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  • Nasal Sol ( ) Prior Authorization Form

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Date Caterpillar Prescription Drug Benefit PRIOR AUTH CRITERIA- NASAL SOLUTION * ( Nasal Solution) M.D. Last Name: M.D. First Name: Physician Phone: Physician Fax: Patient.

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The cost for nasal spray (15.75 mg/inh) is around $2,059 for a supply of 5 spray, depending on the pharmacy you visit. Prices are for cash paying customers only and are not valid with insurance plans.

Discard Used Bottle After 24 Hours Do not use any single bottle for more than one day as it will not deliver the intended dose after 24 hours. Therefore, the bottle must be discarded no more than 24 hours after taking the first dose, even if the bottle still contains some liquid.

is NOT an opioid, NOT a narcotic, and NOT a controlled substance.

ibuprofen Using together with ibuprofen is not recommended. Combining these medications may increase the risk of side effects in the gastrointestinal tract such as inflammation, bleeding, ulceration, and rarely, perforation.

The recommended dose is 31.5 mg (one 15.75 mg spray in each nostril) every 6 to 8 hours. The maximum daily dose is 126 mg (four doses).

Mild and temporary irritation/discomfort in the nose may occur. Upset stomach, nausea, dizziness, or drowsiness may also occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly. This medication may raise your blood pressure.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232