Carglumic acid (Carbaglu®)

Self administration - Oral

Indications for Prior Authorization

  • indicated for the treatment of acute hyperammonemia due to the deficiency of hepatic N-acetylglutamate synthase.

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

  • Diagnosis of hyperammonemia due to the deficiency of hepatic N-acetylglutamate synthase confirmed by enzyme analysis or DNA mutation analysis.
  • Patients may be approved for a three month trial pending the results of the analysis.

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

  • All non-FDA approved uses not listed in the approved indications

Recommended Dosing

carglumic acid 100 mg/Kg/day to 250 mg/Kg/day round to the nearest 100 mg dose

Approval

One year


Western Health Advantage Pharmacy and Therapeutics Committee

Approved/Revised: November 2010 Reviewed: December 2013