MENU×

Find out how your patients respond to AMPYRA® (dalfampridine) with a 60-Day Free* Trial

60 DAY FREE* Trial

The 60-Day Free* Trial is designed so eligible MS patients can try AMPYRA and determine if they respond before they or their health plans incur any expense for the drug.

*Limitations and restrictions apply.

3 simple steps for registration:

1
Complete the 60-Day Free* Trial Service Request Form (SRF).
  • You should obtain an estimated CrCl.
  • You may want to obtain a baseline Timed 25-Foot Walk test, which may be required for continuing therapy after your patient completes the 60-day free trial of AMPYRA.
2
Fax the completed SRF to AMPYRA Patient Support Services (APSS) at 1-888-883-3053. Or click here to submit it online via the iAssist ePrescribing portal.
  • If the report is complete and accurate, your patient can begin AMPYRA within approximately a week.
3
Give your patient the second page of the SRF, which provides information about their delivery of AMPYRA.

After your patient is registered (for your information; no action required)

  • APSS performs benefit investigation and calls the patient to provide co-pay information and the name of the specialty pharmacy.
  • The specialty pharmacy provider will contact your patient to schedule subsequent delivery of AMPYRA.

Important eligibility requirements

  • The MS patient must be an appropriate patient for AMPYRA.
  • Patients participating in Medicaid, Medicare, or any other government-funded programs are not eligible.
  • Patients who have received a prescription for AMPYRA within the last 12 months are not eligible.

See Full Prescribing Information.

See more

Indication

AMPYRA® (dalfampridine) Extended Release Tablets, 10 mg is indicated as a treatment to improve walking in patients with multiple sclerosis (MS). This was demonstrated by an increase in walking speed.

Important Safety Information

AMPYRA is contraindicated in patients with history of seizures, moderate or severe renal impairment (CrCl ≤ 50 mL/min), or history of hypersensitivity to AMPYRA or 4-aminopyridine.

Indication

AMPYRA® (dalfampridine) Extended Release Tablets, 10 mg is indicated as a treatment to improve walking in patients with multiple sclerosis (MS). This was demonstrated by an increase in walking speed.

Important Safety Information

  • AMPYRA is contraindicated in patients with history of seizures, moderate or severe renal impairment (CrCl ≤ 50 mL/min), or history of hypersensitivity to AMPYRA or 4-aminopyridine.
  • AMPYRA can cause seizures. The risk of seizures increases with increasing doses. Discontinue AMPYRA and do not restart if seizure occurs. In the post-marketing period seizures have been reported. The majority of seizures occurred at the recommended dose, in patients without a history of seizures, and generally within days to weeks of starting therapy.
  • AMPYRA has not been evaluated in patients with history of seizures or with epileptiform activity on an EEG, as these patients were excluded from clinical trials. The risk of seizures in patients with epileptiform activity on an EEG is unknown, and could be substantially higher than that observed in clinical studies.
  • AMPYRA should not be taken with other forms of 4-aminopyridine (4-AP, fampridine), since the active ingredient is the same. Patients should discontinue use of any product containing 4-aminopyridine prior to initiating AMPYRA to reduce the potential for dose-related adverse reactions.
  • AMPYRA can cause anaphylaxis and severe allergic reaction. Signs and symptoms included respiratory compromise, urticaria, and angioedema of the throat or tongue. If an anaphylactic or other serious allergic reaction occurs, discontinue AMPYRA and do not restart.
  • AMPYRA is cleared predominantly by the kidneys. The risk of seizures in patients with mild renal impairment (CrCl 51–80 mL/min) is unknown, but AMPYRA plasma levels in these patients may approach those seen at a dose of 15 mg twice daily, a dose that may be associated with an increased risk of seizures; estimated CrCl should be known before initiating AMPYRA and monitored at least annually during treatment.
  • Urinary tract infections (UTIs) were reported more frequently in controlled studies in patients receiving AMPYRA (12%) as compared to placebo (8%). UTIs in AMPYRA-treated patients should be evaluated and treated as clinically indicated.
  • The most common adverse events (incidence ≥ 2% and at a rate greater than the placebo rate) for AMPYRA in MS patients were urinary tract infection, insomnia, dizziness, headache, nausea, asthenia, back pain, balance disorder, multiple sclerosis relapse, paresthesia, nasopharyngitis, constipation, dyspepsia, and pharyngolaryngeal pain.
  • The risk of adverse events, including seizures, increases with increasing AMPYRA doses. No additional benefit was demonstrated at doses greater than 10 mg twice daily.
  • There are no adequate and well-controlled studies of AMPYRA in pregnant women. AMPYRA should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
  • It is not known if AMPYRA passes into breast milk. Discontinue AMPYRA or nursing, taking into consideration the importance of AMPYRA to the mother.
  • Safety and effectiveness of AMPYRA in patients younger than 18 years have not been established.
  • Clinical studies of AMPYRA did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Because elderly patients are more likely to have decreased renal function, it is important to know the estimated CrCl before initiating AMPYRA.

Please review the Full Prescribing Information.