Drug Interaction Report

MONITOR CLOSELY: The effects of botulinum toxin may be potentiated by neuromuscular blockers, aminoglycoside antibiotics, and other drugs that can interfere with neuromuscular transmission. Botulinum toxin inhibits the release of acetylcholine from peripheral cholinergic nerve endings, thus additive neuromuscular blocking effects may occur when these agents are used together.

MANAGEMENT: Caution is advised when botulinum toxin is used in combination with neuromuscular blockers, aminoglycoside antibiotics, or other drugs that can interfere with neuromuscular transmission. These drugs should be avoided in patients suspected of having botulinum toxin overdose or poisoning. Because the effects of botulinum toxin products may spread from the area of injection, patients should be monitored closely for adverse effects such as asthenia, generalized muscle weakness, diplopia, blurred vision, ptosis, dysphagia, dysphonia, dysarthria, urinary incontinence and breathing difficulties, which can occur hours to weeks after injection. Swallowing and breathing difficulties may be life-threatening or fatal. Patients with peripheral motor neuropathic diseases, amyotrophic lateral sclerosis, or neuromuscular junctional disorders such as myasthenia gravis or Lambert-Eaton syndrome may be particularly susceptible.