a hand breaking through a paper poster holds a box with a botox bottle

Botulinum Toxin is one of the most popular and versatile medical devices currently on the market. Botox is used cosmetically in reducing wrinkles and folds in aging skin. It also has numerous medical uses such as treating limb spasticity, crossed eyes, hyperhidrosis, migraine, blepharospasm, cervical dystonia, and overactive bladder.

With so many uses, it is certainly a must have in most clinics’ inventories. However since Botox is an exotoxin produced from bacteria, Many factors can affect its potency and effects. One of the main things to consider when keeping botox in your store is its storage.

How should I store Botox?

Botox is supplied as a powder in vacuum-sealed vials. According to the package insert, in this form, it needs to be stored in a refrigerator at temperatures of 2 to 8 degrees centigrade for up to 24 months for the 200u vial and up to 36 months for the 100u vial. Once it is reconstituted, it will have to be administered within 4 hours. While in this reconstituted form, it will still need to be stored in the same temperature refrigerator until it is ready for injection.

Botox’s product manufacturer has since sent out a statement that the non-reconstituted form of botox can remain stable for up to five days at room temperature.

Other studies have shown that even though the package insert says the reconstituted botox needs to be used up in 4 hours, it can actually be stored for up to 4 weeks in a less than 4℃ refrigerator. These studies have found no harmful effects or reduction in the efficacy of the reconstituted botox, given that it was stored properly in those conditions.

A caveat to this is that the temperature will have to be regulated and monitored as fluctuations in temperature, including refreezing, can denature the toxin’s proteins or reduce the potency of the botox.

That means to get the best results and to prevent possibly wasting a valuable product, it would be best to have a dedicated medical refrigerator that is kept at the ideal temperature for botox storage. A backup power supply should also be considered in case of power failure.

How do I transport Botox?

Considering Botox supplies are usually shipped across large distances, storage during transport should also be considered. The most important tip to transporting Botox is that it should be transported in its unreconstituted form. As mentioned earlier, the manufacturer confirmed that it is still stable up to 5 days at room temperature, allowing plenty of time for travel.

However, since storage conditions may vary depending on the location or the method of travel, some researchers decided to determine if other temperatures can affect botox potency. They found that the unreconstituted botox did not lose efficacy even when stored at 25℃ for 2 weeks. They also found that it can last 7 days at 30℃.

This means that unreconstituted botox can withstand transport of up to 14 days as long as it is kept in reasonable temperatures.

Tips when storing Botox in the refrigerator

Now that you know what temperature to store Botox at, here are a few more tips to help in their storage:

  • Don’t overfill the refrigerator – depending on the size of your refrigerator and what items you place inside, packing too many items at once can cause the temperature to fluctuate. At most, it is recommended to keep your refrigerator only 75% filled.
  • Keep the boxes/bottles away from the walls of the refrigerator – The refrigerator’s walls can be colder than the general temperature. Putting the boxes or bottles too close may cause these to freeze.
  • Keep Botox vials in their box to prevent exposure to light
  • Make sure you are able to monitor the temperature of the refrigerator at all times – consistently check the temperature of your refrigerator to make sure it stays within the ideal conditions. Most medical-grade refrigerators have smart functionality that will allow you to see the temperature at any time and some may even alert you if it falls outside desirable levels.
  • Arrange your Botox vials by manufacturing date so you know which ones will need to be used up first. Any leftovers from reconstituted vials should be used up first before opening a new vial (given that these were stored properly once reconstituted at around 4℃).

So I don’t need to throw out leftover Botox?

That’s right. As mentioned earlier, studies showed that reconstituted Botox stays effective for up to 4 months as long as it is stored at a temperature of less than 4℃. A single patient will most likely use up less than half of a 100U Botox vial, so knowing that we can reuse the leftovers is good news for practitioners and can save them hundreds of dollars.

However, the same study also warned about the risk of contamination when withdrawing from the same vial multiple times. These risks can be kept low to insignificant as long as the rubber stopper on the vial does not have significant damage and proper technique is used in withdrawing from the vial.

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