Botox
Botox (onabotulinumtoxinA) is a prescription injection used for many medical conditions caused by muscle overactivity or nerve problems. It's FDA approved for treating conditions like overactive bladder, excessive armpit sweating, and for preventing migraines. The medication is injected by a trained healthcare professional. Side effects depend on where the injection is given, but they can include urinary tract infections, headache, and neck pain.
Botox (onabotulinumtoxinA) is different from Botox Cosmetic, which is used for facial and neck lines.
What is Botox (onabotulinumtoxinA)?
What is Botox (onabotulinumtoxinA) used for?
- Overactive bladder (OAB) - adults
- Loss of bladder control caused by nerve-bladder problems - adults
- Nerve-related bladder problem - children 5 years and older
- Headache prevention for chronic migraine - adults
- Muscle spasms - adults and children 2 years and older
- Neck muscle spasms - adults
- Excessive armpit sweating - adults
- Eyelid twitching - adults and children 12 years and older
- Crossed eyes - adults and children 12 years and older
How Botox (onabotulinumtoxinA) works
Botox (onabotulinumtoxinA) is a neuromuscular blocker, which means it blocks signals between your nerves and muscles. It works by stopping the release of a chemical called acetylcholine, which your body uses to make muscles move. When Botox (onabotulinumtoxinA) is injected into a muscle, it helps that muscle relax, which can help treat conditions caused by overactive muscles.
When Botox (onabotulinumtoxinA) is injected into the skin, it blocks the nerves that trigger sweat glands. This helps lower sweating in the area where it was injected.
Drug facts
More on Botox (onabotulinumtoxinA) essentials
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
Overactive bladder:
- Urinary tract infection (18%)
- Painful urination (9%)
- Trouble emptying the bladder (6%)
Loss of bladder control:
- Urinary tract infection (24-26%)
- Urine left in the bladder (17%)
- Trouble emptying the bladder (15-17%)
- Difficulty passing urine (15%)
Chronic migraine:
- Neck pain (9%)
- Headache (5%)
Muscle spasms:
- Pain in the arm or leg (up to 9%)
- Muscle weakness (up to 4%)
Neck muscle spasm:
- Trouble swallowing (19%)
- Upper respiratory infection (12%)
- Neck pain (11%)
- Headache (11%)
Excessive armpit sweating:
- Injection site pain (3-10%)
- Bleeding (3-10%)
- Infection (3-10%)
Eyelid twitching:
- Droopy eyelid (21%)
- Damage to surface of the eye (6%)
- Dry eye (6%)
Crossed eyes:
- Droopy eyelid (1-38%)
- Eye misalignment (17%)
Less Common Side Effects
Overactive bladder:
- Bacteria in the urine
- Urine left in the bladder
Loss of bladder control:
- Blood in the urine
- Bacteria in urine
- Painful urination
Chronic migraine:
- Muscle stiffness or weakness
- Muscle pain
- Droopy eyelid
- Injection site pain
Muscle spasms:
- Tiredness
- Joint pain
- Back pain
- Injection site pain
Neck muscle spasm:
- Cough
- Back pain
- Dizziness
- Nausea
Excessive armpit sweating:
- Headache
- Fever
- Neck or back pain
Eyelid twitching:
- Irritation
- Tearing
- Double vision
Crossed eyes:
- Bleeding behind the eye
Botox (onabotulinumtoxinA) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Problems swallowing, speaking, or breathing
- Spread of toxin effects: loss of strength, muscle weakness, double vision, blurred vision, droopy eyelids, voice changes, trouble speaking clearly, loss of bladder control, trouble breathing, trouble swallowing
More on Botox (onabotulinumtoxinA) side effects
The following Botox (onabotulinumtoxinA) 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
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.
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Pros and cons of Botox (onabotulinumtoxinA)
Pros
- FDA approved to treat many different conditions
- Might be a good option when other treatments have failed
- Injected directly into the area causing trouble
- Effects last a few months
Cons
- Needs to be injected by a healthcare professional
- Injections can be uncomfortable
- Has serious risks if the toxin spreads to other parts of your body
- Might need to get repeat treatments
Pharmacist tips for Botox (onabotulinumtoxinA)
- Getting a Botox (onabotulinumtoxinA) injection might feel like a quick pinch. Your prescriber might use ice or a numbing cream to make it hurt less. Talk with them ahead of time if you're worried about pain.
- The number of Botox (onabotulinumtoxinA) injections you need depends on why you're getting them. Ask your prescriber to explain the procedure so you’ll know what to expect.
- Botox (onabotulinumtoxinA) might not work right away. It can take a few weeks to feel the full effect. Talk to your prescriber if you’re unsure about when to expect results.
- Call your prescriber right away if you notice anything unusual after getting Botox (onabotulinumtoxinA). This includes problems like trouble swallowing, speaking, or breathing.
- If Botox (onabotulinumtoxinA) causes weakness, blurry vision, droopy eyelids, or dizziness, don’t drive or do anything that needs your full attention since these side effects can make it unsafe.
- If you're getting Botox (onabotulinumtoxinA) for bladder problems, tell your prescriber if it's hard to urinate or if it burns when you urinate. This could mean something isn't right.
- The effects of Botox (onabotulinumtoxinA) usually last a few months. Your symptoms could come back if you stop the injections. Stay in touch with your prescriber to know when you might need another dose.
Common questions about Botox (onabotulinumtoxinA)
The effects of Botox (onabotulinumtoxinA) injections generally last about 3 months, but this depends on the condition you're treating. For some conditions, like excessive armpit sweating or overactive bladder, it could last for 6 months or longer. Over time, the effects will slowly wear off, and you might start to notice your symptoms coming back.
How fast Botox (onabotulinumtoxinA) works depends on what you're using it for. In general, it can take up to 2 weeks for Botox (onabotulinumtoxinA) for the medication to fully take effect. Talk to your prescriber about when you can expect to see results based on your specific condition.
Botox (onabotulinumtoxinA) is made from a toxin that comes from a bacteria called Clostridium botulinum. In very small, purified amounts, this toxin can be safely used as a medication. The injection is carefully prepared and tested so it’s safe when given by a trained healthcare professional.
After getting Botox (onabotulinumtoxinA) injections, don't drive or do anything risky if you feel muscle weakness, dizziness, droopy eyelids, or blurry vision. These side effects can affect your ability to stay safe. Your prescriber can tell you what other activities to avoid and how long to wait after your treatment.
It might. But most people say the pain from Botox (onabotulinumtoxinA) injections is mild and short-lived. Your prescriber might apply a numbing cream to help reduce any discomfort. Let your care team know if the pain lasts more than a few days, gets worse, or becomes severe since this could be a sign of something more serious.
No, Botox (onabotulinumtoxinA) doesn't cause cancer. In fact, researchers are even studying how it might be used to treat cancer in the future. If you have concerns about the safety of this injection, it’s a good idea to talk with your prescriber.
There isn’t enough information to know if Botox (onabotulinumtoxinA) is safe to use during pregnancy. In animal studies, it caused problems with the baby’s growth. If you’re pregnant, talk to your prescriber about the possible risks and benefits before receiving this medication.
It's not known if Botox (onabotulinumtoxinA) is safe to use while breastfeeding. It’s unclear whether the medication passes into breast milk or could affect your baby, but the risk is likely low. To be safe, talk to your prescriber before getting Botox (onabotulinumtoxinA) while nursing.
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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.
Spread of toxin effect
- Risk factors: Children | History of muscle or nerve conditions
Some people who use Botox (onabotulinumtoxinA) or similar products might have side effects that spread beyond the injection site, sometimes hours to weeks after treatment. This can cause serious side effects like muscle weakness, droopy eyelids, blurry or double vision, breathing problems, trouble swallowing, trouble speaking clearly, or loss of bladder control. If you have trouble swallowing, speaking, or breathing after getting Botox (onabotulinumtoxinA), get medical help right away.
Serious allergic reaction
Serious and sometimes immediate allergic reactions have been reported with Botox (onabotulinumtoxinA). These might include anaphylaxis (a life-threatening allergic reaction), hives, swelling, or trouble breathing. If you experience any of these symptoms, your prescriber will stop treatment and give you medical care right away.
Difficulty swallowing or breathing
- Risk factors: History of swallowing or breathing problems | Using Botox (onabotulinumtoxinA) in certain muscles | People with smaller neck muscles | History of muscle or nerve conditions
Botox (onabotulinumtoxinA) can sometimes cause trouble with swallowing or breathing, especially if you already have these problems. This can happen when the medication weakens muscles near the injection site that help with swallowing or breathing. These problems can start hours to weeks after your injection and can last for months. Your risk is higher if you have certain conditions affecting your muscles or nerves. If you notice any trouble swallowing or breathing, get medical help right away. Be sure to tell your prescriber if you’ve had these problems in the past before getting Botox (onabotulinumtoxinA).
Lung problems in people with breathing conditions
- Risk factors: History of breathing problems
If you have breathing problems and get Botox (onabotulinumtoxinA), your lungs might not work as well, and you might have a higher chance of getting an upper respiratory tract infection. If you have a lung condition, your prescriber might check your breathing before and after treatment. Always let them know if you feel short of breath or notice new breathing symptoms after your injection.
Eye problems and bleeding
- Risk factors: History nerve problems affecting the face | Eyelid twitching | Crossed eyes
If you get Botox (onabotulinumtoxinA) to treat eye muscle problems, it can cause reduced blinking, which might lead to eye problems like dryness or even eye ulcers. Your prescriber will check your eyes and might recommend ointment or special contact lenses to help protect them if needed.
If you use Botox (onabotulinumtoxinA) for crossed eyes, there’s also a small risk of bleeding behind the eye. This can affect blood flow to your eye. Let your prescriber know if you notice any new or unusual eye symptoms after your injection.
Bronchitis and upper respiratory tract infections
- Risk factors: Muscle spasms
If you get Botox (onabotulinumtoxinA) for muscle spasms, you might be more likely to get bronchitis or an upper respiratory tract infection, like a cold. Watch for signs such as a cough, sore throat, or stuffy nose. Let your prescriber know right away if you notice any of these symptoms after your injection.
Overactive nervous system
- Risk factors: Loss of bladder control
Injecting Botox (onabotulinumtoxinA) in certain bladder muscles can cause a life-threatening condition called autonomic dysreflexia. This happens when your nervous system overreacts. Symptoms include a change in heart rate, heavy sweating, high blood pressure, muscle spasms, or changes in your skin color. If you notice any of these symptoms after your injection, get medical help right away.
Urinary tract infections
- Risk factors: Overactive bladder | History of multiple UTIs
Botox (onabotulinumtoxinA) raises your risk for Urinary tract infections (UTI) when using it to treat overactive bladder. Let your prescriber know if you get burning during urination, cloudy urine, or need to go more often — these could be signs of a UTI.
Trouble emptying the bladder
When using Botox (onabotulinumtoxinA) to treat bladder problems, it can become harder to urinate. This means some urine can stay in your bladder instead of fully emptying. If that happens, you may need to use a catheter — a small tube that helps drain your bladder — for a few days or even a few months. If you're worried about this, talk with your prescriber about the risks and benefits before starting treatment with Botox (onabotulinumtoxinA).
Transmission of diseases
Although rare, Botox (onabotulinumtoxinA) has a small risk of spreading certain viruses or diseases because it contains a protein from human blood. Blood donors are screened, the blood is tested for infections, and the product is processed to remove or kill viruses. These steps help lower the risk, but it’s still possible. If you have concerns, talk to your care team.
Botox (onabotulinumtoxinA) dosage
Vial| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 100 units | 1 vial | $631.21 | $631.21 |
| 200 units | 1 vial | $1,256.17 | $1,256.17 |
Typical dosage for Botox (onabotulinumtoxinA)
Botox (onabotulinumtoxinA) is only available as an injection that's administered by a healthcare professional. The dose and number of injection sites will depend on the condition you have.
Adults:
- Overactive bladder: The total dose is 100 units.
- Loss of bladder control: The total dose is 200 units.
- Chronic migraine: The total dose is 155 units.
- Muscle spasms:
- In the arms: The total dose is between 75 units to 400 units.
- In the legs: The total dose is between 300 units to 400 units.
- Neck muscle spasms: The recommended dose is between 198 units to 300 units.
- Excessive armpit sweating: The total dose is 50 units per armpit.
- Eyelid twitching: The total starting dose is between 1.25 units to 2.5 units per muscle.
- Crossed eyes: The total starting dose is between 1.25 units to 2.5 units per muscle.
Children:
- Nerve-related bladder problem:
- Weight 34 kg (75 lbs) or more: The total dose is 200 units.
- Weight less than 34 kg (75 lbs): The total dose is 6 units/kg.
- Muscle spasms:
- In the arms: The total dose is between 3 units/kg to 6 units/kg (maximum 200 units).
- In the legs: The total dose is between 4 units/kg to 8 units/kg (maximum 300 units).
- Eyelid twitching: The total starting dose is between 1.25 units to 2.5 units per muscle.
- Crossed eyes: The total starting dose is between 1.25 units to 2.5 units per muscle.
Interactions between Botox (onabotulinumtoxinA) and other drugs
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.
How much does Botox (onabotulinumtoxinA) cost?
$631.21
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 emptying the bladder or have urine left in the bladder regularly
What are alternatives to Botox (onabotulinumtoxinA)?
