| Migraine Disorders

Botox vs Trokendi XR

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

Deep comparison between: Botox vs Trokendi Xr with Prescriber.AI

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Safety signalsTrokendi Xr has a higher rate of injection site reactions vs Botox based on FDA-approved prescribing information

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

Category

Botox

Trokendi Xr

At A Glance

RouteIM injection

FrequencyEvery 12 weeks

ClassBotulinum toxin type A

RouteOral

FrequencyOnce daily

ClassAnticonvulsant; carbonic anhydrase inhibitor

Indications

Overactive Bladder
Migraine Disorders
Benign essential blepharospasm
Strabismus, Comitant

Lennox-Gastaut Syndrome
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.

Lennox-Gastaut Syndrome Adjunctive therapy: adults (>=17 years) 200-400 mg orally once daily, initiated at 25-50 mg once daily and titrated in 25-50 mg/week increments; pediatric patients 6-16 years approximately 5-9 mg/kg/day orally once daily, initiated at 25 mg/day and titrated at 1-3 mg/kg/day every 1-2 weeks, not to exceed 400 mg/day.

Migraine Disorders Preventive treatment for patients 12 years and older: 100 mg orally once daily, titrated over 4 weeks starting at 25 mg/day (Week 1: 25 mg, Week 2: 50 mg, Week 3: 75 mg, Week 4: 100 mg).

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)

Recent alcohol use within 6 hours prior to or 6 hours after TROKENDI XR administration
History of hypersensitivity reaction to topiramate, TROKENDI XR, or any inactive ingredient (anaphylaxis and angioedema have occurred)

Drug Interactions

377View drug interactions

1204View 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 (>=10%) Paresthesia, weight loss, anorexia, dizziness, somnolence, nervousness, psychomotor slowing, speech disorders, vision abnormal

Serious Acute myopia and secondary angle closure glaucoma, metabolic acidosis, oligohydrosis and hyperthermia, suicidal behavior and ideation, fetal toxicity, DRESS/multiorgan hypersensitivity, serious skin reactions, anaphylaxis and angioedema, hyperammonemia and encephalopathy, decrease of bone mineral density, kidney stones

Postmarketing Hepatic failure, hepatitis, pancreatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, pemphigus, nephrocalcinosis, maculopathy, decreased INR with vitamin K antagonists

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.

Topiramate is a sulfamate-substituted monosaccharide anticonvulsant whose precise mechanism is unknown but is believed to involve blockade of voltage-dependent sodium channels, augmentation of GABA-A receptor activity, antagonism of AMPA/kainate glutamate receptors, and inhibition of carbonic anhydrase isozymes II and IV.

View Full FDA Information

View full FDA information

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Most Common Insurance

Anthem BCBS

Botox