Limited Use Note(s)

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Reason For Use CodeClinical Criteria
171As first line treatment of elevated intraocular pressure in patients who cannot tolerate an ophthalmic beta-blocking agent or where beta-blocking agents are contraindicated.
LU Authorization Period: Indefinite.
172As second line monotherapy or combination therapy in patients who do not have an adequate intraocular pressure lowering response to ophthalmic beta-blocking agents.
LU Authorization Period: Indefinite.
387For use as adjunctive therapy with an ophthalmic beta-blocking agent in an urgent situation (e.g. patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective.
LU Authorization Period: Indefinite.