ANNEXURE A ISSUE No. 02/10 UPDATED: 30-Nov-10 INCLUDES: Supplementary List No: 122 to access cover sheet on page 1 above - unfreeze panes *EDL 1= Primary; A= Hospital Level Adult; P = Hospital Level Paediatrics CATALOGUE OF APPROVED PHARMACEUTICALS FOR USE IN THE DEPARTMENT OF HEALTH PROVINCIAL CODE LIST Page 1 of 96
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ANNEXURE A
ISSUE No. 02/10
UPDATED: 30-Nov-10INCLUDES: Supplementary List No: 122
to access cover sheet on page 1 above - unfreeze panes
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
4-epi-doxorubicin: see epirubicin5-fluoro-uracil: see fluorouracil
J05AF 18.12pgwcARV depot
abacavir 20mg/ml 240ml solution ZIAGEN AIDS programmeAvailable through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.
J05AF 18.12pgwcARV depot
abacavir 300mg 60 tablet ZIAGEN AIDS programme As above.
R05CB 28 Supp List 118 N-acetylcysteine1
A P200mg/ml 1 injection PARVOLEX
S01EC 16.1 acetazolamide A 500mg/10ml 1 injection DIAMOX; AZOMID
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J05AB 18.12 acyclovir A P 250mg 5 injection ZOVIRAX Specialist J05AB 18.12 acyclovir P 200mg/5ml 125ml suspension ZOVIRAX Specialist
J05AB 18.12Suppl List 119/122
acyclovir 1 A P 200mg 25 tablet ZOVIRAXGeneral Clinical Nurse Practitioner
General: For Primary Genital Herpes, GUS, Chronic Herpetic Ulcer, Herpes Zoster, Eczema Herpeticum, Herpes Stomatitis and Ophthalmic Zoster: According to H135/2002 Addendum A - Supp List 92. Clinical Nurse Practitioner:Genital Ulcer Syndrome (GUS) according to EDL STG's
J05AB 18.12Suppl List 119/122
acyclovir 1 A P 400mg 70 tablet ZOVIRAXGeneral Clinical Nurse Practitioner
General: For Primary Genital Herpes, GUS, Chronic Herpetic Ulcer, Herpes Zoster, Eczema Herpeticum, Herpes Stomatitis and Ophthalmic Zoster: According to H135/2002 Addendum A - Supp List 92. Clinical Nurse Practitioner:Genital Ulcer Syndrome (GUS) according to EDL STG's
adamson's ointment modified:look under LPC 4% ……..
C01EB 7.2 Supp List 122 adenosine A P 6mg/2ml 1 injection ADENOCORC01CA 7.1.2 adrenaline B.P. 1 A P 1:1000 1mg/ml 1 injection ADRENALINE
P02CA 13Suppl List 119/121
albendazole 1 A P 200mg 2 tablet ZENTEL
For: - Children under two years of age - Neurocysticercosis - Hydatid cysts - Tape worm - Sandworm
P02CA 13Suppl List 119/121
albendazole 1 A P 400mg 2 tablet ZENTEL
For: - Children under two years of age - Neurocysticercosis - Hydatid cysts - Tape worm - Sandworm
B05AA Ø albumin, normal serum P 0.2 50ml infusionSpecialist paediatrician
B05AA Ø albumin, normal serum P 0.2 100ml infusionSpecialist paediatrician
Page 3 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
M05BA 4.7.1 alendronate A 10mg 30 tablets OSTEOBONSpecialist endocrinologist initiated
Endocrinologist initiated with 18-month follow-up with endocrinilogist. Restricted to severe osteoporosis with T-score -2,5 or less plus osteoporotic fracture
A11CC 20.1 alfacalcidol P 0,25µg 30 capsule ONE-ALPHA
Specialist physicians and paediatricians initiated
A11CC 20.1 alfacalcidol P 1µg 30 capsule ONE-ALPHA
Specialist physicians and paediatricians initiated
N01AH 2.1.2 alfentanil A 1mg/2ml 1 injection RAPIFEN SpecialistN01AH 2.1.2 alfentanil A 5mg/10ml 5 injection RAPIFEN Specialist
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
amethopterin: See methotrexate
J01GB 18.3 amikacin A P 100mg 1 injectionAMIKIN; KACINTH-A
SpecialistTo be confirmed on a microbiologist report or requested on the motivation form. Restriction exempted for ICU's.
J01GB 18.3 amikacin P 250mg 1 injection AMIKIN Specialist As aboveJ01GB 18.3 amikacin A 500mg 1 injection AMIKIN Specialist As above
N05AL 1.5.3Suppl List 116
amisulpiride 50mg 30 tablet SOLIAN
Specialist psychiatrist initiated with annual review with psychiatrist
For patients who have not responded to or experienced intolerable side effects with other coded anti-psychotics. To be used in line with the Mental Health protocol
N05AL 1.5.3Suppl List 116
amisulpiride 200mg 30 tablet SOLIAN
Specialist psychiatrist initiated with annual review with psychiatrist
For patients who have not responded to or experienced intolerable side effects with other coded anti-psychotics. To be used in line with the Mental Health protocol
B02AA 8.1 aminocaproic acid A 250mg/ml 20ml injection AMICARR03DA 10.2.2 aminophylline I.V. 1 A P 250mg/10ml 1 injection PETERPHYLLIN
N06AA 1.4.1 amitriptyline 1 A P 10mg 500 tabletTRYPTANOL; TREPILINE
N06AA 1.4.1 amitriptyline 1 A P 25mg 28 tablet TRYPTANOLN06AA 1.4.1 amitriptyline 1 A P 25mg 56 tablet TRYPTANOLN06AA 1.4.1 amitriptyline 1 A P 25mg 84 tablet TRYPTANOLN06AA 1.4.1 amitriptyline 1 A P 25mg 112 tablet TRYPTANOL
N06AA 1.4.1 amitriptyline 1 A P 25mg 168 tabletTREPILINE-25;ENDEP 25
N06AA 1.4.1 amitriptyline A P 25mg 500 tablet TRYPTANOL
Page 5 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
C08CA 7.3.7Supp List 114 and 119
amlodipine1 A
5mg 30 tablet NORVASC
For a maximum daily dose of up to10mg.When initiating a long acting calcium channel blocker in adults, commence with Amlodipine 5mg per day.NB: For complete guidelines on substituting Nifedipine extended release with Amlodipine: See Circular H5/2006 Amendment (Suppl. List 104 - Annexure D).
C08CA 7.3.7 Supp List 120 amlodipine1 A
10mg 30 tabletNORVASC; AMIODAC 10
For a maximum daily dose of up to10mg.When initiating a long acting calcium channel blocker in adults, commence with Amlodipine 5mg per day.NB: For complete guidelines on substituting Nifedipine extended release with Amlodipine: See Circular H5/2006 Amendment (Suppl. List 104 - Annexure D).
amoxycillin + clavulanic acid: see co-amoxyclav
J01CA 18.1.1 amoxycillin 1 A P 250mg 15 capsule AMOXILFor revised Amoxycillin dosage regimen:See Circular H125/2003 (Addendum A - Suppl. List 98).
J01CA 18.1.1 amoxycillin 1 A P 250mg 100 capsuleAMOXIL; MOXYPEN
As above.
J01CA 18.1.1 amoxycillin A P 250mg 500 capsule AMOXIL As above.
J01CA 18.1.1 amoxycillin 1 A 500mg 15 capsule AMOXILFor revised Amoxycillin dosage regimen:See Circular H125/2003 (Addendum A - Suppl. List 98).
J01CA 18.1.1 amoxycillin 1 A 500mg 100 capsule AMOXIL As above.
J01CA 18.1.1 amoxycillin 1 P 125mg/5ml 75ml suspension ZOXIL
For revised Amoxycillin dosage regimen:See Circular H125/2003 (Addendum A - Suppl. List 98).To use cheapest pack size on tender
J01CA 18.1.1 amoxycillin 1 P 125mg/5ml 100ml suspension AMOXILAs above.To use cheapest pack size on tender.
J01CA 18.1.1 amoxycillin 1 P 250mg/5ml 100ml suspension AMOXILFor revised Amoxycillin dosage regimen:See Circular H125/2003 (Addendum A - Suppl. List 98).
J02AA 18.8 amphotericin-B A P 50mg 1 injection FUNGIZONEA01AB 18.8 amphotericin-B A 10mg 20 lozenge FUNGIZONE
J01CA 18.1.1 ampicillin P 250mg 1 injectionPETERCILLIN; AMPIPEN
Page 6 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J01CA 18.1.1 ampicillin A P 500mg 1 injection PETERCILLIN
S01GA 15.4antazoline + naphazoline
0,5% +0,012% - 0,1%
10ml eye dropsALBALON-AANTISTIN PRIVINE
Maximum one bottle per patient per month.ALTERNATIVE: Next Item Below. Cheapest on tender will be used.
S01GA 15.4antazoline +tetrahydrozoline
0,05% +0,04%
10ml eye drops SPERSALLERGMaximum one bottle per patient per month.ALTERNATIVE: Item Above. Cheapest on tender will be used.
P01BE 18.11 Supp List 120artemether + lumefantrine
1 20mg / 120mg 24 tablets COARTEM
ascorbic acid: See Vitamin C
N02BA 3.2 aspirin soluble 1 A P 300mg 14 tablets DISPRIN
N02BA 3.2 Supp List 115 aspirin soluble1A
300mg 20 tablet DISPRINNot repeatable for acute conditions (short course)
N02BA 3.2 Supp List 115 aspirin soluble 1 A 300mg 24 tablet DISPRINNot repeatable for acute conditions (short course)
N02BA 3.2 Supp List 115 aspirin soluble 1 A P 300mg 1 000 tablets DISPRINNot repeatable for acute conditions (short course)
N02BA 3.3aspirin + codeine phosphate soluble
500mg +8mg
10 tablet CODIS Oncology and facial maxillary surgeons only.
N02BA 3.3aspirin + codeine phosphate soluble
500mg +8mg
30 tablet CODIS As above.
C07AB 7.4 atenolol A 5mg/10ml 5 injection TENORMIN Specialist
C07AB 7.4 atenolol 1 A P 50mg 28 tabletTENORMIN; ATEROL
C10AA 7.7.2 Supp List 116 atorvastatin 10mg 28 tablet LIPITOR
General - ARV clinics only Specialist: lipid clinic initiated
General: ARV clinics only, according to Health Programmes' algorithm for the management of dyslipidemia Specilaist lipid clinic intiated:; For ARV patients and Patients who do not respond suitably to Simvastatin or Bezafibrate (higher doses only i.e. doses equal to and higher than Atrovastatin 40mg daily)
Page 7 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
General: ARV clinics only, according to Health Programmes' algorithm for the management of dyslipidemia Specilaist lipid clinic intiated:; For ARV patients and Patients who do not respond suitably to Simvastatin or Bezafibrate (higher doses only i.e. doses equal to and higher than Atrovastatin 40mg daily)
To be initiated at Lipid clinics only with annual follow-up at lipid clinic
Cheapest Statin on tender to be usedAtorvastatin may only be prescribed if a dose of higher than simvastatin 40mg is required - i.e. in patients not responding to simvastatin. (Suppl. List 110)
C10AA 7.7.2 Supp List 110 atorvastatin 80mg 28 tablet LIPITOR
To be initiated at Lipid clinics only with annual follow-up at lipid clinic
Cheapest Statin on tender to be usedAtorvastatin may only be prescribed if a dose of higher than simvastatin 40mg is required - i.e. in patients not responding to simvastatin. (Suppl. List 110)
M03AC 2.3 atracurium besylate A 25mg/2,5ml 1 injection TRACRIUM For use in liver & kidney impairment onlyM03AC 2.3 atracurium besylate A 50mg/5ml 5 injection TRACRIUM As above.S01FA 15.5 atropine sulphate B.P. 1 1% 5ml eye drops COVAN ATROPINE
Coded until 01 January 2010. The product will, thereafter, be removed from code unless the required report is submitted to the PCC on or before 31 December 2010 for review of product status.
Specialist initiated - includes Family Physician initiated
For cardiac failure. NB! For Dosing Schedules refer to Annexure C of Suppl. List 105 (Circular H46/2006) & Addendum D of Suppl. List 106 (Circular H…/2006)
Specialist initiated - includes Family Physician initiated
For cardiac failure. NB! For Dosing Schedules refer to Annexure C of Suppl. List 105 (Circular H46/2006) & Addendum D of Suppl. List 106 (Circular H…/2006)
Specialist initiated - includes Family Physician initiated
For cardiac failure. NB! For Dosing Schedules refer to Annexure C of Suppl. List 105 (Circular H46/2006) & Addendum D of Suppl. List 106 (Circular H…/2006)
J01DA 18.1.2 cefamandole 1g 1 injection MANDOKEF SpecialistMotivation form to be completed or on mictobiologist report.
J01DA 18.1.2 cefazolin A P 500mg 1 injectionKEFZOL; CEFACIDAL
Specialist
Motivation form to be completed or on Microbiologist report. Cheapest 1st generation cephalosporin on tender to be used.
J01DA 18.1.2 cefazolin 1g 1 injection CEFACIDAL Specialist As for 500mg injection.
J01DA 18.1.2 cefepime 500mg 1 injection MAXIPIME SpecialistOnly for severe nosocomial infections in ICU's & on a Microbiologist report.
JO1DA 18.1.2 cefixime 400mg 1 tablet FIXIMEGeneral code: per national and provincial STI protocol
Page 13 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J01DA 18.1.2 cefotaxime 500mg 1 injection CLAFORAN SpecialistMotivation form to be completed or on Microbiologist report. Exception in neonatology and meningitis.
J01DA 18.1.2 cefotaxime A P 1g 1 injection CLAFORAN Specialist As above
J01DA 18.1.2 cefoxitin A P 1g 1 injection MEFOXIN SpecialistMotivation form to be completed or on Microbiologist report. Exception in surgical prophylaxis & in obstetrics & gynaecology.
J01DA 18.1.2 ceftazidime P 500mg 1 injection FORTUM SpecialistMotivation form to be completed or on Microbiologist report. For pseudomonas infections only.
J01DA 18.1.2 ceftazidime A P 1g 1 injection FORTUM Specialist As for 500mg injection.J01DA 18.1.2 ceftriaxone 1 P 250mg 1 injection ROCEPHIN
J01DA 18.1.2Suppl List 119
ceftriaxone 1 P 500mg 1 injection ROCEPHINGeneral Specialist
GENERAL: Meningitis and Neonatology As a single dose while awaiting transfer for: - Diarrhoea, acute, in children - Dysentery: < 12 months - Septic miscarriage - Acute pyelonephritis - Septic Arthritis - Croup: epiglottitis - Severe pneumonia - Septicaemia in children - LAP (see 1° EDL pg. 207) SPECIALIST: For other conditions - Motivation form to be completed or on microbiologist report.
J01DA 18.1.2Suppl List 119
ceftriaxone1
A P1g 1 injection ROCEPHIN
General Specialist
GENERAL: Meningitis and Neonatology As a single dose while awaiting transfer for: - Diarrhoea, acute, in children - Dysentery: < 12 months - Septic miscarriage - Acute pyelonephritis - Septic Arthritis - Croup: epiglottitis - Severe pneumonia - Septicaemia in children - LAP (see 1° EDL pg. 207) SPECIALIST: For other conditions - Motivation form to be completed or on microbiologist report.
Page 14 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J01DA 18.1.2 cefuroxime P 250mg 5 injection ZINACEF SpecialistMotivation form to be completed or on Microbiologist report.
J01DA 18.1.2 cefuroxime 750mg 1 injection ZINACEF Specialist As above
J01DA 18.1.2 cefuroxime P 125mg/ml 50ml suspension ZINACEFSpecialist paediatrician
For urinary tract infections
J01DA 18.1.2 cefuroxime P 125mg/ml 100ml suspension ZINACEFSpecialist paediatrician
For urinary tract infections
J01DA 18.1.2 cefuroxime 250mg 10 tablet ZINNAT Specialist As above.J01DA 18.1.2 cefuroxime 500mg 10 tablet ZINNAT Specialist As above.
J01DA 18.1.2Suppl List
119cephalexin 125mg/5ml 100ml suspension
RANCEPH CPL-ALLIANCE CEPHALEXIN
Coded in interim i.p.o. Flucloxacillin syrup To be used where Flucloxacillin is indicated and Flucloxacillin capsules cannot be used
J01DA 18.1.2Suppl List
119cephalexin 250mg/5ml 100ml suspension
RANCEPH CPL-ALLIANCE CEPHALEXIN
Coded in interim i.p.o. Flucloxacillin syrup To be used where Flucloxacillin is indicated and Flucloxacillin capsules cannot be used
i) Prescribe only post transplant at academic institutions.ii) Dispense only at academic institutions for patients resident in the metropole.iii) Dispense at non-academic institutions for patients in the rural regions - arrange access to stock with referring Institution
3mg/ml 5ml eye drops CILOXAN; EXOCINSpecialist ophthalmologist, ENT
Cheapest floroquinolone on tender to be used.
J01MA 18.7 ciprofloxacin A P 2mg/ml 50ml injection CIPROBAY SpecialistMotivation form to be completed or on a Microbiologist report. See also under OFLOXACIN.
J01MA 18.7 ciprofloxacin A P 2mg/ml 100ml injection CIPROBAY Specialist As aboveJ01MA 18.7 Supp List 119 ciprofloxacin 1 250mg 10 tablet CIPROBAY NOT FOR MDR-TB. J01MA 18.7 Supp List 119 ciprofloxacin 1 A 500mg 10 tablet CIPROBAY NOT FOR MDR-TB.
J01MA 18.7 ciprofloxacin A 750mg 10 tablet CIPROBAY Specialist
Specialist: NOT FOR MDR-TB. Motivation form to be completed or on a Microbiologist report. Cheapest appropriate fluoroquinolone on tender to be bought. See also under OFLOXACIN.
L01XA 23 cisplatin A P 10mg/vial 1 injectionPLATAMINE; ABIPLATIN
Specialist oncologist
L01XA 23 cisplatin A P 25mg/vial 1 injection PLATAMINESpecialist oncologist
L01XA 23 cisplatin A P 50mg/vial 1 injection PLATAMINESpecialist oncologist
1. For use in High Care and ICU's on a Microbiologist report.2. On a patIent name basis in tertiary hospitals for MOTT (Mycobacterium other than tuberculosis).3. As second line agent for specialists to eradicate H. pylori. Refer to: Circular H95/2005 (Addendum B - Suppl. List 102)
J01FA 18.2 clarithromycin 500mg 14 tablet KLACID Specialist As above.
Page 18 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J01FF 18.7 clindamycin A P 150mg 100 capsule DALACIN-C SpecialistMotivation form to be completed or on a microbiologist report.
J01FF 18.7 clindamycin A P 600mg 1 injectionDALACIN-C; CLINIDAC
Specialist As above.
N05BA 1.3.1 Supp List 118 clobazam 5mg 100 capsule URBANOLSpecialist neurologist Not referable
Central hospitals - not referable. As add on therapy for epilepsy Logistical issues to be managed in the interest of patient care
N05BA 1.3.1 Supp List 118 clobazam 10mg 100 tablet URBANOLSpecialist neurologist Not referable
Central hospitals - not referable. As add on therapy for epilepsy Logistical issues to be managed in the interest of patient care
N06AA 1.4.1 clomipramine A 25mg 100 tablet ANAFRANIL
Specialist psychiatrist & neurologist initiated
N03AE 1.6 clonazepam P 1mg/ml 5 injection RIVOTRILSee guidelines for the treatment of convulsive status epilepticus in paeds: Suppl. List 106 Addendum A
N03AE 1.6 clonazepam P 2,5mg/ml 10ml oral drops RIVOTRIL
See guidelines for the use of benzodiazepines: Circular H24/2006. (Addendum I: Suppl List 107). Specialist psychiatrist, neurologist & paediatrician initiated in epilepsy.
Page 19 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
Specialist physician, cardiologist initiated: Life long use in patients with aspirin intolerance Specialist cardiologist: - other indications: 1. Drug eluting stents: Treatment duration - maximum 6 months post stent treatment 2.Metal stents: treatment duration - 4 weeks post stent treatment
N05AX 1.5.3 clothiapine 40mg/4ml 1 injection ETOMINEG01AF 14.3 clotrimazole 1 P 1% 20g cream XERASPOR T Use cheapest imidazole on tender.G01AF 17.2 clotrimazole P 1% 50g vag. cream CLOSCRIPT Use cheapest imidazole on tender.G01AF 17.2 clotrimazole 1 500mg 1 vaginal tablet CANESTEN 1J01CF 18.1.1 cloxacillin A P 250mg 1 injection ORBENINJ01CF 18.1.1 cloxacillin A P 500mg 1 injection ORBENIN; CLOXIN
N05AH 1.5.3 clozapine 25mg 100 tablet LEPONEX
Specialist psychiatrist & neurologist initiated
Psychiatrists and neurologists - for dose titration only. Policy for the use of Clozapine: Circular H117/1997 (Annexure F - Suppl. List 78.)
N05AH 1.5.3 clozapine 100mg 28 tablet LEPONEX
Specialist psychiatrist & neurologist initiated
As for other pack sizes.Policy for the use of Clozapine: Circular H117/1997 (Annexure F - Suppl. List 78)
N05AH 1.5.3 clozapine 100mg 56 tablet LEPONEX
Specialist psychiatrist & neurologist initiated
As for other pack sizes.Policy for the use of Clozapine: Circular H117/1997 (Annexure F - Suppl. List 78)
N05AH 1.5.3 clozapine 100mg 100 tablet LEPONEX
Specialist psychiatrist & neurologist initiated
Psychiatrists and neurologists.Policy for the use of Clozapine: Circular H117/1997 (Annexure F - Suppl. List 78)
Page 20 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J01CR 18.1.1Suppl List 119
co-amoxiclav 1 P125mg + 31,25mg/5ml
100ml suspension AUGMENTIN
General
Specialist
GENERAL CODE: - Pneumonia in adults with underlying medical conditions (1 ° EDL pg 287) - Pneumonia: patients > 65 years of age - Complicated cystitis in pregnancy and children as per EDL - Uncomplicated lower UTI in adult females only if stat dose of fluoroquinolone has been unsatisfactory - Complicated UTI in adults - Inpatients in place of IVI - Animal and human bites - Diabetic foot SPECIALIST: Other conditions
J01CR 18.1.1Suppl List 119
co-amoxiclav 1 P 250mg + 62,5mg/5ml 100ml suspension AUGMENTIN
General
Specialist
GENERAL CODE: - Pneumonia in adults with underlying medical conditions (1 ° EDL pg 287) - Pneumonia: patients > 65 years of age - Complicated cystitis in pregnancy and children as per EDL - Uncomplicated lower UTI in adult females only if stat dose of fluoroquinolone has been unsatisfactory - Complicated UTI in adults - Inpatients in place of IVI - Animal and human bites - Diabetic foot SPECIALIST: Other conditions
Page 21 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J01CR 18.1.1Suppl List 119
co-amoxiclav1 P
A250mg + 125mg 15 tablet AUGMENTIN
General
Specialist
GENERAL CODE: - Pneumonia in adults with underlying medical conditions (1 ° EDL pg 287) - Pneumonia: patients > 65 years of age - Complicated cystitis in pregnancy and children as per EDL - Uncomplicated lower UTI in adult females only if stat dose of fluoroquinolone has been unsatisfactory - Complicated UTI in adults - Inpatients in place of IVI - Animal and human bites - Diabetic foot SPECIALIST: Other conditions
J01CR 18.1.1Suppl List 119
co-amoxiclav1 P
A250mg + 125mg 100 tablet AUGMENTIN
General
Specialist
GENERAL CODE: - Pneumonia in adults with underlying medical conditions (1 ° EDL pg 287) - Pneumonia: patients > 65 years of age - Complicated cystitis in pregnancy and children as per EDL - Uncomplicated lower UTI in adult females only if stat dose of fluoroquinolone has been unsatisfactory - Complicated UTI in adults - Inpatients in place of IVI - Animal and human bites - Diabetic foot SPECIALIST: Other conditions
Page 22 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J01CR 18.1.1Suppl List 120
co-amoxiclav1 P
A875mg + 125mg 10 tablet
AUGMENTIN; AURO-AMOXICLAV
General
Specialist
GENERAL CODE: - Pneumonia in adults with underlying medical conditions (1 ° EDL pg 287) - Pneumonia: patients > 65 years of age - Complicated cystitis in pregnancy and children as per EDL - Uncomplicated lower UTI in adult females only if stat dose of fluoroquinolone has been unsatisfactory - Complicated UTI in adults - Inpatients in place of IVI - Animal and human bites - Diabetic foot SPECIALIST: Other conditions
N01BC Ø cocaine HCl BP 25g powder ENT only.
R05DA 3.1 Supp List 118 codeine phosphate1P
25mg/5ml 500ml syrupCODEINE PHOSPHATE
For hospital use only (in or out-patients) For use in pain as per EDL and IMCI guidelines
R05DA 3.1 Supp List 116 codeine phosphate1P
30mg 100 tabletCODEINE PHOSPHATE
Specialist initiated
Oncology and GIT clinic initiated
L01XX 23 colaspase A P 10 000u 1 injection LASPARSpecialist oncologist
M04AC 4.23711048 Supp List 113
colchicine 1 A 0,5mg 50 tablet COLCHICINE
For chronic gout: 0,5mg twice a day for 3 months (up to max of 6 months) For acute attacks: Maximum of 10 tablets of 0.5mg to be prescribed per acute attack with no repeats per prescription
D03 14.9collagenase clostridiopeptidase A + peptidases
1,2units/g +0,24units/g
30g ointment IRUXOL MONOCentral Hospitals
Patient name basis.Not referable.
J01EE 18.6 co-trimoxazole I.V. 480mg/5ml 1 injection BACTRIMIntra-venous form only to be used if oral form can not be taken.
J01EE 18.6 co-trimoxazole 1 P 240mg/5ml 50ml syrup BACTRIMJ01EE 18.6 co-trimoxazole 1 P 240mg/5ml 100ml syrup BACTRIM
J01EE 18.6 co-trimoxazole 1 A P 480mg 20 tabletBACTRIM; TRIMOKS
J01EE 18.6 co-trimoxazole 1 A P 480mg 56 tabletBACTRIM; TRIMOKS
Page 23 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J01EE 18.6 co-trimoxazole A P 480mg 1 000 tabletTRIMETHOX; MEZENOL; PURBAC
G03XA 19.8 danazol 200mg 60 tablet LADOGAR Specialist As above.
M03CA 2.3 dantroline A P 20mg 1 injection DANTRIUMFor use in malignant hyperthermia only. Contact Regional Chief Pharmacist to ascertain where stocks are kept.
J04BA 18.8.2 dapsone A 100mg 100 tabletLENNON-DAPSONE; MALOPRIM
L01DB 23 daunorubicin A 20mg 1 injection CERUBIDINSpecialist oncologist
Page 25 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
V03AC 25 Supp List 120 deferasirox 125mg 28dispersible tablet
EXJADESpecialist paediatrician Non-referable
Patient named basis For treatment of Thalassaemia in paediatrics Paediatric patients initiated on deferasirox may continue treatment when handed to an adult Central hospital
V03AC 25 Supp List 120 deferasirox 250mg 28dispersible tablet
EXJADESpecialist paediatrician Non-referable
Patient named basis For treatment of Thalassaemia in paediatrics Paediatric patients initiated on deferasirox may continue treatment when handed to an adult Central hospital
V03AC 25 Supp List 120 deferasirox 500mg 28dispersible tablet
EXJADESpecialist paediatrician Non-referable
Patient named basis For treatment of Thalassaemia in paediatrics Paediatric patients initiated on deferasirox may continue treatment when handed to an adult Central hospital
V03AC 25 desferrioxamine A P 500mg 1 injection DESFERAL Store below 15 degree Celsius.
H01BA8.116.2
desmopressin A P 100µg/ml 2,5mlintranasal solution
Available at Groote Schuur & Tygerberg Hospital Family Planning clinics only. Refer patients to these clinics if unacceptable side effects persist on oral contraceptives.
S01BA 15.2 dexamethasone A 0.1% solution 5ml eye dropsSPERSADEXMAXIDEX
Specialist ophthalmologist initiated
H02AB 19.5 dexamethasone A P 4mg/ml 1 injection DECASONE
S01XA 15.7 Supp List 118dextran 70 + hydroxypropyl methylcellulose
0,3% 15ml eye dropsTEARS NATURALE II
Specialist initiated
V03AH 22 dextrose 1 50% 20ml 1 injectionV03AH 22 dextrose 50% 50ml 1 injectionV04CA Ø dextrose monohydrate BP 75g powderV04CA 31 dextrose monohydrate BP 50g powder For glucose tolerance test.V04CA 31 dextrose monohydrate BP 500g powder
B05ZA Ødialysis solution for haemodialysis with low magnesium
B05DB Ødialysis solution for peritoneal dialysis+ dextrosr 1,5%
1,5%2 000ml in 2 000ml bag
solutionSABAX DIANEAL 1,5AFB 9856
B05DB Ødialysis solution for peritoneal dialysis + dextrose 2,5%
2,5%2 000ml in 2 000ml bag
solutionSABAX DIANEAL 2,5AFB 9876
B05DB Ødialysis solution for peritoneal dialysis+ dextrosr 4,25%
4,25%2 000ml in 2 000ml bag
solutionSABAX DIANEAL 4,25AFB 9792
N05BA 1.3.1 diazepam 1 A P 10mg/2ml 1 injection VALIUM, PAX
Page 27 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
N05BA 1.3.1 diazepam A 2mg 14 tablet VALIUM, PAX
No more than 14 days supply, unless when prescribed by a psychiatrist, neurologist or paediatrician, when 28 days supply may be dispensed. See circular H24/2006; Suppl List 107 - addendum I
N05BA 1.3.1 diazepam A 2mg 500 tabletVALIUM; PAX; DIAQUEL
As above.
N05BA 1.3.1 diazepam A 5mg 14 tablet VALIUM, PAX
No more than 14 days supply, unless when prescribed by a psychiatrist, neurologist or paediatrician, when 28 days supply may be dispensed. See circular H24/2006; Suppl List 107 - addendum I
N05BA 1.3.1 diazepam A 5mg 28 tablet VALIUM; PAX
No more than 14 days supply, unless when prescribed by a psychiatrist, neurologist or paediatrician, when 28 days supply may be dispensed. See circular H24/2006; Suppl List 107 - addendum I
N05BA 1.3.1 diazepam A 5mg 56 tablet VALIUM; PAX
No more than 14 days supply, unless when prescribed by a psychiatrist, neurologist or paediatrician, when 28 days supply may be dispensed. See circular H24/2006; Suppl List 107 - addendum I
N05BA 1.3.1 diazepam A 5mg 500 tablet VALIUM, PAX
No more than 14 days supply, unless when prescribed by a psychiatrist, neurologist or paediatrician, when 28 days supply may be dispensed. See circular H24/2006; Suppl List 107 - addendum I
N05BA 1.3.1 diazepam 10mg 90 tablet VALIUM, PAX As above.C02DA 7.3.1 diazoxide P 300mg/20ml 1 injection HYPERSTAT Specialist
M01AB 4.1 diclophenac 12,5mg 5 suppository VOLTARENSingle dose peri / post operative in paediatrics
M01AB 4.1 diclophenac P 25mg 5 suppository VOLTARENSingle dose peri / post operative in paediatrics
M01AB 4.1 Supp List 119 diclophenac 25mg 84 tabletVOLTAREN, PANAMOR
FOR ACUTE CONDITIONS: Not more than 5 days supply. Not repeatable For longer periods, the appropriate diagnosis and quantities to be written on the prescription
Page 28 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
M01AB 4.1 Supp List 119 diclophenac 25mg 100 tabletVOLTAREN, PANAMOR
FOR ACUTE CONDITIONS: Not more than 5 days supply. Not repeatable For longer periods, the appropriate diagnosis and quantities to be written on the prescription
FOR ACUTE CONDITIONS: Not more than 5 days supply. Not repeatable For longer periods, the appropriate diagnosis and quantities to be written on the prescription
J05AB 18.12pgwcARV depot
didanosine 1 25mg 60 tablet VIDEX AIDS programmeAvailable through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.
J05AB 18.12pgwcARV depot
didanosine 1 50mg 61 tablet VIDEX AIDS programme As above.
J05AB 18.12pgwcARV depot
didanosine 1 100mg 62 tablet VIDEX AIDS programme As above.
J05AB 18.12pgwcARV depot
didanosine 1 150mg 63 tablet VIDEX AIDS programme As above.
C01AA 7.1.1 digoxin P 0,05mg/ml 50mlelixir-paed/geriatr
LANOXIN
C01AA 7.1.1 digoxin A P 0,5mg/2ml 1 injection LANOXIN Specialist For use in ICU's
Specialist initiated: For use in GIT clinics only and intolerance to metoclopramide. Specialist neurologist initiated: For prevention of dopaminergic side effects
C01CA 7.1.2 dopamine HCl A P 200mg/5ml 1 injectionINTROPIN; DYNOS FOR INFUSION
Page 30 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
General code: For benign protatic hyperplasia (BPH) up to a max of 4mg daily with referral to urologist within 6 months Specialist urologist initiated: For BPH up to max of 8mg Specialist physician, paediatrician & nephrologist initiated: For hypertension as 4th or 5th line treatment up to max of 8mg daily
X 1.1.2 doxapram 20mg/ml 20ml 1 injection DOPRAM SpecialistFor use in paediatric intensive care and neonatal units
L01DB 23 doxorubicin A P 10mg 1 injection ADRIBLASTINASpecialist oncologist
L01DB 23 doxorubicin A P 50mg 1 injection ADRIBLASTINASpecialist oncologist
J01AA 18.4.1 doxycycline 1 A P 100mg 6 capsule VIBRAMYCIN
J01AA 18.4.1 doxycycline 1 A P 100mg 10 capsuleVIBRAMYCIN; DOXYCLIN
J01AA 18.4.1 doxycycline 1 A P 100mg 14 capsule DOXYCLINJ01AA 18.4.1 doxycycline A P 100mg 100 capsule VIBRAMYCIN
N01AX 2.1.2 droperidol A 5mg/2ml 1 injection INAPSIN; PAXICAL
G03DB 19.6.3 dydrogesterone 10mg 30 tablet DUPHASTON Specialist Central hospitals only, not referable.
G01AF 17.2 econazole 150mg 3 ovules GYNO-PEVARYL SpecialistCheapest appropriate imidazole preparation on tender to be used
D01AC 14.3 econazole 1g/100g 3x10ml foaming soln. PEVARYL Specialist Central hospitals only, not referable.
J05AG 18.12pgwcARV depot
efavirenz 1 50mg 30 capsule STOCRIN AIDS programmeAvailable through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.
J05AG 19.12pgwcARV depot
efavirenz 1 200mg 30 capsule STOCRIN AIDS programme As above.
J05AG 20.12pgwcARV depot
efavirenz 1 600mg 90 capsule STOCRIN AIDS programme As above.
electrolyte & glucose powder for oral rehydration: See sodium chloride + KCl…
Page 31 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
D02AC 31 emulsifying ointment 1 BP 500g ointmentEMULSIFYING OINT.
X 31 emulsifying wax BP 25kg waxEMULSIFYING WAX
C09AA 7.3.8 Supp List 122 enalapril 1 A P 2,5mg 28 tablet RENITEC
Cheapest ACE inhibitor on tender to be used.For hypertension & cardiac failure: 20mg maximum daily dose.For proteinuria: 40mg maximum daily dose.
C09AA 7.3.8 enalapril 1 A P 5mg 28 tablet RENITEC As aboveC09AA 7.3.8 enalapril 1 A 10mg 28 tablet PHARMAPRESS As aboveC09AA 7.3.8 enalapril 1 A 20mg 28 tablet PHARMAPRESS As above
N01AB 2.1.1 enflurane 250mlinhalation liquid
ETHRANESpecialist aneasthetist
B01AB 8.2 Supp List 119 enoxaparin 40mg/0,4mL 1injection: pre-filled syringe
CLEXANE
General code for indications as stated in the policy for the use of LMWH's (Suppl List 116, Addendum A: Coding Status protocol for LMWH; Prescription must be endorsed with the diagnosis of the patient
B01AB 8.2 Supp List 119 enoxaparin 60mg/0,6mL 1injection: pre-filled syringe
CLEXANE
General code for indications as stated in the policy for the use of LMWH's (Suppl List 116, Addendum A: Coding Status protocol for LMWH; Prescription must be endorsed with the diagnosis of the patient
B01AB 8.2 Supp List 119 enoxaparin 80mg/0,8mL 1injection: pre-filled syringe
CLEXANE
General code for indications as stated in the policy for the use of LMWH's (Suppl List 116, Addendum A: Coding Status protocol for LMWH; Prescription must be endorsed with the diagnosis of the patient
X 22enteral nutrients/special foods
ENSUREIntegrated Nutrition Programme
NOT to be issued as a dietary supplement. Supply only on referal by a dietician for use as an enteral feed according to the Provincial Policy for Enteral Feeding.
Page 32 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
For second line treatment for Tamoxifen intolerant patients.
B02BD 8.1
factor VIIa activated recombinant coagulation (See - eptacog alfa (activated)
60 000iu (1,2mg) vial injectionNOVOSEVEN FACTOR VIIa
Central Hospitals
Haematology.On a patient name basis only.
Page 34 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
B02BD 8.1 factor VIII Concentrate 300IU 1 injectionHAEMOSOLVATE FACTOR VIII
For use in haemophiliacs only. See provincial haemophilia policy
B02BD 8.1 factor VIII Concentrate 500IU 1 injectionHAEMOSOLVATE FACTOR VIII
For use in haemophiliacs only. See provincial haemophilia policy
B02BD 8.1 factor VIII Concentrate 2X500IU 1 injectionHAEMOSOLVATE FACTOR VIII
For use in haemophiliacs only. See provincial haemophilia policy
B02BD 8.1factor IX complex human
500IU 1 injectionHAEMOSOLVEX FACTOR IX
For use in haemophiliacs only. See provincial haemophilia policy
B02BD 8.1factor VIII inhibitor bypassing activity complex
500IU 1 injectionFEIBA TIM 4 IMMUNO
For use in haemophiliacs only. See provincial haemophilia policy
B02BD 8.1factor VIII inhibitor bypassing activity complex
1000IU 1 injectionFEIBA TIM 4 IMMUNO
For use in haemophiliacs only. See provincial haemophilia policy
J05AB 18.1 famciclovir A 250mg 21 tablet FAMVIR SpecialistOnly to be used for registered indications. Motivation form to be completed.
R03AC 10.2.1 fenoterol A 100+F575/inhal 1 x 300 dose MDI complete BEROTEC Use cheapest Beta-stimulant MDI on tender.R03AC 10.2.1 fenoterol A 100µg/inhal 1 x 300 dose MDI refill BEROTEC As above
For stem cell mobilisation in bone marrow transplant donors For severe congenital neutropenia
Page 35 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J01CG 18.1.1 flucloxacillin 1 A P 250mg 20 capsule FLOXAPEN
Dosing schedule as per 1° EDL 2003. Maximum adult dose: 500mg 6 hourly. Cloxacillin may be used for porphyrics and patients over 50 years of age with cholestatic jaundice. Prescription to be endorsed accordingly.
J01CF 18.1.1 flucloxacillin 1 A P 250mg 100 capsule FLOXAPEN as aboveJ01CF 18.1.1 flucloxacillin 1 P 125mg/5ml 100ml suspension FLOXAPEN
J02AC 18.10Suppl List 119
fluconazole1 P
50mg 14 capsule DIFLUCAN
For tinea capitis - as per EDL Donated Fluconazole - Manage as a Schedule 6 medicine for Donation Programme - For management of Cryptococcal Meningitis and Candida Oesophagitis in HIV positive patients
J02AC 18.10Suppl List 119
fluconazole1
A P200mg 28 tablet DIFLUCAN
For tinea capitis - as per EDL Donated Fluconazole - Manage as a Schedule 6 medicine for Donation Programme - For management of Cryptococcal Meningitis and Candida Oesophagitis in HIV positive patients
J02AC 18.10 fluconazole 40mg/ml 35ml suspension DIFLUCANDonation drug. Handle as a special buy out
1. Manage as a Schedule 6 drug for Diflucan donation Programme.2. For management of Candida oesophagitis in HIV positive paediatric patients. Use according to treatment guidelines.
L01BC 23 fluoro-uracil A P 500mg/10ml 5 injection FLUROBLASTIN SpecialistL01BC 14.9 fluoro-uracil A P 50mg/g 10g ointment EFUDIX SpecialistL01BC 23 fluoro-uracil A P 250mg 30 tablet FLUROBLASTIN Specialist
N06AB 1.4.4 fluoxetine 1 A 20mg 28 capsule PROZAC; LORIENAs above. For use at Primary Level see protocol: Circular H112/1998 (Addendum F - Suppl. List 80)
N06AB 1.4.4 fluoxetine A 20mg 100 capsule PROZAC; LORIENNot to be used as first line treatment and a motivation for prescribing to be written on the prescription.
N05AF 1.5.3 flupenthixol A 20mg/ml 1 injection, oily FLUANXOL DEPOT
N05AF 1.5.3 flupenthixol A 40mg/2ml 1 injection, oily FLUANXOL DEPOT
N05AB 1.5.1 fluphenazine decanoate 1 A 25mg/ml 1 injection MODECATEN05AB 1.5.1 fluphenazine decanoate 1 A 250mg/10ml 1 injection MODECATE
Page 37 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
B03BB 20.1 folic acid 1 A P 5mg 28 tablet FOLIC ACIDB03BB 20.1 folic acid A P 5mg 100 tablet FOLIC ACIDB03BB 20.1 folic acid A P 5mg 1 000 tablet FOLIC ACIDV03AF 20.1 folinic acid P 3mg/ml 10 injection REFOLINON SpecialistV03AF 20.1 folinic acid P 30mg/10ml 10 injection LEUCOVORIN SpecialistV03AF 20.1 folinic acid P 50mg 1 injection LEUCOVORIN Specialist
V03AF 20.1 folinic acid P 15mg 10 tabletABIC LEUCOVORIN
Specialist
R03AC 10.2 Supp List 117 formoterol A 12µg/metered dose 1 inhaler - HFAFORATEC INHALER
specialist physician & paediatrician initiated
For adults and children over the age of 6 - cheapest LABA on tender to be used See Circular H 64/2007 Suppl List 110: Annexure A Note: Formoterol inhaler is not registerd for
i hild d th f iX Ø formaldehyde liquid 34% - 38% 2 500ml solution FORMALIN
S01CA 15.3framycetin + gramicidin + dexamethasone
8ml ear drops SOFRADEX Specialist ENT
C03CA 16.1 furosemide 1 A P 20mg/2ml 1 injection LASIX
C03CA 16.1 furosemide A P 250mg/25ml 1 injectionLASIX; SABAX FUROSEMIDE
C03CA 16.1 furosemide P 10mg/ml 100ml oral solution LASIXC03CA 16.1 furosemide 1 A P 40mg 28 tablet LASIXC03CA 16.1 furosemide A P 40mg 56 tablet LASIX; PURESISC03CA 16.1 furosemide A P 40mg 250 tablet LASIXC03CA 16.1 furosemide A P 40mg 5 000 tablet LASIXV08AB Ø gadobutrol 1 injection GADOVIST Specialist Radiology
P03AB 14.2gamma benzene hexachloride
1% 100ml lotion GAMBEX LOTIONOnly for use in children up to the age of 12 years
P03AB 14.2gamma benzene hexachloride
1% 100ml shampooGAMBEX SHAMPOO; QUELLADA
As above
J01GB 18.3 gentamicin P 20mg/2ml 1 injection GARAMYCIN
J01GB 18.3 gentamicin A P 80mg/2ml 1 injectionGARAMYCIN; FERMENTMYCIN
A10BB 19.1.2 glibenclamide 1 A 5mg 28 tablet DAONILA10BB 19.1.2 glibenclamide 1 A 5mg 56 tablet DAONIL
A10BB 19.1.2 glibenclamide 1 A 5mg 84 tabletDAONIL; EUGLUCON; GLYCOMIN
A10BB 19.1.2 glibenclamide A 5mg 100 tablet DAONIL
A10BB 19.1.2 glibenclamide A 5mg 500 tabletGLYBEN; GLYCOMIN
A10BB 19.1.2 gliclazide 1 A 80mg 56 tablet DIAMICRONA10BB 19.1.2 gliclazide A 80mg 504 tablet DIAMICRONH04AA 19.2 glucagon A P 1mg/ml syringe injection GLUCAGON NOVO
M01AE 4.1 ibuprofen P 100mg/5ml 100ml syrup BRUFENGeneral Code Specialist
General Code: For peri/post operative use in paediatrics Specialist: Other indications
M01AE 4.1Suppl List 119
ibuprofen 1 A P 200mg 15 tablet
For acute conditions: Not more than 5 days supply. Not repeatable for acute conditions (short course). For longer periods, the appropriate diagnosis and quantity to be written on the prescription
M01AE 4.1Suppl List 119
ibuprofen 1 A P 200mg 84 tablet BRUFEN
For acute conditions: Not more than 5 days supply. Not repeatable for acute conditions (short course). For longer periods, the appropriate diagnosis and quantity to be written on the prescription
M01AE 4.1Suppl List 119
ibuprofen A P 200mg 1 000 tablet BRUFEN
For acute conditions: Not more than 5 days supply. Not repeatable for acute conditions (short course). For longer periods, the appropriate diagnosis and quantity to be written on the prescription
D05A 31 ichthammol ointment BP 500g ointmentICHTHAMMOL OINT.
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
M01AB 4.1 indomethacin A 25mg 15 capsuleFor use in obstetrics as a stat dose only
M01AB 4.1 indomethacin A 25mg 84 capsule INDOCIDFor use in obstetrics as a stat dose only
M01AB 4.1 indomethacin A 25mg 1 000 capsuleINDOCID; ARTHREXIN
For use in obstetrics as a stat dose only
M01AB 4.1 indomethacin A 100mg 10 suppository ARTHREXINFor in-patient use only.
X Øinhaler device with mask
1AEROCHAMBER (NEONATE)
X Øinhaler device with mask
1GLAXOHALER (CHILDREN)
X Ø Supp List 116 1re-useable pen
BATSWADI AUTOPEN
Specialist physician, paediatrician and endocrinologist
Paediatrics and adolescents only. To be initiated at Central Hospitals only. Autopen: Non-Referable
A10AA 19.1.1 Supp List 116insulin human soluble biosynthetic 100units/ml 3mL cartridge
HUMULIN R CARTRIDGE
Specialist physician, paediatrician and endocrinologist
Paediatrics and adolescents only. To be initiated at Central Hospitals only. Referable
A10AA 19.1.1 Supp List 116insulin human soluble/isophane
30% / 70%100units/ml
3mL cartridgeHUMULIN 30/70 CARTRIDGE
Specialist physician, paediatrician and endocrinologist
Paediatrics and adolescents only. To be initiated at Central Hospitals only. Referable
A10AA 19.1.1 Supp List 116insulin human isophane biosynthetic
100units/ml 3ml cartridge HUMULIN N
Specialist physician, paediatrician and endocrinologist
Paediatrics and adolescents only. To be initiated at Central Hospitals only. Referable
A10AA 19.1.1insulin human soluble biosynthetic 100units/ml 10ml injection
HUMULIN R; ACTRAPID HM(ge)
insulin injection device for use with 3mL insulin cartridge containing 100 units per 1mL (device is colour coded to correspond with insulin type)
Page 43 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
A10AA 19.1.1insulin human soluble biosynthetic A P 100units/ml 3ml penset ACTRAPID HM(ge)
Pensets to be used only in young patients (juvenile diabetes) and patients not capable of using vials & syringes e.g. impaired vision or the elderly.
A10AA 19.1.1insulin human soluble + isophane 1
30% + 70%100units/ml
10ml injectionACTRAPHANE HM(ge) HUMULIN 30/70
A10AA 19.1.1insulin human soluble + isophane (yeast)
30% / 70%100units/ml
3ml pensetACTRAPHANE HM(ge); HUMULIN 30/70
Pensets to be used only in young patients (juvenile diabetes) and patients not capable of using vials & syringes e.g. impaired vision or the elderly.
A10AA 19.1.1insulin human isophane biosynthetic
1 100units/ml 10ml injectionPROTAPHANE HM(ge); HUMULIN N
A10AA 19.1.1insulin human isophane biosynthetic
100units/ml 3ml pensetPROTAPHANE HM(ge)
Pensets to be used only in young patients (juvenile diabetes) and patients not capable of using vials & syringes e.g. impaired vision or the elderly.
A10AA 19.1.1 insulin human lispro 100units/ml 10ml injection HUMALOGCentral Hospitals
Patient name basis.Not referable.
A10AA 19.1.1 insulin human lispro 100units/ml 3ml penset HUMALOGCentral Hospitals
Patient name basis.Not referable.
X Ø insulin needles 100 needlesNOVOFINE NEEDLES
L03AA 23 interferon-alpha 2a A P 3mu/vial 1 injection ROFERON A Specialist
Cheapest on tender of alpha 2a or 2b to be bought.For use in hairy-cell leukemia and condyloma acumiata.
L03AA 29 interferon-alpha 2b A P 3mu/vial 1 injection INTRON - A Specialist As aboveV08AB Ø iobitridol 300mg/ml 50ml 1 injection XENETIX Specialist Only for Radiography
D08AG Ø iodine solution BP 500ml liquidWEAK IODINE SOLN.
EDL
D08A Øiodochlorohydroxyquinolone (clioquinol)
50g powder VIOFORM
Page 44 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
Only for use in patients with a history of reaction to contrast media; history of allergy, coronary angiography in high risk patients & children;myelography; certain neuroradiological procedures; peripheral angiography when necessary.
V08AB Ø iohexol 250mg/ml 10ml 10 injection OMNIPAQUE Specialist As aboveV08AB Ø iohexol A 300mg/ml 20ml 20 injection OMNIPAQUE Specialist As aboveV08AB Ø iohexol A 300mg/ml 50ml 10 injection OMNIPAQUE Specialist As aboveV08AB Ø iohexol 350mg/ml 50ml 10 injection OMNIPAQUE Specialist As aboveV08AB Ø iohexol 350mg/ml 100ml 10 injection OMNIPAQUE Specialist As aboveV08AB Ø iopamidol 0,612g/ml 50ml 10 injection JOPAMIRON SpecialistV08AB Ø iopamidol 0,755g/ml 50ml 10 injection JOPAMIRON Specialist As aboveR03BB 10.4 ipratropium bromide 1 A P 0,04mg/inhal. 1 MDI complete ATROVENT
R03BB 10.4 ipratropium bromide A P 0,25mg/ml 2ml 60 UDVinhalation solution in a Unit Dose Vial
ATROVENT
X Ø iron bile salts 300mg 40 capsule BILRONSpecialist initiated
Lipid clinics only. For use in cerebrotendinous xanthomatosis.
B03AC 8.6 iron sucrose complex 100mg/5ml I.V. 1 injection VENOFER
N01AB 2.1.1 isoflurane A P 100ml inhal FORANE; ISOFOR SpecialistJ04AC 18.6.1 isoniazid 1 A P 100mg 1 000 tablet ISONIAZIDC01DA 7.4 isosorbide dinitrate 1 A P 5mg 50 tablet ISORDIL; DILANIDC01DA 7.4 isosorbide dinitrate A P 40mg 30 tembid ISORDIL TEMBIDS As above
C01DA 7.4 isosorbide dinitrate A P 40mg 100 tembid ISORDIL TEMBIDSMAX. 40mg twice daily with eccentric regimen.
C01DA 7.4 isosorbide-5-mononitrate A P 20mg 60 tablet ELANTAN 20To be used when cost and availability of dinitrate is a problem. 20mg mononitrate is equivalent to 40mg dinitrate.
C01DA 7.4 isosorbide-5-mononitrate A P 20mg 500 tablet ISMO-20To be used when cost and availability of dinitrate is a problem. 20mg mononitrate is equivalent to 40mg dinitrate.
Central hospitals, Patient name basis, Not referable.
J02AC 18.10 itraconazole 100mg 14 capsuleADCO-SPORAZOLE (ON TENDER)
Specialist dermatologist
Specialist dermatologist - Central hospitals, patient name basis - Non-referable Specialist - for AIDS & disseminated histoplasmosis following Amphotericin B initial therapy Non referable
J02AC 18.10 Supp List 113 itraconazole 100mg 28 capsuleSPORANOX/ADCO-SPORAZOLE
Specialist dermatologist Specialist
Specialist dermatologist - Central hospitals, patient name basis - Non-referable Specialist - for AIDS & disseminated histoplasmosis following Amphotericin B initial therapy Non referable
J01GB 18.3 kanamycin 1g/3ml 1 injectionKANAMYCIN NOVO
X Ø kaolin poultice BP 250g poulticeKAOLIN POULTICE
N01AX 2.1.2 ketamine A P 10mg/ml I.V. 20ml injection KETALARN01AX 2.1.2 ketamine A P 100mg/ml I.V. 10ml injection BREVINAZE
J02AB 18.8 ketoconazole A 200mg 30 tablet NIZORAL SpecialistMotivation form to be completed or on a Microbiologist report.
A06AD 12.7 lactulose A P 3.3g/5ml 150ml syrupDUPHALAC; LACSON
Hepatic encephalopathy only.
A06AD 12.7 lactulose A P 3.3g/5ml 500ml syrupDUPHALAC; LACSON
As above.
J05AF 18.12pgwc ARV depot
lamivudine 1 10mg/ml 240ml solution 3-TC AIDS programmeAvailable through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.
Page 46 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J05AF 18.9 lamivudine1
A P150mg 60 tablet 3-TC Specialist
Authority must be obtained from the Regional Chief Pharmacist. Only for needlestick injuries, according to protocol (circular H132/1997).
levonorgestrel 1 0,03mg 28 tablet MICROVAL Family Planning
Page 47 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
G03AB 17.1.1ex family planning stores
levonorgestrel +ethinyl oestradiol
0,1mg +0,02mg
28 tablet LOETTE Family Planning
Not to be prescribed as first line contraceptive. Use according to the Contraceptive Guidelines of the Provincial Reproductive Health Services. See Circular H125/2003 (Addendum F - Suppl. List 98)
G03AB 17.1.1ex family planning stores
levonorgestrel +ethinyl oestradiol
1 A0,15mg +0,03mg
28 tablet NORDETTE Family Planning
G03AB 17.1.1ex family planning stores
levonorgestrel +ethinyl oestradiol
1 A0,05mg;0,125mg +0,05mg
28 tablet BIPHASIL Family PlanningNot to be prescribed as a contraceptive. Prescribe only for treatment of prolonged bleeding on injectables.
G03AB 17.1.1ex family planning stores
levonorgestrel +ethinyl oestradiol
1 A
0,05mg;0,075mg;0,125mg + 0,03mg;0,04mg;0,03mg
28 tablet TRIPHASIL Family Planning
G02BA 17.1.3 Supp List 122levonorgestrel releasing intra uterine system
52mg/system 20µg/24 hours
1intra uterine system
MIRENASpecialist gynaecologist
For women in whom hysterectomy is contra-indicated and/ or who have failed other modalities
N01BB 2.2.1 lidocaine + prilocaine 2,5% + 2,5% 5g cream EMLARestricted to hospital paediatrics for conditions and procedures such as lumbar puncture,oncology, chronic illnesses etc.
D04AB 2.2.1 lignocaine HCl 1 A 2% 20ml gelREMICAINE; PETERKAIEN
N01BB 2.1.1. lignocaine HCl A P10mg per metered spray
475 doses spray XYLOCAINE
N01BB 2.2lignocaine HCl - without adrenaline
A 2% 1,8ml 1dental cartridge
XYLOTOX SE PLAIN
N01BB 2.2lignocaine HCl + nor-adrenaline
2% + 1 : 80 000 1,8ml
1dental cartridge
XYLOTOX L
N01BB 2.2lignocaine HCl + adrenaline
A P2%+ 1 : 80 000 1,8ml
1dental cartridge
XYLOTOX E80-A
N01BB 2.2 lignocaine I.M. 1 A P 1% 20ml 1 injection REMICAINEC01BB 7.2 lignocaine 1 A 2% 5ml 1 injection REMICAINEN01BB 2.2 lignocaine I.M. A P 2% 20ml 1 injection REMICAINEC01BB 7.2 lignocaine I.V. 10% 5ml 1 injection REMICARD Specialist
Available through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.
Third line agent for needle stick injury post exposure prophylaxis according to the Provincial HIV/AIDS/STI/TB Directorate's protocol. Also refer to Circular H1/2009
J05AF 18.12pgwc ARV depot
lopinavir + ritonavir 1 80mg + 20mg/ml 60ml solution KALETRA AIDS programme As above.
N05BA 1.3.1 lorazepam A 4mg/ml 5 injectionATIVAN; TRANQUIL
Page 49 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
N05BA 1.3.1 lorazepam A 1mg 14 tablet TRANQIPAM
Specialist General: for 14 days only & no repeats.
N05BA 1.3.1 lorazepam A 1mg 28 tablet TRANQIPAM
Specialist General: for 14 days only & no repeats.
N05BA 1.3.1 lorazepam A 1mg 100 tablet ATIVAN
Specialist General: for 14 days only & no repeats.
N05BA 1.3.1 lorazepam A 1mg 500 tablet ATIVAN
Specialist General: for 14 days only & no rep
As above
C09CA 7.3.9Supp List 115/120/121
losartan 50mg 30 tabletLOS-ARB / CIPLA LOSARTAN
Specialist physician & paediatrcian initiated
Cheapest angiotensin receptor antogonist (ARB) available on tender to be used. For: - ACEI intolerant patients. Maximum dose: 100mg daily Cross contra-indication between ARB & ACEI with relation to angioedema.
D05AA ‡
LPC (liquor picis carbonis - coal tar solution) in aqueous cream
5% 200g cream
D05AA ‡
LPC (liquor picis carbonis - coal tar solution) in emulsifying base
5% 200g ointment
X 14.8 lubricating jelly 1 50ml jelly - sterile K Y JELLY
X 14.8 lubricating jelly 100 x 2,5mlsachets - sterile
No more than 14 days supply, except when prescribed by a psychiatrist or neurologist when 28 days may be dispensed. See circular H24/2006: Suppl List 107 Addendum I
On General Code ONLY for emergency treatment of aggressive/restless patients in accordance with the applicable protocol - Protocol 1 (2/98).
Page 50 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
B05AA 35
lvp [large volume parenteral] dextran 40 in sodium chloride
P 10% + 0,9% 500ml plastic bag RHEOMACRODEX
B05AA 7.8lvp dextran 70 in sodium chloride
P 500mlglass container
MACRODEX
V03AH Ø lvp dextrose 1 A P 10% 1 000ml plastic bagV03AH Ø lvp dextrose A P 20% 1 000ml plastic bagV03AH Ø lvp dextrose A 35% 1 000ml plastic bagV03AH Ø lvp dextrose P 5% 1 000ml plastic bagV03AH Ø lvp dextrose 1 A P 5% 100ml plastic bagV03AH Ø lvp dextrose 1 A P 5% 200ml plastic bagV03AH Ø lvp dextrose 1 A P 5% 50ml plastic bagV03AH Ø lvp dextrose 1 A P 50% 500ml plastic bag
Specialist gynaecologist, obstetrics and oncologist
G03DA 19.6.3medroxyprogesterone acetate
1 A 150mg/ml 1 injection DEPO PROVERA Available from family planning.
G03DA 19.6.3medroxyprogesterone acetate
5mg 30 tablet PROVERA
V08AA Ømeglumine + sodium diatrizoates
26,1% + 3,9% 250ml
1 injection UROGRAFIN 30%
V08AA Ømeglumine + sodium diatrizoates
A 66% +10% 20ml 10 injection UROGRAFIN 76%
V08AA Ømeglumine + sodium amidotrizoates
A 66% + 10% 100ml 1 injection GASTROGRAFIN
Page 54 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
V08AB Ømeglumine + sodium ioxaglate
39,3% + 19,65% 50ml
10 injection HEXABRIX Specialist
Only for use in patients with a history of reaction to contrast media; history of allergy, coronary angiography in high risk patients & children;myelography; certain neuroradiological procedures; peripheral angiography when necessary
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
N02AC 10.1.1 methadone 2mg/5ml 100ml linctus PHYSEPTONEFor management of opioid withdrawal. To be used according to the Guidelines for the Management of Substance Detoxification.
L01BA 23 Supp List 116methotrexate(amethopterin)
A P 5mg 1 injection METHOBLASTIN
Specialist dermatologist, oncologist, paediatrician and rheumatologist
L01BA 23 Supp List 116methotrexate(amethopterin)
A P 50mg/2ml 1 injection ABITREXATE 50
Specialist dermatologist, oncologist, paediatrician and rheumatologist
L01BA 23 Supp List 116methotrexate(amethopterin)
A P 500mg 1 injectionEMTHEXATE 500mg
Specialist dermatologist, oncologist, paediatrician and rheumatologist
L01BA 23 Supp List 116methotrexate(amethopterin)
A P 1g 1 injection METHOBLASTIN
Specialist dermatologist, oncologist, paediatrician and rheumatologist
L01BA 23 Supp List 116methotrexate(amethopterin)
A P 5g 1 injection METHOBLASTIN
Specialist dermatologist, oncologist, paediatrician and rheumatologist
A01AB 11.3 miconazole 20mg/g 30g oral gel DAKTARIN SpecialistNot to be used as first line treatment. Try nystatin oral drops first.
N05CD 1.2.1 midazolam 15mg/3ml 1 injection DORMICUM Approved for use by paramedics as well.N05CD 1.2.1 midazolam A P 5mg/5ml 1 injection DORMICUM Approved for use by paramedics as well.N05CD 1.2.1 midazolam 7,5mg 20 tablet DORMICUM Pre-med for general paediatric anaesthesia
Page 59 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
G03XB 19.8 Supp List 122 mifepristone 200mg 3 tablet MIFEGYNE
General
Specialist Gynaecologist
General: To be used according to Health Programmes' protocol for MTOP in the first trimester (up to 63 days) Specialist Gynaecologist: For TOP in fetal anomalies
5g / 10g 2 satchets COLO-PREP For pre-procedure bowel preparation
R03DC 10.4.2 Supp List 117 montelukast 4mg/packet 28 packetssprinkles (granules)
SINGULAIR Specialist
Add-on therapy for patients under 5 years old who remain uncontrolled on appropriate doses of inhaled steroids Allergy and Pulmonary clinics only Not referable
Page 60 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
Add-on therapy for patients under 5 years old who remain uncontrolled on appropriate doses of inhaled steroids Allergy and Pulmonary clinics only Not referable
Specialist.Not referable to non-academic institutions in the Metropole. Can be referred to other regions.
i) Prescribe only post transplant at academic institutions.ii) Dispense only at academic institutions for patients resident in the metropole.iii) Dispense at non-academic institutions for patients in the rural regions - arrange access to stock with referring Institution
Specialist: For post transplant patients with GIT side effects. Non-referable, central hospitals. Central (tertiary) hospitals to arrange stock with referring institutions for patients in rural areas
Specialist: For post transplant patients with GIT side effects. Non-referable, central hospitals. Central (tertiary) hospitals to arrange stock with referring institutions for patients in rural areas
J01MB 16.4Supp List 117 and Supp List 119
nalidixic acid 1 A 250mg/5ml 100ml suspension WINLOMYLONAlso to be used for Dysentery, bacillary, instead of Ciprofloxacin suspension as indicated in the EDL
Page 61 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J01MB 16.4 nalidixic acid 1 A 500mg 100 tablet PUROMYLONFor infective diarrhoea and food poisoning only.
V03AB 1.1.2 naloxone 1 A P 0,4mg/ml 1 injection NARCAN
nelfinavir 50mg/g 144g powder VIRA-CEPT AIDS programmeAvailable through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.
J05AE 19.12pgwcARV depot
nelfinavir 250mg 270 tablet VIRA-CEPT AIDS programme As above.
N07AA 5.3 neostigmine A P 0.5mg/ml 1 injection PROSTIGMINN07AA 5.3 neostigmine 2,5mg/ml 1 injection PROSTIGMIN
J05AG 18.12pgwcARV depot
nevirapine 10mg/ml 240ml solution VIRAMUNE AIDS programmeAvailable through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.
J05AG 18.12 nevirapine 200mg 60 tablet VIRAMUNE special buy outFor Mother To Child Transmission Project ONLY.
nifedipine 1 A P 5mg 100 capsuleADALAT; CARDIFEN-5
General Family Physician Specialist physician, paediatrician & gynaecologist
General: hypertensive emergencies in pregnancy and paediatrics Family Physician: For Raynaud's phenomenon
C08CA 7.3..7 Supp List 122 nifedipine 10mg 84 capsuleADALAT; CARDILAT
General Family Physician Specialist physician, paediatrician & gynaecologist
General: As a tocolytic agent Family Physician: For Raynaud's Syndrome Specialist physician, paediatircian & gynaecologist: For Raynaud's phenomenon, Pulmonary Hypertension, and Pregnancy Induced Hypertension.
Page 62 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
C08CA 7.3.7 Supp List 122 nifedipine 10mg 250 capsuleADALAT; CARDILAT
General Family Physician Specialist physician, paediatrician & gynaecologist
J01MA 18.7 ofloxacin A 200mg 100ml infusion soln. TARIVID SpecialistMotivation form to be completed or on a microbiologist report.
J01MA 18.7 ofloxacin A 200mg 10 tablet TARIVID Specialist Fluoroquinolone of choice in Multiple Drug Resistant TB.FOR THE exclusive USE IN MDR TB .
J01MA 18.7 ofloxacin A 200mg 100 tablet TARIVID Specialist As aboveJ01MA 18.7 ofloxacin A 400mg 56 tablet TARIVID Specialist As aboveJ01MA 18.7 ofloxacin A 400mg 100 tablet TARIVID Specialist As aboveX Ø olive oil BP 500ml liquid OLIVE OILA02BC 12.4.4 omeprazole 10mg 28 tablet LOSEC MUPS Specialist Paediatricians only
Page 64 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
A02BC 12.4.4 omeprazole A P 20mg 14 tablet LOSECPaediatrician & Endoscopy units initiated
Cheapest PPI on tender to be used. For treatment guidelines refer to: Circular H95/2005 (Addendum B - Suppl. List 102)
A02BC 12.4.4 omeprazole A P 20mg 28 tablet LOSECPaediatrician & Endoscopy units initiated
As above.
Oral Rehydration Salt solutionsee sodium chloride co. below
H01BA 7.6 ornipressin 5iu/ml 1 injection POR 8 SpecialistN04AB 1.7.2 orphenadrine 1 A 50mg 28 tablet DISIPALN04AB 1.7.2 orphenadrine 1 A 50mg 56 tablet DISIPAL
N04AB 1.7.2 orphenadrine 1 A 50mg 84 tabletPHENERINE; DISIPAL
N04AB 1.7.2 orphenadrine A 50mg 100 tabletDISIPAL; PHENERINE
N04AB 1.7.2 orphenadrine 1 A 50mg 112 tabletPHENERINE; DISIPAL
J05AH 18.12Suppl List 119
oseltamivir 75mg 10 tablet TAMIFLU
For use in prophylaxis and treatment of pandemic H1N1 virus as per national and provincial protocols. Will be made available and accessible when required at strategic sites
J05AH 18.12Suppl List 119
oseltamivir 12mg/ml suspension TAMIFLU
For use in prophylaxis and treatment of pandemic H1N1 virus as per national and provincial protocols. Will be made available and accessible when required at strategic sites
N05BA 1.3.1 oxazepam A 10mg 14 tabletSEREPAX; PURATA
No more than 14 days supply, unless when prescribed by a psychiatrist or neurologist, when 28 days supply may be dispensed. See circular H24/2006; Suppl List 107 - addendum I
N05BA 1.3.1 oxazepam A 10mg 250 tabletSEREPAX; PURATA; OXALINE
No more than 14 days supply, unless when prescribed by a psychiatrist or neurologist, when 28 days supply may be dispensed. See circular H24/2006; Suppl List 107 - addendum I
Page 65 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
N05BA 1.3.1 oxazepam A 15mg 14 tabletSEREPAX; PURATA
Specialist psychiatrist & neurologist
NO NEW PATIENTS TO BE PRESCRIBED THIS STRENGTH, unless if done by a psychiatrist or neurologist. (Refer to circular H24/2006, SL 107, Addendum 1)
N05BA 1.3.1 oxazepam A 15mg 250 tabletSEREPAX; PURATA; OXALINE
Specialist psychiatrist & neurologist
NO NEW PATIENTS TO BE PRESCRIBED THIS STRENGTH, unless if done by a psychiatrist or neurologist. (Refer to circular H24/2006, SL 107, Addendum 1)
S01HA 15.7 oxybuprocaine 1 A P 0,4% 3ml eye drops NOVESIN
S01HA 15.7 oxybuprocaine 1 A P 0,4% 0,5ml x 20 minimsMINIMS BENOXINATE
G04BD 5.4 oxybutynin A 5mg 100 tabletDITROPAN; SANDOZ OXYBUTYNIN
Specialist neurologist, urologist, gynaecologist, nephrologist, paediatrician & Western Cape Rehab Centre initiated
M03AC 2.3 pancuronium bromide A P 4mg/2ml 1 injection PAVULONA02BC 12.4.4 pantoprazole 40mg/10ml 1 injection PANTOLOC Specialist
A02BC 12.4.4 pantoprazole A P 40mg 14 tablet PANTOLOCPaediatrician & Endoscopy units initiated
Cheapest PPI on tender to be used. For treatment guidelines refer to: Circular H95/2005 (Addendum B - Suppl. List 102)
A02BC 12.4.4 pantoprazole A P 40mg 28 tablet PANTOLOCPaediatrician & Endoscopy units initiated
As above
J04A 18.8.1 para-aminosalicylic acid 4G 30 powder PASER GRANULES Specialist As per XDR TB protocol
N02BE 3.2 paracetamol 125mg 10 suppository EMPAPED Single, post-operative dose.N02BE 3.2 paracetamol 250mg 10 suppository EMPAPED Single, post-operative dose.
N02BE 3.2 Supp List 119 paracetamol 1 P 120mg 50ml syrup DOLOROL; PAMOL
For acute conditions: Not more than 5 days supply. NOT REPEATABLE FOR ACUTE CONDITIONS. For longer periods, the appropriate diagnosis and quantity to be written on the prescription
N02BE 3.2 Supp List 119 paracetamol 1 P 120mg 100ml syrup DOLOROL; PAMOL
For acute conditions: Not more than 5 days supply. NOT REPEATABLE FOR ACUTE CONDITIONS. For longer periods, the appropriate diagnosis and quantity to be written on the prescription
N02BE 3.2 Supp List 119 paracetamol 1 A P 500mg 10 tablet PANADO
For acute conditions: Not more than 5 days supply. NOT REPEATABLE FOR ACUTE CONDITIONS. For longer periods, the appropriate diagnosis and quantity to be written on the prescription
Page 67 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
N02BE 3.2 Supp List 119 paracetamol 1 A P 500mg 20 tablet DOLOROL
For acute conditions: Not more than 5 days supply. NOT REPEATABLE FOR ACUTE CONDITIONS. For longer periods, the appropriate diagnosis and quantity to be written on the prescription
N02BE 3.2 Supp List 119 paracetamol A P 500mg 100 tablet DOLOROL
For acute conditions: Not more than 5 days supply. NOT REPEATABLE FOR ACUTE CONDITIONS. For longer periods, the appropriate diagnosis and quantity to be written on the prescription
N02BE 3.2 Supp List 119 paracetamol A P 500mg 5000 tablet DOLOROL
For acute conditions: Not more than 5 days supply. NOT REPEATABLE FOR ACUTE CONDITIONS. For longer periods, the appropriate diagnosis and quantity to be written on the prescription
paraffin soft: see soft paraffin
L03AB 24.2 Supp List 117pegylated interferon alfa-2a
135µg/0,5ml 1pre-filled syringe
PEGASYS Specialist
Central hospitals only. Patient Named Basis. Number of patients to be treated to be decided by local PTC
L03AB 24.2 Supp List 117pegylated interferon alfa-2a
180µg/0,5ml 1pre-filled syringe
PEGASYS Specialist
Central hospitals only. Patient Named Basis. Number of patients to be treated to be decided by local PTC
M01CC 25 penicillamine A 300mg 100 capsule METALCAPTASE Specialist
J01CE 18.1.1 penicillin; benzathine 1 A P 1.2Mu 1 injectionBICILLIN LA; PENILENTE LA
For use in smaller hospitals; admission wards of larger hospitals and by district surgeons.
V04B Øreagent strip - 10 diagnosis for urine
100 reagent strip COMBUR 10For use in trauma units and neurosurgery when specific gravity is required.
V04CA Øreagent strip - glucose in blood - visual & meter
50 reagent strip LENSTRIP GLYCO
Page 74 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
V04CA Øreagent strip - glucose in blood
50 reagent strip ACCUTREND
Use with Accutrent meter. Can be issued to patients with machines provided by the company. PAWC does not issue Accutrend strips to non-insulin users.Issue up to 100 tests monthly if necessary to patients on multiple daily insulin administration, and up to 50 tests every four months if necessary to patients on a once daily insulin regimen (See Suppl. List 98).
V04CA Øreagent strip - glucose in blood
50 reagent stripACCU-CHECK ACTIVE
will replace eventually Accutrend
V04CA Øreagent strip - glucose in blood
50 reagent strip ONE TOUCH
Only for clinics with machines and patients with own machines. PAWC does not issue One Touch strips to non-insulin users.Issue up to 100 tests monthly if necessary to patients on multiple daily insulin administration, and up to 50 tests every four months if necessary to patients on a once daily insulin regimen (See Suppl. List 98).
V04CA Øreagent strip - glucose in blood
50 reagent stripGLUCOTREND PLUS
TO BE RENAMED TO Accu-Check Active
Use with Glucotrend 2 meter. Can be issued to patients with machines provided by the company. PAWC does not issue Glucotrend Plus strips to non-insulin users.Issue up to 100 tests monthly if necessary to patients on multiple daily insulin administration, and up to 50 tests every four months if necessary to patients on a once daily insulin regimen (See Suppl. List 98).
V04CA Øreagent strip - glucose in blood - visual & meter
50 reagent strip GLUCOSTIX
X Ø
reagent strip - rapid determination of HIV-1/2 antibodies in whole blood
20 reagent strip HIV CHECK 1 + 2For Mother To Child Transmission Project ONLY.
X Øreagent strip - rapid detemination of syphilis
100 reagent stripDETERMINE SYPHILIS
Page 75 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
X Øreagent tablet - blood in faeces
50 reagent tablet HEMATEST
N01AH 2.1.2 remifentanyl 1mg 1 injection ULTIVA SpecialistCentral hospitals, For use in endoscopy ENT surgery only
N01AH 2.1.2 remifentanyl 2mg 1 injection ULTIVA SpecialistCentral hospitals, For use in endoscopy ENT surgery only
N01AH 2.1.2 remifentanyl 5mg 1 injection ULTIVA SpecialistCentral hospitals, For use in endoscopy ENT surgery only
N05AX 1.5.3 Supp List 120 risperidone 25mg 1injection IM - prolonged release
RISPERDAL CONSTA
Psychiatrist initiated
For: - Specific non-compliant patients - Patients that do not tolerate 1st generation depot anti-psychotics To be used in line with Mental Health Guidelines
N05AX 1.5.3 Supp List 120 risperidone 37,5mg 1injection IM - prolonged release
RISPERDAL CONSTA
Psychiatrist initiated
For: - Specific non-compliant patients - Patients that do not tolerate 1st generation depot anti-psychotics To be used in line with Mental Health Guidelines
Page 77 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
N05AX 1.5.3 Supp List 120 risperidone 50mg 1injection IM - prolonged release
RISPERDAL CONSTA
Psychiatrist initiated
For: - Specific non-compliant patients - Patients that do not tolerate 1st generation depot anti-psychotics To be used in line with Mental Health Guidelines
J05AE 18.12pgwc ARV depot
ritonavir 100mg 84 capsule NORVIR AIDS programmeAvailable through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.
J05AE 19.12pgwc ARV depot
ritonavir 80mg/ml 90ml solution NORVIR AIDS programme As above.
R03AC 10.2.1 salbutamol 1 P 5mg/ml 20mlinhalation solution
VENTOLIN; VENTEZE
R03CC 10.2.1 salbutamol P 2mg/5ml 150ml syrup VENTOLIN For use in paediatricsR03CC 10.2.1 salbutamol P 2mg/5ml 500ml syrup VENTOLIN As above
R03CC 10.2.1 salbutamol P 2mg 500 tabletVENTOLIN; VENTEZE
As above
R03AC 10.2.1 salbutamol 1 A P 100µg/inhalation 1 x 200 dose MDI complete VENTEZE Use cheapest Beta-stimulant MDI on tender.
Page 78 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
R03AC 10.2.1 salbutamol 1 A P 100µg/inhalation 1 x 200 dose MDI refill VENTEZE As aboveR03AC 10.2.1 salbutamol 1 A P 100µg/inhalation 1 x 300 dose MDI complete VENTOLIN As aboveR03AC 10.2.1 salbutamol 1 A P 100µg/inhalation 1 x 300 dose MDI refill VENTOLIN As above
D05AX ‡salicylic acid in cetomacrogol ointment
2% 200g ointment
D05AX ‡salicylic acid in cetomacrogol ointment
5% 200g ointment
D01AE ‡salicylic acid in soft white paraffin
40% 200g ointment
D01AE ‡salicylic acid + lactic acid in collodion flex
For adults and children over the age of 6 - cheapest LABA on tender to be used See Circular H 64/2007 Suppl List 110: Annexure A
X 15.7 salt solution, balanced 15ml eye soln. B.S.S.Specialist ophthalmologist
X 15.7 salt solution, balanced 250ml eye soln. B.S.S.Specialist ophthalmologist
X 15.7 salt solution, balanced 500ml eye soln. B.S.S.Specialist ophthalmologist
J06A Ø scorpion antivenom A P 5ml 1 injectionD01AE 14.3 selenium sulphide 1 2,5% 50ml shampoo SELSUN
A06AB 12.7 senna 1 Aequivalent to 7,5mg sennoside B
12 tablet SENOKOT
A06AB 12.7 senna Aequivalent to 7,5mg sennoside B
48 tabletSENOKOT; SENNALAX
A06AB 12.7 senna Aequivalent to 7,5mg sennoside B
200 tablet SENOKOT
A06AB 12.7 senna Aequivalent to 7,5mg sennoside B
1 000 tablet SENOKOT
A06AB 12.7 sennoside A & B A 142mg/71ml 71ml liquid X-PREPSpecialist radiologist
X serum, human stabilised P 0.05 50ml infusion Specialist
X Ø serum, human stabilised 0.05 250ml infusion Specialist
Page 79 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
N01AB 2.1.1 sevoflurane A 250ml liquid ULTANECentral Hospitals
Patient name basis.Not referable.
sildenafil: see phosphodiesterase-5-inhibitors
D08AL Ø silver nitrate stick A P 0.95 1 pencilSILVER NITRATE PEN.
D06BA 14.1 silver sulphadiazine A P 1% 50g creamFLAMAZINE; ARGENT-EZE
D06BA 14.1 silver sulphadiazine 1 A P 1% 500g cream FLAMAZINE
C10AA 7.7.2 Supp List 116 simvastatin 10mg 28 tablet ZOCOR
1. General
2. Specialist physician initiated
Cheapest Statin on tender to be used1. 10mg daily dose: For secondary prevention of coronary artery disease, thrombotic stroke, peripheral arterial disease, acute coronary syndrome and diabetes.For primary prevention if 10yr risk of CHD greater than 20%.
2. Up to 20mg daily dose if 10yr risk of CHD greater than 20% Up to 40mg daily dose for hyperlipidaemia. For higher doses / inadequate response refer to lipid clinic - See Atorvastatin
C10AA 7.7.2 Supp List 116 simvastatin 20mg 28 tablet ZOCOR As above As above
Specialist.Not referable to non-academic institutions in the Metropole. Can be referred to other regions.
i) Prescribe only post transplant at academic institutions.ii) Dispense only at academic institutions for patients resident in the metropole.iii) Dispense at non-academic institutions for patients in the rural regions - arrange access to stock with referring Institution
L04AA 24.1 sirolimus 1mg 30 tablet RAPAMUNE As above As above
J06AA Øsnake bite antivenom, polivalent
1 A P 10ml 1 injectionSee Circular on availability of antivenom prodicts
X 28sodium thiosulphate + sodium nitrite + amyl nitrite inhalaion
kit TRIPAC-CYANO
X Ø soft paraffin, white BP 500g ointment WHITE PARAFFINX Ø soft paraffin, white BP 4kg ointment WHITE PARAFFINX Ø soft paraffin, white BP 15kg ointment WHITE PARAFFIN
X Ø soft paraffin, yellow BP 4kg ointmentYELLOW SOFT PARAFFIN
A06AD Ø sorbitol 1 A 70% 500ml liquidNOT to be used for hepatic encephalopathy. Only as a laxative.
M03AB 2.3 suxamethonium Cl A P 100mg/2ml 1 injection SCOLINEX Ø syrup simplex BP 2 500ml syrup
L04AA 24.1 tacrolimus 1mg 100 capsule PROGRAF
Specialist.Not referable to non-academic institutions in the Metropole. Can be referred to other regions.
i) Prescribe only post transplant at academic institutions.ii) Dispense only at academic institutions for patients resident in the metropole.iii) Dispense at non-academic institutions for patients in the rural regions - arrange access to stock with referring Institution
L04AA 24.1 tacrolimus 5mg 50 capsule PROGRAF
Specialist.Not referable to non-academic institutions in the Metropole. Can be referred to other regions.
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
GO4CA 16.5 Supp List 121 tamsulosin SR 0,4mg 30slow release capsule
FLOMAX
For BPH: with referral to a urologist within 6 months for those patients who have not previously been on an alpha-blocker (i.e. referral within 6 months for patients intiated on an alpha-blocker).
D05AA 14.5? tar extracts125ml / 250ml
shampoo TRITARSpecialist dermatologist initiated
N05CD 1.2.1 temazepam 20mg 100 capsule NORMISON
Maximum dose 20mg/day for 14 days unless prescribed by a psychiatrist, neurologist or paediatrician. See Circular H24/2006 Suppl List 107 Addendum I
Limited to patients with malignant glioma with positive status for a methylated promoter for the methylguanine methyl transferase (MGMT) gene.
L01CB 23 teniposide P 50mg/5ml 1 injection VUMONSpecialist oncologist
J05AF 18.12 Supp List 119tenofivir disoproxil funerate
1 300mg 30 tablet VIREADGeneral Specialist
GENERAL: For ARV clinics, in line with PGWC Health Programmes protocol: Circular H81/2008 SPECIALIST: For Liver / GIT clinic for the management of chronic Hepatitis B patients. For this indication Tenofovir must be procured via the Cape Medical Depot and not the ARV Depot
Page 85 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J05AF 18.12 Supp List 122tenofivir disoproxil funerate / emtracitabine
Only to be initiated in consultation with MDR TB Referral Centres Brooklyn Chest and Brewelskloof Hospitals. Patients can be referred out and continue treatment on an outpatient basis.
J01AA 18.4.1 tetracycline A 250mg 100 capsule ROTETCheapest of the hydrochloride or phosphate will be supplied.
J01AA 18.4.1 tetracycline A 250mg 1 000 capsule ROTET As above.R03DA 10.2.2 theophyllin 125mg 60 SR capsule MICRO-PHYLLIN For use in paediatrics only.R03DA 10.2.2 theophyllin P 25mg/5ml 200ml syrup NUELIN For use in paediatrics only.R03DA 10.2.2 theophyllin BP anhydr. 125mg 100 tablet NUELIN
R03DA 10.2.2 Supp List 119 theophyllin anhydr. LA 1 A P 200mg 60 tabletTHEO-DUR; BRONCHOPEN
Not to be used as first line therapy in asthma. Refer to coding guidelines: Suppl List 119 - Addendum A: Amended in 2009: Theophyllin maximum dose increased to 300mg
R03DA 10.2.2Suppl List 119
theophyllin anhydr. LA 1 A 300mg 60 tabletTHEO-DUR; BRONCHOPEN
Not to be used as first line therapy in asthma. Refer to coding guidelines: Suppl List 119 - Addendum A: Amended in 2009: Theophyllin maximum dose increased to 300mg
Page 86 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
R03DA 10.2.2 Supp List 119 theophyllin anhydr. LA A 300mg 500 tablet THEO-DUR
Not to be used as first line therapy in asthma. Refer to coding guidelines: Suppl List 119 - Addendum A: Amended in 2009: Theophyllin maximum dose increased to 300mg
L01BB 23 thioguanine P 40mg 25 tablet LANVISSpecialist oncologist
N01AF 2.1.2 thiopentone A P 0,5g 20ml injection SANDOTHAL
L01AC 23thiotepa(tespa)
A P 15mg 1 injection THIOTEPA Specialist
X ‡ thymol in chloroform 2% 500ml liquidthyrotrop(h)in releasing hormone: See protirelin
H03AA 19.3 thyroxine A P 0,05mg 100 tablet ELTROXINH03AA 19.3 thyroxine A P 0,1mg 100 tablet ELTROXIN
N02AX 3.1 tilidine P 50mg/0,5ml 10ml oral drops VALORONFor paediatrics ONLY. See protocol on selection of analgesics: Circular H112/1998 (Addendum E - Suppl. List 80)
S01ED 15.6 Supp List 121 timolol maleate A 0.0025 5ml eye drops TIMOPTOLSpecialist ophthalmologist initiated
X ‡
tincture benz. Co in lassar's paste (zinc oxide 2% + salicylic acid 2%)
15% 500ml liquid
G01AF 17.2 tioconazole 100mg 3vaginal tablets
GYNO-TROSYDCheapest appropriate imidazole preparation on tender will be issued.
General: As add-on therapy to paracetamol. Recommended dose 50mg six hourly. Not repeatable for acute conditions (short course) Specialist initiated: For neuropathic pain as second or third line (may be used without paracetamol). Prescription must be endorsed with 'neuropathic pain' NOTE: Refer to Sup List 111 Addendum A: warning - tramadol and serotonin syndrome Refer to Supp List 121: Addendum B: warning - tramadol and amitriptyline interaction
B02AA 8.1 tranexamic acid P 500mg/5ml 1 injection CYKLOKAPRON Specialist
In Gynaecology: Second line treatment where NSAID's have failed, max 7 days. May be repeated monthly. In Haematology: For haemophiliacs. May be prescribed for one month. May be repeated
D10AD 14.6 tretinion A P 0,5mg/g 20g cream RETIN A; AIROLSpecialist dermatologist
D10AD 14.6 tretinion A P 0,25mg/g 20g gel RETIN ASpecialist dermatologist
1 0,5ml 1 dose injection PENTAXIM As per EPI immunisation schedule
J07BC 26 vaccine hepatitis B 1 A adult 1 injection ENGERIX-BJ07BC 26 vaccine hepatitis B 1 P paed. 1 dose injection HEPPACINE-BJ07BC 26 vaccine hepatitis B 1 P paed. 10 dose injection HEPPACINE-B
J07BB 26 vaccine influenza 0,5ml single injection MUTAGRIP
Current product on tender to be bought.Use only in the following HIGH RISK CASES:☼ Chronic cardio pulmonary disease - Transplant patients - Patients in nursing homes ☼ Children with: cystic fibrosis, HIV and other immuno compromising conditions☼ PGWC staff working in high risk areas in institutions
Use only in the following HIGH RISK CASES:☼ Chronic cardio pulmonary disease - Transplant patients - Patients in nursing homes ☼ Children with: cystic fibrosis, HIV and other immuno compromising conditions☼ PGWC staff working in high risk areas in institutions
For post transplant patients on maintenance therapy on discharge post ganciclovir IV. For adults and children. Non-referable
N03AG 1.6 Supp List 114 valproate sodium P 100mg 100crushable tablets
EPILIM CRUSH TABS
Use according to epilepsy treatment guidelines. See Circular H35/2005 (Addendum B - Suppl. List 101)
N03AG 1.6 valproate sodium 400mg 1 injection EPILIMFor status epilepticus only: as third line agent if phenobarbitone injection is not available, otherwise as fourth line agent
N03AG 1.63870928 Supp List 101
valproate sodium P 200mg/5ml 300ml
syrup, sugar free
EPILIMUse according to epilepsy treatment guidelines. See Circular H35/2005 (Addendum B - Suppl. List 101)
N03AG 1.6valproate sodium + valproic acid
AP
133,2mg + 58mg 100 tablet EPILIM CR 200
General code Specialist neurologists, psychiatrists, paediatricians, neurosurgeons and physicians initiated.
For ARV clinics only, in line with Suppl List 112 Addendum A. Use according to epilepsy treatment guidelines. See Circular H35/2005 (Addendum B - Suppl. List 101)
N03AG 1.6valproate sodium + valproic acid
AP
199,8mg + 87mg 100 tablet EPILIM CR 300
General codeSpecialist neurologists, psychiatrists, paediatricians, neurosurgeons and physicians initiated.
For ARV clinics only, in line with Suppl List 112 Addendum A. Use according to epilepsy treatment guidelines. See Circular H35/2005 (Addendum B - Suppl. List 101)
Page 92 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
N03AG 1.6valproate sodium + valproic acid
AP
333mg + 145mg 100 tablet EPILIM CR 500
General codeSpecialist neurologists, psychiatrists, paediatricians, neurosurgeons and physicians initiated.
For ARV clinics only, in line with Suppl List 112 Addendum A. Use according to epilepsy treatment guidelines. See Circular H35/2005 (Addendum B - Suppl. List 101)
N03AG 1.6 valproic acid A P 150mg 100 capsule CONVULEX As aboveNo new patients. To be used for patients already on valproic acid only.
N03AG 1.6 valproic acid A P 300mg 100 capsule CONVULEX As aboveNo new patients. To be used for patients already on valproic acid only.
N03AG 1.6 valproic acid A P 500mg 100 capsule CONVULEX As aboveNo new patients. To be used for patients already on valproic acid only.
N03AG 1.6 valproic acid P 250mg/5ml 100ml suspension CONVULEX As aboveNo new patients. To be used for patients already on valproic acid only.
J01XA 18.7 vancomycin A P 500mg 1 injection VANCOCIN Specialist As above.
J01XA 18.7 vancomycin A P 1g 1 injection VANCOCIN SpecialistMotivation form to be completed or microbiologist report. Cheapest of CP or plain to be bought.
vardenafil: see phosphodiesterase-5-inhibitors
M03AC 2.3 vecuronium A P 4mg 50 injection NORCURON
C08DA 7.3.7 verapamil A P 5mg/2ml 1 injection ISOPTIN
C08DA 7.3.7 verapamil A 40mg 56 tablet ISOPTINSee protocol on Calcium channel antagonists: Circular H112/1998 (Addendum D - Suppl. List 80)
C08DA 7.3.7 verapamil A 40mg 84 tablet ISOPTIN As above.C08DA 7.3.7 verapamil A 40mg 500 tablet ISOPTIN As above.C08DA 7.3.7 verapamil A 80mg 56 tablet ISOPTIN As above.
Page 93 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
C08DA 7.3.7 verapamil A 80mg 84 tabletISOPTIN; BONCEUR
As above.
C08DA 7.3.7 verapamil A 80mg 250 tablet ISOPTIN As above.
L01CA 23 vinblastine A P 10mg 1 injection VELBESpecialist oncologist
L01CA 23 vincristine A P 1mg 1 injectionONCOVIN; PERICRISTINE
Specialist oncologist
L01CA 23 vincristine A P 1mg + diluent 10 injection ONCOVINSpecialist oncologist
L01CA 23 vincristine A P 2mg + diluent 1 injection ONCOVINSpecialist oncologist
L01CA 23 vincristine A P 5mg + diluent 10 injection ONCOVINSpecialist oncologist
A11CA 20.1 vitamin A 50 000iu/ml 2ml 5 injection AROVIT
A11CA 20.1 vitamin A 1 P 50 000iu 50capsule white snip off
VITAFORCE
A11CA 20.1 vitamin A 1 P 50 000iu 200 tablet AROVIT; AVITA
A11CA 20.1 vitamin A 1 P 100 000iu 50capsule blue snip off
VITAFORCE
A11CA 20.1 vitamin A 1 P 200 000iu 50capsule red snip off
VITAFORCE
A11CA 20.1 vitamin A 200 000iu 250 capsuleVITAMIN A - Lennons
For Nutrition Program Only.
A11DA 20.1 vitamin B1 (thiamine) A 100mg/ml 1 injection VITAMIN B 1A11DA 20.1 vitamin B1 (thiamine) 1 A 100mg 100 tablet VITAMIN B 1A11HA 20.1 vitamin B6 (pyridoxine) P 50mg/ml 10 injection VITAMIN B 6A11HA 20.1 vitamin B 6 (pyridoxine) 1 A P 25mg 100 tablet
B03BA 20.1vitamin B12
(cyanocobalamin)A P 1 000µg/ml 1 injection VITAMIN B12
B03BA 20.1vitamin B12
(cyanocobalamin) A P 1 000µg/ml 10ml 1 injection
LABETHICA VITAMIN B 12
A11EA 20.1.1 vitamin B Co A 10ml 1 injection BECOPLEXA11EA 20.1.1 vitamin B Co 1 A 56 tabletA11EA 20.1 vitamin B Co A 1 000 tablet BECOPLEXA11EA 20.1.1 vitamin B Co A 5 000 tabletA11GA 20.1 vitamin C A 500mg/5ml 1 injection VITAMIN CA11GA 20.1 vitamin C A P 100mg 1 000 tablet VITAMIN C
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
A11BA 20.1.1 vitamin Co - multivitamin P 20ml oral drops VIDAYLIN
A11BA 20.1.1 vitamin Co - multivitamin 1 P 100ml syrup MULTIVITAMIN
A11BA 20.1.1 vitamin Co - multivitamin 2 500ml syrup MULTIVITAMIN
vitamin D: see alfacalcidol, calciferol & ergocalciferolvitamin K: see phytomenadione
B01AA 8.2 warfarin A 5mg 100 tablet COUMADIN
V07AB Ø water for injection B.P. 1 x 5ml injectionWATER FOR INJECTION
V07AB Ø water for injection B.P. 1 x 10ml injectionWATER FOR INJECTION
V07AB Ø water for injection B.P. 1 x 20ml injectionWATER FOR INJECTION
X Ø wool fat, anhydrous 500g ointment
R01AA 11.1 xylometazoline 1 P 0,05% 10mlnasal drops - paed
OTRIVIN PAED. ALTERNATIVE: Oxymetazoline when cheaper
R01AA 11.1 xylometazoline 1 A 0,1% 10ml nasal drops OTRIVIN As above
J05AB 18.12 zidovudine 1 A P 100mg 100 capsule RETROVIR
1. For prevention of mother to child transmission of HIV 2. For rape victims. * For other uses: Authority to be obtained from the Regional Drug and Therapeutics Committee.
J05AB 18.12 zidovudine1
A P100mg 14 capsule RETROVIR
1. For prevention of mother to child transmission of HIV 2. For rape victims. * For other uses: Authority to be obtained from the Regional Drug and Therapeutics Committee.
Only for the treatment of rape survivors (children) & PMCTC according to the provincial protocol.
Page 95 of 96
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J05AB 18.123797948 &pgwc ARV depot
zidovudine 1 300mg 60 tablet RETROVIR
General - AIDS programme Clinical Nurse Practitioner
General: Available through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols. Clinical Nurse Practitioner: According to PMTC policy and guidelines
J05AF 18.12pgwc ARV depot
zidovudine + lamivudine 300mg + 150mg 60 tablet COMBIVIR AIDS programmeAvailable through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.
J05AF 18.12 ------- zidovudine + lamivudineInitiation of therapy extended to Clinical Nurse Practitioner in accordance with the PGWC PEP protocol.