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- What is botulinum toxin type A, and how does it work (mechanism of action)?
- What are the uses for botulinum toxin type A?
- What are the side effects of botulinum toxin type A?
- What is the dosage for botulinum toxin type A?
- Which drugs or supplements interact with botulinum toxin type A?
- Is botulinum toxin type A safe to take if I'm pregnant or breastfeeding?
- What else should I know about botulinum toxin type A?
What is botulinum toxin type A, and how does it work (mechanism of action)?
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.
What brand names are available for botulinum toxin type A?
Botox, Botox Cosmetic
Is botulinum toxin type A available as a generic drug?
GENERIC AVAILABLE: No
Do I need a prescription for botulinum toxin type A?
What are the side effects of botulinum toxin type A?
Side effects of onabotulinumtoxinA include:
- allergic reactions,
- neck pain,
- difficulty swallowing,
- shortness of breath,
- weakness, and dry mouth.
- drooping of the eyelid (ptosis),
- inflammation of the cornea (keratitis),
- eye dryness,
- double vision,
- and sensitivity to light.
Those treated for urinary incontinence may experience:
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.
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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.
Is botulinum toxin type A safe to take if I'm pregnant or breastfeeding?
There are no adequate studies of onabotulinumtoxinA in pregnant women.
OnabotulinumtoxinA has not been evaluated in nursing mothers
What else should I know about botulinum toxin type A?
What preparations of botulinum toxin type A are available?
Powder for Injection: 50, 100 or 200 units
How should I keep botulinum toxin type A stored?
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.
OnabotulinumtoxinA (Botox, Botox Cosmetic) is an injectable neuro-toxin used for the treatment of chronic migraine headache, axillary hyperhidrosis, upper limb spasticity, cervical dystonia, strabismus, and frown lines. Review side effects, drug interactions, pregnancy, and safety information prior to taking any medication.
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Temporomandibular Joint Syndrome (TMJ)
Temporomandibular joint (TMJ) syndrome is a disorder that causes symptoms like pain, clicking, and popping of the jaw. TMJ is caused by injury to the temporomandibular joint. Stress, poor posture, jaw trauma, genetic predisposition, and inflammatory disorders are risk factors for the condition. A variety of self-care measures (application of ice, use of over-the-counter pain medication, massage, relaxation techniques) and medical treatment options (dental splint, Botox, prescription medications, surgery) are available to manage TMJ. The prognosis of TMJ is good with proper treatment.
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Multiple Sclerosis (MS)
Multiple sclerosis (MS) symptoms vary from person to person, and can last for days to months without periods of remission. Symptoms of MS include sexual problems and problems with the bowel, bladder, eyes, muscles, speech, swallowing, brain, and nervous system. The early symptoms and signs of multiple sclerosis usually start between age 20 and 40. MS in children, teens, and those over age 40 is rare. Treatment options for multiple sclerosis vary depending on the type and severity of symptoms. Medications may be prescribed to manage MS symptoms.
Migraine vs. Headache: Differences and Similarities
Headaches are the most common reason why a person goes to the doctor or other healthcare professional for treatment. There are different types of headaches, for example, migraine, tension, and cluster headaches. The most common type of headache is tension headache. Migraine is much less common. There are few similarities between migraine and other headaches, for example, the severity of the pain can be the same, mild, moderate, or severe; and they can occur on one side or both sides of the head. However, there are many differences between migraine and other types of headaches. Migraine headaches also have different names, for example, migraine with aura and menstrual migraine. Symptoms of migraine that usually aren't experienced by a person with another type of headache include nausea, vomiting, worsens with mild exercise, debilitating pain, eye pain, throbbing head pain. Migraine trigger include light, mild exercise, strong smells, certain foods like red wine, aged cheese, smoked meats, artificial sweeteners, chocolate, alcohol, and dairy products, menstrual period, stress, oversleeping, and changes in barometric pressure. Untreated migraine attacks usually last from 4 to 72 hours, but may last for weeks. Most headaches resolve within 24-48 hours. Doctors don't know exactly what causes migraine headaches; however, other headaches like tension headaches have more specific triggers and causes. Additional tests usually are required to diagnose migraine from other types of headaches, diseases, or other medical problems. Most headaches can be treated and cured with home remedies like essential oils, massage, and over-the-counter pain medication like acetaminophen (Tylenol) and NSAIDs (nonsteroidal anti-inflammatory drugs) like naproxen (Aleve, Anaprox, Naprosyn) or ibuprofen (Advil, Midol, Motrin). Most headaches resolve with OTC and home remedy treatment, while your doctor may need to prescribe medication to treat your migraines. If you have the "worst headache of your life," seek medical care immediately.
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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.
Excessive Sweating (Hyperhidrosis)
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.
Overactive Bladder (OAB)
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.
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.
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Nerve Disease and Bladder Control
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.
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