Drugs › Acetylcholine release inhibitor
Generic name
Botulinum toxin type a: adverse event reports filed with FDA
4,736 reports list it as a suspect or interacting product, 2004–2026. Class: Acetylcholine release inhibitor. Also reported as Botulinum Toxin Type A Nos.
- 4,736
- reports as suspect product
- 0% of all reports · about 211 a year
- 972
- reports, 12 months to June 2026
- 1,050 in the 12 months before
- 87.1%
- marked serious by the reporter
- 20.1% across the class
- 34%
- record death among outcomes, as reported
- 1,612 reports · not verified by FDA
4,736 adverse event reports received by FDA list botulinum toxin type a, a generic name as a suspect or interacting product, from February 2004 to June 2026. A further 922 reports list it only as a concomitant medication, and those are not counted in the figures on this page.
In the 12 months to June 2026, 972 reports listed it, close to the 1,050 of the 12 months before. FDA releases FAERS data quarterly, so the newest months are incomplete and grow in later releases. Over its reporting history that is about 211 reports a year and 0% of the 20,646,523 reports in the database, and 5.3% of the reports for the acetylcholine release inhibitor class. How many people take it is not in the data, so a count is not a rate of occurrence.
Reporters most often recorded off label use (42.2%), drug ineffective (31.3%) and drug intolerance (24.6%). A report can list several reactions, so shares add to more than 100%; 667 different terms appear across these reports. Off label use is recorded in 42.2% of these reports, a larger share than in the median acetylcholine release inhibitor drug (28.2%).
87.1% of the reports are marked serious by the reporter (20.1% across the class); 34% record death among the outcomes and 40.6% record hospitalisation, as reported. 55.3% of the reports came from other health professionals, and the largest patient age group is 18 to 44 (44.1%). FDA states that "a causal relationship cannot be established between product and reactions listed in a report" and that for any given report "there is no certainty that a suspected drug caused the event."
Reports by month, five years
Reports by the month FDA received them. FDA releases FAERS data quarterly, so the newest months are incomplete and grow in later releases.
By year received
2026 covers reports received through June 2026 only.
Reactions recorded in the reports
share of Botulinum toxin type a reports recording the termmedian drug in acetylcholine release inhibitor
- Off label useused for a purpose or in a way not on the label42.2%2,000
- Drug ineffectivethe medicine did not work as expected31.3%1,483
- Drug intolerancethe medicine was not tolerated24.6%1,163
- Product use in unapproved indicationused for a purpose not on the label24.1%1,140
- Headachehead pain20%947
- Maternal exposure during pregnancythe mother took the medicine during pregnancy19.2%911
- Migrainemigraine18.6%879
- Hypoaesthesianumbness17.7%837
- Nauseafeeling sick17.3%821
- Painpain, site not specified17%804
- Epilepsy16.6%788
- Hypertensionhigh blood pressure16.4%779
- Gastrooesophageal reflux diseaseacid reflux16.2%767
- Blepharospasm15.8%747
- Dizzinesslight-headedness or unsteadiness15.5%732
- Paraesthesiatingling or pins and needles15.4%727
- Depressionlow mood15.2%722
- Abdominal pain upperupper stomach pain15.2%721
- Systemic lupus erythematosuslupus, an autoimmune disease15.2%721
- Astheniaweakness or lack of energy15.2%719
- Psoriatic arthropathy15.2%719
- Condition aggravatedthe condition being treated got worse15.1%716
- Confusional stateconfusion15%712
- Arthropathy14.9%705
- Intentional product use issuedeliberate use not as intended14.8%703
- Fatiguetiredness14.8%702
- Pemphigus14.8%699
- General physical health deteriorationgeneral decline in health14.7%697
- Rheumatoid arthritisrheumatoid arthritis, an inflammatory joint disease14.7%695
- Type 2 diabetes mellitustype 2 diabetes14.5%688
Top 30 of 667 MedDRA preferred terms recorded across these reports, with a plain-language gloss where one is available. One report can record several terms. The hollow bar is the median share across the 6 drugs in the acetylcholine release inhibitor class; it describes the reports, not the patients. FDA states that adverse event reports "represent a small percentage of total usage numbers of a product", that "common products may have a higher number of adverse events due to the higher total number of people using the product", and that the data "by themselves are not an indicator of the safety profile of the drug or biologic."
Outcomes recorded
Outcome flags as the reporter set them; a report can carry several, and "other serious" is FDA's own category for serious reports outside the named outcomes. Grey bar: all 88,564 reports in the class. FDA has not verified any outcome and states that the reports "cannot be used to estimate the incidence of these events."
Patients and reporters
Patient age
Patient sex
Who reported
Age and sex as stated in the report; the reporter's qualification is the primary source recorded by FDA. 17.6% of reports give the United States as the country of the event or reporter.
Reason for use recorded
| Indication as recorded (MedDRA) | Reports | Share |
|---|---|---|
| Migraine | 586 | 12.4% |
| Skin wrinkling | 186 | 3.9% |
| Skin cosmetic procedure | 93 | 2% |
| Torticollis | 89 | 1.9% |
| Muscle spasticity | 74 | 1.6% |
| Foetal exposure during pregnancy | 73 | 1.5% |
The indication field is filled in by the reporter and is often blank; shares are of all 4,736 reports.
Drugs most often listed in the same reports
| Drug (any role in the report) | Reports | Share of Botulinum toxin type a reports |
|---|---|---|
| Acetaminophen | 1,947 | 41.1% |
| Topiramate | 1,875 | 39.6% |
| Prednisone | 1,712 | 36.1% |
| Naproxen | 1,683 | 35.5% |
| Diclofenac sodium | 1,581 | 33.4% |
| Candesartan | 1,562 | 33% |
| Cosentyx | 1,547 | 32.7% |
| Berinert | 1,524 | 32.2% |
| Desoximetasone | 1,523 | 32.2% |
| Actemra | 1,516 | 32% |
Other products listed in reports where Botulinum toxin type a is a suspect product, whatever their own role. Co-listing means the two were recorded together; it says nothing about either product's part in the event. Only the 2,500 most-reported names are counted here.
In context
| Measure | Botulinum toxin type a | Acetylcholine release inhibitor | All reports |
|---|---|---|---|
| Reports as suspect product | 4,736 | 88,564 | 20,646,523 |
| Share of that pool | — | 5.3% | 0% |
| Reports, latest 12 months | 972 | — | 1,332,454 |
| Marked serious | 87.1% | 20.1% | 57.4% |
| Death recorded among outcomes, per 1,000 reports | 340 | 43 | 91 |
| Hospitalisation recorded, per 1,000 reports | 406 | 67 | 213 |
| Consumer-filed share | 21.2% | 31.3% | 45.8% |
| Top term, share of reports | Off label use 42.2% | median 28.2% | 4.1% |
Shares are of reports, not of patients treated. The number of people taking a product is not in the data, so none of these figures is a rate, and differences between columns reflect who takes a product, who reports and how long it has been sold. FDA states that adverse event reports "represent a small percentage of total usage numbers of a product", that "common products may have a higher number of adverse events due to the higher total number of people using the product", and that the data "by themselves are not an indicator of the safety profile of the drug or biologic."
Other drugs in the acetylcholine release inhibitor class
| Drug | Name type | Reports | Latest 12 months | Marked serious |
|---|---|---|---|---|
| BOTOX Cosmetic | brand | 38,760 | 1,409 | 2.4% |
| Botox | brand | 29,345 | 2,936 | 34.3% |
| Dysport | brand | 6,545 | 367 | 29.5% |
| Xeomin | brand | 5,438 | 637 | 12.2% |
| Jeuveau | brand | 3,740 | 496 | 1.4% |
Ordered by report count for navigation only. FDA states that adverse event reports "represent a small percentage of total usage numbers of a product", that "common products may have a higher number of adverse events due to the higher total number of people using the product", and that the data "by themselves are not an indicator of the safety profile of the drug or biologic." A brand and its generic are separate rows because reporters name them separately.
Questions about Botulinum toxin type a reports
How many adverse event reports has FDA received for Botulinum toxin type a?
4,736 reports list Botulinum toxin type a as a suspect or interacting product in the openFDA FAERS release of 28 Sep 2026, covering reports received through June 2026. 972 of them arrived in the latest 12 months. Another 922 list it only as a concomitant medication.
What reactions are recorded in Botulinum toxin type a reports?
off label use (42.2%), drug ineffective (31.3%), drug intolerance (24.6%), product use in unapproved indication (24.1%) and headache (20%). These are MedDRA preferred terms coded from what the reporter described; a report can list several, and a term's presence is not a finding that Botulinum toxin type a was responsible.
How serious are the reports?
87.1% are marked serious by the reporter. Among the outcomes recorded, 34% of reports include death and 40.6% include hospitalisation. FDA has not verified these outcomes and states that the reports "cannot be used to estimate the incidence" of the events.
Who files these reports?
other health professional (55.3%), physician (21.8%) and consumer or non-health professional (21.2%). Most reports reach FDA through the manufacturer, which must forward reports it receives.
Are reports for Botulinum toxin type a rising?
972 reports in the 12 months to June 2026, close to the 1,050 of the 12 months before. FDA releases FAERS data quarterly, so the newest months are incomplete and grow in later releases. Counts also move with how many people take a product, its time on the market and publicity.
Do these reports show that Botulinum toxin type a was responsible for these reactions?
No. FDA states that "a causal relationship cannot be established between product and reactions listed in a report" and that for any given report "there is no certainty that a suspected drug caused the event." The reaction may relate to the condition being treated, to other medicines, or to something else.
Is this a list of the side effects of Botulinum toxin type a?
No. It is a count of what was reported to FDA. The adverse reactions observed in clinical studies are printed on the FDA-approved label, which a pharmacist or clinician can go through with you.
How do I report an adverse event?
Consumers and health professionals can report to FDA through MedWatch (Form FDA 3500 online, or 1-800-FDA-1088), or to the manufacturer, which must pass reports on. See the guide on how to report.
Where this comes from. Counts are built from the openFDA Drug Adverse Event (FAERS) bulk export released 28 Sep 2026, which holds reports FDA received through 30 Jun 2026. Drug names are as reported, resolved to the brand or generic name on the FDA label where openFDA's harmonisation matched them; classes are the pharmacologic class (EPC) from the label and the National Drug Code Directory of 17 Sep 2026. A report counts here when it lists Botulinum toxin type a as a suspect or interacting product; reports listing it only as a concomitant medication (922) are excluded. No report narrative, lot number, patient detail or reporter identity is published. See the methodology and sources; FDA's record is authoritative, and corrections are handled within five working days.
Drug data (FAERS) through 30 Jun 2026; device data (MAUDE) through 31 Aug 2026. Not medical advice.