EXSERVAN Resources and FAQs

Access information supporting patient access for EXSERVAN.

EXSERVAN™ Prescription Enrollment Form

Prescription and Enrollment Form

Download the Prescription and Enrollment Form to get patients started on EXSERVAN.

Guide to Patient Access

Guide to Patient Access

Learn about access information available to your patients from PANTHERx Rare Pharmacy.

Patient Authorization to Enroll in EXSERVAN™ Form

Patient Authorization Form

Use this form to obtain patient authorization to receive access information if the patient did not sign the Prescription and Enrollment Form. The signed Patient Authorization Form can be provided via fax.

Sample: Letter of Medical Necessity

Sample Letter of Medical Necessity

Consider using this sample letter to help your patients with a prescription for EXSERVAN start on therapy.

Sample: Exceptions Letter

Sample Exceptions Letter

Consider using this sample letter if your patient's coverage is denied because EXSERVAN is not on the patient's health plan formulary, or for another reason.

Sample: Appeal Letter

Sample Appeal Letter

Consider using this sample letter if your patient's coverage is denied because their condition did not meet the plan's criteria for prescribing EXSERVAN.

EAT-10 Swallowing Screening Tool

EAT-10 Screening Tool

Download a tool to help facilitate discussions about your patients' swallowing abilities.


The sample letters are provided by Mitsubishi Tanabe Pharma America for informational purposes for patients who have been prescribed EXSERVAN, and are not meant to substitute for a prescriber's independent medical decision-making.

Frequently Asked Questions About EXSERVAN

Get answers to some of the most frequently asked questions about treatment with EXSERVAN.


EXSERVAN is an oral film formulation of riluzole, approved by the FDA for the treatment of ALS.1

What is the mechanism of action of EXSERVAN?

The mechanism by which riluzole exerts its therapeutic effects in patients with ALS is unknown.1

Does EXSERVAN have any drug interactions?

Coadministration with strong to moderate CYP1A2 inhibitors may increase EXSERVAN-associated adverse reactions. Coadministration with strong to moderate CYP1A2 inducers may result in decreased efficacy. EXSERVAN-treated patients that take other hepatotoxic drugs may be at increased risk for hepatotoxicity.1

What are the contraindications of EXSERVAN?

EXSERVAN is contraindicated in patients with a history of severe hypersensitivity reactions to riluzole or to any of its components (anaphylaxis has occurred).1

What are the ingredients in EXSERVAN?

Each EXSERVAN oral film contains 50 mg of riluzole and the following inactive ingredients: FD&C yellow #6, fructose, glycerin, glycerol monooleate, hypromellose, natural honey flavor, natural & artificial lemon, polacrilex resin, polyethylene oxide, polysaccharide, sucralose, xanthan gum, and xylitol.1

Can patients take EXSERVAN if they are pregnant?

There are no studies of riluzole in pregnant women, and case reports have been inadequate to inform the drug-associated risk. Advise patients to notify their healthcare provider if they become pregnant or intend to become pregnant during EXSERVAN therapy.1

Can patients take EXSERVAN if they are breastfeeding?

There are no data on the presence of riluzole in human milk, the effects on the breastfed infant, or the effects on milk production. Riluzole or its metabolites have been detected in milk of lactating rat. The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for EXSERVAN and any potential adverse effects on the breastfed infant from EXSERVAN or from the underlying maternal condition. Advise patients to notify their healthcare provider if they are breastfeeding or intend to breastfeed during EXSERVAN therapy.1

How is EXSERVAN supplied?

Each EXSERVAN oral film is an orange, rectangular-shaped film that contains 50 mg of riluzole with "R50" printed in white ink on one side. Each film is packaged in a pouch.1

NDC 70510-2201-1: 50 mg oral film, carton of 60 pouches.1

How is EXSERVAN stored?

Store EXSERVAN oral film pouches at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F).1

Can EXSERVAN be administered with liquids?

Do not administer EXSERVAN with liquids. As the film dissolves, saliva should be swallowed in a normal manner, but the patient should refrain from chewing, spitting or talking.1

Can EXSERVAN be administered with food?

EXSERVAN should not be taken with food. EXSERVAN should be taken at least 1 hour before or 2 hours after a meal.1

How is EXSERVAN administered?

Apply EXSERVAN on top of the tongue where it adheres and dissolves. Do not cut or split the film. Instruct patients and/or caregivers to read the "Instructions for Use" carefully for complete directions on how to properly dose and administer EXSERVAN oral films. Only one oral film should be taken at a time.1

What is the recommended dosage for EXSERVAN?

The recommended dosage for EXSERVAN is 50 mg taken orally twice daily.1

How is EXSERVAN different from TIGLUTIK® (riluzole)?

EXSERVAN is an oral film formulation, designed to address the needs of people with ALS, including those who have difficulties swallowing some medications. TIGLUTIK is an oral suspension formulation of riluzole administered via feeding tubes or orally by mouth. Please refer to the Prescribing Information for both products for more information.1,2

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Learn more about the first and only oral film formulation of riluzole

  1. EXSERVAN (riluzole) Prescribing Information. Jersey City, NJ: Mitsubishi Tanabe Pharma America, Inc.; 2021.
  2. TIGLUTIK (riluzole) Prescribing Information. Berwyn, PA: ITF Pharma, Inc; 2018.