Indications for Prior Authorization:
- Indiated for adjunctive treatment of seizures associated with Lennox-Gastaut syndrome (LGS) in patients 2 years of age or older
Patients must meet the following criteria for the indication(s) above:
- Prescribed by or in collaboration with a neurologist, AND
- 2 years of age or older, AND
- Diagnosis of Lennox-Gastaut syndrome, AND
- Currently receiving treatment with at least one other antiepileptic medication
- Dose patients according to body weight. Individualize dosing within each body weight group, based on clinical efficacy and tolerability.
|Less than or equal to 30 kg Body Weight||Greater than 30 kg Body weight|
|Starting Dose||5 mg||10 mg|
|Starting Day 7||10 mg||20 mg|
|Starting Day 14||20 mg||40 mg|
- Administer tablets whole, broken in half along the score, or crushed and mixed in applesauce.
- To discontinue, taper by decreasing the total daily dose by 5-10 mg/day on a weekly basis until discontinued.
- 1 year
Last review date: June 12, 2017