Botox

Botulinum toxin, or simply botulinum toxin, is a neurotoxin produced by the bacterium Clostridium botulinum. It is the most popular drug for cosmetic and medical procedures called "Botox".

Botulinum toxin works by blocking nerve impulses to muscles, causing them to become temporarily paralyzed. In medicine and cosmetology, botulinum toxin is used to treat a variety of conditions and for aesthetic purposes:

1. Cosmetology: Botulinum toxin is used to reduce expression wrinkles and lines on the face, such as forehead wrinkles, lip curl, wrinkles around the eyes (crow's feet wrinkles), and others. This is achieved by temporarily paralyzing the muscles that cause these wrinkles.
2. Medical uses: Botulinum toxin is used to treat migraines, muscle spasms, excessive sweating (hyperhidrosis), myofascial pain, some forms of strabismus, and other conditions.
3. Bladder Treatment: Botulinum toxin may be used to treat some forms of urinary incontinence and overactive bladder.

Although botulinum toxin is considered relatively safe when used and dosed correctly, it can also cause side effects such as temporary muscle weakness, redness and swelling at the injection site, allergic reactions, and others.

It is important that botulinum toxin treatments are performed by a licensed and experienced professional who can properly evaluate your condition, decide if this type of treatment or cosmetic procedure is right for you, and perform the procedure safely.

Indications botox

1. Cosmetology:

   • Reduction of wrinkles and lines on the face, such as forehead wrinkles, lip curl, wrinkles around the eyes (crow's feet wrinkles) and others.
   • Correction of facial contours, such as raising the eyebrows or reducing the size of the jaw (the "masseter" procedure).
   • Treatment of hyperhidrosis (excessive sweating), especially in the armpits, palms or feet.

2. Medical applications:

   • Migraine treatment.
   • Reducing spastic muscle contractions in conditions such as cerebral palsy or post-stroke spasticity.
   • Treatment of myofascial pain (pain in muscles and tendons).
   • Correction of strabismus.

3. Medical applications in urology:

   • Treatment of urinary incontinence and overactive bladder.

4. Other medical uses:

   • Treatment of hypersalivation (excessive salivation).
   • Help in the treatment of migraines, for example through injections into the muscles of the neck and head.

Release form

Botox is usually supplied as a powder for making an injectable solution. This powder contains botulinum toxin type A, which is the active ingredient. Once the solution is made, which is usually made by a healthcare professional, it can be injected under the skin to treat a variety of medical conditions or for cosmetic purposes, such as reducing wrinkles.

Pharmacodynamics

1. Blocking acetylcholine release: Botox inhibits the release of the neurotransmitter acetylcholine from nerve endings, resulting in muscle paralysis. It does this by binding the toxin to synaptic proteins in the nerve endings and blocking the secretion of acetylcholine.
2. Muscle paralysis: After Botox is injected into a muscle, the local muscle tissue section becomes paralyzed. This occurs due to the blocking of the contractile signal from the nerve endings to the muscle fibers.
3. Temporary action: The effect of Botox is temporary and usually lasts from several months to six months. After that, the muscles regain their activity as the neurotransmitter exchange is restored.
4. Cosmetic uses: In cosmetic medicine, Botox is used to reduce wrinkles and lines on the face, such as wrinkles on the forehead, between the eyebrows and around the eyes.
5. Medical Uses: Botox is also used medically to treat a variety of conditions such as migraines, muscle spasms, spastic paralysis, and hyperhidrosis (excessive sweating).
6. Safety: When used correctly, Botox is considered a relatively safe drug, but side effects may include temporary muscle weakness and, rarely, allergic reactions.

Pharmacokinetics

1. Absorption: Botulinum toxin is absorbed into the bloodstream after administration, regardless of the route of administration (local intramuscular or subcutaneous injection).
2. Distribution: After absorption, botulinum toxin is distributed into the tissues at the injection site and may migrate to adjacent nerve endings.
3. Metabolism: Botulinum toxin is metabolized very slowly, if at all, and is not broken down for several months.
4. Action: Botox works by blocking the release of acetylcholine in nerve endings, which leads to temporary muscle paralysis.
5. Duration of action: The effect of Botox injections usually lasts from several months to six months, after which a repeat injection is required.
6. Excretion: Botulinum toxin is eliminated from the body slowly because it is metabolized and excreted from the body through the kidneys.
7. Half-life: The half-life of Botox can vary depending on the dosage, injection site, and individual differences, but is typically several weeks or months.

Dosing and administration

1. Cosmetic use (wrinkle reduction):

   • The dosage and number of injection points may vary depending on the area to be treated and the individual characteristics of the patient.
   • In general, for injections in the facial area, the dosage is usually between 4 and 20 units of Botox per injection site.
   • Typically no more than 50-100 units per session is recommended.

2. Medical use (treatment of medical conditions):

   • Dosage and injection sites can vary greatly depending on the specific medical condition being treated.
   • For the treatment of muscle spasms, doses higher than those used for cosmetic purposes are usually used.
   • Injections are usually given into the muscles using a very thin needle.

Use botox during pregnancy

The safety of botulinum toxin during pregnancy has not been established. Due to limited data and potential risks, Botox use during pregnancy is not recommended. Here are some key points to consider:

1. Lack of data:

   • There is very little clinical data on the safety of Botox in pregnant women. Animal studies have shown some negative effects, but the data are limited and difficult to extrapolate to humans.

2. Theoretical risks:

   • Botox works by blocking nerve impulses, causing muscles to relax. Theoretically, its effects could extend beyond the injection site, potentially affecting other areas of the body, including uterine tone or even fetal development.

3. Doctors' recommendations:

   • Most doctors advise avoiding non-essential procedures, including Botox injections, during pregnancy, especially in the first trimester when the baby's most important structures are being formed.

Alternatives:

For women looking for ways to care for their skin during pregnancy, there are safer, more natural alternatives that can help manage pregnancy-related skin changes without posing a risk to the developing baby. These methods include using moisturizing and nourishing creams, as well as gentle cleansers and sunscreens.

Contraindications

1. Individual intolerance or allergic reaction: People with known individual intolerance to botulinum toxin or any other component of the drug should avoid using it.
2. Pregnancy and breastfeeding: The safety of using botulinum toxin during pregnancy and breastfeeding has not been established. Therefore, to avoid negative consequences, its use should be agreed with a doctor.
3. Myasthenia gravis: Botulinum toxin use may worsen muscle weakness in patients with myasthenia gravis, which can lead to serious complications.
4. Injection Site Infections: Botulinum toxin injection procedures are not recommended if there are active infections in the area where the injection is planned.
5. Multiple Sclerosis: In multiple sclerosis, the use of botulinum toxin may increase muscle weakness and make the condition worse.
6. Blood clotting problems: Patients with bleeding disorders may require caution when using botulinum toxin due to the risk of bleeding at the injection site.
7. Weakened muscles or atrophy: Using Botox can cause further weakening of already weakened muscles or atrophy, especially if used incorrectly.

Overdose

1. Muscle paralysis: Too high a dose of Botox can cause the paralyzing effect to spread to nearby muscles, which can cause difficulty breathing, trouble swallowing, and other problems.
2. General systemic effects: Overdose of Botox may cause general systemic symptoms such as weakness, fatigue, dizziness, nausea, vomiting, loss of appetite, fever, and others.
3. Loss of muscle control: Severe muscle weakness may develop, which can lead to loss of control of movement and even paralysis.
4. Systemic complications: Overdose of Botox can cause serious systemic complications such as respiratory failure, arterial hypotension, cardiac arrhythmia, and others.
5. Allergic reactions: In rare cases, allergic reactions to the components of the drug may develop.

Interactions with other drugs

1. Antibiotics: Using Botox in combination with antibiotics, such as aminoglycoside antibiotics (eg, gentamicin), may increase muscle weakness or paralysis.
2. Medications that affect blood clotting: Using anticoagulants or antiplatelet medications in combination with Botox may increase the risk of bleeding or bruising at the injection site.
3. Muscle relaxants: Combining Botox with muscle relaxants may enhance their interaction and result in increased muscle weakness or relaxation.
4. Drugs that affect nervous system function: Using drugs that affect nervous system function in combination with Botox may alter its effect or increase centrally acting side effects.
5. Drugs that change sweating: Combining Botox with drugs that affect sweating (such as anticholinergic drugs) may alter the effect of hyperhidrosis treatment.

Storage conditions

Store in the refrigerator at a temperature of 2°C to 8°C. Botox should not be frozen. Refrigeration helps maintain the stability of the product and prevents its decomposition.

After diluting the Botox powder with saline (sodium chloride), the solution should be used immediately or stored in the refrigerator at 2°C to 8°C and used within a few hours.