How is onabotulinumtoxinA (BOTOX) reconstituted for injections to treat neurogenic detrusor overactivity?

Updated: Mar 06, 2019
  • Author: Pamela I Ellsworth, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Reconstitution of onabotulinumtoxinA may be accomplished in 1 of 2 ways. The first is to reconstitute a 200-U vial by adding 6 mL of 0.9% sterile nonpreserved saline solution, mixing gently, and withdrawing 2 mL from the vial into each of 3 separate 10-mL syringes. Reconstitution is completed by adding 8 mL of 0.9% nonpreserved saline solution into each of the 10-mL syringes and mixing gently. Each of the 3 syringes will then contain 10 mL (about 67 U of onabotulinumtoxinA), for a total of 200 U of reconstituted onabotulinumtoxinA.

The second option is to reconstitute a pair of 100-U vials by placing 6 mL of 0.9% nonpreserved saline solution into each one, mixing the vials gently, withdrawing 4 mL from each of the 2 vials into 2 separate 10-mL syringes, and withdrawing the remaining 2 mL from each vial into a third 10-mL syringe. Reconstitution is completed by adding 6 mL of 0.9% nonpreserved saline into each of the 10-mL syringes and mixing gently. As with the first option, each of the 3 syringes will then contain 10 mL (about 67 U of onabotulinumtoxinA), for a total dose of 200 U.


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