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	Administering BOTOX®
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Administering BOTOX^®

A straightforward procedure

Supplies needed

Iodine Starch Test	Reconstitution	Injection
Iodine solution Cornstarch Surgical pen Alcohol (to clean area	0.9% nonpreserved sterile saline only BOTOX® 100 Units 20-gauge, 1½-inch extraction needle	30-gauge, ½-inch injection needle

5 Steps¹

1. Perform Iodine Starch Test. (See below for a step-by-step description.)
2. Reconstitute BOTOX^® product
3. Prepare treatment area
4. Map area for injection
5. Inject BOTOX^® product

See below for an illustrated guide to performing the iodine starch test and injection procedure for BOTOX^® in patients with excessive axillary hyperhidrosis that is inadequately managed with topical agents. This information can also be accessed in a video or slide format.

Iodine Starch Test Information
Patients should shave underarms and abstain from use of over-the-counter deodorants or antiperspirants for 24 hours prior to the test. Patient should be resting comfortably without exercise, hot drinks, etc for approximately 30 minutes prior to the test. Dry the underarm area and then immediately paint it with iodine solution. Allow the area to dry, then lightly sprinkle the area with starch powder. Gently blow off any excess starch powder. The hyperhidrotic area will develop a deep blue-black color over approximately 10 minutes.

First dry affected axilla. Then immediately paint axilla with iodine solution, making sure to cover excess area around axilla. Allow iodine to dry.
Brush area with starch powder and wait 10 minutes. (A blue-black mark identifies affected area.)
Circle affected area with a surgical marker, then clean area inside circle with alcohol.
Use a surgical pen and standard ruler to mark injection points 1.5 to 2 cm apart and staggered.
Count injection points and allocate recommended dosage of BOTOX® solution per injection, based on 50 Units per axilla.
Inject to a depth of approximately 2 mm and at a 45° angle to skin surface with bevel side up. Be sure not to inject directly on ink mark to avoid a permanent tattoo effect. After injection, clean treated area with alcohol.

Reference

1. BOTOX^® Prescribing Information.

BOTOX^® is indicated for the treatment of excessive primary axillary hyperhidrosis that is inadequately managed with topical agents.

Important Safety Information

Contraindications
BOTOX^® treatment is contraindicated in the presence of infection at the proposed injection site(s) and in individuals with known hypersensitivity to any ingredient in the formulation.

Warnings
The recommended dosage and frequency of administration for BOTOX^® should not be exceeded. Risks resulting from administration at higher dosages are not known.

Serious and/or immediate hypersensitivity reactions have been rarely reported. These reactions include anaphylaxis, urticaria, soft tissue edema, and dyspnea. If such a reaction occurs, further BOTOX^® injection should be discontinued and appropriate medical therapy immediately instituted. BOTOX^® should only be diluted with 0.9% nonpreserved sodium chloride.

Individuals with peripheral motor neuropathic diseases (eg, amyotrophic lateral sclerosis or motor neuropathy) or neuromuscular junctional disorders (eg, myasthenia gravis or Lambert-Eaton syndrome) should only receive BOTOX^® with caution. Patients with neuromuscular disorders may be at increased risk of clinically significant systemic effects including severe dysphagia and respiratory compromise from typical doses of BOTOX^®.

Precautions
Patients should be evaluated for potential causes of secondary hyperhidrosis (eg, hyperthyroidism) to avoid symptomatic treatment of hyperhidrosis without the diagnosis and/or treatment of the underlying disease.

Adverse Reactions
There have been rare reports of adverse events involving the cardiovascular system, including arrhythmia and myocardial infarction, some with fatal outcomes. Some of these patients had risk factors including cardiovascular disease. The exact relationship of these events to the botulinum toxin injection has not been established.

The most frequently reported adverse events (3% to 10% of patients) following BOTOX^® injection for excessive primary axillary hyperhidrosis included injection-site pain and hemorrhage, non-axillary sweating, infection, pharyngitis, flu syndrome, headache, fever, neck or back pain, pruritus, and anxiety.

Please see Prescribing Information.

Do I Have Excessive Underarm Sweating?  |  Can BOTOX^® Treatment Help?  |  What Should I Expect After BOTOX^® Treatment?
For More Information  |  Important Safety Information  |  Information for Physicians

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