July 13, 2014

Botox Injection Severe Side Effects Treatment

Side effects from botox injections are not uncommon and even expected to some degree in the region where the injection was performed. For example, when botox is injected into the voicebox for spasmodic dysphonia, normal and expected side effects include hoarseness and dysphagia.

However, in very rare instances, more severe side effects may occur that may even appear to be life-threathening including stridor, shortness of breath, profound difficulty swallowing, etc. Botox overdose so to speak.

In such situations, beyond supportive care and ruling out more serious conditions like a heart attack, treatment with pyridostigmine can be quite effective in alleviating if not outright reversing the severe botox side effects.

Pyridostigmine is a drug that prevents the body from breaking down the chemical mediator (acetylcholine) that causes muscle contraction. Given botox works by preventing the release of acetylcholine, it makes sense that by preventing the body from breaking this hormone down, more of it is around to activate the muscle.

Put simply, pyridostigmine increases acetylcholine levels to counteract the botox effect of decreasing acetylcholine leading to a net zero effect theoretically. But does it work that way? According to one research paper, it certainly appears to do so!

In cases of stridor due to bilateral vocal cord paralysis or other severe side effect, an initial treatment of 300 mg of pyridostigmine x 2 doses separated by 6 hours followed by 30 mg 3x per day is recommended. Symptom improvement occurs fairly rapidly.

In less dire situations, simply starting a patient on pyridostigmine 30 mg 3x per day without an initial loading dose is sufficient.

In young children, dosing typically is 6-7 mg/kg/day divided into every 4-6 hours.

Duration of treatment is typically about 6 weeks.

Otherwise, behavioral support alone is recommended for less severe botox side effects.

Pyridostigmine for Reversal of Severe Sequelae From Botulinum Toxin Injection. Journal of Voice. 2014 Jul 5. pii: S0892-1997(14)00091-5. doi: 10.1016/j.jvoice.2014.04.010. [Epub ahead of print]

Pyridostigmine for the Reversal of Severe Adverse Reactions to Botulinum Toxin in Children. The Journal of Pediatrics (2017). DOI: 10.1016/j.jpeds.2017.11.013
Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.


Mark said...

For me botox did a great job.

Unknown said...

I had Botox increased by 100 units to 300 units injected into my head, neck and shoulders. It's been over two weeks, and I still am suffering from severe side effects losing an entire work week over the past three weeks. These include neck drop, headaches, neck pain, EXTREME Lethargy, Dizziness, depression, anxiety, loss of appetite, blurred vision, memory loss and loss of concentration. It's done nothing but poison my body!

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