CHRONIC RENAL FAILURE REGISTRATION CRITERIA: Diagnosis confirmed by a GP or Specialist Faxed copy of lab results required : serum creatinine clearance value <30ml/min or a Glomerular Filtration Rate estimate of <30ml/min as per Risk Equalisation Fund criteria. * NEPHROLOGIST PRESCRIPTION AND SUPPORTING BLOOD RESULTS WILL BE REQUIRED ** BLOOD RESULTS CONFIRMING IRON DEFICIENCY WILL BE REQUIRED *** REQUEST FOR ANGIO-TENSIN RECEPTOR BLOCKER WILL REQUIRE MOTIVATION Drug Class Active Ingredient Trade Name ACE inhibitors Captopril Tab 12.5 MG CAPTOHEXAL 12.5MG Captopril Tab 25 MG Captopril Tab 50 MG Enalapril Maleate Tab 10 MG Enalapril Maleate Tab 2.5 MG Enalapril Maleate Tab 5 MG Enalapril Maleate Tab 20 MG Lisinopril Tab 2.5 MG Lisinopril Tab 5 MG ADCO-CAPTOMAX 25MG TAB ADCO-CAPTOPRIL 25MG BIO-CAPTOPRIL 25MG MERCK-CAPTOPRIL 25MG SANDOZ CAPTOPRIL 25MG ZAPTO 25MG TAB ADCO-CAPTOMAX 50MG TAB ADCO-CAPTOPRIL 50MG BIO-CAPTOPRIL (ACETEN) 50MG MERCK-CAPTOPRIL 50MG SANDOZ CAPTOPRIL 50MG ZAPTO 50MG TAB ALAPREN 10MG TAB CIPLATEC 10MG ENAP 10MG TAB HR-ENALAPRIL 10MG PHARMAPRESS 10MG HR-ENALAPRIL 2.5MG ALAPREN 5MG TAB CIPLATEC 5MG ENAP 5MG TAB HYPACE 5MG PHARMAPRESS 5MG TAB ALAPREN 20MG TAB CIPLATEC 20MG ENAP 20MG TAB HR-ENALAPRIL 20MG AUSTELL LISINOPRIL 2.5MG HEXAL-LISINOPRIL 5MG TAB PRILOSIN 5MG TAB SINOPREN 5MG TAB SIMAYLA LISINOPRIL 5MG
ZEMAX 5MG ZEPROSIL 10MG TAB ADCO-ZETOMAX 5MG TAB Lisinopril Tab 10 MG Lisinopril Tab 20 MG Perindopril Erbumine Tab 4 MG HEXAL-LISINOPRIL 10MG TAB PRILOSIN 10MG TAB SINOPREN 10MG TAB ZEPROSIL 10MG TAB SIMAYLA LISINOPRIL 10MG AUSTELL LISINOPRIL 20MG SIMAYLA LISINOPRIL 20MG SINOPREN 20MG TAB ZEMAX 20MG TAB ZEPROSIL 20MG TAB HEXAL-LISINOPRIL 20MG TAB CIPLA-PERINDOPRIL 4MG TABLETS PREXUM 4MG TAB RAN-PERINDOPRIL 4MG TAB VECTORYL 4MG TABLETS ACE inhibitors/diuretics Captopril & Hydrochlorothiazide Tab 25-12.5MGCAPTORETIC HS TAB Captopril & Hydrochlorothiazide Tab 50-25 MG CAPTORETIC TAB ZAPTO-CO TAB Enalapril Maleate & Hydrochlorothiazide Lisinopril & Hydrochlorothiazide Tab 10-12.5 Lisinopril & Hydrochlorothiazide Tab 20-12.5 ENAP-CO TAB PHARMAPRESS CO HEXAL-LISINOPRIL CO 10MG LISORETIC 10/12.5 LISOZIDE 10MG/12.5MG TAB ADCO-ZETOMAX-CO 20/12.5MG DIACE CO 20/12.5 MG TAB HEXAL-LISINOPRIL CO 20MG LISORETIC 20/12.5 LISOZIDE 20MG/12.5MG TAB ZESTOZIDE 20MG TAB Perindopril Erbumine-Indapamide Tab 4-1.25 MPREXUM PLUS TAB VECTORYL PLUS TABLETS Angiotensin receptor antagonists*** Candesartan Cilexetil Tab 8 MG ATACAND 8MG TAB Candesartan Cilexetil Tab 16 MG ATACAND 16MG TAB Losartan Potassium Tab 50 MG LEPITRIN 50MG TAB CIPLA LOSARTAN 50MG TAB
LOSARTAN-WINTHROP TABS LOS-ARB 50MG TAB Losartan Potassium Tab 100 MG CIPLA LOSARTAN 100MG TAB ZARTAN 100MG TAB Telmisartan Tab 40 MG Telmisartan Tab 80 MG MICARDIS 40MG MICARDIS 80MG Valsartan Tab 80 MG TAREG 80MG TAB Valsartan Tab 160 MG TAREG 160MG TAB Angiotensin receptor antagonists/diuretics*** Candesartan Cilexetil-Hydrochlorothiazide ATACAND PLUS 16/12.5MG Telmisartan-Hydrochlorothiazide Tab 40-12.5 Telmisartan-Hydrochlorothiazide Tab 80-12.5 CO-MICARDIS 40/12.5MG CO-MICARDIS 80/12.5MG Valsartan-Hydrochlorothiazide Tab 80-12.5 MGCO-TAREG 80/12.5MG TAB Alpha- and beta-receptor blockers Carvedilol Tab 6.25 MG CARVETREND 6.25MG TAB MERCK-CARVEDILOL 6.25MG TAB CARLOC 6.25MG TAB VEDIBLOK 6.25MG TAB Carvedilol Tab 12.5 MG Carvedilol Tab 25 MG CARVETREND 12.5MG TAB CARLOC 12.5MG TAB CARVEDILOL-HEXAL 12.5MG VEDIBLOK 12.5MG TAB CARVETREND 25MG TAB CARLOC 25MG TAB MERCK-CARVEDILOL 25MG TAB CARVEDILOL-HEXAL 25MG TAB VEDIBLOK 25MG TAB Alpha-receptor blockers Doxazosin Mesylate Tab 1 MG ADCO-DOXAZOSIN 1MG TAB CARDUGEN 1MG TAB Doxazosin Mesylate Tab 2 MG Doxazosin Mesylate Tab 4 MG Prazosin HCl Tab 1 MG ADCO-DOXAZOSIN 2MG TAB CARDUGEN 4MG TAB PRATSIOL 1MG TAB Alpha-receptor blockers Prazosin HCl Tab 2 MG PRATSIOL 2MG TAB
Alpha-receptor blockers Prazosin HCl Tab 5 MG PRATSIOL 5MG TAB Phopshate Binders Calcium Carbonate-Glycine Tab 420-180 MG TITRALAC TAB Beta-receptor blockers Atenolol Tab 50 MG IVAX-ATENOLOL 50 B-BLOCK 50MG HEXABLOK 50MG TAB SANDOZ ATENOLOL 50 TENOPRESS 50MG TAB Atenolol Tab 100 MG B-BLOCK 100MG HEXABLOK 100MG TAB SANDOZ ATENOLOL 100 TENOPRESS 100MG TAB Propranolol HCl Tab 10 MG Propranolol HCl Tab 40 MG Sotalol HCl Tab 80 MG Sotalol HCl Tab 160 MG INDOBLOK 10MG PRODOROL 10MG TB SANDOZ-PROPRANOLOL 10 PUR-BLOKA 10MG TAB INDOBLOK 40MG PRODOROL 40MG TAB SANDOZ PROPRANOLOL 40 PUR-BLOKA 40MG TAB SOTAHEXAL 80MG TAB SOTAHEXAL 160MG TAB Beta-receptor blockers/diuretics Atenolol & Chlorthalidone Tab 50-12.5 MG SANDOZ CO-TENIDONE 50/12. Atenolol & Chlorthalidone Tab 100-25 MG SANDOZ CO-TENIDONE 100/25 Calcium channel blockers Diltiazem HCl Cap SR 24HR 180 MG ZILDEM 180MG SR Diltiazem HCl Cap SR 24HR 240 MG Diltiazem HCl Tab 60 MG Diltiazem HCl Tab 90 MG ZILDEM 240MG SR SANDOZ DILTIAZEM 60MG DILATAM 60MG TAB ZILDEM 90MG TAB Verapamil HCl Tab 40 MG SANDOZ VERAPAMIL HCL 40 VASOMIL 40MG TAB
Verapamil HCl Tab 80 MG SANDOZ VERAPAMIL HCL 80 VASOMIL 80MG TAB Verapamil HCl Tab 120 MG SANDOZ VERAPAMIL HCL 120 ROLAB-VERAPAMIL HCL 120 Verapamil HCl Tab CR 240 MG Felodipine Tab SR 24HR 2.5 MG Felodipine Tab SR 24HR 5 MG Felodipine Tab SR 24HR 10 MG Nifedipine Cap 5 MG Nifedipine Cap 10 MG Nifedipine Cap CR 30 MG Nifedipine Tab SR 12HR 10 MG Nifedipine Tab SR 12HR 20 MG Amlodipine Besylate Tab 5 MG Amlodipine Maleate Tab 5 MG Amlodipine Besylate Tab 10 MG VERAHEXAL 240 SR CALCICARD SR 240MG RAVAMIL SR 240MG PLENDIL 2.5MG TAB FELODIPINE-HEXAL 5MG TAB FELODIPINE-HEXAL 10MG TAB CARDIFEN TM 5MG CAP BIO-NIFEDIPINE 5MG BIO-NIFEDIPINE NIFEDALAT 10MG CAP ADCO-VASCARD 30 SR CAPS ADALAT RETARD 10MG NIFEDALAT 20SR TAB CIPALAT RETARD 20MG ALMADIN 5MG TAB AMLODAC 5MG TAB AUSTELL AMLODIPINE 5MG TAB CALBLOC 5MG TAB CIPLAVASC 5MG TAB CPL ALLIANCE AMLODIPINE 5 INDO AMLODIPINE 5MG TAB KLODIP-5 PHARMA DYNAMICS AMLODIPINE BES AMLATE 5MG TAB SANDOZ-AMLODIPINE 5MG TAB ALMADIN 10MG TAB AMLODAC 10MG TAB AUSTELL AMLODIPINE 10MG TAB CALBLOC 10MG TAB CIPLAVASC 10MG TAB CPL ALLIANCE AMLODIPINE 10MG PHARMA DYNAMICS AMLODIPINE BES
Amlodipine Maleate Tab 10 MG AMLATE 10MG TAB SANDOZ-AMLODIPINE 10MG Central acting sympathetic nervous system inhibitors Methyldopa Tab 250 MG SANDOZ METHYLDOPA 250MG MERCK-METHYLDOPA 250 TAB Diuretics Amiloride & Hydrochlorothiazide Tab 2.5- AMILORETIC HS TAB Amiloride & Hydrochlorothiazide Tab 5-50 Furosemide Cap 40 MG Furosemide Tab 40 MG Hydrochlorothiazide Tab 25 MG Hydrochlorothiazide-Potassium Chloride Indapamide Tab 2.5 MG Spironolactone Tab 25 MG Spironolactone Tab 100 MG Triamterene & Hydrochlorothiazide Tab 50 BETARETIC TAB ADCO-RETIC TAB AMILORETIC TAB SPEC-CO-AMILORIDE TAB AQUARID 40MG CAP SANDOZ FUROSEMIDE 40 MG AUSTELL-FUROSEMIDE 40MG TAB BEURESIS 40MG TAB DIURESIX 40MG TAB MERCK-FUROSEMIDE 40 MG PURESIS 40MG TAB HEXAZIDE 25MG TAB URIREX-K TAB DAPTRIL 2.5MG TAB LIXAMIDE 2.5MG TAB MERCK-INDAPAMIDE 2.5 TABS CIPLA-INDAPAMIDE 2.5MG TAB SANDOZ SPIRONOLACTONE 25M SPIRACTIN 25MG TAB SPIRACTIN 100MG TAB RENEZIDE TAB ROLAB-TRIAMTERENE HCT Haematinics * Epoetin Alfa Inj 10000 Unit/ML EPREX 10000U/ML INJ (ONLY IF IRON THERAPY FAILURE Hb < 8g/dl) Epoetin Alfa Inj 10000 Unit/ML EPREX PREFILL 10000U INJ Epoetin Alfa Inj 2000 Unit/ML Epoetin Alfa Inj 2000 Unit/ML Epoetin Alfa Inj 2000 Unit/ML Epoetin Alfa Inj 4000 Unit/ML Epoetin Alfa Inj 4000 Unit/ML Epoetin Alfa Inj 4000 Unit/ML EPREX 2000U/ML INJ EPREX PREFILL 2000U INJ REPOTIN 2000U EPREX 4000U/ML INJ EPREX PREFILL 4000U INJ REPOTIN 4000U
Epoetin Alfa Inj 40000 Unit/ML Epoetin Beta For Inj 1000 Unit Epoetin Beta For Inj 2000 Unit Epoetin Beta Inj 10000 Unit/ML Epoetin Beta Inj 10000 Unit/ML Epoetin Beta Inj 2000 Unit/0.3ML Epoetin Beta Inj 4000 Unit/0.3ML Epoetin Beta Inj 500 Unit/0.3ML Epoetin Beta Inj 5000 Unit/ML Epoetin Beta Inj 6000 Unit/0.3ML (20000 Epoetin Beta Inj 6000 Unit/0.3ML (20000 Epoetin Beta Inj 6000 Unit/0.3ML (20000 EPREX 40000U/ML RECORMON 1000U VIAL RECORMON 2000U VIAL RECORMON 10000 PREFILL RECORMON PRE-FILLED SYRIN RECORMON 2000 PREFILL RECORMON 4000U PREFILL RECORMON 500U PREFILL RECORMON 50000 10ML RECORMON 6000U PREFIL RECORMON 100000 5ML MD RECORMON 20000 PENFILL Oral Iron ** Ferrous Sulfate Tab 100 MG FERROUS SULPHATE 100MG Ferrous Sulfate Tab 30 MG FERROUS SULPHATE 30MG Intravenous Iron ** Iron Polymaltose Inj 50 MG/ML (Elemental FERRIMED 100MG/2ML INJ (only allowed if failure on oral iron therapy-3 mnths oral iron use) Polysaccharide Iron Complex IV Soln 20 M VENOFER 20MG/ML INJ 5ML 1 Alpha Hydroxy Cholecalciferol Alfacalcidol Cap 0.25 MCG ONE ALPHA 0.25MCG CAP Alfacalcidol Cap 1 MCG ONE ALPHA 1MCG CAP Ergocalciferol Soln 5000 Unit/ML Ergocalciferol Tab 50000 Unit CALCIFEROL OILY 15ML SOLN CALCIFEROL 50000IU TAB Potassium Potassium Chloride Tab CR 8 meq PLENISH K 600MG TAB (Only with Poatssium Depleting Diuretics) SANDOZ K-600 Folic Acid Folic Acid Tab 5 MG BE-TABS FOLIC ACID 5MG TA Sympathetic nervous blockers Reserpine Tab 0.25 MG RESERPINE 0.25MG TAB PRIOR TO CHRONIC REGISTRATION, ALL FORMULARY DRUGS ARE SUBJECT TO SCHEME RULES, CLINICAL PROTOCOLS AND CHANGES IN PRODUCTS AND PRICES