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Botulinum toxin type a

Generic Name: onabotulinumtoxina (ON-a-BOT-ue-LYE-num-TOX-in-AY)
Brand Name: Botox

Botulinum toxin type a may spread from the injection site to other areas of the body, causing symptoms of a serious condition called botulism. These symptoms may occur hours to weeks after you receive botulinum toxin type a. Symptoms may include loss of strength; muscle weakness; double or blurred vision; drooping eyelids; hoarseness; change in or loss of voice; loss of bladder control; or trouble speaking, breathing, or swallowing. The risk may be greater in children being treated for spasticity (muscle spasms), but these symptoms may also occur in adults. Contact your doctor immediately if these symptoms occur.

Severe and sometimes fatal breathing or swallowing problems have been reported. The risk may be greater in patients who already have breathing or swallowing problems. Tell your doctor if you have or are at risk of developing breathing or swallowing problems.


Botulinum toxin type a is used for:

Preventing headaches in certain patients with chronic migraines. It is used for reducing the severity of abnormal head position and neck pain associated with neck problems. It may be used to reduce armpit sweating that does not respond to treatment with other medicines. It may also be used to treat muscle stiffness in the elbow, wrist, or fingers. It may also be used to treat loss of bladder control in certain patients. It may also be used to treat certain types of eyelid muscle spasms, eye focusing problems, or other conditions as determined by your doctor.

Botulinum toxin type a is a neurotoxin. It works by blocking nerve impulses to the muscles or sweat glands, temporarily paralyzing the muscle or gland.

Do NOT use botulinum toxin type a if:

  • you are allergic to any ingredient in botulinum toxin type a or another botulinum toxin product
  • you have an infection at the injection site
  • you are using botulinum toxin type a to treat loss of bladder control and you have a urinary tract infection
  • you are using botulinum toxin type a to treat loss of bladder control, you are unable to urinate, and have not been routinely emptying your bladder using a catheter

Contact your doctor or health care provider right away if any of these apply to you.

Slideshow: Living with Your Migraines: Tips for Treatment and Prevention

Before using botulinum toxin type a:

Some medical conditions may interact with botulinum toxin type a. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

  • if you are pregnant, planning to become pregnant, or are breast-feeding
  • if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
  • if you have allergies to medicines, foods, or other substances
  • if you have had any side effect from any botulinum toxin product in the past
  • if you have nerve problems or disease (eg, amyotrophic lateral sclerosis [ALS or Lou Gehrig disease], motor neuropathy), muscle problems or disease (eg, myasthenia gravis, Lambert-Eaton syndrome), or severe weakness or wasting of the muscles at the injection site
  • if you have a history of bleeding problems, seizures, heart problems (eg, irregular heartbeat, recent heart attack), swallowing problems, lung or breathing problems (eg, asthma), eye problems (eg, glaucoma, drooping eyelid), or an overactive thyroid
  • if you have migraine headaches and you have less than 14 headache days per month
  • if you have inflammation, scarring, or other skin disorders at the injection site
  • if you plan to have surgery or if you have received botulinum toxin type a or any other botulinum toxin in the past, especially within the last 4 months
  • if you have weakness in your forehead muscles (eg, trouble raising your eyebrows), any change in the way your face normally looks, or you have had surgery on your face
  • if you are taking an allergy or cold medicine

Some MEDICINES MAY INTERACT with botulinum toxin type a. Tell your health care provider if you are taking any other medicines, especially any of the following:

  • Aminoglycoside antibiotics (eg, gentamicin), anticholinergic medicines (eg, oxybutynin, scopolamine), anticholinesterase medicines (eg, neostigmine), lincosamides (eg, clindamycin), magnesium, muscle relaxants (eg, cyclobenzaprine), polymyxin, quinidine, or a sleep medicine (eg, zolpidem) because they may increase the risk of botulinum toxin type a's side effects
  • Anticoagulants (eg, warfarin), antiplatelet medicines (eg, clopidogrel), or aspirin because the risk of bleeding at the injection site may be increased

This may not be a complete list of all interactions that may occur. Ask your health care provider if botulinum toxin type a may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use botulinum toxin type a:

Use botulinum toxin type a as directed by your doctor. Check the label on the medicine for exact dosing instructions.

  • Botulinum toxin type a comes with an extra patient information sheet called a Medication Guide. Read it carefully. Read it again each time you get botulinum toxin type a refilled.
  • Botulinum toxin type a is usually given as an injection at your doctor's office, hospital, or clinic.
  • If you miss a dose of botulinum toxin type a, contact your doctor right away.

Ask your health care provider any questions you may have about how to use botulinum toxin type a.

Important safety information:

  • Botulinum toxin type a may cause dizziness, drowsiness, loss of strength, weakness, blurred vision, or drooping eyelids. These effects may be worse if you take it with alcohol or certain medicines. Use botulinum toxin type a with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
  • Do NOT use more than the recommended dose or use for longer than prescribed without checking with your doctor.
  • Tell your doctor or dentist that you take botulinum toxin type a before you receive any medical or dental care, emergency care, or surgery.
  • A certain severe nervous system problem (autonomic dysreflexia) has been reported in patients using botulinum toxin type a to treat loss of bladder control. Seek immediate medical attention if you experience unusual sweating or flushing, unusual muscle tightness, blurred vision, fast or slow heartbeat, severe dizziness or nausea, severe or throbbing headache, unexplained goose bumps, or unexplained stuffy nose.
  • Do not switch between botulinum toxin type a and other brands of botulinum toxin type a or other types of botulinum toxin products. Contact your doctor if you have any questions.
  • Botulinum toxin type a contains albumin, which comes from human blood. There is a very rare risk of getting a viral disease or a central nervous system disease called Creutzfeldt-Jakob disease from products with albumin. No cases of these problems have been found in patients who have used botulinum toxin type a.
  • To prevent injury, resume normal activities gradually after using botulinum toxin type a.
  • Botulinum toxin type a should be used with extreme caution in CHILDREN younger than 12 years old; safety and effectiveness in these children have not been confirmed.
  • PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using botulinum toxin type a while you are pregnant. It is not known if botulinum toxin type a is found in breast milk. If you are or will be breast-feeding while you use botulinum toxin type a, check with your doctor. Discuss any possible risks to your baby.

Possible side effects of botulinum toxin type a:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Anxiety; arm or leg pain; back pain; constipation; dizziness; drowsiness; dry mouth; dry or irritated eyes; facial pain; flu-like symptoms; headache; inability to focus the eyes; increased cough; indigestion; mild sore throat; nausea; neck pain; pain, redness, swelling, or tenderness at the injection site; runny nose; sensitivity to light; stiff or weak muscles at or near the injection site; sweating; tiredness.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness; wheezing); bleeding at the injection site; blood in the urine; burning, numbness, or tingling; burning with urination; chest pain; difficult, frequent, or painful urination; difficulty swallowing or breathing; double or blurred vision, or other vision changes; drooping of the upper eyelid; eyelid swelling; fainting; fever, chills, or persistent sore throat; irregular heartbeat; loss of bladder control; loss of strength; paralysis; seizures; severe or persistent muscle weakness, headache, or dizziness; shortness of breath; speech changes or problems; worsening migraine.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include body weakness; difficulty breathing; paralysis.

Proper storage of botulinum toxin type a:

Botulinum toxin type a is usually handled and stored by a health care provider. If you are using botulinum toxin type a at home, store botulinum toxin type a as directed by your pharmacist or health care provider. Keep botulinum toxin type a out of the reach of children and away from pets.

General information:

  • If you have any questions about botulinum toxin type a, please talk with your doctor, pharmacist, or other health care provider.
  • Botulinum toxin type a is to be used only by the patient for whom it is prescribed. Do not share it with other people.
  • If your symptoms do not improve or if they become worse, check with your doctor.
  • Check with your pharmacist about how to dispose of unused medicine.

This information should not be used to decide whether or not to take botulinum toxin type a or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about botulinum toxin type a. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to botulinum toxin type a. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using botulinum toxin type a.

Issue Date: September 3, 2014
Database Edition 14.3.1.003
Copyright © 2014 Wolters Kluwer Health, Inc.

Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using this medicine.

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