Managed Healthcare Executive - March 2009 - (Page 20) { DRUG CLASS OVERVIEW } Some Drugs for Treatment of Migraine Drug Almotriptan – Axert (Ortho-McNeil) Eletriptan – Relpax (P zer) Frovatriptan – Frova (Endo) Naratriptan – Amerge (GlaxoSmithKline) Rizatriptan – Maxalt, Maxalt-MLT (Merck) Sumatriptan – Imitrex (GlaxoSmithKline) Formulations 6.25, 12.5 mg tabs 20, 40 mg tabs 2.5 mg tabs 1, 2.5 mg tabs 5, 10 mg tabs; 5, 10 mg orally disintegrating tabs 25, 50, 100 mg tabs 5, 20 mg nasal spray 4, 6 mg/0.5 mL cartridges; 6 mg/0.5 mL vials Usual dosage 12.5 mg PO; can be repeated once after 2 hrs (max 2 doses/d) 20 or 40 mg PO; can be repeated after 2 hrs (max 80 mg/d) 2.5 mg PO; can be repeated after 2 hrs (max 7.5 mg/d) 2.5 mg PO; can be repeated once after 4 hrs (max 5 mg/d) 5 or 10 mg PO; can be repeated after 2 hrs (max 30 mg/d) 50 or 100 mg PO; can be repeated after 2 hrs (max 200 mg/d) 5, 10 or 20 mg intranasally; can be repeated once after 2 hrs (max 40 mg/d) 6 mg SC; can be repeated once after 1 hr (max 12 mg/d) 2.5 or 5 mg PO; can be repeated after 2 hrs (max 10 mg/d) 5 mg intranasally; can be repeated once after 2 hrs Cost1 $21.15 19.95 21.92 24.47 21.06 22.88 34.71 81.62 20.07 29.25 Serotonin (5-HT1B/1D) Receptor Agonists (“Triptans”) Zolmitriptan – Zomig, Zomig ZMT (AstraZeneca) 2.5, 5 mg tabs; orally disintegrating tabs 5 mg/100 mcL nasal spray Ergot Alkaloids Dihydroergotamine mesylate – generic D.H.E. 45 (Valeant) Migranal Nasal Spray (Valeant) Ergotamine tartrate – Ergomar (Rosedale) Ergotamine/caffeine – Cafergot (Novartis) 1 mg/mL ampules 1 mg IM or SC; can be repeated at 1 hr intervals (max 3 mg/24 hrs, 6 mg/wk) 1 spray (0.5 mg) into each nostril, repeated 15 min later (2 mg/dose; max 3 mg/24 hrs) 2 mg sublingually; can be repeated q30min PRN (max 6 mg/24 hrs, 10 mg/wk) 2 tabs PO, then 1 q30min x 4 PRN (max 6 tabs/attack) 1 rectal suppository; can be repeated once 1 hr later 33.99 81.93 4 mg/mL nasal spray 2 mg sublingual tabs 1 mg/100 mg tabs 2 mg/100 mg rectal suppositories 44.27 8.66 1.50 8.03 1. Average cost of one dose at the lowest usual dosage, according to data from December 31, 2007, from retail pharmacies nationwide available from Wolters Kluwer Health. Prices of generic drugs may vary widely. Source: Treatment Guidelines from The Medical Letter, Vol. 6 (67) March 2008 practitioner, continuing Kaiser programs for migraine patients also could be led by a physician or a neurologist. It turns out the most important bene t of these sessions is the way they increase the patient’s sense of self-e cacy. “We found how much they learn isn’t the main factor,” says Morris Maizels, MD, a family physician at the Kaiser Permanente Woodland Hills Medical Center, and the lead author of the study. “Most importantly, patients feel empowered after the group experience. They have the sense that ‘I’m going to take 20 MARCH 2009 control of this situation, rather than letting it control me.’” Dr. Maizels estimates that if the study were repeated today, pharmacy costs would go up modestly, but the overall savings would go up dramatically. Migraine tends to be underdiagnosed and undertreated, he says. One reason is that once a patient has been diagnosed with another condition, such as sinus headaches or tension headaches, physicians often accept the diagnosis instead of doing their own evaluation. In addition, people may have a percep- tion of migraine as a horrible condition, when, in reality it can take a much milder form. MHE This article is based on information supplied by The Medical Letter (www.medicalletter.org), a non-pro t organization that publishes newsletters o ering critical appraisals of new drugs and comparative reviews of older drugs. The Medical Letter is completely independent of the pharmaceutical industry. It is supported entirely by subscription sales and accepts no advertising, grants or donations. Institutional site license inquiries can be sent to info@medicalletter.org. http://www.medicalletter.org
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