Pain Sensation during Intradermal Injections of Three Different Botulinum Toxin Preparations in Different Doses and Dilutions

Abstract

Our data demonstrate that BoNT type B injections are associated with substantial pain. There is a considerable difference between the commercially available BoNT type B compared to the two BoNT type A preparations. Therefore, considering mitigation of injection pain seems necessary when using BoNT type B.

Long-term efficacy and respective potencies of botulinum toxin A and B: a randomized, double-blind study

“…BTX‐A (BOT) and BTX‐B (NBC) are pharmaceutical preparations that belong to the same family of Clostridium botulinum exotoxins but have different biochemical characteristics and biological effects: they come from different Clostridium strains (BOT: Hall A; NBC: Bean B), target different SNARE proteins (BOT: SNAP‐25; NBC: VAMP), are differently stabilized (BOT: vacuum drying; NBC: pH reduction) and contain different amounts of protein (BOT: 5 ng; NBC: 100 ng) with a different specific biological activity (BOT: 60 mU ng −1 BTX; NBC: 5 mU ng −1 BTX, where mU ng −1 BTX equates to the amount of biologically active toxin) 4,21 . Whereas the low pH value in NBC is most likely to be responsible for the significantly higher pain during injection compared with BTX‐A, 22 the lower specific biological activity in NBC accounts for its high antigenicity 2 …”

Clinical differences between botulinum neurotoxin type A and B

“…Rima/B injection is associated with significantly more pain in the injection site than Ona/A, Abo/A, saline (Colosimo et al, 2003;Barnes et al, 2005;Kranz et al, 2006), perhaps related to the low pH (5.6), as normalization to 7.5 the pH with sodium bicarbonate reduced pain in 3 individuals (Lowe and Lowe, 2014) although cannot be recommended because of the potential to alter the effect of the toxin. Xerostomia (dry mouth) is the most frequently reported side effect of BoNT/B in all the studies at higher frequency and severity than BoNT/A Dressler and Benecke, 2003), even with very low doses (Blitzer, 2005).…”

RimabotulinumtoxinB versus OnabotulinumtoxinA in the Treatment of Masseter Hypertrophy: A 24-Week Double-Blind Randomized Split-Face Study

“…In our study, one patient complained of transient injection site pain after BTX-B injection. There are several reports that BTX-B injections cause more pain than BTX-A injections [7,19]. Although the relative contribution of each toxin in the appearance of xerostomia could not be identified here, BTX-B is known to have a greater risk of inducing xerostomia than BTX-A [10].…”