RUCONEST (recombinant C1 esterase inhibitor)

RUCONEST (recombinant C1 esterase inhibitor)

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