Lomitapide (Juxtapid®)


Indications for Prior Authorization:

  • Treatment of adult patients homozygous familial hypercholesterolemia (HoFH)

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

  • Patient is on low fat diet and other lipid lowering medications with inadequate response
  • All patients must undergo genetic testing to confirm HoFH status

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


  • Initial dose 5 mg orally once a day
  • Increase to 10 mg daily after at least two weeks based on tolerability
  • At four week intervals increase to 20 mg, 40mg, 60 mg (maximum dose) daily if necessary based on efficacy and tolerability


One year

Box warnings for:

  • Hepatotoxicity


Last review date: December 2, 2013

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