penicillin G aqueous (Rx)

Brand and Other Names:Pfizerpen, penicillin G potassium, more...penicillin G sodium, Crystapen
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

premixed injectable solution

  • 1 million units/50mL
  • 2 million units/50mL
  • 3 million units/50mL

potassium, powder for injectable solution

  • 5 million units/vial
  • 20 million units/vial

sodium, powder for injectable solution

  • 5 million units/vial

Meningococcal Meningitis/Septicemia

20-30 million units/day IV continuous infusion x14 days or afebrile x7days, OR

200,000-300,000 units/kg/day IV divided q2-4hr x24 doses

Actinomycosis

Cervicofacial cases: 1-6 million units/day IV

Thoracic and abdominal disease: 10-20 million units/day IV divided q4-6hr x 6 weeks, may follow with penicillin V

Botulism

Adjunctive to antitoxin: 20 million units/day IV divided q4-6hr

Vincent’s Infection (fusospirochetosis)

5-10 million units/day IV divided q4-6hr

Rat-Bite Fever

Indicated for Streptobacillus moniliformis and Spirillum minus (rat-bite fever)

12-20 million units/day IV divided q4-6hr x3-4 weeks

Listeria Infections

Meningitis: 15-20 million units/day IV divided q4-6hr x2 weeks

Endocarditis: 15-20 million units/day IV divided q4-6hr x4 weeks

Pasteurella Infections

Bacteremia or meningitis: 4-6 million units/day IV divided q4-6hr x2 weeks

Erysipeloid

Endocarditis: 12-20 million units/day IV divided q4-6hr x4-6 weeks

Diphtheria

Adjunct to antitoxin or to prevent carrier state: 2-3 million units/day IV divided q4-6hr x10-12 days

Anthrax

Minimum: 5 million units/day IV

12-20 million units/day IV have been used

Streptococcal Infections

Empyema, pneumonia, pericarditis, endocarditis, meningitis: 5-24 million units/day IV divided q4-6hr

Syphilis

Neurosyphilis: 18-24 million units/day IV x10-14 days

Streptococcal Group B Infection

Prophylaxis: 5 million units IV at the onset of labor or after membrane rupture followed by 2.5 million units IV q4hr until delivery

Lyme Disease (Off-label)

200,000-300,000 units/kg/day IV x 10-14 days

Renal Impairment

CrCl 10-50 mL/min: Decrease dose by 25%

CrCl <10 mL/min: Decrease dose by 50-70%

Hemodialysis: Removed by hemodialysis; administer after dialysis

Dosage Forms & Strengths

premixed injectable solution

  • 1 million units/50mL
  • 2 million units/50mL
  • 3 million units/50mL

potassium, powder for injectable solution

  • 5 million units/vial
  • 20 million units/vial

sodium, powder for injectable solution

  • 5 million units/vial

Neonatal Bacterial Infection General Dosing Guidlines

<7 days & <2000 g: 50,000 units/kg/day IV divided q12hr  

<7 days & >2000 g: 75,000 units/kg/day IV divided q8hr

>7 days & <1200 g: 50,000 units/kg/day IV divided q12hr

>7 days & 1200-2000 g: 75,000 units/kg/day IV divided q8hr

>7 days & >2000 g: 100,000 units/kg/day IV divided q6hr

Infant & Children Bacterial Infection General Dosing Guidelines

Moderate Infection: 25,000-50,000 units/kg/day IV/IM divided q6hr  

Severe Infection: 250,000-400,000 units/kg/day IV/IM divided q4-6hr

Not to exceed 24 million units/day

Meningitis

Neonates <7 days & <2000 g: 100,000 units/kg/day IV divided q12hr  

Neonates <7 days & >2000 g: 150,000 units/kg/day IV divided q8hr

Neonates >7 days & <1200 g: 100,000 units/kg/day IV divided q12hr

Neonates >7 days & 1200-2000 g: 150,000 units/kg/day IV divided q8hr

Neonates >7 days & >2000 g: 200,000 units/kg/day IV divided q6hr

Infants & Children: 250,000-400,000 units/kg/day IV divided q4hr; not to exceed 24 million units/day

Group B Streptococcal Meningitis

Neonates <7 days: 250,000-450,000 units/kg/day IV divided q8hr  

Neonates >7 days: 450,000 units/kg/day IV divided q6hr

Congenital Syphilis

Neonates <7 days: 100,000 units/kg/day IV divided q12hr  

Neonates >7 days: 150,000 units/kg/day IV divided q8hr

Endocarditis

Infants and Children <45 kg: 250,000 units/kg/day IV divided q4hr  

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Interactions

Interaction Checker

and penicillin G aqueous

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      Serious - Use Alternative

        Significant - Monitor Closely

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              Serious - Use Alternative (10)

              • BCG vaccine live

                penicillin G aqueous decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

              • cholera vaccine

                penicillin G aqueous, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.

              • demeclocycline

                demeclocycline decreases effects of penicillin G aqueous by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

              • doxycycline

                doxycycline decreases effects of penicillin G aqueous by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

              • minocycline

                minocycline decreases effects of penicillin G aqueous by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

              • omadacycline

                omadacycline decreases effects of penicillin G aqueous by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Tetracyclines may interfere with the bactericidal action of penicillins. Monitor for decreased therapeutic effects of penicillins if concomitantly used with a tetracycline.

              • pretomanid

                pretomanid will increase the level or effect of penicillin G aqueous by Other (see comment). Avoid or Use Alternate Drug. In vitro studies demonstrated that pretomanid significantly inhibits OAT3; monitor for increased adverse effects and consider dosage reduction for OAT3 substrates.

              • sarecycline

                sarecycline decreases effects of penicillin G aqueous by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Tetracyclines may interfere with the bactericidal action of penicillins. Monitor for decreased therapeutic effects of penicillins if concomitantly used with a tetracycline.

              • tetracycline

                tetracycline decreases effects of penicillin G aqueous by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

              • typhoid vaccine live

                penicillin G aqueous decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

              Monitor Closely (21)

              • amifampridine

                penicillin G aqueous increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

              • amiloride

                penicillin G aqueous increases effects of amiloride by unspecified interaction mechanism. Use Caution/Monitor. Hyperkalemia.

              • aspirin

                penicillin G aqueous, aspirin. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

                penicillin G aqueous, aspirin. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • aspirin rectal

                penicillin G aqueous, aspirin rectal. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

                penicillin G aqueous, aspirin rectal. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

              • aspirin/citric acid/sodium bicarbonate

                penicillin G aqueous, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

                penicillin G aqueous, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

              • bazedoxifene/conjugated estrogens

                penicillin G aqueous will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • choline magnesium trisalicylate

                penicillin G aqueous, choline magnesium trisalicylate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

                penicillin G aqueous, choline magnesium trisalicylate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

              • deflazacort

                penicillin G aqueous and deflazacort both decrease serum potassium. Use Caution/Monitor.

              • dienogest/estradiol valerate

                penicillin G aqueous will decrease the level or effect of dienogest/estradiol valerate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. An alternate or additional form of birth control may be advisable during concomitant use.

              • ethinylestradiol

                penicillin G aqueous decreases levels of ethinylestradiol by increasing metabolism. Use Caution/Monitor. Risk of oral contraceptive failure.

              • fostemsavir

                fostemsavir will increase the level or effect of penicillin G aqueous by Other (see comment). Modify Therapy/Monitor Closely. Fostemsavir inhibits OATP1B1/3 transporter. If possible, avoid coadministration or modify dose of OATP1B1/3 substrates coadministered with fostemsavir.

              • hydrochlorothiazide

                penicillin G aqueous, hydrochlorothiazide. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • ibuprofen IV

                penicillin G aqueous, ibuprofen IV. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

                penicillin G aqueous, ibuprofen IV. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

              • neomycin PO

                neomycin PO decreases levels of penicillin G aqueous by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • probenecid

                probenecid increases levels of penicillin G aqueous by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.

              • rose hips

                penicillin G aqueous, rose hips. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • salicylates (non-asa)

                penicillin G aqueous, salicylates (non-asa). Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

              • salsalate

                penicillin G aqueous, salsalate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

              • sodium phenylacetate

                penicillin G aqueous, sodium phenylacetate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • sodium picosulfate/magnesium oxide/anhydrous citric acid

                penicillin G aqueous decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.

              • willow bark

                penicillin G aqueous, willow bark. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              Minor (12)

              • azithromycin

                azithromycin decreases effects of penicillin G aqueous by pharmacodynamic antagonism. Minor/Significance Unknown.

              • chloramphenicol

                chloramphenicol decreases effects of penicillin G aqueous by pharmacodynamic antagonism. Minor/Significance Unknown.

              • chlorothiazide

                chlorothiazide increases levels of penicillin G aqueous by decreasing renal clearance. Minor/Significance Unknown.

              • clarithromycin

                clarithromycin decreases effects of penicillin G aqueous by pharmacodynamic antagonism. Minor/Significance Unknown.

              • erythromycin base

                erythromycin base decreases effects of penicillin G aqueous by pharmacodynamic antagonism. Minor/Significance Unknown.

              • erythromycin ethylsuccinate

                erythromycin ethylsuccinate decreases effects of penicillin G aqueous by pharmacodynamic antagonism. Minor/Significance Unknown.

              • erythromycin lactobionate

                erythromycin lactobionate decreases effects of penicillin G aqueous by pharmacodynamic antagonism. Minor/Significance Unknown.

              • erythromycin stearate

                erythromycin stearate decreases effects of penicillin G aqueous by pharmacodynamic antagonism. Minor/Significance Unknown.

              • furosemide

                furosemide increases levels of penicillin G aqueous by decreasing renal clearance. Minor/Significance Unknown.

              • hydrochlorothiazide

                hydrochlorothiazide increases levels of penicillin G aqueous by decreasing renal clearance. Minor/Significance Unknown.

              • methyclothiazide

                methyclothiazide increases levels of penicillin G aqueous by decreasing renal clearance. Minor/Significance Unknown.

              • roxithromycin

                roxithromycin decreases effects of penicillin G aqueous by pharmacodynamic antagonism. Minor/Significance Unknown.

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              Adverse Effects

              Frequency Not Defined

              Seizure

              Anemia

              Interstitial nephritis

              Hypersensitivity

              Anaphylaxis

              Jarisch-Herxheimer reaction

              Positive Coombs' reaction

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              Warnings

              Contraindications

              Allergy to penicillins, cephalosporins, imipenem

              Cautions

              Serious and occasionally fatal hypersensitivity (anaphylactic) reactions reported; reactions likely to occur in individuals with a history of penicillin hypersensitivity and/or a history of sensitivity to multiple allergens; before initiating therapy, inquire about previous hypersensitivity reactions to penicillins, cephalosporins, or other allergens; discontinue and institute appropriate therapy If an allergic reaction occurs

              Severe cutaneous adverse reactions (SCAR), such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP) reported when SCAR is suspected, discontinue therapy and consider an alternative treatment

              The use of antibiotics may promote overgrowth of nonsusceptible organisms, including fungi; indwelling intravenous catheters encourage superinfections; should superinfection occur, appropriate measures should be taken; when indicated, incision and drainage or other surgical procedures should be performed in conjunction with antibiotic therapy

              Care should be taken to avoid intravenous or accidental intraarterial administration, or injection into or near major peripheral nerves or blood vessels, since such injections may produce neurovascular damage; particular care should be taken with IV administration because of possibility of thrombophlebitis

              Skipping doses or not completing the full course of therapy may decrease the effectiveness of the immediate treatment and increase the likelihood that bacteria will develop resistance and will not be treatable by Penicillin G Potassium for Injection, USP or other antibacterial drugs in the future

              In renal/hepatic impairment, reduce dose based on severity of impairment

              Clostridium difficile

              • Clostridium difficile associated diarrhea (CDAD) reported; may range in severity from mild diarrhea to fatal colitis; CDAD must be considered in all patients who present with diarrhea following antibiotic use; may occur over two months after administration of antibacterial agents
              • If suspected or confirmed, discontinue ongoing antibiotic use not directed against C. difficile; administer appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be institute as clinically indicated
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              Pregnancy & Lactation

              Pregnancy Category: B

              Lactation: excreted in breast milk

              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

              Half-Life: 20-50 min (ESRD 3-5 hr)

              Peak Plasma Time: IM 30 min, IV 1 hr

              Protein Bound: 65%

              Distribution: crosses placenta, poor blood brain barrier diffusion

              Metabolism: hepatic to active metabolites

              Excretion: urine

              Mechanism of Action

              Interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms.

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              Administration

              IV Incompatibilities

              Additive: floxacillin, quinidine

              Syringe: heparin

              Y-site: aminophylline, cefamandole, cefazolin(?), heparin, Na bicarb

              IV Compatibilities

              Additive: dobutamine, lidocaine, KCl, procainamide, propafenone, verapamil

              Y-site: cefazolin(?), clarithromycin, dobutamine, dopamine, erythromycin, gentamicin, lidocaine, morphine, norepinephrine, KCl, vancomycin

              IV Preparation

              Rapid loading: 150 mg/100 mL D5W (1.5 mg/mL)

              Slow infusions: 900 mg/500 mL D5W (1.8 mg/mL)

              IV Administration

              If infusion >2 hr: use glass or polyolefin bottles

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              penicillin G sodium injection
              -
              5 million unit vial

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              penicillin G sodium injection

              PENICILLIN G - INJECTION

              (pen-ih-SILL-in GEE)

              COMMON BRAND NAME(S): Pfizerpen

              USES: This medication is used to treat a wide variety of bacterial infections. It is also used to prevent infection of the heart (bacterial endocarditis) in patients with certain heart diseases who are having surgery. This medication is known as a natural penicillin antibiotic. It works by stopping the growth of bacteria.

              HOW TO USE: Depending on your specific product, this medication is given by injection into a vein or into a muscle. Use exactly as directed by your doctor. The dosage is based on your medical condition and response to therapy. For children, the dosage is also based on weight.If you are giving this medication to yourself at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.Give aminoglycosides (such as gentamicin) separately from this medication. Do not mix together in the same IV fluid.For the best effect, use this antibiotic at evenly spaced times. To help you remember, use this medication at the same time(s) every day.Continue to use this medication until the full prescribed amount is finished, even if symptoms disappear after a few days. Stopping the medication too early may allow bacteria to continue to grow, which may result in a return of the infection.Tell your doctor if your condition persists or worsens.

              SIDE EFFECTS: Pain/redness/swelling at injection site may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she 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 you have any serious side effects, including: joint/muscle pain, muscle weakness, swelling of ankles/feet, dark/cloudy urine, extreme tiredness, fast/slow/irregular heartbeat, new signs of infection (e.g., fever, persistent sore throat), easy bruising/bleeding, signs of kidney problems (such as change in the amount of urine), numbness/tingling of arms/legs, seizures, uncontrolled movements, confusion.If used to treat syphilis or other spirochetal infections (e.g., Lyme disease), this medication may cause a condition known as Jarisch-Herxheimer reaction. This condition may occur 1 to 2 hours after you receive the medication and can last up to 24 hours. Notify your doctor right away if you experience any of these symptoms: fever/chills, muscle pain, worsening of skin sores, fast heartbeat, fast breathing, dizziness, flushing.This medication may rarely cause a severe intestinal condition due to a bacteria called C. difficile. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn't stop, abdominal or stomach pain/cramping, blood/mucus in your stool.If you have these symptoms, do not use anti-diarrhea or opioid products because they may make symptoms worse.Use of this medication for prolonged or repeated periods may result in oral thrush or a new vaginal yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before using this medication, tell your doctor or pharmacist if you are allergic to it; or to penicillin or cephalosporin antibiotics; or if you have any other allergies. This product may contain inactive ingredients (such as corn for products containing dextrose), 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: asthma, kidney disease.Penicillin may cause live bacterial vaccines (such as typhoid vaccine) to not work as well. Do not have any immunizations/vaccinations while using this medication unless your doctor tells you to.Certain products of this medication contain sodium. Consult your doctor or pharmacist if you are on a salt-restricted diet or if you have a condition that could be worsened by an increase in salt intake (e.g., congestive heart failure).Certain products of this medication contain potassium. Consult your doctor or pharmacist if you are taking potassium supplements, salt substitutes containing potassium, or medications that can increase potassium (including ACE inhibitors such as lisinopril), or if you have a high potassium level (hyperkalemia).Kidney function declines as you grow older. This medication is removed by the kidneys. Therefore, elderly people may be at greater risk for side effects while using this drug.Kidney function is not fully developed in newborns and infants. This medication is removed by the kidneys. Therefore, newborns and infants may be at greater risk for side effects while using this drug.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This drug passes into breast milk. 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: "blood thinners" (e.g., warfarin), methotrexate, NSAIDS (e.g., aspirin, indomethacin), tetracyclines.Low-dose aspirin should be continued if prescribed by your doctor for specific medical reasons such as heart attack or stroke prevention (usually 81-162 milligrams a day). Ask your doctor or pharmacist for more details.This medication may interfere with certain laboratory tests (including certain urine glucose tests), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: seizures, confusion, mental/mood changes (e.g., agitation).

              NOTES: Laboratory and/or medical tests (e.g., kidney function, complete blood count, potassium/sodium levels) may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

              MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.

              STORAGE: Consult the product instructions and your pharmacist for storage details. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised April 2021. Copyright(c) 2021 First Databank, Inc.

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

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              Formulary

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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.
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              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
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