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MYOBLOC™
Botulinum Toxin Type B Dosing Guidelines

05 November 2004

An initial total starting dose should be selected on an individualized basis for each patient. The starting dose should be selected based on the condition being treated as well as the dose modifying factors shown below.

Botulinum Toxin Dose Modifiers

 

Total Starting Dose

Clinical Situation

Start at the low end
of the range if:

Start at the high end
of the range if:

Patient weight

Low

High

Muscle bulk

Very small

Very large

Disease severity

Mild

Severe

Concern for weakness

High

Low

Results of previous therapy

Too much weakness

-


MYOBLOC™ Total Starting Dose Range

Indication

Total Starting Dose Range

Number of Muscles

Cervical Dystonia

5,000 - 10,000 U

2-6

Blepharospasm

1,500 - 5,000 U
(750 - 2,500 U per side)

2-6
(1-3 per side)

Headache

2,500 - 10,000 U

1-6

Oromandibular Dystonia

2,500 - 10,000 U
(1,250 - 5,000 U per side)

2-6
(1-3 per side)

Hemifacial Spasm

750 - 5,000 U

2-8

Dystonia Upper Limb

2,500 - 10,000 U

1-4

Dystonia Lower Limb

2,500 - 10,000 U

1-4

Spasticity Upper Limb

5,000 - 15,000 U

1-4

Spasticity Lower Limb

5,000 - 15,000 U

1-6

  • MYOBLOC™ is available in 2,500 U, 5,000 U, and 10,000 U vials all at 5,000 U/mL.

  • MYOBLOC™ can be diluted up to 6 fold and maintain its structural integrity.

  • Adverse events with MYOBLOC™ may include dry mouth, dysphagia, unwanted weakness, or injection site pain.

Starting MYOBLOC™ Dose Guidelines for Adults (except in select situations):

  • Total maximum dose per visit = 10,000 - 15,000 U

  • Maximum dose per injection site = 2,500 U

  • Maximum volume per site = 0.5 ml

  • Reinjections > 3 months

An initial total starting dose should be selected on an individualized basis for each patient. The starting dose should be selected based on the condition being treated as well as the dose modifying factors.

Suggested Adult MYOBLOC™ Dosing

HEAD AND NECK

Indication/Clinical Pattern

Potential Muscles Involved

Starting Dose Range MYOBLOC™

# Sites Injected

Cervical dystonia

 

5,000 - 10,000 U

 

 

sternocleidomastoid (SCM)

1,000 - 3,000

1-4

scalenus complex

1,000 - 3,000

2-4

splenius capitis

1,000 - 5,000

2-4

semispinalis capitis

1,000 - 5,000

2-4

longissimus capitis

1,000 - 5,000

2-4

trapezius

1,000 - 5,000

2-6

levator scapulae

1,000 - 4,000

2-4

Blepharospasm

 

1,500 - 5,000 U
(750 - 2,500 U per side)

 

 

orbicularis oculi

250 - 1,000

3-5/side

procerus

250 - 500

1

corrugator

250 - 750

1/side

Headache

 

2,500 - 10,000 U

 

 

frontalis

500 - 1,500

2-5/side

temporalis

500 - 1,500

2-6/side

occipitalis

750 - 1,500

1-2/side

splenius capitis

1,000 - 2,000

1-4/side

upper trapezius

1,000 - 2,000

1-4/side

procerus

250 - 500

1

corrugator

500 - 750

1-2/side

Oromandibular Dystonia

 

2,500 - 10,000 U
(1,250 - 5,000 U per side)

 

 

masseter

1,000 - 3,000

2/side

temporalis

1,000 - 3,000

2-4/side

orbicularis oris

250 - 500

2-4/side

digastric

250 - 750

1/side

medial pterygoid

1,000 - 3,000

1/side

lateral pterygoid

1,000 - 3,000

1/side

Lingual dystonia

genioglossus

500 - 1,000

1/side

Hemifacial Spasm

 

750 - 5,000 U

 

 

zygomaticus

125 - 500

1-2/side

orbicularis oculi

250 - 1,000

3-5/side

corrugator

125 - 750

1/side

orbicularis oris

75 - 250

1-4

risorius

125 - 250

1/side

angularis depressor

125 - 250

1/side

procerus

125 - 500

1

levator labii superiorus

125 - 250

1/side

mentalis

125 - 250

1/side

depressor labii

125 - 250

1/side

platysma

500 - 2,500

2-10

nasalis

125 - 250

1/side

UPPER LIMB DYSTONIA

Indication/Clinical Pattern

Potential Muscles Involved

Starting Dose Range MYOBLOC™

# Sites Injected

Dystonia Upper Limb

 

2,500 - 10,000 U

 

Task-specific dystonia

adductor pollicis

500 - 1,500

1

flexor carpi radialis

500 - 2,500

1-2

adductor digiti minimi

125 - 250

1

flexor carpi ulnaris

500 - 2,500

1-2

opponens pollicis

125 - 250

1

flexor digitorum profundus

250 - 1,500

1-3

flexor digitorum superficialis

250 - 1,500

1-3

pronator quadratus

500 - 1,500

1

pronator teres

500 - 1,500

1-2

dorsal interosseus

250 - 500

1

extensor indices

500 - 1,000

1

flexor pollicis longus

1,000 - 2,500

1

extensor carpi radialis

500 - 1,500

1-2

extensor carpi ulnaris

500 - 1,500

1-2

LOWER LIMB DYSTONIA

Indication/Clinical Pattern

Potential Muscles Involved

Starting Dose Range MYOBLOC™

# Sites Injected

Dystonia Lower Limb

 

2,500 - 10,000 U

 

 

peroneus longus

2,500 - 5,000

1-2

peroneus brevis

2,500 - 5,000

1-2

tibialis posterior

2,500 - 7,500

1-3

tibialis anterior

2,500 - 5,000

1-2

extensor hallucis longus

2,000 - 4,000

1-2

flexor digitorum longus

2,500 - 5,000

1-2

flexor digitorum brevis

2,500 - 5,000

1-2

UPPER LIMB SPASTICITY

Indication/Clinical Pattern

Potential Muscles Involved

Starting Dose Range MYOBLOC™

# Sites Injected

Spasticity Upper Limb

 

5,000 - 15,000 U

 

Adducted/internally rotated shoulder

pectoralis complex

2,500 - 5,000

2-6

latissimus dorsi

2,500 - 5,000

2-6

teres major

1,000 - 3,000

1-4

subscapularis

1,000 - 3,000

1-2

Flexed elbow

brachioradialis

1,000 - 3,000

2-4

biceps

2,500 - 5,000

2-4

brachialis

1,000 - 3,000

2

Pronated forearm

pronator quadratus

1,000 - 2,500

1-2

pronator teres

1,000 - 2,500

1-2

Flexed wrist

flexor carpi radialis

1,000 - 3,000

1-2

flexor carpi ulnaris

1,000 - 3,000

1-2

Thumb-in-palm

flexor pollicis longus

1,000 - 2,500

1-2

adductor pollicis

500 - 2,500

1

opponens pollicis

500 - 1,500

1

Clenched fist/fingers

flexor digitorum superficialis

1,000 - 3,000

1-2

flexor digitorum profundus

1,000 - 3,000

1-2

Intrinsic hand

lumbricales/interossei
(per hand)

1,500 - 4,500

3

LOWER LIMB SPASTICITY

Indication/Clinical Pattern

Potential Muscles Involved

Starting Dose Range MYOBLOC™

# Sites Injected

Spasticity Lower Limb

 

5,000 - 15,000 U

 

Flexed hip

iliopsoas

3,000 - 7,500

2-3

psoas

3,000 - 7,500

1-2

rectus femoris

2,500 - 5,000

1-3

Flexed knee

medial hamstrings

2,500 - 7,500

2-4

gastrocnemius
(as knee flexor)

3,000 - 7,500

2-4

lateral hamstrings

2,500 - 7,500

2-4

Adducted thighs

adductor brevis/longus/magnus

5,000 - 10,000

2-6

Stiff (extended) knee

quadriceps

5,000 - 7,500

2-6

Equinovarus foot

gastrocnemius

3,000 - 7,500

2-4

soleus

2,500 - 5,000

1-3

tibialis posterior

3,000 - 7,500

1-3

tibialis anterior

2,500 - 5,000

1-2

flexor digitorum longus

2,500 - 5,000

1-2

flexor digitorum brevis

2,500 - 5,000

1-2

flexor hallucis longus

1,500 - 3,500

1-2

Striatal toe

extensor hallucis longus

2,000 - 4,000

1-2

An initial total starting dose should be selected on an individualized basis for each patient. The starting dose should be selected based on the condition being treated as well as the dose modifying factors.