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NDC 50991-0132-16 Polytussin DM 7.5; 5; 12.5 mg/5mL; mg/5mL; mg/5mL Details
Polytussin DM 7.5; 5; 12.5 mg/5mL; mg/5mL; mg/5mL
Polytussin DM is a ORAL SYRUP in the HUMAN OTC DRUG category. It is labeled and distributed by Poly Pharmaceuticals, Inc.. The primary component is DEXTROMETHORPHAN HYDROBROMIDE; PHENYLEPHRINE HYDROCHLORIDE; PYRILAMINE MALEATE.
Product Information
| NDC | 50991-0132 |
|---|---|
| Product ID | 50991-132_fda90ac0-7479-4cd6-e053-6294a90abbf0 |
| Associated GPIs | |
| GCN Sequence Number | 085040 |
| GCN Sequence Number Description | pyrilamine/phenylephrine/DM LIQUID 12.5-5MG/5 ORAL |
| HIC3 | B3R |
| HIC3 Description | NON-OPIOID ANTITUS-1ST GEN.ANTIHISTAMINE-DECONGEST |
| GCN | 54479 |
| HICL Sequence Number | 035673 |
| HICL Sequence Number Description | PYRILAMINE MALEATE/PHENYLEPHRINE HCL/DEXTROMETHORPHAN HBR |
| Brand/Generic | Brand |
| Proprietary Name | Polytussin DM |
| Proprietary Name Suffix | n/a |
| Non-Proprietary Name | Dextromethorphan HBr, Phenylephrine HCl, Pyrilamine Maleate |
| Product Type | HUMAN OTC DRUG |
| Dosage Form | SYRUP |
| Route | ORAL |
| Active Ingredient Strength | 7.5; 5; 12.5 |
| Active Ingredient Units | mg/5mL; mg/5mL; mg/5mL |
| Substance Name | DEXTROMETHORPHAN HYDROBROMIDE; PHENYLEPHRINE HYDROCHLORIDE; PYRILAMINE MALEATE |
| Labeler Name | Poly Pharmaceuticals, Inc. |
| Pharmaceutical Class | Adrenergic alpha1-Agonists [MoA], Sigma-1 Agonist [EPC], Sigma-1 Receptor Agonists [MoA], Uncompetitive N-methyl-D-aspartate Receptor Antagonist [EPC], Uncompetitive NMDA Receptor Antagonists [MoA], alpha-1 Adrenergic Agonist [EPC] |
| DEA Schedule | n/a |
| Marketing Category | OTC MONOGRAPH FINAL |
| Application Number | part341 |
| Listing Certified Through | 2024-12-31 |
Package
NDC 50991-0132-16 (50991013216)
| NDC Package Code | 50991-132-16 |
|---|---|
| Billing NDC | 50991013216 |
| Package | 480 mL in 1 BOTTLE (50991-132-16) |
| Marketing Start Date | 2023-06-08 |
| NDC Exclude Flag | N |
| Pricing Information | |
| Price Per Unit | 0.0566 |
| Pricing Unit | ML |
| Effective Date | 2023-11-22 |
| NDC Description | POLYTUSSIN DM 7.5-5-12.5 MG/5 ML |
| Pharmacy Type Indicator | C/I |
| OTC | Y |
| Explanation Code | 4, 5 |
| Classification for Rate Setting | G |
| As of Date | 2024-02-21 |
This pricing file, entitled the NADAC (National Average Drug Acquisition
Cost) files, provide
state Medicaid agencies with covered outpatient drug prices by averaging
survey invoice
prices from retail community pharmacies across the United States. These
pharmacies include
independent retail community pharmacies and chain pharmacies. The prices
are updated on a
weekly and monthly basis