contraindicated or not tolerated,
OR
o Are not candidates for combination DMARD therapy, must have had adequate trial of at least three traditional
DMARDs in sequence, one of which must have been methotrexate unless contraindicated,
AND
o Have had an adequate trial of leflunomide unless it is contraindicated or not tolerated.
o Must be prescribed by a rheumatologist.
Abatacept should not be used in combination with anti-TNF agents or other TNF antagonists.
ABIRATERONE (ZYTIGA)
250mg tablets
For the treatment of metastatic castration-resistant prostate cancer in patients who have received prior chemotherapy
containing docetaxel and who have an ECOG performance status of 0-2*.
* Patients who are asymptomatic and those who are symptomatic and in bed less than 50% of the time.
ACAMPROSATE CALCIUM (CAMPRAL)
333mg tablets
For the maintenance of abstinence from alcohol in patients with alcohol dependence who have been abstinent for at
least four days, and who have contraindications to naltrexone (e.g. currently receiving opioids, acute hepatitis or liver
failure). Treatment with acamprosate should be part of a comprehensive management plan that includes counseling.
ACARBOSE (GLUCOBAY)
50mg and 100mg tablets
For non-insulin-dependent diabetes mellitus (NIDDM) patients failing or having contraindications to sulphonylurea
and/or biguanide oral hypoglycemics after a reasonable attempt at diet and exercise therapy.
ADALIMUMAB (HUMIRA)
40mg/0.8mL (50mg/mL) injection
Ankylosing Spondylitis
• For the treatment of patients with moderate to severe ankylosing spondylitis (e.g. Bath AS Disease Activity Index
(BASDAI) score ≥ 4 on 10 point scale) who:
o Have axial symptoms* and who have failed to respond to the sequential use of at least 2 NSAIDs at the
optimum dose for a minimum period of 3 months observation or in whom NSAIDs are contraindicated
OR
o Have peripheral symptoms and who have failed to respond to, or have contraindications to, the sequential use
of at least 2 NSAIDs at the optimum dose for a minimum period of 3 months observation and have had an
inadequate response to an optimal dose or maximal tolerated dose of a DMARD.
* Patients with recurrent uveitis (2 or more episodes within 12 months) as a complication to axial disease, do not
require a trial of NSAIDs alone.
• Must be prescribed by a rheumatologist or internist
• Approval will be for a maximum of 6 months
• Requests for renewal must include information showing the beneficial effects of the treatment, specifically:
o A decrease of at least 2 points on the BASDAI scale, compared with the pre-treatment score
February 2014
A - 15
OR
o Patient and expert opinion of an adequate clinical response as indicated by a significant functional
improvement (measured by outcomes such as HAQ or “ability to return to work”)
• Approvals will be for a maximum dose of 40mg every two weeks
• Adalimumab will not be reimbursed in combination with other anti-TNF agents
Crohn’s Disease
• For moderately to severely active Crohn's disease in patients who are refractory or have contraindications to an
adequate course of 5-aminosalicylic acid and corticosteroids and other immunosuppressive therapy.
o Eligible patients should receive an induction dose of 160mg followed by 80mg two weeks later.
o Clinical response should be assessed four weeks after the first induction dose.
o Initial requests will be approved for a maximum of 12 weeks.
o Ongoing coverage for maintenance therapy will only be reimbursed for responders and for a dose not
exceeding 40mg every two weeks.
Psoriatic Arthritis
• For the treatment of active psoriatic arthritis in patients who:
o Have at least three active and tender joints, and
o Have not responded to an adequate trial of two DMARDs or have an intolerance or contraindication to
DMARDs.
• Must be prescribed by a rheumatologist.
• The number of doses is limited to twenty-six 40 mg doses per year with no dose escalation permitted.
• Should not be used in combination with other tumor necrosis factor (TNF) antagonists.
Rheumatoid Arthritis
•
•
•
OR
o Are not candidates for combination DMARD therapy must have had adequate trial of at least three traditional
DMARDs in sequence, one of which must have been methotrexate unless contraindicated
AND
Must be prescribed by a rheumatologist.
The number of doses is limited to twenty-six 40 mg doses per year with no dose escalation permitted.
Should not be used in combination with other tumor necrosis factor (TNF) antagonists
Plaque Psoriasis
• Requests will be considered for treatment of patients with severe, debilitating chronic plaque psoriasis who meet
•
•
•
•
•
•
all of the following criteria:
o Body surface area (BSA) involvement of >10% and/or significant involvement of the face, hands, feet or
genital region;
o Failure to respond to, contraindications to or intolerance to methotrexate and cyclosporine;
o Failure to respond to, intolerance to or unable to access phototherapy
Initial approval limited to 16 weeks.
Continuation of therapy beyond 16 weeks will be based on response. Patients not responding adequately at
these time points should have treatment discontinued with no further treatment with the same agent
recommended.
An adequate response is defined as either:
o ≥75% reduction in the Psoriasis Area and Severity Index (PASI) score from when treatment started (PASI 75),
or
o ≥50% reduction in the PASI score (PASI 50) with a ≥5 point improvement in the Dermatology Life Quality
Index (DLQI) from when treatment started, or
o A quantitative reduction in BSA affected with qualitative consideration of specific regions such as face, hands,
feet, or genital region.
Must be prescribed by a dermatologist
Concurrent use of >1 biologic will not be approved
Approval limited to a dose of 80 mg administered once followed by 40 mg after 1 week of initial dose, then 40 mg
every other week thereafter, up to a year (if response criteria met at 16 weeks).
February 2014
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ADEFOVIR DIPIVOXIL (HEPSERA)
10mg tablets
For the treatment of Hepatitis B when used in combination with lamivudine, in patients who have failed lamivudine, as
defined by an increase in HBV DNA of > 1 log 10 IU/mL above the nadir, measured on two separate occasions within
an interval of at least one month, after the first three months of lamivudine therapy, and when lamivudine failure is not
due to poor adherence to therapy.
ALENDRONATE (FOSAMAX and generic brand)
40mg tablets
For the treatment of Paget’s disease.
ALENDRONATE (FOSAMAX and generic brands)
See criteria under Osteoporosis Drugs.
ALENDRONATE/CHOLECALCIFEROL (FOSAVANCE 70/5600 and generic brand)
70mg/ 140 μg tablets
1. For the treatment of osteoporosis:
• with documented fragility fracture or;
• without documented fractures in patients at high 10-year fracture risk
2. For prophylaxis of corticosteroid induced osteoporosis in patients who will be or have been on systemic
corticosteroid therapy for ≥ 3 months.
ALGLUCOSIDASE ALFA (MYOZYME)
50mg vial injection
For the treatment of infantile-onset Pompe disease, as demonstrated by onset of symptoms and confirmed
cardiomyopathy within the first 12 months of life.
Monitoring of therapy
The monitoring of markers of disease severity and response to treatment must include at least:
1. Weight, length and head circumference.
2. Need for ventilatory assistance, including supplementary oxygen, CPAP, BiPAP, or endotracheal intubation and
ventilation.
3. Left ventricular mass index (LVMI) as determined by echocardiography (not ECG alone).
4. Periodic consultation with cardiology.
5. Periodic consultation with respirology.
Withdrawal of therapy
1. Patients to be considered for reimbursement of drug costs for alglucosidase alfa treatment must be willing to
participate in the long-term evaluation of the efficacy of treatment by periodic medical assessment. Failure to
comply with recommended medical assessment and investigations may result in withdrawal of financial support of
drug therapy.
2. The development of the need for continuing invasive ventilatory support after the initiation of ERT should be
considered a treatment failure. Funding for ERT should not be continued for infants who fail to achieve ventilatorfree status, or who deteriorate further, within 6 months after the initiation of ventilatory support.
3. Deterioration of cardiac function, as shown by failure of LV hypertrophy (as indicated by LV mass index) to
regress by more than Z=1 unit, or persistent clinical or echocardiographic findings of cardiac systolic or diastolic
failure without evidence of improvement, in spite of 24 weeks of ERT, should be considered a treatment failure
and funding for ERT should be discontinued.
ALMOTRIPTAN (AXERT and generic brands)
6.25mg and 12.5mg tablets
• For the treatment of migraine1 headache of moderate2 intensity when other therapies (e.g. NSAIDs,
acetaminophen, DHE spray) are not effective AND patients have not responded to oral sumatriptan, zolmitriptan,
rizatriptan and naratriptan.
• For the treatment of migraine1 headache of severe2 or ultra severe2 intensity when patients have not responded to
oral sumatriptan, zolmitriptan, rizatriptan and/or naratriptan.
• Coverage limited to 6 doses / 30 days3
February 2014
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o patients with >3 migraines/month on average despite prophylactic therapy may be considered for up to a
maximum of 12 doses / 30 days
1
As diagnosed based on current Canadian guidelines.
Definitions:
•
Moderate - pain is distracting causing need to slow down and limit activities;
•
Severe - pain affects ability to concentrate and very difficult to continue with daily activities;
•
Ultra severe - unable to speak or think clearly; not able to function; likely lying down or sleeping
2
3
Reimbursement will be available for a maximum quantity of triptan doses as outlined in criteria per 30 days regardless of the
agent(s) used within the 30 day period.
Special authorization for the products almotriptan 6.25mg and 12.5mg tablets, naratriptan 1mg and 2.5mg tablets,
rizatriptan 5mg and 10mg tablets and wafers, sumatriptan 5mg and 20mg nasal spray and zolmitriptan 2.5mg tablets
and orally dispersible tablets, 2.5mg and 5mg nasal spray will be considered as a set. Approvals will include all
products in this list, however reimbursement will be available for a maximum quantity of one agent per month.
AMBRISENTAN (VOLIBRIS)
5mg, 10mg tablets
For treatment of patients with pulmonary arterial hypertension (PAH), of at least World Health Organization (WHO)
functional class III, which is associated with either idiopathic or connective tissue disease and who have failed to
respond to or who have contraindications to, or who are not a candidate for sildenafil.
• Diagnosis of PAH should be confirmed by cardiac catheterization
• The maximum dose of ambrisentan that will be reimbursed is 10 mg daily
• Ambrisentan will not be approved when used concurrently with other endothelin receptor antagonists,
epoprostenol, treprostinil or sildenafil.
AMLODIPINE BESYLATE / ATORVASTATIN (CADUET and generic brands)
5/10mg, 5/20mg, 5/40mg, 5/80mg, 10/10mg, 10/20mg, 10/40mg and 10/80mg tablets
For the treatment of patients who have been titrated to a stable combination of the separate components, amlodipine
and atorvastatin.
If the beneficiary has had a claim for both amlodipine and atorvastatin reimbursed by NBPDP in the previous 6
months, the claim for Caduet will automatically be reimbursed without requiring special authorization.
APREPITANT (EMEND)
80 mg and 125 mg capsule; Tri-Pack
For the prevention of acute and delayed nausea and vomiting due to highly emetogenic cancer chemotherapy (e.g.
2
cisplatin >70 mg/m ) in patients who have experienced emesis despite treatment with a combination of a 5-HT3
antagonist and dexamethasone in a previous cycle of highly emetogenic chemotherapy.
Note: Prescription claims for up to a maximum of 2 Tri-packs, or 6 capsules will be automatically reimbursed every 28
days when the prescription is written by an oncologist or an oncology clinical associate/general practitionersoncology. If additional medication is required within a 28 day period subsequent to the initial prescription, a request
should be made through special authorization.
ARIPIPRAZOLE (ABILIFY)
2mg, 5mg, 10mg, 15mg, 20mg, 30mg tablets
For the treatment of schizophrenia and related psychotic disorders (not dementia related) in patients with a history of
failure, intolerance, or contraindication to at least one less expensive antipsychotic agent.
ASENAPINE (SAPHRIS)
5mg, 10mg sublingual tablets
For the acute treatment of manic or mixed episodes associated with bipolar I disorder as either:
• Monotherapy, after a trial of lithium or divalproex sodium has failed, and trials of less expensive atypical
antipsychotic agents have failed due to intolerance or lack of response
• Co-therapy with lithium or divalproex sodium, after trials of less expensive atypical antipsychotic agents have
failed due to intolerance or lack of response.
February 2014
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ATOVAQUONE (MEPRON)
750mg/5mL suspension
For the treatment of mild to moderate Pneumocystis Carinii pneumonia in beneficiaries who are intolerant to
trimethoprim-sulfamethoxazole.
AZITHROMYCIN (ZITHROMAX and generic brands)
600mg tablets
For the prevention of disseminated Mycobacterium Avium Complex (MAC) in HIV positive patients who are severely
9
immunocompromised with CD4 levels <0.1 x 10 /L.
BETAHISTINE (SERC and generic brands)
8mg, 16mg and 24mg tablets
For the symptomatic treatment of the recurrent episodes of vertigo associated with Ménière’s disease.
BOCEPREVIR (VICTRELIS)
200mg capsule
For the treatment of patients with chronic hepatitis C genotype 1 infection (HCV RNA positive) in combination with
peginterferon alpha and ribavirin if the following criteria are met:
• Fibrosis stage of F2, F3 or F4 or on recommendation of an Internal Medicine Specialist
• Patient is not co-infected with HIV
One course of treatment only (for up to 44 weeks duration) will be approved.
Notes:
1. Response-guided therapy should be considered in patients for whom this is appropriate.
2. Therapy should be discontinued in all patients with HCV RNA levels ≥ 100 IU/mL at treatment week 12, or
confirmed HCV RNA positive at treatment week 24.
BOCEPREVIR/RIBAVIRIN PLUS PEGINTERFERON ALFA-2B (VICTRELIS TRIPLE)
200mg / 200mg capsules plus 80mcg injection
For the treatment of patients with chronic hepatitis C genotype 1 infection (HCV RNA positive) if the following criteria
are met:
• Patient is not co-infected with HIV
One course of treatment only (for up to 44 weeks duration) will be approved.
Notes:
2. Therapy should be discontinued in all patients with HCV RNA levels ≥ 100 IU/mL at treatment week 12, or
confirmed HCV RNA positive at treatment week 24.
BOSENTAN (TRACLEER and generic brands)
62.5mg and 125mg tablets
For treatment of pulmonary arterial hypertension (PAH) in patients with World Health Organization (WHO) functional
class III or IV
• idiopathic pulmonary arterial hypertension (IPAH) in patients who do not demonstrate vasoreactivity on testing or
who demonstrate vasoreactivity on testing but fail a trial of, or are intolerant to, calcium channel blockers.
• pulmonary arterial hypertension associated with connective tissue disease or congenital heart disease or human
immunodeficiency virus (HIV) who do not respond adequately to conventional therapy.
BUDESONIDE/FORMOTEROL (SYMBICORT)
100mcg/6mcg and 200mcg/6mcg metered dose inhaler
Reversible obstructive airway disease:
• For patients with reversible obstructive airways disease who are
- Stabilized on an inhaled corticosteroid and a long-acting beta2-adrenergic agonist,
OR
February 2014
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-
Using optimal doses of inhaled corticosteroids but are still poorly controlled.
Chronic Obstructive Pulmonary Disease:
• For the treatment of chronic obstructive pulmonary disease (COPD) if:
o symptoms persist after 2-3 months of short-acting bronchodilator therapy (i.e. salbutamol at a maximum dose
of 8 puffs/day or ipratropium at maximum dose of 12 puffs/day)
• Coverage can be provided without a trial of short-acting agent if:
o there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and FEV1 /FVC
ratio < 0.7) and significant symptoms i.e. MRC score of 3-5**.
• Combination therapy with tiotropium AND a long-acting beta2-adrenergic agonist/inhaled corticosteroid
(LABA/ICS) will only be considered if:
- there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and
FEV1/FVC ratio < 0.7), and significant symptoms i.e., MRC score of 3-5** AND
- there is evidence of one or more moderate-to-severe exacerbations per year, on average, for 2
consecutive years requiring antibiotics and/or systemic (oral or intravenous) corticosteroids.
NOTE: If spirometry cannot be obtained, reasons must be clearly explained and other evidence regarding severity of
condition must be provided for consideration (i.e. MRC scale). Spirometry reports from any point in time will be
accepted.
**Medical Research Council (MRC) Dyspnea Scale
COPD Stage
Symptoms
MODERATE – MRC 3 to 4
Shortness of breath from COPD causing the patient to stop after walking about
100 meters (or after a few minutes) on the level.
SEVERE – MRC 5
Shortness of breath from COPD resulting in the patient being too breathless to
leave the house or breathless after undressing, or the presence of chronic
respiratory failure or clinical signs of right heart failure.
BUPRENORPHINE / NALOXONE (SUBOXONE)
2 mg/0.5 mg and 8 mg/2 mg sublingual tablets
For the treatment of opioid dependence for patients in whom methadone is contraindicated (e.g. patients at high risk
of, or with QT prolongation, or hypersensitivity to methadone). Commonly reported adverse effects associated with
methadone therapy (eg. sweating, constipation, insomnia, etc.) will not be considered to be hypersensitivity.
Requests from New Brunswick physicians authorized to prescribe methadone or physicians with experience in the
treatment of opioid dependence will be considered.
BUSERELIN ACETATE (SUPREFACT)
1mg/ml nasal solution
Approved for the palliative treatment of stage D2 carcinoma of the prostate (Plan F beneficiaries).
CABERGOLINE (DOSTINEX and generic brand)
0.5mg tablets
For the treatment of patients with hyperprolactinemia who have failed or are intolerant to bromocriptine
CALCIPOTRIOL/BETAMETHASONE DIPROPIONATE (DOVOBET)
50µg/0.5mg/g gel
For the treatment of scalp psoriasis after failure of a topical steroid used alone AND failure of a topical steroid used
concomitantly with calcipotriol as single agents.
CAPECITABINE (XELODA and generic brand)
Colorectal Cancer
• For single agent therapy of colorectal cancer in patients who are chemotherapy naive or patients who have
progressed 6 months after completion of adjuvant 5-FU/ leucovorin therapy. Coverage will be limited to:
a) Metastatic colorectal cancer, with an ECOG performance status of 0-2*, when first line combination
chemotherapy (5-FU/ leucovorin/irinotecan) is declined or not tolerated.
†
b) Stage III (Dukes’ C) colon cancer and ECOG status 0-1 as adjuvant therapy.
• As part of the CAPOX (capecitabine-oxaliplatin) regimen for the first-line and second-line treatment of Metastatic
Colorectal Cancer (mCRC) for patients with an ECOG performance status of 0-2*.
February 2014
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Metastatic Breast Cancer
For treatment of metastatic breast cancer where patients have progressed after prior chemotherapy and who have an
ECOG performance status of 0-2*.
Requests for capecitabine must be prescribed by a specialist in hematology/oncology. Approvals will be granted for
up to 6 months at a time.
CARVEDILOL (COREG and generic brands)
3.125mg, 6.25mg, 12.5mg and 25mg tablets
For the treatment of stable symptomatic heart failure in patients with a left ventricular ejection fraction (LVEF) less
than or equal to 40%.
Prescriptions written by cardiologists or internists do not require special authorization. Subsequent refills ordered by
other practitioners will not require special authorization.
CELECOXIB (CELEBREX)
100mg and 200mg capsules
For the treatment of osteoarthritis and rheumatoid arthritis in patients who have at least one of the following risk
factors:
• Past history of ulcers
• Concurrent warfarin therapy
• Concurrent prednisone therapy
• Failure or intolerance to at least two other NSAIDs (e.g. ibuprofen, diclofenac, naproxen)
Recommended maximum daily doses: 200mg for osteoarthritis
400mg for rheumatoid arthritis
Note: Celecoxib is a regular benefit for beneficiaries age 65 and over.
February 2014
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CHOLINESTERASE INHIBITORS (Donepezil, Galantamine, Rivastigmine)
- For the treatment of mild to moderate Alzheimer’s disease
To initiate therapy:
Requests must be submitted on the appropriate NBPDP special authorization form.
http://www.gnb.ca/0212/alzheimers-e.asp
For a patient
being started on a
first
cholinesterase
inhibitor (ChEI):
Patients who meet all of the following reimbursement criteria will be approved for an
initial 6 months of therapy:
•
a diagnosis of probable Alzheimer’s disease or possible Alzheimer’s disease with
vascular component or Lewy bodies;
•
a Mini Mental Score Exam (MMSE) score of 10 to 30; and
•
a Functional Assessment & Staging Test (FAST) score of 4 to 5
For a patient who
has previously
taken no more
than one other
ChEI and is
switching:
Patients will be approved for an initial 6 months of therapy with a second ChEI when the
following information is provided:
•
the reason for discontinuing the first ChEI
Requests to switch from one agent in the class to another will not be considered beyond
the initial 6 month approval.
To continue therapy for 1 year period (once initial 6 month approval has been completed):
Patients who meet the following monitoring criteria will be approved for 1 year periods of therapy:
•
MMSE score of 10 to 30 (Note: MMSE score must be provided 6 months after starting a ChEI and then
only annually thereafter.); and
•
FAST score of 4 to 5 (Note: FAST score must be provided 6 months after starting a ChEI and then only
annually thereafter.)
Note: Monitoring of target symptoms will no longer be required; however, physicians will be asked at the initial
and subsequent reassessments if, in their opinion, the patient is benefiting from the drug.
CIPROFLOXACIN (CILOXAN and generic brand)
0.3% ophthalmic solution
For the treatment of corneal ulcers and bacterial conjunctivitis.
Prescriptions written by New Brunswick ophthalmologists and optometrists do not require special authorization.
CIPROFLOXACIN (CIPRO and generic brands)
500mg/5mL Oral Suspension
For the treatment of:
Complicated urinary tract infections caused by resistant bacteria.
Skin, soft tissue, bone and joint infections caused by Gram negative bacteria.
Severe (“malignant”) otitis externa.
Infections with Pseudomonas aeruginosa (susceptible strains – resistance is now common).
•
•
•
•
Prescriptions written by New Brunswick urologists, infectious disease specialists, medical oncologists, hematologists,
respiratory medicine specialists or medical microbiologists do not require special authorization.
February 2014
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CIPROFLOXACIN (CIPRO XL)
1000mg tablets
For the treatment of complicated urinary tract infection and acute uncomplicated pyelonephritis when alternative
agents are ineffective, not tolerated or contraindicated.
Prescriptions written by New Brunswick urologists, infectious disease specialists and medical microbiologists do not
require special authorization.
CIPROFLOXACIN HCL / DEXAMETHASONE (CIPRODEX)
0.3% / 0.1% otic suspension
• For the treatment of acute otitis media with otorrhea through tympanostomy tubes who require treatment.
• For the treatment of acute otitis externa in the presence of a tympanostomy tube or known perforation of the
tympanic membrane.
CLOPIDOGREL (PLAVIX and generic brands)
75mg tablets
1. Secondary prevention of vascular ischemic events (myocardial infarction, stroke) in patients with a history of
symptomatic atherosclerotic disease (including symptomatic peripheral artery disease) who have had treatment
failure or are intolerant or allergic to ASA.
2. For the prevention of thrombosis post stent implantation for a period of up to 6 months for bare-metal stents
(BMS) and 12 months for drug- eluting stents (DES). Prescriptions written by invasive (interventional)
cardiologists for this procedure do not require special authorization. The claims adjudication system will
automatically recognize the NBPDP physician ID number of the cardiologists at the Atlantic Health Sciences
Centre.
3. For the prevention of vascular ischemic events in patients who have been hospitalized with acute coronary
syndrome (i.e. unstable angina or non-ST segment elevation myocardial infarction) in combination with ASA for a
period of three months.
Longer term combination therapy may be considered for a period of 12 months post NSTE-ACS for patients:
• with a second acute coronary syndrome within 12 months, or
• with complex or extensive CAD (i.e. diffuse 3 vessel CAD not amenable to revascularization), or
• who have had a previous stroke, transient ischemic attack or symptomatic PAD
CLOZAPINE (CLOZARIL and generic brands)
CLOZAPINE (GEN-CLOZAPINE)
• Requests will be considered for beneficiaries who are non-responsive to, or intolerant of, conventional or other
•
atypical antipsychotic drugs.
o non-responsiveness is defined as a lack of satisfactory clinical response, despite treatment with the
appropriate courses of maximum tolerated therapeutic doses of at least two chemically-unrelated
antipsychotics.
o intolerance is defined as the inability to achieve adequate benefit with conventional antipsychotics because of
dose-limiting, intolerable adverse effects such as parkinsonism, dystonia, akathesia and tardive dyskinesia.
Clozapine must be prescribed by, or in consultation with, a psychiatrist. Prescriptions written by New Brunswick
psychiatrists do not require special authorization. Subsequent refills ordered by other practitioners will not require
special authorization.
CODEINE (CODEINE CONTIN)
50mg, 100mg, 150mg, and 200mg tablets (controlled release)
For the treatment of mild to moderate cancer-related or chronic non-cancer pain.
CRIZOTINIB (XALKORI)
200mg, 250mg capsules
Second-line therapy for patients with anaplastic lymphoma kinase (ALK) -positive advanced non-small cell lung
cancer (NSCLC) with an ECOG performance status of 0-2.
February 2014
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CYCLOSPORINE (NEORAL and generic brand)
10mg, 25mg, 50mg, 100mg capsules
100mg/mL oral solution
• For the treatment of severe psoriasis
• For the treatment of severe rheumatoid arthritis
DABIGATRAN (PRADAXA)
110 mg and 150 mg tablets
For the prevention of stroke and systemic embolism in at-risk patients with non-valvular atrial fibrillation for whom:
• Anticoagulation is inadequate following at least a two month trial of warfarin; or
• Warfarin is contraindicated or not possible due to inability to regularly monitor through International Normalized
Ratio (INR) testing (i.e. no access to INR testing services at a laboratory, clinic, pharmacy and at home).
The following patient groups are excluded from coverage for dabigatran for atrial fibrillation:
Patients with impaired renal function (creatinine clearance or estimated glomerular filtration rate < 30 mL/min)
Patients 75 years of age or older without documented stable renal function
Patients with hemodynamically significant rheumatic valvular heart disease, especially mitral stenosis
Patients with prosthetic heart valves
•
•
•
•
Notes:
1. At-risk patients with atrial fibrillation are defined as those with a CHADS2 score of ≥ 1.
2. Inadequate anticoagulation is defined as INR testing results that are outside the desired INR range for at least
35% of the tests during the monitoring period (i.e. adequate anticoagulation is defined as INR test results that are
within the desired INR range for at least 65% of the tests during the monitoring period).
3. Since renal impairment can increase bleeding risk, renal function should be regularly monitored. Other factors that
increase bleeding risk should also be assessed and monitored (see dabigatran Product Monograph).
4. Documented stable renal function is defined as creatinine clearance or estimated glomerular filtration rate that
maintained for at least three months (i.e. 30-49 mL/min for 110 mg twice daily dosing or ≥ 50 mL/min for 150 mg
twice daily dosing).
5. There is currently no data to support that dabigatran provides adequate anticoagulation in patients with rheumatic
valvular disease or those with prosthetic heart valves, so dabigatran is not recommended in these populations.
6. Patients starting dabigatran should have ready access to appropriate medical services to manage a major
bleeding event.
DALTEPARIN SODIUM (FRAGMIN)
10,000 IU ampoule, 25,000IU/mL multidose vials
5,000 IU/mL, 7,500 IU/mL, 10,000 IU/mL, 12,500IU/mL, 15,000IU/mL, 18,000IU/mL prefilled syringes
See criteria under Low Molecular Weight Heparins.
DARBEPOETIN (ARANESP)
®
10, 20, 30, 40, 50, 60, 80, 100, 130, 150, 200, 300 and 500mcg SingleJect prefilled
Syringes
• For the treatment of anemia associated with chronic renal failure. Note: patients on dialysis (end-stage renal
disease) receive darbepoetin through the dialysis units.
• For the treatment of transfusion dependent patients with hematologic malignancies whose transfusion
requirements are ≥ 2 units of packed red blood cells per month over 3 months.
o Initial approval for 12 weeks.
o Approval of further 12 week cycles is dependent on evidence of satisfactory clinical response or reduced
treatment requirement to less than 2 units of PRBC monthly.
February 2014
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DARIFENACIN HYDROBROMIDE (ENABLEX)
7.5mg and 15mg extended release tablets
• For the treatment of overactive bladder with symptoms of urinary frequency, urgency and/or urge incontinence in
patients who have not tolerated a reasonable trial of immediate-release oxybutynin.
• Requests for the treatment of stress incontinence will not be considered.
If the beneficiary has had a claim for oxybutynin in the previous 24 months, the adjudication system will recognize this
information and the claim for darifenacin will be automatically reimbursed without the need for a written special
authorization request.
Written special authorization will continue to be available as an option for beneficiaries who may not have the relevant
first line agent on history due to changes in drug coverage or other factors.
DARUNAVIR (PREZISTA)
75mg, 150mg, 400mg, 600mg and 800mg tablets
• As part of a HIV treatment regimen for treatment-experienced adult patients (Plan U beneficiaries) who have
•
•
demonstrated failure to multiple protease inhibitors (PIs), and in whom less expensive PIs are not a treatment
option.
As part of a HIV treatment regimen for treatment-naïve patients (Plan U beneficiaries) for whom protease inhibitor
therapy is indicated.
As part of a HIV treatment regimen for treatment-experienced HIV-1 pediatric patients (Plan U beneficiaries).
DASATINIB (SPRYCEL)
Chronic Myeloid Leukemia (CML)
For adult patients with chronic phase CML
• with primary or acquired resistance to imatinib 600mg per day. Dosing recommendation: 100mg per day or 70mg
two times daily
• who progress to accelerated phase on imatinib 600mg per day. Dosing recommendation: 140mg per day
• who have blast crisis while on imatinib 600mg per day. Dosing recommendation: 140mg per day
• who have intolerance to imatinib or have experienced grade 3 or higher toxicities to imatinib
Initial approval period: 1 year
Renewal criteria: Request for renewal must specify how the patient has benefited from therapy and is expected to
continue to do so.
Renewal period: 1 year
Acute Lymphoblastic Leukemia (ALL)
For adult patients with Philadelphia chromosome positive acute lymphoblastic leukemia (ALL) whose disease is
resistant to imatinib-containing chemotherapy (patient must have tried 600mg/day) or have experienced grade 3 nonhematologic toxicity, or grade 4 hematologic toxicity persisting for more than 7 days as a result of therapy with
imatinib.
Initial approval period: 1 year.
Renewal criteria: Written confirmation that the patient has benefited from therapy and is expected to continue to
do so.
Renewal period: 1 year.
DEFERASIROX (EXJADE)
125mg, 250mg, 500mg dispersable tablets for suspension
For patients who require iron chelation but in whom deferoxamine is contraindicated.
DELTA-9-TETRAHYDROCANNABINOL (MARINOL)
2.5mg and 5mg capsules
• Treatment of severe nausea and vomiting associated with cancer chemotherapy in patients who have not been
well controlled by standard antiemetic therapy
• Treatment of anorexia with weight loss associated with acquired immune deficiency syndrome (AIDS).
February 2014
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DENOSUMAB (PROLIA)
60mg/mL prefilled syringe
• For the treatment of osteoporosis in postmenopausal women who would otherwise be eligible for coverage of oral
•
bisphosphonate therapy and who have clinically or radiographically-documented fracture due to osteoporosis
AND
Contraindication to oral bisphosphonates for one of the following reasons:
o immune-mediated hypersensitivity reaction to oral bisphosphonates;
OR
o abnormalities of the esophagus which delay esophageal emptying such as stricture or achalasia.
Please note that commonly reported adverse effects or intolerance to bisphosphonates will not be
considered to be hypersensitivity.
DENOSUMAB (XGEVA)
120mg/1.7mL single use vial
For the prevention of skeletal-related events (SREs) in patients with castrate-resistant prostate cancer (CRPC) with
one or more documented bone metastases and an ECOG performance status of 0-2*.
DESMOPRESSIN (DDAVP and generic brands)
0.1mg and 0.2mg tablets
DESMOPRESSIN (DDAVP MELT)
60mcg, 120mcg and 240mcg tablets
• For the management of diabetes insipidus.
• For the treatment of patients 18 years and older with nocturnal enuresis.
Note: Desmopressin oral formulations and solution for injection are regular benefits for Plans EFG-18.
DESMOPRESSIN (DDAVP and generic brand)
10µg/metered dose nasal spray and 0.1mg/mL intranasal solution
• For the treatment of patients with diabetes insipidus.
The nasal formulations are no longer indicated for nocturnal enuresis due to the risk of hyponatremia.
DIENOGEST (VISANNE)
2mg tablet
For the management of pelvic pain associated with endometriosis in patients for whom one or more less costly
hormonal options are either ineffective or cannot be used.
Note: Continuous combined oral contraceptives and medroxyprogesterone are examples of less costly hormonal
options.
DIPYRIDAMOLE EXTENDED RELEASE/ASA IMMEDIATE RELEASE (AGGRENOX)
200mg/25mg capsules
For the secondary prevention of ischemic stroke/TIA in patients who have experienced a recurrent thrombotic event
(stroke, symptoms of TIA) while taking ASA.
DOLASETRON (ANZEMET)
100 mg tablets
For the treatment of emesis in patients who are:
• receiving moderately or severely emetogenic chemotherapy
OR
• receiving intravenous chemotherapy or radiotherapy and who have not experienced adequate control with other
•
available antiemetics
OR
receiving any intravenous chemotherapy or radiotherapy and have experienced emesis with a prior cycle of
chemotherapy with intolerable side effects to other antiemetics, including steroids and anti-dopaminergic agents.
February 2014
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Only requests for the oral dosage forms are eligible for consideration. Usually a single oral dose pre-chemotherapy is
sufficient to control symptoms.
Some patients may require additional therapy up to 48 hours after the last dose of chemotherapy or last radiation
treatment. Benefit beyond 48 hours has not been established.
When used in combination with aprepitant, only a single oral dose pre-chemotherapy will be covered.
Note: Prescription claims for up to a maximum of 12 tablets of ondansetron or 2 tablets of either granisetron or
dolasetron will be automatically reimbursed every 28 days when the prescription is written by an oncologist or an
oncology clinical associate/general practitioners-oncology. If additional medication is required within a 28 day period
subsequent to the initial prescription, a request should be made through special authorization.
DONEPEZIL (ARICEPT and generic brands)
See criteria under Cholinesterase Inhibitors.
DORNASE ALPHA RECOMBINANT (PULMOZYME)
1 mg/mL solution
For cystic fibrosis (Plan B) patients with a FEV1<70% predicted with clinically significant decline in FEV1 not
responsive to usual treatment.
DULOXETINE (CYMBALTA)
30 mg and 60 mg capsules
For the treatment of peripheral neuropathic pain in diabetic patients who have failed treatment with at least 2 other
less costly agents used for the treatment of neuropathic pain. (i.e. tricyclic antidepressants and/or an anticonvulsant).
The maximum allowable dose is 60 mg/day.
DUTASTERIDE (AVODART)
0.5mg capsules
For the treatment of benign prostatic hyperplasia (BPH) when alpha-blockers are contraindicated, not tolerated or
failed.
ECULIZUMAB (SOLIRIS)
10mg/mL vial
For the treatment of paroxysmal nocturnal hemoglobinuria (PNH). A Request for Coverage including the completed
consent and specific special authorization forms must be submitted and the patient must:
1. Satisfy the Clinical Criteria for eculizumab (initial or continued coverage, as appropriate);
2. Not meet any of the criteria specified in Contraindications to Coverage or Discontinuance of Coverage.
Please contact the NBPDP at 1-800-332-3691 for a packet containing the Clinical Criteria and required forms.
ELVITEGRAVIR/COBICISTAT/EMTRICITABINE/TENOFOVIR DISOPROXIL FUMARATE (STRIBILD)
150mg/150mg/200mg/300mg tablet
As a complete regimen for antiretroviral treatment naïve HIV-1 infected patients in whom efavirenz is not indicated.
ENOXAPARIN SODIUM (LOVENOX)
Prefilled syringes and 100mg/mL multidose vial
ENOXAPARIN SODIUM (LOVENOX HP)
Prefilled syringes
ENTACAPONE (COMTAN and generic brand)
200mg tablets
Treatment of Parkinson’s disease as adjunctive therapy in patients not well controlled and are experiencing
significant “wearing off” symptoms despite optimal therapy with levodopa/decarboxylase or levodopa/benserazide.
February 2014
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ENTECAVIR (BARACLUDE and generic brand)
0.5mg tablets
For the treatment of chronic hepatitis B infection in patients with cirrhosis documented on radiologic or histologic
grounds and a HBV DNA concentration above 2,000 lU/mL.
ENZALUTAMIDE (XTANDI)
40mg tablet
For treatment of patients with metastatic castration resistant prostate cancer, who have progressed on docetaxelbased chemotherapy with an ECOG performance status ≤2 and no risk factors for seizures and would be an
alternative to abiraterone for patients in the post-docetaxel setting but would not be an add-on therapy to abiraterone
treatment.
EPOETIN ALFA (EPREX)
1000IU/0.5mL, 2000IU/0.5mL, 3000IU/0.3mL, 4000IU/0.4mL, 5000IU/.5mL, 6000IU/.6mL, 8000IU/.8mL,
10000IU/mL, 20000IU/mL, 30,000IU/0.75mL and 40000IU/mL vials and prefilled syringes
1. Treatment of anemia associated with chronic renal failure. Note: patients on dialysis (end-stage renal disease)
receive epoetin through the dialysis units.
2. Treatment of transfusion dependent anemia related to therapy with zidovudine in HIV-infected patients.
3. Treatment of transfusion dependent patients with hematologic malignancies whose transfusion requirements are
≥ 2 units of packed red blood cells per month over 3 months.
• Initial approval for 12 weeks.
• Approval of further 12 week cycles is dependent on evidence of satisfactory clinical response or reduced
treatment requirement to less than 2 units of PRBC monthly.
EPOPROSTENOL SODIUM (CARIPUL et FLOLAN)
0.5mg and 1.5mg vials for injection
1. For the treatment of World Health Organization (WHO) class III or IV idiopathic pulmonary arterial hypertension in
patients who do not demonstrate vasoreactivity on testing or who demonstrate vasoreactivity on testing but fail a
trial of, or are intolerant to, calcium channel blockers.
2. For the treatment of WHO class III or IV pulmonary arterial hypertension associated with scleroderma in patients
who do not respond adequately to conventional therapy.
ERLOTINIB (TARCEVA)
Non-small Cell Lung Cancer (NSCLC)
For the treatment of patients with locally advanced or metastatic NSCLC after failure of at least one prior platinumbased chemotherapy regimen.
Initial approval period: 6 month trial.
Renewal criteria: Written confirmation that the patient has responded to treatment and in whom there is no evidence
of disease progression.
Renewal period: 6 months
ESTRADIOL-17β (VIVELLE and ESTRADOT and generic brands)
25 mcg, 37.5mcg, 50mcg, 75mcg and 100mcg transdermal patches
For the treatment of menopausal symptoms in women for whom oral forms of HRT are not tolerated or indicated.
ETANERCEPT (ENBREL)
25mg liquid injection
50mg/mL pre-filled syringe
o have axial symptoms* and who have failed to respond to the sequential use of at least 2 NSAIDs at the
OR
o have peripheral symptoms and who have failed to respond to, or have contraindications to, the sequential use
February 2014
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o a decrease of at least 2 points on the BASDAI scale, compared with the pre-treatment score;
OR
o patient and expert opinion of an adequate clinical response as indicated by a significant functional
• Approvals will be for a maximum dose of 50mg per week.
• Etanercept will not be reimbursed in combination with other anti-TNF agents.
Juvenile Rheumatoid Arthritis
• For the treatment of children (age 4-17) with moderately to severely active polyarticular juvenile rheumatoid
arthritis who have:
o not responded to adequate treatment with one or more disease modifying antirheumatic drug (DMARD) for at
least 3 months,
OR
o intolerance to DMARDs
Psoriatic Arthritis
For the treatment of patients with active psoriatic arthritis who have not responded to an adequate trial with two
disease modifying antirheumatic drugs (DMARDs) or who have an intolerance or contraindication to DMARDs.
•
For patients with moderate to severe active rheumatoid arthritis who:
OR
AND
•
Plaque Psoriasis
Requests will be considered for treatment of patients with severe, debilitating chronic plaque psoriasis who meet
genital region;
• Initial approval limited to 12 weeks.
• Continuation of therapy beyond 12 weeks will be based on response. Patients not responding adequately at
recommended.
• An adequate response is defined as either:
or
• Must be prescribed by a dermatologist
• Concurrent use of >1 biologic will not be approved
•
February 2014
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• Approval limited to a dose of 50 mg twice weekly for an initial 12 weeks, then 50 mg weekly, thereafter up to a
year (if response criteria met at 12 weeks)
ETIDRONATE (DIDRONEL and generic brands)
200mg tablets
ETIDRONATE AND CALCIUM (DIDROCAL and generic brands)
400mg /500mg
ETONOGESTREL / ETHINYL ESTRADIOL (NUVARING)
11.4mg /2.6mg vaginal ring
For conception control in women who are unable to take oral contraceptives.
ETRAVIRINE (INTELENCE)
For the treatment of HIV-1 infection in patients (plan U beneficiaries) who are antiretroviral experienced and have
virologic failure due to HIV-1 strains resistant to multiple antiretroviral agents, including other non-nucleoside reverse
transcriptase inhibitors.
EVEROLIMUS (AFINITOR)
2.5mg, 5mg, 10mg tablets
1. For the treatment of metastatic renal cell carcinoma (mRCC) with clear cell morphology, in patients previously
treated with a tyrosine kinase inhibitor.
2. In combination with exemestane, for the treatment of hormone-receptor positive, HER2 negative advanced breast
cancer, in postmenopausal women with ECOG performance status ≤ 2 after recurrence or progression following a
non-steroidal aromatase inhibitor (NSAI), if the treating oncologist would consider using exemestane.
3. For the treatment of patients with progressive, unresectable, well or moderately differentiated, locally advanced or
metastatic pancreatic neuroendocrine tumours (pNET) with good performance status (ECOG 0-2), until disease
progression.
Dosing for above indications: maximum 10mg daily
EZETIMIBE (EZETROL)
10mg tablets
For the treatment of hypercholesterolemia.
• As adjunctive therapy with a statin, in patients who have not reached treatment goals on maximum tolerated statin
therapy alone,
OR
• As monotherapy in patients who are intolerant to statins and, when appropriate, fibrates.
FEBUXOSTAT (ULORIC)
80mg tablets
For patients with symptomatic gout who have documented hypersensitivity to allopurinol. Hypersensitivity to
allopurinol is a rare condition that is characterized by a major skin manifestation, fever, multi-organ involvement,
lymphadenopathy and hematological abnormalities (eosinophilia, atypical lymphocytes).
Note: Intolerance or lack of response to allopurinol will not be covered by these criteria.
FENTANYL (DURAGESIC MAT and generic brands)
Transdermal system 12mcg/hr, 25mcg/hr, 50mcg/hr, 75mcg/hr and 100mcg/hr
For the management of malignant or chronic non-malignant pain in adult patients;
• who were previously receiving continuous opioid administration (i.e. not opioid naive),
OR
• who are unable to take oral therapy.
February 2014
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FESOTERODINE FUMARATE (TOVIAZ)
4mg, 8mg extended-release tablets
• For the treatment of overactive bladder with symptoms of urinary frequency, urgency and/or urge incontinence in
patients who have not tolerated a reasonable trial of immediate release oxybutynin.
• Requests for the treatment of stress incontinence will not be considered.
information and the claim for fesoterodine fumarate will be automatically reimbursed without the need for a written
special authorization request.
FILGRASTIM (NEUPOGEN - AMGEN)
300mcg/1mL, 480mcg/1.6mL injection
GENERAL
Filgrastim must be prescribed or requested by a certified hematologist or medical oncologist.
1. USE FOR CHEMOTHERAPY SUPPORT
a) Primary prophylaxis:
For use in previously untreated patients receiving a moderate to severely myelosuppressive chemotherapy
regimen (i.e. ≥ 40% incidence of febrile neutropenia). Febrile neutropenia is defined as a temperature ≥
0
0
38.5 C or > 38 C three times in a 24 hour period and neutropenia with an absolute neutrophil count (ANC) <
9
0.5 x 10 /L.
b) Secondary prophylaxis:
• For use in patients receiving myelosuppressive chemotherapy who have experienced an episode of febrile
neutropenia, neutropenic sepsis or profound neutropenia in a previous cycle of chemotherapy; or
• For use in patients who have experienced a dose reduction or treatment delay longer than one week, due
to neutropenia.
c) Dosing for Chemotherapy support:
The manufacturer recommends an initial dose of 5mcg/kg/day. When dose scavenging techniques are not
available, the following recommendations are suggested:
• Patients ≤70 Kg use 1 ml vial (300mcg) DIN 01968017
• Patients > 70 Kg use 1.6 ml vial (480mcg) PIN 00999001
2. USE FOR NON-MALIGNANT INDICATIONS
a) Treatment of congenital neutropenia, idiopathic neutropenia or cyclic neutropenia in patients with recurrent
clinical infections.
b) Drug-induced neutropenia (e.g. antiviral therapy in patients with HIV).
c) Refer to product monograph for dosing recommendations.
3.
USE IN STEM-CELL TRANSPLANTATION
a) Mobilization:
As an adjunct to progenitor cell transplantation, for mobilization of peripheral blood stem cells (PBSC). The
recommended dosage is 10mcg/kg/day.
b) Reconstitution/Engraftment:
Post bone marrow transplantation (BMT) or PBSC transplantation to speed hematopoietic reconstitution. The
recommended dosage is 5mcg/kg/day.
4. UNACCEPTABLE USE
Treatment of febrile neutropenia or in the prevention of febrile neutropenia in the palliative setting.
FINASTERIDE (PROSCAR and generic brands)
5mg tablets
For the treatment of benign prostatic hyperplasia (BPH);
• when alpha-blockers are contraindicated, not tolerated or failed.
• in combination with an alpha-blocker when alpha-blocker therapy has been tried as monotherapy and a partial
response has been observed.
February 2014
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FINGOLIMOD (GILENYA)
0.5 mg capsules
For the treatment of patients with Relapsing Remitting Multiple Sclerosis (RRMS) who meet all of the following
criteria:
1
• Failure to respond
to full and adequate courses of at least one interferon OR glatiramer acetate; OR documented
2
intolerance to both therapies
• Have experienced one or more clinically disabling relapses in the previous year
• Demonstrate a significant increase in T2 lesion load compared with that from a previous MRI scan (i.e. 3 or more
new lesions) OR have at least one gadolinium enhancing lesion
• Request is being made by and followed by a neurologist experienced in the management of RRMS
• Patient has a recent Expanded Disability Status Scale (EDSS) score less than or equal to 5.5 (i.e. patients must
be able to ambulate at least 100 meters without assistance)
1
Failure to respond to full and adequate courses is defined as a trial of at least 6 months of interferon or glatiramer
therapy AND experienced at least one disabling relapse (attack) while on interferon or glatiramer therapy (MRI report
does not need to be submitted with the request)
2
Intolerance is defined as documented serious adverse effects or contraindications that are incompatible with further
use of that class of drug. (Note that skin reactions at the site of the injection do NOT qualify as a contraindication to
interferon or glatiramer therapy.)
Dosage: 0.5 mg once daily
Approval period: 1 year
Exclusion Criteria:
• Combination therapy of Fingolimod with other disease modifying therapies (e.g. Avonex, Betaseron, Copaxone,
Rebif, Extavia, Tysabri) will not be funded.
• Combination therapy of Fingolimid with Fampyra will not be funded.
• Patients with EDSS > 5.5 will not be funded
• Patients who have experienced a heart attack or stroke within the 6 months prior to the funding request will not be
considered.
• Patients with a history of sick sinus syndrome, atrioventricular block, significant QT prolongation, bradycardia,
ischemic heart disease, or congestive heart failure will not be considered.
• Patients younger than 18 years of age will not be considered.
• Patients with needle phobia or those having a preference for an oral therapy over an injection and who do not
have one or more clinical contraindications to interferon or glatiramer therapy will not be funded.
• Skin reactions at the site of the injection do NOT qualify as a contraindication to interferon or glatiramer therapy.
Requirements for Initial Requests:
• The patient’s physician must provide documentation setting out the details of the patient’s most recent
neurological examination within ninety (90) days of the submitted request. This must include a description of any
recent attacks, the dates, and the neurological findings.
Renewal requests will be considered.
• Date and details of the most recent neurological examination and EDSS scores must be provided (exam must
have occurred within that last 90 days); AND
• Patient must be stable or have experienced no more than 1 disabling attack/relapse in the past year; AND
• The recent Expanded Disability Status Scale (EDSS) score must be less than or equal to 5.5 (i.e. patients must
be able to ambulate at least 100 meters without assistance)
Dosage: 0.5 mg once daily
Renewal period: 2 years
FLUDARABINE (FLUDARA)
10mg tablets
For the first-line treatment of chronic lymphocytic leukemia (CLL) in combination with rituximab (with or without
cyclophosphamide).
February 2014
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FORMOTEROL (FORADIL)
12 µg dry powder for inhalation
• For the treatment of patients, 12 years of age or older, with reversible obstructive airway disease who are using
optimal corticosteroid treatment, but are still poorly controlled.
• For the treatment of chronic obstructive pulmonary disease (COPD) with EITHER a long-acting beta2-adrenergic
agonist (LABA) such as formoterol, OR tiotropium if symptoms persist after 2-3 months of short-acting
bronchodilator therapy (i.e. salbutamol at a maximum dose of 8 puffs/day or ipratropium at maximum dose of 12
puffs/day).
• Coverage can be provided without a trial of short-acting agent if there is spirometric evidence of at least moderate
to severe airflow obstruction (FEV1 < 60% and FEV1 /FVC ratio < 0.7) and significant symptoms (i.e. MRC score
of 3-5**).
- there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and FEV1/FVC
ratio < 0.7), and significant symptoms (i.e., MRC score of 3-5**) AND
- there is evidence of one or more moderate-to-severe exacerbations per year, on average, for 2 consecutive
years requiring antibiotics and/or systemic (oral or intravenous) corticosteroids.
accepted.
COPD Stage
Symptoms
SEVERE – MRC 5
Prescriptions written by certified New Brunswick respirologists do not require special authorization. Subsequent
refills ordered by other practitioners will not require special authorization.
FORMOTEROL (OXEZE)
12 µg turbuhaler
FORMOTEROL (OXEZE)
6 µg and 12 µg turbuhaler
agonist (LABA) such as formoterol, OR tiotropium if:
o symptoms persist after 2-3 months of short-acting bronchodilator therapy (i.e. salbutamol at a maximum dose
of 8 puffs/day or ipratropium at maximum dose of 12 puffs/day)
• Coverage can be provided without a trial of short-acting agent if:
o there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and FEV1 /FVC
•
ratio < 0.7) and significant symptoms i.e. MRC score of 3-5**.
Combination therapy with tiotropium AND a long-acting beta2-adrenergic agonist/inhaled corticosteroid
February 2014
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-
there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and FEV1/FVC
ratio < 0.7), and significant symptoms i.e., MRC score of 3-5** AND
accepted.
COPD Stage
Symptoms
SEVERE – MRC 5
GALANTAMINE (REMINYL ER and generic brands)
8mg, 16mg, and 24mg tablets
GLYCOPYRRONIUM BROMIDE (SEEBRI BREEZHALER)
50mcg capsule
•
•
•
For the treatment of chronic obstructive pulmonary disease (COPD) with EITHER glycopyrronium bromide OR a
long-acting beta2-adrenergic agonist (LABA) if symptoms persist after 2-3 months of short-acting bronchodilator
therapy (i.e. salbutamol at a maximum dose of 8 puffs/day or ipratropium at maximum dose of 12 puffs/day).
Coverage can be provided without a trial of short-acting agent if there is spirometric evidence of at least moderate
of 3-5**).
Combination therapy with glycopyrronium bromide AND a long-acting beta2-adrenergic agonist/inhaled
corticosteroid (LABA/ICS) will only be considered if:
ratio < 0.7), and significant symptoms (i.e. MRC score of 3-5**) AND
Note: If spirometry cannot be obtained, reasons must be clearly explained and other evidence regarding severity of
accepted.
COPD Stage
Symptoms
SEVERE – MRC 5
GOLIMUMAB (SIMPONI)
50mg/0.5mL autoinjector/prefilled syringe
1. For the treatment of patients with moderate to severe ankylosing spondylitis (e.g. Bath AS Disease Activity Index
• Have axial symptoms* and who have failed to respond to the sequential use of at least 2 NSAIDs at the
optimum dose for a minimum 3 month observation period or in whom NSAIDs are contraindicated OR
• Have peripheral symptoms and who have failed to respond to, or have contraindications to, the sequential use
of at least 2 NSAIDs at the optimum dose for a minimum 3 month observation period and have had an
• Must be prescribed by a rheumatologist or internist.
February 2014
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• Initial approval will be for 4 x 50 mg doses in a 4 month period.
• Requests for continuation of therapy must include information showing the clinical beneficial effects of the
treatment, specifically:
 a decrease of at least 2 points on the BASDAI scale, compared with the pre-treatment score OR
 patient and expert opinion of an adequate clinical response as indicated by a significant functional
• Approvals for continuation of therapy will be for 12 x 50 mg doses annually with no dose escalation permitted.
• Golimumab will not be reimbursed in combination with other anti-TNF agents.
* Patients with recurrent uveitis (2 or more episodes within 12 months) as a complication to axial disease do not
2. For the treatment of moderate to severe psoriatic arthritis in patients who:
• Have at least three active and tender joints, and
• Have not responded to an adequate trial of two DMARDs or have an intolerance or contraindication to
DMARDs.
• Must be prescribed by a rheumatologist or internist.
• Requests for continuation of therapy must include information demonstrating clinical beneficial effects of the
treatment.
3.
• Have not responded to, or have had intolerable side-effects with, an adequate trial of combination therapy of
include methotrexate unless contraindicated or not tolerated, OR
• Are not candidates for combination DMARD therapy must have had adequate trial of at least three traditional
DMARDs in sequence, one of which must have been methotrexate unless contraindicated. AND
• Have had an adequate trial of leflunomide unless it is contraindicated or not tolerated.
• Requests for continuation of therapy must include information demonstrating clinical beneficial effects of the
treatment.
GOSERELIN ACETATE (ZOLADEX)
3.6mg depot
1. Requests will be considered for beneficiaries of Plans E and F for the palliative treatment of stage D2 carcinoma
of the prostate.
• The value of continued anti-androgen therapy in patients with evidence of disease relapse and progression is
questionable. Since the mean time to disease progression after initial hormone management is approximately
two years, Special Authorization must be obtained for continuation beyond this period. This should include
urologic evaluation detailing physical examination, PSA determinations, and bone scan or acid phosphatase
where appropriate.
• The continued use of this medication would require such authorization every two years if the patient is to
remain on the medication.
2. Approved for the hormonal management of endometriosis, including pain relief and reduction of endometriotic
lesions. Requests will be considered for women age 18 and older. Approval limits payment to a maximum of 6
months of therapy.
GRANISETRON (KYTRIL and generic brand)
1 mg tablets
OR
February 2014
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•
OR
Hp-PAC (Containing LANSOPRAZOLE 30mg Cap, AMOXICILLIN 500mg Cap, CLARITHROMYCIN 500mg Tab)
For the treatment of patients with H. pylori infection and active duodenal ulcer disease. Treatment should be limited to
a period of 7 days for first-line therapy.
Note: In cases of H. pylori treatment failure or re-infection, second-line treatment should be limited to a period of 7-14
days provided at least 4 weeks have elapsed from first-line treatment. In addition, if treatment failure or re-infection
occurs within a three month period of first-line treatment, a different antibiotic should be used.
IMATINIB (GLEEVEC and generic brands)
Requests from specialists in hematology/oncology will be considered for:
1. Patients who have documented evidence of Philadelphia chromosome positive (Ph+) chronic myeloid leukemia
(CML), with an ECOG performance status of 0-2*.
2. Patients with C-Kit positive (CD117), metastatic or locally advanced, inoperable gastrointestinal stromal tumours
(GIST), who have an ECOG performance status of 0-2*.
3. For the treatment of adult patients with newly diagnosed Philadelphia chromosome-positive acute lymphoblastic
leukemia (Ph+ALL) when used as a single agent for induction and maintenance phase therapy.
*Patients who are asymptomatic and those who are symptomatic and in bed less than 50% of the time.
IMIQUIMOD (ALDARA)
5% cream
• For the treatment of external genital and external perianal/condyloma acuminata warts.
• For the treatment of actinic keratosis in patients who have failed treatment with 5-Fluorouracil (5-FU) and
cryotherapy.
• For the treatment of biopsy-confirmed primary superficial basal cell carcinoma:
-
with a tumour diameter of ≤ 2 cm AND
located on the trunk, neck or extremities (excluding hands and feet) AND
where surgery or irradiation therapy is not medically indicated
- recurrent lesions in previously irradiated area OR
- multiple lesions, too numerous to irradiate or remove surgically.
Approval Period: 6 weeks
Note: Surgical management should be considered first-line for superficial basal cell carcinoma in most patients,
especially for isolated lesions.
INCOBOTULINUMTOXIN-A (XEOMIN)
50 LD50 units/ vial and 100 unit vial for injection
• For the treatment of blepharospasm in patients 18 years of age and older.
• For the treatment of cervical dystonia (spasmodic torticollis) in patients 18 years of age or older.
February 2014
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INDACATEROL MALEATE (ONBREZ BREEZHALER)
75mcg inhalation powder hard capsules
For the treatment of chronic obstructive pulmonary disease (COPD)
• If symptoms persist after 2-3 months of short-acting bronchodilator therapy (i.e. salbutamol at a maximum dose of
8 puffs/day or ipratropium at maximum dose of 12 puffs/day)
• Coverage can be provided without a trial of short-acting agent if there is spirometric evidence of at least moderate
of 3-5**)
• Combination therapy with tiotropium AND a long-acting beta agonist/inhaled corticosteroid (LABA/ICS) will only be
considered if:
o there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and FEV1/FVC
ratio < 0.7), and significant symptoms (i.e. MRC score of 3-5**) AND
o there is evidence of one or more moderate-to-severe exacerbations per year, on average, for 2 consecutive
• Dose not to exceed 75mcg/day.
accepted.
COPD Stage
Symptoms
SEVERE – MRC 5
INFLIXIMAB (REMICADE)
100mg liquid injection
o have axial symptoms* and who have failed to respond to the sequential use of at least 2 NSAIDs at the
OR
o have peripheral symptoms and who have failed to respond to, or have contraindications to, the sequential use
o a decrease of at least 2 points on the BASDAI scale, compared with the pre-treatment score;
OR
o patient and expert opinion of an adequate clinical response as indicated by a significant functional
• Approvals will be for a maximum of 5mg/kg at weeks 0, 2 and 6, then every 6 to 8 weeks thereafter.
• Infliximab will not be reimbursed in combination with other anti-TNF agents.
Crohn’s Disease
• For moderately to severely active Crohn's disease in patients who are refractory or have contraindications to an
adequate course of 5-aminosalicylic acid and corticosteroids and other immunosuppressive therapy. Initial
approval will consist of 3 doses of 5 mg/kg given at weeks 0, 2 and 6.
• Ongoing coverage for maintenance therapy will only be reimbursed for responders and for a dose not exceeding
5mg/kg every 8 weeks. Coverage must be reassessed annually and is dependent on evidence of continued
response.
February 2014
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• Must be prescribed by, or in consultation with, a gastroenterologist or physician with a specialty in
gastroenterology.
• Infliximab will not be reimbursed in combination with other anti-TNF agents.
Plaque Psoriasis
• Requests will be considered for treatment of patients with severe, debilitating chronic plaque psoriasis who meet
genital region;
• Initial approval limited to 12 weeks.
• Continuation of therapy beyond 12 weeks will be based on response. Patients not responding adequately at
recommended.
• An adequate response is defined as either:
or
• Must be prescribed by a dermatologist
• Concurrent use of >1 biologic will not be approved
• Approval limited to a dose of 5 mg/kg administered at 0, 2, and 6 weeks, then every 8 weeks up to a year (if
response criteria met at 12 weeks)
OR
AND
INSULIN ASPART (NOVORAPID)
10mL vials and 5x3mL cartridges
For patients with type I or II diabetes who have experienced frequent episodes of postprandial hypoglycemia; have
unpredictable mealtimes; have insulin resistance; or who are using continuous subcutaneous insulin infusion.
Prescriptions written by New Brunswick endocrinologists and internists do not require special authorization.
INSULIN DETEMIR (LEVEMIR PENFILL)
100 U/mL cartridge
For the treatment of patients who have been diagnosed with Type 1 or Type 2 diabetes requiring insulin and have
previously taken insulin NPH and/or pre-mix daily at optimal dosing.
AND
1. Have experienced unexplained nocturnal hypoglycemia at least once a month despite optimal management.
OR
2. Have documented severe or continuing systemic or local allergic reaction to existing insulin(s).
Note:
Requests should be submitted on the long-acting insulin analogue special authorization request form.
February 2014
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INSULIN GLARGINE (LANTUS)
100U/mL vial, cartridge, & SoloSTAR
For the treatment of patients who have been diagnosed with Type 1 or Type 2 diabetes requiring insulin and have
previously taken insulin NPH and/or pre-mix daily at optimal dosing.
AND
1. Have experienced unexplained nocturnal hypoglycemia at least once a month despite optimal management.
OR
2. Have documented severe or continuing systemic or local allergic reaction to existing insulin(s).
Note:
Requests should be submitted on the long-acting insulin analogue special authorization request form.
INSULIN GLULISINE (APIDRA)
100IU/mL vials, cartridges and SoloSTAR pre-filled pens
Note: Insulin glulisine is a regular benefit for Plans EFG<18 years of age.
INSULIN LISPRO (HUMALOG)
10mL vials, 1.5mL and 3mL cartridges, and KwikPen prefilled pen
INTERFERON ALFA-2B RIBAVIRIN (REBETRON)
Injection + 200mg capsules
Requests will be considered from internal medicine specialists for the treatment of chronic hepatitis C (HCV
RNA positive).
• Initial coverage of 24 weeks will be approved for all patients. Coverage for an additional 24 weeks will be
approved for patients with HCV genotype 1.
• A positive HCV RNA assay after 24 weeks of therapy is an indication to stop treatment.
• Interferon monotherapy should be reserved for patients who cannot tolerate ribavirin.
ITRACONAZOLE (SPORANOX)
100mg capsules
1. For the treatment of severe systemic fungal infections.
2. For the treatment of severe or resistant fungal infections in immunocompromised patients.
3. For the treatment of severe onychomycosis when used as pulse therapy;
• Reimbursement for the treatment of fingernail mycosis is limited to 56 x 100mg capsules over an 8 week period.
• Reimbursement for the treatment of toenail mycosis is limited to 84 x 100mg capsules over a 12 week period.
LACOSAMIDE (VIMPAT)
50mg, 100mg, 150mg, 200mg tablets
For the adjunctive treatment of refractory partial-onset seizures in patients who meet all of the following criteria:
• are under the care of a physician experienced in the treatment of epilepsy, and
• are currently receiving two or more antiepileptic drugs, and
• in whom all other antiepileptic drugs are ineffective or not appropriate
February 2014
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LACTULOSE (various brands)
667 mg/mL
For the treatment of hepatic encephalopathy in patients with liver disease.
Please note requests for treatment of constipation will not be considered.
LAMIVUDINE (HEPTOVIR and generic brand)
5mg/mL solution
For the treatment of patients with chronic hepatitis B with evidence of hepatitis B replication, defined as:
1. HBsAg positive for at least 6 months.
2. Evidence of active viral replication (HBeAg positive).
3. ALT level elevated on at least 3 consecutive occasions over a 3 month period.
Prescriptions written by New Brunswick internal medicine specialists do not require special authorization.
LANREOTIDE ACETATE (SOMATULINE AUTOGEL)
60mg, 90mg and 120mg prefilled syringes
For the treatment of acromegaly.
LANSOPRAZOLE (PREVACID and generic brands)
15mg and 30mg capsules
See criteria under Proton Pump Inhibitors.
LANSOPRAZOLE (PREVACID FASTAB)
15mg and 30mg delayed release tablet
For patients who meet the special authorization criteria for a proton pump inhibitor and require administration through
a feeding tube.
LAPATINIB (TYKERB)
250mg tablets
For use in combination with capecitabine, for the treatment of HER2-positive patients with advanced or metastatic
breast cancer who have progressed on trastuzumab-based treatments (e.g. taxanes, anthracycline, trastuzumab) and
who have an ECOG performance status of 0-2.
Initial approval period: 6 months
Renewal criteria: Written confirmation that the patient has responded to treatment and that there is no evidence of
disease progression.
Renewal period: 6 months
Note: Requests will not be considered for use in combination with trastuzumab for second-line HER2-positive
metastatic breast cancer or in the adjuvant setting.
LEFLUNOMIDE (ARAVA and generic brands)
For the treatment of patients with active rheumatoid arthritis who have not responded to, or have had intolerable
toxicity with, an adequate trial of combination traditional DMARD (disease modifying antirheumatic drug) therapy.
Combination DMARD therapy must include methotrexate unless contraindicated or not tolerated.
Patients who are not candidates for combination DMARD therapy must have had adequate trial of at least three
traditional DMARDs in sequence, one of which must have been methotrexate unless contraindicated.
LENALIDOMIDE (REVLIMID)
5mg, 10mg, 15mg and 25mg capsule
1. For the treatment of Myelodysplastic Syndrome (MDS) in patients with:
• Demonstrated diagnosis of MDS on bone marrow aspiration
• Presence of 5-q deletion documented by appropriate genetic testing
• International Prognostic Scoring System (IPSS) risk category low or intermediate-1†
• Presence of symptomatic anemia (defined as transfusion dependent)*
February 2014
A - 40
†
calculator available on www.uptodate.com
* Requests for patients who are not transfusion-dependent will be considered on a case-by-case basis. The
physician should provide clinical evidence of symptomatic anemia affecting the patient’s quality of life and the
rationale for why transfusions are not being used.
Renewal criteria:
• For patients who were transfusion-dependent and have demonstrated a reduction in transfusion requirements
of at least 50%.
• Renewal requests for all other patients will be considered on a case-by-case basis. Information describing the
results of serial CBC (pre- and post-lenalidomide) and any other objective evidence of response should be
included.
2. For the treatment of multiple myeloma when used in combination with dexamethasone, in patients who:
• Are not candidates for autologous stem cell transplant;
AND
• Where the patient is either:
o Refractory to or has relapsed after the conclusion of initial or subsequent treatments and who is suitable
for further chemotherapy; or
o Has completed at least one full treatment regimen as initial therapy and is experiencing intolerance to their
current chemotherapy.
Note: Due to its structural similarities to thalidomide, lenalidomide (Revlimid) is only available through a controlled
SM
distribution program called RevAid to minimize the risk of fetal exposure. Only prescribers and pharmacists
registered with this program are able to prescribe and dispense lenalidomide (Revlimid). In addition, patients must be
registered and meet all the conditions of the program in order to receive the product. For information, call 1-888RevAid1 or log onto www.RevAid.ca.
LEUPROLIDE (LUPRON & LUPRON DEPOT)
5mg injection and 7.5mg depot (1-month slow release)
Requests will be considered for beneficiaries of Plans E and F for the palliative treatment of stage D2 carcinoma of
the prostate.
1. (i) The value of continued anti-androgen therapy in patients with evidence of disease relapse and progression is
questionable. Since the mean time to disease progression after initial hormone management is approximately
two years, Special Authorization must be obtained for continuation beyond this period. This should include
urologic evaluation detailing physical examination, PSA determinations, and bone scan or acid phosphatase
where appropriate.
(ii) The continued use of this medication would require such authorization every two years if the patient is to
remain on the medication.
2. For the treatment of central precocious puberty.
LEUPROLIDE (LUPRON DEPOT)
3.75mg injection (1-month slow release)
1. For the hormonal management of endometriosis, including pain relief and reduction of endometriotic lesions.
Requests will be considered for women age 18 and older. Approval limits payment to a maximum of 6 months of
therapy.
2. For the treatment of central precocious puberty.
LEUPROLIDE (LUPRON DEPOT)
11.25mg injection (3-month slow release)
For the hormonal management of endometriosis, including pain relief and reduction of endometriotic lesions.
Requests will be considered for women age 18 and older. Approval limits payment to a maximum of 6 months of
therapy.
LEVETIRACETAM (KEPPRA and generic brands)
250mg, 500mg, 750mg tablets
An adjunctive therapy in the management of patients with epilepsy who are not satisfactorily controlled by
conventional therapy.
February 2014
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LEVODOPA/CARBIDOPA / ENTACAPONE (STALEVO)
50/12.5/200 mg, 75/18.75/200 mg, 100/25/200 mg, 125/31.25/200 mg, and 150/37.5/200 mg tablets
For the treatment of patients with Parkinson’s disease
• who are currently receiving immediate-release levodopa/carbidopa and entacapone, or
• who are not well controlled and are experiencing significant “wearing off” symptoms despite optimal therapy with
levodopa/decarboxylase.
LEVOFLOXACIN (LEVAQUIN and generic brands)
250mg, 500mg tablets
• For the completion of therapy instituted in the hospital setting for the treatment of nosocomial pneumonia,
•
•
•
community acquired pneumonia (CAP) or acute exacerbation of chronic bronchitis (AECB).
For the treatment of severe pneumonia in nursing home patients (regular benefit for Plan V).
1
For the treatment of CAP in patients;
o with co-morbidity2 upon radiographic confirmation of pneumonia, or
o who have failed first line therapies (macrolide, doxycycline, amoxicillin-clavulanate).
1
3
For the treatment of AECB in complicated patients who have failed treatment with one of the following
(amoxicillin, doxycycline, TMP-SMX, cefuroxime, macrolide, ketolide or amoxicillin-clavulanate).
respirologists and internal medicine specialists will not require special authorization.
1. If treated with an antibiotic within the past 3 months choose an antibiotic from a different class.
2. Co-morbidity includes chronic lung disease, malignancy, diabetes, liver, renal or congestive heart failure, use of
antibiotics or steroids in the past 3 months, suspected macroaspiration, hospitalization within last 3 months,
HIV/AIDs, smoking, malnutrition or acute weight loss.
3. Complicated AECB defined as increased cough and sputum, sputum purulence and increased dyspnea
AND
o FEV1 < 50% predicted
OR
o FEV1 50-65% and one of the following:
•
≥ 4 exacerbations per year
•
Ischemic heart disease
•
Chronic oral steroid use
•
Antibiotic use in the past 3 months
LINAGLIPTIN (TRAJENTA)
5mg tablets
For patients with type 2 diabetes mellitus with inadequate glycemic control while on optimal doses of metformin and a
sulfonylurea, and for whom NPH insulin is not an option, when added as a third agent.
LINEZOLID (ZYVOXAM)
600mg tablets
•
•
For treatment of proven vancomycin-resistant enterocci (VRE) infections.
For the treatment of proven methicillin-resistant Staphylococcus aureus (MRSA) / methicillin-resistant
Staphylococcus epidermidis (MRSE) infections in patients who are unresponsive to, or intolerant of, intravenous
vancomycin or in whom intravenous vancomycin is not appropriate.
The drug must be prescribed by, or in consultation with, an infectious disease specialist or medical
microbiologist.
February 2014
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LOW MOLECULAR WEIGHT HEPARINS (Dalteparin Sodium, Enoxaparin Sodium, Nadroparin Calcium,
Tinzaparin Sodium).
1.
2.
3.
4.
5.
For the treatment of deep vein thrombosis (DVT) and/or pulmonary embolism (PE) for a maximum of 10 days.
For the extended treatment of recurrent symptomatic venous thromboembolism (VTE) that has occurred while
patients are on therapeutic doses of warfarin.
For the prophylaxis of venous thromboembolism (VTE) up to 35 days following elective hip replacement or hip
fracture surgery.
For the prophylaxis of VTE up to 10 days following elective knee replacement surgery.
For the treatment and secondary prevention of symptomatic venous thromboembolism (VTE) or pulmonary
embolism (PE) for a period of up to 6 months in patients with cancer for whom warfarin therapy is not an option.
Note: One prescription claim annually will be automatically reimbursed, up to the average amount required for one
DVT treatment (approximately 10 days of therapy). If additional medication is required subsequent to the initial
prescription, a request should be made through special authorization.
Product Name
DIN
10 Day Treatment Quantity
Dalteparin sodium (Fragmin)
•
•
•
•
10,000IU/mL prefilled syringe
• 25,000IU/mL multidose vial
2352656
2352664
2352672
2352680
0.4mL x 10 syringes = 4mL
2231171
3.8mL x 2 vials = 8mL
2236564
3mL x 5 vials = 15mL
2242692
2378469
1mL x 10 syringes = 10mL
2240114
2167840
2229515
2231478
2mL x 8 vials = 16mL
2mL x 4 vials = 8mL
Enoxaparin sodium (Lovenox)
• 100mg/mL multidose vial
Enoxaparin sodium (Lovenox HP)
• 120mg/0.8mL prefilled syringe
• 150mg/mL prefilled syringe
Nadroparin calcium (Fraxiparin Forte)
• 19,000IU/mL prefilled syringe
Tinzaparin sodium (Innohep)
• 20,000IU/mL prefilled syringe
February 2014
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MARAVIROC (CELSENTRI)
For the treatment of HIV-1 infection in patients (Plan U beneficiaries) who have CCR5 tropic viruses and who have
documented resistance to at least one agent from each of the three major classes of antiretrovirals (i.e.
nucleoside/tide reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors and protease
inhibitors.)
Requests for HIV-1 treatment-naïve patients will not be considered.
METHADONE
Compounded Oral Solution
Requests from New Brunswick physicians authorized to prescribe methadone will be considered:
1. For the treatment of severe cancer-related or chronic non-malignant pain as an alternative to other opioids.
2. For the treatment of opioid dependence.
All requests must meet requirements set out in the NBPDP methadone reimbursement policies.
Pharmacy Claims:
Claims submitted by pharmacies must be billed using the applicable PIN.
Opioid dependence
Chronic pain
00999734
00999801
METHADONE HCL (METHADOSE)
10mg/mL dye-free, sugar-free, unflavored oral concentrate
Pharmacy Claims:
Claims submitted by pharmacies must be billed using DIN 02394618.
METHADONE HCL (METADOL)
1 mg/mL oral solution and 10 mg/mL oral concentrate
Pharmacy Claims:
Claims submitted by pharmacies must be billed using the applicable PIN.
1mg/mL oral solution
Opioid dependence
Chronic pain
10mg/mL oral concentrate
Opioid dependence
Chronic pain
00903823
00903825
00903824
00903826
METHADONE HCL (METADOL)
1mg, 5mg, 10mg, 25mg tablets
Requests will not be considered:
2. Preparations compounded using Metadol tablets will not be considered.
February 2014
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METHYLPHENIDATE (BIPHENTIN)
10mg, 15mg, 20mg, 30mg, 40mg, 50mg, 60mg and 80mg controlled release capsules
For the treatment of Attention-Deficit Hyperactivity Disorder (ADHD) in children age 6 to 25 years who demonstrate
significant symptoms and who have tried immediate release and slow release methylphenidate with unsatisfactory
results.
Requests will be considered from specialists in pediatric psychiatry, pediatricians or general practitioners with
expertise in ADHD.
METHYLPHENIDATE-ER (CONCERTA AND TEVA-METHYLPHENIDATE ER-C)
18 mg, 27 mg, 36 mg and 54 mg extended-release tablets
For the treatment of Attention-Deficit Hyperactivity Disorder (ADHD) in children aged 6 to 25 years who demonstrate
significant symptoms and who have tried immediate release or slow release methylphenidate with unsatisfactory
results.
Requests will be considered from specialists in pediatric psychiatry, pediatricians or general practitioners with
expertise in ADHD.
MODAFINIL (ALERTEC and generic brands)
100mg tablet
For the treatment of narcolepsy confirmed by a sleep study.
MOMETASONE FUROATE/FORMOTEROL FUMARATE DIHYDRATE (ZENHALE)
5mcg/50mcg, 5mcg/100mcg, 5mcg/200mcg per actuation metered-dose inhaler
For patients with reversible obstructive airways disease who are:
• Stabilized on an inhaled corticosteroid and a long-acting beta2-adrenergic agonist
OR
• Using optimal doses of inhaled corticosteroids but are still poorly controlled.
MONTELUKAST (SINGULAIR and generic brands)
4mg, 5mg chewable tablets
10mg tablets
4mg oral granules
For the treatment of moderate to severe asthma in patients who:
Are not adequately controlled with moderate to high dose inhaled corticosteroids despite compliance with
treatment
AND
• Require increasing amounts of short-acting beta2-adrenergic agonists.
•
MOXIFLOXACIN (AVELOX)
400mg tablets
•
•
•
•
For the completion of therapy instituted in the hospital setting for the treatment of nosocomial pneumonia,
community acquired pneumonia (CAP) or acute exacerbation of chronic bronchitis (AECB).
For the treatment of severe pneumonia in nursing home patients (regular benefit for Plan V).
1
For the treatment of CAP in patients;
o with co-morbidity2 upon radiographic confirmation of pneumonia, or
o who have failed first line therapies (macrolide, doxycycline, amoxicillin-clavulanate).
1
3
For the treatment of AECB in complicated patients who have failed treatment with one of the following
(amoxicillin, doxycycline, TMP-SMX, cefuroxime, macrolide, ketolide or amoxicillin-clavulanate).
respirologists and internal medicine specialists will not require special authorization.
1.
2.
3.
If treated with an antibiotic within the past 3 months choose an antibiotic from a different class.
Co-morbidity includes chronic lung disease, malignancy, diabetes, liver, renal or congestive heart failure, use of
antibiotics or steroids in the past 3 months, suspected macroaspiration, hospitalization within last 3 months,
HIV/AIDs, smoking, malnutrition or acute weight loss.
Complicated AECB defined as increased cough and sputum, sputum purulence and increased dyspnea
AND
o FEV1 < 50% predicted
February 2014
A - 45
o
OR
FEV1 50-65% and one of the following:
•
≥ 4 exacerbations per year
•
Ischemic heart disease
•
Chronic oral steroid use
•
Antibiotic use in the past 3 months
NABILONE (CESAMET and generic brands)
0.25mg, 0.5 mg and 1 mg capsules
For the management of severe nausea and vomiting associated with cancer chemotherapy.
NADROPARIN CALCIUM (FRAXIPARINE)
Prefilled syringes
NADROPARIN CALCIUM (FRAXIPARIN FORTE)
Prefilled syringes
NAFARELIN ACETATE (SYNAREL)
2mg/mL nasal solution
Approved for the hormonal management of endometriosis, including pain relief and reduction of endometriotic
lesions. Requests will be considered for women age 18 and older. Approval limits payment to a maximum of 6
months of therapy.
NALTREXONE (REVIA)
50mg tablets
•
•
For the treatment of alcohol dependence, as an adjunct to a comprehensive program to support abstinence, and
reduce the risk of relapse.
For the maintenance of opioid-free state in individuals who were previously opioid-dependent but have
successfully completed detoxification. Treatment should not be attempted until the patient has remained opioidfree for 7 - 10 days. Requests will be considered only when used as an adjunct to psychosocial intervention. In
the event that a patient participates in a program other than those offered by New Brunswick Addiction Services,
details on the type of counselling/supportive program the patient will be involved in will be requested.
Coverage will be approved initially for 12 weeks. Continued coverage will require information on the outcome of
therapy as well as patient's compliance with treatment programs.
NARATRIPTAN (AMERGE and generic brands)
1mg and 2.5mg tablets
•
•
1
For the treatment of migraine headache when:
o Migraines are moderate2 in severity and other therapies (e.g. NSAIDs, acetaminophen, DHE spray) are not
effective, or
o Migraine attacks are severe2 or ultra severe2
3
Coverage limited to 6 doses / 30 days
1
Definitions:
•
•
•
2
3
February 2014
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NATALIZUMAB (TYSABRI)
300mg/15mL vial
Initial Request:
For the treatment of Relapsing-Remitting Multiple Sclerosis (RRMS) in patients who meet all the following criteria:
• The patient’s physician is a neurologist experienced in the management of relapsing-remitting multiple sclerosis
(RRMS); AND
The patient;
• Has a current EDSS less than or equal to 5.0; AND
• Has failed to respond to a full and adequate course (see note below) of at least ONE disease modifying therapy
OR has contraindications/intolerance to at least TWO disease modifying therapies; AND
• Has had ONE of the following types of relapses in the past year:
-
The occurrence of one relapse with partial recovery during the past year AND has at least ONE gadoliniumenhancing lesion on brain MRI, OR significant increase in T2 lesion load compared to a previous MRI; OR
The occurrence of two or more relapses with partial recovery during the past year; OR
The occurrence of two or more relapses with complete recovery during the past year AND has at least ONE
gadolinium-enhancing lesion on brain MRI, OR significant increase in T2 lesion load compared to a previous
MRI.
Approval Period: 1 year
Requirements for Initial Requests:
•
•
The patient’s physician provides documentation setting out the details of the patient’s most recent neurological
examination within ninety (90) days of the submitted request. This must include a description of any recent
attacks, the dates, and the neurological findings.
MRI reports do NOT need to be submitted with the initial request
Renewal:
•
•
•
Date and details of the most recent neurological examination and EDSS scores must be provided (exam must
have occurred within that last 90 days) AND
Patients must be stable or have experienced no more than 1 disabling attack/relapse in the past year; AND
Recent Expanded Disability Status Scale (EDSS) score less than or equal to 5.0
Notes:
• Failure to respond to a full and adequate course: defined as a trial of at least 6 months of interferon or glatiramer
therapy AND experienced at least one disabling relapse (attack) while on interferon or glatiramer therapy.
Combination therapy of Natalizumab with other disease modifying therapies (e.g. Avonex, Betaseron, Copaxone,
Rebif, Extavia, Gilenya) will not be funded.
NILOTINIB (TASIGNA)
150mg capsules
For the first-line treatment of adult patients with Philadelphia chromosome positive chronic myeloid leukemia (Ph+
CML) in chronic phase.
NILOTINIB (TASIGNA)
200mg capsules
For the treatment of chronic phase (CP) and accelerated phase (AP) Philadelphia chromosome positive (Ph+) chronic
myeloid leukemia (CML) in adult patients who:
• are resistant or intolerant to imatinib, or
• intolerant to dasatinib
NORETHINDRONE ACETATE / ESTRADIOL-17β (ESTALIS)
140/50mcg and 250/50mcg transdermal patches
For the treatment of menopausal symptoms in women for whom oral forms of HRT are not tolerated or indicated.
February 2014
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OCTREOTIDE ACETATE (SANDOSTATIN and generic brand)
50mcg, 100mcg, 500mcg ampoules and 200mcg multi-dose vial
•
•
For the control of symptoms associated with metastatic carcinoid and vasoactive intestinal peptide-secreting
tumors (VIPomas).
OCTREOTIDE ACETATE (SANDOSTATIN LAR)
10mg, 20mg and 30mg vials
OFLOXACIN (OCUFLOX and generic brands)
0.3% ophthalmic solution
For the treatment of bacterial conjunctivitis.
Prescriptions written by New Brunswick ophthalmologists and optometrists do not require special authorization.
OLANZAPINE (ZYPREXA and generic brands)
2.5mg, 5mg, 7.5mg, 10mg and 15mg tablets
OLANZAPINE (ZYPREXA ZYDIS and generic brands)
5mg, 10mg, 15mg and 20mg oral disintegrating tablets
•
•
•
For the acute and maintenance treatment of schizophrenia and related psychotic disorders.
For the acute treatment of manic or mixed episodes in bipolar l disorder in patients with intolerance or a history of
failure to one other atypical antipsychotic.
For maintenance treatment in patients with bipolar disorder who are currently stabilized on olanzapine.
Advice from a psychiatrist is suggested prior to starting therapy. Prescriptions written by New Brunswick psychiatrists
do not require special authorization. Subsequent refills ordered by other practitioners will not require special
authorization.
OMEPRAZOLE (LOSEC and generic brands)
20mg tablets
20mg capsules
ONABOTULINUMTOXINA (BOTOX)
50 Allergan units per vial (PIN 00903741) and 100 Allergan units per vial
1.
2.
3.
4.
For the management of focal spasticity following stroke in adults
For the treatment of equinus foot deformity in cerebral palsy in patients 2 years of age and older
To reduce the subjective symptoms and objective signs of cervical dystonia (spasmodic torticollis) in adults
For the treatment of blepharospasm, hemifacial spasm (VII nerve disorder) and strabismus in patients 12 years
of age and older
ONABOTULINUMTOXINA (BOTOX)
200 Allergan units per vial (PIN 00999505)
For the treatment of urinary incontinence due to neurogenic detrusor overactivity resulting from neurogenic bladder
associated with multiple sclerosis (MS) or subcervical spinal cord injury (SCI) if the following conditions are met:
• patient failed to respond to behavioural modification and anticholinergics and/or is intolerant to anticholinergics
• subsequent treatments are provided at intervals no less than every 36 weeks
Patients who fail to respond to initial treatment with onabotulinumtoxinA should not be retreated.
ONDANSETRON (ZOFRAN and generic brands)
4mg and 8mg tablets
4mg/5mL oral solution
OR
February 2014
A - 48
•
•
receiving intravenous chemotherapy or radiotherapy and who have not experienced adequate control with other
OR
ONDANSETRON (ZOFRAN ODT and generic brand)
4mg and 8mg oral disintegrating tablets
Requests will be considered for the treatment of emesis in patients who have difficulty swallowing oral tablets and
are:
OR
OR
• receiving any intravenous chemotherapy or radiotherapy and have experienced emesis with a prior cycle of
Only requests for the oral dosage forms are eligible for consideration.
Usually a single oral dose pre-chemotherapy is sufficient to control symptoms.
When used in combination with aprepitant, only a single oral dose prechemotherapy will be covered.
OSELTAMIVIR (TAMIFLU)
30mg, 45mg and 75mg capsules
For beneficiaries residing in long-term care facilities* during an influenza outbreak situation and further to the
recommendation of a Medical Officer of Health:
• For treatment of long-term care residents with clinically suspected or lab confirmed influenza A or B. A clinically
suspected case is one in which the patient meets the criteria of influenza-like illness and there is confirmation of
influenza A or B circulating within the facility or surrounding community.
• For prophylaxis of long-term care residents where the facility has an influenza A or B outbreak. Prophylaxis
should be continued until the outbreak is over. An outbreak is declared over 7 days after the onset of the last
case in the facility.
∗
In these criteria, long-term care facility refers to a licensed nursing home and does not include special care
homes.
February 2014
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OSTEOPOROSIS DRUGS (alendronate, etidronate, raloxifene and risedronate)
Requests for osteoporosis drugs for patients without documented fracture should reference the most recent (2010)
1
version of the Canadian Association of Radiologist and Osteoporosis Canada (CAROC) table , or the World Health
Organization (WHO) Fracture Risk Assessment Tool (FRAX) http://www.shef.ac.uk/FRAX/tool.jsp?lang=en when
determining whether the patient meets criteria for high (>20%) 10-year fracture risk.
Fracture Risk Tables
Age
(years)
Women
10-YEAR RISK
Low Risk
Moderate Risk
< 10%
10% - 20%
50
55
60
65
70
75
80
85
1
> - 2.5
> - 2.5
> - 2.3
> - 1.9
> - 1.7
> - 1.2
> - 0.5
> +0.1
LOWEST T-SCORE
femoral neck
- 2.5 to - 3.8
- 2.5 to - 3.8
- 2.3 to - 3.7
- 1.9 to - 3.5
- 1.7 to - 3.2
- 1.2 to - 2.9
- 0.5 to - 2.6
+ 0.1 to - 2.2
High
Risk
> 20%
Age
(years)
< - 3.8
< - 3.8
< - 3.7
< - 3.5
< - 3.2
< - 2.9
< - 2.6
< - 2.2
50
55
60
65
70
75
80
85
Low Risk
< 10%
Men
10-YEAR RISK
Moderate Risk
10% - 20%
> -2.5
> -2.5
> -2.5
> -2.4
> -2.3
> -2.3
> -2.1
> -2.0
LOWEST T-SCORE
femoral neck
- 2.5 to - 3.9
- 2.5 to - 3.9
- 2.5 to - 3.7
- 2.4 to - 3.7
- 2.3 to - 3.7
- 2.3 to - 3.8
- 2.1 to - 3.8
- 2.0 to - 3.8
High
Risk
> 20%
< - 3.9
< - 3.9
< - 3.7
< - 3.7
< - 3.7
< - 3.8
< - 3.8
< - 3.8
Ref: Can Assoc Radiol J, 2011; 62(4): 243-50
ALENDRONATE (FOSAMAX and generic brands) 10mg and 70mg tablets
RISEDRONATE (ACTONEL and generic brands) 5mg and 35mg tablets
1.
2.
For the treatment of osteoporosis:
• with documented fragility fracture; or
• without documented fractures in patients at high 10-year fracture risk (see fracture risk tables).
For prophylaxis of corticosteroid induced osteoporosis in patients who will be or have been on systemic
corticosteroid therapy for ≥ 3 months.
ETIDRONATE (DIDRONEL and generic brands) 200mg tablets
ETIDRONATE AND CALCIUM (DIDROCAL KIT and generic brands) 400mg/500mg tablets
For the treatment of osteoporosis:
• with documented fragility fracture when alendronate or risedronate are not tolerated or contraindicated; or
• without documented fractures in patients at high 10-year fracture risk (see fracture risk tables) when alendronate
or risedronate are not tolerated or contraindicated.
RALOXIFENE (EVISTA and generic brands) 60mg tablets
For the treatment of postmenopausal osteoporosis
with documented fragility fracture when bisphosphonates are not tolerated or contraindicated; or
without documented fractures in patients at high 10-year fracture risk (see fracture risk tables) when
bisphosphonates are not tolerated or contraindicated.
•
•
February 2014
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OXCARBAZEPINE (TRILEPTAL and generic brand)
60mg/mL suspension
For the treatment of epilepsy in patients who have had an inadequate response or are intolerant to at least 3 other
antileptics including carbamazepine.
OXYBUTYNIN (DITROPAN XL)
OXYBUTYNIN (UROMAX)
10mg, 15mg controlled release tablets
•
•
For the treatment of overactive bladder with symptoms of urinary frequency, urgency and/or urge incontinence in
Requests for the treatment of stress incontinence will not be considered.
OXYCODONE (OXY IR and generic and SUPEUDOL)
5mg, 10mg and 20mg tablets (immediate release)
For the treatment of moderate to severe cancer-related or chronic non-malignant pain.
PALIPERIDONE (INVEGA SUSTENNA)
50mg/0.5mL, 75mg/0.75mL, 100mg/mL, 150mg/1.5mL prefilled syringes
For the treatment of schizophrenia in patients:
• for whom compliance with an oral antipsychotic presents problems,
OR
• who are currently receiving a typical depot antipsychotic and experiencing significant side effects (EPS or
TD) or lack of efficacy.
PANTOPRAZOLE SODIUM (PANTOLOC and generic brands)
PAZOPANIB (VOTRIENT)
200mg tablets
For the treatment of advanced or metastatic renal cell (clear cell) carcinoma (mRCC) in patients who are unable to
tolerate sunitinib and who have an ECOG performance status of 0 or 1.
•
•
•
Initial approval period: 1 year
do so.
PEGFILGRASTIM (NEULASTA)
6mg prefilled syringe
Requests will be considered when prescribed by, or on the advice of, a hematologist or medical oncologist for the
following indications:
Chemotherapy Support
Primary prophylaxis:
For use in previously untreated patients receiving a moderate to severely myelosuppressive chemotherapy
regimen (i.e. ≥ 40% incidence of febrile neutropenia). Febrile neutropenia is defined as a temperature ≥ 38.5°C
or > 38.0°C three times in a 24 hour period and neutropenia with an absolute neutrophil count (ANC) < 0.5 x
9
10 /L.
• Secondary prophylaxis:
•
-
•
For use in patients receiving myelosuppressive chemotherapy who have experienced an episode of febrile
neutropenia, neutropenic sepsis or profound neutropenia in a previous cycle of chemotherapy; or
- For use in patients who have experienced a dose reduction or treatment delay longer than one week, due to
neutropenia.
Dosing for chemotherapy support:
The recommended dosage of pegfilgrastim is a single subcutaneous injection of 6mg, administered once per
February 2014
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cycle of chemotherapy. Pegfilgrastim should be administered no sooner than 24 hours after the administration of
cytotoxic chemotherapy.
Pegfilgrastim is not indicated and requests will not be considered for the following:
• Myeloid malignancies
• Pediatric patients with cancer receiving myelosuppressive chemotherapy
• Non-malignant neutropenias
• Stem-cell transplantation
• Treatment of febrile neutropenia or in the prevention of febrile neutropenia in the palliative setting
Note: Filgrastim (Neupogen ) dosing is 5 mcg/kg/day. For patients ≤ 60 kg who are prescribed filgrastim 300mcg for 9
or fewer days, the cost of filgrastim therapy is less than the cost of pegfilgrastim 6mg.
®
PEGINTERFERON ALFA-2A (PEGASYS)
180mcg/0.5mL pre-filled syringe
180mcg/mL vial injection
Requests will be considered from internal medicine specialists for the treatment of:
• chronic hepatitis C (HCV RNA positive) for patients who cannot tolerate ribavirin.
o Initial coverage of 24 weeks will be approved for all patients. Coverage for an additional 24 weeks will be
approved for patients with HCV genotype 1.
o A positive HCV RNA assay after 24 weeks of therapy is an indication to stop treatment.
• HBeAg negative chronic hepatitis B patients with compensated liver disease, liver inflammation and evidence of
viral replication with demonstrated intolerance or failure to lamivudine therapy.
o Maximum duration of coverage will be 48 weeks.
PEGINTERFERON ALFA-2A AND RIBAVIRIN (PEGASYS RBV)
180mcg injection and 200mg tablets
Requests will be considered from internal medicine specialists:
1. For the treatment of peginterferon and ribavirin treatment-naïve chronic hepatitis C (HCV RNA positive) patients.
Note: Initial coverage of 24 weeks will be approved for all patients. Coverage for an additional 24 weeks will be
approved for patients with HCV genotypes other than 2 and 3. A positive HCV RNA assay after 24 weeks of therapy
is an indication to stop treatment.
2.
For the treatment of patients with chronic hepatitis C genotype 1 infection (HCV RNA positive) in combination
with boceprevir or telaprevir.
Note: Coverage will be approved for up to a total of 48 weeks in combination with boceprevir or telaprevir.
PEGINTERFERON ALFA-2B AND RIBAVIRIN (PEGETRON and PEGETRON REDIPEN)
50mcg injection and 200mg capsule, 80mcg injection and 200mg capsule
100mcg injection and 200mg capsule, 120mcg injection and 200mg capsule
150mcg injection and 200mg capsule
Requests will be considered from internal medicine specialists:
1. For the treatment of peginterferon and ribavirin treatment-naïve chronic hepatitis C (HCV RNA positive) patients.
Note: Initial coverage of 24 weeks will be approved for all patients. Coverage for an additional 24 weeks will be
approved for patients with HCV genotypes other than 2 and 3. A positive HCV RNA assay after 24 weeks of therapy
is an indication to stop treatment.
2.
For the treatment of patients with chronic hepatitis C genotype 1 infection (HCV RNA positive) in combination
with boceprevir or telaprevir.
Note: Coverage will be approved for up to a total of 48 weeks in combination with boceprevir or telaprevir.
PIOGLITAZONE (ACTOS and generic brands)
For patients with type 2 diabetes who are not adequately controlled by diet, exercise and drug therapy. Drug therapy
should include a trial of a sulfonylurea and metformin, alone and in combination, unless one of these agents is not
tolerated or is contraindicated.
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PRASUGREL HYDROCHLORIDE (EFFIENT)
10mg tablet
In combination with ASA for patients with:
ST-elevated myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) who
have not received antiplatelet therapy prior to arrival in the catheterization lab. Treatment must be initiated in
hospital.
OR
Acute coronary syndrome who failed on optimal clopidogrel and ASA therapy as defined by definite stent
thrombosis1, or recurrent STEMI, or NSTEMI or UA after prior revascularization via PCI.
Notes:
1. Definite stent thrombosis, according to the Academic Research Consortium, is a total occlusion originating in or
within 5 mm of the stent or is a visible thrombus within the stent or is within 5 mm of the stent in the presence of
an acute ischemic clinical syndrome within 48 hours. Definite stent thrombosis must be confirmed by
angiography or by pathologic evidence of acute thrombosis.
2. As per the product monograph, prasugrel is contraindicated in patients with a known history of transient ischemic
attack or stroke; those with active pathological bleeding such as gastrointestinal bleeding or intracranial
hemorrhage; and those with severe hepatic impairment (Child-Pugh Class C).
3. As per the product monograph, prasugrel is not recommended in patients ≥ 75 years of age because of the
increase risk of fatal and intracranial bleeding; or those with body weight < 60 kg because of increased risk of
major bleeding due to an increase in exposure to the active metabolite of prasugrel.
Approval will be for a maximum of 12 months.
Prescriptions written by invasive (interventional) cardiologists do not require special authorization.
PREGABALIN (LYRICA and generic brands)
For the treatment of neuropathic pain (e.g. diabetic peripheral neuropathy, postherpetic neuralgia) in patients who
have failed a trial of a tricyclic antidepressant (e.g. amitriptyline, desipramine, imipramine, nortriptyline).
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PROTON PUMP INHIBITORS (Lansoprazole, Omeprazole, Pantoprazole Sodium)
Omeprazole dose > 20mg daily
Requests for omeprazole doses >20mg daily will be considered for indications listed below when beneficiaries
remain symptomatic despite an adequate trial of regular benefit PPI (i.e. pantoprazole magnesium*, rabeprazole*
OR omeprazole at a dose of 20mg daily) for a minimum of 8 weeks.
Lansoprazole 15mg & 30mg capsules and Pantoprazole Sodium 20mg & 40mg tablets
Requests for lansoprazole and pantoprazole sodium will be considered for beneficiaries in whom there has been a
therapeutic failure with regular benefit PPIs (i.e. pantoprazole magnesium*, rabeprazole*, omeprazole 20mg daily).
Approval Periods
Requests for lansoprazole, pantoprazole sodium, and doses of omeprazole greater than 20mg per day meeting
criteria above will be considered for the following maximum approval periods:
Indication and Diagnostic Information
Maximum Approval Period
1
Symptomatic GERD or other refluxassociated indications (i.e. non-cardiac
chest pain)
Considered for short-term (8-12 week) approval
2
Erosive/ulcerative esophagitis or Barrett’s
esophagus
Considered for long term approval
3
Zollinger-Ellison Syndrome
Considered for long-term approval
4
Gastric/duodenal ulcers in individuals who
are H. pylori negative or having
uninvestigated peptic ulcer disease (PUD)
Considered for up to 12 weeks
Omeprazole 20mg BID will be reimbursed without a special
authorization as part of an H. pylori eradication regimen.*
5
H. pylori positive patients with PUD
H. pylori regimens containing lansoprazole or pantoprazole
sodium will be reimbursed only under special authorization.
6
Gastro-duodenal protection (ulcer
prophylaxis) for high risk patients (e.g. high
risk NSAID users)
Considered for one year with reassessment
*Pantoprazole Magnesium (Tecta) 40 mg tablets and rabeprazole 10mg and 20mg tablets are regular benefits
for Plans ABEFGVW without quantity limit.
Note: Omeprazole 20mg tablets and capsules, when prescribed in doses up to 20mg daily, are listed as
regular benefits for Plans ABEFGVW. For Plans ABEFGV, a bi-annual quantity limit has been established.
QUINAGOLIDE (NORPROLAC)
0.075mg, 0.15mg tablets
For the treatment of patients with hyperprolactinemia who have failed or are intolerant to bromocriptine.
RALOXIFENE (EVISTA and generic brands)
60mg tablets
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RANIBIZUMAB (LUCENTIS)
2.3 mg / 0.23 mL vial for intravitreal injection
Neovascular (wet) age-related macular degeneration (AMD)
Initial Coverage:
An initial claim of up to two vials of ranibizumab (one vial per eye treated) will be automatically reimbursed when
prescribed by an ophthalmologist. If additional medication is required, a request should be made through special
authorization. Requests will be considered:
For the treatment of patients with neovascular (wet) age-related macular degeneration (AMD) where all of the
following apply to the eye to be treated:
• Best Corrected Visual Acuity (BCVA) is between 6/12 and 6/96
• The lesion size is less than or equal to 12 disc areas in greatest linear dimension
• There is evidence of recent (< 3 months) presumed disease progression (blood vessel growth, as indicated by
fluorescein angiography, or optical coherence tomography (OCT)
• Administration is to be done by a qualified ophthalmologist experienced in intravitreal injections.
• The interval between doses should not be shorter than 1 month.
Coverage will not be approved for patients:
• With permanent retinal damage as defined by the Royal College of Ophthalmology guidelines
• Receiving concurrent treatment with verteporfin.
Continued Coverage:
Treatment with ranibizumab should be continued only in people who maintain adequate response to therapy.
Ranibizumab should be permanently discontinued if any one of the following occurs:
• Reduction in BCVA in the treated eye to less than 15 letters (absolute) on 2 consecutive visits in the treated eye,
attributed to AMD in the absence of other pathology
• Reductions in BCVA of 30 letters or more compared to either baseline and/or best recorded level since baseline
as this may indicate either poor treatment effect, adverse events or both.
• There is evidence of deterioration of the lesion morphology despite optimum treatment over 3 consecutive visits.
The NBPDP will limit reimbursement to a maximum of 1 vial of ranibizumab per eye treated every 30 days. Claims
submitted for greater than 1 vial, or submitted within 30 days of a previous claim will not be reimbursed.
Diabetic macular edema (DME)
Initial coverage:
For the treatment of visual impairment due to diabetic macular edema (DME) in patients who meet all of the following
criteria:
• clinically significant centre-involving macular edema for whom laser photocoagulation is also indicated
• hemoglobin A1c test in the past 6 months with a value of less than or equal to 11%
• best corrected visual acuity of 20/32 to 20/400
• central retinal thickness greater than or equal to 250 micrometers
Approval Period: 1 year
Renewal Criteria:
• confirm that a hemoglobin A1c test in the past 6 months had a value of less than or equal to 11%
• date of last visit and results of best corrected visual acuity at that visit
• date of last OCT and central retinal thickness on that examination
• if ranibizumab is being administered monthly, please provide details on the rationale
Notes : Treatment should be given monthly until maximum visual acuity is achieved (i.e. stable visual acuity for three
consecutive months while on ranibizumab). Thereafter, the patient's visual acuity should be monitored monthly.
Treatment should be resumed when monitoring indicates a loss of visual acuity due to DME until stable visual acuity
is reached again for three consecutive months.
Pharmacy Claims:
Claims submitted by pharmacies for reimbursement of Lucentis should be billed per vial. This is an exception to the
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claims submission quantity standards outlined in the April 14, 2009 NBPDP Bulletin #749.
Lucentis is supplied by the manufacturer as a 2.3 mg/0.23 mL vial, however CPhA3 messaging for the online
submission of pharmacy claims permits transmission of quantities to only one decimal place. Since the 0.23 mL vial
cannot be adjudicated to two decimal places, this product should be claimed per vial.
REPAGLINIDE (GLUCONORM and generic brands)
0.5mg, 1mg and 2mg tablets
For patients with type 2 diabetes who are not adequately controlled by diet and exercise and glyburide and/or
metformin or who have frequent or severe hypoglycemic episodes despite dosage adjustment of glyburide.
RIFABUTIN (MYCOBUTIN)
150mg capsules
Requests will be considered for the prophylaxis of disseminated Mycobacterium avium
complex (MAC) disease in the following beneficiaries:
• HIV infected patients with an AIDS defining diagnosis and CD4+ cell count less
3
than or equal to 200/mm .
• HIV positive patients without an AIDS defining diagnosis and CD4+ cell count
3
less than or equal to 100/mm .
RILUZOLE (RILUTEK and generic brands)
50mg tablets
For the treatment of amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s Disease, when initiated by a physician with
expertise in the management of ALS in patients who have:
• A probable or definite diagnosis of ALS as defined by the World Federation of Neurology criteria.
• ALS symptoms for less than five years.
• FVC > 60 % predicted upon initiation of therapy.
• No tracheostomy for invasive ventilation
∗
∗
Requests will be approved for a maximum of six months coverage.
Coverage cannot be renewed once the patient has a tracheostomy for the purpose of invasive ventilation.
RISEDRONATE (ACTONEL and generic brand)
30mg tablets
For the treatment of Paget’s disease.
RISEDRONATE (ACTONEL and generic brands)
5mg tablets and 35mg tablets
RISPERIDONE (RISPERDAL M and generic brand)
0.5mg, 1mg, 2mg, 3mg and 4mg tablets
1.
2.
3.
For the treatment of schizophrenia and related psychotic disorders.
For use in severe dementia for the short-term symptomatic management of inappropriate behaviour due to
aggression and/or psychosis.
For the acute management of manic episodes associated with Bipolar 1 disorder.
Requests will be considered for patients who have difficulty swallowing oral tablets.
Prescriptions written by New Brunswick psychiatrists do not require special authorization. Subsequent refills ordered
by other practitioners will not require special authorization.
RISPERIDONE (RISPERDAL CONSTA)
Prolonged release suspension for injection 12.5mg, 25mg, 37.5mg and 50mg vials
For the treatment of schizophrenia in patients:
for whom compliance with an oral antipsychotic presents problems, OR
who are currently receiving a typical depot antipsychotic and experiencing significant side effects (EPS or TD) or
lack of efficacy
•
•
February 2014
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RITUXIMAB (RITUXAN)
10mg/mL injection
• For the treatment of adult patients with severe active rheumatoid arthritis who have failed to respond to an
•
adequate trial with an anti-TNF agent.
o Rituximab will not be reimbursed concomitantly with anti-TNF agents.
o Approval for re-treatment with rituximab will only be considered for patients who have achieved a response,
followed by a subsequent loss of effect and, after an interval of no less than six months from the previous
dose.
For the induction of remission in patients with severely active granulomatosis with polyangiitis (GPA) or
microscopic polyangiitis (MPA) who have severe intolerance or other contraindication to cyclophosphamide, or
who have failed an adequate trial of cyclophosphamide.
RIVAROXABAN (XARELTO)
10mg tablet
Venous thromboembolism prophylaxis (following total knee or total hip replacement surgery)
• For the prophylaxis of venous thromboembolism as an alternative to low molecular weight heparins for total knee
replacement (usual duration up to 14 days) OR total hip replacement surgery (usual duration up to 35 days).
• The maximum dose of rivaroxaban that will be reimbursed is 10 mg daily for up to 30 days during a 6 month
period.
Note: Subsequent requirements for prophylaxis within a 6 month period (i.e. second joint replacement procedure
within the 6 month period) will require Special Authorization.
Stroke and systemic embolism prophylaxis in patients with non-valvular atrial fibrillation
For the prevention of stroke and systemic embolism in at-risk patients with non-valvular atrial fibrillation for whom:
a. Anticoagulation is inadequate following a at least a two month trial on warfarin; or
b. Warfarin is contraindicated or not possible due to inability to regularly monitor through International Normalized
Ratio (INR) testing (i.e. no access to INR testing services at a laboratory, clinic, pharmacy, and at home).
The following patient groups are excluded from coverage for rivaroxaban for atrial fibrillation:
a. Patients with impaired renal function (creatinine clearance or estimated glomerular filtration rate <30 mL/min)
b. Patients 75 years of age or older without documented stable renal function
c. Patients with hemodynamically significant rheumatic valvular heart disease, especially mitral stenosis
d. Patients with prosthetic heart valves.
Notes:
1. At-risk patients with atrial fibrillation are defined as those with a CHADS2 score of ≥ 1. Although the ROCKET-AF
trial included patients with higher CHADS2 scores (≥ 2), other landmark studies with the other newer oral
anticoagulants demonstrated a therapeutic benefit in patients with a CHADS2 score of 1. Prescribers may
consider an antiplatelet regimen or oral anticoagulation for patients with a CHADS2 score of 1.
2. Inadequate anticoagulation is defined as INR testing results that are outside the desired INR range for at least
35% of the tests during the monitoring period (i.e., adequate anticoagulation is defined as INR test results that
are within the desired INR range for at least 65% of the tests during the monitoring period).
3. Since renal impairment can increase bleeding risk, renal function should be regularly monitored. Other factors
that increase bleeding risk should also be assessed and monitored (see rivaroxaban product monograph).
4. Documented stable renal function is defined as creatinine clearance or estimated glomerular filtration rate that is
maintained for at least 3 months (i.e. 30-49 mL/min for 15 mg once daily dosing or ≥ 50 mL/min for 20 mg once
daily dosing).
5. There is currently no data to support that rivaroxaban provides adequate anticoagulation in patients with
rheumatic valvular disease or those with prosthetic heart valves, rivaroxaban is not recommended in these
populations.
6. Patients starting rivaroxaban should have ready access to appropriate medical services to manage a major
bleeding event.
February 2014
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10mg, 15mg, 20mg film-coated tablets
DVT without symptomatic PE
For the treatment of deep vein thrombosis (DVT) without symptomatic pulmonary embolism (PE).
Approval Period: Up to 6 months
Notes:
• The recommended dose of rivaroxaban for patients initiating DVT treatment is 15mg twice daily for 3 weeks,
followed by 20mg once daily.
• Drug plan coverage for rivaroxaban is an alternative to heparin/warfarin for up to 6 months. When used for
greater than 6 months, rivaroxaban is more costly than heparin/warfarin. As such, patients with an intended
duration of therapy greater than 6 months should he considered for initiation on heparin/warfarin.
• Since renal impairment can increase bleeding risk, it is important to monitor renal function regularly. Other
factors that increase bleeding risks should also be assessed and monitored (see product monograph).
RIVASTIGMINE (EXELON and generic brands)
1.5mg, 3mg, 4.5mg and 6mg capsules
2mg/mL oral liquid
RIZATRIPTAN (MAXALT, MAXALT RPD and generic brands)
•
•
1
effective, or
3
1
Definitions:
•
•
•
2
3
RUFINAMIDE (BANZEL)
For the adjunctive treatment of seizures associated with Lennox-Gastaut syndrome for patients who meet all of the
following criteria:
•
are under the care of a physician experienced in treating Lennox-Gastaut syndrome-associated seizures, AND
•
are currently receiving two or more antiepileptic drugs, AND
•
in whom less costly antiepileptic drugs are ineffective or not appropriate.
RUXOLITINIB (JAKAVI)
For patients with intermediate to high risk symptomatic Myelofibrosis (MF) as assessed using the Dynamic
International Prognostic Scoring System (DIPSS) Plus or patients with symptomatic splenomegaly. Patients should
have ECOG performance status ≤3 and be either previously untreated or refractory to other treatment.
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SALMETEROL/FLUTICASONE (ADVAIR)
50/100mcg, 50/250mcg and 50/500mcg discus
25/125mcg and 25/250mcg metered dose inhaler
Reversible Obstructive Airway Disease:
• For patients with reversible obstructive airways disease who are
Stabilized on an inhaled corticosteroid and a long-acting beta2-adrenergic agonist,
-
OR
Using optimal doses of inhaled corticosteroids but are still poorly controlled.
• For the treatment of chronic obstructive pulmonary disease (COPD) if symptoms persist after 2-3 months of
short-acting bronchodilator therapy (i.e. salbutamol at a maximum dose of 8 puffs/day or ipratropium at maximum
dose of 12 puffs/day).
• Coverage can be provided without a trial of short-acting agent if there is spirometric evidence of at least
moderate to severe airflow obstruction (FEV1 < 60% and FEV1 /FVC ratio < 0.7) and significant symptoms (i.e.
MRC score of 3-5**).
accepted.
COPD Stage
Symptoms
SEVERE – MRC 5
SALMETEROL XINAFOATE (SEREVENT)
25mcg/actuation metered dose inhaler, 50µg diskus
Reversible Obstructive Airway Disease:
agonist (LABA) such as salmeterol, OR tiotropium if symptoms persist after 2-3 months of short-acting
bronchodilator therapy (i.e. salbutamol at a maximum dose of 8 puffs/day or ipratropium at maximum dose of 12
puffs/day).
• Coverage can be provided without a trial of short-acting agent if there is spirometric evidence of at least
accepted.
February 2014
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COPD Stage
Symptoms
SEVERE – MRC 5
SEVELAMER (RENAGEL)
•
•
Treatment of severe renal failure, where a calcium salt is contraindicated or not tolerated or when a phosphate
binder is needed in association with a calcium salt, where a calcium salt alone does not produce optimal control
of the hyperphosphatemia.
The prescription must be initiated by a nephrologist.
SILDENAFIL CITRATE (REVATIO and generic brands)
20mg tablets
•
•
•
•
For the treatment of patients with World Health Organization (WHO) functional class III idiopathic pulmonary
arterial hypertension (IPAH) who do not demonstrate. vasoreactivity on testing or who do demonstrate
vasoreactivity on testing but fail a trial of calcium channel blockers.
For the treatment of patients with World Health Organization (WHO) functional class III pulmonary arterial
hypertension (PAH) associated with connective tissue disease who do not respond to conventional therapy.
Diagnosis of PAH should be confirmed by cardiac catheterization.
The maximum dose of sildenafil that will be reimbursed is 20mg three times daily.
SITAGLIPTIN (JANUVIA)
100mg tablets
SITAGLIPTIN / METFORMIN (JANUMET)
50mg/500mg, 50mg/850mg, 50mg/1000mg tablets
For the treatment of Type 2 diabetes mellitus in patients for whom NPH insulin is not an option and:
• Who have inadequate glycemic control while on optimal doses of metformin and a sulfonylurea when added as a
third agent; or
• In combination with metformin when a sulfonylurea is not suitable due to contraindications or intolerance; or
• As monotherapy when metformin and sulfonylurea are not suitable due to contraindications or intolerance
SOLIFENACIN (VESICARE)
•
•
information and the claim for solifenacin will be automatically reimbursed without the need for a written special
February 2014
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SOMATROPIN (HUMATROPE)
1mg, 6mg, 12mg and 24mg/vial injection
SOMATROPIN (NUTROPIN AQ)
5mg/mL Pen Cartridge and NuSpin
SOMATROPIN (SAIZEN)
3.33mg, 5mg and 8.8mg/vial injection
6mg, 12mg and 20mg/cartridge
•
For the treatment of short stature associated with Turner Syndrome in patients whose epiphyses are not closed.
Must be prescribed by, or in consultation with, an endocrinologist.
Note: Somatropin is a regular benefit of Plan T.
SORAFENIB (NEXAVAR)
200mg tablets
Metastatic Renal Cell Carcinoma (MRCC)
As second-line therapy for patients with histologically confirmed metastatic clear cell renal cell carcinoma, who:
o have disease progression after prior cytokine therapy (e.g. interferon; aldesleukin) within the previous 8
months; and
o have a†performance status of 0 or 1 on the basis of the Eastern Cooperative Oncology Group (ECOG)
criteria ; and
o have a favourable or intermediate risk status, according to the Memorial Sloan-Kettering Cancer Center
(MSKCC) prognostic score.
•
•
•
†
Initial approval period: 1 year.
do so.
Renewal period: 1 year.
Patients who are asymptomatic and those who are symptomatic but completely ambulant.
Advanced Hepatocellular Carcinoma (HCC)
For patients with Child-Pugh Class A* who have:
o A performance status of 0,1, or 2† on the basis of the Eastern Cooperative Oncology Group (ECOG) criteria;
and
o Either progressed on trans-arterial chemoembolization (TACE) or not suitable for the TACE procedure.
o Coverage may be renewed for patients with documentation of radiography and/or scan results indicating no
progression
•
•
Approval period for renewal: 1 year
Sorafenib will not be reimbursed if used with induction or adjuvant intent along with other curative-intent treatments;
for maintenance therapy after trans-arterial chemoembolization; or if patients have Child-Pugh B or Child-Pugh C
cirrhosis.
*A Child-Pugh score of 5-6 is considered class A (well-compensated disease); 7-9 is class B (significant functional
compromise); and 10-15 is class C (decompensated disease).
†
Patients who are asymptomatic and those who are symptomatic and in bed less than 50% of the time.
The Memorial Sloan-Kettering Cancer Center (MSKCC) Prognostic Score categorizes patients into three risk groups according to
the number of pre-treatment risk factors present: Favourable = none; Intermediate = one or two; Poor = three or more. Pretreatment risk factors:
•
Low Karnofsky performance status (<80%)
•
Lactate Dehydrogenase level greater than 1.5 times the upper limit of normal
•
Hemoglobin level below the lower limit of normal
•
High corrected serum calcium level (>10 mg/dL or 2.5 mmol/L)
•
Interval of less than 1 year between diagnosis and treatment
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SUMATRIPTAN (IMITREX AND IMITREX DF and generic brands)
•
•
1
effective, or
3
1
Definitions:
•
•
•
2
3
SUMATRIPTAN (IMITREX NASAL SPRAY)
5mg and 20mg nasal spray
•
•
•
1
2
For the treatment of migraine headache of moderate intensity when other therapies (e.g. NSAIDs,
1
2
2
For the treatment of migraine headache of severe or ultra severe intensity when patients have not responded
to oral sumatriptan, zolmitriptan, rizatriptan and/or naratriptan.
3
patients with >3 migraines/month on average despite prophylactic therapy may be considered for up to a
o
1
Definitions:
•
•
•
2
3
SUMATRIPTAN (IMITREX INJECTION and generic brand)
6mg injection
•
•
•
1
2
acetaminophen, DHE spray) are not effective AND oral and nasal triptans are not appropriate.
1
2
2
For the treatment of migraine headache of severe or ultra severe intensity when oral and nasal triptans are not
appropriate.
3
1
Definitions:
•
•
•
2
February 2014
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3
SUNITINIB (SUTENT)
12.5mg, 25mg and 50mg capsules
1.
For the treatment of patients with progressive, unresectable, well or moderately differentiated, locally advanced
or metastatic pancreatic neuroendocrine tumors (pNET) with an ECOG performance status of 0-2, until disease
progression.
2.
For the treatment of patients with c-KIT expressing (CD117+) unresectable or metastatic/recurrent
gastrointestinal stromal tumour (GIST) who meet the criteria for imatinib and who have:
o Early progression (within 6 months) while on imatinib;
o Progression following treatment with optimum (escalated) doses of imatinib; or
o Intolerance to imatinib
• The dose reimbursed will be 50mg per day (4 weeks on, 2 weeks off)
• Response to sunitinib therapy should be assessed at least every six months and therapy should be
discontinued when there is objective evidence of disease progression
• Sunitinib will not be reimbursed concomitantly with imatinib
3.
For patients with histologically confirmed metastatic renal cell carcinoma (MRCC), who require:
o First-line therapy for the treatment of MRCC, and the patient is either a favourable or intermediate risk
according to the Memorial Sloan-Kettering Cancer Center (MSKCC) prognostic score* or,
o Second-line therapy for the treatment of MRCC, provided that disease progression has occurred after
prior cytokine therapy (e.g. interferon; aldesleukin).
• The prescribed dosage is 50mg daily for four weeks, followed by two weeks off. This dosage is repeated in
six week cycles.
• Initial approval period: 1 year
• Renewal criteria: Written confirmation that the patient has benefited from therapy and is expected to
continue to do so.
• Renewal period: 1 year
* The Memorial Sloan-Kettering Cancer Center (MSKCC) Prognostic Score categorizes patients into three risk groups according to
the number of pre-treatment risk factors present: Favourable = none; Intermediate = one or two; Poor = three or more. Pretreatment risk factors:
•
Low Karnofsky performance status (<80%)
•
Lactate Dehydrogenase level greater than 1.5 times the upper limit of normal
•
Hemoglobin level below the lower limit of normal
•
High corrected serum calcium level (>10 mg/dL or 2.5 mmol/L)
•
Interval of less than 1 year between diagnosis and treatment
Reference: Motzer RJ, Bacik J, Murphy BA et al. Interferon-alfa as a comparative treatment for clinical trials of new
therapies against advanced renal cell carcinoma. J Clin Oncol 2002;20;289-96.
TACROLIMUS (PROTOPIC)
0.03% ointment
For children over 2 years of age with refractory atopic dermatitis. Approvals will be given for up to twelve months at a
time.
TACROLIMUS (PROTOPIC)
0.1% ointment
For the treatment of adults with moderate to severe atopic dermatitis who have failed or are intolerant to a site
appropriate strength of corticosteroid therapy (i.e. low potency for the face versus intermediate to high potency for the
trunk and extremities).
TELAPREVIR (INCIVEK)
375mg tablet
For the treatment of patients with chronic hepatitis C genotype 1 infection (HCV RNA positive) in combination with
peginterferon alpha and ribavirin if the following criteria are met:
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•
Patient is not co-infected with HIV
One course of treatment only (for up to 12 weeks duration) will be approved
Notes:
2. Therapy should be discontinued in all patients with HCV RNA levels greater than 1,000 IU/mL at treatment week
4 or 12, or confirmed HCV RNA positive at treatment week 24.
TEMOZOLOMIDE (TEMODAL and generic brand)
5mg, 20mg, 100mg, 140mg, 180mg, 250mg capsules
For the treatment of newly diagnosed high grade glioma patients with a good performance status (Karnofsky
performance status greater or equal to 60%) when used in combination with radiotherapy or as adjuvant therapy
post-radiation up to a maximum of 6 cycles.
TENOFOVIR (VIREAD)
300mg tablets
•
•
For the treatment of adult patients who have experienced adverse events or virologic failure with nucleoside
reverse transcriptase inhibitors.
For the treatment of chronic hepatitis B infection in patients with cirrhosis documented on radiologic or histologic
grounds and a HBV DNA concentration above 2000 lU/mL.
TERBINAFINE HYDROCHLORIDE (LAMISIL and generic brands)
250mg tablets
•
•
Treatment of onychomycosis
o approval limits payment for 6 weeks for the treatment of fingernail mycosis
o approval limits payment for 12 weeks for the treatment of toenail mycosis.
Treatment of dermatophyte infection unresponsive to other treatments or unlikely to respond to other treatments
due to the site or severity of the infection.
TESTOSTERONE (ANDRODERM, ANDROGEL, TESTIM)
12.2mg and 24.3mg patches, 2.5g and 5g packets, 1% gel
TESTOSTERONE UNDECANDOATE (ANDRIOL and generic brand)
40 mg capsules
For the treatment of congenital and acquired primary or secondary hypogonadism in males with a specific diagnosis
of:
•
•
Primary: cryptorchidism, Klinefelter’s, orchiectomy, and other established causes
Secondary: Pituitary-hypothalamic injury due to tumors, trauma, radiation
Testosterone deficiency should be clearly demonstrated by clinical features and confirmed by two separate free
testosterone measurements before initiating any replacement therapy
Note: Older males with non-specific symptoms of fatigue, malaise, or depression who have low testosterone levels do
not satisfy these criteria.
THYROTROPIN ALPHA (THYROGEN)
0.9mg/mL injection
1. For on-going evaluation in patients who have documented evidence of thyroid cancer, have undergone
appropriate surgical and/or medical management, and require monitoring for recurrence and metastatic disease.
This includes:
The patient has failed to respond to, or relapsed during:
• Primary use in patients with inability to raise an endogenous TSH level (≥ 25 mu/L) with thyroid hormone
withdrawal.
• Primary use in patients with one of the following documented comorbidities in whom severe hypothyroidism
could be life threatening:
o unstable angina
o recent myocardial infarction
o class III-IV congestive heart failure
o uncontrolled psychiatric illness
February 2014
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other medical condition in which the clinical course could lead to a potential life threatening situation
Secondary use in patients with previous thyroid hormone withdrawal resulting in a documented life threatening
event.
o
•
2. As an adjunctive treatment as pre-therapeutic stimulation for radioiodine ablation of thyroid tissue remnants in
patients maintained on thyroid hormone suppression therapy who have undergone near-total or total
thyroidectomy for well-differentiated thyroid cancer without evidence of distant metastatic thyroid cancer.
TICAGRELOR (BRILINTA)
90mg tablet
a
To be taken in combination with ASA 75mg -150mg daily for patients with acute coronary syndrome (i.e. ST
elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), or unstable angina (UA),
as follows:
STEMI
•
b,c
STEMI patients undergoing primary PCI
b,c
NSTEMI or UA
• Presence of high risk features irrespective of intent to perform revascularization:
o High GRACE risk score (>140)
o High TIMI risk score (5-7)
o Second ACS within 12 months
o Complex or extensive coronary artery disease e.g. diffuse three vessel disease
o Definite documented cerebrovascular or peripheral vascular disease
o Previous CABG
OR
• Undergoing PCI + high risk angiographic anatomyd
Notes:
(a) Co-administration of ticagrelor with high maintenance dose ASA (>150mg daily) is not recommended.
(b) In the PLATO study more patients on ticagrelor experienced non CABG related major bleeding than patients on
clopidogrel, however, there was no difference between the rate of overall major bleeding, between patients
treated with ticagrelor and those treated with clopidogrel. As with all other antiplatelet treatments the benefit/risk
ratio of antithrombotic effect vs. bleeding complications should be evaluated.
(c) Ticagrelor is contraindicated in patients with active pathological bleeding, in those with a history of intracranial
hemorrhage and moderate to severe hepatic impairment.
(d) High risk angiographic anatomy is defined as any of the following: left main stenting, high risk bifurcation
stenting (i.e., two-stent techniques), long stents ≥ 38 mm or overlapping stents, small stents ≤ 2.5 mm in
patients with diabetes.
Approval will be for a maximum of 12 months.
Prescriptions written by invasive (interventional) cardiologists do not require special authorization.
TINZAPARIN SODIUM (INNOHEP)
10,000IU/mL multidose vials and prefilled syringes
20,000IU/mL multidose vials and prefilled syringes
See criteria under Low Molecular Weight Heparins
TIOTROPIUM (SPIRIVA)
18mcg capsule for inhalation
•
•
•
For the treatment of chronic obstructive pulmonary disease (COPD) with EITHER tiotropium OR a long-acting
beta2-adrenergic agonist (LABA) if symptoms persist after 2-3 months of short-acting bronchodilator therapy (i.e.
salbutamol at a maximum dose of 8 puffs/day or ipratropium at maximum dose of 12 puffs/day).
Coverage can be provided without a trial of short-acting agent if there is spirometric evidence of at least
Combination therapy with tiotropium AND a long-acting beta2-adrenergic agonist/inhaled corticosteroid
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accepted.
COPD Stage
Symptoms
SEVERE – MRC 5
TIPRANAVIR (APTIVUS)
250mg capsules
For the treatment of adult patients with HIV-1 infection (plan U beneficiaries) who are treatment experienced, have
demonstrated failure to multiple protease inhibitors and in whom no other protease inhibitor is a treatment option.
TIZANIDINE (ZANAFLEX and generic brands)
4mg tablets
For the treatment of spasticity caused by traumatic brain injury, multiple sclerosis (MS), spinal cord injury (SCI) or
cerebral vascular accident (CVA) in patients in whom baclofen is contraindicated, ineffective or not tolerated.
TOBRAMYCIN (TOBI)
300mg/5mL solution for inhalation
For the treatment of cystic fibrosis patients who do not tolerate injectable tobramycin when used for inhalation.
TOCILIZUMAB (ACTEMRA)
80mg, 200mg, 400mg single dose vials (20mg/mL)
• Have not responded to an adequate trial of combination therapy of at least two traditional DMARDs (diseasemodifying antirheumatic drugs). Combination DMARD therapy must include methotrexate unless contraindicated
or not tolerated,
OR
• Are not candidates for combination DMARD therapy, must have had adequate trial of at least three traditional
AND
• Have had an inadequate response to a tumour necrosis factor (TNF)-alpha antagonist.
• Initial approval will be for 16 weeks at a dose of 4 mg/kg.
• Requests for continuation of therapy must include information demonstrating clinical response.
• No dose escalation permitted above 8 mg/kg every 4 weeks or a maximum dose of 800 mg per infusion for
individuals whose body weight is more than 100 kg.
• Will not be reimbursed in combination with other biologic agents.
Systemic Juvenile Idiopathic Arthritis (sJIA)
For the treatment of active systemic juvenile idiopathic arthritis (sJIA), in patients 2 years of age or older, who have
responded inadequately to non-steroidal anti-inflammatory drugs (NSAIDs) and systemic corticosteroids (with or
without methotrexate) due to intolerance or lack of efficacy.
• Must be prescribed by, or in consultation with, a pediatric rheumatologist.
• Coverage will be approved for a dose of 12 mg/kg for patients weighing less than 30kg or 8 mg/kg for patients
weighing greater than or equal to 30kg to a maximum of 800mg, administered every two weeks.
• Continued coverage will be dependent on a positive patient response as determined by a pediatric
rheumatologist.
Initial approval period: 16 weeks
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TOLTERODINE (DETROL)
1mg and 2mg tablets
•
•
information and the claim for tolterodine will be automatically reimbursed without the need for a written special
TOLTERODINE (DETROL LA)
2mg, 4mg capsules
•
•
TOPIRAMATE (TOPAMAX and generic brands)
25mg, 50mg, 100mg and 200mg tablets
•
•
For the treatment of refractory epilepsy not well controlled with conventional therapy.
To reduce the frequency of migraine headaches in adult patients who have failed an adequate trial of, or have
contraindications to, beta blockers AND tricyclics for prophylaxis.
TREPROSTINIL (REMODULIN)
1mg/mL, 2.5mg/mL, 5mg/mL, 10mg/mL solution
For the treatment of patients with primary pulmonary hypertension or pulmonary hypertension secondary to collagen
vascular disease, with New York Heart Association class III or IV disease who have both:
1. failed to respond to non-prostanoid therapies and
2. who are not candidates for epoprostenol therapy because of:
• prior recurrent complications with central line access (e.g. infection, thrombosis) or;
• inability to operate the complicated delivery system of epoprostenol or;
• they reside in an area without ready access to medical care, which could complicate problems
associated with an abrupt interruption of epoprostenol.
TRETINOIN (VESANOID)
10mg capsules
For the induction of remission in acute promyelocytic leukemia (APL) in previously untreated patients as well as in
those who have relapsed after, or were refractory to, standard chemotherapy.
TROSPIUM (TROSEC)
20mg tablets
•
•
information and the claim for trospium will be automatically reimbursed without the need for a written special
TRYPTOPHAN (TRYPTAN and generic brands)
500mg capsules, 250mg, 500mg, 750mg and 1g tablets
As an adjunctive therapy for drug resistant bipolar affective disorder.
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URSODIOL (URSO and generic brand)
250mg tablets
URSODIOL (URSO DS and generic brand)
500mg tablets
For the management of cholestatic liver diseases, such as primary biliary cirrhosis.
USTEKINUMAB (STELARA)
45 mg/0.5 mL vial for subcutaneous injection
•
•
•
•
•
•
•
For patients with severe, debilitating chronic plaque psoriasis who meet all of the following criteria:
genital region;
o Failure to respond to, contraindications to, or intolerant to methotrexate and cyclosporine;
o Failure to respond to, intolerant to, or unable to access phototherapy
Initial approval limited to 16 weeks.
Continuation of therapy beyond 16 weeks will be based on response. Patients not responding adequately at
recommended.
An adequate response is defined as either:
o ≥75% reduction in Psoriasis Area Severity Index (PASI) score from when treatment started, or
o ≥50% reduction in PASI with a ≥5 point improvement in the Dermatology Life Quality Index (DLQI), or
o A quantitative reduction in BSA affected with qualitative consideration of specific regions such as the face,
hands, feet or genital region.
Must be prescribed by a dermatologist
Concurrent use of >1 biologic will not be approved
Approval limited to a dose of 45 mg administered initially at weeks 0, 4 and 16, then 45 mg every 12 weeks
thereafter, up to a year (if response criteria met at 16 weeks).
VALGANCICLOVIR (VALCYTE and generic brand)
450mg tablets
•
•
For the treatment of cytomegalovirus (CMV) retinitis in HIV positive patients on the advice of an infectious
disease specialist.
For the prevention of cytomegalovirus (CMV) disease in solid organ transplant patients at high-risk (i.e. donor
CMV seropositive / recipient seronegative.) Coverage will be for a maximum of 100 days post transplant.
VEMURAFENIB (ZELBORAF)
240mg film-coated tablet
•
•
For the first line treatment of patients with BRAF V600 mutation-positive unresectable or metastatic
melanoma who have an ECOG status performance of ≤1.
For the second line treatment of patients with BRAF V600 mutation-positive unresectable or metastatic
melanoma who have an ECOG performance status of ≤1 and did not receive vemurafenib as first line treatment.
VIGABATRIN (SABRIL)
500mg tablets, 500mg sachets
1.
Requests will be considered for:
the adjunctive management of epilepsy which is not satisfactorily controlled by
conventional therapy.
• initial monotherapy for the management of infantile spasms.
The maximum approved dose will be 4g/day
•
2.
VORICONAZOLE (VFEND)
50mg, 200mg tablets
•
•
For the treatment of invasive aspergillosis. Initial requests will be approved for a maximum of 3 months.
For culture proven invasive candidiasis with documented resistance to fluconazole.
Must be prescribed in consultation with a specialist in infectious diseases or medical microbiology.
February 2014
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ZAFIRLUKAST (ACCOLATE)
20mg tablets
For the treatment of moderate to severe asthma in patients who:
• Are not adequately controlled with moderate to high dose inhaled corticosteroids despite compliance with
treatment AND
• Require increasing amounts of short-acting beta2-adrenergic agonists.
ZANAMIVIR (RELENZA)
5mg powder for inhalation
For beneficiaries residing in long-term care facilities meeting the same criteria as for oseltamivir and for whom there
is suspected or confirmed oseltamivir resistance, or for whom oseltamivir is contraindicated.
ZOLEDRONIC ACID (ACLASTA)
5mg/100mL solution for infusion
Osteoporosis
For the treatment of osteoporosis in postmenopausal women who were previously approved or would otherwise be
eligible for coverage of oral bisphosphonates and who:
• Have experienced further significant decline in bone mineral density (BMD) after 1 year of continuous oral
bisphosphonate therapy.
OR
• Have experienced serious intolerance to oral bisphosphonates.
OR
• Have a contraindication to oral bisphosphonates.
Note: Serious intolerance is defined as esophageal ulceration, erosion or stricture, or lower gastrointestinal symptoms
severe enough to cause discontinuation of oral bisphosphonates, or swallowing disorders that will increase the risk of
esophageal ulceration from oral bisphosphonates.
Paget’s Disease
For the treatment of Paget’s disease of bone.
ZOLMITRIPTAN (ZOMIG and generic brands)
2.5mg tablets
ZOLMITRIPTAN (ZOMIG RAPIMELT and generic brands)
2.5mg tablets
•
•
1
effective, or
3
1
Definitions:
•
•
•
2
3
ZOLMITRIPTAN (ZOMIG NASAL SPRAY)
2.5mg and 5mg nasal spray
•
1
2
February 2014
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•
•
1
2
2
For the treatment of migraine headache of severe or ultra severe intensity when patients have not responded
to oral sumatriptan, zolmitriptan, rizatriptan and/or naratriptan.
3
1
Definitions:
•
•
•
2
3
February 2014
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new brunswick prescription drug program formulary

Transcription

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