Botulinum toxin type A has achieved blockbuster status since Allergan and GlaxoSmithKline jointly posted 2006 sales of Botox of more than US$ 1 bln which were generated at nearly equal parts from medical uses and from cosmetic uses. Medical uses of Botox include cervical dystonia, axillary hyperhidrosis, strabism and about 20 more indications. Aesthetic medicine indications include the treatment of frown lines. Allergan is conducting a number of clinical studies with Botox to expand its label: post-stroke spasticity, neurogenic overactive bladder, benign prostate hyperplasia and more. Botox blocks neuromuscular transmission by binding to acceptor sites on motor or sympathetic nerve terminals, entering the nerve terminals, and inhibiting the release of acetylcholine. This inhibition occurs as the neurotoxin cleaves SNAP-25, a protein integral to the successful docking and release of acetylcholine from vesicles situated within nerve endings. Several competitors have other botulinum toxin type A or type B preparations on the market or in development. Next generation developments are directed to improve the purity of the preparation or reduce the molecular weight of the toxin and avoid the injection of the neurotoxin replacing it by transdermal application procedures with needle-free delivery systems.

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