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
carglumic acid 100 mg/Kg/day to 250 mg/Kg/day round to the nearest 100 mg dose
Western Health Advantage Pharmacy and Therapeutics Committee
Approved/Revised: November 2010 Reviewed: December 2013