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, resulting in temporary paralysis. In medicine and cosmetology, botulinum toxin is used to treat various conditions and aesthetic purposes:

1. Cosmetology: Botulinum toxin is used to reduce facial wrinkles and lines, such as forehead wrinkles, curled lips, 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 can 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 assess your condition, decide whether this 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), and others.
   • Facial contour correction, 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 soles of the feet.

2. Medical applications:

   • Treatment of migraines.
   • Reduction of spastic muscle contractions in diseases such as cerebral palsy or spasticity after a stroke.
   • 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 applications:

   • Treatment of hypersalivation (excessive salivation).
   • Assistance in the treatment of migraines, for example by 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. This is achieved by binding the toxin to synaptic proteins in nerve endings and blocking the secretion of acetylcholine.
2. Muscle paralysis: After Botox is injected into a muscle, the local muscle tissue becomes paralyzed. This occurs due to blocking the contractile signal from nerve endings to muscle fibers.
3. Temporary effect: The effect of Botox is temporary and usually lasts from several months to six months. After this, the muscles restore their activity as neurotransmitter metabolism is restored.
4. Cosmetic Uses: In cosmetic medicine, Botox is used to reduce wrinkles and lines on the face, such as those on the forehead, between the eyebrows, and around the eyes.
5. Medical Uses: Botox is also used medically to treat various 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 unwanted 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 administration).
2. Distribution: After absorption, botulinum toxin is distributed in the tissues at the injection site and can migrate to adjacent nerve endings.
3. Metabolism: Botulinum toxin is metabolized very slowly, if at all, and does not degrade for several months.
4. Action: The action of Botox is based on blocking the release of acetylcholine in nerve endings, which leads to temporary paralysis of muscles.
5. Duration of action: The effect of Botox injection usually lasts from several months to six months, after which a second injection is required.
6. Excretion: Botulinum toxin is eliminated from the body slowly as it is metabolized and exits the body through the kidneys.
7. Half-life: The half-life of Botox can vary depending on the dosage, injection site and individual characteristics, but is usually several weeks or months.

Dosing and administration

1. Cosmetic use (reduction of wrinkles):

   • 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 facial injections, the dosage is usually 4 to 20 units of Botox per injection site.
   • No more than 50-100 units per session is usually recommended.

2. Medical use (treatment of medical conditions):

   • Dosage and injection sites can vary greatly depending on the specific medical condition being treated.
   • Treatment of muscle spasms usually uses doses higher than those used for cosmetic purposes.
   • 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, the use of Botox during pregnancy is not recommended. Here are the main points to consider:

1. Lack of data:

   • There is very little clinical data on the safety of Botox in pregnant women. Animal experiments 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, which leads to muscle relaxation. Theoretically, its effects could spread 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 critical 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 the use of moisturizing and nourishing creams, as well as gentle cleansers and sunscreens.

Contraindications

1. Individual intolerance or allergic reaction: People with a known individual intolerance to botulinum toxin or any other component of the drug should avoid its use.
2. Pregnancy and breastfeeding: The safety of botulinum toxin use during pregnancy and breastfeeding has not been established. Therefore, in order to avoid negative consequences, its use should be agreed with a doctor.
3. Myasthenia gravis: The use of botulinum toxin may increase muscle weakness in patients with myasthenia gravis, which can lead to serious complications.
4. Injection site infections: The botulinum toxin injection procedure is not recommended if there is active infection in the area where the injection is planned.
5. Multiple sclerosis: In multiple sclerosis, use of botulinum toxin may increase muscle weakness and worsen the condition.
6. Blood coagulation problems: Patients with bleeding disorders may require careful use of botulinum toxin due to the risk of bleeding at the injection site.
7. Weakened muscles or atrophy: Use of Botox can lead to 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 breathing difficulties, problems swallowing and other problems.
2. General systemic effects: An overdose of Botox can 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 and even paralysis.
4. System complications: Overdose of Botox can cause serious systemic complications such as respiratory failure, arterial hypotension, cardiac arrhythmias 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 (such as gentamicin), may increase muscle weakness or paralysis.
2. Drugs that affect blood clotting: Using anticoagulants or antiplatelet drugs 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 increase their interaction and lead to increased muscle weakness or relaxation.
4. Drugs affecting nervous system function: The use of drugs affecting nervous system function in combination with Botox may alter its effect or increase side effects associated with central action.
5. Drugs that alter sweating: Combining Botox with medications that affect sweating (such as anticholinergics) may alter the effect of hyperhidrosis treatment.

Storage conditions

Store in the refrigerator at a temperature of 2°C to 8°C. Do not freeze Botox. Storing in the refrigerator helps maintain the stability of the product and prevent its decomposition.

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