Comparison and Overview of Currently Available Neurotoxins

Background: Botulinum toxin has been in use since the 1970s. Over the last few years, the indications for botulinum toxin use have extended for cosmetic and noncosmetic applications. Three preparations of botulinum toxin type A and one preparation of botulinum toxin type B are commercially available and approved for use in the United States by the United States Food and Drug Administration. Objective: To review the most recent literature on all commercially available botulinum toxins in the United States, their indications, Food and Drug Administration approvals, and handling (reconstitution, storage, and dilution). Methods: A literature review (not Cochrane type analysis) using several databases (PubMed, MEDLINE, textbooks, Food and Drug Administration homepage, and manufacturer information) was performed. Conclusion: Several different preparations of botulinum toxins exist worldwide, none of which are identical or interchangeable. Manufacturer recommendations on all available botulinum neurotoxins advise the use of unpreserved saline for reconstitution. Side effects are mostly mild and always self-limited. More serious complications are associated with higher doses, improper injection techniques, and occur in patients with underlying comorbidities.