siltuximab (Rx)

Brand and Other Names:Sylvant
  • Print

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

lyophilized powder for reconstitution

  • 100mg/vial
  • 400mg/vial

Castleman Disease

Indicated for multicentric Castleman disease in patients who are negative for HIV and human herpesvirus-8

11 mg/kg IV q3weeks; infuse over 1 hr

Continue until treatment failure

Dosage Modifications

Renal impairment

  • CrCl ≥15 mL/min: No initial dosage adjustment required
  • End-stage renal disease: No information

Hepatic impairment

  • Mild-to-moderate (Child-Pugh A and B): No initial dosage adjustment required
  • Severe (Child-Pugh C): No information

Dosing Considerations

Do not administer with severe infection until resolved

Discontinue with severe infusion-related reactions, anaphylaxis, severe allergic reactions, or cytokine release syndromes; do not reinstitute treatment

Hematology lab tests

  • Perform hematology tests before each dose for first 12 months and every 3 dosing cycles thereafter
  • If following criteria not met, consider delaying treatment (do NOT reduce dose):
  • If following criteria not met, consider delaying treatment (do NOT reduce dose)
    • ANC: ≥1 x 10^9/L
    • Platelets: ≥75 x 10^9/L (before 1st dose); ≥50 x 10^9/L (retreatment criteria)
    • Hgb: <17 g/dL

Safety and efficacy not established

Next:

Interactions

Interaction Checker

and siltuximab

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 

            Contraindicated (0)

              Serious - Use Alternative (8)

              • axicabtagene ciloleucel

                siltuximab, axicabtagene ciloleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • baricitinib

                baricitinib, siltuximab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Baricitinib is not recommended in combination with other JAK inhibitors, biologic DMARDs, or potent immunosuppressives.

              • brexucabtagene autoleucel

                siltuximab, brexucabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • ciltacabtagene autoleucel

                siltuximab, ciltacabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • idecabtagene vicleucel

                siltuximab, idecabtagene vicleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • lisocabtagene maraleucel

                siltuximab, lisocabtagene maraleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • palifermin

                palifermin increases toxicity of siltuximab by Other (see comment). Avoid or Use Alternate Drug. Comment: Palifermin should not be administered within 24 hr before, during infusion of, or within 24 hr after administration of antineoplastic agents. Coadministration of palifermin within 24 hr of chemotherapy resulted in increased severity and duration of oral mucositis.

              • tisagenlecleucel

                siltuximab, tisagenlecleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              Monitor Closely (32)

              • carbamazepine

                siltuximab, carbamazepine. Other (see comment). Use Caution/Monitor. Comment: CYP450 activity in the liver is down regulated by infection and inflammation stimuli including cytokines (eg, IL-6); inhibition of IL-6 by siltuximab may restore CYP450 enzymatic activity; caution if coadministered with CYP substrates that have a narrow therapeutic index.

              • cholera vaccine

                siltuximab decreases effects of cholera vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs and corticosteroids (used in greater than physiologic doses), may reduce the immune response to cholera vaccine.

              • colchicine

                siltuximab, colchicine. Other (see comment). Use Caution/Monitor. Comment: CYP450 activity in the liver is down regulated by infection and inflammation stimuli including cytokines (eg, IL-6); inhibition of IL-6 by siltuximab may restore CYP450 enzymatic activity; caution if coadministered with CYP substrates that have a narrow therapeutic index.

              • cyclosporine

                siltuximab, cyclosporine. Other (see comment). Use Caution/Monitor. Comment: CYP450 activity in the liver is down regulated by infection and inflammation stimuli including cytokines (eg, IL-6); inhibition of IL-6 by siltuximab may restore CYP450 enzymatic activity; caution if coadministered with CYP substrates that have a narrow therapeutic index.

              • dengue vaccine

                siltuximab decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. Immunosuppressive therapies (eg, irradiation, antimetabolites, alkylating agents, cytotoxic drugs, corticosteroids [greater than physiologic doses]) may reduce immune response to dengue vaccine.

              • desogestrel

                siltuximab, desogestrel. Other (see comment). Use Caution/Monitor. Comment: CYP450 activity in the liver is down regulated by infection and inflammation stimuli including cytokines (eg, IL-6); inhibition of IL-6 by siltuximab may restore CYP450 enzymatic activity; caution if coadministered with CYP substrates that have a narrow therapeutic index.

              • dienogest/estradiol valerate

                siltuximab, dienogest/estradiol valerate. Other (see comment). Use Caution/Monitor. Comment: CYP450 activity in the liver is down regulated by infection and inflammation stimuli including cytokines (eg, IL-6); inhibition of IL-6 by siltuximab may restore CYP450 enzymatic activity; caution if coadministered with CYP substrates that have a narrow therapeutic index.

              • drospirenone

                siltuximab, drospirenone. Other (see comment). Use Caution/Monitor. Comment: CYP450 activity in the liver is down regulated by infection and inflammation stimuli including cytokines (eg, IL-6); inhibition of IL-6 by siltuximab may restore CYP450 enzymatic activity; caution if coadministered with CYP substrates that have a narrow therapeutic index.

              • efgartigimod alfa

                efgartigimod alfa will decrease the level or effect of siltuximab by receptor binding competition. Use Caution/Monitor. Coadministration of efgartigimod with medications that bind to the human neonatal Fc receptor may lower systemic exposures and effectiveness of such medications. Closely monitor for reduced effectiveness of medications that bind to the human neonatal Fc receptor. If long-term use of such medications is essential, consider discontinuing efgartigimod and using alternative therapies.

              • ethinylestradiol

                siltuximab, ethinylestradiol. Other (see comment). Use Caution/Monitor. Comment: CYP450 activity in the liver is down regulated by infection and inflammation stimuli including cytokines (eg, IL-6); inhibition of IL-6 by siltuximab may restore CYP450 enzymatic activity; caution if coadministered with CYP substrates that have a narrow therapeutic index.

              • etynodiol

                siltuximab, etynodiol. Other (see comment). Use Caution/Monitor. Comment: CYP450 activity in the liver is down regulated by infection and inflammation stimuli including cytokines (eg, IL-6); inhibition of IL-6 by siltuximab may restore CYP450 enzymatic activity; caution if coadministered with CYP substrates that have a narrow therapeutic index.

              • isavuconazonium sulfate

                siltuximab and isavuconazonium sulfate both decrease immunosuppressive effects; risk of infection. Use Caution/Monitor.

              • levonorgestrel oral

                siltuximab, levonorgestrel oral. Other (see comment). Use Caution/Monitor. Comment: CYP450 activity in the liver is down regulated by infection and inflammation stimuli including cytokines (eg, IL-6); inhibition of IL-6 by siltuximab may restore CYP450 enzymatic activity; caution if coadministered with CYP substrates that have a narrow therapeutic index.

              • lomustine

                lomustine and siltuximab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.

              • mechlorethamine

                mechlorethamine, siltuximab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.

              • mestranol

                siltuximab, mestranol. Other (see comment). Use Caution/Monitor. Comment: CYP450 activity in the liver is down regulated by infection and inflammation stimuli including cytokines (eg, IL-6); inhibition of IL-6 by siltuximab may restore CYP450 enzymatic activity; caution if coadministered with CYP substrates that have a narrow therapeutic index.

              • norelgestromin

                siltuximab, norelgestromin. Other (see comment). Use Caution/Monitor. Comment: CYP450 activity in the liver is down regulated by infection and inflammation stimuli including cytokines (eg, IL-6); inhibition of IL-6 by siltuximab may restore CYP450 enzymatic activity; caution if coadministered with CYP substrates that have a narrow therapeutic index.

              • norethindrone

                siltuximab, norethindrone. Other (see comment). Use Caution/Monitor. Comment: CYP450 activity in the liver is down regulated by infection and inflammation stimuli including cytokines (eg, IL-6); inhibition of IL-6 by siltuximab may restore CYP450 enzymatic activity; caution if coadministered with CYP substrates that have a narrow therapeutic index.

              • norethindrone acetate

                siltuximab, norethindrone acetate. Other (see comment). Use Caution/Monitor. Comment: CYP450 activity in the liver is down regulated by infection and inflammation stimuli including cytokines (eg, IL-6); inhibition of IL-6 by siltuximab may restore CYP450 enzymatic activity; caution if coadministered with CYP substrates that have a narrow therapeutic index.

              • norgestimate

                siltuximab, norgestimate. Other (see comment). Use Caution/Monitor. Comment: CYP450 activity in the liver is down regulated by infection and inflammation stimuli including cytokines (eg, IL-6); inhibition of IL-6 by siltuximab may restore CYP450 enzymatic activity; caution if coadministered with CYP substrates that have a narrow therapeutic index.

              • ocrelizumab

                siltuximab and ocrelizumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Coadministration of ocrelizumab with immunomodulators is expected to increase the risk of immunosuppression.

              • ofatumumab SC

                ofatumumab SC, siltuximab. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Consider the risk of additive immune system effects when coadministering immunosuppressive therapies with coadministration. When switching from therapies with immune effects, take into account the duration and mechanism of action of these therapies when initiating ofatumumab SC.

              • ozanimod

                ozanimod, siltuximab. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Coadministration with immunosuppressive therapies may increase the risk of additive immune effects during therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs in order to avoid unintended additive immunosuppressive effects.

              • ponesimod

                ponesimod and siltuximab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

              • quinidine

                siltuximab, quinidine. Other (see comment). Use Caution/Monitor. Comment: CYP450 activity in the liver is down regulated by infection and inflammation stimuli including cytokines (eg, IL-6); inhibition of IL-6 by siltuximab may restore CYP450 enzymatic activity; caution if coadministered with CYP substrates that have a narrow therapeutic index.

              • siponimod

                siponimod and siltuximab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

              • sirolimus

                siltuximab, sirolimus. Other (see comment). Use Caution/Monitor. Comment: CYP450 activity in the liver is down regulated by infection and inflammation stimuli including cytokines (eg, IL-6); inhibition of IL-6 by siltuximab may restore CYP450 enzymatic activity; caution if coadministered with CYP substrates that have a narrow therapeutic index.

              • tacrolimus

                siltuximab, tacrolimus. Other (see comment). Use Caution/Monitor. Comment: CYP450 activity in the liver is down regulated by infection and inflammation stimuli including cytokines (eg, IL-6); inhibition of IL-6 by siltuximab may restore CYP450 enzymatic activity; caution if coadministered with CYP substrates that have a narrow therapeutic index.

              • temsirolimus

                siltuximab, temsirolimus. Other (see comment). Use Caution/Monitor. Comment: CYP450 activity in the liver is down regulated by infection and inflammation stimuli including cytokines (eg, IL-6); inhibition of IL-6 by siltuximab may restore CYP450 enzymatic activity; caution if coadministered with CYP substrates that have a narrow therapeutic index.

              • theophylline

                siltuximab, theophylline. Other (see comment). Use Caution/Monitor. Comment: CYP450 activity in the liver is down regulated by infection and inflammation stimuli including cytokines (eg, IL-6); inhibition of IL-6 by siltuximab may restore CYP450 enzymatic activity; caution if coadministered with CYP substrates that have a narrow therapeutic index.

              • trastuzumab

                trastuzumab, siltuximab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • trastuzumab deruxtecan

                trastuzumab deruxtecan, siltuximab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              Minor (0)

                Previous
                Next:

                Adverse Effects

                >10%

                Pruritus (28%)

                Rash (28%)

                Edema (16-26%)

                Upper respiratory tract infection (26%)

                Increased weight (19%)

                Abdominal pain/distension (12%)

                Hyperuricemia (11%)

                1-10%

                Thrombocytopenia (9%)

                Lower respiratory tract infection (8%)

                Constipation (8%)

                Oropharyngeal pain (8%)

                Renal impairment (8%)

                Headache (8%)

                Hypertriglyceridemia (8%)

                Hypotension (4-6%)

                Hypercholesterolemia (4%)

                Skin hyperpigmentation (4%)

                Eczema (4%)

                Psoriasis (4%)

                Dry skin (4%)

                Decreased appetite (4%)

                Dehydration (4%)

                Postmarketing Reports

                Infections and infestations: Nasopharyngitis, urinary tract infection

                Blood and lymphatic system disorders: Neutropenia

                Nervous system disorders: Dizziness

                Vascular disorders: Hypertension

                Gastrointestinal disorders: Nausea, abdominal pain, vomiting, diarrhea, gastroesophageal reflux disease, mouth ulceration, gastrointestinal perforation

                Previous
                Next:

                Warnings

                Contraindications

                Severe hypersensitivity

                Cautions

                Do not administer to patients with severe infections until the infection resolves; may mask signs and symptoms of acute inflammation, including suppression of fever and of acute phase reactants such as C-reactive protein

                Monitor closely for infections; institute prompt, anti-infective therapy and do not administer further therapy with siltuximab until the infection resolves

                Do not administer live vaccines to patients or infants born to patients receiving drug because IL-6 inhibition may interfere with normal immune response to new antigens

                Stop infusion if signs of anaphylaxis occur; if mild-to-moderate reaction, may restart at lower infusion rate; consider premedicating with antihistamines, acetaminophen, and corticosteroids; discontinue if infusion not tolerated after these interventions

                Advise women to avoid pregnancy; women of childbearing potential should use contraception during and for 3 months after treatment

                Gastrointestinal perforation reported

                Previous
                Next:

                Pregnancy & Lactation

                Pregnancy

                There are no adequate or well-controlled studies in pregnant women; In animal reproduction studies, administration of a human antibody to IL-6 to pregnant cynomolgus monkeys caused decreases in globulin levels in pregnant animals and in the offspring; the drug crossed the placenta in monkeys; infants born to pregnant women receiving therapy, may be at increased risk of infection, and caution is advised in administration of live vaccines to these infants; therapy should be used during pregnancy only if potential benefit justifies potential risk to fetus; advise patients of childbearing potential to avoid pregnancy; women of childbearing potential should use contraception during and for 3 months after treatment

                Monoclonal antibodies are transported across placenta as pregnancy progresses, with largest amount transferred during third trimester; infants born to pregnant women treated, may be at increased risk of infection; consider risks and benefits of administering live or live-attenuated vaccines to infants exposed to drug in utero

                Lactation

                There are no data on the presence of siltuximab in human milk, the effects on the breastfed child, or the effects on milk production; low levels of human antibody to IL-6 was present in milk of lactating cynomolgus monkeys; when a drug is present in animal milk, it is likely that the drug will be present in human milk; because of potential for serious adverse reactions in breastfed child including gastrointestinal perforations, advise patients that breastfeeding is not recommended during treatment with drug, and for 3 months after last dose

                Pregnancy Categories

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

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

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

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

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

                NA: Information not available.

                Previous
                Next:

                Pharmacology

                Mechanism of Action

                Anti-interleukin-6 (IL-6) monoclonal antibody

                Binds human IL-6 and prevents the binding of IL-6 to both soluble and membrane-bound IL-6 receptors; overproduction of IL-6 has been linked to systemic manifestations of multicentric Castleman disease

                Absorption

                Peak plasma time: Occurs at end of IV infusion

                Peak plasma concentration: 332 mcg/mL

                Predose trough level: 84 mcg/mL

                Distribution

                Vd: 4.5 L (70 kg male)

                Elimination

                Half-life: 20.6 days

                Clearance: 0.23 L/day

                Previous
                Next:

                Administration

                IV Preparation

                Use aseptic technique

                Calculate the dose and total volume of reconstituted solution required and the number of vials needed

                Allow the vial(s) to come to room temperature over ~30 minutes

                Siltuximab should remain at room temperature for the duration of the preparation

                Reconstitute vials with sterile water for injection; 100-mg vial with 5.2 mL and 400-mg vial with 20 mL

                Reconstituted concentration is 20 mg/mL

                Gently swirl vials to aid dissolution of lyophilized powder; do NOT shake or swirl vigorously

                Do not withdraw contents until all solids are completely dissolved (should dissolve in <60 minutes)

                Within 2 hr of reconstitution, further dilute in D5W (PVC with DEHP, or polyolefin)

                Withdraw volume from 250-mL bag of D5W that is equal to total calculated volume of reconstituted siltuximab, then slowly add calculated volume of reconstituted siltuximab; gently invert to mix solution

                IV Administration

                Administer in a setting that has resuscitation equipment, medication, and personnel trained to provide resuscitation

                Administer IV over 1 hr using administration sets lined with PVC with DEHP or polyurethane containing a 0.2 micron inline polyethersulfone filter

                Complete infusion within 4 hr of dilution of the reconstituted solution to the infusion bag

                Do not infuse concomitantly in the same IV line with other agents

                Do not store any unused portion of the reconstituted product or of the infusion solution

                Storage

                Unopened vials

                • Refrigerate at 2-8ºC (36-46ºF)
                • Protect from light
                • Contains no preservatives
                Previous
                Next:

                Images

                No images available for this drug.
                Previous
                Next:

                Patient Handout

                Patient Education
                siltuximab intravenous

                SILTUXIMAB - INJECTION

                (sil-TUX-i-mab)

                COMMON BRAND NAME(S): Sylvant

                USES: Siltuximab is used to treat a certain rare illness (multicentric Castleman's disease - MCD) if you do not have HIV or herpes infections. Siltuximab blocks a certain natural substance that affects the immune system.Siltuximab can improve the symptoms of MCD including lumps under the skin, fever, weakness or tiredness, or night sweats.

                HOW TO USE: Read the Patient Information Leaflet if available from your pharmacist before you start using siltuximab and each time you get a refill. If you have any questions, ask your doctor or pharmacist.This medication is given by a health care professional. It is given slowly into a vein as directed by your doctor, usually over 1 hour every 3 weeks. The dosage is based on your weight, medical condition, and response to treatment.Siltuximab may cause side effects (such as trouble breathing, chest pain/discomfort, pounding heartbeat, wheezing, dizziness, back pain, flushing, nausea, vomiting, swelling of the lips, or rash) while it is being given. Your doctor may decide to temporarily stop or slow down the medication infusion if this happens during your treatment. Tell your healthcare professional right away if you have any of these symptoms. Your doctor may direct you to take other medications (such as antihistamines, drugs for fever, or corticosteroids such as prednisone) to treat your reaction and before your next treatment(s) to prevent these reactions from happening again. If the reaction is severe, your doctor may stop any further treatment with siltuximab.Use this medication regularly to get the most benefit from it. To help you remember, use it on the same day every 3 weeks.Tell your doctor if your condition gets worse.

                SIDE EFFECTS: Dry skin, darkening skin, diarrhea, headache, weight gain, fatigue, constipation, pain in the arms/legs, or joint pain may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.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 you have any serious side effects, including: easy bleeding/bruising, signs of infection (such as sore throat that doesn't go away, fever, chills), stomach/abdominal pain, signs of kidney problems (such as change in the amount of urine).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 siltuximab, 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: active infection, HIV infection, a certain herpes infection (human herpes virus-8), stomach/intestinal problems (such as ulcers).Siltuximab can make you more likely to get infections or may worsen any current infections. Avoid contact with people who have infections that may spread to others (such as chickenpox, measles, flu). Consult your doctor if you have been exposed to an infection or for more details.This product may cause live bacterial vaccines (such as typhoid vaccine) to not work well. Tell your health care professional that you are using this medication before having any immunizations/vaccinations.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Tell your doctor if you are pregnant or plan to become pregnant. Siltuximab may harm an unborn baby. Ask about reliable forms of birth control while using this medication and for 3 months after stopping treatment. If you become pregnant, talk to your doctor right away about the risks and benefits of this medication.It is unknown if this medication passes into breast milk. Because of the possible risk to the infant, breast-feeding is not recommended while using this drug and for 3 months after stopping treatment. 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.

                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.

                NOTES: Do not share this medication with others.Lab and/or medical tests (such as blood counts, platelet counts, uric acid, cholesterol, triglycerides) should be done while you are using this medication. Keep all medical and lab appointments. 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: Not applicable. This medication is given in a hospital or clinic and will not be stored at home.

                Information last revised October 2021. Copyright(c) 2022 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.

                Previous
                Next:

                Formulary

                FormularyPatient Discounts

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

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

                Adding plans allows you to:

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

                The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

                Tier Description
                1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
                2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
                3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
                4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                NC NOT COVERED – Drugs that are not covered by the plan.
                Code Definition
                PA Prior Authorization
                Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
                QL Quantity Limits
                Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
                ST Step Therapy
                Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
                OR Other Restrictions
                Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
                Additional Offers
                Email to Patient

                From:

                To:

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

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

                Email Forms to Patient

                From:

                To:

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

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

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