Drilldown: Medicines

None (1) · Insulin degludec (1) · Insulin glargine (1)

Botox (1) · Lantus, Basaglar, Semglee, Toujeo (U-300) (1) · Tresiba (1)

neuromuscular blocker (presynaptic) (1) · Neurotoxin (1) · [[:Category:Basal_insulins|Basal insulin]] (2) · [[:Category:Insulins|Insulin]] (2) · [[:Category:Long-acting_insulins|Long-acting insulin analog]] (1) · [[:Category:Ultra-long-acting_insulins|Ultra-long-acting insulin analog]] (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) · '"`UNIQ--vote-00000237-QINU`"' Binds the same insulin receptor as endogenous insulin with comparable mitogenic-to-metabolic ratio; provides basal hepatic glucose suppression and peripheral glucose uptake without prandial peaks'"`UNIQ--ref-00000238-QINU`"'. (1) · '"`UNIQ--vote-00001356-QINU`"' Binds the same insulin receptor as endogenous insulin with comparable mitogenic-to-metabolic ratio'"`UNIQ--ref-00001357-QINU`"'. (1)

Chronic migraine (≥15 headache days/month), cervical dystonia, blepharospasm, hyperhidrosis, overactive bladder, urinary incontinence, strabismus, spasticity, cosmetic problems (1) · '"`UNIQ--vote-00000239-QINU`"', '"`UNIQ--vote-0000023A-QINU`"' (1) · '"`UNIQ--vote-00001358-QINU`"', '"`UNIQ--vote-00001359-QINU`"' (1)

Chronic migraine (PREEMPT protocol): 155 units divided across 31 sites in 7 head/neck muscle groups every 12 weeks (1) · ~10 units SC at the same time daily, or 0.1-0.2 units/kg/d; titrate by fasting glucose (2)

100 U/mL (FlexTouch pen) and 200 U/mL (FlexTouch pen, higher-dose convenience) (1) · 100 U/mL (Lantus, Basaglar, Semglee) vials and pens; 300 U/mL (Toujeo) pens (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

Other values:

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Intramuscular (PREEMPT injections for migraine) (1) · Subcutaneous (never IV; not for use in insulin pumps) (2)

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

>42 hours per dose (effectively flat once at steady state) (1) · ~12 weeks (1) · ~24 hours per dose (peakless profile by design) (1)

Tissue half-life not formally measured; clinical effect ~12 weeks (1) · ~12 hours apparent (functional duration ~24 hours due to depot release kinetics)'"`UNIQ--ref-0000023B-QINU`"' (1) · ~25 hours apparent (functional duration well over 42 hours from multi-hexamer depot)'"`UNIQ--ref-0000135A-QINU`"' (1)

Local (intramuscular) (1) · ~100% from subcutaneous depot (1) · ~100% from subcutaneous depot (by definition of the route) (1)

Category C; limited data (1) · Insulin is the preferred glucose-lowering therapy in pregnancy; degludec has reassuring observational data.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Insulin is the preferred glucose-lowering therapy in pregnancy; glargine has reassuring observational data, though NPH and detemir remain the traditional choices.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1)

Rx; black-box warning for distant spread of toxin effect (1) · [[USLegal:Prescription only|Rx-only]] in US (2)