Prescribe MuGard® Oral Mucoadhesive in 2 steps
The completed prescription order form should be faxed to 888-307-0071.
NOTE: Electronic prescriptions (eRx) must be sent specifically to: “AllianceRx (Specialty) Walgreens Pharmacy – PENNSYLVANIA”.
It’s important to remember that:
- One bottle of MuGard lasts about one week
- When completing the prescription order form, indicate the initial quantity to be dispensed
- Please complete the entire form, and be sure you and your patient both sign and date the form. Note that accompanying forms can be provided in lieu of certain fields on the prescription order form (ie, the patient bio sheet) as long as all information is provided
- Patients may be contacted by Soleva Assist or the pharmacy if additional information is required
- Additional refills may be required depending on the patient’s cancer regimen and length of treatment
For more information, contact Soleva Assist toll-free at 1-877-319-7272
Indication and Important Safety Information
Indication: MuGard® Oral Mucoadhesive is indicated for the management of oral mucositis/stomatitis (that may be caused by radiotherapy and/or chemotherapy) and all types of oral wounds (mouth sores and injuries), including aphthous ulcers/canker sores and traumatic ulcers, such as those caused by oral surgery or ill-fitting dentures or braces.
Contraindications: MuGard is contraindicated in patients with known hypersensitivity to any of the ingredients in the formulation.
Special Precautions for Use: Patients should avoid eating or drinking for at least one hour after using MuGard. After use, patients should replace the bottle cap and tightly seal the bottle. This product should not be used after the expiration date shown on the carton and product label. Do not use this product in patients with known sensitivity to any of the product’s ingredients. Dilution of the product prior to use is not recommended.