Drug - Triptans
December 2007
Therapeutic area - Migraine Headache
Table 1. Oral and Nasal Dosage Forms
Brand | Generic | Form | Strengths |
Amerge | naratriptan | Tablet | 1 mg, 2.5 mg |
Axert | almotriptan | Tablet | 6.25 mg, 12.5 mg |
Frova | frovatriptan | Tablet | 2.5 mg |
Imitrex | sumatriptan | Tablet | 25 mg, 50 mg, 100 mg |
Imitrex | sumatriptan | Nasal spray | 5 mg, 20 mg |
Maxalt
Maxalt MLT |
rizatriptan | Tablet
Dissolving tablet |
5 mg, 10 mg |
Relpax | eletriptan | Tablet | 20 mg, 40 mg |
Zomig
Zomig ZMT |
zolmitriptan | Tablet
Dissolving tablet |
2.5 mg, 5 mg |
Zomig | zolmitriptan | Nasal spray | 5 mg |
Table 2. Injectable dosage forms
Brand | Generic | Form | Strengths |
Imitrex | sumatriptan | Injection kit | 6 mg/0.5mL, 4 mg/0.5mL |
Imitrex | sumatriptan | Kit refill | 6 mg/0.5mL |
Imitrex | sumatriptan | Vials for injection | 6 mg/0.5mL |
Quantity limits will be 18 oral or nasal dosage forms of all triptan brands per rolling calendar month.
Imitrex injectable
Imitrex injectable quantity limits: 2 kits in 15 days. The minimum quantity is set to 1 kit and the maximum quantity is set to 2 kits.
For Cluster Headache Only
Cluster headache must be confirmed. Patient must receive relief of cluster headache pain from the triptan. A PA may be issued for the amount of drug necessary to cover the cluster headache episode.
MHCP Provider Call Center 651-431-2700 or 800-366-5411