FormWeb • alglucosidase alfa

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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alglucosidase alfa

alglucosidase alfa

Restricted Rarely Used Drugs and Expensive (RUDE)
Restricted Lumizyme, Myozyme --> Restricted to Outpatient Medical with administration approval.

Drug Name	Form	Strength	Formulary Unrestricted	Formulary Restricted	Non-Formulary	Interchange
Lumizyme	POWDER FOR INJECTION, INTRAVENOUS	50 mg
Myozyme	POWDER FOR INJECTION, INTRAVENOUS	50 mg

Comments:

Both classified as restricted to outpatient, if case arises notify pharmacy administration for approval, each case will be evaluated on an individual basis, referral to a treatment center would be considered.

Lumizyme approved for a specific patient to receive at Outpatient Medical on a longterm basis.

Reviewed: June 27, 2006 (Myozyme), September 29, 2010 and September 25, 2013 (Lumizyme)

Last updated: Dec. 28, 2017

Black Box Warning: Anaphylaxis; Cardiorespiratory Failure

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