Policycriteria provider must submit documentation such as office chart notes, lab results or other clinical information supporting that member has met all approval criteria. Vimpat lacosamide injection, for intravenous use, cv. Enbrel etanerceptinjection, for subcutaneous use enbrel etanercept for injection, for subcutaneous use initial u. Discover prescription topamax topiramate for migraine prevention in adults and find a coupon. Banzel rufinamide is an antiepileptic drug indicated for. As the safety of briviact injection in pediatric patients has not been established, briviact injection is indicated for the. Scored tablets may not provide the exact mgkg dosage that has. Inactive ingredients are colloidal silicon dioxide, corn starch crosscarmellose sodium, hypromellose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, and sodium lauryl sulphate. Banzel is contraindicated in patients with familial short qt syndrome 4 banzel. Banzel rufinamide, onfi clobazam, and sympazan clobazam are indicated for the adjunctive treatment of seizures associated with lennoxgastaut syndrome lgs. Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death 5. Banzel fda prescribing information, side effects and uses. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Prescribing information phenobarbital sodium injection usp 30 mgml, 120 mgml therapeutic classification anticonvulsant, hypnotic, sedative barbiturate sandoz canada inc.
Atrovent hfa ipratropium bromide hfa inhalation aerosol, for oral inhalation use initial u. This emedtv web segment further describes other side effects seen with the drug, including other common side effects and those that require immediate medical attention. Vimpat lacosamide film coated tablet, for oral use, cv. Ethosuximide zarontin prescribing information medworks.
Talk to your healthcare provider if you have questions. See full prescribing information for complete boxed warning. Fetal toxicity when pregnancy is detected, discontinue entresto as soon as possible 5. Drug name patient information prescribing physician. Highlights of prescribing information these highlights do not include all the information needed to use zoladex safely and effectively. Please refer to each products fdaapproved label and indication for further information.
Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate. Rufinamide is a triazole derivative used as an antiepileptic drug aed, structurally unrelated to currently marketed. Highlights of prescribing information these highlights do not include all the information needed to use pletal safely and effectively. February 26, 2015 boucherville, qc, canada j4b 7k8. In clinical trials, rufinamide dosage was tapered by approximately 25% every other day. Fda approved indication banzel is indicated for the adjunctive treatment of seizures associated with lennoxgastaut syndrome lgs in pediatric patients 1 year of age and older, and in adults. Mirena is also indicated for the treatment of heavy menstrual bleeding in women who choose to use intrauterine contraception as their method of contraception. This pharmacy coverage guideline provides information related to. The fda indication approves the use of rufinamide to a small focused population adjunctive use in patients 4yearsold and over with lgs, as these are the only parameters in which randomized, doubleblind, placebocontrolled data exists table 3. These highlights do not include all the information needed to use. Highlights of prescribing information these highlights do not include all the information needed to use banzel. For a complete listing, see dosage forms, composition and.
Highlights of prescribing information these highlights do not include all the information needed to use atrovent hfa safely and effectively. Fax signed forms to aetna better health florida at. Highlights of prescribing information these highlights do not include all the information needed to use caprelsa safely and effectively. Pdf rufinamide in patients with lennoxgastaut syndrome. Banzel is for use in adults and children who are at least 1 year old. Please see the full prescribing information, including medication guide, for additional information about depakote. Vimpat lacosamide film coated tablet, for oral use, cv vimpat lacosamide injection, for intravenous use, cv. Clinical pharmacy program guidelines for anticonvulsants. Please see full prescribing information for additional details.
Please contact cvs caremark at 18555822022 with questions regarding the prior authorization process. It is used in combination with other medication and therapy to treat lennoxgastaut syndrome and various other seizure disorders. These highlights do not include all the information needed to use effexor xr safely and effectively. Zyprexa olanzapine patient information healthyplace. Banzel rufinamide dose, indications, adverse effects. Banzel filmcoated tablets can be administered whole, as half tablets or crushed. Full prescribing information 1 indications and usage spinraza is indicated for the treatment of spinal muscular atrophy sma in pediatric and adult patients. Banzel is available for oral administration in filmcoated tablets, scored on both sides, containing 200 and 400 mg of rufinamide. Ethosuximide zarontin prescribing information medworks media. Unitedhealthcare pharmacy clinical pharmacy programs.
Banzel is indicated for adjunctive treatment of seizures associated with lennoxgastaut syndrome in pediatric patients 1 year of age and older and in adults. Lamictal odt lamotrigine orally disintegrating tablets, for oral use. Please answer the following questions and fax this form to the number listed above. Dec 12, 2019 banzel is available for oral administration in filmcoated tablets, scored on both sides, containing 200 and 400 mg of rufinamide. Full prescribing information 1 indications and usage briviact is indicated for the treatment of partialonset seizures in patients 4 years of age and older. Financial assistance for patients lenvima reimbursement. It is recommended for use during pregnancy only if the doctor feels that its potential benefit outweighs the potential risk to. Prior authorization form banzel hmf this fax machine is located in a secure location as required by hipaa regulations. Special information if you are pregnant or breastfeeding in animal studies, topamax has caused harm to the developing fetus, and its safety has not been verified in pregnant humans. These highlights do not include all the information needed to use vimpat safely and effectively. The provided adapter and calibrated oral dosing syringe should be used to administer the oral suspension.
Banzel rufinamide tablet, film coated for oral use banzel rufinamide oral suspension initial u. Highlights of prescribing information these highlights do not include all the information needed to use imlygicsafely and effectively. This fax machine is located in a secure location as required by hipaa regulations. Information for vermont prescribers of prescription drugs. Data sources include ibm watson micromedex updated 28 feb 2020, cerner multum updated 2 mar 2020, wolters kluwer updated. Highlights of prescribing information these highlights do not include all the information needed to use banzel safely and effectively. Pdf peggy o clark,1 patricia a gibson2 1cincinnati childrens hospital medical center, the. Banzel is contraindicated in patients with familial short qt syndrome 4. Drug information on banzel rufinamide includes side effects, uses, drug interactions, dosage, drug pictures, overdose symptoms, and what to avoid. Fanapt is a type of prescription medication used for the acute treatment of schizophrenia in adults. For the full prescribing information pdf, click the button below to be directed to the fda pdf label for this drug. For the adjunctive treatment of seizures banzel rufinamide. Highlights of prescribing information these highlights do not include all the information needed to use velcade safely and effectively. Learn about banzel rufinamide indicated for the adjunctive treatment of seizures associated with lgs.
When conditions are met, we will authorize the coverage of banzel. Full prescribing information 1 indications and usage mirena is indicated for intrauterine contraception for up to 5 years. Banzel is specifically indicated for adjunctive treatment of seizures. Hematologic toxicity, myopathy, lactic acidosis and severe hepatomegaly with steatosis, and exacerbations of hepatitis b see full prescribing information for complete boxed warning. Imlygictalimogene laherparepvec suspensionfor intralesionalinjection initial u. Are you current on new important fda drug announcements during the past month. The following points are shortened, highlighted information from prescribing information for this drug.
You are encouraged to report negative side effects of prescription drugs to the fda. Sections or subsections omitted from the full prescribing information are not listed. Banzel rufinamide filmcoated tablet, for o ral use banzel rufinamide oral suspension. Prescribing information depakote divalproex sodium. Find out why zyprexa olanzapine is prescribed, side effects of zyprexa, zyprexa warnings, effects of zyprexa during pregnancy, more in plain english. Review the latest key information on fda drug approvals, changes, and interactions. If this is an urgent request, please call upmc health plan pharmacy services. Banzel oral suspension should be shaken well before every administration.
These highlights do not include all the information needed to use lamictal safely and effectively. Please contact cvscaremark at 18443808831 with questions regarding the. Pdr drug summaries are concise pointofcare prescribing, dosing and administering information to help phsyicans more efficiently and accurately prescribe in their practice pdr s drug summaries are available free of charge and serve as a great resource for us based mds, dos, nps and pas in patient practice. Highlights of prescribing information these highlights do not include all the information needed to use contraindications banzel. Effexor xr venlafaxine extendedrelease capsules initial u. Full prescribing information 1 indications and usage keveyis is indicated for the treatment of primary hyperkalemic periodic paralysis, primary hypokalemic periodic paralysis, and related variants. See full prescribing information for effects of banzel on other aeds 7. Combivir lamivudine and zidovudine tablets, for oral use initial u. Banzel is indicated for the adjunctive treatment of seizures associated with lennoxgastaut syndrome lgs in pediatric patients 1 year of age and older, and in adults.
Gabitril tiagabine, banzel rufinamide, onfi clobazam, epidiolex cannabidiol, sympazan clobazam, sabril, vigabatrin, diacomit stiripentol. Highlights of prescribing information these highlights do not. Topamax topiramate patient information healthyplace. Efficacy and safety of rufinamide in pediatric epilepsy.
Rufinamide, a triazole derivative, was developed in 2004 by novartis pharma, ag, and is manufactured by eisai. Highlights of prescribing information these highlights do not include all the information needed to use enbrel safely and effectively. Find patient medical information for banzel oral on webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Headaches, nausea, and fatigue are some of the most common banzel side effects. Yescarta axicabtagene ciloleucel suspension for intravenous infusion.
Unitedhealthcare pharmacy clinical pharmacy programs program. Banzel is used together with other medicines to treat seizures caused by lennoxgastaut syndrome, a severe form of childhood epilepsy that also causes developmental and behavior problems. Ethosuximide zarontin prescribing information highlights the following points are shortened, highlighted information from prescribing information for this drug. Highlights of prescribing information adjust adult. Banzel this fax machine is located in a secure location as required by hipaa regulations. Banzel rufinamide tablet, film coated for oral use initial u. Highlights of prescribing information ll the information needed to use banzel safely and effectively. Information for colorado prescribers of prescription drugs.