216: Botulinum Toxin Flashcards
What are the seven distinct serotypes of botulinum toxin?
The seven distinct serotypes of botulinum toxin are A, B, C1, D, E, F, and G.
What is the significance of the 150-kDa dichain polypeptides in botulinum toxin?
The 150-kDa dichain polypeptides consist of a heavy chain and a light chain linked by disulfide bonds, which are crucial for the toxin’s function.
How does botulinum toxin enter the nerve cells?
Botulinum toxin enters nerve cells by binding to surface protein receptors and undergoing endocytosis into internalized vesicles.
What is the role of SNARE proteins in the action of botulinum toxin?
SNARE proteins are cleaved by the light chain of botulinum toxin, inhibiting the exocytosis of acetylcholine, which leads to muscle paralysis.
What are the differences in the preparations of botulinum toxin products?
The preparations differ in their methods of manufacture, commercial form, and biologic profiles, and the units used to describe them are not interchangeable.
What is the dilution method for Botox when used for glabellar frown lines?
Botox is generally diluted with 1, 2, or 2.5 mL of saline per 100 units, producing concentrations of either 10 units per 0.1 mL, 5 units per 0.1 mL, or 4 units per 0.1 mL.
What is the clinical significance of collateral sprouting in the context of botulinum toxin treatment?
Collateral sprouting allows the nerve endings to eventually make contact with targets, helping to overcome the loss of neurotransmitter and restore muscle activity and gland secretion.
What is the FDA’s Risk Evaluation and Mitigation Strategy (REMS) related to botulinum toxin products?
The FDA instituted a REMS and a boxed warning for botulinum toxin products to address safety concerns associated with their use.
What is the mechanism of action of botulinum toxin in inhibiting muscle activity?
Botulinum toxin enters the nerves by binding to surface protein receptors and undergoing endocytosis. The light chain cleaves SNARE proteins (e.g., SNAP-25 for Type A toxin), inhibiting acetylcholine exocytosis, leading to chemodenervation and localized absence of skeletal muscle activity.
What are the key differences between Botox® and Dysport® in terms of dilution and injection volumes?
Botox® is generally diluted with 1, 2, or 2.5 mL of saline per 100 units, producing concentrations of 10, 5, or 4 units per 0.1 mL, respectively. Dysport® is usually diluted with 1.5 mL of saline per 300-unit vial, producing a concentration of 10 units in 0.05 mL. Dysport® pivotal trials used injection volumes half those of Botox®.
What is the role of SNARE proteins in the mechanism of botulinum toxin?
SNARE proteins (e.g., SNAP-25 for Type A toxin) are cleaved by the botulinum toxin light chain, inhibiting acetylcholine release and leading to chemodenervation.
What is the significance of collateral sprouting in the mechanism of botulinum toxin?
Collateral sprouting occurs near the primary terminus of chemodenervated nerve endings, allowing the nerve to reestablish contact with its targets and overcome neurotransmitter loss.
What are the key differences between serotypes A and B of botulinum toxin?
Both serotypes A and B have 150-kDa dichain polypeptides with a heavy and light chain linked by disulfide bonds. Type A cleaves SNAP-25, while Type B cleaves VAMP/synaptobrevin.
What is the significance of the FDA’s Risk Evaluation and Mitigation Strategy (REMS) for botulinum toxin products?
The REMS emphasizes the noninterchangeability of botulinum toxin products and aims to minimize medication errors and tailor specific doses to specific situations.
What is the role of preservative-containing sterile saline in botulinum toxin preparation?
Preservative-containing sterile saline (e.g., benzyl alcohol) as a diluent reduces the sting of injection with Botox® and Dysport®.
What is the significance of the SNARE protein complex in botulinum toxin’s mechanism of action?
The SNARE protein complex is cleaved by botulinum toxin, inhibiting acetylcholine release and leading to chemodenervation.
What is the role of collateral sprouting in the recovery process after botulinum toxin treatment?
Collateral sprouting allows chemodenervated nerve endings to reestablish contact with their targets, overcoming neurotransmitter loss.
What is the significance of the FDA’s boxed warning for botulinum toxin products?
The boxed warning highlights the possibility of toxin spread distant from the injection site, which could have life-threatening consequences.
What are the seven distinct serotypes of botulinum toxin and how do they differ in their characteristics?
The seven distinct serotypes of botulinum toxin are A, B, C1, D, E, F, and G. They vary in their biosynthesis, size, cellular sites of action, binding kinetics, duration of effect, and stability. Serotypes A and B are commercially available and derived from different strains of Clostridium botulinum, both having 150-kDa dichain polypeptides linked by disulfide bonds.
Describe the mechanism of action of botulinum toxin in the nervous system.
Botulinum toxin enters the nerves by binding to surface protein receptors and undergoing endocytosis into internalized vesicles. The light chain is released into the nerve cytosol, cleaving the SNARE protein complex, which inhibits the exocytosis of acetylcholine. Type A toxin cleaves SNAP-25, while Type B cleaves VAMP/synaptobrevin, leading to chemodenervation of motor or autonomic nerves and a localized absence of muscle activity or autonomic control.
What is the significance of collateral sprouting in the context of botulinum toxin treatment?
Collateral sprouting refers to the process where chemodenervated nerve endings develop new sprouts that make contact with target muscles or glands. This process helps to overcome the loss of neurotransmitter, reestablishing chemical contact with targets, allowing muscles to resume activity and glands to begin secreting, despite the initial effects of the toxin.
How do the different preparations of botulinum toxin vary in their methods of manufacture and biological profiles?
The different preparations of botulinum toxin, such as Botox, Xeomin, and Dysport, differ in their methods of manufacture, commercial form, and biological profiles. Each product has unique characteristics based on the assays used to determine their potency, and they are not interchangeable. For example, Botox is diluted with saline in varying amounts, while Dysport has a different dilution method.
What are the clinical implications of using different diluents for botulinum toxin injections?
The use of different diluents, such as sterile saline with preservative (benzyl alcohol), can affect the injection experience. For instance, using benzyl alcohol appears to lessen the sting of injection with Botox and Dysport. Additionally, the volume of diluent can influence diffusion and persistence of the drug at the injection site, impacting clinical outcomes.
What are the potential side effects associated with the use of Myobloc compared to other botulinum toxin preparations?
Myobloc, the B serotype of botulinum toxin, is associated with more discomfort upon injection due to its low pH. However, it is stable in liquid form at room temperature for many months. In contrast, other preparations like Botox and Dysport may have different side effect profiles related to their formulation and dilution methods.
What is the role of the FDA’s Risk Evaluation and Mitigation Strategy (REMS) concerning botulinum toxin products?
The FDA instituted a Risk Evaluation and Mitigation Strategy (REMS) for botulinum toxin products to ensure that the benefits of these treatments outweigh the risks. This includes boxed warnings that inform healthcare providers and patients about potential serious side effects and the need for careful monitoring during treatment.
How does the dilution of Botox affect its concentration and clinical application?
Botox is generally diluted with 1, 2, or 2.5 mL of saline per 100 units, producing concentrations of either 10 units per 0.1 mL, 5 units per 0.1 mL, or 4 units per 0.1 mL, respectively. This dilution affects the clinical application, as different concentrations may be used for various indications, such as treating glabellar frown lines.
What are the differences in the preparation and dilution of Dysport compared to Botox?
Dysport is usually diluted with 1.5 mL of saline per 300-unit vial, producing a concentration of 10 units in 0.05 mL. In contrast, Botox is diluted with varying amounts of saline per 100 units, leading to different concentrations. These differences in preparation and dilution can influence the clinical outcomes and patient experience during treatment.
What are the clinical observations regarding the use of botulinum toxin for treating glabellar frown lines?
Clinical observations indicate that for treating glabellar frown lines, 20 units of Botox or Xeomin and 50 units of Dysport are commonly used. These dosages are based on clinical trials and experiences, highlighting the effectiveness of different botulinum toxin preparations for this specific indication.
What are the primary indications for the use of botulinum toxin in cosmetic dermatology?
Botulinum toxin is primarily used for treating dynamic expression lines in the upper third of the face, including:
- Glabellar brow furrows
- Horizontal frontalis forehead lines
- Periocular rhytides (crow’s feet)
Additionally, it is used for the treatment of axillary hyperhidrosis.
What is the recommended injection technique for treating glabellar lines with botulinum toxin?
To treat glabellar lines, the following injection technique is recommended:
1. Use a 30-gauge, 31-gauge, or 32-gauge needle with a tuberculin or diabetic syringe to minimize trauma.
2. Inject 20 to 35 units of Botox® or Xeomin® or 50 to 75 units of Dysport® in 5 separate points:
- (1) Just at or above the medial brow
- (2) Medial to the midpupillary line, at least 1 cm above the bony orbital rim
- (3) Place the fifth injection in the procerus at the midline, just above the horizontal creases in the glabella.
What precautions should patients take after receiving botulinum toxin injections in the brow area?
Patients should remain upright for 2 to 3 hours after receiving botulinum toxin injections in the brow area to limit the incidence of eyelid ptosis, which can occur due to diffusion of the toxin into the levator muscles of the lid.
How is the frontalis muscle treated to avoid inactivation of the lower third of the muscle?
The frontalis muscle is treated at the horizontal equator of the forehead or above to avoid inactivation of the lower third of the frontalis muscle, which is responsible for suspension and movement of the eyebrows. Typically, 12 to 20 units of Botox® or 20 to 50 units of Dysport® are injected in 4 or 5 divided doses.
A patient presents with dynamic expression lines in the upper third of the face. What are the primary indications for botulinum toxin treatment in this area?
The primary indications are glabellar brow furrow, horizontal frontalis forehead lines, and periocular rhytides (crow’s feet).
You are treating a patient for glabellar lines. What is the recommended dose and injection technique for Botox®?
The recommended dose is 20 to 35 units of Botox® or Xeomin® (or 50 to 75 units of Dysport®) placed in 5 separate injection points: (1) just at or above the medial brow, (2) in or just medial to the midpupillary line (at least 1 cm above the bony orbital rim), and (3) in the procerus at the midline just above the horizontal creases in the glabella.
What is the role of apraclonidine in managing eyelid ptosis after botulinum toxin treatment?
Apraclonidine 0.5% eyedrops can temporarily stimulate Muller muscle in the lid, producing 2 to 3 mm of lash margin elevation to manage eyelid ptosis.
What are the key considerations when treating glabellar lines with botulinum toxin?
Key considerations include understanding facial anatomy, using appropriate doses (20 to 35 units of Botox® or Xeomin®), and placing injections at least 1 cm above the bony orbital rim to avoid ptosis.
What are the primary indications for the use of botulinum toxin in cosmetic dermatology?
Botulinum toxin is primarily used for treating dynamic expression lines in the upper third of the face, including:
- Glabellar brow furrows
- Horizontal frontalis forehead lines
- Periocular rhytides (crow’s feet)
Additionally, it is used for treating axillary hyperhidrosis.
What is the recommended injection technique for treating glabellar lines with botulinum toxin?
To treat glabellar lines, the following injection technique is recommended:
1. Use a 30-gauge, 31-gauge, or 32-gauge needle with a tuberculin or diabetic syringe.
2. Inject 20 to 35 units of Botox® or Xeomin® or 50 to 75 units of Dysport® in 5 separate points:
- (1) Just at or above the medial brow.
- (2) Medial to the midpupillary line, at least 1 cm above the bony orbital rim.
- (3) Place the fifth injection in the procerus at the midline, just above the horizontal creases in the glabella.
What is the significance of immunologic resistance to botulinum toxin in dermatology?
Immunologic resistance to Botox® and Botox Cosmetic® does not appear to be clinically relevant in dermatology, even at dosages used for treating hyperhidrosis. The treatment interval does not significantly affect clinical resistance for newer batches, and the development of neutralizing antibodies is extremely rare in clinical practice.
How should horizontal forehead lines be treated with botulinum toxin?
To treat horizontal forehead lines, the frontalis muscle should be injected at the horizontal equator of the forehead or above to avoid inactivation of the lower third of the frontalis muscle. Typically, 12 to 20 units of Botox® or 20 to 50 units of Dysport® are placed in 4 or 5 divided injections.
What are the less common indications for botulinum toxin treatment?
Less common and therapeutically more challenging indications for botulinum toxin treatment include:
- Platysmal banding in the neck
- Perioral rhytides
- Marionette lines at the corners of the mouth
- Shaping the lower face with masseter volume reduction
- Postsurgical synkinesis in the lower face
- Palmar/plantar and forehead/scalp hyperhidrosis.
How many units of Dysport® are typically placed in injections?
50 units of Dysport® are placed in 4 or 5 divided injections.
What are the less common indications for botulinum toxin treatment?
Less common indications include platysmal banding in the neck, perioral rhytides, marionette lines, shaping the lower face with masseter volume reduction, postsurgical synkinesis in the lower face, and hyperhidrosis.
What is the incidence of ptosis after brow injection with botulinum toxin?
With operator experience, the incidence of ptosis after injection of the brow should be less than 2%.
What temporary measures can stimulate the Muller muscle after botulinum toxin injection?
Temporary stimulation can be achieved with 0.5% apraclonidine eyedrops, 2.5% phenylephrine eyedrops, or Naphazoline hydrochloride 0.025%/pheniramine maleate 0.3% eyedrops (Naphcon A®). These can produce 2 to 3 mm of elevation of the lash margin.
Why is understanding facial anatomy important in botulinum toxin application?
A firm understanding of facial anatomy is essential for successful aesthetic therapy, influencing the effectiveness and safety of the treatment.
What are the potential life-threatening consequences of botulinum toxin injection?
Potential consequences include spread distant from the injection site, leading to serious complications. Tailoring specific doses to situations is crucial to minimize risks.
What are the potential side effects of applying too large a dose of botulinum toxin in the forehead area?
Applying too large a dose can lead to brow ptosis and loss of brow arch. There is no available adrenergic agent to reverse this effect.
What is the recommended approach for treating crow’s feet with botulinum toxin?
The toxin should be injected at 1 to 3 points approximately 1 cm lateral to the lateral canthus, with typical doses ranging from 10 to 18 units of Botox® or 25 to 30 units of Dysport®.
How does combination therapy enhance cosmetic treatments involving botulinum toxin?
Combination therapy allows synergy between soft-tissue fillers and neurotoxins, providing control over muscles of expression and secondary lines, and repairing age-related volume changes.
What is the duration of effect for focal axillary hyperhidrosis treated with botulinum toxin?
The duration of effect appears to be dose-related, with 50 to 100 units producing reliable anhidrosis lasting 8 to 12 months, and up to 200 units lasting up to 29 months.
What precautions should be taken when injecting botulinum toxin for crow’s feet?
Precautions include ensuring good lower eyelid tarsal tone to avoid senile ectropion and pretreating the area before laser resurfacing.
What could cause brow ptosis after forehead botulinum toxin treatment?
Brow ptosis can occur if too large a dose is applied or injection sites are placed too low. To avoid this, restrict injections to the upper two-thirds of the frontalis and reduce doses.
What is the recommended injection technique and dose for treating crow’s feet?
The toxin is placed at 1 to 3 injection points approximately 1 cm lateral to the lateral canthus, with doses ranging from 10 to 18 units of Botox® or 25 to 30 units of Dysport®.
What should patients expect regarding the duration of anhidrosis after axillary hyperhidrosis treatment?
Reliable anhidrosis is produced within 72 hours and lasts for 8 to 12 months with doses of 50 to 100 units of Botox®.
What is the recommended dose and injection technique for treating forehead lines with botulinum toxin?
Twelve to 20 units of Botox® or 20 to 50 units of Dysport® are placed in 4 or 5 divided doses equidistantly along the forehead equator.
What are the key considerations when treating crow’s feet with botulinum toxin?
Key considerations include ensuring good lower eyelid tarsal tone, using intradermal injections to avoid bruising, and avoiding injections at or below the malar eminence.
What is the recommended dose and injection technique for treating axillary hyperhidrosis with Botox®?
Doses of 2.5 to 4.0 units of Botox® are placed every 1 to 2 cm as intradermal injections, totaling 50 to 100 units per axilla.
What are the potential complications of botulinum toxin treatment for the frontalis muscle?
Complications include brow ptosis and loss of brow arch if too large a dose is applied or injection sites are placed too low.
What are the potential complications of botulinum toxin treatment for crow’s feet?
Complications include bruising, senile ectropion, and zygomaticus muscle paralysis if injections are placed at or below the malar eminence.
What is the recommended dose and injection technique for treating lateral canthal lines with Dysport®?
The recommended dose is 25 to 30 units of Dysport®, placed at 1 to 3 injection points approximately 1 cm lateral to the lateral canthus.
What are the key considerations when treating hyperhidrosis with botulinum toxin?
Key considerations include mapping the affected area, using appropriate doses, and counseling patients about transient side effects.
What is the recommended dose and injection technique for treating forehead lines with Dysport®?
The recommended dose is 20 to 50 units of Dysport®, placed in 4 or 5 divided doses equidistantly along the forehead equator.
What are the potential complications of botulinum toxin treatment for the lower face?
Complications include drooping corners of the mouth and difficulty in tasks requiring strength after palmar hyperhidrosis treatment.
What is the recommended dose and injection technique for treating axillary hyperhidrosis with Dysport®?
The recommended dose is up to 200 units of Dysport® per axilla, placed every 1 to 2 cm as intradermal injections.
What are the potential consequences of applying too large a dose of botulinum toxin in the forehead area?
Applying too large a dose can lead to brow ptosis and loss of brow arch, with no available agent to reverse the effect.
Why is it recommended to wait between treating the glabellar area and the forehead area?
Waiting helps to avoid overtreatment and brow ptosis, which can be bothersome for patients.
What is the recommended approach for injecting botulinum toxin to treat crow’s feet?
To treat crow’s feet, the toxin is usually injected at 1 to 3 points approximately 1 cm lateral to the lateral canthus.
What complications can arise from placing botulinum toxin at or below the malar eminence?
Placing toxin at or below the malar eminence may lead to paralysis of the zygomaticus muscles and a drooping corner of the mouth.
How can pretreatment of the crow’s feet area be beneficial before laser resurfacing?
Pretreatment prevents the reformation of rhytides during the healing period.
What is the significance of combining soft-tissue fillers with neurotoxins in cosmetic procedures?
Combining fillers with neurotoxins allows for better control of expression muscles and repairs age-related volume changes.
What is the typical dosing range for botulinum toxin when treating focal axillary hyperhidrosis?
Typical doses range from 50 to 100 units of Botox per axilla, producing reliable anhidrosis within 72 hours.
What are the potential side effects of botulinum toxin injections for hyperhidrosis?
Aside from minor bruising, there are no apparent side effects. Compensatory hyperhidrosis is not considered significant.
What challenges are associated with treating palmar hyperhidrosis compared to axillary hyperhidrosis?
Palmar hyperhidrosis is more challenging due to limited diffusion of the toxin and pain associated with injections.
What is the role of the Minor starch-iodine test in the treatment of axillary hyperhidrosis?
The test is used to map the surface area affected by hyperhidrosis, guiding botulinum toxin injections.
What is the typical onset time for anhidrosis after Botox injections for hyperhidrosis?
The onset of anhidrosis peaks in 5 to 7 days after Botox injections.
What are the common side effects associated with Botox injections for hyperhidrosis?
Common side effects include minor needle trauma, bruising, palmar weakness, and transient lid edema.
What is the recommended approach to minimize eyelid ptosis during Botox injections?
To minimize ptosis, injections should be placed at least 1 cm from the superior orbital rim and patients should avoid prone positions after injection.
What are the FDA-approved indications for cosmetic use of botulinum toxin?
The FDA-approved indications are glabellar frown lines and lateral canthal lines (crow’s feet).
What is a common consequence of injecting Botox into the palms for hyperhidrosis?
A common consequence is palmar weakness, making strength-requiring tasks difficult.
What precautions should be taken to avoid eyelid ptosis after glabellar injections?
Injections should be placed at least 1 cm from the superior orbital rim, with a slow injection rate, and patients should avoid prone positions.
What are the potential complications of botulinum toxin treatment for palmar hyperhidrosis?
Complications include minor weakness of the intrinsic muscles of the hand, which usually subsides within 3 weeks.
What are the potential complications of botulinum toxin treatment for the glabellar area?
Complications include eyelid ptosis due to toxin diffusion and minor bruising.
What are the potential complications of botulinum toxin treatment for the platysma?
Complications include difficulty swallowing or speaking if the toxin diffuses to unintended areas.
What are the key considerations when treating the masseter muscle with botulinum toxin?
Key considerations include using appropriate doses to avoid excessive weakening.
What are the potential complications of botulinum toxin treatment for the mentalis muscle?
Complications include difficulty in lip movement or speech if the toxin diffuses to unintended areas.
What are the potential complications of botulinum toxin treatment for the orbicularis oculi muscle?
Complications include transient lid edema and bruising.
What is the expected duration of palmar weakness after Botox injections for hyperhidrosis?
Palmar weakness usually subsides within 3 weeks, while anhidrosis persists for several months.
What are the common complications associated with Botox injections in the glabellar area?
Common complications include eyelid ptosis, brow ptosis, transient lid edema, headaches, and palmar weakness.
How can eyelid ptosis be minimized during Botox injections?
Eyelid ptosis can be minimized by placing midbrow injections at least 1 cm from the superior orbital rim.
What are the FDA-approved indications for cosmetic use of botulinum toxin?
The only FDA-approved indications for cosmetic botulinum toxin are the glabellar frown lines and the lateral canthal lines (crow’s feet).
What is a potential consequence of injecting Botox into the palms for hyperhidrosis?
Injecting Botox into the palms for hyperhidrosis can lead to palmar weakness, which makes tasks requiring strength difficult to perform.
What should patients be advised regarding their position after receiving Botox for glabellar lines?
Patients have been instructed to remain upright for a certain period to limit the incidence of complications such as eyelid ptosis.
What happens if too large a dose of Botox is applied to horizontal forehead lines?
If too large a dose is applied or injection sites are placed too low, it can lead to complications such as brow ptosis.
What is the clinical significance of antibody-mediated resistance in patients treated with Botox?
Antibody-mediated resistance appears to be an exceedingly rare event in patients treated with Botox, with no well-documented evidence of immunologic resistance in cosmetic doses.
What is the recommended approach to manage headaches that may occur after Botox injections?
Usually, NSAIDs are sufficient to treat headaches after injections, unless the patient experiences migraines, in which case their usual migraine medication will be required.
What are the key differences in the manufacturing processes of the commercially available forms of Botulinum Toxin in the United States?
The manufacturing processes for the commercially available forms of Botulinum Toxin include:
Proprietary Name | Process |
|——————|———————-|
| BOTOX® | Crystallization |
| DYSPORT® | Chromatography |
| XEOMIN® | Chromatography |
| MYOBLOC® | Chromatography |
| RT001 TOPICAL | Chromatography |
How do the excipients differ among the various forms of Botulinum Toxin available in the United States?
The excipients used in the various forms of Botulinum Toxin include:
Proprietary Name | Excipients |
|——————|——————————–|
| BOTOX® | HSA (500 µg), Sodium chloride |
| DYSPORT® | HSA (125 µg), Lactose |
| XEOMIN® | HSA (1 mg/vial) |
| MYOBLOC® | HSA (500 µg/mL), Sodium succinate |
| RT001 TOPICAL | HSA |
What is the significance of the receptor/target differences among the various Botulinum Toxin products?
The receptor/target differences among the various Botulinum Toxin products indicate variations in their mechanism of action and potential clinical applications:
Proprietary Name | Receptor/Target |
|——————|——————-|
| BOTOX® | SV2/SNAP-25 |
| DYSPORT® | SV2/SNAP-25 |
| XEOMIN® | SV2/SNAP-25 |
| MYOBLOC® | 5yt L/VAMP |
| RT001 TOPICAL | SV2/SNAP-25 |
What are the differences in the commercial status of Botulinum Toxin products in the United States?
The commercial status of Botulinum Toxin products in the United States varies:
Proprietary Name | Commercial Status |
|——————|——————-|
| BOTOX® | Yes |
| DYSPORT® | Pending US |
| XEOMIN® | Yes |
| MYOBLOC® | Pending US |
| RT001 TOPICAL | Pending US |
What are the key differences in the serotype of commercially available forms of botulinum toxin in the United States?
The serotypes of commercially available forms of botulinum toxin in the United States are as follows:
Product Name | Serotype |
|————–|———-|
| BOTOX® | A |
| DYSPORT® | A |
| XEOMIN® | A |
| MYOBLOC® | B |
| RT001 | A |
How does the process of manufacturing differ among the various forms of botulinum toxin available in the United States?
The manufacturing processes for different forms of botulinum toxin are:
Product Name | Process |
|————–|——————|
| BOTOX® | Crystallization |
| DYSPORT® | Chromatography |
| XEOMIN® | Chromatography |
| MYOBLOC® | Chromatography |
| RT001 | Chromatography |
What are the excipient differences among the various botulinum toxin products available in the United States?
The excipients used in different botulinum toxin products are:
Product Name | Excipients |
|————–|—————————–|
| BOTOX® | HSA (500 µg), Sodium chloride |
| DYSPORT® | HSA (125 µg), Lactose |
| XEOMIN® | HSA (1 mg/vial) |
| MYOBLOC® | HSA (500 µg/mL), Sodium succinate |
| RT001 | HSA |
What is the significance of the receptor/target differences in the various botulinum toxin products?
The receptor/target differences among botulinum toxin products indicate their specificity and potential efficacy:
Product Name | Receptor/Target |
|————–|——————|
| BOTOX® | SV2/SNAP-25 |
| DYSPORT® | SV2/SNAP-25 |
| XEOMIN® | SV2/SNAP-25 |
| MYOBLOC® | 5yt L/VAMP |
| RT001 | SV2/SNAP-25 |
How do the stabilization and solubilization methods differ among the botulinum toxin products?
The stabilization and solubilization methods for botulinum toxin products are:
Product Name | Stabilization | Solubilization |
|————–|———————–|————————-|
| BOTOX® | Vacuum dried | Normal saline |
| DYSPORT® | Lyophilization | Normal saline |
| XEOMIN® | Vacuum dried | Normal saline |
| MYOBLOC® | Solution | N/A |
| RT001 | Lyophilization | Normal saline |
What are the package sizes available for the different forms of botulinum toxin in the United States?
The package sizes for various botulinum toxin products are:
Product Name | Package Size (units per vial) |
|————–|——————————-|
| BOTOX® | 100, 200 |
| DYSPORT® | 300, 500 |
| XEOMIN® | 50 (100 U vial) |
| MYOBLOC® | 2500/5000/10,000 |
| RT001 | 50 |
What are the neurotoxin protein content differences among the botulinum toxin products?
The neurotoxin protein content per vial for different products is:
Product Name | Neurotoxin Protein Content (per vial) |
|————–|————————————–|
| BOTOX® | 1 (100 U vial) |
| DYSPORT® | 4.35 (500 U vial) |
| XEOMIN® | 0.6 (100 U vial) |
| MYOBLOC® | 25/50/100 |
| RT001 | 1 (100 U vial) |
What is the recommended number of injections and total dose for treating the glabella with Botox® or Xeomin®?
5 injections with a total dose of 20-35 units for Botox® or Xeomin®; Dysport® total dose is 50-75 units.
How many injections are recommended for the forehead and what is the total dose for Botox® and Dysport®?
4 or 5 divided doses equidistantly along the forehead equator; total dose for Botox® is 12-20 units and for Dysport® is 20-50 units.
What is the injection technique and total dose for treating crow’s feet?
1 to 3 injection points approximately 1 cm lateral to the lateral canthus; total dose for Botox® is 10-18 units and for Dysport® is 25-30 units.
What is the recommended dosage and injection technique for axillary hyperhidrosis?
2.5 to 4.0 units of Botox® are placed every 1 to 2 cm as intradermal injections in axillary skin; total dose for Botox® is 50-100 units per axilla (8-12 months anhidrosis) and for Dysport® is 200 units per axilla (29 months anhidrosis).
What is the recommended dosage for palmar hyperhidrosis?
For palmar hyperhidrosis, 50 to 60 intradermal units are injected per palm, with 2 to 3 units for each injection; total dose for Botox® is 100-150 units.
What is the recommended injection technique and dosage for treating glabellar lines with Botox® or Xeomin®?
For glabellar lines, administer 5 injections:
- Corrugators:
1. Just at or above the medial brow
2. In or just medial to the midpupillary line at least 1 cm above the bony orbital rim
- Procerus: At the midline, just above the horizontal creases at the bridge of the nose.
Total Dose: Botox® 20-35 units, Dysport® 50-75 units.
How should Botox® be administered for forehead lines, and what is the total dosage?
For forehead lines, administer 4 or 5 divided doses equidistantly along the forehead equator (upper two-thirds of the frontalis).
Total Dose: Botox® 12-20 units, Dysport® 20-50 units.
What is the injection protocol for treating crow’s feet with Botox®?
For crow’s feet, administer 1 to 3 injection points approximately 1 cm lateral to the lateral canthus.
Total Dose: Botox® 10-18 units, Dysport® 25-30 units.
What is the recommended dosage and injection technique for axillary hyperhidrosis using Botox®?
For axillary hyperhidrosis, administer 2.5 to 4.0 units of Botox® every 1 to 2 cm as intradermal injections in the axillary skin.
Total Dose: Botox® 50-100 units per axilla (8-12 months anhidrosis), Dysport® 200 units per axilla (29 months anhidrosis).
What is the injection protocol for palmar hyperhidrosis with Botox®?
For palmar hyperhidrosis, administer 50 to 60 intradermal units per palm, with 2 to 3 units for each injection.
