ANITOBA DRUG INTERCHANGEABILITY FORMULARY LISTE …

1 124 124/20181 ONE HUNDRED AND FIRST EDITION SCHEDULEEFFECTIVE OCTOBER 18, 2018 CENT UNI ME ANNEXE EN VIGUEUR LE 18 OCTOBRE 2018 DINP roduct NameManufacturerNIMP roduitFabricantABACAVIR 300 mg TabletsPerParABACAVIR 300 mg comprim sTabletcomprim , ,2241 ABACAVIR/LAMIVUDINE 600/300 mg TabletsPerParABACAVIR/LAMIVUDINE 600/300 mg comprim sTabletcomprim ,425702399539 Apo- ,974902416662 Teva- ,974902454513 Auro- ,987502450682 Mylan- ,987502458381pms- ,9875 ABACAVIR/LAMIVUDINE/ZIDOVUDINE 300/150/300 mg TabletsPerParABACAVIR/LAMIVUDINE/ZIDOVUD INE 300/150/300 mg comprim sTabletcomprim , ,6425 ACETAMINOPHEN COMPOUND WITH CODEINE 8 mg TabletsPerParCOMPOS AC TAMINOPH NE ET COD INE 8 mg comprim sTabletcomprim ,081400653233ratio-Lenoltec #1/ratio-Lenoltec n ,0303 ACETAMINOPHEN COMPOUND WITH CODEINE 15 mg TabletsPerParCOMPOS AC TAMINOPH NE ET COD INE 15 mg comprim sTabletcomprim 02163934 Tylenol with Codeine No.

2 2/Tylenol n 2 avec cod ine , ,1001 ACETAMINOPHEN COMPOUND WITH CODEINE 30 mg TabletsPerParCOMPOS AC TAMINOPH NE ET COD INE 30 mg comprim sTabletcomprim ,145802163926 Tylenol with Codeine No. 3/Tylenol n 3 avec cod ine , ,0798 ACITRETIN 10 mg CapsulesPerParACITRETIN 10 mg , , ,2965 ACITRETIN 25 mg CapsulesPerParACITRETIN 25 mg , , ,2770 MANITOBA drug INTERCHANGEABILITY FORMULARYLISTE DES M DICAMENTS INTERCHANGEABLESPOUR LE MANITOBAP rice ($)Prix ($) 124 124/20182 DINP roduct NameManufacturerNIMP roduitFabricantPrice ($)Prix ($)ACYCLOVIR 200 mg TabletsPerParACYCLOVIR 200 mg comprim sTabletcomprim , , , ,9660 ACYCLOVIR 400 mg TabletsPerParACYCLOVIR 400 mg comprim sTabletcomprim , , , , ,9015 ACYCLOVIR 800 mg TabletsPerParACYCLOVIR 800 mg comprim sTabletcomprim , , , ,1412 ALENDRONATE 5 mg TabletsPerParALENDRONATE 5 mg comprim sTabletcomprim , , , ,1407 ALENDRONATE 10 mg TabletsPerParALENDRONATE 10 mg comprim sTabletcomprim , , , , , , ,498702288087 Sandoz , , 124 124/20183 DINP roduct NameManufacturerNIMP roduitFabricantPrice ($)Prix ($)

3 ALENDRONATE 70 mg TabletsPerParALENDRONATE 70 mg comprim sTabletcomprim , , , , ,206502299712 Alendronate , , , ,206502288109 Sandoz , , , ,2065 ALFUZOSIN 10 mg TabletsPerParALFUZOSIN 10 mg comprim sTabletcomprim , ,745002304678 Sandoz , , ,2601 ALLOPURINOL 100 mg TabletsPerParALLOPURINOL 100 mg comprim sTabletcomprim , , ,0780 ALLOPURINOL 200 mg TabletsPerParALLOPURINOL 200 mg comprim sTabletcomprim , , ,1300 ALLOPURINOL 300 mg TabletsPerParALLOPURINOL 300 mg comprim sTabletcomprim , ,2125 ALPRAZOLAM mg TabletsPerParALPRAZOLAM 0,25 mg comprim sTabletcomprim , , , , , , , 124 124/20184 DINP roduct NameManufacturerNIMP roduitFabricantPrice ($)Prix ($)ALPRAZOLAM mg TabletsPerParALPRAZOLAM 0,5 mg comprim sTabletcomprim , , , , , , ,0728 ALPRAZOLAM 1 mg TabletsPerParALPRAZOLAM 1 mg comprim sTabletcomprim , , ,2092 ALPRAZOLAM 2 mg TabletsPerParALPRAZOLAM 2 mg comprim sTabletcomprim , , , ,3718 AMCINONIDE Topical CreamPer Par AMCINONIDE 0,1 % cr me , , ,2750 AMCINONIDE Topical LotionAMCINONIDE 0,1 % lotion topiquePer mLPar , ,2860 AMILORIDE HCl/HYDROCHLOROTHIAZIDE 5 mg/50 mg TabletsAMILORIDE (CHLORHYDRATE D')/HYDROCHLOROTHIAZIDE 5 mg/50 mg PerParcomprim sTabletcomprim , ,1917 AMIODARONE HCl 200 mg TabletsPerParAMIODARONE (CHLORHYDRATE D') 200 mg comprim sTabletcomprim , , , , , ,389102243836 Sandoz , , 124 124/20185 DINP roduct NameManufacturerNIMP roduitFabricantPrice ($)Prix ($)

4 AMITRIPTYLINE 10 mg TabletsPerParAMITRIPTYLINE 10 mg comprim sTabletcomprim , , , , ,0664 AMITRIPTYLINE 25 mg TabletsPerParAMITRIPTYLINE 25 mg comprim sTabletcomprim , , , , ,1211 AMITRIPTYLINE 50 mg TabletsPerParAMITRIPTYLINE 50 mg comprim sTabletcomprim , , , , ,2347 AMITRIPTYLINE 75 mg TabletsPerParAMITRIPTYLINE 75 mg comprim sTabletcomprim , , ,3634 AMLODIPINE 5 mg TabletsPerParAMLODIPINE 5 mg comprim sTabletcomprim , ,141002297485 ACT , , , , , , , , , , ,141002284383 Sandoz , , , , 124 124/20186 DINP roduct NameManufacturerNIMP roduitFabricantPrice ($)Prix ($)AMLODIPINE 10 mg TabletsPerParAMLODIPINE 10 mg comprim sTabletcomprim ,258102297493 ACT , , , , , , , , , , , ,209302284391 Sandoz , , , ,2093 AMLODIPINE/ATORVASTATIN 5 mg/10 mg TabletsPerParAMLODIPINE/ATORVASTATIN 5 mg/10 mg comprim sTabletcomprim ,629402411253 Apo- ,580202362759GD- ,580202404222pms- ,5802 AMLODIPINE/ATORVASTATIN 5 mg/20 mg TabletsPerParAMLODIPINE/ATORVASTATIN 5 mg/20 mg comprim sTabletcomprim ,100602411261 Apo- ,684202362767GD- ,684202404230pms- ,6842 AMLODIPINE/ATORVASTATIN 5 mg/40 mg TabletsPerParAMLODIPINE/ATORVASTATIN 5 mg/40 mg comprim sTabletcomprim ,181902411288 Apo- ,723202362775GD- ,7232 AMLODIPINE/ATORVASTATIN 5 mg/80 mg TabletsPerParAMLODIPINE/ATORVASTATIN 5 mg/80 mg comprim sTabletcomprim ,277402411296 Apo- ,723202362783GD- ,7232 AMLODIPINE/ATORVASTATIN 10 mg/10 mg TabletsPerParAMLODIPINE/ATORVASTATIN 10 mg/10 mg comprim sTabletcomprim ,776002411318 Apo.

5 612502362791GD- ,612502404249pms- , 124 124/20187 DINP roduct NameManufacturerNIMP roduitFabricantPrice ($)Prix ($)AMLODIPINE/ATORVASTATIN 10 mg/20 mg TabletsPerParAMLODIPINE/ATORVASTATIN 10 mg/20 mg comprim sTabletcomprim ,460802411326 Apo- ,763602362805GD- ,763602404257pms- ,7636 AMLODIPINE/ATORVASTATIN 10 mg/40 mg TabletsPerParAMLODIPINE/ATORVASTATIN 10 mg/40 mg comprim sTabletcomprim ,520002411334 Apo- ,800002362813GD- ,8000 AMLODIPINE/ATORVASTATIN 10 mg/80 mg TabletsPerParAMLODIPINE/ATORVASTATIN 10 mg/80 mg comprim sTabletcomprim ,625702411342 Apo- ,800002362821GD- ,8000 AMOXICILLIN 250 mg CapsulesPerParAMOXICILLINE 250 mg , , , , , , ,1750 AMOXICILLIN 500 mg CapsulesPerParAMOXICILLINE 500 mg , , , , , , ,3417 AMOXICILLIN 125 mg/5 mL Oral Liquid AMOXICILLINE 125 mg/5 ml liquide oralPer mLPar ml01934171 Novamoxin Sugar Reduced/Novamoxin teneur r duite en , , ,035302230879 Apo-Amoxi Sugar Free/Apo-Amoxi sans , , 124 124/20188 DINP roduct NameManufacturerNIMP roduitFabricantPrice ($)Prix ($)

6 AMOXICILLIN 250 mg/5 mL Oral LiquidAMOXICILLINE 250 mg/5 ml liquide oralPer mLPar ,054002352788 Amoxicillin (sugar reduced) , , ,054002230880 Apo-Amoxi Sugar Free/Apo-Amoxi sans ,054001934163 Novamoxin Sugar Reduced/Novamoxin teneur r duite en , , ,0540 AMOXICILLIN/CLAVULANIC ACID 500 mg/125 mg TabletsPerParAMOXICILLINE/ACIDE CLAVULANIQUE 500 mg/125 mg comprim sTabletcomprim 01916858 Clavulin-500 FGSK1,62801, ,027602243351 Apo-Amoxi ,0275 AMOXICILLIN/CLAVULANIC ACID 875 mg/125 mg TabletsPerParAMOXICILLINE/ACIDE CLAVULANIQUE 875 mg/125 mg comprim sTabletcomprim , ,401302245623 Apo-Amoxi , ,3871 ANAGRELIDE HCl mg CapsulesPerParANAGR LIDE (CHLORHYDRATE D') 0,5 mg , , ,684002260107 Sandoz ,6840 ANASTROZOLE 1 mg TabletsPerParANASTROZOLE 1 mg comprim sTabletcomprim , , , ,000002394898 ACT , , , , , , ,000002338467 Sandoz , , ,0000 ARIPIPRAZOLE 2 mg TabletsPerParARIPIPRAZOLE 2 mg comprim sTabletcomprim , , , ,809202473658 Sandoz , 124 124/20189 DINP roduct NameManufacturerNIMP roduitFabricantPrice ($)Prix ($)

7 ARIPIPRAZOLE 5 mg TabletsPerParARIPIPRAZOLE 5 mg comprim sTabletcomprim , , , ,904602473666 Sandoz ,9046 ARIPIPRAZOLE 10 mg TabletsPerParARIPIPRAZOLE 10 mg comprim sTabletcomprim , , , ,075402473674 Sandoz ,0754 ARIPIPRAZOLE 15 mg TabletsPerParARIPIPRAZOLE 15 mg comprim sTabletcomprim , , , ,269202473682 Sandoz , ,2692 ARIPIPRAZOLE 20 mg TabletsPerParARIPIPRAZOLE 20 mg comprim sTabletcomprim , , , ,001702473690 Sandoz , ,0017 ARIPIPRAZOLE 30 mg TabletsPerParARIPIPRAZOLE 30 mg comprim sTabletcomprim , , , ,001702473704 Sandoz ,0017 ATAZANAVIR 150 mg CapsulesPerParATAZANAVIR 150 mg , , ,6771 ATAZANAVIR 200 mg CapsulesPerParATAZANAVIR 200 mg , , , 124 124/201810 DINP roduct NameManufacturerNIMP roduitFabricantPrice ($)Prix ($)ATAZANAVIR 300 mg CapsulesPerParATAZANAVIR 300 mg , , ,2165 ATENOLOL 25 mg TabletsPerParAT NOLOL 25 mg comprim sTabletcomprim , , , , , , , ,0547 ATENOLOL 50 mg TabletsPerParAT NOLOL 50 mg comprim sTabletcomprim ,676502255545 ACT , , , , , , , , , , ,1162 ATENOLOL 100 mg TabletsPerParAT NOLOL 100 mg comprim sTabletcomprim , , ,191202255553 ACT , , , , , , , , , ,1912 ATENOLOL/CHLORTHALIDONE 50 mg/25 mg TabletsPerParAT NOLOL/CHLORTHALIDONE 50 mg/25 mg comprim sTabletcomprim , , , 124 124/201811 DINP roduct NameManufacturerNIMP roduitFabricantPrice ($)Prix ($)

8 ATENOLOL/CHLORTHALIDONE 100 mg/25 mg TabletsPerParAT NOLOL/CHLORTHALIDONE 100 mg/25 mg comprim sTabletcomprim , , ,7118 ATORVASTATIN 10 mg TabletsPerParATORVASTATIN 10 mg comprim sTabletcomprim , , , , , , , , , , , ,183102324946 Sandoz , ,1831 ATORVASTATIN 20 mg TabletsPerParATORVASTATIN 20 mg comprim sTabletcomprim , , , , , , , , , , ,228802324954 Sandoz , ,2288 ATORVASTATIN 40 mg TabletsPerParATORVASTATIN 40 mg comprim sTabletcomprim , , , , , , , , , , , ,245902324962 Sandoz , , 124 124/201812 DINP roduct NameManufacturerNIMP roduitFabricantPrice ($)Prix ($)ATORVASTATIN 80 mg TabletsPerParATORVASTATIN 80 mg comprim sTabletcomprim , , , , , , , , , , ,245902324970 Sandoz , ,2459 AZATHIOPRINE 50 mg TabletsPerParAZATHIOPRINE 50 mg comprim sTabletcomprim , , , , ,5960 AZITHROMYCIN 20 mg/mL Oral SuspensionPer ParAZITHROMYCIN 20 mg/ml suspension , , , ,746702332388 Sandoz , ,3726 AZITHROMYCIN 40 mg/mL Oral SuspensionPer ParAZITHROMYCIN 40 mg/ml suspension , , ,058002332396 Sandoz , ,5280 AZITHROMYCIN 250 mg TabletsPerParAZITHROMYCIN 250 mg comprim sTabletcomprim ,698002255340 ACT , , , ,988102415542 Apo-Azithromycin , , , , ,988102265826 Sandoz , 124 124/201813 DINP roduct NameManufacturerNIMP roduitFabricantPrice ($)Prix ($)

9 AZITHROMYCIN 600 mg TabletsPerParAZITHROMYCIN 600 mg comprim sTabletcomprim ,276302256088 ACT ,3873 BACLOFEN mg/mL InjectionPerParBACLOF NE 0,05 mg/mL injectionmLml02131048 Lioresal ,540402413620 Baclofen ,3760 BACLOFEN mg/mL InjectionPerParBACLOF NE 0,5 mg/mL injectionmLml02131056 Lioresal ,640502413639 Baclofen ,7490 BACLOFEN 2 mg/mL InjectionPerParBACLOF NE 2 mg/mL injectionmLml02131064 Lioresal ,760002413647 Baclofen ,9952 BACLOFEN 10 mg TabletsPerParBACLOF NE 10 mg comprim sTabletcomprim , , , , , , ,2911 BACLOFEN 20 mg TabletsPerParBACLOF NE 20 mg comprim sTabletcomprim 00636576 Lioresal , , , , , , ,6234 BECLOMETHASONE DIPROPIONATE 200 Dose 50 mcg/dose Aqueous Nasal SprayB CLOM THASONE (DIPROPIONATE DE) 200 doses 50 mcg/dose Per Parvaporisateur nasal pour solution ,067502172712 Mylan-Beclo ,0674 BETAHISTINE 8 mg TabletsPerParBETAHISTINE 8 mg comprim sTabletcomprim , , 124 124/201814 DINP roduct NameManufacturerNIMP roduitFabricantPrice ($)Prix ($)BETAHISTINE 16 mg TabletsPerParBETAHISTINE 16 mg comprim sTabletcomprim ,524302374757 ACT , , , , ,1106 BETAHISTINE 24 mg TabletsPerParBETAHISTINE 24 mg comprim sTabletcomprim ,786202374765 ACT , , , , ,1659 BETAMETHASONE DIPROPIONATE Topical CreamPerParB TAM THASONE (DIPROPIONATE DE) 0,05 % cr me , , ,2320 BETAMETHASONE DIPROPIONATE Topical Glycol CreamB TAM THASONE (DIPROPIONATE DE) 0,05 % cr me topiquePerPar base de , ,5705 BETAMETHASONE DIPROPIONATE Topical Glycol LotionB TAM THASONE (DIPROPIONATE DE) 0,05 % lotion topiquePer Par base de , ,2967 BETAMETHASONE DIPROPIONATE Topical Glycol OintmentB TAM THASONE (DIPROPIONATE DE)

10 0,05 % pommade topique PerParbase de , ,5706 BETAMETHASONE DIPROPIONATE Topical LotionPer ParB TAM THASONE (DIPROPIONATE DE) 0,05 % lotion , ,2178 BETAMETHASONE DIPROPIONATE Topical OintmentPerParB TAM THASONE (DIPROPIONATE DE) 0,05 % pommade , , 124 124/201815 DINP roduct NameManufacturerNIMP roduitFabricantPrice ($)Prix ($)BETAMETHASONE DIPROPIONATE mg/g and Salicylic Acid 20 mg/g LotionB TAM THASONE (DIPROPIONATE DE) 0,5 mg/g et Per Paracide salicylique 20 mg/g 0,05 % , ,4650 BETAMETHASONE 17 VALERATE CreamPerParB TAM THASONE 17 (VAL RATE DE) 0,05 % cr , ,059602357860 Celestoderm ,0596 BETAMETHASONE 17 VALERATE CreamPerParB TAM THASONE 17 (VAL RATE DE) 0,1 % cr , ,088902357844 Celestoderm ,0889 BETAMETHASONE 17 VALERATE OintmentPerParB TAM THASONE 17 (VAL RATE DE) 0,05 % ,059602357879 Celestoderm ,0596 BETAMETHASONE 17 VALERATE OintmentPerParB TAM THASONE 17 (VAL RATE DE) 0,1 % ,088902357852 Celestoderm ,0889 BETAMETHASONE 17 VALERATE Scalp LotionPer ParB TAM THASONE 17 (VAL RATE DE) 0,1 % lotion , , ,0939 BEZAFIBRATE 400 mg Sustained Release TabletsPerParBEZAFIBRATE 400 mg comprim s lib ration progressiveTabletcomprim 02083523 Bezalip ,561002453312 Jamp-Bezalip ,9207 BICALUTAMIDE 50 mg TabletsPerParBICALUTAMIDE 50 mg comprim sTabletcomprim , , , , , , , ,3325 BISACODYL 5 mg Enteric TabletsPerParBISACODYL 5 mg comprim s enrobage ent rosolubleTabletcomprim , , 124 124/201816 DINP roduct NameManufacturerNIMP roduitFabricantPrice ($)Prix ($)BISOPROLOL FUMARATE 5 mg TabletsPerParBISOPROLOL (FUMARATE DE) 5 mg comprim sTabletcomprim , , , ,075102247439 Sandoz ,0751 BISOPROLOL FUMARATE 10 mg TabletsPerParBISOPROLOL (FUMARATE DE)