cidofovir (Rx)

Brand and Other Names:Vistide
  • Print

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 75mg/mL

Cytomegalovirus Retinitis

Induction treatment: 5 mg/kg IV over 1 hour, once/week x2 weeks  

Maintenance treatment: 5 mg/kg IV q2Weeks

Serum creatinine (SCr) increase 0.3-0.4 mg/dL above baseline: Reduce to 3 mg/kg IV

SCr increase >0.4 mg/dL above baseline: Discontinue therapy

Monitor: SCr, urine protein, WBC with differential prior to each dose, IOP, visual acuity

Concomitant Therapy

Must administer probenecid orally with each dose of cidofovir

Probenecid dose: Must administer 2 g of probenecid 3 hours prior to each cidofovir dose and 1 g at 2 hours and again at 8 hours after completion of 1 hour cidofovir infusion (for a total of 4 g); ingestion of food prior to each dose of probenecid may reduce drug-related nausea and vomiting

Hydration: Must receive at least 1 L of 0.9% (normal) saline solution IV prior to each infusion of cidofovir; should administer over 1-2 hours; may administer a second liter over 1-3 hours at start of cidofovir infusion or immediately following infusion if tolerated

<18 years old: Safety & efficacy not established

Next:

Interactions

Interaction Checker

and cidofovir

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 

            Contraindicated (8)

            • amikacin

              amikacin and cidofovir both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            • amphotericin B deoxycholate

              amphotericin B deoxycholate and cidofovir both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            • contrast media (iodinated)

              cidofovir and contrast media (iodinated) both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            • cyclosporine

              cidofovir and cyclosporine both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            • ioversol

              cidofovir and ioversol both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            • neomycin PO

              cidofovir and neomycin PO both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            • tacrolimus

              cidofovir and tacrolimus both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            • teicoplanin

              cidofovir and teicoplanin both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            Serious - Use Alternative (14)

            • acyclovir

              acyclovir and cidofovir both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • bacitracin

              cidofovir and bacitracin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. Avoid concurrent use of bacitracin with other nephrotoxic drugs

            • capreomycin

              capreomycin and cidofovir both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • carboplatin

              carboplatin and cidofovir both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. Concomitant use of cidofovir and agents with nephrotoxic potential is contraindicated. Such agents must be discontinued at least 7 days prior to starting therapy with cidofovir.

            • cephaloridine

              cephaloridine and cidofovir both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • cisplatin

              cidofovir and cisplatin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. Concomitant use of cidofovir and agents with nephrotoxic potential is contraindicated. Such agents must be discontinued at least 7 days prior to starting therapy with cidofovir.

            • colistin

              cidofovir and colistin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • deferiprone

              deferiprone, cidofovir. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.

            • gentamicin

              cidofovir and gentamicin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • oxaliplatin

              cidofovir and oxaliplatin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. Concomitant use of cidofovir and agents with nephrotoxic potential is contraindicated. Such agents must be discontinued at least 7 days prior to starting therapy with cidofovir.

            • polymyxin B

              cidofovir and polymyxin B both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • streptozocin

              cidofovir and streptozocin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. Concomitant use of cidofovir and agents with nephrotoxic potential is contraindicated. Such agents must be discontinued at least 7 days prior to starting therapy with cidofovir.

            • tobramycin

              cidofovir and tobramycin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • zidovudine

              cidofovir, zidovudine. Either increases levels of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: When cidofovir is administered concurrently with probenecid, zidovudine clearance may be decreased. Reduce dose of zidovudine by 50% on days of cidofovir/probenecid administration. .

            Monitor Closely (21)

            • acalabrutinib

              acalabrutinib, cidofovir. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may increase risk of myelosuppressive effects.

            • adefovir

              adefovir and cidofovir both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • cabozantinib

              cidofovir will increase the level or effect of cabozantinib by Other (see comment). Use Caution/Monitor. MRP2 inhibitors increase cabozantinib toxicity

            • dichlorphenamide

              dichlorphenamide and cidofovir both decrease serum potassium. Use Caution/Monitor.

              dichlorphenamide, cidofovir. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis.

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              cidofovir, elvitegravir/cobicistat/emtricitabine/tenofovir DF. Either increases toxicity of the other by decreasing renal clearance. Use Caution/Monitor. Toxicity may result from coadministration of emtricitabine and tenofovir with other drugs that are also primarily excreted by glomerular filtration and/or active tubular secretion .

              cidofovir and elvitegravir/cobicistat/emtricitabine/tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • emtricitabine

              cidofovir increases levels of emtricitabine by Other (see comment). Use Caution/Monitor. Comment: Coadministration of emtricitabine with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of emtricitabine.

            • foscarnet

              cidofovir and foscarnet both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • hydroxyurea

              cidofovir, hydroxyurea. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of myelosuppression.

            • ifosfamide

              ifosfamide, cidofovir. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Ifosfamide may enhance renal toxicity. .

            • lomustine

              lomustine, cidofovir. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Lomustine may enhance the toxicities of myelosuppressive agents. Monitor for increased risk of myelosuppression.

            • methotrexate

              cidofovir and methotrexate both decrease immunosuppressive effects; risk of infection. Use Caution/Monitor. May increase myelosupression.

            • methoxyflurane

              cidofovir and methoxyflurane both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • paromomycin

              cidofovir and paromomycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • pentamidine

              cidofovir and pentamidine both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • peramivir

              cidofovir increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

            • streptomycin

              cidofovir and streptomycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • tenofovir DF

              cidofovir and tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              cidofovir increases levels of tenofovir DF by Other (see comment). Use Caution/Monitor. Comment: Coadministration of tenofovir with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of tenofovir.

            • tobramycin inhaled

              tobramycin inhaled and cidofovir both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Avoid concurrent or sequential use to decrease risk for ototoxicity

            • vancomycin

              cidofovir and vancomycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • voclosporin

              voclosporin, cidofovir. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • zidovudine

              cidofovir, zidovudine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of myelosuppression.

            Minor (1)

            • entecavir

              cidofovir, entecavir. Either increases levels of the other by decreasing renal clearance. Minor/Significance Unknown. Coadministration with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of either entecavir or the coadministered drug.

            Previous
            Next:

            Adverse Effects

            >10%

            Infection

            Chills

            Fever

            Headache

            Amnesia

            Anxiety

            Confusion

            Seizures

            Insomnia

            Weakness

            Paresthesia

            Alopecia

            Rash

            Acne

            Skin discoloration

            Nausea

            Vomiting

            Diarrhea

            Anorexia

            Abdominal pain

            Constipation

            Dyspepsia

            Gastritis

            Thrombocytopenia

            Neutropenia

            Anemia

            Amblyopia

            Conjunctivitis

            Ocular hypotony

            Tubular damage

            Proteinuria

            Elevated creatinine

            1-10%

            Hypotension

            Diaphoresis

            Pallor

            Syncope

            Tachycardia

            Dizziness

            Hallucinations

            Depression

            Somnolence

            Malaise

            Pruritus

            Urticaria

            Hyperglycemia

            Hyperlipidemia

            Hypocalcemia

            Hypokalemia

            Dehydration

            Abnormal taste

            Stomatitis

            Glycosuria

            Hematuria

            Urinary incontinence

            Urinary tract infections

            Skeletal pain

            Retinal detachment

            Iritis

            Uveitis

            Abnormal vision

            Pneumonia

            Rhinitis

            Sinusitis

            Allergic reactions

            Previous
            Next:

            Warnings

            Black Box Warnings

            Renal impairment is the major toxicity, and acute renal failure resulting in dialysis or contributing to death have occurred with as few as 1 or 2 doses

            Reduce nephrotoxicity risk by IV prehydration with normal saline, and administration of probenecid must be used with each infusion

            Renal function (serum creatinine and urine protein) must be monitored within 48 hr prior to each dose, and, if necessary, modify dose in renal function as appropriate

            Contraindicated if taking other nephrotoxic agents

            Neutropenia observed; monitor neutrophil counts

            Indicated only for the treatment of cytomegalovirus (CMV) retinitis in patients with acquired immunodeficiency syndrome (AIDS)

            Animal studies showed cidofovir was carcinogenic, teratogenic, and caused hypospermia

            Contraindications

            Hypersensitivity to cidofovir or probenecid

            SCr >1.5 mg/dL, CrCl <55 mL/min, urine protein >100 mg/dL (2+ proteinuria)

            Direct intraocular injection

            Concomitant nephrotoxic drugs

            Cautions

            Risk of nephrotoxicity (dose-limiting)

            Risk of neutropenia

            Probenecid must be administered w/each dose: 2 g PO 3 hr before cidofovir, 1 g at 2 hr & 8 hr after completion of cidofovir infusion

            1 L saline IV with each cidofovir infusion; 1 add'l liter if pt can tolerate

            Previous
            Next:

            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: It is not known whether cidofovir is excreted in milk. It should not be administered to nursing mothers. The CDC advises HIV-infected women not to breast-feed to avoid postnatal transmission of HIV.

            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

            Distribution: Vd: 0.54 L/kg; does not cross significantly into CSF

            Protein Bound: <6%

            Half-life elimination: 2.6 hr

            Metabolism: minimal; phosphorylation occurs intracellularly

            Excretion: urine

            Mechanism of Action

            Inhibits viral DNA synthesis in CMV

            Previous
            Next:

            Administration

            IV Preparation

            Administer within 24 hr of dilution; refrigerate if not used immediately but still use within 24 hr

            Admixtures should be allowed to equilibrate to room temp prior to use

            IV Administration

            For IV infusion only

            Infuse in 100 mL NS over 1 hr

            Prehydrate with 1 L of NS IV over 1-2 hr prior to cidofovir infusion; a second liter may be administered over a 1-3 hr period immediately following infusion, if tolerated

            Storage

            Store at controlled room temp

            Store admixtures under refrigeration

            Previous
            Next:

            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            cidofovir intravenous
            -
            75 mg/mL vial
            cidofovir intravenous
            -
            75 mg/mL vial

            Copyright © 2010 First DataBank, Inc.

            Previous
            Next:

            Patient Handout

            Patient Education
            cidofovir intravenous

            CIDOFOVIR - INJECTION

            (sye-DOH-foh-veer)

            COMMON BRAND NAME(S): Vistide

            WARNING: This medication may cause serious (possibly fatal) kidney problems. To prevent kidney problems, your doctor will usually prescribe another medication (probenecid) and direct you to receive fluids into a vein. Avoid other medications that may also damage your kidneys (see also Drug Interactions section). Tell your doctor right away if you have any signs of kidney problems, such as change in the amount of urine, frothy urine, or bloody/pink urine.This medication can lower the body's ability to fight an infection. Tell your doctor promptly if you develop any signs of an infection such as fever, chills, or persistent sore throat.Laboratory and/or medical tests (e.g., kidney function tests, complete blood counts) should be performed before each dose to check for these side effects. Consult your doctor for more details. Keep all medical and laboratory appointments.Cidofovir has caused tumors in laboratory animals. Although there is no information in humans, cidofovir should be considered cancer-causing (carcinogenic). See also How to Use section.

            USES: This drug is used with probenecid to treat a certain viral eye infection (retinitis due to cytomegalovirus-CMV) in people with AIDS. It lowers your risk of blindness and other vision problems. Cidofovir belongs to a class of drugs known as antivirals. It works by stopping the growth of the virus.Cidofovir is not a cure for CMV retinitis, and your disease may still worsen during and after treatment.

            HOW TO USE: This medication is given into a vein as directed by your doctor, usually over 1 hour. It is usually given every 1 to 2 weeks or as directed by your doctor. This medication should not be injected into the eyes. Permanent loss of vision may occur.Dosage is based on your medical condition, body weight, and response to treatment. You will usually receive IV fluids before your dose of cidofovir. Your doctor will also direct you to take probenecid by mouth before and after you receive cidofovir. To prevent kidney problems, drink plenty of fluids unless otherwise directed by your doctor. This is especially important if you are vomiting or having diarrhea.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.It is very important to use the probenecid with this medication exactly as prescribed by your doctor. Nausea and vomiting due to probenecid may be prevented by taking it after meals. Your doctor may also prescribe another medication to prevent nausea, and may direct you to take antihistamines (e.g., diphenhydramine) and/or acetaminophen to prevent allergic reactions to probenecid.This medication works best when it is used regularly. Keep all your medical appointments. You may want to mark a calendar to help you remember.Do not use more or less of this drug than prescribed or stop using it (or your HIV medicines) even for a short time unless directed to do so by your doctor. Doing so may cause the amount of virus to increase, make the infection more difficult to treat (resistant), or worsen side effects.Avoid direct contact of this medicine with the skin/eyes/mouth. If contact occurs, wash thoroughly with soap and water. For eyes, rinse with a steady stream of tap water for at least 5 minutes.

            SIDE EFFECTS: See also Warning section.Nausea may occur. Headache, nausea, and vomiting may occur with probenecid use. If any of these effects persist or worsen, 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: dark urine, swelling, loss of appetite, unusual tiredness/sluggishness, stomach/abdominal pain, muscle loss, signs of infection (e.g., fever, persistent sore throat/cough), vision changes, new/increased eye redness or irritation, new/increased eye pain, mental/mood changes (e.g., confusion), persistent nausea/vomiting, yellowing eyes/skin.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 cidofovir, tell your doctor or pharmacist if you are allergic to it; or to other antivirals (e.g., ganciclovir); or to probenecid; or to other sulfa drugs (e.g., sulfamethoxazole); 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: diabetes, ganciclovir eye implant, kidney disease.This drug may cause vision changes. Do not drive, use machinery, or do any activity that requires clear vision until you are sure you can perform such activities safely. Limit alcoholic beverages.Older adults may be at a greater risk for kidney damage while using this drug.During pregnancy, cidofovir should be used only when clearly needed. It may harm an unborn baby. Discuss the risks and benefits with your doctor. The manufacturer recommends avoiding pregnancy. To prevent pregnancy, men with female partners should use effective barrier protections (such as latex or polyurethane condoms) during all sexual activity during treatment and for at least 90 days after stopping the medication. Women should use effective forms of birth control (such as birth control pills and condoms) during treatment and for at least 1 month after stopping the medication.It is not known if this medication passes into breast milk. Because of the possible risks to the infant and because breast milk can transmit HIV, do not breast-feed.

            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: acyclovir, ACE inhibitors (e.g., captopril, lisinopril), aminosalicylic acid, barbiturates (e.g., phenobarbital), benzodiazepines (e.g., triazolam), bumetanide, clofibrate, methotrexate, furosemide, nonsteroidal anti-inflammatory drugs-NSAIDs (e.g., ibuprofen), zidovudine.If you are taking probenecid and any of the medications listed above, ask your doctor if you should temporarily stop the other medication or decrease its dosage because probenecid may affect how well those medications are removed from your body. This is very important for zidovudine.Tell your doctor if you have had previous use of foscarnet.Avoid taking other medications that may damage your kidneys (e.g., amphotericin B, foscarnet, pentamidine, vancomycin, aminoglycosides including tobramycin, nonsteroidal anti-inflammatory drugs-NSAIDs including ibuprofen) within 7 days before and during treatment with this medication. In some cases, serious (possibly fatal) kidney damage may occur. See also Warning section.Check the labels on all your medicines because they may contain NSAIDs (e.g., ibuprofen, naproxen). Ask your pharmacist about using those products safely.

            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: change in the amount of urine.

            NOTES: Laboratory and/or medical tests (e.g., eye exams) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.To decrease your risk of spreading HIV disease to others, use an effective barrier method (e.g., latex or polyurethane condoms/dental dams) during sexual activity. Consult your doctor or pharmacist for more details.

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

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

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

            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.