(FDA approved in bold)

• Cervical Dystonia (CD)
  
• Glabellar lines
  
• Axillary hyperhidrosis
  
• Strabismus and blepharospasm associated with dystonia
  
• Hemifacial spasm
  
• Spasmodic torticollis
  
• Spasmodic dysphonia (laryngeal dystonia)
  
• Writer’s cramp and other task-specific dystonias
  
• Spasticity associated with stroke
  
• Dynamic muscle contracture in cerebral palsy
  
• Sialorrhea (drooling)
  
• Headache
  
• Myofascial pain

• Blocks neuromuscular transmission by cleaving the vesicle-associated membrane protein synaptobrevin, which inhibits the vesicular release of acetylcholine from nerve terminals
  
• In CD and other dystonias, produces partial denervation of muscle and localized reduction in muscle activity. In hyperhidrosis, produces chemical denervation of sweat glands
  
• Also appears to inhibit release of neurotransmitters involved in pain transmission (including glutamate, calcitonin gene-related peptide, and substance P) and may enter CNS via retrograde axonal transport

• Usually 1–3 days with peak effect beginning at 2 weeks

• Continue to use as long as effective, but monitor for clinical effects

• Increase dose or change injection technique. Some pain disorders may respond better to oral medications

• Increase dose, number of injections or change site of location

• None