Product Details
PDP-Levetiracetam
Levetiracetam100 mg/mL
Oral Solution
DIN/PIN/NPN
02490447
Manufacturer
Pendopharm, Division of Pharmascience Inc.
Formulary Listing Date
2022-12-21
Unit Price
0.8142
Amount MOH Pays
0.8142
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
N03AX14
Interchangeable Products
NOLU Clinical Criteria
LU Code | Auth. Period | Clinical Criteria |
---|---|---|
640 | 1 year | For patients unable to swallow or tolerate oral solid dosage forms and who are using this as adjunctive therapy in the treatment of seizure disorders where control by other listed anticonvulsants has been unsatisfactory. |
705 | 1 year | As adjunctive therapy in the treatment of seizure disorders in pediatric patients (less than 18 years of age) where control by other listed anticonvulsants has been unsatisfactory and where the appropriate dose cannot be achieved using listed solid oral levetiracetam dosage formats. |