Could I have gotten Botox poisoning?

Question

Two years ago I had botox in my forehead for probably about the 5th time in my life. About 2 weeks after I had breathing difficulties, weak neck muscles, heart palpitations, difficulty swallowing and muscle weakness all over. I read on the 'black box' warning these are all possible side effects. Could it have been the botox? Should I never get it again? I really want to get it again, but now I am scared.

Ron Shelton, MD · Answer

Too much of a dose, or inadvertent administration of Botox in a blood vessel that is hidden underneath the skin could contribute to Botox being disseminated to other sites in the body and a toxic reaction could have occurred with the symptoms described by you. This is not necessarily an allergic reaction and I had two patients who after having Botox had flu-like symptoms who came back many months later and had it done again without the same symptoms occurring.  As you had so many symptoms some of which can be alarming, I would not recommend you have it done especially as it is being done for an elective cosmetic reason.The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs.

Jeffrey R. Raval, MD, FACS, MBA · Answer

Hello, thank you for your question and I am so sorry to hear that happened to you. Understanding how long your symptoms lasted and if you saw your PCP regarding them will help to better estimate whether this was indeed botulism or not. I would guess if it was botulism, that you were given a false brand. It is very very rare to get botulism from Botox administered by a properly trained injector. Good luck!

Heidi A. Waldorf, MD · Answer

Two details you don't mention are 1) how long did your symptoms last  and 2) did you see a doctor when you had those symptoms .  I ask because those symptoms could be related to other diagnoses (upper respiratory infection, anxiety).  Without your having seen a doctor for diagnosis it is impossible to know why you had them.  There have been no cases of anyone getting systemic botulism from Botox, Xeomin or Dysport.  If you had a very large amount injected  in the neck you could potentially get neck weakness and theoretically even trouble swallowing, but not from forehead injections.  And IF you were injected with a laboratory level botulinum rather than the purified branded ones we use, your symptoms would likely have required you to be hospitalized.See your physician and discuss your concerns.  And if you have any symptoms like you describe return to that physician asap(unless they are so serious that you require immediate care at an emergency room)I hope this answer was helpful. Best wishes.

Steven F. Weiner, MD · Answer

This is consistent with botulism. This is extremely unusual and I question whether you actually got the brand Botox or some counterfeit brand. Dosing for cosmetic uses are so small compared to what would be considered toxic doses (3000u) that it is hard to imagine how these low doses can cause botulism. I would consider trying again but maybe one area and see how you react. Obviously I would go to another provider.

Wayne Wertheim, MD · Answer

reactions to botox are extremely rare provided that the injector is skilled, uses the proper amount and is using FDA approved product. Cases such as yours, if related to injections, have been found to have happened almost entirely in people that had unapproved product injected or an untrained injector. i would try again (particularly since you had some good experiences too) using a well respected injector...good luck

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