pyridoxine (Rx, OTC)

Brand and Other Names:vitamin B6, Nestrex
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablets

  • 25mg
  • 50mg
  • 100mg
  • 250mg
  • 500mg

tablets, extended release

  • 200mg

capsule

  • 250mg

RDA

Males

  • <50 years old: 1.3 mg/day
  • >50 years old: 1.7 mg/day

Females

  • <50 years old: 1.3 mg/day
  • >50 years old: 1.5 mg/day
  • Pregnant: 1.9 mg/day
  • Lactation: 2mg

Pyridoxine Deficiency

10-20 mg/day IV/IM for 3 weeks

2.5-10 mg/day PO

Nausea in Pregnancy

10-25 mg PO q8hr

Prevention of Peripheral Neuropathy

Patients treated with isoniazid for Mycobacterium tuberculosis: 25-50 mg/day PO

Seizures (Orphan)

Treatment of pyridoxine dependent seizures

Orphan indication sponsor

  • NBI Pharmaceuticals, Inc; 1087 Stoneridge Drive; Bozeman, MT 59718

Dosage Forms & Strengths

tablets

  • 25mg
  • 50mg
  • 100mg
  • 200mg
  • 250mg
  • 500mg

tablets, extended release

  • 200mg

capsule

  • 250mg

RDA

<6 months: 0.1 mg/day

6-12 months: 0.3 mg/day

1-3 years: 0.5 mg/day

3-8 years: 0.6 mg/day

8-13 years: 1 mg/day

13-18 years: 1.3 mg/day (male); 1.5 mg/day (female)

Isoniazid-Induced Seizures/Coma

Dose of pyridoxine is equal to amount of isoniazid ingested

Administer at rate of 0.5-1 g/min until seizures stop or maximum initial dose (70 mg/kg) administered; may administer q5-10min PRN to control persistent seizure activity and/or CNS toxicity

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Interactions

Interaction Checker

and pyridoxine

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      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (0)

              Serious - Use Alternative (1)

              • selinexor

                selinexor, pyridoxine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              Monitor Closely (11)

              • azithromycin

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

              • cisplatin

                pyridoxine decreases effects of cisplatin by unknown mechanism. Use Caution/Monitor. Use of pyridoxine, vitamin B6 with cisplatin and altretamine (hexamethylmelamine) may not be advisable.

              • clarithromycin

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

              • dichlorphenamide

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

              • erythromycin base

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

              • levodopa

                pyridoxine decreases levels of levodopa by increasing metabolism. Use Caution/Monitor.

              • omadacycline

                pyridoxine 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 pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              Minor (62)

              • amikacin

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

              • amiodarone

                pyridoxine increases toxicity of amiodarone by unspecified interaction mechanism. Minor/Significance Unknown. Increased risk of photosensitivity.

              • aztreonam

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

              • bazedoxifene/conjugated estrogens

                bazedoxifene/conjugated estrogens decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

              • cefadroxil

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

              • cefamandole

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

              • cefotetan

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

              • cefpirome

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

              • ceftibuten

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

              • cephalexin

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

              • chlorhexidine oral

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

              • ciprofloxacin

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

              • clindamycin

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

              • conjugated estrogens

                conjugated estrogens decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

              • conjugated estrogens, vaginal

                conjugated estrogens, vaginal decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

              • dapsone

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

              • demeclocycline

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

              • doxycycline

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

              • ertapenem

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

              • estradiol

                estradiol decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

              • estrogens conjugated synthetic

                estrogens conjugated synthetic decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

              • estrogens esterified

                estrogens esterified decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

              • estropipate

                estropipate decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

              • ethotoin

                pyridoxine decreases levels of ethotoin by increasing metabolism. Minor/Significance Unknown. High dose of pyridoxine (vitamin B6), >=200 mg/day.

              • fleroxacin

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

              • fosfomycin

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

              • fosphenytoin

                pyridoxine decreases levels of fosphenytoin by increasing metabolism. Minor/Significance Unknown. High dose of pyridoxine (vitamin B6), >=200 mg/day.

              • gemifloxacin

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

              • gentamicin

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

              • hydralazine

                hydralazine decreases levels of pyridoxine by unspecified interaction mechanism. Minor/Significance Unknown.

              • isoniazid

                isoniazid decreases levels of pyridoxine by unspecified interaction mechanism. Minor/Significance Unknown. If INH dose >10 mg/kg/day, supplement 50 100mg pyridoxine/day.

              • levofloxacin

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

              • linezolid

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

              • meropenem

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

              • meropenem/vaborbactam

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

              • mestranol

                mestranol decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

              • metronidazole

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

              • minocycline

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

              • moxifloxacin

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

              • neomycin PO

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

              • nitrofurantoin

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

              • ofloxacin

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

              • oxytetracycline

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

              • paromomycin

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

              • penicillamine

                penicillamine decreases levels of pyridoxine by unspecified interaction mechanism. Minor/Significance Unknown.

              • phenobarbital

                pyridoxine decreases levels of phenobarbital by increasing metabolism. Minor/Significance Unknown.

              • phenytoin

                pyridoxine decreases levels of phenytoin by increasing metabolism. Minor/Significance Unknown. High dose of pyridoxine (vitamin B6), >=200 mg/day.

              • pivmecillinam

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

              • quinupristin/dalfopristin

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

              • streptomycin

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

              • sulfadiazine

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

              • sulfamethoxazole

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

              • sulfisoxazole

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

              • teicoplanin

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

              • temocillin

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

              • tetracycline

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

              • theophylline

                theophylline decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

              • ticarcillin

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

              • tigecycline

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

              • tobramycin

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

              • trimethoprim

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

              • vancomycin

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

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              Adverse Effects

              Frequency Not Defined

              Headache

              Seizure (from very large IV dose)

              Somnolence

              Decreased folic acid

              Acidosis

              Increased hepatic AST

              Nausea

              Paresthesia

              Neuropathy

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              Warnings

              Contraindications

              Hypersensitivity

              Cautions

              Long-term large doses associated with induced neuropathy

              Use caution in patients with impaired renal function and neonates (some parental products contain aluminum)

              May cause dependence/withdrawal

              Pyridoxine deficiency rare (enaluate for other deficiencies)

              Dependence and withdrawal associated with >200 mg/day

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              Pregnancy & Lactation

              Pregnancy Category: A/C-when exceeding RDA recommendations

              Lactation: Safe

              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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              Nutrition

              Sources: Beef liver, pork, baked potato, spinach, banana, cereals, milk, fish, avocado

              Function: Cofactor in enzymatic reactions

              Deficiency: Inflammation of mouth, lips, tongue; anxiety, depression, confusion; anemia; rarely seizures

              Deficiency may be caused by some medications (isoniazid, alcohol, penicillamine, theophylline)

              Reduced by: Estrogens, stewing/boiling

              Toxicity: >200 mg/day can lead to nerve damage & photosensitivity

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              Pharmacology

              Mechanism of Action

              Precursor of pyridoxal; plays a role in metabolism of proteins, carbohydrates, and fats; aids in the sythesis of GABA

              Aids in release of liver and muscle stored glycogen

              Pharmacokinetics

              Absorption (parenteral/enteral): Well absorbed

              Half-life: 15-20 days

              Excretion: Urine

              Metabolism: Liver to pyridoxal phosphate and pyridoxamine phosphate (active forms)

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              pyridoxine (vitamin B6) oral
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              pyridoxine (vitamin B6) injection
              -
              100 mg/mL vial

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

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              Patient Education
              pyridoxine (vitamin B6) oral

              PYRIDOXINE - ORAL

              (PIR-i-DOX-een)

              COMMON BRAND NAME(S): Neuro-K, Vitamin B-6

              USES: Pyridoxine (vitamin B6) is used to prevent or treat low levels of vitamin B6 in people who do not get enough of the vitamin from their diets. Most people who eat a normal diet do not need extra vitamin B6. However, some conditions (such as alcoholism, liver disease, overactive thyroid, heart failure) or medications (such as isoniazid, cycloserine, hydralazine, penicillamine) can cause low levels of vitamin B6. Vitamin B6 plays an important role in the body. It is needed to maintain the health of nerves, skin, and red blood cells.Pyridoxine has been used to prevent or treat a certain nerve disorder (peripheral neuropathy) caused by certain medications (such as isoniazid). It has also been used to treat certain hereditary disorders (such as xanthurenic aciduria, hyperoxaluria, homocystinuria).

              HOW TO USE: Take this vitamin by mouth with or without food, usually once daily. Follow all directions on the product package, or take as directed by your doctor. If you have any questions, ask your doctor or pharmacist.If you are taking the extended-release capsules, swallow them whole. Do not crush or chew extended-release capsules or tablets. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split extended-release tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing.If you are using the liquid form of this product, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose. If your liquid form is a suspension, shake the container well before each use.If you are taking the powder, mix it thoroughly in the proper amount of liquid and stir well. Drink all of the liquid right away. Do not prepare a supply for future use.Dosage is based on your medical condition and response to treatment.Use this vitamin regularly to get the most benefit from it. To help you remember, take it at the same time each day.Tell your doctor if your condition lasts or gets worse. If you think you may have a serious medical problem, get medical help right away.

              SIDE EFFECTS: Pyridoxine usually has no side effects when used in recommended doses.If your doctor has prescribed this medication, remember that 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.Pyridoxine can cause side effects when taken in large doses for a long time. Tell your doctor right away if you have any serious side effects, including: headache, nausea, drowsiness, numbness/tingling of arms/legs.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 pyridoxine, 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 vitamin, tell your doctor or pharmacist your medical history.During pregnancy, this vitamin has been found to be safe when used in recommended doses.This vitamin passes into breast milk and is considered to be safe during breast-feeding when used in recommended doses. Consult your doctor for more information.

              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.A product that may interact with this vitamin is: altretamine.This vitamin may interfere with certain lab tests (including urine test for urobilinogen), possibly causing false test results. Make sure lab personnel and all your doctors know you use this vitamin.

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

              NOTES: Keep all regular medical and laboratory appointments.This product is not a substitute for a proper diet. It is best to get your vitamins from healthy foods. Vitamin B6 is commonly found in pork, fish, chicken, whole wheat products, and beans, among others. Consult your doctor, pharmacist, or nutritionist 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: Different brands of this vitamin have different storage needs. Check the product package for instructions on how to store your brand, or ask your pharmacist. 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 April 2022. 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.

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              Formulary

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