Limited coverage criteria – eslicarbazepine acetate

 

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Generic name	eslicarbazepine acetate
Strength & form	200 mg, 400 mg, 600 mg and 800 mg tablet

Special Authority criteria

Approval period

For the treatment of partial-onset seizures in adults and to be used: As adjunctive therapy (used in combination with at least one other anti-epileptic drug) for partial-onset seizures AND 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)

• Log in to eForms
• 5328 – General Special Authority request (PDF, 656KB)