Hospital Formulary List - Deputy Prime Minister · 20% Nutrition and Blood B05AA01 Hospital Doctors...

131
Directorate for Pharmaceutical Affairs Ministry for Health Hospital Formulary List January 2020

Transcript of Hospital Formulary List - Deputy Prime Minister · 20% Nutrition and Blood B05AA01 Hospital Doctors...

Page 1: Hospital Formulary List - Deputy Prime Minister · 20% Nutrition and Blood B05AA01 Hospital Doctors Hospital Use ALBUMIN HUMAN SOLUTION FOR INFUSION 4% or 5% Nutrition and Blood B05AA01

Directorate for

Pharmaceutical

AffairsMinistry for Health

Hospital Formulary List

January 2020

Page 2: Hospital Formulary List - Deputy Prime Minister · 20% Nutrition and Blood B05AA01 Hospital Doctors Hospital Use ALBUMIN HUMAN SOLUTION FOR INFUSION 4% or 5% Nutrition and Blood B05AA01

v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

ABACAVIR + LAMIVUDINE TABLETS 600mg + 300mg Infections J05AR02 Consultant Infectious

Diseases Physicians,

Consultants Hospital

Infection Control

To be

dispensed from

Hospitals only

MP 292

ABIRATERONE TABLETS 500mg Malignant Disease

and

Immunosuppression

L02BX03 Consultant Oncologists MP 8

ACETAZOLAMIDE POWDER FOR

SOLUTION FOR

INJECTION

500mg Eye S01EC01 Hospital Doctors Hospital Use

ACETAZOLAMIDE TABLETS 250mg Eye, Central

Nervous System

S01EC01 Consultants

ACETYLCHOLINE POWDER FOR

SOLUTION FOR

INJECTION

1% Eye S01EB09 Hospital Doctors Hospital Use

ACETYLCYSTEINE (stand-

by)

EYE DROPS 5% Eye S01XA08 Consultant

Ophthalmologists (on

payment)

ACETYLCYSTEINE (stand-

by)

INJECTION 200mg/mL IN

10mL

Antidotes V03AB23 Hospital Doctors Hospital Use

ACICLOVIR (ACYCLOVIR ) CAPSULES/

TABLETS

200mg Infections J05AB01 Consultants, GU Clinic

Consultants

MP 2

ACICLOVIR (ACYCLOVIR ) CAPSULES/

TABLETS

800mg Infections J05AB01 Consultants MP 2

ACICLOVIR (ACYCLOVIR ) CREAM 5% Skin D06BB03 Consultant Dermatologists

ACICLOVIR (ACYCLOVIR ) EYE OINTMENT 3% Eye S01AD03 Consultant

Ophthalmologists

ACICLOVIR (ACYCLOVIR ) ORAL SUSPENSION 200mg/5mL Infections J05AB01 Consultants MP 3

Page 2 of 131

Page 3: Hospital Formulary List - Deputy Prime Minister · 20% Nutrition and Blood B05AA01 Hospital Doctors Hospital Use ALBUMIN HUMAN SOLUTION FOR INFUSION 4% or 5% Nutrition and Blood B05AA01

v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

ACICLOVIR (ACYCLOVIR ) SOLUTION FOR

INJECTION/

POWDER FOR

SOLUTION FOR

INJECTION

250mg Infections J05AB01 Consultants Hospital Use As per

antimicrobial

guidelines

ACITRETIN CAPSULES/

TABLETS

10mg Skin D05BB02 Consultant Dermatologists

ACITRETIN CAPSULES/

TABLETS

25mg Skin D05BB02 Consultant Dermatologists

ACTINOMYCIN D (stand-

by) (DACTINOMYCIN )

SOLUTION FOR

INJECTION/

POWDER FOR

SOLUTION FOR

INJECTION

500mcg Malignant Disease

and

Immunosuppression

L01DA01 Hospital Doctors Hospital Use

ADENOSINE SOLUTION FOR

INJECTION

6mg (3mg/mL) Cardiovascular

System

C01EB10 Hospital Doctors Hospital Use

ADENOSINE INJECTION 3mg/mL IN

10mL

Cardiovascular

System

C01EB10 Hospital Doctors as per

specified department

Department of

Medical

Imaging,

Department of

Cardiology

ADRENALINE INJECTION 1:1,000 IN 1mL Cardiovascular

System

C01CA24 Hospital Doctors Hospital Use

ADRENALINE INJECTION 1:10,000 IN

10mL

Cardiovascular

System

C01CA24 Hospital Doctors as per

specified department

Intensive Care

Unit, Coronary

Care Unit

ADRENALINE PRE-FILLED

SYRINGES

1:10,000 IN

10mL

Cardiovascular

System

C01CA24 Hospital Doctors Hospital Use

AJMALINE INJECTION 50mg/10mL Cardiovascular

System

C01BA05 Consultant Cardiologists MP 12

ALBENDAZOLE CHEWABLE

TABLETS/ TABLETS

400mg Infections P02CA03 Consultants

Page 3 of 131

Page 4: Hospital Formulary List - Deputy Prime Minister · 20% Nutrition and Blood B05AA01 Hospital Doctors Hospital Use ALBUMIN HUMAN SOLUTION FOR INFUSION 4% or 5% Nutrition and Blood B05AA01

v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

ALBUMIN HUMAN SOLUTION FOR

INFUSION

20% Nutrition and Blood B05AA01 Hospital Doctors Hospital Use

ALBUMIN HUMAN SOLUTION FOR

INFUSION

4% or 5% Nutrition and Blood B05AA01 Hospital Doctors Hospital Use

ALCOHOL DEHYDRATED

BP (stand-by)

INJECTION Antidotes V03AB16 Hospital Doctors Hospital Use

ALFACALCIDOL (1-α

HYDROXYVITAMIN D 3 )

CAPSULES 0.25mcg Endocrine System,

Nutrition and Blood

A11CC03 Consultants

ALFACALCIDOL (1-α

HYDROXYVITAMIN D 3 )

CAPSULES 1mcg Endocrine System,

Nutrition and Blood

A11CC03 Consultants

ALFACALCIDOL (1-α

HYDROXYVITAMIN D 3 )

ORAL DROPS 2mcg/mL Endocrine System,

Nutrition and Blood

A11CC03 Consultants MP 5

ALFENTANIL INJECTION 500mcg/mL IN

10mL

Central Nervous

System

N01AH02 Hospital Doctors Hospital Use

ALFENTANIL INJECTION 500mcg/mL IN

2mL

Central Nervous

System

N01AH02 Hospital Doctors Hospital Use

ALGINATE COMPOUND

(CURRENTLY

GAVISCON®)

ORAL POWDER IN

UNIT DOSE

SACHETS

INFANT Gastro-intestinal

System

A02AX Hospital Doctors as per

specified department

NPICU

ALLOPURINOL TABLETS 100mg Musculoskeletal and

Joint Diseases

M04AA01 Medical Practitioners

ALLOPURINOL TABLETS 300mg Musculoskeletal and

Joint Diseases

M04AA01 Medical Practitioners

ALTEPLASE INJECTION 50mg

(29 million units)

Cardiovascular

System

B01AD02 Hospital Doctors as per

specified department

Hospital Use

AMANTADINE CAPSULES/

TABLETS

100mg Infections N04BB01 Consultants

AMIKACIN INJECTION 500mg IN 2mL Infections J01GB06 Consultants Hospital Use MP 6

AMILORIDE +

HYDROCHLOROTHIAZIDE

TABLETS 5mg + 50mg Cardiovascular

System

C03EA01 Medical Practitioners

Page 4 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

AMINO ACID WITH

ELECTROLYTES

INJECTION PROVIDING 18g

NITROGEN/L

Nutrition and Blood B05BA31 Hospital Doctors Hospital Use

AMINO ACID WITHOUT

ELECTROLYTES

INJECTION PROVIDING 18g

NITROGEN/L

Nutrition and Blood B05BA01 Hospital Doctors Hospital Use

AMINO ACID WITHOUT

ELECTROLYTES

INJECTION PROVIDING 13-

16g

NITROGEN/L

Nutrition and Blood B05BA01 Hospital Doctors Hospital Use

AMINOPHYLLINE INJECTION 250mg IN 10mL Respiratory System R03DA05 Hospital Doctors Hospital Use

AMIODARONE

HYDROCHLORIDE

INJECTION 50mg/mL IN

3mL

Cardiovascular

System

C01BD01 Hospital Doctors Hospital Use

AMIODARONE

HYDROCHLORIDE

TABLETS 200mg Cardiovascular

System

C01BD01 Consultants

AMITRIPTYLINE TABLETS 10mg Central Nervous

System

N06AA09 Medical Practitioners

AMITRIPTYLINE TABLETS 25mg Central Nervous

System

N06AA09 Medical Practitioners

AMLODIPINE CAPSULES/

TABLETS

10mg Cardiovascular

System

C08CA01 Consultants

AMLODIPINE CAPSULES/

TABLETS

5mg Cardiovascular

System

C08CA01 Consultants

AMOXICILLIN CAPSULES/

TABLETS

250mg Infections J01CA04 Medical Practitioners, GU

Clinic Consultants

AMOXICILLIN ORAL SUSPENSION 125mg/5mL Infections J01CA04 Medical Practitioners

AMOXICILLIN POWDER FOR

SOLUTION FOR

INJECTION

250mg Infections J01CA04 Medical Practitioners

AMOXICILLIN POWDER FOR

SOLUTION FOR

INJECTION

500mg Infections J01CA04 Medical Practitioners

Page 5 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

AMOXICILLIN SACHETS 3g Infections J01CA04 Hospital Doctors Dental

Department

AMOXICILLIN +

CLAVULANIC ACID

CAPSULES/

TABLETS

250mg + 125mg Infections J01CR02 Medical Practitioners

AMOXICILLIN +

CLAVULANIC ACID

ORAL SUSPENSION 156mg/5mL Infections J01CR02 Medical Practitioners

AMOXICILLIN +

CLAVULANIC ACID

POWDER FOR

SOLUTION FOR

INJECTION

1g + 200mg Infections J01CR02 Hospital Doctors Hospital Use

AMOXICILLIN +

CLAVULANIC ACID

POWDER FOR

SOLUTION FOR

INJECTION

500mg + 100mg Infections J01CR02 Hospital Doctors Hospital Use

AMPHOTERICIN LIPOSOMAL

INFUSION

50mg Infections J02AA01 Consultant Infectious

Diseases Physicians,

Consultant Infectious

Diseases Paediatricians,

Consultant

Haematologists,

Consultant Oncologists,

Mater Dei Hospital

Antibiotic Team

Consultants

Hospital Use MP 119

AMPHOTERICIN POWDER FOR

SOLUTION FOR

INJECTION

50mg Infections J02AA01 Hospital Doctors Hospital Use

AMSACRINE INFUSION IN 75mg VIAL Malignant Disease

and

Immunosuppression

L01XX01 Consultant Oncologist,

Consultant

Haematologists,

Consultant Paediatricians

Hospital Use MP 7

ANASTROZOLE CAPSULES/

TABLETS

1mg Malignant Disease

and

Immunosuppression

L02BG03 Consultant Oncologists

Page 6 of 131

Page 7: Hospital Formulary List - Deputy Prime Minister · 20% Nutrition and Blood B05AA01 Hospital Doctors Hospital Use ALBUMIN HUMAN SOLUTION FOR INFUSION 4% or 5% Nutrition and Blood B05AA01

v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

ANGIOTENSIN-II

RECEPTOR

ANTAGONISTS

(CURRENTLY

VALSARTAN)

SCORED TABLETS 80mg Cardiovascular

System

C09CA03 Consultant Physicians,

Consultant Cardiologists,

Consultant Cardiac

Surgeons

MP 9

ANGIOTENSIN-II

RECEPTOR

ANTAGONISTS

(CURRENTLY

VALSARTAN)

CAPSULES/

TABLETS

160mg Cardiovascular

System

C09CA03 Consultant Physicians,

Consultant Cardiologists,

Consultant Cardiac

Surgeons

MP 9

ANTACID CHEWABLE

TABLETS

Gastro-intestinal

System

A02AX Medical Practitioners

ANTI-D [Rho]

IMMUNOGLOBULIN

(HUMAN )

SOLUTION FOR

INJECTION/

POWDER FOR

SOLUTION FOR

INJECTION

250mcg (1,250

IU) to

300mcg(1,500

IU)

Immunological

Products and

Vaccines

J06BB01 Hospital Doctors Hospital Use

ANTI-HAEMOPHILIAC

FACTOR IX

INFUSION 500IU Cardiovascular

System

B02BD04 Consultant

Haematologists,

Consultant Paediatricians,

Consultant Infectious

Diseases Physicians

To be

dispensed from

Hospitals only

ANTI-HAEMOPHILIAC

FACTOR VIII (stand-by)

INFUSION 500IU Cardiovascular

System

B02BD02 Consultant

Haematologists,

Consultant Paediatricians

Consultant Infectious

Diseases

To be

dispensed from

Hospitals only

Page 7 of 131

Page 8: Hospital Formulary List - Deputy Prime Minister · 20% Nutrition and Blood B05AA01 Hospital Doctors Hospital Use ALBUMIN HUMAN SOLUTION FOR INFUSION 4% or 5% Nutrition and Blood B05AA01

v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

ANTI-HAEMOPHILIAC

FACTOR VIII (stand-by)

INFUSION 1,000IU Cardiovascular

System

B02BD02 Consultant

Haematologists,

Consultant Paediatricians,

Consultant Infectious

Diseases Physicians

To be

dispensed from

Hospitals only

ANTI-HAEMOPHILIAC

FACTOR VIII INHIBITOR

BYPASSING

ACTIVITY/FRACTION

(stand-by)

INFUSION 500U or 1,000U Cardiovascular

System

B02BD03 Consultant

Haematologists,

Consultant Paediatricians,

Consultant Infectious

Diseases Physicians

To be

dispensed from

Hospitals only

ANTI-HAEMOPHILIAC

FACTOR VIII

INTERMEDIATE (+ VON

WILLEBRAND FACTOR)

INFUSION 500IU Cardiovascular

System

B02BD06 Consultant

Haematologists,

Consultant Paediatricians,

Consultant Infectious

Diseases Physicians

To be

dispensed from

Hospitals only

ANTI-HUMAN

THYMOCYTE

IMMUNOGLOBULIN

(RABBIT) (stand-by)

POWDER FOR

SOLUTION FOR

INFUSION

25mg VIAL Immunological

Products and

Vaccines

L04AA04 Consultants Hospital Use

ANTI-RABIES

IMMUNOGLOBULIN

(HUMAN) (stand-by)

SOLUTION FOR

INJECTION/

POWDER FOR

SOLUTION FOR

INJECTION IM

300IU or 500IU

VIAL

Immunological

Products and

Vaccines

J06BB05 Hospital Doctors Hospital Use

APREPITANT CAPSULES 125mg Central Nervous

System

A04AD12 Consultant

Heamatologists,

Consultant Oncologists,

Consultant Paediatric

Oncologists, Consultant

Palliative Care

MP 269

Page 8 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

APREPITANT CAPSULES 80mg Central Nervous

System

A04AD12 Consultant

Heamatologists,

Consultant Oncologists,

Consultant Paediatric

Oncologists, Consultant

Palliative Care

MP 269

APROTININ INJECTION 10,000 KIU/mL Cardiovascular

System

B02AB01 Consultant Cardiac

Surgeons

Hospital Use

AQUEOUS CREAM CREAM Skin D02AX Medical Practitioners

ARGATROBAN CONCENTRATE

FOR SOLUTION FOR

INFUSION

100mg/mL Nutrition and Blood B01AE03 Consultant Surgeons in

consultation with

Consultant Haematologist,

Consultant Cardiologists in

consultation with

Consultant Haematologist,

Consultant Haematologists

Hospital Use MP 299

ARTESUNATE POWDER AND

SOLVENT FOR

INJECTION

60mg Infections P01BE03 Consultant Infectious

Diseases Physicians,

Infectious Diseases

Specialists

Hospital Use MP 1

ARTIFICIAL SALIVA ORAL SPRAY Ear, Nose and

Oropharynx

A01AD11 ENT Consultants,

Consultant

Heamatologists,

Consultant Oncologists,

Consultant Palliative Care

ASCORBIC ACID TABLETS 100-250mg Nutrition and Blood A11GA01 Medical Practitioners

ASPARAGINASE

(COLASPASE)

INJECTION 10,000IU Malignant Disease

and

Immunosuppression

L01XX02 Consultants Hospital Use

Page 9 of 131

Page 10: Hospital Formulary List - Deputy Prime Minister · 20% Nutrition and Blood B05AA01 Hospital Doctors Hospital Use ALBUMIN HUMAN SOLUTION FOR INFUSION 4% or 5% Nutrition and Blood B05AA01

v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

ASPIRIN DISPERSIBLE

TABLETS

300mg Musculoskeletal and

Joint Diseases

N02BA01 Medical Practitioners

ASPIRIN CAPSULES/

TABLETS

300mg Musculoskeletal and

Joint Diseases

N02BA01 Medical Practitioners

ASPIRIN TABLETS 75-100mg Cardiovascular

System

B01AC06 Medical Practitioners

ATENOLOL INJECTION 500mcg/mL IN

10mL

Cardiovascular

System

C07AB03 Hospital Doctors Hospital Use

ATENOLOL TABLETS 100mg Cardiovascular

System

C07AB03 Medical Practitioners

ATENOLOL TABLETS 25mg

(TABLETS) or

50mg (SCORED

TABLETS)

Cardiovascular

System

C07AB03 Medical Practitioners

ATOMOXETINE CAPSULES 18mg Central Nervous

System

N06BA09 Consultant Paediatricians

(Community Paediatrics),

Consultant Paediatricians

(Paediatric Neurology and

Neurodisability),

Consultant Psychiatrists

MP 4

ATOMOXETINE CAPSULES 25mg Central Nervous

System

N06BA09 Consultant Paediatricians

(Community Paediatrics),

Consultant Paediatricians

(Paediatric Neurology and

Neurodisability),

Consultant Psychiatrists

MP 4

ATOMOXETINE CAPSULES 40mg Central Nervous

System

N06BA09 Consultant Paediatricians

(Community Paediatrics),

Consultant Paediatricians

(Paediatric Neurology and

Neurodisability),

Consultant Psychiatrists

MP 4

ATORVASTATIN CAPSULES/

TABLETS

10mg Cardiovascular

System

C10AA05 Consultants

Page 10 of 131

Page 11: Hospital Formulary List - Deputy Prime Minister · 20% Nutrition and Blood B05AA01 Hospital Doctors Hospital Use ALBUMIN HUMAN SOLUTION FOR INFUSION 4% or 5% Nutrition and Blood B05AA01

v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

ATORVASTATIN CAPSULES/

TABLETS

20mg Cardiovascular

System

C10AA05 Consultants

ATORVASTATIN CAPSULES/

TABLETS

40mg Cardiovascular

System

C10AA05 Consultants

ATOSIBAN (stand-by) CONCENTRATE

FOR INFUSION

7.5mg/mL Obstetrics and

Gynaecology,

Urinary Tract

Disorders

G02CX01 Hospital Doctors as per

specified department

Gynaecology

Department

ATOSIBAN (stand-by) SOLUTION FOR

INJECTION

7.5mg/mL Obstetrics and

Gynaecology,

Urinary Tract

Disorders

G02CX01 Hospital Doctors as per

specified department

Gynaecology

Department

ATRACURIUM BESYLATE INJECTION 10mg/mL IN

2.5mL

Anaesthesia M03AC04 Hospital Doctors Hospital Use

ATROPINE SULPHATE EYE DROPS 1% Eye S01FA01 Consultants

ATROPINE SULPHATE PRE-FILLED

SYRINGES

100mcg/mL in

5mL

Cardiovascular

System

A03BA01 Hospital Doctors Hospital Use

ATROPINE SULPHATE TABLETS 500mcg or

600mcg

Cardiovascular

System

A03BA01 Consultant Neurologists,

Consultant Geriatricians,

Consultant Paediatricians

MP 13

ATROPINE SULPHATE SINGLE USE EYE

DROPS

1% IN 0.5mL Eye S01FA01 Hospital Doctors Ophthalmic

Department

ATROPINE SULPHATE

(stand-by)

INJECTION 600mcg/mL Antidotes,

Cardiovascular

System

A03BA01 Hospital Doctors Hospital Use

ATROPINE SULPHATE +

PRALIDOXIME CHLORIDE

KIT - INJECTIONS 2mg + 600mg Antidotes V03AB04 Hospital Doctors Accident and

Emergency

Department,

Intensive Care

Unit

AZACITIDINE POWDER FOR

SUSPENSION FOR

INJECTION

100mg Malignant Disease

and

Immunosuppression

L01BC07 Consultant Haematologists Hospital Use MP 301

Page 11 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

AZATHIOPRINE CAPSULES/

TABLETS

50mg Malignant Disease

and

Immunosuppression

L04AX01 Hospital Doctors

AZITHROMYCIN CAPSULES/

TABLETS

250mg Infections J01FA10 Consultant Paediatricians,

Consultant Infectious

Diseases, GU Clinic

Consultant, Consultant

Respiratory Physicians,

Mater Dei Hospital

Antibiotic Team

Consultants

MP 11

AZITHROMYCIN CAPSULES/

TABLETS

500mg Infections J01FA10 Consultant Paediatricians,

Consultant Infectious

Diseases, GU Clinic

Consultant, Consultant

Respiratory Physicians,

Mater Dei Hospital

Antibiotic Team

Consultants

MP 11

AZITHROMYCIN ORAL SUSPENSION 200mg/5mL Infections J01FA10 Consultant Paediatricians,

Consultant Infectious

Diseases, GU Clinic

Consultant, Consultant

Respiratory Physicians,

Mater Dei Hospital

Antibiotic Team

Consultants

MP 11

AZTREONAM POWDER FOR

SOLUTION FOR

INJECTION

1g Infections J01DF01 Consultants Hospital Use MP 10

Page 12 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

AZTREONAM POWDER FOR

SOLUTION FOR

INJECTION

2g Infections J01DF01 Consultants Hospital Use MP 10

BACLOFEN INTRATHECAL

INJECTION

2,000mcg/mL Musculoskeletal and

Joint Diseases

M03BX01 Consultant Anaesthetists

(Pain Clinic), Pain Clinic

Specialists

Hospital Use MP 16

BACLOFEN INTRATHECAL

INJECTION

3,000mcg/mL Musculoskeletal and

Joint Diseases

M03BX01 Consultant Anaesthetists

(Pain Clinic), Pain Clinic

Specialists

Hospital Use MP 16

BACLOFEN INTRATHECAL

INJECTION

50mcg/mL Musculoskeletal and

Joint Diseases

M03BX01 Consultant Anaesthetists

(Pain Clinic), Pain Clinic

Specialists

Hospital Use MP 16

BACLOFEN ORAL SOLUTION 5mg/5mL Musculoskeletal and

Joint Diseases

M03BX01 Consultant Paediatricians,

Consultant Neurologists,

Consultant Palliative Care,

Consultant Oncologists,

MP 14

BACLOFEN TABLETS 10mg Musculoskeletal and

Joint Diseases

M03BX01 Consultants

BALANCED SALT

SOLUTION

STERILE SOLUTION Eye S01XA20 Hospital Doctors as per

specified department

Ophthalmic

Department,

Ophthalmic

Theatre

BALANCED SALT

SOLUTION PLUS

INTRA-OCULAR

IRRIGATION

SOLUTION

500mL Eye S01XA20 Hospital Doctors as per

specified department

Ophthalmic

Department,

Ophthalmic

Theatre

BASILIXIMAB (stand-by) INJECTION 20mg Malignant Disease

and

Immunosuppression

L04AC02 Hospital Doctors as per

specified department

Renal Unit

BCG (BACILLUS

CALMETTE-GUÉRIN)

INTRAVESICAL

INJECTION

81mg Malignant Disease

and

Immunosuppression

L03AX03 Consultant Urologists Hospital Use MP 15

Page 13 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

BCG (BACILLUS

CALMETTE-GUÉRIN)

VACCINE Immunological

Products and

Vaccines

J07AN01 Hospital Doctors as per

specified department

Floriana

Immunisation

Services

BECLOMETASONE

DIPROPIONATE

INHALER 250mcg/DOSE Respiratory System R03BA01 Consultants

BECLOMETASONE

DIPROPIONATE

INHALER 50mcg/DOSE Respiratory System R03BA01 Medical Practitioners

BECLOMETASONE

DIPROPIONATE

NASAL SPRAY 50mcg/DOSE Respiratory System R01AD01 Consultants

BENDROFLUMETHIAZIDE

(BENDROFLUAZIDE)

CAPSULES/

TABLETS

2.5mg Cardiovascular

System

C03AA01 Medical Practitioners

BENDROFLUMETHIAZIDE

(BENDROFLUAZIDE)

TABLETS 5mg Cardiovascular

System

C03AA01 Medical Practitioners

BENZATHINE

BENZYLPENICILLIN

INJECTION 1.2 MU Infections J01CE08 Hospital Doctors, GU Clinic

Consultants

Hospital Use

BENZYLPENICILLIN INJECTION 600mg Infections J01CE01 Medical Practitioners

BERACTANT

(NATURAL SURFACTANT)

SUSPENSION FOR

INTRATRACHEAL

ADMINISTRATION

Respiratory System R07AA Consultant Paediatricians Hospital Use Officially

Deleted.

Available until

stocks last.

BETA-BLOCKER

PRESERVATIVE FREE

(TIMOLOL, BETAXOLOL

OR LEVOBUNOLOL)

EYE DROPS Eye S01ED Consultant

Ophthalmologists

MP 127

BETAMETHASONE

DIPROPIONATE

CREAM 0.05% Skin D07AC01 Consultant Dermatologists

BETAMETHASONE +

SALICYLIC ACID

OINTMENT 0.05% + 3% Skin D07XC01 Consultant Dermatologists

BETAMETHASONE

VALERATE

CREAM 0.10% Skin D07AC01 Medical Practitioners

BETAMETHASONE

VALERATE

OINTMENT 0.1% Skin D07AC01 Medical Practitioners

Page 14 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

BETAMETHASONE

VALERATE

SCALP

APPLICATION

0.10% Skin D07AC01 Hospital Doctors

BETAMETHASONE

VALERATE

OINTMENT 0.025% Skin D07AC01 Consultant Dermatologists

BETAXOLOL

HYDROCHLORIDE

EYE DROPS 0.25%

(SUSPENSION)

or 0.5%

(SOLUTION)

Eye S01ED02 Consultant

Ophthalmologists

BEVACIZUMAB VIALS 100mg/4mL Eye, Malignant

Disease and

Immunosuppression

S01LA Consultant Oncologists,

Consultant

Ophthalmologists

Hospital Use MP 225

BEXAROTENE CAPSULES 75mg Malignant Disease

and

Immunosuppression

L01XX25 Consultant

Haematologists,

Consultant Oncologists

To be

dispensed from

Hospitals only

MP 18

BEZAFIBRATE MODIFIED RELEASE

TABLETS

400mg Cardiovascular

System

C10AB02 Medical Practitioners

BICALUTAMIDE CAPSULES/

TABLETS

50mg Malignant Disease

and

Immunosuppression

L02BB03 Consultant Urologists,

Consultant Oncologists

MP 19

BISACODYL SUPPOSITORIES 10mg Gastro-intestinal

System

A06AB02 Medical Practitioners

BISACODYL TABLETS 5mg Gastro-intestinal

System

A06AB02 Medical Practitioners

BISMUTH SUBNITRATE +

IODOFORM PASTE

IMPREGNATED

GAUZE

Ear, Nose and

Oropharynx

D09AA Hospital Doctors as per

specified department

Dental

Department,

ENT

Department

Page 15 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

BLEOMYCIN SULFATE INJECTION 15,000 IU Malignant Disease

and

Immunosuppression

L01DC01 Consultant

Haematologists,

Consultant Oncologists,

Consultant Paediatric

Hospital Use/

Day Clinic

BORTEZOMIB POWDER FOR

SOLUTION FOR

INJECTION

1mg Malignant Disease

and

Immunosuppression

L01XX32 Consultant

Haematologists,

Consultant Oncologists

Hospital Use/

Day Clinic

MP 261

BOTULINUM TOXIN TYPE

A

POWDER FOR

SOLUTION FOR

INJECTION

Central Nervous

System, Eye

M03AX01 Consultant Neurologists,

Consultant

Ophthalmologists,

Consultant Urologist,

Consultant Paediatrician

Hospital Use MP 21

BOTULISM ANTITOXIN

TYPE A, B AND E

IMMUNOGLOBULIN

(stand-by)

SOLUTION FOR

INFUSION

Antidotes,

Immunological

Products and

Vaccines

J06AA04 Hospital Doctors Hospital Use

BOWEL CLEANSING

PREPARATION (ADULT)

ORAL POWDER FOR

RECONSTITUTION

Gastro-intestinal

System

A06A Hospital Doctors Hospital Use/To

be dispensed

from Hospitals

or Primary

Health Care

Department for

screening only

BOWEL CLEANSING

PREPARATION

(PAEDIATRIC)

ORAL POWDER FOR

RECONSTITUTION

Gastro-intestinal

System

A06A Hospital Doctors as per

specified department

Endoscopy

Department,

Paediatric

Department/To

be dispensed

from Hospitals

only

BRIMONIDINE TARTRATE EYE DROPS 0.2% Eye S01EA05 Consultant

Ophthalmologists

Page 16 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

BRINZOLAMIDE EYE DROPS 10mg/mL Eye S01EC04 Consultant

Ophthalmologists

BROMAZEPAM TABLETS 1.5mg Central Nervous

System

N05BA08 Medical Practitioners

BROMAZEPAM TABLETS 3mg Central Nervous

System

N05BA08 Medical Practitioners

BROMAZEPAM TABLETS 6mg Central Nervous

System

N05BA08 Medical Practitioners

BROMHEXINE ORAL LIQUID 4mg/5mL Respiratory System R05CB02 Medical Practitioners

BROMOCRIPTINE

MESYLATE

TABLETS 2.5mg Endocrine System G02CB01/

N04BC01

Consultants

BUDESONIDE AEROSOL INHALER 200mcg/DOSE Respiratory System R03BA02 Consultants MP 26

BUDESONIDE CONTROLLED

RELEASE

CAPSULES

3mg Gastro-intestinal

System

A07EA06 Consultant

Gastroenterologists,

Consultant Paediatricians,

Consultant Surgeons

MP 23

BUDESONIDE DRY POWDER

METERED DOSE

INHALER

100mcg/DOSE Respiratory System R03BA02 Consultants Respiratory

Physicians, Consultant

Paediatricians, Specialist

Respiratory Medicine

Consultants

MP 27

BUDESONIDE NEBULISER

SOLUTION

250mcg/mL Respiratory System R03BA02 Consultants Respiratory

Physicians, Consultant

Paediatricians, Consultant

Oncologists, Specialist

Respiratory Medicine

Consultants

MP 28

Page 17 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

BUDESONIDE NEBULISER

SOLUTION

500mcg/mL Respiratory System R03BA02 Consultants Respiratory

Physicians, Consultant

Paediatricians, Consultant

Oncologists, Specialist

Respiratory Medicine

Consultants

MP 28

BUDESONIDE RETENTION ENEMA 2mg/100mL Gastro-intestinal

System

A07EA Consultant

Gastroenterologists,

Consultant Paediatricians,

Consultant Surgeons

MP 24

BUMETANIDE INJECTION 0.5mg/mL IN

4mL

Cardiovascular

System

C03CA02 Hospital Doctors Hospital Use

BUMETANIDE TABLETS 1mg Cardiovascular

System

C03CA02 Medical Practitioners

BUMETANIDE TABLETS 5mg Cardiovascular

System

C03CA02 Medical Practitioners

BUPIVACAINE INJECTION 0.25% Anaesthesia N01BB01 Hospital Doctors Hospital Use

BUPIVACAINE INJECTION 0.50% Anaesthesia N01BB01 Hospital Doctors Hospital Use

BUPIVACAINE +

ADRENALINE

INJECTION 5mg/mL +

1:200,000 IN

10mL

Anaesthesia N01BB51 Hospital Doctors Hospital Use

BUPIVACAINE +

ADRENALINE

INJECTION 2.5mg/mL +

1:200,000 IN

10mL

Anaesthesia N01BB51 Hospital Doctors Hospital Use

BUPIVACAINE +

GLUCOSE

INJECTION 5mg/mL +

80mg/mL IN

4mL

Anaesthesia N01BB51 Hospital Doctors Hospital Use

BUSPIRONE

HYDROCHLORIDE

TABLETS 10mg Central Nervous

System

N05BE01 Consultants

BUSULFAN CAPSULES/

TABLETS

2mg Malignant Disease

and

Immunosuppression

L01AB01 Consultant Oncologist,

Consultant

Haematologists,

Consultant Paediatricians

Page 18 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

C1-ESTERASE INHIBITOR POWDER AND

SOLVENT FOR

SOLUTION FOR

INJECTION/

INFUSION

500IU/10mL Respiratory System B06AC01 Consultant Surgeons,

Consultant Physicians

Hospital Use

CABERGOLINE TABLETS 0.5mg Endocrine System G02CB03 Consultant Physicians MP 29

CAFFEINE CITRATE POWDER/ORAL

LIQUID

Central Nervous

System

N06BC01 Consultant Paediatricians NPICU MP 248

CALAMINE LOTION LOTION Skin D04AX Medical Practitioners

CALCIPOTRIOL OINTMENT 50mcg/g Skin D05AX02 Consultant Dermatologists

CALCIPOTRIOL +

BETAMETHASONE

OINTMENT or

CUTANEOUS FOAM

50mcg/g +

500mcg/g

Skin D05AX52 Consultant Dermatologists

CALCITONIN (SALMON

SYNTHETIC )

INJECTION 100IU/mL in 1mL Endocrine System H05BA01 Consultants

CALCIUM EFFERVESCENT

TABLETS

400mg or 500mg Nutrition and Blood A12AA04 Consultant Paediatricians,

Consultant Physicians

MP 30

CALCIUM CARBONATE CHEWABLE

TABLETS/ TABLETS

1250mg

(equivalent to

500mg elemental

calcium)

Gastro-intestinal

System

A02AC01 Consultants

CALCIUM CHLORIDE PRE-FILLED

SYRINGES

10% w/v Nutrition and Blood A12AA07 Hospital Doctors Hospital Use

CALCIUM CHLORIDE

(stand-by)

INFUSION Antidotes, Nutrition

and Blood

A12AA07 Hospital Doctors Hospital Use

CALCIUM FOLINATE

(CALCIUM

LEUCOVORIN/FOLINIC

ACID )

SOLUTION FOR

INJECTION/

POWDER FOR

SOLUTION FOR

INJECTION

50mg/5mL Malignant Disease

and

Immunosuppression

V03AF03 Hospital Doctors Hospital Use

Page 19 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

CALCIUM FOLINATE

(CALCIUM

LEUCOVORIN/FOLINIC

ACID ) (stand-by)

CAPSULES/

TABLETS

15mg Malignant Disease

and

Immunosuppression

V03AF03 Hospital Doctors To be

dispensed from

Hospitals only in

Malignant

Diseases

CALCIUM GLUCONATE

(stand-by)

SOLUTION FOR

INJECTION

85mg/mL to

100mg/mL IN

10mL

Nutrition and Blood A12AA03 Hospital Doctors Hospital Use

CALCIUM LACTATE CAPSULES/

TABLETS

300mg

(equivalent to

39mg elemental

calcium)

Nutrition and Blood A12AA05 Medical Practitioners

CAPECITABINE TABLETS 150mg Malignant Disease

and

Immunosuppression

L01BC06 Consultant Oncologists To be

dispensed from

Hospitals only

MP 31

CAPECITABINE TABLETS 500mg Malignant Disease

and

Immunosuppression

L01BC06 Consultant Oncologists To be

dispensed from

Hospitals only

MP 31

CAPTOPRIL TABLETS 25mg Cardiovascular

System

C09AA01 Medical Practitioners

CARBAMAZEPINE CONTROLLED

RELEASE TABLETS

200mg Central Nervous

System

N03AF01 Consultant Paediatricians,

Consultant Neurologists,

Consultant Psychiatrists,

Consultant Geriatricians

CARBAMAZEPINE CONTROLLED

RELEASE TABLETS

400mg Central Nervous

System

N03AF01 Consultant Paediatricians,

Consultant Neurologists,

Consultant Psychiatrists,

Consultant Geriatricians

CARBAMAZEPINE ORAL SUSPENSION 100mg/5mL Central Nervous

System

N03AF01 Medical Practitioners

Page 20 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

CARBAMAZEPINE TABLETS 200mg Central Nervous

System

N03AF01 Medical Practitioners

CARBIDOPA +

LEVODOPA

TABLETS 10mg + 100mg Central Nervous

System

N04BA02 Medical Practitioners

CARBIDOPA +

LEVODOPA +

ENTACAPONE

TABLETS 25mg + 100mg +

200mg

Central Nervous

System

N04B Consultant Geriatricians,

Consultant Neurologists

MP 216

CARBIMAZOLE CAPSULES/

TABLETS

5mg Endocrine System H03BB01 Medical Practitioners

CARBOPLATIN INJECTION 150mg IN 15mL Malignant Disease

and

Immunosuppression

L01XA02 Consultant Oncologists,

Consultant

Haematologists,

Consultant Paediatricians

Hospital Use

CARBOPROST INJECTION 250mcg/mL Obstetrics and

Gynaecology,

Urinary Tract

Disorders

G02ADD4 Hospital Doctors Hospital Use

CARDIOPLEGIA

CONCENTRATE (Stand-

by)

CONCENTRATE

FOR PERFUSION

Cardiovascular

System

B05XA16 Consultant Cardiac

Surgeons

Cardiothoracic

Surgery

CARVEDILOL TABLETS 6.25mg Cardiovascular

System

C07AG02 Consultants

CARVEDILOL TABLETS 25mg Cardiovascular

System

C07AG02 Consultants

CASPOFUNGIN POWDER FOR

RECONSTITUTION

FOR INTRAVENOUS

INFUSION

50mg Infections J02AX04 Consultant Infectious

Diseases Physicians,

Consultant Infectious

Diseases Paediatricians,

Consultant

Haematologists,

Consultant Oncologists,

Mater Dei Hospital

Antibiotic Team

Consultants

Hospital Use MP 33

Page 21 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

CASPOFUNGIN POWDER FOR

RECONSTITUTION

FOR INTRAVENOUS

INFUSION

70mg Infections J02AX04 Consultant Infectious

Diseases Physicians,

Consultant Infectious

Diseases Paediatricians,

Consultant

Haematologists,

Consultant Oncologists,

Mater Dei Hospital

Antibiotic Team

Consultants

Hospital Use MP 33

CEFALEXIN CAPSULES/

TABLETS

250mg Infections J01DB01 Medical Practitioners

CEFALEXIN ORAL SUSPENSION 125mg/5mL Infections J01DB01 Medical Practitioners

CEFEPIME

HYDROCHLORIDE

(Stand-by)

INJECTION IV 1g or 2g Infections J01DE01 Consultant Infectious

Diseases Physicians

Hospital Use MP 36

CEFOTAXIME SODIUM POWDER FOR

SOLUTION FOR

INJECTION

IM & IV

1g Infections J01DD01 Consultants Hospital Use

CEFTAZIDIME

PENTAHYDRATE

POWDER FOR

SOLUTION FOR

INJECTION

IM & IV

1g Infections J01DD02 Consultants Hospital Use MP 35

CEFTRIAXONE SODIUM POWDER FOR

SOLUTION FOR

INJECTION

IM & IV

1g Infections J01DD04 Consultants Hospital Use MP 40

CEFTRIAXONE SODIUM POWDER FOR

SOLUTION FOR

INJECTION IV

2g Infections J01DD04 Consultants Hospital Use MP 40

Page 22 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

CEFTRIAXONE SODIUM POWDER FOR

SOLUTION FOR

INJECTION IV

500mg Infections J01DD04 Consultants Hospital Use MP 40

CEFUROXIME AXETIL ORAL SUSPENSION 125mg/5mL Infections J01DC02 Medical Practitioners

CEFUROXIME AXETIL TABLETS 250mg Infections J01DC02 Medical Practitioners

CEFUROXIME SODIUM POWDER FOR

SOLUTION FOR

INJECTION

IM & IV

250mg Infections J01DC02 Hospital Doctors Hospital Use

CEFUROXIME SODIUM POWDER FOR

SOLUTION FOR

INJECTION

IM & IV

750mg Infections J01DC02 Hospital Doctors Hospital Use

CETUXIMAB SOLUTION FOR

INFUSION

5mg/mL Malignant Disease

and

Immunosuppression

L01XC06 Consultant Oncologist Hospital Use MP 39

CHARCOAL ACTIVATED

(stand-by)

POWDER/ORAL

SUSPENSION

Antidotes A07BA01 Hospital Doctors Hospital Use

CHLORAL HYDRATE ORAL SOLUTION 500mg/5mL Central Nervous

System

N05CC01 Hospital Doctors Hospital Use

CHLORAMBUCIL TABLETS 2mg Malignant Disease

and

Immunosuppression

L01AA02 Consultants

CHLORAMPHENICOL CAPSULES/

TABLETS

250mg Infections J01BA01 Consultants

CHLORAMPHENICOL EYE DROPS 0.5% Eye S01AA01 Medical Practitioners

CHLORAMPHENICOL EYE OINTMENT 1% Eye S01AA01 Medical Practitioners

CHLORAMPHENICOL

SODIUM SUCCINATE

POWDER FOR

SOLUTION FOR

INJECTION IV

1g Infections J01BA01 Hospital Doctors Hospital Use

CHLORHEXIDINE AQUEOUS

SOLUTION

Infections D08AC02 Infection Control Policy Hospital Use

Page 23 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

CHLORHEXIDINE +

CETRIMIDE

SOLUTION IN

SACHETS

25mL Infections D08AC52 Infection Control Policy Hospital Use

CHLORHEXIDINE +

NEOMYCIN

NASAL CREAM 0.1% + 0.5% Ear, Nose and

Oropharynx

D08AC52 Infection Control Policy Hospital Use

CHLORHEXIDINE

ACETATE/ GLUCONATE

SOLUTION 0.05% Infections D08AC02 Infection Control Policy Hospital Use

CHLORHEXIDINE

GLUCONATE

SAPONACEOUS

SOLUTION

4% Infections D08AC02 Infection Control Policy Hospital Use

CHLORHEXIDINE

GLUCONATE

OBSTETRIC CREAM 1% Infections G01AX Infection Control Policy Hospital Use

CHLORHEXIDINE

GLUCONATE

OBSTETRIC

SOLUTION

5% Infections G01AX Infection Control Policy Hospital Use

CHLORHEXIDINE

GLUCONATE +

CETRIMIDE

POWDER 0.015% + 0.15% Skin D08AC52 Infection Control Policy Hospital Use

CHLORHEXIDINE

GLUCONATE IN

ISOPROPYL ALCOHOL

SOLUTION (HAND

CLEANSING)

Skin D08AC52 Infection Control Policy,

Consultants (for TPN only)

Hospital Use/To

be dispensed

from Hospitals

only (TPN

patients only)

MP 37

CHLORHEXIDINE

GLUCONATE/

DIGLUCONATE

MOUTHWASH 0.20% Ear, Nose and

Oropharynx

A01AB03 Dentists, Hospital Doctors

CHLOROFORM WATER SOLUTION Miscellaneous N01AB02 Hospital Doctors Hospital Use

CHLOROQUINE ORAL SYRUP 50mg/5mL Infections P01BA01 Medical Practitioners (as

per ‘Dispensing of Oral

Antimalarials to Out-

Patients’ [refer to page 10

on Out-Patients Formulary]

or against payment)

Page 24 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

CHLOROQUINE SYRUP 150mg

BASE/5mL

Infections P01BA01 Medical Practitioners (as

per ‘Dispensing of Oral

Antimalarials to Out-

Patients’ [refer to page 10

on Out-Patients Formulary]

or against payment)

CHLOROQUINE TABLETS 250mg Infections P01BA01 Medical Practitioners (as

per ‘Dispensing of Oral

Antimalarials to Out-

Patients’ [refer to page 10

on Out-Patients Formulary]

or against payment)

CHLORPHENAMINE

MALEATE

INJECTION 10mg/mL Respiratory System R06AB04 Hospital Doctors Hospital Use

CHLORPROMAZINE

HYDROCHLORIDE

INJECTION 50mg in 2 mL Central Nervous

System

N05AA01 Hospital Doctors Hospital Use

CHLORPROMAZINE

HYDROCHLORIDE

TABLETS 100mg Central Nervous

System

N05AA01 Medical Practitioners

CHLORPROMAZINE

HYDROCHLORIDE

TABLETS 25mg Central Nervous

System

N05AA01 Medical Practitioners

CHOLERA VACCINE ORAL SUSPENSION Immunological

Products and

Vaccines

J07AE Hospital Doctors as per

specified department

Floriana

Immunisation

Services

CHORIONIC

GONADOTROPHIN

HUMAN (HCG )

INJECTION 1,000 IU Endocrine System G03GA01 Consultants

CHORIONIC

GONADOTROPHIN

HUMAN (HCG )

INJECTION 5,000 IU Endocrine System G03GA01 Consultants

Page 25 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

CICLOSPORIN

(CYCLOSPORIN )

CAPSULES 25mg Malignant Disease

and

Immunosuppression

, Skin

L04AD01 Consultants MP 46

CICLOSPORIN

(CYCLOSPORIN )

CAPSULES 100mg Malignant Disease

and

Immunosuppression

, Skin

L04AD01 Consultants MP 46

CICLOSPORIN

(CYCLOSPORIN )

ORAL SOLUTION 100mg/mL Malignant Disease

and

Immunosuppression

L04AD01 Consultants MP 47

CICLOSPORIN

(CYCLOSPORIN ) (stand-

by)

CONCENTRATE

FOR SOLUTION FOR

INFUSION

50mg in 1 mL Malignant Disease

and

Immunosuppression

, Skin

L04AD01 Consultant Nephrologists Hospital Use -

Renal Unit

CIPROFLOXACIN ORAL SUSPENSION 250mg/5mL Infections J01MA02 Consultants MP 38

CIPROFLOXACIN SOLUTION FOR

INFUSION

100mg in 50mL Infections J01MA02 Consultants Hospital Use

CIPROFLOXACIN SOLUTION FOR

INFUSION

200mg in 100mL Infections J01MA02 Consultants Hospital Use

CIPROFLOXACIN TABLETS 250mg Infections J01MA02 Hospital Doctors

CISPLATIN SOLUTION FOR

INJECTION

50mg Malignant Disease

and

Immunosuppression

L01XA01 Hospital Doctors Hospital Use

CLADRIBINE INJECTION 10mg Malignant Disease

and

Immunosuppression

L01BB04 Consultant

Haematologists,

Consultant Oncologists

Hospital Use MP 236

CLARITHROMYCIN INJECTION IV 500mg Infections J01FA09 Consultant Physicians Hospital Use

CLARITHROMYCIN ORAL SUSPENSION 125mg/5mL Infections J01FA09 Consultant Paediatricians

Page 26 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

CLARITHROMYCIN TABLETS 250mg Infections J01FA09 Consultants

CLINDAMYCIN CAPSULES/

TABLETS

150mg Infections J01FF01 Consultants

CLINDAMYCIN

PHOSPHATE

INJECTION

IM & IV

150mg/mL IN

2mL

Infections J01FF01 Hospital Doctors Hospital Use

CLOBAZAM CAPSULES/

TABLETS

10mg Central Nervous

System

N05BA09 Consultant Neurologists,

Consultant Paediatricians

CLOBETASOL

PROPIONATE

CREAM 0.05% Skin D07AD01 Consultant Dermatologists

CLOBETASOL

PROPIONATE

OINTMENT 0.05% Skin D07AD01 Consultant Dermatologists

CLOBETASOL

PROPIONATE

SCALP

APPLICATION

0.05% Skin D07AD01 Consultant Dermatologists

CLOFAZIMINE CAPSULES/

TABLETS

50mg Infections J04BA01 Consultants

CLOMIPRAMINE

HYDROCHLORIDE

CAPSULES/

TABLETS

10mg Central Nervous

System

N06AA04 Medical Practitioners

CLOMIPRAMINE

HYDROCHLORIDE

CAPSULES/

TABLETS

25mg Central Nervous

System

N06AA04 Medical Practitioners

CLONAZEPAM TABLETS 0.5mg Central Nervous

System

N03AE01 Consultants

CLONAZEPAM TABLETS 2mg Central Nervous

System

N03AE01 Consultants

CLONIDINE

HYDROCHLORIDE

INJECTION 150mcg/mL IN

1mL

Cardiovascular

System

C02AC01 Hospital Doctors Hospital Use

CLONIDINE

HYDROCHLORIDE

TABLETS 100mcg Cardiovascular

System

C02AC01 Consultants

CLOPIDOGREL TABLETS 75mg Cardiovascular

System

B01AC04 Consultant Physicians MP 276

CLOTRIMAZOLE CREAM 1% Skin D01AC01 Medical Practitioners

CLOTRIMAZOLE PESSARIES 100mg Obstetrics and

Gynaecology,

Urinary Tract

Disorders

G01AF02 Medical Practitioners, GU

Clinic Consultants

Page 27 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

CLOZAPINE TABLETS 25mg Central Nervous

System

N05AH02 Consultant Psychiatrists To be

dispensed from

Hospitals only

MP 42

CLOZAPINE TABLETS 100mg Central Nervous

System

N05AH02 Consultant Psychiatrists To be

dispensed from

Hospitals only

MP 42

COAL TAR SHAMPOO Skin D05AA Medical Practitioners Availability

temporarily

suspended

due to

problematic

sourcing.

CO-DANTHRAMER ORAL SUSPENSION 75/1000 IN 5mL Gastro-intestinal

System

A06AB53 Consultant

Haematologists,

Consultant Oncologists,

Consultant Paediatricians,

Consultant Palliative Care

MP 43

CODEINE PHOSPHATE ORAL LIQUID 15mg/5mL Respiratory System R05DA04 Medical Practitioners

CODEINE PHOSPHATE TABLETS 30mg Central Nervous

System

R05DA04 Hospital Doctors

COLCHICINE TABLETS 500mcg Musculoskeletal and

Joint Diseases

M04AC01 Medical Practitioners

COLESTYRAMINE

(CHOLESTYRAMINE)

POWDER FOR ORAL

SUSPENSION

4g Gastro-intestinal

System,

Cardiovascular

System

C10AC01 Medical Practitioners

Page 28 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

COLISTIMETHATE

SODIUM (COLISTIN

SULPHOMETHATE

SODIUM)

POWDER FOR

SOLUTION FOR

INJECTION OR

INHALATION

1 Million Units Infections J01XB01 Mater Dei Hospital

Antibiotic Team

Consultants, Consultant

Paediatricians, Consultant

Infectious Diseases

Physicians, Consultant

Respiratory Physicians

MP 44

COMPOUND BENZOIN TINCTURE 30 - 50mL Respiratory System R01AX10 Medical Practitioners

COMPOUND EMOLLIENT

CREAM/OINTMENT

(CURRENTLY

LIPOBASE ®)

CREAM/ OINTMENT Skin D02AX Consultant Dermatologists

COMPOUND SODIUM

LACTATE

INFUSION 1,000mL Nutrition and Blood B05BB01 Hospital Doctors Hospital Use

COMPOUND SODIUM

LACTATE

INFUSION 500mL Nutrition and Blood B05BB01 Hospital Doctors Hospital Use

CONJUGATED

ESTROGENS (EQUINE)

CAPSULES/

TABLETS

0.625mg Endocrine System G03CA57 Consultants

CONJUGATED

ESTROGENS (EQUINE)

TABLETS 1.25mg Endocrine System G03CA57 Consultants

CONSUMABLES Consultants

CO-TRIMOXAZOLE INFUSION 480mg/5mL Infections J01EE01 Consultants Hospital Use

CO-TRIMOXAZOLE ORAL SUSPENSION ADULT

480mg/5mL

Infections J01EE01 Medical Practitioners

CO-TRIMOXAZOLE ORAL SUSPENSION PAEDIATRIC

240mg/5mL

Infections J01EE01 Medical Practitioners

CO-TRIMOXAZOLE TABLETS 400mg + 80mg Infections J01EE01 Medical Practitioners

CROTAMITON CREAM 10% Skin D04AX Medical Practitioners

Page 29 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

CYCLIZINE SOLUTION FOR

INJECTION

50mg/mL Central Nervous

System

R06AE03 Consultant Anaesthetists,

Consultants Emergency

Medicine, Consultant

Haematologists,

Consultants Obstetrics and

Gynaecology, Consultant

Oncologists, Consultant

Paediatric Oncologists,

Consultant Palliative Care

MP 267

CYCLIZINE TABLETS 50mg Central Nervous

System

R06AE03 Hospital Doctors

CYCLOPENTOLATE

HYDROCHLORIDE

SINGLE USE EYE

DROPS

1% Eye S01FA04 Hospital Doctors

(Ophthalmic Department),

Consultant

Ophthalmologists

CYCLOPHOSPHAMIDE SOLUTION FOR

INJECTION/

POWDER FOR

SOLUTION FOR

INJECTION

500mg VIAL Malignant Disease

and

Immunosuppression

L01AA01 Consultants Hospital Use/

Day Clinic

CYCLOPHOSPHAMIDE TABLETS 50mg Malignant Disease

and

Immunosuppression

L01AA01 Consultants

CYCLOSERINE (stand-by) TABLETS 250mg Infections J04AB01 Consultant Infectious

Diseases Physicians,

Paediatric Infectious

Diseases Clinic

Physicians, Consultant

Respiratory Physicians,

Chest Clinic Physicians

To be

dispensed from

Hospitals only

Page 30 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

CYPROTERONE

ACETATE

TABLETS 50mg Endocrine System,

Obstetrics,

Gynaecology and

Urinary Tract

Disorders

G03HA01 Consultants, Consultants

Endocrinology

(Transgender MDT)

CYTARABINE SOLUTION FOR

INJECTION/

POWDER FOR

SOLUTION FOR

INJECTION

100mg IN 5mL Malignant Disease

and

Immunosuppression

L01BC01 Consultant Oncologists,

Consultant

Haematologists,

Consultant Paediatricians

Hospital Use/

Day Clinic

CYTARABINE SOLUTION FOR

INJECTION/

POWDER FOR

SOLUTION FOR

INJECTION

500mg VIAL Malignant Disease

and

Immunosuppression

L01BC01 Consultant Oncologists,

Consultant

Haematologists,

Consultant Paediatricians

Hospital Use/

Day Clinic

DABRAFENIB CAPSULES 75mg Malignant Disease

and

Immunosuppression

L01XE23 Consultant Oncologists MP 303

DACARBAZINE INJECTION 200mg Malignant Disease

and

Immunosuppression

L01AX04 Consultant Oncologists,

Consultant

Haematologists,

Consultant Paediatricians

Hospital Use/

Day Clinic

DANAPAROID SODIUM SOLUTION FOR

INJECTION

750 units/0.6mL Nutrition and Blood B01AB09 Consultant Surgeons in

consultation with

Consultant Haematologist,

Consultant Cardiologists in

consultation with

Consultant Haematologist,

Consultant Haematologists

Hospital Use MP 298

Page 31 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

DANTROLENE SODIUM CAPSULES 25mg Musculoskeletal and

Joint Diseases

M03CA01 Consultants

DANTROLENE SODIUM

(stand-by)

POWDER FOR

SOLUTION FOR

INJECTION

20mg Antidotes,

Musculoskeletal and

Joint Diseases

M03CA Hospital Doctors as per

specified department

Operating

Theatre

DAPSONE TABLETS 100mg Infections J04BA02 Consultants

DAPSONE TABLETS 50mg Infections J04BA02 Consultants

DAPTOMYCIN POWDER FOR

SOLUTION FOR

INJECTION OR

INFUSION

500mg Infections J01XX09 Mater Dei Hospital

Antibiotic Team

Consultants

Hospital Use MP 59

DAUNORUBICIN (stand-

by)

LIPOSOMAL

INFUSION

50mg Malignant Disease

and

Immunosuppression

L01DB02 Consultant

Haematologists,

Consultant Oncologists,

Consultant Paediatricians

Hospital Use

DAUNORUBICIN

HYDROCHLORIDE

SOLUTION FOR

INJECTION/

POWDER FOR

SOLUTION FOR

INJECTION

20mg Malignant Disease

and

Immunosuppression

L01DB02 Consultant Oncologists,

Consultant

Haematologists,

Consultant Paediatricians

Hospital Use

DEFERASIROX TABLETS 180mg Nutrition and Blood V03AC03 Thalassaemia Clinic

Consultants, Consultant

Haematologists

MP 277

DEFERASIROX TABLETS 360mg Nutrition and Blood V03AC03 Thalassaemia Clinic

Consultants, Consultant

Haematologists

MP 277

DEMECLOCYCLINE

HYDROCHLORIDE

CAPSULES/

TABLETS

150mg Endocrine System J01AA01 Consultant Physicians MP 49

DESFERRIOXAMINE

MESILATE

(DEFEROXAMINE ) (stand-

by)

INJECTION 500mg Antidotes V03AC01 Consultants Hospital

Use/Hospital

dispensing only

DESFLURANE INHALATION

ANAESTHETIC

Anaesthesia N01AB07 Hospital Doctors as per

specified department

Hospital Use

Page 32 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

DESMOPRESSIN INJECTION 4mcg/mL Endocrine System H01BA02 Consultants Endocrinology

and Diabetes, Consultant

Paediatricians

Hospital Use

DESMOPRESSIN NASAL SPRAY 10mcg/DOSE Endocrine System H01BA02 Consultants Endocrinology

and Diabetes, Consultant

Nephrologists, Consultant

Paediatricians, Consultant

Oncologists

MP 50

DESMOPRESSIN TABLETS 0.1mg Endocrine System H01BA02 Consultants Endocrinology

and Diabetes, Consultant

Nephrologists, Consultant

Paediatricians, Consultant

Oncologists

MP 51

DEXAMETHASONE CAPSULES/

TABLETS

2mg Endocrine System H02AB02 Consultant

DEXAMETHASONE EYE DROPS 0.1% Eye S01BA01 Medical Practitioners

DEXAMETHASONE TABLETS 0.5mg Endocrine System H02AB02 Medical Practitioners

DEXAMETHASONE

PHOSPHATE

INJECTION 4mg/mL IN 2mL Endocrine System H02AB02 Hospital Doctors Hospital Use

DEXAMFETAMINE

SULPHATE

TABLETS 5mg Central Nervous

System

N06BA02 Consultants

DEXTRAN 40 IN

DEXTROSE

INFUSION IV 10% IN 5%

Dextrose

Nutrition and Blood B05AA05 Hospital Doctors Hospital Use

DEXTROSE INFUSION IV 20% IN 500mL Nutrition and Blood B05BA03 Hospital Doctors Hospital Use

DEXTROSE INFUSION IV 5% IN 1,000mL Nutrition and Blood B05BA03 Hospital Doctors Hospital Use

DEXTROSE INFUSION IV 5% IN 100mL Nutrition and Blood B05BA03 Hospital Doctors Hospital Use

DEXTROSE INFUSION IV 5% IN 500mL Nutrition and Blood B05BA03 Hospital Doctors Hospital Use

DEXTROSE INFUSION IV 50% IN 500mL Nutrition and Blood B05BA03 Hospital Doctors Hospital Use

DEXTROSE INFUSION IV 50% IN 50mL Nutrition and Blood B05BA03 Hospital Doctors Hospital Use

DEXTROSE INFUSION IV 10% IN 500mL Nutrition and Blood B05BA03 Hospital Doctors Hospital Use

Page 33 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

DEXTROSE + SODIUM

CHLORIDE

INFUSION 10% + 0.18% IN

500mL

Nutrition and Blood B05BB02 Hospital Doctors Hospital Use

DEXTROSE + SODIUM

CHLORIDE

INFUSION 10% + 0.225%

IN 500mL

Nutrition and Blood B05BB02 Hospital Doctors Hospital Use

DEXTROSE + SODIUM

CHLORIDE

INFUSION 5% + 0.225% IN

500mL

Nutrition and Blood B05BB02 Hospital Doctors Hospital Use

DEXTROSE + SODIUM

CHLORIDE

INFUSION 5% + 0.45% IN

500mL

Nutrition and Blood B05BB02 Hospital Doctors Hospital Use

DEXTROSE + SODIUM

CHLORIDE

INFUSION IV 5% + 0.9% IN

500mL

Nutrition and Blood B05BB02 Hospital Doctors Hospital Use

DIAMORPHINE

HYDROCHLORIDE

(HEROIN

HYDROCHLORIDE)

INJECTION

IV, IM & SC

5mg Central Nervous

System

N07BC06 Hospital Doctors as per

specified department

Accident and

Emergency

Department,

Department of

Cardiology,

Obstetrics and

Gynaecology

Department,

Intensive Care

Unit

DIAMORPHINE

HYDROCHLORIDE

(HEROIN

HYDROCHLORIDE)

INTRATHECAL

INJECTION

100mg Central Nervous

System

N07BC06 Consultant Anaesthetists Pain Clinic MP 240

DIAZEPAM INJECTION

IM & IV

5mg/mL IN 2mL Central Nervous

System

N05BA01 Hospital Doctors Hospital Use,

Substance

Misuse In-

Patients Unit

DIAZEPAM INJECTION IV

(EMULSION)

5mg/mL IN 2mL Central Nervous

System

N05BA01 Hospital Doctors Hospital Use

DIAZEPAM RECTAL TUBES 10mg/2.5mL Central Nervous

System

N05BA01 Medical Practitioners

DIAZEPAM RECTAL TUBES 5mg/2.5mL Central Nervous

System

N05BA01 Medical Practitioners

Page 34 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

DIAZEPAM ORAL SOLUTION 2mg/5mL Central Nervous

System

N05BA01 Medical Practitioners

DIAZEPAM TABLETS 5mg Central Nervous

System

N05BA01 Medical Practitioners

DIAZEPAM TABLETS 2mg Central Nervous

System

N05BA01 Medical Practitioners

DICLOFENAC SODIUM EYE DROPS 0.1% Eye S01BC03 Hospital Doctors as per

specified department

Ophthalmic

Department

DICLOFENAC SODIUM INJECTION 75mg Musculoskeletal and

Joint Diseases

M01AB05 Consultants Hospital Use

DICLOFENAC SODIUM SUPPOSITORIES 100mg Musculoskeletal and

Joint Diseases

M01AB05 Medical Practitioners

DICLOFENAC SODIUM SUPPOSITORIES 12.5mg Musculoskeletal and

Joint Diseases

M01AB05 Consultant Paediatricians

DICLOFENAC SODIUM TABLETS 25mg Musculoskeletal and

Joint Diseases

M01AB05 Medical Practitioners

DICOBALT EDETATE

(stand-by)

INJECTION 300mg Antidotes V03AB03 Hospital Doctors Hospital Use

DIETHYLENETRIAMINE

PENTACETATE (DTPA)

INJECTION Radiopharmaceutic

als

V09 Consultant Radiologists

DIETHYLSTILBESTROL

(STILBOESTROL)

TABLETS 1mg Endocrine System,

Malignant Disease

and

Immunosuppression

G03CB02,

L02AA01

Consultants

DIGOXIN INJECTION 500mcg/mL IN

2mL

Cardiovascular

System

C01AA05 Hospital Doctors Hospital Use

DIGOXIN INJECTION 250mcg/mL IN

2mL

Cardiovascular

System

C01AA05 Hospital Doctors Hospital Use

DIGOXIN ORAL SOLUTION 50mcg/mL Cardiovascular

System

C01AA05 Consultants

DIGOXIN TABLETS 0.0625mg Cardiovascular

System

C01AA05 Medical Practitioners

Page 35 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

DIGOXIN TABLETS 0.25mg Cardiovascular

System

C01AA05 Medical Practitioners

DIGOXIN ANTIBODIES

(stand-by)

POWDER FOR

SOLUTION FOR

INJECTION

38mg OR 40mg Antidotes V03AB24 Hospital Doctors Hospital Use

DIHYDROCODEINE

TARTRATE

TABLETS 30mg Central Nervous

System

N02AA08 Hospital Doctors

DILTIAZEM TABLETS 60mg Cardiovascular

System

C08DB01 Consultants

DIMERCAPROL (stand-by) INJECTION 300mg Antidotes V03AB09 Hospital Doctors Accident and

Emergency

Department,

Intensive Care

Unit

DIMERCAPTOSUCCINIC

ACID (DMSA)

INJECTION Radiopharmaceutic

als

V09 Consultant Radiologists

DIMETHYL FUMARATE GASTRO-

RESISTANT HARD

CAPSULES

120mg Central Nervous

System

L04AX07 Consultant Neurologists MP 60

DIMETHYL FUMARATE GASTRO-

RESISTANT HARD

CAPSULES

240mg Central Nervous

System

L04AX07 Consultant Neurologists MP 60

DINOPROSTONE INJECTION 0.75mg IN

0.75mL

Obstetrics,

Gynaecology and

Urinary Tract

Disorders

G02AD02 Hospital Doctors as per

specified department

Antenatal Ward

DINOPROSTONE VAGINAL DELIVERY

SYSTEM

10mg Obstetrics,

Gynaecology and

Urinary Tract

Disorders

G02AD02 Hospital Doctors as per

specified department

Antenatal Ward

DINOPROSTONE VAGINAL GEL 400mcg/mL Obstetrics,

Gynaecology and

Urinary Tract

Disorders

G02AD02 Hospital Doctors as per

specified department

Antenatal Ward

Page 36 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

DINOPROSTONE VAGINAL GEL 800mcg/mL Obstetrics,

Gynaecology and

Urinary Tract

Disorders

G02AD02 Hospital Doctors as per

specified department

Antenatal Ward

DIPEPTIDYLPEPTIDASE-4

INHIBITORS [GLIPTINS]

(CURRENTLY

VILDAGLIPTIN)

TABLETS 50mg Endocrine System A10BH01 Consultants Endocrinology

and Diabetes

MP 89 

DIPHENHYDRAMINE

CONTAINING

PREPARATION FOR

CHESTY COUGH

ORAL LIQUID Respiratory System R05X Medical Practitioners

DIPHTHERIA (LOW DOSE)

+ TETANUS +

POLIOMYELITIS

(INACTIVATED)

VACCINE

(ADSORBED)

Immunological

Products and

Vaccines

J07CA01 Hospital Doctors as per

specified department

Floriana

Immunisation

Services

DIPHTHERIA + TETANUS

+ PERTUSSIS

(ACELLULAR) +

POLIOMYELITIS

(INACTIVATED) +

HAEMOPHILUS

INFLUENZAE TYPE B

CONJUGATE

VACCINE

(ADSORBED)

Immunological

Products and

Vaccines

J07CA06 Hospital Doctors as per

specified department

Floriana

Immunisation

Services

DIPYRIDAMOLE TABLETS 100mg Cardiovascular

System

B01AC07 Medical Practitioners

DIPYRIDAMOLE TABLETS 25mg Cardiovascular

System

B01AC07 Medical Practitioners

DISODIUM

PAMIDRONATE

CONCENTRATE

FOR SOLUTION FOR

INFUSION

15mg Endocrine System M05BA03 Consultants; Consultant

Diabetologists, Consultants

Endocrinology and

Diabetes

Hospital Use MP 159

Page 37 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

DISOPYRAMIDE CAPSULES 100mg Cardiovascular

System

C01BA03 Consultants

DISTILLED WATER STERILE SOLUTION

FOR IRRIGATION

1,000mL Miscellaneous Hospital Doctors Hospital Use

DISULFIRAM TABLETS 200mg Central Nervous

System

N07BB01 Hospital Doctors

DOBUTAMINE INJECTION 250mg Cardiovascular

System

C01CA07 Hospital Doctors Hospital Use

DOCETAXEL SOLUTION FOR

INJECTION/

POWDER FOR

SOLUTION FOR

INJECTION

80mg Malignant Disease

and

Immunosuppression

L01CD02 Consultant Oncologists Hospital Use/

Day Clinic

MP 220

DOCUSATE SODIUM CAPSULES/

TABLETS

100mg Gastro-intestinal

System, Central

Nervous System

A06AA02 Consultant Oncologists,

Consultant Palliative Care

MP 54

DOMPERIDONE ORAL SUSPENSION 5mg/5mL Gastro-intestinal

System, Central

Nervous System

A03FA03 Consultants MP 57

DOMPERIDONE TABLETS 10mg Gastro-intestinal

System, Central

Nervous System

A03FA03 Consultants

DONEPEZIL

HYDROCHLORIDE

TABLETS 10mg Central Nervous

System

N06DA02 Consultant Geriatricians,

Consultant Neurologists,

Consultant Psychiatrists

MP 58

DONEPEZIL

HYDROCHLORIDE

TABLETS 5mg Central Nervous

System

N06DA02 Consultant Geriatricians,

Consultant Neurologists,

Consultant Psychiatrists

MP 58

DOPAMINE INFUSION 40mg/mL IN

5mL

Cardiovascular

System

C01CA04 Hospital Doctors Hospital Use

DORNASE ALFA NEBULISER

SOLUTION

1000units/mL

(2.5mg IN

2.5mL)

Respiratory System R05CB13 Consultant Paediatricians,

Consultant Respiratory

Physicians

MP 52

Page 38 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

DORZOLAMIDE EYE DROPS 20mg/mL Eye S01EC03 Consultant

Ophthalmologists

DOXAPRAM INJECTION 100mg Respiratory System R07AB01 Hospital Doctors Hospital Use

DOXAZOSIN TABLETS 2mg Cardiovascular

System

C02CA04 Consultants

DOXAZOSIN TABLETS 4mg Cardiovascular

System

C02CA04 Consultants

DOXAZOSIN TABLETS 1mg Cardiovascular

System

C02CA04 Consultants

DOXORUBICIN

HYDROCHLORIDE

INJECTION 50mg Malignant Disease

and

Immunosuppression

L01DB01 Hospital Doctors Hospital Use/

Day Clinic

DOXYCYCLINE CAPSULES/

TABLETS

100mg Infections J01AA02 Consultants, GU Clinic

Consultants

DOXYCYCLINE (stand-by) SOLUTION FOR

INJECTION/

POWDER FOR

SOLUTION FOR

INJECTION

100mg Infections J01AA02 Consultant Physicians Hospital Use

DYDROGESTERONE TABLETS 10mg Endocrine System G03DB01 Consultants

ECONAZOLE PESSARIES 150mg Obstetrics,

Gynaecology and

Urinary Tract

Disorders

G01AF05 Consultants

EFAVIRENZ CAPSULES/

TABLETS

200mg Infections J05AG03 Consultant Infectious

Diseases Physicians

To be

dispensed from

Hospitals only

MP 208

EFAVIRENZ CAPSULES/

TABLETS

600mg Infections J05AG03 Consultant Infectious

Diseases Physicians

To be

dispensed from

Hospitals only

MP 222

EMOLLIENT BATH OR

SHOWER PREPARATION

Skin D02AX Consultant Dermatologists

Page 39 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

EMULSIFYING OINTMENT OINTMENT Skin D02AX Consultant Dermatologists To be

dispensed from

Sir Paul Boffa

Hospital

Pharmacy & St

Vincent De Paul

Residence

Pharmacy only

ENALAPRIL TABLETS 20mg Cardiovascular

System

C09AA02 Medical Practitioners

ENALAPRIL TABLETS 5mg Cardiovascular

System

C09AA02 Medical Practitioners

ENOXAPARIN SODIUM PRE-FILLED

SYRINGES

SINGLE DOSE

100mg

(10,000 IU)

Cardiovascular

System

B01AB05 Consultants MP 204

ENOXAPARIN SODIUM PRE-FILLED

SYRINGES

SINGLE DOSE

20mg

(2,000 IU)

Cardiovascular

System

B01AB05 Consultants MP 204

ENOXAPARIN SODIUM PRE-FILLED

SYRINGES

SINGLE DOSE

40mg

(4,000 IU)

Cardiovascular

System

B01AB05 Consultants MP 204

ENOXAPARIN SODIUM PRE-FILLED

SYRINGES

SINGLE DOSE

60mg

(6,000 IU)

Cardiovascular

System

B01AB05 Consultants MP 204

ENOXAPARIN SODIUM PRE-FILLED

SYRINGES

SINGLE DOSE

80mg

(8,000 IU)

Cardiovascular

System

B01AB05 Consultants MP 204

Page 40 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

ENOXIMONE INJECTION 100mg/20mL Cardiovascular

System

C01CE03 Hospital Doctors as per

specified department

Intensive Care

Unit, Coronary

Care Unit,

Theatre,

Catheterization

Laboratory,

Renal Unit.

ENZALUTAMIDE CAPSULES 40mg Malignant Disease

and

Immunosuppression

L02BB04 Consultant Oncologists MP 300

EPHEDRINE INJECTION 30mg Respiratory System C01CA26 Hospital Doctors Hospital Use

EPIRUBICIN

HYDROCHLORIDE

SOLUTION FOR

INJECTION

50mg (RAPID

DISSOLUTION)

Malignant Disease

and

Immunosuppression

L01DB03 Consultant Oncologists,

Consultant

Haematologists,

Consultant Paediatricians

Hospital Use/

Day Clinic

MP 63

EPOPROSTENOL

(PROSTACYCLIN) (stand-

by)

POWDER FOR

SOLUTION FOR

INFUSION

500mcg Cardiovascular

System

B01AC09 Consultant Paediatricians,

Consultant Physicians,

Consultant Cardiologists

NPICU

EPTACOG ALFA

(RECOMBINANT FACTOR

VIIa) (stand-by)

INJECTION 2mg (100 KIU) Cardiovascular

System

B02BD08 Consultant Anaesthetists,

Consultant Haematologists

To be

dispensed from

Hospitals only

ERLOTINIB CAPSULES/

TABLETS

150mg Malignant Disease

and

Immunosuppression

L01XE03 Consultant Oncologist Hospital Use/To

be dispensed

from Hospitals

only

MP 262

Page 41 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

ERTAPENEM POWDER FOR

SOLUTION FOR

INFUSION

1g Infections J01DH03 Consultant Infectious

Diseases Physicians,

Consultants (after

discussion with the Mater

Dei Hospital Antibiotic

Team)

Hospital Use MP 289

ERYTHROMYCIN CAPSULES/

TABLETS

250mg Infections J01FA01 Medical Practitioners, GU

Clinic Consultants

ERYTHROMYCIN ORAL SUSPENSION 125mg/5mL Infections J01FA01 Medical Practitioners

ERYTHROMYCIN

LACTOBIONATE

POWDER FOR

SOLUTION FOR

INJECTION

1g Infections J01FA01 Hospital Doctors Hospital Use

ESMOLOL

HYDROCHLORIDE

(stand-by)

INFUSION 10mg/mL IN

250mL

INFUSION

BAGS

Cardiovascular

System

C07AB09 Hospital Doctors Hospital Use

ESMOLOL

HYDROCHLORIDE

(stand-by)

INJECTION 10mg/mL IN

10mL VIALS

Cardiovascular

System

C07AB09 Hospital Doctors Hospital Use

ESTRADIOL (AS

HEMIHYDRATE) +

DYDROGESTERONE

TABLETS 2mg + 10mg Endocrine System G03FA10 Consultants Endocrinology

and Diabetes, Consultant

Oncologists, Consultant

Haematologists

MP 234

ESTRADIOL VALERATE TABLETS 1mg Endocrine System G03CA03 Consultants Obstetrics and

Gynaecology, Consultants

Endocrinology

(Transgender MDT)

ETANERCEPT

(BENEPALI®)

PRE-FILLED PENS 50mg Musculoskeletal and

Joint Diseases

L04AB01 Consultant Dermatologists,

Consultant

Rheumatologists

MP 66

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

ETANERCEPT

(ENBREL®)

POWDER AND

SOLVENT FOR

SOLUTION FOR

INJECTION

25mg Musculoskeletal and

Joint Diseases

L04AB01 Consultant Dermatologists,

Consultant

Rheumatologists

MP 66

ETANERCEPT

(ENBREL®)

PRE-FILLED PENS 50mg Musculoskeletal and

Joint Diseases

L04AB01 Consultant Dermatologists,

Consultant

Rheumatologists

MP 66

ETHAMBUTOL TABLETS 100mg Infections J04AK02 Consultant Infectious

Diseases Physicians,

Paediatric Infectious

Diseases Clinic

Physicians, Consultant

Respiratory Physicians,

Chest Clinic Physicians

To be

dispensed from

Hospitals only

As per

antimicrobial

guidelines

ETHAMBUTOL TABLETS 400mg Infections J04AK02 Consultant Infectious

Diseases Physicians,

Paediatric Infectious

Diseases Clinic

Physicians, Consultant

Respiratory Physicians,

Chest Clinic Physicians

To be

dispensed from

Hospitals only

ETHINYLESTRADIOL CAPSULES/

TABLETS

10mcg Endocrine System G03CA01 Consultant Paediatrician,

Consultant

Endocrinologist,

Consultants Endocrinology

(Transgender MDT)

MP 235

ETHIONAMIDE TABLETS 250mg Infections J04AD03 Consultant Infectious

Diseases Physicians,

Chest Clinic Physicians

To be

dispensed from

Hospitals only

MP 255

ETHOSUXIMIDE CAPSULES 250mg Central Nervous

System

N03AD01 Consultants

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

ETHOSUXIMIDE ORAL SOLUTION 250mg/5mL Central Nervous

System

N03AD01 Consultants

ETHYL CHLORIDE SPRAY 100mL Anaesthesia N01BX01 Hospital Doctors Hospital Use

ETOMIDATE INJECTION 20mg Central Nervous

System

N01AX07 Hospital Doctors Hospital Use

ETOPOSIDE CAPSULES 50mg Malignant Disease

and

Immunosuppression

L01CB01 Consultant Oncologists,

Consultant

Haematologists,

Consultant Paediatricians

To be

dispensed from

Hospitals only

ETOPOSIDE SOLUTION FOR

INJECTION/

POWDER FOR

SOLUTION FOR

INJECTION

100mg Malignant Disease

and

Immunosuppression

L01CB01 Consultant Oncologists,

Consultant

Haematologists,

Consultant Paediatricians

Hospital Use

ETOPOSIDE

(NEONATES)

SOLUTION FOR

INJECTION

100mg Malignant Disease

and

Immunosuppression

L01CB02 Consultant Oncologists,

Consultant

Haematologists,

Consultant Paediatricians

Hospital Use

EVEROLIMUS TABLETS 10mg Malignant Disease

and

Immunosuppression

L01XE10 Consultant Oncologists To be

dispensed from

Hospitals only

MP 302

EVEROLIMUS TABLETS 5mg Malignant Disease

and

Immunosuppression

L01XE10 Consultant Oncologists To be

dispensed from

Hospitals only

MP 302

EXEMESTANE TABLETS 25mg Malignant Disease

and

Immunosuppression

L02BG06 Consultant Oncologists To be

dispensed from

Hospitals only

MP 64

FACTOR XIII

CONCENTRATE (stand-

by)

POWDER AND

SOLVENT FOR

SOLUTION FOR

INJECTION

250 IU Cardiovascular

System

B02BD07 Consultant Haematologists To be

dispensed from

Hospitals only

MP 211

Page 44 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

FENOFIBRATE CAPSULES 67mg

(micronised)

Cardiovascular

System

C10AB05 Medical Practitioners

FENOFIBRATE CAPSULES/

TABLETS

200mg

(micronised)

CAPSULES or

145mg

(nanocrystal)

TABLETS

Cardiovascular

System

C10AB05 Medical Practitioners

FENTANYL INJECTION 0.1mg/2mL Central Nervous

System

N01AH01 Hospital Doctors Hospital Use

FENTANYL INJECTION 0.5mg/10mL Central Nervous

System

N01AH01 Hospital Doctors Hospital Use

FENTANYL TRANSDERMAL

PATCHES

25mcg/hr Central Nervous

System

N02AB03 Consultant Anaesthetists

(Pain Clinic), Consultant

Haematologists,

Consultant Oncologists,

Consultant Palliative Care

MP 67

FENTANYL TRANSDERMAL

PATCHES

50mcg/hr Central Nervous

System

N02AB03 Consultant Anaesthetists

(Pain Clinic), Consultant

Haematologists,

Consultant Oncologists,

Consultant Palliative Care

MP 67

FERRIC SUB-SULPHATE SOLUTION Obstetrics,

Gynaecology and

Urinary Tract

Disorders

B03AB Hospital Doctors as per

specified department

Gynaecology

Department

Page 45 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

FIBRINOGEN

CONCENTRATE

POWDER FOR

SOLUTION FOR

INJECTION

1g Cardiovascular

System

B02BB01 Consultant Anaesthetists,

Consultants Emergency

Medicine, Consultant

Cardiologists, Consultant

Haematologists,

Consultant Obstetricians,

Consultant Surgeons

To be

dispensed from

Mater Dei

Hospital only

MP 212

FILGRASTIM (REC.

HUMAN G-CSF )

INJECTION 30 Million Units Nutrition and Blood L03AA02 Consultant Oncologists,

Consultant

Haematologists,

Consultant Paediatricians,

Consultant Infectious

Diseases Physicians

Hospital Use/To

be dispensed

from Hospitals

only

MP 69

FINASTERIDE TABLETS 5mg Malignant Disease

and

Immunosuppression

G04CB01 Consultant Urologists,

Consultants Endocrinology

(Transgender MDT)

FINGOLIMOD CAPSULES 0.5mg Central Nervous

System

L04AA27 Consultant Neurologist MP 70

FLAVOUR SACHETS SACHETS Nutrition and Blood N/A Consultant Paediatrician,

Consultant

Gastroenterologist,

Dietitian

MP 232

FLECAINIDE ACETATE INJECTION 150mg/15mL Cardiovascular

System

C01BC04 Hospital Doctors Hospital Use

FLECAINIDE ACETATE TABLETS 100mg Cardiovascular

System

C01BC04 Consultants

FLUCLOXACILLIN CAPSULES 250mg Infections J01CF05 Medical Practitioners

FLUCLOXACILLIN ORAL SOLUTION 125mg/5mL Infections J01CF05 Medical Practitioners

Page 46 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

FLUCLOXACILLIN POWDER FOR

SOLUTION FOR

INJECTION

250mg Infections J01CF05 Medical Practitioners

FLUCLOXACILLIN POWDER FOR

SOLUTION FOR

INJECTION AND

INFUSION

1g Infections J01CF05 Medical Practitioners Hospital Use

FLUCONAZOLE CAPSULES 50mg Infections J02AC01 Consultants MP 72

FLUCONAZOLE CAPSULES/

TABLETS

150mg Infections J02AC01 Consultants MP 72

FLUCONAZOLE INFUSION 2mg/mL IN

100mL

Infections J02AC01 Consultants Hospital Use As per

antimicrobial

guidelines

FLUCONAZOLE ORAL SUSPENSION 50mg/5mL Infections J02AC01 Consultants MP 73

FLUDARABINE SOLUTION FOR

INJECTION/

POWDER FOR

SOLUTION FOR

INJECTION

50mg Malignant Disease

and

Immunosuppression

L01BB05 Consultant Oncologists,

Consultant

Haematologists,

Consultant Paediatricians

Hospital Use/

Day Clinic

FLUDARABINE TABLETS 10mg Malignant Disease

and

Immunosuppression

L01BB05 Consultant Oncologists,

Consultant

Haematologists,

Consultant Paediatricians

To be

dispensed from

Hospitals only

FLUDROCORTISONE

ACETATE

TABLETS 0.1mg Endocrine System H02AA02 Hospital Doctors

FLUID THICKENER POWDER Food Supplements V07A Consultants

FLUMAZENIL (stand-by) INJECTION 500mcg IN 5mL Antidotes V03AB25 Hospital Doctors Hospital Use

FLUORESCEIN SODIUM INJECTION 100mg/mL Eye S01JA01 Hospital Doctors as per

specified department

Ophthalmic

Department

FLUOROMETHOLONE EYE DROPS 0.1% Eye S01BA07 Hospital Doctors as per

specified department

Ophthalmic

Department

Page 47 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

FLUOROURACIL CREAM 5% Malignant Disease

and

Immunosuppression

L01BC02 Consultant Dermatologist,

Consultant Oncologists

FLUOROURACIL SOLUTION FOR

INJECTION AND

INFUSION

500mg/10mL Malignant Disease

and

Immunosuppression

L01BC02 Consultant Oncologists,

Consultant

Ophthalmologists

Hospital Use

FLUOXETINE CAPSULES 20mg Central Nervous

System

N06AB03 Consultant Psychiatrists,

Consultant Geriatricians

FLUPENTIXOL

DECANOATE

INJECTION 100mg/mL Central Nervous

System

N05AF01 Consultant Psychiatrists

FLUPENTIXOL

DECANOATE

INJECTION 20mg/mL Central Nervous

System

N05AF01 Consultant Psychiatrists

FLUPENTIXOL

DIHYDROCHLORIDE

TABLETS 0.5mg Central Nervous

System

N05AF01 Consultant Psychiatrists

FLUPHENAZINE

DECANOATE

INJECTION 100mg/mL Central Nervous

System

N05AB02 Consultant Psychiatrists

FLUPHENAZINE

DECANOATE

INJECTION 25mg/mL Central Nervous

System

N05AB02 Consultant Psychiatrists

FLUTAMIDE TABLETS 250mg Malignant Disease

and

Immunosuppression

L02BB01 Consultant Oncologists,

Consultant Urologists

FLUTICASONE

PROPIONATE

AEROSOL INHALER 250mcg/DOSE Respiratory System R03BA05 Consultant Respiratory

Physicians, Consultant

Paediatricians, Specialist

Respiratory Medicine

Consultants

MP 78

FLUTICASONE

PROPIONATE

AEROSOL INHALER 50mcg/DOSE Respiratory System R03BA05 Consultant Respiratory

Physicians, Consultant

Paediatricians, Specialist

Respiratory Medicine

Consultants

MP 77

Page 48 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

FLUVOXAMINE MALEATE TABLETS 100mg Central Nervous

System

N06AB08 Consultant Psychiatrists,

Consultant Geriatricians

FOLIC ACID ORAL SOLUTION 2.5mg/5mL Nutrition and Blood B03BB01 Consultant Paediatricians,

Consultant

Rheumatologists

MP 80

FOLIC ACID TABLETS 5mg Nutrition and Blood B03BB01 Medical Practitioners

FOOD SUPPLEMENT -

e.g. FOOD LINK®

or

SUSTAGEN®

- (DIET

SUPPLEMENTATION)

POWDER Food Supplements V06 Hospital Doctors

FOOD SUPPLEMENT -

e.g. DUOCAL®

- (FAT

AND CARBOHYDRATE

ENERGY SUPPLEMENT)

POWDER Food Supplements V06 Consultant Paediatricians MP 68

FOOD SUPPLEMENT -

e.g. ELEMENTAL 028

EXTRA®

- (ENTERAL

FEED - ELEMENTAL

FORMULA)

POWDER Food Supplements V06 Consultant Paediatricians,

Consultant

Gastroenterologists

MP 61

FOOD SUPPLEMENT -

e.g. MAXIJUL®

-

(CARBOHYDRATE

ENERGY SUPPLEMENT )

POWDER Food Supplements V06DC Consultants MP 32

FOOD SUPPLEMENT -

e.g. NEOCATE®

LCP or

ALFAMINO®

- (AMINO

ACID-BASED INFANT

FORMULA)

POWDER Food Supplements V06 Consultant Paediatricians MP 62

Page 49 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

FOOD SUPPLEMENT -

e.g. NUTRISON®

or

NUTRICOMP®

STANDARD - (ENTERAL

FEED - COMPLETE

NUTRITIONAL

PREPARATION)

LIQUID 500mL Food Supplements V06 Medical Practitioners

FOOD SUPPLEMENT -

e.g. PAEDIASURE®

-

(PAEDIATRIC LIQUID

FOOD PREPARATION)

LIQUID 200mL Food Supplements V06 Consultant Paediatricians MP 158

FOOD SUPPLEMENT -

e.g. RESOURCE

ENERGY®

(FORMERLY

KNOWN AS ENSURE®

OR CLINUTREN®

) -

(ENTERAL FEED -

COMPLETE

NUTRITIONAL

PREPARATION)

LIQUID 200mL Food Supplements V06 Medical Practitioners

FORMALDEHYDE SOLUTION 500mL - 5000mL Miscellaneous D08AX Infection Control Policy Hospital Use

FOSCARNET (stand-by) INFUSION IV 24mg/mL Infections J05AD01 Consultant Infectious

Diseases Physicians

Hospital Use

FOSFOMYCIN GRANULES FOR

ORAL SUSPENSION

3g Infections J01XX01 Mater Dei Hospital

Antibiotic Team

Consultants

Hospital Use MP 81

FRAMYCETIN +

DEXAMETHASONE +

GRAMICIDIN

EYE/EAR DROPS 0.5% + 0.05% +

0.005%

Ear, Nose and

Oropharynx, Eye

S02CA06 Medical Practitioners

FUROSEMIDE

(FRUSEMIDE)

INJECTION 250mg/25mL Cardiovascular

System

C03CA01 Hospital Doctors as per

specified department

Hospital Use

FUROSEMIDE

(FRUSEMIDE)

ORAL SOLUTION 1mg/mL Cardiovascular

System

C03CA01 Consultants

Page 50 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

FUROSEMIDE

(FRUSEMIDE)

SOLUTION FOR

INJECTION AND

INFUSION

20mg/2mL Cardiovascular

System

C03CA01 Hospital Doctors Hospital Use

FUROSEMIDE

(FRUSEMIDE)

TABLETS 40mg Cardiovascular

System

C03CA01 Medical Practitioners

FUROSEMIDE

(FRUSEMIDE) +

AMILORIDE

TABLETS 40mg + 5mg Cardiovascular

System

C03EB01 Consultant Cardiologists,

Consultant Cardiac

Surgeons

MP 82

FUSIDATE SODIUM TABLETS 250mg Infections J01XC01 Consultants

FUSIDIC ACID ORAL SUSPENSION 250mg/5mL Infections J01XC01 Consultants

FUSIDIC ACID VISCOUS EYE

DROPS

1% Eye S01AA13 Hospital Doctors as per

specified department

Ophthalmic

Department,

Paediatric

Department

GABAPENTIN CAPSULES 100mg Central Nervous

System

N03AX12 Consultant Neurologists,

Consultant Paediatricians

MP 83

GABAPENTIN CAPSULES 300mg Central Nervous

System

N03AX12 Consultant Neurologists,

Consultant Paediatricians

MP 83

GALLIUM 67-CITRATE INJECTION Radiopharmaceutic

als

V09HX01 Consultant Radiologists

GANCICLOVIR (stand-by) POWDER FOR

SOLUTION FOR

INJECTION AND

INFUSION

500mg Infections J05AB06 Consultant

Gastroenterologists,

Consultant Nephrologist,

Consultant Infectious

Diseases Physicians

Hospital use As per

antimicrobial

guidelines

GELATIN MODIFIED

FLUID

INJECTION 500mL Nutrition and Blood B05AA06 Hospital Doctors Hospital Use

GEMCITABINE

HYDROCHLORIDE

SOLUTION FOR

INJECTION/

POWDER FOR

SOLUTION FOR

INJECTION

1g Malignant Disease

and

Immunosuppression

L01BC05 Consultant

Haematologists,

Consultant Oncologists

Hospital Use MP 84

Page 51 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

GENTAMICIN BEAD CHAINS 30 Infections J01GB Hospital Doctors as per

specified department

Orthopaedic

Theatre

GENTAMICIN EYE/ EAR DROPS 0.3% Ear, Nose and

Oropharynx, Eye

S03AA06 Medical Practitioners

GENTAMICIN INJECTION 80mg Infections J01GB03 Hospital Doctors

GENTAMICIN POWDER Skin D06AX07 Hospital Doctors Hospital Use

GLIBENCLAMIDE TABLETS 5mg Endocrine System A10BB01 Medical Practitioners

GLICLAZIDE TABLETS 80mg Endocrine System A10BB09 Consultants

GLUCAGON (stand-by) POWDER AND

SOLVENT FOR

SOLUTION FOR

INJECTION

1mg Antidotes,

Endocrine System

H04AA01 Consultants Endocrinology

and Diabetes

GLUCOSE SOLUTION FOR

PERITONEAL

DIALYSIS

Nutrition and Blood B05CX01 Hospital Doctors Hospital Use

GLUCOSE

MONOHYDRATE B.P.

POWDER Miscellaneous V06DC01 Hospital Doctors Hospital Use

GLUTARALDEHYDE SOLUTION 2% Skin D08AX Infection Control Policy Hospital Use

GLUTEN-FREE DIETARY

ITEMS

VOUCHER SCHEME

FOR COELIAC

PATIENTS

Food Supplements V06 Consultant

Gastroenterologists,

Consultant Paediatricians,

Consultant Surgeons

MP 85

GLYCEROL/GLYCERIN ADULT

SUPPOSITORIES

4g Gastro-intestinal

System

A06AX01 Medical Practitioners

GLYCEROL/GLYCERIN ENEMA 3.9g Gastro-intestinal

System

A06AG04 Hospital Doctors Hospital Use

GLYCEROL/GLYCERIN INFANT

SUPPOSITORIES

1g Gastro-intestinal

System

A06AX01 Medical Practitioners

GLYCEROL/GLYCERIN LIQUID Food Supplements A06AX01 Hospital Doctors Hospital Use

GLYCERYL TRINITRATE INJECTION 1mg/mL IN

50mL

Cardiovascular

System

C01DA02 Hospital Doctors as per

specified department

Hospital Use

GLYCERYL TRINITRATE METERED DOSE

SPRAY

400mcg Cardiovascular

System

C01DA02 Hospital Doctors as per

specified department

Hospital Use

Page 52 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

GLYCERYL TRINITRATE SUBLINGUAL

TABLETS

500mcg Cardiovascular

System

C01DA02 Medical Practitioners

GLYCERYL TRINITRATE TRANSDERMAL

PATCHES

10mg/24hrs Cardiovascular

System

C01DA02 Consultant Physicians,

Consultant Cardiologists,

Consultant Cardiac

Surgeons

GLYCERYL TRINITRATE TRANSDERMAL

PATCHES

5mg/24hrs Cardiovascular

System

C01DA02 Consultant Physicians,

Consultant Cardiologists,

Consultant Cardiac

Surgeons

GLYCINE IRRIGATION

SOLUTION

1.5% W/V IN 3L Obstetrics,

Gynaecology and

Urinary Tract

Disorders

B05CX03 Hospital Doctors Hospital Use

GLYCOPYRRONIUM

BROMIDE

(GLYCOPYRROLATE)

(stand-by)

INJECTION 0.6mg Anaesthesia A03AB02 Hospital Doctors as per

specified department

To be

dispensed from

Hospitals only

GONADORELIN (LH-

RELEASING HORMONE )

INJECTION 100mcg Endocrine System,

Malignant Disease

and

Immunosuppression

H01CA01 Hospital Doctors as per

specified department

Endocrine

Department,

Paediatric

Department

GOSERELIN IMPLANT 10.8mg Malignant Disease

and

Immunosuppression

L02AE03 Consultant Oncologists,

Consultant Urologists,

Consultants Endocrinology

(Transgender MDT)

MP 87

GOSERELIN IMPLANT 3.6mg Malignant Disease

and

Immunosuppression

L02AE03 Consultants Obstetrics and

Gynaecology, Consultant

Oncologists, Consultants

Endocrinology

(Transgender MDT)

MP 86

Page 53 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

GRISEOFULVIN CAPSULES/

TABLETS

125mg Infections D01BA01 Hospital Doctors

HAEMOPHILUS

INFLUENZAE TYPE B

VACCINE 10mcg/0.5mL Immunological

Products and

Vaccines

J07AG01 Consultants Hospital Use

HALOGENATED

TERTIARY AMINE

(TRIGENE

DISINFECTANT

SOLUTION )

AQUEOUS

SOLUTION

5L Skin D08AX Infection Control Policy Hospital Use

HALOGENATED

TERTIARY AMINE

(TRIGENE

DISINFECTANT SPRAY )

SPRAY Skin D08AX Infection Control Policy Hospital Use

HALOPERIDOL CAPSULES/

TABLETS

0.5mg Central Nervous

System

N05AD01 Consultant Geriatricians,

Consultant

Haematologists,

Consultant Oncologists,

Consultant Palliative Care,

Consultant Psychiatrists

HALOPERIDOL INJECTION 5mg Central Nervous

System

N05AD01 Consultant Geriatricians,

Consultant

Haematologists,

Consultant Oncologists,

Consultant Palliative Care,

Consultant Psychiatrists

Page 54 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

HALOPERIDOL ORAL SOLUTION 2mg/mL Central Nervous

System

N05AD01 Consultant Geriatricians,

Consultant

Haematologists,

Consultant Oncologists,

Consultant Palliative Care,

Consultant Psychiatrists

HALOPERIDOL TABLETS 1.5mg Central Nervous

System

N05AD01 Consultant Geriatricians,

Consultant

Haematologists,

Consultant Oncologists,

Consultant Palliative Care,

Consultant Psychiatrists

HALOPERIDOL TABLETS 5mg Central Nervous

System

N05AD01 Consultant Geriatricians,

Consultant

Haematologists,

Consultant Oncologists,

Consultant Palliative Care,

Consultant Psychiatrists

HALOPERIDOL

DECANOATE

INJECTION 100mg Central Nervous

System

N05AD01 Consultant Psychiatrists

HALOPERIDOL

DECANOATE

INJECTION 50mg Central Nervous

System

N05AD01 Consultant Psychiatrists

HEPARIN SODIUM (WITH

PRESERVATIVE)

INJECTION 5,000 IU/mL IN

5mL

Cardiovascular

System

B01AB01 Hospital Doctors as per

specified department

Hospital Use

HEPARIN SODIUM

(WITHOUT BACTERICIDE)

INJECTION 1,000 IU/mL IN

10mL - 20mL

Cardiovascular

System

B01AB01 Hospital Doctors Cardiac

Theatres, Renal

Unit, NPICU

HEPARIN SODIUM IN

0.9% SODIUM CHLORIDE

INFUSION 500 IU IN 500mL

STERILE BAGS

Cardiovascular

System

B01AB01 Consultant Cardiac

Surgeons

Hospital Use

Page 55 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

HEPARIN SODIUM IN

SODIUM CHLORIDE

FLUSHING

SOLUTION

10 IU/mL IN 5mL Cardiovascular

System

B01AB01 Hospital Doctors To be

dispensed from

Hospitals only

(TPN patients

only)

HEPATITIS A (ADULT) VACCINE Immunological

Products and

Vaccines

J07BC02 Hospital Doctors as per

specified department

Floriana

Immunisation

Services

HEPATITIS A

(PAEDIATRIC)

VACCINE Immunological

Products and

Vaccines

J07BC02 Hospital Doctors as per

specified department

Floriana

Immunisation

Services

HEPATITIS B IMMUNOGLOBULIN Immunological

Products and

Vaccines

J06BB04 Hospital Doctors Hospital Use

HEPATITIS B (ADULT)

(stand-by)

VACCINE Immunological

Products and

Vaccines

J07BC01 Hospital Doctors as per

specified department

Floriana

Immunisation

Services, Mater

Dei Hospital

HEPATITIS B

(PAEDIATRIC) (stand-by)

VACCINE Immunological

Products and

Vaccines

J07BC01 Hospital Doctors as per

specified department

Floriana

Immunisation

Services, Mater

Dei Hospital

HUMAN NORMAL

IMMUNOGLOBULIN

INJECTION IM 250mg Immunological

Products and

Vaccines

J06BA02 Hospital Doctors Hospital Use

HUMAN NORMAL

IMMUNOGLOBULIN

(GAMMAGLOBULIN)

INJECTION IV 5-6g Immunological

Products and

Vaccines

J06BA02 Hospital Doctors Hospital Use

HUMAN

PAPILLOMAVIRUS (HPV)

VACCINE Immunological

Products and

Vaccines

J07BM Hospital Doctors as per

specified department

Floriana

Immunisation

Services

Page 56 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

HYALURONIDASE POWDER FOR

SOLUTION FOR

INJECTION

1,500 IU Musculoskeletal and

Joint Diseases

B06AA03 Hospital Doctors Hospital Use

HYDRALAZINE POWDER FOR

SOLUTION FOR

INJECTION

20mg Cardiovascular

System

C02DB02 Hospital Doctors Hospital Use

HYDRALAZINE TABLETS 25mg Cardiovascular

System

C02DB02 Medical Practitioners

HYDROCORTISONE CREAM 1% Skin D07AA02 Medical Practitioners

HYDROCORTISONE FOAM ENEMA 10% Gastro-intestinal

System

A07EA02 Consultant

Gastroenterologists,

Consultant Surgeons,

Consultant Paediatricians,

Consultant Oncologists,

Consultant Palliative Care

Availability

temporarily

suspended

due to

problematic

sourcing.

HYDROCORTISONE OINTMENT 1% Skin D07AA02 Medical Practitioners

HYDROCORTISONE TABLETS 20mg Endocrine System H02AB09 Consultants

HYDROCORTISONE TABLETS 5mg (HALF

SCORED) or

10mg

(QUARTER

SCORED)

Endocrine System H02AB09 Consultant Paediatricians,

Consultant Physicians

HYDROCORTISONE

BUTYRATE

CREAM 0.10% Skin D07AB02 Medical Practitioners

HYDROCORTISONE

BUTYRATE

CREAM FATTY

BASE

0.10% Skin D07AB02 Medical Practitioners

HYDROCORTISONE

SODIUM SUCCINATE

INJECTION 100mg Endocrine System H02AB09 Consultants To be

dispensed from

Hospitals only

HYDROGEN PEROXIDE SOLUTION 6% Ear, Nose and

Oropharynx

A01AB02/

D08AX01

Medical Practitioners

HYDROXOCOBALAMIN

(VITAMIN B12 )

INJECTION 1mg Nutrition and Blood B03BA03 Medical Practitioners

Page 57 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

HYDROXOCOBALAMIN

(VITAMIN B12 ) (stand-by)

INJECTION 5g Antidotes V03AB33 Hospital Doctors Hospital Use

HYDROXYCARBAMIDE

(HYDROXYUREA)

CAPSULES 500mg Malignant Disease

and

Immunosuppression

L01XX05 Consultant Oncologists,

Consultant

Haematologists,

Consultant Paediatricians,

Thalassaemia Clinic

Consultants

HYDROXYCHLOROQUINE TABLETS 200mg Musculoskeletal and

Joint Diseases

P01BA02 Consultants

HYDROXYZINE TABLETS 25mg Central Nervous

System

N05BB01 Medical Practitioners

HYOSCINE

BUTYLBROMIDE

INJECTION 20mg Gastro-intestinal

System

A03BB01 Hospital Doctors Hospital Use/To

be dispensed

from Hospitals

only (Consultant

Palliative Care)

HYOSCINE

BUTYLBROMIDE

TABLETS 10mg Gastro-intestinal

System

A03BB01 Medical Practitioners

HYOSCINE

HYDROBROMIDE

INJECTION 400mcg Gastro-intestinal

System

A04AD01,

N05CM05

Hospital Doctors Hospital Use/To

be dispensed

from Hospitals

only (Consultant

Palliative Care)

HYPROMELLOSE EYE DROPS 0.3% - 0.5% Eye S01KA02 Medical Practitioners

Page 58 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

IBUPROFEN ORAL SUSPENSION 100mg/5mL Musculoskeletal and

Joint Diseases

M01AE01 Consultant Oncologists,

Consultant Paediatric

Oncologists, Consultant

Paediatric Surgeons,

Consultant Paediatricians,

Consultant Palliative Care,

Consultant

Rheumatologists

MP 92

IBUPROFEN TABLETS 200mg Musculoskeletal and

Joint Diseases

M01AE01 Medical Practitioners

IBUPROFEN LYSINE SOLUTION FOR

INJECTION/

POWDER FOR

SOLUTION FOR

INJECTION

10mg/mL Cardiovascular

System

C10EB16 Hospital Doctors Paediatric

Department

IFOSFAMIDE SOLUTION FOR

INJECTION/

POWDER FOR

SOLUTION FOR

INJECTION

2g Malignant Disease

and

Immunosuppression

L01AA06 Consultant Oncologists,

Consultant

Haematologists,

Consultant Paediatricians

Hospital Use MP 93

ILOPROST

TROMETAMOL

INFUSION 20mcg/ml IN ALL Cardiovascular

System

B01AC11 Consultant

Rheumatologists

Hospital Use MP 94

IMATINIB CAPSULES/

TABLETS

100mg Malignant Disease

and

Immunosuppression

L01XE01 Consultant Oncologists,

Consultant

Haematologists,

Consultant Paediatricians

To be

dispensed from

Hospitals only

MP 95

IMIPENEM + CILASTATIN INJECTION 500mg + 500mg Infections J01DH51 Consultants (after

discussion with the Mater

Dei Hospital Antibiotic

Team)

Hospital Use MP 253

Page 59 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

IMIPRAMINE TABLETS 10mg Central Nervous

System

N06AA02 Medical Practitioners

IMIPRAMINE TABLETS 25mg Central Nervous

System

N06AA02 Medical Practitioners

INDIUM-111 LABELLED

OCTREOTIDE

INJECTION Radiopharmaceutic

als

V09IB01 Consultant Radiologists

INDOCYANINE GREEN INJECTION 25mg Eye V04CX Consultant Ophthalmic

Surgeons

 Hospital Use

INDOMETACIN CAPSULES 25mg Musculoskeletal and

Joint Diseases

M01AB01 Medical Practitioners

INFLIXIMAB

(REMICADE®)

POWDER FOR

CONCENTRATE

FOR SOLUTION FOR

INFUSION

100mg Gastro-intestinal

System

L04AB02 Consultant

Gastroenterologists,

Consultant Paediatricians,

Consultant

Rheumatologists,

Consultant Dermatologists

Hospital Use/

Day Clinic

MP 98

INFLIXIMAB

(REMSIMA® or

INFLECTRA®)

POWDER FOR

CONCENTRATE

FOR SOLUTION FOR

INFUSION

100mg Gastro-intestinal

System

L04AB02 Consultant

Gastroenterologists,

Consultant Paediatricians,

Consultant

Rheumatologists,

Consultant Dermatologists

Hospital Use/

Day Clinic

MP 98

INFLUENZA VACCINE Immunological

Products and

Vaccines

J07BB01 Hospital Doctors Floriana

Immunisation

Services

INSULIN ASPART CARTRIDGES 100 UNITS/mL Endocrine System A10AB05 Consultants Endocrinology

and Diabetes

MP 207

Page 60 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

INSULIN BIPHASIC

ISOPHANE (ISOPHANE +

NEUTRAL)

CARTRIDGES (70%, 30%)

100 UNITS/mL

Endocrine System A10AD01 Consultants Endocrinology

and Diabetes, Consultant

Paediatricians

MP 100

INSULIN BIPHASIC

ISOPHANE (ISOPHANE +

NEUTRAL)

INJECTION (70%, 30%)

100 UNITS/mL

Endocrine System A10AD01 Consultants Endocrinology

and Diabetes, Consultant

Paediatricians

INSULIN GLARGINE CARTRIDGES 100 UNITS/mL Endocrine System A10AE04 Consultants Endocrinology

and Diabetes

MP 101

INSULIN ISOPHANE CARTRIDGES 100 UNITS/mL Endocrine System A10AC01 Consultants Endocrinology

and Diabetes, Consultant

Paediatricians

MP 100

INSULIN ISOPHANE INJECTION 100 UNITS/mL Endocrine System A10AC01 Consultants Endocrinology

and Diabetes, Consultant

Paediatricians

INSULIN NEUTRAL

(SOLUBLE INSULIN)

CARTRIDGES 100 UNITS/mL Endocrine System A10AB01 Consultants Endocrinology

and Diabetes, Consultant

Paediatricians

MP 100

INSULIN NEUTRAL

(SOLUBLE INSULIN)

INJECTION 100 UNITS/mL Endocrine System A10AB01 Consultants Endocrinology

and Diabetes, Consultant

Paediatricians

INTERFERON BETA-1a INJECTION 30mcg (6 Million

IU)

Malignant Disease

and

Immunosuppression

L03AB07 Consultant Neurologists

Page 61 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

INTERFERON BETA-1b INJECTION 300mcg (9.6

Million IU)

Malignant Disease

and

Immunosuppression

L03AB08 Consultant Neurologists

INTERFERON GAMMA-1b INJECTION 100mcg Immunological

Products and

Vaccines

L03AB03 Consultant Paediatricians,

Consultant Respiratory

Physicians, Consultant

Infectious Diseases

Physicians

To be

dispensed from

Hospitals only

(TPN patients

only)

MP 104

IODINE-131-

METAIODOBENZYLGUAN

IDINE (MIBG I-131)

INJECTION Radiopharmaceutic

als

V09 Consultant Radiologists

IODIXANOL SOLUTION FOR

INJECTION

320mg

IODINE/ml

Contrast Media V08AB09 Consultant Radiologists Hospital Use MP 233

IPRATROPIUM BROMIDE AEROSOL INHALER 20mcg/DOSE Respiratory System R03BB01 Consultants

IPRATROPIUM BROMIDE NEBULISER

SOLUTION

250mcg/mL Respiratory System R03BB01 Consultants

IRINOTECAN CONCENTRATE

FOR SOLUTION FOR

INFUSION

100mg Malignant Disease

and

Immunosuppression

L01XX19 Consultant Oncologists,

Consultant Paediatric

Oncologists

Hospital Use/

Day Clinic

IRINOTECAN CONCENTRATE

FOR SOLUTION FOR

INFUSION

40mg Malignant Disease

and

Immunosuppression

L01XX19 Consultant Oncologists,

Consultant Paediatric

Oncologists

Hospital Use/

Day Clinic

IRON + FOLIC ACID CAPSULES/

TABLETS

Nutrition and Blood B03AD02 Medical Practitioners

Page 62 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

IRON SUCROSE

(FERRIC HYDROXIDE

WITH SUCROSE)

INJECTION 100mg Nutrition and Blood B03AB04 Hospital Doctors as per

specified department

Gastroenterolog

y Department,

Nephrology

Department, Sir

Anthony Mamo

Oncology

Centre

ISOFLURANE INHALATION

ANAESTHETIC

Anaesthesia N01AB06 Hospital Doctors Hospital Use

ISONIAZID TABLETS 100mg Infections J04AC01 Consultant Infectious

Diseases Physicians,

Paediatric Infectious

Diseases Clinic

Physicians, Consultant

Respiratory Physicians,

Chest Clinic Physicians

To be

dispensed from

Hospitals only

ISONIAZID (stand-by) INJECTION 50mg/2mL Infections J04AC01 Consultants Hospital Use

ISOPRENALINE (stand-

by)

INJECTION 200mcg/1mL Cardiovascular

System

C01CA02 Hospital Doctors as per

specified department

Cardiothoracic

Surgery

ISOPROPYL ALCOHOL GEL Skin D08AX05 Infection Control Policy Hospital Use

ISOPROPYL ALCOHOL HAND RUB Skin D08AX05 Infection Control Policy Hospital Use

ISOSORBIDE DINITRATE INJECTION 1mg/mL Cardiovascular

System

C01DA08 Hospital Doctors Hospital Use

ISOSORBIDE DINITRATE TABLETS 10mg Cardiovascular

System

C01DA08 Medical Practitioners

ISOSORBIDE

MONONITRATE

MODIFIED RELEASE

TABLETS

60mg Cardiovascular

System

C01DA14 Consultant Physicians,

Consultant Cardiologists,

Consultant Cardiac

Surgeons

Page 63 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

ISOSORBIDE

MONONITRATE

TABLETS 20mg Cardiovascular

System

C01DA14 Consultant Physicians,

Consultant Cardiologists,

Consultant Cardiac

Surgeons, Consultant

Gastroenterologists

ISOTRETINOIN CAPSULES/

TABLETS

20mg Skin D10BA01 Consultant Dermatologists

ISPAGHULA HUSK POWDER Gastro-intestinal

System

A06AC01 Medical Practitioners

ITRACONAZOLE CAPSULES 100mg Infections J02AC02 Consultant Paediatricians,

Consultant Oncologists,

Consultant

Haematologists,

Consultant Infectious

Diseases Physicians,

Consultant Geriatricians

MP 108

ITRACONAZOLE ORAL SOLUTION 50mg/5mL Infections J02AC02 Consultant Paediatricians,

Consultant Oncologists,

Consultant

Haematologists,

Consultant Infectious

Diseases Physicians,

Consultant Geriatricians

MP 107

IVERMECTIN TABLETS 3mg Skin P02CF01 Consultants, Senior Public

Health Physicians

KETAMINE INJECTION 50mg/mL IN

10mL

Cardiovascular

System,

Anaesthesia

N01AX03 Hospital Doctors Hospital Use/To

be dispensed

from Hospitals

only if for oral

use (for

malignancy

only)

Page 64 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

KETAMINE INJECTION 50mg/mL IN

2mL

Cardiovascular

System,

Anaesthesia

N01AX03 Hospital Doctors Hospital Use

LABETALOL

HYDROCHLORIDE

INJECTION 5mg/mL IN

20mL

Cardiovascular

System

C07AG01 Hospital Doctors Hospital Use

LABETALOL

HYDROCHLORIDE

TABLETS 100mg Cardiovascular

System

C07AG01 Hospital Doctors

LABETALOL

HYDROCHLORIDE

TABLETS 200mg Cardiovascular

System

C07AG01 Hospital Doctors

LACTULOSE ORAL SOLUTION 3.35g/5mL Gastro-intestinal

System

A06AD11 Consultants

LAMIVUDINE ORAL SOLUTION 50mg/5mL Infections J05AF05 Consultants To be

dispensed from

Hospitals only

MP 256

LAMIVUDINE TABLETS 100mg Infections J05AF05 Consultant

Gastroenterologists,

Consultant Infectious

Diseases Physicians

MP 110

LAMIVUDINE TABLETS 150mg Infections J05AF05 Consultant Infectious

Diseases Physicians,

Consultants Hospital

Infection Control

to be dispensed

from Hospitals

only

MP 99

LAMOTRIGINE DISPERSIBLE

TABLETS

25mg Central Nervous

System

N03AX09 Consultant Paediatricians,

Consultant Neurologists,

Consultant Psychiatrists

Page 65 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

LAMOTRIGINE DISPERSIBLE

TABLETS

5mg Central Nervous

System

N03AX09 Consultant Paediatricians,

Consultant Neurologists,

Consultant Psychiatrists

LAMOTRIGINE TABLETS 100mg Central Nervous

System

N03AX09 Consultant Paediatricians,

Consultant Neurologists,

Consultant Psychiatrists

LAMOTRIGINE TABLETS 25mg Central Nervous

System

N03AX09 Consultant Paediatricians,

Consultant Neurologists,

Consultant Psychiatrists

LAMOTRIGINE TABLETS 50mg Central Nervous

System

N03AX09 Consultant Paediatricians,

Consultant Neurologists,

Consultant Psychiatrists

LANTHANUM CHEWABLE

TABLETS

750mg Nutrition and Blood V03AE03 Consultant Nephrologists MP 273

LEDIPASVIR +

SOFOSBUVIR

TABLETS 90mg + 400mg Infections J05AP51 Consultant

Gastroenterologist (HCV

Patient Management

Committee), Consultant

Infectious Disease

Physician (HCV Patient

Management Committee)

To be

dispensed from

Hospitals only

MP 112

LEFLUNOMIDE TABLETS 10mg Musculoskeletal and

Joint Diseases

L04AA13 Consultant

Rheumatologists

MP 113

LEFLUNOMIDE TABLETS 20mg Musculoskeletal and

Joint Diseases

L04AA13 Consultant

Rheumatologists

MP 113

LENALIDOMIDE CAPSULES 25mg Malignant Disease

and

Immunosuppression

L04AX04 Consultant Oncologists,

Consultant Haematologists

To be

dispensed from

Hospitals only

MP 263

Page 66 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

LETROZOLE CAPSULES/

TABLETS

2.5mg Malignant Disease

and

Immunosuppression

L02BG04 Consultant Oncologists

LEUPRORELIN INJECTION 3.75mg Endocrine System L02AE02 Consultant Paediatricians,

Consultants Endocrinology

and Diabetes, Consultants

Endocrinology

(Transgender MDT)

MP 114

LEVETIRACETAM ORAL SOLUTION 100mg/mL Central Nervous

System

N03AX14 Consultant Paediatricians,

Consultant Palliative Care,

Consultant Neurologists

MP 116

LEVETIRACETAM TABLETS 500mg Central Nervous

System

N03AX14 Consultant Paediatricians,

Consultant Palliative Care,

Consultant Neurologists

MP 115

LEVETIRACETAM TABLETS 1000mg Central Nervous

System

N03AX14 Consultant Paediatricians,

Consultant Palliative Care,

Consultant Neurologists

MP 115

LEVETIRACETAM CONCENTRATE

FOR SOLUTION FOR

INFUSION

500mg/5mL Central Nervous

System

N03AX14 Consultant Neurologists,

Consultant Anaesthetists

(ITU), Consultants

Emergency Medicine,

Consultant Paediatricians

Hospital Use MP 226

LEVODOPA +

BENSERAZIDE

HYDROCHLORIDE

CAPSULES 100mg + 25mg Central Nervous

System

N04BA02 Medical Practitioners

Page 67 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

LEVODOPA +

BENSERAZIDE

HYDROCHLORIDE

CAPSULES 50mg + 12.5mg Central Nervous

System

N04BA02 Medical Practitioners

LEVODOPA +

BENSERAZIDE

HYDROCHLORIDE

CAPSULES/

TABLETS

200mg + 50mg Central Nervous

System

N04BA02 Medical Practitioners

LEVODOPA +

BENSERAZIDE

HYDROCHLORIDE

DISPERSIBLE

TABLETS

100mg + 25mg Central Nervous

System

N04BA02 Consultant Geriatricians,

Consultant Neurologists

MP 118

LEVOFLOXACIN SOLUTION FOR

INTRAVENOUS

INFUSION

500mg Infections J01MA12 Consultant Physicians Hospital Use MP 173

LEVOFLOXACIN TABLETS 500mg Infections J01MA12 Consultant Physicians,

Mater Dei Hospital

Antibiotic Team

Consultants

MP 173

LEVOMEPROMAZINE

(stand-by)

INJECTION 25mg/mL Central Nervous

System

N05AA02 Consultant

Haematologists,

Consultant Oncologists,

Consultant Paediatric

Oncologists, Consultant

Paediatricians, Consultant

Palliative Care

Hospital Use MP 286

LEVOMEPROMAZINE

(stand-by)

TABLETS 25mg Central Nervous

System

N05AA02 Consultant

Haematologists,

Consultant Oncologists,

Consultant Paediatric

Oncologists, Consultant

Paediatricians, Consultant

Palliative Care

MP 287

LEVOTHYROXINE

(THYROXINE )

TABLETS 100mcg Endocrine System H03AA01 Medical Practitioners

LEVOTHYROXINE

(THYROXINE )

TABLETS 50mcg Endocrine System H03AA01 Medical Practitioners

Page 68 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

LIDOCAINE

(LIGNOCAINE)

HYDROCHLORIDE

GEL 2% Skin D04AB01 Hospital Doctors

LIDOCAINE

(LIGNOCAINE)

HYDROCHLORIDE

INJECTION 0.2% in 5%

GLUCOSE

Cardiovascular

System

C01BB01 Hospital Doctors Hospital Use

LIDOCAINE

(LIGNOCAINE)

HYDROCHLORIDE

INJECTION 1% IN 20mL Anaesthesia N01BB02 Hospital Doctors Hospital Use

LIDOCAINE

(LIGNOCAINE)

HYDROCHLORIDE

INJECTION 2% IN 20mL Anaesthesia N01BB02 Hospital Doctors Hospital Use

LIDOCAINE

(LIGNOCAINE)

HYDROCHLORIDE

INJECTION 2% IN 5mL Anaesthesia N01BB02 Hospital Doctors Hospital Use

LIDOCAINE

(LIGNOCAINE)

HYDROCHLORIDE

INJECTOR KIT 4% IN 4mL Anaesthesia N01BB02 Hospital Doctors as per

specified department

LIDOCAINE

(LIGNOCAINE)

HYDROCHLORIDE

PRE-FILLED

SYRINGES

2% (100mg/5mL) Cardiovascular

System

C01BB01 Hospital Doctors Hospital Use Availability

temporarily

suspended

due to

problematic

sourcing.

LIDOCAINE

(LIGNOCAINE)

HYDROCHLORIDE

SPRAY 10% Skin D04AB01 Consultants Hospital Use

LIDOCAINE

(LIGNOCAINE)

HYDROCHLORIDE

TOPICAL SOLUTION 4% Anaesthesia N01BB02 Hospital Doctors as per

specified department

Endoscopy

Department,

Day Surgery

Unit

Page 69 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

LIDOCAINE

(LIGNOCAINE)

HYDROCHLORIDE +

ADRENALINE

DENTAL

CARTRIDGE

2% + <

1:125,000

Anaesthesia N01BB52 Hospital Doctors as per

specified department

Dental

Department

LIDOCAINE

(LIGNOCAINE)

HYDROCHLORIDE +

ADRENALINE

INJECTION 2% + 1:200,000 Anaesthesia N01BB52 Hospital Doctors Hospital Use

LIDOCAINE

(LIGNOCAINE)

HYDROCHLORIDE +

ADRENALINE

INJECTION 1% + 1:200,000 Anaesthesia N01BB52 Hospital Doctors Hospital Use

LIDOCAINE

(LIGNOCAINE)

HYDROCHLORIDE +

PRILOCAINE

CREAM 25mg + 25mg

(5%)

Skin N01BB52,

N01BB54

Hospital Doctors as per

specified department

LINEZOLID SOLUTION FOR

INTRAVENOUS

INFUSION/ POWDER

FOR SOLUTION FOR

INTRAVENOUS

600mg Infections J01XX08 Mater Dei Hospital

Antibiotic Team

Consultants

Hospital Use MP 283

LINEZOLID TABLETS 600mg Infections J01XX08 Mater Dei Hospital

Antibiotic Team

Consultants

Hospital Use MP 283

LIOTHYRONINE SODIUM

(L-TRI-IODOTHYRONINE

SODIUM)

POWDER FOR

SOLUTION FOR

INJECTION

20mcg Endocrine System H03AA02 Hospital Doctors Hospital Use

LIOTHYRONINE SODIUM

(L-TRI-IODOTHYRONINE

SODIUM)

TABLETS 25mcg Endocrine System H03AA02 Consultants MP 242

LISINOPRIL TABLETS 10mg Cardiovascular

system

C09AA03 Consultants

LISINOPRIL TABLETS 5mg Cardiovascular

system

C09AA03 Consultants

Page 70 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

LITHIUM CARBONATE TABLETS 400mg Central Nervous

System

N05AN01 Medical Practitioners

LITHIUM CITRATE

TETRAHYDRATE

ORAL LIQUID 509mg/5mL

(equivalent to

200mg lithium

carbonate)

Central Nervous

System

N05AN01 Consultant Psychiatrists MP 120

LOMUSTINE CAPSULES 40mg Malignant Disease

and

Immunosuppression

L01AD02 Consultant

Haematologists,

Consultant Oncologists,

Consultant Paediatric

Oncologists,

Consultant Paediatricians

To be

dispensed from

Hospitals only

LONG ACTING BETA2-

AGONIST FOR CHILDREN

AGED 4 - 12 YEARS

(FORMOTEROL OR

SALMETEROL)

INHALER Respiratory System R03AC12/

R03AC13

Consultant Respiratory

Physicians, Consultant

Paediatricians, Specialist

Respiratory Medicine

Consultants

MP 270

LONG ACTING BETA2-

AGONIST FOR PATIENTS

OVER 12 YEARS

(FORMOTEROL OR

SALMETEROL)

INHALER Respiratory System R03AC12/

R03AC13

Consultant Respiratory

Physicians, Consultant

Paediatricians, Specialist

Respiratory Medicine

Consultants, Consultant

Geriatricians

MP 271

LOPERAMIDE

HYDROCHLORIDE

CAPSULES 2mg Gastro-intestinal

System

A07DA03 Medical Practitioners

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

LOPINAVIR + RITONAVIR CAPSULES/

TABLETS

200mg + 50mg Infections J05AR10 Consultant Infectious

Diseases Physicians,

Consultant Hospital

Infection Control

Physicians, GU Clinic

Consultants, Emergency

Medicine Physicians,

Gynaecologists, Infectious

Diseases Specialists

To be

dispensed from

Hospitals only

MP 221

LOPINAVIR + RITONAVIR ORAL SOLUTION 400mg + 100mg

per 5mL

Infections J05AR10 Consultant Paediatricians,

Consultant Infectious

Diseases Physicians

To be

dispensed from

Hospitals only

MP 257

LORAZEPAM INJECTION

IM & IV

4mg/mL Central Nervous

System

N05BA06 Hospital Doctors Accident and

Emergency

Department,

Intensive Care

Unit, Psychiatric

Department,

Neurological

Wards

LORAZEPAM TABLETS 1mg Central Nervous

System

N05BA06 Medical Practitioners

LORAZEPAM TABLETS 2mg Central Nervous

System

N05BA06 Medical Practitioners

LOW PROTEIN BREAD Food Supplements V06 Consultants

LOW PROTEIN CRACKER

BREAD

Food Supplements V06 Consultants

LOW PROTEIN

FLAVOURED BISCUITS

Food Supplements V06 Consultants

LOW PROTEIN FLOUR Food Supplements V06 Consultants

Page 72 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

LOW PROTEIN PASTA Food Supplements V06 Consultants

LOW PROTEIN PLAIN

BISCUITS

200g Food Supplements V06 Consultants

LUBRICATING JELLY GEL Obstetrics,

Gynaecology and

Urinary Tract

Disorders

V07AY Hospital Doctors

MAGNESIUM

GLYCEROPHOSPHATE

TABLETS 97.2mg (4mmol) Nutrition and Blood A12CC Consultant

Gastroenterologists,

Consultant

Haematologists,

Consultant Nephrologists,

Consultant Oncologists,

Consultant Paediatricians

To be

dispensed from

Hospitals only

MP 122

MAGNESIUM HYDROXIDE

+ ALUMINIUM

HYDROXIDE +

SIMETICONE

ORAL SUSPENSION Gastro-intestinal

System

A02AX Medical Practitioners

MAGNESIUM HYDROXIDE

MIXTURE

ORAL SUSPENSION Gastro-intestinal

System

A02AA04 Medical Practitioners

MAGNESIUM SULPHATE PASTE Skin D11AX05 Medical Practitioners

MAGNESIUM SULPHATE SOLUTION FOR

INJECTION

20% IN 20mL Nutrition and Blood B05XA05 Hospital Doctors Hospital Use

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

MAGNESIUM SULPHATE SOLUTION FOR

INJECTION

50% IN 10mL Nutrition and Blood B05XA05 Hospital Doctors Hospital Use

MALATHION LIQUID 0.5% W/W Skin P03AX03 Medical Practitioners

MANNITOL INFUSION IV 10% Cardiovascular

System

B05BC01 Hospital Doctors Hospital Use

MANNITOL INFUSION IV 15% - 20% Cardiovascular

System

B05BC01 Hospital Doctors Hospital Use

MAPROTILINE

HYDROCHLORIDE

TABLETS 25mg Central Nervous

System

N06AA21 Hospital Doctors

MARAVIROC TABLETS 300mg Infections J05AX09 Consultant Infectious

Diseases Physicians

To be

dispensed from

Hospitals only

MP 121

MEASLES + MUMPS +

RUBELLA (MMR)

VACCINE Immunological

Products and

Vaccines

J07BX Hospital Doctors as per

specified department

Floriana

Immunisation

Services

MEBENDAZOLE CHEWABLE

TABLETS

100mg Infections P02CA01 Consultants

MEBENDAZOLE ORAL SUSPENSION 2% Infections P02CA01 Consultants

MEBEVERINE

HYDROCHLORIDE

TABLETS 135mg Gastro-intestinal

System

A03AA04 Medical Practitioners Availability

temporarily

suspended

due to

problematic

sourcing.

MEBROFENIN INJECTION 40mg Radiopharmaceutic

als

V09DA04 Consultant Radiologists

MEDICAL AIR

(COMPRESSED AIR )

GAS Respiratory System V03AN Hospital Doctors Hospital Use

MEDICAL OXYGEN GAS 1.5m3 Respiratory System V03AN01 Medical Practitioners

MEDICAL OXYGEN

0.55m3

GAS Respiratory System V03AN01 Hospital Doctors Hospital Use

Page 74 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

MEDICAL OXYGEN 7m3 GAS Respiratory System V03AN01 Hospital Doctors Hospital Use

MEDRONIC ACID

(METHYLENE

DIPHOSPHONATE)

INJECTION Radiopharmaceutic

als

V09BA02 Consultant Radiologists

MEDROXYPROGESTERO

NE ACETATE

TABLETS 100mg Malignant Disease

and

Immunosuppression

L02AB02 Consultants, Consultants

Endocrinology

(Transgender MDT)

MEDROXYPROGESTERO

NE ACETATE

TABLETS 5mg Endocrine System,

Malignant Disease

and

Immunosuppression

G03AC06,

L02AB02

Hospital Doctors,

Consultants Endocrinology

(Transgender MDT)

MEFENAMIC ACID CAPSULES 250mg Musculoskeletal and

Joint Diseases

M01AG01 Medical Practitioners

MEFLOQUINE TABLETS 250mg Infections P01BC02 Medical Practitioners (as

per ‘Dispensing of Oral

Antimalarials to Out-

Patients’ [refer to page 10

on Out-Patients Formulary]

or against payment)

MELOXICAM TABLETS 7.5mg Musculoskeletal and

Joint Diseases

M01AC06 Consultant

Rheumatologists,

Consultant Palliative Care,

Consultant Oncologists,

Consultant Geriatricians

MP 45

MELPHALAN TABLETS 2mg Malignant Disease

and

Immunosuppression

L01AA03 Consultants

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

MENADIOL SODIUM

PHOSPHATE

TABLETS 10mg Malignant Disease

and

Immunosuppression

B02BA02 Consultants Availability

temporarily

suspended

due to

problematic

sourcing.

MENINGOCOCCAL

GROUP C CONJUGATE

VACCINE Immunological

Products and

Vaccines

J07AH07 Consultants Hospital Use

MENINGOCOCCAL

QUADRIVALENT

CONJUGATE (A, C, W135

and Y)

VACCINE Immunological

Products and

Vaccines

J07AH08 Consultants, Consultant

Microbiologists,

Consultants Hospital

Infection Control

Hospital Use,

Floriana

Immunisation

Services

MP 131

MENTHOL + AQUEOUS

CREAM

CREAM Skin EXTEMP1 Consultant Dermatologists To be

dispensed from

Hospitals only

MEPACRINE

HYDROCHLORIDE

TABLETS 100mg Infections P01AX05 Consultant Physicians To be

dispensed from

Hospitals only

MP 123

MERCAPTOPURIN TABLETS 50mg Malignant Disease

and

Immunosuppression

L01BB02 Consultants

MEROPENEM INJECTION 1g Infections J01DH02 Consultants (after

discussion with the Mater

Dei Hospital Antibiotic

Team)

Hospital Use MP 253

MEROPENEM INJECTION 500mg Infections J01DH02 Consultants (after

discussion with the Mater

Dei Hospital Antibiotic

Team)

Hospital Use MP 253

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

MESALAZINE FOAM/ RETENTION

ENEMA

1g Gastro-intestinal

System

A07EC02 Consultant

Gastroenterologists,

Consultant Surgeons,

Consultant Paediatricians

MESALAZINE SUPPOSITORIES 500mg Gastro-intestinal

System

A07EC02 Consultant

Gastroenterologists,

Consultant Surgeons,

Consultant Paediatricians

MESALAZINE (ACTIVE

INGREDIENT RELEASED

FROM DUODENUM TO

RECTUM )

MODIFIED RELEASE

TABLETS

500mg Gastro-intestinal

System

A07EC02 Consultant

Gastroenterologists,

Consultant Surgeons,

Consultant Paediatricians

MP 125

MESALAZINE (ACTIVE

INGREDIENT RELEASED

AT pH ≥7)

MODIFIED RELEASE

TABLETS

400mg Gastro-intestinal

System

A07EC02 Consultant

Gastroenterologists,

Consultant Surgeons,

Consultant Paediatricians

MP 124

Availability

temporarily

suspended

MESALAZINE (e.g.

PENTACOL®, ASACOL®,

OCTASA®)

MODIFIED RELEASE

TABLETS

400mg Gastro-intestinal

System

A07EC02 Consultant

Gastroenterologists,

Consultant Surgeons,

Consultant Paediatricians

MESNA (stand-by) INJECTION 100mg/mL IN

10mL

Antidotes, Malignant

Disease and

Immunosuppression

V03AF01 Hospital Doctors as per

specified department

Oncology

Department,

Haematology

Department,

Paediatric

Oncology

Department

METFORMIN

HYDROCHLORIDE

CAPSULES/

TABLETS

500mg Endocrine System A10BA02 Medical Practitioners

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

METHADONE HCl

MIXTURE

ORAL SOLUTION 5mg/5mL Central Nervous

System

N07BC02 Hospital Doctors as per

specified department

Detox Clinic

METHADONE

HYDROCHLORIDE

TABLETS 5mg Central Nervous

System

N07AC52 Designated Consultant as

appointed by DGPHR

Detox Clinic

METHOTREXATE SOLUTION FOR

INJECTION IV

1g Malignant Disease

and

Immunosuppression

L01BA01,

L04AX03

Hospital Doctors Haematology

Department,

Oncology

Department/

Day Clinic,

Paediatric

Oncology

Department

METHOTREXATE SOLUTION FOR

INJECTION IV, IM &

INTRATHECAL

50mg Malignant Disease

and

Immunosuppression

L01BA01,

L04AX03

Consultant

Gastroenterologists,

Consultant

Haematologists,

Consultant Oncologists,

Consultant Paediatric

Oncologists

Hospital Use/

Day Clinic

METHOTREXATE SOLUTION FOR

INJECTION IV, IM &

INTRATHECAL

5mg Malignant Disease

and

Immunosuppression

L01BA01,

L04AX03

Consultant

Haematologists,

Consultant Oncologists,

Consultant Paediatric

Oncologists

Hospital Use/

Day Clinic

METHOTREXATE TABLETS 2.5mg Malignant Disease

and

Immunosuppression

L01BA01,

L04AX03

Consultants

METHOXSALEN CAPSULES/

TABLETS

10mg Skin D05BA02 Consultant Dermatologists

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

METHOXSALEN LOTION 1.2% Skin D05AD02   Consultant Dermatologists

METHYLDOPA TABLETS 250mg Cardiovascular

System

C02AB Medical Practitioners

METHYLPHENIDATE

HYDROCHLORIDE

PROLONGED

RELEASE TABLETS

18mg Central Nervous

System

N06BA04 Consultant Paediatricians

(Community Paediatrics),

Consultant Paediatricians

(Paediatric Neurology and

Neurodisability),

Consultant Psychiatrists

MP 126

METHYLPHENIDATE

HYDROCHLORIDE

PROLONGED

RELEASE TABLETS

36mg Central Nervous

System

N06BA04 Consultant Paediatricians

(Community Paediatrics),

Consultant Paediatricians

(Paediatric Neurology and

Neurodisability),

Consultant Psychiatrists

MP 126

METHYLPHENIDATE

HYDROCHLORIDE

TABLETS 10mg Central Nervous

System

N06BA04 Consultant Psychiatrists,

Consultant Paediatricians

METHYLPREDNISOLONE TABLETS 4mg Endocrine System H02AB04 Consultant Dermatologists

METHYLPREDNISOLONE

(as SODIUM SUCCINATE

or HEMISUCCINATE)

INJECTION

IM & IV

40mg Endocrine System H02AB04 Consultants

METHYLPREDNISOLONE

(as SODIUM SUCCINATE)

INJECTION

IM & IV

500mg Endocrine System H02AB04 Consultants

METHYLPREDNISOLONE

ACETATE

INJECTION IM 40mg/ml Endocrine System H02AB04 Consultants

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

METHYLSALICYLATE CREAM IN HEAVY

KAOLIN (KAOLIN

POULTICE)

Musculoskeletal and

Joint Diseases

M02AX Hospital Doctors Hospital Use Availability

temporarily

suspended

due to

manufacturing

issues

METHYLTHIONINIUM

CHLORIDE (METHYLENE

BLUE) (stand-by)

INJECTION 5mg/mL Antidotes V03AB17 Hospital Doctors as per

specified department

Theatres,

Endoscopy

Department,

Oncology

Department

METOCLOPRAMIDE INJECTION

IM & IV

10mg/2mL Gastro-intestinal

System

A03FA01 Hospital Doctors

(Consultant Oncologists or

Consultant Palliative Care

for Out-Patient Use)

Hospital

Use/Hospital

dispensing only

METOCLOPRAMIDE TABLETS 10mg Gastro-intestinal

System

A03FA01 Medical Practitioners

METOLAZONE

TARTRATE

TABLETS 5mg Cardiovascular

System

C03BA08 Consultant Cardiac

Surgeons, Consultant

Physicians

MP 128

METOPROLOL

TARTRATE

INJECTION 1mg/mL Cardiovascular

System

C07AB02 Hospital Doctors as per

specified department

Ophthalmic

Department,

Cardiac

Department

METOPROLOL

TARTRATE

SCORED TABLETS 100mg Cardiovascular

System

C07AB02 Consultants

METRONIDAZOLE GEL 0.75% Skin D06BX01 Consultant Oncologists,

Consultant Dermatologists,

Consultant Palliative Care

MP 129

METRONIDAZOLE INJECTION 500mg Infections J01XD01 Hospital Doctors Hospital Use

METRONIDAZOLE ORAL SUSPENSION 200mg/5mL Infections P01AB01 Medical Practitioners

METRONIDAZOLE SUPPOSITORIES 500mg Infections P01AB01 Medical Practitioners

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

METRONIDAZOLE TABLETS 200mg Infections P01AB01 Medical Practitioners, GU

Clinic Consultants

MEXILETINE CAPSULES 200mg Cardiovascular

System

Consultant Cardiologists MP 142

MIANSERIN TABLETS 10mg Central Nervous

System

N06AX03 Medical Practitioners

MIANSERIN TABLETS 30mg Central Nervous

System

N06AX03 Medical Practitioners

MICONAZOLE +

HYDROCORTISONE

CREAM 2% + 1% Skin D01AC52,

D07XA01

Consultant Dermatologists,

Consultant Geriatricians

MICONAZOLE +

HYDROCORTISONE

BUTYRATE

CREAM 1:1 Skin EXTEMP2 Consultant Dermatologists To be

dispensed from

Hospitals only

MICONAZOLE NITRATE CREAM 2% Skin D01AC02 Medical Practitioners

MICRO-ENEMA

(CURRENTLY SODIUM

CITRATE COMPOUND)

MICRO-ENEMA Gastro-intestinal

System

A06AG11 Consultant Oncologists To be

dispensed from

Sir Anthony

Mamo

Oncology

Centre

Pharmacy only

MP 130

MIDAZOLAM SOLUTION FOR

INJECTION

10mg IN 2mL

AND 5mL VIALS

Central Nervous

System

N05CD08 Hospital Doctors Hospital Use

MILK SUBSTITUTE e.g.

PREGESTIMIL®

LIPIL -

(HYDROLYSATE

FORMULA)

POWDER Food Supplements V06DF Hospital Doctors

MILK SUBSTITUTE e.g.

SMA®

WYSOY - (SOYA-

BASED FORMULA)

POWDER Food Supplements V06DF Hospital Doctors

Page 81 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

MILRINONE (stand-by) SOLUTION FOR

INJECTION

10mg/10mL Cardiovascular

System

C01CE02 Hospital Doctors as per

specified department

Cardiac

Intensive Care

Unit.

MISOPROSTOL TABLETS 200mcg Gastro-intestinal

System

A02BB01 Consultant

Rheumatologists,

Consultant

Gastroenterologists,

Consultants Obstetrics and

Gynaecology, Consultant

Cardiologists, Consultant

Cardiac Surgeons

MP 132

MITOMYCIN C INJECTION 10mg Malignant Disease

and

Immunosuppression

L01DC03 Consultant

Haematologists,

Consultant Oncologists,

Consultant

Ophthalmologists,

Consultant Paediatricians,

Consultant Urologists

Hospital Use/

Day Clinic

MITOMYCIN C POWDER FOR

SOLUTION FOR

INJECTION

40mg Malignant Disease

and

Immunosuppression

L01DC03 Consultant Urologists Hospital Use MP 138

MITOXANTRONE

HYDROCHLORIDE

SOLUTION FOR

INFUSION

20mg Malignant Disease

and

Immunosuppression

L01DB07 Consultant Oncologists,

Consultant

Haematologists,

Consultant Paediatricians

Hospital Use/

Day Clinic

MP 133

MIVACURIUM CHLORIDE INJECTION 10mg/5mL Anaesthesia M03AC10 Hospital Doctors as per

specified department

Paediatric

Department,

Thalasseamia

Clinic

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

MOCLOBEMIDE TABLETS 150mg Central Nervous

System

N06AG02 Consultant Psychiatrists MP 134

MOMETASONE FUROATE CREAM 0.10% Skin D07AC13 Consultant Dermatologists

MOMETASONE FUROATE OINTMENT 0.1% Skin D07AC13 Consultant Dermatologists

MONTELUKAST CHEWABLE

TABLETS

4mg Respiratory System R03DC03 Consultant Respiratory

Physicians, Consultant

Paediatricians

MP 295

MONTELUKAST CHEWABLE

TABLETS

5mg Respiratory System R03DC03 Consultant Respiratory

Physicians, Consultant

Paediatricians

MP 295

MONTELUKAST TABLETS 10mg Respiratory System R03DC03 Consultant Respiratory

Physicians, Consultant

Paediatricians

MP 295

MORPHINE SULFATE MODIFIED RELEASE

TABLETS

100mg Central Nervous

System

N02AA01 Hospital Doctors

MORPHINE SULFATE MODIFIED RELEASE

TABLETS

10mg Central Nervous

System

N02AA01 Hospital Doctors

MORPHINE SULFATE MODIFIED RELEASE

TABLETS

30mg Central Nervous

System

N02AA01 Hospital Doctors

MORPHINE SULFATE MODIFIED RELEASE

TABLETS

60mg Central Nervous

System

N02AA01 Hospital Doctors

MORPHINE SULFATE ORAL SOLUTION 10mg/5mL Central Nervous

System

N02AA01 Hospital Doctors

MORPHINE SULFATE/

HYDROCHLORIDE

INJECTION 15mg/mL Central Nervous

System

N02AA01 Hospital Doctors

MORPHINE SULFATE/

HYDROCHLORIDE

INJECTION 20mg/mL Central Nervous

System

N02AA01 Hospital Doctors

MORPHINE SULFATE/

HYDROCHLORIDE

(CURRENTLY

WOCKHARDT )

INJECTION 10mg/mL Central Nervous

System

N02AA01 Hospital Doctors

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

MORPHINE SULFATE/

HYDROCHLORIDE (for

PAEDIATRIC USE -

CURRENTLY MERCURY

PHARMA )

INJECTION 10mg/mL Central Nervous

System

N02AA01 Hospital Doctors

MORPHINE SULPHATE INJECTION 30mg/mL Central Nervous

System

N02AA01 Hospital Doctors

MOXIFLOXACIN TABLETS 400mg Infections J01MA14 Consultant Infectious

Diseases Physicians

To be

dispensed from

Hospitals only

MP 250

MULTIVITAMIN +

MINERAL PREPARATION

(KETOVITE® )

ORAL LIQUID Nutrition and Blood A11AA03 Consultant Paediatricians,

Consultant Physicians,

Consultant

Gastroenterologists

MP 137

MULTIVITAMIN +

MINERAL PREPARATION

(KETOVITE®)

TABLETS Nutrition and Blood A11AA03 Consultant Paediatricians,

Consultant Physicians,

Consultant

Gastroenterologists

MP 136

MULTIVITAMINS (WATER

SOLUBLE) FOR TPN FOR

CHILDREN ≤ 11 YEARS

ONLY

POWDER FOR

SOLUTION FOR

INJECTION

Nutrition and Blood A11BA Hospital Doctors Hospital Use

MULTIVITAMINS

(ABIDEC® )

ORAL DROPS Nutrition and Blood A11BA Consultant Paediatricians MP 135

MULTIVITAMINS

(CERNEVIT® ) FOR TPN

FOR ADULTS AND

CHILDREN OVER 11

YEARS

POWDER FOR

SOLUTION FOR

INJECTION OR

INFUSION

Nutrition and Blood A11BA Consultants To be

dispensed from

Hospitals only

(TPN patients

only)

MUPIROCIN NASAL OINTMENT 2% Ear, Nose and

Oropharynx

R01AX06 Consultants Hospital

Infection Control

Hospital Use MP 139

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Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

MUPIROCIN OINTMENT 2% Skin D06AX09 Consultant Dermatologists Hospital Use MP 297

MYCOPHENOLATE

MOFETIL

ORAL SUSPENSION 1g/5mL Malignant Disease

and

Immunosuppression

L04AA06 Consultant Nephrologists,

Consultant Paediatricians,

Consultant Cardiac

Surgeons, Consultant

Gastroenterologists

MP 141

MYCOPHENOLATE

MOFETIL (stand-by)

POWDER FOR

CONCENTRATE

FOR SOLUTION FOR

INFUSION

500mg Malignant Disease

and

Immunosuppression

L04AA06 Consultant Nephrologists Hospital Use MP 272

MYCOPHENOLATE

SODIUM

ENTERIC-COATED

TABLETS

180mg Malignant Disease

and

Immunosuppression

L04AA06 Consultant Nephrologists,

Consultant Paediatricians

(Paediatric Nephrology)

MP 140

MYCOPHENOLATE

SODIUM

ENTERIC-COATED

TABLETS

360mg Malignant Disease

and

Immunosuppression

L04AA06 Consultant Nephrologists,

Consultant Paediatricians

(Paediatric Nephrology)

MP 140

N-ACETYLCYSTEINE CAPSULES/

TABLETS

600mg Antidotes V03AB Consultant Surgeons,

Consultant Physicians,

Consultant Respiratory

Physicians

To be

dispensed from

Mater Dei

Hospital only

MP 252

NALOXONE

HYDROCHLORIDE (stand-

by)

INJECTION 400mcg/mL Antidotes V03AB15 Hospital Doctors Hospital Use

NALTREXONE

HYDROCHLORIDE

TABLETS 50mg Central Nervous

System

N07BB04 Consultant Psychiatrists

NANDROLONE

DECANOATE (stand-by)

OILY INJECTION 50mg/mL Endocrine System A14AB01 Consultants Hospital Use

NAPROXEN TABLETS 250mg Musculoskeletal and

Joint Diseases

M01AE02 Medical Practitioners

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

NATALIZUMAB CONCENTRATE

FOR SOLUTION FOR

INFUSION

300mg Central Nervous

System

L04AA23 Consultant Neurologist Hospital Use MP 251

NEONATAL

MAINTENANCE

PARENTERAL NUTRITION

- AQUEOUS PART (stand-

by)

INTRAVENOUS

NUTRITION

Nutrition and Blood B05BA Hospital Doctors as per

specified department

NPICU

NEONATAL START-UP

PARENTERAL NUTRITION

- AQUEOUS PART (stand-

by)

INTRAVENOUS

NUTRITION

Nutrition and Blood B05BA Hospital Doctors as per

specified department

NPICU

NEOSTIGMINE

METHYLSULPHATE

INJECTION 0.5mg/mL Musculoskeletal and

Joint Diseases,

Anaesthesia

N07AA01 Hospital Doctors Hospital Use

NEOSTIGMINE

METILSULFATE

INJECTION 2.5mg/mL Musculoskeletal and

Joint Diseases,

Anaesthesia

N07AA01 Hospital Doctors Hospital Use

NEVIRAPINE ORAL SUSPENSION 50mg/5mL Infections J05AG01 Consultant Paediatricians,

Consultant Infectious

Diseases Physicians

To be

dispensed from

Hospitals only

MP 258

NEVIRAPINE TABLETS 200mg Infections J05AG01 Consultant Infectious

Diseases Physicians

To be

dispensed from

Hospitals only

MP 143

NICLOSAMIDE (stand-by) TABLETS 0.5g Infections P02DA01 Consultant Infectious

Diseases Physicians

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Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

NICORANDIL TABLETS 10mg Cardiovascular

System

C01DX16 Consultant Physicians,

Consultant Cardiologists

MP 144

Availability

temporarily

suspended

due to

problematic

sourcing.

NICOTINAMIDE CAPSULES/

TABLETS

250mg Nutrition and Blood A11HA01 Consultant Dermatologists

NIFEDIPINE CAPSULES/

TABLETS

10mg Cardiovascular

System

C08CA05 Consultants

NIFEDIPINE MODIFIED RELEASE

CAPSULES/

TABLETS

20mg Cardiovascular

System

C08CA05 Consultants

NIFEDIPINE MODIFIED RELEASE

TABLETS

10mg Cardiovascular

System

C08CA05 Consultants

NIMODIPINE CAPSULES/

TABLETS

30mg Cardiovascular

System

C08CA06 Consultant Neurologists,

Consultant Anaesthetists

(ITU), Consultants

Emergency Medicine

MP 146

NIMODIPINE INJECTION 200mcg/mL IN

50mL

Cardiovascular

System

C08CA06 Consultant Neurologists,

Consultant Anaesthetists

(ITU), Consultants

Emergency Medicine

Hospital Use MP 146

NITAZOXANIDE ORAL SUSPENSION 100mg/5mL Infections P01AX11 Consultant Infectious

Diseases Physicians,

Mater Dei Hospital

Antibiotic Team

Consultants, Consultant

Gastroenterologists

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Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

NITAZOXANIDE TABLETS 500mg Infections P01AX11 Consultant Infectious

Diseases Physicians,

Mater Dei Hospital

Antibiotic Team

Consultants, Consultant

Gastroenterologists

NITRAZEPAM TABLETS 5mg Central Nervous

System

N05CD02 Medical Practitioners

NITROFURANTOIN CAPSULES/

TABLETS

50mg Infections J01XE01 Medical Practitioners

NITROFURANTOIN ORAL SUSPENSION 25mg/5mL Infections J01XE01 Medical Practitioners

NITROUS OXIDE GAS Anaesthesia N01AX13 Hospital Doctors Hospital Use

NITROUS OXIDE +

OXYGEN

GAS 50% + 5% Anaesthesia N01AX63 Hospital Doctors Hospital Use

NIVOLUMAB CONCENTRATE

FOR SOLUTION FOR

INFUSION

40mg/4mL Malignant Disease

and

Immunosuppression

L01XC17 Consultant Oncologists,

Consultant Haematologists

Hospital Use

NIVOLUMAB CONCENTRATE

FOR SOLUTION FOR

INFUSION

100mg/10mL Malignant Disease

and

Immunosuppression

L01XC17 Consultant Oncologists,

Consultant Haematologists

Hospital Use

NORADRENALINE ACID

TARTRATE

INJECTION 2mg/mL

(equivalent to

1mg/mL

Noradrenaline

Base)

Cardiovascular

System

C01CA03 Hospital Doctors Hospital Use

NORETHISTERONE TABLETS 5mg Endocrine System G03DC02 Hospital Doctors

NORFLOXACIN TABLETS 400mg Infections J01MA06 Consultants

NORTRIPTYLINE TABLETS 10mg Central Nervous

System

N06AA10 Medical Practitioners

NORTRIPTYLINE TABLETS 25mg Central Nervous

System

N06AA10 Medical Practitioners

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

NYSTATIN ORAL SUSPENSION 100000 IU Infections A07AA02 Medical Practitioners

OCTREOTIDE INJECTION 200mcg/mL

(MULTIDOSE)

Malignant Disease

and

Immunosuppression

H01CB02 Consultants Emergency

Medicine, Consultants

Endocrinology and

Diabetes, Consultant

Gastroenterologists,

Consultant Surgeons,

Consultant Oncologists,

Consultant Palliative Care

To be

dispensed from

Hospitals only

MP 147

OCTREOTIDE (stand-by) INJECTION 500mcg/mL Antidotes, Malignant

Disease and

Immunosuppression

H01CB02 Consultant

Gastroenterologists,

Consultant Surgeons,

Consultant Oncologists,

Consultant Palliative Care

Hospital Use MP 148

OCTREOTIDE LONG

ACTING

POWDER AND

SOLVENT FOR

SUSPENSION FOR

INJECTION

20mg Malignant Disease

and

Immunosuppression

H01CB02 Consultants Endocrinology

and Diabetes, Consultant

Oncologists

To be

dispensed from

Hospitals only

MP 149

OCTREOTIDE LONG

ACTING

POWDER AND

SOLVENT FOR

SUSPENSION FOR

INJECTION

30mg Malignant Disease

and

Immunosuppression

H01CB02 Consultants Endocrinology

and Diabetes, Consultant

Oncologists

To be

dispensed from

Hospitals only

MP 149

OCTREOTIDE LONG

ACTING (stand-by)

POWDER AND

SOLVENT FOR

SUSPENSION FOR

INJECTION

10mg Malignant Disease

and

Immunosuppression

H01CB02 Consultants Endocrinology

and Diabetes, Consultant

Oncologists

To be

dispensed from

Hospitals only

MP 149

OLANZAPINE CAPSULES/

TABLETS

10mg Central Nervous

System

N05AH03 Consultant Psychiatrists,

Consultant Geriatricians

OLANZAPINE CAPSULES/

TABLETS

5mg Central Nervous

System

N05AH03 Consultant Psychiatrists,

Consultant Geriatricians

OMALIZUMAB INJECTION 150mg Respiratory System R03DX05 Consultant Respiratory

Physicians, Consultant

Paediatricians

To be

dispensed from

Hospitals only

MP 294

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Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

OMEPRAZOLE CAPSULES/

TABLETS

20mg Gastro-intestinal

System

A02BC01 Medical Practitioners

OMEPRAZOLE

(PAEDIATRIC USE ONLY)

POWDER FOR

SOLUTION FOR

INFUSION

40mg Gastro-intestinal

System

A02BC01 Consultant

Gastroenterologists,

Consultant Surgeons,

Consultant Anaesthetists,

Consultant Paediatricians,

Consultants Emergency

Medicine

Hospital Use MP 152

ONDANSETRON INJECTION 4mg Central Nervous

System

A04AA01 Consultant, Consultant

Anaesthetists, Consultant

Surgeons

Hospital Use

ONDANSETRON INJECTION 8mg Central Nervous

System

A04AA01 Consultant, Consultant

Anaesthetists, Consultant

Surgeons

Hospital Use

ONDANSETRON ORAL SOLUTION 4mg/5mL Central Nervous

System

A04AA01 Consultant Emergency

Medicine Paediatricians,

Consultant

Haematologists,

Consultant Oncologists,

Consultant Paediatric

Surgeons,

Consultant Paediatricians,

Consultants Palliative Care

MP 153

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Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

ONDANSETRON TABLETS 4mg Central Nervous

System

A04AA01 Consultants MP 154

ONDANSETRON TABLETS 8mg Central Nervous

System

A04AA01 Consultants MP 154

ORAL IRON (CURRENTLY

FERROUS FUMARATE

200MG [65MG

ELEMENTAL IRON])

TABLETS Nutrition and Blood B03AA Medical Practitioners

ORAL REHYDRATION POWDER Nutrition and Blood A07CA Medical Practitioners

ORPHENADRINE

HYDROCHLORIDE

TABLETS 50mg Musculoskeletal and

Joint Diseases

N04AB02 Hospital Doctors

OSELTAMIVIR CAPSULES 75mg Infections J05AH02  Consultants, Resident

Specialists, Infection

Control Consultants

Hospital Use MP 155

OXALIPLATIN SOLUTION FOR

INJECTION/

POWDER FOR

SOLUTION FOR

INJECTION

100mg Malignant Disease

and

Immunosuppression

L01XA03 Consultant

Haematologists,

Consultant Oncologists

Hospital Use

OXYBUPROCAINE SINGLE USE EYE

DROPS

0.4% Eye S01HA02 Hospital Doctors as per

specified department

Ophthalmic

Department

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Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

OXYBUTYNIN

HYDROCHLORIDE

TABLETS 5mg Obstetrics,

Gynaecology and

Urinary Tract

Disorders

G04BD04 Consultants

OXYTOCIN INJECTION 10 IU/Ml Obstetrics,

Gynaecology and

Urinary Tract

Disorders

H01BB02 Hospital Doctors Hospital Use

OXYTOCIN +

ERGOMETRINE

INJECTION 5 IU/mL +

500mcg

Obstetrics,

Gynaecology and

Urinary Tract

Disorders

G02AC Hospital Doctors Hospital Use

PACLITAXEL CONCENTRATE

FOR INTRAVENOUS

INFUSION

100mg Malignant Disease

and

Immunosuppression

L01CD01 Consultant Oncologists Hospital Use MP 157

PANCREATIN CAPSULES (CREON

10,000U)

Gastro-intestinal

System

A09AA02 Consultants

PANCREATIN CAPSULES (CREON

25,000U)

Gastro-intestinal

System

A09AA02 Consultants

PANCURONIUM

BROMIDE

INJECTION 4mg/2mL Anaesthesia M03AC01 Hospital Doctors Hospital Use

PAPAVERINE INJECTION 40mg/mL Obstetrics,

Gynaecology and

Urinary Tract

Disorders

G04BE02 Hospital Doctors as per

specified department

Theatre

PARACETAMOL CAPLETS/ TABLETS 500mg Central Nervous

System

N02BE01 Medical Practitioners

PARACETAMOL ORAL SUSPENSION 120mg/5mL Central Nervous

System

N02BE01 Medical Practitioners

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

PARACETAMOL SOLUTION FOR

INFUSION

10mg/mL IN

100mL

Central Nervous

System

N02BE01 Hospital Doctors Hospital Use

PARACETAMOL SUPPOSITORIES 125mg Central Nervous

System

N02BE01 Medical Practitioners

PARACETAMOL SUPPOSITORIES 250mg Central Nervous

System

N02BE01 Medical Practitioners

PARACETAMOL SUPPOSITORIES 500mg Central Nervous

System

N02BE01 Medical Practitioners

PARENTERAL FAT

EMULSION

EMULSION FOR

INTRAVENOUS

INFUSION

20% in 100mL Antidotes, Nutrition

and Blood

B05BA02 Hospital Doctors Hospital Use

PARENTERAL FAT

EMULSION LCT (stand-

by)

EMULSION FOR

INTRAVENOUS

INFUSION

20% in 500mL Antidotes, Nutrition

and Blood

B05BA02 Hospital Doctors To be

dispensed from

Hospitals only

(TPN patients

only)

PAROXETINE TABLETS 20mg Central Nervous

System

N06AB05 Consultant Oncologists,

Consultant Psychiatrists,

Consultant Palliative Care,

Consultant Geriatricians

PEGASPARGASE (stand-

by)

INJECTION 750 UNITS/mL Malignant Disease

and

Immunosuppression

L01XX24 Hospital Doctors as per

specified department

Paediatric

Department

PEG-INTERFERON ALFA-

2a

PRE-FILLED

SYRINGES

180mcg Malignant Disease

and

Immunosuppression

L03AB11 Consultant

Gastroenterologists,

Consultant

Haematologists,

Consultant Infectious

Diseases Physicians,

Consultant Oncologists

MP 102

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Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

PEMETREXED POWDER FOR

CONCENTRATE

FOR SOLUTION FOR

INFUSION

500mg Malignant Disease

and

Immunosuppression

L01BA04 Consultant Oncologists Hospital Use MP 275

PENICILLAMINE (stand-

by)

TABLETS 250mg Musculoskeletal and

Joint Diseases

M01CC01 Consultants

PENTAMIDINE

ISETIONATE (stand-by)

POWDER FOR

SOLUTION FOR

INJECTION,

INFUSION AND

NEBULISATION

300mg Infections P01CX01 Hospital Doctors Hospital Use As per

antimicrobial

guidelines

PENTAZOCINE

HYDROCHLORIDE

TABLETS 25mg Central Nervous

System

N02AD01 Consultants

PENTOSTATIN

(DEOXYCOFORMYCIN)

INJECTION 10mg Malignant Disease

and

Immunosuppression

L01XX02 Consultant

Haematologists,

Consultant Oncologists

Hospital Use MP 237

PENTOXIFYLLINE

(OXPENTIFYLLINE)

TABLETS 400mg Cardiovascular

System

C04AD03 Consultant Cardiologists,

Consultant Cardiac

Surgeons, Consultant

Vascular Surgeons,

Consultant

Rheumatologists

PERINDOPRIL TABLETS 4mg Cardiovascular

System

C09AA04 Consultants

PERMETHRIN PREPARATION FOR

TREATMENT OF

HEAD LICE AND

NITS

1% w/w Skin P03AC04 Medical Practitioners

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Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

PERMETHRIN TOPICAL

PREPARATION FOR

TREATMENT OF

SCABIES

5% w/w Skin P03AC04 Consultant Dermatologists,

Consultant Infectious

Diseases, Consultants (In

Patient use only), Public

Health Physicians,

Paediatric Infectious

Diseases Clinic Physicians

MP 245

PETHIDINE

HYDROCHLORIDE

INJECTION 50mg/mL Central Nervous

System

N02AB02 Hospital Doctors Hospital Use

PETHIDINE

HYDROCHLORIDE

INJECTION 100mg/2mL Central Nervous

System

N02AB02 Hospital Doctors Hospital Use

PETHIDINE

HYDROCHLORIDE

TABLETS 50mg Central Nervous

System

N02AB02 Hospital Doctors

PHENOBARBITAL

(PHENOBARBITONE)

INJECTION 30mg/mL Central Nervous

System

N03AA02 Consultant Paediatricians NPICU,

Paediatric

Emergency

Department

PHENOBARBITAL

(PHENOBARBITONE)

INJECTION 60mg/mL Central Nervous

System

N03AA02 Hospital Doctors Hospital Use

PHENOBARBITAL

(PHENOBARBITONE)

POWDER Central Nervous

System

N03AA02 Hospital Doctors

PHENOBARBITAL

(PHENOBARBITONE)

TABLETS 15mg or 30mg Central Nervous

System

N03AA02 Medical Practitioners

PHENOL OILY INJECTION 5% Gastro-intestinal

System

C05BB05 Hospital Doctors as per

specified department

Main Operating

Theatre

PHENOL IN WATER INJECTION 6% Gastro-intestinal

System

C05BB05 Hospital Doctors as per

specified department

Pain Clinic

PHENOLIC DERIVATIVE

(HYCOLINE )

SOLUTION Skin D08AE Infection Control Policy Hospital Use

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Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

PHENOXYBENZAMINE

(stand-by)

CAPSULES 10mg Cardiovascular

System

C04AX02 Consultant Anaesthetists,

Consultants Endocrinology

and Diabetes, Consultant

Intensivists, Consultant

Oncologists

MP 238

PHENOXYMETHYLPENICI

LLIN (PENICILLIN V )

ORAL SOLUTION 125mg/5mL Infections J01CE02 Medical Practitioners

PHENOXYMETHYLPENICI

LLIN (PENICILLIN V )

TABLETS 250mg Infections J01CE02 Medical Practitioners

PHENTOLAMINE

MESYLATE (stand-by)

INJECTION 5mg/mL Antidotes,

Cardiovascular

System

C04AB01 Hospital Doctors as per

specified department

Accident and

Emergency

Department,

Catheterization

Laboratory,

Cardiac

Intensive Care

Unit, Main

Operating PHENYLEPHRINE

HYDROCHLORIDE

INJECTION 10mg/mL Cardiovascular

System

C01CA06 Hospital Doctors as per

specified department

Cardiothoracic

Surgery,

Cardiac

Intensive Care

Unit, Main

Operating

Theatre,

Orthopaedic

Theatre

PHENYLEPHRINE

HYDROCHLORIDE

SINGLE USE EYE

DROPS

2.5% Eye S01FB01,

S01GA05

Hospital Doctors as per

specified department

Ophthalmic

Department

PHENYLEPHRINE

HYDROCHLORIDE

SINGLE USE EYE

DROPS

10% Eye S01FB01,

S01GA05

Hospital Doctors as per

specified department

Ophthalmic

Department

PHENYTOIN SODIUM CAPSULES 50mg Central Nervous

System

N03AB02 Consultants

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Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

PHENYTOIN SODIUM CAPSULES 100mg Central Nervous

System

N03AB02 Consultants

PHENYTOIN SODIUM ORAL SUSPENSION 30mg/5mL Central Nervous

System

N03AB02 Consultants

PHENYTOIN SODIUM SOLUTION FOR

INJECTION

250mg/5mL Central Nervous

System

N03AB02 Hospital Doctors Hospital Use

PHOSPHATE ENEMA Gastro-intestinal

System

A06AG Medical Practitioners

PHOSPHATE INFUSION Nutrition and Blood B05XA Hospital Doctors Hospital Use

PHOSPHATE

SUPPLEMENT

EFFERVESCENT

TABLETS

Nutrition and Blood A12CX Consultant Paediatricians,

Consultant Physicians

MP 165

PHYTOMENADIONE

(VITAMIN K1) (stand-by)

INJECTION 10mg/mL in

0.2mL

Antidotes, Nutrition

and Blood

B02BA01 Hospital Doctors Hospital Use/To

be dispensed

from Hospitals

only if for oral

use

PHYTOMENADIONE

(VITAMIN K1) (stand-by)

INJECTION 10mg/mL in 1mL Antidotes, Nutrition

and Blood

B02BA01 Hospital Doctors Hospital Use/To

be dispensed

from Hospitals

only if for oral

use

PILOCARPINE

HYDROCHLORIDE

EYE DROPS 1% Eye S01EB01 Medical Practitioners

PILOCARPINE

HYDROCHLORIDE

EYE DROPS 2% Eye S01EB01 Medical Practitioners

PILOCARPINE

HYDROCHLORIDE

EYE DROPS 4% Eye S01EB01 Medical Practitioners

PIMOZIDE TABLETS 4mg Central Nervous

System

N05AG02 Consultant Psychiatrists MP 163

PIPERACILLIN WITH

TAZOBACTAM

INJECTION 4.5g Infections J01CR05 Consultant (after

discussion with the Mater

Dei Hospital Antibiotic

Team)

Hospital Use MP 162

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Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

PIPERACILLIN WITH

TAZOBACTAM

INJECTION 2.25g Infections J01CR05 Consultant (after

discussion with the Mater

Dei Hospital Antibiotic

Team)

Hospital Use MP 162

PNEUMOCOCCAL CONJUGATE

VACCINE

(ADSORBED)

Immunological

Products and

Vaccines

J07AL02 Consultant Paediatrician Hospital Use MP 227

PNEUMOCOCCAL UNCONJUGATED

VACCINE

(POLYVALENT)

Immunological

Products and

Vaccines

J07AL01 Consultants Hospital Use

PODOPHYLLOTOXIN CREAM 0.15% Skin D06BB04 Hospital Doctors as per

specified department, GU

Clinic Consultants

Dermatology

Department

POLIDOCANOL INJECTION 3% Cardiovascular

System

C05BB02 Hospital Doctors Hospital Use

POLYSTYRENE

SULFONATE (e.g.

CALCIUM RESONIUM®)

POWDER Gastro-intestinal

System

V03AE01 Consultants

PORACTANT ALFA

(NATURAL SURFACTANT)

SUSPENSION FOR

INTRATRACHEAL

ADMINISTRATION

Respiratory System R07AA Consultant Paediatricians Hospital Use

POTASSIUM CHLORIDE CONCENTRATE

FOR SOLUTION FOR

INFUSION

20% Nutrition and Blood B05XA01 Hospital Doctors Hospital Use

POTASSIUM CHLORIDE ORAL LIQUID 1mmol/mL

(7.5%)

Nutrition and Blood A12BA01 Medical Practitioners

POTASSIUM CITRATE ORAL SOLUTION 1.5g/5mL Obstetrics,

Gynaecology and

Urinary Tract

Disorders

A12BA02 Consultant Nephrologist,

Consultant Urologist,

Consultant Paediatricians

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Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

POTASSIUM

PERMANGANATE

AQUEOUS

SOLUTION

1:10000 Skin D08AX06 Hospital Doctors Hospital Use

POTASSIUM PHOSPHATE INFUSION IV EACH mL

CONTAINS

2mmol

PHOSPHATE,

1.5mmol

POTASSIUM

AND 1.5mmol

SODIUM

Nutrition and Blood B05XA06 Hospital Doctors Hospital Use

POTASSIUM

SUPPLEMENT

EFFERVESCENT

TABLETS

Nutrition and Blood A12BA Medical Practitioners

POVIDONE-IODINE ALCOHOLIC

SOLUTION

10% Skin D08AG02 Infection Control Policy Hospital Use

POVIDONE-IODINE DRY POWDER

SPRAY

2.50% Skin D08AG02 Hospital Doctors Hospital Use

POVIDONE-IODINE OINTMENT 10% Skin D08AG02 Hospital Doctors Burns Unit,

Renal Unit

POVIDONE-IODINE SOLUTION

AQUEOUS

10% Skin D08AG02 Infection Control Policy Hospital Use

POVIDONE-IODINE SURGICAL SCRUB 7.50% Skin D08AG02 Infection Control Policy Hospital Use

POVIDONE-IODINE SWAB STICKS Skin D08AG02 Hospital Doctors as per

specified department

Main Operating

Theatre

POVIDONE-IODINE VAGINAL CLEANSER 10% Obstetrics,

Gynaecology and

Urinary Tract

Disorders

G01AX11 Hospital Doctors as per

specified department

Gynaecology

Department

PRALIDOXIME

MESYLATE (stand-by)

POWDER FOR

SOLUTION FOR

INJECTION

1g Antidotes V03AB04 Hospital Doctors Hospital Use

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Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

PRAZIQUANTEL TABLETS 500mg or 600mg Infections P02BA01 Consultant Infectious

Diseases Physicians

PRAZOSIN

HYDROCHLORIDE

TABLETS 1mg Cardiovascular

System

C02CA01 Consultant Physicians,

Consultant Cardiologists,

Consultant Cardiac

Surgeons

MP 166

PREDNISOLONE CAPSULES/

TABLETS

1mg Endocrine System H02AB06 Medical Practitioners

PREDNISOLONE ENTERIC-COATED

TABLETS

5mg Endocrine System H02AB06 Medical Practitioners

PREDNISOLONE RETENTION ENEMA 20mg/100mL Gastro-intestinal

System

A07EA01 Consultant

Gastroenterologists,

Consultant Surgeons,

Consultant Paediatricians,

Consultant Oncologists,

Consultant Palliative Care

PREDNISOLONE SOLUBLE TABLETS 5mg Endocrine System H02AB06 Consultant Paediatricians

PREDNISOLONE TABLETS 5mg Endocrine System H02AB06 Medical Practitioners, GU

Clinic Consultants

Page 100 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

PREGABALIN CAPSULES 150mg Central Nervous

System

N03AX16 Consultant Anaesthetists,

Consultant Geriatricians,

Consultant Neurologists,

Consultant Oncologists,

Consultant Palliative Care,

Consultant Psychiatrists,

Pain Clinic Specialists,

Consultant Haematologists

MP 160

PREGABALIN CAPSULES 300mg Central Nervous

System

N03AX16 Consultant Anaesthetists,

Consultant Geriatricians,

Consultant Neurologists,

Consultant Oncologists,

Consultant Palliative Care,

Consultant Psychiatrists,

Pain Clinic Specialists,

Consultant Haematologists

MP 160

PREGABALIN CAPSULES 75mg Central Nervous

System

N03AX16 Consultant Anaesthetists,

Consultant Geriatricians,

Consultant Neurologists,

Consultant Oncologists,

Consultant Palliative Care,

Consultant Psychiatrists,

Pain Clinic Specialists,

Consultant Haematologists

MP 160

PRILOCAINE

HYDROCHLORIDE

INJECTION 1% Anaesthesia N01BB04 Hospital Doctors Hospital Use

Page 101 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

PRILOCAINE

HYDROCHLORIDE +

FELYPRESSIN

INJECTION

CARTRIDGES

30mg + 0.03 IU Anaesthesia N01BB54 Hospital Doctors as per

specified department

Dental

Department

PRIMAQUINE TABLETS 7.5mg Infections P01BA03 Hospital Doctors Hospital Use

PRIMIDONE TABLETS 250mg Central Nervous

System

N03AA03 Medical Practitioners

PROCARBAZINE CAPSULES/

TABLETS

50mg Malignant Disease

and

Immunosuppression

L01XB01 Consultants

PROCHLORPERAZINE INJECTION 12.5mg/mL Central Nervous

System

N05AB04 Hospital Doctors Hospital Use

PROCHLORPERAZINE TABLETS 5mg Central Nervous

System

N05AB04 Medical Practitioners

PROCYCLIDINE INJECTION

IM & IV

10mg/2mL Central Nervous

System

N04AA04 Consultant Neurologists,

Consultant Psychiatrists,

Consultant Geriatricians

PROCYCLIDINE ORAL SYRUP 5mg/5mL Central Nervous

System

N04AA04 Consultant Geriatricians,

Consultant Neurologists,

Consultant Psychiatrists

MP 168

PROCYCLIDINE TABLETS 5mg Central Nervous

System

N04AA04 Consultant Geriatricians,

Consultant Neurologists,

Consultant Psychiatrists

PROGESTERONE INJECTION 50mg/mL Endocrine System G03DA04 Hospital Doctors Hospital Use

PROGUANIL

HYDROCHLORIDE +

ATOVAQUONE

TABLETS 100mg + 250mg Infections P01BB51 Medical Practitioners (as

per ‘Dispensing of Oral

Antimalarials to Out-

Patients’ [refer to page 10

on Out-Patients Formulary]

or against payment)

PROMETHAZINE

HYDROCHLORIDE

INJECTION 25mg/mL Respiratory System,

Central Nervous

System

R06AD02 Hospital Doctors Hospital Use

Page 102 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

PROMETHAZINE

HYDROCHLORIDE

ORAL SOLUTION 5mg/5mL Respiratory System,

Central Nervous

System

R06AD02 Medical Practitioners

PROMETHAZINE

HYDROCHLORIDE

TABLETS 10mg Respiratory System,

Central Nervous

System

R06AD02 Medical Practitioners

PROMETHAZINE

HYDROCHLORIDE

TABLETS 25mg Respiratory System,

Central Nervous

System

R06AD02 Medical Practitioners

PROPAFENONE TABLETS 150mg Cardiovascular

System

C01BC03 Consultant Physicians,

Consultant Cardiologists

MP 169

PROPOFOL INJECTION 10mg/mL IN

20mL

Anaesthesia N01AX10 Hospital Doctors as per

specified department

Hospital Use

PROPOFOL INJECTION 10mg/mL IN

50mL

Anaesthesia N01AX10 Hospital Doctors as per

specified department

Hospital Use

PROPRANOLOL

HYDROCHLORIDE

ORAL SOLUTION 5mg/5mL Cardiovascular

System

C07AA05 Consultant Paediatricians,

Consultant Psychiatrists

PROPRANOLOL

HYDROCHLORIDE

TABLETS 10mg Cardiovascular

System

C07AA05 Medical Practitioners

PROPRANOLOL

HYDROCHLORIDE

TABLETS 40mg Cardiovascular

System

C07AA05 Medical Practitioners

PROPYLTHIOURACIL CAPSULES/

TABLETS

50mg Endocrine System H03BA02 Medical Practitioners

PROSTAGLANDIN

ANALOGUES

(CURRENTLY

LATANOPROST)

EYE DROPS Eye S01EE Consultant

Ophthalmologists

PROTAMINE SULFATE

(stand-by)

INJECTION 50mg/5ml Antidotes,

Cardiovascular

System

V03AB14 Hospital Doctors Hospital Use

Page 103 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

PROTEIN (e.g. CASILAN®

or PROMOD®

or

PROTIFAR®

)

POWDER (HIGH) 80-90% Food Supplements V06B Hospital Doctors

PROTEIN (e.g.

FORCEVAL®

)

POWDER Food Supplements V06B Hospital Doctors

PROTON PUMP

INHIBITOR FOR

INFUSION (CURRENTLY

ESOMEPRAZOLE)

INFUSION 40mg Gastro-intestinal

System

A02BC Consultant

Gastroenterologist,

Consultant Surgeons,

Consultant Anaesthetist,

Consultant Geriatricians,

Consultant Palliative Care,

Consultants Emergency

Medicine, Consultant

Oncologist

Hospital Use MP 152

PYRAZINAMIDE TABLETS 500mg Infections J04AK01 Consultant Infectious

Diseases Physicians,

Paediatric Infectious

Diseases Clinic

Physicians, Consultant

Respiratory Physicians,

Chest Clinic Physicians

To be

dispensed from

Hospitals only

PYRIDOSTIGMINE

BROMIDE

TABLETS 60mg Musculoskeletal and

Joint Diseases

N07AA02 Hospital Doctors

PYRIDOXINE (VITAMIN

B 6 )

TABLETS 10mg or 20mg Nutrition and Blood A11HA02 Medical Practitioners TB patients to

collect item

from Hospitals

only

PYRIDOXINE (VITAMIN

B 6 )

TABLETS 50mg Antidotes, Nutrition

and Blood

A11HA02 Medical Practitioners TB patients to

collect item

from Hospitals

only

PYRIDOXINE (VITAMIN

B 6 ) (stand-by)

INJECTION 100mg/mL Nutrition and Blood A11HA02 Hospital Doctors as per

specified department

NPICU,

Accident and

Emergency

Department,

Page 104 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

PYRIMETHAMINE (stand-

by)

TABLETS 25mg Infections P01BD01 Hospital Doctors To be

dispensed from

Hospitals only

QUETIAPINE CAPSULES/

TABLETS

100mg Central Nervous

System

N05AH04 Consultant Psychiatrists,

Consultant Geriatricians

QUETIAPINE CAPSULES/

TABLETS

200mg Central Nervous

System

N05AH04 Consultant Psychiatrists,

Consultant Geriatricians

QUETIAPINE CAPSULES/

TABLETS

25mg Central Nervous

System

N05AH04 Consultant Psychiatrists,

Consultant Geriatricians

QUININE

DIHYDROCHLORIDE

INJECTION 300mg Infections P01BC01 Hospital Doctors Hospital Use

QUININE SULFATE TABLETS 300mg Infections P01BC01 Consultants Hospital Use

RABIES VACCINE Immunological

Products and

Vaccines

J07BG01 Hospital Doctors as per

specified department

Floriana

Immunisation

Services

RANITIDINE ORAL SOLUTION 75mg/5mL Gastro-intestinal

System

A02BA02 Consultant

Gastroenterologists,

Consultant Geriatricians,

Consultant Oncologists,

Consultant Paediatric

Oncologist, Consultant

Paediatricians, Consultant

Palliative Care

RANITIDINE ORAL SOLUTION 75mg/5mL

(Extemp -

Alcohol free)

Gastro-intestinal

System

EXTEMP13 Consultant Paediatricians

RANITIDINE SOLUTION FOR

INJECTION

50mg Gastro-intestinal

System

A02BA02 Hospital Doctors Hospital Use

RANITIDINE TABLETS 150mg Gastro-intestinal

System

A02BA02 Medical Practitioners

RASAGILINE TABLETS 1mg Central Nervous

System

N04BD02 Consultant Neurologists,

Consultant Geriatricians

MP 268

Page 105 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

RASBURICASE CONCENTRATE

FOR SOLUTION FOR

INFUSION

1.5mg Malignant Disease

and

Immunosuppression

V03AF07 Consultant

Haematologists,

Consultant Oncologists,

Consultant Paediatric

Oncologists

Hospital Use MP 278

RASBURICASE CONCENTRATE

FOR SOLUTION FOR

INFUSION

7.5mg Malignant Disease

and

Immunosuppression

V03AF07 Consultant

Haematologists,

Consultant Oncologists,

Consultant Paediatric

Oncologists

Hospital Use MP 278

RECOMBINANT HUMAN

ERYTHROPOIETIN

PRE-FILLED

SYRINGES

2,000 IU Nutrition and Blood B03XA01 Consultant

Gastroenterologists,

Consultant

Heamatologists,

Consultant Nephrologists,

Consultant Paediatricians

MP 65

RECOMBINANT HUMAN

ERYTHROPOIETIN

PRE-FILLED

SYRINGES

4,000 IU Nutrition and Blood B03XA01 Consultant

Gastroenterologists,

Consultant

Heamatologists,

Consultant Nephrologists,

Consultant Paediatricians

MP 65

RECOMBINANT HUMAN

ERYTHROPOIETIN

PRE-FILLED

SYRINGES

3,000 IU Nutrition and Blood B03XA01 Consultant

Gastroenterologists,

Consultant

Heamatologists,

Consultant Nephrologists,

Consultant Paediatricians

MP 65

Page 106 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

REMIFENTANIL

HYDROCHLORIDE

INJECTION 1mg Anaesthesia N01AH06 Hospital Doctors Hospital Use

REPAGLINIDE TABLETS 0.5mg Endocrine System A10BX02 Consultants Endocrinology

and Diabetes

REPAGLINIDE TABLETS 2mg Endocrine System A10BX02 Consultants Endocrinology

and Diabetes

RIBAVIRIN CAPSULES/

TABLETS

200mg Infections J05AP01 Consultant

Gastroenterologist (HCV

Patient Management

Committee), Consultant

Infectious Disease

Physician (HCV Patient

Management Committee)

To be

dispensed from

Hospitals only

MP 171

RIFABUTIN CAPSULES 150mg Infections J04AB04 Consultant Infectious

Diseases Physicians,

Chest Clinic Physicians

To be

dispensed from

Hospitals only

MP 259

RIFAMPICIN CAPSULES 300mg Infections J04AB02 Consultants TB patients to

collect item

from Hospitals

only

MP 174

RIFAMPICIN ORAL SUSPENSION 100mg/5mL Infections J04AB02 Consultants TB patients to

collect item

from Hospitals

only

MP 174

Page 107 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

RIFAMPICIN POWDER FOR

SOLUTION FOR

INJECTION

600mg/10mL Infections J04AB02 Consultants Hospital Use MP 174

RIFAMPICIN + ISONIAZID TABLETS 300mg + 150mg Infections J04AM02 Consultant Infectious

Diseases Physicians,

Paediatric Infectious

Diseases Clinic

Physicians, Consultant

Respiratory Physicians,

Chest Clinic Physicians

To be

dispensed from

Hospitals only

RIFAMPICIN + ISONIAZID TABLETS 150mg + 100mg Infections J04AM02 Consultant Infectious

Diseases Physicians,

Paediatric Infectious

Diseases Clinic

Physicians, Consultant

Respiratory Physicians,

Chest Clinic Physicians

To be

dispensed from

Hospitals only

RINGER'S SOLUTION

FOR INJECTION

(COMPOUND SODIUM

CHLORIDE)

INFUSION IV Sodium

147mmol/L,

Potassium

4mmol/L,

Calcium

2mmol/L,

Chloride

156mmol/L per

1000mL

Nutrition and Blood B05CX10 Hospital Doctors Hospital Use

RISPERIDONE DEPOT INJECTION 25mg Central Nervous

System

N05AX08 Consultant Psychiatrists To be collected

from Psychiatric

Out-Patients

and Mental

Health Clinics

Only

MP 291

Page 108 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

RISPERIDONE DEPOT INJECTION 37.5mg Central Nervous

System

N05AX08 Consultant Psychiatrists To be collected

from Psychiatric

Out-Patients

and Mental

Health Clinics

Only

MP 291

RISPERIDONE DEPOT INJECTION 50mg Central Nervous

System

N05AX08 Consultant Psychiatrists To be collected

from Psychiatric

Out-Patients

and Mental

Health Clinics

Only

MP 291

RISPERIDONE ORAL SOLUTION 5mg/5mL Central Nervous

System

N05AX08 Consultant Psychiatrists,

Consultant Geriatricians

MP 175

RISPERIDONE TABLETS 1mg Central Nervous

System

N05AX08 Consultant Psychiatrists,

Consultant Geriatricians

RISPERIDONE TABLETS 2mg Central Nervous

System

N05AX08 Consultant Psychiatrists,

Consultant Geriatricians

RITONAVIR CAPSULES/

TABLETS

100mg Infections J05AE03 Consultant Infectious

Diseases Physicians

To be

dispensed from

Hospitals only

MP 176

RITUXIMAB CONCENTRATE

FOR SOLUTION FOR

INFUSION

100mg Malignant Disease

and

Immunosuppression

L01XC02 Consultant Oncologists,

Consultant

Haematologists,

Consultant

Rheumatologists

Hospital Use/

Day Clinic

MP 217

RITUXIMAB CONCENTRATE

FOR SOLUTION FOR

INFUSION

500mg Malignant Disease

and

Immunosuppression

L01XC02 Consultant Oncologists,

Consultant

Haematologists,

Consultant

Rheumatologists

Hospital Use/

Day Clinic

MP 217

Page 109 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

RIVAROXABAN TABLETS 10mg Cardiovascular

System

B01AF01 Consultant Orthopaedic

Surgeons, Resident

Specialist Orthopaedic

Department, Senior

Registrar Orthopaedic

Department

Hospital Use MP 290

ROCURONIUM BROMIDE SOLUTION FOR

INJECTION

10mg/mL Anaesthesia M03AC09 Consultant Anaesthetist Hospital Use MP 288

ROPINIROLE TABLETS 1mg Central Nervous

System

N04BC04 Consultant Geriatricians,

Consultant Neurologists

MP 215

ROPINIROLE TABLETS 250mcg Central Nervous

System

N04BC04 Consultant Geriatricians,

Consultant Neurologists

MP 215

ROPINIROLE TABLETS 5mg Central Nervous

System

N04BC04 Consultant Geriatricians,

Consultant Neurologists

MP 215

ROSUVASTATIN CAPSULES/

TABLETS

20mg Cardiovascular

System

C10AA07 Consultants MP 177

ROSUVASTATIN CAPSULES/

TABLETS

40mg Cardiovascular

System

C10AA07 Consultants MP 177

RUFINAMIDE TABLETS 200mg Central Nervous

System

N03AF03 Consultant Neurologists,

Consultant Paediatricians

MP 293

SALBUTAMOL AEROSOL INHALER 100mcg/DOSE Respiratory System R03AC02 Medical Practitioners

SALBUTAMOL ORAL SOLUTION 2mg/5mL Respiratory System R03CC02 Medical Practitioners

SALBUTAMOL RESPIRATOR

SOLUTION

5mg/mL Respiratory System R03AC02 Medical Practitioners

SALBUTAMOL SOLUTION FOR

INTRAVENOUS

INFUSION

5mg/5mL Respiratory System R03CC02 Hospital Doctors Hospital Use

SALBUTAMOL TABLETS 4mg Respiratory System R03CC02 Medical Practitioners

Page 110 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

SALICYLIC ACID +

BETAMETHASONE

CREAM 5% Skin EXTEMP3 Consultant Dermatologists To be

dispensed from

Hospitals only

SALICYLIC ACID +

BETAMETHASONE

CREAM 10% Skin EXTEMP4 Consultant Dermatologists To be

dispensed from

Hospitals only

SALICYLIC ACID +

BETAMETHASONE

OINTMENT 5% Skin EXTEMP5 Consultant Dermatologists To be

dispensed from

Hospitals only

SALICYLIC ACID +

BETAMETHASONE

OINTMENT 10% Skin EXTEMP6 Consultant Dermatologists To be

dispensed from

Hospitals only

SALICYLIC ACID +

CLOBETASOL

CREAM 5% Skin EXTEMP7 Consultant Dermatologists To be

dispensed from

Hospitals only

SALICYLIC ACID +

CLOBETASOL

CREAM 10% Skin EXTEMP8 Consultant Dermatologists To be

dispensed from

Hospitals only

SALICYLIC ACID +

CLOBETASOL

OINTMENT 5% Skin EXTEMP9 Consultant Dermatologists To be

dispensed from

Hospitals only

SALICYLIC ACID +

CLOBETASOL

OINTMENT 10% Skin EXTEMP10 Consultant Dermatologists To be

dispensed from

Hospitals only

SALICYLIC ACID +

HYDROCORTISONE

BUTYRATE

CREAM 5% Skin EXTEMP11 Consultant Dermatologists To be

dispensed from

Hospitals only

SALICYLIC ACID +

HYDROCORTISONE

BUTYRATE

CREAM 10% Skin EXTEMP12 Consultant Dermatologists To be

dispensed from

Hospitals only

SALICYLIC ACID IN

BETAMETHASONE

LOTION (DIPROSALIC®

)*

SCALP

APPLICATION

2% + 0.05% Skin D07XC01 Consultant Dermatologists

Page 111 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

SAQUINAVIR CAPSULES/

TABLETS

500mg Infections J05AE01 Consultant Infectious

Diseases Physicians

To be

dispensed from

Hospitals only

MP 178

SELEGILINE TABLETS 5mg Central Nervous

System

N04BD01 Medical Practitioners

SENNA TABLETS 7.5mg Gastro-intestinal

System

A06AB06 Medical Practitioners

SEVOFLURANE INHALATION

ANAESTHETIC

Anaesthesia N01AB08 Hospital Doctors as per

specified department

Hospital Use

SILICONE OIL OILY INJECTION 100% V/V IN

10mL

Ear, Nose and

Oropharynx

S01XA Hospital Doctors as per

specified department

Hospital Use

SILVER NITRATE

(CAUSTIC APPLICATOR)

STICKS 95% Ear, Nose and

Oropharynx

D08AL01 Hospital Doctors Hospital Use

SILVER SULPHADIAZINE CREAM 1% Skin D06BA01 Hospital Doctors Hospital Use

SIMETICONE ORAL SUSPENSION 40mg/mL Gastro-intestinal

System

N/A Hospital Doctors as per

specified department

Endoscopy

Department

SIMVASTATIN CAPSULES/

TABLETS

10mg Cardiovascular

System

C10AA01 Medical Practitioners

SIMVASTATIN CAPSULES/

TABLETS

20mg Cardiovascular

System

C10AA01 Medical Practitioners

SIMVASTATIN CAPSULES/

TABLETS

40mg Cardiovascular

System

C10AA01 Medical Practitioners

SIROLIMUS TABLETS 1mg Malignant Disease

and

Immunosuppression

L04AA10 Consultant Nephrologist MP 231

SODA LIME CRYSTALS Miscellaneous D08AX Hospital Doctors Hospital Use

SODIUM BICARBONATE CAPSULES/

TABLETS

500mg or 600mg Nutrition and Blood A12CA Hospital Doctors

SODIUM BICARBONATE PRE-FILLED

SYRINGES

8.4% IN 10mL Nutrition and Blood B05XA02 Hospital Doctors Hospital Use

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

SODIUM BICARBONATE PRE-FILLED

SYRINGES

8.4% IN 50mL Nutrition and Blood B05XA02 Hospital Doctors Hospital Use/To

be dispensed

from Hospitals

only if for oral

use

SODIUM BICARBONATE SOLUTION FOR

INJECTION

8.4% IN 10mL Nutrition and Blood B05XA02 Hospital Doctors Hospital Use

SODIUM BICARBONATE

(stand-by)

SOLUTION FOR

INFUSION

8.4% IN 200mL Antidotes, Nutrition

and Blood

B05XA02 Hospital Doctors Hospital Use

SODIUM CALCIUM

EDETATE (stand-by)

INJECTION 1g Antidotes V03AB03 Hospital Doctors Hospital Use

SODIUM CHLORIDE SOLUTION FOR

INJECTION

30% Nutrition and Blood B05XA03 HMO as per specified

department

Hospital Use

SODIUM CHLORIDE INJECTION IV 0.9% IN 3000mL

BOTTLE

Nutrition and Blood B05XA03 Hospital Doctors Hospital Use

SODIUM CHLORIDE SOLUTION FOR

INFUSION

0.45% IN 500mL Nutrition and Blood B05XA03 Hospital Doctors Hospital Use

SODIUM CHLORIDE SOLUTION FOR

INFUSION

0.9% IN

1,000mL

Nutrition and Blood B05XA03 Hospital Doctors Hospital Use

SODIUM CHLORIDE SOLUTION FOR

INFUSION

0.9% IN 100mL Nutrition and Blood B05XA03 Hospital Doctors Hospital Use

SODIUM CHLORIDE SOLUTION FOR

INFUSION

0.9% IN 250mL Nutrition and Blood B05XA03 Hospital Doctors Hospital Use

SODIUM CHLORIDE SOLUTION FOR

INFUSION

0.9% IN 500mL Nutrition and Blood B05XA03 Hospital Doctors Hospital Use

SODIUM CHLORIDE SOLUTION FOR

INFUSION

0.9% IN 50mL Nutrition and Blood B05XA03 Hospital Doctors Hospital Use

SODIUM CHLORIDE SOLUTION FOR

INJECTION

0.9% IN 10mL Nutrition and Blood B05XA03 Hospital Doctors

SODIUM CHLORIDE SOLUTION FOR

INJECTION

0.9% IN 20mL Nutrition and Blood B05XA03 Hospital Doctors Hospital Use

SODIUM CHLORIDE SOLUTION FOR

INJECTION

0.9% IN 2mL Nutrition and Blood B05XA03 Hospital Doctors Hospital Use

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

SODIUM CHLORIDE SOLUTION FOR

IRRIGATION

0.9% IN 100 -

500mL

Nutrition and Blood B05XA03 Hospital Doctors Hospital Use

SODIUM CHLORIDE SOLUTION FOR

IRRIGATION

0.9% IN 3L Nutrition and Blood B05CB01 Hospital Doctors Hospital Use

SODIUM CHLORIDE

(oncology only)

SOLUTION FOR

INFUSION

0.9% IN

1,000mL PVC-

FREE BAGS

Nutrition and Blood B05XA03 Hospital Doctors Hospital Use

SODIUM CHLORIDE

(oncology only)

SOLUTION FOR

INFUSION

0.9% IN 500mL

PVC-FREE

BAGS

Nutrition and Blood B05XA03 Hospital Doctors Hospital Use

SODIUM CHLORIDE 0.9%

W/V BY 5ML FOR

TECHNETIUM

GENERATOR

Radiopharmaceutic

als

N/A Consultant Radiologists

SODIUM CITRATE BLADDER

IRRIGATION

3.8% IN 20mL Obstetrics,

Gynaecology and

Urinary Tract

Disorders

B05CB02 Hospital Doctors Hospital Use

SODIUM CITRATE ORAL SOLUTION 0.3M Miscellaneous B05CB02 Hospital Doctors Hospital Use

SODIUM CLODRONATE CAPSULES/

TABLETS

400mg Malignant Disease

and

Immunosuppression

M05BA02 Consultant Oncologists,

Consultant Haematologists

MP 41

SODIUM CROMOGLICATE EYE DROPS 2% Eye S01GX01 Medical Practitioners

SODIUM

DICHLOROISOCYANURA

TE (DISINFECTANT

GRANULES )

GRANULES Miscellaneous D08AX Hospital Doctors Hospital Use

SODIUM

DICHLOROISOCYANURA

TE (STERILIZATION

TABLETS )

TABLETS Miscellaneous D08AX Hospital Doctors Hospital Use

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

SODIUM FEREDETATE

(ORAL IRON )

ORAL SYRUP 190mg SODIUM

FEREDATE IN

5mL

EQUIVALENT

TO 27.5mg

Nutrition and Blood B03AB03 Medical Practitioners

SODIUM HYALURONATE INJECTION 10mg/mL Miscellaneous M09AX01 Hospital Doctors as per

specified department

Operating

Theatre

SODIUM IODIDE I-131

CAPSULES

CAPSULES Radiopharmaceutic

als

V09FX03,

V10XA01  

Consultant Radiologists

SODIUM NITRITE (stand-

by)

INJECTION 300mg (3% W/V) Antidotes V03AB08 Hospital Doctors Hospital Use

SODIUM NITROPRUSSIDE SOLUTION FOR

INJECTION/

POWDER FOR

SOLUTION FOR

INJECTION

50mg Cardiovascular

System

C02DD01 Hospital Doctors Hospital Use

SODIUM

STIBOGLUCONATE

INJECTION 10g Infections P01CB02 Hospital Doctors Hospital Use

SODIUM TETRADECYL

SULFATE

INJECTION 1% in 2mL Cardiovascular

System

C05BB04 Consultant Vascular

Surgeon

Hospital Use

SODIUM TETRADECYL

SULFATE

INJECTION 3% in 2mL Cardiovascular

System

C05BB04 Consultant Vascular

Surgeon

Hospital Use

SODIUM THIOSULFATE

(stand-by)

SOLUTION FOR

INJECTION

25% w/v or 50%

w/v

Antidotes,

Cardiovascular

System

V03AB06 Hospital Doctors Hospital Use

SODIUM VALPROATE INJECTION 400mg Central Nervous

System

N03AG01 Consultants Hospital Use

SODIUM VALPROATE ORAL SOLUTION 200mg/5mL Central Nervous

System

N03AG01 Consultant Paediatricians,

Consultant Neurologists,

Consultant Geriatricians

SODIUM VALPROATE PROLONGED

RELEASE TABLETS

200mg Central Nervous

System

N03AG01 Consultants

SODIUM VALPROATE PROLONGED

RELEASE TABLETS

500mg Central Nervous

System

N03AG01 Consultants

Page 115 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

SOMATROPIN

(RECOMBINANT HUMAN

GROWTH HORMONE)

INJECTION Endocrine System H01AC01 Consultant Paediatricians,

Consultants Endocrinology

and Diabetes

MP 88

SOTALOL TABLETS 80mg Cardiovascular

System

C07AA07 Consultants

SPECTINOMYCIN POWDER FOR

SOLUTION FOR

INJECTION

2g Infections J01XX04 Hospital Doctors, GU Clinic

Consultants

Hospital Use

SPIRONOLACTONE CAPSULES/

TABLETS

100mg Cardiovascular

System

C03DA01 Consultants, Consultants

Endocrinology

(Transgender MDT)

SPIRONOLACTONE TABLETS 25mg Cardiovascular

System

C03DA01 Medical Practitioners,

Consultants Endocrinology

(Transgender MDT)

STOMA - ADHESIVE

REMOVER

STOMA

STOMA - DEODORISING

AGENT

STOMA

STOMA - FLANGES

WAFER

STOMA

STOMA - GAUZE (NON

STERILE)

STOMA

STOMA - POUCHES

CLOSED

STOMA

STOMA AND RELATED

CONSUMABLES

STOMA Consultants

STREPTOMYCIN

SULFATE

POWDER FOR

SOLUTION FOR

INJECTION

1g Infections J01GA01 Consultants Hospital Use

SUCRALFATE ORAL SUSPENSION 1g/5mL Gastro-intestinal

System

A02BX02 Consultants

Page 116 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

SUFENTANIL INJECTION 5mcg/mL Central Nervous

System

N01AH03 Hospital Doctors Hospital Use

SUGAMMADEX (stand-by) SOLUTION FOR

INJECTION

100mg/mL Anaesthesia V03AB35 Consultant Anaesthetists,

Resident Specialists

Anaesthesia Department

Hospital Use MP 179

SULFADIAZINE TABLETS 500mg Infections J01EC02 Hospital Doctors

SULFASALAZINE ORAL SUSPENSION 250mg/5mL Gastro-intestinal

System

A07EC01 Consultant

Gastroenterologists,

Consultant Paediatricians,

Consultant Surgeons

MP 186

SULFASALAZINE SUPPOSITORIES 500mg Gastro-intestinal

System

A07EC01 Consultant

Gastroenterologists

MP 185

SULFASALAZINE TABLETS 500mg Gastro-intestinal

System

A07EC01 Consultant

Gastroenterologists,

Consultant Paediatricians,

Consultant Surgeons,

Consultant

Rheumatologists

SULPHUR

HEXAFLOURIDE

INJECTION 8 microlitres/mL Contrast Media V08DA05 Consultant Cardiologists,

Consultant Radiologists.

Hospital Use MP 184

SULPIRIDE CAPSULES/

TABLETS

50mg Central Nervous

System

N05AL01 Consultant Psychiatrists

SULPIRIDE ORAL SOLUTION 200mg/5mL Central Nervous

System

N05AL01 Consultant Psychiatrists

SULPIRIDE TABLETS 200mg Central Nervous

System

N05AL01 Consultant Psychiatrists

SUNITINIB CAPSULES 12.5mg Malignant Disease

and

Immunosuppression

L01XE04 Consultant Oncologists To be

dispensed from

Hospitals only

MP 264

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

SUNITINIB CAPSULES 25mg Malignant Disease

and

Immunosuppression

L01XE04 Consultant Oncologists To be

dispensed from

Hospitals only

MP 264

SUNITINIB CAPSULES/

TABLETS

50mg Malignant Disease

and

Immunosuppression

L01XE04 Consultant Oncologists To be

dispensed from

Hospitals only

MP 264

SUNSCREEN SPF50+ LOTION/ MILK Skin D02BA Consultant Dermatologists,

Consultant

Rheumatologists

MP 180

SUXAMETHONIUM

CHLORIDE

INJECTION 100mg/2mL Anaesthesia M03AB01 Hospital Doctors Hospital Use

TACROLIMUS CAPSULES 0.5mg Malignant Disease

and

Immunosuppression

L04AD02 Consultant

Gastroenterologists,

Consultant Paediatricians,

Consultant Nephrologists

MP 210

TACROLIMUS CAPSULES 1mg Malignant Disease

and

Immunosuppression

L04AD02 Consultant

Gastroenterologists,

Consultant Paediatricians,

Consultant Nephrologists

MP 210

TACROLIMUS CAPSULES 5mg Malignant Disease

and

Immunosuppression

L04AD02 Consultant

Gastroenterologists,

Consultant Paediatricians,

Consultant Nephrologists

MP 210

TACROLIMUS CONCENTRATE

FOR INTRAVENOUS

INFUSION

5mg/mL Malignant Disease

and

Immunosuppression

L04AD02 Consultant Nephrologists Hospital Use

Page 118 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

TAMOXIFEN TABLETS 20mg Malignant Disease

and

Immunosuppression

L02BA01 Medical Practitioners

TECHNETIUM (Tc-99m)

MACROAGGREGATED

ALBUMIN (MAA)

INJECTION Radiopharmaceutic

als

V09GA04   Consultant Radiologists

TECHNETIUM (Tc-99m)

PHYTATE

INJECTION Radiopharmaceutic

als

V09DB07 Consultant Radiologists

TECHNETIUM (Tc-99m)

RHENIUM SULPHIDE

COLLOID

INJECTION Radiopharmaceutic

als

V09DB06 Consultant Radiologists

TECHNETIUM (Tc-99m)

SESTAMIBI

INJECTION Radiopharmaceutic

als

V09GA01 Consultant Radiologists

TECHNETIUM (Tc-99m)

STANNOUS AGENT

INJECTION Radiopharmaceutic

als

V09GA06 Consultant Radiologists

TECHNETIUM-99m

GENERATOR

Radiopharmaceutic

als

N/A Consultant Radiologists

TEICOPLANIN INJECTION 200mg Infections J01XA02 Consultants Hospital Use MP 280

TEMAZEPAM ORAL SOLUTION 10mg/5mL Central Nervous

System

N05CD07 HMO as per specified

department

Paediatric

Department,

Surgical Wards,

Theatre

TEMOZOLOMIDE CAPSULES/

TABLETS

100mg Malignant Disease

and

Immunosuppression

L01AX03 Consultant Oncologist,

Consultant Paediatric

Oncologist

To be

dispensed from

Hospitals only

TEMOZOLOMIDE CAPSULES/

TABLETS

140mg Malignant Disease

and

Immunosuppression

L01AX03 Consultant Oncologist,

Consultant Paediatric

Oncologist

To be

dispensed from

Hospitals only

Page 119 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

TEMOZOLOMIDE CAPSULES/

TABLETS

20mg Malignant Disease

and

Immunosuppression

L01AX03 Consultant Oncologist,

Consultant Paediatric

Oncologist

To be

dispensed from

Hospitals only

TEMOZOLOMIDE CAPSULES/

TABLETS

5mg Malignant Disease

and

Immunosuppression

L01AX03 Consultant Oncologist,

Consultant Paediatric

Oncologist

To be

dispensed from

Hospitals only

TENOFOVIR TABLETS 245mg Infections J05AF07 Consultant Infectious

Diseases Physicians,

Consultant

Gastroenterologists

MP 187

TERBUTALINE DRY POWDER

INHALER

500mcg/DOSE Respiratory System R03AC03 Consultant Respiratory

Physicians, Consultant

Paediatricians, Specialist

Respiratory Medicine

Consultants

MP 206

TERIFLUNOMIDE TABLETS 14mg Central Nervous

System

L04AA31 Consultant Neurologists MP 195

TERIPARATIDE PRE-FILLED PENS 20mcg/80mcL Endocrine System H05AA02 Consultant

Rheumatologists,

Consultant

Endocrinologists

MP 190

TERLIPRESSIN ACETATE INJECTION 1mg Endocrine Sytem H01BA04 Hospital Doctors Hospital Use

TESTOSTERONE OILY INJECTION 250mg Endocrine System G03BA03 Consultant Paediatrician,

Consultant Oncologist,

Consultant

Endocrinologist,

Consultants Endocrinology

(Transgender MDT)

MP 188

Page 120 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

TESTOSTERONE

UNDECANOATE

INJECTION 1,000mg/4mL Endocrine System G03BA03 Consultants Endocrinology

and Diabetes, Consultants

Endocrinology

(Transgender MDT)

MP 279

TETANUS IMMUNOGLOBULIN 250 IU Immunological

Products and

Vaccines

J06BB02 Hospital Doctors Hospital Use

TETANUS OR

DIPHTHERIA

(ADSORBED) + TETANUS

VACCINE ADULT Immunological

Products and

Vaccines

J07AM51 Hospital Doctors as per

specified department

Hospital Use,

Floriana

Immunisation

Services

TETRABENAZINE TABLETS 25mg Central Nervous

System

N07XX06 Consultants

TETRACOSACTIDE

(TETRACOSACTRIN)

INJECTION 0.25mg Endocrine System H01AA02 Hospital Doctors Hospital Use

TETRACYCLINE CAPSULES/

TABLETS

250mg Infections J01AA07 Medical Practitioners

THALIDOMIDE CAPSULES/

TABLETS

50mg Skin L04AX02 Consultant

Rheumatologists,

Consultant Dermatologists,

Consultant

Haematologists,

Consultant Infectious

Disease Physicians,

Consultant Oncologists

To be

dispensed from

Hospitals only

MP 189

THEOPHYLLINE TABLETS 250mg Respiratory System R03DA04 Consultant Respiratory

Physicians, Specialist

Respiratory Medicine

Consultants

THIAMINE (VITAMIN B 1 ) TABLETS 50mg Nutrition and Blood A11DA01 Medical Practitioners

THIOPENTAL SODIUM

(THIOPENTONE SODIUM)

POWDER FOR

SOLUTION FOR

INJECTION

500mg Central Nervous

System,

Anaesthesia

N01AF03,

N05CA19

Hospital Doctors Hospital Use

Page 121 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

TIGECYCLINE POWDER FOR

SOLUTION FOR

INTRAVENOUS

INFUSION

50mg Infections J01AA12 Consultant (after

discussion with Mater Dei

Hospital Antibiotic Team

member)

Hospital Use MP 260

TIMOLOL MALEATE EYE DROPS 0.25% Eye S01ED01 Medical Practitioners

TIMOLOL MALEATE EYE DROPS 0.5% Eye S01ED01 Medical Practitioners

TIOGUANINE TABLETS 40mg Malignant Disease

and

Immunosuppression

L01BB03 Consultant Oncologists,

Consultant

Haematologists,

Consultant Paediatricians

TIROFIBAN CONCENTRATE

FOR SOLUTION FOR

INFUSION

250mcg/mL Cardiovascular

System

B01AC17 Consultant Cardiologist MP 266

TOBRAMYCIN EYE DROPS 0.3% Eye S01AA12 Consultants Ophthalmic

Department

TOBRAMYCIN INJECTION 40mg/mL Infections J01GB01 Consultants Hospital Use As per

antimicrobial

guidelines

TOPIRAMATE TABLETS 100mg Central Nervous

System

N03AX11 Consultant Neurologists,

Consultant Paediatricians

MP 191

TOPIRAMATE TABLETS 200mg Central Nervous

System

N03AX11 Consultant Neurologists,

Consultant Paediatricians

MP 191

TOPIRAMATE TABLETS 25mg Central Nervous

System

N03AX11 Consultant Neurologists,

Consultant Paediatricians

MP 191

TOPIRAMATE TABLETS 50mg Central Nervous

System

N03AX11 Consultant Neurologists,

Consultant Paediatricians

MP 191

TOTAL PARENTERAL

NUTRITION (ADULT)

INTRAVENOUS

NUTRITION

Nutrition and Blood B05BA Hospital Doctors To be

dispensed from

Hospitals only

(TPN patients

only)

Page 122 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

TRABECTEDIN POWDER FOR

CONCENTRATE

FOR SOLUTION FOR

INFUSION

0.25mg Malignant Disease

and

Immunosuppression

L01CX01 Consultant Oncologist Hospital Use MP 284

TRABECTEDIN POWDER FOR

CONCENTRATE

FOR SOLUTION FOR

INFUSION

1mg Malignant Disease

and

Immunosuppression

L01CX01 Consultant Oncologist Hospital Use MP 284

TRACE ELEMENTS CONCENTRATE

FOR INFUSION

PAEDIATRIC Nutrition and Blood B05XA31 Hospital Doctors as per

specified department

NPICU

TRACE ELEMENTS +

ELECTROLYTES

INFUSION ADULTS Nutrition and Blood B05XA31 Hospital Doctors as per

specified department

To be

dispensed from

Hospitals only

(TPN patients

only)

TRAMADOL CAPSULES 50mg Central Nervous

System

N02AX02 Consultant Physicians,

Consultant Surgeons,

Consultant Anaesthetists,

Consultant Oncologists,

Consultant Palliative Care,

Pain Clinic Specialists,

Consultant Neurologists

MP 192

TRAMADOL INJECTION 100mg Central Nervous

System

N02AX02 Consultant Physicians,

Consultant Surgeons,

Consultant Anaesthetists,

Consultant Oncologists,

Consultant Palliative Care

Hospital Use MP 193

TRAMETINIB TABLETS 2mg Malignant Disease

and

Immunosuppression

L01XE25 Consultant Oncologists MP 304

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

TRANEXAMIC ACID INJECTION 500mg/5mL Cardiovascular

System

B02AA02 Hospital Doctors Hospital Use

TRANEXAMIC ACID TABLETS 500mg Cardiovascular

System

B02AA02 Consultants

TRASTUZUMAB INFUSION 150mg Malignant Disease

and

Immunosuppression

L01XC03 Consultant Oncologists Hospital Use/

Day Clinic

MP 244

TRAVOPROST

(BENZALKONIUM FREE)

EYE DROPS 40mcg/mL Eye S01EE04 Consultant

Ophthalmologists

MP 194

TRETINOIN CAPSULES/

TABLETS

10mg Malignant Disease

and

Immunosuppression

L01XX14 Consultant

Haematologists,

Consultant Oncologists,

Consultant Paediatric

Oncologists

TRIAMCINOLONE INJECTION 40mg/mL Endocrine System H02AB08 Consultant Dermatologists,

Consultant

Rheumatologists,

Consultant Ophthalmic

Surgeons, Consultant

Plastic Surgeons,

Consultant Radiologists

Hospital Use MP 249

TRICLOSAN SKIN CLEANSER 2% Skin D08AE04 Infection Control Policy Hospital Use

TRIFLUOPERAZINE TABLETS 5mg Central Nervous

System

N05AB06 Medical Practitioners

TRIHEXYPHENIDYL

HYDROCHLORIDE

(BENZHEXOL

HYDROCHLORIDE)

TABLETS 2mg Central Nervous

System

N04AA01 Medical Practitioners

TRIMETAZIDINE

DIHYDROCHLORIDE

TABLETS 20mg Cardiovascular

System

C01EB15 Consultant Physicians,

Consultant Cardiologists,

Consultant Cardiac

Surgeons

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

TRIMETHOPRIM TABLETS 100mg Infections J01EA01 Medical Practitioners

TROPICAMIDE SINGLE USE EYE

DROPS

0.5% Eye S01FA06 Consultant

Ophthalmologists

TROPICAMIDE SINGLE USE EYE

DROPS

1% Eye S01FA06 Hospital Doctors Diabetes

Retinopathy

Screening (for

inpatient

testing),

Ophthalmic

Department

TUBERCULIN MANTOUX VACCINE Immunological

Products and

Vaccines

V04CF01 Hospital Doctors Hospital Use

TYPHOID VACCINE Immunological

Products and

Vaccines

J07AP Hospital Doctors as per

specified department

Floriana

Immunisation

Services

UNIVERSITY OF

WISCONSIN (stand-by)

SOLUTION Nutrition and Blood B05 Hospital Doctors Hospital Use

UREA + LACTIC ACID CREAM 10% + 5% Skin D02AE51 Consultant Dermatologists

UROKINASE POWDER FOR

SOLUTION FOR

INJECTION AND

INFUSION

10,000 IU Cardiovascular

System

B01AD04 Hospital Doctors as per

specified department

Hospital Use

URSODEOXYCHOLIC

ACID

CAPSULES 250mg Gastro-intestinal

System

A05AA02 Consultant

Gastroenterologists,

Consultant Oncologists,

Consultant Paediatricians

URSODEOXYCHOLIC

ACID

TABLETS 150mg Gastro-intestinal

System

A05AA02 Consultant

Gastroenterologists,

Consultant Oncologists,

Consultant Paediatricians

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

VALGANCICLOVIR TABLETS 450mg Infections J05AB14 Consultant Infectious

Diseases Physicians,

Consultant Nephrologists,

Consultant Cardiac

Surgeons, Consultant

Gastroenterologists

To be

dispensed from

Hospitals only

MP 247

VANCOMYCIN CAPSULES 125mg Infections A07AA09 Consultants Hospital Use/

Hospital

Initiation as per

Protocol

MP 281

VANCOMYCIN POWDER FOR

SOLUTION FOR

INJECTION

500mg Infections J01XA01 Consultants Hospital Use/

Hospital

Initiation as per

Protocol

MP 282

VARICELLA-ZOSTER VACCINE SC 1,000 PFU Immunological

Products and

Vaccines

J07BK01 Hospital Doctors as per

specified department

Floriana

Immunisation

Services

VARICELLA-ZOSTER

(stand by)

IMMUNOGLOBULIN Immunological

Products and

Vaccines

J06BB03 Consultants Hospital Use

VECURONIUM BROMIDE INJECTION 10mg Anaesthesia M03AC03 Hospital Doctors as per

specified department

Theatre,

Intensive Care

Unit

VENLAFAXINE

HYDROCHLORIDE

MODIFIED RELEASE

CAPSULES/

TABLETS

75mg Central Nervous

System

N06AX16 Consultant Psychiatrists,

Consultant Geriatricians

VERAPAMIL INJECTION 5mg/2mL Cardiac System C08DA01 Hospital Doctors Hospital Use

VERAPAMIL MODIFIED RELEASE

TABLETS

240mg Cardiac System C08DA01 Consultant Physicians,

Consultant Cardiologists,

Consultant Cardiac

Surgeons

MP 196

VERAPAMIL TABLETS 40mg Cardiac System C08DA01 Medical Practitioners

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

VIGABATRIN SACHETS 500mg Central Nervous

System

N03AG04 Consultant Paediatricians,

Consultant Neurologists

MP 198

VIGABATRIN TABLETS 500mg Central Nervous

System

N03AG04 Consultant Paediatricians,

Consultant Neurologists

MP 197

VINBLASTINE SULFATE SOLUTION FOR

INJECTION

10mg/10mL Malignant Disease

and

Immunosuppression

L01CA01 Consultant

Haematologists,

Consultant Oncologists,

Consultant Paediatric

Oncologists

Hospital Use/

Day Clinic

VINCRISTINE SULFATE SOLUTION FOR

INJECTION

2mg/2mL Malignant Disease

and

Immunosuppression

L01CA02 Consultant

Haematologists,

Consultant Oncologists,

Consultant Paediatric

Oncologists

Hospital Use/

Day Clinic

VINORELBINE SOLUTION FOR

INJECTION

10mg/mL IN

5mL

Malignant Disease

and

Immunosuppression

L01CA04 Consultant

Haematologists,

Consultant Oncologists,

Consultant Paediatric

Oncologists

Hospital Use

VITAMIN (FAT SOLUBLE)

FOR PARENTERAL

NUTRITION - ADULT

EMULSION FOR

INFUSION

Nutrition and Blood B05XC Hospital Doctors Hospital Use

VITAMIN (FAT SOLUBLE)

FOR PARENTERAL

NUTRITION - INFANT

EMULSION FOR

INFUSION

Nutrition and Blood B05XC Hospital Doctors Hospital Use

VITAMIN A (RETINOL) CAPSULES/

TABLETS

25,000 IU OR

50,000 IU

Nutrition and Blood A11CA01 Hospital Doctors

VITAMIN A + D CAPSULES 4,000 IU + 400

IU

Nutrition and Blood A11CB Medical Practitioners

Page 127 of 131

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

VITAMIN B + C

(PABRINEX )

INJECTION IV High potency Nutrition and Blood A11EB Hospital Doctors Hospital Use

VITAMIN B COMPLEX

(NICOTINAMIDE +

RIBOFLAVIN + THIAMINE)

TABLETS 15mg + 1mg +

1mg

Nutrition and Blood A11EA Medical Practitioners Availability

temporarily

suspended.

VITAMIN B COMPOUND

STRONG (NICOTINAMIDE

+ PYRIDOXINE +

RIBOFLAVIN + THIAMINE)

TABLETS 20mg + 2mg +

2mg + 5mg

Nutrition and Blood A11EA Medical Practitioners Preparation

temporarily

available

instead of

Vitamin B

Complex

(Nicotinamide

15mg,

Riboflavin

1mg,

Thiamine

1mg)

VITAMIN E (ALPHA

TOCOPHERYL)

CAPSULES 670mg (1,000

IU)

Nutrition and Blood A11HA03 Consultant Paediatricians,

Consultant

Gastroenterologists,

Consultant Respiratory

Physicians, Consultants

Endocrinology and

Diabetes

MP 200

VITAMIN E (ALPHA

TOCOPHERYL)

ORAL SUSPENSION 500mg/5mL Nutrition and Blood A11HA03 Consultant Paediatricians,

Consultant

Gastroenterologists,

Consultant Respiratory

Physicians, Consultants

Endocrinology and

Diabetes

MP 199

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

VITAMIN E (dl-ALPHA

TOCOPHERYL ACETATE

or d-ALPHA

TOCOPHEROL)

CAPSULES/

TABLETS

100mg-200mg

(dl-Alpha

Tocopheryl

Acetate) OR

67mg-135mg (d-

Alpha

Tocopherol)

Nutrition and Blood A11HA03 Consultant Paediatricians,

Consultant

Gastroenterologists,

Consultant Respiratory

Physicians, Consultants

Endocrinology and

Diabetes

MP 200

WARFARIN TABLETS 1mg Cardiovascular

System

B01AA03 Medical Practitioners

WARFARIN TABLETS 3mg Cardiovascular

System

B01AA03 Medical Practitioners

WARFARIN TABLETS 5mg Cardiovascular

System

B01AA03 Medical Practitioners

WATER FOR INJECTION SOLUTION FOR

INJECTION

100mL Nutrition and Blood B05B Hospital Doctors Hospital Use

WATER FOR INJECTION SOLUTION FOR

INJECTION

10mL Nutrition and Blood B05B Hospital Doctors

WATER FOR INJECTION SOLUTION FOR

INJECTION

5mL Nutrition and Blood B05B Hospital Doctors

WATER STERILE

(DILUENT)

INJECTION Nutrition and Blood B05B Hospital Doctors Hospital Use

WHITE SOFT PARAFFIN OINTMENT Skin D02AC Hospital Doctors

WOUND DRESSING

EMULSION (CURRENTLY

TROLAMINE [BIAFINE®

])

EMULSION Skin Consultant Dermatologists,

Consultant Oncologists,

Consultant Surgeons

MP 201

XYLOMETAZOLINE

HYDROCHLORIDE

NASAL DROPS 0.1% Ear, Nose and

Oropharynx

R01AA07 Medical Practitioners

XYLOMETAZOLINE

HYDROCHLORIDE

(PAEDIATRIC)

NASAL DROPS 0.05% Ear, Nose and

Oropharynx

R01AA07 Medical Practitioners

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v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

YELLOW FEVER VACCINE Immunological

Products and

Vaccines

J07BL01 Hospital Doctors as per

specified department

Floriana

Immunisation

Services

ZIDOVUDINE

(AZIDOTHYMIDINE )

CAPSULES/

TABLETS

100mg Infections J05AF01 Consultant Infectious

Diseases Physicians,

Consultants Hospital

Infection Control

To be

dispensed from

Hospitals only

MP 203

ZIDOVUDINE

(AZIDOTHYMIDINE )

(stand-by)

INJECTION 10mg/mL Infections J05AF01 Consultant Infectious

Diseases Physicians,

Consultant Paediatrician,

Paediatric Infectious

Diseases Clinic Physician

Hospital Use MP 214

ZIDOVUDINE

(AZIDOTHYMIDINE )

(stand-by)

ORAL SOLUTION 50mg/5mL Infections J05AF01 Consultant Infectious

Diseases Physicians,

Consultant Paediatrician,

Paediatric Infectious

Diseases Clinic Physicians

To be

dispensed from

Hospitals only

MP 202

ZIDOVUDINE +

LAMIVUDINE

TABLETS 300mg + 150mg Infections J05AR01 Consultant Infectious

Diseases Physicians,

Consultant Hospital

Infection Control

Physicians, GU Clinic

Consultants, Emergency

Medicine Physicians,

Gynaecologists, Infectious

Diseases Specialists

To be

dispensed from

Hospitals only

MP 209

ZINC BASED BARRIER

CREAM/OINTMENT

CREAM/ OINTMENT Skin D02AB Medical Practitioners

ZOLEDRONIC ACID INFUSION 4mg Endocrine System M05BA08 Consultants Hospital Use/

Day Clinic

MP 228

Page 130 of 131

Page 131: Hospital Formulary List - Deputy Prime Minister · 20% Nutrition and Blood B05AA01 Hospital Doctors Hospital Use ALBUMIN HUMAN SOLUTION FOR INFUSION 4% or 5% Nutrition and Blood B05AA01

v2.0 January 2020

Active Ingredient Dosage Form Dosage

Strength

Disease Category ATC Code Prescriber Criteria Department Protocol

ZOLEDRONIC ACID INFUSION 5mg Endocrine System M05BA08 Consultants Hospital Use/

Day Clinic

MP 229

ZUCLOPENTHIXOL

ACETATE

OILY INJECTION 50mg Central Nervous

System

N05AF05 Consultant Psychiatrists

ZUCLOPENTHIXOL

DECANOATE

INJECTION 200mg Central Nervous

System

N05AF05 Consultant Psychiatrists

ZUCLOPENTHIXOL

DIHYDROCHLORIDE

TABLETS 10mg Central Nervous

System

N05AF05 Consultant Psychiatrists

ZUCLOPENTHIXOL

DIHYDROCHLORIDE

TABLETS 25mg Central Nervous

System

N05AF05 Consultant Psychiatrists

ZUCLOPENTHIXOL

DIHYDROCHLORIDE

TABLETS 2mg Central Nervous

System

N05AF05 Consultant Psychiatrists

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