Safety and Efficacy of a Multi-use Neurotoxin Protocol in Academic Settings

BACKGROUND Botulinum neurotoxin (BoNT) is approved as single-use vials containing doses higher than necessary for most patients, which contributes to waste and lost revenue. It is common practice to administer a single-use BoNT vial to multiple patients, but data are lacking to support the safety of this practice. OBJECTIVE To determine the safety and efficacy of a multiuse vial protocol for BoNT at an academic medical center. MATERIALS AND METHODS A retrospective review of the electronic medical record identified patients receiving cosmetic BoNT at Oregon Health & Science University between 2020 and 2025. Adverse events that occurred within 30 days of the procedure were recorded. RESULTS A total of 2,666 patients receiving cosmetic BoNT were included. Overall, 354 (13.28%) follow-ups occurred within 30 days, and 39 (1.46%) adverse events occurred. The majority of these were related to inadequate paralysis (16) or asymmetrical paralysis (12). No serious complications or infections were identified. CONCLUSION Complications when using a multiuse vial policy for BoNT are infrequent and not related to infection. Adoption of similar policies nationwide will lead to a reduction in medical waste and increased revenue.