FormWeb • emicizumab

Huntsville Hospital

Approved Hospital Formulary

Suggestions or Corrections? Above and Beyond Nominations Formulary Request

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Medications not yet evaluated by P&T are considered NON-FORMULARY . . . . . Always check 2 unique patient identifiers - NAME and DATE OF BIRTH - at every step! . . . . . Please be sure to document all clinical activities daily.

Huntsville Hospital

Approved Hospital Formulary

Suggestions or Corrections? Above and Beyond Nominations Formulary Request

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Emicizumab

emicizumab

Restricted Hemlibra--> Restricted to outpatient hematology/oncology use.

Drug Name	Form	Strength	Formulary Unrestricted	Formulary Restricted	Non-Formulary	Interchange
Hemlibra	SOLUTION, SUBCUTANEOUS	30 mg/mL, 60 mg/0.4 mL, 105 mg/0.7 mL, 150 mg/mL

Comments:

Hemlibra is generally inteded for self-administration at home. Restricted to outpatient orders by hematology/oncology specalists for FDA approved indication. Inpatients may use own supply if necessary; if own supply not available, pharmacist to contact MD to discuss possible use of Helixate FS as alternative to inpatient use.

Reviewed: 26 June 18 (Hemlibra)

Last updated: Jun. 28, 2018

Black Box Warning: Thrombotic Microangiopathy and Thromboembolism
Formulary, Not Routinely Stocked: Hemlibra--> 30 mg/mL, 60 mg/0.4 mL, 105 mg/0.7 mL, 150 mg/mL

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