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1
CHRONIC MEDICATION COMPREHENSIVE FORMULARY
Effective 1 January 2011 • This formulary represents drugs covered for chronic use for 25 Chronic Disease List (CDL) conditions and individual Diagnosis and Treatment Pairs (DTP) conditions, where
applicable for each scheme. • Reimbursement of medication for non-CDL and non-DTP conditions is subject to Scheme Rules and Qualsa’s medicine reimbursement policy. • Unless otherwise stipulated, all active ingredients listed in this formulary are subject to the Qualsa Maximum Price (QMP). • The examples below serve as a guide on the trade names available for the active ingredients listed and not for marketing a specific brand. Any product within the QMP
category may be used, however, a co-payment may be attracted if the product selected is above the generic reference threshold. • The dispensing pharmacist may make a generic substitution to assist members in avoiding a co-payment, where necessary. • Treatment designated as “Accepted treatment” indicates that this is a medication covered as first line, according to the Qualsa medicine reimbursement policy. • For treatment designated as “Motivation required”, certain criteria as specified in the Qualsa medicine reimbursement policy should be met. • For treatment designated as “Special investigation”, the relevant clinical investigation reports as specified in the Qualsa medicine reimbursement policy are required.
Abbreviations of dosage form
CAP Capsule ECT Enteric-coated tablet NAS Nasal spray SRT Slow release tablet
CHU Chew tablet ENE Enema NOD Nasal drops SUP Suppository
CPS Capsule (Inhaler) FCT Film-coated tablet OPD Eye drops SUS Suspension
CRM Cream INH Inhaler SAC Sachet SYR Syrup
DRP Drops INJ Injection SLN Sublingual TAB Tablet
DSP Dispersable LOT Lotion SRC Slow release capsule UNG Ointment
2
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Addison's disease
Corticosteroids, oral
Fludrocortisone acetate 0.1mg TAB Florinef acetate Motivation required
Hydrocortisone 10mg TAB Covocort Accepted treatment
Prednisolone 5mg TAB Lenisolone Capsoid Prelone Accepted treatment
Prednisone 5mg TAB Be-tabs prednisone Panafcort Trolic Accepted treatment
Asthma
Beta agonists, short-acting
Fenoterol INH Berotec HFA Accepted treatment
Fenoterol and ipratropium bromide 50mcg/20mcg INH Duovent HFA Accepted treatment
Salbutamol 100mcg INH Venteze Asthavent Accepted treatment
Salbutamol 2.5mg SLN Ventolin nebules Motivation required
Salbutamol 200mcg CPS Asthavent Accepted treatment
Salbutamol 200mcg CPS Ventodisks Accepted treatment
Salbutamol 400mcg CPS Ventodisks Motivation required
Terbutaline 0.5mg INH Bricanyl Motivation required
Beta agonists, long-acting
Formoterol 12mcg CPS/INH Foratec Accepted treatment
Formoterol 9mcg INH Oxis Motivation required
Salmeterol 25mcg INH Serevent Motivation required
Salmeterol 50mcg INH Serevent Motivation required
Corticosteroids, inhaled
Beclometasone 100mcg INH/ATH Beclate Qvar Accepted treatment
Beclometasone 200mcg INH Beclate Accepted treatment
Beclometasone 50mcg INH/ATH Beclate Qvar Accepted treatment
Budesonide 100mcg INH/CPS Inflacor Budeflam Inflammide Accepted treatment
Budesonide 200mcg INH/CPS Inflacor Budeflam Inflammide Accepted treatment
Budesonide 400mcg INH/CPS Inflacor Inflammide Novoliser Accepted treatment
Ciclesonide 80mcg INH Alvesco Motivation required
Ciclesonide 160mcg INH Alvesco Motivation required
Fluticasone 100mcg INH Flixotide CFC-free Motivation required
Fluticasone 125mcg INH Flixotide CFC-free Motivation required
Fluticasone 250mcg INH Flixotide CFC-free Motivation required
Fluticasone 500mcg INH Flixotide accuhaler Motivation required
3
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Fluticasone 50mcg INH Flixotide CFC-free Motivation required
Corticosteroids and beta agonists, long-acting
Budesonide and formoterol 160mcg/4.5mcg INH Symbicord 60 dose Symbicord 120 dose Motivation required
Budesonide and formoterol 320mcg/9mcg INH Symbicord 60 dose Motivation required
Budesonide and formoterol 80mcg/4.5mcg INH Symbicord 120 dose Motivation required
Salmeterol and fluticasone 25mcg/125mcg INH Sereflo Seretide Accepted treatment
Salmeterol and fluticasone 25mcg/250mcg INH Sereflo Seretide Accepted treatment
Salmeterol and fluticasone 25mcg/50mcg INH Sereflo Seretide Accepted treatment
Salmeterol and fluticasone 50mcg/100mcg INH Foxair Seretide Accepted treatment
Salmeterol and fluticasone 50mcg/250mcg INH Foxair Seretide Accepted treatment
Salmeterol and fluticasone 50mcg/500mcg INH Foxair Seretide Accepted treatment
Xanthines
Aminophylline 225mg SRT Phyllocontin Motivation required
Theophylline 200mg SRT Sandoz Theophylline Motivation required Theophylline 250mg SRT Nuelin SA Motivation required Theophylline 300mg SRT Sandoz Theophylline Motivation required Theophylline 400mg SRT Uniphyl Motivation required Theophylline 600mg SRT Uniphyl Motivation required Leukotriene receptor antagonists
Montelukast 10mg TAB Singulair Motivation required
Montelukast 4mg CHU/SAC Singulair Singulair Sprinkles Motivation required
Montelukast 5mg CHU Singulair Motivation required
Zafirlukast 20mg TAB Accolate Motivation required
Other
Ketotifen 1mg/2mg TAB Zaditen Motivation required
Ketotifen 1mg SYR Zetofen Motivation required
Bipolar mood disorder
Heterocyclic antidepressants
Amitriptyline 25mg TAB Sandoz-amitriptyline Trepiline Tryptanol Accepted treatment
Clomipramine 10mg TAB Anafranil Equinorm Accepted treatment Clomipramine 25mg TAB Anafranil Clomidep Equinorm Accepted treatment Clomipramine 75mg TAB Anafranil Motivation required
Dothiepin 25mg CAP Thaden Prothiaden Sandoz-dothiepin Accepted treatment Dothiepin 75mg TAB Thaden Sandoz-dothiepin Accepted treatment
4
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Imipramine 25mg TAB Ethipramine Tofranil Accepted treatment
Lofepramine 70mg TAB Emdalen Motivation required
Mianserin 10mg TAB Lantanon Motivation required
Mianserin 30mg TAB Lantanon Motivation required
Maprotiline 25mg TAB Ludiomil Motivation required
Maprotiline 75mg TAB Ludiomil Motivation required
Trimipramine 25mg TAB Tydamine Motivation required
Trimipramine 50mg CAP Tydamine Motivation required
Selective serotonin receptor inhibitors
Citalopram 10mg TAB Austell-citalopram Accepted treatment
Citalopram 20mg TAB Austell-citalopram Citalopram-Winthrop Sandoz-citalopram Accepted treatment
Citalopram 40mg TAB Austell-citalopram Citalopram-Winthrop Depramil Accepted treatment
Escitalopram 5mg TAB Lexamil Motivation required
Escitalopram 10mg TAB Citraz Lexamil Aspen Escitalopram Motivation required
Escitalopram 20mg TAB Citraz Lexamil Zytomil Motivation required
Fluoxetine 20mg CAP/TAB A-lennon fluoxetine Zydus-fluoxetine Ranflocs Accepted treatment
Fluoxetine 40mg DSP Prohexal T Accepted treatment
Fluvoxamine 10mg TAB Faverin Fluvoxamine-hexal Luvox Motivation required Paroxetine 20mg TAB Serrapress Austell-paroxetine Xet Motivation required Paroxetine 30mg TAB Serrapress Austell-paroxetine Motivation required Sertraline 50mg TAB Serlife Austell-sertraline Arrow Sertraline Motivation required Sertraline 100mg TAB Serlife Austell-sertraline Motivation required Serotonin and noradrenaline re-uptake inhibitors
Duloxetine 30mg CAP Cymgen Cymbalta Motivation required
Duloxetine 60mg CAP Cymgen Cymbalta Motivation required
Venlafaxine 37.5mg CAP Venlor Odiven Motivation required
Venlafaxine 50mg TAB Efexor Motivation required
Venlafaxine 75mg CAP Venlor Sandoz Venlafaxine Odiven Motivation required
Venlafaxine 150mg CAP Venlor Sandoz Venlafaxine Efegen Motivation required
Monoamine oxidase type A inhibitors
Moclobemide 150mg TAB Depnil Motivation required
Moclobemide 300mg TAB Clorix Depnil Motivation required
5
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Other
Bupropion 150mg SRT Wellbutrin Motivation required
Bupropion 300mg SRT Wellbutrin Motivation required
Mirtazapine 15mg TAB Sandoz Mirtazapine Adco-mirteron Aspen Mirtazapine Motivation required
Mirtazapine 30mg TAB Sandoz Mirtazapine Adco-mirteron Aspen Mirtazapine Motivation required
Moclobemide 150mg TAB Depnil Motivation required
Moclobemide 300mg TAB Clorix Depnil Motivation required
Reboxetine 4mg TAB Edronax Motivation required
Sulpiride 200mg TAB Bio-sulpiride Eglonyl Accepted treatment
Sulpiride 25mg SYR Eglonyl Accepted treatment Sulpiride 50mg CAP Espiride Eglonyl Sandoz Sulpiride Accepted treatment Trazodone 50mg CAP Molipaxin Aspen Trazodone Motivation required
Trazodone 100mg CAP Molipaxin Aspen Trazodone Motivation required
Mood stabilisers
Lithium 250mg TAB Camcolit Accepted treatment
Lithium 400mg TAB Camcolit Accepted treatment
Lithium 450mg TAB Quilonum Retard Accepted treatment
Carbamazepine 200mg TAB/SRT Sandoz Carbamazepine CR Degranol CPL-carbamazepine Accepted treatment
Carbamazepine 400mg SRT Sandoz Carbamazepine CR Accepted treatment
Lamotrigine 100mg TAB Aspen-lamotrigine Lamitor Dyna-Lamotrigine Accepted treatment
Lamotrigine 200mg TAB Lamidus Austell-lamotrigine Dyna-Lamotrigine Accepted treatment
Lamotrigine 25mg TAB Aspen-lamotrigine Lamitor Dyna-Lamotrigine Accepted treatment
Lamotrigine 50mg TAB Aspen-lamotrigine Lamitor Dyna-Lamotrigine Accepted treatment
Topiramate 100mg TAB Toplep Adco-topiramate Sandoz-topiramate Motivation required
Topiramate 200mg TAB Toplep Adco-topiramate Sandoz-topiramate Motivation required
Topiramate 25mg TAB Toplep Adco-topiramate Sandoz-topiramate Motivation required
Topiramate 50mg TAB Toplep Adco-topiramate Sandoz-topiramate Motivation required
Valproic acid 150mg CAP/SRT Convulex Epilim Accepted treatment
Valproic acid 100mg TAB Epilim Accepted treatment
Valproic acid 200mg SRT Epilim Accepted treatment
Valproic acid 300mg CAP Convulex Accepted treatment
Valproic acid 500mg CAP/SRT Convulex Epilim Accepted treatment
Antipsychotics
Chlorpromazine 100mg TAB Largactil Accepted treatment
6
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Chlorpromazine 25mg TAB Largactil Accepted treatment
Chlorpromazine 50mg TAB Largactil Accepted treatment
Haloperidol 0.5mg CAP Serenace Accepted treatment
Haloperidol 1.5mg TAB Serenace Sandoz Haloperidol Accepted treatment
Haloperidol 10mg TAB Serenace Accepted treatment
Haloperidol 5mg TAB Serenace Sandoz Haloperidol Accepted treatment
Risperidone 0.5mg TAB Auropidone DRL-Risperidone Mylan Risperidone Accepted treatment Risperidone 1mg TAB Auropidone DRL-Risperidone Mylan Risperidone Accepted treatment Risperidone 2mg TAB Auropidone DRL-Risperidone Mylan Risperidone Accepted treatment Risperidone 3mg TAB Auropidone DRL-Risperidone Perizal Accepted treatment Risperidone 4mg TAB Auropidone Aspen Risperidone Risponz Accepted treatment Risperidone 1mg/ml SLN Auropidone Risperdal Motivation required
Quetiapine 25mg TAB Seroquel Motivation required
Quetiapine 100mg TAB Seroquel Motivation required
Quetiapine 200mg TAB Seroquel Seroquel XR Motivation required
Quetiapine 300mg TAB Seroquel Seroquel XR Motivation required
Quetiapine 400mg TAB Seroquel XR Motivation required
Quetiapine 50mg TAB Seroquel XR Motivation required
Trifluoperazine 1mg TAB Stelazine Accepted treatment
Trifluoperazine 5mg TAB Stelazine Accepted treatment
Zuclopenthixole 10mg TAB Clopixol Motivation required
Zuclopenthixole 2mg TAB Clopixol Motivation required
Bronchiectasis
Antibiotic treatment will be reimbursed subject to Qualsa’s Medicine Policy and specific organism sensitivity.
Cardiomyopathy/Heart failure
Aspirin
Acetylsalicylic acid 100mg TAB Bayer aspirin cardio Disprin CV Myoprin Accepted treatment
Acetylsalicylic acid 125mg TAB Lo-aspirin Accepted treatment
Acetylsalicylic acid 300mg TAB Be-tabs aspirin Disprin Gulf aspirin Accepted treatment
Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment (in children)
Acetylsalicylic acid 81mg ECT Ecotrin Coprin Accepted treatment
Anticoagulants
Warfarin 1mg TAB Cipla-warfarin Accepted treatment
Warfarin 3mg TAB Cipla-warfarin Accepted treatment
7
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Warfarin 5mg TAB Cipla-warfarin Accepted treatment
Diuretics
Bumetanide 1mg TAB Burinex Motivation required
Chlortalidone 50mg TAB Hygroton Motivation required
Furosemide 10mg/ml SYR Lasix Oral Motivation required
Furosemide 20mg TAB Lasix Accepted treatment
Furosemide 40mg TAB Beuresis Diuresix Mylan Furosemide Accepted treatment
Furosemide 500mg TAB Lasix Motivation required
Furosemide 60mg CAP Lasix Motivation required
Furosemide 80mg TAB Lasix Motivation required
Hydrochlorothiazide 12.5mg TAB Ridaq Accepted treatment
Hydrochlorothiazide 25mg TAB Hexazide Ridaq Accepted treatment
Hydrochlorothiazide and amiloride 25mg/2.5mg TAB Amiloretic HS Moduretic HS Accepted treatment
Hydrochlorothiazide and amiloride 50mg/5mg TAB Amiloretic Betaretic Spec-Co-Amiloride Accepted treatment
Hydrochlorothiazide and potassium 50mg/300mg TAB Urirex K Accepted treatment
Indapamide 1.5mg TAB Natrilix SR Accepted treatment
Indapamide 2.5mg TAB Cipla-Indapamide Daptril Mylan-indapamide Accepted treatment
Piretanide 3mg TAB Arelix Motivation required
Piretanide 6mg TAB Arelix Motivation required
Spironolactone 100mg TAB Aldactone Spiractin Accepted treatment
Spironolactone 25mg TAB Spiractin Sandoz Spironolactone Accepted treatment
Torasemide 10mg TAB Unat Torahexal Motivation required
Torasemide 2.5mg TAB Unat Torahexal Motivation required
Torasemide 5mg TAB Unat Torahexal Motivation required
Triamterine and hydrochlorothiazide 50mg/25mg TAB Renezide Accepted treatment
Potassium supplements
Potassium chloride 600mg TAB Plenish-K Sandoz K-600 Accepted treatment
ACE-inhibitors and combinations
Benazepril 10mg TAB Cibace Motivation required
Benazepril and diuretics TAB Cibadrex Accepted treatment
Benazepril and diuretics 10mg/12.5mg TAB Cibadrex FCT Motivation required
Captopril 12.5mg TAB Captohexal Accepted treatment
Captopril 25mg TAB Captohexal Mylan-captopril Bio-captopril Accepted treatment
Captopril 50mg TAB Captohexal Mylan-captopril Zapto Accepted treatment
8
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Captopril and diuretic 50mg/25mg TAB Captoretic Zapto-Co Capozide Accepted treatment
Cilazapril 5mg TAB Inhibace Motivation required
Cilazapril and diuretic 5mg/12.5mg TAB Inhibace Plus Motivation required
Enalapril 10mg TAB Alapren Ciplatec Pharmapress Accepted treatment
Enalapril 2.5mg TAB Renitec Accepted treatment
Enalapril 20mg TAB Alapren Ciplatec Pharmapress Accepted treatment
Enalapril 5mg TAB Alapren Ciplatec Pharmapress Accepted treatment
Enalapril and diuretic 12.5mg TAB Enap Co Pharmapress Co Accepted treatment
Fosinopril 10mg TAB Mylan-fosinopril Motivation required
Fosinopril 20mg TAB Mylan-fosinopril Motivation required
Lisinopril 10mg TAB Sinopren Simayla-lisinopril Zemax Accepted treatment
Lisinopril 2.5mg TAB Austell-lisinopril Accepted treatment
Lisinopril 20mg TAB Sinopren Simayla-lisinopril Zemax Accepted treatment
Lisinopril 5mg TAB Sinopren Simayla-lisinopril Zemax Accepted treatment
Lisinopril and diuretic 10mg/12.5mg TAB Lisoretic Lisozide Hexal-lisinopril Co Accepted treatment
Lisinopril and diuretic 20mg/12.5mg TAB Lisoretic Zestozide Hexal-lisinopril Co Accepted treatment
Moexipril 7.5mg TAB Perdix Motivation required
Perindopril 10mg TAB Prexum Coversyl Accepted treatment
Perindopril 4mg TAB Prexum Vectoryl Cipla-perindopril Accepted treatment
Perindopril 8mg TAB Vectoryl Cipla-perindopril Accepted treatment
Perindopril and indapamide 2mg/0.625mg TAB Preterax Spec-Perindopril Plus Accepted treatment
Perindopril and indapamide 4mg/1.5mg TAB Pearinda Plus Prexum Plus Vectoryl Plus Accepted treatment
Quinapril 10mg TAB Quinaspen Accumax Quinace Accepted treatment
Quinapril 20mg TAB Quinaspen Accumax Quinace Accepted treatment
Quinapril 40mg TAB Accupril Quinagen Motivation required
Quinapril 5mg TAB Accupril Quinagen Motivation required
Quinapril and diuretic 10mg/12.5mg TAB Accumax Co Quinace Co Adco-quinaretic Motivation required
Quinapril and diuretic 20mg/12.5mg TAB Accumax Co Quinace Co Adco-quinaretic Motivation required
Ramipril 1.25mg TAB/CAP Austell-ramipril Rampil Tritace Accepted treatment
Ramipril 10mg CAP Austell-ramipril Ran-ramipril Rampil Accepted treatment
Ramipril 2.5mg TAB/CAP Austell-ramipril Ramiwin Rampil Accepted treatment
Ramipril 5mg TAB/CAP Austell-ramipril Ramiwin Rampil Accepted treatment
Ramipril and calcium channel blocker 2.5mg/2.5mg TAB Tri-plen Motivation required
Ramipril and calcium channel blocker 5mg/5mg TAB Tri-plen Forte Motivation required
9
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Trandolapril 0.5mg CAP Mavik Accepted treatment
Trandolapril 2mg CAP Mavik Accepted treatment
Angiotensin receptor blockers and combinations
Candesartan 16mg TAB Atacand Motivation required
Candesartan 8mg TAB Atacand Motivation required
Candesartan 32mg TAB Atacand Motivation required
Candesartan and diuretic 16mg/12.5mg TAB Atacand Plus Motivation required
Eprosartan 600mg TAB Teveten Motivation required
Eprosartan and diuretic 600mg/12.5mg TAB Teveten Plus Motivation required
Irbesartan 150mg TAB Iberwin Aprovel Motivation required
Irbesartan 300mg TAB Iberwin Aprovel Motivation required
Irbesartan and diuretic 150mg/12.5mg TAB Co-Iberwin Coaprovel Motivation required
Irbesartan and diuretic 300mg/12.5mg TAB Co-Iberwin Coaprovel Motivation required
Losartan 50mg TAB Losartan-Winthrop Cipla-losartan Los-arb Accepted treatment
Losartan 100mg TAB Zartan Cipla-losartan Accepted treatment
Losartan and diuretic 100mg/25mg TAB Fortzaar Accepted treatment
Losartan and diuretic 50mg/12.5mg TAB Cozaar Comp Sartoc Accepted treatment
Telmisartan 40mg TAB Micardis Pritor Motivation required
Telmisartan 80mg TAB Micardis Pritor Motivation required
Telmisartan and diuretic 40mg/12.5mg TAB Co-micardis Co-Pritor Motivation required
Telmisartan and diuretic 80mg/12.5mg TAB Co-micardis Co-Pritor Motivation required
Valsartan 160mg TAB Tareg Zomevek Motivation required
Valsartan 320mg TAB Diovan Motivation required
Valsartan 40mg TAB Diovan Motivation required
Valsartan 80mg TAB Tareg Zomevek Motivation required
Valsartan and diuretic 160mg/12.5mg TAB Co-diovan Co-Zomevek Co-Migroben Motivation required
Valsartan and diuretic 160mg/25mg TAB Co-diovan Plus Co-Zomevek Co-Migroben Motivation required
Valsartan and diuretic 320mg/12.5mg TAB Co-diovan Motivation required
Valsartan and diuretic 320mg/25mg TAB Co-diovan Motivation required
Valsartan and diuretic 80mg/12.5mg TAB Co-tareg Co-Zomevek Co-Migroben Motivation required
Valsartan and amlodipine 160mg/5mg TAB Exforge Accepted treatment Valsartan and amlodipine 160mg/10mg TAB Exforge Accepted treatment
10
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Calcium channel blockers and combinations
Amlodipine 10mg TAB Almadin Ciplavasc Amlate Accepted treatment
Amlodipine 5mg TAB Almadin Ciplavasc Amlate Accepted treatment
Diltiazem 240mg SRT Zildem SR Accepted treatment
Diltiazem 180mg SRT Zildem SR Accepted treatment
Diltiazem 60mg TAB Zildem Accepted treatment
Diltiazem 90mg TAB Zildem Accepted treatment
Felodipine 10mg SRT Felodipine-hexal Plendil Accepted treatment
Felodipine 2.5mg SRT Plendil Accepted treatment
Felodipine 5mg SRT Felodipine-hexal Plendil Accepted treatment
Isradipine 2.5mg TAB Dynacirc Motivation required
Isradipine 5mg CAP Dynacirc SRO Motivation required
Lercanidipine 10mg TAB Zanidip Motivation required
Lercanidipine 20mg TAB Zanidip Motivation required
Lercanidipine and enalapril 10mg/10mg TAB Zaneril Motivation required
Lercanidipine and enalapril 10mg/20mg TAB Zaneril Motivation required
Nifedipine 20mg SRT Nifedalat SR Cipalat Retard Accepted treatment
Nifedipine 30mg SRT Adco-Vascard SR Fedaloc Macorel Accepted treatment
Nifedipine 60mg SRT Fedaloc Macorel Motivation required
Verapamil 240mg SRT Verahexal Calcicard Ravamil Accepted treatment
Verapamil and trandolapril 180mg/2mg SRC Tarka Motivation required
Verapamil 40mg TAB Vasomil Accepted treatment
Verapamil 80mg TAB Vasomil Accepted treatment
Beta blockers and combinations
Acebutolol 100mg CAP Sectral Motivation required
Acebutolol 200mg CAP Sectral Motivation required
Acebutolol 400mg TAB Butobloc Sectral Motivation required
Atenolol 100mg TAB Tenopress Sandoz Atenolol B-block Accepted treatment
Atenolol 25mg TAB Tenopress Tenormin Accepted treatment
Atenolol 50mg TAB Tenopress Sandoz Atenolol B-block Accepted treatment
Atenolol and other diuretics 100mg/25mg TAB Sandoz Co-tenidone Tenchlor Adco-loten Accepted treatment
Atenolol and other diuretics 50mg/12.5mg TAB Sandoz Co-tenidone Tenchlor HS Accepted treatment
Bisoprolol 10mg TAB Cardicor Bilocor Adco-bisocor Accepted treatment
Bisoprolol 2.5mg TAB Cardicor Accepted treatment
11
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Bisoprolol 5mg TAB Cardicor Bilocor Adco-bisocor Accepted treatment
Bisoprolol and diuretic 10mg/6.25mg TAB Ziak Accepted treatment
Bisoprolol and diuretic 2.5mg/6.25mg TAB Ziak Accepted treatment
Bisoprolol and diuretic 5mg/6.25mg TAB Ziak Accepted treatment
Metoprolol 100mg TAB Lopresor Motivation required
Nebivolol 5mg TAB Nebilet Motivation required
Propranolol 10mg TAB Indoblok Prodorol Purbloka Accepted treatment
Propranolol 160mg CAP Inderal LA Motivation required
Propranolol 40mg TAB Indoblok Prodorol Purbloka Accepted treatment
Propranolol 80mg CAP Inderal LA Motivation required
Propranolol and thiazides 80mg/2.5mg CAP Inderetic Motivation required
Timolol, thiazides and other diuretics 10/2.5/25mg TAB Servatrin Motivation required
Alpha/beta blockers
Carvedilol 12.5mg TAB Carloc Carvetrend Vediblok Accepted treatment
Carvedilol 25mg TAB Carloc Carvetrend Vediblok Accepted treatment
Carvedilol 6.25mg TAB Carloc Carvetrend Vediblok Accepted treatment
Vasodilators
Hydralazine 10mg TAB Hyperphen Accepted treatment
Hydralazine 25mg TAB Sandoz Hydralazine Accepted treatment
Hydralazine 50mg TAB Hyperphen Sandoz Hydralazine Accepted treatment
Cardiac glycosides
Digoxin 0.0625mg TAB Lanoxin Accepted treatment
Digoxin 0.25mg TAB Lanoxin Purgoxin Accepted treatment
Digoxin 0.05mg/ml SYR Lanoxin Paed Motivation required in adults
Organic nitrates
Isosorbide dinitrate 10mg TAB Sandoz Isosorbide dinitrate Isordil Accepted treatment
Isosorbide dinitrate 30mg TAB Sandoz Isosorbide Accepted treatment
Isosorbide dinitrate 40mg TAB Isordil Tembid Accepted treatment
Isosorbide dinitrate 5mg TAB Sandoz Isosorbide dinitrate Accepted treatment
Chronic Obstructive Pulmonary Disease
Beta agonists, short-acting
Fenoterol INH Berotec HFA Accepted treatment
Fenoterol and ipratropium bromide 50mcg/20mcg INH Duovent HFA Accepted treatment
Salbutamol 100mcg INH Venteze Asthavent Accepted treatment
12
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Salbutamol 2.5mg SLN Ventolin nebules Motivation required
Salbutamol 200mcg CPS Asthavent Accepted treatment
Salbutamol 200mcg CPS Ventodisks Accepted treatment
Salbutamol 400mcg CPS Ventodisks Motivation required
Terbutaline 0.5mg INH Bricanyl Motivation required
Beta agonists, long-acting
Formoterol 12mcg CPS/INH Foratec Accepted treatment
Formoterol 9mcg INH Oxis Accepted treatment
Salmeterol 25mcg INH Serevent Accepted treatment
Salmeterol 50mcg INH Serevent Accepted treatment
Anticholinergics, inhaled
Ipratropium bromide 20mcg INH Atrovent 20 HFA Accepted treatment
Ipratropium bromide 40mcg INH Ipvent Accepted treatment
Ipratropium bromide and salbutamol 20mcg/100mcg INH Combivent Accepted treatment
Tiotropium bromide 18mcg CPS Spiriva Forvent Motivation required
Corticosteroids, inhaled
Beclometasone 100mcg INH Beclate Special investigations
Beclometasone 200mcg INH Beclate Special investigations
Beclometasone 50mcg INH Beclate Special investigations
Budesonide 100mcg INH/CPS Inflacor Budeflam Inflammide Special investigations
Budesonide 200mcg INH/CPS Inflacor Budeflam Inflammide Special investigations
Budesonide 400mcg INH/CPS Inflacor Inflammide Novoliser Special investigations
Cyclesonide 80mcg INH Alvesco Special investigations
Cyclesonide 160mcg INH Alvesco Special investigations
Fluticasone 100mcg INH Flixotide CFC-free Special investigations
Fluticasone 125mcg INH Flixotide CFC-free Special investigations
Fluticasone 250mcg INH Flixotide CFC-free Special investigations
Fluticasone 500mcg INH Flixotide accuhaler Special investigations
Fluticasone 50mcg INH Flixotide CFC-free Special investigations
Corticosteroids and beta agonists, long-acting
Salmeterol and fluticasone 25mcg/125mcg INH Seretide Sereflo Special investigations
Salmeterol and fluticasone 25mcg/250mcg INH Seretide Sereflo Special investigations
Salmeterol and fluticasone 25mcg/50mcg INH Seretide Sereflo Special investigations
Salmeterol and fluticasone 50mcg/100mcg INH Seretide Foxair Special investigations
13
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Salmeterol and fluticasone 50mcg/250mcg INH Seretide Foxair Special investigations
Salmeterol and fluticasone 50mcg/500mcg INH Seretide Foxair Special investigations
Xanthines
Aminophylline 100mg TAB Norstan-ted Accepted treatment
Aminophylline 200mg TAB Norstan-ted Accepted treatment
Aminophylline 225mg SRT Phyllocontin Accepted treatment
Theophylline SYR Alcophyllin Nuelin liquid Accepted treatment
Theophylline 200mg SRT Sandoz Theophylline Accepted treatment
Theophylline 250mg SRT Nuelin SA Accepted treatment
Theophylline 300mg SRT Sandoz Theophylline Accepted treatment
Theophylline 400mg SRT Uniphyl Accepted treatment
Theophylline 600mg SRT Uniphyl Accepted treatment
Theophylline combinations excl. psycholeptics SYR Solphyllin Theophen Accepted treatment
Chronic kidney failure
Diuretics
Bumetanide 1mg TAB Burinex Motivation required
Chlortalidone 50mg TAB Hygroton Motivation required
Furosemide 10mg/ml SYR Lasix Oral Motivation required
Furosemide 20mg TAB Lasix Accepted treatment
Furosemide 40mg TAB Beuresis Diuresix Mylan Furosemide Accepted treatment
Furosemide 500mg TAB Lasix Motivation required
Furosemide 60mg CAP Lasix Motivation required
Furosemide 80mg TAB Lasix Motivation required
Hydrochlorothiazide 12.5mg TAB Ridaq Accepted treatment
Hydrochlorothiazide 25mg TAB Hexazide Ridaq Accepted treatment
Hydrochlorothiazide and amiloride 25mg/2.5mg TAB Amiloretic HS Moduretic HS Accepted treatment
Hydrochlorothiazide and amiloride 50mg/5mg TAB Amiloretic Betaretic Spec-Co-Amiloride Accepted treatment
Hydrochlorothiazide and potassium 50mg/300mg TAB Urirex K Accepted treatment
Indapamide 1.5mg TAB Natrilix SR Accepted treatment
Indapamide 2.5mg TAB Cipla-Indapamide Daptril Mylan-indapamide Accepted treatment
Piretanide 3mg TAB Arelix Motivation required
Piretanide 6mg TAB Arelix Motivation required
Spironolactone 100mg TAB Aldactone Spiractin Accepted treatment
Spironolactone 25mg TAB Spiractin Sandoz Spironolactone Accepted treatment
14
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Torasemide 10mg TAB Unat Torahexal Motivation required
Torasemide 2.5mg TAB Unat Torahexal Motivation required
Torasemide 5mg TAB Unat Torahexal Motivation required
Triamterine and hydrochlorothiazide 50mg/25mg TAB Renezide Accepted treatment
Potassium supplements
Potassium chloride 600mg TAB Plenish-K Sandoz K-600 Accepted treatment
ACE-inhibitors and combinations
Benazepril 10mg TAB Cibace Motivation required
Benazepril and diuretics 10mg/12.5mg FCT Cibadrex Motivation required
Captopril 12.5mg TAB Captohexal Accepted treatment
Captopril 25mg TAB Captohexal Mylan-captopril Bio-captopril Accepted treatment
Captopril 50mg TAB Captohexal Mylan-captopril Zapto Accepted treatment
Captopril and diuretic 50mg/25mg TAB Captoretic Zapto-Co Capozide Accepted treatment
Cilazapril 5mg TAB Inhibace Motivation required
Cilazapril and diuretic 5mg/12.5mg TAB Inhibace Plus Motivation required
Enalapril 10mg TAB Alapren Ciplatec Pharmapress Accepted treatment
Enalapril 2.5mg TAB Renitec Accepted treatment
Enalapril 20mg TAB Alapren Ciplatec Pharmapress Accepted treatment
Enalapril 5mg TAB Alapren Ciplatec Pharmapress Accepted treatment
Enalapril and diuretic 12.5mg TAB Enap Co Pharmapress Co Accepted treatment
Fosinopril 10mg TAB Mylan-fosinopril Motivation required
Fosinopril 20mg TAB Mylan-fosinopril Motivation required
Lisinopril 10mg TAB Sinopren Simayla-lisinopril Zemax Accepted treatment
Lisinopril 2.5mg TAB Austell-lisinopril Accepted treatment
Lisinopril 20mg TAB Sinopren Simayla-lisinopril Zemax Accepted treatment
Lisinopril 5mg TAB Sinopren Simayla-lisinopril Zemax Accepted treatment
Lisinopril and diuretic 10mg/12.5mg TAB Lisoretic Lisozide Hexal-lisinopril Co Accepted treatment
Lisinopril and diuretic 20mg/12.5mg TAB Lisoretic Zestozide Hexal-lisinopril Co Accepted treatment
Moexipril 7.5mg TAB Perdix Motivation required
Perindopril 10mg TAB Prexum Coversyl Accepted treatment
Perindopril 4mg TAB Prexum Vectoryl Cipla-perindopril Accepted treatment
Perindopril 8mg TAB Vectoryl Cipla-perindopril Accepted treatment
Perindopril and indapamide 2mg/0.625mg TAB Preterax Spec-Perindopril Plus Accepted treatment
Perindopril and indapamide 4mg/1.5mg TAB Pearinda Plus Prexum Plus Vectoryl Plus Accepted treatment
15
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Quinapril 10mg TAB Quinaspen Accumax Quinace Accepted treatment
Quinapril 20mg TAB Quinaspen Accumax Quinace Accepted treatment
Quinapril 40mg TAB Accupril Quinagen Motivation required
Quinapril 5mg TAB Accupril Quinagen Motivation required
Quinapril and diuretic 10mg/12.5mg TAB Accumax Co Quinace Co Adco-quinaretic Motivation required
Quinapril and diuretic 20mg/12.5mg TAB Accumax Co Quinace Co Adco-quinaretic Motivation required
Ramipril 1.25mg TAB/CAP Austell-ramipril Rampil Tritace Accepted treatment
Ramipril 10mg CAP Austell-ramipril Ran-ramipril Rampil Accepted treatment
Ramipril 2.5mg TAB/CAP Austell-ramipril Ramiwin Rampil Accepted treatment
Ramipril 5mg TAB/CAP Austell-ramipril Ramiwin Rampil Accepted treatment
Ramipril and diuretic 2.5mg/2.5mg TAB Tri-plen Motivation required
Ramipril and diuretic 5mg/5mg TAB Tri-plen Forte Motivation required
Trandolapril 0.5mg CAP Mavik Accepted treatment
Trandolapril 2mg CAP Mavik Accepted treatment
Angiotensin receptor blockers and combinations
Candesartan 16mg TAB Atacand Motivation required
Candesartan 8mg TAB Atacand Motivation required
Candesartan 32mg TAB Atacand Motivation required
Candesartan and diuretic 16mg/12.5mg TAB Atacand Plus Motivation required
Eprosartan 600mg TAB Teveten Motivation required
Eprosartan and diuretic 600mg/12.5mg TAB Teveten Plus Motivation required
Irbesartan 150mg TAB Iberwin Aprovel Motivation required
Irbesartan 300mg TAB Iberwin Aprovel Motivation required
Irbesartan and diuretic 150mg/12.5mg TAB Co-Iberwin Coaprovel Motivation required
Irbesartan and diuretic 300mg/12.5mg TAB Co-Iberwin Coaprovel Motivation required
Losartan 50mg TAB Losartan-Winthrop Cipla-losartan Los-arb Accepted treatment
Losartan 100mg TAB Zartan Cipla-losartan Accepted treatment
Losartan and diuretic 100mg/25mg TAB Fortzaar Accepted treatment
Losartan and diuretic 50mg/12.5mg TAB Cozaar Comp Sartoc Accepted treatment
Telmisartan 40mg TAB Micardis Pritor Motivation required
Telmisartan 80mg TAB Micardis Pritor Motivation required
Telmisartan and diuretic 40mg/12.5mg TAB Co-micardis Co-Pritor Motivation required
Telmisartan and diuretic 80mg/12.5mg TAB Co-micardis Co-Pritor Motivation required
Valsartan 160mg TAB Tareg Zomevek Motivation required
16
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Valsartan 320mg TAB Diovan Motivation required
Valsartan 40mg TAB Diovan Motivation required
Valsartan 80mg TAB Tareg Zomevek Motivation required
Valsartan and diuretic 160mg/12.5mg TAB Co-diovan Co-Zomevek Co-Migroben Motivation required
Valsartan and diuretic 160mg/25mg TAB Co-diovan Plus Co-Zomevek Co-Migroben Motivation required
Valsartan and diuretic 320mg/12.5mg TAB Co-diovan Motivation required
Valsartan and diuretic 320mg/25mg TAB Co-diovan Motivation required
Valsartan and diuretic 80mg/12.5mg TAB Co-tareg Co-Zomevek Co-Migroben Motivation required
Valsartan and amlodipine 160mg/5mg TAB Exforge Accepted treatment Valsartan and amlodipine 160mg/10mg TAB Exforge Accepted treatment Calcium channel blockers and combinations
Amlodipine 10mg TAB Almadin Ciplavasc Amlate Accepted treatment
Amlodipine 5mg TAB Almadin Ciplavasc Amlate Accepted treatment
Diltiazem 240mg SRT Zildem SR Tilazem Accepted treatment
Diltiazem 180mg SRT Zildem SR Tilazem Accepted treatment
Diltiazem 60mg TAB Zildem Accepted treatment
Diltiazem 90mg TAB Zildem Accepted treatment
Felodipine 10mg SRT Felodipine-hexal Plendil Accepted treatment
Felodipine 2.5mg SRT Plendil Accepted treatment
Felodipine 5mg SRT Felodipine-hexal Plendil Accepted treatment
Isradipine 2.5mg TAB Dynacirc Motivation required
Isradipine 5mg CAP Dynacirc SRO Motivation required
Lercanidipine 10mg TAB Zanidip Motivation required
Lercanidipine 20mg TAB Zanidip Motivation required
Lercanidipine and enalapril 10mg/10mg TAB Zaneril Motivation required
Lercanidipine and enalapril 10mg/20mg TAB Zaneril Motivation required
Nifedipine 20mg SRT Nifedalat SR Cipalat Retard Accepted treatment
Nifedipine 30mg SRT Adco-Vascard SR Fedaloc Accepted treatment
Nifedipine 60mg SRT Fedaloc Motivation required
Verapamil 240mg SRT Verahexal Calcicard Ravamil Accepted treatment
Verapamil and trandolapril 180mg/2mg SRC Tarka Motivation required
Verapamil 40mg TAB Vasomil Accepted treatment
Verapamil 80mg TAB Vasomil Accepted treatment
17
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Beta blockers and combinations
Acebutolol 100mg CAP Sectral Motivation required
Acebutolol 200mg CAP Sectral Motivation required
Acebutolol 400mg TAB Butobloc Sectral Motivation required
Atenolol 100mg TAB Tenopress Sandoz Atenolol B-block Accepted treatment
Atenolol 25mg TAB Tenopress Tenormin Accepted treatment
Atenolol 50mg TAB Tenopress Sandoz Atenolol B-block Accepted treatment
Atenolol and other diuretics 100mg/25mg TAB Sandoz Co-tenidone Tenchlor Adco-loten Accepted treatment
Atenolol and other diuretics 50mg/12.5mg TAB Sandoz Co-tenidone Tenchlor HS Accepted treatment
Bisoprolol 10mg TAB Cardicor Bilocor Adco-bisocor Accepted treatment
Bisoprolol 2.5mg TAB Cardicor Accepted treatment
Bisoprolol 5mg TAB Cardicor Bilocor Adco-bisocor Accepted treatment
Bisoprolol and diuretic 10mg/6.25mg TAB Ziak Accepted treatment
Bisoprolol and diuretic 2.5mg/6.25mg TAB Ziak Accepted treatment
Bisoprolol and diuretic 5mg/6.25mg TAB Ziak Accepted treatment
Metoprolol 100mg TAB Lopresor Motivation required
Nebivolol 5mg TAB Nebilet Motivation required
Propranolol 10mg TAB Indoblok Prodorol Purbloka Accepted treatment
Propranolol 160mg CAP Inderal LA Motivation required
Propranolol 40mg TAB Indoblok Prodorol Purbloka Accepted treatment
Propranolol 80mg CAP Inderal LA Motivation required
Propranolol and thiazides 80mg/2.5mg CAP Inderetic Motivation required
Timolol, thiazides and other diuretics 10/2.5/25mg TAB Servatrin Motivation required
Alpha/beta blockers
Carvedilol 12.5mg TAB Carloc Carvetrend Vediblok Accepted treatment
Carvedilol 25mg TAB Carloc Carvetrend Vediblok Accepted treatment
Carvedilol 6.25mg TAB Carloc Carvetrend Vediblok Accepted treatment
Vasodilators
Hydralazine 10mg TAB Hyperphen Accepted treatment
Hydralazine 25mg TAB Sandoz Hydralazine Accepted treatment
Hydralazine 50mg TAB Hyperphen Sandoz Hydralazine Accepted treatment
Erythropoietin and supplements
Alfacalcidol 0.25mg CAP One alpha Accepted treatment
Alfacalcidol 1mg CAP One alpha Accepted treatment
18
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Calcitriol 0.25mg CAP Rocaltrol Accepted treatment Ergocalciferol 50,000u TAB Calciferol Accepted treatment Calcium carbonate TAB Titralac Accepted treatment Erythropoietin INJ Repotin Recormon Eprex Special investigations
Methoxy polyethhylene glycol- epoetin beta INJ Mircera Special investigations& motivation
Iron in other combinations INJ Venofer Cosmofer Special investigations
Folic acid 0.5mg TAB Folic acid Accepted treatment Folic acid 5mg TAB/CAP Be-tabs folic acid Accepted treatment Folic acid and vitamin B12 CAP Folic Acid Forte Accepted treatment Phosphate binders
Sevelamer hydrochloride 800mg TAB Renagel Special investigations& motivation
Lanthanum carbonate 750mg TAB Fosrenol Special investigations& motivation
Lanthanum carbonate 500mg TAB Fosrenol Special investigations& motivation
Hormone Inhibitors
Cinacalcet 30mg TAB Sensipar Special investigations & Motivation
Cinacalcet 60mg TAB Sensipar Special investigations& Motivation
Iron supplementation subject to Qualsa’s Medicine Reimbursement Policy
Coronary Artery Disease
Aspirin
Acetylsalicylic acid 100mg TAB Bayer aspirin cardio Disprin CV Myoprin Accepted treatment
Acetylsalicylic acid 125mg TAB Lo-aspirin Accepted treatment
Acetylsalicylic acid 300mg TAB Be-tabs aspirin Disprin Gulf aspirin Accepted treatment
Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment (in children)
Acetylsalicylic acid 81mg ECT Ecotrin Coprin Accepted treatment
Calcium channel blockers
Amlodipine 10mg TAB Almadin Ciplavasc Amlate Accepted treatment
Amlodipine 5mg TAB Almadin Ciplavasc Amlate Accepted treatment
Diltiazem 240mg SRT Zildem SR Tilazem Accepted treatment
Diltiazem 180mg SRT Zildem SR Tilazem Accepted treatment
Diltiazem 60mg TAB Zildem Accepted treatment
Diltiazem 90mg TAB Zildem Accepted treatment
Felodipine 10mg SRT Felodipine-hexal Plendil Accepted treatment
19
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Felodipine 2.5mg SRT Plendil Accepted treatment
Felodipine 5mg SRT Felodipine-hexal Plendil Accepted treatment
Diltiazem 240mg SRT Zildem SR Accepted treatment
Diltiazem 180mg SRT Zildem SR Accepted treatment
Diltiazem 60mg TAB Zildem Accepted treatment
Diltiazem 90mg TAB Zildem Accepted treatment
Isradipine 2.5mg TAB Dynacirc Motivation required
Isradipine 5mg CAP Dynacirc SRO Motivation required
Lercanidipine 10mg TAB Zanidip Motivation required
Lercanidipine 20mg TAB Zanidip Motivation required
Lercanidipine and enalapril 10mg/10mg TAB Zaneril Motivation required
Lercanidipine and enalapril 10mg/20mg TAB Zaneril Motivation required
Nifedipine 20mg SRT Nifedalat SR Cipalat Retard Accepted treatment
Nifedipine 30mg SRT Adco-Vascard SR Fedaloc Accepted treatment
Nifedipine 60mg SRT Fedaloc Accepted treatment
Verapamil 240mg SRT Verahexal Calcicard Ravamil Accepted treatment
Verapamil and trandolapril 180mg/2mg SRC Tarka Motivation required
Verapamil 240mg SRT Verahexal Calcicard Ravamil Accepted treatment
Verapamil 40mg TAB Vasomil Accepted treatment
Verapamil 80mg TAB Vasomil Accepted treatment
Beta blockers
Acebutolol 100mg CAP Sectral Motivation required
Acebutolol 200mg CAP Sectral Motivation required
Acebutolol 400mg TAB Butobloc Sectral Motivation required
Atenolol 100mg TAB Tenopress Sandoz Atenolol B-block Accepted treatment
Atenolol 25mg TAB Tenopress Tenormin Accepted treatment
Atenolol 50mg TAB Tenopress Sandoz Atenolol B-block Accepted treatment
Atenolol and other diuretics 100mg/25mg TAB Sandoz Co-tenidone Tenchlor Adco-loten Accepted treatment
Atenolol and other diuretics 50mg/12.5mg TAB Sandoz Co-tenidone Tenchlor HS Accepted treatment
Bisoprolol 10mg TAB Cardicor Bilocor Adco-bisocor Accepted treatment
Bisoprolol 2.5mg TAB Cardicor Accepted treatment
Bisoprolol 5mg TAB Cardicor Bilocor Adco-bisocor Accepted treatment
Bisoprolol and diuretic 10mg/6.25mg TAB Ziak Accepted treatment
Bisoprolol and diuretic 2.5mg/6.25mg TAB Ziak Accepted treatment
20
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Bisoprolol and diuretic 5mg/6.25mg TAB Ziak Accepted treatment
Metoprolol 100mg TAB Lopresor Motivation required
Nebivolol 5mg TAB Nebilet Motivation required
Propranolol 10mg TAB Indoblok Prodorol Purbloka Accepted treatment
Propranolol 160mg CAP Inderal LA Motivation required
Propranolol 40mg TAB Indoblok Prodorol Purbloka Accepted treatment
Propranolol 80mg CAP Inderal LA Motivation required
Propranolol and thiazides 80mg/2.5mg CAP Inderetic Motivation required
Timolol, thiazides and other diuretics 10/2.5/25mg TAB Servatrin Motivation required
Alpha/beta blockers
Carvedilol 12.5mg TAB Carloc Carvetrend Vediblok Accepted treatment
Carvedilol 25mg TAB Carloc Carvetrend Vediblok Accepted treatment
Carvedilol 6.25mg TAB Carloc Carvetrend Vediblok Accepted treatment
Organic nitrates
Glyceryl trinitrate 0.5mg TAB Angised Accepted treatment
Isosorbide dinitrate 10mg TAB Sandoz Isosorbide dinitrate Accepted treatment
Isosorbide dinitrate 30mg TAB Sandoz Isosorbide Accepted treatment
Isosorbide dinitrate 40mg TAB Isordil Tembid Accepted treatment
Isosorbide dinitrate 5mg TAB Sandoz Isosorbide dinitrate Accepted treatment
Isosorbide mononitrate 20mg TAB Elantan Accepted treatment
Isosorbide mononitrate 50mg SRC Elantan LA Accepted treatment
Isosorbide -5 -mononitrate 60mg SRT Monicor Imdur Accepted treatment
Anticoagulants
Warfarin 1mg TAB Cipla-warfarin Accepted treatment
Warfarin 3mg TAB Cipla-warfarin Accepted treatment
Warfarin 5mg TAB Cipla-warfarin Accepted treatment
Dipyridimole 200mg SRC Persantin Motivation required
Dipyridimole 100mg TAB Plato Motivation requred
Dipyridimole 25mg TAB Plato Motivation required
Clopidogrel 75mg TAB Clopivas Mistro Pharma Dynamics Clopidogrel Motivation required
IF-Channel blockers
Ivabradine 5mg TAB Coralan Motivation required
Ivabradine 7.5mg TAB Coralan Motivation required
21
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Crohn's disease
Corticosteroids, topical
Budesonide ENE Entocord Motivation required
Corticosteroids, oral
Budesonide 3mg CAP Entocord Motivation required
Hydrocortisone 10mg TAB Covocort Motivation required
Methylprednisolone 4mg TAB Medrol Motivation required
Methylprednisolone 16mg TAB Medrol Motivation required
Prednisolone 5mg TAB Lenisolone Capsoid Accepted treatment
Prednisone 5mg TAB Be-tabs prednisone Panafcort Trolic Accepted treatment
5-ASA agents
Mesalazine 2g/50ml ENE Asacol Motivation required
Mesalazine 400mg TAB Asacol Motivation required
Mesalazine 800mg TAB Asacol Motivation required
Mesalazine 500mg TAB/SUP Asacol Pentasa Motivation required
Mesalazine 1000mg SUP Pentasa Motivation required
Olsalazine 250mg CAP Dipentum Motivation required
Sulfasalazine 500mg TAB Salazopyrin Accepted treatment Immunosuppressants
Azathioprine 50mg TAB Zaprine Azathioprine 50 PCH Azapress Accepted treatment
Leflunomide 10mg TAB Arava Motivation required
Leflunomide 20mg TAB Arava Motivation required
Methotrexate 2.5mg TAB Methotrexate Emthexate Accepted treatment
Biologicals will be reimbursed subject to Qualsa’s Medicine Policy and special investigations.
Supplements
Folic acid 0.5mg TAB Folic acid Accepted treatment Folic acid 5mg TAB/CAP Be-tabs folic acid Accepted treatment Folic acid and vitamin B12 CAP Folic Acid Forte Accepted treatment Diabetes insipidus
Vasopressin analogues
Desmopressin 0.1mg/ml NAS/NOD DDAVP nasal spray 5ml DDAVP 2.5ml Motivation required
Desmopressin 0.1mg TAB DDAVP Motivation required
Desmopressin 0.2mg TAB DDAVP Motivation required
22
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Diabetes mellitus, type 1
Insulin
Insulin (human) INJ Humulin Actraphane Protaphane Accepted treatment
Insulin aspart INJ Novorapid Novomix Accepted treatment
Insulin detemir INJ Levemir Accepted treatment
Insulin glargine INJ Lantus Accepted treatment
Insulin glulisine INJ Apidra Accepted treatment
Insulin lispro INJ Humalog Humalog Mix Accepted treatment
Diabetes mellitus, type 2
Suphonylureas
Glibenclamide 5mg TAB Sandoz Glibenclamide Diacare Glycomin Accepted treatment
Gliclazide 30mg TAB Diaran MR Diamicron MR Motivation required
Gliclazide 40mg TAB Austell-gliclazide Accepted treatment
Gliclazide 80mg TAB Austell-gliclazide Mylan-gliclazide Sandoz Gliclazide Accepted treatment
Glimepiride 1mg TAB Sulphonur Mylan-Glimepiride Sandoz Glimepiride Accepted treatment
Glimepiride 2mg TAB Sulphonur Mylan-Glimepiride Sandoz Glimepiride Accepted treatment
Glimepiride 3mg TAB Amaryl Aspen-Glimepiride Motivation required
Glimepiride 4mg TAB Sulphonur Mylan-Glimepiride Sandoz Glimepiride Motivation required
Glipizide 5mg TAB Minidiab Motivation required
Insulin
Insulin (human) INJ Humulin Actraphane Protaphane Accepted treatment
Insulin aspart INJ Novorapid Novomix Accepted treatment
Insulin detemir INJ Levemir Accepted treatment Insulin glargine INJ Lantus Accepted treatment Insulin glulisine INJ Apidra Accepted treatment
Insulin lispro INJ Humalog Humalog Mix Accepted treatment
Biguanides and combinations
Metformin 1000mg TAB Glucophage Bigsens Metored Accepted treatment
Metformin 500mg TAB Austell-metformin Bigsens Forminal Accepted treatment
Metformin 850mg TAB Austell-metformin Bigsens Forminal Accepted treatment
Metformin 500mg XR TAB Glucophage XR Accepted treatment
Metformin and glibenclamide 250mg/1.25mg TAB Glucovance Motivation required
Metformin and glibenclamide 500mg/2.5mg TAB Glucovance Motivation required
Metformin and glibenclamide 500mg/5mg TAB Glucovance Motivation required
23
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Thiazolidinediones
Pioglitazone 15mg TAB Cipla-pioglitazine Actos Motivation required
Pioglitazone 30mg TAB Cipla-pioglitazine Actos Motivation required
Rosiglitazone 2mg TAB Avandia Motivation required
Rosiglitazone 4mg TAB Avandia Motivation required
Other
Acarbose 50mg TAB Glucobay Motivation required
Acarbose 100mg TAB Glucobay Motivation required
Nateglinide 120mg TAB Starlix Motivation required
Repaglinide 0.5mg TAB Novonorm Motivation required
Repaglinide 1mg TAB Novonorm Motivation required
Repaglinide 2mg TAB Novonorm Motivation required
Dysrhythmias
Aspirin
Acetylsalicylic acid 100mg TAB Bayer aspirin cardio Disprin CV Myoprin Accepted treatment
Acetylsalicylic acid 125mg TAB Lo-aspirin Accepted treatment
Acetylsalicylic acid 300mg TAB Be-tabs aspirin Disprin Gulf aspirin Accepted treatment
Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment (in children)
Acetylsalicylic acid 81mg ECT Ecotrin Coprin Accepted treatment
Anticoagulants
Warfarin 1mg TAB Cipla-warfarin Accepted treatment
Warfarin 3mg TAB Cipla-warfarin Accepted treatment
Warfarin 5mg TAB Cipla-warfarin Accepted treatment
Calcium channel blockers
Diltiazem 240mg SRT Zildem SR Tilazem Accepted treatment
Diltiazem 180mg SRT Zildem SR Tilazem Accepted treatment
Verapamil 240mg SRT Verahexal Calcicard Ravamil Accepted treatment
Verapamil 40mg TAB Vasomil Accepted treatment
Verapamil 80mg TAB Vasomil Accepted treatment
Beta blockers
Acebutolol 100mg CAP Sectral Motivation required
Acebutolol 200mg CAP Sectral Motivation required
Acebutolol 400mg TAB Butobloc Sectral Motivation required
24
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Atenolol 100mg TAB Tenopress Sandoz Atenolol B-block Accepted treatment
Atenolol 25mg TAB Tenopress Accepted treatment
Atenolol 50mg TAB Tenopress Sandoz Atenolol B-block Accepted treatment
Bisoprolol 10mg TAB Cardicor Bilocor Adco-bisocor Accepted treatment
Bisoprolol 2.5mg TAB Cardicor Accepted treatment
Bisoprolol 5mg TAB Cardicor Bilocor Adco-bisocor Accepted treatment
Metoprolol 100mg TAB Lopresor Motivation required
Propranolol 10mg TAB Indoblok Prodorol Purbloka Accepted treatment
Propranolol 40mg TAB Indoblok Prodorol Purbloka Accepted treatment
Propranolol 80mg CAP Inderal LA Motivation required
Propranolol 160mg CAP Inderal LA Motivation required
Sotalol 160mg TAB Sotahexal Motivation required
Sotalol 80mg TAB Sotahexal Motivation required
Cardiac glycosides
Digoxin 0.05mg/ml SYR Lanoxin Paed Accepted treatment in children
Digoxin 0.0625mg TAB Lanoxin Accepted treatment
Digoxin 0.25mg TAB Lanoxin Purgoxin Accepted treatment
Anti-arrhythmics
Amiodarone 100mg TAB Arycor Hexarone Cordarone X Accepted treatment
Amiodarone 200mg TAB Arycor Hexarone Bio-Amiodarone Accepted treatment
Disopyramide 100mg CAP Rythmodan Motivation required
Disopyramide 250mg TAB Rythmodan Motivation required
Flecainide 100mg TAB Tambocor Motivation required
Propafenone 150mg TAB Rythmol Motivation required
Propafenone 300mg TAB Rythmol Motivation required
Quinidine sulphate 200mg TAB Quinidine Motivation required
Epilepsy
Anticonvulsants
Carbamazepine 100mg/5ml SUS Tegretol S Accepted treatment
Carbamazepine 200mg TAB/SRT Sandoz Carbamazepine CR Degranol CPL-carbamazepine Accepted treatment
Carbamazepine 400mg SRT Sandoz Carbamazepine CR Accepted treatment
Ethosuxamide 250mg/5ml SYR Zarontin Accepted treatment
Felbamate 400mg TAB Taloxa Motivation required
Felbamate 600mg/5ml SUS Taloxa Motivation required
25
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Gabapentin 100mg CAP Neurexal Epleptin Ran-gabapentin Motivation required
Gabapentin 300mg CAP Neurexal Epleptin Ran-gabapentin Motivation required
Gabapentin 400mg CAP Neurexal Epleptin Ran-gabapentin Motivation required
Gabapentin 600mg TAB Neurontin Motivation required
Gabapentin 800mg TAB Neurontin Motivation required
Lamotrigine 100mg TAB Aspen-lamotrigine Lamitor Dyna-Lamotrigine Accepted treatment
Lamotrigine 200mg TAB Lamidus Austell-lamotrigine Dyna-Lamotrigine Accepted treatment
Lamotrigine 25mg TAB Aspen-lamotrigine Lamitor Dyna-Lamotrigine Accepted treatment
Lamotrigine 50mg TAB Aspen-lamotrigine Lamitor Dyna-Lamotrigine Accepted treatment
Levetiracetam 250mg TAB Keppra Redilev Motivation required
Levetiracetam 500mg TAB Redilev Motivation required
Levetiracetam 750mg TAB Keppra Redilev Motivation required
Oxcarbazepine 300mg TAB Trileptal Motivation required Oxcarbazepine 600mg TAB Trileptal Motivation required Phenobarbital 30mg TAB Sedabarb Lethyl Accepted treatment
Phenobarbital SYR Adco-phenobarb vital Accepted treatment
Phenytoin 100mg TAB/CAP Phenytoin sod Epanutin Accepted treatment
Phenytoin 125mg/5ml SUS Epanutin Accepted treatment
Phenytoin 250mg/5ml SUS Epanutin Accepted treatment in children
Topiramate 100mg TAB Toplep Adco-topiramate Sandoz-topiramate Motivation required
Topiramate 200mg TAB Toplep Adco-topiramate Sandoz-topiramate Motivation required
Topiramate 25mg TAB Toplep Adco-topiramate Sandoz-topiramate Motivation required
Topiramate 50mg TAB Toplep Adco-topiramate Sandoz-topiramate Motivation required
Topiramate 15mg CAP Topamax SC sprinkle Motivation required
Topiramate 25mg CAP Topamax SC sprinkle Motivation required
Topiramate 50mg CAP Topamax SC sprinkle Motivation required
Valproic acid 100mg TAB Epilim Accepted treatment
Valproic acid 150mg CAP/SRT Convulex Accepted treatment
Valproic acid 200mg SRT Epilim Accepted treatment
Valproic acid 200mg/5ml SYR Epilim Accepted treatment
Valproic acid 300mg CAP/SRT Convulex Epilim Accepted treatment
Valproic acid 500mg CAP/SRT Convulex Epilim Accepted treatment
Valproic acid 50mg/ml SYR Convulex Accepted treatment
Vigabatrin 500mg TAB Sabril Motivation required
26
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Benzodiazepine derivatives
Clonazepam 0.5mg TAB Rivotril Motivation required
Clonazepam 2.5mg DRP Rivotril Motivation required
Clonazepam 2mg TAB Rivotril Motivation required
Glaucoma
Beta blockers
Betoxalol 0.25% OPD Betoptic S 5ml Accepted treatment
Betoxalol 5mg/ml OPD Betoptic 5ml Accepted treatment
Carteolol 2% OPD Teoptic 5ml Accepted treatment
Levobunolol 5% OPD Betagan 7.5ml Accepted treatment
Metapranolol 3% OPD Beta-opthiole 5ml Accepted treatment
Metapranolol 6% OPD Beta-opthiole 5ml Accepted treatment
Timolol 1mg/g OPD Nyogel Accepted treatment
Timolol 2.5mg/ml OPD Timoptol Accepted treatment
Timolol 5mg/ml OPD Glaucosan Timoptol Accepted treatment
Parasympathomimetics
Pilocarpine 10mg/ml OPD Isopto-carpine Accepted treatment
Pilocarpine 20mg/ml OPD Isopto-carpine Accepted treatment
Pilocarpine 40mg/ml OPD Isopto-carpine Accepted treatment
Sympathomimetics
Brimonidine OPD Alphagan Purite Motivation required
Dipivefrine 1% OPD Propine Motivation required
Carbonic anhydrase inhibitors
Acetazolamide 250mg TAB Azomid Diamox Motivation required
Brinzolamide 1% OPD Azoptic 5ml eye suspension Motivation required
Dorzolamide 2% OPD Trusopt Motivation required
Prostaglandin analogues
Bimatoprost 0.3mg/3ml OPD Lumigan Accepted treatment Latanoprost OPD Xalatan 2.5ml Accepted treatment Travoprost 4% OPD Travatan Accepted treatment Beta blockers, combinations
Timolol and dordolamide OPD Cosopt Motivation required
Timolol and latanoprost OPD Xalacom Motivation required
27
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Timolol and travoprost OPD DuoTrav Motivation required
Haemophilia
Analgesics and antipyretics
Paracetamol 120mg/5ml SYR Feverpain Napamol Painblok Accepted treatment
Paracetamol 500mg TAB Napamol Gencetamol Antalgic Accepted treatment
Antifibrinolytics
Tranexamic acid 500mg TAB Cyklokapron Tranexamic acid Medwich Special investigations
Blood coagulation factors will be reimbursed subject to Qualsa’s Medicine Policy and pathology report.
Hyperlipidaemia
Aspirin
Acetylsalicylic acid 100mg TAB Bayer aspirin cardio Disprin CV Myoprin Accepted treatment
Acetylsalicylic acid 125mg TAB Lo-aspirin Accepted treatment
Acetylsalicylic acid 300mg TAB Be-tabs aspirin Disprin Gulf aspirin Accepted treatment
Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment (in children)
Acetylsalicylic acid 81mg ECT Ecotrin Coprin Accepted treatment
Fibrates
Bezafibrate 200mg TAB Bezalip Special investigations
Bezafibrate 400mg TAB Sandoz bezafibrate Bezachole SR Dyna-Bezafibrate SR Special investigations
Fenofibrate 200mg CAP Lipanthyl Special investigations & Motivation
Gemfibrozil 600mg TAB Lopid Special investigations & Motivation
Statins
Atorvastatin 10mg TAB Aspavor Lipitor Ran-Atorvastatin Special investigations & Motivation
Atorvastatin 20mg TAB Aspavor Lipitor Ran-Atorvastatin Special investigations & Motivation
Atorvastatin 40mg TAB Aspavor Lipitor Ran-Atorvastatin Special investigations & Motivation
Atorvastatin 80mg TAB Lipitor Ran-Atorvastatin Special investigations & Motivation
Fluvastatin 20mg CAP Lescol Special investigations & Motivation
Fluvastatin 40mg CAP Lescol Special investigations & Motivation
Fluvastatin 80mg TAB Lescol Special investigations & Motivation
Lovastatin 20mg TAB Lovachol Special investigations
Lovastatin 40mg TAB Lovachol Special investigations
Pravastatin 10mg TAB Sandoz Pravastatin Aspen-pravastatin Pranalip Special investigations & Motivation
28
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Pravastatin 20mg TAB Sandoz Pravastatin Aspen-pravastatin Pranalip Special investigations & Motivation
Pravastatin 40mg TAB Sandoz Pravastatin Aspen-pravastatin Colite Special investigations & Motivation
Rosuvastatin 10mg TAB Crestor Special investigations & Motivation
Rosuvastatin 20mg TAB Crestor Special investigations & Motivation
Rosuvastatin 40mg TAB Crestor Special investigations & Motivation
Rosuvastatin 5mg TAB Crestor Special investigations & Motivation
Simvastatin 10mg TAB Arrow-simvastatin Zocor Michol Special investigations
Simvastatin 20mg TAB Arrow-simvastatin Zocor Michol Special investigations
Simvastatin 40mg TAB Arrow-simvastatin Zocor Michol Special investigations
Simvastatin 80mg TAB Zysim Cipla-simvastatin Michol Special investigations
Statins, combinations
Atorvastatin and amlodipine 10mg/5mg TAB Caduet Special investigations & Motivation
Atorvastatin and amlodipine 10mg/10mg TAB Caduet Special investigations & Motivation
Atorvastatin and amlodipine 20mg/5mg TAB Caduet Special investigations & Motivation
Atorvastatin and amlodipine 20mg/10mg TAB Caduet Special investigations & Motivation
Atorvastatin and amlodipine 40mg/5mg TAB Caduet Special investigations & Motivation
Atorvastatin and amlodipine 40mg/10mg TAB Caduet Special investigations & Motivation
Atorvastatin and amlodipine 80mg/5mg TAB Caduet Special investigations & Motivation
Atorvastatin and amlodipine 80mg/10mg TAB Caduet Special investigations & Motivation
Other
Colestyramine SAC Questran Lite Special investigations & Motivation
Ezetimibe 10mg TAB Ezetrol Special investigations & Motivation
Ezetimibe/simvastatin 10/10mg TAB Inegy Special investigations & Motivation
Ezetimibe/simvastatin 10/20mg TAB Inegy Special investigations & Motivation
Ezetimibe/simvastatin 10/40mg TAB Inegy Special investigations & Motivation
Probucol 250mg TAB Lurselle Special investigations & Motivation
Hypertension
Aspirin
29
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Acetylsalicylic acid 100mg TAB Bayer aspirin cardio Disprin CV Myoprin Accepted treatment
Acetylsalicylic acid 125mg TAB Lo-aspirin Accepted treatment
Acetylsalicylic acid 300mg TAB Be-tabs aspirin Disprin Gulf aspirin Accepted treatment
Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment (in children)
Acetylsalicylic acid 81mg ECT Ecotrin Coprin Accepted treatment
Diuretics
Bumetanide 1mg TAB Burinex Motivation required
Chlortalidone 50mg TAB Hygroton Motivation required
Furosemide 10mg/ml SYR Lasix Oral Motivation required
Furosemide 20mg TAB Lasix Accepted treatment
Furosemide 40mg TAB Beuresis Diuresix Mylan Furosemide Accepted treatment
Furosemide 500mg TAB Lasix Motivation required
Furosemide 60mg CAP Lasix Motivation required
Furosemide 80mg TAB Lasix Motivation required
Hydrochlorothiazide 12.5mg TAB Ridaq Accepted treatment
Hydrochlorothiazide 25mg TAB Hexazide Ridaq Accepted treatment
Hydrochlorothiazide and amiloride 25mg/2.5mg TAB Amiloretic HS Moduretic HS Accepted treatment
Hydrochlorothiazide and amiloride 50mg/5mg TAB Amiloretic Betaretic Spec-Co-Amiloride Accepted treatment
Hydrochlorothiazide and potassium 50mg/300mg TAB Urirex K Accepted treatment
Indapamide 1.5mg TAB Natrilix SR Accepted treatment
Indapamide 2.5mg TAB Cipla-Indapamide Daptril Mylan-indapamide Accepted treatment
Piretanide 3mg TAB Arelix Motivation required
Piretanide 6mg TAB Arelix Motivation required
Spironolactone 100mg TAB Aldactone Spiractin Accepted treatment
Spironolactone 25mg TAB Spiractin Sandoz Spironolactone Accepted treatment
Torasemide 10mg TAB Unat Torahexal Motivation required
Torasemide 2.5mg TAB Unat Torahexal Motivation required
Torasemide 5mg TAB Unat Torahexal Motivation required
Triamterine and hydrochlorothiazide 50mg/25mg TAB Renezide Accepted treatment
Potassium supplements
Potassium chloride 600mg TAB Plenish-K Sandoz K-600 Accepted treatment
ACE-inhibitors and combinations
Benazepril 10mg TAB Cibace Motivation required
Benazepril and diuretics 10mg/12.5mg FCT Cibadrex Motivation required
30
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Captopril 12.5mg TAB Captohexal Accepted treatment
Captopril 25mg TAB Captohexal Mylan-captopril Bio-captopril Accepted treatment
Captopril 50mg TAB Captohexal Mylan-captopril Zapto Accepted treatment
Captopril and diuretic 50mg/25mg TAB Captoretic Zapto-Co Capozide Accepted treatment
Cilazapril 5mg TAB Inhibace Motivation required
Cilazapril and diuretic 5mg/12.5mg TAB Inhibace Plus Motivation required
Enalapril 10mg TAB Alapren Ciplatec Pharmapress Accepted treatment
Enalapril 2.5mg TAB Renitec Accepted treatment
Enalapril 20mg TAB Alapren Ciplatec Pharmapress Accepted treatment
Enalapril 5mg TAB Alapren Ciplatec Pharmapress Accepted treatment
Enalapril and diuretic 12.5mg TAB Enap Co Pharmapress Co Accepted treatment
Fosinopril 10mg TAB Mylan-fosinopril Motivation required
Fosinopril 20mg TAB Mylan-fosinopril Motivation required
Lisinopril 10mg TAB Sinopren Simayla-lisinopril Zemax Accepted treatment
Lisinopril 2.5mg TAB Austell-lisinopril Accepted treatment
Lisinopril 20mg TAB Sinopren Simayla-lisinopril Zemax Accepted treatment
Lisinopril 5mg TAB Sinopren Simayla-lisinopril Zemax Accepted treatment
Lisinopril and diuretic 10mg/12.5mg TAB Lisoretic Lisozide Hexal-lisinopril Co Accepted treatment
Lisinopril and diuretic 20mg/12.5mg TAB Lisoretic Zestozide Hexal-lisinopril Co Accepted treatment
Moexipril 7.5mg TAB Perdix Motivation required
Perindopril 10mg TAB Prexum Coversyl Accepted treatment
Perindopril 4mg TAB Prexum Vectoryl Cipla-perindopril Accepted treatment
Perindopril 8mg TAB Vectoryl Cipla-perindopril Accepted treatment
Perindopril and indapamide 2mg/0.625mg TAB Preterax Spec-Perindopril Plus Accepted treatment
Perindopril and indapamide 4mg/1.5mg TAB Pearinda Plus Prexum Plus Vectoryl Plus Accepted treatment
Quinapril 10mg TAB Quinaspen Accumax Quinace Accepted treatment
Quinapril 20mg TAB Quinaspen Accumax Quinace Accepted treatment
Quinapril 40mg TAB Accupril Quinagen Motivation required
Quinapril 5mg TAB Accupril Quinagen Motivation required
Quinapril and diuretic 10mg/12.5mg TAB Accumax Co Quinace Co Adco-quinaretic Motivation required
Quinapril and diuretic 20mg/12.5mg TAB Accumax Co Quinace Co Adco-quinaretic Motivation required
Ramipril 1.25mg TAB/CAP Austell-ramipril Rampil Tritace Accepted treatment
Ramipril 10mg CAP Austell-ramipril Ran-ramipril Rampil Accepted treatment
Ramipril 2.5mg TAB/CAP Austell-ramipril Ramiwin Rampil Accepted treatment
31
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Ramipril 5mg TAB/CAP Austell-ramipril Ramiwin Rampil Accepted treatment
Ramipril and diuretic 2.5mg/2.5mg TAB Tri-plen Motivation required
Ramipril and diuretic 5mg/5mg TAB Tri-plen Forte Motivation required
Trandolapril 0.5mg CAP Mavik Accepted treatment
Trandolapril 2mg CAP Mavik Accepted treatment
Angiotensin receptor blockers and combinations
Candesartan 16mg TAB Atacand Motivation required
Candesartan 8mg TAB Atacand Motivation required
Candesartan 32mg TAB Atacand Motivation required
Candesartan and diuretic 16mg/12.5mg TAB Atacand Plus Motivation required
Eprosartan 600mg TAB Teveten Motivation required
Eprosartan and diuretic 600mg/12.5mg TAB Teveten Plus Motivation required
Irbesartan 150mg TAB Iberwin Aprovel Motivation required
Irbesartan 300mg TAB Iberwin Aprovel Motivation required
Irbesartan and diuretic 150mg/12.5mg TAB Co-Iberwin Coaprovel Motivation required
Irbesartan and diuretic 300mg/12.5mg TAB Co-Iberwin Coaprovel Motivation required
Losartan 50mg TAB Losartan-Winthrop Cipla-losartan Los-arb Accepted treatment
Losartan 100mg TAB Zartan Cipla-losartan Accepted treatment
Losartan and diuretic 100mg/25mg TAB Fortzaar Accepted treatment
Losartan and diuretic 50mg/12.5mg TAB Cozaar Comp Sartoc Accepted treatment
Telmisartan 40mg TAB Micardis Pritor Motivation required
Telmisartan 80mg TAB Micardis Pritor Motivation required
Telmisartan and diuretic 40mg/12.5mg TAB Co-micardis Co-Pritor Motivation required
Telmisartan and diuretic 80mg/12.5mg TAB Co-micardis Co-Pritor Motivation required
Valsartan 160mg TAB Tareg Zomevek Motivation required
Valsartan 320mg TAB Diovan Motivation required
Valsartan 40mg TAB Diovan Motivation required
Valsartan 80mg TAB Tareg Zomevek Motivation required
Valsartan and diuretic 160mg/12.5mg TAB Co-diovan Co-Zomevek Co-Migroben Motivation required
Valsartan and diuretic 160mg/25mg TAB Co-diovan Plus Co-Zomevek Co-Migroben Motivation required
Valsartan and diuretic 320mg/12.5mg TAB Co-diovan Motivation required
Valsartan and diuretic 320mg/25mg TAB Co-diovan Motivation required
Valsartan and diuretic 80mg/12.5mg TAB Co-tareg Co-Zomevek Co-Migroben Motivation required
Valsartan and amlodipine 160mg/5mg TAB Exforge Accepted treatment
32
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Valsartan and amlodipine 160mg/10mg TAB Exforge Accepted treatment Calcium channel blockers and combinations
Amlodipine 10mg TAB Almadin Ciplavasc Amlate Accepted treatment
Amlodipine 5mg TAB Almadin Ciplavasc Amlate Accepted treatment
Diltiazem 240mg SRT Zildem SR Accepted treatment
Diltiazem 180mg SRT Zildem SR Accepted treatment
Diltiazem 60mg TAB Zildem Accepted treatment
Diltiazem 90mg TAB Zildem Accepted treatment
Felodipine 10mg SRT Felodipine-hexal Plendil Accepted treatment
Felodipine 2.5mg SRT Plendil Accepted treatment
Felodipine 5mg SRT Felodipine-hexal Plendil Accepted treatment
Isradipine 2.5mg TAB Dynacirc Motivation required
Isradipine 5mg CAP Dynacirc SRO Motivation required
Lercanidipine 10mg TAB Zanidip Motivation required
Lercanidipine 20mg TAB Zanidip Motivation required
Lercanidipine and enalapril 10mg/10mg TAB Zaneril Motivation required
Lercanidipine and enalapril 10mg/20mg TAB Zaneril Motivation required
Nifedipine 20mg SRT Nifedalat SR Cipalat Retard Accepted treatment
Nifedipine 30mg SRT Adco-Vascard SR Fedaloc Macorel Accepted treatment
Nifedipine 60mg SRT Fedaloc Macorel Motivation required
Verapamil 240mg SRT Verahexal Calcicard Ravamil Accepted treatment
Verapamil and trandolapril 180mg/2mg SRC Tarka Motivation required
Verapamil 40mg TAB Vasomil Accepted treatment
Verapamil 80mg TAB Vasomil Accepted treatment
Beta blockers and combinations
Acebutolol 100mg CAP Sectral Motivation required
Acebutolol 200mg CAP Sectral Motivation required
Acebutolol 400mg TAB Butobloc Sectral Motivation required
Atenolol 100mg TAB Tenopress Sandoz Atenolol B-block Accepted treatment
Atenolol 25mg TAB Tenopress Tenormin Accepted treatment
Atenolol 50mg TAB Tenopress Sandoz Atenolol B-block Accepted treatment
Atenolol and other diuretics 100mg/25mg TAB Sandoz Co-tenidone Tenchlor Adco-loten Accepted treatment
Atenolol and other diuretics 50mg/12.5mg TAB Sandoz Co-tenidone Tenchlor HS Accepted treatment
Bisoprolol 10mg TAB Cardicor Bilocor Adco-bisocor Accepted treatment
33
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Bisoprolol 2.5mg TAB Cardicor Accepted treatment
Bisoprolol 5mg TAB Cardicor Bilocor Adco-bisocor Accepted treatment
Bisoprolol and diuretic 10mg/6.25mg TAB Ziak Accepted treatment
Bisoprolol and diuretic 2.5mg/6.25mg TAB Ziak Accepted treatment
Bisoprolol and diuretic 5mg/6.25mg TAB Ziak Accepted treatment
Metoprolol 100mg TAB Lopresor Motivation required
Nebivolol 5mg TAB Nebilet Motivation required
Propranolol 10mg TAB Indoblok Prodorol Purbloka Accepted treatment
Propranolol 160mg CAP Inderal LA Motivation required
Propranolol 40mg TAB Indoblok Prodorol Purbloka Accepted treatment
Propranolol 80mg CAP Inderal LA Motivation required
Propranolol and thiazides 80mg/2.5mg CAP Inderetic Motivation required
Timolol, thiazides and other diuretics 10/2.5/25mg TAB Servatrin Motivation required
Alpha/beta blockers
Carvedilol 12.5mg TAB Carloc Carvetrend Vediblok Accepted treatment
Carvedilol 25mg TAB Carloc Carvetrend Vediblok Accepted treatment
Carvedilol 6.25mg TAB Carloc Carvetrend Vediblok Accepted treatment
Alpha blockers
Doxazosin 1mg TAB Adco-doxazosin Cardugen Accepted treatment
Doxazosin 2mg TAB Adco-doxazosin Accepted treatment
Doxazosin 4mg TAB Adco-doxazosin Cardugen Accepted treatment
Doxazosin (extended-release) 4mg TAB Cardura XL Carzin XL Motivation required
Doxazosin (extended-release) 8mg TAB Cardura XL Carzin XL Motivation required
Prazosin 1mg TAB Pratsiol Accepted treatment
Prazosin 2mg TAB Pratsiol Accepted treatment
Prazosin 5mg TAB Pratsiol Accepted treatment
Terazosin 1mg TAB Hytrin Motivation required
Terazosin 2mg TAB Hytrin Motivation required
Terazosin 5mg TAB Hytrin Motivation required
Terazosin 10mg TAB Hytrin Motivation required
Vasodilators
Hydralazine 10mg TAB Hyperphen Accepted treatment
Hydralazine 25mg TAB Sandoz Hydralazine Accepted treatment Hydralazine 50mg TAB Hyperphen Sandoz Hydralazine Accepted treatment
34
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Minoxidil 10mg TAB Loniten Motivation required
Minoxidil 5mg TAB Loniten Motivation required
Antiadrenegic agents, centrally acting
Methyldopa 250mg TAB Hypotone Sandoz Methyldopa Mylan-methyldopa Accepted treatment
Methyldopa 500mg TAB Hypotone Accepted treatment
Moxonidine 0.2mg TAB Moxotens Cynt Physiotens Motivation required
Moxonidine 0.3mg TAB Moxotens Physiotens Motivation required
Moxonidine 0.4mg TAB Moxotens Cynt Physiotens Motivation required
Reserpine 0.25mg TAB Reserpine Accepted treatment
Reserpine and diuretics TAB Brinerdin Motivation required
Hypothyroidism
Thyroid hormones
Levothyroxine 100mcg TAB Eltroxin Euthyrox Accepted treatment
Levothyroxine 50mcg TAB Eltroxin Euthyrox Accepted treatment
Levothyroxine 25mcg TAB Euthyrox Accepted treatment
Liothyronine 20mcg TAB Tertroxin Accepted treatment
Thyroxine and liothyronine 90mcg/10mcg TAB Diotroxin Accepted treatment
Multiple sclerosis
Heterocyclic antidepressants
Amitriptyline 10mg TAB Trepiline Accepted treatment
Amitriptyline 25mg TAB Sandoz-amitriptyline Trepiline Tryptanol Accepted treatment
Clomipramine 10mg TAB Equinorm Motivation required
Clomipramine 25mg TAB Equinorm Motivation required
Imipramine 10mg TAB Ethipramine Accepted treatment
Imipramine 25mg TAB Ethipramine Accepted treatment
Anticonvulsants
Carbamazepine 200mg TAB/SRT Sandoz Carbamazepine CR Degranol CPL-carbamazepine Accepted treatment
Carbamazepine 400mg SRT Sandoz Carbamazepine CR Accepted treatment
Carbamazepine 100mg/5ml SUS Tegretol S Motivation required in adults
Immunosuppressants
Azathioprine 50mg TAB Zaprine Azathioprine 50 PCH Azapress Accepted treatment
Cyclophosphamide 50mg TAB Endoxan Motivation required
Methotrexate 2.5mg TAB Methotrexate Emthexate Accepted treatment
Muscle relaxants
35
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Baclofen 10mg TAB Bio-baclofen Accepted treatment
Baclofen 25mg TAB Lioresal Motivation required
Orphenadrine 100mg TAB Norflex Accepted treatment
Corticosteroids, oral
Methylprednisolone 4mg TAB Medrol Motivation required
Prednisolone 5mg TAB Lenisolone Capsoid Accepted treatment
Prednisone 5mg TAB Be-tabs prednisone Panafcort Trolic Accepted treatment
Anticholinergics, oral
Darifenacin 7.5mg TAB Enablex Motivation required
Darifenacin 15mg TAB Enablex Motivation required
Oxybutynin 5mg TAB Lenditro Mylan-oxybutynin Urihexal Accepted treatment
Oxybutynin (extended-release) 5mg TAB Lyrinel Motivation required
Oxybutynin (extended-release) 10mg TAB Lyrinel Motivation required
Propiverine 15mg TAB Detrunorm Motivation required
Solifenacin 5mg TAB Vesicare Motivation required
Solifenacin 10mg TAB Vesicare Motivation required
Tolterodine 2mg CAP Detrusitol SR Motivation required
Tolterodine 4mg CAP Detrusitol SR Motivation required
Trospium 20mg TAB Uricon Motivation required
Supplements
Folic acid 0.5mg TAB Folic acid Accepted treatment+ Folic acid 5mg TAB/CAP Be-tabs folic acid Accepted treatment+ Folic acid and vitamin B12 CAP Folic Acid Forte Accepted treatment+ Inteferons will be reimbursed for Relapsing-Remitting Multiple Sclerosis (RRMS) subject to Qualsa’s Medicine Policy and EDSS score.
Parkinson's disease
Dopa and dopa derivatives, combinations
Carbidopa and levodopa 25mg/100mg TAB Carbilev Accepted treatment
Carbidopa and levodopa 25mg/250mg TAB Carbilev Accepted treatment
Carbidopa and levodopa 50mg/200mg SRT Sinemet CR Accepted treatment
Levodopa and benserazide 100mg/25mg CAP Madopar HBS Accepted treatment
Levodopa and benserazide 200mg/50mg TAB Madopar Accepted treatment
Levodopa, carbidopa and entecapone 50/12.5/200mg TAB Stalevo Motivation required
Levodopa, carbidopa and entecapone 100/25/200mg TAB Stalevo Motivation required
Levodopa, carbidopa and entecapone 150/37.5/200mg TAB Stalevo Motivation required
36
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Anticholinergics, oral
Biperiden 2mg TAB Akineton Accepted treatment
Orphenadrine 50mg TAB Disipal Accepted treatment
Orphenadrine 100mg TAB Norflex Accepted treatment
Trihexyphenidyl 2mg TAB Benzhexol Accepted treatment
Adamantine derivatives
Amantadine 100mg CAP Symadin Symmetrel Accepted treatment
Dopamine agonists
Bromocriptine 2.5mg TAB Aspen-Bromocriptine Parlodel Motivation required
Pramipexole 0.125mg TAB Pexola Motivation required
Pramipexole 0.5mg TAB Pexola Motivation required
Pramipexole 1mg TAB Pexola Motivation required
Ropinirole 0.25mg TAB Requip Motivation required
Ropinirole 0.5mg TAB Requip Motivation required
Ropinirole 1mg TAB Requip Motivation required
Ropinirole 2mg TAB Requip Requip XL Motivation required
Ropinirole 4mg TAB Requip XL Motivation required
Ropinirole 5mg TAB Requip Motivation required
Ropinirole 8mg TAB Requip XL Motivation required
Monoamine oxidase type B inhibitors
Selegiline 5mg TAB Parkilyne Accepted treatment
Rasagiline 1mg TAB Azilect Motivation required
Catechol-O-methyltransferase inhibitors
Entecapone 200mg TAB Comtan Motivation required
Tolcapone 100mg TAB Tasmar Motivation required
Rheumatoid arthritis
Immunosuppressants
Azathioprine 50mg TAB Zaprine Azathioprine 50 PCH Azapress Accepted treatment
Leflunomide 10mg TAB Arava Motivation required
Leflunomide 20mg TAB Arava Motivation required
Methotrexate 2.5mg TAB Methotrexate Emthexate Accepted treatment
Sulfasalazine 500mg TAB Salazopyrin Accepted treatment
37
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Other
Chloroquine 150mg TAB Daramal Accepted treatment
Chloroquine 200mg TAB/CAP Nivaquine Plasmoquine Accepted treatment
Corticosteroids, oral
Methylprednisolone 16mg TAB Medrol Motivation required
Methylprednisolone 4mg TAB Medrol Accepted treatment
Prednisolone 5mg TAB Lenisolone Capsoid Accepted treatment
Prednisone 5mg TAB Be-tabs prednisone Panafcort Trolic Accepted treatment
Non-steroidal anti-inflammatory drugs
Diclofenac 100mg SRT/CAP Fortfen SR Sandoz Diclofenac sodium SR Difen SR Accepted treatment
Diclofenac 25mg TAB Mylan-diclofenac sodium Diclohexal A-lennon diclofenac Accepted treatment
Diclofenac 50mg TAB Mylan-diclofenac sodium Diclohexal A-lennon diclofenac Accepted treatment
Diclofenac 75mg CAP/TAB Panamor SR Veltex CR Accepted treatment
Diclofenac 100mg SRC Veltex CR Motivation required
Diclofenac and misoprostol 50mg ECT Arthrotec Motivation required
Diclofenac and misoprostol 75mg TAB Arthrotec Motivation required
Flurbiprofen 200mg CAP Froben SR Motivation required
Ibuprofen 200mg TAB Ranfen Ibunate Betaprofen Accepted treatment
Ibuprofen 400mg TAB Ranfen Adco-ibuprofen Betaprofen 400 FC Accepted treatment
Ibuprofen 600mg TAB Sandoz Ibuprofen Accepted treatment
Ibuprofen 800mg TAB Brufen Retard Motivation required
Indomethacin 100mg SUP Arthrexin Accepted treatment
Indomethacin 25mg CAP Betacin Gulf-indomethacin Adco-indomethacin Accepted treatment
Indomethacin 50mg CAP Arthrexin Accepted treatment
Ketoprofen 200mg SRT Ketoflam Accepted treatment
Lornoxicam 4mg TAB Xefo Motivation required
Lornoxicam 8mg TAB Xefo Motivation required
Mefenamic acid 250mg CAP Sandoz Mefenamic acid Fenamin Adco-mefenamic acid Motivation required
Mefenamic acid 500mg TAB Ponac Forte Fenamin Ponstel Forte Motivation required
Meloxicam 15mg TAB Zydus-meloxicam Flexocam Loxiflam Accepted treatment
Meloxicam 7.5mg TAB Zydus-meloxicam Flexocam Loxiflam Accepted treatment
Naproxen 250mg TAB/ECT Mylan-naproxen Napflam Naprel Accepted treatment
Naproxen 500mg TAB Napflam Accepted treatment
38
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Naproxen 500mg SUP Nafasol Motivation required
Piroxicam 10mg CAP Adco-piroxicam Accepted treatment
Piroxicam 20mg CAP/DSP Xycam Roxifen Pyrocaps Accepted treatment
Analgesics and antipyretics
Paracetamol 120mg/5ml SYR Feverpain Napamol Painblok Accepted treatment
Paracetamol 500mg TAB Napamol Gencetamol Antalgic Accepted treatment
COX-2 inhibitors
Celecoxib 100mg CAP Celebrex Motivation required
Celecoxib 200mg CAP Celebrex Motivation required
Supplements
Folic acid 0.5mg TAB Folic acid Accepted treatment+ Folic acid 5mg TAB/CAP Be-tabs folic acid Accepted treatment+ Folic acid and vitamin B12 CAP Folic Acid Forte Accepted treatment+ Biologicals will be reimbursed subject to Qualsa’s Medicine Policy and special investigations in combination with methotrexate.
Schizophrenia
Heterocyclic antidepressants
Amitriptyline 25mg TAB Sandoz-amitriptyline Trepiline Tryptanol Accepted treatment
Clomipramine 10mg TAB Anafranil Equinorm Accepted treatment Clomipramine 25mg TAB Anafranil Clomidep Equinorm Accepted treatment Clomipramine 75mg TAB Anafranil Motivation required
Dothiepin 25mg CAP Thaden Sandoz-dothiepin Accepted treatment Dothiepin 75mg TAB Thaden Sandoz-dothiepin Accepted treatment Imipramine 25mg TAB Ethipramine Tofranil Accepted treatment
Lofepramine 70mg TAB Emdalen Motivation required
Mianserin 10mg TAB Lantanon Motivation required
Mianserin 30mg TAB Lantanon Motivation required
Maprotiline 25mg TAB Ludiomil Motivation required
Maprotiline 75mg TAB Ludiomil Motivation required
Trimipramine 25mg TAB Tydamine Motivation required
Trimipramine 50mg CAP Tydamine Motivation required
Selective serotonin receptor inhibitors
Citalopram 10mg TAB Austell-citalopram Accepted treatment
Citalopram 20mg TAB Austell-citalopram Citalopram-Winthrop Sandoz-citalopram Accepted treatment
Citalopram 40mg TAB Austell-citalopram Citalopram-Winthrop Depramil Accepted treatment
39
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Escitalopram 5mg TAB Lexamil Motivation required
Escitalopram 10mg TAB Citraz Lexamil Aspen Escitalopram Motivation required
Escitalopram 20mg TAB Citraz Lexamil Zytomil Motivation required
Fluoxetine 20mg CAP/TAB A-lennon fluoxetine Zydus-fluoxetine Ranflocs Accepted treatment
Fluoxetine 40mg DSP Prohexal T Accepted treatment
Fluvoxamine 10mg TAB Faverin Fluvoxamine-hexal Luvox Motivation required
Paroxetine 20mg TAB Serrapress Austell-paroxetine Xet Motivation required
Paroxetine 30mg TAB Serrapress Austell-paroxetine Motivation required
Sertraline 50mg TAB Serlife Austell-sertraline Arrow Sertraline Motivation required
Sertraline 100mg TAB Serlife Austell-sertraline Motivation required
Duloxetine 30mg CAP Cymgen Cymbalta Motivation required
Duloxetine 60mg CAP Cymgen Cymbalta Motivation required
Venlafaxine 37.5mg CAP Venlor Odiven Motivation required
Venlafaxine 50mg TAB Efexor Motivation required
Venlafaxine 75mg CAP Venlor Sandoz Venlafaxine Odiven Motivation required
Venlafaxine 150mg CAP Venlor Sandoz Venlafaxine Efegen Motivation required
Monoamine oxidase type A inhibitors
Moclobemide 150mg TAB Depnil Motivation required
Moclobemide 300mg TAB Clorix Depnil Motivation required
Other
Bupropion 150mg SRT Wellbutrin Motivation required
Bupropion 300mg SRT Wellbutrin Motivation required
Mirtazapine 15mg TAB Sandoz Mirtazapine Adco-mirteron Aspen Mirtazapine Motivation required
Mirtazapine 30mg TAB Sandoz Mirtazapine Adco-mirteron Aspen Mirtazapine Motivation required
Moclobemide 150mg TAB Depnil Motivation required
Moclobemide 300mg TAB Clorix Depnil Motivation required
Reboxetine 4mg TAB Edronax Motivation required
Sulpiride 200mg TAB Bio-sulpiride Eglonyl Accepted treatment
Sulpiride 25mg SYR Eglonyl Accepted treatment
Sulpiride 50mg CAP Espiride Eglonyl Sandoz Sulpiride Motivation required
Trazodone 50mg CAP Molipaxin Aspen Trazodone Motivation required
Trazodone 100mg CAP Molipaxin Aspen Trazodone Motivation required
Mood stabilisers
40
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Lithium 250mg TAB Camcolit Accepted treatment
Lithium 400mg TAB Camcolit Accepted treatment
Lithium 450mg TAB Quilonum Retard Accepted treatment
Antipsychotics
Amisulpiride 200mg TAB Solian Motivation required
Amisulpiride 50mg TAB Solian Motivation required
Ariprazole 10mg TAB Abilify Motivation required
Ariprazole 15mg TAB Abilify Motivation required
Ariprazole 5mg TAB Abilify Motivation required
Chlorpromazine 100mg TAB Largactil Accepted treatment
Chlorpromazine 25mg TAB Largactil Accepted treatment
Chlorpromazine 50mg TAB Largactil Accepted treatment
Clozapine 100mg TAB Cloment Leponex Accepted treatment
Clozapine 25mg TAB Cloment Leponex Accepted treatment
Haloperidol 0.5mg CAP Serenace Accepted treatment
Haloperidol 1.5mg TAB Sandoz Haloperidol Accepted treatment
Haloperidol 10mg TAB Serenace Accepted treatment
Haloperidol 5mg TAB Serenace Sandoz Haloperidol Accepted treatment
Olanzepine 10mg TAB Zyprexa Motivation required
Olanzepine 2.5mg TAB Zyprexa Motivation required
Olanzepine 5mg TAB Zyprexa Motivation required
Pimozide 1mg TAB Orap Motivation required
Pimozide 4mg TAB Orap Motivation required
Quetiapine 25mg TAB Seroquel Motivation required
Quetiapine 100mg TAB Seroquel Motivation required
Quetiapine 200mg TAB Seroquel Seroquel XR Motivation required
Quetiapine 300mg TAB Seroquel Seroquel XR Motivation required
Quetiapine 400mg TAB Seroquel XR Motivation required
Quetiapine 50mg TAB Seroquel XR Motivation required
Risperidone 0.5mg TAB DRL-Risperidone Mylan-Risperidone Risperidone-Hexal Accepted treatment
Risperidone 1mg TAB DRL-Risperidone Mylan-Risperidone Risperidone-Hexal Accepted treatment
Risperidone 2mg TAB DRL-Risperidone Mylan-Risperidone Risperidone-Hexal Accepted treatment
Risperidone 3mg TAB DRL-Risperidone Risperidone-Hexal Perizal Accepted treatment
Risperidone 4mg TAB Aspen Risperidone Auropidone Risponz Accepted treatment
41
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Risperidone 1mg/ml SLN Auropidone Risperdal Motivation required
Trifluoperazine 1mg TAB Stelazine Accepted treatment
Trifluoperazine 5mg TAB Stelazine Accepted treatment
Ziprasidone 20mg CAP Geodon Motivation required
Ziprasidone 40mg CAP Geodon Motivation required
Ziprasidone 60mg CAP Geodon Motivation required
Ziprasidone 80mg CAP Geodon Motivation required
Zuclopenthixole 10mg TAB Clopixol Motivation required
Zuclopenthixole 2mg TAB Clopixol Motivation required
Systemic lupus erythematosus
Immunosuppressants
Azathioprine 50mg TAB Zaprine Azathioprine 50 PCH Azapress Accepted treatment
Cyclophosphamide 50mg TAB Endoxan Motivation required
Methotrexate 2.5mg TAB Methotrexate Emthexate Accepted treatment
Ciclosporin 25mg CAP Ciclohexal Sandimmun neoral Motivation required
Ciclosporin 100mg CAP Ciclohexal Sandimmun neoral Motivation required
Mycophenolate 250mg CAP Mycophenolate-Hexal Cellcept Motivation required
Other
Chloroquine 150mg TAB Daramal Accepted treatment
Chloroquine 200mg TAB/CAP Nivaquine Plasmoquine Accepted treatment
Aspirin
Acetylsalicylic acid 100mg TAB Bayer aspirin cardio Disprin CV Myoprin Accepted treatment
Acetylsalicylic acid 125mg TAB Lo-aspirin Accepted treatment
Acetylsalicylic acid 300mg TAB Be-tabs aspirin Disprin Gulf aspirin Accepted treatment
Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment (in children)
Acetylsalicylic acid 81mg ECT Ecotrin Coprin Accepted treatment
Corticosteroids, oral
Hydrocortisone 10mg TAB Covocort Accepted treatment
Prednisolone 5mg TAB Lenisolone Capsoid Accepted treatment
Prednisone 5mg TAB Be-tabs prednisone Panafcort Trolic Accepted treatment
Non-steroidal anti-inflammatory drugs and combinations
Diclofenac 100mg SRT/CAP Fortfen SR Sandoz Diclofenac sodium SR Difen SR Accepted treatment
Diclofenac 25mg TAB Mylan-diclofenac sodium Diclohexal A-lennon diclofenac Accepted treatment
Diclofenac 50mg TAB Mylan-diclofenac sodium Diclohexal A-lennon diclofenac Accepted treatment
42
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Diclofenac 75mg CAP/TAB Panamor SR Veltex CR Accepted treatment
Diclofenac 75mg SRC Veltex CR Accepted treatment
Diclofenac and misoprostol 50mg ECT Arthrotec Motivation required
Diclofenac and misoprostol 75mg TAB Arthrotec Motivation required
Flurbiprofen 200mg CAP Froben SR Motivation required
Ibuprofen 200mg TAB Ranfen Ibunate Betaprofen Accepted treatment
Ibuprofen 400mg TAB Ranfen Adco-ibuprofen Betaprofen 400 FC Accepted treatment
Ibuprofen 600mg TAB Sandoz Ibuprofen Accepted treatment
Ibuprofen 800mg TAB Brufen Retard Motivation required
Indomethacin 100mg SUP Arthrexin Accepted treatment
Indomethacin 25mg CAP Betacin Gulf-indomethacin Adco-indomethacin Accepted treatment
Indomethacin 50mg CAP Arthrexin Accepted treatment
Ketoprofen 200mg SRT Ketoflam Accepted treatment
Lornoxicam 4mg TAB Xefo Motivation required
Lornoxicam 8mg TAB Xefo Motivation required
Mefenamic acid 250mg CAP Sandoz Mefenamic acid Fenamin Adco-mefenamic acid Motivation required
Mefenamic acid 500mg TAB Ponac Forte Fenamin Ponstel Forte Motivation required
Meloxicam 15mg TAB Zydus-meloxicam Flexocam Loxiflam Accepted treatment
Meloxicam 7.5mg TAB Zydus-meloxicam Flexocam Loxiflam Accepted treatment
Naproxen 250mg TAB/ECT Mylan-naproxen Napflam Naprel Accepted treatment
Naproxen 500mg TAB Napflam Accepted treatment
Naproxen 500mg SUP Nafasol Motivation required
Piroxicam 10mg CAP Adco-piroxicam Accepted treatment
Piroxicam 20mg CAP/DSP Xycam Roxifen Pyrocaps Accepted treatment
COX-2 inhibitors
Celecoxib 100mg CAP Celebrex Motivation required
Celecoxib 200mg CAP Celebrex Motivation required
Corticosteroids, topical
Beclometasone CRE Beclate Accepted treatment
Betamethasone 0.5mg/100g CRM Betnovate Motivation required
Betamethasone 0.05% CRM/UNG Diprosone Motivation required
Clobetasol 0.05% LOT Dermovate scalp Motivation required
Clobetasol 0.5mg CRM/UNG Dovate Xenovate Motivation required
Clobetasone CRM/UNG Eumovate Accepted treatment
43
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Diflucortolone 0.1% CRM/UNG Nerisone Motivation required
Diflucortolone 0.3% UNG Nerisone Forte Motivation required
Flucinolone 0.025mg/g CRM/UNG/GEL Cortoderm Synalar Accepted treatment
Fluticasone 0.005% UNG Cutivate Motivation required
Fluticasone 0.05% CRM Cutivate Motivation required
Hydrocortisone 0.5mg UNG Dilucort Accepted treatment
Hydrocortisone 10mg/g CRM/UNG Vari-hydrocortisone Biocort (STX) Mylocort Accepted treatment
Hydrocortisone 5mg/g CRM/LOT Dilucort Link mezzoderm Accepted treatment
Hydrocortisone butyrate CRM/UNG/LOT Locoid Motivation required
Methylprednisolone aceponate CRM/UNG Advantan Motivation required
Mometasone 0.1% CRM/UNG/LOT Aspen-mometasone Elocon Motivation required
Supplements
Folic acid 0.5mg TAB Folic acid Accepted treatment Folic acid 5mg TAB/CAP Be-tabs folic acid Accepted treatment Folic acid and vitamin B12 CAP Folic Acid Forte Accepted treatment Ulcerative colitis
Corticosteroids, topical
Budesonide ENE Entocord Motivation required
Corticosteroids, oral
Betamethasone 0.5mg TAB Betanoid Motivation required
Budesonide 3mg CAP Entocord Motivation required
Hydrocortisone 10mg TAB Covocort Accepted treatment
Methylprednisolone 4mg TAB Medrol Accepted treatment
Methylprednisolone 16mg TAB Medrol Motivation required
Prednisolone 5mg TAB Lenisolone Capsoid Accepted treatment
Prednisone 5mg TAB Be-tabs prednisone Panafcort Trolic Accepted treatment
5-ASA agents
Mesalazine 2g/50ml ENE Asacol Motivation required
Mesalazine 400mg TAB Asacol Motivation required
Mesalazine 800mg TAB Asacol Motivation required
Mesalazine 500mg TAB/SUP Asacol Pentasa Motivation required
Mesalazine 1000mg SUP Pentasa Motivation required
Olsalazine 250mg CAP Dipentum Motivation required
Sulfasalazine 500mg TAB Salazopyrin Accepted treatment
44
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Immunosuppressants
Azathioprine 50mg TAB Zaprine Azathioprine 50 PCH Azapress Accepted treatment
Methotrexate 2.5mg TAB Methotrexate Emthexate Accepted treatment
Supplements
Folic acid 0.5mg TAB Folic acid Accepted treatment Folic acid 5mg TAB/CAP Be-tabs folic acid Accepted treatment Folic acid and vitamin B12 CAP Folic Acid Forte Accepted treatment Biologicals will be reimbursed subject to Qualsa’s Medicine Policy and special investigations.
45
DIAGNOSIS AND TREATMENT PAIRS (DTP) CONDITIONS
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Adrenocortical Hypersecretion
Diuretics
Hydrochlorothiazide and potassiumsparing agents TAB Urirex k Amiloretic Betaretic Accepted treatment
Spironolactone 100mg TAB Spiractin Accepted treatment
Spironolactone 25mg TAB Spiractin Sandoz Spironolactone Accepted treatment
Eplerenone 25mg TAB Inspra Motivation required
Eplerenone 50mg TAB Inspra Motivation required
Adrenocortical Insufficiency
Corticosteroids Oral
Hydrocortisone 10mg TAB Covocort Accepted treatment
Prednisone 5mg TAB Be-tabs prednisone Panafcort Accepted treatment
Prednisolone 5mg TAB Lenisolone Capsoid Accepted treatment
Fludrocortisone 0.1mg TAB Florinef acetate Motivation required
Anaemia
Iron supplementation, oral
Ferrous salts TAB / CAP Ferrous Sulphate Special investigations
Ferric oxide polymaltose complex TAB/CAP Ferrimed Special investigations
Iron and folic acid TAB / CAP Ferofolic Special investigations
Iron multivitamins and folic acid 100mg TAB Autrin Ferograd Foliferr Special investigations
Iron vitamin B12 and folic acid TAB Foliglobin Special investigations
Vitamin B
Folic acid 0.5mg TAB Folic acid Special investigations
Folic acid 5mg TAB / CAP Be-tabs folic acid Special investigations
Cyanocobalamin INJ Vitamin B12 Special investigations Arrhythmias Aspirin
Acetylsalicylic acid 100mg TAB Bayer aspirin cardio Disprin CV Accepted treatment
Acetylsalicylic acid 125mg TAB Lo-aspirin Accepted treatment
46
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Acetylsalicylic acid 300mg TAB Gulf aspirin Be-tabs aspirin Accepted treatment
Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment in children
Acetylsalicylic acid 81mg ECT Ecotrin Accepted treatment
Antiarrythmics
Amiodarone 100mg TAB Arycor Hexarone Cordarone x Accepted treatment
Amiodarone 200mg TAB Arycor Hexarone Cordarone x Accepted treatment
Quinidine 200mg TAB Quinadine Motivation required
Disopyramide 100mg CAP Rythmodan Motivation required
Propafenone 150mg TAB Rhythmol Motivation required
Flecainide 100mg TAB Tambocor Motivation required
Betablockers
Atenolol 100mg TAB Tenopress Sandoz Atenolol B-block Accepted treatment
Atenolol 50mg TAB Tenopress Sandoz Atenolol B-block Accepted treatment
Atenolol 25mg TAB Tenopress Accepted treatment
Acebutalol 100mg TAB Sectral Motivation required
Acebutalol 200mg TAB Sectral Motivation required Acebutalol 400mg TAB Sectral Motivation required Bisoprolol 10mg TAB Cardicor Bilocor Adco-Bisocor Accepted treatment
Bisoprolol 5mg TAB Cardicor Bilocor Adco-Bisocor Accepted treatment
Bisoprolol 2.5mg TAB Cardicor Accepted treatment
Metoprolol 100mg TAB Lopressor Motivation required
Propranolol 10mg TAB Indoblock Prodolol Purbloka Accepted treatment
Propronalol 40mg TAB Indoblock Prodolol Purbloka Accepted treatment
Propronalol 160mg TAB Inderal LA Motivation required Propronalol 80mg TAB Inderal LA Motivation required Sotalol 160mg TAB Sotahexal Motivation required
Sotalol 80mg TAB Sotahexal Motivation required
Cardiac Glycosides
Digoxin 0.05mg/ml SYR Lanoxin Paed Accepted treatment
Digoxin 0.0625mg TAB Lanoxin Accepted treatment
Digoxin 0.25mg TAB Lanoxin Purgoxin Accepted treatment
47
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Calcium Channel Blockers
Diltiazem 180mg SRC Zildem SR Accepted treatment
Diltiazem 240mg SRC Zildem SR Accepted treatment
Diltiazem 90mg TAB Zildem Accepted treatment
Diltiazem 60mg TAB Zildem Accepted treatment
Verapamil 240mg SRT Verahexal Calcicard Ravamil Accepted treatment
Verapamil 80mg TAB Vasomil Accepted treatment
Verapamil 40mg TAB Vasomil Accepted treatment
Anti-coagulants
Clopidrogel 75mg TAB Pharma Dynamics Clopidogrel Plagrol Mistro Motivation required
Dipyridamole 25mg TAB Plato Motivation required
Dipyridamole 100mg TAB Plato Motivation required Dipyridamole 200mg SRT Persantin Motivation required Warfarin 5mg TAB Cipla-Warfarin Accepted treatment
Warfarin 3mg TAB Cipla-Warfarin Accepted treatment
Warfarin 1mg TAB Cipla-Warfarin Accepted treatment
Benign Prostatic Hypertrophy
Alfuzosin 10mg TAB Xatral XL Motivation required
Doxazosin 1mg TAB Adco-Doxazosin Cardugen Accepted treatment
Doxazosin 2mg TAB Adco-Doxazosin Accepted treatment
Doxazosin 4mg TAB Adco-Doxazosin Cardugen Accepted treatment
Doxazosin (Extended Release) 4mg TAB Carzin XL Cardura XL Motivation required
Doxazosin (Extended Release) 8mg TAB Cardura XL Motivation required
Prazosin 1mg TAB Pratsiol Accepted treatment
Prazosin 2mg TAB Pratsiol Accepted treatment
Prazosin 5mg TAB Pratsiol Accepted treatment
Tamsulosin 0.4mg SRC Uromax Tamsul Flomax sr Accepted treatment
Terazosin 1mg TAB Hytrin Motivation required Terazosin 2mg TAB Hytrin Motivation required Terazosin 5mg TAB Hytrin Motivation required Terazosin 10mg TAB Hytrin Motivation required Finasteride 5mg TAB Fincar Finpro Proscar Motivation required
Dutasteride 0.5mg CAP Avodart Motivation required
48
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Chronic Kidney Failure
Ace Inhibitor and Combinations
Benazepril 10mg TAB Cibace Motivation required
Benazepril and diuretic TAB Cibadrex Accepted treatment
Benazepril and diuretic 10mg/12.5mg TAB Cibadrex FCT Motivation required
Captopril 12.5mg TAB Captohexal Accepted treatment
Captopril 25mg TAB Captohexal Mylan Captopril Bio-Captopril Accepted treatment
Captopril 50mg TAB Captohexal Mylan Captopril Zapto Accepted treatment
Captopril and diuretics 50mg/25mg TAB Captoretic Zapto Co Capozide Accepted treatment
Cilazapril 5mg TAB Inhibace Motivation required
Cilazapril and diuretic 5mg/12.5mg TAB Inhibace Plus Motivation required
Enalapril 2.5mg TAB Renitec Accepted treatment
Enalapril 5mg TAB Alapren Ciplatec Pharmapress Accepted treatment
Enalapril 10mg TAB Alapren Ciplatec Pharmapress Accepted treatment
Enalapril 20mg TAB Alapren Ciplatec Pharmaperss Accepted treatment
Enalaprin and diuretics 20mg/12.5mg TAB Enap Co Pharmapress Co Accepted treatment
Fosinopril 10mg TAB Mylan-fosinopril Motivation required
Fosinopril 20mg TAB Mylan-fosinopril Motivation required
Lisinopril 20mg TAB Sinopren Simayla-lisinopril Zemax Accepted treatment
Lisinopril 10mg TAB Sinopren Simayla-lisinopril Zemax Accepted treatment
Lisinopril 5mg TAB Sinopren Simayla-lisinopril Zemax Accepted treatment
Lisinopril 2.5mg TAB Austell-lisinopril Accepted treatment
Lisinopril and diuretics 10mg/12.5mg TAB Lisoretic Lisozide Hexal-lisinopril Co Accepted treatment
Lisinopril and diuretics 20mg/12.5mg TAB Lisoretic Zestozide Hexal-lisinopril Co Accepted treatment
Moexipril 7.5mg TAB Perdix Motivation required
Perindopril 4mg TAB Prexum Vectoryl Cipla-Perindopril Accepted treatment
Perindopril 8mg TAB Vectoryl Cipla-Perindopril Accepted treatment
Perindopril 10mg TAB Prexum Coversyl Accepted treatment
Perindopril and diuretics 4mg/1.25mg TAB Prexum Plus Vectoryl Plus Accepted treatment
Perindopril and indapamide 2mg/0.625mg TAB Preterax Spec-Perindopril Plus Accepted treatment
Perindopril and indapamide 4mg/1.5mg TAB Pearinda plus Prexum plus Vectoryll plus Accepted treatment
Quinapril 10mg TAB Quinaspen Accumax Quinace Accepted treatment
Quinapril 20mg TAB Quinaspen Accumax Quinace Accepted treatment Quinapril 40mg TAB Accupril Quinagen Motivation required
49
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Quinapril 5mg TAB Accupril Quinagen Motivation required
Quinapril and diuretic 10mg/12.5mg TAB Accumax Co Quinace Co Adco-quinoretic Motivation required
Ramipril 1.25mg TAB/CAP Austell-ramipril Ramiwin Rampil Accepted treatment
Ramipril 2.5mg TAB/CAP Austell-ramipril Ran-ramipril Rampil Accepted treatment
Ramipril 5mg TAB/CAP Austell-ramipril Ramiwin Rampil Accepted treatment
Ramipril 10mg TAB/CAP Austell-ramipril Ran-ramipril Rampil Accepted treatment
Ramipril and calcium channel blocker 2.5mg/2.5mg TAB Tri-plen Motivation required
Ramipril and calcium channel blocker 5mg/5mg TAB Tri-plen forte Motivation required
Trandolapril 0.5mg CAP Mavik Accepted treatment
Trandolapril 2mg CAP Mavik Accepted treatment
Angiotensin Receptor Blockers
Candesartan 8mg TAB Atacand Motivation required
Candesartan 16mg TAB Atacand Motivation required
Candesartan 32mg TAB Atacand Motivation required
Candesartan and diuretic 16mg/12.5mg TAB Atacand plus Motivation required
Eprosartan 600mg TAB Teveten Motivation required
Eprosartan and diuretic 600mg/12.5mg TAB Teveten Plus Motivation required
Irbesartan 150mg TAB Iberwin Motivation required Irbesartan 300mg TAB Iberwin Motivation required Irbesartan and diuretic 150mg/12.5mg TAB Co-Iberwin Coaprovel Motivation required Irbesartan and diuretic 300mg/12.5mg TAB Co-Iberwin Coaprovel Motivation required Losartan 100mg TAB Zartan Cipla-Losartan Accepted treatment
Losartan 50mg TAB Lepitrin Cipla-Losartan Los-arb Accepted treatment
Losartan and diuretics 100mg/12.5mg TAB Fortzaar Accepted treatment
Losartan and diuretics 50mg/12.5mg TAB Cozaar Comp Sartoc Accepted treatment
Telmisartan 40mg TAB Micardis Pritor Motivation required Telmisartan 80mg TAB Micardis Pritor Motivation required Telmisartan and diuretic 40mg/12.5mg TAB Co-micardis Co-Pritor Motivation required Telmisartan and diuretic 80mg/12.5mg TAB Co-micardis Co-Pritor Motivation required Valsartan 320mg TAB Diovan Motivation required
Valsartan 160mg TAB Tareg Zomevak Motivation required
Valsartan 80mg TAB Tareg Zomevak Motivation required
Valsartan 40mg TAB Diovan Motivation required
Valsartan and diuretics 320mg/50mg TAB Co-diovan Co-Zomevak Co-Microben Motivation required
50
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Valsartan and diuretics 160mg/25mg TAB Co-diovan Plus Co-Zomevak Co-Microben Motivation required
Valsartan and diuretics 160mg/12.5mg TAB Co-diovan Motivation required
Valsartan and diuretics 80mg/12.5mg TAB Co-tareg Co-Zomevak Co-Microben Motivation required Valsartan and amlodipine 160mg/5mg TAB Exforge Accepted treatment Valsartan and amlodipine 160mg/10mg TAB Exforge Accepted treatment
Beta Blockers and Combinations
Atenolol 100mg TAB Tenopress Sandoz Atenolol B-block Accepted treatment
Atenolol 50mg TAB Tenopress Sandoz Atenolol B-block Accepted treatment
Atenolol 25mg TAB Tenopress Accepted treatment
Atenolol and other diuretics 100mg/25mg TAB Sandoz Co-tenidone Tenchlor Adco-loten Accepted treatment
Atenolol and other diuretics 50mg/12.5mg TAB Sandoz Co-tenidone Tenchlor HS Accepted treatment
Atenolol and thiazides 100mg/25mg TAB Adco-loten Accepted treatment
Acebutalol 100mg TAB Sectral Motivation required
Acebutalol 200mg TAB Sectral Motivation required Acebutalol 400mg TAB Sectral Motivation required Bisoprolol 10mg TAB Cardicor Bilocor Adco-bisocor Accepted treatment
Bisoprolol 5mg TAB Cardicor Bilocor Adco-bisocor Accepted treatment
Bisoprolol 2.5mg TAB Cardicor Accepted treatment
Bisoprolol and diuretic 10mg/6.25mg TAB Ziak Accepted treatment
Bisoprolol and diuretic 5mg/6.25mg TAB Ziak Accepted treatment Bisoprolol and diuretic 2.5mg/6.25mg TAB Ziak Accepted treatment Metoprolol 100mg TAB Lopressor Motivation required
Nebivolol 5mg TAB Nebilet Motivation required
Propranolol 10mg TAB Indoblock Prodorol Purbloka Accepted treatment
Propranolol 160mg CAP Inderal LA Motivation required
Propranolol 40mg TAB Indoblok Prodorol Purbloka Accepted treatment
Propranolol 80mg CAP Inderal LA Motivation required
Propranolol and thiazides 80mg/2.5mg CAP Inderetic Motivation required
Timolol,thiazides and other diuretics 10/2.5/25mg TAB Servatrin Motivation required
Alpha/beta blockers
Carvedilol 12.5mg TAB Carloc Carvetrend Vediblock Accepted treatment
Carvedilol 25mg TAB Carloc Carvetrend Vediblock Accepted treatment Carvedilol 6.25mg TAB Carloc Carvetrend Vediblock Accepted treatment
51
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Vasodilators
Hydralazine 10mg TAB Hyperphen Accepted treatment Hydralazine 25mg TAB Sandoz Hydralazine Accepted treatment Hydralazine 50mg TAB Hyperphen Sandoz Hydralazine Accepted treatment Calcium Channel Blockers
Amlodipine 10mg TAB Almadin Ciplavasc Amlate Accepted treatment
Amlodipine 5mg TAB Almadin Ciplavasc Amlate Accepted treatment
Diltiazem 240mg SRC Zildem SR Accepted treatment
Diltiazem 180mg SRC Zildem SR Accepted treatment
Diltiazem 90mg TAB Zildem Accepted treatment
Diltiazem 60mg TAB Zildem Accepted treatment
Felodipine 10mg SRT Felodipine-hexal Plendil Accepted treatment
Felodipine 5mg SRT Felodipine-hexal Plendil Accepted treatment
Felodipine 2.5mg SRT Plendil Accepted treatment
Isradipine 2.5mg TAB Dynacirc Motivation required
Isradipine 5mg CAP Dynacirc SRC Motivation required
Lercandipine 10mg TAB Zanidip Motivation required
Lercandipine 20mg TAB Zanidip Motivation required
Lercandipine and enalapril 10mg/10mg TAB Zaneril Motivation required
Lercandipine and enalapril 10mg/20mg TAB Zaneril Motivation required
Nifedipine 60mg TAB Fedaloc Accepted treatment
Nifedipine 30mg TAB Fedaloc Accepted treatment
Nifedipine 30mg SRT Adco-Vascard SR Fedaloc Accepted treatment
Nifedipine 20mg SRT Nifedalat SR Cipalat retard Accepted treatment
Verapamil TAB Vasomil Accepted treatment
Diuretics
Bumetanide 1mg TAB Burinex Motivation required
Chlortalidone 50mg TAB Hygroton Motivation required
Hydrochlorothiazide 12.5mg TAB Ridaq Accepted treatment
Hydrochlorothiazide 25mg TAB Hexazide Ridaq Accepted treatment
Hydrochlorothiazide and potassium 50mg/300mg TAB Urirek-k Accepted treatment
Hydrochlorothiazide and potassium-sparing agents 25mg/2.5mg TAB Amiloretic hs Moduretic HS Accepted treatment
Hydrochlorothiazide and potassium-sparing agents 50mg/25mg TAB Dyazide Accepted treatment
Hydrochlorothiazide and potassium-sparing agents 50mg/5mg TAB Amiloretic Betaretic Spec-Co-Amiloride Accepted treatment
52
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Indapamide 1.5mg TAB Natrilix SR Accepted treatment
Indapamide 2.5mg TAB Cipla-Indapamide Daptril Mylan-indapamide Accepted treatment
Furosemide 20mg TAB Lasix Accepted treatment
Furosemide 40mg TAB/CAP Diuresix Mylan-Furosemide Accepted treatment
Furosemide 500mg TAB Lasix Motivation required
Furosemide 60mg CAP Lasix Motivation required
Furosemide 80mg TAB Lasix Motivation required
Furosemide 10mg/ml SYR Lasix Oral Motivation required in adults
Piretanide 3mg TAB Arelix Motivation required
Piretanide 6mg TAB Arelix Motivation required
Spironolactone 100mg TAB Aldactone Spiractin Accepted treatment
Spironolactone 25mg TAB Spiractin Sandoz Spironolactone Accepted treatment
Torasemide 10mg TAB Unat Torahexal Motivation required
Torasemide 2.5mg TAB Unat Torahexal Motivation required
Torasemide 5mg TAB Unat Torahexal Motivation required
Triamterine and hydrochlorothiazide 50mg/25mg TAB Renezide Accepted treatment
Erythropoetin and Supplements
Alfacalcidol 0.25mcg TAB One Alpha Special investigation
Alfacalcidol 1mcg TAB One Alpha Special investigation
Ferrous fumarate TAB Pregamal Special investigation
Ferrous sulfate 30mg TAB Ferrous sulfate Special investigation
Ferrous sulfate 100mg TAB Ferrous sulfate Special investigation
Ferric oxide polymaltose complex TAB/CAP Ferrimed Special investigations
Folic acid 0.5mg TAB Folic acid Special investigation
Folic acid 5mg TAB Be-tabs folic acid Special investigation
Iron and multivitamins TAB Ferograd Special investigation
Iron multivitamins and folic acid TAB Foliferr Autrin Special investigation
Erythropoetin INJ Repotin Recormon Eprex Special investigation
Dextraferron INJ Cosmofer Special investigation and motivation
Darbepoetin alpha INJ Aranesp Special investigation and motivation
Iron vitamin B12 and folic acid TAB Foliglobin Special investigations
Iron in other combinations INJ Ferofolic Special investigation
Calcium carbonate 300mg CHU Caltrate 300 Special investigation
53
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Calcium carbonate 500mg CHU Virtual care Calcium Special investigation
Calcium carbonate 500mg EFT Sandoz Calcium Forte Fizzical Special investigation
Calcium carbonate 500mg TAB Caltrate d Special investigation
Potassium Supplement
Potassium chloride 600mg TAB Plenish-K Accepted treatment
Hormone inhibitors
Cinacalcet 30mg TAB Senispar Motivation required
Cinacalcet 60mg TAB Senispar Motivation required
Complications of Hypertension
Calcium Channel Blockers
Amlodipine 10mg TAB Almadin Ciplavasc Amlate Accepted treatment
Amlodipine 5mg TAB Almadin Ciplavasc Amlate Accepted treatment
Diltiazem 240mg SRC Zildem SR Accepted treatment
Diltiazem 180mg SRC Zildem SR Accepted treatment
Diltiazem 90mg TAB Zildem Accepted treatment
Diltiazem 60mg TAB Zildem Accepted treatment
Isradipine 2.5mg TAB Dynacirc Motivation required
Isradipine 5mg CAP Dynacirc sro Motivation required
Verapamil 240mg SRT Verahexal Calcicard Ravamil Accepted treatment
Verapamil 80mg TAB Vasomil Accepted treatment
Verapamil 40mg TAB Vasomil Accepted treatment
Felodipine 10mg SRT Felodipine -hexal Accepted treatment
Nifedipine 60mg TAB Fedaloc Accepted treatment
Nifedipine 30mg TAB Fedaloc Accepted treatment
Nifedipine 30mg SRT Adco-Vascard SR Fedaloc Accepted treatment
Nifedipine 20mg SRT Nifedalat SR Cipalat Retard Accepted treatment
Cardiac Glycosides
Digoxin 0.05mg/ml SYR Lanoxin Paed Accepted treatment
Digoxin 0.0625mg TAB Lanoxin Accepted treatment
Digoxin 0.25mg TAB Lanoxin Accepted treatment
Diuretics
Bumetanide TAB Burinex Motivation required
54
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Hydrochlorothiazide and potassium-sparing agents TAB Aldazide Accepted treatment
Furosemide 40mg TAB/CAP Diuresix Mylan-furosemide Beuresis Accepted treatment
Furosemide 10mg/ml SYR Lasix Oral Motivation required in adults
Indapamide 2.5mg TAB Cipla-Indapamide Daptril Mylan-indapamide Accepted treatment
Spironolactone 25mg TAB Spiractin Sandoz Spironolactone Accepted treatment
Spironolactone 100mg TAB Spiractin Accepted treatment
Torasemide 2.5mg TAB Torahexal Motivation required Torasemide 5mg TAB Torahexal Motivation required Torasemide 10mg TAB Torahexal Motivation required Piretanide 3mg TAB Arelix Motivation required
Piretanide 6mg TAB Arelix Motivation required
Anticoagulants
Clopidrogel 75mg TAB Pharma Dynamics Clopidogrel Plagrol Mistro Motivation required
Dypiridamole 100mg TAB Plato Accepted treatment
Dypiridamole 200mg SRC Persantin retard Accepted treatment
Dypiridamole 200mg/25mg CAP Asasantin Retard Accepted treatment
Dypiridamole 25mg TAB Plato Accepted treatment
Warfarin 5mg TAB Cipla-Warfarin Lennon warfarin Accepted treatment
Warfarin 3mg TAB Cipla-Warfarin Accepted treatment
Warfarin 1mg TAB Cipla-Warfarin Accepted treatment
Vasodilators
Sildenafil 20mg TAB Revatio Motivation required
Cushing’s syndrome
Growth hormone release inhibitor
Ketoconazole 200mg TAB Ketazol Nizoral Motivation required
Octreotide 0.05mg INJ Sandostatin Motivation required
Octreotide 0.1mg INJ Sandostatin Motivation required
Octreotide 0.2mg INJ Sandostatin Motivation required
Octreotide 10mg INJ Sandostatin LAR pre-filled Motivation required
Octreotide 20mg INJ Sandostatin LAR pre-filled Motivation required
Delusional disorders
Heterocyclic antidepressants
Amitriptyline 25mg TAB Trepiline Sandoz-Amitryptyline Accepted treatment
55
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Dothiepin (dosulepin) 25mg CAP Thaden Sandoz-Dothiepen Accepted treatment
Dothiepin (dosulepin) 75mg TAB Thaden Sandoz-Dothiepen Accepted treatment
Imipramine 25mg TAB Ethipramine Tofranil Accepted treatment
Lofepramine 70mg TAB Emdalen Motivation required
Maprotiline 25mg TAB Ludiomil Motivation required
Maprotiline 75mg TAB Ludiomil Motivation required
Mianserin 10mg TAB Lantonon Motivation required
Mianserin 30mg TAB Lantonon Motivation required
Mirtazapine 15mg TAB Beron Sandoz Mirtazapine Aspen Mirtazapine Motivation required Mirtazapine 30mg TAB Beron Sandoz Mirtazapine Aspen Mirtazapine Motivation required Selective serotonin receptor inhibitors
Citalopram 10mg TAB Austell-Citalopram Accepted treatment
Citalopram 20mg TAB Austell-Citalopram Citalopram-Winthrop Sandoz-Citalopram Accepted treatment
Citalopram 40mg TAB Austell-Citalopram Citalopram-Winthrop Depramil Accepted treatment
Escitalopram 5mg TAB Lexamil Motivation required
Escitalopram 10mg TAB Citraz Zytomil Mylan Escitalopram Motivation required Escitalopram 20mg TAB Citraz Zytomil Mylan Escitalopram Motivation required Fluoxetine 20mg CAP / TAB A-lennon fluoxetine Zydus Fluoxetine Ranflocs Accepted treatment
Fluoxetine 40mg DSP Prohexal T Motivation required
Paroxetine 20mg TAB Austell Paroxetine Serrapress Xet Motivation required Paroxetine 30mg TAB Austell Paroxetine Serrapress Motivation required Sertraline 50mg TAB Austell Sertraline Sertzol Serdep Motivation required
Sertraline 100mg TAB Austell Sertraline Serlife Sertzol Motivation required
Serotonin and noadrenalin reuptake inhibitors
Duloxetine 30mg CAP Cymgen Motivation required
Duloxetine 60mg CAP Cymgen Motivation required
Venlafaxine 37.5mg CAP Venlor XR Motivation required Venlafaxine 75mg CAP Illovex SR Efegen XR Sandoz Venlafaxine XL Motivation required Venlafaxine 150mg CAP Illovex SR Efegen XR Sandoz Venlafaxine XL Motivation required Monoamine oxidase inhibitor
Moclobemide 150mg TAB Depnil Motivation required
Moclobemide 300mg TAB Clorix Depnil Motivation required
Other antidepressants
Edronax 4mg TAB Edronax Motivation required
56
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Sulpiride 200mg TAB Bio-Sulpiride Motivation required
Sulpiride 25mg SYR Eglonyl Motivation required
Sulpiride 50mg CAP Espiride Accepted treatment
Bupropion 150mg SRT Wellbutrin XL Motivation required
Bupropion 300mg SRT Wellbutrin XL Motivation required
Trazodone 50mg CAP Aspen Trazodone Molipaxin Motivation required
Trazodone 100mg CAP Aspen Trazodone Molipaxin Motivation required
Antipsychotics
Amisulpiride 200mg TAB Solian Motivation required
Amisulpiride 50mg TAB Solian Motivation required
Aripiprazole 5mg TAB Abilify Motivation required
Aripiprazole 10mg TAB Abilify Motivation required Aripiprazole 15mg TAB Abilify Motivation required Chlorpromazine 100mg TAB Largactil Accepted treatment
Chlorpromazine 25mg TAB Largactil Accepted treatment
Chlorpromazine 50mg TAB Largactil Accepted treatment
Clozapine 100mg TAB Cloment Accepted treatment
Clozapine 25mg TAB Cloment Accepted treatment
Haloperidol 0.5mg CAP Serenace Accepted treatment
Haloperidol 1.5mg TAB Serenace Sandoz Haloperidol Accepted treatment
Haloperidol 10mg TAB Serenace Accepted treatment
Haloperidol 5mg TAB Serenace Sandoz Haloperidol Accepted treatment
Risperidone 0.5mg TAB DRL-Risperidone Risperidone-Hexal Mylan-Risperidone Motivation required
Risperidone 1mg TAB DRL-Risperidone Risperidone-Hexal Mylan-Risperidone Motivation required
Risperidone 2mg TAB DRL-Risperidone Risperidone-Hexal Mylan-Risperidone Motivation required
Risperidone 3mg TAB DRL-Risperidone Risperidone-Hexal Perizal Motivation required
Risperidone 4mg TAB Aspen Risperidone Risponz Motivation required
Trifluoperazine 1mg TAB Stelazine Accepted treatment
Trifluoperazine 5mg TAB Stelazine Accepted treatment
Zuclopenthixole 10mg TAB Clopixal Motivation required
Zuclopenthixole 2mg TAB Clopixal Motivation required
Endometriosis
Hormonal preparations, oral
Cyproterone and estrogen 2mg TAB Diva -35 Ginette Minerva Motivation required
57
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Cyproterone acetate 50mg TAB Cipla-Cyproterone Acetate Cyproplex Androcur Motivation required
Desogestrel and estrogen TAB Mercilon Marvelon Motivation required
Drospirenone and estrogen TAB Yasmin Yaz Motivation required
Gestodene and estrogen TAB Minulette Melodene Femodene ed Motivation required
Levonorgestrel and estrogen TAB Biphasil Triphasil Motivation required
Medroxyprogesterone 5mg TAB Hexal-PMA Provera Accepted treatment
Norethisterone 5mg TAB Primulot n Accepted treatment
Norethisterone and estrogen TAB Trinovum Motivation required
Norgestimate & oestrogen TAB Tricilest Motivation required
Antigonadotropins
Danazol 100mg CAP Danogen Ladazol Motivation required
Danazol 200mg CAP Danogen Ladazol Motivation required Gonadotrophin Releasing Hormones and analogues
Goserelin 3.6mg INJ Zoladex Motivation required
Nafarelin 2 mg/mL NAS Synarel Motivation required
Leuprorelin 11.25mg INJ Lucrin Depot Motivation required
Hyperparathyroidism
Aminoquinolines
Chloroquine 150mg TAB Daramal Accepted treatment
Chloroquine 200mg TAB/CAP Nivaquine Plasmoquine Accepted treatment
Calcitonin
Calcitonin 200iu NAS Miacalcic nasal spray Motivation required
Calcitonin 100iu INJ Miacalcic Motivation required
Hormone inhibitors
Cinacalcet 30mg TAB Sensipar Motivation required
Cinacalcet 60mg TAB Sensipar Motivation required
Hyperthyroidism
Imidazole derivatives
Carbimazole 5mg TAB Neo-mercazole Motivation required
Beta blockers
Propranolol 10mg TAB Indoblok Prodorol Purbloka Accepted treatment
Propranolol 40mg TAB Indoblok Prodorol Purbloka Accepted treatment
58
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Hypoparathyroidism
Calcium supplementation
Calcium TAB/EFT B-cal Accepted treatment
Calcium and vitamin D TAB B-cal d Caltrate d Accepted treatment
Idiopathic thrombocytopaenic purpura
Corticosteroids –Oral
Betamethasone 0.5mg TAB Betanoid Celestone Motivation required
Prednisolone 5mg TAB Lenisolone Capsoid Accepted treatment
Prednisone 5mg TAB Be-tabs prednisone Panafcort Accepted treatment
Prednisone 20mg TAB Pulmison Accepted treatment
Alkylating agents
Cyclophosphamide 50mg TAB Endoxan Motivation required
Immunosuppressive agents
Azathioprine 50mg TAB Zaprine Azathioprine 50 PCH Azapress Accepted treatment
Methotrexate 2.5mg TAB Methotrexate Accepted treatment
Ischaemic Heart Disease
Aspirin
Acetylsalicylic acid 100mg TAB Bayer Aspirin Cardio Disprin CV Myoprin Accepted treatment
Acetylsalicylic acid 125mg TAB Lo-Aspirin Accepted treatment
Acetylsalicylic acid 300mg TAB Gulf Aspirin Be-Tabs Aspirin Aspirin (Resmed) Accepted treatment in children
Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment
Acetylsalicylic acid 81mg ECT Ecotrin Accepted treatment
Anticoagulants
Warfarin 5mg TAB Cipla-Warfarin Lennon Warfarin Accepted treatment
Warfarin 3mg TAB Cipla-Warfarin Accepted treatment
Warfarin 1mg TAB Cipla-Warfarin Accepted treatment
Dypiridamole 100mg TAB Plato Accepted treatment
Dypiridamole 200mg SRC Persantin Accepted treatment
Dypiridamole 200mg/25mg CAP Asasantin Retard Accepted treatment
Dypiridamole 25mg TAB Plato Accepted treatment
Menopause
Hormone replacement therapy
Conjugated estrogen TAB Premarin Accepted treatment
Cyproterone and estrogen TAB Claro 35 Diva 35 Accepted treatment
59
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Drospirenone and estrogen 1mg/2mg TAB Angeliq Accepted treatment
Dydrogesterone and estrogen TAB Femoston conti Accepted treatment
Dydrogesterone 10mg TAB Duphaston Accepted treatment
Dydrogesterone CRM Progesterone cream Motivation required
Estradiol PAD/TAB/IMP Evorel Accepted treatment
Estradiol CRM Vagifem Motivation required
Estradiol combinations TAB Menoflush Accepted treatment
Estriol 2mg TAB Synapause e3 Accepted treatment
Estriol CRM Synapause Vag Motivation required
Estrone 0.0625mg TAB Ortho est Accepted treatment
Medrogestone and estrogen TAB Premelle Accepted treatment
Medroxyprogesterone TAB Hexal PMA Provera Accepted treatment
Norethisterone and estrogen PAD/TAB Trinovum Accepted treatment
Norgestimate and estrogen TAB Cilest Accepted treatment
Norgestral and estrogen TAB Tricilest Accepted treatment
Progesterone 100mg CAP Utrogestan Accepted treatment
Tibolone 2.5mg TAB Livifem Motivation required
Alpha-2 agonists
Clonidine 0.025mg TAB Dixarit Menograine Accepted treatment Mycobacterial Infections (Excluding TB)
Pulmonary Disease & Others
Isoniazid 100mg TAB Be-tabs Isoniazid Special Investigations
Pyrazinamide 500mg TAB Sandoz Pyrazinamide Special Investigations
Rifampicin 100mg/5ml SUS R-Cin rifampicin Special Investigations
Rifampicin 600mg TAB Rimactane Special Investigations
Rifampicin & isoniazid 150/75mg TAB Rimactazid Special investigations
Rifampicin & isoniazid 300/150mg TAB Rimactazid Special investigations
Rifampicin & isoniazid 60/30mg TAB Rimactazid Paed Special investigations
Rifampicin, isoniazid & pyrazinamide 60/30/150mg TAB Rimcure Paed 3 FDC Special investigations
Rifampicin, isoniazid, pyrazinamide & ethambutol 150/75/400/275mg TAB Rifafour E- 275 Rimstar 4 -FDC Special investigations
Ethambutol 400mg TAB Sandoz Ethambutol Special Investigations
Clarithromycin 250mg TAB Clacee Special Investigations
Clarithromycin 500mg TAB Clacee Clarihexal Special Investigations
Clarithromycin 250mg/5ml SUS Clarihexal Ran-Clarithromycin Special Investigations
60
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Clarithromycin 125mg/5ml SUS Clarihexal Ran-Clarithromycin Special Investigations
Tetracycline 250mg TABS/CAPS Be-oxytet Oxypan Special Investigations
Neonatal Cardiac Dysrhythmia
Antiarrhythmics
Amiodarone 100mg TAB Arycor Cordarone X Motivation required
Amiodarone 150mg/3ml INJ Cordarone X Motivation required
Quinidine 200mg TAB Quinidine Sulphate Motivation required
Disopyramide 100mg CAP Rhythmodan Motivation required
Propafenone 150mg TAB Rythmol Motivation required
Flecainide 100mg TAB Rythmol Motivation required
Propranolol 10mg TAB Indoblok Prodorol Purbloka Accepted treatment
Sotalol 80mg TAB Sotahexal Motivation required
Atenolol 25mg TAB Tenopress Accepted treatment
Bisoprolol 2.5mg TAB Cardicor Accepted treatment
Cardiac Glycosides
Digoxin 0.05mg/ml SYR Lanoxin Paed Accepted treatment Neonatal Cardiac Failure Cardiac Glycosides
Digoxin 0.05mg/ml SYR Lanoxin Paed Accepted treatment
Diuretics
Furosemide 10mg/ml SYR Lasix Oral Accepted treatment Nephritic Syndrome Calcium Channel Blockers
Amlodipine 10mg TAB Almadin Ciplavasc Amlate Accepted treatment
Amlodipine 5mg TAB Almadin Ciplavasc Amlate Accepted treatment
Diltiazem 240mg SRC Zildem SR Accepted treatment
Diltiazem 180mg SRC Zildem SR Accepted treatment
Diltiazem 90mg TAB Zildem Accepted treatment
Diltiazem 60mg TAB Zildem Accepted treatment
Felodipine 10mg SRT Felodipine-hexal Accepted treatment
Felodipine 5mg SRT Felodipine-hexal Accepted treatment
Isradipine 2.5mg TAB Dynacirc Motivation required
Isradipine 5mg CAP Dynacirc SRO Motivation required
Lercanidipine 10mg TAB Zanidip Motivation required Lercanidipine 20mg TAB Zanidip Motivation required
61
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Nifedipine 60mg SRT Fedaloc Motivation required
Nifedipine 30mg SRT Adco-Vascard SR Fedaloc Accepted treatment
Nifedipine 20mg SRT Nifedalat SR Cipalat Retard Accepted treatment
Diuretics
Bumetanide 1mg TAB Burinex k Motivation required
Chlortalidone 50mg TAB Hygroton Motivation required
Hydrochlorothiazide 12.5mg TAB Ridaq Accepted treatment
Hydrochlorothiazide 25mg TAB Hexazide Ridaq Accepted treatment
Hydrochlorothiazide and potassium 50mg/300mg TAB Urirex K Accepted treatment
Hydrochlorothiazide and potassium-sparing agents 25mg/2.5mg TAB Amiloretic hs Accepted treatment
Hydrochlorothiazide and potassium-sparing agents 50mg/25mg TAB Dyazide Accepted treatment
Hydrochlorothiazide and potassium-sparing agents 50mg/5mg TAB Amiloretic Accepted treatment
Indapamide 2.5mg TAB Cipla-Indapamide Daptril Accepted treatment
Furosemide 40mg TAB/CAP Diuresix Mylan-Furosemide Beuresis Accepted treatment
Furosemide 10mg/ml SYR Lasix Oral Motivation required in adults
Piretanide 3mg TAB Arelix Motivation required
Piretanide 6mg TAB Arelix Motivation required
Spironolactone 100mg TAB Aldactone Spiractin Accepted treatment
Spironolactone 25mg TAB Spiractin Sandoz Spironolactone Accepted treatment
Torasemide 10mg TAB Unat Torahexal Motivation required
Torasemide 2.5mg TAB Unat Torahexal Motivation required
Torasemide 5mg TAB Unat Torahexal Motivation required
Triamterene and hydrochlorothiazide 50mg/25mg TAB Renezide Accepted treatment
Beta Blocker and Combinations
Acebutolol 100mg TAB Sectral Motivation required
Acebutolol 200mg TAB Sectral Motivation required
Acebutolol 400mg TAB Butoblok Sectral Motivation required
Atenolol 100mg TAB Tenopress Sandoz Atenolol B-block Accepted treatment
Atenolol 50mg TAB Tenopress Sandoz Atenolol B-block Accepted treatment
Atenolol 25mg TAB Tenopress Accepted treatment
Atenolol and other diuretics 100mg/25mg TAB Sandoz Co-tenidone Accepted treatment
Atenolol and other diuretics 50mg/12.5mg TAB Sandoz Co-tenidone Accepted treatment
Atenolol and thiazides 100mg/25mg TAB Sandoz Co-tenidone Tenchlor Adco-loten Accepted treatment
Bisoprolol 10mg TAB Cardicor Bilocor Adco-bisocor Accepted treatment
62
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Bisoprolol 5mg TAB Cardicor Bilocor Adco-bisocor Accepted treatment
Bisoprolol 2.5mg TAB Cardicor Accepted treatment
Metoprolol 100mg TAB Lopressor Motivation required
Nebivolol 5mg TAB Nebilet Motivation required
Propranolol 10mg TAB Indoblock Prodorol Purbloka Accepted treatment
Propranolol 40mg TAB Indoblock Prodorol Purbloka Accepted treatment
Propranolol 80mg CAP Inderal LA Motivation required
Propranolol and thiazide 80mg/2.5mg CAP Inderetic Motivation required
Propranolol 160mg CAP Inderal LA Motivation required
Timolol,thiazide and other diuretics 10/2.5/25mg TAB Servatrin Motivation required
Ace Inhibitor And Combinations
Benzepril 10mg TAB Cibace Motivation required
Benzepril 10mg/12.5mg TAB Cibadrex Motivation required
Captopril 12.5mg TAB Captohexal Accepted treatment
Captopril 25mg TAB Captohexal Mylan-captopril Bio-Captopril Accepted treatment
Captopril 50mg TAB Captohexal Mylan-captopril Zapto Accepted treatment
Captopril and diuretics 50mg/25mg TAB Captoretic Zapto-Co Capozide Accepted treatment
Cilazapril 5mg TAB Inhibace Motivation required
Cilazapril and diuretic 5mg/12.5mg TAB Inhibace plus Motivation required
Enalapril 2.5mg TAB Renitec Accepted treatment
Enalapril 5mg TAB Alapren Ciplatec Pharmapress Accepted treatment
Enalapril 10mg TAB Alapren Ciplatec Pharmapress Accepted treatment
Enalapril 20mg TAB Alapren Ciplatec Pharmapress Accepted treatment
Enalaprin and diuretics 20mg/12.5mg TAB Enap-Co Pharmapress co Accepted treatment
Enalapril and Lercadapine 10mg/10mg TAB Zaneril Motivation required
Enalapril and Lercadapine 10mg/20mg TAB Zaneril Motivation required
Fosinopril 10mg TAB Mylan fosinopril Motivation required
Lisinopril 20mg TAB Sinopren Simayla-lisinopril Zemax Accepted treatment
Lisinopril 10mg TAB Sinopren Simayla-lisinopril Zemax Accepted treatment
Lisinopril 5mg TAB Sinopren Simayla-lisinopril Zemax Accepted treatment
Lisinopril 2.5mg TAB Austell-lisinopril Accepted treatment
Lisinopril and diuretics 10mg/12.5mg TAB Lisoretic Lisozide Hexal-lisinopril Co Accepted treatment
Lisinopril and diuretics 20mg/12.5mg TAB Lisoretic Zestozide Hexal-lisinopril Co Accepted treatment
Moexipril 7.5mg TAB Perdix Motivation required
63
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Perindopril 4mg TAB Prexum Vectoryl Cipla-Perindopril Accepted treatment
Perindopril 8mg TAB Vectoryl Cipla-perindopril Accepted treatment
Perindopril 10mg TAB Prexum Coversyl Motivation required
Perindopril and diuretics 4mg/1.25mg TAB Prexum plus Coversyl Plus Accepted treatment
Quinapril 5mg TAB Quinagen Accupril Motivation required
Quinapril 10mg TAB Accumax Quinace Quinaspen Accepted treatment
Quinapril 20mg TAB Accumax Quinace Quinaspen Accepted treatment
Quinapril 40mg TAB Accupril Quinagen Motivation required
Quinapril and diuretic 10mg/12.5mg TAB Accumax Co Quinace Co Adco-quinaretic Motivation required
Quinapril and diuretic 20mg/12.5mg TAB Accumax Co Quinace Co Adco-quinaretic Motivation required
Ramipril 1.25mg TAB/CAP Austell-ramipril Ramiwin Rampil Accepted treatment
Ramipril 2.5mg TAB/CAP Austell-ramipril Ramiwin Rampil Accepted treatment
Ramipril 5mg TAB/CAP Austell-ramipril Ramiwin Rampil Accepted treatment
Ramipril 10mg TAB/CAP Austell-ramipril Ran-ramipril Rampil Accepted treatment
Ramipril and diuretic 2.5mg/2.5mg TAB Tri-plen Motivation required
Trandolapril 0.5mg CAP Mavik Accepted treatment
Trandolapril 2mg CAP Mavik Accepted treatment
Angiotensin receptor blockers and combinations
Candesartan 8mg TAB Atacand Motivation required
Candesartan 16mg TAB Atacand Motivation required Candesartan 32mg TAB Atacand Motivation required Candesartan and diuretic 16mg/12.5mg TAB Atacand Plus Motivation required Eprosartan 600mg TAB Teveten Motivation required
Losartan 100mg TAB Zartan Cipla-Losartan Accepted treatment
Losartan 50mg TAB Lepitrin Cipla-Losartan Los-Arb Accepted treatment
Losartan and diuretics 100mg/12.5mg TAB Fortzaar Accepted treatment
Losartan and diuretics 50mg/12.5mg TAB Cozaar-comp Accepted treatment
Irbesartan 150mg TAB Iberwin Motivation required
Irbesartan 300mg TAB Iberwin Motivation required
Irbesartan and diuretic 150mg/12.5mg TAB Co-Iberwin Motivation required Irbesartan and diuretic 300mg/12.5mg TAB Co-Iberwin Motivation required Telmisartan 40mg TAB Pritor Motivation required Telmisartan 80mg TAB Pritor Motivation required Telmisartan and diuretic 40mg/12.5mg TAB Co-Pritor Motivation required
64
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Telmisartan and diuretic 80mg/12.5mg TAB Co-Pritor Motivation required Valsartan 320mg TAB Diovan Motivation required
Valsartan 160mg TAB Tareg Motivation required
Valsartan 80mg TAB Tareg Motivation required
Valsartan 40mg TAB Diovan Motivation required
Valsartan and diuretics 320mg/12.5mg TAB Co-diovan Motivation required
Valsartan and diuretics 320mg/25mg TAB Co-diovan Motivation required
Valsartan and diuretics 160mg/25mg TAB Co-diovan plus Motivation required
Valsartan and diuretics 160mg/12.5mg TAB Co-diovan Motivation required
Valsartan and diuretics 80mg/12.5mg TAB Co-tareg Motivation required
Valsartan and amlodipine 160mg/5mg TAB Exforge Motivation required
Valsartan and amlodipine 160mg/10mg TAB Exforge Motivation required
Potassium Supplements
Potassium chloride 600mg TAB Plenish-k Accepted treatment
Erythropoetin and Supplements
Alfacalcidol 0.25mcg TAB One Alpha Special investigation
Alfacalcidol 1mcg TAB One Alpha Special investigation
Ferrous fumarate TAB Pregamal Special investigation
Ferrous sulfate 30mg TAB Ferrous sulfate Special investigation
Ferrous sulfate 100mg TAB Ferrous sulfate Special investigation
Ferric oxide and polymaltose complex TAB Ferrimed Special investigation
Folic acid 0.5mg TAB Folic acid Special investigation
Folic acid 5mg TAB Be-tabs folic acid Special investigation
Iron multivitamins and folic acid 100mg TAB Autrin Ferograd Foliferr Special investigation
Erythropoetin INJ Repotin Recormon Eprex Special investigation
Dextriferron 50mg/ml INJ Cosmofer Special investigation
Methoxy polyethylene glycol-epoetin beta INJ Mircera Special investigation
Darbepoetin INJ Aranesp Special investigation
Iron in other combinations INJ Ferofolic Special investigation
Calcium carbonate 300mg CHU Caltrate 300 Special investigation
Calcium carbonate 500mg CHU Virtual care Calcium Special investigation
Calcium carbonate 500mg EFT Sandoz Calcium Forte Fizzical Special investigation
Calcium carbonate 500mg TAB Caltrate d Special investigation
65
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Hormone inhibitors
Cinacalcet 30mg TAB Senispar Specail investigations*
Cinacalcet 60mg TAB Senispar Specail investigations* Nephrogenic Diabetes Insipidus Thiazide diuretic
Hydrochlorothiazide 25mg TAB Hexazide Ridaq Accepted treatment
Hydrochlorothiazide 12.5mg TAB Ridaq Accepted treatment
Neurological abnormalities of the newborn - Spasticity
Muscle relaxants
Baclofen 10mg TAB Bio-baclofen Teva-baclofen Lioresal Accepted treatment
Dantrolene 20mg/70ml INJ Dantrium Motivation required Diabetes Mellitus – Complications Neurological
Tricyclic antidepressants
Amitryptiline 10mg TAB Trepiline Accepted treatment
Amitryptiline 25mg TAB Trepiline Sandoz Amitriptyline Accepted treatment
Anti-convulsants
Carbamazepine 200mg TAB Degranol CPL-carbamazepine Accepted treatment
Phenytoin 100mg TAB Epanutin Accepted treatment
Other
Gabapentin 100mg CAP Ran Gabapentin Neurexal Epleptin Accepted treatment
Gabapentin 300mg CAP Ran Gabapentin Neurexal Epleptin Accepted treatment Gabapentin 400mg CAP Ran Gabapentin Neurexal Epleptin Accepted treatment Ovarian dysfunction Hormonal preparations, oral Cyproterone 2mg TAB Diva -35 Ginette Minerva Motivation required
Cyproterone 50mg TAB Cipla-Cyproterone Acetate Cyproplex Androcur Motivation required
Desogestrel and estrogen TAB Mercilon Marvelon Motivation required
Drospirenone and estrogen TAB Yasmin Yaz Motivation required
Gestodene and estrogen TAB Minulette Melodene Femodene ed Motivation required
Levonorgestrel and estrogen TAB Biphasil Triphasil Motivation required
Norethisterone and estrogen TAB Trinovum Motivation required
Norgestimate & oestrogen TAB Tricilest Motivation required
66
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Pemphigus and other disseminated bullous skin disease
Immuosuppressants
Azathioprine 50mg TAB Zaprine Azapress Azathioprine 50 PCH Accepted treatment
Methotrexate 2.5mg TAB Methotrexate Accepted treatment
Ciclosporin 25mg CAP Sandimmun neural soft gel Motivation required
Ciclosporin 100mg CAP Sandimmun neural soft gel Motivation required
Corticosteroids oral
Prednisone 5mg CAP Be-tabs prednisone Panafcort Trolic Accepted treatment
Prednisolone 5mg TAB Lenisolone Capsoid Accepted treatment
Alkylating agents
Cyclophosphamide 50mg TAB Endoxan Motivation required Peptic Ulcer Disease H2-receptor antagonists
Cimetidine 200mg TAB Bio-Cimetidine Cimlok Lenamet Accepted treatment
Cimetidine 400mg TAB Bio-Cimetidine Cimlok Lenamet Accepted treatment
Ranitidine 150mg TAB Ranihexal Ranit Histak Accepted treatment
Ranitidine 300mg TAB Ranihexal Ranit Histak Accepted treatment
Ranitidine 150mg/10ml SYR Zantac Motivation required
Proton Pump Inhibitors
Omeprazole 10mg CAP Omez Altosec DRL-omeprazole Accepted treatment
Omeprazole 20mg CAP Nozer Altosec Omez Accepted treatment
Omeprazole 40mg TAB/CAP Omez Losec mups DRL-omeprazole Accepted treatment
Pantoprazole 20mg TAB Topzole Pantoloc Controloc Motivation required
Pantoprazole 40mg TAB Topzole Pantoloc Controloc Motivation required
Esomeprazole 20mg TAB Nexiam Motivation required
Esomeprazole 40mg TAB Nexiam Motivation required
Lansoprazole 15mg TAB/CAP Lansoloc Lancap Aspen Lansoprazole Motivation required
Lansoprazole 30mg TAB/CAP Lansoloc Lancap Aspen Lansoprazole Motivation required
Rabeprazole 10mg TAB Pariet Motivation required
Rabeprazole 20mg TAB Pariet Motivation required
Peripheral vascular disease
Aspirin
Acetylsalicylic acid 100mg TAB Bayer aspirin cardio Disprin CV Myoprin Accepted treatment
Acetylsalicylic acid 125mg TAB Lo-Aspirin Accepted treatment
67
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Acetylsalicylic acid 300mg TAB Gulf Aspirin Be-tabs aspirin Aspirin (Resmed) Accepted treatment
Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment in children
Acetylsalicylic acid 81mg ECT Ecotrin Accepted treatment
Dypiridamole 100mg TAB Plato Accepted treatment
Dypiridamole 200mg SRC Persantin Accepted treatment
Dypiridamole 200mg/25mg CAP Asasantin Retard Accepted treatment
Dypiridamole 25mg TAB Plato Accepted treatment
Anticoagulants
Warfarin 1mg TAB Cipla-warfarin Accepted treatment
Warfarin 5mg TAB Cipla-warfarin Accepted treatment
Warfarin 3mg TAB Cipla-warfarin Accepted treatment
Clopidrogel 75mg TAB Pharma Dynamics Clopidogrel Plagrol Mistro Motivation required
Pituitary hyperfunction Dopamine Agonists
Carbergoline 0.5mg TAB Dostinex Special investigations & motivation
Quinagolide 75mg TAB Norprolac Special investigations & motivation Quinagolide 150mg TAB Norprolac Special investigations & motivation Growth Hormone Release Inhibitors
Octreotide 0.05mg/ml INJ Sandostatin Special investigations Pituitary hypofunction Thyroid Hormones
Levothyroxine 100mcg TAB Eltroxin Euthyrox Accepted treatment
Levothyroxine 50mcg TAB Eltroxin Euthyrox Accepted treatment
Levothyroxine 25mcg TAB Euthyrox Accepted treatment
Liothyronine 20mcg TAB Tertroxin Accepted treatment
Thyroxine and liothyronine 90mcg/10mcg TAB Diotroxin Accepted treatment
Growth Hormone
Humatrope 6mg INJ Isopto homotropine Motivation required
Sex Hormones
Depo- Testosterone 100mg/ml INJ Depot testosterone Motivation required
Conjugated oestrogens 0.625 mg TAB Premarin Accepted treatment
Conjugated oestrogens 0.3mg TAB Premarin Accepted treatment
Glucocorticoids,oral
Hydrocortisone 10mg TAB Covocort Accepted treatment
68
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Schizo-affective disorder
Heterocyclic antidepressants
Amitriptyline 25mg TAB Trepiline Accepted treatment
Clomipramine 25mg TAB Clomidep Equinorm Motivation required
Dothiepin (dosulepin) 25mg CAP Thaden Sandoz -dothiepin Accepted treatment
Dothiepin (dosulepin) 75mg TAB Thaden Sandoz-dothiepin Accepted treatment
Imipramine 25mg TAB Ethipramine Accepted treatment
Lofepramine 70mg TAB Emdalen Motivation required
Maprotiline 25mg TAB Ludiomil Motivation required
Maprotiline 75mg TAB Ludiomil Motivation required
Mianserin 10mg TAB Lantanon Motivation required Mianserin 30mg TAB Lantanon Motivation required Mirtazapine 15mg TAB Beron Mylan Mirtazapine Sandoz Mirtazaopine Motivation required
Mirtazapine 30mg TAB Beron Mylan Mirtazapine Sandoz Mirtazaopine Motivation required
Selective serotonin receptor inhibitors
Citalopram 10mg TAB Austell-citalopram Accepted treatment
Citalopram 20mg TAB Austell-citalopram Citalopram-Winthrop Sandoz-citalopram Accepted treatment
Citalopram 40mg TAB Austell-citalopram Citalopram-Winthrop Depramil Accepted treatment
Escitalopram 5mg TAB Lexamil Motivation required Escitalopram 10mg TAB Aspen Escitalopram Zytomil Citraz Motivation required Escitalopram 20mg TAB Zytomil Citraz Motivation required Fluoxetine 20mg CAP / TAB A-lennon fluoxetine Zydus-fluoxetine Ranflocs Accepted treatment
Fluoxetine 40mg DSP Prohexal T Motivation required
Fluvoxamine 100mg TAB Faverin Fluvoxamine-hexal Motivation required
Paroxetine 20mg TAB Serrapress Austell Paroxetine Xydus Paroxetine Motivation required Paroxetine 25mg TAB Aropax CR Motivation required Paroxetine 30mg TAB Serrapress Austell Paroxetine Motivation required Sertraline 50mg TAB Austell-Sertraline Zolid Sertzol Motivation required Sertraline 100mg TAB Austell-Sertraline Serlife Motivation required Serotonin and noradrenalin reuptake inhibitors
Duloxetine 30mg CAP Cymgen Motivation required
Duloxetine 60mg CAP Cymgen Motivation required
Venlafaxine 37.5mg TAB/CAP Venlor XR Motivation required
69
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Venlafaxine 50mg TAB Efexor Motivation required Venlafaxine 75mg TAB/CAP Ilovex SR Sandoz Venlafaxine Efegen XR Motivation required Venlafaxine 150mg TAB/CAP Efegen XR Ilovex SR Sandoz Venlafaxine Motivation required Other
Bupropion 150mg SRT Wellbutrin Motivation required Bupropion 300mg SRT Wellbutrin XL Motivation required Sulpiride 200mg TAB Bio-Sulpiride Motivation required
Sulpiride 25mg SYR Eglonyl Motivation required
Sulpiride 50mg CAP Espiride Sandoz Sulpiride Accepted treatment
Trazadone 50mg CAP Aspen Trazadone Molipaxin Motivation required
Trazadone 100mg CAP Aspen Trazadone Molipaxin Motivation required
Reboxetine 4mg TAB Edronax Motivation required
Monoamine oxidase type A inhibitors
Moclobemide 150mg TAB Depnil Motivation required
Moclobemide 300mg TAB Depnil Motivation required
Mood stabilisers
Lithium 250mg TAB Camcolit Accepted treatment
Lithium 400mg TAB Camcolit Accepted treatment
Lithium 450mg TAB Quinolum Retard Accepted treatment
Antipsychotics
Amisulpiride 200mg TAB Solian Motivation required
Amisulpiride 50mg TAB Solian Motivation required
Aripiprazole 5mg TAB Abilify Motivation required
Aripiprazole 10mg TAB Abilify Motivation required
Aripiprazole 15mg TAB Abilify Motivation required
Chlorpromazine 100mg TAB Largactil Accepted treatment
Chlorpromazine 25mg TAB Largactil Accepted treatment
Chlorpromazine 50mg TAB Largactil Accepted treatment
Clozapine 100mg TAB Cloment Accepted treatment
Clozapine 25mg TAB Cloment Accepted treatment
Haloperidol 0.5mg CAP Serenace Accepted treatment
Haloperidol 1.5mg TAB Serenace Sandoz Haloperidol Accepted treatment
Haloperidol 10mg TAB Serenace Accepted treatment
Haloperidol 5mg TAB Serenace Sandoz Haloperidol Accepted treatment
70
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Olanzapine 2.5mg TAB Olexar Zyprexa Motivation required
Olanzapine 5mg TAB Olexar Zyprexa Motivation required Olanzapine 10mg TAB Olexar Zyprexa Motivation required Quetiapine 25mg TAB Seroquel Motivation required Quetiapine 50mg TAB Seroquel XR Motivation required Quetiapine 100mg TAB Seroquel Motivation required Quetiapine 200mg TAB Seroquel Motivation required Quetiapine 300mg TAB Seroquel Seroquel XR Motivation required Quetiapine 400mg TAB Seroquel XR Motivation required Risperidone 0.5mg TAB DRL-Risperidone Risperidone-Hexal Mylan-Risperidone Motivation required
Risperidone 1mg TAB DRL-Risperidone Risperidone-Hexal Mylan-Risperidone Motivation required
Risperidone 2mg TAB DRL-Risperidone Risperidone-Hexal Mylan-Risperidone Motivation required
Risperidone 3mg TAB DRL-Risperidone Risperidone-Hexal Perizal Motivation required
Risperidone 4mg TAB Aspen Risperidone Risponz Motivation required
Trifluoperazine 1mg TAB Stelazine Accepted treatment
Trifluoperazine 5mg TAB Stelazine Accepted treatment
Ziprasidone 20mg CAP Geodon Motivation required Ziprasidone 40mg CAP Geodon Motivation required Ziprasidone 60mg CAP Geodon Motivation required Ziprasidone 80mg CAP Geodon Motivation required Zuclopenthixole 10mg TAB Clopixol Motivation required
Zuclopenthixole 2mg TAB Clopixol Motivation required
Spinal cord injuries
Antipropulsives
Loperamide 2mg TAB/CAP Adco loperamide Gastron Imodium Accepted treatment
Loperamide 1mg/5ml SYR Adco loperamide Imodium Accepted treatment
Laxatives
Bisacodyl 5mg TAB Dulcolax Accepted treatment
Glycerol SYR / SUP Glycerine Accepted treatment
Ispaghula and combinations GRA / SAC Fybogel Agiolax Accepted treatment
Lactulose 3.3g/5ml SYR Duphalac Aculax Adco-liquilax Accepted treatment
Lactulose SAC Duphalac dry Laxette dry Accepted treatment
Laurisulfate including combinations ENE Microlax Accepted treatment
Osmotically acting laxatives SAC Movicol Accepted treatment
71
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Sterculia GRA Normacol Accepted treatment
Sterculia, combinations GRA Normacol plus Accepted treatment
Senna glycosides and combinations TAB / GRA Senokot Soflax Accepted treatment
Heterocyclic Antidepressants
Amitriptyline 10mg TAB Trepiline Accepted treatment
Amitriptyline 25mg TAB Trepiline Sandoz-amitriptyline Accepted treatment
Muscle Relaxants
Baclofen 10mg TAB Bio-baclofen Accepted treatment
Baclofen 25mg TAB Lioresal Motivation required
Dantrolene 25mg CAP Dantrium Motivation required
Orphenadrine 100mg TAB Norflex Accepted treatment
Antibiotics, oral
Nalidixic acid 500mg TAB Puromylon Motivation required
Nalidixic acid SUS Winlomylin Mtoivation required
Nitrofurantoin 50mg CAP Macrodantin Accepted treatment
Nitrofurantoin 100mg CAP Macrodantin Accepted treatment
Nitrofurantoin 25mg/5ml SUS Furadantin Accepted treatment
Pipemidic Acid CAP Deblaston Motivation required
Stroke
Aspirin
Acetylsalicylic acid 100mg TAB Bayer Aspirin cardio Disprin CV Myoprin Accepted treatment
Acetylsalicylic acid 125mg TAB Lo-Aspirin Accepted treatment
Acetylsalicylic acid 300mg TAB Gulf Aspirin Be-tabs aspirin Aspirin (resmed) Accepted treatment
Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment in children
Acetylsalicylic acid 81mg ECT Ecotrin Accepted treatment
Anticoagulants
Warfarin 1mg TAB Cipla-warfarin Accepted treatment
Warfarin 3mg TAB Cipla-warfarin Accepted treatment
Warfarin 5mg TAB Cipla-warfarin Lennon warfarin Accepted treatment
Clopidrogel 75mg TAB Pharma Dynamics Clopidogrel Plagrol Mistro Motivation required
Thalassemia Supplemments
Folic acid 0.5mg TAB Folic Acid Accepted treatment
72
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Chelating agents
Deferasirox 125mg DSP Exjade Special investigation
Deferasirox 250mg DSP Exjade Special investigation
Deferasirox 500mg DSP Exjade Special Investigation
Deferoxamine 500mg INJ Desferal Special investigation Thromboembolic disease Aspirin
Acetylsalicylic acid 100mg TAB Bayer Aspirin cardio Disprin CV Myoprin Accepted treatment
Acetylsalicylic acid 125mg TAB Lo-Aspirin Accepted treatment
Acetylsalicylic acid 300mg TAB Gulf Aspirin Be-tabs aspirin Aspirin (resmed) Accepted treatment
Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment in children
Acetylsalicylic acid 81mg ECT Ecotrin Accepted treatment
Dypiridamole 100mg TAB Plato Accepted treatment
Dypiridamole 200mg SRC Persantin Accepted treatment
Dypiridamole 200mg/25mg CAP Asasantin Retard Accepted treatment
Dypiridamole 25mg TAB Plato Accepted treatment
Anticoagulants
Warfarin 1mg TAB Cipla-warfarin Accepted treatment
Warfarin 3mg TAB Cipla-warfarin Accepted treatment
Warfarin 5mg TAB Cipla-warfarin Lennon warfarin Accepted treatment
Clopidrogel 75mg TAB Pharma Dynamics Clopidogrel Plagrol Mistro Motivation required
Transient Ischaemic Attack
Aspirin
Acetylsalicylic acid 100mg TAB Bayer Aspirin cardio Disprin CV Myoprin Accepted treatment
Acetylsalicylic acid 125mg TAB Lo-Aspirin Accepted treatment
Acetylsalicylic acid 300mg TAB Gulf Aspirin Be-tabs aspirin Aspirin (resmed) Accepted treatment
Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment in children
Acetylsalicylic acid 81mg ECT Ecotrin Accepted treatment
Anticoagulants
Warfarin 1mg TAB Cipla-warfarin Accepted treatment
Warfarin 3mg TAB Cipla-warfarin Accepted treatment
Warfarin 5mg TAB Cipla-warfarin Accepted treatment
73
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Clopidrogel 75mg TAB Pharma Dynamics Clopidogrel Plagrol Mistro Motivation required
Tuberculosis
Drugs
Ethambutol 400mg TAB Sandoz ethambutol Special investigations
Isoniazid 100mg TAB Be-tabs Isoniazid Special investigations (also prophylaxis)
Pyrazinamide 500mg TAB Sandoz Pyrazinamide
Special investigations
Rifampicin 450mg TAB Rimactane Special investigations
Rifampicin 600mg TAB Rimactane Special investigations
Rifampicin 150mg CAP Rimactane Special investigations
Rifampicin 300mg CAP Rimactane Special investigations
Rifampicin 100mg/5ml SUS R-cin Special investigations
Rifampicin & isoniazid 150/75mg TAB Rimactazid Special investigations
Rifampicin & isoniazid 300/150mg TAB Rimactazid Special investigations
Rifampicin & isoniazid 60/30mg TAB Rimactazid Paed Special investigations
Rifampicin, isoniazid & pyrazinamide 60/30/150mg TAB Rimcure Paed 3 FDC Special investigations
Rifampicin, isoniazid, pyrazinamide & ethambutol 150/75/400/275mg TAB Rifafour E- 275 Rimstar 4 -FDC Special investigations
Streptomycin 1g/3ml INJ Bio-strep Special investigations
Pyridoxine 25mg TAB Pyridoxine Be-tabs Pyridoxine Accepted treatment Multi Drug-Resistant TB and Extensively Drug-Resistant TB
Pyrazinamide 500mg TAB Sandoz Pyrazinamide Special investigations
Ethambutol 400mg TAB Sandoz ethambutol Special investigations
Ethionamide 250mg TAB Ethatyl Special investigations
Ofloxacin 200mg TAB Zanocin Tafloc Special investigations
Ofloxacin 400mg TAB Zanocin Tafloc Special investigations
Ciprofloxacin 250mg TAB Ciplox Special investigations
Ciprofloxacin 500mg TAB Ciplox Special investigations
Kanamycin 1g/3ml INJ Bio-kanamycin Special investigations
Amikacin 100mg INJ Amikacin-fresenius Special investigations
Amikacin 250mg INJ Amikacin-fresenius Special investigations
Amikacin 500mg INJ Amikacin-fresenius Special investigations
Amikacin 1000mg INJ Amikacin-fresenius Special investigations
Terizidone 250mg CAP Terivalidin Special investigations
74
INGREDIENT STRENGTH DOSAGE FORM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 COMMENT
Cycloserine 250mg CAP Aspen Cycloserine Special investigations
Tuberculoid Leprosy
Rifampicin 450mg TAB Rimactane Special Investigation
Rifampicin 600mg TAB Rimactane Special Investigation
Rifampicin 150mg CAP Rimactane Special Investigation
Rifampicin 300mg CAP Rimactane Special Investigation
Rifampicin 450mg TAB Rimactane Special Investigation
Dapsone 100mg TAB Dapsone Special Investigation
Valvular heart disease
Antibiotics
Benzylpenicillin INJ Bio-pen Accepted treatment
Phenoxymethylpenicillin 250mg TAB Betapen Pen VK Accepted treatment
Erythromycin 250mg CAP Adco-erythromycin Betamycin Accepted treatment
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