Botulinum toxin (Botox, Dysport) is being used for a wide range of conditions and is in demand for cosmetic use. Anything expensive and in demand may be a target for counterfeiting.
Counterfeiting may encompass:
(1) dilution
(2) failing to keep properly refrigerated during shipping and storage
(3) unlicensed attempt to prepare the toxin from Clostridium botulinum
(4) use of adulterants
Clues to recognize counterfeit Botox:
(1) manufacturer lot numbers on the drug package does not match the number on drug vials
(2) suspicious packaging (low quality, misspellings, etc.)
(3) altered appearance of product
(4) failure to achieve effect
(5) need for higher dose to achieve effect
(6) unexpected complications, such as clinical botulism
(7) acquisition from an online or foreign pharmacy
(8) use by an unlicensed professional in a nonmedical setting
