RUCONEST (recombinant C1 esterase inhibitor)
OFFICE ADMINISTRATION
Indications for Prior Authorization:
- Indicated for the treatment of acute attacks in adult and adolescent patients with hereditary angioedema (HAE)
Patient must meet the following criteria for the above indications:
- Diagnosis of HAE
The following indications do not meet the criteria for use established by the Western Health Advantage Pharmacy and Therapeutics Committee:
- Not approvable for laryngeal HAE attacks
- For any indications not mentioned above
Dosing:
- The recommended dose is 50 IU per Kg. The maximum dose is 4,200 IU for patients weighing over 84 Kg. The dose is given IV over 5 minutes
- If symptoms persist, a second dose can be administered at the recommend dose level. No more than 2 doses should be administered within a 24 hour period
Approval:
One year
Last review date: September 1, 2014