XURIDEN (uridine triacetate)

XURIDEN (uridine triacetate)

ORAL ADMINISTRATION

Indications for Prior Authorization:

• Hereditary orotic aciduria (Xuriden): Treatment of hereditary orotic aciduria

All of the following must be met as a condition for coverage:

• Use for uridine replacement for treatment of hereditary orotic aciduria (as documented by chart notes)

This Medication is Not Approvable for the following condition(s).

• Any condition not listed above as an approved indication

Dosing:

• Initial dosage: 60 mg/kg once daily
• Maximum dose: 8 g/day

Dosage adjustment:

Increase to 120 mg/kg (maximum: 8 g) for insufficient efficacy (eg, urine orotic acid levels remaining above normal or increasing above the usual/expected range for the patient; lab values affected by orotic acid [red or white blood cell indices] worsening; worsening disease signs/symptoms)

Approval:  

One year