Sumatriptan nasal (Onzetra Xsail)


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


  • 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.


One year

Last review date: March 7, 2017

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