cabergoline (Rx)

Brand and Other Names:Dostinex
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 0.5mg

Hyperprolactinemia

Indicated for hyperprolactinemic disorders of either idiopathic or pituitary adenoma origin

Initital: 0.25 mg PO 2x/week

May increase by 0.25 mg q4Weeks (or longer) up to 1 mg 2x/week

Safety & efficacy not established

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Interactions

Interaction Checker

and cabergoline

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    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (14)

            • almotriptan

              cabergoline, almotriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.

            • eletriptan

              cabergoline, eletriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.

            • frovatriptan

              cabergoline, frovatriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.

            • glyceryl trinitrate pr

              cabergoline decreases effects of glyceryl trinitrate pr by pharmacodynamic antagonism. Contraindicated.

            • naratriptan

              cabergoline, naratriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.

            • nitroglycerin IV

              cabergoline decreases effects of nitroglycerin IV by pharmacodynamic antagonism. Contraindicated.

            • nitroglycerin sublingual

              cabergoline decreases effects of nitroglycerin sublingual by pharmacodynamic antagonism. Contraindicated.

            • nitroglycerin topical

              cabergoline decreases effects of nitroglycerin topical by pharmacodynamic antagonism. Contraindicated.

            • nitroglycerin transdermal

              cabergoline decreases effects of nitroglycerin transdermal by pharmacodynamic antagonism. Contraindicated.

            • nitroglycerin translingual

              cabergoline decreases effects of nitroglycerin translingual by pharmacodynamic antagonism. Contraindicated.

            • rizatriptan

              cabergoline, rizatriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.

            • sumatriptan

              cabergoline, sumatriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.

            • sumatriptan intranasal

              cabergoline, sumatriptan intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.

            • zolmitriptan

              cabergoline, zolmitriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.

            Serious - Use Alternative (71)

            • amyl nitrite

              amyl nitrite increases effects of cabergoline by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.

            • aripiprazole

              aripiprazole decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

            • atazanavir

              atazanavir increases levels of cabergoline by decreasing metabolism. Contraindicated.

            • benperidol

              benperidol decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

            • benzphetamine

              cabergoline, benzphetamine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • bromocriptine

              cabergoline, bromocriptine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. The concomitant use of bromocriptine with ergot alkaloids may potentially lead to ergot toxicity; therefore the combination should be avoided.

            • chlorpromazine

              chlorpromazine decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

            • clarithromycin

              clarithromycin increases levels of cabergoline by decreasing metabolism. Contraindicated.

            • clozapine

              clozapine decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

            • darunavir

              darunavir increases levels of cabergoline by decreasing metabolism. Contraindicated.

            • dexfenfluramine

              dexfenfluramine, cabergoline. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Risk of serotonin syndrome.

              cabergoline, dexfenfluramine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • dexmethylphenidate

              cabergoline, dexmethylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • dextroamphetamine

              cabergoline, dextroamphetamine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • diethylpropion

              cabergoline, diethylpropion. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • dobutamine

              cabergoline, dobutamine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • dopamine

              cabergoline, dopamine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • droperidol

              droperidol decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

            • efavirenz

              efavirenz increases levels of cabergoline by decreasing metabolism. Avoid or Use Alternate Drug. Competitive inhibition of CYP3A4 might lead to vasospasm and ischemia.

            • ephedrine

              cabergoline, ephedrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • epinephrine

              cabergoline, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • fenfluramine

              fenfluramine, cabergoline. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Risk of serotonin syndrome.

              cabergoline, fenfluramine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • fluphenazine

              fluphenazine decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

            • fosamprenavir

              fosamprenavir increases levels of cabergoline by decreasing metabolism. Contraindicated.

            • glyceryl trinitrate pr

              glyceryl trinitrate pr increases effects of cabergoline by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.

            • haloperidol

              haloperidol decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

            • iloperidone

              iloperidone decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

            • indinavir

              indinavir increases levels of cabergoline by decreasing metabolism. Contraindicated.

            • isoproterenol

              cabergoline, isoproterenol. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • isosorbide dinitrate

              isosorbide dinitrate increases effects of cabergoline by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.

            • isosorbide mononitrate

              isosorbide mononitrate increases effects of cabergoline by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.

            • lisdexamfetamine

              cabergoline, lisdexamfetamine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • loxapine

              loxapine decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

            • loxapine inhaled

              loxapine inhaled decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

            • methamphetamine

              cabergoline, methamphetamine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • methylenedioxymethamphetamine

              cabergoline, methylenedioxymethamphetamine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • methylphenidate

              cabergoline, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • metoclopramide

              metoclopramide decreases levels of cabergoline by inhibition of GI absorption. Applies only to oral form of both agents. Contraindicated.

              metoclopramide decreases levels of cabergoline by pharmacodynamic antagonism. Contraindicated.

            • metoclopramide intranasal

              metoclopramide intranasal, cabergoline. dopaminergic effects. Avoid or Use Alternate Drug. Opposing effects of metoclopramide and the interacting drug on dopamine. Potential exacerbation of symptoms (eg, parkinsonian symptoms) or decreased therapeutic effects of metoclopramide.

            • midodrine

              cabergoline, midodrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • nelfinavir

              nelfinavir increases levels of cabergoline by decreasing metabolism. Contraindicated.

            • nicorandil

              nicorandil increases effects of cabergoline by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.

            • nitroglycerin IV

              nitroglycerin IV increases effects of cabergoline by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.

            • nitroglycerin PO

              nitroglycerin PO increases effects of cabergoline by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.

            • nitroglycerin sublingual

              nitroglycerin sublingual increases effects of cabergoline by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.

            • nitroglycerin topical

              nitroglycerin topical increases effects of cabergoline by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.

            • nitroglycerin transdermal

              nitroglycerin transdermal increases effects of cabergoline by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.

            • nitroglycerin translingual

              nitroglycerin translingual increases effects of cabergoline by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.

            • norepinephrine

              cabergoline, norepinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • olanzapine

              olanzapine decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

            • paliperidone

              paliperidone decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

            • perphenazine

              perphenazine decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

            • phendimetrazine

              cabergoline, phendimetrazine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • phentermine

              cabergoline, phentermine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • phenylephrine

              cabergoline, phenylephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • phenylephrine PO

              cabergoline, phenylephrine PO. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • pimozide

              pimozide decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

            • prochlorperazine

              prochlorperazine decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

            • promethazine

              promethazine decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

            • propylhexedrine

              cabergoline, propylhexedrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • pseudoephedrine

              cabergoline, pseudoephedrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • quetiapine

              quetiapine decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

            • risperidone

              risperidone decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

            • ritonavir

              ritonavir increases levels of cabergoline by decreasing metabolism. Contraindicated.

            • saquinavir

              saquinavir increases levels of cabergoline by decreasing metabolism. Contraindicated.

            • thioridazine

              thioridazine decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

            • thiothixene

              thiothixene decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

            • tipranavir

              tipranavir increases levels of cabergoline by decreasing metabolism. Contraindicated.

            • trifluoperazine

              trifluoperazine decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

            • xylometazoline

              cabergoline, xylometazoline. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • yohimbine

              cabergoline, yohimbine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • ziprasidone

              ziprasidone decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

            Monitor Closely (9)

            • apomorphine

              apomorphine and cabergoline both increase dopaminergic effects. Use Caution/Monitor.

            • bromocriptine

              bromocriptine and cabergoline both increase dopaminergic effects. Use Caution/Monitor. Combining drugs may be therapeutic in patients with Parkinsonism.

            • dopamine

              cabergoline and dopamine both increase dopaminergic effects. Use Caution/Monitor.

            • lisuride

              cabergoline and lisuride both increase dopaminergic effects. Use Caution/Monitor.

              lisuride, cabergoline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

            • lurasidone

              lurasidone, cabergoline. Either decreases effects of the other by Other (see comment). Use Caution/Monitor. Comment: Antipsychotics may diminish the therapeutic effect of anti-parkinson's agents; may increase risk if hypotension.

            • methyldopa

              cabergoline and methyldopa both increase dopaminergic effects. Use Caution/Monitor.

            • pramipexole

              cabergoline and pramipexole both increase dopaminergic effects. Use Caution/Monitor.

            • ropinirole

              cabergoline and ropinirole both increase dopaminergic effects. Use Caution/Monitor.

            • solriamfetol

              cabergoline and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            Minor (0)

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              Adverse Effects

              >10%

              Nausea (27%)

              Headache (26%)

              Dizziness (15%)

              1-10%

              Asthenia (9%)

              Fatigue (7%)

              Abdominal pain (5%)

              Somnolence (5%)

              Postural hypotension (4%)

              Depression (3%)

              Dyspepsia (2%)

              Nervousness (2%)

              Abnormal vision (1%)

              Breast pain (1%)

              Dysmenorrhea (1%)

              Hot flashes (1%)

              Paresthesia (1%)

              Constipation (10%)

              <1%

              Aggression

              Fibrosis

              Gastric ulcer

              Valvulopathy

              Gastric ulcer

              Pleural effusion

              Psychosis

              Postmarketing Reports

              Impulse control/compulsive behavior symptoms, including hypersexuality, increased libido and pathological gambling

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              Warnings

              Contraindications

              Uncontrolled hypertension

              Hypersensitivity to ergot derivatives

              Severe hepatic disease

              Concurrent use with D2 antagonists

              History of pulmonary, pericardial, or retroperitoneal fibroti disorders

              Women planning to nurse

              History of cardiac valvular disorders as suggested by anatomical evidence of valvulopathy of any valve, determined by pretreatment evaluation including echocardiographic demonstration of valve leaflet thickening, valve restriction, or mixed valve restriction-stenosis

              Cautions

              Initial doses >1 mg may produce orthostatic hypotension

              Concomitant antihypertensives

              May cause somnolence; avoid performing tasks that require mental alertness

              Reportedly can cause cardiac damage

              May cause orthostatic hypotension; avoid concurrent use with antihypertensives

              Rare cases of retroperitoneal fibrosis reported

              Hepatic impairment

              Inhibits lactation

              Impulse control/compulsive behaviors reported in patients receiving therapy; this has been generally reversible upon reduction of dose or treatment discontinuation; prescribers should consider dose reduction or stopping medication if a patient develops such urges while receiving therapy

              Valvular disease

              • All patients should undergo a cardiovascular evaluation, including echocardiogram to assess the potential presence of valvular disease; if valvular disease is detected, the patient should not be treated with cabergoline
              • Following treatment initiation, clinical and diagnostic monitoring (for example, chest x-ray, CT scan and cardiac echocardiogram) should be conducted to assess the risk of cardiac valvulopathy
              • Discontinue if an echocardiogram reveals new valvular regurgitation, valvular restriction or valve leaflet thickening
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              Pregnancy & Lactation

              Pregnancy Category: B

              Lactation: excretion in milk unknown; 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

              Long acting dopamine receptor agonist with high affinity for D2 receptors, thereby inhibiting prolactin release

              Pharmacokinetics

              Half-life:63-69 hr

              Peak Plasma: 30-70 pg/mL following single oral doses of 0.5-1.5 mg

              Excretion: Urine (22%); feces (60%)

              Protein Bound: 40-42%

              Peak plasma time: 2-3 hr

              Metabolism: Extensively hydrolyzed in the liver

              Renal Clearance: 0.08 L/min

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              cabergoline oral
              -
              0.5 mg tablet
              cabergoline oral
              -
              0.5 mg tablet
              cabergoline oral
              -
              0.5 mg tablet
              cabergoline oral
              -
              0.5 mg tablet

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              cabergoline oral

              CABERGOLINE - ORAL

              (ka-BER-goe-leen)

              COMMON BRAND NAME(S): Dostinex

              USES: This medication is used to treat high levels of prolactin hormone in your body. High levels of prolactin in women can cause symptoms such as unwanted breast milk and missed periods and can cause difficulty becoming pregnant. High levels of prolactin in men can cause symptoms such as enlarged breasts and decreased sexual ability/desire. Cabergoline is an ergot medication and works by blocking the release of prolactin from the pituitary gland.

              HOW TO USE: Take this medication by mouth with or without food, usually twice a week or as directed by your doctor.The dosage is based on your medical condition and response to treatment (prolactin levels). Your doctor will start you at a low dose and slowly increase your dose over several months to help decrease side effects. Follow your doctor's instructions carefully.Take this medication regularly to get the most benefit from it. To help you remember, mark the days on the calendar when you need to take the medication.Tell your doctor if your condition persists or worsens.

              SIDE EFFECTS: Nausea, vomiting, stomach upset, constipation, dizziness, lightheadedness, or tiredness may occur. If any of these effects persist or worsen, tell 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 any of these rare but serious side effects occur: persistent cough, mental/mood changes (such as nervousness), unusual strong urges (such as increased gambling, increased sexual urges), vision changes, painful menses, breast pain, symptoms of heart failure (such as shortness of breath, swelling ankles/feet, unusual tiredness, unusual/sudden weight gain).Get medical help right away if you have any serious side effects, including: chest pain, signs of kidney problems (such as change in the amount of urine, lower back/flank pain).A very serious allergic reaction to this drug is rare. However, seek immediate medical attention 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 cabergoline, tell your doctor or pharmacist if you are allergic to it; or to other ergot medications (such as ergotamine); 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: liver disease, high blood pressure (hypertension), heart valve disease, abnormal scarring/thickening of the lining in the lungs/heart/behind the abdomen (pulmonary/pericardial/retroperitoneal fibrosis).This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. 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).To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this medication passes into breast milk. However, this medication may affect breast milk production. Breast-feeding while using this drug is not recommended. 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.Some products that may interact with this drug include: antipsychotic medications (such as chlorpromazine, haloperidol, thiothixene), lorcaserin, metoclopramide, prochlorperazine.Other medications can affect the removal of cabergoline from your body, which may affect how cabergoline works. Examples include certain azole antifungals (such as itraconazole, ketoconazole, posaconazole), cobicistat, HIV protease inhibitors (such as ritonavir, saquinavir), among others.

              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 severe dizziness, fainting, mental/mood changes (such as hallucinations).

              NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as prolactin levels, EKG) should be performed before starting and while you are taking this medication to monitor your progress or check for side effects. Consult your doctor for more details.

              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 at room temperature away from light and moisture. Do not store in the bathroom. 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 August 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

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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.
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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.