History
- 1944: toxin purified
- 1970: clinical trials
- 1989: FDA approval of oculinum
Consideration
- advantages: focal & reversible
- natural product, no generics
- 1U = LD50 in mouse
- intraspecies difference in sensitivity
Pharmacology
- 7 serotypes that cleave SNAP, synaptobrevin, and syntaxin
- toxins A and B are usual targets
Types
A - Botox (OnabotulinumtoxinA); Dysport (AbobotulinumtoxinA); Xeomin (IncobotulinumtoxinA); Daxxify (DaxxibotulinumtoxinA-lanm)
B - Myobloc (RimabotulinumtoxinB)
Dilution
Vials type
- botox 50 (cosmetic only)/100/200U
- xeomin 50/100U
Observations
- xeomin can be 1st line, depending on insurance; VA is xeomin instead of botox