Product Details
Riva-Levetiracetam
Levetiracetam500 mg
Tablet
DIN/PIN/NPN
02482282
Manufacturer
Laboratoire Riva Inc.
Formulary Listing Date
2019-12-20
Unit Price
0.3911
Amount MOH Pays
0.3911
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
N03AX14
Interchangeable Products
DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
---|---|---|---|
02461994 | Sandoz Levetiracetam | 0.3911 | 0.3911 |
02482282 | Riva-Levetiracetam | 0.3911 | 0.3911 |
02499207 | NRA-Levetiracetam | 0.3911 | 0.3911 |
02440210 | Nat-Levetiracetam | 0.3911 | 0.3911 |
02399784 | Ach-Levetiracetam | 0.3911 | 0.3911 |
02454661 | Levetiracetam | 0.3911 | 0.3911 |
02442558 | Levetiracetam | 0.3911 | 0.3911 |
02353350 | Levetiracetam | 0.3911 | 0.3911 |
02247028 | Keppra | 2.1725 | 0.3911 |
02403021 | Jamp-Levetiracetam | 0.3911 | 0.3911 |
02375257 | Auro-Levetiracetam | 0.3911 | 0.3911 |
02285932 | Apo-Levetiracetam | 0.3911 | 0.3911 |
02274191 | Act Levetiracetam | 0.3911 | 0.3911 |
02504561 | Jamp Levetiracetam Tablets | 0.3911 | 0.3911 |
02524570 | M-Levetiracetam | 0.3911 | 0.3911 |
02442396 | Mint-Levetiracetam | 0.3911 | 0.3911 |
02296128 | PMS-Levetiracetam | 0.3911 | 0.3911 |
LU Clinical Criteria
LU Code | Auth. Period | Clinical Criteria |
---|---|---|
473 | Indefinite | As adjunctive therapy in the treatment of seizure disorders where control by other listed anticonvulsants has been unsatisfactory. |