MESNA

mesna 400 mg/4 mL injection, 15 x 4 mL ampoules

MESNA (5960Q)

mesna 400 mg/4 mL injection, 15 x 4 mL ampoules
5960Q
Manner of administration:Injection
Section 100 (CT)
Restricted Benefit

Restriction

Indication: Urothelial toxicity
Treatment phase: Prophylaxis or reduction of toxicity
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 15 # of repeats: 5 DPMQ: $51.74 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Uromitexan