Dysport vs Botox: What's the difference?
Dysport and Botox both have cosmetic uses. But what is the difference?
Botox is the brand name for a specific type A botulinum 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.
The main differences between Botox and Dysport are:
- 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; to treat cervical dystonia and spasticity in adults; and upper and lower limb spasticity in adolescents and children aged 2 and older. Botox is also approved to treat chronic migraine; excessive sweating; bladder dysfunction and urinary incontinence associated with certain neurological conditions; blepharospasm; and strabismus.
- Even though Botox and Dysport are both type A botulinum toxins, their nontoxin protein content is different due to differences in their manufacturing. This means that there are several similarities but slight differences between the two products.
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.
Does Botox have more FDA approved indications than Dysport?
Yes, Botox does have more approved indications than Dysport.
Botox Cosmetic is FDA approved to 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 FDA approved for bladder dysfunction (overactive bladder and urinary incontinence associated with a neurological condition (such as spinal cord injury or Multiple Sclerosis), chronic migraine (≥15 days per month with headache lasting 4 hours a day or longer), spasticity in adults, upper and lower limb spasticity in adolescents and children aged 2 and older, primary axillary hyperhidrosis (excessive sweating), blepharospasm and strabismus, and cervical dystonia. For some indications, there is a lower age limit for use.
Dysport is FDA approved for the treatment of glabellar lines, cervical dystonia, spasticity in adults, and upper and lower limb spasticity in adolescents and children aged 2 and older.
For more information about Botox and botulinum toxins in general, see Botox For Beginners: What You Need To Know.
- FDA Approves Botox (onabotulinumtoxinA) for Pediatric Patients with Lower Limb Spasticity, Excluding Spasticity Caused by Cerebral Palsy. Oct 24 2019
- FDA Approves Botox (onabotulinumtoxinA) for Pediatric Patients with Upper Limb Spasticity. June 21, 2019. https://www.drugs.com/newdrugs/fda-approves-botox-onabotulinumtoxina-pediatric-patients-upper-limb-spasticity-4998.html
- Dysport (Botulinum toxin type A ) [Package Insert] Updated 09/2019. Drugs.com. Ipsen Biopharmaceuticals, Inc https://www.drugs.com/pro/dysport.html
- Botox (onabotulinumtoxintypeA) [Package Inset] Revised 06/2019. Allergan, Inc. https://www.drugs.com/pro/botox.html
- Botox Cosmetic (onabotulinumtoxintypeA) [Package Inset] Revised 10/2019. 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
- FDA Approves Expanded Botox (onabotulinumtoxinA) Label for the Treatment of Pediatric Patients with Spasticity July 9 2020 https://www.drugs.com/newdrugs/fda-approves-expanded-botox-onabotulinumtoxina-label-pediatric-patients-spasticity-5298.html
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