levorphanol (Rx)

Brand and Other Names:Levo Dromoran
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet: Schedule II

  • 2mg

Pain

Opiate-naive

  • 2 mg PO q6-8hr PRN
  • 1 mg IM/SC q6-8hr PRN
  • 1 mg slow IV q3-6hr; not to exceed 4-8 mg/24 hr PRN

Prior opiate exposure

  • 2-4 mg PO q6-8hr PRN
  • 1-2 mg IV/SC q6-8hr PRN
  • 1 mg slow IV q3-6hr; not to exceed 4-8 mg/24hr PRN

Premedication

1-2 mg/dose IM/SC 60-90 min prior to surgery

Renal Impairment

Use caution; reduce initial dose in severe renal impairment

Hepatic Impairment

Use caution; reduce initial dose in severe hepatic impairment

Other Indications & Uses

General anesthesia, local anesthesia

<18 yo: not recommended

Pain

Opiate-naive

- 2 mg PO q6-8hr PRN

- 1 mg IM/SC q6-8hr PRN

- 1 mg slow IV q3-6hr; not to exceed 4-8 mg/24 hr PRN

Prior opiate exposure

- 2-4 mg PO q6-8hr PRN

- 1-2 mg IV/SC q6-8hr PRN

- 1 mg slow IV q3-6hr; not to exceed 4-8 mg/24hr PRN

Premedication

1-2 mg/dose IM/SC 60-90 min prior to surgery

Next:

Interactions

Interaction Checker

and levorphanol

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      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (1)

            • alvimopan

              alvimopan, levorphanol. receptor binding competition. Contraindicated. Alvimopan is contraindicated in opioid tolerant patients (ie, those who have taken therapeutic doses of opioids for >7 consecutive days immediately prior to taking alvimopan). Patients recently exposed to opioids are expected to be more sensitive to the effects of alvimopan and therefore may experience abdominal pain, nausea and vomiting, and diarrhea. No significant interaction is expected with concurrent use of opioid analgesics and alvimopan in patients who received opioid analgesics for 7 or fewer consecutive days prior to alvimopan.

            Serious - Use Alternative (33)

            • benzhydrocodone/acetaminophen

              benzhydrocodone/acetaminophen, levorphanol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • bremelanotide

              bremelanotide will decrease the level or effect of levorphanol by Other (see comment). Avoid or Use Alternate Drug. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. Avoid use when taking any oral drug that is dependent on threshold concentrations for efficacy. Interactions listed are representative examples and do not include all possible clinical examples.

            • buprenorphine

              buprenorphine, levorphanol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • buprenorphine buccal

              buprenorphine buccal, levorphanol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • butorphanol

              butorphanol, levorphanol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • calcium/magnesium/potassium/sodium oxybates

              levorphanol, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • cimetidine

              cimetidine increases effects of levorphanol by decreasing metabolism. Avoid or Use Alternate Drug.

            • desvenlafaxine

              desvenlafaxine and levorphanol both increase serotonin levels. Avoid or Use Alternate Drug. May cause serotonin syndrome

            • diazepam intranasal

              diazepam intranasal, levorphanol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • eluxadoline

              levorphanol, eluxadoline. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that cause constipation. Increases risk for constipation related serious adverse reactions. .

            • fentanyl

              fentanyl, levorphanol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

            • fentanyl intranasal

              fentanyl intranasal, levorphanol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

            • fentanyl transdermal

              fentanyl transdermal, levorphanol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

            • fentanyl transmucosal

              fentanyl transmucosal, levorphanol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

            • hydrocodone

              hydrocodone, levorphanol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • isocarboxazid

              isocarboxazid increases toxicity of levorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • linezolid

              linezolid increases toxicity of levorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • methylene blue

              methylene blue and levorphanol both increase serotonin levels. Avoid or Use Alternate Drug. If drug combination must be administered, monitor for evidence of serotonergic or opioid-related toxicities

            • metoclopramide intranasal

              levorphanol, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

            • nalbuphine

              nalbuphine, levorphanol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • ozanimod

              ozanimod and levorphanol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

            • pentazocine

              pentazocine, levorphanol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • phenelzine

              phenelzine increases toxicity of levorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • procarbazine

              procarbazine increases toxicity of levorphanol by unknown mechanism. Avoid or Use Alternate Drug. MAOIs may potentiate CNS depression and hypotension. Do not use within 14 days of MAOI use. .

            • rasagiline

              rasagiline increases toxicity of levorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.

            • selegiline transdermal

              selegiline transdermal increases toxicity of levorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.

            • selinexor

              selinexor, levorphanol. 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.

            • sodium oxybate

              levorphanol, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • sufentanil SL

              sufentanil SL, levorphanol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • tramadol

              tramadol, levorphanol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

            • tranylcypromine

              tranylcypromine increases toxicity of levorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • valerian

              valerian and levorphanol both increase sedation. Avoid or Use Alternate Drug.

            • venlafaxine

              venlafaxine and levorphanol both increase serotonin levels. Avoid or Use Alternate Drug. May cause serotonin syndrome

            Monitor Closely (186)

            • albuterol

              levorphanol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • alfentanil

              alfentanil and levorphanol both increase sedation. Use Caution/Monitor.

            • alprazolam

              alprazolam and levorphanol both increase sedation. Use Caution/Monitor.

            • amitriptyline

              levorphanol and amitriptyline both increase sedation. Use Caution/Monitor.

            • amobarbital

              amobarbital and levorphanol both increase sedation. Use Caution/Monitor.

            • amoxapine

              levorphanol and amoxapine both increase sedation. Use Caution/Monitor.

            • apomorphine

              levorphanol and apomorphine both increase sedation. Use Caution/Monitor.

            • arformoterol

              levorphanol increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • aripiprazole

              levorphanol and aripiprazole both increase sedation. Use Caution/Monitor.

            • armodafinil

              levorphanol increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • azelastine

              azelastine and levorphanol both increase sedation. Use Caution/Monitor.

            • baclofen

              baclofen and levorphanol both increase sedation. Use Caution/Monitor.

            • belladonna and opium

              levorphanol and belladonna and opium both increase sedation. Use Caution/Monitor.

            • benperidol

              levorphanol and benperidol both increase sedation. Use Caution/Monitor.

            • benzphetamine

              levorphanol increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • brexanolone

              brexanolone, levorphanol. Either increases toxicity of the other by sedation. Use Caution/Monitor.

            • brompheniramine

              brompheniramine and levorphanol both increase sedation. Use Caution/Monitor.

            • buprenorphine

              buprenorphine and levorphanol both increase sedation. Use Caution/Monitor.

            • buprenorphine buccal

              buprenorphine buccal and levorphanol both increase sedation. Use Caution/Monitor.

            • buprenorphine, long-acting injection

              levorphanol increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

            • butabarbital

              butabarbital and levorphanol both increase sedation. Use Caution/Monitor.

            • butalbital

              butalbital and levorphanol both increase sedation. Use Caution/Monitor.

            • butorphanol

              butorphanol and levorphanol both increase sedation. Use Caution/Monitor.

            • caffeine

              levorphanol increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • carbinoxamine

              carbinoxamine and levorphanol both increase sedation. Use Caution/Monitor.

            • carisoprodol

              carisoprodol and levorphanol both increase sedation. Use Caution/Monitor.

            • chloral hydrate

              chloral hydrate and levorphanol both increase sedation. Use Caution/Monitor.

            • chlordiazepoxide

              chlordiazepoxide and levorphanol both increase sedation. Use Caution/Monitor.

            • chlorpheniramine

              chlorpheniramine and levorphanol both increase sedation. Use Caution/Monitor.

            • chlorpromazine

              levorphanol and chlorpromazine both increase sedation. Use Caution/Monitor.

            • chlorzoxazone

              chlorzoxazone and levorphanol both increase sedation. Use Caution/Monitor.

            • cinnarizine

              cinnarizine and levorphanol both increase sedation. Use Caution/Monitor.

            • clemastine

              clemastine and levorphanol both increase sedation. Use Caution/Monitor.

            • clobazam

              levorphanol, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

            • clomipramine

              levorphanol and clomipramine both increase sedation. Use Caution/Monitor.

            • clonazepam

              clonazepam and levorphanol both increase sedation. Use Caution/Monitor.

            • clorazepate

              clorazepate and levorphanol both increase sedation. Use Caution/Monitor.

            • clozapine

              levorphanol and clozapine both increase sedation. Use Caution/Monitor.

            • codeine

              codeine and levorphanol both increase sedation. Use Caution/Monitor.

            • cyclizine

              cyclizine and levorphanol both increase sedation. Use Caution/Monitor.

            • cyclobenzaprine

              cyclobenzaprine and levorphanol both increase sedation. Use Caution/Monitor.

            • cyproheptadine

              cyproheptadine and levorphanol both increase sedation. Use Caution/Monitor.

            • dantrolene

              dantrolene and levorphanol both increase sedation. Use Caution/Monitor.

            • desflurane

              desflurane and levorphanol both increase sedation. Use Caution/Monitor. Opioids may decrease MAC requirements, less inhalation anesthetic may be required.

            • desipramine

              levorphanol and desipramine both increase sedation. Use Caution/Monitor.

            • deutetrabenazine

              levorphanol and deutetrabenazine both increase sedation. Use Caution/Monitor.

            • dexchlorpheniramine

              dexchlorpheniramine and levorphanol both increase sedation. Use Caution/Monitor.

            • dexfenfluramine

              levorphanol increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dexmedetomidine

              dexmedetomidine and levorphanol both increase sedation. Use Caution/Monitor.

            • dexmethylphenidate

              levorphanol increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dextroamphetamine

              levorphanol increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dextromoramide

              dextromoramide and levorphanol both increase sedation. Use Caution/Monitor.

            • diamorphine

              diamorphine and levorphanol both increase sedation. Use Caution/Monitor.

            • diazepam

              diazepam and levorphanol both increase sedation. Use Caution/Monitor.

            • diethylpropion

              levorphanol increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • difenoxin hcl

              difenoxin hcl and levorphanol both increase sedation. Use Caution/Monitor.

            • dimenhydrinate

              dimenhydrinate and levorphanol both increase sedation. Use Caution/Monitor.

            • diphenhydramine

              diphenhydramine and levorphanol both increase sedation. Use Caution/Monitor.

            • diphenoxylate hcl

              diphenoxylate hcl and levorphanol both increase sedation. Use Caution/Monitor.

            • dipipanone

              dipipanone and levorphanol both increase sedation. Use Caution/Monitor.

            • dobutamine

              levorphanol increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dopamine

              levorphanol increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dopexamine

              levorphanol increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dosulepin

              levorphanol and dosulepin both increase sedation. Use Caution/Monitor.

            • doxepin

              levorphanol and doxepin both increase sedation. Use Caution/Monitor.

            • doxylamine

              doxylamine and levorphanol both increase sedation. Use Caution/Monitor.

            • droperidol

              levorphanol and droperidol both increase sedation. Use Caution/Monitor.

            • eltrombopag

              eltrombopag increases levels of levorphanol by decreasing metabolism. Use Caution/Monitor. UGT inhibition; significance of interaction unclear.

            • ephedrine

              levorphanol increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • epinephrine

              levorphanol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • epinephrine racemic

              levorphanol increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • esketamine intranasal

              esketamine intranasal, levorphanol. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

            • estazolam

              estazolam and levorphanol both increase sedation. Use Caution/Monitor.

            • ethanol

              levorphanol and ethanol both increase sedation. Use Caution/Monitor.

            • etomidate

              etomidate and levorphanol both increase sedation. Use Caution/Monitor.

            • fenfluramine

              levorphanol increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • flibanserin

              levorphanol and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.

            • fluphenazine

              levorphanol and fluphenazine both increase sedation. Use Caution/Monitor.

            • flurazepam

              flurazepam and levorphanol both increase sedation. Use Caution/Monitor.

            • formoterol

              levorphanol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • gabapentin

              gabapentin, levorphanol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • gabapentin enacarbil

              gabapentin enacarbil, levorphanol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • haloperidol

              levorphanol and haloperidol both increase sedation. Use Caution/Monitor.

            • hydromorphone

              hydromorphone and levorphanol both increase sedation. Use Caution/Monitor.

            • hydroxyzine

              hydroxyzine and levorphanol both increase sedation. Use Caution/Monitor.

            • iloperidone

              levorphanol and iloperidone both increase sedation. Use Caution/Monitor.

            • imipramine

              levorphanol and imipramine both increase sedation. Use Caution/Monitor.

            • isoproterenol

              levorphanol increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ketamine

              ketamine and levorphanol both increase sedation. Use Caution/Monitor.

            • ketotifen, ophthalmic

              levorphanol and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

            • lasmiditan

              lasmiditan, levorphanol. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

            • lemborexant

              lemborexant, levorphanol. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

            • levalbuterol

              levorphanol increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lisdexamfetamine

              levorphanol increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lofepramine

              levorphanol and lofepramine both increase sedation. Use Caution/Monitor.

            • lofexidine

              levorphanol and lofexidine both increase sedation. Use Caution/Monitor.

            • loprazolam

              loprazolam and levorphanol both increase sedation. Use Caution/Monitor.

            • lorazepam

              lorazepam and levorphanol both increase sedation. Use Caution/Monitor.

            • lormetazepam

              lormetazepam and levorphanol both increase sedation. Use Caution/Monitor.

            • loxapine

              levorphanol and loxapine both increase sedation. Use Caution/Monitor.

            • loxapine inhaled

              levorphanol and loxapine inhaled both increase sedation. Use Caution/Monitor.

            • lurasidone

              lurasidone, levorphanol. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

            • maprotiline

              levorphanol and maprotiline both increase sedation. Use Caution/Monitor.

            • marijuana

              levorphanol and marijuana both increase sedation. Use Caution/Monitor.

            • melatonin

              levorphanol and melatonin both increase sedation. Use Caution/Monitor.

            • meperidine

              levorphanol and meperidine both increase sedation. Use Caution/Monitor.

            • meprobamate

              levorphanol and meprobamate both increase sedation. Use Caution/Monitor.

            • metaproterenol

              levorphanol increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • metaxalone

              metaxalone and levorphanol both increase sedation. Use Caution/Monitor.

            • methadone

              levorphanol and methadone both increase sedation. Use Caution/Monitor.

            • methamphetamine

              levorphanol increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • methocarbamol

              methocarbamol and levorphanol both increase sedation. Use Caution/Monitor.

            • methylenedioxymethamphetamine

              levorphanol increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • midazolam

              midazolam and levorphanol both increase sedation. Use Caution/Monitor.

            • midazolam intranasal

              midazolam intranasal, levorphanol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of benzodiazepines and opioids increases risk of respiratory depression. Use only in patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required.

            • midodrine

              levorphanol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • mirtazapine

              levorphanol and mirtazapine both increase sedation. Use Caution/Monitor.

            • modafinil

              levorphanol increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • morphine

              levorphanol and morphine both increase sedation. Use Caution/Monitor.

            • motherwort

              levorphanol and motherwort both increase sedation. Use Caution/Monitor.

            • moxonidine

              levorphanol and moxonidine both increase sedation. Use Caution/Monitor.

            • nabilone

              levorphanol and nabilone both increase sedation. Use Caution/Monitor.

            • nalbuphine

              levorphanol and nalbuphine both increase sedation. Use Caution/Monitor.

            • norepinephrine

              levorphanol increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nortriptyline

              levorphanol and nortriptyline both increase sedation. Use Caution/Monitor.

            • olanzapine

              levorphanol and olanzapine both increase sedation. Use Caution/Monitor.

            • oliceridine

              oliceridine, levorphanol. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • opium tincture

              levorphanol and opium tincture both increase sedation. Use Caution/Monitor.

            • orphenadrine

              orphenadrine and levorphanol both increase sedation. Use Caution/Monitor.

            • oxazepam

              oxazepam and levorphanol both increase sedation. Use Caution/Monitor.

            • oxycodone

              levorphanol and oxycodone both increase sedation. Use Caution/Monitor.

            • oxymorphone

              levorphanol and oxymorphone both increase sedation. Use Caution/Monitor.

            • paliperidone

              levorphanol and paliperidone both increase sedation. Use Caution/Monitor.

            • papaveretum

              levorphanol and papaveretum both increase sedation. Use Caution/Monitor.

            • papaverine

              levorphanol and papaverine both increase sedation. Use Caution/Monitor.

            • pegvisomant

              levorphanol decreases effects of pegvisomant by unknown mechanism. Use Caution/Monitor.

            • pentazocine

              levorphanol and pentazocine both increase sedation. Use Caution/Monitor.

            • pentobarbital

              pentobarbital and levorphanol both increase sedation. Use Caution/Monitor.

            • perampanel

              perampanel and levorphanol both decrease sedation. Use Caution/Monitor.

            • perphenazine

              levorphanol and perphenazine both increase sedation. Use Caution/Monitor.

            • phendimetrazine

              levorphanol increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenobarbital

              phenobarbital and levorphanol both increase sedation. Use Caution/Monitor.

            • phentermine

              levorphanol increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenylephrine

              levorphanol increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pholcodine

              levorphanol and pholcodine both increase sedation. Use Caution/Monitor.

            • pimozide

              levorphanol and pimozide both increase sedation. Use Caution/Monitor.

            • pirbuterol

              levorphanol increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pregabalin

              pregabalin, levorphanol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • primidone

              primidone and levorphanol both increase sedation. Use Caution/Monitor.

            • prochlorperazine

              levorphanol and prochlorperazine both increase sedation. Use Caution/Monitor.

            • promethazine

              promethazine and levorphanol both increase sedation. Use Caution/Monitor.

            • propofol

              propofol and levorphanol both increase sedation. Use Caution/Monitor.

            • propylhexedrine

              levorphanol increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • protriptyline

              levorphanol and protriptyline both increase sedation. Use Caution/Monitor.

            • quazepam

              quazepam and levorphanol both increase sedation. Use Caution/Monitor.

            • quetiapine

              levorphanol and quetiapine both increase sedation. Use Caution/Monitor.

            • ramelteon

              levorphanol and ramelteon both increase sedation. Use Caution/Monitor.

            • remimazolam

              remimazolam, levorphanol. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

            • risperidone

              levorphanol and risperidone both increase sedation. Use Caution/Monitor.

            • salmeterol

              levorphanol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • scullcap

              levorphanol and scullcap both increase sedation. Use Caution/Monitor.

            • secobarbital

              secobarbital and levorphanol both increase sedation. Use Caution/Monitor.

            • selegiline

              selegiline increases toxicity of levorphanol by unknown mechanism. Modify Therapy/Monitor Closely. Potential for increased CNS depression, drowsiness, dizziness or hypotension, so use with any MAOI should be cautious.

            • sevoflurane

              sevoflurane and levorphanol both increase sedation. Use Caution/Monitor.

            • shepherd's purse

              levorphanol and shepherd's purse both increase sedation. Use Caution/Monitor.

            • stiripentol

              stiripentol, levorphanol. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

            • sufentanil

              levorphanol and sufentanil both increase sedation. Use Caution/Monitor.

            • suvorexant

              suvorexant and levorphanol both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary

            • tapentadol

              levorphanol and tapentadol both increase sedation. Use Caution/Monitor.

            • temazepam

              temazepam and levorphanol both increase sedation. Use Caution/Monitor.

            • terbutaline

              levorphanol increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • thioridazine

              levorphanol and thioridazine both increase sedation. Use Caution/Monitor.

            • thiothixene

              levorphanol and thiothixene both increase sedation. Use Caution/Monitor.

            • topiramate

              levorphanol and topiramate both increase sedation. Modify Therapy/Monitor Closely.

            • tramadol

              levorphanol and tramadol both increase sedation. Use Caution/Monitor.

            • trazodone

              levorphanol and trazodone both increase sedation. Use Caution/Monitor.

            • triazolam

              triazolam and levorphanol both increase sedation. Use Caution/Monitor.

            • triclofos

              triclofos and levorphanol both increase sedation. Use Caution/Monitor.

            • trifluoperazine

              levorphanol and trifluoperazine both increase sedation. Use Caution/Monitor.

            • trimipramine

              levorphanol and trimipramine both increase sedation. Use Caution/Monitor.

            • triprolidine

              triprolidine and levorphanol both increase sedation. Use Caution/Monitor.

            • xylometazoline

              levorphanol increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • yohimbine

              levorphanol increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ziconotide

              levorphanol and ziconotide both increase sedation. Use Caution/Monitor.

            • ziprasidone

              levorphanol and ziprasidone both increase sedation. Use Caution/Monitor.

            • zotepine

              levorphanol and zotepine both increase sedation. Use Caution/Monitor.

            Minor (6)

            • brimonidine

              brimonidine increases effects of levorphanol by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • dextroamphetamine

              dextroamphetamine increases effects of levorphanol by unspecified interaction mechanism. Minor/Significance Unknown.

            • eucalyptus

              levorphanol and eucalyptus both increase sedation. Minor/Significance Unknown.

            • lidocaine

              lidocaine increases toxicity of levorphanol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.

            • sage

              levorphanol and sage both increase sedation. Minor/Significance Unknown.

            • ziconotide

              ziconotide, levorphanol. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.

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            Adverse Effects

            >10%

            Dizziness

            Hypoventilation

            Nausea

            Pruritus

            1-10%

            Hypotension

            Constipation

            Vomiting

            Disturbance of consciousness

            Disturbance in mood

            <1%

            Bradyarrhythmia

            Cardiac arrest

            Cardiac dysrhythmia

            Palpitations

            Tachyarrhythmia

            Apnea

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            Warnings

            Contraindications

            Absolute: acute abdominal condition, pseudomembranous colitis, respiratory depression

            Relative: asthma (acute), inflammatory bowel disease, respiratory impairment

            Cautions

            Cardiac arrhythmias, drug abuse/dependence, emotional lability, gallbladder disease, head injury, hepatic impairment, hypothyroidism, increased intracranial pressure, prostatic hypertrophy, renal impairment, seizures with epilepsy, urethral stricture, urinary tract surgery, toxin-mediated diarrhea

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            Pregnancy & Lactation

            Pregnancy Category: B; D if used for prolonged periods or near term

            Lactation: not known if excreted in breast milk

            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

            Narcotic agonist-analgesic of opiate receptors; inhibits ascending pain pathways, which causes alteration in response to pain; produces analgesia, respiratory depression, and sedation

            Pharmacokinetics

            Half-Life: 12-16 hr

            Onset of action: 10-60 min (PO)

            Duration: 4-8 hr

            Peak Plasma Time: 20 min (IV); 60-90 min (SC)

            Metabolism: Liver (conjugation with glucuronic acid)

            Excretion: Urine (primarily)

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            Administration

            IV Incompatibilities

            Additive: aminophylline, ammonium chloride, amobarbital, chlorothiazide, heparin, pentobarbital, phenobarbital, phenytoin, sodium bicarbonate, thiopental

            IV Administration

            IV: inject 3 mg over 4-5 min

            Storage

            Store at room temp

            Protect from freezing

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            levorphanol tartrate oral
            -
            2 mg tablet
            levorphanol tartrate oral
            -
            3 mg tablet
            levorphanol tartrate oral
            -
            2 mg tablet

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            levorphanol tartrate oral

            LEVORPHANOL - ORAL

            (lee-VOR-fa-nole)

            COMMON BRAND NAME(S): Levo-Dromoran

            WARNING: Levorphanol has a risk for abuse and addiction, which can lead to overdose and death. Levorphanol may also cause severe, possibly fatal, breathing problems. To lower your risk, your doctor should have you take the smallest dose of levorphanol that works, and take it for the shortest possible time. See also How to Use section for more information about addiction.The risk for severe breathing problems is higher when you start this medication and after a dose increase, or if you take the wrong dose/strength. Taking this medication with alcohol or other drugs that can cause drowsiness or breathing problems may cause very serious side effects, including death. Be sure you know how to take levorphanol and what other drugs you should avoid taking with it. See also Drug Interactions section. Get medical help right away if any of these very serious side effects occur: slow/shallow breathing, unusual lightheadedness, severe drowsiness/dizziness, difficulty waking up.Keep this medicine in a safe place to prevent theft, misuse, or abuse. If someone accidentally swallows this drug, get medical help right away.Before using this medication, women of childbearing age should talk with their doctor(s) about the risks and benefits. Tell your doctor if you are pregnant or if you plan to become pregnant. During pregnancy, this medication should be used only when clearly needed. It may slightly increase the risk of birth defects if used during the first two months of pregnancy. Also, using it for a long time or in high doses near the expected delivery date may harm the unborn baby. To lessen the risk, take the smallest effective dose for the shortest possible time. Babies born to mothers who use this drug for a long time may develop severe (possibly fatal) withdrawal symptoms. Tell the doctor right away if you notice any symptoms in your newborn baby such as crying that doesn't stop, slow/shallow breathing, irritability, shaking, vomiting, diarrhea, poor feeding, or difficulty gaining weight.

            USES: This medication is used to treat moderate to severe pain. Levorphanol is an opioid pain reliever. It acts on certain centers in the brain to give you pain relief.

            HOW TO USE: Read the Medication Guide provided by your pharmacist before you start taking levorphanol and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth, usually every 6 to 8 hours as needed or as directed by your doctor. You may take this drug with or without food. If you have nausea, you may take this drug with food, although this may cause your body to absorb less of the drug and get less benefit from it. Ask your doctor or pharmacist about other ways to decrease nausea (such as lying down for 1-2 hours with as little head movement as possible).The dosage is based on your medical condition, age, response to treatment, and other medications that you may be taking. Pain medications work best if they are used as the first signs of pain occur. If you wait until the pain has worsened, the medication may not work as well.Before you start using this medication, ask your doctor or pharmacist if you should stop or change how you use your other opioid medication(s). Other pain relievers (such as acetaminophen, ibuprofen) may also be prescribed. Ask your doctor or pharmacist about using levorphanol safely with other drugs.Suddenly stopping this medication may cause withdrawal, especially if you have used it for a long time or in high doses. To prevent withdrawal, your doctor may lower your dose slowly. Tell your doctor or pharmacist right away if you have any withdrawal symptoms such as restlessness, mental/mood changes (including anxiety, trouble sleeping, thoughts of suicide), watering eyes, runny nose, nausea, diarrhea, sweating, muscle aches, or sudden changes in behavior.Though it helps many people, this medication may sometimes cause addiction. This risk may be higher if you have a substance use disorder (such as overuse of or addiction to drugs/alcohol). Take this medication exactly as prescribed to lower the risk of addiction. Ask your doctor or pharmacist for more details.When used for an extended period, this medication may not work as well and may require different dosing. Talk with your doctor if this medication stops working well.Tell your doctor if your pain does not get better or if it gets worse.

            SIDE EFFECTS: See also Warning section.Nausea, vomiting, constipation, lightheadedness, dizziness, drowsiness, dry mouth, flushing, or vision problems may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.To prevent constipation, eat dietary fiber, drink enough water, and exercise. You may also need to take a laxative. Ask your pharmacist which type of laxative is right for you.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: interrupted breathing during sleep (sleep apnea), mental/mood changes (e.g., confusion, depression, abnormal thoughts), trouble urinating, fast/slow/irregular heartbeat, severe stomach/abdominal pain, signs of your adrenal glands not working well (such as loss of appetite, unusual tiredness, weight loss).Get medical help right away if you have any very serious side effects, including: slow/shallow breathing, fainting, severe drowsiness/difficulty waking up, seizures.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 levorphanol, 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: brain disorders (e.g., seizures, head injury, tumor, increased intracranial pressure), heart problems (e.g., irregular heartbeat), low blood pressure, certain bowel diseases (e.g., paralytic ileus, toxic megacolon), breathing problems (e.g., asthma, chronic obstructive pulmonary disease-COPD, emphysema, low oxygen/high carbon dioxide in the blood, sleep apnea), disease of the pancreas (e.g., pancreatitis), mental/mood disorders (e.g., toxic psychosis), a certain spinal problem (kyphoscoliosis), gallbladder disease, personal or family history of a substance use disorder (such as overuse of or addiction to drugs/alcohol), kidney disease, liver disease, adrenal gland problem (e.g., Addison's disease), difficulty urinating (e.g., due to enlarged prostate or urethral stricture), underactive thyroid (hypothyroidism).Before having surgery, tell your doctor or dentist that you are taking this medication.This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).To lower your risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.Older adults may be more sensitive to the side effects of this drug, especially confusion, dizziness, drowsiness, and slow/shallow breathing.During pregnancy, this medication should be used only when clearly needed. It may harm an unborn baby. Discuss the risks and benefits with your doctor. (See also Warning section.)Based on information from related drugs, this medication may pass into breast milk. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: See also Warning 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: certain pain medications (mixed opioid agonist-antagonists such as butorphanol, nalbuphine, pentazocine), cimetidine, MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine), naltrexone, samidorphan.The risk of serious side effects (such as slow/shallow breathing, severe drowsiness/dizziness) may be increased if this medication is taken with other products that may also cause drowsiness or breathing problems. Tell your doctor or pharmacist if you are taking other products such as other opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.This medication may interfere with certain laboratory tests (including amylase/lipase levels), 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, give them naloxone if available, then call 911. If the person is awake and has no symptoms, 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: slow breathing, slow heartbeat, weak muscles, extreme drowsiness, coma.

            NOTES: Do not share this medication with others. Sharing it is against the law.This medication has been prescribed for your current condition only. Do not use it later for another condition unless told to do so by your doctor. A different medication may be necessary in that case.Ask your doctor or pharmacist if you should have naloxone available to treat opioid overdose. Teach your family or household members about the signs of an opioid overdose and how to treat it.

            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 October 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

            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.
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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.