ketorolac intranasal (Rx)

Brand and Other Names:Sprix
  • Print

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

intranasal

  • 15.75mg per 100 microL spray; 8 sprays/1.7g bottle

Pain

Indicated for short-term (up to 5 days) management of moderate to moderately severe pain

<65 years: 31.5 mg (ie, 1 spray in each nostril) q6-8h; not to exceed 126 mg/day

<50 kg or ≥65 years: 15.75 mg (ie, 1 spray in only 1 nostril) q6-8h; not to exceed 63 mg/day

Also see Administration

Dosage Modifications

Renal impairment

  • 1 spray (15.75 mg) in 1 nostril
  • Total dose: 15.75 mg intranasal q6-8hr; not to exceed 4 doses (63 mg/day)

Hepatic Impairment

  • Use caution; may cause elevation of liver enzymes; discontinued if symptoms of liver toxicity develop

Safety and efficacy not established

Next:

Interactions

Interaction Checker

and ketorolac intranasal

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 
            Due to system maintenance, the drug interactions feature you are attempting to access is temporarily unavailable. Please try again later.
            Previous
            Next:

            Adverse Effects

            >10%

            Nasal discomfort (15%)

            Rhinalgia (13%)

            1-10%

            Increased lacrimation (5%)

            Throat irritation (4%)

            Oliguria (3%)

            Rash (3%)

            Bradycardia (2%)

            Decreased urine output (2%)

            Increased ALT and/or AST (2%)

            Hypertension (2%)

            Rhinitis (2%)

            Previous
            Next:

            Warnings

            Black Box Warnings

            Limitations of use

            • Total duration of use of intranasal alone or sequentially with and other ketorolac formulations should not exceed 5 days

            Cardiovascular risk

            • NSAIDs may increase risk of serious cardiovascular thrombotic events, myocardial infarction (MI), and stroke, which can be fatal; risk may increase with duration of use; patients with risk factors for or existing cardiovascular disease may be at greater risk; contraindicated for perioperative pain in the setting of CABG surgery (increased risk of MI and stroke)

            Gastrointestinal risk

            • NSAIDs increase risk of serious GI adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal; GI adverse events may occur at any time during use and without warning symptoms; elderly patients are at greater risk for serious GI events

            Bleeding risk

            • Inhibits platelet function and is contraindicated with suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis, or high risk of bleeding

            Renal risk

            • Contraindicated with advanced renal impairment and patients at risk for renal failure due to volume depletion

            Contraindications

            Hypersensitivity to ketorolac, other NSAID, aspirin, ethylenediamine tetraacetic acid (EDTA)

            Active peptic ulcer disease, recent GI bleeding or perforation, or history of peptic ulcer disease or GI bleeding

            History of asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs

            Prophylactic analgesic before any major surgery; during the perioperative period in the setting of coronary artery bypass graft (CABG) surgery; advanced renal disease or patients at risk for renal failure due to volume depletion

            Labor and delivery

            Breastfeeding women

            Suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis, or those for whom hemostasis is critical

            Coadministration with probenecid or pentoxifylline

            Cautions

            May lead to onset of new hypertension or exacerbate existing hypertension

            NSAIDs may cause serious skin reactions (eg, exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis)

            Common local adverse effects include mild and transient nasal discomfort and irritation

            Long-term administration of NSAIDs may result in renal papillary necrosis and other renal injury; patients at greatest risk include the elderly, or those with impaired renal function, hypovolemia, heart failure, liver dysfunction, salt depletion, and individuals taking diuretics, ACE inhibitors, or ARBs

            Drug reaction with eosinophilia and systemic symptoms (DRESS)

            • Drug Reaction reported in patients taking NSAIDs; some of these events have been fatal or life-threatening; DRESS typically, although not exclusively, presents with fever, rash, lymphadenopathy, and/or facial swelling
            • Other clinical manifestations may include hepatitis, nephritis, hematological abnormalities, myocarditis, or myositis; sometimes symptoms of DRESS may resemble an acute viral infection
            • Eosinophilia is often present; because this disorder is variable in its presentation, other organ systems not noted here may be involved
            • Early manifestations of hypersensitivity, such as fever or lymphadenopathy, may be present even though rash is not evident; if such signs or symptoms are present, discontinue therapy and evaluate the patient immediately
            Previous
            Next:

            Pregnancy & Lactation

            Pregnancy

            Use of NSAIDs can cause premature closure of fetal ductus arteriosus and fetal renal dysfunction leading to oligohydramnios and, in some cases, neonatal renal impairment

            Because of these risks, limit dose and duration of use between about 20 and 30 weeks of gestation, and avoid use at about 30 weeks of gestation and later in pregnancy

            Use of NSAIDs at about 30 weeks gestation or later in pregnancy increases risk of premature closure of fetal ductus arteriosus

            Avoid use of NSAIDs in women at about 30 weeks gestation and later in pregnancy, because NSAIDs can cause premature closure of fetal ductus arteriosus

            Use of NSAIDs at about 20 weeks gestation or later in pregnancy has been associated with cases of fetal renal dysfunction leading to oligohydramnios, and in some cases, neonatal renal impairment

            If an NSAID is necessary at about 20 weeks gestation or later in pregnancy, limit the use to the lowest effective dose and shortest duration possible; if treatment extends beyond 48 hours, consider monitoring with ultrasound for oligohydramnios; if oligohydramnios occurs, discontinue therapy and follow up according to clinical practice

            Data from observational studies regarding other potential embryofetal risks of NSAID use in women in first or second trimesters of pregnancy are inconclusive

            In animal studies, administration of prostaglandin synthesis inhibitors resulted in increased pre-and post-implantation loss

            Prostaglandins also have been shown to have an important role in fetal kidney development; in published animal studies, prostaglandin synthesis inhibitors have been reported to impair kidney development when administered at clinically relevant doses

            Lactation

            Excreted in human milk

            Limited data from one published study involving ten nursing mothers 2-6 days postpartum showed low levels of ketorolac in breast milk

            Exercise caution when administering drug to a nursing woman; available information has not shown any specific adverse events in nursing infants; however, instruct patients to contact their infant’s health care provider if they note any adverse events

            The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for the drug and any potential adverse effects on the breastfed infant from the drug or from the underlying maternal condition

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

            Previous
            Next:

            Pharmacology

            Mechanism of Action

            Inhibits synthesis of prostaglandins in body tissues by inhibiting at least 2 cyclooxygenase isoenzymes, cyclooxygenase-1 (COX-1) and -2 (COX-2)

            May inhibit chemotaxis, may alter lymphocyte activity, decrease proinflammatory cytokine activity, and may inhibit neutrophil aggregation. These effects may contribute to its anti-inflammatory activity

            Pharmacokinetics

            Bioavailability: 60% (compared with 30 mg IM)

            Peak plasma time: 0.75 hr

            Peak plasma concentration: 1805.8 ng/mL

            Protein bound: 99% (5% to albumin)

            Vd: 13 L

            Metabolism: By liver via hydroxylation and conjugation

            Half-life: 5.24 hr; 6-19 hr with renal impairment

            Excretion: 92% urine (~40% as metabolites); 6% feces

            Previous
            Next:

            Administration

            Intranasal Administration

            Is not an inhaled product; do not inhale when administering this product

            Do not use concomitantly with other formulations of ketorolac or other NSAIDs

            Activate pump

            • Activate the pump before using the bottle for the FIRST time, activate the pump
            • To activate the pump, hold the bottle at arm’s length away from the body with index finger and middle finger resting on the top of the finger flange and thumb supporting the base
            • Press down evenly and release the pump 5 times; patient may not see a spray the first few times it is pressed down
            • No need to activate the pump again if more doses are used from the bottle

            Patient instructions

            • Step 1
              • Blow nose gently to clear nostrils
              • Sit up straight or stand; tilt head slightly forward
              • Insert the tip of the container into your right nostril
              • Point the container away from the center of your nose
              • Hold your breath and spray once into your right nostril, pressing down evenly on both sides
              • Immediately after administration, resume breathing through mouth to reduce expelling the product
              • Also pinch the nose to help retain the spray if it starts to drip
              • If only one spray per dose is prescribed, administration is complete; skip to Step 3 below
            • Step 2
              • If a dose of 2 sprays is prescribed, repeat the process in Step 1 for the left nostril
              • Again, be sure to point the spray away from the center of nose
              • Spray once into the left nostril
            • Step 3
              • Replace the clear plastic cover and place the bottle in a cool, dry location out of direct sunlight
              • Keep out of reach of children
              • Discard bottle within 24 hr after first priming, even if bottle still contains medication (will not deliver intended dose after 24 hr)

            Storage

            Protect from light and freezing

            Refrigerate unopened bottle at 2-8°C (36-46°F)

            Store at controlled room temperature during use, between 15-30°C (59-86°F), out of direct sunlight

            Discard within 24 hr of priming

            Previous
            Next:

            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            ketorolac intramuscular
            -
            60 mg/2 mL vial
            ketorolac intramuscular
            -
            60 mg/2 mL vial
            ketorolac intramuscular
            -
            60 mg/2 mL vial
            ketorolac intramuscular
            -
            60 mg/2 mL solution
            ketorolac intramuscular
            -
            60 mg/2 mL vial
            ketorolac intramuscular
            -
            60 mg/2 mL vial
            ketorolac intramuscular
            -
            60 mg/2 mL vial
            ketorolac intramuscular
            -
            60 mg/2 mL vial
            ketorolac intramuscular
            -
            60 mg/2 mL solution
            ketorolac intramuscular
            -
            60 mg/2 mL vial
            ketorolac intramuscular
            -
            60 mg/2 mL vial
            Acular LS ophthalmic (eye)
            -
            0.4 % drops
            Acular ophthalmic (eye)
            -
            0.5 % drops
            Sprix nasal
            -
            15.75 mg/spray liquid
            Sprix nasal
            -
            15.75 mg/spray liquid
            ketorolac nasal
            -
            15.75 mg/spray liquid
            ketorolac injection
            -
            30 mg/mL (1 mL) vial
            ketorolac injection
            -
            15 mg/mL vial
            ketorolac injection
            -
            15 mg/mL vial
            ketorolac injection
            -
            15 mg/mL vial
            ketorolac injection
            -
            30 mg/mL vial
            ketorolac injection
            -
            30 mg/mL (1 mL) vial
            ketorolac injection
            -
            15 mg/mL vial
            ketorolac injection
            -
            30 mg/mL (1 mL) vial
            ketorolac injection
            -
            15 mg/mL solution
            ketorolac injection
            -
            30 mg/mL solution
            ketorolac injection
            -
            30 mg/mL (1 mL) vial
            ketorolac injection
            -
            30 mg/mL (1 mL) vial
            ketorolac injection
            -
            30 mg/mL (1 mL) vial
            ketorolac injection
            -
            30 mg/mL (1 mL) vial
            ketorolac injection
            -
            15 mg/mL vial
            ketorolac injection
            -
            30 mg/mL solution
            ketorolac injection
            -
            15 mg/mL vial
            ketorolac injection
            -
            30 mg/mL (1 mL) vial
            ketorolac injection
            -
            15 mg/mL vial
            ketorolac injection
            -
            30 mg/mL (1 mL) vial
            ketorolac injection
            -
            30 mg/mL (1 mL) vial
            ketorolac injection
            -
            15 mg/mL vial
            ketorolac injection
            -
            30 mg/mL solution
            ketorolac ophthalmic (eye)
            -
            0.4 % drops
            ketorolac ophthalmic (eye)
            -
            0.5 % drops
            ketorolac ophthalmic (eye)
            -
            0.5 % drops
            ketorolac ophthalmic (eye)
            -
            0.5 % drops
            ketorolac ophthalmic (eye)
            -
            0.5 % drops
            ketorolac ophthalmic (eye)
            -
            0.5 % drops
            ketorolac ophthalmic (eye)
            -
            0.5 % drops
            ketorolac ophthalmic (eye)
            -
            0.5 % drops
            ketorolac ophthalmic (eye)
            -
            0.5 % drops
            ketorolac ophthalmic (eye)
            -
            0.5 % drops
            ketorolac ophthalmic (eye)
            -
            0.5 % drops
            ketorolac ophthalmic (eye)
            -
            0.5 % drops
            ketorolac oral
            -
            10 mg tablet
            ketorolac oral
            -
            10 mg tablet
            ketorolac oral
            -
            10 mg tablet

            Copyright © 2010 First DataBank, Inc.

            Previous
            Next:

            Patient Handout

            Select a drug:
            Patient Education
            ketorolac nasal

            KETOROLAC SPRAY - NASAL

            (KEE-toe-ROLE-ak)

            COMMON BRAND NAME(S): Sprix

            WARNING: Do not use any ketorolac products (including this nasal spray, tablets, or injection) for more than a total of 5 days. Do not use this medication for minor or long-term painful conditions.This drug may rarely cause serious (rarely fatal) bleeding from the stomach or intestines. This effect can occur without warning at any time while using this drug. Older adults may be at higher risk for this effect. Do not use this medication if you have stomach/intestinal problems (such as ulcers, bleeding).This drug may also increase your risk of serious bleeding in other parts of your body. Do not use this medication if you have bleeding or blood clotting problems, or are at high risk for bleeding.Nonsteroidal anti-inflammatory drugs (including ketorolac) may rarely increase the risk for a heart attack or stroke. This effect can happen at any time while using this drug but is more likely if you use it for a long time. The risk may be greater in older adults or if you have heart disease or increased risk for heart disease (for example, due to smoking, family history of heart disease, or conditions such as high blood pressure or diabetes). Talk to your doctor about the benefits and risks of using this drug.Do not use this drug right before or after heart bypass surgery (CABG) or before any surgery. It also should not be used during labor/delivery or in people with severe kidney problems or high risk for kidney problems.Stop using ketorolac and get medical help right away if you notice any of the following rare but serious side effects: bloody or black/tarry stools, stomach/abdominal pain, vomit that looks like coffee grounds, unusual or easy bruising/bleeding, chest/jaw/left arm pain, shortness of breath, unusual sweating, weakness on one side of the body, sudden vision changes, trouble speaking.

            USES: Ketorolac is used for the short-term treatment (up to 5 days) of moderate to severe pain in adults, such as after surgery. Reducing pain helps you recover more comfortably so you can return to your normal daily activities. This medication is a nonsteroidal anti-inflammatory drug (NSAID). It works by decreasing inflammation, swelling, and pain.

            HOW TO USE: Read the Medication Guide provided by your pharmacist before you start using ketorolac and each time you get a refill. Also read and follow the product instructions for how to properly prime and use this nasal spray. If you have any questions, ask your doctor or pharmacist.Spray this medication in your nose as directed by your doctor, usually every 6 to 8 hours. Your doctor may adjust your dosage so that you spray the medication in only one nostril instead of both nostrils. The dosage is based on your medical condition, age, weight, and response to treatment.To reduce your risk of stomach bleeding and other side effects, use this medication at the lowest effective dose for the shortest possible time. Do not increase your dose or use this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of side effects will increase.Use this medication regularly to get the most benefit from it. To help you remember, use it at the same times each day.If you are using this drug "as needed" (not on a regular schedule), remember that pain medications work best if they are used as the first signs of pain occur. If you wait until the pain has worsened, the medicine may not work as well.Drink plenty of fluids during treatment with this medication. This will help reduce the risk of kidney problems.Avoid getting this medication in your eyes. If this occurs, rinse your eyes with water or saline and call your doctor if eye irritation lasts.Tell your doctor if your condition does not improve or if it worsens.

            SIDE EFFECTS: See also Warning section.Mild and temporary irritation/discomfort in the nose may occur. Upset stomach, nausea, dizziness, or drowsiness may also occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.Tell your doctor right away if you have any serious side effects, including: headache that is severe or doesn't go away, signs of kidney problems (such as change in the amount of urine), hearing changes (such as ringing in the ears), mental/mood changes, unexplained stiff neck, signs of infection (such as sore throat that doesn't go away, fever, chills), symptoms of heart failure (such as swelling ankles/feet, unusual tiredness, unusual/sudden weight gain).This drug may rarely cause serious (possibly fatal) liver disease. Stop using ketorolac and get medical help right away if you have any symptoms of liver damage, including: nausea/vomiting that doesn't stop, loss of appetite, stomach/abdominal pain, yellowing eyes/skin, dark urine.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: fever, swollen lymph nodes, 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: See also Warning section.Before using ketorolac, tell your doctor or pharmacist if you are allergic to it; or to aspirin; or to other NSAIDs (such as ibuprofen, naproxen, celecoxib); or if you have any other allergies. This product may contain inactive ingredients (such as EDTA), 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: asthma (including a history of worsening breathing after taking aspirin or other NSAIDs), growths in the nose (nasal polyps), heart disease (such as previous heart attack), high blood pressure, liver disease, swelling of the hands/ankles/feet (edema).Kidney problems can sometimes occur with the use of NSAID medications, including ketorolac. Problems are more likely to occur if you are dehydrated, have heart failure or kidney disease, are an older adult, or if you take certain medications (see also Drug Interactions section). Drink plenty of fluids as directed by your doctor to prevent dehydration and tell your doctor right away if you have a change in the amount of urine.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. Talk to your doctor if you are using marijuana (cannabis).Daily use of alcohol and tobacco, especially when combined with this medication, may increase your risk for stomach bleeding. Limit alcohol and stop smoking.This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be at greater risk for stomach/intestinal bleeding, kidney problems, heart attack, and stroke while using this drug.Before using this medication, women of childbearing age should talk with their doctor(s) about the benefits and risks. Tell your doctor if you are pregnant or if you plan to become pregnant. This medication may harm an unborn baby and cause problems with normal labor/delivery. It is not recommended for use in pregnancy from 20 weeks until delivery. If your doctor decides that you need to use this medication between 20 and 30 weeks of pregnancy, you should use the lowest effective dose for the shortest possible time. You should not use this medication after 30 weeks of pregnancy.This drug passes into breast milk. 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: aliskiren, ACE inhibitors (such as captopril, lisinopril), angiotensin II receptor blockers (such as valsartan, losartan), cidofovir, probenecid, corticosteroids (such as prednisone), "water pills" (diuretics such as furosemide).This medication may increase the risk of bleeding when used with other drugs that also may cause bleeding. Examples include anti-platelet drugs such as clopidogrel, "blood thinners" such as dabigatran/enoxaparin/warfarin, pentoxifylline, among others.Do not use this medication with other forms of ketorolac, high doses of aspirin, or other NSAIDs.Check all prescription and nonprescription medicine labels carefully since many medications contain pain relievers/fever reducers (aspirin, NSAIDs such as ibuprofen or naproxen). These drugs are similar to ketorolac and may increase your risk of side effects if taken together. However, if your doctor has directed you to take low-dose aspirin to prevent heart attack or stroke (usually 81-162 milligrams a day), you should continue taking the aspirin unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details.

            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: nausea, vomiting, stomach pain, drowsiness.

            NOTES: Do not share this medication with others.Lab and/or medical tests (including blood pressure, kidney function) may be done while you are using this medication. Keep all medical and lab appointments. Consult your doctor for more details.

            MISSED DOSE: If you are using this medication on a regular schedule (not just "as needed") and you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Refrigerate unopened bottles. Do not freeze. Store the opened bottle in use at room temperature, away from light and direct sunlight. Since this medication does not contain preservatives, throw away the bottle 24 hours after you first use it, even if there is still some medication left in it. 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 December 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.

            Previous
            Next:

            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous
            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.