Histamine 2 blocker drugs – cimetidine
Special Authority requests can now be submitted online. It's simple and quick!
Learn more or log in.
Generic name |
cimetidine |
---|---|
Strength |
200 mg, 300 mg |
Form |
tablet |
Special Authority 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:
- Pediatrics
- Pediatric cardiology
- Pediatric general surgery
Special notes
- Prescription dose of ranitidine for adults is considered to be 150 mg twice daily or 300 mg once daily