NEW BRUNSWICK PRESCRIPTION DRUG PROGRAM FORMULARY

Transcription

1 NEW BRUNSWICK PRESCRIPTION DRUG PROGRAM FORMULARY FORMULAIRE DU PLAN DE MÉDICAMENTS SUR ORDONNANCE DU NOUVEAU-BRUNSWICK MARCH 2012 MARS 2012

2 NEW BRUNSWICK PRESCRIPTION DRUG PROGRAM FORMULARY Copyright HM The Queen in Right of The Province of New Brunswick as represented by The Honourable Madeleine Dubé Minister of Health ADMINISTERED BY MEDAVIE BLUE CROSS ON BEHALF OF THE GOVERNMENT OF NEW BRUNSWICK

3 TABLE OF CONTENTS Page Introduction New Brunswick Prescription Drug Program Plans Exclusions Drug Review Process ACDR Drug Requirements Legend Comment Sheet I II - III IV - V VI VII VIII IX Pharmacologic - Therapeutic Classification of Drugs 4:00 Antihistamines 1 8:00 Anti-Infective Agents 3 10:00 Antineoplastic Agents 35 12:00 Autonomic Drugs 42 20:00 Blood Formation and Coagulation 52 24:00 Cardiovascular Agents 62 28:00 Central Nervous System Agent :00 Electrolytic, Caloric and Water Balance :00 Antitussives, Expectorants & Mucolytic Agents :00 Eye, Ear, Nose and Throat (EENT) Preparations :00 Gastrointestinal Drugs :00 Gold Compounds :00 Heavy Metal Antagonists :00 Hormones and Synthetic Substitutes :00 Serums, Toxoids, and Vaccines :00 Skin and Mucous Membrane Agents :00 Smooth Muscle Relaxants :00 Vitamins :00 Miscellaneous Therapeutic Agents 256

4 TABLE OF CONTENTS Page Appendices I-A Abbreviations of Dosage Forms A-1 - A-3 I-B Abbreviations of Routes A-4 - A-5 I-C Abbreviations of Units A-6 - A-7 I-D Abbreviations of Manufacturers' Names A-8 - A-9 II Placebos A-10 III Extemporaneous Preparations A-11 IV Special Authorization A-12 - A-13 IV Special Authorization Drug Criteria A-14

5 NEW BRUNSWICK PRESCRIPTION DRUG PROGRAM FORMULARY Introduction The New Brunswick Prescription Drug Program (NBPDP) provides prescription drug coverage to eligible New Brunswick residents (see pages II and III). The New Brunswick Prescription Drug Program (NBPDP) Formulary is a list of the drugs which are eligible benefits under the Program. All drugs considered for listing as benefits must be reviewed according to the drug review process. Most drugs listed in the NBPDP Formulary are regular benefits which are reimbursed with no criteria or prior approval requirements. Some drugs require special authorization in order to be reimbursed. Certain drug products are not eligible benefits and are identified on the exclusion list (see Formulary pages IV and V). An electronic copy of the Formulary is updated quarterly on the NBPDP web page. To have your name added to the mailing list to receive notification of quarterly updates and Formulary Update Bulletins, please send a message to BC_nbpdp@medavie.bluecross.ca or call the NBPDP Inquiry Line at I March 2012

6 New Brunswick Prescription Drug Program Plans Plans Fees Participating Beneficiaries Legislative Authority A $9.05 per prescription up to an annual copay ceiling of $500 for GIS recipients. $15.00 per prescription with no annual ceiling for non- GIS recipients Eligible residents of the province who are sixty-five years of age or older Prescription Drug Payment Act and Regulations B $50 per year registration fee (1) ; 20% of cost of prescription to a maximum of $20 per prescription up to an annual ceiling of $500 per family unit Persons with cystic fibrosis who are eligible residents and registered with the Department of Health Prescription Drug Payment Act and Regulations E $4 per prescription; up to an annual copay ceiling of $250 per person (2) Persons in licensed residential facilities who are in receipt of financial assistance from the Department of Social Development and hold a valid health card issued by the Department of Social Development Health Services Act and Regulations F $4 per prescription for adults (18 years and over) $2 per prescription for children (under 18 years); up to an annual copay ceiling of $250 per family unit (2) Department of Social Development clients Health Services Act and Regulations G None Children in care of the Minister of the Department of Social Development and special needs children Health Services Act and Regulations H $50 per year premium; copay ranges from zero to 100 per cent for each prescription Persons with multiple sclerosis who are eligible residents and registered with the Department of Health Prescription Drug Payment Act and Regulations R $50 per year registration fee (1) ; 20% of cost of prescription to a maximum of $20 per prescription up to an annual ceiling of $500 per family unit Solid organ transplant recipients who are eligible residents and registered with the Department of Health Prescription Drug Payment Act and Regulations II March 2012

7 New Brunswick Prescription Drug Program Plans Plans Fees Participating Beneficiaries Legislative Authority T $50 per year registration fee (1) ; 20% of cost of prescription to a maximum of $20 per prescription up to an annual ceiling of $500 per family unit Persons with growth hormone deficiency who are eligible residents and registered with the Department of Health Prescription Drug Payment Act and Regulations U $50 per year registration fee (1) ; 20% of cost of prescription to a maximum of $20 per prescription up to an annual ceiling of $500 per family unit HIV-infected persons who are eligible residents and registered with the Department of Health Prescription Drug Payment Act and Regulations V None Eligible residents of Nursing Homes as defined in the Nursing Home Act operated by a licensee under the Act Prescription Drug Payment Act and Regulations Special Authorization Plan dependent (3) Persons approved to have payment made for certain drugs following medical consultation Prescription Drug Payment Act Non-NBPDP Plan Fees Participating Beneficiaries Legislative Authority W $9.05 per prescription Extra Mural Hospital patients who are in possession of a Prescription Drug Authorization Form Hospital Services Act (1) Family and Community Services clients are exempted from these fees. (2) Exempted from these fees for contraceptives. (3) See Appendix IV. III March 2012

8 Exclusions Exclusions are items that are not eligible benefits under the New Brunswick Prescription Drug Program. These items fall outside of the program s mandate or are excluded based on the recommendation of an expert advisory committee and are not considered for coverage. 1. Patent medicines such as Jack and Jill Cough Syrup, Extract of Wild Strawberry, etc. 2. Non-prescription acetylsalicylic acid (ASA) preparations except enteric coated ASA products designated as benefits. 3. Non-prescription mouth, throat and nasal preparations, including decongestants. 4. Prescription and non-prescription, cough and cold products (e.g. antitussives, expectorants and decongestants) except those listed as benefits for children in care (Plan G). 5. (a) Non-prescription adult vitamins with or without iron supplements (Plans A, E, F [over 18 years of age]) as a dietary supplement. (b) Multivitamins (prescription and non-prescription) as a dietary supplement. 6. Non-prescription tonics and compounded iron preparations (except single entity iron preparations designated as benefits). 7. Dietary/nutritional supplements and food products. 8. Artificial sweetening agents. 9. Weight loss products (prescription and non-prescription). 10. Calcium preparations (prescription and non-prescription) as a dietary supplement. 11. Laxatives (Plans A, E,F and G). 12. Antacids (Plans A only). 13. Smoking cessation products. 14. Ergoloid mesylates, oral, (Hydergine). 15. Potassium supplements, oral, when supplied as K-Lyte effervescent tablets, lime or orange flavoured. 16. Retinoic acid (eg. Tretinoin) topical and oral preparations (Plan A only). 17. Cosmetic, health, dental and beauty aids, and cosmetic drugs. IV March 2012

9 18. Soaps, cleansers and shampoos, medicated or otherwise. 19. Appliances, devices and medical supplies including prostheses, first aid supplies and syringes. 20. Diagnostic agents and point-of-care testing kits. 21. Household remedies e.g. calamine lotion, iodine, hydrogen peroxide, antiseptics and disinfectants. 22. Injectables or other products normally administered in a hospital setting or requiring a health care professional for administration and/or monitoring to ensure the appropriate standard of patient care is provided. 23. Any insured service for which the resident is entitled to benefit under Department of Veterans Affairs, Workplace Health & Safety Compensation Commission or other legislation. 24. Delivery, postal or C.O.D. charges. 25. Refills in excess of the number specified by the physician or any refill of a prescription older than one year unless approved for refill by the prescriber. 26. Antihistamines (Plans A, E, F, and V) 27. Benzoyl Peroxide preparations in strengths of 5% or less. 28. Lactase Enzyme products. 29. All drug products used for the treatment of infertility. 30. Products for the treatment of impotence and sexual dysfunction. 31. Butorphanol nasal spray. 32. Drugs excluded as eligible benefits further to the expert advisory committee s review and recommendation that they not be listed. 33. Medications for the prevention of travel acquired diseases (eg. malaria, gastrointestinal illnesses and other potential conditions) V March 2012

10 Drug Review Process All drugs considered for benefit status in the New Brunswick Prescription Drug Program (NBPDP) Formulary are subject to a standard review process and reviewed by the Canadian Expert Drug Advisory Committee (CEDAC) or the Atlantic Expert Advisory Committee (AEAC). The expert advisory committees are comprised of practicing physicians, pharmacists and others with expertise in drug therapy and drug evaluation. They review and evaluate scientific and economic information on new drugs and make a recommendation to provincial drug programs on whether a drug should be listed as a program benefit, including conditions and/or criteria for coverage. Listing decisions for the NBPDP are determined by the Minister of Health. Authority for deletion of products from the NBPDP Formulary remains with the Minister of Health. National Common Drug Review NBPDP is a participant in the national Common Drug Review (CDR). The CDR provides participating federal, provincial and territorial drug benefit plans with a systematic review of the best available clinical evidence, a critique of manufacturer-submitted pharmacoeconomic studies and a formulary listing recommendation made by the Canadian Expert Drug Advisory Committee (CEDAC). Eligible submissions from manufacturers include those for new drugs, new combination products and drugs with new indications. Information on the CDR requirements and procedures is posted at: Atlantic Common Drug Review The Atlantic Common Drug Review (ACDR) reviews the clinical and cost effectiveness of drugs that do not fall under the national Common Drug Review (CDR) mandate and provides formulary listing recommendations made by the Atlantic Expert Advisory Committee (AEAC) to the Atlantic provincial drug programs. Drugs reviewed by ACDR include: New single source products that do not fall under CDR mandate Line extensions Resubmissions for products not previously reviewed by CDR Currently listed drugs Drug classes Information on the Atlantic CDR requirements and procedures is posted at: Drug submissions should be sent to: Director, NB Prescription Drug Program Phone: (506) Department of Health Fax: (506) King Street, 6 th Floor HSBC Place info@nbpdp-pmnob.ca PO Box 5100 Fredericton, NB E3B 5G8 Submissions are accepted on an on-going basis and there are no deadlines. In general, submissions are reviewed in order of receipt of complete submissions. Manufacturers are charged for any costs associated with the review of drug submissions and resubmissions. Cheques for payment of review costs are to be made payable to the Minister of Finance. However, costs for drugs reviewed by CDR processes are infrequent. VI March 2012

11 ACDR Drug Submission Requirements All documents must be provided to each participating province in electronic format on compact disc accompanied by a cover letter. One complete hard copy submission must be sent to the ACDR coordinator. Receipt of submissions is acknowledged by the ACDR secretariat by . Please include a contact address in the submission. New drug products not eligible for review by CDR 1. Executive Summary 2. Notice of Compliance (NOC) 3. Product Monograph 4. Therapeutic classifications: American Hospital Formulary Service, Pharmacologic-Therapeutic Classification (PTC) and World Health Organization's Anatomical Therapeutic Chemical (ATC) classification 5. Clinical evidence on efficacy, effectiveness and safety. Double-blind, randomized, controlled trials (RCTs) published in peer-reviewed journals are given the most weight If unpublished/abstract data is submitted, it must be indicated why it is unpublished List all studies submitted in one table and specify the study name, date, authors and whether it is published or unpublished Published articles supporting the validity of outcome measures in studies (if available) 6. Economic Information a. A pharmacoeconomic evaluation is required for most new chemical entities. Studies should follow current guidelines from the Canadian Agency for Drugs and Technologies in Health (CADTH) b. Budget impact analysis 7. Pricing and availability a. Current price for all strengths and dosage forms b. Method of distribution to pharmacies (wholesale, direct or other arrangements) c. Evidence of ability to supply anticipated demand 8. A letter authorizing unrestricted communication regarding the drug product between the New Brunswick Prescription Drug Program and a. Other federal, provincial and territorial (F/P/T) drug programs b. F/P/T health authorities and related facilities c. Health Canada d. Patented Medicine Prices Review Board (PMPRB) e. Canadian Agency for Drugs and Technologies in Health (CADTH) 9. A letter specifying the current or intended Compendium of Pharmaceuticals and Specialties (CPS) listing status. 10. A copy of the Pharmaceutical Advertising Advisory Board (PAAB) approved promotional materials 11. Manufacturers will be invoiced for any costs associated with the review of a drug submission or resubmission. Drug submission requirements for line extensions and resubmissions are posted at: VII March 2012

12 Legend 1. Pharmacological - therapeutic classification 7. Manufacturers' identification code. See Appendix II 2. Pharmacological - therapeutic sub-classification for an explanation of codes 3. Nonproprietary or generic name of the drug 8. Drug program plans for which the product is considered 4. Dosage form, route and strength. Strength represents to be a benefit the amount of ingredients present in a solid dose 9. Indicates that the copay is waived for Plan E and form (Tablet) or in one gram or one millilitre of Plan "F" prescriptions a preparation (Cream, Liquid, etc.) 10. Indicates that the products are interchangeable 5. Brand or manufacturers' product name 11. Manufacturer has discontinued this product. It will be 6. Drug Identification Number (DIN) deleted from the list as a benefit on the date indicated 12. Date of publication VIII March 2012

13 Your comments please... The New Brunswick Prescription Drug Program would like to offer you the opportunity to provide your comments. If you have any concerns and/or suggestions concerning the formulary, product listings, etc., please let us know. Please return to: NB Prescription Drug Program P.O. Box 5100 Fredericton, New Brunswick E3B 5G8 or FAX to: (506) IX March 2012

14 04:00 Antihistamines Antihistaminiques 04:00:00 Antihistamine Drugs Antihistaminiques Cetirizine Hydrochloride Cétirizine (chlorhydrate de) 10mg REACTINE JNJ f G APO-CETIRIZINE APX f G EXTRA STRENGTH ALLERGY RELIEF PDP f G Chlorpheniramine Maleate Chlorphéniramine (maléate de) 4mg Diphenhydramine Hydrochloride Diphénhydramine (chlorhydrate de) Cap Orl 50mg Caps Elx Orl 2.5mg Elixir 25mg NOVO-PHENIRAM NOP G CHLOR-TRIPOLON SCO G BENADRYL JNJ G BENADRYL JNJ G BENADRYL JNJ G Levocabastine Lévocabastine Sus Oph 0.5mg Susp. Loratadine Loratadine 10mg LIVOSTIN (DISC/NON DISP June 27/13) NVO AEFGVW CLARITIN SCO f G APO-LORATADINE APX f G 04:04:04 Ethanolamine Derivatives Dérivés de l éthanolamine Diphenhydramine Diphénhydramine 25mg DIPHENHYDRAMINE JPC G Page 1

15 04:00 Antihistamines Antihistaminiques 04:04:04 Ethanolamine Derivatives Dérivés de l éthanolamine Diphenhydramine Diphénhydramine 50mg DIPHENHYDRAMINE JPC G Page 2

16 08:00 Anti-Infective Agents Anti-infectieux 08:04:00 Amebicides Amoebicides Iodoquinol Iodoquinol 650mg DIODOQUIN GLE AEFGVW 08:08:00 Anthelmintics Anthelmintiques Mebendazole Mébendazole 100mg Pyrantel Pamoate Pyrantel (pamoate de) Sus Orl 50mg Susp. 125mg VERMOX JAN AEFGVW COMBANTRIN JNJ EF-18G COMBANTRIN JNJ EF-18G 08:12:00 Anitbiotics Antibiotiques Meropenem Méropenem Pws Inj 1gm Pds. Pws Inj 500mg Pds. MERREM AZE W MERREM AZE W 08:12:02 Antibiotics (Aminoglycosides) Antibiotiques (aminosides) Amikacin sulfate Sulfate d'amikacine Liq Inj 250mg/mL Liq AMIKACIN SDZ W Gentamicin Sulphate Gentamicine (sulfate de) Liq Inj 40mg Liq GENTAMYCIN * SDZ BEFGVW Page 3

17 08:00 Anti-Infective Agents Anti-infectieux 08:12:02 Antibiotics (Aminoglycosides) Antibiotiques (aminosides) Tobramycin Sulfate Tobramycine (sulfate de) Liq Inj 40mg/mL Liq TOBRAMYCIN * SDZ BEFGVW 08:12:04 Antibiotics (Antifungals) Antibiotiques (antifongiques) Amphotericin B Amphotéricine B Pws Inj 50mg Pds. Griseofulvin Griséofulvine 500mg Nystatin Nystatine Sus Orl IU Susp IU FUNGIZONE IV BRI W GRISOVIN FP SHI AEFGVW pms-nystatin ORAL PMS ABEFGVW ratio-nystatin RPH ABEFGVW ratio-nystatin RPH ABEFGVW 08:12:06 Antibiotics (Cephalosporins) Antibiotiques (céphalosporines) Cefaclor Céfaclor Cap Orl 250mg Caps CECLOR MMT f ABEFGVW APO-CEFACLOR (DISC/NON DISP Oct 14/12) APX f ABEFGVW NU-CEFACLOR (DISC/NON DISP Oct 18/12) NXP f ABEFGVW CEFACLOR (DISC/NON DISP Jan 12/14) IVX f ABEFGVW Cap Orl 500mg Caps CECLOR MMT f ABEFGVW APO-CEFACLOR (DISC/NON DISP Oct 14/12) APX f ABEFGVW NU-CEFACLOR (DISC/NON DISP Oct 18/12) NXP f ABEFGVW CEFACLOR (DISC/NON DIPS Jan 12/14) IVX f ABEFGVW Page 4

18 08:00 Anti-Infective Agents Anti-infectieux 08:12:06 Antibiotics (Cephalosporins) Antibiotiques (céphalosporines) Cefaclor Céfaclor Pws Orl 25mg Pds. Pws Orl 50mg Pds. Pws Orl 75mg Pds. Cefadroxil Céfadroxil Cap Orl 500mg Caps Cefazolin Sodium Céfazoline sodique Pws Inj 1gm Pds. Pws Inj 500mg Pds. Cefepime Hydrochloride céfépime (chlorhydrate de) Pws Inj 1gm Pds. Pws Inj 2gm Pds. Cefixime Céfixime Pws Orl 20mg Pds. CECLOR MMT ABEFGVW CECLOR MMT ABEFGVW CECLOR B.I.D MMT ABEFGVW NOVO-CEFADROXIL NOP f AEFGVW APO-CEFADROXIL APX f AEFGVW CEFAZOLIN SODIUM * NOP f BEFGW CEFAZOLIN * HOS f BEFGW CEFAZOLIN SODIUM * SDZ f BEFGW CEFAZOLIN SODIUM * NOP f BEFGW CEFAZOLIN SODIUM * SDZ f BEFGW MAXIPIME BRI W MAXIPIME BRI f W CEFEPIME APX f W SUPRAX SAV ABEFGVW Page 5

19 08:00 Anti-Infective Agents Anti-infectieux 08:12:06 Antibiotics (Cephalosporins) Antibiotiques (céphalosporines) Cefixime Céfixime 400mg Cefotaxime Sodium Céfotaxime sodique Pws Inj 1gm Pds Pws Inj 2gm Pds Pws Inj 500mg Pds SUPRAX SAV ABEFGVW CLAFORAN SAV W CLAFORAN SAV W CLAFORAN SAV W Ceftazidime Pentahydrate Ceftazidime (pentahydrate de) Pws Inj 1gm Pds. CEFTAZIDIME * LYP BEFGW FORTAZ * GSK BEFGW Pws Inj 2gm Pds. CEFTAZIDIME * LYP BEFGW FORTAZ * GSK BEFGW Pws Inj 500mg Pds. FORTAZ * GSK BEFGW Ceftriaxone Disodium Ceftriazone disodique Pws Inj 1gm Pds. Pws Inj 2gm Pds. Pws Inj 250mg Pds. ROCEPHIN (DISC/NON DISP June 17/13) * HLR f BEFGVW CEFTRIAXONE * SDZ f BEFGVW CEFTRIAXONE * APX f BEFGVW CEFTRIAXONE * SDZ f BEFGVW CEFTRIAXONE * APX f BEFGVW ROCEPHIN * HLR f BEFGW CEFTRIAXONE * APX f BEFGW Page 6

20 08:00 Anti-Infective Agents Anti-infectieux 08:12:06 Antibiotics (Cephalosporins) Antibiotiques (céphalosporines) Cefuroxime Axetil Céfuroxime axetil Liq Orl 125mg/5mL Liq 250mg 500mg CEFTIN GSK ABEFGVW CEFTIN GSK f ABEFGVW ratio-cefuroxime RPH f ABEFGVW APO-CEFUROXIME APX f ABEFGVW CEFTIN GSK f ABEFGVW ratio-cefuroxime RPH f ABEFGVW APO-CEFUROXIME APX f ABEFGVW Cefuroxime Sodium Céfuroxime sodique Pws Inj 1.5gm Pds. CEFUROXIME * LYP BEFGW Pws Inj 750mg Pds. CEFUROXIME * LYP BEFGW Cephalexin Monohydrate Céphalexine (monohydrate de) Cap Orl 250mg Caps Cap Orl 500mg Caps Pws Orl 25mg Pds. Pws Orl 50mg Pds. 250mg NOVO-LEXIN NOP ABEFGVW NOVO-LEXIN NOP ABEFGVW NOVO-LEXIN NOP ABEFGVW NOVO-LEXIN NOP ABEFGVW NOVO-LEXIN NOP f ABEFGVW APO-CEPHALEX APX f ABEFGVW NU-CEPHALEX NXP f ABEFGVW Page 7

21 08:00 Anti-Infective Agents Anti-infectieux 08:12:06 Antibiotics (Cephalosporins) Antibiotiques (céphalosporines) Cephalexin Monohydrate Céphalexine (monohydrate de) 500mg NOVO-LEXIN NOP f ABEFGVW APO-CEPHALEX APX f ABEFGVW NU-CEPHALEX NXP f ABEFGVW 08:12:07 Antibiotics (Miscellaneous Beta-Lactam) Antibiotiques (divers bêta-lactames) Cefoxitin Sodium Cefoxitin sodique Pws Inj 1gm Pds. Pws Inj 2gm Pds. Pws Inj 10gm Pds. CEFOXITIN SODIUM NOP W CEFOXITIN SODIUM NOP W NOVO-CEFOXITIN NOP W Imipenem Monohydrate/ Cilastatin Sodium Imipénem (monohydrate de/cilastatine sodique Pws Inj 250mg Pds. Pws Inj 500mg Pds. PRIMAXIN FRS W PRIMAXIN FRS W 08:12:12 Antibiotics (Macrolides) Antibiotiques (macrolides) Azithromycin Azithromycine Pws Inj 500mg Pds. Pws Orl 20mg Pds. ZITHROMAX PFI W ZITHROMAX PFI f ABEFGVW pms-azithromycin PMS f ABEFGVW NOVO-AZITHROMYCIN PEDIATRIC NOP f ABEFGVW SANDOZ AZITHROMYCIN SDZ f ABEFGVW AVA-AZITHROMYCIN AVA f ABEFGVW phl-azithromycin PHL ABEFGVW Page 8

22 08:00 Anti-Infective Agents Anti-infectieux 08:12:12 Antibiotics (Macrolides) Antibiotiques (macrolides) Azithromycin Azithromycine Pws Orl 40mg Pds. 250mg 600mg Clarithromycin Clarithromycin Pws Orl 25mg Pds. Pws Orl 50mg Pds. ZITHROMAX PFI f ABEFGVW pms-azithromycin PMS f ABEFGVW NOVO-AZITHROMYCIN PEDIATRIC NOP f ABEFGVW SANDOZ AZITHROMYCIN SDZ f ABEFGVW AVA-ZITHROMYCIN AVA f ABEFGVW phl-azithromycin PHL ABEFGVW ZITHROMAX PFI f ABEFGVW APO-AZITHROMYCIN APX f ABEFGVW CO AZITHROMYCIN COB f ABEFGVW pms-azithromycin PMS f ABEFGVW SANDOZ-AZITHROMYCIN SDZ f ABEFGVW NOVO-AZITHROMYCIN NOP f ABEFGVW GD-AZITHROMYCIN GMD f ABEFGVW ratio-azithromycin RPH f ABEFGVW MYLAN-AZITHROMYCIN MYL f ABEFGVW AZITHROMYCIN SAS f ABEFGVW AVA-AZITHROMYCIN AVA f ABEFGVW ZITHROMAX PFI f W CO AZITHROMYCIN COB f W pms-azithromycin PMS f W AZITHROMYCIN SAS f W BIAXIN ABB ABEFGVW BIAXIN ABB ABEFGVW Page 9

23 08:00 Anti-Infective Agents Anti-infectieux 08:12:12 Antibiotics (Macrolides) Antibiotiques (macrolides) Clarithromycin Clarithromycin 250mg 500mg Erythromycin Base Erythromycine base ECC Orl 333mg Caps.Ent. SRC Orl 250mg Caps.L.L. 250mg Erythromycin Estolate Erythromycine (estolate d') Liq Orl 50mg Liq BIAXIN BID ABB f ABEFGVW pms-clarithromycin PMS f ABEFGVW ratio-clarithromycin RPH f ABEFGVW MYLAN-CLARITHROMYCIN MYL f ABEFGVW SANDOZ CLARITHROMYCIN SDZ f ABEFGVW APO-CLARITHROMYCIN APX f ABEFGVW RAN-CLARITHROMYCIN RAN f ABEFGVW AVA-CLARITHROMYCIN AVA f ABEFGVW BIAXIN BID ABB f ABEFGVW pms-clarithromycin PMS f ABEFGVW ratio-clarithromycin RPH f ABEFGVW MYLAN-CLARITHROMYCIN MYL f ABEFGVW SANDOZ CLARITHROMYCIN SDZ f ABEFGVW APO-CLARITHROMYCIN APX f ABEFGVW RAN-CLARITHROMYCIN RAN f ABEFGVW AVA-CLARITHROMYCIN AVA f ABEFGVW BIAXIN XL ABB ABEFGVW ERYC PFI f ABEFGVW ERYTHRO E-C AAP f ABEFGVW ERYC PFI f ABEFGVW ERYTHRO E-C AAP f ABEFGVW ERYTHRO AAP ABEFGVW NOVO-RYTHRO ESTOLATE NOP ABEFGVW Page 10

24 08:00 Anti-Infective Agents Anti-infectieux 08:12:12 Antibiotics (Macrolides) Antibiotiques (macrolides) Erythromycin Ethylsuccinate Erythromycine (ethylsuccinate d') Pws Orl 40mg Pds. Pws Orl 80mg Pds. 600mg Erythromycin Stearate Erythromycine (stéarate d') 250mg 500mg Spiramycin Spiramycine Cap Orl IU Caps Cap Orl IU Caps NOVO-RYTHRO NOP ABEFGVW NOVO-RYTHRO NOP ABEFGVW ERYTHRO-ES AAP ABEFGVW ERYTHRO-S AAP ABEFGVW ERYTHRO-S AAP ABEFGVW ROVAMYCINE ODN AEFGVW ROVAMYCINE ODN AEFGVW 08:12:16 Antibiotics (Penicillins) Antibiotiques (pénicillines) Amoxicillin Amoxicilline Cap Orl 250mg Caps NOVAMOXIN NOP f ABEFGVW APO-AMOXI APX f ABEFGVW NU-AMOXI NXP f ABEFGVW pms-amoxicillin PMS f ABEFGVW MYLAN-AMOXICILLIN MYL f ABEFGVW AMOXICILLIN NUM f ABEFGVW AMOXICILLIN SAS f ABEFGVW Page 11

25 08:00 Anti-Infective Agents Anti-infectieux 08:12:16 Antibiotics (Penicillins) Antibiotiques (pénicillines) Amoxicillin Amoxicilline Cap Orl 500mg Caps Pws Orl 25mg Pds. Pws Orl 50mg Pds. NOVAMOXIN NOP f ABEFGVW APO-AMOXI APX f ABEFGVW NU-AMOXI NXP f ABEFGVW pms-amoxicillin PMS f ABEFGVW MYLAN-AMOXICILLIN MYL f ABEFGVW AMOXICILLIN NUM f ABEFGVW AMOXICILLIN SAS f ABEFGVW NOVAMOXIN NOP f ABEFGVW APO-AMOXI APX f ABEFGVW NU-AMOXI NXP f ABEFGVW NOVAMOXIN 125 (sugar-reduced) NOP f ABEFGVW pms-amoxicillin PMS f ABEFGVW AMOXICILLIN SAS f ABEFGVW AMOXICILLIN (sugar-reduced) SAS f ABEFGVW NOVAMOXIN NOP f ABEFGVW APO-AMOXI APX f ABEFGVW NU-AMOXI NXP f ABEFGVW NOVAMOXIN 250 (sugar-reduced) NOP f ABEFGVW pms-amoxicillin PMS f ABEFGVW AMOXICILLIN SAS f ABEFGVW AMOXICILLIN (sugar-reduced) SAS f ABEFGVW TabC Orl C 125mg NOVAMOXIN CHEW NOP ABEFGVW TabC Orl C 250mg NOVAMOXIN CHEW NOP f ABEFGVW AMOXICILLIN CHEW (DISC/NON DISP Jan 12/14) SAS f ABEFGVW Amoxicillin/Clavulanic Acid Amoxicilline/acide clavulanique Pws Orl 25mg/6.25mg Pds. CLAVULIN GSK f ABEFGVW APO-AMOXI CLAV APX f ABEFGVW ratio-aclavulanate 125 F RPH f ABEFGVW Page 12

26 08:00 Anti-Infective Agents Anti-infectieux 08:12:16 Antibiotics (Penicillins) Antibiotiques (pénicillines) Amoxicillin/Clavulanic Acid Amoxicilline/acide clavulanique Pws Orl 50mg/12.5mg Pds. Pws Orl 200/28.5mg/5mL Pds. Pws Orl 400/57/5mL Pds. 250mg/125mg 500mg/125mg 875mg/125mg Ampicillin Ampicilline Cap Orl 250mg Caps Cap Orl 500mg Caps Pws Inj 1gm Pds. Pws Inj 2gm Pds. Pws Inj 500mg Pds. CLAVULIN-250F GSK f ABEFGVW APO-AMOXI CLAV APX f ABEFGVW ratio-aclavulanate 250 F RPH f ABEFGVW CLAVULIN GSK ABEFGVW CLAVULIN GSK f ABEFGVW APO-AMOXI CLAV APX f ABEFGVW APO-AMOXI CLAV APX ABEFGVW CLAVULIN-500F GSK f ABEFGVW APO-AMOXI CLAV APX f ABEFGVW ratio-aclavulanate RPH ABEFGVW CLAVULIN GSK f ABEFGVW APO-AMOXI CLAV APX f ABEFGVW ratio-aclavulanate RPH f ABEFGVW NOVO-CLAVAMOXIN NOP f ABEFGVW NOVO-AMPICILLIN NOP AEFGVW NOVO-AMPICILLIN NOP AEFGVW NOVO-AMPICILLIN NOP W AMPICILLIN SODIUM NOP W NOVO-AMPICILLIN NOP W Page 13

27 08:00 Anti-Infective Agents Anti-infectieux 08:12:16 Antibiotics (Penicillins) Antibiotiques (pénicillines) Cloxacillin Sodium Cloxacilline sodique Cap Orl 250mg Caps Cap Orl 500mg Caps NOVO-CLOXIN NOP f ABEFGVW APO-CLOXI (DISC/NON DISP April 29/13) APX f ABEFGVW NU-CLOXI (DISC/NON DISP May 10/13) NXP f ABEFGVW NOVO-CLOXIN NOP f ABEFGVW APO-CLOXI (DISC/NON DISP April 29/13) APX f ABEFGVW NU-CLOXI (DISC/NON DISP May 10/13) NXP f ABEFGVW Pws Inj 1gm Pds. CLOXACILLIN SODIUM * NOP BEFGW Pws Inj 2gm Pds. CLOXACILLIN SODIUM * NOP BEFGW Pws Inj 500mg Pds. CLOXACILLIN SODIUM * NOP BEFGW Pws Orl 25mg Pds. NOVO-CLOXIN NOP f ABEFGVW APO-CLOXI (DISC/NON DISP April 29/13) APX f ABEFGVW NU-CLOXI (DISC/NON DISP May 10/13) NXP f ABEFGVW Penicillin G Benzathine Pénicilline G bénzathine Sus Inj IU Susp. Penicillin G Sodium Pénicilline G sodique Liq Inj IU Liq Liq Inj IU Liq Liq Inj IU Liq BICILLIN L-A KNG AEFGVW PENICILLIN G SODIUM NOP W PENICILLIN G SODIUM NOP W PENICILLIN G SODIUM NOP W Page 14

28 08:00 Anti-Infective Agents Anti-infectieux 08:12:16 Antibiotics (Penicillins) Antibiotiques (pénicillines) Penicillin V Potassium Pénicilline v potassique Pws Orl 25mg Pds. Pws Orl 60mg Pds. 300mg Piperacilin G Sodium Pipéracilline G sodique Pws Inj IU Pds. Pws Inj IU Pds. APO-PEN VK APX AEFGVW NOVO-PEN-VK NOP AEFGVW APO-PEN VK APX AEFGVW NOVO-PEN-VK NOP f AEFGVW APO-PEN VK APX f AEFGVW NU-PEN-VK NXP f AEFGVW CRYSTAPEN BCH W CRYSTAPEN BCH W Piperacilin Sodium Pipéracilline sodique Pws Inj 2gm Pds. PIPERACILLIN (DISC/NON DISP Oct 31/12) HOS W Pws Inj 3gm Pds. Pws Inj 4gm Pds. PIPERACILLIN HOS W PIPERACILLIN (DISC/NON DISP Oct 31/12) HOS W Piperacilin Sodium/Tazobactam Pipéracilline sodique/tazobactam Pws Inj 2g/0.25g Pds. TAZOCIN PFI W PIPERACILLIN & TAZOBACTAM SDZ W PIPERACILLIN & TAZOBACTAM APX W Page 15

29 08:00 Anti-Infective Agents Anti-infectieux 08:12:16 Antibiotics (Penicillins) Antibiotiques (pénicillines) Piperacilin Sodium/Tazobactam Pipéracilline sodique/tazobactam Pws Inj 3g/0.375g Pds. Pws Inj 4g/0.5g Pds. Ticarcillin Disodium Ticarcilline disodique Pws Inj 3gm Pds. TAZOCIN PFI W PIPERACILLIN & TAZOBACTAM SDZ W PIPERACILLIN & TAZOBACTAM APX W TAZOCIN PFI W PIPERACILLIN & TAZOBACTAM SDZ W PIPERACILLIN & TAZOBACTAM APX W TIMENTIN GSK W 08:12:18 Quinolones Quinolones Ciprofloxacin Ciprofloxacine ERT Orl 1000mg L.P. **CIPRO XL BAY ABEFGV **Prescriptions written by New Brunswick urologists, infectious disease specialists and medical microbiologists do not require special authorization. Les ordonnances provenant d'urologues, spécialistes en maladies infectieuses, ou microbiologistes du Nouveau-Brunswick ne nécessiteront pas une autorisation spéciale. Page 16

30 08:00 Anti-Infective Agents Anti-infectieux 08:12:18 Quinolones Quinolones Ciprofloxacin Ciprofloxacin Liq Inj 2mg/mL Liq Liq Inj 10mg/mL Liq Liq Orl 100mg Liq CIPROFLOXACIN I.V NOP f W CIPROFLOXACIN SDZ f W CIPROFLOXACIN PDL W **CIPRO ORAL SUSPENSION BAY ABEFGV Ciprofloxacin Hydrochloride Ciprofloxacine (chlorhydrate de) 250mg **CIPRO BAY f AEFGV CIPRO BAY f BW **NOVO-CIPROFLOXACIN NOP f AEFGV NOVO-CIPROFLOXACIN NOP f BW **APO-CIPROFLOX APX f AEFGV APO-CIPROFLOX APX f BW MYLAN-CIPROFLOXACIN MYL f BW **MYLAN-CIPROFLOXACIN MYL f AEFGV **ratio-ciprofloxacin RPH f AEFGV ratio-ciprofloxacin RPH f BW CO CIPROFLOXACIN COB f BW **CO CIPROFLOXACIN COB f AEFGV pms-ciprofloxacin PMS f BW **pms-ciprofloxacin PMS f AEFGV SANDOZ CIPROFLOXACIN SDZ f BW **SANDOZ CIPROFLOXACIN SDZ f AEFGV RAN-CIPROFLOXACIN (DISC/NON DISP Aug 6/12) RAN f BW **RAN-CIPROFLOXACIN (DISC/NON DISP Aug 6/12) RAN f AEFGV RAN-CIPROFLOX RAN f BW **RAN-CIPROFLOX RAN f AEFGV **MINT-CIPROFLOXACIN MNT f AEFGV MINT-CIPROFLOXACIN MNT f BW CIPROFLOXACIN SAS f BW **CIPROFLOXACIN SAS f AEFGV Page 17

31 08:00 Anti-Infective Agents Anti-infectieux 08:12:18 Quinolones Quinolones Ciprofloxacin Hydrochloride Ciprofloxacine (chlorhydrate de) 500mg **CIPRO BAY f AEFGV CIPRO BAY f BW **NOVO-CIPROFLOXACIN NOP f AEFGV NOVO-CIPROFLOXACIN NOP f BW **APO-CIPROFLOX APX f AEFGV APO-CIPROFLOX APX f BW **MYLAN-CIPROFLOXACIN MYL f AEFGV MYLAN-CIPROFLOXACIN MYL f BW ratio-ciprofloxacin RPH f BW **ratio-ciprofloxacin RPH f AEFGV CO CIPROFLOXACIN COB f BW **CO CIPROFLOXACIN COB f AEFGV pms-ciprofloxacin PMS f BW **pms-ciprofloxacin PMS f AEFGV **SANDOZ CIPROFLOXACIN SDZ f AEFGV SANDOZ CIPROFLOXACIN SDZ f BW **RAN-CIPROFLOXACIN (DISC/NON DISP Aug 6/12) RAN f AEFGV RAN-CIPROFLOXACIN (DISC/NON DISP Aug 6/12) RAN f BW RAN-CIPROFLOX RAN f BW **RAN-CIPROFLOX RAN f AEFGV **MINT-CIPROFLOXACIN MNT f AEFGV MINT-CIPROFLOXACIN MNT f BW **CIPROFLOXACIN SAS f AEFGV CIPROFLOXACIN SAS f BW Page 18

32 08:00 Anti-Infective Agents Anti-infectieux 08:12:18 Quinolones Quinolones Ciprofloxacin Hydrochloride Ciprofloxacine (chlorhydrate de) 750mg CIPRO BAY f BW **CIPRO BAY f AEFGV **NOVO-CIPROFLOXACIN NOP f AEFGV NOVO-CIPROFLOXACIN NOP f BW APO-CIPROFLOX APX f BW **APO-CIPROFLOX APX f AEFGV MYLAN-CIPROFLOXACIN MYL f BW **MYLAN-CIPROFLOXACIN MYL f AEFGV **ratio-ciprofloxacin RPH f AEFGV ratio-ciprofloxacin RPH f BW CO CIPROFLOXACIN COB f BW **CO CIPROFLOXACIN COB f AEFGV **pms-ciprofloxacin PMS f AEFGV pms-ciprofloxacin PMS f BW **SANDOZ CIPROFLOXACIN SDZ f AEFGV SANDOZ CIPROFLOXACIN SDZ f BW **RAN-CIPROFLOXACIN (DISC/NON DISP Aug 6/12) RAN f AEFGV RAN-CIPROFLOXACIN (DISC/NON DISP Aug 6/12) RAN f W RAN-CIPROFLOX RAN f BW **RAN-CIPROFLOX RAN f AEFGV MINT-CIPROFLOXACIN MNT f BW **MINT-CIPROFLOXACIN MNT f AEFGV **CIPROFLOXACIN SAS f AEFGV CIPROFLOXACIN SAS f BW **Requests for coverage of Cipro (ciprofloxacin) will be considered under special authorization (see Appendix IV). Prescriptions written by New Brunswick urologists, infectious disease specialists, medical oncologists, hemotologists, respiratory medicine specialists or medical microbiologists will not require special authorization. Les demandes de protection pour le Cipro (ciprofloxacin) seront examinées sur autorisation spéciale. Veuillez consulter l annexe IV. Les ordonnances rédigées par les urologues, spécialistes en maladies infectieuses, oncologues, hématologues, inhalothérapeutes ou microbiologistes du Nouveau-Brunswick ne nécessiteront pas une autorisation spéciale. Page 19

33 08:00 Anti-Infective Agents Anti-infectieux 08:12:18 Quinolones Quinolones Levofloxacin Léofloxacine Tab Inj 5mg/mL 250mg 500mg LEVAQUIN JAN W **LEVAQUIN JAN f ABEFG LEVAQUIN JAN f VW NOVO-LEVOFLOXACIN NOP f VW **NOVO-LEVOFLOXACIN NOP f ABEFG **pms-levofloxacin PMS f ABEFG pms-levofloxacin PMS f VW **APO-LEVOFLOXACIN APX f ABEFG APO-LEVOFLOXACIN APX f VW SANDOZ LEVOFLOXACIN SDZ f VW **SANDOZ LEVOFLOXACIN SDZ f ABEFG MYLAN-LEVOFLOXACIN MYL f VW **MYLAN-LEVOFLOXACIN MYL f ABEFG CO LEVOFLOXACIN COB f VW **CO LEVOFLOXACIN COB f ABEFG LEVAQUIN JAN f VW **LEVAQUIN JAN f ABEFG **NOVO-LEVOFLOXACIN NOP f ABEFG NOVO-LEVOFLOXACIN NOP f VW pms-levofloxacin PMS f VW **pms-levofloxacin PMS f ABEFG **APO-LEVOFLOXACIN APX f ABEFG APO-LEVOFLOXACIN APX f VW SANDOZ LEVOFLOXACIN SDZ f VW **SANDOZ LEVOFLOXACIN SDZ f ABEFG **MYLAN-LEVOFLOXACIN MYL f ABEFG MYLAN-LEVOFLOXACIN MYL f VW CO LEVOFLOXACIN COB f VW **CO LEVOFLOXACIN COB f ABEFG Page 20

34 08:00 Anti-Infective Agents Anti-infectieux 08:12:18 Quinolones Quinolones Levofloxacin Léofloxacine 750mg Moxifloxacin Moxifloxacine Liq Inj 400mg Liq 400mg LEVAQUIN JAN f W NOVO-LEVOFLOXACIN NOP f W SANDOZ LEVOFLOXACIN SDZ f W pms-levofloxacin PMS f W CO LEVOFLOXACIN COB f W APO-LEVOFLOXACIN APX f W AVELOX I.V BAY W **AVELOX BAY ABEFG AVELOX BAY VW ** Prescriptions written by New Brunswick infectious disease specialists, medical microbiologists, medical oncologists, respirologists and internal medicine specialists will not require special authorization. Les ordonnances rédigées par les infectologues, les microbiologistes médicaux, oncologues, les spécialistes de médecine interne ou les pneumologues du Nouveau-Brunswick ne requièrent pas d'autorisation spéciale. Norfloxacin Norfloxacine 400mg APO-NORFLOX APX f AEFVW NOVO-NORFLOXACIN NOP f AEFVW PMS-NORFLOXACIN PMS f AEFVW CO NORFLOXACIN COB f AEFVW Page 21

35 08:00 Anti-Infective Agents Anti-infectieux 08:12:18 Quinolones Quinolones Ofloxacin Ofloxacine 200mg ** OFLOXACIN AAP f EF18+ **NOVO-OFLOXACIN (DISC/NON DISP June 1/12) NOP f EF mg ** OFLOXACIN AAP f EF18+ **NOVO-OFLOXACIN (DISC/NON DISP Apr 29/12) NOP f EF mg ** OFLOXACIN AAP EF18+ ** The use of Quinolones in children < 18 years of age is generally contraindicated. Les quinolones sont habituellement contreindiquées pour les enfants. 08:12:20 Sulfonamides Sulfonamides Sulfasalazine Sulfasalazine ECT Orl 500mg Ent. 500mg Trimethoprim/Sulfamethoxazole Triméthoprime/sulfaméthoxazole Sus Orl 8mg/40mg Susp. 20mg/100mg 80mg/400mg pms-sulfasalazine PMS AEFGVW SALAZOPYRIN EN PFI AEFGVW pms-sulfasalazine PMS AEFGVW SALAZOPYRIN PFI AEFGVW NOVO-TRIMEL NOP ABEFGVW APO-SULFATRIM APX ABEFGVW APO-SULFATRIM APX f ABEFGVW NOVO-TRIMEL NOP f ABEFGVW NU-COTRIMOX NXP f ABEFGVW Page 22

36 08:00 Anti-Infective Agents Anti-infectieux 08:12:20 Sulfonamides Sulfonamides Trimethoprim/Sulfamethoxazole Triméthoprime/sulfaméthoxazole 160mg/800mg APO-SULFATRIM DS APX f ABEFGVW NOVO-TRIMEL DS NOP f ABEFGVW NU-COTRIMOX DS NXP f ABEFGVW 08:12:24 Antibiotics (Tetracyclines) Antibiotiques (tétracyclines) Doxycycline Hyclate Doxycycline (hyclate de) Cap Orl 100mg Caps VIBRAMYCIN PFI f ABEFGVW NOVO-DOXYLIN NOP f ABEFGVW APO-DOXY APX f ABEFGVW NU-DOXYCYCLINE NXP f ABEFGVW DOXYCYCLINE SAS f ABEFGVW pms-doxycycline (DISC/NON DISP Oct 15/12) PMS ABEFGVW 100mg APO-DOXY APX f ABEFGVW NOVO-DOXYLIN NOP f ABEFGVW DOXYCYCLINE SAS f ABEFGVW pms-doxycycline (DISC/NON DISP Oct 15/12) PMS ABEFGVW Minocycline Hydrochloride Minocycline (chlorhydrate de) Cap Orl 50mg Caps ratio-minocycline (DISC/NON DISP Aug 12/13) RPH f ABEFGVW APO-MINOCYCLINE APX f ABEFGVW NOVO-MINOCYCLINE NOP f ABEFGVW MINOCIN (DISC/NON DISP Nov 21/13) GSK f ABEFGVW MYLAN-MINOCYCLINE MYL f ABEFGVW SANDOZ MINOCYCLINE SDZ f ABEFGVW pms-minocycline (DISC/NON DISP Mar 1/12) PMS f ABEFGVW MINOCYCLINE SAS f ABEFGVW pms-minocycline PMS f ABEFGVW Page 23

37 08:00 Anti-Infective Agents Anti-infectieux 08:12:24 Antibiotics (Tetracyclines) Antibiotiques (tétracyclines) Minocycline Hydrochloride Minocycline (chlorhydrate de) Cap Orl 100mg Caps ratio-minocycline (DISC/NON DISP Aug 12/13) RPH f ABEFGVW APO-MINOCYCLINE APX f ABEFGVW NOVO-MINOCYCLINE NOP f ABEFGVW MINOCIN (DISC/NON DISP Feb 1/13) GSK f ABEFGVW MYLAN-MINOCYCLINE MYL f ABEFGVW SANDOZ MINOCYCLINE SDZ f ABEFGVW pms-minocycline (DISC/NON DISP Mar 1/12) PMS f ABEFGVW MINOCYCLINE IVX f ABEFGVW MINOCYCLINE SAS f ABEFGVW pms-minocycline PMS f ABEFGVW Tetracycline Hydrochloride Tétracycline (chlorhydrate de) Cap Orl 250mg Caps TETRA AAP f AEFGVW NU-TETRA (DISC/NON DISP Apr 19/12) NXP f AEFGVW 08:12:28 Antibiotics (Miscellaneous) Antibiotiques (autres antibiotiques) Clindamycin Hydrochloride Clindamycine (chlorhydrate de) Cap Orl 150mg Caps DALACIN C PFI f ABEFGVW TEVA-CLINDAMYCIN TEV f ABEFGVW APO-CLINDAMYCIN APX f ABEFGVW MYLAN-CLINDAMYCIN MYL f ABEFGVW pms-clindamycin (DISC/NON DISP May 10/12) PMS f ABEFGVW Cap Orl 300mg Caps DALACIN C PFI f ABEFGVW TEVA-CLINDAMYCIN TEV f ABEFGVW APO-CLINDAMYCIN APX f ABEFGVW MYLAN-CLINDAMYCIN MYL f ABEFGVW pms-clindamycin (DISC/NON DISP May 10/12) PMS f ABEFGVW Page 24

38 08:00 Anti-Infective Agents Anti-infectieux 08:12:28 Antibiotics (Miscellaneous) Antibiotiques (autres antibiotiques) Clindamycin Phosphate Clindamycine (phosphate de) Liq Inj 150mg/mL Liq. DALACIN C PHOSPHATE PFI f W CLINDAMYCIN (Bulk vials) SDZ f W CLINDAMYCIN (2mL, 4mL, 6mL vials) SDZ f W Clindamycin-Palmitate Hydrochloride Clindamycine (chlorhydrate de palmitate de) Pws Orl 15mg Pds. DALACIN C PFI AEFGVW Polymyxin B Sulfate/Neomycin Sulphate Polymyxine b (sulfate de)/néomycine (sulfate de) Liq Liq Urh IU/40mg NEOSPORIN IRRIGATING SOLUTION GSK AEFGVW Vancomycin Hydrochloride Vancomycine (chlorhydrate de) Cap Orl 125mg Caps Cap Orl 250mg Caps VANCOCIN IRO AEFGVW VANCOCIN IRO AEFGVW Pws Inj 1gm Pds. VANCOMYCIN HCL * LYP ABEFGW pms-vancomycin * PMS ABEFGW VAL-VANCOMYCIN * VAL ABEFGW Pws Inj 500mg Pds. STERILE VANCOMYCIN HCL * LYP ABEFGW pms-vancomycin * PMS ABEFGW VAL-VANCOMYCIN * VAL ABEFGW 08:14:04 Allylamines Allylamines Terbinafine Hydrochloride Terbinafine (chlorhydrate de) Crm Top 1% Cr. LAMISIL NVR AEFGVW Page 25

39 08:00 Anti-Infective Agents Anti-infectieux 08:14:08 Azoles Azoles Fluconazole Fluconazole Cap Orl 150mg Caps DIFLUCAN (DISC/NON DISP March 31/12) PFI f AEFGVW APO-FLUCONAZOLE APX f AEFGVW MYLAN-FLUCONAZOLE (DISC/NON DISP July 20/12) MYL f AEFGVW pms-fluconazole PMS f AEFGVW CO FLUCONAZOLE-150 (DISC/NON DISP June 7/12) COB f AEFGVW Liq Inj 2mg/mL Liq DIFLUCAN PFI f W FLUCONAZOLE OMEGA (DISC/NON DISP July 19/12) HOS f W FLUCONAZOLE NOP f W 50mg 100mg Ketoconazole Kétoconazole 200mg NOVO-FLUCONAZOLE NOP f AEFGVW APO-FLUCONAZOLE APX f AEFGVW MYLAN-FLUCONAZOLE MYL f AEFGVW pms-fluconazole PMS f AEFGVW CO FLUCONAZOLE COB f AEFGVW NOVO-FLUCONAZOLE NOP f AEFGVW APO-FLUCONAZOLE APX f AEFGVW MYLAN-FLUCONAZOLE MYL f AEFGVW pms-fluconazole PMS f AEFGVW CO FLUCONAZOLE COB f AEFGVW NU-KETOCON NXP f AEFGVW NOVO-KETOCONAZOLE NOP f AEFGVW APO-KETOCONAZOLE APX f AEFGVW 08:16:00 Antituberculosis Agents Antituberculeux Rifampin Rifampine Cap Orl 150mg Caps ROFACT VLN ABEFGVW RIFADIN SAV ABEFGVW Page 26

40 08:00 Anti-Infective Agents Anti-infectieux 08:16:00 Antituberculosis Agents Antituberculeux Rifampin Rifampine Cap Orl 300mg Caps ROFACT VLN ABEFGVW RIFADIN SAV ABEFGVW 08:18:00 Antivirals Antiviraux Acyclovir Acyclovir 200mg 400mg ZOVIRAX GSK f AEFGVW ratio-acyclovir RPH f AEFGVW NU-ACYCLOVIR NXP f AEFGVW APO-ACYCLOVIR APX f AEFGVW MYLAN-ACYCLOVIR MYL f AEFGVW TEVA-ACYCLOVIR TEV f AEFGVW ACYCLOVIR SAS f AEFGVW ZOVIRAX GSK f AEFGVW ratio-acyclovir RPH f AEFGVW NU-ACYCLOVIR NXP f AEFGVW APO-ACYCLOVIR APX f AEFGVW MYLAN-ACYCLOVIR MYL f AEFGVW TEVA-ACYCLOVIR TEV f AEFGVW ACYCLOVIR SAS f AEFGVW 800mg ZOVIRAX (ZOSTAB PAC) (DISC/NON DISP Aug 3/13) GSK f AEFGVW ratio-acyclovir RPH f AEFGVW NU-ACYCLOVIR NXP f AEFGVW APO-ACYCLOVIR APX f AEFGVW MYLAN-ACYCLOVIR MYL f AEFGVW TEVA-ACYCLOVIR TEV f AEFGVW ACYCLOVIR SAS f AEFGVW Acyclovir Sodium Acyclovir sodique Liq Inj 25mg/mL Liq ACYCLOVIR SODIUM HOS W Page 27

41 08:00 Anti-Infective Agents Anti-infectieux 08:18:00 Antivirals Antiviraux Acyclovir Sodium Acyclovir sodique Liq Inj 50mg/mL Liq Famciclovir Famciclovir 125mg 250mg 500mg Ganciclovir Sodium Ganciclovir Sodique Pws Inj 500mg Pds. Valacyclovir Valacyclovir 500mg ACYCLOVIR SODIUM LYP W FAMVIR NVR f AEFGVW pms-famciclovir PMS f AEFGVW SANDOZ FAMCICLOVIR SDZ f AEFGVW APO-FAMCICLOVIR APX f AEFGVW CO FAMCICLOVIR COB f AEFGVW FAMVIR NVR f AEFGVW pms-famciclovir PMS f AEFGVW SANDOZ FAMCICLOVIR SDZ f AEFGVW APO-FAMCICLOVIR APX f AEFGVW CO FAMCICLOVIR COB f AEFGVW FAMVIR NVR f AEFGVW pms-famciclovir PMS f AEFGVW SANDOZ FAMCICLOVIR SDZ f AEFGVW APO-FAMCICLOVIR APX f AEFGVW CO FAMCICLOVIR COB f AEFGVW CYTOVENE HLR W VALTREX GSK f AEFGVW APO-VALACYCLOVIR APX f AEFGVW pms-valacyclovir PMS f AEFGVW CO VALACYCLOVIR COB f AEFGVW MYLAN-VALACYCLOVIR MYL f AEFGVW Page 28

42 08:00 Anti-Infective Agents Anti-infectieux 08:18:08 Antiretroviral Agents Agents antirétroviral Abacavir Sulfate Sulphate d'abacavir Liq Orl 20mg Liq ZIAGEN VIV U 300mg ZIAGEN VIV U Abacavir Sulfate/Lamivudine/Zidovudine Sulphate d'abacavir/lamivudine/zidovudine 300mg Abacavir/Lamivudine Abacavir/Lamivudine 600mg/300mg Atazanavir Atazanavir Cap Orl 150mg Caps TRIZIVIR VIV U KIVEXA VIV U REYATAZ BRI U Cap Orl Caps Cap Orl Caps 200mg 300mg REYATAZ BRI U REYATAZ BRI U Didanosine Didanosine ECC Orl 125mg Caps.Ent. VIDEX EC BRI U ECC Orl Caps.Ent. ECC Orl Caps.Ent. ECC Orl Caps.Ent. 200mg 250mg 400mg VIDEX EC BRI U VIDEX EC BRI U VIDEX EC BRI U Page 29

43 08:00 Anti-Infective Agents Anti-infectieux 08:18:08 Antiretroviral Agents Agents antirétroviral Efavirenz Éfavirenz Cap Orl Caps Cap Orl Caps 50mg 200mg 600mg SUSTIVA BRI U SUSTIVA BRI U SUSTIVA BRI U Efavirenz/tenofovir/emtricitabine Éfavirenz/ténofovir/emtricitabine 600/300/200mg Fosamprenavir Fosamprenavir Sus Orl 50mg Susp. ATRIPLA GIL U TELZIR VIV U Indinavir Indinavir Cap Orl Caps Cap Orl Caps 700mg 200mg 400mg TELZIR VIV U CRIXIVAN FRS U CRIXIVAN FRS U Lamivudine Lamivudine Liq Orl 5mg Liq **HEPTOVIR VIV AEFV ** Prescriptions written by certified New Brunswick internal medicine specialists do not require special authorization. Les ordonnances rédigées par les spécialistes en médecine interne du Nouveau-Brunswick ne requièrent pas d'autorisation spéciale. Liq Orl 10mg Liq 3TC VIV U Page 30

44 08:00 Anti-Infective Agents Anti-infectieux 08:18:08 Antiretroviral Agents Agents antirétroviral Lamivudine Lamivudine 100mg HEPTOVIR VIV AEFGVW 150mg 300mg 3TC VIV U 3TC VIV U Lopinavir/Ritonavir Lopinavir/Ritonavir Liq Orl 80mg Liq KALETRA ORAL SOLUTION ABB U 100mg/25mg 200mg/50mg KALETRA ABB U KALETRA TAB ABB U Nelfinavir Mesylate Mésylate de nelfinavir 250mg VIRACEPT VIV U 625mg VIRACEPT VIV U Nevirapine Névirapine 200mg Saquinavir Mesylate Mésylate de saquinavir Cap Orl 200mg Caps VIRAMUNE BOE f U AURO-NEVIRAPINE ARO f U TEVA-NEVIRAPINE TEV f U INVIRASE HLR U Page 31

45 08:00 Anti-Infective Agents Anti-infectieux 08:18:08 Antiretroviral Agents Agents antirétroviral Saquinavir Mesylate Mésylate de saquinavir 500mg Stavudine d4t Stavudine d4t Cap Orl 15mg Caps INVIRASE HLR U ZERIT BRI U Cap Orl Caps Cap Orl Caps Cap Orl Caps 20mg 30mg 40mg ZERIT BRI U ZERIT BRI U ZERIT BRI U Tenofovir/emtricitabine Ténofovir/emtricitabine 300/200mg Zidovudine Zidovudine Cap Orl 100mg Caps Liq Inj 10mg Liq Syr Orl 10mg Sir. TRUVADA GIL U RETROVIR VIV f U APO-ZIDOVUDINE APX f U RETROVIR VIV U RETROVIR VIV U Page 32

46 08:00 Anti-Infective Agents Anti-infectieux 08:26:00 Sulfones Sulfones Dapsone Dapsone 100mg DAPSONE JCB AEFGVW 08:30:08 Antimalarial Antipaludéens Chloroquine Diphosphate Chloroquine (phosphate de) 250mg TEVA-CHLOROQUINE TEV AEFGVW Hydroxychloroquine Sulfate Hydroxychloroquine (sulfate d') 200mg PLAQUENIL SAV f AEFGVW APO-HYDROXYQUINE APX f AEFGVW MYLAN-HYDROXYCHLOROQUINE MYL f AEFGVW Pyrimethamine Pyriméthamine 25mg Quinine Sulphate Quinine (sulfate de) Cap Orl 200mg Caps Cap Orl 300mg Caps 300mg DARAPRIM TRB AEFGVW NOVO-QUININE NOP AEFGVW QUININE SULFATE ODN AEFGV APO-QUININE APX AEFGV NOVO-QUININE NOP AEFGVW QUININE SULFATE ODN AEFGV APO-QUININE APX AEFGV QUININE SULFATE ODN AEFGVW Page 33

47 08:00 Anti-Infective Agents Anti-infectieux 08:36:00 Urinary Anti-Infectives Anti-infectieux des voies urinaires Methenamine Mandelate Méthénamine (mandélate de) 500mg Nitrofurantoin Nitrofurantoïne Cap Orl 50mg Caps Cap Orl 100mg Caps 50mg 100mg Trimethoprim Triméthoprime 100mg 200mg MANDELAMINE ERF AEFGVW TEVA-FURANTOIN TEV AEFGVW MACROBID WNC AEFGVW NITROFURANTOIN AAP AEFGVW NITROFURANTOIN AAP AEFGVW TRIMETHOPRIM AAP AEFGVW TRIMETHOPRIM AAP AEFGVW 08:40:00 Miscellaneous Anti-Infectives Autres anti-infectieux Metronidazole Métronidazole Liq Inj 0.50% Liq 250mg METRONIDAZOLE HOS W METRONIDAZOLE BAX W METRONIDAZOLE AAP AEFGVW Page 34