Is it accepted practice to use 'single patient use' Botox vials for multiple patients?

 In our practice, we purchase 100 unit vials of Botox.  If you look at a bottle of Botox from the manufacturer, you will see that the product is a dry white powder on the bottom of the glass vial. We reconstitute the Botox with approximately 4 mL of saline, which is sterile  salt water.  Using sterile technique, we fill tuberculin syringes with 12.5 units of Botox. In this scenario, one 100 unit vial of Botox will provide eight syringes each containing 12.5 units -  The contents of each syringe are completely sterile and are stored refrigerated for future use There is no possibility of spreading disease using this aseptic technique.  Our technique  of reconstitution allows us great flexibility in administering Botox to our patients, along with dose adjustments, if necessary, in a sterile, reproducible fashion.  Hope this helps! Dr. Joseph. 

Thank you for your question. Most Botox vials are either 50 or 100 units therefore it is not uncommon to use the same vial for more than one patient. However, the top of the vial should be sterilized with alcohol and change needles for each syringe. It is common to use a different needle for withdrawing the Botox than for injecting. If you have any concerns please discuss with your injector. Best of Luck!

Thank you for your question. You are correct that the FDA requires Allergan to label vials of Botox for single patient use. The simple answer is that it would be cost prohibitive for most people if all vials were used on a single patient. It is common practice for a vial to be used on 2-3 patients. Each draw is a sterile draw with new syringes and needles.

Botox vials comes in different sizes.  The usual size purchased by Doctors Offices is the 100 unit bottle, although if the clinic isn't using it regularly, they may be purchasing the 50 unit size.  Even with the smallest size, most patients wouldn't use the entire vial.  This would produce an incredible amount of waste and that cost would be passed on to the patient.  It is truly more cost effective to use the vials for more than one patient so that the cost could be "shared."  If the physician you are seeing uses good sterile technique and changes needle and syringes between withdrawals of the Botox, you are completely safe "sharing" that vial.  I hope that helps!  Regards, Dr. DiPasquale

Thank you for your question.  You're absolutely correct - according to the FDA, individual vials of Botox are for single patient use.  That said, the smallest vials of Botox contain 50 units, and the ones most commonly available for purchase contain 100 units.  If the vials were only used on single patients, and every patient was forced to purchase a full 100 units of Botox every time they came in, the cost of treatments would be prohibitive for most patients.   In practice, 100 units is enough Botox to perform full treatments on at least 2-3 patients.  As a result, it's not uncommon for physicians to treat multiple patients from a single vial of product, using new needles and syringes to draw up the Botox each time, under sterile technique.