Rpts. GENERAL General Schedule (Code GE)

Transcription

1 Pantoprazole 20mg Name, Restriction, Manner of administration and form Pantoprazole 20mg enteric tablet, 30 (8399C) Gastro-oesophageal reflux disease

2 Name, Restriction, Manner of administration and form Pantoprazole 20mg enteric tablet, 30 (8399C) Scleroderma oesophagus

3 Name, Restriction, Manner of administration and form Pantoprazole 20mg enteric tablet, 30 (8399C) Zollinger-Ellison syndrome

4 Pantoprazole 40mg Name, Restriction, Pantoprazole 40mg enteric tablet, 30 (8007K) Pantoprazole 40mg enteric coated granules, 30 sachets (9423Y) Peptic Ulcer Treatment phase: Clinical criteria: Initial treatment The therapy must be for initial treatment of a peptic ulcer, in a patient testing negative for helicobacter pylori infection OR The patient must have failed treatment with helicobacter pylori eradication therapy Helicobacter pylori eradication therapy should be considered. No increase in the maximum number of repeats may be authorised. Low dose proton pump inhibitors are appropriate step-down therapy from standard dose proton pump inhibitors A low dose proton pump inhibitor includes: lansoprazole 15mg, omeprazole 10mg, pantoprazole 20mg and rabeprazole 10mg steppingup therapy No increase in the maximum quantity or number of repeats may be authorised.

5 Name, Restriction, Pantoprazole 40mg enteric tablet, 30 (8008L) Max. Pantoprazole 40mg enteric coated granules, 30 sachets (9424B) Scleroderma oesophagus Treatment criteria: Must be treated by a gastroenterologist or in consultation with a gastroenterologist Low dose proton pump inhibitors are appropriate step-down therapy from standard dose proton pump inhibitors A low dose proton pump inhibitor includes: lansoprazole 15mg, omeprazole 10mg, pantoprazole 20mg and rabeprazole 10mg No increase in the maximum quantity or number of repeats may be authorised.

6 Name, Restriction, Pantoprazole 40mg enteric tablet, 30 (8008L) Pantoprazole 40mg enteric coated granules, 30 sachets (9424B) Zollinger-Ellison syndrome Treatment criteria: Must be treated by a gastroenterologist or in consultation with a gastroenterologist Low dose proton pump inhibitors are appropriate step-down therapy from standard dose proton pump inhibitors A low dose proton pump inhibitor includes: lansoprazole 15mg, omeprazole 10mg, pantoprazole 20mg and rabeprazole 10mg steppingup therapy No increase in the maximum quantity or number of repeats may be authorised.

7 Name, Restriction, Pantoprazole 40mg enteric tablet, 30 (8008L) Max. Pantoprazole 40mg enteric coated granules, 30 sachets (9424B) Gastro-oesophageal reflux disease Clinical criteria: The treatment must be maintenance therapy for erosive reflux oesophagitis AND The condition must have been previously diagnosed by endoscopy Low dose proton pump inhibitors are appropriate step-down therapy from standard dose proton pump inhibitors A low dose proton pump inhibitor includes: lansoprazole 15mg, omeprazole 10mg, pantoprazole 20mg and rabeprazole 10mg No increase in the maximum quantity or number of repeats may be authorised.

8 Name, Restriction, Pantoprazole 40mg enteric tablet, 30 (New) 1 1 Pantoprazole 40mg enteric coated granules, 30 sachets (New) 1 1 Gastro-oesophageal reflux disease Clinical criteria: The treatment must be for initial treatment of symptomatic gastro-oesophageal reflux disease OR The treatment must be for the short-term maintenance treatment of gastrooesophageal reflux disease Low dose proton pump inhibitors are appropriate step-down therapy from standard dose proton pump inhibitors A low dose proton pump inhibitor includes: lansoprazole 15mg, omeprazole 10mg, pantoprazole 20mg and rabeprazole 10mg stepping-up therapy No increase in the maximum quantity or number of repeats may be authorised.