Will Botox Expire if Left Unchilled for 24 Hours?

I stored botox in a coolerbox with 5 icepacks at 09:00 in the morning.The following day at 14:00 I realised that I had forgotten to refrigeate it. Can it still be used, or is it now expired?

Doctor Answers 12

Botox for Television.

We have used Botox onstage on my partner Drew Ordon's show, The Doctors.  We go through great pains to keep it cold but one time it was left out in our office overnight.  Unsure if it would work, we tried it out on our staff members.  It worked perfectly. We had very happy staff after that!

Beverly Hills Plastic Surgeon
5.0 out of 5 stars 33 reviews


If you are a physician, I would suggest contacting Allergan directly as they will be able to assist you. Best of luck!

Michael Sullivan, MD
Columbus Facial Plastic Surgeon
4.9 out of 5 stars 88 reviews

Improperly stored botox

If your botox vials were not reconstituted there might be less of a concern to have been left in the cooler, but if it was diluted already and then left out, it could potentially increase the risk of bacterial growth.  If you are a licensed injector, then you should be able to contact Allergan and ask their scientific division your question. They may have privileged information that is not available on line.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 37 reviews

Unchilled Botox may be effective, but be extra cautious.

I agree with the other docs in regards to bacteriostasis. Trial and error will safely tell if it's effective, and keep note of those patients who get this Botox to offer them retreatment if less effective than usual, but I would have a much lower threshold for the time I'd be willing to use a reconstituted vial before tossing. And I agree about using bacteriostatic saline especially in this case.

Jessica J. Krant, MD, MPH
New York Dermatologic Surgeon
4.7 out of 5 stars 41 reviews

Unchilled Botox

As long as the Botox was not exposed to heat it should be fine. If you are not satisfied with results after using this Botox, do supplemental injections on those patients.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

The rules for botox storage are unclear.

The rules for botox storage are unclear. After reconstitution botox can remain in a refrigerator for a month or more. Our experience is that botox may be left a room temperature for 8 hours and still be effective.

Edward Lack, MD
Chicago Dermatologist
2.8 out of 5 stars 5 reviews

Botox out of the cold

This has happened to me with a power outage, and the neurotoxin still worked. If it does not, let the patients know that they may need further injection (comped of course)

Purvisha Patel, MD
Germantown Dermatologist
5.0 out of 5 stars 4 reviews

Can Botox left unrefrigerated overnight still be used

It is best to keep Botox refrigerated, but leaving it out of the refrigerator, especially since it was cooled part of the time, for one day should not affect its potency.

Emily Altman, MD
Short Hills Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

BOTOX® is very stable

As a practical matter, we have learned over the past 20 years that BOTOX® is a very stable formulation of BTX-A, and appears to retain full potency for at least several weeks at room temperature after reconstitution using Hospira brand normal saline with 0.9% benzyl alcohol preservative [pH ~5.0]. 

The fact that BOTOX® [uniquely among the BTX-A formulations commecially available in North America] has a full complement of protective proteins may contribute to its stability, in particular when reconstituted at a low pH.

Having said that, best practice is to keep all BTX-A formulations, including BOTOX®, refrigerated after reconstitution.

Kevin C. Smith, MD
Niagara Falls Dermatologic Surgeon
4.7 out of 5 stars 4 reviews

Botox Left Unchilled

I had a power outage and the Botox was not kept cold for 24 hours but still worked fine. I also always use bacteriostatic saline to reconstitute Botox. Make sure you follow up with the patient to see that it worked.

Mitchell Schwartz, MD
South Burlington Dermatologic Surgeon
4.7 out of 5 stars 12 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.