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Articles

Safety in Lactation: Antimigraine drugs

21 October 2020If simple analgesics, e.g. paracetamol and ibuprofen, are insufficient to treat symptoms, sumatriptan is the drug of choice for the treatment of acute migraine. Although…

Safety in Lactation: Drugs for movement disorders

10 November 2018Additional information relating to breastfeeding To be used in conjunction with individual drug entries for specific information and guidance.  Drugs for dystonias and other involuntary…

Hypersalivation – what drug treatment options are available?

1 August 2018This Medicines Q&A is one of a series of five Q&A documents to address the drug treatment of hypersalivation (drooling or sialorrhoea). It gives a…

Hypersalivation – what are the treatment alternatives to glycopyrronium and hyoscine?

1 August 2018This Medicines Q&A outlines possible alternatives to hyoscine hydrobromide and glycopyrronium in the treatment of non drug-induced hypersalivation, e.g. botulinum toxin, amitriptyline, atropine (eye drops…

Drug-induced hypersalivation – what treatment options are available?

1 August 2018This Medicines Q&A summarises published studies or case reports concerning the pharmacological treatment of drug-induced hypersalivation (drooling or sialorrhoea), particularly hypersalivation caused by clozapine. Update…
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Refrigerated Storage

BotoxAllergan Ltd.

Allergan Ltd.
Botox
Powder for solution for injection 50, 100, 200 units/vial

In the event of an inadvertent temperature excursion the following data may be used:

There is no effect on the stability of the product if it is exposed to temperatures:
Within a range of -70°C  to 30°C  for a period of no more than five days (120 hours)

Please also refer to the manufacturer’s product literature for recommended storage information at https://www.medicines.org.uk

The product should be returned to the fridge as soon as possible and marked "use first" if exposed to the storage conditions specified above.
25 March 2021
London MI Service

DysportIpsen Ltd.

Ipsen Ltd.
Dysport
Injection, vials containing 500 units or 300 units

Contact Ipsen in all cases where a deviation from the recommended storage conditions has occurred. Refer to the current BNF for company contact details.

Please also refer to the manufacturer’s product literature for recommended storage information at https://www.medicines.org.uk

No Information
No Information

Do not freeze

5 May 2020
London MI services

AzzalureGalderma

Galderma
Azzalure
125 units powder for solution for injection

In the event of an inadvertent temperature excursion the following data may be used:
Stability studies have been conducted on unreconstituted Azzalure at 25°C and 40°C for short periods, and these have shown that Azzalure remains stable at 25°C for up to two weeks and at 40°C for up to 24 hours.
Please also refer to the manufacturer’s product literature for recommended storage information at https://www.medicines.org.uk

Information not provided by manufacturer
Yes
19 December 2019
London Medicines Information Service

Lactation Safety Information

Yes
-
No published evidence of safety after therapeutic use. Botulism in a mother showed no transfer of toxin to infant via breast milk
No systemic absorption in mother if used correctly. Therefore, not expected to be found in breast milk
Delay cosmetic use until infant weaned
8 November 2018

New Medicines

DysportTreatment of upper limb spasticity in children aged 2 to 17 years

Information

Dysport
Licence extension / variation
Ipsen
Not Known

Development and Regulatory status

Launched
Launched
Launched
January 2020
Jan 20Approved in UK by MHRA for use in symptomatic treatment of focal spasticity of upper limbs in paediatric cerebral palsy (CP) patients, two years of age or older. Approval was based on a PIII study, which found that the drug reduced spasticity symptoms in children aged two years and older being treated for upper limb spasticity due to CP. The approval means the treatment is now the first and only botulinum toxin in the UK approved for the treatment of paediatric spasticity in both upper and lower limbs [5].
Sep 19Approved in the US for the treatment of upper limb spasticity in children aged ≥2 years, excluding spasticity caused by cerebral palsy [4].
Jun 19According to Ipsen pipeline, Dysport is pre-registration for paediatric upper limb spasticity; location not stated but assume US & EU [3].

Category

Glutamate receptor antagonist
Pooled data from five active cerebral palsy registers in the UK suggest a mean annual prevalence rate for normal birth-weight children of 1.2 per 1,000 live births [1].
Treatment of upper limb spasticity in children aged 2 to 17 years
Intramuscular

Trial or other data

Oct 18PIII PUL study has completed [2].
Apr 14PIII PUL study (NCT02106351) to assess the efficacy and safety of multiple doses of Dysport used in the treatment of upper limb spasticity (altered skeletal muscle performance) in children with cerebral palsy (CP) starts. 212 children aged 2 to 17 years will be recruited in the US, Belgium, Czechia, Israel, Mexico, Spain, Turkey and Poland. Collection of primary outcome data (Mean change from baseline in the Primary Targeted Muscle Group on Modified Ashworth Scale (MAS) at week 6) due to complete in Sep 17 [2].

DysportTreatment of urinary incontinence in patients with neurogenic detrusor overactivity due to spinal cord injury or multiple sclerosis

Information

Dysport
Licence extension / variation
Ipsen
Not Known

Development and Regulatory status

Phase III Clinical Trials
Phase III Clinical Trials
Phase III Clinical Trials

Category

Glutamate receptor antagonist. 600U (start dose) or 800U (highest dose) per treatment session, dosed no more frequently than every 12 weeks.
60-80% of people with MS and 75-80% of people with spinal cord injury will have some degree of bladder dysfunction including urinary incontinence [1].
Treatment of urinary incontinence in patients with neurogenic detrusor overactivity due to spinal cord injury or multiple sclerosis
Intramuscular

XeominChronic sialorrhoea due to neurological disorders in children

Information

Xeomin
Licence extension / variation
Merz Pharmaceuticals
Merz Pharmaceuticals

Development and Regulatory status

None
Phase III Clinical Trials
Launched
Dec 20FDA approves a supplemental Biologics License Application (sBLA) for botulinum toxin A (Xeomin) for the treatment of patients aged 2 years and older with chronic sialorrhea. Xeomin is the first and only FDA-approved neuromodulator with this indication and was granted a priority review designation upon acceptance by the FDA [6].
Jul 18Will be filed in the EU using the mutual recognition procedure [2].

Category

Glutamate receptor antagonist
Prevalence of moderate-to-severe drooling in children, young people and adults with neurological conditions, particularly cerebral palsy, is estimated to be between 10% and 37% [1].
Chronic sialorrhoea due to neurological disorders in children
Intramuscular

Trial or other data

Nov 20No update to PIII trial (NCT02270736) registry; still no results available [5].
Jul 19PIII trial (NCT02270736) completed May 19; no results posted [4].
Jun 18PIII trial (NCT02270736) is active but has completed recruitment. No results posted yet [3].
Dec 14PIII trial to assess the safety and efficacy of botulinum toxin A in children and adolescents for the treatment of chronic troublesome sialorrhoea associated with neurological disorders (e.g. cerebral palsy, traumatic brain injury) and/or intellectual disability starts (SIPEXI; NCT02270736). 249 patients, aged 2 to 17 years old, will be recruited in Georgia, Hungary, Poland, Russia and Serbia. This trial contains an open-label extension period. Primary outcomes are change in unstimulated salivary flow rate [uSFR] from baseline to Week 4 (for subjects aged 6-17 years only. uSFR: weighing of dental rolls soaked with saliva over 5 minutes; procedure repeated after 30 minutes. The reduction of measured weight over the study relates to improvement of sialorrhea), Global Impression of Change Scale [GICS] at Week 4 representing the functional improvement in drooling since baseline as assessed by the carer/parent(s), and occurrence of treatment emergent AEs. Collection of these data are due to complete Feb 18 [3].

Evidence based evaluations

XeominTreatment of muscle spasticity in children and adolescents aged 2 to 17 years

Information

Xeomin
Licence extension / variation
Merz Pharmaceuticals
Merz Pharmaceuticals

Development and Regulatory status

None
Phase III Clinical Trials
None

Category

Glutamate receptor antagonist
Pooled data from five active cerebral palsy registers in the UK suggest a mean annual prevalence rate for normal birth-weight children of 1.2 per 1,000 live births [3].
Treatment of muscle spasticity in children and adolescents aged 2 to 17 years
Intramuscular

XeominLower limb muscle spasticity following stroke or traumatic brain injury - first-line in adults

Information

Xeomin
Licence extension / variation
Merz Pharmaceuticals
Merz Pharmaceuticals

Development and Regulatory status

Phase III Clinical Trials
Phase III Clinical Trials
Phase III Clinical Trials

Category

Glutamate receptor antagonist
In England, approximately 110,000 people have a stroke each year and between 19 and 38% of them (up to 41,800 people) are affected by spasticity. Of the people who have spasticity associated with stroke, 79% report spasticity in the elbow, 66% report spasticity in the wrist, 50% report spasticity in the hip, 54% report spasticity in the knee, and 66% report spasticity in the ankle [1].
Lower limb muscle spasticity following stroke or traumatic brain injury - first-line in adults
Intramuscular

Further information

Yes
To be confirmed

Botox Treatment of upper limb muscle spasticity in children aged 2 to 17 years with cerebral palsy and stroke

Information

Botox
Licence extension / variation
Allergan
Allergan

Development and Regulatory status

Phase III Clinical Trials
Phase III Clinical Trials
Launched
Jun 19Approved in US for treatment of upper limb spasticity in children aged 2 to 17 years [1].

Category

Glutamate receptor antagonist
Cerebral palsy is the most common condition associated with spasticity in children and young people, although it can also occur with other forms of nonprogressive and progressive brain disorders. The incidence of cerebral palsy is not known, but its prevalence in the UK is 186 per 100,000 population, with a total of 110,000 people affected [2,3].
Treatment of upper limb muscle spasticity in children aged 2 to 17 years with cerebral palsy and stroke
Intramuscular

Trial or other data

Sep 18Allergan complete PIII trial (NCT01603615) of Botox for treatment of pediatric upper limb spasticity. A second PIII study (NCT01603602) completed June 17 [4].

Botox Treatment of lower limb muscle spasticity in children aged 2 to 17 years with cerebral palsy and stroke

Information

Botox
Licence extension / variation
Allergan
Allergan

Development and Regulatory status

Phase III Clinical Trials
Phase III Clinical Trials
Launched
Oct 19FDA approves license extension for Botulinum A toxin for treatment of lower limb spasticity in children and adolescents aged 2 to 17 years [5].
Mar 19Filed in US for treatment of lower limb spasticity aged 2 to 17 years; a decision is expected Q4 2019 [1,2].

Category

Glutamate receptor antagonist
Cerebral palsy is the most common condition associated with spasticity in children and young people, although it can also occur with other forms of nonprogressive and progressive brain disorders. The incidence of cerebral palsy is not known, but its prevalence in the UK is 186 per 100,000 population, with a total of 110,000 people affected [3,4].
Treatment of lower limb muscle spasticity in children aged 2 to 17 years with cerebral palsy and stroke
Intramuscular

Evidence based evaluations