Amantadine Extended-Release (Osmolex ER)

Amantadine Extended-Release (Osmolex ER®)

SELF ADMINISTRATION - Oral

Indication for Prior Authorization:

• Indicated for the treatment of Parkinson's disease and for the treatment of drug-induced extrapyramidal reactions in adult patients

Patients must meet the following criteria for the indication(s) above:

• Used for the treatment of Parkinson's disease and for the treatment of drug-induced extrapyramidal reactions in adult patients, confirmed by chart note documentation, AND
• Patient has tried and failed amantadine immediate-release
• Gocovri® is contraindicated in patients with end stage renal disease.

Dosing:

• Initial: 129 mg once daily in the morning
• The dosage may be increased in weekly intervals to a maximum daily dose of 322 mg (administered as 129 mg and 193 mg tablet), taken in the morning
• Osmolex ER® is not interchangeable with other amantadine immediate- or extended-release products.
• For patients unable to tolerate more than 100 mg per day of immediate-release amantadine, there is no equivalent dose or dosing regimen of Osmolex ER®
• Dose adjusted for renal impairment (contraindicated in patients with end stage renal disease)