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Approved Risk Evaluation and Mitigation Strategies (REMS)

Juxtapid (lomitapide)
NDA #203858
REMS last update: 04/26/2024



What is the purpose of the REMS?

The goal of the JUXTAPID REMS is to mitigate the risk of hepatotoxicity associated with the use of JUXTAPID by ensuring that:

  1. Prescribers are educated about the approved indication for JUXTAPID, the risk of hepatotoxicity associated with the use of JUXTAPID; and the need to monitor patients during treatment with JUXTAPID as per product labeling.

What do participants need to know?

Below is a general overview of the REMS for all REMS participants (e.g., patients, pharmacies, and healthcare providers). See the application holder(s) REMS Website or the approved REMS materials for more information.

View application holder(s) REMS Website See Disclaimer page regarding links to external sites

Healthcare Providers who prescribe JUXTAPID must:

To become certified to prescribe
Before treatment initiation (first dose)
  • Counsel the patient about the appropriate use, risks associated with JUXTAPID, and need for periodic liver function monitoring using the Patient Guide. Provide a copy of the material to the patient.
    | Patient Guide |
  • Assess the patient to confirm a clinical or laboratory diagnosis consistent with the approved indication.
  • Assess the patient’s liver function.
  • Enroll the patient by completing and submitting the Patient- Prescriber Acknowledgement Form to the REMS Program.
    | Patient-Prescriber Acknowledgement Form |
  • Order the prescription using the Prescription Authorization Form.
    | Prescription Authorization Form |
During treatment, at least monthly for the first year and every 3 months thereafter
  • Assess the patient’s liver function.
During treatment, before dose increases
  • Assess the patient’s liver function.
During treatment; before each prescription

Patients who are prescribed JUXTAPID:

Receive counseling from the prescriber on the appropriate use, risks of JUXTAPID, and need for periodic liver function monitoring using the Patient Guide.
  • Receive counseling from the prescriber on the appropriate use, risks of JUXTAPID, and need for periodic liver function monitoring using the Patient Guide.
    | Patient Guide |
  • Enroll in the REMS Program by completing the Patient-Prescriber Acknowledgement Form with the prescriber. Enrollment information will be provided to the REMS Program.
    | Patient-Prescriber Acknowledgement Form |
  • Get blood tests to check your liver.
During treatment
  • Get blood tests as directed by your prescriber to check your liver so your prescriber can modify your JUXTAPID treatment, if needed.
At all times
  • Inform the prescriber of signs and/or symptoms of liver injury.

Pharmacies that dispense JUXTAPID must:

To become certified to dispense
  • Designate an authorized representative to carry out the certification process and oversee implementation and compliance with the REMS Program on behalf of the pharmacy.
  • Have the authorized representative review the Prescribing Information, Fact Sheet and Pharmacy Training Module.
    | Pharmacy Training Module and Knowledge Assessment | | Fact Sheet |
  • Have the authorized representative successfully complete the Knowledge Assessment and submit it to the REMS Program.
    | Pharmacy Training Module and Knowledge Assessment |
  • Have the authorized representative enroll in the REMS Program by completing the Pharmacy Enrollment Form and submitting it to the REMS Program.
    | Pharmacy Enrollment Form |
  • Establish processes and procedures to verify the prescriber is certified, the patient is enrolled, and a completed Prescription Authorization Form is received for each prescription.
    | Prescription Authorization Form |
  • Train all relevant staff involved in dispensing of JUXTAPID on the REMS Program requirements.
Before dispensing
  • Verify that the prescriber is certified, the patient is enrolled, and a completed Prescription Authorization Form for the patient is received for each prescription through the processes and procedures established as a requirement of the REMS Program.
    | Prescription Authorization Form |
To maintain certification to dispense
  • Have a new authorized representative enroll by completing and submitting the Pharmacy Enrollment Form, if the authorized representative changes.
    | Pharmacy Enrollment Form |
At all times
  • Not distribute, transfer, loan, or sell JUXTAPID.
  • Maintain records documenting staff’s completion of REMS training.
  • Maintain and submit records of prescription data to the REMS Program.
  • Maintain records that all REMS processes and procedures are in place and are being followed.
  • Comply with audits carried out by Chiesi Farmaceutici S.p.A.or a third-party acting on behalf of Chiesi Farmaceutici S.p.A., to ensure that all processes and procedures are in place and are being followed.

Wholesalers-distributors that distribute JUXTAPID must:

To be able to distribute
  • Establish processes and procedures to ensure the drug is distributed only to certified pharmacies.
  • Train all relevant staff involved in distribution on the REMS requirements.
At all times
  • Distribute only to certified pharmacies.
  • Maintain records of all drug distribution.
  • Maintain records that all REMS processes and procedures are in place and are being followed.
  • Comply with audits carried out by Chiesi Farmaceutici S.p.A.or a third-party acting on behalf of Chiesi Farmaceutici S.p.A., to ensure that all processes and procedures are in place and are being followed.

What materials are included in the REMS?

The REMS includes a REMS Document. In addition, the REMS includes the following materials intended for patients and healthcare providers. For a specific Medication Guide of a product in the Juxtapid REMS, see the DailyMed link(s).
Material Name Material Name Link
Fact Sheet (PDF) https://www.accessdata.fda.gov/drugsatfda_docs/rems/Juxtapid_2024_04_26_Fact_Sheet.pdf
Patient Guide (PDF) https://www.accessdata.fda.gov/drugsatfda_docs/rems/Juxtapid_2024_04_26_Patient_Guide.pdf
Patient-Prescriber Acknowledgement Form (PDF) https://www.accessdata.fda.gov/drugsatfda_docs/rems/Juxtapid_2024_04_26_Patient_Prescriber_Acknowledgement_Form.pdf
Pharmacy Enrollment Form (PDF) https://www.accessdata.fda.gov/drugsatfda_docs/rems/Juxtapid_2024_04_26_Pharmacy_Enrollment_Form.pdf
Pharmacy Training Module and Knowledge Assessment (PDF) https://www.accessdata.fda.gov/drugsatfda_docs/rems/Juxtapid_2024_04_26_Pharmacy_Training_Module_and_Knowledge_Assessment.pdf
Prescriber Enrollment Form (PDF) https://www.accessdata.fda.gov/drugsatfda_docs/rems/Juxtapid_2024_04_26_Prescriber_Enrollment_Form.pdf
Prescriber Training Module and Knowledge Assessment (PDF) https://www.accessdata.fda.gov/drugsatfda_docs/rems/Juxtapid_2024_04_26_Prescriber_Training_Module_and_Knowledge_Assessment.pdf
Prescription Authorization Form (PDF) https://www.accessdata.fda.gov/drugsatfda_docs/rems/Juxtapid_2024_04_26_Prescription_Authorization_Form.pdf
REMS Document (PDF) https://www.accessdata.fda.gov/drugsatfda_docs/rems/Juxtapid_2024_04_26_REMS_Document.pdf
REMS Full (PDF) https://www.accessdata.fda.gov/drugsatfda_docs/rems/Juxtapid_2024_04_26_REMS_Full.pdf
REMS Website (PDF) https://www.accessdata.fda.gov/drugsatfda_docs/rems/Juxtapid_2024_04_26_REMS_Website.pdf

What assessment is available to the REMS?

Assessment Plan
REMS assessment plan unavailable for posting at this time.

What updates have been made to the REMS?

Date Summary of change
04/26/2024 Revised to update the Prescriber Authorization Form to have the prescriber signature on same page as the drug order to meet various states’ Board of Pharmacy requirements.
01/25/2024 Revised to reflect change in application ownership.
06/16/2022 Modified to reflect:
  • A revised Prescription Authorization Form (PAF) consolidated to one page instead of 2 pages, so that the prescriber signature and the drug order are not separated by a page break
  • Addition of state-specific pharmacy practice language to increase pharmacy usability and reduce necessity of pharmacy intervention on incoming prescriptions in the PAF as follows:
    • “The prescriber shall comply with his/her state-specific prescription requirements such as e-prescribing, state-specific prescription form, fax language, etc., as required. Noncompliance with state-specific requirements could result in pharmacy outreach to the prescriber.”
  • Removal of the “scan and email” option from the PAF.
  • Updated the Juxtapid (lomitapide) REMS website screenshots to align with changes to the PAF
02/01/2022 Modified to:
  1. Update the format of the REMS document in line with the recommendations in the Format and Content of a REMS Document- Guidance for Industry.
  2. Change program materials secondary to findings of the completed Qualitative Research (QR) around the deficit of prescriber knowledge on program requirements around liver monitoring as demonstrated in recent poor KAB survey scores.
  3. Omit obsolete materials (2017 Stakeholder letters).
  4. Make editorial changes such as added demographic fields to Patient Guide, Patient Prescriber Acknowledgement Form (PPAF) and Prescription Authorization Form (PAF) and other editorial revisions related to punctuation, grammar, spelling, defining acronyms, flow, font, simplification, and consistency to REMS appended materials.
05/27/2021 Modified to add online fillable fields in REMS forms and modified the design and formatting of the REMS materials.
10/21/2020 Revised to make editorial changes.
05/18/2020 Revised to reflect change in ownership.
03/13/2020 Revised to make editorial changes.
06/13/2019 Revised to update the corporate address.
06/18/2018 Revised to make an editorial change.
06/04/2018 Modified to:

  1. remove the option of emailing completed Patient-Prescriber Authorization Forms (PPAFs) for protection of patient information
  2. require patients reaching age 18 to sign a PPAF (previously signed by a parent)
  3. add language on the website to clarify the order of actions for prescriber participation in the REMS
  4. establish an all-electronic process for submission of the certificate of completion of training and knowledge assessment
  5. streamline the process for completion of the prescriber enrollment form (use of auto-completion of the form using prescriber information already submitted)
  6. add text to the REMS website requesting pharmacies to contact Aegerion before attempting to certify
  7. update font colors on REMS forms to enhance readability
  8. add clarifying language on the Prescription Authorization Form (PAF) regarding how to submit a prescription
03/02/2017 Revised to make an editorial change.
01/03/2017 Modified to conform to the Safety Labeling Change Notification/REMS Modification Notification letter issued on March 11, 2016 in the REMS document, the existing REMS materials, and the following new REMS materials: Patient Guide and Patient-Prescriber Acknowledgement Form.
08/13/2013 Modified to allow prescribers to complete the REMS-required training and enrollment online.
12/21/2012 Approval of the REMS.

Disclaimer: This webpage provides general information about REMS programs to various REMS participants (e.g., patients, pharmacies, and healthcare providers). The summary information provided herein is not comprehensive and may not include all of the information relevant to REMS participants. This webpage does not constitute a replacement, modification, or revision of the approved REMS document, including any appended REMS materials. Refer to the approved REMS document for complete information on the REMS requirements for each approved application.

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