Hand and wrist disability due to upper limb spasticity
associated with stroke (specialist use only) | Foot and
ankle disability due to lower limb spasticity associated
with stroke (specialist use only) | Blepharospasm
(specialist use only) | Hemifacial spasm (specialist use
only) | Spasmodic torticollis (specialist use only) | Severe
hyperhidrosis of the axillae (specialist use only) |
Prophylaxis of headaches in chronic migraine (specialist
use only) | Temporary improvement of moderate to
severe upper facial lines in adults under 65 years
(specialist use only) | Management of bladder
dysfunctions (specialist use only) | Chronic sialorrhoea
[due to neurological disorders] (specialist use only)
▶BY SUBCUTANEOUS INJECTION, OR BY INTRADERMAL
INJECTION, OR BY INTRAMUSCULAR INJECTION, OR BY LOCAL
INFILTRATION
▶Adult: (consult product literature)
DOSE EQUIVALENCE AND CONVERSION
▶Important: information is specific to each individual
preparation.
PDF page 447
Acute urinary retention (specific to
use in bladder disorders only). catheterisation difficulties
(specific to use in bladder disorders only). infection at
injection site. presence of bladder calculi (specific to use
in bladder disorders only). urinary tract infection (specific
to use in bladder disorders only)
PDF page 447
GENERAL CAUTIONS Atrophy in target muscle. chronic
respiratory disorder. elderly. excessive weakness in target
muscle. history of aspiration. history of dysphagia.
inflammation in target muscle. neurological disorders.
neuromuscular disorders. off-label use (fatal adverse
events reported)
SPECIFIC CAUTIONS
▶When used for blepharospasm or hemifacial spasm Risk of
angle-closure glaucoma
CAUTIONS, FURTHER INFORMATION Neuromuscular or
neurological disorders can lead to increased sensitivity and
exaggerated muscle weakness including dysphagia and
respiratory compromise.
▶Blepharospasm or hemifacial spasm When used for
blepharospasm and hemifacial spasm, reduced blinking
can lead to corneal exposure, persistent epithelial defect
and corneal ulceration (especially in those with VIIth
nerve disorders)—careful testing of corneal sensation in
Nervous system
previously operated eyes, avoidance of injection in lower
lid area to avoid ectropion, and vigorous treatment of
epithelial defect needed.
PDF pages 447, 448
Preparations are not interchangeable.
PDF page 448
NICE decisions
▶Botulinum toxin type A for the prevention of headaches in
adults with chronic migraine (June 2012) NICE TA260
Botulinum toxin type A (Botox ®)is recommended as an
option for the prophylaxis of headaches in adults with
chronic migraine, (defined as headaches on at least 15 days
per month, of which at least 8 days are with migraine):
. that has not responded to at least three prior
pharmacological prophylaxis therapies, and
. whose condition is appropriately managed for
medication overuse.
Treatment should be stopped in people whose condition:
. is not adequately responding to treatment (defined as
less than a 30% reduction in headache days per month
after two treatment cycles), or
. has changed to episodic migraine (defined as fewer than
15 headache days per month) for three consecutive
months.
Patients currently receiving treatment that is not as
recommended above should have the option to continue
treatment until they and their clinician consider it
appropriate to stop.
www.nice.org.uk/guidance/ta260
▶Xeomin ® (botulinum neurotoxin type A) for treating chronic
sialorrhoea (October 2019) NICE TA605
Xeomin ®(botulinum neurotoxin type A) is recommended,
within its marketing authorisation, as an option for
treating chronic sialorrhoea caused by neurological
conditions in adults. It is recommended only if the
manufacturer provides it according to the commercial
arrangement.
www.nice.org.uk/guidance/ta605
Scottish Medicines Consortium (SMC) decisions
SMC No. 931/13
The Scottish Medicines Consortium has advised (July 2014)
that botulinum toxin type A (Botox ®) is accepted for
restricted use within NHS Scotland for the management of
bladder dysfunctions in adults who are not adequately
managed with anticholinergics (overactive bladder with
symptoms of urinary incontinence, urgency and
frequency), who have failed appropriate oral treatment
options.
SMC No. 692/11
The Scottish Medicines Consortium has advised (February
2017) that botulinum toxin type A (Botox ®) is accepted for
restricted use within NHS Scotland for the prophylaxis of
headaches in adults with chronic migraine, (defined as
headaches on at least 15 days per month, of which at least
8 days are with migraine), that has not responded to at
least three prior oral pharmacological prophylaxis
therapies and whose condition is appropriately managed
for medication overuse.
SMC No. SMC2212
The Scottish Medicines Consortium has advised
(November 2019) that clostridium botulinum neurotoxin
type A (Xeomin ®) is accepted for use within NHS Scotland
for the symptomatic treatment of chronic sialorrhoea due
to neurological disorders in adults.
PDF page 448
