Does the drug pyridostigmine help alleviate if not outright reverse side effects caused by Botox?

Question

I have done extensive reading on the use of Botox for cosmetic purposes and cannot ignore the many reports of users claiming terrible side effects caused at even low doses. I have come across the drug pyridostigmine on an online forum claiming its efficacy against Botox side effects. I would like to know whether any medical doctor has experience with pyridostigmine for said purpose and if the drug is indeed efficient against Botox side effects. Thank you

Jason Emer, MD · Answer

There is almost no side effects from Botox and if you are concerned please see your injector.  There is nothing to reverse the cosmetic effects of botox except for waiting/time.  Best, Dr. Emer.

Tim Neavin, MD · Answer

Hi, I am unaware of the side effect profile that you are describing.  I would be careful about what you read online.  Botox is a very, very safe medication when used appropriately.  Even in higher than usual doses administered subcutaneously, it is exceptionally to see "terrible" side effects in the body.  It acts locally on the muscle.

James Bonaparte, MD, MSc, FRCSC · Answer

Before I answer, I am curious about what you have been reading about Botox for cosmetic purposes. If used correctly, it is an extremely safe medication. People claiming that Botox has long term side effects or that it  "stays in the body" are doing just that, making claims. Botox has been used for over 30 years at doses 10 times  and more for what it is used for cosmetics, even in young children! I have recently completed the largest study assessing all the studies published on Botox for cosmetic purposes and the side effects are mild and typically brief. The most common being a short headache. I would be very suspicious of people making claims about long term complications. Although like everything in medicine, there will be people who believe something and no matter what information you provide, you will not be able to change their mind.That being said, Pyridostigmine has been shown to reduce the effects of Botox overdose for MEDICAL problems. Particularly issues with the voice box. In my field, in addition to cosmetics, we sometimes inject Botox into the muscles of the vocal cords. One of the potential complications of this is that you can get complete paralysis of them and the patient may not be able to breath for three months while you wait for the medication to wear off. there was a study by Young published in 2013 in the Journal of Voice that demonstrated a significant reduction in symptoms of the Botox. This drug works by increasing a neurotransmitter in the nerve terminals. Acetylcholine, when it is released by nerves causes muscles to contract. Botox, prevents the release of this neurotransmitter thus causing muscles not to contract or move. Pyridostigmine increases the Acetylcholine and thus allows the muscles to contract a little bit more. So, remember, Pyridostigmine ONLY helps the effects of Botox while it is in your body. It does not "cleanse" your body or do anything else. It has absolutely no effect on Botox other than help counteract the effect of Botox itself. Pyridostigmine does NOThave any effect on Botox that may "stay in the body," even though there is no evidence that Botox even does this. One last point, with respect to Botox for cosmetic purposes, there has never been a study published looking at the effect of this. Perhaps it helps for things like overdose in the face, ptosis (a droopy eyelid) or other things like that. James P. Bonaparte, MD, MSc, FRCSCHead and Neck Surgerypracticing in Facial Plastic and Reconstructive SurgeryAssistant Professor, University of OttawaOttawa, Ontario, Canada

Stephen Weber MD, FACS · Answer

Pyridostigmine will not reverse the effects of Botox. This drug will, however, definitely, give you side effects. Botox "breaks" the connection between nerve and muscle. This takes 3-4 months to regrow/ repair. A cholinesterase will do nothing to support a missing nerve/ muscle connection. Botox is very, very safe in experienced hands. Patients satisfaction is also very high. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Andrew A. Hendricks, MD · Answer

Botox is an extremely safe cosmetic treatment for facials lines and wrinkles with minimal side effects.  In rare instances of eyelid laxity (ptosis) after Botox treatment, apraclonidine (Iopidine) and/or phenylephrine eyedrops three times a day can help until the eye muscles recover.      Pyridostigmine is an interesting drug for the treatment of myasthenia gravis.  It has been used for rare overdoses of Botox when Botox is employed at extremely high doses for neuromuscular disorders.  The potential side effects of pyridostigmine mitigate against its use for minor Botox-induced cosmetic problems.

Does the drug pyridostigmine help alleviate if not outright reverse side effects caused by Botox?

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