cefuroxime (Rx)

Brand and Other Names:Ceftin, Zinacef
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

oral suspension (discontinued; anticipated final availability early 2018)

  • 125mg/5mL
  • 250mg/5mL

powder for injection

  • 750mg
  • 1.5g
  • 7.5g
  • 75g
  • 225g

tablet

  • 250mg
  • 500mg

Pharyngitis/Tonsillitis

250 mg PO q12hr for 10 days

Acute Bacterial Maxillary Sinusitis

250 mg PO q12hr for 10 days

Acute Bacterial Exacerbations of Chronic Bronchitis

250-500 mg PO q12hr for 10 days

500-750 mg IV q8hr; switch to oral therapy as soon as clinically possible

Secondary Bacterial Infections of Acute Bronchitis

250-500 mg PO q12hr for 5-10 days

Uncomplicated Pneumonia

750 mg IV/IM q8hr

Uncomplicated Skin/Skin Structure Infections

250-500 mg PO q12hr for 10 days

750 mg IV/IM q8hr; switch to oral therapy as soon as clinically possible

Uncomplicated Urinary Tract Infections

125-250 mg PO q12hr for 7-10 days

750 mg IV/IM q8hr; switch to oral therapy as soon as clinically possible

Gonorrhea

Uncomplicated: 1 g PO once or 1.5 g IM once at 2 different sites with 1 g probenecid PO

Disseminated: 750 mg IV/IM q8hr

Early Lyme Disease

500 mg PO q12hr for 20 days

Severe or Complicated Infections

1.5 g IV/IM q8hr; may be administered q6hr in life-threatening situations

Dosage Modifications

Renal impairment

  • CrCl >30 mL/min: No adjustment necessary
  • CrCl 10-30 mL/min: Administer dose q24hr
  • CrCl <10 mL/min: Administer dose q48hr

Dosing Considerations

Susceptible organisms

  • Borrelia burgdorferi, Escherichia coli, Haemophilus influenzae, Klebsiella spp, Moraxella catarrhalis, Neisseria gonorrhoeae, Proteus mirabilis, Streptococcus pneumoniae, Streptococcus pyogenes

Dosage Forms & Strengths

oral suspension (discontinued; anticipated final availability early 2018)

  • 125mg/5mL
  • 250mg/5mL

powder for injection

  • 750mg
  • 1.5g
  • 7.5g
  • 75g
  • 225g

tablet

  • 250mg
  • 500mg

Acute Bacterial Maxillary Sinusitis

<3 months: Safety and efficacy not established

3 months-12 years: 30 mg/kg/day suspension PO divided q12hr for 10 days; not to exceed 1000 mg/day; alternatively, 75-150 mg/kg/day IV/IM divided q8hr; not to exceed 6 g/day  

>12 years: 250 mg tablet PO q12hr for 10 days

Acute Otitis Media

<3 months: Safety and efficacy not established

3 months-12 years: 30 mg/kg/day suspension PO divided q12hr for 10 days; not to exceed 1000 mg/day; alternatively, 75-150 mg/kg/day IV/IM divided q8hr; not to exceed 6 g/day  

Alternatively: 125-250 mg PO q12hr for 10 days

>12 years: 250-500 mg tablet PO q12hr for 10 days

Impetigo

<3 months: Safety and efficacy not established

3 months-12 years: 30 mg/kg/day suspension PO divided q12hr for 10 days; not to exceed 1000 mg/day or 75-100mg/kg/day IV/IM divided q8hr; not to exceed 6 g/day  

Alternatively: 125-250 mg PO q12hr for 10 days

>12 years: 250-500 mg tablet PO q12hr for 10 days

Pharyngitis/Tonsillitis

<3 months: Safety and efficacy not established

3 months-12 years: 20 mg/kg/day PO divided q12hr for 10 days; not to exceed 500 mg/day or 75-150 mg/kg/day IV/IM divided q8hr; not to exceed 6 g/day  

Alternatively: 125-250 mg PO q12hr for 10 days

>12 years: 250 mg PO q12hr for 10 days

Severe or Serious Infections (Off-label)

<6 days, <2 kg: 100 mg/kg/day IV/IM divided q12hr  

<6 days, >2 kg: 150 mg/kg/day IV/IM divided q8hr

>7 days: 150 mg/kg/day IV/IM divided q8hr

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Interactions

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              Serious - Use Alternative (9)

              • argatroban

                cefuroxime will increase the level or effect of argatroban by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

              • BCG vaccine live

                cefuroxime decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

              • bivalirudin

                cefuroxime will increase the level or effect of bivalirudin by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

              • cholera vaccine

                cefuroxime, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.

              • dalteparin

                cefuroxime will increase the level or effect of dalteparin by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

              • enoxaparin

                cefuroxime will increase the level or effect of enoxaparin by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

              • fondaparinux

                cefuroxime will increase the level or effect of fondaparinux by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

              • heparin

                cefuroxime will increase the level or effect of heparin by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

              • warfarin

                cefuroxime will increase the level or effect of warfarin by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

              Monitor Closely (30)

              • aluminum hydroxide

                aluminum hydroxide will decrease the level or effect of cefuroxime by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • azithromycin

                azithromycin decreases effects of cefuroxime by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

              • bazedoxifene/conjugated estrogens

                cefuroxime will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • calcium carbonate

                calcium carbonate will decrease the level or effect of cefuroxime by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • cimetidine

                cimetidine will decrease the level or effect of cefuroxime by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • clarithromycin

                clarithromycin decreases effects of cefuroxime by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

              • demeclocycline

                demeclocycline decreases effects of cefuroxime by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

              • didanosine

                didanosine will decrease the level or effect of cefuroxime by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Applies to didanosine chewable tablets and powder for oral solution; administer 2 hr before or several hours after didanosine oral solution or chewable tablet administration

              • dienogest/estradiol valerate

                cefuroxime will decrease the level or effect of dienogest/estradiol valerate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. An alternate or additional form of birth control may be advisable during concomitant use.

              • doxycycline

                doxycycline decreases effects of cefuroxime by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

              • erythromycin base

                erythromycin base decreases effects of cefuroxime by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

              • erythromycin ethylsuccinate

                erythromycin ethylsuccinate decreases effects of cefuroxime by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

              • erythromycin lactobionate

                erythromycin lactobionate decreases effects of cefuroxime by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

              • erythromycin stearate

                erythromycin stearate decreases effects of cefuroxime by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

              • esomeprazole

                esomeprazole will decrease the level or effect of cefuroxime by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • ethinylestradiol

                cefuroxime will decrease the level or effect of ethinylestradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • famotidine

                famotidine will decrease the level or effect of cefuroxime by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • ibuprofen/famotidine

                ibuprofen/famotidine will decrease the level or effect of cefuroxime by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • levonorgestrel oral/ethinylestradiol/ferrous bisglycinate

                cefuroxime will decrease the level or effect of levonorgestrel oral/ethinylestradiol/ferrous bisglycinate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. Antibiotics may decrease hormonal contraceptive efficacy.

              • minocycline

                minocycline decreases effects of cefuroxime by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

              • nizatidine

                nizatidine will decrease the level or effect of cefuroxime by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • omeprazole

                omeprazole decreases effects of cefuroxime by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • probenecid

                probenecid will increase the level or effect of cefuroxime by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.

              • rabeprazole

                rabeprazole will decrease the level or effect of cefuroxime by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • sodium bicarbonate

                sodium bicarbonate will decrease the level or effect of cefuroxime by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • sodium picosulfate/magnesium oxide/anhydrous citric acid

                cefuroxime decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.

              • sodium zirconium cyclosilicate

                sodium zirconium cyclosilicate will decrease the level or effect of cefuroxime by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.

              • tetracycline

                tetracycline decreases effects of cefuroxime by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

              • voclosporin

                voclosporin, cefuroxime. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

              • warfarin

                cefuroxime increases effects of warfarin by Other (see comment). Use Caution/Monitor. Comment: Decr vitamin K-producing intestinal flora may increase INR after a few days.

              Minor (4)

              • chloramphenicol

                chloramphenicol decreases effects of cefuroxime by pharmacodynamic antagonism. Minor/Significance Unknown. bacteriostatic agents may inhibit the effects of bactericidal agents.

              • choline magnesium trisalicylate

                cefuroxime will increase the level or effect of choline magnesium trisalicylate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • furosemide

                cefuroxime increases toxicity of furosemide by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of nephrotoxicity.

              • rose hips

                rose hips will increase the level or effect of cefuroxime by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

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              Adverse Effects

              >10%

              Diarrhea (4-11%; depends on duration)

              1-10%

              Decreased hemoglobin or hematocrit (10%)

              Eosinophilia (7%)

              Nausea or vomiting (3-7%)

              Vaginitis (<5%)

              Transient rise in hepatic transaminases (2-4%)

              Diaper rash (3%)

              Increase in alkaline phosphatase (2%)

              Thrombophlebitis (2%)

              Increase in lactate dehydrogenase (1%)

              <1%

              Anemia

              Cholestasis

              Colitis

              Dyspnea

              Epidermal necrolysis

              Increase in blood urea nitrogen (BUN) and creatinine

              Jaundice

              Nephritis

              Prolonged prothrombin time (PT)/international normalized ratio (INR)

              Rash

              Stevens-Johnson syndrome

              Stomach cramps

              Transient neutropenia and leukopenia

              Urticaria

              Postmarketing Reports

              Immune system disorders: Angioedema, acute myocardial ischemia with or without myocardial infarction

              Neurologic system disorders: Seizure

              Cutaneous vasculitis

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              Warnings

              Contraindications

              Documented hypersensitivity

              Cautions

              Do not crush tablet

              Prolonged INR in nutritionally deficient patients, prolonged treatment, and hepatic and renal disease reported

              Film-coated tablet and oral solution are not bioequivalent; tablets should not be crushed

              Use caution in patients with history of colitis, renal impairment, or with a history of seizure disorders

              Use with caution in patients with history of penicillin allergy

              Reduce dosage by 50% if CrCl is 10-30 mL/min and by 75% if CrCl <10 mL/min (high doses may cause CNS toxicity)

              Some products may contain phenylalanine

              Bacterial or fungal overgrowth of nonsusceptible organisms may occur with prolonged or repeated therapy

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              Pregnancy & Lactation

              Pregnancy

              Available data from published epidemiologic studies, case series, and case reports over several decades in pregnant women have not established drug-associated risks of major birth defects, miscarriage, or adverse maternal or fetal outcomes

              Animal data

              • In studies in pregnant mice and rats administered orally during organogenesis at 14 and 9 times maximum recommended human dose (MRHD) based on body surface area, respectively, there were no adverse developmental outcomes

              Lactation

              Based on several published case reports describing multiple lactating women receiving therapy via intravenous, intramuscular, and oral routes, drug is present in human milk; the highest maternal milk concentration described occurred in lactating women 8 hours after an intramuscular administration of 750 mg; allowing for an infant milk consumption of 150 mL/kg/day, the estimated breastfed infant dose would be less than 1% of adult dose

              No data are available on effects of drug on breastfed infant or on milk production; developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for therapy and any potential adverse effects on breastfed infant from drug or from underlying maternal condition

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Binds to penicillin-binding proteins and inhibits final transpeptidation step of peptidoglycan synthesis, resulting in cell-wall death; resists degradation by beta-lactamase; proper dosing and appropriate route of administration are determined by condition of patient, severity of infection, and susceptibility of microorganism

              Absorption

              Bioavailability: Fasting, 37%; postprandial, 52%

              Peak serum time: 2-3 hr (PO); 15-60 min (IM); 2-3 min (IV)

              Distribution

              Widely distributed to body tissues and fluids, including cerebrospinal fluid (CSF)

              Protein bound: 33-50%

              Metabolism

              Partially metabolized in liver

              Elimination

              Half-life: 1-2 hr (prolonged with renal impairment)

              Excretion: Urine (66-100% as unchanged drug)

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              Administration

              IV Incompatibilities

              Additive: Aminoglycosides, ciprofloxacin, ranitidine, sodium bicarbonate

              Syringe: Doxapram

              Y-site: Azithromycin, cisatracurium (potentially; compatible at low concentration [0.1 mg/mL]), clarithromycin, filgrastim, fluconazole, midazolam, vancomycin, vinorelbine

              IV Compatibilities

              Solution: D5W, NS

              Additive: Clindamycin, floxacillin, furosemide, gentamicin (incompatible in total parenteral nutrition [TPN]), metronidazole, midazolam, netilmicin

              Y-site (partial list): Acyclovir, allopurinol, amiodarone, diltiazem, linezolid, milrinone, morphine sulfate, ondansetron, propofol, tacrolimus

              IV Preparation

              Direct injection: reconstitute in 8 mL (for 750-mg vial) or 16 mL (for 1.5-g vial) to obtain ~90 mg/mL solution

              Infusion: Reconstitute in 100 mL SWI, D5W or NS to obtain 7.5 mg/mL (750-mg vial) or 15 mg/mL (1.5-g vial) solution

              7.5 g bulk package not to be used for direct injection

              IM Preparation

              Reconstitute 750 mg in 3 mL SWI to obtain ~220 mg/mL solution

              IV Administration

              Direct injection: Inject directly into vein over 3-5 minutes or slowly into tubing of free-flowing compatible IV solution

              Infusion: Infuse intermittently over 15-60 minutes

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              cefuroxime axetil oral
              -
              500 mg tablet
              cefuroxime axetil oral
              -
              500 mg tablet
              cefuroxime axetil oral
              -
              250 mg tablet
              cefuroxime axetil oral
              -
              250 mg tablet
              cefuroxime axetil oral
              -
              500 mg tablet
              cefuroxime axetil oral
              -
              250 mg tablet
              cefuroxime axetil oral
              -
              250 mg tablet
              cefuroxime axetil oral
              -
              500 mg tablet

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              cefuroxime axetil oral

              CEFUROXIME SUSPENSION - ORAL

              (sef-you-ROX-eem)

              COMMON BRAND NAME(S): Ceftin

              USES: Cefuroxime is used to treat a wide variety of bacterial infections. This medication is known as a cephalosporin antibiotic. It works by stopping the growth of bacteria.This antibiotic treats only bacterial infections. It will not work for viral infections (such as common cold, flu). Using any antibiotic when it is not needed can cause it to not work for future infections.

              HOW TO USE: Shake the bottle well before each dose. Measure the dose out carefully with a medication spoon/cup. Take this medication by mouth with food, usually twice daily (every 12 hours), or as directed by your doctor. Dosage is based on your medical condition and response to therapy. In children, the dosage is also based on weight.For the best effect, take this antibiotic at evenly spaced times. To help you remember, take this medication at the same time(s) every day.Continue to take this medication until the full-prescribed amount is finished, even if symptoms disappear after a few days. Stopping the medication too early may allow bacteria to continue to grow, which may result in a relapse of the infection.Inform your doctor if your condition persists or worsens.

              SIDE EFFECTS: Nausea, vomiting, diarrhea, strange taste in the mouth, or stomach pain may occur. Diaper rash may occur in young children. Dizziness and drowsiness may occur less frequently, especially with higher doses. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: unusual tiredness/weakness, signs of liver problems (such as nausea/vomiting that doesn't stop, stomach/abdominal pain, yellowing eyes/skin, dark urine), signs of kidney problems (such as change in the amount of urine), signs of new infection (such as fever, persistent sore throat), easy bruising/bleeding, jerky movements, mental/mood changes (such as confusion).This medication may rarely cause a severe intestinal condition due to a bacteria called C. difficile. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn't stop, abdominal or stomach pain/cramping, blood/mucus in your stool.If you have these symptoms, do not use anti-diarrhea or opioid products because they may make symptoms worse.Use of this medication for prolonged or repeated periods may result in oral thrush or a new vaginal yeast infection (oral or vaginal fungal infection). Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge or other new symptoms.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before taking cefuroxime, tell your doctor or pharmacist if you are allergic to it; or to penicillins or other cephalosporin antibiotics (e.g., cephalexin); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, intestinal disease (colitis), liver disease, poor nutrition.This medicine may contain aspartame. If you have phenylketonuria (PKU) or any other condition where you must restrict your intake of aspartame (or phenylalanine), consult your doctor or pharmacist regarding the safe use of this medicine.This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Cefuroxime may cause live bacterial vaccines (such as typhoid vaccine) to not work as well. Do not have any immunizations/vaccinations while using this medication unless your doctor tells you to.Caution is advised when using this drug in the elderly because they may be more sensitive to its effects.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This medication passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.This medication may affect the results of certain lab tests. It may cause false positive results with certain diabetic urine testing products (cupric sulfate-type) and false negative results with certain blood glucose tests. Make sure laboratory personnel and your doctors know you use this drug.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include seizures.

              NOTES: Do not share this medication with others.This medication has been prescribed for your current condition only. Do not use it later for another infection unless your doctor tells you to.

              MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store the suspension in a refrigerator. Do not freeze. Discard any unused medication after 10 days. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised September 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

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              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.