Page 1 of 27

69 N06AX14 TIANEPTINUM COAXIL R DRAJ. 12.5mg LES LAB. SERVIER IND. FRANTA Cutie x 1 blist. Al/PVC x 30 draj. P-RF;M 30 29.36 0.98 0.98 0.98
70 N05AL03 TIAPRIDUM TIAPRIDAL R 100 mg COMPR. 100mg SANOFI-SYNTHELABO FRANCE FRANTA Cutie x 2 blist. Al/PVC x 10 compr. P-RF;M 20 19.26 0.96 0.96 0.96
71 N05AL03 TIAPRIDUM TIAPRIDAL 100 mg/2 ml SOL. INJ. 100mg/2ml SANOFI-AVENTIS FRANCE FRANTA Cutie x 2 suporturi PVC x 6 fiole x 2 ml P-RF;M 12 18.29 1.52 1.52 1.52
72 N06AX05 TRAZODONUM TRITTICO AC 150 mg COMPR. ELIB. PREL. 150mg ANGELINI FRANCESCO SPA ITALIA Cutie x 1blist. x 20 compr. elib. prel. P-RF;M 20 34.64 1.73 1.73 1.73
73 N05AE04 ZIPRASIDONUM ZELDOX R 40 mg CAPS. 40mg PFIZER EUROPE MA EEIG U.K. Cutie x 4 blist. x 14 caps. P-RF;M 56 462.43 8.26 8.26 8.26
74 N05AE04 ZIPRASIDONUM ZELDOX R 60 mg CAPS. 60mg PFIZER EUROPE MA EEIG U.K. Cutie x 4 blist. x 14 caps. P-RF;M 56 500.49 8.94 8.94 8.94
75 N05AE04 ZIPRASIDONUM ZELDOX R 80 mg CAPS. 80mg PFIZER EUROPE MA EEIG U.K. Cutie x 4 blist. x 14 caps. P-RF;M 56 584.55 10.44 10.44 10.44
76 N05AE04 ZIPRASIDONUM ZELDOX R 20 mg/ml LIOF. PT. SOL. INJ. + SOLV. 20mg/ml PFIZER EUROPE MA EEIG U.K. Cutie x 1 flac. liof. + 1 fiola x 1,2 ml solv. S/P-RF;M 1 55.02 55.02 55.02 55.02
77 N05AE04 ZIPRASIDONUM ZELDOX R 10 mg/ml SUSP. ORALA 10mg/ml PFIZER EUROPE MA EEIG U.K. Cutie x 1 flac. PEID opaca, alba x 60 ml + seringa P-RF;M 1 137.23 137.23 137.23 137.23
78 N05AF05 ZUCLOPENTHIXOLUM CLOPIXOL R 10 mg COMPR. FILM. 10mg H. LUNDBECK A/S DANEMARCA Flac. x 50 compr. film. P-RF;M 50 23.53 0.47 0.47 0.47
79 N05AF05 ZUCLOPENTHIXOLUM CLOPIXOL R 25 mg COMPR. FILM. 25mg H. LUNDBECK A/S DANEMARCA Flac. x 50 compr. film. P-RF;M 50 48.21 0.96 0.96 0.96
80 N05AF05 ZUCLOPENTHIXOLUM CLOPIXOL 20 mg/ml PIC. ORALE-SOL. 20mg/ml H. LUNDBECK A/S DANEMARCA Cutie x 1 flac. + capac securizat pt. copii x 20 m P-RF;M 1 25.50 25.50 25.50 25.50
81 N05AF05 ZUCLOPENTHIXOLUM CLOPIXOL R DEPOT SOL. INJ. 200mg/ml H. LUNDBECK A/S DANEMARCA Cutie x 10 fiole x 1 ml P-RF;M 10 146.93 14.69 14.69 14.69
82 N05AF05 ZUCLOPENTHIXOLUM CLOPIXOL ACUPHASE R SOL. INJ. 50mg/ml H. LUNDBECK A/S DANEMARCA Cutie x 5 fiole x 1 ml
Se vor prescrie de catre sau la indicatia medicului în specialitatea psihiatrie.
P-RF;M 5 41.11 8.22 8.22 8.22
14. DEMENŢE (degenerative, vasculare, mixte) - G 16
1 N06DA02 DONEPEZILUM* ARICEPT R 10 mg COMPR. FILM. 10mg PFIZER EUROPE MA EEIG U.K. Cutie x 2 blist. PVC/Al x 14 compr. film. P-RF;M 28 321.73 11.49 11.49 11.49
2 N06DA02 DONEPEZILUM* ARICEPT R 5 mg COMPR. FILM. 5mg PFIZER EUROPE MA EEIG U.K. Cutie x 2 blist. Al/PVC x 14 compr. film. P-RF;M 28 321.73 11.49 11.49 11.49
3 N06DX01 MEMANTINUM* EBIXA R 10 mg COMPR. FILM. 10mg H. LUNDBECK A/S DANEMARCA Cutie x 4 blist. x 14 compr. film. P-RF;M 56 419.59 7.49 7.49 7.49
4 N06DX01 MEMANTINUM* EBIXA R 10 mg COMPR. FILM. 10mg H. LUNDBECK A/S DANEMARCA Cutie x 2 blist. x 14 compr. film. P-RF 28 232.89 8.32 7.49 7.49
5 N06DX01 MEMANTINUM* EBIXA R 10 mg/g SOL. ORALA IN PICATURI 10mg/g H. LUNDBECK A/S DANEMARCA Cutie x 1 flacon, din sticla bruna, picurator x 20 P-RF;M 1 173.25 173.25 173.25 173.25
6 N06DX01 MEMANTINUM* EBIXA R 10 mg/g SOL. ORALA IN PICATURI 10mg/g H. LUNDBECK A/S DANEMARCA Cutie x 1 flacon, din sticla bruna, picurator x 50 P-RF 1 415.76 415.76 173.25 173.25
7 N06DX01 MEMANTINUM* EBIXA R 10 mg/g SOL. ORALA IN PICATURI 10mg/g H. LUNDBECK A/S DANEMARCA Cutie x 1 flacon, din sticla bruna, picurator x 10 P-RF 1 831.48 831.48 173.25 173.25
8 N06DA03 RIVASTIGMINUM* EXELON CAPS. 1.5mg NOVARTIS EUROPHARM LTD. U.K. Cutie x 2 blist. x 14 caps. P-RF;M 28 166.05 5.93 5.93 5.93
9 N06DA03 RIVASTIGMINUM* EXELON CAPS. 1.5mg NOVARTIS EUROPHARM LTD. U.K. Cutie x 4 blist. x 14 caps. P-RF;M 56 332.13 5.93 5.93 5.93
10 N06DA03 RIVASTIGMINUM* EXELON CAPS. 3mg NOVARTIS EUROPHARM LTD. U.K. Cutie x 2 blist. x 14 caps. P-RF;M 28 166.05 5.93 5.93 5.93
11 N06DA03 RIVASTIGMINUM* EXELON CAPS. 3mg NOVARTIS EUROPHARM LTD. U.K. Cutie x 4 blist. x 14 caps. P-RF;M 56 332.13 5.93 5.93 5.93
12 N06DA03 RIVASTIGMINUM* EXELON CAPS. 4.5mg NOVARTIS EUROPHARM LTD. U.K. Cutie x 2 blist. x 14 caps. P-RF;M 28 166.05 5.93 5.93 5.93
13 N06DA03 RIVASTIGMINUM* EXELON CAPS. 4.5mg NOVARTIS EUROPHARM LTD. U.K. Cutie x 4 blist. x 14 caps. P-RF;M 56 332.13 5.93 5.93 5.93
14 N06DA03 RIVASTIGMINUM* EXELON CAPS. 6mg NOVARTIS EUROPHARM LTD. U.K. Cutie x 2 blist. x 14 caps. P-RF;M 28 166.05 5.93 5.93 5.93
15 N06DA03 RIVASTIGMINUM* EXELON CAPS. 6mg NOVARTIS EUROPHARM LTD. U.K. Cutie x 4 blist. x 14 caps. P-RF;M 56 332.13 5.93 5.93 5.93
*Se vor prescrie de catre sau la indicatia medicului în specialitatea neurologie sau psihiatrie sau geriatrie; se vor prescrie cu aprobarea comisiilor de la nivelu
15. COLAGENOZE MAJORE (lupus eritematos sistemic, sclerodermie, dermatomiozita, poliarterita nodoasa) - G 17
1 L04AX01 AZATHIOPRINUM IMURAN R COMPR. FILM. 50mg THE WELLCOME FOUNDATION LTD. U.K. Cutie x 4 blist. x 25 compr. film. S/P-RF;M 100 67.37 0.67 0.67 0.67
2 L01AA01 CYCLOPHOSPHAMIDUM ENDOXAN R 50 mg DRAJ. 50mg BAXTER ONCOLOGY GMBH GERMANIA Cutie x 5 blist. PVC-PVDC/Al x 10 draj. S/P-RF;M 50 31.56 0.63 0.63 0.63
3 L01AA01 CYCLOPHOSPHAMIDUM ENDOXAN R 1 g PULB. PT. SOL. INJ./PERF. 1g BAXTER ONCOLOGY GMBH GERMANIA Cutie x 1 flac. din sticla cu pulb. pt. sol. perf. P-RF;M 1 40.24 40.24 40.24 40.24
4 L01AA01 CYCLOPHOSPHAMIDUM ENDOXAN R 500 mg PULB. PT. SOL. INJ./PERF. 500mg BAXTER ONCOLOGY GMBH GERMANIA Cutie x 1 flac. din sticla cu pulb. pt. sol. perf. P-RF;M 1 20.14 20.14 20.14 20.14
5 L01AA01 CYCLOPHOSPHAMIDUM ENDOXAN 200 mg PULB. PT. SOL. PERF./INJ. I.V. 200mg SINDAN SRL ROMANIA Cutie x 1 flac. pulb. pt. sol. perf./inj P-RF;M 1 10.57 10.57 10.57 10.57
6 L01BA01 METHOTREXATUM ANTIFOLAN R 2,5 mg COMPR. 2.5mg SINDAN SRL ROMANIA Cutie x 1 flac. x 50 compr. S/P-RF;M 50 13.61 0.27 0.27 0.27
7 L01BA01 METHOTREXATUM METHOTREXAT "EBEWE" 1000 mg CONC. PT. SOL. INJ./PERF. 100mg/ml EBEWE PHARMA GMBH NFG. KG AUSTRIA Cutie x 1 tub din material plastic x 1 fiola x 10 P-RF;M 1 83.92 83.92 83.92 83.92
Page 17 of 29