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The number of injections and dose require clinical judgment. The BOTOX® should be diluted to a concentration of 100 U/mL. By consensus, the faculty recommends 12-15 U/kg as a safe total body dose but agree that higher doses can be used with caution. The dose stated above is the total amount to be distributed in many muscles in the patient with cerebral palsy.
For injection of a single muscle, doses of 1-2 U/kg and 3-6 U/kg per site are considered safe for small and large muscles, respectively. The maximum dose per injection site should not exceed 50 U in a volume of 0.5 mL. The reinjection interval should be ³3 months to avoid resistance considerations.