ANNEXURE A
ISSUE No. 02/10
UPDATED: 26-May-11INCLUDES: Supplementary List No: 123 and 124
to access cover sheet on page 1 above - unfreeze panes
*EDL 1= Primary; A= Hospital Level Adult; P = Hospital Level Paediatrics
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
CATALOGUE OF APPROVED PHARMACEUTICALS FOR USE
IN THE DEPARTMENT OF HEALTH
PROVINCIAL CODE LIST
Page 1 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
4-epi-doxorubicin: see epirubicin5-fluoro-uracil: see fluorouracil
J05AF 18.12pgwcARV depot
abacavir 20mg/ml 240ml solution ZIAGEN AIDS programmeAvailable through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.
J05AF 18.12pgwcARV depot
abacavir 300mg 60 tablet ZIAGEN AIDS programme As above.
R05CB 28 Supp List 118 N-acetylcysteine1
A P200mg/ml 1 injection PARVOLEX
S01EC 16.1 acetazolamide A 500mg/10ml 1 injection DIAMOX; AZOMID
Specialist: neurologist, neurosurgeon & opthalmologist
S01EC 16.1 Supp List 119 acetazolamide1
A P250mg 100 tablet DIAMOX
General . neurologist, neurosurgeon & ophthalmologist Initiated
General - for Glaucoma emergencies
S02AA Ø Supp List 118 acetic acid 1 1% in aqueous 10ml ear dropsX Ø acetone 500ml liquid ACETONE
S01EB 15.7 acetylcholine + mannitol40mg + 200mg/ 4,5ml
1intraocular injection
COVOCHOLSpecialist: ophthalmologist
acetylsalicylic acid: see aspirinacid citrate monohydrate: see citric acid
D05BB 14.5 acitretin A 10mg 30 capsule NEOTIGASONSpecialist: dermatologist
D05BB 14.5 acitretin A 10mg 100 capsule NEOTIGASONSpecialist: dermatologist
D05BB 14.5 acitretin A 25mg 30 capsule NEOTIGASONSpecialist: dermatologist
R02AA Ø acriflavine 0,1% 100ml emulsionACRIFLAVIN EMULSION
R02AA Ø acriflavine 0,1% 500ml emulsionACRIFLAVIN EMULSION
S01AD 15.1.1 acyclovir A 30mg/g 4,5g eye ointment ZOVIRAXSpecialist : ophthalmologist
J05AB 18.12 acyclovir A P 250mg 5 injection ZOVIRAX Specialist J05AB 18.12 acyclovir P 200mg/5ml 125ml suspension ZOVIRAX Specialist
Page 2 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J05AB 18.12Suppl List 119/122
acyclovir 1 A P 200mg 25 tablet ZOVIRAXGeneral Clinical Nurse Practitioner
General: For Primary Genital Herpes, GUS, Chronic Herpetic Ulcer, Herpes Zoster, Eczema Herpeticum, Herpes Stomatitis and Ophthalmic Zoster: According to H135/2002 Addendum A - Supp List 92. Clinical Nurse Practitioner:Genital Ulcer Syndrome (GUS) according to EDL STG's
J05AB 18.12Suppl List 119/122
acyclovir 1 A P 400mg 70 tablet ZOVIRAXGeneral Clinical Nurse Practitioner
General: For Primary Genital Herpes, GUS, Chronic Herpetic Ulcer, Herpes Zoster, Eczema Herpeticum, Herpes Stomatitis and Ophthalmic Zoster: According to H135/2002 Addendum A - Supp List 92. Clinical Nurse Practitioner:Genital Ulcer Syndrome (GUS) according to EDL STG's
adamson's ointment modified:look under LPC 4% ……..
C01EB 7.2 Supp List 122 adenosine A P 6mg/2ml 1 injection ADENOCORC01CA 7.1.2 adrenaline B.P. 1 A P 1:1000 1mg/ml 1 injection ADRENALINE
P02CA 13Suppl List 119/121
albendazole 1 A P 200mg 2 tablet ZENTEL
For: - Children under two years of age - Neurocysticercosis - Hydatid cysts - Tape worm - Sandworm
P02CA 13Suppl List 119/121
albendazole 1 A P 400mg 2 tablet ZENTEL
For: - Children under two years of age - Neurocysticercosis - Hydatid cysts - Tape worm - Sandworm
B05AA Ø albumin, normal serum P 0.2 50ml infusionSpecialist paediatrician
B05AA Ø albumin, normal serum P 0.2 100ml infusionSpecialist paediatrician
M05BA 4.7.1 alendronate A 10mg 30 tablets OSTEOBONSpecialist endocrinologist initiated
Endocrinologist initiated with 18-month follow-up with endocrinilogist. Restricted to severe osteoporosis with T-score -2,5 or less plus osteoporotic fracture
A11CC 20.1 alfacalcidol P 0,25µg 30 capsule ONE-ALPHA
Specialist physicians and paediatricians initiated
Page 3 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
A11CC 20.1 alfacalcidol P 1µg 30 capsule ONE-ALPHA
Specialist physicians and paediatricians initiated
N01AH 2.1.2 alfentanil A 1mg/2ml 1 injection RAPIFEN SpecialistN01AH 2.1.2 alfentanil A 5mg/10ml 5 injection RAPIFEN Specialist
A02BX 12.4.1
alginic acid + aluminium hydrox. dried gel + magnesium trisil. + sodium bicarb.
924mg + 200mg + 50mg + 340mg/2g
2g sachets GAVISCON INFANTSpecialist: paediatrician
For use in paediatrics for PROVEN reflux oesophagitis.
Supp List 124allergen-skin prick tests for allergy
ALLERGEN SKIN PRICK TESTS
Allergy clinics
M04AA 4.2 allopurinol A P 100mg 500 tablet ZYLOPRIM; PURICOSM04AA 4.2 allopurinol 300mg 30 tablet ZYLOPRIM
C01EA 7.5 alprostadil 0,5mg/ml 1 injection PROSTIN VRSpecialist: paediatrician
G04BE 17.5.2 alprostadil 20µg/ml 1 injection CAVERJECTCentral HospitalsSpecialist: urologist
Urology. Erectile dysfunction. Maximum of 4 doses.Patient name basis.
B01AD 8.3 alteplase 50mg 1 injection ACTILYSE SpecialistFor acute arterial occlusion and deep vein thrombosis.
A02AB 12.4 aluminium hydroxide A 300mg/5ml 350ml suspension AMPHOGELA02AB 12.4 aluminium hydroxide A 300mg/5ml 2 500ml suspension AMPHOGEL
A02AD 12.4aluminium hydrox. + magnesium trisil.
1 A 250mg + 500mg 24 tablet GELUSIL
A02AD 12.4aluminium hydrox. + magnesium trisil.
1 A 250mg + 500mg 96 tablet GELUSIL
A02AD 12.4.1 Supp List 124aluminium hydrox.+ magnesium hydrox. + oxethazaine
291mg + 98mg + 10mg/5ml
500ml suspension MUCAINESpecialist oncologist
For radio-oncology patients only, non-referable. Maximum dose 10ml 4 times daily.
N04BB 1.7.1 amantadine HCl 100mg 20 capsuleSYMMETREL; ANTADINE
Specialist: neurologist
D04AB 2.2.1 amethocaine HCl 0.01 25g cream ANETHAINEamethopterin: See methotrexate
J01GB 18.3 amikacin A P 100mg 1 injection AMIKIN; KACINTH-A SpecialistTo be confirmed on a microbiologist report or requested on the motivation form. Restriction exempted for ICU's.
J01GB 18.3 amikacin P 250mg 1 injection AMIKIN Specialist As aboveJ01GB 18.3 amikacin A 500mg 1 injection AMIKIN Specialist As above
N05AL 1.5.3Suppl List 116
amisulpiride 50mg 30 tablet SOLIAN
Specialist psychiatrist initiated with annual review with psychiatrist
For patients who have not responded to or experienced intolerable side effects with other coded anti-psychotics. To be used in line with the Mental Health protocol
Page 4 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
N05AL 1.5.3Suppl List 116
amisulpiride 200mg 30 tablet SOLIAN
Specialist psychiatrist initiated with annual review with psychiatrist
For patients who have not responded to or experienced intolerable side effects with other coded anti-psychotics. To be used in line with the Mental Health protocol
B02AA 8.1 aminocaproic acid A 250mg/ml 20ml injection AMICARR03DA 10.2.2 aminophylline I.V. 1 A P 250mg/10ml 1 injection PETERPHYLLIN
C01BD 7.2 amiodarone HCl A 150mg/3ml 1 injection CORDARONE X Specialist physician
C01BD 7.2 amiodarone HCl A 200mg 30 tablet CORDARONE X Specialist physician
N06AA 1.4.1 amitriptyline 1 A P 10mg 500 tabletTRYPTANOL; TREPILINE
N06AA 1.4.1 amitriptyline 1 A P 25mg 28 tablet TRYPTANOLN06AA 1.4.1 amitriptyline 1 A P 25mg 56 tablet TRYPTANOLN06AA 1.4.1 amitriptyline 1 A P 25mg 84 tablet TRYPTANOLN06AA 1.4.1 amitriptyline 1 A P 25mg 112 tablet TRYPTANOL
N06AA 1.4.1 amitriptyline 1 A P 25mg 168 tabletTREPILINE-25;ENDEP 25
N06AA 1.4.1 amitriptyline A P 25mg 500 tablet TRYPTANOL
C08CA 7.3.7Supp List 114 and 119
amlodipine1 A
5mg 30 tablet NORVASC
For a maximum daily dose of up to10mg.When initiating a long acting calcium channel blocker in adults, commence with Amlodipine 5mg per day.NB: For complete guidelines on substituting Nifedipine extended release with Amlodipine: See Ci l H5/2006 A d t (S l Li t 104
C08CA 7.3.7 Supp List 120 amlodipine1 A
10mg 30 tabletNORVASC; AMIODAC 10
For a maximum daily dose of up to10mg.When initiating a long acting calcium channel blocker in adults, commence with Amlodipine 5mg per day.NB: For complete guidelines on substituting Nifedipine extended release with Amlodipine: See Ci l H5/2006 A d t (S l Li t 104amoxycillin + clavulanic
acid: see co-amoxyclav
J01CA 18.1.1 amoxycillin 1 A P 250mg 15 capsule AMOXILFor revised Amoxycillin dosage regimen:See Circular H125/2003 (Addendum A - Suppl. List 98).
J01CA 18.1.1 amoxycillin 1 A P 250mg 100 capsule AMOXIL; MOXYPEN As above.J01CA 18.1.1 amoxycillin A P 250mg 500 capsule AMOXIL As above.
J01CA 18.1.1 amoxycillin 1 A 500mg 15 capsule AMOXILFor revised Amoxycillin dosage regimen:See Circular H125/2003 (Addendum A - Suppl. List 98).
J01CA 18.1.1 amoxycillin 1 A 500mg 100 capsule AMOXIL As above.
J01CA 18.1.1 amoxycillin 1 P 125mg/5ml 75ml suspension ZOXIL
For revised Amoxycillin dosage regimen:See Circular H125/2003 (Addendum A - Suppl. List 98).To use cheapest pack size on tender
Page 5 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J01CA 18.1.1 amoxycillin 1 P 125mg/5ml 100ml suspension AMOXILAs above.To use cheapest pack size on tender.
J01CA 18.1.1 amoxycillin 1 P 250mg/5ml 100ml suspension AMOXILFor revised Amoxycillin dosage regimen:See Circular H125/2003 (Addendum A - Suppl. List 98).
J02AA 18.8 amphotericin-B A P 50mg 1 injection FUNGIZONE
J01CA 18.1.1 ampicillin P 250mg 1 injectionPETERCILLIN; AMPIPEN
J01CA 18.1.1 ampicillin A P 500mg 1 injection PETERCILLIN
S01GA 15.4antazoline + naphazoline
0,5% +0,012% - 0,1%
10ml eye dropsALBALON-AANTISTIN PRIVINE
Maximum one bottle per patient per month.ALTERNATIVE: Next Item Below. Cheapest on tender will be used.
S01GA 15.4antazoline +tetrahydrozoline
0,05% +0,04%
10ml eye drops SPERSALLERGMaximum one bottle per patient per month.ALTERNATIVE: Item Above. Cheapest on tender will be used.
B02AB 27 aprotinin500 000 iu/50ml1 000 000 iu/100ml
1 injection TRASYLOL Central hospitals only, not referable.
D02AC Ø aqueous cream 1 B.P. 100g cream AQUEOUS CREAMD02AC Ø aqueous cream B.P. 500g cream AQUEOUS CREAM
P01BE 18.11 Supp List 120artemether + lumefantrine
1 20mg / 120mg 24 tablets COARTEM
ascorbic acid: See Vitamin C
N02BA 3.2 aspirin soluble 1 A P 300mg 14 tablets DISPRIN
N02BA 3.2 Supp List 115 aspirin soluble1A
300mg 20 tablet DISPRIN Not repeatable for acute conditions (short course)
N02BA 3.2 Supp List 115 aspirin soluble 1 A 300mg 24 tablet DISPRIN Not repeatable for acute conditions (short course)
N02BA 3.2 Supp List 115 aspirin soluble 1 A P 300mg 1 000 tablets DISPRIN Not repeatable for acute conditions (short course)
N02BA 3.3aspirin + codeine phosphate soluble
500mg +8mg
10 tablet CODIS Oncology and facial maxillary surgeons only.
N02BA 3.3aspirin + codeine phosphate soluble
500mg +8mg
30 tablet CODIS As above.
C07AB 7.4 atenolol A 5mg/10ml 5 injection TENORMIN SpecialistC07AB 7.4 atenolol 1 A P 50mg 28 tablet TENORMIN; ATEROL
Page 6 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
C10AA 7.7.2Supp List 116/124
atorvastatin 10mg 28 tablet LIPITOR
General - ARV clinics only Specialist: lipid clinic initiated
General: ARV clinics only, according to Health Programmes' algorithm for the management of dyslipidaemia Specialist lipid clinic initiated:; - For HIV/AIDS patients - Familial heterozygous hypercholesterolaemia and familial homozygous hypercholesterolaemia patients who do not tolerate simvastatin - Familial homozygous hypercholesterolaemia (doses of 40mg and higher)
C10AA 7.7.2Supp List 116/124
atorvastatin 20mg 28 tablet LIPITORSpecialist: lipid clinic initiated
General: ARV clinics only, according to Health Programmes' algorithm for the management of dyslipidaemia Specialist lipid clinic initiated:; - For HIV/AIDS patients - Familial heterozygous hypercholesterolaemia and familial homozygous hypercholesterolaemia patients who do not tolerate simvastatin - Familial homozygous hypercholesterolaemia (doses of 40mg and higher)
C10AA 7.7.2Supp List 116/124
atorvastatin 40mg 28 tablet LIPITORSpecialist: lipid clinic initiated
General: ARV clinics only, according to Health Programmes' algorithm for the management of dyslipidaemia Specialist lipid clinic initiated:; - For HIV/AIDS patients - Familial heterozygous hypercholesterolaemia and familial homozygous hypercholesterolaemia patients who do not tolerate simvastatin - Familial homozygous hypercholesterolaemia (doses of 40mg and higher)
C10AA 7.7.2Supp List 116/124
atorvastatin 80mg 28 tablet LIPITORSpecialist: lipid clinic initiated
General: ARV clinics only, according to Health Programmes' algorithm for the management of dyslipidaemia Specialist lipid clinic initiated:; - For HIV/AIDS patients - Familial heterozygous hypercholesterolaemia and familial homozygous hypercholesterolaemia patients who do not tolerate simvastatin - Familial homozygous hypercholesterolaemia (doses of 40mg and higher)
M03AC 2.3 atracurium besylate A 25mg/2,5ml 1 injection TRACRIUM For use in liver & kidney impairment onlyM03AC 2.3 atracurium besylate A 50mg/5ml 5 injection TRACRIUM As above.S01FA 15.5 atropine sulphate B.P. 1 1% 5ml eye drops COVAN ATROPINEPage 7 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
S01FA 15.5atropine sulphate + hypromellose
1 1% + 0,5% 5ml eye drops ISOPTO ATROPINE
A03BA 5.4 atropine sulphate 1 A P 0,5mg/ml 1 injection SABAX ATROPINEA03BA 5.4 atropine sulphate 1 1mg/ml 1 injection SABAX ATROPINEL04AX 24.1 azathioprine 50mg/vial 1 injection IMURAN; ASOTRIM Specialist Central hospitals only, not referable.L04AX 24.1 azathioprine A P 50mg 100 tablet IMURAN Specialist
M03BX 4.5 baclofen 10mg 30 tablet LIORESAL
Specialist initiated: neurologists, neurosurgeons, paediatricians, pain clinics and WCRC
M03BX 4.5 baclofen 25mg 30 tabletLIORESAL; NEUROSPAS
Specialist initiated: neurologists, neurosurgeons, paediatricians, pain clinics and WCRC
balanced salt solution (BSS): see salt solution
V08BA 33 barium sulphate 1,2kg powder EZPAQUEV08BA 33 barium sulphate 11,34kg powder EZPAQUE
R01AD 10.4.1beclomethasone dipropionate
50µg/spray 1aqueous nasal spray
BECONASEBECLATE AQUAN.
Maximum: One per month. Two may be dispensed only if prescription is endorsed by an Allergy Clinic.
S01HA 15.7 benoxinate HCl 0,4% 0,5ml x 20 minims MINIM BENOXINATE Cheapest agent on tender to be used
N04AA 1.7.2benzhexol (trihexyphenidyl)
A 2mg 28 tablet ARTANE
N04AA 1.7.2benzhexol (trihexyphenidyl)
A 2mg 56 tablet ARTANE
N04AA 1.7.2benzhexol (trihexyphenidyl)
2mg 84 tablet ARTANE
N04AA 1.7.2benzhexol (trihexyphenidyl)
A 2mg 100 tablet ARTANE
D01AE Øbenzoic acid + salicylic acid
1 BPC (6% + 3%) 25g ointment WHITFIELD'S OINT.
R01AX Øbenzoin compound tincture
BP 20ml liquid FRIAR'S BALSEM
R01AX Øbenzoin compound tincture
BP 500ml liquid FRIAR'S BALSEM
D10AE 14.6 benzoyl peroxide 1 A 5g/100g 40g gel PANOXYLD10AE 14.6 benzoyl peroxide A 10g/100g 40g gel PANOXYL SpecialistA01AD 11.3 benzydamine HCl 22,5mg/15ml 200ml solution ANDOLEX Specialist Central hospitals only, not referable.P03AX 14.2 benzyl-benzoate 1 (1/2 strength) 50/100ml emulsionP03AX 14.2 benzyl-benzoate 1 BP 25% 100ml emulsion ASCABIOL
Xberactant: See total phospholipids
H02AB 19.5 betamethasone 4mg/ml I.V./I.M 1 injection CELESTONEPage 8 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
HO2AB 19.5 betamethasone 0,5mg 100 tabletsCELESTONE; BETANOID
D07AC 14.4betamethasone dipropionate
0,5mg/g 20g cream DIPROSONESpecialist dermatologist initiated
Cheapest category IV topical steroid on tender to be used. See Clobetasol
D07AC 14.4betamethasone dipropionate
0,5mg/g 20g ointment DIPROSONESpecialist dermatologist initiated
As above.
M01C 19.5Suppl List
120
betamethasone sodium phosphate + betamethasone acetate
3mg +3mg/ml 1ml
1 injectionCELESTONE SOLUSPAN
Specialist Opthalmology
D07AC 14.4 betamethasone valerate A 0,1% 15g cream BETNOVATECheapest grade III Steroid cream on tender to be used
D07AC 14.4 betamethasone valerate A 0,1% 500g cream LENOVATECheapest grade III Steroid cream on tender to be used
D07AC 14.4 betamethasone valerate A 0,1% 15g ointment BETNOVATECheapest grade III Steroid ointment on tender to be used
D07AC 14.4 betamethasone valerate A 0,1% 500g ointment PERSIVATECheapest grade III Steroid ointment on tender to be used
D07AC 14.4 betamethasone valerate 0,1% 20ml lotion CELESTODERM-VSpecialist dermatologist
Use for a maximum of 3 months at a time.
D05AX 14.4betamethasone + salicylic acid
0,5mg + 30mg/g 20g ointment DIPROSALICSpecialist dermatologist initiated
S01ED 15.6 betaxolol 2,5mg/ml 5ml eye drops BETOPTIC SSpecialist ophthalmology initiated
Only use cheapest beta-blocker ophthalmic solution of appropriate concentration available on tender.
L01DC 23Supp List 121/124
bevacizumab 100mg/4ml 4ml injection AVASTINSpecialist ophthalmologist
C10AB 7.7 Supp List 116 bezafibrate 400mg 30 retard tablet BEZALIPSpecialist physician initiated General
Specialist physician initiated General: ARV clinics only, according to Health Programmes' management algorithm.
S01EE 15.6 bimatoprost 0,03% 3ml eye drops LUMIGANSpecialist ophthalmologist initiated
Cheapest prostaglandin ophthalmic solution to be used. See lantanoprost - see RT280-2009MF
N04AA 1.7.2 biperiden A 5mg/ml 1 injection AKINETONA06AB 12.7 bisacodyl 10mg 10 suppository DULCOLAXA06AB 12.7 bisacodyl 5mg 200 tablet DULCOLAX; PERILAX
C05AX Øbismuth subnitrate & iodoform paste
BPC 100g pasteBISMUTH & IODOFORM PASTE
C05AX 12.10bismuth subgal. + bismuth oxide + zinc oxide
122,5mg + 8,75mg + 107,5mg
25g ointment ANUSOL
C05AX 12.10bismuth subgal. + bismuth oxide + zinc oxide
159mg + 24mg + 296mg
10 suppository ANUSOLPage 9 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
L01DC 23 bleomycin A P 15units/amp 1 injection BLENOXANE Specialist oncologyM03AX 15.7 botulinum toxin type A A 100iu 1 injection BOTOX Specialist Central hospitals only, not referable
S01EA 15.6 brimonidine tartrate 0,2% 1 eye drops ALPHAGANSpecialist ophthalmologist initiated
G02CB 19.8 bromocriptine A 2,5mg 30 tablet PARLODEL SpecialistG02CB 19.8 bromocriptine 5mg 100 capsule PARLODEL Specialist
A07EA 12.10 budesonide 0,02mg/ml7 tabs + 7 bott of vehicle
enema ENTOCORDSpecialist gastroenterologist
R03BA 10.4 budesonide 1 A P 100µg / inhal. 1 MDI complete INFLAMMIDE 100General Code, including Clinical Nurse Practitioners
R03BA 10.4 budesonide 1 A P 200µg / inhal. 1 MDI complete INFLAMMIDE 200 As above.N01BB 2.2 bupivacaine A P 5mg/ml 4ml 10 injection MACAINE SPINALN01BB 2.2 bupivacaine A P 5mg/ml 10ml 1 injection MACAINE; REGIBLOC
N01BB 2.2bupivacaine + adrenaline
5mg + 5µg/ml 20ml
10 injectionMACAINE 0,5% + EPINEPHRINE
Central hospitals only, not referable.
N01BB 2.2 bupivacaine + dextrose A P5mg + 72,7mg/ml 4ml
10 injectionMACAINE SPINAL + DEXTROSE
N02AE 3.4 Supp List 121buprenorphine + naloxone
2mg + 0,5mg 7sublingual tablets
SUBOXONESpecialist psychiatry
Stikland and GSH detoxification unit only
Supp List 121buprenorphine + naloxone
8mg + 0,5mg 7sublingual tablets
SUBOXONESpecialist psychiatry
Stikland and GSH detoxification unit only
L02AE 19.7 Supp List 119 buserelin 9,9mgdepot injection
SUPREFACTSpecialist Urologist and Oncologist
Cheapest similar tropic hormone on tender to be used As single dose for patients with prostatic carcinoma pending orchidectomy / radiotherapy
L01AB 23 busulphan A P 2mg 100 tablet MYLERAN Specialist
J06A Ø button spider antivenom 5ml injection
G02CB 19.8 cabergoline 0,5mg 2 tablet DOSTINEXSpecialist endocrinologist
Not referable.Second line treatment.
G02CB 19.8 cabergoline 0,5mg 4 tablet DOSTINEXSpecialist endocrinologist
Not referable.Second line treatment.
D04AX 31 calamine lotion 1 P BP 100ml lotion CALAMINE LOTIONcalciferol: see ergocalciferol
D05AX 14.5 Supp List 124calcipotriol & betamethasone diprop.
50µg/g 30g ointment DOVONEX
Specialist physician, dermatologist and rheumatologist initiated
D05AX 14.5 calcipotriol 50µg/g 30g cream DOVONEXSpecialist dermatologist
D05AX 14.5 calcipotriol 50µg/g 100g cream DOVONEXSpecialist dermatologistPage 10 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
D05AX 14.5 calcipotriol 50µg/g 30g ointment DOVONEXSpecialist dermatologist
D05AX 14.5 calcipotriol 50µg/g 100g ointment DOVONEXSpecialist dermatologist
H05BA 19.4 calcitonin 100iu/ml 5 injection MIACALCIC Specialist Central hospitals only, not referable.A11CC 20.1 calcitriol A 0,25µg 30 capsule ROCALTROL Specialist
A02AC 12.4calcium carbonate + glycine
A P 420mg + 180mg 300 tablet TITRALAC To be used for calcium supplementation.
A12A 20.2 calcium chloride A P 10% 10ml 1 injection CALCIUM CHLORIDEcalcium folinate: See folinic acid
A12A 20.2 calcium gluconate 1 A P 10% 10ml 1 injection CALCIUM GLUCONATE
L01BC 23 Supp List 121 capecitabine 150mg 60 tablet XELODASpecialist oncologists
Not referable.For colorectal and gastric cancer.
L01BC 23 Supp List 121 capecitabine 500mg 120 tablet XELODASpecialist oncologists
Not referable.For colorectal and gastric cancer.
J04A 18.8.1 capreomycin 1G 1 injection CAPASTAT Specialist As per XDR TB protocol
C09AA 7.3.8 captopril P 25mg 60 tablet CAPOTENSpecialist paediatrician
Only to be used for children under 13 years of age.
N03AF 1.6 carbamazepine 1 A P 100mg/5ml 250ml suspension TEGRETOL-SN03AF 1.6 carbamazepine 1 A P 200mg 56 tablet TEGRETOLN03AF 1.6 carbamazepine 1 A P 200mg 84 tablet TEGRETOLN03AF 1.6 carbamazepine A P 200mg 500 tablet TEGRETOLN04BA 1.7.1 carbidopa + levodopa A 25mg + 100mg 100 tablet SINEMET 25/100N04BA 1.7.1 carbidopa + levodopa 25mg + 250mg 100 tablet SINEMETH03BB 19.3 carbimazole A 5mg 100 tablet NEO-MERCAZOLE
L01DC 23 carboplatin 150mg 1 injection ABIC-CARBOPLATINSpecialist oncologist; haematologist
L01DC 23 carboplatin 450mg 1 injection ABIC-CARBOPLATINSpecialist oncologist; haematologist
L01AD 23 carmustine 100mg 1 injection BiCNUSpecialist oncologist
C07AG 7.3.4 carvedilol 12,5mg 30 tablet DILATREND; CARLOCSpecialist initiated - includes Family Physician initiated
For cardiac failure. NB! For Dosing Schedules refer to Annexure C of Suppl. List 105 (Circular H46/2006) & Addendum D of Suppl. List 106 (Circular H…/2006)
C07AG 7.3.4 carvedilol 25mg 30 tablet DILATREND; CARLOCSpecialist initiated - includes Family Physician initiated
For cardiac failure. NB! For Dosing Schedules refer to Annexure C of Suppl. List 105 (Circular H46/2006) & Addendum D of Suppl. List 106 (Circular H…/2006)
J01DA 18.1.2 cefamandole 1g 1 injection MANDOKEF SpecialistMotivation form to be completed or on mictobiologist report.
J01DA 18.1.2 cefazolin A P 500mg 1 injection KEFZOL; CEFACIDAL SpecialistMotivation form to be completed or on Microbiologist report. Cheapest 1st generation cephalosporin on tender to be used.Page 11 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J01DA 18.1.2 cefazolin 1g 1 injection CEFACIDAL Specialist As for 500mg injection.
J01DA 18.1.2 cefepime 500mg 1 injection MAXIPIME SpecialistOnly for severe nosocomial infections in ICU's & on a Microbiologist report.
JO1DA 18.1.2 cefixime 400mg 1 tablet FIXIMEGeneral code: per national and provincial STI protocol
J01DA 18.1.2 cefotaxime 500mg 1 injection CLAFORAN SpecialistMotivation form to be completed or on Microbiologist report. Exception in neonatology and meningitis
J01DA 18.1.2 cefotaxime A P 1g 1 injection CLAFORAN Specialist As above
J01DA 18.1.2 cefoxitin A P 1g 1 injection MEFOXIN SpecialistMotivation form to be completed or on Microbiologist report. Exception in surgical prophylaxis & in obstetrics & gynaecology.
J01DA 18.1.2 ceftazidime P 500mg 1 injection FORTUM SpecialistMotivation form to be completed or on Microbiologist report. For pseudomonas infections only.
J01DA 18.1.2 ceftazidime A P 1g 1 injection FORTUM Specialist As for 500mg injection.J01DA 18.1.2 ceftriaxone 1 P 250mg 1 injection ROCEPHIN
J01DA 18.1.2Suppl List 119/124
ceftriaxone 1 P 500mg 1 injection ROCEPHINGeneral Specialist
GENERAL: Meningitis and Neonatology At PHC level, administer as a single dose while awaiting transfer for: Diarrhoea, acute, in children; Dysentry: < 12 months; Septic miscarriage; Acute pyelonephritis; Septic Arthritis; Croup: epiglottitis; Severe pneumonia; Septicaemia in children; Severe malnuntrition; LAP (see 1° EDL pg. 207) SPECIALIST: For other conditions; motivation form to be completed or on micobiologist report Ceftriaxone injection 250mg is on general code
J01DA 18.1.2Suppl List 119/124
ceftriaxone1
A P1g 1 injection ROCEPHIN
General Specialist
GENERAL: Meningitis and Neonatology At PHC level, administer as a single dose while awaiting transfer for: Diarrhoea, acute, in children; Dysentry: < 12 months; Septic miscarriage; Acute pyelonephritis; Septic Arthritis; Croup: epiglottitis; Severe pneumonia; Septicaemia in children; Severe malnuntrition; LAP (see 1° EDL pg. 207) SPECIALIST: For other conditions; motivation form to be completed or on micobiologist report Ceftriaxone injection 250mg is on general code
J01DA 18.1.2 cefuroxime P 250mg 5 injection ZINACEF SpecialistMotivation form to be completed or on Microbiologist report.
J01DA 18.1.2 cefuroxime 750mg 1 injection ZINACEF Specialist As above
J01DA 18.1.2 cefuroxime P 125mg/ml 50ml suspension ZINACEFSpecialist paediatrician
For urinary tract infections
J01DA 18.1.2 cefuroxime P 125mg/ml 100ml suspension ZINACEFSpecialist paediatrician
For urinary tract infectionsPage 12 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J01DA 18.1.2 cefuroxime 250mg 10 tablet ZINNAT Specialist As above.J01DA 18.1.2 cefuroxime 500mg 10 tablet ZINNAT Specialist As above.
J01DA 18.1.2Suppl List
119cephalexin 125mg/5ml 100ml suspension
RANCEPH CPL-ALLIANCE CEPHALEXIN
Coded in interim i.p.o. Flucloxacillin syrup To be used where Flucloxacillin is indicated and Flucloxacillin capsules cannot be used
J01DA 18.1.2Suppl List
119cephalexin 250mg/5ml 100ml suspension
RANCEPH CPL-ALLIANCE CEPHALEXIN
Coded in interim i.p.o. Flucloxacillin syrup To be used where Flucloxacillin is indicated and Flucloxacillin capsules cannot be used
R06AE 6.1Suppl List 119/122
cetirizine di-HCl 1 10mg 30 tablet ZYRTECGeneral Clinical Nurse Practitioner
Clinical Nurse Pratitioner: Approved in line with EDL STG's
D08AJ Ø cetrimide conc. 40% 100ml solution CETAVLON
D08AJ 14.1cetrimide + chlorhexidine conc.
15% +1,5% 5 000ml solution SAVLON
D02AC 14.8 cetomacrogol 500g creamCETOMACROGOL CREAM B.P.
D02AC 14.8 cetomacrogol 500g ointmentCETOMACROGOL EMULSIFYING OINTMENT B.P.
A01AB 11.3cetylpyridinium Cl + benzocaine + dibucaine + benzyl alcohol
3,713mg + 30mg +5mg + 60mg
100ml solution CEPACAINE Specialist Oncology patients only
X 31 charcoal, activated 1 A P 25g powderL01AA 23 chlorambucil A 2mg 25 tablet LEUKERAN Specialist
J01BA 18.4.2 chloramphenicol A P 250mg 100 capsuleCHLOROMYCETIN; FENICOL
S01AA 15.1 chloramphenicol A P 0,5% 5ml eye dropsCHLOROMYCETIN REDIDROPS
S01AA 15.1 chloramphenicol1
A P1% 3,5g eye ointment
CHLOROMYCETIN; CHLORAMEX
J01BA 18.4.2 chloramphenicol 1 A P 1g 1 injectionCHLOROMYCETIN; CHLORPHEN
S01CA 15.3chloramphenicol + dexamethasone
P 0,5% + 0,1% 5ml eye drops SPERSADEX CO.Specialist ophthalmologist
D08AC Ø chlorhexidine0,5% 100 x 100mm
10 tulle BACTIGRAS
D08AC Ø chlorhexidine0,5% 100 x 400mm
10 tulle BACTIGRAS
D08AC 14.1chlorhexidine antiseptic cream
A 1% 50g creamHIBITANE ANTISEPTIC CREAM
D08AC 14.1 chlorhexidine obstetric 1% 100ml cream HIBITANED08AC 14.1 chlorhexidine 20% 500ml liquid HIBITANE CONC. Colourless liquid.D08AC 14.1 chlorhexidine gluc. 1 A P 0,05% 50ml solution HIBIDILD08AC 14.1 chlorhexidine gluc. 1 A P 0,05% 100ml solution HIBIDIL
D08AC 14.1chlorhexidine gluc. in 70 % alcohol
0,5% 500ml solution D-GERM
Page 13 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
D08AC 14.1chlorhexidine gluc.0,5% in 70 % alcohol
0,5% 5 000ml solution D-GERM
D08AC 14.1 Supp List 124chlorhexidine gluc.0,5% in 70 % alcohol - skin disinfectant
0,5% 500ml solution BIOTANE
D08AC 14.1 Supp List 124chlorhexidine gluc.0,5% in 70 % alcohol - skin disinfectant
0,5% 5 000ml solution BIOTANE
D08AC 14.1chlorhexidine gluc. surgical scrub
4% 500ml solution HIBISCRUB; BIOSCRUB
D08AC 14.1chlorhexidine gluc. surgical scrub
4% 5 000ml solution HIBISCRUB; BIOSCRUB
D08AC 14.1chlorhexidine gluc. surgical scrub
4% 20 000ml solution HIBISCRUB; BIOSCRUB
D08AC 14.1 chlorhexidine conc. 1 5% 5 000ml solution HIBITANEP01BA 18.11 chloroquine phosphate 250mg 100 tablet ANOCLORP01BA 18.11 chloroquine sulphate 1 P 68mg/5ml 100ml syrup NIVAQUINEP01BA 18.11 chloroquine sulphate 1 A P 150mg base 100 tablet NIVAQUINER06AB 6.1 chlorpheniramine 1 2mg/5ml 50ml syrup ALLERGEX CNP may prescribe. For atopic eczema & rhinitisR06AB 6.1 chlorpheniramine 1 2mg/5ml 100ml syrup ALLERGEX CNP may prescribe. For atopic eczema & rhinitisR06AB 6.1 chlorpheniramine 1 A 4 mg 20 tablet ALLERGEX
R06AB 6.1 chlorpheniramine 1 A 4 mg 100 tabletCHLOR-TRIMETON; ALLERGEX
R06AB 6.1 chlorpheniramine A 4 mg 1 000 tabletCHLOR-TRIMETON; ALLERGEX
R06AB 6.1 chlorpheniramine 8 mg 100 tabletCHLOR-TRIMETON REPETABS
R01BA 10.1.3chlorpheniramine + phenylephrine
P 1,25mg + 2,5mg/5ml 50ml syrup DEMAZINSpecialist paediatrician
Only for children up to 5 years old. For blocked nose only. Twice a day dose. Maximum 50ml per prescription.
N05AA 1.5.1 chlorpromazine P 50mg/2ml 1 injection LARGACTILN05AA 1.5.1 chlorpromazine P 25mg/5ml 100ml syrup LARGACTILN05AA 1.5.1 chlorpromazine 1 25mg 28 tablet LARGACTILN05AA 1.5.1 chlorpromazine 25mg 500 tablet LARGACTILN05AA 1.5.1 chlorpromazine 50mg 28 tablet LARGACTILN05AA 1.5.1 chlorpromazine 50mg 50 tablet LARGACTILN05AA 1.5.1 chlorpromazine 50mg 56 tablet LARGACTILN05AA 1.5.1 chlorpromazine 50mg 500 tablet LARGACTILN05AA 1.5.1 chlorpromazine 1 100mg 28 tablet LARGACTILN05AA 1.5.1 chlorpromazine 1 100mg 56 tablet LARGACTILN05AA 1.5.1 chlorpromazine 1 100mg 84 tablet LARGACTILN05AA 1.5.1 chlorpromazine 1 100mg 112 tablet LARGACTILN05AA 1.5.1 chlorpromazine 100mg 500 tablet LARGACTIL
Page 14 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
B04AD 7.7.4 Supp List 121 cholestyramine P 4g 4g sachet powder QUESTRAN
General
Specialist initiated
General: Paediatric use in diarrhoea management
Specialist initiated: Lipid clinics
N02BA 11.3choline salicylate + cetalkonium
8,7% + 0,01% 5g gel TEEJEL
G03GA 19.7 chorionic gonadotropin 1 500u 3 injection PROFASI Specialist Central hospitals only, not referable.G03GA 19.7 chorionic gonadotropin 5 000u 1 injection PROFASI; PREGNYL Specialist As above.
L04AA 24.1 ciclosporin 25mg 50 capsule SANDIMMUN NEORALSpecialist.Not referable.
i) Prescribe only post transplant at academic institutions.ii) Dispense only at academic institutions for patients resident in the metropole.iii) Dispense at non-academic institutions for patients in the rural regions - arrange access to stock with referring Institution
L04AA 24.1 ciclosporin 100mg 50 capsule SANDIMMUN NEORALSpecialistAs above
As above
L04AA 24.1 ciclosporin 250mg/5ml 10 injection SANDIMMUN SpecialistAs above
As above
L04AA 24.1 ciclosporin 100mg/ml 50ml oral solution SANDIMMUN NEORALSpecialistAs above
As above
A02BA 12.4.2Suupl List 119
cimetidine 200mg/2ml 1 injection TAGAMET For inpatient use only
A02BA 12.4.2 cimetidine 200mg/5ml 200ml syrup TAGAMET Specialist
N07CA 1.8 cinnarizine 25mg 100 tabletSTUGERON; ANTIMET; PURAZINE
S01AX 15.1ciprofloxacin/ofloxacin ophthalmic anti-infectives
3mg/ml 5ml eye drops CILOXAN; EXOCINSpecialist ophthalmologist, ENT
Cheapest floroquinolone on tender to be used.
J01MA 18.7 ciprofloxacin A P 2mg/ml 50ml injection CIPROBAY SpecialistMotivation form to be completed or on a Microbiologist report. See also under OFLOXACIN.
J01MA 18.7 ciprofloxacin A P 2mg/ml 100ml injection CIPROBAY Specialist As aboveJ01MA 18.7 Supp List 119 ciprofloxacin 1 250mg 10 tablet CIPROBAY NOT FOR MDR-TB. J01MA 18.7 Supp List 119 ciprofloxacin 1 A 500mg 10 tablet CIPROBAY NOT FOR MDR-TB.
Page 15 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J01MA 18.7 ciprofloxacin A 750mg 10 tablet CIPROBAY Specialist
Specialist: NOT FOR MDR-TB. Motivation form to be completed or on a Microbiologist report. Cheapest appropriate fluoroquinolone on tender to be bought. See also under OFLOXACIN.
L01XA 23 cisplatin A P 10mg/vial 1 injectionPLATAMINE; ABIPLATIN
Specialist oncologist
L01XA 23 cisplatin A P 25mg/vial 1 injection PLATAMINESpecialist oncologist
L01XA 23 cisplatin A P 50mg/vial 1 injection PLATAMINESpecialist oncologist
N06AB 1.4.4 citalopram 20mg 28 tablet CILIFTSpecialist psychiatrist initiated
A09AB 31 citric acid monohydrate BP 500g powder
J01FA 18.2 clarithromycin 500mg 1 injection KLACID Specialist
1. For use in High Care and ICU's on a Microbiologist report.2. On a patIent name basis in tertiary hospitals for MOTT (Mycobacterium other than tuberculosis).3. As second line agent for specialists to eradicate H. pylori. Refer to: Circular H95/2005 (Addendum B - Suppl. List 102)
J01FA 18.2 clarithromycin 500mg 14 tablet KLACID Specialist As above.
J01FF 18.7 clindamycin A P 150mg 100 capsule DALACIN-C SpecialistMotivation form to be completed or on a microbiologist report.
J01FF 18.7 clindamycin A P 600mg 1 injection DALACIN-C; CLINIDAC Specialist As above.
N05BA 1.3.1 Supp List 118 clobazam 5mg 100 capsule URBANOLSpecialist neurologist Not referable
Central hospitals - not referable. As add on therapy for epilepsy Logistical issues to be managed in the interest of patient care
N05BA 1.3.1 Supp List 118 clobazam 10mg 100 tablet URBANOLSpecialist neurologist Not referable
Central hospitals - not referable. As add on therapy for epilepsy Logistical issues to be managed in the interest of patient care
D07AD 14.4 clobetasol propionate 0,05% 25g cream DERMOVATE; DOVATESpecialist dermatologist initiated
Cheapest category IV topical steroid on tender to be used. See betamethasone dipropionate
D07AD 14.4 clobetasol propionate 0,05% 25g ointment DERMOVATE; DOVATESpecialist dermatologist initiated
As above.Page 16 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J04BA 18.6.2 clofazimine 50mg 100 capsule LAMPRENE Specialist
J04BA 18.6.2 clofazimine A 100mg 100 capsule LAMPRENESpecialistGeneral - only for MDR TB
G03GB 19.7 clomiphene A 50mg 5 tablet CLOMIDSpecialist gynaecologist
N06AA 1.4.1 clomipramine 10mg 100 tablet ANAFRANILSpecialist psychiatrist & neurologist initiated
N06AA 1.4.1 clomipramine A 25mg 100 tablet ANAFRANILSpecialist psychiatrist & neurologist initiated
N03AE 1.6 clonazepam P 1mg/ml 5 injection RIVOTRILSee guidelines for the treatment of convulsive status epilepticus in paeds: Suppl. List 106 Addendum A
N03AE 1.6 clonazepam P 2,5mg/ml 10ml oral drops RIVOTRIL
Specialist psychiatrist, nuerologist & paediatricians
See guidelines for the use of benzodiazepines: Circular H24/2006. (Addendum I: Suppl List 107). Specialist psychiatrist, neurologist & paediatrician initiated in epilepsy.
N03AE 1.6 clonazepam A 0,5mg 90 tablet RIVOTRIL
Specialist psychiatrist, nuerologist & paediatricians
As above.
N03AE 1.6 clonazepam A 2mg 90 tablet RIVOTRIL
Specialist psychiatrist, nuerologist & paediatricians
As above.
C02AC 1.9 clonidine P 0,025mg 100 tablet DIXARIT; MENOGRAINE
B01AC 8.4 Supp List 120 clopidogrel 75mg 28 tablet PLAVIX
Specialist physician initiated Specialist cardiologist
Specialist physician, cardiologist initiated: Life long use in patients with aspirin intolerance Specialist cardiologist: - other indications: 1. Drug eluting stents: Treatment duration - maximum 6 months post stent treatment 2.Metal stents: treatment duration - 4 weeks post stent treatment
N05AX 1.5.3 clothiapine 40mg/4ml 1 injection ETOMINEG01AF 14.3 clotrimazole 1 P 1% 20g cream XERASPOR T Use cheapest imidazole on tender.G01AF 17.2 clotrimazole P 1% 50g vag. cream CLOSCRIPT Use cheapest imidazole on tender.G01AF 17.2 clotrimazole 1 500mg 1 vaginal tablet CANESTEN 1J01CF 18.1.1 cloxacillin A P 250mg 1 injection ORBENINJ01CF 18.1.1 cloxacillin A P 500mg 1 injection ORBENIN; CLOXIN
N05AH 1.5.3 clozapine 25mg 100 tablet LEPONEXSpecialist psychiatrist & neurologist initiated
Psychiatrists and neurologists - for dose titration only. Policy for the use of Clozapine: Circular H117/1997 (Annexure F - Suppl. List 78.)
Page 17 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
N05AH 1.5.3 clozapine 100mg 28 tablet LEPONEXSpecialist psychiatrist & neurologist initiated
As for other pack sizes.Policy for the use of Clozapine: Circular H117/1997 (Annexure F - Suppl. List 78)
N05AH 1.5.3 clozapine 100mg 56 tablet LEPONEXSpecialist psychiatrist & neurologist initiated
As for other pack sizes.Policy for the use of Clozapine: Circular H117/1997 (Annexure F - Suppl. List 78)
N05AH 1.5.3 clozapine 100mg 100 tablet LEPONEXSpecialist psychiatrist & neurologist initiated
Psychiatrists and neurologists.Policy for the use of Clozapine: Circular H117/1997 (Annexure F - Suppl. List 78)
J01CR 18.1.1 Supp List 124 co-amoxiclav 0,6 g 1 injection AUGMENTIN, SANDOZ CO-AMOXYCLAV
SpecialistSpecialist microbiologist report or motivation form to be completed
J01CR 18.1.1 Supp List 124 co-amoxiclav 1,2g 1 injection AUGMENTIN, SANDOZ CO-AMOXYCLAV
SpecialistSpecialist microbiologist report or motivation form to be completed
J01CR 18.1.1Suppl List 119
co-amoxiclav 1 P125mg + 31,25mg/5ml
100ml suspension AUGMENTIN
General
Specialist
GENERAL CODE: - Pneumonia in adults with underlying medical conditions (1 ° EDL pg 287) - Pneumonia: patients > 65 years of age - Complicated cystitis in pregnancy and children as per EDL - Uncomplicated lower UTI in adult females only if stat dose of fluoroquinolone has been unsatisfactory - Complicated UTI in adults - Inpatients in place of IVI - Animal and human bites - Diabetic foot SPECIALIST: Other conditions
J01CR 18.1.1Suppl List 119
co-amoxiclav 1 P 250mg + 62,5mg/5ml 100ml suspension AUGMENTIN
General
Specialist
GENERAL CODE: - Pneumonia in adults with underlying medical conditions (1 ° EDL pg 287) - Pneumonia: patients > 65 years of age - Complicated cystitis in pregnancy and children as per EDL - Uncomplicated lower UTI in adult females only if stat dose of fluoroquinolone has been unsatisfactory - Complicated UTI in adults - Inpatients in place of IVI - Animal and human bites - Diabetic foot SPECIALIST: Other conditions
Page 18 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J01CR 18.1.1Suppl List 119
co-amoxiclav1 P
A250mg + 125mg 15 tablet AUGMENTIN
General
Specialist
GENERAL CODE: - Pneumonia in adults with underlying medical conditions (1 ° EDL pg 287) - Pneumonia: patients > 65 years of age - Complicated cystitis in pregnancy and children as per EDL - Uncomplicated lower UTI in adult females only if stat dose of fluoroquinolone has been unsatisfactory - Complicated UTI in adults - Inpatients in place of IVI - Animal and human bites - Diabetic foot SPECIALIST: Other conditions
J01CR 18.1.1Suppl List 119
co-amoxiclav1 P
A250mg + 125mg 100 tablet AUGMENTIN
General
Specialist
GENERAL CODE: - Pneumonia in adults with underlying medical conditions (1 ° EDL pg 287) - Pneumonia: patients > 65 years of age - Complicated cystitis in pregnancy and children as per EDL - Uncomplicated lower UTI in adult females only if stat dose of fluoroquinolone has been unsatisfactory - Complicated UTI in adults - Inpatients in place of IVI - Animal and human bites - Diabetic foot SPECIALIST: Other conditions
J01CR 18.1.1Suppl List 120
co-amoxiclav1 P
A875mg + 125mg 10 tablet
AUGMENTIN; AURO-AMOXICLAV
General
Specialist
GENERAL CODE: - Pneumonia in adults with underlying medical conditions (1 ° EDL pg 287) - Pneumonia: patients > 65 years of age - Complicated cystitis in pregnancy and children as per EDL - Uncomplicated lower UTI in adult females only if stat dose of fluoroquinolone has been unsatisfactory - Complicated UTI in adults - Inpatients in place of IVI - Animal and human bites - Diabetic foot SPECIALIST: Other conditions
N01BC Ø cocaine HCl BP 25g powder ENT only.
R05DA 3.1 Supp List 118 codeine phosphate1P
25mg/5ml 500ml syrup CODEINE PHOSPHATEFor hospital use only (in or out-patients) For use in pain as per EDL and IMCI guidelines
R05DA 3.1 Supp List 116 codeine phosphate1P
30mg 100 tablet CODEINE PHOSPHATE Specialist initiated Oncology and GIT clinic initiated
L01XX 23 colaspase A P 10 000u 1 injection LASPARSpecialist oncologist
Page 19 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
M04AC 4.23711048 Supp List 113
colchicine 1 A 0,5mg 50 tablet COLCHICINE
For chronic gout: 0,5mg twice a day for 3 months (up to max of 6 months) For acute attacks: Maximum of 10 tablets of 0.5mg to be prescribed per acute attack with no repeats per prescription
D03 14.9collagenase clostridiopeptidase A + peptidases
1,2units/g +0,24units/g
30g ointment IRUXOL MONO Central HospitalsPatient name basis.Not referable.
J01EE 18.6 co-trimoxazole I.V. 480mg/5ml 1 injection BACTRIMIntra-venous form only to be used if oral form can not be taken.
J01EE 18.6 co-trimoxazole 1 P 240mg/5ml 50ml syrup BACTRIMJ01EE 18.6 co-trimoxazole 1 P 240mg/5ml 100ml syrup BACTRIMJ01EE 18.6 co-trimoxazole 1 A P 480mg 20 tablet BACTRIM; TRIMOKSJ01EE 18.6 co-trimoxazole 1 A P 480mg 56 tablet BACTRIM; TRIMOKS
J01EE 18.6 co-trimoxazole A P 480mg 1 000 tabletTRIMETHOX; MEZENOL; PURBAC
cromoglycate: See sodium cromoglyc…
R06AE 1.8 cyclizine 50mg/ml 1 injection VALOID, TRIAZINE Radiotherapy only.R06AE 1.8 cyclizine 50mg 10 tablet VALOID; NAUZINE Radiotherapy only.
S01FA 15.5 cyclopentolate 1% 15ml eye drops CYCLOGYLSpecialist ophthalmology initiated
S01FA 15.5 cyclopentolate 1%0,5ml x 10 (20)
minimsMINIMS CYCLOPENTOLATE
Specialist ophthalmology initiated
S01FA 15.5cyclopentolate + phenylephrine
A 2mg +10mg/ml 5ml eye drops CYCLOMYDRILSpecialist ophthalmology initiated
L01AA 23 cyclophosphamide A P 200mg 10 injection ENDOXAN
Specialist physicians, oncologists and paediatricians
L01AA 23 cyclophosphamide A P 500mg 1 injection ENDOXAN
Specialist physicians, oncologists and paediatricians
L01AA 23 cyclophosphamide A P 1g 5 injection ENDOXAN
Specialist physicians, oncologists and paediatricians
L01AA 23 cyclophosphamide A P 50mg 50 tablet ENDOXAN
Specialist physicians, oncologists and paediatricians
Page 20 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
L01AA 23 cyclophosphamide A P 50mg 250 tabletENDOXAN; CYCLOBLASTIN
Specialist physicians, oncologists and paediatricians
J04AB cycloserine Available from Eli Lilly
MDR patients only, treatment to be initiated in consultation with Brookland Chest hospital
G03HA 19.8 Supp List 114 cyproterone acetate 300mg/3mL 1injection, depot
ANDROCURSpecialist: Psychiatrist APH only
Patient Named Basis Non-Referable
G03HB 14.6cyproterone + ethinyl estradiol
2mg + 0,035mg 28 tablet DIANE-35
Specialist endocrinologist, dermatologist & gynaecologist
L01BC 23 cytarabine A P 100mg 1 injection CYTOSARSpecialist oncologist
L01BC 23 cytarabine A P 500mg 1 injection CYTOSARSpecialist oncologist
X Ø cytological fixative 100g spray
L01AX 23 dacarbazine P 100mg 1 injection D.T.I.C.Specialist oncologist
L01AX 23 dacarbazine P 200mg 1 injection D.T.I.C.Specialist oncologist
L01DA 23 dactinomycin P 0,5mg/3ml 1 injection COSMEGENSpecialist oncologist
B01AB 8.2 dalteparin 5 000iu/0,2ml 1injection: pre-filled syringe
FRAGMIN SpecialistTo be used according to Addendum A: Coding Status protocol for LMWH; Supp List 116
G03XA 19.8 danazol 100mg 60 tablet LADAZOL; LADOGAR Specialist Central hospitals only, not referable.G03XA 19.8 danazol 200mg 60 tablet LADOGAR Specialist As above.
M03CA 2.3 dantroline A P 20mg 1 injection DANTRIUMFor use in malignant hyperthermia only. Contact Regional Chief Pharmacist to ascertain where stocks are kept.
J04BA 18.8.2 dapsone A 100mg 100 tabletLENNON-DAPSONE; MALOPRIM
L01DB 23 daunorubicin A 20mg 1 injection CERUBIDINSpecialist oncologist
V03AC 25 Supp List 120 deferasirox 125mg 28dispersible tablet
EXJADESpecialist paediatrician Non-referable
Patient named basis For treatment of Thalassaemia in paediatrics Paediatric patients initiated on deferasirox may continue treatment when handed to an adult Central hospital
Page 21 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
V03AC 25 Supp List 120 deferasirox 250mg 28dispersible tablet
EXJADESpecialist paediatrician Non-referable
Patient named basis For treatment of Thalassaemia in paediatrics Paediatric patients initiated on deferasirox may continue treatment when handed to an adult Central hospital
V03AC 25 Supp List 120 deferasirox 500mg 28dispersible tablet
EXJADESpecialist paediatrician Non-referable
Patient named basis For treatment of Thalassaemia in paediatrics Paediatric patients initiated on deferasirox may continue treatment when handed to an adult Central hospital
V03AC 25 desferrioxamine A P 500mg 1 injection DESFERAL Store below 15 degree Celsius.
H01BA8.116.2
desmopressin A P 100µg/ml 2,5mlintranasal solution
DDAVP
Specialist haematologist, endocrinologist & neurosurgeons initiated
H01BA8.116.2
desmopressin A P100µg/ml10µg/spray
5mlintranasal spray
DDAVP
Specialist haematologist, endocrinologist & neurosurgeons initiated
H01BA8.116.2
Supp List 119 desmopressin A P 100µg 30 tablet DDAVP
Specialist haematologist, endocrinologist & neurosurgeons initiated
NOT INTERCHANGEABLE with Desmopressin 200mcg
H01BA8.116.2
Supp List 119 desmopressin A P 200µg 30 tablet DDAVP
Specialist haematologist, endocrinologist & neurosurgeons initiated
NOT INTERCHANGEABLE with Desmopressin 100mcg
H01BA8.116.2
desmopressin A P 4mcg/ml 1ml injection DDAVP
Specialist haematologist, endocrinologist & neurosurgeons
G03AA 17.1.1ex family planning stores
desogestrel + ethinyl oestradiol
0,15mg +0,03mg
28 tablet MARVELON 150/30 Family Planning
Available at Groote Schuur & Tygerberg Hospital Family Planning clinics only. Refer patients to these clinics if unacceptable side effects persist on oral contraceptives.
S01BA 15.2 dexamethasone A 0.1% solution 5ml eye dropsSPERSADEXMAXIDEX
Specialist ophthalmologist initiated
H02AB 19.5 dexamethasone A P 4mg/ml 1 injection DECASONE
S01XA 15.7 Supp List 118dextran 70 + hydroxypropyl methylcellulose
0,3% 15ml eye drops TEARS NATURALE II Specialist initiated
V03AH 22 dextrose 1 50% 20ml 1 injectionV03AH 22 dextrose 50% 50ml 1 injectionPage 22 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
V04CA Ø dextrose monohydrate BP 75g powderV04CA 31 dextrose monohydrate BP 50g powder For glucose tolerance test.V04CA 31 dextrose monohydrate BP 500g powder
B05ZA Ødialysis solution for haemodialysis with low magnesium
concentrate 5 000ml solutionSABAX DIASOLFORMULA 16 - AFM 1045
B05DB Ødialysis solution for peritoneal dialysis+ dextrosr 1,5%
1,5%2 000ml in 2 000ml bag
solutionSABAX DIANEAL 1,5AFB 9856
B05DB Ødialysis solution for peritoneal dialysis + dextrose 2,5%
2,5%2 000ml in 2 000ml bag
solutionSABAX DIANEAL 2,5AFB 9876
B05DB Ødialysis solution for peritoneal dialysis+ dextrosr 4,25%
4,25%2 000ml in 2 000ml bag
solutionSABAX DIANEAL 4,25AFB 9792
N05BA 1.3.1 diazepam 1 A P 10mg/2ml 1 injection VALIUM, PAX
N05BA 1.3.1 diazepam A 2mg 14 tablet VALIUM, PAX
No more than 14 days supply, unless when prescribed by a psychiatrist, neurologist or paediatrician, when 28 days supply may be dispensed. See circular H24/2006; Suppl List 107 - addendum I
N05BA 1.3.1 diazepam A 2mg 500 tablet VALIUM; PAX; DIAQUEL As above.
N05BA 1.3.1 diazepam A 5mg 14 tablet VALIUM, PAX
No more than 14 days supply, unless when prescribed by a psychiatrist, neurologist or paediatrician, when 28 days supply may be dispensed. See circular H24/2006; Suppl List 107 - addendum I
N05BA 1.3.1 diazepam A 5mg 28 tablet VALIUM; PAX
No more than 14 days supply, unless when prescribed by a psychiatrist, neurologist or paediatrician, when 28 days supply may be dispensed. See circular H24/2006; Suppl List 107 - addendum I
N05BA 1.3.1 diazepam A 5mg 56 tablet VALIUM; PAX
No more than 14 days supply, unless when prescribed by a psychiatrist, neurologist or paediatrician, when 28 days supply may be dispensed. See circular H24/2006; Suppl List 107 - addendum I
N05BA 1.3.1 diazepam A 5mg 500 tablet VALIUM, PAX
No more than 14 days supply, unless when prescribed by a psychiatrist, neurologist or paediatrician, when 28 days supply may be dispensed. See circular H24/2006; Suppl List 107 - addendum I
N05BA 1.3.1 diazepam 10mg 90 tablet VALIUM, PAX As above.C02DA 7.3.1 diazoxide P 300mg/20ml 1 injection HYPERSTAT SpecialistM01AB 4.1 diclophenac 75mg/3ml 1 injection VOLTAREN; PANAMOR Specialist To be given as a single dose only.M01AB 4.1 diclophenac 12,5mg 5 suppository VOLTAREN Single dose peri / post operative in paediatricsM01AB 4.1 diclophenac P 25mg 5 suppository VOLTAREN Single dose peri / post operative in paediatricsPage 23 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
M01AB 4.1 Supp List 119 diclophenac 25mg 84 tablet VOLTAREN, PANAMOR
FOR ACUTE CONDITIONS: Not more than 5 days supply. Not repeatable For longer periods, the appropriate diagnosis and quantities to be written on the prescription
M01AB 4.1 Supp List 119 diclophenac 25mg 100 tablet VOLTAREN, PANAMOR
FOR ACUTE CONDITIONS: Not more than 5 days supply. Not repeatable For longer periods, the appropriate diagnosis and quantities to be written on the prescription
M01AB 4.1 Supp List 119 diclophenac 25mg 500 tabletVOLTAREN; PANAMOR; DIFENAC
FOR ACUTE CONDITIONS: Not more than 5 days supply. Not repeatable For longer periods, the appropriate diagnosis and quantities to be written on the prescription
J05AB 18.12pgwcARV depot
didanosine 1 25mg 60 tablet VIDEX AIDS programmeAvailable through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.
J05AB 18.12pgwcARV depot
didanosine 1 50mg 61 tablet VIDEX AIDS programme As above.
J05AB 18.12pgwcARV depot
didanosine 1 100mg 62 tablet VIDEX AIDS programme As above.
J05AB 18.12pgwcARV depot
didanosine 1 150mg 63 tablet VIDEX AIDS programme As above.
C01AA 7.1.1 digoxin P 0,05mg/ml 50mlelixir-paed/geriatr
LANOXIN
C01AA 7.1.1 digoxin A P 0,5mg/2ml 1 injection LANOXIN Specialist For use in ICU's
C01AA 7.1.1 digoxin 0,0625mg 100tablet-paed/geriatr
LANOXIN
C01AA 7.1.1 digoxin 1 A 0,25mg 14 tablet LANOXINC01AA 7.1.1 digoxin 1 A 0,25mg 28 tablet LANOXINC01AA 7.1.1 digoxin A 0,25mg 500 tablet LANOXIN; PURGOXINC02DB 7.3.1 dihydralazine 1 A P 25mg 1 injection NEPRESOLN02AA 3.1 dihydrocodeine 50mg/ml 5 injection DF-118 Specialist Neurology & Radiotherapy only.
G02AD 17.3 dinoprostone 0,5mg/3g 1 gel PREPIDILUse to be controlled in restricted substances register.
G02AD 17.3 dinoprostone 1mg/3g 1 gel PRANDIN E2Use to be controlled in restricted substances register.
G02AD 17.3 dinoprostone 5mg/ml 1 injection PROSTIN F2, ALPHASpecialist gynaecologist
G02AD 17.3 dinoprostoneAP
0,5mg 10 tablet PROSTIN E2 Specialist
In-hospital emergency use only. For off-label Neonatal use in Suspected Congenital Cyanotic heart disease.NOT FOR INDUCTION OF LABOUR
M05BA 4.7.1 Supp List 118 disodium pamidronate 15mg 1 injection AREDIASpecialist Specialist oncologist
For treatment of Hypercalcaemia - refer to Suppl List 118: Addendum A
C01BA 7.2 disopyramide 150mg 100 capsule NORPACE Specialist Central hospitals only, not referable.Page 24 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
V03AA 9 disulfiram A 400mg 50 tablet ANTABUSEAdequate maintenance dose 200mg (1/2 tablet) daily or 400mg (1 tablet)on alternate days.
D05AC ‡dithranol in lygal's base (salicylic acid 3% + sulphur 5%)
1% 200g ointmentSpecialist dermatologist
Not referable
D05AC ‡dithranol in lygal's base (salicylic acid 3% + sulphur 5%)
2% 200g ointmentSpecialist dermatologist
Not referable
D05AC ‡dithranol + salicylic acid in white soft paraffin
1% + 5% 200g ointmentSpecialist dermatologist
Not referable
D05AC ‡dithranol + salicylic acid in white soft paraffin
2% + 5% 200g ointmentSpecialist dermatologist
Not referable
D05AC ‡dithranol + salicylic acid in white soft paraffin
3% + 5% 200g ointmentSpecialist dermatologist
Not referable
C01CA 7.1.2 dobutamine A P 250mg/20ml 1 injection DOBUTREX Specialist For use in cardiac, respiratory & cardio-thoracic ICU's & theatres.
A03FA 1.8 domperidone 1mg/ml 100ml suspension MOTILIUMSpecialist paediatrician
A03FA 1.83714233 Supp List 113
domperidone 10mg 100 tablet MOTILIUMSpecialist initiated Specialist neurologist initiated
Specialist initiated: For use in GIT clinics only and intolerance to metoclopramide. Specialist neurologist initiated: For prevention of dopaminergic side effects
C01CA 7.1.2 dopamine HCl A P 200mg/5ml 1 injectionINTROPIN; DYNOS FOR INFUSION
C02CA 7.3.2Supp List 120/123
doxazosin A P 4mg 30 tablet CARDURA XL
Specialist physician, paediatrician & nephrologist
Specialist physician, paediatrician & nephrologist initiated: For hypertension as 4th line treatment up to max of 8mg daily
X 1.1.2 doxapram 20mg/ml 20ml 1 injection DOPRAM SpecialistFor use in paediatric intensive care and neonatal units
L01DB 23 doxorubicin A P 10mg 1 injection ADRIBLASTINASpecialist oncologist
L01DB 23 doxorubicin A P 50mg 1 injection ADRIBLASTINASpecialist oncologist
J01AA 18.4.1 doxycycline 1 A P 100mg 6 capsule VIBRAMYCIN
J01AA 18.4.1 doxycycline 1 A P 100mg 10 capsuleVIBRAMYCIN; DOXYCLIN
J01AA 18.4.1 doxycycline 1 A P 100mg 14 capsule DOXYCLINJ01AA 18.4.1 doxycycline A P 100mg 100 capsule VIBRAMYCINN01AX 2.1.2 droperidol A 5mg/2ml 1 injection INAPSIN; PAXICALG03DB 19.6.3 dydrogesterone 10mg 30 tablet DUPHASTON Specialist Central hospitals only, not referable.
G01AF 17.2 econazole 150mg 3 ovules GYNO-PEVARYL SpecialistCheapest appropriate imidazole preparation on tender to be used
Page 25 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
D01AC 14.3 econazole 1g/100g 3x10ml foaming soln. PEVARYL Specialist Central hospitals only, not referable.
J05AG 18.12pgwcARV depot Supp List 124
efavirenz 1 50mg 30 capsule STOCRIN
General code: AIDS programme CNP / Professional nurse
General code: AIDS programme: Available through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols. CNP / Professional nurse: Available through HIV / AIDS programme: For first line treatment of adult AIDS patients as per HIV / AIDS guidelines 2010 for treating AIDS patients and per Circular H30/2011: Authorisation of Nurse Prescribing for Antiretroviral Treatment
J05AG 19.12pgwcARV depot Supp List 124
efavirenz 1 200mg 30 capsule STOCRIN
General code: AIDS programme CNP / Professional nurse
As above.
J05AG 20.12pgwcARV depot Supp List 124
efavirenz 1 600mg 90 capsule STOCRIN
General code: AIDS programme CNP / Professional nurse
As above.
electrolyte & glucose powder for oral rehydration: See sodium chloride + KCl…
emtracitabine / tenofovir: please refer to tenofovir disoproxil fumerate / emtracitabine…
D02AC 31 emulsifying ointment 1 BP 500g ointment EMULSIFYING OINT.X 31 emulsifying wax BP 25kg wax EMULSIFYING WAX
C09AA 7.3.8 Supp List 122 enalapril 1 A P 2,5mg 28 tablet RENITEC
Cheapest ACE inhibitor on tender to be used.For hypertension & cardiac failure: 20mg maximum daily dose.For proteinuria: 40mg maximum daily dose.
C09AA 7.3.8 enalapril 1 A P 5mg 28 tablet RENITEC As aboveC09AA 7.3.8 enalapril 1 A 10mg 28 tablet PHARMAPRESS As aboveC09AA 7.3.8 enalapril 1 A 20mg 28 tablet PHARMAPRESS As above
N01AB 2.1.1 enflurane 250mlinhalation liquid
ETHRANESpecialist aneasthetist
B01AB 8.2 Supp List 124 enoxaparin 40mg/0,4mL 1injection: pre-filled syringe
CLEXANE
Coding Status protocol for use of LMWH per Supp List 116 Addendum A is repealed and replaced by: - General code for indications as stated in the LMWH policy: Supp List 124 Addendum A: Coding Status protocol for use of LMWH Prescription must be endorsed with the diagnosis
Page 26 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
B01AB 8.2 Supp List 124 enoxaparin 60mg/0,6mL 1injection: pre-filled syringe
CLEXANE
Coding Status protocol for use of LMWH per Supp List 116 Addendum A is repealed and replaced by: - General code for indications as stated in the LMWH policy: Supp List 124 Addendum A: Coding Status protocol for use of LMWH Prescription must be endorsed with the diagnosis
B01AB 8.2 Supp List 124 enoxaparin 80mg/0,8mL 1injection: pre-filled syringe
CLEXANE
Coding Status protocol for use of LMWH per Supp List 116 Addendum A is repealed and replaced by: - General code for indications as stated in the LMWH policy: Supp List 124 Addendum A: Coding Status protocol for use of LMWH Prescription must be endorsed with the diagnosis
X 22enteral nutrients/special foods
ENSUREIntegrated Nutrition Programme
NOT to be issued as a dietary supplement. Supply only on referal by a dietician for use as an enteral feed according to the Provincial Policy for Enteral Feeding.
C01C 7 ephedrine SO4 50mg/ml 10 injection EPHEDRINE SULPHATE
L01DB 23 epirubicin 10mg 1 injection FARMORUBICINSpecialist oncologist
L01DB 23 epirubicin 50mg 1 injection FARMORUBICINSpecialist oncologist
B02BD 8.1eptacog alfa (activated) -See factor VIIa
60 000iu (1,2mg) vial injectionNOVOSEVEN FACTOR VIIa
Central HospitalsHaematology.On a patient name basis only.
A11CC 20.1 ergocalciferol P 5 000u/ml 15ml oily solution VITAMIN D
A11CC 20.1 ergocalciferol A 50 000units 100 tabletSTRONG CALCIFEROL TABLETS
G02AB 17.3 ergometrine P 0,5mg 1 injection ERGOTRATE
N02CA 1.9ergotamine + belladonna + butalbital + caffeine
2mg + 0,25mg + 100mg + 100mg
5 suppository CAFERGOT P-B
N02CA 1.9ergotamine + cyclizine + caffeine
2mg + 50mg + 100mg
10 tablet MIGRIL
J01DH 18.1.3 ertapenem 1g 1 injection INVANZ SpecialistOnly for severe nosocomial infections in ICU's & on a Microbiologist report.
J01FA 18.2 erythromycin A P 1g 1 injection ERYTHROCIN Restricted for use in proven Legionnaires Disease.
J01FA 18.2 erythromycin 1 A P 250mg 20 tablet ERYTHROMIDJ01FA 18.2 erythromycin 250mg 100 tablet/capsule SPECTRASONEJ01FA 18.2 erythromycin A P 250mg 500 tablet ERYTHROMID
J01FA 18.2 erythromycin estolate 1 P 125mg/5ml 100mlgranules/suspension
E-MYCIN As below
J01FA 18.2 erythromycin estolate 1 P 250mg/5ml 100mlgranules/suspension
PURMYCINNot to be used for longer than 5 days. For long term or high dosage, use ethylsuccinate.
Page 27 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
BO3XA 8.6Suppl List 119
erythropoietin 500iupre-filledsyringe
IV/SC injection RECORMON
Specialist nephrology, haematology & neonatology
BO3XA 8.6Suppl List 119
erythropoietin 1 000iupre-filledsyringe
IV/SC injection RECORMON
Specialist nephrology, haematology & neonatology
BO3XA 8.6 erythropoietin 2 000iupre-filledsyringe
IV/SC injection EPREX; RECORMON
Specialist nephrology, haematology & neonatology
BO3XA 8.6 erythropoietin 4 000iupre-filledsyringe
IV/SC injection EPREX; RECORMON
Specialist nephrology, haematology & neonatology
C07AB 5.2 esmolol 100mg/10ml 1 injection BREVIBLOC Use cheapest intravenous beta blocker on tenderJ04AK 18.6.1 ethambutol 25mg/ml 500ml suspension MYAMBUTOLJ04AK 18.6.1 ethambutol 100mg 1 000 tablet MYAMBUTOLJ04AK 18.6.1 ethambutol 1 A 400mg 100 tablet MYAMBUTOL; MYCROLJ04A 18.6.1 ethambutol + isoniazid 300mg + 100mg 500 tablet MYNAH; TUBEROL
C05BB 8.5? ethanolamine oleate 5% 5ml 10 injectionETHANOLAMINE OLEATE
G03CA 19.6.2 ethinyl oestradiol A 0,02mg 100 tablet ESTINYLG03CA 19.6.2 ethinyl oestradiol A 0,05mg 100 tablet ESTINYLJ04AD 18.6.1 ethionamide P 250mg 250 tablet TRESCATYL; ETHATYL
N03AD 1.6 ethosuximide A P 250mg 50 capsule ZARONTIN
Specialist psychiatrists, neurologists and paediatricians
N01BX 31 ethyl chloride 1 BP 100g spray ETHYL CHLORIDEC01CA 7.6 etilefrine A P 10mg/ml 1 injection EFFORTIL SpecialistN01AX 2.1.2 etomidate A P 20mg/10ml 5 injection HYPNOMIDATE Specialist
L01CB 23 etoposide A P 100mg 10 capsule VEPESIDSpecialist oncologist
L01CB 23 etoposide A P 100mg/5ml 1 injection VEPESIDSpecialist oncologist
L02BG 19.8 Supp List 121 exemestane 25mg 30 tablet AROMASINSpecialist oncologist initiated
For second line treatment for Tamoxifen intolerant patients.
C10AB 7.7.3 Supp List 123 ezetimibe 10mg 30 tablet EZETROL Specialist Lipid Clinic only
B02BD 8.1
factor VIIa activated recombinant coagulation (See - eptacog alfa (activated)
60 000iu (1,2mg) vial injectionNOVOSEVEN FACTOR VIIa
Central HospitalsHaematology.On a patient name basis only.
B02BD 8.1 factor VIII Concentrate 300IU 1 injectionHAEMOSOLVATE FACTOR VIII
For use in haemophiliacs only. See provincial haemophilia policy
Page 28 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
B02BD 8.1 factor VIII Concentrate 500IU 1 injectionHAEMOSOLVATE FACTOR VIII
For use in haemophiliacs only. See provincial haemophilia policy
B02BD 8.1 factor VIII Concentrate 2X500IU 1 injectionHAEMOSOLVATE FACTOR VIII
For use in haemophiliacs only. See provincial haemophilia policy
B02BD 8.1factor IX complex human
500IU 1 injectionHAEMOSOLVEX FACTOR IX
For use in haemophiliacs only. See provincial haemophilia policy
B02BD 8.1factor VIII inhibitor bypassing activity complex
500IU 1 injection FEIBA TIM 4 IMMUNOFor use in haemophiliacs only. See provincial haemophilia policy
B02BD 8.1factor VIII inhibitor bypassing activity complex
1000IU 1 injection FEIBA TIM 4 IMMUNOFor use in haemophiliacs only. See provincial haemophilia policy
J05AB 18.1 famciclovir A 250mg 21 tablet FAMVIR SpecialistOnly to be used for registered indications. Motivation form to be completed.
R03AC 10.2.1 fenoterol A 100+F575/inhal 1 x 300 dose MDI complete BEROTEC Use cheapest Beta-stimulant MDI on tender.R03AC 10.2.1 fenoterol A 100µg/inhal 1 x 300 dose MDI refill BEROTEC As above
R03AC 10.2.1 fenoterol 1mg/ml 20mlinhalation solution
BEROTEC
R03AC 10.2.1 fenoterol A 1,25mg/2ml60 x 2ml UDV
inhalation solution in a Unit Dose Vial
BEROTEC U.D.V.
N01AH 2.1.2 fentanyl A P 0,1mg/2ml 1 injection SUBLIMAZEN01AH 2.1.2 fentanyl A P 0,5mg/10ml 5 injection SUBLIMAZE; TANYLB03AA 8.6 ferrous gluconate P 250mg/5ml 100ml syrup KIDDIE VITE Contains 28,5mg elemental iron /5mlB03AA 8.6 ferrous lactate P 25mg/ml Fe++ 10ml oral drops FERRO DROPS Contains 25mg elemental iron /ml
B03AA 8.6 ferrous sulphate co BPC 1 A P
FeSO4: 170mgequiv: 56,67mg Fe++
5H2O.CuSO4: 2.5mg4H2O.MnSO4: 2.5mg
28 tablet FERROUS SULPHATE
B03AA 8.6 ferrous sulphate co BPC A P BPC - as above 5 000 tablet FERROUS SULPHATE
L03AA 26 Supp List 114 filgrastim 300µg (30MU) 1 injection NEUPOGENSpecialist oncologist
For stem cell mobilisation in bone marrow transplant donors For severe congenital neutropenia
J01CG 18.1.1 flucloxacillin 1 A P 250mg 20 capsule FLOXAPEN
Dosing schedule as per 1° EDL 2003. Maximum adult dose: 500mg 6 hourly. Cloxacillin may be used for porphyrics and patients over 50 years of age with cholestatic jaundice. Prescription to be endorsed accordingly.
J01CF 18.1.1 flucloxacillin 1 A P 250mg 100 capsule FLOXAPEN as aboveJ01CF 18.1.1 flucloxacillin 1 P 125mg/5ml 100ml suspension FLOXAPEN
Page 29 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J02AC 18.10Suppl List 119
fluconazole1 P
50mg 14 capsule DIFLUCAN
For tinea capitis - as per EDL Donated Fluconazole - Manage as a Schedule 6 medicine for Donation Programme - For management of Cryptococcal Meningitis and Candida Oesophagitis in HIV positive patients
J02AC 18.10Suppl List 119
fluconazole1
A P200mg 28 tablet DIFLUCAN
For tinea capitis - as per EDL Donated Fluconazole - Manage as a Schedule 6 medicine for Donation Programme - For management of Cryptococcal Meningitis and Candida Oesophagitis in HIV positive patients
J02AC 18.10 fluconazole 40mg/ml 35ml suspension DIFLUCANDonation drug. Handle as a special buy out
1. Manage as a Schedule 6 drug for Diflucan donation Programme.2. For management of Candida oesophagitis in HIV positive paediatric patients. Use according to treatment guidelines.
L01BB 23.00Suppl List
118fludarabine 10mg 20 tablet FLUDARA
Specialist haemotologist
Haematology.
L01BB 23.00 fludarabine 50mg 1 injection FLUDARASpecialist haemotologist
Haematology. Second line treatment for chronic lymphocytic leukaemia and follicular lymphoma
H02AA 19.5 fludrocortisone A P 0,1mg 100 tablet FLORINEF
V03AB 1.1.3 flumazenil P 0,5mg/5ml 1 injection ANEXATEFor use in ICU's only
V03AB 1.1.3 flumazenil P 1mg/10ml 1 injection ANEXATEFor use in ICU's only
S02C 11.2 flumethasone + cliquinol 0,2mg +10mg/ml 7,5ml ear dropsLOCACORTEN VIOFORM
D07AC 14.4 fluocinolone 0,025% 15g cream SYNALARCheapest grade III Steroid cream on tender to be used
D07AC 14.4 fluocinolone 0,025% 500g cream SYNALARCheapest grade III Steroid cream on tender to be used
D07AC 14.4 fluocinolone 0,025% 15g ointment SYNALARCheapest grade III Steroid ointment on tender to be used
D07AC 14.4 fluocinolone 0,025% 500g ointmentSYNALAR, CORTODERM
Cheapest grade III Steroid ointment on tender to be used
S01JA 15.7 fluorescein 500mg/2ml 12 injection FLUORESCITESpecialist ophthalmologist
S01JA 15.7 fluorescein 1 2% 0,5ml x 20 minims MINIMS FLUORESCEINS01JA 15.7 fluorescein 1mg 100 strips FLUORETS
S01H 15.7 fluorescein + lignocaine1,25mg + 20mg/0,5ml
0,5ml x 20 minimsMINIMS LIGNOCAINE & FLUORESCEIN
Specialist ophthalmologist
S01BA 15.2 fluorometholone 0,1% 5ml eye drops FMLSpecialist ophthalmologist initiated
L01BC 23 fluoro-uracil A P 500mg/10ml 5 injection FLUROBLASTIN SpecialistPage 30 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
L01BC 14.9 fluoro-uracil A P 50mg/g 10g ointment EFUDIX SpecialistL01BC 23 fluoro-uracil A P 250mg 30 tablet FLUROBLASTIN Specialist
N06AB 1.4.4 Supp List 123 fluoxetine 1 A 20mg 28 capsule PROZAC; LORIENFor depression (Addendum F of SL 80, Circular H112/1998 is repealed)
N06AB 1.4.4 Supp List 123 fluoxetine A 20mg 100 capsule PROZAC; LORIENFor depression (Addendum F of SL 80, Circular H112/1998 is repealed)
N05AF 1.5.3 flupenthixol A 20mg/ml 1 injection, oily FLUANXOL DEPOTN05AF 1.5.3 flupenthixol A 40mg/2ml 1 injection, oily FLUANXOL DEPOTN05AB 1.5.1 fluphenazine HCl 25mg/10ml 1 injection MODECATE ACUTUMN05AB 1.5.1 fluphenazine decanoate 1 A 25mg/ml 1 injection MODECATEN05AB 1.5.1 fluphenazine decanoate 1 A 250mg/10ml 1 injection MODECATEB03BB 20.1 folic acid 1 A P 5mg 28 tablet FOLIC ACIDB03BB 20.1 folic acid A P 5mg 100 tablet FOLIC ACIDB03BB 20.1 folic acid A P 5mg 1 000 tablet FOLIC ACIDV03AF 20.1 folinic acid P 3mg/ml 10 injection REFOLINON SpecialistV03AF 20.1 folinic acid P 30mg/10ml 10 injection LEUCOVORIN SpecialistV03AF 20.1 folinic acid P 50mg 1 injection LEUCOVORIN SpecialistV03AF 20.1 folinic acid P 15mg 10 tablet ABIC LEUCOVORIN Specialist
R03AC 10.2 Supp List 117 formoterol A 12µg/metered dose 1 inhaler - HFA FORATEC INHALERspecialist physician & paediatrician initiated
For adults and children over the age of 6 - cheapest LABA on tender to be used See Circular H 64/2007 Suppl List 110: Annexure A Note: Formoterol inhaler is not registerd for use in children under the age of six
X Ø formaldehyde liquid 34% - 38% 2 500ml solution FORMALIN
S01CA 15.3framycetin + gramicidin + dexamethasone
8ml ear drops SOFRADEX Specialist ENT
C03CA 16.1 furosemide 1 A P 20mg/2ml 1 injection LASIX
C03CA 16.1 furosemide A P 250mg/25ml 1 injectionLASIX; SABAX FUROSEMIDE
C03CA 16.1 furosemide P 10mg/ml 100ml oral solution LASIXC03CA 16.1 furosemide 1 A P 40mg 28 tablet LASIXC03CA 16.1 furosemide A P 40mg 56 tablet LASIX; PURESISC03CA 16.1 furosemide A P 40mg 250 tablet LASIXC03CA 16.1 furosemide A P 40mg 5 000 tablet LASIXV08AB Ø gadobutrol 1 injection GADOVIST Specialist Radiology
P03AB 14.2gamma benzene hexachloride
1% 100ml lotion GAMBEX LOTION Only for use in children up to the age of 12 years
P03AB 14.2gamma benzene hexachloride
1% 100ml shampooGAMBEX SHAMPOO; QUELLADA
As above
Page 31 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J05AB 18.12 Supp list 124 ganciclovir 500mg 1 injection CYMEVENE Specialist
Specialist infectious diseases, virologist - for use in life threatening CMV infections: Retinitis / Encephalitis / Pneumonitis / Colitis / Oesophagitis / Cholangitis Ophthalmic use to be approved by ophthalmologist Regional and Central hospitals
L01BC 23 Supp list 124 gemcitabine 200mg 1 injection GEMZAR Specialist Specialist oncologist, for bladder cancerL01BC 23 Supp list 124 gemcitabine 1000mg 1 injection GEMZAR Specialist Specialist oncologist, for bladder cancerJ01GB 18.3 gentamicin P 20mg/2ml 1 injection GARAMYCIN
J01GB 18.3 gentamicin A P 80mg/2ml 1 injectionGARAMYCIN; FERMENTMYCIN
J01GB 18.3gentamycin + methylmethacrylate cement
0,5g + 33,8g2 x 40g pdr2 x 20ml liquid
powderPALACOS R with GARAMYCIN
Specialist orthopaedic surgeon
D07C/X 14.4.1gentamycin + betamethasone + clioquinol + tonaftate
1mg + 0,5mg + 10mg + 10mg per gram
20g cream QUADRIDERM Specialist ENT ENT in-clinic/hospital use only.
D01AE Ø gentian violet medicinal 1 0,5% 20ml paintGENTIAN VIOLET PAINT
G03XA 19.8 gestrinone 2,5mg 10 capsule TRIDOMOSESpecialist gynaecologist
Central hospitals only, not referable.
A10BB 19.1.2 glibenclamide 1 A 5mg 28 tablet DAONILA10BB 19.1.2 glibenclamide 1 A 5mg 56 tablet DAONIL
A10BB 19.1.2 glibenclamide 1 A 5mg 84 tabletDAONIL; EUGLUCON; GLYCOMIN
A10BB 19.1.2 glibenclamide A 5mg 100 tablet DAONILA10BB 19.1.2 glibenclamide A 5mg 500 tablet GLYBEN; GLYCOMINA10BB 19.1.2 gliclazide 1 A 80mg 56 tablet DIAMICRONA10BB 19.1.2 gliclazide A 80mg 504 tablet DIAMICRONH04AA 19.2 glucagon A P 1mg/ml syringe injection GLUCAGON NOVOV07AV Ø glutaraldehyde 2% 1 000ml liquid G-CIDE; GLUTERALV07AV Ø glutaraldehyde 2% 5 000ml liquid G-CIDE; GLUTERALA06A Ø glycerine BP 500ml liquidA06A Ø glycerine BP 5 000ml liquid
A06AG 12.7glycerine + sodium stearate
0,891ml + 0,113g 12 suppository GLYCERINE (PAED.)
A06AG 12.7glycerine + sodium stearate
A 1,698ml + 0,213g 12 suppository GLYCERINE (ADULT)
ØSuppl List 119
glycerine & thymol co 1 BPC 100ml liquidFor dental use only
A03AB 5.4glycopyrrolate (glycopyrronium)
P 0,4mg/2ml 1 injection ROBINUL
D01BA 18.8 griseofulvin 1 125mg 100 tablet FULCIND01BA 18.8 griseofulvin 1 500mg 100 tablet FULCIN; MICROCIDAL
Page 32 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
Growth Stimulating Factor see Filgrastim
N05AD 1.5.2 haloperidol 1 A P 0,5mg 56 capsule SERENACEN05AD 1.5.2 haloperidol 1 A P 0.5mg 60 capsule SERENACEN05AD 1.5.2 haloperidol 1 A P 0,5mg 84 capsule SERENACEN05AD 1.5.2 haloperidol A P 0,5mg 500 capsule SERENACEN05AD 1.5.2 haloperidol 5mg/ml 1 injection SERENACEN05AD 1.5.2 haloperidol 20mg/2ml 6 injection SERENACEN05AD 1.5.2 haloperidol A 1,5mg 100 tablet SERENACEN05AD 1.5.2 haloperidol A 1,5mg 500 tablet HALOPERIDOLN05AD 1.5.2 haloperidol 1 5mg 28 tablet SERENACEN05AD 1.5.2 haloperidol 1 5mg 56 tablet CEREENN05AD 1.5.2 haloperidol A 5mg 100 tablet SERENACEN05AD 1.5.2 haloperidol 5mg 500 tablet SERENACE
N01AB 2.1.1 halothane A P BP 250mlinhalation liquid
FLUOTHANE
B01AB 8.2 heparin sodium A P 1 000u/ml 5ml 1 injection PULARINB01AB 8.2 heparin sodium A 5 000u/ml 5ml 1 injection PULARINB01AB 8.2 heparin sodium A 25 000u/ml 5ml 1 injection PULARIN
S01FA 15.5homatropine + hypromellose
P 2% + 0,5% 5ml eye drops ISOPTO HOMATROPINE
X 19.7human menopausal gonadotrophin
FSH + LH 75iu 1 injection HUMEGON Specialist Central hospitals only, not referable.
human serum albumin: see albumin, normal serum
human serum stabilised: see serum, human stabilised
X 27 Supp List 121 hyaluronidase 1 500iu 1 injection HYALASESpecialist Opthalmologist
C03AA 16.1 hydrochlorothiazide 1 A P 25mg 14 tablet DICHLOTRIDEC03AA 16.1 hydrochlorothiazide 1 A P 25mg 28 tablet DICHLOTRIDEC03AA 16.1 hydrochlorothiazide P 25mg 500 tablet DICHLOTRIDE; RIDAQD07AA 14.4 hydrocortisone 1 A 1% 20g cream MYLOCORTD07AA 14.4 hydrocortisone A 1% 20g ointment MYLOCORT
H02AB 19.5hydrocortisone sodium succinate
1 A P 100mg I.V./I.M. 1 injection SOLU-CORTEF
H02AB 19.5 hydrocortisone A P 10mg 100 tablet COVOCORT
X Ø hydrogen peroxide liquid 20 vol 500ml liquid HYDROGEN PEROXIDE
S01KA 15.7 hydroxypropyl methylcellulose
0.3% - 0.5% 15ml eye dropsVISCOTRAANSPERSATEAR
L01XX 23 hydroxyurea A P 500mg 100 capsule HYDREA SpecialistPage 33 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
N05BB 1.3.2 hydroxyzine 10mg/5ml 100ml syrup ATERAXSpecialist paediatrician & dermatologist
N05BB 1.3.2 hydroxyzine 25mg 100 tablet ATERAXSpecialist paediatrician & dermatologist
N05BB 1.3.2 hydroxyzine 100mg 100 tablet ATERAXSpecialist paediatrician & dermatologist
A03BB 12.3hyoscine-N-butyl bromide
A P 20mg/ml 1 injectionBUSCOPAN; HYOSPASMOL
A03BB 12.3hyoscine-N-butyl bromide
10mg 10 tablet BUSCOPAN
A03BB 12.3hyoscine-N-butyl bromide
10mg 100 tablet BUSCOPAN
A03BB 12.3hyoscine-N-butyl bromide
10mg 500 tablet BUSCOPAN
M01AE 4.1 ibuprofen P 100mg/5ml 100ml syrup BRUFENGeneral Code Specialist
General Code: For peri/post operative use in paediatrics Specialist: Other indications
M01AE 4.1Suppl List 119
ibuprofen 1 A P 200mg 15 tablet
For acute conditions: Not more than 5 days supply. Not repeatable for acute conditions (short course). For longer periods, the appropriate diagnosis and quantity to be written on the prescription
M01AE 4.1Suppl List 119
ibuprofen 1 A P 200mg 84 tablet BRUFEN
For acute conditions: Not more than 5 days supply. Not repeatable for acute conditions (short course). For longer periods, the appropriate diagnosis and quantity to be written on the prescription
M01AE 4.1Suppl List 119
ibuprofen A P 200mg 1 000 tablet BRUFEN
For acute conditions: Not more than 5 days supply. Not repeatable for acute conditions (short course). For longer periods, the appropriate diagnosis and quantity to be written on the prescription
D05A 31 ichthammol ointment BP 500g ointment ICHTHAMMOL OINT.V03A Ø ichthammol glycerin 1 BPC 500ml liquid
J01DH 18.1.3imipenem + cilastatin sodium
A 500mg + 500mg 120ml injection TIENAM 500Specialist ICU & highcare
Use on microbiologist report only.
N06AA 1.4.1 imipramine A P 10mg 100 tablet TOFRANIL Specialist initiatedOpen code for use in children up to a maximum dose of 25mg daily.
N06AA 1.4.1 imipramine A P 25mg 28 tablet MIPRALIN Specialist initiatedN06AA 1.4.1 imipramine A P 25mg 56 tablet MIPRALIN Specialist initiatedN06AA 1.4.1 imipramine A P 25mg 84 tablet MIPRALIN Specialist initiated -------N06AA 1.4.1 imipramine A P 25mg 100 tablet TOFRANIL Specialist initiated -------
N06AA 1.4.1 imipramine A P 25mg 1 000 tabletTOFRANIL; ETHIPRAMINE
Specialist initiated -------Page 34 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
D06BB 14.9 imiquimod 5% sachet cream ALDARASpecialist dermatologist & oncologist
J06BB 26immunoglobulin anti-D rhesus
1 A 100µg 2ml injection
J06BB 26immunoglobulin anti-hep. B
A P 170 iu 2ml injection
J06BB 26immunoglobulin anti-measles
2ml injection
J06BB 26immunoglobulin anti-rubella
5ml injection
J06BB 26immunoglobulin anti-tetanus
1 A P 250 iu 2ml injection
J06BB 26immunoglobulin anti-varicella zoster
A P 16,5% 2ml injection
J06BA 26 immunoglobulin human P 16% 5ml injection
J06BA 26 immunoglobulin human 5% 0,5g 10ml solvent I.V. infusion POLYGAMSpecialist physician & paediatrician
J06BA 26 immunoglobulin human P 3% 1g 33ml solvent I.V. infusion POLYGAMSpecialist physician & paediatrician
J06BA 26 immunoglobulin human P 3% 3g100ml solvent
I.V. infusion POLYGAMSpecialist physician & paediatrician
J06BA 26 immunoglobulin human P 3% 6g200ml solvent
I.V. infusion POLYGAMSpecialist physician & paediatrician
J06BB 26immunoglobulin, human, anti-rabies
1 A P 150iu/ml 2ml injection RABIGAM IM
M01AB 4.1 indomethacin A 25mg 15 capsuleFor use in obstetrics as a stat dose only
M01AB 4.1 indomethacin A 25mg 84 capsule INDOCIDFor use in obstetrics as a stat dose only
M01AB 4.1 indomethacin A 25mg 1 000 capsule INDOCID; ARTHREXINFor use in obstetrics as a stat dose only
M01AB 4.1 indomethacin A 100mg 10 suppository ARTHREXINFor in-patient use only.
X Øinhaler device with mask
1AEROCHAMBER (NEONATE)
X Øinhaler device with mask
1GLAXOHALER (CHILDREN)
Page 35 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
X Ø Supp List 116 1 re-useable pen BATSWADI AUTOPEN
Specialist physician, paediatrician and endocrinologist
Paediatrics and adolescents only. To be initiated at Central Hospitals only. Autopen: Non-Referable
Supp List 124 1 re-useable pen NOVO RAPID penfillSpecialist paediatrician initiated
For patients under 5 years old. Device to be initiated at central hospitals and is not referable. Cartridges may be accessed at periphery as required i.e. referable. .
A10AA 19.1.1 Supp List 124insulin analogue human, insulin aspart
100units/ml 3mL cartridge NOVO RAPID penfillSpecialist paediatrician initiated
For patients under 5 years old. To be initiated at central hospitals. Cartridges may be accessed at periphery as required i.e. referable. (Insulin device not referable).
A10AA 19.1.1 Supp List 116insulin human soluble biosynthetic 100units/ml 3mL cartridge
HUMULIN R CARTRIDGE
Specialist physician, paediatrician and endocrinologist
Paediatrics and adolescents only. To be initiated at Central Hospitals only. Referable
A10AA 19.1.1 Supp List 116insulin human soluble/isophane
30% / 70%100units/ml
3mL cartridgeHUMULIN 30/70 CARTRIDGE
Specialist physician, paediatrician and endocrinologist
Paediatrics and adolescents only. To be initiated at Central Hospitals only. Referable
A10AA 19.1.1 Supp List 116insulin human isophane biosynthetic
100units/ml 3ml cartridge HUMULIN N
Specialist physician, paediatrician and endocrinologist
Paediatrics and adolescents only. To be initiated at Central Hospitals only. Referable
A10AA 19.1.1insulin human soluble biosynthetic 100units/ml 10ml injection
HUMULIN R; ACTRAPID HM(ge)
A10AA 19.1.1insulin human soluble biosynthetic A P 100units/ml 3ml penset ACTRAPID HM(ge)
Pensets to be used only in young patients (juvenile diabetes) and patients not capable of using vials & syringes e.g. impaired vision or the elderly.
A10AA 19.1.1insulin human soluble + isophane 1
30% + 70%100units/ml
10ml injectionACTRAPHANE HM(ge) HUMULIN 30/70
A10AA 19.1.1insulin human soluble + isophane (yeast)
30% / 70%100units/ml
3ml pensetACTRAPHANE HM(ge); HUMULIN 30/70
Pensets to be used only in young patients (juvenile diabetes) and patients not capable of using vials & syringes e.g. impaired vision or the elderly.
A10AA 19.1.1insulin human isophane biosynthetic
1 100units/ml 10ml injectionPROTAPHANE HM(ge); HUMULIN N
A10AA 19.1.1insulin human isophane biosynthetic
100units/ml 3ml penset PROTAPHANE HM(ge)Pensets to be used only in young patients (juvenile diabetes) and patients not capable of using vials & syringes e.g. impaired vision or the elderly.
A10AA 19.1.1 insulin human lispro 100units/ml 10ml injection HUMALOGCentral Hospitals Patient name basis.
Not referable.
A10AA 19.1.1 insulin human lispro 100units/ml 3ml penset HUMALOG Central HospitalsPatient name basis.Not referable.
insulin injection device for use with 3mL insulin cartridge containing 100 units per 1mL (device is colour coded to correspond with insulin type)
insulin injection devise (penfill) for use with 3mL insulin aspart, human cartridge containing 100 units / mL
Page 36 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
X Ø insulin needles 100 needles NOVOFINE NEEDLES
L03AA 23 interferon-alpha 2a A P 3mu/vial 1 injection ROFERON A SpecialistCheapest on tender of alpha 2a or 2b to be bought.For use in hairy-cell leukemia and condyloma acumiata.
L03AA 29 interferon-alpha 2b A P 3mu/vial 1 injection INTRON - A Specialist As aboveV08AB Ø iobitridol 300mg/ml 50ml 1 injection XENETIX Specialist Only for RadiographyD08AG Ø iodine solution BP 500ml liquid WEAK IODINE SOLN. EDL
V08AB Ø iohexol 180mg/ml 10 injection OMNIPAQUE Specialist
Only for use in patients with a history of reaction to contrast media; history of allergy, coronary angiography in high risk patients & children;myelography; certain neuroradiological procedures; peripheral angiography when necessary.
V08AB Ø iohexol 250mg/ml 10ml 10 injection OMNIPAQUE Specialist As aboveV08AB Ø iohexol A 300mg/ml 20ml 20 injection OMNIPAQUE Specialist As aboveV08AB Ø iohexol A 300mg/ml 50ml 10 injection OMNIPAQUE Specialist As aboveV08AB Ø iohexol 350mg/ml 50ml 10 injection OMNIPAQUE Specialist As aboveV08AB Ø iohexol 350mg/ml 100ml 10 injection OMNIPAQUE Specialist As aboveV08AB Ø iopamidol 0,612g/ml 50ml 10 injection JOPAMIRON SpecialistV08AB Ø iopamidol 0,755g/ml 50ml 10 injection JOPAMIRON Specialist As aboveR03BB 10.4 ipratropium bromide 1 A P 0,04mg/inhal. 1 MDI complete ATROVENT
R03BB 10.4 ipratropium bromide A P 0,25mg/ml 2ml 60 UDVinhalation solution in a Unit Dose Vial
ATROVENT
X Ø iron bile salts 300mg 40 capsule BILRON Specialist initiatedLipid clinics only. For use in cerebrotendinous xanthomatosis.
B03AC 8.6 iron sucrose complex 100mg/5ml I.V. 1 injection VENOFER
Specialist physician, paediatrician & gynaecologist
N01AB 2.1.1 isoflurane A P 100ml inhal FORANE; ISOFOR SpecialistJ04AC 18.6.1 isoniazid 1 A P 100mg 1 000 tablet ISONIAZIDC01DA 7.4 isosorbide dinitrate 1 A P 5mg 50 tablet ISORDIL; DILANIDC01DA 7.4 isosorbide dinitrate A P 40mg 30 tembid ISORDIL TEMBIDS As aboveC01DA 7.4 isosorbide dinitrate A P 40mg 100 tembid ISORDIL TEMBIDS MAX. 40mg twice daily with eccentric regimen.
C01DA 7.4isosorbide-5-mononitrate
A P 20mg 60 tablet ELANTAN 20To be used when cost and availability of dinitrate is a problem. 20mg mononitrate is equivalent to 40mg dinitrate.
C01DA 7.4isosorbide-5-mononitrate
A P 20mg 500 tablet ISMO-20To be used when cost and availability of dinitrate is a problem. 20mg mononitrate is equivalent to 40mg dinitrate.
D10BA 14.6 isotretinoin 10mg 60 capsule ROACCUTANE Central HospitalsPatient name basis.Not referable.
D10BA 14.6 isotretinoin 20mg 60 capsule ROACCUTANE Central HospitalsPatient name basis.Not referable.Page 37 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
A06AC 12.7 ispaghula husk P 3,5g 30 sachets FYBOGEL ORANGE Specialist initiatedMaximum: 30 sachets per month. Cheapest bulk forming agent currently on tender to be used.
J02AC 18.10 itraconazole 100mg 4 capsuleSPORANOX/ADCO-SPORAZOLE
Specialist dermatologist
Central hospitals, Patient name basis, Not referable.
J02AC 18.10 itraconazole 100mg 14 capsuleADCO-SPORAZOLE (ON TENDER)
Specialist dermatologist
Specialist dermatologist - Central hospitals, patient name basis - Non-referable Specialist - for AIDS & disseminated histoplasmosis following Amphotericin B initial therapy Non referable
J02AC 18.10 Supp List 113 itraconazole 100mg 28 capsuleSPORANOX/ADCO-SPORAZOLE
Specialist dermatologist Specialist
Specialist dermatologist - Central hospitals, patient name basis - Non-referable Specialist - for AIDS & disseminated histoplasmosis following Amphotericin B initial therapy Non referable
J01GB 18.3 kanamycin 1g/3ml 1 injection KANAMYCIN NOVOX Ø kaolin poultice BP 250g poultice KAOLIN POULTICEN01AX 2.1.2 ketamine A P 10mg/ml I.V. 20ml injection KETALARN01AX 2.1.2 ketamine A P 100mg/ml I.V. 10ml injection BREVINAZE
J02AB 18.8 ketoconazole A 200mg 30 tablet NIZORAL SpecialistMotivation form to be completed or on a Microbiologist report.
S01BC 15.7 ketorolac 5mg/ml 5ml eye drops ACULARSpecialist ophthalmologist
R06AX 10.4 ketotifen 1mg/5ml 200ml syrup ZADITENSpecialist paediatrician initiated
To be used in paediatric allergy clinics for children 3 years of age and younger.
C07AG 7.3.1 labetalol 100mg/20ml 1 injection TRANDATE SpecialistG01AD Ø lactic acid 500ml liquidA06AD 12.7 lactulose A P 3.3g/5ml 150ml syrup DUPHALAC; LACSON Hepatic encephalopathy only.A06AD 12.7 lactulose A P 3.3g/5ml 500ml syrup DUPHALAC; LACSON As above.
J05AF 18.12pgwc ARV depot
lamivudine 1 10mg/ml 240ml solution 3-TC AIDS programmeAvailable through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.
J05AF 18.9pgwcARV depot Supp List 124
lamivudine1
A P150mg 60 tablet
3-TC, Adco-Lamivudine, Aspen Lamivudine
General code: AIDS programme CNP / Professional nurse
General code: AIDS programme: Available through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols. CNP / Professional nurse: Available through HIV / AIDS programme: For first line treatment of adult AIDS patients as per HIV / AIDS guidelines 2010 for treating AIDS patients and per Circular H30/2011: Authorisation of Nurse Prescribing for Antiretroviral Treatment
Page 38 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J05AF 18.9pgwcARV depot Supp List 124
lamivudine1
A P300mg 60 tablet
General code: AIDS programme CNP / Professional nurse
General code: AIDS programme: Available through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols. CNP / Professional nurse: Available through HIV / AIDS programme: For first line treatment of adult AIDS patients as per HIV / AIDS guidelines 2010 for treating AIDS patients and per Circular H30/2011: Authorisation of Nurse Prescribing for Antiretroviral Treatment
N03AX 1.6Suppl List 118
lamotrigine 1 25mg 60 tablet LAMICTIN Specialist initiatedFor Mood Disorders: Psychiatrist initiated Patients may only be referred once stabilised on the maintenance dose
N03AX 1.6Supply List 118
lamotrigine 1 50mg 60 tablet LAMICTIN Specialist initiatedFor Mood Disorders: Psychiatrist initiated Patients may only be referred once stabilised on the maintenance dose
N03AX 1.6Suppl List 118
lamotrigine 1 100mg 60 tablet LAMICTIN Specialist initiatedFor Mood Disorders: Psychiatrist initiated Patients may only be referred once stabilised on the maintenance dose
N03AX 1.6Suppl List 118
lamotrigine 1 200mg 60 tablet LAMICTIN Specialist initiatedFor Mood Disorders: Psychiatrist initiated Patients may only be referred once stabilised on the maintenance dose
S01XA 15.7 lanolin anhydrous liquid A P 30mg/g 3.5g eye ointment DURATEARS Specialist initiated Cheapest eye ointment on tender to be used.
S01XA 15.7lanolin anhydrous derivatives
20mg/g 3,5g eye ointment LACRI-LUBE Specialist initiated Cheapest eye ointment on tender to be used.
A02BC 12.4.4 lansoprazole 30mg 14 capsule LANZORPaediatrician & Endoscopy units initiated
Cheapest PPI on tender to be used. For treatment guidelines refer to: Circular H95/2005 (Addendum B - Suppl. List 102)
A02BC 12.4.4 lansoprazole 30mg 28 capsule LANZORPaediatrician & Endoscopy units initiated
As above.
S01EE 15.6Suppl List
121 latanoprost A 50µg/ml 2,5ml eye drops XALANTAN
Specialist ophthalmologist initiated
Cheapest prostaglandin analogue ophthalmic solution to be used. See bimatoprost - refer RT280-2009MF
S01EE/D 15.6 Supp List 117 latanoprost + timolol 50µg + 5mg/ml 2,5ml eye drops XALACOMSpecialist ophthalmologist
For patients not responding to a single agent
N03AX 1.6 levetiracetam 250mg 30 tablets KEPPRASpecialist neurologist
As third or fourth line therapy. Non-referable. Maximum dose: 2000mg
S01ED 15.6 levobunolol HCl 0,5% 5ml eye drops BETAGANSpecialist ophthalmologist initiated
Only use cheapest beta-blocker drops of appropriate concentration available on tender.
N04BA 1.7.1 levodopa + benserazide A 200mg + 50mg 100 tablet MADOPAR
G03AC 17.1.1ex family planning stores
levonorgestrel 1 0,03mg 28 tablet MICROVAL Family Planning
Page 39 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
G03AB 17.1.1ex family planning stores
levonorgestrel +ethinyl oestradiol
0,1mg +0,02mg
28 tablet LOETTE Family Planning
Not to be prescribed as first line contraceptive. Use according to the Contraceptive Guidelines of the Provincial Reproductive Health Services. See Circular H125/2003 (Addendum F - Suppl. List 98)
G03AB 17.1.1ex family planning stores
levonorgestrel +ethinyl oestradiol
1 A0,15mg +0,03mg
28 tablet NORDETTE Family Planning
G03AB 17.1.1ex family planning stores
levonorgestrel +ethinyl oestradiol
1 A0,05mg;0,125mg +0,05mg
28 tablet BIPHASIL Family PlanningNot to be prescribed as a contraceptive. Prescribe only for treatment of prolonged bleeding on injectables.
G03AB 17.1.1ex family planning stores
levonorgestrel +ethinyl oestradiol
1 A
0,05mg;0,075mg;0,125mg + 0,03mg;0,04mg;0,03mg
28 tablet TRIPHASIL Family Planning
G02BA 17.1.3 Supp List 122levonorgestrel releasing intra uterine system
52mg/system 20µg/24 hours
1intra uterine system
MIRENASpecialist gynaecologist
For women in whom hysterectomy is contra-indicated and/ or who have failed other modalities
N01BB 2.2.1 lidocaine + prilocaine 2,5% + 2,5% 5g cream EMLARestricted to hospital paediatrics for conditions and procedures such as lumbar puncture,oncology, chronic illnesses etc.
D04AB 2.2.1 lignocaine HCl 1 A 2% 20ml gelREMICAINE; PETERKAIEN
N01BB 2.1.1. lignocaine HCl A P10mg per metered spray
475 doses spray XYLOCAINE
N01BB 2.2lignocaine HCl - without adrenaline
A 2% 1,8ml 1dental cartridge
XYLOTOX SE PLAIN
N01BB 2.2lignocaine HCl + nor-adrenaline
2% + 1 : 80 000 1,8ml
1dental cartridge
XYLOTOX L
N01BB 2.2lignocaine HCl + adrenaline
A P2%+ 1 : 80 000 1,8ml
1dental cartridge
XYLOTOX E80-A
N01BB 2.2 lignocaine I.M. 1 A P 1% 20ml 1 injection REMICAINEC01BB 7.2 lignocaine 1 A 2% 5ml 1 injection REMICAINEN01BB 2.2 lignocaine I.M. A P 2% 20ml 1 injection REMICAINEC01BB 7.2 lignocaine I.V. 10% 5ml 1 injection REMICARD Specialist
J01XX 18.9 Supp List 124 linezolid 600mg 10 tablets ZYVOXID Specialist
Infectious disease specialist or microbiologist approval: - vancomycin resistant Staphylococcal or Enterococcal infection - vancomycin intolerant (use excluded in red man syndrome) - methicillin resistant Staphylococcus aureus
Page 40 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J01XX 18.9 Supp List 124 linezolid 200mg 1 injection ZYVOXID Specialist
Infectious disease specialist or microbiologist approval: - vancomycin resistant Staphylococcal or Enterococcal infection - vancomycin intolerant (use excluded in red man syndrome) - methicillin resistant Staphylococcus aureus
J01XX 18.9 Supp List 124 linezolid 600mg 1 injection ZYVOXID Specialist
Infectious disease specialist or microbiologist approval: - vancomycin resistant Staphylococcal or Enterococcal infection - vancomycin intolerant (use excluded in red man syndrome) - methicillin resistant Staphylococcus aureus
J01XX 18.9 Supp List 124 linezolid 200mg/ml 150ml suspension ZYVOXID Specialist
Infectious disease specialist or microbiologist approval: - vancomycin resistant Staphylococcal or Enterococcal infection - vancomycin intolerant (use excluded in red man syndrome) - methicillin resistant Staphylococcus aureus
H03AA 19.3 liothyronine 20µg 50 tabletTERTROXIN; TRI-IODOTHYRONINE
Specialist endocrinologist
lipid emulsion: see tpn fat emulsion
A06AA Ø liquid paraffin 1 A BP 200ml liquid LIQUID PARAFFIN Maximum 200ml / patient / monthA06AA Ø liquid paraffin A BP 1 000ml liquid LIQUID PARAFFIN Maximum 200ml / patient / month.
N05AN 1.4.5 lithium carbonate A 250mg 56 tablet CAMCOLITSpecialist psychiatrist initiated
N05AN 1.4.5 lithium carbonate A 250mg 84 tablet CAMCOLITSpecialist psychiatrist initiated
N05AN 1.4.5 lithium carbonate A 250mg 100 tablet CAMCOLITSpecialist psychiatrist initiated
N05AN 1.4.5 lithium carbonate A 250mg 112 tablet CAMCOLITSpecialist psychiatrist initiated
N05AN 1.4.5 lithium carbonate A 250mg 1 000 tablet CAMCOLITSpecialist psychiatrist initiated
N05AN 1.4.5 lithium carbonate 400mg 100 tablet CAMCOLITSpecialist psychiatrist initiated
L01AD 23 lomustine A P 10mg 20 tablet CeeNUSpecialist oncologistPage 41 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
L01AD 23 lomustine A P 40mg 20 capsule CeeNUSpecialist oncologist
A07DA 12.8 loperamide A 2mg 6 tablet IMODIUM; GASTRON
A07DA 12.8 loperamide A 2mg 500 tabletIMODIUM; GASTRONPRODIUM
J05AF 18.12
pgwc ARV depot
lopinavir + ritonavir 1 200mg + 50mg 90 capsule ALUVIA
AIDS programme
General Code
Available through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.
Third line agent for needle stick injury post exposure prophylaxis according to the Provincial HIV/AIDS/STI/TB Directorate's protocol. Also refer to Circular H1/2009
J05AF 18.12pgwc ARV depot
lopinavir + ritonavir 1 80mg + 20mg/ml 60ml solution KALETRA AIDS programme As above.
N05BA 1.3.1 lorazepam A 4mg/ml 5 injection ATIVAN; TRANQUIL
N05BA 1.3.1 lorazepam A 1mg 14 tablet TRANQIPAMSpecialist General: for 14 days only & no repeats.
N05BA 1.3.1 lorazepam A 1mg 28 tablet TRANQIPAMSpecialist General: for 14 days only & no repeats.
N05BA 1.3.1 lorazepam A 1mg 100 tablet ATIVANSpecialist General: for 14 days only & no repeats.
N05BA 1.3.1 lorazepam A 1mg 500 tablet ATIVANSpecialist General: for 14 days only & no rep
As above
C09CA 7.3.9Supp List 115/120/121/123/ 124
losartan 50mg 30 tabletLOS-ARB / CIPLA LOSARTAN
Specialist physician, nephrologists, cardiologist and paediatrician initiated
Cheapest angiotensin receptor antagonist (ARB) available on tender to be used. For: ACEI intolerant patients. Maximum dose: 100mg daily Cross contra-indication between ARB & ACEI with relation to angioedema.
D05AA ‡
LPC (liquor picis carbonis - coal tar solution) in aqueous cream
5% 200g cream
D05AA ‡
LPC (liquor picis carbonis - coal tar solution) in emulsifying base
5% 200g ointment
X 14.8 lubricating jelly 1 50ml jelly - sterile K Y JELLY
X 14.8 lubricating jelly 100 x 2,5mlsachets - sterile
K Y JELLY SACHETS
No more than 14 days supply, except when prescribed by a psychiatrist or neurologist when 28 days may be dispensed. See circular H24/2006: Suppl List 107 Addendum I
On General Code ONLY for emergency treatment of aggressive/restless patients in accordance with the applicable protocol - Protocol 1 (2/98).
Page 42 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
H01CA 19.7luteinising hormone-releasing hormone; gonadorelin
0,1mg 1 injection H.R.F. Specialist Central hospitals only, not referable.
H01CA 19.7luteinising hormone-releasing hormone; gonadorelin
0,5mg 1 injection H.R.F. Specialist As above
B05AA 35
lvp [large volume parenteral] dextran 40 in sodium chloride
P 10% + 0,9% 500ml plastic bag RHEOMACRODEX
B05AA 7.8lvp dextran 70 in sodium chloride
P 500mlglass container
MACRODEX
V03AH Ø lvp dextrose 1 A P 10% 1 000ml plastic bagV03AH Ø lvp dextrose A P 20% 1 000ml plastic bagV03AH Ø lvp dextrose A 35% 1 000ml plastic bagV03AH Ø lvp dextrose P 5% 1 000ml plastic bagV03AH Ø lvp dextrose 1 A P 5% 100ml plastic bagV03AH Ø lvp dextrose 1 A P 5% 200ml plastic bagV03AH Ø lvp dextrose 1 A P 5% 50ml plastic bagV03AH Ø lvp dextrose 1 A P 50% 500ml plastic bag
B05AA 7.8
lvp gelatin, degraded, bovine (polygeline) + polypeptides + Na, K, Ca & Cl
3,5% 500ml infusion HAEMACEL
B05AA 7.8lvp hydroxyethyl starch (hetastarch) + sodium chloride
6% + 0,9%
500mlpolyethylene infusion bottle
HAES-STERIL 6%Cheapest colloid to be used For use in ICU, High Care. Theatre & in patients with ongoing massive haemorrhage
B05AA 7.8 Supp List 118lvp hydroxyethyl starch (hetastarch) 130 / 0,4 + sodium chloride
6% + 0,9%
500ml infusion VOLUVENCheapest colloid to be used For use in ICU, High Care. Theatre & in patients with ongoing massive haemorrhage
B05AA 7.8 Supp List 118lvp hydroxyethyl starch (hetastarch) 130 / 0,42 + sodium chloride
6% + 0,9%
500ml infusion VENOFUNDENCheapest colloid to be used For use in ICU, High Care. Theatre & in patients with ongoing massive haemorrhage
B05BC Ølvp mannitol for irrigation
5% 3 000ml plastic bag SABAX OSMITROL
B05BC Ø lvp mannitol infusion 20% 500ml plastic bag
B05BB Ølvp multi-electrolyte inf. with no potassium
P 200ml plastic bagPOT. FREE NEONATAL MAINTENANCE
B05BB Ølvp multi-electrolyte infusion
A 1 000mlREPLACEMENT SOLUTION
B05BB Ølvp multi-electrolyte infusion
A 1 000mlglass container
PLASMALYTE B
B05BB Ølvp multi-electrolyte infusion
A 200mlglass container
PLASMALYTE B
B05BB Ølvp multi-electrolyte infusion
1 P 200ml plastic bagHALF DARROW'S & DEXTROSE 5%
Page 43 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
B05BB Ølvp multi-electrolyte infusion
1 P 500ml palstic bagHALF DARROW'S & DEXTROSE 5%
B05BB Ølvp multi-electrolyte infusion
A 1 000ml plastic bagSUSTENANCE SOLNMAINTELYTE & DEXTROSE 5%
B05BB Ølvp multi-electrolyte infusion
A 1 000ml plastic bag ELECTROLYTE No 2
B05BB Ølvp multi-electrolyte infusion
1 000ml plastic bagMAINTELYTE + GLUCOSE 10%
B05BB Ølvp multi-electrolyte infusion
P 200ml plastic bagNEONATALYTE + GLUCOSE 10%
B05BB Ølvp multi-electrolyte infusion
1 A P 200ml plastic bag RINGER LACTATE
B05BB Ø Supp List 119lvp multi-electrolyte infusion
A P 1 000ml plastic bag RINGER LACTATE
B05BB Ø Supp List 119lvp multi-electrolyte infusion
1 A 1 000ml plastic bagMODIFIED RINGER LACTATE
B05BB Ølvp multi-electrolyte intravenous infusion
P 200ml plastic bagPAED.MAINTENANCE + GLUCOSE 5%
B05BB Ølvp sodium bicarbonate infusion
4,2% 200mlglass container
B05BB Ø lvp sodium chloride 0,9% 200mlglass container
B05BB Ø lvp sodium chloride A P 5% 200mlglass container
B05BB Ø lvp sodium chloride A P 0,45% 1000ml plastic bagB05BB Ø lvp sodium chloride 1 A P 0,9% 1 000ml plastic bagB05BB Ø lvp sodium chloride 1 A P 0,9% 100ml plastic bagB05BB Ø lvp sodium chloride 1 A P 0,9% 200ml plastic bagB05BB Ø lvp sodium chloride 1 A P 0,9% 50ml plastic bag
Ølvp sodium chloride + dextrose
0,45% + 2,5% 1 000ml plastic bag
Ølvp sodium chloride + dextrose
0,45% + 5% 1 000ml plastic bag REHYDRATION SOLN
Ølvp sodium chloride + dextrose
0,2% + 5% 200ml plastic bag
Ølvp sodium chloride + dextrose
A 0,9% + 5% 1 000ml plastic bag
Ølvp sodium chloride + dextrose
1 A 0,9% + 5% 200ml plastic bag
Ølvp sodium chloride + dextrose
5% + 0,2% 200ml plastic bag
Ølvp solutionn for irrigation mannitol
5% 3 000ml plastic bagMANNITOL 5% FOR IRRIGATION
Ølvp solution for irrigation multi-electrolyte
3000ml plastic bagRINGER LACTATE INJECTION BP
Page 44 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
Ølvp solution for irrigation purified water
1 1 000ml pour bottleWATER FOR IRRIGATION
Ølvp solution for irrigaationsodium chloride
1 0,9% 3 000ml plastic bagSOD.CHLORIDE 0,9% FOR IRRIGATION
Ølvp solution for irrigationsodium chloride
1 0.9% 1 000ml plastic bagSOD.CHLORIDE 0,9% FOR IRRIGATION
Ølvp solution for irrigation sodium chloride
1 0.9% 1 000ml pour bottleSOD.CHLORIDE FOR IRRIGATION
Ølvp solution for irrigation sodium chloride
1 0.9% 500ml pour bottleSOD.CHLORIDE FOR IRRIGATION
Ølvp solution for irrigation sterile water
1 1 000ml plastic bagSTERILE WATER FOR IRRIGATION
Ølvp solution for irrigation sterile water
1 3 000ml plastic bagSTERILE WATER FOR IRRIGATION
Ø lvp water for injection 1 000mlglass container
Ø lvp water for injection 200mlglass container
A12CC 20.4 magnesium chloride 500mg - 700mg 60 tablet ULTIMAG; SLOW-MAGA12CC 20.4 magnesium chloride 500mg - 700mg 100 tablet ULTIMAG; SLOW-MAG
A02AA 12.4magnesium hydroxide mixture
BP 2 500ml suspension
A12CC 20.4 magnesium sulphate 1 A P 50% 2ml 1 injectionADCO-MAGNESIUM SULPHATE
X Ø magnesium sulphate A P BP 500g powder
A02AA 12.4magnesium trisilicate mixture compound
BPC 500ml suspension MIST MAG TRISIL CO.
A02AA Ø magnesium trisilicate BP 100ml mixtureMIST MAG TRISILICATE BP
D03 14.9
malic acid + benzoic acid + salicylic acid + propylene glycol
0,375% + 0,025% + 0,006% + 1,75%
50g cream ASERBINE
B05BC 16.1 mannitol 1 A P 25% 50ml 1 injection ADCO-MANNITOLP02CA 13 mebendazole 1 A 500mg 1 tablet VERMOX For children over two years of age and for adults.
L02AB 19.6.3 medroxyprogesterone 100mg 100 tablet FARLUTAL
Specialist gynaecologist, obstetrics and oncologist
Page 45 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
L02AB 19.6.3 medroxyprogesterone 500mg 100 tablet FARLUTAL
Specialist gynaecologist, obstetrics and oncologist
G03DA 19.6.3medroxyprogesterone acetate
1 A 150mg/ml 1 injection DEPO PROVERA Available from family planning.
G03DA 19.6.3medroxyprogesterone acetate
5mg 30 tablet PROVERA
V08AA Ømeglumine + sodium diatrizoates
26,1% + 3,9% 250ml
1 injection UROGRAFIN 30%
V08AA Ømeglumine + sodium diatrizoates
A 66% +10% 20ml 10 injection UROGRAFIN 76%
V08AA Ømeglumine + sodium amidotrizoates
A 66% + 10% 100ml 1 injection GASTROGRAFIN
V08AB Ømeglumine + sodium ioxaglate
39,3% + 19,65% 50ml
10 injection HEXABRIX Specialist
Only for use in patients with a history of reaction to contrast media; history of allergy, coronary angiography in high risk patients & children;myelography; certain neuroradiological procedures; peripheral angiography when necessary
V08AA Ø meglumine iothalamate A 60% 50ml 1 injection CONRAY 280V08AA Ø meglumine iothalamate A 70% 50ml 1 injection CONRAY 420
L01AA 23 melphalan A P 100mg 1 injection ALKERANSpecialist oncologist
L01AA 23 melphalan A P 2mg 25 tablet ALKERANSpecialist oncologist
L01AA 23 melphalan A P 5mg 25 tablet ALKERANSpecialist oncologist
L01BB 23 mercaptopurine P 50mg 25 tablet PURI-NETHOLSpecialist oncologist
D08AK Ø mercurochrome 1% 20ml solution MERCUROCHROME
J01DH 18.1.3 meropenem 500mg 1 injection MERONEM SpecialistOnly for severe nosocomial infections in ICU's & on a Microbiologist report.
A07EC 12.10 mesalazine 500mg 20 suppository ASACOLSpecialist gastroenterologist
A07EC 12.10 mesalazine 400mg 90 tablet ASACOLSpecialist gastroenterologist
mesna inhalation solution: see sodium-2-mercapto sulfonate
G03BB 19.6.1 mesterolone 25mg 100 tablet PROVIRONSpecialist endocrinologist
A10BA 19.1.2 metformin 1 A 500mg 56 tablet GLUCOPHAGEA10BA 19.1.2 metformin 1 A 500mg 84 tablet GLUCOPHAGEA10BA 19.1.2 metformin A 500mg 500 tablet GLUCOPHAGEA10BA 19.1.2 metformin 1 A 850mg 56 tablet GLUCOPHAGE FORTEA10BA 19.1.2 metformin A 850mg 300 tablet GLUCOPHAGE FORTEPage 46 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
N02AC 3.1 methadone 10mg/ml 1 injection PHYSEPTONE
N02AC 10.1.1 methadone 2mg/5ml 100ml linctus PHYSEPTONEFor management of opioid withdrawal. To be used according to the Guidelines for the Management of Substance Detoxification.
L01BA 23 Supp List 116methotrexate(amethopterin)
A P 5mg 1 injection METHOBLASTIN
Specialist dermatologist, oncologist, paediatrician and rheumatologist
L01BA 23 Supp List 116methotrexate(amethopterin)
A P 50mg/2ml 1 injection ABITREXATE 50
Specialist dermatologist, oncologist, paediatrician and rheumatologist
L01BA 23 Supp List 116methotrexate(amethopterin)
A P 500mg 1 injection EMTHEXATE 500mg
Specialist dermatologist, oncologist, paediatrician and rheumatologist
L01BA 23 Supp List 116methotrexate(amethopterin)
A P 1g 1 injection METHOBLASTIN
Specialist dermatologist, oncologist, paediatrician and rheumatologist
L01BA 23 Supp List 116methotrexate(amethopterin)
A P 5g 1 injection METHOBLASTIN
Specialist dermatologist, oncologist, paediatrician and rheumatologist
L01BA 23methotrexate(amethopterin)
A P 2,5mg 100 tablet METHOTREXATE
Specialist physician, dermatologist, oncologist, paediatrician & rheumatologist
D05BA 14.7 methoxsalen 10mg 100 capsule OXSORALENSpecialist dermatologist
Not referable.
C02AB 7.3.1 Supp List 123 methyldopa 1 A 250mg 56 tablet ALDOMETGeneral code Clinical Nurse Practitioner
General code: For hypertension in pregnancy Clinical Nurse Practitioner: For hypertension in pregnancy. Nursing to implement an AE reporting system, with 6 month report to District PTC.
Page 47 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
C02AB 7.3.1 Supp List 123 methyldopa 1 A 250mg 84 tablet ALDOMETGeneral code Clinical Nurse Practitioner
General code: For hypertension in pregnancy Clinical Nurse Practitioner: For hypertension in pregnancy. Nursing to implement an AE reporting system, with 6 month report to District PTC.
C02AB 7.3.1 Supp List 123 methyldopa A 250mg 500 tablet ALDOMETGeneral code Clinical Nurse Practitioner
General code: For hypertension in pregnancy Clinical Nurse Practitioner: For hypertension in pregnancy. Nursing to implement an AE reporting system, with 6 month report to District PTC.
V03AB Ø methylene blue A P 1% 10 injection METHYLENE BLUEX Ø methylparaben 100g powder
N06BA 1.1.3 Supp List 116 methylphenidate P 10mg 30 tablet RITALIN
Specialist psychiatrists, neurologists, paediatricians and school doctor initiated
N06BA 1.1.3 Supp List 116 methylphenidate P 20mg 30Long -acting tablet
RITALIN LA
Specialist psychiatrists, neurologists, paediatricians and school doctor initiated
For use after trial of the short-acting formulation proved unsuccessful.
N06BA 1.1.3 Supp List 116 methylphenidate P 30mg 30Long -acting tablet
RITALIN LA
Specialist psychiatrists, neurologists, paediatricians initiated
For use after trial of the short-acting formulation proved unsuccessful.
H02AB 19.5 methylprednisolone 125mg 1 injection SOLU-MEDROLH02AB 19.5 methylprednisolone P 500mg injection SOLU-MEDROLH02AB 19.5 methylprednisolone 1g 1 injection SOLU-MEDROL
D07AC 14.4methylprednisolone aceponate
1mg/g 15g cream ADVANTAN CREAMSpecialist dermatologist
Dermatologists only. To be strictly controlled, not to be referred.
D07AC 14.4methylprednisolone aceponate
1mg/g 30g cream ADVANTAN CREAMSpecialist dermatologist
Dermatologists only. To be strictly controlled, not to be referred.
D07AC 14.4methylprednisolone aceponate
1mg/g 15g ointment ADVANTAN OINTMENTSpecialist dermatologist
Dermatologists only. To be strictly controlled, not to be referred.
D07AC 14.4methylprednisolone aceponate
1mg/g 30g ointment ADVANTAN OINTMENTSpecialist dermatologist
Dermatologists only. To be strictly controlled, not to be referred.
D07AC 14.4methylprednisolone aceponate
1mg/g 15g fatty ointmentADVANTAN FATTY OINTMENT
Specialist dermatologist
Dermatologists only. To be strictly controlled, not to be referred.
D07AC 14.4methylprednisolone aceponate
1mg/g 30g fatty ointmentADVANTAN FATTY OINTMENT
Specialist dermatologist
Dermatologists only. To be strictly controlled, not to be referred.
Page 48 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
H02AB 19.5 Supp List 114methylprednisolone acetate
80mg/2ml I.M. 1 injection DEPO-MEDROLFor Intra-lesional, Intra-bursal, Intra-articular and Peri-articular administration only.
D07A 14.4 Supp List 124methylprednisolone acetate
ADVANTANCheapest steroid scalp application on tender to be coded
MA2AB Ø Supp List 119 methyl salicylate 1 10% - 25% 25g ointmentRestricted for use in patients with soft tissue rheumatism
N02CA 1.9 methysergide 1mg 100 tablet DESERILSpecialist neurologist
A03FA 1.8 metoclopramide A P 10mg/2ml 1 injection MAXOLON; CLOPAMONA03FA 1.8 metoclopramide 1 P 5mg/5ml 50ml syrup MAXOLONA03FA 1.8 metoclopramide 1 A P 10mg 10 tablet MAXOLONA03FA 1.8 metoclopramide A P 10mg 100 tablet MAXOLON; PROSTALA03FA 1.8 metoclopramide A P 10mg 500 tablet CLOPAMON-TA03FA 1.8 metoclopramide A P 10mg 1 000 tablet CLOPAMON-T
C03BA 16.1 metolazone P 2,5mg 30 tablet ZAROXOLYNSpecialist nephrologist
For use in renal units & patients with renal failure. Available via Section 21
C03BA 16.1 metolazone 5mg 30 tablet ZAROXOLYNSpecialist nephrologist
As above
P01ABJ01XD
18.9 metronidazole A P 500mg/100ml I.V 1 infusion FLAGYL; TRICHAZOLE SpecialistFirst dose only if necessary, then change to oral or supp. as soon as possible.
P01AB 18.9 metronidazole A 500mg 10 suppository FLAGYLP01AB 18.9 metronidazole 1g 10 suppository FLAGYLP01AB 18.9 metronidazole 1 P 200mg/5ml 50ml suspension FLAGYLP01AB 18.9 metronidazole 1 P 200mg/5ml 100ml suspension FLAGYLP01AB 18.9 metronidazole 1 A P 200mg 21 tablet FLAGYL; ZOLEROLP01AB 18.9 metronidazole A P 200mg 250 tablet FLAGYL; ZOLEROL
P01AB 18.9 metronidazole 400mg 5 tabletFLAGYL; METRAZOLE-400
P01AB 18.9 metronidazole 400mg 15 tablet FLAGYLP01AB 18.9 metronidazole 400mg 21 tablet FLAGYLP01AB 18.9 metronidazole 400mg 100 tablet FLAGYL; ZOLEROLP01AB 18.9 metronidazole 400mg 500 tablet FLAGYL
C01BB 7.2 mexiletine 50mg 100 capsule MEXITILSpecialist cardiologist
C01BB 7.2 mexiletine 100mg 100 capsule MEXITILSpecialist cardiologist
C01BB 7.2 mexiletine 200mg 100 capsule MEXITILSpecialist cardiologist
C01BB 7.2 mexiletine 250mg/10ml 5 injection MEXITILSpecialist cardiologist
N06AX 1.4.2 mianserin 10mg 28 tablet LANTANON
Specialist psychiatrist & geriatrician initiated
Page 49 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
N06AX 1.4.2 mianserin 10mg 56 tablet LANTANON
Specialist psychiatrist & geriatrician initiated
N06AX 1.4.2 mianserin 10mg 90 tablet LANTANON
Specialist psychiatrist & geriatrician initiated
N06AX 1.4.2 mianserin 10mg 300 tablet LANTANON
Specialist psychiatrist & geriatrician initiated
N06AX 1.4.2 mianserin 30mg 28 tablet LANTANON
Specialist psychiatrist & geriatrician initiated
N06AX 1.4.2 mianserin 30mg 42 tablet LANTANON
Specialist psychiatrist & geriatrician initiated
N06AX 1.4.2 mianserin 30mg 100 tablet LANTANON
Specialist psychiatrist & geriatrician initiated
A01AB 11.3 miconazole 20mg/g 30g oral gel DAKTARIN SpecialistNot to be used as first line treatment. Try nystatin oral drops first.
N05CD 1.2.1 midazolam 15mg/3ml 1 injection DORMICUM Approved for use by paramedics as well.N05CD 1.2.1 midazolam A P 5mg/5ml 1 injection DORMICUM Approved for use by paramedics as well.N05CD 1.2.1 midazolam 7,5mg 20 tablet DORMICUM Pre-med for general paediatric anaesthesia
G03XB 19.8 Supp List 122 mifepristone 200mg 3 tablet MIFEGYNE
General
Specialist Gynaecologist
General: To be used according to Health Programmes' protocol for MTOP in the first trimester (up to 63 days) Specialist Gynaecologist: For TOP in fetal anomalies
C02DC 7.3.1 minoxidil 10mg 100 tablet LONITENSpecialist physician initiated
C02DC 7.3.1 minoxidil 5mg 100 tablet LONITENSpecialist physician initiated
A02BB 12.4.2 misoprostol 200µg 56 tablet CYTOTEC
Specialist gastroenterologist & gynaecologist. TOP clinics as per provincial circular
May be used in casualty for miscarriage without specialist prescription. See EDL warning re uterine rupture
mitomycin-C: See streptomyces caespitosis
L01DB 23 mitoxantrone A P 10mg/5ml 1 injection NOVANTRONE SpecialistPage 50 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
L01DB 23 mitoxantrone A P 20mg/10ml 1 injection NOVANTRONE Specialist
N06AG 1.4.6 moclobemide 150mg 60 tablet AURORIXSpecialist psychiatrist
Medicines to be obtained from institution initiating prescription.
A06AD 12.6 Supp List 122
monobasic sodium phosphate anhydrous + dibasic sodium phosphate anhydrous
5g / 10g 2 satchets COLO-PREP For pre-procedure bowel preparation
R03DC 10.4.2 Supp List 117 montelukast 4mg/packet 28 packetssprinkles (granules)
SINGULAIR Specialist
Add-on therapy for patients under 5 years old who remain uncontrolled on appropriate doses of inhaled steroids Allergy and Pulmonary clinics only Not referable
R03DC 10.4.2 Supp List 117 montelukast 5mg 28 chew tablet SINGULAIR Specialist
Add-on therapy for patients under 5 years old who remain uncontrolled on appropriate doses of inhaled steroids Allergy and Pulmonary clinics only Not referable
A06AG 12.7sodium phosphate & sodium acid phosphate
60mg & 160mg/135ml
1 enema - adult LENOLAX; FOSENEMA
P03AA 14.2 monosulfiram 1 5% 75g soap TETMOSOLN02AA 31 morphine HCl 10g powderN02AA 3.1 morphine sulphate 1 A P 10mg/ml 1 injection MORPHINEN02AA 3.1 morphine sulphate 15mg/ml 1 injection MORPHINE
R01AX 11.1 mupirocin A 2% 3gnasal ointment
BACTROBAN NASAL SpecialistOn confirmation of nasal staphylococcus infection from a microbiologist report ONLY.
D06AX 14.1 mupirocin A 2% 15g ointment BACTROBAN TOPICAL Specialist For Staph. resistant infections in burns units only.
L04AA 24.1 mycophenolate mofetil 250mg 100 capsule CELLCEPT
Specialist.Not referable to non-academic institutions in the Metropole. Can be referred to other regions.
i) Prescribe only post transplant at academic institutions.ii) Dispense only at academic institutions for patients resident in the metropole.iii) Dispense at non-academic institutions for patients in the rural regions - arrange access to stock with referring Institution
L04AA 24.1 Supp List 122 mycophenolate sodium 180mg 120enteric coated tablet
MYFORTIC Specialist
Specialist: For post transplant patients with GIT side effects. Non-referable, central hospitals. Central (tertiary) hospitals to arrange stock with referring institutions for patients in rural areas
L04AA 24.1 Supp List 122 mycophenolate sodium 360mg 120enteric coated tablet
MYFORTIC Specialist
Specialist: For post transplant patients with GIT side effects. Non-referable, central hospitals. Central (tertiary) hospitals to arrange stock with referring institutions for patients in rural areas
J01MB 16.4Supp List 117 and Supp List 119
nalidixic acid 1 A 250mg/5ml 100ml suspension WINLOMYLONAlso to be used for Dysentery, bacillary, instead of Ciprofloxacin suspension as indicated in the EDL
J01MB 16.4 nalidixic acid 1 A 500mg 100 tablet PUROMYLON For infective diarrhoea and food poisoning only.Page 51 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
V03AB 1.1.2 naloxone 1 A P 0,4mg/ml 1 injection NARCAN
A14AB 19.6.1 nandrolone decanoate 25mg/ml 1 injection DECA-DURABOLINSpecialist endocrinologist
A14AB 19.6.1 nandrolone decanoate 50mg/ml 1 injection DECA-DURABOLINSpecialist endocrinologist
J05AE 18.12pgwcARV depot
nelfinavir 50mg/g 144g powder VIRA-CEPT AIDS programmeAvailable through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.
J05AE 19.12pgwcARV depot
nelfinavir 250mg 270 tablet VIRA-CEPT AIDS programme As above.
S02C 15.3neomycin + betamethasone sod. phos
0,00035% + 0,1% 3g eye ointment BETNESOL NSpecialist ophthalmologist
N07AA 5.3 neostigmine A P 0.5mg/ml 1 injection PROSTIGMINN07AA 5.3 neostigmine 2,5mg/ml 1 injection PROSTIGMIN
J05AG 18.12pgwcARV depot
nevirapine 10mg/ml 240ml solutionADCO-NEVIRAPINE, ASPEN NEVIRAPINE, VIRAMUNE
AIDS programme Available through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.
J05AG 18.12pgwcARV depot Supp List 124
nevirapine 200mg 60 tablet VIRAMUNE
General code: AIDS programme CNP / Professional nurse
General code: AIDS programme: Available through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols. CNP / Professional nurse: Available through HIV / AIDS programme: For first line treatment of adult AIDS patients as per HIV / AIDS guidelines 2010 for treating AIDS patients and per Circular H30/2011: Authorisation of Nurse Prescribing for Antiretroviral Treatment
A11HA 20.1? nicotinamide 1 A 100mg 100 tablet NICOTINAMDEB04AE 20.1 nicotinic acid 100mg 100 tablet NICOTINIC ACID
C08CA 7.3.7Supp List 119/122
nifedipine 1 A P 5mg 100 capsuleADALAT; CARDIFEN-5
General Family Physician Specialist physician, paediatrician & gynaecologist
General: hypertensive emergencies in pregnancy and paediatrics Family Physician: For Raynaud's phenomenon
C08CA 7.3..7 Supp List 122 nifedipine 10mg 84 capsuleADALAT; CARDILAT
General Family Physician Specialist physician, paediatrician & gynaecologist
General: As a tocolytic agent Family Physician: For Raynaud's Syndrome Specialist physician, paediatircian & gynaecologist: For Raynaud's phenomenon, Pulmonary Hypertension, and Pregnancy Induced Hypertension.
C08CA 7.3.7 Supp List 122 nifedipine 10mg 250 capsule ADALAT; CARDILAT
General Family Physician Specialist physician, paediatrician & gynaecologist
As above
Page 52 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
C08CA 7.3.7 nifedipine 30mg 28 tablet ADALAT XLSpecialist gynaecologist
For hypertension in pregnancy only.
Supp List 123nipastat preservative solution
2,5L liquid
C08CA 7.5 Supp List 122 nimodipine 30mg 100 tablet NIMOTOPSpecialist neurosurgeon
Neurosurgery, central hospitals only Non-referable
C08CA 7.5 Supp List 122 nimodipine 10mg/50ml 1 infusion NIMOTOPSpecialist neurosurgeon
Neurosurgery, central hospitals only Non-referable
G04AC 16.4 nitrofurantoin P 50mg 50 capsuleMACRODANTIN; FURADANTIN
G04AC 16.4 nitrofurantoin 100mg 50 capsule MACRODANTINC01DA 7.5.2 nitroglycerine 50mg/10ml 1 infusion TRIDIL SpecialistC01DA 7.5.2 nitroglycerine starterpack 1 infusion TRIDIL SpecialistG03DC 19.6.3 norethisterone A 5mg 30 tablet PRIMOLUT-N
G03AC 17.1.1ex family planning stores
norethisterone enanthate
1 200mg/ml 1 injection NUR-ISTERATE Family Planning
G03AB 17.1.1ex family planning stores
norethisterone +ethinyl oestradiol
0,5mg;0,75mg;1mg +0,035mg
28 tablet TRINOVUM Family Planning EDL
G03AA 17.1.1norgestrel + ethinyl oestradiol
1 A0,5mg +0,05mg
28 tablet OVRAL Family Planning
G03FB 19.6.4norgestrel + oestradiol
A0,5mg +2mg
28 tablet POSTOVAL
A01AB 18.8 nystatin 1 P 100 000u/ml 20ml suspension NYSTACIDD01AA 18.8 nystatin 1 100 000u/g 15g topical cream NYSTACID ointment/cream: buy cheapest on tender
D01AA 18.8 nystatin 1 100 000u/g 15gtopical ointment
NYSTACID ointment/cream: buy cheapest on tender
G01AA 18.8 nystatin vaginal 1 A 100 000u 15 vaginal tabletsNYSTACID; MYCOSTATIN
G03CA 19.6.2 oestradiol 2mg 28 tablet ESTROFEM
Specialist gynaecologists, obstetricians & endocrinologists initiated.
G03CA 19.6.2 oestradiol valerate A 1mg 21 tabletPROGYNOVAESTRO-PAUSE
G03CA 19.6.2 oestradiol valerate 2mg 21 tablet PROGYNOVA
G03CA 19.6.2 oestradiol implant 20mg 1 pellet OESTRADIOLSpecialist gynaecologist
G03FB 19.6.4oestradiol + norethisterone
A2mg;2mg;1mg + 1mg
28 tablet TRISEQUENS
G03CA 19.6.2oestrogen conjugated I.V./I.M.
A 25mg / 5ml 1 injection PREMARIN
G03CA 19.6.2 oestrogen conjugated 0,3mg 100 tablet PREMARING03CA 19.6.2 oestrogen conjugated A 0,625mg 28 tablet PREMARING03CA 19.6.2 oestrogen conjugated A 0,625mg 500 tablet PREMARINPage 53 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
G03CA 19.6.2 oestrogen conjugated A 1,25mg 28 tablet PREMARING03CA 19.6.2 oestrogen conjugated A 1,25mg 500 tablet PREMARING03CA 19.6.2 oestrogen conjugated 0,625mg/g 43g vaginal cream PREMARIN
G03FB 19.6.4oestrogens, conjugated +medrogestone
0,625mg +5mg
38 tablet PREMPACK-N
G03FB 19.6.4oestrogens, conjugated +medrogestone
1,25mg +5mg
38 tablet PREMPACK-N
G03DB 19.6.4oestrogens, conjugated +medroxyprogesterone
0,625mg +2,5mg
28 tablet PREMELLEUse according to HRT guidelines. See Circular H95/2005 L1011
S01AX 15.1 ofloxacin 3mg/ml 5ml eye drops EXOCIN; OCTINSpecialist ophthalmologist, paediatrician & ENT
Cheapest fluoroquinolone on tender to be bought.
J01MA 18.7 ofloxacin A 200mg 100ml infusion soln. TARIVID SpecialistMotivation form to be completed or on a microbiologist report.
J01MA 18.7 ofloxacin A 200mg 10 tablet TARIVID Specialist Fluoroquinolone of choice in Multiple Drug Resistant TB.FOR THE exclusive USE IN MDR TB .
J01MA 18.7 ofloxacin A 200mg 100 tablet TARIVID Specialist As aboveJ01MA 18.7 ofloxacin A 400mg 56 tablet TARIVID Specialist As aboveJ01MA 18.7 ofloxacin A 400mg 100 tablet TARIVID Specialist As aboveX Ø olive oil BP 500ml liquid OLIVE OILA02BC 12.4.4 omeprazole 10mg 28 tablet LOSEC MUPS Specialist Paediatricians only
A02BC 12.4.4 omeprazole A P 20mg 14 tablet LOSECPaediatrician & Endoscopy units initiated
Cheapest PPI on tender to be used. For treatment guidelines refer to: Circular H95/2005 (Addendum B - Suppl. List 102)
A02BC 12.4.4 omeprazole A P 20mg 28 tablet LOSECPaediatrician & Endoscopy units initiated
As above.
Oral Rehydration Salt solutionsee sodium chloride co. below
H01BA 7.6 ornipressin 5iu/ml 1 injection POR 8 SpecialistN04AB 1.7.2 orphenadrine 1 A 50mg 28 tablet DISIPALN04AB 1.7.2 orphenadrine 1 A 50mg 56 tablet DISIPALN04AB 1.7.2 orphenadrine 1 A 50mg 84 tablet PHENERINE; DISIPALN04AB 1.7.2 orphenadrine A 50mg 100 tablet DISIPAL; PHENERINEN04AB 1.7.2 orphenadrine 1 A 50mg 112 tablet PHENERINE; DISIPAL
J05AH 18.12Suppl List 119
oseltamivir 75mg 10 tablet TAMIFLU
For use in prophylaxis and treatment of pandemic H1N1 virus as per national and provincial protocols. Will be made available and accessible when required at strategic sitesPage 54 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J05AH 18.12Suppl List 119
oseltamivir 12mg/ml suspension TAMIFLU
For use in prophylaxis and treatment of pandemic H1N1 virus as per national and provincial protocols. Will be made available and accessible when required at strategic sites
N05BA 1.3.1 oxazepam A 10mg 14 tablet SEREPAX; PURATA
No more than 14 days supply, unless when prescribed by a psychiatrist or neurologist, when 28 days supply may be dispensed. See circular H24/2006; Suppl List 107 - addendum I
N05BA 1.3.1 oxazepam A 10mg 250 tabletSEREPAX; PURATA; OXALINE
No more than 14 days supply, unless when prescribed by a psychiatrist or neurologist, when 28 days supply may be dispensed. See circular H24/2006; Suppl List 107 - addendum I
N05BA 1.3.1 oxazepam A 15mg 14 tablet SEREPAX; PURATASpecialist psychiatrist & neurologist
NO NEW PATIENTS TO BE PRESCRIBED THIS STRENGTH, unless if done by a psychiatrist or neurologist. (Refer to circular H24/2006, SL 107, Addendum 1)
N05BA 1.3.1 oxazepam A 15mg 250 tabletSEREPAX; PURATA; OXALINE
Specialist psychiatrist & neurologist
NO NEW PATIENTS TO BE PRESCRIBED THIS STRENGTH, unless if done by a psychiatrist or neurologist. (Refer to circular H24/2006, SL 107, Addendum 1)
S01HA 15.7 oxybuprocaine 1 A P 0,4% 3ml eye drops NOVESINS01HA 15.7 oxybuprocaine 1 A P 0,4% 0,5ml x 20 minims MINIMS BENOXINATE
G04BD 5.4 oxybutynin A 5mg 100 tabletDITROPAN; SANDOZ OXYBUTYNIN
Specialist neurologist, urologist, gynaecologist, nephrologist, paediatrician & Western Cape Rehab Centre
Maximum dose: 5mg three times a day.
S01GA 15.4 oxymetazoline 1 0,025% 10ml eye drops AFRIN
R01AA 11.1 oxymetazoline 1 P 0.03% 10mlpaed. nose drops
DRIXINE ALTERNATIVE: Xylometazoline when cheaper.
R01AA 11.1 oxymetazoline 1 A 0,05% 10mladult nose drop
DRIXINE/ILIADEN As above.
S01AA 15.1oxytetracycline + polymyxin B
1 A 5mg + 10 000u/g 5g eye ointment TERRAMYCIN
H01BB 17.3 oxytocin A P 5iu/ml 1 injection SYNTOCINONH01BB 17.3 oxytocin 1 A 10iu/ml 1 injection SYNTOCINONG02AB 17.3 oxytocin + ergometrine 5iu + 0,5mg/ml 5 injection SYNTOMETRINE
pamidronate: see disodium-pamidronate
A09 12.1 pancreatin 150mg
amylase 8 000; lipase 10 000; protease 600 FIP units enzyme activity
100 capsule CREONSpecialist physician & paediatrician
Page 55 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
A09 12.1 pancreatin 300mg
amylase 18 000; lipase 25 000; protease 1 000 FIP units enzyme activity
100 capsule CREONSpecialist physician & paediatrician
M03AC 2.3 pancuronium bromide A P 4mg/2ml 1 injection PAVULONA02BC 12.4.4 pantoprazole 40mg/10ml 1 injection PANTOLOC Specialist
A02BC 12.4.4 pantoprazole A P 40mg 14 tablet PANTOLOCPaediatrician & Endoscopy units initiated
Cheapest PPI on tender to be used. For treatment guidelines refer to: Circular H95/2005 (Addendum B - Suppl. List 102)
A02BC 12.4.4 pantoprazole A P 40mg 28 tablet PANTOLOCPaediatrician & Endoscopy units initiated
As above
J04A 18.8.1 para-aminosalicylic acid 4G 30 powder PASER GRANULES Specialist As per XDR TB protocol
N02BE 3.2 Supp List 123 paracetamol 500mg 1 injection PERFALGAN Specialist
For patients who cannot swallow and safely receive postoperative opioids in : - Obstructive sleep apnoea - Neuromuscular weakness - Respiratory failure Expenditure and usage to be closely monitored.
N02BE 3.2 Supp List 123 paracetamol 1000mg 1 injection PERFALGAN Specialist
For patients who cannot swallow and safely receive postoperative opioids in : - Obstructive sleep apnoea - Neuromuscular weakness - Respiratory failure Expenditure and usage to be closely monitored.
N02BE 3.2 paracetamol 125mg 10 suppository EMPAPED Single, post-operative dose.N02BE 3.2 paracetamol 250mg 10 suppository EMPAPED Single, post-operative dose.
N02BE 3.2 Supp List 119 paracetamol 1 P 120mg 50ml syrup DOLOROL; PAMOL
For acute conditions: Not more than 5 days supply. NOT REPEATABLE FOR ACUTE CONDITIONS. For longer periods, the appropriate diagnosis and quantity to be written on the prescription
N02BE 3.2 Supp List 119 paracetamol 1 P 120mg 100ml syrup DOLOROL; PAMOL
For acute conditions: Not more than 5 days supply. NOT REPEATABLE FOR ACUTE CONDITIONS. For longer periods, the appropriate diagnosis and quantity to be written on the prescription
N02BE 3.2 Supp List 119 paracetamol 1 A P 500mg 10 tablet PANADO
For acute conditions: Not more than 5 days supply. NOT REPEATABLE FOR ACUTE CONDITIONS. For longer periods, the appropriate diagnosis and quantity to be written on the prescription
Page 56 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
N02BE 3.2 Supp List 119 paracetamol 1 A P 500mg 20 tablet DOLOROL
For acute conditions: Not more than 5 days supply. NOT REPEATABLE FOR ACUTE CONDITIONS. For longer periods, the appropriate diagnosis and quantity to be written on the prescription
N02BE 3.2 Supp List 119 paracetamol A P 500mg 100 tablet DOLOROL
For acute conditions: Not more than 5 days supply. NOT REPEATABLE FOR ACUTE CONDITIONS. For longer periods, the appropriate diagnosis and quantity to be written on the prescription
N02BE 3.2 Supp List 119 paracetamol A P 500mg 5000 tablet DOLOROL
For acute conditions: Not more than 5 days supply. NOT REPEATABLE FOR ACUTE CONDITIONS. For longer periods, the appropriate diagnosis and quantity to be written on the prescription
paraffin soft: see soft paraffin
L03AB 24.2 Supp List 117pegylated interferon alfa-2a
135µg/0,5ml 1pre-filled syringe
PEGASYS Specialist
Central hospitals only. Patient Named Basis. Number of patients to be treated to be decided by local PTC
L03AB 24.2 Supp List 117pegylated interferon alfa-2a
180µg/0,5ml 1pre-filled syringe
PEGASYS Specialist
Central hospitals only. Patient Named Basis. Number of patients to be treated to be decided by local PTC
M01CC 25 penicillamine A 300mg 100 capsule METALCAPTASE Specialist
J01CE 18.1.1 penicillin; benzathine 1 A P 1.2Mu 1 injectionBICILLIN LA; PENILENTE LA
J01CE 18.1.1 penicillin; benzathine 1 2.4Mu 1 injectionBICILLIN LA; PENILENTE LA
J01CE 18.1.1penicillin; benzathine penicillin; procaine penicillin; benzyl sodium
600 000 units300 000 units300 000 units
1single dose
injectionBICILLIN; PENILENTE FORTE 1,2 MU
J01CE 18.1.1penicillin; benzathine penicillin; procainepenicillin; benzyl sodium
600 000 units300 000 units 300 000 units
1 multi-dose
injectionBICILLIN; PENILENTE FORTE 6 MU
J01CE 18.1.1 penicillin; benzyl sodium 1 A P 1Mu (600mg) 1 injectionNOVOPEN; BENZYLPENICILLIN
J01CE 18.1.1 penicillin; benzyl sodium 1 5Mu (3g) 1 injectionNOVOPEN; BENZYLPENICILLIN
J01CE 18.1.1penicillin; phenoxymethyl
1 P 125mg/5ml 100ml suspensionDAROCILLIN; COPEN; BETAPEN
J01CE 18.1.1penicillin; phenoxymethyl
1 P 250mg/5ml 100ml suspensionDAROCILLIN; COPEN; BETAPEN
Page 57 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J01CE 18.1.1penicillin; phenoxymethyl
1 A P 250mg 20 tablet DELTACILLIN
J01CE 18.1.1penicillin; phenoxymethyl
A P 250mg 100 tablet COPEN; BETAPEN
J01CE 18.1.1penicillin; phenoxymethyl
A P 250mg 500 tablet COPEN; BETAPEN
J01CE 18.1.1 penicillin; procaine A P 0.3Mu/ml 10ml 1 injectionPROCILLIN; NOVOCILLIN
V04CG Ø pentagastrin 250µg/ml 5 injection PEPTAVLON Specialist
N02AB 3.1 pethidine 1 P 25mg/ml 1 injectionPETHIDINE INJ. LABETHICA
Restricted to labour wards, midwife obstetric units, midwifes and patients allergic to morphine.Morphine remains first agent of choice.
N02AB 3.1 pethidine 1 A 50mg/ml 1 injectionPETHIDINE INJ. LABETHICA
As above.
N02AB 3.1 pethidine A 100mg/2ml 1 injectionPETHIDINE INJ. LABETHICA
As above.
petroleum jelly: see soft paraffin
N03AA 1.2.2phenobarbitone + vitamins
1 P 16mg/5ml 100ml elixirADCO-PHENOBARBITONE VITALET
N03AA 1.2.2 phenobarbitone P 200mg/ml 1 injection GARDENALN03AA 1.2.2 phenobarbitone 15mg 1 000 tablet LETHYLN03AA 1.2.2 phenobarbitone 1 A P 30mg 84 tablet LETHYL
N03AA 1.2.2 phenobarbitone A P 30mg 1 000 tabletLETHYLSEDABARB
N03AA 1.2.2 phenobarbitone A P 30mg 5 000 tablet LETHYLC01CA 7.6? phenylephrine A P 10mg/ml 1 injection PHENYLEPHRINE
N03AB 1.6 phenytoin 1 A P 250mg/5ml 1 injection EPANUTINFor use in convulsive status epilepticus and trauma ONLY.
N03AB 1.6 phenytoin 1 A 100mg 56 tablet EPANUTINN03AB 1.6 phenytoin 1 A 100mg 84 tablet EPANUTINN03AB 1.6 phenytoin A 100mg 500 tablet EPANUTINN03AB 1.6 phenytoin A 100mg 5 000 tablet EPANUTIN
X 20.4 phosphate supplement P 100tablet, effervescent
PHOSPHATE SANDOZ Specialist
phospholipid solurion: See total phospholipids
G04BE 17.5.2
phosphodiesterase-5-inhibitors: sildenafil; tadalafil; vardenafil
various various tabletsVIAGRA; CIALIS; LEVITRA
Central HospitalSpecialist
Urology. Not for treatment. To be used only as a dia- gnostic tool in erectile dysfunction - 2 doses maximum. Patient name basis.
B02BA 8.1 phytomenadione (vit K1) 1 P 2mg/0,2ml 1injection for IV & oral
KONAKION MM
B02BA 8.1 phytomenadione (vit K1) A P 10mg/ml 1 injection KONAKIONB02BA 8.1 phytomenadione (vit K1) A P 10mg 10 tablets KONAKION specialist
Page 58 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
S01EB 15.6pilocarpine + hypromellose
1 A P 1% + 0,5% 15ml eye drops ISOPTO-CARPINE
S01EB 15.6 pilocarpine 2% 15ml eye drops ISOPTO-CARPINE
S01EB 15.6 pilocarpine 4% 5g gel PILOGELSpecialist ophthalmologist initiated
N05AG 1.5.1 pimozide 1mg 75 tablet ORAP
Specialist paediatrician, neurologist, psychiatrist
Patient name basis only
N05AG 1.5.1 pimozide 4mg 100 tablet ORAP
Specialist paediatrician, neurologist, psychiatrist
As above
J01CR 18.1.1piperacillin + tazobactam
4g + 500mg 1 injection TAZOCIN SpecialistOnly for severe nosocomial infections in ICU's & on a Microbiologist report.
D06BB 14.9 Supp List 117podophyllotoxin topical solution
A 5mg/ml 3mL liquid WARTECFor genital warts. To be applied by health professional
X 10.5 poractant alfa 80mg/ml vialintratrachial suspension
CUROSURFNeonatal ICU and high care
For use in selected pre-term infants between 700g and 1 000g body weight
A12BA 20.4 potassium chloride A P 15% 10ml 1 injectionSABAX POTASSIUM CHLORIDE INJ.
A12BA 20.4 potassium chloride 600mg 500 tablet SLOW-K 600General
Specialist initiated
For proven hypokalaemia.• For in-patients• For out-patients - maximum of 12 weeks
» For long term use
G04B Øpotassium citrate mixture
A
BP: Citric Acid 5% Pot. Citrate 30%
100ml liquidPOTASSIUM CITRATE MIXTURE
G04B Øpotassium citrate mixture
A
BP: Citric Acid 5% Pot. Citrate 30%
200ml liquidPOTASSIUM CITRATE MIXTURE
D08AX Øpotassium permanganate
500g crystalsPOTASSIUM PERMANGANATE BP
B05XA 20.4 potassium phosphate A P 10ml 10 injectionSABAX POTASSIUM PHOSPHATE
D08AG 14.1 povidone iodine 1 P 5% 25g cream BETADINED08AG 14.1 povidone iodine 1 P 5% 500g cream BETADINE; BIOCREAMD08AG 14.1 povidone iodine 1 10mg/10ml 1 000ml liquid BETADINED08AG 14.1 povidone iodine 1 10mg/10ml 5 000ml liquid BETADINED08AG 14.1 povidone iodine 1 10% 25g ointment BETADINED08AG 14.1 povidone iodine 1 10% 500g ointment BETADINEG01AX 17.2 povidone iodine 200mg 14 pessary BETADINED08AG 14.1 povidone iodine 4g/100ml 150ml shampoo BETADINE
A01 11.3 povidone iodine 1 100mg/10ml 200ml solutionBETADINE ORAL ANTISEPTICPage 59 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
D08AG 14.1 povidone iodine 75mg/ml 1 litre solution ZEDCHEM PVP-I SCRUB
G01AX 17.2 povidone iodine 100mg/ml 250mlvaginal douche
BETADINE CLEANSER KIT
Specialist gynaecologists
G01AX 17.2 povidone iodine 10% 90g vaginal gel BETADINEP02BA 13 praziquantel 500mg 100 tablet CYSTICIDEP02BA 13 praziquantel 1 A P 600mg 10 tablet
BILTRICIDE; CYSTICIDE
C02CA 7.3.2 prazosin A P 1mg 100 tablet PRATSIOLSpecialist paediatricians
S01BA 15.2 prednisolone 10mg/ml 5ml eye drops PRED FORTESpecialist ophthalmologist.
Alternative: Dexamethasone on Specialist Initiated code
H02AB 19.5 prednisolone P 15mg/5ml 60ml syrup PRELONESpecialist paediatrician
H02AB 19.5 prednisolone 5mg 100 tabletMETICORTELONE; LENISOLONE
H02AB 19.5 prednisone P 1mg 100 tablet METICORTENH02AB 19.5 prednisone 1 A P 5mg 28 tablet METICORTENH02AB 19.5 prednisone 1 A P 5mg 100 tablet METICORTENH02AB 19.5 prednisone 1 A P 5mg 500 tablet METICORTENH02AB 19.5 prednisone 5mg 5 000 tablet METICORTEN
V04CX Ø pregnancy test 25iu/L sensitive25 tests per kit maxinum
dipstick test strip
To detect ectopic pregnancy as well as for routine testing.
NO3AA 1.6 Supp List 113 primidone 250mg 100 tablet MYSOLINESpecialist neurologist initiated
For the management of Essential Tremor only
M04AB 4.2 probenecid A 500mg 100 tablet BENEMID; PROBEN
C01BA 7.2 procainamide P 100mg/ml 1 injection PRONESTYLSpecialist cardiologist
L01XB 23 procarbazine A P 50mg 50 tablet NATULANSpecialist oncologist
N05AB 1.5.1 prochlorperazine 12,5mg/ml 1 injection STEMETILN05AB 1.8 prochlorperazine 5mg 5 suppository STEMETILN05AB 1.8 prochlorperazine 25mg 5 suppository STEMETILN05AB 1.5.1 prochlorperazine 5mg 10 tablet STEMETILN05AB 1.5.1 prochlorperazine 5mg 250 tablet STEMETIL; MITILN05AB 1.5.1 prochlorperazine 5mg 500 tablet STEMETIL; MITILR06AD 6.1 promethazine 1 A P 25mg/ml 1 injection PHENERGANR06AD 6.1 promethazine 50mg/2ml 1 injection PHENERGANR06AD 6.1 promethazine A P 10mg 28 tabletR06AD 6.1 promethazine A P 10mg 500 tablet PHENERGANR06AD 6.1 promethazine A P 25mg 28 tabletR06AD 6.1 promethazine A P 25mg 500 tablet PHENERGAN
A03AB 12.3 Supp List 116 propantheline bromide 15mg 100 tablet PRO-BANTHINEFor Western Cape Rehab Centre only. Not referable
N01AX 2.1.2 propofol A P 200mg/20ml 1 injection DIPRIVAN SpecialistC07AA 7.4 propranolol A P 1mg/ml 1 injection INDERALC07AA 7.4 propranolol A P 10mg 84 tablet INDERALC07AA 7.4 propranolol A P 10mg 250 tablet INDERALPage 60 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
C07AA 7.4 propranolol A P 10mg 1 000 tablet INDERALC07AA 7.4 propranolol A 40mg 56 tablet INDERAL;REXIGENC07AA 7.4 propranolol A 40mg 84 tablet INDERALC07AA 7.4 propranolol A 40mg 250 tablet INDERALC07AA 7.4 propranolol A 40mg 1 000 tablet INDERALX Ø propylene glycol 2 500ml liquidX Ø propylparaben 100g powder
prostaglandins: see dinoprostone
V03AB 18.1? protamine sulphate P 50mg/5ml 1 injection PROTAMINE SULPHATE
V04CJ 19.3protirelin (thyrotropin releasing hormone, TRF, TRH)
0,2mg/2ml 10 injection TRH-ROCHE Specialist Endocrinologists only.
X Øpump, dispenser, for 500ml bottle bioscrub/hibiscrub
1 plungerUse only on 500ml 4% chlorhexidine gluconate surgical scrub bottles.
A06AC 12.7psyllium hydrophilic muciloid
49g/100g 250g powder METAMUCIL
J04AK 18.6.1 pyrazinamide P 500mg 1 000 tabletISOPAS; CAMIZIDE; ROZIDE
N07AA 5.3 pyridostigmine P 10mg 50 tablet MESTINONN07AA 5.3 pyridostigmine A P 60mg 150 tablet MESTINON
1.5.3 quetiapine 25mg 100 tablet SEROQUELSpecialist psychiatrist initiated
Psychiatrists only. For treatment guidelines refer to Circular H99/2005 (Addendum A - Suppl. List 103).
1.5.3 quetiapine 100mg 90 tablet SEROQUELSpecialist psychiatrist initiated
As above.
1.5.3 quetiapine 200mg 60 tablet SEROQUELSpecialist psychiatrist initiated
As above.
1.5.3 quetiapine 300mg 60 tablet SEROQUELSpecialist psychiatrist initiated
As above.
P01BC 18.11 quinine sulphate 1 A P 300mg 100 tabletP01BC 18.11 quinine sulphate A P 300mg 1 000 tabletP01BC 18.9 quinine dihydrochloride 1 A P 300mg/ml 10 injection ADCO-QUININE
S01AX 15.1
quinolone (ciprofloxacin/ofloxacin) ophthalmic anti-infectives
3mg/ml 5ml eye drops CILOXAN; EXOCINSpecialist: ophthalmologist & ENT
Cheapest on tender to be used.
A02BA 12.4.3 Supp List 120 ranitidine 150mg P 150mg 60 tabletZANTAC; CPL ALLIANCE RANITIDINE
Page 61 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
V04B Øreagent strip - glucose in urine
30 test stripGLUKOTESTTECO-URS 1G
For home monitoring of maturity onset, non-ketotic diabetes mellitus. Recommended 1 container per month.
X Øreagent tablet - glucose in urine
36 reagent tablet CLINITESTRestricted to paediatric wards or on a prescription chart.
V04B Øreagent strip - glucose, ketones in urine
50 reagent strip KETO-DIABURFor home monitoring of juvenile type diabetes mellitus. 1 Bottle per month.
V04B Øreagent strip - glucose, protein in urine
50 reagent strip URICHECK 2(s)
V04B Øreagent strip - 5 diagnosis for urine
100 reagent strip LENSTRIP 5For use in general outpatient departments & wards of larger hospitals. Cheapest on tender will be issued.
V04B Ø
reagent strip - blood, glucose, ketones, protein, nitrite & pH in urine
100 reagent strip URICHECK 5N
V04B Øreagent strip - 9 diagnosis for urine
100 reagent strip COMBUR 9For use in smaller hospitals; admission wards of larger hospitals and by district surgeons.
V04B Øreagent strip - 10 diagnosis for urine
100 reagent strip COMBUR 10For use in trauma units and neurosurgery when specific gravity is required.
V04CA Øreagent strip - glucose in blood - visual & meter
50 reagent strip LENSTRIP GLYCO
V04CA Øreagent strip - glucose in blood
50 reagent strip ACCUTREND
Use with Accutrent meter. Can be issued to patients with machines provided by the company. PAWC does not issue Accutrend strips to non-insulin users.Issue up to 100 tests monthly if necessary to patients on multiple daily insulin administration, and up to 50 tests every four months if necessary to patients on a once daily insulin regimen (See Suppl. List 98).
V04CA Øreagent strip - glucose in blood
50 reagent strip ACCU-CHECK ACTIVE will replace eventually Accutrend
V04CA Øreagent strip - glucose in blood
50 reagent strip ONE TOUCH
Only for clinics with machines and patients with own machines. PAWC does not issue One Touch strips to non-insulin users.Issue up to 100 tests monthly if necessary to patients on multiple daily insulin administration, and up to 50 tests every four months if necessary to patients on a once daily insulin regimen (See Suppl. List 98).
Page 62 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
V04CA Øreagent strip - glucose in blood
50 reagent strip GLUCOTREND PLUSTO BE RENAMED TO Accu-Check Active
Use with Glucotrend 2 meter. Can be issued to patients with machines provided by the company. PAWC does not issue Glucotrend Plus strips to non-insulin users.Issue up to 100 tests monthly if necessary to patients on multiple daily insulin administration, and up to 50 tests every four months if necessary to patients on a once daily insulin regimen (See Suppl. List 98).
V04CA Øreagent strip - glucose in blood - visual & meter
50 reagent strip GLUCOSTIX
X Ø
reagent strip - rapid determination of HIV-1/2 antibodies in whole blood
20 reagent strip HIV CHECK 1 + 2For Mother To Child Transmission Project ONLY.
X Øreagent strip - rapid detemination of syphilis
100 reagent strip DETERMINE SYPHILIS
X Øreagent tablet - blood in faeces
50 reagent tablet HEMATEST
N01AH 2.1.2 remifentanyl 1mg 1 injection ULTIVA SpecialistCentral hospitals, For use in endoscopy ENT surgery only
N01AH 2.1.2 remifentanyl 2mg 1 injection ULTIVA SpecialistCentral hospitals, For use in endoscopy ENT surgery only
N01AH 2.1.2 remifentanyl 5mg 1 injection ULTIVA SpecialistCentral hospitals, For use in endoscopy ENT surgery only
J05AB 18.12 Supp List 117 ribavirin 200mg 42 tablets COPEGUS Specialist
Central hospitals only. Patient Named Basis. Number of patients to be treated to be decided by local PTC
J04AB 18.6.1 rifampicin 1 P 150mg 100 capsule ROLAB RIFAMPICINFor use in tuberculosis or for meningoccocal meningitis prophylaxis.
J04AB 18.6.1 rifampicin 1 P 450mg 100 capsule ROLAB RIFAMPICINJ04AB 18.6.1 rifampicin 1 A P 600mg 100 capsule ROLAB RIFAMPICIN As aboveJ04AB 18.6.1 rifampicin A 300mg 1 injection RIMACTANE
J04AB 18.6.1 rifampicin 1 P 100mg/5ml 180ml suspension RIFADINFor use in tuberculosis or for meningoccocal meningitis prophylaxis.
J04AM 18.6.1 rifampicin + isoniazid P 60mg + 30mg (60; 30) tablet RIMACTACID PAED 60/30
J04AM 18.6.1 rifampicin + isoniazid 1 P 60mg + 60mg 80 tabletRIMACTAZID PAED 60/60
J04AM 18.6.1 rifampicin + isoniazid 1 A 300mg + 150mg 40 tabletRIFINAH 300 RIMACTAZID 300/150
J04AM 18.6.1rifampicin + isoniazid + pyrazinamide
1 P60mg + 30mg + 150mg
80 tablet RIMCURE PAED 3-FDC
J04AM 18.6.1rifampicin + isoniazid + pyrazinamide
1 P60mg + 30mg + 150mg
500 tablet RIMCURE PAED 3-FDCPage 63 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J04AM 18.6.1rifampicin + ethambutol + isoniazid + pyrazinamide
1 A150mg + 275mg + 75mg + 400mg
28 tabletRIFAFOUR e-275; RIMSTAR 4- FDC
J04AM 18.6.1rifampicin + ethambutol + isoniazid + pyrazinamide
1 A150mg + 275mg + 75mg + 400mg
56 tabletRIFAFOUR e-275; RIMSTAR 4- FDC
J04AM 18.6.1rifampicin + ethambutol + isoniazid + pyrazinamide
1 A150mg + 275mg + 75mg + 400mg
84 tabletRIFAFOUR e-275; RIMSTAR 4- FDC
J04AM 18.6.1rifampicin + ethambutol + isoniazid + pyrazinamide
1 A150mg + 275mg + 75mg + 400mg
112 tabletRIFAFOUR e-275; RIMSTAR 4- FDC
J04AM 18.6.1rifampicin + ethambutol + isoniazid + pyrazinamide
1 A150mg + 275mg + 75mg + 400mg
100 tabletRIFAFOUR e-275; RIMSTAR 4- FDC
N05AX 1.5.3 risperidone 1mg 30 tablet RISPERDAL
Specialist & paediatricians psychiatrist initiated
For treatment guidelines refer to Circular H99/2005 (Addendum A - Suppl List 103).
N05AX 1.5.3 risperidone 2mg 30 tablet RISPERDAL
Specialist & paediatricians psychiatrist initiated
As above.
N05AX 1.5.3 risperidone 3mg 30 tablet RISPERDAL
Specialist & paediatricians psychiatrist initiated
As above.
N05AX 1.5.3 Supp List 120 risperidone 25mg 1injection IM - prolonged release
RISPERDAL CONSTAPsychiatrist initiated
For: - Specific non-compliant patients - Patients that do not tolerate 1st generation depot anti-psychotics To be used in line with Mental Health Guidelines
N05AX 1.5.3 Supp List 120 risperidone 37,5mg 1injection IM - prolonged release
RISPERDAL CONSTAPsychiatrist initiated
For: - Specific non-compliant patients - Patients that do not tolerate 1st generation depot anti-psychotics To be used in line with Mental Health Guidelines
N05AX 1.5.3 Supp List 120 risperidone 50mg 1injection IM - prolonged release
RISPERDAL CONSTAPsychiatrist initiated
For: - Specific non-compliant patients - Patients that do not tolerate 1st generation depot anti-psychotics To be used in line with Mental Health GuidelinesPage 64 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J05AE 18.12pgwc ARV depot
ritonavir 100mg 84 capsule NORVIR AIDS programmeAvailable through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.
J05AE 19.12pgwc ARV depot
ritonavir 80mg/ml 90ml solution NORVIR AIDS programme As above.
M03AC 2.3 rocuronium 50mg/5ml 1 injection ESMERON
N04BC 1.7.1 ropinirole 0,25mg 210 tablet REQUIP Specialist initiatedFor Parkinson Disease patients only. As add-on therapy to Levodopa. May only be referred on maintenance therapy
N04BC 1.7.1 ropinirole 0,5mg 84 tablet REQUIP Specialist initiatedFor Parkinson Disease patients only. As add-on therapy to Levodopa. May only be referred on maintenance therapy
N04BC 1.7.1
Supp List 114
ropinirole 1mg 84 tablet REQUIP Specialist initiatedFor Parkinson Disease patients only. As add-on therapy to Levodopa. May only be referred on maintenance therapy
N04BC 1.7.1 ropinirole 2mg 84 tablet REQUIP Specialist initiatedFor Parkinson Disease patients only. As add-on therapy to Levodopa. May only be referred on maintenance therapy
N04BC 1.7.1 ropinirole 5mg 84 tablet REQUIP Specialist initiatedFor Parkinson Disease patients only. As add-on therapy to Levodopa. May only be referred on maintenance therapy
R03CC 10.2.1 salbutamol P 500µg/ml 1 injection VENTOLINR03CC 10.2.1 salbutamol 5mg/5ml 1 infusion VENTOLIN
R03AC 10.2.1 salbutamol 1 P 5mg/ml 20mlinhalation solution
VENTOLIN; VENTEZE
R03CC 10.2.1 salbutamol P 2mg/5ml 150ml syrup VENTOLIN For use in paediatricsR03CC 10.2.1 salbutamol P 2mg/5ml 500ml syrup VENTOLIN As aboveR03CC 10.2.1 salbutamol P 2mg 500 tablet VENTOLIN; VENTEZE As aboveR03AC 10.2.1 salbutamol 1 A P 100µg/inhalation 1 x 200 dose MDI complete VENTEZE Use cheapest Beta-stimulant MDI on tender.R03AC 10.2.1 salbutamol 1 A P 100µg/inhalation 1 x 200 dose MDI refill VENTEZE As aboveR03AC 10.2.1 salbutamol 1 A P 100µg/inhalation 1 x 300 dose MDI complete VENTOLIN As aboveR03AC 10.2.1 salbutamol 1 A P 100µg/inhalation 1 x 300 dose MDI refill VENTOLIN As above
D05AX ‡salicylic acid in cetomacrogol ointment
2% 200g ointment
D05AX ‡salicylic acid in cetomacrogol ointment
5% 200g ointment
D01AE ‡salicylic acid in soft white paraffin
40% 200g ointment
D01AE ‡salicylic acid + lactic acid in collodion flex
20% + 20% 500ml liquid WART PAINT
R03AC 10.2.1 salmeterol xinafoate 25µg/inhalation 1 x 120 dose MDI complete SEREVENTspecialist physician & paediatrician initiated
For adults and children over the age of 6 - cheapest LABA on tender to be used See Circular H 64/2007 Suppl List 110: Annexure A
Page 65 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
R03AC 10.2.1 salmeterol xinafoate 50µg/inhalation 1 x 120 dose MDI complete SEREVENTspecialist physician & paediatrician initiated
For adults and children over the age of 6 - cheapest LABA on tender to be used See Circular H 64/2007 Suppl List 110: Annexure A
X 15.7 salt solution, balanced 15ml eye soln. B.S.S.Specialist ophthalmologist
X 15.7 salt solution, balanced 250ml eye soln. B.S.S.Specialist ophthalmologist
X 15.7 salt solution, balanced 500ml eye soln. B.S.S.Specialist ophthalmologist
J06A Ø scorpion antivenom A P 5ml 1 injectionD01AE 14.3 selenium sulphide 1 2,5% 50ml shampoo SELSUN
A06AB 12.7 senna 1 Aequivalent to 7,5mg sennoside B
12 tablet SENOKOT
A06AB 12.7 senna Aequivalent to 7,5mg sennoside B
48 tablet SENOKOT; SENNALAX
A06AB 12.7 senna Aequivalent to 7,5mg sennoside B
200 tablet SENOKOT
A06AB 12.7 senna Aequivalent to 7,5mg sennoside B
1 000 tablet SENOKOT
A06AB 12.7 sennoside A & B A 142mg/71ml 71ml liquid X-PREPSpecialist radiologist
X serum, human stabilised P 0.05 50ml infusion Specialist
X Ø serum, human stabilised 0.05 250ml infusion Specialist
N01AB 2.1.1 sevoflurane A 250ml liquid ULTANE Central HospitalsPatient name basis.Not referable.
sildenafil: see phosphodiesterase-5-inhibitors
D08AL Ø silver nitrate stick A P 0.95 1 pencil SILVER NITRATE PEN.
D06BA 14.1 silver sulphadiazine A P 1% 50g creamFLAMAZINE; ARGENT-EZE
D06BA 14.1 silver sulphadiazine 1 A P 1% 500g cream FLAMAZINE
Page 66 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
C10AA 7.7.2 Supp List 116 simvastatin 10mg 28 tablet ZOCOR
1. General
2. Specialist physician initiated
Cheapest Statin on tender to be used
1. 10mg daily dose : For secondary prevention of coronary artery disease, thrombotic stroke, peripheral arterial disease, acute coronary syndrome and diabetes.For primary prevention if 10yr risk of CHD greater than 20%.
2. Up to 20mg daily dose if 10yr risk of CHD greater than 20% Up to 40mg daily dose for hyperlipidaemia. For higher doses / inadequate response refer to lipid clinic - See Atorvastatin
C10AA 7.7.2 Supp List 116 simvastatin 20mg 28 tablet ZOCOR As above As above
L04AA 24.1 sirolimus 1mg/ml 60ml solution RAPAMUNE
Specialist.Not referable to non-academic institutions in the Metropole. Can be referred to other regions.
i) Prescribe only post transplant at academic institutions.ii) Dispense only at academic institutions for patients resident in the metropole.iii) Dispense at non-academic institutions for patients in the rural regions - arrange access to stock with referring Institution
L04AA 24.1 sirolimus 1mg 30 tablet RAPAMUNE As above As above
J06AA Øsnake bite antivenom, polivalent
1 A P 10ml 1 injection See Circular on availability of antivenom prodicts
B05BB 20.4 sodium bicarbonate 4% 50ml 1 injectionADCO-SODIUM BICARBONATE
B05BB 20.4 sodium bicarbonate 1 A P 8,5% 50ml 1 injectionADCO-SODIUM BICARBONATE
V03AX Ø sodium bicarbonate A BP 500g powderBICARBONATE OF SODA
A12CA 20.4 sodium chloride 1 0,9% 10ml 1 injectionSABAX SODIUM CHLORIDE
EDL
X Ø sodium chloride BP 500g powder
A07CA Ø
sodium chloride + potassium chloride + sodium citrate + dextrose monohydr.
1 P2g + 1,5g + 2,9g + 19,6g = 26g
50 sachetsGASTROLYTESOROL
G04B 16.3sodium citrate co. effervescent
P 60g granulesCITRO-SODA; EFFERSOL
S01GX 15.7 sodium cromoglycate 2% 10ml eye dropsOPTICROM; VISTACROM
Specialist ophthalmologist, paediatrician &allergologist initiated
R03BC 10.4 sodium cromoglycate 20mg 50 inhal. capsule LOMUDALSpecialist paediatrician Page 67 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
X 10.4 sodium cromoglycate 1 spinhaler LOMUDAL SPINHALER
X 4.6sod. fluoride + ascorbic acid
25mg + 200mg 60 tablet OSSIPLEX RETARDSpecialist endocrinologist.
Not referable.
J01XC 18.7 sodium fusidate A 250mg 100capsule / tablet
FUCIDIN Specialist
Recommended to be used in confirmed Staphylococcus infections which have failed to respond to the use of beta-lactam resistant penicillins alone.
J01XC 18.7 sodium fusidate A 500mg 1 infusion I.V. FUCIDIN Specialist As above.J01XC 18.7 sodium fusidate 250mg/5ml 50ml suspension FUCIDIN Specialist As above.
S01KA 15.7 sodium hyaluronate 10mg/ml 0,4ml injection HEALON; AMVISCSpecialist ophthalmologist
S01KA 15.7sodium hyaluronate +sodium chondroitin sulphate
30mg/ml +40mg/ml
0,5ml injection VISCOAT Specialist As above
D08AX Ø sodium hypochlorite 1% 5 000ml liquid MILTOND08AX Ø sodium hypochlorite 1% 500ml liquid MILTONV08AA Ø sodium iothalamate A 20% 300ml injection INFUSO CONRAYV08AA Ø sodium iothalamate 54% 50ml injection CONRAY 325 RadiologyV08AA Ø sodium iothalamate 70% 50ml injection CONRAY 420 Radiology
V08AA Øsodium iothalamate + meglumine iothalamate
52% + 26% 50ml injection CARDIO CONRAY Radiology
V08AC Ø sodium ipodate A 500mg 6 capsule BILOPTIN
R05CB 10.3sodium-2-mercapto sulphonate (MESNA)
P 600mg 3mlinhal. ampoules
MISTABRON Specialist Respiratory specialists & thoracic surgeons. Treatment can not be initiated by physiotherapist.
C02DD 7.3.1 sodium nitroprusside A P 2% 5ml 1 infusion HYPOTEN SpecialistA01AB Ø sodium perborate 162g powder PERASAFE Use as per PGWC Antiseptic Policy.A01AB Ø sodium perborate 810g powder PERASAFE As above
A06AG 12.7sodium phosphate + sodium acid phosphate
A P60mg + 160mg/ml
135ml enema LENOLAX
V03AE 25sodium polystyrene sulphonate
A 454g powder KEXALATE
C05BB 8.5sodium tetradecyl sulphate
30mg/ml 5ml injection STD Specialist
sodium valproate etc. see valproate sodium ….
X 28sodium thiosulphate + sodium nitrite + amyl nitrite inhalaion
kit TRIPAC-CYANO
X Ø soft paraffin, white BP 500g ointment WHITE PARAFFINX Ø soft paraffin, white BP 4kg ointment WHITE PARAFFINX Ø soft paraffin, white BP 15kg ointment WHITE PARAFFIN
X Ø soft paraffin, yellow BP 4kg ointmentYELLOW SOFT PARAFFIN
A06AD Ø sorbitol 1 A 70% 500ml liquidNOT to be used for hepatic encephalopathy. Only as a laxative.Page 68 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
C07AA 7.3.1 sotalol 80mg 100 tablet SOTACORSpecialist cardiologist initiated
C07AA 7.3.1 sotalol 160mg 100 tablet SOTACORSpecialist cardiology initiated
J01XX 18.7 spectinomycin 1 2g 1 injection TROBICINJ06A Ø spider antivenom A P 5ml 1 injection See Circular on antivenom products
C03DA 16.1 spironolactone A P 25mg 200 tabletALDACTONE; TENSIN; SPIRACTIN
stabilised human serum:see serum, human stabilised
J05AF 18.12pgwc ARV depot
stavudine 1 15mg 56 capsuleASPEN STAVUDINE; ZERIT
AIDS programmeAvailable through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.
J05AF 18.12pgwc ARV depot
stavudine 1 20mg 56 capsuleASPEN STAVUDINE; ZERIT
AIDS programmeAvailable through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols.
J05AF 18.12pgwcARV depot Supp List 124
stavudine 1 20mg 60 capsuleASPEN STAVUDINE; ZERIT
General code: AIDS programme CNP / Professional nurse
General code: AIDS programme: Available through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols. CNP / Professional nurse: Available through HIV / AIDS programme: For first line treatment of adult AIDS patients as per HIV / AIDS guidelines 2010 for treating AIDS patients and per Circular H30/2011: Authorisation of Nurse Prescribing for Antiretroviral Treatment
J05AF 18.12pgwcARV depot Supp List 124
stavudine 1 30mg 60 capsuleASPEN STAVUDINE; ZERIT
General code: AIDS programme CNP / Professional nurse
General code: AIDS programme: Available through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols. CNP / Professional nurse: Available through HIV / AIDS programme: For first line treatment of adult AIDS patients as per HIV / AIDS guidelines 2010 for treating AIDS patients and per Circular H30/2011: Authorisation of Nurse Prescribing for Antiretroviral Treatment
J05AF 18.12pgwc ARV depot
stavudine 1 1mg/ml 200ml solution ZERIT AIDS programme As above.
A06AC 12.6 sterculia + frangula P 62% + 8% 200g granules NORMACOL PLUS Specialist initiatedMaximum 200g per month. Cheapest bulk forming agent currently on tender to be used.
B01AD 8.3 streptokinase 1 A P 750 000iu 1 injection KABIKINASETo be used according to protocol. See Circular H80/1997 (Addendum 1 - Suppl. List 77)
B01AD 8.3 streptokinase 1 A P 1 500 000iu 1 injectionKABIKINASE; STREPTASE
As above.
L01DC 23streptomyces caespitosis
2mg 1 injection MITOMYCIN - C SpecialistPage 69 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
L01DC 23streptomyces caespitosis
10mg 1 injection MITOMYCIN - C Specialist
J01GA 18.3 streptomycin 1 A 1g 1 injectionNOVOSTREP; SOLUSTREP
J01GA 18.3 streptomycin 5g 1 injection NOVOSTREP
A02BX 12.5 sucralfate P 1g/5ml 300ml suspension ULSANIC Specialistendoscopy units - for proven active peptic ulcers - and ICUs only. Also paeds
A02BX 12.5 sucralfate P 1g/5ml 600ml suspension ULSANIC Specialist As above
P01BD 18.9sulfadoxine + pyrimethamine
1 A P 500 + 25mg 3 tablet FANSIDAR Treatment of malaria - 2-3 tablets immediately.
A07EC 12.11 sulphasalazine A P 500mg 100 tabletSALAZOPYRIN
Specialist initiated GIT and Rheumatology clinics only.
D10AB ‡sulphur in soft white paraffin
5% 200g ointment
D10AB 31 sulphur ointment BP 25g ointment SULPHUR OINT.D10AB 31 sulphur ointment BP 500g ointment SULPHUR OINT.
N05AL 1.4.6 sulpiride 50mg 100 capsule EGLONYLSpecialist psychiatrist & neurologist initiated
NOT TO BE USED for lactation as safety in neonates unknown.
N05AL 1.4.7 supp List 116 sulpiride 200mg 50 tabletBIO-SULPIRIDE 200; EGLONYL FORTE
Specialist psychiatrist initiated
D02BA 14.8 sun barrier cream minimum SPF15 50ml cream/lotion DINO-BLOC SPF 15
Specialist dermatologist & rheumatologist initiated
surfactant: See total phospholipids
M03AB 2.3 suxamethonium Cl A P 100mg/2ml 1 injection SCOLINEX Ø syrup simplex BP 2 500ml syrup
L04AA 24.1 tacrolimus 1mg 100 capsule PROGRAF
Specialist.Not referable to non-academic institutions in the Metropole. Can be referred to other regions.
i) Prescribe only post transplant at academic institutions.ii) Dispense only at academic institutions for patients resident in the metropole.iii) Dispense at non-academic institutions for patients in the rural regions - arrange access to stock with referring Institution
L04AA 24.1 tacrolimus 5mg 50 capsule PROGRAF
Specialist.Not referable to non-academic institutions in the Metropole. Can be referred to other regions.
As above
Page 70 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
tadalafil: see phosphodiesterase-5-inhibitors
L02BA 19.8 tamoxifen 10mg 30 tablet NEOPHEDAN-10 Specialist initiatedL02BA 19.8 tamoxifen 10mg 250 tablet NOLVADEX; KESSAR Specialist initiatedL02BA 19.8 tamoxifen 20mg 30 tablet NEOPHEDAN-20 Specialist initiatedL02BA 19.8 tamoxifen 20mg 250 tablet KESSAR Specialist initiated
GO4CA 16.5Supp List 121/124
tamsulosin SR 0,4mg 30slow release capsule
FLOMAX
For BPH and/or LUTS: with referral to a urologist within 6 months for those patients who have not previously been on an alpha-blocker (i.e. referral within 6 months for patients initiated on an alpha-blocker for BPH / LUTS). LUTS = Lower Urinary Tract Symptoms in males
D05AA 14.5? tar extracts125ml / 250ml
shampoo TRITARSpecialist dermatologist initiated
N05CD 1.2.1 temazepam 20mg 100 capsule NORMISON
Maximum dose 20mg/day for 14 days unless prescribed by a psychiatrist, neurologist or paediatrician. See Circular H24/2006 Suppl List 107 Addendum I
L01AX 23 Supp List 121 temozolomide 5mg 5 capsule TEMODALSpecialist oncologist
Limited to patients with malignant glioma with positive status for a methylated promoter for the methylguanine methyl transferase (MGMT) gene.
L01AX 23 Supp List 121 temozolomide 20mg 5 capsule TEMODALSpecialist oncologist
Limited to patients with malignant glioma with positive status for a methylated promoter for the methylguanine methyl transferase (MGMT) gene.
L01AX 23 Supp List 121 temozolomide 100mg 5 capsule TEMODALSpecialist oncologist
Limited to patients with malignant glioma with positive status for a methylated promoter for the methylguanine methyl transferase (MGMT) gene.
L01AX 23 Supp List 121 temozolomide 250mg 5 capsule TEMODALSpecialist oncologist
Limited to patients with malignant glioma with positive status for a methylated promoter for the methylguanine methyl transferase (MGMT) gene.
L01CB 23 teniposide P 50mg/5ml 1 injection VUMONSpecialist oncologist
Page 71 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J05AF 18.12Supp List 119/124
tenofivir disoproxil funerate
1 300mg 30 tablet VIREAD
General code: AIDS programme CNP / Professional nurse Specialist
GENERAL: Availabe through HIV / AIDS programme for treating AIDS patients according to the appropriate protocols. CNP/ Professional nurse: Available through HIV/ AIDS programme: For first line treatment of adult AIDS patients as per HIV / AIDS guidelines 2010 for treating AIDS patient and per Circular H30/2011 - Authorisation of Nurse Prescribing for Antiretroviral Treatment SPECIALIST: For Liver / GIT clinic for the management of chronic Hepatitis B patients. For this indication Tenofovir must be procured via the Cape Medical Depot and not the ARV Depot
J05AF 18.12 Supp List 122tenofivir disoproxil funerate / emtracitabine
1 300mg / 200mg 30 tabletDIDIVIR / TYRICTEN / TRUVADA
To be used according to Health Programmes' protocol for PMTC
D01BA 18.10 terbinafine 250mg 14 tablets LAMISILSpecialist dermatologist
Patient name basis.Not referable.
J04AK 18.8.1 terizidone 250mg 100 capsules TERIVALIDINSpecial Programmes
Only to be initiated in consultation with MDR TB Referral Centres Brooklyn Chest and Brewelskloof Hospitals. Patients can be referred out and continue treatment on an outpatient basis.
X 19.6.3testosterone + oestradiol
100mg 1 injection PRIMODIAN-DEPOT Specialist
G03BA 19.6.1testosterone cypionate L.A.
A 100mg/ml 10ml injection DEPO-TESTOSTERONE
G03BA 19.6.1
testosterone propionate +testosterone phenylpropionate +testosterone isocaproate +testosterone decanoate
30mg60mg60mg100mg
3 injection SUSTANON 250 Specialist
H01AA 19.7 tetracosactide 1mg/ml 1 injection SYNACTHEN DEPOT Specialist
J01AA 18.4.1 tetracycline A 250mg 100 capsule ROTETCheapest of the hydrochloride or phosphate will be supplied.
J01AA 18.4.1 tetracycline A 250mg 1 000 capsule ROTET As above.R03DA 10.2.2 theophyllin 125mg 60 SR capsule MICRO-PHYLLIN For use in paediatrics only.R03DA 10.2.2 theophyllin P 25mg/5ml 200ml syrup NUELIN For use in paediatrics only.R03DA 10.2.2 theophyllin BP anhydr. 125mg 100 tablet NUELIN
R03DA 10.2.2 Supp List 119 theophyllin anhydr. LA 1 A P 200mg 60 tabletTHEO-DUR; BRONCHOPEN
Not to be used as first line therapy in asthma. Refer to coding guidelines: Suppl List 119 - Addendum A: Amended in 2009: Theophyllin maximum dose increased to 300mg
Page 72 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
R03DA 10.2.2Suppl List 119
theophyllin anhydr. LA 1 A 300mg 60 tabletTHEO-DUR; BRONCHOPEN
Not to be used as first line therapy in asthma. Refer to coding guidelines: Suppl List 119 - Addendum A: Amended in 2009: Theophyllin maximum dose increased to 300mg
R03DA 10.2.2 Supp List 119 theophyllin anhydr. LA A 300mg 500 tablet THEO-DUR
Not to be used as first line therapy in asthma. Refer to coding guidelines: Suppl List 119 - Addendum A: Amended in 2009: Theophyllin maximum dose increased to 300mg
L01BB 23 thioguanine P 40mg 25 tablet LANVISSpecialist oncologist
N01AF 2.1.2 thiopentone A P 0,5g 20ml injection SANDOTHAL
L01AC 23thiotepa(tespa)
A P 15mg 1 injection THIOTEPA Specialist
X ‡ thymol in chloroform 2% 500ml liquidthyrotrop(h)in releasing hormone: See protirelin
H01AB Ø
thyrotrophic hormone (thyroid stimulating hormone, TSH, thyrotrophin)
injection THYTROPARSpecialist endocrinologist
H03AA 19.3 thyroxine A P 0,05mg 100 tablet ELTROXINH03AA 19.3 thyroxine A P 0,1mg 100 tablet ELTROXIN
N02AX 3.1 tilidine P 50mg/0,5ml 10ml oral drops VALORONFor paediatrics ONLY. See protocol on selection of analgesics: Circular H112/1998 (Addendum E - Suppl. List 80)
S01ED 15.6 Supp List 121 timolol maleate A 0.0025 5ml eye drops TIMOPTOLSpecialist ophthalmologist initiated
X ‡
tincture benz. Co in lassar's paste (zinc oxide 2% + salicylic acid 2%)
15% 500ml liquid
G01AF 17.2 tioconazole 100mg 3 vaginal tablets GYNO-TROSYDCheapest appropriate imidazole preparation on tender will be issued.
B01AC 8.4 tirofiban 0,25mg/ml 1 injection AGGRASTETSpecialist cardiologist
Central hospital, Post stent.Patient name basis.
S01AA 15.1 tobramycin 3mg/ml 5ml eye drops TOBREXSpecialist ophthalmologist
Not referable
S01AA 15.1 tobramycin 3mg/g 3,5g eye ointment TOBREXSpecialist ophthalmologist
Not referable
J01GB 18.3 tobramycin 80mg 1 injectionTOBRAMYCIN-FRESENIUS
Specialist Only for severe nosocomial infections in ICU's & on a Microbiologist report.
A11HA 20.1 tocopherol acetate 100mg 100 tablet VITAMIN EA10BB 19.1.2 tolbutamide 1 A 500mg 200 tablet RASTINON; TYDADEX
N03AX 1.6 topiramate 50mg 60 tablet TOPAMAXSpecialist neurologist
For Neurology only at Central Hospitals on a patient name basis and non-referable.
Page 73 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
N03AX 1.6 topiramate 100mg 60 tablet TOPAMAXSpecialist neurologist
As above.
X 10.5 total phospholipids 200mg/8ml 8ml vial SURVANTANeonatal ICU and highcare
For use in selected pre-term infants between 700g and 1 000g body weight
X 10.5 total phospholipids 100mg/4ml 4ml vial SURVANTANeonatal ICU and highcare
As above.
B01BA Øtpn amino acid + electrolytes infusion
1 000ml plastic bagSYNTHAMIN 9 + ELECTROLYTES
B01BA Øtpn amino-acid + electrolytes + glucose
A P 1 000mlglass container
VAMIN + GLUCOSE
B01BA Øtpn amino-acid + electrolytes + glucose
A P 100mlglass container
VAMIN + GLUCOSE
B01BA Øtpn amino-acid + electrolytes + glucose
A P 500mlglass container
VAMIN + GLUCOSE
B05BA Øtpn amino-acid + electrolytes + glucose + fat
7% + 10% + 20% 1 000mlI.V. infusion solns
VITRIMIX
B01BA Øtpn amino-acid + electrolytes infusion
1 000ml plastic bagSYNTHAMIN 14 + ELECTROLYTES
B01BA Ø tpn amino-acid infusion 500mlglass container
VAMIN 18
B01BA Ø tpn amino-acid infusion 500ml plastic bagSYNTHAMIN 14 WITHOUT ELECT.
B05BA Øtpn electrolytes + trace elements
A P 10ml ampoule ADDAMEL
B05BA Øtpn electrolytes + trace elements
A P 20ml ampoule PED-EL
B01BA Ø tpn fat emulsion A P 20% 500ml I.V. infusion LIPOVENOUS 20%B01BA Ø tpn fat emulsion A P 20% 100ml I.V.infusion LIPOVENOUS 20%
B01BA Ø tpn fat emulsion A P 10% 100mlglass container
LIPOVENOUS 10%
B01BA Ø tpn fat emulsion A P 10% 500mlglass container
LIPOVENOUS 10%
B05BA 22tpn fat emulsion + amino acids + electrolytes
2 000mlIV triple chamber plastic bag
CLINOMEL Specialist For use in central and regional hospitals only.
B05BA Ø tpn vitamins fat soluble P adult 10ml x10 ampoule VITALIPID ADULTB05BA Ø tpn vitamins fat soluble P paediatric 10ml x10 ampoule VITALIPID INFANT
B05BA Øtpn vitamins water soluble
P 10ml x10 vial SOLUVIT
TRH, TRF: See protirelin
Page 74 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
N02AX 3.4Supp List 111/115/119/121/122
tramadol1 A
50mg 100 capsule Tramal; TramazacGeneral Specialist initiated
General: As add-on therapy to paracetamol. Recommended dose 50mg six hourly. Not repeatable for acute conditions (short course) Specialist initiated: For neuropathic pain as second or third line (may be used without paracetamol). Prescription must be endorsed with 'neuropathic pain' NOTE: Refer to Sup List 111 Addendum A: warning - tramadol and serotonin syndrome Refer to Supp List 121: Addendum B: warning - tramadol and amitriptyline interaction
B02AA 8.1 tranexamic acid P 500mg/5ml 1 injection CYKLOKAPRON Specialist
B02AA 8.1 Supp List 114 tranexamic acidAP
500mg 100 tablet CYCLOKAPRON
Specialist physician, oncologist, gynaecologist & paediatrician
In Gynaecology: Second line treatment where NSAID's have failed, max 7 days. May be repeated monthly. In Haematology: For haemophiliacs. May be prescribed for one month. May be repeated
D10AD 14.6 tretinion A P 0,5mg/g 20g cream RETIN A; AIROLSpecialist dermatologist
D10AD 14.6 tretinion A P 0,25mg/g 20g gel RETIN ASpecialist dermatologist
As above.
A01AC 11.3triamcinolone acetonide in orabase
0,1% 5g ointment KENALOG IN ORABASE Specialist
N05AB 15.1 trifluoperazine 1mg 50 tablet STELAZINESpecialist psychiatrist initiated
N05AB 1.5.1 trifluoperazine 2mg 250 tablet STELAZINESpecialist psychiatrist initiated
As above
N05AB 1.5.1 trifluoperazine 5mg 28 tablet STELAZINESpecialist psychiatrist initiated
As above.
N05AB 1.5.1 trifluoperazine 5mg 56 tablet STELAZINESpecialist psychiatrist initiated
As above.
N05AB 1.5.1 trifluoperazine 5mg 112 tablet STELAZINESpecialist psychiatrist initiated
As above.
N05AB 1.5.1 trifluoperazine 5mg 250 tablet STELAZINESpecialist psychiatrist initiated
As above
Page 75 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
S01AD 15.1.1 trifluorothymidine 1% 5ml eye drops T.F.T.Specialist ophthalmologist
trihexiphenidyl: see benzhexol
R06AD 6.1 trimeprazine P 30mg/5ml 100ml syrup VALLERGAN FORTES01FA 15.5 tropicamide 10mg/ml 15ml eye drops MYDRIACILS01FA 15.5 tropicamide 5mg/0,5ml 0,5ml x 20 minims MINIMS TROPICAMIDE SpecialistV04CF 26 tuberculin PPD 2TU/0,1ml 1,5ml vial MANTOUX Freeze dried
V04CF 26 tuberculin PPD test 5TU/applicator 20/25skin prick apparat.
TINE TEST; BIOCINE PPD
EDL
D02AE ‡urea in cetomacrogol cream
10% 200g cream
A05AA ‡ ursodeoxycholic acid 100mg% 100 tablet URSOTANSpecialist GIT clinic, hepatic clinic & liver transplants
Hepatic clinic - only for primary biliary cirrhosis..Central hospitals, non-referable.
J07AN 26 vaccine BCG 1 A 10 doseinjection percutaneous
J07AN 26 vaccine BCG 1 A 20 doseinjection intradermal
J07AF 26vaccine diphtheria, tetanus
1 10ml 20 dose injection
J07AF 26vaccine diphtheria, tetanus, pertussis
1 10ml 20 dose injection D.T.P. MERIEUX
J07AG 26vaccine diphtheria, tetanus, pertussis, HiB & polio
1 0,5ml 1 dose injection PENTAXIM As per EPI immunisation schedule
J07BC 26 vaccine hepatitis B 1 A adult 1 injection ENGERIX-BJ07BC 26 vaccine hepatitis B 1 P paed. 1 dose injection HEPPACINE-BJ07BC 26 vaccine hepatitis B 1 P paed. 10 dose injection HEPPACINE-B
J07BB 26 vaccine influenza 0,5ml single injection MUTAGRIP
Current product on tender to be bought.Use only in the following HIGH RISK CASES:☼ Chronic cardio pulmonary disease - Transplant patients - Patients in nursing homes ☼ Children with: cystic fibrosis, HIV and other immuno compromising conditions☼ PGWC staff working in high risk areas in institutions
J07BB 26 vaccine influenza 5ml multidose injection MUTAGRIP
Use only in the following HIGH RISK CASES:☼ Chronic cardio pulmonary disease - Transplant patients - Patients in nursing homes ☼ Children with: cystic fibrosis, HIV and other immuno compromising conditions☼ PGWC staff working in high risk areas in institutions
J07BD 26 vaccine measles 1 1 dose injection MORBILVAX; ROUVAXJ07BD 26 vaccine measles 1 5ml 10 dose injection MORBILVAX; ROUVAXPage 76 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J07AL 26vaccine pneumococcal,polivalent
A P 0,5ml 1 injectionPNEUMOVAX 23IMOVAX PNEUMO 23
Specialist
J07AL 26Suppl List 119
vaccine pneumococcal, conjugate 1 0,5ml 1 injection PREVENAR As per EPI immunisation schedule
J07BF 26vaccine poliomyelitis, trivalent, oral
1 10 doseoral preparation
POLIORAL
J07BG 26 vaccine rabies 1 A P 1 dose injection IMOVAX RABIES VERO
J07BH 26Suppl List 119
vaccine rotavirus 1 1ml
1 dose with syringe filled diluent and reconstitution device
oral preparation
ROTARIX As per EPI immunisation schedule
J07BJ 26 vaccine rubella A 0,5ml 1 injection RUBEATEN BERNA
J07AM 26vaccine tetanus adsorbed toxoid
1 A P 40iu/0,5ml 5ml1 multidose
injection TETAVAX
J05AB 18.10 valaciclovir A 500mg 42 tablet ZELITREX 500 SpecialistMicrobiology approval. Motivation form to be completed.
J05AB 18.12 Supp List 122 valganciclovir 450mg 60 tablet VALCYTE Specilaist
For post transplant patients on maintenance therapy on discharge post ganciclovir IV. For adults and children. Non-referable
N03AG 1.6 Supp List 114 valproate sodium P 100mg 100crushable tablets
EPILIM CRUSH TABSUse according to epilepsy treatment guidelines. See Circular H35/2005 (Addendum B - Suppl. List 101)
N03AG 1.6 valproate sodium 400mg 1 injection EPILIMFor status epilepticus only: as third line agent if phenobarbitone injection is not available, otherwise as fourth line agent
N03AG 1.63870928 Supp List 101
valproate sodium P 200mg/5ml 300ml
syrup, sugar free
EPILIMUse according to epilepsy treatment guidelines. See Circular H35/2005 (Addendum B - Suppl. List
N03AG 1.6valproate sodium + valproic acid
AP
133,2mg + 58mg 100 tablet EPILIM CR 200
General code mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm Specialist neurologists, psychiatrists, paediatricians, neurosurgeons and physicians initiated.
For ARV clinics only, in line with Suppl List 112 Addendum A. mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmUse according to epilepsy treatment guidelines. See Circular H35/2005 (Addendum B - Suppl. List 101)
Page 77 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
N03AG 1.6valproate sodium + valproic acid
AP
199,8mg + 87mg 100 tablet EPILIM CR 300
General code mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmSpecialist neurologists, psychiatrists, paediatricians, neurosurgeons and physicians initiated.
For ARV clinics only, in line with Suppl List 112 Addendum A. mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmUse according to epilepsy treatment guidelines. See Circular H35/2005 (Addendum B - Suppl. List 101)
N03AG 1.6valproate sodium + valproic acid
AP
333mg + 145mg 100 tablet EPILIM CR 500
General code mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmSpecialist neurologists, psychiatrists, paediatricians, neurosurgeons and physicians initiated.
For ARV clinics only, in line with Suppl List 112 Addendum A. mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmUse according to epilepsy treatment guidelines. See Circular H35/2005 (Addendum B - Suppl. List 101)
N03AG 1.6 valproic acid A P 150mg 100 capsule CONVULEX As aboveNo new patients. To be used for patients already on valproic acid only.
N03AG 1.6 valproic acid A P 300mg 100 capsule CONVULEX As aboveNo new patients. To be used for patients already on valproic acid only.
N03AG 1.6 valproic acid A P 500mg 100 capsule CONVULEX As aboveNo new patients. To be used for patients already on valproic acid only.
N03AG 1.6 valproic acid P 250mg/5ml 100ml suspension CONVULEX As aboveNo new patients. To be used for patients already on valproic acid only.
J01XA 18.7 vancomycin A P 500mg 1 injection VANCOCIN Specialist As above.
J01XA 18.7 vancomycin A P 1g 1 injection VANCOCIN SpecialistMotivation form to be completed or microbiologist report. Cheapest of CP or plain to be bought.
vardenafil: see phosphodiesterase-5-inhibitors
M03AC 2.3 vecuronium A P 4mg 50 injection NORCURON
NO6AX 1.4.5 Supp List 115 venlafaxine 37,5mg 37,5mg 30extended release capsule
VENLOR; EFEXOR Specialist psychiatrist initiated
NO6AX 1.4.5 Supp List 115 venlafaxine 75mg 75mg 30extended release capsule
VENLOR; EFEXOR Specialist psychiatrist initiated
NO6AX 1.4.5 Supp List 116 venlafaxine 150mg 150mg 30extended release capsule
VENLOR; EFEXOR Specialist psychiatrist initiated
C08DA 7.3.7 Supp List 124 verapamil A P 5mg/2ml 1 injection ISOPTIN SpecialistCentral Hospitals; Non-referable; for vascular surgery
C08DA 7.3.7 verapamil A 40mg 56 tablet ISOPTINSee protocol on Calcium channel antagonists: Circular H112/1998 (Addendum D - Suppl. List 80)Page 78 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
C08DA 7.3.7 verapamil A 40mg 84 tablet ISOPTIN As above.C08DA 7.3.7 verapamil A 40mg 500 tablet ISOPTIN As above.C08DA 7.3.7 verapamil A 80mg 56 tablet ISOPTIN As above.C08DA 7.3.7 verapamil A 80mg 84 tablet ISOPTIN; BONCEUR As above.C08DA 7.3.7 verapamil A 80mg 250 tablet ISOPTIN As above.
N03AG 1.6 vigabatrin 500mg 100 tablet SABRILSpecialist neurologist
Not referable.
L01CA 23 vinblastine A P 10mg 1 injection VELBESpecialist oncologist
L01CA 23 vincristine A P 1mg 1 injectionONCOVIN; PERICRISTINE
Specialist oncologist
L01CA 23 vincristine A P 1mg + diluent 10 injection ONCOVINSpecialist oncologist
L01CA 23 vincristine A P 2mg + diluent 1 injection ONCOVINSpecialist oncologist
L01CA 23 vincristine A P 5mg + diluent 10 injection ONCOVINSpecialist oncologist
L01CA 23 Supp List 124 vinorelbine 20mg 1 capsules NAVELBINESpecialist oncologist
Patient Name Basis Adjuvant therapy of completed resected NSCLC (stage2 & 3 only) Patient numbers to be decided upon by Central Hospitals
L01CA 23 Supp List 124 vinorelbine 30mg 1 capsules NAVELBINESpecialist oncologist
Patient Name Basis Adjuvant therapy of completed resected NSCLC (stage2 & 3 only) Patient numbers to be decided upon by Central Hospitals
L01CA 23 Supp List 124 vinorelbine 40mg 1 capsules NAVELBINESpecialist oncologist
Patient Name Basis Adjuvant therapy of completed resected NSCLC (stage2 & 3 only) Patient numbers to be decided upon by Central Hospitals
L01CA 23 Supp List 124 vinorelbine 80mg 1 capsules NAVELBINESpecialist oncologist
Patient Name Basis Adjuvant therapy of completed resected NSCLC (stage2 & 3 only) Patient numbers to be decided upon by Central Hospitals
L01CA 23 Supp List 124 vinorelbine 10mg 1 injection NAVELBINESpecialist oncologist
Patient Name Basis Adjuvant therapy of completed resected NSCLC (stage2 & 3 only) Patient numbers to be decided upon by Central Hospitals
L01CA 23 Supp List 124 vinorelbine 50mg 1 injection NAVELBINESpecialist oncologist
Patient Name Basis Adjuvant therapy of completed resected NSCLC (stage2 & 3 only) Patient numbers to be decided upon by Central HospitalsPage 79 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
A11CA 20.1 vitamin A 50 000iu/ml 2ml 5 injection AROVIT
A11CA 20.1 vitamin A 1 P 50 000iu 50capsule white snip off
VITAFORCE
A11CA 20.1 vitamin A 1 P 50 000iu 200 tablet AROVIT; AVITA
A11CA 20.1 vitamin A 1 P 100 000iu 50capsule blue snip off
VITAFORCE
A11CA 20.1 vitamin A 1 P 200 000iu 50capsule red snip off
VITAFORCE
A11CA 20.1 vitamin A 200 000iu 250 capsule VITAMIN A - Lennons For Nutrition Program Only.A11DA 20.1 vitamin B1 (thiamine) A 100mg/ml 1 injection VITAMIN B 1A11DA 20.1 vitamin B1 (thiamine) 1 A 100mg 100 tablet VITAMIN B 1A11HA 20.1 vitamin B6 (pyridoxine) P 50mg/ml 10 injection VITAMIN B 6A11HA 20.1 vitamin B 6 (pyridoxine) 1 A P 25mg 100 tablet
B03BA 20.1vitamin B12
(cyanocobalamin)A P 1 000µg/ml 1 injection VITAMIN B12
B03BA 20.1vitamin B12
(cyanocobalamin) A P 1 000µg/ml 10ml 1 injection
LABETHICA VITAMIN B 12
A11EA 20.1.1 vitamin B Co A 10ml 1 injection BECOPLEXA11EA 20.1.1 vitamin B Co 1 A 56 tabletA11EA 20.1 vitamin B Co A 1 000 tablet BECOPLEXA11EA 20.1.1 vitamin B Co A 5 000 tabletA11GA 20.1 vitamin C A 500mg/5ml 1 injection VITAMIN CA11GA 20.1 vitamin C A P 100mg 1 000 tablet VITAMIN C
A11BA 20.1.1vitamin Co - multivitamin
10ml 1 injection PANCEBRIN Specialist
A11BA 20.1.1vitamin Co - multivitamin
P 20ml oral drops VIDAYLIN
A11BA 20.1.1vitamin Co - multivitamin
1 P 100ml syrup MULTIVITAMIN
A11BA 20.1.1vitamin Co - multivitamin
2 500ml syrup MULTIVITAMIN
vitamin D: see alfacalcidol, calciferol & ergocalciferolvitamin K: see phytomenadione
B01AA 8.2 warfarin A 5mg 100 tablet COUMADINV07AB Ø water for injection B.P. 1 x 5ml injection
WATER FOR INJECTION
V07AB Ø water for injection B.P. 1 x 10ml injectionWATER FOR INJECTION
V07AB Ø water for injection B.P. 1 x 20ml injectionWATER FOR INJECTION
X Ø wool fat, anhydrous 500g ointment
R01AA 11.1 xylometazoline 1 P 0,05% 10mlnasal drops - paed
OTRIVIN PAED. ALTERNATIVE: Oxymetazoline when cheaper
R01AA 11.1 xylometazoline 1 A 0,1% 10ml nasal drops OTRIVIN As above
Page 80 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
J05AB 18.12 zidovudine 1 A P 100mg 100 capsule RETROVIR
1. For prevention of mother to child transmission of HIV 2. For rape victims. * For other uses: Authority to be obtained from the Regional Drug and Therapeutics Committee.
J05AB 18.12 zidovudine1
A P100mg 14 capsule RETROVIR
1. For prevention of mother to child transmission of HIV 2. For rape victims. * For other uses: Authority to be obtained from the Regional Drug and Therapeutics Committee.
J05AB 18.12 zidovudine1 P
250mg 100 capsule RETROVIR As above
J05AB 18.12 zidovudine 1 50mg/5ml 200ml syrup RETROVIR Special programmeOnly for the treatment of rape survivors (children) & PMCTC according to the provincial protocol.
J05AB 18.12
3797948 &pgwc ARV depot Supp List 124
zidovudine 1 300mg 60 tablet RETROVIR
General code - AIDS programme Clinical Nurse Practitioner CNP / Professional nurse
General: Available through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols. Clinical Nurse Practitioner: According to PMTC policy and guidelines CNP / Professional nurse: Available through HIV AIDS programme: For first line treatment of adult AIDS patients as per HIV / AIDS guidelines 2010 for treating AIDS patients and per Circular H30/2011 - Authorisation of Nurse Prescribing for Antiretroviral Treatment
J05AF 18.12pgwc ARV depot Supp List 124
zidovudine + lamivudine 300mg + 150mg 60 tablet COMBIVIR; LAMZID
General code - AIDS programme Clinical Nurse Practitioner CNP / Professional nurse
General: Available through the HIV/AIDS programme - for treating AIDS patients according to the appropriate protocols. Clinical Nurse Practitioner: For initiation of therapy for 3 days, according to PGWC PEP protocol. CNP / Professional nurse: Available through HIV AIDS programme: For first line treatment of adult AIDS patients as per HIV / AIDS guidelines 2010 for treating AIDS patients and per Circular H30/2011 - Authorisation of Nurse Prescribing for Antiretroviral Treatment
J05AF 18.12 ------- zidovudine + lamivudineInitiation of therapy extended to Clinical Nurse Practitioner in accordance with the PGWC PEP protocol.
A12CB 20.4 zinc gluconate 417mg 30 tablet LEPPIN ZINC 50mgD02AB Ø zinc oxide 1 BP 500g ointment ZINC OXIDE OINT.
D05AX Øzinc oxide + salicylic acid
BP 500g paste LASSAR'S PASTE
A12CB 20.2 Supp List 120zinc sulphate dispersible tablet
120mg elemental zinc
100dispersible tablet
SMART ZINC 20
A12CB 20.4 zinc sulphate 220mg 100 tablet ZN 220
PEP starting dose: Zidovudine 300mg twice daily for 3 days
+ Lamivudine 150mg twice daily for 3 days
Page 81 of 82
ATC MIMS SUPP LIST GENERIC DESCRIPTION *EDL STRENGTH PACK FORM TRADE NAME RESTRICTION COMMENT
D01AE 14.3zinc undecenoate + undecenoic acid
20% + 2% 50g powder MYCOTA
D02AB Ø zinc & castor oil 1 BP 25g ointment ZINC & CASTOR OILD02AB Ø zinc & castor oil BP 500g ointment ZINC & CASTOR OIL
N05AF 1.5.3 zuclopenthixol acetate A 50mg/ml 1 injection CLOPIXOL ACUPHASESpecialist psychiatrist
N05AF 1.5.3 zuclopenthixol acetate A 100mg/2ml 1 injection CLOPIXOL ACUPHASESpecialist psychiatrist
N05AF 1.5.3zuclopenthixol decanoate
1 200mg/ml 1 injection CLOPIXOL DEPOT On General Code for continuation of therapy.
Page 82 of 82