Caisse Nationale De L'Assurance Maladie mardi 25 Novembre 2014 LISTE DES SPECIALITES PHARMACEUTIQUES SOUMISES A L'ACCORD PREALABLE (CLASSEES PAR DCI) ANTALGIQUES Morphine et morphinomimétiques FENTANYL 502107 502104 502105 502106 DUROGESIC TTD 10mg/40cm² Bt 5 # DUROGESIC TTD 2,5mg/10cm² Bt 5 # DUROGESIC TTD 5,0mg/20cm² Bt 5 # DUROGESIC TTD 7,5mg/30cm² Bt 5 # MORPHINE 502042 502440 502443 502444 502441 502442 500051 500052 500053 MORPHINE Fl inj 10mg/ml vrac #* MOSCONTIN Comp enr LP 10mg Bt 14 # MOSCONTIN Comp enr LP 100mg Bt 14 # MOSCONTIN Comp enr LP 200mg Bt 14 # MOSCONTIN Comp enr LP 30mg Bt 14 # MOSCONTIN Comp enr LP 60mg Bt 14 # SKENAN LP Gélule Ret. 10mg Bt 14 # SKENAN LP Gélule Ret. 30mg Bt 14 # SKENAN LP Gélule Ret. 60mg Bt 14 # CANCEROLOGIE Agents cytostatiques ANASTROZOLE 104283 ARIMIDEX Comp Pell 1 mg Bt 30 BICALUTAMIDE 501637 CASODEX Comp Enr 50 mg BT 30 EXEMESTANE 508896 AROMASINE Comp Enr 25mg Bt 30 # GOSERELINE 506491 ZOLADEX IMPLANT Implant inj 3.6mg Bt 1 # 501274 ZOLADEX 10,8mg/Implant Bt 1 Seringue # LANREOTIDE 857860 SOMATULINE LP Amp inj 30 mg Bt 1 852336 SOMATULINE LP Amp Inj 90mg Bt1 LETROZOLE 502114 FEMARA Comp 2,5mg Bt 30 # 504553 LETROZOLE ACTAVIS Comp Pell 2.5 MG BT 100 MEGESTROL 800912 MEGACE Comp 160mg Bt 30 # Page 1 Caisse Nationale De L'Assurance Maladie mardi 25 Novembre 2014 LISTE DES SPECIALITES PHARMACEUTIQUES SOUMISES A L'ACCORD PREALABLE (CLASSEES PAR DCI) CANCEROLOGIE Agents cytostatiques OCTREOTIDE 503355 SANDOSTATINE 0.05 mg /ml Sol Inj Bt 5 503350 SANDOSTATINE 100 µG 1 ML Amp Inj Bt 5 TRIPTORELINE 502295 DECAPEPTYL LP 11.25 Pdre pp Inj Bt 1 # 501578 DECAPEPTYL SC Sol inj 100µg/Dose Bt 7 +Solv # 501263 DECAPEPTYL Sol inj LP 3mg + Ser. # Cytotoxiques AMSICRINE 857789 AMSIDINE Amp inj 75 mg Bt 5 # ASPARAGINASE ( L ) 852849 KIDROLASE 10000 UI Fl Inj Bt 1 BEVACIZUMAB 860001 AVASTIN inj 100mg Bt 1 852893 AVASTIN inj 400mg Bt 1 BLEOMYCINE 506240 BLEOMYCINE Fl inj 15mg Bt 10 Sans Solvant # 504059 BLEOMYCINE Fl inj 15mg vrac # CAPECITABINE 851331 XELODA Comp 500mg Bt 120 # CARBOPLATINE 501931 CARBOPLATIN MERCK 150 MG Sol Inj Bt1 502354 CARBOPLATINE-EBEWE Fl Inj 150mg Bt 1 # 506451 PARAPLATINE Fl Inj 150mg Bt 1 # CARMUSTINE 806249 BICNU Pdre inj 100mg Bt 1 # CETUXIMAB 853449 ERBITUX 100 MG (5 MG/ML) Inj FL 20 ML CHLORAMBUCIL 851967 CHLORAMINOPHENE Comp 2mg Bt 30 # CISPLATINE 503611 CISPLATIN -EBEWE Sol Inj 25 mg/50 ml Bt 1 FL 501816 CISPLATINE MYLAN Fl Inj 25mg Bt 1+1 (EX MERCK GENERIQUE) Page 2 Caisse Nationale De L'Assurance Maladie mardi 25 Novembre 2014 LISTE DES SPECIALITES PHARMACEUTIQUES SOUMISES A L'ACCORD PREALABLE (CLASSEES PAR DCI) CANCEROLOGIE Cytotoxiques CYCLOPHOSPHAMIDE 500394 500798 504064 506267 500291 ENDOXAN Comp drag 50mg Bt 50 # ENDOXAN pdre inj 1gr/Fl Bt 1 ENDOXAN Pdre/prép inj 200mg Fl vrac # ENDOXAN Pdre/prép inj 200mg/Fl Bt 10 # ENDOXAN Pdre/Prép inj 500mg/Fl Bt 1 # CYTARABINE 503286 503287 501712 507864 ALEXAN 1gr/20ml Sol I nj Bt 1 ALEXAN 100mg/5ml Sol Inj Bt 1 ARACYTINE Fl inj 100mg Bt 1+1(5ml) # ARACYTINE Pdre P Prep Inj 1 gr Bt 1 DACARBAZINE 506269 DETICENE Fl inj 100mg Bt 10+10 # 503043 DETICENE Fl inj 100mg vrac # DACTINOMYCINE 856855 COSMOGEN Pdre inj 0,5mg Fl # DASATINIB 850134 SPRYCEL Comp Pell 70 mg Bt 60 853621 SPRYCEL Comp Pell 20 mg Bt 60 850047 SPRYCEL Comp Pell 50 mg Bt 60 DAUNORUBICINE 506391 CERUBIDINE 20mg Fl inj Bt 1+1(4ml) # DOCETAXEL 854106 854110 854109 854111 808243 808242 DOXETAL 20 MG Sol P Perfusion Bt 1 FL /0.5 ml + sol DOXETAL 80 MG Sol P Perf Bt 1 FL /2ML + solv/6 ml ERIOX 20 MG Sol P Perf Bt 1 Fl /0.5 ML +Sol ERIOX 80 MG Sol P Perf Bt 1 Fl /2 ML + Sol TAXOTERE Pdre Inj 20mg Bt 1Fl+solv. # TAXOTERE Pdre Inj 80mg Bt 1Fl+solv. # DOXORUBICINE 504297 504298 502005 507324 ADRIABLASTINE Sol O Perf 10mg/5 ml Bt 1 Fl 5ml ADRIABLASTINE Sol Per 50 mg/25ml Bt 1 FL 25 ml DOXORUBICIN EBEWE Fl inj 10mg Bt 1/5ml # DOXORUBICIN EBEWE Sol inj 50mg/25ml 1Fl 25ml # EPIRUBICINE 503087 503088 506890 506891 EPIRUBICINE EBEWE 2MG/ML Sol/Per 10mg Bt 1(5ml) EPIRUBICINE EBEWE 2MG/ML Sol/Per 50mg Bt 1(25) FARMORUBICINE RD 10 Fl inj 10mg Bt1+1(5ml) # FARMORUBICINE RD 50 Fl inj 50mg Bt 1 Sans solv. # Page 3 Caisse Nationale De L'Assurance Maladie mardi 25 Novembre 2014 LISTE DES SPECIALITES PHARMACEUTIQUES SOUMISES A L'ACCORD PREALABLE (CLASSEES PAR DCI) CANCEROLOGIE Cytotoxiques ETOPOSIDE 500917 ETOPOSIDE EBEWE 100MG Sol Inj Bt1 502448 ETOPOSIDE MERCK Sol/perfusion 100mg/5ml Bt 10 # 501818 ETOPOSIDE MERCK Sol/perfusion 100mg/5ml vrac # FLUDARABINE PHOSPHATE 850220 FLUDARA Pdre inj 50 mg Bt 5 # FLUOROURACILE 501906 FLUORO-URACILE inj 250mg/5ml Bt 1 Fl # GEMCITABINE 853967 853966 504300 504301 808791 808792 854113 854112 GEMCITABIN EBEWE 10 MG/ML (1000 MG) Sol P Perf Bt 1 FL GEMCITABIN EBEWE 10 MG/ML (200 MG) Sol P Perfu Bt 1 Fl GEMCITABINE HOSPIRA 1 GR Pdre P Pre Inj Bt 1 FL GEMCITABINE HOSPIRA 200 MG Pdre P Pre Inj Bt 1 GEMZAR Pdre Prép. Inj IV 1gr Bt 1 # GEMZAR Pdre Prép. Inj IV 200mg Bt 1 # GEZT 1 GR pdre P Prep Inj Bt 1 FL GEZT 200 MG Poudre P Pr Inj Bt 1 Fl HYDROXYCARBAMIDE 506545 HYDREA Gélule 500mg Bt 20 # IDARUBICINE 506944 ZAVEDOS Pdre Prép inj 10mg Bt 1 # 506943 ZAVEDOS Prep inj 5 mg Bt 1 solv 2 ml # IFOSFAMIDE 507301 HOLOXAN Pdre Prép.Inj 1grI Bt 1 # IMATINIB MESILATE 854635 854636 853356 852896 CEMIVIL Comp Pell Séc 100 mg BT 30 (IMATINIB ) CEMIVIL Comp Pell Sec 400 MG BT 30 (IMATINIB) GLIVEC Comp Pell 400 MG BT 30 (IMATINIB) GLIVEC 100MG Comp Bt 60 (IMATINIB) IRINOTECAN CHLORHYDRATE 502657 502906 503987 503985 CAMPTO Sol Inj 100mg/5ml Bt 1 Fl 5ml # CAMPTO Sol P Per 40 mg/2ml Bt 1 FL 2 ML IRINOTESIN 40MG/2ML Sol P Per BT 1 FL IRINOTESIN 100MG/5ML Sol P Per BT 1 FL MELPHALAN 507927 ALKERAN Comp 2mg Bt 50 # 850312 ALKERAN Fl inj 50mg # Page 4 Caisse Nationale De L'Assurance Maladie mardi 25 Novembre 2014 LISTE DES SPECIALITES PHARMACEUTIQUES SOUMISES A L'ACCORD PREALABLE (CLASSEES PAR DCI) CANCEROLOGIE Cytotoxiques METHOTREXATE 503614 501662 506351 506350 502678 502652 501972 501973 502288 EBETREXAT Sol P Per 5000mg/50 ml BT 1 METHOTREXATE Amp inj 20mg Bt 10 # METHOTREXATE EBEWE Amp inj 50mg Bt 5/5ml # METHOTREXATE Fl inj 20mg Bt 1 vrac # METHOTREXATE Fl Inj 25mg Bt 1 # METHOTREXATE Fl Inj 5gr Bt 10 # METHOTREXATE Fl inj 5gr B/1 Fl + Solvant # METHOTREXATE Fl inj 500mg Bt 1 Fl 5ml # METHOTREXATE 5 mg amp.inj. Bt 1 MITOXANTRONE 503289 503288 500307 507989 EBEXANTRON 2MG/ML Sol Inj Bt 1(10ml) EBEXANTRON 2MG/ML Sol Inj Bt 1(5ml) NOVANTRONE Sol inj 10mg/5ml Fl 5ml # NOVANTRONE Sol inj 20mg/10ml Fl 10ml # NILOTINIB 853835 TASIGNA Gelule 200 mg Bt 28 OXALIPLATINE 508476 508475 504303 504304 503312 503313 ELOXATINE Pdre inj 100mg Fl 50ml # ELOXATINE Pdre inj 50mg Fl 36ml # OXALIPLATIN ACTAVIS 5 MG/ML( 100 MG) Pdre Pre Inj BT 1FL 20 ML OXALIPLATIN ACTAVIS 5 MG/ML (50 MG) Pdre P Pre Inj bt 1 FL 10 ML OXALIPLATIN EBEWE 5MG/ML Pdre P P Inj (100mg) Bt (20ml) OXALIPLATIN EBEWE 5MG/ML(50mg) Pdre P Pr Inj Bt(10ml) PACLITAXEL 504114 503267 503268 503266 504093 504173 504306 504305 807704 DRIFEN 100 MG Sol Perf Bt 1 Fl EBETAXEL 100MG Sol P PERFUSION Bt 1 (16.7ml) EBETAXEL 150MG Sol P PERFUSION Bt (25ml) EBETAXEL 30MG Sol P Perfusion Bt (5ml) PACLITAXEL STRAGEN 6 MG/ML (150 mg ) Sol P Perf Bt 1 FL 25 ML PACLITAXEL STRAGEN 6 MG/ML (30 MG) Sol PPerf Bt 1 FL 5 ML SINDAXEL Sol P Perf 6 MG/ML ( 30 MG ) BT 1 FL 5 ml SINDAXEL 6 MG/ML ( 100 MG) Sol P Per BT 1 FL /16.7 ML TAXOL Sol Inj 30mg 5ml Bt 1 # PEMETREXED 503383 ALIMTA Pdre P Pre Inj 500mg Bt 1 PROCARBAZINE 501879 NATULAN Caps 50mg Bt 50 # Page 5 Caisse Nationale De L'Assurance Maladie mardi 25 Novembre 2014 LISTE DES SPECIALITES PHARMACEUTIQUES SOUMISES A L'ACCORD PREALABLE (CLASSEES PAR DCI) CANCEROLOGIE Cytotoxiques STREPTOZOCINE 857039 ZANOZAR Fl Inj 1gr Bt 1 # TRASTUZUMAB 851875 HERCEPTIN pdre perf 150mg Fl 15ml Bt 1 VINBLASTINE 507246 VINBLASTINE Fl inj 10mg vrac # 508209 VINBLASTINE Pdre/prép Inj 10mg/ Bt10+10 # VINCRISTINE 506431 VINCRISTINE Fl Inj 1mg Bt 1+1 # VINORELBINE DITARTRATE 807023 807160 854127 854150 NAVELBINE Sol inj 10MG/ML BT 10/1ML NAVELBINE Sol INJ 50MG/5ML BT 10/5ML VINOREL 10 MG/1ML Sol INJ Bt 1 FL /1 ML VINOREL 50 MG/5 ML Sol INJ BT 1 FL /5 ML Modificateurs de la réponse immunitaire BCG 999999 IMMUN BCG 75mg/ml Bt 1 INTERFERON ALFA 2A 502133 502349 502618 502134 ROFERON A Fl inj 3M Bt 5+5 # ROFERON A Fl inj 3MUI vrac # ROFERON A Fl inj 9 MUI vrac # ROFERON A Fl inj 9M Bt 5+5 # INTERFERON ALPHA 2B 507136 INTRONA STYLO 30 MUI (6 doses de 5MUI) # 502155 INTRONA 18Mui STYLO Inj (6DOSES X3MUI) # PEGINTERFERON ALFA - 2A 508922 PEGASYS Sol inj 135µgr Fl 1ml # 508889 PEGASYS Sol inj 180µGR Fl 1ml # PEGINTERFERON ALPHA 2b 508893 VIRAFERON PEG 100µG/5ml FL + solv # 508888 VIRAFERON PEG 120µG/5ml FL + solv # 508874 VIRAFERON PEG 80µG/5ml FL + solv # RITUXIMAB 802297 MABTHERA Amp inj 100mg Bt 2 # 802303 MABTHERA Amp inj 500mg Bt 1 # Page 6 Caisse Nationale De L'Assurance Maladie mardi 25 Novembre 2014 LISTE DES SPECIALITES PHARMACEUTIQUES SOUMISES A L'ACCORD PREALABLE (CLASSEES PAR DCI) CANCEROLOGIE Modificateurs de la réponse immunitaire TOCILIZUMAB 854540 ACTEMRA Sol Inj P Per 200 MG/10ML BT 1 FL 854539 ACTEMRA Sol Inj P Per 400 MG/20ML BT 1 FL 854541 ACTEMRA Sol Inj P Per 80 MG/4ML BT 1 FL Traitements associés ACIDE IIBANDRONIQUE 503144 BONDRONAT Sol/perfusion 6mg/6ml DOLASETRON 501935 ANZEMET Amp inj 100mg/5ml Bt 1 501936 ANZEMET Amp inj 12.5 mg/0.625ml Bt 1 FOLINATE DE CALCIUM 507943 504321 502121 508516 851383 CALCIUMFOLINAT-EBEWE Amp Inj 30mg/3ml Bt 5 # FOLINATE DE CALCIUM AGUETTANT Pdre P Pre Inj 200 mg Bt 1 FL FOLINATE DE CALCIUM Pdre inj 50 mg Bt 10 # FOLINATE DE CALCIUM sol inj 25mg/10ml Bt 10 # LEDERFOLINE Comp 25mg Bt 30 GRANISETRON 507123 KYTRIL Amp inj 3mg/3ml Bt 5 # LEVOFOLINATE DE CALCIUM 351529 LEVOFOLINA 50 SOL INJ 10 MG/1 ML BT 1 AMPOULE 5 ML MESNA 501174 UROMITEXAN Comp 400mg Bt 10 # 501181 UROMITEXAN Comp 600mg Bt 10 # 507302 UROMITEXAN inj 400mg 4ml Bt 15 # ONDANSETRONE 350738 350739 351446 350834 502734 501928 500361 506603 500374 506576 ONDANSETRON MEDIS sol inj 4mg/2ml Bt 5 # ONDANSETRON MEDIS sol inj 8mg/4ml Bt 5 # ONDANSETRON UNIMED Sol INJ 8 MG/4ML BT 10 ONDANSETRON 8MG Comp Pell Bt 10 SETRON sol inj 8mg/4ml Bt 5 # ZEMITRON Comp enr. 8mg Bt 10 # ZOPHREN Sol inj 4mg/2ml Bt 1 Amp 2ml # ZOPHREN Sol inj 4mg/2ml Bt 5 Amp 2ml # ZOPHREN Sol inj 8mg/4ml Bt 1 Amp 4ml # ZOPHREN Sol inj 8mg/4ml Bt 5 Amp 4ml # RASBURICASE 852859 FASTURTEC pdre ing 1.5 mg Bt 3+3 852857 FASTURTEC pdre ing 7.5 mg Bt 1+1 Page 7 Caisse Nationale De L'Assurance Maladie mardi 25 Novembre 2014 LISTE DES SPECIALITES PHARMACEUTIQUES SOUMISES A L'ACCORD PREALABLE (CLASSEES PAR DCI) CANCEROLOGIE Traitements associés ZOLEDRONIQUE ACIDE 854637 ZOLEDRONIC ACID HIKMA Sol Inj 4MG/5 ML BT 1 FL 854999 ZOMETA Sol Inj 4mg Bt 1 CARDIOLOGIE ET ANGIOLOGIE Antihypertenseurs AMLODIPINE+ATORVASTATINE 103487 CADUET Comp Pell 5mg/10mg Bt 30 103486 CADUET Comp Pell 10mg/10mg Bt 30 Prévention cardiovasculaire CLOPIDOGREL 104520 301812 309111 309112 309056 301505 301506 301507 104634 301550 301282 300885 301379 301755 301424 AGREGEX Comp Pell 75 MG BT 30 CLOPIDOGREL PFIZER Comp Pell 75 MG BT 30 CLOPIX Comp Pell 75 mg Bt 60 CLOPIX Comp Pell 75 mg Bt 90 CLOPIX Comp Pell 75mg Bt 30 COPIGREL Comp Pell 75 mg Bt 30 COPIGREL Comp Pell 75 mg Bt 60 COPIGREL Comp Pell 75 mg Bt 90 PEDOVEX Comp Pell 75 MG BT 30 PIDOGREL Comp Pell 75 MG Bt 90 PIDOGREL Comp Pell 75 mg Bt 60 PIDOGREL Comp Pell 75mg Bt 30 PLAGREL Comp Pell 75 mg Bt 28 PLAGREL Comp Pell 75 MG BT 90 PLAVIX Comp Pell 75 mg Bt 28 DERMATOLOGIE Médicaments du psoriasis ACITRETINE 103422 NEOTIGASON Capsule 10 MG BT 30 103423 NEOTIGASON Capsule 25 MG BT 30 CALCIPOTRIOL 107131 DAIVONEX Crème derm 0.005% Tb 30gr 107132 DAIVONEX Lotion 0.005% Fl 60ml 107333 DAIVONEX Pde derm Tb 30gr CALCIPOTRIOL + BETAMETHASONE 103204 DAIVOBET Pde Der 50µG/0.5MG Tbe 60 104235 XAMIOL Gel Dermique 50 mcg/0.5 mg/ gr Fl 60 gr Page 8 Caisse Nationale De L'Assurance Maladie mardi 25 Novembre 2014 LISTE DES SPECIALITES PHARMACEUTIQUES SOUMISES A L'ACCORD PREALABLE (CLASSEES PAR DCI) DERMATOLOGIE thalidomide THALIDOMIDE 853433 MYRIN ( THALIDOMIDE ) 50 mg Comp Bt 30 854050 MYRIN (THALIDOMIDE ) 100 mg Comp Bt 30 852590 THALIDOMIDE comp 50mg Bt 100 ENDOCRINOLOGIE Hormones de croissance SOMATROPINE 502978 GENOTONORM 1.3 mg (4UI) Pdre +Sol Fl 1 503598 HHT Pdre P Inj 4 UI Bt 1Fl /1 ml (SOMATROPINE) 504552 NORDITROPIN NORDILET 5mg/1.5ml BT 1 STYLO/ 1.5 ml (15 UI SOMATROPINE) 501992 SAIZEN 4UI Pdre/prép inj Bt 1Fl+Solv/1ml # Médicaments de l'axe hypophyso-gonadique CETRORELIX 109708 CETROTIDE Pdre P Inj 0.25mg Bt 1 +ser 1ml 102275 CETROTIDE Pdre P Inj 3mg Bt 1+ ser 3ml DANAZOL 103671 DANATROL Gélule 200mg Bt 100 103670 DANATROL Gélule 200mg Bt 40 FSH 104528 FOSTIMON Pdre P Pre Inj 75 UI BT 1 FL 101860 GONAL F Pdre/Prep 75 UI Bt 1+1 103920 GONAL-F PEN Sol Inj 450 UI/0.75 ml Bt 1 Stylo + 7 Aiguilles FSH+LH 103283 MENOPUR Pdre P Inj 75 UI Bt 5 104529 MERIONAL Pdre P Prepation Inj 75 UI /ML BT 1 Fl +Amp solvant LUTROPINE ALFA 103259 LUVERIS 75 UI P.P.P.Inj Bt 1 + S NORETHANDROLONE 502806 NILEVAR Comp 10mg Bt 30 # GASTRO-ENTEROLOGIE Médicaments de la rectocolite hémorragique INFLIXIMAB 854313 REMICADE Pdre P Prep IN 100 MG BT 1 FL Page 9 Caisse Nationale De L'Assurance Maladie mardi 25 Novembre 2014 LISTE DES SPECIALITES PHARMACEUTIQUES SOUMISES A L'ACCORD PREALABLE (CLASSEES PAR DCI) HEMATOLOGIE ET HEMOSTASE Antianémiques ERYTHROPOIETINE HUMAINE 503205 503192 502157 504299 EPOTIN 2000 UI Sol Inj Bt 1 ( vrac ) EPOTIN 2000 UI Sol Inj BT 10 Fl HEMAX pdre inj 2000 UI Bt 1 IOR EPOCIM 2000UI Sol Inj Bt 10 FL FER 301405 FER PLUS Sol Inj 62.5 mg/5ml Bt 10 351350 IV-FER Sol P Perf 100 mg/5 ml Bt 5 Antineutropéniques FILGRASTIM 503504 501929 501930 504383 504384 504473 IOR LEUKOCIM Sol Inj 30 MUI/ML Bt 10 Fl/1 ML NEUPOGEN 30 MU Sol inj Bt 1 ser. 0,5ml # NEUPOGEN 48 MU Sol inj Bt 1 ser. 0,5ml # NEUTROMAX Sol Inj 30 MU BT 1 FL/1ML NEUTROMAX Sol Inj 48 MU Bt 1FL /1 ML ZARZIO 48 MU SOL INJ BT 5 Seri 0.5 ml LENOGRASTIM 508373 GRANOCYTE 34 Pdre/Prép Inj 263µG Bt 5fl+Solv1ml # Facteurs sanguins de la coagulation FACTEUR IX 550009 NANOTIV 500 UI 550008 OCTANINE F 250 UI FACTEUR VIII 550014 550013 551371 550299 550298 550057 551329 551330 HAEMOCTIN SDH 250UI HAEMOCTIN SDH 500UI IMMUNATE Pdre P Pre Inj 500 UI BT 1 FL + S/5ML KOGENATE FS PDRE P Inj 1000 UI BT 1 FL KOGENATE FS PDRE P iNJ 500 UI BT 1 FL OCTANATE 250UI REFACTO AF PDRE P Inj 500 UI BT 1 REFACTO AF PDRE P Inj 1000UI Bt 1 FL HEPATOLOGIE Traitement de la Cirrhose OCTREOTIDE 506849 SANDOSTATINE 100 Amp inj 100µg/ml Bt 6 # 506486 SANDOSTATINE 50 Amp inj 50µg/ml Bt 6 # Page 10 Caisse Nationale De L'Assurance Maladie mardi 25 Novembre 2014 LISTE DES SPECIALITES PHARMACEUTIQUES SOUMISES A L'ACCORD PREALABLE (CLASSEES PAR DCI) HEPATOLOGIE Traitement de la Cirrhose URSODESOXYCHOLIQUE ACIDE 856963 URSOLVAN Gélule 200mg Bt 30 # IMMUNOLOGIE Immunosuppresseurs CICLOSPORINE 501856 501854 501855 501670 502374 502375 502377 502381 801830 801776 806441 801829 CONSUPREN Caps 100mg Bt 50 # CONSUPREN Caps 25mg Bt 50 # CONSUPREN Caps 50mg Bt 50 # CONSUPREN Sol Buv 100mg/ml Fl 50ml # EQUORAL Caps molle 100mg Bt 50 # EQUORAL Caps molle 25mg Bt50 # EQUORAL Caps molle 50mg Bt 50 # EQUORAL Sol buv 100mg/ml Fl 50ml # NEORAL Caps molle 25mg Bt 60 # NEORAL 100mg Caps Molles Bt/60 NEORAL 100mg/ml Susp Or Fl 50 ML NEORAL 50mg Caps Molles Bt/60 FINGOLIMOD 854480 GILENYA GELULE 05.MG BT 28 MYCOPHENOLATE MOFETIL 500023 502739 350912 351564 CELLCEPT Comp pell.500mg Bt 50 # CELLCEPT 500MG Comp Pell Bt 150 MMF comp pell 500 mg Bt 56 MMF 250 MG Comp Pell BT 100 NATALIZUMAB 503415 TYSABRI 300mg Sol P Perfusion Bt 1 (Fl 15ml) TACROLIMUS 508482 PROGRAF Gélule 1mg Bt 100 # 502075 PROGRAF Gélule 5mg Bt 100 # INFECTIOLOGIE Antifongiques systémiques ITRACONAZOLE 301273 301433 852962 103457 503457 ITRA Gelule 100 mg Bt 32 ITRA SKIN Gelule 100 mg Bt 28 ITRACON 100MG Capsule Bt 30 ITRACONAZOL-CIMEX Gelule 100 mg Bt 30 ITRACONAZOL-CIMEX Gelule 100 MG BT 30 Page 11 Caisse Nationale De L'Assurance Maladie mardi 25 Novembre 2014 LISTE DES SPECIALITES PHARMACEUTIQUES SOUMISES A L'ACCORD PREALABLE (CLASSEES PAR DCI) INFECTIOLOGIE Antifongiques systémiques ITRACONAZOLE 301776 ITRAZOL Gelule 100 MG BT 32 857985 SPORANOX Gélule 100mg Bt 30 # 857064 SPORANOX Sol Buv 10mg/ml Fl 150ml VORICONAZOLE 802917 802919 802921 503460 VFEND comp pell 200mg Bt 14 VFEND comp pell 50mg Bt 28 VFEND pdre inj 200mg Bt 1 VFEND Pdre P Sus Buv 40mg/ml fl 45 gr Anti-viraux ACICLOVIR 300933 ACICLOVIR Comp 200mg Bt 30 103608 ZOVIRAX Comp 200 mg Bt 25 ADEFOVIR DIPIVOXIL 854318 HEPSERA 10mg Comp. Bt 30 DIDANOSINE 858863 VIDEX Comp soluble 100mg Fl 60 # EFAVIRENZ 853527 STOCRIN Comp Pell 200 mg Bt 90 ENTECAVIR 503362 BARACLUDE Comp Pell 0.5mg Fl 30 503218 BARACLUDE Comp Pell 1mg Fl 30 INDINAVIR 850044 CRIXIVAN Gélule 400mg Bt 180 # LAMIVUDINE 500046 501877 501751 502098 EPIVIR Comp pell. 150mg Fl 60 # EPIVIR Susp or.10mg Fl 240ml # ZEFFIX Comp pell 100mg Bt 28 # ZEFFIX Sol Buv 5mg/ml Fl 240ml # LOPINAVIR+RITONAVIR 802429 KALETRA caps molles 133.33/33.3 MG Bt 180 RIBAVIRINE 852067 COPEGUS Comp 200 mg BT 28 502067 COPEGUS comp 200mg Bt 168 (Lié à l'achat de Pégasys) 501377 REBETOL Gelule 200 MG Bt 84 (lié à l'achat de VIRAFERON -PEG) Page 12 Caisse Nationale De L'Assurance Maladie mardi 25 Novembre 2014 LISTE DES SPECIALITES PHARMACEUTIQUES SOUMISES A L'ACCORD PREALABLE (CLASSEES PAR DCI) INFECTIOLOGIE Anti-viraux RIBAVIRINE 808830 801374 801377 508830 REBETOL Gelule 200mg Bt 140 # REBETOL Gélule 200mg Bt 168 # REBETOL Gélule 200mg Bt 84 # REBIF Gelule 200 MG BT 140 (lié à l'achat de VIRAFERON-PEG) STAVUDINE 853112 ZERIT Gelule 40mg Fl 60 ZIDOVUDINE 808427 RETROVIR Comp 100mg Bt 100 Immunoglobulines humaines IMMUNOGLOBULINES HUMAINES POLYVALENTES A USAGE IM 550004 550003 550015 550016 BERIGLOBIN P 2ml BERIGLOBIN P 5ml INTRAGLOBIN Fl 2.5gr Bt 1 INTRAGLOBIN Fl 5gr Bt 1 IMMUNOGLOBULINES HUMAINES POLYVALENTES A USAGE IV 550105 550103 550012 550011 551361 551281 INTRATEC 5GR INTRATECT 2,5 GR OCTAGAM 2,5 GR OCTAGAM 5 GR TEGELINE Pdre P PREP Inj 50 MG/ML FL+S/200ML +Set de Transfert TEGELINE 5GR METABOLISME ET NUTRITION Hypolipidémiants/Hypocholestérolémiants ATORVASTATINE 301267 301562 300894 301268 301563 300898 301196 301195 301392 301393 301197 301394 301514 301515 ATOR Comp Pell 10 mg Bt 56 ATOR Comp Pell 10 MG Bt 91 ATOR Comp Pell 10mg Bt 28 ATOR Comp Pell 40 mg Bt 56 ATOR Comp Pell 40 MG Bt 92 ATOR Comp Pell 40mg Bt 28 ATORVEX Comp Pell 20 mg Bt 30 ATORVEX Comp Pell 10 mg Bt 30 ATORVEX Comp Pell 10 mg Fl 90 ATORVEX Comp Pell 20 mg Fl 90 ATORVEX Comp Pell 40 mg Bt 30 ATORVEX Comp Pell 40 mg Fl 90 STATINOR Comp Pell 10 mg Bt 30 STATINOR Comp Pell 10 mg Bt 60 Page 13 Caisse Nationale De L'Assurance Maladie mardi 25 Novembre 2014 LISTE DES SPECIALITES PHARMACEUTIQUES SOUMISES A L'ACCORD PREALABLE (CLASSEES PAR DCI) METABOLISME ET NUTRITION Hypolipidémiants/Hypocholestérolémiants ATORVASTATINE 301516 301551 301552 301553 301852 301151 300884 301685 103529 301164 301632 103416 300789 309119 309061 309120 309121 309088 309122 309123 309033 309048 STATINOR Comp Pell 10 mg Bt 90 STATINOR Comp Pell 20 MG BT 30 STATINOR Comp Pell 20 MG Bt 60 STATINOR Comp Pell 20 MG Bt 90 STATINOR Comp Pell 40 MG BT 30 TAHOR Comp Pell 10mg Bt 91 TAHOR Comp Pell 10mg Bt 56 TAHOR Comp Pell 20 MG BT 28 TAHOR Comp Pell 20 mg Bt 28 TAHOR Comp Pell 40 mg BT 28 TAHOR Comp Pell 40 MG BT 91 TAHOR Comp Pell 80 mg Bt 28 TAHOR 10 mg comp.pell.Bt/28 TORVA Comp Pell 10 mg Bt 90 TORVA comp Pell 10mg Bt 60 TORVA Comp Pell 20 mg Bt 60 TORVA Comp Pell 20 mg Bt 90 TORVA Comp Pell 40 mg Bt 30 TORVA Comp Pell 40 mg Bt 60 TORVA Comp Pell 40 mg Bt 90 TORVA 10mg comp.pell Bt 30 TORVA 20mg comp.pell Bt 30 FLUVASTATINE 103519 LESCOL Comp LP 80 mg Bt 28 103021 LESCOL 20mg Gélule Bt 28 103022 LESCOL 40mg gélu.b/28 PRAVASTATINE 103346 PRAVASTATIN Comp 20mg Bt 30 301155 PRAVASTATINE WINTHROP Comp Sec 20 mg Bt 28 ROSUVASTATINE 104522 104521 301790 301508 301780 301509 301781 301658 301657 301778 301779 CRESTOR Comp Pell 10 MG BT 30 CRESTOR Comp Pell 20 MG BT 30 ROSUVASTATINE ZENTIVA Comp Pell Sec 10 MG BT 30 SUPERSTAT Comp Pell 10 mg Bt 30 SUPERSTAT Comp Pell 10 MG BT 90 SUPERSTAT Comp Pell 20 mg Bt 30 SUPERSTAT Comp Pell 20 MG BT 90 VISSEN Comp Pell 20 mg BT 30 VISSEN Comp Pell 10 MG BT 30 VISSEN Comp Pell 10 MG BT 90 VISSEN Comp Pell 20 mg BT 90 Page 14 Caisse Nationale De L'Assurance Maladie mardi 25 Novembre 2014 LISTE DES SPECIALITES PHARMACEUTIQUES SOUMISES A L'ACCORD PREALABLE (CLASSEES PAR DCI) METABOLISME ET NUTRITION Hypolipidémiants/Hypocholestérolémiants SIMVASTATINE 300901 301518 301800 301100 301519 301801 300643 301528 301683 301016 301414 301242 301243 300599 300600 301489 301488 300842 300659 300658 301461 301462 301463 301464 LIPICARD Comp Pel Sec 20mg Bt 28 LIPICARD Comp Pell Sec 20 mg Bt 56 LIPICARD Comp Pell Sec 20 MG BT 98 LIPICARD Comp Pell Sec 40 mg Bt 28 LIPICARD Comp Pell Sec 40 mg Bt 56 LIPICARD Comp Pell Sec 40 MG BT 98 REDULIP Comp pell 20mg Bt 30 REDULIP Comp Pell Sec 20 mg Bt 90 REDULIP Comp Pell Sec 40 MG BT 90 REDULIP 40mg Comp Pell Sec Bt 30 SIMVASTATINE WINTHROP Comp Pell 20 mg Bt 30 SIMVAX Comp Pell Sec 20 mg Bt 30 SIMVAX Comp Pell Sec 40 mg Bt 30 VASCOR Comp enr sec 10mg Bt 30 VASCOR Comp enr sec 20mg Bt 30 VASCOR Comp Pell Sec 40 mg Bt 90 VASCOR Comp Pell Sec 20 mg Bt 90 VASCOR 40mg comp.pell Bt 28 ZOVATIN Comp 20mg Bt 30 ZOVATIN Comp 40mg Bt 30 ZOVATIN 20 Comp Pell Sec 20 mg Bt 60 ZOVATIN 20 Comp Pell Sec 20 MG Bt 90 ZOVATIN 40 Comp Pell Sec 40 mg Bt 60 ZOVATIN 40 Comp Pell Sec 40 MG Bt 90 Insulines INSULINE ANALOGUE : DETEMIR 103183 LEVEMIR FLEXPEN 100 UI/ml Sol Inj Stylo 3ml Bt 5 INSULINE ANALOGUE : GLARGINE 102258 LANTUS Sol inj 100 UI/ml Carton.3ml Bt 5 103378 LANTUS SOLOSTAR 100UI/ML Sol Inj Bt 5 Stylos INSULINE ANALOGUE : INSULINE ASPARTATE 102865 NOVOMIX 30 FLEX-PEN Susp Inj 100UI/ml Bt 5 stylo/3ml 103314 NOVORAPID FLEXPEN 100 UI/ML Sol Inj Bt 5 Stylo/3ml INSULINE ANALOGUE:GLULISINE 103380 APIDRA SOLOSTAR 100 UI/ML Sol Inj Bt 5 Stylos Page 15 Caisse Nationale De L'Assurance Maladie mardi 25 Novembre 2014 LISTE DES SPECIALITES PHARMACEUTIQUES SOUMISES A L'ACCORD PREALABLE (CLASSEES PAR DCI) NEUROLOGIE - PSYCHATRIE Antidepresseurs CITALOPRAM 301256 CELOPRAM Comp Pell Sec 20 mg Bt 30 301255 CELOPRAM Sol Buv 40 mg/ml Fl 12 ml ESCITALOPRAM 301310 301667 301816 301813 103525 103231 104409 ESOPREX Comp Pell Sec 10 mg Bt 30 ESOPREX Comp Pell 10 mg Bt 15 PURLEX Comp Pell Sec 10 MG BT 30 RETABLISS Comp Pell 10 MG BT 30 SEROPLEX Comp Pell Sec 10 mg Bt 14 SEROPLEX Comp Pell Sec 10mg Bt 28 S-OROPRAM Comp Pell Sec 10 mg Bt 30 PAROXETINE 301277 301276 108466 103136 103139 300927 300985 301417 301416 104005 DEPROXYL Comp Pell Sec 20 mg Bt 30 DEPROXYL Comp Pell Sec 20 mg Bt 14 DEROXAT Comp pell 20mg Bt 14 DIVARIUS Comp Pell Sec 20mg Bt 14 DIVARIUS Comp PELL Sec 20mg Bt 28 PAREXAT Comp Pell Sec 20mg Bt 14 PAREXAT 20 mg Comp Bt 30 PAROXiNE Comp Pell Sec 20 mg Bt 28 PAROXINE Comp Pell Sec 20 mg Bt 14 PAXETIN Comp Pell Sec 20 mg Bt 30 SERTRALINE 309073 103520 103521 301397 301398 301198 301199 301200 301069 301060 301493 NETRAL 50 Comp Pell 50mg Bt 30 SERTRALINE ACTAVIS Comp Pell Sec 100 MG Bt 30 SERTRALINE ACTAVIS Comp Pell Sec 50 mg Bt 30 SERVAL Gelule 25 mg Bt 30 SERVAL Gelule 50 mg Bt 30 SOLOTIK Comp Pell Sec 50 MG fL 15 SOLOTIK Comp Pell Sec 50 mg Fl 30 SOLOTIK Comp Pell Se 100 mg Fl 15 ZOLIT Comp Pell Sec 50 mg Bt 15 ZOLIT Comp Pell Sec 50mg Bt 30 ZOLOFT Comp Pell Sec 50 MG Bt 15 VENLAFAXINE 102316 103518 301171 301173 301172 301388 301389 EFFEXOR GELULE LP 37,5mg Bt 30 EFFEXOR LP Gelule 75 mg Bt 30 TEDEMA Comp Pell 25 mg Bt 30 TEDEMA Comp Pell 50 mg Bt 30 TEDEMA Geule LP 37.5 MG Bt 30 ZENEXOR LP Gelule LP 37.5 mg Bt 30 ZENEXOR LP Gelule LP 75 MG Bt 30 Page 16 Caisse Nationale De L'Assurance Maladie mardi 25 Novembre 2014 LISTE DES SPECIALITES PHARMACEUTIQUES SOUMISES A L'ACCORD PREALABLE (CLASSEES PAR DCI) NEUROLOGIE - PSYCHATRIE Antiépileptiques GABAPENTINE 301761 301143 301008 301311 301576 301460 GABA Gelule 300 MG BT 50 GABA Gelule 300mg Bt 90 GABENTIN 300mg Gelule Bt 45 GABOREX Gelule 300 mg Bt 48 GABOREX Gelule 300 MG BT 96 NEURALGIN Gelule 300 mg Bt 90 LAMOTRIGINE 103392 100923 103171 101844 103174 LAMICTAL Comp Dis 50 mg Bt 30 LAMICTAL Comp Disp 100mg Bt 30 LAMICTAL Comp Disp 25mg Bt 30 LAMICTAL Comp Disp 5mg Bt 30 LAMICTAL Comp Disper 200mg Bt 30 LEVETIRACETAM 101721 KEPPRA Comp Pell 500 mg Bt 60 301809 LEVET Comp Pell 500 MG BT 60 PREGABALINE 103290 LYRICA Gelule 150mg Bt 56 103291 LYRICA Gelule 75mg Bt 14 VIGABATRIN 500270 SABRIL Comp 500mg Bt 60 # Antiparkinsoniens ATOMOXETINE 853811 853812 853813 853814 STRATTERA Gelule 10 mg Bt 28 STRATTERA Gelule 18 mg Bt 28 STRATTERA Gelule 25 mg Bt 28 STRATTERA Gelule 40 mg Bt 28 PRAMIPEXOLE 104239 104236 104238 104237 SIFROL Comp 0.18 mg BT 100 SIFROL Comp 0.18 mg Bt 30 SIFROL Comp 0.70 mg Bt 100 SIFROL Comp 0.70 mg Bt 30 ROPINIROLE 101007 REQUIP Comp pell 2mg Bt 21 101005 REQUIP Comp pell 5mg Bt 21 101004 REQUIP Comp 0.5mg Bt 21 Page 17 Caisse Nationale De L'Assurance Maladie mardi 25 Novembre 2014 LISTE DES SPECIALITES PHARMACEUTIQUES SOUMISES A L'ACCORD PREALABLE (CLASSEES PAR DCI) NEUROLOGIE - PSYCHATRIE Maladie d'ALZHEIMER DONEPEZIL 102045 102046 502046 502045 301764 301763 351005 351004 301005 301004 ARICEPT Comp Pell 10 mg Bt 28 ARICEPT Comp Pell 10mg Bt 28 ARICEPT Comp pell. 10mg Bt 28 # ARICEPT Comp pell. 5mg Bt 28 # ARIZIL Comp Pell 10 MG BT 30 ARIZIL Comp Pell 5 MG BT 30 DOPEZIL Comp Pell 10 mg BT 30 DOPEZIL Comp Pell 5 MG Bt 30 DOPEZIL 10mg Comp Pell Bt 30 DOPEZIL 5mg Comp Pell Bt 30 RIVASTIGMINE 508904 502479 502480 502481 EXELON Gélule 1.5 mg Bt 28 # EXELON Gélule 3 mg Bt 28 # EXELON Gélule 4.5 mg Bt 28 # EXELON Gélule 6 mg Bt 28 # Neuroleptiques AMISULPRIDE 103164 102415 301121 301122 300795 300754 SOLIAN Comp Sec 100mg Bt 30 SOLIAN Comp Pell Sec 400mg Bt 30 ZOLEN Comp Pell Sec 100 mg Bt 30 ZOLEN Comp Pell Sec 400 mg Bt 30 ZOLEN 200 mg comp.Bt 20 ZOLEN 200 mg comp.sec. Bt/60 ARIPIPRAZOLE 103420 ABILIFY Comp 15 mg Bt 28 103421 ABILIFY Comp 10 mg Bt 28 CLOZAPINE 503165 LEPONEX Comp Sec 100mg Bt 50 503167 LEPONEX 25MG Comp Sec Bt 50 OLANZAPINE 301759 309092 301758 309091 301861 301860 300871 300872 OLANZA Comp Pell 10 MG BT 30 OLANZA Comp Pell 10 mg Bt 30 OLANZA Comp Pell 5 MG BT 30 OLANZA Comp Pell 5 mg Bt 30 POLAR Comp Pell 10 MG BT 30 POLAR Comp Pell 5 MG BT 30 VAINCOR Comp Enro Séc 5mg Bt 28 VAINCOR Comp Enro Séca 10mg Bt 28 Page 18 Caisse Nationale De L'Assurance Maladie mardi 25 Novembre 2014 LISTE DES SPECIALITES PHARMACEUTIQUES SOUMISES A L'ACCORD PREALABLE (CLASSEES PAR DCI) NEUROLOGIE - PSYCHATRIE Neuroleptiques QUETIAPINE 103993 SEROQUEL Comp Pell 300 mg Bt 60 RISPERIDONE 309109 309977 103532 104432 101346 103053 301126 301668 301723 RAXIDONE Comp Pell Sec 2 mg Bt 30 RAXIDONE Comp Pell Sec 2mg Bt 60 RESPIROX Comp 2 mg Bt 20 RISDONE Sol Buv 1 MG/ML FL 100 ML RISPERDAL Comp sec 2mg Bt 60 RISPERDAL 1mg/ml sol.buv. Fl 60 ml RISPERIDONE Comp Pell 2 mg Bt 60 RISPERIDONE- TERIAK Comp Pell 2 MG BT 20 RISPERIDONE TERIAK Sol Buv 1MG/ML FL 60 ML Sclérose en plaques: Interféron INTERFERON BETA-1A 800210 854053 807829 808864 853795 854207 AVONEX Pdre Prép. Inj 6 Mui 1ml Bt 4 # BETAFERON Pdre P P Inj 250 mcg/ml Bt 15 REBIF Inj 22 µGR 6 MUI 0.5ml Bt 3 # REBIF Inj 44 µGR 12 mui 0.5ml Bt 12 # REBIF 22 µGR 6MUI Sol Inj BT 12 Seringues /0.5 ml REBIF 44 µg/0.5 ml Sol Inj Bt 4 Cartouches /1.5 ml Sclérose latérale amyotrophique RILUZOLE 850710 RILUTEK Comp 50mg Bt 56 # Toxine botulique TOXINE BOTULIQUE TYPE A 508838 BOTOX Pdre Inj 100 U Bt 1 # 807677 DYSPORT Pdre Prép. Inj 500 U FL Bt 2 # 807678 DYSPORT Pdre Prép. Inj 500 U FL vrac # OPHTALMOLOGIE produits divers d'ophtalmologie HYALURONATE DE SODIUM 502052 HEALON Sol IntraOcul 10mg/ml # Page 19 Caisse Nationale De L'Assurance Maladie mardi 25 Novembre 2014 LISTE DES SPECIALITES PHARMACEUTIQUES SOUMISES A L'ACCORD PREALABLE (CLASSEES PAR DCI) RHUMATOLOGIE Médic. d'appoint des affections rhumatologiques HYALURONATE DE SODIUM 100396 HYALGAN 20 mg/2 ml sol.inj.fl/2 ml 103798 SUPLASYN Sol Inj 20 mg/2ml Bt 1 Traitement de fond des rhumatismes inflammatoires ADALIMUMAB 803592 HUMIRA Sol INJ 40mg BT 2 Seringues ETANERCEPT 854284 ENBREL Sol In 50 MG BT 4Seringues Pré -Remplies 802984 ENBREL 25 mg SOL INJ /Fl Bt 4 Seringue Pré -Remplies LEFLUNOMIDE 102064 ARAVA Comp pell 10mg Bt 30 102062 ARAVA Comp pell 100mg Bt 3 102063 ARAVA Comp pell 20mg Bt 30 Traitement des ostéopathies ALENDRONATE + COLECALCIFEROL 103470 FOSAVANCE Comp 70mg/5600 UI Bt 4 ALENDRONATE ANHYDRE 300954 FOSALEN Comp 70 mg Bt 4 CLODRONATE 103866 508254 301054 351054 BONEFOS Comp Pell 800 mg Bt 100 BONEFOS Gélule 400mg Bt 100 # CLEDOS Gelule 400mg Bt 50 CLEDOS Gelule 400mg Bt 50 PAMIDRONATE 807241 800944 503397 503396 AREDIA Pdre Prép. Inj 15 mg 5ml Bt 4 # AREDIA Pdre Prép. Inj 90mg 10ml Bt 1 # OSTEPAM Sol P Perfusion 90mg/6ml Bt 1 Ampoule OSTEPAM Sol P Perfusion 15mg /ml Bt 4 Ampoules RALOXIFENE 101880 EVISTA 60 mg comp pell Bt 28 RANELATE DE STRONTIUM 103284 PROTELOS Pdre Susp Orle /Sachet 2gr Bt 28 RISEDRONATE 101926 ACTONEL Comp pell 30mg Bt 28 Page 20 Caisse Nationale De L'Assurance Maladie mardi 25 Novembre 2014 LISTE DES SPECIALITES PHARMACEUTIQUES SOUMISES A L'ACCORD PREALABLE (CLASSEES PAR DCI) RHUMATOLOGIE Traitement des ostéopathies RISEDRONATE 102371 101996 301184 301567 301236 301101 ACTONEL Comp 35mg Bt 4 ACTONEL Comp 5mg Bt 28 AKTONATE Comp Pell 35 mg BT 4 AKTONATE Comp Pell 35 mg Bt 12 OSTENEL Comp Pell 35 mg Bt 12 OSTENEL Comp Pell 35mg Bt 4 ZOLEDRONIQUE ACIDE 854266 ACLASTA Sol P Perfusion 5 MG/100ML FL 100 ML TOXICOLOGIE Chélateurs DEFERASIROX 503552 EXJADE Comp Dispersible 125 mg Bt 28 503553 EXJADE Comp Dispersible 250 mg Bt 28 503554 EXJADE Comp Dispersible 500 mg Bt 28 DEFERIPRONE 502347 FERRIPROX Comp Pell 500 MG Fl 100 DEFEROXAMINE 506270 DESFERAL Fl inj 500mg Bt 1+1(5ml) # Page 21
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