ivermectin (Rx)

Brand and Other Names:Stromectol
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 3mg

Strongyloidiasis of the Intestinal Tract

15-24 kg: 3 mg PO once

25-35 kg: 6 mg PO once

36-50 kg: 9 mg PO once

51-65 kg: 12 mg PO once

66-79 kg: 15 mg PO once

>80 kg: 200 mcg/kg PO once  

Dosing considerations

  • In general repeat doses not necessary; perform stool examinations to verify eradication of infection

River Blindness (Onchocerciasis)

15-25 kg: 3 mg PO; may repeat in 3-12 mo

26-44 kg: 6 mg PO; may repeat in 3-12 mo

45-64 kg: 9 mg PO; may repeat in 3-12 mo

65-84 kg: 12 mg PO; may repeat in 3-12 mo

≥85 kg: 150 mcg/kg PO; may repeat in 3-12 mo  

Dosing considerations

  • Note: Does not treat adult worms (must be surgically excised)

Head Lice (Pediculosis capitis; Off-label)

200 mcg/kg PO once; may require 1-2 additional doses repeated after 7 days  

Blepharitis (Demodex folliculorum; Off-label)

200 mcg/kg PO once as a single dose, THEN repeat dose once in 7 days  

Filariasis Due to Mansonella Ozzardi (Off-label)

6 mg PO as single dose

Filariasis Due to Mansonella Streptocera (Off-label)

150 mcg/kg as single dose

Scabies Due to Sarcoptes Scabiel

Immunocompromised patients: 200 mcg/kg as single dose; may repeat in 14 days if necessary

Gnathostoma Spinigerum

Gnathostomiasis: 200 mcg/kg as single dose

Administration

Take on empty stomach

Monitor: Stool exams (Strongyloides)

Dosage Forms & Strengths

tablet

  • 3mg

River Blindness (Onchocerciasis)

<15 kg: Safety and efficacy not established

15-25 kg: 3 mg PO; may repeat in 3-12 mo

26-44 kg: 6 mg PO; may repeat in 3-12 mo

45-64 kg: 9 mg PO; may repeat in 3-12 mo

65-84 kg: 12 mg PO; may repeat in 3-12 mo

≥85 kg: 150 mcg/kg PO; may repeat in 3-12 mo  

Dosing considerations

  • Note: Does not treat adult worms (must be surgically excised)

Strongyloidiasis of the Intestinal Tract

<15 kg: Safety and efficacy not established

15-24 kg: 3 mg PO once

25-35 kg: 6 mg PO once

36-50 kg: 9 mg PO once

51-65 kg: 12 mg PO once

66-79 kg: 15 mg PO once

>80 kg: 200 mcg/kg PO once  

Dosing considerations

  • In general repeat doses not necessary; perform stool examinations to verify eradication of infection

Administration

Take on empty stomach

Monitor: Stool exams (Strongyloides)

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Interactions

Interaction Checker

and ivermectin

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      Serious - Use Alternative

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            Contraindicated (0)

              Serious - Use Alternative (5)

              • erdafitinib

                erdafitinib will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If coadministration unavoidable, separate administration by at least 6 hr before or after administration of P-gp substrates with narrow therapeutic index.

              • lasmiditan

                lasmiditan increases levels of ivermectin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

              • quinidine

                quinidine will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

              • sotorasib

                sotorasib will decrease the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications.

              • tepotinib

                tepotinib will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If concomitant use unavoidable, reduce the P-gp substrate dosage if recommended in its approved product labeling.

              Monitor Closely (49)

              • amiodarone

                amiodarone will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • atorvastatin

                atorvastatin will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • berotralstat

                berotralstat will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor or titrate P-gp substrate dose if coadministered.

              • bosutinib

                bosutinib increases levels of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • clarithromycin

                clarithromycin will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • clotrimazole

                clotrimazole will decrease the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • dronedarone

                dronedarone will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • elagolix

                elagolix will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • eliglustat

                eliglustat increases levels of ivermectin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the P-gp substrate and titrate to clinical effect.

              • erythromycin base

                erythromycin base will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • erythromycin ethylsuccinate

                erythromycin ethylsuccinate will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • erythromycin lactobionate

                erythromycin lactobionate will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • erythromycin stearate

                erythromycin stearate will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • felodipine

                felodipine will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • fosphenytoin

                fosphenytoin will decrease the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • fostamatinib

                fostamatinib will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Concomitant use of fostamatinib may increase concentrations of P-gp substrates. Monitor for toxicities of the P-gp substrate drug that may require dosage reduction when given concurrently with fostamatinib.

              • glecaprevir/pibrentasvir

                glecaprevir/pibrentasvir will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • indinavir

                indinavir will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • istradefylline

                istradefylline will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. Consider dose reduction of sensitive P-gp substrates.

              • itraconazole

                itraconazole will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • ivacaftor

                ivacaftor increases levels of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Ivacaftor and its M1 metabolite has the potential to inhibit P-gp; may significantly increase systemic exposure to sensitive P-gp substrates with a narrow therapeutic index.

              • ketoconazole

                ketoconazole will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • lapatinib

                lapatinib will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • lomitapide

                lomitapide increases levels of ivermectin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing dose when used concomitantly with lomitapide.

              • lonafarnib

                lonafarnib will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Lonafarnib is a weak P-gp inhibitor. Monitor for adverse reactions if coadministered with P-gp substrates where minimal concentration changes may lead to serious or life-threatening toxicities. Reduce P-gp substrate dose if needed.

              • loratadine

                loratadine will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • lovastatin

                lovastatin will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • nefazodone

                nefazodone will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • nicardipine

                nicardipine will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • nifedipine

                nifedipine will decrease the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • nilotinib

                nilotinib will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • phenobarbital

                phenobarbital will decrease the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • phenytoin

                phenytoin will decrease the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • ponatinib

                ponatinib increases levels of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • quercetin

                quercetin will decrease the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • ranolazine

                ranolazine will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • rifampin

                rifampin will decrease the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • ritonavir

                ritonavir will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • sarecycline

                sarecycline will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor for toxicities of P-gp substrates that may require dosage reduction when coadministered with P-gp inhibitors.

              • simvastatin

                simvastatin will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • sirolimus

                sirolimus will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • St John's Wort

                St John's Wort will decrease the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • stiripentol

                stiripentol will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing the dose of P-glycoprotein (P-gp) substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.

              • tacrolimus

                tacrolimus will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • tolvaptan

                tolvaptan will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • trazodone

                trazodone will decrease the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • tucatinib

                tucatinib will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.

              • verapamil

                verapamil will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • warfarin

                ivermectin increases effects of warfarin by unknown mechanism. Use Caution/Monitor. Rare interaction.

              Minor (0)

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                Adverse Effects

                Frequency Not Defined

                Abdominal pain

                Asthenia

                Hypotension

                Mild EKG changes

                Peripheral & facial edema

                Transient tachycardia

                Dizziness

                Headache

                Hyperthermia

                Insomnia

                Somnolence

                Vertigo

                Pruritus

                Rash

                Urticaria

                Diarrhea

                Nausea

                Vomiting

                Eosinophilia

                Leukopenia

                ALT/AST increased

                Limbitis

                Myalgia

                Tremor

                Blurred vision

                Mild conjunctivitis

                Punctate opacity

                Mazzotti reaction (with onchocerciasis)

                Edema

                Fever

                Lymphadenopathy

                Ocular damage

                Pruritus rash

                Conjunctival hemorrhage (with onchocerciasis)

                Hepatitis

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                Warnings

                Contraindications

                Hypersensitivity to ivermectin

                Cautions

                Strongyloidiasis: The patient should be reminded of the need for repeated stool examinations to document clearance of infection with Strongyloides stercoralis; not active against disseminated Strongyloides, only intestinal

                Onchocerciasis: The patient should be reminded that treatment does not kill the adult Onchocerca volvulus parasite, and therefore repeated follow-up and retreatment is usually required

                Long-term studies in animals have not been performed to evaluate carcinogenic potential of ivermectin

                Therapy had no adverse effects on fertility in rats in studies at repeated doses of up to 3 times maximum recommended human dose of 200 mcg/kg (on a mg/m2/day basis)

                Immunocompromised patients may require repeated treatment; control of extraintestinal strongyloidiasis may require suppressive therapy (eg, once monthly)

                Mazzotti reactions

                • Microfilaricidal drugs, such as diethylcarbamazine citrate (DEC-C), might cause cutaneous and/or systemic reactions of varying severity (the Mazzotti reaction) and ophthalmological reactions in patients with onchocerciasis
                • These reactions are probably due to allergic and inflammatory responses to the death of microfilariae; onchocerciasis treated patients may experience these reactions in addition to clinical adverse reactions possibly related to the drug itself
                • The treatment of severe Mazzotti reactions has not been subjected to controlled clinical trials; oral hydration, recumbency, intravenous normal saline, and/or parenteral corticosteroids have been used to treat postural hypotension; antihistamines and/or aspirin have been used for most mild to moderate cases

                Loiasis

                • Rarely, patients with onchocerciasis who are also heavily infected with Loa loa may develop a serious or even fatal encephalopathy either spontaneously or following treatment with an effective microfilaricide
                • The following adverse experiences have been reported in these patients, pain (including neck and back pain), red eye, conjunctival hemorrhage, dyspnea, urinary and/or fecal incontinence, difficulty in standing/walking, mental status changes, confusion, lethargy, stupor, seizures, or coma
                • This syndrome has been seen very rarely following the use of ivermectin; in individuals who warrant treatment with ivermectin for any reason and have had significant exposure to Loa loa-endemic areas of West or Central Africa, implement pretreatment assessment for loiasis and careful post-treatment follow-up

                Drug interactions overview

                • Post-marketing reports of increased INR (International Normalized Ratio) have been rarely reported when ivermectin was co-administered with warfarin
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                Pregnancy & Lactation

                Pregnancy category: C

                Pregnancy

                There are no studies in pregnant women; epidemiologic studies during pregnancy are insufficient to inform a drug-associated risk of adverse developmental outcomes, because either the timing of administration during gestation was not accurately ascertained or the administration occurred only during the second trimester; however, systemic exposure from topical use of ivermectin is much lower than that from oral use

                In animal reproduction studies, ivermectin induced adverse developmental outcomes when orally administered to pregnant mice, rats and rabbits during the period of organogenesis only at or near doses that were maternally toxic to the pregnant females

                Lactation

                There is information available on the presence of ivermectin in human milk in 4 lactating women after a single 150 mcg/kg oral dose of ivermectin; however, there is insufficient information from this study to determine effects of ivermectin on breastfed infant or on milk production

                Topical ivermectin systemic exposure is much lower than that for oral ivermectin; furthermore, amount of ivermectin present in human milk after topical application to lactating women has not been studied

                The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for therapy and any potential adverse effects on breastfed infant or from underlying maternal condition

                Lactation: Enters breast milk (AAP Committee states compatible with nursing)

                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

                Binds glutamate-gated Cl ion channels in invertebrate nerve and muscle cells; produces paralysis, death of parasite

                Absorption

                Well absorbed

                Peak serum time: 4 hr

                Peak effect: 3-6 months (treatment of orchocerciasis); 3 months (treatment of strongyloides)

                Distribution

                Protein bound: 93%

                Vd: 3-3.5 L/kg

                Does not cross blood-brain barrier

                Metabolism

                Hepatic (CYP3A4, CYP2D6, CYP2E1)

                Elimination

                Half-life: 18 hr

                Excretion: Feces; urine (<1%)

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                Images

                BRAND FORM. UNIT PRICE PILL IMAGE
                ivermectin oral
                -
                3 mg tablet
                Soolantra topical
                -
                1 % cream
                Soolantra topical
                -
                1 % cream
                Stromectol oral
                -
                3 mg tablet
                Sklice topical
                -
                0.5 % lotion

                Copyright © 2010 First DataBank, Inc.

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                ivermectin oral

                IVERMECTIN - ORAL

                (EYE-ver-MEK-tin)

                COMMON BRAND NAME(S): Stromectol

                USES: This medication is used to treat certain parasitic roundworm infections. Curing parasitic infections helps to improve your quality of life. In people with weakened defense (immune) systems, curing roundworm infections can reduce the risk of developing a severe or life-threatening infection. Ivermectin belongs to a class of drugs known as antihelmintics. It works by paralyzing and killing parasites.Ivermectin is not recommended for coronavirus disease, also known as COVID-19, unless you are enrolled in a study. Talk to your doctor about the risks and benefits.

                HOW TO USE: Take this medication by mouth with a full glass of water (8 ounces or 240 milliliters) on an empty stomach at least 1 hour before a meal. Ivermectin is usually taken as a single dose or series of doses, or as directed by your doctor.Dosage is based on your weight, medical condition, and response to treatment.Tell your doctor if your condition persists or worsens.

                SIDE EFFECTS: Headache, dizziness, muscle pain, nausea, or diarrhea may occur. If you are being treated for "river blindness" (onchocerciasis), you may experience reactions to the dying parasites during the first 4 days of treatment, including joint pain, tender/swollen lymph nodes, eye swelling/redness/pain, weakness, vision changes, itching, rash, and fever. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.To reduce dizziness upon standing, get up slowly when rising from a sitting or lying position.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: neck/back pain, swelling face/arms/hands/feet, chest pain, fast heartbeat, confusion, seizures, loss of consciousness.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 taking ivermectin, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver problems.If you have traveled or lived in West or Central Africa, you may be infected with certain parasites (such as Loa loa, African trypanosomiasis) that could cause problems with ivermectin treatment. These effects could rarely result in serious (possibly fatal) effects on the brain (such as encephalopathy). Consult your doctor for more information.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 have a weakened immune system (such as due to HIV infection), you may need repeat treatments with this medicine. Talk to your doctor for more details.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.Ivermectin passes into breast milk. Though there have been no reports of harm to nursing infants, 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 of the products that may interact with this drug include: barbiturates (such as phenobarbital, butalbital), benzodiazepines (such as clonazepam, lorazepam), sodium oxybate (GHB), valproic acid.

                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: numbness, tingling, trouble breathing, loss of coordination, seizures.

                NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as stool exams for intestinal parasites) should be performed periodically to monitor your progress or check for side effects. If you are being treated for "river blindness," you may need more medical examinations and repeated treatment because ivermectin does not kill adult Onchocerca worms. Consult your doctor for more details.

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

                STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. 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 March 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.
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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.