Adult Botulinum Toxin

Download and print as a PDF (198kB pdf)

Blepharospasm, Hemifacial Spasm, Cervical dystonia, Excessive Salivation

This is a guide only and you will be able to discuss this treatment in your outpatient appointment with your consultant or nurse injector.

What is Botulinum Toxin?

Botulinum toxin is produced by bacteria which can be used in minute quantities to reduce stiffness or tone within individual muscles.

What is Botulinum toxin used for?

Botulinum toxin is used for the treatment of different types of Dystonia, and excessive salivation.

Some of these include:

• Blepharospasm: uncontrollable blinking and closure of the eyelids.
• Hemifacial Spasm: a movement disorder causing one side of the face to contract.
• Cervical dystonia: (Cervical Torticollis) causing the head to tilt or twist to one side or backwards or forwards.
• Excessive Salivation: Treats sialorrhea (drooling)

How does Botulinum toxin work?

The toxin acts on the junctions between the nerves and muscles preventing the release of one of the chemical messengers called acetylcholine from the nerve endings, which would normally cause the muscle to contract. This results in a weakened muscle and helps to reduce some of the abnormal muscle contractions.

How long does it take to work and how often will I have the injections?

The toxin can take up to a week to take effect and on average lasts between 3-4 months, some patients notice wearing off symptoms 2-3 weeks before their next injection.

Although it can last longer. Some patient may only need treatment every 6 months but on average patients have the injections every 3-4 months.

Can I have the injections more often than three months and what is the maximum dose I can have?

It is not recommended to have the injections any sooner than every three months. Although depending on the brand that is used this may be sooner, your doctor or nurse can give your more information about this.

The dosage varies depending on each patient’s individual condition and can be altered according to the effect they have had or if any side effects are experienced.

Is there any reason for not being given botulinum toxin?

You should not be given botulinum toxin if you are having a baby, are breast feeding or have a known allergy to the drug.

If you are using any antibiotics (for example aminoglycosides or fluoroquinolones). 

Any medicines that affect the nerves that control muscles (for example anticholinesterase medicines or muscle relaxants). Some of these medicines may increase the effect of Botulinum toxin. 

If you have recently been injected with any other medicine containing a botulinum toxin, as this may increase the effect of botulinum toxin too much.

If you are taking any antiplatelet (such as aspirin) products and/or anticoagulants (blood thinners). Botulinum toxin can be safely administered to patients on antiplatelets or anticoagulants, but there is an increased risk of bruising, swelling, and bruising at the injection site.

Please let your Doctor, Pharmacist or Nurse know.

How will the injections be given?

You will be assessed by a trained doctor or nurse before your injections; this is to assess if the injections helped your symptoms or whether you experienced any side effects.

The botulinum toxin will be injected into the affected muscle.

You must tell the doctor or nurse if you have experienced any of the following after your previous injections:

• You have had any breathing problems
• Flu like symptoms
• Skin rashes
• Swallowing problems
• Problems with your eyes closing
• The injections have not helped in any way
• You are on warfarin or any blood thinning medication.

Will I be able to drive or work straight after the injections?

You can drive or go back to work after the injections; most patients don’t have any immediate side effects.

What will happen if I miss an injection or stop having the injections?

Nothing will happen if you stop or miss an injection other than your symptoms will return.

The effect of the toxin will wear off and the muscles will return to how they were before the treatment.

What are the side effects?

On rare occasions there have been complaints of flu-like symptoms, such as headaches or tiredness.

When injections are carried out over the eye area this can cause eye dryness, double vision and bruising. Sometimes the eye may close completely or there may be asymmetry of the face.

When injections are carried out in neck muscles patients can sometimes experience swallowing difficulties and may need to eat a soft diet until swallowing becomes easier.

Botox for excessive salivation, side effects include, Dry Mouth, Thickened Saliva Swallowing/Chewing Difficulties, Injection Site Reactions and Facial Weakness.

These symptoms are usually short lasting but please let the nurse or doctor know on your next appointment.

If you are concerned or your symptoms are becoming worse, and you consider it urgent, please contact Sharon Elder 01273 696955 Ext. 62964 (Mon-Fri) or contact NHS 111 out of hours or 999.

More information