Serotonin Agonists, Oral

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PDL Reference Documents

Drug Use Review Documents

PDL Status Values

Y = preferred
N = non-preferred. Non-preferred drugs listed as N but without clinical drug use criteria are subject to the Non-Preferred Drugs in Select PDL Classes prior authorization criteria. New drugs will be listed as N until reviewed by the P&T Committee and are subject to the New Drug Policy.
V = voluntary non-preferred. Non-preferred mental health drugs are listed as V and prior authorization is not required.
Null (i.e. blank) = indicates the class or specific drug has not been reviewed for PDL placement.

To request a Prior Authorization, please use this form.

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NDC Brand Name Generic Name Form Strength PDL
Status		 Rebate Current Drug Use Criteria
00093526119 ALMOTRIPTAN MALATE almotriptan malate TABLET 12.5 mg N Y Quantity Limit
00093526129 ALMOTRIPTAN MALATE almotriptan malate TABLET 12.5 mg N Y Quantity Limit
00378524632 ALMOTRIPTAN MALATE almotriptan malate TABLET 12.5 mg N Y Quantity Limit
00378524685 ALMOTRIPTAN MALATE almotriptan malate TABLET 12.5 mg N Y Quantity Limit
27241004221 ALMOTRIPTAN MALATE almotriptan malate TABLET 12.5 mg N Y Quantity Limit
27241004268 ALMOTRIPTAN MALATE almotriptan malate TABLET 12.5 mg N Y Quantity Limit
00093526018 ALMOTRIPTAN MALATE almotriptan malate TABLET 6.25 mg N Y Quantity Limit
00093526019 ALMOTRIPTAN MALATE almotriptan malate TABLET 6.25 mg N Y Quantity Limit
00378524532 ALMOTRIPTAN MALATE almotriptan malate TABLET 6.25 mg N Y Quantity Limit
00378524585 ALMOTRIPTAN MALATE almotriptan malate TABLET 6.25 mg N Y Quantity Limit
27241004111 ALMOTRIPTAN MALATE almotriptan malate TABLET 6.25 mg N Y Quantity Limit
27241004168 ALMOTRIPTAN MALATE almotriptan malate TABLET 6.25 mg N Y Quantity Limit
69557033301 ELYXYB celecoxib SOLUTION 120 mg/4.8 mL (25 mg/mL) N Y Quantity Limit
69557033302 ELYXYB celecoxib SOLUTION 120 mg/4.8 mL (25 mg/mL) N Y Quantity Limit
00093831018 ELETRIPTAN HBR eletriptan hydrobromide TABLET 20 mg Y Y Quantity Limit
00093831019 ELETRIPTAN HBR eletriptan hydrobromide TABLET 20 mg Y Y Quantity Limit
00378428732 ELETRIPTAN HBR eletriptan hydrobromide TABLET 20 mg Y Y Quantity Limit
00378428785 ELETRIPTAN HBR eletriptan hydrobromide TABLET 20 mg Y Y Quantity Limit
27241003968 ELETRIPTAN HBR eletriptan hydrobromide TABLET 20 mg Y Y Quantity Limit
59651010406 ELETRIPTAN HBR eletriptan hydrobromide TABLET 20 mg Y Y Quantity Limit
59651010469 ELETRIPTAN HBR eletriptan hydrobromide TABLET 20 mg Y Y Quantity Limit
68382092286 ELETRIPTAN HBR eletriptan hydrobromide TABLET 20 mg Y Y Quantity Limit
00049233045 RELPAX eletriptan hydrobromide TABLET 20 mg Y Y Quantity Limit
00049233079 RELPAX eletriptan hydrobromide TABLET 20 mg Y Y Quantity Limit
58151036732 RELPAX eletriptan hydrobromide TABLET 20 mg Y Y Quantity Limit
58151036756 RELPAX eletriptan hydrobromide TABLET 20 mg Y Y Quantity Limit
00093831118 ELETRIPTAN HBR eletriptan hydrobromide TABLET 40 mg Y Y Quantity Limit
00093831119 ELETRIPTAN HBR eletriptan hydrobromide TABLET 40 mg Y Y Quantity Limit
00378428808 ELETRIPTAN HBR eletriptan hydrobromide TABLET 40 mg Y Y Quantity Limit
00378428832 ELETRIPTAN HBR eletriptan hydrobromide TABLET 40 mg Y Y Quantity Limit
00378428885 ELETRIPTAN HBR eletriptan hydrobromide TABLET 40 mg Y Y Quantity Limit
27241004011 ELETRIPTAN HBR eletriptan hydrobromide TABLET 40 mg Y Y Quantity Limit
27241004021 ELETRIPTAN HBR eletriptan hydrobromide TABLET 40 mg Y Y Quantity Limit
27241004068 ELETRIPTAN HBR eletriptan hydrobromide TABLET 40 mg Y Y Quantity Limit
59651010506 ELETRIPTAN HBR eletriptan hydrobromide TABLET 40 mg Y Y Quantity Limit
59651010569 ELETRIPTAN HBR eletriptan hydrobromide TABLET 40 mg Y Y Quantity Limit
68382092386 ELETRIPTAN HBR eletriptan hydrobromide TABLET 40 mg Y Y Quantity Limit
00049234005 RELPAX eletriptan hydrobromide TABLET 40 mg Y Y Quantity Limit
00049234079 RELPAX eletriptan hydrobromide TABLET 40 mg Y Y Quantity Limit
58151036832 RELPAX eletriptan hydrobromide TABLET 40 mg Y Y Quantity Limit
58151036856 RELPAX eletriptan hydrobromide TABLET 40 mg Y Y Quantity Limit
58151036896 RELPAX eletriptan hydrobromide TABLET 40 mg Y Y Quantity Limit
63481002509 FROVA frovatriptan succinate TABLET 2.5 mg N Y Quantity Limit
00603371834 FROVATRIPTAN SUCCINATE frovatriptan succinate TABLET 2.5 mg N Y Quantity Limit
50742029909 FROVATRIPTAN SUCCINATE frovatriptan succinate TABLET 2.5 mg N Y Quantity Limit
68462069497 FROVATRIPTAN SUCCINATE frovatriptan succinate TABLET 2.5 mg N Y Quantity Limit
69238153909 FROVATRIPTAN SUCCINATE frovatriptan succinate TABLET 2.5 mg N Y Quantity Limit
00002449101 REYVOW lasmiditan succinate TABLET 100 mg N Y Quantity Limit
00002449108 REYVOW lasmiditan succinate TABLET 100 mg N Y Quantity Limit
00002431208 REYVOW lasmiditan succinate TABLET 50 mg N Y Quantity Limit
00054027803 NARATRIPTAN HCL naratriptan HCl TABLET 1 mg Y Y Quantity Limit
23155005419 NARATRIPTAN HCL naratriptan HCl TABLET 1 mg Y Y Quantity Limit
00054027903 NARATRIPTAN HCL naratriptan HCl TABLET 2.5 mg Y Y Quantity Limit
23155005519 NARATRIPTAN HCL naratriptan HCl TABLET 2.5 mg Y Y Quantity Limit
69452034160 NARATRIPTAN HCL naratriptan HCl TABLET 2.5 mg Y Y Quantity Limit
69452034172 NARATRIPTAN HCL naratriptan HCl TABLET 2.5 mg Y Y Quantity Limit
78206014301 MAXALT MLT rizatriptan benzoate TAB RAPDIS 10 mg Y Y Quantity Limit
78206014399 MAXALT MLT rizatriptan benzoate TAB RAPDIS 10 mg Y Y Quantity Limit
29300026931 RIZATRIPTAN rizatriptan benzoate TAB RAPDIS 10 mg Y Y Quantity Limit
33342009402 RIZATRIPTAN rizatriptan benzoate TAB RAPDIS 10 mg Y Y Quantity Limit
33342009441 RIZATRIPTAN rizatriptan benzoate TAB RAPDIS 10 mg Y Y Quantity Limit
33342009452 RIZATRIPTAN rizatriptan benzoate TAB RAPDIS 10 mg Y Y Quantity Limit
57237008663 RIZATRIPTAN rizatriptan benzoate TAB RAPDIS 10 mg Y Y Quantity Limit
65862062603 RIZATRIPTAN rizatriptan benzoate TAB RAPDIS 10 mg Y Y Quantity Limit
65862062612 RIZATRIPTAN rizatriptan benzoate TAB RAPDIS 10 mg Y Y Quantity Limit
65862062690 RIZATRIPTAN rizatriptan benzoate TAB RAPDIS 10 mg Y Y Quantity Limit
69452015773 RIZATRIPTAN rizatriptan benzoate TAB RAPDIS 10 mg Y Y Quantity Limit
69452015774 RIZATRIPTAN rizatriptan benzoate TAB RAPDIS 10 mg Y Y Quantity Limit
29300026831 RIZATRIPTAN rizatriptan benzoate TAB RAPDIS 5 mg Y Y Quantity Limit
33342009302 RIZATRIPTAN rizatriptan benzoate TAB RAPDIS 5 mg Y Y Quantity Limit
33342009341 RIZATRIPTAN rizatriptan benzoate TAB RAPDIS 5 mg Y Y Quantity Limit
33342009345 RIZATRIPTAN rizatriptan benzoate TAB RAPDIS 5 mg Y Y Quantity Limit
33342009352 RIZATRIPTAN rizatriptan benzoate TAB RAPDIS 5 mg Y Y Quantity Limit
57237008563 RIZATRIPTAN rizatriptan benzoate TAB RAPDIS 5 mg Y Y Quantity Limit
65862062503 RIZATRIPTAN rizatriptan benzoate TAB RAPDIS 5 mg Y Y Quantity Limit
65862062512 RIZATRIPTAN rizatriptan benzoate TAB RAPDIS 5 mg Y Y Quantity Limit
65862062590 RIZATRIPTAN rizatriptan benzoate TAB RAPDIS 5 mg Y Y Quantity Limit
69452015673 RIZATRIPTAN rizatriptan benzoate TAB RAPDIS 5 mg Y Y Quantity Limit
69452015674 RIZATRIPTAN rizatriptan benzoate TAB RAPDIS 5 mg Y Y Quantity Limit
78206014201 MAXALT rizatriptan benzoate TABLET 10 mg Y Y Quantity Limit
78206014299 MAXALT rizatriptan benzoate TABLET 10 mg Y Y Quantity Limit
00093747219 RIZATRIPTAN rizatriptan benzoate TABLET 10 mg Y Y Quantity Limit
00093747243 RIZATRIPTAN rizatriptan benzoate TABLET 10 mg Y Y Quantity Limit
00378140496 RIZATRIPTAN rizatriptan benzoate TABLET 10 mg Y Y Quantity Limit
23155024522 RIZATRIPTAN rizatriptan benzoate TABLET 10 mg Y Y Quantity Limit
29300031731 RIZATRIPTAN rizatriptan benzoate TABLET 10 mg Y Y Quantity Limit
33342008802 RIZATRIPTAN rizatriptan benzoate TABLET 10 mg Y Y Quantity Limit
33342008841 RIZATRIPTAN rizatriptan benzoate TABLET 10 mg Y Y Quantity Limit
33342008845 RIZATRIPTAN rizatriptan benzoate TABLET 10 mg Y Y Quantity Limit
33342008852 RIZATRIPTAN rizatriptan benzoate TABLET 10 mg Y Y Quantity Limit
57237008834 RIZATRIPTAN rizatriptan benzoate TABLET 10 mg Y Y Quantity Limit
57237008863 RIZATRIPTAN rizatriptan benzoate TABLET 10 mg Y Y Quantity Limit
65862060003 RIZATRIPTAN rizatriptan benzoate TABLET 10 mg Y Y Quantity Limit
65862060012 RIZATRIPTAN rizatriptan benzoate TABLET 10 mg Y Y Quantity Limit
67877026206 RIZATRIPTAN rizatriptan benzoate TABLET 10 mg Y Y Quantity Limit
67877026218 RIZATRIPTAN rizatriptan benzoate TABLET 10 mg Y Y Quantity Limit
68462046640 RIZATRIPTAN rizatriptan benzoate TABLET 10 mg Y Y Quantity Limit
68462046699 RIZATRIPTAN rizatriptan benzoate TABLET 10 mg Y Y Quantity Limit
76282046306 RIZATRIPTAN rizatriptan benzoate TABLET 10 mg Y Y Quantity Limit
76282046318 RIZATRIPTAN rizatriptan benzoate TABLET 10 mg Y Y Quantity Limit
00093747119 RIZATRIPTAN rizatriptan benzoate TABLET 5 mg Y Y Quantity Limit
00093747143 RIZATRIPTAN rizatriptan benzoate TABLET 5 mg Y Y Quantity Limit
00378140396 RIZATRIPTAN rizatriptan benzoate TABLET 5 mg Y Y Quantity Limit
23155024422 RIZATRIPTAN rizatriptan benzoate TABLET 5 mg Y Y Quantity Limit
29300031631 RIZATRIPTAN rizatriptan benzoate TABLET 5 mg Y Y Quantity Limit
33342008702 RIZATRIPTAN rizatriptan benzoate TABLET 5 mg Y Y Quantity Limit
33342008741 RIZATRIPTAN rizatriptan benzoate TABLET 5 mg Y Y Quantity Limit
33342008745 RIZATRIPTAN rizatriptan benzoate TABLET 5 mg Y Y Quantity Limit
33342008752 RIZATRIPTAN rizatriptan benzoate TABLET 5 mg Y Y Quantity Limit
47335023160 RIZATRIPTAN rizatriptan benzoate TABLET 5 mg Y Y Quantity Limit
57237008734 RIZATRIPTAN rizatriptan benzoate TABLET 5 mg Y Y Quantity Limit
57237008763 RIZATRIPTAN rizatriptan benzoate TABLET 5 mg Y Y Quantity Limit
65862059903 RIZATRIPTAN rizatriptan benzoate TABLET 5 mg Y Y Quantity Limit
65862059912 RIZATRIPTAN rizatriptan benzoate TABLET 5 mg Y Y Quantity Limit
67877026106 RIZATRIPTAN rizatriptan benzoate TABLET 5 mg Y Y Quantity Limit
67877026118 RIZATRIPTAN rizatriptan benzoate TABLET 5 mg Y Y Quantity Limit
68462046540 RIZATRIPTAN rizatriptan benzoate TABLET 5 mg Y Y Quantity Limit
68462046599 RIZATRIPTAN rizatriptan benzoate TABLET 5 mg Y Y Quantity Limit
76282046206 RIZATRIPTAN rizatriptan benzoate TABLET 5 mg Y Y Quantity Limit
76282046218 RIZATRIPTAN rizatriptan benzoate TABLET 5 mg Y Y Quantity Limit
81968002009 SYMBRAVO rizatriptan benzoate/meloxicam TABLET 10 mg-20 mg N Y Quantity Limit
16714089101 SUMATRIPTAN SUCC-NAPROXEN SOD sumatriptan succ/naproxen sod TABLET 85 mg-500 mg N Y Quantity Limit
47335041022 SUMATRIPTAN SUCC-NAPROXEN SOD sumatriptan succ/naproxen sod TABLET 85 mg-500 mg N Y Quantity Limit
65862092836 SUMATRIPTAN SUCC-NAPROXEN SOD sumatriptan succ/naproxen sod TABLET 85 mg-500 mg N Y Quantity Limit
00173073701 IMITREX sumatriptan succinate TABLET 100 mg Y Y Quantity Limit
00378563259 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 100 mg Y Y Quantity Limit
16714079801 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 100 mg Y Y Quantity Limit
55111029309 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 100 mg Y Y Quantity Limit
55111029336 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 100 mg Y Y Quantity Limit
55111029390 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 100 mg Y Y Quantity Limit
55111029398 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 100 mg Y Y Quantity Limit
62756052269 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 100 mg Y Y Quantity Limit
62756052288 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 100 mg Y Y Quantity Limit
63304009911 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 100 mg Y Y Quantity Limit
64980066227 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 100 mg Y Y Quantity Limit
64980066236 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 100 mg Y Y Quantity Limit
64980066291 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 100 mg Y Y Quantity Limit
65862014836 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 100 mg Y Y Quantity Limit
69452034660 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 100 mg Y Y Quantity Limit
69452034672 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 100 mg Y Y Quantity Limit
00173073500 IMITREX sumatriptan succinate TABLET 25 mg Y Y Quantity Limit
00378563059 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 25 mg Y Y Quantity Limit
16714079601 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 25 mg Y Y Quantity Limit
55111029109 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 25 mg Y Y Quantity Limit
55111029136 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 25 mg Y Y Quantity Limit
55111029190 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 25 mg Y Y Quantity Limit
55111029198 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 25 mg Y Y Quantity Limit
62756052069 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 25 mg Y Y Quantity Limit
62756052088 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 25 mg Y Y Quantity Limit
63304009711 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 25 mg Y Y Quantity Limit
64980066027 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 25 mg Y Y Quantity Limit
64980066036 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 25 mg Y Y Quantity Limit
64980066091 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 25 mg Y Y Quantity Limit
65862014636 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 25 mg Y Y Quantity Limit
69452034460 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 25 mg Y Y Quantity Limit
69452034472 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 25 mg Y Y Quantity Limit
00173073601 IMITREX sumatriptan succinate TABLET 50 mg Y Y Quantity Limit
00378563159 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 50 mg Y Y Quantity Limit
16714079701 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 50 mg Y Y Quantity Limit
55111029209 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 50 mg Y Y Quantity Limit
55111029236 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 50 mg Y Y Quantity Limit
55111029290 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 50 mg Y Y Quantity Limit
55111029298 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 50 mg Y Y Quantity Limit
62756052169 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 50 mg Y Y Quantity Limit
62756052188 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 50 mg Y Y Quantity Limit
63304009811 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 50 mg Y Y Quantity Limit
64980066127 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 50 mg Y Y Quantity Limit
64980066136 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 50 mg Y Y Quantity Limit
64980066191 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 50 mg Y Y Quantity Limit
65862014736 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 50 mg Y Y Quantity Limit
69452034560 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 50 mg Y Y Quantity Limit
69452034572 SUMATRIPTAN SUCCINATE sumatriptan succinate TABLET 50 mg Y Y Quantity Limit
33342013974 ZOLMITRIPTAN ODT zolmitriptan TAB RAPDIS 2.5 mg Y Y Quantity Limit
62332018106 ZOLMITRIPTAN ODT zolmitriptan TAB RAPDIS 2.5 mg Y Y Quantity Limit
64980025616 ZOLMITRIPTAN ODT zolmitriptan TAB RAPDIS 2.5 mg Y Y Quantity Limit
68382071569 ZOLMITRIPTAN ODT zolmitriptan TAB RAPDIS 2.5 mg Y Y Quantity Limit
68382071586 ZOLMITRIPTAN ODT zolmitriptan TAB RAPDIS 2.5 mg Y Y Quantity Limit
68462049940 ZOLMITRIPTAN ODT zolmitriptan TAB RAPDIS 2.5 mg Y Y Quantity Limit
68462049976 ZOLMITRIPTAN ODT zolmitriptan TAB RAPDIS 2.5 mg Y Y Quantity Limit
33342014052 ZOLMITRIPTAN ODT zolmitriptan TAB RAPDIS 5 mg Y Y Quantity Limit
62332018203 ZOLMITRIPTAN ODT zolmitriptan TAB RAPDIS 5 mg Y Y Quantity Limit
64980025713 ZOLMITRIPTAN ODT zolmitriptan TAB RAPDIS 5 mg Y Y Quantity Limit
68382071782 ZOLMITRIPTAN ODT zolmitriptan TAB RAPDIS 5 mg Y Y Quantity Limit
68382071787 ZOLMITRIPTAN ODT zolmitriptan TAB RAPDIS 5 mg Y Y Quantity Limit
68462050033 ZOLMITRIPTAN ODT zolmitriptan TAB RAPDIS 5 mg Y Y Quantity Limit
68462050040 ZOLMITRIPTAN ODT zolmitriptan TAB RAPDIS 5 mg Y Y Quantity Limit
16571080316 ZOLMITRIPTAN zolmitriptan TABLET 2.5 mg Y Y Quantity Limit
27241002168 ZOLMITRIPTAN zolmitriptan TABLET 2.5 mg Y Y Quantity Limit
62332046206 ZOLMITRIPTAN zolmitriptan TABLET 2.5 mg Y Y Quantity Limit
64980020316 ZOLMITRIPTAN zolmitriptan TABLET 2.5 mg Y Y Quantity Limit
68001024901 ZOLMITRIPTAN zolmitriptan TABLET 2.5 mg Y Y Quantity Limit
68001024919 ZOLMITRIPTAN zolmitriptan TABLET 2.5 mg Y Y Quantity Limit
68462049776 ZOLMITRIPTAN zolmitriptan TABLET 2.5 mg Y Y Quantity Limit
71626010106 ZOLMITRIPTAN zolmitriptan TABLET 2.5 mg Y Y Quantity Limit
60846013030 ZOMIG zolmitriptan TABLET 2.5 mg Y Y Quantity Limit
60846238303 ZOMIG zolmitriptan TABLET 2.5 mg Y Y Quantity Limit
16571080413 ZOLMITRIPTAN zolmitriptan TABLET 5 mg Y Y Quantity Limit
27241002238 ZOLMITRIPTAN zolmitriptan TABLET 5 mg Y Y Quantity Limit
62332046303 ZOLMITRIPTAN zolmitriptan TABLET 5 mg Y Y Quantity Limit
64980020413 ZOLMITRIPTAN zolmitriptan TABLET 5 mg Y Y Quantity Limit
68001025001 ZOLMITRIPTAN zolmitriptan TABLET 5 mg Y Y Quantity Limit
68001025018 ZOLMITRIPTAN zolmitriptan TABLET 5 mg Y Y Quantity Limit
68462049833 ZOLMITRIPTAN zolmitriptan TABLET 5 mg Y Y Quantity Limit
71626010203 ZOLMITRIPTAN zolmitriptan TABLET 5 mg Y Y Quantity Limit
60846013360 ZOMIG zolmitriptan TABLET 5 mg Y Y Quantity Limit
60846238404 ZOMIG zolmitriptan TABLET 5 mg Y Y Quantity Limit
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