Is Botulinum toxin (Botox) safe during breastfeeding?

From the Guidelines

Botulinum toxin (Botox) is likely safe during breastfeeding, as its large molecular weight (150,000 daltons) may prevent its passage into breast milk 1.

Key Points

• The molecular weight of botulinum toxin is high, which suggests that it is less likely to achieve clinically relevant levels in breast milk 1.
• There have been no reported cases of botulism in infants breastfed by mothers with botulism, and no botulinum toxin was detected in breast milk in the few cases where it was tested 1.
• Although there is limited data available on the use of botulinum toxin during breastfeeding, the available evidence suggests that it is unlikely to pose a significant risk to the nursing infant 1.
• As a precautionary measure, breastfeeding women should consult with their healthcare provider before undergoing Botox treatment, and consider waiting at least 24-48 hours after treatment before resuming breastfeeding.
• It is also important to note that the typical dose of Botox used for cosmetic purposes is not expected to pose a significant risk to the nursing infant 1.

From the FDA Drug Label

1. 2 Lactation There is no information regarding the presence of prabotulinumtoxinA-xvfs in human or animal milk, its effects on the breastfed infant, or on milk production The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for JEUVEAU and any potential adverse effects on the breastfed infant from JEUVEAU or from the underlying maternal condition

The FDA drug label does not answer the question.

From the Research

Safety of Botulinum Toxin (Botox) During Breastfeeding

• The safety of botulinum toxin (Botox) during breastfeeding has been studied in a pilot study, which detected the presence of botulinum toxin in breast milk from lactating subjects treated with facial botulinum toxin injections 2.
• The study found that although some breast milk samples had detectible amounts of botulinum toxin, the amounts were well below the reported lethal oral dose for an infant, suggesting that facial botulinum toxin injections may not warrant an interruption in breastfeeding 2.
• However, it is essential to note that the study had a small sample size, and further studies with larger sample sizes are needed to confirm these findings.
• Other studies have discussed the safety and efficacy of botulinum toxin (Botox) for various cosmetic and therapeutic uses, but they do not specifically address the safety of Botox during breastfeeding 3, 4, 5.
• A study on the safety of antituberculosis medications during breastfeeding found that most antituberculosis drugs appear to be safe for use with breastfeeding, but it did not provide information on the safety of botulinum toxin (Botox) during breastfeeding 6.

Key Findings

• Botulinum toxin was detected in some breast milk samples, but the amounts were well below the reported lethal oral dose for an infant 2.
• The study suggests that facial botulinum toxin injections may not warrant an interruption in breastfeeding, but further studies are needed to confirm these findings 2.
• Other studies have discussed the safety and efficacy of botulinum toxin (Botox) for various uses, but they do not specifically address the safety of Botox during breastfeeding 3, 4, 5.