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Consensus Statement Regarding Storage and Reuse of Previously Reconstituted Neuromodulators

Alam, Murad MD*,†,‡; Bolotin, Diana MD, PhD§; Carruthers, Jean MD; Hexsel, Doris MD¶,#; Lawrence, Naomi MD**; Minkis, Kira MD, PhD*,††; Ross, Edward Victor MD‡‡

doi: 10.1097/DSS.0000000000000303
Original Article

BACKGROUND Legacy recommendations suggest that vials of botulinum toxin be used within 24 hours of reconstitution and in a single patient. Current standard of care is consistent with storage after reconstitution and use of a single vial for several patients.

OBJECTIVE To develop expert consensus regarding the effectiveness and safety of storage and reuse of botulinum toxin.

MATERIALS AND METHODS The American Society for Dermatologic Surgery authorized a task force of content experts to review the literature and provide guidance. Data extraction was followed by clinical question review, a consensus Delphi process, and validation of the results by peer review.

RESULTS After 2 rounds of Delphi process, the task force concluded by unanimous consensus and with the highest level of confidence that a vial of toxin reconstituted appropriately can, for facial muscle indications, be (1) refrigerated or refrozen for at least 4 weeks before injection without significant risk for contamination or decreased effectiveness and (2) used to treat multiple patients, assuming appropriate handling.

CONCLUSION The standard of care, which allows for use of botulinum toxin more than 24 hours after reconstitution and in more than 1 patient per vial, is appropriate and consistent with the safe and effective practice of medicine.

Departments of *Dermatology,

Otolaryngology, and

Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;

§Section of Dermatology, University of Chicago Medicine, Chicago, Illinois;

Department of Ophthalmology, University of British Columbia, Vancouver, BC, Canada;

Department of Dermatology, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil;

#Brazilian Center for Studies in Dermatology, Porto Alegre, Brazil;

**Division of Dermatology, Cooper University Hospital Medical Center, Marlton, New Jersey;

††Department of Dermatology, Weill Cornell Medical College, Cornell University, New York, New York;

‡‡Division of Dermatology, Scripps Clinic, San Diego, California

Address correspondence and reprint requests to: Murad Alam, MD, Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Ste 1600, Chicago, IL 60611, or e-mail:

J. Carruthers is a consultant to and researcher for Allergan, Merz, and Kythera Biopharma. D. Hexsel is a consultant to and researcher for Allergan, Galderma, and Ipsen. The remaining authors have indicated no significant interest with commercial supporters.

© 2015 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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