Botox Injections

BOTOX® is a therapeutic muscle-relaxing agent that works at motor nerve endings
(nerves that lead to muscles). It is in a class of drugs called neurotoxins. When
considering neurotoxin therapy, it is important to understand how the product works,
the history of its use in patients, its protein content, and possible side effects. This
information will help you understand more about BOTOX®: what it is, how it
works, and how it can help you.

What is BOTOX®?
BOTOX® is a novel therapeutic agent derived from the bacterium, Clostridium
Botulinum. Also known as Botulinum Toxin Type A, the brand BOTOX® is
produced in controlled laboratory conditions and given in extremely small
therapeutic doses. BOTOX® is indicated for the treatment of blepharospasm
associated with dystonia in patients 12 years of age and above. BOTOX® is being
investigated for several conditions associated with overactive muscle activity,
known as myofascial pain. Botulinum Toxin Type A is the most studied of the seven
different serotypes of botulinum toxin (A, B, C1, D, E, F, G). Each serotype has
different properties and actions. No two are exactly alike.
How does BOTOX® work?
Normally your brain sends electrical messages to your muscles so that they can
contract and move. The electrical message is transmitted to the muscle by a
substance called acetylcholine. BOTOX® works to block the release of
acetylcholine and, as a result, the muscle doesn’t receive the message to contract.
This means that the muscle spasms stop or are greatly reduced after using BOTOX®,
providing predictable and reliable relief from symptoms.

BOTOX® is not a cure. For many patients, however, its effects have been dramatic
– symptoms usually begin to dissipate within a few days and the effects can last up
to six months.

How is BOTOX® administered?
BOTOX® is injected into the muscle. Your physician will determine the muscle(s)
in need of treatment.
Does the treatment hurt?
A very fine needle is used for the one to three injections that are usually given per
muscle. Some patients report minor and temporary discomfort from treatment.
When does BOTOX® start to work?
Usually you will see the effects of BOTOX® within three days. The maximum
benefit is reached in one to two weeks.
How long does the effect last?
Given its unique mechanism of action, BOTOX® offers sustained relief, dose after
dose over the course of long-term treatment. The relief you will feel from a single
treatment of BOTOX® will normally be sustained for approximately three to six
months. You may notice a gradual fading of its effects. At this point you will return
to your physician for additional evaluation and treatment. BOTOX® injections can
be repeated in three to six months. Symptoms may vary throughout the course of the
condition, and so the degree of relief and duration of effect varies from person to
person. Consult your physician, who has special knowledge about how to achieve
the best possible results with BOTOX® for your individual case.
How long can I be treated with BOTOX®?
Treatment with BOTOX® can typically be repeated indefinitely. BOTOX® has
been used for over 10 years worldwide. Acceptable safety in long-term treatment

has been well established. There are a number of factors that can impact the long-
term usage of BOTOX®. These include:

1. Setting appropriate expectations – Changes occurring with subsequent
BOTOX® injections may be less dramatic than the first injection.
2. Appropriate muscle selection – Identifying and injecting the affected muscle
can be difficult, complicated by the changing pattern of muscle involvement
and progression of the disorder.
3. Adequate dosing – Changes in response may require dose adjustment.
4. Minimizing exposure to neurotoxin complex proteins – Botulinum toxins
contain proteins. In certain circumstances, when foreign proteins enter the
body, the natural response is to form antibodies to the protein. When
antibodies are formed, the effect may be that one is no longer able to
respond to the therapy. High doses and frequent injections of botulinum
toxin have been linked to the formation of antibodies. 1,2 Antibody
formation with BOTOX® is rare. The likelihood of forming antibodies is
reduced by having treatment no more frequently than about every three
months. BOTOX® has approximately 5ng of neurotoxin complex proteins
per 100 unit vial, a relatively low amount of protein, which may help to
further minimize the potential to form antibodies.

Is BOTOX® a new treatment?
Not at all! BOTOX® has been used for over 10 years in hundreds of thousands of patients
worldwide. The American Academy of Neurology, American Academy of
Ophthalmology, and National Institutes of Health have recognized BOTOX®
(Botulinum Toxin Type A) as a valuable treatment.

Is BOTOX® right for me?
Ask your physician if BOTOX® is the right treatment for you. BOTOX® should not
be used during pregnancy, if you are nursing, or if you are taking certain
medications. Only your physician can determine the best course of therapy. The
effects of BOTOX® may be increased with the use of certain antibiotics or other
drugs that interfere with neuromuscular transmission. Ensure that your physician is
aware of any current medications you are taking.

What side effects may be experienced when using BOTOX®?
All medications have some side effects. With BOTOX®, side effects are usually
transient and mild to moderate in nature. Some people notice temporary weakness
of muscles or discomfort at the injection site. Other less common side effects may
include low grade fever, or flu-like symptoms for the first 24 hours. If you have
any questions regarding the use of BOTOX® treatment, please consult your
physician.

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