Order Drug Samples Online

Thank you for your interest in obtaining samples from Laser Pharmaceuticals. We look forward to providing you with any additional information you may need to learn more about our products. If you are a licensed healthcare provider in your state, please complete the form below and fax a signed copy to 864-286-8230.

Please select the product samples you are interested in receiving:


DALLERGY - Effective relief for the symptoms of congestion, runny nose, itchy-watery eyes, sneezing, post-nasal drip, and hay fever
NDC Item and Size Active Ingredients Qty
 16477-120-30 Dallergy Drops (30 mL) Phenylephrine HCI, Chlorpheniramine Maleate 1
 16477-152-20 Dallergy Chewable Tablet (20 ct bin) Chlorcyclizine HCl, Phenylephrine HCl 2
 16477-160-20 Dallergy Tablets (20 ct bin) Chlorcyclizine HCl, Phenylephrine HCl 2
 16477-820-15 Dallergy Syrup (15mL) Chlorcyclizine HCl, Phenylephrine HCl 12


MILLIPRED - Family of Prednisolone based steriods available in tablets, dose packs & a great tasting oral solution that doesn't require refrigeration.
NDC Item and Size Active Ingredients Qty
 16477-505-12 Millipred Tablet (12 cnt.) Prednisolone, 5mg 2
 16477-510-15 Millipred Oral Solution (15mL) Prednisolone Sodium Phosphate 8


DONATUSSIN - Effective relief of coughs and nasal congestion, helping to clear bronchial passageways of mucus, making coughs more productive.
NDC Item and Size Active Ingredients Qty
 16477-0106-30 Donatussin Drops (30 mL) Phenylephrine HCI, Guaifenesin 2
 16477-0811-30 Donatussin DM Drops (30 mL) Chlorpheniramine Maleate, Dextromethorphan HBr, Phenylephrine HCI 2
 16477-185-15 Donatussin Syrup (15mL) Chlophedianol, Guaifenesin, Phenylephrine HCL 12


NEO - Provides relief of cough and upper respiratory symptoms, including nasal congestion.
NDC Item and Size Active Ingredients Qty
 16477-0620-30 NEO DM Drops (30 mL) Dextromethorphan HBr, Chlorpheniramine Maleate, Phenylephrine HCI 2
 16477-562-30 Neo DM Syrup (30mL) Dextromethorphan HBr, Pseudoephedrine HCl, Brompheniramine Maleate 12


OTHER
NDC Item and Size Active Ingredients Qty
 *16477-0701-60 Cesinex (60 mL) Dried Egg Whites, Tannic Acid 4
 16477-0306-20 Respaire 30 IR Capsules (20 Cnt.) Guaifenesin, Pseudoephedrine HCI 2
 16477-401-20 Cyclivert Tablets (20 ct bin) Cyclizine 2
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* Cesinex is a medical food and has been assigned a product code formatted to standard industry practice.

If all the above information is correct, please submit the form.
You will then see a printable copy, which must be signed and faxed to Laser Pharmaceuticals, LLC.