Storage and Reuse of Botulinum Toxin

Selected by Pietro Cazzola

BotulinBACKGROUND
Legacy recommendations suggest that vials of botulinum toxin be used within 24 hours of reconstitution and in a single patient. Current standard of care is consistent with storage after reconstitution and use of a single vial for several patients.

OBJECTIVE
To develop expert consensus regarding the effectiveness and safety of storage and reuse of botulinum toxin.

MATERIALS AND METHODS
The American Society for Dermatologic Surgery authorized a task force of content experts to review the literature and provide guidance. Data extraction was followed by clinical question review, a consensus Delphi process, and validation of the results by peer review.

RESULTS
After 2 rounds of Delphi process, the task force concluded by unanimous consensus and with the highest level of confidence that a vial of toxin reconstituted appropriately can, for facial muscle indications, be (1) refrigerated or refrozen for at least 4 weeks before injection without significant risk for contamination or decreased effectiveness and (2) used to treat multiple patients, assuming appropriate handling.

CONCLUSION
The standard of care, which allows for use of botulinum toxin more than 24 hours after reconstitution and in more than 1 patient per vial, is appropriate and consistent with the safe and effective practice of medicine.

M Alam, D Bolotin, J Carruthers, D Hexsel, N Lawrence, K Minkis, EV Ross. 
Consensus Statement Regarding Storage and Reuse of Previously Reconstituted Neuromodulators
Dermatol Surg 2015 Mar 01;41(3)321-326