Product Details

Act Amphetamine XR

Mixed Salt Amphetamine
25 mg
ER Capsule


DIN/PIN/NPN

02439271

Manufacturer

Actavis Pharma Company

Formulary Listing Date

2015-10-29  

Unit Price

0.8305

Amount MOH Pays

0.8305

Coverage Status

General Benefit

ODB Formulary Therapeutic Classification

Therapeutic Note

C.N.S. Stimulants (28:20): Stimulant medication should only be used when diagnostic criteria for narcolepsy or attention deficit disorder have been met and when stimulant medication has been demonstrated to produce clinical benefits. The use of conventional-release medication should almost always precede the use of extended-release preparations. Mixed Salt Amphetamine 25 mg ER Capsule: Notes: Patients >6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or psychosocial needs, and who meet the following: 1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning; AND 2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner with expertise in ADHD; AND 3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor symptom control, side effects, administrative barriers, or societal barriers. Administrative barriers include: - inability of a school to dose the child at lunch; - the school lunch hour does not coincide with the dosing schedule; - poor compliance with noon or afternoon doses; - the patient is unable to swallow tablets. Societal barriers include: - the patient or patient's caregiver(s) has(have) a history of substance abuse or diversion of listed immediate-release alternatives; - the patient or patient's caregiver(s) is/are at risk of substance abuse or diversion of listed immediate-release alternatives.

ATC Code

N06BA01

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02457334 Sandoz Amphetamine XR 0.8305 0.8305
02445530 Apo-Amphetamine XR 0.8305 0.8305
02248812 Adderall XR 3.6657 0.8305
02439271 Act Amphetamine XR 0.8305 0.8305
 

LU Clinical Criteria

NO  

EAP Criteria

NO

Product Monograph

View Monograph