86:00 Smooth muscle relaxants

86:12.04 ANTIMUSCARINICS

DARIFENACIN HYDROBROMIDE

Limited use benefit (prior approval required).

For the symptomatic relief of overactive bladder in patients:

with symptoms of urinary frequency, urgency or urge incontinence; and
who have failed on or are intolerant to therapy with immediate-release oxybutynin or solifenacin or tolterodine ER.

Table: DARIFENACIN HYDROBROMIDE
Drug strength and dosage form	DIN	Brand name	Manufacturer code
7.5MG Tablet (Extended Release)	02273217	ENABLEX	UNK
15MG Tablet (Extended Release)	02273225	ENABLEX	UNK

FESOTERODINE FUMARATE

Limited use benefit (prior approval required).

For the symptomatic relief of overactive bladder in patients:

with symptoms of urinary frequency, urgency or urge incontinence; and
who have failed on or are intolerant to therapy with immediate-release oxybutynin or solifenacin or tolterodine ER.

Table: FESOTERODINE FUMARATE
Drug strength and dosage form	DIN	Brand name	Manufacturer code
^ST4MG Tablet (Extended Release)	02380021	TOVIAZ	PFI
^ST8MG Tablet (Extended Release)	02380048	TOVIAZ	PFI

FLAVOXATE HYDROCHLORIDE

Table: FLAVOXATE HYDROCHLORIDE
Drug strength and dosage form	DIN	Brand name	Manufacturer code
^ST200MG Tablet	00728179	URISPAS	PAL

OXYBUTYNIN CHLORIDE

Table: OXYBUTYNIN CHLORIDE
Drug strength and dosage form	DIN	Brand name	Manufacturer code
^ST1MG/ML Syrup	02231089	APO-OXYBUTYNIN	APX
^ST1MG/ML Syrup	02223376	PMS-OXYBUTYNIN	PMS
^ST2.5MG Tablet	02240549	PMS-OXYBUTYNIN	PMS
^ST5MG Tablet	02163543	APO-OXYBUTYNIN	APX
^ST5MG Tablet	02241285	DOM-OXYBUTYNIN	DPC
^ST5MG Tablet	02350238	OXYBUTYNIN	SAN
^ST5MG Tablet	02240550	PMS-OXYBUTYNIN	PMS
^ST5MG Tablet	02299364	RIVA-OXYBUTYNIN	RIV
^ST5MG Tablet	02230394	TEVA-OXYBUTYNIN	TEV

PROPIVERINE HYDROCHLORIDE

Table: PROPIVERINE HYDROCHLORIDE
Drug strength and dosage form	DIN	Brand name	Manufacturer code
5MG Tablet	02460289	MICTORYL PEDIATRIC	DUI

SOLIFENACIN SUCCINATE

Table: SOLIFENACIN SUCCINATE
Drug strength and dosage form	DIN	Brand name	Manufacturer code
^ST5MG Tablet	02423375	APO-SOLIFENACIN	APX
^ST5MG Tablet	02446375	AURO-SOLIFENACIN	AUR
^ST5MG Tablet	02424339	JAMP-SOLIFENACIN	JMP
^ST5MG Tablet	02428911	MED-SOLIFENACIN	GMP
^ST5MG Tablet	02417723	PMS-SOLIFENACIN	PMS
^ST5MG Tablet	02399032	SANDOZ SOLIFENACIN	SDZ
5MG Tablet	02458144	SOLIFENACIN	PDL
5MG Tablet	02458241	SOLIFENACIN	SAN
^ST5MG Tablet	02437988	TARO-SOLIFENACIN	SUN
^ST5MG Tablet	02397900	TEVA-SOLIFENACIN	TEV
^ST5MG Tablet	02277263	VESICARE	AST
^ST10MG Tablet	02423383	APO-SOLIFENACIN	APX
^ST10MG Tablet	02446383	AURO-SOLIFENACIN	AUR
^ST10MG Tablet	02424347	JAMP-SOLIFENACIN	JMP
^ST10MG Tablet	02428938	MED-SOLIFENACIN	GMP
^ST10MG Tablet	02417731	PMS-SOLIFENACIN	PMS
^ST10MG Tablet	02399040	SANDOZ SOLIFENACIN	SDZ
10MG Tablet	02458152	SOLIFENACIN	PDL
^ST10MG Tablet	02458268	SOLIFENACIN	SAN
^ST10MG Tablet	02437996	TARO-SOLIFENACIN	SUN
^ST10MG Tablet	02397919	TEVA-SOLIFENACIN	TEV
^ST10MG Tablet	02277271	VESICARE	AST

TOLTERODINE TARTRATE

Table: TOLTERODINE TARTRATE
Drug strength and dosage form	DIN	Brand name	Manufacturer code
^ST2MG Capsule (Extended Release)	02244612	DETROL LA	PFI
^ST2MG Capsule (Extended Release)	02404184	MYLAN-TOLTERODINE ER	MYL
^ST2MG Capsule (Extended Release)	02413140	SANDOZ TOLTERODINE LA	SDZ
^ST2MG Capsule (Extended Release)	02412195	TEVA-TOLTERODINE LA	TEV
^ST4MG Capsule (Extended Release)	02244613	DETROL LA	PFI
^ST4MG Capsule (Extended Release)	02404192	MYLAN-TOLTERODINE ER	MYL
^ST4MG Capsule (Extended Release)	02413159	SANDOZ TOLTERODINE LA	SDZ
^ST4MG Capsule (Extended Release)	02412209	TEVA-TOLTERODINE LA	TEV
^ST1MG Tablet	02369680	APO-TOLTERODINE	APX
^ST1MG Tablet	02239064	DETROL	PFI
^ST1MG Tablet	02423308	MINT-TOLTERODINE	MIN
^ST1MG Tablet	02299593	TEVA-TOLTERODINE	TEV
^ST2MG Tablet	02369699	APO-TOLTERODINE	APX
^ST2MG Tablet	02239065	DETROL	PFI
^ST2MG Tablet	02423316	MINT-TOLTERODINE	MIN
^ST2MG Tablet	02299607	TEVA-TOLTERODINE	TEV

TROSPIUM CHLORIDE

Limited use benefit (prior approval required).

For the symptomatic relief of overactive bladder in patients:

with symptoms of urinary frequency, urgency or urge incontinence; and
who have failed on or are intolerant to therapy with immediate-release oxybutynin or solifenacin or tolterodine ER.

Table: TROSPIUM CHLORIDE
Drug strength and dosage form	DIN	Brand name	Manufacturer code
^ST20MG Tablet	02488353	MAR-TROSPIUM	MAR
^ST20MG Tablet	02275066	TROSEC	SPC

86:12.08 BETA-ADRENERGIC AGONISTS

MIRABEGRON

Limited use benefit (prior approval required).

For the symptomatic relief of overactive bladder in patients:

with symptoms of urinary frequency, urgency or urge incontinence; and
who have failed on or are intolerant to therapy with immediate-release oxybutynin or solifenacin or tolterodine ER.

Table: MIRABEGRON
Drug strength and dosage form	DIN	Brand name	Manufacturer code
^ST25MG Tablet (Extended Release)	02402874	MYRBETRIQ	AST
^ST50MG Tablet (Extended Release)	02402882	MYRBETRIQ	AST

86:16.00 RESPIRATORY SMOOTH MUSCLE RELAXANTS

OXTRIPHYLLINE

Table: OXTRIPHYLLINE
Drug strength and dosage form	DIN	Brand name	Manufacturer code
^ST20MG/ML Elixir	00476366	CHOLEDYL	ERF

THEOPHYLLINE

Table: THEOPHYLLINE
Drug strength and dosage form	DIN	Brand name	Manufacturer code
^ST5.33MG/ML Elixir	00466409	PULMOPHYLLINE	RIV
^ST5.33MG/ML Elixir	01966219	THEOLAIR	VAE
^ST5.33MG/ML Elixir	00627410	THEOPHYLLINE	ATL
^ST100MG Tablet (Extended Release)	00692689	APO-THEO-LA	AAP
^ST200MG Tablet (Extended Release)	00692697	APO-THEO-LA	AAP
^ST300MG Tablet (Extended Release)	00692700	APO-THEO-LA	AAP
^ST400MG Tablet (Extended Release)	02360101	THEO ER	AAP
^ST400MG Tablet (Extended Release)	02014165	UNIPHYL	PFR
^ST600MG Tablet (Extended Release)	02360128	THEO ER	AAP
^ST600MG Tablet (Extended Release)	02014181	UNIPHYL	PFR

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Date modified:: 2020-10-15