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- What is botulinum toxin type A, and how does it work (mechanism of action)?
- What brand names are available for botulinum toxin type A?
- Is botulinum toxin type A available as a generic drug?
- Do I need a prescription 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 are the side effects of botulinum toxin type A?
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.
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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.
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.
Summary
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. Side effects, drug interactions, pregnancy, and safety information should be reviewed prior to taking any medication.
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Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
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Esophageal achalasia is a disease of the esophagus that mainly affects young adults. Achalasia makes it difficult to swallow, can cause chest pain, and may lead to regurgitation. Here we discuss achalasia symptoms, surgery, treatment, and causes. Learn the definition of achalasia and what you can do to treat the disease.Anal Fissure
An anal fissure is a small tear or cut in the skin lining of the anus. Pain and/or rectal bleeding during bowel movements are common symptoms of anal fissures. Treatment involves:- increasing liquid intake,
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Migraine headache is a type of headache associated with a sensitivity to light, smells, or sounds, eye pain, severe pounding on one side of the head, and sometimes nausea and vomiting. The exact cause of migraine headaches is not known.Triggers for migraine headaches include certain foods, stress, hormonal changes, strong stimuli (loud noises), and oversleeping.
Treatment guidelines for migraines include medicine, pain management, diet changes, avoiding foods that trigger migraines, staying hydrated, getting adequate sleep, and exercising regularly. Prevention of migraine triggers include getting regular exercise, drinking water daily, reducing stress, and avoiding trigger foods.
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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.
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Migraine trigger (examples)
- Light
- Sound
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- Strong smells
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- Menstrual period
- Stress
- Oversleeping
- Changes in barometric pressure
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