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MHCP Enrolled Providers – Pharmacies Fee-for-Service PA Criteria Sheet – Vimpat (April 2015) Drug Therapeutic Area Vimpat (lacosamide) tablets and oral suspension Anti-Seizure, Anti-Epileptic How Supplied and Dosing 50 mg, 100 mg, 150 mg, 200 mg (and IV infusion, which is not prior authorized) Oral solution 10 mg/ml Initial recommended dose 50 mg BID, may be increased weekly by 100 mg/day given as 2 divided doses up to a daily dose of 200-600 mg/day based on response and tolerance. FDA approved indication: Adjunctive therapy for the treatment of partial seizures Criteria Vimpat is being used for partial-onset seizures and is being added onto at least one other anti-seizure therapy AND Patient has tried and failed 3 or more anti-epileptic drugs which include: gabapentin, lamotrigine, levetiracetam, divalproex sodium, oxcarbazepine, topiramate, valproic acid or carbamazepine. <br> MHCP Provider Call Center 651-431-2700 or 800-366-5411