fenfluramine (Rx)

Brand and Other Names:Fintepla
  • Print

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

oral solution, Schedule IV

  • 2.2mg/mL

Seizures

Indicated for treatment of seizures associated with Dravet syndrome

Without concomitant stiripentol

  • Initial dose: 0.1 mg/kg PO BID; not to exceed 26 mg/day
  • May be increased weekly based on efficacy and tolerability
  • On Day 7: May increase dose up to 0.2 mg/kg PO BID (maximum of 26 mg/day)
  • On Day14: May increase dose up to 0.35 mg/kg PO BID (maximum of 26 mg/day)
  • In whom a more rapid titration is warranted, may increase dose every 4 days

With concomitant stiripentol and clobazam

  • Initial dose: 0.1 mg/kg PO BID; not to exceed 17 mg/day
  • May be increased weekly based on efficacy and tolerability
  • On Day 7: May increase dose up to 0.15 mg/kg PO BID (maximum of 17 mg/day)
  • On Day14: May increase dose up to 0.2 mg/kg PO BID (maximum of 17 mg/day)

Dosage Modifications

Renal impairment

  • Moderate-to-severe: Not recommended

Hepatic impairment

  • All severities: Not recommended

Dosing Considerations

Assessment during and after administration

  • Obtain echocardiogram (ECHO) every 6 months during treatment, and 3-6 months after final dose

Discontinuing fenfluramine

  • Gradually decrease dose
  • Avoid abrupt discontinuation when possible to minimize the risk of increased seizure frequency and status epilepticus

Dosage Forms & Strengths

oral solution, Schedule IV

  • 2.2mg/mL

Seizures

<2 years: Safety and efficacy not established

≥2 years

  • Indicated for treatment of seizures associated with Dravet syndrome in patients aged 2 years and older

  • Without concomitant stiripentol
    • Initial dose: 0.1 mg/kg PO BID; not to exceed 26 mg/day
    • May be increased weekly based on efficacy and tolerability
    • On Day 7: May increase dose up to 0.2 mg/kg PO BID (maximum of 26 mg/day)
    • On Day14: May increase dose up to 0.35 mg/kg PO BID (maximum of 26 mg/day)
    • In whom a more rapid titration is warranted, may increase dose every 4 days
  • With concomitant stiripentol and clobazam
    • Initial dose: 0.1 mg/kg PO BID; not to exceed 17 mg/day
    • May be increased weekly based on efficacy and tolerability
    • On Day 7: May increase dose up to 0.15 mg/kg PO BID (maximum of 17 mg/day)
    • On Day14: May increase dose up to 0.2 mg/kg PO BID (maximum of 17 mg/day)

Dosage Modifications

Renal impairment

  • Moderate-to-severe: Not recommended

Hepatic impairment

  • All severities: Not recommended

Dosing Considerations

Assessment during and after administration

  • Obtain echocardiogram (ECHO) every 6 months during treatment, and 3-6 months after final dose
  • Carefully monitor growth of children and adolescents
  • Monitor weight regularly during treatment; dose modifications should be considered if a decrease in weight is observed

Discontinuing fenfluramine

  • Gradually decrease dose
  • Avoid abrupt discontinuation when possible to minimize the risk of increased seizure frequency and status epilepticus
Next:

Interactions

Interaction Checker

and fenfluramine

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 

            Contraindicated (5)

            • isocarboxazid

              isocarboxazid increases effects of fenfluramine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

              fenfluramine, isocarboxazid. Either increases effects of the other by serotonin levels. Contraindicated. Coadministration with drugs that increase serotonin may increase the risk of serotonin syndrome. Do not use concomitantly or within 14 days of MAOIs.

            • linezolid

              linezolid increases effects of fenfluramine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • phenelzine

              phenelzine increases effects of fenfluramine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

              fenfluramine, phenelzine. Either increases effects of the other by serotonin levels. Contraindicated. Coadministration with drugs that increase serotonin may increase the risk of serotonin syndrome. Do not use concomitantly or within 14 days of MAOIs.

            • selegiline transdermal

              selegiline transdermal increases effects of fenfluramine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • tranylcypromine

              tranylcypromine increases effects of fenfluramine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

              fenfluramine, tranylcypromine. Either increases effects of the other by serotonin levels. Contraindicated. Coadministration with drugs that increase serotonin may increase the risk of serotonin syndrome. Do not use concomitantly or within 14 days of MAOIs.

            Serious - Use Alternative (29)

            • amitriptyline

              amitriptyline, fenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • amoxapine

              amoxapine, fenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • cabergoline

              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.

            • clomipramine

              clomipramine, fenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • desflurane

              desflurane increases toxicity of fenfluramine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • desipramine

              desipramine, fenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • dihydroergotamine

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

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

            • dihydroergotamine intranasal

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

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

            • doxapram

              doxapram increases effects of fenfluramine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

            • doxepin

              doxepin, fenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • ergoloid mesylates

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

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

            • ergotamine

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

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

            • ether

              ether increases toxicity of fenfluramine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • imipramine

              imipramine, fenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • isocarboxazid

              isocarboxazid and fenfluramine both increase serotonin levels. Avoid or Use Alternate Drug.

            • isoflurane

              isoflurane increases toxicity of fenfluramine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • linezolid

              linezolid and fenfluramine both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.

            • lofepramine

              lofepramine, fenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • maprotiline

              maprotiline, fenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • methoxyflurane

              methoxyflurane increases toxicity of fenfluramine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • methylergonovine

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

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

            • nortriptyline

              nortriptyline, fenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • phenelzine

              phenelzine and fenfluramine both increase serotonin levels. Avoid or Use Alternate Drug.

            • protriptyline

              protriptyline, fenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • sevoflurane

              sevoflurane increases toxicity of fenfluramine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • tranylcypromine

              tranylcypromine and fenfluramine both increase serotonin levels. Avoid or Use Alternate Drug.

            • trazodone

              trazodone, fenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • trimipramine

              trimipramine, fenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • yohimbe

              yohimbe, fenfluramine. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            Monitor Closely (237)

            • 5-HTP

              5-HTP and fenfluramine both increase serotonin levels. Use Caution/Monitor.

            • albuterol

              albuterol and fenfluramine both decrease sedation. Use Caution/Monitor.

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

            • alfentanil

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

            • almotriptan

              almotriptan and fenfluramine both increase serotonin levels. Use Caution/Monitor.

              fenfluramine, almotriptan. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • alosetron

              alosetron decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • alprazolam

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

            • amitriptyline

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

              amitriptyline and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

              fenfluramine, amitriptyline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • amobarbital

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

            • amoxapine

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

              amoxapine and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

              fenfluramine, amoxapine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • arformoterol

              arformoterol and fenfluramine both decrease sedation. Use Caution/Monitor.

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

            • aripiprazole

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

              aripiprazole decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • armodafinil

              armodafinil and fenfluramine both decrease sedation. Use Caution/Monitor.

            • asenapine

              asenapine decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • asenapine transdermal

              asenapine transdermal decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • azelastine

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

            • baclofen

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

            • belladonna and opium

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

            • benperidol

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

            • benzphetamine

              benzphetamine and fenfluramine both decrease sedation. Use Caution/Monitor.

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

            • brexanolone

              fenfluramine, brexanolone. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • brompheniramine

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

            • buprenorphine

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

            • buprenorphine buccal

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

            • bupropion

              fenfluramine, bupropion. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • buspirone

              buspirone and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • butabarbital

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

            • butalbital

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

            • butorphanol

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

            • caffeine

              caffeine and fenfluramine both decrease sedation. Use Caution/Monitor.

            • carbinoxamine

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

            • cariprazine

              cariprazine decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • carisoprodol

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

            • chloral hydrate

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

            • chlordiazepoxide

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

            • chlorpheniramine

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

            • chlorpromazine

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

              chlorpromazine, fenfluramine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • chlorzoxazone

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

            • cinnarizine

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

            • citalopram

              fenfluramine, citalopram. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • clemastine

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

            • clomipramine

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

              clomipramine and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

              fenfluramine, clomipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • clonazepam

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

            • clorazepate

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

            • clozapine

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

              clozapine decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • cocaine

              cocaine and fenfluramine both increase serotonin levels. Use Caution/Monitor.

            • codeine

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

            • cyclizine

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

            • cyclobenzaprine

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

            • cyproheptadine

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

              cyproheptadine decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • dantrolene

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

            • desflurane

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

            • desipramine

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

              desipramine and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

              fenfluramine, desipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • desvenlafaxine

              fenfluramine, desvenlafaxine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • dexchlorpheniramine

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

            • dexfenfluramine

              dexfenfluramine and fenfluramine both decrease sedation. Use Caution/Monitor.

              dexfenfluramine and fenfluramine both increase serotonin levels. Use Caution/Monitor.

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

            • dexmedetomidine

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

            • dexmethylphenidate

              dexmethylphenidate and fenfluramine both decrease sedation. Use Caution/Monitor.

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

            • dextroamphetamine

              dextroamphetamine and fenfluramine both decrease sedation. Use Caution/Monitor.

              dextroamphetamine and fenfluramine both increase serotonin levels. Use Caution/Monitor.

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

            • dextromethorphan

              dextromethorphan and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

              fenfluramine, dextromethorphan. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • dextromoramide

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

            • diamorphine

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

            • diazepam

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

            • diethylpropion

              diethylpropion and fenfluramine both decrease sedation. Use Caution/Monitor.

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

            • difenoxin hcl

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

            • dihydroergotamine

              dihydroergotamine and fenfluramine both increase serotonin levels. Use Caution/Monitor.

              dihydroergotamine decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • dihydroergotamine inhaled

              dihydroergotamine inhaled decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • dihydroergotamine intranasal

              dihydroergotamine intranasal and fenfluramine both increase serotonin levels. Use Caution/Monitor.

              dihydroergotamine intranasal decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • dimenhydrinate

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

            • diphenhydramine

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

            • diphenoxylate hcl

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

            • dipipanone

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

            • dobutamine

              dobutamine and fenfluramine both decrease sedation. Use Caution/Monitor.

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

            • dolasetron

              dolasetron decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • dopamine

              dopamine and fenfluramine both decrease sedation. Use Caution/Monitor.

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

            • dopexamine

              dopexamine and fenfluramine both decrease sedation. Use Caution/Monitor.

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

            • doxepin

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

              doxepin and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

              fenfluramine, doxepin. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • doxylamine

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

            • droperidol

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

            • duloxetine

              duloxetine and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

              fenfluramine, duloxetine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • eletriptan

              eletriptan and fenfluramine both increase serotonin levels. Use Caution/Monitor.

              fenfluramine, eletriptan. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • ephedrine

              ephedrine and fenfluramine both decrease sedation. Use Caution/Monitor.

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

              ephedrine, fenfluramine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

            • epinephrine

              epinephrine and fenfluramine both decrease sedation. Use Caution/Monitor.

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

            • epinephrine racemic

              epinephrine racemic and fenfluramine both decrease sedation. Use Caution/Monitor.

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

            • ergoloid mesylates

              ergoloid mesylates decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • ergonovine

              ergonovine decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • ergotamine

              ergotamine and fenfluramine both increase serotonin levels. Use Caution/Monitor.

              ergotamine decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • escitalopram

              escitalopram and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

              fenfluramine, escitalopram. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • esketamine intranasal

              fenfluramine, esketamine intranasal. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • estazolam

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

            • ethanol

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

            • etomidate

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

            • flibanserin

              fenfluramine, flibanserin. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • fluoxetine

              fluoxetine and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

              fenfluramine, fluoxetine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • fluphenazine

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

              fluphenazine, fenfluramine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • flurazepam

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

            • fluvoxamine

              fluvoxamine and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

              fenfluramine, fluvoxamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • formoterol

              formoterol and fenfluramine both decrease sedation. Use Caution/Monitor.

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

            • frovatriptan

              frovatriptan and fenfluramine both increase serotonin levels. Use Caution/Monitor.

              fenfluramine, frovatriptan. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • gepirone

              fenfluramine, gepirone. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • granisetron

              granisetron decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • haloperidol

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

            • hydralazine

              hydralazine, fenfluramine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hypertension.

            • hydromorphone

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

            • hydroxyzine

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

            • iloperidone

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

              iloperidone decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • imipramine

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

              imipramine and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

              fenfluramine, imipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • insulin aspart

              fenfluramine increases effects of insulin aspart by Other (see comment). Use Caution/Monitor. Comment: Fenfluramine enhances glucose uptake in peripheral tissue, increasing risk of hypoglycemia.

            • insulin detemir

              fenfluramine increases effects of insulin detemir by Other (see comment). Use Caution/Monitor. Comment: Fenfluramine enhances glucose uptake in peripheral tissue, increasing risk of hypoglycemia.

            • insulin glargine

              fenfluramine increases effects of insulin glargine by Other (see comment). Use Caution/Monitor. Comment: Fenfluramine enhances glucose uptake in peripheral tissue, increasing risk of hypoglycemia.

            • insulin glulisine

              fenfluramine increases effects of insulin glulisine by Other (see comment). Use Caution/Monitor. Comment: Fenfluramine enhances glucose uptake in peripheral tissue, increasing risk of hypoglycemia.

            • insulin lispro

              fenfluramine increases effects of insulin lispro by Other (see comment). Use Caution/Monitor. Comment: Fenfluramine enhances glucose uptake in peripheral tissue, increasing risk of hypoglycemia.

            • insulin NPH

              fenfluramine increases effects of insulin NPH by Other (see comment). Use Caution/Monitor. Comment: Fenfluramine enhances glucose uptake in peripheral tissue, increasing risk of hypoglycemia.

            • insulin regular human

              fenfluramine increases effects of insulin regular human by Other (see comment). Use Caution/Monitor. Comment: Fenfluramine enhances glucose uptake in peripheral tissue, increasing risk of hypoglycemia.

            • isoniazid

              fenfluramine and isoniazid both increase serotonin levels. Use Caution/Monitor.

            • isoproterenol

              isoproterenol and fenfluramine both decrease sedation. Use Caution/Monitor.

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

            • ketamine

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

            • ketotifen, ophthalmic

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

            • L-tryptophan

              fenfluramine and L-tryptophan both increase serotonin levels. Use Caution/Monitor.

            • lasmiditan

              fenfluramine, lasmiditan. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • levalbuterol

              levalbuterol and fenfluramine both decrease sedation. Use Caution/Monitor.

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

            • levomilnacipran

              levomilnacipran and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

              fenfluramine, levomilnacipran. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • levorphanol

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

            • lisdexamfetamine

              lisdexamfetamine and fenfluramine both decrease sedation. Use Caution/Monitor.

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

            • lithium

              fenfluramine and lithium both increase serotonin levels. Use Caution/Monitor.

            • lofepramine

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

              lofepramine and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • lofexidine

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

            • loprazolam

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

            • lorazepam

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

            • lormetazepam

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

            • loxapine

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

            • loxapine inhaled

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

            • lsd

              fenfluramine and lsd both increase serotonin levels. Use Caution/Monitor.

            • lurasidone

              lurasidone decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • maprotiline

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

              maprotiline and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

              fenfluramine, maprotiline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • marijuana

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

            • melatonin

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

            • meperidine

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

              fenfluramine and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • meprobamate

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

            • metaproterenol

              metaproterenol and fenfluramine both decrease sedation. Use Caution/Monitor.

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

            • metaxalone

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

            • methadone

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

            • methamphetamine

              methamphetamine and fenfluramine both decrease sedation. Use Caution/Monitor.

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

            • methocarbamol

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

            • methyldopa

              methyldopa increases effects of fenfluramine by unknown mechanism. Use Caution/Monitor.

            • methylenedioxymethamphetamine

              methylenedioxymethamphetamine and fenfluramine both decrease sedation. Use Caution/Monitor.

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

            • methylergonovine

              methylergonovine decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • methylphenidate

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

            • midazolam

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

            • midodrine

              fenfluramine and midodrine both decrease sedation. Use Caution/Monitor.

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

            • milnacipran

              milnacipran and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

              fenfluramine, milnacipran. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • mirtazapine

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

              fenfluramine, mirtazapine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • modafinil

              modafinil and fenfluramine both decrease sedation. Use Caution/Monitor.

            • morphine

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

              fenfluramine and morphine both increase serotonin levels. Use Caution/Monitor.

            • motherwort

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

            • moxonidine

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

            • nabilone

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

            • nalbuphine

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

            • naratriptan

              naratriptan and fenfluramine both increase serotonin levels. Use Caution/Monitor.

              fenfluramine, naratriptan. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • nefazodone

              nefazodone and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

              fenfluramine, nefazodone. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • netupitant/palonosetron

              netupitant/palonosetron decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • norepinephrine

              norepinephrine and fenfluramine both decrease sedation. Use Caution/Monitor.

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

            • nortriptyline

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

              nortriptyline and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

              fenfluramine, nortriptyline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • olanzapine

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

              olanzapine decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • ondansetron

              ondansetron decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • opium tincture

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

            • orphenadrine

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

            • oxazepam

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

            • oxycodone

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

            • oxymorphone

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

            • oxytocin

              oxytocin increases effects of fenfluramine by pharmacodynamic synergism. Use Caution/Monitor.

            • paliperidone

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

              paliperidone decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • palonosetron

              palonosetron decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • papaveretum

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

            • papaverine

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

            • paroxetine

              paroxetine and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

              fenfluramine, paroxetine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • pentazocine

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

              fenfluramine and pentazocine both increase serotonin levels. Use Caution/Monitor.

            • pentobarbital

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

            • perphenazine

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

              perphenazine, fenfluramine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • phendimetrazine

              fenfluramine and phendimetrazine both decrease sedation. Use Caution/Monitor.

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

            • phenobarbital

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

              phenobarbital will decrease the level or effect of fenfluramine by Other (see comment). Modify Therapy/Monitor Closely. Coadministration with drugs that increase serotonin may increase the risk of serotonin syndrome.

            • phentermine

              phentermine and fenfluramine both decrease sedation. Use Caution/Monitor.

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

            • phenylephrine

              fenfluramine and phenylephrine both decrease sedation. Use Caution/Monitor.

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

            • phenylephrine PO

              fenfluramine and phenylephrine PO both decrease sedation. Use Caution/Monitor.

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

            • pholcodine

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

            • pimavanserin

              pimavanserin decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • pimozide

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

            • pirbuterol

              pirbuterol and fenfluramine both decrease sedation. Use Caution/Monitor.

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

            • primidone

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

              primidone will decrease the level or effect of fenfluramine by Other (see comment). Modify Therapy/Monitor Closely. Coadministration with drugs that increase serotonin may increase the risk of serotonin syndrome.

            • prochlorperazine

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

              prochlorperazine, fenfluramine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • promazine

              promazine, fenfluramine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • promethazine

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

              promethazine, fenfluramine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • propofol

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

            • propylhexedrine

              fenfluramine and propylhexedrine both decrease sedation. Use Caution/Monitor.

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

            • protriptyline

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

              protriptyline and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

              fenfluramine, protriptyline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • pseudoephedrine

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

            • quazepam

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

            • quetiapine

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

              quetiapine decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • ramelteon

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

            • rifampin

              rifampin will decrease the level or effect of fenfluramine by Other (see comment). Modify Therapy/Monitor Closely. Coadministration with drugs that increase serotonin may increase the risk of serotonin syndrome.

            • risperidone

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

              risperidone decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • rizatriptan

              rizatriptan and fenfluramine both increase serotonin levels. Use Caution/Monitor.

              fenfluramine, rizatriptan. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • salmeterol

              salmeterol and fenfluramine both decrease sedation. Use Caution/Monitor.

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

            • SAMe

              fenfluramine and SAMe both increase serotonin levels. Use Caution/Monitor.

            • samidorphan

              samidorphan decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • scullcap

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

            • secobarbital

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

            • selegiline transdermal

              selegiline transdermal and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • sertraline

              sertraline and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

              fenfluramine, sertraline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • sevoflurane

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

            • shepherd's purse

              shepherd's purse increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • St John's Wort

              fenfluramine, St John's Wort. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • sufentanil

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

            • sumatriptan

              sumatriptan and fenfluramine both increase serotonin levels. Use Caution/Monitor.

              fenfluramine, sumatriptan. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • sumatriptan intranasal

              sumatriptan intranasal and fenfluramine both increase serotonin levels. Use Caution/Monitor.

              fenfluramine, sumatriptan intranasal. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • sumatriptan transdermal

              fenfluramine, sumatriptan transdermal. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • tapentadol

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

            • temazepam

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

            • terbutaline

              terbutaline and fenfluramine both decrease sedation. Use Caution/Monitor.

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

            • thioridazine

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

              thioridazine, fenfluramine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • thiothixene

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

            • topiramate

              topiramate increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • tramadol

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

              fenfluramine and tramadol both increase serotonin levels. Use Caution/Monitor.

            • trazodone

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

              trazodone and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

              fenfluramine, trazodone. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • triazolam

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

            • triclofos

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

            • trifluoperazine

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

              trifluoperazine, fenfluramine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • trimipramine

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

              trimipramine and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

              fenfluramine, trimipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • triprolidine

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

            • venlafaxine

              venlafaxine and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

              fenfluramine, venlafaxine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • vilazodone

              fenfluramine, vilazodone. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • vortioxetine

              fenfluramine, vortioxetine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • xylometazoline

              fenfluramine and xylometazoline both decrease sedation. Use Caution/Monitor.

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

            • yohimbine

              yohimbine and fenfluramine both decrease sedation. Use Caution/Monitor.

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

            • ziconotide

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

            • ziprasidone

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

              ziprasidone decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • zolmitriptan

              zolmitriptan and fenfluramine both increase serotonin levels. Use Caution/Monitor.

              fenfluramine, zolmitriptan. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • zolmitriptan transdermal

              fenfluramine, zolmitriptan transdermal. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            Minor (3)

            • desmopressin

              desmopressin increases effects of fenfluramine by pharmacodynamic synergism. Minor/Significance Unknown.

            • eucalyptus

              eucalyptus increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

            • sage

              sage increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

            Previous
            Next:

            Adverse Effects

            >10%

            • Decreased appetite (23-49%)
            • Diarrhea (15-31%)
            • Fatigue, malaise, asthenia (15-30%)
            • Somnolence, sedation, lethargy (23-26%)
            • Abnormal ECHO (9-23%)
            • Pyrexia (15-21%)
            • Upper respiratory tract infection (7-21%)
            • Trace of mitral or aortic valve regurgitation (14-16%)
            • Blood pressure increased (8-13%)
            • Drooling, salivary hypersecretion (8-13%)
            • Weight decreased (5-13%)
            • Status epilepticus (3-12%)

            1-10%

            • Fall (10%)
            • Ataxia, balance disorder, gait disturbance (7-10%)
            • Vomiting (5-10%)
            • Constipation (3-10%)
            • Decreased blood glucose (9%)
            • Abnormal behavior (8-9%)
            • Ear infection (3-9%)
            • Irritability (3-9%)
            • Tremor (3-9%)
            • Bronchitis (3-9%)
            • Hypotonia (8%)
            • Headache (8%)
            • Rash (5-8%)
            • Rhinitis (3-8%)
            • Gastroenteritis (2-8%)
            • Blood prolactin increased (5%)
            • Decreased activity (5%)
            • Dehydration (5%)
            • Stereotypy (5%)
            • Contusion (5%)
            • Eczema (5%)
            • Enuresis (5%)
            • Laryngitis (5%)
            • Negativism (5%)
            • Urinary tract infection (5%)
            • Viral infection (5%)
            • Croup (3-5%)
            • Increased heart rate (3-5%)
            • Urinary incontinence (3-5%)
            • Chills (2-5%)
            • Insomnia (2-5%)
            Previous
            Next:

            Warnings

            Black Box Warnings

            Valvular heart disease and pulmonary arterial hypertension

            • There is an association between serotonergic drugs with 5-HT2B receptor agonist activity, including fenfluramine (the active ingredient), and valvular heart disease and pulmonary arterial hypertension
            • ECHO assessments are required before, during, and after treatment
            • Consider the benefits versus the risks of initiating or continuing fenfluramine based on ECHO findings
            • Owing to the risks of valvular heart disease and pulmonary arterial hypertension, fenfluramine is available only through a restricted program called the Fintepla REMS program

            Contraindications

            Hypersensitivity to fenfluramine or any of the excipients

            Concomitant use of, or within 14 days of, the administration of monoamine oxidase inhibitors (MAOIs)

            Cautions

            Owing to the association between serotonergic drugs with 5-HT2B receptor agonist activity, fenfluramine, pulmonary arterial hypertension, and valvular heart disease, cardiac monitoring is required before initiating treatment, during treatment, and after completion of fenfluramine

            May decrease appetite and weight; monitor weight regularly during treatment and modify dose if a decrease in weight is observed

            May cause somnolence, sedation, and lethargy; other CNS depressants, including alcohol, could potentiate these effects

            Advise patients not to drive or operate machinery until they have gained sufficient experience on fenfluramine

            Antiepileptic drugs (AEDs) increase the risk of suicidal thoughts or behavior in patients taking these drugs for any indication; monitor for the emergence or worsening of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior

            As with most AEDs, fenfluramine should be withdrawn gradually because of the risk of increased seizure frequency and status epilepticus; if withdrawal is needed owing to serious adverse reaction, rapid discontinuation can be considered

            Serotonin syndrome may occur, particularly with coadministration of fenfluramine with other serotonergic drugs, including, but not limited to, selective serotonin-norepinephrine reuptake inhibitors (SNRIs), selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), bupropion, triptans, dietary supplements (eg, St. John’s Wort, tryptophan), drugs that impair metabolism of serotonin (MAOIs, which are contraindicated with fenfluramine), dextromethorphan, lithium, tramadol, and antipsychotics with serotonergic agonist activity

            Significant elevation in blood pressure, including hypertensive crisis, has been reported; monitor blood pressure during treatment

            May cause mydriasis and can precipitate angle-closure glaucoma; discontinue therapy in patients with acute decrease in visual acuity or ocular pain

            Fintepla REMS program

            • Further information is available at http://www.FinteplaREMS.com or by telephone at 1-877-964-3649
            • Prescribers
              • Must be certified by enrolling in the program
              • Must counsel patients receiving fenfluramine about the risk of valvular heart disease and pulmonary arterial hypertension, signs and symptoms of valvular heart disease and pulmonary arterial hypertension, cardiac monitoring via ECHO during treatment, and cardiac monitoring after treatment
            • Patients
              • Must enroll in the REMS program and comply with ongoing monitoring requirements
            • Pharmacies, wholesalers, and distributers
              • Must be certified by enrolling in the REMS program and must only dispense to patients who are authorized to receive treatment
              • Wholesalers and distributers must only distribute to certified pharmacies

            Drug interaction overview

            • Stiripentol plus clobazam
              • Coadministration with stiripentol plus clobazam, with or without valproate, inhibits the metabolism of fenfluramine, thereby increasing fenfluramine plasma concentrations and decreasing its metabolite, norfenfluramine
              • Dose adjustment is required for patients taking stiripentol plus clobazam
            • Strong CYP1A2 and CYP2B6 inducers
              • Coadministration with rifampin or strong CYP1A2 and CYP2B6 inducers decreases fenfluramine plasma levels and effects
              • Consider increasing fenfluramine dosage when coadministered with rifampin or a strong CYP1A2 and CYP2B6 inducer; do not exceed the maximum daily dosage
            • Serotonin receptor antagonists
              • Monitor appropriately when coadministered with cyproheptadine or potent 5-HT1A, 5-HT1D, 5-HT2A, or 5-HT2C serotonin receptor antagonists
              • Cyproheptadine and potent 5-HT1A, 5-HT1D, 5-HT2A, and 5-HT2C serotonin receptor antagonists may decrease the efficacy of fenfluramine
            • Serotonergic drugs
              • Coadministration with MAOIs is contraindicated
              • Use with caution in patients taking medications that increase serotonin
              • Coadministration with drugs (eg, SSRIs) that increase serotonin may increase the risk of serotonin syndrome
            Previous
            Next:

            Pregnancy & Lactation

            Pregnancy

            There are adequate human or animal data on the developmental risks associated with the use in pregnant females

            Pregnancy exposure registry

            • Registry monitors pregnancy outcomes in females exposed to AEDs, such as fenfluramine during pregnancy
            • Encourage females who are taking fenfluramine during pregnancy to enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry by calling the toll-free number 1-888-233-2334 or visiting http://www.aedpregnancyregistry.org

            Lactation

            No data available on the presence of fenfluramine or its metabolites in human milk, the effects on the breastfed infant, or the effects on milk production

            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.

            Previous
            Next:

            Pharmacology

            Mechanism of Action

            Mechanism of action for the treatment of seizures associated with Dravet syndrome is unknown

            Fenfluramine and the metabolite, norfenfluramine, increase extracellular levels of serotonin through interaction with serotonin transporter proteins, and exhibit agonist activity at serotonin 5HT-2 receptors

            Absorption

            Peak plasma concentration (steady-state): 68 ng/mL

            AUC (steady-state): 1390 ng⋅hr/mL

            Peak plasma time (steady-state): 4-5 hr

            Absolute bioavailability: ~68-74%

            Distribution

            Vd: 11.9 L/kg

            Protein bound: 50%

            Metabolism

            Primarily metabolized by CYP1A2, CYP2B6, and CYP2D6

            Minor extent are CYP2C9, CYP2C19, and CYP3A4/5

            Norfenfluramine is then deaminated and oxidized to form inactive metabolites

            Elimination

            Half-life: 20 hr

            Clearance: 24.8 L/hr

            Excretion

            • Urine: >90% as fenfluramine; <25% of total (norfenfluramine, or other metabolites)
            • Feces: <5%
            Previous
            Next:

            Administration

            Oral Administration

            Use a calibrated measuring device (either a 3- or 6-mL oral syringe) provided by the pharmacy to measure and administer the prescribed dose accurately; do not use a household teaspoon or tablespoon

            Also compatible with commercially available gastric and nasogastric feeding tubes

            Storage

            Unopened bottle

            • Store at room temperature (20-25ºC [68-77ºF]); excursions permitted to 15-30ºC (59-86ºF)
            • Do not refrigerate or freeze
            • Store the bottle and syringe together

            Opened bottle

            • Discard any unused portion 3 months after first opening the bottle or the “Discard After” date on the bottle, whichever is sooner
            • Do not refrigerate or freeze
            • Store the bottle and syringe together
            Previous
            Next:

            Images

            No images available for this drug.
            Previous
            Next:

            Patient Handout

            A Patient Handout is not currently available for this monograph.
            Previous
            Next:

            Formulary

            FormularyPatient Discounts

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

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            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.
            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous
            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.