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ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST

INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page

NUMERIC AEROCHAMBER PLUS FLOW-VU W/ SMALL MASK 191


AEROSOL HOLDING CHAMBER................................191
AEROSOL HOLDING CHAMBER/MASK ....................191
282 ................................................................................ 76
AGGRENOX ..................................................................33
282 MEP ....................................................................... 77
AIROMIR CFC-FREE .....................................................25
292 ................................................................................ 77
ALCAINE ......................................................................134
5-FLUOROURACIL ..................................................... 180
ALDACTAZIDE 25 .........................................................70
ALDACTAZIDE 50 .........................................................70
ALDACTONE .................................................................70
A ALDARA ............................................................. SEC 3.47
ALENDRONATE ................................................ SEC 3.14
ABATACEPT ........................................................ SEC 3.6 ALENDRONATE SODIUM ................................. SEC 3.14
ABILIFY ......................................................................... 98 ALENDRONATE SODIUM/ VITAMIN D3 ........... SEC 3.15
ACARBOSE ................................................................ 162 ALENDRONATE-FC .......................................... SEC 3.14
ACCEL PIOGLITAZONE .................................... SEC 3.72 ALERTEC .......................................................... SEC 3.59
ACCOLATE ................................................................. 129 ALERTONIC.................................................................186
ACCOLATE ........................................................ SEC 3.94 ALESSE (21 DAY) .......................................................159
ACCUPRIL .................................................................... 63 ALESSE (28 DAY) .......................................................159
ACCURETIC 10/12.5 .................................................... 63 ALFACALCIDOL ..........................................................185
ACCURETIC 20/12.5 .................................................... 63 ALFUZOSIN HCL ............................................... SEC 3.15
ACCURETIC 20/25 ....................................................... 63 ALLERGY SERUM.......................................................171
ACCUTANE ................................................................ 181 ALLOPURINOL ............................................................187
ACEBUTOLOL .............................................................. 49 ALPHAGAN .................................................................135
ACEBUTOLOL HCL ...................................................... 49 ALPRAZOLAM .............................................................110
ACENOCOUMAROL ..................................................... 29 ALPROSTADIL ..............................................................46
ACETAZOLAMIDE ...................................................... 136 ALTACE (CAPSULE) .....................................................63
ACETYLCYSTEINE .................................................... 130 ALTACE (CAPSULE) .....................................................64
ACITRETIN ................................................................. 180 ALTACE HCT .................................................................64
ACLASTA ........................................................... SEC 3.94 ALVESCO ....................................................................155
ACTEMRA (10 ML) ............................................ SEC 3.89 AMANTADINE HCL .....................................................116
ACTEMRA (20 ML) ............................................ SEC 3.89 AMCINONIDE ..............................................................175
ACTEMRA (4 ML) .............................................. SEC 3.89 AMERGE .....................................................................114
ACTONEL .......................................................... SEC 3.75 AMERGE ........................................................... SEC 3.61
ACTOS ............................................................... SEC 3.72 AMILORIDE HCL .........................................................126
ACULAR...................................................................... 134 AMINOBENZOATE POTASSIUM ................................180
ACYCLOVIR ................................................................. 17 AMINOPHYLLINE ........................................................183
ADALAT XL ................................................................... 56 AMIODARONE...............................................................36
ADALIMUMAB ................................................... SEC 3.13 AMIODARONE HCL ......................................................36
ADEFOVIR DIPIVOXIL ................................................. 17 AMITRIPTYLINE HCL ....................................................95
ADRENALIN ................................................................ 135 AMLODIPINE .................................................................55
ADRENALIN .................................................................. 26 AMLODIPINE BESYLATE .............................................55
ADVAIR 100 DISKUS.................................................... 26 AMOXICILLIN ................................................................10
ADVAIR 125 .................................................................. 25 AMOXICILLIN ................................................................11
ADVAIR 250 .................................................................. 25 AMOXICILLIN SUGAR-REDUCED ................................10
ADVAIR 250 DISKUS.................................................... 26 AMOXICILLIN SUGAR-REDUCED ................................11
ADVAIR 500 DISKUS.................................................... 26 AMOXICILLIN TRIHYDRATE.........................................10
AEROCHAMBER AC BOYZ CHAMBER..................... 191 AMOXICILLIN TRIHYDRATE.........................................11
AEROCHAMBER AC GIRLZ CHAMBER .................... 191 AMOXICILLIN TRIHYDRATE/ CLAVULANATE
AEROCHAMBER PLUS FLOW-VU W/ LARGE MASK 191 POTASSIUM ..............................................................11
AEROCHAMBER PLUS FLOW-VU W/ MEDIUM MASK AMPHOTERICIN B ........................................................16
................................................................................ 191 AMPICILLIN ....................................................... SEC 3.15
AEROCHAMBER PLUS FLOW-VU W/ MOUTHPIECE191 AMPICILLIN SODIUM ....................................................11
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

193 EFFECTIVE JULY 1, 2012


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
ANAFRANIL .................................................................. 95 APO-CIPROFLOX.............................................. SEC 3A.3
ANAKINRA ......................................................... SEC 3.17 APO-CITALOPRAM .......................................................91
ANAPROX..................................................................... 75 APO-CLINDAMYCIN ......................................................14
ANAPROX DS ............................................................... 75 APO-CLOBAZAM...........................................................83
ANDRIOL ........................................................... SEC 3.86 APO-CLOMIPRAMINE ...................................................95
ANDROCUR ...................................................... SEC 3.21 APO-CLONAZEPAM......................................................84
ANDROCUR DEPOT ......................................... SEC 3.21 APO-CLOPIDOGREL ....................................................32
ANDRODERM (2.5 MG/DAY) ............................ SEC 3.86 APO-CLOPIDOGREL ........................................ SEC 3.20
ANDRODERM (5 MG/DAY) ............................... SEC 3.86 APO-CLORAZEPATE ..................................................110
ANODAN-HC .............................................................. 178 APO-CLOZAPINE ..........................................................98
ANZEMET ................................................................... 142 APO-CLOZAPINE ..........................................................99
APIDRA ....................................................................... 164 APO-CYCLOBENZAPRINE ...........................................27
APIDRA CARTRIDGE ................................................. 164 APO-CYCLOSPORINE ...................................... SEC 3.21
APIDRA PEN .............................................................. 164 APO-DESIPRAMINE ......................................................95
APO-ACEBUTOLOL ..................................................... 49 APO-DESMOPRESSIN ...............................................167
APO-ACYCLOVIR ......................................................... 17 APO-DEXAMETHASONE ............................................156
APO-ALENDRONATE........................................ SEC 3.14 APO-DIAZEPAM ..........................................................110
APO-ALFUZOSIN .............................................. SEC 3.15 APO-DIAZEPAM ..........................................................111
APO-ALPRAZ ............................................................. 110 APO-DICLO ...................................................................72
APO-AMILZIDE ........................................................... 126 APO-DICLO SR .............................................................72
APO-AMIODARONE ..................................................... 36 APO-DIFLUNISAL..........................................................73
APO-AMLODIPINE ....................................................... 55 APO-DILTIAZ .................................................................56
APO-AMOXI .................................................................. 10 APO-DILTIAZ CD ...........................................................56
APO-AMOXI .................................................................. 11 APO-DILTIAZ CD ...........................................................57
APO-AMOXI CLAV........................................................ 11 APO-DILTIAZ TZ............................................................57
APO-ATENIDONE......................................................... 50 APO-DILTIAZ TZ............................................................58
APO-ATENOL ............................................................... 49 APO-DIPYRIDAMOLE (FC) ...........................................46
APO-ATENOL ............................................................... 50 APO-DIVALPROEX .......................................................85
APO-ATORVASTATIN .................................................. 38 APO-DIVALPROEX .......................................................86
APO-AZATHIOPRINE ................................................. 187 APO-DOMPERIDONE .................................................148
APO-AZITHROMYCIN .................................................... 9 APO-DORZO-TIMOP ...................................................138
APO-BACLOFEN .......................................................... 27 APO-DOXAZOSIN .........................................................47
APO-BECLOMETHASONE ......................................... 132 APO-DOXEPIN ..............................................................95
APO-BISOPROLOL ...................................................... 50 APO-DOXEPIN ..............................................................96
APO-BRIMONIDINE.................................................... 135 APO-DOXY ....................................................................13
APO-BROMAZEPAM .................................................. 110 APO-ENALAPRIL...........................................................60
APO-BROMOCRIPTINE ............................................. 118 APO-ENALAPRIL MALEATE/HCTZ ..............................60
APO-BUSPIRONE ...................................................... 112 APO-ENTACAPONE ....................................................117
APO-CALCITONIN ............................................. SEC 3.85 APO-FAMOTIDINE ......................................................145
APO-CANDESARTAN .................................................. 65 APO-FENO-MICRO .......................................................37
APO-CAPTO ................................................................. 59 APO-FENO-SUPER .......................................................37
APO-CARVEDILOL ....................................................... 51 APO-FENO-SUPER (TABLET) ......................................37
APO-CEFADROXIL............................................ SEC 3.19 APO-FENOFIBRATE .....................................................37
APO-CEFPROZIL ........................................................... 6 APO-FINASTERIDE ........................................... SEC 3.41
APO-CEFUROXIME........................................................ 7 APO-FLUCONAZOLE ....................................................15
APO-CEPHALEX ............................................................ 5 APO-FLUNISOLIDE .....................................................132
APO-CHLORAX .......................................................... 110 APO-FLUOXETINE ........................................................92
APO-CHLORDIAZEPOXIDE ....................................... 110 APO-FLUPHENAZINE .................................................105
APO-CILAZAPRIL ......................................................... 59 APO-FLUPHENAZINE .................................................106
APO-CILAZAPRIL/HCTZ .............................................. 59 APO-FLURAZEPAM ....................................................111
APO-CIMETIDINE ....................................................... 144 APO-FLURBIPROFEN ...................................................73
APO-CIPROFLOX .............................................. SEC 3A.2 APO-FLUTAMIDE .............................................. SEC 3.42
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE JULY 1, 2012 194


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
APO-FLUVOXAMINE .................................................... 92 APO-MOCLOBEMIDE ...................................................89
APO-FOLIC ................................................................. 185 APO-MONTELUKAST .................................................129
APO-FOSINOPRIL ........................................................ 61 APO-MONTELUKAST ....................................... SEC 3.60
APO-FUROSEMIDE...................................................... 44 APO-NABUMETONE .....................................................74
APO-FUROSEMIDE...................................................... 45 APO-NADOL ..................................................................52
APO-GABAPENTIN ...................................................... 86 APO-NAPRO-NA ...........................................................75
APO-GEMFIBROZIL ..................................................... 37 APO-NAPRO-NA DS .....................................................75
APO-GLICLAZIDE....................................................... 165 APO-NAPROXEN ..........................................................74
APO-GLYBURIDE ....................................................... 166 APO-NAPROXEN EC ....................................................75
APO-HALOPERIDOL .................................................. 104 APO-NITRAZEPAM .....................................................112
APO-HALOPERIDOL .................................................. 105 APO-NIZATIDINE ........................................................145
APO-HYDRALAZINE .................................................... 44 APO-NORFLOX .............................................................12
APO-HYDRO .............................................................. 126 APO-NORTRIPTYLINE ..................................................96
APO-HYDROMORPHONE ........................................... 78 APO-OFLOXACIN........................................................131
APO-HYDROXYQUINE ................................................ 18 APO-OLANZAPINE......................................................100
APO-HYDROXYZINE.................................................. 113 APO-OLANZAPINE........................................................99
APO-IBUPROFEN......................................................... 73 APO-OLANZAPINE ODT .............................................100
APO-INDAPAMIDE ..................................................... 127 APO-OMEPRAZOLE (CAPSULE) ...............................147
APO-IPRAVENT............................................................ 24 APO-ONDANSETRON ................................................143
APO-ISMN .................................................................... 46 APO-ORCIPRENALINE .................................................25
APO-K ......................................................................... 125 APO-OXAZEPAM ........................................................112
APO-KETOCONAZOLE ................................................ 15 APO-OXYBUTYNIN .....................................................183
APO-KETOROLAC ..................................................... 134 APO-OXYCODONE .......................................................82
APO-KETOROLAC ....................................................... 74 APO-PANTOPRAZOLE ...............................................148
APO-LACTULOSE ...................................................... 125 APO-PAROXETINE .......................................................93
APO-LAMOTRIGINE ..................................................... 87 APO-PEN-VK .................................................................10
APO-LANSOPRAZOLE............................................... 147 APO-PENTOXIFYLLINE SR ..........................................33
APO-LATANOPROST ................................................. 137 APO-PIMOZIDE ...........................................................108
APO-LEFLUNOMIDE .................................................. 189 APO-PINDOL .................................................................53
APO-LEVETIRACETAM................................................ 87 APO-PIOGLITAZONE ........................................ SEC 3.72
APO-LEVOCARB ........................................................ 118 APO-PIROXICAM ..........................................................76
APO-LEVOFLOXACIN ....................................... SEC 3A.4 APO-PRAMIPEXOLE ...................................................119
APO-LISINOPRIL .......................................................... 61 APO-PRAVASTATIN .....................................................40
APO-LISINOPRIL .......................................................... 62 APO-PRAZO ..................................................................47
APO-LISINOPRIL/HCTZ ............................................... 62 APO-PREDNISONE .....................................................158
APO-LITHIUM CARBONATE ...................................... 114 APO-PROCHLORAZINE .............................................142
APO-LORAZEPAM ..................................................... 111 APO-PROPAFENONE ...................................................35
APO-LOSARTAN .......................................................... 67 APO-PROPRANOLOL ...................................................53
APO-LOSARTAN/HCTZ................................................ 67 APO-QUETIAPINE.......................................................100
APO-LOSARTAN/HCTZ ................................................ 68 APO-QUETIAPINE.......................................................101
APO-LOVASTATIN ....................................................... 39 APO-QUININE ...............................................................19
APO-MEDROXY ......................................................... 167 APO-RABEPRAZOLE ..................................................148
APO-METFORMIN ...................................................... 163 APO-RALOXIFENE............................................ SEC 3.74
APO-METHOPRAZINE ............................................... 106 APO-RAMIPRIL (CAPSULE) .........................................63
APO-METHOTREXATE ................................................ 21 APO-RAMIPRIL (CAPSULE) .........................................64
APO-METHYLPHENIDATE ........................................ 109 APO-RANITIDINE ........................................................145
APO-METHYLPHENIDATE SR .................................. 109 APO-RANITIDINE ........................................................146
APO-METOPROLOL..................................................... 52 APO-REPAGLINIDE ....................................................165
APO-METOPROLOL (TYPE L) ..................................... 52 APO-RISEDRONATE ........................................ SEC 3.75
APO-METOPROLOL SR............................................... 52 APO-RISPERIDONE ....................................................102
APO-MINOCYCLINE..................................................... 13 APO-RISPERIDONE ....................................................103
APO-MIRTAZAPINE ..................................................... 98 APO-RISPERIDONE ....................................................104
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

195 EFFECTIVE JULY 1, 2012


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
APO-RIVASTIGMINE ......................................... SEC 3.78 ARANESP (0.3/0.4/0.6/1.0 ML SYR) ................. SEC 3.23
APO-ROPINIROLE ..................................................... 119 ARANESP (0.4 ML SYRINGE)........................... SEC 3.23
APO-ROPINIROLE ..................................................... 120 ARANESP (0.5 ML SYRINGE)........................... SEC 3.23
APO-ROSUVASTATIN.................................................. 41 ARAVA .........................................................................189
APO-SALVENT ............................................................. 25 AREDIA ........................................................................189
APO-SALVENT CFC FREE .......................................... 25 ARICEPT ........................................................... SEC 3.25
APO-SELEGILINE....................................................... 120 ARIPIPRAZOLE .............................................................98
APO-SERTRALINE ....................................................... 93 ARISTOCORT C ..........................................................179
APO-SERTRALINE ....................................................... 94 ARISTOCORT R ..........................................................179
APO-SIMVASTATIN...................................................... 42 ARIXTRA (0.5 ML SYRINGE) ........................................32
APO-SIMVASTATIN...................................................... 43 ARIXTRA (0.6 ML SYRINGE) ........................................32
APO-SOTALOL ............................................................. 54 ARLIDIN .........................................................................47
APO-SUCRALFATE .................................................... 146 ARTHROTEC-50............................................................72
APO-SULFATRIM ......................................................... 12 ARTHROTEC-75............................................................72
APO-SULFATRIM DS ................................................... 12 ASA ................................................................................71
APO-SULIN ................................................................... 76 ASA/ CODEINE PHOSPHATE/ CAFFEINE CITRATE ...76
APO-SUMATRIPTAN .................................................. 115 ASACOL ......................................................................149
APO-SUMATRIPTAN ......................................... SEC 3.84 ASACOL 800................................................................149
APO-TAMSULOSIN CR ................................................ 48 ATACAND ......................................................................65
APO-TEMAZEPAM ..................................................... 112 ATACAND PLUS............................................................65
APO-TERAZOSIN ......................................................... 48 ATARAX .......................................................................113
APO-TERBINAFINE ...................................................... 15 ATENOLOL ....................................................................49
APO-THEO LA ............................................................ 183 ATENOLOL ....................................................................50
APO-TIAPROFENIC ..................................................... 76 ATENOLOL/ CHLORTHALIDONE .................................50
APO-TICLOPIDINE ....................................................... 33 ATIVAN ........................................................................111
APO-TIMOL .................................................................. 54 ATORVASTATIN............................................................38
APO-TIMOP ................................................................ 136 ATORVASTATIN CALCIUM ..........................................38
APO-TIZANIDINE............................................... SEC 3.87 ATOVAQUONE ..............................................................19
APO-TOPIRAMATE ...................................................... 88 ATROPINE SULFATE ..................................................134
APO-TRAZODONE ....................................................... 94 ATROPINE SULFATE ....................................................23
APO-TRAZODONE D ................................................... 94 ATROVENT....................................................................24
APO-TRIAZIDE ........................................................... 126 ATROVENT HFA ...........................................................24
APO-TRIAZO .............................................................. 112 AURANOFIN ................................................................151
APO-TRYPTOPHAN ..................................................... 97 AURO-CEFPROZIL .........................................................6
APO-VALACYCLOVIR (CAPLET) ................................. 18 AURO-CEFUROXIME ......................................................7
APO-VALPROIC ........................................................... 89 AURO-GABAPENTIN ....................................................86
APO-VALSARTAN ........................................................ 69 AURO-LEVETIRACETAM ..............................................87
APO-VALSARTAN/HCTZ .............................................. 69 AURO-TERBINAFINE ....................................................15
APO-VALSARTAN/HCTZ .............................................. 70 AURO-TOPIRAMATE ....................................................88
APO-VENLAFAXINE XR ............................................... 90 AVA-ACEBUTOLOL.......................................................49
APO-VERAP ................................................................. 58 AVA-AMIODARONE ......................................................36
APO-VERAP SR ........................................................... 58 AVA-AZITHROMYCIN .....................................................9
APO-WARFARIN .......................................................... 29 AVA-BACLOFEN ...........................................................27
APO-WARFARIN .......................................................... 30 AVA-BISOPROLOL ........................................................50
APO-ZOPICLONE ....................................................... 113 AVA-BUPROPION SR ...................................................97
APRACLONIDINE HCL ............................................... 138 AVA-CARVEDILOL ........................................................51
APREPITANT .............................................................. 144 AVA-CEFPROZIL.............................................................6
APREPITANT/ APREPITANT ..................................... 144 AVA-CLARITHROMYCIN ................................................9
APRI 21 ....................................................................... 159 AVA-CLINDAMYCIN ......................................................14
APRI 28 ....................................................................... 159 AVA-DICLOFENAC........................................................72
ARANESP (0.3/ 0.4/ 0.5 ML SYR)...................... SEC 3.23 AVA-DICLOFENAC SR ..................................................72
ARANESP (0.3/ 0.4/ 0.5/ 0.65 ML SYR)............. SEC 3.23 AVA-DOMPERIDONE ..................................................148
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE JULY 1, 2012 196


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
AVA-ENALAPRIL .......................................................... 60 AVONEX (30 MCG) ............................................. SEC 2.4
AVA-FAMOTIDINE ...................................................... 145 AVONEX PS/PEN (30 MCG/0.5 ML) ................... SEC 2.4
AVA-FENOFIBRATE MICRO ........................................ 37 AXID .............................................................................145
AVA-FLUOXETINE ....................................................... 92 AZARGA ......................................................................137
AVA-FLUVOXAMINE .................................................... 92 AZATHIOPRINE...........................................................187
AVA-FUROSEMIDE ...................................................... 44 AZELAIC ACID.............................................................180
AVA-FUROSEMIDE ...................................................... 45 AZITHROMYCIN ..............................................................9
AVA-GLICLAZIDE ....................................................... 165 AZITHROMYCIN ................................................ SEC 3.17
AVA-GLYBURIDE ....................................................... 166 AZOPT .........................................................................136
AVA-IRBESARTAN ....................................................... 66 AZTREONAM..................................................... SEC 3.17
AVA-IRBESARTAN/HCTZ ............................................ 66
AVA-IRBESARTAN/HCTZ ............................................ 67
AVA-LEVETIRACETAM ................................................ 87 B
AVA-LEVOFLOXACIN ....................................... SEC 3A.4
AVA-LISINOPRIL HCT .................................................. 62 BACLOFEN ....................................................................27
AVA-LOVASTATIN........................................................ 39 BACTROBAN ...............................................................174
AVA-METFORMIN ...................................................... 163 BARACLUDE .................................................................17
AVA-METOPROLOL ..................................................... 52 BECLOMETHASONE DIPROPIONATE ......................132
AVA-METOPROLOL (TYPE L) ..................................... 52 BECLOMETHASONE DIPROPIONATE ......................155
AVA-MIRTAZAPINE ...................................................... 98 BECLOMETHASONE DIPROPIONATE ......................175
AVA-NAPROXEN .......................................................... 74 BELLADONNA/ ERGOTAMINE TARTRATE/
AVA-NAPROXEN EC .................................................... 75 PHENOBARBITAL .....................................................23
AVA-NORTRIPTYLINE ................................................. 96 BELLERGAL SPACETABS ............................................23
AVA-OLANZAPINE ....................................................... 99 BENAZEPRIL .................................................................58
AVA-PANTOPRAZOLE ............................................... 148 BENAZEPRIL HCL.........................................................58
AVA-PIOGLITAZONE ........................................ SEC 3.72 BENTYLOL ....................................................................23
AVA-PRAMIPEXOLE .................................................. 119 BENURYL ....................................................................127
AVA-RAMIPRIL (TABLET) ............................................ 63 BENZACLIN ....................................................... SEC 3.19
AVA-RAMIPRIL (TABLET) ............................................ 64 BENZOYL PEROXIDE ....................................... SEC 3.18
AVA-RISEDRONATE ......................................... SEC 3.75 BENZTROPINE............................................................117
AVA-RISPERIDONE ................................................... 102 BENZTROPINE MESYLATE........................................117
AVA-RISPERIDONE ................................................... 103 BENZTROPINE OMEGA .............................................117
AVA-RISPERIDONE ................................................... 104 BENZYDAMINE HCL ...................................................135
AVA-SOTALOL ............................................................. 54 BETADERM MILD........................................................176
AVA-SUMATRIPTAN .................................................. 115 BETADERM REGULAR ...............................................176
AVA-SUMATRIPTAN ......................................... SEC 3.84 BETAGAN ....................................................................136
AVA-TAMSULOSIN CR ................................................ 48 BETAHISTINE DIHYDROCHLORIDE..........................187
AVA-TOPIRAMATE....................................................... 88 BETAMETHASONE DIPROPIONATE .........................175
AVA-VALSARTAN......................................................... 69 BETAMETHASONE DIPROPIONATE/ CLOTRIMAZOLE
AVA-VALSARTAN HCT ................................................ 69 .................................................................................179
AVA-VALSARTAN HCT ................................................ 70 BETAMETHASONE DIPROPIONATE/ SALICYLIC ACID
AVA-ZOPICLONE ....................................................... 113 .................................................................................175
AVALIDE 150/12.5 ........................................................ 66 BETAMETHASONE SODIUM PHOSPHATE ...............176
AVALIDE 300/12.5 ........................................................ 66 BETAMETHASONE SODIUM PHOSPHATE/
AVANDAMET ..................................................... SEC 3.80 BETAMETHASONE ACETATE................................155
AVANDIA ........................................................... SEC 3.79 BETAMETHASONE SODIUM PHOSPHATE/
AVAPRO ....................................................................... 66 GENTAMICIN SULFATE .........................................133
AVELOX ............................................................. SEC 3A.5 BETAMETHASONE VALERATE .................................176
AVENTYL ...................................................................... 96 BETASERON (0.3 MG) ........................................ SEC 2.4
AVIANE 21 .................................................................. 159 BETAXOLOL HCL ........................................................135
AVIANE 28 .................................................................. 159 BETNESOL (5MG/100ML) ...........................................176
AVODART .......................................................... SEC 3.25
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

197 EFFECTIVE JULY 1, 2012


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
BETOPTIC S ............................................................... 135 CALCIPOTRIOL MONOHYDRATE/ BETAMETHASONE
BEZAFIBRATE .............................................................. 37 DIPROPIONATE ......................................................181
BEZALIP ....................................................................... 37 CALCIPOTRIOL/ BETAMETHASONE DIPROPIONATE
BIAXIN ............................................................................ 9 .................................................................................181
BIAXIN BID ..................................................................... 9 CALCITRIOL ................................................................185
BIAXIN XL ....................................................................... 9 CALCIUM POLYSTYRENE SULPHONATE ................125
BIMATOPROST .......................................................... 137 CALTINE 100 (100 IU/ML) ...........................................166
BISOPROLOL FUMARATE .......................................... 50 CANCIDAS ........................................................ SEC 3.19
BLEPHAMIDE ............................................................. 133 CANDESARTAN CILEXETIL .........................................65
BLEPHAMIDE S.O.P................................................... 133 CANDESARTAN CILEXETIL/ HYDROCHLOROTHIAZIDE
BLOOD GLUCOSE TEST STRIPS ................................. 1 ...................................................................................65
BLOOD LETTING LANCET ............................................ 1 CAPTOPRIL ...................................................................59
BONEFOS ................................................................... 187 CARBACHOL ...............................................................137
BOTOX (50/100/200 UNITS/VIAL) .............................. 189 CARBAMAZEPINE ........................................................85
BOTULINUM NEUROTOXIN TYPE A (150KD), FREE CARBOLITH.................................................................114
FROM COMPLEXI .................................................. 187 CARDIZEM CD ..............................................................56
BREVICON 0.5/35 (21 DAY) ....................................... 160 CARDIZEM CD ..............................................................57
BREVICON 0.5/35 (28 DAY) ....................................... 160 CARDURA .....................................................................47
BREVICON 1/35 (21 DAY) .......................................... 160 CARNITOR ........................................................ SEC 3.57
BREVICON 1/35 (28 DAY) .......................................... 160 CARVEDILOL ................................................................51
BRICANYL TURBUHALER ........................................... 26 CASPOFUNGIN ................................................. SEC 3.19
BRIMONIDINE TARTRATE ........................................ 135 CATAPRES ....................................................................43
BRIMONIDINE TARTRATE/ TIMOLOL MALEATE ..... 137 CAYSTON .......................................................... SEC 3.17
BRINZOLAMIDE ......................................................... 136 CEDOCARD-SR ............................................................45
BRINZOLAMIDE/ TIMOLOL MALEATE ...................... 137 CEFADROXIL .................................................... SEC 3.19
BROMAZEPAM ........................................................... 110 CEFAZOLIN .....................................................................5
BROMOCRIPTINE MESYLATE .................................. 118 CEFAZOLIN SODIUM......................................................5
BUDESONIDE ............................................................ 132 CEFIXIME ........................................................................7
BUDESONIDE ............................................................ 155 CEFOTAXIME SODIUM ..................................................7
BUDESONIDE ............................................................ 176 CEFPROZIL .....................................................................6
BUDESONIDE ................................................... SEC 3.18 CEFTAZIDIME .................................................................7
BUDESONIDE/ FORMOTEROL FUMARATE CEFTIN ............................................................................7
DIHYDRATE ............................................................. 24 CEFTRIAXONE FOR INJECTION USP ...........................7
BUPRENORPHINE HCL/ NALOXONE CEFTRIAXONE SODIUM ................................................7
HYDROCHLORIDE DIHYDRATE ............................. 83 CEFUROXIME AXETIL ....................................................7
BUPROPION HCL......................................................... 97 CEFZIL .............................................................................6
BUSCOPAN .................................................................. 23 CELEBREX ........................................................ SEC 3.19
BUSERELIN ACETATE ..................................... SEC 3.18 CELECOXIB....................................................... SEC 3.19
BUSPIRONE HCL ....................................................... 112 CELESTONE SOLUSPAN ...........................................155
BUTALBITAL/ CAFFEINE/ ASA .................................... 71 CELEXA .........................................................................91
BUTALBITAL/ CODEINE PHOSPHATE/ ASA/ CAFFEINE CELONTIN .....................................................................85
.................................................................................. 76 CEPHALEXIN ..................................................................5
CEPHALEXIN ..................................................................6
C CESAMET ....................................................................144
CHAMPIX .......................................................................28
C.E.S. .......................................................................... 161 CHAMPIX ........................................................... SEC 3.92
CABERGOLINE ................................................. SEC 3.18 CHAMPIX (STARTER PACK) ........................................28
CAFERGOT .................................................................. 26 CHAMPIX (STARTER PACK) ............................ SEC 3.93
CALCIJEX ................................................................... 185 CHLORAL HYDRATE ..................................................112
CALCIMAR .................................................................. 166 CHLORAMPHENICOL SODIUM SUCCINATE ................8
CALCIPOTRIOL .......................................................... 181 CHLORDIAZEPOXIDE HCL ........................................110
CHLORDIAZEPOXIDE HCL/ CLIDINIUM BROMIDE ..110
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE JULY 1, 2012 198


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
CHLOROMYCETIN ......................................................... 8 CLODRONATE DISODIUM .........................................187
CHLOROQUINE PHOSPHATE .................................... 18 CLODRONATE DISODIUM TETRAHYDRATE............187
CHLORPROMAZINE HCL .......................................... 105 CLOMID .......................................................................162
CHLORTHALIDONE ................................................... 126 CLOMIPHENE CITRATE .............................................162
CHOLEDYL ................................................................. 183 CLOMIPRAMINE HCL ...................................................95
CHOLEDYL EXPECTORANT ..................................... 183 CLONAZEPAM ..............................................................84
CHOLESTYRAMINE RESIN ......................................... 36 CLONIDINE HCL .........................................................187
CICLESONIDE ............................................................ 155 CLONIDINE HCL ...........................................................43
CICLOPIROX OLAMINE ............................................. 175 CLOPIDOGREL BISULFATE .........................................32
CILAZAPRIL.................................................................. 59 CLOPIDOGREL BISULFATE ............................. SEC 3.20
CILAZAPRIL/ HYDROCHLOROTHIAZIDE ................... 59 CLOPIXOL ...................................................................108
CILOXAN .................................................................... 131 CLOPIXOL ACUPHASE ..............................................107
CIMETIDINE ............................................................... 144 CLOPIXOL DEPOT ......................................................107
CIPRALEX .................................................................... 91 CLORAZEPATE DIPOTASSIUM .................................110
CIPRO ................................................................ SEC 3A.1 CLOXACILLIN SODIUM ................................................12
CIPRO ................................................................ SEC 3A.2 CLOZAPINE ...................................................................98
CIPRO ................................................................ SEC 3A.3 CLOZAPINE ...................................................................99
CIPRODEX ................................................................. 132 CLOZARIL .....................................................................98
CIPROFLOXACIN .............................................. SEC 3A.1 CLOZARIL .....................................................................99
CIPROFLOXACIN .............................................. SEC 3A.2 CO ALENDRONATE .......................................... SEC 3.14
CIPROFLOXACIN .............................................. SEC 3A.3 CO AMLODIPINE...........................................................55
CIPROFLOXACIN HCL ............................................... 131 CO ATENOLOL..............................................................49
CIPROFLOXACIN HCL ...................................... SEC 3A.2 CO ATENOLOL..............................................................50
CIPROFLOXACIN HCL ...................................... SEC 3A.3 CO ATORVASTATIN .....................................................38
CIPROFLOXACIN HCL/ DEXAMETHASONE ............ 132 CO AZITHROMYCIN .......................................................9
CITALOPRAM ............................................................... 91 CO AZITHROMYCIN ......................................... SEC 3.17
CITALOPRAM HYDROBROMIDE ................................ 91 CO BETAHISTINE .......................................................187
CITALOPRAM-ODAN ................................................... 91 CO CABERGOLINE ........................................... SEC 3.18
CLAFORAN ..................................................................... 7 CO CANDESARTAN ......................................................65
CLARITHROMYCIN ........................................................ 9 CO CILAZAPRIL ............................................................59
CLARUS...................................................................... 181 CO CIPROFLOXACIN ....................................... SEC 3A.2
CLASTEON ................................................................. 187 CO CIPROFLOXACIN ....................................... SEC 3A.3
CLAVULIN-125F ........................................................... 11 CO CITALOPRAM .........................................................91
CLAVULIN-200 ............................................................. 11 CO CLOMIPRAMINE .....................................................95
CLAVULIN-250F ........................................................... 11 CO CLONAZEPAM ........................................................84
CLAVULIN-400 ............................................................. 11 CO CLOPIDOGREL .......................................................32
CLAVULIN-500F ........................................................... 11 CO CLOPIDOGREL ........................................... SEC 3.20
CLAVULIN-875 ............................................................. 11 CO DILTIAZEM CD ........................................................56
CLIMARA 100 (7.8 MG/PTH) ...................................... 161 CO DILTIAZEM CD ........................................................57
CLIMARA 25 (2 MG/PTH) ........................................... 161 CO DILTIAZEM T ...........................................................57
CLIMARA 50 (3.9 MG/PTH) ........................................ 161 CO DILTIAZEM T ...........................................................58
CLIMARA 75 (5.7 MG/PTH) ........................................ 161 CO ENALAPRIL .............................................................60
CLINDAMYCIN ............................................................. 14 CO ETIDROCAL ..........................................................188
CLINDAMYCIN (60 & 120 ML) ...................................... 14 CO ETIDRONATE........................................................188
CLINDAMYCIN HCL ..................................................... 14 CO FINASTERIDE ............................................. SEC 3.41
CLINDAMYCIN PALMITATE HCL................................. 14 CO FLUCONAZOLE ......................................................15
CLINDAMYCIN PHOSPHATE ...................................... 14 CO FLUOXETINE ..........................................................92
CLINDAMYCIN PHOSPHATE/ BENZOYL PEROXIDE CO FLUVOXAMINE .......................................................92
....................................................................... SEC 3.19 CO GABAPENTIN..........................................................86
CLINDOXYL ....................................................... SEC 3.19 CO IRBESARTAN ..........................................................66
CLOBAZAM .................................................................. 83 CO IRBESARTAN/HCT .................................................66
CLOBETASOL 17-PROPIONATE .............................. 176 CO IRBESARTAN/HCT .................................................67
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

199 EFFECTIVE JULY 1, 2012


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
CO LATANOPROST ................................................... 137 COLESTID .....................................................................36
CO LEVETIRACETAM .................................................. 87 COLESTID ORANGE .....................................................36
CO LEVOFLOXACIN ......................................... SEC 3A.4 COLESTIPOL HCL ........................................................36
CO LISINOPRIL ............................................................ 61 COLISTIMETHATE FOR INJECTION ............................14
CO LISINOPRIL ............................................................ 62 COLISTIMETHATE SODIUM .........................................14
CO LOSARTAN ............................................................ 67 COLLAGENASE ..........................................................181
CO LOVASTATIN.......................................................... 39 COMBIGAN..................................................................137
CO METFORMIN ........................................................ 163 COMBINATION ANTI-INFECTIVE /CORTICOSTEROID
CO OLANZAPINE ....................................................... 100 .................................................................................179
CO OLANZAPINE ......................................................... 99 COMBIVENT UDV .........................................................24
CO OLANZAPINE ODT............................................... 100 COMPD- NSAID/ ANALG/MUSCLE RELAX (NOT
CO ONDANSETRON .................................................. 143 DICLOFENAC)-TOPICAL ..........................................71
CO PANTOPRAZOLE ................................................. 148 COMPD-CHLORHEX. MOUTH RINSE (ANY
CO PAROXETINE ......................................................... 93 CONCENTRATION, NOT 0.12%) ............................135
CO PIOGLITAZONE .......................................... SEC 3.72 COMPD-CHLORHEX. MOUTH RINSE (ANY
CO PRAMIPEXOLE .................................................... 119 CONCENTRATION, NOT 12%) ...............................135
CO PRAVASTATIN ....................................................... 40 COMPD-NSAID/ ANALG/MUSCLE RELAX (NOT
CO QUETIAPINE ........................................................ 100 DICLOFENAC)-TOPICAL ..........................................71
CO QUETIAPINE ........................................................ 101 COMPOUND - RETINOIC ACID (TRETINOIN) (TOPICAL) ......................
CO RAMIPRIL (CAPSULE) ........................................... 63 COMPOUND HORMONES (ESTROGEN PROGEST
CO RAMIPRIL (CAPSULE) ........................................... 64 TESTOSTERONE)...................................................155
CO RANITIDINE.......................................................... 145 COMPOUND NARCOTIC MIXTURES - ORAL AND
CO REPAGLINIDE ...................................................... 165 INJECTION ................................................................77
CO RISPERIDONE ..................................................... 102 COMPOUND PRESCRIPTION ....................................135
CO RISPERIDONE ..................................................... 103 COMPOUND PRESCRIPTION ....................................155
CO RIZATRIPTAN ODT .............................................. 114 COMPOUND PRESCRIPTION ....................................173
CO RIZATRIPTAN ODT .............................................. 115 COMPOUND PRESCRIPTION ....................................176
CO RIZATRIPTAN ODT ..................................... SEC 3.79 COMPOUND PRESCRIPTION ....................................179
CO ROPINIROLE ........................................................ 119 COMPOUND PRESCRIPTION ....................................180
CO ROPINIROLE ........................................................ 120 COMPOUND PRESCRIPTION ....................................188
CO ROSUVASTATIN .................................................... 41 COMPOUND PRESCRIPTION ......................................71
CO SERTRALINE ......................................................... 93 COMPOUND PRESCRIPTION ......................................77
CO SERTRALINE ......................................................... 94 COMPOUND- DICLOFENAC (TOPICAL) ......................71
CO SIMVASTATIN ........................................................ 42 COMPOUND- SALICYLIC ACID (TOPICAL) ...............180
CO SIMVASTATIN ........................................................ 43 COMPOUND-ANTI-INFECTIVE (TOPICAL) ................173
CO SOTALOL ............................................................... 54 COMPOUND-CORTICOSTEROIDS - TOPICAL .........176
CO SUMATRIPTAN .................................................... 115 COMPOUND-DICLOFENAC (TOPICAL) .......................71
CO SUMATRIPTAN ........................................... SEC 3.84 COMTAN .....................................................................117
CO TEMAZEPAM........................................................ 112 CONJUGATED ESTROGENS .....................................161
CO TERBINAFINE ........................................................ 15 COPAXONE ......................................................... SEC 2.4
CO TOPIRAMATE......................................................... 88 CORDARONE ................................................................36
CO VALACYCLOVIR .................................................... 18 CORTAMED.................................................................132
CO VALSARTAN........................................................... 69 CORTEF ......................................................................156
CO VENLAFAXINE XR ................................................. 90 CORTENEMA (100MG/60ML) .....................................177
CO ZOPICLONE ......................................................... 113 CORTIFOAM................................................................178
CODEINE PHOSPHATE ............................................... 77 CORTISONE ACETATE ..............................................155
CODEINE PHOSPHATE/ ACETAMINOPHEN .............. 77 CORTODERM MILD ....................................................177
CORTODERM REGULAR ...........................................
CODEINE PHOSPHATE/ ACETAMINOPHEN/ CAFFEINE ................................................................................ 77 177
CODEINE PHOSPHATE/ ASA/ CAFFEINE CITRATE .. 77 COSOPT ......................................................................138
CODEINE PHOSPHATE/ ASA/ MEPROBAMATE/ COSOPT PRESERVATIVE-FREE ...............................138
CAFFEINE CITRATE ................................................ 77 COSYNTROPIN ZINC HYDROXIDE COMPLEX .........166
COLCHICINE .............................................................. 187 COTAZYM ...................................................................141
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE JULY 1, 2012 200


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
COTAZYM ECS 20 ..................................................... 141 DELATESTRYL............................................................158
COTAZYM ECS 8 ....................................................... 141 DEMEROL .....................................................................79
COUMADIN ................................................................... 29 DEMULEN 30 (21 DAY) ...............................................159
COUMADIN ................................................................... 30 DEMULEN 30 (28 DAY) ...............................................159
COVERSYL ................................................................... 62 DENOSUMAB .................................................... SEC 3.24
COVERSYL ................................................................... 63 DEPAKENE ...................................................................89
COVERSYL PLUS ........................................................ 63 DEPO-MEDROL ..........................................................157
COVERSYL PLUS HD .................................................. 63 DEPO-MEDROL (PRESERVED) .................................157
COZAAR ....................................................................... 67 DEPO-MEDROL WITH LIDOCAINE ............................157
CREON 10 MINIMICROSPHERES ............................. 141 DEPO-PROVERA ........................................................167
CREON 25 MINIMICROSPHERES ............................. 141 DEPO-TESTOSTERONE CYPIONATE .......................158
CRESTOR ..................................................................... 41 DERMOVATE ..............................................................176
CTP 30 .......................................................................... 91 DESFERAL ..................................................................153
CUPRIMINE ................................................................ 153 DESFERRIOXAMINE MESILATE ................................153
CYANOCOBALAMIN .................................................. 185 DESIPRAMINE HCL ......................................................95
CYCLEN (21 DAY) ...................................................... 160 DESMOPRESSIN ........................................................167
CYCLEN (28 DAY) ...................................................... 160 DESMOPRESSIN ACETATE .......................................167
CYCLOBENZAPRINE ................................................... 27 DESOGESTREL/ ETHINYL ESTRADIOL ....................159
CYCLOBENZAPRINE HCL ........................................... 27 DESOGESTREL/ ETHINYL ESTRADIOL/
CYCLOCORT .............................................................. 175 DESOGESTREL/ ETHINYL ESTRADIOL/
CYCLOGYL ................................................................. 134 DESOGESTREL/ ETHINYL ESTRADIOL ................159
CYCLOMEN ................................................................ 158 DESONIDE ..................................................................177
CYCLOPENTOLATE HCL .......................................... 134 DESOXIMETASONE ...................................................177
CYCLOSPORINE ............................................... SEC 3.21 DESSICATED THYROID .............................................168
CYKLOKAPRON ........................................................... 33 DETROL LA ....................................................... SEC 3.89
CYMBALTA ................................................................... 90 DEVICE ........................................................................191
CYPROTERONE................................................ SEC 3.21 DEXAMETHASONE .....................................................132
CYPROTERONE ACETATE .............................. SEC 3.21 DEXAMETHASONE .....................................................156
CYTOMEL ................................................................... 168 DEXAMETHASONE SODIUM PHOSPHATE ..............132
CYTOVENE .................................................................. 18 DEXAMETHASONE SODIUM PHOSPHATE ..............156
DEXAMETHASONE/ FRAMYCETIN SULFATE/
GRAMICIDIN............................................................133
D DEXAMETHASONE/ NEOMYCIN SULFATE/
POLYMYXIN B SULFATE ........................................133
DABIGATRAN ETEXILATE ................................ SEC 3.22 DEXAMETHASONE/ TOBRAMYCIN ...........................133
DALACIN C ................................................................... 14 DEXASONE .................................................................156
DALACIN C PALMITATE .............................................. 14 DEXEDRINE ................................................................108
DALACIN C PHOSPHATE ............................................ 14 DEXIRON .......................................................................29
DALTEPARIN SODIUM ................................................ 30 DEXTROAMPHETAMINE SULFATE ...........................108
DALTEPARIN SODIUM ................................................ 31 DIABETA ......................................................................166
DANAPAROID SODIUM .................................... SEC 3.22 DIABETES SUPPLIES .....................................................1
DANAZOL ................................................................... 158 DIAMICRON.................................................................165
DANTRIUM ................................................................... 27 DIAMICRON MR ..........................................................165
DANTROLENE SODIUM .............................................. 27 DIAZEMULS.................................................................111
DAPSONE ..................................................................... 16 DIAZEPAM ...................................................................110
DARAPRIM ................................................................... 18 DIAZEPAM ...................................................................111
DARBEPOETIN ................................................. SEC 3.23 DIAZOXIDE ....................................................................44
DARIFENACIN HYDROBROMIDE .................... SEC 3.23 DICETEL ......................................................................149
DDAVP ........................................................................ 167 DICLECTIN ..................................................................144
DEFERASIROX ................................................. SEC 3.24 DICLOFENAC SODIUM ...............................................134
DEFEROXAMINE MESYLATE ................................... 153 DICLOFENAC SODIUM .................................................72
DICLOFENAC SODIUM SR ...........................................72
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

201 EFFECTIVE JULY 1, 2012


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
DICLOFENAC SODIUM/ MISOPROSTOL .................... 72 DOVONEX ...................................................................181
DICYCLOMINE HCL ..................................................... 23 DOXAZOSIN MESYLATE ..............................................47
DICYCLOMINE HYDROCHLORIDE ............................. 23 DOXEPIN HCL ...............................................................95
DIDROCAL .................................................................. 188 DOXEPIN HCL ...............................................................96
DIFLUCAN .................................................................... 15 DOXYCYCLINE .............................................................13
DIFLUCAN ......................................................... SEC 3.42 DOXYCYCLINE HYCLATE ............................................13
DIFLUCORTOLONE VALERATE ............................... 177 DOXYLAMINE SUCCINATE/ PYRIDOXINE HCL ........144
DIFLUNISAL ................................................................. 73 DROSPIRENONE/ ETHINYL ESTRADIOL ..................159
DIGOXIN ....................................................................... 36 DULOXETINE HYDROCHLORIDE ................................90
DIGOXIN PEDIATRIC ................................................... 36 DUO TRAV ..................................................................138
DIHYDROERGOTAMINE (DHE) ................................... 26 DUTASTERIDE .................................................. SEC 3.25
DIHYDROERGOTAMINE MESYLATE.......................... 26
DILANTIN ...................................................................... 84
DILANTIN INFATABS ................................................... 84 E
DILANTIN-125 ............................................................... 84
DILANTIN-30 ................................................................. 84 ECULIZUMAB .................................................... SEC 3.30
DILAUDID ..................................................................... 78 EDECRIN .......................................................................44
DILAUDID STERILE POWDER .................................... 79 EFFEXOR XR ................................................................90
DILAUDID-HP ............................................................... 78 EFUDEX ......................................................................180
DILTIAZEM HCL ........................................................... 56 ELAVIL ...........................................................................95
DILTIAZEM HCL ........................................................... 57 ELMIRON .....................................................................189
DILTIAZEM HCL ........................................................... 58 ELOCOM .....................................................................178
DIMENHYDRINATE .................................................... 142 ELTROXIN ...................................................................168
DIMENHYDRINATE I.M. ............................................. 142 EMEND ........................................................................144
DIMENHYDRINATE I.V............................................... 142 EMEND TRI-PACK ......................................................144
DIMETHYL SULFOXIDE ............................................. 188 EMO-CORT..................................................................177
DIMETHYL SULFOXIDE IRRIGATION ....................... 188 ENABLEX .......................................................... SEC 3.23
DIODOQUIN ................................................................. 18 ENALAPRIL MALEATE ..................................................60
DIOVAN ........................................................................ 69 ENALAPRIL MALEATE/ HYDROCHLOROTHIAZIDE ...60
DIOVAN-HCT ................................................................ 69 ENBREL ............................................................. SEC 3.38
DIOVAN-HCT ................................................................ 70 ENDOCET .....................................................................82
DIPENTUM ................................................................. 149 ENGERIX-B .................................................................171
DIPHENHYDRAMINE ..................................................... 3 ENOXAPARIN SODIUM ................................................31
DIPHENHYDRAMINE HCL ............................................. 3 ENTACAPONE ............................................................117
DIPHENOXYLATE HCL/ ATROPINE SULFATE ......... 141 ENTECAVIR...................................................................17
DIPROLENE GLYCOL ................................................ 175 ENTOCORT ....................................................... SEC 3.18
DIPROSALIC .............................................................. 175 ENTOCORT (115 ML) ..................................................176
DIPROSONE ............................................................... 175 ENTROPHEN 10............................................................71
DIPYRIDAMOLE ........................................................... 46 EPINEPHRINE ...............................................................26
DIPYRIDAMOLE/ ASA .................................................. 33 EPINEPHRINE HCL.....................................................135
DISOPYRAMIDE ........................................................... 35 EPINEPHRINE HCL.......................................................26
DIVALPROEX SODIUM (VALPROIC ACID EQUIV.) .... 85 EPIPEN ..........................................................................26
DIVALPROEX SODIUM (VALPROIC ACID EQUIV.) .... 86 EPIPEN JR ....................................................................26
DIXARIT ...................................................................... 187 EPIVAL ..........................................................................85
DOLASETRON MESYLATE ....................................... 142 EPIVAL ..........................................................................86
DOMPERIDONE ......................................................... 148 EPOETIN ALFA ................................................. SEC 3.30
DOMPERIDONE MALEATE ....................................... 148 EPOETIN ALFA ................................................. SEC 3.31
DONEPEZIL HCL ............................................... SEC 3.25 EPREX ............................................................... SEC 3.30
DORZOLAMIDE HCL .................................................. 136 EPREX (0.3 ML SYRINGE) ............................... SEC 3.31
DORZOLAMIDE HCL/ TIMOLOL MALEATE .............. 138 EPREX (0.4 ML SYRINGE) ............................... SEC 3.31
DOSTINEX ......................................................... SEC 3.18 EPREX (0.5 ML SYRINGE) ............................... SEC 3.31
DOVOBET................................................................... 181
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE JULY 1, 2012 202


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
EPREX (0.6 ML SYRINGE) ................................ SEC 3.31 F
EPREX (0.8 ML SYRINGE) ................................ SEC 3.31
EPREX (1 ML SYRINGE) ................................... SEC 3.31
FAMOTIDINE ...............................................................145
EPROSARTAN MESYLATE ......................................... 65
FEBUXOSTAT ................................................... SEC 3.39
EPROSARTAN MESYLATE/ HYDROCHLOROTHIAZIDE
FELODIPINE ..................................................................55
.................................................................................. 65
FELODIPINE ..................................................................56
ERGOLOID MESYLATES ............................................. 26
FENOFIBRATE ..............................................................37
ERGOTAMINE TARTRATE/ CAFFEINE....................... 26
FENOFIBRATE MICRO .................................................37
ERTAPENEM ..................................................... SEC 3.32
FENOFIBRATE-S ..........................................................37
ERYC .............................................................................. 8
FENOFIBRATE-S (TABLET)..........................................37
ERYTHRO-BASE ............................................................ 8
FENTANYL ........................................................ SEC 3.39
ERYTHRO-EC ................................................................ 8
FENTANYL ........................................................ SEC 3.40
ERYTHRO-ES ................................................................. 8
FENTANYL CITRATE ........................................ SEC 3.40
ERYTHRO-S ................................................................... 8
FILGRASTIM...................................................... SEC 3.41
ERYTHROMYCIN ....................................................... 131
FINACEA .....................................................................180
ERYTHROMYCIN ........................................................... 8
FINASTERIDE ................................................... SEC 3.41
ERYTHROMYCIN ESTOLATE ....................................... 8
FIORINAL ......................................................................71
ERYTHROMYCIN ETHYLSUCCINATE .......................... 8
FIORINAL-C 1/2 .............................................................76
ERYTHROMYCIN STEARATE ....................................... 8
FIORINAL-C 1/4 .............................................................76
ERYTHROMYCIN/ TRETINOIN ......................... SEC 3.32
FLAGYL .......................................................................174
ESCITALOPRAM OXALATE ......................................... 91
FLAGYSTATIN.............................................................174
ESTALIS (2.7*.62 MG/PTH) ........................................ 162
FLAREX .......................................................................132
ESTALIS (4.8*.51 MG/PTH) ........................................ 162
FLECAINIDE ..................................................................35
ESTRACE ................................................................... 161
FLECAINIDE ACETATE ................................................35
ESTRADERM-100 (8.0 MG/PTH) ............................... 161
FLOCTAFENINE ............................................................73
ESTRADERM-25 (2 MG/PTH) .................................... 161
FLORINEF ...................................................................156
ESTRADIOL-17B ........................................................ 161
FLOVENT DISKUS ......................................................156
ESTRADOT 100 (1.56 MG/PTH) ................................ 161
FLOVENT HFA ............................................................156
ESTRADOT 25 (0.39 MG/PTH) .................................. 161
FLUANXOL ..................................................................107
ESTRADOT 37.5 (0.585 MG/PTH).............................. 161
FLUANXOL DEPOT .....................................................107
ESTRADOT 50 (0.78 MG/PTH) .................................. 161
FLUCONAZOLE.............................................................15
ESTRADOT 75 (1.17 MG/PTH) .................................. 161
FLUCONAZOLE................................................. SEC 3.42
ESTRING .................................................................... 161
FLUCONAZOLE OMEGA ..............................................15
ESTROGEL ................................................................. 161
FLUDROCORTISONE ACETATE................................156
ETANERCEPT ................................................... SEC 3.38
FLUMETHASONE PIVALATE/ CLIOQUINOL..............133
ETHACRYNIC ACID ..................................................... 44
FLUNARIZINE..............................................................188
ETHOPROPAZINE HCL ............................................. 117
FLUNARIZINE HCL .....................................................188
ETHOSUXIMIDE ........................................................... 85
FLUNISOLIDE..............................................................132
ETHYNODIOL DIACETATE/ ETHINYL ESTRADIOL.. 159
FLUOCINONIDE ..........................................................177
ETIDROCAL ................................................................ 188
FLUOR-A-DAY .............................................................121
ETIDRONATE DISODIUM .......................................... 188
FLUOROMETHOLONE ...............................................132
ETIDRONATE DISODIUM/ CALCIUM CARBONATE . 188
FLUOROMETHOLONE ACETATE ..............................132
ETODOLAC .................................................................. 73
FLUOXETINE.................................................................92
EUFLEX ............................................................. SEC 3.42
FLUOXETINE HCL ........................................................92
EVISTA .............................................................. SEC 3.74
FLUPENTIXOL DECANOATE .....................................107
EXELON ............................................................. SEC 3.78
FLUPENTIXOL DIHYDROCHLORIDE.........................107
EXJADE ............................................................. SEC 3.24
FLUPHENAZINE DECANOATE...................................105
EXTAVIA (0.3 MG) ............................................... SEC 2.4
FLUPHENAZINE HCL..................................................105
EZETIMIBE ........................................................ SEC 3.38
FLUPHENAZINE HCL..................................................106
EZETROL ........................................................... SEC 3.38
FLUPHENAZINE OMEGA ...........................................105
FLURAZEPAM HCL .....................................................111

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

203 EFFECTIVE JULY 1, 2012


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
FLURBIPROFEN........................................................... 73 GENTAMICIN...................................................................5
FLUTAMIDE ....................................................... SEC 3.42 GENTAMICIN SULFATE .............................................131
FLUTICASONE PROPIONATE ................................... 156 GENTAMICIN SULFATE .............................................173
FLUVASTATIN SODIUM............................................... 39 GENTAMICIN SULFATE .................................................5
FLUVOXAMINE MALEATE ........................................... 92 GLATIRAMER ACETATE .................................... SEC 2.4
FML FORTE ................................................................ 132 GLICLAZIDE ................................................................165
FOLIC ACID ................................................................ 185 GLICLAZIDE MR..........................................................165
FONDAPARINUX SODIUM .......................................... 32 GLUCAGEN .................................................................166
FORADIL ....................................................................... 24 GLUCAGEN HYPOKIT ................................................166
FORMOTEROL FUMARATE ........................................ 24 GLUCAGON.................................................................166
FORMOTEROL FUMARATE DIHYDRATE ................... 25 GLUCAGON, RDNA ORIGIN .......................................166
FORTAZ .......................................................................... 7 GLUCOBAY .................................................................162
FOSAMAX.......................................................... SEC 3.14 GLUCONORM .............................................................165
FOSAVANCE ..................................................... SEC 3.15 GLUCOPHAGE ............................................................163
FOSINOPRIL ................................................................ 61 GLYBURIDE ................................................................166
FOSINOPRIL SODIUM ................................................. 61 GLYCOPYRROLATE .....................................................23
FRAGMIN ...................................................................... 30 GOLD SODIUM THIOMALATE ....................................151
FRAGMIN (0.2 ML SYRINGE) ...................................... 30 GOLIMUMAB ..................................................... SEC 3.46
FRAGMIN (0.3 ML SYRINGE) ...................................... 30 GOSERELIN ACETATE ..................................... SEC 3.46
FRAGMIN (0.4 ML SYRINGE) ...................................... 30 GRANISETRON ...........................................................142
FRAGMIN (0.5 ML SYRINGE) ...................................... 30 GRANISETRON HCL ...................................................142
FRAGMIN (0.6 ML SYRINGE) ...................................... 30
FRAGMIN (0.72 ML SYRINGE) .................................... 31
FRAXIPARINE (.3-1ML SYR) ....................................... 31 H
FRAXIPARINE FORTE (.6-1ML SYR) .......................... 31
FUCIDIN...................................................................... 173
HALOBETASOL PROPIONATE ..................................177
FUCIDIN...................................................................... 174
HALOPERIDOL............................................................104
FUNGIZONE IV ............................................................. 16
HALOPERIDOL............................................................105
FUROSEMIDE .............................................................. 44
HALOPERIDOL DECANOATE ....................................105
FUROSEMIDE .............................................................. 45
HALOPERIDOL LA ......................................................105
FUSIDIC ACID ............................................................ 173
HEPARIN LEO ...............................................................31
HEPARIN SODIUM ........................................................31
HEPATITIS B VACCINE (RECOMBINANT) ................171
G HEPSERA ......................................................................17
HEPTOVIR .....................................................................16
GABAPENTIN ............................................................... 86 HOMATROPINE HYDROBROMIDE ............................134
GALANTAMINE HYDROBROMIDE ................... SEC 3.42 HP-PAC ( KIT ).............................................................147
GANCICLOVIR SODIUM .............................................. 18 HUMALOG ...................................................................164
GARAMYCIN .............................................................. 131 HUMALOG CARTRIDGE/KWIKPEN ...........................164
GARASONE ................................................................ 133 HUMALOG MIX 25 CARTRIDGE/KWIKPEN ...............164
GD-AMLODIPINE.......................................................... 55 HUMALOG MIX 50 CARTRIDGE/KWIKPEN ...............164
GD-ATORVASTATIN .................................................... 38 HUMATROPE .................................................... SEC 3.82
GD-AZITHROMYCIN ...................................................... 9 HUMIRA ............................................................. SEC 3.13
GD-GABAPENTIN......................................................... 86 HUMULIN 30/70 ...........................................................164
GD-LATANOPROST ................................................... 137 HUMULIN 30/70 CARTRIDGE .....................................164
GD-SERTRALINE ......................................................... 93 HUMULIN N .................................................................164
GD-SERTRALINE ......................................................... 94 HUMULIN N CARTRIDGE/KWIKPEN..........................164
GD-VENLAFAXINE XR ................................................. 90 HUMULIN R .................................................................164
GEMFIBROZIL .............................................................. 37 HUMULIN R CARTRIDGE ...........................................164
GEN-CLOZAPINE ......................................................... 98 HYCORT (100MG/60ML) .............................................177
GEN-CLOZAPINE ......................................................... 99 HYDERGINE ..................................................................26
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE JULY 1, 2012 204


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
HYDERM..................................................................... 178 IMITREX DF ....................................................... SEC 3.84
HYDRALAZINE HCL ..................................................... 44 IMOVANE ....................................................................113
HYDROCHLOROTHIAZIDE ........................................ 126 IMURAN .......................................................................187
HYDROCHLOROTHIAZIDE/ AMILORIDE HCL .......... 126 INDAPAMIDE HEMIHYDRATE ....................................127
HYDROCHLOROTHIAZIDE/ SPIRONOLACTONE ...... 70 INDERAL-LA ..................................................................53
HYDROCHLOROTHIAZIDE/ TRIAMTERENE ............ 126 INDOMETHACIN ...........................................................73
HYDROCORTISONE .................................................. 156 INFLIXIMAB ....................................................... SEC 3.55
HYDROCORTISONE .................................................. 177 INFUFER .......................................................................29
HYDROCORTISONE 17-VALERATE ......................... 178 INHIBACE ......................................................................59
HYDROCORTISONE ACETATE ................................ 132 INHIBACE PLUS ............................................................59
HYDROCORTISONE ACETATE ................................ 178 INNOHEP .......................................................................31
HYDROCORTISONE ACETATE/ PRAMOXINE HCL . 178 INNOHEP (0.25 ML SYRINGE) .....................................31
HYDROCORTISONE ACETATE/ PRAMOXINE HCL/ INNOHEP (0.35 ML SYRINGE) .....................................31
ZINC SULFATE ....................................................... 178 INNOHEP (0.45 ML SYRINGE) .....................................31
HYDROCORTISONE ACETATE/ UREA..................... 178 INNOHEP (0.5 ML SYRINGE) .......................................31
HYDROCORTISONE ACETATE/ ZINC SULFATE ..... 178 INNOHEP (0.7 ML SYRINGE) .......................................31
HYDROCORTISONE SOD. SUCCINATE ................... 156 INNOHEP (0.9 ML SYRINGE) .......................................32
HYDROCORTISONE SOD. SUCCINATE ................... 157 INSULIN ASPART........................................................163
HYDROCORTISONE SODIUM SUCCINATE ............. 156 INSULIN DETEMIR ......................................................163
HYDROCORTISONE SODIUM SUCCINATE ............. 157 INSULIN GLARGINE ...................................................163
HYDROCORTISONE/ CINCHOCAINE HCL/ INSULIN GLULISINE (RDNA ORIGIN) ........................164
FRAMYCETIN SULFATE/ ESCULIN ...................... 179 INSULIN HUMAN BIOSYNTHETIC (ISOPHANE)........164
HYDROMORPH CONTIN ............................................. 78 INSULIN HUMAN BIOSYNTHETIC (REGULAR) .........164
HYDROMORPHONE .................................................... 78 INSULIN HUMAN BIOSYNTHETIC (REGULAR)/ INSULIN
HYDROMORPHONE HCL ............................................ 78 HUMAN BIOSYNTHETIC (ISOPHANE) ...................164
HYDROMORPHONE HCL ............................................ 79 INSULIN LISPRO .........................................................164
HYDROMORPHONE HP .............................................. 78 INSULIN LISPRO/ INSULIN LISPRO PROTAMINE ....164
HYDROMORPHONE HP 20 ......................................... 78 INSULIN PEN NEEDLES .................................................1
HYDROMORPHONE HP 50 ......................................... 78 INSULIN SYRINGES .......................................................1
HYDROVAL ................................................................ 178 INTERFERON BETA-1A ...................................... SEC 2.4
HYDROXYCHLOROQUINE SULFATE ......................... 18 INTERFERON BETA-1B ...................................... SEC 2.4
HYDROXYZINE HCL .................................................. 113 INVANZ .............................................................. SEC 3.32
HYOSCINE BUTYLBROMIDE ...................................... 23 INVEGA SUSTENNA (0.5 ML SYR) .................. SEC 3.65
HYTRIN ......................................................................... 48 INVEGA SUSTENNA (0.75 ML SYR) ................ SEC 3.65
HYZAAR ........................................................................ 67 INVEGA SUSTENNA (1 ML SYR) ..................... SEC 3.65
HYZAAR DS .................................................................. 68 INVEGA SUSTENNA (1.5 ML SYR) .................. SEC 3.65
IODOQUINOL ................................................................18
IOPIDINE .....................................................................138
I IPRATROPIUM BROMIDE ............................................24
IPRATROPIUM BROMIDE ................................ SEC 3.55
IPRATROPIUM BROMIDE/ SALBUTAMOL SULFATE .24
IBUPROFEN ................................................................. 73
IRBESARTAN ................................................................66
IMDUR .......................................................................... 46
IRBESARTAN/ HYDROCHLOROTHIAZIDE ..................66
IMIPENEM/ CILASTATIN SODIUM.................... SEC 3.47
IRBESARTAN/ HYDROCHLOROTHIAZIDE ..................67
IMIPRAMINE ................................................................. 96
IRBESARTAN/HCTZ ......................................................66
IMIPRAMINE HCL ......................................................... 96
IRBESARTAN/HCTZ ......................................................67
IMIQUIMOD ....................................................... SEC 3.47
IRON DEXTRAN COMPLEX..........................................29
IMITREX...................................................................... 115
ISDN ..............................................................................45
IMITREX............................................................. SEC 3.83
ISOPTIN SR ...................................................................58
IMITREX (0.5 ML) ....................................................... 115
ISOPTO ATROPINE ....................................................134
IMITREX (0.5 ML) .............................................. SEC 3.84
ISOPTO CARBACHOL ................................................137
IMITREX DF ................................................................ 115
ISOPTO CARPINE.......................................................137
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

205 EFFECTIVE JULY 1, 2012


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
ISOPTO HOMATROPINE ........................................... 134 KETOPROFEN-E ...........................................................74
ISOSORBIDE DINITRATE ............................................ 45 KETOROLAC TROMETHAMINE .................................134
ISOSORBIDE-5-MONONITRATE ................................. 46 KETOROLAC TROMETHAMINE ...................................74
ISOTRETINOIN ........................................................... 181 KETOTIFEN FUMARATE ................................................3
ITRACONAZOLE .......................................................... 15 KINERET ........................................................... SEC 3.17
ITRACONAZOLE ............................................... SEC 3.55 KYTRIL ........................................................................142

J L

JAMP-AMLODIPINE ..................................................... 55 L-TRYPTOPHAN ...........................................................97


JAMP-ATENOLOL ........................................................ 49 LABETALOL HCL ..........................................................51
JAMP-ATENOLOL ........................................................ 50 LABETALOL HYDROCHLORIDE ..................................51
JAMP-CITALOPRAM .................................................... 91 LACOSAMIDE.................................................... SEC 3.55
JAMP-FINASTERIDE ......................................... SEC 3.41 LACOSAMIDE.................................................... SEC 3.56
JAMP-FOSINOPRIL ...................................................... 61 LACTULOSE ................................................................125
JAMP-GABAPENTIN .................................................... 86 LAMICTAL .....................................................................87
JAMP-LACTULOSE .................................................... 125 LAMISIL .........................................................................15
JAMP-LISINOPRIL ........................................................ 61 LAMISIL .......................................................................174
JAMP-LISINOPRIL ........................................................ 62 LAMIVUDINE .................................................................16
JAMP-METOPROLOL-L ............................................... 52 LAMOTRIGINE ..............................................................87
JAMP-ONDANSETRON .............................................. 143 LANREOTIDE ACETATE ................................... SEC 3.56
JAMP-PRAVASTATIN................................................... 40 LANSOPRAZOLE ........................................................147
JAMP-QUETIAPINE .................................................... 100 LANSOPRAZOLE/ AMOXICILLIN TRIHYDRATE/
JAMP-QUETIAPINE .................................................... 101 CLARITHROMYCIN .................................................147
JAMP-RAMIPRIL (CAPSULE) ...................................... 63 LANTUS .......................................................................163
JAMP-RAMIPRIL (CAPSULE) ...................................... 64 LANTUS CARTRIDGE .................................................163
JAMP-RISPERIDONE ................................................. 102 LANTUS PEN...............................................................163
JAMP-RISPERIDONE ................................................. 103 LASIX .............................................................................44
JAMP-ROPINIROLE ................................................... 119 LASIX .............................................................................45
JAMP-ROPINIROLE ................................................... 120 LASIX SPECIAL .............................................................45
JAMP-SIMVASTATIN.................................................... 42 LATANOPROST ..........................................................137
JAMP-SIMVASTATIN.................................................... 43 LATANOPROST/ TIMOLOL MALEATE .......................138
JANUMET .......................................................... SEC 3.81 LECTOPAM .................................................................110
LEDERLE LEUCOVORIN CALCIUM ...........................188
LEFLUNOMIDE............................................................189
K LESCOL .........................................................................39
LESCOL XL ...................................................................39
LEUCOVORIN CALCIUM ............................................188
K-10 ORAL LIQUID ..................................................... 125
LEUPROLIDE ACETATE ................................... SEC 3.56
K-DUR ......................................................................... 125
LEVAQUIN ......................................................... SEC 3A.4
K-LYTE........................................................................ 125
LEVEMIR CARTRIDGE ...............................................163
KADIAN ......................................................................... 81
LEVETIRACETAM .........................................................87
KAYEXALATE ............................................................. 126
LEVOBUNOLOL HCL ..................................................136
KENALOG-10 .............................................................. 158
LEVOCARB CR ...........................................................118
KENALOG-40 .............................................................. 158
LEVOCARNITINE .............................................. SEC 3.57
KEPPRA........................................................................ 87
LEVODOPA/ BENSERAZIDE HCL ..............................117
KETOCONAZOLE ......................................................... 15
LEVODOPA/ CARBIDOPA ..........................................118
KETOCONAZOLE ....................................................... 174
LEVODOPA/ CARBIDOPA/ ENTACAPONE ................118
KETODERM ................................................................ 174
LEVOFLOXACIN................................................ SEC 3A.4
KETOPROFEN ............................................................. 74
LEVONORGESTREL ...................................................159
KETOPROFEN SR........................................................ 74
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE JULY 1, 2012 206


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
LEVONORGESTREL/ ETHINYL ESTRADIOL ............ 159 LOVENOX HP (0.8ML/1ML SYRINGE) .........................31
LEVONORGESTREL/ ETHINYL ESTRADIOL/ LOXAPAC ....................................................................108
LEVONORGESTREL/ ETHINYL ESTRADIOL/ LOXAPINE HCL ...........................................................108
LEVONORGESTREL/ ETHINYL ESTRADIOL ........ 159 LOXAPINE SUCCINATE .............................................108
LEVOTHYROXINE SODIUM ...................................... 168 LOZIDE ........................................................................127
LIBRAX ....................................................................... 110 LUCENTIS ...................................................................139
LIDOCAINE ................................................................. 179 LUMIGAN RC 0.01% ...................................................137
LIDOCAINE HCL ......................................................... 134 LUPRON ............................................................ SEC 3.56
LIDOCAINE HCL ......................................................... 180 LUPRON DEPOT ............................................... SEC 3.56
LIDODAN .................................................................... 179 LUVOX ...........................................................................92
LIDODAN VISCOUS ................................................... 134 LYDERM ......................................................................177
LINAGLIPTIN ..................................................... SEC 3.57
LINESSA 21 ................................................................ 159
LINESSA 28 ................................................................ 159 M
LINEZOLID......................................................... SEC 3.58
LIORESAL..................................................................... 27
M-ESLON .......................................................................80
LIORESAL D.S. ............................................................. 27
M-ESLON .......................................................................81
LIORESAL INTRATHECAL ........................................... 27
M.O.S. SULFATE ...........................................................80
LIOTHYRONINE SODIUM .......................................... 168
M.O.S.-SR ......................................................................79
LIPASE/ AMYLASE/ PROTEASE ............................... 141
MACROBID ....................................................................19
LIPIDIL MICRO ............................................................. 37
MAGLUCATE ...............................................................125
LIPIDIL SUPRA ............................................................. 37
MAGNESIUM GLUCOHEPTONATE ...........................125
LIPIDIL SUPRA (TABLET) ............................................ 37
MAGNESIUM GLUCONATE ........................................125
LIPITOR ........................................................................ 38
MAJEPTIL ....................................................................106
LISINOPRIL .................................................................. 61
MAPROTILINE HCL.......................................................96
LISINOPRIL .................................................................. 62
MAR-AMLODIPINE ........................................................55
LISINOPRIL/ HYDROCHLOROTHIAZIDE .................... 62
MAR-ATENOLOL ...........................................................49
LISINOPRIL/HCTZ (TYPE Z) ....................................... 62
MAR-ATENOLOL ...........................................................50
LITHANE ..................................................................... 114
MAR-CIPROFLOXACIN ..................................... SEC 3A.2
LITHIUM CARBONATE............................................... 114
MAR-CIPROFLOXACIN ..................................... SEC 3A.3
LOCACORTEN VIOFORM .......................................... 133
MAR-CITALOPRAM.......................................................91
LOESTRIN 1.5/30 (21 DAY)........................................ 160
MAR-METFORMIN ......................................................163
LOESTRIN 1.5/30 (28 DAY)........................................ 160
MAR-ONDANSETRON ................................................143
LOMOTIL .................................................................... 141
MAR-RISPERIDONE ...................................................102
LONITEN ....................................................................... 44
MAR-RISPERIDONE ...................................................103
LOPRESOR .................................................................. 52
MAR-SIMVASTATIN ......................................................42
LOPRESOR SR ............................................................ 52
MAR-SIMVASTATIN ......................................................43
LOPROX ..................................................................... 175
MARVELON (21 DAY) .................................................159
LORAZEPAM .............................................................. 111
MARVELON (28 DAY) .................................................159
LOSARTAN POTASSIUM ............................................. 67
MAVIK ............................................................................64
LOSARTAN POTASSIUM/ HYDROCHLOROTHIAZIDE
MAVIK ............................................................................65
.................................................................................. 67
MAXALT .......................................................................114
LOSARTAN POTASSIUM/ HYDROCHLOROTHIAZIDE
MAXALT ............................................................. SEC 3.79
.................................................................................. 68
MAXALT RPD ..............................................................114
LOSEC (SUSTAINED-RELEASE CAPSULE) ............. 147
MAXALT RPD ..............................................................115
LOSEC (SUSTAINED-RELEASE TABLET) ................ 147
MAXALT RPD .................................................... SEC 3.79
LOTENSIN .................................................................... 58
MAXIDEX .....................................................................132
LOTRIDERM ............................................................... 179
MAXITROL ...................................................................133
LOVASTATIN ................................................................ 39
MEBENDAZOLE ..............................................................5
LOVENOX ..................................................................... 31
MEDROL ......................................................................157
LOVENOX (0.3 ML SYRINGE) ..................................... 31
MEDROXYPROGESTERONE ACETATE ...................167
LOVENOX (0.4 - 1 ML SYRINGE) ................................ 31
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

207 EFFECTIVE JULY 1, 2012


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
MEFENAMIC ................................................................. 74 METROLOTION ...........................................................173
MEFENAMIC ACID ....................................................... 74 METRONIDAZOLE ......................................................173
MEGACE OS ..................................................... SEC 3.58 METRONIDAZOLE ......................................................174
MEGESTROL ..................................................... SEC 3.58 METRONIDAZOLE ........................................................19
MEGESTROL ACETATE ................................... SEC 3.58 METRONIDAZOLE/ NYSTATIN...................................174
MEPERIDINE HCL ........................................................ 79 MEVACOR .....................................................................39
MEPERIDINE HYDROCHLORIDE................................ 79 MEXILETINE HCL ..........................................................35
MEPRON ...................................................................... 19 MIACALCIN........................................................ SEC 3.85
MEROPENEM .................................................... SEC 3.59 MICARDIS .....................................................................68
MERREM ........................................................... SEC 3.59 MICARDIS PLUS ...........................................................68
MESALAZINE ............................................................. 149 MICRO-K EXTENCAPS ...............................................125
MESASAL ................................................................... 149 MICRONOR (28 DAY) .................................................159
MESTINON ................................................................... 23 MIDAMOR ....................................................................126
MESTINON-SR ............................................................. 23 MIDAZOLAM ................................................................111
METADOL ..................................................................... 79 MIDAZOLAM HCL ........................................................111
METADOL CONCENTRATE ......................................... 79 MIDODRINE...................................................................24
METFORMIN .............................................................. 163 MIDODRINE HCL ..........................................................24
METFORMIN HCL ...................................................... 163 MIGRANAL ....................................................................26
METHADONE ............................................................... 79 MIN-OVRAL (21 DAY) .................................................159
METHADONE COMPOUND ......................................... 79 MIN-OVRAL (28 DAY) .................................................159
METHADONE HCL ....................................................... 79 MINESTRIN 1/20 (21 DAY) ..........................................160
METHAZOLAMIDE ..................................................... 136 MINESTRIN 1/20 (28 DAY) ..........................................160
METHIMAZOLE .......................................................... 169 MINITRAN 0.2 ................................................................46
METHOTREXATE ......................................................... 21 MINITRAN 0.4 ................................................................46
METHOTREXATE SOD. (PRESERVED)...................... 21 MINITRAN 0.6 ................................................................46
METHOTREXATE SOD.(UNPRESERVED) ................. 21 MINOCYCLINE ..............................................................13
METHOTREXATE SODIUM ......................................... 21 MINOCYCLINE HCL ......................................................13
METHOTRIMEPRAZINE HCL .................................... 106 MINOXIDIL .....................................................................44
METHOTRIMEPRAZINE MALEATE ........................... 106 MINT-AMLODIPINE .......................................................55
METHOXSALEN ......................................................... 180 MINT-ATENOL ...............................................................49
METHSUXIMIDE ........................................................... 85 MINT-ATENOL ...............................................................50
METHYLDOPA ............................................................. 43 MINT-CIPROFLOXACIN .................................... SEC 3A.2
METHYLDOPA ............................................................. 44 MINT-CIPROFLOXACIN .................................... SEC 3A.3
METHYLPHENIDATE HCL ......................................... 109 MINT-CITALOPRAM ......................................................91
METHYLPREDNISOLONE ......................................... 157 MINT-FLUOXETINE .......................................................92
METHYLPREDNISOLONE ACETATE ........................ 157 MINT-ONDANSETRON ...............................................143
METHYLPREDNISOLONE ACETATE (P) .................. 157 MINT-PIOGLITAZONE ....................................... SEC 3.72
METHYLPREDNISOLONE ACETATE/ LIDOCAINE HCL MINT-PRAVASTATIN ....................................................40
................................................................................ 157 MINT-RISPERIDON .....................................................102
METHYLPREDNISOLONE ACETATE/ NEOMYCIN MINT-RISPERIDON .....................................................103
SULFATE/ ALUMINUM CHLORHYDROXIDE MINT-SIMVASTATIN .....................................................42
COMPLEX/ SULFUR ..................................... SEC 3.59 MINT-SIMVASTATIN .....................................................43
METHYLPREDNISOLONE SOD SUCCIN. ................. 157 MINT-TOPIRAMATE ......................................................88
METHYLPREDNISOLONE SODIUM SUCCINATE .... 157 MIRENA SYSTEM .......................................................159
METOCLOPRAMIDE HCL .......................................... 148 MIRTAZAPINE ...............................................................98
METOCLOPRAMIDE HCL .......................................... 149 MISCELLANEOUS COMPOUND ................................188
METOCLOPRAMIDE HYDROCHLORIDE .................. 149 MISCELLANEOUS INJECTABLE COMPOUND ..........188
METOLAZONE ........................................................... 127 MISCELLANEOUS ORAL COMPOUND ......................188
METOPROLOL ............................................................. 52 MISCELLANEOUS TOPICAL COMPOUND ................173
METOPROLOL TARTRATE ......................................... 52 MISOPROSTOL ...........................................................146
METROCREAM .......................................................... 173 MOCLOBEMIDE ............................................................89
METROGEL ................................................................ 173 MODAFINIL........................................................ SEC 3.59
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE JULY 1, 2012 208


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
MODECATE CONCENTRATE .................................... 105 MYLAN-CLARITHROMYCIN ...........................................9
MODULON .................................................................. 150 MYLAN-CLINDAMYCIN .................................................14
MOGADON ................................................................. 112 MYLAN-CLONAZEPAM .................................................84
MOMETASONE FUROATE ........................................ 132 MYLAN-CLOPIDOGREL ................................................32
MOMETASONE FUROATE ........................................ 178 MYLAN-CLOPIDOGREL .................................... SEC 3.20
MONOPRIL ................................................................... 61 MYLAN-COMBO STERINEBS .......................................24
MONTELUKAST ......................................................... 129 MYLAN-CYCLOBENZAPRINE ......................................27
MONTELUKAST ................................................ SEC 3.60 MYLAN-DOMPERIDONE ............................................148
MONTELUKAST SODIUM .......................................... 129 MYLAN-DOXAZOSIN ....................................................47
MONTELUKAST SODIUM ................................. SEC 3.60 MYLAN-ENALAPRIL ......................................................60
MORPHINE HCL ........................................................... 79 MYLAN-ETI-CAL-CAREPAC .......................................188
MORPHINE HP 25 ........................................................ 81 MYLAN-ETIDRONATE ................................................188
MORPHINE HP 50 ........................................................ 81 MYLAN-FAMOTIDINE .................................................145
MORPHINE LP EPIDURAL ........................................... 81 MYLAN-FENOFIBRATE MICRO....................................37
MORPHINE SR ............................................................. 80 MYLAN-FINASTERIDE ...................................... SEC 3.41
MORPHINE SULFATE .................................................. 80 MYLAN-FLUCONAZOLE ...............................................15
MORPHINE SULFATE .................................................. 81 MYLAN-FLUOXETINE ...................................................92
MOXIFLOXACIN HCL ........................................ SEC 3A.5 MYLAN-FOSINOPRIL ....................................................61
MS CONTIN .................................................................. 80 MYLAN-GABAPENTIN ..................................................86
MS.IR ............................................................................ 80 MYLAN-GALANTAMINE ER .............................. SEC 3.42
MUCOMYST ............................................................... 130 MYLAN-GEMFIBROZIL .................................................37
MUPIROCIN ................................................................ 174 MYLAN-GLICLAZIDE...................................................165
MYCOBUTIN ...................................................... SEC 3.74 MYLAN-GLYBE............................................................166
MYDFRIN .................................................................... 135 MYLAN-HYDROXYCHLOROQUINE .............................18
MYDRIACYL ............................................................... 134 MYLAN-INDAPAMIDE .................................................127
MYL-RANITIDINE ....................................................... 145 MYLAN-IPRATROPIUM .................................................24
MYLAN-ACEBUTOLOL ................................................. 49 MYLAN-IPRATROPIUM STERINEBS ............... SEC 3.55
MYLAN-ACEBUTOLOL (TYPE S)................................. 49 MYLAN-IRBESARTAN ...................................................66
MYLAN-ACYCLOVIR .................................................... 17 MYLAN-LAMOTRIGINE .................................................87
MYLAN-ALENDRONATE ................................... SEC 3.14 MYLAN-LANSOPRAZOLE ...........................................147
MYLAN-ALPRAZOLAM............................................... 110 MYLAN-LEVOFLOXACIN .................................. SEC 3A.4
MYLAN-AMANTADINE ............................................... 116 MYLAN-LISINOPRIL ......................................................61
MYLAN-AMIODARONE ................................................ 36 MYLAN-LISINOPRIL ......................................................62
MYLAN-AMLODIPINE................................................... 55 MYLAN-LISINOPRIL HCTZ ...........................................62
MYLAN-AMOXICILLIN .................................................. 10 MYLAN-LOSARTAN ......................................................67
MYLAN-ATENOLOL...................................................... 49 MYLAN-LOSARTAN HCTZ ............................................67
MYLAN-ATENOLOL...................................................... 50 MYLAN-LOSARTAN HCTZ ............................................68
MYLAN-ATORVASTATIN ............................................. 38 MYLAN-LOVASTATIN ...................................................39
MYLAN-AZATHIOPRINE ............................................ 187 MYLAN-METFORMIN ..................................................163
MYLAN-AZITHROMYCIN ............................................... 9 MYLAN-METOPROLOL .................................................52
MYLAN-BACLOFEN ..................................................... 27 MYLAN-METOPROLOL (TYPE L) .................................52
MYLAN-BECLO AQ. ................................................... 132 MYLAN-MINOCYCLINE .................................................13
MYLAN-BUDESONIDE AQ ......................................... 132 MYLAN-MIRTAZAPINE .................................................98
MYLAN-CANDESARTAN .............................................. 65 MYLAN-MONTELUKAST .............................................129
MYLAN-CAPTOPRIL .................................................... 59 MYLAN-MONTELUKAST ................................... SEC 3.60
MYLAN-CARBAMAZEPINE CR .................................... 85 MYLAN-NABUMETONE ................................................74
MYLAN-CARVEDILOL .................................................. 51 MYLAN-NAPROXEN EC ...............................................75
MYLAN-CILAZAPRIL .................................................... 59 MYLAN-NIFEDIPINE EXTENDED RELEASE................56
MYLAN-CIMETIDINE .................................................. 144 MYLAN-NITRO ..............................................................46
MYLAN-CIPROFLOXACIN ................................ SEC 3A.2 MYLAN-OLANZAPINE .................................................100
MYLAN-CIPROFLOXACIN ................................ SEC 3A.3 MYLAN-OLANZAPINE ...................................................99
MYLAN-CITALOPRAM ................................................. 91 MYLAN-OLANZAPINE ODT ........................................100
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

209 EFFECTIVE JULY 1, 2012


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
MYLAN-OMEPRAZOLE (CAPSULE) .......................... 147
N
MYLAN-ONDANSETRON ........................................... 143
MYLAN-OXYBUTYNIN ............................................... 183
MYLAN-PANTOPRAZOLE .......................................... 148 NABILONE ...................................................................144
MYLAN-PAROXETINE.................................................. 93 NABUMETONE ..............................................................74
MYLAN-PIOGLITAZONE ................................... SEC 3.72 NADOLOL ......................................................................52
MYLAN-PRAMIPEXOLE ............................................. 119 NADROPARIN CALCIUM ..............................................31
MYLAN-PRAVASTATIN ................................................ 40 NAFARELIN ACETATE ...............................................189
MYLAN-QUETIAPINE ................................................. 100 NALCROM ...................................................................130
MYLAN-QUETIAPINE ................................................. 101 NAPROSYN ...................................................................75
MYLAN-RAMIPRIL (CAPSULE) .................................... 63 NAPROSYN E................................................................75
MYLAN-RAMIPRIL (CAPSULE) .................................... 64 NAPROSYN SR .............................................................75
MYLAN-RANITIDINE .................................................. 145 NAPROXEN ...................................................................74
MYLAN-RISEDRONATE .................................... SEC 3.75 NAPROXEN ...................................................................75
MYLAN-RISPERIDONE .............................................. 102 NAPROXEN EC .............................................................75
MYLAN-RISPERIDONE .............................................. 103 NAPROXEN SODIUM ....................................................75
MYLAN-RIVASTIGMINE .................................... SEC 3.78 NAPROXEN SODIUM DS ..............................................75
MYLAN-RIZATRIPTAN ODT ....................................... 114 NARATRIPTAN HCL ....................................................114
MYLAN-RIZATRIPTAN ODT ....................................... 115 NARATRIPTAN HCL .......................................... SEC 3.61
MYLAN-RIZATRIPTAN ODT .............................. SEC 3.79 NARDIL ..........................................................................89
MYLAN-ROSUVASTATIN ............................................. 41 NASONEX ...................................................................132
MYLAN-SALBUTAMOL STERINEBS P.F. .................... 25 NATALIZUMAB .................................................... SEC 2.7
MYLAN-SELEGILINE .................................................. 120 NAVANE ......................................................................107
MYLAN-SERTRALINE .................................................. 93 NEO-MEDROL ACNE ........................................ SEC 3.59
MYLAN-SERTRALINE .................................................. 94 NEOMYCIN SULFATE/ POLYMYXIN B SULFATE .....174
MYLAN-SIMVASTATIN ................................................. 42 NEOMYCIN SULFATE/ POLYMYXIN B SULFATE/
MYLAN-SIMVASTATIN ................................................. 43 GRAMICIDIN............................................................131
MYLAN-SOTALOL ........................................................ 54 NEORAL ............................................................ SEC 3.21
MYLAN-SUMATRIPTAN ............................................. 115 NEOSPORIN................................................................174
MYLAN-SUMATRIPTAN .................................... SEC 3.84 NEOSTIGMINE BROMIDE ............................................23
MYLAN-TAMSULOSIN ................................................. 48 NERISONE ..................................................................177
MYLAN-TELMISARTAN................................................ 68 NERISONE OILY .........................................................177
MYLAN-TELMISARTAN HCTZ ..................................... 68 NEULASTA (0.6 ML SYRINGE) ......................... SEC 3.65
MYLAN-TERBINAFINE ................................................. 15 NEULEPTIL .................................................................106
MYLAN-TIZANIDINE .......................................... SEC 3.87 NEUPOGEN....................................................... SEC 3.41
MYLAN-TOPIRAMATE ................................................. 88 NEURONTIN ..................................................................86
MYLAN-TRAZODONE .................................................. 94 NIFEDIPINE ...................................................................56
MYLAN-VALACYCLOVIR (CAPLET) ............................ 18 NITOMAN .......................................................... SEC 3.87
MYLAN-VALPROIC....................................................... 89 NITRAZADON ..............................................................112
MYLAN-VALSARTAN HCTZ ......................................... 69 NITRAZEPAM ..............................................................112
MYLAN-VALSARTAN HCTZ ......................................... 70 NITRO-DUR 0.2 .............................................................46
MYLAN-VENLAFAXINE XR .......................................... 90 NITRO-DUR 0.4 .............................................................46
MYLAN-VERAPAMIL .................................................... 58 NITRO-DUR 0.6 .............................................................46
MYLAN-VERAPAMIL SR .............................................. 58 NITRO-DUR 0.8 .............................................................46
MYLAN-WARFARIN...................................................... 29 NITROFURANTOIN .......................................................19
MYLAN-WARFARIN...................................................... 30 NITROGLYCERIN..........................................................46
MYLAN-ZOLMITRIPTAN ............................................ 116 NITROL ..........................................................................46
MYLAN-ZOLMITRIPTAN ................................... SEC 3.95 NITROLINGUAL PUMPSPRAY .....................................46
MYLAN-ZOPICLONE .................................................. 113 NITROSTAT ...................................................................46
MYOCHRYSINE.......................................................... 151 NIZATIDINE .................................................................145
NORETHINDRONE .....................................................159
NORETHINDRONE ACETATE/ ESTRADIOL-17B ......162
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE JULY 1, 2012 210


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
NORETHINDRONE ACETATE/ ETHINYL ESTRADIOL NOVO-DIFENAC............................................................72
................................................................................ 160 NOVO-DIFENAC SR ......................................................72
NORETHINDRONE/ ETHINYL ESTRADIOL .............. 160 NOVO-DIFLUNISAL FC .................................................73
NORETHINDRONE/ ETHINYL ESTRADIOL/ NOVO-DILTAZEM..........................................................56
NORETHINDRONE/ ETHINYL ESTRADIOL .......... 160 NOVO-DILTAZEM CD ...................................................56
NORETHINDRONE/ ETHINYL ESTRADIOL/ NOVO-DILTAZEM CD ...................................................57
NORETHINDRONE/ ETHINYL ESTRADIOL/ NOVO-DILTIAZEM HCL ER ..........................................57
NORETHINDRONE/ ETHINYL ESTRADIOL .......... 160 NOVO-DILTIAZEM HCL ER ..........................................58
NORFLOXACIN ............................................................ 12 NOVO-DIVALPROEX ....................................................85
NORGESTIMATE/ ETHINYL ESTRADIOL ................. 160 NOVO-DIVALPROEX ....................................................86
NORGESTIMATE/ ETHINYL ESTRADIOL/ NOVO-DOXAZOSIN ......................................................47
NORGESTIMATE/ ETHINYL ESTRADIOL/ NOVO-DOXEPIN ...........................................................95
NORGESTIMATE/ ETHINYL ESTRADIOL ............. 160 NOVO-DOXEPIN ...........................................................96
NORITATE .................................................................. 173 NOVO-DOXYLIN............................................................13
NORPROLAC .................................................... SEC 3.73 NOVO-ENALAPRIL........................................................60
NORTRIPTYLINE HCL ................................................. 96 NOVO-ENALAPRIL/HCTZ .............................................60
NORVASC .................................................................... 55 NOVO-ETIDRONATECAL ...........................................188
NOVAMILOR ............................................................... 126 NOVO-FAMOTIDINE ...................................................145
NOVAMOXIN ................................................................ 10 NOVO-FENOFIBRATE MICRONIZED ...........................37
NOVAMOXIN ................................................................ 11 NOVO-FENOFIBRATE-S ...............................................37
NOVAMOXIN SUGAR-REDUCED ................................ 10 NOVO-FENOFIBRATE-S (TABLET) ..............................37
NOVAMOXIN SUGAR-REDUCED ................................ 11 NOVO-FENTANYL 100 ...................................... SEC 3.40
NOVO-5 ASA .............................................................. 149 NOVO-FENTANYL 25 ........................................ SEC 3.39
NOVO-ACEBUTOLOL .................................................. 49 NOVO-FENTANYL 50 ........................................ SEC 3.40
NOVO-ACYCLOVIR ...................................................... 17 NOVO-FENTANYL 75 ........................................ SEC 3.40
NOVO-ALFUZOSIN PR ..................................... SEC 3.15 NOVO-FINASTERIDE ........................................ SEC 3.41
NOVO-AMPICILLIN............................................ SEC 3.15 NOVO-FLUCONAZOLE .................................................15
NOVO-ATORVASTATIN ............................................... 38 NOVO-FLURPROFEN ...................................................73
NOVO-AZITHROMYCIN ................................................. 9 NOVO-FLUTAMIDE ........................................... SEC 3.42
NOVO-BENZYDAMINE............................................... 135 NOVO-FLUVOXAMINE ..................................................92
NOVO-BETAHISTINE ................................................. 187 NOVO-FURANTOIN ......................................................19
NOVO-BISOPROLOL ................................................... 50 NOVO-GEMFIBROZIL ...................................................37
NOVO-BROMAZEPAM ............................................... 110 NOVO-GLICLAZIDE ....................................................165
NOVO-BUSPIRONE ................................................... 112 NOVO-HYDROXYZIN ..................................................113
NOVO-CAPTORIL......................................................... 59 NOVO-INDAPAMIDE ...................................................127
NOVO-CEFADROXIL......................................... SEC 3.19 NOVO-IPRAMIDE ..........................................................24
NOVO-CHLOROQUINE ................................................ 18 NOVO-KETOCONAZOLE ..............................................15
NOVO-CILAZAPRIL ...................................................... 59 NOVO-KETOROLAC .....................................................74
NOVO-CILAZAPRIL/HCTZ ........................................... 59 NOVO-KETOTIFEN .........................................................3
NOVO-CIMETINE ....................................................... 144 NOVO-LAMOTRIGINE ...................................................87
NOVO-CIPROFLOXACIN .................................. SEC 3A.2 NOVO-LANSOPRAZOLE ............................................147
NOVO-CIPROFLOXACIN .................................. SEC 3A.3 NOVO-LEFLUNOMIDE ................................................189
NOVO-CITALOPRAM ................................................... 91 NOVO-LEVOCARBIDOPA ...........................................118
NOVO-CLAVAMOXIN ................................................... 11 NOVO-LEVOFLOXACIN .................................... SEC 3A.4
NOVO-CLOBAZAM ....................................................... 83 NOVO-LEXIN ...................................................................5
NOVO-CLOBETASOL................................................. 176 NOVO-LEXIN ...................................................................6
NOVO-CLONAZEPAM .................................................. 84 NOVO-LISINOPRIL (TYPE Z) ........................................61
NOVO-CLONIDINE ..................................................... 187 NOVO-LISINOPRIL (TYPE Z) ........................................62
NOVO-CLONIDINE ....................................................... 43 NOVO-LISINOPRIL/HCTZ (TYPE P) .............................62
NOVO-CLOXIN ............................................................. 12 NOVO-LORAZEM ........................................................111
NOVO-CYCLOPRINE ................................................... 27 NOVO-LOVASTATIN .....................................................39
NOVO-DESMOPRESSIN ............................................ 167 NOVO-MAPROTILINE ...................................................96
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

211 EFFECTIVE JULY 1, 2012


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
NOVO-MEDRONE ...................................................... 167 NOVO-SUMATRIPTAN DF ................................ SEC 3.84
NOVO-METFORMIN ................................................... 163 NOVO-SUNDAC ............................................................76
NOVO-METHACIN ........................................................ 73 NOVO-TAMSULOSIN ....................................................48
NOVO-MEXILETINE ..................................................... 35 NOVO-TEMAZEPAM ...................................................112
NOVO-MINOCYCLINE.................................................. 13 NOVO-TERBINAFINE ....................................................15
NOVO-MIRTAZAPINE .................................................. 98 NOVO-TIAPROFENIC ...................................................76
NOVO-MOCLOBEMIDE ................................................ 89 NOVO-TICLOPIDINE .....................................................33
NOVO-MORPHINE SR ................................................. 80 NOVO-TIMOL ................................................................54
NOVO-NABUMETONE ................................................. 74 NOVO-TOPIRAMATE ....................................................88
NOVO-NADOLOL ......................................................... 52 NOVO-TRIAMZIDE ......................................................126
NOVO-NARATRIPTAN ............................................... 114 NOVO-TRIMEL ..............................................................12
NOVO-NARATRIPTAN ...................................... SEC 3.61 NOVO-TRIMEL DS ........................................................12
NOVO-NIZATIDINE..................................................... 145 NOVO-VALPROIC .........................................................89
NOVO-NORFLOXACIN................................................. 12 NOVO-VERAMIL SR ......................................................58
NOVO-NORTRIPTYLINE .............................................. 96 NOVO-WARFARIN ........................................................29
NOVO-OMEPRAZOLE (DELAYED RELEASE TABLET) NOVO-WARFARIN ........................................................30
................................................................................ 147 NOVO-ZOPICLONE .....................................................113
NOVO-OXYBUTYNIN ................................................. 183 NOVOLIN GE 30/70 .....................................................164
NOVO-PANTOPRAZOLE ........................................... 148 NOVOLIN GE 30/70 CARTRIDGE ...............................164
NOVO-PEN-VK ............................................................. 10 NOVOLIN GE 40/60 CARTRIDGE ...............................164
NOVO-PERIDOL ......................................................... 104 NOVOLIN GE 50/50 CARTRIDGE ...............................164
NOVO-PERIDOL ......................................................... 105 NOVOLIN GE NPH ......................................................164
NOVO-PINDOL ............................................................. 53 NOVOLIN GE NPH CARTRIDGE ................................164
NOVO-PIOGLITAZONE ..................................... SEC 3.72 NOVOLIN GE TORONTO ............................................164
NOVO-PIROCAM .......................................................... 76 NOVOLIN GE TORONTO CARTRIDGE ......................164
NOVO-PRAMIPEXOLE ............................................... 119 NOVORAPID................................................................163
NOVO-PRANOL ............................................................ 53 NOVORAPID CARTRIDGE .........................................163
NOVO-PRAVASTATIN.................................................. 40 NOZINAN .....................................................................106
NOVO-PRAZIN ............................................................. 47 NYLIDRIN HCL ..............................................................47
NOVO-PROFEN............................................................ 73 NYSTATIN .....................................................................16
NOVO-QUETIAPINE ................................................... 100
NOVO-QUETIAPINE ................................................... 101
NOVO-QUININE............................................................ 19 O
NOVO-RALOXIFENE ......................................... SEC 3.74
NOVO-RANIDINE ....................................................... 145
OCTOSTIM ..................................................................167
NOVO-RANIDINE ....................................................... 146
OCTREOTIDE ACETATE .................................. SEC 3.61
NOVO-RISEDRONATE...................................... SEC 3.75
OCTREOTIDE ACETATE .................................. SEC 3.62
NOVO-RISPERIDONE ................................................ 102
OCTREOTIDE ACETATE OMEGA .................... SEC 3.61
NOVO-RISPERIDONE ................................................ 103
OCUFLOX ....................................................................131
NOVO-RIVASTIGMINE ...................................... SEC 3.78
OESCLIM 25 (5 MG/PTH) ............................................161
NOVO-RYTHRO EES ..................................................... 8
OESCLIM 50 (10 MG/PTH) ..........................................161
NOVO-RYTHRO ESTOLATE .......................................... 8
OFLOXACIN ................................................................131
NOVO-SELEGILINE.................................................... 120
OFLOXACIN ...................................................... SEC 3A.5
NOVO-SEMIDE ............................................................. 44
OLANZAPINE ..............................................................100
NOVO-SEMIDE ............................................................. 45
OLANZAPINE ................................................................99
NOVO-SOTALOL .......................................................... 54
OLANZAPINE ODT ......................................................100
NOVO-SPIROTON ........................................................ 70
OLESTYR LIGHT ...........................................................36
NOVO-SPIROZINE ....................................................... 70
OLESTYR REGULAR ....................................................36
NOVO-SUCRALATE ................................................... 146
OLMESARTAN MEDOXOMIL........................................45
NOVO-SUMATRIPTAN ............................................... 115
OLMESARTAN MEDOXOMIL/
NOVO-SUMATRIPTAN ...................................... SEC 3.84
HYDROCHLOROTHIAZIDE.......................................45
NOVO-SUMATRIPTAN DF ......................................... 115
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE JULY 1, 2012 212


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
OLMETEC ..................................................................... 45 OXYNEO ........................................................................82
OLMETEC PLUS........................................................... 45
OLSALAZINE SODIUM ............................................... 149
OMALIZUMAB ................................................... SEC 3.64 P
OMEPRAZOLE ........................................................... 147
OMEPRAZOLE (CAPSULE) ....................................... 147
PALIPERIDONE PALMITATE ............................ SEC 3.65
OMNITROPE ..................................................... SEC 3.82
PAMIDRONATE DISODIUM ........................................189
ONABOTULINUMTOXINA .......................................... 189
PAMIDRONATE DISODIUM OMEGA ..........................189
ONDANSETRON ........................................................ 142
PANCREASE MT 10 ....................................................141
ONDANSETRON ........................................................ 143
PANCREASE MT 16 ....................................................141
ONDANSETRON HCL DIHYDRATE........................... 143
PANCREASE MT 4 ......................................................141
ONDANSETRON OMEGA (PRESERVATIVE FREE) . 143
PANECTYL ......................................................................3
ONDANSETRON OMEGA (WITH PRESERVATIVE) . 143
PANOXYL 10 ..................................................... SEC 3.18
ONDANSETRON-ODAN ............................................. 143
PANOXYL 20 ..................................................... SEC 3.18
ONE-ALPHA ............................................................... 185
PANTOLOC .................................................................148
ONGLYZA .......................................................... SEC 3.80
PANTOPRAZOLE ........................................................148
OPIUM/ BELLADONNA ................................................ 81
PAPAVERINE HCL ............................................ SEC 3.65
OPTICHAMBER ADVANTAGE II (CHAMBER ONLY) 191
PARIET ........................................................................148
OPTICHAMBER ADVANTAGE II (WITH LARGE MASK)
PARNATE ......................................................................89
................................................................................ 191
PAROXETINE ................................................................93
OPTICHAMBER ADVANTAGE II (WITH MEDIUM MASK)
PAROXETINE HCL ........................................................93
................................................................................ 191
PARSITAN ...................................................................117
OPTICHAMBER ADVANTAGE II (WITH SMALL MASK)
PAT-GALANTAMINE ER ................................... SEC 3.42
................................................................................ 191
PAXIL .............................................................................93
OPTIMYXIN PLUS ...................................................... 131
PEDIAPRED ................................................................158
ORACORT .................................................................. 179
PEGASYS (0.5 ML SYRINGE).......................................17
ORAP .......................................................................... 108
PEGASYS (0.5 ML SYRINGE)........................... SEC 3.67
ORCIPRENALINE SULFATE ........................................ 25
PEGASYS RBV (KIT) ......................................... SEC 3.69
ORENCIA ............................................................. SEC 3.6
PEGETRON (KIT) .............................................. SEC 3.71
ORGARAN ......................................................... SEC 3.22
PEGETRON REDIPEN (KIT) ............................. SEC 3.71
ORTHO 0.5/35 (21 DAY)............................................. 160
PEGFILGRASTIM .............................................. SEC 3.65
ORTHO 0.5/35 (28 DAY)............................................. 160
PEGINTERFERON ALFA-2A .........................................17
ORTHO 1/35 (21 DAY)................................................ 160
PEGINTERFERON ALFA-2A ............................. SEC 3.67
ORTHO 1/35 (28 DAY)................................................ 160
PEGINTERFERON ALFA-2A/ RIBAVIRIN ......... SEC 3.69
ORTHO 7/7/7 (21 DAY)............................................... 160
PEGINTERFERON ALFA-2B/ RIBAVIRIN ......... SEC 3.71
ORTHO 7/7/7 (28 DAY)............................................... 160
PENICILLAMINE ..........................................................153
ORTHO-CEPT (28 DAY) ............................................. 159
PENICILLIN G SODIUM ................................................10
OXAZEPAM ................................................................ 112
PENICILLIN V POTASSIUM ..........................................10
OXEZE TURBUHALER ................................................. 25
PENTASA ....................................................................149
OXSORALEN .............................................................. 180
PENTASA (1G/100ML) ................................................149
OXSORALEN ULTRA ................................................. 180
PENTASA (4G/100 ML) ...............................................149
OXTRIPHYLLINE ........................................................ 183
PENTAZOCINE HCL .....................................................83
OXTRIPHYLLINE/ GUAIFENESIN .............................. 183
PENTAZOCINE LACTATE ............................................83
OXY-IR .......................................................................... 82
PENTOSAN POLYSULFATE SODIUM .......................189
OXYBUTYNIN ............................................................. 183
PENTOXIFYLLINE .........................................................33
OXYBUTYNIN CHLORIDE ......................................... 183
PEPCID ........................................................................145
OXYBUTYNIN CHLORIDE ................................ SEC 3.64
PERCOCET ...................................................................82
OXYCODONE HCL ....................................................... 82
PERCOCET DEMI .........................................................82
OXYCODONE HCL/ ACETAMINOPHEN...................... 82
PERICYAZINE .............................................................106
OXYCODONE HCL/ ASA.............................................. 83
PERINDOPRIL ERBUMINE ...........................................62
OXYCODONE/ACET .................................................... 82
PERINDOPRIL ERBUMINE ...........................................63
OXYCONTIN ................................................................. 82
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

213 EFFECTIVE JULY 1, 2012


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
PERINDOPRIL ERBUMINE/ INDAPAMIDE PIZOTIFEN MALATE ...................................................120
HEMIHYDRATE ........................................................ 63 PLAN B ........................................................................159
PERPHENAZINE ........................................................ 106 PLAQUENIL SULFATE ..................................................18
PHENELZINE SULFATE............................................... 89 PLAVIX ..........................................................................32
PHENOBARB .............................................................. 109 PLAVIX .............................................................. SEC 3.20
PHENOBARBITAL ...................................................... 109 PLENDIL ........................................................................55
PHENYLEPHRINE HCL .............................................. 135 PLENDIL ........................................................................56
PHENYTOIN ................................................................. 84 PMS - POTASSIUM CHLORIDE..................................125
PHENYTOIN SODIUM .................................................. 84 PMS-ALENDRONATE-FC ................................. SEC 3.14
PHL-AMLODIPINE ........................................................ 55 PMS-AMANTADINE HYDROCHLORIDE ....................116
PHL-ATENOLOL ........................................................... 49 PMS-AMIODARONE ......................................................36
PHL-ATENOLOL ........................................................... 50 PMS-AMLODIPINE ........................................................55
PHL-AZITHROMYCIN ..................................................... 9 PMS-AMOXICILLIN .......................................................10
PHL-BACLOFEN ........................................................... 27 PMS-AMOXICILLIN .......................................................11
PHL-CARVEDILOL ....................................................... 51 PMS-ATENOLOL ...........................................................49
PHL-CITALOPRAM ....................................................... 91 PMS-ATENOLOL ...........................................................50
PHL-CLONAZEPAM ..................................................... 84 PMS-ATORVASTATIN ...................................................38
PHL-CLONAZEPAM-R.................................................. 84 PMS-AZITHROMYCIN .....................................................9
PHL-FLUOXETINE........................................................ 92 PMS-AZITHROMYCIN ....................................... SEC 3.17
PHL-ONDANSETRON ................................................ 143 PMS-BACLOFEN ...........................................................27
PHL-PIOGLITAZONE......................................... SEC 3.72 PMS-BENZTROPINE ...................................................117
PHL-RANITIDINE ........................................................ 145 PMS-BENZYDAMINE ..................................................135
PHL-RISPERIDONE ................................................... 102 PMS-BISOPROLOL .......................................................50
PHL-RISPERIDONE ................................................... 103 PMS-BRIMONIDINE ....................................................135
PHL-SERTRALINE........................................................ 93 PMS-BUPROPION SR ...................................................97
PHL-SERTRALINE........................................................ 94 PMS-BUSPIRONE .......................................................112
PHL-SIMVASTATIN ...................................................... 42 PMS-CARBAMAZEPINE ...............................................85
PHL-SIMVASTATIN ...................................................... 43 PMS-CARBAMAZEPINE-CR .........................................85
PHL-TOPIRAMATE ....................................................... 88 PMS-CARVEDILOL .......................................................51
PHOSPHATE-NOVARTIS ........................................... 125 PMS-CHLORAL HYDRATE .........................................112
PHYTONADIONE........................................................ 185 PMS-CILAZAPRIL..........................................................59
PILOCARPINE HCL .................................................... 137 PMS-CIPROFLOXACIN ...............................................131
PILOCARPINE HCL ...................................................... 23 PMS-CIPROFLOXACIN ..................................... SEC 3A.2
PILOPINE HS .............................................................. 137 PMS-CIPROFLOXACIN ..................................... SEC 3A.3
PIMOZIDE ................................................................... 108 PMS-CITALOPRAM .......................................................91
PINAVERIUM BROMIDE ............................................ 149 PMS-CLARITHROMYCIN ................................................9
PINDOLOL .................................................................... 53 PMS-CLOBAZAM ..........................................................83
PINDOLOL/ HYDROCHLOROTHIAZIDE...................... 53 PMS-CLONAZEPAM .....................................................84
PIOGLITAZONE HCL ......................................... SEC 3.72 PMS-CLONAZEPAM-R ..................................................84
PIOGLITAZONE HYDROCHLORIDE ................ SEC 3.72 PMS-CLOPIDOGREL ....................................................32
PIPERACILLIN AND TAZOBACTAM ................. SEC 3.73 PMS-CLOPIDOGREL ........................................ SEC 3.20
PIPERACILLIN SODIUM/ TAZOBACTAM SODIUM PMS-CYCLOBENZAPRINE ...........................................27
....................................................................... SEC 3.73 PMS-DEFEROXAMINE ...............................................153
PIPERACILLIN SODIUM/TAZOBACTAM SODIUM PMS-DESMOPRESSIN ...............................................167
....................................................................... SEC 3.73 PMS-DESONIDE .........................................................177
PIPORTIL L4 ............................................................... 106 PMS-DEXAMETHASONE ............................................156
PIPOTIAZINE PALMITATE ......................................... 106 PMS-DEXAMETHASONE SODIUM PHOSP ...............156
PIPRADROL HCL/ THIAMINE HCL/ RIBOFLAVIN/ PMS-DICLOFENAC .......................................................72
PYRIDOXINE HCL/ NIACINAMIDE/ CHOLINE/ PMS-DICLOFENAC-SR .................................................72
INOSITOL ............................................................... 186 PMS-DILTIAZEM CD .....................................................56
PIROXICAM .................................................................. 76 PMS-DILTIAZEM CD .....................................................57
PIZOTIFEN MALATE .................................................. 116 PMS-DOMPERIDONE .................................................148
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE JULY 1, 2012 214


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
PMS-DOXAZOSIN ........................................................ 47 PMS-NAPROXEN ..........................................................75
PMS-ENALAPRIL.......................................................... 60 PMS-NAPROXEN EC ....................................................75
PMS-ERYTHROMYCIN .............................................. 131 PMS-NIZATIDINE ........................................................145
PMS-FENOFIBRATE MICRO ....................................... 37 PMS-NORFLOXACIN ....................................................12
PMS-FENTANYL MTX ....................................... SEC 3.39 PMS-NORTRIPTYLINE .................................................96
PMS-FENTANYL MTX ....................................... SEC 3.40 PMS-NYSTATIN ............................................................16
PMS-FINASTERIDE........................................... SEC 3.41 PMS-OFLOXACIN .......................................................131
PMS-FLUCONAZOLE ................................................... 15 PMS-OLANZAPINE .....................................................100
PMS-FLUOROMETHOLONE ...................................... 132 PMS-OLANZAPINE .......................................................99
PMS-FLUOXETINE ....................................................... 92 PMS-OLANZAPINE ODT .............................................100
PMS-FLUTAMIDE .............................................. SEC 3.42 PMS-OMEPRAZOLE (SUSTAINED-RELEASE
PMS-FLUVOXAMINE.................................................... 92 CAPSULE) ...............................................................147
PMS-GABAPENTIN ...................................................... 86 PMS-OMEPRAZOLE DR (DELAYED RELEASE TABLET)
PMS-GEMFIBROZIL ..................................................... 37 .................................................................................147
PMS-GLYBURIDE....................................................... 166 PMS-ONDANSETRON ................................................143
PMS-HYDROCHLOROTHIAZIDE ............................... 126 PMS-OXTRIPHYLLINE ................................................183
PMS-HYDROMORPHONE ........................................... 78 PMS-OXYBUTYNIN .....................................................183
PMS-HYDROMORPHONE ........................................... 79 PMS-OXYCODONE .......................................................82
PMS-HYDROXYZINE ................................................. 113 PMS-PANTOPRAZOLE ...............................................148
PMS-INDAPAMIDE ..................................................... 127 PMS-PAROXETINE .......................................................93
PMS-IPRATROPIUM .................................................... 24 PMS-PINDOLOL ............................................................53
PMS-IPRATROPIUM ......................................... SEC 3.55 PMS-PIOGLITAZONE ........................................ SEC 3.72
PMS-IPRATROPIUM (1ML) ............................... SEC 3.55 PMS-PIROXICAM ..........................................................76
PMS-IPRATROPIUM (2ML) ............................... SEC 3.55 PMS-PRAMIPEXOLE ..................................................119
PMS-IRBESARTAN ...................................................... 66 PMS-PRAVASTATIN .....................................................40
PMS-IRBESARTAN-HCTZ ............................................ 66 PMS-PREDNISOLONE ................................................158
PMS-IRBESARTAN-HCTZ ............................................ 67 PMS-PROCYCLIDINE .................................................117
PMS-ISMN .................................................................... 46 PMS-QUETIAPINE ......................................................100
PMS-KETOPROFEN..................................................... 74 PMS-QUETIAPINE ......................................................101
PMS-LACTULOSE ...................................................... 125 PMS-RABEPRAZOLE EC ............................................148
PMS-LAMOTRIGINE..................................................... 87 PMS-RALOXIFENE ........................................... SEC 3.74
PMS-LEVETIRACETAM ............................................... 87 PMS-RAMIPRIL (CAPSULE) .........................................63
PMS-LEVOBUNOLOL ................................................. 136 PMS-RAMIPRIL (CAPSULE) .........................................64
PMS-LEVOFLOXACIN ....................................... SEC 3A.4 PMS-RAMIPRIL-HCTZ ..................................................64
PMS-LISINOPRIL.......................................................... 61 PMS-RANITIDINE ........................................................145
PMS-LISINOPRIL.......................................................... 62 PMS-REPAGLINIDE ....................................................165
PMS-LITHIUM CARBONATE ...................................... 114 PMS-RISEDRONATE ........................................ SEC 3.75
PMS-LORAZEPAM ..................................................... 111 PMS-RISPERIDONE ...................................................102
PMS-LOSARTAN .......................................................... 67 PMS-RISPERIDONE ...................................................103
PMS-LOVASTATIN ....................................................... 39 PMS-RISPERIDONE ...................................................104
PMS-METFORMIN...................................................... 163 PMS-RISPERIDONE ODT ...........................................104
PMS-METHYLPHENIDATE ........................................ 109 PMS-RIVASTIGMINE ........................................ SEC 3.78
PMS-METOCLOPRAMIDE ......................................... 148 PMS-ROPINIROLE ......................................................119
PMS-METOCLOPRAMIDE ......................................... 149 PMS-ROPINIROLE ......................................................120
PMS-METOPROLOL-L ................................................. 52 PMS-ROSUVASTATIN ..................................................41
PMS-MINOCYCLINE .................................................... 13 PMS-SALBUTAMOL ......................................................25
PMS-MIRTAZAPINE ..................................................... 98 PMS-SALBUTAMOL POLYNEB ....................................25
PMS-MONTELUKAST ................................................ 129 PMS-SERTRALINE........................................................93
PMS-MONTELUKAST ....................................... SEC 3.60 PMS-SERTRALINE........................................................94
PMS-MONTELUKAST FC ........................................... 129 PMS-SIMVASTATIN ......................................................42
PMS-MONTELUKAST FC .................................. SEC 3.60 PMS-SIMVASTATIN ......................................................43
PMS-NABILONE ......................................................... 144 PMS-SODIUM CROMOGLYCATE ..............................130
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

215 EFFECTIVE JULY 1, 2012


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
PMS-SODIUM POLYSTYRENE SULF. ...................... 126 PRINIVIL ........................................................................62
PMS-SOTALOL ............................................................. 54 PRINZIDE ......................................................................62
PMS-SULFASALAZINE ................................................ 13 PROBENECID .............................................................127
PMS-SUMATRIPTAN.................................................. 115 PROCAINAMIDE HCL ...................................................35
PMS-SUMATRIPTAN......................................... SEC 3.84 PROCAN SR ..................................................................35
PMS-TERAZOSIN ......................................................... 48 PROCHLORPERAZINE ...............................................142
PMS-TERBINAFINE...................................................... 15 PROCTODAN-HC ........................................................178
PMS-TIMOLOL ........................................................... 136 PROCTOFOAM-HC .....................................................178
PMS-TOBRAMYCIN ................................................... 131 PROCTOL ....................................................................179
PMS-TOPIRAMATE ...................................................... 88 PROCTOSEDYL ..........................................................179
PMS-TRAZODONE ....................................................... 94 PROCYCLIDINE HCL ..................................................117
PMS-URSODIOL C ..................................................... 141 PROGESTERONE .......................................................167
PMS-VALACYCLOVIR (CAPLET) ................................ 18 PROGLYCEM ................................................................44
PMS-VALPROIC ACID.................................................. 89 PROLIA .............................................................. SEC 3.24
PMS-VALPROIC ACID E.C. .......................................... 89 PROLOPA 100-25........................................................117
PMS-VANCOMYCIN ..................................................... 14 PROLOPA 200-50........................................................117
PMS-VENLAFAXINE XR ............................................... 90 PROLOPA 50-12.5.......................................................117
PMS-VERAPAMIL SR ................................................... 58 PROMETHAZINE.............................................................3
PMS-ZOLMITRIPTAN ................................................. 116 PROMETHAZINE HCL ....................................................3
PMS-ZOLMITRIPTAN ........................................ SEC 3.95 PROMETRIUM.............................................................167
PMS-ZOLMITRIPTAN ODT ........................................ 116 PROPADERM ..............................................................175
PMS-ZOLMITRIPTAN ODT ............................... SEC 3.95 PROPAFENONE HCL ...................................................35
PMS-ZOPICLONE....................................................... 113 PROPARACAINE HCL ................................................134
PODOFILOX ............................................................... 181 PROPRANOLOL HCL ....................................................53
PORTIA 21 .................................................................. 159 PROPYL-THYRACIL ....................................................169
PORTIA 28 .................................................................. 159 PROPYLTHIOURACIL .................................................169
POTABA ...................................................................... 180 PROSCAR ......................................................... SEC 3.41
POTASSIUM CHLORIDE (K+) .................................... 125 PROSTIGMIN ................................................................23
POTASSIUM CHLORIDE (K+)(CL-)............................ 125 PROSTIN VR .................................................................46
POTASSIUM CITRATE (K+) ....................................... 125 PROTOPIC ........................................................ SEC 3.85
PRADAX ............................................................ SEC 3.22 PROTOPIC ........................................................ SEC 3.86
PRAMIPEXOLE .......................................................... 119 PROVERA ...................................................................167
PRAMIPEXOLE DIHYDROCHLORIDE....................... 119 PROZAC ........................................................................92
PRAVACHOL ................................................................ 40 PULMICORT NEBUAMP .............................................155
PRAVASTATIN ............................................................. 40 PULMICORT TURBUHALER .......................................155
PRAVASTATIN SODIUM .............................................. 40 PYRIDOSTIGMINE BROMIDE ......................................23
PRAZOSIN HCL ............................................................ 47 PYRIMETHAMINE .........................................................18
PRED FORTE ............................................................. 133
PRED MILD ................................................................. 133
PREDNISOLONE ACETATE ...................................... 133 Q
PREDNISOLONE ACETATE/ SULFACETAMIDE
SODIUM .................................................................. 133
QUETIAPINE ...............................................................100
PREDNISOLONE SODIUM PHOSPHATE ................. 158
QUETIAPINE ...............................................................101
PREDNISONE ............................................................ 158
QUETIAPINE FUMARATE ...........................................100
PREMARIN ................................................................. 161
QUETIAPINE FUMARATE ...........................................101
PREVACID .................................................................. 147
QUINAGOLIDE .................................................. SEC 3.73
PREVEX B .................................................................. 176
QUINAPRIL HCL............................................................63
PREVEX HC ............................................................... 177
QUINAPRIL HCL/ HYDROCHLOROTHIAZIDE .............63
PRIMAQUINE PHOSPHATE ........................................ 18
QUININE SULFATE .......................................................19
PRIMAXIN .......................................................... SEC 3.47
QVAR CFC-FREE ........................................................155
PRIMIDONE .................................................................. 83
PRINIVIL ....................................................................... 61
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE JULY 1, 2012 216


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
RAN-ZOPICLONE........................................................113
R
RANIBIZUMAB.............................................................139
RANITIDINE .................................................................145
RABEPRAZOLE EC .................................................... 148 RANITIDINE .................................................................146
RABEPRAZOLE SODIUM .......................................... 148 RANITIDINE HCL.........................................................145
RALOXIFENE HCL ............................................ SEC 3.74 RANITIDINE HCL.........................................................146
RAMIPRIL ..................................................................... 63 RATIO-ACLAVULANATE ...............................................11
RAMIPRIL ..................................................................... 64 RATIO-ACLAVULANATE 125F......................................11
RAMIPRIL (CAPSULE) ................................................. 63 RATIO-ACLAVULANATE 250F......................................11
RAMIPRIL (CAPSULE) ................................................. 64 RATIO-ACYCLOVIR ......................................................17
RAMIPRIL/ HYDROCHLOROTHIAZIDE ....................... 64 RATIO-ALENDRONATE .................................... SEC 3.14
RAN-AMLODIPINE ....................................................... 55 RATIO-AMCINONIDE ..................................................175
RAN-ATENOLOL .......................................................... 49 RATIO-AMIODARONE ..................................................36
RAN-ATENOLOL .......................................................... 50 RATIO-AMLODIPINE .....................................................55
RAN-ATORVASTATIN .................................................. 38 RATIO-ATENOLOL ........................................................49
RAN-CARVEDILOL ....................................................... 51 RATIO-ATENOLOL ........................................................50
RAN-CEFPROZIL ........................................................... 6 RATIO-ATORVASTATIN ...............................................38
RAN-CIPROFLOX .............................................. SEC 3A.2 RATIO-AZITHROMYCIN ..................................................9
RAN-CIPROFLOX .............................................. SEC 3A.3 RATIO-BACLOFEN ........................................................27
RAN-CITALO ................................................................ 91 RATIO-BRIMONIDINE .................................................135
RAN-DOMPERIDONE ................................................ 148 RATIO-BUPROPION SR ...............................................97
RAN-ENALAPRIL .......................................................... 60 RATIO-CARVEDILOL ....................................................51
RAN-FENTANYL MATRIX ................................. SEC 3.39 RATIO-CEFUROXIME .....................................................7
RAN-FENTANYL MATRIX ................................. SEC 3.40 RATIO-CIPROFLOXACIN .................................. SEC 3A.2
RAN-FINASTERIDE ........................................... SEC 3.41 RATIO-CIPROFLOXACIN .................................. SEC 3A.3
RAN-FOSINOPRIL ........................................................ 61 RATIO-CITALOPRAM ....................................................91
RAN-GABAPENTIN ...................................................... 86 RATIO-CLARITHROMYCIN .............................................9
RAN-IRBESARTAN HCTZ ............................................ 66 RATIO-CLOBETASOL .................................................176
RAN-IRBESARTAN HCTZ ............................................ 67 RATIO-CLONAZEPAM ..................................................84
RAN-LISINOPRIL .......................................................... 61 RATIO-CODEINE...........................................................77
RAN-LISINOPRIL .......................................................... 62 RATIO-DEXAMETHASONE ........................................156
RAN-METFORMIN ...................................................... 163 RATIO-DILTIAZEM CD ..................................................56
RAN-NABILONE ......................................................... 144 RATIO-DILTIAZEM CD ..................................................57
RAN-OMEPRAZOLE (DELAYED RELEASE TABLET)147 RATIO-DOMPERIDONE MALEATE ............................148
RAN-ONDANSETRON................................................ 143 RATIO-ECTOSONE MILD ...........................................176
RAN-PANTOPRAZOLE .............................................. 148 RATIO-ECTOSONE REGULAR...................................176
RAN-PRAVASTATIN..................................................... 40 RATIO-ECTOSONE SCALP ........................................176
RAN-RABEPRAZOLE ................................................. 148 RATIO-EMTEC-30 .........................................................77
RAN-RAMIPRIL (CAPSULE) ........................................ 63 RATIO-FENOFIBRATE MC ...........................................37
RAN-RAMIPRIL (CAPSULE) ........................................ 64 RATIO-FENTANYL ............................................ SEC 3.39
RAN-RANITIDINE ....................................................... 145 RATIO-FENTANYL ............................................ SEC 3.40
RAN-RISPERIDONE ................................................... 102 RATIO-FINASTERIDE ....................................... SEC 3.41
RAN-RISPERIDONE ................................................... 103 RATIO-FLUOXETINE HYDROCHLORIDE ....................92
RAN-ROPINIROLE ..................................................... 119 RATIO-FLUVOXAMINE .................................................92
RAN-ROPINIROLE ..................................................... 120 RATIO-GABAPENTIN ....................................................86
RAN-ROSUVASTATIN.................................................. 41 RATIO-GENTAMICIN SULFATE .................................173
RAN-SERTRALINE ....................................................... 93 RATIO-GLYBURIDE ....................................................166
RAN-SERTRALINE ....................................................... 94 RATIO-HEMCORT H.C. ...............................................178
RAN-SIMVASTATIN...................................................... 42 RATIO-INDOMETHACIN ...............................................73
RAN-SIMVASTATIN...................................................... 43 RATIO-IPRA SAL UDV ..................................................24
RAN-VALSARTAN ........................................................ 69 RATIO-IPRATROPIUM UDV.............................. SEC 3.55
RAN-VENLAFAXINE XR ............................................... 90 RATIO-IRBESARTAN ....................................................66
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

217 EFFECTIVE JULY 1, 2012


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
RATIO-IRBESARTAN HCTZ ......................................... 66 REMICADE ........................................................ SEC 3.55
RATIO-IRBESARTAN HCTZ ......................................... 67 REMINYL ER ..................................................... SEC 3.42
RATIO-KETOROLAC .................................................. 134 RENEDIL .......................................................................55
RATIO-LACTULOSE ................................................... 125 RENEDIL .......................................................................56
RATIO-LAMOTRIGINE ................................................. 87 REPAGLINIDE .............................................................165
RATIO-LENOLTEC NO.2 .............................................. 77 REQUIP .......................................................................119
RATIO-LENOLTEC NO.3 .............................................. 77 REQUIP .......................................................................120
RATIO-LENOLTEC NO.4 .............................................. 77 RESONIUM CALCIUM .................................................125
RATIO-LEVOBUNOLOL ............................................. 136 RESTORIL ...................................................................112
RATIO-LISINOPRIL P ................................................... 61 RHINOCORT TURBUHALER ......................................132
RATIO-LISINOPRIL P ................................................... 62 RHO-NITRO PUMPSPRAY ...........................................46
RATIO-LISINOPRIL Z ................................................... 61 RHOTRAL ......................................................................49
RATIO-LISINOPRIL Z ................................................... 62 RHOVANE ...................................................................113
RATIO-LOVASTATIN .................................................... 39 RIDAURA .....................................................................151
RATIO-METFORMIN HYDROCHLORIDE .................. 163 RIFABUTIN ........................................................ SEC 3.74
RATIO-METHOTREXATE SODIUM ............................. 21 RILUTEK ............................................................ SEC 3.74
RATIO-MOMETASONE .............................................. 178 RILUZOLE ......................................................... SEC 3.74
RATIO-MORPHINE ....................................................... 79 RIMSO-50 ....................................................................188
RATIO-NYSTATIN ........................................................ 16 RISEDRONATE ................................................. SEC 3.75
RATIO-OMEPRAZOLE (SUSTAINED-RELEASE RISEDRONATE SODIUM .................................. SEC 3.75
TABLET) ................................................................. 147 RISPERDAL .................................................................102
RATIO-ONDANSETRON ............................................ 143 RISPERDAL .................................................................103
RATIO-OXYCOCET ...................................................... 82 RISPERDAL .................................................................104
RATIO-OXYCODAN...................................................... 83 RISPERDAL CONSTA ....................................... SEC 3.76
RATIO-PAROXETINE ................................................... 93 RISPERDAL M-TAB .....................................................104
RATIO-PIOGLITAZONE ..................................... SEC 3.72 RISPERIDONE ............................................................102
RATIO-PREDNISOLONE ............................................ 133 RISPERIDONE ............................................................103
RATIO-PROCTOSONE............................................... 179 RISPERIDONE ............................................................104
RATIO-RANITIDINE .................................................... 145 RISPERIDONE .................................................. SEC 3.76
RATIO-RISEDRONATE ..................................... SEC 3.75 RISPERIDONE TARTRATE ........................................104
RATIO-RIVASTIGMINE ..................................... SEC 3.78 RITALIN .......................................................................109
RATIO-SALBUTAMOL .................................................. 25 RITALIN SR .................................................................109
RATIO-SALBUTAMOL SULF U.D.P.F. ......................... 25 RITUXAN ........................................................... SEC 3.77
RATIO-SALBUTAMOL UNI DOSE P.F. ........................ 25 RITUXIMAB........................................................ SEC 3.77
RATIO-SALBUTAMOL UNIT DOSE P.F ....................... 25 RIVAROXABAN .............................................................32
RATIO-SOTALOL.......................................................... 54 RIVASTIGMINE HYDROGEN TARTRATE ........ SEC 3.78
RATIO-TAMSULOSIN ................................................... 48 RIVOTRIL ......................................................................84
RATIO-TECNAL ............................................................ 71 RIZATRIPTAN BENZOATE .........................................114
RATIO-TECNAL-C 1/2 .................................................. 76 RIZATRIPTAN BENZOATE .........................................115
RATIO-TECNAL-C 1/4 .................................................. 76 RIZATRIPTAN BENZOATE ............................... SEC 3.79
RATIO-TERAZOSIN...................................................... 48 ROCALTROL ...............................................................185
RATIO-TOPILENE ...................................................... 175 ROPINIROLE ...............................................................119
RATIO-TOPISALIC ..................................................... 175 ROPINIROLE ...............................................................120
RATIO-TOPISONE...................................................... 175 ROPINIROLE HCL .......................................................119
RATIO-TRYPTOPHAN.................................................. 97 ROPINIROLE HCL .......................................................120
RATIO-VALPROIC ........................................................ 89 ROSASOL ....................................................................173
RATIO-VENLAFAXINE XR ........................................... 90 ROSIGLITAZONE MALEATE ............................ SEC 3.79
RATIO-ZOPICLONE ................................................... 113 ROSIGLITAZONE MALEATE/ METFORMIN HCL
REBIF (0.5 ML SYRINGE) ................................... SEC 2.4 ....................................................................... SEC 3.80
REBIF (1.5 ML CARTRIDGE) .............................. SEC 2.4 ROSUVASTATIN CALCIUM ..........................................41
RECOMBIVAX-HB ...................................................... 171 ROUGIER MAGNESIUM .............................................125
REMERON .................................................................... 98 RYTHMODAN ................................................................35
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE JULY 1, 2012 218


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
RYTHMOL ..................................................................... 35 SANDOZ CLONAZEPAM ..............................................84
SANDOZ CLOPIDOGREL .............................................32
SANDOZ CLOPIDOGREL ................................. SEC 3.20
S SANDOZ CYCLOSPORINE ............................... SEC 3.21
SANDOZ DEXAMETHASONE SOD. PHOSPHATE ....132
SANDOZ DICLOFENAC ................................................72
SABRIL ......................................................................... 89
SANDOZ DICLOFENAC SR ..........................................72
SAIZEN .............................................................. SEC 3.82
SANDOZ DILTIAZEM CD ..............................................56
SAIZEN (1.5 ML) ................................................ SEC 3.82
SANDOZ DILTIAZEM CD ..............................................57
SAIZEN (2.5 ML) ................................................ SEC 3.82
SANDOZ DILTIAZEM T .................................................57
SALAGEN ..................................................................... 23
SANDOZ DILTIAZEM T .................................................58
SALAZOPYRIN ............................................................. 13
SANDOZ DORZOLAMIDE ...........................................136
SALAZOPYRIN EN-TABS ............................................. 13
SANDOZ DORZOLAMIDE/ TIMOLOL .........................138
SALBUTAMOL .............................................................. 25
SANDOZ ENALAPRIL ...................................................60
SALBUTAMOL SULFATE ............................................. 25
SANDOZ ESTRADIOL DERM 100 (8 MG/PTH) ..........161
SALMETEROL XINAFOATE ......................................... 25
SANDOZ ESTRADIOL DERM 50 (4 MG/PTH) ............161
SALMETEROL XINAFOATE/ FLUTICASONE
SANDOZ ESTRADIOL DERM 75 (6 MG/PTH) ............161
PROPIONATE ........................................................... 25
SANDOZ FELODIPINE ..................................................55
SALMETEROL XINAFOATE/ FLUTICASONE
SANDOZ FELODIPINE ..................................................56
PROPIONATE ........................................................... 26
SANDOZ FENOFIBRATE S ...........................................37
SALOFALK.................................................................. 149
SANDOZ FENOFIBRATE S (TABLET) ..........................37
SALOFALK (2G/60G) .................................................. 149
SANDOZ FENTANYL PATCH ........................... SEC 3.39
SALOFALK (4G/60G) .................................................. 149
SANDOZ FENTANYL PATCH ........................... SEC 3.40
SANDOMIGRAN ......................................................... 116
SANDOZ FINASTERIDE ................................... SEC 3.41
SANDOMIGRAN DS ................................................... 120
SANDOZ FLUOXETINE .................................................92
SANDOSTATIN .................................................. SEC 3.61
SANDOZ FLUVOXAMINE .............................................92
SANDOSTATIN LAR .......................................... SEC 3.61
SANDOZ GENTAMICIN SULFATE..............................131
SANDOSTATIN LAR .......................................... SEC 3.62
SANDOZ GLYBURIDE ................................................166
SANDOZ FLUOXETINE ............................................... 92
SANDOZ INDOMETHACIN ...........................................73
SANDOZ GLYBURIDE............................................... 166
SANDOZ IRBESARTAN ................................................66
SANDOZ ALENDRONATE ................................ SEC 3.14
SANDOZ IRBESARTAN HCT ........................................66
SANDOZ ALFUZOSIN ....................................... SEC 3.15
SANDOZ IRBESARTAN HCT ........................................67
SANDOZ AMIODARONE .............................................. 36
SANDOZ LATANOPROST ..........................................137
SANDOZ AMLODIPINE ................................................ 55
SANDOZ LEFLUNOMIDE ............................................189
SANDOZ ANUZINC HC .............................................. 178
SANDOZ LEVOBUNOLOL ..........................................136
SANDOZ ANUZINC HC PLUS .................................... 178
SANDOZ LEVOFLOXACIN ................................ SEC 3A.4
SANDOZ ATENOLOL ................................................... 49
SANDOZ LISINOPRIL ...................................................61
SANDOZ ATENOLOL ................................................... 50
SANDOZ LISINOPRIL ...................................................62
SANDOZ ATORVASTATIN ........................................... 38
SANDOZ LISINOPRIL HCT ...........................................62
SANDOZ AZITHROMYCIN ............................................. 9
SANDOZ LOSARTAN ....................................................67
SANDOZ BISOPROLOL ............................................... 50
SANDOZ LOSARTAN HCT ...........................................67
SANDOZ BRIMONIDINE ............................................ 135
SANDOZ LOSARTAN HCT DS......................................68
SANDOZ BUPROPION SR ........................................... 97
SANDOZ LOVASTATIN .................................................39
SANDOZ CALCITONIN NS ................................ SEC 3.85
SANDOZ METFORMIN FC ..........................................163
SANDOZ CANDESARTAN ........................................... 65
SANDOZ METHYLPHENIDATE ..................................109
SANDOZ CARBAMAZEPINE ........................................ 85
SANDOZ METOPROLOL (TYPE L)...............................52
SANDOZ CARBAMAZEPINE CR.................................. 85
SANDOZ METOPROLOL SR ........................................52
SANDOZ CEFPROZIL .................................................... 6
SANDOZ MINOCYCLINE ..............................................13
SANDOZ CIPROFLOXACIN .............................. SEC 3A.2
SANDOZ MIRTAZAPINE ...............................................98
SANDOZ CIPROFLOXACIN .............................. SEC 3A.3
SANDOZ MONTELUKAST ..........................................129
SANDOZ CITALOPRAM ............................................... 91
SANDOZ MONTELUKAST ................................ SEC 3.60
SANDOZ CLARITHROMYCIN ........................................ 9
SANDOZ MORPHINE SR ..............................................80
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

219 EFFECTIVE JULY 1, 2012


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
SANDOZ NARATRIPTAN ........................................... 114 SANDOZ TRIFLURIDINE ............................................131
SANDOZ NARATRIPTAN .................................. SEC 3.61 SANDOZ VALPROIC .....................................................89
SANDOZ NITRAZEPAM ............................................. 112 SANDOZ VALSARTAN ..................................................69
SANDOZ OLANZAPINE.............................................. 100 SANDOZ VALSARTAN HCT..........................................69
SANDOZ OLANZAPINE................................................ 99 SANDOZ VALSARTAN HCT..........................................70
SANDOZ OLANZAPINE ODT ..................................... 100 SANDOZ VENLAFAXINE XR.........................................90
SANDOZ OMEPRAZOLE (SUSTAINED-RELEASE SANDOZ ZOLMITRIPTAN ...........................................116
CAPSULE) .............................................................. 147 SANDOZ ZOLMITRIPTAN ................................. SEC 3.95
SANDOZ ONDANSETRON ........................................ 143 SANDOZ ZOLMITRIPTAN ODT ..................................116
SANDOZ OPIUM & BELLADONNA .............................. 81 SANDOZ ZOLMITRIPTAN ODT ........................ SEC 3.95
SANDOZ OPTICORT .................................................. 133 SANDOZ ZOPICLONE ................................................113
SANDOZ PANTOPRAZOLE ....................................... 148 SANDOZ-OXYCODONE ACET .....................................82
SANDOZ PAROXETINE ............................................... 93 SANTYL .......................................................................181
SANDOZ PENTASONE .............................................. 133 SARNA HC ..................................................................177
SANDOZ PINDOLOL .................................................... 53 SAXAGLIPTIN HCL ........................................... SEC 3.80
SANDOZ PIOGLITAZONE ................................. SEC 3.72 SECTRAL ......................................................................49
SANDOZ PRAMIPEXOLE ........................................... 119 SELECT 1/35 (21 DAY) ...............................................160
SANDOZ PRAVASTATIN ............................................. 40 SELECT 1/35 (28 DAY) ...............................................160
SANDOZ PREDNISOLONE ACETATE ...................... 133 SELEGILINE HCL ........................................................120
SANDOZ PROCHLORPERAZINE .............................. 142 SEPTA-AMLODIPINE ....................................................55
SANDOZ PROCTOMYXIN HC ................................... 179 SEPTA-ATENOLOL .......................................................49
SANDOZ QUETIAPINE............................................... 100 SEPTA-ATENOLOL .......................................................50
SANDOZ QUETIAPINE............................................... 101 SEPTA-CITALOPRAM ...................................................91
SANDOZ RABEPRAZOLE .......................................... 148 SEPTA-ONDANSETRON ............................................143
SANDOZ RAMIPRIL (TABLET) .................................... 63 SEPTRA .........................................................................12
SANDOZ RAMIPRIL (TABLET) .................................... 64 SERC ...........................................................................187
SANDOZ RANITIDINE ................................................ 145 SEREVENT ....................................................................25
SANDOZ REPAGLINIDE ............................................ 165 SEREVENT DISKHALER ............................................191
SANDOZ RISEDRONATE ................................. SEC 3.75 SEREVENT DISKUS .....................................................25
SANDOZ RISPERIDONE ............................................ 102 SEROPHENE...............................................................162
SANDOZ RISPERIDONE ............................................ 103 SEROQUEL .................................................................100
SANDOZ RIVASTIGMINE .................................. SEC 3.78 SEROQUEL .................................................................101
SANDOZ RIZATRIPTAN ODT .................................... 114 SERTRALINE.................................................................93
SANDOZ RIZATRIPTAN ODT .................................... 115 SERTRALINE.................................................................94
SANDOZ RIZATRIPTAN ODT ........................... SEC 3.79 SERTRALINE HCL ........................................................93
SANDOZ ROSUVASTATIN .......................................... 41 SERTRALINE HCL ........................................................94
SANDOZ SALBUTAMOL .............................................. 25 SIMPONI ............................................................ SEC 3.46
SANDOZ SERTRALINE ................................................ 93 SIMVASTATIN ...............................................................42
SANDOZ SERTRALINE ................................................ 94 SIMVASTATIN ...............................................................43
SANDOZ SIMVASTATIN .............................................. 42 SIMVASTATIN-ODAN ....................................................42
SANDOZ SIMVASTATIN .............................................. 43 SIMVASTATIN-ODAN ....................................................43
SANDOZ SOTALOL ...................................................... 54 SINEMET 100/10 .........................................................118
SANDOZ SUMATRIPTAN ........................................... 115 SINEMET 100/25 .........................................................118
SANDOZ SUMATRIPTAN .................................. SEC 3.84 SINEMET 250/25 .........................................................118
SANDOZ TAMSULOSIN ............................................... 48 SINEMET CR 100/25 ...................................................118
SANDOZ TAMSULOSIN CR ......................................... 48 SINEMET CR 200/50 ...................................................118
SANDOZ TELMISARTAN ............................................. 68 SINEQUAN ....................................................................95
SANDOZ TERBINAFINE ............................................... 15 SINEQUAN ....................................................................96
SANDOZ TICLOPIDINE ................................................ 33 SINGULAIR ..................................................................129
SANDOZ TIMOLOL MALEATE ................................... 136 SINGULAIR ........................................................ SEC 3.60
SANDOZ TOBRAMYCIN ............................................ 131 SINTROM ......................................................................29
SANDOZ TOPIRAMATE ............................................... 88 SITAGLIPTIN PHOSPHATE MONOHYDRATE . SEC 3.81
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE JULY 1, 2012 220


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
SITAGLIPTIN PHOSPHATE MONOHYDRATE/ SULFASALAZINE ..........................................................13
METFORMIN HCL ......................................... SEC 3.81 SULFINPYRAZONE .....................................................127
SLOW K ...................................................................... 125 SULFUR/ SULFACETAMIDE SODIUM ............. SEC 3.83
SODIUM ACID PHOSPHATE/ SODIUM BICARBONATE/ SULINDAC .....................................................................76
POTASSIUM BICARBONATE ................................ 125 SUMATRIPTAN ...........................................................115
SODIUM AUROTHIOMALATE .................................... 151 SUMATRIPTAN ................................................. SEC 3.84
SODIUM CROMOGLYCATE ...................................... 130 SUMATRIPTAN HEMISULFATE .................................115
SODIUM FLUORIDE ................................................... 121 SUMATRIPTAN HEMISULFATE ....................... SEC 3.83
SODIUM FUSIDATE ................................................... 174 SUMATRIPTAN SUCCINATE ......................................115
SODIUM POLYSTYRENE SULFONATE .................... 126 SUMATRIPTAN SUCCINATE ............................ SEC 3.84
SODIUM TETRADECYL SULFATE .............................. 47 SUMATRIPTAN SUN (0.5 ML).....................................115
SOFRACORT .............................................................. 133 SUMATRIPTAN SUN (0.5 ML)........................... SEC 3.84
SOLIFENACIN SUCCINATE .............................. SEC 3.82 SUPEUDOL ...................................................................82
SOLIRIS ............................................................. SEC 3.30 SUPRAX ..........................................................................7
SOLU-CORTEF .......................................................... 156 SUPREFACT ..................................................... SEC 3.18
SOLU-CORTEF .......................................................... 157 SUPREFACT DEPOT ........................................ SEC 3.18
SOLU-MEDROL .......................................................... 157 SUPREFACT INTRANASAL .............................. SEC 3.18
SOLU-MEDROL ACT-O-VIAL (PRESERVATIVE FREE) SYMBICORT 100 TURBUHALER..................................24
................................................................................ 157 SYMBICORT 200 TURBUHALER..................................24
SOLU-MEDROL ACT-O-VIAL (WITH PRESERVATIVE) SYNACTHEN DEPOT..................................................166
................................................................................ 157 SYNAREL ....................................................................189
SOLYSTAT ................................................................. 126 SYNPHASIC (21 DAY) .................................................160
SOMATROPIN ................................................... SEC 3.82 SYNPHASIC (28 DAY) .................................................160
SOMATROPIN R-DNA ORIGIN ......................... SEC 3.82 SYNTHETIC CALCITONIN SALMON (SALCATONIN)
SOMATULINE AUTOGEL (0.3 ML SYRINGE) .. SEC 3.56 .................................................................................166
SOMATULINE AUTOGEL (0.5 ML SYRINGE) .. SEC 3.56 SYNTHETIC CALCITONIN SALMON (SALCATONIN)
SORIATANE ............................................................... 180 ....................................................................... SEC 3.85
SOTALOL HCL ............................................................. 54 SYNTHROID ................................................................168
SPACE CHAMBER ..................................................... 191
SPACE CHAMBER ADULT MASK ............................. 191 T
SPACE CHAMBER INFANT MASK ............................ 191
SPACE CHAMBER PEDIATRIC MASK ...................... 191
TACROLIMUS.................................................... SEC 3.85
SPIRIVA ........................................................................ 24
TACROLIMUS.................................................... SEC 3.86
SPIRONOLACTONE ..................................................... 70
TALWIN .........................................................................83
SPORANOX .................................................................. 15
TAMBOCOR ..................................................................35
SPORANOX ....................................................... SEC 3.55
TAMSULOSIN HCL ........................................................48
STALEVO .................................................................... 118
TAPAZOLE ..................................................................169
STATEX ........................................................................ 80
TARO-AMCINONIDE ...................................................175
STATEX ........................................................................ 81
TARO-CARBAMAZEPINE .............................................85
STELARA (0.5 ML VIAL OR SYRINGE) ............ SEC 3.91
TARO-CLOBETASOL ..................................................176
STIEVA-A ........................................................... SEC 3.89
TARO-MOMETASONE ................................................178
STIEVA-A ........................................................... SEC 3.90
TARO-MUPIROCIN .....................................................174
STIEVA-A FORTE .............................................. SEC 3.89
TARO-PHENYTOIN .......................................................84
STIEVAMYCIN FORTE ...................................... SEC 3.32
TARO-WARFARIN .........................................................29
STIEVAMYCIN MILD ......................................... SEC 3.32
TARO-WARFARIN .........................................................30
STIEVAMYCIN REGULAR ................................. SEC 3.32
TAZAROTENE .............................................................181
SUBOXONE .................................................................. 83
TAZOCIN ........................................................... SEC 3.73
SUCRALFATE ............................................................ 146
TAZORAC ....................................................................181
SULCRATE ................................................................. 146
TECTA .........................................................................148
SULCRATE SUSPENSION PLUS .............................. 146
TEGRETOL ....................................................................85
SULFACET-R ..................................................... SEC 3.83
TEGRETOL CR..............................................................85
SULFAMETHOXAZOLE/ TRIMETHOPRIM .................. 12
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

221 EFFECTIVE JULY 1, 2012


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
TELMISARTAN ............................................................. 68 TEVA-LISINOPRIL (TYPE P) .........................................62
TELMISARTAN/ AMLODIPINE BESYLATE .................. 68 TEVA-LISINOPRIL/HCTZ (TYPE Z) ..............................62
TELMISARTAN/ HYDROCHLOROTHIAZIDE ............... 68 TEVA-LOSARTAN .........................................................67
TEMAZEPAM .............................................................. 112 TEVA-LOSARTAN/HCTZ ...............................................67
TENOFOVIR DISOPROXIL FUMARATE ...................... 16 TEVA-LOSARTAN/HCTZ ...............................................68
TENORETIC 50/25....................................................... 50 TEVA-METOPROL ........................................................52
TENORETIC 100/25...................................................... 50 TEVA-METOPROL (FC) ................................................52
TENORMIN ................................................................... 49 TEVA-MONTELUKAST ................................................129
TENORMIN ................................................................... 50 TEVA-MONTELUKAST ...................................... SEC 3.60
TENOXICAM ................................................................. 76 TEVA-NAPROX .............................................................74
TERAZOSIN .................................................................. 48 TEVA-NAPROX EC .......................................................75
TERAZOSIN HCL.......................................................... 48 TEVA-NAPROX SODIUM ..............................................75
TERBINAFINE .............................................................. 15 TEVA-NAPROX SODIUM DS ........................................75
TERBINAFINE HCL ...................................................... 15 TEVA-OLANZAPINE ....................................................100
TERBINAFINE HCL .................................................... 174 TEVA-OLANZAPINE ......................................................99
TERBUTALINE SULFATE ............................................ 26 TEVA-OLANZAPINE OD .............................................100
TESTOSTERONE .............................................. SEC 3.86 TEVA-ONDANSETRON ...............................................143
TESTOSTERONE CYPIONATE ................................. 158 TEVA-PAROXETINE .....................................................93
TESTOSTERONE ENANTHATE ................................ 158 TEVA-RABEPRAZOLE ................................................148
TESTOSTERONE UNDECANOATE.................. SEC 3.86 TEVA-RAMIPRIL (CAPSULE)........................................63
TETRABENAZINE.............................................. SEC 3.87 TEVA-RAMIPRIL (CAPSULE)........................................64
TETRACYCLINE ........................................................... 13 TEVA-ROSUVASTATIN .................................................41
TETRACYCLINE HCL ................................................... 13 TEVA-SERTRALINE ......................................................93
TEVA-ALENDRONATE ...................................... SEC 3.14 TEVA-SERTRALINE ......................................................94
TEVA-ALPRAZOL ....................................................... 110 TEVA-SIMVASTATIN .....................................................42
TEVA-AMIODARONE ................................................... 36 TEVA-SIMVASTATIN .....................................................43
TEVA-AMLODIPINE...................................................... 55 TEVA-TAMSULOSIN CR ...............................................48
TEVA-ATENOL ............................................................. 49 TEVA-TELMISARTAN ...................................................68
TEVA-ATENOL ............................................................. 50 TEVA-TELMISARTAN HCTZ .........................................68
TEVA-ATENOLOL......................................................... 49 TEVA-TERAZOSIN ........................................................48
TEVA-ATENOLTHALIDONE ......................................... 50 TEVA-TRAZODONE ......................................................94
TEVA-AZATHIOPRINE ............................................... 187 TEVA-VALSARTAN .......................................................69
TEVA-CANDESARTAN................................................. 65 TEVA-VALSARTAN/HCTZ .............................................69
TEVA-CARBAMAZ ........................................................ 85 TEVA-VALSARTAN/HCTZ .............................................70
TEVA-CHLORPROMAZINE ........................................ 105 TEVA-VENLAFAXINE XR ..............................................90
TEVA-CLINDAMYCIN ................................................... 14 TEVA-ZOLMITRIPTAN ................................................116
TEVA-CLOPIDOGREL .................................................. 32 TEVA-ZOLMITRIPTAN ...................................... SEC 3.95
TEVA-CLOPIDOGREL ....................................... SEC 3.20 TEVA-ZOLMITRIPTAN OD ..........................................116
TEVA-DOMPERIDONE............................................... 148 TEVA-ZOLMITRIPTAN OD ................................ SEC 3.95
TEVA-DORZOTIMOL .................................................. 138 TEVETEN ......................................................................65
TEVA-ENTACAPONE ................................................. 117 TEVETEN PLUS ............................................................65
TEVA-FLUOXETINE ..................................................... 92 THEOLAIR ...................................................................183
TEVA-FOSINOPRIL ...................................................... 61 THEOPHYLLINE ..........................................................183
TEVA-GABAPENTIN..................................................... 86 THIAMIJECT ................................................................185
TEVA-GALANTAMINE ER ................................. SEC 3.42 THIAMINE HCL ............................................................185
TEVA-GLYBURIDE ..................................................... 166 THIOPROPERAZINE MESYLATE ...............................106
TEVA-HYDROMORPHONE .......................................... 78 THIOTHIXENE .............................................................107
TEVA-IRBESARTAN ..................................................... 66 THYROGEN .................................................................123
TEVA-IRBESARTAN/HCTZ .......................................... 66 THYROID .....................................................................168
TEVA-IRBESARTAN/HCTZ .......................................... 67 THYROTROPIN ALFA .................................................123
TEVA-LACTULOSE .................................................... 125 TIAMOL ........................................................................177
TEVA-LISINOPRIL (TYPE P) ........................................ 61 TIAPROFENIC ACID .....................................................76
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE JULY 1, 2012 222


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
TIAZAC ......................................................................... 57 TRIAMCINOLONE ACETONIDE .................................179
TIAZAC ......................................................................... 58 TRIAMCINOLONE ACETONIDE USP .........................158
TIAZAC XC ................................................................... 56 TRIAZOLAM.................................................................112
TICLOPIDINE HCL........................................................ 33 TRIFLUOPERAZINE ....................................................107
TIMOLOL MALEATE ................................................... 136 TRIFLUOPERAZINE HCL ............................................107
TIMOLOL MALEATE ..................................................... 54 TRIFLURIDINE ............................................................131
TIMOPTIC ................................................................... 136 TRIHEXYPHENIDYL ....................................................117
TIMOPTIC-XE ............................................................. 136 TRIHEXYPHENIDYL HCL ...........................................117
TINZAPARIN SODIUM.................................................. 31 TRIMEBUTINE .............................................................150
TINZAPARIN SODIUM.................................................. 32 TRIMEBUTINE MALEATE ...........................................150
TIOTROPIUM BROMIDE MONOHYDRATE ................. 24 TRIMEPRAZINE TARTRATE...........................................3
TIZANIDINE HCL ............................................... SEC 3.87 TRIMETHOPRIM ...........................................................19
TOBI ................................................................................ 5 TRIMIPRAMINE .............................................................96
TOBI PODHALER ........................................................... 5 TRIMIPRAMINE .............................................................97
TOBRADEX ................................................................ 133 TRIMIPRAMINE MALEATE ...........................................96
TOBRAMYCIN ............................................................ 131 TRIMIPRAMINE MALEATE ...........................................97
TOBRAMYCIN ................................................................ 5 TRINIPATCH 0.2............................................................46
TOBRAMYCIN SULFATE ............................................... 5 TRINIPATCH 0.4............................................................46
TOBREX ..................................................................... 131 TRINIPATCH 0.6............................................................46
TOCILIZUMAB ................................................... SEC 3.89 TRIQUILAR (21 DAY) ..................................................159
TOLOXIN ...................................................................... 36 TRIQUILAR (28 DAY) ..................................................159
TOLOXIN PEDIATRIC .................................................. 36 TROMBOJECT ..............................................................47
TOLTERODINE L-TARTRATE ........................... SEC 3.89 TROPICAMIDE ............................................................134
TOPAMAX..................................................................... 88 TROSEC ............................................................ SEC 3.90
TOPAMAX SPRINKLE .................................................. 88 TROSPIUM CHLORIDE ..................................... SEC 3.90
TOPICORT .................................................................. 177 TRUSOPT ....................................................................136
TOPICORT MILD ........................................................ 177 TRUSOPT (PRESERVATIVE-FREE) ..........................136
TOPIRAMATE ............................................................... 88 TRYPTAN ......................................................................97
TORADOL ..................................................................... 74 TWINJECT AUTO INJECTOR .......................................26
TRAJENTA ......................................................... SEC 3.57 TWYNSTA .....................................................................68
TRANDATE ................................................................... 51 TYLENOL NO. 2 ............................................................77
TRANDOLAPRIL ........................................................... 64 TYLENOL NO. 3 ............................................................77
TRANDOLAPRIL ........................................................... 65 TYLENOL NO. 4 ............................................................77
TRANEXAMIC ACID ..................................................... 33 TYLENOL WITH CODEINE ...........................................77
TRANSDERM-NITRO 0.2 ............................................. 46 TYSABRI .............................................................. SEC 2.7
TRANSDERM-NITRO 0.4 ............................................. 46
TRANSDERM-NITRO 0.6 ............................................. 46
TRANYLCYPROMINE SULFATE ................................. 89 U
TRAVATAN Z .............................................................. 137
TRAVOPROST ........................................................... 137
ULORIC ............................................................. SEC 3.39
TRAVOPROST/ TIMOLOL MALEATE ........................ 138
ULTRASE MS4 MICROSPHERES ..............................141
TRAZODONE ................................................................ 94
ULTRASE MT12 MINITABLETS ..................................141
TRAZODONE HCL........................................................ 94
ULTRASE MT20 MINITABLETS ..................................141
TRENTAL ...................................................................... 33
ULTRAVATE ................................................................177
TRETINOIN ........................................................ SEC 3.89
UNIPHYL .....................................................................183
TRETINOIN ........................................................ SEC 3.90
UREMOL-HC ...............................................................178
TRI-CYCLEN (21 DAY) ............................................... 160
URINE TEST STRIPS ......................................................1
TRI-CYCLEN (28 DAY) ............................................... 160
UROMAX ........................................................... SEC 3.64
TRI-CYCLEN LO 21 .................................................... 160
URSO ...........................................................................141
TRI-CYCLEN LO 28 .................................................... 160
URSO DS .....................................................................141
TRIADERM REGULAR ............................................... 179
URSODIOL ..................................................................141
TRIAMCINOLONE ACETONIDE................................. 158
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

223 EFFECTIVE JULY 1, 2012


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
USTEKINUMAB ................................................. SEC 3.91 VITAMIN K1 PEDIATRIC .............................................185
VOLTAREN ....................................................................72
VOLTAREN OPHTHA ..................................................134
V VOLTAREN SR ..............................................................72
VORICONAZOLE............................................... SEC 3.93
VORTEX ......................................................................191
VAGIFEM .................................................................... 161
VORTEX BABY WHIRL INFANT MASK ......................191
VAL-VANCO ................................................................. 14
VORTEX SPINNER PEDIATRIC MASK ......................191
VALACYCLOVIR ........................................................... 18
VALCYTE ........................................................... SEC 3.92
VALGANCICLOVIR HCL .................................... SEC 3.92
VALISONE SCALP...................................................... 176
W
VALPROIC ACID........................................................... 89
VALSARTAN ................................................................. 69 WARFARIN ....................................................................29
VALSARTAN/ HYDROCHLOROTHIAZIDE .................. 69 WARFARIN ....................................................................30
VALSARTAN/ HYDROCHLOROTHIAZIDE .................. 70 WARFARIN SODIUM.....................................................29
VALTREX (CAPLET)..................................................... 18 WARFARIN SODIUM.....................................................30
VANCOCIN ........................................................ SEC 3.92 WARTEC .....................................................................181
VANCOMYCIN HCL ...................................................... 14 WELLBUTRIN SR ..........................................................97
VANCOMYCIN HCL ........................................... SEC 3.92 WELLBUTRIN XL ...........................................................97
VARENICLINE TARTRATE .......................................... 28 WINPRED ....................................................................158
VARENICLINE TARTRATE ............................... SEC 3.92
VARENICLINE TARTRATE/ VARENICLINE TARTRATE
.................................................................................. 28 X
VARENICLINE TARTRATE/ VARENICLINE TARTRATE
....................................................................... SEC 3.93 XALACOM ...................................................................138
VASERETIC .................................................................. 60 XALATAN .....................................................................137
VASOTEC ..................................................................... 60 XAMIOL .......................................................................181
VENLAFAXINE HCL ..................................................... 90 XANAX .........................................................................110
VENLAFAXINE XR........................................................ 90 XARELTO ......................................................................32
VENTOLIN .................................................................... 25 XATRAL ............................................................. SEC 3.15
VENTOLIN HFA ............................................................ 25 XEOMIN .......................................................................187
VENTOLIN NEBULES P.F. ........................................... 25 XOLAIR .............................................................. SEC 3.64
VERAPAMIL HCL.......................................................... 58 XYLAC .........................................................................108
VERMOX......................................................................... 5 XYLOCAINE.................................................................179
VESICARE ......................................................... SEC 3.82 XYLOCAINE JELLY .....................................................180
VFEND ............................................................... SEC 3.93 XYLOCAINE VISCOUS ...............................................134
VIBRAMYCIN ................................................................ 13
VIGABATRIN ................................................................ 89
VIMPAT .............................................................. SEC 3.55 Y
VIMPAT .............................................................. SEC 3.56
VIOKASE .................................................................... 141 YASMIN 21 ..................................................................159
VIOKASE 16 ............................................................... 141 YASMIN 28 ..................................................................159
VIREAD ......................................................................... 16
VIROPTIC ................................................................... 131
VISKAZIDE 10/25.......................................................... 53 Z
VISKAZIDE 10/50.......................................................... 53
VISKEN ......................................................................... 53
ZADITEN ..........................................................................3
VITAMIN A ACID ................................................ SEC 3.89
ZAFIRLUKAST .............................................................129
VITAMIN A ACID ................................................ SEC 3.90
ZAFIRLUKAST ................................................... SEC 3.94
VITAMIN B12 .............................................................. 185
ZANAFLEX ........................................................ SEC 3.87
VITAMIN K1 ................................................................ 185
ZANTAC .......................................................................145
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE JULY 1, 2012 224


ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS


Product Name Page Product Name Page
ZANTAC ...................................................................... 146
ZARONTIN .................................................................... 85
ZAROXOLYN .............................................................. 127
ZELDOX ...................................................................... 104
ZESTORETIC ............................................................... 62
ZESTRIL ....................................................................... 61
ZESTRIL ....................................................................... 62
ZIPRASIDONE HYDROCHLORIDE MONOHYDRATE104
ZITHROMAX ................................................................... 9
ZITHROMAX ...................................................... SEC 3.17
ZOCOR ......................................................................... 42
ZOCOR ......................................................................... 43
ZOFRAN ..................................................................... 143
ZOFRAN ODT ............................................................. 142
ZOLADEX .......................................................... SEC 3.46
ZOLADEX LA ..................................................... SEC 3.46
ZOLEDRONIC ACID .......................................... SEC 3.94
ZOLMITRIPTAN .......................................................... 116
ZOLMITRIPTAN ................................................. SEC 3.95
ZOLOFT ........................................................................ 93
ZOLOFT ........................................................................ 94
ZOMETA CONCENTRATE ................................ SEC 3.94
ZOMIG ........................................................................ 116
ZOMIG ............................................................... SEC 3.95
ZOMIG RAPIMELT...................................................... 116
ZOMIG RAPIMELT............................................. SEC 3.95
ZOPICLONE ............................................................... 113
ZOVIRAX ...................................................................... 17
ZUCLOPENTHIXOL ACETATE .................................. 107
ZUCLOPENTHIXOL DECANOATE............................. 107
ZUCLOPENTHIXOL DIHYDROCHLORIDE ................ 108
ZYLOPRIM .................................................................. 187
ZYPREXA ................................................................... 100
ZYPREXA ..................................................................... 99
ZYPREXA ZYDIS ........................................................ 100
ZYVOXAM .......................................................... SEC 3.58

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

225 EFFECTIVE JULY 1, 2012

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