Limited coverage criteria – nadroparin
Last updated on April 4, 2025
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Generic name |
nadroparin |
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Strength |
Form |
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| 2,850 Iu(Anti-Xa)/0.3 mL 3,800 Iu(Anti-Xa)/0.4 mL 5,700 Iu(Anti-Xa)/0.6 mL 9,500 Iu(Anti-Xa)/0.3 mL 11,400 Iu(Anti-Xa)/0.6 mL 15,200 Iu(Anti-Xa)/0.8 mL 19,000 Iu(Anti-Xa)/1 mL |
pre-filled syringe |
Special Authority criteria |
Approval period(to complete balance of duration of therapy for outpatients) |
|---|---|
| Treatment of acute deep vein thrombosis or pulmonary embolus continued from an acute care (hospital) setting to bridge time to achieve therapeutic INR on oral anticoagulants | Up to 10 days supply |
| Following failure on oral anticoagulant therapy (recurrence of one or more deep vein thromboses or pulmonary emboli in patients with therapeutic INR on oral anticoagulants) | Up to 3 months, then reassessed |
| Following elective total knee replacement surgery | Up to 14 days |
| Following elective total hip replacement surgery | Up to 35 days |
| Following orthopedic surgery for major trauma | Up to 10 days |
| Concurrent lupus anticoagulant syndrome, antiphospholipid syndrome, or thrombophilia | Up to 3 months |
| Associated with pregnancy | Up to 4 weeks post-partum |
Practitioner exemptions
- PharmaCare coverage will be provided for a patient who meets the limited coverage criteria, and whose prescription is written by an orthopedic surgeon who has entered into a Collaborative Prescribing Agreement (CPA)
- Due to the individual nature of each CPA, the agreement must be signed by the prescriber and not their delegate
Special notes
- The total duration of therapy includes the period during which doses are administered post-operatively in an acute care (hospital) setting, and the approval period is for the balance of the total duration after discharge (i.e., for outpatients only)