Stomach Botox Overdoses - Poisoning Botulism

You may have learned from the press that cases of botulism, a poisoning with Botulinum toxin, have occurred after stomach Botox treatments in Turkey. For your information, we provide you with a brief update:

Recently, there have been 12 cases in Germany, 1 each in Austria and Switzerland, and 57 cases in Turkey of patients reporting symptoms of botulism after stomach Botox treatments in Istanbul. These symptoms include muscular vision and speech disturbances, swallowing difficulties, and generalized muscle weakness. In the worst case, paralysis of the respiratory muscles could occur, but fortunately, it seems this has not happened.

As a prominent practitioner of the method in Germany, affected individuals have contacted me directly seeking advice. I am familiar with the treatment parameters used in Istanbul for these affected individuals and can provide an assessment of the issue.

There are four major manufacturers of Botulinum toxin approved for medical use in Germany and the rest of the world, with a fifth currently introducing another product to the market. The challenge here is that the effectiveness of the product is determined and categorized into units by the manufacturers themselves. The potency of one unit of the active ingredient from Manufacturer A does not correspond to that of Manufacturer B.

In treating my patients, I use 300 or 400 units of Botulinum toxin from the company Allergan/AbbVie. These dosages have been used in various studies since around 2005, of which there are now about 40. In none of these studies have similar side effects occurred. Apart from mild nausea for a maximum of 3-5 days after treatment, no side effects have been reported. Studies can clearly show that increasing the amount of the active ingredient does not result in an additional effect. Therefore, I strictly adhere to the dosages used in the stomach Botox studies and have not observed any side effects in my patients accordingly.

In Turkey, in the cases that I know of firsthand, the Botulinum toxin of another manufacturer was used. There is a conversion factor of about 1:2 between its units and the Allergan units. In addition, 1500 units of this substance were used, leading to the poisoning symptoms.

The described cases involve a significant overdose of the active ingredient, explaining the side effects. The dosage was either chosen out of ignorance or following the principle of "more is better." This principle does not apply to Botox treatments in general, and even Paracelsus knew in the 16th century:

"The dose makes the poison."

In the correct dosage, the method remains safely applicable. For example, in urology, the bladder is routinely treated endoscopically with 300 units of Botulinum toxin. This procedure has been approved since 2013. If you have any questions or would like advice, we are happy to assist you.