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  • Cns Stimulants Prior Authorization Request Form Page 1 Of 2

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is a combination of amphetamine and , two central nervous stimulants that improve focus and reduce impulsivity by increasing and levels in the brain.

Precautions. The CNS stimulants should be used cautiously in patients with respiratory illness, renal or hepatic impairment, and history of substance abuse. The CNS stimulants should be used cautiously in pregnant or lactating women.

Central Nervous System (CNS) Stimulants Amphetamines (including ecstasy or methylenedioxymethamphetamine) . . Cocaine. . . Oxybate. Pitolisant.

DRUG INTERACTIONS MAO inhibitors are contraindicated with amphetamines and . Concurrent use of these medications risks serious consequences, including hypertensive crisis and death.

Contraindications Treatment with MAO inhibitors and for up to 14 days after discontinuation. Symptomatic cardiovascular disease or cardiac issues. Glaucoma. Advanced arteriosclerosis. Untreated hyperthyroidism. Known hypersensitivity or allergy to the stimulant medication.

A type of drug that increases the levels of certain chemicals in the brain and increases alertness, attention, energy, and physical activity. CNS stimulants also raise blood pressure and increase heart rate and breathing rate.

Stimulants are contraindicated if the patient has any of the following: Comorbid Tourette's disorder. Thyrotoxicosis. Arrhythmias. Uncontrolled moderate to severe hypertension. Active angina. Pheochromocytoma. Glaucoma. Alcohol use disorder.

Prior Authorization (PA) is required for CNS stimulants and for patients 21 years of age or older. Prior to requesting PA for any covered diagnosis, the prescriber must review the patient's use of controlled substances on the Iowa Prescription Monitoring Program (PMP) website.

The use of CNS stimulants is contraindicated in patients with significant cardiovascular impairment such as uncompensated heart failure, severe coronary disease, severe hypertension (including that associated with hyperthyroidism or pheochromocytoma), cardiac structural abnormalities, serious arrhythmias, etc.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232