ONZETRA XSAIL (sumatriptan nasal)

SELF ADMINISTRATION - NASAL

Indications for Prior Authorization:

  • Acute treatment of migraine attacks in adults

Patients must meet the following criteria for the indication(s) above:

  • Total number of tablets requested per month does not exceed the amount needed to treat the number of headache days experienced per month, AND

  • Patient is not taking it together with another triptan or ergot-type drug (e.g. DHE, ergotamine, Cafergot, Migranal), AND
  • Medical rationale why patient is unable to use preferred generically available nasal sumatriptan (Imitrex) formulation.

This Medication is Not Approvable for the following conditions(s):

  • Prophylactic therapy of migraine attacks

  • Treatment of cluster headache

Dosing:

  • Intranasal: A single dose of 22mg (11mg nosepiece in each nostril).  If headache has not resolved within 2 hours or returns, the dose may be repeated once at least 2 hours after the first dose (maximum: 44mg [4 nosepieces] per 24 hours or 22mg [2 nosepieces] and one dose of another sumatriptan product [separated by at least 2 hours] per 24 hours).  The safety of treating an average of >4 headaches in a 30-day period has not been established.

Approval:

One year

Last review date: March 7, 2017

Rite Aid Pharmacy Patients: All Rite Aid pharmacies nationwide are closing! Please be on the lookout for information from Rite Aid pharmacies about their bankruptcy and store closures. Call your Rite Aid pharmacy for questions about your prescriptions and new pharmacy options. WHA is here to help as well. Contact Us via Phone