onabotulinumtoxinA, Botox, Botox Cosmetic

  • Pharmacy Author:
    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: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    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.

What is the dosage for botulinum toxin type A?

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.

Which drugs or supplements interact with botulinum toxin type A?

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.

Medically Reviewed by a Doctor on 7/23/2015

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