Sumatriptan nasal (Onzetra Xsail)
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
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.
Last review date: March 7, 2017