FormWeb • agalsidase beta

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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agalsidase beta

agalsidase beta

Restricted Miscellaneous Program Formulary
Restricted Fabrazyme --> Restricted to Outpatient Medical and admin approval.

Drug Name	Form	Strength	Formulary Unrestricted	Formulary Restricted	Non-Formulary	Interchange
Fabrazyme	POWDER FOR INJECTION, INTRAVENOUS	35 mg

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Comments:

Fabrazyme is restricted to outpatient use. An evaluation of patient case and pharmacy administration approval are required.

FABRAZYME is approved for use for a specific patient - to be infused at Outpatient Medical.

Reviewed: May 27, 2014

Last updated: Feb. 25, 2019

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