IncobotulinumtoxinA
Mechanism :
It inhibits acetylcholine release from peripheral nerve endings. It cleaves the SNAP25 protein, whose function is to ensure the release of acetylcholine from vesicles within nerve endings. It blocks cholinergic transmission at the nerve muscle junction by preventing acetylcholine release from the peripheral cholinergic nerve endings.
Indication :
- To reverse upper limb spasticity
- To treat blepharospasm
- To treat cervical dystonia
- To reverse moderate to severe glabellar lines (facial wrinkles)
- To treat chronic sialorrhea
Contraindications :
Albumin hypersensitivity, infection, dysphagia, respiratory insufficiency, ALS, Myasthenia gravis, closed angle glaucoma etc neuromusculer diseases, viral infection, closed angle glaucoma.
Breastfeeding- No data is available on the presence of incobotulinumtoxinA in human milk
Pregnancy- Use only if the benefits justifies the potential harm to the fetus
Dosing :
For upper limb spasticity:
8 units/kg IM divided among affected muscles up to 200 units.
For the treatment of chronic sialorrhea:
Children 2 to 17 years:
Weighing 12 kg to <15 kg:
6 units intraglandular for each parotid gland and 4 units intraglandular for each submandibular gland.
Weighing 15 kg to <19 kg:
9 units intraglandular for each parotid gland and 6 units intraglandular for each submandibular gland.
Weighing 19 kg to <23 kg:
12 units intraglandular for each parotid gland and 8 units intraglandular for each submandibular gland.
Weighing 23 kg to <27 kg:
15 units intraglandular for each parotid gland and 10 units intraglandular for each submandibular gland.
Weighing 27 kg to <30 kg:
18 units intraglandular for each parotid gland and 12 units intraglandular for each submandibular gland.
Weighing > 30 kg: 22.5 units intraglandular for each parotid gland and 15 units intraglandular for each submandibular gland.
Adverse Effect :
visual impairment ,seizures ,anaphylactoid reactions ,serum sickness ,corneal erosion ,dysphagia,blurred vision ,dyspnea ,hypertension ,dysphonia ,photophobia ,hematoma ,antibody formation ,blepharospasm ,edema ,erythema ,dysarthria ,urinary incontinence ,infection ,ptosis ,xerophthalmia ,xerostomia ,weakness ,injection site reaction ,diarrhea ,headache etc
Mild - myalgia, pruritus, urticaria, influenza, pharyngitis, back pain.
Interaction :
• Moderate drug reactions with atropine (decreased absorption and potentiation of adverse effects) and antimuscarinins
• Dantrolene (excess neuromuscular weakness)
• Tubocurarine (effect of botulinum toxin is potentiated) and neuromuscular blockers
Hepatic Dose :
No data available