Oleptro

Drug - Oleptro (extended-release trazodone)

June 2012

Therapeutic area - Antidepressant

Approval criteria

  • Patient is 18 years of age or older AND
  • Patient has a diagnosis of major depressive disorder AND
  • Patient has tried and failed two separate 2 month trials of 2 preferred SSRIs AND
  • Patient has a documented intolerance/contraindication to OR has tried and failed a 2 month trial of 2 other preferred new generation antidepressant (i.e. venlafaxine, bupropion, mirtazapine or a tri-cyclic antidepressant) AND
  • Patient meets the New Dosage Forms controlled-release or extended-release preparation criteria

Selective Serotonin Reuptake Inhibitors

Preferred Nonpreferred
citalopram Celexa
fluoxetine Paxil/Paxil CR
paroxetine Prozac
Pexeva Fluoxetine DR (weekly)
Lexapro Prozac weekly
sertraline paroxetine suspension
Sarafem
Viibryd*
Zoloft
*individual PA criteria apply
New Generation Antidepressants 
Preferred Nonpreferred
bupropion IR, SA, XL Aplenzin* (bupropion HBr) 
fluvoxamine Cymbalta
mirtazapine Desyrel
nefazodone Effexor, Effexor XR
trazodone Luvox CR*
Oleptro
venlafaxine extended release Pristiq*
venlafaxine extend release capsules (generic EffexorXR) Remeron
venlafaxine extended release Wellbutrin/SR/XL
tablets (generic) *individual PA criteria apply


Quantity limit

Quantity Limit = 34 (all strengths)

Background information

Oleptro is an extended-release dosage form of generically available trazodone. The most recent guidelines published by Kaiser Permanente Care Management Institute in 2006 for the treatment of depression in primary care recommend SSRIs, TCAs, serotonin norepinephrine reuptake inhibitors SNRIs, and dopamine agonists as first-line treatment of MDD. The preference of antidepressant is based on patient’s history with drug treatment, clinician choice, adverse effects, among other factors.

Oleptro is subject to quantity level limits and prior authorization. 

Questions?

MHCP Provider Call Center 651-431-2700 or 800-366-5411