BOTOX
BOTULINUM TOXIN TYPE A · by BARRETT HODGSON
Composition
Inj: Botox 100 units powder for solution for injection vials
Indications & Dosage
Hand and wrist disability due to upper limb spasticity associated with stroke, Foot and ankle disability due to lower limb spasticity associated with stroke, Blepharospasm, Hemifacial spasm, Spasmodic torticollis, Severe hyperhidrosis of the axillae, Prophylaxis of headaches in chronic migraine, Temporary improvement of moderate to severe upper facial lines in adults under 65 years, Management of bladder dysfunctions, Chronic sialorrhoea due to neurological disorders (specialist use only): BY SUBCUTANEOUS INJ, OR BY INTRADERMAL INJ, OR BY IM INJ, OR BY LOCAL INFILTRATION: Adult: (consult product literature)
Contraindications
Specific to use in bladder disorders only; Acute urinary retention, catheterization difficulties, presence of bladder calculi, and urinary tract infection. Infection at injection site.
Precautions
History of aspiration, history of dysphagia, neurological disorders, neuromuscular disorders (can lead to increased sensitivity and exaggerated muscle weakness including dysphagia and respiratory compromise), atrophy in target muscle, inflammation in target muscle, chronic respiratory disorder, elderly, excessive weakness in target muscle. When used for blepharospasm or hemifacial spasm risk of angle-closure glaucoma, 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. Avoid in women of child-bearing age unless using effective contraception.
Interactions
Antihypertensives, lithium, fentanyl, morphine, TCADs, ibuprofen, levodopa, carbidopa, alcohol, CNS depressants, CNS active drugs.
Pregnancy
Avoid unless essential - toxicity
Lactation
Avoid unless essential
Side Effects
Alopecia, asthenia, autonomic dysreflexia, bladder diverticulum, brow ptosis, constipation, dizziness, drowsiness, dry eye, dry mouth, dysphagia, ecchymosis, eye discomfort, eye disorders, facial paresis, gait abnormal, haematuria, headaches, hot flush, fever or influenza like illness, insomnia, joint disorders, leukocyturia, malaise, muscle weakness, musculoskeletal stiffness, nausea, oedema, pain, subcutaneous nodule, urinary disorders vision disorders, nxiety, depression, dysphonia, dyspnoea, facial paralysis, oral paraesthesia, speech impairment. Rare: Angioedema, angle closure glaucoma, arrhythmia, myocardial infarction, nerve disorders, respiratory disorders, seizure, syncope, vertigo.