Incontinence due to detrusor instability, associated with a neurologic condition
- 200 units administered as thirty 1mL (approximately 6.7 units/mL) injections across detrusor muscle via a flexible or rigid cytoscope
Note:
- Median time to retreatment is 42 to 48 weeks, but no sooner than 12 wks; Max 200 units per treatment
- 155 units as 5 units (0.1mL) IM into each of 31 sites divided across 7 muscle areas in the head and neck (20 units divided in 4 sites in frontalis muscle, 10 units divided in 2 sites in corrugator muscle, 5 units in 1 site in procerus muscle, 30 units divided in 6 sites in occipitalis muscle, 40 units divided in 8 sites in temporalis muscle, 30 units divided in 6 sites in trapezius muscle, and 20 units divided in 4 sites in cervical paraspinal muscle group)
Note:
- Retreatment recommended every 12 wks
- Biceps Brachii: 100-200 units IM divided in 4 sites
- Flexor carpi radialis: 12.5-50 units IM in 1 site
- Flexor carpi ulnaris: 12.5-50 units IM in 1 site
- Flexor digitorum profundus: 30-50 units IM in 1 site
- Flexor digitorum sublimis: 30-50 units IM in 1 site
- Select dose based on muscles affected, severity of muscle activity, prior response to treatment, and adverse event history. Electromyographic guidance is recommended
- Use lowest recommended starting dose, and do not exceed 50 units per site
- Repeat the dose treatment when the effect of a previous injection has diminished, but generally no sooner than 12 wks after the previous injection
- 236 units (25th to 75th percentile range of 198 Units to 300 Units) IM among affected muscles. Inject < 100 units IM injected to sternocleidomastoid muscles, to decrease the occurrence of dysphagia
Note:
- Individualize dose based on patient's head and neck position, localization of pain, muscle hypertrophy, patient response, and adverse event history
- Use lowest recommended starting dose, and do not exceed 50 units per site
- Repeat treatment after 3 months
- Clinical improvement: begins within 2 wks; maximum clinical benefit: approximately 6 wks post-injection
Primary axilary hyperhidrosis
- 50 units (2 mL) per axilla injected intradermally in 0.1-0.2 mL (10-20 unit) aliquots to each axila evenly divided in multiple sites (10-15) approximately 1-2 cm apart; repeat treatment after effect of a previous injection diminishes
- 1.25-2.5 units (0.05 mL-0.1 mL volume at each site) IM q3 months into the medial and lateral pre-tarsal orbicularis oculi of the upper lid and into the lateral pre-tarsal orbicularis oculi of the lower lid
- Cumulative dose: 200 units/30 days
- Clinical improvement: begins within 3 days; peak: approximately 1-2 wks post-injection
- Range 0.05-0.15 mL IM per muscle into extraocular muscles with EMG guidance
- Initial doses
- Vertical muscles & horizontal strabismus of <20 prism diopters: 1.25-2.5 units in any one muscle
- Horizontal strabismus of 20-50 prism diopters: 2.5-5 units in any one muscle
- Persistent VI nerve palsy (duration
1mo): 1.25-2.5 units in the medial rectus muscle
- Subsequent doses: Re-examine 7-14 days post injection
- If adequate paralysis achieved: Give dose comparable to initial dose if subsequent injection required
- Incomplete paralysis achieved: Dose can be increased two fold compared to previously administered dose
- Max dose 25 units/site
Moderate-severe glabellar lines
- 20 units IM div in 5 sites q3-4 months
- >16 yrs: 236 units (25th to 75th percentile range of 198 Units to 300 Units) IM among affected muscles. Inject < 100 units IM injected to sternocleidomastoid muscles, to decrease the occurrence of dysphagia
Note:
- Individualize dose based on patient's head and neck position, localization of pain, muscle hypertrophy, patient response, and adverse event history
- Use lowest recommended starting dose, and do not exceed 50 units per site
- Repeat treatment after 3 months
- Clinical improvement: begins within 2 wks; maximum clinical benefit: approximately 6 wks post-injection
- >12 yrs: 1.25-2.5 units (0.05 mL-0.1 mL volume at each site) IM q3 months into the medial and lateral pre-tarsal orbicularis oculi of the upper lid and into the lateral pre-tarsal orbicularis oculi of the lower lid
- Cumulative dose: 200 units/30 days
- Clinical improvement: begins within 3 days; peak: approximately 1-2 wks post-injection
- >12 yrs: Range 0.05-0.15 mL IM per muscle into extraocular muscles with EMG guidance
- Initial doses:
- Vertical muscles & horizontal strabismus of <20 prism diopters: 1.25-2.5 units in any one muscle
- Horizontal strabismus of 20-50 prism diopters: 2.5-5 units in any one muscle
- Persistent VI nerve palsy (duration 1mo): 1.25-2.5 units in the medial rectus muscle
- Subsequent doses: Re-examine 7-14 days post injection
- If adequate paralysis achieved: Give dose comparable to initial dose if subsequent injection required
- Incomplete paralysis achieved: Dose can be increased two fold compared to previously administered dose
- Max dose 25 units/site
65 years of age (Botox Cosmetic)
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