How Long Will a Vial of Botox Last?

Question

I have heard varying information regarding how long a vial of Botox lasts after it is reconsituted with saline.  I know the manufacturers say use within 4 hours, I have heard use within 2 weeks and also even longer. Does anyone know or tried using the Botox after different lengths of time?

Kenneth D. Steinsapir, MD · Answer

Dear Mixibunny
Allergan, the maker of BOTOX continues to advise doctors to keep BOTOX frozen or very cold until reconstituted and then use the product with in 4 hours. In busy offices this is not a problem. However, some offices do not use the reconstituted product this rapidly. One still sees offices that have "BOTOX days" for this reason. However, about 10 years ago, Allergan leveled with the medical community and reported that their own research indicated that reconstituted BOTOX can last 2 weeks in a refrigerator without loss of effect. Some investigators have extended this and it is probable that the product will last a month or more and still retain most of its effectiveness.
Allergan has not felt compelled to change their product insert even though the Federal government through Medicare is forced to pay for the "waste BOTOX" that is not used within 4 hours when Medicare patients are treatment for medical reasons (it is not all used for cosmetic purposes). Be that as it may, that BOTOX is good for a very long time. If you are getting treatment and it is not working as well as it did in the past, chances are that it is not that the BOTOX has gone bad, just that your are not getting all the product you think you are paying for.

Mark K. Markarian, MD, MSPH, FACS · Answer

Typically, if the Botox is re-constituted with preservative-free saline, it should be used within 4 hours.  If the Botox is re-constituted with bacteriostatic saline, and then refrigerated, it can last for up to 2 weeks.

David Hansen, MD · Answer

A Dr. James Fulton did a study many yrs ago that showed that Botox was still effective after 30 days, but most doctors use it up in a short time within a few days since so many patients get it now. We can go through a few bottles a day now in no time. We charge $300, 500 or 675 for 1, 2, or 3 areas.

Michael A. Persky, MD · Answer

Hi Mixibunny,
In the early days of Botox use, we scheduled "Botox days" so that we could use the mixed Botox within the four to eight hours.  As time went on, many practioners have found that when refrigerated, Botox remained effective for much longer time periods.
Now that Botox injections are so popular, most practioners seldom have mixed Botox around for more than a few days.  Beyond two weeks on the shelve,  you may want to consider treating your mother in-law with the older Botox batch.
Good luck and be well.
Dr. P

John Whitt, MD (retired) · Answer

It depends on how the Botox is reconstituted. If preservative-free saline is used, then it does have to be used within a few hours. If bacteriostatic saline is used, then the Botox will last 2 weeks or longer.

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