Uses
What is Botox used for?
Botox (onabotulinumtoxinA) is commonly used for the following conditions.
- Overactive bladder, when you have an urgent need to pee even if your bladder is not full, wetting accidents because of a strong need to pee, or frequent peeing
- Leakage of urine (urinary incontinence) or overactive bladder caused by certain nervous system conditions
- Prevention of headaches in people with chronic migraine
- Muscle stiffness in people with spasticity
- Abnormal head position and neck pain that happens with cervical dystonia, a condition that causes your neck muscles to contract
- Certain eye muscle problems, such as crossed eyes (strabismus) or abnormal spasms of the eyelids (blepharospasm)
- Severe underarm or armpit sweating, also called axillary hyperhidrosis
For information on Botox for cosmetic use, see Botox Cosmetic.
Botox may also be used for other conditions as determined by your healthcare provider.
How does Botox work (mechanism of action)?
Botox works by blocking certain nerve signals and reducing muscle activity at the site where it is injected.
How is Botox supplied (dosage forms)?
Botox is available as an injection that is given by a healthcare provider.
How should I store Botox?
Botox is usually given by a healthcare provider in a hospital or clinic. If you will store Botox at home, follow the instructions given by your healthcare provider.
Side Effects
What are the most common side effects of Botox?
The most common side effects of Botox are listed below. These side effects may vary depending on the condition that is being treated and where you receive your injection. Tell your healthcare provider if you have any of these side effects that bother you.
- Discomfort or pain at the injection site
- Dry mouth
- Tiredness
- Headache
- Pain in your neck, back, arms, or legs
- Eye problems, such as double vision, blurred vision, decreased eyesight, drooping eyelids, swelling of your eyelids, and dry eyes
- Drooping eyebrows
- Trouble swallowing
- Sweating
- Urinary tract infection
- Feeling pain when you pee
- Dark, cloudy, or bloody pee or pee that smells bad
- Urinary retention, which is the inability to empty your bladder
- Infection in the nose or throat, sore throat, cough, runny or stuffy nose, flu-like symptoms, or common cold symptoms
There may be other side effects of Botox that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.
What are the serious side effects of Botox?
While less common, the most serious side effects of Botox are described below, along with what to do if they happen.
Severe Allergic Reactions. Botox may cause allergic reactions, which can be serious. Stop using Botox and get help right away if you have any of the following symptoms of a serious allergic reaction.
- Breathing problems or wheezing
- Racing heart
- Fever or general ill feeling
- Swollen lymph nodes
- Swelling of the face, lips, mouth, tongue, or throat
- Trouble swallowing or throat tightness
- Itching, skin rash, or pale red bumps on the skin called hives
- Nausea or vomiting
- Dizziness, feeling lightheaded, or fainting
- Stomach cramps
- Joint pain
Breathing, Swallowing, or Speaking Problems. Botox may cause problems with breathing, swallowing, or speaking. This can be serious or life-threatening. This is caused if the muscles you use to breathe and swallow become weak after the injection. It can happen hours, days, or weeks after your dose. Swallowing difficulties can last for several months. People who have trouble swallowing may need a feeding tube to get food and water. If swallowing issues are severe, food or liquids could enter your lungs. Get emergency medical help right away if you have trouble breathing, swallowing, or speaking.
Spread of Toxin Effects. The medicine in Botox may affect areas of your body away from the injection site. This may cause symptoms of a serious condition called botulism. Symptoms of botulism can start within hours, days, or weeks after your dose. Contact your healthcare provider right away if you have any of the following symptoms of botulism.
- Loss of muscle strength or muscle weakness all over your body
- Double vision, blurred vision, and drooping eyelids
- Losing your voice or voice changes, such as hoarseness
- Trouble saying words clearly
- Loss of bladder control
- Trouble breathing or swallowing
Eye Surface Problems. When Botox is used to treat eyelid spasms (blepharospasm), it can reduce blinking. This may cause the surface of your eye to dry out and become exposed, which can lead to more serious issues, like an open sore on your eye (corneal ulcer). The risk is higher in people with certain nerve disorders. If you notice any changes in your eyes, such as eye dryness or irritation, tell your healthcare provider right away. Your healthcare provider may treat you with eye drops, ointments, special contact lenses, or covering your eye to protect it.
Eye Bleeding. When Botox is used to treat crossed eyes (strabismus), bleeding can sometimes happen behind the eye, called retrobulbar hemorrhage. This can affect blood flow to a part of your eye called the retina, which is important for vision. Tell your healthcare provider right away if you have any eye problems, such as eye pain, vision loss or other vision changes, or bulging eyes.
Bronchitis and Upper Respiratory Infections. When Botox is used to treat muscle stiffness (spasticity) in the arms, bronchitis (lung inflammation) or upper respiratory infections may occur. The risk is higher in people with certain lung problems. Tell your healthcare provider if you have signs of a respiratory infection, such as coughing, a stuffy nose, or a sore throat.
High Blood Pressure Caused By Nervous System Problems. When Botox is used to treat bladder problems caused by certain nerve conditions, it can lead to a serious reaction called autonomic dysreflexia. This condition can cause sudden high blood pressure and may need immediate medical treatment. If you measure your blood pressure and the top number (systolic) is 180 mm Hg or higher or the bottom number (diastolic) is 120 mm Hg or higher, get medical attention right away. Increases in blood pressure may not be noticeable but look out for any of the following symptoms of severely high blood pressure.
- Sudden severe headache
- Chest pain
- Dizziness or confusion
- Trouble breathing
- Nausea/vomiting
- Blurry or other changes to vision
- Anxiety
- Buzzing in the ears
- Nosebleed
- Feeling of skipped heartbeats
Inability to Empty Bladder (Urinary Retention). When Botox is used to treat overactive bladder or urinary incontinence caused by certain nervous system conditions, it might make it harder to empty your bladder. Call your healthcare provider right away if you are having trouble peeing or cannot empty your bladder. Your healthcare provider may decide that you need a catheter to help drain your bladder if you are unable to pee on your own.
Heart Effects. Botox may increase your risk of certain effects on the heart, such as causing an abnormal heart rhythm (arrhythmia) or a heart attack, which could lead to death. Get emergency help if you have chest pain or pressure, trouble breathing, or if you have a change in your heart rate or rhythm, such as a fast, slow, pounding, or skipping heartbeat.
Warnings & Precautions
Who should not use Botox?
Allergies to Ingredients. People who are allergic to any of the following should not use Botox.
- OnabotulinumtoxinA
- Botox or Botox Cosmetic
- Other botulinum toxins, such as rimabotulinumtoxinB (Myobloc), abobotulinumtoxinA (Dysport), or incobotulinumtoxinA (Xeomin)
- Any of the ingredients in the specific product dispensed
Your pharmacist can tell you all of the ingredients in Botox.
Skin Infection. Botox should not be injected into skin that is infected. Tell your healthcare provider if you have any symptoms of skin infection, such as redness, pain, swelling, warm skin, or blisters.
Urinary Tract Infection. Botox should not be used to treat certain conditions if you have a urinary tract infection. Tell your healthcare provider if you have any of the following symptoms of a urinary tract infection before or after you receive Botox.
- Dark, cloudy, or bloody pee or pee that smells bad
- Fever and chills
- Loss of appetite
- Needing to pee a lot or feeling pain when you pee
- Pain in your lower back, side, or groin
- Upset stomach, nausea, and vomiting
Inability to Empty Bladder (Urinary Retention). Botox should not be used to treat certain conditions if you are unable to empty your bladder, also called urinary retention. Tell your healthcare provider if you cannot empty your bladder.
What should I know about Botox before using it?
Do not use Botox unless it has been prescribed by a healthcare provider. Your healthcare provider will store and give you the medicine.
Botox may cause loss of strength, muscle weakness, vision problems, or dizziness. This may happen within hours, days, or weeks after an injection of Botox. Do not drive or do other activities that require alertness or coordination until you know how Botox affects you.
People who are 65 and older can be at greater risk for some side effects from Botox. Talk to your healthcare provider about your risks if you are in this age group.
What should I tell my healthcare provider before using Botox?
Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if Botox is right for you.
In particular, make sure that you discuss any of the following.
Current and Past Health Conditions. Tell your healthcare provider if you have any of the following.
- Muscle or nerve disorders, such as amyotrophic lateral sclerosis (ALS) or Lou Gehrig's disease, myasthenia gravis, or Lambert-Eaton syndrome
- Breathing problems, such as asthma or emphysema
- Swallowing problems
- Bleeding problems
- Plans to have surgery
- Past surgery on your face
- Weakness of your forehead muscles, such as trouble raising your eyebrows
- Drooping eyelids
- Changes in the way your face normally looks
- Urinary tract infection symptoms, such as pain or burning when you pee, frequent peeing, or fever
- Inability to empty your bladder (urinary retention)
- Diabetes
- Heart problems, including heart disease
Other Medicines and Supplements. Botox may interact with other medicines and supplements. Before receiving Botox, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.
Pregnancy. It is not known if or how Botox could affect pregnancy or harm an unborn baby. Tell your healthcare provider if you are or plan to become pregnant.
Breastfeeding. It is not known if Botox passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should receive Botox while breastfeeding.
How can I get more information about Botox?
For more information about Botox, you can visit the manufacturer’s website at www.botox.com or call them at 800-255-5162.
Interactions
Does Botox interact with foods or drinks?
There are no known interactions between Botox and foods or drinks.
It is unknown if drinking alcohol will affect Botox. If you have dizziness or blurred vision from Botox, alcohol may worsen these effects.
Does Botox interact with other medicines (drug interactions)?
Botox interacts with many other medicines. Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.
In particular, make sure that you discuss if you are using or have used any of the following before using Botox.
- Any other botulinum toxin product, such as rimabotulinumtoxinB (Myobloc), abobotulinumtoxinA (Dysport), or incobotulinumtoxinA (Xeomin)
- Any aminoglycoside antibiotic, such as amikacin or gentamicin, which is given by injection to treat infections
- A muscle relaxant, such as carisoprodol (Soma), cyclobenzaprine (Amrix), or tizanidine (Zanaflex)
- An anticholinergic medicine, which includes antihistamines and medicines commonly used for overactive bladder, Parkinson’s disease, or stomach problems
- A sleep medicine, such as temazepam (Restoril), zolpidem (Ambien and others), or eszopiclone (Lunesta)
- Aspirin, which is in many prescription and OTC products including those for pain, swelling, and fever
- An antiplatelet medicine, such as clopidogrel (Plavix), ticagrelor (Brilinta), aspirin/dipyridamole, or cilostazol, which is a medicine used to prevent blood clots
- A blood thinner, which is a medicine used to treat or prevent blood clots
This may not be a complete list of medicines that can interact with Botox. Always check with your healthcare provider.
Overdose/Missed Dose
What should I do if I accidentally use too much Botox?
If you or someone else has used too much Botox, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.
What should I do if I miss a dose of Botox?
Botox is usually given by a healthcare provider in a clinic. Your healthcare provider will make sure you are receiving Botox as scheduled.
If you miss an appointment to get your Botox dose, call to make another appointment as soon as possible.