onabotulinumtoxinA, Botox, Botox Cosmetic
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
GENERIC NAME: onabotulinumtoxinA
BRAND NAME: Botox, Botox Cosmetic
DRUG CLASS AND MECHANISM: OnabotulinumtoxinA is an injectable neuro-toxin, that is, a toxic chemical that blocks the ability of nerves to make muscles contract. In other words, it paralyzes muscles.
To cause muscles to contract, nerves release a chemical, acetylcholine, where they meet muscle cells. The acetylcholine attaches to receptors on the muscle cells and causes the muscle cells to contract or shorten. OnabotulinumtoxinA prevents the release of acetylcholine and thereby prevents contraction of the muscle cells. In order to affect the release of acetylcholine, onabotulinumtoxinA must be injected into the muscle. OnabotulinumtoxinA was approved by the FDA in December 1991.
GENERIC AVAILABLE: No
PREPARATIONS: Powder for Injection: 50, 100 or 200 units
STORAGE: Unopened vials or reconstituted onabotulinumtoxinA should be refrigerated at 35.6 to 46.4 F (2 to 8 C). Reconstituted toxin should be used within 24 hours.
It is injected into the muscles that control the eyeball for treating strabismus (misaligned or lazy eyes) and the muscles of the eyelid for treating blepharospasm (uncontrollable blinking) associated with a condition called dystonia.
It also is effective for managing urinary incontinence associated with neurologic conditions such as multiple sclerosis for which it is injected into the muscular bladder wall to prevent involuntary muscular spasm that leads to incontinence (uncontrollable urination). B
Botox cosmetic is used for reducing glabellar lines (frown lines) in adults 65 years of age or younger.
DOSING: OnabotulinumtoxinA is giving by intramuscular injection. Dosing should be individualized (based on its purpose and the patient in whom it is being used), and the lowest effective dose should be used. OnabotulinumtoxinA is not interchangeable with other preparations of botulinum toxin.
DRUG INTERACTIONS: Administration of onabotulinumtoxinA with other agents (for example, aminoglycosides, curare) that affect neuromuscular function may increase the effect of onabotulinumtoxinA. Use of muscle relaxants may increase the occurrence of weakness. Use of drugs that block acetylcholine may increase some effects of onabotulinumtoxinA.
PREGNANCY: There are no adequate studies of onabotulinumtoxinA in pregnant women.
NURSING MOTHERS: OnabotulinumtoxinA has not been evaluated in nursing mothers
SIDE EFFECTS: Side effects of onabotulinumtoxinA include allergic reactions, rash, itching, headache, neck pain, difficulty swallowing, shortness of breath, nausea, weakness, and dry mouth. Patients also complain of pain and tenderness at the injection site. Patients treated for blepharospasm may experience drooping of the eyelid (ptosis), inflammation of the cornea (keratitis), eye dryness, double vision, tearing, and sensitivity to light. Those treated for urinary incontinence may experience difficulty urinating. Heart attacks, abnormal heart beats, and death have also been reported.
Reference: FDA Prescribing Information
Last Editorial Review: 11/30/2011
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