Terms and Conditions
By using the RELPAX $10 Co-pay Card, you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions described below:
- Co-pay cards are not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, or other federal or state healthcare programs (including any state prescription drug assistance programs and the Government Health Insurance Plan available in Puerto Rico [formerly known as "La Reforma De Salud"]).
- Co-pay cards are not valid for prescriptions that are eligible to be reimbursed by private insurance plans or other health or pharmacy benefit programs that reimburse you for the entire cost of your prescription drugs.
- Patients must be 18 or older.
- By using a co-pay card, a patient may pay only $10 per prescription. Savings provided by each co-pay card are limited to $100 per month. Each co-pay card may be used once per month for twelve (12) months. Provided you continue to meet the eligibility criteria, you may be eligible to receive a second co-pay card during the offering.
- Each patient is limited to one active co-pay card at a time during this offering period and the co-pay cards are not transferable.
- You must deduct the value received under this program from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf.
- The co-pay card cannot be combined with any other rebate or coupon, free trial, or similar offer for the specified prescription.
- The co-pay card will be accepted only at participating pharmacies.
- The co-pay card is not health insurance.
- This offer is good only in the United States and Puerto Rico.
- Pfizer reserves the right to rescind, revoke, or amend the co-pay card without notice.
- Offer valid from 4/1/11 to 12/31/13. No membership fees apply.
For help with the RELPAX $10 Co-pay Card, call 1-800-926-5334, or write:
Pfizer, ATTN: RELPAX, PO Box 2225, Morrisville, PA 19067-8025.
RELPAX® (eletriptan HBr) is indicated for the acute treatment of migraine with or without aura in adults.
IMPORTANT SAFETY INFORMATION
If you have certain types of heart disease, a history of stroke, transient ischemic attack, peripheral vascular disease (eg narrowing of blood vessels to the legs, arms, stomach, intestines, or kidneys), uncontrolled blood pressure, or severe liver problems, you should not take RELPAX. Very rarely, certain people, even some without heart disease, have had serious heart-related problems.
Do not take RELPAX if you have migraines that cause temporary paralysis on one side of your body or basilar migraine (rare form of migraine with symptoms including but not limited to: loss of balance, slurred speech, hearing change).
Do not take RELPAX if you are allergic to eletriptan or any of the other ingredients in RELPAX, or if you have taken any other drugs in its class (triptans) or ergotamine medicines within 24 hours.
When you have a migraine headache, take your medicine as directed by your doctor. RELPAX should be taken as a single 40-mg tablet. You may take a second tablet, at least 2 hours after the first dose, if your migraine symptoms come back. Do not exceed 2 doses in a 24-hour period. If the first tablet did not help your headache at all, do not take a second tablet without talking with your doctor.
RELPAX should not be used within at least 72 hours of treatment with the following medicines: Nizoral® (ketoconazole), Sporanox® (itraconazole), Serzone® (nefazodone), TAO® (troleandomycin), Biaxin® (clarithromycin), Norvir® (ritonavir), and Viracept® (nelfinavir).
All brands are trademarks of their owners.
RELPAX, as with other triptans can cause serotonin syndrome, particularly when used with certain medications commonly used to treat depression such as selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs).
RELPAX should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Most common side effects are dizziness, nausea, weakness, feeling sleepy and pain or pressure sensation in the chest or throat. Tell your doctor about any side effects you have.
RELPAX is available in 20 mg and 40 mg tablets.
RELPAX is available by prescription only.