XERMELO (telotristat ethyl)
SELF ADMINISTRATION - ORAL
Indications for Prior Authorization:
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Treatment of carcinoid syndrome diarrhea in combination with somatostatin analog (SSA) therapy in adults inadequately controlled by SSA therapy
Patients must meet the following criteria for the indication(s) above:
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Diagnosis of carcinoid syndrome diarrhea
- 18 years of age or older
- Patient is followed by a specialist (oncologist or gastroenterologist)
- Patient is inadequately controlled on maximum SSA therapy and needs additional therapy
- Approval for a maximum of 250mg three times daily
Dosing:
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250mg orally three times daily with food
- If used in combination with short-acting octretotide, administer octreotide at least 30 minutes after telotristat ethyl
Approval:
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Initial: 3 months
- Renewal: 1 year
Last review date: May 1, 2017