Limited Use Note(s)

Reason For Use CodeClinical Criteria
384For use in combination with an alpha blocker for the treatment of men with symptomatic* Benign Prostatic Hyperplasia.
LU Authorization Period: Indefinite.
385For monotherapy, as a second line agent in patients with symptomatic* Benign Prostatic Hyperplasia following treatment failure or intolerance to an alpha blocker.
* Symptomatic is defined as having moderate (about half the time) to severe (almost always) symptoms related to the prostate in at least 4 of the following domains: 1. feeling of incomplete emptying of the bladder after voiding 2. needing to urinate again less than 2 hours after previous void 3. stopping and starting urine several times while voiding 4. difficulty postponing urination 5. weak urinary stream 6. pushing or straining to begin voiding 7. the need to get up to void at least 3 times in the night.
LU Authorization Period: Indefinite.