| Migraine Disorders
Botox vs Inderal LA
Side-by-side clinical, coverage, and cost comparison for migraine disorders.Deep comparison between: Botox vs Inderal 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 signalsInderal has a higher rate of injection site reactions vs Botox based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Inderal but not Botox, including UnitedHealthcare
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Category
Botox
Inderal
At A Glance
IM injection
Every 12 weeks
Botulinum toxin type A
Oral
Once daily
Nonselective beta-blocker
Indications
- Overactive Bladder
- Migraine Disorders
- Benign essential blepharospasm
- Strabismus, Comitant
- Hypertensive disease
- Coronary Arteriosclerosis
- Migraine Disorders
- Idiopathic hypertrophic subaortic stenosis
Dosing
Overactive Bladder 100 Units injected as 0.5 mL (5 Units) across 20 sites into the detrusor via cystoscope; repeat no sooner than 12 weeks.
Detrusor Overactivity associated with a Neurologic Condition 200 Units injected as 1 mL (~6.7 Units) across 30 sites into the detrusor via cystoscope; repeat no sooner than 12 weeks.
Pediatric Detrusor Overactivity associated with a Neurologic Condition 200 Units (>=34 kg) or 6 Units/kg (<34 kg) via intradetrusor injection across 20 sites; repeat no sooner than 12 weeks.
Migraine Disorders 155 Units IM as 0.1 mL (5 Units) per site divided across 7 head/neck muscle areas; re-treat every 12 weeks.
Adult Upper Limb Spasticity 75-400 Units IM divided among affected muscles; re-treat no sooner than 12 weeks.
Adult Lower Limb Spasticity 300-400 Units IM divided across 5 muscles (gastrocnemius, soleus, tibialis posterior, flexor hallucis longus, flexor digitorum longus); re-treat no sooner than 12 weeks.
Pediatric Upper Limb Spasticity 3-6 Units/kg IM (maximum 200 Units) divided among affected muscles; re-treat no sooner than 12 weeks.
Pediatric Lower Limb Spasticity 4-8 Units/kg IM (maximum 300 Units) divided among affected muscles; re-treat no sooner than 12 weeks.
Cervical Dystonia Dose individualized based on head/neck position, pain, and muscle hypertrophy; mean dose approximately 236 Units IM divided among affected muscles.
Primary Axillary Hyperhidrosis 50 Units per axilla injected intradermally across 10-15 sites approximately 1-2 cm apart.
Benign essential blepharospasm 1.25-2.5 Units injected into 3 sites per affected eye; re-treat approximately every 3 months.
Strabismus, Comitant 1.25-5 Units per muscle via electromyographic-guided injection, dosed based on deviation size in prism diopters; re-examine 7-14 days after each injection.
Hypertensive disease Initial 80 mg once daily; may increase to 120 mg or higher; usual maintenance 120-160 mg once daily; up to 640 mg may be required.
Coronary Arteriosclerosis Start 80 mg once daily; increase at 3-7 day intervals; average optimal dose 160 mg once daily; maximum established dose 320 mg once daily.
Migraine Disorders Initial 80 mg once daily; usual effective range 160-240 mg once daily; discontinue if no response within 4-6 weeks at maximal dose.
Idiopathic hypertrophic subaortic stenosis Usual dosage 80-160 mg once daily.
Contraindications
- Hypersensitivity to any botulinum toxin product or to any component of the formulation
- Infection at the proposed injection site(s)
- Urinary tract infection at time of intradetrusor injection
- Urinary retention or post-void residual urine volume >200 mL in patients not routinely performing clean intermittent self-catheterization (for intradetrusor injection)
- Cardiogenic shock
- Sinus bradycardia and greater than first-degree block
- Bronchial asthma
- Known hypersensitivity to propranolol hydrochloride
Adverse Reactions
Most common (>=2%) Urinary tract infection, dysuria, urinary retention, neck pain, headache, muscular weakness, eyelid ptosis, injection site pain, dysphagia, upper respiratory infection
Serious Spread of toxin effects, dysphagia and breathing difficulties, hypersensitivity reactions, autonomic dysreflexia, corneal exposure and ulceration, retrobulbar hemorrhage
Postmarketing Abdominal pain, alopecia, brachial plexopathy, peripheral neuropathy, arrhythmia, myocardial infarction, death associated with dysphagia and pneumonia, new onset or recurrent seizures
Cardiovascular Bradycardia, congestive heart failure, intensification of AV block, hypotension, paresthesia of hands, thrombocytopenic purpura, arterial insufficiency (Raynaud type)
Central Nervous System Light-headedness, mental depression, insomnia, lassitude, weakness, fatigue, catatonia, visual disturbances, hallucinations, vivid dreams, disorientation, short-term memory loss, emotional lability
Gastrointestinal Nausea, vomiting, epigastric distress, abdominal cramping, diarrhea, constipation, mesenteric arterial thrombosis, ischemic colitis
Allergic Hypersensitivity reactions including anaphylactic/anaphylactoid reactions, pharyngitis, agranulocytosis, erythematous rash, fever with aching and sore throat, laryngospasm, respiratory distress
Respiratory Bronchospasm
Hematologic Agranulocytosis, nonthrombocytopenic purpura, thrombocytopenic purpura
Autoimmune Systemic lupus erythematosus
Skin and Mucous Membranes Stevens-Johnson Syndrome, toxic epidermal necrolysis, dry eyes, exfoliative dermatitis, erythema multiforme, urticaria, alopecia, SLE-like reactions, psoriasisiform rashes
Genitourinary Male impotence, Peyronie's disease
Pharmacology
Botulinum toxin type A that blocks neuromuscular transmission by inhibiting acetylcholine release at motor and autonomic nerve terminals through cleavage of SNAP-25, producing localized, reversible chemical denervation of muscle, sweat glands, or the detrusor depending on injection site.
Propranolol is a nonselective beta-adrenergic receptor-blocking agent that competitively blocks beta-receptor-stimulating agents, reducing chronotropic, inotropic, and vasodilator responses to beta-adrenergic stimulation; at doses greater than required for beta blockade, it also exerts a quinidine-like membrane action affecting the cardiac action potential.
Enter your patient's insuranceCheck specific coverage details for your patient.
Most Common Insurance
Anthem BCBS
Botox
- Covered on 5 commercial plans
- PA (11/12) · Step Therapy (11/12) · Qty limit (0/12)
Inderal
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (0/12) · Qty limit (5/12)
UnitedHealthcare
Botox
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Inderal
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Botox
- Covered on 0 commercial plans
- PA (0/3) · Step Therapy (0/3) · Qty limit (0/3)
Inderal
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (0/3) · Qty limit (0/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
Cost estimate not availableAccessia Health: Multiple Sclerosis - Private Insurance: Waitlist
Commercial or private insurance
Medicare, Medicaid, VA, TRICARE
No savings programs available for Inderal.
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.