niacin (Rx, OTC)

Brand and Other Names:vitamin B3, Niacor, more...Niaspan, nicotinic acid
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 50mg
  • 100mg
  • 250mg
  • 500mg

tablet, extended-release

  • 250mg
  • 500mg
  • 750mg
  • 1000mg

capsule extended-release

  • 250mg
  • 500mg

Nutritional Supplementation

Recommended daily allowance (RDA)

Males: ≥19 years: 16 mg/day

Females: ≥19 years: 14 mg/day

Pregnant women: 18 mg/day

Breastfeeding: 17 mg/day

Dietary supplement (OTC)

50 mg PO q12hr or 100 mg PO qDay; many formulations exist

Hyperlipidemia

Immediate-release: 250 mg PO once daily; dose or frequency adjusted every 4-7 days on basis of effect and tolerance to first-level therapeutic dose of 1.5-2 g PO divided q6-8hr, then adjusted every 2-4 weeks; not to exceed 6 g/day

Extended-release: 500 mg/day PO at bedtime initially; dose adjusted every 4 weeks on basis of effect and tolerance to therapeutic dose of 1-2 g once daily; not to exceed 1-2 g/day

Indications

  • Reduce elevated TC, LDL-C, Apo B and TG levels, and to increase HDL-C in patients with primary hyperlipidemia and mixed dyslipidemia
  • Indicated to reduce the risk of recurrent nonfatal myocardial infarction in patients with history of MI and hyperlipidemia
  • Indicated in combination with a bile acid binding resin to slow progression or promote regression of atherosclerotic disease in patients with history of CAD and hyperlipidemia, and also to reduce elevated TC and LDL-C levels in adults with primary hyperlipidemia
  • Indicated as adjunctive therapy for treatment of adult patients with severe hypertriglyceridemia who present a risk of pancreatitis and who do not respond adequately to a determined dietary effort to control them
  • Extended release niacin did not reduce cardiovascular morbidity or mortality among patients treated with simvastatin in a large rantomized trial

Dosing Considerations

Limitations of use: Extended-release niacin did not reduce cardiovascular morbidity or mortality among patients treated with simvastatin in a large rantomized trial

Nonsteroidal anti-inflammatory drug (NSAID) will decrease flushing when administered 30-60 minutes before dosing

Monitor liver function tests (LFTs)

Indication for use with statins withdrawn by FDA

  • April 15, 2016: Based on several large cardiovascular outcome trials including AIM-HIGH, ACCORD, and HPS2-THRIVE, the FDA decided that "scientific evidence no longer supports the conclusion that a drug-induced reduction in triglyceride levels and/or increase in HDL-cholesterol levels in statin-treated patients results in a reduction in the risk of cardiovascular events"
  • Consistent with this conclusion, the FDA has determined that the benefits of niacin ER tablets for coadministration with statins no longer outweigh the risks, and the approval for this indication should be withdrawn

Overdose management

  • Symptoms of acute overdose include flushing, GI distress, and pruritus
  • Chronic overdose has been associated with hepatitis
  • Treatment is symptomatic

Pellagra (Off-label)

50-100 mg PO q6-8hr; not to exceed 500 mg/day

Dosage Forms & Strengths

tablet

  • 50mg
  • 100mg
  • 250mg
  • 500mg

tablet, extended-release

  • 250mg
  • 500mg
  • 750mg
  • 1000mg

capsule extended-release

  • 250mg
  • 500mg

Nutritional Supplementation

RDA

0-6 months: 2 mg/day

6-12 months: 3 mg/day

1-4 years: 6 mg/day

4-9 years: 8 mg/day

9-14 years: 12 mg/day

14-18 years: 16 mg/day (boys); 14 mg/day (girls)

Pellagra (Off-label)

50-100 mg PO q8hr

Monitor LFTs

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Interactions

Interaction Checker

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              Serious - Use Alternative (7)

              • atorvastatin

                niacin, atorvastatin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of rhabdomyolysis (>1 g/day niacin).

              • fluvastatin

                niacin, fluvastatin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of rhabdomyolysis (>1 g/day niacin).

              • lovastatin

                niacin, lovastatin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of rhabdomyolysis (>1 g/day niacin). Do not exceed 20 mg/day of lovastatin.

              • pitavastatin

                niacin, pitavastatin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of rhabdomyolysis (>1 g/day niacin).

              • pravastatin

                niacin, pravastatin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of rhabdomyolysis (>1 g/day niacin).

              • rosuvastatin

                niacin, rosuvastatin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of rhabdomyolysis (>1 g/day niacin).

              • simvastatin

                niacin, simvastatin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of rhabdomyolysis (>1 g/day niacin).

              Monitor Closely (22)

              • cholestyramine

                cholestyramine decreases levels of niacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • erythromycin base

                erythromycin base will decrease the level or effect of niacin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              • erythromycin ethylsuccinate

                erythromycin ethylsuccinate will decrease the level or effect of niacin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              • erythromycin lactobionate

                erythromycin lactobionate will decrease the level or effect of niacin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              • erythromycin stearate

                erythromycin stearate will decrease the level or effect of niacin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              • insulin aspart

                niacin decreases effects of insulin aspart by pharmacodynamic antagonism. Use Caution/Monitor. Concomitant use of insulin and niacin may require insulin dosage adjustment and increased glucose monitoring.

              • insulin aspart protamine/insulin aspart

                niacin decreases effects of insulin aspart protamine/insulin aspart by pharmacodynamic antagonism. Use Caution/Monitor. Concomitant use of insulin and niacin may require insulin dosage adjustment and increased glucose monitoring.

              • insulin degludec

                niacin decreases effects of insulin degludec by pharmacodynamic antagonism. Use Caution/Monitor. Concomitant use of insulin and niacin may require insulin dosage adjustment and increased glucose monitoring.

              • insulin degludec/insulin aspart

                niacin decreases effects of insulin degludec/insulin aspart by pharmacodynamic antagonism. Use Caution/Monitor. Niacin interferes with glucose metabolism and can result in hyperglycemia.

              • insulin detemir

                niacin decreases effects of insulin detemir by pharmacodynamic antagonism. Use Caution/Monitor. Concomitant use of insulin and niacin may require insulin dosage adjustment and increased glucose monitoring.

              • insulin glargine

                niacin decreases effects of insulin glargine by pharmacodynamic antagonism. Use Caution/Monitor. Concomitant use of insulin and niacin may require insulin dosage adjustment and increased glucose monitoring.

              • insulin glulisine

                niacin decreases effects of insulin glulisine by pharmacodynamic antagonism. Use Caution/Monitor. Concomitant use of insulin and niacin may require insulin dosage adjustment and increased glucose monitoring.

              • insulin inhaled

                niacin decreases effects of insulin inhaled by pharmacodynamic antagonism. Use Caution/Monitor. Concomitant use of insulin and niacin may require insulin dosage adjustment and increased glucose monitoring.

              • insulin isophane human/insulin regular human

                niacin decreases effects of insulin isophane human/insulin regular human by pharmacodynamic antagonism. Use Caution/Monitor. Concomitant use of insulin and niacin may require insulin dosage adjustment and increased glucose monitoring.

              • insulin lispro

                niacin decreases effects of insulin lispro by pharmacodynamic antagonism. Use Caution/Monitor. Concomitant use of insulin and niacin may require insulin dosage adjustment and increased glucose monitoring.

              • insulin lispro protamine/insulin lispro

                niacin decreases effects of insulin lispro protamine/insulin lispro by pharmacodynamic antagonism. Use Caution/Monitor. Concomitant use of insulin and niacin may require insulin dosage adjustment and increased glucose monitoring.

              • insulin NPH

                niacin decreases effects of insulin NPH by pharmacodynamic antagonism. Use Caution/Monitor. Concomitant use of insulin and niacin may require insulin dosage adjustment and increased glucose monitoring.

              • insulin regular human

                niacin decreases effects of insulin regular human by pharmacodynamic antagonism. Use Caution/Monitor. Concomitant use of insulin and niacin may require insulin dosage adjustment and increased glucose monitoring.

              • metformin

                niacin decreases effects of metformin by pharmacodynamic antagonism. Use Caution/Monitor. Patient should be closely observed for loss of blood glucose control; when drugs are withdrawn from a patient receiving metformin, patient should be observed closely for hypoglycemia.

              • mipomersen

                mipomersen, niacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.

              • omadacycline

                niacin will decrease the level or effect of omadacycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

              • roxithromycin

                roxithromycin will decrease the level or effect of niacin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              Minor (18)

              • carbamazepine

                niacin increases levels of carbamazepine by decreasing renal clearance. Minor/Significance Unknown.

              • cefamandole

                cefamandole will decrease the level or effect of niacin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • cefpirome

                cefpirome will decrease the level or effect of niacin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • colestipol

                colestipol decreases levels of niacin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • demeclocycline

                demeclocycline will decrease the level or effect of niacin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • doxycycline

                doxycycline will decrease the level or effect of niacin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • isoniazid

                isoniazid decreases levels of niacin by pharmacodynamic antagonism. Minor/Significance Unknown.

              • mecamylamine

                niacin, mecamylamine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypotension.

              • meropenem/vaborbactam

                meropenem/vaborbactam will decrease the level or effect of niacin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • minocycline

                minocycline will decrease the level or effect of niacin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • nicotine inhaled

                nicotine inhaled increases effects of niacin by pharmacodynamic synergism. Minor/Significance Unknown.

              • nicotine intranasal

                nicotine intranasal increases effects of niacin by pharmacodynamic synergism. Minor/Significance Unknown.

              • oxytetracycline

                oxytetracycline will decrease the level or effect of niacin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • pivmecillinam

                pivmecillinam will decrease the level or effect of niacin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • sulfisoxazole

                sulfisoxazole will decrease the level or effect of niacin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • teicoplanin

                teicoplanin will decrease the level or effect of niacin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • temocillin

                temocillin will decrease the level or effect of niacin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • tetracycline

                tetracycline will decrease the level or effect of niacin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

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              Adverse Effects

              Frequency Not Defined

              Reversible increase in serum aminotransferase

              Flushing (lower incidence with extended-release products)

              Pruritus, rash

              Diarrhea

              Headache

              Arrhythmias

              Hepatic necrosis, hepatotoxicity (higher incidence with extended-release products)

              Postural hypotension

              Rhabdomyolysis

              Abdominal pain

              Dyspepsia

              Nausea

              Vomiting

              Postmarketing Reports

              Burning sensation of skin

              Depression

              Dermatomyositis

              Peripheral nerve palsy

              Progression of cataracts

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              Warnings

              Contraindications

              Hypersensitivity

              Hepatic disease, active peptic ulcer, severe hypotension, arterial bleeding

              Persistent, unexplained elevation of serum aminotransferase

              Cautions

              Flushing or pruritus may occur

              Hepatotoxicity reported

              Use with caution in patients with history of liver disease, gout or gouty diathesis, diabetes mellitus, gallbladder disease, cardiovascular disease, or renal or hepatic impairment

              Use with caution if patients are taking anticoagulants or HMG-CoA reductase inhibitors or if symptoms of myopathy occur (monitor creatine phosphokinase)

              Immediate release and extended release dosage forms are not interchangeable

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              Pregnancy & Lactation

              Pregnancy

              Discontinue therapy when pregnancy is recognized in patients receiving drug for treatment of hyperlipidemia; assess individual risks and benefits of continuing therapy during pregnancy in patients receiving drug for treatment of hypertriglyceridemia; advise patients to inform their healthcare provider of a known or suspected pregnancy

              Potential for embryofetal toxicity with doses of niacin in is unknown; available data on drug use in pregnant women are insufficient to evaluate for drug- associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes

              Treatment of hypercholesterolemia is not generally necessary during pregnancy; atherosclerosis is a chronic process and the discontinuation of lipid-lowering drugs during pregnancy should have little impact on outcome of long-term therapy of primary hypercholesterolemia for most patients

              Animal data

              Animal reproduction studies not conducted

              Lactation

              Drug is present in human milk and amount of drug increases with maternal supplementation; there is no information on effects of doses on breastfed infant or effects on milk production; because of potential for serious adverse reactions in breastfeeding infants, including hepatotoxicity, advise patients not to breastfeed during treatment

              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

              Component of two coenzymes necessary for lipid metabolism, tissue respiration, glycogenolysis, inhibition of very low-density lipoprotein (VLDL) synthesis

              May increaase chylomicron triglyceride removal from plasma

              Absorption

              Rapidly absorbed (60-76%)

              Peak plasma time: Immediate release, 30-60 min; extended release, 4-5 hr

              Metabolism

              Metabolized in liver

              Pharmacokinetics

              Half-life: 20-45 min

              Excretion: Urine (60-88% as unchanged drug)

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Niacor oral
              -
              500 mg tablet
              niacin oral
              -
              500 mg tablet
              niacin oral
              -
              1,000 mg tablet
              niacin oral
              -
              750 mg tablet
              niacin oral
              -
              500 mg tablet
              niacin oral
              -
              500 mg tablet
              niacin oral
              -
              1,000 mg tablet
              niacin oral
              -
              500 mg tablet
              niacin oral
              -
              250 mg capsule
              niacin oral
              -
              250 mg capsule
              niacin oral
              -
              500 mg tablet
              niacin oral
              -
              250 mg capsule
              niacin oral
              -
              750 mg tablet
              niacin oral
              -
              500 mg tablet
              niacin oral
              -
              500 mg tablet
              niacin oral
              -
              500 mg tablet
              niacin oral
              -
              1,000 mg tablet
              niacin oral
              -
              1,000 mg tablet
              niacin oral
              -
              1,000 mg tablet
              niacin oral
              -
              500 mg tablet
              niacin oral
              -
              250 mg tablet
              niacin oral
              -
              250 mg tablet
              niacin oral
              -
              500 mg capsule
              niacin oral
              -
              100 mg tablet
              niacin oral
              -
              750 mg tablet
              niacin oral
              -
              1,000 mg tablet
              niacin oral
              -
              500 mg tablet
              niacin oral
              -
              500 mg tablet
              niacin oral
              -
              750 mg tablet
              niacin oral
              -
              500 mg tablet
              Niaspan oral
              -
              500 mg tablet
              Niaspan oral
              -
              1,000 mg tablet
              Niaspan oral
              -
              750 mg tablet

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              niacin oral

              NIACIN (CHOLESTEROL-LOWERING) - ORAL

              (NYE-a-sin)

              COMMON BRAND NAME(S): Niacor

              USES: Niacin is used with a proper diet and exercise program to help lower "bad" cholesterol and fats (LDL, triglycerides) and raise "good" cholesterol (HDL) in the blood. It is generally used after non-drug treatments have not been fully successful at lowering cholesterol. Niacin is also known as vitamin B-3 (nicotinic acid), one of the B-complex vitamins. It may be used with or without other medications. Lowering "bad" cholesterol/triglycerides and raising "good" cholesterol helps prevent strokes and heart attacks. Lowering fats may also help reduce the risk of pancreas problems (pancreatitis) in people at risk.In addition to eating a proper diet (such as a low-cholesterol/low-fat diet), other lifestyle changes that may help this medication work better include exercising, losing weight if overweight, and stopping smoking. Consult your doctor for more details.

              HOW TO USE: Take this medication by mouth with food as directed by your doctor, usually 1-3 times daily. If you take this medicine once daily, take it with your evening meal. Taking niacin on an empty stomach increases side effects (such as flushing, upset stomach).Niacin is available in different formulations (such as immediate and sustained release). Do not switch between strengths, brands, or forms of niacin. Severe liver problems may occur.The dosage is based on your medical condition and response to treatment. Generally, your doctor will start you at a low dose and gradually increase your dose in order to minimize side effects. Your dose will need to be increased slowly, even if you are already taking niacin and are being switched from another niacin product (such as extended-release) to this product. Follow your doctor's instructions carefully.If you also take certain other drugs to lower your cholesterol (bile acid-binding resins such as cholestyramine or colestipol), take niacin at least 4-6 hours before or after taking these medications. These products can react with niacin, preventing its full absorption. Continue to take other medications to lower your cholesterol as directed by your doctor.To lessen the chance of side effects such as flushing, avoid alcohol, hot beverages, and eating spicy foods near the time you take niacin. Taking a plain (non-enteric coated, 325 milligram) aspirin or a nonsteroidal anti-inflammatory drug (such as ibuprofen, 200 milligrams) 30 minutes before taking niacin may help prevent flushing. Ask your doctor if this treatment is right for you.Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day. Keep taking this medication even if you feel well. Most people with high cholesterol do not feel sick.Do not stop taking this medicine unless instructed by your doctor. If you stop taking niacin, you may need to return to your original dose and gradually increase it again. Ask your doctor or pharmacist for instructions on restarting your dose if you have not taken your medication for several days.It is very important to continue to follow your doctor's advice about diet and exercise.

              SIDE EFFECTS: Flushing of the face and neck along with warmth, headache, itching, burning, sweating, chills, or tingling may occur within 20 minutes of taking this medication. Flushing may persist for a few hours after use. These effects should improve or go away as your body adjusts to the medication. Dizziness, stomach upset, heartburn, nausea, vomiting, and diarrhea may also occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position. This is very important if you are also taking medication to lower your blood pressure.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: severe dizziness/fainting, fast/irregular heartbeat, severe headache (migraine), unusual joint pain, swelling of legs/arms, vision problems, severe stomach/abdominal pain, black stools, easy bruising/bleeding, unexplained muscle pain/tenderness/weakness, persistent nausea/vomiting, signs of kidney problems (such as change in the amount of urine), dark urine, vomit that looks like coffee grounds, 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 taking niacin, 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: very low blood pressure, alcohol use, bleeding problems (such as low platelets), diabetes, gallbladder disease, glaucoma, gout, heart disease (such as recent heart attack, unstable angina), kidney disease, liver disease/increase in liver enzymes, untreated mineral imbalance (low phosphate levels), history of stomach/intestinal ulcers, underactive thyroid (hypothyroidism).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).This medication may rarely make your blood sugar rise, which can cause or worsen diabetes. If you already have diabetes, check your blood sugar regularly as directed and share the results with your doctor. Tell your doctor right away if you have symptoms of high blood sugar such as increased thirst/urination. Your doctor may need to adjust your diabetes medication, exercise program, or diet.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This medication passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: See also How to Use section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: "blood thinners" (such as acenocoumarol, warfarin).Check all prescription and nonprescription medicine labels carefully since vitamins/dietary supplements may also contain niacin or niacinamide (nicotinamide). These may increase your risk of side effects if taken together. Ask your doctor or pharmacist for more details.This medication may interfere with certain laboratory tests (including urine or blood catecholamines, copper-based urine glucose tests), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: Do not share this medication with others.Laboratory tests (such as blood lipids, blood sugar, liver function tests) should be performed periodically to monitor your progress or check for side effects. 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 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.

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              Formulary

              FormularyPatient Discounts

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              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic 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.