NITRAZEPAM

NITRAZEPAM (2723H)

nitrazepam 5 mg tablet, 25
2723H
Body System:
Manner of administration:Oral
General Schedule
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 25 # of repeats: 0 DPMQ: $16.50 Max safety net: $17.98 General Patient Charge: $20.77
Available brands
Alodorm
Mogadon

NITRAZEPAM (2732T)

nitrazepam 5 mg tablet, 25
2732T
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Myoclonic epilepsy

Restriction

Indication: Malignant neoplasia (late stage)

Restriction

Indication: Insomnia

Restriction

Indication: Insomnia
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 50 # of repeats: 5 DPMQ: $19.22 Max safety net: $20.70 General Patient Charge: $23.49
Available brands
Alodorm
Mogadon

NITRAZEPAM (5189D)

nitrazepam 5 mg tablet, 25
5189D
Body System:
Manner of administration:Oral
General Schedule
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 25 # of repeats: 0 DPMQ: $16.50 Max safety net: $17.98 General Patient Charge: $20.77
Available brands
Alodorm
Mogadon

NITRAZEPAM (5359C)

nitrazepam 5 mg tablet, 25
5359C
Body System:
Manner of administration:Oral
Palliative Care
Authority Required

Restriction

Indication: Insomnia
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 50 # of repeats: 3 DPMQ: $19.22 Max safety net: $20.70 General Patient Charge: $23.49
Available brands
Alodorm
Mogadon