H2 Blocker Drugs - Special Authority Criteria
| Generic Name / Strength / Form |
| nizatidine |
| Criteria |
Approval Period |
| 1. Treatment failure or intolerance to cimetidine or ranitidine. | 1. Indefinite |
OR |
2. Concurrent treatment with warfarin, phenytoin or theophylline. |
2. First approval: One year Renewals: One year |
Practitioner Exemptions
- No practitioner exemptions
Special Notes
Online Form (PDF)
Click on the link to complete a special authority request form.
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