Botulinum Toxin Administration Guidelines

Contraindications and Precautions

The American Academy of Allergy, Asthma, and Immunology recommends that patients with a history of anaphylaxis to botulinum toxin preparations should not receive Xeomin, as the anaphylaxis risk is approximately 1-2% with botulinum toxin preparations 1
The Centers for Disease Control and Prevention recommends that epinephrine and antihistamine treatments should be available for all patients receiving botulinum toxin, and caregivers capable of identifying and responding to anaphylaxis should observe patients during administration 2

Patients should remain upright for 3-4 hours after treatment, avoid touching, rubbing, or massaging the treated areas, refrain from strenuous exercise for 24 hours, avoid alcohol consumption for 24 hours, and maintain normal facial expressions but avoid excessive facial movements 3

The Centers for Disease Control and Prevention recommends that skin testing before administration is no longer recommended as it requires specialized training, is time-consuming, and has low positive predictive value 2
The critical period for potential toxin spread is within the first 24-48 hours after injection 3