minoxidil (Rx)

Brand and Other Names:Loniten, Minodyl, more...Minoxidil HTN
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 2.5mg
  • 10mg

Severe or Refractory Hypertension (HTN)

Initial: 5mg PO qDay, increase every 3 days PRN

Maintenance: 2.5-80 mg/day qDay or q12hr; not to exceed 100 mg/day

Dosage Forms & Strengths

tablet

  • 2.5mg
  • 10mg

Severe or Refractory Hypertension (HTN)

< 12 years

  • Initial: 0.1-0.2 mg/kg; not to exceed 5 mg/day PO; titrate to response every 3 days  
  • 0.25-1 mg/kg/day PO qDay or q12hr; not to exceed 50 mg/day

> 12 years

  • Initial: 5mg PO qDay, increase every 3 days PRN
  • Maintenance: 2.5-80 mg/day qDay or q12hr; not to exceed 100 mg/day

Hypertension

2.5 mg PO qDay; titrate to response gradually

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Interactions

Interaction Checker

and minoxidil

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      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (0)

              Serious - Use Alternative (2)

              • bremelanotide

                bremelanotide will decrease the level or effect of minoxidil 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.

              • lofexidine

                lofexidine, minoxidil. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.

              Monitor Closely (19)

              • aldesleukin

                aldesleukin increases effects of minoxidil by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • amifostine

                amifostine, minoxidil. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.

              • avanafil

                avanafil increases effects of minoxidil by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • bretylium

                minoxidil, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.

              • carbidopa

                carbidopa increases effects of minoxidil by pharmacodynamic synergism. Use Caution/Monitor. Therapy with carbidopa, given with or without levodopa or carbidopa-levodopa combination products, is started, dosage adjustment of the antihypertensive drug may be required.

              • dulaglutide

                dulaglutide, minoxidil. Other (see comment). Use Caution/Monitor. Comment: Dulaglutide slows gastric emptying and may impact absorption of concomitantly administered oral medications; be particularly cautious when coadministered with drugs that have a narrow therapeutic index.

              • epoprostenol

                epoprostenol, minoxidil. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

              • fenoldopam

                fenoldopam, minoxidil. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

              • ferric maltol

                ferric maltol, minoxidil. Either increases levels of the other by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Coadministration of ferric maltol with certain oral medications may decrease the bioavailability of either ferric maltol and some oral drugs. For oral drugs where reductions in bioavailability may cause clinically significant effects on its safety or efficacy, separate administration of ferric maltol from these drugs. Duration of separation may depend on the absorption of the medication concomitantly administered (eg, time to peak concentration, whether the drug is an immediate or extended release product).

              • hydralazine

                hydralazine, minoxidil. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

              • iloprost

                iloprost, minoxidil. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

              • levodopa

                levodopa increases effects of minoxidil by pharmacodynamic synergism. Use Caution/Monitor. Consider decreasing dosage of antihypertensive agent.

              • maraviroc

                maraviroc, minoxidil. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.

              • nitroglycerin rectal

                nitroglycerin rectal, minoxidil. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Observe for possible additive hypotensive effects during concomitant use. .

              • tadalafil

                tadalafil increases effects of minoxidil by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • teduglutide

                teduglutide increases levels of minoxidil by Other (see comment). Use Caution/Monitor. Comment: Teduglutide may increase absorption of concomitant PO medications; caution with with drugs requiring titration or those with a narrow therapeutic index; dose adjustment may be necessary.

              • treprostinil

                minoxidil, treprostinil. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

              • ustekinumab

                ustekinumab, minoxidil. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, normalizing the formation of CYP450 enzymes. Upon initiation or discontinuation of ustekinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

              • xipamide

                xipamide increases effects of minoxidil by pharmacodynamic synergism. Use Caution/Monitor.

              Minor (25)

              • agrimony

                agrimony increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown.

              • amiloride

                amiloride increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown.

              • bendroflumethiazide

                bendroflumethiazide increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown.

              • brimonidine

                brimonidine increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown.

              • bumetanide

                bumetanide increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown.

              • chlorothiazide

                chlorothiazide increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown.

              • chlorthalidone

                chlorthalidone increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown.

              • cornsilk

                cornsilk increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown.

              • cyclopenthiazide

                cyclopenthiazide increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown.

              • drospirenone

                drospirenone increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown.

              • ethacrynic acid

                ethacrynic acid increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown.

              • forskolin

                forskolin increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown.

              • furosemide

                furosemide increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown.

              • hydrochlorothiazide

                hydrochlorothiazide increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown.

              • indapamide

                indapamide increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown.

              • maitake

                maitake increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown. Maitake mushroom has anti-tumor effects (animal/in vitro research).

              • methyclothiazide

                methyclothiazide increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown.

              • metolazone

                metolazone increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown.

              • reishi

                reishi increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown.

              • shepherd's purse

                shepherd's purse, minoxidil. Other (see comment). Minor/Significance Unknown. Comment: Theoretically, shepherd's purse may interfere with BP control.

              • spironolactone

                spironolactone increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown.

              • tizanidine

                tizanidine increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • torsemide

                torsemide increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown.

              • treprostinil

                treprostinil increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown.

              • triamterene

                triamterene increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown.

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              Adverse Effects

              >10%

              Hypertrichosis (80%)

              Abnormal ECG (60%)

              1-10%

              Pericardial effusion (3%)

              Frequency Not Defined

              Angina

              Cardiac tamponade

              Fluid and sodium retention

              Hypotension

              Pericarditis

              Tachyarrhythmia

              Stevens-Johnson syndrome (rare )

              Hirsutism

              Leukopenia (rare)

              Thrombocytopenia (rare)

              Toxic epidermal necrolysis

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              Warnings

              Black Box Warnings

              Can precipitate effusion, occasionally progressing to tamponade

              May exacerbate angina pectoris

              Reserve for patients who do not respond adequately to maximum therapeutic doses of a diuretic and 2 other antihypertensives

              In experimental animals, minoxidil caused several kinds of myocardial lesions as well as other adverse cardiac effects

              Must be administered under close supervision, usually concomitantly with therapeutic doses of a beta-adrenergic blocking agent to prevent tachycardia and increased myocardial workload

              Usually given with a diuretic (typically loop diuretic) to prevent serious fluid accumulation

              Patients with malignant hypertension and those already receiving guanethidine should be hospitalized when minoxidil first administered (monitoring required because risk for rapid/large decrease in BP)

              Contraindications

              Hypersensitivity to minoxidil

              Pheochromocytoma

              Cautions

              Reserve for severe hypertension refractory to other drugs

              In patients with severe blood pressure elevation, too rapid control of blood pressure, especially with intravenous agents, can precipitate syncope, cerebrovascular accidents, myocardial infarction and ischemia of special sense organs with resulting decrease or loss of vision or hearing; patients with compromised circulation or cryoglobulinemia may also suffer ischemic episodes of affected organs

              Patients with malignant hypertension should have initial treatment with minoxidil carried out in a hospital setting, both to assure that blood pressure is falling and to assure that it is not falling more rapidly than intended

              Neonatal hypertrichosis reported following exposure to minoxidil during pregnancy

              Although minoxidil does not itself cause orthostatic hypotension, administration to patients already receiving guanethidine can result in profound orthostatic effects; if at all possible, discontinue guanethidine well before minoxidil is begun; if this is not possible, therapy should be started in hospital and patient should remain institutionalized until severe orthostatic effects are no longer present or patient has learned to avoid activities that provoke them

              Therapy not used in patients who have had a myocardial infarction within preceding month; it is possible that reduction of arterial pressure with drug might further limit blood flow to myocardium, although this might be compensated by decreased oxygen demand because of lower blood pressure

              Patients with renal failure or on dialysis, may require smaller doses and should have close medical supervision to prevent exacerbation of renal failure or precipitation of cardiac failure

              Pericarditis and pericardial effusion

              • There have been reports of pericarditis occurring in association with therapy; the relationship of this association to renal status is uncertain; pericardial effusion, occasionally with tamponade, has been observed in about 3% of treated patients not on dialysis, especially those with inadequate or compromised renal function
              • Although in many cases, pericardial effusion associated with a connective tissue disease, uremic syndrome, congestive heart failure, or marked fluid retention, there have been instances in which these potential causes of effusion were not present; observe patients closely for any suggestion of a pericardial disorder, and perform echocardiographic studies if suspicion arises
              • More vigorous diuretic therapy, dialysis, pericardiocentesis, or surgery may be required; if effusion persists, withdrawal of drug should be considered in light of other means of controlling hypertension and patient’s clinical status

              Concomitant treatment for prevention of tachycardia

              • Therapy increases heart rate; angina may worsen or appear for first time during treatment, probably because of increased oxygen demands associated with increased heart rate and cardiac output
              • Increase in rate and occurrence of angina generally can be prevented by concomitant administration of a beta-adrenergic blocking drug or other sympathetic nervous system suppressant
              • Ability of beta-adrenergic blocking agents to minimize papillary muscle lesions in animals further supports using agent concomitantly; round-the-clock effectiveness of sympathetic suppressant should be ensured

              Water retention

              • Congestive heart failure—concomitant use of adequate diuretic required; drug must usually be administered concomitantly with diuretic adequate to prevent fluid retention and possible congestive heart failure; high ceiling (loop) diuretic is almost always required
              • Monitor body weight if drug is used without a diuretic; retention of several hundred milli-equivalents of salt and corresponding volumes of water can occur within a few days, leading to increased plasma and interstitial fluid volume and local or generalized edema
              • Diuretic treatment alone, or in combination with restricted salt intake, will usually minimize fluid retention, although reversible edema did develop in approximately 10% of nondialysis patients so treated
              • Ascites reported; diuretic effectiveness limited mostly by disease-related impaired renal function; condition of patients with preexisting congestive heart failure occasionally deteriorated in association with fluid retention although because of fall in blood pressure (reduction of afterload), more than twice as many improved than worsened
              • Rarely, refractory fluid retention may require discontinuation of therapy; provided that patient is under close medical supervision, it may be possible to resolve refractory salt retention by discontinuing therapy for 1 or 2 days and then resuming treatment in conjunction with vigorous diuretic therapy
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              Pregnancy & Lactation

              Pregnancy Category: C

              Lactation: controversial; excreted in breast milk, not recommended for long term use if breastfeeding

              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

              Direct vasodilator; dilate arterioles with little effect on vein, decreases systemic resistance, which subsequently decreases blood pressure.

              Pharmacokinetics

              Half-Life: 4 hr

              Excretion: Urine (12% as unchanged drug)

              Duration: 2-5 Days

              Peak Plasma Time: PO (HTN): 1 hr

              Bioavailability: PO (HTN): 90%

              Protein Bound: Negligible

              Metabolism: liver, 88% via glucuronidation

              Metabolite: minoxidil-0-glucuronide (active)

              Onset

              • Initial effect: PO (HTN): 30-60 min
              • Max effect: PO (HTN): 4-8 hr
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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              minoxidil oral
              -
              10 mg tablet
              minoxidil oral
              -
              2.5 mg tablet
              minoxidil oral
              -
              10 mg tablet
              minoxidil oral
              -
              2.5 mg tablet
              minoxidil oral
              -
              10 mg tablet
              minoxidil oral
              -
              2.5 mg tablet
              minoxidil topical
              -
              5 % solution
              minoxidil topical
              -
              5 % solution
              minoxidil topical
              -
              2 % solution
              minoxidil topical
              -
              2 % solution
              Hair Regrowth Treatment topical
              -
              5 % solution
              Rogaine topical
              -
              5 % foam
              Rogaine topical
              -
              2 % solution
              Rogaine topical
              -
              5 % foam
              Rogaine topical
              -
              5 % foam
              Rogaine topical
              -
              5 % foam

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Select a drug:
              Patient Education
              minoxidil oral

              MINOXIDIL - ORAL

              (min-OX-i-dil)

              COMMON BRAND NAME(S): Loniten

              WARNING: Minoxidil may cause serious heart problems or worsen chest pain (angina). Therefore, this medication is only used when other treatments have not worked well or cannot be taken.Your doctor should direct you to also take other medications to reduce the side effects of minoxidil. These medications include a "water pill" (diuretic) to prevent the body from holding on to too much water and salt and a heart medication (such as a beta blocker including propranolol) to prevent the heart from working too hard or beating too fast.Your doctor will follow you closely while you are taking this medication. Keep all regular medical and laboratory appointments.

              USES: Minoxidil is used with other medications to treat high blood pressure (hypertension). Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Minoxidil works by relaxing blood vessels so blood can flow more easily.

              HOW TO USE: Read the Patient Information Leaflet if available from your pharmacist before you start taking this medication and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth with or without food as directed by your doctor, usually once or twice a day.The dosage is based on your medical condition and response to treatment. In children, the dosage is also based on weight. Your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully.Take this medication and your other blood pressure medications regularly in order to get the most benefit from them. To help you remember, take them at the same time(s) each day. Keep taking your medications even if you feel well. Most people with high blood pressure do not feel sick.Do not stop taking this medication without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped. Your dose may need to be gradually decreased.It may take several days to a couple of weeks before you get the full benefit of this drug. Tell your doctor if your condition does not improve or if it worsens (your blood pressure readings remain high or increase).

              SIDE EFFECTS: Dizziness or lightheadedness may occur as your body adjusts to the medication. If either of these effects persists or worsens, tell your doctor or pharmacist promptly.Minoxidil may cause increased growth or darkening of fine body hairs. If this bothers you, consult your doctor. When you stop taking the medication, the hair will usually return to normal within 1 to 6 months.Remember that your doctor has prescribed this medication because he or she 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: fast heartbeat, symptoms of heart failure (such as shortness of breath, swelling ankles/feet, unusual tiredness, unusual/sudden weight gain), fainting.Get medical help right away if you have any very serious side effects, including: chest/jaw/left arm pain.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 minoxidil, 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: pheochromocytoma, heart problems (such as heart failure, chest pain, recent heart attack), kidney disease, a certain lung disease (pulmonary hypertension).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).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This drug passes into breast milk, but is unlikely to harm a nursing infant. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: guanethidine.Some products have ingredients that could raise your blood pressure. Tell your pharmacist what products you are using, and ask how to use them safely (especially cough-and-cold products, diet aids, or NSAIDs such as ibuprofen/naproxen).

              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: severe dizziness.

              NOTES: Do not share this medication with others.Lifestyle changes that may help this medication work better include stress reduction programs, exercise, and dietary changes. Talk to your doctor or pharmacist about lifestyle changes that might benefit you.Lab and/or medical tests (such as blood minerals levels, kidney function, weight) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.Have your blood pressure and pulse (heart rate) checked regularly while taking this medication. Learn how to monitor your own blood pressure and pulse at home, and share the results with your doctor.

              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 May 2020. 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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              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.
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              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
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              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
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              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the 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.