Product Details
Act Solifenacin
Solifenacin Succinate5 mg
Tablet
DIN/PIN/NPN
02422239
Manufacturer
Actavis Pharma Company
Formulary Listing Date
2015-11-26
Unit Price
0.3041
Amount MOH Pays
0.3041
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
G04BD08
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02277263 | Vesicare | 1.6892 | 0.3041 |
| 02397900 | Teva-Solifenacin | 0.3041 | 0.3041 |
| 02448335 | Solifenacin Succinate Tablets | 0.3041 | 0.3041 |
| 02458241 | Solifenacin | 0.3041 | 0.3041 |
| 02399032 | Sandoz Solifenacin | 0.3041 | 0.3041 |
| 02437988 | Ran-Solifenacin | 0.3041 | 0.3041 |
| 02493039 | PRZ-Solifenacin | 0.3041 | 0.3041 |
| 02417723 | PMS-Solifenacin | 0.3041 | 0.3041 |
| 02428911 | Jamp Solifenacin Succinate | 0.3041 | 0.3041 |
| 02424339 | Jamp-Solifenacin | 0.3041 | 0.3041 |
| 02446375 | Auro-Solifenacin | 0.3041 | 0.3041 |
| 02423375 | Apo-Solifenacin | 0.3041 | 0.3041 |
| 02422239 | Act Solifenacin | 0.3041 | 0.3041 |
| 02439344 | Ach-Solifenacin Succinate | 0.3041 | 0.3041 |
| 02529696 | M-Solifenacin Succinate | 0.3041 | 0.3041 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 290 | Indefinite | For patients with urinary frequency, urgency or urge incontinence who have: Failed to respond to behavioral techniques AND an adequate trial of oxybutynin with gradual dose escalation has shown to be either ineffective or resulted in unacceptable side effects. Note: If after a trial of 2 weeks patients continue to experience similar side effects and no greater efficacy than oxybutynin, continued therapy with this more costly agent should be reassessed. Antimuscarinic agents should be used with caution in the elderly due to potentially serious adverse effects (e.g. confusion, psychosis, acute urinary retention, constipation). Antimuscarinic agents should be avoided in older adults with pre-existing cognitive impairment (e.g., dementia) and those who are already using other drugs with significant anticholinergic effects (e.g., tricyclic antidepressants) in order to avoid a high overall anticholinergic drug burden. |