[Botulinum toxin and the hospital pharmacy]

Abstract

Botulinum toxin is a neurotoxic protein synthesized by Clostridium botulinum. Among approved indications for type A pharmaceutical formulations is the treatment of upper limb spasticity in post-stroke patients. Neurologists and rehabilitator physicians have extended their use to treat other types of muscles spasticity. In 2002, most of prescriptions in France were off-label. The activity of the R. Poincaré hospital is dedicated to treating handicapped patients. Working in close collaboration, prescribing physicians and hospital pharmacists elaborated a set of guidelines for the use of botulinum toxin type A. The protocol includes a specific order form, pharmaceutical validation of prescriptions and distribution follow-up. The numbers of prescriptions and treated patients have greatly increased from 2003 to 2005. As a consequence to the extension of marketing authorization for indications for the use of botulinum toxin type A in 2005, 77% of treated therapeutic indications are now compliant to marketing authorization specifications. Through prescription analysis, in-hospital pharmacists participate in the implementation of guidelines for follow-up and management of medical expenditures.