Botox Cosmetic

• Reduction of Glabellar Lines
• IM (Adults ): 0.1 mL (4 units) into each of five sites (two in each corrugator muscle and one in the procerus muscle; total dose of 20 units); not more frequently than every 3 mo.
• Reduction of Lateral Canthal Lines
• IM (Adults ): 0.1 mL (4 units) into each of three sites per side in the lateral orbicularis oculi muscle (12 units per side; total dose of 24 units); not more frequently than every 3 mo.
• Reduction of Forehead Lines
• IM (Adults ): 0.1 mL (4 units) into each of five sites in the frontalis muscle (total dose of 20 units); not more frequently than every 3 mo.
• Reduction of Platysma Bands
• IM (Adults ): 0.05 mL (2 units) into each of four sites in upper segment of platysma muscle, below the jawline, and on each side, as well as 0.025 mL (1 unit) into each of five sites along each vertical neck band. Depending on platysma band severity, total dose may be 26 units (one band/side), 31 units (one band on one side, two bands on other side), or 36 units (two bands/side). Not to be administered more frequently than every 3 mo.

Botox

• Upper Limb Spasticity
• IM (Adults ): Biceps brachii: 60–200 units divided in 2–4 sites; not more frequently than every 3 mo; Brachioradialis: 45–75 units divided in 1–2 sites; not more frequently than every 3 mo; Brachialis: 30–50 units divided in 1–2 sites; not more frequently than every 3 mo; Pronator teres: 15–25 units in one site; not more frequently than every 3 mo; Pronator quadratus: 10–50 units in one site; not more frequently than every 3 mo; Flexor carpi radialis or flexor carpi ulnaris: 12.5–50 units in one site; not more frequently than every 3 mo; Flexor digitorum profundus or flexor digitorum sublimis: 30–50 units in one site; not more frequently than every 3 mo; Lumbricals/interossei: 5–10 units in one site; not more frequently than every 3 mo; Adductor pollicis or flexor pollicis longus: 20 units in one site; not more frequently than every 3 mo; Flexor pollicis brevis/opponens pollicis: 5–25 units in one site; not more frequently than every 3 mo.
• IM (Children ≥2 yr): 3–6 units/kg divided among affected muscles, with the following doses being used for each muscle: Biceps brachii: 1.5–3 units/kg divided in 4 sites; not more frequently than every 3 mo; Brachialis, flexor carpi radialis, or flexor carpi ulnaris: 1–2 units/kg divided in 2 sites; not more frequently than every 3 mo; Brachioradialis, flexor digitorum profundus, or flexor digitorum sublimis: 0.5–1 units/kg divided in 2 sites; not more frequently than every 3 mo.
• Lower Limb Spasticity
• IM (Adults ): Gastrocnemius medial head, gastrocnemius lateral head, soleus, or tibialis posterior: 75 units divided in 3 sites; not more frequently than every 3 mo; Flexor hallucis longus or flexor digitorum longus : 50 units divided in 2 sites; not more frequently than every 3 mo.
• IM (Children ≥2 yr): 4–8 units/kg divided among affected muscles, with the following doses being used for each muscle: Gastrocnemius, soleus, or tibialis posterior: 1–2 units/kg divided in 2 sites; may be repeated after 3 mo, based on return of symptoms.
• Cervical Dystonia
• IM (Adults ): Mean dose is 236 units divided among the affected muscles in patients previously treated with botulinum toxin; initial dose should be lower in previously untreated patients; subsequent dosing should be based on patient's head and neck position, localization of pain, muscle hypertrophy, patient response, and previous tolerability; total dose injected into sternocleidomastoid muscles should be ≤100 units (to ↓ incidence of dysphagia); not more frequently than every 3 mo.
• Axillary Hyperhidrosis
• IM (Adults ): 50 units per axilla; may repeat when clinical effect diminishes.
• Blepharospasm
• IM (Adults and Children ): 1.25–2.5 units into the medial and lateral pretarsal orbicularis oculi of the upper lid and into the lateral pretarsal orbicularis oculi of the lower lid; not more frequently than every 3 mo.
• Strabismus
• IM (Adults and Children ≥12 yr): Vertical muscles and for horizontal strabismus <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 of ≥1 mo: 1.25–2.5 units in the medial rectus muscle.
• Chronic Migraine
• IM (Adults ): 155 units divided among seven specific head/neck muscle areas (see prescribing information for dose to be injected into each area) every 12 wk.
• Urinary Incontinence
• IM (Adults ): 200 units injected into the detrusor muscle; may repeat when clinical effect diminishes, but not more frequently than every 3 mo.
• Overactive Bladder
• IM (Adults ): 100 units injected into the detrusor muscle; may repeat when clinical effect diminishes, but not more frequently than every 3 mo.
• Pediatric Detrusor Overactivity associated with a Neurologic Condition
• IM (Children ≥5 yr and ≥34 kg): 200 units injected into the detrusor muscle; may repeat when clinical effect diminishes, but not more frequently than every 3 mo.
• IM (Children ≥5 yr and <34 kg): 6 units/kg injected into the detrusor muscle; may repeat when clinical effect diminishes, but not more frequently than every 3 mo.