Limited Coverage Drugs – Lacosamide tablets
Generic Name |
lacosamide | |
Strength | 50mg, 100mg, 150mg, 200mg | |
Form | tablet |
Special Authority Criteria |
Approval Period |
For the treatment of partial-onset seizures in adults and to be used:
AND
|
Indefinite |
Practitioner Exemptions
- None
Special Notes
- Special Authority requests should include documentation stating which other anti-epileptic drugs have been tried in adequate doses. Examples of other anti-epileptic drugs include:
- phenytoin (Dilantin®)
- levetiracetam (Keppra®)
- carbamazepine (Tegretol®)
- perampanel (Fycompa™)
- gabapentin (Neurontin®)
- vigabatrin (Sabril®)
- topiramate (Topamax®)
- eslicarbazepine acetate (Aptiom™)
- lamotrigine (Lamictal®)
- valproic acid (Epival®)
Special Authority Request Form(s)
- 5328 - General Special Authority Request (PDF, 523KB)