Application to prescribe doses of stimulant medication greater than those specified in the routine prescribing criteria

Summary

In accordance with TG181 Criteria for the Diagnosis and Management of Attention Deficit Hyperactivity Disorder in Children and Adolescents, authorisation from the NSW Ministry of Health is required to prescribe the following doses:

• >1 mg/kg/day of dexamphetamine or > 50mg dexamphetamine per day, or
• >2 mg/kg/day of methylphenidate or > 108mg methylphenidate per day

An Application to Prescribe Doses of Stimulant Medication Greater than those Specified in the Routine Prescribing Criteria (TG 181) is to be used to apply for authorisation from the Ministry.

The form may be completed electronically using Adobe Reader. (The latest version of Adobe Reader can be downloaded for free from Adobe).  Save the form to a local hard drive before typing in details.

Completed forms are to be faxed to Pharmaceutical Services on (02) 98595175 or posted to Pharmaceutical Services, NSW Ministry of Health, PO Box 103, Gladesville NSW 1675.

For assistance or further information telephone the Monitoring and Compliance Section, Pharmaceutical Services, during business hours on (02) 98795239.

File link: Application to prescribe doses of stimulant medication greater than those specified in the routine prescribing criteria
File Format: PDF
File size: 131Kb
Type: Form
Date of Publication: 23 January 2012
Author Branch: Pharmaceutical Services