Rimabotulinumtoxinb (Intramuscular Route)

Mainly used to treat the symptoms of cervical dystonia, Rimabotulinumtoxinb works as a muscle relaxant.

Overview

Also known as spasmodic torticollis, cervical dystonia primarily affects the neck muscles. When the condition is present, it causes the patient’s neck muscles to spasm or contract uncontrollably. In addition to being painful, these contractions can pull the neck and the head into abnormal positions.

Without effective treatment, patients with cervical dystonia may find that their head is uncontrollably drawn to one side or that their head is pulled backwards or forwards. As patients are unable to control or rectify these movements, the condition can cause pain and extreme discomfort.

By using Rimabotulinumtoxinb injections, physicians can provide suitable treatment for patients. When administered via injection, Rimabotulinumtoxinb will relax the muscles surrounding the injection site. When injected into the neck muscles, Rimabotulinumtoxinb can release them from their contracted state and enable the patient to move their neck and head more freely.

It is believed that cervical dystonia is a neurological condition which occurs because the brain sends the wrong messages to the muscles in the body. Whilst Rimabotulinumtoxinb doesn’t prevent these messages from being sent, it does effectively treat the symptoms of the condition and relieve the pain and discomfort associated with the muscle spasms.

Rimabotulinumtoxinb, also referred to as botulinum toxin type B, is formed from the bacteria which causes botulism. Although toxic in larger doses, botulinum toxin type B can be used as a muscle relaxant in small doses. By blocking nerve activity in the affected muscles, Rimabotulinumtoxinb prevents the incorrect nerve signals from affecting the muscles, thus preventing the abnormal contracture. As Rimabotulinumtoxinb causes a temporary reduction in the muscle’s activity, the neck muscles no longer respond to the incorrect signals which are being sent by the brain. As a result, patients do not suffer the painful spasms and contractions associated with cervical dystonia.

Conditions Treated

  • Cervical Dystonia

Type of Medicine

  • Neurotoxic Protein

Side Effects

Although Rimabotulinumtoxinb injections can be an effective treatment for cervical dystonia, they have been associated with some side effects. After receiving treatment, patients may experience the following effects in some cases:

  • Sour or acid stomach
  • Pain in back
  • Belching
  • Blistering, bleeding, burning, hives, discoloration of the skin, swelling, and/or coldness at the injection site.
  • Feeling of pressure, stinging, itching, irritation, lumps, pain, rash and/or numbness at the injection site.
  • Redness, scarring, soreness, tenderness, warmth, tingling and/or ulceration at the injection site.
  • Cough
  • Difficulty moving
  • Infection at site of injection
  • Dizziness
  • Flu-like symptoms
  • Dry mouth
  • Headache
  • Indigestion and/or heartburn
  • Loss or lack of energy or strength
  • Nausea
  • Muscle weakness, stiffness and/or pain
  • Swelling, redness or pain of the joints
  • Stomach upset, pain or discomfort

Often, these side effects are fairly mild and diminish following treatment. If patients are concerned about any side effects following treatment with Rimabotulinumtoxinb, they should seek medical advice. Patients should also discuss the possibility of side effects occurring with their doctor before treatment. Often, physicians will be able to advise patients on how to minimize the chance of adverse effects occurring.

Following treatment with Rimabotulinumtoxinb injections, patients should obtain medical help if they experience any of the following side effects:

  • Difficulty with speaking and/or breathing
  • Infection
  • Muscle weakness
  • Pain in neck
  • Difficulty swallowing
  • Uncontrollable twisting of the neck

Although these side effects will not affect all, or even most, patients, they do warrant medical attention if they occur.

Dosage

Typically, Rimabotulinumtoxinb is used in doses of 5000 units per milliliter. If patients have previously received Rimabotulinumtoxinb injections, a dose of 2500-5000 units may be used, although this dose will generally be split between all the affected muscles, rather than being administered to just one of the muscles in the neck.

During the first treatment, patients may be given a lower dose of Rimabotulinumtoxinb. Physicians will attempt to treat the condition with the lowest therapeutic dose of Rimabotulinumtoxinb but may increase the dose as required.

If patients require additional treatment, further Rimabotulinumtoxinb injections may be given after 12-16 weeks. Rimabotulinumtoxinb injections are administered directly into the muscles and should be given by an experienced healthcare practitioner. Patients will not, therefore, have to administer Rimabotulinumtoxinb injections themselves at home.

Warnings

Like all medicines, Rimabotulinumtoxinb could interact with other substances the patient is taking. Before receiving treatment, patients should tell their doctor if they are taking any other prescription medicines, over-the-counter medicines, vitamins and/or supplements. After receiving Rimabotulinumtoxinb injections, patients should obtain medical advice before using any other medicines, supplements and/or vitamins.

If patients have other existing health problems, it may affect their treatment with Rimabotulinumtoxinb injections. Patients should discuss their complete medical history with their doctor to ensure that treatment with Rimabotulinumtoxinb is appropriate for them. The following conditions can be particularly relevant if Rimabotulinumtoxinb injections are being considered as a form of treatment:

  • Infection at previous injection site
  • Amyotrophic lateral sclerosis (also known as Lou Gehrig’s disease)
  • Urinary incontinence
  • Lambert-Eaton syndrome
  • Droopy eyelid (Ptosis)
  • Motor neuropathy
  • Dysphonia (Voice problems)
  • Myasthenia Gravis
  • Dysphagia (Difficulty swallowing)
  • Breathing problems
  • Dysarthria (Difficulty speaking)

If Rimabotulinumtoxinb injections are administered to pregnant patients, it may present a risk to the unborn fetus. Due to this, physicians may be unwilling to recommend this form of treatment to patients who are currently pregnant or who are planning to become pregnant in the near future. Typically, Rimabotulinumtoxinb injections should only be administered to pregnant patients if the benefits greatly outweigh the potential risks.

If patients become pregnant whilst receiving treatment with Rimabotulinumtoxinb injections, they should seek medical advice.

It is not yet known if Rimabotulinumtoxinb can be passed on to an infant via breastfeeding. Due to this, patients may be advised to refrain from breastfeeding after receiving treatment with Rimabotulinumtoxinb. If patients are breastfeeding, they should discuss the risks with their doctor before receiving Rimabotulinumtoxinb injections.

Rimabotulinumtoxinb injections are not typically used to treat children or infants as their safety has not been established in this age range. If doctors prescribe Rimabotulinumtoxinb injections for younger patients, they should only do so if the benefit of the treatment will outweigh the risks.

Whilst receiving Rimabotulinumtoxinb injections, patients should be monitored by their doctor. This will enable their physician to confirm no adverse effects are taking place and alter their dose, if it is necessary to do so.

On rare occasions, patients may develop muscle reactions after receiving Rimabotulinumtoxinb injections. They may occur within hours or weeks of the injection being administered and may include difficulty swallowing, breathing and/or talking and/or muscle weakness. Patients should seek immediate medical help if they begin to experience these symptoms. Trouble with breathing, talking and/or swallowing can be life-threatening and should be treated as a medical emergency.

When receiving Rimabotulinumtoxinb injections, patients may notice that their muscles feel weak or that their vision has changed. If so, they should not drive or operate heavy machinery until these effects have worn off.

Rimabotulinumtoxinb is comprised, in part, of human blood which has been donated. There is a low risk that certain viruses can be transferred to the patient via the use of donated blood. Donors are tested prior to giving blood and blood is tested during the manufacturing process which means that the risk of this happening is relatively low. Patients should discuss this with their doctor if they are concerned about the possibility of contracting any virus when receiving Rimabotulinumtoxinb injections.

Before receiving treatment, patients should inform their physician if they have any allergies. If patients experience any allergic reactions after receiving a Rimabotulinumtoxinb injection, they should seek urgent medical help. An allergic reaction may include the following symptoms:

  • Rash on the skin
  • Blistering or peeling of the skin
  • Itching
  • Welts or hives
  • Tightness in the chest
  • Wheezing
  • Fever
  • Difficulty talking or breathing
  • Tightness in the throat
  • Swelling of the throat, face and/or lips
  • Hoarseness

Storage

In most cases, Rimabotulinumtoxinb should be stored in a refrigerator at a temperature of 2°-8°C. As Rimabotulinumtoxinb is normally supplied in single use vials, these can be disposed of once used. If any medication remains, this should be disposed of, rather than being reused.

Once opened, Rimabotulinumtoxinb should be used immediately. In some cases, it may be appropriate to use Rimabotulinumtoxinb within 4 hours of the medication being opened and/or diluted.

When patients receive Rimabotulinumtoxinb injections, they will normally be in a clinical setting and their injection will be administered by a healthcare professional. Due to this patients should not have to store, manage or prepare Rimabotulinumtoxinb at home.

Summary

As cervical dystonia is caused by incorrect nerve signals being sent from the brain to the neck muscles, it can be a difficult condition to cure. Whilst neurosurgeons and specialists are still investigating a complete cure for the condition, Rimabotulinumtoxinb injections do provide an effective form of treatment.

Whilst the brain still continues to send incorrect messages, Rimabotulinumtoxinb prevents the neck muscles from responding to them. Reducing the muscular activity in the affected area means that the neck muscles no longer respond to the signals which previously caused them to contract.

Once Rimabotulinumtoxinb prevents this from happening, patients will no longer experience the pain and discomfort associated with spasms and muscle contractions.

 

Resources
Last Reviewed:
January 30, 2018
Last Updated:
January 27, 2018
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