Dosage and Administration
1. Blepharospasm
For blepharospasm, it is injected using a 27-30 gauge sterile needle without an electromyographic guide. The recommended starting dose is 1.25 – 2.5 U (0.05 mL to 0.1 mL volume at each site) injected into the medial and lateral pre-tarsal oruli of the upper lid and into the orbicular pre-tarsal oruli side of the bottom cover. The benefits can be noticed after three days after the treatment. The cumulative dose of NEURONOX treatment over a 30 day period should not exceed 200 U.
2. Pediatric cerebral palsy
For pediatric cerebral palsy, NEURONOX is injected with a 26-30 gauge sterile needle into each of the medial and lateral heads of the gastrocnemius muscles. The total recommended dose is 4U / kg body weight for the gastrocnemius muscle in patients with hemiplegia. And in patients with diplegia, the recommended dose is 6U / kg of body weight divided between the two legs. The total dose administered should not exceed 200 U / patient at a time.
3. Glabellar wrinkles
NEURONOX is reconstituted to produce 200 U / 5.0 mL (4 U / 0.1 mL) with sterile non-conserved 0.9% saline solution. Using a 30 gauge needle, 20 U of NEURONOX are injected in two places on the corrugating muscle for each eye and one point on the procero muscle, for a total of 5 sites with 0.1 ml per site. In order to avoid the effect of drooping eyelids (ptosis), the botulinum should not be injected near the upper eyelids of the levator. The duration of NEURONOX for glabellar wrinkles is approximately 3-4 months.
4. Muscle spasticity
The dosage varies from individual to individual based on the size, number and position of the muscles involved, the severity of spasticity, the presence of local muscle weakness and the patient’s response to the previous treatment. After 4-6 weeks, an improvement in muscle tone can be noted
In controlled clinical trials, the following doses are administered:
Biceps brachii 100-200U : up to 4 sites
Flexor digitorum profundus 15-50U : 1-2 sites
Flexor digitorum sublimis 15-50U : 1-2 sites
Flexor carpi radialis 15-60U : 1-2 sites
Flexor carpi ulnaris 10-50U : 1-2 sites
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