| Migraine Disorders
Botox vs Treximet
Side-by-side clinical, coverage, and cost comparison for migraine disorders.Deep comparison between: Botox vs Treximet 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 signalsTreximet has a higher rate of injection site reactions vs Botox based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Treximet but not Botox, including UnitedHealthcare
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Category
Botox
Treximet
At A Glance
IM injection
Every 12 weeks
Botulinum toxin type A
Oral
As needed (max 2 doses/24 hrs)
5-HT1 agonist + NSAID
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 - Adults 1 tablet of 85/500 mg orally; max 2 tablets per 24 hours separated by at least 2 hours.
Migraine Disorders - Pediatric Patients 12 to 17 Years 1 tablet of 10/60 mg orally; max 1 tablet of 85/500 mg per 24 hours.
Migraine Disorders - Mild to Moderate Hepatic Impairment 1 tablet of 10/60 mg orally per 24 hours.
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
- Coronary artery bypass graft (CABG) surgery setting
- 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 medication, ergot-type medication (e.g., dihydroergotamine or methysergide), or another 5-HT1 agonist
- Concurrent or recent (within 2 weeks) use of a monoamine oxidase-A (MAO-A) inhibitor
- History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
- Known hypersensitivity to sumatriptan, naproxen, or any component of TREXIMET
- Severe hepatic impairment
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%) Dizziness, somnolence, paresthesia, nausea, dyspepsia, dry mouth, chest discomfort/chest pain, neck/throat/jaw pain/tightness/pressure
Serious Cardiovascular thrombotic events, GI bleeding/ulceration/perforation, arrhythmias, cerebrovascular events, other vasospasm reactions, hepatotoxicity, hypertension, heart failure and edema, medication overuse headache, serotonin syndrome, renal toxicity and hyperkalemia, anaphylactic reactions, serious skin reactions, DRESS, hematological toxicity, exacerbation of aspirin-sensitive asthma, seizures
Postmarketing Exfoliative dermatitis, Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), fixed drug eruption (FDE)
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 causes cranial vessel constriction and inhibits trigeminal neuropeptide release to abort migraine; naproxen sodium is an NSAID that inhibits COX-1 and COX-2, reducing prostaglandin synthesis to provide analgesic and anti-inflammatory effects.
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)
Treximet
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (10/12) · Qty limit (9/12)
UnitedHealthcare
Botox
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Treximet
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (1/8)
Humana
Botox
- Covered on 0 commercial plans
- PA (0/3) · Step Therapy (0/3) · Qty limit (0/3)
Treximet
- Covered on 0 commercial plans
- PA (1/3) · Step Therapy (3/3) · Qty limit (2/3)
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 Treximet.
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.