Botox Dosage

Generic name: onabotulinumtoxinA
Brand names: Botox, Botox Cosmetic
Drug class: Skeletal muscle relaxants

Medically reviewed by  A Ras MD.

Adult Dosing

Dosage forms:  INJ

Special Note

[dosing clarification]

Info: max cumulative dose is 400 units q12wk when using onabotulinumtoxinA for 1 or more indications

Overactive bladder

[100 units IM divided in 20 sites x1]

Info: may repeat no more frequently than q12wk

Detrusor overactivity, neurogenic

[200 units IM divided in 30 sites x1]

Info: may repeat no more frequently than q12wk

Migraine headache prophylaxis

[155 units IM divided in 31 sites q12wk]

Info: see pkg insert for dose per site

Upper limb spasticity

[biceps brachii]

Dose: 60-200 units IM divided in 2-4 sites x1; Max: 50 units/site; Info: individualize dose based on spasticity severity, presence of local muscle weakness, prior response or adverse rxns; may repeat no more frequently than q12wk

[brachioradialis]

Dose: 45-75 units IM divided in 1-2 sites x1; Max: 50 units/site; Info: individualize dose based on spasticity severity, presence of local muscle weakness, prior response or adverse rxns; may repeat no more frequently than q12wk

[brachialis]

Dose: 30-50 units IM divided in 1-2 sites x1; Max: 50 units/site; Info: individualize dose based on spasticity severity, presence of local muscle weakness, prior response or adverse rxns; may repeat no more frequently than q12wk

[pronator teres]

Dose: 15-25 units IM in 1 site x1; Max: 50 units/site; Info: individualize dose based on spasticity severity, presence of local muscle weakness, prior response or adverse rxns; may repeat no more frequently than q12wk

[pronator quadratus]

Dose: 10-50 units IM in 1 site x1; Max: 50 units/site; Info: individualize dose based on spasticity severity, presence of local muscle weakness, prior response or adverse rxns; may repeat no more frequently than q12wk

[flexor carpi radialis or ulnaris]

Dose: 12.5-50 units IM in 1 site x1; Max: 50 units/site; Info: individualize dose based on spasticity severity, presence of local muscle weakness, prior response or adverse rxns; may repeat no more frequently than q12wk

[flexor digitorum profundus or sublimis]

Dose: 30-50 units IM in 1 site x1; Max: 50 units/site; Info: individualize dose based on spasticity severity, presence of local muscle weakness, prior response or adverse rxns; may repeat no more frequently than q12wk

[lumbricals or interossei]

Dose: 5-10 units IM in 1 site x1; Max: 50 units/site; Info: individualize dose based on spasticity severity, presence of local muscle weakness, prior response or adverse rxns; may repeat no more frequently than q12wk

[adductor pollicis or flexor pollicis longus]

Dose: 20 units IM in 1 site x1; Max: 50 units/site; Info: individualize dose based on spasticity severity, presence of local muscle weakness, prior response or adverse rxns; may repeat no more frequently than q12wk

[flexor pollicis brevis or opponens pollicis]

Dose: 5-25 units IM in 1 site x1; Max: 50 units/site; Info: individualize dose based on spasticity severity, presence of local muscle weakness, prior response or adverse rxns; may repeat no more frequently than q12wk

Lower limb spasticity

[gastrocnemius medial head, gastrocnemius lateral head, soleus, or tibialis posterior]

Dose: 75 units IM divided in 3 sites x1; Max: 50 units/site; Info: individualize dose based on spasticity severity, presence of local muscle weakness, prior response or adverse rxns; may repeat no more frequently than q12wk

[flexor hallucis longus or flexor digitorum longus]

Dose: 50 units IM divided in 2 sites x1; Max: 50 units/site; Info: individualize dose based on spasticity severity, presence of local muscle weakness, prior response or adverse rxns; may repeat no more frequently than q12wk

Cervical dystonia

[198-300 units IM divided among affected muscles x1]

Max: 50 units/site; Info: individualize dose based on head/neck position, pain localization, muscle hypertrophy, adverse rxns; may repeat after 3mo

Hyperhidrosis, primary axillary

[50 units/axilla intradermally divided in 10-15 sites x1]

Info: repeat when effects diminish

Blepharospasm

[1.25-2.5 units/site IM q3mo]

Max: cumulative dose 200 units/30 days

Strabismus

[1.25-5 units/site IM q3mo]

Max: 25 units/site

Spasmodic dysphonia

[1.25-7.5 units IM divided among affected muscles x1]

Start: 2.5-5 units IM divided among affected muscles x1; Info: individualize dose; repeat when effects diminish

Renal dosing

[not defined]

renal impairment: not defined

HD/PD: not defined

Hepatic dosing

[not defined]

SRC: NLM .