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Botox

onabotulinumtoxina
Used for Migraine, Spasticity, Overactive Bladder, Excessive Sweating, Cervical Dystonia
Used for Migraine, Spasticity, Overactive Bladder, Excessive Sweating, Cervical Dystonia

Botox (onabotulinumtoxinA) is used for many movement problems, bladder problems, and headache prevention, but it can have dangerous side effects if it spreads to areas outside of the injection area. It's only available as an injection that's administered by a healthcare provider.

Last reviewed on January 18, 2022
basics-icon

What is Botox (onabotulinumtoxinA)?

What is Botox (onabotulinumtoxinA) used for?

  • Overactive bladder (OAB) in adults

  • Loss of bladder control due to nerve problems in people 5 years and older

  • Headache prevention in adults with long-term migraine (headaches lasting 4 hours or longer for 15 or more days per month)

  • Muscle spasms in people 2 years and older

  • Neck spasms in adults

  • Excessive armpit sweating in adults

  • Eyelid twitching in people 12 years and older

  • Crossed eyes in people 12 years and older

How Botox (onabotulinumtoxinA) works

Botox (onabotulinumtoxinA) is a neuromuscular blocker. It's a toxin made from bacteria (Clostridium botulinum) that temporarily lowers muscle activity by stopping a chemical called acetylcholine from being released in your muscle. This is helpful to treat muscle spasms that are caused by many different conditions. Although the way Botox (onabotulinumtoxinA) works to prevent migraine headaches is unclear, it's thought to affect chemicals that cause pain in the brain.

Are you looking for information on Botox Cosmetic (onabotulinumtoxinA) for wrinkles, Xeomin (incobotulinumtoxinA), or Dysport (abobotulinumtoxinA) instead?

Drug Facts

Common BrandsBotox
Drug ClassNeuromuscular blocker
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only

More on Botox (onabotulinumtoxinA) essentials

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What are the side effects of Botox (onabotulinumtoxinA)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

OAB
  • Urinary tract infection (UTI, 18%)
  • Painful urination (9%)
  • Difficulty passing urine (6%)
Loss of bladder control
  • Urinary tract infection (UTI, 24-26% in adults, 7% in children)
  • Urine left in bladder (17% in adults)
  • Difficulty passing urine (15-17% in adults)
  • Bacteria in urine (9% in adults, 20% in children)
  • White blood cells in urine (7% in children)
  • Painful urination (5% in adults)
Migraine prevention in adults
  • Neck pain (9%)
  • Headache (5%)
^*Not a comprehensive list of side effects, as they vary depending on the condition you have. Refer to the source below for more details.^

Other Side Effects

  • Bacteria in urine (OAB)
  • Urine left in bladder (OAB)
  • Blood in urine (loss of bladder control)
  • Difficulty moving parts of the face (migraine prevention)
  • Muscle spasms (migraine prevention)
  • Muscle aches
  • Muscle weakness
  • Feeling stiff
  • Joint pain
  • Nausea
  • Bronchitis
  • Drooping eyelids
  • Eye inflammation
  • Eye dryness
  • Upper respiratory tract infection (e.g., common cold)
  • Pain or redness at injection site

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Trouble breathing or swallowing
  • Serious allergic reaction: trouble breathing, swelling of the lips or tongue, rash

Source: DailyMed

The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

Difficulty with swallowing

Rare

Difficulty with breathing or speaking

muscle weakness

More common—for blepharospasm

Dryness of the eyes

inability to close the eyelids completely

More common—for upper limb spasticity

Body aches or pain

chills

cough

ear congestion

fever

headache

loss of voice

runny or stuffy nose

sneezing

sore throat

unusual tiredness or weakness

More common—for urinary incontinence caused by an overactive bladder

Bladder pain

bloody or cloudy urine

difficult, burning, or painful urination

frequent urge to urinate

lower back or side pain

Less common—for blepharospasm

Decreased blinking

irritation of the cornea (colored portion) of the eyes

turning outward or inward of the edge of the eyelids

Less common—for forehead lines

Drooping of the brows and upper eyelids

Less common—for glabellar lines

Drooping of the upper eyelid

facial pain

muscle weakness

partial or slight paralysis of the face

Less common—for lateral canthal lines

Swelling of the eyelids

Less common—for upper limb spasticity

Cough producing mucus

difficulty breathing

muscle weakness

nausea

seizures

tightness in the chest

weakness

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common—for blepharospasm

Blue or purplish bruise on the eyelids

drooping of the upper eyelids

irritation or watering of the eyes

sensitivity of the eyes to light

More common—for cervical dystonia

Body aches or pain

chills

cough

ear congestion

fever

headache

loss of voice

neck pain

runny or stuffy nose

sneezing

sore throat

unusual tiredness or weakness

More common—for chronic migraine

Neck pain

More common—for forehead lines

Headache

More common—for hyperhidrosis

Body aches or pain

chills

congestion

cough

diarrhea

dryness or soreness of the throat

fear

fever

general feeling of discomfort or illness

headache

heavy bleeding from the place where the shot was given

itching skin

joint pain

loss of appetite

nausea

nervousness

painful or difficult urination

runny nose

shivering

sweating

tender, swollen glands in the neck

trouble sleeping

trouble swallowing

voice changes

vomiting

More common—for strabismus

Drooping of the upper eyelid

eye pointing upward or downward instead of straight ahead

More common—for upper limb spasticity

Pain in the arms

Less common—for blepharospasm

Skin rash

swelling of the skin of the eyelid

Less common—for chronic migraine

Bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site

blurred vision

body aches or pain

cough producing mucus

difficulty with breathing

dizziness

drooping of the upper eyelid

headache

muscle aches and pains

nervousness

pounding in the ears

slow or fast heartbeat

tightness in the chest

Less common—for forehead lines

Skin tightness

Less common—for lower limb spasticity

Back pain

body aches or pain

chills

cough

difficulty with breathing

ear congestion

fever

headache

loss of voice

sneezing

sore throat

stuffy nose

unusual tiredness or weakness

Less common—for strabismus

Difficulty finding the location of objects

double vision

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

pros-and-cons

Pros and cons of Botox (onabotulinumtoxinA)

thumbs-up

Pros

Works well to treat and prevent many different conditions

Might be a good option when other treatments have failed

Injected directly into the affected area(s)

Effects can last many weeks or even months

thumbs-down

Cons

Needs to be injected by a healthcare provider

Injections can be uncomfortable

Has serious risks if the toxin spreads to other parts of your body

Brand only, so might be expensive

faqs

Frequently asked questions about Botox (onabotulinumtoxinA)

What is Botox (onabotulinumtoxinA) used for?
Botox (onabotulinumtoxinA) has many uses. Find out more about some of these uses in this neat article. In addition to treating movement problems, excessive sweating, bladder problems, and preventing headaches, Botox (onabotulinumtoxinA) also comes as a brand known as Botox Cosmetic (onabotulinumtoxinA), which is only used for temporarily improving the appearance of wrinkles. Specifically, Botox Cosmetic is used to treat forehead lines, crow's feet lines around your eyes, and frown lines. The two products can't be interchanged, meaning you can't use Botox Cosmetic (onabotulinumtoxinA) to treat any of the conditions Botox (onabotulinumtoxinA) is approved to treat. Likewise, you can't use Botox (onabotulinumtoxinA) to treat wrinkles. Talk to your provider about which form of Botox is best for you.
Is Botox (onabotulinumtoxinA) safe to use during pregnancy?
There isn't enough information available to know if Botox (onabotulinumtoxinA) is safe to use during pregnancy. In animal studies, Botox (onabotulinumtoxinA) caused harm to pregnant mothers and their unborn babies. If you're currently pregnant, discuss the risks and benefits of this medication with your provider.
Can I use Botox (onabotulinumtoxinA) at home?
No. Botox (onabotulinumtoxinA) is typically injected by a healthcare provider at their office. It's injected into your muscles or between the layers of your skin, depending on what condition you're using the medication for.
How long does Botox (onabotulinumtoxinA) work to treat overactive bladder (OAB), and when can I get another treatment?
Typically, Botox (onabotulinumtoxinA) works to treat frequent urination caused by OAB for around 6 months. It's recommended to wait at least 3 months (12 weeks) from your last bladder injection before getting your next injection.
Is Botox (onabotulinumtoxinA) used to treat migraine headaches?
No, Botox (onabotulinumtoxinA) is not approved to treat headache or migraine symptoms. Botox (onabotulinumtoxinA) is only approved to prevent headaches in adults with long-term migraine (headaches lasting at least 4 hours on 15 or more days per month).
How often can I get Botox (onabotulinumtoxinA) to prevent migraine headaches, and how well does it work?
Botox (onabotulinumtoxinA) treatments are given every 3 months (12 weeks) for the prevention of migraine headaches in adults with long-term migraine (headaches lasting at least 4 hours on 15 or more days per month). Each treatment session typically takes about 10 to 20 minutes. Botox (onabotulinumtoxinA) has been shown to prevent 8 to 9 headache days a month.
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What are the risks and warnings for Botox (onabotulinumtoxinA)?

Botox (onabotulinumtoxinA) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

risk-warning

Spread of toxin effects

  • Risk factors: Children | History of muscle, eye, or lung conditions

    Botox (onabotulinumtoxinA) has been linked to spreading to other body areas outside of the injection site and cause toxic effects, occurring hours to weeks after receiving the medication. This can cause serious side effects, such as unexplained muscle weakness, drooping eyelids, blurred or double vision, breathing or swallowing difficulty, slurred speech or trouble speaking, or the need to urinate more frequently. If you notice any of these side effects, seek medical help right away.

    risk-warning

    Serious allergic reaction

    Serious allergic reactions, such as anaphylaxis (closing of the throat), have been reported after using Botox (onabotulinumtoxinA). If you experience trouble breathing, swelling anywhere in your body, or rash, call 911 or seek medical attention immediately. Don't use Botox (onabotulinumtoxinA) again if you experience any of these symptoms.

    risk-warning

    Higher risk of side effects

    • Risk factors: History of certain muscle-nerve conditions

      People with certain muscle-nerve conditions (e.g., myasthenia gravis) have a higher risk of experiencing serious side effects from Botox (onabotulinumtoxinA). These effects include muscle weakness anywhere in the body, blurry vision, drooping eyelids, and trouble speaking, eating, drinking, or breathing. If you experience any of these side effects, seek medical help right away. Make sure to discuss your full medical history with your provider before using Botox (onabotulinumtoxinA).

      risk-warning

      Difficulty swallowing or breathing

      • Risk factors: History of swallowing or breathing problems | Myasthenia gravis | Lambert-Eaton syndrome | Current muscle-nerve conditions | Small neck muscles | Using Botox (onabotulinumtoxinA) in certain muscles

        Botox (onabotulinumtoxinA) can cause life-threatening problems with swallowing or breathing by weakening muscles involved in these functions, occurring hours to weeks after receiving Botox (onabotulinumtoxinA). These effects can last for many months. Your risk is higher if you have certain conditions affecting your muscles or nerves, history of breathing or swallowing problems, small neck muscles, or if you're getting Botox (onabotulinumtoxinA) injected into certain muscles (e.g., sternocleidomastoid muscle). In people being treated for spasms, bronchitis and upper respiratory tract infections (e.g., common cold) were seen as side effects. These conditions can make it more difficult to breathe. If you experience trouble breathing, eating, or swallowing, seek medical help right away. If you have a history of swallowing or breathing problems, let your provider know before receiving Botox (onabotulinumtoxinA).

        risk-warning

        Reduced blinking and eye bleeding

        • Risk factors: Previous eye surgery | Certain nerve problems | Using Botox (onabotulinumtoxinA) for eye conditions

          Injecting Botox (onabotulinumtoxinA) in or near the eyelid muscle leads to reduced blinking, which can lead to eye problems like ulcers in your eye. You're at a higher risk if you have a history of eye surgery or certain nerve problems. Your provider will make sure your eyes are okay and may prescribe an ointment or special contact lenses to protect your eyes if there are any problems. Rarely, Botox (onabotulinumtoxinA) can also cause serious bleeding in your eyes. Let your provider know right away if you experience any vision changes after getting your injection.

          risk-warning

          Abnormal overreaction of your nervous system (autonomic dysreflexia)

          • Risk factors: Treatment of loss of bladder control

            Injecting Botox (onabotulinumtoxinA) in certain bladder muscles can cause a life-threatening condition called autonomic dysreflexia, where your body's nervous system overreacts. Symptoms of autonomic dysreflexia include a change in heart rate, excessive sweating, high blood pressure, muscle spasms, or skin color changes. If you experience any of these symptoms after using Botox (onabotulinumtoxinA), seek medical help immediately.

            risk-warning

            Higher risk of urinary tract infections (UTI) and trouble urinating (urinary retention)

            • Risk factors: History of multiple UTIs | Treatment of bladder problems

              Botox (onabotulinumtoxinA) raises your risk for UTI when using it to treat frequent urination (overactive bladder or OAB). Symptoms of a UTI include painful urination, fever, feeling tired, and smelly urine. Let your provider know if you experience any of these symptoms after using Botox (onabotulinumtoxinA). Your risk is higher if you've had UTIs that keep coming back. Discuss your full medical history with your provider, and the risks and benefits of using Botox (onabotulinumtoxinA).

              In addition, when using Botox (onabotulinumtoxinA) to treat bladder problems, it can cause you to have trouble urinating. This can cause urine to stay in your bladder. If this happens, you might need to empty your bladder using a device called a catheter for days to months. If you have concerns, discuss the risks and benefits of using Botox (onabotulinumtoxinA) for bladder problems with your provider.

              dosage

              Botox (onabotulinumtoxinA) dosage forms

              Typical dosing for Botox (onabotulinumtoxinA)

              Botox (onabotulinumtoxinA) is only available as an injection that's administered by a healthcare provider. The dose and number of injection sites will depend on the condition you have.

              interactions

              Interactions between Botox (onabotulinumtoxinA) and other drugs

              Botox (onabotulinumtoxinA) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Botox (onabotulinumtoxinA). Please note that only the generic name of each medication is listed below.

              Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

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              How much does Botox (onabotulinumtoxinA) cost?

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              contraindications-icon

              Botox (onabotulinumtoxinA) contraindications

              Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Botox (onabotulinumtoxinA) will not be safe for you to take.
              • Infection at injection site(s)

              • UTI during bladder treatment

              • Trouble urinating and not using a catheter during bladder treatment regularly

              alternatives

              What are alternatives to Botox (onabotulinumtoxinA)?

              There are a number of medications that your doctor can prescribe in place of Botox (onabotulinumtoxinA). Compare a few possible alternatives below.
              Botox (onabotulinumtoxinA)
              Used for:
              • Overactive bladder (OAB) in adults

              • Loss of bladder control due to nerve problems in people 5 years and older

              • Headache prevention in adults with long-term migraine (headaches lasting 4 hours or longer for 15 or more days per month)

              • Muscle spasms in people 2 years and older

              • Neck spasms in adults

              • Excessive armpit sweating in adults

              • Eyelid twitching in people 12 years and older

              • Crossed eyes in people 12 years and older

              $1278.73 Lowest GoodRx priceView Prices
              Used for:
              • Long-term excessive drooling (sialorrhea) in people 2 years and older

              • Arm spasms in people 2 years and older

              • Uncontrollable neck spasms (cervical dystonia) in adults

              • Uncontrollable eye twitching (blepharospasm) in adults

              • Frown lines in adults

              Used for:
              $13.80 Lowest GoodRx priceView Prices
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