Medicines and poisons

Northern Territory hospital formulary

The NT Hospital formulary is a list of core medicines which are approved for use within NT public hospitals and health services. Through a Territory-wide approach to the availability of medicines, NT Department of Health (DoH) aims to optimise the quality use of medicines, improve and promote equity of access to medicines and increase the cost-effectiveness of medicine use across the NT.

Download the NT Hospital formulary DOCX (235.8 KB)

For any queries related to NT Hospital Formulary, email NTDTC.DoH@nt.gov.au.

Search medicines from the list

Formulary listing key:

  • Y – Listed on NT Hospital Formulary and not restricted
  • S – Highly Specialised Drugs Program (Section 100)
  • R – Listed on NT Hospital Formulary with restrictions

Drug

Dose form

Strength

Formulary Listing

Notes

ABACAVIR

Tablet

300mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

ABACAVIR & LAMIVUDINE

Tablet

600/300mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

ABIRATERONE

Tablet

250mg

R

Restricted to Haematology and Oncology for PBS listed indications.

ACAMPROSATE

Tablet

333mg

R

Restricted to Addiction medicine prescribers

ACETAZOLAMIDE

Injection

500mg

Y

 

ACETAZOLAMIDE

Tablet

250mg

Y

 

ACETIC ACID

Solution

0.25% & 5%

Y

ACETONE

Liquid

 

Y

 

ACETYLCHOLINE

Intraocular Irrigation

1% (2mg/2mL)

Y

 

ACETYLCYSTEINE

Injection

2g/10mL

Y

 

ACETYLCYSTEINE

Nebulised vial

800mg/4mL

Y

 

ACICLOVIR

Injection

250mg

Y

 

ACICLOVIR

Tablet

200mg & 800mg

Y

 

ACICLOVIR

Ointment

3%

Y

 

ACICLOVIR COLD SORE

Cream

5%

Y

 

ACTIVATED CHARCOAL

Oral Liquid

0.2g/mL

Y

 

ADALIMUMAB

Injection

40mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

ADEFOVIR DIPIVOXIL

Tablet

10mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

ADENOSINE

Injection

6mg/2mL

Y

 

ADRENALINE (EPINEPHRINE)

Injection

1 in 1000 & 1 in 10 000

Y

 

ADRENALINE (EPINEPHRINE)

Min-I-Jet

1 in 1000

Y

 

ADRENALINE (EPINEPHRINE)

Auto-injector

300 mcg and 150 mcg

R

EPI-PEN® AND EPI-PEN® JUNIOR

Restricted to after-hours use only by the Emergency Department.

ALBENDAZOLE

Tablet

200mg

Y

 

ALCOHOL

Injection

100%

Y

 

ALCOHOL

Solution

70% untinted, 95% untinted, absolute

Y

 

ALCOHOL STERILE SPRAY

Spray

70%

Y

 

ALENDRONATE

Tablet

70mg

Y

 

ALFENTANIL

Injection

1mg/2mL

Y

 

ALLOPURINOL

Tablet

100mg & 300mg

Y

 

ALPROSTADIL

Injection

500 mcg

Y

 

ALTEPLASE

Syringe

2mg/2mL

Y

Cathflo® (alteplase) is a Special Access Scheme (SAS) Product. Please complete appropriate SAS form which can be located on the PGC.

ALTEPLASE

Injection

50mg

R

Restricted to Cardiology and ICU only

Restricted to ED for stroke thrombolysis under direction of the Neurologist.

ALUMINIUM HYDROXIDE

Tablet

600mg

Y

 

ALUMINIUM HYDROXIDE, MAGNESIUM HYDROXIDE and MAGNESIUM TRISILICATE (Gastrogel®)

Suspension

50mg/ 24mg/ 24mg/mL

Y

 

AMIES MEDIUM SWABS

Single Swabs

 

Y

 

AMIKACIN

Injection

500mg/2mL

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

AMINO ACID AND CARBOHYDRATE SUPPLEMENT (HEPATICAL®)

Sachet

100grams

Y

 

AMINO ACID LONG CHAIN POLYUNSATURATED FATTY ACIDS

Powder

 

R

Restricted to PBS indications.

AMINO ACIDS 7% GLUCOSE

Solution

7%

Y

 

AMINOPHYLLINE

Injection

250mg

Y

 

AMIODARONE

Injection

150mg

Y

 

AMIODARONE

Tablet

100mg & 200mg

Y

 

AMISULPRIDE

Tablet

100mg, 200mg & 400mg

R

Restricted to Mental Health

AMITRIPTYLINE

Tablet

10mg, 25mg & 50mg

Y

 

AMLODIPINE

Tablet

5mg & 10mg

Y

 

AMOXICILLIN

Suspension

250mg/5mL

Y

 

AMOXICILLIN

Capsule/ Tablet

250mg, 500mg & 1000mg

Y

 

AMOXICILLIN, CLARITHROMYCIN & ESOMEPRAZOLE (Nexium HP7 Triple Therapy Pack®)

Tablet

500mg/ 250mg/ 20mg

Y

 

AMOXICILLIN/ CLAVULANIC ACID

Injection

1g+200mg, 500mg+100mg, 2g+200mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

AMOXICILLIN/ CLAVULANIC ACID (Augmentin Duo®)

Tablet

500/125mg & 875/125mg

Y

 

AMOXICILLIN/ CLAVULANIC ACID (Augmentin Duo®)

Suspension

400/57mg /5mL

Y

 

AMPHOTERICIN

Lozenges

10mg

Y

 

AMPHOTERICIN LIPOSOMAL

Injection

50mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

AMPICILLIN

Injection

500mg & 1g

Y

 

ANAKINRA

Injection

100mg

R

Restricted to ICU Physicians as per use in REMAP CAP clinical trials only

ANASTROZOLE

Tablet

1mg

R

Restricted to Oncology and Haematology only

ANIDULAFUNGIN

Injection

100mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

ANTIVENOM BOX JELLYFISH

Injection

20 000 units

Y

 

ANTIVENOM-BLACK SNAKE

Injection

18 000 units

Y

 

ANTIVENOM-BROWN SNAKE

Injection

1 000 units

Y

 

ANTIVENOM-DEATH ADDER

Injection

6 000 units

Y

 

ANTIVENOM-POLYVALENT SNAKE

Injection

40 000 units

Y

 

ANTIVENOM-RED BACK SPIDER

Injection

500 units

Y

 

ANTIVENOM-SEA SNAKE

Injection

1000 units

Y

 

ANTIVENOM-STONE FISH

Injection

2000 units

Y

 

ANTIVENOM-TAIPAN SNAKE

Injection

12 000 units

Y

 

APIXABAN

Tablet

2.5mg, 5mg

R

Restricted to PBS indications.

APRACLONIDINE

Eye drop

0.50% (5mg/mL)

Y

 

AQUEOUS CREAM

Cream

 

Y

 

ARGIPRESSIN (VASOPRESSIN)

Injection

20units

R

Restricted to ICU

ARIPIPRAZOLE

Tablet

10mg, 15mg, 20mg, 30mg

R

Restricted to Mental Health for the treatment of schizophrenia.

ARIPIPRAZOLE (Abilify Maintena®)

Depot Injection

300mg, 400mg

R

Restricted to Mental Health for the treatment of schizophrenia.

ARTEMETHER & LUMEFANTRINE (Riamet®)

Tablet

20mg/120mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

ARTESUNATE

Injection

60mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

This is a Special Access Scheme (SAS) Product. Please complete appropriate SAS form which can be located on the PGC.

ASCORBIC ACID

Injection

15g/100mL

R

REMAP CAP Trial as prescribed by the ICU consultants.

ASCORBIC ACID

Tablet

500mg

Y

 

ASPIRIN

Dispersible tablets

300mg

Y

 

ASPIRIN

Tablet

100mg

Y

 

ATAZANAVIR

Capsule

150mg, 200mg & 300mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

ATAZANAVIR & COBICISTAT (Evotaz®)

Tablet

300mg/150mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

ATENOLOL

Tablet

50mg

Y

 

ATENOLOL

Liquid

50mg/10mL

Y

 

ATORVASTATIN

Tablet

10mg, 20mg, 40mg & 80mg

Y

 

ATOVAQUONE & PROGUANIL

Tablet

250mg/100mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

ATRACURIUM

Injection

25mg

Y

 

ATROPINE SULFATE

eye drop & Minims

1%

Y

 

ATROPINE SULFATE

Injection

600mcg

Y

Blanket approval for outpatient supply. Restricted to: Haematology/Oncology.

AZACITIDINE

Injection

100mg

R

Restricted to Haematology and Oncology for PBS listed indications.

AZATHIOPRINE

Tablet

25mg & 50mg

Y

 

AZITHROMYCIN

Injection

500mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

AZITHROMYCIN

Suspension

200mg/ 5mL

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

Blanket outpatient approval for bronchiectasis in paediatric patients.

AZITHROMYCIN

Tablet

500mg & 600mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

Blanket outpatient approval for bronchiectasis in paediatric patients and for susceptible infections not listed on the PBS approved by Infectious Disease/Tuberculosis clinic only.

AZTREONAM

Injection

1g

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

BACLOFEN

Intrathecal Injection

10mg/5mL

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

BACLOFEN

Tablet

10mg & 25mg

Y

 

BALANCED SALT

Solution

 

Y

 

BATH WASH (Q.V. SOAP FREE KIDS WASH®)

Wash

 

Y

 

MYCOBACTERIUM BOVIS (BACILLUS CALMETTE AND GUERIN (BCG) STRAIN BLADDER INSTALLATION (Immucyst®)

Syringe

 

R

Restricted to Urologist

BCG VACCINE

Injection

 

Y

 

BECLOMETHASONE

Nasal Spray

50mcg

Y

 

BENDAMUSTINE

Injection

25mg, 100mg

R

Restricted to Haematology/Oncology.

BENZATHINE PENICILLIN (LA Bicillin®)

Injection

1,200,000 Units (900mg)/2.3mL,

600,000 Units (517mg)/1.17mL

Y

 

BENZOIN COMPOUND (Friars’ Balsam Tincture)

Tincture

 

Y

 

BENZTROPINE

Injection

2mg

Y

 

BENZTROPINE

Tablet

2mg

Y

 

BENZYDAMINE (Difflam®)

Liquid

22.5mg/15mL

Y

 

BENZYDAMINE/ LIDOCAINE (LIGNOCAINE)/DICHLOROBENZYL ALCOHOL (Difflam Plus ®)

Lozenges

3mg/4mg/1.2mg

Y

 

BENZYL BENZOATE

Solution

25%

Y

 

BENZYLPENICILLIN

Injection

600mg, 1.2g & 3g

Y

 

BENZYLPENICILLIN (PENICILLIN G)

Infusor

3.6g/6g

Y

 

BETAHISTINE

Tablet

16mg

Y

 

BETAMETHASONE (Celestone Chronodose®)

Injection

5.7mg/mL

Y

 

BETAMETHASONE DIPROPIONATE

Ointment/ Cream

0.05%

Y

 

BETAMETHASONE DIPROPIONATE/ CALCIPOTRIOL

Ointment

0.05%/0.005%

Y

 

BETAMETHASONE VALERATE

Cream

0.02%

Y

 

BETAXOLOL

Eye drops

0.25% & 0.5%

Y

 

BEVACIZUMAB

Intravitreal Injection

 

R

Restricted to eye clinic - for Ophthalmology specialist use only.

Avastin® brand only. Not to substitute with biosimilars.

For SAS Avastin®, please complete appropriate SAS form (Category B) which can be located on the PGC. SAS form is not required for TGA-approved Authorised Prescribers.

BEVACIZUMAB

Injection

100mg/4mL, 400mg/16mL

R

Restricted to Haematology and Oncology for PBS listed indications.

BICALUTAMIDE

Tablet

50mg

R

Restricted to Haematology and Oncology

BICTEGRAVIR/EMTRICITABINE/ TENOFOVIR ALAFENAMIDE

Tablet

50mg/200mg/25mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

BIFIDOBACTERIA BIFIDUM & LACTOBACILLUS ACIDOPHILIS (Infloran®)

Capsule

1 x 109

1 x 109

R

Restricted to Special Care Nursery and Neonatal Intensive Care Unit.

BIFIDOBACTERIUM INFANTIS, BIFIDOBACTERIUM BIFIDUM, LACTOBACILLUS ACIDOPHILUS (Labinic Paediatric Drops ®)

Drops

1.5 billion CFU/0.16mL

R

Restricted to Special Care Nursery and Neonatal Intensive Care Unit during the period that Infloran® is unavailable. This is a Special Access Scheme (SAS) Product. Please complete appropriate SAS form which can be located on the PGC.

BISACODYL

Tablet

5 mg

Y

 

BISACODYL

Enema

10mg/5mL

Y

 

BISACODYL

Suppository

10mg

Y

 

BISMUTH & IODOFORM GAUZE

GAUZE

 

Y

 

BISOPROLOL

Tablet

2.5mg, 5mg & 10mg

Y

 

BIVALIRUDIN

Injection

250mg

R

Restricted to use in RDH ICU by ICU specialists only – please refer to RDH ICU: Medical Management of suspected Heparin Induced Thrombocytopaenia with or without Thrombosis (HIT/HITTS) guideline

BLEOMYCIN

Injection

15,000 international units

R

Restricted to Haematology and Oncology for PBS listed indications.

BNT162b2 [mRNA] COVID-19 VACCINE (Comirnaty®)

Injection

 

R

As per eligibility criteria outlined in the Australian Government Immunisation Implementation plan January 2021

BONE CEMENT with TOBRAMYCIN

  

Y

 

BORTEZOMIB

Injection

1mg, 3.5mg

R

Restricted to Haematology and Oncology for PBS listed indications.

BOSENTAN

Tablet

62.5mg & 125mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

Restricted to patients <18 years old. Macitentan is first line for adults.

BOTULINUM A TOXIN

Injection

100 units & 500 units

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

Restricted to surgical division/gastroenterology for treatment of anal fissure repair for patients who have failed conservative/first-line medical measures (100 unit injection only).

BRANCHED CHAIN AMINO ACIDS POWDER

Sachet

 

Y

 

BREXPIPRAZOLE

Tablet

1mg, 2mg, 3mg, 4mg

Y

 

BRIMONIDINE

Eye drops

0.20%

Y

 

BRINZOLAMIDE

Eye drops

1%

Y

 

BROMHEXINE

Elixir

4mg/5mL

Y

 

BROMOCRIPTINE

Tablet

2.5mg

Y

 

BUDESONIDE

Nasal Spray

64mcg

Y

 

BUDESONIDE

Capsule and Tablet

3mg and 9mg

R

Blanket approval for inpatient and outpatient supply. Restricted to gastroenterologists for the;

  • Induction of remission in mild to moderate Crohn’s   disease affecting small bowel - 12 weeks therapy
  • Induction therapy for extensive ulcerative colitis if no   response to sulfasalazine or mesalazine, or intolerance to either drug – 8   weeks therapy
  • Treatment of microscopic colitis – ongoing
  • Contraindications to prednisolone for the treatment of   autoimmune gastrointestinal diseases (e.g. refractory coeliac disease,   eosinophilic esophagitis, autoimmune hepatitis, inflammatory bowel disease) –   ongoing

BUDESONIDE

Turbuhaler

100mcg, 200mcg & 400mcg

Y

 

BUDESONIDE

Respule

500mcg/2mL & 1mg/2mL

Y

 

BUDESONIDE/ FORMOTEROL (EFORMETEROL) (Symbicort®)

Rapihaler

50/3mcg &

100/3mcg & 200/6mcg

Y

 

BUPIVACAINE

Infusion

0.125%, 0.25% & 0.5%

Y

 

BUPIVACAINE & ADRENALINE

Injection

0.25%/ 1:400,000

Y

 

BUPIVACAINE & FENTANYL

Injection

0.125%/2mcg/ mL

Y

 

BUPIVACAINE & FENTANYL

Injection

0.0625%/2.5mcg/mL

Y

*For use as labour epidural

BUPIVACAINE & GLUCOSE

Injection

0.5%

R

Operating Theatre

BUPRENORPHINE

Sublingual Tablet

400mcg, 2mg &, 8mg

R

Restricted to Addiction medicine prescribers

BUPRENORPHINE

Sublingual Tablet

200mcg

R

Restricted to Acute Pain Specialists for patients who are:

Inpatients only

and

The patient is unable to absorb via the oral route

and

A discharge plan for analgesia has been considered

or

It’s a continuation of regular mediation

BUPRENORPHINE (Norspan®)

Patch

5mg (5 mcg/hr), 10mg (10 mcg/hr) & 20mg (20 mcg/hr)

R

Chronic severe disabling pain not responding to non-narcotic analgesics.

BUPRENORPHINE & NALOXONE

Sublingual Film

2mg/0.5mg & 8mg/2mg

R

Restricted to Addiction medicine prescribers

BUPRENORPHINE (Buvidal®)

Weekly Depot Injection

8 mg/0.16 mL,

16 mg/0.32 mL,

24 mg/0.48 mL &

32 mg/0.64 mL

R

Restricted to Addiction medicine prescribers

BUPRENORPHINE (Buvidal®)

Monthly Depot Injection

64 mg/0.18 mL,

96 mg/0.27 mL,

128 mg/0.36 mL,

160mg/0.45mL

R

Restricted to Addiction medicine prescribers

BUPRENORPHINE (Sublocade®)

Monthly Depot Injection

100mg/0.5mL,

300mg/1.5mL

R

Restricted to Addiction medicine prescribers

CABAZITAXEL

Injection

60mg

R

Restricted to Haematology and Oncology for PBS listed indications.

CABERGOLINE

Tablet

1mg

Y

 

CABOTEGRAVIR (Vocabria®)

Tablet

30mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

CABOTEGRAVIR & RILPIRIVINE (combination pack with tradename Cabenuva®)

Injection

600mg/3mL; 900mg/3mL

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

CAFFEINE

Solution

50mg (10mg/mL)

Y

 

CAFFEINE

Injection

20mg/2mL

Y

 

CALAMINE

Lotion

15%

Y

 

CALCITRIOL

Capsule

0.25mcg

Y

 

CALCIUM & MAGNESIUM CHLORIDE

Haemofiltration infusion

 

R

To ICU only

CALCIUM CARBONATE

Tablet

1.25g

Y

 

CALCIUM CARBONATE/COLECALCIFEROL (CHOLECALCIFEROL)

Tablet

1.5g/12.5mcg

R

Restricted to Haematology and Oncology.

CALCIUM CHLORIDE

Injection

10%

Y

 

CALCIUM DISODIUM EDETATE

Injection

500mg/10mL

R

Stock held by RDH Emergency Department for treatment of severe lead poisoning.

CALCIUM FOLINATE

Injection

50mg

Y

 

CALCIUM FOLINATE

Tablet

15mg

Y

 

CALCIUM GLUCONATE

Injection

931mg/10mL

(2.2 mmol/10mL elemental calcium); also formerly known as Calcium Gluconate

10%

Y

 

CALCIUM GLUCONATE

Gel

2.50%

Y

 

CANDESARTAN

Tablet

4mg, 16mg

Y

 

CAPECITABINE

Tablet

150mg, 500mg

R

Restricted to Haematology and Oncology for PBS listed indications AND for EOX protocol for upper GI.

CAPTOPRIL

Solution

25mg/5mL

Y

 

CARBAMAZEPINE

Modified release Tablets

200mg & 400mg

Y

 

CARBAMAZEPINE

Tablet

200mg

Y

 

CARBAMAZEPINE

Suspension

100mg/5mL

Y

 

CARBIMAZOLE

Tablet

5mg

Y

 

CARBITOCIN

Injection

1mg

R

Restricted to Obstetrician or Anaesthetist in attendance for prevention of uterine atony and postpartum haemorrhage following the delivery of an infant by elective caesarean section under epidural or spinal anaesthesia

CARBOPLATIN

Injection

150mg/5mL, 450mg/45mL, 50mg/5mL

R

Restricted to Haematology and Oncology for PBS listed indications.

CARBOPROST

Injection

250mcg/mL

Y

 

CARMELLOSE (Cellufresh®)

Eye drop

0.50%

Y

 

CARNITINE

Solution

1g/10mL

Y

 

CARVEDILOL

Tablet

3.125mg, 6.25mg, 12.5mg & 25mg

Y

 

CASPOFUNGIN

Injection

50mg & 70mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

CEFALEXIN MONOHYDRATE (CEPHALEXIN)

Capsules

250mg & 500mg

Y

 

CEFALEXIN MONOHYDRATE (CEPHALEXIN)

Suspension

250mg/5mL

Y

 

CEFAZOLIN (CEPHAZOLIN)

Eye drop

5%

R

Restricted to eye clinic (Manufactured at RDH).

Blanket outpatient approval for treatment or prevention of ophthalmic infections.

CEFAZOLIN (CEPHAZOLIN)

Injection

1g

Y

 

CEFAZOLIN (CEPHAZOLIN)

Infusor

 

Y

 

CEFEPIME

Injection

1g

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

CEFOTAXIME

Injection

1g

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

CEFOXITIN

Infusor

1g & 12g

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

CEFTAROLINE

Injection

600mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

CEFTAZIDIME

Injection

1g, 2g

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

CEFTAZIDIME

24 hour Infusor

2g, 3g, 4g, 5g & 6g

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

CEFTRIAXONE

Infusor

 

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

CEFTRIAXONE

Injection

1g

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

CEFUROXIME

Tablet

250mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

CEFUROXIME

Suspension

125mg/5mL

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

CELECOXIB

Capsule

100mg & 200mg

Y

 

CETIRIZINE

Tablet

10mg

R

For patients who fail to respond to loratadine. Restricted to dermatology and immunology.

CETOMACROGOL

Cream

100g

Y

 

CETUXIMAB

Injection

100mg/20mL, 500mg/100mL

R

Restricted to Haematology and Oncology for PBS listed indications.

CHLORAL HYDRATE

Solution

1g/10mL

Y

 

CHLORAMBUCIL

Tablet

2mg

Y

Blanket approval for outpatient supply with PBS prescription. Restricted to: Haematology/Oncology.

CHLORAMPHENICOL

Injection

1g

R

Restricted to ICU and IFD only. This is a Special Access Scheme (SAS) Product. Please complete appropriate SAS form which can be located on the PGC.

CHLORAMPHENICOL (Chlorsig®)

Eye ointment

1%

Y

 

CHLORAMPHENICOL (Chlorsig®)

Eye Drops

0.50%

Y

 

CHLORHEXIDINE

Obstetric cream

1%

Y

 

CHLORHEXIDINE

Mouth wash

0.20%

Y

 

CHLORHEXIDINE 3mg/PHENYLEPHRINE 2.5mg

Nasal Ointment

0.3%/0.25%

Y

 

CHLORHEXIDINE IN ALCOHOL 70%

Solution

0.50%

Y

 

CHLORHEXIDINE SCRUB

Medisponge

 

Y

 

CHLORHEXIDINE/ CETRIMIDE

Irrigation

0.015/0.15%

Y

 

CHLORHEXIDINE/ CETRIMIDE

Solution

0.015/0.15%

Y

 

CHLORHEXIDINE/ CETRIMIDE

Cream

0.1%/0.5%

Y

 

CHLORPROMAZINE

Injection

50mg/2mL

Y

 

CHLORPROMAZINE

Tablet

10mg, 25mg & 100mg

Y

 

CHLORPROMAZINE

Syrup

25mg/5mL

Y

 

CHOLINE SALICYLATE/CETALKONIUM CHLORIDE/MENTHOL (Sedagel®)

Dental Gel

8.7%/0.01%/0.057%

Y

 

CICLOSPORIN (CYCLOSPORIN)

Injection

50mg/mL

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

CICLOSPORIN (CYCLOSPORIN)

Capsule

10mg, 25mg, 50mg & 100mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

CINACALCET

Tablet

30mg, 60mg, and 90mg

R

Restricted to nephrologists for patients who meet the PBS criteria

CINCHOCAINE & HYDROCORTISONE (Proctosedyl®)

Suppositories

5mg/5mg

Y

 

CINCHOCAINE & HYDROCORTISONE (Proctosedyl®)

Ointment

0.5%/0.5%

Y

 

CINCHOCAINE & ZINC OXIDE (Rectinol®)

Ointment

0.5%/20%

Y

 

CIPROFLOXACIN

Ear Drops

0.30%

Y

 

CIPROFLOXACIN

Tablet

250mg, 500mg & 750mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

Blanket outpatient approval for susceptible infections not listed on the PBS approved by Infectious Diseases.

CIPROFLOXACIN

Injection

200mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

CIPROFLOXACIN/ HYDROCORTISONE (CIPROFLOXACIN CO®)

Ear Drops

0.2%/1%

Y

 

CISPLATIN

Injection

100mg/100mL, 50mg/50mL

R

Restricted to Haematology and Oncology for PBS listed indications.

CITALOPRAM

Tablet

20mg

Y

 

CLADRIBINE

Injection

10mg/10mL, 10mg/5mL

R

Restricted to Haematology and Oncology for PBS listed indications.

CLARITHROMYCIN

Tablet

250mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

Blanket outpatient approval for susceptible infections not listed on the PBS approved by Infectious Diseases.

CLINDAMYCIN

Capsule

150mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

CLINDAMYCIN

Solution

75mg/5mL

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

Use restricted to discharge and outpatients only.

This is a Special Access Scheme (SAS) Product. Please complete appropriate SAS form which can be located on the PGC.

CLINDAMYCIN

Injection

600mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

CLOFAZAMINE/ DAPSONE/ RIFAMPICIN (LEPROSY PACK)

Capsules & Tablets

300mg/100mg/ 100mg

R

This is a Special Access Scheme (SAS) Product. Please complete appropriate SAS form which can be located on the PGC.

CLONAZEPAM

Injection

1mg

Y

Blanket outpatient approval for Palliative care patients.

CLONAZEPAM

Solution

2.5mg/mL

Y

Blanket outpatient approval for Palliative care patients.

CLONAZEPAM

Tablet

500mcg & 2mg

Y

Blanket outpatient approval for Palliative care patients.

CLONIDINE

Injection

150mcg/1mL

Y

 

CLONIDINE

Tablet

100mcg & 150mcg

Y

 

CLOPIDOGREL

Tablet

75mg

Y

 

CLOTRIMAZOLE

Pessary

500mg

Y

 

CLOTRIMAZOLE

Vaginal Cream

1%

Y

 

CLOTRIMAZOLE

Cream

1%

Y

 

CLOVE OIL BP

Oil

10mL

Y

 

CLOZAPINE

Tablet

25mg, 50mg, 100mg & 200mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

COAL TAR

Solution

200mL

Y

 

COBICISTAT/ELVITEGRAVIR/EMTRICITABINE/TENOFOVIR (Genvoya®)

Tablet

150mg/150mg/200mg/10mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

COCAINE

Solution

10%

Y

 

CODEINE PHOSPHATE

Tablet

30mg

Y

 

COLCHICINE

Tablet

500mcg

Y

 

COLECALCIFEROL (CHOLECALCIFEROL)

Capsule

1000 units

Y

 

COLECALCIFEROL (CHOLECALCIFEROL)

Oral Solution

5000 units / mL

Y

 

COLESTYRAMINE (CHOLESTYRAMINE) LIGHT

Sachets

4g

Y

 

Colistimethate Sodium (Colistin)

Injection

150mg/2ml

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

COLLOIDAL OATMEAL (DermaVeen®)

Lotion

20mg/g

R

Restricted to burns unit & wound clinic

CONJUGATED ESTROGENS (OESTROGENS CONJUGATED)

Tablet

300microg & 625microg

Y

 

CORTISONE ACETATE

Tablet

5mg & 25mg

Y

 

COVID MEDICINES

-

-

R

Blanket approval for all medicines listed in the National Living COVID Guidelines.

Blanket approval for prescribers to use Clinical Excellence Commission (CEC) resources available at: COVID-19 Resources - NSW Therapeutic Advisory Group (nswtag.org.au) and

Medication Safety Updates - Clinical Excellence Commission (nsw.gov.au)

CROTAMITON

Cream

10%

Y

 

CYCLIZINE

Injection

50mg/mL

R

Restricted to Anaesthetics and Palliative Care for the treatment of postoperative nausea and vomiting, and nausea and vomiting in the palliative care setting.

Blanket outpatient approval for prevention of nausea and vomiting in Palliative Care patients.

CYCLOPENTOLATE

eye drop & Minims

1%

Y

 

CYCLOPENTOLATE

Minims

0.50%

Y

 

CYCLOPHOSPHAMIDE

Infusor

 

Y

 

CYCLOPHOSPHAMIDE

Injection

500mg, 1gram, 2gram

Y

 

CYCLOPHOSPHAMIDE

Tablet

50mg

Y

Blanket approval for outpatient supply with PBS prescription. Restricted to: Haematology/Oncology.

CYPROTERONE

Tablet

50mg

Y

 

CYTARABINE

Injection

100mg/5mL

R

Restricted to Haematology and Oncology for PBS listed indications.

DABRAFENIB

Capsules

50mg, 75mg

R

Restricted to Haematology and Oncology for PBS listed indications.

DACARBAZINE

Infusion

 

R

Restricted to Haematology and Oncology for Metastatic Melanoma and Hodgkin’s Lymphoma.

DACTINOMYCIN

Injection

 

R

Restricted to Haematology and Oncology for Low Risk Gestational Trophoblastic Disease.

DANTROLENE

Injection

20mg

Y

 

DANTROLENE

Capsules

25mg & 50mg

Y

 

DAPAGLIFLOZIN

TABLET

10mg

Y

 

DAPSONE

Tablet

100mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

DAPTOMYCIN

Injection

500mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

DARBEPOETIN ALFA

Injection

10mcg, 20mcg, 30mcg, 40mcg, 60mcg, 80mcg, 100mcg & 150mcg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

DARUNAVIR

Tablet

150mg, 600mg, 800mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

DARUNAVIR/COBICISTAT (Prezcobix®)

Tablet

800mg/150mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

DARUNAVIR/COBICISTAT/EMTRICITABINE/TENOFOVIR ALAFENAMIDE (Symtuza®)

Tablet

800mg/150mg/

200mg/10mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

DAUNORUBICIN MINIBAG

Injection

 

R

Restricted to Haematology and Oncology for Acute Myeloid Leukaemia.

DEFERASIROX (JADENU®)

tablets

90mg, 180mg, 360mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

DEGARELIX

Injection

80mg, 120mg

R

Restricted for PBS listed indications.

Blanket approval for outpatient supply with PBS prescription.

DENOSUMAB

Injection

60mg, 120mg

R

Restricted to Haematology and Oncology for PBS listed indications.

Blanket approval for outpatient supply with PBS prescription. Restricted to: Haematology/Oncology.

DESFERASIOXAMINE

Injection

2g

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

DESFLURANE

Solution

240mL

Y

 

DESLORATADINE

Liquid

2.5mg/5mL

Y

 

DESMOPRESSIN

Injection

4mcg

Y

 

DESMOPRESSIN

Nasal Solution

100mcg/mL

Y

 

DESMOPRESSIN

Tablet

200mcg

Y

 

DESMOPRESSIN

Nasal Spray

10mcg/dose

Y

 

DEXAMETHASONE

eye drop

0.10%

Y

Blanket approval for outpatient supply. Restricted to: Haematology/Oncology.

DEXAMETHASONE

Tablet

500mcg & 4mg

Y

Blanket approval for outpatient supply. Restricted to: Haematology/Oncology.

DEXAMETHASONE

Liquid

1mg/mL

Y

 

DEXAMETHASONE

Injection

4mg & 8mg

Y

 

DEXAMETHASONE, FRAMYCETIN & GRAMICIDIN (Sofradex®/Otodex®)

Ear Drops

0.05%/ 0.5%/ 0.005%

Y

 

DEXAMFETAMINE

Tablet

5mg

R

Use in attention deficit hyperactivity disorder

DEXCHLORPHENIRAMINE

Tablet

2mg

Y

 

DEXMEDETOMIDINE

Injection

200mcg/2mL

R

Restricted to ICU, Palliative Care and Anaesthetics only

DIAZEPAM

Suspension

10mg/10mL

Y

 

DIAZEPAM

Rectal Solution

5mg/5mL

Y

 

DIAZEPAM

Tablet

2mg & 5mg

Y

 

DIAZEPAM

Injection

10mg

Y

 

DIAZOXIDE

Tablet

25mg

R

This is a Special Access Scheme (SAS) Product. Please complete appropriate SAS form which can be located on the PGC.

DICLOFENAC

Enteric Coated Tablet

25mg & 50mg

Y

 

DICLOFENAC

Gel

1%

Y

 

DICLOFENAC

Suppositories

100mg

Y

 

DICLOXACILLIN

Capsule

250mg & 500mg

Y

 

DIGOXIN

Suspension

250mcg/5mL

Y

 

DIGOXIN

Tablet

62.5mcg & 250mcg

Y

 

DIGOXIN

Injection

50mcg & 500mcg

Y

 

DIGOXIN-SPECIFIC ANTIBODY (DigiFab®)

Injection

40mg

R

This medication is restricted to ED, ICU and CCU for the treatment of digoxin toxicity, or for other cardiac glycoside poisoning such as Oleander and Bufotoxin (cane toad).

DILTIAZEM

Modified release Capsules

180mg, 240mg & 360mg

Y

 

DILTIAZEM

Tablet

60mg

Y

 

DIMERCAPROL

Injection

200mg

R

Stock held by RDH Emergency Department for treatment of severe lead poisoning.

DIMETHICONE (Hedrin 15®)

Gel Spray

4%

Y

 

DIMETHICREAM

Cream

100g

Y

 

DINOPROSTONE

Vaginal Gel

1mg & 2mg

R

Restricted to Specialist Obstetricians and their Registrars for induction of labour according to local guidelines.

DINOPROSTONE CR

Controlled Release Pessary

10mg

R

Restricted to Specialist Obstetricians and their Registrars for induction of labour according to local guidelines.

DIPHENOXYLATE & ATROPINE (Lomotil®)

Tablet

2.5/0.025mg

Y

 

DIPHTHERIA & TETANUS VACCINE (ADT®)

Injection

 

Y

 

DIPHTHERIA TETANUS & PERTUSSIS VACCINE (Boostrix®)

Injection

 

Y

 

DIPHTHERIA, TETANUS, PERTUSSIS & POLIO (Infanrix-IPV®)

Injection

 

Y

 

DISODIUM EDETATE

Injection

3%

Y

 

DOBUTAMINE

Injection

250mg

Y

 

DOCETAXEL

Injection

20mg, 80mg, 160mg

R

Restricted to Haematology and Oncology for PBS listed indications.

DOCUSATE & SENNA (Coloxyl & Senna®)

Tablet

50/8mg

Y

 

DOCUSATE SODIUM

Tablet

50mg & 120mg

Y

 

DOCUSATE SODIUM EAR DROPS (Waxsol®)

Ear Drops

 

Y

 

DOLUTEGRAVIR

Tablet

50mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

DOLUTEGRAVIR/ABACAVIR/LAMIVUDINE (Triumeq®)

Tablet

50mg/600mg/300mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

DOLUTEGRAVIR/LAMIVUDINE (Dovato®)

Tablet

50mg/300mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

DOLUTEGRAVIR/RILPIVIRINE (Juluca®)

Tablet

50mg/25mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

DOMPERIDONE

Tablet

10mg

Y

Blanket outpatient approval for the stimulation of lactation.

DONEPEZIL

Tablet

5mg & 10mg

Y

 

DOPAMINE

Injection

200mg

Y

 

DORNASE ALFA

Nebulised solution

2.5mg/2.5mL

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

DOSULEPIN (DOTHIEPIN)

Tablet

75mg

Y

 

DOSULEPIN (DOTHIEPIN)

Capsule

25mg

Y

 

DOXORUBICIN

Injection

50mg/25mL, 200mg/100mL

R

Restricted to Haematology and Oncology for PBS listed indications.

DOXORUBICIN LIPOSOMAL

Injection

20mg/10mL, 50mg/25mL

R

Restricted to Haematology and Oncology for PBS listed indications.

DOXYCYCLINE

Tablet

100mg

Y

Blanket outpatient approval for susceptible infections not listed on the PBS approved by Infectious Diseases.

DOXYCYCLINE

Injection

100mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

This is a Special Access Scheme (SAS) Product. Please complete appropriate SAS form which can be located on the PGC.

DOXYLAMINE

Tablets

25mg

Y

 

DROPERIDOL

Injection

2.5mg/1mL 10mg/2mL

Y/ R

10mg/2mL restricted to Emergency Departments and Mental Health

DULAGLUTIDE

Syringe

1.5mg

R

Restricted to PBS indications

DULOXETINE

Capsules

30mg, 60mg

R

Restricted to PBS indications.

DUTASTERIDE/TAMSULOSIN

Capsules

500mcg/400mcg

R

Restricted to PBS indications.

ECULIZUMAB

Injection

300mg/30mL

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

Note: Eculizumab is reimbursed by the PBS under S100 HSD arrangements for both outpatients and public hospital admitted patients for the treatment of aHUS.

EDROPHONIUM

Injection

10mg

Y

 

EFAVIRENZ

Tablet

200mg & 600mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

EMICIZUMAB

Syringe

30mg/mL

60mg/0.4mL

105mg/0.7mL

150mg/1mL

R

Restricted to inpatient and outpatient Haematology patients that meet the National Product List (NPL) restrictions.

EMPAGLIFLOZIN

Tablet

10mg & 25mg

Y

 

EMTRICITABINE & RILPIVIRINE & TENOFOVIR ALAFENAMIDE (Odefsey®)

Tablet

200mg/25mg/25mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

EMTRICITABINE/TENOFOVIR (Descovy®)

Tablet

200mg/25mg & 200mg/10mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

ENALAPRIL

Tablet

5mg, 10mg, 20mg

Y

For paediatric patients with heart failure or breastfeeding women with hypertension or heart failure

ENOXAPARIN

Injection

20mg, 40mg, 60mg, 80mg 100mg, 120mg & 150mg

Y

Blanket outpatient approval for non-PBS indications for 120mg and 150mg strengths.

ENTECAVIR

Tablet

500mcg & 1mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

Blanket outpatient approval for the prevention of hepatitis B virus reactivation or progression in patients >16 years old who are immunosuppressed or live in a remote area and do not meet PBS criteria restricted to prescribers under the direction of Infectious Diseases or Liver Clinic Specialists.

EPHEDRINE

Injection

30mg

Y

 

EPIRUBICIN

Injection

2mg/mL

R

Restricted to Oncology/Haematologist use only

EPLERENONE

Tablet

25mg & 50mg

R

Restricted to Cardiology

EPOPROSTENOL

Injection

500 mcg, 1.5mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

EPTACOG ALPHA (NovoSeven RT®)

Injection

1mg & 2mg

R

Available at RDH only. Restricted to ICU, stock is kept in ICU. 1.2mg strength is non-formulary and stock is supplied by blood transfusion services for Haematology protocol use.

ERGOMETRINE

Injection

500mcg

Y

 

ERGOMETRINE & OXYTOCIN

Injection

500mcg/5 IU

Y

 

ERLOTINIB

Tablet

25mg, 100mg, 150mg

R

Restricted to Haematology and Oncology for PBS listed indications.

ERTAPENEM

Injection

1g

Y

 

ERYTHROMYCIN

Capsule

250mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

ERYTHROMYCIN ETHYL SUCCINATE

Suspension

200mg/5mL

Y

 

ERYTHROMYCIN LACTOBIONATE

Injection

1g

Y

 

ESCITALOPRAM

Tablets

10mg, 20mg

R

PBS indications only.

ESMOLOL

Injection

100mg/10mL

Y

 

ESTRIOL (OESTRADIOL VALERATE)

Tablet

1mg

Y

 

ESTRIOL (OESTRADIOL)

Patch

25mcg, 50mcg & 100mcg

Y

 

ESTRIOL (OESTRADIOL)

Implant

100mg

Y

 

ESTRIOL (OESTRIOL)

Vaginal Cream

1mg/g

Y

 

ETANERCEPT

Injection

25mg

Y

 

ETHAMBUTOL

Tablet

100mg, 400mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

Blanket outpatient approval for the treatment of Tuberculosis.

ETONOGESTREL (Implanon NXT®)

Implant

68mg

R

Restricted to:

O&G use for inpatients where access to Implanon NXT® insertion in primary care is not appropriate or not available

or

Paediatricians (for TEHS only) for high risk adolescents

ETOPOSIDE

Capsule

50mg & 100mg

R

Restricted to Haematology and Oncology for PBS listed indications.

Blanket approval for outpatient supply with PBS prescription. Restricted to: Haematology/Oncology.

ETOPOSIDE

Injection

100mg, 1gram

R

Restricted to Haematology and Oncology for PBS listed indications.

ETRAVIRINE

Tablet

200mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

EVEROLIMUS

Tablet

500mcg & 750mcg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

EXEMESTANE

Tablet

25mg

Y

 

EZETIMIBE

Tablet

10mg

R

Restricted for use in patients who are on an HMG CoA reductase inhibitor (statin) in patients whose cholesterol levels are inadequately controlled

FAMOTIDINE

Tablet

20mg, 40mg

Y

 

FENOFIBRATE

Tablet

48mg, 145mg

Y

 

FENTANYL

Injection

100mcg & 500mcg

Y

 

FENTANYL

Patch

12mcg, 25mcg, 50mcg, 75mcg & 100mcg

Y

 

FENTANYL (ABSTRAL®)

Sublingual Tablets

100mcg, 300mcg & 400mcg

R

Restricted to Palliative Care as per the PBS Criteria

FERRIC CARBOXYMALTOSE (IRON)

Injection

500mg/10mL & 100mg/2mL

R

Restricted to use in remote health according to approved protocol. All stock to be dispensed from pharmacy on an individual patient basis.

Restricted to use in outpatients who are able to access supply via a PBS prescription (500mg/10mL strength only).

Restricted to use in inpatients for the following indications;

  • Previously documented adverse drug reaction to iron   polymaltose.
  • Heart failure with a documented fluid restriction.

FERRIC SUBSULPHATE (IRON)

Gel

21%

R

Restricted to gynaecology use only.

FERROUS FUMARATE & FOLIC ACID (Ferro-F®)

Modified Release Tablets

310mg/350mcg

Y

 

FERROUS SULFATE HEPTAHYDRATE

Liquid

150mg/5mL

Y

 

FERROUS SULFATE HEPTAHYDRATE & VITAMIN C

Modified Release Tablets

325mg/500mg

Y

 

FERROUS SULFATE HEPTAHYDRATE (Ferrograd®)

Tablet

325mg

Y

 

FILGRASTIM

Injection

300mcg & 480mcg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

FLECAINIDE

Injection

150mg

Y

 

FLECAINIDE

Tablet

50mg & 100mg

Y

 

FLUCLOXACILLIN

Injection

500mg & 1g

Y

 

FLUCLOXACILLIN

Infusor

4g, 6g, 8g & 12g

Y

 

FLUCLOXACILLIN

Suspension

250mg/5mL

Y

 

FLUCONAZOLE

Capsule

50mg, 100mg & 200mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

Restricted to Haematology and Oncology for PBS listed indications.

Blanket outpatient approval for susceptible infections not listed on the PBS approved by Infectious Diseases and for antifungal prophylaxis in haematological malignancies with immunosuppressive chemotherapy.

FLUCONAZOLE

Injection

100mg & 200mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

Restricted to Haematology and Oncology for PBS listed indications.

FLUCONAZOLE

Suspension

50mg/5mL

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

Restricted to Haematology and Oncology for PBS listed indications.

FLUCYTOSINE

Capsule

500mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

This is a Special Access Scheme (SAS) Product. Please complete appropriate SAS form which can be located on the PGC.

FLUDARABINE

Injection

50mg

R

Restricted to Haematology and Oncology for PBS listed indications.

FLUDARABINE

Tablet

10mg

R

Restricted to Haematology and Oncology for PBS listed indications.

FLUDROCORTISONE

Tablet

100mcg

Y

 

FLUMAZENIL

Injection

500mcg

Y

 

FLUORESCEIN

Strips

1mg

Y

 

FLUORESCEIN SODIUM

Minims

2%

Y

 

FLUORESCEIN SODIUM

Injection

10%

Y

 

FLUOROMETHOLONE (Flucon®)

Eye drops

0.10%

R

Restricted to Ophthalmologist use only

FLUOROMETHOLONE ACETATE (Flarex®)

Eye drops

0.10%

R

Restricted to Ophthalmologist use only

FLUOROURACIL

Infusion

 

R

Restricted to Haematology and Oncology for PBS listed indications.

FLUOROURACIL

Injection

500mg, 1gram, 2.5gram, 5gram

R

Restricted to Haematology and Oncology for PBS listed indications.

FLUOXETINE

Capsule & Dispersible tablets

20mg

R

Dispersible tablets are restricted to Paediatrics and Mental Health

FLUPENTHIXOL DECANOATE

Injection

20mg, 40mg & 100mg

Y

*Order on request

FLUTICASONE

Inhaler

125mcg, 250mcg & 50mcg

Y

 

FLUTICASONE & SALMETEROL (Seretide®)

Accuhaler

100/50mcg, 250/50mcg & 500/50mcg

Y

 

FLUTICASONE & SALMETEROL (Seretide®)

Inhaler

50/25mcg, 125/25mcg & 250/25mcg,

Y

 

FLUTICASONE / VILANTEROL (Ellipta Breo®)

Inhaler

100mcg/25mcg, 200mcg/25mcg

Y

 

FOLIC ACID

Injection

15mg

Y

 

FOLIC ACID

Tablet

500mcg & 5mg

Y

Blanket outpatient approval for prevention of sulfamethoxazole/trimethoprim induced folate deficiency in patients receiving treatment for melioidosis.

FONDAPARINUX

Injection

2.5mg/0.5mL

R

Restricted to use by ICU and Haematology for Heparin Inducted Thrombocytopenia/Thrombosis (HIT).

FORMALIN

Solution

10%

Y

 

FOSAMPRENAVIR

Tablet

700mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

FOSAPREPITANT

Injection

150mg

R

Restricted to Haematology and Oncology for PBS listed indications in patients who cannot tolerate orals

FOSFOMYCIN

Granules for Solution

3g Sachet

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

FOSFOMYCIN

Injection

4g

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

This is a Special Access Scheme (SAS) Product. Please complete appropriate SAS form which can be located on the PGC.

FOTEMUSTINE

Injection

208mg

R

Restricted to Haematology and Oncology for PBS listed indications.

FUROSEMIDE (FRUSEMIDE)

Solution (SyrSpend®)

50mg/5mL

Y

PBS 20mg tablets should be prescribed where doses can be divided into 5mg increments.

Blanket outpatient approval for paediatrics where the dose is not in 5mg increments.

FUROSEMIDE (FRUSEMIDE)

Injection

20mg & 250mg

Y

 

FUROSEMIDE (FRUSEMIDE)

Tablet

20mg, 40mg & 500mg

Y

 

GABAPENTIN

Capsule

100mg, 300mg, 400mg & 800mg

Y

Blanket outpatient approval for the treatment of neuropathic pain.

GANCICLOVIR

Injection

500mg

S

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

GEFITINIB

Tablet

250mg

R

Restricted to Haematology and Oncology for PBS listed indications.

GEMCITABINE

Injection

200mg, 1g, 2g

R

Restricted to Haematology and Oncology for PBS listed indications.

GENTAMICIN

Injection

80mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

GENTAMICIN

Eye drops

0.3% & 1.5% (1.5% manufactured)

R

Restricted to Ophthalmologist use only.

Blanket outpatient approval for treatment or prevention of ophthalmic infections.

GENTAMICIN/CITRATE

Syringe

10mg/31.3mg

Y

 

GLECAPREVIR/PIBRENTASVIR (Maviret®)

Tablets

100/40mg

S

Restricted to specialists working in the liver clinic running the HCV treatment program. For initiation in outpatients via the Highly specialised Drugs Program (Section 100). Refer to PBS Criteria.

GLICLAZIDE

Modified release tablets

30mg

Y

 

GLICLAZIDE

Modified release tablets

60mg

R

For discharge prescriptions only

GLICLAZIDE

Tablet

80mg

Y

 

GLIMEPIRIDE

Tablet

1mg, 2mg & 4mg

Y

 

GLUCAGON

Injection

1mg

Y

 

GLUCOSE

Injection

10%

Y

 

GLUCOSE

Injection

5% - 500mL & 1L

Y

 

GLUCOSE

Injection & mini-jet

50% - 50mL, 500mL

Y

Mini-jet is restricted to resuscitation room in the emergency department

GLUCOSE & SODIUM CHLORIDE

2.5%/0.45%, 4%/0.18%

500mL & 1L

Y

 

GLUCOSE & SODIUM CHLORIDE

5%/0.9%

1L

Y

 

GLUCOSE TOLERANCE TEST

Solution

75g

Y

 

GLYCEROL

Suppositories

700mg, 2.8g

Y

 

GLYCEROL BP

Solution

200mL

Y

 

GLYCERYL TRINITRATE

Sublingual Tablet

300mcg, 600mcg

Y

*300mcg added for short-term listing while 600mcg is out of stock.

GLYCERYL TRINITRATE

Ointment

0.20%

Y

 

GLYCERYL TRINITRATE

Spray

400mcg

Y

 

GLYCERYL TRINITRATE

Patch

5mg/24 hour & 10mg/24 hour

Y

 

GLYCERYL TRINITRATE

Injection

50mg

Y

 

GLYCINE

Irrigation

1.50%

Y

 

GLYCOPYRRONIUM BROMIDE (GLYCOPYRROLATE)

Injection

200mcg

Y

Blanket outpatient approval for Palliative care patients.

GOSERELIN

Implant

3.6mg, 10.8mg

R

Restricted to PBS listed indications AND for Ovarian Suppression with chemotherapy (3.6mg only).

Blanket approval for outpatient supply with PBS prescription.

GRAMICIDIN/NEOMYCIN/NYSTATIN/TRIAMCINOLONE ACETONIDE (Otocomb Otic®)

Ear Ointment

0.25mg/2.5mg/100,000 units/1mg/g

Y

 

GRANISETRON

Tablet

2mg

R

Restricted to Haematology and Oncology for PBS listed indications (outpatient/same day admission only).

GRISEOFULVIN

Tablet

125mg & 500mg

Y

 

HAEMOFILTRATION (CITRATE)

Solution

 

R

Restricted to ICU only

HAEMOFILTRATION LACTATE FREE

Solution

 

R

Restricted to ICU only

HAEMOPHILUS INFLUENZA B VACCINE

Injection

 

Y

 

HALOPERIDOL

Tablet

500mcg, 1.5mg & 5mg

Y

 

HALOPERIDOL

Injection

5mg

Y

Blanket outpatient approval for Palliative care patients.

HALOPERIDOL

Solution

10mg/5mL

Y

 

HALOPERIDOL DECANOATE

Injection

50mg

Y

 

HEPARIN SODIUM

Injection

5000units/0.2mL, 5000units/5mL, 25000units/5mL

Y

 

HEPARINISED SALINE

Injection

50units/5mL

Y

 

HEPARINOIDS (HEPARINOID CREAM)

Cream

0.3%

Y

 

HEPATITIS A VACCINE

Injection

 

Y

 

HEPATITIS A&B VACCINE

Injection

 

Y

 

HEPATITIS B VACCINE (ADULT)

Injection

 

Y

Available brands:

H-B-Vax II (Adult)® or Engerix B (Adult)®

HEPATITIS B VACCINE (PAEDIATRIC)

Injection

 

Y

Available brands:

H-B-Vax II (Paediatric)® or Engerix B (Paediatric)®

HEPATITIS B VACCINE (DIALYSIS FORMULATION)

Injection

 

Y

Available brands:

H-B-Vax II (Dialysis formulation)®

HEPATITIS B, Hib & POLIO (Infanrix-Hexa®)

Injection

 

Y

 

HEPATITIS-B VACCINE (DIALYSIS)

Injection

40mcg/mL

Y

 

HUMAN PAPILLOMAVIRUS (HPV) VACCINE

Injection

 

Y

 

HYALURONIDASE

Injection

15000 u

Y

 

HYDRALAZINE

Injection

20mg

Y

 

HYDRALAZINE

Tablet

25mg & 50mg

Y

 

HYDROCHLORIC ACID

Injection

2M

Y

 

HYDROCHLOROTHIAZIDE

Tablet

25mg

Y

 

HYDROCORTISONE

Ointment

1%

Y

 

HYDROCORTISONE

Cream

1%

Y

 

HYDROCORTISONE

Tablet

4mg & 20mg

Y

 

HYDROCORTISONE

Eye ointment

1%

Y

 

HYDROCORTISONE

Foam

10%

Y

 

HYDROCORTISONE SODIUM SUCCINATE

Injection

100mg

Y

Blanket approval for outpatient supply. Restricted to: Haematology/Oncology.

HYDROCORTISONE/ CLOTRIMAZOLE

Cream

1%

Y

 

HYDROGEN PEROXIDE

Solution

3%

Y

 

HYDROMORPHONE

Tablet

2mg, 4mg, 8mg

R

Restricted to Palliative Care, Rehabilitation and Pain teams only

HYDROMORPHONE

Modified Release Tablets

4mg, 16mg, 32mg & 64mg

R

Restricted to Palliative Care, Rehabilitation and Pain teams only

HYDROMORPHONE

Liquid

5mg/5mL

R

Restricted to Palliative Care, Rehabilitation and Pain teams only

HYDROMORPHONE

Injection

2mg, 10mg & 50mg

R

Restricted to Palliative Care, Rehabilitation and Pain teams only.

Blanket outpatient approval for chronic pain in palliative care patients.

HYDROXOCOBALAMIN

Injection

1000mcg

Y

Blanket approval for outpatient supply. Restricted to: Haematology/Oncology.

HYDROXYCHLOROQUINE

Tablet

200mg

Y

 

HYDROXYUREA

Capsule

500mg

Y

 

HYOSCINE BUTYLBROMIDE

Injection

20mg

Y

Blanket outpatient approval for Palliative care patients.

HYOSCINE BUTYLBROMIDE

Tablet

10mg

Y

 

HYOSCINE HYDROBROMIDE

Injection

400mcg

Y

Blanket outpatient approval for excess respiratory tract secretions.

HYOSCINE HYDROBROMIDE

Tablet

300mcg

R

For the treatment of hypersalivation restricted to inpatients who have clozapine induced sialorrhoea (CIS).

HYPROMELLOSE

Eye drop

0.50%

Y

 

HYPROMELLOSE/ CARBOMER GEL (Genteal®)

Eye drop

3mg/2mg

Y

 

IBUPROFEN

Injection

10mg

Y

 

IBUPROFEN

Tablet

200mg & 400mg

Y

 

IBUPROFEN

Syrup

100mg/5mL

Y

 

ICATIBANT ACETATE

Pre-filled Syringe

30mg/3mL

R

Restricted to Emergency Medicine consultants under the advice of the duty immunologist for the emergency treatment of:

  • Alteplase induced angioedema;
  • Severe angioedema affecting the airway due to ACE   inhibitors;
  • Symptomatic treatment of acute attacks of hereditary   angioedema in adults with C1 esterase inhibitor deficiency.

IDARUBICIN

Injection

5mg, 10mg

R

Restricted to Haematology and Oncology for PBS listed indications.

IDARUBICIN

Capsules

5mg, 10mg

R

Restricted to Haematology and Oncology for PBS listed indications AND for Myeloma.

IFOSFAMIDE

Injection

1gram, 2gram

R

Restricted to Haematology and Oncology for PBS listed indications.

ILOPROST

Injection

20mcg/2mL

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

INCREMIN IRON MIXTURE

Mixture

 

Y

 

INDAPAMIDE

Modified Release Tablets

1.5mg

Y

 

INDOMETHACIN

Capsule

25mg

Y

 

INDOMETHACIN

Injection

1mg

Y

 

INDOMETHACIN

Suppositories

100mg

Y

 

INFLIXIMAB

Injection

100mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

INFLUENZA VACCINE

Injection

60 microg/0.5mL

Y

 

INSULIN ASPART Injection (NovoRapid®)

Flexpen (3mL), Penfill (3mL) & Vial (10mL)

100 units/mL

Y

 

INSULIN ASPART PROTAMINE 70 units/mL + INSULIN ASPART 30 units/mL Injection (Novomix 30 ®)

Flexpen (3mL) & Penfill (3mL)

100 units/mL

Y

 

INSULIN ASPART 30 units/mL + INSULIN DEGLUDEC 70 units/mL injection (Ryzodeg® 70/30)

Flexpen (3mL) & Penfill (3mL)

100 units/mL

Y

 

INSULIN GLARGINE Injection (Lantus®/Optisulin®)

Penfill & Vial

100 units/mL

Y

 

INSULIN ISOPHANE Injection (Protaphane®)

Vial, Innolet, Novolet and Penfill

100 units/mL

Y

 

INSULIN ISOPHANE NPH Injection (Humulin NPH®)

Penfill

100 units/mL

R

To be used second line when other formulary insulin products are not suitable, or as continuing therapy for patients commenced in the community.

INSULIN LISPRO Injection (Humalog®)

Penfill,

Kwik Pen

100 units/mL

R

To be used second line when other formulary insulin products are not suitable, or as continuing therapy for patients commenced in the community.

INSULIN LISPRO 25 units/mL /INSULIN LISPRO PROTAMINE 75 units/mL Injection (Humalog 25®)

Flexpen (3mL) & Penfill (3mL)

100 units/mL

R

To be used second line when other formulary insulin products are not suitable, or as continuing therapy for patients commenced in the community.

INSULIN NEUTRAL (Actrapid®)

Penfill & Vial

100 units/mL

Y

 

INSULIN NEUTRAL/ ISOPHANE (Mixtard 30/70®)

Vial, Innolet & Penfill

100 units/mL

Y

 

IODINE/POTASSIUM IODIDE (Lugol’s®)

Solution (100mL)

5%/10% w/v

Y

 

IPILIMUMAB

Injection

213mg

R

For oncologist use only - restricted to patients eligible for compassionate supply programme.

IPILIMUMAB

Injection

50mg, 200mg

R

Restricted to Haematology and Oncology for PBS listed indications.

IPRATROPIUM

Inhaler

21microg

Y

 

IPRATROPIUM

nebulised solution

500microg

Y

 

IRBESARTAN

Tablet

75mg, 150mg & 300mg

Y

 

IRBESARTAN &HYDROCHLOROTHIAZIDE

Tablet

150/12.5mg & 300/12.5mg

Y

 

IRINOTECAN

Injection

40mg, 100mg, 500mg

R

Restricted to Haematology and Oncology for PBS listed indications.

IRON POLYMALTOSE

Injection

100mg

Y

 

ISOFLURANE

Liquid for inhalation

 

Y

 

ISONIAZID

Tablet

100mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

Blanket outpatient approval for the treatment of active or latent tuberculosis.

ISOPRENALINE

Injection

200mcg

Y

 

ISOPROPYL ALCOHOL BP

Solution

 

Y

 

ISOSORBIDE DINITRATE

Sublingual Tablet

5mg

Y

 

ISOSORBIDE MONONITRATE

Modified Release Tablets

60mg

Y

 

ITRACONAZOLE

Solution

50mg/5mL

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

ITRACONAZOLE (LOZANOC®)

Capsule

50mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

IVABRADINE

Tablet

5mg, 7.5mg

R

Restricted to Cardiologists for treatment of Chronic heart failure for patients that meet the PBS criteria.

Restricted to Cardiology for use in patients with a heart rate greater than 60 beats per minute prior to computed tomography coronary angiography (CTCA) when beta blockers and/or calcium channel blockers are contraindicated or insufficient.

IVERMECTIN

Tablet

3mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

KETAMINE

Injection

200mg

Y

 

KETAMINE

Wafer

25mg

R

Restricted to use by RDH Acute Pain Service (APS) as an analgesic agent for painful procedures on the ward.

KETOCONAZOLE

Shampoo

2%

Y

 

KETOROLAC

Injection

30mg

Y

 

KETOROLAC

Eye drop

0.50%

Y

 

KIDNEY PERFUSION

Infusion

 

R

Restricted for kidney harvesting

LABETALOL

Tablet

100mg

Y

 

LABETALOL

Injection

50mg/10mL

R

Restricted to ICU/OT for severe pre-eclampsia - refer to protocol on the PGC.

Restricted to ED/ICU for the management of hypertension in Stroke Thrombolysis or Pulmonary Embolism thrombolysis – refer to protocols on the PGC.

LACTASE

Drops

 

Y

 

LACTULOSE

Syrup

 

Y

 

LAMIVUDINE

Solution

10mg/mL

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

LAMIVUDINE

Tablet

100mg, 150mg & 300mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

LAMIVUDINE + ZIDOVUDINE

Tablet

150/300mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

LAMOTRIGINE

Tablet

5mg, 25mg, 50mg & 100mg

Y

 

LANOLIN BP

Ointment

5gram

Y

 

LANREOTIDE

Injection

60mg & 90mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

LANTHANUM

Tablet

500mg, 750mg and 1g

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

LATANOPROST

Eye drop

50mcg

Y

 

LENALIDOMIDE

Capsule

5mg, 10mg, 15mg, 25mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

LETROZOLE

Tablet

2.5mg

R

Restricted to Haematology and Oncology

LEUCOVORIN

Tablet

15mg

R

Restricted to Haematology and Oncology for PBS listed indications.

LEUCOVORIN

Injection

50mg, 100mg, 300mg, 1gram

R

Restricted to Haematology and Oncology for PBS listed indications.

LEVAMISOLE

Tablets

50mg

R

Blanket outpatient/inpatient approval. Restricted to Paediatric nephrologists.

This is a Special Access Scheme (SAS) Product. Please complete appropriate SAS form which can be located on the PGC.

LEVETIRACETAM

Injection

500mg/5mL

Y

 

LEVETIRACETAM

Solution

500mg/5mL

Y

 

LEVETIRACETAM

Tablet

250mg, 500mg & 1000mg

Y

 

LEVOBUPIVACAINE

Injection

50mg

Y

 

LEVODOPA/ CARBIDOPA MONOHYDRATE (Kinson® or Sinemet®)

Tablet

100/25mg & 250/25mg

Y

 

LEVODOPA/BENSERAZIDE (Madopar®)

Tablet

100/25mg

Y

 

LEVODOPA/BENSERAZIDE (Madopar®)

Capsule

100mg/25mg & 200mg/50mg

Y

 

LEVODOPA/BENSERAZIDE(Madopar® HBS)

Controlled Release Capsules

100/25mg

Y

 

LEVODOPA/CARBIDOPA MONOHYDRATE (Sinemet CR®)

Controlled Release Tablets

200/50mg

Y

 

LEVOFLOXACIN

Tablets

500mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

This is a Special Access Scheme (SAS) Product. Please complete appropriate SAS form which can be located on the PGC

Blanket outpatient/inpatient approval for the treatment of Helicobacter pylori (H. pylori) infection following documented treatment failure with a clarithromycin based regimen; or, for primary treatment of H. pylori infection in a patient who cannot tolerate clarithromycin (due to drug allergy or unavoidable drug interactions).

LEVOMEPROMAZINE

Injection

25mg/mL

R

This is a Special Access Scheme (SAS) Product. Please complete appropriate SAS form which can be located on the PGC.

Blanket outpatient/inpatient approval for intractable nausea and vomiting and second line sedative for delirium/agitation in palliative care patients.

LEVONORGESTREL

Tablet

1.5mg

Y

 

LEVONORGESTREL (Mirena®)

Intra-uterine system (IUS)

52mg

R

Restricted to O&G use for:

  • Inpatients where access to Mirena® insertion in primary care is not appropriate or not available.
  • Outpatients where supply cannot be accessed via the PBS.

All Mirena® will be supplied by hospital pharmacies on an individual patient basis.

LEVOSIMENDAN

Injection

12.5mg

R

Restricted to ICU - This is a Special Access Scheme (SAS) Product. Please complete appropriate SAS form which can be located on the PGC.

LEVOTHYROXINE SODIUM (THYROXINE) (Brands: Eutroxsig and Oroxine only)

Tablet

50mcg & 100mcg

Y

 

LEVOTHYROXINE

Injection

200mcg/mL

R

Restricted to Endocrinologists, Emergency Medicine and Intensive Care Specialists for the treatment of myxoedema coma and symptomatic hypothyroidism in patients unable to be treated effectively with oral medications

This is a Special Access Scheme (SAS) Product. Please complete appropriate SAS form which can be located on the PGC.

LIDOCAINE (LIGNOCAINE )/ ADRENALINE

Injection

1%/1:100,000, 2%/1:80,000, 2%/1:200,000

Y

 

LIDOCAINE (LIGNOCAINE)

Ointment

5%

Y

 

LIDOCAINE (LIGNOCAINE)

Injection

0.5%, 1% & 2% & 500mg

Y

 

LIDOCAINE (LIGNOCAINE)

Topical Solution

4%

Y

 

LIDOCAINE (LIGNOCAINE)

Jelly

2%

Y

 

LIDOCAINE (LIGNOCAINE)

Catheter Syringe

2%

Y

 

LIDOCAINE (LIGNOCAINE)

Spray

10%

Y

 

LIDOCAINE (LIGNOCAINE)

Oral Gel

2%

Y

 

LIDOCAINE (LIGNOCAINE) / GLUCOSE

Injection

0.4%/5%

Y

 

LIDOCAINE (LIGNOCAINE)/PRILOCAINE (Emla®)

Patch

2.5%/2.5%

Y

 

LIGNOCAINE/PHENYEPHRINE (Co-phenylcaine Forte®)

Nasal Spray

5%/0.5%

Y

 

LINAGLIPTIN

Tablet

5mg

Y

 

LINEZOLID

Infusion

600mg/300mL

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

LINEZOLID

Tablet

600mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

LINEZOLID

Suspension

100mg/5mL

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

LIOTHYRONINE

Injection

20mcg

R

This is a Special Access Scheme (SAS) Product. Please complete appropriate SAS form which can be located on the PGC.

LIOTHYRONINE

Tablet

20mcg

Y

 

LIPASE/AMYLASE/PROTEASE (Creon®)

Micro granules

5000 units

Y

 

LIPASE/AMYLASE/PROTEASE (Creon®)

Capsule

10,000 & 25,000 units

Y

 

LIPID EMULSION (SMOFlipid®)

Emulsion

20%

Y

Blanket approval for Renal outpatients

LIQUID PARAFFIN EMULSION (Parachoc®)

Emulsion

 

Y

 

LIQUID PARAFFIN LIGHT (Hamilton®)

Bath Oil

500mL

Y

 

LIRAGLUTIDE (Saxenda®)

Syringe

6mg/mL

R

Blanket outpatient approval for RDPH Weight Management Clinic

LITHIUM CARBONATE

Tablet

250mg

Y

 

LITHIUM CARBONATE

Modified Release Tablets

450mg

Y

 

LOPERAMIDE (Gastro-Stop®)

Capsule

2mg

Y

Blanket approval for outpatient supply. Restricted to: Haematology/Oncology.

LOPINAVIR& RITONAVIR

Tablet

200mg/50mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

Or

Restricted to the ASCOT or REMAP CAP Trial as prescribed by the infectious disease and ICU consultants.

LOPINAVIR& RITONAVIR

Liquid

80/20mg/mL

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

Or

Restricted to the ASCOT or REMAP CAP Trial as prescribed by the infectious disease and ICU consultants.

LORATADINE

Tablet

10mg

Y

 

LORAZEPAM

Tablet

1mg & 2.5mg

Y

 

LUBRICATING JELLY

Sachets or Tube

 

Y

 

MACITENTAN

Tablets

10mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

MACROGOL/POTASSIUM CHLORIDE/SODIUM BICARBONATE/SODIUM CHLORIDE LAXATIVE (Lax®)

Sachets

13.125g/46.6mg/178.5mg/350.7mg

Y

 

MAGNESIUM ASPARTATE TETRAHYDRATE

Tablet

500mg

Y

 

MAGNESIUM CHLORIDE

Injection

5mmol

Y

 

MAGNESIUM SULPHATE

Injection

2mmol & 10mmol

Y

 

MAGNESIUM SULPHATE CO (Magnoplasm®)

Paste

 

Y

 

MANNITOL

Injection

20%

Y

 

MEDIUM CHAIN TRIGLYCERIDE

Oil

 

Y

 

MEDIUM CHAIN TRIGLYCERIDES

Emulsion

 

Y

 

MEDROXYPROGESTERONE

Tablet

10mg & 100mg

Y

 

MEDROXYPROGESTERONE

Injection

150mg

Y

 

MEFLOQUINE

Tablet

250mg

Y

 

MELATONIN

Modified Release Tablet

2mg

Y

Restricted to Geriatrics, Rehabilitation and General medicine for inpatient use only for patients greater than 55 years of age with sleep disturbance, where other hypnotics are contraindicated (e.g. falls risk, dementia, behavioural disturbance), and non-pharmacological measures have been ineffective. For a maximum of 13 weeks.

MELPHALAN

Tablet

2mg

Y

Blanket approval for outpatient supply with PBS prescription. Restricted to: Haematology/Oncology.

MEMANTINE

Tablet

10mg

R

Restricted to patients who meet the PBS criteria

MENINGOCOCCAL ACWY VACCINE 4vMenCV

Injection

0.5mL

Y

Blanket approval for outpatient splenectomy patients.

MENINGOCOCCAL C VACCINE (NeisVac-C®)

Injection

 

Y

 

MENINGOCOCCAL MULTICOMPONENT GROUP B VACCINE (Bexsero®)

Injection

0.5mL

Y

Restricted for the vaccination of adult inpatients and outpatients with asplenia or complement component disorders.

MERCAPTOPURINE

Tablet

50mg

Y

 

MEROPENEM

Injection

500mg & 1g

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

MESALAZINE

Enteric Coated Tablet

250mg

Y

 

MESNA

Injection

400mg & 1g

R

Restricted to Haematology and Oncology for PBS listed indications.

MESNA

Tablets

400mg & 600mg

R

Restricted to Haematology and Oncology for the prevention of haemorrhagic cystitis with cyclophosphamide or ifosfamide.

METARAMINOL

Injection

10mg/mL

Y

METARAMINOL

Pre-filled syringe

2.5mg/5mL, 5mg/10mL

Y

Stocked syringes:

RDH, GDH, KH: 2.5mg/5mL

ASH: 5mg/10mL

METFORMIN

Tablet

500mg, 850mg & 1000mg

Y

 

METFORMIN MR

Modified Release Tablet

500mg & 1000mg

Y

 

METHADONE

Tablet

10mg

Y

 

METHADONE

Injection

10mg

Y

 

METHADONE

Syrup

5mg/mL

R

Restricted to Addiction medicine prescribers, Pain team and Palliative Care.

METHOTREXATE

Tablet

2.5mg & 10mg

Y

Blanket approval for outpatient supply with PBS prescription. Restricted to: Haematology/Oncology.

METHOTREXATE

Syringe

10mg, 12mg, 15mg, 20mg, 25mg, 50mg & 75mg

Y

 

METHOTREXATE

Injection

5mg, 50mg, 500mg, 1gram, 5gram

R

Restricted to Haematology and Oncology for PBS listed indications.

METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA

Injection

30mcg, 50mcg, 75mcg, 100mcg, 120mcg, 200mcg, 360mcg.

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

METHOXYFLURANE

Liquid for inhalation

3mL

R

Restricted to haematology use for analgesia during bone marrow biopsy procedure

METHYL SALICYLATE/EUCALYPTUS MENTHOL

Rub

 

Y

 

METHYLDOPA SESQUIHYDRATE

Tablet

250mg

Y

 

METHYLENE BLUE

Injection

1% (50mg)

Y

 

METHYLNALTREXONE

Injection

12mg

R

Palliative Care and ICU only for treatment of opioid-induced constipation in patients who have failed to respond to laxatives.

METHYLPHENIDATE

Tablet

10mg

R

Use in attention deficit hyperactivity disorder

METHYLPREDISOLONE ACETATE (Depo- Nisolone®)

Depot injection

40mg/mL

Y

 

METHYLPREDISOLONE ACETATE in FATTY OINTMENT

Ointment

0.1%

Y

 

METHYLPREDNISOLONE SODIUM SUCCINATE

Injection

1g & 40mg

Y

 

METOCLOPRAMIDE

Injection

10mg

Y

 

METOCLOPRAMIDE

Tablet

10mg

Y

Blanket approval for outpatient supply. Restricted to: Haematology/Oncology.

METOPROLOL

Modified Release Tablet

23.75mg, 47.5mg, 95mg & 190mg

Y

 

METOPROLOL

Tablet

50mg & 100mg

Y

 

METOPROLOL TARTRATE

Injection

1mg

Y

 

METRONIDAZOLE

Suspension

200mg/5mL

Y

 

METRONIDAZOLE

Suppositories

500mg

Y

 

METRONIDAZOLE

Tablet

200mg & 400mg

Y

 

METRONIDAZOLE

Infusion

500mg

Y

 

MICONAZOLE

Oral gel

2%

Y

 

MIDAZOLAM

Injection

5mg/mL, 5mg/5mL, 15mg/3mL & 50mg/10mL

Y

Blanket outpatient approval for epilepsy in paediatric patients (5mg/mL plastic ampoules).

Blanket outpatient approval for palliative care patients for various indications.

MIDODRINE

Tablet

2.5mg, 5mg

R

Blanket outpatient approval for management of symptomatic hypotension (including orthostatic and intradialytic) where non-pharmacological management has failed, restricted to medical and renal physicians.

MIFEPRISTONE

Tablet

200mg

Y

Restricted to Obstetrics & Gynaecology specialists for the medical termination of pregnancy beyond the first trimester up to 22 completed weeks gestation and beyond 22 weeks for foetal death in utero only. Prescribers and dispensing pharmacists must be registered and certified with MS Health via: https://www.ms2step.com.au/

MIFEPRISTONE/ MISOPROSTOL (MS 2 STEP®)

Tablet

200mg/200mcg

Y

Restricted to Katherine Hospital only, for medical termination of an intrauterine pregnancy (MTOP) up to 63 days gestation (PBS indications).

MS2Step can be accessed in community pharmacies in other areas of the NT.

MILRINONE

Injection

10mg/10mL

R

Restricted to ICU and CCU

MINOCYCLINE

Tablet

50mg

Y

 

MINOXIDIL

Tablet

10mg

Y

 

MIRTAZAPINE

Orally disintegrating tablet & tablets

15mg, 30mg & 45mg

Y

 

MISOPROSTOL

Tablet

200mcg

Y

 

MITOMYCIN

Eye drop

0.02%

R

Restricted to Ophthalmologist use only

MITOMYCIN

Bladder instillation Syringe

40mg

R

Restricted to Urologist

MITOMYCIN

Injection

 

R

0.02% & 0.05% for Ophthalmologist use.

Oncologist use for treatment of Anal Cancer.

MITOZANTRONE

Injection

20mg/10mL, 25mg/12.5mL

R

Restricted to Haematology and Oncology for PBS listed indications.

MIVACURIUM

Injection

20mg/10mL

Y

 

MMR VACCINE

Injection

 

Y

 

MOMETASONE FUROATE

Nasal Spray

50mcg

Y

 

MOMETASONE FUROATE

Lotion

1%

Y

 

MONKEYPOX (Jynneos®) VACCINE

  

R

Stock via National Medicines Stockpile (NMS).

MONKEYPOX VIRUS TREATMENTS

  

R

Restricted for use by Infectious Diseases and/or Sexual Health physicians.

Stock via National Medicines Stockpile (NMS).

Approved treatments are Tecovirimat 200mg capsules (Tpoxx®), Vaccinia Immunoglobulin (VIG) ≥50,000 units/15mL and Cidofovir 375mg/5mL injection vials (Empovir®).

MORPHINE HCl MIXTURE

Mixture

1mg/mL & 5mg/mL

Y

 

MORPHINE INTRATHECAL

Injection

200microgram/mL

R

Restricted for use by anaesthetics for patients requiring spinal anaesthetic undergoing a caesarean section or as an adjunct analgesia for patients undergoing major surgery

MORPHINE SULFATE

Injection

10mg & 30mg

Y

Blanket outpatient approval for Palliative care patients.

MORPHINE SULFATE (Kapanol®)

Capsule

10mg, 20mg, 50mg & 100mg

Y

 

MORPHINE SULPHATE (MS Contin®) SLOW RELEASE

Slow Release Tablets

5mg, 10mg, 30mg, 60mg & 100mg

Y

 

MORPHINE TATRATE

Injection

120mg

R

Restricted to palliative care and pain team

Blanket outpatient approval for Palliative care patients.

MOXIFLOXACIN

Tablet & Injection

400mg & 400mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

MOXONIDINE

Tablet

200mcg

Y

 

MULTI-B VITAMINS (Cenovis Mega-B®)

Tablet

 

Y

 

MULTIVITAMIN & MINERALS (Cenovis®)

Tablets

 

Y

 

MULTIVITAMIN (CERNEVIT)

Injection

 

Y

 

MULTIVITAMIN (Pentavite Infant®)

Infant drops

 

Y

 

MULTIVITAMIN WITH IRON (Pentavite®)

Syrup

 

Y

 

MULTIVITAMINS PLUS ZINC (VitABDECK®)

Capsule

 

R

Vitamin for Cystic Fibrosis patients.

Blanket outpatient approval as a vitamin for Cystic Fibrosis patients.

MUPIROCIN

Ointment & Nasal Ointment

2%

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

MYCOPHENOLATE MOFETIL

Capsule

250mg & 500mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

Formulary for renal transplant use

MYCOPHENOLATE MOFETIL

Injection

500mg

Y

 

MYCOPHENOLATE SODIUM

(MYFORTIC®)

Tablet

180mg & 360mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

Restricted for use in Lupus Nephritis HSD indications only. The capsules are the formulary mycophenolate option for renal transplant indications.

NALOXONE

Injection

400mcg

Y

 

NALOXONE

Nasal Spray

1.8mg

R

Restricted to Alcohol and Other Drug (AOD) prescribers for Opioid Pharmacotherapy (OPP) patients

NALTREXONE

Tablet

50mg

R

Restricted to Addiction Medicine prescribers for use as an adjunct for the treatment of alcohol dependence.

NAPHAZOLINE/ PHEIRAMINE (Naphcon-A®)

Eye drop

0.025%/0.3%

Y

 

NAPROXEN

Tablet

250mg

Y

 

NAPROXEN

Modified Release Tablet

1g

Y

 

NATALIZUMAB

Injection

300mg/15mL

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

NATAMYCIN

Eye drop

5%

Y

This is a Special Access Scheme (SAS) Product. Please complete appropriate SAS form which can be located on the PGC.

NEISSERIA MENINGITIDIS/HAEMOPHILUS INFLUENZAE TYPE B (HIB) (Menitorix®)

Injection

5microg/5microg

Y

 

NEOSTIGMINE

Injection

500mcg & 2.5mg

Y

 

NETUPITANT/PALONOSETRON

Capsules

300mcg/500mcg

R

Restricted to Haematology and Oncology for PBS listed indications.

NEVIRAPINE

Tablet

200mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

NEVIRAPINE MODIFIED RELEASE

Tablet

400mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

NICORANDIL

Tablet

10mg & 20mg

Y

 

NICOTINE

Inhaler

15mg

Y

 

NICOTINE

Patch

7mg, 14mg & 21mg

Y

 

NICOTINE

Gum

2mg & 4mg

Y

 

NICOTINE

Oral Strips

2.5mg

R

Restricted to Remote Health

NIFEDIPINE

Tablet

10mg & 20mg

Y

 

NIFEDIPINE MR

Modified Release Tablet

30mg & 60mg

Y

 

NIMODIPINE

Injection

10mg

Y

 

NIMODIPINE

Tablet

30mg

Y

 

NITAZOXANIDE

Suspension

100mg/5mL

Y

 

NITRIC OXIDE

Inhalation

800ppm

Y

 

NITROFURANTOIN

Capsule

50mg & 100mg

Y

 

NIVOLUMAB

Infusion

Variable

R

Restricted to Medical Oncologists for use in patients enrolled in the Nivolumab Extended Access Program.

NORADRENALINE

Injection

2mg

Y

 

NORETHISTERONE

Tablet

5mg

Y

 

NORFLOXACIN

Tablet

400mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

NYSTATIN

Capsules

500 000 units

Y

 

NYSTATIN

Oral drops

100 000 units

Y

 

OCTREOTIDE

Depot Injection

10mg, 20mg & 30mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

OCTREOTIDE

Injection

50mcg, 100mcg & 500mg

Y

 

OFLOXACIN

Eye drop

3mg

R

Restricted to Ophthalmologist use only

OLANZAPINE

Tablet

2.5mg, 5mg & 10mg

Y

 

OLANZAPINE

Injection

10mg

R

Restricted to Mental Health & ED

OLANZAPINE (Zyprexa Zydis®)

Wafers

5mg, 10mg. 15mg & 20mg

Y

 

OLANZAPINE PAMOATE (Zyprexa Relprevv®)

Long Acting Injection

210mg, 300mg, 405mg

R

Restricted to Mental Health

OLIVE OIL

Liquid

 

Y

 

OMEPRAZOLE

Solution

2mg/mL

Y

Manufactured at RDH.

Blanket outpatient approval for administration via NG/PEG tube in paediatric patients.

OMEPRAZOLE

Injection

40mg

Y

Pantoprazole is first line therapy

OMEPRAZOLE

Tablet

10mg & 20mg

Y

Pantoprazole is first line therapy

ONDANSETRON

Injection

4mg & 8mg

Y

 

ONDANSETRON

Wafers

4mg & 8mg

Y

 

OPSITE SPRAY DRESSING

Spray

 

Y

 

ORABASE (CARMELLOSE/ PECTIN/ GELATIN)

Paste

 

Y

 

ORAL REHYDRATION SALTS SOLUTION

Sachets

Ice Blocks

 

Y

 

OSELTAMIVIR

Liquid

6mg/mL

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

OSELTAMIVIR (Tamiflu®)

Capsule

30mg & 75mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

OXALIPLATIN

Injection

50mg, 100mg, 200mg

R

Restricted to Haematology and Oncology for PBS listed indications.

OXAZEPAM

Tablet

15mg & 30mg

Y

 

OXYBUPROCAINE

Minims

0.40%

Y

 

OXYBUTYNIN

Tablet

5mg

Y

 

OXYCODONE

Suppositories

30mg

Y

For use by GDH only

OXYCODONE

Liquid

5mg/5mL

Y

 

OXYCODONE (Endone®)

Tablet

5mg

Y

 

OXYCODONE (Oxycontin SR ®)

Slow Release Tablets

10mg, 15mg 20mg, 30mg, 40mg & 80mg

Y

NB: Not all strengths are stocked at all sites

OXYCODONE (Oxynorm®)

Capsule

10mg & 20mg

Y

 

OXYCODONE HYDROCHLORIDE/NALOXONE HYDROCHLORIDE DIHYDRATE (Targin®)

Tablet

5/2.5mg, 10/5mg, 20/10mg, 40/20mg

R

Restricted to chronic pain when opioid-induced constipation is refractory to optimised regular laxatives

OXYCODONE (Oxynorm®)

Intravenous

50mg/mL

R

Restricted to Acute Pain Service/Anaesthetics for Patient Controlled Analgesia (PCA)

OXYMETAZOLINE

Nasal Spray

0.05%

Y

 

OXYTOCIN

Injection

10units

Y

 

PACLITAXEL

Injection

30mg, 100mg, 150mg, 300mg

R

Restricted to Haematology and Oncology for PBS listed indications AND advanced or recurrent endometrial cancer, AND as neoadjuvant upper GI with RT.

PACLITAXEL NANOPARTICLE ALBUMIN BOUND

Injection

100mg

R

Restricted to Haematology and Oncology for PBS listed indications.

PALACOS R BONE CEMENT with GENTAMICIN

Cement

 

Y

 

PALIPERIDONE

Modified Release Tablet

3mg, 6mg & 9mg

R

Restricted to Mental Health

PALIPERIDONE PALMITATE 1 MONTHLY

Depot injection

25mg, 50mg, 75mg, 100mg & 150mg

R

Restricted to Mental Health

PALIPERIDONE PALMITATE 3 MONTHLY

Depot injection

175mg, 263mg, 350mg, 525mg

R

Restricted to Mental Health.

For initiation in the outpatient setting only in patients who meet PBS criteria.

PALONOSETRON

Injection

250mcg/5mL

R

Restricted to Haematology and Oncology for prevention of nausea and vomiting induced by moderately emetogenic chemotherapy protocols.

PAMIDRONATE DISODIUM

Injection

15mg & 90mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

PANCURONIUM

Injection

4mg

Y

 

PANITUMUMAB

Injection

100mg/5mL, 400mg/20mL

R

Restricted to Haematology and Oncology for PBS listed indications.

PANTHENOL/BENZALKONIUM CHLORIDE (BEPANTHEN®)

Cream

5%/0.05%

Y

 

PANTOPRAZOLE

Tablet

20mg & 40mg

Y

 

PANTOPRAZOLE

Injection

40mg

Y

 

PAPAVERINE

Injection

120mg

Y

 

PARACETAMOL

Tablet

500mg

Y

Blanket approval for outpatient supply. Restricted to: Haematology/Oncology.

PARACETAMOL

Suppositories

125mg, 250mg & 500mg

Y

 

PARACETAMOL

Drops & Elixir

100mg/mL & 240mg/5mL

Y

 

PARACETAMOL

Soluble Tablet

500mg

Y

 

PARACETAMOL

Injection

1000mg

R

Restricted for post-surgery and patients unable to tolerate oral or rectal route

PARACETAMOL & CODEINE

Tablet

500mg/30mg

Y

 

PARACETAMOL MR

Modified Release Tablet

665mg

R

Restricted to Palliative Care & Remote Health

PARAFFIN CO

Eye ointment

3.5g

Y

 

PARAFFIN EMULSION (Parachoc®)

Oral Liquid

2.5mL/5mL

Y

 

PARAFFIN STERILE

Sterile Liquid

5g

Y

 

PARAFFIN WHITE SOFT

Cream

10g (sterile), 50g & 500g

Y

 

PARAFFIN WHITE SOFT & LIQUID PARAFFIN

Ointment

50%/50%

Y

 

PARALDEHYDE

Injection

 

Y

NB: Not stocked at all sites. May need to be ordered on a case by case basis.

PARECOXIB SODIUM

Injection

40mg

R

Restricted to Pain team and ICU

PATENT BLUE VIOLET 2.5%

Pre-Filled Syringe

2.50%

Y

 

PAW-PAW OINTMENT

Ointment

 

Y

 

PAZOPANIB

Tablet

200mg, 400mg

R

Restricted to Haematology and Oncology for PBS listed indications.

PEGFILGRASTIM (RISTEMPA®)

Injection

6mg/0.6mL

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

PEMETREXED

Injection

100mg, 500mg

R

Restricted to Haematology and Oncology for PBS listed indications.

PENTAMIDINE

Injection

300mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

Restricted to haematology/oncology patients and others under the management /recommendation of IFD

PEPPERMINT

Lip Balm

20g

R

Restricted to Palliative Care only

PERHEXILINE

Tablet

100mg

Y

 

PERINDOPRIL

Tablet

2.5mg, 5mg & 10mg

Y

 

PERINDOPRIL ARGININE & INDAPAMIDE

Tablet

5mg/1.25mg

Y

 

PERMETHRIN

Cream

5%

Y

 

PHENTERMINE

Tablet

15mg

R

Blanket outpatient approval for RDPH Weight Management Clinic

PHENTOLAMINE MESYLATE

Injection

5mg

R

Restricted to Emergency Department for the treatment of dermal necrosis and sloughing following intravenous administration or extravasation of noradrenaline or adrenaline.

This is a Special Access Scheme (SAS) Product. Please complete appropriate SAS form which can be located on the PGC.

PHENOBARBITAL (PHENOBARBITONE)

Injection

200mg

Y

 

PHENOBARBITAL (PHENOBARBITONE)

Tablet

30mg

Y

 

PHENOBARBITAL (PHENOBARBITONE)

Syrup

15mg/5mL

Y

 

PHENOXYMETHYLPENICILLIN

Capsule

250mg & 500mg

Y

 

PHENOXYMETHYLPENICILLIN (PENICILLIN V)

Suspension

150mg/5mL

Y

 

PHENYLEPHRINE

Minims

2.5% & 10%

Y

 

PHENYTOIN

Injection

100mg & 250mg

Y

 

PHENYTOIN

Chewable tablets

50mg

Y

 

PHENYTOIN

Capsule

30mg & 100mg

Y

 

PHENYTOIN

Suspension

30mg/5mL

Y

 

PHOLCODINE

Linctus

5mg/5mL

Y

 

PHOSPHATE (Fleet®)

Enema

133mL

Y

 

PHOSPHATE, SODIUM ACID (Phosphate Sandoz®)

Effervescent Tablet

500mg

Y

 

PHYSOSTIGMINE

Injection

2mg

Y

 

PHYTOMENADIONE (Vitamin K®)

Injection

2mg & 10mg

Y

Blanket outpatient approval.

PILOCARPINE

Minims

2%

R

Restricted to eye department

PILOCARPINE (with preservative)

Eye drop

1%, 2% & 4%

Y

 

PIMECROLIMUS

Cream

1%

R

For patients who fail to hydrocortisone 1% cream/ointment.

PIPERACILLIN & TAZOBACTAM

Infusor

Variable

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

PIPERACILLIN & TAZOBACTAM

Injection

4g/0.5g

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

PIROXICAM

Capsule

10mg

Y

 

PLASMA-LYTE 148 in WATER

IV fluid

 

Y

 

PLASMA-LYTE 148 with Dextrose 5%

IV fluid

 

R

Restricted to use in PRoMPT Trial (Paediatrics)

PNEUMOCOCCAL 13-VALENT CONJUGATE VACCINE (Paediatric)

Injection

 

Y

 

PNEUMOCOCCAL VACCINE 23 VALENT (Adult)

Injection

 

Y

 

PODOPHYLLOTOXIN

Solution

0.50%

Y

 

PODOPHYLLOTOXIN

Cream

0.15%

Y

 

POLIOMYELITIS VACCINE (Ipol®)

Injection

 

Y

 

POLOXAMER

Drops

100mg/mL

Y

 

POLYVINYL ALCOHOL

Eye drops

1.40%

Y

 

PORACTANT

Suspension for intratracheal administration

240mg/3mL

Y

 

POSACONAZOLE

Modified Release Tablet & Oral Suspension

100mg & 40mg/mL (105mL)

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

Blanket outpatient approval for PBS listed indications, restricted to Haematology and Oncology/ Infectious Diseases.

POSACONAZOLE

Injection

300mg/16.7mL

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

POTASSIUM ACETATE

Injection

25mmol

Y

 

POTASSIUM CHLORIDE

Effervescent tablets

14mmol

Y

 

POTASSIUM CHLORIDE

Injection

10mmol/10mL

Y

 

POTASSIUM CHLORIDE

Modified Release Tablet

600mg

Y

 

POTASSIUM CHLORIDE FOR DIALYSIS

Solution

26.1%w/v

Y

 

POTASSIUM CHLORIDE in GLUCOSE

IV fluid

10mmol/10% in 500mL

Y

 

POTASSIUM CHLORIDE in SODIUM CHLORIDE

IV fluid

10mmol/0.26% in 100mL, 20mmol/0.9% in 1000mL, 30mmol/0.9% in 100mL, 40mmol/0/58% in 1000mL

Y

 

POTASSIUM CHLORIDE in SODIUM LACTATE COMPOUND

IV fluid

30mmol in 1L

Y

 

POTASSIUM CHLORIDE/SODIUM CHLORIDE AND GLUCOSE

IV fluid

10mmol/018%/4% in 500mL, 20mmol/0.18%/4% in 1L

Y

 

POTASSIUM DIHYDROGEN PHOSPHATE

Injection

10mmol/10mL

R

ICU only

POTASSIUM PERMANGANATE

Crystals

 

Y

 

POVIDONE IODINE

Solution

7.50%

Y

 

POVIDONE IODINE

Scrub Brush

 

Y

 

POVIDONE IODINE

Ointment Sachets

10%

Y

 

POVIDONE IODINE (100mL)

Solution

10%

Y

 

POVIDONE IODINE ALCOHOLIC

Skin Preparation

 

Y

 

PRALIDOXIME IODIDE

Injection

500mg

Y

 

PRAMIPEXOLE

Tablet

180mcg & 250mcg

R

Restricted to remote patients with Machado Joseph Disease

PRAZIQUANTEL

Tablet

600mg

Y

Blanket approval for outpatient supply. Restricted to the treatment of Hymenolepsis nana (dwarf tape worm) infection.

PRAZOSIN

Tablet

1mg, 2mg & 5mg

Y

 

PREDNISOLONE

Tablet

1mg, 5mg & 25mg

Y

Blanket approval for outpatient supply. Restricted to: Haematology/Oncology.

PREDNISOLONE

Suspension

25mg/5mL

Y

 

PREDNISOLONE & PHENYLEPHRINE (PREDNEFRIN FORTE EYE®)

Eye drops

1%/0.12%

Y

 

PREDNISOLONE ENEMA

Enema

0.2mg/mL

Y

 

PREDNISOLONE SODIUM PHOSPHATE

Eye drop minims

0.5%

R

Restricted to use by ophthalmology.

Blanket outpatient approval for patients with allergy to preservatives in prednisolone containing eye drops or for patients where prednisolone as a single ingredient is required.

PREGABALIN

Capsule

25mg, 75mg & 150mg

R

Blanket outpatient approval for neuropathic pain for patients with fibromyalgia syndrome only. Prescriber to annotate script as “fibromyalgia syndrome/non-PBS indication”.

PREGNANCY TEST

Strip

 

Y

 

PRILOCAINE

Injection

0.50%

Y

 

PRIMAQUINE

Tablet

7.5mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

Blanket outpatient approval for prevention or relapse of malaria or treatment of Pneumocystis carinii pneumonia (PCP).

PRIMIDONE

Tablet

250mg

Y

 

PROBENECID

Tablet

500mg

Y

 

PROCAINE BENZYLPENICILLIN

Injection

1.5g

Y

 

PROCARBAZINE

Capsule

50mg

R

Restricted to Haematology and Oncology for BEACOPP (Hodgkin Lymphoma) AND PCV (Neuro).

PROCHLORPERAZINE

Injection

12.5mg/5mL

Y

 

PROCHLORPERAZINE

Tablet

5mg

Y

 

PROGESTERONE

Pessaries

200mg

R

Restricted to O&G for PBS listed indications.

PROMETHAZINE

Elixir

1mg/mL

Y

 

PROMETHAZINE

Tablet

10mg & 25mg

Y

 

PROMETHAZINE

Injection

50mg

R

Restricted to haematology/oncology patients on chemotherapy requiring hypersensitivity reaction rescue AND remote primary health care for indications outlined in CARPA

PROPANTHELINE

Tablet

15mg

Y

 

PROPOFOL

Injection

200mg & 500mg

Y

 

PROPRANOLOL

Suspension

10mg/5mL

Y

 

PROPRANOLOL

Tablet

10mg, 40mg & 160mg

Y

 

PROPYLENE GLYCOL

Solution

 

Y

 

PROPYLTHIOURACIL

Tablet

50mg

Y

 

PROTAMINE SULPHATE

Injection

50mg/5mL

Y

 

PSEUDOEPHEDRINE

Tablet

60mg

Y

 

PYRANTEL

Tablet

125mg

Y

 

PYRAZINAMIDE

Tablet

500mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

Blanket outpatient approval for the treatment of tuberculosis.

PYRIDOSTIGMINE

Tablet

10mg & 60mg

Y

 

PYRIDOXINE

Tablet

25mg

Y

Blanket outpatient approval for the prevention of isoniazid-induced peripheral neuropathy.

PYRIMETHAMINE

Tablet

25mg

Y

 

QUETIAPINE

Tablet

25mg, 100mg, 200mg & 300mg

Y

 

QUETIAPINE

Modified Release Tablet

50mg, 200mg & 300mg

Y

 

RABIES VACCINE

Injection

 

Y

 

RALTEGRAVIR

Tablet

400mg

600mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

RALTITREXED

Injection

2mg

R

Restricted to Haematology and Oncology for PBS listed indications.

RAMIPRIL

Tablet & capsules

1.25mg, 2.5mg, 5mg & 10mg

Y

 

RANIBIZUMAB

Injection

2.3mg & 3mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

RASBURICASE

Injection

1.5mg/1mL

R

Restricted to use in Haematology and Oncology for the treatment of acute hyperuricaemia of presumed or confirmed tumour lysis syndrome, in accordance with approved guidelines.

REMDESIVIR

Injection

100mg

R

Restricted to prescribing by ICU and IFD Physicians for COVID – 19 Patients on ICU and 4B who are 12 years or older and weigh at least 40kg with pneumonia and requiring supplemental oxygenation.

REMIFENTANIL

Injection

1mg & 5mg

Y

 

Reteplase

Injection

10 units

Y

Short-term listing for thrombolysis in acute STEMI while tenecteplase is out of stock.

RIBAVIRIN (Ibavyr®)

Tablet

200mg

S

Restricted to specialists working in the liver clinic running the HCV treatment program. For initiation in outpatients via the Highly specialised Drugs Program (Section 100). Refer to PBS Criteria.

RIFABUTIN

Capsule

150mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

RIFAMPICIN

Syrup

100mg/5mL

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

Blanket outpatient approval for susceptible infections not listed on the PBS approved by Infectious Diseases.

RIFAMPICIN

Injection

600mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

RIFAMPICIN

Capsule

150mg & 300mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

Blanket outpatient approval for susceptible infections not listed on the PBS approved by Infectious Diseases.

RIFAXIMIN

Tablet

550mg

Y

Restricted to PBS indications.

RILPIVIRINE

Tablet

25mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

RISPERIDONE

Solution

5mg/5mL

Y

 

RISPERIDONE

Tablet

0.5mg, 1mg 2mg, 3mg & 4mg

Y

 

RISPERIDONE (CONSTA®)

Depot Injection

25mg, 37.5mg & 50mg

R

Restricted to Mental Health for continuing treatment in patients already stabilised on Risperidone depot, or initial treatment in patients where paliperidone depot is unsuitable or not tolerated.

RITONAVIR

Solution

600mg/7.5mL

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

RITONAVIR

Tablet

100mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

RITUXIMAB

Injection

100mg/10mL, 500mg/50mL

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

RITUXIMAB

Infusion

 

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

RIVAROXABAN

Tablets

10mg,15mg & 20mg

R

Restricted to PBS indications.

ROCURONIUM

Injection

50mg

Y

 

ROPIVACAINE

Injection

75mg/10mL

Y

Other strengths are available on request.

ROSUVASTATIN

Tablets

5mg, 10mg, 20mg & 40mg

Y

 

ROTAVIRUS ORAL VACCINE

Oral Solution

 

Y

 

ROXITHROMYCIN

Tablet

150mg

Y

 

SACUBITRIL WITH VALSARTAN

Tablet

24mg/26mg, 49mg/51mg, 97mg/103mg

Y

Restricted to PBS indications.

SALBUTAMOL

Injection

500mcg

Y

 

SALBUTAMOL

Nebuliser

2.5mg & 5mg

Y

 

SALBUTAMOL

Inhaler

100mcg

Y

 

SALICYLIC ACID / COAL TAR in AQUEOUS CREAM

Cream

6%/6%

Y

 

SALICYLIC ACID/ LACTIC ACID

Paint

16.70%

Y

 

SALINE LAXATIVE (Fleet®) FLEET

Mixture & Enema

 

Y

 

SALIVA ARTIFICIAL

Solution

 

Y

 

SEMAGLUTIDE

Syringe

1.34mg/mL (1.5mL & 3mL)

R

Restricted to PBS indications.

SENNA

Tablets

7.5mg

Y

 

SERTRALINE

Tablets

50mg & 100mg

Y

 

SEVELAMER

Tablets

800mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

SEVOFLURANE

Liquid for inhalation

 

Y

 

SILDENAFIL

Injection

10mg/12.5ml

R

Restricted to ICU use only for patients with pulmonary arterial hypertension.

SILDENAFIL

Tablets

20mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

SILVER NITRATE/POTASSIUM NITRATE

Pencil & Sticks

427.5mg/22.5mg

Y

 

SILVER SULPHADIAZINE

Cream

1%

Y

 

SIMETHICONE

Drops

100mg/mL

Y

 

SIMETHICONE

Liquid

120mg/mL

Y

*For short-term listing while drops are out of stock

SIMVASTATIN

Tablet

10mg, 20mg 40mg & 80mg

Y

 

SIROLIMUS

Tablet

0.5mg, 1mg, 2mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

SITAGLIPTIN

Tablet

25mg, 50mg, 100mg

Y

 

SOAP ENEMA

Enema

5%

Y

 

SODA LIME (Medisorb®)

Prepacked Canister

 

Y

 

SODIUM BENZOATE

Injection

2g/10mL

R

Restricted to Paediatricians under the advice of a Metabolic Specialist for the emergency treatment of hyperammonaemia in urea cycle defects.

This is a Special Access Scheme (SAS) Product. Please complete appropriate SAS form which can be located on the PGC.

SODIUM BICARBONATE

Capsule

840mg

Y

 

SODIUM BICARBONATE

Injection & Mini-jet

100mmol

Y

Mini-jet is restricted to resuscitation room in the emergency department

SODIUM CHLORIDE

Tablets

600mg

Y

 

SODIUM CHLORIDE

Injection

0.9%/5% (1L)

Y

 

SODIUM CHLORIDE

Eye Drops

5%

R

This is a Special Access Scheme (SAS) Product. Please complete appropriate SAS form which can be located on the PGC.

Blanket outpatient approval for corneal oedema.

SODIUM CHLORIDE

Injection

0.45% (500mL), 0.9% (10mL, 20mL, 50mL, 100mL, 250mL, 500mL, 1L & 2L), 3% (1L), 23.4% (10mL),

Y

 

SODIUM CHLORIDE, SODIUM BICARBONATE, POTASSIUM CHLORIDE, GLUCOSE ANHYDROUS, CALCIUM LACTATE PENTAHYDRATE (Flo®)

Nasal Sachets/ Irrigation kit

 

R

Restricted to ENT and Radiation Oncology

SODIUM CHONDROITIN SULPHATE/SODIUM HYALURONATE (Viscoat®)

Eye Irrigation

40mg/30mg/mL

Y

 

SODIUM CITRATE

Solution

8.80%

Y

 

SODIUM CITRATE/ SODIUM LAURYL SULFOACETATE (Microlax®)

Enema

90mg/9mg/mL

Y

 

SODIUM CITRO-TARTRATE

Sachets

 

Y

 

SODIUM CROMOGLYCATE

Eye Drops

2%

Y

 

SODIUM DIHYDROGEN PHOSPHATE

Injection

10mmol/10mL

Y

FUSIDIC ACID HEMIHYDRATE

Tablet

250mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

Blanket outpatient approval for susceptible infections not listed on the PBS approved by Infectious Diseases.

SODIUM HYALURONATE (Provisc®)

Intraocular Injection

8.5mg/0.85mL

Y

 

SODIUM LACTATE CO (Hartmann’s®)

IV fluid

 

Y

 

SODIUM NITROPRUSSIDE

Injection

50mg

Y

 

SODIUM PICOSULFATE, MAGNESIUM OXIDE & CITRIC ACID (Picoprep®)

Sachets

 

Y

 

SODIUM POLYSTYRENE SULFONATE (Resonium A®)

Powder

454g

Y

 

SODIUM SULFATE DECAHYDRATE / MACROGOL/ ELECTROLYTES (COLONLYTELY®)

Sachets

 

Y

 

SODIUM TETRADECYL SULPHATE

Injection

3%

Y

 

SODIUM THIOSULFATE

Injection

25g/100mL

R

This is a Special Access Scheme (SAS) Product. Please complete appropriate SAS form which can be located on the PGC.

Blanket outpatient approval for calciphylaxis, restricted to nephology.

SODIUM VALPROATE

Injection

400mg

Y

 

SODIUM VALPROATE

Suspension

200mg/5mL

Y

 

SODIUM VALPROATE

Chewable tablets

100mg

Y

 

SODIUM VALPROATE

Enteric Coated Tablet

200mg & 500mg

Y

 

SOFOSBUVIR/VELPATASVIR (Epclusa®)

Tablet

400mg/100mg

S

Restricted to specialists working in the liver clinic running the HCV treatment program. For initiation in outpatients via the Highly specialised Drugs Program (Section 100). Refer to PBS Criteria.

SOFOSBUVIR/VELPATASVIR/ VOXILAPREVIR (VOSEVI®)

Tablet

400mg/100mg/ 100mg

S

Restricted to specialists working in the liver clinic running the HCV treatment program. For initiation in outpatients via the Highly specialised Drugs Program (Section 100). Refer to PBS Criteria.

SOMATROPIN

Injection

1mg, 8mg, 10mg & 12mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

SORAFENIB

Tablet

200mg

R

Restricted to Haematology and Oncology for PBS listed indications.

Blanket approval for outpatient supply with PBS prescription. Restricted to: Haematology/Oncology.

SORBITOL

Solution

70%

Y

 

SOTALOL

Injection

40mg

Y

 

SOTALOL

Tablet

80mg & 160mg

Y

 

SPACER – DISPOSABLE

  

R

For use by Emergency Department and NCCRTC only.

SPACER FOR AEROSOL

  

Y

 

SPILL KIT FOR CYTOTOXIC DRUGS

  

Y

 

SPIRONOLACTONE

Tablet

25mg & 100mg

Y

 

SPIRONOLACTONE

Solution

12.5mg/5mL

Y

 

STERCULIA (Normafibe®)

Granules

500g

Y

 

STREPTOMYCIN

Injection

1g

Y

 

SUCROSE

Oral Solution

24%

Y

 

SUFENTANIL

Injection

50mcg

R

This is a Special Access Scheme (SAS) Product. Please complete appropriate SAS form which can be located on the PGC.

Blanket outpatient approval for cancer pain.

SUGAMMADEX

Injection

200mg

R

Restricted to use by Anaesthetic, ICU and ED specialists only.

SULFASALAZINE

Enteric Coated Tablet

500mg

Y

 

SULPHAMETHOXAZOLE/ TRIMETHOPRIM (Bactrim®)

Suspension

200mg/40mg/ 5mL

Y

 

SULPHAMETHOXAZOLE/ TRIMETHOPRIM (Bactrim®)

Tablet

400mg/80mg & 800mg/160mg

Y

Blanket outpatient approval for melioidosis eradication and Pneumocystis carinii pneumonia (PCP). Restricted to: Haematology/Oncology and Infectious Diseases.

SULPHAMETHOXAZOLE/ TRIMETHOPRIM (Bactrim®)

Injection

400mg/80mg

Y

 

SUNITINIB

Capsule

12.5mg, 25mg, 50mg

R

Restricted to Haematology and Oncology for PBS listed indications.

SUNSCREEN SPF

Lotion

15+, 30+

Y

 

SUNSCREEN with ZINC

CREAM

50+

Y

 

SUXAMETHONIUM

Injection

100mg

Y

 

TACROLIMUS

Capsule

500mcg, 1mg & 5mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

TACROLIMUS XL

Extended Release Capsule

500mcg, 1mg, 3mg & 5mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

TALC (STERILE LARGE PARTICLE) (Steritalc®)

Powder

4g

Y

 

TAMOXIFEN

Tablet

10mg & 20mg

Y

 

TAMSULOSIN

Tablets

400mcg

R

Restricted to urologists and geriatricians.

Restricted ONLY for the treatment of benign prostate hypertension (BPH) in patients where prazosin is not appropriate or not tolerated.

TAPENTADOL IR

Immediate Release Tablet

50mg

R

Restricted to;

Continuing inpatient use (regular medicine) OR

Initiation of treatment by Acute Pain Service, Geriatricians or Rehabilitation Consultants that meet the following;

  • Inpatient use only AND
  • Patients with severe incident-pain   and complex pain management needs where its use will form part of a   multimodal analgesic regimen AND
  • Patient has contraindications to   the use of tramadol (indicate reason)
  • Taking other medication with   serotonergic effects
  • At risk of seizures (Note: Tapentadol should be prescribed with   care in patient at risk of seizures)
  • Other (reasons to be provided)

AND

  • Plan for analgesia requirements on   discharge has been considered and documented if required. Tapentadol   immediate release tablets cannot be supplied on discharge from hospital

TAPENTADOL SR

Slow Release Tablet

50mg, 100mg, 150mg, 200mg, 250mg

R

Restricted to PBS indications.

TEA TREE

Oil

 

Y

 

TEICOPLANIN

Injection

400mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

TEMAZEPAM

Tablet

10mg

Y

 

TEMOZOLOMIDE

Capsule

5mg, 20mg, 100mg, 140mg, 180mg, 250mg

R

Restricted to Haematology and Oncology for PBS listed indications.

TENECTEPLASE

Injection

50mg

Y

Restricted for acute myocardial infarction in the settings of pre-hospital thrombolysis (e.g. ambulance service, Careflight, RFDS), small rural hospitals (GDH, KDH, Tennant Creek Hospital) and remote facilities (Aboriginal health services).

TENOFOVIR DF

Tablet

300mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

Blanket outpatient approval for management of Hepatitis B in pregnancy.

TENOFOVIR DF & EMTRICITABINE

Tablet

300mg/200mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

TENOFOVIR/ EMTRICITABINE/ EFAVIRENZ

Tablet

300mg/ 200mg/ 600mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

TENOFOVIR/ EMTRICITABINE/ RILPIVIRINE

Tablet

300mg/ 200mg/ 25mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

TERBINAFINE

Tablet

250mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

TERBINAFINE

Cream

1%

R

Restricted to indications meeting PBS criteria.

TERBUTALINE

Injection

500mcg/mL

R

Restricted to use in obstetrics for pregnant women with foetal distress requiring immediate delivery, or prior to External Cephalic Version (ECV)

TERBUTALINE

Turbuhaler

500mcg

Y

 

TERLIPRESSIN

Injection

0.85mg/mL

R

  • Restricted to Emergency Physicians, Intensive Care   Physicians and Gastroenterologists for haemorrhaging oesophageal varices.
  • Restricted to Intensive Care Physicians,   Gastroenterologists and Nephrologists for Type 1 Hepatorenal Syndrome.

TESTOSTERONE ESTERS

Injection

100mg & 250mg

Y

 

TETRABENAZINE

Tablet

25mg

Y

 

TETRACAINE (AMETHOCAINE) HYDROCHLORIDE

Minims

1%

Y

 

TETRACAINE (AMETHOCAINE) HYDROCHLORIDE

Gel

4%

Y

 

TETRACAINE (AMETHOCAINE) HYDROCHLORIDE / LIDOCAINE (LIGNOCAINE)–ADRENALINE (EPINEPHRINE) (LACERAINE®)

Gel

40mg/5mg/1mg/5mL

Y

 

TETRACAINE/ LIDOCAINE/ EPINEPHRINE

Injection

0.5%/ 4%/ 1:1000

Y

 

TETRACOSACTIDE (TETRACOSACTRIN) (Synacthen®)

Injection

250mcg & 1mg

Y

 

THALIDOMIDE

Capsule

50mg, 100mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

THEOPHYLLINE

Modified Release Tablet

200mg, 250mg & 300mg

Y

 

THIAMINE

Tablet

100mg

Y

 

THIAMINE

Injection

300mg

Y

 

THIOPENTONE

Injection

500mg

Y

 

THROMBIN

Injection

5000units

Y

 

THYMOL

Mouthwash

 

Y

 

TICAGRELOR

Tablet

90mg

R

Restricted to Cardiologists & Interventional Cardiologists for patients undergoing planned PCI and CABG, and for patients who have had a cardiac event whilst taking clopidogrel.

TIGECYCLINE

Injection

50mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

TIMOLOL

Eye Drops

0.25% & 0.5%

Y

 

TIMOLOL LA

Long Acting Eye drops

0.50%

Y

 

TIOGUANINE (THIOGUANINE)

Tablet

40mg

R

Restricted to Haematology and Oncology for PBS listed indications.

Blanket approval for outpatient supply with PBS prescription. Restricted to: Haematology/Oncology.

TIOTROPIUM

Capsules for Inhalation

18mcg

Y

 

TIOTROPIUM

Inhaler

 

Y

 

TIROFIBAN

Injection

12.5mg

R

Restricted to Cardiology

TOBRAMYCIN

Injection

80mg (with preservative & preservative free for inhalation) & 500mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

Blanket outpatient approval for cystic fibrosis (preservative free ampoules).

TOBRAMYCIN

Eye ointment

0.30%

Y

 

TOBRAMYCIN (Tobi Podhaler®)

Capsules for Inhalation

28mg

R

Restricted to Respiratory physicians/advanced trainees for the management of cystic fibrosis patients with pseudomonas aeruginosa infections.

TOCILIZUMAB

Injection

200mg & 400mg

 

Restricted to ICU Physicians as per use in REMAP CAP clinical trials only

TOPIRAMATE

Sprinkle Capsule

25mg

Y

 

TOPIRAMATE

Tablet

25mg, 50mg & 100mg

Y

Blanket outpatient approval for RDPH Weight Management Clinic

TOPOTECAN

Injection

4mg

R

Restricted to Haematology and Oncology for PBS listed indications AND Small Cell Lung Cancer, AND Neuroendocrine Unknown Primary Cancer.

TPN ADULT STD TRIPLE PHASE BAG (SmofKabiven®)

IV fluid

1970mL

Y

 

TPN NEONATE 34 WEEK TO TERM

IV fluid

1200mL

Y

Order on request

TPN NEONATE CONCENTRATED PRETERM

IV fluid

750mL

Y

Order on request

TPN NEONATE HIGH SODIUM PRETERM

IV fluid

750mL

Y

Order on request

TPN NEONATE PRETERM (7.5% GLUCOSE)

IV fluid

750mL

Y

Order on request

TPN NEONATE STANDARD PRETERM

IV fluid

750mL

Y

RDH Stocked

TPN NEONATE STARTER

IV fluid

750mL

Y

RDH Stocked

TRAMADOL

Capsule

50mg

Y

 

TRAMADOL

Injection

100mg

Y

 

TRANEXAMIC ACID

Injection

1000mg/10mL

R

Restricted to Emergency Department, theatre and ICU.

TRANEXAMIC ACID

Tablet

500mg

Y

 

TRASTUZUMAB

Injection

60mg, 150mg, 600mg/5mL

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

TRIAMCINOLONE

Injection

10mg & 40mg

Y

 

TRIAMCINOLONE

Dental paste

0.10%

Y

 

TRICLOSAN

Solution

1%

Y

 

TRIHEXYPHENIDYL HCL (BENZHEXOL)

Tablet

2mg

Y

 

TRIMETHOPRIM

Tablet

300mg

Y

 

TROPICAMIDE

Minims

0.5% & 1%

Y

 

TROPONIN

Test strips

 

Y

 

TRYPAN BLUE

Injection

0.10%

Y

 

TUBERCULIN PPD

Injection

100units/mL

Y

 

UMECLIDINIUM (Ellipta Incruse®)

Inhaler

62.5mcg

Y

 

UMECLIDINIUM / FLUTICASONE/ VILANTEROL (Ellipta Trelegy®)

Inhaler

62.5mcg/ 100mcg/ 25mcg

Y

 

UMECLIDINIUM / VILANTEROL (Ellipta Anoro®)

Inhaler

62.5mcg/ 25mcg

Y

 

UREA & LACTIC ACID (Calmurid®)

Cream

10%/5%

Y

 

UREA (Dermadrate®)

Cream

10%

Y

 

UREA (Ure-Na®)

Sachets

15gm

R

Restricted to Endocrinology.

This is a Special Access Scheme (SAS) Product. Please complete appropriate SAS form which can be located on the PGC.

URINE STRIPS

Strips

   

URSODEOXYCHOLIC ACID

Suspension

250mg/5mL

Y

 

URSODEOXYCHOLIC ACID

Capsule

250mg

Y

Blanket outpatient approval for obstetric cholestasis.

USTEKINUMAB

Injection

130mg and 45mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

Note: The 45mg injection is to be sourced under PBS general schedule for outpatients.

VALACICLOVIR

Tablet

500mg

S

Restricted to PBS criteria

Blanket inpatient/outpatient approval for viral prophylaxis in haematology patients undergoing suppressive chemotherapy OR Ophthalmic Herpes Simplex.

VALGANCICLOVIR

Tablet

450mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

VANCOMYCIN

Infusor

Variable

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

VANCOMYCIN

Injection

500mg, 1g

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

VARICELLA ZOSTER (Chicken Pox®) VACCINE

Injection

 

Y

 

VECURONIUM

Injection

4mg, 10mg

Y

 

VEDOLIZUMAB

Injection

300mg

S

Restricted to Gastroenterologists for Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

VENLAFAXINE

Modified Release Capsule

37.5mg, 75mg & 150mg

Y

 

VERAPAMIL

Injection

5mg

Y

 

VERAPAMIL

Tablet

40mg & 80mg

Y

 

VERAPAMIL

Modified Release Capsule

180mg & 240mg

Y

 

VINBLASTINE

Injection

10mg/10mL

R

Restricted to Haematology and Oncology for PBS listed indications.

VINCRISTINE

Injection

1mg/mL

R

Restricted to Haematology and Oncology for PBS listed indications.

VINORELBINE

Capsule

20mg, 30mg

R

Restricted to Haematology and Oncology for PBS listed indications.

VINORELBINE

Injection

10mg/mL, 50mg/5mL

R

Restricted to Haematology and Oncology for PBS listed indications.

VITAMIN A

Ointment

 

Y

 

VITAMIN A (RETINOL PALMITATE)

Capsule

50,000units

Y

 

VITAMIN B COMPLEX (Cenovis Mega B®)

Tablets

 

Y

 

VITAMIN E

Oral Liquid

156iu

Y

 

VITAMIN PREGNANCY & BREASTFEEDING (I-Folic®)

Tablets

 

R

Restricted to remote health and maternity inpatients for women who are pregnant or breastfeeding.

VORICONAZOLE

Injection

200mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

VORICONAZOLE

Tablet

50mg & 200mg

R

Restricted antimicrobial - Please refer to the Restricted Antimicrobial Guideline NT

Blanket outpatient approval for susceptible infections not listed on the PBS approved by Infectious Diseases.

WARFARIN

(Coumadin® Brand)

Tablet

1mg, 2mg & 5mg

Y

 

WATER FOR INJECTIONS

Injection

10mL, 20mL & 1L

Y

 

WATER FOR IRRIGATION

Irrigation

1L & 2L

Y

 

WOOL ALCOHOLS

Ointment

100g

Y

 

XYLOMETAZOLINE

Nasal Drops

0.05%

Y

 

ZINC & CASTOR OIL

Cream

20g

Y

 

ZINC (Elemental)

Capsule

50mg

Y

 

ZINC OXIDE

Cream

 

Y

 

ZINC SULPHATE

Solution

50mg/mL

Y

Contains elemental Zinc 11.3mg/mL.

ZOLEDRONIC ACID

Injection

5mg

R

Blanket outpatient approval for osteoporosis in patients who don’t meet PBS criteria.

ZOLEDRONIC ACID

Injection

4mg

S

Highly Specialised Drugs Program (Section 100). Refer to PBS Criteria.

ZOLMITRIPTAN

Tablet

2.5

Y

 

ZUCLOPENTHIXOL

Injection

50mg

Y

 

ZUCLOPENTHIXOL

Tablet

10mg

Y

 

ZUCLOPENTHIXOL DECANOATE

Injection

200mg

Y

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Last updated: 10 November 2022

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