Postmarketing Experience: The following adverse reactions have been identified during postapproval use of LATISSE®: dry skin of the eyelid and/or periocular area, eye swelling, eyelid edema, hypersensitivity (local allergic reactions), lacrimation increased, madarosis and trichorrhexis (temporary loss of a few eyelashes to loss of sections of eyelashes, and temporary eyelash breakage, respectively), periorbital and lid changes associated with a deepening of the eyelid sulcus, rash (including macular and erythematous), skin discoloration (periorbital), and vision blurred.

On July 29, 2016, Food and Drug Administration (FDA), of the United States of America approved abobotulinumtoxinA for injection for the treatment of lower limb spasticity in pediatric patients two years of age and older.[20] AbobotulinumtoxinA is the first and only FDA-approved botulinum toxin for the treatment of pediatric lower limb spasticity. In the United States of America, the FDA approves the text of the labels of prescription medicines. The FDA approves which medical conditions the drug manufacturer may sell the drug for. However, those approved by the FDA to prescribe these drugs may freely prescribe them for any condition they wish, called off-label use. Botulinum toxins have been used off-label for several pediatric conditions, including infantile esotropia.[21]

As part of the settlement, Allergan agreed to plead guilty to one criminal misdemeanor misbranding charge and pay $375 million. The company acknowledged that its marketing of Botox led to off-label uses of the drug. Allergan also agreed to pay $225 million to resolve civil charges alleging that the marketing of Botox had caused doctors to file false reimbursement claims, though Allergan denied wrongdoing. The company said in a statement that the settlement was in the best interest of its stockholders because it avoided litigation costs and "permits us to focus our time and resources on ... developing new treatments."


In November, the FDA held a two-day hearing asking for expert comment on the agency's rules concerning off-label drug use and marketing. Some said the practice paves the way for scientific progress and gives doctors and their patients much needed alternatives for hard-to-treat medical conditions. Others said that off-label drug use is primarily financially motivated and that it poses a serious threat to public health, particularly when drugs are used experimentally on children.
The American Migraine Foundation recently launched the American Registry for Migraine Research, or ARMR. ARMR collects information and biospecimens from patients living with migraine and other disorders that cause head pain. ARMR will be used to help health care providers and scientists better understand the causes, characteristics, and management of migraine and other headache types. Anonymized ARMR data will be made available to researchers who apply for access, enhancing the efficiency by which headache research can be conducted. Dr. Todd Schwedt, Professor of Neurology at the Mayo Clinic in Scottsdale, Arizona, and co-principal investigator of ARMR, expands on the registry.
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As with the injection of any medication, your body's immune system can develop antibodies to the medication, which render the drug less effective or possibly cause development of an allergy to the drug. The more frequently the drug is injected or the more quantity that is injected, the higher the risk for these antibodies to be formed against the drug.
In the event of overdose, antitoxin raised against botulinum toxin is available from the Centers for Disease Control and Preventio n (CDC) in Atlanta, GA. However, the antitoxin will not reverse any botulinum toxin-induced effects already apparent by the time of antitoxin administration. In the event of suspected or actual cases of botulinum toxin poisoning, please contact your local o r state Health Department to process a request for antitoxin through the CDC. If you do not receive a response within 30 minutes, please contact the CDC directly at 1-770-488-7100. More information can be obtained at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5232a8.htm.
Three percent of patients experienced eyelid drooping in the frown lines studies, one percent of patients experienced eyelid swelling in the crow's feet studies, and one percent of patients experienced brow drooping in the forehead lines studies. Other possible side effects include: dry mouth; discomfort or pain at the injection site; tiredness; headache; neck pain; eye problems: double vision, blurred vision, decreased eyesight and dry eyes; and allergic reactions. These are not all of the possible serious side effects of BOTOX® Cosmetic. Please see the Important Safety Information including Boxed Warning and Medication Guide and talk to your specialist.

Botox should only be injected with sterile instruments in a doctor's office or a medical spa — not at Botox parties at your local nail salon or neighbor's living room. Botox injection is usually performed with some local anesthesia or a numbing cream. You may feel some minimal discomfort from the shot, but today's needles are so thin and fine that the procedure is often painless. Depending on the extent of treatment, the procedure can take anywhere from a few minutes to 20 minutes.
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Botox only lasts three to six months—and yet what's less commonly discussed is this: Facial muscles naturally weaken over time and going overboard in a certain area could have unwanted consequences. "If you do too much Botox on your forehead for many, many years, the muscles will get weaker and flatter," cautions Wexler, adding that the skin can also appear thinner and looser. Moreover, as your muscles become weaker, they can start to recruit surrounding muscles when you make facial expressions. "If one stops using their forehead muscles, they may start squinting using their nose and have wrinkles along the side of their nose," she explains. Translation: You need even more Botox for the newly recruited muscles, says Wexler. To avoid these kind of missteps, researching a doctor diligently is essential, as is approaching injectables conservatively, and asking questions about how the treatment will be tailored to your needs.
Two double-blind, placebo-controlled, randomized, multi-center clinical studies were conducted in patients with urinary incontinence due to detrusor overactivity associated with a neurologic condition who were either spontaneously voiding or using catheterization (Studies NDO-1 and NDO-2). A total of 691 spinal cord injury (T1 or below) or multiple sclerosis patients, who had an inadequate response to or were intolerant of at least one anticholinergic medication, were enrolled. These patients were randomized to receive either 200 Units of BOTOX (n=227), 300 Units of BOTOX (n=223), or placebo (n=241).
Botox often gets a bad rep for leaving patients looking a little frozen, but that's the fault of bad technique, not necessarily the procedure itself, explains Day. "In many places where it's not a trained aesthetic physician doing the injection, it's really just inject by number," she says. The problem with this is that no two faces, or even two sides of a face, are the same. "That cookie cutter, one-size-fits-all approach is what often gives these treatments a bad name," says Day.
"I had 25 units of Botox done by Dr. Goldberg on my forehead and frown lines. Few days later I could see the result with which I was very happy! [...] I have done Botox few times before with other specialists, after which my face would resemble a doll [...] However, after procedure with Dr. Goldberg, I am still able to lift my eyebrows and frown without forming any wrinkles." – from Dinara D.'s review of Alexander Golberg Physician PC in New York.
Galli has been living with migraine for most of her adult life, but recently, her attacks became more severe and frequent. “My whole life went upside down and nothing was the same,” Galli says, upon being diagnosed with chronic migraine. “The person I used to be wasn't there anymore. I didn't even recognize myself.” To cope with the symptoms that often accompany chronic migraine, Galli found herself retreating to a dark room, waiting for the pain to pass, but it never did. In response, Galli says, she asked herself what she could do to feel better but also share her story. “Everyone around me that knew how high energy, and how much of a go-getter I am, asked what was happening? Where was that person?” When she came across the announcement of the Migraine Moment Film Contest, she saw it as her opportunity to bring awareness about what it is like to live with migraine and bust the misconceptions surrounding this invisible disease. Enter: “Invisible Hero.”
There are no data on the presence of BOTOX in human or animal milk, the effects on the breastfed child, or the effects on milk production. The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for BOTOX and any potential adverse effects on the breastfed infant from BOTOX or from the underlying maternal conditions.
An injection of BOTOX is prepared by drawing into an appropriately sized sterile syringe an amount of the properly reconstituted toxin slightly greater than the intended dose. Air bubbles in the syringe barrel are expelled and the syringe is attached to an appropriate injection needle. Patency of the needle should be confirmed. A new, sterile needle and syringe should be used to enter the vial on each occasion for removal of BOTOX.
A migraine requires only two of the following headache features: a unilateral distribution (one-sided), pulsatile quality (throbbing), moderate or severe pain (more than 5 out of 10), and aggravation by physical activity (such as bending over). In addition, to diagnose migraine, only one of the following is required: nausea or vomiting or sensitivity to light and noise.
In recent years, a number of high-profile lawsuits have been brought against Allergan in which plaintiffs claimed that off-label uses--for ailments including a child's cerebral-palsy symptoms, for instance, or an adult's hand tremors--resulted in lasting deleterious side effects. Still, the drug's acceptance in a growing number of doctors' offices worldwide, and its revenue growth, show no signs of slowing.
CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.
Galli’s winning film presents herself, and people with migraine, as superheroes, living with a secret identity: migraine. “Other than me laying down on my couch, and knowing what's going on inside my body, nobody sees what's happening,” she says. “It's all happening inside. It's like that same struggle that superheroes have.” The migraine symptoms are superpowers, albeit ones that you don’t want. When her migraine attacks first began, Galli recalls an increased sensitivity to sound, odors, light and “all these things that feel not normal.” Many people with migraine are fighting the disease on their own, because their peers can’t relate to what their feeling on a daily basis. “It's time that we create better awareness and we tell the world that no, we don't need to be alone,” she says. “We don't need to fight alone and hide in the dark.” The film, she hopes, will add to the conversation and bring this disease out of the shadows. For the more than 37 million Americans living with migraine, Galli says: “You’re all superheroes. I hear you, I feel you.”

Ray Chester, an attorney in Austin who has represented several plaintiffs in lawsuits against Allergan, says that just about all the cases he has handled involved off-label use of the drug. In 2014 a New York couple argued that Botox, which they chose to try off-label to treat their son's cerebral-palsy symptoms, caused life-threatening complications. The family was awarded $6.75 million by a jury. Allergan, which initially planned to appeal, ended up privately settling the case with the family, and the terms of the settlement have been kept confidential.
Strabismus is caused by imbalances in the actions of muscles that rotate the eyes, and can sometimes be relieved by weakening a muscle that pulls too strongly, or pulls against one that has been weakened by disease or trauma. Muscles weakened by toxin injection recover from paralysis after several months, so it might seem that injection would then need to be repeated. However, muscles adapt to the lengths at which they are chronically held,[18] so that if a paralyzed muscle is stretched by its antagonist, it grows longer, while the antagonist shortens, yielding a permanent effect. If there is good binocular vision, the brain mechanism of motor fusion, which aligns the eyes on a target visible to both, can stabilize the corrected alignment.
In clinical trials, 30.6% of patients (33/108) who were not using clean intermittent catheterization (CIC) prior to injection, required catheterization for urinary retention following treatment with BOTOX® 200 Units as compared to 6.7% of patients (7/104) treated with placebo. The median duration of postinjection catheterization for these patients treated with BOTOX® 200 Units (n = 33) was 289 days (minimum 1 day to maximum 530 days) as compared to a median duration of 358 days (minimum 2 days to maximum 379 days) for patients receiving placebo (n = 7).

Investors have been unhappy with Allergan's stock performance over the last year, and some have expressed interest in seeing the pharma company explore splitting up. On Wednesday, Allergan announced it plans to sell its women's health and infectious disease businesses. The news sent Allergan's stock down 2%, suggesting the move didn't go as far as some would like.


When you choose BOTOX® Cosmetic, you can trust in its established track record. Backed by over 15 years of clinical studies, BOTOX® Cosmetic is the most widely researched and studied treatment of its kind, approved for use in 96 countries. The safety and efficacy of BOTOX® Cosmetic has been described in more than 495 peer-reviewed articles in scientific and medical journals.

How Was the Botox Mixed? A factor that many patients are unaware of is that Botox and Dysport come in a powder form that must be mixed with sterile saline to reconstitute the vial. The amount of water that is mixed with the Botox or Dysport can vary and will determine the concentration of the medicine. Some doctors and nurses dilute the powder too much so that the final concentration of Botox or Dysport is weak. So if you go to a provider who advertises a cheap price (for instance below the wholesale price) the injections you may be getting may be very dilute and may not be as effective as a more concentrated (more expensive) injection.
The 3rd Annual Migraine Moment Film Contest received a record-breaking number of film submissions this year. Each film delivered a unique message on living with migraine and how people cope with the symptoms that accompany this debilitating disease. At the 60th Annual Scientific Meeting in San Francisco earlier this year, Maria Galli was announced as the contest’s winner. Her powerful film, Invisible Hero, spoke to her strength and superhero-like qualities in fighting a disease that oftentimes makes her feel isolated and alone. In a recent Facebook Live hosted by the American Foundation, Maria Galli spoke with Dr. Bert Vargas, a Neurologist at UT Southwestern, about her experience living with chronic migraine and her outstanding work. [embed]https://www.facebook.com/americanmigrainefoundation/videos/1616373701807260/[/embed]
Still, there have been enough concerns that the FDA instituted a REMS (Risk Evaluation and Mitigation Strategy) requirement for all botulinum toxin preparations that specifically addresses the issues of distant spread of the toxin and the risk of problems, leading to death, from swallowing or breathing issues in certain patients who may be susceptible after botulinum toxin treatment. All products, including Dysport, Myobloc, Xeomin, and Botox, are monitored via this strategy. This is specifically aimed at a certain population of patients receiving more than the usual doses of botulinum toxin and not aimed at the casual user of Botox, per se.
When women in their 20's first consider getting Botox, prevention is often the primary factor, since the early signs of aging—such as crow's feet, forehead wrinkles, and fine lines—are beginning to show. "Lines get deeper and deeper with age," explains Wexler. "If you start [getting Botox] early enough and it's done properly, you're not going to need [as much] in the future." For younger patients wary of the frozen look—remember, youthful faces move—Wexler likes to employ lower doses of Botox via ultra-targeted micro injections administered on specific areas of the face such as the forehead, brows, or around the eyes.
Richard Clark, a plastic surgeon from Sacramento (CA), was the first to document a cosmetic use for botulinum toxin.[51] He treated forehead asymmetry caused by left sided forehead nerve paralysis that occurred during a cosmetic facelift. Since the injured nerve could possibly regenerate by 24 months, a two-year waiting period was necessary before definitive surgical treatment could be done. Clark realized that botulinum toxin, which had been previously used only for cross eyed babies and facial tics, could also be injected to smooth the wrinkles of the right forehead to match her paralyzed left. He received FDA approval for this cosmetic application of the toxin and successfully treated the person and published the case study in 1989.[51]
Other than that, there don’t seem to be any specific groups of people or health conditions that are contraindicated for Botox injections. As with all treatments, general health guidelines apply. People with a healthy body-mass index who are non-smokers, moderate or non-drinkers, and physically active will nearly always tolerate any type of medical treatment well.
The seven toxin types (A-G) have different tertiary structures and sequence differences.[35][36] While the different toxin types all target members of the SNARE family, different toxin types target different SNARE family members.[34] The A, B, and E serotypes cause human botulism, with the activities of types A and B enduring longest in vivo (from several weeks to months).[35]
My patients who do respond say that it is absolutely worth it. For people who can’t get their headaches under control with the usual medications, or who suffer from problematic side effects from those drugs, Botox can be a great option. For many of my patients, it has reduced their medication needs and restored their ability to function in their jobs and families.
Baby Botox can also be used as an upkeep strategy. "I really think of it as small maintenance doses of Botox over time instead of standard doses given at three- to six-month intervals," says Smith. "The other term that describes this well is 'tweakment' — subtle changes done over a longer period of time using lower doses of product at each treatment."
Not a Botox patient? Listen anyway. This is good practice for asking the price for other medical procedures like an MRI or a colonoscopy, where the information can be much harder to get. The common replies you could get: “What’s your insurance?” “We can’t tell you because it depends on your deductible.” “We don’t know.” “You’ll have to call billing.”
BOTOX® is the brand name of a toxin produced by the bacterium Clostridium botulinum. In large amounts, this toxin can cause a form of muscle paralysis known as botulism, which is usually associated with food poisoning. Even though one of the most serious complications of botulism is paralysis, scientists have discovered a way to use it to human advantage. Small, diluted (weakened) amounts can be directly injected into specific muscles, causing controlled relaxation of the muscles.

Most SkinMedica® products are intended to meet the FDA's definition of a cosmetic product, an article applied to the human body to cleanse, beautify, promote attractiveness, and alter appearances. These SkinMedica® products are not intended to be drug products that diagnose, treat, cure, or prevent any disease or condition. These products have not been approved by the FDA, and the statements have not been evaluated by the FDA.
Receiving Botox injections for migraines is a straightforward outpatient procedure. The skin in the area to be injected is cleaned. Most injections are administered in the forehead area, usually above the eyes or where “worry lines” might occur. Because this area may be sensitive or patients may be experiencing hypersensitivity to pain, a topical anesthetic may be applied before the injection.

After a muscle has been injected, the nerves still send the signal to the muscle to contract, and the acetylcholine is still released, but is unable to bind to the muscle, resulting in a reduction of muscle activity and temporarily preventing contraction of the muscles that cause frown lines. The binding process typically begins within about 48 hours from the time it is injected into the muscle, and results typically become noticeable within 7 to 10 days. While results are often most noticeable in dynamic wrinkles (wrinkles that appear when a muscle contracts), it can also help soften wrinkles that are present even without muscle contraction. If you’re serious about improving the appearance of moderate to severe frown lines, it may be just the right treatment option for you.
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