Drilldown: Medicines

None · Codeine · 1,4-Butanediol · 1B-LSD · 1cP-LSD · 1P-LSD · 1V-LSD · 2-AI · 2-FA · 2-FDCK · 2-FMA · 25B-NBOH · 25B-NBOMe · 25C-NBOH · 25C-NBOMe · 25I-NBOH · 25I-NBOMe · 25N-NBOMe · 2C-B · 2C-B-FLY

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Belsomra (1) · Botox (1) · Trintellix (US), Brintellix (formerly) (1)

Dual orexin receptor antagonist (DORA) (1) · Multimodal antidepressant: SERT inhibitor + 5HT1A agonist + 5HT1B partial agonist + 5HT3/5HT7 antagonist (1) · 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. 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) · Major depressive disorder in adults (FDA-approved 2013). Notable for evidence of cognitive benefit (processing speed) that distinguishes it from other antidepressants. (1)

10 mg PO 30 min before bedtime (with ≥7 hours of sleep planned) (1) · 10 mg PO once daily; may increase to 20 mg as tolerated, or decrease to 5 mg if needed (1) · Chronic migraine (PREEMPT protocol): 155 units divided across 31 sites in 7 head/neck muscle groups every 12 weeks (1)

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

None · Indication-specific · 40 mg/d · 10 mg/d · 20 mg/d · 80 mg/d · 10 mg/d (adults) · 100 mg/d · 4 g/d · 400 mg/d · 40 mg/d typical; up to 240 mg/d for Zollinger-Ellison · 5 mg/d · 50 mg/d · 600 mg/d · No fixed ceiling; titrate to clinical effect and tolerability with CDC opioid prescribing guidance constraints on morphine-milligram-equivalent (MME) totals · No fixed maximum; titrated to TSH target · TID per eye · Titrated to glucose; no fixed ceiling · Titrated to glucose; no fixed maximum · '''20 mg/day in adults >60 years''' per FDA's 2011-2012 QT-prolongation warning; 40 mg/day in adults ≤60

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Intramuscular (PREEMPT injections for migraine) (1) · Oral (2)

1–2 weeks for muscle effects; preventive migraine benefit accrues over 12-week cycles (1) · Typical antidepressant 4-6 week onset (1) · ~30 min (1)

Daily dosing (1) · ~12 weeks (1) · ~7-8 hours (1)

Tissue half-life not formally measured; clinical effect ~12 weeks (1) · ~12 hours (1) · ~66 hours (1)

Local (intramuscular) (1) · ~75% (1) · ~82% (1)

Category C; limited data (1) · Limited data; avoid (1) · Limited data; weigh benefits/risks (1)

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