Japanese encephalitis virus vaccine (Rx)

Brand and Other Names:Ixiaro
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

suspension for IM injection

  • 0.5mL prefilled syringe

Active Immunization

Vaccine recommended for adults at increased risk of Japanese encephalitis virus (JEV) during travel to Asia

Complete primary immunization series at least 1 week prior to potential exposure to JEV

18 through 65 years: 2 doses (0.5 mL) administered either 7 or 28 days apart

≥66 years: 2 doses (0.5 mL) IM administered 28 days apart

Booster dose

  • A single 5-mL booster dose (third dose) may be given at least 11 months after completing the primary immunization series if ongoing exposure or re-exposure to JEV is expected

Dosage Forms & Strengths

suspension for IM injection

  • 0.5mL prefilled syringe

Active Immunization

Vaccine recommended for adults and children aged ≥2 months at increased risk of Japanese encephalitis virus (JEV) during travel to Asia

<2 months: Safety and efficacy not established

Complete all immunization at least 1 week prior to potential exposure to JEV

Primary immunization series

  • 2 months to <3 years: 2 doses (0.25 mL) IM administered 28 days apart
  • ≥3 years: 2 doses (0.5 mL) IM administered 28 days apart

Booster dose

  • A booster dose (third dose) may be given at least 11 months after completing the primary immunization series if ongoing exposure or re-exposure to JEV is expected
  • 14 months to <3 years: Administer a single 0.25-mL booster dose
  • ≥3 years: Administer a single 0.5-mL booster dose
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Interactions

Interaction Checker

and Japanese encephalitis virus vaccine

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Contraindicated (1)

            • belimumab

              belimumab decreases effects of Japanese encephalitis virus vaccine by immunosuppressive effects; risk of infection. Contraindicated. Do not administer live vaccines 30 days before or concurrently with belimumab.

            Serious - Use Alternative (37)

            • adalimumab

              adalimumab decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • alefacept

              alefacept decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • anakinra

              anakinra decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • antithymocyte globulin equine

              antithymocyte globulin equine decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • antithymocyte globulin rabbit

              antithymocyte globulin rabbit decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • azathioprine

              azathioprine decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • basiliximab

              basiliximab decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • budesonide

              budesonide decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • canakinumab

              canakinumab decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • cortisone

              cortisone decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • deflazacort

              deflazacort decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • dexamethasone

              dexamethasone decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • etanercept

              etanercept decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • everolimus

              everolimus decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • fludrocortisone

              fludrocortisone decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • glatiramer

              glatiramer decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • golimumab

              golimumab decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • hydrocortisone

              hydrocortisone decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • hydroxychloroquine sulfate

              hydroxychloroquine sulfate decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • infliximab

              infliximab decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • leflunomide

              leflunomide decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • methylprednisolone

              methylprednisolone decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • muromonab CD3

              muromonab CD3 decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • mycophenolate

              mycophenolate decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • ocrelizumab

              ocrelizumab decreases effects of Japanese encephalitis virus vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Vaccination with live-attenuated or live vaccines is not recommended during ocrelizumab treatment and until B-cell repletion.

            • ofatumumab SC

              ofatumumab SC decreases effects of Japanese encephalitis virus vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Administer all immunizations according to immunization guidelines at least 2 weeks before initiating ofatumumab SC for inactivated vaccines, and whenever possible.

            • prednisolone

              prednisolone decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • prednisone

              prednisone decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • rilonacept

              rilonacept decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • secukinumab

              secukinumab decreases effects of Japanese encephalitis virus vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            • siponimod

              siponimod decreases effects of Japanese encephalitis virus vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Pause vaccinations beginning 1 week before initiating siponimod and for 4 weeks after stopping treatment. Coadministration with live attenuated vaccines may increase infection risk.

            • sirolimus

              sirolimus decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • tacrolimus

              tacrolimus decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • temsirolimus

              temsirolimus decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • tocilizumab

              tocilizumab decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • triamcinolone acetonide injectable suspension

              triamcinolone acetonide injectable suspension decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • ustekinumab

              ustekinumab decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Prior initiating therapy, patients should receive all age-appropriate immunizations as recommended by current guidelines. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            Monitor Closely (15)

            • certolizumab pegol

              certolizumab pegol decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Use Caution/Monitor.

            • cyclosporine

              cyclosporine decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. If possible, complete all age-appropriate vaccinations at least 2 weeks before initiating immunosuppressant therapy. Patients vaccinated <14 days before starting immunosuppressive therapy or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued if immune competence has been restored. Longer waiting periods may be required for drugs that maintain their immunosuppressive effects for more than 3 months after discontinuation (eg, ocrelizumab). .

            • ibrutinib

              ibrutinib decreases effects of Japanese encephalitis virus vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • ifosfamide

              ifosfamide decreases effects of Japanese encephalitis virus vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • lomustine

              lomustine decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • mechlorethamine

              mechlorethamine decreases effects of Japanese encephalitis virus vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • melphalan

              melphalan decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • mercaptopurine

              mercaptopurine decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • methotrexate

              methotrexate decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Use Caution/Monitor. Concomitant administration of methotrexate can decrease the immunological response of vaccines.

            • onasemnogene abeparvovec

              onasemnogene abeparvovec decreases effects of Japanese encephalitis virus vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Adjust vaccinations to accommodate concomitant corticosteroid administration prior to and following onasemnogene abeparvovec infusion. When initiating systemic corticosteriod therapy, wait 2 weeks after an inactivated vaccine.

            • oxaliplatin

              oxaliplatin decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • ponesimod

              ponesimod decreases effects of Japanese encephalitis virus vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

            • procarbazine

              procarbazine decreases effects of Japanese encephalitis virus vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • rituximab

              rituximab, Japanese encephalitis virus vaccine. immunosuppressive effects; risk of infection. Use Caution/Monitor. When used for rheumatoid arthritis, follow current immunization guidelines and administer non-live vaccines at least 4 weeks prior to a course of rituximab.

            • rituximab-hyaluronidase

              rituximab-hyaluronidase, Japanese encephalitis virus vaccine. immunosuppressive effects; risk of infection. Use Caution/Monitor. When used for rheumatoid arthritis, follow current immunization guidelines and administer non-live vaccines at least 4 weeks prior to a course of rituximab.

            Minor (2)

            • chloroquine

              chloroquine decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • ozanimod

              ozanimod decreases effects of Japanese encephalitis virus vaccine by immunosuppressive effects; risk of infection. Minor/Significance Unknown. No clinical data are available on the efficacy and safety of vaccinations in patients taking ozanimod. Vaccinations may be less effective if coadministered with ozanimod.

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            Adverse Effects

            Suspected adverse events after administration of any vaccine may be reported to Vaccine Adverse Events Reporting System (VAERS), 1-800-822-7967

            >10%

            Infants 2 month to <1 year

            • Injection site redness (5.3-17.6%)
            • Irritability (8.4-15.3%)
            • Fever, 99.9-101.5°F (12.2-17.6%)
            • Diarrhea (8.4-11.5%)

            Children 1 year to <3 years

            • Fever, 99.9-101.5F (8.5-15.6%)

            Adolescents 12 years to <18 years

            • Injection pain (6.7-15%)

            Adults ≥18 years

            • Headache (27.9%)
            • Myalgia (15.6%)
            • Influenzalike illness (12.3%)
            • Fatigue (11.3%)

            1-10%

            Infants 2 month to <1 year

            • Rash (3.8-8.4%)
            • Vomiting (3.8-7.6%)
            • Fever, 101.6-102.7°F (1.5-6.1%)
            • Loss of appetite (5.3%)
            • Excessive fatigue (1.5-3.1%)
            • Injection site tenderness (0.8-3.1%)
            • Injection site swelling (1.5%)

            Children 1 year to <3 years

            • Flulike symptoms (4-7.7%)
            • Irritability (2.7-7.7%)
            • Diarrhea (4.6-7%)
            • Injection site redness (2.5-6.1%)
            • Loss of appetite (2.5-5.6%)
            • Vomiting (2.8-4.2%)
            • Rash (1.3-4.2%)
            • Injection site pain (3.6%)
            • Injection site tenderness or swelling (1.4-3.1%)
            • Fever, 101.6-102.7°F (2.5-3%)
            • Excessive fatigue (1.1-2.5%)
            • Muscle pain (0.7-2.3%)
            • Nausea (0.9-2.2%)
            • Fever, 102.8-104.9°F (1.6%)
            • Headache (1.4-1.5%)

            Children 3 years to <12 years

            • Fever, 99.9-101.5°F (3.3-7.7%)
            • Injection site pain or tenderness (1.7-5.5%)
            • Headache (1.4-3.8%)
            • Injection site itching, hardening, swelling, or redness (0.7-3%)
            • Muscle pain (0.3-2.4%)
            • Fever, 101.6-102.7°F (0.7-2%)
            • Vomiting (0.7-1.7%)
            • Flulike symptoms (0.3-1.4%)
            • Rash (1%)
            • Loss of appetite (1%)
            • Fever, 102.8-104.9°F (0.7-1%)
            • Excessive fatigue (0.7-1%)

            Adolescents 12 years to <18 years

            • Injection site tenderness (0.4-10%)
            • Headache (3.4-4.6%)
            • Fever, 99.9-101.5°F (3.3-3.8%)
            • Flulike symptoms (1.3-3.3%)
            • Muscle pain (1.3-2.9%)
            • Excessive fatigue (0.4-2.5%)
            • Irritability (2.1%)
            • Nausea (2.1%)
            • Loss of appetite (0.4-2.1%)
            • Vomiting (1.3%)
            • Fever, 101.6-102.7°F (0.4-1.3%)
            • Injection site hardening (0.4-1.3%)

            Adults ≥18 years

            • Nausea (6.6%)
            • Nasopharyngitis (4.7%)
            • Fever (3.2%)
            • URI (1.7%)
            • Pharyngolaryngeal pain (1.6%)
            • Diarrhea (1.5%)
            • Rhinitis (1.4%)
            • Vomiting (1.4%)
            • Back pain (1.3%)
            • Rash (1.3%)
            • Cough (1.2%)

            <1%

            Infants 2 month to <1 year

            • Fever, 102.8-104.9°F (0.8%)

            Children 1 year to <3 years

            • Fever, >104.9°F (0.2%)

            Postmarketing Reports

            Nervous system disorders: Paraesthesia, neuritis, syncope

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            Warnings

            Contraindications

            Severe allergic reaction (eg, anaphylaxis) after previous dose, another Japanese encephalitis virus vaccine, or any component, including protamine sulfate; if history uncertain, refer to allergist

            Cautions

            Contains protamine sulfate, potentially allergenic (see Contraindications)

            Syncope can occur in association with administration of injectable vaccines; follow procedures to avoid falling injury and to restore cerebral perfusion following syncope

            Limitations of vaccine effectiveness; vaccination may not protect all individuals

            Immunocompromised individuals may have a diminished immune response; immunosuppressive therapies may decrease immune response to JEV

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            Pregnancy & Lactation

            Pregnancy

            Data are not available to establish the presence or absence of drug-associated risk during pregnancy

            Healthcare practitioners are encouraged to report use in pregnant women to the distributor, Valneva USA, Inc., at 844-349-4276

            Disease-associated maternal and/or embryo/fetal risk: Miscarriages and intrauterine infection have been reported following maternal infection with JEV

            Lactation

            Unknown if excreted in human milk

            The development and health benefits of breastfeeding should be considered along with the mother’s clinical need for the drug and any potential adverse effects on the breastfed child or from the 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

            JE virus antigen, inactivated adsorbed

            These products convey active immunity via stimulation of production of endogenously produced antibodies

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            Administration

            IM Preparation

            During storage, a clear liquid with a white precipitate can be observed; shake syringe well to obtain a white, opaque, homogeneous suspension

            Inspected visually for particulate matter and discoloration prior to administration

            0.25-mL dose preparation

            • Shake the prefilled syringe containing 0.5 mL to obtain homogenous suspension
            • Remove the syringe tip cap by gently twisting it; do not attempt to snap or pull the tip off as this may damage the syringe
            • Attach a sterile safety needle to the prefilled syringe (needle is not provided)
            • Hold the syringe in an upright position and uncap the needle
            • Push the plunger stopper to the edge of the red line on the syringe barrel and discard expelled volume into medical waste container
            • Lock the needle safety shield and remove the needle
            • Attach a new sterile needle prior to injection of the remaining volume

            0.5-mL dose preparation

            • Shake the prefilled syringe containing 0.5 mL to obtain homogenous suspension
            • Remove the syringe tip cap by gently twisting it; do not attempt to snap or pull the tip off as this may damage the syringe
            • Attach a sterile safety needle to the prefilled syringe (needle is not provided)

            IM Administration

            For IM administration only; do not administer IV, SC, or ID

            When JEV is concomitantly used with injectable vaccines, separate syringes at different injection sites; do not be mixed with any other vaccine in the same syringe or vial

            Administration sites

            • Aged 2-11 months: Anterolateral aspect of the thigh
            • Aged 1 to <3 years: Anterolateral aspect of the thigh (or the deltoid muscle if muscle mass is adequate)
            • Aged ≥3 years: Deltoid muscle

            Storage

            Prefilled syringe: Store refrigerated between 2-8°C (35-46°F)

            Do not freeze

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            Patient Handout

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

            FormularyPatient Discounts

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            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.
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            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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