Product Details

Lamictal

Lamotrigine
5 mg
Chewable Tablet


DIN/PIN/NPN

02240115

Manufacturer

GlaxoSmithKline Inc., GlaxoSmithKline Consumer Health Care

Formulary Listing Date

2023-04-28  

Unit Price

0.2070

Amount MOH Pays

0.2070

Coverage Status

Exceptional Access Program Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

N03AX09

Interchangeable Products

NO  

LU Clinical Criteria

NO  

EAP Criteria

Therapeutic Class Reimbursement Criteria
Anticonvulsants

Lamotrigine (chewable)

  • Brand(s): Lamictal
  • Dosage Form/Strength: 5 mg chewable tablet

For the adjunctive therapy for children over 2 years of age who are suffering from refractory seizures associated with Lennox-Gastaut syndrome, and who have previously tried other antiepileptic drugs. 

Duration of Approval: 1 year

EAP Drug Request Form:

Standard Form for EAP Drug Requests

Product Monograph

View Monograph