Formulary
Botulinum toxin type A: Indications, Dosing, Side Effects and Interactions
Botulinum toxin type A clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Botulinum toxin type A: Indications, Dosing, Side Effects and Interactions
Botulinum toxin type A clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Hand and wrist disability due to upper limb spasticity associated with stroke (specialist use only),Foot and ankle disability due to lower limb spasticity associated with stroke (specialist use only),Blepharospasm (specialist use only),Hemifacial spasm (specialist use only),Spasmodic torticollis (specialist use only),Severe hyperhidrosis of the axillae (specialist use only),Prophylaxis of headaches in chronic migraine (specialist use only),Temporary improvement of moderate to severe upper facial lines in adults under 65 years (specialist use only),Management of bladder dysfunctions (specialist use only),Chronic sialorrhoea [due to neurological disorders] (specialist use only)**
- **Adult** (By Subcutaneous Injection, Or By Intradermal Injection, Or By Intramuscular Injection, Or By Local Infiltration): (consult product literature).
**Dynamic equinus foot deformity caused by spasticity in ambulant paediatric cerebral palsy (specialist use only), Upper limb spasticity in paediatric cerebral palsy (specialist use only) for botulinum toxin type A**
- **Child 2-17 years** (By intramuscular injection): (consult product literature).
**Chronic sialorrhoea [due to neurological or neurodevelopmental disorders] (specialist use only) for botulinum toxin type A**
- **Child 2-17 years (body-weight 12 kg and above)** (By local infiltration): (consult product literature).
Cautions
For botulinum toxin type A General cautions: Atrophy in target muscle; chronic respiratory disorder; elderly; excessive weakness in target muscle; history of aspiration; history of dysphagia; inflammation in target muscle; neurological disorders; neuromuscular disorders; off-label use (fatal adverse events reported) Specific cautions: When used for blepharospasm or hemifacial spasm Risk of angle-closure glaucoma Cautions, further information Neuromuscular or neurological disorders can lead to increased sensitivity and exaggerated muscle weakness including dysphagia and respiratory compromise. Blepharospasm or hemifacial spasm When used for blepharospasm and hemifacial spasm, reduced blinking can lead to corneal exposure, persistent epithelial defect and corneal ulceration (especially in those with VIIth nerve disorders)- careful testing of corneal sensation in previously operated eyes, avoidance of injection in lower lid area to avoid ectropion, and vigorous treatment of epithelial defect needed. M
Contraindications
For botulinum toxin type A Acute urinary retention (specific to use in bladder disorders only); catheterisation difficulties (specific to use in bladder disorders only); infection at injection site; presence of bladder calculi (specific to use in bladder disorders only); urinary tract infection (specific to use in bladder disorders only)
Side effects
For botulinum toxin type A Common or very common Alopecia; asthenia; autonomic dysreflexia; bladder diverticulum; brow ptosis; constipation; dizziness; drowsiness; dry eye; dry mouth; dysphagia (most common after injection into sternocleidomastoid muscle and salivary gland); ecchymosis (minimised by applying gentle pressure at injection site immediately after injection); eye discomfort; eye disorders; eye inflammation; facial paresis; fall; fever; gait abnormal; haematuria; headaches; hot flush; increased risk of infection; influenza like illness; insomnia; joint disorders; leukocyturia; malaise; muscle complaints; muscle weakness; musculoskeletal stiffness; nausea; oedema; pain; sensation abnormal; skin reactions; subcutaneous nodule; urinary disorders; vision disorders Uncommon Anxiety; coordination abnormal; depression; dysphonia; dyspnoea; facial paralysis; memory loss; oral paraesthesia; photosensitivity reaction; postural hypotension; speech impairment; taste altered; vertigo Frequency not known Abdominal pain; angioedema; angle closure glaucoma; appetite decreased; arrhythmia; diarrhoea; hearing impairment; hypersensitivity; myocardial infarction; myopathy; nerve disorders; neuromuscular dysfunction; pneumonia aspiration (potentially fatal); respiratory disorders; seizure; syncope; tinnitus; vomiting
Pregnancy
For botulinum toxin type A Avoid unless essential-toxicity in animal studies (manufacturer of Botox advise avoid).
Breast feeding
For botulinum toxin type A Low risk of systemic absorption but avoid unless essential.
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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