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Dziennik Ustaw 1998 Nr 31 poz. 167 - Zm.: rozporządzenie w sprawie uprawnień do nabycia leku, preparatu diagnostycznego, artykułu sanitarnego i sprzętu jednorazowego użytku w przypadku niektórych chor
ROZPORZĄDZENIE MINISTRA ZDROWIA I OPIEKI SPOŁECZNEJ
z dnia 26 lutego 1998 r.
zmieniające rozporządzenie w sprawie uprawnień do nabycia leku, preparatu diagnostycznego, artykułu sanitarnego i sprzętu jednorazowego użytku w przypadku niektórych chorób.
(Dz. U. z dnia 10 marca 1998 r.)
Na podstawie art. 11 ust. 1 ustawy z dnia 27 września 1991 r. o zasadach odpłatności za leki i artykuły sanitarne (Dz. U. Nr 94, poz. 422, z 1994 r. Nr 111, poz. 535, z 1995 r. Nr 138, poz. 684, z 1996 r. Nr 139, poz. 646 oraz z 1997 r. Nr 80, poz. 502 i Nr 104, poz. 661) zarządza się, co następuje:
§ 1. W rozporządzeniu Ministra Zdrowia i Opieki Społecznej z dnia 2 sierpnia 1996 r. w sprawie uprawnień do nabycia leku, preparatu diagnostycznego, artykułu sanitarnego i sprzętu jednorazowego użytku w przypadku niektórych chorób (Dz. U. Nr 98, poz. 456 i Nr 154, poz. 756 oraz z 1997 r. Nr 135, poz. 920) załączniki nr 1-5 do rozporządzenia otrzymują brzmienie ustalone w załącznikach nr 1-5 do niniejszego rozporządzenia.
§ 2. Rozporządzenie wchodzi w życie z dniem 23 marca 1998 r.
ZAŁĄCZNIKI
ZAŁĄCZNIK Nr 1
WYKAZ LEKÓW DO BEZPŁATNEGO WYDAWANIA1 NA RECEPTY - CHORYM W LECZENIU: ___________ 1 do wysokości ustalonego limitu
Lp. | | | | | Nazwa | Postać i dawka | Kat. cen | Opakowanie, dla którego ustalono kategorię cen |
Mukowiscydozy |
1 | | | | | Acetylocysteinum | | | |
| | B | Rp. | | Acetylocysteina 0,1 | kaps. 0,1 g | c | 20 kaps. |
| | B | Rp. | | ACC 100 | granulat 100 mg | d | 20 saszetek po 3 g |
| | B | Rp. | | ACC 200 | granulat 200 mg | d | 20 saszetek po 3 g |
| | B | Rp. | | ACC 200 | kaps. 0,2 g | c | 20 kaps. |
| | B | Rp. | | ACC 100 | tabl. mus. 0,1 g | d | 20 tabl. |
| | B | Rp. | | ACC 200 | tabl. mus. 0,2 g | d | 20 tabl. |
| | B | Rp. | | ACC 600 | tabl. mus. 0,6 g | e | 20 tabl. |
| | B | Rp. | | Fluimucil | gran. 100 mg/sasz. | x | 20 sasz. a 1 g |
| | B | Rp. | | Fluimucil | gran. 200 mg/sasz. | x | 20 sasz. a 1 g |
| | B | Rp. | | Fluimucil | tabl. mus. 0,6 g | x | 10 tabl. |
| | B | Rp. | | Mucisol | proszek do sporz. roztw. (4,8 g n-acetylcysteinum) | c | 60 g |
| | B | Rp. | | Tussicom 100 granulat | granulat 100 mg/5 g | c | 20 saszetek po 5 g |
| | B | Rp. | | Tussicom 200 granulat | granulat 200 mg/5 g | c | 20 saszetek po 5 g |
2 | | | | | Ambroxoli hydrochloridum | | | |
| | B | Rp. | | Aflegan | inj. 0,015 g/2 ml | d | 10 amp. |
| | B | Rp. | | Ambrohexal | tab. 0,03 g | c | 20 tabl. |
| | B | Rp. | | Ambrohexal | inj. 0,015 g/2 ml | c | 5 amp. |
| | B | Rp. | | Ambrosol | syrop 15 mg/5 ml | b | 120 ml |
| | B | Rp. | | Ambrosol | syrop 30 mg/5 ml | b | 120 ml |
| | B | Rp. | | Ambroxol-Ratiopharm 15 | inj. 0,015 g/2 ml | d | 10 amp. |
| | B | Rp. | | Ambroksol | syrop 15 mg/5 ml | c | 150 ml |
| | B | Rp. | | Ambroksol | syrop 30 mg/5 ml | c | 150 ml |
| | B | Rp. | | Deflegmin | kaps. retard 75 mg | c | 10 kaps. |
| | B | Rp. | | Deflegmin | krople 0,75% | c | 50 ml |
| | B | Rp. | | Deflegmin | tabl. 0,03 g | b | 20 tabl. |
| | B | Rp. | | Mucosolvan | inj. 0,015 g/2 ml | d | 10 amp. |
| | B | Rp. | | Mucosolvan | tabl. 0,03 g | b | 20 tabl. |
| | B | Rp. | | Mucosolvan | syrop 30 mg/5 ml | c | 100 ml |
| | B | Rp. | | Mucosolvan | płyn do inh. 0,75 g/100 ml | d | 1 op. |
| | B | Rp. | | Mukobron | syrop 0,3 g/100 ml | b | 100 ml |
| | B | Rp. | | Mukobron | syrop 30 mg/5 ml | c | 100 ml |
| | B | Rp. | | Mukobron | tabl. 0,03 g | c | 50 tabl. |
| | B | Rp. | | Bronchopront Saft | syrop 15 mg/5 ml | c | 100 ml |
| | B | Rp. | | Bronchopront Tropfen | krople 7,5 mg/1 ml | c | 50 ml |
3 | | | | | Carbocisteinum | | | |
| | | Rp. | | Karbocistein | syrop 125 mg/5 ml | c | 200 ml |
| | | Rp. | | Karbocistein | syrop 250 mg/5 ml | d | 200 ml |
| | | Rp. | | Karbocistein | kaps. 375 mg | d | 32 kaps. |
| | | Rp. | | Mukolina 2% | syrop 2% | b | 120 ml |
| | | Rp. | | Mukolina 5% | syrop 5% | c | 120 ml |
| | | Rp. | | Mucodyne | kaps. 0,375 g | f | 100 kaps. |
| | | Rp. | | Mucodyne | syrop 5% | d | 200 ml |
| | | Rp. | | Mucopront | syrop 5% - 200 ml | e | 200 ml |
| | | Rp. | | Pectox | kaps. 0,35 g | x | 20 kaps. |
4 | | | | | Mesnum | | | |
| | B | Rp. | | Mistabron | płyn do inh. 0,6 g/3 ml | d | 5 amp. |
| | B | Rp. | | Mistabron | aerosol do nosa 12,5 ml | d | 1 op. |
| | B | Rp. | | Mucofluid | aerosol do nosa 12,5 ml | d | 1 op. |
5 | | | | | Pancreatinum | | | |
| | | Rp. | * | Kreon | kaps. 300 mg (8.000 j. lipazy) | d | 20 kaps. |
| | | Rp. | * | Panzytrat 10.000 | kaps. 10.000 j. lipazy | d | 20 kaps. |
Chorób nowotworowych |
6 | | | | | Aminoglutethimidum | | | |
| | B | Rp. | | Aminoglutethimid | tabl. 0,25 g | f | 100 tabl. |
7 | | | | | Amsacrinum | | | |
| | B | Rp. | | Amsacrine | inj. doż 75 mg/15 ml | f | 6 amp. + 6 fiol. rozp. |
| | B | Rp. | | Amsidyl | inj. doż. 0,05 g/ml konc. (0,085/1,7 ml) | f | 6 amp. + 6 fiol. rozp. |
8 | | | | | Asparaginasum | | | |
| | B | Rp. | | Kidrolase | inj. 10.000 j.m. | f | 10 fiol. |
9 | | | | | Azathioprinum | | | |
| | B | Rp. | | Azathioprine | tabl. 0,05 g | f,e | 50 tabl. |
| | B | Rp. | | Azamun | tabl. powl. 0,05 g | x | 50 tabl. powl. |
| | B | Rp. | | Imuran | tabl. 0,025 g | e | 100 tabl. |
| | B | Rp. | | Imuran | tabl. 0,05 g | f | 100 tabl. |
10 | | | | | Bleomycini hydrochloridum | | | |
| | B | Rp. | | Bleocin | inj. 0,015 g | f | 1 fiol. s. subst. |
11 | | | | | Buprenorphini hydrochloridum | | | |
| $ | B | Rp. | w | Bunondol | tabl. podjęz. 0,2 mg | e | 60 tabl. |
| $ | B | Rp. | w | Bunondol | tabl. podjęz. 0,4 mg | e | 30 tabl. |
| $ | B | Rp. | w | Temgesic | tabl. podjęz. 0,2 mg | e | 10 tabl. |
12 | | | | | Busulfanum | | | |
| | B | Rp. | | Myleran | tabl. 0,002 g | f | 25 tabl. |
13 | | | | | Calcii folinas | | | |
| | B | Rp. | | Calciumfolinat-Ebewe | inj. 0,003 g/ml | e | 10 amp. |
| | B | Rp. | | Calciumfolinat-Ebewe | inj. 0,03 g/3 ml | f | 5 amp. |
| | B | Rp. | | Calciumfolinat-Ebewe | inj. 0,1 g/10 ml | f | 5 amp. |
| | B | Rp. | | Calciumfolinat-Ebewe | inj. 0,2 g/10 ml | f | 5 amp. |
| | B | Rp. | | Calciumfolinat-Ebewe | kaps. 0,015 g | f | 20 kaps. |
| | B | Rp. | | Calciumfolinat-Ebewe | kaps. 0,1 g | f | 20 kaps. |
| | B | Rp. | | Leucovorin | tabl. 15 mg | x | 10 tabl. |
| | B | Rp. | | Leucovorin | inj. 10 mg/1 ml | x | 1 amp. |
| | B | Rp. | | Leucovorin | inj. 30 mg/3 ml | x | 1 amp. |
| | B | Rp. | | Leucovorin | inj. 50 mg/5 ml | x | 1 amp. |
| | B | Rp. | | Leucovorin | inj. 300 mg/30 ml | x | 1 fiol. |
| | B | Rp. | | Leucovorin-Ca | fiol. 0,01 g | f | 10 fiol. s. subst. |
| | B | Rp. | | Leucovorin-Ca | fiol. 0,025 g | f | 10 fiol. s. subst. |
| | B | Rp. | | Folinate de Calcium | inj. 0,0025 g/1 ml | x | 5 amp. 1 ml |
| | B | Rp. | | Folinate de Calcium | inj. 0,025 g/10 ml | f | 5 amp. 10 ml |
| | B | Rp. | | Antrex | tabl. 0,015 g | e | 30 tabl. |
14 | | | | | Carboplatinum | | | |
| | B | Rp. | | Cycloplatin | inj. 0,05 g | f | 10 fiol. |
| | B | Rp. | | Cycloplatin | inj. 0,2 g | f | 5 fiol. |
| | B | Rp. | | Paraplatin | inj. 0,15 g/15 ml | f | 1 fiol. |
| | B | Rp. | | Paraplatin | inj. 0,05 g/5 ml | f | 1 fiol. |
| | B | Rp. | | Paraplatin | inj. 0,45 g/45 ml | f | 1 fiol. |
15 | | | | | Chlorambucilum | | | |
| | B | Rp. | | Leukeran | tabl. 0,002 g | e | 25 tabl. |
| | B | Rp. | | Leukeran | tabl. 0,005 g | f | 25 tabl. |
16 | | | | | Chlormethini hydrochloridum | | | |
| | A | Rp. | | Nitrogranulogen | inj. 0,001 g/10 ml | d | 10 amp. s. subst. |
17 | | | | | Cisplatinum | | | |
| | B | Rp. | | Abiplatin | inj. 0,5 mg/ml-20 ml | d | 1 fiol. |
| | B | Rp. | | Abiplatin | inj. 0,5 mg/ml-50 ml | e | 1 fiol. |
| | B | Rp. | | Abiplatin | inj. 0,5 mg/ml-100 ml | e | 1 fiol. |
| | B | Rp. | | Abiplatin | inj. 0,5 mg/ml-200 ml | f | 1 fiol. |
| | B | Rp. | | Blastolem | inj. 0,01 g | d | 1 fiol. s. subst. + rozp. |
| | B | Rp. | | Blastolem | inj. 0,05 g | e | 1 fiol. s. subst. |
| | B | Rp. | | Cisplatin-Ebewe | inj. 0,01 g/20 ml | d | 1 fiol. |
| | B | Rp. | | Cisplatin-Ebewe | inj. 0,025 g/50 ml | e | 1 fiol. |
| | B | Rp. | | Cisplatin-Ebewe | inj. 0,05 g/100 ml | e | 1 fiol. |
| | B | Rp. | | Cisplatinum | inj. 0,01 g/20 ml | f | 10 fiol. |
| | B | Rp. | | Cisplatinum | inj. 0,025 g/50 ml | e | 1 fiol. |
| | B | Rp. | | Cisplatinum | inj. 0,05 g/100 ml | f | 1 fiol. |
| | B | Rp. | | Cisplatyl | inj. 0,01 g | f | 10 fiol. |
| | B | Rp. | | Cisplatyl | inj. 0,025 g | f | 10 fiol. |
| | B | Rp. | | Cisplatyl | inj. 0,05 g | f | 5 fiol. |
| | B | Rp. | | Platidiam | inj. 0,01 g | f | 10 fiol. |
| | B | Rp. | | Platidiam | inj. 0,025 g | f | 5 fiol. |
| | B | Rp. | | Platidiam | inj. 0,05 g | e | 1 fiol. |
| | B | Rp. | | Platamine | inj. 0,01 g | d | 1 fiol. |
| | B | Rp. | | Platamine | inj. 0,025 g | x | 1 fiol. |
| | B | Rp. | | Platamine | inj. 0,05 g | e | 1 fiol. |
| | B | Rp. | | Platinex | inj. 0,025 g/50 ml | f | 1 fiol. |
| | B | Rp. | | Platinol | inj. 0,01 g | e | 1 fiol. |
| | B | Rp. | | Platinol | inj. 0,05 g | f | 1 fiol. |
18 | | | | | Cyclophosphamidum | | | |
| | B | Rp. | | Cyclophosphamid | draż. 0,05 g | x | 50 draż. |
| | B | Rp. | | Endoxan-Asta | draż. 0,05 g | e | 50 draż. |
| | B | Rp. | | Endoxan-Asta, Endoxan | inj. 0,2 g | f | 10 fiol. s. subst. |
| | B | Rp. | | Endoxan-Asta | inj. 0,5 g | d | 1 fiol. |
| | B | Rp. | | Endoxan-Asta | inj. 1 g | e | 1 fiol. |
19 | | | | | Cytarabini hydrochloridum | | | |
| | B | Rp. | | Alexan | inj. 0,04 g/2 ml | e | 10 fiol. |
| | B | Rp. | | Alexan | inj. 0,1 g/5 ml | f | 10 fiol. s. subst. + rozp. |
| | B | Rp. | | Alexan | inj. 0,5 g/10 ml | e | 1 fiol. |
| | B | Rp. | | Alexan | inj. 1 g/ 20 ml | f | 1 fiol. |
| | B | Rp. | | Cytarabin | subst. liof. 0,1 g | f | 10 fiol., amp. |
| | B | Rp. | | Cytosar | inj. 0,1 g | d | 1 fiol. s. subst. + rozp. |
| | B | Rp. | | Cytosar | inj. 0,5 g | f | 1 fiol. liof. + rozp. |
| | B | Rp. | | Cytosar | inj. 1 g | f | 1 fiol. liof. |
20 | | | | | Dacarbazinum | | | |
| | A | Rp. | | DTIC, Deticene | inj. 0,1 g | f | 1 fiol. |
| | A | Rp. | | DTIC, Deticene | inj. 0,2 g | x | 1 fiol. |
21 | | | | | Daunorubicini hydrochloridum | | | |
| | B | Rp. | | Cerubidine | inj. 0,02 g | g | 10 fiol. s. subst. + rozp. |
22 | | | | | Doxorubicini hydrochloridum | | | |
| | B | Rp. | | Adriblastina RD | inj. 0,01 g | e | 1 fiol. s. subst. + rozp. |
| | B | Rp. | | Adriblastina RD | inj. 0,05 g | f | 1 fiol. s. subst. + rozp. |
| | B | Rp. | | Biorubina | liof. do inj. 0,01 g | e | 1 fiol. s. subst. + rozp. |
| | B | Rp. | | Doxolem | inj. 0,01 g | e | 1 fiol. s. subst. + rozp. |
| | B | Rp. | | Doxolem | inj. 0,05 g | e | 1 fiol. s. subst. |
| | B | Rp. | | Rastocin | inj. 0,01 g | f | 10 fiol. |
23 | | | | | Epirubicini hydrochloridum | | | |
| | B | Rp. | | Bioepicyna | inj. 0,01 g | x | 1 fiol. |
| | B | Rp. | | Farmarubicin RD | inj. 0,01 g | f | 1 fiol. s. subst. + rozp. |
| | B | Rp. | | Farmarubicin RD | inj. 0,05 g | f | 1 fiol. s. subst. + rozp. |
24 | | | | | Etoposidum | | | |
| | B | Rp. | | Lastet | kaps. 0,025 g | f | 40 kaps. |
| | B | Rp. | | Lastet | kaps. 0,05 g | f | 20 kaps. |
| | B | Rp. | | Lastet | kaps. 0,1 g | f | 10 kaps. |
| | B | Rp. | | Lastet | inj. 0,1 g/5 ml | f | 10 amp. |
| | B | Rp. | | Vepesid | kaps. 0,05 g | f | 20 kaps. |
| | B | Rp. | | Vepesid | kaps. 0,1 g | f | 10 kaps. |
| | B | Rp. | | Vepesid | inj. 0,1 g/5 ml | f | 10 amp. |
25 | | | | | Fluorouracilum | | | |
| | B | Rp. | | 5-Fluorouracil | inj. 0,25 g/5 ml | d | 10 amp. |
| | B | Rp. | | Fluroblastin | inj. 0,5 g/10ml | x | 2 amp. |
| | B | Rp. | | Fluroblastin | inj. 0,25 g/5 ml | x | 2 amp. |
| | B | Rp. | | Fluorouracil | inj. 0,25 g/5 ml | e | 5 amp. |
| | B | Rp. | | Fluorouracil | inj. 0,25 g/10 ml | x | 10 amp. |
26 | | | | | Flutamidum | | | |
| | B | Rp. | | Fugerel | tabl. 0,25 g | f | 100 tabl. |
| | B | Rp. | | Flutacan | tabl. 0,25 g | x | 50 tabl. |
| | B | Rp. | | Flutamid | tabl. 0,25 g | e | 100 tabl. |
27 | | | | | Hydroxycarbamidum | | | |
| | B | Rp. | | Hydroxycarbamid | kaps. 0,5 g | f | 100 kaps. |
28 | | | | | Ifosfamidum | | | |
| | B | Rp. | | Holoxan | inj. 0,2 g | f | 10 fl. |
| | B | Rp. | | Holoxan | inj. 0,5 g | f | 10 fl. |
| | B | Rp. | | Holoxan | inj. 1 g | f | 10 fl. |
| | B | Rp. | | Holoxan | inj. 2 g | f | 10 fl. |
| | B | Rp. | | Macdafen | inj. 0,5 g/24 ml | e | 1 fiol. |
| | B | Rp. | | Macdafen | inj. 1 g/50 ml | e | 1 fiol. |
| | B | Rp. | | Macdafen | inj. 2 g/50 ml | x | 1 fiol. |
29 | | | | | Levamisoli hydrochloridum | | | |
| | B | Rp. | | Decaris | tabl. 0,15 g | b | 1 tabl. |
| | B | Rp. | | Decaris | tabl. 0,05 g | b | 2 tabl. |
30 | | | | | Lomustinum | | | |
| | B | Rp. | | Cecenu | tabl., kaps. 0,04 g | x | 5 tabl., kaps. |
| | B | Rp. | | Lomustinum | tabl., kaps. 0,04 g | f | 5 tabl., kaps. |
31 | | | | | Melphalanum | | | |
| | B | Rp. | | Alkeran | tabl. 0,002 g | d | 25 tabl. |
| | B | Rp. | | Alkeran | tabl. 0,005 g | e | 25 tabl. |
32 | | | | | Mercaptopurinum | | | |
| | B | Rp. | | Mercaptopurinum | tabl. 0,05 g | d | 30 tabl. |
| | B | Rp. | | Puri-Nethol | tabl. 0,05 g | f | 25 tabl. |
33 | | | | | Methotrexatum | | | |
| | A | Rp. | | Methotrexat | inj. 0,005 g/2 ml | e | 10 amp. |
| | A | Rp. | | Methotrexat | inj. 0,02 g/2 ml | f | 10 amp. |
| | A | Rp. | | Methotrexat | inj. 0,05 g | f | 10 amp. |
| | A | Rp. | | Methotrexat | inj. 0,05 g/5 ml | f | 10 amp. |
| | A | Rp. | | Methotrexat | inj. 1 g | f | 10 amp. |
| | A | Rp. | | Methotrexat | inj. 1 g/20 ml | f | 10 amp. |
| | A | Rp. | | Methotrexat | tabl. 2,5 mg | f | 100 tabl. |
| | A | Rp. | | Methotrexat | tabl. 0,01 g | f | 100 tabl. |
| | A | Rp. | | Methotrexat | inj. 25 mg/ml | x | 1 amp. |
| | A | Rp. | | Methotrexat | inj. 50 mg/2 ml | x | 1 amp. |
| | A | Rp. | | Methotrexat | inf. 5 g/200 ml | x | 1 but. a 200 ml |
| | A | Rp. | | Methotrexat | inf. 0,5 g/20 ml | x | 1 but. a 20 ml |
| | A | Rp. | | Methotrexat | inf. 1,0 g/40 ml | x | 1 but. a 40 ml |
| | A | Rp. | | Methotrexate | fiol. 0,005 g | e | 10 fiol. |
| | A | Rp. | | Methotrexate | fiol. 0,02 g | f | 10 fiol. |
| | A | Rp. | | Methotrexate | fiol. 0,05 g | f | 10 fiol. |
| | A | Rp. | | Methotrexate | fiol. 0,5 g | f | 10 fiol. |
| | A | Rp. | | Methotrexate | tabl. 2,5 mg | d | 20 tabl. |
| | A | Rp. | | Methotrexate-Ebewe | inj. 0,005 g/1 ml | e | 10 amp. |
| | A | Rp. | | Methotrexate-Ebewe | inj. 0,01 g/1 ml | e | 10 amp. |
| | A | Rp. | | Methotrexate-Ebewe | inj. 0,05 g/5 ml | e | 5 amp. |
| | A | Rp. | | Methotrexate-Ebewe | inj. 0,5 g/5 ml | f | 5 amp. |
| | A | Rp. | | Methotrexate-Ebewe | inj. 1 g/10 ml | f | 1 amp. |
| | A | Rp. | | Methotrexate-Ebewe | inj. 5 g/50 ml | f | 1 amp. |
| | A | Rp. | | Trexan | tabl. 2,5 mg | e | 100 tabl. |
| | A | Rp. | | Trexan | inj. 0,005 g | f | 10 fiol. |
| | A | Rp. | | Trexan | inj. 25 mg/ml-20 ml | e | 1 fiol. |
| | A | Rp. | | Trexan | inj. 0,05 g | f | 10 fiol. |
34 | | | | | Mitomycin | | | |
| | B | Rp. | | Mitomycin C | fiol. 0,002 g | d | 10 fiol. |
| | B | Rp. | | Mitomycin C | fiol. 0,01 g | f | 10 fiol. |
| | B | Rp. | | Mitomycin C | fiol. 0,02 g | f | 10 fiol. |
35 | | | | | Mitoxantronum | | | |
| | B | Rp. | | Mitoxantrone | inj. 0,02 g/10 ml | e | 1 fiol. |
36 | | | | | Morphini hydrochloridum | | | |
| $ | N | Rp. | w | Morphinum hydrochloricum | inj. 0,01 g/1 ml | c | 10 amp. |
| $ | N | Rp. | w | Morphinum hydrochloricum | inj. 0,02 g/1 ml | d | 10 amp. |
| $ | N | Rp. | w | Morphinum hydrochloricum | lek recepturowy sporządz. z subst. o nazwie "morphinum hydrochloricum" | | |
37 | | | | | Prednisoni acetas | | | |
| | B | Rp. | | Encorton | tabl. 0,001 g | a | 20 tabl. |
| | B | Rp. | | Encorton | tabl. 0,005 g | a | 20 tabl. |
38 | | | | | Procarbazini hydrochloridum | | | |
| | B | Rp. | | Natulan | kaps. 0,05 g | f | 50 kaps. |
39 | | | | | Tamoxifeni citras | | | |
| @ | A | Rp. | | Nolvadex | tabl. 0,01 g | c | 30 tabl. |
| @ | A | Rp. | | Nolvadex D | tabl. powl. 0,02 g | e | 30 tabl. powl. |
| @ | A | Rp. | | Tamoxifen 10 Hexal | tabl. powl. 0,01 g | c | 30 tabl. powl. |
| @ | A | Rp. | | Tamoxifen 20 Hexal | tabl. powl. 0,02 g | e | 30 tabl. powl. |
| @ | A | Rp. | | Tamoxifen 30 Hexal | tabl. powl. 0,03 g | e | 30 tabl. powl. |
| @ | A | Rp. | | Tamoxifen 40 Hexal | tabl. powl. 0,04 g | e | 30 tabl. powl. |
| @ | A | Rp. | | Tamoxifen Ebewe | tabl. 0,01 g | x | 30 tabl. |
| @ | A | Rp. | | Tamoxifen Ebewe | tabl. 0,02 g | x | 30 tabl. |
| @ | A | Rp. | | Tamoxifen Ebewe | tabl. 0,03 g | x | 30 tabl. |
| @ | A | Rp. | | Tamoxifen | tabl., tabl. powl. 0,01 g | c | 30 tabl., tabl. powl. |
| @ | A | Rp. | | Tamofen | tabl. 0,01 g | e | 60 tabl. |
| @ | A | Rp. | | Tamofen | tabl. 0,02 g | e | 30 tabl. |
| @ | A | Rp. | | Tamofen | tabl. 0,04 g | x | 30 tabl. |
| @ | A | Rp. | | Zemide 10 | tabl. 0,01 g | c | 30 tabl. |
| @ | A | Rp. | | Zemide 20 | tabl. 0,02 g | e | 30 tabl. |
| @ | A | Rp. | | Zemide 30 | tabl. powl. 0,03 g | e | 30 tabl. powl. |
| @ | A | Rp. | | Zemide 40 | tabl. 0,04 g | e | 30 tabl. |
| @ | A | Rp. | | Zitazonium | tabl. 0,01 g | c | 30 tabl. |
40 | | | | | Teniposidum | | | |
| | B | Rp. | | Vumon | inj. 0,05 g/5 ml | f | 10 amp. |
41 | | | | | Tioguaninum | | | |
| | B | Rp. | | Lanvis | tabl. 0,04 g | f | 25 tabl. |
42 | | | | | Tramadoli hydrochloridum | | | |
| @ | B | Rp. | | Tramadol | czopek 0,1 g | c | 5 czopków |
| @ | B | Rp. | | Tramadol | kaps. 0,05 g | c | 20 kaps. |
| @ | B | Rp. | | Tramadol | inj. 0,05 g/1 ml | c | 5 amp. |
| @ | B | Rp. | | Tramadol | inj. 0,1 g/2 ml | c | 5 amp. |
| @ | B | Rp. | | Tramadol | krople 0,1 g/1 ml | c | 10 ml |
| @ | B | Rp. | | Tramal | kaps. 0,05 g | c | 20 kaps. |
| @ | B | Rp. | | Tramal | inj. 0,05 g/1 ml | c | 5 amp. |
| @ | B | Rp. | | Tramal | inj. 0,1 g/2 ml | c | 5 amp. |
| @ | B | Rp. | | Tramal | krople 0,1 g/1 ml | d | 96 ml |
| @ | B | Rp. | | Tramal | czopek 0,1 g | d | 5 czopków |
| @ | B | Rp. | | Trodon | kaps. 0,05 g | c | 20 kaps. |
| @ | B | Rp. | | Trodon | inj. 0,05 g/1 ml | d | 5 amp. |
| @ | B | Rp. | | Trodon | inj. 0,1 g/2 ml | d | 5 amp. |
| @ | B | Rp. | | Trodon | krople 0,1 g/1 ml | d | 10 ml |
| @ | B | Rp. | | Trodon | czopek 0,1 g | d | 5 czopków |
43 | | | | | Mesnum | | | |
| | B | Rp. | | Uromitexan | inj. 0,2 g/2 ml | e | 15 amp. |
| | B | Rp. | | Uromitexan | inj. 0,4 g/4 ml | f | 15 amp. |
| | B | Rp. | | Anti-Uron | inj. 0,2 g/2 ml | f | 50 amp. |
44 | | | | | Vinblastini sulfas | | | |
| | B | Rp. | | Vinblastin | inj. 0,005 g | f | 10 fiol. s. subst. + rozp. |
| | B | Rp. | | Velbe | inj. 0,01 g | e | 1 fiol. + rozp. |
45 | | | | | Vincristini sulfas | | | |
| | B | Rp. | | Vincristin | inj. 0,001 g | f | 10 fiol. s. subst. + rozp. |
| | B | Rp. | | Vincristin | inj. 0,5 mg | x | 10 fiol. s. subst. + rozp. |
| | B | Rp. | | Oncovin | inj. 0,001 g + rozp. | e | 1 fiol. s. subst. + rozp. |
Padaczki |
46 | | | | | Acidum valproicum | | | |
| @ | B | Rp. | | Convulex | kaps. 0,15 g | e | 100 kaps. |
| @ | B | Rp. | | Convulex | kaps. 0,3 g | e | 100 kaps. |
| @ | B | Rp. | | Convulex | kaps. 0,5 g | f | 100 kaps. |
| @ | B | Rp. | | Convulex | syrop. 0,05 g/1 ml-100 ml | d | 100 ml |
47 | | | | | Carbamazepinum | | | |
| @ | B | Rp. | | Amizepin | tabl. 0,2 g | c | 50 tabl. |
| @ | B | Rp. | | Tegretol | syrop 2% - 100 ml | d | 100 ml |
| @ | B | Rp. | | Tegretol | syrop 2% - 250 ml | e | 250 ml |
| @ | B | Rp. | | Tegretol CR 200 | tabl. 0,2 g | e | 50 tabl. |
| @ | B | Rp. | | Tegretol CR 400 | tabl. 0,4 g | e | 30 tabl. |
| @ | B | Rp. | | Neurotop retard | tabl. 0,3 g | e | 50 tabl. |
| @ | B | Rp. | | Neurotop retard | tabl. 0,6 g | f | 50 tabl. |
48 | | | | | Clonazepamum | | | |
| @ | B | Rp. | | Clonazepamum | tabl. 0,5 mg | a | 30 tabl. |
| @ | B | Rp. | | Clonazepamum | tabl. 0,002 g | a | 30 tabl. |
| @ | B | Rp. | | Clonazepamum | inj. 1 mg/1 ml | d | 10 amp. |
| @ | B | Rp. | | Antelepsin | tabl. 0,25 mg | c | 50 tabl. |
| @ | B | Rp. | | Antelepsin | tabl. 0,001 g | d | 50 tabl. |
| @ | B | Rp. | | Rivotril | tabl. 0,5 mg | c | 50 tabl. |
| @ | B | Rp. | | Rivotril | tabl. 0,002 g | e | 100 tabl. |
| @ | B | Rp. | | Rivotril | inj. 0,001 g | e | 5 amp. s. subst. + 5 rozp. |
49 | | | | | Ethosuximidum | | | |
| @ | B | Rp. | | Petinimid | kaps. 0,25 g | e | 100 kaps. |
| @ | B | Rp. | | Ronton | syrop 0,25 g/5 g | d | 150 g |
| @ | B | Rp. | | Suxinutin | kaps. 0,25 g | f | 100 kaps. |
50 | | | | | Magnesii valproas | | | |
| @ | B | Rp. | | Dipromal | tabl. powl. 0,2 g | d | 40 tabl. powl. |
51 | | | | | Natrii valproas | | | |
| @ | B | Rp. | | Vupral | płyn 20% | c | 30 ml |
| @ | B | Rp. | | Apilepsin | tabl. powl. 0,3 g | x | 100 tabl. powl. |
| @ | B | Rp. | | Depakine | tabl. powl. 0,2 g | d | 40 tabl. powl. |
| @ | B | Rp. | | Depakine | tabl. 0,3 g | f | 100 tabl. |
| @ | B | Rp. | | Depakine | tabl. powl. 0,5 g | e | 40 tabl. powl. |
| @ | B | Rp. | | Depakine | syrop 5,764 g/100 ml | d | 150 ml |
| @ | B | Rp. | | Sodium valproate | tabl.powl. 0,2 g | x | 100 tabl. powl. |
52 | @ | B | Rp. | | Depakine-Chrono | tabl. powl. 0,3 g | d | 30 tabl. powl. |
| @ | B | Rp. | | Depakine-Chrono 300 | tabl. 0,3 g | d | 30 tabl. powl. |
| @ | B | Rp. | | Depakine-Chrono | tabl. powl. 0,5 g | d | 30 tabl. |
| @ | B | Rp. | | Depakine-Chrono 500 | tabl. 0,5 g | d | 30 tabl. |
53 | | | | | Phenytoinum | | | |
| @ | B | Rp. | | Phenytoinum | tabl. 0,1 g | b | 60 tabl. |
54 | | | | | Promidonum | | | |
| @ | B | Rp. | | Mizodin | tabl. 0,25 g | c | 60 tabl. |
Miastenii |
55 | | | | | Ambenonii chloridum | | | |
| | B | Rp. | | Mytelase | tabl. 0,01 g | e | 100 tabl. |
56 | | | | | Neostigmini methylsulfas | | | |
| | A | Rp. | | Polstigminum | tabl. 0,015 g | c | 20 tabl. |
| | A | Rp. | | Polstigminum | inj. 0,5 mg/1 ml | b | 10 amp. |
57 | | | | | Pyridostigmini bromidum | | | |
| | B | Rp. | | Mestinon | draż. 0,06 g | f | 150 draż. |
Chorób psychicznych lub upośledzeń umysłowych |
58 | | | | | Amitriptilinum hydrochloridum | | | |
| @ | B | Rp. | | Amitriptilinum | draż. 0,01 g | b | 60 draż. |
| @ | B | Rp. | | Amitriptilinum | draż. 0,025 g | c | 60 draż. |
| @ | B | Rp. | | Amitriptilinum 2,5% | inj. 2,5%/2 ml | b | 5 amp. |
59 | | | | | Carbamazepinum | | | |
| @ | B | Rp. | | Amizepin | tabl. 0,2 g | c | 50 tabl. |
| @ | B | Rp. | | Neurotop retard | tabl. 0,3 g | e | 50 tabl. |
| @ | B | Rp. | | Neurotop retard | tabl. 0,6 g | f | 50 tabl. |
| @ | B | Rp. | | Tegretol | syrop 2% - 100 ml | d | 1 fl. |
| @ | B | Rp. | | Tegretol | syrop 2% - 250 ml | e | 1 fl. |
| @ | B | Rp. | | Tegretol CR 200 | tabl. 0,2 g | e | 50 tabl. |
| @ | B | Rp. | | Tegretol CR 400 | tabl. 0,4 g | e | 30 tabl. |
60 | | | | | Chlorprothixenum | | | |
| @ | B | Rp. | | Chlorprothixen | tabl. powl. 0,015 g | c | 50 tabl. |
| @ | B | Rp. | | Chlorprothixen | tabl. powl. 0,05 g | d | 50 tabl. |
61 | | | | | Chlorpromazini hydrochloridum | | | |
| @ | B | Rp. | | Fenactil | draż. 0,01 g | a | 30 draż. |
| @ | B | Rp. | | Fenactil | draż. 0,025 g | a | 20 draż. |
| @ | B | Rp. | | Fenactil | draż. 0,1 g | a | 30 draż. |
| @ | B | Rp. | | Fenactil | krople 4% | a | 10 g |
| @ | B | Rp. | | Fenactil | inj. dom. 0,025 g/5 ml | b | 5 amp. |
62 | | | | | Clomipramini hydrochloridum | | | |
| @ | B | Rp. | | Anafranil | tabl. powl. 0,025 g | d | 30 tabl. powl. |
| @ | B | Rp. | | Anafranil | tabl. powl. 0,01 g | d | 30 tabl. powl. |
| @ | B | Rp. | | Anafranil SR 75 | tabl. 0,075 g | e | 20 tabl. |
| @ | B | Rp. | | Anafranil | inj. 0,025 g/2 ml | e | 10 amp. |
| @ | B | Rp. | | Hydiphen | draż. 0,025 g | e | 50 draż. |
| @ | B | Rp. | | Hydiphen | inj. 0,025 g/2 ml | e | 10 amp. |
63 | | | | | Clozapinum | | | |
| @ | B | Rp. | | Clocinol | tabl. 0,025 g | x | 20 tabl. |
| @ | B | Rp. | | Clocinol | tabl. 0,1 g | x | 20 tabl. |
| @ | B | Rp. | | Klozapol | tabl. 0,025 g | d | 50 tabl. |
| @ | B | Rp. | | Klozapol | tabl. 0,1 g | e | 50 tabl. |
| @ | B | Rp. | | Leponex | tabl. 0,025 g | e | 50 tabl. |
| @ | B | Rp. | | Leponex | tabl. 0,1 g | f | 50 tabl. |
64 | | | | | Desipraminum | | | |
| | B | Rp. | | Petylyl | draż. 0,025 g | d | 50 draż. |
65 | | | | | Dibenzepini hydrochloridum | | | |
| | B | Rp. | | Noveril | tabl. 0,24 g | e | 20 tabl. |
66 | | | | | Flupentixoli dihydrochloridum | | | |
| @ | B | Rp. | | Fluanxol | draż. 0,5 mg | d | 50 draż. |
| @ | B | Rp. | | Fluanxol | draż. 0,003 g | e | 50 draż. |
67 | | | | | Flupentixoli decanoas | | | |
| @ | B | Rp. | | Fluanxol Depot | inj. 0,02 g/1 ml | f | 10 amp. |
| @ | B | Rp. | | Fluanxol Depot | inj. 0,04 g/2 ml | f | 10 amp. |
68 | | | | | Fluphenazini caprinoas | | | |
| @ | A | Rp. | | Mirenil prolongatum | inj. 0,025 g/1 ml | c | 5 amp. |
69 | | | | | Fluphenazini dihydrochloridum | | | |
| @ | A | Rp. | | Mirenil | draż. 0,25 mg | a | 60 draż. |
| @ | A | Rp. | | Mirenil | draż. 0,001 g | b | 60 draż. |
| @ | A | Rp. | | Mirenil | inj. 0,001 g/1 ml | b | 10 amp. |
70 | | | | | Haloperidolum | | | |
| @ | B | Rp. | | Apo-Haloperidol | tabl. 0,0005 g | x | 100 tabl. |
| @ | B | Rp. | | Apo-Haloperidol | tabl. 0,001 g | x | 100 tabl. |
| @ | B | Rp. | | Apo-Haloperidol | tabl. 0,002 g | x | 100 tabl. |
| @ | B | Rp. | | Apo-Haloperidol | płyn 0,002 g/1 ml | x | 15 ml |
| @ | B | Rp. | | Decaldol | płyn 0,05 g/1 ml-1 ml | e | 5 amp. a 1 ml |
| @ | B | Rp. | | Decaldol | płyn 0,05 g/1 ml-3 ml | e | 5 amp. a 3 ml |
| @ | B | Rp. | | Haldol | tabl. 0,002 g | x | 25 tabl. |
| @ | B | Rp. | | Haldol | inj. 0,005 g/1 ml | x | 10 amp. |
| @ | B | Rp. | | Haldol | krople 0,002 g/ml | x | 15 ml |
| @ | B | Rp. | | Haldol | krople 0,01 g/ml | x | 30 ml |
| @ | B | Rp. | | Haloperidol | tabl. 0,001 g | a | 40 tabl. |
| @ | B | Rp. | | Haloperidol | tabl. 0,005 g | x | 30 tabl. |
| @ | B | Rp. | | Haloperidol | tabl. 0,01 g | x | 20 tabl. |
| @ | B | Rp. | | Haloperidol | krople 0,002 g/1 ml | a | 10 ml |
| @ | B | Rp. | | Haloperidol | inj. 0,005 g/1 ml | c,d | 5 amp. |
| @ | B | Rp. | | Haloperidol | tabl. 1,5 mg | x | 50 tabl. |
| @ | B | Rp. | | Haloperidol Decanoat | inj. 0,05 g/1 ml-1 ml | f | 5 amp. |
| @ | B | Rp. | | Haloperidol-Ratiopharm | krople 0,002 g/1 ml | d | 30 ml |
| @ | B | Rp. | | Haloperidol-Radiopharm 5 | inj. 0,005 g/ml-1 ml | d | 5 amp. |
71 | | | | | Imipramini hydrochloridum | | | |
| @ | B | Rp. | | Imipramin | draż. 0,01 g | a | 20 draż. |
| @ | B | Rp. | | Imipramin | draż. 0,025 g | a | 20 draż. |
| @ | B | Rp. | | Imipramin | inj. 0,025 g/2 ml | c | 10 amp. |
| @ | B | Rp. | | Melipramin | draż. 0,01 g | x | 50 draż. |
| @ | B | Rp. | | Melipramin | draż. 0,025 g | x | 50 draż. |
| @ | B | Rp. | | Melipramin | inj. 0,025 g/2 ml | x | 10 amp. |
72 | | | | | Levomepromazini hydromaleas | | | |
| @ | B | Rp. | | Tisercin | tabl. powl. 0,025 g | c | 50 tabl. powl. |
| @ | B | Rp. | | Tisercin | inj. 0,025 g/1 ml | c | 10 amp. |
73 | | | | | Lithii carbonas | | | |
| @ | B | Rp. | | Lithium carbonicum | tabl. 0,25 g | c | 60 tabl. |
74 | | | | | Perazini dimaleas | | | |
| @ | B | Rp. | | Pernazinum | tabl. 0,025 g | a | 20 tabl. |
| @ | B | Rp. | | Pernazinum | tabl. 0,1 g | c | 30 tabl. |
| @ | B | Rp. | | Taxilan | draż. 0,025 g | x | 25 draż. |
| @ | B | Rp. | | Taxilan | inj. 80,64 mg/2 ml | d | 10 amp. |
75 | | | | | Perphenazinum | | | |
| @ | B | Rp. | | Trilafon | draż. 0,008 g | d | 100 draż. |
| @ | B | Rp. | | Trilafon | inj. 0,005 g/1 ml | e | 10 amp. |
76 | | | | | Perphenazini enanthas | | | |
| @ | B | Rp. | | Trilafon enanthate | inj. 0,1 g/1 ml | f | 10 amp. |
77 | | | | | Prochlorperazini dimaleas | | | |
| @ | B | Rp. | | Chloropernazinum | tabl. 0,01 g | b | 20 tabl. |
78 | | | | | Promazini hydrochloridum | | | |
| @ | B | Rp. | | Promazin | draż. 0,025 g | b | 60 draż. |
| @ | B | Rp. | | Promazin | draż. 0,05 g | c | 60 draż. |
| @ | B | Rp. | | Promazin | draż. 0,1 g | c | 60 draż. |
| @ | B | Rp. | | Promazin | inj. 0,1 g/2 ml | c | 10 amp. |
79 | | | | | Sulpiridum | | | |
| @ | B | Rp. | | Eglonyl | kaps. 0,05 g | x | 30 kaps. |
| @ | B | Rp. | | Eglonyl forte | tabl. 0,2 g | x | 12 tabl. |
| @ | B | Rp. | | Eglonyl | inj. 0,01 g/2 ml | x | 1 amp. |
| @ | B | Rp. | | Eglonyl | syrop 0,5 g/100 ml | x | 120 ml |
| @ | B | Rp. | | Meresa 50 | kaps. 0,05 g | x | 20 kaps. |
| @ | B | Rp. | | Meresa 200 | tabl. 0,2 g | x | 20 tabl. |
| @ | B | Rp. | | Meresa | inj. 0,1 g/3 ml | x | 6 amp. |
| @ | B | Rp. | | Sulpirid | kaps. 0,05 g | x | 30 kaps. |
| @ | B | Rp. | | Sulpirid | tabl., kaps. 0,2 g | x | 12 tabl., kaps. |
| @ | B | Rp. | | Sulpirid | inj. 0,1 g/2 ml | x | 1 amp. |
| @ | B | Rp. | | Sulpiryd | syrop 0,5 g/100 ml | b | 1 fl. |
| @ | B | Rp. | | Sulpiryd | syrop 2,0 g/100 ml | b | 1 fl. |
| @ | B | Rp. | | Sulpiryd | kaps. 0,05 g | b | 24 kaps. |
| @ | B | Rp. | | Sulpiryd | kaps. 0,1 g | b | 24 kaps. |
| @ | B | Rp. | | Sulpiryd | tabl. 0,2 g | b | 12 tabl. |
| @ | B | Rp. | | Sulpiryl | kaps. 0,05 g | x | 30 kaps. |
| @ | B | Rp. | | Sulpiryl | tabl. 0,2 g | x | 12 tabl. |
80 | | | | | Thioridazini hydrochloridum | | | |
| @ | B | Rp. | | Thioridazin | draż. 0,01 g | a | 30 draż. |
| @ | B | Rp. | | Thioridazin 25 mg | draż. 0,025 g | a | 20 draż. |
| @ | B | Rp. | | Thioridazin | draż. 0,1 g | a | 20 draż. |
| @ | B | Rp. | | Thioridazin prolongatum | tabl. 0,2 g | d | 20 tabl. |
81 | | | | | Trifluoperazini dihydrochloridum | | | |
| @ | B | Rp. | | Apo-Trifluoperazine | tabl. powl. 0,001 g | c | 100 tabl. powl. |
| @ | B | Rp. | | Apo-Trifluoperazine | tabl. powl. 0,002 g | c | 100 tabl. powl. |
| @ | B | Rp. | | Apo-Trifluoperazine | tabl. powl. 0,005 g | c | 100 tabl. powl. |
| @ | B | Rp. | | Apo-Trifluoperazine | tabl. powl. 0,01 g | c | 100 tabl. powl. |
| @ | B | Rp. | | Apo-Trifluoperazine | tabl. powl. 0,02 g | d | 100 tabl. powl. |
| @ | B | Rp. | | Stelazine | draż. 0,005 g | d | 50 draż. |
| @ | B | Rp. | | Terfluzine | draż. 0,01 g | c | 20 draż. |
82 | | | | | Trihexyphenidyli hydrochloridum | | | |
| @ | B | Rp. | w | Parkopan 2 | tabl. 0,002 g | c | 100 tabl. |
| @ | B | Rp. | w | Parkopan 5 | tabl. 0,005 g | d | 100 tabl. |
83 | | | | | Valpromidum | | | |
| @ | B | Rp. | | Depamide | draż. 0,3 g | e | 30 draż. |
84 | | | | | Zuclopenthixoli decanoate | | | |
| @ | B | Rp. | | Clopixol Depot | inj. 0,2 g/1 ml | d | 1 amp. |
85 | | | | | Zuclopenthixoli dihydrochloridum | | | |
| @ | B | Rp. | | Clopixol | tabl. 0,01 g | e | 100 tabl. |
| @ | B | Rp. | | Clopixol | tabl. 0,025 g | f | 100 tabl. |
Karłowatości przysadkowej u dzieci |
86 | | | | | Somatropinum | | | |
| | B | Rp. | | Genotropin | inj. 4 j.m. | x | 1 fiol. s. subst. + rozp. |
| | B | Rp. | | Genotropin | inj. 16 j.m. | x | 1 fiol. s. subst. + rozp. |
| | B | Rp. | | Grorm | inj. 2 j.m. | x | 6 fiol. s. subst. + rozp. |
| | B | Rp. | | Grorm | inj. 4 j.m. | x | 1 fiol. s. subst. + rozp. |
| | B | Rp. | | Humatrope | inj. 4 j.m. | x | 6 fiol. s. subst. + rozp. |
| | B | Rp. | | Norditropin Pen Set 12 | fiol. 12 j.m. | x | 1 fiol. s. subst. + rozp. |
| | B | Rp. | | Norditropin Pen Set 24 | fiol. 24 j.m. | x | 1 fiol. s. subst. + rozp. |
| | B | Rp. | | Saizen | inj. 4 j.m. | x | 1 fiol. s. subst. + rozp. |
| | B | Rp. | | Saizen | inj. 10 j.m. | x | 1 fiol. s. subst. + rozp. |
Gruźlicy |
87 | | | | | Capreomycini sulfas | | | |
| | B | Rp. | | Capastat | inj. 1 g | f | 1 fiol. s. subst. |
88 | | | | | Ethambutoli dihydrochloridum | | | |
| | B | Rp. | | Ethambutol | kaps. 0,25 g | e | 250 kaps. |
89 | | | | | Ethionamidum | | | |
| | B | Rp. | | Ethionamid | draż. 0,25 g | x | 100 draż. |
90 | | | | | Isoniazidum | | | |
| @ | B | Rp. | | Isoniazidum | tabl. 0,05 g | b | 100 tabl. |
91 | | | | | Pyrazinamidum | | | |
| | | Rp. | | Pyrazinamid | tabl. 0,5 g | d | 250 tabl. |
92 | | B | Rp. | | Rifamazid | kaps. 0,15 g | e | 100 kaps. |
| | B | Rp. | | Rifamazid | kaps. 0,3 g | f | 100 kaps. |
93 | | | | | Rifampicinum | | | |
| | B | Rp. | | Rifampicin | kaps. 0,15 g | d | 100 kaps. |
| | B | Rp. | | Rifampicin | kaps. 0,3 g | e | 100 kaps. |
94 | | | | | Rifamycinum | | | |
| | B | Rp. | | Rifocin | inj. dom. 0,25 g/3 ml | f | 10 amp. |
| | B | Rp. | | Rifogal | inj. dom. 0,25 g/3 ml | e | 5 amp. |
95 | | | | | Streptomycini sulfas | | | |
| | B | Rp. | | Streptomycinum | inj. 1 g | a | 1 fiol. z suchą subst. |
Cukrzycy |
96 | | | | | Glibenclamidum | | | |
| | B | Rp. | | Euclamin | tabl. 0,005 g | a | 60 tabl. |
97 | | | | | Glicliazidum | | | |
| | B | Rp. | | Diaprel | tabl. 0,08 g | e | 60 tabl. |
| | B | Rp. | | Diabrezide | tabl. 0,08 g | d | 40 tabl. |
| | B | Rp. | | Glinormax | tabl. 0,08 g | x | 60 tabl. |
| | B | Rp. | | Diabezid | tabl. 0,08 g | x | 60 tabl. |
98 | | | | | Glipolamidum | | | |
| | B | Rp. | | Glipolamid | tabl. 0,03 g | d | 60 tabl. |
99 | | | | | Glipizidum | | | |
| | B | Rp. | | Minidiab | tabl. 0,005 g | d | 30 tabl. |
| | B | Rp. | | Glibenese | tabl. 0,005 g | d | 30 tabl. |
100 | | | | | Gliquidonum | | | |
| | B | Rp. | | Glurenorm | tabl. 0,03 g | e | 50 tabl. |
101 | | | | | Glucagoni hydrochloridum | | | |
| | B | Rp. | | Glucagon | inj. 0,001 g | e | 1 fiol. s. subst. + rozp. |
| | B | Rp. | | Glucagon zestaw natychmiastowej pomocy | liof. 0,001 g + strzyk. z rozp. | f | 1 fiol. |
| | B | Rp. | | GlucaGen 1 mg HypoKit | liof. do inj. 1 mg/1 ml | f | 1 fiol. a 1 mg + strzyk. z rozp. a 1 ml |
| | B | Rp. | | GlucaGen 1 mg | liof. do inj. 1 mg/1 ml | f | 1 fiol. a 1 mg + rozp. a 1 ml |
102 | | | | | Insuliny chromatograficznie oczyszczone | | | |
| | B | Rp. | | Insulinum Maxirapid ChOS | fiol. 80 j.m./1 ml-10 ml | d | fiol. 10 ml |
| | B | Rp. | | Insulinum Sol. Neutralis ChOS | fiol. 80 j.m./1 ml-10 ml | d | fiol. 10 ml |
| | B | Rp. | | Insulinum Semilente ChOS | fiol. 80 j.m./1 ml-10 ml | d | fiol. 10 ml |
| | B | Rp. | | Insulinum Isophanicum ChOS | fiol. 80 j.m./1 ml-10 ml | d | fiol. 10 ml |
| | B | Rp. | | Insulinum Lente ChOS | fiol. 80 j.m./1 ml-10 ml | d | fiol. 10 ml |
| | B | Rp. | | Insulinum Ultralente ChOS | fiol. 80 j.m./1 ml-10 ml | d | fiol. 10 ml |
| | B | Rp. | | Insuline Semi Tardum | fiol. 40 j.m./1 ml-10 ml | x | fiol. 10 ml |
| | B | Rp. | | Insuline Tardum MX | fiol. 40 j.m./1 ml-10 ml | x | fiol. 10 ml |
| | B | Rp. | | N.P.H. Endopacrine Protamine Cristallisee | fiol. 40 j.m./1 ml-10 ml | x | fiol. 10 ml |
| | B | Rp. | | Orgasuline Ordinaire Insuline Humaine | fiol. 40 j.m./1 ml-10 ml | x | fiol. 10 ml |
| | B | Rp. | | Endopacrine | fiol. 40 j.m./1 ml-10 ml | x | fiol. 10 ml |
| | B | Rp. | | Orgasuline NPH Humaine | fiol. 40 j.m./1 ml-10 ml | x | fiol. 10 ml |
| | B | Rp. | | Insulin Minilente SPP | fiol. 40 j.m./1 ml-10 ml | x | fiol. 10 ml |
| | B | Rp. | | Insulin Superlente SPP | fiol. 40 j.m./1 ml-10 ml | x | fiol. 10 ml |
| | B | Rp. | | Inutral SPP | fiol. 40 j.m./1 ml-10 ml | x | fiol. 10 ml |
| | | | | Insuliny wysokooczyszczone pochodzenia zwierzęcego | | | |
| | B | Rp. | | Insulinum Maxirapid WOS | fiol. 40 j.m./1 ml-10 ml | x | fiol. 10 ml |
| | B | Rp. | | Insulinum Maxirapid WOS | fiol. 80 j.m./1 ml-10 ml | e | fiol. 10 ml |
| | B | Rp. | | Insulinum Sol. Neutralis WOS | fiol. 40 j.m./1 ml-10 ml | x | fiol. 10 ml |
| | B | Rp. | | Insulinum Sol. Neutralis WOS | fiol. 80 j.m./1 ml-10 ml | e | fiol. 10 ml |
| | B | Rp. | | Insulinum Semilente WOS | fiol. 40 j.m./1 ml-10 ml | x | fiol. 10 ml |
| | B | Rp. | | Insulinum Semilente WOS | fiol. 80 j.m./1 ml-10 ml | e | fiol. 10 ml |
| | B | Rp. | | Insulinum Isophanicum WOS | fiol. 40 j.m./1 ml-10 ml | x | fiol. 10 ml |
| | B | Rp. | | Insulinum Isophanicum WOS | fiol. 80 j.m./1 ml-10 ml | e | fiol. 10 ml |
| | B | Rp. | | Insulinum Lente WOS | fiol. 40 j.m./1 ml-10 ml | x | fiol. 10 ml |
| | B | Rp. | | Insulinum Lente WOS | fiol. 80 j.m./1 ml-10 ml | e | fiol. 10 ml |
| | B | Rp. | | Insulinum Ultralente WOS | fiol. 40 j.m./1 ml-10 ml | x | fiol. 10 ml |
| | B | Rp. | | Insulinum Ultralente WOS | fiol. 80 j.m./1 ml-10 ml | e | fiol. 10 ml |
| | B | Rp. | | Insulin Actrapid MC | fiol. 40 j.m./1 ml-10 ml | e | fiol. 10 ml |
| | B | Rp. | | Insulin Actrapid MC | fiol. 80 j.m./1 ml-10 ml | e | fiol. 10 ml |
| | B | Rp. | | Insulin Semilente MC | fiol. 40 j.m./1 ml-10 ml | e | fiol. 10 ml |
| | B | Rp. | | Insulin Semilente MC | fiol. 80 j.m./1 ml-10 ml | e | fiol. 10 ml |
| | B | Rp. | | Insulin Lente MC | fiol. 40 j.m./1 ml-10 ml | e | fiol. 10 ml |
| | B | Rp. | | Insulin Lente MC | fiol. 80 j.m./1 ml-10 ml | e | fiol. 10 ml |
| | B | Rp. | | Insulin Ultralente MC | fiol. 40 j.m./1 ml-10 ml | e | fiol. 10 ml |
| | B | Rp. | | Insulin Ultralente MC | fiol. 80 j.m./1 ml-10 ml | e | fiol. 10 ml |
| | B | Rp. | | Insulin Monotard MC | fiol. 40 j.m./1 ml-10 ml | e | fiol. 10 ml |
| | B | Rp. | | Insulin Monotard MC | fiol. 80 j.m./1 ml-10 ml | e | fiol. 10 ml |
| | B | Rp. | | Iletin II R (Pork) | fiol. 40 j.m./1 ml-10 ml | d | fiol. 10 ml |
| | B | Rp. | | Iletin II NPH (Pork) | fiol. 40 j.m./1 ml-10 ml | d | fiol. 10 ml |
| | B | Rp. | | Iletin II Lente (Pork) | fiol. 40 j.m./1 ml-10 ml | d | fiol. 10 ml |
| | B | Rp. | | Iletin II Protamine Zinc. (Pork) | fiol. 40 j.m./1 ml-10 ml | d | fiol. 10 ml |
| | | | | Insuliny wysokooczyszczone ludzkie | | | |
| | B | Rp. | | Insulin Actrapid HM | fiol. 40 j.m./1 ml-10 ml | e | fiol. 10 ml |
| | B | Rp. | | Insulin Actrapid HM | fiol. 100 j.m./1 ml-10 ml | f | fiol. 10 ml |
| | B | Rp. | | Insulin Insulatard HM (Protaphane HM) | fiol. 40 j.m./1 ml-10 ml | e | fiol. 10 ml |
| | B | Rp. | | Insulin Insulatard HM (Protaphane HM) | fiol. 100 j.m./1 ml-10 ml | f | fiol. 10 ml |
| | B | Rp. | | Insulin Monotard HM | fiol. 40 j.m./1 ml-10 ml | e | fiol. 10 ml |
| | B | Rp. | | Insulin Monotard HM | fiol. 100 j.m./1 ml-10 ml | f | fiol. 10 ml |
| | B | Rp. | | Insulin Mixtard 30 (Actraphane HM) | fiol. 40 j.m./1 ml - 10 ml | e | fiol. 10 ml |
| | B | Rp. | | Insulin Mixtard 30 (Actraphane HM) | fiol. 100 j.m./1 ml - 10 ml | f | fiol. 10 ml |
| | B | Rp. | | Insulin Ultratard HM | fiol. 40 j.m./1 ml-10 ml | e | fiol. 10 ml |
| | B | Rp. | | Insulin Ultratard HM | fiol. 100 j.m./1 ml - 10 ml | f | fiol. 10 ml |
| | B | Rp. | | Humulin R | fiol. 40 j.m./1 ml-10 ml | e | fiol. 10 ml |
| | B | Rp. | | Humulin R | fiol. 100 j.m./1 ml - 10 ml | f | fiol. 10 ml |
| | B | Rp. | | Humulin N | fiol. 40 j.m./1 ml-10 ml | e | fiol. 10 ml |
| | B | Rp. | | Humulin N | fiol. 100 j.m./1ml-10 ml | f | fiol. 10 ml |
| | B | Rp. | | Humulin L | fiol. 40 j.m./1 ml-10 ml | e | fiol. 10 ml |
| | B | Rp. | | Humulin L | fiol. 100 j.m./1 ml - 10ml | f | fiol. 10 ml |
| | B | Rp. | | Humulin U | fiol. 40 j.m./1 ml-10 ml | e | fiol. 10 ml |
| | B | Rp. | | Humulin U | fiol. 100 j.m./1 ml - 10 ml | f | fiol. 10 ml |
| | B | Rp. | | Humulin M1 (10/90) | fiol. 40 j.m./1 ml-10 ml | e | fiol. 10 ml |
| | B | Rp. | | Humulin M2 (20/80) | fiol. 40 j.m./1 ml-10 ml | f | fiol. 10 ml |
| | B | Rp. | | Humulin M3 (30/70) | fiol. 40 j.m./1 ml - 10 ml | e | fiol. 10 ml |
| | B | Rp. | | Humulin M4 (40/60) | fiol. 40 j.m./1 ml - 10 l | f | fiol. 10 ml |
| | B | Rp. | | Insulinum Rapid | fiol. 40 j.m./1 ml - 10 ml | f | 5 fiol. 10 ml |
| | B | Rp. | | Insulinum Rapid | fiol. 100 j.m./1 ml - 5 ml | f | 5 fiol. 5 ml |
| | B | Rp. | | Insulinum Comb 25/75 | fiol. 40 j.m./1 ml - 10 ml | f | 5 fiol. 10 ml |
| | B | Rp. | | Insulinum Comb 25/75 | fiol. 100 j.m./1 ml - 5 ml | f | 5 fiol. 5 ml |
| | B | Rp. | | Insulinum Basal | fiol. 40 j.m./1 ml - 10 ml | f | 5 fiol. 10 ml |
| | B | Rp. | | Insulinum Basal | fiol. 100 j.m./1 ml - 5 ml | f | 5 fiol. 5 ml |
103 | | | | | Metformini hydrochloridum | | | |
| | B | Rp. | | Metformin | tabl. 0,5 g | c | 30 tabl. |
104 | | | Rp. | | Strzykawki jednorazowego użytku z wyeliminowaną przestrzenią martwą z igłą o grubości do 0,4 mm, przeznaczone do podawania insuliny | | | |
105 | | | | | Tolbutamidum | | | |
| | B | Rp. | | Diabetol | tabl. 0,5 g | b | 40 tabl. |
Jaskra |
106 | | | | | Betaxololi hydrochloridum | | | |
| | | Rp. | | Betoptic S | krople do oczu 0,25% | d | 5 ml |
| | | Rp. | | Betoptic 0,5% | krople do oczu 0,5% | e | 5 ml |
107 | | | | | Pilocarpini hydrochloridum | | | |
| @ | A | Rp. | * | Pilocarpinum 2% | krople do oczu 2% | b | 10 ml |
| @ | A | Rp. | | Pilocarpinum ophtalmicum | maść do oczu 2% | b | 3 g |
| @ | A | Rp. | * | Isopto-Carpine 1% | krople do oczu 1% | c | 15 ml |
| @ | A | Rp. | * | Isopto-Carpine 2% | krople do oczu 2% | c | 15 ml |
| @ | A | Rp. | | Pilogel HS | żel 4% | e | 5 g |
| @ | A | Rp. | * | Pilomann 1% | krople do oczu 1% | c | 10 ml |
| @ | A | Rp. | * | Pilomann 2% | krople do oczu 2% | c | 10 ml |
| @ | A | Rp. | * | Pilomann 3% | krople do oczu 3% | c | 10 ml |
| @ | A | Rp. | * | Sol. Pilocarpini 3% | krople do oczu 3% | x | 3 x 5 ml |
| @ | A | Rp. | * | Sol. Pilocarpini 4% | krople do oczu 4% | x | 3 x 5 ml |
108 | | | | | Carbacholi chloridum | | | |
| @ | | Rp. | | Carbachol | krople do oczu 3% | a | 10 ml |
| @ | | Rp. | | Isopto-Carbachol 1,5% | krople do oczu 1,5% | c | 15 ml |
| @ | | Rp. | | Isopto-Carbachol 3,0% | krople do oczu 3% | d | 15 ml |
109 | | | | | Metipranololum | | | |
| | | Rp. | | Betamann | krople do oczu 0,1% | d | 5 ml |
| | | Rp. | | Betamann | krople do oczu 0,3% | d | 5 ml |
110 | | | | | Timololi maleas | | | |
| | | Rp. | | Cusimolol 0,25% | krople do oczu 0,25% | b | 1 flak. 5 ml |
| | | Rp. | | Cusomolol 0,50% | krople do oczu 0,5% | c | 1 flak. 5 ml |
| | | Rp. | | Oftan-Timolol | krople do oczu 0,25% | x | 1 flak. 5 ml |
| | | Rp. | | Oftan-Timolol | krople do oczu 0,5% | x | 1 flak. 5 ml |
| | | Rp. | | Oftensin | krople do oczu 0,25% | c | 1 flak. 5 ml |
| | | Rp. | | Oftensin | krople do oczu 0,5% | c | 1 flak. 5 ml |
| | | Rp. | | Timohexal 0,1% | krople do oczu 0,1% | c | 1 flak. 5 ml |
| | | Rp. | | Timohexal 0,25% | krople do oczu 0,25% | c | 1 flak. 5 ml |
| | | Rp. | | Timohexal 0,5% | krople do oczu 0,5% | c | 1 flak. 5 ml |
| | | Rp. | | Timoptic 0,25% | krople do oczu 0,25% | d | 1 flak. 5 ml |
| | | Rp. | | Timoptic 0,5% | krople do oczu 0,5% | d | 1 flak. 5 ml |
| | | Rp. | | Timoptic XE | krople do oczu tworzące żel 0,25% | e | 1 flak. 2,5 ml |
| | | Rp. | | Timoptic XE | krople do oczu tworzące żel 0,5% | e | 1 flak. 2,5 ml |
ZAŁĄCZNIK Nr 2
WYKAZ LEKÓW ORAZ TESTÓW DIAGNOSTYCZNYCH DO WYDAWANIA NA RECEPTY PO WNIESIENIU OPŁATY RYCZAŁTOWEJ2 - CHORYM W LECZENIU: ______________________________ 2 do wysokości ustalonego limitu
Lp. | | | | | Nazwa | Postać i dawka | | Opakow., na które ustalone ryczałt |
|
Fenyloketonurii do diet eliminacyjnych oraz celiakii i zespołów wrodzonych defektów metabolicznych |
111 | | | | | Protein hydrolisat compositum | | | |
| | | Rp. | | Humana z MCT | proszek | d | 350 g |
| | | Rp. | | Humana SL | proszek | e | 650 g |
| | | Rp. | | Isomil | proszek | d | 400 g |
| | | Rp. | | Nofelan S | proszek | e | 400 g |
| | | Rp. | | Nofemix | proszek | e | 350 g |
| | | Rp. | | Nofemix FT | proszek | e | 350 g |
| | | Rp. | | Nofemix ILW | proszek | e | 350 g |
| | | Rp. | | Nutramigen | proszek | e | 425 g |
| | | Rp. | | Lofenalac | proszek | c | 450 g |
| | | Rp. | | Pregestimil | proszek | e | 450 g |
| | | Rp. | | ProSobee | proszek | d | 400 g |
| | | Rp. | | ProSobee 2 | proszek | d | 400 g |
| | | Rp. | | Mixamin | proszek | e | 600 g |
| | | Rp. | | Bebilon sojowy | proszek | d | 400 g |
| | | Rp. | | Bebilon pepti MCT | proszek | e | 450 g |
| | | Rp. | | Bebilon pepti | proszek | x | 450 g |
Mukowiscydozy |
112 | | | | | Dornasum alfa | | | |
| | | Rp. | | Pulmozyme | roztw. do inh. 1 mg/ml - 2,5 ml | f | 30 amp. |
Padaczki |
113 | | | | | Diazepamum | | | |
| | B | Rp. | | Relanium | tabl., tabl. powl. 2 mg | x | 20 tabl., tabl. powl. |
| | B | Rp. | | Relanium | tabl., tabl. powl. 5 mg | x | 20 tabl., tabl. powl. |
| | B | Rp. | | Relanium | zaw. 2 mg/5 ml | x | 100 g |
Chorób psychicznych lub upośledzeń umysłowych |
114 | | | | | Risperidonum | | | |
| @ | B | Rp. | | Rispolept | tabl. powl. 1 mg | e | 20 tabl. powl. |
| @ | B | Rp. | | Rispolept | tabl. powl. 2 mg | f | 20 tabl. powl. |
| @ | B | Rp. | | Rispolept | tabl. powl. 3 mg | f | 20 tabl. powl. |
| @ | B | Rp. | | Rispolept | tabl. powl. 4 mg | f | 20 tabl. powl. |
Cukrzycy |
115 | | | | | Insuliny wysokooczyszczone ludzkie | | | |
| | B | Rp. | | Insulin Actrapid HM Penfill | fiol. 100 j.m./1 ml - 1,5 ml | f | 10 fiol. 1,5 ml |
| | B | Rp. | | Insulin Actrapid HM Penfill | fiol. 100 j.m./1 ml - 3 ml | f | 5 fiol. 3 ml |
| | B | Rp. | | Insulin Insulatard HM Penfill | fiol. 100 j.m./1 ml - 1,5 ml | f | 10 fiol. 1,5 ml |
| | B | Rp. | | Insulin Insulatard HM Penfill | fiol. 100 j.m./1 ml - 3 ml | f | 5 fiol. 3 ml |
| | B | Rp. | | Insulin Mixtard 10 HM Penfill | fiol. 100 j.m./1 ml - 1,5 ml | f | 10 fiol. 1,5 ml |
| | B | Rp. | | Insulin Mixtard 10 HM Penfill | fiol. 100 j.m./1 ml - 3 ml | f | 5 fiol. 3 ml |
| | B | Rp. | | Insulin Mixtard 30 HM Penfill | fiol. 100 j.m./1 ml - 1,5 ml | f | 10 fiol. 1,5 ml |
| | B | Rp. | | Insulin Mixtard 30 HM Penfill | fiol. 100 j.m./1 ml - 3 ml | f | 5 fiol. 3 ml |
| | B | Rp. | | Insulin Mixtard 20 HM Penfill | fiol. 100 j.m./1 ml - 1,5 ml | f | 10 fiol. 1,5 ml |
| | B | Rp. | | Insulin Mixtard 20 HM Penfill | fiol. 100 j.m./1 ml - 3 ml | f | 5 fiol. 3 ml |
| | B | Rp. | | Insulin Mixtard 40 HM Penfill | fiol. 100 j.m./1 ml - 1,5 ml | f | 10 fiol. 1,5 ml |
| | B | Rp. | | Insulin Mixtard 40 HM Penfill | fiol. 100 j.m./1 ml - 3 ml | f | 5 fiol. 3 ml |
| | B | Rp. | | Insulin Mixtard 50 HM Penfill | fiol. 100 j.m./1 ml - 1,5 ml | f | 10 fiol. 1,5 ml |
| | B | Rp. | | Insulin Mixtard 50 HM Penfill | fiol. 100 j.m./1 ml - 3 ml | f | 5 fiol. 3 ml |
| | B | Rp. | | Insulin Mixtard 10 HM NovoLet | fiol. 100 j.m./1 ml - 3 ml | f | 5 fiol. 3 ml |
| | B | Rp. | | Insulin Mixtard 20 HM NovoLet | fiol. 100 j.m./1 ml - 3 ml | f | 5 fiol. 3 ml |
| | B | Rp. | | Insulin Mixtard 40 HM NovoLet | fiol. 100 j.m./1 ml - 3 ml | f | 5 fiol. 3 ml |
| | B | Rp. | | Insulin Mixtard 50 HM NovoLet | fiol. 100 j.m./1 ml - 3 ml | f | 5 fiol. 3 ml |
| | B | Rp. | | Insulin Actrapid NovoLet | fiol. 100 j.m./1 ml - 1,5 ml | f | 10 fiol. 1,5 ml |
| | B | Rp. | | Insulin Actrapid NovoLet | fiol. 100 j.m./1 ml - 3 ml | f | 5 fiol. 3 ml |
| | B | Rp. | | Insulin Mixtard 30 HM NovoLet | fiol. 100 j.m./1 ml - 1,5 ml | f | 10 fiol. 1,5 ml |
| | B | Rp. | | Insulin Mixtard 30 HM NovoLet | fiol. 100 j.m./1 ml - 3 ml | f | 5 fiol. 3 ml |
| | B | Rp. | | Insulin Insulatard NovoLet | fiol. 100 j.m./1 ml - 1,5 ml | f | 10 fiol. 1,5 ml |
| | B | Rp. | | Insulin Insulatard NovoLet | fiol. 100 j.m./1 ml - 3 ml | f | 5 fiol. 3 ml |
| | B | Rp. | | Humulin R - cartidge | fiol. 100 j.m./1 ml - 1,5 ml | f | 10 fiol. 1,5 ml |
| | B | Rp. | | Humulin R - cartidge | fiol. 100 j.m./1 ml - 3 ml | f | 5 fiol. 3 ml |
| | B | Rp. | | Humulin N - cartidge | fiol. 100 j.m./1 ml - 1,5 ml | f | 10 fiol. 1,5 ml |
| | B | Rp. | | Humulin N - cartidge | fiol. 100 j.m./1 ml - 3 ml | f | 5 fiol. 3 ml |
| | B | Rp. | | Humulin M1 (10/90) - cartidge | fiol. 100 j.m./1 ml - 1,5 ml | f | 10 fiol. 1,5 ml |
| | B | Rp. | | Humulin M1 (10/90) - cartidge | fiol. 100 j.m./1 ml - 3 ml | f | 5 fiol. 3 ml |
| | B | Rp. | | Humulin M2 (20/80) - cartidge | fiol. 100 j.m./1 ml - 1,5 ml | f | 10 fiol. 1,5 ml |
| | B | Rp. | | Humulin M2 (20/80) - cartidge | fiol. 100 j.m./1 ml - 3 ml | f | 5 fiol. 3 ml |
| | B | Rp. | | Humulin M3 (30/70) - cartidge | fiol. 100 j.m./1 ml - 1,5 ml | f | 10 fiol. 1,5 ml |
| | B | Rp. | | Humulin M3 (30/70) - cartidge | fiol. 100 j.m./1 ml - 3 ml | f | 5 fiol. 3 ml |
| | B | Rp. | | Humulin M4 (40/60) - cartidge | fiol. 100 j.m./1 ml - 1,5 ml | f | 10 fiol. 1,5 ml |
| | B | Rp. | | Humulin M4 (40/60) - cartidge | fiol. 100 j.m./1 ml - 3 ml | f | 5 fiol. 3 ml |
| | B | Rp. | | Insuman Rapid | fiol. 100 j.m./1 ml - 3 ml | f | 5 wkładów do Optipen |
| | B | Rp. | | Insuman Comb 25/75 | fiol. 100 j.m./1 ml - 3 ml | f | 5 wkładów do Optipen |
| | B | Rp. | | Insuman Basal | fiol. 100 j.m./1 ml - 3 ml | f | 5 wkładów do Optipen |
| | | | | Testy diagnostyczne | | | |
116 | | | | | - do oznaczenia glukozy w moczu | | | |
| | | Rp. | | Diabur Test 5000 | test paskowy | e | 50 pasków |
| | | Rp. | | S-Glukotest | test paskowy | e | 50 pasków |
| | | Rp. | | TEST-TAPE | test paskowy | d | 50 oznaczeń |
117 | | | | | - do oznaczenia glukozy i acetonu w moczu | | | |
| | | | | Ketodiastix | test paskowy | e | 50 pasków |
| | | Rp. | | Cormay Uritest-1 | test paskowy | d | 50 pasków |
| | | Rp. | | Keto-Diabur-Test 5000 | test paskowy | e | 50 pasków |
| | | Rp. | | - do oznaczenia glukozy we krwi | | | |
118 | | | | | Dextrostix | test paskowy | f | 50 pasków |
| | | Rp. | | Glucocard | test paskowy | f | 50 pasków |
| | | Rp. | | Glucostix | test paskowy | f | 50 pasków |
| | | Rp. | | BM test-1-44RF/Haemo-Glukotest 20-800RF | test paskowy | f | 50 pasków |
| | | Rp. | | ExacTech | test paskowy | f | 50 pasków |
| | | Rp. | | One Touch Glucose | test paskowy | f | 50 pasków |
| | | Rp. | | Diascan | test paskowy | f | 50 pasków |
| | | Rp. | | Accu-Chek Glucose | test paskowy | f | 50 pasków |
| | | Rp. | | AccutrendGlucose | test paskowy | f | 50 pasków |
| | | Rp. | | Glucocard | test paskowy | f | 50 pasków |
| | | Rp. | | Glucocard II | test paskowy | x | 50 pasków |
| | | Rp. | | Elite SensorsTM | test paskowy | x | 50 pasków |
ZAŁĄCZNIK Nr 3
WYKAZ LEKÓW ORAZ SPRZĘTU JEDNORAZOWEGO UŻYTKU DO WYDAWANIA NA RECEPTY ZA CZĘŚCIOWĄ ODPŁATNOŚCIĄ 30% CENY 3 - CHORYM W LECZENIU: ___________________________ 3 do wysokości ustalonego limitu
Lp. | | | | | Nazwa | Postać i dawka | | Opakowanie, dla którego ustalono kategorię cen |
Chorób nowotworowych |
119 | | | | | Cyproteroni acetas | | | |
| | B | Rp. | | Androcur | tabl. 0,05 g | f | 20 tabl. |
120 | | | | | Granisetroni hydrochloridum | | | |
| | B | Rp. | | Kytril | tabl. powl. 0,001 g | x | 10 tabl. powl. |
121 | | | | | Nilutamidum | | | |
| | B | Rp. | | Anandron | tabl. 0,05 g | f | 90 tabl. |
122 | | | | | Ondansetron hydrochloride dihydrate | | | |
| | B | Rp. | | Zofran | tabl. 0,004 g | f | 10 tabl. |
| | B | Rp. | | Zofran | tabl. 0,008 g | f | 10 tabl. |
123 | | | | | Tropisetron hydrochloridum | | | |
| | B | Rp. | | Navoban | kaps. 0,005 g | f | 5 kaps. |
Chorób psychicznych lub upośledzeń umysłowych |
124 | | | | | Fluoxetine hydrochloride | | | |
| @ | B | Rp. | | Prozac | kaps. 0,02 g | f | 28 kaps. |
| @ | B | Rp. | | Seronil | kaps. 0,02 g | d | 30 kaps. |
| @ | B | Rp. | | Seronil | tabl. powl. 0,01 g | e | 30 tabl. powl. |
| @ | B | Rp. | | Bioxetin | tabl. 0,02 g | e | 30 tabl. |
| @ | B | Rp. | | Fluxin | kaps. 0,02 g | x | 14 kaps. |
125 | | | | | Mianserini hydrochloridum | | | |
| @ | B | Rp. | | Lerivon | tabl. powl. 0,01 g | d | 30 tabl. powl. |
| @ | B | Rp. | | Lerivon | tabl. 0,03 g | e | 20 tabl. |
| @ | B | Rp. | | Lerivon | tabl. powl. 0,06 g | f | 30 tabl. powl. |
| @ | B | Rp. | | Miansan | tabl. powl. 0,01 g | d | 30 tabl. powl. |
| @ | B | Rp. | | Miansan | tabl. 0,03 g | e | 14 tabl. |
| @ | B | Rp. | | Mianserin | tabl. powl. 0,01 g | f | 100 tabl. powl. |
126 | | | | | Moclobemidum | | | |
| | B | Rp. | | Aurorix Roche | tabl. powl. 0,15 g | e | 30 tabl. |
Jaskry |
127 | | | | | Dorzolamidi hydrochloridum | | | |
| @ | B | Rp. | | Trusopot | krople do oczu 2% | f | 5 ml |
ZAŁĄCZNIK Nr 4
WYKAZ LEKÓW ORAZ SPRZĘTU JEDNORAZOWEGO UŻYTKU DO WYDAWANIA NA RECEPTY ZA CZĘŚCIOWĄ ODPŁATNOŚCIĄ 50% CENY4 - CHORYM W LECZENIU:
_______________ 4 do wysokości ustalonego limitu
Lp. | | | | | Nazwa | Postać i dawka | | Opakowanie, dla którego ustalono kategorię cen |
Chorób nowotworowych |
128 | | | | | Estramustini phosphas | | | |
| | B | Rp. | | Estracyt | kaps. 0,14 g | f | 100 kaps. |
| | B | Rp. | | Estracyt | inj. 0,3 g | f | 10 fiol. s. subst. + rozp. |
Chorób psychicznych lub upośledzeń umysłowych |
129 | | | | | Buspironi hydrochloridum | | | |
| @ | B | Rp. | | Spamilan | tabl. 0,005 g | c | 30 tabl. |
| @ | B | Rp. | | Spamilan | tabl. 0,01 g | d | 30 tabl. |
| @ | B | Rp. | | Mabuson | tabl. 5 mg | x | 30 tabl. |
| @ | B | Rp. | | Mabuson | tabl. 10 mg | x | 30 tabl. |
130 | | | | | Fluvoxamini maleas | | | |
| @ | B | Rp. | | Fevarin | tabl. powl. 50 mg | f | 10 tabl. powl. |
| @ | B | Rp. | | Fevarin | tabl. powl. 100 mg | f | 10 tabl. powl. |
131 | | | | | Paroxetini hydrochloridum | | | |
| | B | Rp. | | Seroxat | tabl. powl. 20 mg | f | 30 tabl. powl. |
| | B | Rp. | | Seroxat | tabl. powl. 30 mg | x | 30 tabl. powl. |
Cukrzycy |
132 | | | | | Acarbosum | | | |
| | | Rp. | | Glucobay 50 | tabl. 0,05 g | e | 30 tabl. |
| | | Rp. | | Glucobay 100 | tabl. 0,1 g | e | 30 tabl. |
133 | | | | | Chlorpropamidum | | | |
| | B | Rp. | | Apo-Chlorpropamid | tabl. 0,25 g | x | 100 tabl. |
| | B | Rp. | | Chlorpropamid | tabl. 0,25 g | b | 60 tabl. |
| | B | Rp. | | Diabinese | tabl. 0,25 g | x | 20 tabl. |
Chorób układu krążenia |
134 | | | | | Cerivastatinum | | | |
| | B | Rp. | | Lipobay | tabl. powl. 0,1 mg | x | 28 tabl. |
| | B | Rp. | | Lipobay | tabl. powl. 0,2 mg | x | 28 tabl. |
| | B | Rp. | | Lipobay | tabl. powl. 0,3 mg | x | 28 tabl. |
135 | | | | | Fluvastatinum | | | |
| | B | Rp. | | Lescol | kaps. 20 mg | f | 28 kaps. |
| | B | Rp. | | Lescol | kaps. 40 mg | f | 28 kaps. |
136 | | | | | Lovastatinum | | | |
| | B | Rp. | | Mevacor | tabl. 20 mg | f | 28 tabl. |
137 | | | | | Pravastatinum | | | |
| | B | Rp. | | Lipostat | tabl. 20 mg | f | 30 tabl. |
138 | | | | | Simvastatinum | | | |
| | B | Rp. | | Zocor | tabl. 10 mg | f | 28 tabl. |
| | B | Rp. | | Zocor | tabl. 20 mg | f | 28 tabl. |
ZAŁĄCZNIK Nr 5
WYKAZ ARTYKUŁÓW SANITARNYCH NIEZBĘDNYCH DO STOSOWANIA PRZY CHOROBACH NOWOTWOROWYCH I UPOŚLEDZENIU UMYSŁOWYM WYDAWANYCH NA RECEPTĘ PO WNIESIENIU OPŁATY RYCZAŁTOWEJ
139 | | | Rp. | | Wata celulozowa | arkusze | | |
Objaśnienie oznaczeń Rp. - lek wydawany z apteki na recepty; Rp.w. - lek wydawany z apteki na podstawie recepty z kopią, wypisywanej na blankietach receptowych wzoru Mz/Pom-33; N - lek zaliczany do leków odurzających z grupy I (wydawanie z apteki - patrz Rp.w.); Rp.* - lek dopuszczony do wydawania również bez recept w ilości jednego najmniejszego opakowania; A - lek bardzo silnie działający; B - lek silnie działający; $ - środek farmaceutyczny silnie upośledzający sprawność psychofizyczną; bezwzględny zakaz prowadzenia pojazdów i obsługiwania urządzeń mechanicznych w ruchu przez 24 h po zastosowaniu; @ - środek farmaceutyczny, który może wpływać upośledzająco na sprawność psychofizyczną; jeżeli przepisana dawka i droga podania wskazują, że w okresie stosowania może pojawić się wyraźne upośledzenie sprawności psychofizycznej, to należy udzielić wskazówek co do zachowania szczególnej ostrożności w zakresie prowadzenia pojazdów lub obsługiwania urządzeń mechanicznych w ruchu bądź uprzedzić o konieczności czasowego zaniechania takich czynności (w tekście - z przyczyn technicznych - w trójkącie nie umieszczono pionowej kreski, jak przy znaku ostrzegawczym na opakowaniach leków);
Kat. cen - kategorie cen: a - cena leku do 2,50 zł b - cena leku od 2,51 zł do 5,00 zł c - cena leku od 5,01 zł do 10,00 zł d - cena leku od 10,01 zł do 20,00 zł e - cena leku od 20,01 zł do 50,00 zł f - powyżej 50,00 zł x - brak aktualnych danych

Pozycje
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125, 126, 127, 128, 129, 130, 131, 132, 133, 134, 135, 136, 137, 138, 139, 140, 141, 142, 143, 144, 145, 146, 147, 148, 149, 150, 151, 152, 153, 154, 155, 156, 157, 158, 159, 160, 161, 162, 163, 164, 165, 166, 167, 168, 169, 170, 171, 172, 173, 174, 175, 176, 177, 178, 179, 180, 181, 182, 183, 184, 185, 186, 187, 188, 189, 190, 191, 192, 193, 194, 195, 196, 197, 198, 199, 200, 201, 202, 203, 204, 205, 206, 207, 208, 209, 210, 211, 212, 213, 214, 215, 216, 217, 218, 219, 220, 221, 222, 223, 224, 225, 226, 227, 228, 229, 230, 231, 232, 233, 234, 235, 236, 237, 238, 239, 240, 241, 242, 243, 244, 245, 246, 247, 248, 249, 250, 251, 252, 253, 254, 255, 256, 257, 258, 259, 260, 261, 262, 263, 264, 265, 266, 267, 268, 269, 270, 271, 272, 273, 274, 275, 276, 277, 278, 279, 280, 281, 282, 283, 284, 285, 286, 287, 288, 289, 290, 291, 292, 293, 294, 295, 296, 297, 298, 299, 300, 301, 302, 303, 304, 305, 306, 307, 308, 309, 310, 311, 312, 313, 314, 315, 316, 317, 318, 319, 320, 321, 322, 323, 324, 325, 326, 327, 328, 329, 330, 331, 332, 333, 334, 335, 336, 337, 338, 339, 340, 341, 342, 343, 344, 345, 346, 347, 348, 349, 350, 351, 352, 353, 354, 355, 356, 357, 358, 359, 360, 361, 362, 363, 364, 365, 366, 367, 368, 369, 370, 371, 372, 373, 374, 375, 376, 377, 378, 379, 380, 381, 382, 383, 384, 385, 386, 387, 388, 389, 390, 391, 392, 393, 394, 395, 396, 397, 398, 399, 400, 401, 402, 403, 404, 405, 406, 407, 408, 409, 410, 411, 412, 413, 414, 415, 416, 417, 418, 419, 420, 421, 422, 423, 424, 425, 426, 427, 428, 429, 430, 431, 432, 433, 434, 435, 436, 437, 438, 439, 440, 441, 442, 443, 444, 445, 446, 447, 448, 449, 450, 451, 452, 453, 454, 455, 456, 457, 458, 459, 460, 461, 462, 463, 464, 465, 466, 467, 468, 469, 470, 471, 472, 473, 474, 475, 476, 477, 478, 479, 480, 481, 482, 483, 484, 485, 486, 487, 488, 489, 490, 491, 492, 493, 494, 495, 496, 497, 498, 499, 500, 501, 502, 503, 504, 505, 506, 507, 508, 509, 510, 511, 512, 513, 514, 515, 516, 517, 518, 519, 520, 521, 522, 523, 524, 525, 526, 527, 528, 529, 530, 531, 532, 533, 534, 535, 536, 537, 538, 539, 540, 541, 542, 543, 544, 545, 546, 547, 548, 549, 550, 551, 552, 553, 554, 555, 556, 557, 558, 559, 560, 561, 562, 563, 564, 565, 566, 567, 568, 569, 570, 571, 572, 573, 574, 575, 576, 577, 578, 579, 580, 581, 582, 583, 584, 585, 586, 587, 588, 589, 590, 591, 592, 593, 594, 595, 596, 597, 598, 599, 600, 601, 602, 603, 604, 605, 606, 607, 608, 609, 610, 611, 612, 613, 614, 615, 616, 617, 618, 619, 620, 621, 622, 623, 624, 625, 626, 627, 628, 629, 630, 631, 632, 633, 634, 635, 636, 637, 638, 639, 640, 641, 642, 643, 644, 645, 646, 647, 648, 649, 650, 651, 652, 653, 654, 655, 656, 657, 658, 659, 660, 661, 662, 663, 664, 665, 666, 667, 668, 669, 670, 671, 672, 673, 674, 675, 676, 677, 678, 679, 680, 681, 682, 683, 684, 685, 686, 687, 688, 689, 690, 691, 692, 693, 694, 695, 696, 697, 698, 699, 700, 701, 702, 703, 704, 705, 706, 707, 708, 709, 710, 711, 712, 713, 714, 715, 716, 717, 718, 719, 720, 721, 722, 723, 724, 725, 726, 727, 728, 729, 730, 731, 732, 733, 734, 735, 736, 737, 738, 739, 740, 741, 742, 743, 744, 745, 746, 747, 748, 749, 750, 751, 752, 753, 754, 755, 756, 757, 758, 759, 760, 761, 762, 763, 764, 765, 766, 767, 768, 769, 770, 771, 772, 773, 774, 775, 776, 777, 778, 779, 780, 781, 782, 783, 784, 785, 786, 787, 788, 789, 790, 791, 792, 793, 794, 795, 796, 797, 798, 799, 800, 801, 802, 803, 804, 805, 806, 807, 808, 809, 810, 811, 812, 813, 814, 815, 816, 817, 818, 819, 820, 821, 822, 823, 824, 825, 826, 827, 828, 829, 830, 831, 832, 833, 834, 835, 836, 837, 838, 839, 840, 841, 842, 843, 844, 845, 846, 847, 848, 849, 850, 851, 852, 853, 854, 855, 856, 857, 858, 859, 860, 861, 862, 863, 864, 865, 866, 867, 868, 869, 870, 871, 872, 873, 874, 875, 876, 877, 878, 879, 880, 881, 882, 883, 884, 885, 886, 887, 888, 889, 890, 891, 892, 893, 894, 895, 896, 897, 898, 899, 900, 901, 902, 903, 904, 905, 906, 907, 908, 909, 910, 911, 912, 913, 914, 915, 916, 917, 918, 919, 920, 921, 922, 923, 924, 925, 926, 927, 928, 929, 930, 931, 932, 933, 934, 935, 936, 937, 938, 939, 940, 941, 942, 943, 944, 945, 946, 947, 948, 949, 950, 951, 952, 953, 954, 955, 956, 957, 958, 959, 960, 961, 962, 963, 964, 965, 966, 967, 968, 969, 970, 971, 972, 973, 974, 975, 976, 977, 978, 979, 980, 981, 982, 983, 984, 985, 986, 987, 988, 989, 990, 991, 992, 993, 994, 995, 996, 997, 998, 999, 1000, 1001, 1002, 1003, 1004, 1005, 1006, 1007, 1008, 1009, 1010, 1011, 1012, 1013, 1014, 1015, 1016, 1017, 1018, 1019, 1020, 1021, 1022, 1023, 1024, 1025, 1026, 1027, 1028, 1029, 1030, 1031, 1032, 1033, 1034, 1035, 1036, 1037, 1038, 1039, 1040, 1041, 1042, 1043, 1044, 1045, 1046, 1047, 1048, 1049, 1050, 1051, 1052, 1053, 1054, 1055, 1056, 1057, 1058, 1059, 1060, 1061, 1062, 1063, 1064, 1065, 1066, 1067, 1068, 1069, 1070, 1071, 1072, 1073, 1074, 1075, 1076, 1077, 1078, 1079, 1080, 1081, 1082, 1083, 1084, 1085, 1086, 1087, 1088, 1089, 1090, 1091, 1092, 1093, 1094, 1095, 1096, 1097, 1098, 1099, 1100, 1101, 1102, 1103, 1104, 1105, 1106, 1107, 1108, 1109, 1110, 1111, 1112, 1113, 1114, 1115, 1116, 1117, 1118, 1119, 1120, 1121, 1122, 1123, 1124, 1125, 1126, 1127, 1128, 1129, 1130, 1131, 1132, 1133, 1134, 1135, 1136, 1137, 1138, 1139, 1140, 1141, 1142, 1143, 1144, 1145, 1146, 1147, 1148, 1149, 1150, 1151, 1152, 1153, 1154, 1155, 1156, 1157, 1158, 1159, 1160, 1161, 1162, 1163, 1164, 1165, 1166, 1167, 1168, 1169, 1170, 1171, 1172, 1173, 1174, 1175, 1176, 1177, 1178, 1179, 1180, 1181, 1182, 1183, 1184, 1185, 1186, 1187, 1188, 1189, 1190, 1191, 1192, 1193, 1194, 1195, 1196, 1197, 1198, 1199, 1200, 1201, 1202, 1203, 1204, 1205, 1206, 1207, 1208, 1209, 1210, 1211, 1212, 1213, 1214, 1215, 1216, 1217, 1218, 1219, 1220, 1221, 1222, 1223, 1224, 1225, 1226, 1227, 1228, 1229, 1230, 1231, 1232, 1233, 1234, 1235, 1236, 1237, 1238, 1239, 1240, 1241, 1242, 1243, 1244, 1245, 1246, 1247, 1248, 1249, 1250, 1251, 1252, 1253, 1254, 1255, 1256, 1257, 1258, 1259, 1260, 1261, 1262, 1263, 1264, 1265, 1266, 1267
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