Limited coverage drugs – benzydamine

Last updated on March 17, 2025

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Generic name	benzydamine
Strength & form	oral rinse - 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

Special Authority criteria

Approval period

For treatment of mucositis, ulcerative complications of chemotherapy

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)

Log in to eForms
HLTH 5328 - General Special Authority request (PDF, 656KB)

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