RimabotulinumtoxinB

What is RimabotulinumtoxinB

RimabotulinumtoxinB (formerly known as botulinum toxin type B) is a botulinum toxin produced from fermentation of Clostridium botulinum type B.

RimabotulinumtoxinB is approved for treating cervical dystonia and chronic sialorrhea in adults.

It decreases the severity of abnormal head position and neck pain in patients with cervical dystonia, and it has been found effective in patients with cervical dystonia who do and do not respond to type A.

RimabotuliniumtoxinB significantly decreased salivary flow rate among patients with various neurologic disorders including Parkinson’s disease, amyotrophic lateral sclerosis (ALS), and stroke.

Spread of the toxin effect beyond the injection site may occur with use which can produce swallowing and breathing difficulties.

Brand Name

Myobloc

Indications

  • cervical dystonia
  • sialorrhea

Side Effects

  1. amblyopia
  2. angioedema
  3. antibody formation
  4. anxiety
  5. arthralgia
  6. asthenia
  7. back pain
  8. blurred vision
  9. chest pain (unspecified)
  10. chills
  11. confusion
  12. constipation
  13. cough
  14. cystitis
  15. dental caries
  16. diplopia
  17. distant spread of toxin effects
  18. dizziness
  19. drowsiness
  20. dysarthria
  21. dysgeusia
  22. dyspepsia
  23. dysphagia
  24. dysphonia
  25. dyspnea
  26. ecchymosis
  27. edema
  28. fever
  29. headache
  30. hypercholesterolemia
  31. hyperesthesia
  32. infection
  33. influenza
  34. injection site reaction
  35. malaise
  36. migraine
  37. musculoskeletal pain
  38. myasthenia
  39. peripheral edema
  40. peripheral vasodilation
  41. pruritus
  42. ptosis
  43. rash
  44. respiratory arrest
  45. rhinitis
  46. tinnitus
  47. torticollis
  48. tremor
  49. urinary incontinence
  50. urticaria
  51. vertigo
  52. visual impairment
  53. weakness
  54. xerostomia

Monitoring Parameters

  • laboratory monitoring not necessary

Contraindications

  • albumin hypersensitivity
  • amyotrophic lateral sclerosis (ALS)
  • autonomic neuropathy
  • breast-feeding
  • cerebral palsy
  • children
  • distant spread of toxin effects
  • driving or operating machinery
  • dysphagia
  • geriatric
  • infection
  • inflammation
  • myasthenia gravis
  • myopathy
  • neuromuscular disease
  • pregnancy
  • requires an experienced clinician
  • respiratory insufficiency
  • surgery
  • viral infection

Interactions

  • Amikacin
  • Anticholinergics
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Atracurium
  • Atropine
  • Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Atropine; Difenoxin
  • Atropine; Diphenoxylate
  • Atropine; Edrophonium
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Bacitracin
  • Baclofen
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Belladonna; Opium
  • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Benztropine
  • Capreomycin
  • Capsaicin; Metaxalone
  • Carisoprodol
  • Chlordiazepoxide; Clidinium
  • Chlorzoxazone
  • Cisatracurium
  • Cyclobenzaprine
  • Dantrolene
  • Dicyclomine
  • Doxacurium
  • Flavoxate
  • Gentamicin
  • Glycopyrrolate
  • Glycopyrrolate; Formoterol
  • Homatropine; Hydrocodone
  • Hyoscyamine
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Indacaterol; Glycopyrrolate
  • Kanamycin
  • Mepenzolate
  • Metaxalone
  • Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
  • Methscopolamine
  • Mivacurium
  • Neomycin
  • Neuromuscular blockers
  • OnabotulinumtoxinA
  • Orphenadrine
  • Oxybutynin
  • Pancuronium
  • Paromomycin
  • Polymyxins
  • Propantheline
  • Rapacuronium
  • Rocuronium
  • Scopolamine
  • Skeletal Muscle Relaxants
  • Solifenacin
  • Streptomycin
  • Succinylcholine
  • Tapentadol
  • Tobramycin
  • Trihexyphenidyl
  • Trospium
  • Tubocurarine
  • Vecuronium
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