Toxin Injections Treatment, Procedure & Costs

 

Learn how toxin injections, a common cosmetic surgery treatment for facial lines, immobilise overactive facial muscles...

The chemical we use for our anti-wrinkles treatment has been used by neurologists and ophthalmologists for years, notably for the treatment of eye squint and nervous twitching. 

Our Aesthetic Surgery Specialists have gathered below information about this toxin pharmacology and contraindications.

Name of the drug

Clostridium botulinum type A toxin-haemagglutinin complex

Description

Toxin Powder for Injection contains 500* IPSEN UNITS per vial of Clostridium botulinum type A toxin-haemagglutinin complex, 125 microgram human serum albumin and 2.5 mg lactose in a sterile, lyophilised form without a preservative.

ONE IPSEN UNIT is not equivalent to ONE UNIT of another toxin preparation.

Clostridium botulinum type A toxin-haemagglutinin complex has a molecular weight of about 900,000 and is a complex of proteins.

Pharmacology - Pharmacodynamics

Clostridium botulinum type A toxin-haemagglutinin complex blocks peripheral cholinergic transmission at the neuromuscular junction by a presynaptic action at a site proximal to the release of acetylcholine. The toxin acts within the nerve ending to antagonise those events that are triggered by Ca2+ which culminate in transmitter release. It does not affect postganglionic cholinergic transmission or postganglionic sympathetic transmission.

The action of toxin involves an initial binding step whereby the toxin attaches rapidly and avidly to the presynaptic nerve membrane. Secondly, there is an internalisation step in which toxin crosses the presynaptic membrane, without causing onset of paralysis. Finally the toxin inhibits the release of acetylcholine by disrupting the Ca2+ mediated acetylcholine release mechanism, thereby diminishing the endplate potential and causing paralysis.

Recovery of impulse transmission occurs gradually as new nerve terminals sprout and contact is made with the postsynaptic motor endplate, a process which takes 6-8 weeks in the experimental animal.

Pharmacology - Pharmacokinetics

Pharmacokinetics have not been formally studied in humans or animals. Following intramuscular injection to man, there is usually a delay of 2-3 days with a peak effect between 10 and 21 days after injection. The duration of response varies but on average is 8-12 weeks.

Contraindications

This toxin is contraindicated in pregnancy and lactation. It should not be used concomitantly with any drug that interferes with neuromuscular transmission or intraneuronal Ca2+ concentration.

Precautions

This toxin should only be injected by specialists experienced in the diagnosis and management of spasmodic torticollis and/or spasticity and who have received training on the administration of this toxin.

Careful consideration should be given before the re-injection of patients who have experienced a previous allergic reaction. The risk of a further allergic reaction must be considered in relation to the benefit of treatment.

Care should be taken on administration of this toxin to any patient with pre-existing swallowing or breathing difficulties that may be exacerbated by diffusion of toxin.

This toxin should only be used with caution under close supervision in patients with subclinical or clinical evidence of marked defective neuromuscular transmission. Such patients may have an increased sensitivity to agents such as this toxin that may result in excessive muscle weakness.

Extensive or inappropriate doses outside the recommended dosage range lead to an increased risk of adverse events. Antibody formation to this toxin had been noted in a small number of patients receiving therapy with this toxin. This is thought to be dose and interval dependent. In patients with neutralising antibodies, it is unlikely that an alternative type A preparation would be effective due to cross-reactivity.

Training

The product distributor will facilitate training in administration of this toxin injections.

This product contains a small amount of human albumin. The risk of transmission of viral infection cannot be excluded with absolute certainty following the use of human blood or blood products.

DUE TO THE LACK OF AN INTERNATIONAL UNIT, this toxin IS NOT THERAPEUTICALLY EQUIVALENT TO THE OTHER TYPE A PREPARATION CURRENTLY AVALABLE ON THE AUSTRALIAN MARKET. THE POTENCIES OF this toxin AND THE OTHER TYPE A PREPARATION ARE BASED ON DIFFERENT ASSAY METHODS. IN VIEW OF THIS LACK OF HARMONISATION OF UNIT SYSTEMS FOR THE OTHER TOXINS TYPE A ON THE MARKET, EXTREME CAUTION IS REQUIRED IF IT SHOULD PROVE NECESSARY TO SUBSTITUTE THE TYPE A TOXIN OF ONE PHARMACEUTICAL COMPANY BY ANOTHER.

Interaction with other drugs

Any drugs which interfere with neuromuscular transmission, such as muscle relaxants; or drugs which interfere with the intraneuronal concentrations of Ca2+ have the potential to interact with botulinum type A toxin. Aminoglycoside antibiotics cause flaccid paralysis by a similar mechanism to that of botulinum neurotoxin. Therefore, in patients undergoing treatment with this toxin, the additive action of aminoglycoside antibiotics may raise the total neuromuscular blockade to the minimum required for an overt effect.

Use in children

The safety and effectiveness of this toxin in children under 2 years of age has not been demonstrated.

Use in elderly

A reduced dose may be appropriate in elderly patients where reduced muscle mass may exist.

Impaired renal or hepatic function

No information is available on the use of this toxin in this population.

Carcinogenesis, mutagenesis and impairment of fertility

Long-term studies in animals have not been performed to evaluate the carcinogenic potential of this toxin. No studies have been conducted to assess the mutagenic potential of this toxin or to assess any likely effect on fertility.

Use in pregnancy - (Category B3)

Animal reproduction studies have not been conducted with this toxin. It is also known whetherthis toxin can cause foetal harm when administered to a pregnant woman or can affect reproduction capacity.

Use in lactation

It is not known whether this drug is excreted in human milk. The safety of the use of this toxin in breastfeeding woman has not been demonstrated.

Effects on ability to drive and use machines

None known.

*One unit (U) is defined as the median lethal intra-pertoneal dose (LD50) in mice of the reconstituted Toxin Powder for Injection.

Please note that this information is for illustrative purposes only. Always ask your Cosmetic Surgery Specialist first!

This page was last updated on the 16th of July of 2009.

For more than two decades, The Aesthetic Surgery Centre has built a reputation as one of Sydney's best Cosmetic Surgery clinics, employing experienced doctors and surgeons and knowledgeable beauty specialists. From major cosmetic surgery operations to non-surgical treatments, our highly skilled team is always committed on delivering professional advice and personalised guidance. So, if you are looking for operations prices, cost and fees information or before & after cosmetic surgery pictures, contact us… or make an online enquiry today.