NOURIANZ (istradefylline)


SELF ADMINISTRATION - ORAL 


Indications for Prior Authorization:
  • Indicated as adjunctive treatment to levodopa/carbidopa in adult patients with Parkinson's disease (PD) experiencing "off" episodes.
Patients must meet the following criteria for the indication(s) above:
  • Patient is 18 years of age or older, AND
  • Patient has a diagnosis of PD as confirmed by chart note documentation, AND
  • Patient is currently taking carbidopa-levodopa, AND
  • Patient has previously tried at least 2 of the following for treatment of “off” episodes: entacapone, rasagiline, pramipexole, ropinirole, and tolcapone, AND
  • Prescribed by or in consultation with a neurologist
Dosing:
  • Recommended dosage: 20 mg to 40 mg once daily based on individual need and tolerability.
  • Max dose with concomitant use of strong CYP3A4 inhibitors is 20 mg once daily
  • Avoid use with strong CYP3A4 inducers
  • Max dose in those with moderate hepatic impairment (Child-Pugh B) is 20 my once daily; avoid use in those with severe hepatic impairment (Child-Pugh C)
  • In patients who use tobacco in amounts of 20 or more cigarettes per day (or the equivalent of another tobacco product) use Nourianz 40 mg once daily
Approval:
  • 1 year

Last review date: February 18, 2020

Friday, July 19 Breaking News: A widespread computer software outage is impacting systems across the globe. Health care services in Northern California are reporting some disruption. WHA encourages members to call ahead to your provider if you have an appointment scheduled for today or this weekend.