Botox

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

Medically reviewed by  A Ras MD.

What are Botox and Botox Cosmetic?

Botox is a prescription medicine that is injected into muscles and used to treat overactive bladder symptoms such as a strong need to urinate with leaking or wetting accidents (urge urinary incontinence), a strong need to urinate right away (urgency), and urinating often (frequency) in adults when another type of medicine (anticholinergic) does not work well enough or cannot be taken.

it is also used to treat leakage of urine (incontinence) in adults with overactive bladder due to neurologic disease when another type of medicine (anticholinergic) does not work well enough or cannot be taken, to treat overactive bladder due to a neurologic disease in children 5 years of age and older when another type of medicine (anticholinergic) does not work well enough or cannot be taken, to prevent headaches in adults with chronic migraine who have 15 or more days each month with headache lasting 4 or more hours each day.

Botox is also injected into the skin to treat the symptoms of severe underarm sweating (severe primary axillary hyperhidrosis) when medicines used on the skin (topical) do not work well enough.

Botox Cosmetic is a prescription medicine for adults that is injected into muscles and used for a short period of time (temporary) to improve the look of moderate to severe frown lines between the eyebrows (glabellar lines), moderate to severe crow’s feet lines, moderate to severe forehead lines

You may receive treatment for frown lines, crow’s feet lines, and forehead lines at the same time.

It is not known whether Botox is safe or effective in people younger than:

  • 18 years of age for treatment of urinary incontinence
  • 18 years of age for treatment of chronic migraine
  • 16 years of age for treatment of cervical dystonia
  • 18 years of age for treatment of hyperhidrosis
  • 12 years of age for treatment of strabismus or blepharospasm
  • 2 years of age for treatment of spasticity

Botox Cosmetic is not recommended for use in children younger than 18 years of age.
It is not known whether Botox and Botox Cosmetic are safe or effective to prevent headaches in people with migraine who have 14 or fewer headache days each month (episodic migraine).
It is not known whether Botox and Botox Cosmetic are safe or effective for severe sweating anywhere other than your armpits.
It is not known if Botox Cosmetic is safe and effective for use more than 1 time every 3 months.

Description

BOTOX Cosmetic (onabotulinumtoxinA) for injection, is a sterile, vacuum-dried purified botulinum toxin type A, produced from fermentation of Hall strain Clostridium botulinum type A intended for intramuscular use. It is purified from the culture solution by dialysis and a series of acid precipitations to a complex consisting of the neurotoxin, and several accessory proteins. The complex is dissolved in sterile sodium chloride solution containing Albumin Human and is sterile filtered (0.2 microns) prior to filling and vacuum-drying.

The primary release procedure for BOTOX Cosmetic uses a cell-based potency assay to determine the potency relative to a reference standard. The assay is specific to Allergan’s products BOTOX and BOTOX Cosmetic. One Unit of BOTOX Cosmetic corresponds to the calculated median intraperitoneal lethal dose (LD50) in mice. Due to specific details of this assay such as the vehicle, dilution scheme and laboratory protocols, Units of biological activity of BOTOX Cosmetic cannot be compared to nor converted into Units of any other botulinum toxin or any toxin assessed with any other specific assay method. The specific activity of BOTOX Cosmetic is approximately 20 Units/nanogram of neurotoxin complex.

Each vial of BOTOX Cosmetic contains either 50 Units of Clostridium botulinum type A neurotoxin complex, 0.25 mg of Albumin Human, and 0.45 mg of sodium chloride; or 100 Units of Clostridium botulinum type A neurotoxin complex, 0.5 mg of Albumin Human, and 0.9 mg of sodium chloride in a sterile, vacuum-dried form without a preservative.

Mechanism of Action

BOTOX Cosmetic blocks neuromuscular transmission by binding to acceptor sites on motor nerve terminals, entering the nerve terminals, and inhibiting the release of acetylcholine. This inhibition occurs as the neurotoxin cleaves SNAP-25, a pre-synaptic protein integral to the successful docking and release of acetylcholine from vesicles situated within nerve endings. When injected intramuscularly at therapeutic doses, BOTOX Cosmetic produces partial chemical denervation of the muscle resulting in a localized reduction in muscle activity. In addition, the muscle may atrophy, axonal sprouting may occur, and extrajunctional acetylcholine receptors may develop. There is evidence that reinnervation of the muscle may occur, thus slowly reversing muscle denervation produced by BOTOX Cosmetic.

What is the most important information I should know about Botox and Botox Cosmetic?

Botox and Botox Cosmetic may cause serious side effects that can be life threatening, including:

  • Problems breathing or swallowing
  • Spread of toxin effects

These problems can happen hours, days, to weeks after an injection of Botox or Botox Cosmetic. Call your doctor or get medical help right away if you have any of these problems after treatment with Botox or Botox Cosmetic:

  • Problems swallowing, speaking, or breathing. These problems can happen hours, days, to weeks after an injection of Botox or Botox Cosmetic usually because the muscles that you use to breathe and swallow can become weak after the injection. Death can happen as a complication if you have severe problems with swallowing or breathing after treatment with Botox or Botox Cosmetic.
    • People with certain breathing problems may need to use muscles in their neck to help them breathe. These people may be at greater risk for serious breathing problems with Botox or Botox Cosmetic.
    • Swallowing problems may last for several months. People who cannot swallow well may need a feeding tube to receive food and water. If swallowing problems are severe, food or liquids may go into your lungs. People who already have swallowing or breathing problems before receiving Botox or Botox Cosmetic have the highest risk of getting these problems.
  • Spread of toxin effects. In some cases, the effect of botulinum toxin may affect areas of the body away from the injection site and cause symptoms of a serious condition called botulism. The symptoms of botulism include:
    • loss of strength and muscle weakness all over the body
    • double vision, blurred vision and drooping eyelids
    • hoarseness or change or loss of voice (dysphonia)
    • trouble saying words clearly (dysarthria)
    • loss of bladder control
    • trouble breathing
    • trouble swallowing

These symptoms can happen hours, days, to weeks after you receive an injection of Botox or Botox Cosmetic.
These problems could make it unsafe for you to drive a car or do other dangerous activities. See “What should I avoid while receiving Botox or Botox Cosmetic?”

There has not been a confirmed serious case of spread of toxin effect away from the injection site when Botox has been used at the recommended dose to treat chronic migraine, severe underarm sweating, blepharospasm, or strabismus, or when Botox Cosmetic has been used at the recommended dose to treat frown lines, crow’s feet lines, and/or forehead lines.

Who should not use Botox or Botox Cosmetic?

Do not receive Botox or Botox Cosmetic if you:

  • are allergic to any of the ingredients in Botox or Botox Cosmetic. See the end of this Medication Guide for a list of ingredients in Botox and Botox Cosmetic.
  • had an allergic reaction to any other botulinum toxin product such as Myobloc, Dysport, or Xeomin
  • have a skin infection at the planned injection site
  • are being treated for urinary incontinence and have a urinary tract infection (UTI)
  • are being treated for urinary incontinence and find that you cannot empty your bladder on your own (only applies to people who are not routinely catheterizing).

What should I tell my healthcare provider before using Botox or Botox Cosmetic?

Tell your doctor about all your medical conditions, including if you:

  • have a disease that affects your muscles and nerves (such as amyotrophic lateral sclerosis [ALS or Lou Gehrig’s disease], myasthenia gravis or Lambert-Eaton syndrome). See “What is the most important information I should know about Botox and Botox Cosmetic?”
  • have allergies to any botulinum toxin product
  • had any side effect from any botulinum toxin product in the past
  • have or have had a breathing problem, such as asthma or emphysema
  • have or have had swallowing problems
  • have or have had bleeding problems
  • have plans to have surgery
  • had surgery on your face
  • have weakness of your forehead muscles, such as trouble raising your eyebrows
  • have drooping eyelids
  • have any other change in the way your face normally looks
  • have symptoms of a urinary tract infection (UTI) and are being treated for urinary incontinence. Symptoms of a urinary tract infection may include pain or burning with urination, frequent urination, or fever.
  • have problems emptying your bladder on your own and are being treated for urinary incontinence
  • are pregnant or plan to become pregnant. It is not known if Botox or Botox Cosmetic can harm your unborn baby.
  • are breastfeeding or plan to breastfeed. It is not known if Botox or Botox Cosmetic passes into breast milk.

Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins and herbal supplements. Using Botox or Botox Cosmetic with certain other medicines may cause serious side effects. Do not start any new medicines until you have told your doctor that you have received Botox or Botox Cosmetic in the past.
Especially tell your doctor if you:

  • have received any other botulinum toxin product in the last four months
  • have received injections of botulinum toxin, such as Myobloc (rimabotulinumtoxinB), Dysport (abobotulinumtoxinA), or Xeomin (incobotulinumtoxinA) in the past. Be sure your doctor knows exactly which product you received.
  • have recently received an antibiotic by injection
  • take muscle relaxants
  • take an allergy or cold medicine
  • take a sleep medicine
  • take anti-platelets (aspirin-like products) and/or anti-coagulants (blood thinners)

Ask your doctor if you are not sure if your medicine is one that is listed above.
Know the medicines you take. Keep a list of your medicines with you to show your doctor and pharmacist each time you get a new medicine.

How will I use Botox or Botox Cosmetic?

  • Botox or Botox Cosmetic is an injection that your doctor will give you.
  • Botox is injected into your affected muscles, skin, or bladder.
  • Botox Cosmetic is injected into your affected muscles.
  • Your doctor may change your dose of Botox or Botox Cosmetic, until you and your doctor find the best dose for you.
  • Your doctor will tell you how often you will receive your dose of Botox or Botox Cosmetic injections.

What should I avoid while using Botox or Botox Cosmetic?

Botox and Botox Cosmetic may cause loss of strength or general muscle weakness, vision problems, or dizziness within hours to weeks of taking Botox or Botox Cosmetic. If this happens, do not drive a car, operate machinery, or do other dangerous activities. See “What is the most important information I should know about Botox and Botox Cosmetic?”.

What are the possible side effects of Botox and Botox Cosmetic?

Botox and Botox Cosmetic can cause serious side effects. See “What is the most important information I should know about Botox and Botox Cosmetic?”.

Other side effects of Botox and Botox Cosmetic include:

  • dry mouth
  • discomfort or pain at the injection site
  • tiredness
  • headache
  • neck pain
  • eye problems: double vision, blurred vision, decreased eyesight, drooping eyelids, swelling of your eyelids, and dry eyes
  • drooping eyebrows
  • urinary tract infection in people being treated for urinary incontinence
  • painful urination in people being treated for urinary incontinence
  • inability to empty your bladder on your own and are being treated for urinary incontinence. If you have difficulty fully emptying your bladder after getting Botox, you may need to use disposable self-catheters to empty your bladder up to a few times each day until your bladder is able to start emptying again.
  • allergic reactions. Symptoms of an allergic reaction to Botox or Botox Cosmetic may include: itching, rash, red itchy welts, wheezing, asthma symptoms, or dizziness or feeling faint. Tell your doctor or get medical help right away if you are wheezing or have asthma symptoms, or if you become dizzy or faint.
  • upper respiratory tract infection

Tell your doctor if you have any side effect that bothers you or that does not go away.

These are not all the possible side effects of Botox and Botox Cosmetic. For more information, ask your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Lan information about the safe and effective use of Botox and Botox Cosmetic

Medicines are sometimes prescribed for purposes other than those listed in a Medication guide.

This guide summarizes the most important information about Botox and Botox Cosmetic. If you would like more information, talk with your doctor. You can ask your doctor or pharmacist for information about Botox and Botox Cosmetic that is written for healthcare professionals.

What are the ingredients in Botox and Botox Cosmetic?

Active ingredient: onabotulinumtoxin A

Inactive ingredients: human albumin and sodium chloride

Label

  • PRINCIPAL DISPLAY PANEL

     

    Botox
    Cosmetic
    onabotulinumtoxinA
    for Injection
    50
    Units/Vial

    PRINCIPAL DISPLAY PANEL Botox Cosmetic onabotulinumtoxinA for Injection 50 Units/Vial

  • PRINCIPAL DISPLAY PANEL

     

    Botox
    Cosmetic
    onabotulinumtoxinA
    for Injection
    100
    Units/Vial

    PRINCIPAL DISPLAY PANEL Botox Cosmetic onabotulinumtoxinA for Injection 100 Units/Vial

    SRC: NLM .