Drilldown: Medicines

None (4)

Belsomra (1) · Botox (1) · Dayvigo (1) · Quviviq (1)

Dual orexin receptor antagonist (DORA) (3) · neuromuscular blocker (presynaptic) (1) · Neurotoxin (1) · the first approved (1)

None (1) · Cleaves SNAP-25 protein in presynaptic motor and autonomic nerve terminals, blocking acetylcholine release; in chronic migraine, hypothesized to inhibit peripheral sensitization of trigeminovascular nociceptors (1) · Competitive antagonist at OX1R and OX2R. Faster receptor association/dissociation kinetics than suvorexant (~16 sec dissociation vs ~57 sec) hypothesized to support sleep onset, with sufficient duration for maintenance. (1) · Competitive antagonist at OX1R and OX2R. First-in-class DORA. Receptor dissociation slower than lemborexant or daridorexant. (1)

Chronic migraine (≥15 headache days/month), cervical dystonia, blepharospasm, hyperhidrosis, overactive bladder, urinary incontinence, strabismus, spasticity, cosmetic problems (1) · Insomnia (sleep onset and/or maintenance) in adults (FDA-approved August 2014). Also studied for insomnia in mild-moderate Alzheimer disease. (1) · Insomnia (sleep onset and/or maintenance) in adults (FDA-approved Dec 2019) (1) · Insomnia (sleep onset and/or sleep maintenance) in adults (FDA-approved Jan 2022) (1)

10 mg PO 30 min before bedtime (with ≥7 hours of sleep planned) (1) · 25 mg PO at bedtime (no titration); may increase to 50 mg if 25 mg inadequate (1) · 5 mg PO at bedtime; may increase to 10 mg if inadequate (1) · Chronic migraine (PREEMPT protocol): 155 units divided across 31 sites in 7 head/neck muscle groups every 12 weeks (1)

25 mg, 50 mg tablets (1) · 5 mg, 10 mg tablets (1) · 5 mg, 10 mg, 15 mg, 20 mg tablets (1) · 50, 100, or 200 unit vials of lyophilized powder for reconstitution (1)

10 mg/d (1) · 195 units/treatment for chronic migraine; max varies by problem (1) · 20 mg/d (1) · 50 mg/d (1)

Intramuscular (PREEMPT injections for migraine) (1) · Oral (3)

1–2 weeks for muscle effects; preventive migraine benefit accrues over 12-week cycles (1) · ~30 min (3)

None · 24 hours · 4-6 hours · 12 hours · 6-8 hours · Daily dosing · 8-12 hours · 12-24 hours · Hours · Hours per application · 24 hours (HS dosing) · 24 hours (once-daily dosing) · 24 h · N/A · N/A (replacement) · Variable · ~7-8 hours · 3-5 hours · 4-6 hours (IR); 24 hours (ER) · 6-12 hours

Other values:

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Tissue half-life not formally measured; clinical effect ~12 weeks (1) · ~12 hours (1) · ~17-19 hours (longer than daridorexant) (1) · ~8 hours (shorter than suvorexant and lemborexant) (1)

Local (intramuscular) (1) · ~44% (1) · ~62% (1) · ~82% (1)

Category C; limited data (1) · Limited data; avoid (3)

Rx, Schedule IV (US) (3) · Rx; black-box warning for distant spread of toxin effect (1)