nitroglycerin IV (Rx)

Brand and Other Names:glyceryl trinitrate IV, IV Nitroglycerin, more...NitroBid IV, NTG, Tridil
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

infusion solution

  • 25mg/250mL
  • 50mg/250mL
  • 100mg/250mL

injectable solution

  • 5mg/mL

Angina

If intolerant of or unresponsive to SL NTG

5 mcg/min

Increase by 5 mcg/min q3-5min up to 20 mcg/min, THEN  

Increase by 10 mcg/min

May later increase by 20 mcg/min

Higher dosages required for PVC admin sets

Uninterrupted infusion >24 hours produces tolerance

Renal Failure

CrCl: 10-50 mL/min: Administer q24-72hr

CrCl: <10 mL/min: Administer q72-96hr

Other Indications & Uses

Angina pectoris, perioperative HTN, CHF in the setting of MI, induction of intra-operative hypotension

Off-label: hypertensive crisis, variceal bleeds (with vasopressin), sympathomimetic-induced cardiopulmonary toxicities

Dosage Forms & Strengths

infusion solution

  • 25mg/250mL
  • 50mg/250mL
  • 100mg/250mL

injectable solution

  • 5mg/mL

Congestive Heart Failure

Not FDA approved

Initial: 0.25-0.5 mcg/kg/min IV infusion, may increase by 0.5-1 mcg/kg/min q3-5min PRN  

Usual range: 1-5 mcg/kg/min IV infusion

No more than 20 mcg/min

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Interactions

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      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (12)

            • avanafil

              nitroglycerin IV, avanafil. Mechanism: additive vasodilation. Contraindicated. Potentially fatal hypotension.

            • bromocriptine

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

            • cabergoline

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

            • dihydroergotamine

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

            • dihydroergotamine intranasal

              dihydroergotamine intranasal decreases effects of nitroglycerin IV by pharmacodynamic antagonism. Contraindicated.

            • ergoloid mesylates

              ergoloid mesylates decreases effects of nitroglycerin IV by pharmacodynamic antagonism. Contraindicated.

            • ergotamine

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

            • methylergonovine

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

            • riociguat

              nitroglycerin IV, riociguat. Either increases effects of the other by additive vasodilation. Contraindicated. Coadministration of nitrates or nitric oxide donors is contraindicated due to risk of hypotension.

            • sildenafil

              nitroglycerin IV, sildenafil. Mechanism: additive vasodilation. Contraindicated. Potentially fatal hypotension.

            • tadalafil

              nitroglycerin IV, tadalafil. Mechanism: additive vasodilation. Contraindicated. Potentially fatal hypotension.

            • vardenafil

              nitroglycerin IV, vardenafil. Mechanism: additive vasodilation. Contraindicated. Potentially fatal hypotension.

            Serious - Use Alternative (5)

            • cabergoline

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

            • ergoloid mesylates

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

            • ergotamine

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

            • lofexidine

              lofexidine, nitroglycerin IV. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.

            • methylergonovine

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

            Monitor Closely (6)

            • arginine

              nitroglycerin IV, arginine. Mechanism: additive vasodilation. Use Caution/Monitor. Possible hypotension.

            • benazepril

              nitroglycerin IV, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.

            • bretylium

              nitroglycerin IV, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.

            • bupivacaine implant

              nitroglycerin IV, bupivacaine implant. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Local anesthetics may increase the risk of developing methemoglobinemia when concurrently exposed to drugs that also cause methemoglobinemia.

            • dapsone topical

              nitroglycerin IV increases toxicity of dapsone topical by altering metabolism. Modify Therapy/Monitor Closely. May induce methemoglobinemia.

            • tetracaine

              tetracaine, nitroglycerin IV. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.

            Minor (5)

            • acetylcysteine

              acetylcysteine increases effects of nitroglycerin IV by Other (see comment). Minor/Significance Unknown. Comment: Acetylcysteine may enhance vasodilatory effects of nitroglycerin.

            • acetylcysteine (Antidote)

              acetylcysteine (Antidote) increases effects of nitroglycerin IV by Other (see comment). Minor/Significance Unknown. Comment: Acetylcysteine may enhance vasodilatory effects of nitroglycerin.

            • ethanol

              nitroglycerin IV, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible hypotension.

            • heparin

              nitroglycerin IV decreases effects of heparin by unspecified interaction mechanism. Minor/Significance Unknown.

            • metronidazole

              nitroglycerin IV, metronidazole. Mechanism: decreasing metabolism. Minor/Significance Unknown. Disulfiram like reaction.

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            Adverse Effects

            Common

            Headache

            Hypotension

            Tachycardia

            Dyspnea

            Dizziness

            Lightheadedness

            Blurred vision

            Flushing

            N/V

            Nervousness

            Xerostomia

            Serious

            Methemoglobinemia (rare)

            Syncope

            Prolonged bleeding time

            Exfoliative dermatitis

            Unstable angina

            Rebound hypertension

            Thrombocytopenia

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            Warnings

            Contraindications

            Recent use (within several days) of PDE-5 inhibitors (eg, avanafil, sildenafil, tadalafil, or vardenafil) may cause dangerously low hypotension; the time course of the interaction appears to be related to the PDE-5 inhibitor half-life

            Riociguat; coadministration may cause hypotension

            Narrow angle glaucoma (controversial: may not be clinically significant)

            Hypersensitivity

            Symptomatic hypotension, uncorrected hypovolemia, increased intracranial pressure (head trauma, cerebral hemorrhage), severe anemia, constrictive pericarditis, pericardial tamponade, restrictive cardiomyopathy

            Cautions

            Use caution in alcohol use, hyperthyroidism, hypertrophic cardiomyopathy, postural hypotension, severe renal impairment, hepatic impairment

            Gradually decrease dose to avoid withdrawal reaction

            May need 10-12 hr/day nitrate-free interval to avoid tolerance development

            Doses ~ 200 mcg/min

            Some products contain alcohol and propylene glycol

            Remove topical forms when starting IV infusion

            Use glass bottles and non-PVC (polyvinyl chloride) tubing to avoid adsorption of drug to delivery devices; use of PVC tubing in infusion sets may lead to loss of active ingredient due to adsorption of nitroglycerin to PVC tubing; dosage is affected; adsorption by PVC tubing is increased when tubing is long, flow rates are low, and nitroglycerin concentration of solution is high; delivered fraction of solution's original nitroglycerin content has been 20-60% in published studies; fraction varies with time during single infusion, and no simple correction factor can be used; if intravenous nitroglycerin is administered through non-adsorptive tubing, doses based upon published reports will generally be too high; some in-line intravenous filters also adsorb nitroglycerin and should be avoided

            Solutions containing dextrose without electrolytes should not be administered through the same administration set as blood, as this may result in pseudoagglutination or hemolysis

            Intravenous administration of solutions may cause fluid overloading resulting in dilution of serum electrolyte concentrations, overhydration and congested states of pulmonary edema; risk of dilutional states is inversely proportional to electrolyte concentrations of injections; risk of solute overload causing congested states with peripheral and pulmonary edema is directly proportional to electrolyte concentration of injections

            Severe hypotension and shock may occur with even small doses of nitroglycerin; monitor patients who may be volume depleted or, for whatever reason, are already hypotensive; hypotension induced by nitroglycerin may be accompanied by paradoxical bradycardia and increased angina pectoris

            Nitrate therapy may aggravate angina caused by hypertrophic cardiomyopathy

            Tolerance development and occurrence of cross tolerance to other nitro compounds reported

            Administer nitroglycerin in 5% dextrose Injection only via infusion pump that can maintain constant infusion rate

            Monitor patients with known sub-clinical or overt diabetes mellitus when using solutions containing dextrose

            Cases of methemoglobinemia reported with moderate doses of organic nitrates; when methemoglobinemia is diagnosed, discontinue treatment of nitroglycerin; if condition not reversed, treat with methylene blue, 1-2 mg/kg intravenously

            Protect from freezing and light

            Do not change brands unintentionally as not all are bioequivalent

            Treat drug-induced headache with aspirin or acetaminophen

            Provide nitrate-free interval (10-12 hr or overnight) to avoid development of tolerance

            Use supportive treatment in overdose; there is no specific antidote for overdose; risk of overdose can be minimized by close monitoring during treatment

            Drug interaction overview

            • The vasodilating effects of nitroglycerin may be additive with those of other antihypertensives. (e.g., beta-blockers, calcium channel blockers and tricyclic antidepressants) and may cause increased hypotensive effects
            • Concomitant use of nitroglycerin in 5% dextrose injection concomitant use with phosphodiesterase inhibitors (e.g. sildenafil, tadalafil, or vardenafil) in any form is contraindicated
            • Concomitant use of nitroglycerin in 5% dextrose injection with riociguat, a soluble guanylate cyclase stimulator, can cause hypotension and is contraindicated
            • Marked symptomatic orthostatic hypotension reported when calcium channel blockers and organic nitrates used in combination
            • Nitroglycerin at higher dosages may interfere with anticoagulant effect of heparin; intravenous nitroglycerin can induce heparin resistance
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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: Developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for nitroglycerin and any potential adverse effects on breastfed child from nitroglycerin or from underlying maternal condition

            Pregnancy Categories

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

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

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

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

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

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Organic nitrate which causes systemic venodilation, decreasing preload

            Cellular mechanism: enters vascular smooth muscle and is converted to nitric oxide (NO) which induces synthesis of cGMP and vasodilation

            Relaxes smooth muscle via dose-dependent dilation of arterial and venous beds to reduce both preload and afterload, and myocardial O2 demand

            Also improves coronary collateral circulation. Lower BP, increased HR, occasional paradoxical bradycardia

            Pharmacokinetics

            Half-life: 1-4 min

            Onset: 1-3 min

            Duration: 3-5 min

            Protein bound: 60%

            Vd: 3 L/kg

            Metabolism: Mainly in liver, extrahepatic sites (vascular wall, RBC)

            Metabolites: 1,3-glyceryl dinitrate, 1,2-glyceryl dinitrate, and glyceryl mononitrate (inactive)

            Clearance: 5.5-11 L/min

            Excretion: Urine

            Dialyzable: No

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            Administration

            IV Compatibilities

            Additive: aminophylline, dobutamine, dopamine, furosemide, lidocaine, verapamil

            Syringe: heparin

            Y-site: amiodarone, diltiazem, dobutamine, dopamine, famotidine, lidocaine, pancuronium, ranitidine, sodium nitroprusside, streptokinase, tacrolimus, vecuronium

            IV Incompatibilities

            Additive: hydralazine, phenytoin

            Syringe: caffeine

            Y-site: alteplase, hydralazine

            IV Preparation

            Solution: 50 mg in 250 mL (200 mcg/mL) D5W or NS

            IV Administration

            3 mL/hr (10 mcg/min)

            Only use glass IV bottles and administration sets

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
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            400 mcg/spray aerosol
            Minitran transdermal
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            Minitran transdermal
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            Minitran transdermal
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            Nitrostat sublingual
            -
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            Nitrostat sublingual
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            0.3 mg tablet
            Nitrostat sublingual
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            0.6 mg tablet
            Nitrostat sublingual
            -
            0.4 mg tablet
            Rectiv rectal
            -
            0.4 % (w/w) ointment
            GoNitro sublingual
            -
            400 mcg powder
            GoNitro sublingual
            -
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            Nitrolingual translingual
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            Nitrolingual translingual
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            400 mcg/spray solution
            Nitro-Time oral
            -
            9 mg capsule
            Nitro-Time oral
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            6.5 mg capsule
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            2.5 mg capsule
            nitroglycerin oral
            -
            6.5 mg capsule
            nitroglycerin oral
            -
            9 mg capsule
            nitroglycerin oral
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            9 mg capsule
            nitroglycerin oral
            -
            9 mg capsule
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            -
            2.5 mg capsule
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            -
            2.5 mg capsule
            Nitro-Bid transdermal
            -
            2 % ointment
            Nitro-Bid transdermal
            -
            2 % ointment
            Nitro-Bid transdermal
            -
            2 % ointment
            nitroglycerin transdermal
            -
            0.6 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.4 mg/hr transdermal system
            nitroglycerin transdermal
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            0.6 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.1 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.2 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.4 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.2 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.6 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.4 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.6 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.4 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.2 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.1 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.2 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.4 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.2 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.2 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.6 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.4 mg/hr transdermal system
            Nitro-Dur transdermal
            -
            0.3 mg/hr transdermal system
            Nitro-Dur transdermal
            -
            0.6 mg/hr transdermal system
            Nitro-Dur transdermal
            -
            0.2 mg/hr transdermal system
            Nitro-Dur transdermal
            -
            0.8 mg/hr transdermal system
            Nitro-Dur transdermal
            -
            0.3 mg/hr transdermal system
            nitroglycerin sublingual
            -
            0.4 mg tablet
            nitroglycerin sublingual
            -
            0.6 mg tablet
            nitroglycerin sublingual
            -
            0.4 mg tablet
            nitroglycerin sublingual
            -
            0.3 mg tablet
            nitroglycerin sublingual
            -
            0.4 mg tablet
            nitroglycerin sublingual
            -
            0.4 mg tablet
            nitroglycerin sublingual
            -
            0.4 mg tablet
            nitroglycerin sublingual
            -
            0.6 mg tablet
            nitroglycerin sublingual
            -
            0.6 mg tablet
            nitroglycerin sublingual
            -
            0.3 mg tablet
            nitroglycerin sublingual
            -
            0.4 mg tablet
            nitroglycerin translingual
            -
            400 mcg/spray solution
            nitroglycerin translingual
            -
            400 mcg/spray solution
            nitroglycerin translingual
            -
            400 mcg/spray solution
            nitroglycerin translingual
            -
            400 mcg/spray solution
            nitroglycerin intravenous
            -
            50 mg/10 mL (5 mg/mL) vial

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

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            Patient Education
            nitroglycerin transdermal

            NITROGLYCERIN PATCH - TRANSDERMAL

            (NYE-troe-GLIS-er-in)

            COMMON BRAND NAME(S): Nitro-Dur, Transderm-Nitro

            USES: This medication is used to prevent chest pain (angina) in people with a certain heart condition (coronary artery disease). Nitroglycerin belongs to a class of drugs known as nitrates. Angina occurs when the heart muscle is not getting enough blood. This drug works by relaxing and widening blood vessels so blood can flow more easily to the heart.This medication will not relieve chest pain once it occurs. It is also not intended to be used just before physical activities (such as exercise, sexual activity) to prevent chest pain. Other medications may be needed in these situations. Consult your doctor for more details.

            HOW TO USE: Read the Patient Information Leaflet available from your pharmacist. Consult your doctor or pharmacist if you have any questions.Remove the patch from its pouch, and peel off the protective clear liner as directed. Usually, you will wear the patch on the upper arm or chest. However, you can wear it anywhere on the body below the neck and above the knees or elbows. Apply the patch to a clean, dry, and hairless area. Hair in the area may be clipped, but not shaved. Avoid areas with cuts or irritation. Do not apply the patch immediately after bathing or showering. Wait until your skin is completely dry. However, you may bathe, shower, and swim while wearing the patch. Press the patch firmly in place with the palm of your hand. Wash your hands after applying the patch.You will usually use 1 patch a day and wear it for 12 to 14 hours or as directed by your doctor. The dosage is based on your medical condition and response to treatment.To reduce skin irritation, apply each new patch to a different area of skin. After removing the old patch, fold it in half with the sticky sides together, and discard out of reach of children and pets.Use this medication regularly to get the most benefit from it. To help you remember, use it at the same time each day.Do not suddenly stop using this medication without consulting your doctor. Some conditions may become worse when the drug is suddenly stopped. Your dose may need to be gradually decreased.Although unlikely, when this medication is used for a long time, it may not work as well and may require different dosing. Tell your doctor if this medication stops working well (for example, you have worsening chest pain or it occurs more often).

            SIDE EFFECTS: Headache, dizziness, lightheadedness, nausea, and flushing may occur as your body adjusts to this medication. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Headache is often a sign that this medication is working. Your doctor may recommend treating headaches with an over-the-counter pain reliever (such as acetaminophen, aspirin). If the headaches continue or become severe, tell your doctor promptly.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if any of these unlikely but serious side effects occur: fainting, fast/irregular/pounding heartbeat.A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any of the following symptoms of a serious allergic reaction: 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 this medication, tell your doctor or pharmacist if you are allergic to it; or to similar drugs (such as isosorbide mononitrate); or to nitrites; 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: recent head injury, anemia, low blood pressure, dehydration, other heart problems (such as recent heart attack).This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).If you are going to have an MRI test, tell testing personnel that you are using this patch. Some patches may contain metals that can cause serious burns during an MRI. Ask your doctor whether you will need to remove your patch before the test and apply a new patch afterward, and how to do so properly.Older adults may be more sensitive to the side effects of this medication, especially dizziness and lightheadedness, which could increase the risk of falls.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is not known whether this drug passes into breast milk or if it may harm a nursing infant. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: drugs used to treat erectile dysfunction-ED or pulmonary hypertension (such as sildenafil, tadalafil), certain drugs to treat migraine headaches (ergot alkaloids such as ergotamine), riociguat.This medication may interfere with certain laboratory tests (including blood cholesterol levels), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

            OVERDOSE: This medication patch may be harmful if chewed or swallowed. If someone has overdosed, remove the patch if possible. For serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: slow heartbeat, vision changes, severe nausea/vomiting, sweating, cold/clammy skin, bluish fingers/toes/lips.

            NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as blood pressure monitoring) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.Lifestyle changes such as dietary changes, exercise, and stopping smoking may help this drug work better. Talk to your doctor or pharmacist about lifestyle changes that might benefit you.

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

            STORAGE: Store at room temperature between 68-77 degrees F (20-25 degrees C) away from light and moisture. Brief storage between 59-86 degrees F (15-30 degrees C) is permitted. Do not store in the bathroom. Keep all medicines away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed (See How to Use section).

            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 2021. Copyright(c) 2021 First Databank, Inc.

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

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