ZONISAMIDE

ZONISAMIDE (13854E)

zonisamide 100 mg capsule, 56
13854E
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: 224 # of repeats: 5 DPMQ: $139.44 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Zonegran

ZONISAMIDE (9390F)

zonisamide 100 mg capsule, 56
9390F
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: 112 # of repeats: 5 DPMQ: $76.02 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Zonegran