Botox

Indications

Clostridium Botulinum Toxin Type A (botulinum toxin A) is a purified protein given by injection. Medical uses include long-term (chronic) migraine prevention, muscle stiffness and spasm (spasticity) after stroke or in cerebral palsy, abnormal muscle contractions of the neck (cervical dystonia) and eyelids (blepharospasm), squint, heavy underarm sweating, and overactive bladder. It is also used cosmetically to soften frown lines and other facial wrinkles.

How It Works

Nerves make muscles and glands work by releasing a chemical messenger called acetylcholine. Botulinum toxin A blocks this release at the injected site, so the muscle relaxes or the sweat gland becomes less active. The effect starts within a few days, peaks in about 2 weeks and wears off gradually over about 3 to 6 months as new nerve endings grow.

Dosage and Administration

It is injected only by a trained doctor into specific muscles, the skin or the bladder wall. The dose (in units), number of injection points and interval between treatments depend on the condition and are set by the doctor. Doses from different products are not interchangeable. Repeat treatments are usually given no more often than every 3 months.

Interactions

• Aminoglycoside antibiotics (such as Gentamicin), muscle relaxants and some other medicines that affect nerve to muscle signals can increase its effect.
• Anticholinergic medicines may increase side effects such as dry mouth or blurred vision.
• Tell the doctor about any other botulinum toxin treatment in the past few months.

Contraindications

• Allergy to botulinum toxin or any ingredient (such as human albumin)
• Infection at the injection site
• Myasthenia gravis, Lambert-Eaton syndrome or other nerve to muscle disorders, unless a specialist decides otherwise
• For bladder injections: urinary tract infection or inability to empty the bladder without being prepared to use a catheter

Side Effects

• Pain, bruising or swelling at the injection site
• Headache, neck pain or flu-like feeling
• Local muscle weakness, drooping eyelid or eyebrow, uneven facial expression (cosmetic use)
• Dry eyes or mouth
• Urinary tract infection or difficulty passing urine (bladder use)

Get urgent medical help if you have difficulty swallowing, speaking or breathing, widespread muscle weakness, double vision, or signs of a severe allergic reaction. These can happen hours to weeks after injection if the toxin spreads beyond the treated area.

Pregnancy and Lactation

There is limited information on use during pregnancy and breastfeeding. It should not be used for cosmetic reasons during pregnancy or breastfeeding, and medical use should only be considered if clearly needed.

Precautions and Warnings

• Use only products from licensed sources and have injections done only by qualified doctors.
• Tell your doctor if you have swallowing or breathing problems, a bleeding disorder or take blood thinners.
• Avoid tasks needing full muscle strength or clear vision if you feel weak or have blurred vision after treatment.
• Do not rub or massage the treated area for the time advised after cosmetic injections.

Overdose

Overdose may cause severe muscle weakness, trouble swallowing or breathing. It needs emergency hospital care; breathing support and an antitoxin may be required.

Therapeutic Class

Neuromuscular blocking agent (neurotoxin), used for spasticity, dystonia, migraine, hyperhidrosis and cosmetic use.

Storage

Hospital and clinic product. Store as directed on the pack, usually in a refrigerator at 2 to 8°C. Once mixed, use within the time stated in the leaflet. Keep out of the reach of children.