FormWeb • alemtuzumab

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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alemtuzumab

alemtuzumab

Restricted Miscellanous Formulary
Restricted Campath --> Restricted to Oncology use.
Non-formulary Lemtrada --> Non-Formulary

Drug Name	Form	Strength	Formulary Unrestricted	Formulary Restricted	Non-Formulary	Interchange
Lemtrada	SOLUTION, INJECTABLE	12 mg/1.2 mL
Campath	SOLUTION, INTRAVENOUS	30 mg/mL

Comments:

Lemtrada medication guide

Lemtrada --> Non-Formulary. The hospital cannot stock Lemtrada and is distributed to outpatient sites only for specific patient dosages. Each patient case will be reviewed for specific needs and reimbursements and a plan developed to receive the drug. Medication procured as patient own supply or PAP may be administered.

Campath --> restricted to special distribution program where physician and patient must be registered with the company. Hospital cannot order, must come from patients own supply.

Reviewed: 15 December 2015 (Lemtrada)

REMS (Lemtrada): View FDA REMS Info

Last updated: Apr. 23, 2021

Black Box Warning: Hematological toxicity; opportunistic infections
Chemotherapy:

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