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“Botox and Antibiotics Caused Flu-like Symptoms, Extreme Anxiety, Other Problems”

Comments (12)
Updated 20 Sep 2009
Posted 17 Sep 2009
Not Worth It
Spent: $500 in ct

I recieved 30u of cosmetic botox by cosmetic surgeon. I informed him that I was being treated for lyme disease with zithromycin and he said it was not a problem. I subsequently had a severe reaction and have had to discontinue my lyme treatment - possibly until the effects of botox are gone. Do not get botox if you are currently on antibiotics!

I had 30u of cosmetic botox in my forehead and crows feet 3 weeks ago. At the time, I was taking zithromycin and mepron and subsequently had a reaction to the botox of severe flu-like symptoms, extreme anxiety, sweats, difficulty sleeping, loss of appetite. I stopped the antibiotics but am still having anxiety. I am wondering if I can start biaxim and tetracycline for lyme disease or can these still intensify the effects of the botox? Also, can botox still migrate from these areas 3 weeks later? I occasionally feel like my voice box is quivering and it feels like I will lose voice.

This review is the subjective opinion of a RealSelf member and not of RealSelf, Inc.

My Doctor: Name not provided

did not properly inform me of risks associated with botox and antibiotics
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Comments (12)

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Sharon at RealSelf (Community Manager - 4,028 posts) 20 Sep 2009

Thanks for sharing your experience with us.

According to the doctors' replies in this thread - How will antibiotics affect Botox results? - Botox does not cause a reaction with antibiotics. However, I've seen some people on RealSelf who have had experiences similar to yours. Perhaps you could also network with them and share information? A RealSelf community member named "Tried but failed" has done a lot of research on Botox and antibiotics. I believe she was even on tetracyclines.

I hope this information helps!

tried but failed (804 posts) 20 Sep 2009
Thanks Sharon. Hi Iwantthebotoxout - please read my review about botox and antibiotics. I had a similar experience. The research regarding the interaction between botox and various classes of antibiotics is relatively new and I think that the answers from the RealSelf doctors are outdated (and therefore wrong). I was taking a tetracyline antibiotic (Doxycycline) before, during and after the botox. The antibiotic caused the physical effect of the botox to be massively potentiated and I had extreme side effects similar to the ones you are describing. Good news for you! The side effects went away after about 4-5 weeks so, in my experience, they do NOT last the entire time of the botox. Bad news for me, I look absolutely revolting because of the increased physical effect of the botox and after 11 weeks there has been little improvement. I will just have to wait it out, I guess. As to taking more antibiotics, please seek medical advice before you do. I most certainly wouldn't take any antibiotic during the phase where the botox is still actively working (ie the first two weeks or so). This is only my (non-medical) opinion. You really need to find a doctor who knows about these things properly or is prepared to do some research for you to find out. Please go to your doctor armed with information about the interaction between botox and antibiotics because some doctors are still relying on the outdated information that no such interaction exists. Lots of information is available on the internet and I can help you if you need it. Unfortunately, I did have to take more antibiotics recently because there is a whooping cough epidemic in Australia at the moment. I was absolutely petrified to take them because I was afraid the side effects would come back! They didn't. About a fortnight ago (9 weeks post-botox), I took a course of erythomycin for about a week and did not have any recurrence of the botox side effects. That being said, erythomycin is NOT in a class of antibiotics that is listed on the botox information sheets as one that interacts with botox. I feel terrible for you because you have a difficult decision to make and it appears that there are very few people in the medical field who are properly across all the issues here. Some doctors even still deny that there are any side effects of botox, especially flu-like symptoms and anxiety etc!!! If you read more of the posts on this site, you will see that lots of people do experience these side effects so you are not alone. Please contact me if I can help you further. Cheers
tried but failed (804 posts) 21 Sep 2009
Hi again - I wrote that post in a total rush as soon as I saw your review. I was at work but I am home now. The antibiotic I took about 9 weeks after botox because of the whooping cough situation is called "erythromycin" (sorry for spelling error above). I think it is similar to azithromycin. They are both MACROLIDES. All I can tell you from my own experience is that I did not have a return of the horrible botox side effects when I took the 7-day course of erythromycin at around the 8-9 week mark post-botox. Nor did the botox become active again. For me, the erythromycin taken two months after botox did not worsen the physical effect or bring back the side-effects at all, even though I was terrified they would. Back to the Doxycycline and botox interaction, I should add that because of the Doxycycline the botox seemed to 'work' for much longer than normal. My face kept changing for about 3 1/2 weeks whereas in my previous experiences with botox the results were stable within a week or so. And the side effects were horrendous! Extreme anxiety, panic attacks, insomnia, dizziness, nausea, confusion, headache, fatigue, muscle weakness etc etc etc. (I FEEL YOUR PAIN!) I even lost confidence to drive my car for a while because of the anxiety and my lack of ability to concentrate. I really don't know what to tell you except that (if you experience is similar to mine) then your side effects are very, very likely to go away in the next few weeks. I am not a doctor, but I do my own research now because I have (unsurprisingly) lost faith in the medical profession. They are either uninformed or untruthful, I can't decide which one. On the third time I had botox, I could see and feel that something had gone terribly, terribly wrong and the only difference I could think of was that I was taking Doxycycline on the third time and not the other two times. The same person administered the botox all three times in similar amounts in similar places. I was sure that my current horror had to be caused by an interaction between the Doxycycline and the botox. I was fobbed off by the medical profession but persisted with my research anyway. The information is available if you know what to look for and hiding at home waiting for this hideous face to go away gave me the time to look. This is information from the manufacturer of botox, Allergan: http://www.allergan.com/assets/pdf/botox_cosmetic_pi.pdf It is an interesting read especially regarding side effects and precautions!!!! When you complained to Allergan about the drug interaction between botox and azithromycin, they had no right to tell you that it was impossible - it is written in their own literature. (!) On page 7 under the heading "Drug interactions" it lists some drugs that may potentiate the effects of botox because these drugs also interfere with neuromuscular transmission. Aminoglycocides are the worst offenders but there are also some other examples given. The list of examples is not exhaustive. Tetracyclines produce some neuromuscular blockade by chelating calcium and therefore can potentiate botox. I did some more research for you and can tell you that macrolides like erythromycin and azithromycin are also known to interfere with neuromuscular transmission. My personal rule of thumb now is that any drug that should not be given to someone suffering from Myasthenia Gravis, should also not be administered concurrently with botox. See http://www.ncbi.nlm.nih.gov/pubmed/8701248 Even drugs that are not specifically 'contraindicated' with botox can cause horrible physical results and devastating side effects. The Allergan rep told me that they know of the potential for adverse reactions caused by antibiotic-botox interactions but they have not done clinical trials, so Allergan is only required to note the interaction as "potential" or "theoretical" for the time being. No clinical trials are proposed in the future. I know the interaction is more than potential or theoretical (and so do you) and think it is unethical that an adequate warning is not given. Good grief - you even ASKED your injector about it!!!!! I WISH MORE DOCTORS WOULD ADOPT A "BETTER SAFE THAN SORRY" APPROACH WITH BOTOX DRUG INTERACTIONS. It would have saved me months of grief... Please contact me ANYTIME. Cheers
iwantthebotoxout (7 posts) 21 Sep 2009
Thank you so much for your responses. They are making me feel like there is hope. I followed your link and filed a formal adverse reaction complaint with the FDA. I absolutely can not believe that the antibiotic warnings are not widely known and that the medical community is not more cautious. I foolishly trusted my doctor when he said it was not contraindicated to recieve botox while on antibiotics. I wish he would have said "although it is not contraindicated at this time, there are reports that the side effects could be potentiated" I would never have risked it! I will attempt to educate my doctor at my follow up appt this Friday. I missed my 2 week follow up because I could not get out of bed! The side effects seem to be calming down - it has been 3 weeks and 4 days. I am still having waves of anxiety, but not the complete panic. I am also still experiencing insomnia and gritty eyes. The constant breaking out in a sweat has also calmed way down. I too felt like the botox remained 'active' for almost 3 weeks. I got so I couldn't look at myself in the mirror because it kept getting worse. I am actually afraid to say they have calmed down for fear they will come raging back. I am trying to look into the future only 1 week at a time as the thought of being frozen and not feeling well for 6 months is unbearable. I do not know what I will do about my Lyme disease treatment. My Lyme specialist is not aware of any antibiotic/botox contraindications. I'm glad I didn't start the tetracycline! Thank you again for all of your information. I will probably try to wait it out as long as possible before starting a new antibiotic. Did you experience a feeling of "brain fog" as a side effect? I don't know if this particular feeling is the Lyme disease or also a side effect. The other antibiotics that he suggested for Lyme are clarithromycin in pill form or Rocephin IV. Where did you find the info about azithromycin interfering with neuromuscular transmission? I will read the links you referred to and look into the Myasthenia Gravis rule. I too will ALWAYS do my own research from this point on when it comes to medical conditions. Thank you again for taking the time to communicate with me. Be well!
tried but failed (804 posts) 21 Sep 2009
I am so glad you are feeling better and well done for making a report the FDA. I wish more people would do it. I am now 11 weeks past botox and my face is SLOWLY beginning it unfreeze. If the feeling in your forehead is anything to go by, you also seem to be slowly loosening up. My side effects have basically gone, but the unattractive physical effect remains! Months to go before that goes away... Sigh! I definitely had 'brain fog' and this was one of the reasons I stopped driving for a while. My feelings of disorientation, anxiety and confusion were so bad that I was terrified that I would be a danger to others on the road. As to the information about azithromycin interfering with neuromuscular transmission, some of the information I accessed is pay-per-view so I can't put the links up here because they won't work. However, for general information on the effect of macrolides (erythromycin, clarithromycin, azithromycin etc )on neuromuscular transmission, see http://www.ispub.com/journal/the_internet_journal_of_neurology/volume_10_number_2_6/article/drugs_which_may_exacerbate_or_induce_myasthenia_gravis_a_clinician_s_guide.html#h1-9 See also page 346 of "Atlas of neuromuscular diseases: a practical guideline" by Eva L. Feldman, Wolfgang Grisold, James W. Russell. I think you can get this on the internet but I can't find it now (sorry). Rocephin IV is a cephalosporin antibiotic so I am not sure if it affects neuromuscular transmission? I realise it is a bit "old school" but lots of resources are available at your local library for free!! The internet is great for research but pay-per-view can be expensive... Using contraindicated medications for Myasthenia Gravis as a basis for my antibiotic research helped me find the answers. Despite the repeated claims about how 'safe' botox is, I was surprised to see how very few clinical studies undertaken regarding botox drug interactions. Please share what you find out. When this first happened to me there was so little information available and this is what scared me the most. I found that approaching this disaster from a scientific (not a panic) perspective really helped me. I just needed to make sense of it so I could make some informed decisions. It is a difficult decision for you regarding the Lyme disease treatment and I wish you much luck. Stay in touch! Cheers
tried but failed (804 posts) 17 Oct 2009
Has there been any improvement? Have you got any sensible advice from your doctor? Would love to hear from you. Cheers
iwantthebotoxout (7 posts) 24 Oct 2009
Hi Tried But Failed, I am 8 weeks out and have not gone back on antibiotics. My Lyme symptoms have been mild and tolerable - maybe botox kills Lyme spirochetes :). I have continued to have episodes of severe sinus pain and gravel feelings in my eyes with headaches. I swear that after these episodes, I have a tightening between my brows again. I feel like there is 'extra' botox sitting in my sinuses. I would try the muscle stimulator that you bought. I feel that I have loosened the muscles that control the area between my brows by doing repetitive exercises - I will probably end up with even deeper furrows but I do not care anymore. I am still having insomnia issues, but the severe panic attacks have subsided. I have not kept up with this blog because the more information I read, the worse I felt. I am still so mad at myself for not researching this more. I know that information empowered you, but I actually went to the ground and almost fainted a few weeks ago when reading about FDA Botox warnings about migration of cosmetic Botox. I also had unexplained quadriceps muscle pain and weakness for 6 weeks and periods of feeling like my larynx was quivering. I also had alot of heart palpitations and racing. One of the researchers blogging on this site said that there is suspicion or evidence ( i don't remember which) that Botox cross the blood brain barrier. This has been the scariest thing that I have ever experience in my life! I hope you are starting to get some relief. I wonder about you often. Take care.
lotusflower (1 post) 20 Oct 2009
Hi "tried but failed". I found this because I went in google search of "Doxycycline botox interactions". I was recently put on a 10 day prescription of Doxycycline due to a MRSA infection on my face. I just took the last dose of the antibiotic this morning. My issue that prompted me to search is that twice in the past week, my botox injection (to my brow) has essentially "snapped" loose where my brow wrinkles up on it's own & I can't control it! It rights itself within minutes but it's really scary. It's only been a month since my injections & I found it ironic that it's happening now while I was on doxycycline. You didn't list (as far as I can tell) what your particular side effects were with Doxycycline & botox. Do you mind listing them? Any help you can give me would be greatly appreciated!
tried but failed (804 posts) 26 Mar 2010
Hi Lotus Flower - I didn't see your question until now so apologies for the VERY late reply. Usually RealSelf emails them to me but something must have gone wrong. Sorry again. I have had botox three times in total and never more than 20 units. The last time I had botox was on 10 July 2009 (15 units). I had been taking doxycycline for more than two weeks before the botox, I took it on the day of the botox and then I took it for more than a week after the antibiotics. Essentially, the doxycycline (tetracycline antibiotic) massively potentiated the botox effect. It honestly looked like I had 150 units of botox instead of 15 and my face did not stop changing and dropping and freezing for more than a month. The effect on my face is not pleasant. It is hideous, actually and it has lasted for 37 weeks so far. The waiting has been very frustrating and upsetting. I am sick of looking like crap! I also got systemic side effects - headache, sinus pain, nausea, flu-like symptoms, dizziness, disorientation, anxiety, panic attacks, insomnia, facial pain and tingling, unexplained muscle weakness, lethargy etc when the botox was given to me with the doxycycline (and that was also different from the first two times with botox). Those side effects have gone away now. Has your 'spasm' fixed itself now? I hope so! Did you get any systemic side effects? I hope not! Would love to hear from you. K
iwantthebotoxout (7 posts) 4 Dec 2009
Hi Tried But Failed, How are you doing? I am 14 weeks out and seem to have most movement back in my forehead, but cheeks and crows feet are not all the way back yet. I finally started on Tetracycline and Biaxim for my Lyme disease about 2 weeks ago. I have not had a recurrence of botox symptoms. I am feeling back to normal. I hope you are doing well!
tried but failed (804 posts) 3 Mar 2010
Hi iwantthebotoxout - Sorry for late reply! I didn't see that your post until just that second. It has almost been 34 weeks and I am finally seeing a bit of improvement. I still look like crap, but some of it is permanent I think. I am so glad that you are seeing improvement too and you are able to treat your lyme disease without worrying about worsening the botox effect. How are you doing now? Like you, the effect on my forehead started to wear off earlier than the rest. I think that the cheeks and under the eyes takes the longest to wear off. I am still seeing changes in my face after all this time! The physical effect of botox can really last a long, long time. Keep in touch and I would love to know how long it takes before you are fully back to normal. Cheers, K
Yolanda73 (57 posts) 1 Dec 2011
I experienced a total change while taking Bactrim for a UTI..I have always taken Bactrim for UTI and it worked beautifully. It had more trouble clearing the UTI I had thought and the Bactrim gave me the worse side effects- entirely unbearable insomnia (was up two nights no sleep) tremors, twitching, tingling head, extreme fatique and aggitation, ringing ears. Botox is the only thing different and so I believed all along that it altered my system or had an interaction with the anti-biotic. We also are reading often from others using Botox that infections are far more frequent (sinus, UTI and upper respiratory, ears) I am expereincing more cold sores and UTIs than I have ever experienced (and back to back which I have NEVER experienced) following the last injection. My immune system must be shot

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