| 10 | For the treatment of strabismus and blepharospasm associated with dystonia, including benign essential blepharospasm or VII nerve disorders in patients 12 years of age or older. |
| | LU Authorization Period: 1 year |
| 130 | To reduce the subjective symptoms and objective signs of cervical dystonia (spasmodic torticollis) in adults. |
| | LU Authorization Period: 1 year |
| 412 | For the management of focal spasticity, due to stroke or spinal cord injury in adults. |
| | LU Authorization Period: 1 year |
| 413 | For the treatment of focal spasticity secondary to cerebral palsy in patients two years of age or older. |
| | LU Authorization Period: 1 year |
| 440 | For adult patients with urinary incontinence due to neurogenic detrusor overactivity resulting from neurogenic bladder associated with multiple sclerosis or subcervical spinal cord injury who fail to respond to behavioural medication and anticholinergics and/or are intolerant to anticholinergics.
The recommended dose is 200U injected into the detrusor muscle.
Subsequent injections should be provided at intervals of no less than every 36 weeks and patients who fail to respond to initial treatment with Botulinum Toxin Type A should not be retreated.
|
| | LU Authorization Period: 1 year |
| 460 | For adult patients with urinary frequency, urgency or urge incontinence due to overactive bladder who have:
Failed to respond to behavioral techniques AND had an inadequate response or intolerance to adequate trials (i.e., at least 2 weeks at the maximum tolerated dose) of at least two medications for overactive bladder (e.g. anticholinergics, mirabegron).
The recommended dose is 100U injected into the detrusor muscle.
NOTES:
-Patients who fail to achieve a reduction of greater than 50 percent in the frequency of urinary incontinence episodes with 1 dose should not be retreated.
-Maximum 3 doses per year in responders, at a frequency of no more than once every 12 weeks.
-Patients must have a post-void residual (PVR) urine volume of less than 150mL. |
| | LU Authorization Period: 1 year |
| | CAUTION: Note: Botox should be administered personally by a urologist, pediatrician, neurologist, physical medicine specialist or a physician with equivalent post-graduate training and experience with neuromuscular or urological disorders as appropriate. |
