LymePak (Page 5 of 5)

PRINCIPAL DISPLAY PANEL — 100 mg Tablet Blister Pack Carton

NDC 72336-596-87

LYMEPAK
(doxycycline hyclate tablets)

Contains 3 Cards Each Card with:
14 Tablets | 21 Day Supply

100mg*

R x Only

PRINCIPAL DISPLAY PANEL -- 100 mg Tablet Blister Pack Carton
(click image for full-size original)
LYMEPAK
doxycycline hyclate tablet, film coated
Product Information
Product Type HUMAN PRESCRIPTION DRUG Item Code (Source) NDC:72336-596
Route of Administration ORAL DEA Schedule
Active Ingredient/Active Moiety
Ingredient Name Basis of Strength Strength
DOXYCYCLINE HYCLATE (DOXYCYCLINE ANHYDROUS) DOXYCYCLINE ANHYDROUS 100 mg
Inactive Ingredients
Ingredient Name Strength
ANHYDROUS LACTOSE
SILICON DIOXIDE
D&C YELLOW NO. 10
FD&C BLUE NO. 1
FD&C YELLOW NO. 6
HYPROMELLOSE, UNSPECIFIED
MAGNESIUM STEARATE
METHYLCELLULOSE (400 MPA.S)
MICROCRYSTALLINE CELLULOSE
POLYETHYLENE GLYCOL, UNSPECIFIED
SODIUM STARCH GLYCOLATE TYPE A POTATO
STEARIC ACID
TITANIUM DIOXIDE
Product Characteristics
Color green Score no score
Shape ROUND Size 9mm
Flavor Imprint Code LP1
Contains
Packaging
# Item Code Package Description Multilevel Packaging
1 NDC:72336-596-87 3 BLISTER PACK in 1 CARTON contains a BLISTER PACK (72336-596-86)
1 NDC:72336-596-86 14 TABLET, FILM COATED in 1 BLISTER PACK This package is contained within the CARTON (72336-596-87)
Marketing Information
Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date
NDA NDA209844 09/10/2021
Labeler — LIFSA DRUGS LLC (081205160)
Establishment
Name Address ID/FEI Operations
Chartwell Pharmaceuticals LLC 962619982 analysis (72336-596), label (72336-596), manufacture (72336-596), pack (72336-596)

Revised: 09/2021 LIFSA DRUGS LLC

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