Botox, Botox Cosmetic,  BoNT-A, BTA

Botulinum toxin type A injection (Botox) is used to relieve the symptoms of cervical dystonia (spasmodic torticollis; uncontrollable tightening of the neck muscles that may cause neck pain and abnormal head positions), strabismus (an eye muscle problem that causes the eyes to turn inward or outward), and blepharospasm (uncontrollable tightening of the eyelid muscles that may cause blinking, squinting, and abnormal eyelid movements). Botulinum toxin type A injection (Botox) is also used to control severe underarm sweating that cannot be treated with products that are applied to the skin. Botulinum toxin type A injection (Botox Cosmetic) is used to temporarily smooth frown lines (wrinkles between the eyebrows). Botulinum toxin type A is in a class of medications called neurotoxins. When botulinum toxin type A is injected into a muscle, it blocks the nerve signals that cause uncontrollable tightening and movements of the muscle. When botulinum toxin type A is injected into a sweat gland, it decreases the activity of the gland to reduce sweating.

Botulinum toxin type A comes as a powder to be mixed with a liquid and injected into a muscle or into the skin by a doctor. Your doctor will choose the best place to inject the medication in order to treat your condition.You may receive additional injections of botulinum toxin type A every 3-4 months, depending on your condition and on how long the effects of the treatment last. If you are using botulinum toxin type A to treat severe underarm sweating, you may need to receive additional injections once every 6-7 months or when your symptoms return.

If you are receiving botulinum toxin type A injection to treat severe underarm sweating, your doctor will probably perform a test to find the areas that need to be treated. Your doctor will tell you how to prepare for this test. You will probably be told to shave your underarms and not to use nonprescription deodorants or antiperspirants for 24 hours before the test.

Your doctor may use an anesthetic cream, a cold pack, or eye drops to numb your skin or eyes before injecting botulinum toxin type A.

Botulinum toxin type A may help control your condition but will not cure it. It may take several days or several weeks before you feel the full benefit of botulinum toxin type A. The effects of the treatment may last 3-4 months for most conditions, or 6-7 months when used to treat severe underarm sweating, and then you may need to receive another injection to control your symptoms.

Botulinum toxin type A may cause side effects. Ask your doctor which side effects you are most likely to experience since some side effects may be related to (or occur more often in) the part of the body where you received the injection. Tell your doctor if any of these symptoms are severe or do not go away:

• pain, tenderness, or bruising in the place where you received the injection
• headache
• neck or back pain
• dizziness
• drowsiness
• tight muscles
• dry mouth
• nausea
• anxiety
• pain or tightness in the face
• drooping eyelids
• dry or irritated eyes
• teary eyes
• difficulty closing the eyes

Some side effects can be serious. If you experience any of these symptoms at any time during the first several weeks after your treatment, call your doctor immediately:

• shortness of breath
• difficulty breathing, swallowing, or talking
• weakness
• weakness or numbness of the arms or legs
• difficulty holding the head up
• vision changes
• difficulty moving the face
• irregular heartbeat
• chest pain
• fainting
• fever, cough, and other signs of infection
• seizures
• rash
• hives

Botulinum toxin type A has caused severe, life-threatening breathing problems and death. These symptoms occurred as soon as one day and as late as several weeks after botulinum toxin type A injections were given. These problems may have occurred when botulinum toxin type A spread through the body and affected areas other than the muscles that were being treated. Talk to your doctor about the risks of receiving this medication.

Botulinum toxin type A may cause other side effects. Call your doctor if you have any unusual problems while receiving this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/MedWatch/index.html] or by phone at 1-800-332-1088.

Before receiving botulinum toxin type A,

• tell your doctor and pharmacist if you are allergic to botulinum toxin type A, botulinum toxin type B (Myobloc), any other medications, or any of the ingredients in botulinum toxin type A injection. Ask your doctor for a list of the ingredients.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: certain antibiotics such as amikacin, clindamycin (Cleocin), colistimethate (Coly-Mycin), gentamicin, kanamycin,lincomycin (Lincocin), neomycin (Neo-Rx, Neo-Fradin), polymyxin, streptomycin, or tobramycin (Tobi); cholinesterase inhibitors such as ambenonium (Mytelase), donepezil (Aricept), galantamine (Razadyne), neostigmine (Prostigmin), physostigmine, pyridostigmine (Mestinon, Regonol), rivastigmine (Exelon) and tacrine (Cognex); magnesium sulfate; and quinidine. Also tell your doctor if you have received botulinum toxin type B in the past several months. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have swelling or other signs of infection in the area where botulinum toxin type A will be injected. Your doctor will not inject the medication into an infected area.
• tell your doctor if you have or have ever had eye or face surgery; seizures; any condition that affects your muscles or nerves such as amyotrophic lateral sclerosis (ALS, Lou Gehrig's disease; condition in which the nerves that control muscle movement slowly die, causing the muscles to shrink and weaken), motor neuropathy (condition in which the muscles weaken over time), myasthenia gravis (condition that causes certain muscles to weaken, especially after activity), or Lambert-Eaton syndrome (condition that causes muscle weakness that may improve with activity); or heart disease.
• if you will be receiving botulinum toxin type A to treat wrinkles, your doctor will examine you to see if the medication is likely to work for you. Botulinum toxin type A may not smooth your wrinkles or may cause other problems if you have droopy eyelids, excess skin on your eyelids, or deeply scarred, thick, or oily skin, or if your wrinkles cannot be smoothed by spreading them apart with your fingers.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while receiving botulinum toxin type A, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are receiving botulinum toxin type A.
• if you are receiving botulinum toxin type A to treat a condition that limited your activities, talk to your doctor about increasing your activities after your treatment. Your doctor will probably want you to increase your activities gradually as your body adjusts to the effects of your treatment.

Unless your doctor tells you otherwise, continue your normal diet.

Botulinum toxin type A is also sometimes used to treat other conditions in which abnormal muscle tightening causes pain, abnormal movements, or other symptoms. Botulinum toxin type A is also sometimes used to treat excessive sweating of the hands or feet, excessive sweating that occurs during or after eating, and many types of wrinkles of the face. The medication is also sometimes used to relax the leg muscles and improve the ability to move in children with cerebral palsy (condition that causes difficulty with movement and balance). Talk to your doctor about the risks of using this drug for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Symptoms of overdose usually occur some time after the overdose. If you received too much botulinum toxin type A or if you swallowed the medication, tell your doctor right away and also tell your doctor if you experience either of the following symptoms during the next several weeks:

• weakness
• difficulty moving any part of your body

Keep all appointments with your doctor.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.