dacarbazine (Rx)

Brand and Other Names:DTIC Dome

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

powder for injection

  • 100mg
  • 200mg

Hodgkin Lymphoma

With other antineoplastics, eg ABVD

Dosage dependent on protocol

150 mg/m² IV qDay for 5 days, repeat q4Weeks OR  

375 mg/m² IV on Day 1; repeat every 15 Days

Monitor: CBC, LFTs

Metastatic Malignant Melanoma

2-4.5 mg/kg IV qDay for 10 days, repeat q4Weeks OR  

250 mg/m² IV qDay for 5 days, repeat q3Weeks

Monitor: CBC, LFTs

Renal Impairment

CrCl 46-60 mL/min: 80% of regular dose

CrCl 31-45 mL/min: 75% of regular dose

CrCl <30 mL/min: 70% of regular dose

Hepatic Impairment

Not studied; monitor for signs of liver toxicity

Other Indications & Uses

Off-label: Soft-tissue sarcomas, thyroid cancer, neuroblastoma

Dosage Forms & Strengths

powder for injection

  • 100mg
  • 200mg

Hodgkin Lymphoma

With other antineoplastics, eg ABVD

Dosage dependent on protocol150 mg/m² IV qDay for 5 days, repeat q4Weeks OR  

375 mg/m² IV on Day 1; repeat every 15 Days

Neuroblastoma Combination Therapy (Off-label)

800-900 mg/m² IV once on day 1; may repeat q3-4weeks  

Hodgkin Lymphoma

With other antineoplastics, eg ABVD

Dosage dependent on protocol

150 mg/m² IV qDay for 5 days, repeat q4Weeks OR  

375 mg/m² IV on Day 1; repeat every 15 Days

Monitor: CBC, LFTs

Metastatic Malignant Melanoma

2-4.5 mg/kg IV qDay for 10 days, repeat q4Weeks OR  

250 mg/m² IV qDay for 5 days, repeat q3Weeks

Monitor: CBC, LFTs

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Interactions

Interaction Checker

and dacarbazine

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            Contraindicated (0)

              Serious - Use Alternative (13)

              • adenovirus types 4 and 7 live, oral

                dacarbazine decreases effects of adenovirus types 4 and 7 live, oral by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3mo after cessation of immunosuppressive therapy.

              • axicabtagene ciloleucel

                dacarbazine, axicabtagene ciloleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • brexucabtagene autoleucel

                dacarbazine, brexucabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • ciltacabtagene autoleucel

                dacarbazine, ciltacabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • givosiran

                givosiran will increase the level or effect of dacarbazine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP1A2 substrates with givosiran. If unavoidable, decrease the CYP1A2 substrate dosage in accordance with approved product labeling.

              • idecabtagene vicleucel

                dacarbazine, idecabtagene vicleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • influenza virus vaccine quadrivalent, adjuvanted

                dacarbazine decreases effects of influenza virus vaccine quadrivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.

              • influenza virus vaccine trivalent, adjuvanted

                dacarbazine decreases effects of influenza virus vaccine trivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.

              • lisocabtagene maraleucel

                dacarbazine, lisocabtagene maraleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • palifermin

                palifermin increases toxicity of dacarbazine by Other (see comment). Avoid or Use Alternate Drug. Comment: Palifermin should not be administered within 24 hrbefore, during infusion of, or within 24 hr after administration of antineoplastic agents. Coadministration of palifermin within 24 hr of chemotherapy resulted in increased severity and duration of oral mucositis.

              • ropeginterferon alfa 2b

                ropeginterferon alfa 2b, dacarbazine. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Myelosuppressive agents can produce additive myelosuppression. Avoid use and monitor patients receiving the combination for effects of excessive myelosuppression.

              • tisagenlecleucel

                dacarbazine, tisagenlecleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • tofacitinib

                dacarbazine, tofacitinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              Monitor Closely (34)

              • acalabrutinib

                acalabrutinib, dacarbazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may increase risk of myelosuppressive effects.

              • belatacept

                belatacept and dacarbazine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor.

              • bendamustine

                bendamustine, dacarbazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • busulfan

                busulfan, dacarbazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • cannabidiol

                cannabidiol, dacarbazine. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Owing to the potential for both CYP1A2 induction and inhibition with the coadministration of CYP1A2 substrates and cannabidiol, consider reducing dosage adjustment of CYP1A2 substrates as clinically appropriate.

              • carboplatin

                carboplatin, dacarbazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • carmustine

                carmustine, dacarbazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • chlorambucil

                chlorambucil, dacarbazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • cholera vaccine

                dacarbazine decreases effects of cholera vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs and corticosteroids (used in greater than physiologic doses), may reduce the immune response to cholera vaccine.

              • cisplatin

                cisplatin, dacarbazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • cyclophosphamide

                cyclophosphamide, dacarbazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • deferasirox

                deferasirox increases levels of dacarbazine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • dengue vaccine

                dacarbazine decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. Immunosuppressive therapies (eg, irradiation, antimetabolites, alkylating agents, cytotoxic drugs, corticosteroids [greater than physiologic doses]) may reduce immune response to dengue vaccine.

              • denosumab

                dacarbazine, denosumab. Other (see comment). Use Caution/Monitor. Comment: Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.

              • fexinidazole

                fexinidazole will increase the level or effect of dacarbazine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • fingolimod

                dacarbazine increases effects of fingolimod by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects. .

              • hydroxyurea

                dacarbazine, hydroxyurea. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of myelosuppression.

              • ifosfamide

                dacarbazine, ifosfamide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • influenza A (H5N1) vaccine

                dacarbazine decreases effects of influenza A (H5N1) vaccine by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce immune response to H5N1 vaccine.

              • influenza virus vaccine (H5N1), adjuvanted

                dacarbazine decreases effects of influenza virus vaccine (H5N1), adjuvanted by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce immune response to H5N1 vaccine.

              • isavuconazonium sulfate

                dacarbazine and isavuconazonium sulfate both decrease immunosuppressive effects; risk of infection. Use Caution/Monitor.

              • lomustine

                dacarbazine, lomustine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • meningococcal group B vaccine

                dacarbazine decreases effects of meningococcal group B vaccine by pharmacodynamic antagonism. Use Caution/Monitor. Individuals with altered immunocompetence may have reduced immune responses to the vaccine.

              • ofatumumab SC

                ofatumumab SC, dacarbazine. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Consider the risk of additive immune system effects when coadministering immunosuppressive therapies with coadministration. When switching from therapies with immune effects, take into account the duration and mechanism of action of these therapies when initiating ofatumumab SC.

              • olaparib

                dacarbazine and olaparib both increase pharmacodynamic synergism. Use Caution/Monitor. Coadministration with other other myelosuppressive anticancer agents, including DNA damaging agents, may potentiate and prolongate the myelosuppressive toxicity.

              • rucaparib

                rucaparib will increase the level or effect of dacarbazine by affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP1A2 substrates, if clinically indicated.

              • siponimod

                siponimod and dacarbazine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

              • sipuleucel-T

                dacarbazine decreases effects of sipuleucel-T by pharmacodynamic antagonism. Modify Therapy/Monitor Closely.

              • stiripentol

                stiripentol, dacarbazine. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP1A2 inhibitor and inducer. Monitor CYP1A2 substrates coadministered with stiripentol for increased or decreased effects. CYP1A2 substrates may require dosage adjustment.

              • streptozocin

                dacarbazine, streptozocin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • teriflunomide

                teriflunomide decreases levels of dacarbazine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • thiotepa

                dacarbazine, thiotepa. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • trastuzumab

                trastuzumab, dacarbazine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • trastuzumab deruxtecan

                trastuzumab deruxtecan, dacarbazine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              Minor (2)

              • vitamin A

                vitamin A, dacarbazine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Antioxidants such as vitamin A enhance the efficacy, and reduce toxicity, of antineoplastic drugs.

              • vitamin E

                vitamin E, dacarbazine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Antioxidants such as vitamin E enhance the efficacy, and reduce toxicity, of antineoplastic drugs.

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              Adverse Effects

              >10%

              Nausea (>90%)

              Vomiting(>90%)

              Injection site pain

              Leukopenia

              Thrombocytopenia

              1-10%

              Alopecia

              Rash

              Photosensitivity

              Anorexia

              Metallic taste

              Flu-like syndrome

              Frequency Not Defined

              Anaphylaxis

              Photosensitivity (rare)

              Cerebral hemorrhage

              Seizure

              Myelosuppression

              Hepatic necrosis

              Hepatic vein thrombosis

              Hepatotoxicity

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              Warnings

              Black Box Warnings

              The drug should be administered under the supervision of an experienced cancer chemotherapy physician.

              The most common toxicity for injectable dacarbazine is hemopoietic (bone marrow) depression

              Hepatic necrosis reported

              Carcinogenic and teratogenic effects reported in animals.

              The physician must weigh the possible therapeutic benefits against the risks of toxicity.

              Contraindications

              Hypersensitivity

              Breastfeeding

              Severe anemia, severe thrombocytopenia

              Cautions

              Caution in hepatic/renal impairment; monitor for toxicity

              May cause severe pain & burning at injection site & along vein; to alleviate, may increase diluent, reduce infusion rate & apply cold compresses

              Risk of potentially fatal hepatocellular necrosis

              Avoid pregnancy

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              Pregnancy & Lactation

              Pregnancy Category: C

              Lactation: not known if excreted in breast milk, do not nurse

              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

              Non-cell cycle specific; alkylates DNA & RNA; causes DNA double strand breaks and apoptosis

              Pharmacokinetics

              Half-Life: 5 hr (terminal)

              Peak Plasma: 8 mcg/mL (4.5 mg/kg dose)

              Protein Bound: ~5%

              Vd: 0.6 L/kg

              Metabolism: Liver

              Metabolites: 5-(3-monomethyl-1-triazenyl)-1H-imidazole-4-carboxamide (MIC)

              Excretion: Urine (~40%)

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              Administration

              IV Incompatibilities

              Additive: hydrocortisone sodium succinate

              Y-site: allopurinol, cefepime, piperacillin/tazobactam

              IV Compatibilities

              Solution: D5W(?)

              Additive: ondansetron

              Y-site: amifostine, aztreonam, doxorubicin liposomal, etoposide PO4, filgrastim, fludarabine, granisetron, heparin (at dacarbazine 10 mg/mL; incompatible at 25 mg/mL), melphalan, ondansetron, paclitaxel, sargramostim, teniposide, thiotepa, vinorelbine

              IV Preparation

              Reconstitute with a 9.9 mL (100 mg vial) or 19.7 mL (200 mg vial) of SWI to obtain a 10 mg/mL soln

              For infusion, dilute with D5W or NS up to 250 mL

              IV Administration

              IVP over 1 min (may be irritant & painful) OR infusion over 15-60 min

              Rapid infusion may cause severe venous irritation

              Has also been given intraarterial

              Extravasation Management

              Local pain, burning sensation & irritation at injection site may be relieved by local application of hot packs

              If extravasation occurs, apply cold packs

              Protect exposed tissue from light following extravasation

              Storage

              Store intact vials under refrigeration

              Protect from light

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              dacarbazine intravenous
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              200 mg vial
              dacarbazine intravenous
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              200 mg vial
              dacarbazine intravenous
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              200 mg vial
              dacarbazine intravenous
              -
              100 mg vial
              dacarbazine intravenous
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              200 mg vial
              dacarbazine intravenous
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              200 mg vial

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              dacarbazine intravenous

              DACARBAZINE - INJECTION

              (duh-KAR-buh-zeen)

              COMMON BRAND NAME(S): DTIC-Dome

              WARNING: This medication may often cause serious blood disorders (decreased bone marrow function leading to a low number of red blood cells, white blood cells, and platelets). These effects can cause anemia, lower your body's ability to fight an infection, and increase your risk of bleeding. Dacarbazine may also cause rare but serious liver problems. These side effects may rarely be life-threatening. Your doctor will monitor you closely while you are receiving this medication.Tell your doctor right away if you develop any of the following symptoms: nausea/vomiting that doesn't stop, unusual tiredness, pale skin, easy bruising/bleeding, signs of infection (such as sore throat that doesn't go away, fever, chills), dark urine, yellowing eyes/skin, stomach/abdominal pain.

              USES: Dacarbazine is used to treat certain types of cancer, such as skin cancer and Hodgkin's disease. It is a cancer chemotherapy drug that is used to slow or stop cancer cell growth.

              HOW TO USE: This medication is given by injection into a vein by a health care professional. It is given on a schedule as directed by your doctor. The dosage is based on your medical condition, body size, and response to treatment.

              SIDE EFFECTS: See also Warning section.Nausea, vomiting, and loss of appetite commonly occur. Vomiting may last up to 12 hours. Your doctor may prescribe medication to prevent or relieve nausea and vomiting. Eating several small meals, not eating for 4 to 6 hours before treatment, or limiting activity may help lessen these effects. These symptoms usually decrease after 1 to 2 days. Diarrhea, flu-like symptoms (such as discomfort, uneasiness, body aches, headache), blurred vision, or flushing/numbness/tingling of the face may also occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Temporary hair loss may occur. Normal hair growth should return after treatment has ended.People using this medication may have serious side effects. However, you have been prescribed this drug because your doctor has judged that the benefit to you is greater than the risk of side effects. Careful monitoring by your doctor may decrease your risk.If this medication leaks out of the vein into the tissue under the skin, it may cause serious tissue damage. Tell your doctor right away if you experience pain, burning, redness, or swelling at the injection site.Tell your doctor right away if you have any serious side effects, including: mouth sores, confusion, seizures.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 using dacarbazine, tell your doctor or pharmacist if you are allergic to it; 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, liver disease, blood disorders, decreased bone marrow function, current infections.Tell your health care professional that you are using dacarbazine before having any immunizations/vaccinations. Avoid contact with people who have recently received live vaccines (such as flu vaccine inhaled through the nose).Dacarbazine can make you more likely to get infections or may make current infections worse. Stay away from anyone who has an infection that may easily spread (such as chickenpox, COVID-19, measles, flu). Talk to your doctor if you have been exposed to an infection or for more details.To lower the chance of getting cut, bruised, or injured, use caution with sharp objects like safety razors and nail cutters, and avoid activities such as contact sports.This drug may rarely cause blurred vision. Do not drive, use machinery, or do any activity that requires clear vision until you are sure you can perform such activities safely.This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Because of the possible risk to the infant, 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.

              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.

              NOTES: Lab and/or medical tests (such as complete blood counts) should be done while you are using this medication. Keep all medical and lab appointments. Consult your doctor for more details.

              MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule.

              STORAGE: Not applicable. This medication is given in a clinic and will not be stored at home.

              MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

              Information last revised August 2023. Copyright(c) 2023 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.
              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.
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              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
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              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
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              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
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              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
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              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the 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.