Drug reference
Abobotulinum toxin A
Botulinum Toxin · Muscle Relaxant; Antispasmodic; Cosmetic Agent
Also known as Botulinum toxin type A, Botulinum toxin type A haemagglutinin complex
Botulinum ToxinMuscle Relaxant; Antispasmodic; Cosmetic Agent
CDSCO approvedSchedule H
EXCRETION
—
not curated
INTERACTIONS
—
none in our sources
PREGNANCY
—
not curated
Mechanism
Abobotulinum toxin A, a potent exotoxin produced by Clostridium botulinum, is targeted to presynaptic proteins. It inhibits synaptic exocytosis through clipping of vesicle fusion proteins in the presynaptic nerve terminal. This action blocks the release of acetylcholine (ACh), leading to long-lasting flaccid paralysis of skeletal muscle and diminished activity of parasympathetic and sympathetic cholinergic synapses.
Indications
StrabismusBlepharospasmHemifacial spasmsAdductor spasmodic dysphoniaOromandibular dystoniaCervical dystonia (spasmodic torticollis)Spasms associated with the lower esophageal sphincter and anal fissuresHyperhidrosis of the palms and axillae (resistant to topical and iontophoretic remedies)Removal of facial lines associated with excessive nerve stimulation and muscle activity (cosmetic procedure)Upper and lower limb spasm due to cerebral palsyUpper and lower limb spasm due to multiple sclerosisOveractive bladderMigraine (chronic migraine, defined as headaches on at least 15 days per month with at least 8 days with migraine, not responded to at least three prior oral pharmacological prophylaxis therapies, and whose condition is appropriately managed for medication overuse)NystagmusPost stroke spasticityAxillary hyperhidrosis
Dosing
- Adult
- fever, severe muscle rigidity, mental status change, and dysautonomia. Administration of 1-2.5 mg/kg dantrolene in severe NMS cases,
Pharmacokinetics
Duration
Several weeks to 4 months
Contraindications
- History of dysphagia or aspiration
Side effects
Common
Dry mouthDysphagiaDysphoniaHeadacheInfluenza like illnessMuscle weaknessNeck painTaste alteredVision disordersAstheniaConstipation
Serious
- Angioedema
- Dyspnoea
- Pneumonia aspiration
- Ptosis
- Respiratory paralysis from unexpected spread of the toxin from the site of injection (FDA safety alert)
- Falls
- Potential spread of toxin leading to excessive weakness (black box warning after use for cerebral palsy with spasticity)
- Diplopia
- Facial swelling
- Dysarthria
Related guidelines
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