Treximet info--pharmacists/assistants please

[Luna Baby]

I had my regular checkup today with my GP for med refills. One being my Treximet that I take for migraines. She asked me if I'd had any issue getting them filled. She mentioned that she had been told that Treximet was going to be discontinued and that should that happen, she would just write me the rx for regular Imitrex and that I could take a naproxen with it for the same result. I'm curious if any of you working directly with meds have heard this. I know the Trex is a combo drug that came out after the original Imitrex but can't see any reason why it would be discontinued.

I can take either/or but one does work slightly better for me. I really hate to think I finally found something that works and it might be jerked out from under me. Anyone else heard this? Any truth to it?

[Buzzard]

Yup, it's a combo pill, and Naproxen is the second part of it. MDs take a full med-chemistry course-set for a reason, and you're seeing it.

As for discontinuation: Any number of reasons, really, from loss of profit-margin, lack of demand, to "reasons, unspecified".

Having generic options available is a good thing though. It's the exact same molecule, giving the exact same benefit. The only difference is the shape/color of the pill, and the inert 'filler'. (can't be exact, as that's patent infringement, and we'll own you in court) The biggest (and only real) difference is the price tag.

[Luna Baby]

Yup, it's a combo pill, and Naproxen is the second part of it. MDs take a full med-chemistry course-set for a reason, and you're seeing it.

As for discontinuation: Any number of reasons, really, from loss of profit-margin, lack of demand, to "reasons, unspecified".

Having generic options available is a good thing though. It's the exact same molecule, giving the exact same benefit. The only difference is the shape/color of the pill, and the inert 'filler'. (can't be exact, as that's patent infringement, and we'll own you in court) The biggest (and only real) difference is the price tag.

The way she talked, it would be discontinued, not just replaced with a generic. Generics are fine, if available, as that's what is always dispensed here unless otherwise directed. When I was taking the Imitrex, it was the generic form since I was taking it 15+ years after it hit the market. So if a generic Trex is available, I'm fine with that. But I'm curious about totally discontinuing the product.

The biggest reason for my concern is that I dealt with a side effect of Imitrex that I didn't have as much with taking Treximet. Imitrex was 100 mg and the same drug in Treximet is only 85 mg. That reduction in the dosage was enough to reduce the one side effect that I didn't like. If I have to do my own "combo" by combining 2 drugs, I may be stuck taking more or less than the 85mg.

[EvilEmpryss]

You know, the dosage info online says that 100 mg of Imitrex might not give you any better relief that the 50 mg and increases the risk of unpleasant side effects. If the 85 mg of treximet works for you, you could talk to the doc about trying the lower dose imitrex, or combining the 50 mg and 25 mg pills to get up to 75 mg and add naproxin. I know that for one of my meds the exact dosage isn't available and I have to take a 600 mg and a 300 mg to get me "close enough".

As for fillers, I know they're supposed to be inert and make no difference, but I can see the diff when I have to cut pills. One company's pill shatters into dust no matter how carefully I follow the cutting line, the other makes clean cuts every time. Filler can make a decided difference between one generic and another.

[Luna Baby]

That was my thought, EE. I just haven't been able to find any information online regarding a potential discontinuation of the medication I currently take. I'd like to know before hand in the event I run out and try to get a refill and it not be available. I don't leave home without my med for fear that I will run into a trigger and bam! I'm down.

I'll probably speak directly with my pharmacist today while I'm in store and in the event of a discontinue, I'll try to just keep a couple extra on hand before I call in for a refill so that I will have time to get Doc to write for the base medication in the meantime.

I have considered trying something different since this med seems to be taking longer to work but I'm terrified that whatever I do try won't work at all.

**I also read where the 100 mg may not be any more effective than the 50 mg. Back when I very first started taking Imitrex, it was the auto-injector. IIRC, it was only 6 mg. I'm wondering how 6 mg of the drug was so much better than 50 or 100 mg. The injection worked within 10-15 minutes but was terribly expensive (same copay for 2 injections as it is for 9 tablets). That was how I got switched to the tablets.

[EvilEmpryss]

Injections go straight into your bloodstream so you need less than you would if it had to be processed through your digestive system. I have no idea what actual amount of medication makes it into your bloodstream with the pills, but that's the basics of it.

And I've seen my sis use the injections, and watching her go from barely able to open her eyes to up and waking and able to function in minutes. It's amazing how quick it works.

As far as it being discontinued, contact the company directly. They should have a customer service number on the web and you can just get it straight from the horse's mouth. People forget that you don't have to wait for someone else to post it on the web to find something out.

[Shalom]

Just checked with my wholesaler; they still have 62 packages in the warehouse, and no indication that it's being discontinued.

That being said, it wholesales for $606.74 for 9 tablets, or just about $67.42 per tablet. Generic sumatriptan for the cheapest brand (made in India, for what that's worth) is 70 cents a tablet. Big difference there.

It could be that the drug isn't being discontinued, just your insurance's willingness to pay for it?

Sumatriptan comes in 25, 50 and 100 mg tablets. The tablets bear warnings against crushing or splitting them, so you can't just take 1-1/2 of the 50s. If you had to, you could take 3 of the 25s for 75mg total dose. These run about 59c/tablet, wholesale.

If you do decide to go this route, by the way, note that the insurance may limit the number of tablets you can get at any one time. This is a holdover from back when the generic was still mondo expensive; I see the same thing with ondansetron (Zofran, an anti-nausea med that used to cost insane money before it went generic). If you have to pay cash, I'd suggest going to an independent pharmacy who can work with you on pricing. The chains will charge you based on AWP which is around 28 dollars a tablet for the 25s; whereas someplace like me will probably try to make $10-20 profit on the script and call it a day.

(BTW: The manufacturer of Treximet is PERNIX THERAPEUTICS INC, phone number 800-793-2145. Give 'em a call.)

[Sapphire Silk]

I can take either/or but one does work slightly better for me. I really hate to think I finally found something that works and it might be jerked out from under me. Anyone else heard this? Any truth to it?

I had not heard this, but I can tell you something about the drug that may explain things.

Treximet is an effort on the part of the company who originally patented the drug to hang onto sales and profits when Imitrex went generic. A lot of companies do this; they make a minor molecular change to the drug, get it FDA approved (doesn't take much since the expensive part of the process is already done) and then push the "new" drug over the old drug when often there is no proven benefit of one over the other.

There really was no reason to combine the drugs other than to hang onto profits. You can just take an OTC naproxen with the Imitrex tablet and get the same result.

Just checked with my wholesaler; they still have 62 packages in the warehouse, and no indication that it's being discontinued.

That being said, it wholesales for $606.74 for 9 tablets, or just about $67.42 per tablet. Generic sumatriptan for the cheapest brand (made in India, for what that's worth) is 70 cents a tablet. Big difference there.

It could be that the drug isn't being discontinued, just your insurance's willingness to pay for it?

This seems likely. Luna: every insurance company has a "Formulary"; what the OP might have heard was that it was being discontinued from the Formulary, and you misunderstood that to mean they weren't making the drug at all.

Sumatriptan comes in 25, 50 and 100 mg tablets. The tablets bear warnings against crushing or splitting them, so you can't just take 1-1/2 of the 50s. If you had to, you could take 3 of the 25s for 75mg total dose. These run about 59c/tablet, wholesale.

Luna, listen to this. If the drug has a warning against crushing or splitting the drug, follow it. In this case, it could lead to too rapid absorption which is not good for your cardio vascular system.

If you do decide to go this route, by the way, note that the insurance may limit the number of tablets you can get at any one time. This is a holdover from back when the generic was still mondo expensive;

Well, there's another consideration when it comes to the 'triptans, the class that Imitrex is in.

Luna: basically the idea is that migraines are thought to be caused by vasospasms in the microvasculature of the brain. Imitrex and drugs like it cause vasoconstriction of the arteries, stopping the spasm and hence the pain.

However, the effects of the drug are not limited to the brain. They affect the cardiovascular system throughout the body. This can lead to a decreased blood supply to organ systems that results in ischemia. Most commonly, the side effect we see is chest pain: reduced arterial blood flow to the heart because of the vasoconstriction decreases oxygen to the heart, resulting in pain. People who develop this symptom should not take the drug until they've been evaluated by a cardiologist.

I happen to be one of these people.

Because of this, there is a 24 hour limit on the dose, and people should not be taking this drug on a daily basis. That's why people should not get more than so many pills per month. Of course, I don't know if Luna's migraines are that frequent. Mine used to be; at one point almost daily. I had to quit cold turkey all meds for headache and suffer through them for several weeks because of "rebound syndrome."

[Luna Baby]

Thanks for the additional information, Shalom and Sapphire. I hadn't really given it any thought about contacting the manufacturer direct (EE mentioned, I believe) so I'll keep that in mind in case I do start having trouble getting it.

As far as my insurance, this particular med is on my 3rd tier copay ($30) but funny as the last refill was only $25. I could have met a maximum OOP but I don't recall there being one on medications. My receipt did show cash price and insurance price. It was then that I was thankful for insurance since that refill was well over $600 had I paid cash. The injections cost me the same for 2 injections as it does for 9 tablets.

If a medication isn't specifically scored for splitting or coated for time release, I know not to do so. While I'm no longer in the medical field, I was at one time with quite a bit of work directly with medications/administration.

I can manage on regular generic Imitrex if I need do, even adding the naproxen for the added long term pain relief. But there was something about that slight reduction in strength that helped with the burning sensation that I experience on Imitrex. My tonsils, nose, every single nerve ending feels on fire. Still there, only ever so slightly, with the Treximet. The nurse practitioner that first switched me thought there was a slight 'reformulation' of the sumitriptan that allowed the lesser side effect. Doc thinks it's the naproxen. Doesn't matter to me except that it works.

I'm dealing with 2-4 per month on average right now. I'm finding more and more triggers as I age. Dehydration/overly tired, excessive sugar, bright lights, weather changes, etc. Now that I'm finding my triggers, I'm starting to be able to control some of the headaches.

SS, you mentioned this drug reducing blood flow to the heart. I do have tachycardia. It tends to run in the family-mother and sister. Sis and I both chose not to take medication for it. I only have an episode 1-2 a month now. I never put 2 and 2 together, but I'm wondering if it might be possible that the Treximet could be a trigger to the tachy episodes. I was diagnosed somewhere around 15 years ago and took meds off and on until I decided I couldn't stand the lack of "desire" that most of the meds caused. I have been medication free (for that dx for about 6-7 years).

I think I'll be doing a little more research and probably be armed with a list of questions when I follow up with the doc again.

Thanks again, to all that have responded.

[Sapphire Silk]

I don't think it's likely the Imitrex is triggering the tachycardia episodes. That's not a side effect I'm aware of.

However, it could lead to increased risks if you're having a tachy episode at the same time as a migraine. I'd discuss the matter with your GP.