Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting...

116
Revised item list (Pharmaceuticals) 2016/2017 Page 1 Approved list of Pharmaceutical items (Formulary revision 2016/2017) Medical Supplies Division

Transcript of Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting...

Page 1: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 1

Approved list of Pharmaceutical items

(Formulary revision 2016/2017)

Medical Supplies Division

Page 2: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 2

Members of the Core Committee – Formulary Revision 2016/2017

(Pharmaceuticals)

1. Dr. Lal Panapitiya, Director/ Medical Supplies Division

2. Dr. Kamal Jayasinghe, Chief Executive Officer/NMRA

3. Dr.A.T.S. Sudarshana, Deputy Director/ Medical Supplies Division

4. Prof. Laal Jayakody, Professor of Pharmacology, University of Colombo

5. Prof. Gita Fernando, Emeritus Professor of Pharmacology, University of Sri Jayawardenapura

6. Prof. Rohini Fernandopulle, Professor of Pharmacology,Kothalawala Defence University

7. Prof. Shalini Sri Ranganathan, Professor in Pharmacology,University of Colombo

8. Prof. Priyadarshani Galappatthy, Professor in Pharmacology, University of Colombo

9. Prof. Athula Kaluarachchi, Professor in Obstetrics & Gynecology, University of Colombo

10. Prof. Raveen Hanwella, Professor of Psychiatry, University of Colombo

11. Prof. Pujitha Wickramasinghe, Professor in Pediatrics, University of Colombo

12. Dr. Ananda Wijewickrama, Consultant Physician, National Institute of Infectious Diseases

13. Dr. Mahanama Gunesekara, Consultant Surgeon, National Hospital of Sri Lanka

14. Dr. Geethika Patabendige, Consultant Clinical Microbiologist, National Hospital of Sri Lanka

15. Dr. Anoma Perera, Consultant Anaesthesiologist, Lady Ridgway Hospital

16. Mr. E.D.Weerarathne, Former Assistant Director, Medical Supplies Division

Page 3: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 3

Level demarcation

Level 01 – Primary Medical Care Units(Central Dispensaries, Maternity Clinics)

Level 02 – Divisional Hospitals (District Hospitals, Divisional Hospitals)

Level 03 - Base Hospitals

Level 04 – Provincial General Hospitals, Teaching Hospitals, District General Hospitals

Vital, Essential and Non-essential status

V- Vital drugs are potentially lifesaving and crucial for providing basic health services. It should

be available at all times.

E- Those drugs that satisfy the health care needs of the majority of the population; they should

therefore be available at all times in adequate amounts and in appropriate dosage forms, at a

price the community can afford. (Essential drugs are effective against less severe but are

nevertheless significant forms of illness but are not absolutely vital to providing basic health

care).

N- Non essential drugs are used for minor illnesses are of questionable efficacy or have a

comparatively high cost for a marginal therapeutic advantage.

Regular Items

Item this had been approved to be included in the formulary for the use of general practice.

These items will be regularly supplied by MSD.

Complimentary Items

Essential medicines for priority diseases for which specialized diagnostic or monitoring facilities

and/or specialist medical care and /or specialist training are needed. In case of doubt, medicines

may also be listed as complimentary on the basis of consistence higher costs or less attractive in

a variety of settings.

Named patient items

The items issued for a particular patient for a specific indication

Page 4: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 4

Table of Contents

1. Drugs used in Infections

1.1. Members of the sub committee 06

1.2. Approved item list 07

2. Drugs used in Cardiovascular system

2.1. Members of the sub committee 17

2.2. Approved item list 18

3. Drugs used in Central Nervous System

3.1. Members of the sub committee 25

3.2. Approved item list 26

4. Drugs affecting Nutrition and Blood

4.1. Members of the sub committee 32

4.2. Approved item list 33

5. Drugs used in Respiratory system

5.1. Members of the sub committee 40

5.2. Approved item list 41

6. Vaccines and Immunological products

6.1. Members of the sub committee 46

6.2. Approved item list 47

7. Drugs used in Endocrine system

7.1. Members of the sub committee 50

7.2. Approved item list 51

8. Drugs used in Gastrointestinal system

8.1. Members of the sub committee 48

8.2. Approved item list 49

9. Drugs acting on the Eye

9.1. Members of the sub committee 61

9.2. Approved item list 62

10. Drugs used in the treatment of diseases of Ear, Nose and Oropharynx

10.1. Members of the sub committee 66

10.2. Approved item list 67

Page 5: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 5

11. Drugs acting on the Skin

11.1. Members of the sub committee 69

11.2. Approved item list 70

12. Drugs used in the Malignant diseases

12.1. Members of the sub committee 74

12.2. Approved item list 75

13. Drugs used in Obstetrics and Gynecology

13.1. Members of the sub committee 82

13.2. Approved item list 83

14. Drugs use in Renal Diseases

14.1. Members of the sub committee 86

14.2. Approved item list 87

15. Drugs used in the treatment of musculoskeletal and Joint Diseases

15.1. Members of the sub committee 93

15.2. Approved item list 94

16. Drugs used in Anaesthesia

16.1. Members of the sub committee 97

16.2. Approved item list 98

17. Antidotes

17.1. Members of the sub committee 103

17.2. Approved item list 104

18. Antiseptics and disinfectants 106

19. Surgical Dressings

19.1. Members of the sub committee 108

19.2. Approved item list 109

Page 6: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 6

01. Drugs used in Infections

1.1. Members of the sub committee

1. Dr. Lal Panapitiya, Director, Medical Supplies Division

2. Prof. Rohini Fernandopulle, Professor of Pharmacology

3. Prof. Shalini Sri Ranganathan, Professor in Pharmacology, Faculty of Medicine, Uni of

Colombo

4. Dr. Geethika Patabadige, Consultant Clinical Microbiologist, NHSL

5. Dr. Kushlani Jayatilleke, Consultant Microbiologist, SJGH

6. Dr. Kanthi Nanayakkara, Consultant Vaccinologist and Virologist, MRI

7. Dr. Nadeeka Janage, Consultant Virologist, T.H.Kandy

8. Dr. Primali Jayasekara, Consultant Mycologist, MRI

9. Dr. Ananda Wijewickrama, Consultant Physician, National Institute of Infectious Diseases

10. Dr. Ajantha Liyanage, Consultant Physician, T.H.Kalubowila

11. Dr. Surantha Perera, Consultant Peadiatrician, Kethumathie Hospital

12. Dr. Sameera Jayasinghe, Consultant Surgeon, Accident service, NHSL

13. Dr. Nadeeja Samarasinghe, Consultant Surgeon, B.H.Dambadeniya

14. Mr. E.D.Weerarathne, Former Assistant Director, MSD

Page 7: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 7

1.2. Approved item list - Drugs used in Infections

Drugs available for all levels of Institutions

No

Item

Code Medium Description

Item

Category

VEN

status

1 00100101 Amoxicillin capsule 250mg R E

2 00100102 Amoxycillin capsule 500mg R E

3 00100103 Amoxicillin tablet ( soluble ) 125mg R E

4 00100104

Amoxicillin oral suspension 125mg / 5ml, 100ml

bottle R E

5

New

00100403

Phenoxymethyl penicillin oral Solution 125mg

/5ml, 100ml R E

6 00100402 Phenoxymethyl penicillin tablet 250 mg R E

7

New

00100404 Phenoxymethyl penicillin tablet 500 mg R E

8

New

00100805 Flucloxacillin capsule 250mg R E

9 00100801 Flucloxacillin capsule 500mg R E

10

New

00100804

Flucloxacillin oral solution 125mg/5ml, 100ml

bottle R E

11 00101301 Cefalexin capsule 250mg R E

12 00101302 Cefalexin syrup 125 mg / 5ml,100ml bottle R E

13 00101303 Cefalexin dispersible tablet 125mg R N

14 00101304 Cephalexin capsule 500mg C N

15 00102301 Doxycycline hydrochloride capsule 100mg R E

16 00102903

Erythromycin oral suspension 125mg / 5 ml, 100ml

bottle R N

17 00103001 Clarithromycin tablet 250mg R E

18 00103006 Clarithromycin tablet 500mg C E

19 00103002

Clarithromycin lactobionate for IV infusion 500mg

vial R E

20

New

00103903 Trimethoprim tablet 200 mg R E

21

New

00103901 Trimethoprim tablet 100mg R E

22

New

00103902

Trimethoprim oral suspension 50mg / 5ml, 100ml

bottle R E

23 00105201 Metronidazole tablet 200mg R E

24 00105202 Metronidazole tablet 400 mg R E

25

New

00105204

Metronidazole oral suspension 200mg/5ml, 100ml

bottle R E

Page 8: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 8

26 00105301 Furazolidone tablet 100mg R N

27 00105302

Furazolidone oral suspension 25mg / 5ml,100ml

bottle R N

28 00105501 Nalidixic acid tablet 250mg R N

29 00105502 Nalidixic acid tablet 500mg R E

30 00105901 Nitrofurantoin tablet 50mg R E

31

New

00105903 Nitrofurantoin syrup 25mg/5ml, 300ml bottle R E

32 00106601 Mebendazole tablet 100mg R E

33 00106602 Mebendazole tablet 500mg R N

34 00106901 Diethyl carbamazine citrate tablet 50mg R E

35 00108801 Albendazole tablet 400mg C N

36

New

00108802 Albendazole syrup 200mg/5ml ,30ml bottle C N

37 00106001 Chloroquine phosphate tablet 250mg R E

38 00106101 Primaquine tablets 7.5 mg R E

Drugs available for Level 2,3 & 4 Institutions

No Item Code

Medium Description

Item

Category

VEN

status

1 00100201 Benzylpenicillin injection 1 million unit vial R E

2 00100301 Benzathine penicillin injection 1.2 million unit vial R E

3 00100601 Ampicillin Injection 250mg vial R E

4

New

00100603 Ampicillin injection 1g vial

R E

5 00100704 Cloxacillin injection 250 mg vial R E

6 00100705 Cloxacillin injection 500mg vial R E

7 00100802 Flucloxacillin injection 500mg vial R E

8

New

00100803 Flucloxacillin injection 1g vial

R E

9 00105601 Norfloxacin tablet 400 mg R N

10 00107901 Aciclovir tablet 200mg R E

11 00107902 Aciclovir tablet 800mg R N

12

New

00107904

Aciclovir oral suspension 200mg / 5ml, 125ml

bottle R N

Drugs available for Level 3 & 4 Institutions

No

Item

Code Medium Description

Item

Category

VEN

status

1 00100901 Co-amoxyclav tablet 375mg R E

Page 9: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 9

2 00100902 Co-amoxiclav tablet 625mg R E

3 00100903

Co-Amoxiclav oral suspension 125/31mg, /5ml,

100ml bottle R E

4

New

00100906 Co-Amoxiclav dispersible tablet 125mg R E

5 00100904 Co-amoxyclav injection 500/100mg vial R E

6 00100905 Co-amoxyclav injection 1000/200mg vial R E

7 00101001

Piperacillin 4g with tazobactam injection 500mg

vial C N

8 00101202

Ticarcillin disodium 3g & Clavulanate potassium

200mg injection vial C E

9 00101401 Cefuroxime tablet 125mg R N

10 00101403 Cefuroxime tablet 500mg R E

11 00101404

Cefuroxime oral suspension 125mg /5ml, 100ml

bottle C E

12 00101405 Cefuroxime injection 250mg vial R E

13 00101406 Cefuroxime injection 750mg vial R E

14

New

00101503 Cefotaxime injection 500mg vial R E

15 00101502 Cefotaxime injection 1g vial R E

16 00101601 Ceftazidime Injection 500mg vial R E

17 00101602 Ceftazidime injection 1g vial R E

18 00101703 Ceftriaxone injection 500mg vial R N

19 00101704 Ceftriaxone injection 1g vial R N

20 00102101 Meropenem injection 500mg vial C E

21 00102102 Meropenem injection 1g vial C E

22 00102502

Gentamicin Sulphate injection 80mg / 2ml

ampoule R N

23 00102601 Amikacin injection 250mg / 1ml vial C N

24 00102603 Amikacin injection 500mg / 2ml vial C N

25 00102701 Netilmicin injection 100mg /2ml vial R N

26 00103003 Clarithromycin syrup 125mg /5ml,100ml bottle R E

27 00103201 Clindamycin hydrochloride capsule 150mg C N

28 00103101 Azithromycin tablet 250mg R N

29 00103102

Azithromycin dihydrate oral suspension

200mg/5ml, 15ml bottle R N

30 00103202 Clindamycin hydrochloride capsule 300mg C N

31 00103301 Chloramphenicol capsule 250mg C N

32 00103302 Chloramphenicol injection 500mg vial C N

33 00103401 Sodium Fusidate tablet 250mg C N

34 00103501 Vancomycin hydrochloride injection 500mg vial C E

35 00103502 Vancomycin hydrochloride injection 1g vial C N

36 00103702 Co-trimoxazole tablet 480 mg R E

37 00103801 Sulphadiazine tablet 500mg C N

Page 10: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 10

38 00104601 Cycloserine capsule 250mg C N

39 00105203 Metronidazole injection 500mg / 100ml bottle R E

40 00105401 Ciprofloxacin tablet 250mg R E

41 00105402 Ciprofloxacin tablet 500 mg R E

42 00105403 Ciprofloxacin injection 200mg / 100ml vial R E

43 00105503

Nalidixicacid oral suspension 300 mg / 5 ml,100ml

bottle R N

44 00106701 Levamisole hydrochloride tablet 40mg R N

45 00106801 Pyrentel pamoate tablet 125mg R E

46 00106802

Pyrantel Pamoate oral suspnsion 50mg/ml,10ml

bottle R E

47 00107101 Fluconazole capsule 50mg C E

48

New

00107103 Fluconazole capsule 200mg C E

49 00107102 Fluconazole injection 200mg / 100ml vial C E

50 00107401 Amphoteracin Injection 50mg Vial R E

51 New

00107403 Liposomal Amphotericin B injection 50mg vial C E

52 00107501 Nystatin tablet 500,000 I.U. R N

53 00107601 Griseofulvin tablet 500mg R E

54

New

00110901 Terbinafine tablet 250mg R N

55 00107701 Zidovudine tablet 300mg C N

56 00107903 Aciclovir injection 250mg vial C E

57 00108201 Oseltamivir capsule 30mg C E

58 00108202 Oseltamivir capsule 45mg C E

59 00108203 Oseltamivir capsule 75mg C E

60

New

00108205 Oseltamivir oral suspension 30mg/5ml, 65ml bottle C E

61

New

00112101 Famciclovir tablet 250mg C N

62

New

00112001

Zanamivir inhaler 5mg /dose Diskhaler device and

rotadisks C N

63 00106201 Quinine sulphate tablet 300 mg R E

64 00106202

Quinine dihydrochloride injection 600mg / 2ml

ampoule R E

Drugs available for Level 4 Institutions

No

Item

Code Medium Description

Item

Category

VEN

status

1

00101101 Sulbactam sodium and Cefoperazone sodium (1:1)

for injection 1g vial C N

Page 11: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 11

2 00101102 Sulbactam sodium and Cefoperazone sodium (1:1)

for injection 2g vial C N

3 00101801 Cefixime dispersible tablet 100mg C N

4 00101802 Cefixime tablet 200mg C N

5 00101901 Cefepime for injection 500mg vial C N

6 00101902 Cefepime for injection 1g vial C N

7 00102001 Imipenem cilastatin sodium infusion 500mg C N

8 00103203 Clindamycin phosphate injection 300mg/2ml C N

9 00103402 Sodium Fusidate injection 500mg vial C N

10 00103601 Teicoplanin injection 200mg vial C N

11 00103602 Teicoplanin injection 400mg vial C N

12 00103703

Co-trimoxazole paediatric oral suspension,50ml

bottle (Sulphamethoxazole 200mg +Trimethoprim

40mg in 5ml)

C E

13 00105701 Ofloxacin tablet 200 mg C E

14 00105702 Ofloxacin tablet, 400 mg C E

15 00105801 Levofloxacin tablet 500mg C E

16 00105802 Levofloxacin injection 500mg vial C N

17 00106401 Pyrimethamine tablet 25 mg C N

18 00106501 Sodium stibogluconte injection 10g/100ml vial C E

19

New

00111401 praziquantel tablet 600mg C N

20 00107201 Itraconazole capsule 100mg C N

21

New

00111901

Itraconazole oral suspension 10mg / ml,150ml

bottle C N

22 00107301 Voriconazole tablet 200mg C N

23 00107302 Voriconazole injection 200mg /10ml, vial C N

24 00107702 Zidovudine Syrup 50mg / 5ml, 100ml bottle C N

25 00108001 Ganciclovir injection for IV use 500mg vial C N

26

New

00111901 Valaciclovir tablet 500mg C N

27 00108101 Valganciclovir tablet 450mg C N

28

New

00108102

Valganciclovir oral suspension 250mg / 5ml,

100ml bottle C N

29

New

00111901 Linezolid tablet 600mg C N

30 00108901 Artemether 20mg with Lumefantrine 120mg tablet C N

31

New

00108902 Artemether injection 80mg / 1ml vial C N

32 00106301 Mefloquine tablet 250mg C N

Drugs available for Level 5 Institutions

No Item Medium Description Item VEN

Page 12: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 12

Code Category status

1 00107801 Lamivudine 150mg tablet C E

2 00109001 Emtricitabine 200 mg + Tenofovir tablet,300mg C E

3 00109101

Lamivudine 150mg + Zidovudine 300mg +

Nevirapine 200mg tablet C E

4 00109102

Lamivudine 30mg + Zidovudine 60mg +

Nevirapine 50mg tablet C E

5 00109201

Isoniazid 75mg +Rifampicin 150mg + Ethambutol

275mg tablet C E

6 00109301 Isoniazid 75mg + Rifampicin 150mg tablet C E

7 00109401

Isoniazid 75mg +Rifampicin 150mg + Ethambutol

275mg + Pyrazinamide 400mg tablet C E

8 00109501 Nevirapine 200 mg,tablet C E

9 00109502 Nevirapine suspension,50 mg / 5 mL,240ml bottle C E

10 00109601 Abacavir tablet 300mg C E

11 00109701 Lopinavir 100mg + Ritonavir 25mg tablet C E

12 00109702 Lopinavir 200mg + Ritonavir 50mg tablet C N

13 00110001

Efavirenz 600 mg, Emtricitabine 200 mg,Tenofovir

disoproxil (as fumarate) 300 mg tablet C E

14 00110101 Darunavir (as ethanolate)300 mg tablet, C N

15 00110301 Raltegravir (as potassium salt) 400 mg,tablet C N

16 00110401 Zidovudine 300mg + Lamivudine 150mg tablet C E

17 00110402 Lamivudine 30mg + Zidovudine 60mg tablet C E

18 00110501 Efavirenz tablet 600mg C N

19 00110502 Efavirenz 200mg tablet C N

20 00110601 Abacavir sulfate 60mg + Lamivudine 30mg tablet C E

21 00110701 Atazanavir (as sulphate) 300 mg capsule C E

22 00110801 Ritonavir tablet 100mg C E

Drugs to be issued on Named Patient basis

No

Item

Code Medium Description Item level

Item

Categ

ory VEN

1 New

00111101 Moxifloxacin tablet 400mg

4 C N

2 00108301 Linezolid injection 600mg / 300ml 4 C N

3 New

00111801 Flucytosine tablet 250mg

3 C N

4 New

00111802 Flucytosine injection 10mg / ml,250ml bottle

3 C N

5 New

00111601 Caspofungin injection 50mg vial

3 C N

Page 13: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 13

6 New

00108701 Anidulafungin injection 100mg vial

4 C N

7 New

00111701 Micafungin injection 50mg vial

3 C N

8 New

00108401 Colistimethate sodium injection 1,000,000 IU, vial 3 C N

9 New

00112901 Cidofovir 75mg/ml, 5ml vial 4 C N

10 New

00113001 Foscarnet sodium 24mg /1ml 250ml bottle

4

C N

11 New

00111501

Posaconazole tablet 100mg 4 C N

12 New

00111502 Posaconazole injection 300mg / 16.5ml 4 C N

13 New

00102304 Tigecycline injection 50mg vial 4 C N

Drugs deleted /tailed offed from the Formulary

No

Item

Code Medium Description

Reasons for the

deletion

1 00100401 Phenoxymethylpenicillin tablet 125mg

125mg/5ml oral

solution is included

2 00100602 Ampicillin injection 500mg vial

Replace with

Ampicillin

Injection1g vial

3 00100701 Cloxacillin capsules 250mg

To tail off the item

and replace with

Flucloxacillin

250mg capsule.

4 00100702 Cloxacillin capsule 500mg

To tail off the item

and replace with

Flucloxacillin

500mg capsule.

5 00100703 Cloxacillin syrup 125mg / 5ml,100ml bottle

To tail off the item

and replace with

Flucloxacillin oral

solution.

6 00101201 Ticarcillin sodium 1.5g + Clavulanic acid 100mg

powder for reconstitution for IV use

To tail off gradually

due to Ticarcillin

sodium 1.5g +

Clavulanic acid

100mg is adequate.

7 00101402 Cefuroxime tablet 250mg

Page 14: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 14

8 00101501 Cefotaxime injection 250mg vial

Replace with

Cefotaxime

Injection 500mg vial

9 00101701 Ceftriaxone injection 250mg

500mg and 1g

strength is adequate.

10 00102401 Tetracycline hydrochloride capsule 250 mg Not required

11 00102501 Gentamicin sulphate injection 20mg / 2ml ampoule

Not used within last

five years

12 00102901 Erythromycin tablet 250mg

To remove and

replace with

Clarythromycin

tablet 250mg

13 00102902 Erythromycin tablet 500mg

To remove and

replace with

Clarythromycin

tablet 500mg

14 00105404

Ciprofloxacin suspension 250 mg / 5 ml,100 ml

bottle

Not used within last

five years

15 00105703 Ofloxacin injection 200mg / 100ml vial

Not used within last

five years

16 00106902 Diethylcarbamazine citrate 100mg tablet

50mg strength is

adequate

17 00107001 Niclosamide chewable tablet 500mg

To substitute with

Praziquantel

18 00107502

Nystatin oral suspension 100,000 I.U. in 1 ml,30ml

bottle

Include miconazole

oral gel

Drugs included to the Formulary

No

Item

Code Medium Description

1

New

00100403

Phenoxymethylpenicillin oral solution 125mg /5ml

100ml

2

New

00100404 Phenoxymethylpenicillin tablet 500 mg

3

New

00100603 Ampicillin injection 1g vial

4

New

00100805 Flucloxacillin capsule 250mg

5

New

00100803 Flucloxacillin injection 1g

6

New

00100804

Flucloxacillin oral solution 125mg / 5ml, 100ml

bottle

7

New

00100906 Co-Amoxiclav dispersible tablet 125mg

8

New

00101503 Cefotaxime injection 500mg vial

Page 15: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 15

9 New

00103903 Trimethoprim tablet 200 mg

10

New

00103901 Trimethoprim tablet 100mg

11

New

00103902

Trimethoprim oral suspension 50mg / 5ml, 100ml

bottle

12

New

00105204

Metronidazole oral suspension 200mg/5ml, 100ml

bottle

13

New

00105903 Nitrofurantoin syrup 25mg/5ml, 300ml bottle

14 New

00111401

Praziquantel tablet 600mg

15

New

00107103 Fluconazole capsule 200mg

16

New

00107202

Itraconazole oral suspension 10mg / ml,150ml

bottle

17

New

00107403 Liposomal amphotericin B injection 50mg vial

18

New

00110901 Terbinafine tablet 250mg

19

New

00107904 Aciclovir oral suspension 200mg/5ml, 125ml bottle

20

New

00111901 Valaciclovir tablet 500mg

21

New

00108102

Valganciclovir oral suspension 250mg/ 5ml, 100ml

bottle

22

New

00108205 Oseltamivir oral suspension 30mg/5ml, 65ml bottle

23

New

00112101 Famciclovir tablet 250mg

24

New

00112001

Zanamivir inhaler 5mg /dose Diskhaler device and

rotadisks

25

New

00108302 Linezolid tablet 600mg

25

New

00108802 Albendazole syrup 200mg/5ml ,30ml bottle

26

New

00108902 Artemether injection 80mg /1ml vial

Newly suggested drugs will be included if they are registered only

Approved drugs to be Local purchased by Institutions

No

Item

Code Items Medium Description

Page 16: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 16

1

New

0011130

1

Aztreonam injection 1g vial

2

New

0011110

2

Moxifloxacin injection 400mg/250ml, bottle

Page 17: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 17

02. Drugs used in Cardiovascular system

2.1. Members of the sub committee

1. Dr. Lal Panapitiya, Director, Medical Supplies Division

2. Prof. Rohini Fernandopulle, Professor in Pharmacology ,KDU

3. Dr. Nimali Fernando, Consultant Cardiologist, NHSL

4. Dr. Gotabhaya Ranasinghe, Resident Cardiologist, NHSL

5. Dr. Chandrika Ponnamperuma, Resident Cardiologist, CSTH

6. Dr. Rohan Gunawardana, Consultant Cardiac Electrophysiologist, NHSL

7. Dr. Chandima Amarasinghe, Consultant Cardiothoracic Surgeon, NHSL

8. Dr. Mahendra Munasinghe, Consultant Cardiothoracic Surgeon, NHSL

9. Dr. Duminda Samarasinghe, Consultant Pediatric Cardiologist, LRH

10. Dr. Shehan Perera, Consultant Pediatric Cardiologist, LRH

11. Dr. Anoma Perera, Consultant Aneasthetist, LRH

12. Dr. Kumuduni Ranathunga, Consultant Aneasthetist, NHSL

13. Dr. Namal Wijesinghe, Consultant Physician, Kothalawala Defence University, Rathmalana

14. Dr. Duminda Samarasinghe, Consultant Pediatric Cardiologist, LRH

15. Dr. Shehan Perera, Consultant Pediatric Cardiologist, LRH

16. Mr. E.D.Weerarathne, former Assistant Director, MSD

Page 18: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 18

2.2. Approved item list : Drugs used in Cardiovascular system

Drugs available for all Levels of Institutions

No Item Code Medium Description Item Category VEN status

1 00200101 Digoxin tablet 0.25mg R E

2 00200201 Hydrochlorothiazide tablet 25mg R E

3 00200301 Furosemide(Frusemide) tablet 40 mg R E

4 00200302

Furosemide(Frusemide) injection 20mg / 2ml,

ampoule R E

5 00200401 Spironolactone tablet 25 mg R E

6 00201001 Atenolol tablet 50 mg R N

7 00201101 Propranolol tablet 10 mg R N

8 00201102 Propranolol tablet 40 mg R N

9 00202201 Methyldopa tablet 250 mg R E

10 00202301 Prazosin hydrochloride tablet 1mg R E

11 00202601 Enalapril maleate tablet 5mg R E

12 00202701 Captopril tablet 25mg C N

13

New

00202702 Captopril tablet 12.5 mg C N

14 00202901 Losartan potassium tablet 50mg R E

15 00203001 Glyceryl trinitrate tablet 0.5 mg R V

16

New

00203203 Isosorbide mononitrate SR tablet 30mg R E

17 00203202 Isosorbide mononitrate SR tablet 60mg R E

18 00203301 Amlodipine besylate tablet 5mg R E

19

New

00203302 Amlodipine Besylate tablet 2.5mg R E

20 00203401 Diltiazem tablet 30mg R E

21 00203501 Nifedipine SR tablet 20mg R N

22 00203701 Verapamil hydrochloride tablet 40mg R E

23 00205404 Aspirin enteric coated tablet 75mg R E

24 00206501 Atorvastatin tablet 10mg R E

25 00206502 Atorvastatin calcium tablet 20mg R E

Drugs available for Level 2,3 & 4 Institutions

No Item Code Medium Description Item Category VEN status

1 00200601 Adenosine injection 6mg / 2ml, vial R E

2 00200702 Amiodarone injection 150mg / 3ml, ampoule R E

3 00201201 Carvedilol tablet 6.25mg R E

4 00201202 Carvedilol tablet 12.5mg R E

Page 19: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 19

5 New

00201203 Carvedilol tablet 3.125mg R E

6 00205501 Clopidogrel tablet 75mg R E

7 00205901 Tranexamic acid capsule 500mg R E

8 00205903

Tranexamic acid injection 500mg / 5ml,

ampoule R E

9

New

00406601

Histidine-tryptophan-ketoglutarate (HTK)

solution R N

Drugs available for Level 3 & 4 Institutions

No Item Code Medium Description Item Category VEN status

1 00200102

Digoxin injection 500 microgram / 2ml,

ampoule R N

2 00200103 Digoxin syrup 50 microgram / 1ml, 60ml bottle R N

3

New

00208601 Metolazone tablet 5mg C N

4

New

00200305 Furosemide (Frusemide) tablet 10 mg R E

5

New

00200306

Furosemide syrup 20mg/5ml suger free,150ml

bottle R E

6 00200303

Furosemide(Frusemide) injection 100mg /

10ml, ampoule R N

7

New

00200403 Spironolactone Syrup 10mg / 5ml 100ml bottle R E

8 00200501 Mannitol 20% I.V.infusion, 250 ml bottle R E

9 00200701 Amiodarone tablet 100mg R E

10 00200901

Lignocaine hydrochloride(Anhydrous)

injection for antiarrhythmic use, 100mg / 5ml,

ampoule

R E

11

New

00201104 Propranolol SR capsules 80mg R E

12

New

00201105 Propranolol SR capsules 160mg R E

13 00201103 Propranolol injection 1mg / 1ml, ampoule C N

14 00201301 Bisoprolol fumarate tablet 5mg R E

15 00201401

Esmolol hydrochloride injection 100mg / 10ml,

vial R E

16 00201501 Labetalol hydrochloride tablet 100mg R E

17 00201502

Labetalol hydrochloride injection 100mg /

20ml, ampoule R E

18

New

00208801 Sotalol tablet 80mg C N

19 00201602

Metoprolol tartrate injection 5mg / 5ml,

ampoule C N

20 00201701 Hydralazine hydrochloride tablet 50mg R E

Page 20: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 20

21 00201702 Hydralazine hydrochloride injection, 20mg /

1ml ampoule R E

22 00201901 Sildenafil tablet 50mg R E

23

New

00201902 Sildenafil tablet 25mg R E

24 00202001 Sodium nitroprusside injection 50mg vial R E

25 00202101 Bosentan tablet 125mg R E

26

New

00202102 Bosentan tablet 62.5mg R E

27

New

00202703 Captopril syrup 5mg / ml 100ml bottle C N

28 00203002 Glyceryl trinitrate injection 50mg / 10ml, vial R E

29 00203402

Diltiazem tablet 60 mg

R E

30

New

00203403 Diltiazem ER tablet 90mg R E

31 00203601 Nimodipine tablet 30mg. R N

32

New

00203703 Verapamil SR tablet 240mg R N

33 00203702

Verapamil hydrochloride injection 5mg / 2ml,

ampoule R E

34 00203801 Nicorandil tablet 10mg R N

35

New

00208901 Ivabradine tablet 5 mg C N

36 00203901 Dobutamine injection 250mg / 20ml, vial R E

37 00204001 Dopamine injection 200mg / 5ml, ampoule R E

38 00204101

Isoprenaline hydrochloride injection 2mg /

2ml, ampoule R E

39 00204201

Ephedrine sulphate injection 30mg / 1ml,

ampoule R E

40 00204401 Noradrenaline acid tartrate 4mg / 2ml, ampoule R E

41 00204501 Phenylephrine injection 10mg /1ml R N

42 00204601 Heparin injection 25,000 I.U / 5ml vial R E

43

New

00204602

Heparin injection Benzyl alcohol free 25,000

I.U / 5ml vial R E

44 00204701

Enoxaparin injection 40mg / 0.4ml, prefilled

syringe R E

45 00204702

Enoxaparin injection 60mg / 0.6ml, prefilled

Syringe R E

46 00205101 Warfarin sodium tablet 0.5mg R N

47 00205102 Warfarin sodium tablet 1mg R E

48 00205103 Warfarin sodium tablet 3mg R E

49 00205104 Warfarin sodium tablet 5 mg R E

50 00205201 Protamine sulphate injection 50mg / 5ml, vial R E

51 00205601 Dipyridamole tablet 100mg R N

Page 21: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 21

52 00205801 Streptokinase injection 1.5 million Units vial R V

53

New

00206901 Tenecteplase injection 40mg vial R V

54 00206601 Fenofibrate capsule 200mg C N

55 00206801

Sodium tetradecyl sulphate injection 60 mg /

2ml, ampoule R N

Drugs available for Level 4 Institutions

No Item Code Medium Description Item Category VEN status

1

New

00208701 Indapamide tablet 1.5mg C N

2 00200801 Mexiletine capsule 50mg R N

3 00200802

Mexiletine hydrochloride

injection250mg/10ml, ampoule R N

4 00201601 Metoprolol tablet 50mg C N

5 00202401

Phenoxybenzamine hydrochloride capsule

10mg C N

6 00202402

Phenoxybenzamine hydrochloride injection

100mg / 2ml C N

7 00202501

Phentolamine mesylate injection 10mg / 10ml,

ampoule C N

8

New

00203602

Nimodipine injection 200 microgram / ml,

50ml vial R N

09 00204301 Metaraminol injection 10mg / 1ml, ampoule R N

10 00204801

Tinzaparin sodium injection 3,500 units,

Prefilled syringe C N

11 00204802

Tinzaparin sodium injection 20,000 IU units

vial C N

12 00204901 Epoprostenol sodium injection 500 microgram C N

13 00205001

Fondaparinux sodium, 2.5mg / 0.5ml, solution

for injection C N

14 00205301

Abciximab Intravenous Infusion, 10mg / 5ml

C N

15 00205701

Alteplase(Recombinent tissue type

plasminogen activator) 20mg vial C N

16 00205702

Alteplase(Recombinent tissue type

plasminogen activator) 50mg vial C N

17 00206401

Aprotinin injection 500,000 kallikrein

inactivator units in 50ml vial C N

18 00207001

Papavarine hydrochloride injection, 20mg /

1ml, ampoule C N

19 00207101

Milrinone lactate injection 10mg/10ml,

ampoule C N

20 00207301 Alprostadil injection 500 microgram ampoule C N

Page 22: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 22

21 00207401 Clonidine hyrochloride injection 150

microgram / 1ml ampoule C N

22 00207501 Cadioplegia infusion(St. Thomas Solution) C E

23 00207002 Papaverine hydrochloride injection 60mg/2ml C N

24 00200903 Flecainide Acetate tablet 50mg C E

25 00200904 Flecainide Acetate injection 10mg/ml, 15ml

ampoule C E

Drugs deleted from the Formulary

No Item Code Medium Description

Reasons for the

deletion

1 00200902

Lignocaine hydrochloride ( Anhydrous

)Injection for antiarrhythmic use 500mg /5ml

ampoule

Not used within

last five years

2 00201801 Minoxidil tablet. 2.5mg Low consumption

3 00201802 Minoxidil tablet. 5mg Low consumption

4 00203201 Isosorbide Mononitrate tablet 20mg

Replaced with

ISMN SR 30mg

tablets

5 00205403 Aspirin enteric coated tablet 150mg

75mg and 300mg

adequate

6 01502401

Prilocaine hydrochloride injection, 3% / 2ml

ampoule

Not used within

last five years

7 00201603 Metoprolol ER tablet 50mg

8 00205401 Aspirin tablet 100mg

75mg and 300mg

adequate

9 00205402 Aspirin tablet 150mg

75mg and 300mg

adequate

Drugs to be issued on Named Patient basis

No Item Code Medium Description

1 00203004

Glyceryl trinitrate spray 400microgram

/Metered dose

Drugs included to the Formulary

No Item Code Items Medium Description

1 New Metolazone tablet 5mg

Page 23: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 23

00208601

2 New

00200305 Furosemide (Frusemide) tablet 10 mg

3

New

00200306

Furosemide syrup 20mg/5ml, suger free,150ml

bottle

4

New

00200403 Spironolactone syrup, 10mg/5ml, 100ml bottle

5

New

00201104 Propranolol SR tablet 80mg

6

New

00201105 Propranolol SR tablet 160mg

7

New

00201203 Carvedilol tablet 3.125mg

8

New

00208801 Sotalol tablet 80mg

9

New

00201902 Sildenafil tablet 25mg

10

New

00202102 Bosentan tablet 62.5mg

11

New

00202702 Captopril tablet 12.5 mg

12

New

00202703 Captopril syrup 5mg/ml, 100ml bottle

13

New

00203203 Isosorbide mononitrate SR tablet 30mg

14

New

00203302 Amlodipine besylate tablet 2.5mg

15

New

00203403 Diltiazem SR tablet 90mg

16

New

00203602

Nimodipine injection 200 microgram /ml,50ml

vial

17

New

00203703 Verapamil SR tablet 240mg

18

New

00204602

Heparin injection (Benzyl alcohol free)25,000

I.U. / 5ml Vial

19

New

00206901 Tenecteplase injection 40mg

20

New

00406601

Histidine-tryptophan-ketoglutarate (HTK)

solution

21

New

00200903 Flecainide Acetate tablet 50mg

22

New

00200904

Flecainide Acetate injection 10mg/ml, 15ml

ampoule

Newly suggested item will be included if they are registered only

Page 24: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 24

Aproved drugs to Local Purchased by institutions

No Item Code Items Medium Description Item Category VEN status

1

New

00208701 Indapamide tablet 1.5mg

C N

2

New

00208901 Ivabradine tablet 5 mg

C N

3

New

00209001 Ranolazine SR tablet 500mg

C N

03.Drugs used in Central Nervous System

Page 25: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 25

3.1. Members of the sub committee

01. Dr. Lal Panapitiya, Director, Medical Supplies Division

02. Prof. Rohini Fernandopulle, Professor in Pharmacology

03. Prof. Raveen Hanwella, Professor of Psychiatry

04. Dr. Swarna Wijethunga, Consultant Pediatric Psychiatrist,

05. Dr. Padma Gunarathne, Consultant Neurologist, NHSL

06. Dr. Sunethra Senanayake, Consultant Neurologist, NHSL

07. Dr. Bimsara Senanayake, Consultant Neurologist, NHSL

08. Dr. Senaka Bandusena, Resident Neurologist, CSTC

09. Dr. Jithangi Wanigasinghe, Consultant Pediatric Neurologist, LRH

10. Dr. Piyara Rathnayake, Consultant Pediatric Neurologist, LRH

11. Mr. E.D.Weerarathne, former assistant Director, MSD

3.2. Approved item list : Drugs used in Central Nervous System

Drugs available for all Levels of Institutions

Page 26: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 26

No Item Code

Medium Description

Item

Category

VEN

status

1 00300102 Diazepam tablet 5mg R E

2 00300104 Diazepam rectal solution 5mg / 2.5ml tube R E

3 New

00300105 Diazepam rectal solution 10mg / 2.5ml tube R N

4 00300201 Chlordiazepoxide tablet 10mg R N

5 00302202 Amitriptyline tablet 25mg R E

6 00302301 Imipramine tablet 25 mg R E

7 00302701 Fluoxetine hydrochloride capsule 20mg R E

8 00303001 Cinnarizine tablet 25mg R N

9 00303201 Aspirin tablet 300mg R E

10 00303301 Paracetamol tablet 500mg R E

11 00303302 Paracetamol syrup 120mg in 5ml, 60ml bottle R E

12 00303703 Phenytoin sodium tablet 100 mg R E

13 00303801 Carbamazepine tablet 100mg R E

14 00303802 Carbamazepine tablet 200mg R E

15 New

00303805 Carbamazepine modified release tablet 200mg C N

16 00304001 Sodium valproate tablet 100mg R E

17 00304002 Sodium valproate tablet 200mg R E

18 00300801 Haloperidol tablet 1.5mg R E

19 00300803 Haloperidol Injection 5mg / 1ml ampoule R E

20 00301501 Prochlorperazine tablet 5mg R E

21 00301701 Trifluoperazine tablet 5mg R E

22 00301901 Olanzapine tablet 5mg R E

23 00301902 Olanzapine tablet 10mg R E

24 00302001 Risperidone tablet 2mg R E

Drugs available for Level 2,3 & 4 Institutions

No Item Code

Medium Description

Item

Category

VEN

status

1 00300103 Diazepam Injection 10mg / 2ml ampoule R E

2 00300301 Lorazepam tablet 1mg R N

3 New

00306801 Alprazolam tablet 0.25 mg R N

4 New

00306802 Alprazolam tablet 0.5mg R N

5 New

00307501

Midazolam nasal spray 0.5mg / metered dose,50

dose unit R N

6 00302101 Lithium carbonate tablet 250mg R E

7 00302402 Clomipramine hydrochloride tablet 25 mg R E

Page 27: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 27

8 00302801 Sertraline tablet 50mg R E

9 00302901 Venlafaxine extended release capsules 37.5mg R E

10 00302902 Venlafaxine hydrochloride extended release

capsules 75mg R E

11 New

00306901 Aripiprazole tablet 10mg R E

12 00303601 Phenobarbitone tablet 15 mg R N

13 00303602 Phenobarbitone tablet 30 mg R N

14 00303701 Phenytoin sodium tablet 25mg C E

15 00303702 Phenytoin sodium tablet 50mg R E

16 00303901 Clonazepam tablet 0.5mg R E

17 00303902 Clonazepam tablet 2mg R E

18 00304004 Sodium valproate syrup 200mg / 5ml,100ml R E

19 00304901 Benzhexol hydrochloride tablet 2mg R E

20 00305001 Co-careldopa tablet 25mg/100mg R E

21 00305002 Co-careldopa tablet 25/250mg R E

22 New

00305004

Co-careldopa Modified Release tablet 50mg /

200mg C N

23 00305201 Benztropine injection 2mg / 2ml Ampoule R N

24 00305401 Disulfiram tablet 200mg R E

25 00305501 Atomoxetine hydrochloride capsule 10mg C N

26 00300902 Chlorpromazine hydrochloride tablet 50mg R N

27 00301001 Fluphenazine decanoate injection 25mg / 1ml

ampoule R N

28 00301101 Flupenthixol decanoate injection 40mg / 2ml

ampoule R N

29 New

00306701 Quetiapine tablet 25mg C E

30 New

00302003 Risperidone tablet 1mg R E

Drugs available for Level 3 & 4 Institutions

No Item Code

Medium Description

Item

Category

VEN

status

1 00300302 Lorazepam injection 4mg / 1ml ampoule. R E

2 00300501 Chloral hydrate crystals R N

3 00300502 Chloral hydrate oral solution, 500mg / 5ml in

200ml bottle R N

4 New

00300505

Chloral betaine tablet 707mg (equal to Chloral

hydrate 414mg) R N

5 00305601 Betahistine tablet 8mg R N

6 00305602 Betahistine tablet 16mg R N

7 00303103 Ondansetron injection 8mg / 4ml, ampoule R E

Page 28: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 28

8 New

00303104 Ondansetron tablet 4mg R E

9 00303401 Tramadol hydrochloride capsule 50mg R E

10 00303403 Tramadol hydrochloride injection 100mg / 2ml,

ampoule C N

11 00303501 Sumatriptan tablet 50mg C E

12 00303604 Phenobarbitone injection 200mg / 1ml ampoule R E

13 New

00307001 Primidone tablet 250mg R E

14 00303704 Phenytoin sodium injection 250mg / 5ml, ampoule R E

15 00303803 Carbamazepine syrup 100mg / 5ml,300ml bottle R N

16 00304101 Paraldehyde rectal solution, 10ml, single dose unit C N

17 00304201 Clobazam tablet 5mg R E

18 00304202 Clobazam tablet 10mg R E

19 New

00304302 Gabapentin capsule 100mg C N

20 00304301 Gabapentin capsules 300mg C N

21 00304401 Lamotrigine tablet 25mg C E

22 New

00304402 Lamotrigine tablet 50mg C N

23 New

00304403 Lamotrigine tablet 100mg C N

24 New

00305902 Levetiracetam tablet 250mg C N

25 New

00305901 Levetiracetam tablet 500mg C N

26 00304501 Topiramate tablet 25mg C E

27 00304502 Topiramate tablet 50mg C E

28 00304601 Ethosuximide capsule 250mg C N

29 00304801 Vigabatrin 500mg tablets C N

30 00305301 Botulinum Toxin 100U vial C N

31 New

00305302 Botulinum Toxin 50U vial C N

32 00305801 Duloxetine (as hydrochloride) capsule 20 mg R E

33 New

00306301 Donepezil tablet 5mg C E

34 00300802 Haloperidol tablet 5mg R E

35 00300804 Haloperidol oral solution 2mg / 1ml. 100ml bottle C N

36 00301201 Zuclopenthixol acetate injection 50mg / 1ml

ampoule R N

37 00301301 Zuclopenthixol deconate injection 200mg / ml, 1ml

ampoule R N

38 00301801 Clozapine tablet 100mg R E

39 New

00306702 Quetiapine modified release tablet 200mg C E

Page 29: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 29

40 00000501

Methadone Tablet 5mg R N

41 00000601

Methylphenidate Hydrochloride Tablet 10mg R E

Drugs available for Level 4 Institutions

No Item Code

Medium Description

Item

Category

VEN

status

1 New

00306401 Ox-carbazepine tablet 150mg C N

2 New

00303903 Clonazepam oral drops 2.5mg / ml , 10ml bottle C N

3 New

00304005 Sodium valproate modified release tablet 300mg C N

4 New

00306601 Pregabalin capsule 75 mg C N

5 New

00305003 Co-careldopa Modified Release tablet 25mg/100mg C N

6 New

00307201 Amantadine capsule 100mg C N

7 New

00307301 Ropinirole tablet 0.5mg C N

8 New

00307401 Pizotifen tablet 0.5mg C N

9 New

00701801 Methylprednisolone tablet 4mg R E

10 New

00306101 Melatonin tablet 2mg C N

11 New

00402804 Pyridoxine tablet 100mg C N

12 New

00407301 pyridoxal phosphate tablet 50mg C N

13 New

00307101 Tetrabenazine tablet 25mg C N

42 00000701

Dexamphetamine tablet 5mg C N

Drugs deleted /tailed offed from the Formulary

No Item Code Medium Description Reasons for the deletion

1 00302403 Clomipramine hydrochloride tablet 50 mg 25mg strength is adequate

2 00302501 Doxepin hydrochloride capsule 50mg

3 00303603 Phenobarbitone tablet 60mg 15mg and 30mg strength

are adequate

Page 30: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 30

4 00304701 Flunarizine capsule 5mg

5 00301202 Zuclopenthixol acetate injection 100mg/2ml

ampoule

200mg/ml(SR No

00301301)can be used

Drugs to be issued on Named Patient basis

No

Item Code Medium Description

Item

Category

VEN

status

1 New

00405901 Biotin capsule 5mg

5 N

Drugs included to the Formulary

No Item Code Medium Description

1

New

00300105 Diazepam rectal solution 10mg in 2.5ml tube

2

New

00306801 Alprazolam tablet 0.25 mg

3

New

00306802 Alprazolam tablet 0.5 mg

4

New

00307501

Midazolam nasal spray 0.5mg/metered dose,50 dose

unit

5

New

00300505

Chloral betaine tablet 707mg (equal to Chloral

hydrate 414mg)

6

New

00306901 Aripiprazole tablet 10mg

7

New

00303104 Ondansetron tablet 4mg

8

New

00307001 Primidone tablet 250mg

9

New

00303805 Carbamazepine modified release tablet 200mg

10

New

00306401 Ox-carbazepine tablet 150mg

11

New

00303903 Clonazepam oral drops 2.5mg/ml , 10ml bottle

12

New

00304005 Sodium valproate modified release tablet 300mg

13 New

00304302

Gabapentin capsule 100mg

14

New

00306601 Pregabalin capsule 75 mg

15

New

00304402 Lamotrigine tablet 50mg

16 New Lamotrigine tablet 100mg

Page 31: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 31

00304403

17 New

00305902 Levetiracetam tablet 250mg

18

New

00305901 Levetiracetam tablet 500mg

19

New

00305003 Co-careldopa Modified Release tablet 25mg/100mg

20

New

00305004

Co-careldopa Modified Release tablet 50mg/200mg

21

New

00307201 Amantadine capsule 100mg

22

New

00307301 Ropinirole tablet 0.5mg

23

New

00305302 Botulinum Toxin 50 IU vial

24

New

00307401 Pizotifen tablet 0.5mg

25

New

00306301 Donepezil tablet 5mg

26

New

00701801 Methylprednisolone tablet 4mg

27

New

00306101 Melatonin tablet 2mg

28

New

00402804 Pyridoxine tablet 100mg

29

New

00407301 Pyridoxal phosphate tablet 50mg

30

New

00307101 Tetrabenazine tablet 25mg

31

New

00306701 Quetiapine tablet 25mg

32

New

00306702 Quetiapine modified release tablet 200mg

33

New

00302003 Risperidone tablet 1mg

Newly suggested drugs will be included if they are registered only

04. Drugs affecting Nutrition and Blood

4.1.Members of the sub committee

Page 32: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 32

1. Dr. Lal Panapitiya, Director, MSD

2. Prof. Rohini Fernandopulle, Professor in Pharmacology

3. Prof. Pujitha Wickramasinghe, Professor in Pediatrics, LRH

4. Dr. Lalindra Goonarathne, Consultant Hematologist, Faculty of Medicine, University of Colombo

5. Dr. Visaka Rathnamala, Consultant Hematologist, NHSL

6. Dr. Rohan Pulleperuma, Consultant Hematologist, D.G.H. Hambanthota

7. Dr.Chandima Thevarapperuma, Consultant Hematologist, B.H.Panadura

8. Dr.Chamil Marasinghe, Consultant Physician, CSTH, Kalubowila

9. Dr. Ruwangi Dissanayake, Consultant Pediatrician, LRH

10. Mr. E.D.Weerarathne, Formar Assistant Director, MSD

4.2 Approved item list : Drugs affecting Nutrition and Blood

Drugs available for all Levels of Institutions

Page 33: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 33

No Item Code

Medium Description

Item

Category

VEN

status

1 00400101 Ferrous sulphate tablet 200mg R E

2 New

00400203

Ferrous fumarate tablet 210mg R E

3 New

00400201

Ferrous fumarate chewable tablet 100mg

(33mg iron) R N

4 New

00400306

Iron syrup 50mg/5ml, 100ml bottle R E

5 00400303 Iron drops 50mg/ml, in 15ml dropper bottle R E

6 00400601 Water for Injection 10ml vial R E

7 New

00400602

Water for injection 5ml ampoule R E

8 00400701 Potassium chloride tablet 600mg R E

9 New

01300602

Potassium citrate tablet 10mEq (1080mg per

tablet) R E

11 New

00406501 Phosphate tablet 500 mg R E

12 00400801 Oral rehydration powder sachets 1000ml (1L) R E

13 New

00400802

Oral rehydration powder sachets 200ml R E

14 00401003 Sodium chloride for intravenous infusion

0.9%, 500ml bottle R V

15 00401101 Dextrose for intravenous infusion 5%, 500ml

bottle R V

16 00401103 Dextrose for intravenous infusion 25%, 25ml

ampoule R N

17 00401104 Dextrose for intravenous infusion 50%, 50ml

ampoule R E

18 00401601 Calcium lactate tablet 300mg R E

19 00402501 Vitamin A high potency oral capsule

100,000IU R E

20 00402601 Vitamin B complex tablet R N

21 00402901 Vitamin C tablet 100mg C N

22 00403401 Folic acid tablet 1mg R E

23 00403601 Multivitamin drops 15ml bottle R N

24 New

00406801

Syrup multivitamin + Zinc 200 ml R N

25 00405401 Calcium 500mg + Vitamin D3 250IU tablet R E

26 New

00405402

Calcium carbonate 500mg + Vitamin D 400IU/

5ml R E

27 00405604 Zinc sulfate dispersible tablet 20mg R N

28 00400501 Ferrous fumarate and Folic Acid tablet BP

(182.4 mg + 400 microgram ) R N

Page 34: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 34

Drugs available for Level 2,3 & 4 Institutions

No Item Code

Medium Description

Item

Category

VEN

status

1

00400702 Potassium chloride injection 15% in 10ml

ampoule R E

2 00400901 Sodium bicarbonate tablet 600mg R E

3

00400903 Sodium bicarbonate 8.4% for intravenous

infusion 50ml ampoule R E

4 00400905 Sodium bicarbonate tablet 500mg R N

5

00401001 Sodium chloride for intravenous infusion 0.9%

,5ml ampoule R N

6

00401102 Dextrose for intravenous infusion 10%, 500ml

bottle C N

7

00401202 Sodium chloride 0.45% & Dextrose 5% for

intravenous infusion 500ml Bottle R E

8

00401301 Compound sodium lactate for intravenous

infusion 500ml bottle R E

9

00401401 Dextran 40,10% w / v in Sodium chloride

0.9% for intravenous infusion, 500ml bottle R E

10

00401501 Tetrastarh solution for intravenous infusion

500ml R N

11

New

00406601

Histidine-tryptophan-Ketoglutarate( H.T.K.)

solution 1000ml bags R E

12 00402701 Vitamin B1 tablet 10mg R N

13 00402801 Pyridoxine tablet 10mg R E

14 00402802 Pyridoxine hydrochloride tablet 25mg R E

15

00403202 Phytomenadione injection 1mg / 0.5ml

ampoule R E

16

00403203 Phytomenadione injection 10mg / 1ml

ampoule R E

17

00403501 Hydroxocobalamine injection 1mg / 1ml

ampoule C N

18 00404801 Desferrioxamine injection 500 mg R E

19 00205901 Tranexamic acid capsule 500mg R E

20

New

00205902 Tranexamic acid tablet 500mg R E

21

00205903 Tranexamic acid injection 500mg / 5ml

ampoule R E

Drugs available for Level 3 & 4 Institutions

No Item Code

Medium Description

Item

Category

VEN

status

1 00400401 Iron sucrose injection 100mg / 5ml ampoule C N

2 00401004 Sodium chloride for intravenous infusion 3%, C E

Page 35: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 35

500ml bottle

3 New

00401006

Sodium chloride for intravenous infusion 3%,

10ml C N

4 New Sodium chloride for intravenous infusion 3%,

20ml C N

5 New

00401005

Sodium chloride for intravenous infusion

0.9% 1000ml (Collapsible bag) R V

6 00401701 Calcium gluconate injection 10% in 10ml

ampoule R E

7 00401801 Calcium carbonate tablet 1.25g C E

8 00401903 Magnesium sulphate injection 50% in 10ml

ampoule R E

9 00402102 Fat emulsion injection 10% in 500ml bottle R N

10 00402103 Fat emulsion injection 20% in 100ml bottle R E

11 00402201 Protein hydrolysate injection 100ml bottle C E

12 00402202 Amino acids solution for intravenous infusion

500ml bottle R E

13 00402301 Peritoneal dialysis solution 1.5% in 1000ml

bottle R E

14 00402702 Thiamine hydrochloride injection 100mg in

2ml ampoule R E

15 00403001 Calcitriol capsule 250mg R E

16 00403101 Alfacalcidol capsule 250ng R E

17 00403201 Phytomenadione tablet 5mg R N

18 New

00406701

Cholecalciferol tablet 400IU R E

19 New

00406702

Cholecalciferol tablet 1000IU R E

20 New

00406703

Cholecalciferol tablet 5000IU R E

21 New

00406704 Cholecalciferol 200,000 I.U ampoule R E

22 00404001 Epoetin injection 2,000 IU vial/pre-filled

syringe C E

23 00404002 Epoetin injection 4,000 IU -5000IU vial/pre-

filled syringe C E

24 New

00404004

Epoetin injection 10,000 IU vial/Pre-filled

syringe C E

25 New

00405801

Eltrombopag tablet 50mg C N

26 00404401 Sodium dihydrogen orthophospate powder C N

27 00404501 Disodium hydrogen orthophospate powder C N

28 00404601 Deferiprone capsule 250mg R E

29 00404602 Deferiprone capsule 500mg R E

30 00404701 Deferasirox tablets 100mg R E

Page 36: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 36

31 00404702 Deferasirox tablets 400mg R E

32 00405201 Calcium chloride injection BP 10mmol (14.7%

W/V) in 10ml C N

33 00405301 Albumin Solution (human) 20%,50ml bottle C E

34 00405302 Albumin solution ( human ) 5% ,250ml bottle C N

35 00206003 Dried Factor VII fraction 2mg (100 KIU) vial C E

36 00206101 Dried,Factor VIII fraction 200-350 IU vial C E

37 00206105 Dried,Factor VIII fraction 200-350IU vial with

von Willebrand factor C E

38 00206201 Dried,Factor IX fraction 500 IU vial C E

39 00206301 Activated Prothrombin Complex Concentrate

injection 500IU vial C N

40 00206302 Prothrombin Complex Concentrate injection

500IU vial C N

41 New

00404301 Oxymetholone tablets 50mg R N

Drugs available for Level 4 Institutions

No Item Code

Medium Description

Item

Category

VEN

status

1 New

00407201 Total Parenteral Nutrition solution C E

2 00404202 Trientine dihydrochloride capsule 300mg C E

Drugs deleted from the Formulary

No Item Code Medium Description Reasons for the deletion

1 00400302 Iron drops 100mg/5ml 15ml bottle Replace with iron syrup

2 00400902 Sodium bicarbonate for intravenous infusion

4.2% in 50 ml bottle

Sodium bicarbonate 8.4% is

adequate.

3 00401002 Sodium chloride for intravenous infusion

0.9%, 100ml pack

500ml and 1000ml are

adequate.

4 00401201 Sodium chloride 0.18% & Dextrose 4% for

intravenous infusion 500ml bottle Not used in last few years

5 00401901 Magnesium sulphate 40% in 25ml injection

ampoule

6 00401904 Magnesium sulphate 50% w/v in 2ml Magnesium sulphate 50%

10ml vial is adequate.

7 00402101 Fat emulsion injection 10% in 100ml bottle Fat emulsion Injection

10%,500ml is adequate.

8 00402803 Pyridoxine hydrochloride tablet 50mg 25mg strength is adequate.

9 00403301 Calciferol tablet 10,000 I.U. Replace with cholecalciferol

10 00403402 Folic acid tablet 5mg 1mg strength is adequate

Page 37: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 37

11

00405501 Parenteral infusion fluid 500ml(K+

5mmol/L,Mg2+ 1.5mmol/L,Na+ 140

mmol/L,Acetate 27mmol/L,Cl-98mmol/L)

Replace withParenteral

infusion fluid in 500ml

collapsible bag/bottle

12

00405601

Zinc sulfate dispersible tablet 10mg

Deleted as 20mg strength of

Zinc sulfate dispersible

tablet is adequate.

13

00405603 Zinc sulfate oral solution 10mg/5ml in 75ml

bottle

Deleted as 20mg strength of

Zinc sulfate dispersible

tablet is adequate.

14

0400502 Ferrous fumarate and Folic acid BP (182.4

mg + 1mg)

as Ferrous Fumarate and

Folic Acid tablet BP (182.4

mg + 400mcg) is adequate.

15

00400503 Ferrous fumarate and Folic acid tablet BP

(91.2mg + 1mg)

as Ferrous Fumarate and

Folic Acid tablet BP (182.4

mg + 400mcg) is adequate.

Drugs to be issued on Named Patient basis

No Item Code Medium Description

1

New

00400402

Iron sucrose injection 50mg/ml ,10ml vial

2

00404101 Methoxy polyethylene glycol-epoetin beta

injection 100 microgram /0.3ml vial/prefilled

syringe

3

00404102 Methoxy polyethylene glycol-epoetin beta

injection 50 microgram /0.3ml vial/prefilled

syringe

4

New

01209302

Ruxolitinib 5mg

5

New

01209303

Ruxolitinib 15mg

6

New

01209301

Ruxolitinib 20mg

Drugs included to the Formulary

No Item Code Medium Description

1

New

00400203

Ferrous fumarate 210mg

2

New

00400201

Ferrous fumarate chewable tablet 100mg

(33mg iron)

3

New

00400306

Iron syrup 50mg/5ml, 100ml bottle

4

New

00400402

Iron sucrose injection 50mg/ml ,10ml vial

5 New Water for injection 5ml vial

Page 38: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 38

00400602

6 New

01300602

Potassium citrate tablet 10mEq (1080mg per

tablet)

8

New

00406501 Phosphate tablet 500 mg

9

New

00400802

Oral rehydration powder sachets 200ml

10

New

00401005

Sodium chloride for intravenous infusion

0.9% 1000ml (Collapsible bag)

11

New

00401006

Sodium chloride for intravenous infusion

3%, 10ml

13

New

00406601

Histidine-tryptophan-Ketoglutarate( H.T.K.)

Solution 1000ml bags

14

New

00406701 Cholecalciferol tablet 400 I.U

15

New

00406702 Cholecalciferol tablet 1000 I.U

16

New

00406703 Cholecalciferol tablet 5000 I.U

17

New

00406704 Cholecalciferol 200,000 I.U ampoule

18

New

00406801

Syrup multivitamin + Zinc 200 ml

19

New

00404004

Epoetin injection 10,000 IU vial/Pre-filled

syringe

21

New

00407201 Total Parenteral Nutrition solution

22

New

00405402

Calcium carbonate 500mg + Vitamin D

400IU/ 5ml

23

New

00404301 Oxymetholone tablets 50mg

24

New

00205902 Tranexamic acid tablet 500mg

25

New

01209302

Ruxolitinib 5mg

26

New

01209303

Ruxolitinib 15mg

27

New

01209301

Ruxolitinib 20mg

Newly suggested drugs will be included if they are registered only

Page 39: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 39

05. Drugs used in Respiratory system

5.1. Members of the sub committee

1. Dr.Lal Panapitiya, Director, Medical Supplies Division

2. Prof. Rohini Fernandopulle, Professor in Pharmacology

3. Dr. Manil Peris, Consultant Respiratory Physician, T.H.Kurunegala

4. Dr. Saman Kularatne, Consultant Respiratory Physician, NHRD, Welisara

Page 40: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 40

5. Dr. Dushantha Medagedara, Consultant Respiratory Physician, T.H.Kandy

6. Dr. S. Muhunathan, Consultant Respiratory Physician, T.H.Karapitiya

7. Dr. Geethika Patabadige, Consultant Clinical Microbiologist, NHSL

8. Dr. Asanka Rathnayake, Consultant Physician, T.H.Kalubowila

9. Dr. Surantha Perera, Consultant Pediatrician, Kethumathi Hospital, Panadura

10. Mr.E.D. Weerarathne, Former Assistant Director, MSD

5.2. Approved item list: Drugs Used in Respiratory system

Drugs available for all Levels of Institutions

No Item Code

Medium Description

Item Category

VEN

status

1 00500101 Salbutamol tablet 2mg R E

2 00500105 Salbutamol dry powder capsule for breath activated

device, 200 microgram R E

3 00500106 Salbutamol dry powder capsules for breath activated

devise, 400 microgram R E

Page 41: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 41

4 00500107 Salbutamol aerosol Inhaler 100 microgram/metered

dose, 200 dose unit R E

5 00500108 Salbutamol aerosol Inhaler 200 microgram/metered

dose, 200 dose unit R E

6 00500109 Salbutamol respiratory solution 0.5% in 15ml vial R E

7 00500111 Salbutamol syrup 2mg/5ml, 60ml bottle R E

8 00500201 Salmeterol xinafoate 50 microgram + Fluticasone

propionate 100 microgram dry powder caps R E

9 00500202

Salmeterol Xinafoate 50mcg + Fluticasone

Propionate 250mcg, dry powder capsules for breath

activated device..

R E

10 00500203

Salmeterol xinafoate 50 microgram + Fluticasone

propionate 500 microgram, dry powder capsules for

DP inhaler

R E

11 00500401 Ipratropium Bromide dry powder capsules 40mcg R N

12 00500501 Theophylline slow released tablet 125mg

R E

13 New

00500505

Theophyllin Syrup 25mg /5ml , 60ml bottle R E

14 00500701 Beclometazone dipropionate dry powder capsule100

microgram for breath activated device R E

15 00500702 Beclomethasone dipropionate dry powder capsule

for breath activated device, 200 microgram R E

16 00500703 Beclomethasone dipropionate dry powder capsule

for breath activated device, 400 microgram R E

17 00500704 Beclomethasone dipropionate aerosol Inhaler 50

microgram /metered dose, 200 dose unit R E

18 00500705 Beclamethasone aerosol Inhaler 100 microgram

metered dose, 200 dose Unit R E

19 00500706 Beclamethasone dipropionate aerosol inhaler 250

microgram /metered dose, 200 dose unit R E

20 00501101 Cetirizine hydrochloride tablet 10mg R E

21 00501102 Cetirizine hydrochloride syrup 5mg/5ml, 60ml

bottle R E

22 00501301 Chlorpheniramine maleate tablet 4mg R E

23 00501302 Chlorpheniramine maleate syrup 2mg / 5ml , 60ml

bottle R E

24 00501401 Promethazine hydrochloride tablet 10mg R N

25 00501402 Promethazine hydrochloride tablet 25mg R N

26 00501403 Promethazine hydrochloride syrup 5mg/5ml,60ml

bottle R N

27 00501405 Promethazine hydrochloride Injection 25mg / 1ml

ampoule R N

28 00501502 Adrenaline bitartrate injection 1mg / 1ml ampoule R V

29 00501701 Breath activated device for dry powder capsules R E

30 00501901 Spacer device for infants R E

Page 42: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 42

31 New

00701704

Prednisolone syrup 5mg / 5ml ,60ml bottle R E

Drugs available for Level 2,3 & 4 Institutions

No Item Code

Medium Description

Item Category

VEN

status

1 00500204

Fluticasone propionate 125 with Salmeterol

xinafoate 25 microgram / metered dose,120 dose

unit

R E

2 00500205

Fluticasone propionate 250 microgram with

Salmeterol xinafoate 25 microgram / metered

dose,120 dose unit

R E

3 New

00500206

Fluticasone propionate 50 microgram with

Salmeterol xinafoate 25mcg / metered dose,120

dose unit

R E

4 00500301 Fluticasone propionate 125 microgram /dose 120

metered doses aerasol inhaler R E

5 00500402 Ipratropium Bromide Respiratory Solution 0.5mg /

2ml vial R E

6 00500403 Ipratropium bromide respiratory solution, 250

microgram / 1ml, 15ml Bottle R E

7 00501304 Chlorpheniramine maleate injection.10mg / 1ml

ampoule R E

Drugs available for Level 3 & 4 Institutions

No Item Code

Medium Description

Item Category

VEN

status

1 00500104 Salbutamol injection 5mg / 5ml ampoule R N

2 New

01001401

Fluticasone propionate nasal spray 50 microgram

/metered dose, 150 dose unit R N

3 New

00500901

Tiotropium bromide dry powder capsule 18

microgram R N

4 New

00502801

Inhalation device for Tiotropium bromide

monohydrate Inhalation powder capsule 18

microgram

R N

5 00500404 Ipratropium bromide 20 microgram /dose 200

metered doses aerosol inhaler R E

6 00500601 Aminophylline injection 250mg / 10ml ampoule R E

7 00500801 Budesonide respiratory suspension 0.5mg in 2ml R E

8 New

00501802

Spacer device,100ml compatible with all metered

dose inhalers R E

9 00502001 Plastic, Baby mask to be compatible with volumetic

spacer R E

Page 43: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 43

10 New

00701703

Prednisolone tablet 20 mg R N

11 New

00501002

Montelukast tablet 10mg R N

12 New

00501001

Montelukast chewable tablet 5mg R N

Drugs available for level 4 Institutions

No Item Code

Medium Description

Item Category

VEN

status

1 00501601 Beractant 8ml vial (25mg/ml) C E

2 00502101 Caffeine citrate oral solution 25mg / 5ml, vial C N

3 00502102 Caffeine citrate injection 40mg / 2ml, vial C N

4 00502201 Desloratidine tablet 5mg C N

5 New

00000203

Codein syrup 25mg /5ml ,100ml C N

Drugs available for Level 5 Institutions

No Item Code

Medium Description

Item Category

VEN

status

1 00104001 Ethambutol tablet 400mg R N

2 New

00104002

Ethambutol injection 100mg/ml,10ml vial R N

3 00104101 Ethionamide tablet 250mg R E

4 00104201 Isoniazid tablet 100mg R E

5 00104202 Isoniazid syrup 50mg in 5ml ,100ml bottle C N

7 00104301 Pyrazinamide tablet 500mg R E

8 00104401 Rifampicin capsule 150mg R E

9 00104402 Rifampicin injection 600mg vial C N

10 00104403 Rifampicin syrup 100mg in 5ml,120ml bottle R E

11 00104501 Streptomycin Injection 1g vial R E

Drugs deleted from the Formulary

No Item Code Medium Description Reasons for the deletion

1 00501801 Spacer device, 750ml compatible with all metered

dose inhalers for adults

Replace with 'Spacer device,

100ml compatible with all

metered dose inhalers'

Drugs to be issued on Named Patient basis

Page 44: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 44

No Item Code

Medium Description

Item level

VEN

status

1 New

00104203

Isoniazid injection 50mg/2ml ampoule

5 N

2 00501503

Adrenaline injection for self administration

(1.05ml single dose auto-injector devise)

. 4 N

3 New

00503001

Pentamidine isetionate powder for solution for

Injection 300mg 3 N

4 New

00502601

Tobramycin nebuliser solution 60mg / ml, in 5ml

ampoule 3 N

5 New

00502501

Pirfenidone tablet 200mg

4 N

6 New

00502701

Omalizumab injection 150mg /ml 1ml vial

4 N

7 New Bupropion hydrochloride modified -release tablet

150mg 4 N

8 New

00502901

Talc powder sterile 4g bottle (sclerosing agent) to

decrease malignant pleural effusions, 3 N

9 New

00103704

Co-trimoxazole Injection 480 mg in 5ml ampoule

3 N

10 New

00108401 Colistimethate sodium injection 1,000,000 IU, vial 3 N

11 New

00603701

Infiuenza vaccine 0.5ml prefilled syringe

4 N

Drugs included to the Formulary

No Item Code Medium Description

1

New

00104002

Ethambutol injection 100mg/ml,10ml vial

2 New

00500206

Fluticasone propionate 50 microgram with

Salmeterol xinafoate 25 microgram / metered

dose,120 dose unit

3

New

01001401

Fluticasone propionate nasal spray 50 microgram

/metered dose, 150 dose unit

4

New

00500901

Tiotropium bromide dry powder capsule 18

microgram

5 New

00502801

Inhalation device for Tiotropium bromide

monohydrate Inhalation powder capsule 18

microgram

6

New

00500505

Theophylline syrup 25mg /5ml , 60ml bottle

7

New

00501802

Spacer device,100ml compatible with all metered

dose inhalers

Page 45: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 45

8 New

00701704

Prednisolone tablet 20mg

9

New

00701704

Prednisolone syrup 5mg / 5ml ,60ml bottle

10

New

00501002

Montelukast tablet 10mg

11

New

00501001

Montelukast chewable tablet 5mg

12

New

00000203

Codeine syrup 25mg /5ml ,100ml

13

New

00502601

Tobramycin nebuliser solution 60mg / ml in 5ml

14

New

00502501

Pirfenidone tablet 200mg

15

New

00502701

Omalizumab injection 150mg /ml 1ml vial

16

New

00306501

Bupropion hydrochloride modified -release tablet

150mg

18

New

00103704

Co-trimoxazole injection 480 mg in 5ml ampoule

19

New

00603701

Infiuenza vaccine 0.5ml prefilled syringe

Newly suggested drugs will be included if they are registered only

06. Vaccines and Immunological products

6.1. Members of the sub committee

1. Dr.Lal Panapitiya, Director, Medical Supplies Division

2. Prof. Shalini Sri Ranganathan, Professor in Pharmacology

3. Prof. Pujitha Wickkramasinghe, Professor in Pediatrics, LRH

4. Dr. Kanthi Nanayakkara, Consultant Vaccinologist and Virologist, MRI

Page 46: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 46

5. Dr. Prabha Palihawadana, Director, Epidemiology unit

6. Dr. Rajeeva de Silva, Consultant Immunologist, MRI

7. Dr. A. Wijewickkrama, Consultant Physician, National Hospital for Infectious Diseases,

8. Dr. Vishaka Rathnamalala, Consultant Heamatologists, NHSL

9. Mr. E.D.Weerarathne, Former Assistant Director, MSD

6.2.Approved item list: Vaccines and Immunological products

Drugs available for all levels of Institutions

No

Item

Code Medium Description Item Category VEN status

1 00600101

Tetanus toxoid vaccine 0.5ml(single dose)

ampule R E

2 00602301 Antisnake venom serum Injection 10ml R V

Drugs available for level 2,3 & 4 Institutions

No Item Code Medium Description Item Category VEN status

Page 47: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 47

1 00600201 Anti Rabies vaccine R V

2 00602201 Antitetanus human immunoglob.250IU R E

Drugs available for level 3 & 4 Institutions

No Item Code Medium Description Item Category VEN status

1 00600301 Hepatitis B vaccine single dose vial C N

2 00600401 Meningococcal vaccine single dose vial C E

3 00603001 Varicella Zoster Immunoglobulin 2ml Ampoule C N

4

00600402 Meningococcal Conjugate Tetravalent vaccine

single dose Vial C N

5 00600501 Pneumococcal vaccine singledose vial C E

6 00600601 Yellow fever vaccine 0.5ml single dose C E

7 00600602 Yellow fever vaccine(10D)vial+diluent C N

8 00601101 Varicella vaccine 0.5ml Vial C N

9 00602401 Anti Rabies serum 1,000I.U./5ml R V

10 00602501 Anti Rabies human immunoglobulin 300I.U. R E

11 00602502 Anti Rabies human immunoglobulin 750IU C N

12 00603201 Human immunoglobulin for IV use, 1g R E

13 00603202 Human Immunoglobulin for IV use 2.5g R E

14 00603205 Human immunoglobulin for IV use 5-6g R E

15 New Human immunoglobulin for subcutaneous use 3 N

Drugs available for level 5 Institution

Page 48: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 48

No Item Code

Medium Description

Item

Category VEN status

1 00600102 Tetanus Toxoid vaccine,10 dose vial C N

2 00600801 Bacillus Calmette-Guerin vaccine ,20 dose vial C N

3 00600901

Typhoid Vi capsular polysaccharide vaccine,10

dose vial C N

4 00601001

Live Japanese Encephalitis vaccine (LJEV), 5 dose

vial C N

5 00601601 MMR vaccine 10 dose vial C N

6 00601701

Adsorbed Adult Tetanus and Diphtheria vaccine

(aTD),10 dose vial C N

7 00601702

Adsorbed Diphtheria and Tetanus vaccine (DT),10

dose vial C N

8

00601801

Adsorbed Diphtheria Tetanus and Purtussis

vaccine(DPT), 1

0 dose vial

C N

9 00601903 Bivalent Poliomyelitis vaccine Live 10 dose vial C N

10 00602001 DPTHepBHIb (Pentavalent) vaccine10 dose vial C N

11 00600903 Human Papilloma virus recombinant vaccine C N

12 00601905 Inactivated poliovirus vaccine (IPV) 5 dose vial

13 00600302 Hepatitis B vaccine, (10 dose) vial C N

14 00603603 Tuberculin for Mantoux test 5TU/0.1 ml, 1ml vial C N

Drugs to issue on Named Patient basis

No Item Code Medium Description

Ite

m

leve

l

VE

N

stat

us

Remarks

1

New

00603701

Infiuenza vaccine 0.5ml prefilled syringe 3 N For prevention of

seasonal influenza

in patients with

high risk for

morbidity and

mortality

2 New

00603002

Varicella zoster specific Immunoglobulin

(VZIG) (Human) Lyophilized 250mg vial

3 N For post exposure

propylaxis of VZV in

immunocompromized

, pregnant, neonates

3 New

00603801

Cytomegalovirus specific Immunoglobulin

(CMVIg) 50mg /ml

3 N For management of

CMV pneumonitis in

severly

immunocompromised

e.g. bone marrow

transplant patients

4

New

00600303

Hepatitis B specific Immunoglobulin(HBIG)

50units/ml in 10ml vial

3 N For post-exposure

propylaxis of HBV in

Page 49: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 49

non immune

individuals

5 00602901 Hepatitis B Immunoglobulin 200I.U. 3 N 1

2

006029

01

Vaccines for animal use

No Item Code Medium Description Item Category VEN status

1 00603301 A.R.V. for animal use 10 dose C N

2 00603501

Japanese Encephalitis

vaccine(swine) C N

Other Decisions

No. Item Remarks

01. 00600401- Meningococcal vaccine single

dose vial

00600402 - Meningococcal conjugate

Tetravalent vaccine single dose Vial

To be procured the most economical product from

the two products of SR.No: 00600401 and

SR.NO: 00600402, As per instruction given by

Vaccinologists.

07.Drugs used in Endocrine system

Page 50: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 50

7.1.Members of the sub committee

1. Dr. Lal Panapitiya, Director, Medical Supplies Division

2. Prof. Rohini Fernandopulle, Professor of Pharmacology

3. Prof. Shyamya de Silva, Professor in Paediatrics , LRH

4. Prof. Athula Kaluarachchi, Professor in Obstetrics and Gynecology

5. Dr. Manilka Sumanathilaka Consultant Endocrinologist, NHSL

6. Dr. Uditha Bulugahapitiya, Consultant Endocrinologist, T.H.Kalubowila

7. Dr.Noel Somasundaram, Consultant Endocrinologist, NHSL

8. Dr. Nayananjalee Karunasena, Consultant Endocrinologist, T.H.Karapitiya

9. Dr. Navoda Athapaththu, Consultant Pediatric Endocrinologist, LRH

10. Dr. K.V.C.Janaka, Consultant Physician, G.H. Sri Jayawardanapura

11. Mr. E.D. Weerarathne, Former Assistant Director, Medical Supplies Division

7.2.Approved item list: Drugs used in diseases of the Endocrine System

Page 51: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 51

Drugs available for all Levels of Institutions

N

o

Item

Code Medium Description

Item

Category

VEN

status

1 00700301 Gliclazide tablet 40mg R E

2 00700302 Gliclazide tablet 80mg R E

3

New

00700303 Gliclazide modified released tablet 30mg R E

4 00700401 Metformin tablet 500mg R E

5

New

00700403 Metformin S.R. tablet 500mg R N

6

00701101

Thyroxine tablet 50 microgram R E

7

New

00701103 Thyroxine tablet 25 microgram R E

8 00701102 Thyroxine sodium tablet 100 microgram R E

9 00701503 Hydrocortisone hemisucci.inj. 100mg R V

10 00701601 Dexamethasone tablet 0.5 mg R E

11 00701701 Prednisolone tablet 5mg R E

12 01300801 Levonorgestrel 0.15mg + Ethinyl oestradiol 0.03mg tablet R E

13 01301301 levonorgestrel tablet 1.5 mg R E

14 00702601

Medroxyprogesterone acetate Injection, 150mg in 1ml

vial R E

Drugs available for Level 2,3 & 4 Institutions

N

o

Item

Code Medium Description

Item

Category

VEN

status

1 00700601

Bipha.Isoph.Insulin(human) Injection (30/70) 1000 IU /

10ml. R E

2 00700701 InsulinIsophane(human)1,000IU/10ml R E

3 00700801 Insulin soluble(human) Inj.1,000IU/10ml R E

4 00701201 Carbimazole tablet 5mg R E

5

New

00701202 Carbimazole tablet 10mg R E

6 00701602 Dexamethasone Inj. 8mg/2ml R E

7 00704301 Potassium Iodide tablet 5 mg R N

Drugs available for Level 3 & 4 Institutions

N Item Medium Description Item VEN

Page 52: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 52

o Code Category status

1 00701001 Glucagon Inj. 1 I.U. vial R N

2 00701301 Propylthiouracil tablet 50mg R E

3 00701401 Fludrocortisone tablet 0.1mg R E

4 00701501 Hydrocortisone tablet 5mg R N

5 00701502 Hydrocortisone tablet 10mg R E

6 00701803

Methylprednisolone acetate Injection for

intramuscular/Intra-articular Injection 40mg 1ml Vial R N

7 00701804 Methylprednisolone IV Inj.500mg R E

8 00701805 Methylprednisolone IV Inj. 1gVial R E

9 00704501 Triamcinolone acetonide Inj40mg/ml R N

10 00702701 Testosterone enanthate Inj.250mg/1ml R N

11

New

00706401 Testosterone undecanoate Inj. 250mg/1ml ,4ml vial R N

12 00703001 Tetracosactrin Inj.250 microgram / 1ml R E

13 00703202 Somatropin for injection BP/USP 2 IU-30 IU R E

14 00703302 Desmopresin acetate nasal spray(60m spray) R E

15 00703502 Alendronate sodium tablet 70mg R E

16 00703701 Zoledronic acid Injection4mg/5ml R N

17 New ketoconazole tablet 200mg R N

18 00703801 Bromocriptine tablet 2.5mg R N

19 00703901 Cabergoline tablet 500 microgram R N

20 00701901 Conjugated estrogens tablet 0.325mg R N

21 00701902 Conjugated estrogens tablet 0.625mg R N

22 00702001 Ethinyloestradiol tablet 5 microgram C N

23 00702003 Ethinyloestradiol tablet 20 microgram R N

24 00702101 Dydrogesterone tablet 10mg R N

25 00702201

Oestradiol valerate 2mg, 11 tablets and Oestradiol

valerate 2mg + Cyproterone acetate 1mg, 10 tablets in a

calendar pack

C N

26 00702401 Hydroxyprogesterone Injection 250mg in 1ml ampoule R E

27 00702501 Norethisterone tablet 5mg R E

28 00702801 Clomiphene citrate tablet 50 mg R E

29 00703101 Human Chorionic Gonadortophin 5000 IU R N

30 00703103 Human Chorionic Gonadotrophin 2000 IU C N

31 01207301 Goserelin acetate implant 3.6mg R E

32

New

00706501 Sitagliptin tablet 100mg C N

33

New

00706801 Insulin pen to be used with replaceable insulin cartridge C N

34

New

00706701

Insulin soluble (human) 25% - 30% + Protamine 70% -

75%, 300 IU per 3ml cartridge C N

35

New

00706901 Insulin soluble (Human) 300 IU in 3ml cartridge C N

Page 53: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 53

36 New

00706802

Needle for insulin pen, size 30-32 gauge, 3mm-5mm

length C N

37

01207402 Octreotide injection 50mcg in 1ml amp R E

Drugs available for Level 4 Institutions

N

o

Item

Code Medium Description

Item

Category

VEN

status

1

New

00705501 Diazoxide tablet 50mg C N

2 00703002 Corticotrophin Injection 200 I.U. in 5ml ampoule R E

3 00703301 Desmopressin tablets 100 microgram R N

4

New

00703305

Desmopressin acetate Injection 4 microgram / ml ,1ml

ampoule C N

5 00703401 Vasopressin Injection 20 I.U. in 1ml ampoule R E

6 00703601 Pamidronate disodium Inj. 30mg R N

7 00704001 Danazol capsule 100mg C N

8

New

00705601 Oxandrolone tablet 10mg C N

9 01207201 Leuprorelin acetate 3.75mg vial with solvent 2ml C N

Drugs deleted /tailed offed from the Formulary

N

o

Item

Code Medium Description

Reasons for the

deletion

1 00700101 Glibenclamide tablet 5mg

To gradually tail off and

to fullfill the

requirement with

Gliclazide

2 00700201 Tolbutamide tablet 500mg

To remove from the list

and replace by

Gliclazide

3 00700402 Metformin tablet S.R. 850mg

To remove from the list

and to be replaced with

metformin 500mg SR

tablet

4 00704401 Methimazole tablet 5mg carbimazole is adequate

5 00703102 Human Chorionic Gonadotrophin 500 IU

To remove from the list

as 5000IU strength is

adequate

6 01207202

Leuprorelin acetate injection 1mg in 0.5ml Goserelin can be used as

an alternatives

Page 54: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 54

7 00703201 Somatropin Inj. 24 IU(8mg)

Replaced by

‘Somatropin for

injection BP/USP 2 IU-

30 IU’

Drugs to issue on a Named Patient basis

N

o

Item

Code Medium Description

Item

Category

VEN

status

1

New

00705602 Oxandrolone tablet 10mg

3 N

2

New

00705101 Cetrorelix injection 250 microgram

3 N

4

New

00705901 Human Menopausal Gonadotrophin Injection 75 IU

3 N

5 01207403

Octreotide injection (LA) 30mg vial with solvent in 2.5ml

pre-filled syringe 3 N

6 00707101 Follicle - Stimulating Hormone (FSH) Injection 75 IU vial

C N

Drugs included to the Formulary

N

o

Item

Code Medium Description

1

New

00700303 Gliclazide Modified released tablet 30mg

2 New Metformin S.R. tablet 500mg

3

New

00706501 Sitagliptin tablet 100mg

4

New

00706801 Insulin pen to be used with replaceable insulin cartridge

5

New

00706701

Insulin soluble (human) 25% - 30% + Protamine 70% -

75%, 300 IU per 3ml cartridge

6

New

00706901 Insulin soluble (human) 300 IU in 3ml cartridge

7

New

00706802

Needle for insulin pen, size 30-32 Gauge, 3mm-5mm

length

8

New

00701101 Thyroxine tablet 25 microgram

9

New

00701202 Carbimazole tablet 10mg

10

New

00706401 Testosterone undecanoate Inj. 250mg/1ml ,4ml vial

11

New

00703305

Desmopressin acetate Injection 4microgram /ml ,1ml

ampoule

Page 55: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 55

12 New

00112201 Ketoconazole tablet 200mg

13

New

00705501 Diazoxide tablet 50mg

Page 56: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 56

08. Drugs used in Gastrointestinal system

08.1.Members of the sub committee

1. Dr. Lal Panapitiya, Director, Medical Supplies Division

2. Prof. Rohini Fernandopulle, Professor in Pharmacology

3. Dr. Ranjith Peris, Consultant Gastroenterologist, NHSL

4. Dr. N.M.M.Nawarathne, Consultant Gastroenterologist, NHSL

5. Dr. Madunil Niriella, Consultant Gastroenterologist, CSTH

6. Dr. Sanjeewa Ariyasinghe, Consultant Gastroenterologist, CSTH

7. Dr. Nilesh Fernandopulle, Consultant Gastroenterologist, T.H.Jaffna

8. Dr. Chamila Ranawaka, Consultant Gastroenterologist, G.H.Rathnapura

9. Dr. Mananjula Senanayake, Consultant Gastroenterologist, G.H.Kurunegala

10. Dr. Sujeeva Kumarasena, Consultant Gastroenterologist, T.H. Galle

11. Dr. Jayani Manchanayake, Consultant Gastroenterologist, CNTH

12. Dr. Shaman Rajindrajith, Consultant Pediatrician, CNTH

13. Dr. Ranjani Edirisooriya, Consultant Pediatrician, G.H. Polonnaruwa

14. Mr. Weerarathne, Former Assistant Director, MSD

Page 57: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 57

08.2.Approved item list: Drugs acting on Gastrointestinal system

Drugs available for all Levels of Institutions

No

Item

Code Medium Description

Item

Category

VEN

status

1 00800401 Domperidone tablet 10mg R E

2 00800402 Domperidone syr. 5mg/5ml,60ml bottle R E

3 00800501 Metoclopramide tablet 10mg R E

4 00800502 Metoclopramide Inj.10mg/2ml ampoule R E

5 00800802 Omeprazole cap. 20mg R E

6 00801201 Bisacodyl tablet 5mg R E

7 00801202 Bisacodyl tablet 10mg R N

8 00801203 Bisacodyl suppository 10mg R N

9 00801302 Lactulose syr.3.0-3.7mg/5ml,120ml bottle R E

10 New

00801304

Lactulose syr.3.0-3.7mg/5ml,500ml bottle R E

Drugs available for Level 2,3 & 4 Institutions

No

Item

Code Medium Description

Item

Category

VEN

status

1 00800201 Hyoscine butylbromide tablet 10mg R N

2 00800601 Famotidine tablet 20mg R N

3 00800801 Omeprazole tablet 10mg R N

4 00800803 Omeprazole sodium Inj. 40mg vial R E

Drugs available for Level 3 & 4 Institutions

No

Item

Code Medium Description

Item

Category

VEN

status

1 00800202 Hyoscine butylbromide injection 20mg /1ml

ampoule R N

2 New

00800406 Domperidone suppository 10mg R E

3 00800404 Domperidone suppository 30mg R E

4 New

00800405 Domperidone suppository 60mg R E

5 00800701 Ranitidine HCl Inj. 50mg/2ml,ampoule R N

6 00800901 Sulphasalazine tablet 500mg R E

7 00801401 Iso-osmotic bowel cleansing preparation

(Macrogols 59g) R E

Page 58: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 58

8 New

00802601

Sodium biphosphate 1.6g and Sodium phosphate

0.6g enema in 10ml , 120 ml container R E

9 00801601

Ursodeoxycholic acid tablets150mg C N

10 01400701

Penicillamine capsule 250mg R E

11 00704501

Triamcinolone acetonide Injection 40mg / 1ml vial R N

Drugs available for Level 4 Institutions

No

Item

Code Medium Description

Item

Category

VEN

status

1 New

00800301

Mebeverine hydrochloride tablet 135mg C N

2 New

00802002 Pantoprazole Injection 40mg vial C N

3 00801001 Mesalazine tablet 400mg C E

4 New

00802401

Macrogols (Polyethylene glycol) Sachet 13.125 g C N

5 New

00802801 L Ornithine L Aspartate 5g in 10ml ampoule C N

6 New

00404202

Trientine dihydrochloride capsule 300mg C N

7 New

00108601

Tenofovir tablet 300mg C N

8 00801701 Pancreatic enzyme capsule (protease 600U, lipase

10000U, amylase 8000U) R N

9 00801702 Pancreatic enzyme capsule (protease 1000U, lipase

25000U, amylase 40000U) 4 N

10 New

00802201

Loperamide hydrochloride tablet 2mg R N

11 New

00802501 Terlipressin acetate1mg vial C N

Drugs available for Level 5 Institutions

No

Item

Code Medium Description

Item

Category

VEN

status

1 00107801 Lamivudine 150mg tablet C E

Page 59: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 59

Drugs deleted from the Formulary

No

Item

Code Medium Description Reasons for the deletion

1 00801501 Glycerine suppository 2g slow moving item

2 00801602 Ursodeoxycholic acid suspension 250mg/5ml Ursodeoxycholic acid

tablet 150mg is adequate.

3 00801801 Tincture Ipecac Not used in last five years

4 00801901 Ginger Tincture Not used in last five years

Drugs to issue on Named Patient basis

No

Item

Code Medium Description Item level

VEN

status

1 New

00801002

Mesalazine suppositories 500mg

4 N

2 New

00802301

Budesonide capsule 3mg

3 N

3 New

00802701 Hydrocortisone acetate 10% foam enema 100mg

4 N

4 New

01401701

Infliximab Injection 100mg vial

4 N

5 New

Cholestyramine 4g Sachet

4 N

6 New

00112301 Sofosbuvir 400mg tablet

4 N

7 New

00112401 Ledipasvir 90mg/Sofosbuvir 400mg tablet

4 N

8 New

00108601

Tenofovir tablet 300mg

4 N

9 New

00801604 Rifaximine tablet 550mg

4 N

10 New

00109803 Ribavirin capsule 400mg

4 N

11 New

01206001

Peg Interferon alfa - 2a 180 microgram prefilled

syringe/vial 4 N

12 New

01206002

Peg Interferon alfa - 2a 135 microgram prefilled

syringe/vial 4 N

13 New

00112501

Valpatasvir 100mg / Sofosbuvir 400mg tablet

4 N

14 New

00112601 Daclatasvir tablet 60mg

4 N

15 New

00112701 Tenofovir alafenamide tablet 25mg

4 N

16 New Entacavir tablet 0.5mg 4 N

Page 60: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 60

00112801

17 00404202 Trientine Dihydrochloride capsule 300mg 4 N

Drugs included to the formulary

No

Item

Code Medium Description

1

New

00800301

Mebeverine hydrochloride tablet 135mg

2

New

00800406 Domperidone suppository 10mg

3

New

00800405 Domperidone suppository 60mg

4

New

00802002 Pantoprazole Injection 40mg

5

New

01401701

Infliximab Injection 100mg vial

6

New

00801304

Lactulose syr.3.0-3.7mg/5ml,500ml bottle

7

New

00802401

Macrogols (Polyethylene glycol) Sachet

8

New

00802601

Sodium biphosphate 1.6g and Sodium Phosphate

0.6g enema in 10ml , 120 ml container

9

New

00802801 L Ornithine L Aspartate 5g in 10ml ampoule

10

New

00404202

Trientine dihydrochloride capsule 300mg

11

New

00112401 Ledipasvir 90mg/Sofosbuvir 400mg tablet

12

New

00802201

Loperamide hydrochloride tablet 2mg

13

New

00802501 Terlipressin acetate1mg vial

Newly suggested drugs will be included if they are registered only

Page 61: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 61

09. Drugs acting on the Eye

09.1.Members of the sub committee

1. Dr. Lal Panapitiya, Director, MSD

2. Prof. Rohini Fernandopulle, Professor in Pharmacology

3. Dr.Binara Amarasingha - Consultant Ophthalmologist, National Eye Hospital,Colombo

4. Dr.Pradeepa K. Siriwardena - Consultant Ophthalmologist, National Eye Hospital,Colombo

5. Dr.Kapila Banduthilake, Consultant Ophthalmologist, National Eye Hospital, Colombo.

6. Dr.Muditha Kulathunga, Consultant Ophthalmologist, National Eye Hospital, Colombo.

7. Dr.Hiranya Abeysekara - Consultant Pediatric Ophthalmologists, Lady Ridgeway Hospital

8. Dr.H.R.Dayawansa, Consultant Ophthalmologist, B.H.Awissawella

9. Dr. Prasad Pathirana, Consultant Ophthalmologist, Base Hospital, Embilipitiya

10. Dr.Kushlani Goonarathne, Consultant Ophthalmologist, Base Hospital, Elpitiya

11. Mr. E.D.Weerarathne, Formar Assistant Director, MSD

Page 62: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 62

09.2.Approved item list: Drugs acting on the Eye

Drugs available for all Levels of Institutions

No

Item

Code Medium Description

Item

Category

VEN

status

1 00900101 Ciprofloxacin eye drops 0.3%, 5ml vial R E

2 00904003 Chloramphenicol eye ointment 1%, 3.5g tube R E

3 00901401 Tropicamide eye drops 1% ,5ml Vial R E

Drugs available for Levels 3 & 4 Institutions

No

Item

Code Medium Description

Item

Category

VEN

status

1 00900201 Fucidic acid eye drop 1%, 5ml vial R E

2 00900301 Tetracycline eye ointment 1%,3.5g R N

3 00900401 Gentamicin eye drops 0.3%,5ml vial C N

4

New

00904901 Natamycin ophthalmic suspension 5% in 15ml vial R E

5 00900602 Acyclovir eye ointment 3%, 5g tube R E

6 00901001 Prednisolone acetate eye drops 1%,5ml vial R E

7

New

00904501 Olopatadine hydrochloride eye drop 1mg/ml,5ml C N

8 00901101 Fluorometholone eye drops 0.1%w/v,5ml vial C N

9 00901201 Atropine sulphate eye drops 1% in 5ml vial R N

10 00901301

Cyclopentolate hydrochloride eye drops 0.5%, 5ml

vial R E

11 00901302 Cyclopentolate hydrochloride eye drops 1.0% 5ml R E

12 00901501

Tropicamide 0.8% with Phenylephrine

hydrochloride 5% eye drops 5ml vial R E

13 00901702 Timolol maleate eye drops 0.5%, 5ml vial R E

14 00901801 Acetazolamide tablet 250mg R E

15 00901802 Acetazolamide sodium Injection 500mg vial R N

16 00901903 Pilocarpine nitrate Eye Drops 4% in 10ml vial R N

17

New

00902602

Acetylcholine chloride intraocular

solution10mg/ml 2ml vial R N

18 00902101 Fluorescein sodium Injection 10% in 5ml vial R E

19 00902103 Fluorescein powder for Eye Drops R N

20

New

Fluorescein dye impregnated strips -No SR R N

21 00902201

Hydroxypropylmethylcellulose ophthalmic solution

for intraocular use 2%, 5ml prefilled syringe R E

22 00902901

Bimatoprost ophthalmic suspension 30 microgram

/ml,3ml vial C E

23 00903001 Brinzolamide eye drops 1%,in 5ml vial C E

Page 63: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 63

24 00903201 Nepafenac ophthalmic suspension 0.1%,3ml R E

25 00903601 Carbachol intraoccular solution 0.01%,1ml vial R N

26 00903801

Hydroxyethylcellulose 0.44% + Sodium chloride

0.35% eye drop 10ml vial R N

27 00904101

Moxifloxacin hydrochloride ophthalmic solution

0.5%, 5ml vial R E

28 00903901

Sodium hyaluronate for intraocular use 4mg/0.4ml

vial R N

29 00904302

Tobramycin 0.3% with Dexamethasone 0.1% eye

drops,10ml dropper bottle R E

30 01202901 Bevacizumab injection 100mg / 4ml vial C N

31

New

00904801

Proparacaine hydrochloride ophthalmic solution

0.5% in 15ml R N

32

00704501

Triamcinolone acetonide injection 40mg / 1ml R N

33

New

14560002 Ophthalmic surgical drape 10cm x12cm(4"x4"1/2) R E

34

New

14560003

Ophthalmic surgical drape with pouch size 50cm

x40cm R E

35

New

14560004

Ophthalmic surgical drape with pouch size 40cm

x60cm R E

36

New

14560001 Ophthalmic surgical Drape 6cm x7cm R E

37

New

00905001

Sodium chondroitin sulfate 40mg with Sodium

hyaluronate 30mg Solution in Pre-filled syringe C N

38

New

00905201

Lidocaine hydrochloride ophthalmic gel 2% in 30g

tube C N

39

New

00904401 Trypan blue solution 0.06% w/v C N

Drugs available for Level 4 Institutions

No

Item

Code Medium Description

Item

Category

VEN

status

1 00901701 Timolol maleate eye drops 0.25%, 5ml vial R N

2 00902001 Balanced salt solution,500ml plastic bottle R E

New

00902002 Balanced salt solution,500ml glass bottle C N

3 00902401 Perflurodecalin 5ml vial C E

4 00902502 Silicone oil 10ml bottle C E

5

New

00905301

Brinzolamide 10 mg/1ml with timolol maleate 5

mg /1 ml eye drop in 5ml dropper bottle R N

6 00903701 Indocyanine green for injection 25mg vial R N

7

New

00904601 Brilliant blue G 0.05% in 1ml vial R N

8 New Cyclosporin eye drop 0.1% w/v, 5ml C N

Page 64: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 64

00904701

9 00107302 Voricanazole Injection 200mg in 10ml C N

Drugs deleted from the Formulary

No

Item

Code Medium Description Reasons for the deletion

1 00900501 Propamidine eye drops0.1%,10ml vial Not used in last five years

2 00901902 Pilocarpine nitrate eye drops 2% in 10ml vial

Pilocarpine nitrate Eye

Drops 4% is adequate

3 00902701 Latanoprost eye drops 50 microgram /ml,2.5ml vial Bimatoprost is adequate

4 00902801 Travoprost eye drops 40 microgram /ml,2.5ml vial Bimatoprost is adequate

5 00903101 Dorzolamide ophthalmic solution 2%,5ml vial Brinzolamide is adequate

6 01401501 Hyaluronidase Injection 1,500 U vial/ampoule

7 01000601 Betamethasone sodium phosphate for Eye,Ear or

Nasal drops 0.1% in 5ml vial

New SR used for Ear and

nasal only preperation (no

need eye drop)

8 01001101 Tobramycin 0.3% with Dexamethasone 0.1% eye

and ear drops, 10ml dropper bottle

Replaced by SR No.

00904302. (Decided to keep

eye and ear separatly)

9 00902103 Fluorescein powder for Eye Drops

Decided to remove the

'Fluorescein powder' from

the formulary after including

fluorescein dye impregnated

strips.

Drugs included to the Formulary

No

Item

Code Medium Description

1

New

00904901 Natamycin ophthalmic suspension 5% in 15ml vial

2

New

00904501 Olopatadine hydrochloride eye drop 1mg/ml,5ml

3

New

00902602

Acetylcholine chloride intraocular

solution10mg/ml 2ml vial

4

New

Fluorescein dye impregnated strips

5

New

00905301

Brinzolamide 10 mg/1ml with timolol maleate 5

mg /1 ml eye drop in 5ml dropper bottle

6

New

00904302

Tobramycin 0.3% with Dexamethasone 0.1% eye

drops,10ml dropper bottle

7

New

00904601 Brilliant blue G 0.05% in 1ml vial

8 New Cyclosporin eye drop 0.1% w/v, 5ml

Page 65: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 65

00904701

9 New

00904701

Proparacaine hydrochloride ophthalmic solution

0.5% in 15ml

New

00902001 Balanced salt solution,500ml glass bottle

10

New

14560002 Ophthalmic surgical drape 10cm x12cm(4"x4"1/2)

11

New

14560003

Ophthalmic surgical drape with pouch size 50cm

x40cm

12

New

14560004

Ophthalmic surgical drape with pouch size 40cm

x60cm

13

New

14560001 Ophthalmic surgical drape 6cm x7cm

Newly suggested drugs will be included if they are registered only

Page 66: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 66

10. Drugs used in the treatment of diseases of Ear, Nose and

Oropharynx

10.1. Members of the sub committee

1. Dr. Lal Panapitiya, Director, MSD

2. Prof. Rohini Fernandopulle, Professor in Pharmacology

3. Dr.Ravi Dayasena, Consultant Otorhinolaryngologists, NHSL

4. Dr.Waruna Jayasinghe, Consultant Otorhinolaryngologists, B.H.Puttalam

5. Dr.Madavika Dayarathna, Consultant Otorhinolaryngologists, DGH Chilaw

6. Dr.Dencil Indika, Consultant Otorhinolaryngologists, B.H.Embilipitiya

7. Dr.A.D.K.S.N.Yasawardana, Consultant Otorhinolaryngologists, LRH

8. Dr.S.M.B.H.Ethulagama, Consultant Otorhinolaryngologists, SBSCH

9. Dr.K.D.R.A .Kirihena, Consultant Otorhinolaryngologists, LRH

10. Mr. E.D.Weerarathne, Formar Assistant Director, MSD

Page 67: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 67

10.2. Approved item list: Drugs Used in the treatment of diseases of Ear, Nose and Oropharynx

Drugs available for all Levels of Institutions

No

Item

Code Medium Description

Item

Category

VEN

status

1 01000201 Gentamicin sulphate ear drops 0.3% w/v in 10ml

vial R E

Drugs available for Level 3 & 4 Institutions

No

Item

Code Medium Description

Item

Category

VEN

status

1 01000301 Gentamicin 0.3% with Hydrocortisone 1% ear

drops 10ml vial R N

2 New

01001901

Ciprofloxacin ear drops 0.3% w/v, 5ml dropper

bottle R N

3 01000401 Clotrimazole 1% with Lignocaine 2% ear drops

10ml vial R E

4 01000501 Docusate sodium ear drops 0.5%, 10ml vial R N

5 01000601 Betamethasone sodium phosphate for Eye,Ear or

Nasal drops 0.1% in 5ml vial R E

6 01000701 Xylometazoline hydrochloride nasal drops 0.1% in

10ml Vial R E

7 01000801 Ofloxacin ear drops 0.6% in 5ml vial C E

8 01000901 Oxytetracycline 3% with Hydrocortisone acetate

1% ,ear ointment 15g R N

9 01001001 Tobramycin ear drops 0.3%, 5ml vial R E

10 01001104 Tobramycin 0.3% with Dexamethasone 0.1% ear

drops,10ml dropper bottle R N

11 01001201 Silver nitrate sticks for nasal cautering R N

12 01001301 Beclomethasone diprionate nasal spray 100

microgram /metered dose 200 dose unit R E

13 01001401 Fluticasone propionate nasal spray 50 microgram /

metered dose, 150 dose unit R N

14 01001501 Triamcinolone acetonide oral paste 0.1%,5g tube

R N

15 New

01001502

Triamcinolone acetonide nasal spray 55

microgram / spray, 120 spray unit R N

16 01001601 Clotrimazole mouth paint 1%, 15ml bottle R E

17

01001701 Betamethasone sodium phosphate 0.1% with

Neomycin sulphate 0.5% for Eye,Ear or Nasal

drops 5ml vial

R E

Page 68: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 68

18 01001801 Miconazole oromucosal gel 40g tube/container. R E

19 01001802 Miconazole oromucosal gel 15g tube/container R E

20 New

01107301 Betamethasone 0.1% with Fusidic acid 2% cream R N

21 01102301 Fusidic acid cream 2% 5g tube C E

22. 00000101

Cocaine Hydrochloride powder C N

Drugs deleted from the Formulary

No

Item

Code Medium Description Reasons for the deletion

1 01001102 Tobramycin 0.3% with Dexamethasone 0.1% eye

and ear drops ,5ml vial

Tobramycin 0.3% with

Dexamethasone 0.05% eye

and ear drops, 10ml vial

(SR No: 01001101) is

adequate.

2 01001101 Tobramycin 0.3% with Dexamethasone 0.1% eye

and ear drops, 10ml dropper bottle

Replaced by SR No.

01001104. (Decided to keep

eye and ear separatly)

3

01105901

Fusidic acid 2% with Hydrocortisone acetate 1%

ointment 15g tube

To replace with

Betamethasone 0.1% with

Fusidic acid 2% cream (SR

01107301)

Drugs included to the Formulary

No

Item

Code Items Medium Description

1

New

01001901

Ciprofloxacin ear drops 0.3% w/v, 5ml dropper

bottle

2

New

01001502

Triamcinolone acetonide nasal spray 55

microgram /spray, 120 spray unit

3

01001104 Tobramycin 0.3% with Dexamethasone 0.1% ear

drops,10ml dropper bottle

4

New

01107301 Betamethasone 0.1% with Fusidic acid 2% cream

Newly suggested drugs will be included if they are registered only

Page 69: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 69

11. Drugs used on the Skin

11.1. Members of the sub committee

1. Dr. Lal Panapitiya, Director, Medical Supplies Division

2. Prof. Rohini Fernandopulle, Professor in Pharmacology

3. Dr. Sriyanie Samaraweera, Consultant Dermatologist, LRH

4. Dr. Indira Kahawita, Consultant Dermatologist, B.H, Homagama

5. Dr. Nayani Madarasinghe, Consultant Dermatologist, Infectious Diseases Hospital, Angoda

6. Dr. D.M. Amerathunga, Consultant Dermatologist, Anti Leprosy Campaign, Colombo

7. Dr. Chamil Marasinghe, Consultant Physician

8. Mr. E.D.Weerarathne, Formar Assistant Director, MSD

Page 70: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 70

11.2. Approved item list: Drugs used on the Skin

Drugs available for all Levels of Institutions

No Item Code Medium Description Item Category VEN status

1 01101403 Hydrocortisone cream 1% ,5g tube R E

2 01102101 Framycetin skin cream 1%, 20 g tube R E

3 01102802 Miconazole nitrate cream 2%, 15g tube R E

4

01103301 Benzyl benzoate application, 25%w/v, 500ml

bottle R E

5 01103401 Permethrin cream 5%, 15g tube R N

6 01103601 Cetrimide powder 500g tin R E

7

New

01106901 Malathion lotion 0.5% w/v 50ml bottle R N

8 01103901 Sodium chloride crystals R E

9 01104001 Hydrogen peroxide 6%v/v , 450ml bottle R E

10 01104201 Potassium permanganate crystal R E

11 01104901 Sulphur precipitated powder R N

12

New

00103903 Trimethoprim tablet 200mg R E

13 01106001 Creta gallica powder R N

14 01106301 Glycerin Liquid R N

15 0104901 MDT-MB Paediatric R E

16 0104902 MDT-MB Adult R E

17 0105001 MDT-PB Paediatric R E

18 0105002 MDT-PB Adult R E

Drugs available for Level 2,3 & 4 Institutions

No Item Code Medium Description Item Category VEN status

1 01100101 Paraffin, liquid R E

2 01100102 Paraffin,yellow soft R E

3

New

01100103 White soft paraffin R E

4 01100201 Wax,emulsifying R E

5 01100801 Starch powder R N

6 01101101 Calamine powder R E

7 01101401 Hydrocortisone ointment 1%, 5g tube R E

8 01101602 Betamethasone ointment 0.1%,15g tube R E

11 01101604 Betamethasone cream 0.1%,15g tube R E

Page 71: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 71

9 01102201 Silver sulphadiazine cream 1%,500g jar R E

10 01102501 Benzoic acid powder R N

11 01102601 Salicylic acid powder R E

12 01102901 Magenta crystals R N

13 01104801 Zinc oxide powder R E

14

New

01107002 Benzoyl peroxide gel 2.5%,20g tube

C N

15

New

01107001 Benzoyl peroxide gel 5%,30g tube

C N

16

01101501 Hydrocortisone 0.5% with clioquinol 3%

cream,15g tube R E

Drugs available for Level 3 & 4 Institutions

No Item Code Medium Description Item Category VEN status

1 01100301 Urea crystals R N

2 01100401 Coconut oil R E

3 01100501 Coal tar solution R E

4 01100601 Dithranol powder R E

5 01100701 Methoxsalen tablet 10mg R N

6 01100901 Flexible collodion R N

7 01101301 Crotamitone cream 10% 20gm tube R E

8 01101402 Hydrocortisone ointment 1%,15g tube R E

9 01101404 Hydrocortisone cream 1%,15g tube R E

10

01101701 Betamethasone dipropionate lotion 0.05%, 50ml

bottle R E

11 01001801 Miconazole oromucosal gel 15g tube/container R E

12 01101901 Fluocinolone cream 0.025% ,15g tube R E

13 01102001 Clobetasol propionate ointment 0.05%,15g tube R N

14 01102301 Fusidic acid cream 2% 5g tube C E

15 01102401 Mupirocin 2% ointment 5g tube. R E

16 01102402 Mupirocin 2% cream 5g tube R E

17 01102701 Clotrimazole cream 1%,15g tube R N

18

New

01107101 Clindamycin gel 1% w/v 30g tube R N

19 0103001 Thymol crystals R N

20 01103101 Selenium sulphide lotion, 2.5%, 60ml bottle R N

21 01104301 Silver nitrate crystals R N

22

01104602 Povidone iodne solutiotion 7.5%w/v for surgcal

scrub C E

23 01105001 Tretinoin cream 0.025%,15g tube R N

24

01105101 Calcipotriol 50 microgram /gram with

Betamethasone ointment 0.05%, 15g tubes C N

25 01105201 Podophyllin resin R N

Page 72: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 72

26 01105301 Resorcinol powder R N

27

New

01107201 Adapalene gel 0.1%,45g tube C N

28 01105701 Mometasone furoate cream 0.1%,5g tube C N

29

New

01105702 Mometasone furoate cream 0.1%,15g tube R N

30

New

01107301 Betamethasone 0.1% with Fusidic acid 2% cream R N

31 01106601 Acitretin capsule 10mg R N

32 00104801 Dapsone tablet 50mg R E

33

New

00104803 Dapsone tablet 25mg R E

34 0105102 Clofazimine tablet 100mg R E

35

New

0105103 Clofazimine capsule 50mg R E

36

New

01106801 Tacrolimus ointment 0.1%, 30g tube R N

37

New

01106802 Tacrolimus ointment 0.03%,30g tube R N

38

New

01106804 Pentoxifylline modified release tablet 400mg

C N

39 01106103

Alcohol based hand rub (75%-85%) 500ml bottle R

N

Drugs deleted from the Formulary

No Item Code Medium Description Reasons for the deletion

1 01101001 Magnesium sulphate crystals Not required

2 01103701 Chlorhexidine and Cetrimide solution Not used in last five years

3 01104101 Iodine solution(weak) Not used in last five years

4 01106201 Alcohol 90%v/v Not required

5

01105901 Fusidic acid 2% with Hydrocortisone acetate, 1%

ointment, 15g tube

To replace with Betamethasone

0.1% with Fusidic acid 2%

cream

Drugs issued on Name Patient basis

No Item Code Medium Description Item level VEN status

1

New

01209503 Isotretinoin capsule 20mg

3 N

2 01209502 Isotretinoin capsule 10mg 3 N

3

New Pentoxifylline modified release tablet 400mg

3 N

Page 73: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 73

01106804

4 New

01106803 Ivermectin tablet 6mg

3 N

5

New

01401702 Etanercept injection 25mg,vial

3 N

Drugs included to the Formulary

No Item Code Medium Description

1

New

01100103 White soft paraffin

2

New

01107101 Clindamycin gel 1% w/v, 30g tube

3

New

01106901 Malathion lotion 0.5% w/v, 50ml bottle

4

New

01107201 Adapalene gel 0.1%,45g tube

5

New

01209503 Isotretinoin capsule 20mg

6

New

00103903

Trimethoprim tablet 200mg

7

New

01105702

Mometasone furoate cream 0.1%,15g tube

8

New

001107301 Betamethasone 0.1% with Fusidic acid 2% cream

9

New

0105103 Clofazimine capsule 50mg

10

New

01106804 Pentoxifylline modified release tablet 400mg

11

New

01106801 Tacrolimus ointment 0.1% ,30g tube

12

New

01106802 Tacrolimus ointment 0.03%,30g tube

13

New

01107002 Benzoyl peroxide gel 2.5%,20g tube

14

New

01107001 Benzoyl peroxide gel 5%,30g tube

Page 74: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 74

12. Drugs used in Malignant diseases

12.1.Members of the sub committee

1. Dr. Lal Panapitiya, Director, MSD

2. Prof. Asitha de Silva, Chairman, NMRA

3. Prof. LaL Jayakody, Professor of Pharmacology

4. Prof. Rohini Fernandopulle, Professor in Pharmacology

5. Prof. Geetha Fernando, Professor in Pharmacology

6. Prof. Priyadharshanie Galappaththy, Professor in Pharmacology

7. Prof. Shalini Sri Ranganathan, Professor in Pharmacology

8. Dr. Damayanthi Peris, Consultant Clinical Oncologist, NCI, Maharagama

9. Dr.Umagowry Sarawanamuttu, Consultant Clinical Oncologist, T.H.Karapitiya

10. Dr. Prasad Abeysinghe, Consultant Clinical Oncologist, NCI, Maharagama

11. Dr. Mahendra Somathilake, Consultant Pediatric Oncologist, NCI, Maharagama

12. Dr. Priyantha Madawala, Consultant Haematoncologist, NCI, Maharagama

13. Dr. Jaliya Jayasekara, Consultant Clinical Oncologist, G.H.Rathnapura

14. Dr. Janaka Cooray, Consultant Clinical Oncologist, T.H. Jaffna

15. Dr. Thushari Hapuarachchi, Consultant Clinical Oncologist, T.H.Anuradapura

16. Dr. Sachini Rasnayake, Consultant Clinical Oncologist, G.H.Gampaha

11. Dr. Lalindra Goonerathne, Consultant Haematologist, Faculty of Medicine, Uni. of Colombo

17. Dr. Rohan Pulleperuma, Consultant Haematologist, D.G.H. Hambanthota

18. Mr. E.D.Weerarathne, Former Assistant Director, MSD

Page 75: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 75

12.2. Approved item list: Drugs used in Malignant diseases

Drugs available for level 2,3 & 4 Institutions

No Item Code Medium Description

Item

Category

VEN

status

1 00000801 Morphine sulphate tablet 10mg R E

2 00000802 Morphine sulphate tablet 15mg R E

3 00000804

Morphine sulphate controlled release

tablet 10mg R E

4 00000805

Morphine sulphate controlled release

tablet 30mg R E

5 00000806

Morphine sulphate controlled release

tablet 60mg R E

6 00000807

Morphine sulphate injection 15mg

ampoule R E

Drugs available for level 3 & 4 Institutions

No Item Code Medium Description

Item

Category

VEN

status

1 01200101 Busulphan tablet 2mg R N

2 01200201 Chlorambucil tablet 2mg R E

3 01200301 Cyclophosphamide tablet 50mg R E

4 01200303

Cyclophosphamide injection 200mg

vial R E

5

New-

01200304 Cyclophosphamide injection 1g vial R E

6 01200401

Ifosfamide injection 1g vial with Mesna

injection 100mg in 1ml, 3 ampoules in

one set

R E

7

New-

01210101 Mesna injection 200mg in 2ml C N

8 01200501 Melphalan tablet 2mg R N

9 01200601 Lomustine hydrochloride capsule 40mg R N

10 01200801

Bleomycin sulphate injection 15000

units vial R N

11 01200901

Actinomycin D injection 500

microgram vial R N

12 01201001

Daunorubicin hydrochloride injection,

20mg vial R N

13 01201101 Doxorubicin hydrochloride injection, R E

Page 76: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 76

10mg vial

14 New-

01201103

Doxorubicin injection 2mg/ml, 25ml

vial R E

15 01201201

Epirubicin hydrochloride injection

10mg vial R N

16 01201202

Epirubicin hydrochloride injection,

50mg vial R E

17 01201401 Mitomycin injection 2mg vial R E

18 01201701 Cytarabine injection 100mg vial R N

19 01201702

Cytarabine injection 100mg in 1ml vial

(preservative free) R N

20 01201902

Fluorouracil injection 250mg in 10ml,

vial R E

21 01202001

Gemcitabine hydrochloride injection,

200mg vial R E

22 01202002

Gemcitabine hydrochloride injection 1g

vial R N

23 01202101 Mercaptopurine tablet 50mg R E

24 01202201 Methotrexate tablet 2.5mg R E

25 01202202 Methotrexate injection 50mg vial R E

26 01202203

Methotrexate inj.50mg/2ml (without

preservative) R N

27 01202204 Methotrexate injection 1g vial R E

28

New-

01202206

Methotrexate injection 500mg/5ml R E

29 01202401 Vincristine sulphate injection 1mg vial R N

30 01202501

Vinblastine sulphate injection 10mg

vial R N

31 01202601 Vinorelbine injection 50mg vial R N

32

New-

01202603 Vinorelbine tablet 30mg R E

33 01202701 Etoposide capsule 100mg R E

34 01202702 Etoposide injection 100mg vial R E

35

New-

01202703 Etoposide capsule 50mg R E

36 01202801 Folinic acid tablet 15mg R E

37 01202802 Folinic acid injection,15mg/2ml vial R E

38

New

01202803 Folinic acid injection 50mg/5ml C E

39 01203201 Asparaginase 10,000 Unit vial R N

40 01203301 Dacarbazine injection 200mg ,vial R N

41 01203401 Temozolomide capsule 100mg R N

42 01203402 Temozolomide capsule 250mg R N

43 01203501 Hydroxyurea capsule 500mg R N

Page 77: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 77

44 01203601 Carboplatin injection 150mg /15ml, vial

with diluent R E

45 01203602 Carboplatin injection 450mg / 45ml vial R E

46 01203701 Cisplatin injection 10mg vial R N

47 01203702 Cisplatin injection 50mg vial R E

48 01203801 Oxaliplatin injection 50mg vial R E

49 01203803 Oxaliplatin injection 100mg vial R E

50 01203901 Procarbazine capsule 50mg R E

51 01204401 Imatinib mesilate capsule100mg R E

52 01204801 Docetaxel injection 20mg vial R E

53 01204802 Docetaxel injection 80mg vial R E

54 01204901 Paclitaxel injection 30mg/5ml vial R E

55 01204904 Paclitaxel injection 260mg / 43.4ml vial R E

56 01204905

Paclitaxel nanoparticle injection 100mg

vial C N

57 01205001 Irinotecan injection 40mg / 2ml R E

58 01205002 Irinotecan injection 100mg / 5ml R E

59 01205901

Interferon alfa injection 3 million unit

vial R E

60 01206401 Thalidomide capsule 100mg R E

61

New-

01206402 Thalidomide capsules 50mg C E

62 01206501 Megestrol acetate tablet 40mg R N

63 01206701 Anastrozole tablet 1mg R E

64 01206802 Tamoxifen tablet 20mg R E

65 01206901 Letrozole tablet 2.5mg R E

66 01207301 Goserelin acetate implant 3.6mg R E

67 01207402

Octreotide injection 50 microgram in

1ml amp R E

69 00303103

Ondansetron injection 8mg / 4ml,

ampoule R E

70 New-

00303102

Ondansetron injection 4mg / 2ml,

ampoule R E

71

New-

00303104 Ondansetron tablet 4mg R E

72

New-

00303105

Ondansetron oral solution 4mg/5ml

,50ml bottle R E

73 00000803 Morphine sulphate tablet 30mg R E

74

New-

00000810

Morphine sulphate syrup, 2mg in 1ml

,100ml bottle R E

75

New-

00701603 Dexamethasone tablet 4mg R E

76

New-

00701604 Dexamethasone tablet 8mg R E

Page 78: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 78

Drugs available for Level 4 Institutions

No Item Code Medium Description

Item

Category

VEN

status

1

New-

01200102

Busulphan Injection 6mg/ml, 10ml vial C N

2

New-

01200502

Melphalan injection 50mg powder with

solvent R N

3 01201301 Idarubicin hydrochloride capsule 5mg C N

4 01201302

Idarubicin hydrochloride injection 5 mg

vial C N

5 01201601 Capecitabine tablet 500mg R N

6

New-

01201703 Cytarabine injection 1g in 10ml vial C E

7

New-

01210201 Azacitadine injection 100mg vial C E

8 01201904 Fluorouracil injection 1g, 20ml vial R E

9 01202602 Vinorelbine Injection 10mg Vial R N

10 01203001 Bortezomib injection 1mg vial R N

11 01203002 Bortezomib injection 2mg vial R N

12 01203202

Crisantaspase ( Ervinia L-asparaginase

enzyme) injection 10,000 units, bottle C N

13

New-

01203502

Hydroxyurea (Hydroxy carbamide)

tablet 100mg R E

14

New-

01204403

Imatinib capsules 400mg R E

15 01205101 Trastuzumab injection 150mg vial C N

16 01205102 Trastuzumab injection 440mg vial C N

17 01205701 Rituximab injection100mg/10ml vial R E

18 01205702 Rituximab injection 500mg/50ml vial R E

19 01206101

Filgrastim injection 300 microgram in

0.5ml /1ml PFS/vial R E

20 1206201

Filgrastim (Pegylated) injection

6mg/0.6ml -1ml C N

21 1206301 Lenalidomide capsule 5mg R E

22 01206302 Lenalidomide capsule 10mg R E

23 1206502 Megestrol acetate tablet 160mg C N

24 1207001 Bicalutamide tablet 50mg R E

25 01207002 Bicalutamide tablet 150mg R E

26 1207901 Exemestane tablet 25mg R E

27 01208601 Cabazitaxel Injection 60 mg /1.5ml vial C N

28 1208901 Nilotinib capsule 150mg C N

Page 79: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 79

29 00108601 Tenofovir tablet 300mg C N

30 01208301 Cladribine injection 10mg/10ml vial C N

31

New-

00000809 Morphine sulphate CR tablet 15mg R E

32 00000401

Fentanyl Citrate transdermal patches 50

microgram per hour R N

33

New-

00000402

Fentanyl dermal patches 12 microgram

per hour R N

34

New-

00000403

Fentanyl Dermal patches 25 microgram

per hour R N

35

New-

01210301

BCG suspension for intravesical

chemotherapy 40mg / 1ml vial R N

Drugs to be issued on Named patient basis

No Item Code Medium Description

1 01201102

Doxorubicin con.(Liposoml)injection

20mg/10ml

2 01201501 Mitoxantrone injection 20mg/10ml vial

3 01201801

Fludarabine phosphate injection 50mg

vial

4

New-

01201703 Azacitadine injection 100mg vial

5

New-

01205305

Tegafur 20mg, Gimeracil 5.8mg and

Oteracil potassium 19.6mg per capsule

6

New-

01202102

Mercaptopurine oral suspension

20mg/ml, 100ml bottle

7 01202901 Bevacizumab injection 100mg/4ml,vial

8 01203101 Cetuximab injection 100mg vial

9 01203202

Crisantaspase (L-Asparaginase) 10000

U

10 01204002 Dasatinib tablet 50mg

11 01204003 Dasatinib tablet 20mg

12 01204101 Erlotinib hydrochloride tablet 150mg

13 01204202 Everolimus tablet 10mg

14 01204501 Lapatinib tablet 250mg

15 01204601 Sorafenib tablet 200mg

16 01204701 Sunitinib malate capsule 50mg

17

New -

01204702 Sunitinib malate capsule 12.5mg

Page 80: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 80

18 01204903 Paclitaxel (protein-bound)injection

100mg vial

19 01204906

Paclitaxel nanoparticle injection 300mg

vial

20 01204905

Paclitaxel nanoparticle injection 100mg

vial

21 01205101 Trastuzumab injection 150mgvial

22 01205102 Trastuzumab injection 440mgvial

23

New-

01206001

Peginterferone alfa 2a injection, 180

microgram / 0.5ml prefilled syringe

24 01206201

Filgrastim (Pegylated) injection

6mg/0.6ml -1ml

25

New-

01207302 Goserelin acetate implant 10.8mg

26 01207401 Octreotide injection 20mg/2.5ml PFS

27 01207601

Pemetrexed disodium injection 100mg

vial

28 01207602

Pemetrexed disodium injection 500mg

vial

29 01207801 Trabectedine injection 1mg

30 01208601 Cabazitaxel Injection 60 mg /1.5ml vial

31 01208901

Nilotinib hydrochloride monohydrate

capsule 150mg

32 01208902

Nilotinib hydrochloride monohydrate

capsule 200mg

33 01209001

Bendamustine hydrochloride injection,

100mg in 20ml vial

34 01209101 Mitotane tablets 500mg

35 01208501 Abiraterone acetate tablet 250mg

36 01208201 Decitabine injection 50mg/20ml vial

37 01204301 Gefitinib tablet 250mg

38 00107802 Lamivudine tablet. 100mg

39 01208101 Pazopanib tablet 200mg

40 01203203 Peg-asparaginase injection 3,750IU

41 01208001

Topotecan hydrochloride injection

2.5mg vial

42 01209501 Tretinoin capsule 10mg

43 01209502 Isotretinoin capsule 10mg

43 01209504 Isotretinoin capsule 20mg

44 00108601 Tenofovir tab. 300mg

45 01208301 Cladribine injection 10mg/10ml vial

46

New

00706101

Thyrotropin alfa (rhTSH) injection 900

microgram vial

Page 81: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 81

Drugs deleted / tailed off from the Formulary

No Item Code

Medium Description

Reasons for the

deletion

1

01200302 Cyclophosphamide injection 100mg

vial

slow moving item

manage with 200mg

2

01200701 Carmustine capsule 40mg Not used during last

five years

3

01202301 Thioguanine tablet 40mg Not used during last

five years

4

01204001 Dasatinib tablet 70mg

50mg & 20mg

adequate.

5

01205801 Nimotuzumab Injection 50mg in 10ml

Deleted

6

01206601 Stilboesterol tablet 1mg Not used during last

five years

7

01206602 Stilboestrol tablet 5mg Not used during last

five years

8

01207202 Leuprorelin acetate injection 1mg in

0.5ml

Tail off due to

Goserelin use as an

alternatives

9

01207403 Octreotide injection 30mg/2.5ml PFS 20mg/2.5ml and 50mcg

adequate.

10

01207501 Thymosin alpha 1 injection1.6mg vial Not used during last

five years

Page 82: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 82

13. Drugs used in Obstetrics and Gynecology

13.1. Members of the sub committee

1. Dr. Lal Panapitiya, Director, MSD

2. Prof. Rohini Fernandopulle, Professor in Pharmacology.

3. Prof. Athula Kaluarachchi, Professor in Obstetrician and Gynecology, D.M.H.,

4. Dr. Mangala Dissanayake, Consultant Obstetrician and Gynecologist, Kethumathie Hospital,

Panadura,

5. Dr. Gayan De Silva, Consultant Obstetrician and Gynecologist, B.H. Kuliyapitiya,

6. Dr. Sanath Lanerolle, Consultant Obstetrician and Gynecologist, Castle Street Hospital,

7. Dr. U.P.D. Rathnasiri, Consultant Obstetrician and Gynecologist, Castle Street Hospital,

8. Dr.S.Godakandage, CCP, Family Health Bureau

9. Mr. E.D. Weerarathne, Former Assistant Director, MSD

Page 83: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 83

13.2. Approved item list: Drugs used in Obstetrics and Gynaecology

Drugs available for all Levels of Institutions

No

Item

Code Medium Description

Item

Category

VEN

status

1 01300801 Levonorgestrel 0.15mg + Ethinyloestradiol 0.03mg tablet R E

2 1301301 levonorgestrel 1.5 mg,tablets R E

3 00702601 Medroxyprogesterone acetate Injection 150mg in 1ml vial R E

Drugs available for Level 2,3 & 4 Institutions

No

Item

Code Medium Description

Item

Category

VEN

status

1 01300102

Ergometrine maleate injection 500microgram / 1ml

ampoule R E

2 01300201 Oxytocin injection 2 I.U.in 2ml ampoule R N

3 01300202 Oxytocin Injection 5 I.U. in 1ml ampoule R E

4 01300402 Levonorgestrel implants two rod (75mg) C E

5 01300501 Etonogestrel Implant single rod (68mg) R N

6 01301201 Clotrimazole pessaries 100mg R E

7

New

01103602 Cetrimide cream 0.5%, 50g tube C E

Drugs available for Level 3 & 4 Institutions

No

Item

Code Medium Description

Item

Category

VEN

status

1 01300301 Dinoprostone vaginal tablet 3mg R E

2 01300302 Dinoprostone vaginal gel 1mg in 2.5ml Tube/Unit R N

3 01300401 Levonorgestrel 20 microgram /24h Intra-uterine system C E

4 01300601 Potassium citrate powder R N

5 01300701 Sodium citrate powder R E

6 01301101 Citric acid crystals R N

7 01301401 Misoprostol tablet 200 micrograms C E

8

New

01301403 Misoprostol tablet 25 mcg C N

9 00701901 Conjugated estrogens tablet 0.325mg R N

10 00701902 Conjugated Estrogens tablet 0.625mg R N

11 00702001 Ethinyloestradiol tablet 5 microgram C N

Page 84: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 84

12 00702003 Ethinyloestradiol tablet 20 microgram R N

13 00702101 Dydrogesterone tablet 10mg R N

14 00702201

Oestradiol valerate 2mg, 11 tablets and Oestradiol valerate

2mg + Cyproterone acetate 1mg, 10 tablets in a calendar

pack

C N

15

New

00706601 Estradiol valerate tablet 1mg R E

16

New

00706602 Estradiol valerate tablet 2mg R E

17

New

01302401

Estrogen vaginal cream 0.01%, 15g tube C E

18 00702401 Hydroxyprogesterone Injection 250mg in 1ml ampoule R E

19

New

00707101 Follicle - Stimulating Hormone (FSH) Injection 1200U vial C N

20 00702501 Norethisterone tablet 5mg R E

21 00702801 Clomiphene citrate tablet 50mg R E

22 00703101 Human Chorionic Gonadotrophin injection 5000 IU R N

23 00703103 Human Chorionic Gonadotrophin injection 2000 IU C N

24 01207301 Goserelin acetate implant 3.6mg R E

25 00602801

Anti D.(Rho)Immunoglobulin injection 300mcg in 1.5ml

vial R E

Drugs available for Level 4 Institutions

No

Item

Code Medium Description

Item

Category

VEN

status

1 01207201 Leuprorelin acetate 3.75mg vial with solvent 2ml C N

Drugs, deleted from the Formulary

No

Item

Code Medium Description Reasons for the deletion

1 01300101

Ergometrine maleate injection 250microgram in 1ml

ampoule

Ergometrine injection

500mcg is adequate

2 01300901 Nystatin pessaries 100,000 IU Slow moving

3 01301202 Clotrimazole pessaries 500mg

Clotrimazole pessaries

100mg is

adequate

4 01301402 Misoprostol Tablet 50 micrograms,

Misoprostol 25mg can be

used use for induction of

labor

5 00704901 Progesterone vaginal gel Not used in last few years

6 00703102 Human Chorionic Gonadotrophin 500 IU

5000IU strength is

adequate

7 01207202 Leuprorelin acetate 1mg in 0.5ml

Goserelin can be used as an

alternatives

Page 85: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 85

Drugs to be issued on Named Patient basis

No

Item

Code Medium Description Item level

1

New

00707101 Follicle - Stimulating Hormone (FSH) Injection 75 IU vial

4

2

New

00600303

Hepatitis B specific Immunoglobulin(HBIG) 50units/ml in

10ml vial 4

3

New

00603002

Varicella Zoster specific Immunoglobulin(VZIG) (Human)

Lyophillized 250mg vial 4

Drugs included to the Formulary

No

Item

Code Medium Description

1

New

01301403 Misoprostol tablet 25 microgram

2

New

00706601 Estradiol valerate tablet 1mg

3

New

00706602 Estradiol valerate tablet 2mg

4

New

01302401

Estrogen vaginal cream 0.01%, 15g tube

5

New

01103602 Cetrimide cream 0.5%, 50g tube

Page 86: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 86

14. Drugs used in Renal Diseases

14.1. Members of the sub committee

1. Dr. Lal Panapitiya, Director, MSD

2. Prof. Rohini Fernandopulle, Professor in Pharmacology

3. Prof. Kamani Wanigasooriya, Consultant Physician,

4. Prof. Mandika Wijerathne, Consultant Vascular Surgeon, NHSL

5. Dr. A.L.M.Nazar, Consultant Nephrologist, NHSL

6. Dr. Mathu Selvarajah, Consultant Nephrologist, Colombo North Teaching Hospital, Ragama

7. Dr. A.W.M. Wazil, Teaching Hospital, Kandy

8. Dr. Manjula Wijewardana, Consultant Urologist, NHSL

9. Dr. Ranga Wickramarachchi, Consultant Urologist, G.H.Ampara

10. Dr. Kanchana Edirisinghe, Consultant Urologist, T.H.Kandy

11. Dr. Vindya Gunasekara, Consultant Peadiatrician, LRH

12. Dr. Inoka Perera, Consultant Peadiatrician, Sirimavo Bandaranaka Hospital, Peradeniya

13. Mr. E.D.Weerarathne, Formar Assistant Director, MSD

Page 87: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 87

14.2. Approved item list: Drugs used in Renal diseases

Drugs available for all Levels of Institutions

No Item Code Medium Description Item Category VEN status

1 New

00406501

Phosphate tablet R E

2 New

00701702 Prednisolone tablet 1mg R E

3 New

00103901 Trimethoprim tablet 100mg R E

4 New

00103902

Trimethoprim oral suspension 50mg / 5ml, 100ml

bottle R E

5 New

00105903

Nitrofurantoin oral suspension 25mg/ 5ml, 300ml

bottle R E

6 00105901 Nitrofurantoin tablet 50mg R E

Drugs available for Level 2,3 & 4 Institutions

No Item Code Medium Description Item Category VEN status

1 00400901 Sodium bicarbonate tablets 600mg R N

Drugs available for Level 3 & 4 Institutions

No Item Code Medium Description Item Category VEN status

1 00404001 Epoetin injection 2,000 IU vial/PFS C E

2 New

00404003

Epoetin injection 1,000 IU vial/PFS C E

3 00404002 Epoetin injection 4,000IU-5,000IU vial/PFS C E

4 01205401 Cyclosporin capsule 25mg C E

5 01205402 Cyclosporin capsule 50mg C E

6 01205403 Cyclosporin capsule 100mg C E

7 New

01205404

Cyclosporine oral solution 100mg/ml, 50ml bottle C E

8 01205201 Azathioprine tablet 50mg R E

9 00405301 Albumin solution (human)20%,50ml C E

10 00405302 Albumin solution (human) 5%,250ml C N

11 00107403 Liposomal Amphotericin B injection 50mg for

I.V. use C E

12 00402301 Peritoneal dialysis solution 1.5% in 1000ml Bottle R E

13 00405001 Administration set for PD solution R E

14 00405101 PD catheter set R E

Page 88: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 88

15 New

00405101

PD catheter set , Peadiatric size R E

16 00404401 Sodium dihydrogen orthophospate powder C N

17 00404501 Disodium hydrogen orthophospate powder C N

18 00401801 Calcium carbonate tablet 1.25g C E

19 New

00401802

Calcium carbonate oral suspension 500mg/5ml C E

20 New

Magnesium glycero Phosphate tablet C N

21 New

00400906

Sodium bicarbonate 1.25% Collapsible bag 500ml C N

22 New

00406101

Calcium acetate tablet 1g C E

23 New

00406102

Calcium acetae oral solution 169mg/5ml C E

24 New

00701703 Prednisolone tablet 20mg C E

25 New

00200304 Furosemide tablet 250mg C N

26 New

00405303 Albumin solution (human) 5%, 500ml bottle C E

27 New

00406301 Potassium phosphate injection 50ml C E

28 New

01301501 Tamsulosin capsule 0.2 mg R E

29 New

01301502 Tamsulosin capsule 0.4 mg R E

30 New

01301601 Terazosin tablet 1mg R E

31 New

01301602 Terazosin tablet 2mg C E

32 New

01301603 Terazosin tablet 5mg C E

33 New

01301701

Alfuzosin hydrochloride tablet (extended release)

10mg C N

34 New

01301801

Tolteridone tablet 1 mg R E

35 New

01301802 Tolteridone capsule sustained release 2mg R E

36 New

00207901 Solifenacin tablet 5 mg R E

37 New

00207901 Oxybutynine hydrocloride tablet 5mg R E

38 New

01302001 Oxybutynine hydrocloride tablet 2.5mg R N

39 New

01302002

Oxybutynine hydrocloride oral solution 1mg /

5ml, 100ml bottle C N

Page 89: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 89

40 New

00706301 Finasteride tablet 5mg R E

41 New

01300603 Potassium citrate oral solution R E

42 New

01300602 Potassium citrate tablet 1080mg R E

43 New

01300702

Sodium citrate oral solution 500mg/334mg per

5ml in 100ml bottle R E

44

New

00401005

Sodium chloride for intravenous infusion 0.9%

1000ml, collapsible bag R E

45 01300601 Potassium citrate powder R N

46 01300701 Sodium citrate powder R E

47 01207101 Flutamide tablet 250mg R E

48 New

00406202

Calcium polystyrene sulphonate powder 17g

powder sachet R E

8 New

00401005

Sodium chloride for intravenous infusion 0.9%

1000ml, collapsible bag R V

Drugs available for Level 4 Institution

No Item Code Medium Description Item Category VEN status

1 01205501 Basiliximab injection 20mg for IV use with

solvent 5ml C N

2 01205601 Tacrolimus capsule 0.5mg C E

3 01205602 Tacrolimus capsule 1mg C E

4 01204201 Everolimus tablet 0.25mg C N

5 01205301 Mycophenolate mofetil capsules 250mg C E

6 01205303 Mycophenolate mofetil capsules 500mg C E

7 New

01205306

Mycophenolate mofetil oral suspension 1g/5ml

in175ml bottle C E

8 00108101 Valganciclovir Tab. 450mg C N

9 00108001 Ganciclovir injection for IV use 500mg C N

10 New

00406901

Magnesium glycinate tablet 400mg (200mg of

elemental magnesium) C N

11 New

01302201

Sevelamer hydrochloride tablet 800mg C

N

12 01207001 Bicalutamide tablet 50mg C N

13 00401007 Sodium chloride for IV use, 0.45%, 500ml R N

14 New

00706201

Dutasteride capsule 0.5 mg

3 E

15 01207201 Leuprorelin acetate 3.75mg vial with solvent 2ml C N

Page 90: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 90

Drugs deleted from the Formulary

No Item Code Medium Description Reasons for the deletion

1 01205603 Tacrolimus capsule 5mg 1mg & 0.5mg strengths are

enough

2 00603101 Anti-Human Thymocyte equine Immunoglobulin

(Lymphoglobulin)5ml Vial

Not used in last five years

Drugs to be issued on a Named Patient basis

No Item Code Medium Description Item level VEN status

1 01208701 Mycophenolic acid tablet 180mg 4 N

2 01208802 Mycophenolic acid tablet 360mg 4 N

3 00404101 MPG-epoetin 100microgram /0.3ml, injection

PF.Sy 3 N

4 00404102 MPG-epoetin 50microgram /0.3ml, injection

PF.Syr 3 N

5 00603102 Antithymocyte inj. 250mg,5ml, vial 4 N

6 New

01302101 Tadalafil tablet 10mg

3 N

7 New

01207205

Leuprorelin acetate injection 7.5 mg

4 N

8 01208501 Abiraterone acetate tablet 250mg 4 N

Drugs included to the Formulary

No Item Code Medium Description

1

New

00404003

Epoetin injection 1,000 IU vial / PFS

2

New

PD catheter set , Peadiatric size

3

New

00401802

Calcium carbonate oral suspension 500mg/5ml

4

New

01205404

Cyclosporin oral solution 100mg/ml in 50ml

bottle

5

New

00406501

Phosphate tablet

6

New

Magnesium glycero Phosphate tablet -No SR.NO

7

New

00406901

Magnesium glycinate tablet 400mg (200mg of

elemental Magnesium)

8 New Sevelamer hydrochloride tablet 800mg

Page 91: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 91

01302201

9 New

00400906

Sodium bicarbonate 1.25% collapsible bag 500ml

10

New

00406101

Calcium acetate tablet 1g

11

New

00406102

Calcium acetae oral solution 169mg/5ml

12

New

00701702 Prednisolone tablet 1mg

13

New

00701703 Prednisolone tablet 20mg

14

New

00200304 Furosemide tablet 250mg

15

New

00406202

Calcium polystyrene sulphonate powder 17g

powder sachet

16

New

01205306

Mycophenolate mofetil oral suspension 1g/5ml

in175ml bottle

17

New

00405303 Albumin solution (human) 5%, 500ml bottle

18

New

00406301 Potassium phosphate injection 50ml

19

New

01301501 Tamsulosin capsule 0.2 mg

20

New

01301502 Tamsulosin capsule 0.4 mg

21

New

01301601 Terazosin tablet 1mg

22

New

01301602 Terazosin tablet 2mg

23

New

01301603 Terazosin tablet 5mg

24

New

01301701

Alfuzosin hydrochloride tablet (extended release)

10mg

25

New

01301801

Tolteridone tablet 1 mg

26

New

01301802 Tolteridone capsule sustained release 2mg

27

New

01301901 Solifenacin tablet 5 mg

28

New

00207901 Oxybutynine hydrocloride tablet 5mg

29

New

01302001 Oxybutynine hydrocloride tablet 2.5mg

30

New

01302002

Oxybutynine hydrocloride oral Solution 1mg in

5ml, 100ml bottle

31

New

00706301 Finasteride tablet 5mg

Page 92: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 92

32 New

01300603 Potassium citrate oral solution

33

New

01300602 Potassium citrate tablet 1080mg

34

New

01300702

Sodium citrate oral solution 500mg/334mg per

5ml in 100ml bottle

35

New

00103901 Trimethoprim tablet 100mg

36

New

00103902

Trimethoprim oral suspension 50mg / 5ml, 100ml

bottle

37

New

00105903

Nitrofurantoin oral suspension 25mg/ 5ml, 300ml

bottle

38

New

00401005

Sodium chloride for intravenous infusion 0.9%

1000ml, collapsible bag

Approved drugs to be Local Purchased by Institutions

No. Item code Item medium description Item catogory VEN

status

Item

level

1. 01302301 Doxazosin tablet 1mg C N 3

2. 01302302 Doxazosin tablet 4mg C N 3

Newly suggested drugs will be included if they are registered only

Page 93: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 93

15.Drugs used in the treatment of Musculoskeletal and Joint Diseases

15.1. Members of the sub committee

1. Dr. Lal Panapitiya, Director, MSD

2. Prof. Rohini Fernandopulle, Professor in Pharmacology

3. Prof. Saroj Jayasinghe, Consultant Physician, NHSL

4. Dr. V.Swarnakumar, Consultanat Orthopedic Surgeon, NHSL

5. Dr. T.G.J.D.Munidasa, Consultanat Orthopedic Surgeon, NHSL

6. Dr. Saman Jayanetti, Consultant Rheumatologist, NHSL

7. Dr. Duminda Munidasa, Consultant Rheumatologist, Rheumatology & Rehabilitation Hospital,

Ragama

8. Dr. Kalum Deshapriya, Consultant Rheumatologist, T.H.Karapitiya

9. Dr. Kelum De Silva, Consultant Rheumatologist, D.G.H.Kaluthara

10. Dr. Monika De silva, Consultant Rhumatologist , NHSL

11. Dr. Rasika Gunapala, Consultant Pediatrician, LRH

12. Mr. E.D.Weerarathne, Former Assistant Director, MSD

Page 94: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 94

15.2. Approved item list: Drugs Used in treatment of Musculoskeletal and Joint Diseases

Drugs available for all Level of Institution

No Item Code

Medium Description

Item

Category

VEN

status

1 01400101 Methyl salicylate R N

2 01400201 Ibuprofen tablet 200mg R E

3 New

01400204

Ibuprofen tablet 400mg R E

4 01400302 Diclofenac sodium tablet 50mg R E

5 01400307 Diclofenac sodium gel 20g tube C E

6 New

00701702

Prednisolone tablet 1mg R E

Drugs available for Level 2,3 & 4 Institutions

No Item Code

Medium Description

Item

Category

VEN

status

1 01400202 Ibuprofen syrup 100mg/5ml, 60ml bottle R E

2 01400301 Diclofenac sodium tablet 25 mg R N

Drugs available for Level 3 & 4 Institutions

No Item Code

Medium Description

Item

Category

VEN

status

1 01400304 Diclofenac sodium suppository 25mg R E

2 01400306 Diclofenac sodium suppository 100mg R E

3 New

01402701

Diclofenac 1% w/w + Capsaicin 0.025% w/w

gel 30g tube C N

4 01400401 Indomethacin capsule 25mg R N

5 New

01402201

Naproxane tablet 250mg R N

6 New

01402301

Celecoxib capsule 100mg R N

7 New

01402302

Celecoxib capsule 200mg R N

8 New

01402401

Meloxicam tablet 7.5mg C N

9 01400701 Penicillamine capsule 250mg R N

10 01400801 Hydroxychloroquine sulphate tablet 200mg R E

Page 95: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 95

11 01400901 Leflunomide 10 mg tablet C E

12 New

01400903

Leflunomide tablet 20 mg C E

13 01401001 Allopurinol tablet 100mg R E

14 01401101 Neostigmine Tab. 15mg R E

15 New

01402501

Febuxostat tablet 40mg R N

16 New

01402601

Colchicine tablet 0.5mg R N

17 01401201 Pyridostigmine bromide tablet 60mg R N

18 01401301 Baclofen tablet 5mg R N

19 01401302 Baclofen tablet 10mg R N

20 New

00302201

Amitriptyline tablet 10mg R N

21 01401601 Mefenamic acid tablet 500mg C N

22 00703502 Alendronate sodium tablet 70mg R E

23 00701803 Methylprednisolone IA Inj.40mg/1ml R N

24 01205201 Azathioprine tablet 50mg R E

25 01202201 Methotrexate tablet 2.5mg R E

26 01202202 Methotrexate injection 50mg vial R E

27 01202203

Methotrexate inj.50mg/2ml(without

preservative) R N

28 01202204 Methotrexate injection 1g vial R E

29 00800901 Sulphasalazine tablet 500mg R E

Drugs available for Level 4 Institutions

No Item Code

Medium Description

Item

Category

VEN

status

1 New

00305701

Paracetamol 500mg+Codeine 8mg (co-

codamol) tablet C N

2 01205701 Rituximab injection100mg/10ml vial R E

3 01205702 Rituximab injection500mg/50ml vial R E

Drugs deleted from the Formulary

No Item Code Medium Description Reasons for the deletion

1 01401501 Hyaluronidase injection 1,500 U vial/ampoule

Drugs to be issued on Named Patient basis

No Item Code

Medium Description Item level

VEN

status

1 01401801 Zoledronic acid injection 5mg in 100ml bottle 3 N

Page 96: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 96

2 01401701 Infliximab injection 100mg vial 4 N

3 01401702 Etanercept injection 25 mg 3 N

4 01209201 Golimumab solution for injection 50mg, in

pre-filled syringe 3 N

5 01207701 Tocilizumab 80mg/4ml for infusion 4 N

6 01207702 Tocilizumab 200mg/10ml for IV infusion 4 N

7 01207703 Tocilizumab 400mg/20ml,concentrated solution 4 N

Drugs included to the Formulary

No Item Code Medium Description

1

New

00305701

Paracetamol 500mg+Codeine 8mg (co-

codamol) tablet

2

New

01400204

Ibuprofen tablet 400mg

3

New

01402701

Diclofenac 1% w/w + Capsaicin 0.025% w/w

gel 30g tube

4

New

01402201

Naproxane tablet 250mg

5

New

01402301

Celecoxib Capsule 100mg

6

New

01402302

Celecoxib Capsule 200mg

7

New

01402401 Meloxicam 7.5mg

8

New

01400903

Leflunomide tablet 20 mg

9

New

01402501

Febuxostat tablet 40mg

10

New

01402601

Colchicine tablet 0.5mg

11

New

00302201

Amitriptyline tablet 10mg

12

New

00701702

Prednisolone tablet 1mg

Newly suggested drugs will be included if they are registered only

Page 97: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 97

16. Drugs used in Anaesthesia

16.1. Members of the sub committee

1. Dr. Lal Panapitiya, Director, MSD

2. Prof. Rohini Fernandopulle, Professor in Pharmacology,

3. Prof. Anuja Abedeera, Professor in Anaesthesiology, Dept. of Surgery, Faculty of Medicine,

University of Colombo,

4. Dr. Ramani Pallemulle, Consultant Anaesthetist, Castle Street Hospital for women, Colombo 08,

5. Dr. Samitha Jayawickrama, Consultant Anaesthetist, Lady Ridgeway Hospital, Colombo,

6. Dr. Vinodini Wanigasekara, Consultant Anaesthetist, NINDT, Maligawaththa,

7. Dr. Anoma Perera, Consultant Anaesthetist, Lady Ridgeway Hospital, Colombo,

8. Dr. Nalin Kithulwatte, Consultant Paediatrician, Lady Ridgeway Hospital, Colombo,

9. Dr. Manjula Hewageegana, Consultant Paediatrician, T.H.Karapitiya

10. Mr. E.D.Weerarathne, Former Assistant Director, MSD

Page 98: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 98

16.2. Approved item list: Drugs used in Anaesthesia

Drugs available for all Level of Institution

No Item Code

Medium Description

Item

Category

VEN

status

1

01500801 Atropine sulphate injection 600 microgram

/1ml ampoule R V

2

New

01500802

Atropine sulphate inj. 0.1mg/ml in 10ml pre-

filled syringe R V

3

01502101 Lignocaine hydrochloride injection 2% , 5ml

single dose vial R E

4 00501502 Adrenaline bitartrate Inj.1mg/1ml ampoule R V

5

New

00501504

Adrenaline solution for injection 1 mg/10 ml

(1:10,000), in pre-filled syringe ampoule R V

Drugs available for Level 2,3 & 4 Institutions

1 Item Code

Medium Description

Item

Category

VEN

status

2

New

01500101

Thiopentone sodium injection 500mg vial R E

3

01500902 Midazolam maleate injection 5mg / 1ml

ampoule R E

4

01501101 Atracurium besylate injection 25mg / 2.5ml

ampoule R E

5

01501401 Suxamethonium chloride injection 100mg /

2ml amp R V

6

New

01501402

Suxamethonium chloride injection 20mg/ml,

10ml pre filed syringe R V

7

01501502 Neostigmine methylsulphate injection 2.5mg /

1ml ampoule R E

8

01501701 Flumazenil injection 500 microgram / 5ml

vial R E

9

01501801 Naloxone injection 400 microgram / 1ml

ampoule R E

10 01502105 Lignocaine anhydrous gel 2% in 30g tubes R E

11

01502201 Lignocaine 2% with Adrenalin 1:80,000

injection 30ml vial R E

12 00001101 Pethidine hydrochloride injection 50mg R E

Page 99: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 99

ampoule

13 00001102

Pethidine hydrochloride injection 75mg

ampoule R E

14 00401501

Tetrastarch solution for intravenous

infusion,500ml collapsible bag R N

15

New

00407001

Gelatin for intravenous infusion 4% w/v in

500ml collapsible bag R N

Drugs available for Level 3 & 4 Institutions

No. Item Code

Medium Description

Item

Category

VEN

status

1

01500201 Ketamine hydrochloride injection 200mg in

20ml vial R E

2

01500202 Ketamine hydrocloride injection 500mg in

10ml vial R E

3 01500301 Propofol IV infusion 20ml ampoule/vial R E

4 01500302 Propofol IV infusion 50ml ampoule/vial R E

5 01500401 Etomidate injection 20mg in 10ml vial C E

6 01500501 Halothane 250ml bottle R E

7

01500602 Isoflurane for inhalational anaesthesia 250ml

bottle R E

8

01500701 Sevoflurane for inhalational anaesthesia

250ml bottle R E

9 01500901 Midazolam maleate tablet 7.5mg R E

10

01501001 Glycopyrrolate injection 200microgram / 1ml

vial C E

11

01501201 Pancuronium bromide injection 4mg / 2ml

ampoule R E

12 01501301 Vecuronium bromide injection 10mg vial R E

13

New

00207402

Clonidine hydrochloride injection

(preservative free) 0.5mg/1ml ,10ml vial R E

14

01501501 Neostigmine methylsulphate injection 0.5mg /

1ml ampoule R E

15

01501601 Edrophonium chloride injection 10mg / 1ml

ampoule R N

16

New

01502601

Sugammadex injection 100mg / ml,5ml vial R E

17 01501901 Dantroline sodium injection 20mg vial C V

18 01502001

Bupivacaine hydrochloride injection 0.5% in

10ml ampoule with sterile wrap R E

19

01502003

Bupivacaine hydrochloride injection 0.5%

with Glucose 8% in 4ml amp in pre-sterilized

theatre pack for spinal anaesthesia

R E

20 01502102 Lignocaine hydrochloride injection 2% w/v in R E

Page 100: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 100

20ml vial

21 01502104 Lignocaine spray 10%, 50ml bottle R E

22

01502106 Lignocaine hydrochloride topical solution

4%w/v in 30ml vial R N

23

01502301 Lignocaine 2.5% with Prilocaine cream 2.5%,

5g tube R E

24

01502501 Rocuronium bromide injection 50mg in 5ml

vial R E

25 43412201 Soda lime R E

26 00204201

Ephedrine SulphateInjection 30mg/1ml

ampoule R E

27

New

00204202

Ephedrine sulphate solution for injection 3

mg/ml, in 10ml pre-filled syringe R E

28 00000301

Fentanyl citrate injection 100 microgram /

2ml ampoule. R E

29 00000808

Morphine sulphate injection (preservative

free) 2mg / 2ml ampoule R E

30

New

00303304 Paracetamol suppository 125mg C N

31

New

00303305

Paracetamol suppository 250mg C N

32

New

00303306

Paracetamol suppository 500mg C N

33

New

00303307

Paracetamol 10mg/ml solution for infusion C N

34

New

00401903

Magnesium sulphate injection 50% in 10ml

ampoule R E

35

New

00400704

Potassium chloride oral solution 10% R E

36

New

00405201

Calcium chloride Intravenous infusion, 10%

w/v C E

37

New

00407101

Parenteral infusion fluid in 500ml collapsible

bag/bottle R N

38 00402102 Fat emulsion injection 10% in 500ml bottle R N

39 00402103 Fat emulsion injection 20% in 100ml bottle R E

40 00402201 Protein hydrolysate injection 100ml bottle C E

41

00402202 Amino acids solution for intravenous infusion

500ml bottle R E

42

New

00402203

Amino acids solution 6.25% C E

Drugs available for Level 4 Institutions

No Item Code

Medium Description

Item

Category

VEN

status

Page 101: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 101

1

New

00001401

Diamorphine hydrochloride injection 5mg

vial C N

2 00001201 Remifentanil injection 1mg / 2ml ampoule. R E

3 00001301 Alfentanil hydrochloride 1mg / 2ml ampoule R N

Drugs deleted from the Formulary

No Item Code Medium Description Reasons for the deletion

1 01500102 Thiopentone sodium injection 1g vial To avoid multy dose vial

2 01502401 Prilocaine hydrochloride 3% in 2ml ampoule

3

00400902 Sodium bicarbonate for intravenous infusion

4.2% in 50 ml bottle

4 00401002

Sodium chloride for intravenous infusion

0.9%, 100ml pack

500ml &1000ml volume are

adequate

5

00401201 Sodium chloride 0.18% & Dextrose 4% for

intravenous infusion 500ml bottle

6

00401901 Magnesium sulphate 40% in 25ml injection

ampoule

7

00401904 Magnesium sulphate injection 50% w/v in

2ml

50%,10ml stength is

adequate

8

00402101 Fat emulsion injection 10% in 100ml bottle 10%,500ml bottle is

adequate

9 00405501

Parenteral infusion fluid 500ml(K+

5mmol/L,Mg2+ 1.5mmol/L,Na+ 140

mmol/L,acetate 27mmol/L,Cl-98mmol/L)

Replace with Parenteral

infusion fluid in 500ml

collapsible bag/bottle (SR

No:00407101)

Drugs included to the Formulary

No Item Code Medium Description

1

New

01500101

Thiopentone sodium injection 500mg vial

2

New

01500802

Atropine Sulphate injection 0.1mg/ml in 10ml

pre-filled syringe

3

New

00207402

Clonidine hydrochloride injection

(preservative free) 0.5mg/1ml ,10ml vial

4

New

01501402

Suxamethonium chloride injection 20mg/ml

in 10ml pre filed syringe

5

New

01502601

Sugammadex injection 100mg/ml,5ml

6

New

00501504

Adrenaline solution for injection 1 mg/10 ml

(1:10,000), in pre-filled syringe

7

New

00204202

Ephedrine sulphate solution for injection 3

mg/ml, in 10ml pre-filled syringe

Page 102: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 102

8 New

00001401

Diamorphine hydrochloride injection 5mg

vial

9

New

00303304 Paracetamol suppository 125mg

10

New

00303305

Paracetamol suppository 250mg

11

New

00303306

Paracetamol suppository 500mg

12

New

00407001

Gelatin for intravenous infusion 4% w/v in

500ml collapsible bag

13

New

00401903

Magnesium sulphate injection 50% in 10ml

ampoule

14

New

00400704

Potassium chloride oral solution 10%

15

New

00406401

Calcium chloride Intravenous infusion, 10%

w/v

16

New

00407101

Parenteral infusion fluid in 500ml collapsible

bag/bottle

17

New

00402203

Amino acids solution for intravenous infusion

6.25%

Newly suggested drugs will be included if they are registered only

Page 103: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 103

17.Antidotes

17.1Members of the sub committee

1. Prof. Rohini Fernandopulle, Professor in Pharmacology,

2. Dr. K.V.C.Janaka, Consultant Physician, Sri Jayewardenepura Hospital,

3. Dr. Rajeeve de silva, Consultant Immunologist, MRI,

4. Dr.Rupika Mahalekama, Consultant Anaesthetist, NHSL,

5. Dr. Waruna Gunathilake, Head , National Poison Information Center, NHSL,

6. Mr.E.D.Weerarathne, Former Assistant Director, MSD

Page 104: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 104

17.2. Approved item list Drugs used as Antidotes

Drugs available for all Level of Institutions

No Item Code Medium Description Item Category VEN status

1 01600101 Charcoal activated 50g Bottle R E

2 01600301 Fuller's earth 60g bottle R E

3 01600401 Methionine tablet 500mg R E

Drugs available for Level 2,3 & 4 Institutions

No Item Code Medium Description Item Category VEN status

1 01600201 Acetylcysteine 2g in 10ml ampoule R E

2 01601001

Pralidoxime chloride injection 1g / 20ml

ampoule R E

3 01501701 Flumazenil injection 500 microgram / 5ml vial R E

4 01501801

Naloxone injection 400 microgram / 1ml

ampoule R E

Drugs available for Level 3 & 4 Institutions

No Item Code Medium Description Item Category VEN status

1 01600501 Dicobalt edetate injection 300mg 20ml ampoule R E

2 01601101 Dehydrated ethanol (96.8w/w) 5ml ampoule R E

3 01601201 Methylene blue 1% injection 10ml ampoule R E

4

New

01600503

Ascorbic acid injection 100mg / ml, 5ml

ampoule C N

5 01601301 Atropine sulphate injection 15mg /25ml vial R E

6

New

01601501

Physostigmine salicylate injection 1mg/ml, 2ml

vial R E

7

New

01600502 Hydroxocobalamin intravenous infusion 5g vial C N

Drugs available for Level 4 Institutions

No Item Code Medium Description Item Category VEN status

1

New

01600801 Dimercaprol injection 100mg / 2ml ampoule R E

2

New

01601401

Fomepizole intravenous infusion 1.5g/1.5ml

(1g/ml) C E

Page 105: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 105

Drugs deleted from the Formulary

No Item Code Medium Description Reasons for the deletion

1 01600901

Sodium calcium edetate injection 1g / 5ml

ampoule

Not used in last five years

2 01601103 Ethanol 40% 20ml vial for IV use Not used in last five years

Drugs included to the Formulary

No Item Code Medium Description

1

New

01600503

Ascorbic acid injection 100mg/ml, 5ml

Ampoule

2

New

01601401

Fomepizole intravenous infusion 1.5g/1.5ml

(1g/ml)

3

New

01601501

Physostigmine salicylate injection 1mg/ml, 2ml

vial

4

New

01600502 Hydroxocobalamin intravenous infusion 5g vial

Newly suggested drugs will be included if they are registered only

Page 106: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 106

18.Antiseptics and Disinfectants

Items available for all Levels of Institutions

No

Item

Code Items Medium Description

1 01104401 Surgical spirit R E

2 01104601 Povidone iodine solution 10%w/v,

500ml bottle R E

3 01104603 Povidone Iodine 5%w/v cream,

15g tube C N

4 01104606 Povidone Iodine ointment 5% w/w,

15g tube

5 01103801 Chlorhexidine

solution20%w/v,500ml bottle R E

6 43400401 Ammonia (strong ) solution R N

7 43400101 Boric acid powder R N

8 43400201 Cresol and soap solution 25L drum R E

9 01106301 Glycerin R N

10 43400301 Tropical chlorinated lime R E

11 43400502 Enzymatic cleaning solution R N

12 43400503 Aldehyde free detergent solution R N

13 43400504 Chlorhexidine gluconate solution

2.5% v/v R N

Items available for Level 2,3 & 4 Institutions

1 01104602

Povidone iodne solutiotion

7.5%w/v for surgcal scrub C E

2 01106103 Alcohol based hand rub (75%-

85%) 500ml bottle R N

3 43400501 Formaldehyde solution R N

4 01101201 Bentonite (as fine powder) R E

5 43412101 Solvent ether, 500ml R N

Items available for Level 3 & 4 Institutions

1 01105501

Ortho-phthaladehyde 0.55%w/v

disinfectant solution R E

2 01105603 Peracetic acid R E

3 43400601 Liquified phenol R N

4 43412201 Soda lime R E

5 01106103 Alcohol based hand rub (75%-

85%) 500ml bottle R N

6 43400502 Enzymatic cleaning solution R N

7 43400503 Aldehyde free detergent solution R N

Page 107: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 107

8 43400504 Chlorhexidine gluconate solution

2.5% v/v R N

Drugs deleted from the Formulary

No

Item

Code Medium Description

Reasons for the

deletion

1 01104101

Iodine solution(weak) Not used in last five

years

2 01106201 Alcohol 90%v/v

Page 108: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 108

19. Surgical Dressings

19.1. Members of the sub committee

1. Professor Mandika Wijerathne, Consultant Vascular Surgeon, NHSL,

2. Dr. Kamal Jayasooriya, Consultant General Surgeon, NHSL,

3. Dr. Lalanta Ranasinghe, Consultant General Surgeon, NHSL,

4. Dr. Rasitha Manathunga, Consultant Oncosurgeon, D.G.H.Badulla,

5. Dr. Swarnakumar, Consultant Orthopedic Surgeon, NHSL,

6. Dr. Dilshan Munidasa, Consultant Orthopedic Surgeon, NHSL,

7. Dr. T.Benaragama, Consultant Plastic Surgeon, NHSL,

8. Dr. Nilaksha Kumarasinghe, Consultant Neurosurgeon, NHSL,

9. Dr. M.Munasinghe, Consultant Cardiothoracic Surgeon, NHSL,

10. Dr. Kapila Banduthilaka, Consultant Ophthalmologist, Eye Hospital,

11. Dr. Samitha Jayawikkrama, Consultant Anaesthesiologist, LRH,

12. Mr. G. Nimalsiri, Former Assistant Director (Surgical), MSD,

13. Mr. E.D.Weerarathne, Former Assistant Director (Pharmaceutical), MSD,

Page 109: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 109

19.2.Approved list of items: Surgical Dressings

Items available for all Level of Institutions

No

Item Code

Medium Description

Item

Categor

y

VEN

status

1 14500101 Gauze absorbent R E

2 14500201 Cotton Wool 500g Roll R E

3

New

14500206 'Interlayered Cotton Wool 2" x 3.5m Roll' R E

4 14500301 Bandage W.O.W. 6.25 cm x 4.5m Roll R E

5

New

14500302 Open Woven Bandage 2.5cm x 5m R E

6

New

14500303 Open Woven Bandage 8 cm x 4.5m R E

7 14500601 Sanitary pads R E

8 14500701 Wadding cellulose 500gm R E

9 14500801 Plaster Adhesive 5cm x 4.5m Roll R E

10 14503001

Synthetic casting material 10.0mm x

3.6mm.Packed individually and labelled

accordingly.

C N

11 14503002 Synthetic casting material 7.5mm x 3.6mm. C N

Items available for Level 2,3 & 4 Institutions

No

Item Code

Medium Description

Item

Categor

y

VEN

status

1

New

14500102

Gauze absorbent 30cmx30cmx8ply R N

2

New

14500103

Gauze Absorbent 23cmx23cmx4ply

R N

3

New

14500104 Gauze absorbent 11cmx11cmx16ply R N

14500105 Gauze Absorbent 11cmx11cmx8ply R N

14500106 Gauze Absorbent 8cmx8cmx8ply R N

14500107 Gauze Absorbent 8cmx8cmx16ply R N

4 14500401 Bandage Crepe 7.5cm x 4.5 m Roll R E

Page 110: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 110

5 New

14500403 Bandage Crepe 2.5cmx2m Roll R E

6

New

14500404 Bandage Crepe 5cmx3m Roll R E

7

New

14500405 Bandage Crepe 10cmx6m Roll R E

8

New

14500406 Bandage Crepe 15cmx6m Roll R E

9 14500501

Lint plain Lint plain 500 g roll

R E

10 14500802 Plaster Adhesive 7.5cm x 4.5 m Roll R E

11 14500901 Bandage Elastic Adhesive 7.5cm x 4.5m Roll R E

12 14501201 Paraffin Gauze 10cm x 10cm R E

Items available for Level 3 & 4 Institutions

No

Item Code

Medium Description

Item

Categor

y

VEN

status

1 14500202 Interlayered Cotton Wool 3" x 3.5m 50g Roll c N

2 14500203 Interlayered Cotton Wool 4" x 3.5m 100g Roll C N

3 14500204 Interlayered Cotton wool 6" x 3.5m 200g Roll C N

4 14500205 Inter layered cotton wool 6",500g roll C N

5

New

14501104

Bandage Plaster of Paris 3cmx2.7m Roll R E

6 14500902 Bandage Elastic Adhesive 10cm x 4.5m Roll R E

7 14501001 Plaster extension 7.5cm x 4.5m Roll R E

8 14501101 Bandage Plaster of Paris 7.5cm x 2.7m Roll R E

9 14501102 Bandage Plaster of Paris 10cm x 2.7m Roll R E

10 14501103 Bandage Plaster of Paris 15cm x 2.7m Roll R E

11

New

14501501

Fusidic impregnated 1-3% paraffin gauze

dressing, 10cm x 10cm R N

12 14501202 Paraffin Gauze 9cm x 7m,01 piece in a box R E

13 14501301 Gelatine Sponge, 2cm x 6cm x 7mm R E

14 14501302 Gelatine Sponge, 8cm x 12.5cm x 10mm R E

15 14501303 Gelatine Sponge, 5cm x 3cm x 10mm R E

16 14501304 Gellatine Sponge,7cm x 5cm x 10mm R E

17 14501401

Non allergenic surgical tape 1.25cm x 9.1m

Roll C N

18

New

14501601

Latex free hypoallergenic paper tape 1.25cm x

9-10m C N

19

New

14501602

Latex free hypoallergenic paper tape 2.5cm x 9-

10m C N

20

New

14501603

Latex free hypoallergenic paper tape 5cm x 9-

10m C N

Page 111: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 111

21 New

14501604

Latex free hypoallergenic paper tape 7. 5cm x 9-

10 m C N

22 14503003

Synthetic casting material 12.5mm x

3.6mm.Packed individually and labelled

accordingly.

C N

24

New

14501701

Transparent dressing for catheter fixation 6cm x

7cm R N

25

New

14501702

Transparent dressing for catheter fixation 10cm

x 12cm R N

26

New

14501901

Rdio Opaque Gauze Swab 30cmx30cmx8ply R N

27

New

14501902

Radio Opaque Gauze Swab 23cmx23cmx4ply R N

28

New

14501903

Radio Opaque Gauze Swab 11cmx11cmx16ply R N

29

New

14501904

Radio Opaque Gauze Swab 11cmx11cmx8ply R N

30

New

14501905

Radio Opaque Gauze Swab 8cmx8cmx8ply R N

31

New

14501906

Radio Opaque Gauze Swab 8cmx8cmx16ply R N

32

New

14501801

Dressing semipermiable water proof size -

6cmx7cm R N

33

New

14501802

dressing semipermiable water proof size -

10cmx12cm R N

34

New

14560002

Ophthalmic Surgical Drape 10cm x

12cm,Sterile. R E

35

New

14560003

Ophthalmic Surgical Drape with pouch size

50cm x 40cm, Sterile. R E

36

New

14560004

Ophthalmic Surgical Drape with pouch size

40cm x 60cm, sterile. R E

37 New

14560001 Ophthalmic surgical Drape 6cm x7cm R E

38

New

14540001

Nanocrystal Silver dressing 10cmX10cm C N

39

New

14540002

Nanocrystal Silver dressing 10cmX20cm C N

40

New

14540003

Nanocrystal Silver dressing 20cmX40cm C N

41

New

14540101

Nanocrystal Silver Flexible dressing

10cmX10cm C N

42

New

14540102

Nanocrystal Silver Flexible dressing

10cmX20cm C N

43

New

14540103

Nanocrystal Silver Flexible dressing

20cmX40cm C N

44

New

14540201

Cadexsomer Powder with Iodine 3g C N

Page 112: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 112

45 New

14540202

Cadexsomer ointment with Iodine 10g C N

46

New

14540301

Hydro gel 25g C N

47

New

14540401

0.5% Chlorhexidine Acetate dressing

10cmX10cm C N

48

New

14540501

Post-Operative water proof dressing with non-

adhesive absorbent pad 6.5cmX5cm C N

49

New

14540502

Post-Operative water proof dressing with non-

adhesive absorbent pad 8.5cmX9.5cm C N

50

New

14540503

Post-Operative water proof dressing with non-

adhesive absorbent pad 15.5cmX8.5cm C N

51

New

14540504

Post-Operative water proof dressing with non-

adhesive absorbent pad20cmX10cm C N

52

New

14540505

Post-Operative water proof dressing with non-

adhesive absorbent pad 25cmX10cm C N

53

New

14540506

Post-Operative water proof dressing with non-

adhesive absorbent pad 30cmX10cm C N

54

New

14540507

Post-Operative water proof dressing with non-

adhesive absorbent pad 35cmX10cm C N

55

New

14540602

Low adherent wound dressing 10cmX10cm C N

56

New

14540601

Low adherent wound dressing 10cmX7m C N

57

New

14540701

Water resistant post-operative spray 40ml C N

58

New

14540702

Water resistant post-operative spray 240ml C N

59

New

14540801

Cellulose ethyl sulphonate wound dressing

5cmx5cm C N

60

New

14540802

Cellulose ethyl sulphonate wound dressing

10cmx10cm C N

61

New

14540803

Cellulose ethyl sulphonate wound dressing

4cmx20cm C N

62 New

14540804

Cellulose ethyl sulphonate wound dressing

15cmx15cm

C N

63

New

14540805

Cellulose ethyl sulphonate wound dressing

2cmx45cm C N

64

New

14540901

Hydrocellularpolyurethane dressing with Silver

5cmX5cm C N

65

New

14540902

Hydrocellular polyurethane dressing with Silver

10cmX10cm C N

66

New

14540903

Hydrocellular polyurethane dressing with Silver

15cmX15cm C N

67 New Hydro surgery system for wound cleaning C N

Page 113: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 113

22310001

68 New

14530001

Hydro surgery system hand piece,14mm-

0.11mm Nozzle C N

69

New

14530002

Hydro surgery system hand Piece, 14mm-

0.10mm Nozzle C N

70

New

22310002

NPWT Pump - Rechargeable (Negative Pressure

Wound Therapy) C N

71 New

14530101

Negative Pressure Wound Therapy Canister kit

800ml C N

72 New

14530102

Negative Pressure Wound Therapy foam

dressing kit Large 25cmX15cmX3cm C N

73

New

14530103

Negative Pressure Wound Therapy foam

dressing kit - Medium 20cmX12.5cmX3cm C N

74

New

14530104

Negative Pressure Wound Therapy gauze

dressing kit - Medium 20cmX12.5cmX3cm C N

Items included to the Formulary

No Item Code Medium Description

1

New

14500102

Gauze absorbent 30cmx30cmx8ply

2

New

14500103

Gauze Absorbent 23cmx23cmx4ply

3

New

14500104 Gauze absorbent 11cmx11cmx16ply

4 14500105 Gauze Absorbent 11cmx11cmx8ply

5 14500106 Gauze Absorbent 8cmx8cmx8ply

6 14500107 Gauze Absorbent 8cmx8cmx16ply

7

New

14500206 'Interlayered Cotton Wool 2" x 3.5m roll'

8

New

14500302 Open Woven Bandage 2.5cm x 5m

9

New

14500303 Open Woven Bandage 8 cmx4.5m

10

New

14500403

Cotton crepe bandage 2.5 cm width and 2m

lengh

11

New

14500404 Cotton crepe bandage 5cm width and 3m lengh

12

New

14500405 Cotton crepe bandage 10cm width and 6m lengh

13

New

14500406

Cotton crepe bandage 15cm width and 6m

length

Page 114: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 114

14 New

14501104

Plaster of Paris Bandage (P.O.P. Bandage)

Width: 3 cm Length: 2.7m Roll

15

New

14501501

Fusidic impregnated 1-3% paraffin gauze

dressing, 10cm x 10cm

13

New

14501601

Latex free hypoallergenic 'paper' tape 1.25cm

and longer size for the length is better

16

New

14501602

Latex free hypoallergenic 'paper' tape 2.5cm

and longer size for the length is better

17

New

14501603

Latex free hypoallergenic 'paper' tape 5cm and

longer size for the length is better

18

New

14501604

Latex free hypoallergenic 'paper' tape 7.5cm

width and longer size for the length is better

19

New

14501701

Transparent dressing for catheter fixation 6cm x

7cm

20

New

14501702

Transparent dressing for catheter fixation 10cm

x 12cm

21

New

14501901

Radio Opaque Gauze Swab 30cmx30cmx8ply

22

New

14501902

Radio Opaque Gauze Swab 23cmx23cmx4ply

23

New

14501903

Radio Opaque Gauze Swab 11cmx11cmx16ply

24

New

14501904

Radio Opaque Gauze Swab 11cmx11cmx8ply

25

New

14501905

Radio Opaque Gauze Swab 8cmx8cmx8ply

26

New

14501906

Radio Opaque Gauze Swab 8cmx8cmx16ply

27

New

14501801

Dressing semipermiable water proof size -

6cmx7cm

28

New

14501802

dressing semipermiable water proof size -

10cmx12cm

29

New

14560002

Ophthalmic surgical drape 10cm

x12cm(4"x4"1/2)

30

New

14560003

Ophthalmic surgical drape with pouch size 50cm

x40cm

31

New

14560004

Ophthalmic surgical drape with pouch size 40cm

x60cm

32

New

14560001 Ophthalmic surgical drape 6cm x7cm

33

New

14540001

Nanocrystal Silver dressing 10cmX10cm

34

New

14540002

Nanocrystal Silver dressing 10cmX20cm

35

New

14540003

Nanocrystal Silver dressing 20cmX40cm

36 New Nanocrystal Silver flexible dressing

Page 115: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 115

14540101 10cmX10cm

37 New

14540102

Nanocrystal Silver flexible dressing

10cmX20cm

38

New

14540103

Nanocrystal Silver flexible dressing

20cmX40cm

39

New

14540201

Cadexsomer powder with Iodine 3g

40

New

14540202

Cadexsomer ointment with Iodine 10g

41

New

14540301

Carboxymethylcellulose 2.3%, Propylene glycol

USP 20.0%, water 77.7%/ ,25g Appli pack.

42

New

14540401

0.5% Chlorhexidine acetate dressing

10cmX10cm

43

New

14540501

Post-operative water proof dressing with non-

adhesive absorbent pad 6.5cmX5cm

44

New

14540502

Post-operative water proof dressing with non-

adhesive absorbent pad 8.5cmX9.5cm

45

New

14540503

Post-operative water proof dressing with non-

adhesive absorbent pad 15.5cmX8.5cm

46 New

14540504

Post-operative water proof dressing with non-

adhesive absorbent pad20cmX10cm

47

New

14540505

Post-operative water proof dressing with non-

adhesive absorbent pad 25cmX10cm

48

New

14540506

Post-operative water proof dressing with non-

adhesive absorbent pad 30cmX10cm

49

New

14540507

Post-operative water proof dressing with non-

adhesive absorbent pad 35cmX10cm

50

New

14540602

Low adherent wound dressing 10cmX10cm

51

New

14540601

Low adherent wound dressing 10cmX7m

52

New

14540701

Water resistant post-operative spray 40ml

53

New

14540702

Water resistant post-operative spray 240ml

54

New

14540801

Cellulose ethyl sulphonate wound dressing

5cmx5cm

55

New

14540802

Cellulose ethyl sulphonate wound dressing

10cmx10cm

56

New

14540803

Cellulose ethyl sulphonate wound dressing

4cmx20cm

57

New

14540804

Cellulose ethyl sulphonate wound dressing

15cmx15cm

58 New

14540805

Cellulose ethyl sulphonate wound dressing

2cmx45cm

Page 116: Approved list of Pharmaceutical items (Formulary revision ... item list... · 4. Drugs affecting Nutrition and Blood 4.1. Members of the sub committee 32 4.2. Approved item list 33

Revised item list (Pharmaceuticals) 2016/2017

Page 116

59 New

14540901

Hydrocellular polyurethane dressing with Silver

5cmX5cm

60

New

14540902

Hydrocellular polyurethane dressing with Silver

10cmX10cm

61

New

14540903

Hydrocellular polyurethane dressing with Silver

15cmX15cm

62

New

22310001

Hydro surgery system for wound cleaning

63 New

14530001

Hydro surgery system hand piece

64

New

14530002

Hydro surgery system hand piece

65

New

22310002

NPWT Pump - Rechargeable (Negative Pressure

Wound Therapy)

66 New

14530101

Negative Pressure Wound Therapy Canister kit

800ml

67 New

14530102

Negative Pressure Wound Therapy foam

dressing kit large 25cmX15cmX3cm

68

New

14530103

Negative Pressure Wound Therapy foam

dressing kit - medium 20cmX12.5cmX3cm

69

New

14530104

Negative Pressure Wound Therapy gauze

dressing kit - medium 20cmX12.5cmX3cm