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

Dosing:

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

Approval:

One year


 

Last review date: December 2, 2013

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