Botulinum toxin type B: pH change reduces injection pain, retains efficacy.

Abstract

BACKGROUND:

Injection of botulinum toxin Type B (BTX-B) is substantially more painful than injection of botulinum toxin Type A (BTX-A).

OBJECTIVE:

A method of reducing pain with BTX-B injection without reducing efficacy. This was evaluated in 2 BTX-A-resistant subjects and another BTX-B-naive subject.

METHODS:

Clinical evaluation and computer analysis of photographs were used to confirm efficacy to different dilutions of Type B toxin and confirm BTX-A resistance. A pilot study of 3 subjects involves BTX-B (usually pH 5.6) that was diluted with sodium bicarbonate to normalize the pH to 7.5 in the syringe immediately before injection. Pain assessment compared the different pH BTX-B solutions.

RESULTS:

Two patients with acquired resistance to 3 BTX-As in upper facial muscles responded to BTX-B. Injection pain of BTX-B changed to pH 7.5 was significantly reduced and retained efficacy over 10 weeks.

CONCLUSION:

Botulinum toxin Type A resistance is documented to 3 BTX-A brands in 2 patients. They had received low doses of Type A toxin, they responded to Type B toxin. Injection pain of the acidic solution of BTX-B neurotoxin was reduced and efficacy not compromised by changing pH of BTX-B solution to pH 7.5. This method improved patient tolerance to BTX-B injections.

• Authors: Philippa L Lowe, Nicholas J Lowe
• Journal: Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] (Dermatol Surg) Vol. 40 Issue 12 Pg. 1328-33 (Dec 2014) ISSN: 1524-4725 [Electronic] United States
• PMID: 25350125 (Publication Type: Journal Article)

Chemical References

• Neuromuscular Agents
• rimabotulinumtoxinB
• Botulinum Toxins, Type A

Topics

• Adult
• Botulinum Toxins, Type A (administration & dosage, chemistry)
• Drug Resistance
• Face
• Female
• Humans
• Hydrogen-Ion Concentration
• Injections
• Male
• Neuromuscular Agents (administration & dosage, chemistry)
• Pain (prevention & control)
• Pain Measurement
• Photography
• Treatment Outcome