Botox Warnings and Precautions

Prior to taking Botox, warnings and precautions for the drug should be reviewed with your healthcare provider. This includes telling him or her if you have a history of heart disease or neuromuscular disease, as well as if you have an infection near the injection site. Botox warnings and precautions also extend to people who are allergic to any components of the drug and women who are pregnant or nursing.

Botox: What Should I Tell My Healthcare Provider?

You should talk with your healthcare provider prior to taking Botox® (onabotulinumtoxinA, previously known as botulinum toxin type A) if you have:
Also, let your healthcare provider know if you are:
  • Pregnant or thinking of becoming pregnant
  • Breastfeeding.
You should also be sure to tell your healthcare provider about all of the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.

Specific Botox Warnings and Precautions

Warnings and precautions to be aware of prior to taking Botox include the following:
  • Rarely, Botox can spread from the site of injection to distant parts of the body, potentially causing serious problems. This is most likely to occur if Botox is used to treat spasticity in children.
  • The medication can cause allergic reactions. If you notice an unexplained rash, itching, wheezing, swelling, or difficulty breathing, tell your healthcare provider right away.
  • Botox can cause difficulty swallowing, which may cause serious problems. This is more likely if you already have swallowing problems or if you have a neuromuscular disease.
  • Botox can cause bronchitis and breathing problems. This can be dangerous for people who already have breathing problems.
  • In rare cases, there have been instances of heart problems occurring after a Botox dose, particularly in people who already have heart disease. It is not clear if these problems were related to Botox. However, you should let your healthcare provider know if you have heart disease.
  • Botox contains albumin, a human protein. Theoretically, viruses or infectious proteins may be transmitted through albumin. However, there have never been any cases of this reported with an albumin product.
  • Some people treated with Botox for urine leakage due to an overactive bladder will have problems completely emptying their bladder. In some cases, this may require catheterization to empty the bladder and may be an ongoing problem. 
  • Sometimes, the medication can decrease your blinking reflex (especially if it is used near the eyes). This can dry out your eyes, increasing your risk of corneal abrasion or other eye problems. If your eyes seem to be dry, let your healthcare provider know right away.
  • Sometimes, Botox injections in the area near the eyes can cause vision changes. These changes are usually temporary.
  • Botox can interact with a few different medications (see Botox Drug Interactions).
  • Botox is considered a pregnancy Category C medication. This means that it may not be safe for use during pregnancy, although the full risks are not known (see Botox and Pregnancy).
  • It is not known if Botox passes through breast milk. Therefore, if you are breastfeeding or plan to start, discuss this with your healthcare provider prior to taking the drug (see Botox and Breastfeeding).
Last reviewed by: Kristi Monson, PharmD
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