When are botulinum toxin injections contraindicated for the treatment of neurogenic detrusor overactivity?

Updated: Mar 06, 2019
  • Author: Pamela I Ellsworth, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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OnabotulinumtoxinA is contraindicated in the presence of infection at the proposed site(s) and in individuals with known hypersensitivity to any botulinum toxin preparation or to any of the components in the formulation. It is also contraindicated in patients with detrusor overactivity associated with a neurologic condition who have an acute urinary tract infection, as well as in patients with acute urinary retention who are not routinely performing clean intermittent self-catheterization (CIC).

Warnings and precautions include the following:

  • Potency units of onabotulinumtoxinA are not interchangeable with other preparations of botulinum toxin products

  • Postmarketing reports indicate that the effects of onabotulinumtoxinA and all botulinum toxin products may spread from the area of injection to produce symptoms consistent with botulinum toxin effects. These may include asthenia, generalized muscle weakness, diplopia, blurred vision, ptosis, dysphagia, dysphonia, dysarthria, urinary incontinence, and breathing difficulties

Potential drug interactions must be taken into account. Patients receiving concomitant treatment with onabotulinumtoxinA and aminoglycosides or other agents interfering with neuromuscular transmission (eg, curare-like agents) or muscle relaxants, should be observed closely because the effect of onabotulinumtoxinA may be potentiated.

Potential transmission of viral disease must also be considered. OnabotulinumtoxinA contains albumin. On the basis of effective donor screening and product manufacturing processes, onabotulinumtoxinA carries an extremely remote risk for transmission of viral diseases. A theoretical risk for transmission of Creutzfeldt-Jakob disease (CJD) is also considered extremely remote. No cases of transmission of viral diseases or CJD have ever been reported for albumin.

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