DUEXIS (ibuprofen and famotidine)

DUEXIS (ibuprofen and famotidine)

SELF ADMINISTRATION - Oral

Indications for Prior Authorization:

• Indicated for the relief of signs and symptoms of rheumatoid arthritis and osteoarthritis and to decrease the risk of developing upper gastrointestinal ulcers, which in the clinical trials was defined as a gastric and/or duodenal ulcer, in patients who are taking ibuprofen for those indications.  Controlled trials do not extend beyond 6 months.

Patients must meet the following criteria for the indication(s) above:

• Used for the relief of signs and symptoms of rheumatoid arthritis and osteoarthritis and to decrease the risk of developing upper gastrointestinal ulcers, AND
• Chart note documentation is provided and confirms: patient has tried and failed both generic Ibuprofen and generic Famotidine as separate products OR there is a medically appropriate reason why generic alternatives cannot be used as separate products

Dosing:

• 800 mg/26.6 mg as a single tablet administered orally three times per day