LACOSAMIDE

LACOSAMIDE (11694L)

lacosamide 10 mg/mL oral liquid, 200 mL
11694L
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17520)

Indication: Intractable focal onset seizures
Treatment phase: Initial treatment

Restriction (Streamlined authority code: 17455)

Indication: Intractable focal onset seizures
Treatment phase: Continuing treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 6 Max qty units: 6 # of repeats: 5 DPMQ: $359.10 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
LACOMED
Vimpat

LACOSAMIDE (12628P)

lacosamide 10 mg/mL oral liquid, 200 mL
12628P
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17513)

Indication: Idiopathic generalised epilepsy with primary generalised tonic-clonic seizures
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 2 # of repeats: 5 DPMQ: $125.56 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
LACOMED
Vimpat

LACOSAMIDE (14013M)

lacosamide 10 mg/mL oral liquid, 200 mL
14013M
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17516)

Indication: Idiopathic generalised epilepsy with primary generalised tonic-clonic seizures
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 4 # of repeats: 5 DPMQ: $242.32 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
LACOMED
Vimpat

LACOSAMIDE (14048J)

lacosamide 10 mg/mL oral liquid, 200 mL
14048J
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17560)

Indication: Intractable focal onset seizures
Treatment phase: Continuing treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 12 Max qty units: 12 # of repeats: 5 DPMQ: $709.32 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
LACOMED
Vimpat