Proven weight-based dosing for Pediatric Spasticity

*For anatomical reference only.

Lines indicate muscle location, and do not point out sites for injection.

*For anatomical reference only.

Lines indicate muscle location, and do not point out sites for injection.

*For anatomical reference only.

Lines indicate muscle location, and do not point out sites for injection.

Approved muscles and BOTOX® doses for common postures1

POSTURE
 

Flexed Elbow

Flexed Wrist/Fingers

MUSCLE
BOTOX® DOSE
SWIPE

Biceps brachii
Brachialis
Brachioradialis

1.5 Units/kg – 3 Units/kg divided in 4 sites
1 Unit/kg – 2 Units/kg divided in 2 sites
0.5 Unit/kg – 1 Unit/kg divided in 2 sites

Flexor carpi radialis
Flexor carpi ulnaris
Flexor digitorum profundus
Flexor digitorum superficialis (sublimis)

1 Unit/kg – 2 Units/kg divided in 2 sites
1 Unit/kg – 2 Units/kg divided in 2 sites
0.5 Unit/kg – 1 Unit/kg divided in 2 sites
0.5 Unit/kg – 1 Unit/kg divided in 2 sites

  • The recommended dose for treating Pediatric ULS is 3 Units/kg to 6 Units/kg divided among the affected muscles1
  • The total dose of BOTOX® administered per treatment session in the upper limb should not exceed 6 Units/kg or 200 Units, whichever is lower1
  • Localization of the involved muscles with techniques such as needle electromyographic guidance, nerve stimulation, or ultrasound is recommended1
  • Repeat BOTOX® treatment may be administered when the effect of a previous injection has diminished
    – Generally, no sooner than 12 weeks after the previous injection1
  • The degree and pattern of muscle spasticity at the time of re-injection may necessitate alterations in the dose of BOTOX® and muscles to be injected1
  • Dosing in initial and sequential treatment sessions should be tailored to the individual based on the size, number, and location of muscles involved; severity of spasticity; the presence of local muscle weakness; the patient’s response to previous treatment; or adverse event history with BOTOX®1
  • The lowest recommended starting dose should be used
    – Generally, no more than 50 Units per site should be administered1
POSTURE
 

Flexed Ankle

MUSCLE
BOTOX® DOSE
SWIPE

Gastrocnemius (medial head)
Gastrocnemius (lateral head)
Soleus
Tibialis Posterior

1 Units/kg – 2 Units/kg divided in 2 sites
1 Units/kg – 2 Units/kg divided in 2 sites
1 Units/kg – 2 Units/kg divided in 2 sites
1 Units/kg – 2 Units/kg divided in 2 sites

  • The recommended dose for treatment Pediatric LLS is 4 Units/kg to 8 Units/kg divided among the affected muscles1
  • The total dose of BOTOX® administered per treatment session in the lower limb should not exceed 8 Units/kg or 300 Units, whichever is lower1
  • Localization of the involved muscles with techniques such as needle electromyographic guidance, nerve stimulation, or ultrasound is recommended1
  • Repeat BOTOX® treatment may be administered when the effect of a previous injection has diminished
    – Generally, no sooner than 12 weeks after the previous injection1
  • The degree and pattern of muscle spasticity at the time of re-injection may necessitate alterations in the dose of BOTOX® and muscles to be injected1
  • Dosing in initial and sequential treatment sessions should be tailored to the individual based on the size, number, and location of muscles involved; severity of spasticity; the presence of local muscle weakness; the patient’s response to previous treatment; or adverse event history with BOTOX®1
  • The lowest recommended starting dose should be used
    – Generally, no more than 50 Units per site should be administered1

Maximum dosing

When treating the pediatric upper and lower limbs in combination, the total dose should not exceed the lower of 10 Units/kg or 340 Units in a 3-month interval1

Localization methods

Techniques such as ultrasound, needle electromyographic guidance, and nerve stimulation are recommended for treatment of Pediatric Spasticity1

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