title: Consensus statement regarding storage and reuse of previously reconstituted neuromodulators.
abstract: BACKGROUND
  Legacy recommendations suggest that vials of botulinum toxin be used within 24 hours of reconstitution and in a single patient. Current standard of care is consistent with storage after reconstitution and use of a single vial for several patients.
  
  
  OBJECTIVE
  To develop expert consensus regarding the effectiveness and safety of storage and reuse of botulinum toxin.
  
  
  METHODS
  The American Society for Dermatologic Surgery authorized a task force of content experts to review the literature and provide guidance. Data extraction was followed by clinical question review, a consensus Delphi process, and validation of the results by peer review.
  
  
  RESULTS
  After 2 rounds of Delphi process, the task force concluded by unanimous consensus and with the highest level of confidence that a vial of toxin reconstituted appropriately can, for facial muscle indications, be (1) refrigerated or refrozen for at least 4 weeks before injection without significant risk for contamination or decreased effectiveness and (2) used to treat multiple patients, assuming appropriate handling.
  
  
  CONCLUSIONS
  The standard of care, which allows for use of botulinum toxin more than 24 hours after reconstitution and in more than 1 patient per vial, is appropriate and consistent with the safe and effective practice of medicine.
authors.affiliation: Departments of *Dermatology, †Otolaryngology, and ‡Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; §Section of Dermatology, University of Chicago Medicine, Chicago, Illinois; ‖Department of Ophthalmology, University of British Columbia, Vancouver, BC, Canada; ¶Department of Dermatology, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil; #Brazilian Center for Studies in Dermatology, Porto Alegre, Brazil; **Division of Dermatology, Cooper University Hospital Medical Center, Marlton, New Jersey; ††Department of Dermatology, Weill Cornell Medical College, Cornell University, New York, New York; ‡‡Division of Dermatology, Scripps Clinic, San Diego, California.
authors.forename: Murad
authors.initials: M
authors.lastname: Alam
authors.forename: Diana
authors.initials: D
authors.lastname: Bolotin
authors.forename: Jean
authors.initials: J
authors.lastname: Carruthers
authors.forename: Doris
authors.initials: D
authors.lastname: Hexsel
authors.forename: Naomi
authors.initials: N
authors.lastname: Lawrence
authors.forename: Kira
authors.initials: K
authors.lastname: Minkis
authors.forename: Edward Victor
authors.initials: EV
authors.lastname: Ross
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000494:pharmacology*; D032921:Consensus; D004340:Drug Contamination; D004356:Drug Storage / Q000592:standards; D006801:Humans; D009465:Neuromuscular Agents / Q000494:pharmacology*; D017410:Practice Guidelines as Topic; D011309:Preservation, Biological / Q000592:standards; D059039:Standard of Care; D013997:Time Factors
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A