Pills

This is the text extract for Hospital Medicines List - effective 1 July 2013, browse documents here.


Section H for Hospital Pharmaceuticals

The Hospital Medicines List (HML)

First edition effective 1 July 2013 New Zealand Pharmaceutical Schedule


Guide to Section H listings

ANATOMICAL HEADING

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Generic name listed by therapeutic group and subgroup

THERAPEUTIC HEADING

CHEMICAL A Presentation A.................................................10.00 Restricted Only for use in children under 12 years of age CHEMICAL B Presentation B1............................................1,589,00 Presentation B2 Restricted Oncologist or haematologist CHEMICAL C Presentation C -1% DV Limit Jan-12 to 2014............................................................15.00 100 Brand A Brand or manufacturer’s name

Indicates only presentation B1 is Restricted

1

Brand B1 (Brand B2)

From 1 January 2012 to 30 June 2014, at least 99% of the total volume of this item purchased must be Brand C

28

Brand C Product with Hospital Supply Status (HSS)

CHEMICAL D Presentation D -1% DV Limit Mar-13 to 2014............................................................38.65

500

Brand D

Standard national price excluding GST

Restricted Limited to five weeks’ treatment Either: 1 For the prophylaxis of venous thromboembolism following a total hip replacement; or 2 For the prophylaxis of venous thromboembolism following a total knee replacement. CHEMICAL E Presentation E (Brand E)

Quantity the Price applies to

Form and strength

Not a contracted product

Restriction Products with Hospital Supply Status (HSS) are in bold


Section H July 2013

Editors Kaye Wilson, Sarah Le Leu & Donna Jennings email: schedule@pharmac.govt.nz Telephone +64 4 460 4990 Facsimile +64 4 460 4995 Level 9, 40 Mercer Street PO Box 10 254 Wellington 6143 Freephone Information Line 0800 66 00 50 Circulation Accessible in an electronic format at no cost on the PHARMAC website www.pharmac. govt.nz You can register to have an electronic version of the Pharmaceutical Schedule (link to PDF copy) emailed each month. Alternatively there is an annual subscription to the printed Schedule publications. To access either of these subscriptions visit our subscription website www.schedule. co.nz. Programmers Anrik Drenth & John Geering email: texschedule@pharmac.govt.nz © Pharmaceutical Management Agency

Contents

Introducing PHARMAC ......................................................3 Introduction to Section H ..................................................4 Named Patient Pharmaceutical Assessment (NPPA)......4 Glossary.......................................................................5 Part I General Rules ...........................................................6 Part II Hospital Pharmaceuticals Alimentary Tract and Metabolism ................................14 Blood and Blood Forming Organs ................................27 Cardiovascular System ...............................................36 Dermatologicals .........................................................48 Genito-Urinary System................................................55 Hormone Preparations ................................................59 Infections ...................................................................65 Musculoskeletal System .............................................87 Nervous System .........................................................97 Oncology Agents and Immunosuppressants..............123 Respiratory System and Allergies ..............................155 Sensory Organs ........................................................161 Special Foods...........................................................167 Vaccines ..................................................................181 Various.....................................................................186 Extemporaneously Compounded Preparations ...........194 Part III Optional Pharmaceuticals ...................................197 Index .............................................................................199

HML Help Contact Details Email hml@pharmac.govt.nz Freephone information line 0800 66 00 50 Fax 04 974 7819


The Hospital Medicines List

Kia ora and welcome to the first edition of a national prescribing list for New Zealand public hospitals – the Hospital Medicines List (the HML), Section H for Hospital Pharmaceuticals. PHARMAC has developed the HML in response to Government’s policy to nationally fund DHB-prescribed medicines and provide access to the same hospital medicines for all New Zealanders, wherever they are being treated. The list is designed to meet clinical needs. It’s built with standard practice of DHBs in mind. The sector has worked hard with us to get the details right and we’re grateful for that input. The rules and new exception processes are designed to ensure PHARMAC can keep responding to clinical needs and feedback. We are ready to respond quickly to how things actually work on the ground as DHBs transition to full use of the HML for all prescribing. We know there will be things that won’t seem perfect to start with. Some items may have been missed, and we need to work through that together with DHBs. We have already made changes in response to feedback on the first lists we published. In emergency or urgent situations, the clinically appropriate action should always be taken. We need you to let us know if that happens. The HML, and its various updates, are available on the printed page, as a pdf and soon as an interactive online tool. We’re also moving as fast as possible to integrate the information into DHB IT systems. We need to hear how things are working for you. Please contact us with any questions or feedback. Our details are on the previous page. Thanks to everyone who has helped get the list to this stage. I look forward to working with you to offer New Zealanders nationally consistent access to DHB hospital pharmaceuticals.

Steffan Crausaz Chief Executive

2


Introducing PHARMAC

PHARMAC, the Pharmaceutical Management Agency, is a Crown entity established pursuant to the New Zealand Public Health and Disability Act 2000 (The Act). The primary objective of PHARMAC is to secure for eligible people in need of pharmaceuticals, the best health outcomes that are reasonably achievable from pharmaceutical treatment and from within the amount of funding provided. The PHARMAC Board consists of up to six members appointed by the Minister of Health. All decisions relating to PHARMAC’s operation are made by or under the authority of the Board. More information on the Board can be found at www.pharmac.govt.nz The functions of PHARMAC are to perform, within the amount of funding provided to it in the Pharmaceutical Budget or to DHBs from their own budgets for the use of pharmaceuticals in their hospitals, as applicable, and in accordance with its annual plan and any directions given by the Minister (Section 103 of the Crown Entities Act)

Decision Criteria

PHARMAC takes into account the following criteria when considering amendments to the Schedule: a) the health needs of all eligible people within New Zealand; b) the particular health needs of Maori and Pacific peoples; c) the availability and suitability of existing medicines, therapeutic medical devices and related products and related things; d) the clinical benefits and risks of pharmaceuticals; e) the cost-effectiveness of meeting health needs by funding pharmaceuticals rather than using other publicly funded health and disability support services; f) the budgetary impact (in terms of the pharmaceutical budget and the Government’s overall health budget) of any changes to the Schedule; g) the direct cost to health service users; h) the Government’s priorities for health funding, as set out in any objectives notified by the Crown to PHARMAC, or in PHARMAC’s Funding Agreement, or elsewhere; and i) such other criteria as PHARMAC thinks fit. PHARMAC will carry out appropriate consultation when it intends to take any such “other criteria” into account. Copies of PHARMAC’s Operating Policies and Procedures and of any applicable supplements are available on the PHARMAC website (www.pharmac.govt.nz), or on request.

PHARMAC’s clinical advisors

Pharmacology and Therapeutics Advisory Committee (PTAC) PHARMAC works closely with the Pharmacology and Therapeutics Advisory Committee (PTAC), an expert medical committee which provides independent advice to PHARMAC on health needs and the clinical benefits of particular pharmaceuticals for use in the community and/or in DHB Hospitals. The chair of PTAC sits with the PHARMAC Board in an advisory capacity. Contact PTAC C/-PTAC Secretary, Pharmaceutical Management Agency, PO Box 10 254, WELLINGTON 6143, Email: PTAC@pharmac.govt.nz PTAC Subcommittees PTAC has subcommittees from which it can seek specialist advice in relation to funding applications. PTAC may seek advice from one or more subcommittees in relation to a funding application, or may make recommendations to PHARMAC without seeking the advice of a subcommittee: Analgesic Subcommittee Anti-Infective Subcommittee Cancer Treatments Subcommittee Cardiovascular Subcommittee Dermatology Subcommittee Diabetes Subcommittee Endocrinology Subcommittee Gastrointestinal Subcommittee Haematology Subcommittee Hospital Pharmaceuticals Subcommittee Immunisation Subcommittee Mental Health Subcommittee Neurological Subcommittee Ophthalmology Subcommittee Pulmonary Arterial Hypertension Subcommittee Reproductive and Sexual Health Subcommittee Respiratory Subcommittee Rheumatology Subcommittee Special Foods Subcommittee Transplant Immunosuppressants Subcommittee 3


PTAC also has a Tender Medical Evaluation Subcommittee to provide advice on clinical matters relating to PHARMAC’s annual multi-product tender and other purchasing strategies. Current membership of PTAC’s subcommittees can be found on PHARMAC’s website: http://www.pharmac.health. nz/about/committees/ptac

Named Patient Pharmaceutical Assessment policy

Named Patient Pharmaceutical Assessment (NPPA) provides a mechanism for individual patients to apply for funding for medicines not listed in the Pharmaceutical Schedule (either at all or for their clinical circumstances). PHARMAC will assess applications that meet the prerequisites according to its Decision Criteria before deciding whether to approve applications for funding. The Decision Criteria will be used to assess both the individual clinical circumstances of each NPPA applicant, and the implications of each NPPA funding decision on PHARMAC’s ability to carry out its legislative functions. For more information on NPPA, or to apply, visit the PHARMAC website at http://www.pharmac.health.nz/toolsresources/forms/named-patient-pharmaceutical-assessment-nppa-forms, or call the Panel Coordinators at (04) 9167553 or (04) 9167521.

The Pharmaceutical Schedule

The purpose of the Schedule is to list: • the Community Pharmaceuticals that are subsidised by the Government and to show the amount of the subsidy paid to contractors, as well as the manufacturer’s price and any access conditions that may apply; • the Hospital Pharmaceuticals that may be used in DHB Hospitals, as well as any access conditions that may apply; and • the Pharmaceuticals used in DHB Hospitals for which national prices have been negotiated by PHARMAC. The purpose of the Schedule is not to show the final cost to Government of subsidising each Community Pharmaceutical or to DHBs in purchasing each Hospital Pharmaceutical since that will depend on any rebate and other arrangements PHARMAC has with the supplier and, for some Hospital Pharmaceuticals, on any logistics arrangements put in place by individual DHB Hospitals.

Finding Information in Section H

Section H lists Pharmaceuticals that can be used in DHB Hospitals, and is split into the following parts: • Part I lists the rules in relation to use of Pharmaceuticals by DHB Hospitals. • Part II lists Hospital Pharmaceuticals that are funded for use in DHB Hospitals. These are classified based on the Anatomical Therapeutic Chemical (ATC) system used for Community Pharmaceuticals. It also provides information on any national contracts that exist, and an indication of which products have Hospital Supply Status (HSS). • Part III lists Optional Pharmaceuticals for which national contracts exist, and DHB Hospitals may choose to fund. These are listed alphabetically by generic chemical entity name and line item, the relevant Price negotiated by PHARMAC and, if applicable, an indication of whether it has Hospital Supply Status (HSS) and any associated Discretionary Variance Limit (DV Limit). The index located at the back of the Section H can be used to find page numbers for generic chemical entities, or product brand names, for Hospital Pharmaceuticals The listings are displayed alphabetically (where practical) within each level of the classification system. Each anatomical section contains a series of therapeutic headings, some of which may contain a further classification level. Community Pharmaceuticals are listed in a separate publication with Sections A to I (excluding Section H).

4


Glossary

Units of Measure gram g kilogram kg international units iu Abbreviations application capsule cream dispersible effervescent emulsion HSS app cap crm disp eff emul microgram milligram millilitre enteric coated granules injection linctus liquid lotion mcg mg ml EC grans inj linc liq lotn millimole unit mmol u

ointment solution suppository tablet tincture

oint soln suppos tab tinc

Hospital Supply Status (Refer to Rule 20)

5


PART I: GENERAL RULES

INTRODUCTION

Section H contains general rules that apply, and other information relating, to Hospital Pharmaceuticals and Optional Pharmaceuticals. Where relevant, Section H shows the Price at which a Pharmaceutical can be purchased directly from the pharmaceutical supplier by DHBs, providers of logistics services, wholesalers or other such distributors, or Contract Manufacturers. The Price is determined via contractual arrangements between PHARMAC and the relevant pharmaceutical supplier. Where a Pharmaceutical is listed in Part II of Section H, but no Price and/or brand of Pharmaceutical is indicated, each DHB may purchase any brand and/or pay the price that the DHB negotiates with the relevant pharmaceutical supplier. As required by section 23(7) of the Act, in performing any of its functions in relation to the supply of Pharmaceuticals, a DHB must not act inconsistently with the Pharmaceutical Schedule.

INTERPRETATION AND DEFINITIONS

1 Interpretations and Definitions 1.1 In this Schedule, unless the context otherwise requires: “Act” means the New Zealand Public Health and Disability Act 2000. “Combined Pharmaceutical Budget” means the pharmaceutical budget set for PHARMAC by the Crown for the subsidised supply of Community Pharmaceuticals and Pharmaceutical Cancer Treatments including for named patients in exceptional circumstances. “Community” means any setting outside of a DHB Hospital. “Community Pharmaceutical” means a Pharmaceutical listed in Sections A to G or I of the Pharmaceutical Schedule that is subsidised by the Funder from the Combined Pharmaceutical Budget and, for the purposes of this Section H, includes Pharmaceutical Cancer Treatments (PCTs). “Contract Manufacturer” means a manufacturer or a supplier that is a party to a contract with the relevant DHB Hospital to compound Pharmaceuticals, on request from that DHB Hospital. “Designated Delivery Point” means at a DHB Hospital’s discretion: a) a delivery point agreed between a pharmaceutical supplier and the relevant DHB Hospital, to which delivery point that pharmaceutical supplier must supply a National Contract Pharmaceutical directly at the Price; and/or b) any delivery point designated by the relevant DHB Hospital or PHARMAC, such delivery point being within 30 km of the relevant pharmaceutical supplier’s national distribution centre. “DHB” means an organisation established as a District Health Board by or under Section 19 of the Act. “DHB Hospital” means a hospital (including community trust hospitals) and/or an associated health service that is funded by a DHB including (but not limited to) district nursing services and child dental services. “DV Limit” means, for a particular National Contract Pharmaceutical with HSS, the National DV Limit or the Individual DV Limit. “DV Pharmaceutical” means a discretionary variance Pharmaceutical that does not have HSS but is used in place of one that does. Usually this means it is the same chemical entity, at the same strength, and in the same or a similar presentation or form, as the relevant National Contract Pharmaceutical with HSS. Where this is not the case, a note will be included with the listing of the relevant Hospital Pharmaceutical. “Extemporaneously Compounded Product” means a Pharmaceutical that is compounded from two or more Pharmaceuticals, for the purposes of reconstitution, dilution or otherwise. “First Transition Period” means the period of time after notification that a Pharmaceutical has been awarded HSS and before HSS is implemented. “Funder” means the body or bodies responsible, pursuant to the Act, for the funding of Pharmaceuticals listed on the Schedule (which may be one or more DHBs and/or the Ministry of Health) and their successors. “Give” means to administer, provide or dispense a Pharmaceutical, or to arrange for the administration, provision or dispensing of a Pharmaceutical, and “Given” has a corresponding meaning. “Hospital Pharmaceuticals” means the list of Pharmaceuticals set out in Section H Part II of the Schedule which includes some National Contract Pharmaceuticals. “HSS” stands for hospital supply status, which means the status of being the brand of the relevant National Contract Pharmaceutical that DHBs are obliged to purchase, subject to any DV Limit, for the period of hospital

6


GENERAL RULES

supply, as awarded under an agreement between PHARMAC and the relevant pharmaceutical supplier. Pharmaceuticals with HSS are listed in Section H in bold text. “Indication Restriction” means a limitation placed by PHARMAC on the funding of a Hospital Pharmaceutical which restricts funding to treatment of particular clinical circumstances. “Individual DV Limit” means, for a particular National Contract Pharmaceutical with HSS and a particular DHB Hospital, the discretionary variance limit, being the specified percentage of that DHB Hospital’s Total Market Volume up to which that DHB Hospital may purchase DV Pharmaceuticals of that National Contract Pharmaceutical. “Local Restriction” means a restriction on the use of Pharmaceutical in specific DHB Hospitals on the basis of prescriber type that is implemented by the relevant DHB in accordance with rule 7. “Medical Device” has the meaning set out in the Medicines Act 1981. “Named Patient Pharmaceutical Assessment Advisory Panel” means the panel of clinicians, appointed by the PHARMAC Board, that is responsible for advising PHARMAC, in accordance with its Terms of Reference, on Named Patient Pharmaceutical Assessment applications and any Exceptional Circumstances renewal applications submitted after 1 March 2012. “National Contract Pharmaceutical” means a brand of Pharmaceutical listed in Section H, where PHARMAC has entered into contractual arrangements with the relevant pharmaceutical supplier that specify the terms and conditions of listing, including the Price. Such Pharmaceuticals are recognisable in Section H because the relevant listing identifies the brand and Price. “National DV Limit” means, for a particular National Contract Pharmaceutical with HSS, the discretionary variance limit, being the specified percentage of the Total Market Volume up to which all DHB Hospitals may collectively purchase DV Pharmaceuticals of that National Contract Pharmaceutical. “Optional Pharmaceuticals” means the list of National Contract Pharmaceuticals set out in Section H Part III of the Schedule. “PHARMAC” means the Pharmaceutical Management Agency established by Section 46 of the Act. “Pharmacode” means the six or seven digit identifier assigned to a Pharmaceutical by the Pharmacy Guild following application from a pharmaceutical supplier. “Pharmaceutical” means a medicine, therapeutic medical device, or related product or related thing listed in Sections B to I of the Schedule. “Pharmaceutical Cancer Treatment” means Pharmaceuticals for the treatment of cancer, listed in Sections A to G of the Schedule and identified therein as a “PCT” or “PCT only” Pharmaceutical that DHBs must fund for use in their DHB hospitals, and/or in association with outpatient services provided by their DHB Hospitals, in relation to the treatment of cancers. “Prescriber Restriction” means a restriction placed by PHARMAC on the funding of a Pharmaceutical on the basis of prescriber type (and where relevant in these rules, includes a Local Restriction). “Price” means the standard national price for a National Contract Pharmaceutical, and, unless agreed otherwise between PHARMAC and the pharmaceutical supplier, includes any costs associated with the supply of the National Contract Pharmaceutical to, at a DHB Hospital’s discretion, any Designated Delivery Point, or to a Contract Manufacturer (expressly for the purpose of compounding), but does not include the effect of any rebates which may have been negotiated between PHARMAC and the pharmaceutical supplier. “Restriction” means a limitation, put in place by PHARMAC or a DHB, restricting the funding of a Pharmaceutical and includes Indication Restrictions, Local Restrictions and Prescriber Restrictions (as defined in this Part I of Section H). “Schedule” means this Pharmaceutical Schedule and all its sections and appendices. “Special Authority Approval” means an approval for funding of a Community Pharmaceutical that is marked in Sections B-G of the Schedule as being subject to a Special Authority restriction. “Total Market Volume” means, for a particular Hospital Pharmaceutical with HSS in any given period, in accordance with the data available to PHARMAC, the sum of: a) the total number of Units of the relevant Hospital Pharmaceutical with HSS purchased by all DHB Hospitals, or by a particular DHB Hospital in the case of the Individual DV Limit; and b) the total number of Units of all the relevant DV Pharmaceuticals purchased by all DHB Hospitals, or by a particular DHB Hospital in the case of the Individual DV Limit.

7


GENERAL RULES

“Unapproved Indication” means, for a Pharmaceutical, an indication for which it is not approved under the Medicines Act 1981. Clinicians prescribing Pharmaceuticals for Unapproved Indications should be aware of, and comply with, their obligations under Section 25 and/or Section 29 of the Medicines Act 1981 and as set out in rule 23. “Unit” means an individual unit of a Pharmaceutical (e.g. a tablet, 1 ml of an oral liquid, an ampoule or a syringe). “Unlisted Pharmaceutical” means a Pharmaceutical that is within the scope of a Hospital Pharmaceutical, but is not listed in Section H Part II. 1.2 In addition to the above interpretations and definitions, unless the content requires otherwise, a reference in the Schedule to: a) the singular includes the plural; and b) any legislation includes a modification and re-enactment of, legislation enacted in substitution for, and a regulation, Order in Council, and other instrument from time to time issued or made under, that legislation.

HOSPITAL SUPPLY OF PHARMACEUTICALS

2 Hospital Pharmaceuticals 2.1 Section H Part II contains the list of Hospital Pharmaceuticals that must be funded by DHB Hospitals. Section H Part II does not currently encompass the following categories of pharmaceuticals: a) Medical Devices; b) whole or fractionated blood products; c) diagnostic products which have an ex vivo use, such as pregnancy tests and reagents; d) disinfectants and sterilising products, except those that are to be used in or on a patient; e) foods and probiotics; f) radioactive materials; g) medical gases; and h) parenteral nutrition. Subject to rule 2.2, the funding of pharmaceuticals identified in a) – h) above is a decision for individual DHB Hospitals. 2.2 Section H Part III lists Optional Pharmaceuticals that PHARMAC and the relevant pharmaceutical supplier have entered into contractual arrangements for the purchase of, including an agreement on a national price and other obligations such as HSS. DHB Hospitals may choose whether or not to fund the Optional Pharmaceuticals listed in Part III of Section H, but if they do, they must comply with any National Contract obligations. Section H Part II does not encompass the provision of pharmaceutical treatments for DHB Hospital staff as part of an occupational health and safety programme. DHB Hospitals may choose whether or not to fund pharmaceutical treatments for such use, but if they do, they must comply with any National Contract obligations. In accordance with section 23(7) of the Act, in performing any of its functions in relation to the supply of pharmaceuticals, a DHB must not act inconsistently with the Pharmaceutical Schedule, which includes these General Rules. DHB Hospitals are not required to hold stock of every Hospital Pharmaceutical listed in Section H Part II, but they must Give it within a reasonable time if it is prescribed. DHB Hospitals are able to hold stock of an Unlisted Pharmaceutical if doing so is considered necessary for the DHB Hospital to be able to Give the Unlisted Pharmaceutical in a timely manner under rules 11-17 inclusive. Except where permitted in accordance with rule 11, DHBs must not Give: a) an Unlisted Pharmaceutical; or b) a Hospital Pharmaceutical outside of any relevant Restrictions.

2.3

3 DHB Supply Obligations 3.1

3.2 3.3 3.4

8


GENERAL RULES

4 Funding 4.1 The purchase costs of Hospital Pharmaceuticals or Optional Pharmaceuticals administered, provided or dispensed by DHB Hospitals must be funded by the relevant DHB Hospital from its own budget, with the exception of: a) Pharmaceutical Cancer Treatments; b) Community Pharmaceuticals that have been brought to the DHB hospital by the patient who is being treated by outpatient Services or who is admitted as an inpatient; c) Community Pharmaceuticals that have been dispensed to a mental health day clinic under a Practitioner’s Supply Order; and d) Unlisted Pharmaceutical that have been brought to the DHB Hospital by the patient who is admitted as an inpatient. For the avoidance of doubt, Pharmaceutical Cancer Treatments and Community Pharmaceuticals are funded through the Combined Pharmaceutical Budget, and Unlisted Pharmaceuticals are funded by the patient.

4.2

LIMITS ON SUPPLY

5 Prescriber Restrictions 5.1 A DHB Hospital may only Give a Hospital Pharmaceutical that has a Prescriber Restriction if it is prescribed: a) by a clinician of the type specified in the restriction for that Pharmaceutical or, subject to rule 5.2, pursuant to a recommendation from such a clinician; b) in accordance with a protocol or guideline that has been endorsed by the DHB Hospital; or c) in an emergency situation, provided that the prescriber has made reasonable attempts to comply with rule 5.1(a) above. If on-going treatment is required (i.e. beyond 24 hours) subsequent prescribing must comply with rule 5.1(a). Where a Hospital Pharmaceutical is prescribed pursuant to a recommendation from a clinician of the type specified in the restriction for that Pharmaceutical: a) the prescriber must consult with a clinician of the type specified in the restriction for that Pharmaceutical; and b) the consultation must relate to the patient for whom the prescription is written; and c) the consultation may be in person, by telephone, letter, facsimile or email; and d) appropriate records are kept of the consultation, including recording the name of the advising clinician on the prescription/chart. Where a clinician is working under supervision of a consultant who is of the type specified in the restriction for that Pharmaceutical, the requirements of rule 5.2 can be deemed to have been met. A DHB Hospital may only Give a Hospital Pharmaceutical that has an Indication Restriction, if it is prescribed for treatment of a patient with the particular clinical circumstances set out in the Indication Restriction. If a patient has a current Special Authority Approval for the Hospital Pharmaceutical that the DHB Hospital wishes to Give, then the Indication Restriction is deemed to have been met. If a Hospital Pharmaceutical has an Indication Restriction that is “for continuation only” then the DHB Hospital should only Give the Hospital Pharmaceutical where: a) the patient has been treated with the Pharmaceutical in the Community; or b) the patient is unable to be treated with an alternative Hospital Pharmaceutical, and the prescriber has explained to the patient that the Pharmaceutical is not fully subsidised in the Community. A DHB Hospital may implement a Local Restriction, provided that: a) in doing so, it ensures that the Local Restriction does not unreasonably limit funded access to the Hospital Pharmaceutical or undermine PHARMAC’s decision that the Hospital Pharmaceutical must be funded; b) it provides PHARMAC with details of each Local Restriction that it implements; and PHARMAC may, when it considers that a Local Restriction does not conform to rule 7.1 above, require a DHB to amend or remove that Local Restriction. Except where otherwise specified in Section H, DHB Hospitals can Give any Hospital Pharmaceutical to a patient for use in the Community, provided that: a) the quantity does not exceed that sufficient for up to 30 days’ treatment, unless:

5.2

5.3

6 Indication Restrictions 6.1 6.2 6.3

7 Local Restrictions 7.1

7.2

8 Community use of Hospital Pharmaceuticals 8.1

9


GENERAL RULES

i) it would be inappropriate to provide less than the amount in an original pack; or ii) the relevant DHB Hospital has a Dispensing for Discharge Policy and the quantity dispensed is in accordance with that policy; and the Hospital Pharmaceutical is supplied consistent with any applicable Restrictions.

b) 9.1 9.2

9 Community use of Medical Devices Subject to rules 9.2 and 9.3, DHB Hospitals may Give a Medical Device for patients for use in the Community. Where a Medical Device (or a similar Medical Device) is a Community Pharmaceutical, the DHB Hospital must supply: a) the brand of Medical Device that is listed in Sections A-G of the Schedule; and b) only to patients who meet the funding eligibility criteria set out in Sections A-G of the Schedule. Where a DHB Hospital has supplied a Medical Device to a patient; and a) that Medical Device (or a similar Medical Device) is subsequently listed in Sections A-G of the Schedule ; and b) the patient would not meet any funding eligibility criteria for the Medical Device set out in Sections A-G of the Schedule; and c) the Medical Device has consumable components that need to be replaced throughout its usable life; then DHB Hospitals may continue to fund consumable products for that patient until the end of the usable life of the Medical Device. At the end of the usable life of the device, funding for a replacement device must be consistent with the Pharmaceutical Schedule and/or in accordance with the Named Patient Pharmaceutical Assessment policy. 9.4 DHB Hospitals may also continue to fund consumable products, as in rule 9.3 above, in situations where the DHB has been funding consumable products but where the Medical Device was funded by the patient.

9.3

10 Extemporaneous Compounding 10.1 A DHB Hospital may Give any Extemporaneously Compounded Product for a patient in its care, provided that: a) all of the component Pharmaceuticals of the Extemporaneously Compounded Product are Hospital Pharmaceuticals; and b) the Extemporaneously Compounded Product is supplied consistent with any applicable rules or Restrictions for its component Hospital Pharmaceuticals. 10.2 For the avoidance of doubt, this rule 10.1 applies to any Extemporaneously Compounded Product, whether it is manufactured by the DHB Hospital or by a Contract Manufacturer.

EXCEPTIONS

11 Named Patient Pharmaceutical Assessment 11.1 A DHB Hospitals may only Give: a) an Unlisted Pharmaceutical; or b) a Hospital Pharmaceutical outside of any relevant Restrictions, in accordance with the Named Patient Pharmaceutical Assessment Policy or rules 12 – 17 inclusive. 12 Continuation 12.1 Where a patient’s clinical circumstances have been stabilised via treatment in the Community with Pharmaceutical that has not been funded by the Funder, and that patient is admitted to hospital as an inpatient, a DHB Hospital may fund that Pharmaceutical for the duration of the patient’s stay, where: a) the patient has not brought (or cannot arrange to bring) the Pharmaceuticals to the DHB Hospital, or pharmacy staff consider that the Pharmaceuticals brought to the DHB Hospital by the patient cannot be used; and b) interrupted or delayed treatment would have significant adverse clinical consequences; and c) it is not considered appropriate to switch treatment to a Hospital Pharmaceutical. 13 Pre-Existing Use 13.1 Subject to 13.2, where a DHB Hospital has Given a Pharmaceutical for a patient prior to 1 July 2013, and the Pharmaceutical: a) is an Unlisted Pharmaceutical; or b) treatment of the patient would not comply with any relevant Restrictions; the DHB Hospital may continue to Give that Pharmaceutical if it is considered that there would be significant

10


GENERAL RULES

adverse clinical consequences from ceasing or switching treatment. 13.2 Each DHB Hospital must, by no later than 1 October 2013, provide PHARMAC with a report on Pharmaceuticals it has Given in accordance with this rule 13 where treatment has continued beyond 1 August 2013. 14 Clinical Trials DHB Hospitals may Give any Pharmaceutical that is funded by a third party and is being used: 14.1 as part of a clinical trial which has Ethics Committee approval; or 14.2 for on-going treatment of patients following the end of such a clinical trial. 15 Pharmaceutical Cancer Treatments in Paediatrics DHB Hospitals may Give any Pharmaceutical for use within a paediatric oncology/haematology service for the treatment of cancer. 16 Other Government Funding DHB Hospitals may Give any Pharmaceutical where funding for that Pharmaceutical has been specifically provided by a Government entity other than PHARMAC or a DHB. 17 Other Exceptions 17.1 PHARMAC may also approve the funding of a Pharmaceutical within a single DHB Hospital for information gathering purposes or otherwise related to PHARMAC’s decision-making process for considering additions to or amendments to the Pharmaceutical Schedule. 17.2 Funding approvals granted under rule 17.1 will be subject to specific limitations on use as determined appropriate by PHARMAC in each circumstance, in consultation with the relevant DHB Hospital and/or DHB.

NATIONAL CONTRACTING

18 Hospital Pharmaceutical Contracts 18.1 A DHB Hospital may enter into a contract for the purchase of any Pharmaceutical that it is entitled to fund in accordance with this Schedule H and that is not a National Contract Pharmaceutical, provided that such a contract: a) does not oblige the relevant DHB Hospital to purchase a volume of that Pharmaceutical, if that Pharmaceutical is a DV Pharmaceutical, that is greater than the relevant DV Limit; b) enables PHARMAC to access and use future price and volume data in respect of that Pharmaceutical; and c) enables the relevant DHB Hospital to terminate the contract or relevant parts of the contract in order to give full effect to the national contract on no more than 3 months’ written notice to the pharmaceutical supplier. 18.2 From 1 July 2013, where a DHB Hospital has a pre-existing supply contract for a particular brand of chemical entity for which there is a National Contract Pharmaceutical, the DHB may continue purchasing the chemical entity in accordance with its pre-existing supply contract however: a) from the day its pre-existing supply contract expires, that DHB Hospital is to purchase the relevant National Contract Pharmaceutical listed in Section H at the Price, and is to comply with any DV Limits for the National Contract Pharmaceutical where it has HSS; b) if purchase of the relevant National Contract Pharmaceutical listed in Section H at the Price, where it has HSS, would not cause the relevant DHB Hospital to be in breach of its pre-existing supply contract for a particular brand of chemical entity; the DHB Hospital must purchase the National Contract Pharmaceutical. 18.3 Following written notification from PHARMAC that a Pharmaceutical is a National Contract Pharmaceutical, either through Section H updates or otherwise, DHB Hospitals must, unless PHARMAC expressly notifies otherwise: a) take any steps available to them to terminate pre-existing contracts or relevant parts of such a contract, and b) not to enter any new contracts or extend the period of any current contracts, for the supply of that National Contract Pharmaceutical or the relevant chemical entity. 19 National Contract Pharmaceuticals 19.1 DHB Hospitals must take all necessary steps to enable any contracts between PHARMAC and a pharmaceutical supplier in relation to National Contract Pharmaceuticals to be given full effect. 19.2 The contractual arrangement between PHARMAC and the relevant pharmaceutical supplier of a National Contract Pharmaceutical requires it to be made available by for purchase at the relevant Price by any or all of the following: a) DHB Hospitals at Designated Delivery Points; and/or b) Contract Manufacturers (expressly for the purpose of compounding).

11


GENERAL RULES

20 Hospital Supply Status (HSS) 20.1 The DV Limit for any National Contract Pharmaceutical which has HSS is set out in the listing of the relevant National Contract Pharmaceutical in Section H, and may be amended from time to time. 20.2 If a National Contract Pharmaceutical is listed in Section H as having HSS, DHB Hospitals: a) are expected to use up any existing stocks of DV Pharmaceuticals during the First Transition Period; b) must not purchase DV Pharmaceuticals in volumes exceeding their usual requirements, or in volumes exceeding those which they reasonably expect to use, within the First Transition Period; c) must ensure that Contract Manufacturers, when manufacturing an Extemporaneously Compounded Product on their behalf, use the National Contract Pharmaceutical with HSS; and d) must purchase the National Contract Pharmaceutical with HSS except: i) to the extent that the DHB Hospital may use its discretion to purchase a DV Pharmaceutical within the DV Limit, provided that (subject to rule 20.2(d)(iii) below) the DV Limit has not been exceeded nationally; ii) if the pharmaceutical supplier fails to supply that National Contract Pharmaceutical, in which case the relevant DHB Hospital does not have to comply with the DV Limit for that National Contract Pharmaceutical during that period of non-supply (and any such month(s) included in a period of nonsupply will be excluded in any review of the DV Limit in accordance with rule 20.3 below); iii) that where the DV Limit has been exceeded nationally, the DHB Hospital may negotiate with the pharmaceutical supplier that supplies the National Contract Pharmaceutical with HSS for written permission to vary the application of that DHB Hospital’s Individual DV Limit for any patient whose exceptional needs require a DV Pharmaceutical. 20.3 PHARMAC may, in its discretion, for any period or part period: a) review usage by DHB Hospitals of the National Contract Pharmaceutical and DV Pharmaceuticals to determine whether the DV Limit has been exceeded; and b) audit compliance by DHB Hospitals with the DV Limits and related requirements. 20.4 PHARMAC will address any issues of non-compliance by any individual DHB or DHB Hospital with a DV Limit by: a) obtaining the relevant DHB or DHB Hospital’s assurance that it will comply with the DV Limit for that National Contract Pharmaceutical with HSS in the remainder of the applicable period and any subsequent periods; and b) informing the relevant supplier of the HSS Pharmaceutical of any individual DHB or DHB Hospital’s noncompliance with the DV Limit for that HSS Pharmaceutical. 20.5 In addition to the steps taken by PHARMAC under rule 20.4 above to address any issues of non-compliance by any individual DHB or DHB Hospital with a DV Limit, the relevant pharmaceutical supplier may require, in its discretion, financial compensation from the relevant DHB or DHB Hospital: a) an amount representing that DHB or DHB Hospital’s contribution towards exceeding the DV Limit (where PHARMAC is able to quantify this based on the information available to it); or b) the sum of $1,000 or $5,000 (depending on the terms of the applicable national contract applying to the HSS Pharmaceutical), whichever is the greater as between sub-paragraphs (a) and (b) within the number of business days specified in the notice from the pharmaceutical supplier requiring such payment to be made. 21 Collection of rebates and payment of financial compensation 21.1 Following the receipt of any rebates from a pharmaceutical supplier in respect of a particular National Contract Pharmaceutical, PHARMAC will notify each relevant DHB and DHB Hospital of the amount of the rebate owing to it, being a portion of the total rebate determined by PHARMAC on the basis of that DHB Hospital’s usage of that National Contract Pharmaceutical, where this is able to be determined. Where data to determine individual DHB Hospitals’ usage is not available, PHARMAC will apportion rebates on the basis of an alternative method agreed between the relevant DHBs and PHARMAC. 21.2 PHARMAC will pay each DHB Hospital the rebate amounts (if any) owing to it, no less frequently than once each calendar quarter in respect of rebates received quarterly (or more often). 22 Price and Volume Data 22.1 DHB Hospitals must provide to PHARMAC, on a monthly basis in accordance with PHARMAC’s requirements, any volume data and, unless it would result in a breach of a pre-existing contract, price data held by those DHB Hospitals in respect of any Hospital Pharmaceuticals listed in Part II of Section H of the Schedule.

12


GENERAL RULES

22.2 All price and volume data provided to PHARMAC under rule 22.1 above should identify the relevant Hospital Pharmaceutical by using a Pharmacode or some other unique numerical identifier, and the date (month and year) on which the DHB Hospital incurred a cost for the purchase of that Hospital Pharmaceutical. Volume is to be measured in units (that being the smallest possible whole Unit – e.g. a capsule, a vial, a millilitre etc).

MISCELLANEOUS PROVISIONS

23 Unapproved Pharmaceuticals Prescribers should, where possible, prescribe Hospital Pharmaceuticals that are approved under the Medicines Act 1981. However, the funding criteria (including Restrictions) under which a Hospital Pharmaceutical is listed in Section H of the Schedule may: 23.1 in some cases, explicitly permit a DHB to fund a Pharmaceutical that is not approved under the Medicines Act 1981 or for an Unapproved Indication; or 23.2 not explicitly prohibit a DHB from funding a Pharmaceutical for use for an Unapproved Indication; Accordingly, if clinicians are planning on prescribing an unapproved Pharmaceutical or a Pharmaceutical for an Unapproved Indication, they should: 23.3 be aware of and comply with their obligations under sections 25 and/or 29 of the Medicines Act 1981, as applicable, and otherwise under that Act and the Medicines Regulations 1984; 23.4 be aware of and comply with their obligations under the Health and Disability Commissioner’s Code of Consumer Rights, including the requirement to obtain informed consent from the patient (PHARMAC recommends that clinicians obtain written consent); and 23.5 exercise their own skill, judgment, expertise and discretion, and make their own prescribing decisions with respect to the use of an unapproved Pharmaceutical or a Pharmaceutical for an Unapproved Indication. Clinicians should be aware that simply by listing a Pharmaceutical on the Pharmaceutical Schedule, PHARMAC makes no representations about whether that Pharmaceutical has any form of approval or consent under, or whether the supply or use of the Pharmaceutical otherwise complies with, the Medicines Act 1981. Further, the Pharmaceutical Schedule does not constitute an advertisement, advertising material or a medical advertisement as defined in the Medicines Act or otherwise.

13


PART II: ALIMENTARY TRACT AND METABOLISM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

ANTACIDS AND ANTIFLATULENTS Antacids and Reflux Barrier Agents

ALUMINIUM HYDROXIDE WITH MAGNESIUM HYDROXIDE AND SIMETHICONE Oral liq 200 mg with magnesium hydroxide 200 mg and simethicone 20 mg per 5 ml Tab 200 mg with magnesium hydroxide 200 mg and simethicone 20 mg SIMETHICONE Oral drops 100 mg per ml SODIUM ALGINATE WITH MAGNESIUM ALGINATE Powder for oral soln 225 mg with magnesium alginate 87.5 mg, sachet SODIUM ALGINATE WITH SODIUM BICARBONATE AND CALCIUM CARBONATE Oral liq 500 mg with sodium bicarbonate 267 mg and calcium carbonate 160 mg per 10 ml ....................................... 4.95 500 ml Tab 500 mg with sodium bicarbonate 267 mg and calcium carbonate 160 mg SODIUM CITRATE Oral liq 8.8% (300 mmol/l)

(Mylanta) (Mylanta)

(Gaviscon Infant)

Acidex (Gaviscon Double Strength)

Phosphate Binding Agents

ALUMINIUM HYDROXIDE Tab 600 mg CALCIUM CARBONATE  Oral liq 250 mg per ml (100 mg elemental per ml) ...................... 39.00 500 ml Roxane

Restricted Only for use in children under 12 years of age for use as a phosphate binding agent

ANTIDIARRHOEALS AND INTESTINAL ANTI-INFLAMMATORY AGENTS Antipropulsives

DIPHENOXYLATE HYDROCHLORIDE WITH ATROPINE SULPHATE Tab 2.5 mg with atropine sulphate 25 mcg LOPERAMIDE HYDROCHLORIDE Cap 2 mg ..................................................................................... 8.95 Tab 2 mg 400 Diamide Relief

14

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


ALIMENTARY TRACT AND METABOLISM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Rectal and Colonic Anti-Inflammatories

BUDESONIDE  Cap 3 mg Restricted Crohn’s disease Both: 1 Mild to moderate ileal, ileocaecal or proximal Crohn’s disease; and 2 Any of the following: 2.1 Diabetes; or 2.2 Cushingoid habitus; or 2.3 Osteoporosis where there is significant risk of fracture; or 2.4 Severe acne following treatment with conventional corticosteroid therapy; or 2.5 History of severe psychiatric problems associated with corticosteroid treatment; or 2.6 History of major mental illness (such as bipolar affective disorder) where the risk of conventional corticosteroid treatment causing relapse is considered to be high; or 2.7 Relapse during pregnancy (where conventional corticosteroids are considered to be contraindicated). Collagenous and lymphocytic colitis (microscopic colitis) Patient has a diagnosis of microscopic colitis (collagenous or lymphocytic colitis) by colonoscopy with biopsies Gut Graft versus Host disease Patient has a gut Graft versus Host disease following allogenic bone marrow transplantation HYDROCORTISONE ACETATE Rectal foam 10% (14 applications) – 1% DV Jan-13 to 2015 ..... 25.30 MESALAZINE Tab 400 mg ............................................................................... 49.50 Tab EC 500 mg .......................................................................... 49.50 Tab long-acting 500 mg ............................................................. 59.05 Suppos 500 mg – 1% DV Sep-11 to 2014 ................................. 22.80 Suppos 1 g ................................................................................ 50.96 Enema 1 g per 100 ml – 1% DV Sep-12 to 2015 ........................ 44.12 OLSALAZINE Cap 250 mg Tab 500 mg SODIUM CROMOGLYCATE Cap 100 mg SULPHASALAZINE Tab 500 mg ............................................................................... 11.68 Tab EC 500 mg .......................................................................... 12.89 100 100 Salazopyrin Salazopyrin EN 21.1 g 100 100 100 20 28 7 Colifoam Asacol Asamax Pentasa Asacol Pentasa Pentasa

LOCAL PREPARATIONS FOR ANAL AND RECTAL DISORDERS Antihaemorrhordal Preparations

CINCHOCAINE HYDROCHLORIDE WITH HYDROCORTISONE Oint 5 mg with hydrocortisone 5 mg per g .................................. 15.00 Suppos 5 mg with hydrocortisone 5 mg per g............................... 9.90 30 g 12 Proctosedyl Proctosedyl

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

15


ALIMENTARY TRACT AND METABOLISM

Price (ex man. Excl. GST) $ Per FLUOCORTOLONE CAPROATE WITH FLUOCORTOLONE PIVALATE AND CINCHOCAINE Oint 950 mcg with fluocortolone pivalate 920 mcg and cinchocaine hydrochloride 5 mg per g ...................................... 6.35 30 g Suppos 630 mcg with fluocortolone pivalate 610 mcg and cinchocaine hydrochloride 1 mg............................................... 2.66 12 Brand or Generic Manufacturer

Ultraproct Ultraproct

Management of Anal Fissures

GLYCERYL TRINITRATE Oint 0.2% ................................................................................... 22.00 30 g Rectogesic

Rectal Sclerosants

OILY PHENOL Inj 5%, 5 ml vial

ANTISPASMODICS AND OTHER AGENTS ALTERING GUT MOTILITY

GLYCOPYRRONIUM BROMIDE Inj 0.2 mg per ml, 1 ml ampoule HYOSCINE BUTYLBROMIDE Inj 20 mg, 1 ml ampoule – 1% DV Nov-11 to 2014 ...................... 9.57 Tab 10 mg – 1% DV Sep-11 to 2014 ........................................... 1.48 MEBEVERINE HYDROCHLORIDE Tab 135 mg – 1% DV Sep-11 to 2014 ....................................... 18.00 5 20 90 Buscopan Gastrosoothe Colofac

ANTIULCERANTS Antisecretory and Cytoprotective

MISOPROSTOL Tab 200 mcg

H2 Antagonists

CIMETIDINE Tab 200 mg Tab 400 mg RANITIDINE Tab 150 mg – 1% DV Sep-11 to 2014 ......................................... 6.79 Tab 300 mg – 1% DV Sep-11 to 2014 ......................................... 9.34 Oral liq 150 mg per 10 ml – 1% DV Sep-11 to 2014 ..................... 5.92 Inj 25 mg per ml, 2 ml ampoule .................................................... 8.75 250 250 300 ml 5 Arrow-Ranitidine Arrow-Ranitidine Peptisoothe Zantac

Proton Pump Inhibitors

LANSOPRAZOLE Cap 15 mg – 1% DV Jan-13 to 2015 ........................................... 2.00 Cap 30 mg – 1% DV Jan-13 to 2015 ........................................... 2.32 28 28 Solox Solox

16

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


ALIMENTARY TRACT AND METABOLISM

Price (ex man. Excl. GST) $ Per OMEPRAZOLE Cap 10 mg – 1% DV Oct-11 to 2014............................................ 2.91 Cap 20 mg – 1% DV Oct-11 to 2014............................................ 3.78 Cap 40 mg – 1% DV Oct-11 to 2014............................................ 5.57 Powder for oral liq – 1% DV Sep-11 to 2014 .............................. 42.50 Inj 40 mg ampoule with diluent – 1% DV Sep-11 to 2014 ........... 28.65 Inj 40 mg ampoule – 1% DV Sep-11 to 2014 ............................. 19.00 90 90 90 5g 5 5 Brand or Generic Manufacturer Omezol Relief Omezol Relief Omezol Relief Midwest Dr Reddy’s Omeprazole Dr Reddy’s Omeprazole

 Tab dispersible 20 mg

Restricted Only for use in tube-fed patients PANTOPRAZOLE Tab 20 mg ................................................................................... 1.23 Tab 40 mg ................................................................................... 1.54 Inj 40 mg vial 28 28

Dr Reddy’s Pantoprazole Dr Reddy’s Pantoprazole

Site Protective Agents

BISMUTH TRIOXIDE Tab 120 mg ............................................................................... 32.50 SUCRALFATE Tab 1 g 112 De-Nol

BILE AND LIVER THERAPY

L-ORNITHINE L-ASPARTATE  Grans for oral liquid 3 g Restricted For patients with chronic hepatic encephalopathy who have not responded to treatment with, or are intolerant to lactulose, or where lactulose is contraindicated.

DIABETES Alpha Glucosidase Inhibitors

ACARBOSE Tab 50 mg – 1% DV Dec-12 to 2015 ........................................... 9.82 Tab 100 mg – 1% DV Dec-12 to 2015 ....................................... 15.83 90 90 Accarb Accarb

Hyperglycaemic Agents

DIAZOXIDE  Cap 25 mg ............................................................................... 110.00  Cap 100 mg ............................................................................. 280.00 Restricted For patients with confirmed hypoglycaemia caused by hyperinsulinism 100 100 Proglicem Proglicem

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

17


ALIMENTARY TRACT AND METABOLISM

Price (ex man. Excl. GST) $ Per GLUCAGON HYDROCHLORIDE Inj 1 mg syringe kit..................................................................... 32.00 GLUCOSE Gel 40% Tab 3.1 mg Tab 1.5 g GLUCOSE WITH SUCROSE AND FRUCTOSE Gel 19.7% with sucrose 35% and fructose 19.7%, 18 g sachet 1 Brand or Generic Manufacturer Glucagen Hypokit

Insulin – Intermediate-Acting Preparations

INSULIN ASPART WITH INSULIN ASPART PROTAMINE Inj insulin aspart 30% with insulin aspart protamine 70%, 100 u per ml, 3 ml prefilled pen .............................................. 52.15 INSULIN ISOPHANE Inj insulin human 100 u per ml, 10 ml vial Inj insulin human 100 u per ml, 3 ml cartridge INSULIN LISPRO WITH INSULIN LISPRO PROTAMINE Inj insulin lispro 25% with insulin lispro protamine 75%, 100 u per ml, 3 ml cartridge ................................................... 52.15 Inj insulin lispro 50% with insulin lispro protamine 50%, 100 u per ml, 3 ml cartridge ................................................... 52.15 INSULIN NEUTRAL WITH INSULIN ISOPHANE Inj insulin neutral 30% with insulin isophane 70%, 100 u per ml, 10 ml vial Inj insulin neutral 30% with insulin isophane 70%, 100 u per ml, 3 ml cartridge Inj insulin neutral 40% with insulin isophane 60%, 100 u per ml, 3 ml cartridge Inj insulin neutral 50% with insulin isophane 50%, 100 u per ml, 3 ml cartridge

5

NovoMix 30 FlexPen

5 5

Humalog Mix 25 Humalog Mix 50

Insulin – Long-Acting Preparations

INSULIN GLARGINE Inj 100 u per ml, 10 ml vial ......................................................... 63.00 Inj 100 u per ml, 3 ml cartridge................................................... 94.50 Inj 100 u per ml, 3 ml disposable pen ......................................... 94.50 1 5 5 Lantus Lantus Lantus SoloStar

Insulin – Rapid-Acting Preparations

INSULIN ASPART Inj 100 u per ml, 10 ml vial Inj 100 u per ml, 3 ml cartridge INSULIN GLULISINE Inj 100 u per ml, 10 ml vial ......................................................... 27.03 Inj 100 u per ml, 3 ml cartridge................................................... 46.07 Inj 100 u per ml, 3 ml disposable pen ......................................... 46.07 1 5 5 Apidra Apidra Apidra SoloStar

18

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


ALIMENTARY TRACT AND METABOLISM

Price (ex man. Excl. GST) $ Per INSULIN LISPRO Inj 100 u per ml, 10 ml vial Inj 100 u per ml, 3 ml cartridge Brand or Generic Manufacturer

Insulin – Short-Acting Preparations

INSULIN NEUTRAL Inj human 100 u per ml, 10 ml vial Inj human 100 u per ml, 3 ml cartridge

Oral Hypoglycaemic Agents

GLIBENCLAMIDE Tab 5 mg GLICLAZIDE Tab 80 mg – 1% DV Sep-11 to 2014 ......................................... 17.60 GLIPIZIDE Tab 5 mg – 1% DV Dec-12 to 2015 ............................................. 3.00 METFORMIN Tab immediate-release 500 mg – 1% DV Oct-12 to 2015 ........... 12.30 Tab immediate-release 850 mg – 1% DV Oct-12 to 2015 ........... 10.10 PIOGLITAZONE Tab 15 mg – 1% DV Sep-12 to 2015 ........................................... 1.50 Tab 30 mg – 1% DV Sep-12 to 2015 ........................................... 2.50 Tab 45 mg – 1% DV Sep-12 to 2015 ........................................... 3.50 500 100 1,000 500 28 28 28 Apo-Gliclazide Minidiab Apotex Apotex Pizaccord Pizaccord Pizaccord

DIGESTIVES INCLUDING ENZYMES

PANCREATIC ENZYME Cap EC 10,000 BP u lipase, 9,000 BP u amylase and 210 BP u protease Cap EC 25,000 BP u lipase, 18,000 BP u amylase and 1,000 BP u protease Cap EC 25,000 BP u lipase, 22,500 BP u amylase and 1,250 BP u protease Powder 25,000 u lipase with 30,000 u amylase and 1,400 u protease per g URSODEOXYCHOLIC ACID  Cap 250 mg – 1% DV May-12 to 2014 ...................................... 71.50 100 Ursosan Restricted Pregnancy/Cirrhosis Either: 1 Patient diagnosed with cholestasis of pregnancy; or 2 Both: 2.1 Primary biliary cirrhosis confirmed by antimitochondrial antibody titre (AMA) > 1:80, and raised cholestatic liver enzymes with or without raised serum IgM or, if AMA is negative, by liver biopsy; and 2.2 Patient not requiring a liver transplant (bilirubin > 170umol/l; decompensated cirrhosis). Note: Liver biopsy is not usually required for diagnosis but is helpful to stage the disease. Haematological Transplant Both: 1 Patient at risk of veno-occlusive disease or has hepatic impairment and is undergoing conditioning treatment prior to allogenic stem cell or bone marrow transplantation; and 2 Treatment for up to 13 weeks.

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

19


ALIMENTARY TRACT AND METABOLISM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

LAXATIVES Bowel-Cleansing Preparations

CITRIC ACID WITH MAGNESIUM OXIDE AND SODIUM PICOSULFATE Powder for oral soln 12 g with magnesium oxide 3.5 g and sodium picosulfate 10 mg per sachet MACROGOL 3350 WITH ASCORBIC ACID, POTASSIUM CHLORIDE AND SODIUM CHLORIDE Powder for oral soln 755.68 mg with ascorbic acid 85.16 mg, potassium chloride 10.55 mg, sodium chloride 37.33 mg and sodium sulphate 80.62 mg per g, 70 g sachet Powder for oral soln 755.68 mg with ascorbic acid 85.16 mg, potassium chloride 10.55 mg, sodium chloride 37.33 mg and sodium sulphate 80.62 mg per g, 210 g sachet

(PicoPrep)

(Glycoprep-C) (Glycoprep-C)

MACROGOL 3350 WITH POTASSIUM CHLORIDE, SODIUM BICARBONATE, SODIUM CHLORIDE AND SODIUM SULPHATE Powder for oral soln 59 g with potassium chloride 0.7425 g, sodium bicarbonate 1.685 g, sodium chloride 1.465 g and sodium sulphate 5.685 g per sachet....................................... 14.31 4 Klean Prep

Bulk-Forming Agents

ISPAGHULA (PSYLLIUM) HUSK Powder for oral soln ..................................................................... 6.02 STERCULIA WITH FRANGULA  Powder for oral soln Restricted For continuation only 500 g Konsyl-D

Faecal Softeners

DOCUSATE SODIUM Cap 50 mg – 1% DV Sep-11 to 2014 ........................................... 2.57 Cap 120 mg – 1% DV Sep-11 to 2014 ......................................... 3.48 DOCUSATE SODIUM WITH SENNOSIDES Tab 50 mg with sennosides 8 mg ................................................. 6.38 PARAFFIN Enema 133 ml Oral liquid 1 mg per ml POLOXAMER Oral drops 10% – 1% DV Sep-11 to 2014 .................................... 3.78 30 ml Coloxyl 100 100 200 Laxofast 50 Laxofast 120 Laxsol

Osmotic Laxatives

GLYCEROL Suppos 1.27 g Suppos 2.55 g Suppos 3.6 g – 1% DV Jan-13 to 2015........................................ 6.50

20

PSM

20

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


ALIMENTARY TRACT AND METABOLISM

Price (ex man. Excl. GST) $ Per LACTULOSE Oral liq 10 g per 15 ml.................................................................. 7.68 1,000 ml Brand or Generic Manufacturer Laevolac

MACROGOL 3350 WITH POTASSIUM CHLORIDE, SODIUM BICARBONATE AND SODIUM CHLORIDE  Powder for oral soln 6.563 g with potassium chloride 23.3 mg, sodium bicarbonate 89.3 mg and sodium chloride 175.4 mg  Powder for oral soln 13.125 g with potassium chloride 46.6 mg, sodium bicarbonate 178.5 mg and sodium chloride 350.7 mg .............................................................................. 10.00 30 Lax-Sachets 18.14 Movicol Restricted Either: 1 The patient has problematic constipation requiring intervention with a per rectal preparation despite an adequate trial of other oral pharmacotherapies including lactulose where lactulose is not contraindicated; or 2 For short-term use for faecal disimpaction. SODIUM CITRATE WITH SODIUM LAURYL SULPHOACETATE Enema 90 mg with sodium lauryl sulphoacetate 9 mg per ml, 5 ml – 1% DV Sep-13 to 2016............................................... 19.95 SODIUM PHOSPHATE WITH PHOSPHORIC ACID Oral liq 16.4% with phosphoric acid 25.14% Enema 10% with phosphoric acid 6.58% ...................................... 2.50

50

Micolette

1

Fleet Phosphate Enema

Stimulant Laxatives

BISACODYL Tab 5 mg ..................................................................................... 4.99 Suppos 5 mg ............................................................................... 3.00 Suppos 10 mg ............................................................................. 3.00 DANTHRON WITH POLOXAMER  Oral liq 25 mg with poloxamer 200 mg per 5 ml.......................... 21.30  Oral liq 75 mg with poloxamer 1 g per 5 ml................................. 43.60 Restricted Only for the prevention or treatment of constipation in the terminally ill SENNOSIDES Tab 7.5 mg 200 6 6 300 ml 300 ml Lax-Tabs Dulcolax Dulcolax Pinorax Pinorax Forte

METABOLIC DISORDER AGENTS

ARGININE Powder Inj 600 mg per ml, 25 ml vial BETAINE  Powder Restricted Metabolic disorders physician or metabolic disorders dietitian HAEM ARGINATE Inj 25 mg per ml, 10 ml ampoule

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

21


ALIMENTARY TRACT AND METABOLISM

Price (ex man. Excl. GST) $ Per IMIGLUCERASE  Inj 40 iu per ml, 5 ml vial  Inj 40 iu per ml, 10 ml vial Restricted Only for use in patients with approval by the Gaucher’s Treatment Panel LEVOCARNITINE  Cap 500 mg  Inj 200 mg per ml, 5 ml vial  Oral soln 500 mg per 15 ml Restricted Metabolic disorders physician, metabolic disorders dietitian or neurologist SODIUM BENZOATE Cap 500 mg Inj 20%, 10 ml ampoule Powder Soln 100 mg per ml SODIUM PHENYLBUTYRATE Inj 200 mg per ml, 10 ml ampoule Oral liq 250 mg per ml Tab 500 mg TRIENTINE DIHYDROCHLORIDE Cap 300 mg Brand or Generic Manufacturer

MINERALS Calcium

CALCIUM CARBONATE Tab 1.25 g (500 mg elemental) – 1% DV Feb-12 to 2014 ............ 6.38 Tab 1.5 g (600 mg elemental) Tab eff 1.75 g (1 g elemental) – 1% DV Nov-11 to 2014 .............. 6.21 250 30 Arrow-Calcium Calsource

Fluoride

SODIUM FLUORIDE Tab 1.1 mg (0.5 mg elemental)

Iodine

POTASSIUM IODATE Tab 256 mcg (150 mcg elemental iodine) POTASSIUM IODATE WITH IODINE Oral liq 10% with iodine 5%

Iron

FERROUS FUMARATE Tab 200 mg (65 mg elemental) .................................................... 4.35 100 Ferro-tab

22

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


ALIMENTARY TRACT AND METABOLISM

Price (ex man. Excl. GST) $ Per FERROUS FUMARATE WITH FOLIC ACID Tab 310 mg (100 mg elemental) with folic acid 350 mcg.............. 4.75 FERROUS GLUCONATE WITH ASCORBIC ACID Tab 170 mg (20 mg elemental) with ascorbic acid 40 mg FERROUS SULPHATE Oral liq 30 mg (6 mg elemental) per ml ...................................... 10.30 Tab long-acting 325 mg (105 mg elemental) FERROUS SULPHATE WITH ASCORBIC ACID Tab long-acting 325 mg (105 mg elemental) with ascorbic acid 500 mg FERROUS SULPHATE WITH FOLIC ACID Tab long-acting 325 mg (105 mg elemental) with folic acid 350 mcg IRON POLYMALTOSE Inj 50 mg per ml, 2 ml ampoule – 1% DV Oct-11 to 2014........... 19.90 IRON SUCROSE Inj 20 mg per ml, 5 ml ampoule ................................................ 100.00 5 5 Ferrum H Venofer 500 ml Ferodan 60 Brand or Generic Manufacturer Ferro-F-Tabs

Magnesium

MAGNESIUM HYDROXIDE Tab 5 mg Tab 311 mg MAGNESIUM SULPHATE Inj 0.4 mmol per ml, 250 ml bag Inj 2 mmol per ml, 5 ml ampoule – 1% DV Feb-13 to 2015 ........ 18.35

10

Martindale

Zinc

ZINC Oral liq 5 mg per drop ZINC CHLORIDE Inj 5.3 mg per ml, 2 ml ampoule ZINC SULPHATE Cap 137.4 mg (50 mg elemental) – 1% DV Nov-11 to 2014 ....... 11.00 100 Zincaps

VITAMINS Vitamin A

RETINOL Tab 10,000 iu Cap 25,000 iu Oral liq 150,000 iu per ml

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

23


ALIMENTARY TRACT AND METABOLISM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Vitamin B

HYDROXOCOBALAMIN ACETATE Inj 1 mg per ml, 1 ml ampoule – 1% DV Sep-12 to 2015 .............. 5.10 PYRIDOXINE HYDROCHLORIDE Tab 25 mg – 1% DV Sep-11 to 2014 .......................................... 2.20 Tab 50 mg – 1% DV Sep-11 to 2014 ......................................... 12.16 Inj 100 mg per ml, 1 ml ampoule THIAMINE HYDROCHLORIDE Tab 50 mg Tab 100 mg Inj 100 mg per ml, 2 ml vial VITAMIN B COMPLEX Tab, strong, BPC 3 ABM Hydroxocobalamin PyridoxADE Apo-Pyridoxine

90 500

Vitamin C

ASCORBIC ACID Tab 100 mg .............................................................................. 13.80 Tab chewable 250 mg 500 Vitala-C

Vitamin D

ALFACALCIDOL Cap 0.25 mcg ........................................................................... 26.32 Cap 1 mcg ................................................................................. 87.98 Oral drops 2 mcg per ml CALCITRIOL Cap 0.25 mcg ............................................................................ 3.03 10.10 Cap 0.5 mcg ............................................................................... 5.62 18.73 Oral liq 1 mcg per ml ................................................................ 39.40 Inj 1 mcg per ml, 1 ml ampoule CHOLECALCIFEROL Tab 1.25 mg (50,000 iu) .............................................................. 7.76 100 100 One-Alpha One-Alpha

30 100 30 100 10 ml

Airflow Calcitriol-AFT Airflow Calcitriol-AFT Rocaltrol

12

Cal-d-Forte

Vitamin E

ALPHA TOCOPHERYL ACETATE  Cap 100 u  Cap 500 u  Oral liq 156 u per ml Restricted Cystic fibrosis Both: 1 Cystic fibrosis patient; and 2 Either: continued...

24

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


ALIMENTARY TRACT AND METABOLISM

Price (ex man. Excl. GST) $ Per continued... 2.1 2.2 Patient has tried and failed the other available funded fat soluble vitamin A,D,E,K supplement (Vitabdeck); or The other available funded fat soluble vitamin A,D,E,K supplement (Vitabdeck) is contraindicated or clinically inappropriate for the patient Brand or Generic Manufacturer

Osteoradionecrosis For the treatment of osteoradionecrosis Other indications All of the following: 1 Infant or child with liver disease or short gut syndrome; and 2 Requires vitamin supplementation; and 3 Either: 3.1 Patient has tried and failed the other available funded fat soluble vitamin A,D,E,K supplements (Vitabdeck); or 3.2 The other available funded fat soluble vitamin A,D,E,K supplement (Vitabdeck) is contraindicated or clinically inappropriate for the patient.

Multivitamin Preparations

MULTIVITAMINS Tab (BPC cap strength)  Cap vitamin A 2500 u, betacarotene 3 mg, cholecalciferol 11 mcg, alpha tocopherol 150 u, phytomenadione 150 mcg, folic acid 0.2 mg, ascorbic acid 100 mg, thiamine 1.5 mg, pantothenic acid 12 mg, riboflavin 1.7 mg, niacin 20 mg, pyridoxine hydrochloride 1.9 mg, cyanocobalamin 3 mcg, zinc 7.5 mg and biotin 100 mcg Restricted Either: 1 Patient has cystic fibrosis with pancreatic insufficiency; or 2 Patient is an infant or child with liver disease or short gut syndrome.  Powder vitamin A 4200 mcg with vitamin D 155.5 mcg, vitamin E 21.4 mg, vitamin C 400 mg, vitamin K1 166 mcg thiamine 3.2 mg , riboflavin 4.4 mg, niacin 35 mg, vitamin B6 3.4 mg, folic acid 303 mcg, vitamin B12 8.6 mcg, biotin 214 mcg, pantothenic acid 17 mg, choline 350 mg and inositol 700 mg Restricted Patient has inborn errors of metabolism. Inj thiamine hydrochloride 250 mg with riboflavin 4 mg and pyridoxine hydrochloride 50 mg, 5 ml ampoule (1) and inj ascorbic acid 500 mg with nicotinamide 160 mg, 2 ml ampoule (1) Inj thiamine hydrochloride 250 mg with riboflavin 4 mg and pyridoxine hydrochloride 50 mg, 5 ml ampoule (1) and inj ascorbic acid 500 mg with nicotinamide 160 mg and glucose 1000 mg, 5 ml ampoule (1) Inj thiamine hydrochloride 500 mg with riboflavin 8 mg and pyridoxine hydrochloride 100 mg, 10 ml ampoule (1) and inj ascorbic acid 1000 mg with nicotinamide 320 mg and glucose 2000 mg, 10 ml ampoule (1) VITAMIN A WITH VITAMINS D AND C Soln 1000 u with vitamin D 400 u and ascorbic acid 30 mg per 10 drops (MultiADE)

(Vitabdeck)

(Paediatric Seravit)

(Pabrinex IM)

(Pabrinex IV)

(Pabrinex IV) (Vitadol C)

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

25


ALIMENTARY TRACT AND METABOLISM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

MOUTH AND THROAT Agents Used in Mouth Ulceration

BENZYDAMINE HYDROCHLORIDE Soln 0.15% Spray 0.15% BENZYDAMINE HYDROCHLORIDE WITH CETYLPYRIDINIUM CHLORIDE Lozenge 3 mg with cetylpyridinium chloride CARBOXYMETHYLCELLULOSE Oral spray CHLORHEXIDINE GLUCONATE Mouthwash 0.2% – 1% DV Dec-12 to 2015 ................................. 2.68 CHOLINE SALICYLATE WITH CETALKONIUM CHLORIDE Adhesive gel 8.7% with cetalkonium chloride 0.01% DICHLOROBENZYL ALCOHOL WITH AMYLMETACRESOL Lozenge 1.2 mg with amylmetacresol 0.6 mg SODIUM CARBOXYMETHYLCELLULOSE WITH PECTIN AND GELATINE Paste Powder TRIAMCINOLONE ACETONIDE Paste 0.1% – 1% DV Sep-11 to 2014 .......................................... 4.34 5g Oracort 200 ml healthE

Oropharyngeal Anti-Infectives

AMPHOTERICIN B Lozenge 10 mg ............................................................................ 5.86 MICONAZOLE Oral gel 20 mg per g – 1% DV Feb-13 to 2015 ............................. 4.95 NYSTATIN Oral liquid 100,000 iu per ml – 1% DV Sep-11 to 2014 ................ 3.19 20 40 g 24 ml Fungilin Decozol Nilstat

Other Oral Agents

SODIUM HYALURONATE  Inj 20 mg per ml, 1 ml syringe Restricted – otolaryngologists THYMOL GLYCERIN Compound, BPC

26

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


BLOOD AND BLOOD FORMING ORGANS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

ANTIANAEMICS Hypoplastic and Haemolytic

ERYTHROPOIETIN ALPHA  Inj 1,000 iu in 0.5 ml syringe ...................................................... 48.68  Inj 2,000 iu in 0.5 ml syringe .................................................... 120.18  Inj 3,000 iu in 0.3 ml syringe .................................................... 166.87  Inj 4,000 iu in 0.4 ml syringe .................................................... 193.13  Inj 5,000 iu in 0.5 ml syringe .................................................... 243.26  Inj 6,000 iu in 0.6 ml syringe .................................................... 291.92  Inj 10,000 iu in 1 ml syringe ..................................................... 395.18 Restricted Both: 1 Both: 1.1 Patient in chronic renal failure; and 1.2 Haemoglobin ≤ 100g/L; and 2 Any of the following: 2.1 Both: 2.1.1 Patient is not diabetic; and 2.1.2 Glomerular filtration rate ≤ 30ml/min; or 2.2 Both: 2.2.1 Patient is diabetic; and 2.2.2 Glomerular filtration rate ≤ 45ml/min; or 2.3 Patient is on haemodialysis or peritoneal dialysis. ERYTHROPOIETIN BETA  Inj 2,000 iu in 0.3 ml syringe .................................................... 120.18  Inj 3,000 iu in 0.3 ml syringe .................................................... 166.87  Inj 4,000 iu in 0.3 ml syringe .................................................... 193.13  Inj 5,000 iu in 0.3 ml syringe .................................................... 243.26  Inj 6,000 iu in 0.3 ml syringe .................................................... 291.92  Inj 10,000 iu in 0.6 ml syringe .................................................. 395.18 Restricted Both: 1 Both: 1.1 Patient in chronic renal failure; and 1.2 Haemoglobin ≤ 100g/L; and 2 Any of the following: 2.1 Both: 2.1.1 Patient is not diabetic; and 2.1.2 Glomerular filtration rate ≤ 30ml/min; or 2.2 Both: 2.2.1 Patient is diabetic; and 2.2.2 Glomerular filtration rate ≤ 45ml/min; or 2.3 Patient is on haemodialysis or peritoneal dialysis. 6 6 6 6 6 6 NeoRecormon NeoRecormon NeoRecormon NeoRecormon NeoRecormon NeoRecormon 6 6 6 6 6 6 6 Eprex Eprex Eprex Eprex Eprex Eprex Eprex

Megaloblastic

FOLIC ACID Oral liq 50 mcg per ml ................................................................ 24.00 Tab 0.8 mg Tab 5 mg Inj 5 mg per ml, 10 ml vial 25 ml Biomed

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

27


BLOOD AND BLOOD FORMING ORGANS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

ANTIFIBRINOLYTICS, HAEMOSTATICS AND LOCAL SCLEROSANTS

FERRIC SUBSULFATE Soln 500 ml Gel 25.9% POLIDOCANOL Inj 0.5%, 30 ml vial SODIUM TETRADECYL SULPHATE Inj 3%, 2 ml ampoule THROMBIN Powder TRANEXAMIC ACID Tab 500 mg ............................................................................... 32.92 Inj 100 mg per ml, 5 ml ampoule .............................................. 124.73 100 10 Cyklokapron Cyklokapron

Blood Factors

EPTACOG ALFA [RECOMBINANT FACTOR VIIA] Inj 1 mg vial .......................................................................... 1,163.75 Inj 2 mg vial .......................................................................... 2,327.50 Inj 5 mg vial .......................................................................... 5,818.75 Inj 8 mg vial .......................................................................... 9,310.00 MOROCTOCOG ALFA [RECOMBINANT FACTOR VIII] Inj 250 iu vial ........................................................................... 225.00 Inj 500 iu vial ........................................................................... 450.00 Inj 1,000 iu vial ........................................................................ 900.00 Inj 2,000 iu vial ..................................................................... 1,800.00 Inj 3,000 iu vial ..................................................................... 2,700.00 NONACOG ALFA [RECOMBINANT FACTOR IX] Inj 250 iu vial ........................................................................... 310.00 Inj 500 iu vial ........................................................................... 620.00 Inj 1,000 iu vial ..................................................................... 1,240.00 Inj 2,000 iu vial ..................................................................... 2,480.00 OCTOCOG ALFA [RECOMBINANT FACTOR VIII] Inj 250 iu vial ........................................................................... 237.50 250.00 Inj 500 iu vial ........................................................................... 475.00 500.00 Inj 1,000 iu vial ........................................................................ 950.00 1,000.00 Inj 1,500 iu vial ..................................................................... 1,425.00 Inj 2,000 iu vial ..................................................................... 1,900.00 2,000.00 Inj 3,000 iu vial ..................................................................... 2,850.00 3,000.00 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 NovoSeven RT NovoSeven RT NovoSeven RT NovoSeven RT Xyntha Xyntha Xyntha Xyntha Xyntha BeneFIX BeneFIX BeneFIX BeneFIX Advate Kogenate FS Advate Kogenate FS Advate Kogenate FS Advate Advate Kogenate FS Advate Kogenate FS

28

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


BLOOD AND BLOOD FORMING ORGANS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Vitamin K

PHYTOMENADIONE Inj 2 mg in 0.2 ml ampoule ........................................................... 8.00 Inj 10 mg per ml, 1 ml ampoule .................................................... 9.21 5 5 Konakion MM Konakion MM

ANTITHROMBOTICS Anticoagulants

BIVALIRUDIN  Inj 250 mg vial Restricted Either: 1 For use in heparin-induced thrombocytopaenia, heparin resistance or heparin intolerance; or 2 For use in patients undergoing endovascular procedures. DABIGATRAN Cap 75 mg ............................................................................... 148.00 Cap 110 mg ............................................................................. 148.00 Cap 150 mg ............................................................................. 148.00 DALTEPARIN Inj 2,500 iu in 0.2 ml syringe ...................................................... 19.97 Inj 5,000 iu in 0.2 ml syringe ...................................................... 39.94 Inj 7,500 iu in 0.75 ml syringe .................................................... 60.03 Inj 10,000 iu in 1 ml syringe ....................................................... 77.55 Inj 12,500 iu in 0.5 ml syringe .................................................... 99.96 Inj 15,000 iu in 0.6 ml syringe .................................................. 120.05 Inj 18,000 iu in 0.72 ml syringe ................................................ 158.47 DANAPAROID  Inj 750 u in 0.6 ml ampoule Restricted For use in heparin-induced thrombocytopaenia, heparin resistance or heparin intolerance. DEFIBROTIDE  Inj 80 mg per ml, 2.5 ml ampoule Restricted – Haematologist Patient has moderate or severe sinusoidal obstruction sydrome as a result of regime-related toxicities after allogeneic stem cell transplantation. DEXTROSE WITH SODIUM CITRATE AND CITRIC ACID [ACID CITRATE DEXTROSE A] Inj 24.5 mg with sodium citrate 22 mg and citric acid 7.3 mg per ml, 100 ml bag ENOXAPARIN Inj 20 mg in 0.2 ml syringe – 1% DV Sep-12 to 2015 ................. 37.24 Inj 40 mg in 0.4 ml syringe – 1% DV Sep-12 to 2015 ................. 49.69 Inj 60 mg in 0.6 ml syringe – 1% DV Sep-12 to 2015 ................. 74.91 Inj 80 mg in 0.8 ml syringe – 1% DV Sep-12 to 2015 ................. 99.86 Inj 100 mg in 1 ml syringe – 1% DV Sep-12 to 2015 ................ 125.06 Inj 120 mg in 0.8 ml syringe – 1% DV Sep-12 to 2015 ............. 155.40 Inj 150 mg in 1 ml syringe – 1% DV Sep-12 to 2015 ................ 177.60 10 10 10 10 10 10 10 Clexane Clexane Clexane Clexane Clexane Clexane Clexane 60 60 60 10 10 10 10 10 10 10 Pradaxa Pradaxa Pradaxa Fragmin Fragmin Fragmin Fragmin Fragmin Fragmin Fragmin

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

29


BLOOD AND BLOOD FORMING ORGANS

Price (ex man. Excl. GST) $ Per FONDAPARINUX SODIUM  Inj 2.5 mg in 0.5 ml syringe  Inj 7.5 mg in 0.6 ml syringe Restricted For use in heparin-induced thrombocytopaenia, heparin resistance or heparin intolerance. HEPARIN SODIUM Inj 100 iu per ml, 250 ml bag Inj 1,000 iu per ml, 1 ml ampoule ............................................... 66.80 Inj 1,000 iu per ml, 5 ml ampoule ............................................... 11.44 46.30 Inj 1,000 iu per ml, 35 ml ampoule Inj 5,000 iu per ml, 1 ml ampoule ............................................... 14.20 Inj 5,000 iu per ml, 5 ml ampoule ............................................. 182.00 Inj 5,000 iu in 0.2 ml ampoule HEPARINISED SALINE Inj 10 iu per ml, 5 ml ampoule .................................................... 32.50 Inj 100 iu per ml, 2 ml ampoule Inj 100 iu per ml, 5 ml ampoule PHENINDIONE Tab 10 mg Tab 25 mg Tab 50 mg PROTAMINE SULPHATE Inj 10 mg per ml, 5 ml ampoule RIVAROXABAN  Tab 10 mg ............................................................................... 153.00 15 Xarelto Brand or Generic Manufacturer

50 10 50 5 50

Mayne Pfizer Pfizer Mayne Pfizer

50

Pfizer

Restricted Either: 1 Limited to five weeks’ treatment for the prophylaxis of venous thromboembolism following a total hip replacement; or 2 Limited to two weeks’ treatment for the prophylaxis of venous thromboembolism following a total knee replacement. SODIUM CITRATE WITH SODIUM CHLORIDE AND POTASSIUM CHLORIDE Inj 4.2 mg with sodium chloride 5.7 mg and potassium chloride 74.6 mcg per ml, 5,000 ml bag TRISODIUM CITRATE Inj 4%, 5 ml ampoule Inj 46.7%, 5 ml ampoule WARFARIN SODIUM Tab 1 mg Tab 2 mg Tab 3 mg Tab 5 mg

30

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


BLOOD AND BLOOD FORMING ORGANS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Antiplatelets

ASPIRIN Tab 100 mg Suppos 300 mg CLOPIDOGREL Tab 75 mg ................................................................................ 16.25 DIPYRIDAMOLE Tab 25 mg Tab long-acting 150 mg – 1% DV Oct-11 to 2014 ...................... 11.52 Inj 5 mg per ml, 2 ml ampoule EPTIFIBATIDE  Inj 750 mcg per ml, 100 ml vial ................................................ 324.00  Inj 2 mg per ml, 10 ml vial ........................................................ 111.00 90 Apo-Clopidogrel

60

Pytazen SR

1 1

Integrilin Integrilin

Restricted For use in patients with acute coronary syndromes undergoing percutaneous coronary intervention. PRASUGREL  Tab 5 mg ................................................................................. 108.00  Tab 10 mg ............................................................................... 120.00 28 28 Effient Effient

Restricted Bare metal stents Limited to 6 months’ treatment Patient has undergone coronary angioplasty in the previous 4 weeks and is clopidogrel-allergic. Drug-eluting stents Limited to 12 months’ treatment Patient has had a drug-eluting cardiac stent inserted in the previous 4 weeks and is clopidogrel-allergic. Stent thrombosis Patient has experienced cardiac stent thrombosis whilst on clopidogrel. Myocardial infarction Limited to 7 days’ treatment For short term use while in hospital following ST-elevated myocardial infarction. Note: Clopidogrel allergy is defined as a history of anaphylaxis, urticaria, generalised rash or asthma (in non-asthmatic patients) developing soon after clopidogrel is started and is considered unlikely to be caused by any other treatment. TICLOPIDINE Tab 250 mg

Fibrinolytic Agents

ALTEPLASE Inj 10 mg vial Inj 50 mg vial STREPTOKINASE Inj 250,000 iu vial .................................................................... 117.70 Inj 1,500,000 iu vial ................................................................. 188.10 TENECTEPLASE Inj 50 mg vial

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

1 1

Streptase Streptase

31


BLOOD AND BLOOD FORMING ORGANS

Price (ex man. Excl. GST) $ Per UROKINASE Inj 10,000 iu vial Inj 50,000 iu vial Inj 100,000 iu vial Inj 500,000 iu vial Brand or Generic Manufacturer

COLONY-STIMULATING FACTORS Granulocyte Colony-Stimulating Factors

FILGRASTIM  Inj 300 mcg in 1 ml vial ............................................................ 650.00  Inj 300 mcg in 0.5 ml syringe – 1% DV Jan-13 to 31 Dec 2015 ......................................... 540.00  Inj 480 mcg in 0.5 ml syringe – 1% DV Jan-13 to 31 Dec 2015 ......................................... 864.00 Restricted Oncologist or haematologist PEGFILGRASTIM  Inj 6 mg per 0.6 ml syringe.................................................... 1,080.00 1 Neulastim 5 5 5 Neupogen Zarzio Zarzio

Restricted For prevention of neutropenia in patients undergoing high risk chemotherapy for cancer (febrile neutropenia risk ≥ 20%*). *Febrile neutropenia risk ≥ 20% after taking into account other risk factors as defined by the European Organisation for Research and Treatment of Cancer (EORTC) guidelines.

FLUIDS AND ELECTROLYTES Intravenous Administration

CALCIUM CHLORIDE Inj 100 mg per ml, 10 ml vial CALCIUM GLUCONATE Inj 10%, 10 ml ampoule ............................................................. 21.40 COMPOUND ELECTROLYTES Inj sodium 140 mmol/l with potassium 5 mmol/l, magnesium 1.5 mmol/l, chloride 98 mmol/l, acetate 27 mmol/l and gluconate 23 mmol/l, bag ..................... 5.00 Inj sodium 140 mmol/l with potassium 5 mmol/l, magnesium 1.5 mmol/l, chloride 98 mmol/l, acetate 27 mmol/l and gluconate 23 mmol/l, bag ..................... 3.10 COMPOUND ELECTROLYTES WITH GLUCOSE Inj glucose 50 g with 140 mmol/l sodium, 5 mmol/l potassium, 1.5 mmol/l magnesium, 98 mmol/l chloride, 27 mmol/l acetate and 23 mmol/l gluconate, bag .................................................. 7.00 10 Mayne

500 ml 1,000 ml

Baxter Baxter

1,000 ml

Baxter

32

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


BLOOD AND BLOOD FORMING ORGANS

Price (ex man. Excl. GST) $ Per COMPOUND SODIUM LACTATE [HARTMANN’S SOLUTION] Inj sodium 131 mmol/l with potassium 5 mmol/l, calcium 2 mmol/l, bicarbonate 29 mmol/l, chloride 111 mmol/l, bag ......................................................... 1.77 Inj sodium 131 mmol/l with potassium 5 mmol/l, calcium 2 mmol/l, bicarbonate 29 mmol/l, chloride 111 mmol/l, bag ......................................................... 1.80 COMPOUND SODIUM LACTATE WITH GLUCOSE Inj sodium 131 mmol/l with potassium 5 mmol/l, calcium 2 mmol/l, bicarbonate 29 mmol/l, chloride 111 mmol/l and glucose 5%, bag ................................ 5.38 GLUCOSE Inj 5%, bag................................................................................... 2.87 Inj 5%, bag................................................................................... 2.84 Inj 5%, bag................................................................................... 3.87 Inj 5%, bag................................................................................... 1.77 Inj 5%, bag................................................................................... 1.80 Inj 10%, bag................................................................................. 3.70 Inj 10%, bag................................................................................. 5.29 Inj 50%, 10 ml ampoule – 1% DV Sep-11 to 2014...................... 19.50 Inj 50%, 90 ml bottle – 1% DV Sep-11 to 2014 .......................... 11.25 Inj 50%, bag................................................................................. 6.84 Inj 70%, 500 ml bag Inj 70%, 1,000 ml bag GLUCOSE WITH POTASSIUM CHLORIDE Inj 5% glucose with 20 mmol/l potassium chloride, bag ................ 7.36 Inj 5% glucose with 30 mmol/l potassium chloride, 1,000 ml bag Inj 10% glucose with 10 mmol/l potassium chloride, 500 ml bag GLUCOSE WITH POTASSIUM CHLORIDE AND SODIUM CHLORIDE Inj 2.5% glucose with potassium chloride 20 mmol/l and sodium chloride 0.45%, 3,000 ml bag Inj 4% glucose with potassium chloride 20 mmol/l and sodium chloride 0.18%, bag .............................................. 3.45 Inj 4% glucose with potassium chloride 20 mmol/l and sodium chloride 0.18%, bag .............................................. 4.30 Inj 4% glucose with potassium chloride 30 mmol/l and sodium chloride 0.18%, bag .............................................. 3.62 Inj 10% glucose with potassium chloride 10 mmol/l and sodium chloride 15 mmol/l, 500 ml bag GLUCOSE WITH SODIUM CHLORIDE Inj glucose 2.5% with sodium chloride 0.45%, bag ....................... 4.95 Inj glucose 5% with sodium chloride 0.2%, 500 ml bag Inj glucose 5% with sodium chloride 0.45%, bag .......................... 5.80 Inj glucose 5% with sodium chloride 0.9%, bag ............................ 4.54 POTASSIUM CHLORIDE Inj 75 mg (1 mmol) per ml, 10 ml ampoule Inj 225 mg (3 mmol) per ml, 20 ml ampoule Brand or Generic Manufacturer

500 ml 1,000 ml

Baxter Baxter

1,000 ml 50 ml 100 ml 250 ml 500 ml 1,000 ml 500 ml 1,000 ml 5 1 500 ml

Baxter Baxter Baxter Baxter Baxter Baxter Baxter Baxter Biomed Biomed Baxter

1,000 ml

Baxter

500 ml 1,000 ml 1,000 ml

Baxter Baxter Baxter

500 ml 1,000 ml 1,000 ml

Baxter Baxter Baxter

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

33


BLOOD AND BLOOD FORMING ORGANS

Price (ex man. Excl. GST) $ Per POTASSIUM CHLORIDE WITH SODIUM CHLORIDE Inj 10 mmol/l potassium chloride with 0.29% sodium chloride, 100 ml bag Inj 20 mmol/l potassium chloride with 0.9% sodium chloride, bag .......................................................................................... 3.85 Inj 30 mmol/l potassium chloride with 0.9% sodium chloride, bag .......................................................................................... 2.59 Inj 40 mmol/l potassium chloride with 0.9% sodium chloride, bag .......................................................................................... 6.62 Inj 40 mmol/l potassium chloride with 0.9% sodium chloride, 100 ml bag POTASSIUM DIHYDROGEN PHOSPHATE Inj 1 mmol per ml, 10 ml ampoule RINGER’S SOLUTION Inj sodium 147 mmol/l with potassium 4 mmol/l, calcium 2.2 mmol/l, chloride 156 mmol/l, bag .......................... 5.13 SODIUM ACETATE Inj 4 mmol per ml, 20 ml ampoule SODIUM BICARBONATE Inj 8.4%, 10 ml vial Inj 8.4%, 50 ml vial .................................................................... 19.95 Inj 8.4%, 100 ml vial .................................................................. 20.50 SODIUM CHLORIDE Inj 0.45%, bag.............................................................................. 5.50  Inj 0.9%, 3 ml syringe  Inj 0.9%, 5 ml syringe  Inj 0.9%, 10 ml syringe Inj 0.9%, 5 ml ampoule .............................................................. 10.85 15.50 Inj 0.9%, 10 ml ampoule ............................................................ 11.50 15.50 Inj 0.9%, 20 ml ampoule .............................................................. 8.41 Inj 0.9%, bag................................................................................ 3.01 Inj 0.9%, bag................................................................................ 2.28 Inj 0.9%, bag................................................................................ 3.60 Inj 0.9%, bag................................................................................ 1.70 1.77 Inj 0.9%, bag................................................................................ 1.71 1.80 Inj 1.8%, 500 ml bottle Inj 3%, bag................................................................................... 5.69 Inj 23.4% (4 mmol/ml), 20 ml – 1% Sep-13 to 2016 .................. 31.25 Restricted For use in flushing of in-situ vascular access devices only. SODIUM DIHYDROGEN PHOSPHATE [SODIUM ACID PHOSPHATE] Inj 1 mmol per ml, 20 ml ampoule Brand or Generic Manufacturer

1,000 ml 1,000 ml 1,000 ml

Baxter Baxter Baxter

1,000 ml

Baxter

1 1 500 ml

Biomed Biomed Baxter

50 50 20 50 ml 100 ml 250 ml 500 ml 1,000 ml 1,000 ml 5

Multichem Pfizer Multichem Pfizer Multichem Baxter Baxter Baxter Freeflex Baxter Freeflex Baxter Baxter Biomed

34

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


BLOOD AND BLOOD FORMING ORGANS

Price (ex man. Excl. GST) $ Per WATER Inj 5 ml ampoule ........................................................................ 10.25 Inj 10 ml ampoule ...................................................................... 11.25 Inj 20 ml ampoule ........................................................................ 6.50 Inj 250 ml bag Inj 500 ml bag .............................................................................. 2.61 Inj 1,000 ml bag ........................................................................... 2.75 50 50 20 500 ml 1,000 ml Brand or Generic Manufacturer Multichem Multichem Multichem Baxter Baxter

Oral Administration

CALCIUM POLYSTRYRENE SULPHONATE Powder .................................................................................... 169.85 COMPOUND ELECTROLYTES Powder for oral soln COMPOUND ELECTROLYTES WITH GLUCOSE Soln with electrolytes PHOSPHORUS Tab eff 500 mg POTASSIUM CHLORIDE Tab eff 548 mg (14 mmol) with chloride 285 mg (8 mmol) Tab long-acting 600 mg (8 mmol) – 1% DV Oct-12 to 2015 ......... 7.42 Oral liq 2 mmol per ml SODIUM BICARBONATE Cap 840 mg ................................................................................. 8.52 SODIUM CHLORIDE Tab 600 mg Oral liq 2 mmol/ml SODIUM POLYSTRYRENE SULPHONATE Powder 300 g Calcium Resonium

200

Span-K

100

Sodibic

Plasma Volume Expanders

GELATINE, SUCCINYLATED Inj 4%, 500 ml bag ..................................................................... 92.50 108.00 10 10 Gelafusal Gelofusine

HYDROXYETHYL STARCH 130/0.4 WITH MAGNESIUM CHLORIDE, POTASSIUM CHLORIDE, SODIUM ACETATE AND SODIUM CHLORIDE Inj 6% with magnesium chloride 0.03%, potassium chloride 0.03%, sodium acetate 0.463% and sodium chloride 0.6%, 500 ml bag ....................................... 198.00 20 HYDROXYETHYL STARCH 130/0.4 WITH SODIUM CHLORIDE Inj 6% with sodium chloride 0.9%, 500 ml bag ......................... 198.00 20

Volulyte 6% Voluven

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

35


CARDIOVASCULAR SYSTEM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

AGENTS AFFECTING THE RENIN-ANGIOTENSIN SYSTEM ACE Inhibitors

CAPTOPRIL Tab 12.5 mg ................................................................................ 2.00 Tab 25 mg ................................................................................... 2.40 Tab 50 mg ................................................................................... 3.50  Oral liq 5 mg per ml.................................................................... 94.99 Restricted Any of the following: 1 For use in children under 12 years of age; or 2 For use in tube-fed patients; or 3 For management of rebound transient hypertension following cardiac surgery. CILAZAPRIL Tab 0.5 mg – 1% DV Sep-13 to 2016 .......................................... 2.00 Tab 2.5 mg – 1% DV Sep-13 to 2016 .......................................... 4.31 Tab 5 mg – 1% DV Sep-13 to 2016 ............................................. 6.98 ENALAPRIL MALEATE Tab 5 mg – 1% DV Dec-12 to 2015 ............................................. 1.07 Tab 10 mg – 1% DV Dec-12 to 2015 ........................................... 1.32 Tab 20 mg – 1% DV Dec-12 to 2015 ........................................... 1.72 LISINOPRIL Tab 5 mg – 1% DV Jan-13 to 2015.............................................. 3.58 Tab 10 mg – 1% DV Jan-13 to 2015............................................ 4.08 Tab 20 mg – 1% DV Jan-13 to 2015............................................ 4.88 PERINDOPRIL Tab 2 mg ..................................................................................... 3.75 Tab 4 mg ..................................................................................... 4.80 QUINAPRIL Tab 5 mg – 1% DV Apr-13 to 2015 .............................................. 3.44 Tab 10 mg – 1% DV Apr-13 to 2015 ............................................ 4.64 Tab 20 mg – 1% DV Apr-13 to 2015 ............................................ 6.34 TRANDOLAPRIL  Cap 1 mg  Cap 2 mg Restricted For continuation only 90 90 90 90 90 90 90 90 90 30 30 90 90 90 Zapril Zapril Zapril m-Enalapril m-Enalapril m-Enalapril Arrow-Lisinopril Arrow-Lisinopril Arrow-Lisinopril Apo-Perindopril Apo-Perindopril Arrow-Quinapril 5 Arrow-Quinapril 10 Arrow-Quinapril 20 100 100 100 95 ml m-Captopril m-Captopril m-Captopril Capoten

ACE Inhibitors with Diuretics

CILAZAPRIL WITH HYDROCHLOROTHIAZIDE Tab 5 mg with hydrochlorothiazide 12.5 mg ................................. 6.30 ENALAPRIL MALEATE WITH HYDROCHLOROTHIAZIDE  Tab 20 mg with hydrochlorothiazide 12.5 mg Restricted For continuation only 28 Inhibace Plus

36

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


CARDIOVASCULAR SYSTEM

Price (ex man. Excl. GST) $ Per QUINAPRIL WITH HYDROCHLOROTHIAZIDE Tab 10 mg with hydrochlorothiazide 12.5 mg – 1% DV Aug-12 to 2015 ........................................................ 3.37 Tab 20 mg with hydrochlorothiazide 12.5 mg – 1% DV Aug-12 to 2015 ........................................................ 4.57 Brand or Generic Manufacturer

30 30

Accuretic 10 Accuretic 20

Angiotensin II Antagonists

CANDESARTAN CILEXETIL  Tab 4 mg – 1% DV Nov-12 to 2015 ............................................. 4.13  Tab 8 mg – 1% DV Nov-12 to 2015 ............................................. 6.10  Tab 16 mg – 1% DV Nov-12 to 2015 ......................................... 10.18  Tab 32 mg – 1% DV Nov-12 to 2015 ......................................... 17.66 90 90 90 90 Candestar Candestar Candestar Candestar

Restricted ACE inhibitor intolerance Either: 1 Patient has persistent ACE inhibitor induced cough that is not resolved by ACE inhibitor retrial (same or new ACE inhibitor); or 2 Patient has a history of angioedema. Unsatisfactory response to ACE inhibitor Patient is not adequately controlled on maximum tolerated dose of an ACE inhibitor. LOSARTAN POTASSIUM Tab 12.5 mg – 1% DV Dec-11 to 2014 ........................................ 2.88 Tab 25 mg – 1% DV Dec-11 to 2014 ........................................... 3.20 Tab 50 mg – 1% DV Dec-11 to 2014 ........................................... 5.22 Tab 100 mg – 1% DV Dec-11 to 2014 ......................................... 8.68 90 90 90 90 Lostaar Lostaar Lostaar Lostaar

Angiotensin II Antagonists with Diuretics

LOSARTAN POTASSIUM WITH HYDROCHLOROTHIAZIDE Tab 50 mg with hydrochlorothiazide 12.5 mg – 1% DV Dec-11 to 2014 ........................................................ 4.89

30

Arrow-Losartan & Hydrochlorothiazide

ALPHA-ADRENOCEPTOR BLOCKERS

DOXAZOSIN Tab 2 mg – 1% DV Jun-11 to 2014.............................................. 8.23 Tab 4 mg – 1% DV Jun-11 to 2014............................................ 12.40 PHENOXYBENZAMINE HYDROCHLORIDE Cap 10 mg Inj 50 mg per ml, 2 ml ampoule PHENTOLAMINE MESYLATE Inj 10 mg per ml, 1 ml ampoule PRAZOSIN Tab 1 mg ..................................................................................... 5.53 Tab 2 mg ..................................................................................... 7.00 Tab 5 mg ................................................................................... 11.70 100 100 100 Apo-Prazo Apo-Prazo Apo-Prazo 500 500 Apo-Doxazosin Apo-Doxazosin

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

37


CARDIOVASCULAR SYSTEM

Price (ex man. Excl. GST) $ Per TERAZOSIN Tab 1 mg – 1% DV Sep-13 to 2016 ............................................. 0.50 Tab 2 mg – 1% DV Sep-13 to 2016 ............................................. 0.45 Tab 5 mg – 1% DV Sep-13 to 2016 ............................................. 0.68 28 28 28 Brand or Generic Manufacturer Arrow Arrow Arrow

ANTIARRHYTHMICS

ADENOSINE Inj 3 mg per ml, 2 ml vial  Inj 3 mg per ml, 10 ml vial Restricted For use in cardiac catheterisation, electrophysiology and MRI. AJMALINE  Inj 5 mg per ml, 10 ml ampoule Restricted Cardiologist AMIODARONE HYDROCHLORIDE Inj 50 mg per ml, 3 ml ampoule – 1% DV Aug-13 to 2016 .......... 22.80 Tab 100 mg Tab 200 mg ATROPINE SULPHATE Inj 600 mcg per ml, 1 ml ampoule – 1% DV Jan-13 to 2015 ...... 71.00 DIGOXIN Tab 62.5 mcg Tab 250 mcg Oral liq 50 mcg per ml Inj 250 mcg per ml, 2 ml vial DISOPYRAMIDE PHOSPHATE Cap 100 mg Cap 150 mg FLECAINIDE ACETATE Tab 50 mg ................................................................................. 45.82 Tab 100 mg ............................................................................... 80.92 Cap long-acting 100 mg ............................................................. 45.82 Cap long-acting 200 mg ............................................................. 80.92 Inj 10 mg per ml, 15 ml ampoule ................................................ 52.45 MEXILETINE HYDROCHLORIDE Cap 150 mg ............................................................................... 65.00 Cap 250 mg ............................................................................. 102.00 PROPAFENONE HYDROCHLORIDE Tab 150 mg 60 60 30 30 5 100 100 Tambocor Tambocor Tambocor CR Tambocor CR Tambocor Mexiletine Hydrochloride USP Mexiletine Hydrochloride USP 6 Cordarone-X

50

AstraZeneca

38

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


CARDIOVASCULAR SYSTEM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

ANTIHYPOTENSIVES

MIDODRINE  Tab 2.5 mg  Tab 5 mg Restricted All of the following: 1 Disabling orthostatic hypotension not due to drugs; and 2 Patient has tried fludrocortisone (unless contra-indicated) with unsatisfactory results; and 3 Patient has tried non pharmacological treatments such as support hose, increased salt intake, exercise, and elevation of head and trunk at night.

BETA-ADRENOCEPTOR BLOCKERS

ATENOLOL Tab 50 mg – 1% DV Oct-12 to 2015 ............................................ 5.56 Tab 100 mg – 1% DV Oct-12 to 2015 .......................................... 9.12 Oral liq 5 mg per ml.................................................................... 21.25 BISOPROLOL Tab 2.5 mg .................................................................................. 3.88 Tab 5 mg ..................................................................................... 4.74 Tab 10 mg ................................................................................... 9.18 CARVEDILOL Tab 6.25 mg .............................................................................. 21.00 Tab 12.5 mg .............................................................................. 27.00 Tab 25 mg ................................................................................. 33.75 CELIPROLOL Tab 200 mg ............................................................................... 19.00 ESMOLOL HYDROCHLORIDE Inj 10 mg per ml, 10 ml vial LABETALOL Tab 50 mg ................................................................................... 8.23 Tab 100 mg ............................................................................... 10.06 Tab 200 mg ............................................................................... 17.55 Tab 400 mg Inj 5 mg per ml, 20 ml ampoule METOPROLOL SUCCINATE Tab long-acting 23.75 mg – 1% DV Sep-12 to 2015 .................... 0.96 Tab long-acting 47.5 mg – 1% DV Sep-12 to 2015 ...................... 1.41 Tab long-acting 95 mg – 1% DV Sep-12 to 2015 ......................... 2.42 Tab long-acting 190 mg – 1% DV Sep-12 to 2015 ....................... 4.66 METOPROLOL TARTRATE Tab 50 mg – 1% DV Aug-12 to 2015 ......................................... 16.00 Tab 100 mg – 1% DV Aug-12 to 2015 ....................................... 21.00 Tab long-acting 200 mg – 1% DV Aug-12 to 2015 ..................... 18.00 Inj 1 mg per ml, 5 ml vial – 1% DV Dec-12 to 2015 .................... 24.00 100 100 100 Hybloc Hybloc Hybloc 500 500 300 ml 30 30 30 30 30 30 180 Mylan Atenolol Mylan Atenolol Atenolol AFT Bosvate Bosvate Bosvate Dilatrend Dilatrend Dilatrend Celol

30 30 30 30 100 60 28 5

Metoprolol - AFT CR Metoprolol - AFT CR Metoprolol - AFT CR Metoprolol - AFT CR Lopresor Lopresor Slow-Lopresor Lopresor

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

39


CARDIOVASCULAR SYSTEM

Price (ex man. Excl. GST) $ Per NADOLOL Tab 40 mg – 1% DV Apr-13 to 2015 .......................................... 15.57 Tab 80 mg – 1% DV Apr-13 to 2015 .......................................... 23.74 PINDOLOL Tab 5 mg ..................................................................................... 5.40 Tab 10 mg ................................................................................... 9.19 Tab 15 mg ................................................................................. 13.80 PROPRANOLOL Tab 10 mg ................................................................................... 3.65 Tab 40 mg ................................................................................... 4.65 Cap long-acting 160 mg ............................................................. 16.06 Oral liq 4 mg per ml Inj 1 mg per ml, 1 ml ampoule SOTALOL Tab 80 mg ................................................................................. 27.50 Tab 160 mg ............................................................................... 10.50 Inj 10 mg per ml, 4 ml ampoule .................................................. 65.39 TIMOLOL MALEATE Tab 10 mg 100 100 100 100 100 100 100 100 Brand or Generic Manufacturer Apo-Nadolol Apo-Nadolol Apo-Pindolol Apo-Pindolol Apo-Pindolol Apo-Propranolol Apo-Propranolol Cardinol LA

500 100 5

Mylan Mylan Sotacor

CALCIUM CHANNEL BLOCKERS Dihydropyridine Calcium Channel Blockers

AMLODIPINE Tab 2.5 mg – 1% DV Mar-12 to 2014 .......................................... 2.45 Tab 5 mg – 1% DV Oct-11 to 2014 .............................................. 2.65 Tab 10 mg – 1% DV Oct-11 to 2014 ............................................ 4.15 FELODIPINE Tab long-acting 2.5 mg – 1% DV Sep-12 to 2015 ........................ 2.90 Tab long-acting 5 mg –1% DV Nov-12 to 2015 ............................ 3.10 Tab long-acting 10 mg – 1% DV Nov-12 to 2015 ......................... 4.60 ISRADIPINE Tab 2.5 mg Cap long-acting 2.5 mg Cap long-acting 5 mg NIFEDIPINE Cap 5 mg Tab long-acting 10 mg Tab long-acting 20 mg ................................................................. 7.30 Tab long-acting 30 mg ................................................................. 8.56 Tab long-acting 60 mg ............................................................... 12.28 NIMODIPINE Tab 30 mg Inj 200 mcg per ml, 50 ml vial 100 100 100 30 30 30 Apo-Amlodipine Apo-Amlodipine Apo-Amlodipine Plendil ER Plendil ER Plendil ER

100 30 30

Nyefax Retard Adefin XL Arrow-Nifedipine XR Adefin XL Arrow-Nifedipine XR

40

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


CARDIOVASCULAR SYSTEM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Other Calcium Channel Blockers

DILTIAZEM HYDROCHLORIDE Tab 30 mg – 5% DV Sep-12 to 2015 ........................................... 4.60 Tab 60 mg – 5% DV Sep-12 to 2015 ........................................... 8.50 Cap long-acting 120 mg – 5% DV Feb-13 to 2015 ..................... 31.83 Cap long-acting 180 mg – 5% DV Feb-13 to 2015 ..................... 47.67 Cap long-acting 240 mg – 5% DV Feb-13 to 2015 ..................... 63.58 Inj 5 mg per ml, 5 ml vial PERHEXILINE MALEATE  Tab 100 mg ............................................................................... 62.90 100 100 500 500 500 Dilzem Dilzem Apo-Diltiazem CD Apo-Diltiazem CD Apo-Diltiazem CD

100

Pexsig

Restricted Both: 1 Patient has refractory angina; and 2 Patient is on the maximal tolerated dose of a beta-blocker, a calcium channel blocker and a long-acting nitrate. VERAPAMIL HYDROCHLORIDE Tab 40 mg – 1% DV Sep-11 to 2014 ........................................... 7.01 Tab 80 mg – 1% DV Sep-11 to 2014 ......................................... 11.74 Tab long-acting 120 mg ............................................................. 15.20 Tab long-acting 240 mg ............................................................. 25.00 Inj 2.5 mg per ml, 2 ml ampoule ................................................... 7.54 100 100 250 250 5 Isoptin Isoptin Verpamil SR Verpamil SR Isoptin

CENTRALLY-ACTING AGENTS

CLONIDINE Patch 2.5 mg, 100 mcg per day ................................................. 23.30 Patch 5 mg, 200 mcg per day .................................................... 32.80 Patch 7.5 mg, 300 mcg per day ................................................. 41.20 CLONIDINE HYDROCHLORIDE Tab 25 mcg – 1% DV Jul-13 to 2015 ........................................ 15.09 Tab 150 mcg – 1% DV Feb-13 to 2015...................................... 34.32 Inj 150 mcg per ml, 1 ml ampoule – 1% DV Nov-12 to 2015 ...... 16.07 METHYLDOPA Tab 125 mg ............................................................................... 14.25 Tab 250 mg ............................................................................... 15.10 Tab 500 mg ............................................................................... 23.15 4 4 4 112 100 5 100 100 100 Catapres-TTS-1 Catapres-TTS-2 Catapres-TTS-3 Clonidine BNM Catapres Catapres Prodopa Prodopa Prodopa

DIURETICS Loop Diuretics

BUMETANIDE Tab 1 mg ................................................................................... 16.36 Inj 500 mcg per ml, 4 ml vial FUROSEMIDE [FRUSEMIDE] Tab 40 mg – 1% DV Sep-12 to 2015 ......................................... 10.25 Tab 500 mg – 1% DV Feb-13 to 2015 ....................................... 25.00 Oral liq 10 mg per ml Inj 10 mg per ml, 2 ml ampoule .................................................... 1.30 Inj 10 mg per ml, 25 ml ampoule 100 Burinex

1,000 50 5

Diurin 40 Urex Forte Frusemide-Claris

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

41


CARDIOVASCULAR SYSTEM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Osmotic Diuretics

MANNITOL Inj 10%, 1,000 ml bag ................................................................ 14.21 Inj 15%, 500 ml bag ..................................................................... 9.84 Inj 20%, 500 ml bag ................................................................... 10.80 1,000 ml 500 ml 500 ml Baxter Baxter Baxter

Potassium Sparing Combination Diuretics

AMILORIDE HYDROCHLORIDE WITH FUROSEMIDE Tab 5 mg with furosemide 40 mg AMILORIDE HYDROCHLORIDE WITH HYDROCHLOROTHIAZIDE Tab 5 mg with hydrochlorothiazide 50 mg

Potassium Sparing Diuretics

AMILORIDE HYDROCHLORIDE Tab 5 mg ................................................................................... 17.50 Oral liq 1 mg per ml.................................................................... 30.00 SPIRONOLACTONE Tab 25 mg – 1% DV Sep-13 to 2016 ........................................... 3.65 Tab 100 mg – 1% DV Sep-13 to 2016 ....................................... 11.80 Oral liq 5 mg per ml.................................................................... 30.00 100 25 ml 100 100 25 ml Apo-Amiloride Biomed Spirotone Spirotone Biomed

Thiazide and Related Diuretics

BENDROFLUMETHIAZIDE [BENDROFLUAZIDE] Tab 2.5 mg – 1% DV Sep-11 to 2014 .......................................... 6.48 Tab 5 mg – 1% DV Sep-11 to 2014 ............................................. 9.95 CHLORTALIDONE [CHLORTHALIDONE] Tab 25 mg ................................................................................... 8.00 CHLOROTHIAZIDE Oral liq 50 mg per ml.................................................................. 26.00 INDAPAMIDE Tab 2.5 mg .................................................................................. 2.95 METOLAZONE  Tab 5 mg Restricted For the treatment of patients with refractory heart failure who are intolerant or have not responded to loop diuretics and/or loop-thiazide combination therapy. 500 500 50 25 ml 90 Arrow-Bendrofluazide Arrow-Bendrofluazide Hygroton Biomed Dapa-Tabs

42

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


CARDIOVASCULAR SYSTEM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

LIPID-MODIFYING AGENTS Fibrates

BEZAFIBRATE Tab 200 mg –1% DV Mar-13 to 2015 .......................................... 9.70 Tab long-acting 400 mg – 1% DV Oct-12 to 2015 ........................ 5.70 GEMFIBROZIL Tab 600 mg ............................................................................... 14.00 90 30 60 Bezalip Bezalip Retard Lipazil

Resins

CHOLESTYRAMINE Powder for oral liq 4 g COLESTIPOL HYDROCHLORIDE Grans for oral liq 5 g

HMG CoA Reductase Inhibitors (Statins)

ATORVASTATIN Tab 10 mg – 1% DV Oct-12 to 2015 ............................................ 2.52 Tab 20 mg – 1% DV Oct-12 to 2015 ............................................ 4.17 Tab 40 mg – 1% DV Oct-12 to 2015 ............................................ 7.32 Tab 80 mg – 1% DV Oct-12 to 2015 .......................................... 16.23 PRAVASTATIN Tab 10 mg Tab 20 mg – 1% DV Nov-11 to 2014 ........................................... 5.44 Tab 40 mg – 1% DV Nov-11 to 2014 ........................................... 9.28 SIMVASTATIN Tab 10 mg – 1% DV Sep-11 to 2014 ........................................... 1.40 Tab 20 mg – 1% DV Sep-11 to 2014 ........................................... 1.95 Tab 40 mg – 1% DV Sep-11 to 2014 ........................................... 3.18 Tab 80 mg – 1% DV Sep-11 to 2014 ........................................... 9.31 90 90 90 90 Zarator Zarator Zarator Zarator

30 30 90 90 90 90

Cholvastin Cholvastin Arrow-Simva Arrow-Simva Arrow-Simva Arrow-Simva

Selective Cholesterol Absorption Inhibitors

EZETIMIBE  Tab 10 mg Restricted All of the following: 1 Patient has a calculated absolute risk of cardiovascular disease of at least 15% over 5 years; and 2 Patient’s LDL cholesterol is 2.0 mmol/litre or greater; and 3 Any of the following: 3.1 The patient has rhabdomyolysis (defined as muscle aches and creatine kinase more than 10 × normal) when treated with one statin; or 3.2 The patient is intolerant to both simvastatin and atorvastatin; or 3.3 The patient has not reduced their LDL cholesterol to less than 2.0 mmol/litre with the use of the maximal tolerated dose of atorvastatin.

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

43


CARDIOVASCULAR SYSTEM

Price (ex man. Excl. GST) $ Per EZETIMIBE WITH SIMVASTATIN  Tab 10 mg with simvastatin 10 mg  Tab 10 mg with simvastatin 20 mg  Tab 10 mg with simvastatin 40 mg  Tab 10 mg with simvastatin 80 mg Restricted All of the following: 1 Patient has a calculated absolute risk of cardiovascular disease of at least 15% over 5 years; and 2 Patient’s LDL cholesterol is 2.0 mmol/litre or greater; and 3 The patient has not reduced their LDL cholesterol to less than 2.0 mmol/litre with the use of the maximal tolerated dose of atorvastatin. Brand or Generic Manufacturer

Other Lipid-Modifying Agents

ACIPIMOX Cap 250 mg NICOTINIC ACID Tab 50 mg Tab 500 mg

NITRATES

GLYCERYL TRINITRATE Tab 600 mcg – 1% DV Sep-11 to 2014 ....................................... 8.00 Oral spray, 400 mcg per dose – 1% DV Mar-12 to 2014 .............. 4.45 Patch 25 mg, 5 mg per day – 1% DV Sep-11 to 2014 ................ 16.56 Patch 50 mg, 10 mg per day – 1% DV Sep-11 to 2014 .............. 19.50 Inj 1 mg per ml, 5 ml ampoule – 1% DV Dec-12 to 2015 ............ 22.70 Inj 5 mg per ml, 10 ml ampoule .................................................. 40.00 Inj 1 mg per ml, 50 ml vial – 1% DV Dec-12 to 2015 ................. 86.60 ISOSORBIDE MONONITRATE Tab 20 mg – 1% DV Jun-11 to 2014.......................................... 17.10 Tab long-acting 40 mg – 1% DV Jun-11 to 2014.......................... 7.50 Tab long-acting 60 mg ................................................................. 3.94 100 250 dose 30 30 10 5 10 100 30 90 Lycinate Glytrin Nitroderm TTS 5 Nitroderm TTS 10 Nitronal Mayne Nitronal Ismo-20 Corangin Duride

OTHER CARDIAC AGENTS

LEVOSIMENDAN  Inj 2.5 mg per ml, 5 ml vial  Inj 2.5 mg per ml, 10 ml vial Restricted Heart transplant Either: 1 For use as a bridge to heart transplant, in patients who have been accepted for transplant; or 2 For the treatment of heart failure following heart transplant. Heart failure – cardiologist or intensivist For the treatment of severe acute decompensated heart failure that is non-responsive to dobutamine.

44

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


CARDIOVASCULAR SYSTEM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

SYMPATHOMIMETICS

ADRENALINE Inj 1 in 1,000, 1 ml ampoule......................................................... 4.98 5.25 Inj 1 in 10,000, 10 ml ampoule................................................... 27.00 49.00 Inj 1 in 10,000, 10 ml syringe Inj 1 in 1,000, 30 ml vial DOBUTAMINE HYDROCHLORIDE Inj 12.5 mg per ml, 20 ml vial DOPAMINE HYDROCHLORIDE Inj 40 mg per ml, 5 ml ampoule – 1% DV Sep-12 to 2015 .......... 69.77 EPHEDRINE Inj 3 mg per ml, 10 ml syringe Inj 30 mg per ml, 1 ml ampoule – 1% DV Nov-12 to 2014 .......... 66.00 ISOPRENALINE Inj 200 mcg per ml, 1 ml ampoule Inj 200 mcg per ml, 5 ml ampoule METARAMINOL Inj 0.5 mg per ml, 20 ml syringe Inj 1 mg per ml, 1 ml ampoule Inj 1 mg per ml, 10 ml syringe Inj 10 mg per ml, 1 ml ampoule NORADRENALINE Inj 0.06 mg per ml, 50 ml syringe Inj 0.06 mg per ml, 100 ml bag Inj 0.1 mg per ml, 100 ml bag Inj 0.12 mg per ml, 50 ml syringe Inj 0.12 mg per ml, 100 ml bag Inj 0.16 mg per ml, 50 ml syringe Inj 1 mg per ml, 2 ml ampoule .................................................... 42.00 Inj 1 mg per ml, 100 ml bag PHENYLEPHRINE HYDROCHLORIDE Inj 10 mg per ml, 1 ml vial ........................................................ 115.50 10 Martindale 5 5 10 Aspen Adrenaline Mayne Mayne Aspen Adrenaline

10

Max Health

6

Levophed

25

Neosynephrine HCL

VASODILATORS

ALPROSTADIL HYDROCHLORIDE Inj 500 mcg per ml, 1 ml ampoule – 1% DV Oct-12 to 2015 .. 1,417.50 AMYL NITRITE Liq 98% in 0.3 ml capsule DIAZOXIDE Inj 15 mg per ml, 20 ml ampoule 5 Prostin VR

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

45


CARDIOVASCULAR SYSTEM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

HYDRALAZINE HYDROCHLORIDE Inj 20 mg ampoule ..................................................................... 25.90 5 Apresoline  Tab 25 mg Restricted Either: 1 For the treatment of refractory hypertension; or 2 For the treatment of heart failure, in combination with a nitrate, in patients who are intolerant or have not responded to ACE inhibitors and/or angiotensin receptor blockers. MILRINONE Inj 1 mg per ml, 10 ml ampoule MINOXIDIL  Tab 10 mg Restricted For patients with severe refractory hypertension which has failed to respond to extensive multiple therapies. NICORANDIL  Tab 10 mg ................................................................................. 27.95  Tab 20 mg ................................................................................. 33.28 60 60 Ikorel Ikorel

Restricted Both: 1 Patient has refractory angina; and 2 Patient is on the maximal tolerated dose of a beta-blocker, a calcium channel blocker and a long-acting nitrate. PAPAVERINE HYDROCHLORIDE Inj 12 mg per ml, 10 ml ampoule ................................................ 73.12 Inj 30 mg per ml, 1 ml vial PENTOXIFYLLINE (OXPENTIFYLLINE) Tab 400 mg SODIUM NITROPRUSSIDE Inj 50 mg vial 5 Mayne

Endothelin Receptor Antagonists

AMBRISENTAN  Tab 5 mg .............................................................................. 4,585.00  Tab 10 mg ............................................................................ 4,585.00 30 30 Volibris Volibris

Restricted 1. For use in patients with approval by the Pulmonary Arterial Hypertension Panel; or 2. In hospital stabilisations in emergency situations. BOSENTAN  Tab 62.5 mg ......................................................................... 2,000.00 4,585.00  Tab 125 mg .......................................................................... 2,000.00 4,585.00 60 60 pms-Bosentan Tracleer pms-Bosentan Tracleer

Restricted 1. For use in patients with approval by the Pulmonary Arterial Hypertension Panel; or 2. In hospital stabilisation in emergency situations.

46

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


CARDIOVASCULAR SYSTEM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Phosphodiesterase Type 5 Inhibitors

SILDENAFIL  Tab 25 mg – 1% DV May-13 to 2014 .......................................... 1.85  Tab 50 mg – 1% DV May-13 to 2014 .......................................... 1.85  Tab 100 mg – 1% DV May-13 to 2014 ........................................ 7.45 4 4 4 Silagra Silagra Silagra

Restricted Any of the following: 1 For use in patients with approval by the Pulmonary Arterial Hypertension Panel; or 2 For use in neonatal units for persistent pulmonary hypertension of the newborn (PPHN); or 3 For use in weaning patients from inhaled nitric oxide; or 4 For perioperative use in cardiac surgery patients; or 5 For use in intensive care as an alternative to nitric oxide; or 6 In-hospital stabilisation in emergency situations; or 7 All of the following: 7.1. Patient has Raynaud’s phenomenon; and 7.2 Patient has severe digital ischaemia (defined as severe pain requiring hospital admission or with a high likihood of digital ulceration; digital ulcers; or gangrene); and 7.3 Patient is following lifestyle management (proper body insulation, avoidance of cold exposure, smoking cessation support, avoidance of sympathomimetic drugs); and 7.4 Patient has persisting severe symptoms despite treatment with calcium channel blockers and nitrates (unless contraindicated or not tolerated).

Prostacyclin Analogues

ILOPROST Inj 50 mcg in 0.5 ml ampoule ................................................... 925.00  Nebuliser soln 10 mcg per ml, 2 ml ....................................... 1,185.00 5 30 Ilomedin Ventavis

Restricted Any of the following: 1 For use in patients with approval by the Pulmonary Arterial Hypertension Panel; or 2 For diagnostic use in catheter laboratories; or 3 For use following mitral or tricuspid valve surgery; or 4 In hopsital stabilisation in emergency situations.

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

47


DERMATOLOGICALS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

ANTIACNE PREPARATIONS

ADAPALENE Crm 0.1% Gel 0.1% BENZOYL PEROXIDE Soln 5% ISOTRETINOIN Cap 10 mg – 1% DV Jan-13 to 2015 ......................................... 18.71 Cap 20 mg - 1% DV Jan-13 to 2015 .......................................... 28.91 TRETINOIN Crm 0.05% 120 120 Oratane Oratane

ANTIPRURITIC PREPARATIONS

CALAMINE Crm, aqueous, BP – 1% DV Mar-13 to 2015 ................................ 1.77 Lotn, BP – 1% DV Nov-12 to 2015............................................. 13.45 CROTAMITON Crm 10% – 1% DV Sep-12 to 2015 ............................................. 3.48 100 g 2,000 ml 20 Pharmacy Health PSM Itch-Soothe

ANTI-INFECTIVE PREPARATIONS Antibacterials

FUSIDATE SODIUM [FUSIDIC ACID] Crm 2% ....................................................................................... 3.25 Oint 2% ........................................................................................ 3.25 HYDROGEN PEROXIDE Crm 1% ....................................................................................... 8.56 Soln 3% (10 vol) MAFENIDE ACETATE  Powder 50 g sachet Restricted For the treatment of burns patients MUPIROCIN Oint 2% SULPHADIAZINE SILVER Crm 1% ..................................................................................... 12.30 50 g Flamazine 15 g 15 g 15 g Foban Foban Crystaderm

Antifungals

AMOROLFINE  Nail soln 5% Restricted For continuation only

48

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


DERMATOLOGICALS

Price (ex man. Excl. GST) $ Per CICLOPIROX OLAXMINE Nail soln 8%  Soln 1% – Restricted: For continuation only CLOTRIMAZOLE Crm 1% – 1% DV Nov-11 to 2014 ............................................... 0.54  Soln 1% – Restricted: For continuation only ECONAZOLE NITRATE  Crm 1% – Restricted: For continuation only Foaming soln 1% KETOCONAZOLE Shampoo 2% – 1% DV Sep-11 to 2014 ....................................... 3.08 METRONIDAZOLE Gel 0.75% MICONAZOLE NITRATE Crm 2% – 1% DV Nov-11 to 2014 ............................................... 0.46  Lotn 2% – Restricted – For continuation only Tinc 2% NYSTATIN Crm 100,000 u per g 15 g Multichem 100 ml Sebizole 20 g Clomazol Brand or Generic Manufacturer

Antiparasitics

LINDANE [GAMMA BENZENE HEXACHLORIDE] Crm 1% MALATHION [MALDISON] Lotn 0.5% Shampoo 1% MALATHION WITH PERMETHRIN AND PIPERONYL BUTOXIDE Spray 0.25% with permethrin 0.5% and piperonyl butoxide 2% Note: Temporary listing to cover out-of-stock. PERMETHRIN Crm 5% – 1% DV Sep-11 to 2014 ............................................... 4.20 Lotn 5% – 1% DV Sep-11 to 2014 ............................................... 3.24 30 g 30 ml Lyderm A-Scabies

BARRIER CREAMS AND EMOLLIENTS Barrier Creams

DIMETHICONE Crm 5% ZINC Crm Oint Paste

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

49


DERMATOLOGICALS

Price (ex man. Excl. GST) $ Per ZINC WITH CASTOR OIL Crm – 1% DV Apr-12 to 2014 ...................................................... 1.63 Oint, BP ZINC WITH WOOL FAT Crm, zinc 15.25% with wool fat 4%. 20 g Brand or Generic Manufacturer Orion

Emollients

AQUEOUS CREAM Crm, 100 g – 1% DV Sep-11 to 2014 .......................................... 1.23 Note: DV limit applies to the pack sizes of 100 g or less. Crm, 500 g – 1% DV Sep-11 to 2014 .......................................... 1.96 Note: DV limit applies to the pack sizes of greater than 100 g. CETOMACROGOL Crm BP, 100 g ............................................................................. 1.65 Crm BP, 500 g ............................................................................. 3.50 CETOMACROGOL WITH GLYCEROL Crm 90% with glycerol 10%, 100 g............................................... 2.10 2.00 3.20 Crm 90% with glycerol 10%, 500 ml ............................................. 4.50 7.30 Crm 90% with glycerol 10%, 1,000 ml .......................................... 6.50 EMULSIFYING OINTMENT Oint BP, 100 g – 1% DV Nov-11 to 2014 ..................................... 1.95 Oint BP, 500 g – 1% DV Sep-11 to 2014 ..................................... 3.04 Note: DV limit applies to pack sizes of greater than 100 g. GLYCEROL WITH PARAFFIN Crm glycerol 10% with white soft paraffin 5% and liquid paraffin 10% OIL IN WATER EMULSION Crm – 1% DV Dec-12 to 2015 ..................................................... 2.63 Crm, 100 g .................................................................................. 1.60 500 g 1 healthE Fatty Cream healthE Fatty Cream 100 g 500 g AFT AFT

1 1 1 1 1 100 g 500 g

healthE Pharmacy Health Pharmacy Health Pharmacy Health healthE Pharmacy Health healthE Pharmacy Health Jaychem AFT

PARAFFIN White soft – 1% DV Feb-13 to 2015............................................. 0.92 10 g healthE Note: DV limit applies to pack sizes of 30 g or less, and to both white soft paraffin and yellow soft paraffin. Yellow soft Oint liquid paraffin 50% with white soft paraffin 50%, 100 g .......... 3.10 1 healthE PARAFFIN WITH WOOL FAT Lotn liquid paraffin 15.9% with wool fat 0.6% Lotn liquid paraffin 91.7% with wool fat 3% UREA Crm 10% WOOL FAT Crm

50

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


DERMATOLOGICALS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

CORTICOSTEROIDS

BETAMETHASONE DIPROPIONATE Crm 0.05% Oint 0.05% BETAMETHASONE VALERATE Crm 0.1% Lotn 0.1% Oint 0.1% CLOBETASOL PROPIONATE Crm 0.05% .................................................................................. 3.68 Oint 0.05% ................................................................................... 3.68 CLOBETASONE BUTYRATE Crm 0.05% DIFLUCORTOLONE VALERATE  Crm 0.1%  Fatty oint 0.1% Restricted For continuation only HYDROCORTISONE Crm 1%, 100 g............................................................................. 3.75 Crm 1%, 500 g – 1% DV Nov-11 to 2014................................... 14.00 Note: DV limit applies to pack sizes of greater than 100 g. HYDROCORTISONE ACETATE Crm 1% ....................................................................................... 2.48 HYDROCORTISONE BUTYRATE Crm 0.1% – 1% DV Mar-13 to 2015 ............................................ 2.30 6.85 Milky emul 0.1% – 1% DV Mar-13 to 2015 .................................. 6.85 Oint 0.1% – 1% DV Mar-13 to 2015............................................. 6.85 HYDROCORTISONE WITH PARAFFIN AND WOOL FAT Lotn 1% with paraffin liquid 15.9% and wool fat 0.6% METHYLPREDNISOLONE ACEPONATE Crm 0.1% .................................................................................... 4.95 Oint 0.1% ..................................................................................... 4.95 MOMETASONE FUROATE Crm 0.1% – 1% DV Sep-12 to 2015 ............................................ 1.78 3.42 Lotn 0.1% Oint 0.1% – 1% DV Sep-12 to 2015 ............................................. 1.78 3.42 15 g 15 g 15 g 45 g 15 g 45 g Advantan Advantan m-Mometasone m-Mometasone m-Mometasone m-Mometasone 100 g 500 g Pharmacy Health Pharmacy Health 30 g 30 g Dermol Dermol

14.2 g 30 g 100 g 100 ml 100 g

AFT Locoid Lipocream Locoid Lipocream Locoid Crelo Locoid

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

51


DERMATOLOGICALS

Price (ex man. Excl. GST) $ Per TRIAMCINOLONE ACETONIDE Crm 0.02% – 1% DV Sep-11 to 2014 .......................................... 6.63 Oint 0.02% – 1% DV Sep-11 to 2014 ........................................... 6.69 100 100 Brand or Generic Manufacturer Aristocort Aristocort

Corticosteroids with Anti-Infective Agents

BETAMETHASONE VALERATE WITH CLIOQUINIOL  Crm 0.1% with clioquiniol 3%  Oint 0.1% with clioquiniol 3% Restricted Either: 1 For the treatment of intertrigo; or 2 For continuation use BETAMETHASONE VALERATE WITH FUSIDIC ACID Crm 0.1% with fusidic acid 2% HYDROCORTISONE WITH MICONAZOLE Crm 1% with miconazole nitrate 2% HYDROCORTISONE WITH NATAMYCIN AND NEOMYCIN Crm 1% with natamycin 1% and neomycin sulphate 0.5% ............. 2.79 Oint 1% with natamycin 1% and neomycin sulphate 0.5% ............. 2.79 15 g 15 g Pimafucort Pimafucort

TRIAMCINOLONE ACETONIDE WITH NEOMYCIN SULPHATE, GRAMICIDIN AND NYSTATIN Crm 1 mg with nystatin 100,000 u, neomycin sulphate 2.5 mg and gramicidin 250 mcg per g

PSORIASIS AND ECZEMA PREPARATIONS

ACITRETIN Cap 10 mg ................................................................................. 38.66 35.95 Cap 25 mg ................................................................................. 83.11 85.40 BETAMETHASONE WITH DIPROPIONATE WITH CALCIPOTRIOL Gel 500 mcg with calcipotriol 50 mcg per g ................................ 26.12 Oint 500 mcg with calcipotriol 50 mcg per g............................... 26.12 CALCIPOTRIOL Crm 50 mcg per g ...................................................................... 45.00 Oint 50 mcg per g ...................................................................... 45.00 Soln 50 mcg per ml.................................................................... 16.00 COAL TAR WITH SALICYLIC ACID AND SULPHUR Oint 12% with salicylic acid 2% and sulphur 4% COAL TAR WITH TRIETHANOLAMINE LAURYL SULPHATE AND FLUORESCEIN Soln 2.3% with triethanolamine lauryl sulphate and fluorescein sodium – 1% DV Nov-11 to 2014 .......................... 3.05 500 ml 5.82 1,000 ml 60 100 60 100 30 g 30 g 100 g 100 g 30 ml Novatretin Neotigason Novatretin Neotigason Daivobet Daivobet Daivonex Daivonex Daivonex

Pinetarsol Pinetarsol

52

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


DERMATOLOGICALS

Price (ex man. Excl. GST) $ Per METHOXSALEN [8-METHOXYPSORALEN] Cap 10 mg Lotn 1.2% POTASSIUM PERMANGANATE Tab 400 mg Brand or Generic Manufacturer

SCALP PREPARATIONS

BETAMETHASONE VALERATE Scalp app 0.1% ............................................................................ 7.75 CLOBETASOL PROPIONATE Scalp app 0.05% .......................................................................... 6.96 HYDROCORTISONE BUTYRATE Scalp lotn 0.1% – 1% DV Mar-13 to 2015.................................... 3.65 100 ml 30 ml 100 ml Beta Scalp Dermol Locoid

WART PREPARATIONS

IMIQUIMOD  Crm 5%, 250 mg sachet – 1% DV Nov-11 to 2014..................... 62.00 12 Aldara

Restricted Any of the following: 1 The patient has external anogenital warts and podophyllotoxin has been tried and failed (or is contraindicated); or 2 The patient has external anogenital warts and podophyllotoxin is unable to be applied accurately to the site; or 3 The patient has confirmed superficial basal cell carcinoma where other standard treatments, including surgical excision, are contraindicated or inappropriate. Notes: Superficial basal cell carcinoma • Surgical excision remains first-line treatment for superficial basal cell carcinoma as it has a higher cure rate than imiquimod and allows histological assessment of tumour clearance. • Imiquimod has not been evaluated for the treatment of superficial basal cell carcinoma within 1 cm of the hairline, eyes, nose, mouth or ears. • Imiquimod is not indicated for recurrent, invasive, infiltrating, or nodular basal cell carcinoma. • Every effort should be made to biopsy the lesion to confirm that it is a superficial basal cell carcinoma. External anogenital warts • Imiquimod is only indicated for external genital and perianal warts (condyloma acuminata). PODOPHYLLOTOXIN Soln 0.5% .................................................................................. 33.60 SILVER NITRATE Sticks with applicator 3.5 ml Condyline

OTHER SKIN PREPARATIONS

SUNSCREEN, PROPRIETARY Crm Lotn ............................................................................................. 2.55 5.10

100 g 200 g

Marine Blue Lotion SPF 30+ Marine Blue Lotion SPF 30+

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

53


DERMATOLOGICALS

Price (ex man. Excl. GST) $ Per DIPHEMANIL METILSULFATE Powder 2% Brand or Generic Manufacturer

Antineoplastics

FLUOROURACIL SODIUM Crm 5% – 1% DV Feb-13 to 2015 .............................................. 25.16 METHYL AMINOLEVULINATE HYDROCHLORIDE  Crm 16 % Restricted Dermatologist or plastic surgeon 20 g Efudix

Wound Management Products

CALCIUM GLUCONATE Gel 2.5% .................................................................................... 21.00 1 healthE

54

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


GENITO-URINARY SYSTEM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

ANTI-INFECTIVE AGENTS

ACETIC ACID Soln 3% Soln 5% ACETIC ACID WITH HYDROXYQUINOLINE, GLYCEROL AND RICINOLEIC ACID Jelly 0.94% with hydroxyquinoline sulphate 0.025%, glycerol 5% and ricinoleic acid 0.75% with applicator CHLORHEXIDINE Crm 1% – 1% DV Oct-12 to 2015 ................................................ 1.24 CHLORHEXIDINE GLUCONATE Lotn 1%, 200 ml .......................................................................... 6.75 CLOTRIMAZOLE Vaginal crm 1% with applicator .................................................... 1.30 Vaginal crm 2% with applicator .................................................... 2.50 MICONAZOLE NITRATE Vaginal crm 2% with applicator NYSTATIN Vaginal crm 100,000 u per 5 g with applicator(s) 50 g 1 35 g 20 g healthE healthE Clomazol Clomazol

CONTRACEPTIVES Antiandrogen Oral Contraceptives

CYPROTERONE ACETATE WITH ETHINYLOESTRADIOL Tab 2 mg with ethinyloestradiol 35 mcg

Combined Oral Contraceptive

ETHINYLOESTRADIOL WITH DESOGESTREL Tab 20 mcg with desogestrel 150 mcg Tab 30 mcg with desogestrel 150 mcg ETHINYLOESTRADIOL WITH LEVONORGESTREL Tab 20 mcg with levonorgestrel 100 mcg Tab 30 mcg with levonorgestrel 150 mcg Tab 50 mcg with levonorgestrel 125 mcg ..................................... 9.45 ETHINYLOESTRADIOL WITH NORETHISTERONE Tab 35 mcg with norethisterone 500 mcg Tab 35 mcg with norethisterone 1 mg NORETHISTERONE WITH MESTRANOL Tab 1 g with mestranol 50 mcg

84

Microgynon 50 ED

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

55


GENITO-URINARY SYSTEM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Emergency Contraceptive

LEVONORGESTREL Tab 1.5 mg – 1% DV Jul-13 to 2016............................................ 3.50 1 Postinor-1

Progestogen-Only Contraceptives

LEVONORGESTREL Tab 30 mcg Implant 75 mg.......................................................................... 133.65  Intra-uterine system, 20 mcg per day

1

Jadelle

Restricted Initiation All of the following: 1 The patient has a clinical diagnosis of heavy menstrual bleeding; and 2 The patient has failed to respond to or is unable to tolerate other appropriate pharmaceutical therapies as per the Heavy Menstrual Bleeding Guidelines; and 3 Either: 3.1 Serum ferritin level < 16 mcg/l (within the last 12 months); or 3.2 Haemoglobin level < 120 g/l. Continuation Either: 1 Patient demonstrated clinical improvement of heavy menstrual bleeding; or 2 Previous insertion was removed or expelled within 3 months of insertion. MEDROXYPROGESTERONE ACETATE Inj 150 mg per ml, 1 ml syringe – 1% DV Sep-13 to 2016 ............ 7.00 NORETHISTERONE Tab 350 mcg 1 Depo-Provera

OESTROGENS

OESTRIOL Crm 1 mg per g with applicator Pessaries 500 mcg

OBSTETRIC PREPARATIONS Antiprogestogens

MIFEPRISTONE Tab 200 mg

Oxytocics

CARBOPROST TROMETAMOL Inj 250 mcg per ml, 1 ml ampoule DINOPROSTONE Pessaries 10 mg Gel 1 mg in 2.5 ml ..................................................................... 52.62 Gel 2 mg in 2.5 ml ..................................................................... 64.60

1 1

Prostin E2 Prostin E2

56

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


GENITO-URINARY SYSTEM

Price (ex man. Excl. GST) $ Per ERGOMETRINE MALEATE Inj 500 mcg per ml, 1 ml ampoule – 1% DV Nov-11 to 2014 ...... 31.00 OXYTOCIN Inj 5 iu per ml, 1 ml ampoule ........................................................ 5.94 Inj 10 iu per ml, 1 ml ampoule ...................................................... 7.48 OXYTOCIN WITH ERGOMETRINE MALEATE Inj 5 iu with ergometrine maleate 500 mcg per ml, 1 ml ampoule – 1% DV Oct-12 to 2015 ....... 11.13 Brand or Generic Manufacturer

5 5 5

DBL Ergometrine Syntocinon Syntocinon

5

Syntometrine

Tocolytics

PROGESTERONE  Cap 100 mg Restricted Only for use in women with previous preterm delivery (less than 28 weeks) and/or a short cervix (< 25 mm). TERBUTALINE  Inj 500 mcg ampoule Restricted Obstetrician

UROLOGICALS 5-Alpha Reductase Inhibitors

FINASTERIDE  Tab 5 mg – 1% DV Nov-11 to 2014 ............................................. 5.10 30 Rex Medical

Restricted Both: 1 Patient has symptomatic benign prostatic hyperplasia; and 2 Either: 2.1 The patient is intolerant of non-selective alpha blockers or these are contraindicated; or 2.2 Symptoms are not adequately controlled with non-selective alpha blockers.

Alpha-1A Adrenoceptor Blockers

TAMSULOSIN  Cap 400 mcg ............................................................................... 5.98 30 Tamsulosin-Rex

Restricted Both: 1 Patient has symptomatic benign prostatic hyperplasia; and 2 The patient is intolerant of non-selective alpha blockers or these are contraindicated.

Urinary Alkalisers

POTASSIUM CITRATE  Oral liq 3 mmol per ml ................................................................ 30.00 200 ml Biomed

Restricted Both: 1 The patient has recurrent calcium oxalate urolithiasis; and 2 The patient has had more than two renal calculi in the two years prior to the application.

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

57


GENITO-URINARY SYSTEM

Price (ex man. Excl. GST) $ Per SODIUM CITRO-TARTRATE Grans eff 4 g sachets ................................................................... 2.75 Brand or Generic Manufacturer

28

Ural

Urinary Antispasmodics

OXYBUTYNIN Tab 5 mg – 1% DV Jun-13 to 2016............................................ 11.20 Oral liq 5 mg per 5 ml – 1% DV Jun-13 to 2016 ......................... 56.45 SOLIFENACIN SUCCINATE  Tab 5 mg .................................................................................. 56.50  Tab 10 mg ................................................................................. 56.50 500 473 ml 30 30 Apo-Oxybutynin Apo-Oxybutynin Vesicare Vesicare

Restricted Patient has overactive bladder and a documented intolerance of, or is non-responsive to oxybutynin. TOLTERODINE TARTRATE  Tab 1 mg ................................................................................... 14.56  Tab 2 mg ................................................................................... 14.56 56 56 Arrow-Tolterodine Arrow-Tolterodine

Restricted Patient has overactive bladder and a documented intolerance of, or is non-responsive to oxybutynin.

58

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


HORMONE PREPARATIONS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

ANABOLIC AGENTS

OXANDROLONE  Tab 2.5 mg Restricted For the treatment of burns patients.

ANDROGEN AGONISTS AND ANTAGONISTS

CYPROTERONE ACETATE Tab 50 mg – 1% DV Oct-12 to 2015 .......................................... 18.80 Tab 100 mg – 1% DV Oct-12 to 2015 ........................................ 34.25 TESTOSTERONE Patch 2.5 mg per day ................................................................. 80.00 TESTOSTERONE CYPIONATE Inj 100 mg per ml, 10 ml vial – 1% DV Feb-12 to 2014 .............. 76.50 TESTOSTERONE ESTERS Inj testosterone decanoate 100 mg, testosterone isocarproate 60 mg, testosterone phenylpropionate 60 mg and testosterone propionate 30 mg per ml, 1 ml ampoule TESTOSTERONE UNDECANOATE Cap 40 mg – 1% DV Oct-12 to 2015.......................................... 31.17 Inj 250 mg per ml, 4 ml ampoule ................................................ 86.00 60 1 Andriol Testocaps Reandron 1000 50 50 60 1 Siterone Siterone Androderm Depo-Testosterone

CALCIUM HOMEOSTASIS

CALCITONIN Inj 100 iu per ml, 1 ml ampoule – 1% DV Sep-11 to 2014 ........ 110.00 ZOLEDRONIC ACID  Inj 0.8 mg per ml, 5 ml vial ....................................................... 550.00 Restricted For hypercalcaemia of malignancy 5 1 Miacalcic Zometa

CORTICOSTEROIDS

BETAMETHASONE Tab 500 mcg Inj 4 mg per ml, 1 ml ampoule BETAMETHASONE SODIUM PHOSPHATE WITH BETAMETHASONE ACETATE Inj 3.9 mg with betamethasone acetate 3 mg per ml, 1 ml ampoule DEXAMETHASONE Tab 1 mg – 1% DV Aug-12 to 2015 ............................................. 5.87 Tab 4 mg – 1% DV Aug-12 to 2015 ............................................. 8.16 Oral liq 1 mg per ml.................................................................... 45.00 100 100 25 ml Douglas Douglas Biomed

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

59


HORMONE PREPARATIONS

Price (ex man. Excl. GST) $ Per DEXAMETHASONE PHOSPHATE Inj 4 mg per ml, 1 ml ampoule .................................................... 21.50 Inj 4 mg per ml, 2 ml vial ............................................................ 31.00 FLUDROCORTISONE ACETATE Tab 100 mcg ............................................................................. 14.32 HYDROCORTISONE Tab 5 mg – 1% DV Nov-12 to 2015 ............................................. 8.10 Tab 20 mg – 1% DV Nov-12 to 2015 ......................................... 20.32 Inj 100 mg vial ............................................................................. 3.99 METHYLPREDNISOLONE ACETATE Inj 40 mg per ml, 1 ml vial – 1% DV Oct-12 to 2015..................... 6.70 METHYLPREDNISOLONE ACETATE WITH LIGNOCAINE Inj 40 mg with lignocaine 10 mg per ml, 1 ml vial – 1% DV Oct-12 to 2015 ......................................................... 7.50 METHYLPREDNISOLONE (AS SODIUM SUCCINATE) Tab 4 mg – 1% DV Oct-12 to 2015 ............................................ 60.00 Tab 100 mg – 1% DV Oct-12 to 2015 ...................................... 166.52 Inj 40 mg vial – 1% DV Oct-12 to 2015 ........................................ 7.50 Inj 125 mg vial – 1% DV Oct-12 to 2015 .................................... 18.50 Inj 500 mg vial – 1% DV Oct-12 to 2015 .................................... 18.00 Inj 1 g vial – 1% DV Oct-12 to 2015 ........................................... 37.50 PREDNISOLONE Oral liq 5 mg per ml.................................................................... 10.45 Enema 200 mcg per ml, 100 ml PREDNISONE Tab 1 mg ................................................................................... 10.68 Tab 2.5 mg ................................................................................ 12.09 Tab 5 mg ................................................................................... 11.09 Tab 20 mg ................................................................................. 29.03 TRIAMCINOLONE ACETONIDE Inj 10 mg per ml, 1 ml ampoule – 1% DV Jun-12 to 2014 .......... 21.90 Inj 40 mg per ml, 1 ml ampoule – 1% DV Jun-12 to 2014 .......... 53.79 TRIAMCINOLONE HEXACETONIDE Inj 20 mg per ml, 1 ml vial 5 5 100 100 100 1 1 Brand or Generic Manufacturer Hospira Hospira Florinef Douglas Douglas Solu-Cortef Depo-Medrol

1

Depo-Medrol with Lidocaine Medrol Medrol Solu-Medrol Solu-Medrol Solu-Medrol Solu-Medrol Redipred

100 20 1 1 1 1 30 ml

500 500 500 500 5 5

Apo-Prednisone Apo-Prednisone Apo-Prednisone Apo-Prednisone Kenacort-A Kenacort-A40

HORMONE REPLACEMENT THERAPY Oestrogens

OESTRADIOL Tab 1 mg Tab 2 mg Patch 25 mcg per day Patch 50 mcg per day Patch 100 mcg per day

60

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


HORMONE PREPARATIONS

Price (ex man. Excl. GST) $ Per OESTRADIOL VALERATE Tab 1 mg Tab 2 mg OESTROGENS (CONJUGATED EQUINE) Tab 300 mcg Tab 625 mcg Brand or Generic Manufacturer

Progestogen and Oestrogen Combined Preparations

OESTRADIOL WITH NORETHISTERONE ACETATE Tab 1 mg with 0.5 mg norethisterone acetate Tab 2 mg with 1 mg norethisterone acetate Tab 2 mg with 1 mg norethisterone acetate (10), and tab 2 mg oestradiol (12) and tab 1 mg oestradiol (6) OESTROGENS WITH MEDROXYPROGESTERONE ACETATE Tab 625 mcg conjugated equine with 2.5 mg medroxyprogesterone acetate Tab 625 mcg conjugated equine with 5 mg medroxyprogesterone acetate

Progestogens

MEDROXYPROGESTERONE ACETATE Tab 2.5 mg – 1% DV Sep-13 to 2016 .......................................... 3.09 Tab 5 mg – 1% DV Sep-13 to 2016 ........................................... 13.06 Tab 10 mg – 1% DV Sep-13 to 2016 ........................................... 6.85 30 100 30 Provera Provera Provera

OTHER ENDOCRINE AGENTS

CABERGOLINE  Tab 0.5 mg – 1% DV Sep-12 to 2015 .......................................... 6.25 25.00 Restricted Either: 1. Patient has pathological hyperprolactinemia; or 2. Patient has acromegaly CLOMIPHENE CITRATE Tab 50 mg – 1% DV Sep-13 to 2016 ......................................... 29.84 DANAZOL Cap 100 mg ............................................................................... 68.33 Cap 200 mg ............................................................................... 97.83 GESTRINONE Cap 2.5 mg METYRAPONE Cap 250 mg PENTAGASTRIN Inj 250 mcg per ml, 2 ml ampoule

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

2 8

Dostinex Dostinex

10 100 100

Serophene Azol Azol

61


HORMONE PREPARATIONS

Price (ex man. Excl. GST) $ Per SECRETIN PENTAHYDROCHLORIDE Inj 100 u ampoule Brand or Generic Manufacturer

OTHER OESTROGEN PREPARATIONS

ETHINYLOESTRADIOL Tab 10 mcg OESTRADIOL Tab 2 mg Implant 50 mg

OTHER PROGESTOGEN PREPARATIONS

MEDROXYPROGESTERONE Tab 100 mg – 1% DV Sep-13 to 2016 ....................................... 96.50 Tab 200 mg ............................................................................... 70.50 NORETHISTERONE Tab 5 mg – 1% DV Nov-11 to 2014 ........................................... 26.50 100 30 100 Provera Provera Primolut N

PITUITARY AND HYPOTHALAMIC HORMONES AND ANALOGUES

CORTICOTRORELIN (OVINE) Inj 100 mcg vial THYROTROPIN ALFA Inj 900 mcg vial

Adrenocorticotropic Hormones

TETRACOSACTIDE [TETRACOSACTRIN] Inj 250 mcg per ml, 1 ml ampoule – 1% DV Sep-11 to 2014 .... 177.18 Inj 1 mg per ml, 1 ml ampoule – 1% DV Sep-11 to 2014 ............ 29.56 10 1 Synacthen Synacthen Depot

GnRH Agonists and Antagonists

BUSERELIN Inj 1 mg per ml, 5.5 ml vial GONADORELIN Inj 100 mcg vial GOSERELIN Implant 3.6 mg......................................................................... 166.20 Implant 10.8 mg....................................................................... 443.76 LEUPRORELIN ACETATE Inj 3.75 mg syringe .................................................................. 221.60 Inj 3.75 mg vial ........................................................................ 221.60 Inj 7.5 mg syringe .................................................................... 166.20 Inj 11.25 mg syringe ................................................................ 591.68 Inj 11.25 mg vial ...................................................................... 591.68 Inj 22.5 mg syringe .................................................................. 443.76 Inj 30 mg syringe .................................................................. 1,109.40 Inj 30 mg vial ........................................................................... 591.68 Inj 45 mg syringe ..................................................................... 832.05 1 1 1 1 1 1 1 1 1 1 1 Zoladex Zoladex Lucrin Depot PDS Lucrin Depot Eligard Lucrin Depot PDS Lucrin Depot Eligard Lucrin Depot PDS Eligard Eligard

62

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


HORMONE PREPARATIONS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Gonadotrophins

CHORIOGONADOTROPIN ALFA Inj 250 mcg in 0.5 ml syringe

Growth Hormones

SOMATROPIN  Inj 16 iu (5.3 mg) vial  Inj 36 iu (12 mg) vial Restricted Only for use in patients with approval by the New Zealand Growth Hormone Committee or the Adult Growth Hormone Panel

THYROID AND ANTITHYROID PREPARATIONS

CARBIMAZOLE Tab 5 mg IODINE Soln BP 50 mg per ml LEVOTHYROXINE Tab 25 mcg Tab 50 mcg Tab 100 mcg LIOTHYRONINE SODIUM Inj 20 mcg vial  Tab 20 mcg Restricted For a maximum of 14 days’ treatment in patients with thyroid cancer who are due to receive radioiodine therapy POTASSIUM PERCHLORATE Cap 200 mg PROPYLTHIOURACIL  Tab 50 mg ................................................................................. 35.00 100 PTU

Restricted Both: 1 The patient has hyperthyroidism; and 2 The patient is intolerant of carbimazole or carbimazole is contraindicated. Note: Propylthiouracil is not recommended for patients under the age of 18 years unless the patient is pregnant and other treatments are contraindicated. PROTIRELIN Inj 100 mcg per ml, 2 ml ampoule

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

63


HORMONE PREPARATIONS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

VASOPRESSIN AGENTS

ARGIPRESSIN [VASOPRESSIN] Inj 20 u per ml, 1 ml ampoule DESMOPRESSIN ACETATE Tab 100 mcg ............................................................................. 36.40 Inj 4 mcg per ml, 1 ml ampoule Inj 15 mcg per ml, 1 ml ampoule Nasal drops 100 mcg per ml Nasal spray 10 mcg per dose – 1% DV Sep-11 to 2014 ............. 27.48 TERLIPRESSIN Inj 1 mg vial ............................................................................. 450.00 30 Minirin

6 ml 5

Desmopressin-PH&T Glypressin

64

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


INFECTIONS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

ANTIBACTERIALS Aminoglycosides

AMIKACIN  Inj 250 mg per ml, 2 ml vial  Inj 5 mg per ml, 5 ml syringe – 1% DV Nov-12 to 2014 ............ 176.00  Inj 5 mg per ml, 10 ml syringe  Inj 15 mg per ml, 5 ml syringe Restricted Infectious disease physician, clinical microbiologist or respiratory physician GENTAMICIN SULPHATE Inj 10 mg per ml, 1 ml ampoule .................................................... 8.56 Inj 40 mg per ml, 2 ml ampoule – 1% DV Sep-12 to 2015 ............ 6.50 PAROMOMYCIN  Cap 250 mg ............................................................................. 126.00 Restricted Infectious disease physician or clinical microbiologist STREPTOMYCIN SULPHATE  Inj 400 mg per ml, 2.5 ml ampoule Restricted Infectious disease physician, clinical microbiologist or respiratory physician TOBRAMYCIN  Inj 40 mg per ml, 2 ml vial – 1% DV Sep-11 to 2014 .................. 29.32  Inj 100 mg per ml, 5 ml vial Restricted Infectious disease physician, clinical microbiologist or respiratory physician 5 DBL Tobramycin 5 10 16 Mayne Pfizer Humatin

10

Biomed

Carbapenems

ERTAPENEM  Inj 1 g vial .................................................................................. 70.00 Restricted Infectious disease physician or clinical microbiologist IMIPENEM WITH CILASTATIN  Inj 500 mg with 500 mg cilastatin vial – 1% DV Dec-12 to 2014 ...................................................... 18.37 Restricted Infectious disease physician or clinical microbiologist MEROPENEM  Inj 500 mg vial – 1% DV Mar-12 to 2014 ................................... 10.50  Inj 1 g vial – 1% DV Mar-12 to 2014 .......................................... 21.00 Restricted Infectious disease physician or clinical microbiologist 1 1 Penembact Penembact 1 Invanz

1

Primaxin

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

65


INFECTIONS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Cephalosporins and Cephamycins – 1st Generation

CEFALEXIN Cap 500 mg ................................................................................. 8.90 Grans for oral liq 25 mg per ml ..................................................... 8.50 Grans for oral liq 50 mg per ml ................................................... 11.50 CEFAZOLIN Inj 500 mg vial – 1% DV Mar-12 to 2014 ..................................... 3.99 Inj 1 g vial – 1% DV Mar-12 to 2014 ............................................ 3.99 20 100 ml 100 ml 5 5 Cephalexin ABM Cefalexin Sandoz Cefalexin Sandoz AFT AFT

Cephalosporins and Cephamycins – 2nd Generation

CEFACLOR Cap 250 mg ............................................................................... 24.57 Grans for oral liq 25 mg per ml ..................................................... 3.53 CEFOXITIN Inj 1 g vial .................................................................................. 55.00 CEFUROXIME Tab 250 mg ............................................................................... 29.40 Inj 750 mg vial – 1% DV Mar-12 to 2014 ..................................... 6.96 Inj 1.5 g vial – 1% DV Apr-12 to 2014 .......................................... 2.65 100 100 ml 5 50 5 1 Ranbaxy-Cefaclor Ranbaxy-Cefaclor Mayne Zinnat m-Cefuroxime Mylan

Cephalosporins and Cephamycins – 3rd Generation

CEFOTAXIME Inj 500 mg vial – 1% DV Oct-11 to 2014 ...................................... 1.90 Inj 1 g vial – 1% DV Nov-11 to 2014 .......................................... 15.58 CEFTAZADIME  Inj 500 mg vial – 1% DV Oct-11 to 2014 ...................................... 2.37  Inj 1 g vial – 1% DV Oct-11 to 2014 ............................................. 3.25  Inj 2 g vial – 1% DV Oct-11 to 2014 ............................................. 6.49 Restricted Infectious disease physician, clinical microbiologist or respiratory physician CEFTRIAXONE Inj 500 mg vial ............................................................................. 2.70 Inj 1 g vial .................................................................................. 10.49 Inj 2 g vial .................................................................................... 5.20 1 5 1 Veracol Aspen Ceftriaxone Veracol 1 10 1 1 1 Cefotaxime Sandoz DBL Cefotaxime Fortum DBL Ceftazidime DBL Ceftazidime

Cephalosporins and Cephamycins – 4th Generation

CEFEPIME  Inj 1 g vial – 1% DV Oct-12 to 2015 ............................................. 8.80  Inj 2 g vial – 1% DV Oct-12 to 2015 ........................................... 17.60 Restricted Infectious disease physician or clinical microbiologist 1 1 DBL Cefepime DBL Cefepime

66

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


INFECTIONS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Macrolides

AZITHROMYCIN  Tab 250 mg ............................................................................... 10.00  Tab 500 mg – 1% DV Feb-13 to 2015 ......................................... 1.25  Oral liq 40 mg per ml.................................................................... 6.60 30 2 15 ml Apo-Azithromycin Apo-Azithromycin Zithromax

Restricted Any of the following: 1 Patient has received a lung transplant and requires treatment or prophylaxis for bronchiolitis obliterans syndrome; or 2 Patient has cystic fibrosis and has chronic infection with Pseudomonas aeruginosa or Pseudomonas related gram negative organisms; or 3 For any other condition for five days’ treatment, with review after five days. CLARITHROMYCIN  Grans for oral liq 25 mg per ml ................................................... 23.12  Tab 250 mg – 1% DV Jan-12 to 2014.......................................... 4.19 70 ml 14 Klacid Apo-Clarithromycin

Restricted Tab 250 mg and oral liquid 1 Atypical mycobacterial infection; or 2 Mycobacterium tuberculosis infection where there is drug resistance or intolerance to standard pharmaceutical agents.

 Tab 500 mg – 1% DV Apr-12 to 2014 ........................................ 10.95

Restricted Tab 500 mg Helicobacter pylori eradication.

14

Apo-Clarithromycin

 Inj 500 mg vial – 1% DV Oct-11 to 2014 .................................... 30.00

1

Klacid

Restricted Infusion 1 Atypical mycobacterial infection; or 2 Mycobacterium tuberculosis infection where there is drug resistance or intolerance to standard pharmaceutical agents; or 3 Community-acquired pneumonia (clarithromycin is not to be used as the first-line macrolide). ERYTHROMYCIN (AS ETHYLSUCCINATE) Tab 400 mg ............................................................................... 16.95 Grans for oral liq 200 mg per 5 ml ................................................ 4.35 Grans for oral liq 400 mg per 5 ml ................................................ 5.85 ERYTHROMYCIN (AS LACTOBIONATE) Inj 1 g vial .................................................................................. 16.00 ERYTHYROMYCIN (AS STEARATE)  Tab 250 mg  Tab 500 mg Restricted For continuation only ROXITHROMYCIN Tab 150 mg – 1% DV Sep-12 to 2015 ......................................... 7.48 Tab 300 mg – 1% DV Sep-12 to 2015 ....................................... 14.40 50 50 Arrow-Roxithromycin Arrow-Roxithromycin 100 100 ml 100 ml 1 E-Mycin E-Mycin E-Mycin Erythrocin IV

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

67


INFECTIONS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Penicillins

AMOXYCILLIN Cap 250 mg ............................................................................... 16.18 Cap 500 mg ............................................................................... 26.50 Grans for oral liq 25 mg per ml ..................................................... 1.55 Grans for oral liq 50 mg per ml ..................................................... 1.10 Inj 250 mg vial – 1% DV Nov-11 to 2014 ................................... 12.96 Inj 500 mg vial – 1% DV Nov-11 to 2014 ................................... 15.08 Inj 1 g vial – 1% DV Nov-11 to 2014 .......................................... 21.94 AMOXYCILLIN WITH CLAVULANIC ACID Tab 500 mg with clavulanic acid 125 mg – 1% DV Aug-12 to 2014 ...................................................... 12.55 Grans for oral liq 25 mg with clavulanic acid 6.25 mg per ml – 1% DV Nov-12 to 2015 ........................................................ 1.61 Grans for oral liq 50 mg with clavulanic acid 12.5 mg per ml – 1% DV Nov-12 to 2015 ........................................................ 2.19 Inj 500 mg with clavulanic acid 100 mg vial – 1% DV Jan-13 to 2015 ....................................................... 10.14 Inj 1,000 mg with clavulanic acid 200 mg vial – 1% DV Jan-13 to 2015 ....................................................... 14.03 BENZATHINE BENZYLPENICILLIN Inj 900 mg (1.2 million units) in 2.3 ml syringe – 1% DV Sep-12 to 2015 ................................................... 315.00 BENZYLPENICILLIN SODIUM [PENICILLIN G] Inj 600 mg (1 million units) vial – 1% DV Nov-11 to 2014 .......... 11.50 FLUCLOXACILLIN Cap 250 mg – 1% DV Oct-12 to 2015........................................ 22.00 Cap 500 mg – 1% DV Oct-12 to 2015........................................ 74.00 Grans for oral liq 25 mg per ml – 1% DV Sep-12 to 2015 ............. 2.49 Grans for oral liq 50 mg per ml – 1% DV Sep-12 to 2015 ............. 3.25 Inj 250 mg vial – 1% DV Nov-11 to 2014 ................................... 10.86 Inj 500 mg vial – 1% DV Nov-11 to 2014 ................................... 11.32 Inj 1 g vial – 1% DV Nov-11 to 2014 .......................................... 14.28 PHENOXYMETHYLPENICILLIN [PENICILLIN V] Cap 250 mg ................................................................................. 9.71 Cap 500 mg ............................................................................... 11.70 Grans for oral liq 25 mg per ml ..................................................... 1.68 Grans for oral liq 50 mg per ml ..................................................... 1.78 PIPERACILLIN WITH TAZOBACTAM  Inj 4 g with tazobactam 0.5 g vial ............................................... 12.00 Restricted Infectious disease physician, clinical microbiologist or respiratory physician PROCAINE PENICILLIN Inj 1.5 g in 3.4 ml syringe – 1% DV Nov-11 to 2014 ................. 123.50 5 Cilicaine 500 500 100 ml 100 ml 10 10 10 Alphamox Alphamox Ospamox Ospamox Ibiamox Ibiamox Ibiamox

100 100 ml 100 ml 10 10

Curam Duo Augmentin Augmentin m-Amoxiclav m-Amoxiclav

10 10 250 500 100 ml 100 ml 10 10 10 50 50 100 ml 100 ml 1

Bicillin LA Sandoz Staphlex Staphlex AFT AFT Flucloxin Flucloxin Flucloxin Cilicaine VK Cilicaine VK AFT AFT Tazocin EF

68

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


INFECTIONS

Price (ex man. Excl. GST) $ Per TICARCILLIN WITH CLAVULANIC ACID  Inj 3 g with clavulanic acid 0.1 mg vial Restricted Infectious disease physician, clinical microbiologist or respiratory physician Brand or Generic Manufacturer

Quinolones

CIPROFLOXACIN  Tab 250 mg – 1% DV Dec-11 to 2014 ......................................... 2.20  Tab 500 mg – 1% DV Dec-11 to 2014 ......................................... 3.00  Tab 750 mg – 1% DV Dec-11 to 2014 ......................................... 5.15  Oral liq 50 mg per ml  Oral liq 100 mg per ml  Inj 2 mg per ml, 100 ml bag ...................................................... 41.00 Restricted Infectious disease physician or clinical microbiologist MOXIFLOXACIN  Tab 400 mg ............................................................................... 52.00  Inj 2 mg per ml, 250 ml bag ....................................................... 70.00 5 1 Avelox Avelox IV 400 28 28 28 10 Cipflox Cipflox Cipflox Aspen Ciprofloxacin

Restricted Mycobacterium infection – infectious disease physician, clinical microbiologist or respiratory physician 1 Active tuberculosis, with any of the following: 1.1 Documented resistance to one or more first-line medications; or 1.2 Suspected resistance to one or more first-line medications (tuberculosis assumed to be contracted in an area with known resistance), as part of regimen containing other second-line agents; or 1.3 Impaired visual acuity (considered to preclude ethambutol use); or 1.4 Significant pre-existing liver disease or hepatotoxicity from tuberculosis medications; or 1.5 Significant documented intolerance and/or side effects following a reasonable trial of first-line medications; or 2 Mycobacterium avium-intracellulare complex not responding to other therapy or where such therapy is contraindicated; Pneumonia – infectious disease physician, clinical microbiologist 1 Immunocompromised patient with pneumonia that is unresponsive to first-line treatment; or 2 Pneumococcal pneumonia or other invasive pneumococcal disease highly resistant to other antibiotics. Penetrating eye injury – ophthalmologist Five days treatment for patients requiring prophylaxis following a penetrating eye injury. NORFLOXACIN Tab 400 mg – 1% DV Sep-11 to 2014 ....................................... 15.45 100 Arrow-Norfloxacin

Tetracyclines

DEMECLOCYCLINE HYDROCHLORIDE Cap 150 mg DOXYCYCLINE  Tab 50 mg – Restricted: For continuation only Tab 100 mg – 1% DV Sep-11 to 2014 ......................................... 7.95 Inj 5 mg per ml, 20 ml vial MINOCYCLINE Tab 50 mg  Cap 100 mg – Restricted: For continuation only

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

250

Doxine

69


INFECTIONS

Price (ex man. Excl. GST) $ Per TETRACYCLINE Tab 250 mg Cap 500 mg ............................................................................... 46.00 TIGECYCLINE  Inj 50 mg vial Restricted Infectious disease physician or clinical microbiologist Brand or Generic Manufacturer

30

Tetracyclin Wolff

Other Antibacterials

AZTREONAM  Inj 1 g vial – 1% DV Sep-11 to 2014 ........................................ 131.00 Restricted Infectious disease physician or clinical microbiologist CHLORAMPHENICOL  Inj 1 g vial Restricted Infectious disease physician or clinical microbiologist CLINDAMYCIN  Cap 150 mg ................................................................................. 9.90  Oral liq 15 mg per ml  Inj 150 mg per ml, 4 ml ampoule – 1% DV Sep-13 to 2016 .................................................... 100.00 Restricted Infectious disease physician or clinical microbiologist COLISTIN SULPHOMETHATE [COLESTIMETHATE]  Inj 150 mg per ml, 1 ml vial ........................................................ 65.00 Restricted Infectious disease physician, clinical microbiologist or respiratory physician DAPTOMYCIN  Inj 350 mg vial Restricted Infectious disease physician or clinical microbiologist FUSIDIC ACID  Tab 250 mg ............................................................................... 34.50 Restricted Infectious disease physician or clinical microbiologist HEXAMINE HIPPURATE Tab 1 g LINCOMYCIN  Inj 300 mg per ml, 2 ml vial Restricted Infectious disease physician or clinical microbiologist 12 Fucidin 1 Colistin-Link 16 10 Clindamycin ABM Dalacin C 5 Azactam

70

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


INFECTIONS

Price (ex man. Excl. GST) $ Per LINEZOLID  Tab 600 mg  Oral liq 20 mg per ml  Inj 2 mg per ml, 300 ml bag Restricted Infectious disease physician or clinical microbiologist NITROFURANTOIN Tab 50 mg Tab 100 mg SULPHADIAZINE  Tab 500 mg Restricted Infectious disease physician, clinical microbiologist or maternal-foetal medicine specialist TEICOPLANIN  Inj 400 mg vial Restricted Infectious disease physician or clinical microbiologist TRIMETHOPRIM Tab 100 mg Tab 300 mg ................................................................................. 9.28 TRIMETHOPRIM WITH SULPHAMETHOXAZOLE [CO-TRIMOXAZOLE] Tab 80 mg with sulphamethoxazole 400 mg Oral liq 8 mg with sulphamethoxazole 40 mg per ml ..................... 2.15 Inj 16 mg with sulphamethoxazole 80 mg per ml, 5 ml ampoule VANCOMYCIN  Inj 500 mg vial – 1% DV Sep-11 to 2014 ..................................... 3.58 Restricted Infectious disease physician or clinical microbiologist Brand or Generic Manufacturer

50

TMP

100 ml

Deprim

1

Mylan

ANTIFUNGALS Imidazoles

KETOCONAZOLE  Tab 200 mg Restricted Infectious disease physician, clinical microbiologist, dermatologist, endocrinologist or oncologist

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

71


INFECTIONS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Polyene Antimycotics

AMPHOTERICIN B  Inj 50 mg vial  Inj (liposomal) 50 mg vial – 1% DV Oct-12 to 2015 ............... 3,450.00 10 AmBisome

Restricted Infectious disease physician, clinical microbiologist, haematologist, oncologist, transplant specialist or respiratory physician Either: 1 Proven or probable invasive fungal infection, to be prescribed under an established protocol; or 2 Both: 2.1 Possible invasive fungal infection; and 2.2 A multidisciplinary team (including an Infectious Disease physician or a Clinical Microbiologist) considers the treatment to be appropriate. NYSTATIN Cap 500,000 u ........................................................................... 12.81 Tab 500,000 u ........................................................................... 14.16 Oral liq 100,000 u per ml – 1% DV Sep-11 to 2014 ...................... 3.19 50 50 24 ml Nilstat Nilstat Nilstat

Triazoles

FLUCONAZOLE  Cap 50 mg – 1% DV Jan-12 to 2014 ........................................... 4.77  Cap 150 mg – 1% DV Jan-12 to 2014 ......................................... 0.91  Cap 200 mg – 1% DV Jan-12 to 2014 ....................................... 13.34  Oral liq 50 mg per 5 ml vial......................................................... 34.56  Inj 2 mg per ml, 50 ml vial ............................................................ 5.68 Restricted Consultant ITRACONAZOLE  Cap 100 mg ................................................................................. 4.25  Oral liq 10 mg per ml 15 Itrazole 28 1 28 35 ml 1 Ozole Ozole Ozole Diflucan Fluconazole-Claris

Restricted Infectious disease physician, clinical microbiologist, clinical immunologist or dermatologist POSACONAZOLE  Oral liq 40 mg per ml................................................................ 761.13 Restricted Infectious disease physician or haematologist 105 ml Noxafil

Initiation Re-assessment required after 6 weeks Both: 1 Either: 1.1 Patient has acute myeloid leukaemia; or 1.2 Patient is planned to receive a stem cell transplant and is at high risk for aspergillus infection; and 2 Patient is to be treated with high dose remission induction therapy or re-induction therapy Continuation Re-assessment required after 6 weeks Both: 1 Patient has previously received posaconazole prophylaxis during remission induction therapy; and 2 Any of the following: 2.1 Patient is to be treated with high dose remission re-induction therapy; or 2.2 Patient is to be treated with high dose consolidation therapy; or 2.3 Patient is receiving a high risk stem cell transplant.

72

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


INFECTIONS

Price (ex man. Excl. GST) $ Per VORICONAZOLE  Tab 50 mg ............................................................................... 730.00  Tab 200 mg .......................................................................... 2,930.00  Oral liq 40 mg per ml................................................................ 730.00  Inj 200 mg vial ......................................................................... 185.00 Restricted Infectious disease physician, clinical microbiologist or haematologist Proven or probable aspergillus infection Both: 1 Patient is immunocompromised; and 2 Patient has proven or probable invasive aspergillus infection. Possible aspergillus infection All of the following: 1 Patient is immunocompromised; and 2 Patient has possible invasive aspergillus infection; and 3 A multidisciplinary team (including an Infectious Disease Physician) considers the treatment to be appropriate. Resistant candidiasis infections and other moulds All of the following: 1 Patient is immunocompromised, and 2 Either: 2.1 Patient has fluconazole resistant candidiasis; or 2.2 Patient has mould strain such as Fusarium spp. and Scedosporium spp; and 3 A multidisciplinary team (including an Infectious Disease Physician or Clinical Microbiologist) considers the treatment to be appropriate. 56 56 70 ml 1 Brand or Generic Manufacturer Vfend Vfend Vfend Vfend

Other Antifungals

CASPOFUNGIN  Inj 50 mg vial – 1% DV Oct-12 to 2015 .................................... 667.50  Inj 70 mg vial – 1% DV Oct-12 to 2015 .................................... 862.50 1 1 Cancidas Cancidas

Restricted Infectious disease physician, clinical microbiologist, haematologist, oncologist, transplant specialist or respiratory physician Either: 1 Proven or probable invasive fungal infection, to be prescribed under an established protocol; or 2 Both: 2.1 Possible invasive fungal infection; and 2.2 A multidisciplinary team (including an Infectious Disease physician or a Clinical Microbiologist) considers the treatment to be appropriate. FLUCYTOSINE  Cap 500 mg Restricted Infectious disease physician or clinical microbiologist. TERBINAFINE Tab 250 mg – 1% DV Nov-11 to 2014 ......................................... 1.78 14 Dr Reddy’s Terbinafine

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

73


INFECTIONS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

ANTIMYCOBACTERIALS Antileprotics

CLOFAZAMINE  Cap 50 mg Restricted Infectious disease physician, clinical microbiologist or dermatologist DAPSONE  Tab 25 mg  Tab 100 mg Restricted Infectious disease physician, clinical microbiologist or dermatologist

Antituberculotics

CYCLOSERINE  Cap 250 mg Restricted Infectious disease physician, clinical microbiologist or respiratory physician ETHAMBUTOL HYDROCHLORIDE  Tab 100 mg ............................................................................... 48.01  Tab 400 mg ............................................................................... 49.34 Restricted Infectious disease physician, clinical microbiologist or respiratory physician ISONIAZID  Tab 100 mg – 1% DV Mar-13 to 2015 ....................................... 20.00 100 PSM 56 56 Myambutol Myambutol

Restricted Internal medicine physician, paediatrician, clinical microbiologist, dermatologist or public health physician ISONIAZID WITH RIFAMPICIN  Tab 100 mg with rifampicin 150 mg  Tab 150 mg with rifampicin 300 mg Restricted Internal medicine physician, paediatrician, clinical microbiologist, dermatologist or public health physician PARA-AMINOSALICYLIC ACID  Grans for oral liq 4 g ................................................................ 280.00 Restricted Infectious disease physician, clinical microbiologist or respiratory physician PROTIONAMIDE  Tab 250 mg ............................................................................. 305.00 Restricted Infectious disease physician, clinical microbiologist or respiratory physician PYRAZINAMIDE  Tab 500 mg Restricted Infectious disease physician, clinical microbiologist or respiratory physician 100 Peteha 30 Paser

74

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


INFECTIONS

Price (ex man. Excl. GST) $ Per RIFABUTIN  Cap 150 mg – 1% DV Sep-13 to 2016 ..................................... 213.19 30 Brand or Generic Manufacturer Mycobutin

Restricted Infectious disease physician, clinical microbiologist, respiratory physician or gastroenterologist RIFAMPICIN  Cap 150 mg  Cap 300 mg  Tab 600 mg  Oral liq 100 mg per 5 ml  Inj 600 mg vial Restricted Internal medicine physician, clinical microbiologist, dermatologist, paediatrician or public health physician

ANTIPARASITICS Anthelmintics

ALBENDAZOLE  Tab 200 mg  Tab 400 mg Restricted Infectious disease physician or clinical microbiologist IVERMECTIN  Tab 3 mg ................................................................................... 17.20 Restricted Infectious disease physician, clinical microbiologist or dermatologist. MEBENDAZOLE Tab 100 mg – 1% DV Nov-11 to 2014 ....................................... 24.19 Oral liq 100 mg per 5 ml PRAZIQUANTEL Tab 600 mg 24 De-Worm 4 Stromectol

Antiprotozoals

ARTEMETHER WITH LUMAFANTRINE  Tab 20 mg with lumefantrine 120 mg Restricted Infectious disease physician or clinical microbiologist ARTESUNATE  Inj 60 mg vial Restricted Infectious disease physician or clinical microbiologist

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

75


INFECTIONS

Price (ex man. Excl. GST) $ Per ATOVAQUONE WITH PROGUANIL HYDROCHLORIDE  Tab 250 mg with proguanil hydrochloride 100 mg Restricted Infectious disease physician or clinical microbiologist CHLOROQUINE PHOSPHATE  Tab 250 mg Restricted Infectious disease physician, clinical microbiologist, dermatologist or rheumatologist MEFLOQUINE HYDROCHLORIDE  Tab 250 mg Restricted Infectious disease physician, clinical microbiologist, dermatologist or rheumatologist METRONIDAZOLE Tab 200 mg ............................................................................... 10.45 Tab 400 mg ............................................................................... 18.15 Oral liq benzoate 200 mg per 5 ml .............................................. 25.00 Suppos 500 mg ......................................................................... 24.48 Inj 5 mg per ml, 100 ml bag ......................................................... 2.46 12.35 NITAZOXANIDE  Tab 500 mg .......................................................................... 1,680.00  Oral liq 100 mg per 5 ml Restricted Infectious disease physician or clinical microbiologist ORNIDAZOLE Tab 500 mg ............................................................................... 16.50 PENTAMIDINE ISETHIONATE  Inj 300 mg vial Restricted Infectious disease physician or clinical microbiologist PRIMAQUINE PHOSPHATE  Tab 7.5 mg Restricted Infectious disease physician or clinical microbiologist PYRIMETHAMINE  Tab 25 mg Restricted Infectious disease physician, clinical microbiologist or maternal-foetal medicine specialist QUININE DIHYDROCHLORIDE  Inj 60 mg per ml, 10 ml ampoule  Inj 300 mg per ml, 2 ml vial Restricted Infectious disease physician or clinical microbiologist 10 Arrow-Ornidazole 100 100 100 ml 10 1 5 30 Trichozole Trichozole Flagyl-S Flagyl Baxter AFT Alinia Brand or Generic Manufacturer

76

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


INFECTIONS

Price (ex man. Excl. GST) $ Per QUININE SULPHATE Tab 300 mg ............................................................................... 54.06 SODIUM STIBOGLUCONATE  Inj 100 mg per ml, 1 ml vial Restricted Infectious disease physician or clinical microbiologist SPIRAMYCIN  Tab 500 mg Restricted Maternal-foetal medicine specialist 500 Brand or Generic Manufacturer Q 300

ANTIRETROVIRALS Non-Nucleoside Reverse Transcriptase Inhibitors

Restricted Confirmed HIV/AIDS Both: 1 Confirmed HIV infection; and 2 Any of the following: 2.1 Symptomatic patient; or 2.2 Patient aged 12 months and under; or 2.3 Both: 2.3.1 Patient aged 1 to 5 years; and 2.3.2 Any of the following: 2.3.2.1 CD4 counts < 1000 cells/mm3; or 2.3.2.2 CD4 counts < 0.25 × total lymphocyte count; or 2.3.2.3 Viral load counts > 100000 copies per ml; or 2.4 Both: 2.4.1 Patient aged 6 years and over; and 2.4.2 CD4 counts < 350 cells/mm3 Prevention of maternal transmission Either: 1 Prevention of maternal foetal transmission; or 2 Treatment of the newborn for up to eight weeks. Post-exposure prophylaxis following non-occupational exposure to HIV Both: 1 Treatment course to be initiated within 72 hours post exposure; and 2 Either: 2.1 Patient has had unprotected receptive anal intercourse with a known HIV positive person; or 2.2 Patient has shared intravenous injecting equipment with a known HIV positive person. Percutaneous exposure Patient has percutaneous exposure to blood known to be HIV positive EFAVIRENZ  Tab 50 mg ............................................................................... 158.33  Tab 200 mg ............................................................................. 474.99  Tab 600 mg ............................................................................. 474.99  Oral liq 30 mg per ml 30 90 30 Stocrin Stocrin Stocrin

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

77


INFECTIONS

Price (ex man. Excl. GST) $ Per ETRAVIRINE  Tab 100 mg ............................................................................. 770.00  Tab 200 mg ............................................................................. 770.00 (Intelence Tab 100 mg to be delisted 1 August 2013) NEVIRAPINE  Oral suspension 10 mg per ml .................................................. 134.55  Tab 200 mg – 1% DV Jan-13 to 2015........................................ 95.94 120 60 Brand or Generic Manufacturer Intelence Intelence

240 ml 60

Viramune Suspension Nevirapine Alphapharm

Nucleoside Reverse Transcriptase Inhibitors

Restricted Confirmed HIV/AIDS Both: 1 Confirmed HIV infection; and 2 Any of the following: 2.1 Symptomatic patient; or 2.2 Patient aged 12 months and under; or 2.3 Both: 2.3.1 Patient aged 1 to 5 years; and 2.3.2 Any of the following: 2.3.2.1 CD4 counts < 1000 cells/mm3; or 2.3.2.2 CD4 counts < 0.25 × total lymphocyte count; or 2.3.2.3 Viral load counts > 100000 copies per ml; or 2.4 Both: 2.4.1 Patient aged 6 years and over; and 2.4.2 CD4 counts < 350 cells/mm3 Prevention of maternal transmission Either: 1 Prevention of maternal foetal transmission; or 2 Treatment of the newborn for up to eight weeks. Post-exposure prophylaxis following non-occupational exposure to HIV Both: 1 Treatment course to be initiated within 72 hours post exposure; and 2 Either: 2.1 Patient has had unprotected receptive anal intercourse with a known HIV positive person; or 2.2 Patient has shared intravenous injecting equipment with a known HIV positive person. Percutaneous exposure Patient has percutaneous exposure to blood known to be HIV positive ABACAVIR SULPHATE  Oral liq 20 mg per ml – 1% DV Jul-11 to 2014 ........................... 50.00  Tab 300 mg – 1% DV Jul-11 to 2014....................................... 229.00 ABACAVIR SULPHATE WITH LAMIVUDINE  Tab 600 mg with lamivudine 300 mg........................................ 630.00 DIDANOSINE [DDI]  Cap 125 mg  Cap 200 mg  Cap 250 mg  Cap 400 mg 240 ml 60 30 Ziagen Ziagen Kivexa

78

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


INFECTIONS

Price (ex man. Excl. GST) $ Per EFAVIRENZ WITH EMTRICITABINE AND TENOFOVIR DISOPROXIL FUMARATE  Tab 600 mg with emtricitabine 200 mg and tenofovir disoproxil fumarate 300 mg............................................... 1,313.19 EMTRICITABINE  Cap 200 mg ............................................................................. 307.20 EMTRICITABINE WITH TENOFOVIR DISOPROXIL FUMARATE  Tab 200 mg with tenofovir disoproxil fumarate 300 mg ............. 838.20 LAMIVUDINE  Oral liq 10 mg per ml  Tab 150 mg STAVUDINE  Cap 30 mg  Cap 40 mg  Powder for oral soln 1 mg per ml ZIDOVUDINE [AZT]  Cap 100 mg ............................................................................. 145.00  Oral liq 10 mg per ml.................................................................. 29.00  Inj 10 mg per ml, 20 ml vial ZIDOVUDINE [AZT] WITH LAMIVUDINE  Tab 300 mg with lamivudine 150 mg – 1% DV Dec-12 to 2014 ...................................................... 63.50 100 200 ml Retrovir Retrovir Brand or Generic Manufacturer

30 30 30

Atripla Emtriva Truvada

60

Alphapharm

Protease Inhibitors

Restricted Confirmed HIV/AIDS Both: 1 Confirmed HIV infection; and 2 Any of the following: 2.1 Symptomatic patient; or 2.2 Patient aged 12 months and under; or 2.3 Both: 2.3.1 Patient aged 1 to 5 years; and 2.3.2 Any of the following: 2.3.2.1 CD4 counts < 1000 cells/mm3; or 2.3.2.2 CD4 counts < 0.25 × total lymphocyte count; or 2.3.2.3 Viral load counts > 100000 copies per ml; or 2.4 Both: 2.4.1 Patient aged 6 years and over; and 2.4.2 CD4 counts < 350 cells/mm3 Prevention of maternal transmission Either: 1 Prevention of maternal foetal transmission; or 2 Treatment of the newborn for up to eight weeks. Post-exposure prophylaxis following non-occupational exposure to HIV Both: 1 Treatment course to be initiated within 72 hours post exposure; and 2 Either:

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

continued...

79


INFECTIONS

Price (ex man. Excl. GST) $ Per continued... 2.1 2.2 Patient has had unprotected receptive anal intercourse with a known HIV positive person; or Patient has shared intravenous injecting equipment with a known HIV positive person. Brand or Generic Manufacturer

Percutaneous exposure Patient has percutaneous exposure to blood known to be HIV positive ATAZANAVIR SULPHATE  Cap 150 mg ............................................................................. 568.34  Cap 200 mg ............................................................................. 757.79 DARUNAVIR  Tab 400 mg ............................................................................. 837.50  Tab 600 mg .......................................................................... 1,190.00 INDINAVIR  Cap 200 mg  Cap 400 mg LOPINAVIR WITH RITONAVIR  Oral liq 80 mg with ritonavir 20 mg per ml ................................ 735.00  Tab 100 mg with ritonavir 25 mg .............................................. 183.75  Tab 200 mg with ritonavir 50 mg .............................................. 735.00 RITONAVIR  Tab 100 mg – 1% DV Oct-12 to 2015 ........................................ 43.31  Oral liq 80 mg per ml 300 ml 60 120 30 Kaletra Kaletra Kaletra Norvir 60 60 60 60 Reyataz Reyataz Prezista Prezista

Strand Transfer Inhibitors

Restricted Confirmed HIV/AIDS Both: 1 Confirmed HIV infection; and 2 Any of the following: 2.1 Symptomatic patient; or 2.2 Patient aged 12 months and under; or 2.3 Both: 2.3.1 Patient aged 1 to 5 years; and 2.3.2 Any of the following: 2.3.2.1 CD4 counts < 1000 cells/mm3; or 2.3.2.2 CD4 counts < 0.25 × total lymphocyte count; or 2.3.2.3 Viral load counts > 100000 copies per ml; or 2.4 Both: 2.4.1 Patient aged 6 years and over; and 2.4.2 CD4 counts < 350 cells/mm3 Prevention of maternal transmission Either: 1 Prevention of maternal foetal transmission; or 2 Treatment of the newborn for up to eight weeks. Post-exposure prophylaxis following non-occupational exposure to HIV Both: 1 Treatment course to be initiated within 72 hours post exposure; and 2 Either:

continued...

80

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


INFECTIONS

Price (ex man. Excl. GST) $ Per continued... 2.1 Patient has had unprotected receptive anal intercourse with a known HIV positive person; or 2.2 Patient has shared intravenous injecting equipment with a known HIV positive person. Percutaneous exposure Patient has percutaneous exposure to blood known to be HIV positive RALTEGRAVIR POTASSIUM  Tab 400 mg .......................................................................... 1,090.00 60 Isentress Brand or Generic Manufacturer

HIV Fusion Inhibitors

ENFUVIRTIDE  Inj 108 mg vial ...................................................................... 2,380.00 60 Fuzeon Restricted Initiation Re-assessment required after 12 months All of the following: 1 Confirmed HIV infection; and 2 Enfuvirtide to be given in combination with optimized back ground therapy (including at least 1 other antiretroviral drug that the patient has never previously been exposed to) for treatment failure; and 3 Either: 3.1 Patient has evidence of HIV replication, despite ongoing therapy; or 3.2 Patient has treatment-limiting toxicity to previous antiretroviral agents; and 4 Previous treatment with 3 different antiretroviral regimens has failed; and 5 All of the following: 5.1 Previous treatment with a non-nucleoside reverse transcriptase inhibitor has failed; and 5.2 Previous treatment with a nucleoside reverse transcriptase inhibitor has failed; and 5.3 Previous treatment with a protease inhibitor has failed. Continuation Patient has had at least a 10 fold reduction in viral load at 12 months

ANTIVIRALS Hepatitis B

ADEFOVIR DIPIVOXIL  10 mg ............................................................................... 670.00 Tab 30 Hepsera

Restricted Gastroenterologist or infectious disease physician All of the following: 1 Patient has confirmed Hepatitis B infection (HBsAg+); and Documented resistance to lamivudine, defined as: 2 Patient has raised serum ALT (> 1 × ULN); and 3 Patient has HBV DNA greater than 100,000 copies per mL, or viral load ≥ 10 fold over nadir; and 4 Detection of M204I or M204V mutation; and 5 Either: 5.1 Both: 5.1.1 Patient is cirrhotic; and 5.1.2 Adefovir dipivoxil to be used in combination with lamivudine; or 5.2 Both: 5.2.1 Patient is not cirrhotic; and 5.2.2 Adefovir dipivoxil to be used as monotherapy. continued...

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

81


INFECTIONS

Price (ex man. Excl. GST) $ Per continued... ENTECAVIR  Tab 0.5 mg .............................................................................. 400.00 30 Baraclude Brand or Generic Manufacturer

Restricted Gastroenterologist or infectious disease physician All of the following: 1 Patient has confirmed Hepatitis B infection (HBsAg positive for more than 6 months); and 2 Patient is Hepatitis B nucleoside analogue treatment-naive; and 3 Entecavir dose 0.5 mg/day; and 4 Either: 4.1 ALT greater than upper limit of normal; or 4.2 Bridging fibrosis or cirrhosis (Metavir stage 3 or greater) on liver histology; and 5 Either: 5.1 HBeAg positive; or 5.2 Patient has ≥ 2,000 IU HBV DNA units per ml and fibrosis (Metavir stage 2 or greater) on liver histology; and 6 No continuing alcohol abuse or intravenous drug use; and 7 Not co-infected with HCV, HIV or HDV; and 8 Neither ALT nor AST greater than 10 times upper limit of normal; and 9 No history of hypersensitivity to entecavir; and 10 No previous documented lamivudine resistance (either clinical or genotypic). LAMIVUDINE  Oral liq 5 mg per ml  Tab 100 mg – 1% DV Dec-12 to 2014 ....................................... 32.50 Restricted Gastroenterologist, infectious disease specialist, paediatrician or general physician Initiation Re-assessment required after 12 months 1 Any of the following: 1.1 All of the following: 1.1.1 HBsAg positive for more than 6 months; and 1.1.2 HBeAg positive or HBV DNA positive defined as > 100,000 copies per ml by quantitative PCR at a reference laboratory; and 1.1.3 ALT greater than twice upper limit of normal or bridging fibrosis or cirrhosis (Metavir stage 3 or 4 or equivalent) on liver histology clinical/radiological evidence of cirrhosis; or 1.2 HBV DNA positive cirrhosis prior to liver transplantation; or 1.3 HBsAg positive and have had a liver, kidney, heart, lung or bone marrow transplant; or 1.4 Hepatitis B surface antigen positive (HbsAg) patient who is receiving chemotherapy for a malignancy, or who has received such treatment within the previous two months; and 2 All of the following: 2.1 No continuing alcohol abuse or intravenous drug use; and 2.2 Not coinfected with HCV or HDV; and 2.3 Neither ALT nor AST greater than 10 times upper limit of normal; and 2.4 No history of hypersensitivity to lamivudine; and 2.5 No previous lamivudine therapy with genotypically proven lamivudine resistance. Continuation – patients who have maintained continuous treatment and response to lamivudine Re-assessment required after 2 years All of the following: 1 Have maintained continuous treatment with lamivudine; and 2 Most recent test result shows continuing biochemical response (normal ALT); and 3 HBV DNA <100,00 copies per ml by quantitative PCR at a reference laboratory; or continued...

28

Zetlam

82

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


INFECTIONS

Price (ex man. Excl. GST) $ Per continued... Continuation – when given in combination with adefovir dipivoxil for patients with cirrhosis and resistance to lamivudine Re-assessment required after 2 years All of the following: 1 Lamivudine to be used in combination with adefovir dipivoxil; and 2 Patient is cirrhotic; and Documented resistance to lamivudine, defined as: 3 Patient has raised serum ALT (> 1 × ULN); and 4 Patient has HBV DNA greater than 100,000 copies per mL, or viral load = 10 fold over nadir; and 5 Detection of M204I or M204V mutation; or Continuation – when given in combination with adefovir dipivoxil for patients with resistance to adefovir dipivoxil Re-assessment required after 2 years All of the following: 1 Lamivudine to be used in combination with adefovir dipivoxil; and Documented resistance to adefovir, defined as: 2 Patient has raised serum ALT (> 1 × ULN); and 3 Patient has HBV DNA greater than 100,000 copies per mL, or viral load = 10 fold over nadir; and 4 Detection of N236T or A181T/V mutation. TENOFOVIR DISOPROXIL FUMARATE  Tab 300 mg ............................................................................. 531.00 30 Viread Brand or Generic Manufacturer

Restricted Confirmed hepatitis B Either: 1 All of the following: 1.1 Patient has confirmed Hepatitis B infection (HBsAg positive for more than 6 months); and 1.2 Patient has had previous lamivudine, adefovir or entecavir therapy; and 1.3 HBV DNA greater than 20,000 IU/mL or increased ≥ 10 fold over nadir; and 1.4 Any of the following: 1.4.1 Lamivudine resistance - detection of M204I/V mutation; or 1.4.2 Adefovir resistance - detection of A181T/V or N236T mutation; or 1.4.3 Entecavir resistance - detection of relevant mutations including I169T, L180M T184S/A/I/L/G/C/M, S202C/G/I,M204V or M250I/V mutation; or 2 Patient is either listed or has undergone liver transplantation for HBV. Pregnant patients Limited to four months’ treatment Both: 1 Patient is HBsAg positive and pregnant; and 2 Either: 2.1 HBV DNA > 20,000 IU/mL and ALT > ULN; or 2.2 HBV DNA > 100 million IU/mL and ALT normal. Confirmed HIV/AIDS Both: 1 Confirmed HIV infection; and 2 Any of the following: 2.1 Symptomatic patient; or 2.2 Patient aged 12 months and under; or 2.3 Both: 2.3.1 Patient aged 1 to 5 years; and 2.3.2 Any of the following: 2.3.2.1 CD4 counts < 1000 cells/mm3; or continued...

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

83


INFECTIONS

Price (ex man. Excl. GST) $ Per continued... 2.3.2.2 CD4 counts < 0.25 × total lymphocyte count; or 2.3.2.3 Viral load counts > 100000 copies per ml; or 2.4 Both: 2.4.1 Patient aged 6 years and over; and 2.4.2 CD4 counts < 350 cells/mm3 Brand or Generic Manufacturer

Prevention of maternal transmission Either: 1 Prevention of maternal foetal transmission; or 2 Treatment of the newborn for up to eight weeks. Post-exposure prophylaxis following non-occupational exposure to HIV Both: 1 Treatment course to be initiated within 72 hours post exposure; and 2 Either: 2.1 Patient has had unprotected receptive anal intercourse with a known HIV positive person; or 2.2 Patient has shared intravenous injecting equipment with a known HIV positive person. Percutaneous exposure Patient has percutaneous exposure to blood known to be HIV positive

Herpesviridae

ACICLOVIR Tab dispersible 200 mg – 1% DV Sep-13 to 2016 ........................ 1.78 Tab dispersible 400 mg – 1% DV Sep-13 to 2016 ........................ 5.98 Tab dispersible 800 mg – 1% DV Sep-13 to 2016 ........................ 6.64 Inj 250 mg vial – 1% DV Mar-13 to 2015 ................................... 14.09 CIDOFOVIR  Inj 75 mg per ml, 5 ml vial Restricted Infectious disease physician, clinical microbiologist, otolaryngologist or oral surgeon FOSCARNET SODIUM  Inj 24 mg per ml, 250 ml bottle Restricted Infectious disease physician or clinical microbiologist GANCICLOVIR  Inj 500 mg vial ......................................................................... 380.00 Restricted Infectious disease physician or clinical microbiologist VALACICLOVIR  Tab 500 mg ............................................................................. 102.72 30 Valtrex 5 Cymevene 25 56 35 5 Lovir Lovir Lovir Zovirax IV

Restricted Any of the following: 1 Patient has genital herpes with 2 or more breakthrough episodes in any 6 month period while treated with aciclovir 400 mg twice daily. 2 Patient has previous history of ophthalmic zoster and the patient is at risk of vision impairment. 3 Patient has undergone organ transplantation.

84

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


INFECTIONS

Price (ex man. Excl. GST) $ Per VALGANCICLOVIR  Tab 450 mg .......................................................................... 3,000.00 60 Brand or Generic Manufacturer Valcyte

Restricted Transplant cytomegalovirus prophylaxis Limited to three months’ treatment Patient has undergone a solid organ transplant and requires valganciclovir for CMV prophylaxis. Lung transplant cytomegalovirus prophylaxis Limited to six months’ treatment Both: 1 Patient has undergone a lung transplant; and 2 Either: 2.1 The donor was cytomegalovirus positive and the patient is cytomegalovirus negative; or 2.2 The recipient is cytomegalovirus positive. Cytomegalovirus in immunocompromised patients Both: 1 Patient is immunocompromised; and 2 Any of the following: 2.1 Patient has cytomegalovirus syndrome or tissue invasive disease; or 2.2 Patient has rapidly rising plasma CMV DNA in absence of disease; or 2.3 Patient has cytomegalovirus retinitis.

Influenza

OSELTAMIVIR  Tab 75 mg  Powder for oral suspension 12 mg per ml Restricted Either: 1 Only for hospitalised patient with known or suspected influenza; or 2 For prophylaxis of influenza in hospitalised patients as part of a DHB hospital approved infections control plan.

IMMUNE MODULATORS

INTERFERON ALPHA-2A Inj 3 m iu prefilled syringe Inj 6 m iu prefilled syringe Inj 9 m iu prefilled syringe INTERFERON ALPHA-2B Inj 18 m iu, 1.2 ml multidose pen Inj 30 m iu, 1.2 ml multidose pen Inj 60 m iu, 1.2 ml multidose pen INTERFERON GAMMA  Inj 100 mcg in 0.5 ml vial Restricted Patient has chronic granulomatous disease and requires interferon gamma.

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

85


INFECTIONS

Price (ex man. Excl. GST) $ Per PEGYLATED INTERFERON ALPHA-2A  Inj 135 mcg prefilled syringe  Inj 180 mcg prefilled syringe  Inl 135 mcg prefilled syringe (4) with ribavirin tab 200 mg (112)  Inj 180 mcg prefilled syringe (4) with ribavirin tab 200 mg (112)  Inj 135 mcg prefilled syringe (4) with ribavirin tab 200 mg (168)  Inj 180 mcg prefilled syringe (4) with ribavirin tab 200 mg (168) Restricted Chronic hepatitis C - genotype 1, 4, 5 or 6 infection or co-infection with HIV Both: 1 Either: 1.1 Patient has chronic hepatitis C, genotype 1, 4, 5 or 6 infection; or 1.2 Patient has chronic hepatitis C and is co-infected with HIV; and 2 Maximum of 48 weeks therapy. Chronic hepatitis C - genotype 2 or 3 infection without co-infection with HIV Both: 1 Patient has chronic hepatitis C, genotype 2 or 3 infection; and 2 Maximum of 6 months therapy. Hepatitis B All of the following: 1 Patient has confirmed Hepatitis B infection (HBsAg positive for more than 6 months); and 2 Patient is Hepatitis B treatment-naive; and 3 ALT > 2 times Upper Limit of Normal; and 4 HBV DNA < 10 log10 IU/ml; and 5 Either: 5.1 HBeAg positive; or 5.2 serum HBV DNA ≥ 2,000 units/ml and significant fibrosis (≥ Metavir Stage F2); and 6 Compensated liver disease; and 7 No continuing alcohol abuse or intravenous drug use; and 8 Not co-infected with HCV, HIV or HDV; and 9 Neither ALT nor AST > 10 times upper limit of normal; and 10 No history of hypersensitivity or contraindications to pegylated interferon; and 11 Maximum of 48 weeks therapy. Brand or Generic Manufacturer

86

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


MUSCULOSKELETAL SYSTEM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

ANTICHOLINESTERASES

EDROPHONIUM CHLORIDE  Inj 10 mg per ml, 1 ml ampoule Restricted For the diagnosis of myasthenia gravis NEOSTIGMINE METILSULFATE Inj 2.5 mg per ml, 1 ml ampoule – 1% DV Sep-11 to 2014 ....... 140.00 NEOSTIGMINE METILSULFATE WITH GLYCOPYRRONIUM BROMIDE Inj 2.5 mg with glycopyrronium bromide 0.5 mg per ml, 1 ml ampoule PYRIDOSTIGMINE BROMIDE Tab 60 mg – 1% DV Sep-11 to 2014 ......................................... 38.90 100 Mestinon 50 AstraZeneca

ANTIRHEUMATOID AGENTS

AURANOFIN Tab 3 mg HYDROXYCHLOROQUINE Tab 200 mg – 1% DV Nov-12 to 2015 ....................................... 18.00 LEFLUNOMIDE Tab 10 mg ................................................................................. 55.00 Tab 20 mg ................................................................................. 76.00 Tab 100 mg ............................................................................... 54.44 PENICILLAMINE Tab 125 mg ............................................................................... 61.93 Tab 250 mg ............................................................................... 98.98 SODIUM AUROTHIOMALATE Inj 10 mg in 0.5 ml ampoule Inj 20 mg in 0.5 ml ampoule Inj 50 mg in 0.5 ml ampoule 100 30 30 3 100 100 Plaquenil Arava Arava Arava D-Penamine D-Penamine

DRUGS AFFECTING BONE METABOLISM Bisphosphonates

ALENDRONATE SODIUM  Tab 40 mg ............................................................................... 133.00 30 Fosamax Restricted Both: 1 Paget’s disease; and 2 Any of the following: 2.1 Bone or articular pain; or 2.2 Bone deformity; or 2.3 Bone, articular or neurological complications; or 2.4 Asymptomatic disease, but risk of complications due to site (base of skull, spine, long bones of lower limbs); or

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

continued...

87


MUSCULOSKELETAL SYSTEM

Price (ex man. Excl. GST) $ Per continued... 2.5 Preparation for orthopaedic surgery. Brand or Generic Manufacturer

 Tab 70 mg ................................................................................. 22.90

4 Fosamax Restricted Osteoporosis Any of the following: 1 History of one significant osteoporotic fracture demonstrated radiologically and documented bone mineral density (BMD) ≥2.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -2.5) (see Note); or 2 History of one significant osteoporotic fracture demonstrated radiologically, and either the patient is elderly, or densitometry scanning cannot be performed because of major logistical, technical or pathophysiological reasons. It is unlikely that this provision would apply to many patients under 75 years of age; or 3 History of two significant osteoporotic fractures demonstrated radiologically; or 4 Documented T-Score ≤ -3.0 (see Note); or 5 A 10-year risk of hip fracture ≥ 3%, calculated using a published risk assessment algorithm (e.g. FRAX or Garvan) which incorporates BMD measurements (see Note); or 6 Patient has had a Special Authority approval for zoledronic acid (osteoporosis) or raloxifene. Initiation – glucocorticosteroid therapy Re-assessment required after 12 months Both: 1 The patient is receiving systemic glucocorticosteroid therapy (≥ 5 mg per day prednisone equivalents) and has already received or is expected to receive therapy for at least three months; and 2 Any of the following: 2.1 The patient has documented BMD ≥1.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤-1.5) (see Note); or 2.2 The patient has a history of one significant osteoporotic fracture demonstrated radiologically; or 2.3 The patient has had a Special Authority approval for zoledronic acid (glucocorticosteroid therapy) or raloxifene. Continuation – glucocorticosteroid therapy Re-assessment required after 12 months The patient is continuing systemic glucocorticosteriod therapy (≥ 5 mg per day prednisone equivalents) Notes: a) BMD (including BMD used to derive T-Score) must be measured using dual-energy x-ray absorptiometry (DXA). Quantitative ultrasound and quantitative computed tomography (QCT) are not acceptable. b) Evidence used by National Institute for Health and Clinical Excellence (NICE) guidance indicates that patients aged 75 years and over who have a history of significant osteoporotic fracture demonstrated radiologically are very likely to have a T-Score ≤ -2.5 and, therefore, do not require BMD measurement for treatment with bisphosphonates. c) Osteoporotic fractures are the incident events for severe (established) osteoporosis, and can be defined using the WHO definitions of osteoporosis and fragility fracture. The WHO defines severe (established) osteoporosis as a T-score below -2.5 with one or more associated fragility fractures. Fragility fractures are fractures that occur as a result of mechanical forces that would not ordinarily cause fracture (minimal trauma). The WHO has quantified this as forces equivalent to a fall from a standing height or less. d) In line with the Australian guidelines for funding alendronate, a vertebral fracture is defined as a 20% or greater reduction in height of the anterior or mid portion of a vertebral body relative to the posterior height of that body, or a 20% or greater reduction in any of these heights compared to the vertebral body above or below the affected vertebral body.

88

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


MUSCULOSKELETAL SYSTEM

Price (ex man. Excl. GST) $ Per ALENDRONATE SODIUM WITH CHOLECALCIFEROL  Tab 70 mg with cholecalciferol 5,600 iu ..................................... 22.90 4 Brand or Generic Manufacturer Fosamax Plus

Restricted Osteoporosis Any of the following: 1 History of one significant osteoporotic fracture demonstrated radiologically and documented bone mineral density (BMD) ≥2.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -2.5) (see Note); or 2 History of one significant osteoporotic fracture demonstrated radiologically, and either the patient is elderly, or densitometry scanning cannot be performed because of major logistical, technical or pathophysiological reasons. It is unlikely that this provision would apply to many patients under 75 years of age; or 3 History of two significant osteoporotic fractures demonstrated radiologically; or 4 Documented T-Score ≤ -3.0 (see Note); or 5 A 10-year risk of hip fracture ≥ 3%, calculated using a published risk assessment algorithm (e.g. FRAX or Garvan) which incorporates BMD measurements (see Note); or 6 Patient has had a Special Authority approval for zoledronic acid (osteoporosis) or raloxifene. Initiation – glucocorticosteroid therapy Re-assessment required after 12 months Both: 1 The patient is receiving systemic glucocorticosteroid therapy (≥ 5 mg per day prednisone equivalents) and has already received or is expected to receive therapy for at least three months; and 2 Any of the following: 2.1 The patient has documented BMD ≥1.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤-1.5) (see Note); or 2.2 The patient has a history of one significant osteoporotic fracture demonstrated radiologically; or 2.3 The patient has had a Special Authority approval for zoledronic acid (glucocorticosteroid therapy) or raloxifene. Continuation – glucocorticosteroid therapy Re-assessment required after 12 months The patient is continuing systemic glucocorticosteriod therapy (≥ 5 mg per day prednisone equivalents) Notes: a) BMD (including BMD used to derive T-Score) must be measured using dual-energy x-ray absorptiometry (DXA). Quantitative ultrasound and quantitative computed tomography (QCT) are not acceptable. b) Evidence used by National Institute for Health and Clinical Excellence (NICE) guidance indicates that patients aged 75 years and over who have a history of significant osteoporotic fracture demonstrated radiologically are very likely to have a T-Score ≤ -2.5 and, therefore, do not require BMD measurement for treatment with bisphosphonates. c) Osteoporotic fractures are the incident events for severe (established) osteoporosis, and can be defined using the WHO definitions of osteoporosis and fragility fracture. The WHO defines severe (established) osteoporosis as a T-score below -2.5 with one or more associated fragility fractures. Fragility fractures are fractures that occur as a result of mechanical forces that would not ordinarily cause fracture (minimal trauma). The WHO has quantified this as forces equivalent to a fall from a standing height or less. d) In line with the Australian guidelines for funding alendronate, a vertebral fracture is defined as a 20% or greater reduction in height of the anterior or mid portion of a vertebral body relative to the posterior height of that body, or a 20% or greater reduction in any of these heights compared to the vertebral body above or below the affected vertebral body. ETIDRONATE DISODIUM Tab 200 mg – 1% DV Sep-12 to 2015 ....................................... 15.80 PAMIDRONATE DISODIUM Inj 3 mg per ml, 5 ml vial ............................................................ 18.75 Inj 3 mg per ml, 10 ml vial – 1% DV Feb-13 to 2014 .................. 16.00 Inj 6 mg per ml, 10 ml vial – 1% DV Feb-13 to 2014 .................. 32.00 Inj 9 mg per ml, 10 ml vial – 1% DV Feb-13 to 2014 .................. 48.00 100 1 1 1 1 Arrow-Etidronate Pamisol Pamidronate BNM Pamidronate BNM Pamidronate BNM

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

89


MUSCULOSKELETAL SYSTEM

Price (ex man. Excl. GST) $ Per ZOLEDRONIC ACID  Inj 0.05 mg per ml, 100 ml vial ................................................. 600.00 100 ml Brand or Generic Manufacturer Aclasta

Restricted Osteogenesis imperfecta Patient has been diagnosed with clinical or genetic osteogenesis imperfecta. Osteoporosis Both: 1 Any of the following: 1.1 History of one significant osteoporotic fracture demonstrated radiologically and documented bone mineral density (BMD) ≥ 2.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -2.5) (see Note); or 1.2 History of one significant osteoporotic fracture demonstrated radiologically, and either the patient is elderly, or densitometry scanning cannot be performed because of major logistical, technical or pathophysiological reasons. It is unlikely that this provision would apply to many patients under 75 years of age; or 1.3 History of two significant osteoporotic fractures demonstrated radiologically; or 1.4 Documented T-Score ≤ -3.0 (see Note); or 1.5 A 10-year risk of hip fracture ≥ 3%, calculated using a published risk assessment algorithm (e.g. FRAX or Garvan) which incorporates BMD measurements (see Note); or 1.6 Patient has had a Special Authority approval for alendronate (Underlying cause - Osteoporosis) or raloxifene; and 2 The patient will not be prescribed more than one infusion in a 12-month period. Initiation – glucocorticosteroid therapy Re-assessment required after 12 months All of the following: 1 The patient is receiving systemic glucocorticosteroid therapy (≥ 5 mg per day prednisone equivalents) and has already received or is expected to receive therapy for at least three months; and 2 Any of the following: 2.1 The patient has documented BMD ≥1.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤-1.5) (see Note); or 2.2 The patient has a history of one significant osteoporotic fracture demonstrated radiologically; or 2.3 The patient has had a Special Authority approval for alendronate (Underlying cause - glucocorticosteroid therapy) or raloxifene; and 3 The patient will not be prescribed more than one infusion in the 12-month approval period. Continuation – glucocorticosteroid therapy Re-assessment required after 12 months Both: 1 The patient is continuing systemic glucocorticosteriod therapy (≥ 5 mg per day prednisone equivalents); and 2 The patient will not be prescribed more than one infusion in the 12-month approval period. Initiation – Paget’s disease Re-assessment required after 12 months All of the following: 1 Paget’s disease; and 2 Any of the following: 2.1 Bone or articular pain; or 2.2 Bone deformity; or 2.3 Bone, articular or neurological complications; or 2.4 Asymptomatic disease, but risk of complications; or 2.5 Preparation for orthopaedic surgery; and 3 The patient will not be prescribed more than one infusion in the 12-month approval period. Continuation – Paget’s disease Re-assessment required after 12 months Both: 1 Any of the following: 1.1 The patient has relapsed (based on increases in serum alkaline phosphatase); or

continued...

90

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


MUSCULOSKELETAL SYSTEM

Price (ex man. Excl. GST) $ Per continued... 1.2 The patient’s serum alkaline phosphatase has not normalised following previous treatment with zoledronic acid; or 1.3 Symptomatic disease (prescriber determined); and 2 The patient will not be prescribed more than one infusion in the 12-month approval period. Notes: a) BMD (including BMD used to derive T-Score) must be measured using dual-energy x-ray absorptiometry (DXA). Quantitative ultrasound and quantitative computed tomography (QCT) are not acceptable. b) Evidence used by National Institute for Health and Clinical Excellence (NICE) guidance indicates that patients aged 75 years and over who have a history of significant osteoporotic fracture demonstrated radiologically are very likely to have a T-Score ≤ -2.5 and, therefore, do not require BMD measurement for treatment with bisphosphonates. c) Osteoporotic fractures are the incident events for severe (established) osteoporosis and can be defined using the WHO definitions of osteoporosis and fragility fracture. The WHO defines severe (established) osteoporosis as a T-score below -2.5 with one or more associated fragility fractures. Fragility fractures are fractures that occur as a result of mechanical forces that would not ordinarily cause fracture (minimal trauma). The WHO has quantified this as forces equivalent to a fall from a standing height or less. d) A vertebral fracture is defined as a 20% or greater reduction in height of the anterior or mid portion of a vertebral body relative to the posterior height of that body, or a 20% or greater reduction in any of these heights compared to the vertebral body above or below the affected vertebral body. Brand or Generic Manufacturer

Other Drugs Affecting Bone Metabolism

RALOXIFENE  Tab 60 mg ................................................................................. 53.76 28 Evista

Restricted Any of the following: 1 History of one significant osteoporotic fracture demonstrated radiologically and documented bone mineral density (BMD) ≥2.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -2.5) (see Notes); or 2 History of one significant osteoporotic fracture demonstrated radiologically, and either the patient is elderly, or densitometry scanning cannot be performed because of major logistical, technical or pathophysiological reasons. It is unlikely that this provision would apply to many patients under 75 years of age; or 3 History of two significant osteoporotic fractures demonstrated radiologically; or 4 Documented T-Score ≤ -3.0 (see Notes); or 5 A 10-year risk of hip fracture ≥ 3%, calculated using a published risk assessment algorithm (e.g. FRAX or Garvan) which incorporates BMD measurements (see Notes); or 6 Patient has had a prior Special Authority approval for zoledronic acid (Underlying cause - Osteoporosis) or alendronate (Underlying cause - Osteoporosis). Notes: a) BMD (including BMD used to derive T-Score) must be measured using dual-energy x-ray absorptiometry (DXA). Quantitative ultrasound and quantitative computed tomography (QCT) are not acceptable. b) Evidence used by the UK National Institute for Health and Clinical Excellence (NICE) in developing its guidance indicates that patients aged 75 years and over who have a history of significant osteoporotic fracture demonstrated radiologically are very likely to have a T-Score ≤ -2.5 and, therefore, do not require BMD measurement for raloxifene funding. c) Osteoporotic fractures are the incident events for severe (established) osteoporosis, and can be defined using the WHO definitions of osteoporosis and fragility fracture. The WHO defines severe (established) osteoporosis as a T-score below -2.5 with one or more associated fragility fractures. Fragility fractures are fractures that occur as a result of mechanical forces that would not ordinarily cause fracture (minimal trauma). The WHO has quantified this as forces equivalent to a fall from a standing height or less. d) A vertebral fracture is defined as a 20% or greater reduction in height of the anterior or mid portion of a vertebral body relative to the posterior height of that body, or a 20% or greater reduction in any of these heights compared to the vertebral body above or below the affected vertebral body.

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

91


MUSCULOSKELETAL SYSTEM

Price (ex man. Excl. GST) $ Per TERIPARATIDE  Inj 250 mcg per ml, 2.4 ml cartridge ......................................... 490.00 1 Brand or Generic Manufacturer Forteo

Restricted Limited to 18 months’ treatment All of the following: 1 The patient has severe, established osteoporosis; and 2 The patient has a documented T-score less than or equal to -3.0 (see Notes); and 3 The patient has had two or more fractures due to minimal trauma; and 4 The patient has experienced at least one symptomatic new fracture after at least 12 months’ continuous therapy with a funded antiresorptive agent at adequate doses (see Notes). Notes: a) The bone mineral density (BMD) measurement used to derive the T-score must be made using dual-energy x-ray absorptiometry (DXA). Quantitative ultrasound and quantitative computed tomography (QCT) are not acceptable. b) Antiresorptive agents and their adequate doses for the purposes of this restriction are defined as: alendronate sodium tab 70 mg or tab 70 mg with cholecalciferol 5,600 iu once weekly; raloxifene hydrochloride tab 60 mg once daily; zoledronic acid 5 mg per year. If an intolerance of a severity necessitating permanent treatment withdrawal develops during the use of one antiresorptive agent, an alternate antiresorptive agent must be trialled so that the patient achieves the minimum requirement of 12 months’ continuous therapy. c) A vertebral fracture is defined as a 20% or greater reduction in height of the anterior or mid portion of a vertebral body relative to the posterior height of that body, or a 20% or greater reduction in any of these heights compared to the vertebral body above or below the affected vertebral body.

ENZYMES

HYALURONIDASE Inj 1,500 iu ampoule

HYPERURICAEMIA AND ANTIGOUT

ALLOPURINOL Tab 100 mg – 1% DV Dec-11 to 2014 ....................................... 15.90 Tab 300 mg – 1% DV Dec-11 to 2014 ....................................... 16.75 BENZBROMARONE  Tab 100 mg ............................................................................... 45.00 1,000 500 100 Apo-Allopurinol Apo-Allopurinol Benzbromaron

Restricted Both: 1 Any of the following: 1.1 The patient has a serum urate level greater than 0.36 mmol/l despite treatment with allopurinol at doses of at least 600 mg/day and appropriate doses of probenecid: or 1.2 The patient has experienced intolerable side effects from allopurinol such that treatment discontinuation is required and serum urate remains greater than 0.36 mmol/l despite appropriate doses of probenecid; or 1.3 Both: 1.3.1 The patient has renal impairment and serum urate remains greater than 0.36 mmol/l despite optimal treatment with allopurinol (see Note); and 1.3.2 The patient has a rate of creatinine clearance greater than or equal to 20 ml/min; or 1.4 All of the following: 1.4.1 The patient is taking azathioprine and requires urate-lowering therapy; and 1.4.2 Allopurinol is contraindicated; and 1.4.3 Appropriate doses of probenecid are ineffective or probenecid cannot be used due to reduced renal function; and 2 The patient is receiving monthly liver function tests. Notes: Benzbromarone has been associated with potentially fatal hepatotoxicity. Optimal treatment with allopurinol in patients with renal impairment is defined as treatment to the creatinine clearance-adjusted dose of allopurinol then, if serum urate remains greater than 0.36 mmol/l, a gradual increase of the dose of allopurinol to 600 mg or the maximum tolerated dose.

92

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


MUSCULOSKELETAL SYSTEM

Price (ex man. Excl. GST) $ Per COLCHICINE Tab 500 mcg ............................................................................... 9.60 PROBENECID Tab 500 mg RASBURICASE  Inj 1.5 mg vial Restricted Haematologist 100 Brand or Generic Manufacturer Colgout

MUSCLE RELAXANTS AND RELATED AGENTS

ATRACURIUM BESYLATE Inj 10 mg per ml, 2.5 ml ampoule – 1% DV Sep-12 to 2015 ......... 6.13 Inj 10 mg per ml, 5 ml ampoule – 1% DV Sep-12 to 2015 ............ 9.19 BACLOFEN Tab 10 mg – 1% DV Jun-13 to 2016............................................ 3.85 Oral liq 1 mg per ml Inj 0.05 mg per ml, 1 ml ampoule – 1% DV Oct-12 to 2015........ 11.55 Inj 2 mg per ml, 5 ml ampoule – 1% DV Oct-12 to 2015........... 209.29 CLOSTRIDIUM BOTULINUM TYPE A TOXIN Inj 100 u vial ............................................................................ 467.50 Inj 500 u vial ......................................................................... 1,295.00 DANTROLENE Cap 25 mg ................................................................................. 65.00 Cap 50 mg ................................................................................. 77.00 Inj 20 mg vial MIVACURIUM CHLORIDE Inj 2 mg per ml, 5 ml ampoule .................................................... 33.92 Inj 2 mg per ml, 10 ml ampoule .................................................. 67.17 ORPHENADRINE CITRATE Tab 100 mg PANCURONIUM BROMIDE Inj 2 mg per ml, 2 ml ampoule – 1% DV Jan-13 to 2015 .......... 260.00 ROCURONIUM BROMIDE Inj 10 mg per ml, 5 ml vial – 1% DV Sep-12 to 2015 .................. 38.25 SUXAMETHONIUM CHLORIDE Inj 50 mg per ml, 2 ml ampoule ................................................ 130.00 VECURONIUM BROMIDE Inj 4 mg ampoule Inj 10 mg vial 50 10 AstraZeneca DBL Rocuronium Bromide AstraZeneca 5 5 100 1 1 1 2 100 100 Tracrium Tracrium Pacifen Lioresal Intrathecal Lioresal Intrathecal Botox Dysport Dantrium Dantrium (Dantrium IV) Mivacron Mivacron

5 5

50

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

93


MUSCULOSKELETAL SYSTEM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Reversers of Neuromuscular Blockade

SUGAMMADEX  Inj 100 mg per ml, 2 ml vial ................................................... 1,200.00  Inj 100 mg per ml, 5 ml vial ................................................... 3,000.00 10 10 Bridion Bridion

Restricted Any of the following: 1 Patient requires reversal of profound neuromuscular blockade following rapid sequence induction that has been undertaken using rocuronium (i.e. suxamethonium is contraindicated or undesirable); or 2 Patient has an unexpectedly difficult airway that cannot be intubated and requires a rapid reversal of anaesthesia and neuromuscular blockade; or 3 The duration of the patient’s surgery is unexpectedly short; or 4 Neostigmine or a neostigmine/anticholinergic combination is contraindicated (for example the patient has ischaemic heart disease, morbid obesity or COPD); or 5 Patient has a partial residual block after conventional reversal.

NON-STEROIDAL ANTI-INFLAMMATORY DRUGS

CELECOXIB  Cap 100 mg  Cap 200 mg  Cap 400 mg Restricted For preoperative and/or postoperative use for a total of up to 8 days’ use. DICLOFENAC SODIUM Tab EC 25 mg – 1% DV Mar-13 to 2015...................................... 4.00 Tab EC 50 mg – 1% DV Mar-13 to 2015.................................... 16.00 Tab 50 mg dispersible Tab long-acting 75 mg – 1% DV Dec-12 to 2015 ......................... 3.10 24.52 Tab long-acting 100 mg – 1% DV Dec-12 to 2015 ..................... 42.25 Suppos 12.5 mg – 1% DV Sep-11 to 2014 .................................. 1.85 Suppos 25 mg – 1% DV Sep-11 to 2014 ..................................... 2.22 Suppos 50 mg – 1% DV Sep-11 to 2014 ..................................... 3.84 Suppos 100 mg – 1% DV Sep-11 to 2014 ................................... 6.36 Inj 25 mg per ml, 3 ml ampoule – 1% DV Sep-11 to 2014 .......... 12.00 ETORICOXIB  Tab 30 mg  Tab 60 mg  Tab 90 mg  Tab 120 mg Restricted For preoperative and/or postoperative use for a total of up to 8 days’ use. IBUPROFEN Tab 200 mg  Tab 400 mg – Restricted: For continuation only  Tab 600 mg – Restricted: For continuation only Tab long-acting 800 mg – 1% DV Oct-11 to 2014 ........................ 8.12 Oral liq 20 mg per ml.................................................................... 2.69 Inj 5 mg per ml, 2 ml ampoule 100 500 30 500 500 10 10 10 10 5 Apo-Diclo Apo-Diclo Diclax SR Diclax SR Diclax SR Voltaren Voltaren Voltaren Voltaren Voltaren

30 200 ml

Brufen SR Fenpaed

94

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


MUSCULOSKELETAL SYSTEM

Price (ex man. Excl. GST) $ Per INDOMETHACIN Cap 25 mg Cap 50 mg Cap long-acting 75 mg Suppos 100 mg Inj 1 mg vial KETOPROFEN Cap long-acting 100 mg ............................................................. 21.56 Cap long-acting 200 mg ............................................................. 43.12 MEFENAMIC ACID  Cap 250 mg Restricted For continuation only MELOXICAM  Tab 7.5 mg Restricted Either: 1 Haemophilic arthropathy, with both of the following: 1.1 The patient has moderate to severe haemophilia with less than or equal to 5% of normal circulating functional clotting factor; and 1.2 Pain and inflammation associated with haemophilic arthropathy is inadequately controlled by alternative funded treatment options, or alternative funded treatment options are contraindicated; or 2 For preoperative and/or postoperative use for a total of up to 8 days’ use. NAPROXEN Tab 250 mg – 1% DV Jan-13 to 2015........................................ 21.25 Tab 500 mg – 1% DV Jan-13 to 2015........................................ 22.25 Tab long-acting 750 mg Tab long-acting 1 g PARECOXIB Inj 40 mg vial ........................................................................... 100.00 SULINDAC  Tab 100 mg  Tab 200 mg Restricted For continuation only TENOXICAM Tab 20 mg Inj 20 mg vial ............................................................................... 9.95 TIAPROFENIC ACID Tab 300 mg ............................................................................... 19.26 500 250 Noflam 250 Noflam 500 100 100 Oruvail SR Oruvail SR Brand or Generic Manufacturer

10

Dynastat

1 60

AFT Surgam

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

95


MUSCULOSKELETAL SYSTEM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

TOPICAL PRODUCTS FOR JOINT AND MUSCULAR PAIN

CAPSAICIN  Crm 0.025% ................................................................................ 9.95 45 g Zostrix

Restricted Patient has osteoarthritis that is not responsive to paracetamol and oral non-steroidal anti-inflammatories are contraindicated.

96

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


NERVOUS SYSTEM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

AGENTS FOR PARKINSONISM AND RELATED DISORDERS Agents for Essential Tremor, Chorea and Related Disorders

TETRABENAZINE Tab 25 mg – 1% DV Sep-13 to 2016 ....................................... 118.00 112 Motetis

Anticholinergics

BENZTROPINE MESYLATE Inj 1 mg per ml, 2 ml ampoule .................................................... 95.00 Tab 2 mg ..................................................................................... 7.99 ORPHENADRINE HYDROCHLORIDE Tab 50 mg PROCYCLIDINE HYDROCHLORIDE Tab 5 mg 5 60 Cogentin Benztrop

Dopamine Agonists and Related Agents

AMANTADINE HYDROCHLORIDE Cap 100 mg – 1% DV Sep-11 to 2014 ....................................... 38.24 APOMORPHINE HYDROCHLORIDE Inj 10 mg per ml, 1 ml ampoule Inj 10 mg per ml, 2 ml ampoule ................................................ 110.00 BROMOCRIPTINE Tab 2.5 mg Cap 5 mg ENTACAPONE Tab 200 mg – 1% DV Dec-12 to 2015 ....................................... 47.92 LEVODOPA WITH BENSERAZIDE Cap 50 mg with benserazide 12.5 mg........................................... 8.00 Tab dispersible 50 mg with benserazide 12.5 mg........................ 10.00 Cap 100 mg with benserazide 25 mg.......................................... 12.50 Cap long-acting 100 mg with benserazide 25 mg........................ 17.00 Cap 200 mg with benserazide 50 mg.......................................... 25.00 LEVODOPA WITH CARBIDOPA Tab 100 mg with carbidopa 25 mg ............................................. 20.00 Tab 250 mg with carbidopa 25 mg ............................................. 40.00 Tab long-acting 200 mg with carbidopa 50 mg ........................... 47.50 LISURIDE HYDROGEN MALEATE Tab 200 mcg ............................................................................. 25.00 PERGOLIDE Tab 0.25 mg – 1% DV Sep-11 to 2014 ...................................... 48.00 Tab 1 mg – 1% DV Sep-11 to 2014 ......................................... 170.00 100 100 100 100 100 100 100 100 100 30 100 100 Entapone Madopar 62.5 Madopar Dispersible Madopar 125 Madopar HBS Madopar 250 Sinemet (Sindopa) Sinemet (Sindopa) Sinemet CR Dopergin Permax Permax 60 Symmetrel

5

Apomine

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

97


NERVOUS SYSTEM

Price (ex man. Excl. GST) $ Per PRAMIPEXOLE HYDROCHLORIDE Tab 0.125 mg .............................................................................. 1.95 Tab 0.25 mg ................................................................................ 2.40 Tab 0.5 mg .................................................................................. 4.20 Tab 1 mg ..................................................................................... 7.20 ROPINIROLE HYDROCHLORIDE Tab 0.25 mg ................................................................................ 6.20 Tab 1 mg ................................................................................... 15.95 Tab 2 mg ................................................................................... 24.95 Tab 5 mg ................................................................................... 38.00 SELEGILINE HYDROCHLORIDE Tab 5 mg TOLCAPONE Tab 100 mg – 1% DV Sep-11 to 2014 ..................................... 126.20 100 Tasmar 30 30 30 30 Brand or Generic Manufacturer Dr Reddy’s Pramipexole Dr Reddy’s Pramipexole Dr Reddy’s Pramipexole Dr Reddy’s Pramipexole Ropin Ropin Ropin Ropin

84 84 84 84

ANAESTHETICS General Anaesthetics

DESFLURANE Soln for inhalation 100%, 240 ml bottle – 1% DV Dec-12 to 2015 ................................................. 1,230.00 DEXMEDETOMIDINE HYDROCHLORIDE Inj 100 mcg per ml, 2 ml vial ETOMIDATE Inj 2 mg per ml, 10 ml ampoule ISOFLURANE Soln for inhalation 100%, 250 ml bottle – 1% DV Dec-12 to 2015 ................................................. 1,020.00 KETAMINE HYDROCHLORIDE Inj 1 mg per ml, 100 bag Inj 4 mg per ml, 50 ml syringe Inj 10 mg per ml, 10 ml syringe Inj 100 mg per ml, 2 ml vial METHOHEXITAL SODIUM Inj 10 mg per ml, 50 ml vial

6

Suprane

6

Aerrane

98

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


NERVOUS SYSTEM

Price (ex man. Excl. GST) $ Per PROPOFOL Inj 10 mg per ml, 20 ml vial ........................................................ 42.00 7.60 Inj 10 mg per ml, 20 ml ampoule .................................................. 7.60 Inj 10 mg per ml, 50 ml vial ........................................................ 25.00 4.00 Inj 10 mg per ml, 50 ml syringe .................................................. 47.00 Inj 10 mg per ml, 100 ml vial ...................................................... 30.00 7.60 SEVOFLURANE Soln for inhalation 100%, 250 ml bottle – 1% DV Dec-12 to 2015 ................................................. 1,230.00 THIOPENTAL (THIOPENTONE) SODIUM Inj 500 mg ampoule 5 5 1 1 1 Brand or Generic Manufacturer Diprivan Provive MCT-LCT 1% Fresofol 1% Diprivan Fresofol 1% Provive MCT-LCT 1% Diprivan Diprivan Fresofol 1% Provive MCT-LCT 1%

6

Baxter

Local Anaesthetics

ARTICAINE HYDROCHLORIDE WITH ADRENALINE Inj 4% with adrenaline 1:100,000, 2.2 ml dental cartridge BENZOCAINE Gel 20% BUPIVACAINE HYDROCHLORIDE Inj 1.25 mg per ml, 100 ml bag Inj 1.25 mg per ml, 200 ml bag Inj 2.5 mg per ml, 20 ml ampoule – 1% DV Oct-12 to 2015........ 35.00 Inj 2.5 mg per ml, 100 ml bag .................................................. 150.00 Inj 2.5 mg per ml, 200 ml bag Inj 5 mg per ml, 4 ml ampoule .................................................... 50.00 Inj 5 mg per ml, 10 ml ampoule .................................................. 35.00 Inj 5 mg per ml, 10 ml ampoule – 1% DV Oct-12 to 2015........... 28.00 Inj 5 mg per ml, 20 ml ampoule – 1% DV Oct-12 to 2015........... 28.00 Note: DV limit applies to theatre packs only. BUPIVACAINE HYDROCHLORIDE WITH ADRENALINE Inj 2.5 mg per ml with adrenaline 1:400,000, 20 ml vial – 1% DV Nov-11 to 2014 .................................................... 135.00 Inj 5 mg per ml with adrenaline 1:200,000, 20 ml vial – 1% DV Nov-11 to 2014 .................................................... 115.00

5 5 5 50 5 5

Marcain Marcain Marcain Isobaric Marcain Marcain Marcain

5 5

Marcain with Adrenaline Marcain with Adrenaline

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

99


NERVOUS SYSTEM

Price (ex man. Excl. GST) $ Per BUPIVACAINE HYDROCHLORIDE WITH FENTANYL Inj 0.625 mg with fentanyl 2 mcg per ml, 100 ml bag Inj 1.25 mg with fentanyl 2 mcg per ml, 15 ml syringe – 1% DV Nov-11 to 2014 ...................................................... 72.00 Inj 1.25 mg with fentanyl 2 mcg per ml, 20 ml syringe – 1% DV Nov-11 to 2014 ...................................................... 92.00 Inj 1.25 mg with fentanyl 2 mcg per ml, 50 ml syringe Inj 1.25 mg with fentanyl 2 mcg per ml, 100 ml bag – 1% DV Nov-11 to 2014 .................................................... 210.00 Inj 1.25 mg with fentanyl 2 mcg per ml, 100 ml syringe Inj 1.25 mg with fentanyl 2 mcg per ml, 200 ml bag – 1% DV Nov-11 to 2014 .................................................... 210.00 BUPIVACAINE HYDROCHLORIDE WITH GLUCOSE Inj 0.5% with glucose 8%, 4 ml ampoule..................................... 38.00 COCAINE HYDROCHLORIDE Paste 5% Soln 4%, 2 ml syringe ................................................................ 25.46 Soln 15%, 2 ml syringe COCAINE HYDROCHLORIDE WITH ADRENALINE Paste 15% with adrenaline 0.06% Paste 25% with adrenaline 0.06% ETHYL CHLORIDE Spray 100% LIDOCAINE [LIGNOCAINE] HYDROCHLORIDE Inj 1%, 5 ml ampoule – 1% DV Jul-13 to 2015 ............................. 8.75 Inj 1%, 20 ml ampoule – 1% DV Jul-13 to 2015 ........................... 2.40 Inj 2%, 5 ml ampoule – 1% DV Jul-13 to 2015 ............................. 6.90 Inj 2%, 20 ml ampoule – 1% DV Jul-13 to 2015 ........................... 2.40 Gel 2%, 10 ml urethral syringe .................................................... 43.26 Gel 2% – 1% DV Oct-12 to 2015 .................................................. 3.40 Oral (viscous) soln 2% – 1% DV Sep-11 to 2014 ....................... 55.00 Spray 10% – 1% DV Sep-13 to 2016 ......................................... 75.00 Soln 4% LIDOCAINE [LIGNOCAINE] HYDROCHLORIDE WITH ADRENALINE Inj 1% with adrenaline 1:100,000, 5 ml ampoule ......................... 27.00 Inj 1% with adrenaline 1:200,000, 20 ml vial ............................... 50.00 Inj 2% with adrenaline 1:200,000, 20 ml vial ............................... 60.00 Inj 2% with adrenaline 1:80,000, 1.7 ml dental cartridge Inj 2% with adrenaline 1:80,000, 1.8 ml dental cartridge Inj 2% with adrenaline 1:80,000, 2.2 ml dental cartridge 25 1 25 1 10 20 ml 200 ml 50 ml Lidocaine-Claris Lidocaine-Claris Lidocaine-Claris Lidocaine-Claris Pfizer Orion Xylocaine Viscous Xylocaine Brand or Generic Manufacturer

10 10 10 10 5

Biomed Biomed Bupafen Bupafen Marcain Heavy

1

Biomed

10 5 5

Xylocaine Xylocaine Xylocaine

LIDOCAINE [LIGNOCAINE] HYDROCHLORIDE WITH ADRENALINE AND TETRACAINE HYDROCHLORIDE Soln 4% with adrenaline 0.1% and tetracaine hydrochloride 0.5%, 5 ml syringe LIDOCAINE [LIGNOCAINE] HYDROCHLORIDE WITH CHLORHEXIDINE Gel 2% with chlorhexidine 0.05%, 10 ml urethral syringe............. 43.26 10 Pfizer

100

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


NERVOUS SYSTEM

Price (ex man. Excl. GST) $ Per LIDOCAINE [LIGNOCAINE] HYDROCHLORIDE WITH PHENYLEPHRINE HYDROCHLORIDE Nasal spray 5% with phenylephrine hydrochloride 0.5% LIDOCAINE [LIGNOCAINE] WITH PRILOCAINE Crm 2.5% with prilocaine 2.5%, 5 g ............................................ 45.00 Crm 2.5% with prilocaine 2.5% ................................................... 45.00 Patch 25 mcg with prilocaine 25 mcg....................................... 115.00 MEPIVACAINE HYDROCHLORIDE Inj 3%, 1.8 ml dental cartridge Inj 3%, 2.2 ml dental cartridge PRILOCAINE HYDROCHLORIDE Inj 0.5%, 50 ml vial .................................................................. 100.00 Inj 2%, 5 ml ampoule ................................................................. 55.00 PRILOCAINE HYDROCHLORIDE WITH FELYPRESSIN Inj 3% with felypressin 0.03 iu per ml, 1.8 ml dental cartridge Inj 3% with felypressin 0.03 iu per ml, 2.2 ml dental cartridge ROPIVACAINE HYDROCHLORIDE Inj 2 mg per ml, 10 ml ampoule Inj 2 mg per ml, 20 ml ampoule .................................................. 75.00 Inj 2 mg per ml, 100 ml bag ..................................................... 200.00 Inj 2 mg per ml, 200 ml bag ..................................................... 265.00 Inj 7.5 mg per ml, 10 ml ampoule ............................................... 45.00 Inj 7.5 mg per ml, 20 ml ampoule ............................................... 84.00 Inj 10 mg per ml, 10 ml ampoule ................................................ 54.00 Inj 10 mg per ml, 20 ml ampoule ROPIVACAINE HYDROCHLORIDE WITH FENTANYL Inj 2 mg with fentanyl 2 mcg per ml, 100 ml bag ...................... 198.50 Inj 2 mg with fentanyl 2 mcg per ml, 200 ml bag ...................... 270.00 TETRACAINE (AMETHOCAINE) HYDROCHLORIDE Gel 4% 5 10 Citanest Citanest 5 30 g 20 EMLA EMLA EMLA Brand or Generic Manufacturer

5 5 5 5 5 5

Naropin Naropin Naropin Naropin Naropin Naropin

5 5

Naropin Naropin

ANALGESICS Non-Opioid Analgesics

ASPIRIN Tab dispersible 300 mg Tab EC 300 mg CAPSAICIN  Crm 0.075% .............................................................................. 12.50 Restricted For post-herpetic neuralgia or diabetic peripheral neuropathy 45 g Zostrix HP

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

101


NERVOUS SYSTEM

Price (ex man. Excl. GST) $ Per METHOXYFLURANE  for inhalation 99.9%, 3 ml bottle Soln Restricted Both: 1 Patient is undergoing a painful procedure with an expected duration of less than one hour; and 2 Only to be used under supervision by a medical practitioner or nurse who is trained in the use of methoxyflurane. NEFOPAM HYDROCHLORIDE Tab 30 mg PARACETAMOL Tab 500 mg Tab soluble 500 mg Oral liq 120 mg per 5 ml – 20% DV Dec-11 to 2014..................... 2.21 Oral liq 250 mg per 5 ml – 20% DV Dec-11 to 2014..................... 6.70 Suppos 25 mg ........................................................................... 56.35 Suppos 50 mg ........................................................................... 56.35 Suppos 125 mg ........................................................................... 7.49 Suppos 250 mg ......................................................................... 14.40 Suppos 500 mg – 1% DV Jan-13 to 2015.................................. 20.70  Inj 10 mg per ml, 50 ml vial  Inj 10 mg per ml, 100 ml vial – 1% DV Apr-13 to 2014 .............. 22.50 Brand or Generic Manufacturer

500 ml 1,000 ml 20 20 20 20 50 10

Ethics Paracetamol Paracare Double Strength Biomed Biomed Panadol Panadol Paracare Paracetamol-AFT

Restricted Intravenous paracetamol is only to be used where other routes are unavailable or impractical, or where there is reduced absorption. The need for IV paracetamol must be re-assessed every 24 hours. SUCROSE Oral liq 25%

Opioid Analgesics

ALFENTANIL HYDROCHLORIDE Inj 0.5 mg per ml, 2 ml ampoule CODEINE PHOSPHATE Tab 15 mg – 1% DV Jul-13 to 2016............................................. 4.75 Tab 30 mg – 1% DV Jul-13 to 2016............................................. 5.80 Tab 60 mg – 1% DV Jul-13 to 2016........................................... 12.50 DIHYDROCODEINE TARTRATE Tab long-acting 60 mg – 1% DV Sep-13 to 2016 ....................... 13.64 FENTANYL Patch 12.5 mcg per hour.............................................................. 8.90 Patch 25 mcg per hour................................................................. 9.15 Patch 50 mcg per hour............................................................... 11.50 Patch 75 mcg per hour............................................................... 13.60 Patch 100 mcg per hour............................................................. 14.50 Inj 10 mcg per ml, 10 ml syringe Inj 10 mcg per ml, 50 ml bag – 1% DV Dec-11 to 2014 ........... 210.00 Inj 10 mcg per ml, 50 ml syringe – 1% DV Dec-11 to 2014 ...... 165.00 Inj 10 mcg per ml, 100 ml bag – 1% DV Dec-11 to 2014 ......... 210.00 Inj 20 mcg per ml, 50 ml syringe – 1% DV Dec-11 to 2014 ..... 185.00 100 100 100 60 5 5 5 5 5 10 10 10 10 PSM PSM PSM DHC Continus Mylan Fentanyl Patch Mylan Fentanyl Patch Mylan Fentanyl Patch Mylan Fentanyl Patch Mylan Fentanyl Patch Biomed Biomed Biomed Biomed

continued...

102

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


NERVOUS SYSTEM

Price (ex man. Excl. GST) $ Per continued... Inj 20 mcg per ml, 100 ml bag Inj 50 mcg per ml, 2 ml ampoule – 1% DV Sep-12 to 2015 .......... 4.50 Inj 50 mcg per ml, 10 ml ampoule – 1% DV Sep-12 to 2015 ...... 11.77 METHADONE HYDROCHLORIDE Tab 5 mg ..................................................................................... 1.85 Oral liq 2 mg per ml – 1% DV Sep-12 to 2015.............................. 5.55 Oral liq 5 mg per ml – 1% DV Sep-12 to 2015.............................. 5.55 Oral liq 10 mg per ml – 1% DV Sep-12 to 2015............................ 6.55 Inj 10 mg per ml, 1 ml vial .......................................................... 61.00 MORPHINE HYDROCHLORIDE Oral liq 1 mg per ml – 1% DV Oct-12 to 2015 .............................. 8.84 Oral liq 2 mg per ml – 1% DV Oct-12 to 2015 ............................ 11.62 Oral liq 5 mg per ml – 1% DV Oct-12 to 2015 ............................ 14.65 Oral liq 10 mg per ml – 1% DV Oct-12 to 2015 .......................... 21.55 MORPHINE SULPHATE Tab immediate-release 10 mg ...................................................... 2.80 Tab immediate-release 20 mg ...................................................... 5.52 Tab long-acting 10 mg – 1% DV Sep-13 to 2016 ......................... 1.95 Tab long-acting 30 mg – 1% DV Sep-13 to 2016 ......................... 2.98 Tab long-acting 60 mg – 1% DV Sep-13 to 2016 ......................... 5.75 Tab long-acting 100 mg – 1% DV Sep-13 to 2016 ....................... 6.45 Cap long-acting 10 mg ................................................................. 2.22 Cap long-acting 30 mg ................................................................. 3.20 Cap long-acting 60 mg ................................................................. 6.90 Cap long-acting 100 mg ............................................................... 8.05 Inj 200 mcg in 0.4 ml syringe Inj 300 mcg in 0.3 ml syringe Inj 1 mg per ml, 2 ml syringe Inj 1 mg per ml, 10 ml syringe – 1% DV Dec-11 to 2014 ............ 39.50 Inj 1 mg per ml, 50 ml syringe – 1% DV Dec-11 to 2014 ............ 79.50 Inj 1 mg per ml, 100 ml bag – 1% DV Dec-11 to 2014 ............. 165.00 Inj 2 mg per ml, 30 ml syringe – 1% DV Dec-11 to 2014 .......... 135.00 Inj 5 mg per ml, 1 ml ampoule – 1% DV Nov-11 to 2014 .............. 5.51 Inj 10 mg per ml, 1 ml ampoule – 1% DV Nov-11 to 2014 ............ 4.79 Inj 10 mg per ml, 100 ml bag Inj 10 mg per ml, 100 mg cassette Inj 15 mg per ml, 1 ml ampoule – 1% DV Nov-11 to 2014 ............ 5.01 Inj 30 mg per ml, 1 ml ampoule – 1% DV Nov-11 to 2014 ............ 5.30 MORPHINE TARTRATE Inj 80 mg per ml, 1.5 ml ampoule – 1% DV Sep-13 to 2016 ....... 35.60 Inj 80 mg per ml, 5 ml ampoule – 1% DV Sep-13 to 2016 ........ 107.67 10 10 10 200 ml 200 ml 200 ml 10 200 ml 200 ml 200 ml 200 ml 10 10 10 10 10 10 10 10 10 10 Boucher and Muir Boucher and Muir Methatabs Biodone Biodone Forte Biodone Extra Forte AFT RA-Morph RA-Morph RA-Morph RA-Morph Sevredol Sevredol Arrow-Morphine LA Arrow-Morphine LA Arrow-Morphine LA Arrow-Morphine LA m-Elson m-Elson m-Elson m-Elson Brand or Generic Manufacturer

10 10 10 10 5 5

Biomed Biomed Biomed Biomed DBL Morphine Sulphate DBL Morphine Sulphate DBL Morphine Sulphate DBL Morphine Sulphate Hospira Hospira

5 5

5 5

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

103


NERVOUS SYSTEM

Price (ex man. Excl. GST) $ Per OXYCODONE HYDROCHLORIDE Cap 5 mg ..................................................................................... 2.83 Cap 10 mg ................................................................................... 5.58 Cap 20 mg ................................................................................... 9.77 Oral liq 5 mg per 5 ml................................................................. 11.20 Tab controlled-release 5 mg ......................................................... 7.51 Tab controlled-release 10 mg ..................................................... 11.14 Tab controlled-release 20 mg ..................................................... 18.93 Tab controlled-release 40 mg ..................................................... 33.29 Tab controlled-release 80 mg ..................................................... 58.03 Inj 1 mg per ml, 100 ml bag Inj 10 mg per ml, 1 ml ampoule – 1% DV Dec-12 to 2015 .......... 10.08 Inj 10 mg per ml, 2 ml ampoule – 1% DV Dec-12 to 2015 .......... 19.87 Inj 50 mg per ml, 1 ml ampoule – 1% DV May-13 to 2015 ......... 60.00 PARACETAMOL WITH CODEINE Tab paracetamol 500 mg with codeine phosphate 8 mg – 1% DV Nov-11 to 2014 ........................................................ 2.70 PETHIDINE HYDROCHLORIDE Tab 50 mg – 1% DV Mar-13 to 2015 ........................................... 3.95 Tab 100 mg – 1% DV Mar-13 to 2015 ......................................... 5.80 Inj 5 mg per ml, 10 ml syringe Inj 5 mg per ml, 100 ml bag Inj 10 mg per ml, 50 ml syringe Inj 10 mg per ml, 100 ml bag Inj 50 mg per ml, 1 ml ampoule – 1% DV Nov-11 to 2014 ............ 5.51 Inj 50 mg per ml, 2 ml ampoule – 1% DV Nov-11 to 2014 ............ 5.83 REMIFENTANIL HYDROCHLORIDE Inj 1 mg vial – 1% DV Feb-12 to 2014 ....................................... 27.95 Inj 2 mg vial – 1% DV Feb-12 to 2014 ....................................... 41.80 TRAMADOL HYDROCHLORIDE Cap 50 mg – 1% DV Sep-11 to 2014 ........................................... 4.95 Tab sustained-release 100 mg ..................................................... 2.14 Tab sustained-release 150 mg ..................................................... 3.21 Tab sustained-release 200 mg ..................................................... 4.28 Oral drops 100 mg per ml Inj 10 mg per ml, 100 ml bag Inj 50 mg per ml, 1 ml ampoule .................................................... 4.50 Inj 50 mg per ml, 2 ml ampoule .................................................... 4.50 20 20 20 250 ml 20 20 20 20 20 5 5 5 Brand or Generic Manufacturer OxyNorm OxyNorm OxyNorm OxyNorm OxyContin OxyContin OxyContin OxyContin OxyContin Oxycodone Orion Oxycodone Orion OxyNorm

100

Paracetamol + Codeine (Relieve) PSM PSM

10 10

5 5

DBL Pethidine Hydrochloride DBL Pethidine Hydrochloride Remifentanil-AFT Remifentanil-AFT Arrow-Tramadol Tramal SR 100 Tramal SR 150 Tramal SR 200 Tramal 50 Tramal 100

5 5 100 20 20 20 5 5

ANTIDEPRESSANTS Cyclic and Related Agents

AMITRIPTYLINE Tab 10 mg – 1% DV Jan-13 to 2014............................................ 3.32 Tab 25 mg – 1% DV Jun-11 to 2014............................................ 1.85 Tab 50 mg – 1% DV Jun-11 to 2014............................................ 3.60 100 100 100 Arrow-Amitriptyline Amitrip Amitrip

104

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


NERVOUS SYSTEM

Price (ex man. Excl. GST) $ Per CLOMIPRAMINE HYDROCHLORIDE Tab 10 mg – 1% DV Jan-13 to 2015.......................................... 12.60 Tab 25 mg – 1% DV Jan-13 to 2015............................................ 8.68 DOTHIEPIN HYDROCHLORIDE Cap 25 mg ................................................................................... 6.17 Tab 75 mg ................................................................................. 10.50 DOXEPIN HYDROCHLORIDE Cap 10 mg Cap 25 mg Cap 50 mg IMIPRAMINE HYDROCHLORIDE Tab 10 mg ................................................................................... 5.48 Tab 25 mg ................................................................................... 8.80 MAPROTILINE HYDROCHLORIDE Tab 25 mg Tab 75 mg MIANSERIN HYDROCHLORIDE  Tab 30 mg Restricted Either: 1 Both: 1.1 Depression; and 1.2 Either: 1.2.1 Co-existent bladder neck obstruction; or 1.2.2 Cardiovascular disease; or 2 Both: 2.1 The patient has a severe major depressive episode; and 2.2 Either: 2.2.1 The patient must have had a trial of two different antidepressants and was unable to tolerate the treatments or failed to respond to an adequate dose over an adequate period of time (usually at least four weeks); or 2.2.2 Both: 2.2.2.1 The patient is currently a hospital in-patient as a result of an acute depressive episode; and 2.2.2.2 The patient must have had a trial of one other antidepressant and either could not tolerate it or failed to respond to an adequate dose over an adequate period of time. NORTRIPTYLINE HYDROCHLORIDE Tab 10 mg – 1% DV Jun-13 to 2016............................................ 4.00 Tab 25 mg – 1% DV Jun-13 to 2016............................................ 9.00 100 180 Norpress Norpress 50 50 Tofranil Tofranil 100 100 100 100 Brand or Generic Manufacturer Apo-Clomipramine Apo-Clomipramine Dopress Dopress

Monoamine-Oxidase Inhibitors – Non-Selective

PHENELZINE SULPHATE Tab 15 mg TRANYLCYPROMINE SULPHATE Tab 10 mg

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

105


NERVOUS SYSTEM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Monoamine-Oxidase Type A Inhibitors

MOCLOBEMIDE Tab 150 mg – 1% DV Apr-13 to 2015 ........................................ 81.83 Tab 300 mg – 1% DV Apr-13 to 2015 ........................................ 29.51 500 100 Apo-Moclobemide Apo-Moclobemide

Other Antidepressants

MIRTAZAPINE  Tab 30 mg – 1% DV Sep-12 to 2015 ........................................... 8.78  Tab 45 mg – 1% DV Sep-12 to 2015 ......................................... 13.95 30 30 Avanza Avanza

Restricted Initiation Re-assessment required after two years Both: 1 The patient has a severe major depressive episode; and 2 Either: 2.1 The patient must have had a trial of two different antidepressants and was unable to tolerate the treatments or failed to respond to an adequate dose over an adequate period of time (usually at least four weeks); or 2.2 Both: 2.2.1 The patient is currently a hospital in-patient as a result of an acute depressive episode; and 2.2.2 The patient must have had a trial of one other antidepressant and either could not tolerate it or failed to respond to an adequate dose over an adequate period of time. Continuation Re-assessment required after two years The patient has a high risk of relapse (prescriber determined) VENLAFAXINE  Cap modified release 37.5 mg ...................................................... 8.71  Cap modified release 75 mg ....................................................... 17.42  Cap modified release 150 mg ..................................................... 21.35  Tab modified release 37.5 mg ...................................................... 7.84  Tab modfied release 75 mg ........................................................ 13.94  Tab modified release 150 mg ..................................................... 17.08  Tab modified release 225 mg ..................................................... 27.14 28 28 28 28 28 28 28 Efexor XR Efexor XR Efexor XR Arrow-Venlafaxine XR Arrow-Venlafaxine XR Arrow-Venlafaxine XR Arrow-Venlafaxine XR

Restricted Initiation Re-assessment required after two years Both: 1 The patient has ‘treatment-resistant’ depression; and 2 Either: 2.1 The patient must have had a trial of two different antidepressants and have had an inadequate response from an adequate dose over an adequate period of time (usually at least four weeks); or 2.2 Both: 2.2.1 The patient is currently a hospital in-patient as a result of an acute depressive episode; and 2.2.2 The patient must have had a trial of one other antidepressant and have had an inadequate response from an adequate dose over an adequate period of time. Continuation Re-assessment required after two years The patient has a high risk of relapse (prescriber determined)

106

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


NERVOUS SYSTEM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Selective Serotonin Reuptake Inhibitors

CITALOPRAM HYDROBROMIDE Tab 20 mg – 1% DV Sep-11 to 2014 ........................................... 2.34 ESCITALOPRAM Tab 10 mg ................................................................................... 2.65 Tab 20 mg ................................................................................... 4.20 FLUOXETINE HYDROCHLORIDE Cap 20 mg ................................................................................... 2.70 Tab dispersible 20 mg, scored ..................................................... 2.50 PAROXETINE HYDROCHLORIDE Tab 20 mg ................................................................................... 2.38 SETRALINE Tab 50 mg – 1% DV Sep-13 to 2016 ........................................... 3.64 Tab 100 mg – 1% DV Sep-13 to 2016 ......................................... 6.28 84 28 28 84 30 30 90 90 Arrow-Citalopram Loxalate Loxalate Fluox Fluox Loxamine Arrow-Sertraline Arrow-Sertraline

ANTIEPILEPSY DRUGS Agents for the Control of Status Epilepticus

CLONAZEPAM Inj 1 mg per ml, 1 ml ampoule .................................................... 19.00 DIAZEPAM Rectal tubes 5 mg ...................................................................... 25.05 Rectal tubes 10 mg .................................................................... 30.50 Inj 5 mg per ml, 2 ml ampoule ...................................................... 9.24 LORAZEPAM Inj 2 mg vial Inj 4 mg per ml, 1 ml vial PARALDEHYDE Inj 5 mg ampoule PHENYTOIN SODIUM Inj 50 mg per ml, 2 ml ampoule Inj 50 mg per ml, 5 ml ampoule 5 5 5 5 Rivotril Stesolid Stesolid Mayne

Control of Epilepsy

CARBAMAZEPINE Oral liq 20 mg per ml Tab 200 mg Tab 400 mg Tab long-acting 200 mg Tab long-acting 400 mg CLOBAZAM Tab 10 mg

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

107


NERVOUS SYSTEM

Price (ex man. Excl. GST) $ Per CLONAZEPAM Oral drops 2.5 mg per ml ETHOSUXIMIDE Cap 250 mg Oral liq 50 mg per ml GABAPENTIN  Cap 100 mg ................................................................................. 7.16  Cap 300 mg ............................................................................... 11.50  Cap 400 mg ............................................................................... 14.75  Tab 600 mg Restricted For preoperative and/or postoperative use for up to a total of 8 days’ use Initiation – epilepsy Re-assessment required after 15 months Either: 1 Seizures are not adequately controlled with optimal treatment with other antiepilepsy agents; or 2 Seizures are controlled adequately but the patient has experienced unacceptable side effects from optimal treatment with other antiepilepsy agents. Note: “Optimal treatment with other antiepilepsy agents” is defined as treatment with other antiepilepsy agents which are indicated and clinically appropriate for the patient, given in adequate doses for the patient’s age, weight, and other features affecting the pharmacokinetics of the drug with good evidence of compliance. Continuation – epilepsy Patient has demonstrated a significant and sustained improvement in seizure rate or severity and/or quality of life. Note: As a guideline, clinical trials have referred to a notional 50% reduction in seizure frequency as an indicator of success with anticonvulsant therapy and have assessed quality of life from the patient’s perspective. Initiation – neuropathic pain Re-assessment required after 3 months Patient has tried and failed, or has been unable to tolerate, treatment with a tricyclic antidepressant. Continuation – neuropathic pain Either: 1 The patient has demonstrated a marked improvement in their control of pain (prescriber determined); or 2 The patient has previously demonstrated clinical responsiveness to gabapentin and has now developed neuropathic pain in a new site. LACOSAMIDE  Tab 50 mg ................................................................................. 25.04  Tab 100 mg ............................................................................... 50.06 200.24  Tab 150 mg ............................................................................... 75.10 300.40  Tab 200 mg ............................................................................. 400.55  Inj 10 mg per ml, 20 ml vial 14 14 56 14 56 56 Vimpat Vimpat Vimpat Vimpat Vimpat Vimpat 100 100 100 Nupentin Nupentin Nupentin Brand or Generic Manufacturer

Restricted Initiation Re-assessment required after 15 months Both: 1 Patient has partial-onset epilepsy; and 2 Seizures are not adequately controlled by, or patient has experienced unacceptable side effects from, optimal treatment with all of the following: sodium valproate, topiramate, levetiracetam and any two of carbamazepine, lamotrigine and phenytoin sodium (see Note). continued...

108

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


NERVOUS SYSTEM

Price (ex man. Excl. GST) $ Per continued... Note: “Optimal treatment” is defined as treatment which is indicated and clinically appropriate for the patient, given in adequate doses for the patient’s age, weight and other features affecting the pharmacokinetics of the drug with good evidence of compliance. Women of childbearing age are not required to have a trial of sodium valproate. Continuation Patient has demonstrated a significant and sustained improvement in seizure rate or severity and/or quality of life compared with that prior to starting lacosamide treatment (see Note). Note: As a guideline, clinical trials have referred to a notional 50% reduction in seizure frequency as an indicator of success with anticonvulsant therapy and have assessed quality of life from the patient’s perspective. LAMOTRIGINE Tab dispersible 2 mg .................................................................... 6.74 Tab dispersible 5 mg .................................................................... 9.64 15.00 Tab dispersible 25 mg ................................................................ 20.40 29.09 19.38 20.40 Tab dispersible 50 mg ................................................................ 34.70 47.89 32.97 34.70 Tab dispersible 100 mg .............................................................. 59.90 79.16 56.91 59.90 LEVETIRACETAM Tab 250 mg ............................................................................... 24.03 Tab 500 mg ............................................................................... 28.71 Tab 750 mg ............................................................................... 45.23 Inj 100 mg per ml, 5 ml vial PHENOBARBITONE Tab 15 mg – 1% DV Mar-13 to 2015 ......................................... 28.00 Tab 30 mg – 1% DV Mar-13 to 2015 ......................................... 29.00 PHENYTOIN Tab 50 mg PHENYTOIN SODIUM Cap 30 mg Cap 100 mg Oral liq 6 mg per ml PRIMIDONE Tab 250 mg SODIUM VALPROATE Tab 100 mg Tab EC 200 mg Tab EC 500 mg Oral liq 40 mg per ml Inj 100 mg per ml, 4 ml vial

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

Brand or Generic Manufacturer

30 30 56 56

56

56

Lamictal Lamictal Arrow-Lamotrigine Arrow-Lamotrigine Lamictal Logem Mogine Arrow-Lamotrigine Lamictal Logem Mogine Arrow-Lamotrigine Lamictal Logem Mogine Levetiracetam-Rex Levetiracetam-Rex Levetiracetam-Rex

60 60 60

500 500

PSM PSM

109


NERVOUS SYSTEM

Price (ex man. Excl. GST) $ Per STIRIPENTOL  Cap 250 mg ............................................................................. 509.29  Powder for oral liq 250 mg sachet ............................................ 509.29 Restricted Paediatric neurologist Initiation Re-assessment required after 6 months Both: 1 Patient has confirmed diagnosis of Dravet syndrome; and 2 Seizures have been inadequately controlled by appropriate courses of sodium valproate, clobazam and at least two of the following: topiramate, levetiracetam, ketogenic diet. Continuation Patient continues to benefit from treatment as measured by reduced seizure frequency from baseline. TOPIRAMATE Tab 25 mg ................................................................................. 11.07 26.04 Tab 50 mg ................................................................................. 18.81 44.26 Tab 100 mg ............................................................................... 31.99 75.25 Tab 200 mg ............................................................................... 55.19 129.85 Cap sprinkle 15 mg .................................................................... 20.84 Cap sprinkle 25 mg .................................................................... 26.04 VIGABATRIN  Tab 500 mg Restricted Both: 1 Either: 1.1 Patient has infantile spasms; or 1.2 Both: 1.2.1 Patient has epilepsy; and 1.2.2 Either: 1.2.2.1 Seizures are not adequately controlled with optimal treatment with other antiepilepsy agents; or 1.2.2.2 Seizures are controlled adequately but the patient has experienced unacceptable side effects from optimal treatment with other antiepilepsy agents; and 2 Either: 2.1 Patient is, or will be, receiving regular automated visual field testing (ideally before starting therapy and on a 6-monthly basis thereafter); or 2.2 It is impractical or impossible (due to comorbid conditions) to monitor the patient’s visual fields. Notes: “Optimal treatment with other antiepilepsy agents” is defined as treatment with other antiepilepsy agents which are indicated and clinically appropriate for the patient, given in adequate doses for the patient’s age, weight, and other features affecting the pharmacokinetics of the drug with good evidence of compliance. Vigabatrin is associated with a risk of irreversible visual field defects, which may be asymptomatic in the early stages. 60 60 60 60 60 60 Arrow-Topiramte Topamax Arrow-Topiramte Topamax Arrow-Topiramte Topamax Arrow-Topiramte Topamax Topamax Topamax 60 60 Brand or Generic Manufacturer Diacomit Diacomit

110

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


NERVOUS SYSTEM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

ANTIMIGRAINE PREPARATIONS Acute Migraine Treatment

DIHYDROERGOTAMINE MESYLATE Inj 1 mg per ml, 1 ml ampoule ERGOMETRINE TARTRATE WITH CAFFEINE Tab 1 mg with caffeine 100 mg METOCLOPRAMIDE HYDROCHLORIDE WITH PARACETAMOL Tab 5 mg with paracetamol 500 mg RIZATRIPTAN BENZOATE Tab orodispersible 10 mg – 1% DV May-12 to 2014 .................. 18.00 SUMATRIPTAN Tab 50 mg ................................................................................. 38.83 Tab 100 mg ............................................................................... 77.66 Inj 12 mg per ml, 0.5 ml cartridge............................................... 36.00 30 100 100 2 Rizamelt Arrow-Sumatriptan Arrow-Sumatriptan Arrow-Sumatriptan

Prophylaxis of Migraine

PIZOTIFEN Tab 500 mcg – 1% DV Mar-13 to 2015 ..................................... 23.21 100 Sandomigran

ANTINAUSEA AND VERTIGO AGENTS

APREPITANT  Cap 2 x 80 mg with 1 x 125 mg ............................................... 116.00 3 Emend Tri-Pack

Restricted Patient is undergoing highly emetogenic chemotherapy and/or anthracycline-based chemotherapy for the treatment of malignancy. BETAHISTINE DIHYDROCHLORIDE Tab 16 mg ................................................................................. 10.00 CYCLIZINE HYDROCHLORIDE Tab 50 mg – 1% DV Sep-12 to 2015 ........................................... 0.59 CYCLIZINE LACTATE Inj 50 mg per ml, 1 ml ampoule .................................................. 14.95 DOMPERIDONE Tab 10 mg – 1% DV Mar-13 to 2015 ........................................... 3.25 DROPERIDOL Inj 2.5 mg per ml, 1 ml ampoule 84 10 5 100 Vergo 16 Nausicalm Nausicalm Prokinex

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

111


NERVOUS SYSTEM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

HYOSCINE HYDROBROMIDE  Patch 1.5 mg ............................................................................. 11.95 2 Scopoderm TTS Restricted Any of the following: 1 Control of intractable nausea, vomiting, or inability to swallow saliva in the treatment of malignancy or chronic disease where the patient cannot tolerate or does not adequately respond to oral anti-nausea agents; or 2 Control of clozapine-induced hypersalivation where trials of at least two other alternative treatments have proven ineffective; or 3 For treatment of post-operative nausea and vomiting where cyclizine, droperidol and a 5HT3 antagonist have proven ineffective, are not tolerated or are contraindicated. Inj 400 mcg per ml, 1 ml ampoule ................................................ 6.66 METOCLOPRAMIDE HYDROCHLORIDE Tab 10 mg – 1% DV Jun-11 to 2014............................................ 3.95 Oral liq 5 mg per 5 ml Inj 5 mg per ml, 2 ml ampoule – 1% DV Sep-11 to 2014 .............. 4.50 ONDANSETRON Tab 4 mg ..................................................................................... 5.10 Tab 8 mg ..................................................................................... 1.70 Tab dispersible 4 mg .................................................................... 0.68 1.70 17.18 Tab dispersible 8 mg .................................................................... 2.00 Inj 2 mg per ml, 2 ml ampoule ...................................................... 2.64 Inj 2 mg per ml, 4 ml ampoule ...................................................... 2.98 PROCHLORPERAZINE Tab 3 mg buccal Tab 5 mg ................................................................................... 16.85 Inj 12.5 mg per ml, 1 ml ampoule Suppos 25 mg PROMETHAZINE THEOCLATE  Tab 25 mg Restricted For continuation only TROPISETRON Cap 5 mg ................................................................................... 77.41 Inj 1 mg per ml, 2 ml ampoule .................................................... 19.20 Inj 1 mg per ml, 5 ml ampoule .................................................... 38.40 5 1 1 Navoban Navoban Navoban 5 100 10 30 10 4 10 10 5 5 Mayne Metamide Pfizer Dr Reddy’s Ondansetron Dr Reddy’s Ondansetron Dr Reddy’s Ondansetron Dr Reddy’s Ondansetron Zofran Zydis Dr Reddy’s Ondansetron Ondanaccord Ondanaccord

500

Antinaus

112

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


NERVOUS SYSTEM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

ANTIPSYCHOTIC AGENTS General

AMISULPRIDE Tab 100 mg ............................................................................... 22.52 Tab 200 mg ............................................................................... 97.03 Tab 400 mg ............................................................................. 185.44 Oral liq 100 mg per ml................................................................ 55.44 ARIPIPRAZOLE  Tab 10 mg ............................................................................... 123.54  Tab 15 mg ............................................................................... 175.28  Tab 20 mg ............................................................................... 213.42  Tab 30 mg ............................................................................... 260.07 30 60 60 60 ml 30 30 30 30 Solian Solian Solian Solian Abilify Abilify Abilify Abilify

Restricted Both: 1 Patient is suffering from schizophrenia or related psychoses; and 2 Either: 2.1 An effective dose of risperidone or quetiapine has been trialled and has been discontinued, or is in the process of being discontinued, because of unacceptable side effects; or 2.2 An effective dose of risperidone or quetiapine has been trialled and has been discontinued, or is in the process of being discontinued, because of inadequate clinical response. CHLORPROMAZINE HYDROCHLORIDE Tab 10 mg Tab 25 mg Tab 100 mg Oral liq 10 mg per ml Inj 25 mg per ml, 2 ml ampoule CLOZAPINE Tab 25 mg ................................................................................. 13.37 26.74 6.69 13.37 Tab 50 mg ................................................................................... 8.67 17.33 Tab 100 mg ............................................................................... 34.65 69.30 17.33 34.65 Tab 200 mg ............................................................................... 34.65 69.30 Oral liq 50 mg per ml.................................................................. 17.33 HALOPERIDOL Tab 500 mcg ............................................................................... 5.42 Tab 1.5 mg .................................................................................. 8.20 Tab 5 mg ................................................................................... 25.84 Oral liq 2 mg per ml.................................................................... 19.87 Inj 5 mg per ml, 1 ml ampoule .................................................... 18.74 50 100 50 100 50 100 50 100 50 100 50 100 100 ml 100 100 100 100 ml 10 Clozaril Clozaril Clopine Clopine Clopine Clopine Clozaril Clozaril Clopine Clopine Clopine Clopine Clopine Serenace Serenace Serenace Serenace Serenace

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

113


NERVOUS SYSTEM

Price (ex man. Excl. GST) $ Per LEVOMEPROMAZINE MALEATE Tab 25 mg Tab 100 mg Inj 25 mg per ml, 1 ml ampoule LITHIUM CARBONATE Cap 250 mg – 1% DV Nov-11 to 2014 ......................................... 9.42 Tab 250 mg – 1% DV Sep-12 to 2015 ....................................... 34.30 Tab 400 mg – 1% DV Sep-12 to 2015 ....................................... 12.83 Tab long-acting 400 mg OLANZAPINE Tab 2.5 mg .................................................................................. 2.00 Tab 5 mg ..................................................................................... 3.85 Tab 10 mg ................................................................................... 6.35 Inj 10 mg vial PERICYAZINE Tab 2.5 mg Tab 10 mg QUETIAPINE Tab 25 mg ................................................................................... 7.00 10.50 Tab 100 mg ............................................................................... 14.00 21.00 Tab 200 mg ............................................................................... 24.00 36.00 Tab 300 mg ............................................................................... 40.00 60.00 RISPERIDONE Tab 0.5 mg .................................................................................. 2.86 3.51 60 90 60 90 60 90 60 90 20 60 Dr Reddy’s Quetiapine Seroquel Quetapel Dr Reddy’s Quetiapine Seroquel Quetapel Dr Reddy’s Quetiapine Seroquel Quetapel Dr Reddy’s Quetiapine Seroquel Quetapel Risperdal Apo-Risperidone Dr Reddy’s Risperidone Ridal Apo-Risperidone Dr Reddy’s Risperidone Ridal Risperdal Apo-Risperidone Dr Reddy’s Risperidone Ridal Risperdal 100 500 100 Douglas Lithicarb FC Lithicarb FC Brand or Generic Manufacturer

28 28 28

Olanzine Olanzine Olanzine

Tab 1 mg ..................................................................................... 6.00

60

16.92 Tab 2 mg ................................................................................... 11.00

60

33.84

continued...

114

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


NERVOUS SYSTEM

Price (ex man. Excl. GST) $ Per continued... Tab 3 mg ................................................................................... 15.00 60 Apo-Risperidone Dr Reddy’s Risperidone Ridal Risperdal Apo-Risperidone Dr Reddy’s Risperidone Ridal Risperdal Apo-Risperidone Risperdal Risperon Brand or Generic Manufacturer

50.78 Tab 4 mg ................................................................................... 20.00

60

67.68 Oral liq 1 mg per ml.................................................................... 18.35 25.26 18.35 TRIFLUOPERAZINE HYDROCHLORIDE Tab 1 mg Tab 2 mg Tab 5 mg ZIPRASIDONE  Cap 20 mg ................................................................................. 87.88  Cap 40 mg ............................................................................... 164.78  Cap 60 mg ............................................................................... 247.17  Cap 80 mg ............................................................................... 329.56 Inj 20 mg Inj 100 mg

30 ml

60 60 60 60

Zeldox Zeldox Zeldox Zeldox

Restricted 1 Patient is suffering from schizophrenia or related psychoses; and 2 Either: 2.1 An effective dose of risperidone or quetiapine has been trialled and has been discontinued, or is in the process of being discontinued, because of unacceptable side effects; or 2.2 An effective dose of risperidone or quetiapine has been trialled and has been discontinued, or is in the process of being discontinued, because of inadequate clinical response. ZUCLOPENTHIXOL ACETATE Inj 50 mg per ml, 1 ml ampoule Inj 50 mg per ml, 2 ml ampoule ZUCLOPENTHIXOL HYDROCHLORIDE Tab 10 mg ................................................................................. 31.45 100 Clopixol

Depot injections

FLUPENTHIXOL DECANOATE Inj 20 mg per ml, 1 ml ampoule .................................................. 13.14 Inj 20 mg per ml, 2 ml ampoule .................................................. 20.90 Inj 100 mg per ml, 1 ml ampoule ................................................ 40.87 FLUPHENAZINE DECANOATE Inj 12.5 mg per 0.5 ml ampoule.................................................. 17.60 Inj 25 mg per ml, 1 ml ampoule .................................................. 27.90 Inj 100 mg per ml, 1 ml ampoule .............................................. 154.50 5 5 5 5 5 5 Fluanxol Fluanxol Fluanxol Modecate Modecate Modecate

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

115


NERVOUS SYSTEM

Price (ex man. Excl. GST) $ Per HALOPERIDOL DECANOATE Inj 50 mg per ml, 1 ml ampoule .................................................. 28.39 Inj 100 mg per ml, 1 ml ampoule ................................................ 55.90 OLANZAPINE  Inj 210 mg vial ......................................................................... 280.00  Inj 300 mg vial ......................................................................... 460.00  Inj 405 mg vial ......................................................................... 560.00 5 5 1 1 1 Brand or Generic Manufacturer Haldol Haldol Concentrate Zyprexa Relprevv Zyprexa Relprevv Zyprexa Relprevv

Restricted Initiation Re-assessment required after 6 months All of the following: 1 The patient has schizophrenia; and 2 The patient has tried but failed to comply with treatment using oral atypical antipsychotic agents; and 3 The patient has been admitted to hospital or treated in respite care, or intensive outpatient or home-based treatment for 30 days or more in the last 12 months. Continuation Re-assessment required after 12 months Either: 1 The patient has had less than 12 months’ treatment with olanzapine depot injection and there is no clinical reason to discontinue treatment; or 2 The initiation of olanzapine depot injection has been associated with fewer days of intensive intervention than was the case during a corresponding period of time prior to the initiation of olanzapine depot injection. PIPOTHIAZINE PALMITATE Inj 50 mg per ml, 1 ml ampoule Inj 50 mg per ml, 2 ml ampoule RISPERIDONE  Inj 25 mg vial ........................................................................... 175.00  Inj 37.5 mg vial ........................................................................ 230.00  Inj 50 mg vial ........................................................................... 280.00 1 1 1 Risperdal Consta Risperdal Consta Risperdal Consta

Restricted Re-assessment required after 6 months All of the following: 1 The patient has schizophrenia or other psychotic disorder; and 2 The patient has tried but failed to comply with treatment using oral atypical antipsychotic agents; and 3 The patient has been admitted to hospital or treated in respite care, or intensive outpatient or home-based treatment for 30 days or more in the last 12 months. Continuation Re-assessment required after 12 months Either: 1 The patient has had less than 12 months’ treatment with risperidone depot injection and there is no clinical reason to discontinue treatment; or 2 The initiation of risperidone depot injection has been associated with fewer days of intensive intervention than was the case during a corresponding period of time prior to the initiation of risperidone depot injection. ZUCLOPENTHIXOL DECANOATE Inj 200 mg per ml, 1 ml ampoule ................................................ 19.80 5 Clopixol

116

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


NERVOUS SYSTEM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Orodispersible Antipsychotics

OLANZAPINE Tab orodispersible 5 mg ............................................................... 6.36 Tab orodispersible 10 mg ............................................................. 8.76 RISPERIDONE  Tab orodispersible 0.5 mg .......................................................... 21.42  Tab orodispersible 1 mg ............................................................. 42.84  Tab orodispersible 2 mg ............................................................. 85.71 28 28 28 28 28 Olanzine-D Olanzine-D Risperdal Quicklet Risperdal Quicklet Risperdal Quicklet

Restricted Acute situations Both: 1 For a non-adherent patient on oral therapy with standard risperidone tablets or risperidone oral liquid; and 2 The patient is under direct supervision for administration of medicine. Chronic situations Both: 1 The patient is unable to take standard risperidone tablets or oral liquid, or once stabilized refuses to take risperidone tablets or oral liquid; and 2 The patient is under direct supervision for administration of medicine.

ANXIOLYTICS

ALPRAZOLAM Tab 250 mcg Tab 500 mcg Tab 1 mg BUSPIRONE HYDROCHLORIDE  Tab 5 mg ................................................................................... 28.00  Tab 10 mg ................................................................................. 17.00 Restricted Both: 1 For use only as an anxiolytic; and 2 Other agents are contraindicated or have failed. CLONAZEPAM Tab 500 mcg ............................................................................... 6.68 Tab 2 mg ................................................................................... 12.75 DIAZEPAM Tab 2 mg ................................................................................... 11.44 Tab 5 mg ................................................................................... 13.71 LORAZEPAM Tab 1 mg ................................................................................... 16.42 Tab 2.5 mg ................................................................................ 11.17 OXAZEPAM Tab 10 mg Tab 15 mg 100 100 500 500 250 100 Paxam Paxam Arrow-Diazepam Arrow-Diazepam Ativan Ativan 100 100 Pacific Busipirone Pacific Busipirone

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

117


NERVOUS SYSTEM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

MULTIPLE SCLEROSIS TREATMENTS

GLATIRAMER ACETATE  Inj 20 mg per ml, 1 ml syringe Restricted Only for use in patients with approval by the Multiple Sclerosis Treatment Assessments Committee INTERFERON BETA-1-ALPHA  Inj 6 million iu vial  Inj 6 million iu in 0.5 ml pen  Inj 6 million iu in 0.5 ml syringe Restricted Only for use in patients with approval by the Multiple Sclerosis Treatment Assessments Committee INTERFERON BETA-1-BETA  Inj 8 million iu per ml, 1 ml vial Restricted Only for use in patients with approval by the Multiple Sclerosis Treatment Assessments Committee

SEDATIVES AND HYPNOTICS

CHLORAL HYDRATE Oral liq 100 mg per ml Oral liq 200 mg per ml LORMETAZEPAM  Tab 1 mg Restricted For continuation only MELATONIN  Cap 2 mg  Cap 3 mg  Tab 1 mg  Tab 2 mg  Tab 3 mg  Tab modified-release 2 mg Restricted For in hospital use only. For the treatment of insomnia where benzodiazepines and zopiclone are contraindicated. MIDAZOLAM Tab 7.5 mg ................................................................................ 40.00 Oral liq 2 mg per ml Inj 1 mg per ml, 5 ml ampoule .................................................... 10.75 10.00 Inj 5 mg per ml, 3 ml ampoule .................................................... 11.90 NITRAZEPAM Tab 5 mg PHENOBARBITONE Inj 200 mg per ml, 1 ml ampoule 100 10 5 Hypnovel Hypnovel Pfizer Hypnovel Pfizer

118

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


NERVOUS SYSTEM

Price (ex man. Excl. GST) $ Per TEMAZEPAM Tab 10 mg – 1% DV Nov-11 to 2014 ........................................... 1.27 TRIAZOLAM  Tab 125 mcg  Tab 250 mcg Restricted For continuation only ZOPICLONE Tab 7.5 mg – 1% DV Jan-12 to 2014........................................... 1.90 30 Apo-Zopiclone 25 Brand or Generic Manufacturer Normison

STIMULANTS/ADHD TREATMENTS

ATOMOXETINE  Cap 10 mg ............................................................................... 107.03  Cap 18 mg ............................................................................... 107.03  Cap 25 mg ............................................................................... 107.03  Cap 40 mg ............................................................................... 107.03  Cap 60 mg ............................................................................... 107.03  Cap 80 mg ............................................................................... 139.11  Cap 100 mg ............................................................................. 139.11 28 28 28 28 28 28 28 Strattera Strattera Strattera Strattera Strattera Strattera Strattera

Restricted All of the following: 1 Patient has ADHD (Attention Deficit and Hyperactivity Disorder) diagnosed according to DSM-IV or ICD 10 criteria; and 2 Once-daily dosing; and 3 Any of the following: 3.1 Treatment with a subsidised formulation of a stimulant has resulted in the development or worsening of serious adverse reactions or where the combination of subsidised stimulant treatment with another agent would pose an unacceptable medical risk; or 3.2 Treatment with a subsidised formulation of a stimulant has resulted in worsening of co-morbid substance abuse or there is a significant risk of diversion with subsidised stimulant therapy; or 3.3 An effective dose of a subsidised formulation of a stimulant has been trialled and has been discontinued because of inadequate clinical response; and 4 The patient will not be receiving treatment with atomoxetine in combination with a subsidised formulation of a stimulant, except for the purposes of transitioning from subsidised stimulant therapy to atomoxetine. Note: A “subsidised formulation of a stimulant” refers to currently subsidised methylphenidate hydrochloride tablet formulations (immediate-release, sustained-release and extended-release) or dexamphetamine sulphate tablets. CAFFEINE Tab 100 mg DEXAMPHETAMINE SULPHATE  Tab 5 mg – 1% DV Mar-13 to 2015 ........................................... 16.50 100 PSM

Restricted ADHD – paediatrician or psychiatrist Patient has ADHD (Attention Deficit and Hyperactivity Disorder), diagnosed according to DSM-IV or ICD 10 criteria Narcolepsy – neurologist or respiratory specialist Patient suffers from narcolepsy

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

119


NERVOUS SYSTEM

Price (ex man. Excl. GST) $ Per METHYLPHENIDATE HYDROCHLORIDE  Tab immediate-release 5 mg ........................................................ 3.20  Tab immediate-release 10 mg ...................................................... 3.00 30 30 30 30 100 30 30 30 30 30 30 30 30 Brand or Generic Manufacturer Rubifen Ritalin Rubifen Rubifen Rubifen SR Ritalin SR Concerta Concerta Concerta Concerta Ritalin LA Ritalin LA Ritalin LA Ritalin LA

 Tab immediate-release 20 mg ...................................................... 7.85  Tab sustained-release 20 mg ..................................................... 10.95        

50.00 Tab extended-release 18 mg ...................................................... 58.96 Tab extended-release 27 mg ...................................................... 65.44 Tab extended-release 36 mg ...................................................... 71.93 Tab extended-release 54 mg ...................................................... 86.24 Cap modified-release 10 mg....................................................... 19.50 Cap modified-release 20 mg....................................................... 25.50 Cap modified-release 30 mg....................................................... 31.90 Cap modified-release 40 mg....................................................... 38.25 Restricted ADHD (immediate-release and sustained-release formulations) – paediatrician or psychiatrist Patient has ADHD (Attention Deficit and Hyperactivity Disorder), diagnosed according to DSM-IV or ICD 10 criteria Narcolepsy (immediate-release and sustained-release formulations) – neurologist or respiratory specialist Patient suffers from narcolepsy Extended-release and modified-release formulations – paediatrician or psychiatrist Both: 1 Patient has ADHD (Attention Deficit and Hyperactivity Disorder), diagnosed according to DSM-IV or ICD 10 criteria; and 2 Either: 2.1 Patient is taking a currently subsidised formulation of methylphenidate hydrochloride (immediate-release or sustained-release) which has not been effective due to significant administration and/or compliance difficulties; or 2.2 There is significant concern regarding the risk of diversion or abuse of immediate-release methylphenidate hydrochloride. MODAFINIL  Tab 100 mg Restricted – neurologist or respiratory specialist All of the following: 1 The patient has a diagnosis of narcolepsy and has excessive daytime sleepiness associated with narcolepsy occurring almost daily for three months or more; and 2 Either: 2.1 The patient has a multiple sleep latency test with a mean sleep latency of less than or equal to 10 minutes and 2 or more sleep onset rapid eye movement periods; or 2.2 The patient has at least one of: cataplexy, sleep paralysis or hypnagogic hallucinations; and 3 Either: 3.1 An effective dose of a subsidised formulation of methylphenidate or dexamphetamine has been trialled and discontinued because of intolerable side effects; or 3.2 Methylphenidate and dexamphetamine are contraindicated.

TREATMENTS FOR DEMENTIA

DONEPEZIL HYDROCHLORIDE Tab 5 mg ..................................................................................... 7.71 Tab 10 mg ................................................................................. 14.06 90 90 Donepezil-Rex Donepezil-Rex

120

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


NERVOUS SYSTEM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

TREATMENTS FOR SUBSTANCE DEPENDENCE

BUPRENORPHINE WITH NALOXONE  Tab 2 mg with naloxone 0.5 mg ................................................. 57.40 28 Suboxone  Tab 8 mg with naloxone 2 mg .................................................. 166.00 28 Suboxone Restricted Detoxification All of the following: 1 Patient is opioid dependent; and 2 Patient is currently engaged with an opioid treatment service approved by the Ministry of Health; and 3 Prescriber works in an opioid treatment service approved by the Ministry of Health. Maintenance treatment All of the following: 1 Patient is opioid dependent; and 2 Patient will not be receiving methadone; and 3 Patient is currently enrolled in an opioid substitution treatment program in a service approved by the Ministry of Health; and 4 Prescriber works in an opioid treatment service approved by the Ministry of Health. BUPROPION HYDROCHLORIDE Tab modified-release 150 mg ..................................................... 65.00 DISULFIRAM Tab 200 mg ............................................................................... 24.30 30 100 Zyban Antabuse

NALTREXONE HYDROCHLORIDE  Tab 50 mg – 1% DV Sep-13 to 2016 ......................................... 79.00 30 Naltraccord Restricted Alcohol dependence Both: 1 Patient is currently enrolled, or is planned to be enrolled, in a recognised comprehensive treatment programme for alcohol dependence; and 2 Naltrexone is to be prescribed by, or on the recommendation of, a physician working in an Alcohol and Drug Service. Constipation For the treatment of opioid-induced constipation NICOTINE Gum 2 mg – 5% DV Oct-11 to 2014 .......................................... 36.47 384 Gum 2 mg – 5% DV Oct-11 to 2014 .......................................... 36.47 384 Gum 2 mg – 5% DV Oct-11 to 2014 .......................................... 36.47 384 Gum 4 mg – 5% DV Oct-11 to 2014 .......................................... 42.04 384 Gum 4 mg – 5% DV Oct-11 to 2014 .......................................... 42.04 384 Gum 4 mg – 5% DV Oct-11 to 2014 .......................................... 42.04 384 Lozenge 1 mg – 5% DV Jul-11 to 2014 ..................................... 19.94 216 Lozenge 2 mg – 5% DV Jul-11 to 2014 ..................................... 24.27 216 Patch 7 mg per 24 hours – 5% DV Jul-11 to 2014 ..................... 18.13 28 Patch 14 mg per 24 hours – 5% DV Jul-11 to 2014 ................... 18.81 28 Patch 21 mg per 24 hours – 5% DV Jul-11 to 2014 ................... 19.14 28  Soln for inhalation 15 mg cartridge Restricted Any of the following: 1 For perioperative use in patients who have a ‘nil by mouth’ instruction; or 2 For use within mental health inpatient units; or 3 For acute use in agitated patients who are unable to leave the hospital facilities. Habitrol (Classic) Habitrol (Fruit) Habitrol (Mint) Habitrol (Classic) Habitrol (Fruit) Habitrol (Mint) Habitrol Habitrol Habitrol Habitrol Habitrol (Nicorette Inhalator)

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

121


NERVOUS SYSTEM

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

VARENICLINE  Tab 0.5 mg x 11 and 1 mg x 14.................................................. 60.48 25 Champix  Tab 1 mg ................................................................................... 67.74 28 Champix 135.48 56 Champix Restricted All of the following: 1 Short-term therapy as an aid to achieving abstinence in a patient who has indicated that they are ready to cease smoking; and 2 The patient is part of, or is about to enrol in, a comprehensive support and counselling smoking cessation programme, which includes prescriber or nurse monitoring; and 3 Either: 3.1 The patient has tried but failed to quit smoking after at least two separate trials of nicotine replacement therapy, at least one of which included the patient receiving comprehensive advice on the optimal use of nicotine replacement therapy; or 3.2 The patient has tried but failed to quit smoking using bupropion or nortriptyline; and 4 The patient has not used funded varenicline in the last 12 months; and 5 Varenicline is not to be used in combination with other pharmacological smoking cessation treatments and the patient has agreed to this; and 6 The patient is not pregnant; and 7 The patient will not be prescribed more than 3 months’ funded varenicline in a 12 month period.

122

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

CHEMOTHERAPEUTIC AGENTS Alkylating Agents

BUSULFAN Tab 2 mg ................................................................................... 59.50 Inj 6 mg per ml, 10 ml ampoule CARMUSTINE Inj 100 mg vial CHLORAMBUCIL Tab 2 mg CYCLOPHOSPHAMIDE Tab 50 mg ................................................................................. 25.71 Inj 1 g vial – 1% DV Nov-11 to 2014 .......................................... 26.70 Inj 2 g vial – 1% DV Nov-11 to 2014 .......................................... 56.90 IFOSFAMIDE Inj 1 g vial .................................................................................. 96.00 Inj 2 g vial ................................................................................ 180.00 LOMUSTINE Cap 10 mg– 1% DV Sep-11 to 2014 ........................................ 132.59 Cap 40 mg – 1% DV Sep-11 to 2014 ....................................... 399.15 MELPHALAN Tab 2 mg Inj 50 mg vial THIOTEPA Inj 15 mg vial 50 1 1 1 1 20 20 Cycloblastin Endoxan Endoxan Holoxan Holoxan Ceenu Ceenu 100 Myleran

Anthracyclines and Other Cytotoxic Antibiotics

BLEOMYCIN SULPHATE Inj 15,000 iu (10 mg) vial DACTINOMYCIN [ACTINOMYCIN D] Inj 0.5 mg vial DAUNORUBICIN Inj 2 mg per ml, 10 ml vial – 1% DV Aug-13 to 2016 ................ 118.72 DOXORUBICIN HYDROCHLORIDE Inj 2 mg per ml, 5 ml vial Inj 2 mg per ml, 25 ml vial – 1% DV Mar-13 to 2015.................. 17.00 Inj 2 mg per ml, 50 ml vial Inj 2 mg per ml, 100 ml vial – 1% DV Mar-13 to 2015................ 65.00 1 Pfizer

1 1

Arrow-Doxorubicin Arrow-Doxorubicin

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

123


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per EPIRUBICIN HYDROCHLORIDE Inj 2 mg per ml, 5 ml vial ............................................................ 25.00 Inj 2 mg per ml, 25 ml vial– 1% DV Aug-12 to 2015 ................... 39.38 Inj 2 mg per ml, 50 ml vial– 1% DV Aug-12 to 2015 ................... 58.20 Inj 2 mg per ml, 100 ml vial– 1% DV Aug-12 to 2015 ................. 94.50 IDARUBICIN HYDROCHLORIDE Cap 5 mg ................................................................................. 115.00 Cap 10 mg ............................................................................... 144.50 Inj 5 mg vial – 1% DV Sep-12 to 2015 ..................................... 100.00 Inj 10 mg vial – 1% DV Sep-12 to 2015 ................................... 200.00 MITOMYCIN C Inj 5 mg vial ............................................................................... 72.75 MITOZANTRONE Inj 2 mg per ml, 5 ml vial .......................................................... 110.00 Inj 2 mg per ml, 10 ml vial ........................................................ 100.00 Inj 2 mg per ml, 12.5 ml vial ..................................................... 407.50 1 1 1 1 Brand or Generic Manufacturer Epirubicin Ebewe DBL Epirubicin Hydrochloride DBL Epirubicin Hydrochloride DBL Epirubicin Hydrochloride Zavedos Zavedos Zavedos Zavedos Arrow Mitozantrone Ebewe Mitozantrone Ebewe Onkotrone

1 1 1 1 1 1 1 1

Antimetabolites

CAPECITABINE Tab 150 mg ............................................................................. 115.00 Tab 500 mg ............................................................................. 705.00 CLADRIBINE Inj 1 mg per ml, 10 ml vial ..................................................... 5,249.75 Inj 2 mg per ml, 5 ml vial CYTARABINE Inj 20 mg per ml, 5 ml vial .......................................................... 76.00 Inj 200 mg per ml, 25 ml vial ...................................................... 18.15 Inj 100 mg per ml, 10 ml vial ...................................................... 37.00 Inj 100 mg per ml, 20 ml vial ...................................................... 31.00 FLUDARABINE PHOSPHATE Tab 10 mg – 1% DV Jun-12 to 2015........................................ 433.50 Inj 50 mg vial – 1% DV Sep-11 to 2014 ................................... 525.00 FLUOROURACIL Inj 25 mg per ml, 100 ml vial ...................................................... 13.55 Inj 50 mg per ml, 10 ml vial ........................................................ 26.25 Inj 50 mg per ml, 20 ml vial .......................................................... 7.50 Inj 50 mg per ml, 50 ml vial ........................................................ 18.00 Inj 50 mg per ml, 100 ml vial ...................................................... 34.50 60 120 7 Xeloda Xeloda Leustatin

5 1 1 1 20 5 1 5 1 1 1

Pfizer Pfizer Pfizer Pfizer Fludara Oral Fludarabine Ebewe Mayne Fluorouracil Ebewe Fluorouracil Ebewe Fluorouracil Ebewe Fluorouracil Ebewe

124

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per GEMCITABINE Inj 10 mg per ml, 20 ml vial ........................................................ 12.50 Inj 10 mg per ml, 100 ml vial ...................................................... 62.50 Inj 200 mg vial ........................................................................... 12.50 Inj 1 g vial .................................................................................. 62.50 1 1 1 1 Brand or Generic Manufacturer Gemcitabine Ebewe Gemcitabine Ebewe Gemcitabine Actavis 200 DBL Gemcitabine Gemcitabine Actavis 1000 Purinethol Methoblastin Methoblastin Hospira Hospira Methotrexate Ebewe Methotrexate Ebewe

MERCAPTOPURINE Tab 50 mg ................................................................................. 47.06 METHOTREXATE Tab 2.5 mg .................................................................................. 5.22 Tab 10 mg ................................................................................. 40.93 Inj 2.5 mg per ml, 2 ml vial Inj 25 mg per ml, 2 ml vial – 1% DV Sep-13 to 2016 .................. 20.20 Inj 25 mg per ml, 20 ml vial – 1% DV Sep-13 to 2016 ................ 27.78 Inj 100 mg per ml, 10 ml vial – 1% DV Sep-11 to 2014 .............. 25.00 Inj 100 mg per ml, 50 ml vial – 1% DV Sep-11 to 2014 ............ 125.00 THIOGUANINE Tab 40 mg

25 30 50 5 1 1 1

Other Cytotoxic Agents

AMSACRINE Inj 50 mg per ml, 1.5 ml ampoule ANAGRELIDE HYDROCHLORIDE Cap 0.5 mg ARSENIC TRIOXIDE Inj 1 mg per ml, 10 ml vial ..................................................... 4,817.00 BORTEZOMIB  Inj 1 mg vial ............................................................................. 540.70  Inj 3.5 mg vial ....................................................................... 1,892.50 10 1 1 AFT Velcade Velcade

Restricted Initiation – treatment naive multiple myeloma/amyloidosis Both: 1 Either: 1.1 The patient has treatment-naive symptomatic multiple myeloma; or 1.2 The patient has treatment-naive symptomatic systemic AL amyloidosis *; and 2 Maximum of 9 treatment cycles. Note: Indications marked with * are Unapproved Indications. Initiation – relapsed/refractory multiple myeloma/amyloidosis All of the following: 1 Either: 1.1 The patient has relapsed or refractory multiple myeloma; or 1.2 The patient has relapsed or refractory systemic AL amyloidosis *; and 2 The patient has received only one prior front line chemotherapy for multiple myeloma or amyloidosis; and 3 The patient has not had prior publicly funded treatment with bortezomib; and continued...

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

125


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per continued... 4 Maximum of 4 treatment cycles. Note: Indications marked with * are Unapproved Indications. Continuation – relapsed/refractory multiple myeloma/amyloidosis Both: 1 The patient’s disease obtained at least a partial response from treatment with bortezomib at the completion of cycle 4; and 2 Maximum of 4 further treatment cycles (making a total maximum of 8 consecutive treatment cycles). Notes: Responding relapsed/refractory multiple myeloma patients should receive no more than 2 additional cycles of treatment beyond the cycle at which a confirmed complete response was first achieved. A line of therapy is considered to comprise either: a) A known therapeutic chemotherapy regimen and supportive treatments; or b) A transplant induction chemotherapy regimen, stem cell transplantation and supportive treatments. Refer to datasheet for recommended dosage and number of doses of bortezomib per treatment cycle. COLASPASE [L-ASPARAGINASE] Inj 10,000 iu vial ...................................................................... 102.32 DACARBAZINE Inj 200 mg vial ........................................................................... 48.00 ETOPOSIDE Cap 50 mg ............................................................................... 340.73 Cap 100 mg ............................................................................. 340.73 Inj 20 mg per ml, 5 ml vial .......................................................... 25.00 ETOPOSIDE (AS PHOSPHATE) Inj 100 mg vial – 1% DV Sep-11 to 2014 ................................... 40.00 HYDROXYUREA Cap 500 mg ............................................................................... 31.76 IRINOTECAN HYDROCHLORIDE Inj 20 mg per ml, 2 ml vial – 1% DV Nov-12 to 2015 .................... 9.34 Inj 20 mg per ml, 5 ml vial – 1% DV Nov-12 to 2015 .................. 23.34 PEGASPARGASE  Inj 750 iu per ml, 5 ml vial ..................................................... 3,005.00 1 1 20 10 1 1 100 1 1 Leunase Hospira Vepesid Vepesid Mayne Etopophos Hydrea Irinotecan Actavis 40 Irinotecan Actavis 100 Oncaspar Brand or Generic Manufacturer

1

Restricted Newly diagnosed ALL Limited to 12 months’ treatment All of the following: 1 The patient has newly diagnosed acute lymphoblastic leukaemia; and 2 Pegaspargase to be used with a contemporary intensive multi-agent chemotherapy treatment protocol; and 3 Treatment is with curative intent. Relapsed ALL Limited to 12 months’ treatment All of the following: 1 The patient has relapsed acute lymphoblastic leukaemia; and 2 Pegaspargase to be used with a contemporary intensive multi-agent chemotherapy treatment protocol; and 3 Treatment is with curative intent.

126

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per PENTOSTATIN [DEOXYCOFORMYCIN] Inj 10 mg vial PROCARBAZINE HYDROCHLORIDE Cap 50 mg ............................................................................... 225.00 TEMOZOLOMIDE  Cap 5 mg – 1% DV Sep-13 to 2016 ............................................. 8.00  Cap 20 mg – 1% DV Sep-13 to 2016 ......................................... 36.00  Cap 100 mg – 1% DV Sep-13 to 2016 ..................................... 175.00  Cap 250 mg – 1% DV Sep-13 to 2016 ..................................... 410.00 50 5 5 5 5 Natulan Temaccord Temaccord Temaccord Temaccord Brand or Generic Manufacturer

Restricted All of the following: 1 Either: 1.1 Patient has newly diagnosed glioblastoma multiforme; or 1.2 Patient has newly diagnosed anaplastic astrocytoma*; and 2 Temozolomide is to be (or has been) given concomitantly with radiotherapy; and 3 Following concomitant treatment temozolomide is to be used for a maximum of six cycles of 5 days treatment, at a maximum dose of 200 mg/m2. Notes: Indication marked with a * is an Unapproved Indication. Studies of temozolomide show that its benefit is predominantly in those patients with a good performance status (WHO grade 0 or 1 or Karnofsky score >80), and in patients who have had at least a partial resection of the tumour. THALIDOMIDE  Cap 50 mg ............................................................................... 504.00  Cap 100 mg .......................................................................... 1,008.00 Restricted Initiation Either: 1 The patient has multiple myeloma; or 2 The patient has systemic AL amyloidosis*; or 3 The patient has erythema nodosum leprosum. Continuation Patient has obtained a response from treatment during the initial approval period. Notes: Prescription must be written by a registered prescriber in the thalidomide risk management programme operated by the supplier. Maximum dose of 400 mg daily as monotherapy or in a combination therapy regimen. Indication marked with * is an Unapproved Indication TRETINOIN Cap 10 mg ............................................................................... 435.90 100 Vesanoid 28 28 Thalomid Thalomid

Platinum Compounds

CARBOPLATIN Inj 10 mg per ml, 5 ml vial .......................................................... 20.00 Inj 10 mg per ml, 15 ml vial ........................................................ 19.50 Inj 10 mg per ml, 45 ml vial ........................................................ 48.50 Inj 10 mg per ml, 100 ml vial .................................................... 105.00 CISPLATIN Inj 1 mg per ml, 50 ml vial .......................................................... 15.00 Inj 1 mg per ml, 100 ml vial ........................................................ 21.00 1 1 1 1 1 1 Carboplatin Ebewe Carbaccord Carbaccord Carboplatin Ebewe Cisplatin Ebewe Cisplatin Ebewe

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

127


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per OXALIPLATIN Inj 50 mg vial – 1% DV Aug-12 to 2015 ..................................... 15.32 Inj 100 mg vial – 1% DV Aug-12 to 2015 ................................... 25.01 1 1 Brand or Generic Manufacturer Oxaliplatin Actavis 50 Oxaliplatin Actavis 100

Protein-Tyrosine Kinase Inhibitors

DASATINIB  Tab 20 mg ............................................................................ 3,774.06  Tab 50 mg ............................................................................ 6,214.20  Tab 70 mg ............................................................................ 7,692.58  Tab 100 mg .......................................................................... 6,214.20 Restricted For use in patients with approval from CML/GIST Co-ordinator ERLOTINIB  Tab 100 mg .......................................................................... 3,100.00  Tab 150 mg .......................................................................... 3,950.00 30 30 Tarceva Tarceva 60 60 60 30 Sprycel Sprycel Sprycel Sprycel

Restricted Initiation Re-assessment required after 3 months Both: 1 Patient has advanced, unresectable, Non Small Cell Lung Cancer (NSCLC); and 2 Patient has documented disease progression following treatment with first line platinum based chemotherapy. Continuation Re-assessment required after 6 months Radiological assessment (preferably including CT scan) indicates NSCLC has not progressed. GEFITINIB  Tab 250 mg .......................................................................... 1,700.00 30 Iressa

Restricted Initiation Re-assessment required after 3 months Both 1 Patient has treatment naive locally advanced, or metastatic, unresectable, non-squamous Non Small Cell Lung Cancer (NSCLC); and 2 There is documentation confirming that disease expresses activating mutations of EGFR tyrosine kinase. Continuation Re-assessment required after 6 months Radiological assessment (preferably including CT scan) indicates NSCLC has not progressed. IMATINIB  Tab 100 mg .......................................................................... 2,400.00 Restricted For use in patients with approval from CML/GIST Co-ordinator LAPATINIB  Tab 250 mg .......................................................................... 1,899.00 Restricted Initiation Re-assessment required after 12 months Either: 70 Tykerb 60 Glivec

continued...

128

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per continued... 1 All of the following: 1.1 The patient has metastatic breast cancer expressing HER-2 IHC 3+ or ISH+ (including FISH or other current technology); and 1.2 The patient has not previously received trastuzumab treatment for HER 2 positive metastatic breast cancer; and 1.3 Lapatinib not to be given in combination with trastuzumab; and 1.4 Lapatinib to be discontinued at disease progression; or 2 All of the following: 2.1 The patient has metastatic breast cancer expressing HER-2 IHC 3+ or ISH+ (including FISH or other current technology); and 2.2 The patient started trastuzumab for metastatic breast cancer but discontinued trastuzumab within 3 months of starting treatment due to intolerance; and 2.3 The cancer did not progress whilst on trastuzumab; and 2.4 Lapatinib not to be given in combination with trastuzumab; and 2.5 Lapatinib to be discontinued at disease progression Continuation Re-assessment required after 12 months All of the following: 1 The patient has metastatic breast cancer expressing HER-2 IHC 3+ or ISH+ (including FISH or other current technology); and 2 The cancer has not progressed at any time point during the previous 12 months whilst on lapatinib; and 3 Lapatinib not to be given in combination with trastuzumab; and 4 Lapatinib to be discontinued at disease progression PAZOPANIB  Tab 200 mg .......................................................................... 1,334.70  Tab 400 mg .......................................................................... 2,669.40 30 30 Votrient Votrient Brand or Generic Manufacturer

Restricted Initiation Re-assessment required after 3 months All of the following: 1 The patient has metastatic renal cell carcinoma; and 2 Any of the following: 2.1 The patient is treatment naive; or 2.2 The patient has only received prior cytokine treatment; or 2.3 Both: 2.3.1 The patient has discontinued sunitinib within 3 months of starting treatment due to intolerance; and 2.3.2 The cancer did not progress whilst on sunitinib; and 3 The patient has good performance status (WHO/ECOG grade 0-2); and 4 The disease is of predominant clear cell histology; and 5 The patient has intermediate or poor prognosis defined as any of the following: 5.1 Lactate dehydrogenase level > 1.5 times upper limit of normal; or 5.2 Haemoglobin level < lower limit of normal; or 5.3 Corrected serum calcium level > 10 mg/dl (2.5 mmol/l); or 5.4 Interval of < 1 year from original diagnosis to the start of systemic therapy; or 5.5 Karnofsky performance score of ≤ 70; or 5.6 ≥ 2 sites of organ metastasis. Continuation Re-assessment required after 3 months Both: 1 No evidence of disease progression; and 2 The treatment remains appropriate and the patient is benefiting from treatment. continued...

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

129


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per continued... Notes: Pazopanib treatment should be stopped if disease progresses. Poor prognosis patients are defined as having at least 3 of criteria 5.1-5.6. Intermediate prognosis patients are defined as having 1 or 2 of criteria 5.1-5.6. SUNITINIB  Cap 12.5 mg ......................................................................... 2,315.38  Cap 25 mg ............................................................................ 4,630.77  Cap 50 mg ............................................................................ 9,261.54 28 28 28 Sutent Sutent Sutent Brand or Generic Manufacturer

Restricted Re-assessment required after 3 months Initiation – RCC 1 The patient has metastatic renal cell carcinoma; and 2 Any of the following: 2.1 The patient is treatment naive; or 2.2 The patient has only received prior cytokine treatment; or 2.3 The patient has only received prior treatment with an investigational agent within the confines of a bona fide clinical trial which has Ethics Committee approval; or 2.4 Both: 2.4.1 The patient has discontinued pazopanib within 3 months of starting treatment due to intolerance; and 2.4.2 The cancer did not progress whilst on pazopanib; and 3 The patient has good performance status (WHO/ECOG grade 0-2); and 4 The disease is of predominant clear cell histology; and 5 The patient has intermediate or poor prognosis defined as any of the following: 5.1 Lactate dehydrogenase level > 1.5 times upper limit of normal; or 5.2 Haemoglobin level < lower limit of normal; or 5.3 Corrected serum calcium level > 10 mg/dl (2.5 mmol/l); or 5.4 Interval of < 1 year from original diagnosis to the start of systemic therapy; or 5.5 Karnofsky performance score of ≤ 70; or 5.6 ≥ 2 sites of organ metastasis; and 6 Sunitinib to be used for a maximum of 2 cycles. Continuation – RCC Re-assessment required after 3 months Both: 1 No evidence of disease progression; and 2 The treatment remains appropriate and the patient is benefiting from treatment. Initiation – GIST Re-assessment required after 3 months Both: 1 The patient has unresectable or metastatic malignant gastrointestinal stromal tumour (GIST); and 2 Either: 2.1 The patient’s disease has progressed following treatment with imatinib; or 2.2 The patient has documented treatment-limiting intolerance, or toxicity to, imatinib. Continuation – GIST Re-assessment required after 6 months Both: The patient has responded to treatment or has stable disease as determined by Choi’s modified CT response evaluation criteria as follows: 1 Any of the following: 1.1 The patient has had a complete response (disappearance of all lesions and no new lesions); or 1.2 The patient has had a partial response (a decrease in size of ≥ 10% or decrease in tumour density in Hounsfield Units (HU) of ≥ 15% on CT and no new lesions and no obvious progression of non-measurable disease); or continued...

130

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per continued... The patient has stable disease (does not meet criteria the two above) and does not have progressive disease and no symptomatic deterioration attributed to tumour progression; and 2 The treatment remains appropriate and the patient is benefiting from treatment. Notes: RCC – Sunitinib treatment should be stopped if disease progresses. Poor prognosis patients are defined as having at least 3 of criteria 5.1-5.6. Intermediate prognosis patients are defined as having 1 or 2 of criteria 5.1-5.6. GIST – it is recommended that response to treatment be assessed using Choi’s modified CT response evaluation criteria (J Clin Oncol, 2007, 25:1753-1759). Progressive disease is defined as either: an increase in tumour size of ≥ 10% and not meeting criteria of partial response (PR) by tumour density (HU) on CT; or: new lesions, or new intratumoral nodules, or increase in the size of the existing intratumoral nodules. 1.3 Brand or Generic Manufacturer

Taxanes

DOCETAXEL Inj 10 mg per ml, 2 ml vial ......................................................... 48.75 Inj 10 mg per ml, 2 ml vial – 1% DV May-13 to 2014 ................. 48.75 Inj 10 mg per ml, 8 ml vial ....................................................... 195.00 Inj 10 mg per ml, 8 ml vial – 1% DV May-13 to 2014 ............... 195.00 PACLITAXEL Inj 6 mg per ml, 5 ml vial – 1% DV Oct-08 to 2014................... 137.50 Inj 6 mg per ml, 16.7 ml vial – 1% DV Oct-08 to 2014................ 91.67 Inj 6 mg per ml, 25 ml vial – 1% DV Oct-08 to 2014................. 137.50 Inj 6 mg per ml, 50 ml vial – 1% DV Oct-08 to 2014................. 275.00 Inj 6 mg per ml, 100 ml vial – 1% DV Oct-08 to 2014............... 550.00 1 1 1 1 5 1 1 1 1 Docetaxel Ebewe Docetaxel Sandoz Docetaxel Ebewe Docetaxel Sandoz Paclitaxel Ebewe Paclitaxel Ebewe Paclitaxel Actavis Anzatax Paclitaxel Actavis Paclitaxel Ebewe Anzatax Paclitaxel Actavis Paclitaxel Ebewe Paclitaxel Ebewe

Treatment of Cytotoxic-Induced Side Effects

CALCIUM FOLINATE Tab 15 mg – 1% DV Nov-11 to 2014 ......................................... 82.45 Inj 3 mg per ml, 1 ml ampoule Inj 10 mg per ml, 5 ml ampoule – 1% DV Sep-08 to 2014 .......... 24.50 Inj 10 mg per ml, 10 ml vial – 1% DV Sep-08 to 2014 .................. 9.75 Inj 10 mg per ml, 30 ml vial – 1% DV Sep-08 to 2014 ................ 30.00 Inj 10 mg per ml, 100 ml vial – 1% DV Sep-08 to 2014 .............. 90.00 MESNA Tab 400 mg ............................................................................. 210.65 Tab 600 mg ............................................................................. 314.40 Inj 100 mg per ml, 4 ml ampoule .............................................. 137.04 Inj 100 mg per ml, 10 ml ampoule ............................................ 314.66 10 5 1 1 1 DBL Leucovorin Calcium Calcium Folinate Ebewe Calcium Folinate Ebewe Calcium Folinate Ebewe Calcium Folinate Ebewe Uromitexan Uromitexan Uromitexan Uromitexan

50 50 15 15

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

131


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Vinca Alkaloids

VINBLASTINE SULPHATE Inj 1 mg per ml, 10 ml vial ........................................................ 137.50 VINCRISTINE SULPHATE Inj 1 mg per ml, 1 ml vial – 1% DV Sep-13 to 2016 .................... 64.80 Inj 1 mg per ml, 2 ml vial – 1% DV Sep-13 to 2016 .................... 69.60 VINORELBINE Inj 10 mg per ml, 1 ml vial – 1% DV Sep-12 to 2015 .................. 12.85 Inj 10 mg per ml, 5 ml vial – 1% DV Sep-12 to 2015 .................. 64.25 5 5 5 1 1 Mayne Hospira Hospira Navelbine Navelbine

ENDOCRINE THERAPY

BICALUTAMIDE  Tab 50 mg – 1% DV Nov-11 to 2014 ......................................... 10.00 Restricted For the treatment of advanced prostate cancer. FLUTAMIDE Tab 250 mg ............................................................................... 55.00 MEGESTROL ACETATE Tab 160 mg – 1% DV Jan-13 to 2015........................................ 51.55 OCTREOTIDE Inj 50 mcg per ml, 1 ml ampoule – 1% DV May-12 to 2014 ...................................................... 19.24 Inj 100 mcg per ml, 1 ml ampoule – 1% DV May-12 to 2014 ...................................................... 36.38 Inj 500 mcg per ml, 1 ml ampoule – 1% DV May-12 to 2014 .................................................... 131.25  Inj 10 mg vial ........................................................................ 1,772.50  Inj 20 mg vial ........................................................................ 2,358.75  Inj 30 mg vial ........................................................................ 2,951.25 100 30 Flutamin Apo-Megestrol 28 Bicalaccord

5 5 5 1 1 1

Octreotide MaxRx Octreotide MaxRx Octreotide MaxRx Sandostatin LAR Sandostatin LAR Sandostatin LAR

Restricted Note: restriction applies only to the long-acting formulations of octreotide Malignant bowel obstruction All of the following: 1 The patient has nausea* and vomiting* due to malignant bowel obstruction*; and 2 Treatment with antiemetics, rehydration, antimuscarinic agents, corticosteroids and analgesics for at least 48 hours has failed; and 3 Octreotide to be given at a maximum dose 1500 mcg daily for up to 4 weeks. Note: Indications marked with * are Unapproved Indications Initiation – acromegaly Re-assessment required after 3 months Both: 1 The patient has acromegaly; and 2 Any of the following: 2.1 Treatment with surgery, radiotherapy and a dopamine agonist has failed; or 2.2 Treatment with octreotide is for an interim period while awaiting the effects of radiotherapy and a dopamine agonist has failed; or continued...

132

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per continued... 2.3 The patient is unwilling, or unable, to undergo surgery and/or radiotherapy Continuation – acromegaly Both: 1 IGF1 levels have decreased since starting octreotide; and 2 The treatment remains appropriate and the patient is benefiting from treatment. Note: In patients with acromegaly octreotide treatment should be discontinued if IGF1 levels have not decreased after 3 months treatment. In patients treated with radiotherapy octreotide treatment should be withdrawn every 2 years, for 1 month, for assessment of remission. Octreotide treatment should be stopped where there is biochemical evidence of remission (normal IGF1 levels) following octreotide treatment withdrawal for at least 4 weeks Other indications Any of the following: 1 VIPomas and Glucagonomas – for patients who are seriously ill in order to improve their clinical state prior to definitive surgery; or 2 Both: 2.1 Gastrinoma; and 2.2 Either: 2.2.1 Patient has failed surgery; or 2.2.2 Patient in metastatic disease after H2 antagonists (or proton pump inhibitors) have failed; or 3 Both: 3.1 Insulinomas; and 3.2 Surgery is contraindicated or has failed; or 4 For pre-operative control of hypoglycaemia and for maintenance therapy; or 5 Both: 5.1 Carcinoid syndrome (diagnosed by tissue pathology and/or urinary 5HIAA analysis); and 5.2 Disabling symptoms not controlled by maximal medical therapy. TAMOXIFEN CITRATE Tab 10 mg ................................................................................. 17.50 Tab 20 mg – 1% DV Jun-11 to 2014............................................ 8.75 100 100 Genox Genox Brand or Generic Manufacturer

Aromatase Inhibitors

ANASTROZOLE Tab 1 mg ................................................................................... 26.55 EXEMESTANE Tab 25 mg – 1% DV Jun-11 to 2014.......................................... 22.57 LETROZOLE Tab 2.5 mg – 1% DV Oct-12 to 2015 ........................................... 4.85 30 Aremed DP-Anastrozole Aromasin Letraccord

30 30

IMMUNOSUPPRESSANTS Calcineurin Inhibitors

CICLOSPORIN Cap 25 mg ................................................................................. 44.63 Cap 50 mg ................................................................................. 88.91 Cap 100 mg ............................................................................. 177.81 Oral liq 100 mg per ml – 1% DV Oct-12 to 2015 ...................... 198.13 Inj 50 mg per ml, 5 ml ampoule – 1% DV Oct-12 to 2015......... 276.30 50 50 50 50 ml 10 Neoral Neoral Neoral Neoral Sandimmun

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

133


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per TACROLIMUS  Cap 0.5 mg .............................................................................. 214.00  Cap 1 mg ................................................................................. 428.00  Cap 5 mg .............................................................................. 1,070.00  Inj 5 mg per ml, 1 ml ampoule Restricted For use in organ transplant recipients Brand or Generic Manufacturer

100 100 50

Prograf Prograf Prograf

Fusion Proteins

ETANERCEPT  Inj 25 mg vial ........................................................................... 949.96  Inj 50 mg autoinjector ........................................................... 1,899.92  Inj 50 mg syringe .................................................................. 1,899.92 4 4 4 Enbrel Enbrel Enbrel

Restricted Initiation – juvenile idiopathic arthritis – rheumatologist or named specialist Re-assessment required after 4 months Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for adalimumab for juvenile idiopathic arthritis (JIA); and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from adalimumab; or 1.2.2 The patient has received insufficient benefit from adalimumab to meet the renewal criteria for adalimumab for JIA; or 2 All of the following: 2.1 Patient diagnosed with JIA; and 2.2 To be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 2.3 Patient has had severe active polyarticular course JIA for 6 months duration or longer; and 2.4 Patient has tried and not responded to at least three months of oral or parenteral methotrexate (at a dose of 10-20 mg/m² weekly or at the maximum tolerated dose) in combination with either oral corticosteroids (prednisone 0.25 mg/kg or at the maximum tolerated dose) or a full trial of serial intra-articular corticosteroid injections; and 2.5 Both: 2.5.1 Either: 2.5.1.1 Patient has persistent symptoms of poorly-controlled and active disease in at least 20 swollen, tender joints; or 2.5.1.2 Patient has persistent symptoms of poorly-controlled and active disease in at least four joints from the following: wrist, elbow, knee, ankle, shoulder, cervical spine, hip; and 2.5.2 Physician’s global assessment indicating severe disease. Continuation – juvenile idiopathic arthritis – rheumatologist or named specialist Re-assessment required after 6 months All of the following: 1 Treatment is to be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 2 Either: 2.1 Following 3 to 4 months’ initial treatment, the patient has at least a 50% decrease in active joint count and an improvement in physician’s global assessment from baseline; or 2.2 On subsequent reapplications, the patient demonstrates at least a continuing 30% improvement in active joint count and continued improvement in physician’s global assessment from baseline. Initiation – rheumatoid arthritis – rheumatologist Re-assessment required after 6 months Either: continued...

134

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per continued... 1 Both: 1.1 The patient has had an initial Special Authority approval for adalimumab for rheumatoid arthritis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from adalimumab; or 1.2.2 The patient has received insufficient benefit from adalimumab to meet the renewal criteria for adalimumab for rheumatoid arthritis; or 2 All of the following: 2.1 Patient has had severe and active erosive rheumatoid arthritis for six months duration or longer; and 2.2 Treatment is to be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 2.3 Patient has tried and not responded to at least three months of oral or parenteral methotrexate at a dose of at least 20 mg weekly or a maximum tolerated dose; and 2.4 Patient has tried and not responded to at least three months of oral or parenteral methotrexate in combination with sulphasalazine and hydroxychloroquine sulphate (at maximum tolerated doses); and 2.5 Any of the following: 2.5.1 Patient has tried and not responded to at least three months of oral or parenteral methotrexate in combination with the maximum tolerated dose of cyclosporin; or 2.5.2 Patient has tried and not responded to at least three months of oral or parenteral methotrexate in combination with intramuscular gold; or 2.5.3 Patient has tried and not responded to at least three months of therapy at the maximum tolerated dose of leflunomide alone or in combination with oral or parenteral methotrexate; and 2.6 Either: 2.6.1 Patient has persistent symptoms of poorly controlled and active disease in at least 20 swollen, tender joints; or 2.6.2 Patient has persistent symptoms of poorly controlled and active disease in at least four joints from the following: wrist, elbow, knee, ankle, and either shoulder or hip; and 2.7 Either: 2.7.1 Patient has a C-reactive protein level greater than 15 mg/L measured no more than one month prior to the date of this application; or 2.7.2 C-reactive protein levels not measured as patient is currently receiving prednisone therapy at a dose of greater than 5 mg per day and has done so for more than three months. Continuation – rheumatoid arthritis – rheumatologist Re-assessment required after 6 months All of the following: 1 Treatment is to be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 2 Either: 2.1 Following 3 to 4 months’ initial treatment, the patient has at least a 50% decrease in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; or 2.2 On subsequent reapplications, the patient demonstrates at least a continuing 30% improvement in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; and 3 Etanercept to be administered at doses no greater than 50 mg every 7 days. Initiation – ankylosing spondylitis – rheumatologist Re-assessment required after 6 months Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for adalimumab for ankylosing spondylitis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from adalimumab; or 1.2.2 The patient has received insufficient benefit from adalimumab to meet the renewal criteria for adalimumab for ankylosing spondylitis; or continued...

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

Brand or Generic Manufacturer

135


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per continued... 2 All of the following: 2.1 Patient has a confirmed diagnosis of ankylosing spondylitis present for more than six months; and 2.2 Patient has low back pain and stiffness that is relieved by exercise but not by rest; and 2.3 Patient has bilateral sacroiliitis demonstrated by plain radiographs, CT or MRI scan; and 2.4 Patient’s ankylosing spondylitis has not responded adequately to treatment with two or more non-steroidal antiinflammatory drugs (NSAIDs), in combination with anti-ulcer therapy if indicated, while patient was undergoing at least 3 months of an exercise regime supervised by a physiotherapist; and 2.5 Either: 2.5.1 Patient has limitation of motion of the lumbar spine in the sagittal and the frontal planes as determined by the following Bath Ankylosing Spondylitis Metrology Index (BASMI) measures: a modified Schober’s test of less than or equal to 4 cm and lumbar side flexion measurement of less than or equal to 10 cm (mean of left and right); or 2.5.2 Patient has limitation of chest expansion by at least 2.5 cm below the average normal values corrected for age and gender (see Notes); and 2.6 Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of at least 6 on a 0-10 scale. Notes: The BASDAI must have been determined at the completion of the 3 month exercise trial, but prior to ceasing NSAID treatment. The BASDAI measure must be no more than 1 month old at the time of starting treatment. Average normal chest expansion corrected for age and gender: 18-24 years – Male: 7.0 cm; Female: 5.5 cm 25-34 years – Male: 7.5 cm; Female: 5.5 cm 35-44 years – Male: 6.5 cm; Female: 4.5 cm 45-54 years – Male: 6.0 cm; Female: 5.0 cm 55-64 years – Male: 5.5 cm; Female: 4.0 cm 65-74 years – Male: 4.0 cm; Female: 4.0 cm 75+ years – Male: 3.0 cm; Female: 2.5 cm Continuation – ankylosing spondylitis – rheumatologist Re-assessment required after 6 months All of the following: 1 Following 12 weeks of etanercept treatment, BASDAI has improved by 4 or more points from pre-treatment baseline on a 10 point scale, or by 50%, whichever is less; and 2 Physician considers that the patient has benefited from treatment and that continued treatment is appropriate; and 3 Etanercept to be administered at doses no greater than 50 mg every 7 days. Initiation – psoriatic arthritis – rheumatologist Re-assessment required after 6 months Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for adalimumab for psoriatic arthritis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from adalimumab; or 1.2.2 The patient has received insufficient benefit from adalimumab to meet the renewal criteria for adalimumab for psoriatic arthritis; or 2 All of the following: 2.1 Patient has had severe active psoriatic arthritis for six months duration or longer; and 2.2 Patient has tried and not responded to at least three months of oral or parenteral methotrexate at a dose of at least 20 mg weekly or a maximum tolerated dose; and 2.3 Patient has tried and not responded to at least three months of sulphasalazine at a dose of at least 2 g per day or leflunomide at a dose of up to 20 mg daily (or maximum tolerated doses); and 2.4 Either: 2.4.1 Patient has persistent symptoms of poorly controlled and active disease in at least 15 swollen, tender joints; or 2.4.2 Patient has persistent symptoms of poorly controlled and active disease in at least four joints from the continued... Brand or Generic Manufacturer

136

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per continued... 2.5 following: wrist, elbow, knee, ankle, and either shoulder or hip; and Any of the following: 2.5.1 Patient has a C-reactive protein level greater than 15 mg/L measured no more than one month prior to the date of this application; or 2.5.2 Patient has an elevated erythrocyte sedimentation rate (ESR) greater than 25 mm per hour; or 2.5.3 ESR and CRP not measured as patient is currently receiving prednisone therapy at a dose of greater than 5 mg per day and has done so for more than three months. Brand or Generic Manufacturer

Continuation – psoriatic arthritis – rheumatologist Re-assessment required after 6 months All of the following: 1 Either: 1.1 Following 3 to 4 months’ initial treatment, the patient has at least a 50% decrease in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; or 1.2 The patient demonstrates at least a continuing 30% improvement in active joint count from baseline and a clinically significant response to prior etanercept treatment in the opinion of the treating physician; and 2 Etanercept to be administered at doses no greater than 50 mg every 7 days. Initiation – plaque psoriasis, prior TNF use – dermatologist Re-assessment required after 4 months Both: 1 The patient has had an initial Special Authority approval for adalimumab for severe chronic plaque psoriasis; and 2 Either: 2.1 The patient has experienced intolerable side effects from adalimumab; or 2.2 The patient has received insufficient benefit from adalimumab to meet the renewal criteria for adalimumab for severe chronic plaque psoriasis; and 3 Patient must be reassessed for continuation after 3 doses. Initiation – plaque psoriasis, treatment-naïve – dermatologist Re-assessment required after 4 months All of the following: 1 Either: 1.1 Patient has “whole body” severe chronic plaque psoriasis with a Psoriasis Area and Severity Index (PASI) score of greater than 15, where lesions have been present for at least 6 months from the time of initial diagnosis; or 1.2 Patient has severe chronic plaque psoriasis of the face, or palm of a hand or sole of a foot, where the plaque or plaques have been present for at least 6 months from the time of initial diagnosis; and 2 Patient has tried, but had an inadequate response (see Note) to, or has experienced intolerable side effects from, at least three of the following (at maximum tolerated doses unless contraindicated): phototherapy, methotrexate, cyclosporin, or acitretin; and 3 A PASI assessment has been completed for at least the most recent prior treatment course (but preferably all prior treatment courses), preferably while still on treatment but no longer than 1 month following cessation of each prior treatment course; and 4 The most recent PASI assessment is no more than 1 month old at the time of initiation. Note: “Inadequate response” is defined as: for whole body severe chronic plaque psoriasis, a PASI score of greater than 15, as assessed preferably while still on treatment but no longer than 1 month following cessation of the most recent prior treatment; for severe chronic plaque psoriasis of the face, hand or foot, at least 2 of the 3 PASI symptom subscores for erythema, thickness and scaling are rated as severe or very severe, and the skin area affected is 30% or more of the face, palm of a hand or sole of a foot, as assessed preferably while still on treatment but no longer than 1 month following cessation of the most recent prior treatment. Continuation – plaque psoriasis – dermatologist Re-assessment required after 6 months All of the following: 1 Either: 1.1 Both:

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

continued...

137


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per continued... 1.1.1 Patient had “whole body” severe chronic plaque psoriasis at the start of treatment; and 1.1.2 Following each prior etanercept treatment course the patient has a PASI score which is reduced by 75% or more, or is sustained at this level, when compared with the pre-etanercept treatment baseline value; or 1.2 Both: 1.2.1 Patient had severe chronic plaque psoriasis of the face, or palm of a hand or sole of a foot at the start of treatment; and 1.2.2 Either: 1.2.2.1 Following each prior etanercept treatment course the patient has a reduction in the PASI symptom subscores for all 3 of erythema, thickness and scaling, to slight or better, or sustained at this level, as compared to the treatment course baseline values; or 1.2.2.2 Following each prior etanercept treatment course the patient has a reduction of 75% or more in the skin area affected, or sustained at this level, as compared to the pre-etanercept treatment baseline value; and 2 Etanercept to be administered at doses no greater than 50 mg every 7 days. Brand or Generic Manufacturer

Monoclonal Antibodies

ABCIXIMAB  Inj 2 mg per ml, 5 ml vial .......................................................... 579.53 1 ReoPro

Restricted Either: 1 For use in patients with acute coronary syndromes undergoing percutaneous coronary intervention; or 2 For use in patients undergoing intra-cranial intervention. ADALIMUMAB  Inj 40 mg per 0.8 ml pen ....................................................... 1,799.92  Inj 40 mg per 0.8 ml syringe.................................................. 1,799.92  Inj 20 mg per 0.4 ml syringe ................................................. 1,799.92 2 2 2 HumiraPen Humira Humira

Restricted Initiation – juvenile idiopathic arthritis – rheumatologist or named specialist Re-assessment required after 4 months Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for etanercept for juvenile idiopathic arthritis (JIA); and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from etanercept; or 1.2.2 The patient has received insufficient benefit from etanercept to meet the renewal criteria for etanercept for JIA; or 2 All of the following: 2.1 Patient diagnosed with JIA; and 2.2 To be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 2.3 Patient has had severe active polyarticular course JIA for 6 months duration or longer; and 2.4 Patient has tried and not responded to at least three months of oral or parenteral methotrexate (at a dose of 10-20 mg/m² weekly or at the maximum tolerated dose) in combination with either oral corticosteroids (prednisone 0.25 mg/kg or at the maximum tolerated dose) or a full trial of serial intra-articular corticosteroid injections; and 2.5 Both: 2.5.1 Either: 2.5.1.1 Patient has persistent symptoms of poorly-controlled and active disease in at least 20 swollen, tender joints; or 2.5.1.2 Patient has persistent symptoms of poorly-controlled and active disease in at least four joints from the following: wrist, elbow, knee, ankle, shoulder, cervical spine, hip; and continued...

138

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per continued... 2.5.2 Physician’s global assessment indicating severe disease. Continuation – juvenile idiopathic arthritis – rheumatologist or named specialist Re-assessment required after 6 months Both: 1 Treatment is to be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 2 Either: 2.1 Following 3 to 4 months’ initial treatment, the patient has at least a 50% decrease in active joint count and an improvement in physician’s global assessment from baseline; or 2.2 On subsequent reapplications, the patient demonstrates at least a continuing 30% improvement in active joint count and continued improvement in physician’s global assessment from baseline. Initiation – fistulising Crohn’s disease – gastroenterologist Re-assessment required after 4 months: All of the following 1 Patient has confirmed Crohn’s disease; and 2 Either: 2.1 Patient has one or more complex externally draining enterocutaneous fistula(e); or 2.2 Patient has one or more rectovaginal fistula(e); and 3 A Baseline Fistula Assessment (a copy of which is available at www.pharmac.govt.nz/latest/BaselineFistulaAssessment. pdf) has been completed and is no more than 1 month old at the time of application. Continuation – fistulising Crohn’s disease – gastroenterologist Re-assessment required after 6 months: Either: 1 The number of open draining fistulae have decreased from baseline by at least 50%; or 2 There has been a marked reduction in drainage of all fistula(e) from baseline as demonstrated by a reduction in the Fistula Assessment score, together with less induration and patient-reported pain. Initiation – Crohn’s disease – gastroenterologist Re-assessment required after 3 months All of the following: 1 Patient has severe active Crohn’s disease; and 2 Any of the following: 2.1 Patient has a Crohn’s Disease Activity Index (CDAI) score of greater than or equal to 300; or 2.2 Patient has extensive small intestine disease affecting more than 50 cm of the small intestine; or 2.3 Patient has evidence of short gut syndrome or would be at risk of short gut syndrome with further bowel resection; or 2.4 Patient has an ileostomy or colostomy, and has intestinal inflammation; and 3 Patient has tried but had an inadequate response to, or has experienced intolerable side effects from, prior systemic therapy with immunomodulators at maximum tolerated doses (unless contraindicated) and corticosteroids; and 4 Surgery (or further surgery) is considered to be clinically inappropriate. Continuation – Crohn’s disease – gastroenterologist Re-assessment required after 3 months Both: 1 Either: 1.1 Either: 1.1.1 CDAI score has reduced by 100 points from the CDAI score when the patient was initiated on adalimumab; or 1.1.2 CDAI score is 150 or less; or 1.2 Both: 1.1.3 The patient has demonstrated an adequate response to treatment but CDAI score cannot be assessed; and 1.1.4 Applicant to indicate the reason that CDAI score cannot be assessed; and continued...

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

Brand or Generic Manufacturer

139


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per continued... 2 Adalimumab to be administered at doses no greater than 40 mg every 14 days. Initiation – rheumatoid arthritis – rheumatologist Re-assessment required after 6 months Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for etanercept for rheumatoid arthritis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from etanercept; or 1.2.2 The patient has received insufficient benefit from etanercept to meet the renewal criteria for etanercept for rheumatoid arthritis; or 2 All of the following: 2.1 Patient has had severe and active erosive rheumatoid arthritis for six months duration or longer; and 2.2 Treatment is to be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 2.3 Patient has tried and not responded to at least three months of oral or parenteral methotrexate at a dose of at least 20 mg weekly or a maximum tolerated dose; and 2.4 Patient has tried and not responded to at least three months of oral or parenteral methotrexate in combination with sulphasalazine and hydroxychloroquine sulphate (at maximum tolerated doses); and 2.5 Any of the following: 2.5.1 Patient has tried and not responded to at least three months of oral or parenteral methotrexate in combination with the maximum tolerated dose of cyclosporin; or 2.5.2 Patient has tried and not responded to at least three months of oral or parenteral methotrexate in combination with intramuscular gold; or 2.5.3 Patient has tried and not responded to at least three months of therapy at the maximum tolerated dose of leflunomide alone or in combination with oral or parenteral methotrexate; and 2.6 Either: 2.6.1 Patient has persistent symptoms of poorly controlled and active disease in at least 20 swollen, tender joints; or 2.6.2 Patient has persistent symptoms of poorly controlled and active disease in at least four joints from the following: wrist, elbow, knee, ankle, and either shoulder or hip; and 2.7 Either: 2.7.1 Patient has a C-reactive protein level greater than 15 mg/L measured no more than one month prior to the date of this application; or 2.7.2 C-reactive protein levels not measured as patient is currently receiving prednisone therapy at a dose of greater than 5 mg per day and has done so for more than three months. Continuation – rheumatoid arthritis – rheumatologist Re-assessment required after 6 months All of the following: 1 Treatment is to be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 2 Either: 2.1 Following 3 to 4 months’ initial treatment, the patient has at least a 50% decrease in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; or 2.2 The patient demonstrates at least a continuing 30% improvement in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; and 3 Either: 3.1 Adalimumab to be administered at doses no greater than 40 mg every 14 days; or 3.2 Patient cannot take concomitant methotrexate and requires doses of adalimumab higher than 40 mg every 14 days to maintain an adequate response. Initiation – ankylosing spondylitis – rheumatologist Re-assessment required after 6 months continued... Brand or Generic Manufacturer

140

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per continued... Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for etanercept for ankylosing spondylitis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from etanercept; or 1.2.2 The patient has received insufficient benefit from etanercept to meet the renewal criteria for etanercept for ankylosing spondylitis. 2 All of the following: 2.1 Patient has a confirmed diagnosis of ankylosing spondylitis for more than six months; and 2.2 Patient has low back pain and stiffness that is relieved by exercise but not by rest; and 2.3 Patient has bilateral sacroiliitis demonstrated by plain radiographs, CT or MRI scan; and 2.4 Patient’s ankylosing spondylitis has not responded adequately to treatment with two or more non-steroidal anti-inflammatory drugs (NSAIDs), in combination with anti-ulcer therapy if indicated, while patient was undergoing at least 3 months of an exercise regime supervised by a physiotherapist; and 2.5 Either: 2.5.1 Patient has limitation of motion of the lumbar spine in the sagittal and the frontal planes as determined by the following Bath Ankylosing Spondylitis Metrology Index (BASMI) measures: a modified Schober’s test of less than or equal to 4 cm and lumbar side flexion measurement of less than or equal to 10 cm (mean of left and right); or 2.5.2 Patient has limitation of chest expansion by at least 2.5 cm below the following average normal values corrected for age and gender (see Notes); and 2.6 A Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of at least 6 on a 0-10 scale. Notes: The BASDAI must have been determined at the completion of the 3 month exercise trial, but prior to ceasing NSAID treatment. The BASDAI measure must be no more than 1 month old at the time of starting treatment. Average normal chest expansion corrected for age and gender: 18-24 years – Male: 7.0 cm; Female: 5.5 cm 25-34 years – Male: 7.5 cm; Female: 5.5 cm 35-44 years – Male: 6.5 cm; Female: 4.5 cm 45-54 years – Male: 6.0 cm; Female: 5.0 cm 55-64 years – Male: 5.5 cm; Female: 4.0 cm 65-74 years – Male: 4.0 cm; Female: 4.0 cm 75+ years – Male: 3.0 cm; Female: 2.5 cm Continuation – ankylosing spondylitis – rheumatologist Re-assessment required after 6 months All of the following: 1 Following 12 weeks of adalimumab treatment, BASDAI has improved by 4 or more points from pre-adalimumab baseline on a 10 point scale, or by 50%, whichever is less; and 2 Physician considers that the patient has benefited from treatment and that continued treatment is appropriate; and 3 Adalimumab to be administered at doses no greater than 40 mg every 14 days. Initiation – psoriatic arthritis – rheumatologist Re-assessment required after 6 months Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for etanercept for psoriatic arthritis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from etanercept; or 1.2.2 The patient has received insufficient benefit from etanercept to meet the renewal criteria for etanercept for psoriatic arthritis; or 2 All of the following: 2.1 Patient has had severe active psoriatic arthritis for six months duration or longer; and 2.2 Patient has tried and not responded to at least three months of oral or parenteral methotrexate at a dose of at least 20 mg weekly or a maximum tolerated dose; and continued...

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

Brand or Generic Manufacturer

141


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per continued... 2.3 2.4 Patient has tried and not responded to at least three months of sulphasalazine at a dose of at least 2 g per day or leflunomide at a dose of up to 20 mg daily (or maximum tolerated doses); and Either: 2.4.1 Patient has persistent symptoms of poorly controlled and active disease in at least 15 swollen, tender joints; or 2.4.2 Patient has persistent symptoms of poorly controlled and active disease in at least four joints from the following: wrist, elbow, knee, ankle, and either shoulder or hip; and Any of the following: 2.5.1 Patient has a C-reactive protein level greater than 15 mg/L measured no more than one month prior to the date of this application; or 2.5.2 Patient has an elevated erythrocyte sedimentation rate (ESR) greater than 25 mm per hour; or 2.5.3 ESR and CRP not measured as patient is currently receiving prednisone therapy at a dose of greater than 5 mg per day and has done so for more than three months. Brand or Generic Manufacturer

2.5

Continuation – psoriatic arthritis – rheumatologist Re-assessment required after 6 months All of the following: 1 Either: 1.1 Following 3 to 4 months’ initial treatment, the patient has at least a 50% decrease in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; or 1.2 The patient demonstrates at least a continuing 30% improvement in active joint count from baseline and a clinically significant response to prior adalimumab treatment in the opinion of the treating physician; and 2 Adalimumab to be administered at doses no greater than 40 mg every 14 days. Initiation – plaque psoriasis, prior TNF use – dermatologist Re-assessment required after 4 months Both: 1 The patient has had an initial Special Authority approval for etanercept for severe chronic plaque psoriasis; and 2 Either: 2.1 The patient has experienced intolerable side effects from etanercept; or 2.2 The patient has received insufficient benefit from etanercept to meet the renewal criteria for etanercept for severe chronic plaque psoriasis. Initiation – plaque psoriasis, treatment-naïve – dermatologist Re-assessment required after 4 months All of the following: 1 Either: 1.1 Patient has “whole body” severe chronic plaque psoriasis with a Psoriasis Area and Severity Index (PASI) score of greater than 15, where lesions have been present for at least 6 months from the time of initial diagnosis; or 1.2 Patient has severe chronic plaque psoriasis of the face, or palm of a hand or sole of a foot, where the plaque or plaques have been present for at least 6 months from the time of initial diagnosis; and 2 Patient has tried, but had an inadequate response (see Note) to, or has experienced intolerable side effects from, at least three of the following (at maximum tolerated doses unless contraindicated): phototherapy, methotrexate, cyclosporin, or acitretin; and 3 A PASI assessment has been completed for at least the most recent prior treatment course (but preferably all prior treatment courses), preferably while still on treatment but no longer than 1 month following cessation of each prior treatment course; and 4 The most recent PASI assessment is no more than 1 month old at the time of initiation. Note: “Inadequate response” is defined as: for whole body severe chronic plaque psoriasis, a PASI score of greater than 15, as assessed preferably while still on treatment but no longer than 1 month following cessation of the most recent prior treatment; for severe chronic plaque psoriasis of the face, hand or foot, at least 2 of the 3 PASI symptom subscores for erythema, thickness and scaling are rated as severe or very severe, and the skin area affected is 30% or more of the face, palm of a hand or sole of a foot, as assessed preferably while still on treatment but no longer than 1 month following cessation of the most recent prior treatment. continued...

142

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per continued... Continuation – plaque psoriasis – dermatologist Re-assessment required after 6 months All of the following: 1 Either: 1.1 Both: 1.1.1 Patient had “whole body” severe chronic plaque psoriasis at the start of treatment; and 1.1.2 Following each prior adalimumab treatment course the patient has a PASI score which is reduced by 75% or more, or is sustained at this level, when compared with the pre-adalimumab treatment baseline value; or 1.2 Both: 1.2.1 Patient had severe chronic plaque psoriasis of the face, or palm of a hand or sole of a foot at the start of treatment; and 1.2.2 Either: 1.2.2.1 Following each prior adalimumab treatment course the patient has a reduction in the PASI symptom subscores for all 3 of erythema, thickness and scaling, to slight or better, or sustained at this level, as compared to the treatment course baseline values; or 1.2.2.2 Following each prior adalimumab treatment course the patient has a reduction of 75% or more in the skin area affected, or sustained at this level, as compared to the pre-adalimumab treatment baseline value; and 2 Adalimumab to be administered at doses no greater than 40 mg every 14 days. BASILIXIMAB  Inj 20 mg vial ........................................................................ 3,200.00 Restricted For use in solid organ transplants BEVACIZUMAB  Inj 25 mg per ml, 4 ml vial  Inj 25 mg per ml, 16 ml vial Restricted Either: 1 Ocular neovascularisation; or 2 Exudative ocular angiopathy. INFLIXIMAB  Inj 100 mg ............................................................................ 1,227.00 Restricted Graft vs host disease Patient has steroid-refractory acute graft vs. host disease of the gut Initiation – rheumatoid arthritis – rheumatologist Re-assessment required after 3-4 months All of the following: 1 The patient has had an initial Special Authority approval for adalimumab and/or etanercept for rheumatoid arthritis; and 2 Either: 2.1 The patient has experienced intolerable side effects from a reasonable trial of adalimumab and/or etanercept; or 2.2 Following at least a four month trial of adalimumab and/or etanercept, the patient did not meet the renewal criteria for adalimumab and/or etanercept; and 3 Treatment is to be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance. Continuation – rheumatoid arthritis – rheumatologist Re-assessment required after 6 months All of the following:

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

Brand or Generic Manufacturer

1

Simulect

1

Remicade

continued...

143


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per continued... 1 Treatment is to be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 2 Either: 2.1 Following 3 to 4 months’ initial treatment, the patient has at least a 50% decrease in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; or 2.2 The patient demonstrates at least a continuing 30% improvement in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; and 3 Infliximab to be administered at doses no greater than 3 mg/kg every 8 weeks. Initiation – ankylosing spondylitis – rheumatologist Re-assessment required after 3 months Both: 1 The patient has had an initial Special Authority approval for adalimumab and/or etanercept for ankylosing spondylitis; and 2 Either: 2.1 The patient has experienced intolerable side effects from a reasonable trial of adalimumab and/or etanercept; or 2.2 Following 12 weeks of adalimumab and/or etanercept treatment, the patient did not meet the renewal criteria for adalimumab and/or etanercept for ankylosing spondylitis. Continuation – ankylosing spondylitis – rheumatologist Re-assessment required after 6 months All of the following: 1 Following 12 weeks of infliximab treatment, BASDAI has improved by 4 or more points from pre-infliximab baseline on a 10 point scale, or by 50%, whichever is less; and 2 Physician considers that the patient has benefited from treatment and that continued treatment is appropriate; and 3 Infliximab to be administered at doses no greater than 5 mg/kg every 6-8 weeks. Initiation – psoriatic arthritis – rheumatologist Re-assessment required after 3-4 months Both: 1 The patient has had an initial Special Authority approval for adalimumab and/or etanercept for psoriatic arthritis; and 2 Either: 2.1 The patient has experienced intolerable side effects from a reasonable trial of adalimumab and/or etanercept; or 2.2 Following 3-4 months’ initial treatment with adalimumab and/or etanercept, the patient did not meet the renewal criteria for adalimumab and/or etanercept for psoriatic arthritis. Continuation – psoriatic arthritis – rheumatologist Re-assessment required after 6 months Both: 1 Either: 1.1 Following 3 to 4 months’ initial treatment, the patient has at least a 50% decrease in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; or 1.2 The patient demonstrates at least a continuing 30% improvement in active joint count from baseline and a clinically significant response to prior infliximab treatment in the opinion of the treating physician; and 2 Infliximab to be administered at doses no greater than 5 mg/kg every 8 weeks. Initiation – severe ocular inflammation Re-assessment required after 3 doses Both: 1 Patient has severe, vision-threatening ocular inflammation requiring rapid control; and 2 Either: 2.1 Patient has failed to achieve control of severe vision-threatening ocular inflammation following high-dose steroids (intravenous methylprednisolone) followed by high dose oral steroids; or 2.2 Patient developed new inflammatory symptoms while receiving high dose steroids. Initiation – chronic ocular inflammation Re-assessment required after 3 doses Both: Brand or Generic Manufacturer

continued...

144

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per continued... 1 Patient has severe uveitis uncontrolled with treatment of steroids and other immunosuppressants with a severe risk of vision loss; and 2 Patient has tried at least two other immunomodulatory agents. Continuation – ocular inflammation Both: 1 Patient had a good clinical response to initial treatment; and 2 Either: 2.1 A withdrawal of infliximab has been trialled and patient has relapsed after trial withdrawal; or 2.2 Patient has Behçet’s disease. Pulmonary sarcoidosis Both: 1 Patient has life-threatening pulmonary sarcoidosis that is refractory to other treatments; and 2 Treatment is to be prescribed by, or has been recommended by, a physician with expertise in the treatment of pulmonary sarcoidosis. Initiation – Crohn’s disease (adults) – gastroenterologist Re-assessment required after 3 months All of the following: 1 Patient has severe active Crohn’s disease; and 2 Any of the following: 2.1 Patient has a Crohn’s Disease Activity Index (CDAI) score of greater than or equal to 300; or 2.2 Patient has extensive small intestine disease affecting more than 50 cm of the small intestine; or 2.3 Patient has evidence of short gut syndrome or would be at risk of short gut syndrome with further bowel resection; or 2.4 Patient has an ileostomy or colostomy, and has intestinal inflammation; and 3 Patient has tried but had an inadequate response to, or has experienced intolerable side effects from, prior systemic therapy with immunomodulators at maximum tolerated doses (unless contraindicated) and corticosteroids; and 4 Surgery (or further surgery) is considered to be clinically inappropriate; and 5 Patient must be reassessed for continuation after 3 months of therapy. Continuation – Crohn’s disease (adults) – gastroenterologist Re-assessment required after 6 months All of the following: 1 One of the following: 1.1 CDAI score has reduced by 100 points from the CDAI score when the patient was initiated on adalimumab; or 1.2 CDAI score is 150 or less; or 1.3 The patient has demonstrated an adequate response to treatment but CDAI score cannot be assessed; and 2 Infliximab to be administered at doses up to 5 mg/kg every 8 weeks. Up to 10 mg/kg every 8 weeks (or equivalent) can be used for up to 3 doses if required for secondary non-response to treatment for re-induction. Another re-induction may be considered sixteen weeks after completing the last re-induction cycle; and 3 Patient must be reassessed for continuation after further 6 months. Initiation – Crohn’s disease (children) – gastroenterologist Re-assessment required after 3 months All of the following: 1 Paediatric patient has severe active Crohn’s disease; and 2 Any of the following: 2.1 Patient has a Paediatric Crohn’s Disease Activity Index (PCDAI) score of greater than or equal to 30; or 2.2 Patient has extensive small intestine disease; and 3 Patient has tried but had an inadequate response to, or has experienced intolerable side effects from, prior systemic therapy with immunomodulators at maximum tolerated doses (unless contraindicated) and corticosteroids; and 4 Surgery (or further surgery) is considered to be clinically inappropriate; and 5 Patient must be reassessed for continuation after 3 months of therapy; continued...

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

Brand or Generic Manufacturer

145


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per continued... Continuation – Crohn’s disease (children) – gastroenterologist Re-assessment required after 6 months 1 One of the following: 1.1 PCDAI score has reduced by 10 points from the CDAI score when the patient was initiated on infliximab; or 1.2 PCDAI score is 15 or less; or 1.3 The patient has demonstrated an adequate response to treatment but CDAI score cannot be assessed; and 2 Infliximab to be administered at doses up to 5 mg/kg every 8 weeks. Up to 10 mg/kg every 8 weeks (or equivalent) can be used for up to 3 doses if required for secondary non-response to treatment for re-induction. Another re-induction may be considered sixteen weeks after completing the last re-induction cycle; and 3 Patient must be reassessed for continuation after further 6 months; Initiation – fistulising Crohn’s disease – gastroenterologist All of the following: 1 Patient has confirmed Crohn’s disease; and 2 Either: 2.1 Patient has one or more complex externally draining enterocutaneous fistula(e); or 2.2 Patient has one or more rectovaginal fistula(e); and 3 Patient must be reassessed for continuation after 4 months of therapy. Continuation – fistulising Crohn’s disease – gastroenterologist All of the following: 1 Either: 1.1 The number of open draining fistulae have decreased from baseline by at least 50%; or 1.2 There has been a marked reduction in drainage of all fistula(e) from baseline (in the case of adult patients, as demonstrated by a reduction in the Fistula Assessment score), together with less induration and patient reported pain; and 2 Infliximab to be administered at doses up to 5 mg/kg every 8 weeks. Up to 10 mg/kg every 8 weeks (or equivalent) can be used for up to 3 doses if required for secondary non-response to treatment for re-induction. Another re-induction may be considered sixteen weeks after completing the last re-induction cycle; and 3 Patient must be reassessed for continuation after further 6 months. Initiation – acute severe fulminant ulcerative colitis – gastroenterologist All of the following: 1 Patient has acute, severe fulminant ulcerative colitis; and 2 Treatment with intravenous or high dose oral corticosteroids has not been successful; and 3 Patient must be reassessed for continuation after 6 weeks of therapy. Continuation – severe fulminant ulcerative colitis – gastroenterologist All of the following: 1 Where maintenance treatment is considered appropriate, infliximab should be used in combination with immunomodulators and reassessed every 6 months; 2 Infliximab to be administered at doses up to 5 mg/kg every 8 weeks. Up to 10 mg/kg every 8 weeks (or equivalent) can be used for up to 3 doses if required for secondary non-response to treatment for re-induction. Another re-induction may be considered sixteen weeks after completing the last re-induction cycle; and 3 Patient must be reassessed for continuation after further 6 months. Initiation – severe ulcerative colitis – gastroenterologist All of the following: 1 Patient has histologically confirmed ulcerative colitis; and 2 The Simple Clinical Colitis Activity Index (SCCAI) is ≥ 4 3 Patient has tried but had an inadequate response to, or has experienced intolerable side effects from, prior systemic therapy with immunomodulators at maximum tolerated doses for an adequate duration (unless contraindicated) and corticosteroids; and 4 Surgery (or further surgery) is considered to be clinically inappropriate; and 5 Patient must be reassessed for continuation after 3 months of therapy. continued... Brand or Generic Manufacturer

146

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per continued... Continuation – severe ulcerative colitis – gastroenterologist All of the following: 1 Patient is continuing to maintain remission and the benefit of continuing infliximab outweighs the risks; 2 SCCAI score has reduced by ≥ 2 points from the SCCAI score when the patient was initiated on infliximab; and 3 Infliximab to be administered at doses up to 5 mg/kg every 8 weeks. Up to 10 mg/kg every 8 weeks (or equivalent) can be used for up to 3 doses if required for secondary non-response to treatment for re-induction. Another re-induction may be considered sixteen weeks after completing the last re-induction cycle. Initiation – plaque psoriasis, prior TNF use – dermatologist Re-assessment required after 3 doses Both: 1 The patient has had an initial Special Authority approval for adalimumab or etanercept for severe chronic plaque psoriasis; and 2 Either: 2.1 The patient has experienced intolerable side effects from adalimumab or etanercept; or 2.2 The patient has received insufficient benefit from adalimumab or etanercept to meet the renewal criteria for adalimumab or etanercept for severe chronic plaque psoriasis. Initiation – plaque psoriasis, treatment-naïve – dermatologist Re-assessment required after 3 doses All of the following: 1 Either: 1.1 Patient has “whole body” severe chronic plaque psoriasis with a Psoriasis Area and Severity Index (PASI) score of greater than 15, where lesions have been present for at least 6 months from the time of initial diagnosis; or 1.2 Patient has severe chronic plaque psoriasis of the face, or palm of a hand or sole of a foot, where the plaque or plaques have been present for at least 6 months from the time of initial diagnosis; and 2 Patient has tried, but had an inadequate response (see Note) to, or has experienced intolerable side effects from, at least three of the following (at maximum tolerated doses unless contraindicated): phototherapy, methotrexate, cyclosporin, or acitretin; and 3 A PASI assessment has been completed for at least the most recent prior treatment course (but preferably all prior treatment courses), preferably while still on treatment but no longer than 1 month following cessation of each prior treatment course; and 4 The most recent PASI assessment is no more than 1 month old at the time of initiation. Note: “Inadequate response” is defined as: for whole body severe chronic plaque psoriasis, a PASI score of greater than 15, as assessed preferably while still on treatment but no longer than 1 month following cessation of the most recent prior treatment; for severe chronic plaque psoriasis of the face, hand or foot, at least 2 of the 3 PASI symptom subscores for erythema, thickness and scaling are rated as severe or very severe, and the skin area affected is 30% or more of the face, palm of a hand or sole of a foot, as assessed preferably while still on treatment but no longer than 1 month following cessation of the most recent prior treatment. Continuation – plaque psoriasis – dermatologist Re-assessment required after 3 doses All of the following: 1 Either: 1.1 Both: 1.1.1 Patient had “whole body” severe chronic plaque psoriasis at the start of treatment; and 1.1.2 Following each prior infliximab treatment course the patient has a PASI score which is reduced by 75% or more, or is sustained at this level, when compared with the pre-infliximab treatment baseline value; or 1.2 Both: 1.2.1 Patient had severe chronic plaque psoriasis of the face, or palm of a hand or sole of a foot at the start of treatment; and 1.2.2 Either: 1.2.2.1 Following each prior infliximab treatment course the patient has a reduction in the PASI symptom subscores for all 3 of erythema, thickness and scaling, to slight or better, or sustained at this continued...

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

Brand or Generic Manufacturer

147


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per continued... level, as compared to the treatment course baseline values; or 1.2.2.2 Following each prior infliximab treatment course the patient has a reduction of 75% or more in the skin area affected, or sustained at this level, as compared to the pre-infliximab treatment baseline value; and 2 Infliximab to be administered at doses no greater than 5 mg/kg every 8 weeks. RANIBIZUMAB  Inj 10 mg per ml, 0.23 ml vial  Inj 10 mg per ml, 0.3 ml vial Restricted Initiation Re-assessment required after 3 doses Both: 1 Either 1.1 Age-related macular degeneration; or 1.2 Choroidal neovascular membrane; and 2 Any of the following: 2.1 The patient has had a severe ophthalmic inflammatory response following bevacizumab; or 2.2 The patient has had a myocardial infarction or stroke within the last three months; or 2.3 The patient has failed to respond to bevacizumab following three intraocular injections; or 2.4 The patient is of child-bearing potential and has not completed a family. Continuation Both: 1 Documented benefit after three doses must be demonstrated to continue; and 2 In the case of but previous non-response to bevacizumab, a retrial of bevacizumab is required to confirm non-response before continuing with ranibizumab. RITUXIMAB  Inj 10 mg per ml, 10 ml vial ................................................... 1,075.50  Inj 10 mg per ml, 50 ml vial ................................................... 2,688.30 2 1 Mabthera Mabthera Brand or Generic Manufacturer

Restricted Initiation – haemophilia with inhibitors – haematologist Any of the following: 1 Patient has mild congenital haemophilia complicated by inhibitors; or 2 Patient has severe congenital haemophilia complicated by inhibitors and has failed immune tolerance therapy; or 3 Patient has acquired haemophilia. Continuation – haemophilia with inhibitors – haematologist All of the following: 1 Patient was previously treated with rituximab for haemophilia with inhibitors; and 2 An initial response lasting at least 12 months was demonstrated; and 3 Patient now requires repeat treatment. Initiation – post-transplant Both: 1 The patient has B-cell post-transplant lymphoproliferative disorder*; and 2 To be used for a maximum of 8 treatment cycles. Note: Indications marked with * are Unapproved Indications. Continuation – post-transplant All of the following: 1 The patient has had a rituximab treatment-free interval of 12 months or more; and 2 The patient has B-cell post-transplant lymphoproliferative disorder*; and 3 To be used for no more than 6 treatment cycles.

continued...

148

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per continued... Note: Indications marked with * are Unapproved Indications. Initiation – indolent, low-grade lymphomas Either: 1 Both: 1.1 The patient has indolent low grade NHL with relapsed disease following prior chemotherapy; and 1.2 To be used for a maximum of 6 treatment cycles; or 2 Both: 2.1 The patient has indolent, low grade lymphoma requiring first-line systemic chemotherapy; and 2.2 To be used for a maximum of 6 treatment cycles. Note: ‘Indolent, low-grade lymphomas’ includes follicular, mantle, marginal zone and lymphoplasmacytic/Waldenstrom macroglobulinaemia. Continuation – indolent, low-grade lymphomas All of the following: 1 The patient has had a rituximab treatment-free interval of 12 months or more; and 2 The patient has indolent, low-grade NHL with relapsed disease following prior chemotherapy; and 3 To be used for no more than 6 treatment cycles. Note: ‘Indolent, low-grade lymphomas’ includes follicular, mantle, marginal zone and lymphoplasmacytic/Waldenstrom macroglobulinaemia. Initiation – aggressive CD20 positive NHL Either: 1 All of the following: 1.1 The patient has treatment naive aggressive CD20 positive NHL; and 1.2 To be used with a multi-agent chemotherapy regimen given with curative intent; and 1.3 To be used for a maximum of 8 treatment cycles; or 2 Both: 2.1 The patient has aggressive CD20 positive NHL with relapsed disease following prior chemotherapy; and 2.2 To be used for a maximum of 6 treatment cycles. Note: ‘Aggressive CD20 positive NHL’ includes large B-cell lymphoma and Burkitt’s lymphoma/leukaemia. Continuation – aggressive CD20 positive NHL 1 The patient has had a rituximab treatment-free interval of 12 months or more; and 2 The patient has relapsed refractory/aggressive CD20 positive NHL; and 3 To be used with a multi-agent chemotherapy regimen given with curative intent; and 4 To be used for a maximum of 4 treatment cycles. Note: ‘Aggressive CD20 positive NHL’ includes large B-cell lymphoma and Burkitt’s lymphoma/leukaemia. Chronic lymphocytic leukaemia All of the following: 1 The patient has progressive Binet stage A, B or C chronic lymphocytic leukaemia (CLL) requiring treatment; and 2 The patient is rituximab treatment naive; and 3 Either: 3.1 The patient is chemotherapy treatment naive; or 3.2 Both: 3.2.1 The patient’s disease has relapsed following no more than three prior lines of chemotherapy treatment; and 3.2.2 The patient has had a treatment-free interval of 12 months or more if previously treated with fludarabine and cyclophosphamide chemotherapy; and 4 The patient has good performance status; and 5 The patient has good renal function (creatinine clearance ≥ 30 ml/min); and 6 The patient does not have chromosome 17p deletion CLL; and 7 Rituximab to be administered in combination with fludarabine and cyclophosphamide for a maximum of 6 treatment cycles; and continued...

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

Brand or Generic Manufacturer

149


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per continued... 8 It is planned that the patient receives full dose fludarabine and cyclophosphamide (orally or dose equivalent intravenous administration). Note: ‘Chronic lymphocytic leukaemia (CLL)’ includes small lymphocytic lymphoma. A line of chemotherapy treatment is considered to comprise a known standard therapeutic chemotherapy regimen and supportive treatments. ‘Good performance status’ means ECOG score of 0-1, however, in patients temporarily debilitated by their CLL disease symptoms a higher ECOG (2 or 3) is acceptable where treatment with rituximab is expected to improve symptoms and improve ECOG score to <2. Initiation – rheumatoid arthritis – prior TNF inhibitor use – rheumatologist Re-assessment required after 2 doses All of the following: 1 Both: 1.1 The patient has had an initial community Special Authority approval for at least one of etanercept and/or adalimumab for rheumatoid arthritis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from a reasonable trial of adalimumab and/or etanercept; or 1.2.2 Following at least a four month trial of adalimumab and/or etanercept, the patient did not meet the renewal criteria for adalimumab and/or etanercept for rheumatoid arthritis; and 2 Either: 2.1 Rituximab to be used as an adjunct to methotrexate or leflunomide therapy; or 2.2 Patient is contraindicated to both methotrexate and leflunomide, requiring rituximab monotherapy to be used; and 3 Maximum of two 1,000 mg infusions of rituximab given two weeks apart. Initiation – rheumatoid arthritis – TNF inhibitors contraindicated – rheumatologist Re-assessment required after 2 doses All of the following: 1 Treatment with a Tumour Necrosis Factor alpha inhibitor is contraindicated; and 2 Patient has had severe and active erosive rheumatoid arthritis for six months duration or longer; and 3 Patient has tried and not responded to at least three months of oral or parenteral methotrexate at a dose of at least 20 mg weekly or a maximum tolerated dose; and 4 Patient has tried and not responded to at least three months of oral or parenteral methotrexate in combination with sulphasalazine and hydroxychloroquine sulphate (at maximum tolerated doses); and 5 Any of the following: 5.1 Patient has tried and not responded to at least three months of oral or parenteral methotrexate in combination with the maximum tolerated dose of cyclosporin; or 5.2 Patient has tried and not responded to at least three months of oral or parenteral methotrexate in combination with intramuscular gold; or 5.3 Patient has tried and not responded to at least three months of therapy at the maximum tolerated dose of leflunomide alone or in combination with oral or parenteral methotrexate; and 6 Either: 6.1 Patient has persistent symptoms of poorly controlled and active disease in at least 20 swollen, tender joints; or 6.2 Patient has persistent symptoms of poorly controlled and active disease in at least four joints from the following: wrist, elbow, knee, ankle, and either shoulder or hip; and 7 Either: 7.1 Patient has a C-reactive protein level greater than 15 mg/L measured no more than one month prior to the date of this application; or 7.2 C-reactive protein levels not measured as patient is currently receiving prednisone therapy at a dose of greater than 5 mg per day and has done so for more than three months; and 8 Either: 8.1 Rituximab to be used as an adjunct to methotrexate or leflunomide therapy; or 8.2 Patient is contraindicated to both methotrexate and leflunomide, requiring rituximab monotherapy to be used; and 9 Maximum of two 1,000 mg infusions of rituximab given two weeks apart. continued... Brand or Generic Manufacturer

150

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per continued... Continuation – rheumatoid arthritis – re-treatment in ‘partial responders’ to rituximab – rheumatologist Re-assessment required after 2 doses All of the following: 1 Either: 1.1 At 4 months following the initial course of rituximab infusions the patient had between a 30% and 50% decrease in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; or 1.2 At 4 months following the second course of rituximab infusions the patient had at least a 50% decrease in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; or 1.3 At 4 months following the third and subsequent courses of rituximab infusions, the patient demonstrates at least a continuing 30% improvement in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; and 2 Rituximab re-treatment not to be given within 6 months of the previous course of treatment; and 3 Either: 3.1 Rituximab to be used as an adjunct to methotrexate or leflunomide therapy; or 3.2 Patient is contraindicated to both methotrexate and leflunomide, requiring rituximab monotherapy to be used; and 4 Maximum of two 1,000 mg infusions of rituximab given two weeks apart. Continuation – rheumatoid arthritis – re-treatment in ‘responders’ to rituximab – rheumatologist Re-assessment required after 2 doses All of the following: 1 Either: 1.1 At 4 months following the initial course of rituximab infusions the patient had at least a 50% decrease in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; or 1.2 At 4 months following the second and subsequent courses of rituximab infusions, the patient demonstrates at least a continuing 30% improvement in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; and 2 Rituximab re-treatment not to be given within 6 months of the previous course of treatment; and 3 Either: 3.1 Rituximab to be used as an adjunct to methotrexate or leflunomide therapy; or 3.2 Patient is contraindicated to both methotrexate and leflunomide, requiring rituximab monotherapy to be used; and 4 Maximum of two 1,000 mg infusions of rituximab given two weeks apart. TOCILIZUMAB  Inj 20 mg per ml, 4 ml vial ............................................................ 1  Inj 20 mg per ml, 10 ml vial .......................................................... 1  Inj 20 mg per ml, 20 ml vial .......................................................... 1 220.00 550.00 1,100.00 Actemra Actemra Actemra Brand or Generic Manufacturer

Initiation – systemic juvenile idiopathic arthritis – paediatric rheumatologist Re-assessment required after 6 months Both: 1 Patient diagnosed with systemic juvenile idiopathic arthritis; and 2 Patient has tried and not responded to a reasonable trial of all of the following, either alone or in combination: oral or parenteral methotrexate; non-steroidal anti-inflammatory drugs (NSAIDs); and systemic corticosteroids. Continuation – systemic juvenile idiopathic arthritis – paediatric rheumatologist Re-assessment required after 6 months Either: 1 Following up to 6 months’ initial treatment, the patient has achieved at least an American College of Rheumatology paediatric 30% improvement criteria (ACR Pedi 30) response from baseline; or 2 On subsequent reapplications, the patient demonstrates at least a continuing ACR Pedi 30 response from baseline.

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

151


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per TRASTUZUMAB  Inj 150 mg vial ...................................................................... 1,350.00  440 mg vial ...................................................................... 3,875.00 Inj 1 1 Brand or Generic Manufacturer Herceptin Herceptin

Restricted Early breast cancer Limited to 12 months’ treatment All of the following: 1 The patient has early breast cancer expressing HER 2 IHC 3+ or ISH + (including FISH or other current technology); and 2 Maximum cumulative dose of 106 mg/kg (12 months’ treatment); and 3 Any of the following: 3.1 9 weeks’ concurrent treatment with adjuvant chemotherapy is planned; or 3.2 12 months’ concurrent treatment with adjuvant chemotherapy is planned; or 3.3 12 months’ sequential treatment following adjuvant chemotherapy is planned; or 3.4 Other treatment regimen, in association with adjuvant chemotherapy, is planned. Initiation – metastatic breast cancer (trastuzumab-naïve patients) Re-assessment required after 12 months Either: 1 All of the following: 1.1 The patient has metastatic breast cancer expressing HER-2 IHC 3+ or ISH+ (including FISH or other current technology); and 1.2 The patient has not previously received lapatinib treatment for HER 2 positive metastatic breast cancer; and 1.3 Trastuzumab not to be given in combination with lapatinib; and 1.4 Trastuzumab to be discontinued at disease progression; or 2 All of the following: 2.1 The patient has metastatic breast cancer expressing HER-2 IHC 3+ or ISH+ (including FISH or other current technology); and 2.2 The patient started lapatinib treatment for metastatic breast cancer but discontinued lapatinib within 3 months of starting treatment due to intolerance; and 2.3 The cancer did not progress whilst on lapatinib; and 2.4 Trastuzumab not to be given in combination with lapatinib; and 2.5 Trastuzumab to be discontinued at disease progression Initiation – metastatic breast cancer (patients previously treated with trastuzumab) Re-assessment required after 12 months All of the following: 1 The patient has metastatic breast cancer expressing HER-2 IHC 3+ or ISH+ (including FISH or other current technology); and 2 The patient received prior adjuvant trastuzumab treatment for early breast cancer; and 3 Any of the following: 3.1 All of the following: 3.1.1 The patient has not previously received lapatinib treatment for metastatic breast cancer; and 3.1.2 Trastuzumab not to be given in combination with lapatinib; and 3.1.3 Trastuzumab to be discontinued at disease progression; or 3.2 All of the following: 3.2.1 The patient started lapatinib treatment for metastatic breast cancer but discontinued lapatinib within 3 months of starting treatment due to intolerance; and 3.2.2 The cancer did not progress whilst on lapatinib; and 3.2.3 Trastuzumab not to be given in combination with lapatinib; and 3.2.4 Trastuzumab to be discontinued at disease progression; or 3.3 All of the following: 3.3.1 The cancer has not progressed at any time point during the previous 12 months whilst on trastuzumab; and 3.3.2 Trastuzumab not to be given in combination with lapatinib; and 3.3.3 Trastuzumab to be discontinued at disease progression. continued...

152

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per continued... Continuation – metastatic breast cancer Re-assessment required after 12 months 1 The patient has metastatic breast cancer expressing HER-2 IHC 3+ or ISH+ (including FISH or other current technology); and 2 The cancer has not progressed at any time point during the previous 12 months whilst on trastuzumab; and 3 Trastuzumab not to be given in combination with lapatinib; and 4 Trastuzumab to be discontinued at disease progression. Brand or Generic Manufacturer

Other Immunosuppressants

ANTITHYMOCYTE GLOBULIN (EQUINE) Inj 50 mg per ml, 5 ml ampoule ............................................. 2,137.50 ANTITHYMOCYTE GLOBULIN (RABBIT) Inj 25 mg vial AZATHIOPRINE Tab 50 mg ................................................................................. 18.45 Inj 50 mg vial ............................................................................. 60.00 BACILLUS CALMETTE-GUERIN (BCG)  Inj 2-8 x 10^8 CFU vial – 1% DV Sep-13 to 2016 ................... 149.37 Restricted For use in bladder cancer MYCOPHENOLATE MOFETIL  Cap 250 mg ............................................................................... 30.00 70.00 60.00  Tab 500 mg ............................................................................... 70.00 60.00 50 100 50 165 ml 4 Ceptolate CellCept Myaccord CellCept Ceptolate Myaccord CellCept CellCept 100 1 1 Imuprine Imuran Imuran OncoTICE 5 ATGAM

 Powder for oral liq 1 g per 5 ml ................................................ 285.00  Inj 500 mg vial ......................................................................... 133.33

Restricted Either: 1 Transplant recipient; or 2 Both: Patients with diseases where: 2.1 Steroids and azathioprine have been trialled and discontinued because of unacceptable side effects or inadequate clinical response; and 2.2 Either: Patients with diseases where: 2.2.1 Cyclophosphamide has been trialed and discontinued because of unacceptable side effects or inadequate clinical response; or 2.2.2 Cyclophosphamide treatment is contraindicated PICIBANIL Inj 100 mg vial

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

153


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Price (ex man. Excl. GST) $ Per SIROLIMUS  Tab 1 mg ................................................................................. 813.00  Tab 2 mg .............................................................................. 1,626.00  Oral liq 1 mg per ml.................................................................. 487.80 Restricted For rescue therapy for an organ transplant recipient Notes: Rescue therapy defined as unresponsive to calcineurin inhibitor treatment as defined by refractory rejection; or intolerant to calcineurin inhibitor treatment due to any of the following: • GFR<30 ml/min; or • Rapidly progressive transplant vasculopathy; or • Rapidly progressive obstructive bronchiolitis; or • HUS or TTP; or • Leukoencepthalopathy; or • Significant malignant disease Brand or Generic Manufacturer

100 100 60 ml

Rapamune Rapamune Rapamune

154

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


RESPIRATORY SYSTEM AND ALLERGIES

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

ANTIALLERGY PREPARATIONS Allergy Desensitisation

BEE VENOM  Inj 120 mcg vial with diluent, 6 vial  Inj 550 mcg vial with diluent Restricted Both: 1 RAST or skin test positive; and 2 Patient has had severe generalised reaction to the sensitising agent. PAPER WASP VENOM  Inj 550 mcg vial with diluent Restricted Both: 1 RAST or skin test positive; and 2 Patient has had severe generalised reaction to the sensitising agent. YELLOW JACKET WASP VENOM  Inj 550 mcg vial with diluent Restricted Both: 1 RAST or skin test positive; and 2 Patient has had severe generalised reaction to the sensitising agent.

Allergy Prophylactics

BECLOMETHASONE DIPROPIONATE Nasal spray 50 mcg per dose ....................................................... 4.85 Nasal spray 100 mcg per dose ..................................................... 5.75 BUDESONIDE Nasal spray 50 mcg per dose ....................................................... 4.85 Nasal spray 100 mcg per dose ..................................................... 5.75 FLUTICASONE PROPIONATE Nasal spray 50 mcg per dose – 1% DV Apr-13 to 2015 ............... 2.30 IPRATROPIUM BROMIDE Nasal spray 0.03% SODIUM CROMOGLYCATE Nasal spray 4% 200 dose 200 dose 200 dose 200 dose 120 dose Alanase Alanase Butacort Aqueous Butacort Aqueous Flixonase Hayfever & Allergy

Antihistamines

CETIRIZINE HYDROCHLORIDE Oral liq 1 mg per ml – 1% DV Nov-11 to 2014.............................. 3.52 Tab 10 mg – 1% DV Sep-11 to 2014 ........................................... 1.59 200 ml 100 Cetrizine - AFT Zetop

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

155


RESPIRATORY SYSTEM AND ALLERGIES

Price (ex man. Excl. GST) $ Per CHLORPHENIRAMINE MALEATE Inj 10 mg per ml, 1 ml ampoule Oral liq 0.4 mg per ml CYPROHEPTADINE HYDROCHLORIDE Tab 4 mg FEXOFENADINE HYDROCHLORIDE Tab 60 mg Tab 120 mg Tab 180 mg LORATADINE Oral liq 1 mg per ml...................................................................... 3.10 Tab 10 mg ................................................................................... 2.09 PROMETHAZINE HYDROCHLORIDE Inj 25 mg per ml, 2 ml ampoule .................................................. 11.00 Oral liq 1 mg per ml – 1% DV Feb-13 to 2015 .............................. 2.79 Tab 10 mg – 1% DV Sep-12 to 2015 ........................................... 1.99 Tab 25 mg – 1% DV Sep-12 to 2015 ........................................... 2.99 TRIMEPRAZINE TARTRATE Oral liq 6 mg per ml 100 ml 100 Lorapaed Loraclear Hayfever Relief Mayne Allersoothe Allersoothe Allersoothe Brand or Generic Manufacturer

5 100 ml 50 50

ANTICHOLINERGIC AGENTS

IPRATROPIUM BROMIDE Aerosol inhaler 20 mcg per dose Nebuliser soln 250 mcg per ml, 1 ml ampoule – 1% DV Sep-13 to 2016 ....................................................... 3.26 Nebuliser soln 250 mcg per ml, 2 ml ampoule – 1% DV Sep-13 to 2016 ....................................................... 3.37 TIOTROPIUM BROMIDE  Powder for inhalation 18 mcg per dose....................................... 70.00

20 20 30 dose

Univent Univent Spiriva

Restricted All of the following: 1 To be used for the long-term maintenance treatment of bronchospasm and dyspnoea associated with COPD; and 2 In addition to standard treatment, the patient has trialled a short acting bronchodilator of at least 40 mcg ipratropium q.i.d for one month; and 3 Either: The patient’s breathlessness according to the Medical Research Council (UK) dyspnoea scale is: 3.1 Grade 4 (stops for breath after walking about 100 meters or after a few minutes on the level); or 3.2 Grade 5 (too breathless to leave the house, or breathless when dressing or undressing); and 4 Actual FEV1 as a % of predicted, must be below 60%. 5 Either: 5.1 Patient is not a smoker; or 5.2 Patient is a smoker and has been offered smoking cessation counselling; and 5.3 The patient has been offered annual influenza immunisation.

156

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


RESPIRATORY SYSTEM AND ALLERGIES

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Anticholinergic Agents with Beta-Adrenoceptor Agonists

SALBUTAMOL WITH IPRATROPIUM BROMIDE Aerosol inhaler 100 mcg with ipratropium bromide 20 mcg per dose Nebuliser soln 2.5 mg with ipratropium bromide 0.5 mg per 2.5 ml ampoule – 1% DV Nov-12 to 2015................................ 3.75

20

Duolin

BETA-ADRENOCEPTOR AGONISTS

SALBUTAMOL Aerosol inhaler, 100 mcg per dose ............................................... 4.00 6.00 Inj 1 mg per ml, 5 ml ampoule Inj 500 mcg per ml, 1 ml ampoule Nebuliser soln 1 mg per ml, 2.5 ml ampoule – 1% DV Nov-12 to 2015 ........................................................ 3.25 Nebuliser soln 2 mg per ml, 2.5 ml ampoule – 1% DV Nov-12 to 2015 ........................................................ 3.44 Oral liq 0.4 mg per ml................................................................... 1.99 TERBUTALINE SULPHATE Powder for inhalation 250 mcg per dose Inj 0.5 mg per ml, 1 ml ampoule 200 dose 200 dose Salamol Ventolin

20 20 150 ml

Asthalin Asthalin Salapin

COUGH SUPPRESSANTS

PHOLCODINE Oral liq 1 mg per ml

DECONGESTANTS

OXYMETAZOLINE HYDROCHLORIDE Aqueous nasal spray 0.25 mg per ml Aqueous nasal spray 0.5 mg per ml PSEUDOPHEDRINE HYDROCHLORIDE Tab 60 mg SODIUM CHLORIDE Aqueous nasal spray 6.5 mg per ml SODIUM CHLORIDE WITH SODIUM BICARBONATE Soln for nasal irrigaiton XYLOMETAZOLINE HYDROCHLORIDE Aqueous nasal spray 0.05% Aqueous nasal spray 0.1% Nasal drops 0.05% Nasal drops 0.1%

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

157


RESPIRATORY SYSTEM AND ALLERGIES

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

INHALED CORTICOSTEROIDS

BECLOMETHASONE DIPROPIONATE Aerosol inhaler 50 mcg per dose .................................................. 8.54 Aerosol inhaler 100 mcg per dose .............................................. 12.50 Aerosol inhaler 250 mcg per dose .............................................. 22.67 BUDESONIDE Powder for inhalation 100 mcg per dose Powder for inhalation 200 mcg per dose..................................... 15.20 Powder for inhalation 400 mcg per dose..................................... 25.60 Nebuliser soln 250 mcg per ml, 2 ml ampoule Nebuliser soln 500 mcg per ml, 2 ml ampoule FLUTICASONE Aerosol inhaler 50 mcg per dose .................................................. 7.50 Aerosol inhaler 125 mcg per dose .............................................. 13.60 Aerosol inhaler 250 mcg per dose .............................................. 27.20 Powder for inhalation 50 mcg per dose......................................... 8.67 Powder for inhalation 100 mcg per dose..................................... 13.87 Powder for inhalation 250 mcg per dose..................................... 24.51 200 dose 200 dose 200 dose Beclazone 50 Beclazone 100 Beclazone 250

200 dose 200 dose

Budenocort Budenocort

120 dose 120 dose 120 dose 60 dose 60 dose 60 dose

Flixotide Flixotide Flixotide Flixotide Accuhaler Flixotide Accuhaler Flixotide Accuhaler

LEUKOTRIENE RECEPTOR ANTAGONISTS

MONTELUKAST  Tab 4 mg ................................................................................... 18.48  Tab 5 mg ................................................................................... 18.48  Tab 10 mg ................................................................................. 18.48 28 28 28 Singulair Singulair Singulair

Restricted Pre-school wheeze All of the following: 1 To be used for the treatment of intermittent severe wheezing (possibly viral) in children under 5 years; and 2 The patient has trialled inhaled corticosteroids at a dose of up to 400 mcg per day beclomethasone or budesonide, or 200 mcg per day fluticasone for at least one month; and 3 The patient continues to have at least three severe exacerbations at least one of which required hospitalisation (defined as in-patient stay or prolonged Emergency Department treatment) in the past 12 months. Exercise-induced asthma Both: 1 Patient is being treated with maximal asthma therapy, including inhaled corticosteroids and long-acting beta-adrenoceptor agonists; and 2 Patient continues to experience frequent episodes of exercise-induced bronchoconstriction. Aspirin desensitisation – clinical immunologist or allergist All of the following: 1 Patient is undergoing aspirin desensitisation therapy under the supervision of a clinical immunologist or allergist; and 2 Patient has moderate to severe aspirin-exacerbated respiratory disease or Samter’s triad; and 3 Nasal polyposis, confirmed radiologically or surgically; and 4 Documented aspirin or NSAID allergy confirmed by aspirin challenge or a clinical history of severe reaction to aspirin or NSAID where challenge would be considered dangerous.

158

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


RESPIRATORY SYSTEM AND ALLERGIES

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

LONG-ACTING BETA-ADRENOCEPTOR AGONISTS

EFORMOTEROL FUMARATE Powder for inhalation 6 mcg per dose Powder for inhalation 12 mcg per dose SALMETEROL Aerosol inhaler 25 mcg per dose ................................................ 26.46 Powder for inhalation 50 mcg dose ............................................ 26.46 120 dose 60 dose Serevent Serevent Accuhaler

Inhaled Corticosteroids with Long-Acting Beta-Adrenoceptor Agonists

Restricted Either: 1 All of the following: 1.1 Patient is a child under the age of 12; and 1.2 Has been treated with inhaled corticosteroids of at least 400 mcg per day beclomethasone or budesonide, or 200 mcg per day fluticasone; and 1.3 The prescriber considers that the patient would receive additional clinical benefit from switching to a combination product; or 2 All of the following: 2.1 Patient is over the age of 12; and 2.2 Has been treated with inhaled corticosteroids of at least 800 mcg per day beclomethasone or budesonide, or 500 mcg per day fluticasone; and 2.3 The prescriber considers that the patient would receive additional clinical benefit from switching to a combination product. BUDESONIDE WITH EFORMETEROL  Aerosol inhaler 100 mcg with eformeterol fumarate 6 mcg  Aerosol inhaler 200 mcg with eformeterol fumarate 6 mcg  Powder for inhalation 100 mcg with eformeterol fumarate 6 mcg  Powder for inhalation 200 mcg with eformeterol fumarate 6 mcg  Powder for inhalation 400 mcg with eformeterol fumarate 12 mcg FLUTICASONE WITH SALMETEROL  Aerosol inhaler 50 mcg with salmeterol 25 mcg.......................... 37.48  Aerosol inhaler 125 mcg with salmeterol 25 mcg........................ 49.69  Powder for inhalation 100 mcg with salmeterol 50 mcg .............. 37.48  Powder for inhalation 250 mcg with salmeterol 50 mcg .............. 49.69 120 dose 120 dose 60 dose 60 dose Seretide Seretide Seretide Accuhaler Seretide Accuhaler

MAST CELL STABILISERS

NEDOCROMIL Aerosol inhaler 2 mg per dose SODIUM CROMOGLYCATE Aerosol inhaler 5 mg per dose Powder for inhalation 20 mcg per dose

METHYLXANTHINES

AMINOPHYLLINE Inj 25 mg per ml, 10 ml ampoule – 1% DV Nov-11 to 2014 ........ 53.75 5 DBL Aminophylline

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

159


RESPIRATORY SYSTEM AND ALLERGIES

Price (ex man. Excl. GST) $ Per CAFFEINE CITRATE Inj 20 mg per ml (caffeine 10 mg per ml), 2.5 ml ampoule .......... 55.75 Oral liq 20 mg per ml (caffeine 10 mg per ml) ............................. 14.85 THEOPHYLLINE Oral liq 80 mg per 15 ml Tab long-acting 250 mg 5 25 ml Brand or Generic Manufacturer Biomed Biomed

MUCOLYTICS AND EXPECTORANTS

DORNASE ALFA  Nebuliser soln 2.5 mg per 2.5 ml ampoule................................ 250.00 Restricted Cystic fibrosis For use in patients with approval by the Cystic Fibrosis Advisory Panel Significant mucus production All of the following: 1 Up to four weeks treatment; and 2 Patient is an in-patient; and 3 The mucus production cannot be cleared by first line chest techniques. SODIUM CHLORIDE Nebuliser soln 7%, 90 ml bottle .................................................. 23.50 90 ml Biomed 6 Pulmozyme

PULMONARY SURFACTANTS

BERACTANT Soln 200 mg per 8 ml vial ........................................................ 550.00 PORACTANT ALFA Soln 120 mg per 1.5 ml vial ..................................................... 425.00 Soln 240 mg per 3 ml vial ........................................................ 695.00 1 1 1 Survanta Curosurf Curosurf

RESPIRATORY STIMULANTS

DOXAPRAM Inj 20 mg per ml, 5 ml vial

SCLEROSING AGENTS

TALC Powder Soln (slurry) 100 mg per ml, 50 ml

160

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


SENSORY ORGANS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

ANTI-INFECTIVE PREPARATIONS Antibacterials

CHLORAMPHENICOL Ear drops 0.5% Eye drops 0.5% – 1% DV Sep-12 to 2015 .................................... 1.20 Eye drops 0.5%, single dose Eye oint 1% – 1% DV Jan-13 to 2015 .......................................... 2.76 CIPROFLOXACIN Eye drops 0.3% FRAMYCETIN SULPHATE Ear/eye drops 0.5% FUSIDIC ACID Eye drops 1%............................................................................... 4.50 GENTAMICIN SULPHATE Eye drops 0.3% .......................................................................... 11.40 PROPAMIDINE ISETHIONATE Eye drops 0.1% SULPHACETAMIDE SODIUM Eye drops 10% TOBRAMYCIN Eye drops 0.3% – 1% DV Sep-11 to 2014 .................................. 11.48 Eye oint 0.3% – 1% DV Sep-11 to 2014 ..................................... 10.45 5 ml 3.5 g Tobrex Tobrex 5g 5 ml Fucithalmic Genoptic

10 ml 4g

Chlorafast Chlorsig

Antifungals

NATAMYCIN Eye drops 5%

Antivirals

ACICLOVIR Eye oint 3%

Combination Preparations

DEXAMETHASONE WITH FRAMYCETIN AND GRAMICIDIN Ear/eye drops 500 mcg with framycetin sulphate 5 mg and gramicidin 50 mcg per ml DEXAMETHASONE WITH NEOMYCIN SULPHATE AND POLYMYXIN B SULPHATE Eye drops 0.1% with neomycin sulphate 0.35% and polymyxin B sulphate 6,000 u per ml Eye oint 0.1% with neomycin sulphate 0.35% and polymyxin B sulphate 6,000 u per g

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

161


SENSORY ORGANS

Price (ex man. Excl. GST) $ Per DEXAMETHASONE WITH TOBRAMYCIN Eye drops 0.1% with tobramycin 0.3% FLUMETASONE PIVALATE WITH CLIOQUINOL Ear drops 0.02% with clioquinol 1% HYDROCORTISONE WITH CIPROFLOXACIN Ear drops 1% with ciprofloxacin 0.2% TRIAMCINOLONE ACETONIDE WITH GRAMICIDIN, NEOMYCIN AND NYSTATIN Ear drops 1 mg with nystatin 100,000 u, neomycin sulphate 2.5 mg with gramicidin 250 mcg per g ....... 5.16 Brand or Generic Manufacturer

7.5 ml

Kenacomb

ANTI-INFLAMMATORY PREPARATIONS Corticosteroids

DEXAMETHASONE Eye drops 0.1% ............................................................................ 4.50 Eye oint 0.1% – 1% DV Sep-11 to 2014 ....................................... 5.86 FLUOROMETHOLONE Eye drops 0.1% – 1% DV Dec-12 to 2015.................................... 3.80 PREDNISOLONE ACETATE Eye drops 0.12% Eye drops 1% PREDNISOLONE SODIUM PHOSPHATE Eye drops 0.5%, single dose 5 ml 3.5 g 5 ml Maxidex Maxidex Flucon

Non-Steroidal Anti-Inflammatory Drugs

DICLOFENAC SODIUM Eye drops 0.1% – 1% DV Sep-11 to 2014 .................................. 13.80 Eye drops 0.1%, single dose KETOROLAC TROMETAMOL Eye drops 0.5% 5 ml Voltaren Ophtha

DECONGESTANTS AND ANTIALLERGICS Antiallergic Preparations

LEVOCABASTINE Eye drops 0.05% LODOXAMIDE Eye drops 0.1% OLOPATADINE Eye drops 0.1% SODIUM CROMOGLYCATE Eye drops 2%

162

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


SENSORY ORGANS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Decongestants

NAPHAZOLINE HYDROCHLORIDE Eye drops 0.1% – 1% DV Sep-11 to 2014 .................................... 4.15 15 ml Naphcon Forte

DIAGNOSTIC AND SURGICAL PREPARATIONS Diagnostic Dyes

FLUORESCEIN SODIUM Eye drops 2%, single dose Ophthalmic strips 1 mg Inj 10%, 5 ml vial ..................................................................... 125.00 FLUORESCEIN SODIUM WITH LIGNOCAINE HYDROCHLORIDE Eye drops 0.25% with lignocaine hydrochloride 4%, single dose LISSAMINE GREEN Ophthalmic strips 1.5 mg ROSE BENGAL SODIUM Ophthalmic strips 1%

12

Fluorescite

Irrigation Solutions

CALCIUM CHLORIDE WITH MAGNESIUM CHLORIDE, POTASSIUM CHLORIDE, SODIUM ACETATE, SODIUM CHLORIDE AND SODIUM CITRATE Eye drops 0.048% with magnesium chloride 0.03%, potassium chloride 0.075%, sodium acetate 0.39%, sodium chloride 0.64% and sodium acetate 0.17%, 15 ml Eye drops 0.048% with magnesium chloride 0.03%, potassium chloride 0.075%, sodium acetate 0.39%, sodium chloride 0.64% and sodium acetate 0.17%, 250 ml Eye drops 0.048% with magnesium chloride 0.03%, potassium chloride 0.075%, sodium acetate 0.39%, sodium chloride 0.64% and sodium acetate 0.17%, 500 ml

(Balanced Salt Solution) (Balanced Salt Solution) (Balanced Salt Solution)

Ocular Anaesthetics

OXYBUPROCAINE HYDROCHLORIDE Eye drops 0.4%, single dose TETRACAINE [AMETHOCAINE] HYDROCHLORIDE Eye drops 0.5%, single dose Eye drops 1%, single dose

Viscoelastic Substances

HYPROMELLOSE Inj 2%, 1 ml syringe Inj 2%, 2 ml syringe

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

163


SENSORY ORGANS

Price (ex man. Excl. GST) $ Per SODIUM HYALURONATE Inj 10 mg per ml, 0.85 ml syringe – 1% DV Oct-12 to 2015........ 30.00 Inj 14 mg per ml, 0.55 ml syringe – 1% DV Oct-12 to 2015........ 50.00 Inj 14 mg per ml, 0.85 ml syringe – 1% DV Oct-12 to 2015........ 50.00 Inj 23 mg per ml, 0.6 ml syringe SODIUM HYALURONATE WITH CHONDROITIN SULPHATE Inj 30 mg per ml with chondroitin sulphate 40 mg per ml, 0.35 ml syringe and inj 10 mg sodium hyaluronate per ml, 0.4 ml syringe ............................................................ 64.00 Inj 30 mg per ml with chondroitin sulphate 40 mg per ml, 0.5 ml syringe and inj 10 mg sodium hyaluronate per ml, 0.55 ml syringe – 1% DV Sep-11 to 2014 .................. 74.00 Inj 30 mg with chondroitin sulphate 40 mg per ml, 0.75 ml syringe 1 1 1 Brand or Generic Manufacturer Provisc Healon GV Healon GV

1 1

Duovisc Duovisc

GLAUCOMA PREPARATIONS Beta Blockers

BETAXOLOL Eye drops 0.25% Eye drops 0.5% LEVOBUNOLOL HYDROCHLORIDE Eye drops 0.25% .......................................................................... 7.00 Eye drops 0.5% ............................................................................ 7.00 TIMOLOL Eye drops 0.25% Eye drops 0.25%, gel forming....................................................... 3.30 Eye drops 0.5% Eye drops 0.5%, gel forming......................................................... 3.78 5 ml 5 ml Betagan Betagan

2.5 ml 2.5 ml

Timoptol XE Timoptol XE

Carbonic Anhydrase Inhibitors

ACETAZOLAMIDE Tab 250 mg – 1% DV Nov-11 to 2014 ....................................... 17.03 Inj 500 mg BRINZOLAMIDE Eye drops 1% DORZOLAMIDE Eye drops 2% DORZOLAMIDE WITH TIMOLOL Eye drops 2% with timolol 0.5% ................................................. 15.50 5 ml Cosopt 100 Diamox

Miotics

ACETYLCHOLINE CHLORIDE Inj 20 mg vial with diluent

164

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


SENSORY ORGANS

Price (ex man. Excl. GST) $ Per PILOCARPINE HYDROCHLORIDE Eye drops 1% Eye drops 2% Eye drops 2%, single dose Eye drops 4% Brand or Generic Manufacturer

Prostaglandin Analogues

BIMATOPROST Eye drops 0.03% LATANOPROST Eye drops 0.005% – 1% DV Sep-12 to 2015 ................................ 1.99 TRAVOPROST Eye drops 0.004% 2.5 ml Hysite

Sympathomimetics

APRACLONIDINE Eye drops 0.5% BRIMONIDINE TARTRATE Eye drops 0.2% – 1% DV Jul-12 to 2014 ..................................... 6.45 BRIMONIDINE TARTRATE WITH TIMOLOL Eye drops 0.2% with timolol 0.5% 5 ml Arrow-Brimonidine

MYDRIATICS AND CYCLOPLEGICS Anticholinergic Agents

ATROPINE SULPHATE Eye drops 0.5% Eye drops 1%............................................................................. 17.36 Eye drops 1%, single dose CYCLOPENTOLATE HYDROCHLORIDE Eye drops 0.5%, single dose Eye drops 1% Eye drops 1%, single dose TROPICAMIDE Eye drops 0.5% – 1% DV Sep-11 to 2014 .................................... 7.15 Eye drops 0.5%, single dose Eye drops 1% – 1% DV Sep-11 to 2014 ....................................... 8.66 Eye drops 1%, single dose 15 ml 15 ml Mydriacyl Mydriacyl

15 ml

Atropt

Sympathomimetics

PHENYLEPHRINE HYDROCHLORIDE Eye drops 2.5%, single dose Eye drops 10%, single dose

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

165


SENSORY ORGANS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

OCULAR LUBRICANTS

CARBOMER Ophthalmic gel 0.2% Ophthalmic gel 0.3%, single dose ................................................. 8.25 CARMELLOSE SODIUM Eye drops 0.5% Eye drops 0.5%, single dose Eye drops 1% Eye drops 1%, single dose HYPROMELLOSE Eye drops 0.5% ............................................................................ 3.92 HYPROMELLOSE WITH DEXTRAN Eye drops 0.3% with dextran 0.1% Eye drops 0.3% with dextran 0.1%, single dose MACROGOL 400 AND PROPYLENE GLYCOL Eye drops 0.4% with propylene glycol 0.3% preservative free, single dose .............................................................................. 4.30 PARAFFIN LIQUID WITH SOFT WHITE PARAFFIN Eye oint 42.5% with soft white paraffin 57.3% PARAFFIN LIQUID WITH WOOL FAT Eye oint 3% with wool fat 3% POLYVINYL ALCOHOL Eye drops 1.4% ............................................................................ 3.62 2.95 Eye drops 3%............................................................................... 3.88 3.80 POLYVINYL ALCOHOL WITH POVIDONE Eye drops 1.4% with povidone 0.6%, single dose RETINOL PALMITATE Oint 138 mcg per g ...................................................................... 3.80 SODIUM HYALURONATE Eye drops 1 mg per ml ............................................................... 22.00 5g 10 ml VitA-POS Hylo-Fresh 15 ml 15 ml Liquifilm Tears Vistil Liquifilm Forte Vistil Forte 15 ml Methopt (Poly-Tears)

30

Poly Gel

24

Systane Unit Dose

OTHER OTOLOGICAL PREPARATIONS

ACETIC ACID WITH PROPYLENE GLYCOL Ear drops 2.3% with propylene glycol 2.8% DOCUSATE SODIUM Ear drops 0.5%

166

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


SPECIAL FOODS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

FOOD MODULES Carbohydrates

Restricted Use as an additive Any of the following: 1 Cystic fibrosis; or 2 Chronic kidney disease; or 3 Cancer in children; or 4 Cancers affecting alimentary tract where there are malabsorption problems in patients over the age of 20 years; or 5 Faltering growth in an infant/child; or 6 Bronchopulmonary dysplasia; or 7 Premature and post premature infant; or 8 Inborn errors of metabolism. Use as a module For use as a component in a modular formula CARBOHYDRATE SUPPLEMENT  Powder 95 g carbohydrate per 100 g, 400 g can  Powder 95 g carbohydrate per 100 g, 368 g can (Polycal) (Moducal)

Fat

Restricted Use as an additive Any of the following: 1 Patient has inborn errors of metabolism; or 2 Faltering growth in an infant/child; or 3 Bronchopulmonary dysplasia; or 4 Fat malabsorption; or 5 Lymphangiectasia; or 6 Short bowel syndrome; or 7 Infants with necrotising enterocolitis; or 8 Biliary atresia; or 9 For use in a ketogenic diet; or 10 Chyle leaks; or 11 Ascites; or 12 Patient has increased energy requirements, and for whom dietary measures have not been successful. Use as a module For use as a component in a modular formula MEDIUM-CHAIN TRIGLYCERIDE SUPPLEMENT  Liquid 95 g fat per 100 ml, 500 ml bottle  Liquid 50 g fat per 100 ml, 250 ml bottle LONG-CHAIN TRIGLYCERIDE SUPPLEMENT  Liquid 50 g fat per 100 ml, 200 ml bottle  Liquid 50 g fat per 100 ml, 500 ml bottle (MCT Oil) (Liquigen) (Calogen) (Calogen)

WALNUT OIL  Liq

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

167


SPECIAL FOODS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Protein

Restricted Use as an additive Either: 1 Protein losing enteropathy; or 2 High protein needs. Use as a module For use as a component in a modular formula PROTEIN SUPPLEMENT  Powder 5 g protein, 0.67 g carbohydrate and 0.6 g fat per 6.6 g, 275 g can  Powder 6 g protein per 7 g, can.................................................... 8.95  Powder 89 g protein, < 1.5 g carbohydrate and 2 g fat per 100 g, 225 g can

227 g

(Promod) Resource Beneprotein (Protifar)

Other Supplements

BREAST MILK FORTIFIER Powder 0.2 g protein, 0.7 g carbohydrate and 0.02 g fat per 1 g sachet Powder 0.5 g protein, 1.2 g carbohydrate and 0.08 g fat per 2 g sachet Powder 0.6 g protein and 1.4 g carbohydrate per 2.2 g sachet CARBOHYDRATE AND FAT SUPPLEMENT  Powder 72.7 g carbohydrate and 22.3 g fat per 100 g, 400 g can Restricted Both: 1 Infant or child aged four years or under; and 2 Any of the following: 2.1 Cystic fibrosis; or 2.2 Cancer in children; or 2.3 Faltering growth; or 2.4 Bronchopulmonary dysplasia; or 2.5 Premature and post premature infants.

(FM 85) (S26 Human Milk Fortifier) (Nutricia Breast Milk Fortifer)

(Super Soluble Duocal)

FOOD/FLUID THICKENERS

NOTE: While pre-thickened drinks have not been included in Section H, DHB hospitals may continue to use such products, provided that use was established prior to 1 July 2013. PHARMAC intends to make a further decision in relation to prethickened drinks in the future, and will notify of any change to this situation. CAROB BEAN GUM WITH MAIZE STARCH AND MALTODEXTRIN Powder GUAR GUM Powder (Karicare Aptamil Feed Thickener) (Guarcol)

168

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


SPECIAL FOODS

Price (ex man. Excl. GST) $ Per MAIZE STARCH Powder MALTODEXTRIN WITH XANTHAN GUM Powder MALTODEXTRIN WITH XANTHAN GUM AND ASCORBIC ACID Powder Brand or Generic Manufacturer

(Resource Thicken Up) (Nutilis) (Instant Thick) (Easy Thick)

STANDARD FEEDS

Restricted Any of the following: 1 For patients with malnutrition, defined as any of the following: 1.1 BMI < 18.5; 1.2 Greater than 10% weight loss in the last 3-6 months; or 1.3 BMI < 20 with greater than 5% weight loss in the last 3-6 months; or 2 For patients who have, or are expected to, eat little or nothing for 5 days; or 3 For patients who have a poor absorptive capacity and/or high nutrient losses and/or increased nutritional needs from causes such as catabolism; or 4 For use pre- and post-surgery; or 5 For patients being tube-fed; or 6 For tube-feeding as a transition from intravenous nutrition, or 7 For any other conditions that meet the community Special Authority criteria. ORAL FEED  Powder 16 g protein, 59.8 g carbohydrate and 14 g fat per 100 g, can .................................................... 13.00

900 g 900 g 900 g

 Powder 18.7 g protein, 54.5 g carbohydrate  Powder 23 g protein, 65 g carbohydrate

Ensure (Chocolate) Ensure (Vanilla) Fortisip (Vanilla) Sustagen Hospital Formula (Chocolate) Sustagen Hospital Formula (Vanilla)

and 18.9 g fat per 100 g, can ................................................... 9.50 and 2.5 g fat per 100 g, can ................................................... 10.22

ORAL FEED 1 KCAL/ML  Liquid 3.8 g protein, 23 g carbohydrate and 12.7 g fibre per 100 ml, 237 ml bottle ORAL FEED 1.5 KCAL/ML  Liquid 4 g protein and 33.5 g carbohydrate per 100 ml, 200 ml bottle  Liquid 5.5 g protein, 21.1 g carbohydrate and 4.81 g fat per 100 ml, can ................................................. 1.33

(Resource Fruit Beverage)

(Fortijuce) 237 ml Ensure Plus (Chocolate) Ensure Plus (Strawberry) Ensure Plus (Vanilla) (Fortisip) continued...

 Liquid 6 g protein, 18.4 g carbohydrate

and 5.8 g fat per 100 ml, 200 ml bottle

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

169


SPECIAL FOODS

Price (ex man. Excl. GST) $ Per continued... Brand or Generic Manufacturer

 Liquid 6.25 g protein, 20.2 g carbohydrate

and 4.92 g fat per 100 ml, carton ............................................. 1.26

200 ml

 Liquid 6 g protein, 18.4 g carbohydrate, 5.8 g fat

and 2.3 g fibre per 100 ml, 200 ml bottle ENTERAL FEED 1 KCAL/ML  Liquid 4 g protein, 12.3 g carbohydrate and 3.9 g fat per 100 ml, 1,000 ml bag

Ensure Plus (Banana) Ensure Plus (Chocolate) Ensure Plus (Fruit of the Forest) Ensure Plus (Vanilla) (Fortisip Multi Fibre)

 Liquid 4 g protein, 13.6 g carbohydrate  Liquid 4 g protein, 13.6 g carbohydrate  Liquid 4 g protein, 13.6 g carbohydrate

(Nutrison Standard RTH) (Nutrison Low Sodium) 250 ml 500 ml 1,000 ml 237 ml 500 ml 1,000 ml Osmolite Osmolite RTH Osmolite RTH Jevity Jevity RTH Jevity RTH (Nutrison Multi Fibre)

and 3.4 g fat per 100 ml, can ................................................... 1.24 and 3.4 g fat per 100 ml, bottle ................................................ 2.65 and 3.4 g fat per 100 ml, bottle ................................................ 5.29 and 1.76 g fibre per 100 ml, can .............................................. 1.32 and 1.76 g fibre per 100 ml, bottle ........................................... 2.65 and 1.76 g fibre per 100 ml, bottle ........................................... 5.29 and 1.5 g fibre per 100 ml, 1,000 ml bag

 Liquid 4 g protein, 14.1 g carbohydrate, 3.47 g fat  Liquid 4 g protein, 14.1 g carbohydrate, 3.47 g fat  Liquid 4 g protein, 14.1 g carbohydrate, 3.47 g fat  Liquid 4 g protein, 12.3 g carbohydrate, 3.9 g fat

ENTERAL FEED 1.2 KCAL/ML  Liquid 5.55 g protein, 15.1 g carbohydrate and 3.93 g fat and 2 g fibre per 100 ml, 1,000 ml bag ENTERAL FEED 1.5 KCAL/ML  Liquid 5.4 g protein, 13.6 g carbohydrate and 3.3 g fat per 100 ml, 1,000 ml bottle

(Jevity Plus RTH)

 Liquid 6 g protein, 18.3 g carbohydrate

(Isosource Standard RTH) 1,000 ml Nutrison Energy (Nutrison Energy Multi Fibre) 250 ml 1,000 ml 1,000 ml Ensure Plus HN Ensure Plus HN RTH Jevity HiCal RTH

 Liquid 6 g protein, 18.4 g carbohydrate, 5.8 g fat

and 1.5 g fibre per 100 ml, 1,000 ml bag

and 5.8 g fat per 100 ml, bag ................................................... 7.00

 Liquid 6.25 g protein, 20 g carbohydrate and 5 g fat per 100 ml,  Liquid 6.27 g protein, 20.4 g carbohydrate and 4.9 g fat per  Liquid 6.38 g protein, 21.1 g carbohydrate, 4.9 g fat and

can .......................................................................................... 1.75 100 ml, bag ............................................................................. 7.00 1.2 g fibre per 100 ml, bag ....................................................... 7.00

170

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


SPECIAL FOODS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

SPECIALISED FORMULAS Diabetic Products

Restricted Any of the following: 1 For patients with type I or type II diabetes suffering weight loss and malnutrition that requires nutritional support; or 2 For patients with pancreatic insufficiency; or 3 For patients who have, or are expected to, eat little or nothing for 5 days; 4 For patients who have a poor absorptive capacity and/or high nutrient losses and/or increased nutritional needs from causes such as catabolism; or 5 For use pre- and post-surgery; or 6 For patients being tube-fed; or 7 For tube-feeding as a transition from intravenous nutrition. LOW-GI ORAL FEED 1 KCAL/ML  Liquid 5 g protein, 9.6 g carbohydrate and 5.4 g fat per 100 ml, bottle ................................................ 1.88

250 ml 237 ml

 Liquid 6 g protein, 9.5 g carbohydrate, 4.7 g fat

Glucerna Select (Vanilla) Resource Diabetic (Vanilla) (Diasip)

and 2.6 fibre per 100 ml, can ................................................... 2.10 and 2 g fibre per 100 ml, 200 ml bottle

 Liquid 4.9 g protein, 11.7 g carbohydrate, 3.8 g fat

LOW-GI ENTERAL FEED 1 KCAL/ML  Liquid 5 g protein, 9.6 g carbohydrate and 5.4 g fat per 100 ml, bottle ............................................... 7.50

1,000 ml

 Liquid 4.3 g protein, 11.3 g carbohydrate

Glucerna Select RTH (Vanilla) (Nutrison Advanced Diason)

and 4.2 g fat per 100 ml, 1,000 ml bottle

Fat Modified Products

Restricted Any of the following: 1 Patient has metabolic disorders of fat metabolism; or 2 Patient has a chyle leak; or 3 Modified as a modular feed for adults. FAT-MODIFIED FEED  Powder 11.4 g protein, 68 g carbohydrate and 11.8 g fat per 100 g, 400 g can

(Monogen)

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

171


SPECIAL FOODS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Elemental and Semi-Elemental Products

Restricted Any of the following: 1 Malabsorption; or 2 Short bowel syndrome; or 3 Enterocutaneous fistulas; or 4 Eosinophilic enteritis (including oesophagitis); or 5 Inflammatory bowel disease; or 6 Acute pancreatitis where standard feeds are not tolerated; or 7 Patients with multiple food allergies requiring enteral feeding. AMINO ACID ORAL FEED  Powder 11.5 g protein, 61.7 g carbohydrate and 0.8 g fat per sachet ........................................................... 4.50 AMINO ACID ORAL FEED 0.8 KCAL/ML  Liquid 2.5 g protein, 11 g carbohydrate and 3.5 g fat per 100 ml, 250 ml carton PEPTIDE-BASED ORAL FEED  Powder 12.5 g protein, 55.4 g carbohydrate and 3.25 g fat per sachet ......................................................... 4.40  Powder 13.7 g protein, 62.9 g carbohydrate and 17.5 g fat per 100 g, 400 g can  Powder 13.8 g protein, 59 g carbohydrate and 18 g fat per 100 g, 400 g can

80.4 g

Vivonex TEN

(Elemental 028 Extra)

79 g

Vital HN (Peptamen Junior) (MCT Peptide) (MCT Peptide 1+)

 Powder 15.8 g protein, 49.5 g carbohydrate

and 4.65 g fat per sachet ......................................................... 7.50

76 g

Alitraq

PEPTIDE-BASED ORAL FEED 1 KCAL/ML  Liquid 5 g protein, 16 g carbohydrate and 1.69 g fat per 100 ml, carton ............................................. 4.95 PEPTIDE-BASED ENTERAL FEED 1 KCAL/ML  Liquid 4 g protein, 17.6 g carbohydrate and 1.7 g fat per 100 ml, 1,000 ml bag

237 ml

Peptamen OS 1.0 (Vanilla)

(Nutrison Advanced Peptisorb)

Hepatic Products

Restricted For children (up to 18 years) who require a liver transplant HEPATIC ORAL FEED  Powder 11 g protein, 64 g carbohydrate and 20 g fat per 100 g, can .................................................... 78.97

400 g

Heparon Junior

172

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


SPECIAL FOODS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

High Calorie Products

Restricted Either: 1 Patient is fluid restricted; or 2 Both: 2.1 Any of the following: 2.1.1 Cystic fibrosis; or 2.1.2 Any condition causing malabsorption; or 2.1.3 Faltering growth in an infant/child; or 2.1.4 Increased nutritional requirements; and 2.2 Patient has substantially increased metabolic requirements. ORAL FEED 2 KCAL/ML  Liquid 8.4 g protein, 22.4 g carbohydrate, 8.9 g fat and 0.8 g fibre per 100 ml, can ................................................ 2.25 ENTERAL FEED 2 KCAL/ML  Liquid 7.5 g protein, 20 g carbohydrate and 10 g fat per 100 ml, bottle ................................................. 5.50  Liquid 8.4 g protein, 21.9 g carbohydrate, 9.1 g fat and 0.5 g fibre per 100 ml, bottle ....................................... 11.00

237 ml

TwoCal HN

500 ml 1,000 ml

Nutrison Concentrated TwoCal HN RTH (Vanilla)

High Protein Products

HIGH PROTEIN ORAL FEED 1 KCAL/ML  Liquid 10 g protein, 10.3 g carbohydrate and 2.1 g fat per 100 ml, 200 ml bottle Restricted Either: 1 Decompensating liver disease without encephalopathy; or 2 Protein losing gastro-enteropathy; or 3 Patient has substantially increased metabolic requirements. (Fortimel Regular)

HIGH PROTEIN ENTERAL FEED 1.25 KCAL/ML  Liquid 6.3 g protein, 14.2 g carbohydrate and 4.9 g fat per 100 ml, 1,000 ml bag  Liquid 6.3 g protein, 14.1 g carbohydrate, 4.9 g fat and 1.5 g fibre per 100 ml, 1,000 ml bag Restricted Both: 1 The patient has a high protein requirement; and 2 Any of the following: 2.1 Patient has liver disease; or 2.2 Patient is obese (BMI > 30) and is undergoing surgery; or 2.3 Patient is fluid restricted; or 2.4 Patient does not have increased energy requirements.

(Nutrison Protein Plus) (Nutrison Protein Plus Multi Fibre)

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

173


SPECIAL FOODS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Infant Formulas

AMINO ACID FORMULA  Powder 16 g protein, 51.4 g carbohydrate and 21 g fat per 100 g, can .................................................... 56.00

400 g

 Powder 14 g protein, 50 g carbohydrate  Powder 1.95 g protein, 8.1 g carbohydrate  Powder 13.5 g protein, 52 g carbohydrate  Powder 2.2 g protein, 7.8 g carbohydrate  Powder 2.2 g protein, 7.8 g carbohydrate  Powder 6 g protein, 31.5 g carbohydrate

and 24.5 g fat per 100 g, 400 g can and 3.5 g fat per 100 ml, 400 g can and 24.5 g fat per 100 g, can ................................................. 56.00 and 3.4 g fat per 100 ml, can ................................................. 53.00 and 3.4 g fat per 100 ml, can ................................................. 53.00 and 5.88 g fat per sachet ......................................................... 6.00 400 g 400 g 400 g 48.5 g and 24.3 g fat per 100 g, 400 g can

Neocate Advance (Vanilla) (Neocate Advance) (Neocate) Neocate Gold (Unflavoured) Elecare LCP (Unflavoured) Elecare (Unflavoured) Elecare (Vanilla) Vivonex Paediatric (Neocate LCP)

 Powder 13 g protein, 52.5 g carbohydrate

Restricted Initiation Any of the following: 1 Extensively hydrolysed formula has been reasonably trialled and is inappropriate due to documented severe intolerance or allergy or malabsorption; or 2 History of anaphylaxis to cows milk protein formula or dairy products; or 3 Eosinophilic oesophagitis. Continuation Both: 1 An assessment as to whether the infant can be transitioned to a cows milk protein, soy, or extensively hydrolysed infant formula has been undertaken; and 2 The outcome of the assessment is that the infant continues to require an amino acid infant formula. EXTENSIVELY HYDROLYSED FORMULA  Powder 14 g protein, 53.4 g carbohydrate and 27.3 g fat per 100 g, 450 g can

(Karicare Aptamil Gold Pepti Junior)

Restricted Initiation – new patients Any of the following: 1 Both: 1.1 Cows milk formula is inappropriate due to severe intolerance or allergy to its protein content; and 1.2 Either: 1.2.1 Soy milk formula has been trialled without resolution of symptoms; or 1.2.2 Soy milk formula is considered clinically inappropriate or contraindicated; or 2 Severe malabsorption; or 3 Short bowel syndrome; or 4 Intractable diarrhoea; or 5 Biliary atresia; or 6 Cholestatic liver diseases causing malsorption; or 7 Cystic fibrosis; or

continued...

174

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


SPECIAL FOODS

Price (ex man. Excl. GST) $ Per continued... 8 Proven fat malabsorption; or 9 Severe intestinal motility disorders causing significant malabsorption; or 10 Intestinal failure. Initiation – step down from amino acid formula Both: 1 The infant is currently receiving funded amino acid formula; and 2 The infant is to be trialled on, or transitioned to, an extensively hydrolysed formula. Continuation Both: 1 An assessment as to whether the infant can be transitioned to a cows milk protein or soy infant formula has been undertaken; and 2 The outcome of the assessment is that the infant continues to require an extensively hydrolysed infant formula. FRUCTOSE-BASED FORMULA Powder 14.6 g protein, 49.7 g carbohydrate and 30.8 g fat per 100 g, 400 g can LACTOSE-FREE FORMULA Powder 1.5 g protein, 7.2 g carbohydrate and 3.6 g fat per 100 ml, 900 g can Powder 1.3 g protein, 7.3 g carbohydrate and 3.5 g fat per 100 ml, 900 g can LOW-CALCIUM FORMULA Powder 14.6 g protein, 53.7 g carbohydrate and 26.1 g fat per 100 g, 400 g can PRETERM FORMULA  Liquid 2.2 g protein, 8.4 g carbohydrate and 4.4 g fat per 100 ml, bottle ................................................ 0.75  Liquid 2.3 g protein, 8.6 g carbohydrate and 4.2 g fat per 100 ml, 90 ml bottle  Liquid 2.6 g protein, 8.4 g carbohydrate and 3.9 g fat per 100 ml, 70 ml bottle Powder 1.9 g protein, 7.5 g carbohydrate and 3.9 g fat per 14 g, can ..................................................... 15.25 Restricted For infants born before 33 weeks’ gestation or weighing less than 1.5 kg at birth THICKENED FORMULA Powder 1.8 g protein, 8.1 g carbohydrate and 3.3 g fat per 100 ml, 900 g can Brand or Generic Manufacturer

(Galactomin 19)

(S26 Lactose Free) (Karicare Aptamil Gold De-Lact)

(Locasol)

100 ml

S26 LBW Gold RTF (Pre Nan Gold RTF) (Karicare Aptamil Gold + Preterm)

400 g

S-26 Gold Premgro

(Karicare Aptamil Thickened AR)

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

175


SPECIAL FOODS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Ketogenic Diet Products

HIGH FAT FORMULA  Powder 15.3 g protein, 7.2 g carbohydrate and 67.7 g fat per 100 g, can ................................................. 35.50

300 g 300 g

 Powder 15.25 g protein, 3 g carbohydrate

Ketocal 3:1 (Unflavoured) Ketocal 4:1 (Unflavoured) Ketocal 4:1 (Vanilla)

and 73 g fat per 100 g, can .................................................... 35.50

Restricted For patients with intractable epilepsy, pyruvate dehydrogenase deficiency or glucose transported type-1 deficiency and other conditions requiring a ketogenic diet.

Paediatric Products

Restricted Both: 1 Child is aged one to ten years; and 2 Any of the following: 2.1 The child is being fed via a tube or a tube is to be inserted for the purposes of feeding; or 2.2 Any condition causing malabsorption; or 2.3 Faltering growth in an infant/child; or 2.4 Increased nutritional requirements; or 2.5 The child is being transitioned from TPN or tube feeding to oral feeding. PAEDIATRIC ORAL FEED  Powder 14.9 g protein, 54.3 g carbohydrate and 24.7 g fat per 100 g, can ................................................. 20.00 PAEDIATRIC ORAL FEED 1 KCAL/ML  Liquid 2.6 g protein, 10.3 g carbohydrate, 5.4 g fat and 0.6 g fibre per 100 ml, 100 ml bottle  Liquid 4.2 g protein, 16.7 g carbohydrate and 7.5 g fat per 100 ml, carton ............................................... 1.07

900 g

Pediasure (Vanilla)

(Infatrini) 200 ml Pediasure (Chocolate) Pediasure (Strawberry) Pediasure (Vanilla) Pediasure (Vanilla)

 Liquid 4.2 g protein, 16.7 g carbohydrate

and 7.5 g fat per 100 ml, can ................................................... 1.27

237 ml

PAEDIATRIC ENTERAL FEED 0.75 KCAL/ML  Liquid 2.5 g protein, 12.5 g carbohydrate, 3.3 g fat and 0.7 g fibre per 100 ml, bag ............................................ 4.00 PAEDIATRIC ENTERAL FEED 1 KCAL/ML  Liquid 2.8 g protein, 11.2 g carbohydrate and 5 g fat per 100 ml, bag ...................................................... 2.68  Liquid 2.8 g protein, 12.3 g carbohydrate and 4.4 g fat per 100 ml, 500 ml bag

500 ml

Nutrini Low Energy Multifibre RTH

500 ml

Pediasure RTH (Nutrini RTH)

176

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


SPECIAL FOODS

Price (ex man. Excl. GST) $ Per PAEDIATRIC ORAL FEED 1.5 KCAL/ML  Liquid 3.4 g protein, 18.8 g carbohydrate and 6.8 g fat per 100 ml, 200 ml bottle  Liquid 4 g protein, 18.8 g carbohydrate, 6.8 g fat and 1.5 g fibre per 100 ml, 200 ml bottle PAEDIATRIC ENTERAL FEED 1.5 KCAL/ML  Liquid 4.1 g protein, 18.5 g carbohydrate and 6.7 g fat per 100 ml, 500 ml bag  Liquid 4.1 g protein, 18.5 g carbohydrate, 6.7 g fat and 0.8 g fibre per 100 ml, bag ................................................ 6.00 Brand or Generic Manufacturer

(Fortini) (Fortini Multifibre)

(Nutrini Energy RTH) 500 ml Nutrini Energy Multi Fibre

Renal Products

LOW ELECTROLYTE ORAL FEED  Powder 7.5 g protein, 59 g carbohydrate and 26.3 g fat per 100 g, 400 g can Restricted For children (up to 18 years) with acute or chronic kidney disease LOW ELECTROLYTE ORAL FEED 2 KCAL/ML  Liquid 3 g protein, 25.5 g carbohydrate and 9.6 g fat per 100 ml, 237 ml bottle  Liquid 7 g protein, 20.6 g carbohydrate, 9.6 g fat and 1.56 g fibre per 100 ml, carton .......................................... 2.43

(Kindergen)

(Suplena) 200 ml 237 ml Nepro (Strawberry) Nepro (Vanilla) Novasource Renal (Vanilla) (Renilon 7.5)

 Liquid 9.1 g protein, 19 g carbohydrate  Liquid 7.5 g protein, 20 g carbohydrate

and 10 g fat per 100 ml, carton ................................................ 3.31 and 10 g fat per 100 ml, 125 ml bottle

Restricted For patients with acute or chronic kidney disease LOW ELECTROLYTE ENTERAL FEED 2 KCAL/ML  Liquid 7 g protein, 20.6 g carbohydrate, 9.6 g fat and 1.56 g fibre per 100 ml, bottle ........................................... 6.08 Restricted For patients with acute or chronic kidney disease

500 ml

Nepro RTH

Respiratory Products

LOW CARBOHYDRATE ORAL FEED 1.5 KCAL/ML  Liquid 6.2 g protein, 10.5 g carbohydrate and 9.32 g fat per 100 ml, bottle .............................................. 1.66

237 ml

Pulmocare (Vanilla)

Restricted For patients with CORD and hypercapnia, defined as a CO2 value exceeding 55 mmHg

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

177


SPECIAL FOODS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Surgical Products

HIGH ARGININE ORAL FEED 1.4 KCAL/ML  Liquid 7.6 g protein, 18.9 g carbohydrate, 3.9 g fat and 1.4 g fibre per 100 ml, carton ............................................ 4.00

237 ml

Impact Advanced Recovery (Chocolate) Impact Advanced Recovery (Vanilla)

Restricted Three packs per day for 5 to 7 days prior to major gastrointestinal, head or neck surgery

METABOLIC PRODUCTS

Restricted Either: 1 For the dietary management of homocystinuria, maple syrup urine disease, phenylketonuria (PKU), glutaric aciduria isovaleric acidaemia, propionic acidaemia, methylmalonic acidaemia, tyrosinaemia or urea cycle disorders; or 2 Patient has adrenoleukodystrophy; or 3 For use as a supplement to the Ketogenic diet in patients diagnosed with epilepsy.

Homocystinuria Products

AMINO ACID FORMULA (WITHOUT METHIONINE)  Liquid 8 g protein, 7 g carbohydrate, 3.8 g fat and 0.25 g fibre per 100 ml, 125 ml bottle

 Powder 13.1 g protein, 49.5 g carbohydrate, 23 g fat  Powder 25 g protein  Powder 39 g protein

and 5.3 g fibre per 100 g, 400 g can and 51 g carbohydrate per 100 g, 500 g can and 34 g carbohydrate per 100 g, 500 g can

(HCU Anamix Junior LQ) (HCU Anamix Infant) (XMET Maxamaid) (XMET Maxamum)

Maple Syrup Urine Disease Products

AMINO ACID FORMULA (WITHOUT ISOLEUCINE, LEUCINE AND VALINE)  Liquid 8 g protein, 7 g carbohydrate, 3.8 g fat and 0.25 fibre per 100 ml, 125 ml bottle

 Powder 13.1 g protein, 49.5 g carbohydrate, 23 g fat  Powder 25 g protein  Powder 39 g protein

and 5.3 g fibre per 100 g, 400 g can and 51 g carbohydrate per 100 g, 500 g can and 34 g carbohydrate per 100 g, 500 g can

(MSUD Anamix Junior LQ) (MSUD Anamix Infant) (MSUD Maxamaid) (MSUD Maxamum)

178

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


SPECIAL FOODS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Phenylketonuria Products

AMINO ACID FORMULA (WITHOUT PHENYLALANINE)  Tab 8.33 g  Liquid 6.7 g protein, 5.1 g carbohydrate and 2 g fat per 100 ml, 250 ml carton  Liquid 8 g protein, 7 g carbohydrate, 3.8 g fat and 0.25 g fibre per 100 ml, bottle ......................................... 13.10 (Phlexy-10) (Easiphen) 125 ml PKU Anamix Junior LQ (Berry) PKU Anamix Junior LQ (Orange) PKU Anamix Junior LQ (Unflavoured) (PKU Lophlex LQ 10) (PKU Lophlex LQ 10) (PKU Lophlex LQ 10) (PKU Lophlex LQ 20) (PKU Lophlex LQ 20) (PKU Lophlex LQ 20) (Phlexy-10) (PKU Anamix Infant) (XP Maxamaid) (PKU Anamix Junior) (XP Maxamum)

 Liquid 10 g protein, 4.4 g carbohydrate and 0.25 g  Liquid 16 g protein, 7 g carbohydrate  Liquid 16 g protein, 7 g carbohydrate  Liquid 16 g protein, 7 g carbohydrate  Liquid 16 g protein, 7 g carbohydrate

fibre per 100 ml, 125 ml bottle fibre per 100 ml, 62.5 ml bottle and 0.27 g fibre per 100 ml, 62.5 ml bottle and 0.4 g fibre per 100 ml, 62.5 ml bottle and 0.27 g fibre per 100 ml, 125 ml bottle and 0.4 g fibre per 100 ml, 125 ml bottle

 Liquid 20 g protein, 8.8 g carbohydrate and 0.34 g  Powder 8.33 g protein

and 8.8 g carbohydrate per 20 g sachet

 Powder 13.1 g protein, 45.9 g carbohydrate,  Powder 25 g protein

23 g fat and 5.3 fibre per 100 g, 400 g can and 51 g carbohydrate per 100 g, 500 g can fibre per 100 9, 29 g sachet

 Powder 29 g protein, 38 g carbohydrate and 13.5 g  Powder 39 g protein

and 34 g carbohydrate per 100 g, 500 g can

Glutaric Aciduria Type 1 Products

AMINO ACID FORMULA (WITHOUT LYSINE AND LOW TRYPTOPHAN)  Powder 13.1 g protein, 49.5 g carbohydrate, 23 g fat and 5.3 g fibre per 100 g, 400 g can  Powder 25 g protein and 51 g carbohydrate per 100 g, 500 g can

(GA1 Anamix Infant) (XLYS Low TRY Maxamaid)

Isovaleric Acidaemia Products

AMINO ACID FORMULA (WITHOUT LEUCINE)  Powder 13.1 g protein, 49.5 g carbohydrate, 23 g fat and 5.3 g fibre per 100 g, 400 g can  Powder 25 g protein and 51 g carbohydrate per 100 g, 500 g can  Powder 39 g protein and 34 g carbohydrate per 100 g, 500 g can

(IVA Anamix Infant) (XLEU Maxamaid) (XLEU Maxamum)

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

179


SPECIAL FOODS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Propionic Acidaemia and Methylmalonic Acidaemia Products

AMINO ACID FORMULA (WITHOUT ISOLEUCINE, METHIONINE, THREONINE AND VALINE)  Powder 13.1 g protein, 49.5 g carbohydrate, 23 g fat and 5.3 fibre per 100 g, 400 g can

 Powder 25 g protein and 51 g carbohydrate per 100 g, 500 g can  Powder 39 g protein and 34 g carbohydrate per 100 g, 500 g can

(MMA/PA Anamix Infant) (XMTVI Maxamaid) (XMTVI Maxamum)

Tyrosinaemia Products

AMINO ACID FORMULA (WITHOUT PHENYLALANINE AND TYROSINE)  Liquid 8 g protein, 7 g carbohydrate, 3.8 g fat and 0.25 fibre per 100 ml, 125 ml bottle

 Powder 13.1 g protein, 49.5 g carbohydrate, 23 g fat  Powder 29 g protein, 38 g carbohydrate  Powder 25 g protein

and 5.3 fibre per 100 g, 400 g can and 13.5 g fat per 100 g, 29 g sachet and 51 g carbohydrate per 100 g, 400 g can

(TYR Anamix Junior LQ) (TYR Anamix Infant) (TYR Anamix Junior) (XPHEN, TYR Maxamaid)

Urea Cycle Disorders Products

AMINO ACID SUPPLEMENT  Powder 25 g protein and 65 g carbohydrate per 100 g, 200 g can  Powder 79 g protein per 100 g, 200 g can

(Dialamine) (Essential Amino Acid Mix)

X-Linked Adrenoleukodystrophy Products

GLYCERYL TRIERUCATE  Liquid, 1,000 ml bottle GLYCERYL TRIOLEATE  Liquid, 500 ml bottle

180

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


VACCINES

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

BACTERIAL VACCINES

BACILLUS CALMETTE-GUERIN VACCINE  Inj 2-8 million CFU per ml vial with diluent Restricted For infants at increased risk of tuberculosis. Note: Increased risk is defined as: 1 living in a house or family with a person with current or past history of TB; or 2 have one or more household members or carers who within the last 5 years lived in a country with a rate of TB > or equal to 40 per 100,000 for 6 months or longer; or 3 during their first 5 years will be living 3 months or longer in a country with a rate of TB > or equal to 40 per 100,000. Note: A list of countries with high rates of TB are available at www.moh.govt.nz/immunisation or www.bcgatlas.org/index. php. DIPHTHERIA AND TETANUS VACCINE  Inj 2 IU diphtheria toxoid with 20 IU tetanus toxoid in 0.5 ml syringe Restricted Any of the following: 1 For vaccination of patients aged 45 and 65 years old; or 2 For vaccination of previously unimmunised patients; or 3 For revaccination following immunosuppression; or 4 For revaccination for patients with tetanus-prone wounds. DIPHTHERIA, TETANUS AND PERTUSSIS VACCINE  Inj 2 IU diphtheria toxoid with 20 IU tetanus toxoid, 8 mcg pertussis toxoid, 8 mcg pertussis filamentous haemagluttinin and 2.5 mcg pertactin in 0.5 ml syringe Restricted Either: 1 For primary vaccination in children aged 7-18 years; or 2 For pregnant women between gestational weeks 28 and 38 during epidemics. HAEMOPHILUS INFLUENZAE TYPE B VACCINE  Inj 10 mcg vial with diluent syringe Restricted Any of the following: 1 For primary vaccination in children; or 2 For revaccination following immunosuppression; or 3 For children aged 0-18 years with functional asplenia; or 4 For patients pre- and post-splenectomy. MENIGOCOCCAL C CONJUGATE VACCINE  Inj 10 mcg in 0.5 ml syringe Restricted Any of the following: 1 For patients pre- and post-splenectomy; or 2 For children aged 0-18 years with functional asplenia; or 3 For organisation and community based outbreaks; or 4 For use in transplant patients aged under 2 years; or 5 For use following immunosuppression in patients aged under 2 years.

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

181


VACCINES

Price (ex man. Excl. GST) $ Per MENINGOCOCCAL (A, C, Y AND W-135) CONJUGATE VACCINE  Inj 48 mcg in 0.5 ml vial Restricted Any of the following: 1 For patients pre- and post-splenectomy; or 2 For children aged 0-18 years with functional asplenia; or 3 For organisation and community based outbreaks; or 4 For use in transplant patients; or 5 For use following immunosuppression. MENINGOCOCCAL (A, C, Y AND W-135) POLYSACCHARIDE VACCINE  Inj 200 mcg vial with diluent Restricted Any of the following: 1 For patients pre- and post-splenectomy; or 2 For children aged 0-18 years with functional asplenia; or 3 For organisation and community based outbreaks. PNEUMOCOCCAL (PCV10) CONJUGATE VACCINE  Inj 16 mcg in 0.5 ml syringe Restricted For primary vaccination in children PNEUMOCOCCAL CONJUGATE (PCV13) VACCINE  Inj 30.8 mcg in 0.5 ml syringe Restricted Any of the following: 1 For high risk children under the age of 5; or 2 For patients aged less than 18 years pre- or post-splenectomy or with functional asplenia; or 3 For revaccination following immunosuppression. PNEUMOCOCCAL (PPV23) POLYSACCHARIDE VACCINE  Inj 575 mcg in 0.5 ml vial Restricted Any of the following: 1 For patients pre- and post-splenectomy or 2 children aged 0-18 years with functional asplenia 3 For revaccination following immunosuppression. SALMONELLA TYPHI VACCINE  Inj 25 mcg in 0.5 ml syringe Restricted For use during typhoid fever outbreaks Brand or Generic Manufacturer

182

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


VACCINES

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

BACTERIAL AND VIRAL VACCINES

DIPHTHERIA, TETANUS, PERTUSSIS AND POLIO VACCINE  Inj 30 IU diphtheria toxoid with 30 IU tetanus toxoid, 25 mcg pertussis toxoid, 25 mcg pertussis filamentous haemagluttinin, 8 mcg pertactin and 80 D antigen units poliomyelitis virus in 0.5 ml syringe Restricted For primary vaccination in children DIPHTHERIA, TETANUS, PERTUSSIS, POLIO, HEPATITIS B AND HAEMOPHILUS INFLUENZAE TYPE B VACCINE  Inj 30 IU diphtheria toxoid with 40 IU tetanus toxoid, 25 mcg pertussis toxoid, 25 mcg pertussis filamentous haemagluttinin, 8 mcg pertactin, 80 D antigen units poliomyelitis virus, 10 mcg hepatitis B surface antigen in 0.5 ml syringe (1) and inj 10 mcg haemophilus influenzae type B vaccine vial Restricted Either: 1 For primary vaccination in children; or 2 For revaccination following immunosuppression.

VIRAL VACCINES

HEPATITIS A VACCINE  Inj 720 ELISA units in 0.5 ml syringe  Inj 1440 ELISA units in 1 ml syringe Restricted Any of the following: 1 For use in transplant patients; or 2 For use in children with chronic liver disease; or 3 For close contacts of known hepatitis A carriers. HEPATITIS B VACCINE  Inj 5 mcg in 0.5 ml vial  Inj 10 mcg in 1 ml vial Restricted Any of the following: 1 Household or sexual contacts of known hepatitis B carriers; or 2 Children born to mothers who are hepatitis B surface antigen (HBsAg) positive; or 3 Dialysis patients; or 4 HIV-positive patients; or 5 Hepatitis C positive patients; or 6 For use in transplant patients; or 7 For use following immunosuppression. HUMAN PAPILOMAVIRUS (6, 11, 16 AND 18) VACCINE  Inj 120 mcg in 0.5 ml syringe Restricted Any of the following: 1 Women aged between 9 and 18 years old; or 2 Male patients aged between 9 and 25 years old with confirmed HIV infection; or 3 For use in transplant patients.

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

183


VACCINES

Price (ex man. Excl. GST) $ Per INFLUENZA VACCINE  Inj 45 mcg in 0.5 ml syringe Restricted Any of the following: 1 All people 65 years of age and over; or 2 People under 65 years of age who: 2.1 Have any of the following cardiovascular diseases: 2.1.1 Ischaemic heart disease; or 2.1.2 Congestive heart disease; or 2.1.3 Rheumatic heart disease; or 2.1.4 Congenital heart disease; or 2.1.5 Cerebo-vascular disease; or 2.2 Have any of the following chronic respiratory diseases: 2.2.1 Asthma, if on a regular preventative therapy; or 2.2.2 Other chronic respiratory disease with impaired lung function; or 2.3 Have diabetes; 2.4 Have chronic renal disease; 2.5 Have any cancer, excluding basal and squamous skin cancers if not invasive; 2.6 Have any of the following other conditions: 2.6.1 Autoimmune disease; 2.6.2 Immune suppression; 2.6.3 HIV; 2.6.4 Transplant recipients; 2.6.5 Neuromuscular and CNS diseases; 2.6.6 Haemoglobinopathies; 2.6.7 Are children on long term aspirin; or 2.7 Are pregnant, or 2.8 Are children aged four and under who have been hospitalised for respiratory illness or have a history of significant respiratory illness; or 3 People under 18 years of age living within the boundaries of the Canterbury District Health Board. Note: The following conditions are excluded from funding: • asthma not requiring regular preventative therapy; and • hypertension and/or dyslipidaemia without evidence of end-organ disease. MEASLES, MUMPS AND RUBELLA VACCINE  Inj 1000 TCID50 measles, 12500 TCID50 mumps and 1000 TCID50 rubella vial with diluent Restricted Any of the following: 1 For primary vaccination in children; or 2 For revaccination following immunosuppression; or 3 For any individual susceptible to measles, mumps or rubella. POLIOMYELITIS VACCINE  Inj 80 D antigen units in 0.5 ml syringe Restricted Either: 1 For previously unvaccinated individuals; or 2 For revaccination following immunosuppression. RABIES VACCINE Inj 2.5 IU vial with diluent Brand or Generic Manufacturer

184

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


VACCINES

Price (ex man. Excl. GST) $ Per VARICELLA ZOSTER VACCINE  Inj 1350 PFU vial with diluent  Inj 2000 PFU vial with diluent Restricted Any of the following: 1 For use in transplant patients; or 2 For use following immunosuppression; or 3 For household contacts of children undergoing immunosuppression with no previous history or disease (clinical history of disease or negative serology) or vaccination. Brand or Generic Manufacturer

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

185


VARIOUS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

AGENTS USED IN THE TREATMENT OF POISONINGS Antidotes

ACETYLCYSTEINE Tab eff 200 mg Inj 200 mg per ml, 10 ml ampoule – 1% DV Jul-12 to 2015 ..... 178.00 Inj 200 mg per ml, 30 ml vial .................................................... 219.00 DIGOXIN IMMUNE FAB Inj 38 mg vial Inj 40 mg vial ETHANOL Liq 96% ETHANOL, DEHYDRATED Inj 100%, 5 ml ampoule ETHANOL WITH GLUCOSE Inj 10% with glucose 5%, 500 ml bottle FLUMAZENIL Inj 0.1 mg per ml, 5 ml ampoule ............................................... 170.10 HYDROXOCOBALAMIN Inj 2.5 g vial NALOXONE HYDROCHLORIDE Inj 400 mcg per ml, 1 ml ampoule .............................................. 33.00 PRALIDOXIME IODIDE Inj 25 mg per ml, 20 ml ampoule SODIUM NITRITE Inj 30 mg per ml, 10 ml ampoule SODIUM THIOSULFATE Inj 250 mg per ml, 10 ml vial Inj 500 mg per ml, 10 ml vial SOYA OIL Inj 20%, 500 ml bag Inj 20%, 500 ml bottle 5 Mayne 5 Anexate

10 4

Martindale Acetylcysteine Acetadote

Antitoxins

BOTULISM ANTITOXIN Inj 250 mg vial DIPHTHERIA ANTITOXIN Inj 10,000 iu vial

186

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


VARIOUS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Antivenoms

RED BACK SPIDER ANTIVENOM Inj 500 u vial SNAKE ANTIVENOM Inj 50 ml vial

Removal and Elimination

CHARCOAL Oral liq 200 mg per ml................................................................ 43.50 DEFERIPRONE Tab 500 mg ............................................................................. 533.17 Oral liq 100 mg per ml.............................................................. 266.59 DESFERRIOXAMINE MESILATE Inj 500 mg vial ........................................................................... 99.00 DICOBALT EDETATE Inj 15 mg per ml, 20 ml ampoule DIMERCAPROL Inj 50 mg per ml, 2 ml ampoule DIMERCAPTOSUCCINIC ACID Cap 100 mg DISODIUM EDETATE Inj 150 mg per ml, 20 ml ampoule Inj 150 mg per ml, 20 ml vial Inj 150 mg per ml, 100 ml vial SODIUM CALCIUM EDETATE Inj 200 mg per ml, 2.5 ml ampoule Inj 200 mg per ml, 5 ml ampoule 250 ml 100 250 ml 10 Carbasorb-X Ferriprox Ferriprox Mayne

ANTISEPTICS AND DISINFECTANTS

CHLORHEXIDINE WITH ETHANOL Soln 0.5% with ethanol 70%, non-staining (pink) 25 ml................. 1.55 Soln 0.5% with ethanol 70%, non-staining (pink) 100 ml............... 2.65 Soln 0.5% with ethanol 70%, staining (red) 100 ml ...................... 2.90 Soln 0.5% with ethanol 70%, non-staining (pink) 500 ml............... 5.45 Soln 0.5% with ethanol 70%, staining (red) 500 ml ....................... 5.90 Soln 2% with ethanol 70%, non-staining (pink) 100 ml.................. 3.54 Soln 2% with ethanol 70%, staining (red) 100 ml .......................... 3.86 Soln 2% with ethanol 70%, staining (red) 500 ml .......................... 9.56 CHLORHEXIDINE Soln 4% ....................................................................................... 1.86 Soln 5% ..................................................................................... 15.50 1 1 1 1 1 1 1 1 50 ml 500 ml healthE healthE healthE healthE healthE healthE healthE healthE healthE healthE

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

187


VARIOUS

Price (ex man. Excl. GST) $ Per CHLORHEXIDINE WITH CETRIMIDE Foaming soln 0.5% with cetrimide Crm 1% with cetrimde 0.5% IODINE WITH ETHANOL Soln 1% with ethanol 70%, 100 ml ............................................... 9.30 ISOPROPYL ALCOHOL Soln 70%, 500 ml ....................................................................... 5.65 5.00 POVIDONE-IODINE Soln 5% Soln 7.5% Soln 10% ..................................................................................... 2.95 6.20 Oint 10% ...................................................................................... 3.27 Pad 10% Swab set 10% POVIDONE-IODINE WITH ETHANOL Soln 10% with ethanol 30% ........................................................ 10.00 Soln 10% with ethanol 70% SODIUM HYPOCHLORITE Soln 1 1 healthE healthE PSM Brand or Generic Manufacturer

100 ml 500 ml 25 g

Riodine Betadine Riodine Betadine

500 ml

Betadine Skin Prep

CONTRAST MEDIA Iodinated X-ray Contrast Media

DIATRIZOATE MEGLUMINE WITH DIATRIZOATE SODIUM Oral liq 660 mg per ml with diatrizoate sodium 100 mg per ml, 100 ml ............................. 21.00 Inj 146 mg with sodium amidotrizoate 40 mg per ml, ............... 210.00 250 ml bottle Inj 370 mg with sodium amidotrizoate 100 mg per ml, 50 ml bottle DIATRIZOATE SODIUM Oral liq 370 mg per ml, 10 ml IODISED OIL Inj 480 mg per ml, 10 ml ampoule

100 ml 10

Gastrografin Gastrografin

188

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


VARIOUS

Price (ex man. Excl. GST) $ Per IODIXANOL Inj 270 mg per ml, 20 ml vial Inj 270 mg per ml, 50 ml bottle ................................................ 223.50 Inj 270 mg per ml, 100 ml bottle .............................................. 447.00 Inj 320 mg per ml, 20 ml vial Inj 320 mg per ml, 50 ml bottle ................................................ 223.50 Inj 320 mg per ml, 100 ml bottle .............................................. 447.00 Inj 320 mg per ml, 150 ml bottle .............................................. 670.50 Inj 320 mg per ml, 200 ml bottle .............................................. 565.56 894.00 IOHEXOL Inj 240 mg per ml, 50 ml bottle .................................................. 77.80 Inj 300 mg per ml, 20 ml bottle .................................................. 24.00 Inj 300 mg per ml, 50 ml bottle .................................................. 77.80 Inj 300 mg per ml, 100 ml bottle .............................................. 155.60 Inj 300 mg per ml, 500 ml bottle .............................................. 468.00 Inj 350 mg per ml, 20 ml bottle .................................................. 24.00 Inj 350 mg per ml, 50 ml bottle .................................................. 77.80 Inj 350 mg per ml, 75 ml bottle ................................................ 116.70 Inj 350 mg per ml, 100 ml bottle .............................................. 155.60 Inj 350 mg per ml, 200 ml bottle .............................................. 186.70 Inj 350 mg per ml, 500 ml bottle .............................................. 780.00 IOMEPROL Inj 150 mg per ml, 50 ml bottle Inj 300 mg per ml, 20 ml vial Inj 300 mg per ml, 50 ml bottle Inj 300 mg per ml, 100 ml bottle Inj 350 mg per ml, 20 ml vial Inj 350 mg per ml, 50 ml bottle Inj 350 mg per ml, 75 ml bottle Inj 350 mg per ml, 100 ml bottle Inj 400 mg per ml, 50 ml bottle IOPROMIDE Inj 240 per ml, 50 ml bottle Inj 300 per ml, 20 ml vial Inj 300 per ml, 50 ml bottle Inj 300 per ml, 100 ml bottle Inj 370 per ml, 30 ml vial Inj 370 per ml, 50 ml bottle Inj 370 per ml, 100 ml bottle Inj 370 per ml, 200 ml bottle IOTROLAN Inj 240 mg per ml, 10 ml vial Brand or Generic Manufacturer

10 10 10 10 10 6 10 10 6 10 10 6 6 10 10 10 6 10

Visipaque Visipaque Visipaque Visipaque Visipaque Visipaque Visipaque Omnipaque Omnipaque Omnipaque Omnipaque Omnipaque Omnipaque Omnipaque Omnipaque Omnipaque Omnipaque Omnipaque

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

189


VARIOUS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Non-iodinated X-ray Contrast Media

BARIUM SULPHATE Oral liq 1 mg per ml Oral liq 13 mg per ml Oral liq 21 mg per ml Oral liq 22 mg per g, 250 ml ..................................................... 175.00 Oral liq 22 mg per g, 450 ml ..................................................... 220.00 Oral liq 130 mg per ml Oral liq 400 mg per ml Oral liq 1,250 mg per ml Liq 1,000 mg per ml Eosophogeal cream 30 mg per g Eosophogeal cream 600 mg per g Eosophogeal paste 400 mg per ml Enema 1,250 mg per ml Powder for oral liq 22.1 g Powder for oral liq 100 g Powder for oral liq 148 g Powder for oral liq 300 g Powder for oral liq 340 g Powder for oral liq 10,000 g Powder for enema 397 g CITRIC ACID WITH SODIUM BICARBONATE Powder 382.2 mg per g with sodium bicarbonate 551.3 mg per g, 4 g sachet

24 24

CT Plus+ CT Plus+

(E-2-GAS II)

Paramagnetic Contrast Media

GADOBENIC ACID Inj 334 mg per ml, 10 ml vial .................................................... 324.74 Inj 334 mg per ml, 20 ml vial .................................................... 636.28 GADOBUTROL Inj 1 mmol per ml, 7.5 ml syringe ............................................. 253.10 Inj 1 mmol per ml, 15 ml vial GADODIAMIDE Inj 287 mg per ml, 5 ml vial Inj 287 mg per ml, 10 ml vial .................................................... 180.00 Inj 287 mg per ml, 10 ml syringe .............................................. 220.00 Inj 287 mg per ml, 15 ml vial .................................................... 270.00 Inj 287 mg per ml, 15 ml syringe .............................................. 330.00 Inj 287 mg per ml, 20 ml vial Inj 287 mg per ml, 20 ml syringe .............................................. 440.00 GADOTERIC ACID Inj 0.5 mmol per ml, 5 ml bottle Inj 0.5 mmol per ml, 10 ml bottle Inj 0.5 mmol per ml, 20 ml bottle GADOXETATE DISODIUM Inj 181 mg per ml, 10 ml syringe 10 10 5 Multihance Multihance Gadovist

10 10 10 10 10

Omniscan Omniscan Omniscan Omniscan Omniscan

190

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


VARIOUS

Price (ex man. Excl. GST) $ Per MEGLUMINE GADOPENTATE Inj 469 mg per ml, 10 ml vial .................................................... 184.00 Inj 469 mg per ml, 10 ml syringe ................................................ 92.00 Inj 469 mg per ml, 15 ml vial Inj 469 mg per ml, 20 ml vial 10 5 Brand or Generic Manufacturer Magnevist Magnevist

DIAGNOSTIC AGENTS

ARGININE Inj 50 mg per ml, 500 ml bottle Inj 100 mg per ml, 300 ml bottle HISTAMINE ACID PHOSPHATE Nebuliser soln 0.6%, 10 ml vial Nebuliser soln 2.5%, 10 ml vial Nebuliser soln 5%, 10 ml vial SECRETIN PENTAHYDROCHLORIDE Inj 100 u ampoule TUBERCULIN, PURIFIED PROTEIN DERIVATIVE Inj 10 TIU per 0.1 ml, 1 ml vial

Diagnostic Dyes

BONNEY’S BLUE DYE Soln INDIGO CARMINE Inj 4 mg per ml, 5 ml ampoule Inj 8 mg per ml, 5 ml ampoule INDOCYANINE GREEN Inj 25 mg vial METHYLTHIONINIUM CHLORIDE [METHYLENE BLUE] Inj 10 mg per ml, 5 ml ampoule Inj 10 mg per ml, 10 ml ampoule PATENT BLUE V Inj 2.5%, 2 ml ampoule

IRRIGATION SOLUTIONS

CHLORHEXIDINE Irrigation soln 0.02%, bottle .......................................................... 2.92 Irrigation soln 0.02%, 500 ml bottle Irrigation soln 0.05%, bottle .......................................................... 3.02 Irrigation soln 0.05%, bottle .......................................................... 3.63 Irrigation soln 0.1%, 30 ml ampoule Irrigation soln 0.1%, bottle ............................................................ 3.10 Irrigation soln 0.5%, bottle ............................................................ 4.69 100 ml 100 ml 500 ml 100 ml 500 ml Baxter Baxter Baxter Baxter Baxter

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

191


VARIOUS

Price (ex man. Excl. GST) $ Per CHLORHEXIDINE WITH CETRIMIDE Irrigation soln 0.015% with cetrimide 0.15%, 30 ml ampoule Irrigation soln 0.015% with cetrimide 0.15%, bottle ....................... 3.21 Irrigation soln 0.015% with cetrimide 0.15%, bottle ....................... 3.47 Irrigation soln 0.015% with cetrimide 0.15%, bottle ...................... 4.17 Irrigation soln 0.05% with cetrimide 0.5%, bottle ........................... 4.20 Irrigation soln 0.05% with cetrimide 0.5%, bottle ........................... 3.87 Irrigation soln 0.1% with cetrimide 1%, bottle ................................ 4.38 Irrigation soln 0.1% with cetrimide 1%, bottle ................................ 5.81 GLYCINE Irrigation soln 1.5%, bottle .......................................................... 11.38 Irrigation soln 1.5%, bottle .......................................................... 14.44 SODIUM CHLORIDE Irrigation soln 0.9%, 30 ml ampoule – 1% DV Nov-11 to 2014 ... 19.50 Irrigation soln 0.9%, bottle ............................................................ 2.49 Irrigation soln 0.9%, bottle ............................................................ 2.88 Irrigation soln 0.9%, bottle ............................................................ 2.96 Irrigation soln 0.9%, bottle .......................................................... 10.00 Irrigation soln 0.9%, bottle .......................................................... 12.67 WATER Irrigation soln, bottle..................................................................... 2.68 Irrigation soln, bottle..................................................................... 2.61 Irrigation sol, bottle ...................................................................... 2.75 Irrigation soln, bottle..................................................................... 9.71 Irrigation soln, bottle................................................................... 15.80 Brand or Generic Manufacturer

100 ml 500 ml 1,000 ml 100 ml 500 ml 100 ml 500 ml 2,000 ml 3,000 ml 30 ml 100 ml 500 ml 1,000 ml 2,000 ml 3,000 ml 100 ml 500 ml 1,000 ml 2,000 ml 3,000 ml

Baxter Baxter Baxter Baxter Baxter Baxter Baxter Baxter Baxter Pfizer Baxter Baxter Baxter Baxter Baxter Baxter Baxter Baxter Baxter Baxter

SURGICAL PREPARATIONS

BISMUTH SUBNITRATE AND IODOFORM PARAFFIN Paste DIMETHYL SULFOXIDE Soln 50% PHENOL Inj 6%, 10 ml ampoule PHENOL WITH IOXAGLIC ACID Inj 12%, 10 ml ampoule TROMETAMOL Inj 36 mg per ml, 500 ml bottle

192

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


VARIOUS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

Cardioplegia Solutions

ELECTROLYTES Inj 110 mmol/l sodium, 16 mmol/l potassium, 1.2 mmol/l calcium, 16 mmol/l magnesium and 160 mmol/l chloride, 1,000 ml bag Inj citric acid 0.07973 mg per ml, sodium phosphate 0.06119 mg per ml, potassium chloride 2.181 mg per ml, sodium chloride 1.788 mg ml, sodium citrate 0.6412 mg per ml and trometamol 5.9 mg per ml, 523 ml bag Inj aspartic acid 8.481 mg per ml, citric acid 0.8188 mg per ml, glutamic acid 9.375 mg per ml, sodium phosphate 0.6285 mg per ml, potassium chloride 2.5 mg per ml, sodium citrate 6.585 mg per ml, sodium hydroxide 5.133 mg per ml and trometamol 9.097 mg per ml, 527 ml bag Inj aspartic acid 10.43 mg per ml, citric acid 0.22476 mg per ml, glutamic acid 11.53 mg per ml, sodium phosphate 0.1725 mg per ml, potassium chloride 2.15211 mg per ml, sodium citrate 1.80768 mg per ml, sodium hydroxide 6.31 mg per ml and trometamol 11.2369 mg per ml, 364 ml bag Inj 143 mmol/l sodium, 16 mmol/l potassium, 16 mmol/l magnesium and 1.2 mmol/l calcium, 1,000 ml bag

(Cardioplegia Solution AHB7832)

(Cardioplegia Base Solution)

(Cardioplegia Enriched Solution)

(Cardioplegia Enriched Paediatric Solution) (Cardioplegia Electrolyte Solution)

MONOSODIUM GLUTAMATE WITH SODIUM ASPARTATE Inj 42.68 mg with sodium aspartate 39.48 mg per ml, 250 ml bottle

Cold Storage Solution

SODIUM WITH POTASSIUM Inj 29 mmol/l with potassium 125 mmol/l, 1,000 ml bag

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

193


EXTEMPORANEOUSLY COMPOUNDED PREPARATIONS

Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer

EXTEMPORANEOUSLY COMPOUNDED PREPARATIONS

ACETIC ACID Liq ALUM Powder BP ARACHIS OIL [PEANUT OIL] Liq ASCORBIC ACID Powder BENZOIN Tincture compound BP BISMUTH SUBGALLATE Powder BORIC ACID Powder CARBOXYMETHYLCELLULOSE Soln 1.5% CETRIMIDE Soln 40% CHLOROFORM Liq BP CITRIC ACID Powder BP CLOVE OIL Liq COAL TAR Soln BP CODEINE PHOSPHATE Powder COLLODION FLEXIBLE Liq COMPOUND HYDROXYBENZOATE Soln CYSTEAMINE HYDROCHLORIDE Powder DISODIUM HYDROGEN PHOSPHATE WITH SODIUM DIHYDROGEN PHOSPHATE Inj 37.46 mg with sodium dihydrogen phosphate 47.7 mg in 1.5 ml ampoule

194

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


EXTEMPORANEOUSLY COMPOUNDED PREPARATIONS

Price (ex man. Excl. GST) $ Per DITHRANOL Powder GLUCOSE Powder GLYCERIN WITH SODIUM SACCHARIN Suspension ................................................................................ 35.50 GLYCERIN WITH SUCROSE Suspension ............................................................................... 35.50 GLYCEROL Liq ............................................................................................. 19.80 HYDROCORTISONE Powder – 1% DV Nov-11 to 2014 .............................................. 44.00 LACTOSE Powder MAGNESIUM HYDROXIDE Paste MENTHOL Crystals METHADONE HYDROCHLORIDE Powder METHYL HYDROXYBENZOATE Powder METHYLCELLULOSE Powder Suspension ................................................................................ 35.50 METHYLCELLULOSE WITH GLYCERIN AND SODIUM SACCHARIN Suspension ................................................................................ 35.50 METHYLCELLULOSE WITH GLYCERIN AND SUCROSE Suspension ................................................................................ 35.50 OLIVE OIL Liq PARAFFIN Liq PHENOBARBITONE SODIUM Powder PHENOL Liq

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

Brand or Generic Manufacturer

473 ml 473 ml 2,000 ml 25 g

Ora-Sweet SF Ora-Sweet ABM ABM

473 ml 473 ml 473 ml

Ora-Plus Ora-Blend SF Ora-Blend

195


EXTEMPORANEOUSLY COMPOUNDED PREPARATIONS

Price (ex man. Excl. GST) $ Per PILOCARPINE NITRATE Powder POLYHEXAMETHYLENE BIGUANIDE Liq POVIDONE K30 Powder PROPYLENE GLYCOL Liq ............................................................................................. 12.00 SALICYLIC ACID Powder SILVER NITRATE Crystals SODIUM BICARBONATE Powder BP SODIUM CITRATE Powder SODIUM METABISULFITE Powder STARCH Powder SULPHUR Precipitated Sublimed SYRUP Liq (pharmaceutical grade) ......................................................... 21.75 TRICHLORACETIC ACID Grans TRI-SODIUM CITRATE Crystals UREA Powder BP WOOL FAT Oint, anhydrous XANTHAN Gum 1% ZINC OXIDE Powder 2,000 ml Midwest 500 ml ABM Brand or Generic Manufacturer

196

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


PART III: OPTIONAL PHARMACEUTICALS

Price (ex man. Excl. GST) $ Per BLOOD GLUCOSE DIAGNOSTIC TEST METER 1 meter with 50 lancets, a lancing device, and 10 diagnostic test strips .................................................. 20.00 Meter ........................................................................................ 19.00 9.00 BLOOD GLUCOSE DIAGNOSTIC TEST STRIP Blood glucose test strips ........................................................... 28.75 10.56 21.65 28.75 Blood glucose test strips × 50 and lancets × 5 ........................ 19.10 BLOOD KETONE DIAGNOSTIC TEST METER Meter ......................................................................................... 40.00 FACTOR EIGHT INHIBITORS BYPASSING AGENT Inj 500 U .............................................................................. 1,640.00 Inj 1,000 U ........................................................................... 3,280.00 INSULIN PEN NEEDLES 29 g × 12.7 mm ...................................................................... 10.50 31 g × 5 mm ............................................................................ 11.75 31 g × 6 mm ........................................................................... 10.50 31 g × 8 mm ............................................................................ 10.50 32 g × 4 mm ........................................................................... 10.50 INSULIN SYRINGES, DISPOSABLE WITH ATTACHED NEEDLE Syringe 0.3 ml with 29 g × 12.7 mm needle .............................. 13.00 Syringe 0.3 ml with 31 g × 8 mm needle .................................. 13.00 Syringe 0.5 ml with 29 g × 12.7 mm needle .............................. 13.00 Syringe 0.5 ml with 31 g × 8 mm needle ................................... 13.00 Syringe 1 ml with 29 g × 12.7 mm needle ................................ 13.00 Syringe 1 ml with 31 g × 8 mm needle ...................................... 13.00 KETONE BLOOD BETA-KETONE ELECTRODES Test strips .................................................................................. 15.50 MASK FOR SPACER DEVICE Size 2 ......................................................................................... 2.99 PEAK FLOW METER Low Range ............................................................................... 11.44 Normal Range ............................................................................ 11.44 Brand or Generic Manufacturer

1 1

CareSens II CareSens N CareSens N POP Accu-Chek Performa FreeStyle Lite On Call Advanced Accu-Chek Performa CareSens CareSens N FreeStyle Lite Freestyle Optium On Call Advanced Freestyle Optium FEIBA FEIBA B-D Micro-Fine B-D Micro-Fine ABM ABM B-D Micro-Fine B-D Micro-Fine B-D Ultra Fine B-D Ultra Fine II B-D Ultra Fine B-D Ultra Fine II ABM B-D Ultra Fine ABM B-D Ultra Fine II Freestyle Optium Ketone EZ-fit Paediatric Mask Breath-Alert Breath-Alert

50 test

50 test 1 1 1 100 100 100 100 100 100 100 100 100 100 100

10 strip

1

1 1

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated.

197


OPTIONAL PHARMACEUTICALS

Price (ex man. Excl. GST) $ Per PREGNANCY TEST – HCG URINE Cassette..................................................................................... 22.80 40 test Brand or Generic Manufacturer Innovacon hCG One Step Pregnancy Test Accu-Chek Ketur-Test Volumatic Space Chamber Plus

SODIUM NITROPRUSSIDE Test strip...................................................................................... 6.00 SPACER DEVICE 800 ml ......................................................................................... 8.50 230 ml (single patient) ................................................................ 4.72

50 strip

1 1

198

 Restriction

(Brand) indicates a brand example only. It is not a contracted product.


INDEX

Symbols 8-methoxypsoralen ............................................ 53 A Abacavir sulphate............................................... 78 Abacavir sulphate with lamivudine ...................... 78 Abciximab ........................................................ 138 Abilify .............................................................. 113 ABM Hydroxocobalamin ..................................... 24 Acarbose ........................................................... 17 Accarb ............................................................... 17 Accu-Chek Ketur-Test ...................................... 198 Accu-Chek Performa ........................................ 197 Accuretic 10 ...................................................... 37 Accuretic 20 ...................................................... 37 Acetadote ........................................................ 186 Acetazolamide ................................................. 164 Acetic acid ................................................. 55, 194 Acetic acid with hydroxyquinoline, glycerol and ricinoleic acid ........................................... 55 Acetic acid with propylene glycol...................... 166 Acetylcholine chloride ...................................... 164 Acetylcysteine.................................................. 186 Aciclovir .................................................... 84, 161 Acid citrate dextrose A ....................................... 29 Acidex ............................................................... 14 Acipimox ........................................................... 44 Acitretin ............................................................. 52 Aclasta .............................................................. 90 Actemra ........................................................... 151 Actinomycin D ................................................. 123 Adalimumab..................................................... 138 Adapalene .......................................................... 48 Adefin XL ........................................................... 40 Adefovir dipivoxil ................................................ 81 Adenosine.......................................................... 38 Adrenaline.......................................................... 45 Advantan ........................................................... 51 Advate ............................................................... 28 Aerrane .............................................................. 98 Airflow ............................................................... 24 Ajmaline............................................................. 38 Alanase............................................................ 155 Albendazole ....................................................... 75 Aldara ................................................................ 53 Alendronate sodium ........................................... 87 Alendronate sodium with cholecalciferol ............. 89 Alfacalcidol ........................................................ 24 Alfentanil hydrochloride .................................... 102 Alinia ................................................................. 76 Alitraq .............................................................. 172 Allersoothe....................................................... 156 Allopurinol.......................................................... 92 Alphamox .......................................................... 68 Alphapharm ....................................................... 79 Alpha tocopheryl acetate .................................... 24 Alprazolam ....................................................... 117 Alprostadil hydrochloride .................................... 45 Alteplase ............................................................ 31 Alum ................................................................ 194 Aluminium hydroxide.......................................... 14 Aluminium hydroxide with magnesium hydroxide and simethicone.............................................. 14 Amantadine hydrochloride .................................. 97 AmBisome ......................................................... 72 Ambrisentan ...................................................... 46 Amethocaine ............................................ 101, 163 Amikacin............................................................ 65 Amiloride hydrochloride...................................... 42 Amiloride hydrochloride with furosemide ............ 42 Amiloride hydrochloride with hydrochlorothiazide ......................................... 42 Amino acid formula .......................................... 174 Amino acid formula (without isoleucine, leucine and valine) .................................................... 178 Amino acid formula (without isoleucine, methionine, threonine and valine) .................. 180 Amino acid formula (without leucine)................ 179 Amino acid formula (without lysine and low tryptophan) ............................................. 179 Amino acid formula (without methionine).......... 178 Amino acid formula (without phenylalanine)...... 179 Amino acid formula (without phenylalanine and tyrosine)................................................. 180 Amino acid oral feed ........................................ 172 Amino acid oral feed 0.8 kcal/ml ...................... 172 Amino acid supplement .................................... 180 Aminophylline .................................................. 159 Amiodarone hydrochloride.................................. 38 Amisulpride...................................................... 113 Amitrip ............................................................. 104 Amitriptyline ..................................................... 104 Amlodipine......................................................... 40 Amorolfine ......................................................... 48 Amoxycillin ........................................................ 68 Amoxycillin with clavulanic acid ......................... 68 Amphotericin B ............................................ 26, 72 Amsacrine ....................................................... 125 Amyl nitrite ........................................................ 45 Anagrelide hydrochloride .................................. 125 Anastrozole ...................................................... 133 Andriol Testocaps .............................................. 59 Androderm......................................................... 59 Anexate............................................................ 186 Antabuse ......................................................... 121 Antinaus .......................................................... 112 Antithymocyte globulin (equine) ....................... 153 Antithymocyte globulin (rabbit) ......................... 153 Anzatax ............................................................ 131 199


INDEX

Apidra ................................................................ 18 Apidra SoloStar .................................................. 18 Apo-Allopurinol .................................................. 92 Apo-Amiloride .................................................... 42 Apo-Amlodipine ................................................. 40 Apo-Azithromycin .............................................. 67 Apo-Clarithromycin ............................................ 67 Apo-Clomipramine ........................................... 105 Apo-Clopidogrel ................................................. 31 Apo-Diclo........................................................... 94 Apo-Diltiazem CD ............................................... 41 Apo-Doxazosin................................................... 37 Apo-Gliclazide .................................................... 19 Apo-Megestrol ................................................. 132 Apomine ............................................................ 97 Apo-Moclobemide............................................ 106 Apomorphine hydrochloride ............................... 97 Apo-Nadolol ....................................................... 40 Apo-Oxybutynin ................................................. 58 Apo-Perindopril .................................................. 36 Apo-Pindolol ...................................................... 40 Apo-Prazo.......................................................... 37 Apo-Prednisone ................................................. 60 Apo-Propranolol ................................................. 40 Apo-Pyridoxine .................................................. 24 Apo-Risperidone .............................................. 114 Apo-Zopiclone.................................................. 119 Apraclonidine ................................................... 165 Aprepitant ........................................................ 111 Apresoline.......................................................... 46 Aqueous cream .................................................. 50 Arachis oil [peanut oil] ..................................... 194 Arava ................................................................. 87 Aremed ............................................................ 133 Arginine ..................................................... 21, 191 Argipressin [Vasopressin] .................................. 64 Aripiprazole ...................................................... 113 Aristocort ........................................................... 52 Aromasin ......................................................... 133 Arrow-Amitriptyline .......................................... 104 Arrow-Bendrofluazide ......................................... 42 Arrow-Brimonidine ........................................... 165 Arrow-Calcium ................................................... 22 Arrow-Citalopram ............................................. 107 Arrow-Diazepam .............................................. 117 Arrow-Doxorubicin ........................................... 123 Arrow-Etidronate ................................................ 89 Arrow-Lamotrigine ........................................... 109 Arrow-Lisinopril ................................................. 36 Arrow-Losartan & Hydrochlorothiazide ............... 37 Arrow-Morphine LA .......................................... 103 Arrow-Nifedipine XR ........................................... 40 Arrow-Norfloxacin .............................................. 69 Arrow-Ornidazole ............................................... 76 200 Arrow-Quinapril 5 ............................................... 36 Arrow-Quinapril 10 ............................................. 36 Arrow-Quinapril 20 ............................................. 36 Arrow-Ranitidine ................................................ 16 Arrow-Roxithromycin ......................................... 67 Arrow-Sertraline ............................................... 107 Arrow-Simva ...................................................... 43 Arrow-Sumatriptan ........................................... 111 Arrow-Tolterodine .............................................. 58 Arrow-Topiramte .............................................. 110 Arrow-Tramadol ............................................... 104 Arrow-Venlafaxine XR....................................... 106 Arsenic trioxide ................................................ 125 Artemether with lumafantrine .............................. 75 Artesunate ......................................................... 75 Articaine hydrochloride with adrenaline ............... 99 Asacol ............................................................... 15 Asamax ............................................................. 15 A-Scabies .......................................................... 49 Ascorbic acid ............................................. 24, 194 Aspen Adrenaline ............................................... 45 Aspen Ceftriaxone .............................................. 66 Aspen Ciprofloxacin ........................................... 69 Aspirin ....................................................... 31, 101 Asthalin ........................................................... 157 Atazanavir sulphate ............................................ 80 Atenolol ............................................................. 39 Atenolol AFT ...................................................... 39 ATGAM ............................................................ 153 Ativan .............................................................. 117 Atomoxetine ..................................................... 119 Atorvastatin........................................................ 43 Atovaquone with proguanil hydrochloride............ 76 Atracurium besylate ........................................... 93 Atripla ................................................................ 79 Atropine sulphate ....................................... 38, 165 Atropt .............................................................. 165 Augmentin ......................................................... 68 Auranofin ........................................................... 87 Avanza............................................................. 106 Avelox................................................................ 69 Avelox IV 400..................................................... 69 Azactam ............................................................ 70 Azathioprine ..................................................... 153 Azithromycin ...................................................... 67 Azol ................................................................... 61 AZT.................................................................... 79 Aztreonam ......................................................... 70 B Bacillus calmette-guerin (BCG) ......................... 153 Bacillus calmette-guerin vaccine....................... 181 Baclofen ............................................................ 93 Balanced Salt Solution...................................... 163 Baraclude .......................................................... 82


INDEX

Barium sulphate ............................................... 190 Basiliximab ...................................................... 143 B-D Micro-Fine................................................. 197 B-D Ultra Fine................................................... 197 B-D Ultra Fine II ................................................ 197 Beclazone 50 ................................................... 158 Beclazone 100 ................................................. 158 Beclazone 250 ................................................. 158 Beclomethasone dipropionate................... 155, 158 Bee venom....................................................... 155 Bendrofluazide ................................................... 42 Bendroflumethiazide [bendrofluazide] ................. 42 BeneFIX ............................................................. 28 Benzathine benzylpenicillin ................................. 68 Benzbromaron ................................................... 92 Benzbromarone .................................................. 92 Benzocaine ........................................................ 99 Benzoin............................................................ 194 Benzoyl peroxide ................................................ 48 Benztrop ............................................................ 97 Benztropine mesylate ......................................... 97 Benzydamine hydrochloride................................ 26 Benzydamine hydrochloride with cetylpyridinium chloride........................................................... 26 Benzylpenicillin sodium [Penicillin G] .................. 68 Beractant ......................................................... 160 Betadine........................................................... 188 Betadine Skin Prep ........................................... 188 Betagan ........................................................... 164 Betahistine dihydrochloride............................... 111 Betaine .............................................................. 21 Betamethasone .................................................. 59 Betamethasone dipropionate .............................. 51 Betamethasone sodium phosphate with betamethasone acetate ................................... 59 Betamethasone valerate ............................... 51, 53 Betamethasone valerate with clioquiniol .............. 52 Betamethasone valerate with fusidic acid ............ 52 Betamethasone with dipropionate with calcipotriol ...................................................... 52 Beta Scalp ......................................................... 53 Betaxolol .......................................................... 164 Bevacizumab ................................................... 143 Bezafibrate ......................................................... 43 Bezalip ............................................................... 43 Bezalip Retard .................................................... 43 Bicalaccord ...................................................... 132 Bicalutamide .................................................... 132 Bicillin LA........................................................... 68 Bimatoprost ..................................................... 165 Biodone Extra Forte .......................................... 103 Biodone Forte................................................... 103 Bisacodyl ........................................................... 21 Bismuth subgallate ........................................... 194 Bismuth subnitrate and iodoform paraffin.......... 192 Bismuth trioxide ................................................. 17 Bisoprolol .......................................................... 39 Bivalirudin .......................................................... 29 Bleomycin sulphate .......................................... 123 Blood glucose diagnostic test meter ................. 197 Blood glucose diagnostic test strip ................... 197 Blood ketone diagnostic test meter ................... 197 Bonney’s blue dye............................................ 191 Boric acid ........................................................ 194 Bortezomib ...................................................... 125 Bosentan ........................................................... 46 Bosvate ............................................................. 39 Botox ................................................................. 93 Botulism antitoxin............................................. 186 Breast milk fortifier ........................................... 168 Breath-Alert...................................................... 197 Bridion ............................................................... 94 Brimonidine tartrate .......................................... 165 Brimonidine tartrate with timolol ....................... 165 Brinzolamide .................................................... 164 Bromocriptine .................................................... 97 Brufen SR .......................................................... 94 Budenocort ...................................................... 158 Budesonide ........................................ 15, 155, 158 Budesonide with eformeterol ............................ 159 Bumetanide........................................................ 41 Bupafen ........................................................... 100 Bupivacaine hydrochloride.................................. 99 Bupivacaine hydrochloride with adrenaline .......... 99 Bupivacaine hydrochloride with fentanyl ........... 100 Bupivacaine hydrochloride with glucose ........... 100 Buprenorphine with naloxone............................ 121 Bupropion hydrochloride .................................. 121 Burinex .............................................................. 41 Buscopan .......................................................... 16 Buserelin............................................................ 62 Buspirone hydrochloride................................... 117 Busulfan .......................................................... 123 Butacort Aqueous ............................................ 155 C Cabergoline........................................................ 61 Caffeine ........................................................... 119 Caffeine citrate ................................................. 160 Calamine............................................................ 48 Calcipotriol......................................................... 52 Calcitonin........................................................... 59 Calcitriol ............................................................ 24 Calcitriol-AFT ..................................................... 24 Calcium carbonate ....................................... 14, 22 Calcium chloride ................................................ 32 Calcium chloride with magnesium chloride, potassium chloride, sodium acetate, sodium chloride and sodium citrate ............... 163 201


INDEX

Calcium folinate ............................................... 131 Calcium Folinate Ebewe.................................... 131 Calcium gluconate ....................................... 32, 54 Calcium polystryrene sulphonate ........................ 35 Calcium Resonium ............................................. 35 Cal-d-Forte......................................................... 24 Calogen ........................................................... 167 Cancidas............................................................ 73 Candesartan cilexetil .......................................... 37 Candestar .......................................................... 37 Capecitabine .................................................... 124 Capoten ............................................................. 36 Capsaicin ................................................... 96, 101 Captopril ............................................................ 36 Carbaccord ...................................................... 127 Carbamazepine ................................................ 107 Carbasorb-X..................................................... 187 Carbimazole ....................................................... 63 Carbohydrate and fat supplement ..................... 168 Carbohydrate supplement................................. 167 Carbomer......................................................... 166 Carboplatin ...................................................... 127 Carboplatin Ebewe ........................................... 127 Carboprost trometamol ...................................... 56 Carboxymethylcellulose.............................. 26, 194 Cardinol LA ........................................................ 40 Cardioplegia Base Solution ............................... 193 Cardioplegia Electrolyte Solution ....................... 193 Cardioplegia Enriched Paediatric Solution ......... 193 Cardioplegia Enriched Solution ......................... 193 Cardioplegia Solution AHB7832 ........................ 193 CareSens ......................................................... 197 CareSens II ...................................................... 197 CareSens N ...................................................... 197 CareSens N POP .............................................. 197 Carmellose sodium .......................................... 166 Carmustine ...................................................... 123 Carob bean gum with maize starch and maltodextrin ........................................... 168 Carvedilol ........................................................... 39 Caspofungin....................................................... 73 Catapres ............................................................ 41 Catapres-TTS-1 ................................................. 41 Catapres-TTS-2 ................................................. 41 Catapres-TTS-3 ................................................. 41 Ceenu .............................................................. 123 Cefaclor ............................................................. 66 Cefalexin ............................................................ 66 Cefalexin Sandoz ................................................ 66 Cefazolin ............................................................ 66 Cefepime ........................................................... 66 Cefotaxime......................................................... 66 Cefotaxime Sandoz ............................................ 66 Cefoxitin ............................................................ 66 202 Ceftazadime ....................................................... 66 Ceftriaxone......................................................... 66 Cefuroxime ........................................................ 66 Celecoxib ........................................................... 94 Celiprolol ........................................................... 39 CellCept ........................................................... 153 Celol .................................................................. 39 Cephalexin ABM ................................................. 66 Ceptolate ......................................................... 153 Cetirizine hydrochloride .................................... 155 Cetomacrogol .................................................... 50 Cetomacrogol with glycerol ................................ 50 Cetrimide ......................................................... 194 Cetrizine - AFT ................................................. 155 Champix .......................................................... 122 Charcoal .......................................................... 187 Chlorafast ........................................................ 161 Chloral hydrate ................................................. 118 Chlorambucil.................................................... 123 Chloramphenicol ........................................ 70, 161 Chlorhexidine ..................................... 55, 187, 191 Chlorhexidine gluconate ............................... 26, 55 Chlorhexidine with cetrimide ..................... 189, 191 Chlorhexidine with ethanol ................................ 187 Chloroform ...................................................... 194 Chloroquine phosphate....................................... 76 Chlorothiazide .................................................... 42 Chlorpheniramine maleate ................................ 156 Chlorpromazine hydrochloride .......................... 113 Chlorsig ........................................................... 161 Chlortalidone [chlorthalidone] ............................. 42 Chlorthalidone .................................................... 42 Cholecalciferol ................................................... 24 Cholestyramine .................................................. 43 Choline salicylate with cetalkonium chloride........ 26 Cholvastin .......................................................... 43 Choriogonadotropin alfa ..................................... 63 Ciclopirox olaxmine ............................................ 49 Ciclosporin ...................................................... 133 Cidofovir ............................................................ 84 Cilazapril ............................................................ 36 Cilazapril with hydrochlorothiazide ...................... 36 Cilicaine ............................................................. 68 Cilicaine VK........................................................ 68 Cimetidine.......................................................... 16 Cinchocaine hydrochloride with hydrocortisone ................................................ 15 Cipflox ............................................................... 69 Ciprofloxacin .............................................. 69, 161 Cisplatin........................................................... 127 Cisplatin Ebewe................................................ 127 Citalopram hydrobromide ................................. 107 Citanest ........................................................... 101 Citric acid ........................................................ 194


INDEX

Citric acid with magnesium oxide and sodium picosulfate .......................................... 20 Citric acid with sodium bicarbonate .................. 190 Cladribine......................................................... 124 Clarithromycin.................................................... 67 Clexane .............................................................. 29 Clindamycin ....................................................... 70 Clindamycin ABM............................................... 70 Clobazam......................................................... 107 Clobetasol propionate................................... 51, 53 Clobetasone butyrate.......................................... 51 Clofazamine ....................................................... 74 Clomazol...................................................... 49, 55 Clomiphene citrate ............................................. 61 Clomipramine hydrochloride ............................. 105 Clonazepam ..................................... 107, 108, 117 Clonidine............................................................ 41 Clonidine BNM ................................................... 41 Clonidine hydrochloride ...................................... 41 Clopidogrel ........................................................ 31 Clopine ............................................................ 113 Clopixol............................................................ 116 Clostridium botulinum type A toxin ..................... 93 Clotrimazole ................................................. 49, 55 Clove oil........................................................... 194 Clozapine ......................................................... 113 Clozaril ............................................................ 113 Coal tar ............................................................ 194 Coal tar with salicylic acid and sulphur ............... 52 Coal tar with triethanolamine lauryl sulphate and fluorescein ............................................... 52 Cocaine hydrochloride...................................... 100 Cocaine hydrochloride with adrenaline .............. 100 Codeine phosphate .................................. 102, 194 Cogentin ............................................................ 97 Colaspase [L-asparaginase] ............................. 126 Colchicine .......................................................... 93 Colestimethate ................................................... 70 Colestipol hydrochloride ..................................... 43 Colgout .............................................................. 93 Colifoam ............................................................ 15 Colistin-Link ....................................................... 70 Colistin sulphomethate [Colestimethate] ............. 70 Collodion flexible .............................................. 194 Colofac .............................................................. 16 Coloxyl .............................................................. 20 Compound electrolytes................................. 32, 35 Compound electrolytes with glucose ............ 32, 35 Compound hydroxybenzoate ............................ 194 Compound sodium lactate [hartmann’s solution] ...................................... 33 Compound sodium lactate with glucose ............. 33 Concerta .......................................................... 120 Condyline........................................................... 53 Corangin ............................................................ 44 Cordarone-X ...................................................... 38 Corticotrorelin (ovine)......................................... 62 Co-trimoxazole ................................................... 71 Cosopt ............................................................. 164 Crotamiton ......................................................... 48 Crystaderm ........................................................ 48 CT Plus+ ........................................................ 190 Curam Duo ........................................................ 68 Curosurf .......................................................... 160 Cyclizine hydrochloride .................................... 111 Cyclizine lactate ............................................... 111 Cycloblastin ..................................................... 123 Cyclopentolate hydrochloride ........................... 165 Cyclophosphamide .......................................... 123 Cycloserine ........................................................ 74 Cyklokapron ....................................................... 28 Cymevene.......................................................... 84 Cyproheptadine hydrochloride .......................... 156 Cyproterone acetate ........................................... 59 Cyproterone acetate with ethinyloestradiol .......... 55 Cysteamine hydrochloride ................................ 194 Cytarabine ....................................................... 124 D Dabigatran ......................................................... 29 Dacarbazine ..................................................... 126 Dactinomycin [Actinomycin D] ......................... 123 Daivobet ............................................................ 52 Daivonex ............................................................ 52 Dalacin C ........................................................... 70 Dalteparin .......................................................... 29 Danaparoid ........................................................ 29 Danazol.............................................................. 61 Danthron with poloxamer.................................... 21 Dantrium ............................................................ 93 Dantrium IV ........................................................ 93 Dantrolene ......................................................... 93 Dapa-Tabs ......................................................... 42 Dapsone ............................................................ 74 Daptomycin ....................................................... 70 Darunavir ........................................................... 80 Dasatinib.......................................................... 128 Daunorubicin ................................................... 123 DBL Aminophylline ........................................... 159 DBL Cefepime .................................................... 66 DBL Cefotaxime ................................................. 66 DBL Ceftazidime................................................. 66 DBL Epirubicin Hydrochloride ........................... 124 DBL Ergometrine ................................................ 57 DBL Gemcitabine ............................................. 125 DBL Leucovorin Calcium .................................. 131 DBL Morphine Sulphate .................................... 103 DBL Pethidine Hydrochloride ............................ 104 DBL Rocuronium Bromide .................................. 93 203


INDEX

DBL Tobramycin ................................................ 65 DDI .................................................................... 78 Decozol ............................................................. 26 Deferiprone ...................................................... 187 Defibrotide ......................................................... 29 Demeclocycline hydrochloride ............................ 69 De-Nol ............................................................... 17 Deoxycoformycin ............................................. 127 Depo-Medrol ...................................................... 60 Depo-Medrol with Lidocaine ............................... 60 Depo-Provera ..................................................... 56 Depo-Testosterone............................................. 59 Deprim............................................................... 71 Dermol......................................................... 51, 53 Desferrioxamine mesilate ................................. 187 Desflurane ......................................................... 98 Desmopressin acetate ........................................ 64 Desmopressin-PH&T.......................................... 64 De-Worm ........................................................... 75 Dexamethasone ......................................... 59, 162 Dexamethasone phosphate................................. 60 Dexamethasone with framycetin and gramicidin .............................................. 161 Dexamethasone with neomycin sulphate and polymyxin B sulphate.............................. 161 Dexamethasone with tobramycin ...................... 162 Dexamphetamine sulphate................................ 119 Dexmedetomidine hydrochloride ......................... 98 Dextrose with sodium citrate and citric acid [acid citrate dextrose A]................... 29 DHC Continus .................................................. 102 Diacomit .......................................................... 110 Dialamine......................................................... 180 Diamide Relief .................................................... 14 Diamox ............................................................ 164 Diasip .............................................................. 171 Diatrizoate meglumine with diatrizoate sodium .. 188 Diatrizoate sodium ........................................... 188 Diazepam................................................. 107, 117 Diazoxide ..................................................... 17, 45 Dichlorobenzyl alcohol with amylmetacresol ....... 26 Diclax SR ........................................................... 94 Diclofenac sodium ..................................... 94, 162 Dicobalt edetate ............................................... 187 Didanosine [DDI]................................................ 78 Diflucan ............................................................. 72 Diflucortolone valerate ........................................ 51 Digoxin .............................................................. 38 Digoxin immune fab ......................................... 186 Dihydrocodeine tartrate .................................... 102 Dihydroergotamine mesylate ............................ 111 Dilatrend ............................................................ 39 Diltiazem hydrochloride ...................................... 41 Dilzem ............................................................... 41 204 Dimercaprol ..................................................... 187 Dimercaptosuccinic acid .................................. 187 Dimethicone....................................................... 49 Dimethyl sulfoxide ............................................ 192 Dinoprostone ..................................................... 56 Diphemanil metilsulfate ...................................... 54 Diphenoxylate hydrochloride with atropine sulphate............................................. 14 Diphtheria and tetanus vaccine ......................... 181 Diphtheria antitoxin........................................... 186 Diphtheria, tetanus and pertussis vaccine ......... 181 Diphtheria, tetanus, pertussis and polio vaccine................................................. 183 Diphtheria, tetanus, pertussis, polio, hepatitis b and haemophilus influenzae type b vaccine.... 183 Diprivan ............................................................. 99 Dipyridamole...................................................... 31 Disodium edetate ............................................. 187 Disodium hydrogen phosphate with sodium dihydrogen phosphate ................................... 194 Disopyramide phosphate .................................... 38 Disulfiram ........................................................ 121 Dithranol .......................................................... 195 Diurin 40 ............................................................ 41 Dobutamine hydrochloride.................................. 45 Docetaxel ......................................................... 131 Docetaxel Ebewe .............................................. 131 Docetaxel Sandoz............................................. 131 Docusate sodium ....................................... 20, 166 Docusate sodium with sennosides ..................... 20 Domperidone ................................................... 111 Donepezil hydrochloride ................................... 120 Donepezil-Rex .................................................. 120 Dopamine hydrochloride .................................... 45 Dopergin ............................................................ 97 Dopress ........................................................... 105 Dornase alfa..................................................... 160 Dorzolamide..................................................... 164 Dorzolamide with timolol .................................. 164 Dostinex ............................................................ 61 Dothiepin hydrochloride.................................... 105 Doxapram ........................................................ 160 Doxazosin .......................................................... 37 Doxepin hydrochloride...................................... 105 Doxine ............................................................... 69 Doxorubicin hydrochloride ................................ 123 Doxycycline ....................................................... 69 DP-Anastrozole ................................................ 133 D-Penamine ....................................................... 87 Droperidol ........................................................ 111 Dr Reddy’s Omeprazole...................................... 17 Dr Reddy’s Ondansetron .................................. 112 Dr Reddy’s Pantoprazole .................................... 17 Dr Reddy’s Pramipexole ..................................... 98


INDEX

Dr Reddy’s Quetiapine ...................................... 114 Dr Reddy’s Risperidone.................................... 114 Dr Reddy’s Terbinafine ....................................... 73 Dulcolax............................................................. 21 Duolin .............................................................. 157 Duovisc ........................................................... 164 Duride ................................................................ 44 Dynastat ............................................................ 95 Dysport .............................................................. 93 E E-2-GAS ii........................................................ 190 Easiphen .......................................................... 179 Easy Thick ....................................................... 169 Econazole nitrate ................................................ 49 Edrophonium chloride ........................................ 87 Efavirenz ............................................................ 77 Efavirenz with emtricitabine and tenofovir disoproxil fumarate.......................................... 79 Efexor XR ......................................................... 106 Effient ................................................................ 31 Eformoterol fumarate........................................ 159 Efudix ................................................................ 54 Elecare LCP (Unflavoured)................................ 174 Elecare (Unflavoured) ....................................... 174 Elecare (Vanilla) ............................................... 174 Electrolytes ...................................................... 193 Elemental 028 Extra ......................................... 172 Eligard ............................................................... 62 Emend Tri-Pack ............................................... 111 EMLA............................................................... 101 Emtricitabine ...................................................... 79 Emtricitabine with tenofovir disoproxil fumarate ......................................................... 79 Emtriva .............................................................. 79 Emulsifying ointment .......................................... 50 E-Mycin ............................................................. 67 Enalapril maleate ................................................ 36 Enalapril maleate with hydrochlorothiazide .......... 36 Enbrel .............................................................. 134 Endoxan........................................................... 123 Enfuvirtide .......................................................... 81 Enoxaparin ......................................................... 29 Ensure (Chocolate) .......................................... 169 Ensure Plus (Banana) ....................................... 170 Ensure Plus (Chocolate) ........................... 169, 170 Ensure Plus (Fruit of the Forest)........................ 170 Ensure Plus HN ................................................ 170 Ensure Plus HN RTH ........................................ 170 Ensure Plus (Strawberry).................................. 169 Ensure Plus (Vanilla) ................................ 169, 170 Ensure (Vanilla)................................................ 169 Entacapone ........................................................ 97 Entapone ........................................................... 97 Entecavir ............................................................ 82 Enteral feed 1.2 Kcal/ml ................................... 170 Enteral feed 1.5 Kcal/ml ................................... 170 Enteral feed 1 kcal/ml ....................................... 170 Enteral feed 2 kcal/ml ....................................... 173 Ephedrine........................................................... 45 Epirubicin Ebewe.............................................. 124 Epirubicin hydrochloride ................................... 124 Eprex ................................................................. 27 Eptacog alfa [recombinant factor viia]................. 28 Eptifibatide ......................................................... 31 Ergometrine maleate .......................................... 57 Ergometrine tartrate with caffeine ..................... 111 Erlotinib ........................................................... 128 Ertapenem ......................................................... 65 Erythrocin IV ...................................................... 67 Erythromycin (as ethylsuccinate)........................ 67 Erythromycin (as lactobionate) ........................... 67 Erythyromycin (as stearate)................................ 67 Erythropoietin alpha............................................ 27 Erythropoietin beta ............................................. 27 Escitalopram .................................................... 107 Esmolol hydrochloride ........................................ 39 Essential Amino Acid Mix ................................. 180 Etanercept........................................................ 134 Ethambutol hydrochloride ................................... 74 Ethanol ............................................................ 186 Ethanol, dehydrated.......................................... 186 Ethanol with glucose ........................................ 186 Ethics Paracetamol .......................................... 102 Ethinyloestradiol ................................................. 62 Ethinyloestradiol with desogestrel ....................... 55 Ethinyloestradiol with levonorgestrel ................... 55 Ethinyloestradiol with norethisterone ................... 55 Ethosuximide ................................................... 108 Ethyl chloride ................................................... 100 Etidronate disodium ........................................... 89 Etomidate .......................................................... 98 Etopophos ....................................................... 126 Etoposide......................................................... 126 Etoposide (as phosphate) ................................. 126 Etoricoxib........................................................... 94 Etravirine............................................................ 78 Evista................................................................. 91 Exemestane ..................................................... 133 Extensively hydrolysed formula......................... 174 Ezetimibe ........................................................... 43 Ezetimibe with simvastatin ................................. 44 EZ-fit Paediatric Mask....................................... 197 F Factor eight inhibitors bypassing agent ............. 197 Fat-Modified Feed............................................. 171 FEIBA............................................................... 197 Felodipine .......................................................... 40 Fenpaed ............................................................. 94 205


INDEX

Fentanyl ........................................................... 102 Ferodan ............................................................. 23 Ferric subsulfate................................................. 28 Ferriprox .......................................................... 187 Ferro-F-Tabs ...................................................... 23 Ferro-tab ............................................................ 22 Ferrous fumarate ................................................ 22 Ferrous fumarate with folic acid .......................... 23 Ferrous gluconate with ascorbic acid .................. 23 Ferrous sulphate ................................................ 23 Ferrous sulphate with ascorbic acid .................... 23 Ferrous sulphate with folic acid .......................... 23 Ferrum H............................................................ 23 Fexofenadine hydrochloride .............................. 156 Filgrastim ........................................................... 32 Finasteride ......................................................... 57 Flagyl ................................................................. 76 Flagyl-S ............................................................. 76 Flamazine........................................................... 48 Flecainide acetate............................................... 38 Fleet Phosphate Enema ...................................... 21 Flixonase Hayfever & Allergy ............................ 155 Flixotide ........................................................... 158 Flixotide Accuhaler ........................................... 158 Florinef .............................................................. 60 Fluanxol ........................................................... 115 Flucloxacillin ...................................................... 68 Flucloxin ............................................................ 68 Flucon.............................................................. 162 Fluconazole ........................................................ 72 Fluconazole-Claris .............................................. 72 Flucytosine ........................................................ 73 Fludarabine Ebewe ........................................... 124 Fludarabine phosphate ..................................... 124 Fludara Oral ..................................................... 124 Fludrocortisone acetate ...................................... 60 Flumazenil........................................................ 186 Flumetasone pivalate with clioquinol ................. 162 Fluocortolone caproate with fluocortolone pivalate and cinchocaine ................................. 16 Fluorescein sodium .......................................... 163 Fluorescein sodium with lignocaine hydrochloride ................................................ 163 Fluorescite ....................................................... 163 Fluorometholone .............................................. 162 Fluorouracil ...................................................... 124 Fluorouracil Ebewe ........................................... 124 Fluorouracil sodium............................................ 54 Fluox................................................................ 107 Fluoxetine hydrochloride ................................... 107 Flupenthixol decanoate ..................................... 115 Fluphenazine decanoate ................................... 115 Flutamide ......................................................... 132 Flutamin ........................................................... 132 206 Fluticasone ...................................................... 158 Fluticasone propionate ..................................... 155 Fluticasone with salmeterol .............................. 159 FM 85 .............................................................. 168 Foban ................................................................ 48 Folic acid ........................................................... 27 Fondaparinux sodium ......................................... 30 Forteo ................................................................ 92 Fortijuce........................................................... 169 Fortimel Regular ............................................... 173 Fortini .............................................................. 177 Fortini Multifibre ............................................... 177 Fortisip ............................................................ 169 Fortisip Multi Fibre ............................................ 170 Fortisip (Vanilla) ............................................... 169 Fortum ............................................................... 66 Fosamax ...................................................... 87, 88 Fosamax Plus .................................................... 89 Foscarnet sodium .............................................. 84 Fragmin ............................................................. 29 Framycetin sulphate ......................................... 161 Freeflex .............................................................. 34 FreeStyle Lite ................................................... 197 Freestyle Optium .............................................. 197 Freestyle Optium Ketone ................................... 197 Fresofol 1%........................................................ 99 Fructose-based formula ................................... 175 Frusemide .......................................................... 41 Frusemide-Claris ................................................ 41 Fucidin ............................................................... 70 Fucithalmic ...................................................... 161 Fungilin .............................................................. 26 Furosemide [frusemide] ..................................... 41 Fusidate sodium [Fusidic acid] ........................... 48 Fusidic acid.......................................... 70, 48, 161 Fuzeon ............................................................... 81 G GA1 Anamix Infant ........................................... 179 Gabapentin ...................................................... 108 Gadobenic acid ................................................ 190 Gadobutrol ....................................................... 190 Gadodiamide.................................................... 190 Gadoteric acid .................................................. 190 Gadoxetate disodium ........................................ 190 Galactomin 19 ................................................. 175 Gamma benzene hexachloride ............................ 49 Ganciclovir......................................................... 84 Gastrografin ..................................................... 188 Gastrosoothe ..................................................... 16 Gaviscon Double Strength .................................. 14 Gaviscon Infant .................................................. 14 Gefitinib ........................................................... 128 Gelafusal............................................................ 35 Gelatine, succinylated ........................................ 35


INDEX

Gelofusine.......................................................... 35 Gemcitabine ..................................................... 125 Gemcitabine Actavis 200.................................. 125 Gemcitabine Actavis 1000................................ 125 Gemcitabine Ebewe.......................................... 125 Gemfibrozil ........................................................ 43 Genoptic .......................................................... 161 Genox .............................................................. 133 Gentamicin sulphate ................................... 65, 161 Gestrinone ......................................................... 61 Glatiramer acetate ............................................ 118 Glibenclamide .................................................... 19 Gliclazide ........................................................... 19 Glipizide ............................................................. 19 Glivec .............................................................. 128 Glucagen Hypokit ............................................... 18 Glucagon hydrochloride ..................................... 18 Glucerna Select RTH (Vanilla) ........................... 171 Glucerna Select (Vanilla) .................................. 171 Glucose ............................................... 18, 33, 195 Glucose with potassium chloride ........................ 33 Glucose with potassium chloride and sodium chloride .............................................. 33 Glucose with sodium chloride............................. 33 Glucose with sucrose and fructose ..................... 18 Glycerin with sodium saccharin ........................ 195 Glycerin with sucrose ....................................... 195 Glycerol ..................................................... 20, 195 Glycerol with paraffin ......................................... 50 Glyceryl trierucate ............................................ 180 Glyceryl trinitrate .......................................... 16, 44 Glyceryl trioleate .............................................. 180 Glycine ............................................................ 192 Glycoprep-C....................................................... 20 Glycopyrronium bromide .................................... 16 Glypressin.......................................................... 64 Glytrin ................................................................ 44 Gonadorelin ....................................................... 62 Goserelin ........................................................... 62 Guarcol ............................................................ 168 Guar gum......................................................... 168 H Habitrol ............................................................ 121 Habitrol (Classic) ............................................. 121 Habitrol (Fruit) .................................................. 121 Habitrol (Mint) .................................................. 121 Haem arginate.................................................... 21 Haemophilus influenzae type b vaccine ............. 181 Haldol .............................................................. 116 Haldol Concentrate ........................................... 116 Haloperidol ...................................................... 113 Haloperidol decanoate ...................................... 116 Hartmann’s solution ........................................... 33 HCU Anamix Infant ........................................... 178 HCU Anamix Junior LQ ..................................... 178 Healon ............................................................. 164 Healon GV........................................................ 164 healthE Fatty Cream ........................................... 50 Heparinised saline .............................................. 30 Heparin sodium.................................................. 30 Heparon Junior ................................................ 172 Hepatic oral feed .............................................. 172 Hepatitis A vaccine........................................... 183 Hepatitis B vaccine........................................... 183 Hepsera ............................................................. 81 Herceptin ......................................................... 152 Hexamine hippurate............................................ 70 High arginine oral feed 1.4 kcal/ml.................... 178 High fat formula ............................................... 176 High protein enteral feed 1.25 kcal/ml ............... 173 High protein oral feed 1 kcal/ml ........................ 173 Histamine acid phosphate ................................ 191 Holoxan ........................................................... 123 Humalog Mix 25................................................. 18 Humalog Mix 50................................................. 18 Human papilomavirus (6, 11, 16 and 18) vaccine ......................................................... 183 Humatin ............................................................. 65 Humira............................................................. 138 HumiraPen ....................................................... 138 Hyaluronidase .................................................... 92 Hybloc ............................................................... 39 Hydralazine hydrochloride .................................. 46 Hydrea ............................................................. 126 Hydrocortisone .................................... 51, 60, 195 Hydrocortisone acetate ................................ 15, 51 Hydrocortisone butyrate ............................... 51, 53 Hydrocortisone with ciprofloxacin ..................... 162 Hydrocortisone with miconazole ......................... 52 Hydrocortisone with natamycin and neomycin .... 52 Hydrocortisone with paraffin and wool fat ........... 51 Hydrogen peroxide ............................................. 48 Hydroxocobalamin ........................................... 186 Hydroxocobalamin acetate ................................. 24 Hydroxychloroquine ........................................... 87 Hydroxyethyl starch 130/0.4 with magnesium chloride, potassium chloride, sodium acetate and sodium chloride ........................................ 35 Hydroxyethyl starch 130/0.4 with sodium chloride .............................................. 35 Hydroxyurea .................................................... 126 Hygroton............................................................ 42 Hylo-Fresh ....................................................... 166 Hyoscine butylbromide....................................... 16 Hyoscine hydrobromide ................................... 112 Hypnovel ......................................................... 118 Hypromellose........................................... 163, 166 Hypromellose with dextran ............................... 166 207


INDEX

Hysite .............................................................. 165 I Ibiamox.............................................................. 68 Ibuprofen ........................................................... 94 Idarubicin hydrochloride ................................... 124 Ifosfamide........................................................ 123 Ikorel ................................................................. 46 Ilomedin............................................................. 47 Iloprost .............................................................. 47 Imatinib............................................................ 128 Imiglucerase ...................................................... 22 Imipenem with cilastatin ..................................... 65 Imipramine hydrochloride ................................. 105 Imiquimod ......................................................... 53 Impact Advanced Recovery (Chocolate) ........... 178 Impact Advanced Recovery (Vanilla) ................ 178 Imuprine .......................................................... 153 Imuran ............................................................. 153 Indapamide ........................................................ 42 Indigo carmine ................................................. 191 Indinavir ............................................................. 80 Indocyanine green ............................................ 191 Indomethacin ..................................................... 95 Infatrini ............................................................ 176 Infliximab ......................................................... 143 Influenza vaccine.............................................. 184 Inhibace Plus ..................................................... 36 Innovacon hCG One Step Pregnancy Test ......... 198 Instant Thick .................................................... 169 Insulin aspart ..................................................... 18 Insulin aspart with insulin aspart protamine......... 18 Insulin glargine ................................................... 18 Insulin glulisine .................................................. 18 Insulin isophane ................................................. 18 Insulin lispro ...................................................... 19 Insulin lispro with insulin lispro protamine ........... 18 Insulin neutral .................................................... 19 Insulin neutral with insulin isophane.................... 18 Insulin pen needles........................................... 197 Insulin syringes, disposable with attached needle ............................................. 197 Integrilin ............................................................. 31 Intelence ............................................................ 78 Interferon alpha-2a ............................................. 85 Interferon alpha-2b ............................................. 85 Interferon beta-1-alpha ..................................... 118 Interferon beta-1-beta....................................... 118 Interferon gamma ............................................... 85 Invanz ................................................................ 65 Iodine ................................................................ 63 Iodine with ethanol ........................................... 188 Iodised oil ........................................................ 188 Iodixanol .......................................................... 189 Iohexol ............................................................. 189 208 Iomeprol .......................................................... 189 Iopromide ........................................................ 189 Iotrolan ............................................................ 189 Ipratropium bromide ................................. 155, 156 Iressa .............................................................. 128 Irinotecan Actavis 40........................................ 126 Irinotecan Actavis 100...................................... 126 Irinotecan hydrochloride ................................... 126 Iron polymaltose ................................................ 23 Iron sucrose....................................................... 23 Isentress ............................................................ 81 Ismo-20 ............................................................. 44 Isoflurane ........................................................... 98 Isoniazid ............................................................ 74 Isoniazid with rifampicin ..................................... 74 Isoprenaline ....................................................... 45 Isopropyl alcohol.............................................. 188 Isoptin ............................................................... 41 Isosorbide mononitrate....................................... 44 Isosource Standard RTH .................................. 170 Isotretinoin ......................................................... 48 Ispaghula (psyllium) husk................................... 20 Isradipine ........................................................... 40 Itch-Soothe ........................................................ 48 Itraconazole ....................................................... 72 Itrazole ............................................................... 72 IVA Anamix Infant ............................................. 179 Ivermectin .......................................................... 75 J Jadelle ............................................................... 56 Jevity ............................................................... 170 Jevity HiCal RTH .............................................. 170 Jevity Plus RTH ................................................ 170 Jevity RTH ....................................................... 170 K Kaletra ............................................................... 80 Karicare Aptamil Feed Thickener ....................... 168 Karicare Aptamil Gold De-Lact .......................... 175 Karicare Aptamil Gold Pepti Junior .................... 174 Karicare Aptamil Gold + Preterm ..................... 175 Karicare Aptamil Thickened AR ......................... 175 Kenacomb ....................................................... 162 Kenacort-A......................................................... 60 Kenacort-A40..................................................... 60 Ketamine hydrochloride ...................................... 98 Ketocal 3:1 (Unflavoured)................................. 176 Ketocal 4:1 (Unflavoured)................................. 176 Ketocal 4:1 (Vanilla) ......................................... 176 Ketoconazole ............................................... 49, 71 Ketone blood beta-ketone electrodes ................ 197 Ketoprofen ......................................................... 95 Ketorolac trometamol ....................................... 162 Kindergen ........................................................ 177 Kivexa ................................................................ 78


INDEX

Klacid ................................................................ 67 Klean Prep ......................................................... 20 Kogenate FS....................................................... 28 Konakion MM..................................................... 29 Konsyl-D............................................................ 20 L L-asparaginase ................................................ 126 Labetalol ............................................................ 39 Lacosamide ..................................................... 108 Lactose............................................................ 195 Lactose-free formula ........................................ 175 Lactulose ........................................................... 21 Laevolac ............................................................ 21 Lamictal ........................................................... 109 Lamivudine .................................................. 79, 82 Lamotrigine...................................................... 109 Lansoprazole ..................................................... 16 Lantus ............................................................... 18 Lantus SoloStar ................................................. 18 Lapatinib .......................................................... 128 Latanoprost...................................................... 165 Laxofast 50 ........................................................ 20 Laxofast 120 ...................................................... 20 Lax-Sachets ....................................................... 21 Laxsol ................................................................ 20 Lax-Tabs............................................................ 21 Leflunomide ....................................................... 87 Letraccord ....................................................... 133 Letrozole .......................................................... 133 Leunase ........................................................... 126 Leuprorelin acetate ............................................. 62 Leustatin .......................................................... 124 Levetiracetam .................................................. 109 Levetiracetam-Rex ........................................... 109 Levobunolol hydrochloride ............................... 164 Levocabastine .................................................. 162 Levocarnitine ..................................................... 22 Levodopa with benserazide ................................ 97 Levodopa with carbidopa ................................... 97 Levomepromazine maleate ............................... 114 Levonorgestrel ................................................... 56 Levophed ........................................................... 45 Levosimendan ................................................... 44 Levothyroxine .................................................... 63 Lidocaine-Claris ............................................... 100 Lidocaine [Lignocaine] hydrochloride ............... 100 Lidocaine [Lignocaine] hydrochloride with adrenaline .............................................. 100 Lidocaine [Lignocaine] hydrochloride with adrenaline and tetracaine hydrochloride .. 100 Lidocaine [Lignocaine] hydrochloride with chlorhexidine ......................................... 100 Lidocaine [Lignocaine] hydrochloride with phenylephrine hydrochloride .......................... 101 Lidocaine [Lignocaine] with prilocaine .............. 101 Lignocaine ............................................... 100, 101 Lincomycin ........................................................ 70 Lindane [Gamma benzene hexachloride]............. 49 Linezolid ............................................................ 71 Lioresal Intrathecal ............................................. 93 Liothyronine sodium........................................... 63 Lipazil ................................................................ 43 Liquifilm Forte .................................................. 166 Liquifilm Tears ................................................. 166 Liquigen ........................................................... 167 Lisinopril ............................................................ 36 Lissamine green............................................... 163 Lisuride hydrogen maleate.................................. 97 Lithicarb FC ..................................................... 114 Lithium carbonate ............................................ 114 Locasol............................................................ 175 Locoid ......................................................... 51, 53 Locoid Crelo ...................................................... 51 Locoid Lipocream .............................................. 51 Lodoxamide ..................................................... 162 Logem ............................................................. 109 Lomustine........................................................ 123 Long-chain triglyceride supplement .................. 167 Loperamide hydrochloride .................................. 14 Lopinavir with ritonavir ....................................... 80 Lopresor ............................................................ 39 Loraclear Hayfever Relief.................................. 156 Lorapaed ......................................................... 156 Loratadine........................................................ 156 Lorazepam ............................................... 107, 117 Lormetazepam ................................................. 118 L-ornithine L-aspartate ....................................... 17 Losartan potassium............................................ 37 Losartan potassium with hydrochlorothiazide...... 37 Lostaar .............................................................. 37 Lovir .................................................................. 84 Low-calcium formula ....................................... 175 Low carbohydrate oral feed 1.5 kcal/ml ............ 177 Low electrolyte enteral feed 2 kcal/ml ............... 177 Low electrolyte oral feed .................................. 177 Low electrolyte oral feed 2 kcal/ml ................... 177 Low-GI enteral feed 1 kcal/ml ........................... 171 Low-GI oral feed 1 kcal/ml ............................... 171 Loxalate ........................................................... 107 Loxamine ......................................................... 107 Lucrin Depot ...................................................... 62 Lucrin Depot PDS............................................... 62 Lycinate ............................................................. 44 Lyderm .............................................................. 49 M Mabthera ......................................................... 148 Macrogol 400 and Propylene glycol.................. 166 Macrogol 3350 with ascorbic acid, 209


INDEX

potassium chloride and sodium chloride .......... 20 Macrogol 3350 with potassium chloride, sodium bicarbonate and sodium chloride......... 21 Macrogol 3350 with potassium chloride, sodium bicarbonate, sodium chloride and sodium sulphate.............................................. 20 Madopar 62.5 .................................................... 97 Madopar 125 ..................................................... 97 Madopar 250 ..................................................... 97 Madopar Dispersible .......................................... 97 Madopar HBS .................................................... 97 Mafenide acetate ................................................ 48 Magnesium hydroxide ................................ 23, 195 Magnesium sulphate .......................................... 23 Magnevist ........................................................ 191 Maize starch .................................................... 169 Malathion [Maldison] ......................................... 49 Malathion with permethrin and piperonyl butoxide ........................................... 49 Maldison ............................................................ 49 Maltodextrin with xanthan gum ......................... 169 Maltodextrin with xanthan gum and ascorbic acid ................................................ 169 m-Amoxiclav...................................................... 68 Mannitol............................................................. 42 Maprotiline hydrochloride ................................. 105 Marcain ............................................................. 99 Marcain Heavy ................................................. 100 Marcain Isobaric ................................................ 99 Marcain with Adrenaline ..................................... 99 Marine Blue Lotion SPF 30+ .............................. 53 Martindale Acetylcysteine ................................. 186 Mask for spacer device .................................... 197 Maxidex ........................................................... 162 m-Captopril ........................................................ 36 m-Cefuroxime .................................................... 66 MCT Oil ........................................................... 167 MCT Peptide .................................................... 172 MCT Peptide 1+ .............................................. 172 Measles, mumps and rubella vaccine ............... 184 Mebendazole...................................................... 75 Mebeverine hydrochloride .................................. 16 Medium-chain triglyceride supplement.............. 167 Medrol ............................................................... 60 Medroxyprogesterone......................................... 62 Medroxyprogesterone acetate....................... 56, 61 Mefenamic acid ................................................. 95 Mefloquine hydrochloride ................................... 76 Megestrol acetate............................................. 132 Meglumine gadopentate ................................... 191 Melatonin ......................................................... 118 Meloxicam ......................................................... 95 Melphalan ........................................................ 123 m-Elson ........................................................... 103 210 m-Enalapril ........................................................ 36 Menigococcal c conjugate vaccine ................... 181 Meningococcal (a, c, y and w-135) conjugate vaccine ......................................... 182 Meningococcal (a, c, y and w-135) polysaccharide vaccine ................................. 182 Menthol ........................................................... 195 Mepivacaine hydrochloride ............................... 101 Mercaptopurine ................................................ 125 Meropenem ....................................................... 65 Mesalazine ......................................................... 15 Mesna ............................................................. 131 Mestinon............................................................ 87 Metamide......................................................... 112 Metaraminol ....................................................... 45 Metformin .......................................................... 19 Methadone hydrochloride ......................... 103, 195 Methatabs ........................................................ 103 Methoblastin .................................................... 125 Methohexital sodium .......................................... 98 Methopt ........................................................... 166 Methotrexate .................................................... 125 Methotrexate Ebewe ......................................... 125 Methoxsalen [8-methoxypsoralen] ...................... 53 Methoxyflurane ................................................ 102 Methyl aminolevulinate hydrochloride ................. 54 Methylcellulose ................................................ 195 Methylcellulose with glycerin and sodium saccharin.......................................... 195 Methylcellulose with glycerin and sucrose ........ 195 Methyldopa ........................................................ 41 Methyl hydroxybenzoate ................................... 195 Methylene blue ................................................. 191 Methylphenidate hydrochloride ......................... 120 Methylprednisolone aceponate ........................... 51 Methylprednisolone acetate ................................ 60 Methylprednisolone acetate with lignocaine ........ 60 Methylprednisolone (as sodium succinate) ......... 60 Methylthioninium chloride [methylene blue] ...... 191 Metoclopramide hydrochloride ......................... 112 Metoclopramide hydrochloride with paracetamol .................................................. 111 Metolazone ........................................................ 42 Metoprolol - AFT CR........................................... 39 Metoprolol succinate .......................................... 39 Metoprolol tartrate .............................................. 39 Metronidazole .............................................. 49, 76 Metyrapone........................................................ 61 Mexiletine hydrochloride ..................................... 38 Mexiletine Hydrochloride USP ............................. 38 Miacalcic ........................................................... 59 Mianserin hydrochloride ................................... 105 Micolette ............................................................ 21 Miconazole ........................................................ 26


INDEX

Miconazole nitrate ........................................ 49, 55 Microgynon 50 ED ............................................. 55 Midazolam ....................................................... 118 Midodrine .......................................................... 39 Mifepristone ....................................................... 56 Milrinone............................................................ 46 Minidiab ............................................................. 19 Minirin ............................................................... 64 Minocycline ....................................................... 69 Minoxidil ............................................................ 46 Mirtazapine ...................................................... 106 Misoprostol........................................................ 16 Mitomycin C .................................................... 124 Mitozantrone .................................................... 124 Mitozantrone Ebewe ......................................... 124 Mivacron ........................................................... 93 Mivacurium chloride ........................................... 93 MMA/PA Anamix Infant .................................... 180 m-Mometasone.................................................. 51 Moclobemide ................................................... 106 Modafinil .......................................................... 120 Modecate......................................................... 115 Moducal .......................................................... 167 Mogine ............................................................ 109 Mometasone furoate .......................................... 51 Monogen ......................................................... 171 Monosodium glutamate with sodium aspartate . 193 Montelukast ..................................................... 158 Moroctocog alfa [recombinant factor viii] ........... 28 Morphine hydrochloride.................................... 103 Morphine sulphate............................................ 103 Morphine tartrate .............................................. 103 Motetis .............................................................. 97 Movicol.............................................................. 21 Moxifloxacin....................................................... 69 MSUD Anamix Infant ........................................ 178 MSUD Anamix Junior LQ .................................. 178 MSUD Maxamaid ............................................. 178 MSUD Maxamum ............................................. 178 MultiADE............................................................ 25 Multihance ....................................................... 190 Multivitamins ..................................................... 25 Mupirocin .......................................................... 48 Myaccord ........................................................ 153 Myambutol......................................................... 74 Mycobutin.......................................................... 75 Mycophenolate mofetil ..................................... 153 Mydriacyl ......................................................... 165 Mylan Atenolol ................................................... 39 Mylan Fentanyl Patch ....................................... 102 Mylanta.............................................................. 14 Myleran ........................................................... 123 N Nadolol .............................................................. 40 Naloxone hydrochloride .................................... 186 Naltraccord ...................................................... 121 Naltrexone hydrochloride .................................. 121 Naphazoline hydrochloride ............................... 163 Naphcon Forte ................................................. 163 Naproxen ........................................................... 95 Naropin ............................................................ 101 Natamycin ....................................................... 161 Natulan ............................................................ 127 Nausicalm........................................................ 111 Navelbine ......................................................... 132 Navoban .......................................................... 112 Nedocromil ...................................................... 159 Nefopam hydrochloride .................................... 102 Neocate ........................................................... 174 Neocate Advance ............................................. 174 Neocate Advance (Vanilla)................................ 174 Neocate Gold (Unflavoured).............................. 174 Neocate LCP .................................................... 174 Neoral .............................................................. 133 NeoRecormon .................................................... 27 Neostigmine metilsulfate .................................... 87 Neostigmine metilsulfate with glycopyrronium bromide ................................. 87 Neosynephrine HCL ........................................... 45 Neotigason ........................................................ 52 Nepro RTH ....................................................... 177 Nepro (Strawberry) .......................................... 177 Nepro (Vanilla) ................................................. 177 Neulastim .......................................................... 32 Neupogen .......................................................... 32 Nevirapine .......................................................... 78 Nevirapine Alphapharm ...................................... 78 Nicorandil .......................................................... 46 Nicorette Inhalator ............................................ 121 Nicotine ........................................................... 121 Nicotinic acid ..................................................... 44 Nifedipine........................................................... 40 Nilstat .......................................................... 26, 72 Nimodipine ........................................................ 40 Nitazoxanide ...................................................... 76 Nitrazepam....................................................... 118 Nitroderm TTS 5................................................. 44 Nitroderm TTS 10............................................... 44 Nitrofurantoin ..................................................... 71 Nitronal .............................................................. 44 Noflam 250 ........................................................ 95 Noflam 500 ........................................................ 95 Nonacog alfa [recombinant factor ix] .................. 28 Noradrenaline..................................................... 45 Norethisterone ............................................. 56, 62 Norethisterone with mestranol ............................ 55 Norfloxacin ........................................................ 69 Normison ......................................................... 119 211


INDEX

Norpress .......................................................... 105 Nortriptyline hydrochloride................................ 105 Norvir ................................................................ 80 Novasource Renal (Vanilla) .............................. 177 Novatretin .......................................................... 52 NovoMix 30 FlexPen ........................................... 18 NovoSeven RT ................................................... 28 Noxafil ............................................................... 72 Nupentin .......................................................... 108 Nutilis .............................................................. 169 Nutricia Breast Milk Fortifer............................... 168 Nutrini Energy Multi Fibre.................................. 177 Nutrini Energy RTH ........................................... 177 Nutrini Low Energy Multifibre RTH .................... 176 Nutrini RTH ...................................................... 176 Nutrison Advanced Diason ............................... 171 Nutrison Advanced Peptisorb ........................... 172 Nutrison Concentrated ...................................... 173 Nutrison Energy ............................................... 170 Nutrison Energy Multi Fibre............................... 170 Nutrison Low Sodium ....................................... 170 Nutrison Multi Fibre .......................................... 170 Nutrison Protein Plus........................................ 173 Nutrison Protein Plus Multi Fibre ....................... 173 Nutrison Standard RTH..................................... 170 Nyefax Retard .................................................... 40 Nystatin ........................................... 26, 49, 55, 72 O Octocog alfa [recombinant factor viii] ................. 28 Octreotide ........................................................ 132 Octreotide MaxRx ............................................. 132 Oestradiol .................................................... 60, 62 Oestradiol valerate.............................................. 61 Oestradiol with norethisterone acetate ................ 61 Oestriol .............................................................. 56 Oestrogens (conjugated equine) ......................... 61 Oestrogens with medroxyprogesterone acetate............................................................ 61 Oil in water emulsion .......................................... 50 Oily phenol ......................................................... 16 Olanzapine ....................................... 114, 116, 117 Olanzine ........................................................... 114 Olanzine-D ....................................................... 117 Olive oil............................................................ 195 Olopatadine ...................................................... 162 Olsalazine .......................................................... 15 Omeprazole........................................................ 17 Omezol Relief ..................................................... 17 Omnipaque ...................................................... 189 Omniscan ........................................................ 190 On Call Advanced ............................................. 197 Oncaspar ......................................................... 126 OncoTICE......................................................... 153 Ondanaccord ................................................... 112 212 Ondansetron .................................................... 112 One-Alpha .......................................................... 24 Onkotrone ........................................................ 124 Ora-Blend ........................................................ 195 Ora-Blend SF.................................................... 195 Oracort .............................................................. 26 Oral feed .......................................................... 169 Oral feed 1.5 kcal/ml ........................................ 169 Oral feed 1 kcal/ml ........................................... 169 Oral feed 2 kcal/ml ........................................... 173 Ora-Plus .......................................................... 195 Ora-Sweet........................................................ 195 Ora-Sweet SF ................................................... 195 Oratane .............................................................. 48 Ornidazole.......................................................... 76 Orphenadrine citrate ........................................... 93 Orphenadrine hydrochloride................................ 97 Oruvail SR.......................................................... 95 Oseltamivir ......................................................... 85 Osmolite .......................................................... 170 Osmolite RTH................................................... 170 Ospamox ........................................................... 68 Oxaliplatin ........................................................ 128 Oxaliplatin Actavis 50 ....................................... 128 Oxaliplatin Actavis 100 ..................................... 128 Oxandrolone....................................................... 59 Oxazepam ........................................................ 117 Oxpentifylline ..................................................... 46 Oxybuprocaine hydrochloride ........................... 163 Oxybutynin ......................................................... 58 Oxycodone hydrochloride ................................. 104 Oxycodone Orion ............................................. 104 OxyContin ........................................................ 104 Oxymetazoline hydrochloride ............................ 157 OxyNorm ......................................................... 104 Oxytocin ............................................................ 57 Oxytocin with ergometrine maleate ..................... 57 Ozole ................................................................. 72 P Pacifen .............................................................. 93 Pacific Busipirone ............................................ 117 Paclitaxel ......................................................... 131 Paclitaxel Actavis ............................................. 131 Paclitaxel Ebewe .............................................. 131 Paediatric enteral feed 0.75 kcal/ml .................. 176 Paediatric enteral feed 1.5 kcal/ml .................... 177 Paediatric enteral feed 1 kcal/ml ....................... 176 Paediatric oral feed........................................... 176 Paediatric oral feed 1.5 kcal/ml......................... 177 Paediatric oral feed 1 kcal/ml............................ 176 Pamidronate BNM .............................................. 89 Pamidronate disodium ....................................... 89 Pamisol ............................................................. 89 Panadol ........................................................... 102


INDEX

Pancreatic enzyme ............................................. 19 Pancuronium bromide ........................................ 93 Pantoprazole ...................................................... 17 Papaverine hydrochloride ................................... 46 Paper wasp venom .......................................... 155 Para-aminosalicylic acid..................................... 74 Paracare .......................................................... 102 Paracare Double Strength ................................. 102 Paracetamol..................................................... 102 Paracetamol-AFT ............................................. 102 Paracetamol + Codeine (Relieve)..................... 104 Paracetamol with codeine ................................ 104 Paraffin ................................................ 20, 50, 196 Paraffin liquid with soft white paraffin ............... 166 Paraffin liquid with wool fat .............................. 166 Paraffin with wool fat.......................................... 50 Paraldehyde ..................................................... 107 Parecoxib........................................................... 95 Paromomycin .................................................... 65 Paroxetine hydrochloride .................................. 107 Paser ................................................................. 74 Patent blue V.................................................... 191 Paxam ............................................................. 117 Pazopanib ........................................................ 129 Peak flow meter ............................................... 197 Peanut oil......................................................... 194 Pediasure (Chocolate) ...................................... 176 Pediasure RTH ................................................. 176 Pediasure (Strawberry)..................................... 176 Pediasure (Vanilla) ........................................... 176 Pegaspargase .................................................. 126 Pegfilgrastim ...................................................... 32 Pegylated interferon alpha-2a ............................. 86 Penembact......................................................... 65 Penicillamine...................................................... 87 Penicillin G ......................................................... 68 Penicillin V ......................................................... 68 Pentagastrin ....................................................... 61 Pentamidine isethionate...................................... 76 Pentasa ............................................................. 15 Pentostatin [Deoxycoformycin]......................... 127 Pentoxifylline [Oxpentifylline] .............................. 46 Peptamen Junior .............................................. 172 Peptamen OS 1.0 (Vanilla) ............................... 172 Peptide-based enteral feed 1 kcal/ml ................ 172 Peptide-based oral feed .................................... 172 Peptide-based oral feed 1 kcal/ml ..................... 172 Peptisoothe ........................................................ 16 Pergolide ........................................................... 97 Perhexiline maleate ............................................ 41 Pericyazine ...................................................... 114 Perindopril ......................................................... 36 Permax .............................................................. 97 Permethrin ......................................................... 49 Peteha ............................................................... 74 Pethidine hydrochloride .................................... 104 Pexsig................................................................ 41 Phenelzine sulphate.......................................... 105 Phenindione ....................................................... 30 Phenobarbitone ........................................ 109, 118 Phenobarbitone sodium.................................... 195 Phenol ..................................................... 192, 195 Phenol with ioxaglic acid .................................. 192 Phenoxybenzamine hydrochloride....................... 37 Phenoxymethylpenicillin [Penicillin V] ................. 68 Phentolamine mesylate ...................................... 37 Phenylephrine hydrochloride ...................... 45, 165 Phenytoin......................................................... 109 Phenytoin sodium .................................... 107, 109 Phlexy-10 ........................................................ 179 Pholcodine ....................................................... 157 Phosphorus ....................................................... 35 Phytomenadione ................................................ 29 Picibanil ........................................................... 153 PicoPrep ............................................................ 20 Pilocarpine hydrochloride ................................. 165 Pilocarpine nitrate ............................................ 196 Pimafucort ......................................................... 52 Pindolol ............................................................. 40 Pinetarsol........................................................... 52 Pinorax .............................................................. 21 Pinorax Forte ...................................................... 21 Pioglitazone ....................................................... 19 Piperacillin with tazobactam ............................... 68 Pipothiazine palmitate....................................... 116 Pizaccord........................................................... 19 Pizotifen ........................................................... 111 PKU Anamix Infant ........................................... 179 PKU Anamix Junior .......................................... 179 PKU Anamix Junior LQ (Berry).......................... 179 PKU Anamix Junior LQ (Orange) ....................... 179 PKU Anamix Junior LQ (Unflavoured) ............... 179 PKU Lophlex LQ 10 .......................................... 179 PKU Lophlex LQ 20 .......................................... 179 Plaquenil ............................................................ 87 Plendil ER .......................................................... 40 pms-Bosentan ................................................... 46 Pneumococcal conjugate (pcv13) vaccine........ 182 Pneumococcal (pcv10) conjugate vaccine........ 182 Pneumococcal (ppv23) polysaccharide vaccine ......................................................... 182 Podophyllotoxin ................................................. 53 Polidocanol ........................................................ 28 Poliomyelitis vaccine ........................................ 184 Poloxamer ......................................................... 20 Polycal............................................................. 167 Poly Gel ........................................................... 166 Polyhexamethylene biguanide ........................... 196 213


INDEX

Poly-Tears ....................................................... 166 Polyvinyl alcohol .............................................. 166 Polyvinyl alcohol with povidone ........................ 166 Poractant alfa ................................................... 160 Posaconazole .................................................... 72 Postinor-1.......................................................... 56 Potassium chloride ...................................... 33, 35 Potassium chloride with sodium chloride ............ 34 Potassium citrate ............................................... 57 Potassium dihydrogen phosphate ....................... 34 Potassium iodate ............................................... 22 Potassium iodate with iodine .............................. 22 Potassium perchlorate........................................ 63 Potassium permanganate ................................... 53 Povidone-iodine ............................................... 188 Povidone-iodine with ethanol ............................ 188 Povidone K30 .................................................. 196 Pradaxa ............................................................. 29 Pralidoxime iodide ............................................ 186 Pramipexole hydrochloride ................................. 98 Prasugrel ........................................................... 31 Pravastatin ......................................................... 43 Praziquantel ....................................................... 75 Prazosin............................................................. 37 Prednisone......................................................... 60 Prednisolone ...................................................... 60 Prednisolone acetate ........................................ 162 Prednisolone sodium phosphate ....................... 162 Pregnancy test – hCG urine .............................. 198 Pre Nan Gold RTF............................................. 175 Preterm formula ............................................... 175 Prezista.............................................................. 80 Prilocaine hydrochloride ................................... 101 Prilocaine hydrochloride with felypressin .......... 101 Primaquine phosphate ........................................ 76 Primaxin ............................................................ 65 Primidone ........................................................ 109 Primolut N.......................................................... 62 Probenecid ........................................................ 93 Procaine penicillin .............................................. 68 Procarbazine hydrochloride .............................. 127 Prochlorperazine .............................................. 112 Proctosedyl........................................................ 15 Procyclidine hydrochloride ................................. 97 Prodopa ............................................................. 41 Progesterone ..................................................... 57 Proglicem .......................................................... 17 Prograf ............................................................ 134 Prokinex........................................................... 111 Promethazine hydrochloride ............................. 156 Promethazine theoclate .................................... 112 Promod............................................................ 168 Propafenone hydrochloride ................................. 38 Propamidine isethionate ................................... 161 214 Propofol ............................................................. 99 Propranolol ........................................................ 40 Propylene glycol .............................................. 196 Propylthiouracil .................................................. 63 Prostin E2 .......................................................... 56 Prostin VR ......................................................... 45 Protamine sulphate ............................................ 30 Protein supplement .......................................... 168 Protifar............................................................. 168 Protionamide...................................................... 74 Protirelin ............................................................ 63 Provera ........................................................ 61, 62 Provisc ............................................................ 164 Provive MCT-LCT 1% ......................................... 99 Pseudophedrine hydrochloride ......................... 157 PTU ................................................................... 63 Pulmocare (Vanilla) .......................................... 177 Pulmozyme ...................................................... 160 Purinethol ........................................................ 125 Pyrazinamide ..................................................... 74 Pyridostigmine bromide...................................... 87 PyridoxADE ........................................................ 24 Pyridoxine hydrochloride .................................... 24 Pyrimethamine ................................................... 76 Pytazen SR ........................................................ 31 Q Q 300 ................................................................ 77 Quetapel .......................................................... 114 Quetiapine........................................................ 114 Quinapril ............................................................ 36 Quinapril with hydrochlorothiazide ...................... 37 Quinine dihydrochloride ...................................... 76 Quinine sulphate ................................................ 77 R Rabies vaccine................................................. 184 Raloxifene .......................................................... 91 Raltegravir potassium......................................... 81 RA-Morph ........................................................ 103 Ranbaxy-Cefaclor............................................... 66 Ranibizumab .................................................... 148 Ranitidine........................................................... 16 Rapamune ....................................................... 154 Rasburicase ....................................................... 93 Reandron 1000 .................................................. 59 Recombinant factor ix ........................................ 28 Recombinant factor viia...................................... 28 Recombinant factor viii....................................... 28 Rectogesic......................................................... 16 Red back spider antivenom .............................. 187 Redipred ............................................................ 60 Remicade ........................................................ 143 Remifentanil-AFT.............................................. 104 Remifentanil hydrochloride ............................... 104 Renilon 7.5 ...................................................... 177


INDEX

ReoPro ............................................................ 138 Resource Beneprotein ...................................... 168 Resource Diabetic (Vanilla) .............................. 171 Resource Fruit Beverage................................... 169 Resource Thicken Up ....................................... 169 Retinol ............................................................... 23 Retinol palmitate .............................................. 166 Retrovir .............................................................. 79 Reyataz.............................................................. 80 Ridal ................................................................ 114 Rifabutin ............................................................ 75 Rifampicin ......................................................... 75 Ringer’s solution ................................................ 34 Riodine ............................................................ 188 Risperdal ......................................................... 114 Risperdal Consta .............................................. 116 Risperdal Quicklet ............................................ 117 Risperidone...................................... 114, 116, 117 Risperon .......................................................... 115 Ritalin .............................................................. 120 Ritalin LA ......................................................... 120 Ritalin SR ......................................................... 120 Ritonavir ............................................................ 80 Rituximab ........................................................ 148 Rivaroxaban ....................................................... 30 Rivotril ............................................................. 107 Rizamelt........................................................... 111 Rizatriptan benzoate ......................................... 111 Rocaltrol ............................................................ 24 Rocuronium bromide ......................................... 93 Ropin ................................................................. 98 Ropinirole hydrochloride..................................... 98 Ropivacaine hydrochloride ............................... 101 Ropivacaine hydrochloride with fentanyl ........... 101 Rose bengal sodium ........................................ 163 Roxithromycin.................................................... 67 Rubifen ............................................................ 120 Rubifen SR ...................................................... 120 S S-26 Gold Premgro .......................................... 175 S26 Human Milk Fortifier .................................. 168 S26 Lactose Free ............................................. 175 S26 LBW Gold RTF .......................................... 175 Salamol ........................................................... 157 Salapin ............................................................ 157 Salazopyrin ........................................................ 15 Salazopyrin EN ................................................... 15 Salbutamol....................................................... 157 Salbutamol with ipratropium bromide................ 157 Salicylic acid .................................................... 196 Salmeterol ....................................................... 159 Salmonella typhi vaccine .................................. 182 Sandimmun ..................................................... 133 Sandomigran ................................................... 111 Sandostatin LAR .............................................. 132 Scopoderm TTS ............................................... 112 Sebizole ............................................................. 49 Secretin pentahydrochloride ....................... 62, 191 Selegiline hydrochloride ..................................... 98 Sennosides ........................................................ 21 Serenace ......................................................... 113 Seretide ........................................................... 159 Seretide Accuhaler ........................................... 159 Serevent .......................................................... 159 Serevent Accuhaler .......................................... 159 Serophene ......................................................... 61 Seroquel .......................................................... 114 Setraline .......................................................... 107 Sevoflurane ........................................................ 99 Sevredol .......................................................... 103 Silagra ............................................................... 47 Sildenafil ............................................................ 47 Silver nitrate ............................................... 53, 196 Simethicone ....................................................... 14 Simulect .......................................................... 143 Simvastatin ........................................................ 43 Sinemet ............................................................. 97 Sinemet CR........................................................ 97 Singulair .......................................................... 158 Sirolimus ......................................................... 154 Siterone ............................................................. 59 Slow-Lopresor ................................................... 39 Snake antivenom.............................................. 187 Sodibic .............................................................. 35 Sodium acetate .................................................. 34 sodium acid phosphate ...................................... 34 Sodium alginate with magnesium alginate........... 14 Sodium alginate with sodium bicarbonate and calcium carbonate .................................... 14 Sodium aurothiomalate ...................................... 87 Sodium benzoate ............................................... 22 Sodium bicarbonate ............................. 34, 35, 196 Sodium calcium edetate ................................... 187 Sodium carboxymethylcellulose with pectin and gelatine .................................................... 26 Sodium chloride ................... 34, 35, 157, 160, 192 Sodium chloride with sodium bicarbonate......... 157 Sodium citrate............................................ 14, 196 Sodium citrate with sodium chloride and potassium chloride ................................... 30 Sodium citrate with sodium lauryl sulphoacetate.................................................. 21 Sodium citro-tartrate .......................................... 58 Sodium cromoglycate ................ 15, 155, 159, 162 Sodium dihydrogen phosphate [sodium acid phosphate]................................. 34 Sodium fluoride .................................................. 22 Sodium hyaluronate ................................... 166, 26 215


INDEX

Sodium hyaluronate with chondroitin sulphate .. 164 Sodium hypochlorite ........................................ 188 Sodium metabisulfite ........................................ 196 Sodium nitrite................................................... 186 Sodium nitroprusside ................................. 46, 198 Sodium phenylbutyrate ....................................... 22 Sodium phosphate with phosphoric acid ............ 21 Sodium polystryrene sulphonate ......................... 35 Sodium stibogluconate ....................................... 77 Sodium tetradecyl sulphate ................................ 28 Sodium thiosulfate ........................................... 186 Sodium valproate ............................................. 109 Sodium with potassium .................................... 193 Solian .............................................................. 113 Solifenacin succinate ......................................... 58 Solox ................................................................. 16 Solu-Cortef ........................................................ 60 Solu-Medrol ....................................................... 60 Somatropin ........................................................ 63 Sotacor .............................................................. 40 Sotalol ............................................................... 40 Soya oil ........................................................... 186 Space Chamber Plus ........................................ 198 Spacer device .................................................. 198 Span-K .............................................................. 35 Spiramycin ........................................................ 77 Spiriva ............................................................. 156 Spironolactone ................................................... 42 Spirotone ........................................................... 42 Sprycel ............................................................ 128 Staphlex ............................................................. 68 Starch .............................................................. 196 Stavudine ........................................................... 79 Sterculia with frangula ........................................ 20 Stesolid ........................................................... 107 Stiripentol ........................................................ 110 Stocrin ............................................................... 77 Streptase ........................................................... 31 Streptokinase ..................................................... 31 Streptomycin sulphate........................................ 65 Stromectol ......................................................... 75 Suboxone ........................................................ 121 Sucralfate .......................................................... 17 Sucrose ........................................................... 102 Sugammadex ..................................................... 94 Sulindac............................................................. 95 Sulphacetamide sodium ................................... 161 Sulphadiazine ..................................................... 71 Sulphadiazine silver ............................................ 48 Sulphasalazine ................................................... 15 Sulphur ............................................................ 196 Sumatriptan ..................................................... 111 Sunitinib .......................................................... 130 Sunscreen, proprietary ....................................... 53 216 Super Soluble Duocal ....................................... 168 Suplena ........................................................... 177 Suprane ............................................................. 98 Surgam .............................................................. 95 Survanta .......................................................... 160 Sustagen Hospital Formula (Chocolate) ............ 169 Sustagen Hospital Formula (Vanilla) ................. 169 Sutent .............................................................. 130 Suxamethonium chloride .................................... 93 Symmetrel ......................................................... 97 Synacthen.......................................................... 62 Synacthen Depot ................................................ 62 Syntocinon......................................................... 57 Syntometrine...................................................... 57 Syrup ............................................................... 196 Systane Unit Dose ............................................ 166 T Tacrolimus....................................................... 134 Talc ................................................................. 160 Tambocor .......................................................... 38 Tambocor CR .................................................... 38 Tamoxifen citrate.............................................. 133 Tamsulosin ........................................................ 57 Tamsulosin-Rex ................................................. 57 Tarceva............................................................ 128 Tasmar .............................................................. 98 Tazocin EF ......................................................... 68 Teicoplanin ........................................................ 71 Temaccord ...................................................... 127 Temazepam ..................................................... 119 Temozolomide ................................................. 127 Tenecteplase...................................................... 31 Tenofovir disoproxil fumarate ............................. 83 Tenoxicam ......................................................... 95 Terazosin ........................................................... 38 Terbinafine ......................................................... 73 Terbutaline ......................................................... 57 Terbutaline sulphate ......................................... 157 Teriparatide ........................................................ 92 Terlipressin ........................................................ 64 Testosterone ...................................................... 59 Testosterone cypionate ...................................... 59 Testosterone esters ............................................ 59 Testosterone undecanoate.................................. 59 Tetrabenazine..................................................... 97 Tetracaine [amethocaine] hydrochloride ... 101, 163 Tetracosactide [tetracosactrin] ........................... 62 Tetracosactrin .................................................... 62 Tetracycline ....................................................... 70 Tetracyclin Wolff ................................................ 70 Thalidomide ..................................................... 127 Thalomid.......................................................... 127 Theophylline .................................................... 160 Thiamine hydrochloride ...................................... 24


INDEX

Thickened formula............................................ 175 Thioguanine ..................................................... 125 Thiopental (thiopentone) sodium ........................ 99 Thiotepa........................................................... 123 Thrombin ........................................................... 28 Thymol glycerin ................................................. 26 Thyrotropin alfa .................................................. 62 Tiaprofenic acid ................................................. 95 Ticarcillin with clavulanic acid ............................ 69 Ticlopidine ......................................................... 31 Tigecycline ........................................................ 70 Timolol ............................................................ 164 Timolol maleate.................................................. 40 Timoptol XE ..................................................... 164 Tiotropium bromide .......................................... 156 TMP................................................................... 71 Tobramycin................................................ 65, 161 Tobrex ............................................................. 161 Tocilizumab ..................................................... 151 Tofranil ............................................................ 105 Tolcapone .......................................................... 98 Tolterodine tartrate ............................................. 58 Topamax.......................................................... 110 Topiramate....................................................... 110 Tracleer ............................................................. 46 Tracrium ............................................................ 93 Tramadol hydrochloride.................................... 104 Tramal 50 ........................................................ 104 Tramal 100 ...................................................... 104 Tramal SR 100................................................. 104 Tramal SR 150................................................. 104 Tramal SR 200................................................. 104 Trandolapril ........................................................ 36 Tranexamic acid ................................................. 28 Tranylcypromine sulphate ................................ 105 Trastuzumab .................................................... 152 Travoprost ....................................................... 165 Tretinoin .................................................... 48, 127 Triamcinolone acetonide ........................ 26, 52, 60 Triamcinolone acetonide with gramicidin, neomycin and nystatin .................................. 162 Triamcinolone acetonide with neomycin sulphate, gramicidin and nystatin..................... 52 Triamcinolone hexacetonide ............................... 60 Triazolam ......................................................... 119 Trichloracetic acid ............................................ 196 Trichozole .......................................................... 76 Trientine dihydrochloride .................................... 22 Trifluoperazine hydrochloride ............................ 115 Trimeprazine tartrate ........................................ 156 Trimethoprim ..................................................... 71 Trimethoprim with sulphamethoxazole [Co-trimoxazole] ............................................. 71 Tri-sodium citrate ............................................. 196 Trisodium citrate ................................................ 30 Trometamol ..................................................... 192 Tropicamide ..................................................... 165 Tropisetron ...................................................... 112 Truvada ............................................................. 79 Tuberculin, purified protein derivative ................ 191 TwoCal HN....................................................... 173 TwoCal HN RTH (Vanilla) ................................. 173 Tykerb ............................................................. 128 TYR Anamix Infant............................................ 180 TYR Anamix Junior ........................................... 180 TYR Anamix Junior LQ ..................................... 180 U Ultraproct ........................................................... 16 Univent ............................................................ 156 Ural.................................................................... 58 Urea........................................................... 50, 196 Urex Forte .......................................................... 41 Urokinase .......................................................... 32 Uromitexan ...................................................... 131 Ursodeoxycholic acid ......................................... 19 Ursosan ............................................................. 19 V Valaciclovir ........................................................ 84 Valcyte............................................................... 85 Valganciclovir .................................................... 85 Valtrex ............................................................... 84 Vancomycin ....................................................... 71 Varenicline ....................................................... 122 Varicella zoster vaccine .................................... 184 Vasopressin ....................................................... 64 Vecuronium bromide .......................................... 93 Velcade............................................................ 125 Venlafaxine ...................................................... 106 Venofer .............................................................. 23 Ventavis ............................................................. 47 Ventolin ........................................................... 157 Vepesid............................................................ 126 Veracol .............................................................. 66 Verapamil hydrochloride ..................................... 41 Vergo 16 .......................................................... 111 Verpamil SR ....................................................... 41 Vesanoid.......................................................... 127 Vesicare............................................................. 58 Vfend ................................................................. 73 Vigabatrin ........................................................ 110 Vimpat ............................................................. 108 Vinblastine sulphate ......................................... 132 Vincristine sulphate .......................................... 132 Vinorelbine ....................................................... 132 Viramune Suspension ........................................ 78 Viread ................................................................ 83 Visipaque ......................................................... 189 Vistil ................................................................ 166 217


INDEX

Vistil Forte ........................................................ 166 Vitabdeck ........................................................... 25 Vitala-C .............................................................. 24 Vital HN ........................................................... 172 Vitamin B complex ............................................. 24 VitA-POS.......................................................... 166 Vivonex Paediatric ............................................ 174 Vivonex TEN..................................................... 172 Volibris .............................................................. 46 Voltaren ............................................................. 94 Voltaren Ophtha ............................................... 162 Volulyte 6% ........................................................ 35 Volumatic ........................................................ 198 Voluven.............................................................. 35 Voriconazole ...................................................... 73 Votrient ............................................................ 129 W Walnut oil......................................................... 167 Warfarin sodium................................................. 30 Water ......................................................... 35, 192 Wool fat ..................................................... 50, 196 X Xanthan ........................................................... 196 Xarelto ............................................................... 30 Xeloda ............................................................. 124 XLEU Maxamaid ............................................... 179 XLEU Maxamum .............................................. 179 XLYS Low TRY Maxamaid ................................ 179 XMET Maxamaid .............................................. 178 XMET Maxamum .............................................. 178 XMTVI Maxamaid ............................................. 180 XMTVI Maxamum ............................................. 180 XPHEN, TYR Maxamaid .................................... 180 XP Maxamaid ................................................... 179 XP Maxamum .................................................. 179 Xylocaine ......................................................... 100 Xylocaine Viscous ............................................ 100 Xylometazoline hydrochloride ........................... 157 Xyntha ............................................................... 28 Y Yellow jacket wasp venom ............................... 155 Z Zantac................................................................ 16 Zapril ................................................................. 36 Zarator ............................................................... 43 Zarzio................................................................. 32 Zavedos ........................................................... 124 Zeldox .............................................................. 115 Zetlam ............................................................... 82 Zetop ............................................................... 155 Ziagen................................................................ 78 Zidovudine [AZT] ................................................ 79 Zidovudine [AZT] with lamivudine ....................... 79 Zinc ............................................................. 23, 49 Zincaps .............................................................. 23 Zinc chloride ...................................................... 23 Zinc oxide ........................................................ 196 Zinc sulphate...................................................... 23 Zinc with castor oil ............................................. 50 Zinc with wool fat ............................................... 50 Zinnat ................................................................ 66 Ziprasidone ...................................................... 115 Zithromax........................................................... 67 Zofran Zydis ..................................................... 112 Zoladex .............................................................. 62 Zoledronic acid ............................................ 59, 90 Zometa .............................................................. 59 Zopiclone ......................................................... 119 Zostrix................................................................ 96 Zostrix HP ........................................................ 101 Zovirax IV ........................................................... 84 Zuclopenthixol acetate ...................................... 115 Zuclopenthixol decanoate ................................. 116 Zuclopenthixol hydrochloride ............................ 115 Zyban .............................................................. 121 Zyprexa Relprevv .............................................. 116

218


Hospital Medicines List queries: Freephone Information line 0800 66 00 50 Fax: 64 4 974 7819 Email: HML@pharmac.govt.nz

Pharmaceutical Management Agency Level 9, 40 Mercer Street, PO Box 10-254, Wellington 6143, New Zealand Phone: 64 4 460 4990 - Fax: 64 4 460 4995 - www.pharmac.govt.nz Freephone Information line (9am-5pm weekdays) 0800 66 00 50

ISSN 1172-3694 (Print) - ISSN 1179-3708 (Online) While care has been taken in compiling this Update, Pharmaceutical Management Agency takes no responsibility for any errors or omissions and shall not be liable to any person for any damages or loss arising out of reliance by that person for any purpose on any of the contents of this Update. Errors and omissions brought to the attention of Pharmaceutical Management Agency will be corrected if necessary by an erratum or otherwise in the next edition of the Update.

If Undelivered, Return To: PO Box 10-254, Wellington 6143, New Zealand

Metadata

Title

Hospital Medicines List - effective 1 July 2013

Abstract

Section H for Hospital Pharmaceuticals The Hospital Medicines List (HML) First edition effective 1 July 2013 New Zealand Pharmaceutical Schedule Guide to Section H listings ANATOMICAL HEADING Price (ex man. Excl. GST) $ Per Brand or Generic Manufacturer Generic name…

Page 1

icon

Note

This text has been extracted from the source PDF document.

Also available as plain text.

Please contact webmaster to discuss alternative format options.