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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.


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

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