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  • Botox and breastfeeding

    I am scheduled to have botox for cosmetic purpose, and I am confused about what to do. When researching your site I saw that Dr.Hale posted a couple of responded regarding botox and bf. In one he said wait 12 hours then resume, in another he said 4 hours, pump and dump, then resume. Which one is it? If its safe, what is the proper protocol? I am currently nursing a two and a half year old, before sleeping and upon waking. I barely produce any milk anymore, so it's mostly for comfort (we are slowly weaning).

  • #2
    Hi, thanks for your post.

    I'm sorry about the inconsistency in our forum posts. As you can see, our understanding of this drug continues to evolve as more literature is published. We now know that if injected properly and at the recommended doses, Botox does not enter the bloodstream or the breastmilk. In rare circumstances, the toxin may leak into a small blood vessel at the injection site. Even then, it would be unlikely to get into the milk because the molecule is so large. We advise that you wait about an hour after the procedure just to make sure you do not have any systemic effects from the injection before you breastfeed. It is not necessary to discard your milk. You should also be aware that there have been reports of toxic effects up to several weeks after the injection. Again, these situations are very rare. If you develop generalized muscle weakness, double vision, drooping eyelids, urinary incontinence, or difficulty swallowing, speaking, or breathing, stop breastfeeding and seek medical attention immediately.

    Please call us at the InfantRisk Center if this has not completely answered your question.*(806)352-2519

    -James Abbey, MD

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    • #3
      Ok. good to know. i have another question...Toxic effects up to several weeks after injection- does that I could possibly have a reaction/side effect to the botox, lets say for example, randomly 4 weeks after initial treatment? How long does the botox stay in the body?

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      • #4
        The prescribing information for this drug contains a black box warning about potential symptoms of botulinum toxin poisoning "hours to weeks after injection." No information about the pharmacokinetics (how long it sticks around) of this drug are available because it is nearly always undetectable in the bloodstream after local injection. I suspect that the cases of delayed toxicity involved inadvertently injecting the drug into scar tissue or cartilage where it wouldn't be broken down properly. This situation seems to be very rare, but the FDA is obligated to make people aware of the risk, how ever small it may be.

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        • #5
          Hi there just tagging on to the end of this message. I'm scheduled to have botox injected into my pelvic floor region for muscle spasm. Does the above advice still apply to me as I'm breastfeeding? Cheers

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          • #6
            Yes, it does.

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            • #7
              Hi tagging on.... Does the above advise aply to Dysport aswell?
              Thank you

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              • #8
                Yes. Dysport contains the same active ingredient as Botox, it is just purified from the original source in a different way. Dysport carries the same FDA warning as Botox.

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                • #9
                  "You should also be aware that there have been reports of toxic effects up to several weeks after the injection" -

                  Since botox stays several weeks in the body, does it mean that there is a chance it may enter the bloodstream at any point of time (as long as it is present in the body)? I have received cosmetic botox and no systemic effects are present so i suppose it was injected properly and did not enter my bloodstream. However there is a chance that it might enter my bloodstream later? Did i get it correctly?
                  Last edited by edenmom; 01-09-2015, 07:44 PM.

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                  • #10
                    I think my post in this thread dated 11-06 addresses your question. The instances of delayed reactions to Botox have been extremely rare.

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                    • #11
                      I have similar concerns as Bbg 1175. I am nursing a one-and-a-half year old, and I am seriously considering botox injections at the moment. I hate some nasty folds that have appeared on my neckline. Doesn't matter what dress I'm wearing. It always shows through. I considered other types of treatment like Ayurvedic and Chinese, but botox looks cheaper and more effective. I had a consultation at a nearby clinic called Beauti-med that does botox lip injection in langley (which is what I need), and I was hoping if you'd weigh in your opinions. Not many in my family has done cosmetic surgery, so pretty much all the feedback I get is from the internet.

                      P.S. I thought Dysport and Botox were the same and just known by different names.

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                      • #12
                        Anne:

                        Botox and Dysport are essentially the same drug. We've had lots of breastfeeding moms use Botox without problems. It is essentially too large to enter the milk compartment after the first week or two of lactation.

                        I don't think you have much to worry about in your situation. However, if YOU note any symptoms, such as breathing difficulties after use, be sure and don't breastfeed. Otherwise, its probably OK.

                        Tom Hale Ph.D.

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                        • #13
                          I generally prefer not to do Botox on patients who are breast feeding. Although Botox stays in the muscle and does not migrate to the breast, there's just no research proving this because we don't ever run tests on pregnant women, breast feeding women, etc. so it's definitiveness cannot be ultimately shown. I don't think you need to be concerned for your baby's safety or your milk; however, it is not generally advised to do any types of injectables on women who are pregnant or nursing.

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                          • #14
                            Kailey:

                            Your are only partially correct. We do have an older paper that suggests the native, extremely large botulism toxin molecule doesn't enter milk. In one patient who was extremely toxic with botulism toxin, none was found in her milk supply. See below.

                            Further all the recent data on Botox suggests that these cleaner preparations, with careful manufacturing, don't even enter the plasma compartment of the patient.

                            In some cases where they used the cheap generic brands, with impure separations of the botulinum toxin, some patients did get quite sick as the smaller toxin molecules were able to be absorbed into the plasma compartment.

                            Hence, the most important rule about using botulism toxin, is to use the carefully prepared and FDA certified commercially available preparations.

                            Personally, I don't think its advisable to use these while pregnant or breastfeeding. Why not wait a few months until you are finished with breastfeeding.

                            But the reality is, that the risk is still exceedingly low and this decision is up to the mom herself.

                            Thanks

                            Tom Hale Ph.D.






                            In one published report, a breastfeeding woman severely poisoned by botulism toxin continued to breastfeed her infant throughout the illness.[1] Four hours after admission, her milk was tested and was free of botulinum toxin or C. botulinum bacteria, although she was still severely ill. The infant showed no symptoms of poisoning. It is apparent from this case that neither botulinum bacteria, nor the toxin is secreted in breastmilk.

                            1. Middaugh J. Botulism and breast milk. N Engl J Med 1978; 298(6):343.

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                            • #15
                              Admin:

                              So finally you are saying that Botox is not advisable for pregnant and breastfeeding woman, just like a said.

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