Product Details

Trispan

Triamcinolone Hexacetonide
20 mg/mL
Injectable Suspension
1-mL Ampoule Pack

DIN/PIN/NPN

02470632

Manufacturer

Medexus Inc.

Formulary Listing Date

2020-06-30  

Unit Price

18.0000

Amount MOH Pays

18.0000

Coverage Status

Limited Use Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

H02AB08

Interchangeable Products

NO  

LU Clinical Criteria

LU Code Auth. Period Clinical Criteria
580 Indefinite

For intra-articular, intrasynovial, or periarticular use in adults and adolescents for the symptomatic treatment of subacute and chronic inflammatory joint diseases including:

- Rheumatoid arthritis
- Juvenile Idiopathic Arthritis (JIA)*
- Osteoarthritis and post-traumatic arthritis
- Synovitis, tendinitis, bursitis and epicondylitis

*Note: triamcinolone hexacetonide injectable suspension may also be used as an intra-articular injection in children aged 3-12 years with Juvenile Idiopathic Arthritis.

 

EAP Criteria

NO

Product Monograph

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