ICON Formulary - October 2018 Legend - ICON Protocols Essential (previously Standard), Core, Enhanced Core, Enhanced Enhanced Class Medicine Name Nappi Strength Form Size Route Abiraterone Acetate ZYTIGA 250 720690001 250 mg 120 ORAL Alemtuzumab Alemtuzumab Anastrozole STRADEXA 1 715720001 1 mg 30 ORAL Anastrozole TEVA ANASTROZOLE 1 718266001 1 mg 30 ORAL Anastrozole ACCORD ANASTROZOLE 1 715703001 1 mg 30 ORAL Bendamustine RIBOMUSTIN 25 717665003 25 mg 1 INJ Bendamustine RIBOMUSTIN 100 710853001 100 mg 1 INJ Bevacizumab AVASTIN 100 706042002 100 mg 1 INJ Bevacizumab AVASTIN 400 706041002 400 mg 1 INJ Bicalutamide CALOXA 50 715721001 50 mg 30 ORAL Bicalutamide SPEC-BICALUTAMIDE 50 718988001 50 mg 30 ORAL Bicalutamide ACCORD BICALUTAMIDE 50 715705001 50 mg 30 ORAL Bicalutamide TEVA BICALUTAMIDE 50 716660001 50 mg 30 ORAL Bicalutamide ANANDROCA 50 723247001 50 mg 30 ORAL Bicalutamide BICALOX 50 712506001 50 mg 30 ORAL Bleomycin Bleolem 15 703658003 15 IU 1 INJ Bortezomib VALTIB 3.5 722781001 3.5 mg 1 INJ Bortezomib VELCADE 3.5 706787001 3.5 mg 1 INJ Buserelin SUPREFACT 3 MONTH DEPOT 9.9 886819006 9.9 mg 1 IMP Cabazitaxel CABITAS 60 3000147001 60 mg 1 INJ Capecitabine PECASET 150 722962001 150 mg 60 ORAL Capecitabine CAPEXA 150 722783001 150 mg 60 ORAL Capecitabine CAPECITABINE SPECPHARM 150 723214001 150 mg 60 ORAL Capecitabine XELODA 150 870072005 150 mg 60 ORAL Capecitabine PECASET 500 722963001 500 mg 120 ORAL Capecitabine CAPEXA 500 722784001 500 mg 120 ORAL Capecitabine CAPECITABINE SPECPHARM 500 723225001 500 mg 120 ORAL Capecitabine XELODA 500 870080008 500 mg 120 ORAL Carboplatin Accord Carboplatin 150 711367001 150 mg 1 INJ Carboplatin Carbosin 150 825069010 150 mg 1 INJ Carboplatin ASPEN CARBOPLATIN 150 720402001 150 mg 1 INJ Carboplatin Accord Carboplatin 450 711368001 450 mg 1 INJ Manufacturer JANSSEN PHARMACEUTICALS ASTELLAS PHARMA ASTELLAS PHARMA SPECPHARM (PTY) LTD ZYDUS CADILA PHARMAPLAN JANSSEN PHARMACEUTICALS SPECPHARM (PTY) LTD SPECPHARM (PTY) LTD
Carboplatin Carbosin 450 704097001 450 mg 1 INJ Carboplatin ASPEN CARBOPLATIN 450 720403001 450 mg 1 INJ Carboplatin Carbosin 600 707364001 600 mg 1 INJ Cetuximab ERBITUX 100 715052001 100 mg 1 INJ Chlorambucil LEUKERAN 2 737887001 2 mg 25 ORAL Cisplatin CISACOR 10 720381001 10 mg 1 INJ Cisplatin P&U CISPLATIN 10 840858020 10 mg 1 INJ Cisplatin CISACOR 50 720382001 50 mg 1 INJ Cisplatin P&U CISPLATIN 50 840831005 50 mg 1 INJ Cyclophosphamide ENDOXAN 500 723282014 500 mg 1 INJ Cyclophosphamide ENDOXAN 1000 723304009 1000 mg 1 INJ Cyclophosphamide ENDOXAN 50 723274002 50 mg 50 ORAL Cyproterone CIPLA-CYPROTERONE ACETATE 50 899089003 50 mg 20 ORAL Cytarabine CYTOSAR 100 717207005 100 mg 1 INJ Cytarabine LARACIT 500 708730001 500 mg 1 INJ Dacarbazine DACIN 200 715877001 200 mg 1 INJ Dactinomycin Dasatinib SPRYCEL 20 711441001 20 mg 60 ORAL Dasatinib SPRYCEL 50 711442001 50 mg 60 ORAL Dasatinib SPRYCEL 70 711443001 70 mg 60 ORAL Dasatinib SPRYCEL 100 718478001 100 mg 30 ORAL Daunorubicin DAUNOBLASTIN 20 717738019 20 mg 1 INJ Docetaxel ERIOX 20 719959001 20 mg 1 INJ Docetaxel KEY DOCETAXEL AND DILUENT 20 723793001 20 mg 1 INJ Docetaxel DOCETAXEL ACCORD 20 723381001 20 mg 1 INJ Docetaxel CIPLA-DOCETAXEL 20 715749001 20 mg 1 INJ Docetaxel ERIOX 80 719960001 80 mg 1 INJ Docetaxel KEY DOCETAXEL AND DILUENT 80 723794001 80 mg 1 INJ Docetaxel DOCETAXEL ACCORD 80 723387001 80 mg 1 INJ Docetaxel CIPLA-DOCETAXEL 80 715807001 80 mg 1 INJ Docetaxel DOCETAXEL ACCORD 160 723388001 160 mg 1 INJ Doxorubicin DOXORUBICIN RTU 10 823635008 10 mg 1 INJ Doxorubicin RUBEXET 10 721800001 10 mg 1 INJ Doxorubicin Cipla-Doxorubicin 10 718301001 10 mg 1 INJ Doxorubicin DOXORUBICIN ACCORD 10 721804001 10 mg 1 INJ Doxorubicin DOXORUBICIN RTU 50 823643019 50 mg 1 INJ Doxorubicin RUBEXET 50 721801001 50 mg 1 INJ Doxorubicin Cipla-Doxorubicin 50 718302001 50 mg 1 INJ Doxorubicin DOXORUBICIN ACCORD 50 721805001 50 mg 1 INJ Doxorubicin RUBEXET 200 721802001 200 mg 1 INJ MERCK
Enzalutamide XTANDI 40 721978001 40 mg 112 ORAL Epirubicin EPICORD 10 10 716240001 10 mg 1 INJ Epirubicin Accord Epirubicin 10 716228001 10 mg 1 INJ Epirubicin ASPEN EPIRUBICIN 10 714241001 10 mg 1 INJ Epirubicin EPICORD 50 50 716241001 50 mg 1 INJ Epirubicin Accord Epirubicin 50 716239001 50 mg 1 INJ Epirubicin ASPEN EPIRUBICIN 50 714220001 50 mg 1 INJ Epirubicin ASPEN EPIRUBICIN 50 714219001 50 mg 1 INJ Eribulin HALAVEN 0.88 718840001 0.88 mg 1 INJ Erlotinib TARCEVA 25 712628001 25 mg 30 ORAL Erlotinib TARCEVA 100 712633001 100 mg 30 ORAL Erlotinib TARCEVA 150 712634001 150 mg 30 ORAL Etoposide EPOSIN 100 100 850926010 100 mg 1 INJ Etoposide ASPEN ETOPOSIDE 100 719861001 100 mg 1 INJ Etoposide oral Everolimus AFINITOR 2.5 723149001 2.5 mg 30 ORAL Everolimus AFINITOR 5 716750001 5 mg 30 ORAL Everolimus AFINITOR 10 716749001 10 mg 30 ORAL Exemestane EXICAN 25 722602001 25 mg 30 ORAL Exemestane EQUISIN 25 720023001 25 mg 30 ORAL Exemestane ASPEN EXEMESTANE 25 721738001 25 mg 30 ORAL Filgrastim FILGRASTIM TEVA 30 3000141001 30 MIU 5 INJ Filgrastim Neupogen Pref Syr 30 894081001 30 MIU 5 INJ Fludarabine TEVA FLUDARABINE 50 716356001 50 mg 1 INJ Fludarabine Fludara 50 820997005 50 mg 5 INJ Fludarabine FLUDARA ORAL 10 710159001 10 mg 20 ORAL Fluorouracil FLORACOR 500 711366001 500 mg 1 INJ Fluorouracil FLURACEDYL 1000 706683001 1000 mg 1 INJ Fluorouracil Fluracedyl 5000 706684001 5000 mg 1 INJ Flutamide FLUTAPLEX 250 701389001 250 mg 90 ORAL Fulvestrant FASLODEX 250 707442002 250 mg 2 INJ Gemcitabine CYTIGEM 200 715322001 200 mg 1 INJ Gemcitabine ACCORD GEMCITABINE 200 713874001 200 mg 1 INJ Gemcitabine GEMCITABINE 200 717963001 200 mg 1 INJ Gemcitabine ONCOGEM 200 718303001 200 mg 1 INJ Gemcitabine CYTIGEM 1000 715323001 1000 mg 1 INJ Gemcitabine ACCORD GEMCITABINE 1000 713873001 1000 mg 1 INJ Gemcitabine GEMCITABINE 1000 717964001 1000 mg 1 INJ Gemcitabine ONCOGEM 1000 718304001 1000 mg 1 INJ Goserelin ZOLADEX DEPOT 3.6 781215005 3.6 mg 1 INJ ASTELLAS PHARMA EQUITY PHARMACEUTICALS EQUITY PHARMACEUTICALS AMGEN ASTRAZENECA ASTRAZENECA
Goserelin ZOLADEX DEPOT 10.8 834270005 10.8 mg 1 INJ Hydroxyurea HYDREA 500 731706005 500 mg 100 ORAL Idarubicin ZAVEDOS 5 788651005 5 mg 1 INJ Idarubicin ZAVEDOS 10 788678019 10 mg 1 INJ Ifosfamide HOLOXAN 500 731285018 500 mg 1 INJ Ifosfamide HOLOXAN 1000 731293002 1000 mg 1 INJ Ifosfamide HOLOXAN 2000 731307003 2000 mg 1 INJ Imatinib SUNMATIN 100 719926001 100 mg 60 ORAL Imatinib MIVESTA 100 722940001 100 mg 60 ORAL Imatinib IMAVEC 100 718595001 100 mg 60 ORAL Imatinib IMATINIB ACCORD 100 722780001 100 mg 60 ORAL Imatinib VATIVIO 100 718477001 100 mg 120 ORAL Imatinib SUNMATIN 400 719927001 400 mg 30 ORAL Imatinib MIVESTA 400 722964001 400 mg 30 ORAL Imatinib IMAVEC 400 723296001 400 mg 30 ORAL Imatinib IMATINIB ACCORD 400 722788001 400 mg 30 ORAL Interferon alfa-2a Interferon alfa-2b Irinotecan IRINOTAS 40 712643001 40 mg 1 INJ Irinotecan ACCORD IRINOTECAN 40 712603001 40 mg 1 INJ Irinotecan CIPLA-IRINOTECAN 40 716182001 40 mg 1 INJ Irinotecan IRINOTECAN 40 717026001 40 mg 1 INJ Irinotecan IRINOTAS 100 712873001 100 mg 1 INJ Irinotecan ACCORD IRINOTECAN 100 712872001 100 mg 1 INJ Irinotecan CIPLA-IRINOTECAN 100 716183001 100 mg 1 INJ Irinotecan IRINOTECAN 100 717027001 100 mg 1 INJ Ketoconazole KETAZOL 200 875368018 200 mg 10 ORAL Ketoconazole KETAZOL 200 875368034 200 mg 30 ORAL Lanreotide SOMATULINE AUTOGEL 60 720985001 60 mg 1 INJ Lanreotide SOMATULINE AUTOGEL 90 720986001 90 mg 1 INJ Lanreotide SOMATULINE AUTOGEL 120 720987001 120 mg 1 INJ Lapatinib TYKERB 250 715582001 250 mg 70 ORAL Letrozole LARADEX 2.5 715718001 2.5 mg 30 ORAL Letrozole CIPLA-LETROZOLE 2.5 718349001 2.5 mg 30 ORAL Letrozole FEMZOLE 2.5 716696001 2.5 mg 30 ORAL Letrozole ACCORD LETROZOLE 2.5 715704001 2.5 mg 30 ORAL Leuprorelin LUCRIN DEPOT S/DOSE 3.75 806382007 3.75 mg 1 INJ Leuprorelin LUCRIN VIAL 11.25 875295002 11.25 mg 1 INJ Leuprorelin Hexal LEUPROLIDE HEXAL 5 722148001 5 mg 1 IMP Leuprorelin with Atrigel ELIGARD 7.5 716857001 7.5 mg 1 INJ ASTRAZENECA ADCOCK INGRAM CRITICAL CARE ABBVIE PTY LTD ABBVIE PTY LTD
Leuprorelin with Atrigel ELIGARD 22.5 716858001 22.5 mg 1 INJ Leuprorelin with Atrigel ELIGARD 45 716859001 45 mg 1 INJ Liposomal Doxorubicin DOXOLIP (10 ml) 20 719985001 20 mg 1 INJ Liposomal Doxorubicin DOXOPEG 20 720412001 20 mg 1 INJ Lomustine 10 Lomustine 40 Medroxyprogesterone PROVERA 100 757942008 100 mg 100 ORAL Medroxyprogesterone PROVERA 500 702084007 500 mg 100 ORAL Melphalan ALKERAN 50 50 797774009 50 mg 1 INJ Melphalan ALKERAN 2 701998008 2 mg 25 ORAL Methotrexate METHACOR 50 711328001 50 mg 1 INJ Methotrexate ABITREXATE 50 782548009 50 mg 1 INJ Methotrexate ABITREXATE VIAL 20ML 500 782556019 500 mg 1 INJ Methotrexate ABITREXATE 1000 782564003 1000 mg 1 INJ Methotrexate ABITREXATE 5000 701110001 5000 mg 1 INJ Methotrexate ABITREXATE 2.5 712504001 2.5 mg 100 ORAL Mitomycin MITOMYCIN-C 2 744212006 2 mg 1 INJ Mitomycin MITOMYCIN-C 10 744220009 10 mg 1 INJ Mitoxantrone MITOXANTRONE-HEXAL 20 708724001 20 mg 1 INJ Nilotinib TASIGNA 150 719121001 150 mg 112 ORAL Nilotinib TASIGNA 200 714086001 200 mg 112 ORAL Octreotide SANDOSTATIN 0.05 762342005 0.05 mg 5 INJ Octreotide SANDOSTATIN 0.1 762350008 0.1 mg 5 INJ Octreotide SANDOSTATIN 1 781452007 1 mg 1 INJ Octreotide SANDOSTATIN LAR PREFILL 10 704532001 10 mg 1 INJ Octreotide SANDOSTATIN LAR PREFILL 20 704534001 20 mg 1 INJ Octreotide SANDOSTATIN LAR PREF 30 708002001 30 mg 1 INJ Oxaliplatin INTAS OXALIPLATIN 50 50 717829001 50 mg 1 INJ Oxaliplatin OXALIPLATIN KEY 50 50 723795001 50 mg 1 INJ Oxaliplatin OPLAXIN 50 723389001 50 mg 1 INJ Oxaliplatin OXALIPLATIN PCH 50 50 717567001 50 mg 1 INJ Oxaliplatin OXALIWIN RTU 50 710319001 50 mg 1 INJ Oxaliplatin INTAS OXALIPLATIN 100 100 717830001 100 mg 1 INJ Oxaliplatin OXALIPLATIN KEY 100 100 723796001 100 mg 1 INJ Oxaliplatin OPLAXIN 100 723390001 100 mg 1 INJ Oxaliplatin OXALIPLATIN PCH 100 100 717569001 100 mg 1 INJ Oxaliplatin OXALIWIN RTU 100 710317001 100 mg 1 INJ Paclitaxel ACCORD PACLITAXEL 30 720614001 30 mg 1 INJ Paclitaxel PCH-PACLITAXEL 30 714756001 30 mg 1 INJ Paclitaxel CIPLA-PACLITAXEL 30 716178001 30 mg 1 INJ ZENTIVA SOUTH AFRICA PTY LTD ZENTIVA SOUTH AFRICA PTY LTD
Paclitaxel ACCORD PACLITAXEL 100 720616001 100 mg 1 INJ Paclitaxel PCH-PACLITAXEL 100 714757001 100 mg 1 INJ Paclitaxel CIPLA-PACLITAXEL 100 716179001 100 mg 1 INJ Paclitaxel ACCORD PACLITAXEL 300 720617001 300 mg 1 INJ Paclitaxel CIPLA-PACLITAXEL 300 716180001 300 mg 1 INJ Paclitaxel PCH-PACLITAXEL 300 714758001 300 mg 1 INJ Pazopanib VOTRIENT 200 720861001 200 mg 30 ORAL Pazopanib VOTRIENT 400 720862001 400 mg 30 ORAL Pemetrexed PEMETREXED ACCORD 500 723384001 500 mg 1 INJ Rituximab MABTHERA 100 853224005 100 mg 2 INJ Rituximab MABTHERA 500 853232008 500 mg 1 INJ Sorafenib NEXAVAR 200 708482002 200 mg 60 ORAL Streptozocin Sunitinib SUTENT 12.5 710179001 12.5 mg 28 ORAL Sunitinib SUTENT 25 710181001 25 mg 28 ORAL Sunitinib SUTENT 50 710182001 50 mg 28 ORAL Tamoxifen KESSAR 20 735175004 20 mg 30 ORAL Tamoxifen TAMOXIHEXAL 20 710403001 20 mg 30 ORAL Tamoxifen TAMOPLEX 20 712610001 20 mg 30 ORAL Tamoxifen NEOPHEDAN 20 782165001 20 mg 30 ORAL Temozolomide TEMINTAS 5 718095001 5 mg 5 ORAL Temozolomide ACCORD TEMOZOLOMIDE 5 718133001 5 mg 5 ORAL Temozolomide TEMODAL 5 859931005 5 mg 5 ORAL Temozolomide TEMINTAS 20 718096001 20 mg 5 ORAL Temozolomide ACCORD TEMOZOLOMIDE 20 718134001 20 mg 5 ORAL Temozolomide TEMODAL 20 859958019 20 mg 5 ORAL Temozolomide TEMINTAS 100 718097001 100 mg 5 ORAL Temozolomide ACCORD TEMOZOLOMIDE 100 718135001 100 mg 5 ORAL Temozolomide TEMODAL 100 859494004 100 mg 5 ORAL Temozolomide TEMODAL 140 718312001 140 mg 5 ORAL Temozolomide TEMODAL 180 718313001 180 mg 5 ORAL Temozolomide TEMINTAS 250 718098001 250 mg 5 ORAL Temozolomide ACCORD TEMOZOLOMIDE 250 718136001 250 mg 5 ORAL Temozolomide TEMODAL 250 859966003 250 mg 5 ORAL Thalidomide THALIDOMIDE CELGENE 50 709228001 50 mg 28 ORAL Topotecan HYCAMTIN 4 847909018 4 mg 5 INJ Topotecan HYCAMTIN 0.25 719444001 0.25 mg 10 ORAL Topotecan HYCAMTIN 1 719443001 1 mg 10 ORAL Trastuzumab HERCEPTIN MULTIDOSE 440 884055001 440 mg 1 INJ Trastuzumab HERCEPTIN SC 600 723199001 600 mg 1 INJ BAYER PHARMA GLAXO SMITHKLINE
Vinblastine VINBLASTINE TEVA 10 722790001 10 mg 1 INJ Vincristine P&U VINCRISTINE CSV 1 840793006 1 mg 5 INJ Vincristine Accord Vincristine 2 713432001 2 mg 1 INJ Vinorelbine VINORELBINE 10 721304001 10 mg 1 INJ Vinorelbine NAVELBINE 10 822655004 10 mg 10 INJ Vinorelbine VINORELBINE 50 721305001 50 mg 1 INJ Vinorelbine NAVELBINE 50 819263001 50 mg 10 INJ Vinorelbine NAVELBINE ORAL 20 700191001 20 mg 1 ORAL Vinorelbine NAVELBINE ORAL 30 700192001 30 mg 1 ORAL Zoledronic Acid ZOMEDRON 4 717192001 4 mg 1 INJ Zoledronic Acid ZOBONE 4 715952001 4 mg 1 INJ Zoledronic Acid ZOMABON 4 719858001 4 mg 1 INJ ACTOR PHARMA