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Oral supplements increase botulinum toxin's effect, duration

Key iconKey Points

  • Supplements combined with toxins could result in greater patient cost savings, greater safety, clinician says
  • Patients in study were treated with botulinum toxin and supplements of either zinc phytase , zinc gluconate or lactulose placebo
  • Zytaze (Ocusoft) is a prescription-only dietary supplement of zinc and phytase

Taking a dietary supplement of organic zinc and the enzyme phytase for four days prior to receiving botulinum toxin injections can increase the degree and duration of the injections' effect, according to a recent study.

"The toxins seemed to have greater effect and last longer," says Charles N.S. Soparkar, M.D., Ph.D., of Plastic Eye Surgery Associates, Houston. "Potentially, this could mean using less toxin, offering patients financial savings, greater safety and more consistent results."

Dr. Soparkar says the research was sparked by a combination of factors. First, the effect of botulinum toxin can vary considerably from patient to patient and even from treatment to treatment within the same patient; second, the toxin requires zinc to function; and finally, there is suspected widespread marginal zinc deficiency in the general population. To achieve effect, Dr. Soparkar says, zinc levels must be adequate around the time of toxin injection.

STUDY DETAILS In a modified double-blind, randomized, placebo-controlled, crossover pilot study, Dr. Soparkar and associates compared the effectiveness of botulinum toxin injections: Botox (onabotulinumtoxinA, Allergan), Myobloc (rimabotulinumtoxinB, Solstice Neurosciences) and Dysport (abobotulinumtoxinA, Medicis) after four days of supplementation with either oral zinc citrate 50 mg plus phytase 3,000 PU, zinc gluconate 10 mg, or lactulose placebo in individuals being treated for benign essential blepharospasm (BEB), hemifacial spasm (HFS) and cosmetic facial rhytids (CFR).

In 77 patients, 92 percent of subjects supplemented with zinc 50 mg and phytase experienced an average increase in toxin duration effect of nearly 30 percent, and 84 percent of participants reported a subjective response increase in toxin effect. No significant increase in duration or effect was reported by patients following supplementation with lactulose placebo or 10 mg of zinc gluconate.1

Duration of effect was compared to each participant's established pre-study treatment interval, and efficacy was participant-graded using participants' experience prior to study inclusion as a baseline. Descriptive statistical analysis determined mean duration and effect rating for each supplementation group, and 95 percent confidence intervals (CI) were calculated to determine statistical significance.

Patients selected for the study from Dr. Soparkar's practice all had well-established treatment protocols with botulinum toxin injection frequencies, patterns and doses, among other treatment specifics, for benign essential blepharospasm, hemifacial spasm or cosmetic rhytids. To be included in the study, patients had to be age 18 or older and had to have had a minimum of three prior unchanging injection patterns with the same botulinum toxin for the treatment of BEB, HFS or CFR. BEB patients with isolated pseudo-apraxic BEB were excluded from study.

"Some of the BEB patients selected were designated as 'hard to treat,' since they had failed at toxin treatment by at least two other physicians before referral and regularly reported suboptimal treatment results, despite maximal medical and botulinum toxin therapy with individualized injection patterns," Dr. Soparkar says.

All BEB study participants kept a daily log of botulinum toxin effect showing their ability to keep their eyes open and perform daily activities, and participants with CFR or HFS kept a weekly log of treatment effect which they were required to show at follow-up visits.


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