Lomitapide (Juxtapid®)

Self administration- Oral

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

Recommended Dosing

  • 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

Approval

One year

  • Box warnings for: hepatotoxicity

Western Health Advantage Pharmacy and Therapeutics Committee

Approved/Revised: March 2013 Reviewed: December 2013