| Migraine Disorders
Trokendi XR vs Zembrace SymTouch
Side-by-side clinical, coverage, and cost comparison for migraine disorders.Deep comparison between: Trokendi Xr vs Zembrace Symtouch 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 signalsZembrace Symtouch has a higher rate of injection site reactions vs Trokendi Xr based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Zembrace Symtouch but not Trokendi Xr, including UnitedHealthcare
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Category
Trokendi Xr
Zembrace Symtouch
At A Glance
Oral
Once daily
Anticonvulsant; carbonic anhydrase inhibitor
SC injection
As needed
5-HT1B/1D receptor agonist
Indications
- Lennox-Gastaut Syndrome
- Migraine Disorders
- Migraine Disorders
Dosing
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).
Migraine Disorders 3 mg SC injection per dose; max 12 mg per 24 hours with doses separated by at least 1 hour.
Contraindications
- 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)
- Ischemic coronary artery disease (CAD) (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 (within 24 hours) use of ergotamine-containing medication, ergot-type medication (such as dihydroergotamine or methysergide), or another 5-HT1 agonist
- Concurrent administration of an MAO-A inhibitor or recent (within 2 weeks) use of an MAO-A inhibitor
- Known hypersensitivity to sumatriptan (angioedema and anaphylaxis seen)
- Severe hepatic impairment
Adverse Reactions
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
Most common (>=2%) Injection site reactions, atypical sensations, tingling, dizziness/vertigo, warm/hot sensation, flushing, feeling of heaviness, burning sensation, pressure sensation, weakness, neck pain/stiffness
Serious Myocardial ischemia/infarction, Prinzmetal's angina, arrhythmias, chest/throat/neck/jaw pain or tightness, cerebrovascular events, vasospasm reactions, medication overuse headache, serotonin syndrome, hypertensive crisis, hypersensitivity reactions, seizures
Postmarketing Hypotension, palpitations, dystonia, tremor
Pharmacology
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.
Sumatriptan is a selective 5-HT1B/1D receptor agonist that exerts therapeutic effects through agonist activity at receptors on intracranial blood vessels and sensory nerves of the trigeminal system, resulting in cranial vessel constriction and inhibition of pro-inflammatory neuropeptide release.
Enter your patient's insuranceCheck specific coverage details for your patient.
Most Common Insurance
Anthem BCBS
Trokendi Xr
- Covered on 5 commercial plans
- PA (5/12) · Step Therapy (0/12) · Qty limit (9/12)
Zembrace Symtouch
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (10/12) · Qty limit (10/12)
UnitedHealthcare
Trokendi Xr
- Covered on 4 commercial plans
- PA (1/8) · Step Therapy (0/8) · Qty limit (0/8)
Zembrace Symtouch
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (1/8)
Humana
Trokendi Xr
- Covered on 0 commercial plans
- PA (1/3) · Step Therapy (0/3) · Qty limit (3/3)
Zembrace Symtouch
- Covered on 0 commercial plans
- PA (1/3) · Step Therapy (3/3) · Qty limit (3/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
No savings programs available for Trokendi Xr.
No savings programs available for Zembrace Symtouch.
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Trokendi XrView full Trokendi Xr profile
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.