TRIPTORELIN

TRIPTORELIN (10907C)

triptorelin acetate 100 microgram/mL injection, 7 x 1 mL syringes
10907C
Body System:
Manner of administration:Injection
S100 IVF
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 5046)

Indication: Assisted Reproductive Technology
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 28 # of repeats: 0 DPMQ: $148.20 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Decapeptyl

TRIPTORELIN (5297T)

triptorelin 22.5 mg injection [1 vial] (&) inert substance diluent [2 mL ampoule], 1 pack
5297T
Body System:
Manner of administration:Injection
General Schedule
Restricted Benefit

Restriction

Indication: Locally advanced (stage C) or metastatic (stage D) carcinoma of the prostate

Restriction

Indication: Central precocious puberty
Treatment phase: Initial treatment

Restriction

Indication: Central precocious puberty
Treatment phase: Continuing treatment with this drug, or, switching gonadotropin releasing hormone analogue therapy
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 0 DPMQ: $1,377.57 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Diphereline

TRIPTORELIN (9378N)

triptorelin 3.75 mg injection [1 vial] (&) inert substance diluent [2 mL ampoule], 1 pack
9378N
Body System:
Manner of administration:Injection
General Schedule
Restricted Benefit

Restriction

Indication: Locally advanced (stage C) or metastatic (stage D) carcinoma of the prostate
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 5 DPMQ: $271.37 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Diphereline

TRIPTORELIN (9379P)

triptorelin 11.25 mg injection [1 vial] (&) inert substance diluent [2 mL ampoule], 1 pack
9379P
Body System:
Manner of administration:Injection
General Schedule
Restricted Benefit

Restriction

Indication: Locally advanced (stage C) or metastatic (stage D) carcinoma of the prostate
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 1 DPMQ: $714.99 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Diphereline