Dysport and Botox both have cosmetic uses. But what is the difference between these botulinum toxins?
Dysport vs Botox: What's the difference?
- 12 Sep 2016
- 12 September 2016
- faq, botox, migraine, hyperhidrosis, migraine prevention, urinary incontinence, overactive bladder, blepharospasm, strabismus, chronic spasticity, migraine prophylaxis, facial wrinkles, cervical dystonia, dystonia, upper limb spasticity, dysport, lower limb spasticity, cosmetic
Botox is the brand name for a specific type of botulinum type A toxin, called onabotulinumtoxinA (ONA). Dysport is the brand name for another type A botulinum toxin called abobotulinumtoxinA (ABO). Botox was first approved for cosmetic use in 2002, and Dysport in 2009.
Even though Botox and Dysport are both type A botulinum toxins, their non-toxin protein content is different due to differences in their manufacturing. This means that there are several similarities but slight differences between the two products.
Both are thought to work in the same way - by blocking nerve signals to the muscles, which cause them to relax. Side effects of Dysport and Botox are similar, with the most common being pain or redness at the injection site. Other side effects are generally minor and include an increased incidence of colds or other respiratory infections.
Is the dosage of Dysport the same as that for Botox?
No. All dosages are product specific and are not interchangeable.
Botox Cosmetic is supplied in single-use vials containing either 50 or 100 units of ONA. The vial is diluted with sodium chloride before use and intended to be used on only one person. The maximum cumulative dose of ONA should generally not exceed 360 units, in a 3-month interval.
Botox multi-use vials (for indications other than cosmetic) contain either 100 or 200 units of ONA per vial, which is diluted with 0.9% sodium chloride to get a predetermined unit per ml dosage. The left-over reconstituted solution can be kept in the fridge but must be used within 24 hours.
Dysport vials contain either 300 or 500 units of ABO per vial and must also be diluted before use. Dysport is only for single use (one injection session for one patient) and reconstituted solution should be kept in the fridge and thrown away after 24 hours if not used.
The potency units of any botulinum toxin for injection is specific to that particular preparation and assay method utilized. 50 units of Botox does not equal 50 units of Dysport. The products indication-specific dosage and administration recommendations should always be followed. The lowest recommended dosage should always be used when first using a botulinum toxin product.
Is Dysport more effective than Botox?
Studies comparing Dysport to Botox have mostly yielded conflicting results. One trial, sponsored by the manufacturer of Dysport, demonstrated that Dysport worked for longer than Botox in participants with severe frontalis lines (horizontal forehead lines). In this trial, a unit-to-unit ratio of 2.5:1 (ie, 25 units of Dysport was considered equivalent to 10 units of Botox) was used. Another trial showed no difference in the duration of action of the products; however, they did find that complete efficacy was more likely to be achieved with Dysport (90% vs 75%). A further trial found Dysport worked quicker and was significantly less painful on injection than Botox. These results should be interpreted with caution.
Botox has more FDA approved indications than Dysport
Dysport is FDA approved for the treatment of glabellar lines, cervical dystonia, upper limb spasticity, and lower limb spasticity (in adults and pediatric patients over the age of 2).
Botox Cosmetic temporarily improves the appearance of moderate to severe frown lines and lines around the eyes (crows feet) in adults over the age of 18.
Botox is indicated for bladder dysfunction (overactive bladder and urinary incontinence associated with a neurological condition (such as spinal cord injury, Multiple sclerosis), chronic migraine (≥15 days per month with headache lasting 4 hours a day or longer), upper and lower limb spasticity, primary axillary hyperhidrosis (excessive sweating), blepharospasm and strabismus and cervical dystonia. For some indications, patients must be older than 12 (lower limb spasticity) but for others, it is 18 (primary axillary hyperhidrosis).
Dysport and Botox are both a type of botulinum toxin type A; however, Botox contains onabotulinumtoxinA and Dysport contain abobotulinumtoxinA. They both work by blocking nerve signals to the muscles, but are manufactured differently and their resulting nontoxin proteins cause them to have different potencies and possibly differences in their duration or onset of effect.
Most studies have used a ratio of 2.5:1, meaning 25 units of Dysport have approximately the same action as 10 units of Botox. Some studies have suggested that Dysport works quicker, lasts longer and hurts less than Botox; however, these results should be interpreted with caution and in some instances, the trials were sponsored by the manufacturer of Dysport.
Both Dysport and Botox are FDA approved for cosmetic indications and to treat cervical dystonia, upper limb spasticity and lower limb spasticity (patients older than 12 years Dysport; patients older than 2 years Botox). Botox is also approved to treat a chronic migraine, excessive sweating, bladder dysfunction and urinary incontinence associated with a neurological condition blepharospasm and strabismus.
For more information about Botox and botulinum toxins in general, see Botox For Beginners: What You Need To Know.
- Dysport (Botulinum toxin type A ) [Package Insert] Revised 08/2016. Drugs.com. Ipsen Biopharmaceuticals, Inc https://www.drugs.com/pro/dysport.html
- Botox (onabotulinumtoxintypeA) [Package Inset] Revised 02/2016. Allergan, Inc. https://www.drugs.com/pro/botox.html
- Botox Cosmetic (onabotulinumtoxintypeA) [Package Inset] Revised 02/2016. Allergan, Inc. https://www.drugs.com/dosage/botox-cosmetic.html
- Nestor MS, Ablon GR. Comparing the clinical attributes of abobotulinumtoxinA and onabotulinumtoxinA utilizing a novel contralateral Frontalis model and the Frontalis Activity Measurement Standard. J Drugs Dermatol. 2011 Oct;10(10):1148-57
- Nestor MS, Ablon GR. Duration of Action of AbobotulinumtoxinA and OnabotulinumtoxinA: A Randomized, Double-blind Study Using a Contralateral Frontalis Model. The Journal of Clinical and Aesthetic Dermatology. 2011;4(9):43-49
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