| Migraine Disorders
Trokendi XR vs Zavzpret
Side-by-side clinical, coverage, and cost comparison for migraine disorders.Deep comparison between: Trokendi Xr vs Zavzpret 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 signalsZavzpret has a higher rate of injection site reactions vs Trokendi Xr based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Zavzpret but not Trokendi Xr, including UnitedHealthcare
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Category
Trokendi Xr
Zavzpret
At A Glance
Oral
Once daily
Anticonvulsant; carbonic anhydrase inhibitor
Intranasal
As needed
CGRP receptor antagonist
Indications
- Lennox-Gastaut Syndrome
- Migraine Disorders
- Migraine Disorders
Dosing
Lennox-Gastaut Syndrome Adjunctive therapy: adults (>=17 years) 200-400 mg orally once daily, initiated at 25-50 mg once daily and titrated in 25-50 mg/week increments; pediatric patients 6-16 years approximately 5-9 mg/kg/day orally once daily, initiated at 25 mg/day and titrated at 1-3 mg/kg/day every 1-2 weeks, not to exceed 400 mg/day.
Migraine Disorders Preventive treatment for patients 12 years and older: 100 mg orally once daily, titrated over 4 weeks starting at 25 mg/day (Week 1: 25 mg, Week 2: 50 mg, Week 3: 75 mg, Week 4: 100 mg).
Migraine Disorders 10 mg as a single spray in one nostril as needed; maximum 10 mg (one spray) per 24-hour period; safety of treating more than 8 migraines in a 30-day period has not been established.
Contraindications
- Recent alcohol use within 6 hours prior to or 6 hours after TROKENDI XR administration
- History of hypersensitivity reaction to topiramate, TROKENDI XR, or any inactive ingredient (anaphylaxis and angioedema have occurred)
- History of hypersensitivity reaction to zavegepant or any component of ZAVZPRET, including anaphylaxis
Adverse Reactions
Most common (>=10%) Paresthesia, weight loss, anorexia, dizziness, somnolence, nervousness, psychomotor slowing, speech disorders, vision abnormal
Serious Acute myopia and secondary angle closure glaucoma, metabolic acidosis, oligohydrosis and hyperthermia, suicidal behavior and ideation, fetal toxicity, DRESS/multiorgan hypersensitivity, serious skin reactions, anaphylaxis and angioedema, hyperammonemia and encephalopathy, decrease of bone mineral density, kidney stones
Postmarketing Hepatic failure, hepatitis, pancreatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, pemphigus, nephrocalcinosis, maculopathy, decreased INR with vitamin K antagonists
Most common (>=2%) Taste disorders (dysgeusia, ageusia), nausea, nasal discomfort, vomiting
Serious Hypersensitivity including facial swelling and urticaria (less than 1%)
Postmarketing Hypersensitivity (anaphylaxis), hypertension, Raynaud's phenomenon
Pharmacology
Topiramate is a sulfamate-substituted monosaccharide anticonvulsant whose precise mechanism is unknown but is believed to involve blockade of voltage-dependent sodium channels, augmentation of GABA-A receptor activity, antagonism of AMPA/kainate glutamate receptors, and inhibition of carbonic anhydrase isozymes II and IV.
Zavegepant is a calcitonin gene-related peptide (CGRP) receptor antagonist; it blocks CGRP receptor signaling implicated in migraine pathophysiology.
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Most Common Insurance
Anthem BCBS
Trokendi Xr
- Covered on 5 commercial plans
- PA (5/12) · Step Therapy (0/12) · Qty limit (9/12)
Zavzpret
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (10/12) · Qty limit (10/12)
UnitedHealthcare
Trokendi Xr
- Covered on 4 commercial plans
- PA (1/8) · Step Therapy (0/8) · Qty limit (0/8)
Zavzpret
- Covered on 4 commercial plans
- PA (5/8) · Step Therapy (4/8) · Qty limit (4/8)
Humana
Trokendi Xr
- Covered on 0 commercial plans
- PA (1/3) · Step Therapy (0/3) · Qty limit (3/3)
Zavzpret
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (2/3) · Qty limit (3/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
No savings programs available for Trokendi Xr.
Cost estimate not availablePAF Co-Pay Relief: Migraine
Commercial or private insurance
Medicare, Medicaid, VA, TRICARE
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Trokendi XrView full Trokendi Xr profile
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.