Prescribe XYREM®
(sodium oxybate)

Utilize the resources below to understand the benefits and risks of XYREM and prescribe XYREM to patients. For more information, please call the XYREM® REMS Program toll free at 1-866-XYREM88® (1-866-997-3688).

Begin Prescription Form Online

Prescribing XYREM

To prescribe XYREM, both prescriber and patient must be enrolled in the XYREM REMS Program.

Complete the Prescription Form

All prescription forms must be submitted via fax or mail only. Choose one of the two methods described below to prescribe XYREM.

Ways To Complete the Prescription Form

Online

Start the prescription process by filling in the online form. The form will be checked by the Certified Pharmacy for completeness. You will be notified once your enrollment is complete.

Complete Form Online

Enter your name and e-mail to start the prescription process.
* = Required Fields

Prescriber Information
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