Does Freezing Botox Change It?

Question

I have been told that a local doctor only injects Botox in his patients on the day he gets it in....other offices have it all the time...because they freeze it. Does freezing the product in the doctor's office change it or make it less effective?

Ron Shelton, MD · Answer

Botox comes as a powder and is shipped on dry ice so it is frozen. It's not as if a physician gets it fresh and then can freeze it. Once the physician needs the Botox powder is mixed with a sterile liquid to make a solution. That solution is then kept refrigerated until the next dose is needed and in busy practices this might be less than one day. An expiration date or the date mixed is written on the bottle. Using fresh mixed or refrigerated Botox has not made any clinical difference when the stored time is less than two weeks.

Harold J. Kaplan, MD · Answer

Hi Tilly's Mom.  Botox is freeze dried when it is received and not frozen.  Like any other pharmaceutical product, Botox has a useful shelf life and this shelf life changes once saline solution is added (reconstitution).

As long as the Botox has not expired (which it rarely will at any office that uses it regularly), using it on the same day is no different than using it days or weeks later, especially if it has not been reconstituted.

It sounds like the MD that is purporting to use it on the same day is trying to use this as a marketing tactic to scare consumers into thinking this is the only way it will be useful.

David Shafer, MD, FACS · Answer

It sounds like you may have some confusing information.  Botox is shipped from the manufacturer on dry ice.  It is then kept in the refrigerator at the recommended temperature until it is reconstituted and used.  Reconstituting it, means that you are mixing the dry powder in the vial with saline so that it can be injected with a syringe.  In general, the Botox should then be used within four hours, but some studies have shown that it last much longer.  In our office, we open a new vial for each patient and reconstitute it right infront of them and then inject it.  That way, the patient knows that they are getting the freshest Botox available and also that they are getting the whole vial.  It would be  inpracticel and unnecessary to use the Botox the day it arrives from the manufacturer. 

	 

	Good Luck.

Theda C. Kontis, MD · Answer

When Botox first came out, we used to have Botox Days--we thought that it had to be mixed fresh and used that day or it would lose its potency. (As you have read, it comes to us as a freeze-dried product that is kept frozen until it is reconstituted with saline.) What studies have shown is that its potency will remain the same for two weeks or more. So, most of us keep it refrigerated (not frozen!) after reconstitution and use it for the next two weeks.

	I suspect if a doctor is still doing Botox Days, they either have a very small volume of Botox patients, or they are uninformed.

Kenneth D. Steinsapir, MD · Answer

BOTOX comes as a dry powder in a tiny sealed vial. It is shipped frozen but it can also simply be kept cold. Once reconstitute, Allergan, the manufacture has told the FDA that the product should be used within 4 hours or discarded. However, they have also told doctors that the product is good for many weeks if kept in a refrigerator once reconstituted with saline for injection. Practically most offices rapidly use up their reconstituted BOTOX so it is virtually never stored once reconstituted.

Tom J. Pousti, MD · Answer

Thank you for your question.

	No, Botox does not need to be used the same day that it is shipped to the doctor. Please make sure that you are having a certified doctor perform the injections.  There are dentists, nurses, aestheticians, etc. who do Botox injections... be careful!

Benjamin Barankin, MD, FRCPC · Answer

Whether Botox is stored in a fridge or freezer, it works consistently well, even if stored for many weeks. It certainly does not need to be injected the same day it is received, though the sooner it is injected after it is reconstituted with saline, the better.

Emily Altman, MD · Answer

Botox comes in 50 or 100 unit vials that contain vacuum-dried botulinum toxin A complex. There are expiration dates on the package. We keep the un-reconstituted vials in their packaging in the freezer. Botox has been shown to be fully effective up to six weeks after reconstitution with bacteriostatic saline. Once reconstituted, the unused Botox is kept in the refrigerator. So it does not need to be used the day it is received.

Daniel Yamini, MD, FACS · Answer

There are no limits on how long you store Botox before you inject it.  It needs to be refrigerated but works just as well weeks later.

Robert L. Kraft, MD, FACS · Answer

Botox comes in a powdered form which is reconstituted.  Before reconstitution it is stored in my medical refrigerator.  There is no reason to freeze it.  Allergen does not recommend freezing.  Most plastic surgeons who inject it all the time keep adequate supplies on had to meet patient demand.

Does Freezing Botox Change It?

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