Bosentan (Tracleer®)

SELF ADMINISTRTION - ORAL

Indications for Prior Authorization:

  • Indicated for the treatment of pulmonary hypertension to improve exercise ability

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

  • Diagnosis of primary pulmonary hypertension class II, III, or IV symptoms confirmed by a cardiologist/pulmonologist/rheumatologist

The Following Conditions Do Not Meet the Criteria for Use as Established by the WHA P & T Committee:

  • Peripheral vasoconstriction
  • Patients on tadalafil or sildenafil therapy
  • All non-FDA approved uses not listed in the approved indications

Dosing:

Patient < 40 Kg

  • Tracleer: 62.5 mg twice a day
  • Maximum dose: 125 mg per day

Patient > 40 Kg

  • Tracleer: Start at 62.5 mg twice a day for 4 weeks, then 125 mg twice a day
  • Maximum dose: 250 mg per day; adjust dose for impair liver function

Approval:

One year


 

Last review date: December 2, 2013

The site you are transferring to is not hosted by WHA. WHA's Terms of Use and internet Privacy Practices do not apply to your use of this linked site. Please review the policies on privacy and terms of use for the linked site. WHA does not control the accuracy, completeness, or timeliness of the content on the linked site.