Browse by Changes

General Pharmaceutical Benefits

Additions

Addition – Item

10389T ADALIMUMAB, adalimumab 20 mg/0.4 mL injection, 2 x 0.4 mL syringes (Humira)
10396E ADALIMUMAB, adalimumab 20 mg/0.4 mL injection, 2 x 0.4 mL syringes (Humira)
10422M ADALIMUMAB, adalimumab 20 mg/0.4 mL injection, 2 x 0.4 mL syringes (Humira)
10397F ADALIMUMAB, adalimumab 40 mg/0.8 mL injection, 6 x 0.8 mL cartridges (Humira)
10399H ADALIMUMAB, adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (Humira)
10400J ADALIMUMAB, adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL cartridges (Humira)
10404N ADALIMUMAB, adalimumab 40 mg/0.8 mL injection, 6 x 0.8 mL syringes (Humira)
10412B ADALIMUMAB, adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (Humira)
10413C ADALIMUMAB, adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL cartridges (Humira)
10419J ADALIMUMAB, adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (Humira)
10420K ADALIMUMAB, adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL cartridges (Humira)
10410X AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE, amino acid formula with vitamins and minerals without phenylalanine oral liquid, 30 x 130 mL pouch (PKU Air 15)
10411Y AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE, amino acid formula with vitamins and minerals without phenylalanine oral liquid, 30 x 174 mL pouch (PKU Air 20)
10414D APIXABAN, apixaban 5 mg tablets, 28 (Eliquis)
10392Y EZETIMIBE + ATORVASTATIN, ezetimibe 10 mg + atorvastatin 10 mg tablet, 30 (Atozet)
10393B EZETIMIBE + ATORVASTATIN, ezetimibe 10 mg + atorvastatin 20 mg tablet, 30 (Atozet)
10377E EZETIMIBE + ATORVASTATIN, ezetimibe 10 mg + atorvastatin 40 mg tablet, 30 (Atozet)
10376D EZETIMIBE + ATORVASTATIN, ezetimibe 10 mg + atorvastatin 80 mg tablet, 30 (Atozet)
10416F GLATIRAMER ACETATE, glatiramer acetate 40 mg/mL injection, 12 x 1 mL syringes (Copaxone)
10394C GLUCOSE INDICATOR BLOOD, glucose indicator blood strip: diagnostic, 100 (Betachek C50)
10395D GLUCOSE INDICATOR BLOOD, glucose indicator blood strip: diagnostic, 100 (Betachek C50)
10378F TESTOSTERONE, testosterone 50 mg/mL cream, 50 mL (AndroForte 5)
10380H TESTOSTERONE, testosterone 1% (12.5 mg/actuation) gel, 2 x 60 actuations (Testogel)
10385N TRAMETINIB, trametinib 500 microgram tablet, 30 (Mekinist)
10403M TRAMETINIB, trametinib 500 microgram tablet, 30 (Mekinist)
10382K TRAMETINIB, trametinib 2 mg tablet, 30 (Mekinist)
10405P TRAMETINIB, trametinib 2 mg tablet, 30 (Mekinist)
10375C TRIGLYCERIDES MEDIUM CHAIN FORMULA, triglycerides medium chain formula oral liquid, 8 x 500 mL pouches (Nutrini Peptisorb)

Addition – Brand

1052J Aciclovir Sandoz, HXACICLOVIR, aciclovir 800 mg tablet, 35
9012H Alendrobell plus D3, GQALENDRONATE + COLECALCIFEROL, alendronate 70 mg + colecalciferol 70 microgram tablet, 4
9183H Alendrobell plus D3, GQALENDRONATE + COLECALCIFEROL, alendronate 70 mg + colecalciferol 140 microgram tablet, 4
2688L Azran, FMAZATHIOPRINE, azathioprine 25 mg tablet, 100
2687K Azran, FMAZATHIOPRINE, azathioprine 50 mg tablet, 100
8604W Bisoprolol generichealth, GQBISOPROLOL, bisoprolol fumarate 2.5 mg tablet, 28
8605X Bisoprolol generichealth, GQBISOPROLOL, bisoprolol fumarate 5 mg tablet, 28
8606Y Bisoprolol generichealth, GQBISOPROLOL, bisoprolol fumarate 10 mg tablet, 28
3138E Calindamin, QACLINDAMYCIN, clindamycin 150 mg capsule, 24
5057E Calindamin, QACLINDAMYCIN, clindamycin 150 mg capsule, 24 (Dental)
1512N Hydroxychloroquine GH, GQHYDROXYCHLOROQUINE, hydroxychloroquine sulfate 200 mg tablet, 100
9478W Lansoprazole ODT GH, GQLANSOPRAZOLE, lansoprazole 30 mg tablet: orally disintegrating, 28 tablets
9169N Levetiracetam-AFT, AELEVETIRACETAM, levetiracetam 100 mg/mL oral liquid, 300 mL
2622B Oxycodone Aspen, FMOXYCODONE, oxycodone hydrochloride 5 mg tablet, 20
5195K Oxycodone Aspen, FMOXYCODONE, oxycodone hydrochloride 5 mg tablet, 20 (Dental)
8399C APOTEX-Pantoprazole, GXPANTOPRAZOLE, pantoprazole 20 mg tablet: enteric, 30 tablets
2565B APO-Propranolol, TXPROPRANOLOL, propranolol hydrochloride 10 mg tablet, 100
2566C APO-Propranolol, TXPROPRANOLOL, propranolol hydrochloride 40 mg tablet, 100

Addition – Equivalence Indicator

9169N Keppra, UCLEVETIRACETAM, levetiracetam 100 mg/mL oral liquid, 300 mL
2622B Endone, QAOXYCODONE, oxycodone hydrochloride 5 mg tablet, 20
5195K Endone, QAOXYCODONE, oxycodone hydrochloride 5 mg tablet, 20 (Dental)
2565B Inderal, APPROPRANOLOL, propranolol hydrochloride 10 mg tablet, 100
2566C Inderal, APPROPRANOLOL, propranolol hydrochloride 40 mg tablet, 100

Deletions

Deletion – Item

2873F CANAGLIFLOZIN, canagliflozin 100 mg tablet, 30 (Invokana)
2987F CANAGLIFLOZIN, canagliflozin 300 mg tablet, 30 (Invokana)
9157Y CINACALCET, cinacalcet 30 mg tablet, 28 (Sensipar)
9158B CINACALCET, cinacalcet 60 mg tablet, 28 (Sensipar)
9159C CINACALCET, cinacalcet 90 mg tablet, 28 (Sensipar)

Deletion – Brand

1003T Acihexal, SZACICLOVIR, aciclovir 200 mg tablet, 25
8604W Bisoprolol GH, GQBISOPROLOL, bisoprolol fumarate 2.5 mg tablet, 28
8605X Bisoprolol GH, GQBISOPROLOL, bisoprolol fumarate 5 mg tablet, 28
8606Y Bisoprolol GH, GQBISOPROLOL, bisoprolol fumarate 10 mg tablet, 28
3064G Genlac, QALACTULOSE, LACTULOSE Mixture 3.34 g per 5 mL, 500 mL, 1

Alterations

Alteration – Restriction

The following items have additions, deletions or alterations to restrictions, notes and/or cautions.

9186L ADALIMUMAB, adalimumab 40 mg/0.8 mL injection, 6 x 0.8 mL syringes (Humira)
9187M ADALIMUMAB, adalimumab 40 mg/0.8 mL injection, 6 x 0.8 mL cartridges (Humira)
9188N ADALIMUMAB, adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (Humira)
9189P ADALIMUMAB, adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (Humira)
9190Q ADALIMUMAB, adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL cartridges (Humira)
9191R ADALIMUMAB, adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL cartridges (Humira)
2735Y APIXABAN, apixaban 5 mg tablet, 60 (Eliquis)
2744K APIXABAN, apixaban 2.5 mg tablet, 60 (Eliquis)
10003L DABRAFENIB, dabrafenib 75 mg capsule, 120 (Tafinlar)
2846T DABRAFENIB, dabrafenib 75 mg capsule, 120 (Tafinlar)
2954L DABRAFENIB, dabrafenib 50 mg capsule, 120 (Tafinlar)
2963Y DABRAFENIB, dabrafenib 50 mg capsule, 120 (Tafinlar)
9254C GLUCOSE AND KETONE INDICATOR URINE, glucose and ketone indicator urine strip: diagnostic, 50 diagnostic strips (Keto-Diabur- Test 5000)
9255D GLUCOSE AND KETONE INDICATOR URINE, glucose and ketone indicator urine strip: diagnostic, 50 diagnostic strips (Keto-Diastix)
9300L GLUCOSE INDICATOR BLOOD, glucose indicator blood strip: diagnostic, 100 (Accu-Chek Mobile)
9301M GLUCOSE INDICATOR BLOOD, glucose indicator blood strip: diagnostic, 100 (Accu-Chek Mobile)
9253B GLUCOSE INDICATOR URINE, glucose indicator urine strip: diagnostic, 50 diagnostic strips (Diastix)
8078E MESNA, mesna 400 mg/4 mL injection, 15 x 4 mL ampoules (Uromitexan)
8079F MESNA, mesna 1 g/10 mL injection, 15 x 10 mL ampoules (Uromitexan)
2946C PHOSPHORUS, phosphorus 500 mg tablet: effervescent, 100 (Phosphate Sandoz)
9475Q POLYLACTIC ACID, polylactic acid 150 mg injection, 1 x 150 mg vial (Sculptra)
9476R POLYLACTIC ACID, polylactic acid 150 mg injection, 1 x 150 mg vial (Sculptra)

Alteration – Manufacturer Code

From To
9183H Dronalen PlusALENDRONATE + COLECALCIFEROL, alendronate 70 mg + colecalciferol 140 microgram tablet, 4 GN FR
8717T AbilifyARIPIPRAZOLE, aripiprazole 10 mg tablet, 30 BQ OS
8718W AbilifyARIPIPRAZOLE, aripiprazole 15 mg tablet, 30 BQ OS
8719X AbilifyARIPIPRAZOLE, aripiprazole 20 mg tablet, 30 BQ OS
8720Y AbilifyARIPIPRAZOLE, aripiprazole 30 mg tablet, 30 BQ OS
2832C Synacthen Depot 1 mg/1 mLTETRACOSACTRIN, tetracosactrin 1 mg/mL injection: modified release, 1 x 1 mL ampoule NV LM
5480K ZelitrexVALACICLOVIR, valaciclovir 500 mg tablet, 30 UA FM
8064K ZelitrexVALACICLOVIR, valaciclovir 500 mg tablet, 42 UA FM
8133C ZelitrexVALACICLOVIR, valaciclovir 500 mg tablet, 10 UA FM
8134D ZelitrexVALACICLOVIR, valaciclovir 500 mg tablet, 30 UA FM

Advance Notices

1 September 2015

Deletion – Brand

1052J Acihexal, SZACICLOVIR, aciclovir 800 mg tablet, 35
8234J Acihexal, SZACICLOVIR, aciclovir 800 mg tablet, 120
5514F Ocufen, AGFLURBIPROFEN, flurbiprofen sodium 0.03% (120 microgram/0.4 mL) eye drops, 5 x 0.4 mL ampoules (Optometrical)
8699W Ocufen, AGFLURBIPROFEN, flurbiprofen sodium 0.03% (120 microgram/0.4 mL) eye drops, 5 x 0.4 mL ampoules
10141R EasyMate II, WIGLUCOSE INDICATOR BLOOD, glucose indicator blood strip: diagnostic, 100
10145Y EasyMate II, WIGLUCOSE INDICATOR BLOOD, glucose indicator blood strip: diagnostic, 100
9485F Lifeline Attest, OIGLUCOSE INDICATOR BLOOD, glucose indicator blood strip: diagnostic, 50
9486G Lifeline Attest, OIGLUCOSE INDICATOR BLOOD, glucose indicator blood strip: diagnostic, 50
8834Y Solu-Medrol, PFMETHYLPREDNISOLONE, methylprednisolone 1 g injection [1 x 1 g vial] (&) inert substance diluent [1 x 16 mL vial], 1 pack
8209C Aredia 30 mg, NVPAMIDRONATE DISODIUM, pamidronate disodium 30 mg injection [2 x 30 mg vials] (&) inert substance diluent [2 x 10 mL ampoules], 1 pack
2476H Exelon, NVRIVASTIGMINE, rivastigmine 2 mg/mL oral liquid, 120 mL
8563Q Exelon, NVRIVASTIGMINE, rivastigmine 2 mg/mL oral liquid, 120 mL

1 October 2015

Deletion – Brand

8023G Lescol, NVFLUVASTATIN, fluvastatin 20 mg capsule, 28
8023G Vastin, NMFLUVASTATIN, fluvastatin 20 mg capsule, 28
8024H Lescol, NVFLUVASTATIN, fluvastatin 40 mg capsule, 28
8024H Vastin, NMFLUVASTATIN, fluvastatin 40 mg capsule, 28
9234B Lescol, NVFLUVASTATIN, fluvastatin 20 mg capsule, 28
9234B Vastin, NMFLUVASTATIN, fluvastatin 20 mg capsule, 28
9235C Lescol, NVFLUVASTATIN, fluvastatin 40 mg capsule, 28
9235C Vastin, NMFLUVASTATIN, fluvastatin 40 mg capsule, 28

1 December 2015

Deletion – Brand

8613H PKU Anamix Junior, SBAMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE, amino acid formula with vitamins and minerals without phenylalanine oral liquid: powder for, 30 x 29 g sachets
9395L TYR Anamix Junior, SBAMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE AND TYROSINE, amino acid formula with vitamins and minerals without phenylalanine and tyrosine oral liquid: powder for, 30 x 29 g sachets
8745G MSUD Anamix Junior, SBAMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT VALINE, LEUCINE AND ISOLEUCINE, amino acid formula with vitamins and minerals without valine, leucine and isoleucine oral liquid: powder for, 30 x 29 g sachets

Palliative Care

Deletions

Deletion – Brand

5387M Genlac, QALACTULOSE, LACTULOSE Mixture 3.34 g per 5 mL, 500 mL, 1
5388N Genlac, QALACTULOSE, LACTULOSE Mixture 3.34 g per 5 mL, 500 mL, 1

Highly Specialised Drugs Program (Private Hospital)

Additions

Addition – Item

10417G POMALIDOMIDE, pomalidomide 3 mg capsule, 21 (Pomalyst)
10386P POMALIDOMIDE, pomalidomide 4 mg capsule, 21 (Pomalyst)
10398G VEDOLIZUMAB, vedolizumab 300 mg injection, 1 x 300 mg vial (Entyvio)
10415E VEDOLIZUMAB, vedolizumab 300 mg injection, 1 x 300 mg vial (Entyvio)

Deletions

Deletion – Item

9625N CINACALCET, cinacalcet 30 mg tablet, 28 (Sensipar)
9626P CINACALCET, cinacalcet 60 mg tablet, 28 (Sensipar)
9627Q CINACALCET, cinacalcet 90 mg tablet, 28 (Sensipar)

Deletion – Brand

6270B Desferal 2 g, NVDESFERRIOXAMINE, desferrioxamine mesylate 2 g injection, 1 x 2 g vial

Deletion – Equivalence Indicator

6270B Hospira Pty Limited, HHDESFERRIOXAMINE, desferrioxamine mesylate 2 g injection, 1 x 2 g vial

Alterations

Alteration – Restriction

The following items have additions, deletions or alterations to restrictions, notes and/or cautions.

10184B INFLIXIMAB, infliximab 100 mg injection, 1 x 100 mg vial (Remicade)
9612X INFLIXIMAB, infliximab 100 mg injection, 1 x 100 mg vial (Remicade)
9613Y INFLIXIMAB, infliximab 100 mg injection, 1 x 100 mg vial (Remicade)

Alteration – Manufacturer Code

From To
6280M ZelitrexVALACICLOVIR, valaciclovir 500 mg tablet, 100 UA FM

Advance Notices

1 September 2015

Deletion – Brand

9647R Apomine PFS, HHAPOMORPHINE, apomorphine hydrochloride 50 mg/10 mL injection: subcutaneous infusion, 5 x 10 mL syringes
6223M Aredia 90 mg, NVPAMIDRONATE DISODIUM, pamidronate disodium 90 mg injection [1 x 90 mg vial] (&) inert substance diluent [1 x 10 mL ampoule], 1 pack
6279L Aredia 30 mg, NVPAMIDRONATE DISODIUM, pamidronate disodium 30 mg injection [2 x 30 mg vials] (&) inert substance diluent [2 x 10 mL ampoules], 1 pack
2378E Incivo, JCTELAPREVIR, telaprevir 375 mg tablet, 42

Highly Specialised Drugs Program (Public Hospital)

Additions

Addition – Item

10406Q POMALIDOMIDE, pomalidomide 3 mg capsule, 21 (Pomalyst)
10387Q POMALIDOMIDE, pomalidomide 4 mg capsule, 21 (Pomalyst)
10384M VEDOLIZUMAB, vedolizumab 300 mg injection, 1 x 300 mg vial (Entyvio)
10390W VEDOLIZUMAB, vedolizumab 300 mg injection, 1 x 300 mg vial (Entyvio)

Deletions

Deletion – Item

5621W CINACALCET, cinacalcet 30 mg tablet, 28 (Sensipar)
5622X CINACALCET, cinacalcet 60 mg tablet, 28 (Sensipar)
5623Y CINACALCET, cinacalcet 90 mg tablet, 28 (Sensipar)

Deletion – Brand

5661Y Desferal 2 g, NVDESFERRIOXAMINE, desferrioxamine mesylate 2 g injection, 1 x 2 g vial

Deletion – Equivalence Indicator

5661Y Hospira Pty Limited, HHDESFERRIOXAMINE, desferrioxamine mesylate 2 g injection, 1 x 2 g vial

Alterations

Alteration – Restriction

The following items have additions, deletions or alterations to restrictions, notes and/or cautions.

10196P INFLIXIMAB, infliximab 100 mg injection, 1 x 100 mg vial (Remicade)
5754W INFLIXIMAB, infliximab 100 mg injection, 1 x 100 mg vial (Remicade)
5755X INFLIXIMAB, infliximab 100 mg injection, 1 x 100 mg vial (Remicade)

Alteration – Manufacturer Code

From To
9568N ZelitrexVALACICLOVIR, valaciclovir 500 mg tablet, 100 UA FM

Advance Notices

1 September 2015

Deletion – Brand

5611H Apomine PFS, HHAPOMORPHINE, apomorphine hydrochloride 50 mg/10 mL injection: subcutaneous infusion, 5 x 10 mL syringes
5702D Aredia 30 mg, NVPAMIDRONATE DISODIUM, pamidronate disodium 30 mg injection [2 x 30 mg vials] (&) inert substance diluent [2 x 10 mL ampoules], 1 pack
5703E Aredia 90 mg, NVPAMIDRONATE DISODIUM, pamidronate disodium 90 mg injection [1 x 90 mg vial] (&) inert substance diluent [1 x 10 mL ampoule], 1 pack
2437G Incivo, JCTELAPREVIR, telaprevir 375 mg tablet, 42

Highly Specialised Drugs Program (Community Access)

Alterations

Alteration – Restriction

The following items have additions, deletions or alterations to restrictions, notes and/or cautions.

10287K DARUNAVIR, darunavir 150 mg tablet, 240 (Prezista)
10329P DARUNAVIR, darunavir 600 mg tablet, 60 (Prezista)

Advance Notices

1 September 2015

Deletion – Brand

10368Q Telzir, VIFOSAMPRENAVIR, fosamprenavir 50 mg/mL oral liquid, 225 mL

Botulinum Toxin Program

Alterations

Alteration – Restriction

The following items have additions, deletions or alterations to restrictions, notes and/or cautions.

6103F BOTULINUM TOXIN TYPE A, botulinum toxin type A 100 units injection, 1 x 100 units vial (Botox)
1152P CLOSTRIDIUM BOTULINUM TYPE A TOXIN-HAEMAGGLUTININ COMPLEX, clostridium botulinum type A toxin-haemagglutinin complex 300 units injection, 1 x 300 units vial (Dysport)
6293F CLOSTRIDIUM BOTULINUM TYPE A TOXIN-HAEMAGGLUTININ COMPLEX, clostridium botulinum type A toxin-haemagglutinin complex 500 units injection, 1 x 500 units vial (Dysport)

Repatriation Pharmaceutical Benefits

Deletions

Deletion – Brand

4592Q DBL Gabapentin, HHGABAPENTIN, gabapentin 300 mg capsule, 100
4593R DBL Gabapentin, HHGABAPENTIN, gabapentin 400 mg capsule, 100
 

Efficient Funding of Chemotherapy (Private Hospital)

Additions

Addition – Item

10418H OBINUTUZUMAB,
obinutuzumab 1 g/40 mL injection, 40 mL vial (Gazyva)
10381J TRASTUZUMAB,
trastuzumab 60 mg injection, 1 x 60 mg vial (Herceptin);
trastuzumab 150 mg injection, 1 x 150 mg vial (Herceptin)
10383L TRASTUZUMAB,
trastuzumab 60 mg injection, 1 x 60 mg vial (Herceptin);
trastuzumab 150 mg injection, 1 x 150 mg vial (Herceptin)
10402L TRASTUZUMAB,
trastuzumab 60 mg injection, 1 x 60 mg vial (Herceptin);
trastuzumab 150 mg injection, 1 x 150 mg vial (Herceptin)

Deletions

Deletion – Item

10270M TRASTUZUMAB,
trastuzumab 60 mg injection, 1 x 60 mg vial (Herceptin);
trastuzumab 150 mg injection, 1 x 150 mg vial (Herceptin)
10296X TRASTUZUMAB,
trastuzumab 60 mg injection, 1 x 60 mg vial (Herceptin);
trastuzumab 150 mg injection, 1 x 150 mg vial (Herceptin)
10324J TRASTUZUMAB,
trastuzumab 60 mg injection, 1 x 60 mg vial (Herceptin);
trastuzumab 150 mg injection, 1 x 150 mg vial (Herceptin)

Efficient Funding of Chemotherapy (Public Hospital)

Additions

Addition – Item

10407R OBINUTUZUMAB,
obinutuzumab 1 g/40 mL injection, 40 mL vial (Gazyva)
10391X TRASTUZUMAB,
trastuzumab 60 mg injection, 1 x 60 mg vial (Herceptin);
trastuzumab 150 mg injection, 1 x 150 mg vial (Herceptin)
10401K TRASTUZUMAB,
trastuzumab 60 mg injection, 1 x 60 mg vial (Herceptin);
trastuzumab 150 mg injection, 1 x 150 mg vial (Herceptin)
10423N TRASTUZUMAB,
trastuzumab 60 mg injection, 1 x 60 mg vial (Herceptin);
trastuzumab 150 mg injection, 1 x 150 mg vial (Herceptin)

Deletions

Deletion – Item

10269L TRASTUZUMAB,
trastuzumab 60 mg injection, 1 x 60 mg vial (Herceptin);
trastuzumab 150 mg injection, 1 x 150 mg vial (Herceptin)
10346M TRASTUZUMAB,
trastuzumab 60 mg injection, 1 x 60 mg vial (Herceptin);
trastuzumab 150 mg injection, 1 x 150 mg vial (Herceptin)
10362J TRASTUZUMAB,
trastuzumab 60 mg injection, 1 x 60 mg vial (Herceptin);
trastuzumab 150 mg injection, 1 x 150 mg vial (Herceptin)

Related Pharmaceutical Benefits for Public Hospital use

Alterations

Alteration – Restriction

The following items have additions, deletions or alterations to restrictions, notes and/or cautions.

5960Q MESNA, mesna 400 mg/4 mL injection, 15 x 4 mL ampoules (Uromitexan)
5961R MESNA, mesna 1 g/10 mL injection, 15 x 10 mL ampoules (Uromitexan)