Product Details

Act Dextroamphetamine SR

Dextroamphetamine Sulfate
15 mg
SR Capsule


DIN/PIN/NPN

02448327

Manufacturer

Actavis Pharma Company

Formulary Listing Date

2018-04-30  

Unit Price

0.9898

Amount MOH Pays

0.9898

Coverage Status

General Benefit

ODB Formulary Therapeutic Classification

Therapeutic Note

C.N.S. Stimulants (28:20:00): 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. Dextroamphetamine Sulfate 15 mg SR Capsule: Notes: Patients greater than 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, 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

N06BA02

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
01924567 Dexedrine Spansules 1.4489 0.9898
02448327 Act Dextroamphetamine SR 0.9898 0.9898
 

LU Clinical Criteria

NO  

EAP Criteria

NO

Product Monograph

View Monograph