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 post-injection 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).
Even if Botox's mechanism isn't always well understood and some of its off-label uses are still unproven, interest in the drug isn't likely to wane. "Botox is a big cash cow for the physicians' practices," says Ronny Gal, an investment analyst at Sanford C. Bernstein who has watched the drug closely for more than a decade. "When I talk to physicians, they say, 'Botox is not a problem. It works and gives you the result you want.' If it works for depression and atrial fibrillation, it could be massive."
Botox is said to decrease the frequency of migraine days by an average of 50 percent for those who suffer chronically (people who experience 15 or more headache days per month). After going through hell with my insurance to get approval, I scheduled an appointment with New York City neurologist and pain-management specialist Risa Ravitz. She was kind enough to speak with me about the wonders of Botox while we did my first procedure in June 2017.
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On April 6, 2016, the company announced it would partner with Heptares Therapeutics in a deal valued up to $3.3 billion to collaborate on the development of a subtype-selective muscarinic agonists for Alzheimer's disease and other major neurological disorders.[21] On April 21, the company announced the acquisition of Topokine Therapeutics for at least $85 million, gaining the phase IIb/III compound XAF5 - a treatment for dermatochalasis.[22] On August 2, the company sold its generic drugs business to Teva Pharmaceutical Industries for $33.4 billion and 100.3 million shares of Teva.[23] On August 11, the company announced the acquisition of ForSight VISION5 for more than $95 million.[24] On September 6, the company acquired RetroSense Therapeutics for more than $60 million, gaining the positive photosensitivity gene therapy treatment, RST-001. RST-001 is to be used in retinas in which rod and cone photoreceptors have degenerated over time, causing in increase in the sensitivity of light hitting the retina.[25] On September 20, the company announced the acquisition of Tobira Therapeutics for $1.695 billion[26] and, a day later, the acquisition of Akarna Therapeutics for $50 million.[27] On October 3, the company sold Anda, its generic drug distribution business, to Teva for $500 million.[28] On October 25, the company acquired Vitae Pharmaceuticals, focused on dermatology treatments, for $639 million.[29] On October 27, the company announced it would acquire Motus Therapeutics, a developer of treatments for gastrointestinal disorders, for $200 million.[30] On November 22, 2016, the company acquired Chase Pharmaceuticals for an upfront payment of $125 million.[31]
Safety and effectiveness of BOTOX® have not been established for the treatment of other upper or lower limb muscle groups or for the treatment of spasticity in pediatric patients under age 18 years. BOTOX® has not been shown to improve upper extremity functional abilities, or range of motion at a joint affected by a fixed contracture. Treatment with BOTOX® is not intended to substitute for usual standard of care rehabilitation regimens.
At the recent American Headache Society meeting in Washington DC, Allergan invested heavily in educating the board-certified headache physicians on the most effective injection sites and methods for Chronic Migraine patients. Find one here. Were I to repeat Botox for Migraine, I would absolutely find one of those Allergan-trained doctors and ask them exactly how many Botox for Migraine procedures they’d done.
Around The Eyes – It is common to see wrinkles and creases around your eyes, as the muscles around your eyes are constantly contracting when you talk or smile. The crow’s feet that have formed on the corner of your eyes can be effectively reduced with the help of Botox.  Moreover, a Botox can help diminish the fine creases that have formed under your eyes.

Patients with compromised respiratory status treated with BOTOX for spasticity should be monitored closely. In a double-blind, placebo-controlled, parallel group study in patients treated for upper limb spasticity with stable reduced pulmonary function (defined as FEV1 40-80% of predicted value and FEV1/FVC ≤0.75), the event rate in change of Forced Vital Capacity (FVC) ≥15% or ≥20% was generally greater in patients treated with BOTOX than in patients treated with placebo (see Table 5).


BOTOX (onabotulinumtoxinA) for injection is a sterile, vacuum-dried purified botulinum toxin type A, produced from fermentation of Hall strain Clostridium botulinum type A, and intended for intramuscular, intradetrusor and intradermal use. It is purified from the culture solution by dialysis and a series of acid precipitations to a complex consisting of the neurotoxin, and several accessory proteins. The complex is dissolved in sterile sodium chloride solution containing Albumin Human and is sterile filtered (0.2 microns) prior to filling and vacuum-drying.
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
When my babies were little, I never discussed migraine with them. As they grew into preschool and elementary age, I found it necessary to explain it to them.  They had seen me experience migraine symptoms for a long time but understood it as just being sick. We went to a migraine walk where we talked about how others cope like I do, and they heard other stories that were similar to mine. They felt empowered that we had fundraised for a disease that affects millions and that we were fighting it as a family and community. My children want to help. Having ways they can help builds their confidence in their ability to take care of me, as I do them. They know to turn the lights off, get ice and talk quietly. I have taught them how to be self-sufficient. I’m so proud of how they take care of themselves and are willing to take care of others. The qualities that they’re learning and displaying will carry them through life.
Botox comes as a crystalline substance from the manufacturer, which then has to be reconstituted with saline or another liquid. Practitioners add varying amounts of liquid when reconstituting it. Although there is no right or wrong amount of liquid to add, most physicians add about 2 mL-3 mL (about a half a teaspoon) of liquid to each vial. Some add quite a bit more, which can lead patients to think they are getting more Botox when, in reality, they are getting the same or less amount of Botox than samples reconstituted in a stronger way. It is the total dose of medication, not the volume of liquid, that leads to the desired effect.
Sarah of My Migraine Life is a mom living with chronic migraine and daily headaches who has tried a gamete of medications, alternative therapies and lifestyle changes. These experiences led her to write “My Migraine Life,” a website for people living with migraine and their caretakers devoted to telling stories, raising awareness, giving support, product reviews and more. My Migraine Life is a partner of the American Migraine Foundation.
Since then, several randomized control trials have shown botulinum toxin type A to improve headache symptoms and quality of life when used prophylactically for patients with chronic migraine[88] who exhibit headache characteristics consistent with: pressure perceived from outside source, shorter total duration of chronic migraines (<30 years), "detoxification" of patients with coexisting chronic daily headache due to medication overuse, and no current history of other preventive headache medications.[89]

The needle should be inserted approximately 2 mm into the detrusor, and 20 injections of 0.5 mL each (total volume of 10 mL) should be spaced approximately 1 cm apart (see Figure 1). For the final injection, approximately 1 mL of sterile normal saline should be injected so that the remaining BOTOX in the needle is delivered to the bladder. After the injections are given, patients shou ld demonstrate their ability to void prior to leaving the clinic. The patient should be obser ved for at least 30 minutes post-injection and until a spontaneous void has occurred.
In study 2, 320 adults with bilateral axillary primary hyperhidrosis were randomized to receive either 50 Units of BOTOX (n=2 42) or placebo (n=78). Treatment responders were defined as subjects showing at least a 50% reduction from baseline in axillary sweating measured by gravimetric measurement at 4 weeks. At week 4 post-injection, the percentages of responders were 91% (219/242) in the BOTOX group and 36% (28/78) in the placebo group, p<0.001. The difference in percentage of responders between BOTOX and placebo was 55% (95% CI=43.3, 65.9).
BOTOX, highly diluted botulinium toxin, works to prevent migraine by blocking the release of a chemical in muscle cells that transmits the signal to contract to muscle fibers. Research into using BOTOX to treat migraines began after patients receiving it for other conditions reported improvement in their migraine symptoms. In 2010, after years of research and collecting clinical data, the FDA approved BOTOX for treating chronic migraines.

There's been a pivotal shift in how women in their 20s look at their faces. And while the reasons are arguably as multi-faceted as this new generation itself, many would agree on one thing: The impact of social media, from selfies to YouTube videos to meticulously crafted Snapchat and Insta Stories, combined with endlessly retouched photographs in magazines and ad campaigns, can not be underestimated. From the constant stream of supernaturally smooth jawlines and chiseled cheekbones to celebrity plastic surgeons posting before-and-after images of their work, the age of 24/7 self-documentation has spurred a novel set of beauty ideals—and, with it, a dramatic increase in cosmetic procedures. For 20-somethings, there's no treatment more popular—or controversial—than Botox. Need proof? According to the American Society of Plastic Surgeons, botulinum toxin procedures have increased 28 percent since 2010 amongst 20 to 29-year-olds.
Tell your doctor about all your medical conditions, including if you: have or have had bleeding problems; have plans to have surgery; had surgery on your face; weakness of forehead muscles; trouble raising your eyebrows; drooping eyelids; any other abnormal facial change; are pregnant or plan to become pregnant (it is not known if BOTOX® can harm your unborn baby); are breastfeeding or plan to (it is not known if BOTOX® passes into breast milk).

Botox is so commonplace these days that you can get it done at some gyms and spas, but in these cases, you never know what you’re getting, how old the product is, with what it's mixed, and whether the injector knows what he or she is doing. Dr. Matarasso suggests only getting it done by what he calls the “core four”: a board-certified physician who is either a dermatologist, a plastic surgeon, an ear-nose-and-throat doctor, or an ophthalmologist.
The recommended dilution is 200 Units/4 mL or 100 Units/2 mL with preservative -free 0.9% Sodium Chloride Injection, USP (see Table 1). The lowest recommended starting dose should be used, and no more than 50 Units p er site should generally be administered. An appropriately sized needle (e.g., 25-30 gauge) may be used for superficial muscles, and a longer 22 gauge needle may be used for deeper musculature. Localization of the involved muscles with techniques such as needle electromyographic guidance or nerve stimulation is recommended.
Even if Botox's mechanism isn't always well understood and some of its off-label uses are still unproven, interest in the drug isn't likely to wane. "Botox is a big cash cow for the physicians' practices," says Ronny Gal, an investment analyst at Sanford C. Bernstein who has watched the drug closely for more than a decade. "When I talk to physicians, they say, 'Botox is not a problem. It works and gives you the result you want.' If it works for depression and atrial fibrillation, it could be massive."
Temporary bruising is the most common side effect of Botox. Headaches, which resolve in 24-48 hours, can occur, but this is rare. A small percentage of patients may develop eyelid drooping. This usually resolves in three weeks. This usually happens when the Botox moves around so you shouldn't rub the treated area for 12 hours after injection or lay down for three to four hours.
BOTOX is indicated for the treatment of upper limb spasticity in adult patients, to decrease the severity of increased muscle tone in elbow flexors (biceps), wrist flexors (flexor carpi radialis and flexor carpi ulnaris) , finger flexors (flexor digitorum profundus and flexor digitorum sublimis), and thumb flexors (adductor pollicis and flexor pollicis longus).

But for some conditions, step therapy can be downright harmful. In a 2016 op-ed in The Boston Globe, a patient with ulcerative colitis wrote that his health insurance forced him to try a cheaper treatment for six months, instead of the pricier meds his doctor wanted to prescribe. In those six months, his colon deteriorated so badly it had to be removed.
“Most people in their twenties decide to try Botox simply because they want to enhance their appearance, such as relaxing the muscles in their forehead, or because they want to keep their skin looking fresh and young,” Shah says. “Starting earlier is better than later because as the lines get more and more embedded into the skin, Botox is not as effective in eliminating the lines.”
There has not been a confirmed serious case of spread of toxin effect away from the injection site when BOTOX® has been used at the recommended dose to treat chronic migraine, severe underarm sweating, blepharospasm, strabismus, or when BOTOX® Cosmetic has been used at the recommended dose to treat frown lines, crow’s feet lines, and/or forehead lines.
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