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First Nations & Inuit Health

Drug Benefit List 2013

86:00 SMOOTH MUSCLE RELAXANTS

86:12.00 GENITOURINARY SMOOTH MUSCLE RELAXANTS

DARIFENACIN HYDROBROMIDE

Limited use benefit (prior approval required).

For the symptomatic relief of patients with an overactive bladder with symptoms of urinary frequency urgency or urge incontinence or any combination of these in patients who have failed on or are intolerant of therapy with oxybutynin.

7.5MG Extended Release Tablet
02273217 ENABLEX NOV
15MG Extended Release Tablet
02273225 ENABLEX NOV

FLAVOXATE HCL

ST 200MG Tablet
00728179 URISPAS PAL

OXYBUTYNIN CHLORIDE

ST 1MG/ML Syrup
02231089 APO-OXYBUTYNIN APX
02223376 PMS-OXYBUTYNIN PMS
ST 2.5MG Tablet
02240549 PMS-OXYBUTYNIN PMS
ST 5MG Tablet
02163543 APO-OXYBUTYNIN APX
02241285 DOM-OXYBUTYNIN DPC
02230800 GEN-OXYBUTYNIN GEN
02220059 OXYBUTYNIN VAE
02350238 OXYBUTYNIN SAN
02220636 OXYBUTYNINE PDL
02240550 PMS-OXYBUTYNIN PMS
02299364 RIVA-OXYBUTYNIN RIV
02230394 TEVA-OXYBUTYNIN TEV

SOLIFENACIN SUCCINATE

Limited use benefit (prior approval required).

For symptomatic relief in patients with an overactive bladder with symptoms of urinary frequency urgency or urge incontinence in patients who have failed on or are intolerant of therapy with oxybutynin.

ST 5MG Tablet
02277263 VESICARE AST
ST 10MG Tablet
02277271 VESICARE AST

TOLTERODINE

Limited use benefit (prior approval required).

For the symptomatic relief of patients with an overactive bladder with symptoms of urinary frequency urgency or urge incontinence or any combination of these in patients who have failed on or are intolerant of therapy with oxybutynin.

ST 2MG Extended Release Capsule
02244612 DETROL LA PFI
ST 4MG Extended Release Capsule
02244613 DETROL LA PFI

TOLTERODINE

Limited use benefit (prior approval required).

For the symptomatic relief of patients with an overactive bladder with symptoms of urinary frequency urgency or urge incontinence or any combination of these in patients who have failed on or are intolerant of therapy with oxybutynin.

ST 1MG Tablet
02239064 DETROL PFI
ST 2MG Tablet
02239065 DETROL PFI

TROSPIUM CHLORIDE

Limited use benefit (prior approval required).

For the symptomatic relief of patients with an overactive bladder with symptoms of urinary frequency, urgency or urge incontinence or any combination of these in patients who have failed on or are intolerant of therapy with oxybutynin.

ST 20MG Tablet
02275066 TROSEC ORY

86:16.00 RESPIRATORY SMOOTH MUSCLE RELAXANTS

OXTRIPHYLLINE

20MG/ML Elixir
00476366 CHOLEDYL PFI
00792942 PMS-OXTRIPHYLLINE PMS
100MG Tablet
00441724 APO-OXTRIPHYLLINE APX
200MG Tablet
00441732 APO-OXTRIPHYLLINE APX
300MG Tablet
00511692 APO-OXTRIPHYLLINE APX

THEOPHYLLINE

5.33MG/ML Elixir
00575151 PMS-THEOPHYLLINE PMS
00466409 PULMOPHYLLIN RIV
00627410 THEOPHYLLINE ATL
5.33MG/ML Solution
01966219 THEOLAIR MMH
100MG Sustained Release Tablet
00692689 APO-THEO APX
02230085 TEVA-THEOPHYL SR TEV
200MG Sustained Release Tablet
00692697 APO-THEO LA APX
02230086 TEVA-THEOPHYL SR TEV
300MG Sustained Release Tablet
00692700 APO-THEO LA APX
02230087 TEVA-THEOPHYL SR TEV
400MG Sustained Release Tablet
02360101 THEO ER AAP
02014165 UNIPHYL PFR

THEOPHYLLINE

600MG Sustained Release Tablet
02360128 THEO ER AAP
02014181 UNIPHYL PFR