Get Your Own Clinical Experience With OSMOLEX® ER (amantadine)

Request samples today


Select the dose(s) of OSMOLEX® ER (amantadine) you would like to receive:

Product ID Product Request
OSMOLEX ER, 129 mg (1 carton per order) contains 5 blister packs, 14 tablets each
OSMOLEX ER, 193 mg (1 carton per order) contains 5 blister packs, 14 tablets each

I certify I am a licensed practitioner eligible to request, receive, prescribe, and dispense these samples. I am the practitioner responsible for prescription samples located at the location above. If I am a Nurse Practitioner or Physician Assistant, I certify I am authorized and eligible, in the state in which I am now practicing, to request at the requested location listed above and receive these samples and I have my supervising Physician’s approval to do so. I acknowledge that the samples cannot be sold, traded, bartered, or returned for credit. I further acknowledge that all samples will be used for the FDA approved product indication.

OHIO ONLY – In addition to the above certification, my signature acknowledges that I received the State of Ohio Board of Pharmacy required attestation (attached) and confirms that I may lawfully possess, sell, distribute or deliver dangerous drugs.

Healthcare Provider Attestation
Required For Samples To Be Delivered in Ohio

To comply with the requirements of Ohio Revised Code § 4729.60, the licensed healthcare provider must complete the applicable attestation statement below. Only those prescribers who are licensed as a Terminal Distributor of Dangerous Drugs (TDDD) by the Ohio Board of Pharmacy, or who are exempt from such licensure under O.R.C. § 4729.541, may request and obtain samples for delivery in Ohio. For a complete list of when a healthcare professional must hold a TDDD license to sell, posses, distribute, or purchase dangerous drugs in Ohio please refer to O.R.C. § 4729.51. For a complete list of exemptions to the TDDD licensing requirement, please refer to O.R.C. § 4729.541. For more information and guidance on TDDD licensing requirements for healthcare professionals, please visit the Ohio Board of Pharmacy website at

Attestation [please check one]


OSMOLEX ER is a prescription medicine used to treat:

  • Parkinson’s disease
  • Drug-induced extrapyramidal reactions in adult patients

It is not known if OSMOLEX ER is safe and effective in children.



  • have kidney problems. Do not take OSMOLEX ER if you have severe kidney problems
  • have unexpected sleepiness, take medicine to help you sleep or that makes you drowsy
  • have mental problems, such as suicidal thoughts, depression, or hallucinations
  • have unusual urges, including gambling, increased sex drive, compulsive eating, or compulsive shopping
  • You should not drink alcohol during treatment with Osmolex due to increased chances of serious side effects
  • are pregnant or plan to become pregnant or are breastfeeding or plan to breastfeed. OSMOLEX ER may harm your unborn baby and can pass into your breastmilk

Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Especially tell your doctor if you take sodium bicarbonate, a medicine that contains sodium bicarbonate, or are planning to receive the flu vaccine. You may receive the flu vaccine shot but should not get a live flu vaccine (nasal spray) while taking OSMOLEX ER


  • Do not drive, operate heavy machinery, or do other dangerous activities until you know how OSMOLEX ER affects you
  • You should not drink alcohol while taking OSMOLEX ER because it can increase your chances of serious side effects
  • Do not stop taking OSMOLEX ER or change your dose before talking with your doctor. Tell your doctor if you have symptoms of withdrawal such as fever, confusion, or severe muscle stiffness


OSMOLEX ER may cause serious side effects, including:

  • falling asleep during normal activities, such as driving, talking, or eating, while taking OSMOLEX ER. You may fall asleep without being drowsy or warning. The risk is greater if you take OSMOLEX ER with other medicines that cause drowsiness or drink alcohol. Tell your doctor right away if this happens
  • suicidal thoughts or actions and depression. Tell your doctor right away if you have significant changes in your mood, behaviors, or thoughts, including thoughts about hurting yourself or ending your life
  • hallucinations (seeing, or hearing things that are not real) while you are taking OSMOLEX ER or if you suddenly stop taking OSMOLEX ER
  • feeling dizzy, faint, or light-headed, especially when you stand up too quickly, when you first start OSMOLEX ER, or if your dose has been increased. Tell your doctor if you become dizzy, light-headed, or faint when standing up
  • unusual urges, including gambling, sexual, spending money, and binge eating, and the inability to control these urges. If you notice or your family notices that you are developing any unusual behaviors, talk to your doctor

The most common side effects of OSMOLEX ER include nausea, dizziness, lightheadedness, and trouble sleeping.

These are not all the possible side effects of OSMOLEX ER. Call your doctor for medical advice about side effects. You may report side effects to the FDA.

Visit or call at 1-800-FDA-1088.

Please see full Patient Prescribing Information.