Drug Interactions of Dysport/Restylane/Perlane Injection

Patients treated concomitantly with botulinum toxins and aminoglycosides or other agents interfering with neuromuscular transmission (e.g., curare-like agents) should be observed closely because the effect of the botulinum toxin may be potentiated. Use of anticholinergic drugs after administration of Dysport may potentiate systemic anticholinergic effects such as blurred vision.

The effect of administering different botulinum neurotoxin products at the same time or within several months of each other is unknown. Excessive weakness may be exacerbated by another administration of botulinum toxin prior to the resolution of the effects of a previously administered botulinum toxin. Excessive weakness may also be exaggerated by administration of a muscle relaxant before or after administration of Dysport.

USE IN SPECIFIC POPULATIONS

Dysport is not recommended for use in children or pregnant women.

Spread of Toxin Effects: In some cases, the effects of Dysport and all botulinum toxin products may affect areas of the body away from the injection site. These effects can cause symptoms of a serious condition called botulism. Symptoms of botulism can happen within hours, or days to weeks after injection and may include swallowing and breathing problems, loss of strength and muscle weakness all over the body, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, or loss of bladder control. Swallowing and breathing problems can be life threatening and there have been reports of death.

ADVERSE REACTIONS

In clinical studies, the most frequently reported adverse events (>2%) were nasopharyngitis, headache, injection site pain, injection site reaction, upper respiratory tract infection, eyelid edema, eyelid ptosis, sinusitis, nausea, dry mouth, tiredness, neck pain, and muscle pain. You should watch out for signs of eye problems: double vision, blurred vision, decreased eyesight, problems with focusing the eyes (accommodation), drooping eyelids, swelling of the eyelids Symptoms of an allergic reaction to Dysport may include: itching, rash, red itchy welts, wheezing, asthma symptoms, or dizziness or feeling faint.

Immunogenicity Information

As with any therapeutic proteins, there is a potential for immunogenicity.
The incidence of antibodies among products in this class varies depending on the sensitivity and specificity of the assay. Comparisons of the incidence of antibodies across products in this class may be misleading.

There was no evidence of neutralizing antibodies in 1,554 clinical study patients who received up to nine treatment cycles of Dysport for the treatment of moderate to severe glabellar lines.

Two subjects (0.13%) tested positive for binding antibodies at baseline, and three additional patients tested positive for binding antibodies after receiving Dysport treatment. None of the patients tested positive for neutralizing antibodies.

Patient Consultation

Always start with a through history, informed consent and a photo to document the patient’s “before” status. Provide a mirror and ask the patient what area or feature of the face is bothering him or her. Ask them to animate their face to illustrate their concerns. Evaluate your patient’s face for asymmetry and point them out to your patient, as well as documenting it on the medical record.

Set realistic expectations and educate your patient depending on your analysis of that individual. Setting unrealistic expectations will eventually lead to high patient dissatisfaction. Proper patient selection and education is paramount to a patient’s satisfaction. DYSPORT® & dermal fillers alone will not completely eliminate all the wrinkles. Some patients benefit from a face lift or a laser resurfacing procedure.

Glabellar spread test is a very useful test to see if DYSPORT® alone will soften a patient’s frown line. You spread the glabellar wrinkles apart with your thumb and index fingers. Patients with thick skin and deep dermal folds who do not improve with manual spreading will respond poorly to Dysport® injections alone. These patients require dermal filler injections.

Reconstitution

  1. Dysport must maintain temperature between 36-46°F (2-8°C) to maintain viability of protein. This will be kept in refrigerator until just prior to use.
  2. Identify product, verify lot number and expiration date of un-reconstituted neuromodulator.
  3. Vigorously scrub vial tops of 0.9% NaCl (Bacterostatic) and neuromodulator with alcohol swab.
  4. Using sterile technique, an 18 gauge needle and 3cc sterile syringe, draw up (1.5cc) of 0.9% NaCl with Preservative. Note: Non-preservative NaCl 0.9% will be used only if the guest has an allergy to Visine products. Insert the dilutent gently and slowly into the neuromodulator vial. The vial should stay in an upright position while reconstituting.
  5. Record, on the vial, the date and time the bottle was reconstituted.
  6. Once reconstituted, the preservative reconstituted vial will remain viable for up to 2 weeks refrigerated when utilizing NaCl 0.9% with preservative and ONLY 8 hours when utilizing Preservative-Free NaCl 0.9%.
  7. From reconstituted vial, vigorously scrub vial top with alcohol swab. Insert needle into rubber topper of vial. Gently draw up the diluted neuromodulator with injecting syringe (0.5 cc tuberculin syringe) with desired units of product to be injected. EX: 0.05ml = 10 units (Drawing up 50 units will yield 0.25ml).

Glabellar Lines

Learn more about Glabellar Lines.