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Brand Name
Common Name
botulinum toxin type A
How does this medication work? What will it do for me?

Botulinum toxin is a neuromuscular paralytic agent. It blocks the nerves that are responsible for muscle activity and helps to relax muscles that are in constant contraction (spasm). It is used to treat conditions that are caused by certain muscles going into spasm. These include:

  • blepharospasm, a condition where the eyelid will not stay open because of a spasm of a muscle in the eye
  • cervical dystonia, also known as spasmodic torticollis, a condition in which the muscles of the neck stay in a state of contraction
  • focal spasticity such as arm spasms after a stroke
  • chronic drooling (sialorrhea) caused by nerve disorders

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are being given this medication, speak to your doctor. Do not stop receiving this medication without consulting your doctor.

How should I use this medication?

Botulinum toxin is injected into a muscle by a qualified health professional. When given for conditions of the eye, the medication is injected into the surrounding muscle or tissue of the eye.

The dose of medication required depends on the condition being treated and individual circumstances. More than one dose may be required, depending on the condition being treated. Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications.

It is important this medication be given exactly as recommended by your doctor. If you miss an appointment to receive botulinum toxin, contact your doctor as soon as possible to reschedule your appointment. It is very important to keep your appointments for treatment and follow-up.

The dried product should be stored at room temperature (up to 25°C). Once reconstituted, it may be stored in a refrigerator at 2°C to 8°C for up to 24 hours. This medication should be kept out of the reach of children.

What form(s) does this medication come in?

50 Units
Each vial of sterile, white, preservative-free powder for solution for injection contains 50 LD50 Units of incobotulinumtoxinA (Clostridium botulinum neurotoxin type A). Nonmedicinal ingredients: sucrose and human serum albumin.

100 Units
Each vial of sterile, white, preservative-free powder for solution for injection contains 100 LD50 Units of incobotulinumtoxinA (Clostridium botulinum neurotoxin type A). Nonmedicinal ingredients: sucrose and human serum albumin.

Who should NOT take this medication?

Do not take botulinum toxin if you:

  • are sensitive or allergic to botulinum toxin or to any of the ingredients of this medication
  • have an infection at the site the injection is to be given
  • have myasthenia gravis, amyotrophic lateral sclerosis, or Eaton Lambert syndrome
What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

General side effects:

  • pain, tenderness, or bruising at the place of injection

When used for blepharospasm:

  • difficulty swallowing
  • drooping of the upper eyelid
  • double or blurred vision
  • dry eye
  • dry mouth
  • eye pain
  • headache
  • irritation or watering of the eye
  • nausea
  • not able to close the eye completely
  • sensitivity of the eye to light
  • speech problems
  • swelling of the eyelid
  • tiredness
  • vision impairment

When used for cervical dystonia:

  • difficulty swallowing
  • dizziness
  • dry mouth
  • flu symptoms
  • headache
  • local or general weakness
  • muscle spasms, stiffness, or weakness
  • nausea
  • neck weakness

When used for focal spasticity:

  • decreased coordination
  • difficulty swallowing
  • feeling of "pins and needles"
  • fever
  • flu symptoms
  • headache
  • increased sensitivity to touch
  • itching
  • joint pain
  • muscle tightness or weakness
  • nausea
  • pain in the affected limb (arm or leg)

When used for chronic drooling (sialorrhea)

  • changed sense of taste
  • difficulty swallowing
  • dry mouth
  • feeling of pins and needles
  • speech problems
  • thickened saliva

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • difficult or painful swallowing, dizziness, shortness of breath, or vision changes facial paralysis or persistent eye irritation or pain (when used for eye conditions)
  • falling (when used for spasticity due to cerebral palsy)
  • fever, especially when accompanied by coughing and shortness of breath
  • irregular heartbeat
  • shortness of breath
  • skin rash
  • symptoms of a urinary tract infection (e.g. pain when urinating, urinating more often than usual, low back or flank pain)

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • breathing problems
  • difficulty swallowing
  • muscle weakness
  • peeling or blistering skin
  • seizures
  • signs of an allergic reaction (e.g., hives; difficulty breathing; swelling of the mouth, tongue, or throat)
  • signs of a heart attack (e.g., chest pain or pressure; shortness of breath; jaw, shoulder, or arm pain; nausea; lightheadedness; sweating)
  • speech problems

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are using this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Angle-closure glaucoma: Botulinum toxin can cause angle-closure glaucoma in those at risk. Your doctor will monitor for this if necessary. If you have glaucoma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Distant toxin spread: Very rarely, this medication may spread to other parts of the body other than where it was injected, leading to muscle weakness, difficulty swallowing, pneumonia, speech difficulties, and breathing problems. Distant toxin spread can be fatal. If you develop severe difficulty swallowing, speaking, or breathing while using this medication, contact your doctor immediately.

Heart disease: Botulinum toxin has rarely been reported to cause arrhythmia and heart attack. People with heart conditions may be at increased risk of irregular heartbeat or heart attack. If you have a heart condition, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Other medical conditions: People with certain nerve or muscle disorders are at increased risk of developing serious side effects, such as difficulty swallowing or breathing. If you have amyotrophic lateral sclerosis, any disorder that produces a depletion of acetylcholine, or disorders that produce peripheral neuromuscular dysfunction, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while receiving this medication, contact your doctor immediately.

Breast-feeding: It is not known if botulinum toxin passes into breast milk. If you are a breast-feeding mother and are receiving this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this have not been established for children under 18 years of age.

What other drugs could interact with this medication?

There may be an interaction between botulinum toxin type A and any of the following:

  • aclidinium
  • aminoglycoside antibiotics (e.g., gentamicin, neomycin, tobramycin, streptomycin)
  • amoxapine
  • antihistamines (e.g., brompheniramine, diphenhydramine)
  • antipsychotics (e.g. clozapine, olanzapine, risperidone)
  • atropine
  • azelastine
  • belladonna
  • benztropine
  • clidinium
  • darifenacin
  • disopyramide
  • flavoxate
  • glycopyrrolate
  • ipratropium
  • monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
  • muscle relaxants (e.g., cyclobenzaprine, orphenadrine)
  • oxybutynin
  • quinidine
  • scopolamine
  • solifenacin
  • tiotropium
  • tolterodine
  • tricyclic antidepressants (e.g., amitriptyline, clomipramine, imipramine)
  • trospium
  • umeclidinium

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. In many cases, interactions are intended or are managed by close monitoring. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

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