Drug - Ampyra™ (dalfampridine)
June 2010
Therapeutic area - Multiple sclerosis (MS)
Further fills approved only after clinic documentation of improvement in walking speed or physical functioning.
Dosing will not exceed 10 mg twice daily. No additional benefit was demonstrated at doses greater than 10 mg twice daily and adverse events, including seizures, were more frequent at higher doses.
Ampyra is dispensed only by specialty pharmacies: Accredo, Aetna, Bioscript, Caremark, Curascript, Diplomat Specialty Pharmacy, Walgreens-Specialty, US Bioservices, Prescription Solutions, PharmaCare. Must be dispensed by a pharmacy that has signed the Minnesota Provider agreement.
Creatinine Clearance Calculation
CLcr (male) = (140-age) * (Wt in kg) / (72 * Cr)
CLcr (female) = (140-age) * (Wt in kg) * (0.85) / (72 * Cr)
These equations are valid for adult patients with serum creatinine level (Scr) >0.5 and < 5 mg/dL
Ampyra (dalfampridine) is indicated as a treatment to improve walking in patients with multiple sclerosis (MS). This is a new indication, never granted by the FDA. This drug is not indicated to decrease relapse rate or prevent the accumulation of disability.
MHCP Provider Call Center 651-431-2700 or 800-366-5411