Mechanism of action
- Inhibits the release of acetylcholine from the presynaptic terminal → loss of muscle activation.
- Causes partial chemical denervation of muscle tissue → local reduction of muscle activity.
- Muscle atrophy may result, axonal sprouting may begin, and extra-junctional acetylcholine receptors can be formed.
Indication
- Cosmesis
- Spasm
- Symptomatic overactive bladder with or without incontinence,
- Chronic migraines
- Muscle spasms
- Cervical dystonia
- Axillary hyperhidrosis
- Strabismus
- CN7 disorders
- AAN recommendations
- Level A — cervical dystonia
- Level B — blepharospasm, upper limb focal dystonia, laryngeal dystonia
- Level C — hemifacial spasm, focal lower limb dystonia, tics
Indication in neurosurgery
- Hemifacial spasm, strabismus, blepharospasm, hyperhidrosis, and occipital neuralgia.
- Spasticity is treated also (off-label).
Pharmacokinetics
- The maximum effects of muscle paralysis occur four to seven days after a dose.
- Serum half-life: 230 to 260 min
Toxicity
- Neuromuscular weakness
- Dysphagia, dysphonia, weakness, dyspnoea or respiratory distress
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