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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.
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viltolarsen

viltolarsen
Drug Name Form Strength Infusion Center Available Restricted Non-formulary Ambulatory Available Interchange REMS
Viltepso SOLUTION, INTRAVENOUS 250 mg/5 mL (50 mg/mL)          
VIEW MORE Antisense Oligonucleotides
CLASS
921800
Additional Information and Links

Criteria for use:

  • Service line: Pediatrics, PMR, Neurology
  • Prior authorization completed and approved
  • Diagnosis: DMD with confirmed mutation of DMD gene, that is amenable to exon 53 skipping
  • Male age ≥ 4 years of age
  • On a stable glucocorticoid dose for at least 3 months
  • Lab monitoring:
    • Baseline Serum cystatin C, urine dipstick, and urine protein-to-creatinine ratio, glomerular filtration rate (optional)
    • Urine analysis prior to infusion or at least 48 hours after most recent infusion
Last updated: Sep. 19, 2021

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