پيوست شماره 3: فهرست 116 قلم داروي سطح اول فهرست اولیه داروهای سطح اول بیمه روستاییان براساس انتخاب نمایندگان پزشکان خانواده و مراکز بهداشتی درمانی روستایی کل کشور )با لحاظ همه دوزها و اشکال دارویی مربوطه( ردیف نام دارو tranexamic acid A.C.A ACETAMINOPHEN -PARACETAMOL ACETAMINOPHEN -PARCETAMOL ACETAMINOPHEN CODEINE ACETAMINOPHEN -PARACETAMOL ACETAZOLAMIDE ACETAZOLAMIDE -AS SODIUM ACICLOVIR ADULT COLD ALBENDAZOL ALENDRONATE -AS SODIUM ALLOPURINOL ALPHA ALPRAZOLAM ALUMINIUM HYDROXIDE -AS GEL ALUMINIUM MG ALUMINIUM MG S AMILORIDE - H AMINOPHYLLINE AMITRIPTYLINE HCI AMLODIPINE -AS BESYLATE cap AMOXICILLIN250 cap AMOXICILLIN500 sol AMOXICILLIN125 sol AMOXICILLIN250 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 124
cap AMPICILLIN250 cap AMPICILLIN500 syr AMPICILLIN125 syr AMPICILLIN250 amp AMPICILLIN1000 amp AMPICILLIN500 AMPICILLIN -AS SODIUM ANTI HEMORRHOID ANTI HISTAMINE DECONGESTANT ARTIFICIAL TEARS -HYPROMELLOSE ASA -ACETYL SALICYLIC ACID ATENOLOL ATORVASTATINE ATROPINE SULFATE AZITHROMYCIN AZITHROMYCIN AZITHROMYCIN -AS EIHYDRATE (سازمان 09 درصد بر اساس سهم) Azitromycin BACLOFEN BECLOMETHASONE DIPROPIONATE BELLADONNA PB BETAHISTINE 2HCL BETAMETHASONE -AS DISODIUM PHOSPHATE BETAMETHASONE -AS VALERATE BETAMETHASONE DISODIUM PHOSPHATE BETAMETHASONE LA BIPERIDEN LACTATE BISACODYL BISMUTH SUB CITRATE BROMHEXINE HCL BURN OINTMENT -FOR MINOR BURNS CALAMINE - D 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 125
CALCIUM -AS CARBONATE CALCIUM - D CALCIUM FORTE CALCIUM GLUCONATE CAPTOPRIL CARBAMAZEPINE CEFAZOLIN -AS DODIUM500 CEFAZOLIN -AS DODIUM1000 cap CEFIXIME200 syrcefixime100 cap CEFIXIME400 CEFOTAXIME -AS SODIUM CEPHALEXIN CETIRIZINE HCL CHARCOAL ACTIVATED CHILDREN COLD CHLOR DIAZEPOXIDE CHLOR HEXIDINE GLUCONATE CHLOR PHENIRAMINE MALEATE CHLORPROMAZINE HCL CHLORAM PHENICOL CHLORAM PHENICOL -AS SODIUM SUCCINATE CHLORO QUINE -AS PHOSPHATE CHOLESTYRAMINE CIMETIDIME -AS HCL CIMETIDIne CIPROFLOXACIN -AS HCL CITALOPRAM C-LAX CLEMASTINE -AS FUMARATE CLIDINIUM-C CLINDAMYCIN 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 126
CLOBETASOL PROPIONATE CLOBUTINOL HCL CLOFAZIMINE CLOMIPRAMINE HCI CLONAZEPAM CLOTRIMAZOLE CLOXACILLIN -AS SODIUM syr CO-AMOXICLAV325 cap CO-AMOXICLAV375 cap CO-AMOXICLAV625 tab CO-AMOXICLAV CO-TRIMOXAZOLE CROMOLYN SODIUM CROTAMITON CYCLOSERINE CYPROHEPTADINE HCL CYPROTERONE COMPOUND DAPSONE DEXA METHASONE DEXTROMETHORPHAN HBR DEXTROMETHORPHAN - P DEXTROSE 3.33% NACL 0.3% DEXTROSE 5% NACL 0.9% DEXTROSE 50% DIAZEPAM DICLOFENAC SODIUM DICYCLOMINE HCL DIGESTIVE DIGOXIN DILTIAZEM HCL DILTIAZEM HCL SR DIMENHYDRINATE 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 127
DIMETHICONE -ACTIVATED DIPHEN HYDRAMIN HCL DIPHEN HYDRAMINE COMPOUND DIPHENOXILATE آلفن ایکس ال( DICLOFENAC S.R SODIUM )EPINEPHRINE تزریقی) DIPYRIDAMOLE DOPAMINE HCL DOXYCYCLINE ENALAPRIL MALEATE EPINEPHRINE -AS ACID TARTRATE ERGOTAMINE - C ERYTHROMYCIN ERYTHROMYCIN -AS ETHYLSUCCINATE ESTRADIOL VALERATE EXPECTORANT EXPECTORANT CODEINE FAMOTIDINE FERROUS SULFATE FERROUS SULFATE - F FLUCONAZOLE FLUOCINOLONE ACETONIDE FLUOXETINE -AS HCL FLUPHENAZINE 2HCL FLUPHENAZINE DECANOATE FLUVOXAMINE FLUVOXAMINE MALEATE FOLIC ACID FURAZOLIDONE FUROSEMIDE GABAPENTIN GEMFIBROZIL 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 128
GENTAMICIN -AS SULFATE GLIBENCLAMIDE GLYCERIN PHENIQE GRISEOFULVIN GUAIFENESIN HALOPERIDOL HALOPERIDOL -AS DECANOATE HALOPERIDOL -AS LACTATE HYDRALAZINE HCL HYDRO CHLOROTHIAZIDE HYDRO CORTISONE ACETATE HYDROXYZINE HCL HYOSCINE.N. BUTYL BROMIDE IBUPROFEN IMIPRAMINE HCL INDOMETHACIN INDOMETHACIN SR INSULIN ISOPHANE -NPH Human INSULIN -REGULAR Human IODOQUINOL -DI IODO HYDROXY QUINOLINE IPRATROPIUM BROMIDE ISOSORBIDE DINITRATE ISOSORBIDE DINITRATE SR ISOXSUPRINE HCL KETOCONAZOLE KETOTIFEN -AS FUMARATE LACTULOSE LEVAMISOLE -AS HCL LEVOTHYROXINE SODIUM LIDOCAINE HCL LINDANE. LITHIUM CARBONATE 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 129
LITHIUM CARBONATE SR LOPERAMIDE HCL LORATADINE LORAZEPAM LOSARTAN POTASSIUM (بر اساس سهم سازمان 09 درصد ( Losartan+Hydrochlorthiazide LOVASTATIN MAGNESIUM HYDROXIDE MEBENDAZOLE MEDROXY PROGESTERONE ACETATE MEFENAMIC ACID MENTHOL SALICYLATE METFORMIN HCL METHIMAZOLE METHOCARBAMOLE METHYL SALICYLATE METHYL DOPA METHYL PREDNISOLONE ACETATE METOCLOPRAMIDE -AS HCL OR 2HCL METOCLOPRAMIDE HCL METOPROLOL TARTRARE METRONIDAZOLE MULTI VITAMIN MULTI VITAMIN PLUS IRON MUPIROCIN NALIDIXIC ACID NALOXONE NAPHAZOLINE ANTAZOLINE NAPHAZOLINE HCL OR NITRATE NAPROXEN NICLOSAMIDE NICOTINIC ACID 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 130
NITROFURANTOIN NITROFURAZONE NITROGLYCERIN NITROGLYCERIN SR NOR TRIPTYLINE -AS HCL NYSTATIN O.R.S. OFLOXACIN OMEPRAZOLE OXAZEPAM OXYBUTYNIN CHLORIDE PEDIATRIC GRIPPE PENICILLIN G BENZATHINE -PENICILLIN LA PENICILLIN G PLUD PROCAINE PENICILLIN V BENZATHINE PENICILLIN V POTASSIUM PENICILLINE 6-3-3 PERPHENAZINE PHENAZO PYRIDINE HCL PHENO BARBITAL PHENYL EPHRINE HCL PHENYTOIN COMPOUND PHENYTOIN SODIUM PHOSPHATE SODIUM PIPERAZINE HEXAHYDRATE PIPERAZINE HEXAHYDRATE -AS CITRATE PIROXICAM POLYMYXIN B SULFATE POLYMYXIN - NH PRAZOSIN -AS HCL PREDNISOLONE PREDNISOLONE FORTE 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 131
PRIMAQUINE -AS PHOSPHATE PROGESTERONE PROMETHAZINE HCL PROPRANOLOL HCL PSEUDO EPHEDRINE HCL PYRAZINAMIDE PYRIMETHAMINE PYRVINIUM -AS PAMOATE RANITIDINE RANITIDINE -AS HCL RINGER S RINGER LACTATE RISPERIDONE SALBUTAMOL SALBUTAMOL -AS SULFATE SILVER SULFADIAZINE SODIUM BICARBONATE SODIUM CHLORIDE SORBITOL SPIRONOLACTONE STREPTOMYCIN -AS SULFATE SUCRALFATE SULFACETAMIDE SODIUM SULFADOXINE- P SULFASALAZINE TETANUS IMMUNE GLOBULIN TETRACAINE HCL TETRACYCLINE HCL THEOPHILLINE G. THEOPHILLINE SR. THIORIDAZINE HCL TIMOLOL -AS MALEATE 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 132
TOLMETIN -AS SODIUM TRETINOIN TRIAMCINOLONE ACETONIDE TRIAMCINOLONE N.N TRIAMTERENE - H TRIFLUO PERAZINE -AS 2HCL TRIHEXYPHENIDYL HCL TRIPLE SULFA VALPROATE SODUIM VALPROATE SODUIM SR VERAPAMIL HCL VITAMIN A VITAMIN A+D VITAMIN B1 -THIAMINE HCL VITAMIN B12 -CYANOCOBALAMIN VITAMIN B2 -RIBOFLAVIN VITAMIN B6 -PYRIDOXINE HCL VITAMIN C -ASCORBIC ACID VITAMIN D3 -COLECALCIFEROL VITAMIN K -PHYTONADIONE WATER (5ml) ZINC OXIDE ZINC SULFATE AMANTADINE HCL anethum BENZOCAINE BENZOYL PEROXIDE - Top Gel BUSPIRON CALCIUM PANTOTHENATE calendula CARAWAY MIXTURE CARBAMAZEPINE 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 133
CARMINT CARVEDILOL CAST CETYLPYRIDINIUM CHOLORIDE CHLOR HEXIDINE GLUCONATE cinarizin COAL TAR - Lotion colchicine conjugated estrogen(tab) dextrometorphan DIHYDRO ERGOTAMIN FIGITOL FIGPLUS FIGSIN FIJAN GLICLAZIDE HYDROXY CHLORO QUINE SULFATE HYPIRAN LEUCOREX VAGINAL CREAM levodopa LIDOCAINE -P - Top Oint METAPROTRENOL(TAB) methyl ergonovin maleate pancreatin EC permethrin Pioglitazone prostatan PROSTATAN psyllium SIMVASTATIN SPECTINOMYCIN (AS 2HCL) TESTOSTERONE ENANTATE 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 134
THIABENDAZOLE trimipramine VALSARTAN VIBRIL 347 348 349 350 135