84:00 Skin and mucous membrane agents
84:04.04 SMMA - ANTIBIOTICS
BACITRACIN ZINC
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
500IU Ointment | 00584908 | BACITIN | PED |
500IU Ointment | 02351714 | JAMP-BACITRACINE | JMP |
CLINDAMYCIN PHOSPHATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
2% Cream | 02060604 | DALACIN | PFI |
1% Solution | 02483769 | CLINDAMYCIN PHOSPHATE TOPICAL | TEL |
1% Solution | 02243659 | CLINDA-T | VAE |
1% Solution | 00582301 | DALACIN T | PFI |
1% Solution | 02266938 | TARO-CLINDAMYCIN | TAR |
pDIN For Extemporaneous Mixture | 99502000 | CLINDAMYCIN IN DILUSOL OR DUONALC | UNK |
CLINDAMYCIN PHOSPHATE, BENZOYL PEROXIDE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
1% & 3% Gel | 02382822 | CLINDOXYL ADV | GSK |
1% & 5% Gel | 02248472 | BENZACLIN | VAE |
1% & 5% Gel | 02243158 | CLINDOXYL | GSK |
1% & 5% Gel | 02464519 | TARO-BENZOYL PEROXIDE / CLINDAMYCIN KIT | TAR |
1% & 5% Gel | 02440180 | TARO-CLINDAMYCIN/BENZOYL PEROXIDE | TAR |
ERYTHROMYCIN, BENZOYL PEROXIDE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
3% & 5% Gel | 02225271 | BENZAMYCIN | VAE |
FUSIDATE SODIUM
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
2% Ointment | 00586676 | FUCIDIN | LEO |
FUSIDIC ACID
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
2% Cream | 00586668 | FUCIDIN | LEO |
FUSIDIC ACID, HYDROCORTISONE ACETATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
2% & 1% Cream | 02238578 | FUCIDIN H | LEO |
METRONIDAZOLE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
1% Cream | 02156091 | NORITATE | BSH |
0.75% Gel | 02092832 | METROGEL | GAC |
0.75% Gel | 02125226 | NIDAGEL | VAE |
1% Gel | 02297809 | METROGEL | GAC |
0.75% Lotion | 02248206 | METROLOTION | GAC |
METRONIDAZOLE, NYSTATIN
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
500MG & 100,000IU Suppository | 01926829 | FLAGYSTATIN | SAC |
MUPIROCIN
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
2% Ointment | 02279983 | TARO-MUPIROCIN | TAR |
MUPIROCIN CALCIUM
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
2% Cream | 02239757 | BACTROBAN | GSK |
POLYMYXIN B SULFATE, BACITRACIN ZINC
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
10,000IU & 500IU Ointment | 02304473 | ANTIBIOTIC OINT | PMS |
10,000IU & 500IU Ointment | 00876488 | BACIMYXIN ONGUENT | PMS |
10,000IU & 500IU Ointment | 00621366 | BIODERM | ODN |
10,000IU & 500IU Ointment | 02357569 | JAMPOLYCIN | JMP |
10,000IU & 500IU Ointment | 02237227 | POLYSPORIN ANTIBIOTIC | JAJ |
10,000IU & 500IU Ointment | 01942921 | POLYTOPIC | SDZ |
10000U & 500U Ointment | 02181908 | POLYDERM | TAR |
POLYMYXIN B SULFATE, BACITRACIN ZINC, GRAMICIDIN
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
10,000U & 500U & 0.25MG Ointment | 02237226 | POLYSPORIN TRIPLE | JAJ |
POLYMYXIN B SULFATE, GRAMICIDIN
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.25MG & 10,000IU Cream | 02230844 | POLYSPORIN ANTIBIOTIC | JAJ |
84:04.06 SMMA - ANTIVIRALS
ACYCLOVIR
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
5% Cream | 02039524 | ZOVIRAX | VAE |
5% Ointment | 02477130 | APO-ACYCLOVIR | APX |
5% Ointment | 00569771 | ZOVIRAX | VAE |
SINECATECHINS
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
10% Ointment | 02411849 | VEREGEN | PAL |
84:04.08 SMMA - ANTIFUNGALS
BETAMETHASONE DIPROPIONATE, CLOTRIMAZOLE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.05% & 1% Cream | 00611174 | LOTRIDERM | FRS |
CICLOPIROX OLAMINE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
1% Cream | 02221802 | LOPROX | VAE |
1% Lotion | 02221810 | LOPROX | VAE |
CLOTRIMAZOLE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
1% Cream | 02150867 | CANESTEN | BAY |
1% Cream | 02150891 | CANESTEN | BAY |
1% Cream | 00812382 | CLOTRIMADERM | TAR |
1% Cream | 00812366 | CLOTRIMADERM VAGINAL 6 | TAR |
1% Cream | 02229380 | CLOTRIMAZOLE | TAR |
1% Cream | 00874043 | NEO-ZOL | PPI |
1% Cream | 00874051 | NEO-ZOL | PPI |
2% Cream | 02150905 | CANESTEN | BAY |
2% Cream | 00812374 | CLOTRIMADERM VAGINAL 3 | TAR |
1% & 200MG Tablet (Controlled Release) | 02264099 | CANESTEN COMBI-PAK COMFORTAB 3 | BAY |
1% & 500MG Tablet (Controlled Release) | 02264102 | CANESTEN COMBI-PAK COMFORTAB 1 | BAY |
500MG Vaginal Tablet | 02150859 | CANESTEN COMFORTAB 1 | BAY |
KETOCONAZOLE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
2% Cream | 02245662 | KETODERM | TPT |
2% Shampoo | 02182920 | NIZORAL | UNK |
MICONAZOLE NITRATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
2% Cream | 02085852 | MICATIN MICONAZOLE NITRATE | WPC |
2% Cream | 02231106 | MICOZOLE | TAR |
2% Cream | 02084309 | MONISTAT 7 | INS |
2% Cream | 02126567 | MONISTAT DERM | INS |
2% & 100MG Cream/Vaginal Suppository | 02126257 | MONISTAT 7 DUAL-PAK | INS |
2% & 400MG Cream/Vaginal Suppository | 02126249 | MONISTAT 3 DUAL-PAK | INS |
400MG Ovule | 02126605 | MONISTAT 3 | INS |
400MG Suppository | 02171775 | MICONAZOLE 3 DAY OVULE TREATMENT | VTH |
NYSTATIN
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
25,000IU Cream | 00716901 | NYADERM | TAR |
100,000IU Cream | 00716871 | NYADERM | TAR |
100,000IU Cream | 02194236 | RATIO-NYSTATIN | TEV |
100,000IU Cream | 02194163 | TEVA-NYSTATIN | TEV |
100,000IU Ointment | 02194228 | RATIO-NYSTATIN | TEV |
TERBINAFINE HYDROCHLORIDE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
1% Cream | 02031094 | LAMISIL | NVR |
TERCONAZOLE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.4% Cream | 02247651 | TARO-TERCONAZOLE | TAR |
TOLNAFTATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
1% Aerosol | 00576050 | TINACTIN AEROSOL | BAY |
1% Cream | 00576034 | TINACTIN | BAY |
1% Powder | 01919245 | DRSCHOLL'S ATHLETE'S FOOT SPRAY | BAY |
1% Powder | 00576042 | TINACTIN | BAY |
84:04.12 SMMA - SCABICIDES AND PEDICULICIDES
CROTAMITON
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
10% Cream | 00623377 | EURAX | CLC |
DIMETHICONE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
50% Solution | 02373785 | NYDA | GPB |
ISOPROPYL MYRISTATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
50% Solution | 02279592 | RESULTZ | MDF |
PERMETHRIN
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
1% Cream | 00771368 | NIX | INS |
5% Cream | 02219905 | NIX DERMAL | GSK |
1% Liquid | 02231480 | KWELLADA-P | MTC |
5% Lotion | 02231348 | KWELLADA-P | MTC |
PIPERONYL BUTOXIDE, PYRETHRINS
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
3% & 0.3% Shampoo | 02125447 | R & C SHAMPOO WITH CONDITIONER | MTC |
84:04.92 SMMA - MISCELLANEOUS LOCAL ANTI-INFECTIVES
ISOPROPYL ALCOHOL
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
70% Liquid | 00426539 | DUONALC | ICN |
METRONIDAZOLE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
10% Cream | 01926861 | FLAGYL | SAC |
POVIDONE-IODINE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
10% Solution | 00158348 | BETADINE | PFR |
SELENIUM SULFIDE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
2.5% Lotion | 00594601 | VERSEL | VAE |
2.5% Shampoo | 00243000 | EXTRA STRENGTH SELSUN | SAC |
SILVER SULFADIAZINE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
1% Cream | 00323098 | FLAMAZINE | SNE |
1% Cream | 09854037 | FLAMAZINE | SMW |
84:06.00 SMMA - ANTI-INFLAMMATORY AGENTS
AMCINONIDE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.1% Cream | 02246714 | TARO-AMCINONIDE | TAR |
0.1% Lotion | 02247097 | RATIO-AMCINONIDE | TEV |
0.1% Ointment | 02247096 | RATIO-AMCINONIDE | TEV |
BECLOMETHASONE DIPROPIONATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.025% Cream | 02089602 | PROPADERM | VAE |
BETAMETHASONE DIPROPIONATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.05% Cream | 00323071 | DIPROSONE | FRS |
0.05% Cream | 02122073 | ROLENE | RIV |
0.05% Cream | 02122049 | ROSONE | RIV |
0.05% Cream | 01925350 | TARO-SONE | TAR |
0.05% Cream | 00849650 | TEVA-TOPILENE | TEV |
0.05% Cream | 00804991 | TEVA-TOPISONE | TEV |
0.05% Lotion | 00417246 | DIPROSONE | FRS |
0.05% Lotion | 02122065 | ROLENE | RIV |
0.05% Lotion | 02122030 | ROSONE | RIV |
0.05% Lotion | 01927914 | TEVA-TOPILENE | TEV |
0.05% Lotion | 00809187 | TEVA-TOPISONE | TEV |
0.05% Ointment | 00629367 | DIPROLENE | FRS |
0.05% Ointment | 00344923 | DIPROSONE | FRS |
0.05% Ointment | 02122081 | ROLENE | RIV |
0.05% Ointment | 02122057 | ROSONE | RIV |
0.05% Ointment | 00849669 | TEVA-TOPILENE | TEV |
0.05% Ointment | 00805009 | TEVA-TOPISONE | TEV |
BETAMETHASONE DIPROPIONATE, CLOTRIMAZOLE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.05% & 1% Cream | 02496410 | TARO-CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE | TAR |
BETAMETHASONE DIPROPIONATE, SALICYLIC ACID
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.05% & 2% Lotion | 02245688 | RATIO-TOPISALIC | TEV |
0.05% & 3% Ointment | 00578436 | DIPROSALIC | FRS |
pDIN For Extemporaneous Mixture | 99500003 | SALICYLIC ACID IN CORTICOSTEROID CREAM | UNK |
pDIN For Extemporaneous Mixture | 99501001 | SALICYLIC ACID IN NON-MEDICATED OINTMENT | UNK |
BETAMETHASONE VALERATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.05% Cream | 00716618 | BETADERM | TAR |
0.05% Cream | 02357860 | CELESTODERM V | VAE |
0.05% Cream | 00535427 | RATIO-ECTOSONE | TEV |
0.1% Cream | 00716626 | BETADERM | TAR |
0.1% Cream | 02357844 | CELESTODERM V | VAE |
0.1% Cream | 00535435 | RATIO-ECTOSONE | TEV |
0.05% Lotion | 00653209 | RATIO-ECTOSONE | TEV |
0.1% Lotion | 00716634 | BETADERM | TAR |
0.1% Lotion | 00750050 | RATIO-ECTOSONE | TEV |
0.1% Lotion | 01940112 | RIVASONE | RIV |
0.1% Lotion | 00027944 | VALISONE | VAE |
0.05% Ointment | 00716642 | BETADERM | TAR |
0.05% Ointment | 02357879 | CELESTODERM V | VAE |
0.1% Ointment | 00716650 | BETADERM | TAR |
0.1% Ointment | 02357852 | CELESTODERM V | VAE |
BUDESONIDE, SODIUM CHLORIDE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.02MG/ML Enema | 02052431 | ENTOCORT | TIL |
CALCIPOTRIOL, BETAMETHASONE DIPROPIONATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
50MCG & 0.5MG Aerosol (Foam) | 02457393 | ENSTILAR | LEO |
0.5MG & 50MCG Gel | 02319012 | DOVOBET | LEO |
0.5MG & 50MCG Ointment | 02244126 | DOVOBET | LEO |
CLOBETASOL PROPIONATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.05% Cream | 02213265 | DERMOVATE | TPT |
0.05% Cream | 02024187 | MYLAN-CLOBETASOL | MYL |
0.05% Cream | 02232191 | PMS-CLOBETASOL | PMS |
0.05% Cream | 02309521 | PMS-CLOBETASOL | PMS |
0.05% Cream | 02245523 | TARO-CLOBETASOL | TAR |
0.05% Cream | 01910272 | TEVA-CLOBETASOL | TEV |
0.05% Lotion | 02213281 | DERMOVATE | TPT |
0.05% Lotion | 02216213 | MYLAN-CLOBETASOL | MYL |
0.05% Lotion | 02232195 | PMS-CLOBETASOL | PMS |
0.05% Lotion | 02245522 | TARO-CLOBETASOL | TAR |
0.05% Lotion | 01910299 | TEVA-CLOBETASOL | TEV |
0.05% Ointment | 02213273 | DERMOVATE | TPT |
0.05% Ointment | 02026767 | MYLAN-CLOBETASOL | MYL |
0.05% Ointment | 02309548 | PMS-CLOBETASOL | PMS |
0.05% Ointment | 02245524 | TARO-CLOBETASOL | TAR |
0.05% Ointment | 01910280 | TEVA-CLOBETASOL | TEV |
CLOBETASONE BUTYRATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.05% Cream | 02214415 | SPECTRO ECZEMACARE | GSK |
DESONIDE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.05% Cream | 02229315 | PDP-DESONIDE | PED |
0.05% Cream | 02154862 | TRIDESILON | PER |
0.05% Ointment | 02229323 | PDP-DESONIDE | PED |
0.05% Ointment | 02154870 | TRIDESILON | PER |
DESOXIMETASONE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.05% Cream | 02221918 | TOPICORT MILD | BSH |
0.25% Cream | 02221896 | TOPICORT | BSH |
0.05% Gel | 02221926 | TOPICORT | BSH |
0.25% Ointment | 02221934 | TOPICORT | BSH |
ESCULIN, FRAMYCETIN SULFATE, DIBUCAINE HYDROCHLORIDE, HYDROCORTISONE ACETATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
1% & 1% & 0.5% & 0.5% Ointment | 02247322 | PROCTOL | ODN |
1% & 1% & 0.5% & 0.5% Ointment | 02223252 | PROCTOSEDYL | APC |
1% & 1% & 0.5% & 0.5% Ointment | 02242527 | SANDOZ PROCTOMYXIN HC | SDZ |
10MG & 10MG & 5MG & 5MG Ointment | 02226383 | TEVA-PROCTOSONE | TEV |
10MG & 10MG & 5MG & 5MG Suppository | 02247882 | PROCTOL | ODN |
10MG & 10MG & 5MG & 5MG Suppository | 02242528 | SANDOZ PROCTOMYXIN HC | SDZ |
10MG & 10MG & 5MG & 5MG Suppository | 02226391 | TEVA-PROCTOSONE | TEV |
FLUOCINONIDE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.05% Cream | 02163152 | LIDEMOL | VAE |
0.05% Cream | 02161923 | LIDEX | VAE |
0.05% Cream | 00716863 | LYDERM | TPT |
0.05% Cream | 00598933 | TIAMOL | TPT |
0.05% Gel | 02161974 | LIDEX | VAE |
0.05% Gel | 02236997 | LYDERM | TPT |
0.01% Lotion | 00873292 | DERMA-SMOOTHE | HIL |
0.025% Ointment | 02162512 | SYNALAR | VAE |
0.05% Ointment | 02161966 | LIDEX | VAE |
0.05% Ointment | 02236996 | LYDERM | TPT |
0.01% Solution | 02162504 | SYNALAR | VAE |
HALOBETASOL PROPIONATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.05% Cream | 01962701 | ULTRAVATE | UNK |
0.05% Ointment | 01962728 | ULTRAVATE | UNK |
HYDROCORTISONE ACETATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
2.5% Cream | 02469421 | SANDOZ HYDROCORTISONE | SDZ |
HYDROCORTISONE ACETATE, UREA
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
1% & 10% Cream | 00681989 | DERMAFLEX HC | PAL |
1% Cream | 80073645 | M-HC UREA | MAN |
1% Lotion | 80073689 | M-HC UREA | MAN |
1.00% Lotion | 00681997 | DERMAFLEX HC | PAL |
HYDROCORTISONE ACETATE, ZINC SULFATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.5% & 0.5% Ointment | 02128446 | ANODAN-HC | ODN |
0.5% & 0.5% Ointment | 00505773 | ANUSOL HC | CHU |
0.5% & 0.5% Ointment | 02209764 | EGOZINC-HC | PMS |
0.5% & 0.5% Ointment | 00607789 | RATIO-HEMCORT-HC | TEV |
0.5% & 0.5% Ointment | 02179547 | RIVA-HC | RIV |
0.5% & 0.5% Ointment | 02247691 | SANDOZ ANUZINC HC | SDZ |
10MG & 10MG Suppository | 02236399 | ANODAN-HC | ODN |
10MG & 10MG Suppository | 00476285 | ANUSOL HC | CHU |
10MG & 10MG Suppository | 02210517 | EGOZINC-HC | PMS |
10MG & 10MG Suppository | 02240112 | RIVASOL-HC | RIV |
10MG & 10MG Suppository | 02242798 | SANDOZ ANUZINC HC | SDZ |
HYDROCORTISONE ACETATE, ZINC SULFATE MONOHYDRATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.5% & 0.5% Ointment | 02387239 | JAMP-ZINC-HC | JMP |
HYDROCORTISONE ACETATE, ZINC SULFATE, PRAMOXINE HYDROCHLORIDE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.5% & 0.5% & 1% Ointment | 00505781 | ANUGESIC HC | MCL |
0.5% & 0.5% & 1% Ointment | 02234466 | PROCTODAN-HC | ODN |
10MG & 10MG & 20MG Suppository | 00476242 | ANUGESIC HC | MCL |
10MG & 10MG & 20MG Suppository | 02240851 | PROCTODAN-HC | ODN |
10MG & 10MG & 20MG Suppository | 02242797 | SANDOZ ANUZINC HC PLUS | SDZ |
HYDROCORTISONE ACETATE-UREA
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
1% Cream | 80061501 | JAMP-HYDROCORTISONE UREA | MAN |
HYDROCORTISONE VALERATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.2% Cream | 02242984 | HYDROVAL | TPT |
0.2% Ointment | 02242985 | HYDROVAL | TPT |
MOMETASONE FUROATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.1% Cream | 00851744 | ELOCOM | FRS |
0.1% Cream | 02367157 | TARO-MOMETASONE | TAR |
0.1% Lotion | 00871095 | ELOCOM | FRS |
0.1% Ointment | 00851736 | ELOCOM | FRS |
0.1% Ointment | 02244769 | PMS-MOMETASONE | PMS |
0.1% Ointment | 02270862 | PMS-MOMETASONE | PMS |
0.1% Ointment | 02266385 | TARO-MOMETASONE | TAR |
0.1% Ointment | 02248130 | TEVA-MOMETASONE | TEV |
pDIN For Extemporaneous Mixture | 99500008 | MOMETASONE CREAM | UNK |
TRIAMCINOLONE ACETONIDE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.1% Cream | 02194058 | ARISTOCORT R | VAE |
0.1% Cream | 00716960 | TRIADERM | TAR |
0.5% Cream | 02194066 | ARISTOCORT C | VAE |
0.1% Ointment | 02194031 | ARISTOCORT R | VAE |
0.1% Paste | 01964054 | ORACORT DENTAL PASTE | TAR |
84:06.08
HYDROCORTISONE ACETATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.5% Cream | 80021088 | CORTATE | BAY |
0.5% Cream | 00716820 | HYDERM | TAR |
0.5% Cream | 02242930 | HYDROCORTISONE ACETATE | TAR |
1% Cream | 00192597 | EMOCORT | GSK |
1% Cream | 02412926 | EUROHYDROCORTISONE | EUR |
1% Cream | 00716839 | HYDERM | TAR |
1% Cream | 00564281 | HYDROSONE | TEV |
1% Cream | 80057178 | JAMP-HC | JMP |
1% Cream | 80057189 | JAMP-HYDROCORTISONE | JMP |
1% Cream | 80066164 | M-HC | MAN |
1% Cream | 00804533 | PREVEX HC | GSK |
0.5% Lotion | 80021087 | CORTATE | BAY |
1% Lotion | 80057191 | JAMP-HYDROCORTISONE | JMP |
1% Lotion | 80066168 | M-HC | MAN |
1% Lotion | 00578541 | SARNA HC | GSK |
0.5% Ointment | 80021085 | CORTATE | BAY |
0.5% Ointment | 00716685 | CORTODERM | TAR |
1% Ointment | 00716693 | CORTODERM | TAR |
84:08.00 SMMA - ANTIPRURITICS AND LOCAL ANESTHETICS
LIDOCAINE
Limited use benefit (prior approval not required).
Coverage will be limited to 35 grams every 30 days.
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
5% Ointment | 02386836 | JAMPOCAINE | JMP |
5% Ointment | 01963988 | LIDODAN | ODN |
5% Ointment | 02083795 | LIDODAN | ODN |
5% Ointment | 00001961 | XYLOCAINE | UNK |
LIDOCAINE HCL
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
5% Ointment | 00811475 | XYLOCAINE | UNK |
LIDOCAINE HYDROCHLORIDE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
2% Solution | 02427745 | JAMPOCAINE VISCOUS | JMP |
LIDOCAINE, PRILOCAINE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
2.5% & 2.5% Cream | 00886858 | EMLA | UNK |
2.5% & 2.5% Patch | 02057794 | EMLA | UNK |
PHENAZOPYRIDINE HYDROCHLORIDE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
100MG Tablet | 00476714 | PYRIDIUM | ERF |
84:16.00 SMMA - CELL STIMULANTS AND PROLIFERANTS
TRETINOIN
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.01% Cream | 00897329 | RETIN-A | UNK |
0.01% Cream | 00657204 | STIEVA-A | GSK |
0.025% Cream | 00897310 | RETIN-A | UNK |
0.025% Cream | 00578576 | STIEVA-A | GSK |
0.05% Cream | 00443794 | RETIN-A | UNK |
0.05% Cream | 00518182 | STIEVA-A | GSK |
0.01% Gel | 00870013 | RETIN-A | UNK |
0.01% Gel | 01926462 | VITAMIN A ACID | VAE |
0.025% Gel | 00443816 | RETIN-A | UNK |
0.025% Gel | 01926470 | VITAMIN A ACID | VAE |
0.05% Gel | 01926489 | VITAMIN A ACID | VAE |
84:24.00 EMOLLIENTS, DEMULCENTS, AND PROTECTANTS
UREA
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
10% Cream | 80079497 | UREMOL 10 | ODN |
10% Cream | 80005397 | URISEC10 | ODN |
20% Cream | 80083394 | UREMOL | ODN |
22% Cream | 00396125 | URISEC 22 | ODN |
10% Lotion | 80079498 | UREMOL 10 | ODN |
12% Lotion | 00514896 | URISEC 12 | ODN |
84:24.12 BASIC OINTMENTS AND PROTECTANTS
DIMETHICONE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
20% Cream | 02060841 | BARRIERE | WPC |
WHITE PETROLATUM
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
71.5% Ointment | 02277778 | CRITIC-AID CLEAR | UNK |
ZINC OXIDE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
15% Cream | 02215799 | ZINC OXIDE | HJS |
25% Paste | 00532576 | PATE D'IHLE | TEV |
25% Paste | 00886327 | PÂTE D'IHLE | ATL |
ZINC OXIDE, WHITE PETROLATUM
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
15% & 80.3% Cream | 02337452 | DIAPER RASH | HJS |
40% Ointment | 02239160 | ZINCOFAX EXTRA STRENGTH | PAL |
84:28.00 KERATOLYTIC AGENTS
BENZOYL PEROXIDE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
5% Gel | 02162113 | BENZAGEL | CLC |
4% Lotion | 02413353 | SPECTRO ACNECARE WASH | GSK |
5% Lotion | 02166607 | BENZAGEL 5 | CLC |
5% Solution | 02162121 | BENZAGEL | CLC |
CANTHARIDIN
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
1% Liquid | 80028872 | CANTHACUR 07 | PAL |
CANTHARIDIN, PODOPHYLLIN, SALICYLIC ACID
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
1% & 2% & 30% Liquid | 00772011 | CANTHARONE PLUS | DOR |
CLINDAMYCIN PHOSPHATE, TRETINOIN
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
1.2% & 0.025% Gel | 02359685 | BIACNA TOPICAL | BSH |
SALICYLIC ACID
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
170MG/ML Gel | 00614246 | COMPOUND W GEL | UNK |
20% Liquid | 00690333 | SOLUVER | DPT |
26% Liquid | 00754951 | OCCLUSAL HP | VAE |
27% Liquid | 00837733 | SOLUVER PLUS | DPT |
40% Plaster | 01967878 | DR SCHOLLS CLEAR AWAY PLANTAR WART REMOVER SYSTEM | BAY |
40% Plaster | 01974335 | DR SCHOLLS CLEAR AWAY WART REMOVER SYSTEM | BAY |
4% Shampoo | 00666106 | SEBCUR | DPT |
84:32.00 KERATOPLASTIC AGENTS
COAL TAR
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
10% Gel | 00344508 | TARGEL | ODN |
0.5% Shampoo | 02240645 | NEUTROGENA | JAJ |
1% Shampoo | 02307146 | T/ THERAPEUTIC SHAMPOO EXTRA STRENGTH | JAJ |
20% Solution | 00358495 | ODAN LIQUOR CARBONIS DETERGENT | ODN |
COAL TAR, SALICYLIC ACID
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
10% & 3% Gel | 00510335 | TARGEL SA | ODN |
10% & 4% Shampoo | 00666114 | SEBCUR-T | DPT |
84:92.00 MISCELLANEOUS SKIN AND MUCOUS MEMBRANE AGENTS
ACITRETIN
Open benefit (prior approval not required).
Soriatane should be used with caution in clients of childbearing potential due to its teratogenicity. Pregnancy must be excluded. Effective contraception must be used. Manufacturer's literature regarding contraindications and warnings should be consulted prior to prescribing or dispensing this drug.
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
ST10MG Capsule | 02468840 | MINT-ACITRETIN | MIN |
ST10MG Capsule | 02070847 | SORIATANE | ALL |
ST10MG Capsule | 02466074 | TARO-ACITRETIN | TAR |
ST25MG Capsule | 02468859 | MINT-ACITRETIN | MIN |
ST25MG Capsule | 02070863 | SORIATANE | ALL |
ST25MG Capsule | 02466082 | TARO-ACITRETIN | TAR |
ADAPALENE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.1% Cream | 02231592 | DIFFERIN | GAC |
0.1% Gel | 02148749 | DIFFERIN | GAC |
0.3% Gel | 02274000 | DIFFERIN XP | GAC |
AZELAIC ACID
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
15% Gel | 02270811 | FINACEA | LEO |
BRODALUMAB
Limited use benefit (prior approval required).
For the treatment of:
- psoriasis according to established criteria.
(Please refer to Appendix A).
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
210MG Solution | 02473623 | SILIQ | VAE |
CALCIPOTRIOL
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
50MCG/G Ointment | 01976133 | DOVONEX | LEO |
CAPSAICIN
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.025% Cream | 02157101 | CAPSAICIN | VAE |
0.025% Cream | 02244952 | ZODERM | EUR |
0.025% Cream | 00740306 | ZOSTRIX | VAE |
0.075% Cream | 02157128 | CAPSAISIN | VAE |
0.075% Cream | 02004240 | ZOSTRIX HP | VAE |
COLLAGENASE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
250U Ointment | 02063670 | SANTYL | SNE |
DUPILUMAB
Limited use benefit (prior approval required).
Initial coverage criteria (4 months):
For adult patient with chronic moderate to severe atopic dermatitis who meet all the following criteria:
- patient has a score greater than or equal to 16 on the Eczema Area and Severity Index (EASI); and
- patient has a score greater than or equal to 8 on the Dermatology Life Quality Index (DLQI); and
- body surface area (BSA) of 10% or more is affected; and
- the disease is insufficiently controlled despite the use of topical treatments including at least two medium or high-potency topical corticosteroids and one topical calcineurin inhibitor; and
- intolerance or lack of response to phototherapy or inability to access phototherapy.
Criteria for renewal or for initial coverage in patients currently maintained on Dupixent (12 months):
- patient has an improvement of at least 75% in the EASI score compared to the baseline level; or
- patient has an improvement of at least 50% in the EASI score; and
- patient has had a decrease of at least five points on the DLQI questionnaire compared to the baseline.
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
150MG Solution | 02470365 | DUPIXENT | SAC |
FLUOROURACIL
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
5% Cream | 00330582 | EFUDEX | VAE |
IMIQUIMOD
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
5% Cream | 02239505 | ALDARA P | BSH |
5% Cream | 02407825 | APO-IMIQUIMOD | APX |
5% Cream | 02482983 | TARO-IMIQUIMOD PUMP | TAR |
ISOTRETINOIN
Open benefit (prior approval not required).
Soriatane should be used with caution in clients of childbearing potential due to its teratogenicity. Pregnancy must be excluded. Effective contraception must be used. Manufacturer's literature regarding contraindications and warnings should be consulted prior to prescribing or dispensing this drug.
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
ST10MG Capsule | 00582344 | ACCUTANE ROCHE | HLR |
ST10MG Capsule | 02257955 | CLARUS | MYL |
10MG Capsule | 02396971 | EPURIS | CIP |
20MG Capsule | 02396998 | EPURIS | CIP |
30MG Capsule | 02397005 | EPURIS | CIP |
ST40MG Capsule | 00582352 | ACCUTANE ROCHE | HLR |
ST40MG Capsule | 02257963 | CLARUS | MYL |
40MG Capsule | 02397013 | EPURIS | CIP |
IXEKIZUMAB
Limited use benefit (prior approval required).
For the treatment of:
- psoriatic arthritis according to established criteria.
- psoriasis according to established criteria.
(Please refer to Appendix A).
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
80MG Solution | 02455102 | TALTZ | LIL |
80MG Solution | 02455110 | TALTZ | LIL |
LUBRICANT
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
Vaginal Gel | 09991643 | CAYA DIAPHRAGM | TSN |
Vaginal Gel | 09991644 | CONTRAGEL GREEN | TSN |
PIMECROLIMUS
Limited use benefit (prior approval required).
For patients who have failed topical corticosteroid therapy or have experienced side effects from such treatment.
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
1% Cream | 02247238 | ELIDEL | VAE |
PODOFILOX
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.5% Solution | 01945149 | CONDYLINE | SAC |
PODOPHYLLIN
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
25% Liquid | 00598208 | PODOFILM | PAL |
RISANKIZUMAB
Limited use benefit (prior approval required).
For the treatment of patients with moderate to severe psoriasis
(Please refer to Appendix A).
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
90MG Solution | 02487454 | SKYRIZI | ABV |
SALICYLIC ACID, FLUOROURACIL
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
10% & 0.5% Solution | 02428946 | ACTIKERALL | CIP |
SECUKINUMAB
Limited use benefit (prior approval required).
For the treatment of:
- psoriasis according to established criteria.
- psoriatic arthritis according to established criteria.
- ankylosing spondylitis according to established criteria.
(Please refer to Appendix A).
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
150MG/ML Injection | 99101215 | COSENTYX (STYLO) | NVC |
150MG/ML Injection | 09857548 | COSENTYX PEN (ON) | NVC |
150MG Solution | 02438070 | COSENTYX | NVR |
TACROLIMUS (PROTOPIC)
Limited use benefit (prior approval required).
For patients who have failed topical corticosteroid therapy or have experienced side effects from such treatment.
Note: Contraindicated in children less than 2 years of age.
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.03% Ointment | 02244149 | PROTOPIC | LEO |
0.1% Ointment | 02244148 | PROTOPIC | LEO |
TAZAROTENE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.05% Cream | 02243894 | TAZORAC | ALL |
0.1% Cream | 02243895 | TAZORAC | ALL |
0.05% Gel | 02230784 | TAZORAC | ALL |
0.1% Gel | 02230785 | TAZORAC | ALL |