AMITRIPTYLINE

AMITRIPTYLINE (2417F)

amitriptyline hydrochloride 10 mg tablet, 50
2417F
Body System:
Manner of administration:Oral
General Schedule
No restrictions
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: $17.43 Max safety net: $18.97 General Patient Charge: $21.76
Available brands
AMITRIPTYLINE-WGR
APX-Amitriptyline
Amitriptyline Lupin
Amitriptyline Viatris 10
ENTRIP
Endep 10
*Additional charge for this brand is $1.82
 DPMQ: $19.25 Max safety net: $18.97 General Patient Charge: $23.58

AMITRIPTYLINE (2418G)

amitriptyline hydrochloride 25 mg tablet, 50
2418G
Body System:
Manner of administration:Oral
General Schedule
No restrictions
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: $17.61 Max safety net: $19.15 General Patient Charge: $21.94
Available brands
AMITRIPTYLINE-WGR
APX-Amitriptyline
Amitriptyline Lupin
Amitriptyline Viatris 25
ENTRIP
Endep 25
*Additional charge for this brand is $1.82
 DPMQ: $19.43 Max safety net: $19.15 General Patient Charge: $23.76

AMITRIPTYLINE (2429W)

amitriptyline hydrochloride 50 mg tablet, 50
2429W
Body System:
Manner of administration:Oral
General Schedule
No restrictions
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: $17.98 Max safety net: $19.52 General Patient Charge: $22.31
Available brands
APX-Amitriptyline
Amitriptyline Lupin
Amitriptyline Viatris 50
ENTRIP
Endep 50
*Additional charge for this brand is $1.82
 DPMQ: $19.80 Max safety net: $19.52 General Patient Charge: $24.13