Histamine 2 Blocker Drugs – Nizatidine

Generic Name            

nizatidine                                         

Strength

150 mg, 300 mg
Form

capsule

Criteria

Approval Period

Treatment failure on prescription dose of, or intolerance to, ranitidine.

Indefinite

Practitioner Exemptions

Practitioners in the following specialty are not required to submit a Special Authority request form for coverage:

  • Paediatric Cardiology
  • Paediatrics
  • Paediatric General Surgery

Special Notes

  • Prescription dose of ranitidine for adults is considered to be 150 mg twice daily or 300 mg once daily.

Special Authority Request Form(s)