08:0

0 A

nti-In

fectiv

e A

gen

ts

08:00

Anti-Infective Agents

ALBERTA DRUG BENEFIT LIST

MEBENDAZOLE

GENTAMICIN SULFATE

TOBRAMYCIN

TOBRAMYCIN SULFATE

CEFADROXIL

CEFAZOLIN SODIUM

100 MG ORAL CHEWABLE TABLET

40 MG / ML (BASE) INJECTION

28 MG INHALATION CAPSULE

60 MG / ML (BASE) INHALATION SOLUTION

40 MG / ML (BASE) INJECTION

500 MG ORAL CAPSULE

500 MG / VIAL (BASE) INJECTION

1 G / VIAL (BASE) INJECTION

00000556734

00002242652

00002365154

000023896220000244336800002239630

00002420287

0000224077400002235134

0000230893200002108119

000022972050000230895900002108127

VERMOX

GENTAMICIN

TOBI PODHALER

TEVA-TOBRAMYCINTOBRAMYCIN INHALATION SOLUTIONTOBI

JAMP-TOBRAMYCIN

APO-CEFADROXILTEVA-CEFADROXIL

CEFAZOLINSTERILE CEFAZOLIN SODIUM

CEFAZOLINCEFAZOLINSTERILE CEFAZOLIN SODIUM

JAI

SDZ

NOV

TEVSDZNOV

JPC

APXTEV

SDZTEV

APXSDZTEV

(FIRST GENERATION CEPHALOSPORINS)

ANTI-INFECTIVE AGENTS

ANTI-INFECTIVE AGENTS

ANTI-INFECTIVE AGENTS

ANTHELMINTICS

ANTIBACTERIALS

ANTIBACTERIALS

08

08

08

:00

:00

:00

08:08

08:12.02

08:12.06.04

4.7933

8.9447

13.4510

5.4763 5.4763

10.7608

2.7250

0.8421 0.8421

2.5000 2.5000

3.2308 3.2308 3.2308

5 EFFECTIVE APRIL 1, 2018

UNIT OF ISSUE - REFER TO PRICE POLICY

$

$

$

$$$

$

$$

$$

$$$

RESTRICTED BENEFIT - This product is a benefit when prescribed by a Specialist in Infectious Diseases or a designated prescriber.

(Refer to Section 3 - Criteria for Special Authorization of Select Drug Products of the Alberta Drug Benefit List for eligibility when the prescriber prescribing the medication is not a Specialistin Infectious Diseases or a designated prescriber.)

This Drug Product is a benefit for use by Home Parenteral Therapy (HPT) programs only.

(AMINOGLYCOSIDES)

CEPHALOSPORINS

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

ALBERTA DRUG BENEFIT LIST

PRODUCT IS NOT INTERCHANGEABLE

CEFAZOLIN SODIUM

CEPHALEXIN

CEFPROZIL

10 G / VIAL (BASE) INJECTION

100 G / G INJECTION

250 MG ORAL TABLET

500 MG ORAL TABLET

250 MG ORAL CAPSULE

500 MG ORAL CAPSULE

25 MG / ML ORAL SUSPENSION

50 MG / ML ORAL SUSPENSION

250 MG ORAL TABLET

500 MG ORAL TABLET

0000223714000002297213000023089670000243712000002108135

00002401029

0000076872300000583413

0000076871500000583421

00000342084

00000342114

00000342106

00000342092

000022929980000229352800002302179

000022930050000229353600002302187

CEFAZOLINCEFAZOLINCEFAZOLINCEFAZOLINSTERILE CEFAZOLIN SODIUM

CEFAZOLIN

APO-CEPHALEXTEVA-CEPHALEXIN

APO-CEPHALEXTEVA-CEPHALEXIN

TEVA-CEPHALEXIN

TEVA-CEPHALEXIN

TEVA-CEPHALEXIN 125

TEVA-CEPHALEXIN 250

APO-CEFPROZILRAN-CEFPROZILSANDOZ CEFPROZIL

APO-CEFPROZILRAN-CEFPROZILSANDOZ CEFPROZIL

FKCAPXSDZSTMTEV

FKC

APXTEV

APXTEV

TEV

TEV

TEV

TEV

APXRANSDZ

APXRANSDZ

(FIRST GENERATION CEPHALOSPORINS)

(SECOND GENERATION CEPHALOSPORINS)

ANTI-INFECTIVE AGENTS

ANTI-INFECTIVE AGENTS

ANTIBACTERIALS

ANTIBACTERIALS

08

08

:00

:00

08:12.06.04

08:12.06.08

30.1500 30.1500 30.1500 30.1500 30.1500

3.0150

0.2250 0.2250

0.4500 0.4500

0.4028

0.7615

0.2212

0.4255

0.4332 0.4332 0.4332

0.8494 0.8494 0.8494

6 EFFECTIVE APRIL 1, 2018

$$$$$

$

$$

$$

$

$

$

$

$$$

$$$

CEPHALOSPORINS

CEPHALOSPORINS

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

ALBERTA DRUG BENEFIT LIST

CEFUROXIME AXETIL

CEFIXIME

CEFOTAXIME SODIUM

CEFTAZIDIME

CEFTRIAXONE SODIUM

250 MG (BASE) ORAL TABLET

500 MG (BASE) ORAL TABLET

400 MG ORAL TABLET

20 MG / ML ORAL SUSPENSION

1 G / VIAL (BASE) INJECTION

2 G / VIAL (BASE) INJECTION

1 G / VIAL INJECTION

2 G / VIAL INJECTION

6 G / VIAL INJECTION

0.25 G / VIAL (BASE) INJECTION

1 G / VIAL (BASE) INJECTION

2 G / VIAL (BASE) INJECTION

000022443930000234482300002212277

000022443940000234483100002212285

0000243277300000868981

00000868965

00002434091

00002434105

00002212218

00002212226

00002212234

0000229286600002325594

00002292270000022928740000228763300002325616

000022922890000229288200002325624

APO-CEFUROXIMEAURO-CEFUROXIMECEFTIN

APO-CEFUROXIMEAURO-CEFUROXIMECEFTIN

AURO-CEFIXIMESUPRAX

SUPRAX

CEFOTAXIME SODIUM

CEFOTAXIME SODIUM

FORTAZ

FORTAZ

FORTAZ

CEFTRIAXONE FOR INJECTION USPCEFTRIAXONE SODIUM FOR INJECTION BP

CEFTRIAXONE FOR INJECTION USPCEFTRIAXONE FOR INJECTION USPCEFTRIAXONE SODIUM FOR INJECTIONCEFTRIAXONE SODIUM FOR INJECTION BP

CEFTRIAXONE FOR INJECTION USPCEFTRIAXONE FOR INJECTION USPCEFTRIAXONE SODIUM FOR INJECTION BP

APXAURGSK

APXAURGSK

AURODN

ODN

STM

STM

GSK

GSK

GSK

APXSTM

SDZAPXTEVSTM

SDZAPXSTM

(SECOND GENERATION CEPHALOSPORINS)

(THIRD GENERATION CEPHALOSPORINS)

ANTI-INFECTIVE AGENTS

ANTI-INFECTIVE AGENTS

ANTIBACTERIALS

ANTIBACTERIALS

08

08

:00

:00

08:12.06.08

08:12.06.12

0.7237 0.7237 1.6775

1.4337 1.4337 3.3231

3.0796 3.0800

0.4403

8.3300

16.6855

22.9268

45.0772

135.2961

3.9500 3.9500

12.4900 12.4900 12.4900 12.4900

24.1300 24.1300 24.1300

7 EFFECTIVE APRIL 1, 2018

UNIT OF ISSUE - REFER TO PRICE POLICY

$$$

$$$

$$

$

$

$

$

$

$

$$

$$$$

$$$

CEPHALOSPORINS

CEPHALOSPORINS

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

ALBERTA DRUG BENEFIT LIST

PRODUCT IS NOT INTERCHANGEABLE

CEFTRIAXONE SODIUM

ERTAPENEM

IMIPENEM/ CILASTATIN SODIUM

MEROPENEM

10 G / VIAL (BASE) INJECTION

1 G / VIAL INJECTION

500 MG / VIAL * 500 MG / VIAL (BASE) INJECTION

500 MG / VIAL INJECTION

1 G / VIAL INJECTION

00002325632

00002247437

00000717282

00002218488

0000243650700002218496

CEFTRIAXONE SODIUM

INVANZ

PRIMAXIN

MERREM

MEROPENEM FOR INJECTION USPMERREM

STM

MFC

MFC

AZC

STMAZC

(THIRD GENERATION CEPHALOSPORINS)

(CARBAPENEMS)

ANTI-INFECTIVE AGENTS

ANTI-INFECTIVE AGENTS

ANTIBACTERIALS

ANTIBACTERIALS

08

08

:00

:00

08:12.06.12

08:12.07.08

153.0000

53.9106

26.0654

26.3500

44.7950 52.7000

8 EFFECTIVE APRIL 1, 2018

$

$

$

$

$$

RESTRICTED BENEFIT - This product is a benefit when prescribed by a Specialist in Infectious Diseases or a designated prescriber.

(Refer to Section 3 - Criteria for Special Authorization of Select Drug Products of the Alberta Drug Benefit List for eligibility when the prescriber prescribing the medication is not a Specialistin Infectious Diseases or a designated prescriber.)

RESTRICTED BENEFIT - This product is a benefit when prescribed by a Specialist in Infectious Diseases or Hematology, or a designated prescriber.

(Refer to Section 3 - Criteria for Special Authorization of Select Drug Products of the Alberta Drug Benefit List for eligibility when the prescriber prescribing the medication is not a Specialistin Infectious Diseases or Hematology, or a designated prescriber.)

RESTRICTED BENEFIT - This product is a benefit when prescribed by a Specialist in Infectious Diseases or Hematology, or a designated prescriber.

(Refer to Section 3 - Criteria for Special Authorization of Select Drug Products of the Alberta Drug Benefit List for eligibility when the prescriber prescribing the medication is not a Specialistin Infectious Diseases or Hematology, or a designated prescriber.)

CEPHALOSPORINS

MISCELLANEOUS B-LACTAMS

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

ALBERTA DRUG BENEFIT LIST

CEFOXITIN SODIUM

CHLORAMPHENICOL SODIUM SUCCINATE

ERYTHROMYCIN

ERYTHROMYCIN STEARATE

1 G / VIAL (BASE) INJECTION

2 G / VIAL (BASE) INJECTION

1 G / VIAL (BASE) INJECTION

250 MG ORAL TABLET

333 MG ORAL CAPSULE (ENTERIC-COATED PELLET)

250 MG ORAL TABLET

500 MG ORAL TABLET

0000229171100002128187

0000229173800002128195

00000312363

00000682020

00000873454

00000545678

00000688568

CEFOXITINCEFOXITIN SODIUM

CEFOXITINCEFOXITIN SODIUM

CHLOROMYCETIN

ERYTHRO-BASE

ERYC

ERYTHRO-S

ERYTHRO-S

APXTEV

APXTEV

ERF

AAP

PFI

AAP

AAP

(CEPHAMYCINS)

(ERYTHROMYCINS)

ANTI-INFECTIVE AGENTS

ANTI-INFECTIVE AGENTS

ANTI-INFECTIVE AGENTS

ANTIBACTERIALS

ANTIBACTERIALS

ANTIBACTERIALS

08

08

08

:00

:00

:00

08:12.07.12

08:12.08

08:12.12.04

10.6000 10.6000

21.2500 21.2500

19.2409

0.1904

0.7189

0.2205

0.5534

9 EFFECTIVE APRIL 1, 2018UNIT OF ISSUE - REFER TO PRICE POLICY

$$

$$

$

$

$

$

$

RESTRICTED BENEFIT - This product is a benefit when prescribed by a Specialist in Infectious Diseases or a designated prescriber.

(Refer to Section 3 - Criteria for Special Authorization of Select Drug Products of the Alberta Drug Benefit List for eligibility when the prescriber prescribing the medication is not a Specialistin Infectious Diseases or a designated prescriber.)

MISCELLANEOUS B-LACTAMS

(CHLORAMPHENICOL)

MACROLIDES

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

ALBERTA DRUG BENEFIT LIST

PRODUCT IS NOT INTERCHANGEABLE

AZITHROMYCIN

CLARITHROMYCIN

250 MG ORAL TABLET

600 MG ORAL TABLET

20 MG / ML ORAL SUSPENSION

40 MG / ML ORAL SUSPENSION

250 MG ORAL TABLET

500 MG ORAL TABLET

500 MG ORAL EXTENDED-RELEASE TABLET

00002415542000023308810000244243400002452308000024523240000227835900002267845000022616340000226582600002212021

0000225608800002261642

000024184520000233238800002223716

00002274574000024184600000233239600002223724

00002442469000024661200000224757300002361426000022665390000224880400001984853

00002247574000022665470000224880500002126710

000024031960000241334500002244756

APO-AZITHROMYCIN ZAZITHROMYCINAZITHROMYCINJAMP-AZITHROMYCINMAR-AZITHROMYCINMYLAN-AZITHROMYCINNOVO-AZITHROMYCINPMS-AZITHROMYCINSANDOZ AZITHROMYCINZITHROMAX

ACT AZITHROMYCINPMS-AZITHROMYCIN

PMS-AZITHROMYCINSANDOZ AZITHROMYCINZITHROMAX

GD-AZITHROMYCINPMS-AZITHROMYCINSANDOZ AZITHROMYCINZITHROMAX

CLARITHROMYCINCLARITHROMYCINPMS-CLARITHROMYCINRAN-CLARITHROMYCINSANDOZ CLARITHROMYCINTEVA-CLARITHROMYCINBIAXIN BID

PMS-CLARITHROMYCINSANDOZ CLARITHROMYCINTEVA-CLARITHROMYCINBIAXIN BID

ACT CLARITHROMYCIN XLAPO-CLARITHROMYCIN XLBIAXIN XL

APXSNSSIVJPCMARMYPTEVPMSSDZPFI

APHPMS

PMSSDZPFI

GMDPMSSDZPFI

SIVSNSPMSRANSDZTEVBGP

PMSSDZTEVBGP

APHAPXBGP

(OTHER MACROLIDES)

ANTI-INFECTIVE AGENTS

ANTIBACTERIALS

08:00

08:12.12.92

0.9410 0.9410 0.9410 0.9410 0.9410 0.9410 0.9410 0.9410 0.9410 5.2318

6.0000 6.0000

0.3726 0.3726 1.1310

0.5280 0.5280 0.5280 1.6026

0.4122 0.4122 0.4122 0.4122 0.4122 0.4122 1.6833

1.6292 1.6292 1.6292 3.3271

1.2572 1.2572 2.5671

10 EFFECTIVE APRIL 1, 2018

$$$$$$$$$$

$$

$$$

$$$$

$$$$$$$

$$$$

$$$

RESTRICTED BENEFIT - This product is a benefit when prescribed by a Specialist in Infectious Diseases or a designated prescriber.

(Refer to Section 3 - Criteria for Special Authorization of Select Drug Products of the Alberta Drug Benefit List for eligibility when the prescriber prescribing the medication is not a Specialist in Infectious Diseases or a designated prescriber.)

MACROLIDES

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

ALBERTA DRUG BENEFIT LIST

CLARITHROMYCIN

PENICILLIN G SODIUM

PENICILLIN V POTASSIUM

AMOXICILLIN TRIHYDRATE

25 MG / ML ORAL SUSPENSION

50 MG / ML ORAL SUSPENSION

1,000,000 IU / VIAL INJECTION

5,000,000 IU / VIAL INJECTION

10,000,000 IU / VIAL INJECTION

300 MG ORAL TABLET

25 MG / ML ORAL LIQUID

60 MG / ML ORAL LIQUID

125 MG (BASE) ORAL CHEWABLE TABLET

250 MG (BASE) ORAL CHEWABLE TABLET

000024089880000239044200002146908

000024089960000239045000002244641

0000193067200002220261

0000088375100002220288

0000193068000002220296

00000642215

00000642223

00000642231

00002036347

00002036355

CLARITHROMYCINTARO-CLARITHROMYCINBIAXIN

CLARITHROMYCINTARO-CLARITHROMYCINBIAXIN

PENICILLIN G SODIUMPENICILLIN G SODIUM

PENICILLIN G SODIUMPENICILLIN G SODIUM

PENICILLIN G SODIUMPENICILLIN G SODIUM

PEN-VK

APO-PEN-VK

APO-PEN-VK

NOVAMOXIN

NOVAMOXIN

SNSTARBGP

SNSTARBGP

TEVFKC

TEVFKC

TEVFKC

AAP

APX

APX

TEV

TEV

(OTHER MACROLIDES)

(NATURAL PENICILLINS)

(AMINOPENICILLINS)

ANTI-INFECTIVE AGENTS

ANTI-INFECTIVE AGENTS

ANTI-INFECTIVE AGENTS

ANTIBACTERIALS

ANTIBACTERIALS

ANTIBACTERIALS

08

08

08

:00

:00

:00

08:12.12.92

08:12.16.04

08:12.16.08

0.2047 0.2047 0.3029

0.3998 0.3998 0.5932

2.4000 2.4000

5.1000 5.1000

8.9000 8.9000

0.1912

0.0535

0.0618

0.5099

0.7512

11 EFFECTIVE APRIL 1, 2018UNIT OF ISSUE - REFER TO PRICE POLICY

$$$

$$$

$$

$$

$$

$

$

$

$

$

MACROLIDES

PENICILLINS

PENICILLINS

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

ALBERTA DRUG BENEFIT LIST

PRODUCT IS NOT INTERCHANGEABLE

AMOXICILLIN TRIHYDRATE

AMOXICILLIN TRIHYDRATE/ CLAVULANATE POTASSIUM

250 MG (BASE) ORAL CAPSULE

500 MG (BASE) ORAL CAPSULE

25 MG / ML (BASE) ORAL SUSPENSION

50 MG / ML (BASE) ORAL SUSPENSION

250 MG (BASE) * 125 MG (BASE) ORAL TABLET

500 MG (BASE) * 125 MG (BASE) ORAL TABLET

875 MG (BASE) * 125 MG (BASE) ORAL TABLET

25 MG / ML (BASE) * 6.25 MG / ML (BASE) ORAL SUSPENSION

40 MG / ML (BASE) * 5.7 MG / ML (BASE) ORAL SUSPENSION

50 MG / ML (BASE) * 12.5 MG / ML (BASE) ORAL SUSPENSION

80 MG / ML (BASE) * 11.4 MG / ML (BASE) ORAL SUSPENSION

00002352710000024014950000062811500002388073000022381710000040672400002230243

00002352729000024015090000062812300002388081000022381720000040671600002230244

00000628131000004521490000193417100002230245

00002352753000024015410000235278800000628158000004521300000193416300002230246

00002243350

0000224335100001916858

0000224562300002238829

00001916882

00002238831

00001916874

00002238830

AMOXICILLINAMOXICILLINAPO-AMOXIAURO-AMOXICILLINMYLAN-AMOXICILLINNOVAMOXINPMS-AMOXICILLIN

AMOXICILLINAMOXICILLINAPO-AMOXIAURO-AMOXICILLINMYLAN-AMOXICILLINNOVAMOXINPMS-AMOXICILLIN

APO-AMOXINOVAMOXINNOVAMOXIN SUGAR-REDUCEDPMS-AMOXICILLIN

AMOXICILLINAMOXICILLINAMOXICILLIN SUGAR-REDUCEDAPO-AMOXINOVAMOXINNOVAMOXIN SUGAR-REDUCEDPMS-AMOXICILLIN

APO-AMOXI CLAV

APO-AMOXI CLAVCLAVULIN-500F

APO-AMOXI CLAVCLAVULIN-875

CLAVULIN-125F

CLAVULIN-200

CLAVULIN-250F

CLAVULIN-400

SNSSIVAPXAURMYPTEVPMS

SNSSIVAPXAURMYPTEVPMS

APXTEVTEVPMS

SNSSIVSNSAPXTEVTEVPMS

APX

APXGSK

APXGSK

GSK

GSK

GSK

GSK

(AMINOPENICILLINS)

ANTI-INFECTIVE AGENTS

ANTIBACTERIALS

08:00

08:12.16.08

0.1750 0.1750 0.1750 0.1750 0.1750 0.1750 0.1750

0.3417 0.3417 0.3417 0.3417 0.3417 0.3417 0.3417

0.0352 0.0352 0.0352 0.0352

0.0540 0.0540 0.0540 0.0540 0.0540 0.0540 0.0540

0.9375

0.6673 1.5110

0.5550 2.2205

0.0969

0.1498

0.2039

0.2857

12 EFFECTIVE APRIL 1, 2018

$$$$$$$

$$$$$$$

$$$$

$$$$$$$

$

$$

$$

$

$

$

$

PENICILLINS

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

ALBERTA DRUG BENEFIT LIST

AMPICILLIN

AMPICILLIN SODIUM

CLOXACILLIN SODIUM

250 MG ORAL CAPSULE

500 MG ORAL CAPSULE

250 MG / VIAL (BASE) INJECTION

500 MG / VIAL (BASE) INJECTION

1 G / VIAL (BASE) INJECTION

2 G / VIAL (BASE) INJECTION

250 MG (BASE) ORAL CAPSULE

500 MG (BASE) ORAL CAPSULE

25 MG / ML (BASE) ORAL LIQUID

500 MG / VIAL (BASE) INJECTION

1 G / VIAL (BASE) INJECTION

2 G / VIAL (BASE) INJECTION

00000020877

00000020885

00000872644

00000872652

00001933345

00001933353

00000337765

00000337773

00000337757

00002367408

00002367416

00002367424

NOVO-AMPICILLIN

NOVO-AMPICILLIN

AMPICILLIN SODIUM

AMPICILLIN SODIUM

AMPICILLIN SODIUM

AMPICILLIN SODIUM

NOVO-CLOXIN

NOVO-CLOXIN

NOVO-CLOXIN

CLOXACILLIN

CLOXACILLIN

CLOXACILLIN

TEV

TEV

TEV

TEV

TEV

TEV

TEV

TEV

TEV

STM

STM

STM

(AMINOPENICILLINS)

(PENICILLINASE-RESISTANT PENICILLINS)

ANTI-INFECTIVE AGENTS

ANTI-INFECTIVE AGENTS

ANTIBACTERIALS

ANTIBACTERIALS

08

08

:00

:00

08:12.16.08

08:12.16.12

0.4223

0.8006

3.1830

3.3384

5.5886

11.1781

0.4489

0.8487

0.1117

4.5600

5.6000

7.3100

13 EFFECTIVE APRIL 1, 2018

UNIT OF ISSUE - REFER TO PRICE POLICY

$

$

$

$

$

$

$

$

$

$

$

$

RESTRICTED BENEFIT - This product is a benefit when prescribed by a Specialist in Infectious Diseases or a designated prescriber.

(Refer to Section 3 - Criteria for Special Authorization of Select Drug Products of the Alberta Drug Benefit List for eligibility when the prescriber prescribing the medication is not a Specialistin Infectious Diseases or a designated prescriber.)

PENICILLINS

PENICILLINS

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

ALBERTA DRUG BENEFIT LIST

PRODUCT IS NOT INTERCHANGEABLE

PIPERACILLIN SODIUM/ TAZOBACTAM SODIUM

NORFLOXACIN

SULFAMETHOXAZOLE/ TRIMETHOPRIM

2 G / VIAL (BASE) * 250 MG / VIAL (BASE) INJECTION

3 G / VIAL (BASE) * 375 MG / VIAL (BASE) INJECTION

4 G / VIAL (BASE) * 500 MG / VIAL (BASE) INJECTION

400 MG ORAL TABLET

100 MG * 20 MG ORAL TABLET

400 MG * 80 MG ORAL TABLET

800 MG * 160 MG ORAL TABLET

00002308444000023626190000240131200002299623

00002308452000023626270000240132000002299631

00002370166

00002308460000023626350000240133900002299658

00002370174

00002237682

00000445266

00000445274

00000445282

PIPERACILLIN AND TAZOBACTAMPIPERACILLIN AND TAZOBACTAMPIPERACILLIN AND TAZOBACTAMPIPERACILLIN SODIUM/TAZOBACTAM SODIUM

PIPERACILLIN AND TAZOBACTAMPIPERACILLIN AND TAZOBACTAMPIPERACILLIN AND TAZOBACTAMPIPERACILLIN SODIUM/TAZOBACTAM SODIUMPIPERACILLIN/TAZOBACTAM

PIPERACILLIN AND TAZOBACTAMPIPERACILLIN AND TAZOBACTAMPIPERACILLIN AND TAZOBACTAMPIPERACILLIN SODIUM/TAZOBACTAM SODIUMPIPERACILLIN/TAZOBACTAM

NOVO-NORFLOXACIN

APO-SULFATRIM

APO-SULFATRIM

APO-SULFATRIM DS

APXSTMTGTSDZ

APXSTMTGTSDZ

TEV

APXSTMTGTSDZ

TEV

TEV

APX

APX

APX

(EXTENDED-SPECTRUM PENICILLINS)

ANTI-INFECTIVE AGENTS

ANTI-INFECTIVE AGENTS

ANTI-INFECTIVE AGENTS

ANTIBACTERIALS

ANTIBACTERIALS

ANTIBACTERIALS

08

08

08

:00

:00

:00

08:12.16.16

08:12.18

08:12.20

4.1727 4.1727 4.1727 4.1727

6.2591 6.2591 6.2591 6.2591

6.2591

8.3458 8.3458 8.3458 8.3458

8.3458

0.5449

0.0911

0.0482

0.1221

14 EFFECTIVE APRIL 1, 2018

$$$$

$$$$

$

$$$$

$

$

$

$

$

RESTRICTED BENEFIT - This product is a benefit when prescribed by a Specialist in Infectious Diseases or Hematology, or a designated prescriber.

(Refer to Section 3 - Criteria for Special Authorization of Select Drug Products of the Alberta Drug Benefit List for eligibility when the prescriber prescribing the medication is not a Specialistin Infectious Diseases or Hematology, or a designated prescriber.)

PENICILLINS

(QUINOLONES)

(SULFONAMIDES)

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

ALBERTA DRUG BENEFIT LIST

SULFAMETHOXAZOLE/ TRIMETHOPRIM

SULFASALAZINE

DOXYCYCLINE HYCLATE

MINOCYCLINE HCL

TETRACYCLINE HCL

40 MG / ML * 8 MG / ML ORAL SUSPENSION

80 MG / ML * 16 MG / ML INJECTION

500 MG ORAL TABLET

500 MG ORAL ENTERIC-COATED TABLET

100 MG (BASE) ORAL TABLET

100 MG (BASE) ORAL CAPSULE

50 MG (BASE) ORAL CAPSULE

100 MG (BASE) ORAL CAPSULE

250 MG ORAL CAPSULE

00000726540

00000550086

00000598461

00000598488

000008742560000235124200002158574

000007407130000235123400000725250

0000208409000002287226000022307350000210814300002294419

00002084104000022872340000223073600002108151

00000580929

TEVA-TRIMEL

SEPTRA

PMS-SULFASALAZINE

PMS-SULFASALAZINE

APO-DOXYDOXYCYCLINETEVA-DOXYCYCLINE

APO-DOXYDOXYCYCLINETEVA-DOXYCYCLINE

APO-MINOCYCLINEMINOCYCLINEMYLAN-MINOCYCLINENOVO-MINOCYCLINEPMS-MINOCYCLINE

APO-MINOCYCLINEMINOCYCLINEMYLAN-MINOCYCLINENOVO-MINOCYCLINE

TETRACYCLINE

TEV

APC

PMS

PMS

APXSNSTEV

APXSNSTEV

APXSNSMYPTEVPMS

APXSNSMYPTEV

AAP

ANTI-INFECTIVE AGENTS

ANTI-INFECTIVE AGENTS

ANTIBACTERIALS

ANTIBACTERIALS

08

08

:00

:00

08:12.20

08:12.24

0.1188

1.5000

0.2550

0.3880

0.5860 0.5860 0.5860

0.5860 0.5860 0.5860

0.1101 0.1101 0.1101 0.1101 0.1101

0.2125 0.2125 0.2125 0.2125

0.0684

15 EFFECTIVE APRIL 1, 2018

UNIT OF ISSUE - REFER TO PRICE POLICY

$

$

$

$

$$$

$$$

$$$$$

$$$$

$

(SULFONAMIDES)

(TETRACYCLINES)

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

ALBERTA DRUG BENEFIT LIST

PRODUCT IS NOT INTERCHANGEABLE

SPIRAMYCIN

VANCOMYCIN HCL

750,000 IU ORAL CAPSULE

1,500,000 IU ORAL CAPSULE

125 MG (BASE) ORAL CAPSULE

250 MG (BASE) ORAL CAPSULE

500 MG / VIAL (BASE) INJECTION

1 G / VIAL (BASE) INJECTION

10 G / VIAL INJECTION

00001927825

00001927817

0000240774400000800430

0000240775200000788716

00002342855

00002342863

0000224180700002405830

ROVAMYCINE-250

ROVAMYCINE-500

JAMP-VANCOMYCINVANCOCIN

JAMP-VANCOMYCINVANCOCIN

VANCOMYCIN HCL

VANCOMYCIN HCL

STERILE VANCOMYCIN HCLVANCOMYCIN HCL

ODN

ODN

JPCMLI

JPCMLI

STM

STM

FKCSTM

(GLYCOPEPTIDES)

ANTI-INFECTIVE AGENTS

ANTI-INFECTIVE AGENTS

ANTIBACTERIALS

ANTIBACTERIALS

08

08

:00

:00

08:12.28

08:12.28.16

1.4300

2.7960

5.1800 5.1800

10.3600 10.3600

31.0500

58.9900

589.9000 589.9000

16 EFFECTIVE APRIL 1, 2018

$

$

$$

$$

$

$

$$

RESTRICTED BENEFIT - This product is a benefit when prescribed by a Specialist in Infectious Diseases or a designated prescriber.

RESTRICTED BENEFIT - This product is a benefit when prescribed by a Specialist in Infectious Diseases or a designated prescriber.

(Refer to Section 3 - Criteria for Special Authorization of Select Drug Products of the Alberta Drug Benefit List for eligibility when the prescriber prescribing the medication is not a Specialist in Infectious Diseases or a designated prescriber.)

RESTRICTED BENEFIT

This Drug Product is a benefit for use by Home Parenteral Therapy (HPT) programs only.

(MISCELLANEOUS ANTIBACTERIALS)

MISCELLANEOUS ANTIBACTERIALS

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

ALBERTA DRUG BENEFIT LIST

CLINDAMYCIN HCL

CLINDAMYCIN PALMITATE HCL

CLINDAMYCIN PHOSPHATE

LINEZOLID

COLISTIMETHATE SODIUM

150 MG (BASE) ORAL CAPSULE

300 MG (BASE) ORAL CAPSULE

15 MG / ML (BASE) ORAL SOLUTION

150 MG / ML (BASE) INJECTION

600 MG ORAL TABLET

150 MG / VIAL INJECTION

00002245232000024369060000225833100002241709

00002245233000024369140000225835800002241710

00000225851

000022305400000223053500000260436

000024265520000242268900002243684

00002244849

APO-CLINDAMYCINAURO-CLINDAMYCINMYLAN-CLINDAMYCINTEVA-CLINDAMYCIN

APO-CLINDAMYCINAURO-CLINDAMYCINMYLAN-CLINDAMYCINTEVA-CLINDAMYCIN

DALACIN C PALMITATE

CLINDAMYCINCLINDAMYCIN (60 & 120 ML)DALACIN C PHOSPHATE

APO-LINEZOLIDSANDOZ LINEZOLIDZYVOXAM

COLISTIMETHATE FOR INJECTION

APXAURMYPTEV

APXAURMYPTEV

PFI

SDZSDZPFI

APXSDZPFI

STM

(LINCOMYCINS)

(OXAZOLIDINONES)

(POLYMYXINS)

ANTI-INFECTIVE AGENTS

ANTI-INFECTIVE AGENTS

ANTI-INFECTIVE AGENTS

ANTIBACTERIALS

ANTIBACTERIALS

ANTIBACTERIALS

08

08

08

:00

:00

:00

08:12.28.20

08:12.28.24

08:12.28.28

0.2217 0.2217 0.2217 0.2217

0.4434 0.4434 0.4434 0.4434

0.1849

3.6550 3.6550 4.3427

37.0500 37.0500 75.7024

33.7397

17 EFFECTIVE APRIL 1, 2018UNIT OF ISSUE - REFER TO PRICE POLICY

$$$$

$$$$

$

$$$

$$$

$

RESTRICTED BENEFIT - This product is a benefit when prescribed by a Specialist in Infectious Diseases or a designated prescriber.

(Refer to Section 3 - Criteria for Special Authorization of Select Drug Products of the Alberta Drug Benefit List for eligibility when the prescriber prescribing the medication is not a Specialistin Infectious Diseases or a designated prescriber.)

MISCELLANEOUS ANTIBACTERIALS

MISCELLANEOUS ANTIBACTERIALS

MISCELLANEOUS ANTIBACTERIALS

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

ALBERTA DRUG BENEFIT LIST

PRODUCT IS NOT INTERCHANGEABLE

TERBINAFINE HCL

FLUCONAZOLE

250 MG (BASE) ORAL TABLET

50 MG ORAL TABLET

100 MG ORAL TABLET

10 MG / ML ORAL SUSPENSION

2 MG / ML INJECTION

0000225472700002239893000023201340000229427300002353121000023852790000224034600002031116

0000228126000002237370000022452920000223697800002245643

0000228127900002237371000022452930000223697900002245644

00002024152

00000891835

ACT TERBINAFINEAPO-TERBINAFINEAURO-TERBINAFINEPMS-TERBINAFINETERBINAFINETERBINAFINETEVA-TERBINAFINELAMISIL

ACT FLUCONAZOLEAPO-FLUCONAZOLEMYLAN-FLUCONAZOLENOVO-FLUCONAZOLEPMS-FLUCONAZOLE

ACT FLUCONAZOLEAPO-FLUCONAZOLEMYLAN-FLUCONAZOLENOVO-FLUCONAZOLEPMS-FLUCONAZOLE

DIFLUCAN

DIFLUCAN

APHAPXAURPMSSNSSIVTEVNOV

APHAPXMYPTEVPMS

APHAPXMYPTEVPMS

PFI

PFI

ANTI-INFECTIVE AGENTS

ANTI-INFECTIVE AGENTS

ANTIFUNGALS

ANTIFUNGALS

08

08

:00

:00

08:14.04

08:14.08

0.7714 0.7714 0.7714 0.7714 0.7714 0.7714 0.7714 4.2875

1.2904 1.2904 1.2904 1.2904 1.2904

2.2890 2.2890 2.2890 2.2890 2.2890

1.1577

0.5014

18 EFFECTIVE APRIL 1, 2018

$$$$$$$$

$$$$$

$$$$$

$

$

RESTRICTED BENEFIT - This product is a benefit when prescribed by a Specialist in Infectious Diseases or a designated prescriber.

(Refer to Section 3 - Criteria for Special Authorization of Select Drug Products of the Alberta Drug Benefit List for eligibility when the prescriber prescribing the medication is not a Specialist in Infectious Diseases or a designated prescriber.)

(ALLYLAMINES)

(AZOLES)

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

ALBERTA DRUG BENEFIT LIST

ITRACONAZOLE

KETOCONAZOLE

VORICONAZOLE

100 MG ORAL CAPSULE

10 MG / ML ORAL SOLUTION

200 MG ORAL TABLET

50 MG ORAL TABLET

200 MG ORAL TABLET

40 MG / ML ORAL SUSPENSION

200 MG / VIAL INJECTION

0000246255900002047454

00002231347

0000223723500002231061

00002409674000023992450000239686600002256460

00002409682000023992530000239687400002256479

00002279991

00002256487

MINT-ITRACONAZOLESPORANOX

SPORANOX

APO-KETOCONAZOLETEVA-KETOCONAZOLE

APO-VORICONAZOLESANDOZ VORICONAZOLETEVA-VORICONAZOLEVFEND

APO-VORICONAZOLESANDOZ VORICONAZOLETEVA-VORICONAZOLEVFEND

VFEND

VFEND

MPIJAI

JAI

APXTEV

APXSDZTEVPFI

APXSDZTEVPFI

PFI

PFI

ANTI-INFECTIVE AGENTS

ANTIFUNGALS

08:00

08:14.08

4.2075 4.3547

0.8222

0.9393 0.9393

3.1958 3.1958 3.1958

13.0387

12.7777 12.7777 12.7777 52.1332

10.2850

156.2700

19 EFFECTIVE APRIL 1, 2018

UNIT OF ISSUE - REFER TO PRICE POLICY

$$

$

$$

$$$$

$$$$

$

$

RESTRICTED BENEFIT - This product is a benefit when prescribed by a Specialist in Infectious Diseases or a designated prescriber.

(Refer to Section 3 - Criteria for Special Authorization of Select Drug Products of the Alberta Drug Benefit List for eligibility when the prescriber prescribing the medication is not a Specialist in Infectious Diseases or a designated prescriber.)

RESTRICTED BENEFIT - This product is a benefit when prescribed by a Specialist in Infectious Diseases or a designated prescriber.

(Refer to Section 3 - Criteria for Special Authorization of Select Drug Products of the Alberta Drug Benefit List for eligibility when the prescriber prescribing the medication is not a Specialistin Infectious Diseases or a designated prescriber.)

(AZOLES)

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

ALBERTA DRUG BENEFIT LIST

PRODUCT IS NOT INTERCHANGEABLE

CASPOFUNGIN

AMPHOTERICIN B

NYSTATIN

DAPSONE

RIFABUTIN

50 MG / VIAL INJECTION

70 MG / VIAL INJECTION

50 MG / VIAL INJECTION

100,000 UNIT / ML ORAL SUSPENSION

100 MG ORAL TABLET

150 MG ORAL CAPSULE

0000246094700002244265

0000246095500002244266

00000029149

000024334430000079266700002194201

00002041510

00002063786

CASPOFUNGINCANCIDAS

CASPOFUNGINCANCIDAS

FUNGIZONE IV

JAMP-NYSTATINPMS-NYSTATINRATIO-NYSTATIN

DAPSONE

MYCOBUTIN

MDAMFC

MDAMFC

BMS

JPCPMSTEV

NTI

PFI

ANTI-INFECTIVE AGENTS

ANTI-INFECTIVE AGENTS

ANTI-INFECTIVE AGENTS

ANTIFUNGALS

ANTIFUNGALS

ANTIMYCOBACTERIALS

08

08

08

:00

:00

:00

08:14.16

08:14.28

08:16.92

188.7000 222.0000

188.7000 222.0000

78.8333

0.0518 0.0518 0.0518

1.4061

5.3993

20 EFFECTIVE APRIL 1, 2018

$$

$$

$

$$$

$

$

RESTRICTED BENEFIT - This product is a benefit when prescribed by a Specialist in Infectious Diseases or a designated prescriber.

(Refer to Section 3 - Criteria for Special Authorization of Select Drug Products of the Alberta Drug Benefit List for eligibility when the prescriber prescribing the medication is not a Specialistin Infectious Diseases or a designated prescriber.)

RESTRICTED BENEFIT - This product is a benefit when prescribed by a Specialist in Infectious Diseases or a designated prescriber.

(Refer to Section 3 - Criteria for Special Authorization of Select Drug Products of the Alberta Drug Benefit List for eligibility when the prescriber prescribing the medication is not a Specialistin Infectious Diseases or a designated prescriber.)

(ECHINOCANDINS)

(POLYENES)

(MISCELLANEOUS ANTIMYCOBACTERIALS)

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

ALBERTA DRUG BENEFIT LIST

LAMIVUDINE

TENOFOVIR DISOPROXIL FUMARATE

PEGINTERFERON ALFA-2A

ACYCLOVIR

100 MG ORAL TABLET

300 MG (BASE) ORAL TABLET

180 MCG / SYR INJECTION SYRINGE

200 MG ORAL TABLET

400 MG ORAL TABLET

0000239323900002239193

0000245198000002460173000024526340000240388900002247128

00002248077

000022076210000224278400002285959

000022076480000224246300002285967

APO-LAMIVUDINE HBVHEPTOVIR

APO-TENOFOVIRAURO-TENOFOVIRMYLAN-TENOFOVIR DISOPROXILTEVA-TENOFOVIRVIREAD

PEGASYS (0.5 ML SYRINGE)

APO-ACYCLOVIRMYLAN-ACYCLOVIRTEVA-ACYCLOVIR

APO-ACYCLOVIRMYLAN-ACYCLOVIRTEVA-ACYCLOVIR

APXGSK

APXAURMYPTEVGIL

HLR

APXMYPTEV

APXMYPTEV

(NUCLEOSIDE AND NUCLEOTIDE REVERSE TRANSCRIPTASE INHIBITORS)

ANTI-INFECTIVE AGENTS

ANTI-INFECTIVE AGENTS

ANTI-INFECTIVE AGENTS

ANTIVIRALS

ANTIVIRALS

ANTIVIRALS

08

08

08

:00

:00

:00

08:18.08.20

08:18.20

08:18.32

3.5316 4.8390

4.8884 4.8884 4.8884 4.8884

18.4879

413.0900

0.6397 0.6397 0.6397

1.2700 1.2700 1.2700

21 EFFECTIVE APRIL 1, 2018UNIT OF ISSUE - REFER TO PRICE POLICY

$$

$$$$$

$

$$$

$$$

RESTRICTED BENEFIT - This product is a benefit when initiated by a Specialist in Internal Medicine or a designated prescriber.

RESTRICTED BENEFIT - This product is a benefit for the treatment of chronic hepatitis B when prescribed by a Specialist in Internal Medicine or a designated prescriber.

RESTRICTED BENEFIT

This product is a benefit for the treatment of chronic hepatitis B when prescribed by a Specialistin Internal Medicine or a designated prescriber. (For eligibility for the treatment of chronic hepatitis C refer to Criteria for Special Authorization of Select Drug Products of the List and Criteria for Special Authorization of Select Drug Products of the Alberta Human Services Drug Benefit Supplement for Alberta Human Services clients.)

ANTIRETROVIRALS

(INTERFERONS)

(NUCLEOSIDES AND NUCLEOTIDES)

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

ALBERTA DRUG BENEFIT LIST

PRODUCT IS NOT INTERCHANGEABLE

ACYCLOVIR

ADEFOVIR DIPIVOXIL

ENTECAVIR

GANCICLOVIR SODIUM

VALACYCLOVIR

800 MG ORAL TABLET

40 MG / ML ORAL SUSPENSION

10 MG ORAL TABLET

0.5 MG ORAL TABLET

500 MG / VIAL (BASE) INJECTION

500 MG ORAL TABLET

1,000 MG ORAL TABLET

000022076560000224246400002285975

00000886157

0000242033300002247823

00002396955000024487770000243057600002282224

00002162695

000022958220000240504000002331748000024414540000244158600002351579000022984570000234709100002357534000024420000000245464500002219492

000023547050000235156000002381230

APO-ACYCLOVIRMYLAN-ACYCLOVIRTEVA-ACYCLOVIR

ZOVIRAX

APO-ADEFOVIRHEPSERA

APO-ENTECAVIRAURO-ENTECAVIRPMS-ENTECAVIRBARACLUDE

CYTOVENE

APO-VALACYCLOVIR (CAPLET)AURO-VALACYCLOVIRCO VALACYCLOVIRJAMP-VALACYCLOVIRMAR-VALACYCLOVIRMYLAN-VALACYCLOVIR (CAPLET)PMS-VALACYCLOVIR (CAPLET)SANDOZ VALACYCLOVIRTEVA-VALACYCLOVIRVALACYCLOVIRVALACYCLOVIRVALTREX (CAPLET)

APO-VALACYCLOVIR (CAPLET)MYLAN-VALACYCLOVIR (CAPLET)PMS-VALACYCLOVIR (CAPLET)

APXMYPTEV

GSK

APXGIL

APXAURPMSBMS

HLR

APXAURAPHJPCMARMYPPMSSDZTEVSIVSNSGSK

APXMYPPMS

ANTI-INFECTIVE AGENTS

ANTIVIRALS

08:00

08:18.32

1.2673 1.2673 1.2673

0.2595

18.2518 23.8405

5.5000 5.5000 5.5000

22.4620

44.5480

0.6198 0.6198 0.6198 0.6198 0.6198 0.6198 0.6198 0.6198 0.6198 0.6198 0.6198 3.4436

1.7218 1.7218 1.7218

22 EFFECTIVE APRIL 1, 2018

$$$

$

$$

$$$$

$

$$$$$$$$$$$$

$$$

RESTRICTED BENEFIT - This product is a benefit for the treatment of chronic hepatitis B when prescribed by a Specialist in Internal Medicine or a designated prescriber.

RESTRICTED BENEFIT - This product is a benefit for the treatment of chronic hepatitis B when prescribed by a Specialist in Internal Medicine or a designated prescriber.

(NUCLEOSIDES AND NUCLEOTIDES)

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

ALBERTA DRUG BENEFIT LIST

VALGANCICLOVIR HCL

CHLOROQUINE PHOSPHATE

HYDROXYCHLOROQUINE SULFATE

PRIMAQUINE PHOSPHATE

QUININE SULFATE

ATOVAQUONE

450 MG (BASE) ORAL TABLET

50 MG / ML ORAL SUSPENSION

250 MG ORAL TABLET

200 MG ORAL TABLET

15 MG (BASE) ORAL TABLET

200 MG ORAL CAPSULE

300 MG ORAL CAPSULE

150 MG / ML ORAL SUSPENSION

00002393824000024351790000241382500002245777

00002306085

00000021261

00002246691000024249910000225260000002017709

00002017776

000022545140000244519000000021008

000022545220000244520400000021016

00002217422

APO-VALGANCICLOVIRAURO-VALGANCICLOVIRTEVA-VALGANCICLOVIRVALCYTE

VALCYTE

TEVA-CHLOROQUINE

APO-HYDROXYQUINEMINT-HYDROXYCHLOROQUINEMYLAN-HYDROXYCHLOROQUINEPLAQUENIL SULFATE

PRIMAQUINE PHOSPHATE

APO-QUININEJAMP-QUININETEVA-QUININE

APO-QUININEJAMP-QUININETEVA-QUININE

MEPRON

APXAURTEVHLR

HLR

TEV

APXMPIMYPSAV

SAV

APXJPCTEV

APXJPCTEV

GSK

ANTI-INFECTIVE AGENTS

ANTI-INFECTIVE AGENTS

ANTI-INFECTIVE AGENTS

ANTIVIRALS

ANTIPROTOZOALS

ANTIPROTOZOALS

08

08

08

:00

:00

:00

08:18.32

08:30.08

08:30.92

5.8553 5.8553 5.8553

24.3195

2.7020

1.3495

0.2620 0.2620 0.2620 0.6302

0.4326

0.2390 0.2390 0.2390

0.3750 0.3750 0.3750

2.7749

23 EFFECTIVE APRIL 1, 2018UNIT OF ISSUE - REFER TO PRICE POLICY

$$$$

$

$

$$$$

$

$$$

$$$

$

(NUCLEOSIDES AND NUCLEOTIDES)

(ANTIMALARIALS)

(MISCELLANEOUS ANTIPROTOZOALS)

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

ALBERTA DRUG BENEFIT LIST

PRODUCT IS NOT INTERCHANGEABLE

METRONIDAZOLE

FOSFOMYCIN TROMETHAMINE

NITROFURANTOIN

TRIMETHOPRIM

250 MG ORAL TABLET

5 MG / ML INJECTION

3 G (BASE) ORAL POWDER PACKET

50 MG ORAL TABLET

100 MG ORAL TABLET

50 MG ORAL CAPSULE (MACROCRYSTALS)

100 MG ORAL CAPSULE (MACROCRYSTALS)

100 MG ORAL CAPSULE (MACROCRYSTALS/MONOHYDRATE)

100 MG ORAL TABLET

200 MG ORAL TABLET

00000545066

0000087042000000649074

00002240335

00000319511

00000312738

00002231015

00002231016

00002063662

00002243116

00002243117

METRONIDAZOLE

FLAGYLMETRONIDAZOLE

MONUROL

NITROFURANTOIN

NITROFURANTOIN

TEVA-NITROFURANTOIN

TEVA-NITROFURANTOIN

MACROBID

TRIMETHOPRIM

TRIMETHOPRIM

AAP

BAXPFI

PAL

AAP

AAP

TEV

TEV

ASC

AAP

AAP

ANTI-INFECTIVE AGENTS

ANTI-INFECTIVE AGENTS

ANTIPROTOZOALS

URINARY ANTI-INFECTIVES

08

08

:00

:00

08:30.92

08:36

0.0620

0.0269 0.1740

17.7600

0.1739

0.2320

0.3841

0.7761

0.7859

0.2672

0.5491

24 EFFECTIVE APRIL 1, 2018

$

$$

$

$

$

$

$

$

$

$

(MISCELLANEOUS ANTIPROTOZOALS)

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.