nabilone (Rx)

Brand and Other Names:Cesamet
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

capsule: Schedule II

  • 1mg

Chemotherapy-Induced Nausea/Vomiting

1-2 mg PO q8-12hr

Renal Impairment

Dose adjustment not necessary

Administration

Give 1-3 hours before chemotherapy

May give one dose the night before chemotherapy

May continue 24 hours after chemotherapy

No more than 6 mg/day

Dosage Forms & Strengths

capsule: Schedule II

  • 1mg

Chemotherapy-Induced Nausea/Vomiting (Off-label)

>4 years

  • <18 kg: 0.5 mg PO q12hr
  • 18-30 kg: 1 mg PO q12hr
  • >30 kg: 1 mg PO q8hr

Chemotherapy-induced nausea/vomiting

1-2 mg PO q8-12hr; not to exceed 6 mg divided q8hr

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Interactions

Interaction Checker

and nabilone

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 

            Contraindicated (0)

              Serious - Use Alternative (3)

              • calcium/magnesium/potassium/sodium oxybates

                nabilone, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • metoclopramide intranasal

                nabilone, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

              • sodium oxybate

                nabilone, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              Monitor Closely (170)

              • albuterol

                nabilone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • alfentanil

                alfentanil and nabilone both increase sedation. Use Caution/Monitor.

              • alprazolam

                alprazolam and nabilone both increase sedation. Use Caution/Monitor.

              • amitriptyline

                amitriptyline and nabilone both increase sedation. Use Caution/Monitor.

              • amobarbital

                amobarbital and nabilone both increase sedation. Use Caution/Monitor.

              • amoxapine

                amoxapine and nabilone both increase sedation. Use Caution/Monitor.

              • apomorphine

                apomorphine and nabilone both increase sedation. Use Caution/Monitor.

              • arformoterol

                nabilone increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • aripiprazole

                aripiprazole and nabilone both increase sedation. Use Caution/Monitor.

              • armodafinil

                nabilone increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • azelastine

                azelastine and nabilone both increase sedation. Use Caution/Monitor.

              • baclofen

                baclofen and nabilone both increase sedation. Use Caution/Monitor.

              • belladonna and opium

                belladonna and opium and nabilone both increase sedation. Use Caution/Monitor.

              • benperidol

                benperidol and nabilone both increase sedation. Use Caution/Monitor.

              • benzphetamine

                nabilone increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • brompheniramine

                brompheniramine and nabilone both increase sedation. Use Caution/Monitor.

              • buprenorphine

                buprenorphine and nabilone both increase sedation. Use Caution/Monitor.

              • buprenorphine buccal

                buprenorphine buccal and nabilone both increase sedation. Use Caution/Monitor.

              • butabarbital

                butabarbital and nabilone both increase sedation. Use Caution/Monitor.

              • butalbital

                butalbital and nabilone both increase sedation. Use Caution/Monitor.

              • butorphanol

                butorphanol and nabilone both increase sedation. Use Caution/Monitor.

              • caffeine

                nabilone increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • carbinoxamine

                carbinoxamine and nabilone both increase sedation. Use Caution/Monitor.

              • carisoprodol

                carisoprodol and nabilone both increase sedation. Use Caution/Monitor.

              • chloral hydrate

                chloral hydrate and nabilone both increase sedation. Use Caution/Monitor.

              • chlordiazepoxide

                chlordiazepoxide and nabilone both increase sedation. Use Caution/Monitor.

              • chlorpheniramine

                chlorpheniramine and nabilone both increase sedation. Use Caution/Monitor.

              • chlorpromazine

                chlorpromazine and nabilone both increase sedation. Use Caution/Monitor.

              • chlorzoxazone

                chlorzoxazone and nabilone both increase sedation. Use Caution/Monitor.

              • cinnarizine

                cinnarizine and nabilone both increase sedation. Use Caution/Monitor.

              • clemastine

                clemastine and nabilone both increase sedation. Use Caution/Monitor.

              • clobazam

                nabilone, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

              • clomipramine

                clomipramine and nabilone both increase sedation. Use Caution/Monitor.

              • clonazepam

                clonazepam and nabilone both increase sedation. Use Caution/Monitor.

              • clonidine

                clonidine, nabilone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration enhances CNS depressant effects.

              • clorazepate

                clorazepate and nabilone both increase sedation. Use Caution/Monitor.

              • clozapine

                clozapine and nabilone both increase sedation. Use Caution/Monitor.

              • codeine

                codeine and nabilone both increase sedation. Use Caution/Monitor.

              • cyclizine

                cyclizine and nabilone both increase sedation. Use Caution/Monitor.

              • cyclobenzaprine

                cyclobenzaprine and nabilone both increase sedation. Use Caution/Monitor.

              • cyproheptadine

                cyproheptadine and nabilone both increase sedation. Use Caution/Monitor.

              • dantrolene

                dantrolene and nabilone both increase sedation. Use Caution/Monitor.

              • desflurane

                desflurane and nabilone both increase sedation. Use Caution/Monitor.

              • desipramine

                desipramine and nabilone both increase sedation. Use Caution/Monitor.

              • dexchlorpheniramine

                dexchlorpheniramine and nabilone both increase sedation. Use Caution/Monitor.

              • dexfenfluramine

                nabilone increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dexmedetomidine

                dexmedetomidine and nabilone both increase sedation. Use Caution/Monitor.

              • dexmethylphenidate

                nabilone increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dextroamphetamine

                nabilone increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dextromoramide

                dextromoramide and nabilone both increase sedation. Use Caution/Monitor.

              • diamorphine

                diamorphine and nabilone both increase sedation. Use Caution/Monitor.

              • diazepam

                diazepam and nabilone both increase sedation. Use Caution/Monitor.

              • diethylpropion

                nabilone increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • difenoxin hcl

                difenoxin hcl and nabilone both increase sedation. Use Caution/Monitor.

              • dimenhydrinate

                dimenhydrinate and nabilone both increase sedation. Use Caution/Monitor.

              • diphenhydramine

                diphenhydramine and nabilone both increase sedation. Use Caution/Monitor.

              • diphenoxylate hcl

                diphenoxylate hcl and nabilone both increase sedation. Use Caution/Monitor.

              • dipipanone

                dipipanone and nabilone both increase sedation. Use Caution/Monitor.

              • dobutamine

                nabilone increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dopamine

                nabilone increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dopexamine

                nabilone increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • doxepin

                doxepin and nabilone both increase sedation. Use Caution/Monitor.

              • doxylamine

                doxylamine and nabilone both increase sedation. Use Caution/Monitor.

              • droperidol

                droperidol and nabilone both increase sedation. Use Caution/Monitor.

              • ephedrine

                nabilone increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • epinephrine

                nabilone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • epinephrine racemic

                nabilone increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • estazolam

                estazolam and nabilone both increase sedation. Use Caution/Monitor.

              • ethanol

                ethanol and nabilone both increase sedation. Use Caution/Monitor.

              • etomidate

                etomidate and nabilone both increase sedation. Use Caution/Monitor.

              • fenfluramine

                nabilone increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • fluphenazine

                fluphenazine and nabilone both increase sedation. Use Caution/Monitor.

              • flurazepam

                flurazepam and nabilone both increase sedation. Use Caution/Monitor.

              • formoterol

                nabilone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • haloperidol

                haloperidol and nabilone both increase sedation. Use Caution/Monitor.

              • hydromorphone

                hydromorphone and nabilone both increase sedation. Use Caution/Monitor.

              • hydroxyzine

                hydroxyzine and nabilone both increase sedation. Use Caution/Monitor.

              • iloperidone

                iloperidone and nabilone both increase sedation. Use Caution/Monitor.

              • imipramine

                imipramine and nabilone both increase sedation. Use Caution/Monitor.

              • isoproterenol

                nabilone increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ketamine

                ketamine and nabilone both increase sedation. Use Caution/Monitor.

              • ketotifen, ophthalmic

                ketotifen, ophthalmic and nabilone both increase sedation. Use Caution/Monitor.

              • levalbuterol

                nabilone increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • levorphanol

                levorphanol and nabilone both increase sedation. Use Caution/Monitor.

              • lisdexamfetamine

                nabilone increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • lofepramine

                lofepramine and nabilone both increase sedation. Use Caution/Monitor.

              • lofexidine

                lofexidine and nabilone both increase sedation. Use Caution/Monitor.

              • loprazolam

                loprazolam and nabilone both increase sedation. Use Caution/Monitor.

              • lorazepam

                lorazepam and nabilone both increase sedation. Use Caution/Monitor.

              • lormetazepam

                lormetazepam and nabilone both increase sedation. Use Caution/Monitor.

              • loxapine

                loxapine and nabilone both increase sedation. Use Caution/Monitor.

              • loxapine inhaled

                loxapine inhaled and nabilone both increase sedation. Use Caution/Monitor.

              • lurasidone

                lurasidone, nabilone. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

              • maprotiline

                maprotiline and nabilone both increase sedation. Use Caution/Monitor.

              • marijuana

                marijuana and nabilone both increase sedation. Use Caution/Monitor.

              • melatonin

                melatonin and nabilone both increase sedation. Use Caution/Monitor.

              • meperidine

                meperidine and nabilone both increase sedation. Use Caution/Monitor.

              • meprobamate

                meprobamate and nabilone both increase sedation. Use Caution/Monitor.

              • metaproterenol

                nabilone increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • metaxalone

                metaxalone and nabilone both increase sedation. Use Caution/Monitor.

              • methadone

                methadone and nabilone both increase sedation. Use Caution/Monitor.

              • methamphetamine

                nabilone increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • methocarbamol

                methocarbamol and nabilone both increase sedation. Use Caution/Monitor.

              • methylenedioxymethamphetamine

                nabilone increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • midazolam

                midazolam and nabilone both increase sedation. Use Caution/Monitor.

              • midazolam intranasal

                midazolam intranasal, nabilone. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

              • midodrine

                nabilone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • mirtazapine

                mirtazapine and nabilone both increase sedation. Use Caution/Monitor.

              • modafinil

                nabilone increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • morphine

                morphine and nabilone both increase sedation. Use Caution/Monitor.

              • motherwort

                motherwort and nabilone both increase sedation. Use Caution/Monitor.

              • moxonidine

                moxonidine and nabilone both increase sedation. Use Caution/Monitor.

              • nalbuphine

                nalbuphine and nabilone both increase sedation. Use Caution/Monitor.

              • naltrexone

                naltrexone increases effects of nabilone by Other (see comment). Use Caution/Monitor. Comment: Naltrexone may enhance therapeutic effects of cannabinoids. .

              • norepinephrine

                nabilone increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • nortriptyline

                nortriptyline and nabilone both increase sedation. Use Caution/Monitor.

              • olanzapine

                olanzapine and nabilone both increase sedation. Use Caution/Monitor.

              • opium tincture

                opium tincture and nabilone both increase sedation. Use Caution/Monitor.

              • orphenadrine

                orphenadrine and nabilone both increase sedation. Use Caution/Monitor.

              • oxazepam

                oxazepam and nabilone both increase sedation. Use Caution/Monitor.

              • oxycodone

                oxycodone and nabilone both increase sedation. Use Caution/Monitor.

              • oxymorphone

                oxymorphone and nabilone both increase sedation. Use Caution/Monitor.

              • paliperidone

                paliperidone and nabilone both increase sedation. Use Caution/Monitor.

              • papaveretum

                papaveretum and nabilone both increase sedation. Use Caution/Monitor.

              • papaverine

                nabilone and papaverine both increase sedation. Use Caution/Monitor.

              • pentazocine

                pentazocine and nabilone both increase sedation. Use Caution/Monitor.

              • pentobarbital

                pentobarbital and nabilone both increase sedation. Use Caution/Monitor.

              • perphenazine

                perphenazine and nabilone both increase sedation. Use Caution/Monitor.

              • phendimetrazine

                nabilone increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • phenobarbital

                phenobarbital and nabilone both increase sedation. Use Caution/Monitor.

              • phentermine

                nabilone increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • phenylephrine

                nabilone increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • phenylephrine PO

                nabilone increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • pholcodine

                nabilone and pholcodine both increase sedation. Use Caution/Monitor.

              • pimozide

                pimozide and nabilone both increase sedation. Use Caution/Monitor.

              • pirbuterol

                nabilone increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • primidone

                primidone and nabilone both increase sedation. Use Caution/Monitor.

              • prochlorperazine

                prochlorperazine and nabilone both increase sedation. Use Caution/Monitor.

              • promethazine

                promethazine and nabilone both increase sedation. Use Caution/Monitor.

              • propofol

                propofol and nabilone both increase sedation. Use Caution/Monitor.

              • propylhexedrine

                nabilone increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • protriptyline

                protriptyline and nabilone both increase sedation. Use Caution/Monitor.

              • quazepam

                quazepam and nabilone both increase sedation. Use Caution/Monitor.

              • quetiapine

                quetiapine and nabilone both increase sedation. Use Caution/Monitor.

              • ramelteon

                nabilone and ramelteon both increase sedation. Use Caution/Monitor.

              • risperidone

                risperidone and nabilone both increase sedation. Use Caution/Monitor.

              • salmeterol

                nabilone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • scullcap

                nabilone and scullcap both increase sedation. Use Caution/Monitor.

              • secobarbital

                secobarbital and nabilone both increase sedation. Use Caution/Monitor.

              • sevoflurane

                sevoflurane and nabilone both increase sedation. Use Caution/Monitor.

              • shepherd's purse

                nabilone and shepherd's purse both increase sedation. Use Caution/Monitor.

              • stiripentol

                stiripentol, nabilone. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

              • sufentanil

                sufentanil and nabilone both increase sedation. Use Caution/Monitor.

              • tapentadol

                tapentadol and nabilone both increase sedation. Use Caution/Monitor.

              • temazepam

                temazepam and nabilone both increase sedation. Use Caution/Monitor.

              • terbutaline

                nabilone increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • thioridazine

                thioridazine and nabilone both increase sedation. Use Caution/Monitor.

              • thiothixene

                thiothixene and nabilone both increase sedation. Use Caution/Monitor.

              • topiramate

                nabilone and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • tramadol

                tramadol and nabilone both increase sedation. Use Caution/Monitor.

              • trazodone

                trazodone and nabilone both increase sedation. Use Caution/Monitor.

              • triazolam

                triazolam and nabilone both increase sedation. Use Caution/Monitor.

              • triclofos

                triclofos and nabilone both increase sedation. Use Caution/Monitor.

              • trifluoperazine

                trifluoperazine and nabilone both increase sedation. Use Caution/Monitor.

              • trimipramine

                trimipramine and nabilone both increase sedation. Use Caution/Monitor.

              • triprolidine

                triprolidine and nabilone both increase sedation. Use Caution/Monitor.

              • xylometazoline

                nabilone increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • yohimbine

                nabilone increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ziconotide

                nabilone and ziconotide both increase sedation. Use Caution/Monitor.

              • ziprasidone

                ziprasidone and nabilone both increase sedation. Use Caution/Monitor.

              Minor (4)

              • benazepril

                nabilone, benazepril. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May increase risk of hypotension.

              • captopril

                nabilone, captopril. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May increase risk of hypotension.

              • eucalyptus

                eucalyptus and nabilone both increase sedation. Minor/Significance Unknown.

              • sage

                nabilone and sage both increase sedation. Minor/Significance Unknown.

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              Adverse Effects

              >10%

              Vertigo (52%)

              Drowsiness (52%)

              Dry mouth (36%)

              Ataxia (14%)

              Visual disturbance (13%)

              Blurred vision (12.8%)

              Concentration difficulties (12%)

              Euphoria (11%)

              Sleep disturbance (11%)

              1-10%

              Depersonalization

              Disorientation

              Dysphoria

              Headache

              Hypotension

              Nausea

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              Warnings

              Contraindications

              Hypersensitivity to cannabinoids

              History of psychotic reactions

              Cautions

              Severe liver impairment

              Give only to patients in whom conventional antiemetics have failed

              Emotionally disturbed patients (non-psychotic)

              Concomitant use of alcohol or other psychoactive substances can potentiate psychotropic effects

              May cause tachycardia and orthostatic hypotension

              May impair ability to drive or perform hazardous tasks

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              Pregnancy & Lactation

              Pregnancy Category: C

              Lactation: not recommended

              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

              Cannabinoid antiemetic may act in the central nervous system by acting on cannabinoid receptors

              Pharmacokinetics

              Excretion: Feces (65%; primarily bile); urine (20%)

              Half-life elimination: 2 hr (parent compound); 35 hr (metabolites)

              Peak plasma time: 2 hr

              Distribution: 12.5 L/kg

              Metabolism: Direct enzymatic oxidation and possibly CYP450 enzymes

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              Images

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              Patient Handout

              A Patient Handout is not currently available for this monograph.
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              Formulary

              FormularyPatient Discounts

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              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
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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.