Recombinant C1 Esterase Inhibitor (Ruconest®)

OFFICE ADMINISTRATION

Indications for Prior Authorization:

  • Indicated for the treatment of acute attacks in adult and adolescent patients with hereditary angioedema (HAE)

Patient must meet the following criteria for the above indications:

  • Diagnosis of HAE

The following indications do not meet the criteria for use established by the Western Health Advantage Pharmacy and Therapeutics Committee:

  • Not approvable for laryngeal HAE attacks
  • For any indications not mentioned above

Dosing:

  • The recommended dose is 50 IU per Kg. The maximum dose is 4,200 IU for patients weighing over 84 Kg. The dose is given IV over 5 minutes
  • If symptoms persist, a second dose can be administered at the recommend dose level. No more than 2 doses should be administered within a 24 hour period

Approval:

One year


 

Last review date: September 1, 2014

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