Product Details

Apo-Levetiracetam

Levetiracetam
500 mg
Tablet


DIN/PIN/NPN

02285932

Manufacturer

Apotex Inc.

Formulary Listing Date

2007-11-10  

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.

 

EAP Criteria

NO

Product Monograph

View Monograph