What is Botox?
Botox (OnabotulinumtoxinA), also called botulinum toxin type A, is made from the bacteria that causes botulism. Botulinum toxin blocks nerve activity in the muscles.
Botox is used to treat cervical dystonia (severe spasms in the neck muscles). It is also used to treat muscle spasms (stiffness) in the upper limbs (elbows, wrists, fingers) or lower limbs (ankles, toes). Botox is also used to treat severe underarm sweating (hyperhidrosis).
It’s also used to treat certain eye muscle conditions caused by nerve disorders. This includes uncontrolled blinking or spasm of the eyelids and a condition in which the eyes do not point in the same direction.
Another usage of Botox is to treat overactive bladder and incontinence (urine leakage) caused by nerve disorders such as spinal cord injury or multiple sclerosis. It is also used to prevent chronic migraine headaches in adults who have migraines for more than 15 days per month, each lasting 4 hours or longer. This medicine should not be used to treat a common tension headache.
Botox Cosmetic is used to lessen the appearance of facial wrinkles temporarily.
Botulinum toxin is one of the most poisonous substances known to man. Scientists have estimated that a single gram could kill as many as 1 million people and a couple of kilograms could kill every human on earth. In high concentrations, botulinum toxin can result in botulism, a severe, life-threatening illness. Botulism, left untreated, may result in respiratory failure and death. Despite botulinum toxin being so toxic, Botox is in huge demand.
Despite this, Botox has proven to be a successful and valuable therapeutic protein.
Botulinum toxin can be injected into humans in extremely small concentrations and works by preventing signals from the nerve cells reaching muscles, therefore paralyzing them.
For muscles to contract, nerves release a chemical messenger, Acetylcholine (a neurotransmitter), at the junction where the nerve endings meet muscle cells. Acetylcholine attaches to receptors on the muscle cells and causes the muscle cells to contract or shorten.
Injected botulinum toxin prevents the release of Acetylcholine, preventing contraction of the muscle cells. Botulinum toxin causes a reduction in abnormal muscle contraction, allowing the muscles to become less stiff.
Uses of Botox
Botox is predominantly used as a treatment to reduce the appearance of facial wrinkles and fine lines.
Beyond aesthetic applications, Botox is used to treat a variety of medical conditions, including eye squints, migraines, excess sweating, and leaky bladders. Botulinum toxin is currently used to treat over 20 different medical conditions, with more applications under investigation. It’s currently approved for the following therapeutic applications:
- Blepharospasm (spasm of the eyelids).
- Idiopathic rotational cervical dystonia (severe neck and shoulder muscle spasms).
- A chronic migraine.
- Severe primary axillary hyperhidrosis (excessive sweating).
- Strabismus (crossed eyes).
- Post-stroke upper limb spasticity.
- Detrusor (bladder wall muscle) overactivity – causing urinary incontinence.
- Overactive bladder.
- Hemifacial spasm.
- Glabellar lines (frown lines between the eyebrows).
- Canthal lines (crow’s feet).
Also, Botulinum toxin is used off-label (not approved) for:
- Achalasia (an issue with the throat that makes swallowing difficult).
- Anal fissure and animus (dysfunction of the anal sphincter).
- Sialorrhea (producing too much saliva).
- Allergic rhinitis (hay fever).
- Sphincter of Oddi (hepatopancreatic) dysfunction (causes abdominal pain).
- Cerebral Palsy.
- Oromandibular dystonia (forceful contraction of the jaw, face, and tongue).
- Laryngeal dystonia (forceful contraction of the vocal cords).
- Botulinum toxin is sold commercially under the names:
- Botox, Vistabel, Botox cosmetic (OnabotulinumtoxinA or botulinum toxin type A).
- Dysport (AbobotulinumtoxinA or botulinum toxin type A).
- Bocouture, Xeomin (IncobotulinumtoxinA or botulinum toxin type A).
- Myobloc (RimabotulinumtoxinB or botulinum toxin type B).
The Botox is administered by diluting the powder in saline and injecting it directly into neuromuscular tissue. It takes 24-72 hours for botulinum toxin to take effect. In very rare circumstances, it may take as long as five days for the full effect of botulinum toxin to be observed.
It should not be used in pregnant or lactating women, or by people who have had a previous allergic reaction to the drug or any of its ingredients.
Risks and Side Effects of Botox
Injections with botulinum toxin are well tolerated, and there are few side effects. In rare cases, an individual may have a genetic predisposition that results in a mild, transient unusual response to the drug.
Around 1 percent of people receiving injections of botulinum toxin type A develop antibodies to the toxin that make subsequent treatments ineffective.
Along with its intended effects, botulinum toxin may cause some unwanted effects. These can include:
- Mild pain, local edema (fluid buildup) and erythema (reddening of the skin) at the injection site.
- A headache.
- Malaise – feeling unwell.
- Mild nausea.
- Temporary unwanted weakness/paralysis of nearby muscles.
- Temporary upper lid or brow ptosis (drooping).
- The weakness of the lower eyelid or lateral rectus (a muscle controlling eye movement).
- Dysphagia – trouble swallowing.
- Neck weakness.
- Flu-like illness.
- Brachial plexopathy – a condition affecting the nerves either side of the neck and chest.
- Gallbladder dysfunction.
- Diplopia (double vision).
- Blurred vision.
- Decreased eyesight.
- Dry mouth.
The Botulinum toxin’s popularity continues to increase, with cosmetic minimally-invasive botulinum toxin type A procedures up 700 percent since 2000, to 6.3 million in 2013.
What should I avoid?
Botox may impair your vision or depth perception. Be careful if you drive or do anything that requires you to be able to see clearly.
Avoid using underarm antiperspirants or deodorants for 24 hours after receiving a Botox injection if you are being treated for excessive underarm sweating.
Avoid going back to your normal physical activities too quickly after receiving an injection.
What other drugs will affect Botulinum Toxin?
Other medicines can increase certain side effects of Botox, especially: cold or allergy medicine, muscle relaxers, sleeping pills, bronchodilators, bladder or urinary medicines, and irritable bowel medicines. Tell your doctor about all your current medicines.
Other drugs may interact with OnabotulinumtoxinA, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your healthcare providers about all medicines you use now and any medicine you start or stop using.