Product Details
Ondansetron
Ondansetron Hydrochloride4 mg
Tablet
DIN/PIN/NPN
02541424
Manufacturer
Sivem Pharmaceuticals ULC
Formulary Listing Date
2024-05-31
Unit Price
3.3495
Amount MOH Pays
2.5450
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
A04AA01
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02213567 | Zofran | 15.4760 | 2.5450 |
| 02376091 | Septa-Ondansetron | 3.3495 | 2.5450 |
| 02274310 | Sandoz Ondansetron | 3.3495 | 2.5450 |
| 02312247 | Ran-Ondansetron | 3.3495 | 2.5450 |
| 02258188 | PMS-Ondansetron | 3.3495 | 2.5450 |
| 02421402 | Ondansetron | 3.2720 | 2.5450 |
| 02417839 | Nat-Ondansetron | 3.3495 | 2.5450 |
| 02297868 | Mylan-Ondansetron | 3.3495 | 2.5450 |
| 02305259 | Mint-Ondansetron | 3.3495 | 2.5450 |
| 02371731 | Mar-Ondansetron | 3.3495 | 2.5450 |
| 02313685 | Jamp-Ondansetron | 3.3495 | 2.5450 |
| 02458810 | CCP-Ondansetron | 3.3495 | 2.5450 |
| 02288184 | Apo-Ondansetron | 3.3495 | 2.5450 |
| 02296349 | Teva-Ondansetron | 3.3495 | 2.5450 |
| 02478927 | Accel-Ondansetron | 2.5450 | 2.5450 |
| 02541424 | Ondansetron | 3.3495 | 2.5450 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 215 | 1 year | For the treatment of emesis in cancer patients receiving highly emetogenic chemotherapy |
| 216 | 1 year | For patients receiving intravenous chemotherapy or radiation therapy who have not experienced adequate control with other available anti-emetics |
| 217 | 1 year | For patients receiving intravenous chemotherapy or radiation therapy who experience intolerable side effects with other anti-emetics |
| 218 | 1 year | For the treatment of emesis in patients receiving radiation therapy which consists of single fraction treatment to the abdominal cavity, hemi-body irradiation and total body irradiation. |
| 454 | 1 year | For the treatment of emesis in cancer patients receiving moderately emetogenic chemotherapy (MEC) regimens |