Angiotensin Converting Enzyme Inhibitors - Cilazapril

Generic Name          

cilazapril, including in combination with hydrochlorothiazide                                                                                                     

Strength

1 mg, 2.5 mg, 5 mg, 5 mg/12.5 mg

Form

tablet

Special Authority Criteria

Approval Period

  1. Treatment failure on optimal doses of, or intolerance to, ramipril

      OR

  1. Complex patient requiring medication(s) for co-existing chronic condition(s).

Indefinite

Practitioner Exemptions

  • Practitioners in the following specialty are not required to submit a Special Authority request form for coverage:
    • Paediatric Cardiology
    • Paediatrics

Special Notes

  • Individuals requiring a diuretic combination product must satisfy the same criteria.
  • Patients with co-existing chronic conditions requiring use of multiple medications will be considered complex for the purposes of Special Authority criteria.

Special Authority Request Form(s)