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