Product Details

PMS-Amitriptyline

Amitriptyline
50 mg
Tablet

DIN/PIN/NPN

00654507

Manufacturer

Pharmascience Inc.

Formulary Listing Date

2015-04-30

Unit Price

0.1540

Amount MOH Pays

0.1540

Coverage Status

General Benefit

ODB Formulary Therapeutic Classification

28:16:04 Antidepressants

Therapeutic Note

NO

ATC Code

N06AA09

Interchangeable Products

DIN/ PIN/ NPN	Brand name	Unit Price	Amount MOH pays
02326078	Teva-Amitriptyline	0.1540	0.1540
00654507	PMS-Amitriptyline	0.1540	0.1540
02429896	Mar-Amitriptyline	0.1540	0.1540
00335088	Elavil	0.2347	0.1540

LU Clinical Criteria

NO

EAP Criteria

NO

Product Monograph

View Monograph