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ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
TAC018 ACTAL NA POLYHYDROXYALUMINIUM
MONOCA
1.50 TAB
TAI010 AIR-X CHEWABLE 80mg SIMETHICONE 1.00 TAB
TAX010 AXID 150mg NIZATIDINE 150mg 7.00 TAB
MBA008 BABCON 20mg/mL DIMETHYLPOLYSILOXANE 20mg 0.50 ML
TBU020 BUWECON 0.125mg HYOSCINE/SCOPOLAMINE 0.700 TAB
TCY040 CYTOTEC 200mcg MISOPROSTOL 200mcg 9.00 TAB
TDE040 DENOL COLLOIDAL BISMUTH SUBCITRATE 6.00 TAB
TDE080 DEXILANT
[DEXLANSOPRAZOLE] MR
DEXLANSOPRAZOLE 16.50 CAP
TDE081 DEXILANT
[DEXLANSOPRAZOLE] MR
DEXLANSOPRAZOLE 25.00 CAP
TGA010 GAVISCON ALGINIC ACID, AL HYDROXIDE... 4.10 TAB
MGA010 GAVISCON ADVANCE SODIUM ALGINATE AND POTASSIUM
BICARBONATE
1.00 ML
MGE016 GELUMAG SUSPENSION ALUMINIUM HYDROXIDE GEL 0.00 ML
TGE010 GELUSIL MG TRISILICATE, AL HYDROXIDE 0.60 TAB
TLO041 LOSEC CAP 20mg (GE) OMEPRAZOLE 20mg 10.00 CAP
TLO042 LOSEC MUPS 10mg OMEPRAZOLE 10mg 17.50 TAB
TLO040 LOSEC MUPS 20mg OMEPRAZOLE 20mg 21.20 TAB
TMA010 MAALOX PLUS AL & MG HYDROXIDE,
SIMETHICONE
0.70 TAB
MMA010 MAALOX SUSPENSION
(GE)
AL HYDROXIDE, DIMETHICONE 0.17 ML
TMI036 MILID 200mg PROGLUMIDE 200mg 2.00 TAB
TMU010 MUCAINE (GE) ALUMINA, MGCO3, OXETHAZINE 0.60 TAB
MMU010 MUCAINE SUSPENSION
(GE)
OXETHAZAINE, AL HYDROXIDE... 0.18 ML
TMY020 MYLANTA (GE) AL & MG HYDROXIDE,
DIMETHICONE
0.60 TAB
MMY020 MYLANTA SUSPENSION
(GE)
AL HYDROXIDE, MG HYDROXIDE... 0.22 ML
TNE050 NEXIUM 20mg ESOMEPRAZOLE 20mg 22.90 TAB
TNE052 NEXIUM 40mg ESOMEPRAZOLE 40mg 32.60 TAB
MNE010 NEXIUM GRANULES 10mg ESOMEPRAZOLE 22.70 SACH
TPA044 PANTOLOC 20mg PANTOPRAZOLE SODIUM 20mg 15.50 TAB
TPA045
PANTALOC 20mg (GE) -
[PANTOPRAZOLE] PANTOPRAZOLE 10.60 TAB
TPA046 PANTOLOC 40mg PANTOPRAZOLE SODIUM 40mg 22.90 TAB
TPA047
PANTALOC 40mg (GE) -
[PANTOPRAZOLE] PANTOPRAZOLE 15.50
TAB
TPA055 GLUCOPHAGE RABEPRAZOLE SODIUM 10mg 8.30 TAB
TPA056 PARIET 20mg RABEPRAZOLE SODIUM 20mg 11.00 TAB
CPA094 PEPCIDINE 20mg FAMOTIDINE 6.00 TAB
TPE040 PEPCIDINE 20mg (GE) FAMOTIDINE 2.40 TAB
CPA098 PEPCIDINE 40mg FAMOTIDINE 10.00 TAB
TPY008 PYLORID 400mg RANITIDINE BISMUTH CITRATE
400mg
15.00 TAB
MSU020
SUCRATE GEL 1G/5mL
SACHETS SUCRALFATE 5.00 SACH
TTA010 TAGAMET 200mg (GE) CIMETIDINE 200mg 2.00 TAB
TTA012 TAGAMET 400mg (GE) CIMETIDINE 400mg 4.00 TAB
TTA020 TAKEPRON 30mg LANSOPRAZOLE 30mg 22.00 CAP
TTA021 TAKEPRON OD 30mg LANSOPRAZOLE 30mg 25.10 TAB
CPA109 TAKEPRON OD 15mg LANSOPRAZOLE 15mg 9.00 TAB
TUL010 ULSANIC 500 mg SUCRALFATE 500mg 2.00 TAB
TUL012 ULSANIC 500mg (GE) SUCRALFATE 500mg 1.40 TAB
MUL010 ULSANIC GRANULES 1g SUCRALFATE 1g 3.70 SACH
IZA010 ZANTAC [ranitidine]
25mg/mL INJ
RANTIDINE 46.40 AMP
TZA030 ZANTAC 150 mg RANITIDINE HCL 150mg 7.60 TAB
TZA032 ZANTAC 300 mg RANITIDINE HCL 300mg 17.80 TAB
TZA034
ZANTAC 150mg (GE)-
[RANITIDINE] RANITIDINE HCL 150mg 4.50 TAB
CPA041 ZANTAC SYRUP RANITIDINE HCL 0.85 ML
TAS010 ASACOL 400mg MESALAZINE 400mg 5.90 TAB
PAS010 ASACOL SUPP 500mg MESALAZINE 20.00 SUPP
TCE052 CEREKINON 100mg TRIMEBUTINE MALEATE 2.00 TAB
TCH010 CHARCOAL 300mg CHARCOAL 300mg 0.60 TAB
TCH012 CHARCOAL 200mg CHARCOAL 200mg 0.800 TAB
TDI102 DIPENTUM 250mg OLSALAZINE SODIUM 250mg 4.50 TAB
TDI106 DISFLATYL 40mg DIMETHICONE/SILICON DIOXIDE 1.90 TAB
TEU020 ENTOCORT 3mg BUDESONIDE 3mg 27.40 CAP
PEN010 ENTOCORT ENEMA
2mg/100mL
BUDESONIDE 200.00 TUB
TGA008 GASTEEL
DIMETHYLPOLYSILOXANE,
ALUMINIUM HYDROXIDE 1.50 TAB
MGA004 GASCON DROP 20mg/mL
300mL
DIMETHYLPOLYSILOXANE 2.00 ML
TMA022 MAGESTO PRECIPITATED CA CARBONATE
200mg/MYLASE 37.5mg/NA
0.60 TAB
CPA097 MOTILIUM 10mg DOMPERIDONE 4.00 TAB
TMO040 MOTILIUM 10mg (GE) DOMPERIDONE 1.70 TAB
PMO010 MOTILIUM SUPP 10mg (GE) DOMPERIDONE 6.00 SUPP
PMO012 MOTILIUM SUPP 30mg (GE) DOMPERIDONE 9.50 SUPP
MMO010 MOTILIUM SYRUP 1mg/mL DOMPERIDONE 1mg 1.80 ML
TMY030 MYLICON (GASTEEL) DIMETHICONE 40mg 1.00 TAB
TPE030 PENTASA 500mg MESALAZINE 500mg 7.80 TAB
PPE010 PENTASA SUPP 1g MESALAZINE 26.00 SUPP
MPE016
PENTASA SACHET 2g
(60's/BOX) MESALAZINE 2g 37.00 SACH
MPE017 PENTASA SCAHET 1g MESALAZINE 1g 18.50 SACH
TPR060 PREPULSID 5mg CISAPRIDE 5mg 3.00 TAB
TPR062 PREPULSID 10mg CISAPRIDE 10mg 5.30 TAB
TSA030 SALOFALK 250mg MESALAZINE 250mg 13.00 TAB
TSA032 SALOFALK 500mg MESALAZINE 500mg 15.00 CAP
PSA010 SALOFALK SUPP 250mg MESALAZINE, 5-AMINOSAL. ACID 55.00 SUPP
ANTACIDS & ANTIULCERANTS
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
Disclaimer: Please note that this list is not exhaustive and contains certain drugs that may not be covered under the Cathay Pacific
Medical Scheme, e.g. drugs use for psychological conditions, drugs use for management of fertility and contraception. Should you
prescribe item that is not included here or have any queries, please call the CPA Provider Hotline at 2851-3870 or email
GIT REGULATORS,ANTIFLATULENTS & ANTI-INFLAMMATORIS
Page 1 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
PSA012 SALOFALK SUPP 500mg MESALAZINE, 5-AMINOSAL. ACID 80.00 SUPP
MSA008
SALOFALK GRANULES
500mg MESALAZINE 500mg 13.00 SACH
MSA010 SALOFALK GRANULES 1G MESALAZINE 1G 26.60 SACH
TST036 STROCAIN
POLYMIGEL 244mg, OXETHAZAINE
5mg 0.95 TAB
TBU010 BUSCOPAN 10mg (GE) HYOSCINE-N-BUTYLBROMIDE 10mg 0.80 TAB
IBU010 BUSCOPAN INJ 20mg/mL HYOSCINE BUTYLBROMIDE 38.00 AMP
IBU012 BUSCOPAN INJ 20mg/mL
10mL
HYOSCINE BUTYLBROMIDE 20.00 ML
MBU010 BUSCOPAN LIQUID
1mg/mL (GE)
HYOSCINE-N-BUTYLBROMIDE 0.40 ML
TDA040 DARICON 5mg OXYPHENCYCLIMINE HCL 5mg 1.10 TAB
MDO010 DONNATAL SYRUP PHENOBARBITONE, HYOSCYAMINE.. 0.27 ML
TDU020 DUSPATALIN 135 mg MEBEVERINE HCL 135mg 5.00 TAB
TDU021 DUSPATALIN RETARD
200mg
MEBEVERINE HCL 200mg 6.80 CAP
THO010 HOLOPON 1mg (GE) SCOPOLAMINE METHYLBROMIDE
1mg
1.10 TAB
MIN010 INFACOL SUSPENSION
(GE)
DIMETHICONE 0.26 ML
MIN012 INFACOL WIND DROPS DIMETHICONE 2.30 ML
TLE016 LEVSIN SL 125mcg HYOSCYAMINE SULFATE 125mcg 2.70 TAB
TLI010 LIBRAX (GE) CHLORDIAZEPOXIDE, CLIDINIUM 1.50 TAB
TLI020 LIBRIUM 5mg (GE) CHLORDIAZEPOXIDE 1.00 TAB
TPR084 PROBANTHINE 15mg (GE) PROPANTHELINE BROMIDE 15mg 0.60 TAB
TSP012 SPASMOMEN 40mg OTILONIUM BROMIDE 4.40 TAB
TSP010 SPASMONAL 60mg (GE) ALVERINE CITRATE 2.20 TAB
CPA096 SPASMONAL CAP 60MG ALVERINE CITRATE 4.00 CAP
TUR020 URISPAS 100mg FLAVOXATE HCL 100mg 1.50 TAB
TUR022 URISPAS 200mg FLAVOXATE HCL 200mg 2.70 TAB
TZE007 ZELMAC 6mg TEGASEROD 6mg 8.00 TAB
TAN020 ANTIDIA 200mg NIFUROXAZIDE 200mg 0.80 CAP
TER020 ERCEFURYL 200mg (GE) NIFUROXAZIDE 200mg 0.65 CAP
MHI010
HIDRASEC 10mg SACHET
(INFANTS) RACECADOTRIL 4.00 SACH
MHI012
HIDRASEC 30mg SACHET
(CHILDREN) RACECADOTRIL 6.00 SACH
TIM028 IMODIUM 2mg LOPERAMIDE HCL 2mg 7.00 CAP
TIM030 IMODIUM 2mg (G.E.) LOPERAMIDE HCL 2mg 1.90 TAB
MIM012 IMODIUM DROPS 2mg/mL
(GE)
LOPERAMIDE HCL 1.00 ML
MIM010 IMODIUM SYRUP 2mg/5mL
(GE)
LOPERAMIDE HCL 1.00 ML
MKA010 KAOPECTATE (GE) LIGHT KAOLIN, PECTIN 0.18 ML
TLO010 LOMOTIL DIPHENOXYLATE HCL, ATROPINE 1.00 TAB
TLO011 LOMOTIL (GE) DIPHENOXYLATE HCL, ATROPINE 0.70 TAB
MLO010 LOMOTIL SYRUP
2.5mg/5mL (GE)
DIPHENOXYLATE, ATROPINE 0.28 ML
MSM010 SMECTA 3g DIOCTAHEDRAL SMECTITE 4.40 SACH
MAG008 AGAROL SUSPENSION LIQUID PARAFFIN 0.20 ML
MAG010 AGAROL SUSPENSION
(GE)
LIQUID PARAFFIN 0.17 ML
MAG015 AGIOCUR GRANULES 250g PLANTAGO SEED, ISPAGHULA
HUSKS
130.00 BOT
MAG020 AGIOLAX 100g PLANTAGO SEED, SENNA PODS... 0.60 g
PBA012 BANDI-ENEMA ADULT GLYCERIN, MG SULFATE, NACL 3.00 TUB
PBA010 BANDI-ENEMA PAED GLYCERIN, MG SULFATE, NACL 2.50 TUB
MBI008 BISACODYL IN
POLYETHYLENE LIQUID
BISACODYL, POLYETHYLENE
GLYCOL
0.25 ML
TDO006 DOCUSATE SODIUM 100mg DOCUSATE Na 1.80 CAP
TDU010 DULCOLAX 5mg (GE) BISACODYL 5mg 0.80 TAB
PDU010 DULCOLAX SUPP 10mg
(GE)
BISACODYL 4.60 SUPP
MDU010 DUPHALAC SYRUP
10g/15mL
LACTULOSE 0.45 ML
PFL020 FLEET ENEMA NA BIPHOSPHATE, NA PHOSPHATE 25.00 BOT
PFL010 FLEET ENEMA
(CHILDREN)
NA BIPHOSPHATE, NA PHOSPHATE 26.00 BOT
MFL006 FLEET PHOSPHO-SODA MONOBASIC Na
PHOSPHATE/DIBASIC
0.80 ML
MF0010 FORLAX MACROGOL 4000 4.70 SACH
MFY010 FYBOGEL ISPAGHULA HUSK 4.00 SACH
PGL010 GLYCERINE SUPP
(ADULT) (GE)
GLYCERIN 6.00 SUPP
PGL012 GLYCERINE SUPP (PAED)
(GE)
GLYCERIN 4.20 SUPP
MKL020 KLEAN-PREP POLYETHYLENE
GLYCOL,KCL,NA2CO3
27.00 SACH
MME010 METAMUCIL POWDER
100g
PSYLLIUM HYDROPHILIC
MUCILLOID
0.40 g
MME012 METAMUCIL POWDER
336g
PSYLLIUM HYDROPHILIC
MUCILLOID
0.45 g
MME013 METAMUCIL POWDER
504g
PSYLLIUM HYDROPHILIC
MUCILLOID
0.60 g
MME015 METAMUCIL POWDER
528g (ORANGE)
PSYLLIUM HYDROPHILIC
MUCILLOID
0.55 g
MME014 METAMUCIL POWDER 6g PSYLLIUM HYDROPHILIC
MUCILLOID
4.00 SACH
PMI010 MICROLAX ENEMA NA CITRATE+LAURYL
SULFOACETATE
10.50 BOT
MMU040 MUCOFALK ORANGE 5g ISPAGHULA HUSK 5g 5.70 SACH
MNA010 NATURLAX POWDER 368g PSYLLIUM HYDROPHILIC
MUCILLOID
0.40 g
MNO010 NORMACOL STERCULIA 62% 9.20 SACH
MNO020 NORMACOL PLUS STERCULIA 62%, FRANGULA 8% 9.20 SACH
MPA020 PARAFFIN LIQUID (GE) PARAFFIN LIQUID 0.30 ML
MPE005 PEGLYTE POWDER POLYETHYLENE GLYCOL,
ELECTROLYTES
45.00 SACH
MPH040 PHOSPHATE SOLUTION
45mL
SODIUM PHOSPHATE 0.40 ML
MPI006 PICOLAX ORAL SOLUTION
NA PICOSULFATE 10mg,MG OXIDE
3.5g//CITRIC ACID 12g 56.00 SACH
MPI008 PICOLAX POWDER 10mg SODIUM PICOSULFATE 40.00 SACH
TSE030 SENOKOT SENNOSIDES B 7.5mg 0.70 TAB
PSA008 SALOFALK ENEMAS
4G/60mL
MESALAZINE, 5-AMINOSAL. ACID 280.00 PC
TCO054 COMBIZYM
PANCREATIN, ENZYME
CONCENTRATE 2.10 TAB
TCR010 CREON PANCREATIN/AMYLASE/LIPASE/PRO
T
4.70 CAP
TEN030 ENZYPLEX AMYLASE,PROTEASE,LIPASE... 1.30 TAB
TPA040 PANKREOFLAT PANCREATIN, SIMETHICONE 2.20 TAB
TBI008 BILSAN CHOLINE, DEHYDROCHOLIC ACID,
INOSITOL…
1.90 TAB
CHOLAGOGUES, CHOLELITHOLYTICS & HEPATIC PROTECTORS
DIGESTIVES
ANTIDIARRHEALS
LAXATIVES, PURGATIVES
ANTISPASMODICS
Page 2 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
TCH020 CHENOFALK 250mg CHENODEOXYCHOLIC ACID 250mg 11.60 CAP
TLE006 LEGALON 35mg SILYMARIN 35mg 3.30 TAB
TLE008 LEGALON 70mg SILYMARIN 70mg 4.40 TAB
CPA088 LEGALON 140mg SILYMARIN 140mg 5.00 TAB
TUR028 URSOFALK 250mg URSODEOXYCHOLIC ACID 16.00 CAP
TUR029
URSOFALK 250mg (GE)-
[URSODEOXYCHOLIC] URSODEOXYCHOLIC ACID 10.50 CAP
TUR030 URSOLVAN 200mg URSODEOXYCHOLIC ACID 200mg 6.00 TAB
IAD012 ADRENALINE INJ 1:10,000
10mL
ADRENALINE 70.00 AMP
TCO070 CORDARONE 200 mg AMIODARONE HCL 200mg 8.80 TAB
ICO015 CORDARONE INJ
150mg/3mL (GE)
AMIODARONE HCL 150mg 85.00 AMP
IDI010 DIGOXIN INJ 0.5mg/2mL DIGOXIN 120.00 AMP
TKI010 KINIDIN DURULE 200mg QUINIDINE BISULFATE 200mg 3.80 TAB
TLA040 LANITOP 0.1mg METILDIGOXIN 0.1mg 1.50 TAB
TLA050 LANOXIN PG 0.0625mg DIGOXIN 0.0625mg 1.20 TAB
TLA052 LANOXIN 0.25mg DIGOXIN 0.25mg 1.70 TAB
TMU035 MULTAQ FILM-COATED
400 mg
DRONEDARONE HC1 17.50 TAB
TNO060 NORPACE 100mg DISOPYRAMIDE PHOSPHATE 100mg 4.40 CAP
TNO070 NORPACE RETARD 150mg DISOPYRAMIDE PHOSPHATE 150mg 5.00 TAB
TRY010 RYTMONORM 150mg PROPAFENONE HCL 150mg 11.00 TAB
TRY012
RYTMONORM
<propafenone> 150mg [APO- PROPAFENONE 11.000 TAB
TSL020 SLOW K 600mg POTASSIUM CHLORIDE 600mg 1.50 TAB
TSL030 SLOW K 600mg (GE) POTASSIUM CHLORIDE 600mg 0.90 TAB
TTA022 TAMBOCOR 100mg FLECAINIDE ACETATE 100mg 17.00 TAB
IXY030 XYLOCARD INJ 100mg/5mL LIDOCAINE HCl 150.00 AMP
TCO069 CORALAN 5mg IVABRADINE 11.00 TAB
TEL010 ELANTAN 20mg ISOSORBIDE MONONITRATE 20mg 7.00 TAB
TIM010 IMDUR 60mg ISOSORBIDE-5-MONONITRATE 60mg 7.10 TAB
TIS008 ISO MACK RETARD 40mg ISOSORBIDE DINITRATE 40mg 2.50 TAB
SIS010 ISOMACK SPRAY ISOSORBIDE DINITRATE 130.00 BOT
TIS040 ISORDIL 10mg ISOSORBIDE DINITRATE 10mg 1.00 TAB
TIS050 ISORDIL SUBLINGUAL 5mg ISOSORBIDE DINITRATE 1.20 TAB
TIS060 ISORDIL TEMBIDS 40mg
(GE)
ISOSORBIDE DINITRATE 40mg 2.00 TAB
CPA150 LOMAKLINE 5 mg AMLODIPINE BESILATE 7.00 TAB
CPA151 LOMAKLINE 10 mg AMLODIPINE BESILATE 7.00 TAB
ANI020 NITRODERM TTS-10 50mg NITROGLYCERIN 30.00 PC
TNI030 NITRODISC 5mg NITROGLYCERIN 14.30 DISC
SNI010 NITROLINGUAL SPRAY
0.4mg
NITROGLYCERIN 0.4mg 220.00 PC
TNI040 NITROSTAT 500mcg
(ANGISED)
GLYCERYL TRINITRATE 500mcg 1.90 TAB
TPE070 PERSANTIN 25mg (GE) DIPYRIDAMOLE 25mg 0.80 TAB
TPE073 PERSANTIN 75mg DIPYRIDAMOLE 75mg 2.70 TAB
TPE072 PERSANTIN 75mg (GE) DIPYRIDAMOLE 75mg 2.00 TAB
TPE074 PERSANTIN PLUS DIPYRIDAMOLE/ACETYSALICYLIC
ACID
3.50 CAP
TVA030 VASTAREL 20mg TRIMETAZIDINE DIHCL 20mg 5.30 TAB
TVA032 VASTAREL MR TRIMETAZIDINE
DIHYDROCHLORIDE 35mg
9.00 TAB
TIS042 ISORDIL 10mg (GE) ISOSORBIDE DINITRATE 10mg 0.60 TAB
TCO101 COZAAR <Losartan> 50mg
(GE)
LOSARTAN 50mg 7.50 TAB
TCO111 COZAAR 100mg (GE)-[LOSARTAN]LOSARTAN 100mg 8.50 TAB
TCO112 COZAAR [Losartan] 100mg [LOSACOR] LOSARTAN 1.26 TAB
THY023 HYZAAR (GE) LOSARTAN,
HYDROCHLOROTHIAZIDE
8.50 TAB
THY024 HYZAAR [LOSACOR HCT
50 mg-12.5mg]
HYDROCHLOROTHIAZIDE ,
LOSARTAN POTASSIUM
9.90 TAB
TMI007 MICARDIS PLUS 80mg TELMISARTAN/HYDROCHLOROTHIA
ZIDE 12.5mg
16.00 TAB
TOL029 OLMETEC 40mg OLMESARTAN MEDOXOMIL 40mg 13.70 TAB
TOL030 OLMETEC 20mg OLMESARTAN MEDOXOMIL 11.70 TAB
TOL031 OLMETEC 10mg OLMESARTAN 9.00 TAB
TOL032
OLMETEC PLUS
20mg/12.5mg
OLMESARTAN,
HYDROCHLOROTHIAZIDE 11.00 TAB
TAC008 ACCUPRIL 10mg QUINAPRIL HCL 10mg 7.00 TAB
TAC007 ACCUPRIL 20mg QUINAPRIL HCL 20mg 10.00 TAB
TAC006 ACCUPRIL 5mg QUINAPRIL HCL 5mg 4.60 TAB
TAC012 ACERTIL 2mg PERINDOPRIL 2mg 3.80 TAB
TAC010 ACERTIL 4mg PERINDOPRIL 4mg 6.70 TAB
CPA081 ACERTIL PLUS FILM-
COATED 5mg
PERINDOPRIL ARGININE 4.50 TAB
TAC011 ACERTIL AR 5mg PERINDOPRIL ARGININE 7.50 TAB
TAL018 ALDOMET 125mg (GE) METHYLDOPA 125mg 1.10 TAB
TAL020 ALDOMET 250mg (GE) METHYLDOPA 250mg 1.60 TAB
TAP010 APRESOLINE 10mg HYDRALAZINE HCL 10mg 1.50 TAB
TAP012 APRESOLINE 25mg HYDRALAZINE HCL 25mg 2.00 TAB
TAP020 APRESOLINE 50mg (GE) HYDRALAZINE HCL 50mg 2.00 TAB
TAP040 APROVEL 150mg IRBESARTAN 150mg 8.50 TAB
TAP042 APROVEL 300mg IRBESARTAN 300mg 14.00 TAB
TBL023 BLOPRESS Plus16mg CANDESARTAN CILEXETIL 16mg 16.00 TAB
TBL021 BLOPRESS Plus 8mg CANDESARTAN CILEXETIL 8mg 9.60 TAB
TBL022 BLOPRESS 16mg CANDESARTAN CILEXETIL 16mg 16.00 TAB
TBL020 BLOPRESS 8mg CANDESARTAN CILEXETIL 8mg 9.60 TAB
TCA050 CAPOTEN 12.5mg CAPTOPRIL 12.5mg 2.60 TAB
TCA052 CAPOTEN 25mg (GE) CAPTOPRIL 25mg 2.00 TAB
TCA056 CAPOTEN 50mg CAPTOPRIL 50mg 7.70 TAB
TCA054 CAPOTEN 50mg (GE) CAPTOPRIL 50mg 3.50 TAB
TCA060 CARDURA 1mg DOXAZOSIN MESYLATE 1mg 6.40 TAB
TCA062 CARDURA 2mg DOXAZOSIN MESYLATE 2mg 10.30 TAB
TCA064 CARDURA XL 4mg DOXAZOSIN MESYLATE 4mg 8.90 TAB
ANGIOTENSIN II ANTAGONIST
ANTI-ANGINAL DRUGS
CARDIAC DRUGS
ANTIHYPERTENSIVE DRUGS
Page 3 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
TCA066 CARDURA XL 8mg DOXAZOSIN MESYLATE 8mg 11.80 TAB
ICA030 CATAPRES INJ 150mcg/mL CLONIDINE HCL 50.00 AMP
TAP043 CO-APROVEL
150mg/12.5mg
IRBESARTAN
150mg/HYDROCHLOROTHIAZIDE
8.50 TAB
TAP044 CO-APROVEL
300mg/12.5mg
IRBESARTAN
300mg/HYDROCHLOROTHIAZIDE
14.00 TAB
CPA125 CO-APROVEL 300/25 mg tab 300mg/25mg IRBESARTAN 300mg /
HCTZ 25mg
14.00 TAB
TCO015 CO-DIOVAN 160mg/12.5mg VALSARTAN
160mg/HYDROCHLOROTHIAZIDE
15.00 TAB
TCO016 CO-DIOVAN 80mg/12.5mg (GE)-[VALSARTAN + HCT]VALSARTAN, HYDROCHLOROTHIAZIDE 7.00 TAB
TCO017 CO-DIOVAN 160mg/12.5mg (GE)-[VALSARTAN + HCT]VALSARTAN, HYDROCHLOROTHIAZIDE 10.00 TAB
TCO013 CO-DIOVAN 80mg/12.5mg VALSARTAN
80mg/HYDROCHLOROTHIAZIDE
10.70 TAB
TRE018 CO-RENITEC ENALAPRIL
20mg/HYDROCHLOROTHIAZIDE
8.50 TAB
TCO110 COZAAR 100mg LOSARTAN POTASSIUM 100mg 10.00 TAB
TCO100 COZAAR 50mg LOSARTAN POTASSIUM 50mg 9.90 TAB
TDI050 DIBENYLINE 10mg PHENOXYBENZAMINE 10mg 8.00 CAP
TDI101 DIOVAN 160mg VALSARTAN 160mg 15.00 TAB
TDI103 DIOVAN 80mg (GE)-[VALSARTAN]VALSARTAN 6.50 TAB
TDI104 DIOVAN 160mg (GE)-[VALSARTAN]VALSARTAN 9.50 TAB
TDI100 DIOVAN 80mg VALSARTAN 80mg 10.70 CAP
TDI099 DIOVAN 320mg VALSARTAN 20.00 TAB
TDY020 DYNACIRC 2.5mg ISRADIPINE 2.5mg 3.50 TAB
THY020 HYZAAR LOSARTAN
50mg/HYDROCHLOROTHIAZIDE
9.90 TAB
THY022 HYZAAR FORTE LOSARTAN
100mg/HYDROCHLOROTHIAZIDE 25
11.50 TAB
THY021 HYZAAR PLUS LOSARTAN,
HYDROCHLOROTHIAZIDE
10.00 TAB
TIN060 INHIBACE 2.5mg CLIAZAPRIL 2.5mg 4.40 TAB
TMI005 MICARDIS 40mg TELMISARTAN 40mg 10.60 TAB
TMI006 MICARDIS 80mg TELMISARTAN 80mg 16.80 TAB
TMI004 MICARDIS PLUS
40mg/12.5mg
TELMISARTAN
40mg/HYDROCHLOROTHIAZIDE
10.00 TAB
TMI050 MINIPRESS 1mg (GE) PRAZOSIN HCL 1mg 1.50 TAB
TMI052 MINIPRESS 2mg (GE) PRAZOSIN HCL 2mg 2.00 TAB
TMI054 MINIPRESS 5mg PRAZOSIN HCL 5mg 8.60 TAB
TMI053 MINIPRESS 5mg (GE) PRAZOSIN HCL 5mg 5.00 TAB
TMO030 MONOPRIL 10mg FOSINOPRIL SODIUM 10mg 4.50 TAB
TNA020 NATRILIX 2.5mg (GE) INDAPAMIDE 2.5mg 2.00 TAB
TNA021 NATRILIX SR 1.5mg INDAPAMIDE 1.5mg 5.20 TAB
TNI026 NIFTEN ATENOLOL 50mg/NIFEDIPINE SR
20mg
11.90 CAP
TPR026 PREDONIUM PERINDOPRIL 2mg/INDAPAMIDE
0.625mg
5.00 TAB
TPR082 PRINIVIL 5mg LISINOPRIL 5mg 3.50 TAB
TRA005 RASILEZ 150mg ALISKIREN 150mg 16.00 TAB
TRA006 RASILEZ 300mg ALISKIREN 300mg 20.00 TAB
TRA007 RASILEZ HCT ALISKIREN 150mg, HCT 12.5mg 16.000 TAB
TRA008 RASILEZ HCT ALISKIREN 300mg, HCT 12.5mg 20.000 TAB
TRE020 RENITEC 10mg ENALAPRIL MALEATE 10mg 5.30 TAB
TRE021 RENITEC 10mg (GE) ENALAPRIL MALEATE 10mg 3.20 TAB
TRE026 RENITEC 2.5mg ENALAPRIL MALEATE 2.5mg 3.00 TAB
TRE022 RENITEC 20mg ENALAPRIL MALEATE 20mg 7.00 TAB
TRE023 RENITEC 20mg (GE) ENALAPRIL MALEATE 20mg 4.20 TAB
TRE024 RENITEC 5mg ENALAPRIL MALEATE 5mg 3.70 TAB
TRE025 RENITEC 5mg (GE) ENALAPRIL MALEATE 5mg 2.10 TAB
TTA025 TANATRIL 10mg IMIDAPRIL 10mg 4.00 TAB
TTA060 TARKA VERAPAMIL,TRANDOLAPRIL 7.20 CAP
TTE030 TENORET 50mg ATENOLOL 50mg/CHLORTHALIDONE
12.5mg
7.50 TAB
TTE040 TENORETIC ATENOLOL
100mg/CHLORTHALIDONE 25mg
10.90 TAB
TTE042 TENORETIC (GE) ATENOLOL
100mg/CHLORTHALIDONE 25mg
5.00 TAB
TTE080 TEVETEN 600mg EPROSARTAN 600mg 15.00 TAB
TTR010 TRANDATE 100mg LABETALOL HCL 100mg 7.00 TAB
TTR068 TRITACE 2.5mg RAMIPRIL 2.5mg 2.40 TAB
TTR070 TRITACE 5mg RAMIPRIL 5mg 3.50 TAB
TZE010 ZESTORETIC LISINOPRIL
20mg/HYDROCHLOROTHIAZIDE
11.30 TAB
TZE020 ZESTRIL 10mg LISINOPRIL DIHYDRATE 10mg 7.20 TAB
TZE021 ZESTRIL 10mg (GE) LISINOPRIL DIHYDRATE 10mg 3.50 TAB
TZE022 ZESTRIL 20mg LISINOPRIL DIHYDRATE 20mg 9.90 TAB
TZE023 ZESTRIL 20mg (GE) LISINOPRIL DIHYDRATE 20mg 5.00 TAB
TZE024 ZESTRIL 5mg LISINOPRIL DIHYDRATE 5mg 4.30 TAB
TZE025 ZESTRIL 5mg (GE) LISINOPRIL DIHYDRATE 5mg 2.00 TAB
DAZ006 AZARGA EYE DROPS BRINZOLAMIDE 10mg,TIMOLOL 5mg 230 BOT
DTA004 TAFLOTAN EYE DROPS
2.5mL
TAFLUPROST 250 BOT
DGA008 GANFORT EYE DROPS BIMATOPROST,TIMOLOL 320.00 BOT
TBE028 BETALOC 100mg METOPROLOL 100mg 6.20 TAB
TBE033 BETALOC 50mg METOPROLOL TARTRATE 50mg 3.70 TAB
TBE032 BETALOC 50mg (GE) METOPROLOL TARTRATE 50mg 1.50 TAB
TBE030 BETALOC 100mg (GE) METOPROLOL TARTRATE 100mg 2.90 TAB
TBE040 BETALOC DURULE 200mg METOPROLOL TARTRATE 200mg 5.50 TAB
TBE046 BETALOC ZOK 25mg METOPROLOL SUCCINATE 25mg 3.80 TAB
TBE048 BETALOC ZOK 50mg METOPROLOL SUCCINATE 50mg 3.70 TAB
TBE049 BETALOC ZOK 50mg (GE) METOPROLOL SUCCINATE 50mg 2.00 TAB
TBE050 BETALOC ZOK 100mg METOPROLOL SUCCINATE 100mg 5.90 TAB
TBE052 BETALOC ZOK 200mg METOPROLOL SUCCINATE 200mg 12.50 TAB
TBE034 BETALOC COMP 100mg METOPROLOL
100mg/HYDROCHLORTHIAZIDE
12.5mg
5.40 TAB
IBE012 BETALOC INJ 1mg/Ml METOPROLOL SUCCINATE 401.30 AMP
TBL010 BLOCADREN 10mg TIMOLOL MALEATE 10mg 3.50 TAB
TCO062 CONCOR 2.5mg BISOPROLOL FUMARATE 2.5mg 3.50 TAB
TCO060 CONCOR 5mg BISOPROLOL FUMARATE 5mg 4.00 TAB
ANTIGLAUCOMA PREPARATION
BETA-BLOCKERS
Page 4 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
TCO080 CORGARD 80mg NADOLOL 80mg 5.00 TAB
TDI075 DILATREND 6.25mg CARVEDILOL 6.25mg 4.00 TAB
TDI076 DILATREND 12.5mg CARVEDILOL 12.5mg 5.10 TAB
TDI077 DILATREND 25mg CARVEDILOL 25mg 5.60 TAB
TIN020 INDERAL 10mg (GE) PROPRANOLOL HCL 10mg 1.00 TAB
CPA148 INDERAL TABLET 10mg PROPRANOLOL HYDROCHLORIDE 1.50 TAB
CPA124 INDERAL 20mg (GE) PROPRANOLOL HCL 20mg 1.30 TAB
TIN022 INDERAL 40mg (GE) PROPRANOLOL HCL 40mg 1.50 TAB
TIN030 INDERAL LA 80mg PROPRANOLOL HCL 80mg 4.50 CAP
TIN032 INDERAL LA 160 mg PROPRANOLOL HCL 160mg 6.70 CAP
IIN010 INDERAL INJ 1mg/mL PROPRANOLOL HCL 80.00 AMP
TLO013 LOGIMAX FELODIPINE 5mg,METOPROLOL 50mg 21.50 TAB
TLO006 LODOZ 2.5mg/6.25mg BISOPROLOL
FUMARATE/HYDROCHLOROTHIAZID
3.30 TAB
TLO007 LODOZ 5mg/6.25mg BISOPROLOL
FUMARATE/HYDROCHLOROTHIAZID
3.30 TAB
TSE010 SECTRAL 100mg ACEBUTOLOL HCL 100mg 2.35 CAP
TSE012 SECTRAL 200mg ACEBUTOLOL HCL 200mg 4.16 CAP
TSE018 SELECTOL 200mg CELIPROLOL HCL 200mg 6.00 TAB
TSO020 SOTACOR 80mg SOTALOL HCL 80mg 5.00 TAB
TSO022
SOTACOR 80mg (GE)-
[SOTALOL] SOTALOL 2.50 TAB
TTE055 TENORMIN 25mg (GE) ATENOLOL 25mg 2.00 TAB
TTE052 TENORMIN 50mg ATENOLOL 50mg 3.00 TAB
TTE054 TENORMIN 50mg (GE) ATENOLOL 50mg 2.00 TAB
TTE050 TENORMIN 100mg ATENOLOL 100mg 4.00 TAB
TTE056 TENORMIN 100mg (GE) ATENOLOL 100mg 2.80 TAB
TAC013 ACERYCAL 5mg/5mg PERINDOPRIL 5mg, AMLODIPINE 5mg 9 TAB
TAC014 ACERYCAL 5mg/10mg PERINDOPRIL 5mg, AMLODIPINE
10mg
12.5 TAB
TAC016 ACERYCAL 10mg/10mg PERINDOPRIL, AMLODIPINE 14.3 TAB
TAC017 ACERYCAL 10mg/5mg PERINDOPRIL, AMLODIPINE 12.5 TAB
TAD012 ADALAT 5mg (GE) NIFEDIPINE 5mg 2.00 CAP
TAD010 ADALAT 10mg (GE) NIFEDIPINE 10mg 3.00 CAP
TAD020 ADALAT GITS 30mg NIFEDIPINE 30mg 10.80 TAB
TAD021 ADALAT GITS 30mg (GE) NIFEDIPINE 30mg 5.50 TAB
TAD022 ADALAT GITS 60mg NIFEDIPINE 60mg 15.90 TAB
TAD028 ADALAT RETARD TAB
20MG
NIFEDIPINE MODIFIED RELEASE 10.00 TAB
TAD030 ADALAT RETARD 20mg
(GE)
NIFEDIPINE 20mg 4.30 TAB
TAZ010 AZOREN 20mg/5mg
OLMESARTAN 20mg, AMLODIPINE
5mg 9.90 TAB
TAZ012 AZOREN 40mg/5mg
OLMESARTAN 40mg, AMLODIPINE
5mg 12.30 TAB
TBA010 BAYPRESS 10mg NITRENDIPINE 10mg 8.80 TAB
TBA020 BAYPRESS 20mg NITRENDIPINE 20mg 11.00 TAB
TEX022 EXFORGE 5mg/160mg AMLODIPINE BESYLATE
VALSARTANA
17.00 TAB
TEX020 EXFORGE 5mg/80mg AMLODIPINE BESYLATE
VALSARTANA
14.00 TAB
TEX023
EXFORGE HCT
5mg/160mg/12.5mg
AMLODIPINE 5mg, VALSARTAN
160mg, HYDROCHLOROTHIAZIDE 17.00 TAB
TEX024 EXFORGE 10mg/160mg AMLODIPINE BESYLATE
VALSARTANA
20.00 TAB
TEX025
EXFORGE HCT
10mg/160mg/12.5mg
AMLODIPINE 10mg, VALSARTAN
160mg, HYDROCHLOROTHIAZIDE 20.00 TAB
TEX026
EXFORGE HCT
10mg/160mg/25mg
AMLODIPINE 10mg, VALSARTAN
160mg, HYDROCHLOROTHIAZIDE 20.00 TAB
TEX027 EXFORGE HCT
10mg/320mg/25mg
AMLODIPINE 10mg, VALSARTAN
320mg, HYDROCHLOROTHIAZIDE
21.7 TAB
CPA085 EXFORGE
HCT(5mg/160mg/12.5mg)
AMLODIPINE, VALSARTANA,
HYDROCHLOROTHIAZIDE
17.60 TAB
THE018 HERBESSER 30mg DILTIAZEM 2.50 TAB
THE020 HERBESSER 30mg (GE) DILTIAZEM HCL 30mg 1.50 TAB
THE022 HERBESSER 60mg (GE) DILTIAZEM HCL 60mg 3.00 TAB
THE024 HERBESSER 60mg DILTIAZEM HCL 60mg 3.20 TAB
THE034 HERBESSER SR 90mg DILTIAZEM HCL 90mg 5.00 TAB
THE030 HERBESSER SR 120mg (GE) DILTIAZEM HCL 120mg 5.50 TAB
THE032 HERBESSER SR 180mg DILTIAZEM HCL 180mg 7.00 TAB
THE033 HERBESSER R 100mg DILTIAZEM HCL 100mg 4.50 TAB
CPA077 HERBESSER SR 200mg DILTIAZEM HCL 200mg 11.00 TAB
IHE050 HERBESSER INJ 50mg DILTIAZEM 90.00 AMP
TIS018 ISOPTIN 40mg VERAPAMIL HCL 40mg 3.60 TAB
TIS020 ISOPTIN 40mg (GE) VERAPAMIL HCL 40mg 2.50 TAB
TIS022 ISOPTIN 80mg (GE) VERAPAMIL HCL 80mg 4.00 TAB
TIS030 ISOPTIN SR 240mg VERAPAMIL HCL 240mg 12.30 TAB
IIS010 ISOPTIN INJ 5mg/2mL VERAPAMIL HCL 90.00 AMP
TLA018 LACIPIL 2mg LACIDIPINE 2mg 5.10 TAB
TLA020 LACIPIL 4mg LACIDIPINE 4mg 7.70 TAB
TNO080 NORVASC 5mg AMLODIPINE BESYLATE 5mg 6.50 TAB
TNO081 NORVASC 5mg [ACTAPIN] AMLODIPINE BESYLATE 5mg 4.00 TAB
TNO082 NORVASC 10mg AMLODIPINE BESYLATE 10mg 11.70 TAB
TNO083 NORVASC 10mg [ACTAPIN] AMLODIPINE BESYLATE 10mg 7.50 TAB
TPL022 PLENDIL 2.5mg FELODIPINE 2.5mg 4.40 TAB
TPL024 PLENDIL 5mg FELODIPINE 5mg 6.80 TAB
TPL025 PLENDIL 5mg (GE) FELODIPINE 4.00 TAB
TPL020 PLENDIL 10mg FELODIPINE 10mg 12.40 TAB
TTW010 TWYNSTA 40mg/5mg TELMISARTAN 40mg, AMLODIPINE
5mg
11.00 TAB
TTW012 TWYNSTA 40mg/10mg TELMISARTAN 40mg, AMLODIPINE
10mg
12.00 TAB
TTW014 TWYNSTA 80mg/5mg TELMISARTAN 80mg, AMLODIPINE
5mg
17.00 TAB
TTW016 TWYNSTA 80mg/10mg TELMISARTAN 80mg, AMLODIPINE
10mg
18.00 TAB
TZA025 ZANIDIP 10mg LERCANIDIPINE HCl 10mg 7.20 TAB
DIURET
ICSTAL012 ALDACTONE 100mg SPIRONOLACTONE 25mg 13.00 TAB
TAL010 ALDACTONE 25mg SPIRONOLACTONE 100mg 5.80 TAB
TAL008 ALDACTONE 25mg (GE) SPIRONOLACTONE 25mg 3.70 TAB
TAM018 AMILORIDE 5mg AMILORIDE 5mg 0.70 TAB
CALCIUM ANTAGONISTS
Page 5 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
TDI030 DIAMOX 250mg (GE) ACETAZOLAMIDE 250mg 2.50 TAB
IDI006 DIAMOX INJ 500mg (GE) ACETAZOLAMIDE 480.00 TAB
TDY008 DYAZIDE TRIAMTERENE
50mg/HYDROCHLOROTHIAZIDE 25mg
2.00 AMP
TDY010 DYAZIDE (GE) TRIAMTERENE
50mg/HYDROCHLOROTHIAZIDE 25mg
1.40 TAB
TEN020 ENDURON 5mg METHYCLOTHIAZIDE 5mg 2.00 TAB
TFR010 FRUMIL FRUSEMIDE 40mg/AMILORIDE 5mg 3.60 TAB
THY006 HYDROCHLOROTHIAZIDE
25mg
HYDROCHLOROTHIAZIDE 25mg 0.30 TAB
THY008 HYDROCHLOROTHIAZIDE
50mg
HYDROCHLOROTHIAZIDE 50mg 0.50 TAB
TLA078 LASIX 40mg FRUSEMIDE 40mg 3.00 TAB
TLA080 LASIX 40mg (GE) FRUSEMIDE 40mg 1.60 TAB
ILA012 LASIX INJ 20mg/2mL FRUSEMIDE 42.00 TAB
TLA090 LASIX SPECIAL TAB 500mg FRUSEMIDE 500mg 23.00 AMP
TMI028 MIDAMOR 5mg AMILORIDE 5mg 1.70 TAB
TMO008 MODURETIC AMILORIDE
5mg/HYDROCHLOROTHIAZIDE 50mg
2.20 TAB
TMO010 MODURETIC (GE) AMILORIDE
5mg/HYDROCHLOROTHIAZIDE 50mg
1.40 TAB
TNA030 NAVISPARE CYCLOPENTHIAZIDE
0.25mg/AMILORIDE 2.5mg
3.30 TAB
TZA050 ZAROXOLYN 5mg METOLZAONE 8.40 TAB
CPA076 ZAROXOLYN METOLAZONE 4.95 TAB
TMI059 MINIRIN 0.1mg DESMOPRESSION 13.50 TAB
TMI060 MINIRIN 0.2mg DESMOPRESSION 20.00 TAB
TMI061 MINIRIN MELT 60mcg DESMOPRESSIN ORAL
LYOPHILISATES 60mcg
12.18 TAB
TMI062 MINIRIN MELT 120mcg DESMOPRESSIN ACETATE 120mcg 30.00 TAB
DMI010 MINIRIN DDAVP NASAL
SPRAY 0.01%
DESMOPRESSION ACETATE 540.00 BOT
IAT006 ATP INJ 20mg/2mL ATP 25.00 AMP
TDO062 DOXIUM 500mg CA DOBESILATE 6.30 CAP
TDU030 DUXARIL AOLMITRINE 30mg,RAUBASINE 10mg 8.90 TAB
TME040 MERISLON 6mg BETAHISTINE MESILATE 6mg 1.20 TAB
TSE056 SERMION 10mg NICERGOLINE 10mg 12.50 TAB
CPA101 SERMION 30mg NICERGOLINE 30mg 33.00 TAB
CPA078 STUGERON 25mg (JASSEN) CINNARIZINE 2.70 TAB
TST040 STUGERON 25mg (GE) CINNARIZINE 25mg 1.20 TAB
MIGRAI
NETCA010 CAFERGOT ERGOTAMINE TARTRATE
1mg/CAFFEINE 100mg
7.00 TAB
TDI120 DIXARIT 0.025mg CLONIDINE HCL 0.025mg 2.80 TAB
TGR006 GRAVERGOL ERGOTAMINE,DIMENHYDRINATE,C
AFFEINE
1.65 CAP
TIM018 IMIGRAN 50mg SUMATRIPTAN SUCCINATE 50mg 96.00 TAB
IIM010 IMIGRAN INJ 6mg/0.5mL
(REFILL)
SUMATRIPTAN SUCCINATE 440.00 AMP
TMI030 MIGRIL ERGOTAMINE,CYCLIZINE,CAFFEINE 5.50 TAB
TSA040 SANDOMIGRAN 0.5mg PIZOTIFEN 0.5mg 3.20 TAB
TSI010 SIBELIUM 5mg (GE) FLUNARIZINE 5mg 3.00 CAP
TZO024 ZOMIG 2.5mg ZOLMITRIPTAN 2.5mg 102.40 TAB
TZO025 ZOMIG RAPIMELT 2.5mg ZOLMITRIPTAN 2.5mg 89.00 TAB
TTR020 TRANSAMIN 250mg TRANEXAMIC ACID 250mg 2.30 CAP
TTR022 TRANSAMIN 500mg TRANEXAMIC ACID 500mg 3.00 TAB
ITR020 TRANSAMIN 5% IV INJ
(250mg/5mL)
TRANEXAMIC ACID 80.00 AMP
ITR010 TRANSAMIN 10% IM INJ
(250mg/2.5mL)
TRANEXAMIC ACID 110.00 AMP
TRE050 REVOLADE 25mg ELTROMBOPAG OLAMINE 400.00 TAB
TVI060 VITAMIN K-3 10mg VITAMIN K-3 10mg 1.10 TAB
TAG010 AGGRENOX DIPYRIDAMOLE,ASPIRIN 6.90 CAP
TBR024 BRILINTA 90mg TICAGRELOR 25.00 TAB
TCA070 CARTIA 100mg ASPIRIN 100mg 1.70 TAB
ICL010 CLEXANE 40mg/0.4mL ENOXAPARIN 40mg 100.00 AMP
ICL012 CLEXANE 60mg/0.6mL ENOXAPARIN 60mg 120.00 AMP
ICL013 CLEXANE 80mg/0.8mL ENOXAPARIN 80mg 150.00 AMP
TCO067 CO-PLAVIX CLOPIDOGREL, ASPIRIN 20.00 TAB
TCO094 COUMADIN 2mg WARFARIN 2mg 1.50 TAB
TEL015 ELIQUIS 5mg APIXABAN 17.00 TAB
IFR010 FRAGMIN INJ 5,000 IU/2mL DALTEPARIN Na 94.00 AMP
IFR019 FRAXIPRARINE 2850 AXa
iu/0.3mL
NADROPARIN Ca 160.00 AMP
IFR020 FRAXIPARINE 3,800 AXa
IU/0.4mL INJ
NADROPARIN Ca 156.00 AMP
IIN018 INNOHEP 20,000 IU/mL
2X0.5mL
TINZAPARIN 190.00 AMP
TXA014 XARELTO 10mg RIVAROXABAN 38.00 TAB
TXA015 XARELTO 20mg RIVAROXABAN 20mg 40.00 TAB
TPR005 PRADAXA 75mg DABIGATRAN 75mg 20.00 CAP
TPR006 PRADAXA 110mg DABIGATRAN 20.00 CAP
TPR007 PRADAXA 150mg DABIGATRAN 150mg 20.00 CAP
TPL014 PLAVIX 75mg CLOPIDOGREL 75mg 20.00 CAP
TPL015 PLAVIX 75mg (GE) CLOPIDOGREL 14.00 TAB
TPL028 PLETAAL 50mg CILOSTAZOL 50mg 6.80 TAB
TTI010 TICLID 250mg TICLOPIDINE 250mg 19.50 TAB
TWA010 WARFARIN 1mg WARFARIN 1mg 1.10 TAB
TWA012 WARFARIN 3mg WARFARIN 3mg 1.60 TAB
TWA014 WARFARIN 5mg WARFARIN 5mg 2.00 TAB
CAN028 ANUSOL OINTMENT 25g BISMUTH SUBGALLATE 2.50 g
CAN030 ANUSOL OINTMENT (GE)
30g
BISMUTH SUBGALLATE 1.00 g
PAN010 ANUSOL SUPP BALSAM PERU, BISMUTH OXIDE... 4.60 SUPP
CAN040 ANUSOL-HC OINTMENT
(GE) 15g
HYDROCORTISONE, ZINC SULFATE 2.00 g
PAN018 ANUSOL-HC SUPP BISMUTH OXIDE, ZINC OXIDE.... 6.00 SUPP
PAN020 ANUSOL-HC SUPP (GE) BISMUTH OXIDE, ZINC OXIDE.... 6.00 SUPP
ANTIDIURETICS
HAEMORRHOIDAL, PHLEBITIS & VARICOSE PREPARATIONS
PERIPHERAL VASODILATORS & CEREBRAL ACTIVATORS
ANTICOAGULANTS, ANTITHROMBOTICS & FIBRINOLYTICS
HAEMOSTATICS
Page 6 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
TDA010 DAFLON 500mg DIOSMIN 450mg, HESPERIDIN 50mg 6.00 TAB
CFA010 FAKTU OINTMENT 20g POLICRESULEN, CINCHOCAINE HCL 4.30 g
PFA010 FAKTU SUPP POLICRESULEN, CINCHOCAINE HCL 6.00 SUPP
CHI031 HIRUDOID CREAM 5g (GE) MUCOPOLYSACCHARIDE
POLYSULFATE
2.30 g
CHI030 HIRUDOID CREAM 14g MUCOPOLYSACCHARIDE
POLYSULFATE
3.80 g
CHI040 HIRUDOID CREAM 40g MUCOPOLYSACCHARIDE
POLYSULFATE
2.80 g
CHI032 HIRUDOID FORTE CREAM
14g
MUCOPOLYSACCHARIDE
POLYSULFATE
4.64 g
IPH020 PHENOL IN ALMOND OIL
INJ 250mg/5mL
PHENOL 100.00 VIA
CPH013 PHENOL 5% IN ALMOND
OIL
PHENOL 3.40 ML
CPR008 PREMARIN VAGINAL
CREAM 14g
CONJUGATED ESTROGENS 84.00 TUB
CPR014 PROCTOSEDYL
OINTMENT 15g
HYDROCORTISONE, CINCHOCAINE... 3.40 g
PRO010 PROCTOSEDYL SUPP HYDROCORTISONE,CINCHOCAINE
HCL
4.60 SUPP
TRE027 REPARIL 20mg AESCIN 1.75 TAB
ISO072 SODIUM TETRADECYL
SULPHATE (FIBRO-VEIN)
SODIUM TETRADECYL SULPHATE 400.00 AMP
ITR040 TROMBOVAR 3% INJ SODIUM TETRADECYL SULFATE 60.00 VIA
CUL010 ULTRAPROCT OINTMENT
10g
FLUOCORTOLONE, CINCHOCAINE 9.00 g
CUL012 ULTRAPROCT-N CREAM
10g
FLUOCORTOLONE PIVALATE 8.60 g
PUL010 ULTRAPROCT SUPP FLUOCORTOLONE, CINCHOCAINE
HCL
9.20 SUPP
TVE020 VENORUTON 300mg TRIHYDROXYETHYLRUTOSIDE
300mg
6.00 CAP
CXY030 XYLOPROCT OINTMENT
20g
LIDOCAINE, HYDROCORTISONE 3.20 g
PXY010 XYLOPROCT SUPP LIDOCAINE, HYDROCORTISONE 5.80 SUPP
CZI020 ZINC OXIDE OINTMENT ZINE OXIDE 15% 0.80 g
CPA112 ARANESP 20 mcg/0.5 mL DARBEPOETIN α 500 AMP
CPA113 ARANESP 40 mcg/0.4 Ml DARBEPOETIN α 880 AMP
CPA114 ARANESP 100 mcg/0.5 mL DARBEPOETIN α 1700 AMP
IAR001 ARANESP [darbepoetin]
40mcg/0.4ml PRE-FILLED
DARBEPOETIN 1314 SYR
ILE010 LEUCOMAX INJ 150mcg MOLGRAMOSTIM 680.00 VIA
ILE012 LEUCOMAX INJ 300mcg MOLGRAMOSTIM 1280.00 VIA
INE005 NEULASTIM 6 mg/0.6 mL PEGFILGRASTIM 14520.00 AMP
INE006
NEUPOGEN 300mcg/0.5mL
PRE-FILLED FILGRASTIM 1300.00 AMP
IRE010 RECORMON INJ 5,000IU ERYTHROPOIETIN 760.00 VIA
IAD005
ADENOSCAN INJ
30mg/10mL ADENOSINE 210 AMP
CPA156 EDARBI 40 mg AZILSARTAN MEDOXOMIL 7.30 TAB
CPA149 EDARBI 80mg AZILSARTAN MEDOXOMIL 8.50 TAB
TEF020 EFFIENT 10mg PRASUGREL 10mg 28.00 TAB
CPA045 EIQUINON 10mg UBIDECARENONE (COENZYME Q10) 2.30 TAB
TGU010 GUTRON 2.5mg MIDRODINE HYDROCHOLORIDE 3.00 TAB
TIM019 IMIGRAN 50mg (GE) SUMATRIPTAN SUCCINATE 50mg 50.00 TAB
TIN080 INSPRA 25mg EPLERENONE 25mg 32.10 TAB
TIN082 INSPRA 50mg EPLERENONE 50mg 51.00 TAB
TPR017 PRAXILENE 100mg NAFTIDROFURYL 100mg 3.70 TAB
TTR030 TRENTAL 400mg PENTOXIFYLLINE 400mg 6.40 TAB
IAD010 ADRENALINE INJ 1:1,000
IM (GE)
ADRENALINE 70.00 AMP
CPA074 ALVESCO METERED-DOSE
INHALER
CICLESONIDE 238.00 PC
CPA144 ALVESCO MDI 160
mcg/actuation
CICLESONIDE 375.00 PC
IAM020 AMINOPHYLLINE INJ
250mg/10mL IV
AMINOPHYLLINE 50.00 AMP
IAM010 AMINOPHYLLINE INJ
250mg/2mL IM
AMINOPHYLLINE 32.00 AMP
SAT018 ATROVENT INHALER
20mcg/puff (200 Doses)
IPRATROPIUM BROMIDE
ANHYDROUS
220.00 PC
SAT010 ATROVENT NEB
SOLUTION 0.25mg/mL
IPRATROPIUM BROMIDE
ANHYDROUS
150.00 BOT
TBA004 BAMBEC 10mg BAMBUTEROL HYDROCHLORIDE 3.50 TAB
MBA010 BAMBEC SYR.1mg/1ml BAMBUTEROL HYDROCHLORIDE 0.60 ML
SBE006 BECLAZONE INHALER
100mcg
BECLOMETHASONE DIPROPIONATE 255.00 PC
SBE010 BECLOFORTE INHALER
250mcg/puff (200 Doses)
BECLOMETHASONE DIPROPIONATE 360.00 PC
SBE011
BECLOFORTE INHALER
250mcg/puff (GE) BECLOMETHASONE DIPROPIONATE 120.00 PC
SBE020 BECODISK 100mcg x 8
Doses
BECLOMETHASONE DIPROPIONATE 18.00 DISC
SBE022 BECODISK 200mcg x 8
Doses
BECLOMETHASONE DIPROPIONATE 30.00 DISC
SBE060 BECOTIDE DISKHALER BECODISK DISKHALER 55.00 PC
SBE070 BECOTIDE INHALER
50mcg/puff (200 Doses)
BECLOMETHASONE DIPROPIONATE 110.00 PC
SBE071 BECOTIDE INHALER
50mcg/puff (GE)
BECLOMETHASONE DIPROPIONATE 70.00 PC
TBE020 BEROTEC 2.5mg FENOTEROL HBr 2.5mg 1.00 TAB
SBE080 BEROTEC INHALER
0.2mg/puff 300 puffs
FENOTEROL HBr 120.00 PC
TBR010 BRICANYL 2.5mg TERBUTALINE SULFATE 2.5mg 1.00 TAB
TBR012 BRICANYL 2.5mg (GE) TERBUTALINE SULFATE 2.5mg 1.20 TAB
TBR020 BRICANYL DURULE 5mg TERBUTALINE SULFATE 5mg 2.60 TAB
TBR022 BRICANYL DURULE 7.5mg TERBUTALINE SULFATE 7.5mg 4.20 TAB
MBR010 BRICANYL SYRUP
1.5mg/5mL (GE)
TERBUTALINE SULFATE 0.17 ML
IBR010 BRICANYL INJ 0.5mg/mL TERBUTALINE SULFATE 77.30 AMP
SBR010 BRICANYL INHALER
250mcg/puff (400 Doses)
TERBUTALINE SULPHATE 132.00 PC
SBR020 BRICANYL NEB SOLUTION
10mg/mL 50mL/BOT
TERBUTALINE SULFATE 160.00 BOT
SBR026 BRICANYL SPACER
INHALER 250mcg/puff 400
TERBUTALINE SULFATE 130.00 PC
SBR030 BRICANYL TURBUHALER
0.5mg/dose (200 Doses)
TERBUTALINE SULFATE 258.00 PC
SBR024 BRINCANYL RESPULE
0.5mg/2mL
TERBUTALINE SULFATE 9.00 AMP
SCO020 COMBIVENT INHALER IPRATROPIUM, SALBUTAMOL 200.00 PC
TDA070 DAXAS 500mcg ROFLUMILAST 20.500 TAB
SCO010 COMBIVENT
NEB.SOLU.2.5ml/vial
IPRATROPIUM Br
ANHYDROUS/SALBU
12.00 VIA
CPA137 COMBIVENT NEBULE IPRATROPIUM BR ANHYDROUS
0.5mg, SALBUTAMOL 2.5mg
9.00 NEB
MDI020 DIPROPHYLLINE
100mg/5mL
DIPROPHYLLINE 0.17 ML
IEP002 EPIPEN AUTO-INJECTOR
1:1000
ADRENALINE 1500.00 AMP
SFL024 FLIXOTIDE ACCUHALER
50mcg
FLUTICASONE PROPIONATE 400.00 PC
SFL026 FLIXOTIDE INHALER
25mcg/puff ( 60 DOSE)
FLUTICASONE PROPIONATE 50.00 PC
ANTIASTHMATIC PREPARATIONS
OTHER CARDIOVASCULAR DRUGS
HAEMATOPOIETIC AGENTS
Page 7 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
SFL028 FLIXOTIDE INHALER
50mcg/puff (60 Doses)
FLUTICASONE PROPIONATE 105.00 PC
SFL029 FLIXOTIDE INHALER
50mcg/puff (120 Doses)
FLUTICASONE PROPIONATE 322.00 PC
SFL030 FLIXOTIDE INHALER
125mcg/puff (60 Doses)
FLUTICASONE PROPIONATE 340.00 PC
SFL032 FLIXOTIDE INHALER
250mcg/puff (120 Doses)
FLUTICASONE PROPIONATE 605.00 PC
SFL033 FLIXOTIDE INHALER
250mcg/puff (60 Doses)
FLUTICASONE PROPIONATE 336.00 PC
SFL025 FLIXOTIDE ACCUHALER
250mcg
FLUTICASONE PROPIONATE 442.00 PC
CPA138 FLIXOTIDE NEBULES 0.5
mg/2 mL
FLUTICASONE PROPIONATE 25.00 NEB
SIN010 INTAL INHALER 1mg/puff
(200 Doses)
SODIUM CROMOGLYCATE 204.00 PC
SIN012 INTAL INHALER 5mg/puff
(112 Doses)
SODIUM CROMOGLYCATE 170.00 PC
SIN030 INTAL NEB SOLUTION
20mg/2mL
SODIUM CROMOGLYCATE 3.00 AMP
SIN040 INTAL SPINCAP 20mg SODIUM CROMOGLYCATE 3.00 CAP
TNU010 NUELIN SR 200mg ANHYDROUS THEOPHYLLINE 200mg 1.30 TAB
TNU012 NUELIN SR 300mg ANHYDROUS THEOPHYLLINE 300mg 1.60 TAB
MNU010 NUELIN SYRUP 80mg/15mL
60mL
THEOPHYLLINE 0.22 ML
CPA145 ONBREZ BREEZHALER 150
mcg INHALATION POWD
CAP
INDACATEROL MALEATE 384.00 PC
CPA146 ONBREZ BREEZHALER 300
mcg INHALATION POWD
CAP
INDACATEROL MALEATE 637.00 PC
SOX010 OXIS TURBUHALER
4.5mcg/dose (60 Doses)
FORMOTEROL FUMARATE 4.5mcg 173.00 PC
SOX011 OXIS TURBUHALER
9mcg/dose (60 Doses)
FORMOTEROL FUMARATE 9 mcg 318.00 PC
SPU012 PULMICORT INHALER
50mcg/puff (200 Doses)
BUDESONIDE 140.00 PC
SPU010 PULMICORT INHALER
200mcg/puff (100 Doses)
BUDESONIDE 210.00 PC
SPU011
PULMICORT INHALER
200mcg/puff (120 Dose) BUDESONIDE 295.00 PC
SPU040 PULMICORT SPACE
INHALER 200mcg/puff (100
BUDESONIDE 210.00 PC
SPU042 PULMICORT SPACE
INHALER 50mcg/puff (200
BUDESONIDE 140.00 PC
SPU060 PULMICORT
TURBUHALER 100mcg/dose
BUDESONIDE 472.00 PC
SPU062 PULMICORT
TURBUHALER 200mcg/dose
BUDESONIDE 795.00 PC
SPU064 PULMICORT
TURBUHALER 400mcg/dose
BUDESONIDE 1210.00 PC
SPU030 PULMICORT RESPULE
0.5mg/2mL
BUDESONIDE 58.30 AMP
SRE010 RESPOLIN AUTO-HALER
100mcg/puff (400 Doses)
SALBUTAMOL SULFATE 260.00 PC
SSE020 SERETIDE INHALER
25mcg/125mcg
SALMETEROL, FLUTICASONE 595.00 PC
SSE009 SERETIDE INHALER
25mcg/50mcg
SALMETEROL, FLUTICASONE 360.00 PC
SSE022 SERETIDE INHALER
25mcg/250mcg
SALMETEROL, FLUTICASONE 825.00 PC
SSE006 SERETIDE ACCUHALER
50mcg/100mcg (60 Doses)
SALMETEROL, FLUTICASONE 462.00 PC
SSE007 SERETIDE ACCUHALER
50mcg/500mcg (60 Doses)
SALMETEROL, FLUTICASONE 905.00 PC
SSE008 SERETIDE ACCUHALER
50mcg/250mcg (60 Doses)
SALMETEROL, FLUTICASONE 755.00 PC
CPA079 SERETIDE ACCUHALER
500mcg
SALMETEROL, FLUTICASONE 820.00 PC
SSE012 SEREVENT INHALER
25mcg/puff (120 Doses)
SALMETEROL XINAFOATE 455.00 PC
SSE010 SEREVENT INHALER
25mcg/puff (60 Doses)
SALMETEROL XINAFOATE 275.00 PC
SSE016 SEREVENT ACCUHALER
50mcg/dose (60 Doses)
SALMETEROL XINAFOATE 629.00 PC
TSI058 SINGULAIR 4mg ZINCAPS 14.30 TAB
TSI060 SINGULAIR 5mg MONTELUKAST SODIUM 5mg 14.30 TAB
TSI062 SINGULAIR 10mg MONTELUKAST SODIUM 10mg 14.30 TAB
MSI020 SINGULAIR ORAL
GRANULES 4mg
MONTELUKAST SODIUM 4mg 14.30 SACH
TSL012 SLO-BID 50mg THEOPHYLLINE 50mg 0.80 CAP
TSL010 SLO-BID 100mg THEOPHYLLINE 100mg 0.70 CAP
TSL011 SLO-BID 200mg THEOPHYLLINE 200mg 0.50 CAP
TSL014 SLO-THEO 50mg ANHYDROUS THEOPHYLLINE 50mg 0.70 CAP
TSL016 SLO-THEO 100mg ANHYDROUS THEOPHYLLINE 100mg 0.90 CAP
SSP020 SPIRIVA 18mcg CAPSULES
FOR INHALATION
TIOTROPIUM 18 mcg 19.00 CAP
CPA089 SPIRIVA RESPIMAT
SOLUTION FOR
TIOTROPIUM BR 600.00 PC
CPA087 SPIRIVA TURBUHALER
18mcg
TIOTROPIUM 18 mcg 400.00 PC
SSY010 SYMBICORT
TURBUHALER 160/4.5mcg
BUDESONIDE/FORMOTEROL
FUMARATE
416.00 PC
SSY012
SYMBICORT
TURBUHALER
320/9mcg/dose (60 doses)
BUDESONIDE 320mcg,FORMOTEROL
FUMARATE DIHYDRATE 9mcg 705
PC
SSY008 SYMBICORT
TURBUHALER
BUDESONIDE/FORMOTEROL
FUMARATE
285.00 PC
TTE006 TEDRAL SA THEOPHYLLINE, EPHEDRINE... 1.10 TAB
TTH010 THEODUR 200mg ANHYDROUS THEOPHYLLINE 200mg 1.20 TAB
TTH012 THEODUR 300mg ANHYDROUS THEOPHYLLINE 300mg 1.50 TAB
STI010 TILADE STANDARD
INHALER 2mg/puff, 112
NEDOCROMIL Na 230.00 PES
CPA147 VANNAIR 160/4.5 mcg MDI BUDESONIDE, FORMOTEROL
FUMARATE DIHYDRATE
820.00 PC
SVE010 VENTIDE INHALER (200
Doses)
SALBUTAMOL, BECLOMETHASONE 200.00 PC
SVE020 VENTODISK 200mcg x 8
Doses
SALBUTAMOL SULPHATE 16.00 DISC
SVE022 VENTODISK 400mcg x 8
Doses
SALBUTAMOL SULPHATE 20.00 DISC
TVE030 VENTOLIN 2mg (GE) SALBUTAMOL 2mg 0.80 TAB
TVE032 VENTOLIN 4mg (GE) SALBUTAMOL 4mg 1.30 TAB
MVE012 VENTOLIN EXPECTORANT
(G.E)
SALBUTAMOL SULPHATE 0.17 ML
MVE010 VENTOLIN SYRUP
2mg/5mL (GE)
SALBUTAMOL SULPHATE 0.19 ML
IVE010 VENTOLIN INJ 0.5mg/mL SALBUTAMOL SULPHATE 30.00 AMP
SVE050 VENTOLIN INHALER
100mcg/puff (200 Doses)
SALBUTAMOL SULPHATE 115.00 PC
SVE052 VENTOLIN INHALER
100mcg/puff (GE)
SALBUTAMOL SULPHATE 56.00 PC
SVE030 VENTOLIN ACCUHALER
200mcg
SALBUTAMOL SULPHATE 215.00 PC
SVE040 VENTOLIN DISKHALER SALBUTAMOL SULPHATE 58.00 PC
SVE060 VENTOLIN NEBULE
2.5mg/2.5mL
SALBUTAMOL SULPHATE 6.70 AMP
SVE070 VENTOLIN RESP
SOLUTION 5mg/mL
SALBUTAMOL SULPHATE 137.00 BOT
TVO010 VOLMAX 4mg SALBUTAMOL SULPHATE 4mg 2.70 TAB
TVO011 VOLMAX {Salbutamol} 4mg
(GE)
SALBUTAMOL SULPHATE 4mg 2.70 TAB
TVO012 VOLMAX 8mg SALBUTAMOL SULPHATE 8mg 4.50 TAB
AVO012 VOLUMATIC SOFT
(GLAXO)
171.00 PC
TZA018 ZADITEN 1mg KETOTIFEN HYDROGEN FUMARATE
1mg
5.00 TAB
TZA020 ZADITEN 1mg (GE) KETOTIFEN 1mg 2.60 TAB
MZA020 ZADITEN SYRUP 1mg/5mL KETOTIFEN HYDROGEN FUMATATE 1.50 ML
MZA030 ZANTAC 150mg/10mL RANITIDINE HCL 2.20 ML
DIN010 INHALANT 30mL/BOT (GE) MENTHOL, EUCALYPTUSE 0.33 ML
Page 8 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
MME005 MEPTIN SYRUP 5mcg/mL PROCATEROL HYDROCHLORIDE 0.79 ML
TAC020 ACTIFED (GE) TRIPROLIDINE, PSEUDOEPHEDRINE 2.00 TAB
MAC008 ACTIFED COMPOUND
LINCTUS
CODEINE PSEUDOEPHEDRINE
TRIPROLIDINE
60.00 BOT
MAC010 ACTIFED CO SYRUP (GE) CODEINE, PSEUDOEPHEDRINE.... 0.40 ML
MAC012 ACTIFED CO SYRUP (1/2
STRENGTH)
CODEINE, PSEUDOEPHEDRINE.... 0.17 ML
MAC014 ACTIFED CO "UNI-FEDRA
COMPOUND" SYRUP
TRIPROLIDINE, CODEINE,
PSEUDOEPHEDRINE
0.32 ML
MAC020 ACTIFED SYRUP (GE) TRIPROLIDINE, PSEUDOEPHEDRINE 0.30 ML
MBE020 BENADRYL
EXPECTORANT (GE)
DIPHENHYDRAMINE, AMMONIUM
CL..
0.20 ML
TBI020 BISOLVON 8mg (GE) BROMHEXINE 8mg 0.85 TAB
MBI020 BISOLVON SYRUP
4mg/5mL (GE)
BROMHEXINE HCL 0.17 ML
MBI022 BISOLVON SYRUP
8mg/5mL (GE)
BROMHEXINE HCL 0.17 ML
MBI010 BISOLVON CO ELIXIR (GE) BROMHEXINE,CODEINE 0.17 ML
TCP010 C.P.P. CHLORPHENIRAMINE,PHENYLEHRI
NE
0.50 TAB
MCH010 CHRISTOLIN SYRUP EPHEDRINE/AMMONIUM
CHLORDIE/PO
0.17 ML
TCL010 CLARINASE LORATADINE, PSEUDOEPHEDRINE 5.50 TAB
TCL012 CLARINASE EXTENDED
RELEASE
LORATADINE, PSEUDOEPHEDRINE 10.20 TAB
MCO010 COCILLANA CO MIXTURE
(GE)
COCILLANA, SENEGA, EUPHORBIA… 0.18 ML
MCO012 COCILLANA CO MIXTURE
WITH CODEINE
COCILLANA, CONDEINE, SENEGA,
EUPHORBIA…
0.42 ML
CPA104 CODAPANE FORTE PARACETAMOL, CODEINE
PHOSPHATE
8.00 TAB
CPA157 CO-CODAMOL PARACETAMOL, CODEINE
PHOSPHATE
2.00 TAB
MCO020 CODEINE LINCTUS
12.5mg/5mL (1/2
CODEINE PHOSPHATE 0.23 ML
MCO022 CODEINE LINCTUS
25mg/5mL (FULL
CODEINE PHOSPHATE 0.32 ML
TCO010 CODEINE PHOSPHATE
15mg
CODEINE PHOSPHATE 15mg 1.00 TAB
TCO012 CODEINE PHOSPHATE
30mg
CODEINE PHOSPHATE 30mg 1.50 TAB
TCO014 CODIPRONT CODEINE, PHENYLTOLOXAMINE 5.50 CAP
TCO020 CODOPLEX CODEINE, CHLORPHENIRAMINE... 1.80 TAB
TCO022 CODOPLEX JUNIOR CODEINE, CHLORPHENIRAMINE... 0.50 TAB
MCO030 CODOPLEX SYRUP CODEINE, CHLORPHENIRAMINE... 0.30 ML
TCO030 COFREL BENPROPERINE 20mg 2.10 TAB
MCO060 COSYR DEXTROMETHORPHAN/CHLORPHEN
IRAM
0.17 ML
TDA026 DANZEN 5mg SERRAPEPTASE 1.20 TAB
MDE010 DEC SYRUP CODEINE,EPHEDRINE,DEXCHLORPH
ENIRAMINE
0.40 ML
MDE050 DEXTROCILLA SYRUP DEXTROMETHORPHAN,COCILLANA
…
0.22 ML
MDE060 DEXTROMETHORPHAN
15mg/5mL SYRUP
DEXTROMETHORPHAN 0.22 ML
CPA099 DURO-TUSS FORT PHOLCODINE 0.50 ML
MEX008 EXPECT STIM MIXTURE
(120mL)
AMMONIUM CO3, IPECAUANHA
TINCT
0.17 ML
MEX010 EXPECT STIM MIXTURE
(3600mL)
AMMONIUM CO3, IPECAUAUHA
TINCT
0.25 ML
MFL020 FLUIMUCIL 100mg ACETYLCYSTEINE 2.00 SACH
MFL022 FLUIMUCIL 200mg ACETYLCYSTEINE 2.50 SACH
MFL021 FLUIMUCIL A 100mg ACETYLCYSTEINE 2.60 SACH
MFL023 FLUIMUCIL A 200mg ACETYLCYSTEINE 3.20 SACH
CPA090 FLUIMUCIL A
EFFERVESCENT 600mg
ACETYLCYSTEINE 4.00 TAB
TFL050 FLU-OFF PARACETAMOL,
CHLORPHENIRAMINE…
1.20 CAP
TFL040 FLUCOR DAY
PARACETAMOL,
PSEUDOEPHEDRINE, 2.000 CAP
MGE010 GEE'S LINCTUS (GE) OPIUM TINCT, SQUIL LIQ EXTRACT 0.18 ML
TGE008 GELOMYRTOL FORTE MYRTOL 300mg 3.70 TAB
MGL010 GLYCERYL
GUAIACOLATE 100mg
GLYCERYL GUAIACOLATE 100mG 0.17 ML
MGU010 GUAIFENESIN 100mg/5mL GUAIFENESIN 100mg 0.17 ML
TLO012 LOGICIN FLU STRENGTH PARACETAMOL, PSEUDOEPHEDRINE 1.85 TAB
CPA111 LOGICIN RAPID RELIEF
LOZ
LIGNOCAINE HCI, BENZYDAMINE
HCI, DICHLOROBENZYL ALCOHOL
1.2 mg
1.50 TAB
MME020 METHORSEDYL SYRUP DEXTROMETHORPHAN,PROMETHAZ
INE
0.25 ML
IME005 METHON-S (50'S/BOX)
CHLORPHENIRAMINE,DEXTROMETHOR
PHAN,GUAIPHENESIN,METHOXPHENAM 35.00 AMP
TMU020 MUCODYNE 375mg (GE) CARBOCISTEINE 1.50 TAB
TMU030 MUCOSOLVAN 30mg (GE) AMBROXOL HCL 30mg 1.20 TAB
CPA039 MUCOSOLVAN 30mg AMBROXOL HCL 30mg 1.50 TAB
MMU024 MUCOSPECT SYRUP
100mg/5mL
CARBOCYSTEINE 0.23 ML
MMU026 MUCOSPECT SYRUP
250mg/5mL
CARBOCYSTEINE 0.27 ML
TPA019 PANADOL EXTEND 665mg ACETAMINOPHEN 1.00 TAB
TPA034 PANADOL COLD & FLU ACETAMINOPHEN/PHENYLEPHRINE 2.00 TAB
MPH012 PHENEXPECT SYRUP DIPHENHYDRAMINE/AMMON CL/NA
CI
0.17 ML
MPH020 PHENSEDYL SYRUP (GE) PROMEHTAZINE,CODEINE,EPHEDRI
NE
0.40 ML
TPH026 PHENSEDYL TAB (GE) PROMETHAZINE,CODEINE,EPHEDRI
NE
2.00 TAB
MPH030 PHOLCODINE SYRUP
5mg/5mL
PHOLCODINE 0.20 ML
MPI010 PIRITON EXPECTORANT
(GE)
CHLORPHENIRAMINE, AMMONIUM
CL
0.17 ML
MPR030 PRODEX COUGH SYRUP DEXTROMETHORPHAN HBR/
EPHEDRINE HCL/PROMETHAZINE
HCL
0.20 ML
MRH008 RHINATHIOL INFANT
SYRUP
CARBOCISTEINE 0.24 ML
TRO050 ROMILAR 15mg
(DEXTROMETHORPHAN)
DEXTROMETHORPHAN 15mg 1.10 TAB
TRO052 ROMILAR 25mg
(DEXTROMETHORPHAN)
DEXTROMETHORPHAN 25mg 1.50 TAB
TSU010 SUDAFED 60mg (GE) PSEUDOEPHEDRINE 60mg 2.00 TAB
MSU010 SUDAFED SYRUP
30mg/5mL (GE)
PSEUDOEPHEDRINE HCL 0.30 ML
MCO052 CORYAID SYRUP (1/2
STRENGTH) (GE)
CHLORPEHNIRAMINE,CODEINE,EPH
ED
0.18 ML
MCO050 CORYAID SYRUP (GE) CHLORPEHNIRAMINE,CODEINE,EPH
ED
0.18 ML
TCO090 CORYZAC (GE) CAFFEINE,CHLORPHENIRAMINE,PPA 0.60 CAP
MDI010 DIMETAPP ELIXIR (GE) BROMPHENIRAMINE,PPA,PHENYLEP
HR
0.18 ML
MMU050 MUCOFLUX D,L-trans-1 methyl-4-cyclohex-1,2-2n-6-ol
80mg, 60% sucrose syrup
1.00 ML
TNE020 NEOZEP PARACETAMOL,PPA,SALICYLAMIDE.
.
1.20 TAB
MRH010 RHINOPRONT SYRUP PPA, CARBINOXAMINE 0.40 ML
MTI010 TIXYLIX SYRUP (GE) PPA, PHOLCODINE, PROMETHAZINE 0.19 ML
TCO008 CODAEWON DIHYDROCODEINE, GUAIFENESIN,
CHLORPHENIRAMINE,
1.20 TAB
SAF012 AFRIN (PAED) NOSE
DROPS/SPRAY 0.025%
OXYMETAZOLINE HCL 45.00 BOT
COUGH & COLD REMEDIES
DECONGESTANTS & OTHER NASAL PREPARATIONSPage 9 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
SAF010 AFRIN (ADULT) NASAL
SPRAY 0.05% 15mL/BOT
OXYMETAZOLINE HCL 60.00 BOT
CPA059 AVAMYS NASAL SPRAY FLUTICASONE FUROATE 120.00 PC
SAV010 AVAMYS NASAL SPRAY
27.5mcg 120 Doses
FLUTICASONE FUROATE 200.00 PC
SBE050 BECONASE NASAL SPRAY
50mcg
BECLOMETHASONE DIPROPIONATE 92.00 BOT
SBE040 BECONASE AQUEOUS
NASAL SPRAY 50mcg
BECLOMETHASONE DIPROPIONATE 175.00 BOT
DCR020 CROMOLYN NASAL
SOLUTION 2%
SODIUM CROMOGLYCATE 90.00 BOT
TDR010 DRIXORAL (GE) DEXBROMPHENIRAMINE,
PSEUDOEPHEDRINE
2.00 TAB
DEP010 EPHEDRINE NASAL
DROPS 0.5% 15mL/BOT
EPHEDRINE 0.5% 0.36 ML
DEP012 EPHEDRINE NASAL
DROPS 1% 15 mL/BOT
EPHEDRINE 1% 0.45 ML
SFL010 FLIXONASE AQUEOUS
NASAL SPRAY
FLUTICASONE PROPIONATE 128.00 BOT
CPA105 MAR PLUS NASAL SPRAY
(140 SPRAYS) 10 mg/1 mL x
DEXPANTHENOAL 10MG,
SEAWATER 250 mg.
30.00 PC
SNA006 NASACORT AQ NASAL
SPRAY
TRIAMICINOLONE ACETONIDE
55mcg
255.00 BOT
SNA010 NASONEX NASAL SPRAY
0.05% 140 Doses
MOMETASONE FUROATE 168.00 BOT
SNA012 NASONEX NASAL SPRAY
0.05% 60 Doses
MOMETASONE FUROATE 135.00 BOT
CNI006 NISITA OINTMENT 20g Na Iodide, Na Bromide, Na Cl.. 2.00 g
SNI004 NISITA NASAL SPRAY Na IODIDE, Na BROMIDE, NaCl 120.00 BOT
CPA103 OMNARIS NASAL SPRAY
50MCG
CICLESONIDE 315.00 PC
SOT010 OTRIVIN CHILDREN
NASAL DROPS
XYLOMETAZOLINE HCL 0.05% 38.00 BOT
SOT030 OTRIVIN ADULTS NASAL
DROPS
XYLOMETAZOLINE HCL 0.1% 60 BOT
SRH010 RHINOCORT NASAL
SPRAY 50mcg (GE)
BUDESONIDE 100.00 BOT
SRH008 RHINOCORT AQUA NASAL
SPRAY 50mcg
BUDESONIDE 145.00 BOT
SRH009 RHINOCORT AQUA NASAL
SPRAY 64mcg
BUDESONIDE 147.90 BOT
SRH012 RHINOCORT
TURBUHALER 100mcg/dose
BUDESONIDE 421.80 PC
SST010 STERIMAR MICROSPRAY
50ml
PHYSIOLOGICAL SEA WATER 60.00 BOT
SRY010 RYNACROM M NASAL
SPRAY 2%
SODIUM CROMOGLYCATE 70.00 BOT
DSI020 SINOMARIN ADULTS
125mL
SEA WATER SOLUTION 83.00 BOT
DSI022 SINOMARIN
CHILDREN/ENFANTS
HYPERTONIC SEA WATER 64.00 BOT
CVI010 VIBROCIL GEL 12g DIMETHINDENE, PHENYLEPHRINE 3.75 g
DXY010 XYLOMA NASAL DROPS
0.1%
XYLOMETAZOLINE HCl 23.00 BOT
TBR030 BROTASE 20mg BROMELAIN 0.800 TAB
TNE040 NEUZYM 30mg LYSOZYME HCL 30mg 1.00 TAB
TNE042 NEUZYM 30mg (GE) LYSOZYME HCL 30mg 0.70 TAB
TNE044 NEUZYM 60mg (GE) LYSOZYME HCL 60mg 0.60 TAB
TPA042 PAPASE PROLASE 10,000U 0.70 TAB
TPA043 PAPASE (GE) PROLASE 10,000U 0.80 TAB
TAS050 ASTRIX 100mg ASPIRIN 1.85 TAB
TAS034 ASPILETS ASPIRIN 80mg 0.50 TAB
TAS030 ASPIRIN 300mg (GE) ASPIRIN 300mg 0.60 TAB
TAS032 ASPIRIN 75mg (GE) ASPIRIN 75mg 0.50 TAB
TAS033 ASPIRIN 80mg (GE) ASPIRIN 80mg 0.70 TAB
TAS040 ASPIRIN SOLUBLE 300mg
(GE)
ASPIRIN SOLUBLE 300mg 0.60 TAB
TBE061 BEXTRA 20mg VALDECOXIB 20mg 10.00 TAB
MCA010 CALPOL SUSPENSION
120mg/5mL
PARACETAMOL 0.25 ML
TDF010 DF 118 30mg DIHYDROCODEINE TARTRATE 30mg 5.50 TAB
TDI108 DISPRIN 300mg ASPIRIN 300mg 1.70 TAB
TDO020 DOLOBID 250mg DIFLUNISAL 250mg 3.20 CAP
TDO030 DOLOGESIC (GE) DEXTROPROPOXYPHENE,PARACET
AMOL
1.20 TAB
TDO040 DOLOXENE 32mg DEXTROPROPOXYPHENE 2.00 CAP
TDO038 DOLOXENE 32mg (GE) DEXTROPROPOXYPHENE 1.00 CAP
TDO050 DOLOXENE CO (GE) DEXTROPROPOXYPHENE,ASA,CAFF
EIN
2.00 CAP
PEP012 EPIZON CHILD RECTOCAP PARACETAMOL,PROPYPHENAZONE
…
5.00 SUPP
PEP010 EPIZON INFANT
RECTOCAP
PARACETAMOL,PROPYPHENAZONE
…
4.80 SUPP
IFE020 FENTANYL INJ 0.05mg/2mL FENTANYL 92.00 AMP
IMO012 MORPHINE INJ 10mg/mL MORPHINE 50.00 AMP
IMO030 MORPHINE INJ 15mg/mL MORPHINE 50.00 AMP
MMO008 MORPHINE SYRUP
10mg/5mL
MORPHINE 0.67 ML
TOX012 OXYNORM [OXYCODONE]
5mg
OXYCODONE 5mg 26.00 CAP
TOX013 OXYNORM [OXYCODONE]
10mg
OXYCODONE 10mg 33.00 CAP
TOX006 OXYCONTIN 5mg OXYCODONE HYDROCHLORIDE 43.00 TAB
TOX008 OXYCONTIN 10mg OXYCODONE HYDROCHLORIDE 54.00 TAB
CPA043 PANADEINE PARACETAMOL, CODEINE 1.60 TAB
TPA020 PANADEINE (GE) PARACETAMOL, CODEINE (500/8mg) 2.00 TAB
TPA028 PANADOL 250mg (GE) PARACETAMOL 250mg 0.30 TAB
TPA018 PANADOL 500mg PARACETAMOL 500mg 2.00 TAB
TPA030 PANADOL 500mg (GE) PARACETAMOL 500mg 0.60 TAB
TPA052 PARCOTEN TAB CODEINE PARACETAMOL 3.00 TAB
PPA010 PANADOL SUPP 125mg
(GE)
PARACETAMOL 2.80 SUPP
PPA012 PANADOL SUPP 250mg
(GE)
PARACETAMOL 2.90 SUPP
MPA014 PANADOL SUSPENSION
250mg/5mL (GE)
PARACETAMOL 0.22 ML
MPA010 PANADOL SYRUP
120mg/5mL (GE)
PARACETAMOL 0.17 ML
MPA012 PANADOL SYRUP
250mg/5mL (GE)
PARACETAMOL 0.20 ML
IPE020 PETHIDINE INJ 100mg/2mL PETHIDINE 60.00 AMP
IPE022 PETHIDINE INJ 50mg/mL PETHIDINE 50.00 AMP
TPH030 PHYSEPTONE 5mg METHADONE HCL 5mg 10.00 TAB
TPO018 PONSTAN 250mg MEFENAMIC ACID 250mg 1.30 CAP
TPO020 PONSTAN 250mg (GE) MEFENAMIC ACID 250mg 1.05 CAP
TPO022 PONSTAN 500mg MEFENAMIC ACID 500mg 1.60 CAP
TPO024 PONSTAN 500mg (GE) MEFENAMIC ACID 500mg 1.30 TAB
TTE028 TEMGESIC 0.2mg BUPRENORPHINE HCL 0.2mg 6.20 TAB
ITE008 TEMGESIC INJ 0.3mg/mL BUPRENORPHINE HCL 50.00 AMP
ANO003 NORSPAN
[BUPRENORPHINE]
TRANSDERMAL PATCH 5
BUPRENORPHINE 820.00 BOX
ANTI-INFLAMMATORY ENZYMES
ANALGESICS & ANTIPYRETICS
Page 10 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
ANO004 NORSPAN
[BUPRENORPHINE]
TRANSDERMAL PATCH 10
BUPRENORPHINE 1320.00 BOX
TTR006 TRAMAL 50mg TRAMADOL HCL 50mg 5.00 CAP
TTR007
TRAMAL <TRAMADOL>
50mg [MABRON] TRAMADOL 2.70 CAP
ITR006 TRAMAL INJ 50mg TRAMADOL 40.00 AMP
ITR007
TRAMAL <TRAMADOL>
INJ 100mg/2mL TRAMADOL 40.00 AMP
TTR008 TRAMAL RETARD 100mg TRAMADOL HCL 100mg 9.20 TAB
TUL030 ULTRACET TRAMADOL
37.5mg/ACETAMINOPHEN 325mg
5.30 TAB
TAF010 AFLOXAN 150mg PROGLUMETACIN 150mg 2.50 CAP
TAR044 ARCOXIA 120mg ETORICOXIB 120mg 11.80 TAB
TAR040 ARCOXIA 60mg ETORICOXIB 60mg 10.50 TAB
TAR042 ARCOXIA 90mg ETORICOXIB 90mg 10.40 TAB
CPA086 ARCOXIA 30mg ETORICOXIB 30mg 8.50 TAB
TAR025 ARTRODAR 50mg DIACEREIN 10.00 CAP
TAR020 ARTHROTEC DICLOFENAC NA, MISOPROSTOL 6.30 TAB
TAS020 ASCRIPTIN A/D AL & MG HYDROXIDE, ASPIRIN 0.50 TAB
TBE060 BEXTRA 10mg VALDECOXIB 10mg 10.00 TAB
TBE062 BEXTRA 40mg VALDECOXIB 40mg 17.00 TAB
TBR120 BRUFEN 200mg (GE) IBUPROFEN 200mg 0.85 TAB
TBR122 BRUFEN 400mg IBUPROFEN 1.700 TAB
TCA080 CATAFLAM 25mg DICLOFENAC POTASSIUM 25mg 3.50 TAB
TCA082 CATAFLAM 50mg DICLOFENAC POTASSIUM 50mg 5.80 TAB
TCE034 CELEBREX 100mg CELECOXIB 100mg 8.00 CAP
TCE036 CELEBREX 200mg CELECOXIB 200mg 9.20 CAP
CPA046 CELEBREX 400mg CELECOXIB 400mg 15.00 CAP
CPA054 CLINORIL 200mg SULINDAC 200mg 4.00 TAB
TCU010 CUPRIMINE 250mg PENICILLAMINE 250mg 6.50 TAB
IDY010 DYNASTAT INJ 40mg PARECOXIB 40 mg 340.00 VIA
TEC010 ECOTRIN 650mg ASPIRIN 650mg 1.00 TAB
IEN020 ENBREL 25mg ETANERCEPT 25mg 1586.00 AMP
TFE010 FELDENE 10mg (GE) PIROXICAM 10mg 3.50 CAP
IFE010 FELDENE INJ PIROXICAM 35.00 AMP
TIN040 INDOCID 25mg (GE) INDOMETHACIN 25mg 1.00 CAP
TLO008 LODINE 200mg ETODOLAC 200mg 6.25 CAP
TME048 MESULID 100mg NIMESULIDE 100mg 3.00 TAB
TMO005 MOBIC 15mg MELOXICAM 10mg 10.00 TAB
TMO004 MOBIC 7.5mg MELOXICAM 7.5mg 7.00 TAB
AMO010 MOHRUS PATCH KETOPROFEN 84.00 BOX
IMY010 MYOCRISIN INJ 20mg NA AUROTHIOMALATE 60.00 AMP
TNA010 NAPROSYN 250mg (GE) NAPROXEN 250mg 2.30 TAB
TNI024 NIDOL 100mg NIMESULIDE 100mg 2.80 TAB
MBR020 BRUFEN SUSPENSION
100MG/5ML 90ml
IBUPROFEN 65.00 BOT
MNU020 NUROFEN SYRUP
100mg/5mL 60mL (GE)
IBUPROFEN 0.50 ML
TOR020 ORUVAIL 100mg KETOPROFEN 100mg 3.30 CAP
TOR030 ORUVAIL 200mg KETOPROFEN 200mg 5.50 CAP
TPL010 PLAQUENIL 200mg HYDROXYCHLOROQUINE 200mg 14.00 TAB
MPO020 PONSTAN SUSPENSION
50mg/5mL (GE)
MEFENAMIC ACID 0.17 ML
MPO022
PONSTAN SUSPENSION
250mg/5mL MEFENAMIC ACID 0.17 ML
TRE010 RELIFEX 500mg NABUMETONE 500mg 8.00 TAB
TRI008 RIDAURA 3mg AURANOFIN 3mg 14.00 TAB
TSA020 SALAZOPYRIN EN 500mg SULFASALAZINE 500mg 4.10 TAB
CPA110 SIMPONI 50mg/0.5 mL GOLIMUMAB 12000.00 UNIT
TSY010 SYNFLEX 275mg NAPROXEN SODIUM 275mg 2.50 TAB
TTI020 TILCOTIL 20mg (GE) TENOXICAM 20mg 2.50 TAB
TVI028 VIOXX 25mg ROFECOXIB 25mg 6.50 TAB
TVI029 VIOXX 50mg ROFECOXIB 50mg 9.50 TAB
TVO020 VOLTAREN 25mg (GE) DICLOFENAC SODIUM 25mg 2.00 TAB
TVO022 VOLTAREN 50mg DICLOFENAC SODIUM 50mg 7.00 TAB
TVO021 VOLTAREN 50mg (GE) DICLOFENAC SODIUM 50mg 4.00 TAB
IVO010 VOLTAREN INJ 75mg (GE) DICLOFENAC SODIUM 58.00 AMP
TVO028 VOLTAREN SR 100mg DICLOFENAC SODIUM 100mg 10.00 TAB
TVO031 VOLTAREN SR 100mg CAP
(GE)
DICLOFENAC SODIUM 100mg 4.50 CAP
TVO030 VOLTAREN SR 100mg TAB
(GE)
DICLOFENAC SODIUM 100mg 5.00 TAB
TVO032 VOLTAREN SR 75mg DICLOFENAC SODIUM 75mg 7.40 TAB
TVO034 VOLTAREN SR 75mg (GE) DICLOFENAC SODIUM 75mg 4.50 TAB
PVO010 VOLTAREN SUPP 100mg
(GE)
DICLOFENAC SODIUM 14.00 SUPP
PVO004 VOLTAREN SUPP 12.5mg DICLOFENAC SODIUM 5.40 SUPP
PVO006 VOLTAREN SUPP 25mg DICLOFENAC SODIUM 7.90 SUPP
AVO005 VOLTAREN PATCH 15mg
5's
DICLOFENAC SODIUM 55.00 BOX
AVO006 VOLTAREN PATCH LARGE
30mg 7's
DICLOFENAC SODIUM 101.50 BOX
GOUT
PREPARTBE010 BENEMID 500mg (GE) PROBENECID 500mg 3.80 TAB
TCO040 COLCHICINE 0.5mg (GE) COLCHICINE 0.5mg 1.00 TAB
TFE004 FEBURIC 80mg FEBUXOSTAT 80mg 20.30 TAB
TZY010 ZYLORIC 100mg (GE) ALLOPURINOL 100mg 1.00 TAB
TZY012 ZYLORIC 300mg (GE) ALLOPURINOL 300mg 2.80 TAB
TZY014 ZYLORIC 300mg ALLOPURINOL 300mg 7.00 TAB
TAT020 ATIVAN 0.5mg LORAZEPAM 0.5mg 2.00 TAB
TAT022 ATIVAN 1mg LORAZEPAM 1mg 3.00 TAB
TLE032 LEXOTAN 1.5mg BROMAZEPAM 1.5mg 3.00 TAB
TLE030 LEXOTAN 1.5mg (GE) BROMAZEPAM 1.5mg 3.00 TAB
MINOR TRANQUILLISERS
ANTIRHEUMATICS, ANTIINFLAMMATORY ANALGESICS
Page 11 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
TLE034 LEXOTAN 3mg BROMAZEPAM 5.00 TAB
TVA010 VALIUM 2mg (GE) DIAZEPAM 2mg 1.50 TAB
TVA012 VALIUM 5mg (GE) DIAZEPAM 5mg 2.00 TAB
IVA010 VALIUM INJ 10mg/2mL DIAZEPAM 60.00 AMP
PVA012 VALIUM RECTAL TUBE
5mg (GE)
DIAZEPAM 80.00 TUB
PVA010 VALIUM RECTAL TUBE
10mg (GE)
DIAZEPAM 100.00 TUB
TLA060 LARGACTIL 25mg CHLORPROMAZINE 25mg 1.70 TAB
TLA061 LARGACTIL 25mg (GE) CHLORPROMAZINE 25mg 1.20 TAB
TST008 STELAZINE 2mg (GE) TRIFLUOPERAZINE 2mg 1.50 TAB
TST010 STELAZINE 5mg (GE) TRIFLUOPERAZINE 5mg 2.00 TAB
TDO070 DORMICUM 7.5mg MIDAZOLAM 7.5mg 4.50 TAB
TDO080 DORMICUM 15mg MIDAZOLAM 15mg 8.00 TAB
IDO010 DORMICUM INJ 5mg/mL MIDAZOLAM 55.00 AMP
IDO011 DORMICUM INJ 5mg/5mL MIDAZOLAM 55.00 AMP
IDO012 DORMICUM INJ 15mg/3ml MIDAZOLAM 90.00 AMP
IGA010 GARDENAL INJ 200mg/mL
(PHENOBARBITONE)
PHENOBARBITONE 30.00 AMP
THA010 HALCION 0.25mg TRIAZOLAM 0.25mg 5.40 TAB
THE010 HEMINEVRIN 300mg CLOMETHIAZOLE 300mg 4.30 CAP
TLO034 LORAMET 1mg LORMETAZEPAM 1mg 5.50 TAB
TMO020 MOGADON 5mg (GE) NITRAZEPAM 5mg 4.10 TAB
IPA010 PARALDEHYDE INJ PARALDEHYDE 50.00 AMP
TRO040 ROHYPNOL 2mg (GE) FLUNITRAZEPAM 2mg 8.00 TAB
TST030 STILNOX 10mg ZOLPIDEM 10mg 4.30 TAB
TST031 STILNOX 10mg (GE) ZOLPIDEM TARTRATE 10mg 3.10 TAB
TDI070 DILANTIN 100mg PHENYTOIN SODIUM 100mg 4.40 CAP
TDI072 DILANTIN 30mg PHENYTOIN SODIUM 30mg 4.40 CAP
TEP010 EPILIM 200mg SODIUM VALPROATE 200mg 3.50 TAB
TEP030 EPILIM CHRONO 200mg SODIUM VALPROATE 250mg 3.50 TAB
TEP028 EPILIM CHRONO 300mg SODIUM VALPROATE 300mg 4.40 TAB
TEP020 EPILIM CHRONO 500mg SODIUM VALPROATE 500mg 7.00 TAB
MEP010 EPILIM SF LIQUID
200mg/5mL 300mL
SODIUM VALPROATE 1.10 ML
TKE028 KEPPRA 250mg LEVETIRACETAM 11.60 TAB
TKE030 KEPPRA 500mg LEVETIRACETAM 21.30 TAB
TKE032 KEPPRA 1000mg LEVETIRACETAM 48.00 TAB
CPA050 KEPPRA SYRUP 100mg/ml LEVETIRACETAM 100mg 4.10 ML
CPA132
LAMICTAL DISPERSIBLE 5
mg LAMOTRIGINE 5mg 3.80 TAB
TLA024 LAMICTAL 50mg LAMOTRIGINE 50mg 11.80 TAB
TLA026 LAMICTAL 100mg LAMOTRIGINE 100mg 19.40 TAB
TLY008 LYRICA 25mg PREGABALIN 25mg 13.20 CAP
TLY009 LYRICA 50mg PREGABALIN 50mg 13.50 CAP
TLY010 LYRICA 75mg PREGABALIN 75mg 13.60 CAP
TLY011 LYRICA 150mg PREGABALIN 150mg 21.90 TAB
TNE034 NEURONTIN 100mg GABAPENTIN 100mg 8.80 CAP
TNE035
NEURONTIN 100mg (GE)-
[GABAPENTIN] GABAPENTIN 100mg 5.00 CAP
TNE036 NEURONTIN 300mg GABAPENTIN 300mg 10.50 CAP
TNE037 NEURONTIN 300mg (GE) GABAPENTIN 300mg 7.00 CAP
TPH020 PHENOBARBITONE 15mg PHENOBARBITONE SODIUM 15mg 1.00 TAB
TPH022 PHENOBARBITONE 30mg PHENOBARBITONE SODIUM 30mg 1.50 TAB
MPH014 PHENOBARBITONE SYRUP
15mg/5mL
PHENOBARBITONE 0.30 ML
TRI050 RIVOTRIL 0.5mg CLONAZEPAM 0.5mg 2.00 TAB
TTE010 TEGRETOL 200mg (GE) CARBAMAZEPINE 200mg 2.00 TAB
TTE020 TEGRETOL CR 200mg CARBAMAZEPINE 200mg 5.50 TAB
MTE020 TEGRETOL SYRUP 2%
250mL
CARBAMAZEPINE 0.56 ML
CPA073 TEGRETOL CR 400MG CARBAMAZEPINE 8.00 TAB
CPA056 TOPAMAX 50mg TOPIRAMATE 19.00 TAB
TTO030 TOPAMAX 25mg TOPIRAMATE 12.60 TAB
TTO032 TOPAMAX 100mg TOPIRAMATE 100mg 33.50 TAB
TTR036 TRILEPTAL 300mg OXCARBAZEPINE 300mg 5.60 TAB
CPA129
VIMPAT FILM-COATED
TAB 50 mg LACOSAMIDE 50mg 19.00 TAB
CPA130
VIMPAT FILM-COATED
TAB 100 mg LACOSAMIDE 100mg 35.00 TAB
CPA131
VIMPAT FILM-COATED
TAB 150 mg LACOSAMIDE 150mg 52.00 TAB
TAR004 ARCALION 200 SULBUTIAMINE 200mg 4.20 TAB
TME062 METHYCOBAL 500mcg MECOBALAMIN 500mcg 5.00 TAB
TME054 METHYCOBAL 500mg MECOBALAMIN 500mg 3.40 TAB
TNO030 NOOTROPIL 400mg (GE) PIRACETAM 400mg 2.00 CAP
TNO032 NOOTROPIL 800mg PIRACETAM 800mg 8.20 TAB
TNO033 NOOTROPIL 800mg (GE)
[VICK-TROPIL]
PIRACETAM 2.50 CAP
CPA100 PIRACETAM (GE) 1200mg PIRACETAM 4.00 CAP
TAV010 AVOMINE 25mg PROMETHAZINE THEOCLATE 25mg 0.80 TAB
TGR012 GRAVOL 50mg DIMENHYDRINATE 50mg 1.00 TAB
TGR010 GRAVOL 50mg (GE) DIMENHYDRINATE 50mg 1.00 TAB
MGR010 GRAVOL SYRUP 15mg/5mL
(GE)
DIMENHYDRINATE 0.40 ML
IGR010 GRAVOL INJ 50mg/mL DIMENHYDRINATE 25.00 ML
IGR011 GRAVOL
<DIMENHYDRINATE> INJ
50mg/mL10mL
DIMENHYDRINATE 28.00 ML
PGR010 GRAVOL SUPP (PAED)
50mg (GE)
DIMENHYDRINATE 5.60 SUPP
IKY010 KYTRIL [GRANISETRON]
1mg/mL INJ
GRANISETRON 121.00 AMP
TMA034 MARZINE 50mg CYCLIZINE HCL 50mg 4.40 TAB
MAJOR TRANQUILLISERS
NOOTROPICS & NEUROTONICS
HYPNOTICS & SEDATIVES
ANTICONVULSANTS
ANTIEMETICS & ANTIVERTIGO DRUGS
Page 12 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
TMA048 MAXOLON 5mg METOCLOPRAMIDE 5mg 1.00 TAB
TMA050 MAXOLON 10mg (GE) METOCLOPRAMIDE 10mg 1.00 TAB
MMA020 MAXOLON SYRUP
5mg/5mL (GE)
METOCLOPRAMIDE 0.23 ML
IMA020 MAXOLON INJ 10mg/2mL METOCLOPRAMIDE 30.00 AMP
TNA026 NAVIDOXINE MECLIZINE HCL, PYRIDOXINE HCL 1.50 TAB
TNA036 NAVOBAN 5mg TROPISETRON 5mg 270.00 TAB
INA010 NAVOBAN INJ 5mg/5mL TROPISETRON 350.00 AMP
TST020 STEMETIL 5mg (GE) PROCHLORPERAZINE 5mg 0.50 TAB
IST010 STEMETIL INJ 12.5mg/mL PROCHLORPERAZINE 25.00 AMP
TZO017 ZOFRAN 4mg ONDANSETRON HCL DIHYDRATE
4mg
52.00 TAB
TZO018 ZOFRAN 8mg ONDANSETRON HCL DIHYDRATE
8mg
214.00 TAB
IZO004 ZOFRAN [ondansetron] 4mg
INJECTION
ONDANSETRON 192.50 AMP
IZO006 ZOFRAN [ondansetron] 8mg
INJECTION
ONDANSETRON 140.00 AMP
TAR006 ARICEPT 5mg DONEPEZIL 5mg 29.00 TAB
TEB010 EBIXA 10mg MEMANTINE HCL 10mg 15.80 TAB
TAM010 AMANTADINE SULFATE
100mg
AMANTADINE SULFATE 100mg 5.00 TAB
TAR010 ARTANE 2mg (GE) TRIHEXYPHENIDYL HCL 2mg 1.50 TAB
TAZ004 AZILECT 1mg RASAGILINE 37.00 TAB
TCO055 COMTAN 200mg ENTACAPONE 14.50 TAB
ICO008 COGENTIN INJ 2mg/2mL BENZTROPINE MESYLATE 75.00 AMP
TJU012 JUMEX SELEGILINE HCL 5mg 13.20 TAB
TJU010 JUMEX 5mg (GE) SELEGILINE HCL 5mg 6.00 TAB
TLE017 LEVOMED 100/25mg LEVODOPA 100mg 2.20 TAB
TMA020 MADOPAR 250mg LEVODOPA, BENSERAZIDE 8.20 TAB
TMA018 MADOPAR DISPERSIBLE
125mg
LEVODOPA, BENSERAZIDE 5.90 TAB
TMA019 MADOPAR HBS 125mg LEVODOPA, BENSERAZIDE 5.70 CAP
ANE060 NEUPRO PATCH 2mg ROTIGOTINE 47.00 PC
ANE062 NEUPRO PATCH 4mg ROTIGOTINE 51.00 PC
ANE064 NEUPRO PATCH 6mg ROTIGOTINE 58.50 PC
ANE066 NEUPRO PATCH 8mg ROTIGOTINE 73.50 PC
TPA060 PARLODEL 2.5mg (GE) BROMOCRIPTINE MESYLATE 2.5mg 6.00 TAB
TRE028 REQUIP 0.25mg AMORPHOUS AESCIN 6.80 TAB
TRE029 REQUIP 1mg ROPINIROLE 12.50 TAB
TRE030 REQUIP 2mg ROPINIROLE 14.30 TAB
TRE032 REQUIP PD 2mg ROPINIROLE 2mg 21.70 TAB
TRE033 REQUIP PD 4mg ROPINIROLE 4 mg 38.00 TAB
TSI032 SINEMET 25/100 CARBIDOPA. LEVODOPA (25/100mg) 5.20 TAB
TSI030 SINEMET 25/250 CARBIDOPA, LEVODOPA (25/250mg) 8.90 TAB
TSI034 SINEMET CR 50/200 CARBIDOPA, LEVODOPA (50/200mg) 7.40 TAB
TME044 MESTINON 10mg PYRIDOSTIGMINE BROMIDE 10mg 2.60 TAB
TME046 MESTINON 60mg PYRIDOSTIGMINE BROMIDE 60mg 11.00 TAB
TNO040 NORGESIC (GE) ORPHENADRINE, PARACETAMOL 1.10 TAB
TME045
PYRIDOSTIGMINE> 10mg
[JM-PYRIDOSTIGMINE] PYRIDOSTIGMINE 2.30 TAB
ITE010 TENSILON INJ 10mg/mL EDROPHONIUM CHLORIDE 50.00 AMP
TRI032 RILUTEK 50mg RILUZOLE 50mg 100.00 TAB
TUB010 UBRETID 5mg DISTIGMINE BROMIDE 5mg 7.90 TAB
TBA002 BACLOFEN 10mg BACLOFEN 10mg 2.50 TAB
TCA069 CARISOPRODOL 125mg 0.60 TAB
TLI024 LIORESAL 10mg (GE) BACOLFEN 10mg 2.00 TAB
TMY018 MYDOCALM 50mg TOLPERISONE HYDROCHLORIDE
50mg
1.60 TAB
TQU010 QUININE BISULPHATE 300
mg
QUININE BISULPHATE 300mg 2.50 TAB
TQU020 QUININE SULPHATE 200mg QUININIE SULPHATE 200mg 2.70 TAB
TRO020 ROBAXIN 500mg METHOCARBAMOL 500mg 3.00 TAB
TAN013 ANDRIOL TESTOCAP 40mg TESTOSTERONE UNDECANOATE 12.00 CAP
CAN018 ANDROGEL 50mg TESTOSTERONE 25.00 TAB
TDA020 DANOCRINE 200mg DANAZOL 200mg 13.00 CAP
TDA022 DANOCRINE 200mg (GE) DANAZOL 200mg 10.00 CAP
INE004 NEBIDO 25% 1000mg/4mL INJTESTOSTERONE UNDECANOATE 1700.00 AMP
TPR140 PROVIRON 25mg MESTEROLONE 25mg 12.00 TAB
ISU010 SUSTANON INJ 250mg/mL TESTOSTERONE PROPIONATE 30mg,
DECABIATE 100mg
205.00 AMP
ITE012 TESTOSTERONE IMPLANT
100mg
TESTOSTERONE 250.00 AMP
ITE020 TESTOVIRON INJ 250mg TESTOSTERONE 270.00 VIA
TAC024 ACTIVELLE 28's ESTRADIOL, NORETHISTERONE 5.00 TAB
TAN014 ANDROCUR 50mg CYPROTERONE ACETATE 29.00 TAB
TAN016 ANGELIQ 28's ESTRADIOL 1mg, DROSPIRENONE
2mg
15.00 TAB
TCL024 CLIMEN 28's ESTRADIOL VALERATE 3.00 TAB
PCY010 CYCLOGEST PESSARY
200mg
PROGESTERONE 20.00 PES
PCY012 CYCLOGEST PESSARY
400mg
PROGESTERONE 38.00 PES
TCY030 CYCLO-PROGYNOVA 2mg
21's
OESTRADIOL
VALERATE,NORGESTREL
5.30 TAB
TDI074 DILENA 21's ESTRADIOL,
MEDROXYPROGESTERONE
5.00 TAB
CPA127 DEPO PROVERA
150MG/ML SUSP., 1ML/
MEDROXYPROGESTERONE
ACETATE
190.00 AMP
TDO056 DOSTINEX 0.5mg CABERGOLINE 132.00 TAB
TDU018 DUPHASTON 10mg DYDROGESTERONE 10mg 11.00 TAB
TES020 ESTRACOMB TTS 50 ESTRADIOL, NORETHISTERONE 245.00 BOX
TES030 ESTRADERM TTS 25 6'S 17 BETA-ESTRADIOL 2mg 170.00 BOX
TES032 ESTRADERM TTS 50 17 BETA-ESTRADIOL 4mg 160.00 BOX
TES034 ESTRADERM TTS 100 (6
PCs)
17 BETA-ESTRADIOL 8mg 200.00 BOX
CES010 ESTREVA GEL 0.1% 50g NATURAL ESTRADIOL 0.1% 2.70 g
MUSCLE RELAXANTS
ANDROGENS & RELATED SYNTHETIC DRUGS
NEURODEGENERATIVE DISEASE DRUGS
ANTIPARKINSONIAN DRUGS
OESTROGEN & PROGESTERONES & RELATED SYNTHETIC DRUGS
NEUROMUSCULAR DISORDER DRUGS
Page 13 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
TES040 ESTROFEM 28's OESTRADIOL 2mg 2.60 TAB
TFE012 FEMARA 2.5mg LETROZOLE 61.00 TAB
TFE013 FEMOSTON 2/10 28'S OESTRADIOL + 155.00 PK
CPA091 KLIOGEST ESTRADIOL, NORETHISTERONE 4.50 TAB
TLI050 LIVIAL 2.5mg 30's TIBOLONE 2.5mg 14.50 TAB
TLU010 LUTENYL 5mg NOMEGESTROL ACETATE 5mg 6.00 TAB
CPA064 NORCOLUT 5mg NORETHISTERONE 2.70 TAB
TNO085 NOVOFEM
ESTRADIOL 1mg,NORETHISTERONE
ACETATE 1mg 4.00 TAB
IOE012 OESTRADIOL IMPLANT
50mg
OESTRADIOL 320.00 AMP
IOF010 OESTRADIOL IMPLANT
100mg
OESTRADIOL 520.00 AMP
COE010 OESTROGEL 0.06% 80g NATURAL 17B-ESTRADIOL 0.06% 1.80 g
TOV008 OVESTIN 1mg 30's ESTRIOL 1mg 3.80 TAB
TPR030 PREMARIN 0.3mg CONJUGATED OESTROGENS 0.3mg 3.40 TAB
TPR032 PREMARIN 0.625mg CONJUGATED OESTROGENS 0.625mg 4.80 TAB
TPR034 PREMARIN 1.25mg CONJUGATED OESTROGENS 1.25mg 3.50 TAB
TPR036 PREMELLE 0.625mg/2.5mg
28's
MEDROXYPROGESTERONE,
OESTROGEN
5.70 TAB
TPR038 PREMELLE CYCLE 28's MEDROXYPROGESTERONE,
OESTROGEN
3.30 TAB
TPR040 PREMPAK 0.625mg 31's MEDROGESTONE, OESTROGENS 2.74 TAB
TPR050 PREMPAK-C 0.625mg 40's NORGESTREL, OESTROGENS 4.00 TAB
TPR052 PREMPAK-C 1.25mg 40's NORGESTREL, OESTROGENS 4.00 TAB
TPR080 PRIMOLUT-N 5mg (GE) NORETHISTERONE 5mg 2.90 TAB
IPR038 PROGESTERONE INJ 50mg PROGESTERONE 50.00 AMP
IPR040 PROGESTERONE INJ 50mg
+ESTRADIOL BENZOATE
PROGESTERONE/ESTRADIOL 110.00 AMP
TPR094 PROGYNOVA 2mg 28's ESTRADIOL VALERATE 2mg 2.70 TAB
IPR054 PROLUTON DEPOT INJ
250mg
HYDROXYPROGESTERONE 130.00 AMP
TPR130 PROVERA 5mg MEDROXYPROGESTERONE
ACETATE
3.90 TAB
TPR132 PROVERA 10mg MEDROXYPROGESTERONE
ACETATE
5.70 TAB
TST022 STILBOESTROL 1mg DIETHYLSTILBOESTROL 0.20 TAB
TST024 STILBOESTROL 5mg DIETHYLSTILBOESTROL 0.30 TAB
TTR060 TRISEQUENS 28's ESTRADIOL, NORETHISTERONE 4.80 TAB
TUT010 UTROGESTAN 100mg PROGESTERONE MICRONISED 100mg 5.00 TAB
CPA153 VAGIFEM VAGINAL TAB
10mcg
ESTRADIOL 18.00 TAB
PVA020 VAGIFEM VAGINAL TAB
25mcg
ESTRADIOL 22.00 TAB
PVA021 VAGIFEM VAGINAL TAB
10mcg 18'S
ESTRADIOL 16.00 PES
CPA093 COLIFOAM ENEMA HYDROCORTISONE 500.00 PC
TCO084 CORTONE 25mg CORTISONE ACETATE 25mg 2.80 TAB
TCO095 CORTEF 20mg HYDROCORTISONE 20mg 3.90 TAB
TDE020 DECADRON 0.5mg (GE) DEXAMETHASONE 0.5mg 1.20 TAB
TDE070 DEXAMETHASONE 4mg DEXAMETHASONE 4mg 2.00 TAB
IDE010 DEPO-MEDROL INJ 40
mg/mL
METHYLPREDNISOLONE ACETATE 145.00 VIA
IDE030 DEPO-
MEDROL+LIDOCAINE INJ
METHYLPREDNISOLONE,
LIDOCAINE
155.00 VIA
IDE038 DEXAMETHASONE INJ
4mg/mL
DEXAMETHASONE SODIUM
PHOSPHATE
25.00 AMP
IDE040 DEXAMETHASONE INJ
50mg/10mL
DEXAMETHASONE SODIUM
PHOSPHATE
25.00 ML
CPA155 DEXAMETHASONE-
HOSPIRA INJ 8 mg/2 mL
DEXAMETHASONE NA PHOSPHATE 70.00 AMP
IDI020 DIPROSPAN INJ 1mL BETAMETHASONE DIPROPIONATE... 90.00 AMP
TFL020 FLORINEF 0.1mg FLUDROCORTISONE ACETATE 0.1mg 2.70 TAB
IHY010 HYDROCORTISONE INJ
100mg/2mL
HYDROCORTISONE 125.00 VIA
THY005 HYDROCORTISONE 20mg HYDROCORTISONE 20mg 2.00 TAB
IKE020 KENACORT-A IA/ID INJ
10mg/mL 5mL
TRIAMCINOLONE ACETONIDE 37.00 ML
IKE010 KENACORT-A IM INJ 40
mg/mL
TRIAMCINOLONE ACETONIDE 150.00 AMP
IKE011 KENACORT-A IM INJ 40
mg/mL (GE)
TRIAMCINOLONE ACETONIDE 70.00 AMP
IKE021 KENACORT-A
{Triamicinolone} IA/ID INJ
TRIAMICINOLONE ACETONIDE 57 ML
TME010 MEDROL 4mg METHYLPREDNISOLONE 4mg 2.75 TAB
TPR018 PREDNISOLONE 1mg PREDNISOLONE 1mg 0.50 TAB
TPR020 PREDNISOLONE 5mg (GE) PREDNISOLONE 5mg 1.20 TAB
DPR014
PREDNISOLONE 0.5%
MINIMS (20'S/BOX) PREDNISOLONE 26.50 PC
MPR010 PREDNISOLONE
SUSPENSION 10mg/5mL
PREDNISOLONE 0.28 ML
IPR010 PREDNISOLONE INJ
25mg/mL 20mL
PREDNISOLONE 25.00 ML
CPA108 REDIPRED (RASPBERRY
FLAVOUR) 5 mg/1 mL x 30
PREDNISOLONE NA 90.00 BOT
MRE020 REDIPRED ORAL LIQUID
5mg/ml
PREDNISOLONE 100.00 BOT
ISO080 SOLU-MEDROL 500mg METHYLPREDNISOLONE NA
SUCCINATE
520.00 VIA
CAC020 ACTHAR GEL 40 UNITS ADRENOCORTICOTROPIC HORMONE 330.00 VIA
ICO020 CORTROSYN DEPOT INJ
1mg/mL
TETRACOSACTIDE HEXAACETATE 330.00 VIA
IDE006 DECAPEPTYL CR INJ TRIPTORELIN 1350.00 VIA
IDE005 DECAPEPTYL INJ 0.1mg TRIPTORELIN 150.00 VIA
IDI016 DIPHERELINE PR INJ
3.75mg
TRIPTORELIN 1740.00 VIA
IEN012 ENANTONE INJ 11.25mg LEUPRORELIN ACETATE 5240.00 VIA
IEN010 ENANTONE INJ 3.75mg LEUPRORELIN ACETATE 2050.00 VIA
IGO012 GONAL-F 150IU/mL FOLLITROPIN ALFA 700.00 VIA
IGO010 GONAL-F 1050IU/1.75mL FOLLITROPIN ALFA 3200.00 VIA
AMI010 MIRENA LEVONORGESTREL 2555.00 SET
AMO020 Mona Lisa CU 375 IUD 375 220.00 PIE
IPR036 PROFASI INJ 10,000IU HUMAN CHORIONIC
GONADOTROPHIN
280.00 AMP
IPR034 PROFASI INJ 5,000 IU HUMAN CHORIONIC
GONADOTROPHIN
150.00 AMP
SSU010 SUPRECUR NASAL SPRAY BUSERELIN ACETATE 690.00 BOT
SSY020 SYNAREL NASAL SPRAY
2mg/mL
NAFARELIN ACETATE 2100.00 BOT
IZO010 ZOLADEX DEPOT INJ
3.6mg
GOSERELIN ACETATE 3.6mg 2500.00 AMP
IZO012 ZOLADEX LA DEPOT INJ
10.8mg
GOSERELIN ACETATE 10.8mg 6040.00 AMP
IZO030 ZOMACTON
[SOMATROPIN] 4MG
SOMATROPIN 1000.00 AMP
IPR015 PREGNYL INJ 5,000iu/mL HUMAN CHORIONIC
GONADOTROPHIN
165.00 AMP
CEPHA
LOSPORTCE008 CECLOR 250mg (GE) CEFACLOR MONOPHYDRATE 4.30 CAP
CORTICOSTEROID HORMONES
TROPHIC HORMONES & RELATED SYNTHETIC DRUGS
Page 14 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
TCE009 CECLOR 500mg (GE)-
[CEFALOR PLUS]
CEFACLOR 7.50 CAP
TCE010 CECLOR MR 375mg CEFACLOR MONOHYDRATE 375mg 13.00 TAB
MCE012 CECLOR SUSPENSION
125mg/5mL (GE)
CEFACLOR MONOHYDRATE 1.20 ML
MCE010 CECLOR SUSPENSION
125mg/5mL 60mL
CEFACLOR MONOHYDRATE 1.10 ML
TCE020 CEDAX 200mg CEFTIBUTEN DIHYDRATE 200mg 25.50 CAP
MCE020 CEDAX SUSPENSION
180mg/5mL 30mL
CEFTIBUTEN DIHYDRATE 4.50 ML
ICE010 CEFOBID INJ 1g CEFOPERAZONE SODIUM 440.00 VIA
TCL040 CLOXACILLIN CLOXACILLIN SODIUM 250mg 2.50 CAP
TDU019 DURACEF 250mg CEFADROXIL MONOHYDRATE 250mg 3.50 CAP
CPA047 CEFADROXIL 500mg (GE) CEFADROXIL 500mg 4.00 CAP
TKE010 KEFLEX 250mg (GE) CEPHALEXIN MONOHYDRATE
262.5mg
3.00 CAP
TKE020 KEFLEX 500mg (GE) CEPHALEXIN MONOHYDRATE 575mg 5.00 CAP
MKE010 KEFLEX SUSPENSION 125
mg/5mL 60mL
CEPHALEXIN 0.90 ML
MKE012 KEFLEX SUSPENSION
125mg/5mL 60mL (GE)
CEPHALEXIN 0.70 ML
CPA084 MAXIPIME IM/IV 1g CEFEPIME HCI 350.00 VIA
IRO013 ROCEPHIN IM 500g (GE) LIGNOCAINE CEFTRIAXONE 150.00 AMP
IRO014 ROCEPHIN INJ 250mg CEFTRIAXONE DISODIUM 120.00 VIA
IRO015 ROCEPHIN INJ 250mg (GE) CEFTRIAXONE DISODIUM 105.00 VIA
IRO012 ROCEPHIN INJ 500mg CEFTRIAXONE DISODIUM 185.00 VIA
IRO010 ROCEPHIN INJ 1g CEFTRIAXONE DISODIUM 380.00 VIA
IRO011 ROCEPHIN INJ 1g (GE) CEFTRIAXONE DISODIUM 330.00 VIA
TVE010 VELOSEF 250mg CEPHRADINE 250mg 5.90 CAP
IZI010 ZINACEF 250mg INJ CEPHRADINE NA 150.00 AMP
TZI010 ZINNAT 125mg CEFUROXIME AXETIL 125mg 9.80 TAB
TZI012 ZINNAT 250mg CEFUROXIME AXETIL 250mg 18.00 TAB
TZI014 ZINNAT 500mg CEFUROXIME AXETIL 500mg 59.00 TAB
MZI006 ZINNAT 125mg/5mL
SUSPENSION
CEFUROXIME AXETIL 2.10 ML
MACRO
LIDESTER010 ERYTHROMYCIN 250mg ERYTHROMYCIN 250mg 1.50 TAB
MER010 ERYTHROMYCIN
GRANULES 200mg/5mL
ERYTHROMYCIN ETHYLSUCCINATE 0.50 ML
MER020 ERYTHROMYCIN
SUSPENSION 125mg/5mL
ERYTHROMYCIN 0.33 ML
TKL010 KLACID 250mg CLARITHROMYCIN 250mg 12.20 TAB
TKL013 KLACID 250mg (GE) CLARITHROMYCIN 250mg 6.00 TAB
TKL011 KLACID 500mg CLARITHROMYCIN 500mg 25.00 TAB
TKL012 KLACID MR 500mg CLARITHROMYCIN 250mg 22.60 TAB
MKL010 KLACID SUSPENSION
125mg/5mL 60mL
CLARITHROMYCIN 1.70 ML
MKL012 KLACID SUSPENSION
125mg (GE) SACHET
CLARITHROMYCIN 6.50 SACH
TRU010 RULID 150mg ROXITHROMYCIN 150mg 13.70 TAB
TZI020 ZITHROMAX 250mg AZITHROMYCIN DIHYDRATE 250mg 22.50 TAB
TZI021 ZITHROMAX 250mg (GE) AZITHROMYCIN 14.00 TAB
MZI010 ZITHROMAX SUSPENSION
200MG/5ML 15ML
AZITHROMYCIN DIHYDRATE 6.20 ML
IDE042 DEXAMETHASONE
8mg/2mL INJ
DEXAMETHASONE 65.00 VIA
IDO020 DOXORUBICIN-EBEWE INJ
50MG/25ML
DOXORUBICIN 983.40 VIA
IEL001 ELOXATIN
[OXALIPLATINE] 50mg INJ
OXALIPLATINE 2750.00 VIA
IEL002 ELOXATIN
[OXALIPLATINE] 100mg
OXALIPLATINE 5200.00 VIA
IEN030 ENDOXAN INJ 1G CYCLOPHOSPHAMIDE 567.60 VIA
IPA020 PARAPLATIN INJ
150mg/15mL
CARBOPLATIN 1080.00 VIA
TPU010 PURI-NETHOL 50mg 6-MERCAPTOPURINE 50mg 70.00 TAB
ITA010 TAXOTERE CONC FOR INF
20mg/0.5ml
DOCETAXEL 2664.000 VIA
ITA012 TAXOTERE CONC FOR
INF. 80mg/2ml
DOCETAXEL 9526.000 VIA
TXE005 XELODA [capecitabine]
150mg
CAPECITABINE 11.00 TAB
TXE006 XELODA [capecitabine]
500mg
CAPECITABINE 37.00 TAB
TCA075 CASODEX [bicalutamide]
150mg
BICALUTAMIDE 283.00 TAB
TFL060 FLUTAMIDE 250mg(G.E) FLUTAMIDE 11.50 TAB
IHE060 HERCEPTIN 150mg TRASTUZUMAB 8976.00 VIA
IHE062 HERCEPTIN 440mg TRASTUZUMAB 25740.00 VIA
TJA002 JAKAVI [ruxolitinib] 5mg RUXOLITINIB 357.00 TAB
TJA003 JAKAVI [ruxolitinib] 20mg RUXOLITINIB 895.00 TAB
TSP030 SPRYCEL[dasatinib] 50mg DASATINIB 435.00 TAB
TXA013 XALKORI 250mg 60's CRIZOTNIB 250mg 1166.00 CAP
PENICIL
LINSTAM020 AMOXIL 250mg (GE) AMOXYCILLIN 250mg 2.20 CAP
TAM022 AMOXIL 500mg (GE) AMOXYCILLIN 500mg 3.50 CAP
MAM010 AMOXIL SYRUP
125mg/5mL (GE)
AMOXYCILLIN TRIHYDRATE 0.42 ML
MAM012 AMOXIL SYRUP
125mg/5mL 60mL- NEO
CHEM
AMOXYCILLIN 0.49 ML
TAM030 AMPICILLIN 250mg AMPICILLIN 250mg 1.50 CAP
TAM032 AMPICILLIN 500mg AMPICILLIN 500mg 2.00 CAP
MAM020 AMPICILLIN SYRUP
125mg/5mL (GE)
AMPICILLIN 0.25 ML
IAM030 AMPICILLIN INJ 500mg AMPICILLIN 45.00 VIA
TAM040 AMPICLOX 500mg (GE) AMPICILLIN, CLOXACILLIN 4.00 CAP
MAM030 AMPICLOX SYRUP
250mg/5mL (GE)
AMPICILLIN, CLOXACILLIN 0.50 ML
TAU010 AUGMENTIN 375mg AMOXYCILLIN, CLAVULANATE K 8.00 TAB
TAU011 AUGMENTIN 375mg (GE)-
[AMOXYCILLIN,
CLAVULANIC ACID]
AMOXYCILLIN, CLAVULANATE K
6.000
TAB
CPA126 AUGMENTIN 625mg AMPICILLIN, CLOXACILLIN 8.00 TAB
TAU012 AUGMENTIN 1g AMOXYCILLIN, CLAVULANIC ACID 11.00 TAB
TAU014 AUGMENTIN 1g (GE) AMOXYCILLIN CLAVULANIC ACID 8.00 TAB
TARGETED CANCER THERAPY
HORMONAL CHEMOTHERAPY
CYTOTOXIC CHEMOTHERAPY
Page 15 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
MAU010 AUGMENTIN SYRUP
156mg/5mL (60mL)
AMOXYCILLIN, CLAVULANATE K 1.05 ML
MAU020 AUGMENTIN BD SYRUP
457mg/5mL, 35mL
AMOXYCILLIN, CLAVULANIC ACID 2.90 ML
MAU011
AUGMENTIN SYRUP
156.25mg/5mL 100mL (GE)- AMOXYCILLIN, CLAVULANIC ACID 1.00 ML
CPA133
CURAM 156.25mg/5 mL
ORAL SUSP, 60mL x 1's AMOXYCILLIN, CLAVULANATE K 30.00 BOT
CPA134
CURAM 312.5mg/5 mL
ORAL SUSP, 60mL x 1's AMOXYCILLIN, CLAVULANATE K 50.00 BOT
CPA135
CURAM 457mg/5 mL ORAL
SUSP, 35mL x 1's AMOXYCILLIN, CLAVULANATE K 70.00 BOT
CPA142 CURAM 375 mg
AMOXYCILLIN, CLAVULANATE
POTASSIUM 6.00 TAB
CPA143 CURAM 1,000 mg
AMOXYCILLIN, CLAVULANATE
POTASSIUM 11.00 TAB
MFL012 FLUCLOXACILLIN ELIXIR
125mg/5mL
FLUCLOXACILLIN 0.50 ML
TOR010 ORBENIN 250mg (GE) CLOXACILLIN 2.50 CAP
MOR010 ORBENIN SYRUP
125mg/5mL 100mL (GE)
CLOXACILLIN 0.45 ML
IPE010 PENADUR LA INJ 1.2MU
4mL
BENZATHINE PENICILLIN G 110.00 VIA
TPE020 PENGLOBE 400mg BACAMPICILLIN 400mg 4.00 TAB
IPE016 PENICILLIN G INJ 600mg BENZYLPENICILLIN SODIUM 35.00 VIA
IPE017 PENICILLIN G INJ 1M IU BENZYLPENICILLIN SODIUM 60.00 VIA
MPE010 PENICILLIN V
SUSPENSION 125mg/5mL
PHENOXYMETHYLPENICILLIN 0.25 ML
TPE010 PEN-V K 250 mg (GE) PHENOXYMETHYLPENICILLIN 250mg 1.00 TAB
IPR030 PROCAINE PENICILLIN G
INJ
PROCAINE PENICILLIN 40.00 VIA
QUINOL
ONESTAV008 AVELOX 400mg MOXIFLOXACIN HCl 400mg 45.00 TAB
TCI010 CIPROXIN 250mg CIPROFLOXACIN 250mg 11.60 TAB
TCI008 CIPROXIN 250mg (GE) CIPROFLOXACIN 250mg 7.70 TAB
TCI009 CIPROXIN 500mg (GE) CIPROFLOXACIN 500mg 11.27 CAP
TCR006 CRAVIT 100mg LEVOFLOXACIN 100mg 8.10 TAB
TCR007 CRAVIT 250mg LEVOFLOXACIN 250mg 16.00 TAB
TCR008 CRAVIT 500mg LEVOFLOXACIN 500mg 29.00 TAB
DCR011
CRAVIT EYE DROPS (GE)-
[LEVOFLOXACIN] LEVOFLOXACIN 40.00 BOT
TLE020 LEXINOR 100mg NORFLOXACIN 100mg 4.50 TAB
TLE021 LEXINOR 400mg TAB NORFLOXACIN 400mg 15.00 TAB
TTA030 TARIVID 100mg OFLOXACIN 100mg 6.00 TAB
TTA036 TARIVID 100mg (GE) OFLOXACIN 100mg 4.20 TAB
TTA032 TARIVID 200mg OFLOXACIN 200mg 11.00 TAB
TTA034 TARIVID 200mg (GE) OFLOXACIN 200mg 8.60 TAB
TUR026 UROTRACTIN PIPEMIDIC ACID 400mg 8.50 CAP
TWI012 WINTOMYLON 500mg NALIDIXIC ACID 500mg 3.10 TAB
TWI010 WINTOMYLON 500mg (GE) NALIDIXIC ACID 500mg 2.50 TAB
TMI072 MINOCIN 50mg MINOCYCLINE HCL 50mg 5.00 CAP
TMI074 MINOCIN 50mg (GE) MINOCYCLINE HCL 50mg 3.50 CAP
TMI070 MINOCIN 100mg MINOCYCLINE HCL 100mg 10.00 CAP
TMI080 MINOCIN MR 100mg MINOCYCLINE HCL 100mg 13.00 CAP
TMI076 MINOCIN 100mg (GE) MINOCYCLINE HCL 100mg 6.00 CAP
TOX010 OXY-TETRACYCLINE 250
mg
OXYTETRACYCLINE HCL 250mg 0.70 CAP
TTE060 TETRACYCLINE 250 mg TETRACYCLINE 250mg 0.90 CAP
TTE070 TETRALYSAL 300 CAP TETRALYSAL 300 CAP 10.00 CAP
TVI018 VIBRAMYCIN 50mg DOXYCYCLINE HYCLATE 50mg 4.00 TAB
TVI020 VIBRAMYCIN 100mg (GE) DOXYCYCLINE HYCLATE 100mg 3.00 TAB
CPA139 VIBRAMYCIN FILM-
COATED TAB 100 mg
DOXYCYXLINE 9.00 TAB
CPA063 CLOZOLE PESSARY 500MG CLOTRIMAZOLE 5.00 TAB
TDI058 DIFLUCAN 50mg FLUCONAZOLE 50mg 85.00 TAB
TDI059 DIFLUCAN 50mg (GE) FLUCONAZOLE 50mg 40.00 CAP
TDI060 DIFLUCAN 150mg FLUCONAZOLE 150mg 180.00 CAP
TDI062 DIFLUCAN 150mg (GE) FLUCONAZOLE 150mg 105.00 CAP
MDI006 DIFLUCAN SUSPENSION
50mg/5mL
FLUCONAZOLE 16.50 ML
TGR030 GRISEOSTATIN 330mg GRISEOFULVIN ULTRAMICROSIZE 4.30 TAB
TGR020 GRISOVIN 125mg GRISEOFULVIN 125mg 1.20 TAB
TGR021 GRISOVIN 125mg (GE) GRISEOFULVIN 125mg 1.20 TAB
TGR022 GRISOVIN 500mg GRISEOFULVIN 500mg 3.00 TAB
TGR023 GRISOVIN 500mg (GE) GRISEOFULVIN 500mg 2.80 TAB
TLA030 LAMISIL 250mg TERBINAFINE 250mg 21.00 TAB
TLA031 LAMISIL 250mg (GE) TERBINAFINE 250mg 14.00 TAB
TMY016 MYCOSTATIN 500,000U
(GE)
NYSTATIN 500,000U 1.30 TAB
MMY010 MYCOSTATIN DROPS
100,000 unit/mL (GE)
NYSTATIN 4.00 ML
TNI060 NIZORAL 200mg KETOCONAZOLE 200mg 26.00 TAB
TNI062 NIZORAL 200mg (GE) KETOCONAZOLE 200mg 7.00 TAB
TSE040 SEPTRIN (GE) TRIMETHOPRIM,
SULFAMETHOXAZOLE
1.50 TAB
MSE010 SEPTRIN SUSPENSION (GE) TRIMETHOPRIM,
SULFAMETHOXAZOLE
0.27 ML
TSP020 SPORANOX 100mg ITRACONAZOLE 100mg 28.00 CAP
TSP022 SPORANOX 100mg (GE) ITRACONAZOLE 100mg 17.00 CAP
IAR003 ARANESP [darbepoetin]
100mcg/0.5ml PRE-FILLED
DARBEPOETIN 100mcg 1892.00 SYR
TDA018 DALACIN C 150mg CLINDAMYCIN 150mg 7.60 CAP
TDA019 DALACIN C 300mg CLINDAMYCIN 300mg 10.50 CAP
TDA034 DAPSONE 100mg DAPSONE 100mg 1.50 TAB
TFL010 FLAGYL 200mg (GE) METRONIDAZOLE 200mg 1.70 TAB
CPA 079 FLAGYL 200mg
(BRANDED)
METRONIDAZOLE 200mg 3.00 TAB
MFL010 FLAGYL-S SUSPENSION
200mg/5mL 100mL
METRONIDAZOLE 1.80 ML
TFL011 FLAGYL 250mg(G.E) METRONIDAZOLE 2.50 TAB
TFL012 FLAGYL 400mg METRONIDAZOLE 7.00 TAB
TFU010 FURADANTIN 50mg (GE) NITROFURANTOIN 50mg 1.30 TAB
IGE010 GENTAMYCIN INJ
80mg/mL + LIDOCAINE 1%
GENTAMICIN, LIDOCAINE 70.00 VIA
IIN080 INVANZ INJ 1g ERTAPENEM 1g 525.00 VIA
ILI020 LINCOCIN INJ 3g/10mL LINCOMYCIN 100.00 VIA
TETRACYCLINES
ANTIFUNGALS
OTHER ANTIBIOTICS
Page 16 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
TLO030 LORABID 200mg LORACARBEF 200mg 32.00 CAP
MMO006 MONUROL 3g FOSFOMYCIN TROMETAMOL 82.50 SACH
IST020 STREPTOMYCIN INJ 1g STREPTOMYCIN 40.00 VIA
CPA 081 TRIMETHOPRIM HCI TRIMETHOPRIM HCI 1.50 ML
ITR030 TROBICIN INJ 2g SPECTINOMYCIN HCL 205.00 VIA
IGE008 GENTAMYCIN INJ
80mg/2mL
GENTAMICIN 50.00 AMP
CPA057 UNASYN 375mg AMPICILLIN SODIUM / SULBACTAM
SODIUM
8.60 TAB
CPA100 ZYVOX 600mg LINZOLID 540.00 TAB
TZY060 ZYVOX [linezolid] 600mg LINEZOLID 517.00 TAB
TIS010 ISONIAZID 100mg (GE) ISONIAZID 100mg 0.50 TAB
TIS012 ISONIAZID 50mg (GE) ISONIAZID 50mg 0.40 TAB
MRI010 MPR050 100mg/5mL RIFAMPICIN 2.00 ML
TMY010 MYAMBUTOL 100mg ETHAMBUTOL 100mg 2.20 TAB
TMY012 MYAMBUTOL 400mg ETHAMBUTOL 400mg 4.80 TAB
TMY013 MYAMBUTOL 400mg (GE) ETHAMBUTOL 400mg 4.40 TAB
TPY010 PYRAMIDE 500mg (GE) PYRAZINAMIDE 500mg 2.00 TAB
TRI010 RIFADIN 150mg (GE) RIFAMPICIN 150mg 4.50 CAP
TRI012 RIFADIN 300mg (GE) RIFAMPICIN 300mg 7.00 CAP
TRI030 RIFADIN 450mg (GE) RIFAMPICIN 450mg 10.00 TAB
TRI014 RIFATER RIFAMPICIN/INH/PYRAZINAMIDE 7.50 TAB
TRI018 RIFINAH 150mg RIFAMPICIN,ISONIAZID 150/100mg 8.60 TAB
TRI020 RIFINAH 300mg RIFAMPICIN,ISONIAZID 300/150mg 19.00 TAB
TFA020 FASIGYN 500mg (GE) TINIDAZOLE 500mg 12.00 TAB
TBI010 BILTRICIDE 600mg PRAZIQUANTEL 600mg 160.00 TAB
TCO050 COMBANTRIN 125mg PYRANTEL PAMOATE 125mg 6.00 TAB
TCO051 COMBANTRIN 125mg (GE) PYRANTEL PAMOATE 125mg 3.00 TAB
MCO040 COMBANTRIN
SUSPENSION 125mg/5mL
PYRANTEL PAMOATE 2.00 ML
MCO042 COMBANTRIN
SUSPENSION 250mg/5mL
PYRANTEL PAMOATE 5.50 ML
TDE030 DECARIS 50mg LEVAMISOLE 50mg 10.00 TAB
TVE040 VERMOX 100mg MEBENDAZOLE 100mg 6.50 TAB
TVE041 VERMOX 100mg (GE) MEBENDAZOLE 100mg 4.50 TAB
CPA080 VERMOX 500mg
(BRANDED)
MEBENDAZOLE 100mg 48.00 TAB
MVE020 VERMOX SUSPENSION
100mg/5mL 30mL
MEBENDAZOLE 3.00 ML
MAC005 ACICLOVIR SUSPENSION
100mg/5mL
ACICLOVIR 0.25 ML
CAL030 ALDARA CREAM 5% IMIQUIMOD 5% CREAM 720.00 BOX
TBA007 BARACLUDE 0.5mg ENTECAVIR 90.00 TAB
TCO066 COPEGUS (RIBAVIRIN)
200mg
RIBAVIRIN 200mg 0.00 TAB
TFA010 FAMVIR 125mg FAMCICLOVIR 125mg 35.00 TAB
TFA012 FAMVIR 250mg FAMCICLOVIR 250mg 38.00 TAB
TFA013
FAMVIR 250mg (GE)-
[FAMCICLOVIR] FAMCICLOVIR 30.00 TAB
THE016 HEPSERA 10mg ADEFOVIR DIPIVOXIL 10mg 75.00 TAB
IPE006 PEG-INTRON REDIPEN INJ
80mcg
RECOMBINANT ALPHA-2B
INTERFERON
1700.00 PEN
IPE004 PEGASYS INJ INTERFERON ALPHA-2A 1680.00 SYR
IPE005 PEGASYS INJ 180mcg/0.5mL ITERFERON ALPHA-2A 1750.00 SYR
IPE007 PEG-INTRON INJ 120mcg
(C.U.)
ALPHA-2B INTERFERON 450.00 VIA
IPE008 PEG-INTRON REDIPEN INJ
100mcg
ALPHA-2B INTERFERON 1700.00 PEN
SRE006 RELENZA INHALER ZANAMIVIR 320.00 BOX
TSE005 SEBIVO 600mg TELBIVUDINE 600mg 56.50 TAB
TTA023 TAMIFLU 75mg OSELTAMIVIR PHOSPHATE 75mg 32.00 CAP
MTA010 TAMIFLU SUSPENSION
12mg/mL x 62mL
OSELTAMIVIR 5.00 ML
TVA020 VALTREX 500mg VALACICLOVIR 500mg 22.00 TAB
TVI027 VIREAD 300mg TENOFOVIR DISOPROXIL
FUMARATE
110.00 TAB
TZE004 ZEFFIX 100mg LAMIVUDINE 100mg 35.00 TAB
TZO030 ZOVIRAX 200mg ACYCLOVIR 200mg 27.60 TAB
TZO031 ZOVIRAX 200mg (GE) ACYCLOVIR 200mg 7.00 TAB
TZO032 ZOVIRAX 400mg ACYCLOVIR 400mg 16.40 TAB
TZO033 ZOVIRAX 400mg (GE) ACYCLOVIR 400mg 10.00 TAB
TZO034 ZOVIRAX 800mg ACYCLOVIR 800mg 20.50 TAB
TZO035 ZOVIRAX 800mg (GE) ACYCLOVIR 800mg 13.00 TAB
MZO010 ZOVIRAX SUSPENSION
200mg/5mL 125mL
ACYCLOVIR 5.40 ML
TAR030 ARIMIDEX 1mg ANASTROZOLE 82.00 TAB
TCA072 CASODEX BICALUTAMIDE 151.00 TAB
CEF022 EFUDIX CREAM 5% 20g 5-FLUORO-URACIL 12.50 g
CEF020 EFUDIX OINTMENT 5% 20g 5-FLUORO-URACIL 12.50 g
TEN010 ENDOXAN 50mg CYCLOPHOSPHAMIDE 50mg 13.50 TAB
IFL010 FLUORO-URACIL INJ
250mg/5mL
5-FLUOROURACIL 80.00 VIA
THY004 HYDREA 500mg HYDROXYUREA 500mg 11.80 CAP
IIN020 INTRON-A INJ 3MIU +
RIBARIVARIN 200mg TAB
INTERFERON ALPHA-2b 580.00 VIA
TME050 METHOTREXATE 2.5mg METHOTREXATE 2.5mg 8.80 TAB
IME007 METHOTREXATE 10mg INJ METHOTREXATE 10mg 40.00 AMP
IME009 METHOTREXATE 25mg/mL INJMETHOTREXATE 160.00 VIA
IMI005 MITOMYCIN-C 2mg MITOMYCIN 130.00 AMP
TNO010 NOLVADEX 10mg (GE) TAMOXIFEN CITRATE 10mg 3.50 TAB
TNO020 NOLVADEX-D 20mg TAMOXIFEN CITRATE 20mg 28.10 TAB
TNO022 NOLVADEX-D 20mg (GE) TAMOXIFEN CITRATE 20mg 6.50 TAB
IRO016 ROFERON-A INJ 3MIU INTERFERON ALPHA 2A 500.00 VIA
TLA070 LARIAM 250mg (GE) MEFLOQUINE 250mg 41.00 TAB
TMA025 MALARONE ATOVAQUONE, PROGUANIL HCL 73.50 TAB
ANTIMALARIALS
ANTINEOPLASTICS
ANTIAMOEBICS
ANTHELMINTICS
ANTIVIRALS
ANTITUBERCULOUS AGENTS
Page 17 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
TNI050 NIVAQUIN 200mg (GE) CHLOROQUINE PHOSPHATE 200mg 1.00 TAB
PAL010 ALBOTHYL VAGINAL
SUPP 90mg
POLICRESULEN 14.50 PES
PBE010 BETADINE PESSARY
200mg
POVIDONE IODINE 5.00 PES
PCA010 CANESTEN PESSARY
100mg 6'S
CLOTRIMAZOLE 17.00 PES
PCA011 CANESTEN VAGINAL TAB
500MG
CLOTRIMAZOLE 120.00 PES
PCA012 CANESTEN PESSARY 500
mg 1's (GE)
CLOTRIMAZOLE 43.00 PES
CPA154 CANESTEN PESSARY 500
mg
CLOTRIMAZOLE 85.00 PES
PCO010 COLPOSEPTINE PESSARY PROMESTRIENE, CHLORQUINALDOL 7.00 PES
CDI006 DIENOESTROL CREAM
0.01% 78g
DIENOESTROL 0.01% 1.92 g
PGI010 GINETRIS PESSARY CHLORAMPHENICOL/MYRALACT//C
LOP
7.80 PES
PGY020 GYNE-LOTREMIN
PESSARY 100mg
CHLORAMPHENICOL/MYRALACT//C
LOP
11.00 PES
PGY016 GYNO-PEVARYL PESSARY
150mg
ECONAZOLE NITRATE 40.00 PES
PGY010 GYNO-TRAVOGEN
PESSARY 300mg
ISOCONAZOLE NITRATE 35.00 PES
PGY030 GYNO-TROSYD PESSARY TIOCONAZOLE 36.00 PES
PGY008 GYNOFLOR VAGINAL TAB
VIABLE LACTOBACILLUS
ACIDOPHILUS ,ESTRIOL 17.00 PES
CPA116 GYNOFLOR VAGINAL CAP
VIABLE LACTOBACILLUS
ACIDOPHILUS ,ESTRIOL 8.00 CAP
CPA140
GYNOPHILUS VAG CAP
341 341 mg
LACTOBACILLUS CASEI V.
RHAMNOSUS DODERLEIN (LCR35) 8.60 CAP
PMY010 MYCOSTATIN PESSARY
100,000U (GE)
NYSTATIN 3.20 PES
CPR010 PREMARIN VAGINAL
CREAM 42.5g
CONJUGATED ESTROGENS 6.00 g
CPA117 PREMARIN VAGINAL
CREAM 0.625 mg/1 g x 14 g
CONJUGATED ESTROGENS 70.00 TUB
PTA010 TALSUTIN PESSARY TETRACYCLINE, AMPHOTERICIN B 4.50 PES
PZA010
ZALAIN VAGINAL OVULE
300mg SERTACONAZOLE 75.00 PES
MCI010 CITRAVESCENT
GRANULES
SODIUM BICARBONATE, CITRIC
ACID…
2.50 PK
TUR024 UROCIT-K POTASSIUM CITRATE 6.50 TAB
MMI010 MIST POTASSIUM
CITRATE
POTASSIUM CITRATE 0.40 ML
TAV009 AVODART 0.5mg DUTASTERIDE 14.70 CAP
THA032 HARNAL D 0.2mg TAMSULOSIN HCl 15.00 TAB
TCE050 CETIPRIN NOVUM 200mg EMEPRONIUM CARRAGEENATE
200mg
4.10 TAB
CPA044 DETRUSITOL 1mg TOLTERODINE I-TARTRATE 1mg 9.10 TAB
TDE044 DETRUSITOL 2mg TOLTERODINE I-TARTRATE 2mg 10.60 TAB
TDI110 DITROPAN 5mg (GE) OXYBUTYNIN CHLORIDE 5mg 2.00 TAB
THA030 HARNAL OCAS 0.4mg TAMSULOSIN HYDROCHLORIDE 13.50 TAB
THY010 HYTRIN 1mg TERAZOSIN HCL 1mg 5.10 TAB
THY012 HYTRIN 2mg TERAZOSIN HCL 2mg 8.30 TAB
THY013 HYTRIN 5mg TERAZOSIN HCL 5mg 23.00 TAB
TPR110 PROSCAR 5mg FINASTERIDE 5mg 15.00 TAB
TPR112 PROSCAR 5mg (GE) FINASTERIDE 5mg 10.00 TAB
TPY020 PYRIDIUM 100mg PHENAZOPYRIDINE HCL 100mg 1.20 TAB
TPY022 PYRIDIUM 100mg (GE) PHENAZOPYRIDINE HCL 100mg 1.00 TAB
TXA016 XATRAL SR 5mg ALFUZOSIN HCL 5mg 6.00 TAB
TXA018 XATRAL XL 10mg ALFUZOSIN HCL 10mg 8.00 TAB
TVE060 VESICARE 5mg SOLIFENACIN SUCCINATE 5mg 10.50 TAB
INSULIN
IAC010 ACTRAPID HM 100IU/mL
(10mL)
INSULIN 355.00 VIA
IAC020 ACTRAPID HM PENFILL
100IU/mL (3mL)
INSULIN 105.00 AMP
IAC030 ACTRAPID-MC 100IU/mL
(10mL)
INSULIN 310.00 VIA
IAP010 APIDRA SOLOSTAR
100IU/mL
INSULIN HUMAN SHORT 140.00 AMP
IHU006 HUMALOG MIX 25 100U/mL KWIPENINSULIN LISPRO 25% ,INSULIN LISPRO PROTAMINE 75%195.00 AMP
IHU007
HUMALOG 100U/mL x
10mL INSULIN LISPRO 500.00 VIA
IHU008 HUMALOG 100IU/mL
PENFILL 5x3mL
INSULIN 180.00 AMP
IHU010 HUMULIN 70/30 100IU/mL
(10mL)
INSULIN (SOLUBLE + ISOPHANE) 260.00 VIA
IHU020 HUMULIN 70/30 PENFILL
100IU/mL (3mL)
INSULIN (SOLUBLE + ISOPHANE) 85.00 AMP
IHU030 HUMULIN L 100IU/mL
(10mL)
LENTE INSULIN 260.00 VIA
IHU040 HUMULIN N 100IU/mL
(10mL)
360.00 VIA
IHU042 HUMULIN N PENFILL
100IU/ML (3mL)
ISOPHANE INSULIN 85.00 AMP
IHU050 HUMULIN R 100IU/mL
(10mL)
INSULIN 260.00 VIA
ILA020 LANTUS 100IU/mL 3mL INSULIN 144.00 AMP
ILA022 LANTUS 100IU/mL 10mL INSULIN GLARGINE 180.00 VIA
ILA021 LANTUS OPTISET
100IU/mL 3mL
INSULIN GLARGINE 144.00 AMP
CPA082 LANTUS SOLOSTAR PRE-
FILLED PEN
INSULIN GLARGINE 160.00 PC
ILE020 LEVEMIR FLEXPEN
100U/mL
INSULIN DETEMIR 198.00 AMP
IMI013 MIXTARD HM PENFILL
10/90 100IU/mL 5x3mL
INSULIN (SOLUBLE + ISOPHANE) 80.00 AMP
IMI012 MIXTARD HM PENFILL
20/80 100IU/mL 5x3mL
INSULIN (SOLUBLE + ISOPHANE) 80.00 AMP
IMI010 MIXTARD HM PENFILL
30/70 100IU/mL 5x3mL
INSULIN (SOLUBLE + ISOPHANE) 105.00 AMP
IMI014 MIXTARD HM PENFILL
50/50 100IU/mL 5X3mL
INSULIN (SOLUBLE + ISOPHANE) 80.00 AMP
IMI020 MIXTARD-HM 100IU/mL
(10mL)
INSULIN (SOLUBLE + ISOPHANE) 355.00 VIA
IMO010 MONOTARD-HM 100IU/mL
(10mL)
INSULIN ZINC SUSPENSION 260.00 VIA
IMO020 MONOTARD-MC 100IU/mL
(10mL)
INSULIN ZN SUSPENSION(PORCINE) 310.00 VIA
INO010 NOVOMIX 30 FLEXPEN
100U/mL
INSULIN ASPART 205.00 AMP
INO020 NOVORAPID PENFILL
100u/mL 3mL
INSULIN ASPART 205.00 AMP
INO021
NOVORAPID FLEXPEN
100U/mL (3mL) INSULIN ASPART 205.00 AMP
TNO050 NORMIX 200mg RIFAXIMIN 40.00 TAB
IPR060 PROTAPHANE HM
PENFILL 100IU/mL (3mL)
INSULIN ISOPHANE 105.00 AMP
IPR062 PROTAPHANE-HM
100IU/mL (10mL)
INSULIN ISOPHANE 355.00 VIA
IPR064 PROTAPHANE-MC
100IU/mL (10mL)
INSULIN 270.00 VIA
IUL010 ULTRATARD HM 100IU/mL
(10mL)
INSULIN CRYSTALLINE SUSPENSION 260.00 VIA
APE050 PEN ULTRA 3mL 460.00 PC
URINARY ANTISEPTICS
DRUGS FOR BLADDER & PROSTATE DISORDERS
OTHER DRUGS ACTING ON GENITO-URINARY SYSTEM
ORAL ANTIDIABETIC AGENTS
PREPARATIONS FOR VAGINAL CONDITIONS
Page 18 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
TAC028 ACTOS 30mg PIOGLITAZONE 30mg 33.00 TAB
TAC029 ACTOSMET 15mg/850 28'S
PIOGLITAZONE HCl 15MG,
METFORMIN HCl 850MG 19.00 TAB
TAC031 ACTOS 15mg PIOGLITAZONE 19.40 TAB
TAV001 AVANDAMET 1mg/500mg ROSIGLITAZONE 1mg, METFORMIN
500mg
5.00 TAB
TAV002 AVANDAMET 2mg/500mg ROSIGLITAZONE 2mg, METFORMIN
500mg
8.60 TAB
TAV003 AVANDAMET 4mg/500mg ROSIGLITAZONE 4mg, METFORMIN
500mg
14.20 TAB
TAV011 AVANDAMET 4mg/1000mg
ROSIGLITAZONE MELEATE
4mg,METFORMIN 1000mg 14.20 TAB
CPA102 AMARYL 1mg GLIMEPIRIDE 1mg 2.50 TAB
TAM014 AMARYL 2mg GLIMEPIRIDE 2mg 5.00 TAB
TAM016 AMARYL 4mg GLIMEPIRIDE 4mg 8.00 TAB
TAV004 AVANDIA 2mg ROSIGLITAZONE MALEATE 2mg 9.30 TAB
TAV006 AVANDIA 4mg ROSIGLITAZONE MALEATE 4mg 17.60 TAB
TAV007 AVANDIA 8mg ROSIGLITAZONE MALEATE 8mg 31.00 TAB
TDA030 DAONIL 5mg (GE) GLIBENCLAMIDE 5mg 1.50 TAB
TDI010 DIABINESE 250mg (GE) CHLORPROPAMIDE 250mg 1.50 TAB
TDI018 DIAMICRON MR 30mg GLICLAZIDE MR 30mg 4.80 TAB
TDI019
DIAMICRON MR 30mg
(GE)-[GLICLAZIDE] GLICLAZIDE 3.20 TAB
TDI017
DIAMICRON MR 60mg 30'S
[GLICLAZIDE] GLICLAZIDE 9.60 TAB
TDI020 DIAMICRON 80mg (GE) GLICLAZIDE 80mg 2.70 TAB
TGA002 GALVUS MET 50mg/850mg VILDAGLIPTIN 50mg, METFORMIN 850mg 7.60 TAB
TGA003 GALVUS MET 50mg/500mg
VILDAGLIPTIN 50mg, METFORMIN
500mg 7.60 TAB
TGA004 GALVUS MET 50mg/1000mg VILDAGLIPTIN 50mg, METFORMIN 1000mg 7.60 TAB
TGA005 GALVUS 50mg VILDAGLIPTIN 7.10 TAB
TGL012 GLUCOBAY 50mg ACARBOSE 50mg 3.40 TAB
TGL010 GLUCOBAY 100mg ACARBOSE 100mg 3.50 TAB
TGL020 GLUCOPHAGE 250mg (GE) METFORMIN HCL 250mg 0.50 TAB
TGL022 GLUCOPHAGE 500mg METFORMIN HCL 500mg 1.00 TAB
TGL023 GLUCOPHAGE XR 500mg METFORMIN 500mg 2.50 TAB
TGL025 GLUCOPHAGE XR 750mg METFORMIN 3.65 TAB
TGL024 GLUCOPHAGE 850mg METFORMIN HCL 850mg 2.50 TAB
TGL030 GLUCOTROL XL 5mg GLIPIZIDE 5mg 4.20 TAB
TGL040 GLUCOVANCE
500mg/2.5mg
METFORMIN, GLIBENCLAMIDE 2.00 TAB
TGL041 GLUCOVANCE 500mg/5mg METFORMIN HCL; GLIBENCLAMIDE 2.00 TAB
TJA020 JANUVIA 100mg SITAGLIPTIN 100mg 17.50 TAB
TJA022 JANUMET 50mg/500mg SITAGLIPTIN 50mg, METFORMIN
500mg
8.75 TAB
TJA023 JANUMET 50mg/1000mg
SITAGLIPTIN PHOSPHATE 50mg,
METFORMIN 1000mg 8.75 TAB
TME020 MELBIN 250mg METFORMIN HCL 250mg 2.40 TAB
TMI040 MINIDIAB 5mg GLIPIZIDE 5mg 4.00 TAB
TN0090 NOVONORM 0.5mg REPAGLINIDE 0.5mg 3.40 TAB
TN0092 NOVONORM 1mg REPAGLINIDE 1mg 4.20 TAB
TNO094 NOVONORM 2mg REPAGLINIDE 2 mg 5.50 TAB
TON040 ONGLYZA 5mg SAXAGLIPTIN 12.000 TAB
CPA118 ONGLYZA FILM-COATED
TAB
SAXAGLIPTIN HCI 13.00 TAB
TRA010 RASTINON 500mg (GE) TOLBUTAMIDE 500mg 1.00 TAB
IBY010 BYETTA 5mcg/20 microlitre EXENATIDE 2400.00 BOX
IBY012 BYETTA 10mcg/20 microlitre EXENATIDE 2400.00 BOX
IVI004 VICTOZA 6mg/mL PRE-FILLED PENLIRAGLUTIDE 1445.00 SYR
TTR004 TRAJENTA 5mg LINAGLIPTIN 15.00 TAB
TEL020 ELTROXIN 100mcg THYROXINE SODIUM 100mcg 1.00 TAB
TTH030 THYROXINE 50mcg THYROXINE 50mcg 0.60 TAB
TTH032 THYROXINE 100mcg THYROXINE 100mcg 1.20 TAB
MLU010 LUGOL'S IODINE
SOLUTION
IODINE 0.60 ML
TNE010 NEO-MERCARZOLE 5mg
(GE)
CARBIMAZOLE 5mg 1.00 TAB
TNE012 NEO-MERCAZOL 5mg CARBIMAZOLE 5mg 0.85 TAB
TPR100 PROPYLTHIOURACIL 50mg PROPYLTHIOURACIL 50mg 1.20 TAB
TPR102 PROPYLTHIOURACIL
200mg
PROPYLTHIOURACIL 200MG 2.20 TAB
TTA026 TAPAZOLE 5mg METHIMAZOLE 5mg 5.00 TAB
TAT030 ATROMID-S 500mg CLOFIBRATE 500mg 3.00 CAP
TBE070 BEZALIP 200mg BEZAFIBRATE 200mg 5.00 TAB
TBE072 BEZALIP RETARD 400mg BEZAFIBRATE 400mg 11.60 TAB
TCA067 CADUET 5mg/10mg AMLODIPINE 5mg, ATORVASTATIN
10mg
15.80 TAB
TCA068 CADUET 10mg/10mg AMLODIPINE 10mg, ATORVASTATIN
10mg
18.70 TAB
TCA073 CADUET 5mg/20mg
AMLODIPINE 5mg, ATORVASTATIN
20mg 24.50 TAB
TCA074 CADUET 10mg/20mg
AMLODIPINE 10mg, ATORVASTATIN
20mg 26.20 TAB
TCR028 CRESTOR 5mg ROSUVASTATIN 5mg 12.90 TAB
TCR030 CRESTOR 10mg ROSUVASTATIN 10mg 16.50 TAB
TCR032 CRESTOR 20mg ROSUVASTATIN 20mg 22.40 TAB
TDU014 DUOLIP 250mg THEOFIBRATE 250mg 2.50 CAP
TDU016 DUOLIP 500mg THEOFIBRATE 500mg 4.80 CAP
TEZ010 EZETROL 10mg EZETIMIBE 10mg 16.50 TAB
TLE010 LESCOL 20mg FLUVASTATIN SODIUM 20mg 4.00 TAB
TLE012 LESCOL 40mg FLUVASTATIN SODIUM 40mg 7.00 TAB
TLE014 LESCOL XL 80mg FLUVASTATIN SODIUM 80mg 7.60 TAB
TLI027
LIPANTHYL 300mg (GE) -
[FENOFIBRATE] FENOFIBRATE 300mg 8.00 CAP
TLI028 LIPANTHYL 100mg FENOFIBRATE 100mg 3.00 TAB
TLI029 LIPANTHYL 200mg FENOFIBRATE 200mg 15.30 TAB
TLI030 LIPANTHYL 300mg FENOFIBRATE 300mg 12.10 TAB
TLI040 LIPITOR 10mg ATORVASTATIN 10mg 11.80 TAB
TLI041 LIPITOR 10mg [ATACOR] ATORVASTATIN CALCIUM 7.20 TAB
ANTITHYROIDS
ANTIDIABETIC AGENTS
THYROID PREPARATIONS
ANTIHYPERLIPIDAEMIC AGENTS
Page 19 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
TLI042 LIPITOR 20mg ATORVASTATIN 20mg 17.40 TAB
TLI043 LIPITOR 20mg [ATACOR] ATORVASTATIN CALCIUM 11.00 TAB
TLI044 LIPITOR 40mg ATORVASTATIN 40mg 28.90 TAB
TLI045 LIPITOR 80mg ATORVASTATIN 80mg 47.00 TAB
TLI046 LIPOBAY 0.2mg CERIVASTATIN SODIUM 0.2mg 12.50 TAB
TLI051 LIPITOR 10mg [LIPISTAD
10] 30'S
ATORVASTATIN 7.20 TAB
TLI052 LIPITOR 20mg [LIPISTAD
20] 30'S
ATORVASTATIN 11.00 TAB
TLO020 LOPID 300mg (GE) GEMFIBROZIL 300mg 3.15 CAP
TLO021 LOPID 600mg GEMFIBROZIL 600mg 8.00 CAP
TLO022 LOPID 600mg (GE) GEMFIBROZIL 600mg 4.40 TAB
TLO024 LOPID 900mg GEMFIBROZIL 900mg 9.50 TAB
TME060 MEVACOR 20mg LOVASTATIN 20mg 11.30 TAB
TME061 MEVACOR 20mg (GE) LOVASTATIN 20mg 7.00 TAB
TNI004 NIASPAN 375mg NICOTINIC ACID 375mg 7.45 TAB
TNI005 NIASPAN 500mg NICOTINIC ACID 500mg 9.00 TAB
TNI006 NIASPAN 1000mg NICOTINIC ACID 1000mg 17.10 TAB
TNI010 NICOBID 250mg NIACIN 5.50 CAP
TOL010 OLBETAM 250mg ACIPIMOX 250mg 9.50 CAP
TPR010 PRAVACHOL 10mg PRAVASTATIN SODIUM 10mg 10.00 TAB
TPR012 PRAVACHOL 20mg PRAVASTATIN SODIUM 20mg 16.00 TAB
TPR014 PRAVACHOL 40mg PRAVASTATIN SODIUM 40mg 18.00 TAB
MQU010 QUESTRAN GRANULES 9g CHOLESTYRAMINE RESIN 12.00 SACH
TTR028 TREDAPTIVE 1G/20mg ER NIACIN, LAROPIPRANT 9.40 TAB
CPA068 TREDAPTIVE LAROPIPRANT
NICOTINIC ACID
20.00 TAB
TVY021 VYTORIN 10mg/10mg EZETIMIBE / SIMVASTATIN 14.30 TAB
TVY022 VYTORIN 10mg/20mg EZETIMIBE / SIMVASTATIN 17.60 TAB
TVY024 VYTORIN 10mg/40mg EZETIMIBE, SIMVASTATIN 26.80 TAB
TZO010 ZOCOR 10mg SIMVASTATIN 10mg 7.80 TAB
TZO011 ZOCOR 10mg (GE) SIMVASTATIN 10mg 6.30 TAB
TZO012 ZOCOR 20mg SIMVASTATIN 20mg 8.80 TAB
TZO013 ZOCOR 20mg (GE) SIMVASTATIN 20mg 7.10 TAB
TZO014 ZOCOR 40mg SIMVASTATIN 40mg 16.50 TAB
TZO015 ZOCOR 40mg (GE) SIMVASTATIN 40mg 11.50 TAB
TZO016 ZOCOR 80mg SIMVASTATIN 80mg 18.00 TAB
TAC023
ACTONEL 150mg ONCE-A-
MONTH RISEDRONATE SODIUM 150mg 300.00 TAB
TAC026 ACTONEL 5mg RISEDRONATE SODIUM 5mg 13.50 TAB
TAC027 ACTONEL 35mg RISEDRONATE SODIUM 35mg 75.00 TAB
TEV010 EVISTA 60mg RALOXIFENE HCL 60mg 16.90 TAB
TFO020 FOSAMAX 10mg ALENDRONATE SODIUM 10mg 16.00 TAB
TFO022 FOSAMAX 70mg ALENDRONATE SODIUM 70mg 81.00 TAB
TFO023 FOSAMAX 70mg (GE) ALENDRONATE SODIUM 70mg 60.00 TAB
TFO024 FOSAMAX PLUS ALENDRONATE, COLECALCIFEROL 81.00 TAB
TFO025 FOSAMAX PLUS 5,600IU ALENDRONATE 70mg,
COLECALCIFEROL 5600IU
81.000 TAB
IGL010 GLUCAGON INJ 1mg/1mL LYOPHILISED GLUCAGON HCL 620.00 AMP
TON010 ONE-ALPHA 0.25mcg ALFACALCIDOL 0.25mcg 3.20 CAP
TON012 ONE-ALPHA 1mcg ALFACALCIDOL 1mcg 8.00 CAP
TOS030 OSTAC 520mg CLODRONIC ACID 75.00 TAB
TRO030 ROCALTROL 0.25mcg CALCITRIOL 0.25mcg 8.00 CAP
TRO032 ROCALTROL 0.5mcg CALCITRIOL 0.5mcg 13.00 CAP
CSI020 SILKIS OINTMENT 30g CALCITRIOL 3mcg/g 6.90 g
MGE020 GES 45 KCL, NACL, NA2CO3, GLUCOSE 3.00 SACH
MOR005 ORAL REHYDRATION
SALTS
KCL, NACL, NA CITRATE 2.80 SACH
IMA006 MAGNESIUM SULPHATE
49.3% INJ
MAGNESIUM SULPHATE 70.00 AMP
MPO030 POTASSIUM CHLORIDE
10%
POTASSIUM CHLORIDE 10% 0.50 ML
TPO050
POTASSIUM CHLORIDE
500mg POTASSIUM CHLORIDE 0.80 TAB
DAZ030 AZYTER 15mg/g EYE
DROPS
AZITHROMYCIN 60.000 BOX
DCE010 CEBEMYXINE EYE
OINTMENT 5g
NEOMYCIN, POLYMYXIN B 22.00 TUB
CCH010 CHLORAMPHENICOL
OINTMENT 2%
CHLORAMPHENICOL 2% 0.67 g
DCH010 CHLORAMPHENICOL EYE
DROPS (GE)
CHLORAMPHENICOL 0.5% 12.50 BOT
DCH020 CHLORAMPHENICOL EYE
OINTMENT 1%
CHLORAMPHENICOL 1% 12.00 TUB
DCH022 CHLORAMPHENICOL
OPTICOPS EYE OINTMENT
CHLORAMPHENICOL 1% 2.50 CAP
DCI010 CILOXAN EYE DROPS 0.3% CIPROFLOXACIN HCl 63.00 BOT
DCR010 CRAVIT OPHTHALMIC
SOLUTION
LEVOFLOXACIN 50.00 BOT
DCU010 CUSIVIRAL EYE
OINTMENT
ACYCLOVIR 3% 175.00 TUB
DFU010 FUCITHALMIC EYE DROPS FUSIDIC ACID 1% 78.50 TUB
DFL010 FLAREX EYE DROPS FLUOROMETHOLONE 62.00 BOT
CGA012 GARAMYCIN CREAM 0.3%
15g (GE)
GENTAMICIN SULFATE 0.3% 2.60 g
DGA010 GARAMYCIN EYE DROPS
(GE)
GENTAMICIN SULFATE 0.3% 44.00 BOT
DGA012 GARAMYCIN EYE
OINTMENT
GENTAMICIN SULFATE 0.3% 42.00 TUB
DMU010 MURO 128 5% EYE
OINTMENT
SODIUM CHLORIDE HYPERTONICITY 54.00 TUB
DNE010 NEOSPORIN EYE DROPS POLYMYXINB,NEOMYCIN,GRAMICI
DIN
32.00 BOT
DNE012 NEOSPORIN EYE DROPS
(GE)
POLYMYXIN B SULPHATE 5000 U 38.00 BOT
DNE020 NEOSPORIN EYE
OINTMENT
POLYMYXINB,NEOMYCIN,BACITRA
CIN
50.00 TUB
DNE030 NEVANAC EYE DROPS NEPAFENAC 82.00 BOT
DOK010 OKACIN EYE DROPS LOMEFLOXACIN 0.3% 58.00 BOT
DPH020 PHYSIODOSE EYE &
NASAL DROP 5ml
SODIUM CHLORIDE 5.00 AMP
DPO010 POLYFAX EYE OINTMENT POLYMYXIN B, BACITRACIN 54.00 TUB
DSU010 SULPHACETAMIDE EYE
DROPS 10% (GE)
SULFACETAMIDE SODIUM 10% 15.00 BOT
EYE ANTI-INFECTIVES & ANTISEPTICS
OTHER AGENTS AFFECTING METABOLISM
ELECTROLYTES AND MINERALS
Page 20 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
DSY010 SYSTANE EYE DROPS
15mL
BORIC ACID, CALCIUM CHLORIDE 70.00 BOT
DSY012
SYSTANE EYE DROPS SDU
(28's) BORIC ACID, CALCIUM
CHLORIDE,HYDROXPROPYL GUAR
115.00 BOX
DSY013
SYSTANE ULTRA EYE
DROPS 10mL POLYETHYLENE
GLYCOL,PROPYLENE GLYCOL
62.00 BOT
DTA010 TARIVID EYE DROPS OFLOXACIN 50.00 BOT
DTA012 TARIVID EYE DROPS (GE) OFLOXACIN 28.00 BOT
DTA020 TARIVID EYE OINTMENT OFLOXACIN 3mg/g 60.00 TUB
DTE020 TERRAMYCIN EYE
OINTMENT
OXYTETRACYCLINE, POLYMYXIN B 38.00 TUB
DTO010 TOBREX EYE DROPS TOBRAMYCIN 0.3% 68.00 BOT
DTO011
TOBREX EYE DROPS (GE) -
[TOBRAMYCIN] TOBRAMYCIN 52.00 BOT
DTO012 TOBREX EYE OINTMENT TOBRAMYCIN 0.3% 83.00 BOT
DTR004 TRIHERPINE EYE
OINTMENT 2.5g
TRIFLUOROTHYMIDINE 1% 135.00 TUB
DVI008 VIGAMOX EYE DROPS MOXIFLOXACIN HYDROCHLORIDE
5.4
110.00 BOT
DZO010 ZOVIRAX EYE OINTMENT ACYCLOVIR 3% 355.00 TUB
ITO010 TOBRAMYCIN 40mg/ml TOBRAMYCIN 30.00 VIA
DEF010 EFEMOLINE EYE DROPS FLUOROMETHOLONE 0.1%... 60.00 BOT
DFM010 FML EYE DROPS 0.02%
(GE)
FLUOROMETHOLONE 0.02% 46.00 BOT
DFM012 FML EYE DROPS 0.1% FLUOROMETHOLONE 0.1% 64.00 BOT
DHY006 HYDROCORTISONE EYE
OINTMENT 1%
HYDROCORTISONE 1% 22.00 TUB
DAL019 ALREX EYE DROPS 0.2% LOTEPREDNOL 85.00 BOT
DLO010 LOTEMAX EYE DROPS LOTEPREDNOL ETABONATE 126.00 BOT
DMA014 MAXIDEX EYE DROPS DEXAMETHASONE 0.1% 60.00 BOT
DPR010 PRED FORTE EYE DROPS
1%
PRENISOLONE ACETATE 1% 54.00 BOT
DPR012 PRED-MILD EYE DROPS PRENISOLONE ACETATE 0.12% 49.00 BOT
DSP048 SPERSADEX 0.1% EYE
DROPS
DEXAMETHASONE NA PHOSPHATE 54.00 BOT
DUL008 ULTRACORTENOL EYE
DROPS
PREDNISOLONE 43.00 BOT
DUL010 ULTRACORTENOL EYE
OINT
PREDNISOLONE ACETATE 5mg/mL 63.00 TUB
DVE010 VEXOL 1% EYE DROPS RIMEXOLONE 1% 133.00 BOT
DFM013 FML EYE DROPS 0.1% (GE) FLUOROMETHOLONE 0.1% 52.00 BOT
DBL010 BLEPHAMIDE EYE DROPS SULFACETAMIDE, PREDNISOLONE.. 39.00 BOT
DCO016 CORTIPHENOL-H EYE
OINTMET
HYDROCORTISONE 1%/CHLORAMPH
1%
68.50 TUB
DCO020 CORTISON-KEMICETINE
EYE OINTMENT
CHLORAMPHENICOL,HYDROCORTIS
ONE
32.00 TUB
DDE020 DEXAMETHASONE 0.1% +
CHLORAMPHENICOL 0.5%
DEXAMETHASONE,
CHLORAMPHENICOL
7.00 BOT
DFM020 FML-NEO EYE DROPS FLUOROMETHOLONE, NEOMYCIN 50.00 BOT
DGA020 GARASONE EYE DROPS GENTAMICIN, BETAMETHASONE 55.00 BOT
DGA030 GARASONE EYE
OINTMENT
GENTAMICIN, BETAMETHASONE 42.00 TUB
DMA010 MAXITROL EYE DROPS DEXAMETHASONE, NEOMYCIN... 65.00 BOT
DMA012 MAXITROL EYE
OINTMENT
DEXAMETHASONE, NEOMYCIN... 72.00 BOT
DSP050 SPERSADEX COMP EYE
DROP
DEXAMETHASONE,
CHLORAMPHENICOL
52.00 BOT
DSP010 SPERSADEXOLINE EYE
DROPS
DEXAMETHASONE,
CHLORAMPHENICOL
45.00 BOT
DSP012 SPERSADEXOLINE EYE
DROPS (GE)
DEXAMETHASONE,
CHLORAMPHENICOL
34.50 BOT
DTO022 TOBRADEX EYE DROPS TOBRAMYCIN, DEXAMETHASONE 73.00 BOT
DTO020 TOBRADEX EYE
OINTMENT
TOBRAMYCIN, DEXAMETHASONE 76.00 TUB
DOT020 OTOZAMBON EAR DROPS LIGNOCAINE NEOMYCIN
POLYMYXIN B
45.00 BOT
DAT010 ATROPINE EYE DROPS 1% ATROPINE SULFATE 1% 75.00 BOT
DAT012 ATROPINE EYE
OINTMENT
ATROPINE SULFATE 1% 60.00 TUB
DCY010 CYCLOPENTOLATE EYE
DROPS 0.5%
CYCLOPENTOLATE HCL 0.5% 45.00 BOT
DCY011 CYCLOPENTOLATE EYE
DROPS 0.5% MINIM
CYCLOPENTOLATE HCL 0.5% 21.00 PC
DCY012 CYCLOPENTOLATE EYE
DROPS 1% MINIM
CYCLOPENTOLATE HCL 1% 20.00 PC
DHO010
HOMATRPINE 2% EYE
DROPS HOMATRPINE 100.00 BOT
DMY010 MYDFRIN EYE DROPS
2.5%
PHENYLEPHRINE HCL 2.5% 36.00 BOT
DMY020 MYDRIACYL EYE DROPS
1%
TROPICAMIDE 1% 134.00 BOT
DMY030 MYDRIN-P EYE DROPS TROPICAMIDE,PHENYLEPHERINE
HCL
94.00 BOT
DNY010 NYOLOL EYE DROPS 0.5% TIMOLOL MALEATE 0.5% 53.00 BOT
DPH010 PHENYLEPHERINE
MINIMS 10% EYE DROPS
PHENYLEPHERINE 10% 24.00 PC
DTR006 TROPICAMIDE 0.5%
MINIMS
TROPICAMIDE 0.5% 21.00 PC
MIOTIC
DRUGSIMI004 MIOCHOL-E 20mg INJ ACETYLCHOLINE CI 200.00 AMP
DAC030 ACULAR 0.5% EYE DROPS KETOROLAC TROMETHAMINE 72.00 BOT
DAL018 ALCAINE EYE DROPS PROPARACAINE HCL 0.5% 52.00 BOT
DAL010 ALOMIDE EYE DROPS LODOXAMIDE 0.1% 105.00 BOT
DAL004 ALBALON EYE DROPS NAPHAZOLINE 75.00 BOT
DAL020 ALPHAGAN EYE DROPS BRIMONIDINE TARTRATE 207.50 BOT
DAL022 ALPHAGAN-P 0.15% EYE
DROPS
BRIMONIDINE TARTRATE 0.15% 230.00 BOT
DAM010 AMETHOCAINE EYE
DROPS 1% MINIMS
TETRACAINE 26.50 PC
DAZ010 AZOPT 1% EYE
SUSPENSION
BRINZOLAMIDE 1% 180.00 BOT
DBE020 BETOPIC-S EYE DROPS BETAXOLOL 0.25% 94.00 BOT
DBE010 BETOPTIC EYE DROPS BETAXOLOL 0.5% 105.00 BOT
DBI010 BION TEARS EYE DROPS
0.45mL
DEXTRAN 70%, HYDROXYPROPYL
MET
108.00 BOX
DBL006 BLEPHAGEL POLOXAMER 188/PEG-75/SODIUM BO 131.00 BOX
DCA010 CATALIN EYE DROPS PIRENOXINE Na 70.00 BOT
DCO006 COBAMIN EYE SOLN
0.2mg/mL
CYANOCOBALAMIN 60.00 BOT
DCO009 COMBIGAN EYE DROPS
BRIMONIDINE TARTRATE
2mg,TIMOLOL 5mg 235.00 BOT
DCO015 CORNEREGEL EYE GEL
DEXPANTHENOL 50mg, CETRIMIDE
0.1mg, WATER FOR INJ. 945.79mg 51.50 TUB
DCO030 COSOPT EYE DROPS DORZOLAMIDE/TIMOLOL MALEATE 280.00 BOT
DCY004 CYCLOGYL 1% EYE
DROPS
CYCLOPENTOLATE 1% 50.00 BOT
DDU006 DUOTRAV EYE DROPS TRAVOPROST,TIMOLOL 340.00 BOT
DDU010 DURATEARS EYE
OINTMENT
WHITE PETROLATUM, LIQ LANOLIN 55.00 TUB
DEM010 EMADINE EYE DROPS
0.05%
EMEDASTINE DIFUMARATE 0.05% 75.00 BOT
DHI010 HIALID 0.1% EYE DROPS
5mL
SODIUM HYALURONATE 0.1% 83.00 BOT
MYDRIATIC DRUGS
EYE CORTICOSTEROIDS
EYE ANTISEPTICS WITH CORTICOSTEROIDS
OTHER EYE PREPARATIONS
EAR ANTI-INFECTIVES & ANTISEPTICS
Page 21 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
DHY010 HYPOTEARS EYE DROPS POLYVINYL ALCOHOL 1% 67.50 BOT
DHY011 HYPOTEARS EYE GEL VIT A PALMITATE/POLYACRYLIC AC 60.00 TUB
DHY012 HYPOTEARS PLUS EYE
DROPS
POLYVINYL ALCOHOL 1% 62.00 BOT
DHY014 HYPOTEARS PLUS SDU
EYE DROPS 0.4mL
POLYVINYL ALCOHOL 1% 3.50 PC
DHY020 HYPROMELLOSE EYE
DROPS 0.3%
HYPROMELLOSE 0.3% 15.00 BOT
DIO010 IOPIDINE EYE DROPS 0.5% APRACLONIDINE HCl 115.00 BOT
DIS012 ISOPTO CARPINE EYE
DROPS 1%
PILOCARPINE NITRATE 1% 56.00 BOT
DIS011 ISOPTO CARPINE EYE
DROPS 2%
PILOCARPINE NITRATE 2% 60.00 BOT
DIS010 ISOPTO CARPINE EYE
DROPS 4%
PILOCARPINE NITRATE 4% 88.00 BOT
DKA010 KARY UNI EYE DROPS
0.05mg/mL
PIRENOXINE 45.00 BOT
DLA010 LARMABAK EYE DROPS SODIUM CHLORIDE 0.9% 95.00 BOT
DLU010 LUMIGAN EYE DROPS BIMATOPROST 390.00 BOT
DNA008 NAAXIA EYE DROPS N-ACETYL ASPARTYLGLUTAMIC
ACID
35.00 BOT
DNA010 NAPHCON-A EYE DROPS
15mL
NAPHAZOLINE HCL, PHENIRAMINE 54.00 BOT
DNA011 NAPHCON-A EYE DROPS
15mL(GE)-
NAPHAZOLINE HCL 0.025%,
PHENIRAMINE MALEATE 0.3%
39.00 BOT
DNA012 NAPHCON-A EYE DROPS
3mL
NAPHAZOLINE HCL, PHENIRAMINE 36.00 BOT
DNO010 NOVESIN EYE DROPS OXYBUPROCAINE HCL 0.4% 42.00 BOT
DOC010 OCULOSAN EYE DROPS ZINC SULFATE, NAPHAZOLINE 60.00 BOT
DOC020 OCUSAN EYE DROPS
0.35ML(20's/BOX)
SODIUM HYALURONATE 0.15% 50.00 BOX
DOP010 OPTICROM EYE DROPS
(GE)
SODIUM CROMOGLYCATE 2% 55.00 BOT
DOP012 OPTICROM 4% EYE DROPS
(GE)
SODIUM CROMOGLYCATE 60.00 BOT
DOP020 OPTIZOLINE EYE DROPS TETRAHYDROZOLINE HCL 0.05% 32.00 BOT
DOP021 OPTIZOLINE EYE DROPS
(GE)
TETRAHYDROZOLINE HCL 0.05% 32.00 BOT
DPA008 PATADAY EYE DROPS
0.2%
OLOPATADINE 0.2% HCL 115.00 BOT
DPA010 PATANOL EYE DROPS
0.1%
OLOPATADINE 112.00 BOT
DPR013 PROPINE EYE DROPS DIPIVEFRIN HCL 0.1% 85.00 BOT
DPR020 PROTAGENT EYE DROPS POLYVINYL PYRROLIDONE 20mg/mL 38.00 BOT
DQU010 QUINAX EYE DROPS AZAPENTACENE POLYSULFONATE
Na
135.00 BOT
DRE010 REFRESH PLUS EYE
DROPS (30pcs)
CARBOXYMETHCELLULOSE NA
(PRESE
115.00 BOX
DRE040 RELESTAT 0.05% EYE
DROPS
EPINASTINE 78.50 BOT
DSI010 SICCAPROTECT EYE
DROPS
DEXPANTHENOL 29.00 BOT
DNO005 SODIUM CHLORIDE EYE
DROPS 0.9%
SODIUM CHLORIDE 20.00 BOT
DSO020 SOLCOSERYL EYE GEL HEMODIALYSATE 20% 79.00 TUB
DSP040 SPERSACARPINE EYE
DROPS 1%
PILOCARPINE HCL 1% 40.00 BOT
DSP044 SPERSACARPINE EYE
DROPS 4%
PILOCARPINE HCL 4% 40.00 BOT
DSP020 SPERSALLERG EYE DROPS ANTAZOLINE, TETRAHYDROZOLINE 45.00 BOT
DSP022 SPERSALLERG SDU EYE
DROPS
ANTAZOLINE, TETRAHYDROZOLINE 70.00 BOX
DSP042 SPERSCARPINE EYE
DROPS 2%
PILOCARPINE HCL 2% 40.00 BOT
DTI010 TIMOPTOL EYE DROPS
0.25%
TIMOLOL MALEATE 0.25% 70.00 BOT
DTI012 TIMOPTOL EYE DROPS
0.5%
TIMOLOL MALEATE 0.5% 85.00 BOT
DTI013 TIMOPTOL EYE DROPS
0.5% (GE)
TIMOLOL MALEATE 0.5% 58.00 BOT
DTI014 TIMOPTOL-XE EYE DROPS
0.5%
TIMOLOL MALEATE 0.5% 85.00 BOT
DTR003 TRAVATAN EYE DROPS TRAVOPROST 365.00 BOT
DTR010 TRUSPOT 2% EYE DROPS DORZOLAMIDE HCL 180.00 BOT
DVI010 VISCOTEARS EYE GEL POLYACRYLIC ACID 0.02% 80.00 TUB
DVI020 VITREOLENT EYE DROPS NA IODIDE 0.3%, K IODIDE 0.3% 60.00 BOT
DVD010 VOLTAREN EYE DROPS DICLOFENAC SODIUM 0.1% 85.50 BOT
DXA006 XALACOM EYE DROPS LATANOPROST 50mcg,TIMOLOL 5mg 400.00 BOT
DXA010 XALATAN EYE DROPS LATANOPROST 0.005% 385.00 BOT
DZA012 ZADITEN (SDU) EYE
DROPS 10's
KETOTIFEN 58.00 BOX
DZA012. ZADITEN (SDU) EYE
DROPS 20's
KETOTIFEN 0.025% 90.00 BOX
DZA010 ZADITEN EYE DROPS KETOTIFEN 0.025% 100.00 BOT
DAP010 APLOSYN EAR DROPS NEOMYCIN, POLYMYXIN,
FLUOCINOLONE
20.00 BOT
DCH034 CHLORAMPHENICOL EAR
DROPS 5%
CHLORAMPHENICOL 5% 1.00 ML
DCH032 CHLORAMPHENICOL EAR
DROP 10% 15mL/BOT
CHLORAMPHENICOL 10% 1.30 ML
DCO018 CORTISON KEMICETINE
EAR DROPS
CHLORAMPHENICOL,
HYDROCORTISONE
49.50 BOT
DDE010 DECADRON & NEOMYCIN
EYE/EAR DROPS
DEXAMETHASONE, NEOMYCIN 20.00 BOT
DKE010 KENACOMB EAR DROPS TRIAMCINOLONE, NEOMYCIN... 55.00 BOT
DOT010 OTOSPORIN EAR DROPS POLYMYXIN B, HYDROCORTISONE... 105.00 BOT
DOT012 OTOSPORIN EAR DROPS
(GE)
POLYMYXIN B, HYDROCORTISONE... 22.00 BOT
DSO010 SOFRADEX EAR/EYE
DROPS (GE)
DEXAMETHASONE, FRAMYCETIN... 61.00 BOT
DTA006 TARIVID EAR DROPS OFLOXACIN 3mg/mL 57.00 BOT
DTR008 TROPEX EAR DROPS 10mL PHENAZONE 5%, GLYCEROL 75.00 BOT
CAC002 A-CERUMEN EAR DROPS
2ml
TEA-COCOYL HYDROLYZED
COLLAGEN, COCO-BETAINE,
14.00 AMP
DOL010 OLIVE OIL EAR DROPS
15mL/BOT
OLIVE OIL 0.60 ML
DWA012 WAX-EZE EAR DROPS
10mL
DOCUSATE SODIUM 0.5% 448.00 BOT
DWA010 WAXSOL EAR DROPS DOCUSATE SODIUM 0.5% 66.00 BOT
TCE049 CEPACOL CETYLPYRIDINIUM CL 0.07% 1.20 TAB
CCO040 CORSODYL CHLORHEXIDINE GLUCONATE 0.2% 0.26 ML
CDA040 DAKTARIN ORAL GEL MICONAZOLE 4.50 g
TDE050 DEQUADIN LOZENGES DEQUALINIUM CHLORIDE 0.25mg 0.60 TAB
TDE051
DEQUADIN LOZENGES
(GE)-[DEQUALINUM] DEQUALINUM CHLORIDE 0.25mg 0.60 TAB
TDI054 DIFFLAM LOZENGES BENZYDAMINE, CETYLPYRIDINIUM 2.80 TAB
ADI020 DIFFLAM SOLUTION
120mL
BENZYDAMINE HCL SOLUTION 0.30 ML
ADI022 DIFFLAM-C SOLUTION BENZYDAMINE HCL, CHLORHEXIDINE 0.60 ML
CEU034 EUROCORT PASTE 5g TRIAMCINOLONE
ACETONIDE/LIGNOC
5.50 g
AGL022 GLYCERINE THYMOL
GARGLE (GE) "BLUE"
GLYCERIN THYMOL GARGLE 0.22 ML
AGL020 GLYCERINE THYMOL
GARGLE (GE) "RED"
GLYCERIN THYMOL GARGLE 0.13 ML
CKE030 KENALOG IN ORABASE 5g
(GE)
TRIAMCINOLONE ACETONIDE 0.1% 8.00 g
CKE032 ORACORT E 5g (GE) LIGNOCAINE, TRIAMCINOLONE 8.80 g
COR010 ORAGESIC GEL 5g TRIAMCINOLONE, CHLORHEXIDINE,
LIGNOCAINE
6.50 g
EAR ANTI-INFECTIVES, ANTISEPTICS WITH OR WITHOUT CORTICOSTEROIDS
OTHER EAR PREPARATIONS
MOUTH / THROAT PREPARATION
Page 22 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
COR020 ORAMEDY PASTE 5g TRIAMCINOLONE ACETONIDE 7.50 g
CTR034 TRI-GEL 5g TRIAMCINOLONE, LIGNOCAINE 5.00 g
TTY010 TYROCAINE LOZENGES TYROTHRICIN, BENZOCAINE 0.52 TAB
CAC010 AUREOMYCIN OINTMENT
3% 15g
CHLORTETRACYCLINE HCL OINT 3% 7.00 g
CBA008 BACTROBAN NASAL
OINTMENT 3g
MUPIROCIN 68.00 g
CPA119 BACTROBAN OINTMENT
15g
MUPIROCIN 83.00 TUB
CBA010 BACTROBAN OINTMENT
15g
MUPIROCIN 5.50 g
CBA012 BACTROBAN OINTMENT
15g (GE)
MUPIROCIN 2% 4.50 g
CBU010 BURNOL CREAM 25g AMINACRIEN HCL, CETRIMIDE 1.00 g
CCH008 CHLORAMPHENICOL
CREAM 2%
CHLORAMPHENICOL 2% 0.67 g
CEL005 ELIDEL CREAM 1% 15g PIMECROLIMUS 1% 21.50 g
CFL008 FLAMAZINE CREAM 25g
(GE)
SILVER SULFADIAZINE 3.47 g
CFL010 FLAMAZINE CREAM 80g
(GE)
SILVER SULFADIAZINE 3.00 g
CFU030 FUCIDIN CREAM 15g FUSIDIC ACID 4.90 g
CFU020 FUCIDIN OINTMENT 5g FUSIDIC ACID 7.60 g
CGA011 GARAMYCIN CREAM 0.1%
450g (GE)
GENTAMICIN SULFATE 0.1% 2.90 g
CGA010 GARAMYCIN SKIN CREAM
0.1% 15g (GE)
GENTAMICIN SULFATE 0.1% 2.70 g
CNE010 NEBACETIN SPRAY
150mL/BOT
NEOMYCIN SULFATE, BACITRACIN 110.00 BOT
CNE030 NEOMYCIN CREAM 0.5%
(G.E.)
NEOMYCIN SULFATE 0.5% 0.90 g
CNO010 NORITATE CREAM 1% 30g METRONIDAZOLE 1% 4.00 g
CPR028 PROTOPIC OINTMENT
0.03% 30g
TACROLIMUS 17.30 g
CPR030 PROTOPIC OINTMENT
0.1% 30g
TACROLIMUS 19.60 g
CRO010 ROZEX GEL 15g METRONIDAZOLE 0.75% 6.30 g
CSU010 SULPHADIAZINE CREAM
5%
SULPHADIAZINE 5% 0.80 g
CTE010 TETRACYCLINE
OINTMENT
TETRACYCLINE 0.80 g
CBE070 BETNOVATE-C CREAM 15g BETAMETHASONE 0.1%,
CLIOQUINOL
3.13 g
CBE090 BETNOVATE-N CREAM
(GE)
BETAMETHASONE, NEOMYCIN 2.90 g
CBE080 BETNOVATE-N CREAM
15g
BETAMETHASONE, NEOMYCIN 0.5% 4.40 g
CPA040 DAKTACORT CREAM 15g MICONAZOLE 2%,
HYDROCORTISONE
5.63 g
CDA020 DAKTACORT CREAM 15g
(GE)
MICONAZOLE 2%,
HYDROCORTISONE
2.50 g
CDI016 DIPROGENTA CREAM 15g BETAMETHASONE DIPROPIONATE
.05
7.00 g
CDI018 DIPROGENTA CREAM 450g BETAMETHASONE DIP, GENTAMICIN 6.00 g
CDI022 DIPROGENTA OINTMENT
15g
BETAMETHASONE DIP, GENTAMICIN 6.70 g
CDI024 DIPROGENTA OINTMENT
450g
BETAMETHASONE DIP, GENTAMICIN 6.00 g
CDI030 DIPROSALIC LOTION
10mL/BOT
BETAMETHASONE DIP, SAL. ACID 75.70 BOT
CDI040 DIPROSALIC OINTMENT
15g
BETAMETHASONE DIP, SAL. ACID 7.60 g
CDI042 DIPROSALIC OINTMENT
450g (GE)
BETAMETHASONE DIP, SAL. ACID 4.68 g
CDI056 DIPROSONE OINTMENT
0.05% (GE)
BETAMETHASONE DIPROPIONATE
0.05%
1.90 g
CPA115 DERMAID 0.5 % x 15 g HYDROCORTISONE 30.00 TUBE
CFU010 FUCICORT CREAM 15g FUSIDIC ACID 2%, BETAMETHASONE 5.20 g
CFU040 FUCIDIN H CREAM 2% FUSIDIC ACID, HYDROCORTISONE 5.20 g
CHY032 HYDROCORTISONE 1% +
MICONAZOLE 2%
HYDROCORTISONE 1%,
MICONAZOLE 2%
1.20 g
CHY042 HYDROCORTISONE 1% +
NEOMYCIN 1% LOTION
HYDROCORTISONE1%, NEOMYCIN
1%
1.20 ML
CHY040 HYDROCORTISONE-
NEOMYCIN CREAM (GE)
HYDROCORTISONE1%,NEOMYCIN
0.5%
1.20 g
CHY050 HYDROCORTISONE-
VIOFORM CREAM (GE)
HYDROCORTISONE1%,
CLIOQUINOL3%
1.20 g
CKE010 KENACOMB CREAM (GE) TRIAMCINOLONE, NEOMYCIN... 4.20 g
CKE011 KENACOMB CREAM 5g TRIAMCINOLONE, NEOMYCIN... 6.00 g
CNE042 NERISONE C CREAM
10g/15g
DIFLUCORTOLONE,
CHLORQUINALDOL
7.10 g
CPE020 PEVISONE CREAM 15g ECONAZOLE1%,
TRIAMCINOLONE0.1%
14.00 g
CSI006 SICORTEN CREAM 10g HALOMETASONE MONOHYDRATE
0.05%
6.00 g
CSY016 SYNALAR-C CREAM 15g FLUOCINOLONE, CLIOQUINOL 2.67 g
CSY018 SYNALAR-C OINTMENT
15g
FLUOCINOLONE, CLIOQUINOL 2.40 g
CSY030 SYNALAR-N CREAM (GE) FLUOCINOLONE 0.025%,NEOMYCIN 1.65 g
CTR010 TRAVOCORT CREAM 10g ISOCONAZOLE, DIFLUCORTOLONE 6.50 g
CTR032 TRIDERM CREAM 100g BETAMETHASONE, CLOTRIMAZOLE.. 6.00 g
CTR033 TRIDERM CREAM 450g
(GE)
BETAMETHASONE, CLOTRIMAZOLE.. 4.00 g
CTR030 TRIDERM CREAM 5g BETAMETHASONE, CLOTRIMAZOLE.. 6.00 g
CTT010 TTY CREAM
(CTcycline/Hydrocortisone/Tra
CTcycline/Hydrocortisone/Trav 3.34 g
CPA123 ZARICORT 15 g HYDROCORTISONE 1%, MICONAZLE
NITRATE 2% 2%
37.00 TUB
CAD008 ADVANTAN CREAM 0.1%
10g
METHYLPREDNISOLONE
ACEPONATE 0
8.00 g
CAD010 ADVANTAN OINTMENT
0.1% 10g
METHYLPREDNISOLONE
ACEPONATE 0
7.00 g
CAD011 ADVANTAN OINTMENT
0.1% 15g
METHYLPREDNISOLONE
ACEPONATE 0
7.50 g
CAQ005 AQUANIL HC LOTION HYDROCORTISONE 1.40 g
CAR010 ARISTOCORT CREAM
0.02%
TRIAMCINOLONE ACETONIDE 2.00 g
CPA058 BEPROSONE OINTMENT BETAMETHASONE DIPROPINATE 1.00 g
CBE042 BETNOVATE CREAM (GE) BETAMETHASONE VALERATE 0.1% 1.65 g
CBE040 BETNOVATE CREAM 15g BETAMETHASONE VALERATE 0.1% 3.90 g
CBE052 BETNOVATE OINTMENT
(GE)
BETAMETHASONE VALERATE 0.1% 1.65 g
CBE050 BETNOVATE OINTMENT
15g
BETAMETHASONE VALERATE 0.1% 3.90 g
CBE060 BETNOVATE SCALP
LOTION 30mL
BETAMETHASONE VALERATE 0.1% 4.80 ML
CBE064 BETNOVATE SCALP
LOTION 450mL (GE)-
BETAMETHASONE SCALP
APPLICATION 0.1%
0.80 ML
CCL010 CLOBETASOL 0.02% & SAL
ACID 7.5% OINTMENT
CLOBETASOL/SAL ACID 2.00 g
CCL016 CLOBEX SHAMPOO 0.05% CLOBETASOL PROPIONATE 0.05% 3.50 ML
CCU010 CUTIVATE CREAM 15g FLUTICASONE PROPIONATE 0.05% 6.10 g
CDE020 DERMOVATE CREAM (GE) CLOBETASOL PROPIONATE 0.05% 1.80 g
CDE022 DERMOVATE CREAM 25g CLOBETASOL PROPIONATE 0.05% 3.80 g
CDE030 DERMOVATE OINTMENT
(GE)
CLOBETASOL PROPIONATE 0.05% 1.80 g
CDE032 DERMOVATE OINTMENT
25g
CLOBETASOL PROPIONATE 0.05% 3.80 g
CDE040 DERMOVATE SCALP
APPLICATION 30mL
CLOBETASOL PROPIONATE 0.05% 4.90 ML
CDI012 DIPROCEL CREAM BETAMETHASONE DIPROPIONATE 3.80 g
CDI014 DIPROCEL OINTMENT BETAMETHASONE DIPROPIONATE 4.40 g
TOPICAL ANTI-INFECTIVES
TOPICAL ANTI-INFECTIVES WITH CORTICOSTEROIDS
TOPICAL CORTICOSTEROIDS
Page 23 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
CDI048 DIPROSONE CREAM
0.0125% 1/4 STRENGTH
BETAMETHASONE DIPROPIONATE 1.34 g
CDI050 DIPROSONE CREAM
0.025% 1/2 STRENGTH (GE)
BETAMETHASONE DIPROPIONATE 2.00 g
CDI052 DIPROSONE CREAM 0.05%
(FULL STRENGTH)
BETAMETHASONE DIPROPIONATE 2.40 g
CDI054 DIPROSONE CREAM 0.05%
(GE)
BETAMETHASONE DIPROPIONATE
0.05%
1.90 g
CDI060 DIPROSONE OINTMENT BETAMETHASONE DIPROPIONATE 2.40 g
CEF010 EFCORTELEN LOTION 1%
30mL/BOT (GE)
DEXAMETHASONE 1% 60.00 BOT
CEL038 ELOMET CREAM 15g MOMETASONE FUROATE 5.60 g
CEL040 ELOMET OINTMENT 15g MOMETASONE FUROATE 6.00 g
CEL042 ELOMET SCALP LOTION
0.1%
MOMETASONE FUROATE 0.1% 4.80 ML
CEU010 EUMOVATE CREAM 25g CLOBETASONE BUTYRATE 4.40 g
CEU030 EURAX-HC CREAM 15g
(GE)
CROTAMITON 2.20 g
CHY020 HYDROCORTISONE
CREAM 0.5% (GE)
HYDROCORTISONE 0.5% 1.00 g
CHY022 HYDROCORTISONE
CREAM 1% (GE)
HYDROCORTISONE 1% 1.20 g
CHY024 HYDROCORTISONE
CREAM 1% 15g (GE)
HYDROCORTISONE 1% 1.20 g
CHY030 HYDROCORTISONE
OINTMENT 1% (GE)
HYDROCORTISONE 1% 1.20 g
CKE020 KENACORT-A CREAM
0.1% 15g
TRIAMCINOLONE ACETONIDE 0.1% 3.33 g
CLA006 LACTICARE-HC LOTION
1%
HYDROCORTISONE,LACTIC ACID/Na 1.20 ML
CME020 METOSYN CREAM 0.05%
15g
FLUOCINONIDE 0.05% 3.10 g
CME040 NERISONE CREAM 0.1%
15g
DIFLUCORTOLONE VALERATE 0.1% 4.80 g
CNE046 NERISONE FATTY
OINTMENT 0.1% 10g
DIFLUCORTOLONE VALERATE 0.1% 7.10 g
CNE044 NERISONE OINTMENT
0.1% 10g
DIFLUCORTOLONE VALERATE 0.1% 5.50 g
CPE010 PERDERM CREAM 0.05% ALCLOMETASONE DIPROPION 0.05% 3.70 g
PPR010 PREDENEMA PREDNISOLONE 70.00 BOT
PPR020 PREDFOAM PREDNISOLONE 430.00 BOX
CQU006 QUADRIDERM CREAM 15g BETAMETHASONE/GENTAMICIN/TO
LNA
7.50 g
CSY008 SYNALAR CREAM 0.005%
(GE)
FLUOCINOLONE ACETONIDE 0.005% 1.65 g
CSY010 SYNALAR CREAM 0.025%
(GE)
FLUOCINOLONE ACETONIDE 0.025% 1.70 g
CSY040 SYNALAR GEL 30g FLUOCINOLONE ACETONIDE 0.025% 2.60 g
CSY020 SYNALAR OINTMENT 15g FLUOCINOLONE ACETONIDE 0.025% 4.50 g
CSY022 SYNALAR OINTMENT 450g
(GE)
FLUOCINOLONE ACETONIDE 0.025% 2.00 g
CAC012 ACNE AID CREAM 40g SULPHUR 2.5%, RESORCINOL 1.25% 2.20 g
CAC013 ACNE AID LIQUID SULFONATED OIL 0.46 ML
CAC014 ACNEDERM OINTMENT
25g
SULFUR 2.5%, ICHTHAMMOL 1% 2.00 g
CAK010 AKNE-MYCIN SOLUTION
25 mL/BOT (GE)
ERYTHROMYCIN SOLUTION 2% 89.00 BOT
CBR010 BREVOXYL CREAM 4%
40g
BENZOYL PEROXIDE 4% 2.80 g
CDA075 DALACIN T GEL 1% 15g
(GE)
CLINDAMYCIN PHOSPHATE 1% 6.00 g
CDA070 DALACIN T SOLU.1% ( G.
E.)
CLINDAMYCIN PHOSPHATE 1% 90.00 BOT
CDA074 DALACIN-T GEL 1% CLINDAMYCIN PHOSPHATE 1% 160.00 BOT
CDA076
DALACIN T GEL 1% 25g
[G.E]-[CLINDAMYCIN] CLINDAMYCIN 1% GEL 4.00 g
CDA072 DALACIN-T LOTION 1% CLINDAMYCIN PHOSPHATE 1% 160.00 BOT
TDI040 DIANE 21's CYPROTERONE,
ETHINYLESTRADIOL
7.90 TAB
CDI009 DIFFERIN CREAM 30g ADAPALENE O.1% 4.40 g
CDI011 DIFFERIN GEL 30g ADAPALENE O.1% 4.40 g
CDI008 DIFFERIN GEL 15g (GE) ADAPALENE 0.1% 3.00 g
CDU003 DUAC GEL CLINDAMYCIN 1%, BENZOYL
PEROXIDE 5%
14.64 g
CEP010 EPIDUO GEL 15g ADAPALENE, BENZOYL PEROXIDE 16.50 g
CER010 ERYLIK GEL 30g ERYTHROMYCIN,TRETINOIN 2.50 g
CIS010 ISOTREX 0.05% CREAM ISOTRETINOIN 0.05% 5.80 g
CIS011 ISOTREX 0.05% GEL ISOTRETINOIN 0.05% 8.10 g
CIS012 ISOTREX 0.1% CREAM ISOTRETINOIN 0.1% 7.00 g
CNE020 NEO-MEDROL ACNE
LOTION 30mL/BOT
METHYLPREDNISOLONE,
NEOMYCIN
140.00 BOT
COX012 OXY-5 (GE) BENZOYL PEROXIDE 5% 1.30 g
COX010 PANOXYL GEL 10% BENZOYL PEROXIDE 10% 2.00 g
CPA012 PANOXYL GEL 2.5% 40g BENZOYL PEROXIDE 2.5% 2.00 g
CRE020 RETIN-A CREAM 0.025%
25g (GE)
TRETINOIN 0.025% 7.70 g
CRE010 RETIN-A CREAM 0.01% 25g
(GE)
TRETINOIN 0.01% 7.70 g
CRE022 RETIN-A CREAM 0.05% 25g
(GE)
TRETINOIN 0.05% 7.70 g
CRE023
RETIN-A <Tretinoin>
CREAM 0.05% 500g [ACTA] TRETINOIN 2.20 g
CRE024 RETIN-A CREAM 0.1% 25g
(GE)
TRETINOIN 0.1% 9.20 g
CRE025
RETIN-A <Tretinoin>
CREAM 0.1% 500g [ACTA] TRETINOIN 1.50 g
CRE021 RETIN-A 0.025% GEL 15g TRETINOIN 0.025% 16.70 g
CRE026 RETIN-A 0.01% GEL 15g TRETINOIN 0.01% 18.00 g
TRO010 ROACCUTANE 10mg ISOTRETINOIN 10mg 31.80 CAP
TRO013 ROACCUTANE 10mg (GE) ISOTRETINOIN 10mg 16.00 CAP
TRO012 ROACCUTANE 20mg ISOTRETINOIN 20mg 40.00 CAP
TRO014 ROACCUTANE 20mg (GE) ISOTRETINOIN 20mg 32.00 CAP
CSK010 SKINOREN 20% 30g MCIRONIZED AZELAIC ACID 20% 6.50 g
CAL010 ALCOHOL, BURNING ALCOHOL, BURNING 0.30 ML
CBE028 BETADINE CREAM 15g POVIDONE-IODINE 3.00 g
CBE030 BETADINE SOLUTION POVIDONE-IODINE 0.35 ML
CCA050 CASTELLANI'S PAINT CASTELLANI'S PAINT 0.40 ML
CCH030
CHLORHEXIDINE
COMPOUND CREAM CHLORHEXIDINE 0.500 g
CCI022 CIDEX SOLUTION (28
DAYS)
ACTIVATED GLUTARALDHYDE 0.10 ML
CCI020 CIDEZYME LIQ. 0.23 ML
CDR010 DRAPOLENE 55g BENZALKONIUM CL, CETRIMIDE 1.58 g
CET010 ETHER 450mL ETHER 0.275 ML
CEU040 EUSOL 3600mL CHLORINATED LIME 0.14 ML
CHI020 HIBITANE 0.5% IN 70%
ALCOHOL
CHLORHEXIDINE GLUCONATE 0.40 ML
CHI018 HIBITANE 5%
CONCENTRATE
CHLORHEXIDINE GLUCONATE 0.20 ML
CHI022 HIBITANE SOLUTION IN
AQ.
CHLORHEXIDINE ACETATE 0.05%w/v 0.15 ML
CHY060 HYDROGEN PEROXIDE 6%
(20 volume)
HYDROGEN PEROXIDE 6% 1.00 ML
CIO010 IODINE TINTURE IODINE TINCTURE 0.28 ML
ACNE TREATMENT PREPARATIONS
ANTISEPTICS & DISINFECTANTS
Page 24 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
CLY010 LYSOL 5000mL 0.13 ML
CME010 MERCUOCHROME
SOLUTION 2.5%
MERCUOCHROME 2.5% 0.50 ML
CNA010 NASEPTIN CREAM 15g
(GE)
CHLORHEXIDINE 1.00 g
AOP010 OPSITE SPRAY 115.00 BOT
CPH010 PHENOL SOL 5% PHENOL 80% 0.30 ML
CKM010 POTASSIUM
PERMANGANATE SOLN
POTASSIUM PERMANGANATE 1% 0.30 ML
CKM012
POTASSIUM
PERMANGANATE SOLN POTASSIUM PERMANGANATE 4% 0.50 ML
CSA024 SAVLON CREAM 30g CHLORHEXIDINE, CETRIMIDE 0.70 g
CPA106 SAVLON CONC SOLUTION
(GE)
CHLORHEXIDINE, CETRIMIDE 0.16 ML
CSU008 SULPHACETAMIDE 20% IN
ALCOHOL 50%
SULPHACETAMIDE 20% 0.39 ML
AUN010 UNISEPT 25mL (HIBITANE) CHLORHEXIDINE 7.00 PK
CVI020 VIOFORM CREAM (GE) CLIOQUINOL 3% 0.70 g
CZI010 ZINC & CASTOR OIL
CREAM (GE)
ZINE OXIDE, CASTOR OIL 0.80 g
CAL040
A-LICES SCALP HYGIENE
SHAMPOO MALATHION 1% 2.40 ML
CAC008 ACETIC ACID 5%
SOLUTION
ACETIC ACID 2% 0.16 ML
CBA020 BATRAFEN NAIL
LACQUER
CICLOPIROX 310.00 BOX
CBE010 BENZYL BENZOATE
APPLICATION 25% 450mL
BENZYL BENZOATE 25% 0.30 ML
CCA038 CANESTEN CREAM 1% CLOTRIMAZOLE 90.00 TUB
CCA040 CANESTEN CREAM
15g/20g/500g (GE)
CLOTRIMAZOLE 2.00 g
CPA121 CANESTEN CREAM 1% 20g CLOTRIMAZOLE 60.00 TUB
CDA030 DAKTARIN CREAM 15g
(GE)
MCIONAZOLE NITRATE 2% 1.50 g
CEX010 EXODERIL CREAM 1% 15g NAFTIFINE HCL 2.40 g
CGA004 GAMMA BENZENE
HEXACHLORIDE 1%
GAMMA BENZENE HEXACHLORIDE
1%
0.60 ML
CGE010 GENTIAN VIOLET (GE) GENTIAN VIOLET 0.17 ML
CLA010 LAMISIL CREAM TERBINAFINE 1% 5.70 g
CLA011 LAMISIL CREAM (GE) TERBINAFINE 3.40 g
CLA012 LAMISIL SPRAY 1% 30mL TERBINAFINE 1% 125.00 BOT
CLI010 LINDANE LOTION 1%
60mL/BOT
GAMMA BENZENE HEXACHLORIDE
1%
80.00 BOT
CLI012 LINDANE SHAMPOO 1%
60mL/BOT
GAMMA BENZENE HEXACHLORIDE
1%
0.80 ML
CLO020 LOCERYL 5% NAIL
LACQUER 2.5mL
AMOROLFINE 5% 385.00 BOT
CLO022 LOCERYL 0.25% CREAM
20g
AMOROLFINE 0.25% 4.20 g
CLO012 LOTREMIN SOLUTION 1%
10mL/BOT
CLOTRIMAZOLE 1% 70.00 BOT
CMY010 MYCOSPOR CREAM 1%
15g
BIFONAZOLE 1% 6.70 g
CMY020 MYCOSTATIN CREAM 15g NYSTATIN 100,000u/g 3.00 g
CNI010 NIZORAL CREAM 2% 15g KETOCONAZOLE 2% 10.00 g
CNI020
NIZORAL SHAMPOO
100mL/BOT KETOCONAZOLE 2% 2.20 ML
CNI020 NIZORAL SHAMPOO
60mL/BOT
KETOCONAZOLE 2% 180.00 BOT
CQU008 QUELLADA HEADLICE
TREATMENT LIQUID
PERMETHRIN 10mg/mL 2.50 ML
CQU010 QUELLADA SCABIES
LOTION 50mg/mL
PERMETHRIN 2.20 ML
CSO018 SODIUM THIOSULPHATE
10%
SODIUM THIOSULPHATE 10% 0.50 ML
CSO020 SODIUM THIOSULPHATE
SOLUTION 20%
SODIUM THIOSULPHATE 20% 0.80 ML
CCO030 CORN PAD SALICYLIC ACID 40% 18.00 BOX
CTA020 TARSUM SHAMPOO 120mL COAL TAR, SALICYLIC ACID 0.54 ML
CTI010 TINEAFAX POWDER (GE)
55g/BOT
UNDECENOIC ACID 2% 50.00 BOT
CTR020 TRAVOGEN CREAM 20 g ISOCONAZOLE NITRATE 1% 3.70 g
CTR040 TROSYD CREAM 1% 30g TIOCONAZOLE 4.00 g
CTR042 TROSYD NAIL SOLUTION TIOCONAZOLE 308.00 BOT
CWH010 WHITFIELD OINTMENT
(GE)
BENZOIC ACID 5%, SAL. ACID 3% 0.67 g
CWH020 WHITFIELD'S SOLUTION
(GE)
BENZOIC ACID 5%, SAL. ACID 3% 2.50 ML
CPA120 ZALAIN CREAM 2% 20g SERTACONAZOLE NITRATE 60.00 TUB
CNI022 ZORINAX SHAMPOO
120mL/BOT
KETOCONAZOLE 2% 120.00 BOT
CNI024 ZORINAX SHAMPOO
30mL/BOT
KETOCONAZOLE 2% 30.00 BOT
CCO004 COAL TAR 10% OINTMENT COAL TAR 10% 0.90 g
CCO005 COAL TAR PASTE 5% COAL TAR 5% 0.80 g
CCO006 COCOIS OINTMENT COAL TAR SOL.12%, SULPHUR 4% 3.20 g
CDA008 DAIVONEX CREAM 30g CALCIOTRIOL 9.00 g
CDA010 DAIVONEX OINTMENT 30g CALCIOTRIOL 9.00 g
CDA012 DAIVONEX SCALP LOTION
30mL
CALCIOTRIOL 7.50 ML
CDA006 DAIVOBET OINTMENT 15g CALCIPOTRIOL, BETAMETHASONE 10.60 g
CDI070 DITHRANOL 1% IN
LASSA'S PASTE
DITHRANOL 1% 1.00 g
CEG010 EGOPSORYL TA SULFUR 0.5%, PHENOL 0.5%, TAR 1.30 g
CEL050 ELOSALIC OINTMENT 15g MOMETASONE, SALICYLIC ACID 5.70 g
CMI004 MICANOL 1% CREAM 50g DITHRANOL 1% 2.50 g
TNE013 NEOTIGASON 10mg ACITRETIN 10mg 19.00 CAP
TNE014 NEOTIGASON 25mg ACITRETIN 25mg 42.00 CAP
CSA033 SAL. ACID OINTMENT 3% SALICYLIC ACID 3% 1.00 g
CST016 STIEPROX LIQUID 1.5% CICLOPIROX 1.30 ML
CSE010 SELSUN SUSPENSION
120mL/BOT
SELENIUM SULFIDE 1% 100.00 BOT
CXA010 XAMIOL GEL 15g CALCIPOTRIOL, BETAMETHASONE 175.00 BOT
CAC030 ACTOVEGIN 5% CREAM
20g
HEMODERIVATIVE 2mg/g 2.00 g
CAL020 ALUMINIUM CHLORIDE
SOLUTION 20%
ALUMINIUM CHLORIDE SOLN 20% 2.00 ML
CCL020 CLOTRIMAZOLE+SYNALA
R+NEOMYCIN CREAM
CLOTRIMAZOLE
/FLUCINOLONE/NEOM
1.00 g
CPA048 DILTIAZEM Cream 200.00 TUB
CTR037 TRILUMA CREAM 15g FLUOCINOLONE,HYDROQUINONE,T
RETINOIN
37.80 g
CTR038 TRILUMA CREAM 30g FLUOCINOLONE,HYDROQUINONE,T
RETINOIN
34.00 g
CZI040 ZINDACLIN 1% GEL CLINDAMYCIN, ZINC ACETARE 5.00 g
CST020 STOXIL 0.5% 5g IDOXURUDINE 11.00 g
CVI012 VIRU-MERZ GEL 10g TROMANTADINE HCL 1% 6.50 g
CZO008 ZOVIRAX COLD SORE
CREAM 5% 5g (GE)
ACYCLOVIR 5% 8.00 g
CZO010 ZOVIRAX COLD SORE
CREAM 5% 4g (GE)
ACYCLOVIR 5% 8.00 g
FUNGICIDES & ANTIPARASITES
PSORIASIS, SEBORRHEA & ICHTHYOSIS
TOPICAL ANTIVIRALS
OTHER DERMOLOGICALS
Page 25 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
CZO012 ZOVIRAX CREAM 5% 10g ACYCLOVIR 5% 169.00 tube
CCO020 COLLOMACK SOLUTION
10mL
SALICYLIC ACID 2G, LACTIC ACID 4.00 ML
CDU008 DUOFILM GEL SALICYLIC ACID 27% 7.40 g
CDU012 DUOFILM SOLUTION 14mL
(GE)
SALICYLIC ACID, LACTIC ACID 4.10 ML
CDU010 DUOFILM SOLUTION 15mL SALICYLIC ACID, LACTIC ACID 6.80 ML
CPO010 PODOPHYLLIN IN SPIRIT
25% 30mL (GE)
TINCT BENZ CO, PODOPHYLLIN 4.50 ML
CPO020 PODOPHYLLIN 5%, SAL.
ACID 5% IN COLLODION
TINCT BENZ CO, PODOPHYLLIN 2.18 ML
CPO050 POSALFILIN OINTMENT
10g
PODOPHYLLUM, SALICYLIC ACID 11.00 g
CSA004 SALICYLIC ACID 1%
OINTMENT
SALICYLIC ACID 1% 0.33 g
CSA006 SALICYLIC ACID 2% IN
SULPHUR 2% CREAM
SALICYLIC ACID 2%/SULPHUR 2% 1.20 g
CSA008 SALICYLIC ACID 5% IN AQ
CREAM
SALICYLIC ACID 5% 0.33 g
CSA009 SALICYLIC ACID 10% IN
AQ CREAM
SALICYLIC ACID 10% 0.60 g
CSA010 SALICYCLIC ACID IN AQ
CREAM 20%
SALICYLIC ACID 20% 0.60 g
CSA018 SALICYCLIC ACID PAINT
15% IN COLLODION
SALICYLIC ACID 15% 1.40 ML
CSA020 SALICYCLIC ACID PAINT
15% (GE)
SALICYLIC ACID 15% 0.83 ML
CSA023 SALICYLIC ACID 20% IN
COLLODIO
SALICYLIC ACID 20% 2.00 ML
CSA032 SAL. ACID OINTMENT 6% SALICYLIC ACID 6% 1.00 g
CSA034 SALICYLIC ACID 4% &
UREA 20% CREAM
SALICYLIC ACID 4%, UREA 20% 1.00 g
CSA035 SALICYLIC ACID 3% IN
ALCOHOL
SALICYLIC ACID 3% 0.19 ML
CTR026 TRICHLOROACETIC ACID
10%
TRICHLOROACAETIC ACID 10% 5.00 ML
CTR027 TRICHLOROACETIC ACID
50%
TRICHLOROACAETIC ACID 50% 6.00 ML
CTR028 TRICHLOROACETIC ACID
90%
TRICHLOROACAETIC ACID 90% 6.00 ML
CVE010 VERRUMAL SOLUTION
13mL/BOT
FLUOROURACIL 0.5%,SAL. ACID10% 80.00 BOT
CWA008 WARTEC 0.15% CREAM 5g PODOPHYLLOTOXIN 0.15% 109.00 g
CWA010 WARTEC TOPICAL
SOLUTION 0.5%
PODOPHYLLOTOXIN 0.5% 475.00 BOT
CAN022 ANTHISAN CREAM 2% 15g MEPYRAMINE 45.00 TUB
CCA010 CALAMINE CREAM (GE) CALAMINE 20% 0.90 g
CCA020 CALAMINE LOTION (GE) CALAMINE 15% 0.40 ML
CCA024 CALAMNE-DPH 1%
CREAM
CALAMINE, DIPHENHYDRAMINE 0.80 g
CCA026 CALAMINE + DPH 0.2%
LOTION
CALAMINE, DIPHENHYDRAMINE 0.17 ML
CCA028 CALAMINE + 0.25%
MENTHOL
CALAMINE,MENTHOL 0.25% 0.17 ML
CCA029 CALAMINE + 5%
SULPHATE LOTION
CALAMINE,SULPHUR 5% 0.30 ML
CEU018 EURAX CREAM 15g (GE) CROTAMITON 1.50 g
CEU020 EURAX CREAM 450g (GE) CROTAMITON CREAM 10% 1.10 g
CHY031 HYDROCORTISONE 1% IN
CALAMINE LOTION
HYDROCORTISONE 1%/CALAMINE 0.60 ML
CST010 STEREX SHAMPOO
114mL/BOT
COAL TAR, SAL.ACID, SULPHUR 70.00 BOT
CUR010 UREA CREAM 10% UREA 10% 1.50 g
TZY024 ZYRTEC-D CETIRIZINE 5mg, PSEUDOEPHEDRINE
120mg
7.50 TAB
CAN020 ANTHISAN CREAM (GE) MEPYRAIMINE MALEATE CREAM 0.84 g
CAN010 ANALGESIC BALM (GE) METHYL SALICYLATE 0.60 g
CBE012 BENGAY 28g METHYL SALICYLATE 30%,
MENTHOL
0.60 g
CBE013 BENGAY 30g (GE) {BAGES
CREAM}
METHYL
SALICYLATE,MENTHOL,CAMPHOR
0.50 g
CBO010 BONJELA 15g CHOLINE SALICYLATE 8.7% 1.90 g
CDI010 DIFFLAM CREAM 30g BENZYDAMINE 1.83 g
CDI019 DIPROGENTA CREAM 450g
(GE)
BETAMETHASONE DIPROPIONATE
0.05%,GENTAMICIN SULFATE 0.1%
1.80 g
CPA141 DUROGESIC D-TRANS
DERMAL PATCH 25 mcg/hr
FENTANYL BASE 340.00 PATCH
CFE010 FELDENE GEL 25g PIROXICAM 0.5% 2.50 g
CIN010 INDOMET GEL 20g INDOMETHACIN 1% 1.25 g
CRU010 RUBESAL CREAM 25g DIETHYLAMINE
SALICYLATE/CAMPHO
0.62 g
CSO040 SOLCOSERYL JELLY 20g METHYL PARAHYDROXYBENZOATE 3.50 g
CSO042 SOLCOSERYL OINTMENT
20g
METHYL PARAHYDROXYBENZOATE 2.40 g
CPA122 OLFEN GEL 1 % x 20 g DICLOFENAC NA 46.00 TUB
CVO006 VOLTAREN EMULGEL 1% DICLOFENAC 65.00 TUB
CVO010 VOLTAREN EMULGEL 20g
(GE)
DICLOFENAC NA 2.30 g
CPA042 VOLTAREN GEL 1% 20g DICLOFENAC NA 2.20 g
DCO014 COCAINE 10% SOLUTION COCAINE 15.00 ML
DCO010 COCAINE 10% WITH
ADRENALINE 1:1000
COCAINE 17.00 ML
DCO012 COCAINE 5% SOLUTION COCAINE 10.00 ML
CEL003 ELA-MAX CREAM 4% LIDOCAINE 4% 15.00 g
CEM010 EMLA CREAM 5% 5g LIDOCAINE 25mg,PRILOCAINE 25mg 30.50 g
CIN018 INSTILLAGEL 11mL LIDOCAINE HYDROCHLOREDE
215.7mg,CHLORHEXIDINE
55.00 TUB
CEM011
EMLA CREAM 5% 5g (GE) -
[LIDOCAINE + LIDOCAINE 25mg,PRILOCAINE 25mg 17.00 g
ILI008 LIGNOCAINE INJ 1% 5mL LIGNOCAINE HCL 30.00 AMP
ILI010 LIGNOCAINE INJ 2% 5mL LIGNOCAINE HCL 62.00 AMP
IMA009 MARCAINE INJ 0.5% 10mL BUPIVACAINE HCL 214.00 VIA
IMA010 MARCAINE INJ 0.5% 20mL BUPIVACAINE HCL 260.00 VIA
IXY004 XYLESTESIN- A 1.8mL LIDOCAINE HCL 20mg/EPINEPHRINE
HCL 0.015mg
4.00 AMP
IXY018 XYLOCAINE 1% +
ADRENALINE INJ 20mL
LIDOCAINE, ADRENALINE 15.00 ML
IXY020 XYLOCAINE 2% +
ADRENALINE INJ 20mL
LIDOCAINE, ADRENALINE 15.00 ML
IXY006 XYLOCAINE INJ 1% 5mL LIDOCAINE HCL 26.00 AMP
IXY007 XYLOCAINE INJ 2% 5mL
(50'S)
LIDOCAINE HCL 29.40 AMP
IXY008 XYLOCAINE INJ 1% 20mL LIDOCAINE HCL 10.00 ML
IXY010 XYLOCAINE INJ 2% 20mL LIDOCAINE HCL 10.00 ML
CXY010 XYLOCAINE JELLY 2% 30g LIDOCAINE HCl 2% 7.10 g
CXY020 XYLOCAINE OINTMENT
5% 35g
LIDOCAINE HCl 5% 3.40 g
CXY040 XYLOCAINE SPRAY 10%
80g/BOT
LIDOCAINE 10% 489.00 BOT
TAC030 ACCOLATE 20mg ZAFIRLUKAST 20mg 8.20 TAB
TAE010 AERIUS 5mg DESLORATADINE 5mg 5.20 TAB
TAT010 ATARAX 10mg HYDROXYZINE 10mg 1.80 TAB
ANTIHISTAMINES & ANTIALLERGICS
KERATOLYTICS
TOPICAL ANTIHISTAMINES / ANTIPRURITICS
ANAESTHETICS - LOCAL & GENERAL
TOPICAL ANALGESICS & ANTIINFLAMMATORIES
Page 26 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
TAT012 ATARAX 25mg HYDROXYZINE 25mg 2.80 TAB
MAT010 ATARAX SYRUP 0.2%
200mL
HYDROXYZINE HCL 0.70 ML
MBE010 BENADRYL ELIXIR
25mg/5mL (GE)
DIPHENHYDRAMINE HCL 0.17 ML
IBE010 BENADRYL INJ
500mg/10mL
DIPHENHYDRAMINE HCL 200.00 VIA
TCE042 CELESTAMINE DEXCHLORPHENIRAMINE,
BETAMETHA
2.20 TAB
TCE040 CELESTAMINE (GE) DEXCHLORPHENIRAMINE,
BETAMETHA
1.50 TAB
MCE030 CELESTAMINE SYRUP
(GE)
DEXCHLORPHENIRAMINE
MALEATE..
0.19 ML
TCL020 CLARITYNE 10mg LORATADINE 10mg 6.00 TAB
TCL022 CLARITYNE 10mg (GE) LORATADINE 10mg 3.80 TAB
MCL010 CLARITYNE SYRUP
1mg/mL (GE)
LORATADINE 0.50 ML
CPA053 CLARITYNE SYRUP
1mg/mL
LORATADINE 1.00 ML
ICO010 CORAMINE INJ NIKETHAMINE 50.00 AMP
CDI013 DIPHENHYDRAMINE 2%
CREAM 450g
DIPHENHYDRAMINE 2% 0.70 g
TDI080 DIMETANE 4mg (GE) BROMPHENIRAMINE MALEATE 4mg 1.00 TAB
TEM010 EMEND [APREPITANT]
TRIPACK
APREPITANT 1030.00 BOX
THI010 HISMANAL ASTEMIZOLE 6.00 TAB
TIN010 INCIDAL 50 mg MEBHYDROLIN NAPADISYLATE 2.00 TAB
TKE050 KESTINE 10mg EBASTINE 10mg 5.00 TAB
TPE060 PERIACTIN 4mg (GE)-
[CYPROHEPTADINE]
CYPROHEPTADINE 4mg 0.18 TAB
TPH010 PHENERGAN 10mg (GE) PROMETHAZINE HCL 10mg 1.10 TAB
TPH012 PHENERGAN 25mg (GE) PROMETHAZINE HCL 25mg 1.10 TAB
MPH010 PHENERGAN ELIXIR
5mg/5mL (GE)
PROMETHAZINE HCL 5MG 0.19 ML
IPH010 PHENERGAN INJ 25mg/mL PROMETHAZINE HCL 25.00 AMP
TPI010 PIRITON 2mg (GE) CHLORPHENIRAMINE MALEATE 2mg 0.40 TAB
TPI012 PIRITON 4mg (GE) CHLORPHENIRAMINE MALEATE 4mg 0.53 TAB
TPI014 PIRITON SR 12mg (GE) CHLORPHENIRAMINE MALEATE
12mg
1.20 CAP
MPI020 PIRITON SYRUP 2.5mg/5mL
(GE)
CHLORPHENIRAMINE MALEATE 0.17 ML
MPI025 PIRITON SYRUP 2mg/5mL
(GE)
CHLORPHENIRAMINE MALEATE 0.17 ML
MPI030 PIRITON FORTE SYRUP
4mg/5mL (GE)
CHLORPHENIRAMINE MALEATE 0.19 ML
IPI010 PIRITON INJ 10mg/mL (GE) CHLORPHENIRAMINE MALEATE 25.00 ML
TPL030 PLOKON TAB PIRINHYDRINATE 3mg 1.30 TAB
TPO010 POLARAMINE 2mg (GE) DEXCHLORPHENIRAMINE MALEATE 0.70 TAB
CPA065 POLARAMINE 6mg DEXCHLORPHENIRAMINE 2.50 TAB
TPO012 POLARAMINE SA 6mg (GE) DEXCHLORPHENIRAMINE MALEATE 1.10 TAB
MPO008 POLARAMINE
EXPECTORANT
DEXCHLORPHENIRAMINE
GUAIPHENESIN PSEUDOEPHEDRINE
50.00 BOT
MPO010 POLARAMINE SYRUP
2mg/5mL (GE)
DEXCHLORPHENIRAMINE MALEATE 0.17 ML
TSE020 SEMPREX 8mg ACRIVASTINE 8mg 2.40 CAP
TTE025 TELDANE (GE) TERFENADINE 60mg 2.00 TAB
MTE010 TELDANE SUSPENSION
30mg/5mL 120mL
TERFENADINE 0.80 ML
TTE026 TELFAST 60mg FEXOFENADINE HCL 60mg 2.50 TAB
TTE024 TELFAST 120mg FEXOFENADINE HCL 120mg 5.50 TAB
TTE027 TELFAST 180mg FEXOFENADINE HCL 180mg 7.50 TAB
TTE029 TELFAST-D FEXOFENADINE
HCL/PSEUDOEPHEDRI
4.20 TAB
MVA010 VALLERGEN FORTE
30mg/5mL 100mL
TRIMEPRAZINE TARTRATE 1.00 ML
MXY010 XYZAL ORAL DROPS
5mg/ml
LEVOCETIRIZINE 284.00 BOT
TXY010 XYZAL 5mg LEVOCETIRIZINE 5mg 6.30 TAB
CPA052 XYZAL DROPS 20 ml LEVOCETIRIZINE 105.00 BOT
TZA010 ZADINE 1mg AZATADINE MALEATE 1mg 2.50 TAB
MZA010 ZADINE SYRUP 0.5mg/5mL
100mL
AZATADINE MALEATE 0.38 ML
TZY020 ZYRTEC 10mg CETIRIZINE HCL 10mg 4.00 TAB
TZY022 ZYRTEC 10mg (GE) CETIRIZINE HCL 10mg 2.40 TAB
MZY010 ZYRTEC ORAL
SOL.1mg/1ml
CETIRIZINE HCL 1.08 ML
MZY008 ZYRTEC ORAL DROPS 1%
(10mL)
CETIRIZINE HCL 8.60 ML
MZY012 ZYRTEC SYRUP 1mg/mL
60mL (GE)
CETIRIZINE HCL 0.60 ML
TBP010 B.P.P. PPA,BROMPHENIRAMINE,PHENYLEP
HR
1.00 TAB
TDI090 DIME-TIME BROMPHENIRAMINE,PPA,PHENYLEP
HE
2.50 TAB
CPA152 BENLYSTA POWDER FOR
CONCENTRATE FOR
SOLUTION FOR INFUSION
BELIMUMAB 14000.00 INJ
TCE046 CELLCEPT 250mg MYCOPHENOLATE MOFETIL 250mg 22.00 CAP
TCE048 CELLCEPT CAP 500mg MYCOPHENOLATE MOFETIL 500mg 41.00 CAP
VGA010 GAMMA GLOBULIN 5mL IMMUNE GLOBULIN IV (HUMAN) 210.00 VIA
IHU009 HUMIRA 40mg/0.8mL ADALIMUMAB 6052.00 SYR
TIM048 IMURAN 25mg AZATHIOPRINE 25mg 16.50 TAB
TIM050 IMURAN 50mg AZATHIOPRINE 50mg 21.60 TAB
TIM051
IMURAN 50mg [APO-
AZATHIOPRINE] AZATHIOPRINE 18.00 TAB
TPR091 PROGRAF 1mg TACROLIMUS 1mg 45.00 TAB
TPR092 PROGRAF 5mg TACROLIMUS 5mg 184.00 CAP
IRE040 REBIF 44mcg RECOMBINANT HUMAN
INTERFERON
870.00 AMP
DRE050 RESTASIS 0.05% EYE
DROPS
CYCLOSPORINE 0.05% 30.00 PC
TSA034 SANDIMMUN NEORAL
100mg
CYCLOSPORIN A 100mg 70.00 TAB
TSA036 SANDIMMUN NEORAL
25mg
CYCLOSPORIN A 25mg 18.50 TAB
IST004 STELARA INJ 45mg USTEKINUMAB 37000.00 VIA
TAR002 ARAVA 10mg LEFLUNOMIDE 20.00 TAB
ISO010 SODIUM BICARBONATE
8.4% 100mL
SODIUM BICARBONATE 90.00 BOT
ISO060 SODIUM CHLORIDE 0.9%
INJ 10mL
SODIUM CHLORIDE 0.9% 2.90 VIA
ISO061 SODIUM CHLORIDE 0.9%
INJ 20mL
SODIUM CHLORIDE 8.00 AMP
TBO010 BONVIVA 150mg IBANDRONIC ACID 150mg 320 TAB
IBO006
BONVIVA INJ 3mg/3mL (1
SYRING/BOX) IBANDRONIC ACID 150mg 1650.00 SYR
IPR052 PROLIA 60mg/Ml DENOSUMAB 4000.00 SYR
MPR050 PROTOS 2g STRONTIUM RANELATE 15.20 SACH
DISEASE-MODIFYING ANIT-RHEUMATIC DRUGS (DMARDs)
IMMUNOLOGICALS & IMMUNOSUPPRESSANTS
INTRAVENOUS & OTHER STERILE SOLUTIONS
AGENT AFFECTING BONE METABOLISM
Page 27 of 28
ITEM
NO.
DRUG DESCRIPTION GENERIC NAME UNIT PRICE
($)
PK UNIT
DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]
CPA128 FORTEO PRE-FILLED PEN
250 mcg/mL, 2.4 mL x 1's
TERIPARATIDE 6000.00 PEN
CBE025 BETACAINE GEL 30g LIDOCAINE 5% 11.00 g
IMI002 MIACALCIC INJ 100 IU/mL SYNTHETIC SALMON CALCITONIN 180.00 AMP
IMI003 MIACALCIC INJ 50 IU/mL SYNTHETIC SALMON CALCITONIN 150.00 AMP
IXY019 XYLOCAINE 2% +
ADRENALINE 1:80,000
LIDOCAINE, ADRENALINE 4.00 AMP
IAT010 ATROPINE INJ 0.6mg/mL
(GE)
ATROPINE SULFATE 30.00 AMP
IDE050 DEXTROSE INJ 5% 500mL DEXTROSE 77.00 BOT
IDE060 DEXTROSE INJ 50% 20mL DEXTROSE 6.50 AMP
IGE020 GELOFUSINE 4% 500mL SUCCINYLATED GELATIN 100.00 BOT
CPA092 TORADOL 30MG/ML/AMP KETOROLAC TROMETAMOL 200 AMP
TRE014 RENAGEL 800mg SEVELAMER HCL 12.50 TAB
DBS008 BSS SOLUTION 15mL
SODIUM CHLORIDE/POTASSIUM
CHLO 111.00 BOT
TS0004 SODIUM BICARBONATE SODIUM BICARBONATE 1.10 TAB
NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs)
MISCELLANEOUS
ANAESTHETICS - LOCAL & GENERAL
INTRAVENOUS & OTHER STERILE SOLUTIONS
Page 28 of 28