Omeprazole 10mg. Name, Restriction, Manner of administration and form OMEPRAZOLE omeprazole 10 mg enteric tablet, 30 (8332M) Max. Qty.

Transcription

1 Omeprazole 10mg Name, Restriction, Manner of administration and form omeprazole 10 mg enteric tablet, 30 (8332M) Gastro-oesophageal reflux disease

2 Name, Restriction, Manner of administration and form omeprazole 10 mg enteric tablet, 30 (8332M) Scleroderma oesophagus

3 Name, Restriction, Manner of administration and form omeprazole 10 mg enteric tablet, 30 (8332M) Zollinger-Ellison syndrome

4 Omeprazole 20mg Name, Restriction, Manner of administration and form omeprazole 20 mg Tablet, 30 (8331L, 9109K) omeprazole 20 mg capsule, 30 (1326T) 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

5 Helicobacter pylori eradication therapy should be considered. Pharmaceutical benefits that have the forms omeprazole tablet 20 mg, omeprazole capsule 20 mg and omeprazole tablet 20 mg (as magnesium) are equivalent for the purposes of substitution. 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 number of repeats may be No increase in the maximum quantity or number of repeats may be

6 Name, Restriction, Manner of administration and form omeprazole 20 mg Tablet, 30 (8333N, 9110L) omeprazole 20 mg capsule, 30 (1372W) Max. Scleroderma oesophagus Treatment criteria: Must be treated by a gastroenterologist or in consultation with a gastroenterologist Pharmaceutical benefits that have the forms omeprazole tablet 20 mg, omeprazole capsule 20 mg and omeprazole tablet 20 mg (as magnesium) are equivalent for the purposes of substitution. 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

7 Name, Restriction, Manner of administration and form omeprazole 20 mg Tablet, 30 (8333N, 9110L) omeprazole 20 mg capsule, 30 (1372W) Zollinger-Ellison syndrome Treatment criteria: Must be treated by a gastroenterologist or in consultation with a gastroenterologist Pharmaceutical benefits that have the forms omeprazole tablet 20 mg, omeprazole capsule 20 mg and omeprazole tablet 20 mg (as magnesium) are equivalent for the purposes of substitution. 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 repeatsmay be

8 Name, Restriction, Manner of administration and form omeprazole 20 mg Tablet, 30 (8333N, 9110L) omeprazole 20 mg capsule, 30 (1372W) Max. 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 Pharmaceutical benefits that have the forms omeprazole tablet 20 mg, omeprazole capsule 20 mg and omeprazole tablet 20 mg (as magnesium) are equivalent for the purposes of substitution 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

9 Name, Restriction, Manner of administration and form omeprazole 20 mg Tablet, 30 (New) 1 1 omeprazole 20 mg capsule, 30 (New) 1 1 Gastro-oesophageal reflux disease Clinical criteria: The treatment must be for initial treatment of symptomatic gastrooesophageal reflux disease OR The treatment must be for the short-term maintenance treatment of gastrooesophageal reflux disease Pharmaceutical benefits that have the forms omeprazole tablet 20 mg, omeprazole capsule 20 mg and omeprazole tablet 20 mg (as magnesium) are equivalent for the purposes of substitution. Low dose proton pump inhibitors are appropriate step-down therapy from standrad 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