Attribution Statement: LactMed is a registered trademark of the U.S. Department of Health and Human Services.
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-.
CASRN: 93384-43-1
Drug Levels and Effects
Summary of Use during Lactation
OnabotulinumtoxinA was not detectable in the milk of two women and detectable in only minute amounts in 5 others after 40 to 92 units injected into the face. One infant was safely breastfed during maternal botulism and no botulinum toxin was detectable in the mother's milk or infant. Breastfeeding appears to protect infants against botulism.[1] No special precautions are required.
Drug Levels
Maternal Levels. Type A botulinum toxin was detected in the blood and stools of a nursing mother after ingesting fermented salmon eggs. She was given 2 vials of trivalent botulism antitoxin, 1 intravenously and 1 intramuscularly. A milk sample obtained 3 days after the onset of her illness and 4 hours after administration of botulinum antitoxin had no detectable botulinum toxin nor botulism organisms.[2]
Four women undergoing cosmetic procedures were injected with doses ranging from 40 to 92 units of onabotulinumtoxinA. Milk samples were taken at baseline and 1, 3 and 5 hours after the injections. Two women had undetectable (<46 ng/L) levels in all samples after receiving 54 and 92 units. Two other women who received 40 and 46 units had peak milk levels of 422 ng/L and 747 ng/L, respectively.[3]
In a preprint, 3 women were reported who received onabotulinumtoxinA at 3 sites for facial cosmetic procedures for a total dose of 64 units. They were instructed to express 200 mL of breastmilk before treatment and 1, 6, 24, 36, 48, and 72 hours after treatment using a manual pump. In addition, milk samples were collected at 5, 6, 7, 10, and 11 days, 2 months, 4 months, and 5 months after the injections. The highest observed concentration was 33.4 ng/L in in one woman 4 days after the injection. In another woman, the highest concentration occurred 3 days after the injection. After the first week, milk concentrations in one woman decreased to a low of 6.9 ng/L at 11 days, before another peak of 26.6 ng/L at 2 months after the injections. If the highest concentration and a dose of 150 mL/kg daily breastmilk intake are used, a breastfed infant would receive a maximum of 5 ng/kg of botulinum toxin A orally per day, which is far below the dose of 12 to 25 units/kg given by injection to children with spastic cerebral palsy.[4]
Infant Levels. Type A botulinum toxin was detected in the blood and stools of a nursing mother after ingesting fermented salmon eggs. No botulinum toxin was detected in the breastfed infant's blood or stool on the day the mother was admitted to the hospital (3 days after the onset of illness) and no botulism organisms were detected in the infant's stools.[2]
Effects in Breastfed Infants
One mother breastfed her infant while she was experiencing toxicity from botulism poisoning. She breastfed her 2-month-old infant. Although the mother died, the infant had no symptoms.[5]
A woman developed botulism after ingesting fermented salmon eggs while breastfeeding her 8-month-old breastfed (extent not stated) infant. The infant developed no signs or symptoms of botulism even though she continued to nurse throughout the mother's hospitalization.[2]
Effects on Lactation and Breastmilk
Relevant published information was not found as of the revision date.
Alternate Drugs to Consider
(Migraine Prophylaxis) Divalproex, Erenumab, Metoprolol, Nortriptyline, Propranolol, Rimegepant, Topiramate, Valproic Acid
References
- 1.
- Arnon SS, Damus K, Thompson B, et al. Protective role of human milk against sudden death from infant botulism. J Pediatr 1982;100:568-73 [PubMed: 7038077]
- 2.
- Middaugh J. Botulism and breast milk. N Engl J Med 1978;298:343 [PubMed: 622098]
- 3.
- Hudson C, Wilson P, Lieberman D, et al. Analysis of breast milk samples in lactating women after undergoing botulinum toxin injections for facial rejuvenation: A pilot study. Facial Plast Surg Aesthet Med 2024 [PubMed: 38306172]
- 4.
- Gu H, Xu Z, Koviazina R, et al. Detection of nontoxic BoNT/A levels in post-facial botox injection breastmilk using a multi-technique approach. bioRxiv 2024. doi:10.1101/2024.05.22.595434 [CrossRef]
- 5.
- Douthirt C. An outbreak of botulism in Tucumcari, New Mexico. Southwest Med 1938:51-3
Substance Identification
Substance Name
onabotulinumtoxinA
CAS Registry Number
93384-43-1
Drug Class
Breastfeeding
Lactation
Milk, Human
Bacterial Toxins
Neuromuscular Agents
Neurotoxins
Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.
- User and Medical Advice Disclaimer
- Drugs and Lactation Database (LactMed) - Record Format
- LactMed - Database Creation and Peer Review Process
- Fact Sheet. Drugs and Lactation Database (LactMed)
- Drugs and Lactation Database (LactMed) - Glossary
- LactMed Selected References
- Drugs and Lactation Database (LactMed) - About Dietary Supplements
- Breastfeeding Links
- PubMedLinks to PubMed
- OnabotulinumtoxinA - Drugs and Lactation Database (LactMed®)OnabotulinumtoxinA - Drugs and Lactation Database (LactMed®)
Your browsing activity is empty.
Activity recording is turned off.
See more...