Limited coverage drugs – benzydamine

Last updated on August 7, 2024

Generic name

benzydamine

Strength

oral rinse
Form

0.15 % mouthwash

Special Authority criteria

Approval period

For treatment of mucositis, ulcerative complications of chemotherapy

OR

Immunocompromised patients at risk of mucosal breakdown

First approval: 1 year

Renewals: 1 year

Practitioner exemptions

  • Oncologist (medical)
  • Oncologist (radiation)

Special notes

  • None

Special Authority request form(s)