Product Details

Firazyr

Icatibant
30 mg/3 mL
Solution for Subcutaneous Injection
Single-Use 3-mL Pre-Filled Syringe

DIN/PIN/NPN

02425696

Manufacturer

Takeda Canada Inc.

Formulary Listing Date

2015-11-05  

Unit Price

2,700.0000

Amount MOH Pays

2,700.0000

Coverage Status

Exceptional Access Program Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

B06AC02

Interchangeable Products

NO  

LU Clinical Criteria

NO  

EAP Criteria

Therapeutic Class Reimbursement Criteria
Blood Modifiers

Icatibant

  • Brand(s): Firazyr
  • Dosage Form/Strength: 30 mg/3 mL prefilled syringe

For the treatment of acute attacks of type I or type II hereditary angioedema (HAE) in adults with lab confirmed c1-esterase inhibitor deficiency if the following conditions are met: 

  1. Treatment of acute non-laryngeal attacks of at least moderate severity; OR 

  1. Treatment of acute laryngeal attacks; AND 

  1. Must be prescribed by physicians (e.g., immunologists, allergists or hematologists) with experience in the treatment of HAE. 

Notes: 

  • Documentation of diagnosis (e.g. patient and family history, symptoms, lab test results) must be provided. 

  • For acute non-laryngeal attacks, documentation of severity (frequency, location, and degree of swelling) must be provided 

Doses for acute treatment are limited to a single dose for self-administration per attack. 

Duration of Approval: Lifetime

EAP Drug Request Form:

Standard Form for EAP Drug Requests

Product Monograph

View Monograph