LACOSAMIDE

LACOSAMIDE (10293R)

lacosamide 50 mg tablet, 14
10293R
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

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: 4 Max qty units: 56 # of repeats: 5 DPMQ: $38.16 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
LACOMED
Lacosam
Lacosamide ARX
Lacosamide Lupin
Lacosamide Sandoz
Vimcosa
Vimpat

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: $349.14 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
LACOMED
Vimpat

LACOSAMIDE (12626M)

lacosamide 50 mg tablet, 14
12626M
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: 4 Max qty units: 56 # of repeats: 5 DPMQ: $38.16 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
LACOMED
Lacosam
Lacosamide ARX
Lacosamide Lupin
Lacosamide Sandoz
Vimcosa
Vimpat

LACOSAMIDE (12627N)

lacosamide 150 mg tablet, 56
12627N
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: 1 Max qty units: 56 # of repeats: 5 DPMQ: $85.78 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
LACOMED
Lacosam
Lacosamide ARX
Lacosamide Lupin
Lacosamide Sandoz
Vimcosa
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: $122.62 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
LACOMED
Vimpat

LACOSAMIDE (12633X)

lacosamide 100 mg tablet, 14
12633X
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17515)

Indication: Idiopathic generalised epilepsy with primary generalised tonic-clonic seizures
Treatment phase: Dose titration at the start of therapy, during therapy or to gradually cease treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 14 # of repeats: 1 DPMQ: $26.27 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
LACOMED
Lacosamide Sandoz
Vimcosa
Vimpat

LACOSAMIDE (12634Y)

lacosamide 100 mg tablet, 56
12634Y
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: 1 Max qty units: 56 # of repeats: 5 DPMQ: $62.00 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
LACOMED
Lacosam
Lacosamide ARX
Lacosamide Lupin
Lacosamide Sandoz
Vimcosa
Vimpat

LACOSAMIDE (12649R)

lacosamide 150 mg tablet, 14
12649R
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17515)

Indication: Idiopathic generalised epilepsy with primary generalised tonic-clonic seizures
Treatment phase: Dose titration at the start of therapy, during therapy or to gradually cease treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 14 # of repeats: 1 DPMQ: $32.22 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
LACOMED
Vimcosa
Vimpat

LACOSAMIDE (12658F)

lacosamide 200 mg tablet, 56
12658F
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: 1 Max qty units: 56 # of repeats: 5 DPMQ: $109.59 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
LACOMED
Lacosam
Lacosamide ARX
Lacosamide Lupin
Lacosamide Sandoz
Vimcosa
Vimpat

LACOSAMIDE (13838H)

lacosamide 150 mg tablet, 56
13838H
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: 2 Max qty units: 112 # of repeats: 5 DPMQ: $159.34 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
LACOMED
Lacosam
Lacosamide ARX
Lacosamide Lupin
Lacosamide Sandoz
Vimcosa
Vimpat