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How to use or fill out XYREM PRESCRIPTION FORM with our platform
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Click ‘Get Form’ to open the XYREM PRESCRIPTION FORM in the editor.
Begin by filling out the Prescriber Information section. Ensure you complete all required fields marked with an asterisk (*), including your first name, last name, street address, phone number, and DEA number.
Next, move to the Patient Information section. Here, indicate the patient's indication for use by selecting one of the options provided. Fill in all required patient details such as first name, last name, date of birth, and primary phone number.
In the Medications section, list all current medications or attach a separate page if necessary. Specify the total quantity needed and any comorbidities.
Complete the Dispensing Instructions carefully. Choose between titrated or fixed dosing based on patient needs and ensure that you follow any special dosing instructions provided.
Finally, sign and date the form in the Prescriber Verification section to confirm your understanding of the REMS requirements.
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Xyrem belongs to the class of medicines known as central nervous system (CNS) depressants. Xyrem contains sodium oxybate, also known as GHB, which is a known street drug of abuse.
Can I buy Xyrem?
The Food and Drug Administration (FDA) has approved Xyrem to treat excessive sleepiness and sudden muscle weakness or paralysis caused by narcolepsy. Its available by prescription only. Heres information about Xyrem as a potential treatment option.
Can a psychiatrist prescribe Xyrem?
Doctors must become certified in the Xyrem REMS program before they can prescribe Xyrem.
How much does Xyrem cost a month?
An FDA-approved liquid medication for narcolepsy called sodium oxybate (Xyrem). It is a controlled substance that is about $49 a month.
Is Xyrem a prescription?
The prescription drug Xyrem is the sodium salt of gamma-hydroxybutyrate (GHB). GHB has not been approved for any medical use and has the potential for abuse, such as in cases of sexual assault. GHB is a Schedule I controlled substance under the Controlled Substances Act.
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Because of the serious risk of central nervous system depression, abuse, and misuse associated with XYREM, it is available only through enrollment in a restricted program called the XYWAV and XYREM REMS.
Are XYWAV and Xyrem the same?
XYWAV is indicated for the treatment of idiopathic hypersomnia (IH) in adults. XYREM is indicated for the treatment of cataplexy or excessive daytime sleepiness (EDS) in patients 7 years of age and older with narcolepsy.
Related links
Prior Authorization Drug Attachment for Xyrem and Xywav
INSTRUCTIONS: Type or print clearly. Before completing this form, read the Prior Authorization Drug Attachment for. Xyrem and Xywav Instructions, F-01430A.
Sep 24, 2013 Xyrem (Sodium oxybate). D. Other drug therapies not mentioned. E. Im not sure. 44. Page 23. Besides your drug therapies, what therapies have
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