Botox® (botulinum toxin type A)

Botox® is a pharmaceutical preparation of the botulinum toxin type A produced by the bacterium Clostridium botulinum, which has muscle relaxant properties. It is usually used in MS for two reasons.

The first reason is for the relief of focal muscle spasticity (spasticity that is localised to a particular region of the body such as the hand, arm or leg) and is usually used in conjunction with stretching and physiotherapy.

The second reason Botox is helpful in MS, is for the treatment of urinary incontinence due to overactivity of the detrusor muscle in the bladder. There are strict criteria to guide selection of the most suitable patients for this procedure, where clinical trials have shown significant improvements in quality of life and incontinence episodes.

Botox® works by temporarily relaxing overactive muscles. It is administered through an injection directly into the muscle. For muscle spasticity, Botox® usually begins to work within two weeks of the injection and lasts between 3-6 months, depending on absorption of the Botox® by the body and the size of the muscle.

In the case of urinary incontinence, injections are made directly into the bladder wall (the detrusor muscle). The treatment is administered by a doctor in the form of multiple injections into the muscle using a specific instrument called a cystoscope, which is a thin, flexible tube with a camera at the end. For urinary incontinence, Botox® usually begins to work within two weeks of the injection and lasts between 8-10 months. Once the effects begin to wear off, the treatment can be repeated, but not more often than every three months.

Botox® may have side effects in some people. All medications have side effects. It is important to notify your health professional if you experience any side effects or are feeling unwell.

When used for muscle spasticity, Botox® injections can cause swelling, pain and bruising at the injection site, headaches and flu-like symptoms. Although unlikely, it is possible for the Botox toxin to spread within the body and the doctor will give specific instructions regarding this, along with instructions for the first few days after injection to manage the injection site.

Botox® for urinary incontinence has some common side effects including urinary tract infection and urinary retention. Intermittent self-catheterisation may be necessary. Other, less common, side effects include difficulty sleeping, constipation, muscle weakness and spasm, bulge in the bladder wall, tiredness and problems with walking and falls. There may also be side effects directly related to the injection procedure such as blood in the urine after the injection.

Your doctor or pharmacist can provide comprehensive information on the use of Botox®, including precautions and side effects.

Botox® is not recommended during pregnancy. It should not be used by pregnant women or women of childbearing age who are not using effective birth control.

If you are currently pregnant or trying to become pregnant, please discuss your individual circumstances and treatment options with your neurologist or healthcare team.

If you are currently breastfeeding, please discuss your individual circumstances and treatment options with your neurologist or healthcare team.

Botox® has been approved by the Therapeutic Goods Administration for the treatment of urinary incontinence due to neurogenic detrusor overactivity in MS and is available on the Pharmaceutical Benefit Scheme (PBS). Please discuss with your neurologist whether Botox® is the right treatment for you. There are a number of criteria you must meet before your doctor can receive authority to write this prescription.

For details of the criteria required to receive a prescription for Botox® treatment through the PBS, please visit the official PBS website at: https://www.pbs.gov.au/medicine/item/10993N-10997T

You will need to click on the red Authority Required (STREAMLINED) link.

If you are eligible for medications through the PBS, you will need to pay a contribution fee each time your prescription is dispensed. The Federal Government pays for the remaining cost. The amount of the contribution fee depends upon whether or not you have a pension or concession card. The amount of this fee is set each year by the Federal Government.

Further information about the PBS, your entitlements and details regarding the PBS safety net (which protects patients and their families requiring a large number of PBS items) is available through the Medicare Australia website at: www.medicare.gov.au

If you are not eligible for Botox® through the PBS, for example if you are a visitor from overseas, your neurologist may write a private prescription. In this instance you will have to pay the full cost to the pharmacy that dispenses your medication. You will need to request a quote from your pharmacist for the price of any medication which is not subsidised by the PBS.