IM Focal spasticity Adult Upper limb: Doses of 500-1,000 u divided among selected muscles: Flexor carpi radialis, flexor carpi ulnaris, flexor digitorum profundus, flexor digitorum superficialis, flexor pollicis longus, brachioradialis, pronator teres: 100-200 u; adductor pollicis: 25-50 u; brachialis, biceps brachii: 200-400 u; triceps brachii, pectoralis major, subscapularis, latissimus dorsi: 150-300 u. Lower limb: Doses of 1,000-1,500 u divided among selected muscles: Soleus muscle: 300-550 u, gastrocnemius (medial & lateral head): 100-450 u, tibialis posterior: 100-250 u, flexor digitorum longus, flexor digitorum brevis, flexor halluces longus: 50-200 u, flexor hallucis brevis: 50-100 u.
Paed cerebral palsy patient ≥2 yr Max total dose/treatment session: Single lower limb: 15 u/kg, both lower limbs: 30 u/kg no sooner than 12 wk; single upper limb: 16 u/kg, both upper limbs: 21 u/kg no sooner than 16 wk; upper & lower limbs: 30 u/kg no sooner than 12-16 wk.
Upper limb focal spasticity Paed cerebral palsy patient ≥2 yr Brachialis, biceps brachii 3-6 u/kg; brachioradialis, flexor carpi ulnaris, flexor digitorum superficialis 1.5-3 u/kg; pronator teres, flexor digitorum profundus, flexor pollicis longus 1-2 u/kg; pronator quadratus, flexor pollicis brevis, opponens pollicis, adductor pollicis, pectoralis major 0.5-1 u/kg; flexor carpi radialis 2-4 u/kg. Total Dose: up to 16 u/kg or 640 u in a single upper limb (Max: 21 u/kg or 840 u if both upper limbs injected).
Upper & lower limb focal spasticity Paed cerebral palsy patient ≥2 yr Max total dose/treatment session: 30 u/kg or 1,000 u. Consider retreatment no sooner than a 12-16 wk.
Dynamic equinus foot deformity due to focal spasticity Paed cerebral palsy patient ≥2 yr (ambulant) Recommended dose range/muscle/leg: Gastrocnemius: 5-15 u/kg, soleus 4-6 u/kg, tibialis posterior 3-5 u/kg. Total Dose: up to 15 u/kg in a single lower or 30 u/kg if both lower limbs injected, Max: 1000 u.
Spasmodic torticollis Adult & elderly Initially 500 u as divided dose & administered to the 2-3 most active neck muscles.
Rotational torticollis Administer 350 u into the ipsilateral splenius capitis muscle & 150 u into the sternomastoid muscle.
Laterocollis Administer 350 u into the ipsilateral splenius capitis muscle & 150 u into the ipsilateral sternomastoid muscle.
Retrocollis Administer 250 u into each splenius capitis muscles.
SC Blepharospasm & hemifacial spasm Adult & elderly Dose of 40 u/eye. Max: 120 u/eye. Inj repeated approx every 12 wk or as required.
IM Moderate to severe glabellar lines 50 u (0.25 mL of reconstituted soln) divided into 5 inj sites, 10 u (0.05 mL of reconstituted soln) are to be administered into each of the 5 sites (2 inj into each corrugator muscle & 1 into the procerus muscle near the nasofrontal angle).
Moderate to severe lateral canthal lines 30 u/side divided into 3 inj site, 10 u (0.05 mL of reconstituted soln) administered into each inj point.
Intradermal Axillary hyperhidrosis Initially 100 u/axilla (armpit), up to 200 u/axilla may be administered in subsequent inj. Max: 200 u/axilla. Intradermal inj should be administered in 10 sites each receiving 10 u, to deliver 100 u/armpit. Inj should not be repeated more frequently than every 12 wk.
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