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BOTOX Injector Training

November 2004

Marks owned by Allergan, Inc. 2004 Allergan, Inc., Irvine, CA 92612

Overview of Injector Training

Patient preparation Supplies needed Iodine starch test BOTOX reconstitution BOTOX injection

Please see important safety information on slide 12.

Patient Preparation
Shave underarms Abstain from use of over-the-counter deodorants or antiperspirants for 24 hours prior to treatment Rest comfortably without exercise, hot beverages, etc., for approximately 30 minutes prior to treatment

Please see Important Safety Information on slide 12.

Supplies Needed
Iodine Starch Test
Iodine solution Starch Powder Surgical pen Alcohol (to clean area)

Reconstitution
0.9% nonpreserved sterile saline only BOTOX 100 units 20-gauge, 1-inch extraction needle

Injection
30-gauge, -inch injection needle

Please see Important Safety Information on slide 12.

Perform the Iodine Starch Test

Dry affected axilla Paint area with iodine swab
Be sure to cover excess area around axilla

Let dry Brush area with starch powder Wait 10 minutes

Please see Important Safety Information on slide 12.

Perform the Iodine Starch Test

Blue-black mark will identify affected area

Circle affected area with surgical marker, then clean area inside circle with alcohol

Please see Important Safety Information on slide 12.

Perform the Iodine Starch Test

Use a surgical pen and standard ruler to mark injection points: 1 to 2 cm apart Staggered to allow for ring effect of intradermal injections Count injection points and allocate recommended dosage of BOTOX solution per injection, based on: 50 Units per axilla

Please see Important Safety Information on slide 12.

BOTOX Reconstitution
Be certain youve received actual BOTOX product from Allergan
Look for holographic film on vial; Allergan should appear within rainbow lines If you do not see rainbow lines or Allergan does not appear, do not use product and please contact Allergan, Inc., directly at (800) 890-4345 from 8:00 a.m. to 4:00 p.m. Pacific time.
Please see Important Safety Information on slide 12.

BOTOX Reconstitution
BOTOX Must Be Properly Reconstituted With Only 0.9% Nonpreserved Saline Solution Prior1 - inch length needle, draw up 4 mL of 0.9% to Injecting Using a 21-gauge,
nonpreserved sterile saline into syringe Insert needle at a 45 angle and slowly inject saline into BOTOX vial
Ensure vacuum is present in vial, which means sterility of vial is intact Do not use vial if there is no vacuum present

Release vacuum by disconnecting syringe from reconstitution needle (with needle remaining attached to bottle) and allowing air to flow into vial and neutralize pressure Gently mix BOTOX with saline by rotating vial; do not invert vial Attach a new sterile syringe to remaining needle and draw fluid from bottom corner of vial for full extraction; do not invert vial Remove reconstitution needle from syringe and attach a 30-gauge injection needle, which is recommended needle for axillary injections
Please see Important Safety Information on slide 12.

BOTOX Injection
Inject at a 45 angle to skin surface Bevel side up to minimize leakage and ensure injections remain intradermal A depth of approximately 2 mm Be sure not to inject directly on ink mark to avoid a permanent tattoo effect

Please see Important Safety Information on slide 12.

BOTOX Injection
Clean treated area with alcohol Treatment complete

Please see Important Safety Information on slide 12.

Important Safety Information

BOTOX treatment is contraindicated in the presence of infection at the proposed injection site(s) and in individuals with known hypersensitivity to any ingredient in the formulation. Serious and/or immediate hypersensitivity reactions have been rarely reported. These reactions include anaphylaxis, urticaria, soft tissue edema, and dyspnea. If such a reaction occurs, further BOTOX injection should be discontinued and appropriate medical therapy immediately instituted. BOTOX should only be diluted with 0.9% nonpreserved sodium chloride. Other diluents, including lidocaine, should not be used for reconstitution. Individuals with peripheral motor neuropathic diseases (eg, amyotrophic lateral sclerosis or motor neuropathy) or neuromuscular junctional disorders (eg, myasthenia gravis or Lambert-Eaton syndrome) should only receive BOTOX treatment with caution. Individuals with neuromuscular disorders may be at increased risk of clinically significant systemic effects including severe dysphagia and respiratory compromise from typical doses of BOTOX. The most frequently reported adverse events (3%-10% of patients) were injection-site pain and hemorrhage, non-axillary sweating, infection, pharyngitis, flu syndrome, headache, fever, neck or back pain, pruritus, and anxiety.
Please see accompanying full prescribing information or visit www.botox.com.

Back Up

Hyperhidrosis Disease Severity Scale (HDSS)

HDSS is a 4-point scale designed to assess severity of hyperhidrosis in everyday clinical practice or in clinical research and effectiveness of hyperhidrosis treatment HDSS can be administered by an interviewer or selfcompleted by patient HDSS assesses disease severity based on extent of excessive-sweating-related impairment of daily activities

Please see Important Safety Information on slide 12.

Hyperhidrosis Disease Severity Scale

Please see Important Safety Information on slide 12.