Botox Poisoning: Start Here

Click on the photo below for our NEW Q&A Tool, which combines information from this website, my books, the medical literature, and more, to answer your questions (note: you must be logged into a Google Account to access this tool, if the link doesn't work, try copying and pasting this link into a Chrome or Safari browser: Botox Side Effects / Iatrogenic Botulism AI Tool - NotebookLM)

I put this information together for people who suspect that they are suffering from Botox poisoning (known as "Iatrogenic botulism" or "Iatrogenic botulism poisoning - IBP") following Botox/Xeomin/Dysport/etc injections. I suggest you read through this post in full.

PLEASE NOTE: This information is provided for educational purposes only. None of this is medical advice. Please work closely with a trusted healthcare provider when making medical decisions. I am not, nor do I claim to be, a medical doctor.

Contents:

1. What is Botox Poisoning?

2. Recognizing Signs/Symptoms

3. Next Steps, Resources & Support

   
   

WHAT IS BOTOX POISONING?

Botox poisoning, or "iatrogenic botulism" is when botulism symptoms occur following botulinum toxin injection (brands include Botox, Dysport, Xeomin, Daxxify, Jeuveau, etc.). Botulism occurs when botulinum toxin spreads into our nervous systems (either via the bloodstream or retrograde axonal transport) and begins attacking our peripheral and central nervous systems. It occurs on a spectrum, depending on how much toxin has entered the nervous system and which nerves it attacks.

Botulism can present in mild, moderate, and severe forms - which results in victims presenting with radically different symptoms and severities. Botulism symptoms occurred in about 1-5% or more of clinical trial patients receiving therapeutic doses of Botox (and other brands, depending on the injection site). The incidence rate is unknown for cosmetic doses.

The Black Box Warning on all botulinum toxin products states the following: 

WARNING: DISTANT SPREAD OF TOXIN EFFECT See full prescribing information for complete boxed warning. The effects of BOTOX and all botulinum toxin products may spread from the area of injection to produce symptoms consistent with botulinum toxin effects. These symptoms have been reported hours to weeks after injection. Swallowing and breathing difficulties can be life threatening and there have been reports of death. The risk of symptoms is probably greatest in children treated for spasticity but symptoms can also occur in adults, particularly in those patients who have an underlying condition that would predispose them to these symptoms

Toxin spread can happen one of three ways:

• through (unintentional) injection into a blood vessel

• through diffusion of the toxin into adjacent muscle tissue (this can happen on its own, or when the toxin is "massaged" or disrupted)

• through retrograde axonal transport, where the toxin “hops” backwards along nerve cells into the CNS (brain). 

Bai and colleagues (2018) noted the following symptoms as occurring in the following three categories (please note: this is NOT a complete list of potential symptoms from botulism):

• Mild botulism: headaches, dizziness, fatigue, blurry vision, anxiety, difficulty swallowing, insomnia, dysarthria (slurred speech), constipation

• Moderate botulism: any of the above characteristics with aspiration occurring with dysphagia (need for feeding tube)

• Severe botulism: any of the above characteristics with need for mechanical ventilation

PLEASE NOTE:

It can be overwhelming and distressing to learn that you might be experiencing botulism symptoms from botulinum toxin injections. Please know that likely, hundreds of thousands of people have been in your exact shoes since 1989 (when Botox was first brought to market). There have been over 18,000 serious adverse effects and 3,000 deaths reported to the FDA FAERS database following botulinum toxin injections; based on research of reporting systems like FAERS, we know that this is likely only about 2-10% of actual events experienced in the real world, due to the persistent problem of underreporting.

RECOGNIZING SIGNS/SYMPTOMS OF POISONING

A (mostly) complete list of potential adverse effects following botulinum toxin injections is below. People can have 1, 5, 10, or 15 or more botulism symptoms, depending on where the toxin "lands" in their bodies once it spreads. This list is not intended to scare you, so please do not read through this list until you are in a good mental space. It would be wise to have a trusted, loving partner and/or family member or friend read through them first.

Central Nervous System:

BoNT (the main ingredient in Botox, Dysport, Xeomin, Daxxify, Jeaveau, etc.) can and does cross the blood-brain barrier, with the ability to enter the CNS and block neurotransmitters that are involved in cognitive processes, including glutamate, GABA, dopamine, and serotonin, among others. Symptoms may include:

• brain fog

• disorganization

• short term memory loss

• word finding difficulties

• slow processing speed

• phonophobia (aversion to loud noises/large crowds)

• photophobia (aversion to bright lights)

• mental fatigue

Psychiatric symptoms:

• anxiety and/or panic attacks

• depression

• mood swings

• depersonalization

• derealization

• feeling hopeless and fixated on the symptoms

• suicidal ideation

Peripheral Nervous System (which includes sensory neurons):

• paresthesia (pins and needles feeling in the limbs)

• muscle weakness/paralysis

• nerve pain

• burning sensations in the mouth/head/limbs

• “buzzing” feeling in the nerves

• nerve and brain “zaps”

• itching sensations

• choking sensations

PNS - Autonomic Nervous System (including the cranial nerves):

• dizziness

• nausea and vomiting

• blurry vision and other vision impairments

• dry eyes

• dry mouth

• dysphagia (difficulty swallowing)

• dyspnea (typically feels like "lazy breathing", as if your lungs might skip a breath, or shortness of breath)

• dysarthria (slurred speech)

• dysphonia (hoarse voice)

• appetite loss/weight loss

• UTIs/urinary retention and interstitial cystitis

• constipation/gastroparesis

• insomnia

• ear disorders (congestion, tinnitus, pain, temporary or permanent deafness)

• heart palpitations

• heart arrhythmias

• chest pain and pressure

• cardiac arrest

• abdominal pain

• night sweats

Other:

• swollen glands

• alopecia (hair loss)

• madarosis (loss of eyebrows and eyelashes)

• loss of libido

• itchy skin (pruritis)

• menstruation changes in women

• loss of muscle mass, in the limbs an face

• changes in skin texture/moistness

In addition to the above symptoms, the following have been reported in Dr. Hristova’s research and the FDA post-marketing reporting system:

• new onset of autoimmune conditions (particularly hypo and hyper thyroid symptoms)

• histamine intolerances/MCAS (about 62% of Hristova's patients developed new onsets of MCAS)

• POTS

• ME

• Lyme disease

• Small fiber neuropathy

• neurodegenerative diseases

  
  

ANXIETY/PANIC ATTACKS?!

Anxiety and/or panic attacks are one of the most commonly reported first symptoms after systemic toxin spread. In our survey, more than 90% reported experiencing new onsets of anxiety and/or panic attacks after BoNT injections. The body usually goes through a period of intense anxiety, insomnia, and fatigue in the first few months of the disease, which can be frightening and debilitating. I personally had near daily anxiety/panic attacks for about 2 months post-injections. For most people the extreme anxiety and insomnia subsides within 3-6 months post injections. Please hang in there and know that you are not alone. Do not hesitate to seek support and mental health resources as needed.

NEXT STEPS, RESOURCES & SUPPORT

IF YOU ARE WITHIN THE FIRST 3-4 WEEKS POST-INJECTIONS AND ARE EXPERIENCING BOTULISM SYMPTOMS…

1. Seek medical attention right away. ER doctors can contact your state health department and/or the CDC to obtain botulinum antitoxin, which cannot undo any damage the toxin has done, but can prevent further damage from occurring. NOTE: It has proven to be VERY difficult to obtain this medication for most, as typically state health departments reserve antitoxin for people who are experiencing descending paralysis and/or respiratory failure. There is no objective test for botulism besides the bioassay mouse test, which is only available via the CDC, and is only accurate in the first few days post-poisoning. I recommend recruiting a loved one to help you advocate for yourself.

   
   

2. Bring handouts to the ER. Print out pages 49-52 of the Botox product insert, which include a full botulism warning: https://www.rxabbvie.com/pdf/botox_pi.pdf

   You can also share a document on Botox Adverse Effects I put together for medical professionals: https://www.iatrogenicbotulism.com/post/botox-adverse-effects-pdf

3. ER doctors and/or your injector can call the following number to reach the CDC Emergency Operations Center to request antitoxin: 770-488-7100. More information here: https://www.cdc.gov/botulism/treatment/index.html

   
   

4. Consider taking activated charcoal and/or celery juice, which helped some iatrogenic botulism patients that Dr. Hristova followed. She found that patients who took 280 mg of activated charcoal every 2 or 3 days had some improvement in symptoms, but warned that those suffering from constipation should not take activated charcoal. , ALWAYS consult a trusted healthcare provider before beginning any new supplements.

IF YOU ARE PAST THE FIRST 4 WEEKS POST-INJECTIONS…

Unfortunately, according to the CDC, it is unlikely that antitoxin will be effective. This is the situation most of us find ourselves in, and we are left with little support from the medical community while our bodies do their best to heal from this poisonous toxin. Please know that many people have been in your situation, and we are here to support you. There are nearly a dozen support groups on Facebook that have tens of thousands of members who have lived through botulism and can help answer questions you have. The support group I started is here:

https://www.facebook.com/groups/botoxsideffects

Reminder: Always work closely with a trusted healthcare provider as you are in the process of healing from botulism.

NEXT STEPS/HEALING PROCESS:

1. Download and read the free PDF "Recovering from Botulism" and/or our A-Z Symptom Helper to learn more about botulism, and which practices/supplements/drugs helped fellow botulism victims on their healing journeys. Please share our resources with friends, family, and your healthcare providers to help educate them about adverse effects following BoNT injections. Feel free to use our AI Q&A tool to ask questions and get quick answers: Botox Side Effects / Iatrogenic Botulism AI Tool - NotebookLM

   
   

2. Educate yourself and your physician on Things to Consider Avoiding if you suspect you have botulism from Botox. Work with your doctor to determine which supplements and medications work for your unique health situation. Much of botulism healing is a waiting game, while in the meantime avoiding procedures/drugs that may worsen symptoms. A mistake that many botulism victims make in the early weeks and months after poisoning is taking new medications or supplements that can actually cause a worsening of symptoms. This is a list of drugs/procedures that have been documented (either through the Botox package insert, medical research, or firsthand experience of fellow botulism sufferers I've interviewed) to cause a worsening of symptoms and/or further spread of the toxin. https://www.iatrogenicbotulism.com/post/botulism-don-ts

   
   

   ToxSafety.com has a more thorough list here: https://www.toxsafety.com/the-caution-list

   
   

3. Report ALL of your symptoms to your Injector/Doctor ASAP, and request that they report them in full to the FDA FAERS database (or the appropriate reporting system in your country). This will help the FDA have accurate numbers on how often these adverse effects are occurring. (https://www.fda.gov/safety/medwatch-fda-safety-information-and-adverse-event-reporting-program)

   
   

   I have made a PDF explaining Botox adverse effects that you can print out and bring to any medical providers: https://www.iatrogenicbotulism.com/post/botox-adverse-effects-pdf

   
   

   You can also print out Dr. Hristova’s research on Iatrogenic Botulism cases for your injector/primary care doctor to read through: https://austinpublishinggroup.com/bacteriology/fulltext/bacteriology-v3-id1035.php

   
   

   The vast majority of doctors and injectors are NOT aware of or educated on Botox’s adverse effects and the nuances of mild botulism. This can lead to sufferers being dismissed and told that they are "fine", when they are in fact suffering from one of the most horrific diseases known to mankind and trying to seek medical attention and answers. I used my botulism journey as an opportunity to educate my primary care doctor and injector. Stand firm while advocating for yourself (or find a family member/friend who can advocate for you). Botox's own package insert contains warnings about many of the side effects you may experience, and can be found here: https://www.rxabbvie.com/pdf/botox_pi.pdf

   (see pages 14-15, 24-25, and 49-52)

   
   

   Drugs.com is also a great resource to send medical professionals to: https://www.drugs.com/sfx/botox-side-effects.html

   
   

   Please email me if you are seeking research articles related to a specific Botox adverse effect, and I will do my best to find you one: metoxpretty@gmail.com

4. I recommend keeping a detailed log of your symptoms, as well as onset dates. You can report your symptoms to the FDA/FAERS database if your doctor won't do it. It shouldn't take more than 10 minutes: (https://www.fda.gov/safety/medwatch-fda-safety-information-and-adverse-event-reporting-program)

   
   

5. Get as much family/friend and mental health support as possible. Botulism is usually a long-haul journey, and you will have good and bad days (symptoms can come and go for many months, if not years, but they will improve with time). You will need emotional and physical support on the bad days. I found that joining a Botox side effects support group helped me tremendously while healing from botulism. There are many on Facebook, the one I started is here: Botox Side Effects - Iatrogenic Botulism

   
   

6. Be EXTREMELY wary of anyone who claims they can “cure” or “treat” botulism - there are no quick fixes or cures for botulism except antitoxin, which cannot undo damage that has already occurred. Don’t get me wrong here - I usually love alternative health and incorporate it into my life often. Botulism is a unique disease that does NOT respond to many alternative treatments in the same way that mold or other bacteria/viruses might. Botulinum toxin causes irreversible damage to our nerve synapses, typically within hours to days after exposure. Our body will REGROW new nerve synapses around the permanently damaged ones in the months/years following injections, which is why we do our best to support our bodies through healthy lifestyle/foods while it is healing.

   
   

7. Many online Botox support groups will suggest that you should immediately start taking copper supplements and celery juice in order to improve your botulism symptoms. While these are unlikely to cause harm, there is not sufficient scientific evidence at this time to guarantee that they will help, either. I want to be realistic about what scientific evidence has shown these supplements can do, rather than giving people false hope. In our survey of BoNT-injured individuals, 14.9% of respondents said that copper and celery juice improved their symptoms.

   
   

   Here is a summary of the scientific studies the copper/celery juice recommendations are based on:

   
   

   In one animal study, researchers found that intravenous copper appeared to partially neutralize botulinum toxin in mice that had been experimentally poisoned with BoNT. The authors noted that copper would likely need to be administered alongside antitoxin if it were ever considered for therapeutic use in humans. While the mice that received IV copper survived longer than those that did not, the treatment did not ultimately prevent any deaths from botulism.

   
   

   Another study examined oral copper and zinc supplementation in rats that had received intramuscular BoNT injections. The researchers reported that the equivalent of approximately 2 mg of oral copper, administered immediately after injection and continued for one week, reduced muscle atrophy associated with the toxin. In contrast, zinc supplementation appeared to increase muscle atrophy in this model. Importantly, this study evaluated copper’s effects only at the neuromuscular junction following localized toxin exposure. It remains unknown whether oral copper would influence systemic toxin spread or improve symptoms in cases of generalized botulism, where the toxin may affect nerve-to-nerve synapses. While these findings are scientifically interesting and may warrant additional research, they should not be interpreted as evidence of a treatment for human botulism.

   
   

   It is also important to understand a fundamental principle of botulinum toxin injury: once the toxin has disrupted a nerve synapse, that damage cannot be “undone.” Recovery occurs gradually as the body forms new synaptic connections around the affected ones over the months following exposure.

   
   

   For individuals who are considering oral copper supplementation, it is important to recognize that supplements cannot reverse damage that has already occurred. Anyone considering supplementation should discuss it with a qualified healthcare provider beforehand. Copper supplementation can cause stomach pain and, in excessive amounts, copper toxicity. Monitoring blood copper levels may be appropriate in some cases, particularly for individuals with other potential sources of copper exposure, such as copper intrauterine devices (IUDs).

   
   

   Celery juice, which was mentioned in Hristova’s study, is unlikely to pose significant risk for most people, though it is high in oxalates and may not be advisable for individuals with certain kidney conditions.

   
   

   It is clear that responses to various supplements and practices vary widely. Some individuals report perceived benefit, while others report no change or even worsening of symptoms. In Hristova’s report, one patient described early symptom improvement after using coffee enemas and activated charcoal, though this observation was anecdotal.

   
   

   As with any health intervention, individuals should not begin new supplements or alternative regimens without first discussing them with a trusted healthcare professional.

   
   

THE BOTTOM LINE:

Botulism of any kind (foodborne, wound, iatrogenic, etc.) is a debilitating and harrowing disease. It is essentially severe nervous system disruption, and it renders most of its victims incapable of participating in life as they know it for extended periods of time. Many of us who end up with the disease after Botox injections were NEVER appropriately warned about the risks of developing this disease. There is extremely limited information on this illness, as well as things that can possibly help improve outcomes for patients.

The most important thing to know is that many thousands of people have been harmed by Botox and have survived. Life may look a bit different, as we may have to avoid certain triggering medications, foods, activities, etc., especially in the first few years post-poisoning, but there is hope for all of us.

Please do not hesitate to reach out if you have any questions about or suggestions for this document: metoxpretty@gmail.com

References: 

Bai L, Peng X, Liu Y, Sun Y, Wang X, Wang X, Lin G, Zhang P, Wan K, Qiu Z. Clinical analysis of 86 botulism cases caused by cosmetic injection of botulinum toxin (BoNT). Medicine (Baltimore). 2018 Aug;97(34):e10659. doi: 10.1097/MD.0000000000010659. PMID: 30142749; PMCID: PMC6112997.

Botox product insert: https://www.rxabbvie.com/pdf/botox-cosmetic_pi.pdf?mibextid=2JQ9oc

Dysport product insert: https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/125274s125lbl.pdf

Fung HT, Chan KM, Lam SKT. A review on iatrogenic botulism. Hong Kong Journal of Emergency Medicine. 2020;27(6):356-367. doi:10.1177/1024907920934901

Hristova, AH. Lenore, J. Swati, S., Wade, J.

Severe Nervous System Complications After Botulinum Type A Therapy: Three Case Reports With Reviews of FDA-Reported Nervous System Adverse Effects, PM&R, Volume 4, Issue 8, 2012, Pages 613-623,

ISSN 1934-1482,

https://doi.org/10.1016/j.pmrj.2012.04.016.

Hristova, AH. “Impaired Neuronal Communication Syndrome (INCS) as Novel Neurological Side Effect to Botulinum Toxin Type A Therapy with 16 Case Reports.” 2016.

Luvisetto S. Botulinum Neurotoxins in Central Nervous System: An Overview from Animal Models to Human Therapy. Toxins (Basel). 2021 Oct 22;13(11):751. doi: 10.3390/toxins13110751. PMID: 34822535; PMCID: PMC8622321.

Mann JM, Martin S, Hoffman R, Marrazzo S. Patient recovery from type A botulism: morbidity assessment following a large outbreak. Am J Public Health. 1981 Mar;71(3):266-9. doi: 10.2105/ajph.71.3.266. PMID: 7468858; PMCID: PMC1619789.

Xeomin product insert: https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/125360s073lbl.pdf 

Zargaran D, Zargaran A, Sousi S, Knight D, Cook H, Woollard A, Davies J, Weyrich T, Mosahebi A. Quantitative and qualitative analysis of individual experiences post botulinum toxin injection - United Kingdom Survey. Skin Health Dis. 2023 Jul 3;3(5):e265. doi: 10.1002/ski2.265. PMID: 37799369; PMCID: PMC10549845.