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.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
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.
PRESCRIPTION: Yes
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.
PRESCRIBED FOR: OnabotulinumtoxinA is used for the treatment of
chronic migraine,
axillary hyperhidrosis (excessive sweating in the armpits), and
spasticity of the upper arms.
It also is used for cervical dystonia (spasm of
the muscles of the neck) to reduce the abnormal head position and neck pain
caused by the muscular spasm.
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.
Chronic Migraine: 155 units divided amongst 31 sites and injected every
12 weeks
Upper limb spasticity: 75-360 units divided among selected sites. No
more than 50 units injected per site; may repeat when effect diminishes but
no sooner than every 12 weeks.
Cervical dystonia: 189-300 units divided among affected muscles. No more
than 50 units injected per site.
Axillary hyperhidrosis: 50 units per arm pit; repeat when effect
diminishes.
Blepharospasm: Initial dose is 1.25-2.5 units. Increase if response is
not adequate. There appears to be no benefit in injecting more than 5 units.
Strabismus: Initial dose is 1.25 to 5 units per muscle; may increase
subsequent doses by up to two-fold; maximum dose for each muscle is 25
units.
Urinary incontinence: 200 units per treatment.
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.
Muscle spasms are involuntary muscle contractions that come on suddenly and are usually quite painful. Dehydration, doing strenuous exercise in a hot environment, prolonged muscle use, and certain diseases of the nervous system may cause muscle spasms. Symptoms and signs of a muscle spasm include an acute onset of pain and a possible bulge seen or felt beneath the skin where the muscle is located. Gently stretching the muscle usually resolves a muscle spasm.
Migraine is usually periodic attacks of headaches on one or both sides of the head. These may be accompanied by nausea, vomiting, increased sensitivity of the eyes to light (photophobia), increased sensitivity to sound (phonophobia), dizziness, blurred vision, cognitive disturbances, and other symptoms. Treatments for migraine headache include therapies that may or may not involve medications.
Overactive bladder is a sudden involuntary contraction of the muscle wall of the bladder causing urinary urgency (an immediate unstoppable need to urinate). Overactive bladder is is a form of urinary incontinence. Treatment options may include Kegel exercises, biofeedback, vaginal weight training, pelvic floor electrical stimulation, behavioral therapy, and medications.
Achalasia is a disease of the esophagus that mainly affects young adults. Abnormal function of nerves and muscles of the esophagus causes difficulty swallowing and sometimes chest pain.
Hyperhidrosis is excessive sweating of the underarms, palms, or soles of the feet. Treatment may involve over-the-counter antiperspirants, prescription antiperspirants, iontophoresis, medications, surgery, and Botox.
Dystonia disorders cause involuntary movements and prolonged muscle contraction, resulting in twisting body motions, tremor, and abnormal posture. There are many forms of dystonia. Some types of dystonia respond to dopamine, or can be controlled with dedative-type medications, or surgery.
People who have bladder spasms, the sensation occurs suddenly and often severely. A spasm itself is the sudden, involuntary squeezing of a muscle. A bladder spasm, or "detrusor contraction," occurs when the bladder muscle squeezes suddenly without warning, causing an urgent need to release urine. The spasm can force urine from the bladder, causing leakage. When this happens, the condition is called urge incontinence or overactive bladder.
Wrinkles, whether they be fine line or deep furrows, typically appear on areas of the body that receive a high amount of exposure to the sun. Smoking, light skin type, hairstyle, the way you dress, your occupational and recreational habits, and heredity are all factors that promote wrinkling. Medical treatments for wrinkles include antioxidants, moisturizers, alpha-hydroxy acids, and vitamin A acid. Cosmetic procedures that treat wrinkles include dermabrasion, microdermabrasion, glycolic acid peels, laser resurfacing, Botox, and fillers.
A nerve problem might affect your bladder control if the nerves that are supposed to carry messages between the brain and the bladder do not work properly. Such problems include urine retention, poor control of sphincter muscles, and overactive bladder. Treatment depends upon the cause of the nerve damage and resulting type of bladder control problem.
Although wrinkles can signify wisdom, most people nowadays would rather not
have them.
Many products and procedures promise to reduce wrinkles. Some do
little or nothing (like the products that claim they reduce "the appearance of
fine lines," which means that they don't reduce the lines themselves). Others
can achieve a fair amount of success.
Skin ages all over the body, but much more
so where there has been sun exposure. Changes brought on by sun damage (photoaging)
include "dryness" (really roughness), sagginess, skin growths like keratoses
("liver spots"), and wrinkles.
Most wrinkles appear on the parts of the body
where sun exposure is greatest. These especially include the face, neck, the
backs of the hands, and the tops of the forearms. Wrinkles come in two
categories: fine surface lines and deep furrows. Wrinkle treatments are in
general much more effective for fine lines. Deeper creases may require more
...
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