5 Botox Interactions: Antibiotics, Muscle Relaxants, and More

Botox (onabotulinumtoxinA) is widely used for cosmetic and medical purposes. Examples include reducing wrinkles and preventing migraine headaches. Botox is injected into specific areas. But it can still interact with certain medications and substances.

These interactions aren’t common. But they can increase the risk of side effects, especially those related to muscle function. Knowing what to watch for can help you use Botox safely.

Botox interactions at a glance

Botox can interact with medications that affect how nerves communicate with muscles. These interactions may amplify Botox’s effects and increase the risk of unwanted muscle weakness.

Common Botox interactions include:

• Certain antibiotics, such as gentamicin and tobramycin (Tobi)

• Muscle relaxants, such as baclofen, carbamazepine, and tizanidine

• Anticholinergic medications, such as oxybutynin and diphenhydramine (Benadryl)

• Neuromuscular-blocking agents (used during surgery)

• Cyclosporine (Neoral, Sandimmune)

Let’s look at five of these interactions and how to manage them.

1. Certain antibiotics

Some antibiotics, especially aminoglycosides such as gentamicin or tobramycin, can interact with Botox. These antibiotics affect how nerves signal muscles, similar to how Botox works. When used with Botox, they can enhance Botox’s muscle-weaking effects. This may increase the risk of side effects such as:

• Excessive muscle weakness

• Drooping eyelids

• Trouble swallowing or breathing (in severe cases)

Before receiving Botox, tell a healthcare professional if you’re taking an antibiotic. They may recommend delaying Botox treatment until you finish your antibiotic course.

2. Muscle relaxants

Muscle relaxants such as baclofen, cyclobenzaprine, and tizanidine can also interact with Botox. Both Botox and these medications reduce muscle activity. Using them together can cause additive effects, leading to more muscle weakness than intended.

But this combination doesn’t need to be avoided entirely. In fact, Botox may be used alongside muscle relaxants in certain situations, such as with treating spasticity from cerebral palsy. A healthcare professional can determine if this combination is appropriate and whether dose or timing adjustments are needed.

3. Anticholinergic medications

Anticholinergic medications, such as diphenhydramine and oxybutynin, can also interact with Botox. Using Botox with them may enhance their anticholinergic side effects, such as dry mouth, blurred vision, and constipation.

This combination is often still safe for many people. But your healthcare team may monitor you more closely or recommend adjusting doses if side effects become bothersome.

4. Neuromuscular-blocking agents (used during surgery)

Neuromuscular-blocking agents, such as rocuronium and vecuronium, are used during anesthesia to temporarily relax muscles. Using Botox with them may increase the risk of unexpected or exaggerated weakness and can complicate monitoring during surgery.

If you’ve had Botox recently, tell your surgical team before your procedure. Botox can affect how your muscles respond. It may also interfere with the monitoring anesthesiologists use during surgery. Because of that, an anesthesiologist may adjust your medications or monitoring.

5. Cyclosporine

Cyclosporine is an immunosuppressant medication used for health conditions such as organ transplants and autoimmune disorders. It may interact with Botox, leading to more significant muscle weakness. There have also been rare reports of respiratory failure with this combination.

If you’re taking cyclosporine, tell your healthcare professional before receiving Botox. They may adjust your treatment plan if needed.

Can you use Botox and Dysport together?

Possibly, but it depends on the situation. Botox and Dysport (abobotulinumtoxinA) are both botulinum toxin products. But they haven’t been studied together. Combining them may increase the risk of side effects. These include muscle weakness and spreading of the toxin’s effects.

That said, some healthcare professionals may use both for specific treatment goals. For example, Botox is more concentrated. So it may be preferred for smaller, targeted areas, such as crow’s feet. Dysport tends to spread more easily, which can make it useful for larger areas. If both are used, it should be done only under the guidance of a healthcare professional.

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Written by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

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