MEDIUM CHAIN TRIGLYCERIDES
Body System:
Manner of administration:Oral
Restriction (Streamlined authority code: 6181)
Indication: Chylous ascites
Restriction (Streamlined authority code: 6134)
Indication: Chylothorax
Restriction (Streamlined authority code: 6164)
Indication: Fat malabsorption
Restriction (Streamlined authority code: 6203)
Indication: Hyperlipoproteinaemia type 1
Restriction (Streamlined authority code: 6155)
Indication: Intractable childhood epilepsy
Restriction (Streamlined authority code: 6135)
Indication: Cerebrospinal fluid glucose transporter defect
Restriction (Streamlined authority code: 6146)
Indication: Long chain fatty acid oxidation disorders
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 8 | Max qty units: 8 | # of repeats: 5 | DPMQ: $170.88 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Liquigen | |||||