FormWeb • alpha 1-proteinase inhibitor

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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Prolastin-C, Zemaira, Aralast

alpha 1-proteinase inhibitor

Restricted Miscellaneous Programs
Restricted Prolastin-C, Zemaira, Aralast --> Restricted to Outpatient Medical.

Drug Name	Form	Strength	Formulary Unrestricted	Formulary Restricted	Non-Formulary	Interchange
Prolastin-C, Zemaira, Aralast	POWDER FOR INJECTION, INTRAVENOUS	500 mg, 1,000 mg

Comments:

Alpha-1- Proteinase Inhibitor (Aralast, Prolastin, Zemaira)- Formulary restricted to outpatient infusion areas, inpatient need is extremely low. Drug given IV infusion once weekly and cost varies from $300 to $1500 or more depending on weight. Patient has been approved to receive Prlastin-C in outpatient medical.

Reviewed: January 31, 2006

Last updated: Dec. 28, 2017

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