Table 2.

Common Clinical Applications of Botulinum Toxin (BoNT) according to Specialty

Specialty	FDA-approved Use (Indication-specific Recommended Dosage)	Off-label Use
Ophthalmology	• Strabismus* (variable) • Blepharospasm (1.25–2.5 U into each of the three sites per affected eye) • Hemifacial spasm*	• Eyelid retraction due to thyroid disease • Apraxia of lid opening • Entropion • Exposure keratopathy • Lacrimal hypersecretion • Chronic dry eyes • Pain relief following acute angle closure glaucoma
Neurology	• Cervical dystonia (variable)• Spasticity*└ Adult upper limb spasticity (400 U total)└ Adult lower limb spasticity (300–400 U total)└ Pediatric upper limb spasticity (3–6 U/kg; 200 U total)└ Pediatric lower limb spasticity (4 – 8 U/kg; 300 U total)• Chronic migraines (5 U (0.1 mL) injections per site divided across seven head or neck muscles; total 155 U)	Movement disorders:• Other types of dystonia (laryngeal, limb, oromandibular, orolingual, truncal) • Hemifacial spasm*• Tremor • Tics • Bruxism*• Myokymia and synkinesis (ie, oculonasal synkinesis) • Palatal myoclonus Painful disorders: • Tension headaches • Myofascial pain syndrome • Temporomandibular joint (TMJ) disorders* trigeminal Neuralgia • Brachial plexus injury*
Plastic surgery and dermatology	• Glabellar lines (4 U (0.1 mL) into each of the five sites; 20 U total) • Lateral canthal lines (4 U (0.1 mL) into each of the three sites per side; 24 U total)• Forehead lines (4 U (0.1 mL) into each of five forehead lines; 20 U total) • Axillary hyperhidrosis (50 U per axilla)	Cosmetic use:• Eyebrow depression • Horizontal nasal bridge lines • Horizontal forehead lines • Vertical lip lines • Ptosis of lateral commissure • Platysmal neck bands • Gummy smile • Peau d’orange chin Other indications:• Bruxism*• Masseter hypertrophy • TMJ dysfunction*• Hyperhidrosis in other regions, such as the palms and soles • Hidradenitis suppurativa • Frey’s syndrome
Orthopedics	• Spasticity* └ Adult upper limb spasticity (400 U total) └ Adult lower limb spasticity (300–400 U total) └ Pediatric upper limb spasticity (3–6 U/kg; 200 U total) └ Pediatric lower limb spasticity (4–8 U/kg; 300 U total)	• Congenital talipes equinovarus • Idiopathic toe walking • Brachial plexus injury*• Sport injuries (ie, lateral epicondylitis/tennis elbow and tendon repair) • Posttraumatic elbow stiffness caused by heterotopic ossification • Club foot • Piriformis syndrome
Gastrointestinal	None	Esophageal:• Achalasia • Diffuse esophageal spasms Gastroduodenal:• Gastroparesis Anorectal:• Chronic anal fissures • Rectal fissures or spasms • Anismus Biliary:• Sphincter of oddi dysfunction Other indications:• Obesity • Proctalgia fugax
Urology and gynecology	• Adult neurogenic detrusor overactivity (~6.7 U (0.1 mL) injections across 30 sites into detrusor; 200 U total)• Pediatric neurogenic detrusor Overactivity (0.5 mL injections across 20 sites into detrusor; total dose of 200 U if ≥34 kg and 6 U/kg if <34 kg)• Nonneurogenic overactive bladder (5 U (0.5 mL) injections across 20 sites into detrusor; 100 U total)	• Prostatic obstruction • Sterile prostatitis • Outflow obstruction Symptoms • Urinary retention • Vaginismus • Vulvodynia • Chronic pelvic pain • Painful bladder syndrome/interstitial cystitis
Rheumatology	None	• Raynaud’s phenomenon

*Denotes conditions that may be treated across multiple specialties. It is important to note that this is not an exhaustive list.