Denosumab Restricted Use Guidelines

Xgeva:

Restricted to use in outpatient formulary in patients with renal dysfunction in whom zoledronic acid (Zometa) may not be used (for patients with CrCl < 30 ml/min, Zometa use is not recommended in bone metastases)

Prolia:

Restricted to use in outpatient formulary in patients with renal dysfunction in whom Reclast may not be used (for patients with CrCl <35 ml/min).

* Patients would need to be scheduled and insurance pre-approved in advance.

Pharmacy will need to order per patient upon a physician order and clearance from insurance.  (Pharmacists: see Marty or Jayne for this).