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What Is A Botox Injection Anyway?
By Peter Lenkefi, Thu Dec 8th
The cosmetic form of botulinum toxin, often referred to by itsproduct name Botox, is a popular non-surgical injection thattemporarily reduces or eliminates frown lines, forehead creases,crows feet near the eyes and thick bands in the neck. The toxinblocks the nerve impulses, temporarily paralyzing the musclesthat cause wrinkles while giving the skin a smoother, morerefreshed appearance. Studies have also suggested that iseffective in relieving migraine headaches, excessive sweatingand muscle spasms in the neck and eyes. Botulinum neurotoxin isproduced by the gram-negative anaerobic bacterium Clostridiumbotulinum. Eight serologically distinct botulinum neurotoxinsexist, designated as A, B, C1, C2, D, E, F, and G. Seven areassociated with paralysis. Types A, B, E and, rarely, F and Gare associated with human botulism. Dose The dose of botulinumtoxin is expressed in mouse units. One unit is equal to theamount that will kill 50% of a group of 18- to 22-g SwissWebster mice when injected intraperitoneally. The human lethaldose (LD) for (botulinum type A purified neurotoxincomplex) is estimated at approximately 3000 units. BOTOXinjections of less than 100 units usually are used for cosmeticpurposes and of less than 300-600 units for other purposes,thereby allowing a wide safety margin. Recognizing that dosesare not interchangeable among different formulations ofbotulinum toxin (BOTOX, Dysport, Myobloc) is important; toachieve similar clinical effects, different doses are used.Botulinum toxin formulations is a sterile lyophilized formof botulinum toxin type A. It is produced from a culture of theHall strain of C botulinum and purified by a series of acidprecipitations to a crystalline complex containing the toxin andother proteins. The FDA approved in December 1989 as anorphan drug for the treatment of strabismus, hemifacial spasms,and blepharospasm. is distributed in 100-unit vials. Theoriginal batch of neurotoxin prepared by Shantz in November 1979(designated batch 79-11) constituted the original BOTOXformulation and was used until December 1997. It was replaced bya new neurotoxin complex batch designated BCB 2024. The new bulkbatch is 5-6 times more potent on a weight basis. In a 100-unitvial, only 4.8 ng of neurotoxin is needed compared to 25 ng of79-11. The new is comparable in clinical efficacy andsafety to the old, and a unit dose of new provides anequivalent response to the same unit dose of old BOTOX.Hopefully, the reduced protein load of the new leads toreduced immunogenicity and a lower incidence of neutralizingantibody formation. Dysport is another formulation of botulinumtoxin type A available in Europe and a few other
countries. Itis prepared using column-based purification techniques anddistributed in 500-unit vials that can be stored at roomtemperature. and Dysport are both botulinum toxin type Apreparations but are quite distinct from one another. isapproximately 4 times more potent on a per unit basis, andDysport doses often are approximately 4 times the dosesused to generate a similar clinical effect. Differences in thesetoxins may relate to differences in the strain of bacterium,preparation, diffusion, and potency testing. Myobloc is abotulinum toxin type B preparation currently in clinical trials.It is anticipated that it will be distributed as a solution.Little information is available concerning the cosmetic use ofDysport and Myobloc. The remainder of this article thereforefocuses on BOTOX, and all unit doses refer to unlessotherwise specified. Reconstitution and storage Store in afreezer at or below -5°C. The package insert recommendsreconstitution of using sterile saline withoutpreservative; 0.9% sodium chloride is the preferred diluent.Some investigators suggest that reconstitution with sterilesaline solution with preservative (0.9% benzyl alcohol) reducesmicrobial contamination and provides a weak local anestheticeffect. However, contamination is rarely a problem, and theanesthetic effect is modest. is denatured easily bybubbling or agitation; gently inject the diluent onto the insidewall of the vial. Discard the vial if a vacuum does not pull thediluent in. The final dilution of is mostly a matter ofpersonal preference; 100 units commonly are reconstituted in1-10 mL of diluent. Theoretically, more concentrated solutionsreduce reliability in delivering a specific unit dose, and moredilute solutions lead to greater diffusion of the toxin. Theauthors prefer to use 2 mL of diluent to prepare a solution of 5U/0.1 mL (50 U in a 1-mL tuberculin syringe if that much is tobe used). Use a 30-gauge 1-inch needle to perform theinjections. Once reconstituted, keep refrigerated at2-8°C. The package insert indicates that reconstituted BOTOXshould be used within 4 hours. One study found no loss ofactivity at 6 hours but a 44% loss after 12 hours and a 70% losswith refreezing at 1-2 weeks. Other authors report nosubstantial loss of potency in a 10 U/1 mL reconstitutedsolution kept refrigerated for 1 month. Most practitionersdiscard unused reconstituted after 1-7 days. About the author:For more more information about injections please visithttp://www.botox-injection-information.net
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