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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