Limited Use Note(s) |
|
Limited Use Note(s) |
|
| Reason For Use Code | Clinical Criteria |
|---|---|
| 645 | For patients unable to swallow or tolerate oral solid dosage forms of amlodipine. |
| LU Authorization Period: 1 year | |
| 706 | For pediatric patients (less than 18 years of age) where the appropriate dose cannot be achieved using a listed solid oral dosage form of amlodipine. |
| LU Authorization Period: 1 year |