Pharmaceutical Schedule New Zealand November 2009 16 2 2009-11-01
Community Pharmaceuticals Alimentary Tract and Metabolism Antacids and Antiflatulants Antacids and Reflux Barrier Agents Alginic acid Sodium alginate 225 mg and magnesium alginate 87.5 mg per sachet Gaviscon Infant 30 4.50 4.50 4.50 0.00000 Simethicone Oral liq aluminium hydroxide 200 mg with magnesium hydroxide 200 mg and activated simethicone 20 mg per 5 ml Mylanta P 500 1.50 4.26 1.50 0.00552 Calcium carbonate with aminoacetic acid Tab 420 mg with aminoacetic acid 180 mg Titralac 100 3.00 6.30 6.30 0.03300 1000 30.00 38.73 38.73 0.00873

Additional subsidy by endorsement is available for pregnant women. The prescription must be endorsed accordingly.

 Sodium alginate Oral liq 500 mg with sodium bicarbonate 267 mg per 10 ml (aniseed) Gaviscon 500 1.50 8.64 1.50 0.01428 Oral liq 500 mg with sodium bicarbonate 267 mg and calcium carbonate 160 mg per 10 ml Acidex 500 1.50 4.95 1.50 0.00690 Tab 500 mg with sodium bicarbonate 267 mg and calcium carbonate 160 mg - peppermint flavour Gaviscon Double Strength 60 1.80 8.60 1.80 0.11333 Phosphate Binding Agents Aluminium hydroxide Tab 600 mg Alu-Tab 100 12.56 12.56 12.56 0.00000 Antidiarrhoeals Agents Which Reduce Motility Diphenoxylate hydrochloride with atropine sulphate Tab 2.5 mg with atropine sulphate 25 mcg Diastop 100 3.90 3.90 3.90 0.00000 Loperamide hydrochloride Tab 2 mg Nodia 400 11.50 11.50 11.50 0.00000 Rectal and Colonic Anti-inflammatories Budesonide Cap 3 mg Entocort CIR 90 166.50 166.50 166.50 0.00000 <range>Budesonide – Cap 3 mg Controlled Release</range> Mild to moderate ileal, ileocaecal or proximal Crohn’s disease Diabetes Cushingoid habitus Osteoporosis where there is significant risk of fracture Severe acne following treatment with conventional corticosteroid therapy any relevant practitioner 3 The treatment remains appropriate and the patient is benefiting from treatment any relevant practitioner 3 1 2

Clinical trials for Entocort CIR use beyond three months demonstrated no improvement in relapse rate.

 Hydrocortisone acetate Rectal foam 10 %, CFC-Free (14 applications) Colifoam 21.1 23.00 23.00 23.00 0.00000 Sodium cromoglycate Cap 100 mg Nalcrom 100 89.21 89.21 89.21 0.00000 Sulphasalazine Tab 500 mg Salazopyrin 100 8.42 8.42 8.42 0.00000 Tab EC 500 mg Salazopyrin EN 100 9.44 9.44 9.44 0.00000 Olsalazine Cap 250 mg Dipentum 100 31.51 31.51 31.51 0.00000 Tab 500 mg Dipentum 100 59.86 59.86 59.86 0.00000 Mesalazine Tab long-acting 500 mg Pentasa 100 59.05 59.05 59.05 0.00000 Enema 1 g per 100 ml Pentasa 7 45.96 45.96 45.96 0.00000 Tab 400 mg Asacol 100 49.50 49.50 49.50 0.00000 Suppos 500 mg Asacol 20 25.20 25.20 25.20 0.00000 Suppos 1 g Pentasa 28 50.96 50.96 50.96 0.00000 Antihaemorrhoidals Corticosteroids Fluocortolone caproate with fluocortolone pivalate and cinchocaine Suppos 630 mcg, with fluocortolone pivalate 610 mcg, and cinchocaine hydrochloride 1 mg Ultraproct 12 2.66 2.66 2.66 0.00000 Oint 950 mcg, with fluocortolone pivalate 920 mcg, and cinchocaine hydrochloride 5 mg per g Ultraproct 30 6.35 6.35 6.35 0.00000 Soothing Agents Zinc oxide Oint zinc oxide with balsam peru Anusol 50 4.50 6.67 4.50 0.04340 Suppos zinc oxide with balsam peru Anusol 12 4.47 6.49 4.47 0.16833 Antispasmodics and Other Agents Altering Gut Motility Antispasmodics and Other Agents Altering Gut Motility Atropine sulphate Inj 600 mcg, 1 ml AstraZeneca 50 1 52.00 52.00 52.00 0.00000 Inj 1200 mcg, 1 ml AstraZeneca 50 1 32.00 32.00 32.00 0.00000 Hyoscine N-butylbromide Tab 10 mg Gastrosoothe 20 1.62 1.62 1.62 0.00000 Inj 20 mg, 1 ml Buscopan 5 1 8.04 8.04 8.04 0.00000 Mebeverine hydrochloride Tab 135 mg Colofac 90 18.00 18.00 18.00 0.00000 Antiulcerants Antisecretory and Cytoprotective Misoprostol Tab 200 mcg Cytotec 120 52.70 52.70 52.70 0.00000 Helicobacter Pylori Eradication Omeprazole, amoxycillin and clarithromycin Omeprazole cap 20 mg x 14, amoxycillin cap 500 mg x 28 and clarithromycin tab 500 mg x 14 Losec Hp7 OAC 1 55.00 55.00 55.00 0.00000 Clarithromycin Tab 500 mg Klamycin 14 23.30 23.30 23.30 0.00000

Subsidised only if prescribed for helicobacter pylori eradication and prescription is endorsed accordingly.

Note: the prescription is considered endorsed if clarithromycin is prescribed in conjunction with a proton pump inhibitor and either amoxycillin or metronidazole.

 H2 Antagonists Cimetidine Tab 200 mg Apo-Cimetidine 100 5.00 7.50 5.00 0.02500 Tab 400 mg Apo-Cimetidine 100 10.00 12.00 10.00 0.02000 Ranitidine hydrochloride Oral liq 150 mg per 10 ml Peptisoothe 300 7.95 7.95 7.95 0.00000 Inj 25 mg per ml, 2 ml Zantac 5 1 8.75 8.75 8.75 0.00000 Tab 150 mg Arrow-Ranitidine 250 7.99 7.99 7.99 0.00000 Tab 300 mg Arrow-Ranitidine 250 10.94 10.94 10.94 0.00000 Famotidine Tab 20 mg Famox 250 8.10 8.10 8.10 0.00000 Tab 40 mg Famox 250 11.35 11.35 11.35 0.00000 Proton Pump Inhibitors Lansoprazole Cap 30 mg Solox 28 4.65 4.65 4.65 0.00000 Cap 15 mg Solox 28 3.50 3.50 3.50 0.00000 Pantoprazole Tab 40 mg Dr Reddy's Pantoprazole 28 3.36 3.36 3.36 0.00000 Tab 20 mg Dr Reddy's Pantoprazole 28 2.24 2.24 2.24 0.00000 Inj 40 mg Pantocid IV 1 8.75 8.75 8.75 0.00000 Omeprazole Cap 20 mg Dr Reddy's Omeprazole 28 2.85 2.85 2.85 0.00000 30 3.05 3.05 3.05 0.00000 Inj 40 mg Dr Reddy's Omeprazole 5 38.20 38.20 38.20 0.00000 Cap 10 mg Dr Reddy's Omeprazole 28 2.00 2.00 2.00 0.00000 30 2.14 2.14 2.14 0.00000 Cap 40 mg Dr Reddy's Omeprazole 28 3.35 3.35 3.35 0.00000 30 3.59 3.59 3.59 0.00000

For omeprazole suspension refer

 Site Protective Agents Sucralfate Tab 1 g Carafate 120 35.50 48.28 35.50 0.10650 Diabetes Hyperglycaemic Agents Glucagon hydrochloride Inj 1 mg syringe kit Glucagen Hypokit 1 27.00 27.00 27.00 0.00000 Insulin - Short-acting Preparations Insulin neutral Inj human 100 u per ml Actrapid 10 25.26 25.26 25.26 0.00000 Humulin R 10 25.26 25.26 25.26 0.00000 Inj human 100 u per ml, 3 ml Actrapid Penfill 5 1 42.66 42.66 42.66 0.00000 Humulin R 5 1 42.66 42.66 42.66 0.00000 Insulin - Intermediate-acting Preparations Insulin isophane Inj human 100 u per ml, 3 ml Protaphane Penfill 5 1 29.86 29.86 29.86 0.00000 Humulin NPH 5 1 29.86 29.86 29.86 0.00000 Inj human 100 u per ml Protaphane 10 17.68 17.68 17.68 0.00000 10 17.68 17.68 17.68 0.00000 Humulin NPH 10 17.68 17.68 17.68 0.00000 Insulin lispro with insulin lispro protamine Inj lispro 25% with insulin lispro protamine 75% 100 u per ml, 3 ml Humalog Mix 25 5 52.15 52.15 52.15 0.00000 Inj lispro 50% with insulin lispro protamine 50% 100 u per ml,3 ml Humalog Mix 50 5 52.15 52.15 52.15 0.00000 Insulin isophane with insulin neutral Inj human with neutral insulin 100 u per ml, 3 ml PenMix 30 5 1 42.66 42.66 42.66 0.00000 PenMix 40 5 1 42.66 42.66 42.66 0.00000 PenMix 50 5 1 42.66 42.66 42.66 0.00000 Humulin 30/70 5 1 42.66 42.66 42.66 0.00000 Inj human with neutral insulin 100 u per ml Mixtard 30 10 25.26 25.26 25.26 0.00000 Humulin 30/70 10 25.26 25.26 25.26 0.00000 Insulin - Long-acting Preparations Insulin glargine Inj 100 u per ml, 3 ml Lantus 5 1 94.50 94.50 94.50 0.00000 Inj 100 u per ml, 10 ml Lantus 1 1 63.00 63.00 63.00 0.00000 Inj 100 u per ml, 3 ml disposable pen Lantus SoloStar 5 1 94.50 94.50 94.50 0.00000 <range>Insulin Glargine</range> Patient has type 1 diabetes and has received an intensive regimen (injections at least three times a day) of an intermediate acting insulin in combination with a rapid acting insulin analogue for at least three months Patient has experienced more than one unexplained severe hypoglycaemic episode in the previous 12 months (severe defined as requiring the assistance of another person) Patient has experienced unexplained symptomatic nocturnal hypoglycaemia, biochemically documented at <3.0 mmol/L, more than once a month despite optimal management Patient has documented severe, or continuing, systemic or local allergic reaction to existing insulins. Note this does not include hypoglycaemic episodes relevant specialist 1 Patient is continuing to derive benefit due to reduced hypoglycaemic events whilst maintaining similar or better glycaemic control Patient’s allergic reaction has significantly decreased, or resolved, following the change to long-acting insulin and patient is continuing to benefit from treatment relevant specialist general practitioner 1 Insulin - Rapid Acting Preparations Insulin lispro Inj 100 u per ml, 3 ml Humalog 5 1 59.52 59.52 59.52 0.00000 Inj 100 u per ml, 10 ml Humalog 10 34.92 34.92 34.92 0.00000 Insulin aspart Inj 100 u per ml, 3 ml NovoRapid Penfill 5 1 51.19 51.19 51.19 0.00000 Inj 100 u per ml, 10 ml NovoRapid 1 1 30.03 30.03 30.03 0.00000 Alpha Glucosidase Inhibitors Acarbose Tab 50 mg Glucobay 90 16.50 16.50 16.50 0.00000 Tab 100 mg Glucobay 90 26.70 26.70 26.70 0.00000 <range>Acarbose</range> The patient has type 2 diabetes Metformin is not tolerated, or is contraindicated The patient has not responded to the maximum appropriate dose of metformin any relevant practitioner Oral Hypoglycaemic Agents Glibenclamide Tab 2.5 mg Gliben 100 3.78 3.78 3.78 0.00000 Tab 5 mg Gliben 100 3.31 3.31 3.31 0.00000 Daonil 100 5.00 5.00 5.00 0.00000 Gliclazide Tab 80 mg Apo-Gliclazide 500 22.24 22.24 22.24 0.00000 Glipizide Tab 5 mg Minidiab 100 3.50 3.50 3.50 0.00000 Metformin hydrochloride Tab immediate-release 500 mg Arrow-Metformin 500 9.75 9.75 9.75 0.00000 Apotex 500 8.09 8.09 8.09 0.00000 Tab immediate-release 850 mg Arrow-Metformin 250 8.00 8.00 8.00 0.00000 Apotex 250 6.67 6.67 6.67 0.00000 Pioglitazone Tab 15 mg Actos 28 2.61 45.78 2.61 1.54179 Pizaccord 28 2.61 2.61 2.61 0.00000 Tab 30 mg Actos 28 5.23 70.43 5.23 2.32857 Pizaccord 28 5.23 5.23 5.23 0.00000 Tab 45 mg Actos 28 7.80 89.39 7.80 2.91393 Pizaccord 28 7.80 7.80 7.80 0.00000 <range>Pioglitazone</range> Patient has not achieved glycaemic control on maximum doses of metformin and/or a sulphonylurea or where either or both are contraindicated or not tolerated Patient is on insulin any relevant practitioner Diabetes Management Glucose/Urine Testing Copper Tab, diagnostic Clinitest 36 5.02 31.80 5.02 0.74389 Glucose oxidase Urine diagnostic test with peroxidase Clinistix 50 4.13 8.65 4.13 0.09040 Diastix 50 4.11 6.26 4.11 0.04300 Urine diagnostic test Diabur 5000 50 4.11 7.00 4.11 0.05780 Ketone Testing Glucose oxidase Urine diagnostic test with peroxidase, potassium iodide, sodium nitroprusside and aminoacetic acid Keto-Diastix 50 4.53 14.87 4.53 0.20680 Urine diagnostic test with peroxidase, sodium nitroprusside and aminoacetic acid Keto-Diabur 5000 50 4.53 8.00 4.53 0.06940 Sodium nitroprusside Urine diagnostic strips, buffered Ketur-Test 50 3.39 6.00 3.39 0.05220 Ketostix 50 3.40 10.94 3.40 0.15080 Test strip Ketostix 20 14.14 14.14 14.14 0.00000 Ketone blood beta-ketone electrodes Test strip Optium Blood Ketone Test Strips 10 8.50 8.50 8.50 0.00000

Patient has type 1 diabetes and has had one or more episodes of ketoacidosis (excluding first presentation). Maximum quantity of 2 packs per annum. No further prescriptions will be subsidised. The prescription must be endorsed accordingly.

 Blood Glucose Testing Blood glucose diagnostic test strip Blood glucose test strips Accu-Chek Performa 50 21.65 21.65 21.65 0.00000 Optium 5 second test 50 21.65 21.65 21.65 0.00000 25 10.82 10.82 10.82 0.00000 SensoCard 50 26.20 26.20 26.20 0.00000 FreeStyle Lite 50 21.65 21.65 21.65 0.00000 Blood glucose test strips x 50 and lancets x 5 CareSens 1 19.60 19.60 19.60 0.00000

The number of test strips available on a prescription is restricted to 50 unless:

  1. Prescribed with insulin or a sulphonylurea but are on a different prescription and the prescription is endorsed accordingly; or

  2. Prescribed on the same prescription as insulin or a sulphonylurea in which case the prescription is deemed to be endorsed; or

  3. Prescribed for a pregnant woman with diabetes and endorsed accordingly.

SensoCard blood glucose test strips are subsidised only if prescribed for a patient who is severely visually impaired and is using a SensoCard Plus Talking Blood Glucose Monitor.

 Blood glucose diagnostic test meter Meter Optium Xceed 1 9.00 9.00 9.00 0.00000 Accu-Chek Performa 1 19.00 19.00 19.00 0.00000 FreeStyle Lite 1 9.00 9.00 9.00 0.00000 CareSens POP 1 6.00 6.00 6.00 0.00000 CareSens II 1 9.00 9.00 9.00 0.00000

  1. A diagnostic blood glucose test meter is subsidised for patients who begin insulin or sulphonylurea therapy after 1 March 2005 or is prescribed for a pregnant woman with diabetes.

  2. Only one meter per patient. No further prescriptions will be subsidised. The prescription must be endorsed accordingly.

 Insulin Syringes and Needles Insulin pen needles 29 g x 12.7 mm B-D Micro-Fine 30 3.15 3.15 3.15 0.00000 100 10.50 10.50 10.50 0.00000 ABM 100 10.50 10.50 10.50 0.00000 SC Profi-Fine 100 11.75 11.75 11.75 0.00000 31 g x 8 mm B-D Micro-Fine 100 10.50 10.50 10.50 0.00000 30 3.15 3.15 3.15 0.00000 ABM 100 10.50 10.50 10.50 0.00000 SC Profi-Fine 100 11.75 11.75 11.75 0.00000 31 g x 5 mm B-D Micro-Fine 100 11.75 11.75 11.75 0.00000 SC Profi-Fine 100 11.75 11.75 11.75 0.00000 31 g x 6 mm NovoFine 100 10.50 26.00 10.50 0.15500 ABM 100 10.50 10.50 10.50 0.00000 Insulin syringes, disposable with attached needle Syringe 0.3 ml with 29 g x 12.7 mm needle B-D Ultra Fine 10 1.30 1.99 1.30 0.06900 100 13.00 13.00 13.00 0.00000 ABM 100 13.00 13.00 13.00 0.00000 DM Ject 100 13.00 13.00 13.00 0.00000 Syringe 0.5 ml with 29 g x 12.7 mm needle B-D Ultra Fine 10 1.30 1.99 1.30 0.06900 100 13.00 13.00 13.00 0.00000 ABM 100 13.00 13.00 13.00 0.00000 DM Ject 100 13.00 13.00 13.00 0.00000 Syringe 1 ml with 29 g x 12.7 mm needle B-D Ultra Fine 10 1.30 1.99 1.59 0.06900 100 13.00 13.00 13.00 0.00000 ABM 100 13.00 13.00 13.00 0.00000 DM Ject 100 13.00 13.00 13.00 0.00000 Syringe 0.3 ml with 31 g x 8 mm needle B-D Ultra Fine II 100 13.00 13.00 13.00 0.00000 10 1.30 1.99 1.30 0.06900 ABM 100 13.00 13.00 13.00 0.00000 DM Ject 100 13.00 13.00 13.00 0.00000 Syringe 0.5 ml with 31 g x 8 mm needle B-D Ultra Fine II 100 13.00 13.00 13.00 0.00000 10 1.30 1.99 1.30 0.06900 ABM 100 13.00 13.00 13.00 0.00000 DM Ject 100 13.00 13.00 13.00 0.00000 Syringe 1 ml with 31 g x 8 mm needle B-D Ultra Fine II 100 13.00 13.00 13.00 0.00000 10 1.30 1.99 1.30 0.06900 ABM 100 13.00 13.00 13.00 0.00000 DM Ject 100 13.00 13.00 13.00 0.00000

Subsidy is available for disposable insulin syringes, needles, and pen needles if prescribed on the same form as the one used for the supply of insulin or when prescribed for an insulin patient and the prescription is endorsed accordingly.

 Digestives Including Enzymes Digestives Including Enzymes Ursodeoxycholic acid Cap 300 mg Actigall 100 179.00 179.00 179.00 0.00000 <range>Ursodeoxycholic Acid – Cap 300 mg</range> 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 Patient not requiring a liver transplant (bilirubin > 170umol/l; decompensated cirrhosis) any relevant practitioner 6

Liver biopsy is not usually required for diagnosis but is helpful to stage the disease.

 The treatment remains appropriate and the patient is benefiting from treatment any relevant practitioner 2

Actigall is not an appropriate therapy for patients requiring a liver transplant (bilirubin > 170 micromol/l; decompensated cirrhosis). These patients should be referred to an appropriate transplant centre. Treatment failure – doubling of serum bilirubin levels, absence of a significant decrease in ALP or ALT and AST, development of varices, ascites or encephalopathy, marked worsening of pruritus or fatigue, histological progression by two stages, or to cirrhosis, need for transplantation.

 Pancreatic enzyme Tab EC 1,900 BP u lipase, 1,700 BP u amylase, 110 BP u protease Pancrex V 300 32.46 32.46 32.46 0.00000 Tab EC 5,600 BP u lipase, 5,000 BP u amylase, 330 BP u protease Pancrex V Forte 300 58.44 58.44 58.44 0.00000 Cap 8,000 BP u lipase, 9,000 BP u amylase, 430 BP u protease Pancrex V 300 67.26 67.26 67.26 0.00000 Cap 8,000 USP u lipase, 30,000 USP u amylase, 30,000 USP u protease Cotazym ECS 250 85.00 85.00 85.00 0.00000 Cap EC 25,000 BP u lipase, 18,000 BP u amylase, 1,000 BP u protease Creon Forte 100 94.38 94.38 94.38 0.00000 Cap EC 25,000 BP u lipase, 22,500 BP u amylase, 1,250 BP u protease Panzytrat 100 94.40 94.40 94.40 0.00000 Cap EC 10,000 BP u lipase, 9,000 BP u amylase and 210 BP u protease Creon 10000 100 34.93 34.93 34.93 0.00000 Laxatives Bulk-forming Agents Mucilaginous laxatives Sugar Free Mucilax 275 4.84 10.60 4.84 0.02095 Dry Mucilax 380 6.69 6.69 6.69 0.00000 Isogel 450 7.92 12.71 7.92 0.01064 Normacol 500 8.80 16.49 8.80 0.01538 Konsyl-D 325 5.72 5.72 5.72 0.00000 Dry-original flavour, regular texture only Metamucil 336 5.91 12.38 5.91 0.01926 Mucilaginous laxatives with stimulants Dry Normacol Plus 200 3.52 7.69 3.52 0.02085 500 8.80 16.49 8.80 0.01538 Faecal Softeners Docusate sodium Tab 50 mg Coloxyl 100 4.89 4.89 4.89 0.00000 Tab 120 mg Coloxyl 100 6.73 6.73 6.73 0.00000 500 24.00 24.00 24.00 0.00000 Enema conc 18% Coloxyl 100 5.40 5.40 5.40 0.00000 Poloxamer Oral drops 10% Coloxyl 30 3.78 3.78 3.78 0.00000 Docusate sodium with sennosides Tab 50 mg with total sennosides 8 mg Laxsol 200 7.98 7.98 7.98 0.00000 Osmotic Laxatives Glycerol Suppos 3.6 g PSM 20 5.00 5.00 5.00 0.00000 Sodium citrate with sodium lauryl sulphoacetate Enema 90 mg with sodium lauryl sulphoacetate 9 mg per ml, 5 ml Microlax 12 7.30 7.30 7.30 0.00000 Lactulose Oral liq 10 g per 15 ml Duphalac 1000 6.65 6.65 6.65 0.00000 Sodium acid phosphate Enema 16% with sodium phosphate 8% Fleet Phosphate Enema 1 2.50 2.50 2.50 0.00000 Macrogol 3350 Powder 13.125 g, sachets Movicol 30 18.14 18.14 18.14 0.00000 <range>Macrogol 3350</range> 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 any relevant practitioner 6 the patient is compliant and is continuing to gain benefit from treatment any relevant practitioner 12 Stimulant Laxatives Senna Tab, standardised Senokot 100 2.17 6.16 2.17 0.03990 20 0.43 1.72 0.43 0.06450 Bisacodyl Tab 5 mg Lax-Tabs 200 5.09 5.09 5.09 0.00000 Suppos 5 mg Dulcolax 6 2.35 3.00 2.35 0.10833 Suppos 10 mg Fleet 12 3.96 3.96 3.96 0.00000 Metabolic Disorder Agents Gaucher's Disease Imiglucerase Inj 40 iu per ml, 200 iu vial Cerezyme 1 1 1072.00 1072.00 1072.00 0.00000 <range>Imiglucerase</range> medical practitioner 1

Subject to a budgetary cap. Applications will be considered and approved subject to funding availability.

Application details may be obtained from PHARMAC's website http://www.pharmac.govt.nz or:

The Co-ordinator, Gaucher’s Treatment Panel

Phone: (04) 460 4990

PHARMAC, PO Box 10 254

Facsimile: (04) 916 7571

Wellington

Email: gaucherpanel@pharmac.govt.nz
Mouth and Throat Agents Used in Mouth Ulceration Benzydamine hydrochloride Soln 0.15% Difflam 200 3.60 7.14 3.60 0.01770 500 9.00 15.36 9.00 0.01272 Chlorhexidine gluconate Mouthwash 0.2% Orion 200 3.06 3.06 3.06 0.00000 Sodium carboxymethylcellulose With pectin and gelatin paste Orabase 15 4.55 7.90 4.55 0.22333 5 1.52 3.60 1.52 0.41600 Stomahesive 56 17.20 17.20 17.20 0.00000 With pectin and gelatin powder Stomahesive 28 8.48 10.95 8.48 0.08821 Triamcinolone acetonide 0.1% in Dental Paste USP Oracort 5 4.38 4.38 4.38 0.00000 Choline salicylate with cetalkonium chloride Adhesive gel 8.7% with cetalkonium chloride 0.01% Bonjela 15 2.06 5.25 2.06 0.21267 Oropharyngeal Anti-infectives Amphotericin B Lozenges 10 mg Fungilin 20 5.86 5.86 5.86 0.00000 Miconazole Oral gel 20 mg per g Daktarin 40 8.70 8.70 8.70 0.00000 Nystatin Oral liq 100,000 u per ml Nilstat 24 3.19 3.19 3.19 0.00000 Other Oral Agents Thymol glycerin Compound, BPC PSM 500 9.15 9.15 9.15 0.00000 Hydrogen peroxide Soln 10 vol PSM 100 1.28 1.28 1.28 0.00000

For folinic mouthwash, pilocarpine oral liquid or saliva substitute formula refer

 Vitamins Vitamin A Vitamin A with vitamins D and C Soln 1000 u with Vitamin D 400 u and ascorbic acid 30 mg per 10 drops Vitadol C 10 4.50 4.50 4.50 0.00000 Vitamin B Group Hydroxocobalamin Inj 1 mg per ml, 1 ml Neo-B12 3 1 10.84 10.84 10.84 0.00000 ABM Hydroxocobalamin 3 1 9.21 9.21 9.21 0.00000 Pyridoxine hydrochloride Tab 25 mg Healtheries 90 3.06 3.06 3.06 0.00000 Tab 50 mg Apo-Pyridoxine 500 17.63 17.63 17.63 0.00000 Thiamine hydrochloride Tab 50 mg Apo-Thiamine 100 5.62 5.62 5.62 0.00000 Vitamin B complex Tab, strong, BPC Apo-B-Complex 500 12.10 12.10 12.10 0.00000 Vitamin C Ascorbic acid Tab 100 mg Apo-Ascorbic Acid 500 17.25 17.25 17.25 0.00000 Vitamin D Alfacalcidol Cap 0.25 mcg One-Alpha 100 26.32 26.32 26.32 0.00000 Cap 1 mcg One-Alpha 100 87.98 87.98 87.98 0.00000 Oral drops 2 mcg per ml One-Alpha 20 60.68 60.68 60.68 0.00000 Cholecalciferol Tab 1.25 mg (50,000 iu) Cal-d-Forte 12 10.35 10.35 10.35 0.00000 Calcitriol Cap 0.25 mcg Calcitriol-AFT 100 13.45 13.45 13.45 0.00000 Cap 0.5 mcg Calcitriol-AFT 100 24.95 24.95 24.95 0.00000 Oral liq 1 mcg per ml Rocaltrol solution 10 39.40 39.40 39.40 0.00000 Vitamin E Alpha tocopheryl acetate Water solubilised soln 156 iu/ml, with calibrated dropper Micelle E 50 18.30 18.30 18.30 0.00000 <range>Alpha Tocopheryl Acetate</range> Cystic fibrosis patient Infant or child with liver disease or short gut syndrome Requires vitamin supplementation any relevant practitioner 2 The treatment remains appropriate and the patient is benefiting from treatment any relevant practitioner 2 Multivitamin Preparations Vitamins Tab (BPC cap strength) Healtheries Multi-vitamin tablets 1000 14.80 14.80 14.80 0.00000 Multivitamins Oral liq Ketovite Liquid 150 13.50 13.50 13.50 0.00000 Powder Paediatric Seravit 100 36.00 36.00 36.00 0.00000 Tab Ketovite 100 19.65 19.65 19.65 0.00000 <range>Multivitamins<instance>Ketovite</instance><instance>Ketovite</instance>Paediatric Seravit<instance>Paediatric Seravit</instance></range> The patient has inborn errors of metabolism For use as a supplement to a ketogenic diet in patients diagnosed with epilepsy any relevant practitioner Patient has had a previous approval for multivitamins any relevant practitioner

Use of Paediatric Seravit is not recommended as a supplement to a ketogenic diet.

 Minerals Calcium Calcium carbonate Tab 1.25 g Calci-Tab 500 250 9.18 9.18 9.18 0.00000 Tab 1.5 g Calci-Tab 600 250 10.33 10.33 10.33 0.00000 Calcium gluconate Inj 10%, 10 ml Mayne 10 1 21.40 21.40 21.40 0.00000 Calcium Tab eff 1 g (elemental) Calsource 30 6.54 6.54 6.54 0.00000 Fluoride Sodium fluoride Tab 1.1 mg PSM 100 4.00 4.00 4.00 0.00000 Iron Ferrous sulphate with folic acid Tab long-acting 325 mg with folic acid 350 mcg Ferrograd-Folic 30 1.80 3.73 1.80 0.06433 Iron polymaltose Inj 50 mg per ml, 2 ml Ferrum H 5 1 20.95 20.95 20.95 0.00000 Ferrous sulphate Tab long-acting 325 mg Ferro-Gradumet 150 5.06 15.58 5.06 0.07013 30 1.01 4.26 1.01 0.10833 Oral liq 150 mg per 5 ml Ferodan 500 10.30 10.30 10.30 0.00000 Ferrous gluconate with ascorbic acid Tab 170 mg with ascorbic acid 40 mg Healtheries Iron with Vitamin C 500 12.04 12.04 12.04 0.00000 Ferrous fumarate Tab 200 mg Ferro-tab 100 4.35 4.35 4.35 0.00000 Ferrous fumarate with folic acid Tab 310 mg with folic acid 350 mcg Ferro-F-Tabs 60 4.75 4.75 4.75 0.00000 Magnesium Magnesium sulphate Inj 49.3% Mayne 10 1 26.60 26.60 26.60 0.00000

For magnesium hydroxide mixture refer

 Zinc Zinc sulphate Cap 220 mg Zincaps 100 10.00 10.00 10.00 0.00000 Blood and Blood Forming Organs Antianaemics Hypoplastic and Haemolytic Erythropoietin alpha Inj human recombinant 2,000 iu, prefilled syringe Eprex 6 1 120.18 120.18 120.18 0.00000 Inj human recombinant 3,000 iu, prefilled syringe Eprex 6 1 166.87 166.87 166.87 0.00000 Inj human recombinant 4,000 iu, prefilled syringe Eprex 6 1 193.13 193.13 193.13 0.00000 Inj human recombinant 10,000 iu, prefilled syringe Eprex 6 1 395.18 395.18 395.18 0.00000 Inj human recombinant 1,000 iu prefilled syringe Eprex 6 1 48.68 48.68 48.68 0.00000 6 1 48.68 48.68 48.68 0.00000 Inj human recombinant 5,000 iu, prefilled syringe Eprex 6 1 243.26 243.26 243.26 0.00000 Inj human recombinant 6,000 iu, prefilled syringe Eprex 6 1 291.92 291.92 291.92 0.00000 Erythropoietin beta Inj 2,000 iu, prefilled syringe NeoRecormon 6 1 120.18 120.18 120.18 0.00000 Inj 3,000 iu, prefilled syringe NeoRecormon 6 1 166.87 166.87 166.87 0.00000 Inj 4,000 iu, prefilled syringe NeoRecormon 6 1 193.13 193.13 193.13 0.00000 Inj 5,000 iu, prefilled syringe NeoRecormon 6 1 243.26 243.26 243.26 0.00000 Inj 10,000 iu, prefilled syringe NeoRecormon 6 1 395.18 395.18 395.18 0.00000 Inj 6,000 iu, prefilled syringe NeoRecormon 6 1 291.29 291.29 291.29 0.00000 <range>Erythropoietin</range> patient in chronic renal failure Haemoglobin 100g/L patient is not diabetic glomerular filtration rate 30ml/min patient is diabetic glomerular filtration rate 45ml/min patient is on haemodialysis or peritoneal dialysis relevant specialist 2 The treatment remains appropriate and the patient is benefiting from treatment relevant specialist 2

Erythropoietin beta is indicated in the treatment of anaemia associated with chronic renal failure (CRF) where no cause for anaemia other than CRF is detected and there is adequate monitoring of iron stores and iron replacement therapy.

The Cockroft-Gault Formula may be used to estimate glomerular filtration rate (GFR) in persons 18 years and over:

GFR (ml/min) (male) = (140 - age) × Ideal Body Weight (kg) / 814 × serum creatinine (mmol/l)

GFR (ml/min) (female) = Estimated GFR (male) × 0.85

 Megaloblastic Folic acid Tab 5 mg Apo-Folic Acid 500 6.59 6.59 6.59 0.00000 Oral liq 50 mcg per ml Biomed 25 21.05 21.05 21.05 0.00000 Tab 0.8 mg Apo-Folic Acid 1000 16.50 16.50 16.50 0.00000 Antifibrinolytics, Haemostatics and Local Sclerosants Antifibrinolytics, Haemostatics and Local Sclerosants Sodium tetradecyl sulphate Inj 0.5% 2 ml Fibro-vein 5 1 23.20 45.52 23.20 4.46400 Inj 1% 2 ml Fibro-vein 5 1 25.00 48.98 25.00 4.79600 Inj 3% 2 ml Fibro-vein 5 1 28.50 55.91 28.50 5.48200 Tranexamic acid Tab 500 mg Cyklokapron 100 49.14 49.14 49.14 0.00000 Vitamin K Phytomenadione Tab 10 mg Konakion 10 5.60 5.60 5.60 0.00000 Inj 10 mg per ml, 1 ml Konakion MM 5 1 9.21 9.21 9.21 0.00000

May be administered orally.

 Inj 2 mg per 0.2 ml Konakion MM 5 1 8.00 8.00 8.00 0.00000

May be administered orally.

 Antithrombotic Agents Antiplatelet Agents Aspirin Tab 100 mg Ethics Aspirin EC 990 16.83 16.83 16.83 0.00000 Dipyridamole Tab 25 mg Persantin 84 8.36 8.36 8.36 0.00000 Tab long-acting 150 mg Pytazen SR 60 11.52 11.52 11.52 0.00000 Clopidogrel Tab 75 mg Plavix 28 25.00 73.38 25.00 1.72786 Apo-Clopidogrel 28 25.00 25.00 25.00 0.00000 Arrow-Clopidogrel 28 25.00 25.00 25.00 0.00000 <range>Clopidogrel</range> The patient is allergic to aspirin (see definition below) The patient has: suffered from a stroke, or transient ischaemic attack experienced an acute myocardial infarction experienced an episode of pain at rest of greater than 20 minutes duration due to coronary disease that required admission to hospital for at least 24 hours had a troponin T or troponin I test result greater than the upper limit of the reference range had a revascularisation procedure experienced symptomatic peripheral vascular disease of a severity that has required specialist consultation any relevant practitioner

Aspirin allergy is defined as a history of anaphylaxis, urticaria or asthma within 4 hours of ingestion of aspirin, other salicylates or NSAIDs.

 The patient has: experienced an acute myocardial infarction had an episode of pain at rest of greater than 20 minutes duration due to coronary disease that required admission to hospital for at least 24 hours had a troponin T or troponin I test result greater than the upper limit of the reference range had a revascularisation procedure any relevant practitioner 3 The patient is on a waiting list or active review list for stenting, coronary artery bypass grafting, or percutaneous coronary angioplasty following acute coronary syndrome any relevant practitioner 6 The patient has had a stent inserted in the previous 4 weeks any relevant practitioner 6 The patient has, while on treatment with aspirin or clopidogrel, experienced documented stent thrombosis. any relevant practitioner While on treatment with aspirin the patient has experienced an additional vascular event following the recent cessation of clopidogrel any relevant practitioner The patient has: experienced an acute myocardial infarction had an episode of pain at rest of greater than 20 minutes duration due to coronary disease that required admission to hospital for at least 24 hours had a troponin T or troponin I test result greater than the upper limit of the reference range had a revascularisation procedure any relevant practitioner 3 The patient is on a waiting list or active review list for stenting, coronary artery bypass grafting or percutaneous coronary angioplasty following acute coronary syndrome any relevant practitioner 6 The patient has had a stent inserted in the previous 4 weeks any relevant practitioner 6 The patient has, while on treatment with aspirin or clopidogrel, experienced documented stent thrombosis any relevant practitioner Heparin and Antagonist Preparations Heparin sodium Inj 1,000 iu per ml, 5 ml Mayne 50 1 66.80 66.80 66.80 0.00000 10 1 13.36 13.36 13.36 0.00000 Pfizer 50 46.30 46.30 46.30 0.00000 10 11.44 11.44 11.44 0.00000 Inj 1,000 iu per ml, 35 ml Mayne 1 1 16.00 16.00 16.00 0.00000 Inj 5,000 iu per ml, 1 ml Mayne 5 1 14.20 14.20 14.20 0.00000 Inj 5,000 iu per ml, 5 ml Multiparin 10 1 43.67 43.67 43.67 0.00000 Pfizer 50 118.50 118.50 118.50 0.00000 Inj 25,000 iu per ml, 0.2 ml Mayne 5 1 9.50 9.50 9.50 0.00000 Protamine sulphate Inj 10 mg per ml, 5 ml Artex 10 1 22.40 86.54 22.40 6.41400 Enoxaparin sodium Inj 20 mg Clexane 10 39.20 39.20 39.20 0.00000 Inj 40 mg Clexane 10 52.30 52.30 52.30 0.00000 Inj 60 mg Clexane 10 78.85 78.85 78.85 0.00000 Inj 80 mg Clexane 10 105.12 105.12 105.12 0.00000 Inj 100 mg Clexane 10 135.20 135.20 135.20 0.00000 Inj 120 mg Clexane 10 168.00 168.00 168.00 0.00000 Inj 150 mg Clexane 10 192.00 192.00 192.00 0.00000 <range>Enoxaparin sodium</range> Low molecular weight heparin treatment is required during a patients pregnancy For the treatment of venous thromboembolism where the patient has a malignancy any relevant practitioner 1 For the short-term treatment of venous thromboembolism prior to establishing a therapeutic INR with oral anti-coagulant treatment For the prophylaxis and treatment of venous thromboembolism in high risk surgery To enable cessation/re-establishment of existing warfarin treatment pre/post surgery For the prophylaxis and treatment of venous thromboembolism in Acute Coronary Syndrome surgical intervention To be used in association with cardioversion of atrial fibrillation any relevant practitioner 1 Low molecular weight heparin treatment is required during a patient's pregnancy For the treatment of venous thromboembolism where the patient has a malignancy any relevant practitioner 1 Low molecular weight heparin treatment or prophylaxis is required for a second or subsequent event (surgery, ACS, cardioversion, or prior to oral anti-coagulation) any relevant practitioner 1 Heparinised saline Inj 10 iu per ml, 5 ml AstraZeneca 50 1 18.00 18.00 18.00 0.00000 Pfizer 50 32.50 32.50 32.50 0.00000 Oral Anticoagulants Warfarin sodium Tab 1 mg Coumadin 50 3.46 3.46 3.46 0.00000 Marevan 100 5.69 5.69 5.69 0.00000 Tab 2 mg Coumadin 50 4.31 4.31 4.31 0.00000 Tab 3 mg Marevan 100 8.00 8.00 8.00 0.00000 Tab 5 mg Coumadin 50 5.93 5.93 5.93 0.00000 Marevan 100 9.64 9.64 9.64 0.00000

Note: Marevan and Coumadin are not interchangeable.

 Fluids and Electrolytes Intravenous Administration Dextrose Inj 50%, 10 ml Biomed 5 1 22.75 22.75 22.75 0.00000 Inj 50%, 90 ml Biomed 1 1 11.25 11.25 11.25 0.00000 Potassium chloride Inj 75 mg per ml, 10 ml AstraZeneca 50 1 26.00 26.00 26.00 0.00000 Inj 150 mg per ml, 10 ml AstraZeneca 50 1 26.00 26.00 26.00 0.00000 Sodium bicarbonate Inj 8.4%, 100 ml Biomed 1 1 20.50 20.50 20.50 0.00000 Inj 8.4%, 50ml Biomed 1 1 19.95 19.95 19.95 0.00000 Sodium chloride Inj 0.9%, 5 ml AstraZeneca 50 1 11.50 11.50 11.50 0.00000 Inj 0.9%, 10 ml AstraZeneca 50 1 11.50 11.50 11.50 0.00000 Inj 0.9%, 20 ml Pharmacia 6 1 4.72 4.72 4.72 0.00000 30 1 11.79 11.79 11.79 0.00000 Multichem 20 1 7.86 7.86 7.86 0.00000 Inf 0.9% Baxter 500 3.06 3.06 3.06 0.00000 1000 4.06 4.06 4.06 0.00000

Only if prescribed on a prescription for renal dialysis, maternity or post-natal care in the home of the patient, or on a PSO for emergency use. (500 ml and 1,000 ml packs)

 Inj 23.4%, 20 ml Biomed 5 1 26.50 26.50 26.50 0.00000 Water Purified for inj 5 ml AstraZeneca 50 1 10.51 10.51 10.51 0.00000 Multichem 50 1 9.31 9.31 9.31 0.00000 Purified for inj 10 ml AstraZeneca 50 1 11.32 11.32 11.32 0.00000 Multichem 50 1 10.38 10.38 10.38 0.00000 Purified for inj 20 ml Multichem 20 1 5.04 5.04 5.04 0.00000

  1. On a prescription or Practitioner’s Supply Order only when on the same form as an injection listed in the Pharmaceutical Schedule requiring a solvent or diluent; or

  2. On a bulk supply order; or

  3. When used in the extemporaneous compounding of eye drops.

 Total parenteral nutrition (TPN) Infusion TPN 1 Oral Administration Calcium polystyrene sulphonate Powder Calcium Resonium 300 169.85 169.85 169.85 0.00000 Dextrose with electrolytes Soln with electrolytes Pedialyte - Fruit 1000 6.66 6.66 6.66 0.00000 Pedialyte - Bubblegum 1000 6.66 6.66 6.66 0.00000 Pedialyte - Plain 1000 6.78 6.78 6.78 0.00000 Compound electrolytes Powder for soln for oral use 5 g Enerlyte 10 2.86 2.86 2.86 0.00000 Potassium bicarbonate Tab eff 315 mg with sodium acid phosphate 1.937 g and sodium bicarbonate 350 mg Phosphate-Sandoz 100 82.50 82.50 82.50 0.00000

For phosphate supplementation

 Potassium chloride Tab eff 548 mg (14 m eq) with chloride 285 mg (8 m eq) Chlorvescent 60 5.26 11.85 5.26 0.10983 Tab long-acting 600 mg Span-K 200 7.00 7.00 7.00 0.00000 Sodium polystyrene sulphonate Powder Resonium-A 450 89.10 89.10 89.10 0.00000 Lipid Modifying Agents Fibrates Bezafibrate Tab 200 mg Fibalip 90 9.75 9.75 9.75 0.00000 Tab long-acting 400 mg Bezalip Retard 30 5.70 5.70 5.70 0.00000 Other Lipid Modifying Agents Nicotinic acid Tab 50 mg Apo-Nicotinic Acid 100 5.08 5.08 5.08 0.00000 Tab 500 mg Apo-Nicotinic Acid 100 17.60 17.60 17.60 0.00000 Acipimox Cap 250 mg Olbetam 30 18.75 18.75 18.75 0.00000 Resins Cholestyramine with aspartame Sachets 4 g with aspartame Questran-Lite 50 19.25 28.88 19.25 0.19260 Colestipol hydrochloride Sachets 5 g Colestid 30 16.17 16.17 16.17 0.00000 HMG CoA Reductase Inhibitors (Statins) Atorvastatin Tab 10 mg Lipitor 30 4.03 18.32 18.32 0.47633 Tab 20 mg Lipitor 30 5.87 26.70 26.70 0.69433 Tab 40 mg Lipitor 30 8.14 37.02 37.02 0.96267 Tab 80 mg Lipitor 30 16.28 110.50 110.50 3.14067 <range>Atorvastatin</range> Patient has a calculated absolute risk of cardiovascular disease of at least 15% over 5 years Patient has severe documented intolerance to simvastatin (blood tests are not required) Patient has been compliant with a dose of simvastatin of 80 mg per day for at least 2 months Patient has venous CABG LDL cholesterol test 1 2.0 mmol/litre LDL cholesterol test 2 2.0 mmol/litre (at least 1 week after test 1) Patient does not have venous CABG LDL cholesterol test 1 2.5 mmol/litre LDL cholesterol test 2 2.5 mmol/litre (at least 1 week after test 1) relevant specialist general practitioner

To confirm that cholesterol levels are not still improving, two lipid tests must be carried out during treatment with simvastatin 80 mg, and have results for LDL cholesterol that have reduced by <10% in the second test. The tests must be carried out while the patient is in a fasted state (with the exception of patients with IDDM).

The following indications of intolerance to simvastatin, are known as class effects for all statins, and hence are likely to mean that the patient may also be intolerant of atorvastatin:

  • Constipation, flatulence (may occur in >1% of patients)
  • Asthenia, abdominal pain, headache (may occur in >1% of patients)
  • Myopathy, rhabdomyolysis (may occur in <3% of patients)
  • Elevated serum transaminase levels (may occur in <1% of patients)

Statins have been shown to be generally well tolerated in clinical studies, with the rate of discontinuation due to adverse reactions being less than 5%, and similar to the discontinuation rate for patients taking a placebo.

 Simvastatin Tab 10 mg Arrow-Simva 10mg 90 2.05 2.05 2.05 0.00000 Tab 20 mg Arrow-Simva 20mg 90 3.00 3.00 3.00 0.00000 Tab 40 mg Arrow-Simva 40mg 90 5.35 5.35 5.35 0.00000 Tab 80 mg Arrow-Simva 80mg 90 11.65 11.65 11.65 0.00000 Pravastatin Tab 10 mg Pravachol 30 27.46 27.46 27.46 0.00000 Tab 20 mg Pravachol 30 42.58 42.58 42.58 0.00000 Tab 40 mg Pravachol 30 65.31 65.31 65.31 0.00000 <range>Pravastatin</range> Patient has dyslipidaemia and an absolute 5 year cardiovascular risk of 15% or greater Confirmed HIV infection Patient is being treated with an HIV protease inhibitor any relevant practitioner 2

Prescribing Guidelines

Treatment with HMG CoA Reductase Inhibitors (statins) is recommended for patients with dyslipidaemia and an absolute 5 year cardiovascular risk of 15% or greater.

 Selective Cholesterol Absorption Inhibitors Ezetimibe Tab 10 mg Ezetrol 30 57.60 57.60 57.60 0.00000 <range>Ezetimibe</range> ezetimibe is to be used in combination with simvastatin ezetimibe is to be used without a statin Patient has a calculated absolute risk of cardiovascular disease >20% over 5 years Patient cannot tolerate statin therapy at a dose of ≥ 40 mg per day Patient has venous CABG LDL cholesterol 2.0 mmol/litre (see note) LDL cholesterol 2.0 mmol/litre (at least 1 week after test 1 – see note) Patient does not have venous CABG LDL cholesterol 2.5 mmol/litre (see note) LDL cholesterol 2.5 mmol/litre (at least 1 week after test 1 – see note) Patient has homozygous familial hypercholesterolemia, or heterozygous familial hypercholesterolemia Patient has been compliant for at least two months with maximum dose statin therapy LDL cholesterol 5 mmol/litre (see note) LDL cholesterol 5 mmol/litre (at least 1 week after test 1 – see note) relevant specialist 2

Two lipid tests are required to assess LDL cholesterol levels, the tests must be at least one week apart, and be carried out in a fasted state (other than for patients with IDDM). The results for LDL cholesterol levels in both tests must be above those specified.

 The treatment remains appropriate and the patient is benefiting from treatment ezetimibe is to be used in combination with simvastatin ezetimibe is to be used without a statin relevant specialist 2 Ezetimibe with simvastatin Tab 10 mg with simvastatin 20 mg Vytorin 30 75.00 75.00 75.00 0.00000 Tab 10 mg with simvastatin 40 mg Vytorin 30 103.50 103.50 103.50 0.00000 Tab 10 mg with simvastatin 80 mg Vytorin 30 123.00 123.00 123.00 0.00000 Tab 10 mg with simvastatin 10 mg Vytorin 30 69.00 69.00 69.00 0.00000 <range>Ezetimibe with Simvastatin<instance>Vytorin</instance></range> Patient has a calculated absolute risk of cardiovascular disease >20% over 5 years Patient cannot tolerate statin therapy at a dose of ≥ 40 mg per day Patient has venous CABG LDL cholesterol 2.0 mmol/litre (see note) LDL cholesterol 2.0 mmol/litre (at least 1 week after test 1 – see note) Patient does not have venous CABG LDL cholesterol 2.5 mmol/litre (see note) LDL cholesterol 2.5 mmol/litre (at least 1 week after test 1 – see note) Patient has homozygous familial hypercholesterolemia, or heterozygous familial hypercholesterolemia Patient has been compliant for at least two months with maximum dose statin therapy LDL cholesterol 5 mmol/litre (see note) LDL cholesterol 5 mmol/litre (at least 1 week after test 1 – see note) relevant specialist 2

Two lipid tests are required to assess LDL cholesterol levels, the tests must be at least one week apart, and be carried out in a fasted state (other than for patients with IDDM). The results for LDL cholesterol levels in both tests must be above those specified.

 The treatment remains appropriate and the patient is benefiting from treatment relevant specialist 2 Cardiovascular System Alpha Adrenoceptor Blockers Alpha Adrenoceptor Blockers Phenoxybenzamine hydrochloride Cap 10 mg Dibenyline 100 26.05 26.05 26.05 0.00000 30 7.82 7.82 7.82 0.00000 Phentolamine mesylate Inj 10 mg per ml, 1 ml Regitine 5 1 17.97 31.65 17.97 2.73600 Prazosin hydrochloride Tab 1 mg Apo-Prazo 100 5.53 5.53 5.53 0.00000 Tab 2 mg Apo-Prazo 100 7.00 7.00 7.00 0.00000 Tab 5 mg Apo-Prazo 100 11.70 11.70 11.70 0.00000 Doxazosin mesylate Tab 2 mg Apo-Doxazosin 500 22.85 22.85 22.85 0.00000 Tab 4 mg Apo-Doxazosin 500 30.26 30.26 30.26 0.00000 Terazosin hydrochloride Tab 2 mg Apo-Terazosin 500 23.30 23.30 23.30 0.00000 Tab 7 x 1 mg and 7 x 2 mg Hytrin Starter Pack 14 0.74 0.74 0.74 0.00000 Tab 5 mg Apo-Terazosin 500 29.00 29.00 29.00 0.00000 Tab 1 mg Apo-Terazosin 28 2.50 2.50 2.50 0.00000 Agents Affecting the Renin-Angiotensin System ACE Inhibitors Trandolapril Cap 1 mg Gopten 28 3.06 18.67 18.67 0.55750 Cap 2 mg Gopten 28 4.43 27.00 27.00 0.80607 Enalapril Tab 5 mg m-Enalapril 90 2.19 2.19 2.19 0.00000 Tab 10 mg m-Enalapril 90 2.76 2.76 2.76 0.00000 Tab 20 mg m-Enalapril 90 3.68 3.68 3.68 0.00000 Cilazapril Tab 0.5 mg Inhibace 30 2.20 2.20 2.20 0.00000 Tab 2.5 mg Inhibace 28 4.10 4.10 4.10 0.00000 Tab 5 mg Inhibace 28 6.01 6.01 6.01 0.00000 Quinapril Tab 5 mg Accupril 30 1.60 1.60 1.60 0.00000 Tab 10 mg Accupril 30 1.75 1.75 1.75 0.00000 Tab 20 mg Accupril 30 2.35 2.35 2.35 0.00000 Lisinopril Tab 5 mg Arrow-Lisinopril 30 2.06 2.06 2.06 0.00000 Tab 10 mg Arrow-Lisinopril 30 2.36 2.36 2.36 0.00000 Tab 20 mg Arrow-Lisinopril 30 2.87 2.87 2.87 0.00000 Perindopril Tab 4 mg Coversyl 30 4.05 25.00 25.00 0.69833 Tab 2 mg Coversyl 30 3.00 18.50 18.50 0.51667 Captopril Tab 12.5 mg Apo-Captopril 500 10.40 10.40 10.40 0.00000 Tab 25 mg Apo-Captopril 500 13.40 13.40 13.40 0.00000 Tab 50 mg Apo-Captopril 500 19.00 19.00 19.00 0.00000 Oral liq 5 mg per ml Capoten 95 51.04 51.04 51.04 0.00000

Oral liquid restricted to children under 12 years of age.

Perindopril and trandolapril will be funded to the level of the ex-manufacturer price listed in the Schedule for patients who were taking these ACE inhibitors for the treatment of congestive heart failure prior to 1 June 1998. The prescription must be endorsed accordingly. We recommend that the words used to indicate eligibility are “certified condition” or an appropriate description of the patient such as “congestive heart failure”, “CHF”, “congestive cardiac failure” or “CCF”.

Definition of Congestive Heart Failure

At the request of some prescribers the PTAC Cardiovascular subcommittee has provided a definition of congestive heart failure for the purposes of the funding of the manufacturer’s surcharge: “Clinicians should use their clinical judgement. Existing patients would be eligible for the funding of the surcharge if the patient shows signs and symptoms of congestive heart failure, and requires or has in the past required concomitant treatment with a diuretic. The definition could also be considered to include patients post myocardial infarction with an ejection fraction of less than 40%.”

 ACE Inhibitors with Diuretics Cilazapril with hydrochlorothiazide Tab 5 mg with hydrochlorothiazide 12.5 mg Inhibace Plus 28 6.30 6.30 6.30 0.00000 Enalapril with hydrochlorothiazide Tab 20 mg with hydrochlorothiazide 12.5 mg Co-Renitec 30 3.32 8.70 3.32 0.17933 Quinapril with hydrochlorothiazide Tab 10 mg with hydrochlorothiazide 12.5 mg Accuretic 10 30 3.37 3.37 3.37 0.00000 Tab 20 mg with hydrochlorothiazide 12.5 mg Accuretic 20 30 4.57 4.57 4.57 0.00000 Angiotension II Antagonists Losartan Tab 50 mg Cozaar 30 23.10 23.10 23.10 0.00000 Tab 12.5 mg Cozaar 30 17.40 17.40 17.40 0.00000 Tab 50 mg with hydrochlorothiazide 12.5 mg Hyzaar 30 30.00 30.00 30.00 0.00000 Tab 100 mg Cozaar 30 35.40 35.40 35.40 0.00000 Tab 25 mg Cozaar 30 21.76 21.76 21.76 0.00000 <range>Losartan with or without hydrochlorothiazide</range> Patient has persistent ACE inhibitor induced cough that is not resolved by ACE inhibitor retrial (same or new ACE inhibitor) Patient has a history of angioedema any relevant practitioner Patient is not adequately controlled on maximum tolerated dose of an ACE inhibitor any relevant practitioner The treatment remains appropriate and the patient is benefiting from treatment any relevant practitioner Candesartan Tab 4 mg Atacand 30 16.22 16.22 16.22 0.00000 Tab 8 mg Atacand 30 19.30 19.30 19.30 0.00000 Tab 16 mg Atacand 30 23.54 23.54 23.54 0.00000 Tab 32 mg Atacand 30 38.50 38.50 38.50 0.00000 <range>Candesartan</range> Patient with congestive heart failure Has been treated with, and cannot tolerate, two ACE inhibitors, due to persistent cough Has experienced angioedema on an ACE inhibitor at any time in the past or who have experienced angioedema (even if not using an ACE inhibitor) in the last 2 years Patient with raised blood pressure Use of fully funded beta blockers or diuretics are contraindicated; or not well tolerated; or insufficient to control blood pressure adequately at appropriate doses Has been treated with, and cannot tolerate, two ACE inhibitors, due to persistent cough Has experienced angioedema on an ACE inhibitor at any time in the past or who have experienced angioedema (even if not using an ACE inhibitor) in the last 2 years any relevant practitioner Antiarrhythmics Antiarrhythmics Amiodarone hydrochloride Tab 100 mg Cordarone-X 30 18.65 18.65 18.65 0.00000 Aratac 30 18.65 18.65 18.65 0.00000 Tab 200 mg Cordarone-X 30 30.52 30.52 30.52 0.00000 Aratac 30 30.52 30.52 30.52 0.00000 Inj 50 mg per ml, 3 ml Cordarone-X 10 1 60.84 60.84 60.84 0.00000 Digoxin Tab 62.5 mcg Lanoxin PG 250 6.94 6.94 6.94 0.00000 Tab 250 mcg Lanoxin 250 15.13 15.13 15.13 0.00000 Oral liq 50 mcg per ml Lanoxin 60 16.60 16.60 16.60 0.00000 Disopyramide phosphate Cap 100 mg Rythmodan 100 15.00 23.87 15.00 0.08870 Cap 150 mg Rythmodan 100 26.21 26.21 26.21 0.00000 Flecainide acetate Tab 50 mg Tambocor 60 42.82 42.82 42.82 0.00000 Tab 100 mg Tambocor 60 75.63 75.63 75.63 0.00000 Inj 10 mg per ml, 15 ml Tambocor 5 1 49.02 49.02 49.02 0.00000 Cap long-acting 100 mg Tambocor CR 30 42.82 42.82 42.82 0.00000 Cap long-acting 200 mg Tambocor CR 30 75.63 75.63 75.63 0.00000 Mexiletine hydrochloride Cap 50 mg Mexitil 100 23.52 23.52 23.52 0.00000 Cap 200 mg Mexitil 100 55.05 55.05 55.05 0.00000 Propafenone hydrochloride Tab 150 mg Rytmonorm 50 40.90 40.90 40.90 0.00000

For lignocaine hydrochloride refer to NERVOUS SYSTEM, Anaesthetics, Local

 Antihypotensives Antihypotensives Midodrine Tab 2.5 mg Gutron 100 53.00 53.00 53.00 0.00000 Tab 5 mg Gutron 100 79.00 79.00 79.00 0.00000 <range>Midodrine</range> Disabling orthostatic hypotension not due to drugs Patient has tried fludrocortisone (unless contra-indicated) with unsatisfactory results Patient has tried non pharmacological treatments such as support hose, increased salt intake, exercise, and elevation of head and trunk at night any relevant practitioner 2

Treatment should be started with small doses and titrated upwards as necessary.

Hypertension should be avoided, and the usual target is a standing systolic blood pressure of 90 mm Hg.

 The treatment remains appropriate and the patient is benefiting from treatment any relevant practitioner 2 Beta Adrenoceptor Blockers Beta Adrenoceptor Blockers Acebutolol Cap 100 mg ACB 100 9.50 9.50 9.50 0.00000 Cap 200 mg ACB 100 15.94 15.94 15.94 0.00000 Atenolol Tab 50 mg Pacific Atenolol 500 6.18 6.18 6.18 0.00000 Noten 30 0.39 0.39 0.39 0.00000 Tab 100 mg Pacific Atenolol 500 10.73 10.73 10.73 0.00000 Labetalol Tab 50 mg Hybloc 100 8.66 8.66 8.66 0.00000 Tab 100 mg Hybloc 100 10.59 10.59 10.59 0.00000 Tab 200 mg Hybloc 100 18.47 18.47 18.47 0.00000 Tab 400 mg Hybloc 100 34.44 34.44 34.44 0.00000 Inj 5 mg per ml, 20 ml Trandate 5 1 59.06 88.60 59.06 5.90800 Metoprolol succinate Tab long-acting 47.5 mg Betaloc CR 30 4.50 4.50 4.50 0.00000 Metoprolol - AFT CR 30 3.41 3.41 3.41 0.00000 Tab long-acting 95 mg Betaloc CR 30 7.40 7.40 7.40 0.00000 Metoprolol - AFT CR 30 5.88 5.88 5.88 0.00000 Tab long-acting 190 mg Betaloc CR 30 12.50 12.50 12.50 0.00000 Metoprolol - AFT CR 30 10.63 10.63 10.63 0.00000 Tab long-acting 23.75 mg Betaloc CR 30 3.61 3.61 3.61 0.00000 Metoprolol - AFT CR 30 2.73 2.73 2.73 0.00000 Metoprolol tartrate Tab 50 mg Lopresor 100 16.50 16.50 16.50 0.00000 Tab 100 mg Lopressor 30 10.90 10.90 10.90 0.00000 60 21.80 21.80 21.80 0.00000 Tab long-acting 200 mg Slow-Lopressor 28 18.40 18.40 18.40 0.00000 Inj 1 mg per ml 5 ml Betaloc 5 1 24.08 34.00 24.08 1.98400 Nadolol Tab 40 mg Apo-Nadolol 100 14.97 14.97 14.97 0.00000 Tab 80 mg Apo-Nadolol 100 22.19 22.19 22.19 0.00000 Pindolol Tab 5 mg Pindol 100 4.50 4.50 4.50 0.00000 Tab 10 mg Pindol 100 8.35 8.35 8.35 0.00000 Tab 15 mg Pindol 100 12.00 12.00 12.00 0.00000 Propranolol Tab 10 mg Cardinol 100 3.55 3.55 3.55 0.00000 Tab 40 mg Cardinol 100 4.65 4.65 4.65 0.00000 Cap long-acting 160 mg Cardinol LA 100 16.90 16.90 16.90 0.00000 Sotalol Tab 80 mg Mylan 500 27.50 27.50 27.50 0.00000 Tab 160 mg Mylan 100 10.50 10.50 10.50 0.00000 Inj 10 mg per ml, 4 ml Sotacor 5 1 41.34 41.34 41.34 0.00000 Timolol maleate Tab 10 mg Apo-Timol 100 10.55 10.55 10.55 0.00000 Celiprolol Tab 200 mg Celol 180 19.00 19.00 19.00 0.00000 Carvedilol Tab 6.25 mg Dilatrend 30 21.00 21.00 21.00 0.00000 Tab 12.5 mg Dilatrend 30 27.00 27.00 27.00 0.00000 Tab 25 mg Dilatrend 30 33.75 33.75 33.75 0.00000 Calcium Channel Blockers Dihydropyridine Calcium Channel Blockers (DHP CCBs) Nifedipine Tab long-acting 10 mg Adalat 10 60 17.72 17.72 17.72 0.00000 Tab long-acting 20 mg Nyefax Retard 100 7.30 7.30 7.30 0.00000 Tab long-acting 30 mg Adalat Oros 30 5.50 19.90 5.50 0.48000 Arrow-Nifedipine XR 30 10.70 10.70 10.70 0.00000 Adefin XL 30 10.70 10.70 10.70 0.00000 Tab long-acting 60 mg Adalat Oros 30 8.00 29.50 8.00 0.71667 Arrow-Nifedipine XR 30 15.35 15.35 15.35 0.00000 Adefin XL 30 15.35 15.35 15.35 0.00000 Felodipine Tab long-acting 5 mg Felo 5 ER 90 10.73 10.73 10.73 0.00000 Tab long-acting 10 mg Felo 10 ER 90 15.60 15.60 15.60 0.00000 Tab long-acting 2.5 mg Plendil ER 30 10.38 10.38 10.38 0.00000 Isradipine Cap long-acting 2.5 mg Dynacirc-SRO 30 7.50 7.50 7.50 0.00000 Cap long-acting 5 mg Dynacirc-SRO 30 7.85 7.85 7.85 0.00000 Amlodipine Tab 5 mg Apo-Amlodipine 100 7.33 7.33 7.33 0.00000 Tab 10 mg Apo-Amlodipine 100 11.79 11.79 11.79 0.00000 Other Calcium Channel Blockers Perhexiline maleate Tab 100 mg Pexsig 100 62.90 62.90 62.90 0.00000 <range>Perhexiline Maleate</range> Refractory angina Patient is already on maximal anti-anginal therapy cardiologist general physician 2 The treatment remains appropriate and the patient is benefiting from treatment cardiologist general physician 2 Verapamil hydrochloride Tab 40 mg Isoptin 100 7.01 7.01 7.01 0.00000 Tab 80 mg Isoptin 100 11.74 11.74 11.74 0.00000 Inj 2.5 mg per ml, 2 ml Isoptin 5 1 7.54 7.54 7.54 0.00000 Tab long-acting 120 mg Verpamil SR 250 15.20 15.20 15.20 0.00000 Tab long-acting 240 mg Verpamil SR 250 25.00 25.00 25.00 0.00000 Diltiazem hydrochloride Tab 30 mg Dilzem 100 4.60 4.60 4.60 0.00000 Tab 60 mg Dilzem 100 8.50 8.50 8.50 0.00000 Cap long-acting 120 mg (once per day) Cardizem CD 30 4.34 4.34 4.34 0.00000 Cap long-acting 180 mg Cardizem CD 30 6.50 6.50 6.50 0.00000 Cap long-acting 240 mg Cardizem CD 30 8.67 8.67 8.67 0.00000 Centrally Acting Agents Centrally Acting Agents Clonidine TDDS 2.5 mg, 100 mcg per day Catapres-TTS-1 4 23.30 23.30 23.30 0.00000 TDDS 5 mg, 200 mcg per day Catapres-TTS-2 4 32.80 32.80 32.80 0.00000 TDDS 7.5 mg, 300 mcg per day Catapres-TTS-3 4 41.20 41.20 41.20 0.00000 Clonidine hydrochloride Tab 150 mcg Catapres 100 33.00 33.00 33.00 0.00000 Inj 150 mcg per ml, 1 ml Catapres 5 1 15.45 15.45 15.45 0.00000 Methyldopa Tab 125 mg Prodopa 100 12.00 12.00 12.00 0.00000 Tab 250 mg Prodopa 100 13.10 13.10 13.10 0.00000 Tab 500 mg Prodopa 100 20.85 20.85 20.85 0.00000 Diuretics Loop Diuretics Bumetanide Tab 1 mg Burinex 100 16.36 16.36 16.36 0.00000 Inj 500 mcg per ml, 4 ml Burinex 5 1 7.95 7.95 7.95 0.00000 Furosemide Tab 40 mg Diurin 40 1000 10.75 10.75 10.75 0.00000 Tab 500 mg Diurin 500 100 12.00 12.00 12.00 0.00000 Oral liq 10 mg per ml Lasix 30 10.66 10.66 10.66 0.00000 Inj 10 mg per ml, 2 ml Mayne 50 1 29.50 29.50 29.50 0.00000 Infusion 10 mg per ml, 25 ml Lasix 5 48.14 48.14 48.14 0.00000 Potassium Sparing Diuretics Amiloride Oral liq 1 mg per ml Biomed 25 26.20 26.20 26.20 0.00000 Spironolactone Tab 25 mg Spirotone 100 8.50 8.50 8.50 0.00000 Tab 100 mg Spirotone 100 21.70 21.70 21.70 0.00000 Oral liq 5 mg per ml Biomed 25 26.80 26.80 26.80 0.00000 Potassium Sparing Combination Diuretics Amiloride with frusemide Tab 5 mg with frusemide 40 mg Frumil 28 4.67 8.63 4.67 0.14143 Amiloride with hydrochlorothiazide Tab 5 mg with hydrochlorothiazide 50 mg Amizide 500 13.00 13.00 13.00 0.00000 Triamterene with hydrochlorothiazide Tab 50 mg with hydrochlorothiazide 25 mg Triamizide 100 5.00 5.00 5.00 0.00000 Thiazide and Related Diuretics Bendrofluazide Tab 2.5 mg Neo-Naclex 500 13.50 13.50 13.50 0.00000

May be supplied on a PSO for reasons other than emergency.

 Tab 5 mg Neo-Naclex 500 21.50 21.50 21.50 0.00000 Chlorothiazide Oral liq 50 mg per ml Biomed 25 22.60 22.60 22.60 0.00000 Chlorthalidone Tab 25 mg Hygroton 50 8.00 8.00 8.00 0.00000 Indapamide Tab 2.5 mg Napamide 100 4.00 4.00 4.00 0.00000 Nitrates Nitrates Glyceryl trinitrate TDDS 10 mg Nitroderm TTS 30 19.60 19.60 19.60 0.00000 Tab 600 mcg Lycinate 100 8.00 8.00 8.00 0.00000 TDDS 5 mg Nitroderm TTS 30 16.56 16.56 16.56 0.00000 Oral pump spray 400 mcg per dose Nitrolingual Pumpspray 250 5.16 5.16 5.16 0.00000 Isosorbide mononitrate Tab 20 mg Ismo 20 100 18.00 18.00 18.00 0.00000 Tab long-acting 40 mg Corangin 30 14.84 14.84 14.84 0.00000 Tab long-acting 60 mg Duride 90 4.15 4.15 4.15 0.00000 Smoking Cessation Nicotine Gum Nicotine Gum 2 mg (Fruit) Nicotinell 96 23.41 23.41 23.41 0.00000 Habitrol 96 14.97 14.97 14.97 0.00000 Gum 4 mg (Fruit) Nicotinell 96 23.41 23.41 23.41 0.00000 Habitrol 96 20.02 20.02 20.02 0.00000 Gum 2 mg (Mint) Nicotinell 96 23.41 23.41 23.41 0.00000 Habitrol 96 14.97 14.97 14.97 0.00000 Gum 4 mg (Mint) Nicotinell 96 23.41 23.41 23.41 0.00000 Habitrol 96 20.02 20.02 20.02 0.00000

For the avoidance of doubt Nicotine will not be funded Close Control in amounts less than 4 weeks.

 Nicotine Lozenge Nicotine Lozenge 1 mg Habitrol 36 11.08 11.08 11.08 0.00000 Lozenge 2 mg Habitrol 36 11.08 11.08 11.08 0.00000

For the avoidance of doubt Nicotine will not be funded Close Control in amounts less than 4 weeks.

 Nicotine Patch Nicotine Patch 21 mg Habitrol 7 12.32 12.32 12.32 0.00000 Patch 14 mg Habitrol 7 11.63 11.63 11.63 0.00000 Patch 7 mg Habitrol 7 10.53 10.53 10.53 0.00000

For the avoidance of doubt Nicotine will not be funded Close Control in amounts less than 4 weeks.

 Other Agents Bupropion hydrochloride Tab modified-release 150 mg Zyban 30 65.00 65.00 65.00 0.00000 Sympathomimetics Sympathomimetics Adrenaline Inj 1 in 1,000, 1 ml Mayne 5 1 5.25 5.25 5.25 0.00000 Aspen Adrenaline 5 4.98 4.98 4.98 0.00000 Inj 1 in 10,000, 10 ml Mayne 5 1 27.00 27.00 27.00 0.00000 Isoprenaline hydrochloride Inj 200 mcg per ml, 1 ml Isuprel 25 1 36.80 135.00 36.80 3.92800 Vasodilators Vasodilators Hydralazine Inj 20 mg per ml, 1 ml Apresoline 5 1 25.90 25.90 25.90 0.00000 Papaverine hydrochloride Inj 12 mg per ml, 10 ml Mayne 5 1 73.12 73.12 73.12 0.00000 Oxypentifylline Tab 400 mg Trental 400 50 36.94 42.26 36.94 0.10640 Amyl nitrite Ampoule, 0.3 ml crushable Baxter 12 62.92 73.40 62.92 0.87333 Endothelin Receptor Antagonists Bosentan Tab 62.5 mg Tracleer 60 4585.00 4585.00 4585.00 0.00000 Tab 125 mg Tracleer 60 4585.00 4585.00 4585.00 0.00000 <range>Bosentan</range> The patient is likely to benefit from treatment medical practitioner 2

Application details may be obtained from PHARMAC's website http://www.pharmac.govt.nz or:

The Coordinator, PAH Panel

PHARMAC, PO Box 10-254, WELLINGTON

Tel: (04) 916 7512, Fax: (04) 974 4858, Email: PAH@pharmac.govt.nz

 Phosphodiesterase Type 5 Inhibitors Sildenafil Tab 25 mg Viagra 4 47.00 47.00 47.00 0.00000 Tab 50 mg Viagra 4 59.50 59.50 59.50 0.00000 Tab 100 mg Viagra 4 66.00 66.00 66.00 0.00000 <range>Sildenafil</range> The patient is likely to benefit from treatment medical practitioner 2

Application details may be obtained from PHARMAC's website http://www.pharmac.govt.nz or:

The Coordinator, PAH Panel

PHARMAC, PO Box 10-254, WELLINGTON

Tel: (04) 916 7512, Fax: (04) 974 4858, Email: PAH@pharmac.govt.nz

 Prostacyclin Analogues Iloprost Nebuliser soln 10 mcg per ml, 2 ml Ventavis 30 1185.00 1185.00 1185.00 0.00000 <range>Iiloprost</range> The patient is likely to benefit from treatment medical practitioner 2

Application details may be obtained from PHARMAC's website http://www.pharmac.govt.nz or:

The Coordinator, PAH Panel

PHARMAC, PO Box 10-254, WELLINGTON

Tel: (04) 916 7512, Fax: (04) 974 4858, Email: PAH@pharmac.govt.nz

 Dermatologicals Antiacne Preparations Antiacne Preparations Isotretinoin Cap 10 mg Oratane 180 48.48 48.48 48.48 0.00000 Isotane 10 100 26.93 26.93 26.93 0.00000 Cap 20 mg Oratane 180 69.70 69.70 69.70 0.00000 Isotane 20 100 38.72 38.72 38.72 0.00000 <range>Isotretinoin</range> Patient has had an adequate trial on other available treatments and has failed these treatments or these are contraindicated Applicant is a vocationally registered dermatologist, vocationally registered general practitioner, or nurse practitioner working in a relevant scope of practice Applicant has an up to date knowledge of the treatment options for acne and is aware of the safety issues around isotretinoin and is competent to prescribe isotretinoin Patient is female and has been counselled and understands the risk of teratogenicity if isotretinoin is used during pregnancy and the applicant has ensured that the possibility of pregnancy has been excluded prior to the commencement of the treatment and that the patient is informed that she must not become pregnant during treatment and for a period of one month after the completion of the treatment Patient is male any relevant practitioner 1

Applicants are recommended to either have used or be familiar with using a decision support tool accredited by their professional body.

 Patient has had an adequate trial on other available treatments and has failed these treatments or these are contraindicated Applicant is a vocationally registered dermatologist, vocationally registered general practitioner, or nurse practitioner working in a relevant scope of practice Applicant has an up to date knowledge of the treatment options for acne and is aware of the safety issues around isotretinoin and is competent to prescribe isotretinoin Patient is female and has been counselled and understands the risk of teratogenicity if isotretinoin is used during pregnancy and the applicant has ensured that the possibility of pregnancy has been excluded prior to the commencement of the treatment and that the patient is informed that she must not become pregnant during treatment and for a period of one month after the completion of the treatment Patient is male any relevant practitioner 1

Applicants are recommended to either have used or be familiar with using a decision support tool accredited by their professional body.

For systemic antibacterials, refer to INFECTIONS, Antibacterials

 Antibacterials Topical Antibacterials Topical Fusidic acid Crm 2 % Foban 15 3.95 3.95 3.95 0.00000 Oint 2 % Foban 15 3.95 3.95 3.95 0.00000 Mupirocin Oint 2% Bactroban 15 6.60 9.26 6.60 0.17733 Silver sulphadiazine Crm 1% with chlorhexidine digluconate 0.2% Silvazine 100 15.04 15.04 15.04 0.00000 Hydrogen peroxide Crm 1% Crystacide 10 8.56 8.56 8.56 0.00000

For systemic antibacterials, refer to INFECTIONS, Antibacterials

 Antifungals Topical Antifungals Topical Clotrimazole Soln 1% Canesten 20 4.36 7.55 4.36 0.15950 Crm 1% Clomazol 20 0.50 0.50 0.50 0.00000 Econazole nitrate Foaming soln 1%, 10 ml sachets Pevaryl 3 9.89 17.23 9.89 2.44667 Crm 1% Pevaryl 20 1.00 7.48 1.00 0.32400 Miconazole nitrate Lotn 2% Daktarin 30 4.36 10.03 4.36 0.18900 Tinct 2% Daktarin 30 4.36 12.10 4.36 0.25800 Crm 2% Multichem 15 0.42 0.42 0.42 0.00000 Ketoconazole Crm 2% Nizoral 15 1.00 9.50 1.00 0.56667 Nystatin Crm 100,000 u per g Mycostatin 15 1.00 5.10 1.00 0.27333 Ciclopiroxolamine Soln 1% Batrafen 20 4.36 11.54 4.36 0.35900 Crm 1% Batrafen 20 1.00 12.82 1.00 0.59100 Nail soln 8% Batrafen 3.5 19.85 19.85 19.85 0.00000 Amorolfine Nail soln 5% Loceryl 5 37.86 61.87 37.86 4.80200

For systemic antifungals, refer to INFECTIONS, Antifungals

 Antipruritic Preparations Antipruritic Preparations Calamine Crm, aqueous, BP ABM 100 2.78 3.02 2.78 0.00240 healthE 100 2.78 2.78 2.78 0.00000 Lotn, BP API 2000 16.70 16.70 16.70 0.00000 ABM 2000 16.70 19.44 16.70 0.00137 Crotamiton Crm 10% Eurax 20 4.26 4.45 4.26 0.00950 Menthol Crystals PSM 25 7.40 7.40 7.40 0.00000 MidWest 100 29.60 29.60 29.60 0.00000

Only in combination with aqueous cream, 10% urea cream, wool fat with mineral oil lotion, 1% hydrocortisone with wool fat and mineral oil lotion, and glycerol, paraffin and cetyl alcohol lotion

 Corticosteroids Topical Corticosteroids - Plain Methylprednisolone aceponate Crm 0.1% Advantan 15 4.95 4.95 4.95 0.00000 Oint 0.1% Advantan 15 4.95 4.95 4.95 0.00000 Betamethasone dipropionate Crm 0.05% Diprosone 15 2.96 6.91 2.96 0.26333 50 8.97 18.36 8.97 0.18780 Oint 0.05% Diprosone 15 2.96 6.51 2.96 0.23667 50 8.97 17.11 8.97 0.16280 Crm 0.05% in propylene glycol base Diprosone OV 30 4.33 13.83 4.33 0.31667 Oint 0.05% in propylene glycol base Diprosone OV 30 4.33 13.83 4.33 0.31667 Clobetasol propionate Crm 0.05% Dermol 30 3.48 3.48 3.48 0.00000 Oint 0.05% Dermol 30 3.48 3.48 3.48 0.00000 Clobetasone butyrate Crm 0.05% Eumovate 30 5.38 7.09 5.38 0.05700 100 16.13 22.00 16.13 0.05870 Diflucortolone valerate Crm 0.1% Nerisone 50 8.97 15.86 8.97 0.13780 Fatty oint 0.1% Nerisone 50 8.97 15.86 8.97 0.13780 Hydrocortisone with wool fat and mineral oil Lotn 1% with wool fat hydrous 3% and mineral oil DP Lotn HC 250 9.95 9.95 9.95 0.00000 Hydrocortisone butyrate Oint 0.1% Locoid 100 15.00 15.00 15.00 0.00000 Lipocream 0.1% Locoid Lipocream 30 5.00 5.00 5.00 0.00000 100 15.00 15.00 15.00 0.00000 Milky emul 0.1% Locoid Crelo 30 5.00 5.00 5.00 0.00000 100 15.00 15.00 15.00 0.00000 Hydrocortisone Powder ABM 25 33.00 33.00 33.00 0.00000

Up to 5% in a dermatological base (not proprietary Topical Corticosteriod – Plain) with or without other dermatological galenicals. Refer

 Crm 1% PSM 500 12.20 12.20 12.20 0.00000 Lemnis Fatty Cream HC 100 2.44 2.44 2.44 0.00000 Triamcinolone acetonide Crm 0.02% Aristocort 100 6.63 6.63 6.63 0.00000 Oint 0.02% Aristocort 100 6.69 6.69 6.69 0.00000 Betamethasone valerate Lotn 0.1% Betnovate 50 10.05 10.05 10.05 0.00000 Crm 0.1% Beta Cream 50 2.00 2.00 2.00 0.00000 Oint 0.1% Beta Ointment 50 2.20 2.20 2.20 0.00000 Mometasone furoate Lotn 0.1% Elocon 30 4.80 4.80 4.80 0.00000 Crm 0.1% Elocon 15 3.96 3.96 3.96 0.00000 45 10.82 10.82 10.82 0.00000 m-Mometasone 15 2.38 2.38 2.38 0.00000 45 4.55 4.55 4.55 0.00000 Oint 0.1% Elocon 45 10.82 10.82 10.82 0.00000 15 3.96 3.96 3.96 0.00000 m-Mometasone 45 4.55 4.55 4.55 0.00000 15 2.38 2.38 2.38 0.00000 Corticosteroids - Combination Betamethasone valerate with clioquinol Crm 0.1% with clioquinol 3% Betnovate-C 15 3.49 4.90 3.49 0.09400 Oint 0.1% with clioquinol 3% Betnovate-C 15 3.49 4.90 3.49 0.09400 Betamethasone valerate with fusidic acid Crm 0.1% with fusidic acid 2% Fucicort 15 3.49 9.61 3.49 0.40800 Hydrocortisone with miconazole Crm 1% with miconazole nitrate 2% Micreme H 15 2.20 2.20 2.20 0.00000 Hydrocortisone with natamycin and neomycin Crm 1% with natamycin 1% and neomycin sulphate 0.5% Pimafucort 15 4.40 4.40 4.40 0.00000 Oint 1% with natamycin 1% and neomycin sulphate 0.5% Pimafucort 15 4.40 4.40 4.40 0.00000 Hydrocortisone butyrate with chlorquinaldol Crm 0.1% with chlorquinaldol 3% Locoid C 15 3.49 3.49 3.49 0.00000 Triamcinolone acetonide with gramicidin, neomycin and nystatin Crm 1 mg with nystatin 100,000 u, neomycin sulphate 2.5 mg and gramicidin 250 mcg per g Viaderm KC 15 3.49 6.60 3.49 0.20733

For systemic corticosteroids, refer to CORTICOSTEROIDS AND RELATED AGENTS

 Disinfecting and Cleansing Agents Disinfecting and Cleansing Agents Chlorhexidine gluconate Soln 4% Orion 500 7.20 7.20 7.20 0.00000 Handrub 1% with ethanol 70% Orion 500 5.40 5.40 5.40 0.00000

Only if prescribed for a dialysis patient and the prescription is endorsed accordingly.

 Sodium hypochlorite Soln Janola 2500 2.71 2.71 2.71 0.00000

Only if prescribed for a dialysis patient and the prescription is endorsed accordingly.

 Dusting Powders Dusting Powders Diphemanil methylsulphate Powder 2% Prantal 50 6.81 13.54 6.81 0.13460

Only if prescribed for an amputee with an artificial limb, or for a paraplegic patient and the prescription endorsed accordingly.

 Barrier Creams and Emollients Barrier Creams Zinc Crm BP PSM 500 6.55 12.00 6.55 0.01090 Zinc and castor oil Oint BP PSM 500 5.11 5.11 5.11 0.00000 Emollients Glycerol with paraffin and cetyl alcohol Lotn 5% with paraffin liq 5% and cetyl alcohol 2% QV 250 1.40 8.10 1.40 0.02680 Urea Crm 10% Nutraplus 100 2.52 3.07 2.52 0.00550 Wool fat with mineral oil Lotn hydrous 3% with mineral oil Alpha-Keri Lotion 1000 5.60 20.53 5.60 0.01493 200 1.12 5.00 1.12 0.01940 375 2.10 9.38 2.10 0.01941 Hydroderm Lotion 250 1.40 2.92 1.40 0.00608 1000 5.60 9.54 5.60 0.00394 BK Lotion 250 1.40 7.73 1.40 0.02532 1000 5.60 23.91 5.60 0.01831 DP Lotion 250 1.40 3.50 1.40 0.00840 1000 5.60 10.90 5.60 0.00530 Aqueous cream Crm AFT 500 2.28 2.28 2.28 0.00000 Cetomacrogol Crm BP PSM 500 3.50 3.50 3.50 0.00000 Emulsifying ointment Oint BP AFT 500 3.69 3.69 3.69 0.00000 Oily cream Crm BP PSM 500 2.80 15.40 2.80 0.02520 David Craig 500 2.80 13.60 2.80 0.02160 Oil in water emulsion Crm Lemnis Fatty Cream 500 2.80 2.80 2.80 0.00000 healthE Fatty Cream 500 2.80 2.80 2.80 0.00000 Other Dermatological Bases Paraffin White soft PSM 500 3.58 8.69 3.58 0.01022 IPW 500 3.58 7.78 3.58 0.00840 2500 20.20 20.20 20.20 0.00000

Only in combination with a dermatological galenical or as a diluent for a proprietary Topical Corticosteroid – Plain.

 Minor Skin Infections Minor Skin Infections Povidone iodine Oint 10% Betadine 25 2.88 3.27 2.88 0.01560 Antiseptic soln 10% Betadine 4500 51.06 51.06 51.06 0.00000 100 1.28 6.01 1.28 0.04730 500 6.20 6.20 6.20 0.00000 15 0.19 3.27 0.19 0.20533 Riodine 100 1.28 4.20 1.28 0.02920 500 6.20 6.20 6.20 0.00000 Skin preparation, povidone iodine 10% with 30% alcohol Betadine Skin Prep 100 1.63 3.60 1.63 0.01970 500 10.00 10.00 10.00 0.00000 Skin preparation, povidone iodine 10% with 70% alcohol Orion 100 1.63 6.04 1.63 0.04410 500 8.13 18.63 8.13 0.02100 Parasiticidal Preparations Parasiticidal Preparations Malathion Liq 0.5% Derbac-M 200 4.99 4.99 4.99 0.00000 Shampoo 1% A-Lices 30 2.83 2.83 2.83 0.00000 Gamma benzene hexachloride Crm 1% Benhex 50 3.50 3.50 3.50 0.00000 Permethrin Crm 5% Lyderm 30 4.20 4.20 4.20 0.00000

  1. Should be strictly reserved for use as second line therapy in:

    1. patients unable to tolerate the other medications, such as infants, young children and patients with allergies or eczema;

    2. cases of scabies which are resistent to gamma benzene hexachloride and resistant to malathion.

  2. Verification of drug resistance is dependent on the persistence of the condition after treatment. In order to establish whether there is drug resistance, the following criteria should be fulfilled:

    1. a definite diagnosis of scabies should be made;

    2. it should be ascertained that the medication was administered properly;

    3. the possibility of reinfestation should have been excluded.

 Psoriasis and Eczema Preparations Psoriasis and Eczema Preparations Coal tar with allantoin, menthol, phenol and sulphur Soln 5% with sulphur 0.5%, menthol 0.75%, phenol 0.5% and allantoin crm 2.5% Egopsoryl TA 30 3.43 4.35 3.43 0.03067 75 6.59 8.00 6.59 0.01880 Tar with triethanolamine lauryl sulphate and fluorescein Soln 2.3% with triethanolamine lauryl sulphate and fluorescein sodium Pinetarsol 500 2.90 2.90 2.90 0.00000 1000 5.54 5.54 5.54 0.00000 Tar with cade oil Bath emul 7.5% coal tar, 2.5% cade oil, 7.5% compound Polytar Emollient 350 9.70 29.60 9.70 0.05686 Acitretin Cap 10 mg Neotigason 100 75.80 75.80 75.80 0.00000 Cap 25 mg Neotigason 100 162.96 162.96 162.96 0.00000 <range>Acitretin</range> Applicant is a vocationally registered dermatologist, vocationally registered general practitioner, or nurse practitioner working in a relevant scope of practice Applicant has an up to date knowledge of the treatment options for psoriasis and of disorders of keratinisation and is aware of the safety issues around acitretin and is competent to prescribe acitretin Patient is female and has been counselled and understands the risk of teratogenicity if acitretin is used during pregnancy and the applicant has ensured that the possibility of pregnancy has been excluded prior to the commencement of the treatment and that the patient is informed that she must not become pregnant during treatment and for a period of two years after the completion of the treatment Patient is male any relevant practitioner 1 Applicant is a vocationally registered dermatologist, vocationally registered general practitioner, or nurse practitioner working in a relevant scope of practice Applicant has an up to date knowledge of the treatment options for psoriasis and of disorders of keratinisation and is aware of the safety issues around acitretin and is competent to prescribe acitretin Patient is female and has been counselled and understands the risk of teratogenicity if acitretin is used during pregnancy and the applicant has ensured that the possibility of pregnancy has been excluded prior to the commencement of the treatment and that the patient is informed that she must not become pregnant during treatment and for a period of two years after the completion of the treatment Patient is male any relevant practitioner 1 Calcipotriol Soln 50 mcg per ml Daivonex 30 20.78 20.78 20.78 0.00000 60 34.72 34.72 34.72 0.00000 Crm 50 mcg per g Daivonex 30 20.76 20.76 20.76 0.00000 100 57.89 57.89 57.89 0.00000 Oint 50 mcg per g Daivonex 30 20.76 20.76 20.76 0.00000 100 57.89 57.89 57.89 0.00000 Coal tar Soln BP PSM 500 36.48 36.48 36.48 0.00000 David Craig 200 12.98 16.20 12.98 0.01610

Up to 10 %

Only in combination with a dermatological base or proprietary Topical Corticosteriod – Plain, refer

With or without other dermatological galenicals.

 Dithranol Crm 1% Micanol 50 27.50 27.50 27.50 0.00000 Salicylic acid Powder PSM 250 18.88 18.88 18.88 0.00000 ABM 500 15.00 15.00 15.00 0.00000

  1. Only in combination with a dermatological base or proprietary Topical Corticosteroid – Plain or collodion flexible, refer

  2. With or without other dermatological galenicals.

  3. Maximum 20 g or 20 ml per prescription when prescribed with white soft paraffin or collodion flexible.

 Sulphur Precipitated PSM 100 6.50 9.25 6.50 0.02750 ABM 100 6.50 6.50 6.50 0.00000

  1. Only in combination with a dermatological base or proprietary Topical Corticosteroid – Plain, refer

  2. With or without other dermatological galenicals.

 Coal tar with salicylic acid and sulphur Soln 12% with salicylic acid 2% and sulphur 4% oint Coco-Scalp 40 7.95 7.95 7.95 0.00000 Scalp Preparations Scalp Preparations Clobetasol propionate Scalp app 0.05% Dermol 30 6.36 6.36 6.36 0.00000 Hydrocortisone butyrate Scalp lotn 0.1% Locoid 100 7.52 7.52 7.52 0.00000 Ketoconazole Shampoo 2% Sebizole 100 3.48 3.48 3.48 0.00000 Betamethasone valerate Scalp app 0.1% Beta Scalp 100 7.22 7.22 7.22 0.00000 Sunscreens Sunscreens Sunscreens, proprietary Crm Hamilton Sunscreen 100 2.55 5.89 2.55 0.03340 Aquasun Oil Free Faces SPF30+ 50 1.28 5.50 1.28 0.08440 Lotn Aquasun 30+ 125 3.19 6.94 3.19 0.03000 Aquasun Sensitive SPF 30+ 125 3.19 8.82 3.19 0.04504 Marine Blue Lotion SPF 30+ 200 5.10 5.10 5.10 0.00000 100 2.55 2.55 2.55 0.00000

Only if prescribed for a patient with severe photosensitivity secondary to a defined clinical condition and the prescription is endorsed accordingly.

 Wart Preparations Wart Preparations Podophyllotoxin Soln 0.5% Condyline 3.5 33.60 33.60 33.60 0.00000 Imiquimod Crm 5% sachet Aldara 12 110.40 110.40 110.40 0.00000 <range>Imiquimod</range> The patient has external anogenital warts and podophyllotoxin has been tried and failed (or is contraindicated) The patient has external anogenital warts and podophyllotoxin is unable to be applied accurately to the site The patient has confirmed superficial basal cell carcinoma where other standard treatments, including surgical excision, are contraindicated or inappropriate any relevant practitioner 4

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.

External anogenital warts

  • Imiquimod is only indicated for external genital and perianal warts (condyloma acuminata).

 Inadequate response to initial treatment for anogenital warts New confirmed superficial basal cell carcinoma where other standard treatments, including surgical excision, are contraindicated or inappropriate Inadequate response to initial treatment for superficial basal cell carcinoma any relevant practitioner 4

Confirmation that the lesion is a superficial basal cell carcinoma should be obtained using a biopsy

For salicylic acid preparations refer to PSORIASIS AND ECZEMA PREPARATIONS

 Other Skin Preparations Antineoplastics Fluorouracil sodium Crm 5% Efudix 20 26.49 26.49 26.49 0.00000 Topical Analgesia Capsaicin Crm 0.075% Zostrix HP 45 12.50 12.50 12.50 0.00000

Subsidised only if prescribed for post-herpetic neuralgia or diabetic peripheral neuropathy and the prescription is endorsed accordingly.

For aspirin & chloroform application refer

 Wound Management Products Hydrogen peroxide Soln 20 vol PSM 100 0.63 2.35 0.63 0.01720 500 3.13 7.00 3.13 0.00774 Magnesium sulphate Paste PSM 80 2.98 4.90 2.98 0.02400 Genito-Urinary System Contraceptives - Non-hormonal Condoms Condoms 52 mm extra strength Marquis Protecta 144 13.36 13.36 13.36 0.00000 53 mm Gold Knight 144 13.36 13.36 13.36 0.00000 12 1.11 1.11 1.11 0.00000 Shield Blue 12 1.11 1.11 1.11 0.00000 144 13.36 13.36 13.36 0.00000 Marquis Titillata 144 13.36 13.36 13.36 0.00000 Marquis Black 144 13.36 13.36 13.36 0.00000 54 mm, shaped Lifestyles Flared 12 1.12 1.24 1.12 0.01000 144 13.36 14.84 13.36 0.01028 52 mm Marquis Supalite 144 13.36 13.36 13.36 0.00000 Marquis Selecta 144 13.36 13.36 13.36 0.00000 Marquis Sensolite 144 13.36 13.36 13.36 0.00000 56 mm, shaped Durex Confidence 12 1.11 1.11 1.11 0.00000 144 13.36 13.36 13.36 0.00000 49 mm Shield 49 144 13.36 13.36 13.36 0.00000 Gold Knight 12 1.11 1.11 1.11 0.00000 144 13.36 13.36 13.36 0.00000 MarquisTantiliza 144 13.36 13.36 13.36 0.00000 53 mm (chocolate) Gold Knight 144 13.36 13.36 13.36 0.00000 12 1.11 1.11 1.11 0.00000 53 mm (strawberry) Gold Knight 12 1.11 1.11 1.11 0.00000 144 13.36 13.36 13.36 0.00000 55 mm Gold Knight 12 1.11 1.11 1.11 0.00000 144 13.36 13.36 13.36 0.00000 Marquis Conforma 144 13.36 13.36 13.36 0.00000 53 mm extra strength Gold Knight 12 1.11 1.11 1.11 0.00000 144 13.36 13.36 13.36 0.00000 60 mm Shield XL 144 13.36 13.36 13.36 0.00000 56 mm extra strength Durex Extra Safe 144 13.36 13.36 13.36 0.00000 56 mm Durex Select Flavours 144 13.36 13.36 13.36 0.00000 Spermicidal Agents Applicator Applicator Ortho 1 4.34 4.34 4.34 0.00000

When ordered with a spermicide.

 Nonoxynol-9 Jelly 2% Gynol II 108 10.95 10.95 10.95 0.00000 Contraceptive Devices Intra-uterine device IUD Multiload Cu 375 1 39.50 39.50 39.50 0.00000 Multiload Cu 375 SL 1 39.50 39.50 39.50 0.00000

Distributed by Pharmaco NZ Ltd, PO Box 4079, Auckland Ph 09 377 3336

 Diaphragm Diaphragm Ortho Coil 1 42.90 42.90 42.90 0.00000 1 42.90 42.90 42.90 0.00000 1 42.90 42.90 42.90 0.00000 1 42.90 42.90 42.90 0.00000 1 42.90 42.90 42.90 0.00000 1 42.90 42.90 42.90 0.00000 1 42.90 42.90 42.90 0.00000 1 42.90 42.90 42.90 0.00000 Ortho All-flex 1 42.90 42.90 42.90 0.00000 1 42.90 42.90 42.90 0.00000 1 42.90 42.90 42.90 0.00000 1 42.90 42.90 42.90 0.00000 1 42.90 42.90 42.90 0.00000 1 42.90 42.90 42.90 0.00000 1 42.90 42.90 42.90 0.00000

One of each size is permitted on a PSO.

 Contraceptives - Hormonal Combined Oral Contraceptives Ethinyloestradiol with norethisterone Tab 35 mcg with norethisterone 500 mcg Brevinor 21 63 21 6.62 6.62 6.62 0.00000 Tab 35 mcg with norethisterone 500 mcg and 7 inert tab Norimin 84 28 6.62 6.62 6.62 0.00000 Tab 35 mcg with norethisterone 1 mg Brevinor 1/21 63 21 6.62 6.62 6.62 0.00000 Tab 35 mcg with norethisterone 1 mg and 7 inert tab Brevinor 1/28 84 28 6.62 6.62 6.62 0.00000 Ethinyloestradiol with desogestrel Tab 20 mcg with desogestrel 150 mcg Mercilon 21 63 21 6.62 16.50 13.80 0.15683 Tab 20 mcg with desogestrel 150 mcg and 7 inert tab Mercilon 28 84 28 6.62 16.50 13.80 0.11762 Tab 30 mcg with desogestrel 150 mcg Marvelon 21 63 21 6.62 16.50 13.80 0.15683 Tab 30 mcg with desogestrel 150 mcg and 7 inert tab Marvelon 28 84 28 6.62 16.50 13.80 0.11762 Ethinyloestradiol with gestodene Tab 30 mcg with gestodene 75 mcg and 7 inert tab Femodene 28 84 28 6.62 16.50 14.49 0.11762 Ethinyloestradiol with levonorgestrel Tab ethinyloestradiol 30 mcg with levonorgestrel 50 mcg (6) and tab ethinyloestradiol 40 mcg with levonorgestrel 75 mcg (5), and tab ethinyloestradiol 30 mcg with levonorgestrel 125 mcg (10) and 7 inert tab Triquilar ED 84 28 6.62 9.45 9.45 0.03369 Trifeme 84 28 6.62 6.62 6.62 0.00000 Tab 50 mcg