Botox composition of the drug for the face

Why is Botox not losing ground and why do patients want to change their faces with these injections? There are many reasons for this, one of them is circulation. Is the drug as safe as the advertisement says? Let's figure it out, because you need to take care of your health. The article details the composition of Botox, as well as other important nuances of the procedure.

Components

What is included in the anti-aging drug? The composition of Botox is as follows:

1. The active substance is botulinum toxin type A, also called hemagglutinin. One bottle of the drug contains 200 or 100 units of action.
2. Human serum albumin. Excipient. For 200 and 100 units there are 1 or 0.5 milligrams.
3. Sodium chloride. One bottle can contain 1.8 or 0.9 milligrams.

"Botox" is available in the form of a lyophilisate, which is necessary for preparing a solution for intramuscular use.

There is no reason to panic yet, but you still do not know the nature of the main substance of the drug. Botulinum toxin is a strong poison. For this reason there are many contraindications.

Pharmacological properties

But still, it is not enough to know the composition of Botox; you need to understand how it works. The molecule consists of two chains: light and heavy. They connect through a disulfide bond.

In the first stage of action, the toxin molecule binds to the presynaptic membrane. At the second stage, the toxin in bound form penetrates the cytoplasm of neurons by endocytosis. In the final stage, prolonged chemodenervation can be observed.

Knowing the composition of Botox, we can assume its therapeutic effect, and it consists in the fact that the muscles relax greatly after the injection. Reinnervation occurs in the denervated muscle. The latter means that lateral processes of nerve endings are formed. The process begins twelve weeks after the injection. This restores muscle contraction in the best possible way.

Before you decide to have injections, you should understand that the effect is very unstable and regression occurs after some time. At this point, primary neuromuscular transmission is activated.

Pharmacokinetics

We have figured out the composition of Botox, let’s move on to the action of the medicine. It begins at the injection site. Studies have been conducted which have confirmed that reverse axonal transport of the active substance, as well as presynaptic uptake from the injection site, is not very important. If you follow the recommended doses, the composition of Botox for the face will not cause harm. A safe drug is now being used.

Antibodies to botulinum toxin are not formed very often - in 1-5%. If Botox is administered in large doses and rest periods are not observed, then more antibodies are produced. This leads to a decrease in the effectiveness of therapy.

Indications

Enough of the confusing medical terms, let's use clear words. The composition of Botox for the face has become safer, but this does not mean that it can be used thoughtlessly. There are indications for which injections are given, and we will now look into them:

1. Deep wrinkles on areas of the face. We are talking about nasolabial folds, frontal lobes. Sharp depressions near the bridge of the nose can also be corrected with Botox; they are also called “bunny” wrinkles.
2. Increased sweating. Oddly enough, botulinum toxin injections also help with excessive sweating (hyperhidrosis).
3. Age-related changes in the face. These include a “leaky” oval, which is corrected through Botox lifting. Often women choose beauty injections instead of surgical lifting and are satisfied.

These are the most common reasons for administering the drug, but few people know that Botox is also used for other problems:

1. Hemifacial spasm.
2. Blepharospasm.
3. Paralytic strabismus or otherwise strabismus.
4. Cervical dystonia (spasmodic torticollis).
5. Local muscle spasm in cerebral palsy. Prescribed for children over two years of age.
6. Focal spasticity of the hand and wrist in those who have had a stroke.

Contraindications

The composition of Botox, a drug for the face, is quite harmless, however, it cannot always be used. What is meant:

1. Breastfeeding and pregnancy.
2. False paralysis or rapid fatigability syndrome of striated muscles.
3. Sessions cannot be performed during chemotherapy or while taking antibiotics. Cosmetologists do not conduct sessions even if the patient takes vitamins with calcium.
4. Exacerbation of herpes.
5. Premenstrual, menstrual period. Injections should not be given two days before the start of menstruation and during bleeding. If a woman has reached menopause, then Botox injections will have to be abandoned.
6. Farsightedness and myopia.
7. For blood diseases or poor circulation. This also includes hemophilia.
8. Infectious diseases and inflammation at the injection site.
9. Hernias on the lower and upper eyelids.
10. Established hypersensitivity to the composition of the drug for the face.
11. Botox cannot be done if there is severe gravitational ptosis of the facial tissues.

When to use with caution

We already know what is included in Botox for the face and have even noted who should not use injections. This doesn't mean there are no options. There are some situations when the use of the drug is possible only after consultation with a doctor. We are talking about the following conditions:

1. Severe atrophy or weakness of the muscles that are supposed to be worked with the solution.
2. Clinical and subclinical signs that neuromuscular transmission is impaired. The category includes Lambert-Eaton syndrome, myasthenia gravis.
3. Peripheral motor neuropathic diseases such as motor neuropathy or amyotrophic sclerosis.

Dosage and method of administration

The first thing to say is that Botox is restored only with a 0.9% sodium chloride solution, which is suitable for injection. The solution is introduced very carefully into the bottle, while the latter must be carefully rotated and under no circumstances shaken. Violent shaking will denature the medication.

If the solution is ready for use, it is colorless or yellowish. There are no foreign particles in the liquid, but slight scattering can sometimes be observed. The finished product can be stored for no more than a day in the refrigerator. Storage temperature should be 2-8 degrees.

What is included in Botox for the face? When a milliliter of solvent is added to a solution, the concentration becomes 10 action units per 0.1 milliliter. It is important to understand that the units of action in different botulinum toxin preparations are not interchangeable.

The solution is administered using an insulin syringe, the needle of which cannot be removed. To make injections without consequences, it is not enough to just know what is included in Botox for the face. It is important to find a specialist who will do everything right. The person to whom you entrust the person must have permission from the manufacturer, as well as complete special courses. To administer the solution, sterile conditions are required, and therefore the drug is not suitable for home use.

The doctor selects the dosage and injection sites for each patient personally. The choice depends on where the muscle activity is located. Sometimes electromyography is used to determine the exact location.

When no improvement is observed after the first procedure, studies are carried out a month later to confirm the effect of the toxin. The reasons for the lack of effectiveness are then identified. This may be incorrectly selected injection points, incorrect injection technique, or insufficient dose. The specialist also evaluates whether it is advisable to continue using the drug.

Injections in the frontal area

The composition of the drug "Botox" only, at first glance, seems simple. In fact, the solution requires special storage conditions, as well as administration techniques.

How is the injection done? First, the desired area is thoroughly cleaned. It doesn't matter whether you have makeup on your face or not. You need to cleanse your skin even without makeup, as your face may be oily, dusty or dirty. An alcohol solution is used for processing.

The forehead is divided into several parts: central, lateral, lower and hairline. First of all, injections are administered to the central zone. How does this happen? The cosmetologist grabs the skin in the middle of the forehead. The result is a small fold, the thickness of which does not exceed 5 millimeters. The needle is inserted until it stops, so that it rests on the bone. As soon as the specialist feels that the needle has reached the bone, he immediately releases the skin and slowly injects the drug.

If after removing the needle from the puncture there is bleeding, it is stopped with a cotton swab soaked in Chlorhexidine. The next injection point is marked at the same level as the previous one. All actions are repeated. How many injections are required depends on the severity of the situation and the depth of the wrinkles.

The composition of Botox is extremely simple, but the solution also has side effects. For example, the formation of a lump at the injection site. You should not be afraid of this, because the drug dissolves on its own.

Where are injections allowed?

We have already discussed what is included in Botox, it’s time to talk about where injections are allowed. First, it is important to understand the methods of administration. So, injections can be subcutaneous and intramuscular. When is what used?

If the patient has increased sweating, the drug is administered subcutaneously. Cosmetologists choose the same method if the client has small facial wrinkles.

As for intramuscular injections, they are used to correct the oval of the face or complex nasolabial folds. Botulinum toxin is injected only into the muscle area of ​​the lower part of the face. The method is also suitable for correcting deep wrinkles in the area of ​​the brow ridges or on the bridge of the nose.

Electromyography is used to determine the points at which injections will be made. This is what is called a muscle responsiveness test. In order not to confuse anything, the places are marked with a felt-tip pen.

If the patient wants a worthwhile result, then it is necessary to find out from the cosmetologist not only which composition is best for Botox, but also what administration regimen he plans to follow. The latter depends on which zone needs to be corrected:

1. To correct longitudinal wrinkles on the forehead, injections are made into the central zone, as well as points that are located at a distance of one and a half centimeters from it.
2. The folds on the bridge of the nose are removed by making injections into the side edges. There are no clear recommendations on distance in this case; the cosmetologist selects it individually
3. When we talk about subcutaneous administration, we mean that the injection range is a centimeter.

What happens after the injections?

The chemical composition of Botox determines the imposition of some restrictions after injections. However, this is typical for all drugs.

So, what should you limit yourself to:

1. For seven days after the injections, you should abstain from alcohol, as it reduces the effect of Botox to zero.
2. Physical activity is also contraindicated for the first time. This is due to the fact that the solution will spread. First of all, you should stop bending forward and lifting heavy objects.
3. Direct sunlight and hot rooms should be avoided. If it’s windy outside, you should also take care. The reason for this is the wounds after punctures. They can become inflamed when exposed to dirt.
4. You will also have to give up makeup until the punctures heal.
5. When washing, it is also better to refuse additional products, giving preference to clean water.

The use of Botox in cosmetology has already become commonplace, and therefore some clients do not take the procedure seriously. Perhaps this happens because they do not know what processes occur after the injection. Let's lift the curtain a little.

Two days after administration, the drug begins to act. Because of this, the effect of a mask lasts on the face for some time. This happens because the muscles relax. Time will pass and the feeling will become familiar. You cannot get rid of it, because it is due to relaxation that tightening occurs.

Side effects often include swelling. It subsides on the fifth day after the injection and does not require any additional measures.

Treatment frequency

The instructions for use of Botox state that correction with the drug can be carried out no earlier than two weeks after the first injection. Sometimes it is necessary, because a cosmetologist cannot always immediately work on the desired area.

As for full-fledged injections, they are done no more than once every six months. The drug has a cumulative effect. This means that after the next procedure the toxin is absorbed more and more slowly.

First of all, dynamic wrinkles are corrected. These include paws around the lips, wrinkles around the eyes and other signs of aging. Injections in these places are allowed once every 90 days. Static wrinkles such as nasolabial folds or sagging cheeks should be corrected no more than once every six months.

Duration of effect

We have already talked about the method of using Botox and even found out in what cases one or the other is used. But there has been no talk yet about how long the effect lasts.

Experts say that the drug lasts on the face for three to six months. This is due to the condition of the skin and, of course, the age of the patient.

So, the toxin will last from four months to a year on the lips and in the corners of the mouth. Eyebrow ridges and crow's feet will smooth out within six months. The cheekbones and chewing glands will also retain the effect for six months. With nasolabial folds, everything is more complicated; the effect of the toxin can last for two months, or maybe for six months.

Remember that the indicators are average, they are taken based on the results of using Botox in cosmetology. It is unknown what will happen in your case.

What is prohibited

To maintain the effect of injections, you must follow the rules. Some of them are described above, and we will talk about others now.

After the procedure, you should not specifically strain the muscles that have undergone injections. But this does not apply to the time immediately after the procedure. At this moment, on the contrary, you need to grimace with all your might so that the drug is better distributed.

You should not take antibiotics, as they can deactivate the toxin. By the way, you shouldn’t touch or scratch your skin either.

If you want to clean, you will have to do this only with soft preparations that do not contain abrasive particles. In the first week after injections, you should not massage your face.

Consequences of beauty injections

The consequences of using Botox can be very sad if you do not properly care for your face. The toxin can cause great harm to the body. What does this mean:

1. Displacement of parts of the face. This can happen when eyebrows are pierced. In this case, one eyebrow goes down and the other goes up. This happens because the drug has spread or the procedure was carried out by an amateur.
2. Quincke's edema. This is a very dangerous allergic reaction that can lead to death. An allergy occurs directly to the toxin.
3. Mask effect. After the muscles have not worked for a long time, they forget what to do. In this case, the face seems lifeless, no emotions are reflected on it.
4. Sagging muscles, weakening of natural turgor.

On the Internet you can see photos of the consequences of using Botox, which will forever turn you away from cosmetic procedures. But you shouldn’t be so categorical about injections, because you just need to choose the right cosmetologist. If beauty injections cause great concern, then you can use generics.

Analogues

Although the safety of the Botox solution has long been proven, some patients are still afraid to use the drug. For this reason, specialists often use an analogue of the solution. There is an opinion that they are not so harmful. What are considered analogues:

1. "Dysport". It is a version of hemagglutinin. It is used not only to prevent wrinkles, but also to treat muscle spasms. The medicine relaxes the muscles and also has a pronounced muscle relaxant effect.
2. "Relatox". A Russian-made drug made from type A toxin. It costs much less than the original, but is in no way inferior in effect.
3. "Xeomin." A solution made in Germany, an alternative to Dysport. The muscles do not get used to the drug, and the effect lasts for a long time. Because of this, the price of the drug is twice as high as the original.

Treatment with Botox effect

The indication for use is wrinkles, but injections cannot be performed at home. What about those who cannot or do not want to visit a cosmetologist? You can use masks with botulinum toxin effect for care. Naturally, the effect will not be the same as from injections, but there are no side effects of any kind.

There is no direct drug in the masks, since it stops working when it comes into contact with air.

There are several of the most famous brands, the effectiveness of which women are convinced of:

1. "Botox Active Expert". The most famous of all skincare products. She is able to tighten the oval of the face and correct deep wrinkles in the nasolabial folds. The mask contains sakura honey extract, hyaluronic acid, peanut butter and shea butter.
2. Dizao Boto Mask 8. Can be called heavy artillery in the fight against wrinkles. The composition contains tocopherol, petroleum jelly, aloe extract, green tea extract and mineral compounds.
3. “Evalar Cream Qi-Clim botoeffect”, as well as “Qi-Clim Botox”. It contains a unique complex of the peptide argillerine. The ingredient can not only moisturize the skin, but also relax muscles, which is very similar to the effect of Botox. The cream also contains hyaluronic acid, D-panthenol, lecithin, and rice extract.
4. "Nano Botox" Facial serum is enriched with synthetic peptides and silver ions. With the help of the drug you can get rid of small facial wrinkles.
5. Shary. This Korean-made anti-aging elixir contains hyaluronic acid, argireline and a complex of plant extracts.

As a rule, such masks are not very cheap, so you can try making them at home. Of course, the results of using Botox and a mask will be different, but it’s still better than nothing.

Folk recipes

A potato starch mask helps against wrinkles. It does not dry out the skin, does not clog pores and consists only of natural ingredients.

So, you will need a tablespoon of potato starch. It must be dissolved in one hundred milliliters of water. It is important to stir the starch thoroughly so that there are no lumps left. Boil 50 milliliters of water and pour into the starch mixture. Cool the pulp and add chicken yolk to it.

The mask should be applied to the décolleté and face and left for half an hour. You can make a mask every three days.

The difference between analogues and the original

First of all, generics differ in cost. The same “Dysport” costs twenty dollars per ampoule, while “Botox” costs twice as much.

Tolerability of drugs is also different. Some do not cause an allergic reaction due to the fact that the concentration of Botox is small. The higher the concentration, the greater the likelihood of conflict with antibodies.

If Botox lasts up to a year and appears about a week after the injection, the effect of analogues lasts only three months. But visible changes occur the very next day.

Whether or not to do beauty injections is up to everyone to decide for themselves. We advise you to study all the information about injections and choose a real professional. If you entrust your face to the hands of an amateur, then health problems cannot be avoided.

Are you afraid of the consequences? Start with cosmetic masks that give a similar effect. It is possible that it will not come to injections. There is no point in resorting to beauty injections if your skin condition does not require radical measures. But as an alternative to surgery, Botox is still better. Do not treat injections as a trifle, study different opinions and, if possible, reviews. This way you will admire the effect for a long time.

It is very important for every woman that her beauty is not lost with age, and that her appearance is always at its best. Fortunately, there is such a branch of medicine as cosmetology, which has many special technologies and techniques that can restore the fair sex to its youth, freshness and former attractiveness in a very short period of time. One of the most common and long-used rejuvenation procedures is botulinum therapy.

Botulinum has the ability to reduce or completely eliminate the activity of facial muscles in those places where it is necessary to prevent skin aging and loss of its beauty. Therefore, if you carefully take care of your appearance and want to maintain the youth of your face, you can use Botox, a drug that prevents the appearance of wrinkles and facial creases on the skin. It is worth noting that you can start procedures using this product even from a fairly young age, because the formation of wrinkles begins even before reaching the age of twenty. Prevention of skin aging is the key to a brilliant appearance after forty years.

What is Botox, and how does this cosmetic product work?

Probably, almost all women know what effect Botox can have on the face. After all, everyone has heard about this method that allows you to smooth out wrinkles and rejuvenate. However, few people have a clear understanding of the mechanism of action of this drug.

By its nature, botulin (the active ingredient of the drug) is a toxic compound with a neuroparalytic effect. However, you should not be afraid of such a frightening characteristic, because in cosmetology it is used in very small concentrations that are not able to affect the general condition of the body. In addition, injection administration ensures local action, that is, the drug will exhibit its effects only at the injection site.

So, after getting under the skin, botulin binds only to the nerve endings that ensure the transmission of efferent impulses to the facial muscles. By blocking neuromuscular synapses, this chemical compound seems to immobilize the area where it was introduced. This allows you to prevent creases in skin folds that form during active facial expressions. After all, wrinkles are most often formed from the fact that we make involuntary movements with facial muscles. Botox will help prevent involuntary wrinkling of the forehead, pursing of the lips and squinting of the eyes (which is what makes the face look older).

Comparative table of botulinum toxin composition

Below we will analyze the different types of botulinum toxins according to their chemical composition. Each of the given parameters is important and affects the effectiveness of the drug and the durability of its cosmetic effect.

Types of Botox preparations used in cosmetology for rejuvenation

Before starting a course of procedures, you should choose Botox, the varieties of which are described in detail in the following table:

How many injections are needed to obtain a lasting effect of the drug and what is the duration of its effect?

Before you come for a face-to-face consultation with a cosmetologist, it is very difficult to say exactly how many injections you will need.

The following factors must be taken into account that affect the amount of botulinum-containing drug required:

1. Firstly, each area of ​​the face requires a different number of injections (most injections are required for the area around the eyes, a little less for the forehead and bridge of the nose). Perhaps you are only worried about one area, then you will not need so many injections.
2. Secondly, each drug has different consumption. For example, for the same area of ​​one drug you will need ten to fifteen units, and another - twenty to forty. Be sure to take this into account when choosing a drug (usually a drug with a lower consumption costs more).
3. Thirdly, each girl has her own facial structure and her own individual anatomy. Some people will need five active units for their entire forehead, while others will need all fifteen, although the drug will be the same.

The duration of action and the time after which you will see the effect are detailed in the table. These features are discussed there separately for each product.

The minimum validity period is usually about three months, and the maximum is seven to eight months. There are no clearly established boundaries, since it depends on the metabolic rate (and it is completely different for everyone) and the rate of utilization of botulinum toxin molecules.

Are there any side effects from this procedure, is there a high likelihood of them occurring?

Like any other cosmetic procedure, botulinum therapy can lead to a number of complications. Most of them can arise due to mistakes by the cosmetologist who performed the Botox injection. But patients themselves can harm their faces by approaching the rehabilitation period irresponsibly and incorrectly.

So, after injections of botulinum-containing drugs, the following side effects may occur:

1. Allergic reaction. Moreover, an allergy can be completely insignificant (a rash and slight itching at the site of the procedure), or it can lead to very dangerous conditions, such as angioedema and anaphylactic shock. These are the most severe degrees of an allergic reaction, and they can threaten the patient’s life, and therefore require urgent qualified medical care.
2. The appearance of facial asymmetry. This may occur due to the inexperience of the cosmetologist, when the anatomy of the nerve branches was not taken into account. In this case, one eyebrow may droop or ptosis (slight drooping of the upper eyelid) may develop.
3. “Mask-like face” effect. Since the movements of some muscles are lost, facial expressions may seem very poor during the period of action of botulinum toxin. In order to avoid this, you do not need to try to capture too large areas of the skin. An experienced doctor will always be able to anticipate such a problem and warn you against it.
4. Swelling of soft tissues in the injection area. This can happen if the patient does not adhere to the recommendations given to her on how to behave during the recovery period. Even excess salt intake from food (smoked meats, pickles, dried fish) can contribute to the appearance of large bags under the eyes. Strictly follow all the doctor’s instructions and remember that beauty and appearance depend on this. Follow a diet, do not lie in a horizontal position for at least several hours after the procedure (the outflow of fluid from the upper body worsens), and do not drink alcohol.

Professional answers to frequently asked questions

Of course, every woman who thinks about such a beauty procedure is tormented by doubts and certain questions arise. We will give you answers to the most common ones:

In what cases should you choose analogues rather than the original?

The original Botox drug has a fairly strong effect, and some girls are afraid that it can cause a “mask-like face” effect. In order to avoid this and protect yourself, you can resort to using its analogues, which have a milder effect. However, keep in mind that deep wrinkles will not be smoothed out as much as with injections of the original Botox product.

Cost of injections?

The price for this cosmetic procedure depends on the cost of the chosen drug, its consumption (everyone is different) and the cost of the cosmetologist’s work. In order to cope with wrinkles on the forehead and around the eyes, you will need about 4,000-10,000 rubles, on the bridge of the nose - 3,500-6,500 rubles. Larger areas, such as the facial contour (jaw line), will cost 10,000-20,000 rubles.

What should you not do after facial Botox?

There are several rules and restrictions that you must adhere to for some time after the procedure. Don’t be alarmed, because they are very simple and will not particularly affect your normal lifestyle. You should not lie down for the first four hours after the injection (the period is not that long, so try to strictly follow this instruction). For several days you should not touch (and especially massage) the skin at the injection site, and for a while stop taking medications that affect blood clotting (this is very important because the procedure was accompanied by a violation of the integrity of the skin, therefore, damage to small vessels cannot be avoided). For several days, try not to tilt your head below chest level for a long time, as this can lead to the development of soft tissue swelling. Give up sports for half a month, and do not drink alcoholic beverages for the same amount of time. In the first ten days, any procedures using heat are prohibited (especially avoid local overheating of the area where the cosmetic procedure was performed). Sunbathing, going to the sauna and even using a hair dryer are prohibited.

Which drug is the most effective?

The effectiveness and durability of each drug depends not only on its quality, but on the individual characteristics of the human body who underwent the procedure. The longest effect can be obtained from the drug Neuronox; the effect of Relatox, Lantox and Dysport will be slightly less long-lasting. The original Botox drug best blocks neuromuscular signal transmission, and therefore has the strongest smoothing effect, but it can contribute to the appearance of some facial expression. In order to choose a drug, contact a qualified doctor who will be able to take into account all the features of your face and those areas that require adjustment.

You can watch a consultation with a cosmetologist on the choice of botulinum toxin in the video:

Conclusion

Botox injections are a way to combat facial wrinkles. Cosmetologists claim that if the manipulation is carried out correctly and a quality product is selected, such “beauty injections” are completely safe. The effectiveness of this procedure is very high, which can be confirmed by many women who have already tried botulinum therapy on themselves.

This method can also be used as preventive measures, which can significantly prolong the youth of the face and maintain freshness even after 40-50 years. The main thing is to choose experienced cosmetologists and safe, high-quality injection drugs (saving on yourself can become dangerous).

Active substance

Pharmacological group

Nosological classification (ICD-10)

Composition and release form

in bottles of 100 units; 1 bottle in a cardboard pack.

Characteristic

pharmachologic effect

Pharmacodynamics

The botulinum toxin type A molecule consists of a heavy (with a molecular weight of 100,000 Da) and a light (with a molecular weight of 50,000 Da) chains linked by a disulfide bridge. The heavy chain has a high binding affinity for specific receptors located on the surface of target neurons. The light chain has Zn 2+ -dependent protease activity, specific to the cytoplasmic regions of the synaptosomal-associated protein with a molecular weight of 25,000 Da (SNAP-25) and involved in the processes of exocytosis. The first step in the action of botulinum toxin type A is the specific binding of the molecule to the presynaptic membrane. This process takes 30 minutes. The second stage is the penetration of the bound toxin into the cytosol of the nerve through endocytosis. Intracellularly, the light chain acts as a Zn 2+ -dependent cytosolic protease, selectively cleaving SNAP-25, which in the third step leads to blockade of acetylcholine release from the presynaptic terminals of cholinergic neurons. The end effect of this process is persistent chemodenervation.

With the intramuscular administration of Botox®, 2 effects develop: direct inhibition of extrafusal muscle fibers through inhibition of alpha motor neurons at the level of the neuromuscular synapse and inhibition of muscle spindle activity through inhibition of the gamma motor neuron cholinergic synapse at the intrafusal fiber. A decrease in gamma activity leads to relaxation of intrafusal muscle spindle fibers and reduces the activity of 1a afferents. This leads to a decrease in the activity of muscle stretch receptors, as well as the efferent activity of alpha and gamma motor neurons. Clinically, this is manifested by a pronounced relaxation of the injected muscles and a significant reduction in pain in them. Along with the process of denervation, a process of reinnervation occurs in these muscles through the appearance of lateral processes of nerve endings, which leads to the restoration of muscle contractions 4–6 months after the injection.

When administered locally in therapeutic doses, Botox ® does not penetrate the BBB and does not cause significant systemic effects. There appears to be minimal presynaptic uptake and reverse axonal transport from the injection site.

Antibodies to botulinum toxin type A hemagglutinin complex develop in 1–5% of patients after repeated Botox ® injections. The formation of antibodies is facilitated by the administration of the drug in high doses (>250 units) and repeated injections in small doses at short intervals. If antibodies to botulinum toxin type A are formed, the effect of the subsequent reaction may be reduced.

Pharmacokinetics

Data on the pharmacokinetics of the drug Botox ® are not provided.

Indications for Botox ®

cervical dystonia (spasmodic torticollis);

local muscle spasm;

smoothing of interglabellar and superciliary wrinkles.

For children over 2 years old:

local muscle spasm in cerebral palsy.

Contraindications

hypersensitivity to the components of the drug;

myasthenic and myasthenic-like syndromes (including Lambert-Eaton syndrome);

inflammatory process at the injection site;

acute phase of infectious diseases;

high degree of myopia (according to the opinion of an ophthalmologist);

aggravated allergy history (especially hypersensitivity to drugs containing proteins);

taking antibiotics of the aminoglycoside group, macrolides, tetracyclines, polymyxins, which enhance the effect of the toxin (if more than 2 weeks have passed after the course of therapy), as well as drugs that increase the intracellular concentration of calcium, benzodiazepines, anticoagulants and antiplatelet agents;

pronounced gravitational ptosis of facial tissues;

pronounced hernias in the upper and lower eyelids;

a period of less than 3 months after facial surgery;

lactation (breastfeeding).

Use during pregnancy and breastfeeding

Botox ® is contraindicated for use during pregnancy and lactation.

Side effects

Local reactions: 2–5% of cases - microhematomas (up to 7 days), pain at the injection site (up to 1 day).

Systemic reactions: slight general weakness for 1 week (occurs when using the drug in doses exceeding the maximum permissible - more than 250 units).

Reactions associated with the spread of the drug to muscle groups located near the injection site: extremely rarely - ptosis of the eyelids, drooping of the interglabellar region, lateral areas of the eyebrows, disturbance of accommodation, asymmetry of the corners of the mouth, impaired articulation, numbness of the lips.

As a rule, these side effects do not require additional therapy and regress within 1 month after the injection.

Complications after injection are extremely rare and can occur when the needle injures nerves or blood vessels if the procedure is not performed properly. Complications in the form of anaphylaxis have not been described, however, when performing an injection, it is necessary to have means for emergency relief of anaphylactic reactions.

Interaction

The effect of Botox ® is enhanced by the simultaneous use of aminoglycoside antibiotics, erythromycin, tetracycline, lincomycin, polymyxins; agents that reduce neuromuscular transmission (including curare-like muscle relaxants).

Directions for use and doses

V/m. Botox ® doses and injection points are determined individually for each patient in accordance with the nature, severity and location of muscle hyperactivity. In some cases, electromyographic control (EMG) is used to more accurately localize the injected muscles.

At treatment of bilateral blepharospasm Botox ® solution is injected superficially intramuscularly into the upper, lateral and lower parts of the orbicularis oculi muscle on both sides. Additional injection sites include the pretarsal portion of the orbicularis oculi muscle, the eyebrow area, and the frontal area. 2.5–5 units of the drug should be injected into each point. The average initial dose is 15–25 units per side. The effect of the drug occurs on the 2-7th day after the procedure and lasts for 3-6 months. For a sustainable clinical effect, it is necessary to administer the drug at the indicated dose every 3–6 months. When treating blepharospasm, the total dose over 12 weeks should not exceed 100 units.

Treatment of patients with hemifacial spasm is carried out in the same way as for unilateral blepharospasm.

During treatment spastic torticollis the drug solution is injected into the most tense muscles of the neck in a total dose of 25–75 units at 2–3 points of each muscle. For rotatory torticollis, the drug is injected into the sternocleidomastoid muscle contralateral to rotation and into the splenius muscle ipsilateral to rotation. In cases accompanied by shoulder elevation, additional injection of the drug into the homolateral trapezius muscle and the levator scapulae muscle is required. If there is a backward tilt of the head, the drug must be injected into both splenius and both trapezius muscles. When the head is tilted forward, the drug is injected into both sternocleidomastoid muscles. Bilateral injections may increase the risk of neck muscle weakness.

With subsequent administration, the dose of the drug can be adjusted to the optimal dose in accordance with the previous clinical effect and the observed side effects. The muscle relaxant effect after injection of the drug occurs after 7–14 days (possibly up to 21 days) and lasts for 3–6 months, after which the drug should be re-administered. Treatment of torticollis depends on the clinical experience of the specialist. In all cases of complex forms of torticollis or in case of low injection effect, EMG of the neck muscles is required for more accurate localization of tense muscles.

At cerebral palsy with spasticity and equinovarus foot deformity and idiopathic tiptoe walking, the drug solution is injected into 2 points of each head of the gastrocnemius muscle; for hemiplegia, the drug can be injected into the flexor muscles of the forearm; when crossing the thighs, you can additionally inject the drug into the adductor muscles of the thigh. The total dose per 1 procedure, amounting to 4–6 IU/kg body weight (but not >300 IU per 1 procedure), is evenly distributed to all muscles involved. For severe spasticity, the total dose may be 10–12 U/kg. Clinical improvement is observed after 7–14 days and may persist for up to 6–12 months. Repeated injections should be done when the clinical effect is reduced by half. Orthopedic correction, stretching, and physiotherapy help improve the clinical effect of the drug.

To eliminate eyebrow wrinkles the drug is usually administered into m.corrugator supercilii And m.procerus, who participate in their formation. To determine the injection site, the patient is asked to frown, at this moment it can be easily palpated m.corrugator, in this case, the point of the most pronounced muscle activity should be 0.5 cm up from the upper medial edge of the eyebrow. Markings are made in the same way on the other side. The needle is inserted into the thickness of the abdomen, the direction of the needle is either at an angle of 45° from front to back, medially, or at an angle of 90°. The depth of needle insertion is 7–10 mm. If the needle rests on the periosteum, it must be pulled out 1 mm and then the drug must be injected. In a number of patients (most men and some women) m.procerus in its medial part it is very wide, forms a deep and long interglacial groove, which requires additional injection of 2.5–5 units into points located 5–7 mm above the primary points. The depth of needle insertion is 2–3 mm, the direction is vertically downward. Point of insertion into m.procerus located in the center of the line connecting the medial edges of the eyebrows. From 2.5 to 7.5 units of the drug are injected into each marked point, depending on age and gender. The position of the needle is from front to back, the depth of needle insertion is 2–3 mm. The total amount of drug injected into this area, as a rule, does not exceed 25 units.

The effect of the drug develops on the 2-7th day after the procedure and lasts 3-6 months. For a sustainable clinical effect, it is necessary to administer the drug in the indicated doses after 3–6 months.

The maximum total dose of the drug should not exceed 250 units per procedure.

Rules for the preparation and administration of solution for injection

When diluting the drug, do not open the bottle by removing the stopper. Before diluting the contents of the bottle, the central part of the rubber stopper must be treated with alcohol. For puncture, use a sterile needle measuring 23–25 G. To dilute the contents of the bottle, use 0.9% sodium chloride solution for injection in a volume of 2–4 ml. The solvent should be administered carefully, with light rotational movements of the bottle, mixing the powder with the solvent for one minute. The amount of solvent used should ensure the possibility of administering all recommended doses (in units) of the drug. Rough shaking and foam formation can lead to denaturation of the drug. If the solvent is not drawn into the vial under vacuum, the vial is destroyed. The resulting solution is a clear, colorless or slightly yellowish liquid without foreign inclusions; slight opalescence is possible.

After dilution, the drug can be stored in the refrigerator at a temperature of 2 to 8 ° C for no more than 4 hours before use. The prepared injection solution is administered with an insulin syringe with a fixed needle with a diameter of 0.27–0.29 mm. The patient's position when injecting the drug into the muscles of the face and neck is sitting on a chair, the back of the head is fixed.

Overdose

Symptoms: general weakness and paresis of injected muscles are possible.

Treatment: constant monitoring of the dynamics of symptoms is necessary; prescription of anticholinesterase drugs, if necessary, resuscitation measures are carried out. The introduction of a specific antitoxin (anti-botulinum serum type A) in accordance with the instructions for use is effective within 30 minutes after the injection of botulinum toxin.

special instructions

Botox ® injections must be performed by a highly qualified physician with special training and permission from the manufacturer. Injections can be performed on an outpatient basis in a treatment room.

Botox ® is dispensed, stored and used exclusively in specialized medical institutions. The drug is stored in a separate closed, labeled box in the refrigerator.

Immediately after the injections, the solution remaining in the vial or syringe should be inactivated with a sodium hypochlorite solution (containing 1% active chlorine). All auxiliary materials that have been in contact with the drug must be disposed of in accordance with the rules for the destruction of biological waste. Spilled drug solution should be wiped with an absorbent cloth soaked in a diluted sodium hypochlorite solution.

All cases of increased reactogenicity or the development of post-injection complications must be reported to the State Research Institute for Standardization and Control of Medical Biological Preparations named after. L.A. Tarasevich (119002, Moscow, Sivtsev Vrazhek, 41) and official distributors of Family Health CJSC.

Impact on the ability to drive vehicles and operate machinery

There was no effect of the drug on the ability to engage in potentially hazardous activities that require increased attention and speed of psychomotor reactions.

Botox ® is not available for free sale through the pharmacy chain and is released only to specialized medical institutions.