Proper Dose, Preparation, and Storage of Botulinum Neurotoxin Serotype A

Abstract

The proper dose, preparation, and storage of the formulation of botulinum neurotoxin serotype A (botulinum toxin type A) that is available in the United States (Botox) are described. The recommended dose of botulinum toxin type A varies widely from 1.25 Units to 100 Units, depending on the site. Small initial doses are used for patients without previous treatment with botulinum toxin. Repeat injections often are required, and subsequent doses should be individualized based on response. Larger repeat doses often are used when the response to initial doses is insufficient. An antitoxin is available in the event of accidental poisoning. Botulinum toxin type A is reconstituted with preservative-free 0.9% sodium chloride. Therefore, it should be stored in a refrigerator and discarded if more than four hours elapse after reconstitution. The safe and effective use of botulinum toxin type A requires the proper dose, preparation, and storage by trained personnel only.