Limited Coverage Drugs - eslicarbazepine acetate

Generic Name             

eslicarbazepine acetate

Strength

200 mg, 400 mg, 600 mg and 800 mg

Form

tablet

 

Special Authority Criteria

Approval Period                                             

For the treatment of partial-onset seizures in adults and to be used:

  1. as adjunctive therapy (used in combination with at least ONE other anti-epileptic drug) for partial-onset seizures

           AND

  1. after at least FOUR other anti-epileptic medications have been tried without success (names of previously tried therapies and patient response to those therapies must be documented on the Special Authority Request, see Special Notes below).

Indefinite

Practitioner Exemptions

  • None

Special Notes

  • Special Authority requests should document which other anti-epileptic medications have been trialed at adequate doses. Examples of other anti-epileptic drugs include:
  • phenytoin (Dilantin®)
  • carbamazepine (Tegretol®)
  • gabapentin (Neurontin®)
  • topiramate (Topamax®),
  • lamotrigine (Lamictal®)
  • levetiracetam (Keppra®)
  • lacosamide (Vimpat®),
  • perampanel (Fycompa™)
  • vigabatrin (Sabril®)
  • valproic acid (Epival®)

Special Authority Request Form(s)