CLOMIPRAMINE

CLOMIPRAMINE (1561E)

clomipramine hydrochloride 25 mg tablet, 50
1561E
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Cataplexy

Restriction

Indication: Obsessive-compulsive disorder

Restriction

Indication: Phobic disorders
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 50 # of repeats: 2 DPMQ: $19.25 Max safety net: $20.79 General Patient Charge: $23.58
Available brands
APO-Clomipramine
CLOMIPRAMINE-WGR
Placil
Anafranil 25
*Additional charge for this brand is $3.57
 DPMQ: $22.82 Max safety net: $20.79 General Patient Charge: $27.15