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