Form To Be Filled By Psychiatrists In The Primary Health Care Centers When Prescribing For Specializ

ATC	Name	B/G	Ingredients	Dosage	Form	Price
D07AD01	DERMOVATE	B	Clobetasol (propionate) - 0.5mg/g	0.05% w/w	Ointment	290,270 L.L
L01ED04	ALUNBRIG	B	Brigatinib - 180mg	180mg	Tablet, film coated	474,793,952 L.L
L02BX03	ZYTIGA	B	Abiraterone acetate - 500mg	500mg	Tablet, film coated	69,627,132 L.L
N03AX16	LYRICA	B	Pregabalin - 75mg	75mg	Capsule	598,010 L.L
R01AD09	NASONEX	B	Mometasone furoate (monohydrate) - 50mcg/dose	0.05%	Spray, suspension	529,474 L.L
A07BA01	BIOCARBON	B	Activated charcoal - 250mg	250mg	Tablet	1,361,312 L.L
A10BH05	TRAJENTA	B	Linagliptin - 5mg	5mg	Tablet, film coated	3,213,127 L.L
C02LA51	ADELPHAN ESIDREX	B	Reserpine - 0.1mg, Hydrochlorothiazide - 10mg, Dihydralazine - 10mg		Tablet	371,157 L.L
C09BX02	COSYREL	B	Perindopril arginine - 10mg, Bisoprolol fumarate - 5mg		Tablet, film coated, scored	749,864 L.L
J01CR02	AUGMENTIN	B	Amoxicillin (trihydrate) - 500mg, Clavulanic Acid (potassium) - 125mg	625mg	Tablet	639,958 L.L
L01ED05	LORBRENA	B	Lorlatinib - 25mg	25mg	Tablet	134,559,469 L.L
N02AA59	DOLOSPASMINE COMP	B	Codeine phosphate - 40 mg, Hexahydro-adipenine HCl - 50 mg, Propyphenazone - 500 mg		Suppository	267,489 L.L
A07BA51	CARBOSYLANE	B	Simethicone (blue-red) - 45mg (blue-red), Activated charcoal (blue-red) - 140mg (blue-red)		Capsule	585,915 L.L
C03AA03	ESIDREX	B	Hydrochlorothiazide - 25mg	25mg	Tablet	380,115 L.L
C09CA01	COZAAR	B	Losartan potassium - 50mg	50mg	Tablet	1,420,634 L.L
L01ED05	LORBRENA	B	Lorlatinib - 100mg	100mg	Tablet	403,677,371 L.L
N06AB05	SEROXAT	B	Paroxetine (HCl) - 20mg	20mg	Tablet, film coated	1,586,205 L.L
L01EX01	SUTENT	B	Sunitinib maleate - 12.5mg	12.5mg	Capsule	L.L
A07BA51	EUCARBON	B	Rhubarbe - 25mg, Sulfur - 50mg, Senna - 105mg, Vegetal charcoal - 180mg		Tablet	795,555 L.L
C03BA04	HYGROTON	B	Chlortalidone - 50mg	50mg	Tablet	422,351 L.L
G04BE03	VIAGRA	B	Sildenafil (citrate) - 100mg	100mg	Tablet, film coated	2,089,675 L.L
L01EF01	IBRANCE	B	Palbociclib - 75mg	75mg	Capsule	172,164,216 L.L
N02AB03	DUROGESIC	B	Fentanyl - 16.8mg	100mcg/h	Patch	5,911,563 L.L
L01EX01	SUTENT	B	Sunitinib maleate - 50mg	50mg	Capsule	L.L
A07BC05	SMECTALIA	B	Diosmectite - 3g/sachet	3g/sachet	Powder for suspension	935,570 L.L
B01AX05	ARIXTRA	B	Fondaparinux sodium - 2.5mg/0.5ml	2.5mg/0.5ml	Injectable solution	5,341,774 L.L
C03BA11	FLUDEX	B	Indapamide - 1.5mg	1.5mg	Tablet, sustained release	517,379 L.L
J01MA02	CIPROBAY	B	Ciprofloxacine (HCl) - 500mg	500mg	Tablet, film coated	654,451 L.L
L01EF01	IBRANCE	B	Palbociclib - 75mg	75mg	Tablet, film coated	172,164,216 L.L
N02AB03	DUROGESIC	B	Fentanyl - 8.4mg	50mcg/h	Patch	3,019,614 L.L