skip to content
Primary navigation

Triptan quantity limits

Drug - Triptans

December 2007

Therapeutic area - Migraine Headache

Table 1. Oral and Nasal Dosage Forms

Brand Generic Form Strengths
Amerge naratriptan Tablet 1 mg, 2.5 mg
Axert almotriptan Tablet 6.25 mg, 12.5 mg
Frova frovatriptan Tablet 2.5 mg
Imitrex sumatriptan Tablet 25 mg, 50 mg, 100 mg
Imitrex sumatriptan Nasal spray 5 mg, 20 mg
Maxalt MLT
rizatriptan Tablet
Dissolving tablet
5 mg, 10 mg
Relpax eletriptan Tablet 20 mg, 40 mg
Zomig ZMT
zolmitriptan Tablet
Dissolving tablet
2.5 mg, 5 mg
Zomig zolmitriptan Nasal spray 5 mg

Table 2. Injectable dosage forms

Brand Generic Form Strengths
Imitrex sumatriptan Injection kit 6 mg/0.5mL, 4 mg/0.5mL
Imitrex sumatriptan Kit refill 6 mg/0.5mL
Imitrex sumatriptan Vials for injection 6 mg/0.5mL
Oral and Nasal dosage forms

Quantity limits will be 18 oral or nasal dosage forms of all triptan brands per rolling calendar month.

Imitrex injectable

Imitrex injectable quantity limits: 2 kits in 15 days. The minimum quantity is set to 1 kit and the maximum quantity is set to 2 kits.

Criteria for QL override

  • One time override per 12 months for the purpose of minimizing Emergency Department visits, unless patient has cluster headache. If patient has cluster headache, more fills may be needed (see below) AND
  • The triptan is being prescribed by a headache specialist or patient has an appointment to see a headache specialist OR
  • Provider is able to demonstrate on behalf of the client that the excess quantity requested has resulted in a decrease in ER visits or hospitalization due to headache or migraine disorder OR
  • Prescriber provides peer reviewed literature showing efficacy and safety of dose that exceeds manufacturer's recommended dosage

For Cluster Headache Only
Cluster headache must be confirmed. Patient must receive relief of cluster headache pain from the triptan. A PA may be issued for the amount of drug necessary to cover the cluster headache episode.


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

back to top