One of my staff left out an undiluted bottle of Botox, and it was not refrigerated for about 3 days. Is it still effective?

Question

One of my staff left out an undiluted bottle of Botox in the room, and it was not refrigerated for about 3 days. Is it still effective?

Eric M. Joseph, MD · Answer

The diversity of opinion among the RealSelf experts is interesting. My hunch is that Dr. Smith is the voice of reason.

	I've had Botox arrive from Allergan at room temperature due to a shipping delay from inclement weather. The product worked fine. If you decide to use the product, save the bottle and check your patient in a week or so to ensure efficacy. If there's a problem with this vial, call Allergan with the lot number, and they would likely replace it at no charge. If you feel uncomfortable offering this to your patients, inject your staff, your family or yourself and let us know your experience.

	Hope this helps.

	Dr. Joseph

Harold J. Kaplan, MD · Answer

It would not seem prudent to use this product on a paying patient if even the slightest chance that it would be ineffective or sub par.  

	When we have had similar situations, we have our staff use the product rather than risking an unhappy patient.  Keep in mind that, even if the patient is monitored and will be cared for in the event that the product was ineffective, his/her time is valuable and should not be subjected to another visit and potentially needless needle sticks.

Ron Shelton, MD · Answer

Testing for the FDA of Botox's effectiveness and safety had been done under certain conditions. Varying these conditions could change the outcome possibly, but this probably hasn't been studied. You should check with Allergan's scientific team who will probably tell you to discard the bottle and not take a chance. I have found their team to be very responsive!

Kenneth D. Steinsapir, MD · Answer

It is not reasonable or appropriate to use this product clinically. It should be considered a loss. I my office, I do not let my staff handle BOTOX. I take responsibility for the diluting, drawing up, administering, and storing of the BOTOX.

Jeffrey Zwiren, MD · Answer

The recommendation is to keep Botox refrigerated before and after dilution.  If it was out for three days I would not trust it.

Edwin Ishoo, MD · Answer

Although the Allergan and FDA advise refrigeration of unreconstituted BOTOX, over night storage at room temperature in a well air conditioned office should have negligible or no effect on the potency of BOTOX.

Charles Perry, MD · Answer

In our experience the Botox left out over night wears off faster and is not as effective.  Your Botox rep would probably be able to help you out of this loss.

Louis W. Apostolakis, MD · Answer

There are studies published that would indicate that Botox does not degrade after extended periods of time at room temp, however, your Allergan rep will probably just swap out the bottle for free if you ask. That is what I would do.

Sheri G. Feldman, MD · Answer

I would call Allergan to answer that question.  In our office we would most likely toss it and take it as a loss.  It's not worth it to use it on a patient who might be unhappy with the results.

Rondi Kathleen Walker, MD - Account Suspended · Answer

I have found Botox to be very stable in the undiluted form and the diluted form if used with preserved saline. However, because of FDA recommendations I do not inject Botox that has not been kept refrigerated.

One of my staff left out an undiluted bottle of Botox, and it was not refrigerated for about 3 days. Is it still effective?

Answers (12)

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