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TABELA DESCRITIVA DO COMPONENTE ESPECIALIZADO DA ASSISTNCIA

FARMACUTICA - PORTARIA 2.981 - com alteraes da 3439/2010


atualizada em 01/11/11

Proced.

Descrio

060460001-1

Acitretina 10 mg (por capsula)

060460002-0

Acitretina 25 mg (por capsula)

CID PERMITIDOS

L400, L401, L404, L408, L440, Q800, Q801, Q802,


Q803, Q808, Q828
L400, L401, L404, L408, L440, Q800, Q801, Q802,
Q803, Q808, Q828
M050, M051, M052, M053, M058, M060, M068,
M070, M073, M080, M45

QTD
MAX

IDADE

217

110

93

110

110

K500, K501, K508

18 110

060446001-5

Adalimumabe 40 mg injetavel (por seringa


preenchida) (ARTRITE)
Adalimumabe 40 mg injetavel (por seringa
preenchida) (CROHN)
Adefovir 10 mg (por comprimido)

B181

31

13 110

060462001-2

Alfacalcidol 0,25 mcg (por capsula)

E200, E201, E208, E892, N180, N188, N250, N258

744

110

060462002-0

Alfacalcidol 1,0 mcg (por capsula)

E200, E201, E208, E892, N180, N188, N250, N258

186

110

060444001-4

E840, E848

62

110

B171, B182, N180, N188, Z948

22

110

N180, N188, Z948

37

110

N180, N188, Z948

37

110

N180, N188, Z948

37

110

N180, N188, Z948

56

110

B180, B181, D180

12

110

B171, B180, B181, B182, D180

56

110

B171,B180, B181, D180

31

110

B171, B180, B182

110

B171, B180, B182

110

B171, B180, B182

110

B171, B180, B182

110

E752

48

110

E752

24

110

060420001-3

Alfadornase 2,5 mg (por ampola)


Alfaepoetina 10.000 ui injetavel (por frascoampola)
Alfaepoetina 1000 ui injetavel (por frascoampola)
Alfaepoetina 2000 ui injetavel (por frascoampola)
Alfaepoetina 3000 ui injetavel (por frascoampola)
Alfaepoetina 4000 ui injetavel (por frascoampola)
Alfainterferona 2b 10.000.000 ui injetavel (por
frasco- ampola)
Alfainterferona 2b 3.000.000 ui injetavel (por
frasco- ampola)
Alfainterferona 2b 5.000.000 ui injetavel (por
frasco- ampola)
Alfapeginterferona 2a 180 mcg (por seringa
preenchida)
Alfapeginterferona 2b 100 mcg (por frascoampola)
Alfapeginterferona 2b 120 mcg (por frascoampola)
Alfapeginterferona 2b 80 mcg (por frascoampola)
Alfavelaglicerase 200 u injetavel (por frasco
ampola)
Alfavelaglicerase 400 u injetavel (por frasco
ampola)
Amantadina 100 mg (por comprimido)

124

110

060436001-0

Atorvastatina 10 mg (por comprimido)

248

110

060436002-9

Atorvastatina 20 mg (por comprimido)

124

110

060436003-7

Atorvastatina 40 mg (por comprimido)

62

110

060436004-5

Atorvastatina 80 mg (por comprimido)

G20
E78.0, E78.1, E78.2, E78.3, E78.4, E78.5, E78.6,
E78.8
E78.0, E78.1, E78.2, E78.3, E78.4, E78.5, E78.6,
E78.8
E78.0, E78.1, E78.2, E78.3, E78.4, E78.5, E78.6,
E78.8
E78.0, E78.1, E78.2, E78.3, E78.4, E78.5, E78.6,
E78.8

31

110

060438001-1
060438006-2

060447005-3
060447001-0
060447002-9
060447003-7
060447004-5
060439003-3
060439001-7
060439002-5
060439004-1
060439006-8
060439007-6
060439005-0
060424004-0
060424005-8

060453001-3

Azatioprina 50 mg (por comprimido)

D610, G700, G35, H300, H301, H302, H308, K500,


K501, K508, K510, K511, K512, K513, K514, K515,
K518, K754, M321, M328, M330, M331, M332,
M340, M341, M348, N040, N041, N042, N043,
N044, N045, N046, N047, N048, T861, Z940, Z941,
Z942, Z943, Z944, Z945, Z946, Z947, Z948

060428002-5

Beclometasona 200 mcg por inalante(por


frasco de 100 doses)

J45.0, J45.1, J45.8

060428001-7

Beclometasona 200 mg (por capsula inalante) J45.0, J45.1, J45.8

060428003-3

Beclometasona 250 mcg spray (por frasco de


200 doses)

060428004-1

248

110

110

124

110

J45.0, J45.1, J45.8

110

Beclometasona 400 mcg (por capsula inalante) J45.0, J45.1, J45.8

62

110

J45.0, J45.1, J45.8

110

G35

14

110

G35

14

110

G35

110

G35

16

110

E780, E781, E782, E783, E784, E785, E786, E788

93

110

E780, E781, E782, E783, E784, E785, E786, E788

31

110

E22.0, E22.1, G20

868

110

E22.0, E22.1, G20

438

110

J45.0, J45.1, J45.8

186

110

J45.0, J45.1, J45.8

110

J45.0, J45.1, J45.8

110

93
310

0
0

110
110

31

110

110

31

110

372

110

30
186

0
0

110
110

060428007-6
060403003-7

Beclometasona 400 mcg por inalante(por


frasco de 100 doses)
Betainterferona 1a 12.000.000 ui (44 mcg )
injetavel (por seringa preenchida)
Betainterferona 1a 6.000.000 (22 mcg )
injetavel (por seringa preenchida)
Betainterferona 1a 6.000.000 ui (30 mcg )
injetavel ( por frasco- ampola ou seringa
preenchida)
Betainterferona 1a 9.600.000 ui (300 mcg )
injetavel (por frasco- ampola)
Bezafibrato 200 mg (por drgea ou
comprimido)
Bezafibrato 400 mg (por comprimido de
desintegrao lenta)
Bromocriptina - 2,5 mg (por comprimido ou
capsula de liberaco retardada)
Bromocriptina - 5 mg (por comprimido ou
capsula de liberaco retardada)
Budesonida 200 mcg (por capsula inalante)
Budesonida 200 mcg por inalante ou aerossol
bucal (por frasco c/ 100 doses)
Budesonida 200 mcg por inalante ou aerossol
bucal (por frasco c/ 200 doses)
Budesonida 400 mcg (por capsula inalante)
Cabergolina 0,5 mg (por comprimido)

060457002-3

Calcitonina 100 ui injetavel (por ampola)

060457003-1

Calcitonina 200 spray nasal (por ampola)

060457001-5

Calcitonina 50 ui injetavel (por ampola)

060462003-9

Calcitriol

060462004-7
060409001-3

Calcitriol 1,0 mcg injetavel (por ampola)


Ciclofosfamida 50 mg (por dragea)

060428005-0
060439010-6
060439008-4
060439009-2
060439011-4
060427001-1
060427002-0
060403001-0
060403002-9
060428006-8
060428008-4
060428009-2

0,25 mcg (por capsula)

J45.0, J45.1, J45.8


E22.0, E22.1,
M800, M801, M802, M803, M804, M805, M808,
M810, M811, M812, M813, M814, M815, M816,
M818, M820, M821, M828, M880, M888
M800, M801, M802, M803, M804, M805, M808,
M810, M811, M812, M813, M814, M815, M816,
M818, M820, M821, M828, M880, M888
M800, M801, M802, M803, M804, M805, M808,
M810, M811, M812, M813, M814, M815, M816,
M818, M820, M821, M828, M880, M888
E200, E201, E208, E550, E559, E643, E833, E892,
M805, M815, M830, M831, M832, M833, M838,
N180, N188, N250, N258
N180, N188, N250, N258
D60.0, M34.0, M34.1, M34.8

Ciclosporina 10 mg (por capsula)

D600, D610, D611, D612, D613, D618, G700, H300,


H301, H302, H308, K500, K501, K508, K510, K511,
K512, K513, K514, K515, K518, L400, L401, L404,
L408, M050, M051, M052, M053, M058, M060,
M068, M070, M073, M080, M321, M328, M330,
M331, M332, N040, N041, N042, N043, N044,
N045, N046, N047, N048, T861, Z940, Z941, Z942,
Z943, Z944, Z945, Z946, Z947, Z948

496

110

Ciclosporina 100 mg (por capsula)

D600, D610, D611, D612, D613, D618, G700, H300,


H301, H302, H308, K500, K501, K508, K510, K511,
K512, K513, K514, K515, K518, L400, L401, L404,
L408, M050, M051, M052, M053, M058, M060,
M068, M070, M073, M080, M321, M328, M330,
M331, M332, N040, N041, N042, N043, N044,
N045, N046, N047, N048, T861, Z940, Z941, Z942,
Z943, Z944, Z945, Z946, Z947, Z948

372

110

Ciclosporina 100 mg/ml soluo oral (por


frasco de 50 ml )

D600, D610, D611, D612, D613, D618, G700, H300,


H301, H302, H308, K500, K501, K508, K510, K511,
K512, K513, K514, K515, K518, L400, L401, L404,
L408, M050, M051, M052, M053, M058, M060,
M068, M070, M073, M080, M321, M328, M330,
M331, M332, N040, N041, N042, N043, N044,
N045, N046, N047, N048, T861, Z940, Z941, Z942,
Z943, Z944, Z945, Z946, Z947, Z948

110

Ciclosporina 25 mg (por capsula)

D600, D610, D611, D612, D613, D618, G700, H300,


H301, H302, H308, K500, K501, K508, K510, K511,
K512, K513, K514, K515, K518, L400, L401, L404,
L408, M050, M051, M052, M053, M058, M060,
M068, M070, M073, M080, M321, M328, M330,
M331, M332, N040, N041, N042, N043, N044,
N045, N046, N047, N048, T861, Z940, Z941, Z942,
Z943, Z944, Z945, Z946, Z947, Z948

496

110

060434003-6

Ciclosporina 50 mg (por capsula)

D600, D610, D611, D612, D613, D618, G700, H300,


H301, H302, H308, K500, K501, K508, K510, K511,
K512, K513, K514, K515, K518, L400, L401, L404,
L408, M050, M051, M052, M053, M058, M060,
M068, M070, M073, M080, M321, M328, M330,
M331, M332, N040, N041, N042, N043, N044,
N045, N046, N047, N048, T861, Z940, Z941, Z942,
Z943, Z944, Z945, Z946, Z947, Z948

744

110

060427003-8
060412001-0

Ciprofibrato 100 mg (por comprimido)


Ciproterona 50 mg (por comprimido)

31
21

0
0

110
110

060418001-2

Clobazam 10 mg (por comprimido)

124

110

060418002-0

Clobazam 20 mg (por comprimido)

62

110

060408001-8

Cloroquina 150 mg por comprimido

186

110

060423008-7

Clozapina 100 mg (por comprimido)

248

110

060423007-9

Clozapina 25 mg (por comprimido)

992

110

R52.2, R52.1

110

R52.2, R52.1
R52.2, R52.1
R52.2, R52.1

744
186
372

0
0
0

110
110
110

060434001-0

060434004-4

060434005-2

060434002-8

060405001-1
060405003-8
060405002-0
060405004-6

Codeina 3 mg/ml Soluo oral (por frasco de


120 ml)
Codeina 30 mg (por comprimido)
Codeina 30 mg/ml (por ampola de 2 ml)
Codeina 60 mg (por comprimido)

E780, E781, E782, E783, E784, E785, E786, E788


E228, E250, E280, E282, L680
G400, G401, G402, G403, G404, G405, G406, G407,
G408
G400, G401, G402, G403, G404, G405, G406, G407,
G408
M050, M051, M052, M053, M058, M060, M068,
M080
F20.0, F20.1,F20.2, F20.3, F20.4, F20.5, F20.6,
F20.8
F20.0, F20.1,F20.2, F20.3, F20.4, F20.5, F20.6,
F20.8

060406002-5

Complemento Alimentar para


Fenilcetonricos Frmula de Aminocidos
E70.0
Isenta de Fenilalanina (para pacientes maiores
de 1 ano de idade) lata por grama

3617

110

060406001-7

Complemento Alimentar para pacientes


Fenilcetonricos Frmula de Aminocidos
E70.0
Isenta de Fenilalanina (para pacientes menores
de 1 ano de idade) lata por grama

1550

060414002-9

Danazol 100 mg ( por cpsula)

248

110

060414003-7

Danazol 200 mg ( por cpsula)

124

110

060414001-0

Danazol 50 mg ( por cpsula)

D841, N800, N801, N802, N803, N804, N805, N808

496

110

060402001-5
060402002-3
060402003-1
060402004-0

T454
T454
T454
T454

744
372
186
465

0
0
0
0

110
110
110
110

N250, T454

310

110

110

31
62
310
62

40
40
0
13

110
110
110
110

110

110

060427004-6

Deferasirox 125 mg/ por comprimido


Deferasirox 250 mg/ por comprimido
Deferasirox 500 mg/ por comprimido
Deferiprona 500 mg / por comprimido
Desferroxamina 500 mg injetavel (por frasco
ampola)
Desmopressina 0,1 mg/ml aplicaao nasal (por
frasco de 2,5 ml)
Donepezila - 10 mg por comprimido
Donepezila - 5 mg (por comprimido)
Entacapona 200 mg (por comprimido)
Entecavir 0,5 mg (por comprimido)
Etanercepte 25 mg injetavel (por frasco ampola)
Etanercepte 50 mg injetavel (por frasco ampola)
Etofibrato 500 mg (por capsula)

31

110

060422001-4

Etossuximida 50 mg/ml (frasco de 120ml)

110

060432001-9
060432002-7
060432003-5
060427005-4

Everolimo 0,5 mg (por comprimido)


Everolimo 0,75 mg (por comprimido)
Everolimo 1,0 mg (por comprimido)
Fenofibrato 200 mg (por capsula)
Fenofibrato 250 mg (por capsula de liberao
E780, E781, E782, E783, E784, E785, E786, E788
retardada)
Fenoterol 100 mcg aerossol (por frasco de 200
J45.0, J45.1, J45.8
doses)

186
124
93
31

0
0
0
0

110
110
110
110

31

110

110

64

110

124

110

124

110

62

110

62

110

J45.0, J45.1, J45.8

62

110

J45.0, J45.1, J45.8

110

J45.0, J45.1, J45.8

110

J45.0, J45.1, J45.8

124

110

060402005-8
060410001-9
060413002-3
060413001-5
060449001-1
060446002-3
060438002-0
060438003-8

060427006-2
060404001-6

060425001-0

Filgrastim 300 mcg injetavel (por frasco)

060442001-3

Fludrocortisona 0,1 mg (por comprimido)


Fluvastatina 20 mg (por capsula)

060436005-3
060436006-1
060404002-4
060404004-0
060404005-9
060404003-2
060404007-5

Fluvastatina 40 mg (por capsula)


Formoterol 12 mcg ( por capsula inalante )
Formoterol 12 mcg + Budesonida 400 mcg
(por capsula inalante)
Formoterol 12 mcg + Budesonida 400 mcg por
inalante(por frasco de 60 doses)
Formoterol 12 mcg por inalante( por frasco de
60 doses )
Formoterol 6 mcg + Budesonida 200 mcg (por
capsula inalante)

D84.1, N80.0, N80.1, N80.2, N80.3, N80.4, N80.5,


N80.8
D84.1, N80.0, N80.1, N80.2, N80.3, N80.4, N80.5,
N80.8

E23.2
G300, G301, G308
G300, G301, G308
G20
B181
M050, M051, M052, M053, M058, M060, M068,
M070, M073, M080, M45
M050, M051, M052, M053, M058, M060, M068,
M070, M073, M080, M45
E780, E781, E782, E783, E784, E785, E786, E788
G400, G401, G402, G403, G404, G405, G406, G407,
G408
T86.1, Z94.0
T86.1, Z94.0
T86.1, Z94.0
E780, E781, E782, E783, E784, E785, E786, E788

B171, B182, B200, B201, B202, B203, B204, B205,


B206, B207, B208, B209, B220, B221, B222, B227,
B230, B231, B232, B238, B24, D460, D461,
D467,D610, D611, D612, D613, D618, D70, Z948
E250,E271,E274
E78.0, E78.1, E78.2, E78.3, E78.4, E78.5, E78.6,
E78.8
E78.0, E78.1, E78.2, E78.3, E78.4, E78.5, E78.6,
E78.8
J45.0, J45.1, J45.8

060404006-7
060450001-7
060450002-5
060413004-0
060413005-8
060413003-1
060427007-0
060427008-9
060452001-8
060411002-2
060411001-4
060408002-6
060417001-7
060417002-5
060417003-3
060417004-1
060417005-0
060448001-6
060433001-4
060424001-5
060424003-1
060430001-8
060430002-6
060430003-4

060431001-3

060431002-1

Formoterol 6 mcg + Budesonida 200 mcg por


J45.0, J45.1, J45.8
inalante(por frasco de 60 doses)
G400, G401, G402, G403, G404, G405, G406, G407,
Gabapentina 300 mg (por capsula)
G408
G400, G401, G402, G403, G404, G405, G406, G407,
Gabapentina 400 mg (por capsula)
G408
Galantamina 16 mg (por capsula de liberao
G300, G301, G308
controlada)
Galantamina 24 mg (por capsula de liberao
G300, G301, G308
controlada)
Galantamina 8 mg (por capsula de liberao
G300, G301, G308
controlada)
Genifibrozila 600 mg (por comprimido)
E780, E781, E782, E783, E784, E785, E786, E788
Genifibrozila 900 mg (por comprimido)
E780, E781, E782, E783, E784, E785, E786, E788
Glatiramer 20 mg injetavel (por frasco-ampola
G35
ou seringa preenchida)
Gosserrelina 10,80 mg injetavel (por seringa D250, D251, D252, E228, N800, N801, N802, N803,
preenchida)
N804, N805, N808
Gosserrelina 3,60 mg injetavel (por seringa
D250, D251, D252, E228, N800, N801, N802, N803,
preenchida)
N804, N805, N808
M050, M051, M052, M053, M058, M060, M068,
Hidroxicloroquina 400 mg (por comprimido)
M080, M330, M331
Hidrxido de Alumnio 230 mg (por
E83.3, N18.0
comprimido)
Hidrxido de Alumnio 300 mg (por
E83.3, N18.0
comprimido)
Hidrxido de Alumnio 61,5 mg/ml (suspenso
E83.3, N18.0
por frasco de 100 ml)
Hidrxido de Alumnio 61,5 mg/ml (suspenso
E83.3, N18.0
por frasco de 150 ml)
Hidrxido de Alumnio 61,5 mg/ml (suspenso
E83.3, N18.0
por frasco de 240 ml)
Hidroxiureia 500 mg (por capsula)
D561, D568, D570, D571, D572
Iloprosta 10 mcg/ml soluo para nebulizao
I27.0, I27.2
(ampola 2 ml)
Imiglucerase 200 ui injetavel (por frasco de
E75.2
ampola)
Imiglucerase 400 ui injetavel (por frasco de
E75.2
ampola)
Imonoglobulina anti-hepatite b 100 ui injetavel
B16.0, B16.2, B18.0, B18.1
(por frasco)
Imonoglobulina anti-hepatite b 500 ui injetavel
B16.0, B16.2, B18.0, B18.1
(por frasco)
Imonoglobulina anti-hepatite b 600 ui injetavel
B16.0, B16.2, B18.0, B18.1
(por frasco)
B200, B201, B202, B203, B204, B205, B206, B207,
B208, B209, B220, B221, B222, B227, B230, B231,
B232, B238, B24, D590, D591, D600, D693, D800,
Imunoglobulina humana 0,5 g injetavel (por
D801, D803, D805, D806, D807, D808, D810, D811,
frasco)
D812, D813, D814, D815, D816, D817, D818, D820,
D821, D830, D832, D838, G610, G700, M330,
M331, M332

Imunoglobulina humana 1,0 g injetavel (por


frasco)

B200, B201, B202, B203, B204, B205, B206, B207,


B208, B209, B220, B221, B222, B227, B230, B231,
B232, B238, B24, D590, D591, D600, D693, D800,
D801, D803, D805, D806, D807, D808, D810, D811,
D812, D813, D814, D815, D816, D817, D818, D820,
D821, D830, D832, D838, G610, G700, M330,
M331, M332

110

372

110

279

110

31

40 110

31

40 110

93

40 110

62
31

0
0

109
110

31

110

110

110

93

110

1456

110

1116

110

54

110

36

110

23

110

217

110

62

110

48

110

24

110

110

110

110

600

110

300

110

060431003-0

060431004-8

060431005-6

060431006-4

060438005-4
060438004-6
060459001-6
060459002-4
060446003-1
060446004-0
060450005-0
060450003-3
060450004-1
060432004-3
060411004-9
060411003-0
060436007-0
060436008-8
060436009-6
060401007-9
060401006-0

Imunoglobulina humana 2,5 g injetavel (por


frasco)

B200, B201, B202, B203, B204, B205, B206, B207,


B208, B209, B220, B221, B222, B227, B230, B231,
B232, B238, B24, D590, D591, D600, D693, D800,
D801, D803, D805, D806, D807, D808, D810, D811,
D812, D813, D814, D815, D816, D817, D818, D820,
D821, D830, D832, D838, G610, G700, M330,
M331, M332

120

110

Imunoglobulina humana 3,0 g injetavel (por


frasco)

B20.0, B20.1, B20.2, B20.3, B20.4, B20.5, B20.6,


B20.7, B20.8, B20.9, B22.0, B22.1, B22.2, B22.7,
B23.0, B23.1, B23.2, B23.8, B24, D59.0, D59.1,
D60.0, D69.3, D80.0, D80.1, D80.3, D80.5, D80.6,
D80.7, D80.8, D81.0, D81.1, D81.2, D81.3, D81.4,
D81.5, D81.6, D81.7, D81.8, D82.0, D82.1, D83.0,
D83.2, D83.8, G61.0, G70.0, M33.0, M33.1, M33.2

100

110

Imunoglobulina humana 5,0 g injetavel (por


frasco)

B20.0, B20.1, B20.2, B20.3, B20.4, B20.5, B20.6,


B20.7, B20.8, B20.9, B22.0, B22.1, B22.2, B22.7,
B23.0, B23.1, B23.2, B23.8, B24, D59.0, D59.1,
D60.0, D69.3, D80.0, D80.1, D80.3, D80.5, D80.6,
D80.7, D80.8, D81.0, D81.1, D81.2, D81.3, D81.4,
D81.5, D81.6, D81.7, D81.8, D82.0, D82.1, D83.0,
D83.2, D83.8, G61.0, G70.0, M33.0, M33.1, M33.2

60

110

Imunoglobulina humana 6,0 g injetavel (por


frasco)

B200, B201, B202, B203, B204, B205, B206, B207,


B208, B209, B220, B221, B222, B227, B230, B231,
B232, B238, B24, D590, D591, D600, D693, D800,
D801, D803, D805, D806, D807, D808, D810, D811,
D812, D813, D814, D815, D816, D817, D818, D820,
D821, D830, D832, D838, G610, G700, M330,
M331, M332

50

110

M070, M073, M45, K500, K501, K508

110

110

620
310

0
0

110
110

110

62

110

155

110

620

110

310

110

31

110

110

110

248

110

124

110

62

110

124

110

124

110

Infliximabe 10 mg/ml injetavel (por frascoampola com 10 ml) (CROHN)


Infliximabe 10 mg/ml injetavel (por frascoampola) (ARTRITE)
Isotretinoina 10 mg (por capsula)
Isotretinoina 20 mg (por capsula)
Lamivudina 10 mg/ml soluo oral (frasco de
240 ml)
Lamivudina 150mg (por comprimido)

M050, M051, M052, M053, M058, M060, M068,


M080
L700, L701, L708
L700, L701, L708
B160, B162, B180, B181

B160, B162, B180, B181


G400, G401, G402, G403, G404, G405, G406, G407,
Lamotrigina 100 mg (por comprimido)
G408
G400, G401, G402, G403, G404, G405, G406, G407,
Lamotrigina 25 mg (por comprimido)
G408
G400, G401, G402, G403, G404, G405, G406, G407,
Lamotrigina 50 mg (por comprimido)
G408
M05.0, M05.1, M05.2, M05.3, M05.8, M06.0,
Leflunomida 20 mg (por comprimido)
M06.8, M07.0, M07.3, M08.0
Leuprorrelina 11,25 mg injetavel (por frasco D250, D251, D252, E228, N800, N801, N802, N803,
ampola)
N804, N805, N808
Leuprorrelina 3,75 mg injetavel (por frasco
D250, D251, D252, E228, N800, N801, N802, N803,
ampola)
N804, N805, N808
Lovastatina 10 mg (por comprimido)
E78.0, E78.1, E78.2, E78.3, E78.4, E78.5, E78.6,
E78.8
Lovastatina 20 mg (por comprimido)
E78.0, E78.1, E78.2, E78.3, E78.4, E78.5, E78.6,
E78.8
Lovastatina 40 mg (por comprimido)
E78.0, E78.1, E78.2, E78.3, E78.4, E78.5, E78.6,
E78.8
Mesalazina - 1 G + diluente 100 ml (enema) - K500, K501, K508, K510, K511, K512, K513, K514,
por dose
K515, K518
K500, K501, K508, K510, K511, K512, K513, K514,
Mesalazina - 1000 mg por supositorio
K515, K518

060401004-4
060401008-7
060401001-0
060401002-8
060401005-2
060401003-6
060441002-6
060441003-4
060441001-8
060428010-6

K500, K501, K508, K510, K511, K512, K513, K514,


K515, K518
Mesalazina - 3 G + diluente 100 ml (enema) - K500, K501, K508, K510, K511, K512, K513, K514,
por dose
K515, K518
K500, K501, K508, K510, K511, K512, K513, K514,
Mesalazina - 400 mg por comprimido
K515, K518
K500, K501, K508, K510, K511, K512, K513, K514,
Mesalazina - 500 mg por comprimido
K515, K518
K500, K501, K508, K510, K511, K512, K513, K514,
Mesalazina - 500 mg por supositorio
K515, K518
K500, K501, K508, K510, K511, K512, K513, K514,
Mesalazina - 800 mg por comprimido
K515, K518
Metadona 10 mg (por comprimido)
R521, R522
Metadona 10 mg/ml injetavel (por ampola de 1
R521, R522
ml)
Metadona 5 mg (por comprimido)
R521, R522
Metilprednisolona 500 mg injetavel (por
T861, Z940, Z941, Z942, Z943, Z944, Z945, Z946,
ampola)
Z947, Z948
Mesalazina - 250 mg por supositorio

496

110

31

110

310

110

248

110

248

110

155

110

620

110

620

110

1240

110

14

110

060453002-1

Metotrexato 2,5 mg (por comprimido)

L400, L401, L404, L408, M050, M051, M052,


M053, M058, M060, M068, M070, M073, M080,
M330, M331, M332, M340,M341, M348, M45

50

110

060453003-0

Metotrexato 25 mg/ml injetavel (por ampola


de 2 ml)

K500, K501, K508, M050, M051, M052, M053,


M058, M060, M068, M070, M073, M080, M330,
M331, M332

110

K500, K501, K508

15

110

T86.1, Z94.0, Z94.1, Z94.4

186

110

T86.1, Z94.0, Z94.1, Z94.4

248

110

T86.1, Z94.0, Z94.1, Z94.4

124

110

E752

93

18 110

B200, B201, B202, B203, B204, B205, B206, B207,


B208, B209, B220, B221, B222, B227, B230, B231,
Molgramostim 300 mcg injetavel (por frasco)
B232, B238, B24, D460, D461, D467, D610, D611,
D612, D613, D618, D70, Z948

64

110

R52.2, R52.1

1860

110

R52.2, R52.1

62

110

R52.2, R52.1
R52.2, R52.1

1860
1240

0
0

110
110

R52.2, R52.1

62

110

R52.2, R52.1

217

110

R52.2, R52.1

124

110

G35
E22.0
E22.0

1
465
93

18 110
0 110
0 110

E22.0

110

E22.0

110

E22.0

110

31

110

93

110

060453004-8
060432005-1
060432006-0
060432007-8
060463001-8

060425002-9

060405005-4
060405006-2
060405007-0
060405008-9
060405011-9
060405009-7
060405010-0
060432011-6
060429004-7
060429005-5
060429001-2
060429002-0
060429003-9

Metotrexato 25 mg/ml injetavel (por ampola


de 20 ml)
Micofenolato de mofetila 500 mg (por
comprimido)
Micofenolato de sodio 180 mg (por
comprimido)
Micofenolato de sodio 360 mg (por
comprimido)
Miglustate 100 mg (por capsula)

Morfina 10 mg/ml (por ampola de 1 ml)


Morfina 10 mg/ml soluo oral(por frasco de
60 ml)
Morfina 10mg (por comprimido)
Morfina 30 mg (por comprimido)
Morfina de Liberao Controlada 100 mg (por
capsula)
Morfina de Liberao Controlada 30 mg (por
capsula)
Morfina de Liberao Controlada 60 mg (por
capsula)
Natalizumabe 300 mg (por frasco-ampola)
Octreotida 0,1 mg/ml injetavel (por ampola)
Octreotida 0,5 mg/ml injetavel (por ampola)
Octreotida Lar 10 mg injetavel (por frasco ampola)
Octreotida Lar 20 mg injetavel (por frasco ampola)
Octreotida Lar 30 mg injetavel (por frasco ampola)

060423002-8

Olanzapina 10 mg (por comprimido)

060423001-0

Olanzapina 5 mg (por comprimido)

F20.0, F20.1,F20.2, F20.3, F20.4, F20.5, F20.6,


F20.8
F20.0, F20.1,F20.2, F20.3, F20.4, F20.5, F20.6,
F20.8

060416001-1

Pamidronato 30 mg injetvel (por frascoampola)

060416002-0

Pamidronato 60 mg injetvel (por frascoampola)

060416003-8
060458001-0
060458002-9
060458004-5
060458005-3
060458006-1
060458003-7
060456001-0
060413011-2
060403004-5
060403005-3
060403006-1
060436010-0
060436011-8
060436012-6

Pamidronato 90 mg injetvel ( por frascoampola)


Pancreatina 10.000 ui (por capsula)
Pancreatina 25.000 ui (por capsula)
Pancrelipase 12.000 ui (por capsula)
Pancrelipase 18.000 ui (por capsula)
Pancrelipase 20.00 ui (por capsula)
Pancrelipase 4500 ui (por capsula)
Penicilamina 250 mg (por capsula)
Piridostigmina 60 mg ( por comprimido)
Pramipexol 0,125 mg (por comprimido)
Pramipexol 0,25 mg (por comprimido)
Pramipexol 1 mg (por comprimido)
Pravastatina 10 mg (por comprimido)
Pravastatina 20 mg (por comprimido)
Pravastatina 40 mg (por comprimido)

060415001-6

Primidona 100 mg (por comprimido)

060415002-4

Primidona 250 mg (por comprimido)

060423004-4

Quetiapina 100 mg (por comprimido)

060423005-2

Quetiapina 200 mg (por comprimido)

060423003-6

Quetiapina 25 mg (por comprimido)

060423006-0

Quetiapina 300 mg (por comprimido)

060443001-9

Raloxifeno 60 mg (por comprimido)

060445001-0
060454001-9

Ribavirina 250 mg (por capsula)


Riluzol 50 mg (por comprimido)

060416005-4

Risedronato 35 mg ( por comprimido)

060416004-6

Risedronato 5 mg (por comprimido)

060451001-2
060451002-0
060451003-9
060413006-6
060413009-0
060413010-4

Risperidona 1 mg (por comprimido)


Risperidona 2 mg (por comprimido)
Risperidona 3 mg (por comprimido)
Rivastigmina 1,5 mg (por cpsula)
Rivastigmina 4,5 mg (por cpsula)
Rivastigmina 6 mg (por cpsula)
Rivastigmina 2,0 mg/ml- soluo oral (por
frasco com 120 ml)
Rivastigmina 3 mg (por cpsula)

060413007-4
060413008-2

M80.0, M80.1, M80.2, M80.3, M80.4, M80.5,


M80.8, M81.0, M81.1, M81.2, M81.3, M81.4,
M81.5, M81.6, M81.8, M82.0, M82.1, M82.8,
M88.0, M88.8
M80.0, M80.1, M80.2, M80.3, M80.4, M80.5,
M80.8, M81.0, M81.1, M81.2, M81.3, M81.4,
M81.5, M81.6, M81.8, M82.0, M82.1, M82.8,
M88.0, M88.8
M88.0, M88.8
E841, E848, K860, K861, K903
E841, E848, K860, K861, K903
E841, E848, K860, K861, K903
E841, E848, K860, K861, K903
E841, E848, K860, K861, K903
E841, E848, K860, K861, K903
E830, M340, M341, M348
G700
G20
G20
G20
E78.0, E78.1, E78.2, E78.3, E78.4, E78.5, E78.6,
E78.8
E78.0, E78.1, E78.2, E78.3, E78.4, E78.5, E78.6,
E78.8
E78.0, E78.1, E78.2, E78.3, E78.4, E78.5, E78.6,
E78.8
G400, G401, G402, G403, G404, G405, G406, G407,
G408
G400, G401, G402, G403, G404, G405, G406, G407,
G408
F20.0, F20.1,F20.2, F20.3, F20.4, F20.5, F20.6,
F20.8
F20.0, F20.1,F20.2, F20.3, F20.4, F20.5, F20.6,
F20.8
F20.0, F20.1,F20.2, F20.3, F20.4, F20.5, F20.6,
F20.8
F20.0, F20.1,F20.2, F20.3, F20.4, F20.5, F20.6,
F20.8
M800, M801, M802, M803, M804, M805, M808,
M810, M811, M812, M813, M814, M815, M816,
M818, M820, M821, M828
B171, B182
G12.2
M80.0, M80.1, M80.2, M80.3, M80.4, M80.5,
M80.8, M81.0, M81.1, M81.2, M81.3, M81.4,
M81.5, M81.6, M81.8, M82.0, M82.1, M82.8,
M88.0, M88.8
M80.0, M80.1, M80.2, M80.3, M80.4, M80.5,
M80.8, M81.0, M81.1, M81.2, M81.3, M81.4,
M81.5, M81.6, M81.8, M82.0, M82.1, M82.8,
M88.0, M88.8
F200, F201, F202, F203, F204, F205, F206, F208
F200, F201, F202, F203, F204, F205, F206, F208
F200, F201, F202, F203, F204, F205, F206, F208
G300, G301, G308
G300, G301, G308
G300, G301, G308

110

110

110

3100
1240
2583
1722
1550
3100
186
372
1116
558
124

0
0
0
0
0
0
0
0
0
0
0

110
110
110
110
110
110
110
110
110
110
110

124

110

62

110

31

110

233

110

93

110

248

110

124

110

992

110

62

110

31

110

217
62

0
0

110
110

110

186

110

186
93
62
248
62
62

0
0
0
40
40
40

110
110
110
110
110
110

G300, G301, G308

40 110

G300, G301, G308

124

40 110

060426001-6
060404008-3
060404009-1

Sacarato de hidroxido ferrico 100 mg injetavel


D50.0, D50.8, N18.0, N18.8
(por frasco de5 ml)
Salbutamol 100 mcg Aerossol(por frasco de
J45.0, J45.1, J45.8
200 doses)
Salmeterol 50 mcg po inalante ou aerossol
J45.0, J45.1, J45.8
bucal (por frasco de 60 doses)

13

110

110

110

060437002-4

Selegilina 10 mg (por dragea ou comprimido) G20

31

110

060437001-6
060440001-2
060435001-5
060432008-6

Selegilina 5 mg (por comprimido)


Sevelamer 800 mg (por comprimido)
Sildenafila 20 mg (por comprimido)
Sirolimo 1 mg (por dragea)
Sirolimo 1 mg/ml soluo oral(por frasco de
60 ml)
Sirolimo 2 mg (por dragea)
Somatropina 12 ui injetavel (por frascoampola)

G20
E833, N180
I27.0, I27.2
T86.1, Z94.0

62
279
93
65

0
18
0
0

110
110
110
110

T86.1, Z94.0

110

T86.1, Z94.0

32

110

E230, Q960, Q961, Q962, Q963, Q964, Q968

31

110

Somatropina 4 ui injetavel (por frasco-ampola) E230, Q960, Q961, Q962, Q963, Q964, Q968

93

110

372

110

930
186
31
186

0
0
13
0

110
110
110
110

124

110

496

110

248

110

060432010-8
060432009-4
060461002-5
060461001-7

K500, K501, K508, K510, K511, K512, K513, K514,


K515, K518, K522, M023, M050, M051, M052,
M053, M058, M060, M068, M070, M073, M074,
M075, M076, M080, M45, M460, M461, M468,
M488
T86.1, Z940, Z94.4
T86.1, Z940, Z94.4
B181
G20
G400, G401, G402, G403, G404, G405, G406, G407,
G408
G400, G401, G402, G403, G404, G405, G406, G407,
G408
G400, G401, G402, G403, G404, G405, G406, G407,
G408

060401009-5

Sulfassalazina - 500 mg por comprimido

060434006-0
060434007-9
060446005-8
060449002-0

Tacrolimo 1 mg (por capsula)


Tacrolimo 5 mg (por capsula)
Tenofovir 300 mg (por comprimido)
Tolcapona 100 mg (por comprimido)

060450008-4

Topiramato 100 mg (por comprimido)

060450006-8

Topiramato 25 mg (por comprimido)

060450007-6

Topiramato 50 mg (por comprimido)

060455001-4

Toxina Botulinica tipo a 100 ui injetavel (por


frasco-ampola)

G041, G240, G241, G242, G243, G244, G245, G248,


G518, G800, G801,G802, G811, G821, G824, I690,
I691, I692, I693, I694, I698, T905, T908

110

060455002-2

Toxina Botulinica tipo a 500 ui injetavel (por


frasco-ampola)

G041,G240, G241, G242, G243, G244, G245,


G248,G518,G800, G801,G802, G811, G821, G824,
I690, I691, I692, I693, I694, I698, T905, T908

110

93

110

110

110

186

110

124

110

62

110

060407001-2
060411006-5
060411005-7

Triexifenidil 5 mg (por comprimido)


Triptorrelina 11,25 mg injetavel (por frasco de
ampola)
Triptorrelina 3,75 mg injetavel (por frasco de
ampola)

060419001-8

Vigabatrina 500 mg (por comprimido)

060421001-9

Ziprasidona 40 mg (por capsula)

060421002-7

Ziprasidona 80 mg (por capsula)

G20
D250, D251, D252, E228, N800, N801, N802, N803,
N804, N805, N808
D250, D251, D252, E228, N800, N801, N802, N803,
N804, N805, N808
G400, G401, G402, G403, G404, G405, G406, G407,
G408
F20.0, F20.1,F20.2, F20.3, F20.4, F20.5, F20.6,
F20.8
F20.0, F20.1,F20.2, F20.3, F20.4, F20.5, F20.6,
F20.8