Description and Brand Names

Drug information provided by: Merative, Micromedex®

US Brand Name

1. Botox
2. Botox Cosmetic

Descriptions

OnabotulinumtoxinA is used to treat certain eye conditions, such as blepharospasm (a condition where the eyelid will not stay open because of a muscle spasm) or strabismus (a condition where the eyes do not line up properly).

OnabotulinumtoxinA is also used to treat the abnormal head position and neck pain that result from cervical dystonia (severe muscle spasms of the neck) and some types of axillary hyperhidrosis (severe sweating of the armpits).

OnabotulinumtoxinA is used to treat increased muscle stiffness in the elbow, wrist, and finger muscles or ankle and toe muscles in adults with upper or lower limb spasticity or in children 2 to 17 years of age with upper and lower limb spasticity.

OnabotulinumtoxinA is also used to prevent headaches in patients with chronic migraine (severe headaches for 15 or more days a month lasting 4 or more hours a day).

OnabotulinumtoxinA is used cosmetically to temporarily improve the appearance of deep facial lines or wrinkles between the eyebrows (glabellar lines), forehead lines, and crow's feet lines around the eyes (lateral canthal lines).

OnabotulinumtoxinA is also used to treat urinary incontinence (loss of bladder control) in patients with an overactive bladder caused by nervous system disorders (eg, multiple sclerosis, spinal cord injury). It is also used to treat an overactive bladder caused by a nervous system disorder or overactive bladder with symptoms, such as loss of bladder control, increased urge to urinate, and frequent need to urinate in patients who have failed treatment with other medicines (eg, anticholinergics).

OnabotulinumtoxinA is a botulinum toxin A product. It works on the nervous system to relax the muscles.

OnabotulinumtoxinA is injected into the affected muscles. Depending on your condition, more than one treatment may be required.

This medicine is available only with your doctor's prescription and will be administered by your doctor.

This product is available in the following dosage forms:

• Powder for Solution

Before Using

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of onabotulinumtoxinA in children. However, safety and effectiveness have not been established in children younger than 2 years of age for upper limb spasticity and lower limb spasticity (except spasms caused by cerebral palsy), in children younger than 5 years of age for overactive bladder caused by a nervous system disorder, in children younger than 12 years of age for blepharospasm or strabismus, in children younger than 16 years of age for cervical dystonia, or in children younger than 18 years of age for chronic migraine, hyperhidrosis, or overactive bladder with symptoms. Use of onabotulinumtoxinA to treat glabellar lines, forehead lines, and lateral canthal lines is not recommended in children.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of onabotulinumtoxinA in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for patients receiving onabotulinumtoxinA.

Breastfeeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Drug Interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• LetibotulinumtoxinA-wlbg

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Amyotrophic lateral sclerosis (Lou Gehrig's disease) or
• Dermatochalasis (a skin problem) or
• Diabetes or
• Lambert-Eaton syndrome (nerve-muscle disorder) or
• Motor neuropathy (muscle or nerve problem) or
• Myasthenia gravis (severe muscle weakness) or
• Sebaceous skin, thick (oily or fatty skin) or
• Surgery on the face, history of—May increase risk for more serious side effects.

• Bleeding problems or
• Breathing problems (eg, asthma, emphysema) or
• Dysarthria (trouble with speaking) or
• Dysphagia (trouble with swallowing) or
• Dysphonia (voice problem) or
• Heart attack, recent or history of or
• Heart or blood vessel disease or
• Heart rhythm problems or
• Lung problems (eg, bronchitis) or
• Ptosis (droopy eyelid) or
• Urinary incontinence (problems passing urine)—Use with caution. May make these conditions worse.

• Infection at the injection site or
• Urinary retention (not able to urinate) or
• Urinary tract infection—Should not be used in patients with these conditions.

Proper Use

Your doctor will give you this medicine in a medical facility. It is given as a shot under your skin or into one of your muscles.

You may be given medicine to numb the area where the shot will be injected. If you receive the medicine around your eyes, you may be given eye drops or ointment to numb the area. After your injection, you may need to wear a protective contact lens or eye patch.

If you are being treated for bladder problems, you may also receive medicine to help prevent urinary tract infection before, during, or after treatment with this medicine.

If you are treated for excessive sweating, shave your underarms but do not use deodorant for 24 hours before your injection. Avoid exercise, hot foods or liquids, or anything else that could make you sweat for 30 minutes before your injection.

This medicine works slowly. For neck disorders, you should have improvement within 2 to 6 weeks after your injection. For upper arm stiffness, you should have improvement within 4 to 6 weeks after your injection. Eyelid disorders should improve within 3 days to 2 weeks after your injection. Strabismus should improve within 1 or 2 days after the injection, and the improvement should last for 2 to 6 weeks. Once your condition has improved, the medicine will last about 3 months, then the effects of the medicine will slowly go away. You might need more injections when the effects of the medicine wear off. The recommended re-treatment schedule for chronic migraine is every 12 weeks.

This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor if you have any questions.

Your doctor will only use onabotulinumtoxinA (Botox® or Botox® Cosmetic) to treat your condition. Other botulinum toxin products may not work the same way and require a different dose.

Precautions

It is very important that your doctor check your or your child's progress at regular visits. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to receive it. Blood and urine tests may be needed to check for unwanted effects.

Serious muscle reactions have occurred within hours to weeks after receiving this medicine. If you start to have muscle weakness, loss of bladder control, or trouble with swallowing, talking, or breathing, call your doctor right away. In some patients, these problems could be life-threatening and may require an immediate treatment in a hospital or clinic.

This medicine may make your muscles weak and cause vision problems (eg, bleeding inside the eye). Do not drive or do anything else that could be dangerous until you know how this medicine affects you.

This medicine may reduce blinking of the eye which can lead to an increased risk of eye problems (eg, corneal exposure and ulcers). Tell your doctor right away if you have a reduced blinking of the eye.

This medicine may cause serious allergic reactions, including anaphylaxis, which can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash, itching, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth while you are receiving this medicine.

After you have received this medicine and your vision or muscle spasms are better, you may find that you are a lot more active than you were before. You should slowly increase your activities to allow time for your body to get stronger. Also, before you start an exercise program, check with your doctor.

This medicine may increase your chances of having bronchitis or upper respiratory tract infections when given for upper limb spasticity. Tell your doctor right away if you have trouble breathing, sneezing, sore throat, coughing, or a fever.

This medicine may cause a condition called autonomic dysreflexia in patients with nervous system disorders (eg, spinal cord injury). It can be a life-threatening condition and requires immediate medical attention. Call your doctor right away if you have headache, increased sweating, slow heartbeat, warmth or redness in your face, neck, or arm, or have problems in urinating while using this medicine.

This medicine is made from donated human blood. Some human blood products have transmitted viruses to people who have received them, although the risk is low. Human donors and donated blood are both tested for viruses to keep the transmission risk low. Talk with your doctor about this risk if you are concerned.

Check with your doctor right away if you have difficulty urinating or a burning sensation while urinating after receiving this medicine.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

1. Difficulty with swallowing

Rare

1. Difficulty with breathing or speaking
2. muscle weakness

More common—for blepharospasm

1. Dryness of the eyes
2. inability to close the eyelids completely

More common—for upper limb spasticity

1. Body aches or pain
2. chills
3. cough
4. ear congestion
5. fever
6. headache
7. loss of voice
8. runny or stuffy nose
9. sneezing
10. sore throat
11. unusual tiredness or weakness

More common—for urinary incontinence caused by an overactive bladder

1. Bladder pain
2. bloody or cloudy urine
3. difficult, burning, or painful urination
4. frequent urge to urinate
5. lower back or side pain

Less common—for blepharospasm

1. Decreased blinking
2. irritation of the cornea (colored portion) of the eyes
3. turning outward or inward of the edge of the eyelids

Less common—for forehead lines

1. Drooping of the brows and upper eyelids

Less common—for glabellar lines

1. Drooping of the upper eyelid
2. facial pain
3. muscle weakness
4. partial or slight paralysis of the face

Less common—for lateral canthal lines

1. Swelling of the eyelids

Less common—for upper limb spasticity

1. Cough producing mucus
2. difficulty breathing
3. muscle weakness
4. nausea
5. seizures
6. tightness in the chest
7. weakness

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common—for blepharospasm

1. Blue or purplish bruise on the eyelids
2. drooping of the upper eyelids
3. irritation or watering of the eyes
4. sensitivity of the eyes to light

More common—for cervical dystonia

1. Body aches or pain
2. chills
3. cough
4. ear congestion
5. fever
6. headache
7. loss of voice
8. neck pain
9. runny or stuffy nose
10. sneezing
11. sore throat
12. unusual tiredness or weakness

More common—for chronic migraine

1. Neck pain

More common—for forehead lines

1. Headache

More common—for hyperhidrosis

1. Body aches or pain
2. chills
3. congestion
4. cough
5. diarrhea
6. dryness or soreness of the throat
7. fear
8. fever
9. general feeling of discomfort or illness
10. headache
11. heavy bleeding from the place where the shot was given
12. itching skin
13. joint pain
14. loss of appetite
15. nausea
16. nervousness
17. painful or difficult urination
18. runny nose
19. shivering
20. sweating
21. tender, swollen glands in the neck
22. trouble sleeping
23. trouble swallowing
24. voice changes
25. vomiting

More common—for strabismus

1. Drooping of the upper eyelid
2. eye pointing upward or downward instead of straight ahead

More common—for upper limb spasticity

1. Pain in the arms

Less common—for blepharospasm

1. Skin rash
2. swelling of the skin of the eyelid

Less common—for chronic migraine

1. Bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site
2. blurred vision
3. body aches or pain
4. cough producing mucus
5. difficulty with breathing
6. dizziness
7. drooping of the upper eyelid
8. headache
9. muscle aches and pains
10. nervousness
11. pounding in the ears
12. slow or fast heartbeat
13. tightness in the chest

Less common—for forehead lines

1. Skin tightness

Less common—for lower limb spasticity

1. Back pain
2. body aches or pain
3. chills
4. cough
5. difficulty with breathing
6. ear congestion
7. fever
8. headache
9. loss of voice
10. sneezing
11. sore throat
12. stuffy nose
13. unusual tiredness or weakness

Less common—for strabismus

1. Difficulty finding the location of objects
2. double vision

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Portions of this document last updated: April 01, 2024

Original article: https://www.mayoclinic.org/ar/drugs-supplements/onabotulinumtoxina-injection-route-intradermal-route-intramuscular-route/side-effects/drg-20068101