Patient Counseling Before BOTOX® Treatment
Patient communication is crucial. Patients want to hear about your anecdotal experience utilizing BOTOX® in your practice. Once a patient is identified as an appropriate candidate for BOTOX®, setting expectations is important.
Patients may have misconceptions about use and safety, and patients should be counseled before a BOTOX® procedure, about the procedure itself and possible adverse events, including potential need for clean intermittent catheterization (CIC) to empty the bladder.
Review patient options for anesthesia:
local anesthesia with or without a sedative.4
The use of anesthesia during the injection procedure is based on the medical needs of the patient, taking into account factors such as tolerance to the procedure, medical needs, and preference of the patient.
Local anesthesia can be achieved by instillation of the bladder with 1% to 2% lidocaine (or similar-acting agent) for at least 20 minutes. The bladder should then by drained of lidocaine, rinsed with saline, and drained again before injection.
Confirm that the patient does not have a urinary tract infection (UTI).
Patients must not have a UTI at the time of treatment. Prophylactic antibiotics, except aminoglycosides, should be administered 1 to 3 days pre-treatment, on the treatment day, and 1 to 3 days post-treatment to reduce likelihood of procedure-related UTI.4
Discontinue anti-platelet therapy at least 3 days before procedure
and manage patients on anticoagulant therapy.
Patients should discontinue anti-platelet therapy at least 3 days before the injection procedure. Patients on anticoagulation therapy need to be managed appropriately to decrease the risk of bleeding.4
Talk to patients about the possibility of urinary retention
Due to the risk of urinary retention, treat only patients who are willing and able to initiate catheterization post-treatment, if required, for urinary retention. Advise patients that if they experience signs of urinary retention, they may need to begin CIC to empty the bladder.4
The Equipment Procedure Guide contains additional information and suggestions on how to communicate information about the BOTOX® procedure and possible adverse events, including treatment and safety concerns, to your BOTOX® for OAB patients.
Maximum Cumulative Dose
When adult patients are treated with BOTOX® for one or more indications, the maximum cumulative dose should generally not exceed 360 Units in a 3-month interval.4
Total dose recommendation for OAB treatment
- 100 Units BOTOX® (10 mL) as 20 intradetrusor injections of 0.5 mL each
Reconstitute BOTOX® per label
Reconstitution protocols vary depending on the indication. See the
BOTOX® Reconstitution Procedure on this website or "Dilution Technique" in the Dosing and Administration section of the full
Prescribing Information for details.
- BOTOX® should be administered within 24 hours after reconstitution in the vial. During this time, reconstituted BOTOX® injectable should be stored in a refrigerator (2°C–8°C).
- BOTOX® should be used immediately after reconstitution in the syringe. Do not store reconstituted BOTOX® in the syringe.
BEFORE ADMINISTERING BOTOX®
CONFIRM THAT THE PATIENT DOES NOT HAVE A UTI AT THE TIME OF TREATMENT AND HAS TAKEN THEIR PROPHYLACTIC ANTIBIOTICS (EXCEPT AMINOGLYCOSIDES) 3 DAYS PRIOR TO TREATMENT AND ON THE DAY OF TREATMENT. PATIENTS SHOULD DISCONTINUE ANTIPLATELET THERAPY AT LEAST 3 DAYS BEFORE THE INJECTION PROCEDURE. PATIENTS ON ANTI-COAGULATION THERAPY NEED TO BE MANAGED APPROPRIATELY TO DECREASE THE RISK OF BLEEDING. APPROPRIATE CAUTION SHOULD BE EXERCISED WHEN PERFORMING A CYSTOSCOPY.
Using a flexible or rigid cystoscope, BOTOX® can be administered in the office, ambulatory surgical center, or outpatient operating room.
For rigid scopes: • 30-degree lens prefered • 17-21F sheath preferred