Side effects and safety

Botulinum toxin is an extraordinarily potent substance, having its therapeutic effects in microscopically small doses. Botox therapy is not however the same as botulism, a rare form of food poisoning in which massive amounts of toxin are ingested, causing general paralysis. Well over a thousand studies have now been performed on the uses of toxin and all have confirmed the high degree of safety associated with Botulinum Toxin treatment. Study after study has confirmed side effects to be minor and transient in the vast majority of applications. The only area where more serious side effects have been reported is in therapy in the neck area, where inadvertent spread can affect the swallowing muscles. Treatment in the neck can also have potential hazards for those with pre existing lung disease. Other than this Botulinum Toxin now has a well established record of safety in both the short and long term. There is no evidence to support the occasionally made suggestion that there may be long term side effects.

Side effects can however occur. The largest study on side effects has been in the use of the toxin in children with cerebral palsy where 1594 treatments resulted in a side effect rate of 12%. Doses used in this condition can be relatively high, and yet all side effects were relatively minor and transient.

Common side effects reported are:

Flu like symptoms. These are mild and transient.
Pain at the site of injection, again mild and transient.
Muscle weakness. This is to be expected in the muscles injected but in practice this is rarely a problem. In cosmetics occasionally the eyelid muscle can be paralysed causing the lid to droop but even this is uncommon.
Weakness in other areas is rarely troublesome and is associated with large doses.
Allergy is a theoretical risk but is virtually unknown.
Antibodies can be produced and if this happens the toxin becomes ineffective, but there no other effects. The antibodies often disappear with time and treatment may be successfully recommenced after an interval.

Although the side effects of the toxin are generally uncommon and not serious there are nonetheless contraindications to treatment with botulinum toxin:

Pregnancy, and lactation.
Infection in the vicinity of the injection site.
Current therapy with a certain class of uncommonly used antibiotics, known as the aminoglycosides.
Blood clotting disorders or current therapy with drugs inhibiting blood clotting, eg Warfarin.
Diseases affecting the muscles, particularly myaesthenia gravis.
Allergy to tetanus toxoid is a potential , but not absolute contraindication.

In summary therefore therapy with botulinum toxin is extremely safe and even minor side effects are uncommon and transient.

M K Kocan. 04/07/2004.


	Side effects and safety Botulinum toxin is an extraordinarily potent substance, having its therapeutic effects in microscopically small doses. Botox therapy is not however the same as botulism, a rare form of food poisoning in which massive amounts of toxin are ingested, causing general paralysis. Well over a thousand studies have now been performed on the uses of toxin and all have confirmed the high degree of safety associated with Botulinum Toxin treatment. Study after study has confirmed side effects to be minor and transient in the vast majority of applications. The only area where more serious side effects have been reported is in therapy in the neck area, where inadvertent spread can affect the swallowing muscles. Treatment in the neck can also have potential hazards for those with pre existing lung disease. Other than this Botulinum Toxin now has a well established record of safety in both the short and long term. There is no evidence to support the occasionally made suggestion that there may be long term side effects. Side effects can however occur. The largest study on side effects has been in the use of the toxin in children with cerebral palsy where 1594 treatments resulted in a side effect rate of 12%. Doses used in this condition can be relatively high, and yet all side effects were relatively minor and transient. Common side effects reported are: Flu like symptoms. These are mild and transient. Pain at the site of injection, again mild and transient. Muscle weakness. This is to be expected in the muscles injected but in practice this is rarely a problem. In cosmetics occasionally the eyelid muscle can be paralysed causing the lid to droop but even this is uncommon. Weakness in other areas is rarely troublesome and is associated with large doses. Allergy is a theoretical risk but is virtually unknown. Antibodies can be produced and if this happens the toxin becomes ineffective, but there no other effects. The antibodies often disappear with time and treatment may be successfully recommenced after an interval. Although the side effects of the toxin are generally uncommon and not serious there are nonetheless contraindications to treatment with botulinum toxin: Pregnancy, and lactation. Infection in the vicinity of the injection site. Current therapy with a certain class of uncommonly used antibiotics, known as the aminoglycosides. Blood clotting disorders or current therapy with drugs inhibiting blood clotting, eg Warfarin. Diseases affecting the muscles, particularly myaesthenia gravis. Allergy to tetanus toxoid is a potential , but not absolute contraindication. In summary therefore therapy with botulinum toxin is extremely safe and even minor side effects are uncommon and transient. M K Kocan. 04/07/2004.
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