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Medicines > routes: Intramuscular (PREEMPT injections for migraine) & onset : 1–2 weeks for muscle effects; preventive migraine benefit accrues over 12-week cycles or Postprandial glucose effect within days; HbA1c by 12 weeks

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generic:
None (1)
brand:
Botox (1)
classes:
neuromuscular blocker (presynaptic) (1) · Neurotoxin (1)
mechanism:
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)
uses:
Chronic migraine (≥15 headache days/month), cervical dystonia, blepharospasm, hyperhidrosis, overactive bladder, urinary incontinence, strabismus, spasticity, cosmetic problems (1)
starting dose:
Chronic migraine (PREEMPT protocol): 155 units divided across 31 sites in 7 head/neck muscle groups every 12 weeks (1)
preparations:
50, 100, or 200 unit vials of lyophilized powder for reconstitution (1)
fda max:
195 units/treatment for chronic migraine; max varies by problem (1)
routes: (Click arrow to add another value)
onset: (Click arrow to add another value)
duration:
~12 weeks (1)
halflife:
Tissue half-life not formally measured; clinical effect ~12 weeks (1)
bioavailability:
Local (intramuscular) (1)
pregnancy:
Category C; limited data (1)
legal:
Rx; black-box warning for distant spread of toxin effect (1)

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