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Medications listed are available on OH EPIC Formulary, unless otherwise noted.
Not all formulary medications are available at each facility. Please refer to your local pharmacy for available inventory.
Search results for:

pegcetacoplan ophthalmic

pegcetacoplan ophthalmic
Drug Name Form Strength Infusion Center Available Restricted Non-formulary Ambulatory Available Interchange REMS
Syfovre SOLUTION, INTRAVITREAL 150 mg/mL          
VIEW MORE EENT Drugs, Miscellaneous
CLASS
529200
Additional Information and Links

Restrictions:

  • Treatment of geographic atrophy (GA) secondary to age-related macular degeneration (AMD)
  • Service line: Ophthalmology – Retina service
  • Formulary location: Ambulatory
  • Service location: Ophthalmology clinic
  • Patient population: Adults
  • Prior authorization required: Yes

Criteria of use (all will apply unless specified):

  • Must not have geographic atrophy (GA) secondary to a condition other than dry age-related macular degeneration (AMD)
  • No ocular or periocular infections
  • No active intraocular inflammation
  • Female of childbearing potential: use effective contraception methods to prevent pregnancy during treatment
Last updated: Jul. 18, 2023
  • Ambulatory: Ophthalmology clinic

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