| Migraine Disorders
Depakote vs Onzetra Xsail
Side-by-side clinical, coverage, and cost comparison for migraine disorders.Deep comparison between: Depakote vs Onzetra Xsail with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsOnzetra Xsail has a higher rate of injection site reactions vs Depakote based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Onzetra Xsail but not Depakote, including UnitedHealthcare
Sign up to reveal the full AI analysis
Category
Depakote
Onzetra Xsail
At A Glance
Oral
Daily in divided doses
Valproate anticonvulsant
Nasal powder
As needed
5-HT1B/1D agonist (triptan)
Indications
- Bipolar Disorder
- Complex partial seizures
- Absence Epilepsy
- Migraine Disorders
- Migraine Disorders
Dosing
Bipolar Disorder 750 mg/day initially in divided doses, titrated rapidly to clinical response; max 60 mg/kg/day; oral.
Complex partial seizures 10-15 mg/kg/day initially, increased by 5-10 mg/kg/week to optimal response; max 60 mg/kg/day; divide doses if total daily dose exceeds 250 mg; oral.
Absence Epilepsy 15 mg/kg/day initially, increased at one-week intervals by 5-10 mg/kg/day until seizures are controlled; max 60 mg/kg/day; divide doses if total daily dose exceeds 250 mg; oral.
Migraine Disorders 250 mg twice daily; some patients may benefit from doses up to 1,000 mg/day; oral.
Migraine Disorders 22 mg (one 11 mg nosepiece per nostril) intranasally as a single dose; if migraine unresolved at 2 hours or returns, a second 22 mg dose may be administered at least 2 hours after the first; maximum 44 mg per 24 hours.
Contraindications
- Hepatic disease or significant hepatic dysfunction
- Mitochondrial disorders caused by mutations in mitochondrial DNA polymerase gamma (POLG; e.g., Alpers-Huttenlocher Syndrome) and children under two years of age suspected of having a POLG-related disorder
- Known hypersensitivity to divalproex sodium, sodium valproate, or valproic acid
- Known urea cycle disorders
- Migraine prophylaxis in pregnant women or in women of childbearing potential not using effective contraception
- Ischemic coronary artery disease or coronary artery vasospasm, including Prinzmetal's angina, or other significant underlying cardiovascular disease
- Wolff-Parkinson-White Syndrome or arrhythmias associated with other cardiac accessory conduction pathway disorders
- History of stroke, transient ischemic attack (TIA), or hemiplegic or basilar migraine
- Peripheral vascular disease
- Ischemic bowel disease
- Uncontrolled hypertension
- Recent use (within 24 hours) of ergotamine-containing or ergot-type medications, or another 5-HT1 agonist
- Concurrent administration or recent use (within 2 weeks) of an MAO-A inhibitor
- Hypersensitivity to sumatriptan
- Severe hepatic impairment
Adverse Reactions
Most common (>=5%) Nausea, vomiting, somnolence, dizziness, tremor, asthenia, alopecia, headache, abdominal pain, dyspepsia, diarrhea, weight gain
Serious Hepatic failure, birth defects, pancreatitis, hyperammonemic encephalopathy, suicidal behavior and ideation, bleeding and hematopoietic disorders, hypothermia, DRESS/multiorgan hypersensitivity, serious dermatologic reactions, angioedema
Postmarketing Toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme, parkinsonism, aplastic anemia, pancytopenia, fractures, decreased bone mineral density, polycystic ovary disease, male infertility, angioedema
Most common (>=2%) Abnormal taste, nasal discomfort, rhinorrhea, rhinitis
Serious Myocardial ischemia, myocardial infarction, Prinzmetal's angina, arrhythmias, chest/throat/neck/jaw pain/tightness/pressure, cerebrovascular events, vasospasm reactions, medication overuse headache, serotonin syndrome, increased blood pressure, hypersensitivity reactions, seizures
Postmarketing Epistaxis
Pharmacology
Divalproex sodium dissociates to the valproate ion in the gastrointestinal tract; its therapeutic mechanisms have not been fully established, but its anticonvulsant activity is thought to relate to increased brain concentrations of gamma-aminobutyric acid (GABA).
Sumatriptan is a selective 5-HT1B/1D receptor agonist that constricts intracranial blood vessels and inhibits pro-inflammatory neuropeptide release from the trigeminal system, relieving migraine headache.
Enter your patient's insuranceCheck specific coverage details for your patient.
Most Common Insurance
Anthem BCBS
Depakote
- Covered on 5 commercial plans
- PA (0/12) · Step Therapy (0/12) · Qty limit (9/12)
Onzetra Xsail
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (10/12) · Qty limit (9/12)
UnitedHealthcare
Depakote
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Onzetra Xsail
- Covered on 4 commercial plans
- PA (3/8) · Step Therapy (0/8) · Qty limit (1/8)
Humana
Depakote
- Covered on 0 commercial plans
- PA (0/3) · Step Therapy (0/3) · Qty limit (0/3)
Onzetra Xsail
- Covered on 0 commercial plans
- PA (1/3) · Step Therapy (3/3) · Qty limit (3/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
No savings programs available for Depakote.
No savings programs available for Onzetra Xsail.
Compare Other Drugs
Let us handle your prior authsJust enter your patient's info and we'll:
- Verify eligibility with the payer.
- Pull the right PA forms directly from the payer.
- Submit, track & send live updates to your dashboard.
Free to start · HIPAA compliant
Next Steps for Your Patient
DepakoteView full Depakote profile
Onzetra XsailView full Onzetra Xsail profile
Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.