Botulinum toxin type A complex [Botox]

[MAF] Botulinum Toxin Type A Complex (Botox) Injection 50 units, 100 units

1. For adults with focal spasticity of the upper limbs due to stroke who have Modified Ashworth Scale of 2 or more at the target muscle intended for botulinum toxin A treatment, and do not have the affected joint permanently fixed in position due to fibrotic shortening of the target muscle, and are concurrently receiving physiotherapy. Botulinum toxin A must be administered by either a neurologist trained in movement disorder or a rehabilitation physician who has undergone training to administer botulinum toxin A.

2. For adults with focal spasticity of the lower limbs due to stroke who have Modified Ashworth Scale of 3 or more at the target muscle intended for botulinum toxin A treatment, and do not have the affected joint permanently fixed in position due to fibrotic shortening of the target muscle, and are concurrently receiving physiotherapy. Botulinum toxin A must be administered by either a neurologist trained in movement disorder or a rehabilitation physician who has undergone training to administer botulinum toxin A.

3. For children aged 2 years or older, with focal spasticity of the upper or lower limbs (including dynamic equinus foot deformity) due to cerebral palsy, and who do not have significant joint contractures (i.e. the affected joint is not permanently fixed in position due to shortening of the target muscle); and are concurrently receiving supportive therapy (e.g. physiotherapy or occupational therapy). Botulinum toxin type A must be administered by a physician specialising in paediatric neurological disorders or paediatric rehabilitation with experience in administering botulinum toxin type A.

4. For adults with cervical dystonia, blepharospasm or hemifacial spasm.
   Botulinum toxin type A must be administered by a neurologist trained in movement disorders or a specialist physician who has undergone training to administer botulinum toxin type A to patients with movement disorders.

5. Prophylaxis of headaches in adults with chronic migraine who have had an inadequate response, intolerance, or contraindication to at least three migraine prophylactic medications. Botulinum toxin type A must be administered by a neurologist.

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This section shows the following:

• Subsidy Scheme and Clinical Indication (where applicable) of drugs listed in the MOH List of Subsidised Drugs

• Subsidised brands of vaccines recommended in the National Immunisation Schedules listed in the MOH Subsidised Vaccine List

• Cancer Drug and Clinical Indication listed in the MediShield Life Cancer Drug List

As this website is updated monthly, please refer to MOH List of Subsidised Drugs, MOH Subsidised Vaccine List or MediShield Life Cancer Drug List for the most updated information.

01/06/2023 Botulinum toxin A for the management of focal spasticity of the lower limbs associated with stroke in adults

The Ministry of Health’s Drug Advisory Committee has recommended:

• Clostridium botulinum toxin type A neurotoxin complex (Botox) 50 units and 100 units injection vials for the management of focal spasticity of the lower limbs associated with stroke in adults who:

  • have a score of 3 or more on the Modified Ashworth Scale at the target muscle intended for botulinum toxin A treatment;

  • do not have the affected joint permanently fixed in position due to fibrotic shortening of the target muscle; and

  • are concurrently receiving physiotherapy.

Funding status

[R] Clostridium botulinum toxin type A neurotoxin complex (Botox) 50 units and 100 units injection vials are recommended for inclusion on the Medication Assistance Fund (MAF) for the abovementioned indication from 1 August 2023.

[R] Botulinum toxin A must be administered by either a neurologist trained in movement disorder or a rehabilitation physician who has undergone training to administer botulinum toxin A.

[NR] MAF assistance does not apply to Botox 200 units injection vial or other brands of botulinum toxin A.

16/03/2023 Botulinum toxin A for the management of focal spasticity of the upper limbs associated with stroke in adults

The Ministry of Health’s Drug Advisory Committee has recommended:

• Clostridium botulinum toxin type A neurotoxin complex (Botox) 50 units and 100 units injection vials for the management of focal spasticity of the upper limbs associated with stroke in adults who:

  • have a score of 2 or more on the Modified Ashworth Scale at the target muscle intended for botulinum toxin A treatment,

  • do not have the affected joint permanently fixed in position due to fibrotic shortening of the target muscle, and

  • are concurrently receiving physiotherapy.

Botulinum toxin A must be administered by either a neurologist trained in movement disorder or a rehabilitation physician who has undergone training to administer botulinum toxin A.

Subsidy status

[R] Clostridium botulinum toxin type A neurotoxin complex (Botox) 50 units and 100 units injection vials are recommended for inclusion on the Medication Assistance Fund (MAF) for the abovementioned indication.

[NR] MAF assistance does not apply to Botox 200 units injection vial, Dysport 300 units and 500 units injection vials and Xeomin 50 units and 100 units injection vials.

04/01/2022 Botulinum toxin type A for the prophylaxis of headaches in adults with chronic migraine

The Ministry of Health’s Drug Advisory Committee has recommended:

• Clostridium botulinum toxin type A neurotoxin complex (Botox) 50 units and 100 units injection vials for the prophylaxis of headaches in adults with chronic migraine who have had an inadequate response, intolerance, or contraindication to at least three migraine prophylactic medications.

Botulinum toxin type A must be administered by a neurologist.

Subsidy status

[R] Clostridium botulinum toxin type A neurotoxin complex (Botox) 50 units and 100 units injection vials are recommended for inclusion on the Medication Assistance Fund (MAF) for the abovementioned indication.

[NR] MAF assistance does not apply to Botox 200 units injection vial, Dysport 300 units and 500 units injection vials, and Xeomin 50 units and 100 units injection vials.

02/09/2019 Botulinum toxin A for treating blepharospasm or hemifacial spasm

The Ministry of Health’s Drug Advisory Committee has recommended:

• Clostridium botulinum toxin type A neurotoxin complex (Botox) 50 units and 100 units injection vials for treating adults with blepharospasm or hemifacial spasm.

Botulinum toxin A must be administered by a neurologist trained in movement disorder or a specialist physician who has undergone training to administer botulinum toxin type A to patients with movement disorders.

Subsidy status

[R] Clostridium botulinum toxin type A neurotoxin complex (Botox) 50 units and 100 units injection vials are recommended for inclusion on the Medication Assistance Fund (MAF) for the abovementioned indications.

[NR] MAF does not apply to Botox 200 units injection vial, Dysport 300 units and 500 units injection vials and Xeomin 50 units and 100 units injection vials.

02/09/2019 Botulinum toxin A for treating cervical dystonia

The Ministry of Health’s Drug Advisory Committee has recommended:

• Clostridium botulinum toxin type A neurotoxin complex (Botox) 50 units and 100 units injection vials for treating adults with cervical dystonia.

Botulinum toxin A must be administered by a neurologist trained in movement disorder or a specialist physician who has undergone training to administer botulinum toxin A to patients with movement disorders.

Subsidy status

[R] Clostridium botulinum toxin type A neurotoxin complex (Botox) 50 units and 100 units injection vials are recommended for inclusion on the Medication Assistance Fund (MAF) for the abovementioned indications.

[NR] MAF does not apply to Botox 200 units injection vial, Dysport 300 units and 500 units injection vials and Xeomin 50 units and 100 units injection vials.

02/09/2019 Botulinum toxin A for treating focal spasticity of the upper or lower limbs in children with cerebral palsy

The Ministry of Health’s Drug Advisory Committee has recommended:

• Clostridium botulinum toxin type A neurotoxin complex (Botox) 50 units and 100 units injection vials for treating children, aged 2 years or older, with focal spasticity of the upper or lower limbs (including dynamic equinus foot deformity) due to cerebral palsy, and who:

  • do not have significant joint contractures, i.e. the affected joint is not permanently fixed in position due to shortening of the target muscle; and

  • are concurrently receiving ongoing supportive therapy, e.g. physiotherapy or occupational therapy.

Botulinum toxin type A must be administered by a physician specialising in paediatric neurological disorders or paediatric rehabilitation with experience in administering botulinum toxin type A.

Subsidy status

[R] Clostridium botulinum toxin type A neurotoxin complex (Botox) 50 units and 100 units injection vials are recommended for inclusion on the Medication Assistance Fund (MAF) for the abovementioned indications.

[NR] MAF does not apply to Botox 200 units injection vial, Dysport 300 units and 500 units injection vials and Xeomin 50 units and 100 units injection vials.

Legend

This section displays recommendation from the MOH Drug Advisory Committee for subsidy and appropriate use of the drug as extracted from the Agency for Care Effectiveness (ACE) Drug Guidances. As this website is updated monthly, please refer to the ACE website for the most updated information.

Note:

General availability information reflected is based on the Public Healthcare Institutions’ (PHI) formulary on what is commonly used for treating their patient population and may or may not be available for patients not under the care of that institution. It does not reflect the PHI’s actual inventory availability and is subjected to change. Please consult the Public Hospitals or Polyclinics for details on availability and supply restrictions/considerations. General availability is not tied to any brand unless otherwise stated.

Users are to consult the respective PHIs for actual inventory availability and supply restrictions/consideration