Product Details
Jamp Granisetron
Granisetron HCl1 mg
Tablet
DIN/PIN/NPN
02472686
Manufacturer
Jamp Pharma Corporation
Formulary Listing Date
2020-12-18
Unit Price
4.5000
Amount MOH Pays
4.5000
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
A04AA02
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02452359 | Nat-Granisetron | 4.5000 | 4.5000 |
| 02185881 | Kytril | NA | NA |
| 02472686 | Jamp Granisetron | 4.5000 | 4.5000 |
| 02308894 | Apo-Granisetron | 4.5000 | 4.5000 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 91 | 1 year | For the treatment of emesis in cancer patients receiving highly emetogenic chemotherapy. |
| 92 | 1 year | For patients receiving intravenous chemotherapy or radiation therapy who have not experienced adequate control with other available anti-emetics. |
| 93 | 1 year | For patients receiving intravenous chemotherapy or radiation therapy who experience intolerable side effects with other anti- emetics. |
| 326 | 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. Note: The therapeutic value of GRANISETRON HCL more than 24 hours after the last dose of chemotherapy is unproven. |
| 454 | 1 year | For the treatment of emesis in cancer patients receiving moderately emetogenic chemotherapy (MEC) regimens |