Drug reference
botulinum toxin
Neurotoxin, Inhibitor of ACh release · Antispasmodic
Neurotoxin, Inhibitor of ACh releaseAntispasmodic
CDSCO approved
EXCRETION
—
not curated
INTERACTIONS
—
none in our sources
PREGNANCY
—
not curated
Mechanism
Botulinum toxins bind to cholinergic neurons, enter the cell, and cleave SNARE proteins, thereby inhibiting vesicular release of acetylcholine. The result is flaccid paralysis of skeletal muscle and diminished activity of parasympathetic and sympathetic cholinergic synapses.
Indications
Management of ocular blepharospasm and strabismusManagement of other muscle spasms and dystoniasFacilitate facial muscle relaxationAchalasia (lower esophageal sphincter injection)Cosmetic procedure for wrinklesCervical dystoniaGlabellar lines (moderate to severe)Axillary hyperhidrosis (severe)Chronic migraine prophylaxisOveractive bladderUpper limb spasticity (severe)Urinary incontinence (due to detrusor overactivity associated with a neurologic condition)
Pharmacokinetics
Duration
Inhibition lasts from several weeks to 3–4 months; restoration of function requires nerve sprouting.
Contraindications
- Units of biological activity for different preparations are not interchangeable
- Administer with great caution due to extreme toxicity
Side effects
Serious
- Extremely poisonous (lethal doses roughly 1 ng/kg IM/IV, 10 ng/kg inhaled, 1000 ng/kg ingested)
- Risk of respiratory paralysis from unexpected spread of the toxin from the site of injection
- Paralysis of swallowing and respiration can be life-threatening
- Symptoms of botulism
Related guidelines
Cervical cancer screening and management
ICMR · Oncology · 2022
Migraine — preventive therapy
AAN · Neurology · 2015
Infective endocarditis prevention
NICE · Cardiology / Dentistry · 2008
Infective endocarditis prevention
AHA · Cardiology / Dentistry · 2007
Gastro-oesophageal reflux disease
ISG · Gastroenterology · 2022
Ask House about botulinum toxin
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: Goodman & Gilman 14e·Verified: 2026-05-10 · House clinical team