Letibotulinumtoxina-Wlbg

5 WARNINGS AND PRECAUTIONS Spread of toxin effects; swallowing and breathing difficulties can lead to death. Seek immediate medical attention if respiratory, speech or swallowing difficulties occur. ( 5.1 , 5.3 , 5.7 ) Potency Units of LETYBO are not interchangeable with other preparations of botulinum toxin products. ( 5.2 , 11 ) Potential serious adverse reactions after LETYBO injections for unapproved uses. ( 5.3 ) If a hypersensitivity reaction occurs, discontinue LETYBO and immediately initiate appropriate therapy. ( 5.4 ) Adverse event reports have been received involving the cardiovascular system, some with fatal outcomes. Use caution when administering to patients with pre-existing cardiovascular disease. ( 5.5 ) Concomitant neuromuscular disorder may exacerbate clinical effects of treatment. ( 5.6 ) Use with caution in patients with compromised respiratory function or dysphagia ( 5.7 ) 5.1 Spread of Toxin Effects Postmarketing safety data from other approved botulinum toxins suggest that botulinum toxin effects may be observed beyond the site of local injection. The symptoms are consistent with the mechanism of action of botulinum toxin and may include asthenia, generalized muscle weakness, diplopia, ptosis, dysphagia, dysphonia, dysarthria, urinary incontinence, blurred vision and breathing difficulties. These symptoms have been reported hours to weeks after injection. Swallowing and breathing difficulties can be life threatening and there have been reports of death related to spread of toxin effects. In unapproved uses and approved indications, symptoms consistent with spread of toxin effects have been reported at doses comparable to or lower than the maximum recommended total dose [see Use in Specific Populations ( 8.4 )] . LETYBO is not approved for any conditions other than glabellar lines. Patients or caregivers should be advised to seek immediate medical care if swallowing, speech or respiratory difficulties occur. 5.2 Lack of Interchangeability between Botulinum Toxin Products The potency units of LETYBO are specific to the preparation and assay method utilized. They are not interchangeable with other preparations of botulinum toxin products and, therefore, units of biological activity of LETYBO cannot be compared to or converted into units of any other botulinum toxin products assessed with any other specific assay method [see Description ( 11 )] . 5.3 Serious Adverse Reactions with Unapproved Use Serious adverse reactions, including excessive weakness, dysphagia, and aspiration pneumonia, with some adverse reactions associated with fatal outcomes, have been reported in patients who received botulinum toxin injections for unapproved uses. In these cases, the adverse reactions may have resulted from the administration of botulinum toxin products to the site of injection and/or adjacent structures. In several of the cases, patients had preexisting dysphagia or other significant disabilities. There is insufficient information to identify factors associated with an increased risk for adverse reactions associated with the unapproved uses of botulinum toxin products. 5.4 Hypersensitivity Reactions Serious and/or immediate hypersensitivity reactions have been reported for botulinum toxin products. These reactions include anaphylaxis, serum sickness, urticaria, soft tissue edema, and dyspnea. If such a reaction occurs, discontinue further injection of LETYBO and immediately institute appropriate medical therapy [see Contraindications ( 4 )] . 5.5 Cardiovascular System Adverse Reactions There have been reports following administration of botulinum toxins of adverse events involving the cardiovascular system, including arrhythmia and myocardial infarction, some with fatal outcomes. Some of these patients had risk factors including pre-existing cardiovascular disease. Use caution when administering to patients with pre-existing cardiovascular disease. 5.6 Increased Risk of Clinically Significant Effects with Pre-Existing Neuromuscular Disorders Patients with neuromuscular disorders may be at increased risk of clinically significant effects including generalized muscle weakness, diplopia, ptosis, dysphonia, dysarthria, severe dysphagia, and respiratory compromise from typical doses of LETYBO. Monitor patients with peripheral motor neuropathic diseases, amyotrophic lateral sclerosis, or neuromuscular junction disorders (e.g., myasthenia gravis or Lambert-Eaton syndrome) for increased neuromuscular compromise following botulinum toxin treatment. 5.7 Dysphagia and Dyspnea Treatment with botulinum toxin products, including LETYBO, can result in dysphagia and dyspnea including respiratory failure. These reactions can occur within hours to weeks after injection with botulinum toxin. Patients with preexisting dysphagia and dyspnea may be more susceptible to these complications. In most cases, this has been a consequence of weakening of muscles in the area of injection that are involved in breathing or oropharyngeal muscles that control swallowing or breathing Deaths as a complication of severe dysphagia have been reported after treatment with botulinum toxin products. Dysphagia may persist for several months. Patients treated with botulinum toxin products, including LETYBO, may require immediate medical attention should they develop problems with swallowing, speech, or breathing. These reactions can occur within hours to weeks after injection with botulinum toxin [see Warnings and Precautions ( 5.1 )] . 5.8 Pre-existing Conditions at the Injection Site Use caution when LETYBO treatment is used in the presence of inflammation at the proposed injection site(s) or when excessive weakness or atrophy is present in the target muscle(s). Use caution when LETYBO treatment is used in patients who have marked facial asymmetry, with surgical alterations to the facial anatomy, pre-existing eyelid or eyebrow ptosis, when excessive weakness or atrophy is present in the target muscles, excessive dermatochalasis, deep dermal scarring, thick sebaceous skin (e.g., the inability to substantially lessen glabellar lines even by physically spreading them apart). 5.9 Ophthalmic Adverse Reactions in Patients Treated with Botulinum Toxin Products Dry eye has been reported with the use of botulinum toxin products in the treatment of glabellar lines. Reduced tear production, reduced blinking, and corneal disorders may occur with use of botulinum toxins, including LETYBO. If symptoms of dry eye (e.g., eye irritation, photophobia or visual changes) persist, consider referring patient to an ophthalmologist [see Warnings and Precautions ( 5.1 )] . 5.10 Human Albumin and Transmission of Viral Diseases This product contains albumin, a derivative of human blood. Based on effective donor screening and product manufacturing processes, it carries a remote risk for transmission of viral diseases and variant Creutzfeldt-Jakob disease (CJD). There is a theoretical risk for transmission of Creutzfeldt-Jakob disease (CJD), which would also be considered remote. No cases of transmission of viral diseases or CJD or vCJD have ever been identified for licensed albumin or albumin contained in other licensed products.