| Migraine Disorders

Botox vs Tosymra

Side-by-side clinical, coverage, and cost comparison for migraine disorders.

Deep comparison between: Botox vs Tosymra 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 signalsTosymra has a higher rate of injection site reactions vs Botox based on FDA-approved prescribing information

Coverage gaps3 major payers require step therapy for Tosymra but not Botox, including UnitedHealthcare

Category

Botox

Tosymra

At A Glance

RouteIM injection

FrequencyEvery 12 weeks

ClassBotulinum toxin type A

RouteNasal spray

FrequencyPer migraine attack

Class5-HT1B/1D receptor agonist

Indications

Overactive Bladder
Migraine Disorders
Benign essential blepharospasm
Strabismus, Comitant

Migraine Disorders

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.

Migraine Disorders 10 mg as a single spray in one nostril; max 30 mg in 24 hours with doses separated by at least 1 hour.

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)

Ischemic coronary artery disease (angina pectoris, history of myocardial infarction, or documented silent ischemia) or coronary artery vasospasm, including Prinzmetal's angina
Wolff-Parkinson-White syndrome or arrhythmias associated with other cardiac accessory conduction pathway disorders
History of stroke or transient ischemic attack (TIA) or history of hemiplegic or basilar migraine
Peripheral vascular disease
Ischemic bowel disease
Uncontrolled hypertension
Recent use (within 24 hours) of ergotamine-containing or ergot-type medication, or another 5-HT1 agonist
Concurrent administration or recent use (within 2 weeks) of an MAO-A inhibitor
Hypersensitivity to sumatriptan
Severe hepatic impairment

Drug Interactions

377View drug interactions

1258View drug interactions

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

Most common (>=2%) Atypical sensations, tingling, dizziness/vertigo, warm/hot sensation, burning sensation, feeling of heaviness, flushing, weakness, neck pain/stiffness, chest discomfort, drowsiness/sedation

Serious Myocardial ischemia/infarction, arrhythmias, cerebrovascular events, vasospasm reactions, serotonin syndrome, increase in blood pressure, hypersensitivity reactions, seizures

Postmarketing Hypotension, palpitations, dystonia, tremor

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.

Sumatriptan is a selective 5-HT1B/1D receptor agonist that exerts its therapeutic effects through agonist activity at 5-HT1B/1D receptors on intracranial blood vessels and sensory nerves of the trigeminal system, resulting in cranial vessel constriction and inhibition of pro-inflammatory neuropeptide release.

View Full FDA Information

View full FDA information

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Most Common Insurance

Anthem BCBS

Botox