Generic rizatriptan (Maxalt) and sumatriptan (Imitrex)

The release of a generic substitute of the branded drug Imitrex (sumatriptan) has dramatically reduced the cost and improved the access to this uniquely effective migraine drug. The generic sumatriptan was released four years ago and now the price of one tablet is down to about $3 from over $20. The cost of two other generic triptans, Amerge (naratriptan) and Maxalt (rizatriptan) has remained very high, but it is expected to drop as more companies begin making generic copies. However, generics are not always the exact copies of the original branded drug that we expect them to be. In my previous post in 2009 I mentioned a study that showed that the generic Topamax (topiramate) does not work as well as the brand for some patients. I have also seen this with sumatriptan – my patients tell me that some generics do not work very well or at all. Out of about 10 generics of sumatriptan, I would guess that two are of poor quality. Once you find a generic that works for you, try to stick with the same generic manufacturer. The name of the manufacturer is printed on the bottle the pharmacy gives you. If one pharmacy does not have your generic, try another one. Here is a part of an email I just received from a patient (she gave me permission to share it with you):
“Just wanted to share with you that my pharmacy filled my maxalt melt prescription with yet another generic brand yesterday, which I found very unpleasant.
Previously the generic refills I’d gotten were from a company called PAR. The PAR pills resembled the original MAXALT melts in style of packaging (foil packets in plastic case) in taste and most important in melt-ability (never timed it but it always seemed to dissolve within 5 to 10 seconds–basically immediate dissolve)
But yesterday’s refill was from Mylan. These melts came in a regular prescription bottle of pills. I called the pharmacy after they were delivered thinking they accidentally gave me non-melts. They checked and told me, no, these were melts, just from a different company. They explained that this company (Mylan) packages them like any other pill (in bottles).
When I took the pill last night it felt like what i imagine it would feel like if you took a chewable vitamin and then waited for it to disintegrate in your mouth. It took minutes to “melt”, instead of seconds, and a grainy feeling remained even after that. it also made my upper palate sore, and tasted bad.
Today I called my pharmacist to double check that this was a melt and they checked again and it is. Luckily they were good enough to switch the rest of the prescription to the PAR generic brand. They also told me they would no longer carry the ones from Mylan. (They did say the Mylan generic is cheaper, though, so not sure how this will work out in the future.)”

  1. Kelly says: 11/20/20152:22 am

    Oh and I forgot to mention, back in the early 90’s I was one of the first patients to get to try imitrex. Back then it was only injectable. It worked super fast but stung like a bee! These drugs changed my life. I hope they improve the quality of the generics.

  2. Kelly says: 11/20/20152:17 am

    That was supposed to say botox. Botox worked great on my wrinkles but did nothing for the migraines.

  3. Kelly says: 11/20/20152:14 am

    I just got a generic for maxalt which I have been taking for many years. After reading these posts, I’m afraid to take it. I used to get 20 + migraines a month and I have popped imitrex and maxalt like candy. I have had horrible migraines for 40 years. I have tried every drug and therapy for migraines that you can imagine and nothing really worked. I did all kinds of antidepressants, antiseizure meds, narcotics, both. Caffergot, biofeedback, beta blockers, you name it, I have done it. I even had a hysterectomy hoping that would help. I was ready to kill myself. I recently started taking lisinopril, a simple blood pressure med to prevent migraines and now I only get 1 to three migraines migraines a month. It is a miracle. I wish I would have tried this sooner.

  4. sue says: 10/06/20155:00 pm

    The Par is no longer being manufactured, and CVS tells me the same is true of Teva. CVS only seems able to get me Mylan and Breckenridge. Really frustrating – the name brand Maxalt and the Par generic seemed to work much better.

  5. Dr. Mauskop says: 09/21/201510:14 am

    I would try other generics of Maxalt made by Sun, Teva. Mylan and try other triptans that come in a generic form – Imitrex (sumatriptan), Amerge (naratriptan), and Zomig (zolmitriptan).

  6. esther says: 03/30/20157:05 am

    i forgot to mention that that lingering headachy/unpleasant feeling, can last for days, taking any more rizatriptan doesn’t help, i tried double dosing as well on the generic brand… no use whatsoever.

  7. esther says: 03/30/20156:58 am

    i have taken maxalt for a few years as well, without any problems, recently i too was switched to a generic brand of rizatriptan. i’ve tried 3 so far all with packaging that is a crime to open (which isn’t a big concern but still) the tiny pill is too compressed and won’t melt at all, My general practitioner told me you can take it with water but it wont be as effective. when i get a migraine i’m usually very nauseous, not being able to swallow the darn thing only makes it worse. and yes i have vomited away my medicine alltogether a few times. if i manage to properly take it, it still gives me hardly any relief from my migraine. my general practitioner then told me i’m allowed to take paracetamol on the side with it. still i have a sort of lingering in my head, it doesn’t get still and though i can go about my day i’m just not concentrated/efficient

  8. Dr. Mauskop says: 06/27/201412:17 am

    It is possible that the inactive ingredients or the sweetener is what makes you drowsy. Try a different generic manufacturer. Some of my patients also complain that the generic rizatriptan (Maxalt MLT) does not melt in the mouth as well as the brand or that it leaves a gritty residue in the mouth.

  9. Nancy H says: 06/26/201410:47 pm

    Has anyone found that the generic Maxalt MLT (Brekenridge) makes you drowsy? I have taken Maxalt MLT for 16 years and loved it, could go about my day after taking. This generic is making me so tired.

  10. Dr. Mauskop says: 04/23/201411:17 am

    Actually, the MLT form of Maxalt and Zomig ZMT, which melt in your mouth do not get absorbed in the mouth, but in the stomach. The advantage of the melting forms is that you do not have to drink water if you do not have water or if you are so nauseous that drinking makes you vomit. Otherwise, it is better to drink water with both the melting or regular tablets.

  11. dr.migraine says: 04/18/20147:48 am

    Hey to evryone saying that it has to be swallowed plz buy regular tablets coz point of mlt is that it dissolves in mouth and gets absored by sublingual vessels bypassing ythe stomach absorption.

  12. Desperate for Relief says: 11/05/20137:14 pm

    I’ve had migraines for 17 years and my only salvation has been that I could depend on MAXALT to work and let me function. Within the past few months, I was forced to switch to generic (Rizatriptan) by my insurance company. The co-pay for MAXALT MLT is now $500-$700 for 36 pills. Finding a generic that works for me has become a nightmare. To date, I have tried 4 different manufacturer’s. I was thrilled when PAR was so close to the original in effectiveness, taste, and ability to dissolve instantly in your mouth But.I was able to get only one 3-month supply; then, PAR was underbid by the other manufacturers and now my pharmacies say they can’t get it for my insurance! I can’t figure out how this is possible. Has anyone else come across this problem? I have somce tried 3 other manufacturers (GlenMarck, Beckenridge, Mylan). None of them even come close to the effectiveness of original Maxalt or PAR generic. If my headache goes away at all, it has been coming back later in the day. Now I’m taking more of the generic pills and am having rebound headaches that don’t respond at all to the drug. I don’t know what to do or who to appeal to for affordable migraine medication that works. If anyone has any advice, it would be much appreciated!

  13. Dr. Mauskop says: 10/28/20139:56 am

    For those of you whose insurance makes you use the MLT or melt form of Maxalt, here is a very useful tip: do not wait for it to melt in your mouth but drink it with water as you would a regular tablet. It will work faster and you won’t have to deal with the taste and grittiness. The reason it works faster if you swallow it with water is that MLT form does not get absorbed in the mouth as many people think, but it has to slowly trickle down your throat into the stomach and then intestine where it eventually does get absorbed.

  14. Judy F. says: 10/28/20139:27 am

    I also agree that the PAR is much closer to the original. I’m all for paying less, and was excited when Maxalt went generic, however, now that the pharmacy that I must use has switched, I noticed it is like the non-MLT kind that I used to have to get. The pharmacist explained that there is probably a range of “meltability” and as long as they meet that, the generic is good to go. It’s horrible! Grainy, bitter (even w/more nutra-sweet than the PAR one) and takes a couple minutes to melt vs. the 5-10 seconds. I’m going to try and crush it to see if that will help it melt fast. Also note that the PAR is made in the United Kingdom, new one is from India.

  15. Topamax apocalypse zombie says: 10/24/201312:17 am

    Thank you so much for this post. After the generic Maxalt became available my co-pay jumped from $50 to $70. So I reluctantly, thought I would try the generic which was only $20. The first month was Mylan melts, in the bottle, unlike the usual individually wrapped ones. I too, initially thought there was a mistake, but the pharmacist confirmed they were the same but generic and only packaged different.
    I really didn’t like how it made my stomach feel immediately after taking it, similar to a bloating feeling. Fortunately, I didn’t suffer from many migraines that month. I got a new prescription and filled at a different pharmacy and they were dispensed in the individual wrappers and were PAR pharmaceuticals. Aside from the normal side effect of an immediate stiff neck or tweaks in my neck, I thought I liked them better. But I wasn’t sure if it was because they were closer to the non generic in terms of being individually wrapped and melted better, and yes as mentioned above, no grainy taste, or if the efficacy was any different. Now that I’ve read this post I feel that my thoughts were true – the PAR ones seem to be closer to the original Maxalt – MLT.

    BTW: I noticed the mention of Topamax. I took this medication for two years – I stopped taking it once I realized my life was becoming unmanageable and I was developing severe cognitive problems, in addition to depression and panic attacks. I have been off several months now, and I still feel like a zombie and I’m scared to death that once extroverted personality, memory and quick-wit, will never be what it once was.

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