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.
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
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.
Source: DailyMed
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
ear congestion
headache
loss of voice
runny or stuffy nose
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
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
ear congestion
headache
loss of voice
neck pain
runny or stuffy nose
unusual tiredness or weakness
More common—for forehead lines
Headache
More common—for hyperhidrosis
Body aches or pain
chills
congestion
dryness or soreness of the throat
fear
general feeling of discomfort or illness
headache
heavy bleeding from the place where the shot was given
itching skin
joint pain
loss of appetite
nervousness
painful or difficult urination
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
difficulty with breathing
ear congestion
headache
loss of voice
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.
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
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
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 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.
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 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 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 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 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 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.
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.
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.
Infection at injection site(s)
UTI during bladder treatment
Trouble urinating and not using a catheter during bladder treatment regularly
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
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
Muscle spasms from multiple sclerosis or spinal cord injuries in people ages 12 years and older
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