Viberzi

Drug - Viberzi™ (eluxadoline) [Allergan]

May 2016

Therapeutic area - IBS-D

Approval criteria

• Patient must be 18 years of age or older AND
• Have a diagnosis of irritable bowel syndrome with diarrhea (IBD-D) AND
• Patient has not responded adequately to at least two drugs considered to be conventional therapy [e.g., dicyclomine, hyoscyamine, loperamide, diphenoxylate/atropine, fiber supplementation] for IBS

Denial criteria

• Severe hepatic impairment (Child-Pugh Class C)
• History of pancreatitis or other disease of the pancreas or pancreatic duct obstruction
• Biliary duct obstruction, or sphincter of Oddi disease or dysfunction
• Alcoholism, alcohol abuse, alcohol addiction, or intake of more than 3 alcoholic beverages per day
• Severe constipation or sequelae from constipation, or known or suspected mechanical gastrointestinal obstruction

Quantity limit

Maximum of 2 tablets daily.

Questions?

MHCP Provider Call Center 651-431-2700 or 800-366-5411