Select a medication above to begin.
Daxxify (daxibotulinumtoxinA-lanm)
daxibotulinumtoxinA
Black Box Warnings .
Distant Spread of Toxin Effect
effects of all botulinum toxin products may spread beyond tx area to produce sx consistent w/ botulinum toxin; sx incl. asthenia, generalized muscle weakness, diplopia, blurred vision, ptosis, dysphagia, dysphonia, dysarthria, urinary incontinence, and breathing difficulties; life-threatening swallowing and breathing difficulties can occur; deaths reported; sx may occur hours to weeks after injection; risk greatest in children treated for spasticity but can occur in adults, esp. if underlying risk factors; in unapproved uses, incl. spasticity in children, and in approved indications, spread of effect reported at doses comparable to or lower than max recommended total dose
Adult Dosing .
Dosage forms: INJ
Special Note
- [formulation clarification]
- Info: nonproprietary name = daxibotulinumtoxinA-lanm
glabellar lines, moderate-severe
- [40 units IM divided equally in 5 sites x1]
- Info: may repeat no more frequently than q3mo
cervical dystonia
- [125-250 units IM divided among affected muscles x1]
- Info: adjust dose in 50-75 unit increments; may repeat no more frequently than q3mo
renal dosing
- [not defined]
- renal impairment: not defined
- HD/PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- injection site infection
- caution: atrophy at injection site
- caution: neuromuscular dz
- caution: cardiovascular dz
- caution: dysphagia
- caution: dyspnea
- caution: neck muscle mass, small (cervical dystonia use)
- caution: injection site inflammation (glabellar line use)
- caution: ptosis (glabellar line use)
- caution: deep dermal scarring (glabellar line use)
- caution: facial asymmetry (glabellar line use)
- caution: sebaceous skin, thick (glabellar line use)
- caution: dermatochalasis (glabellar line use)
- caution: facial anatomy surgery hx (glabellar line use)
Drug Interactions .
Overview
botulinum toxin
acetylcholine release inhibitor
- anticholinergic effects
- neuromuscular blocking effects
Avoid/Use Alternative
- aclidinium inhaled
- amikacin
- amikacin inhaled
- benztropine
- clozapine
- colistimethate
- gentamicin
- glycopyrrolate inhaled
- glycopyrronium topical
- ipratropium inhaled
- neomycin
- olanzapine
- paromomycin
- plazomicin
- polymyxin B
- revefenacin inhaled
- sofpironium topical
- streptomycin
- tiotropium inhaled
- tobramycin
- tobramycin inhaled
- umeclidinium inhaled
Monitor/Modify Tx
- amitriptyline
- atracurium
- botulinum toxin
- cisatracurium
- clomipramine
- desflurane
- desipramine
- imipramine
- isoflurane
- nortriptyline
- pancuronium
- protriptyline
- rocuronium
- sevoflurane
- succinylcholine
- vecuronium
Caution Advised
- alfentanil
- amantadine
- amoxapine
- aripiprazole bimonthly injection
- aripiprazole lauroxil
- aripiprazole monthly injection
- aripiprazole oral
- asenapine
- atropine
- atropine ophthalmic
- baclofen
- baclofen intrathecal
- belladonna alkaloids
- brexpiprazole
- brompheniramine
- buprenorphine
- butorphanol
- carbinoxamine
- cariprazine
- carisoprodol
- chlophedianol
- chloroquine
- chlorpheniramine
- chlorpromazine
- chlorzoxazone
- clemastine
- clidinium
- codeine
- cyclobenzaprine
- cyclopentolate ophthalmic
- cyproheptadine
- dantrolene
- darifenacin
- dexbrompheniramine
- dexchlorpheniramine
- dicyclomine
- dihydrocodeine
- dimenhydrinate
- diphenhydramine
- disopyramide
- doxepin
- doxepin topical
- doxylamine
- fentanyl
- fesoterodine
- flavoxate
- fluphenazine
- glycopyrrolate
- homatropine
- hydrocodone
- hydromorphone
- hydroxychloroquine
- hydroxyzine
- hyoscyamine
- iloperidone
- ipratropium nasal
- isocarboxazid
- levorphanol
- loxapine
- lumateperone
- lurasidone
- meclizine
- meperidine
- metaxalone
- methadone
- methocarbamol
- methscopolamine
- mirabegron
- mirtazapine
- molindone
- morphine
- nalbuphine
- oliceridine
- opium
- orphenadrine
- oxybutynin
- oxycodone
- oxymorphone
- paliperidone
- pentazocine
- perphenazine
- phenelzine
- pheniramine
- pimozide
- procainamide
- prochlorperazine
- promethazine
- pyrilamine
- quetiapine
- quinidine (antiarrhythmic)
- quinidine (CYP2D6 inhibitor)
- remifentanil
- risperidone
- scopolamine
- solifenacin
- sufentanil
- tapentadol
- thioridazine
- thiothixene
- tizanidine
- tolterodine
- topiramate
- tramadol
- tranylcypromine
- trifluoperazine
- trihexyphenidyl
- trimipramine
- triprolidine
- tropicamide ophthalmic
- trospium
- vibegron
- ziprasidone
- zonisamide
Adverse Reactions .
Serious Reactions
- hypersensitivity rxn
- anaphylaxis
- toxin effect spread
- dysphagia, severe (cervical dystonia use)
- respiratory failure (cervical dystonia use)
Common Reactions
- headache
- injection site rxn
- muscle weakness
- URI
- musculoskeletal pain (cervical dystonia use)
- dysphagia (cervical dystonia use)
- arthralgia (cervical dystonia use)
- ptosis (glabellar line use)
- ocular dryness
Safety/Monitoring .
Monitoring Parameters
no routine tests recommended
Pregnancy/Lactation .
Pregnancy
Clinical Summary
may use during pregnancy; risk of fetal harm not expected based on limited human data and expected limited systemic absorption
Lactation
Clinical Summary
may use while breastfeeding; inadequate human data available, though risk of infant harm and adverse effects on milk production not expected based on limited maternal systemic absorption
Pharmacology .
Metabolism: unknown; CYP450: unknown; Info: minimal to no systemic absorption
Excretion: unknown; Half-life: unknown
Subclass: Cosmetic, Dermatologic ; Dystonias/Parkinson Disease
Mechanism of Action
inhibits acetylcholine release from nerve endings, reducing neuromuscular transmission and local muscle activity (neurotoxin)
Formulary .
No Formulary Selected
Join Now to View Patient Handouts!
Create a FREE epocrates Online account to access patient medication instructions. Your patients and caregivers will appreciate you printing these friendly handouts, available in English and Spanish. Each handout addresses common concerns such as how to take the medication, and possible side effects.
Current Members: Sign In.
Pill Pictures
Join Now to View Pill Pictures!
Create a FREE epocrates Online account to access full-color images of medications within the drug monograph.
Current Members: Sign In.