TIAGABINE

TIAGABINE (13892E)

tiagabine 5 mg tablet, 50
13892E
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17444)

Indication: Focal onset 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: 200 # of repeats: 5 DPMQ: $111.56 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Gabitril

TIAGABINE (8221Q)

tiagabine 5 mg tablet, 50
8221Q
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17445)

Indication: Focal onset 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: 100 # of repeats: 5 DPMQ: $62.68 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Gabitril