ISOSORBIDE DINITRATE

ISOSORBIDE DINITRATE (13491C)

isosorbide dinitrate 5 mg sublingual tablet, 100
13491C
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: The condition must be stable for the prescriber to consider the listed maximum quantity of this medicine suitable for this patient.
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 400 # of repeats: 2 DPMQ: $28.84 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Isordil Sublingual

ISOSORBIDE DINITRATE (2588F)

isosorbide dinitrate 5 mg sublingual tablet, 100
2588F
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: 2 Max qty units: 200 # of repeats: 2 DPMQ: $21.32 Max safety net: $22.80 General Patient Charge: $25.00
Available brands
Isordil Sublingual