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General ENT & Therapeutics

Sialorrhea Botulinum Toxin

Salivary gland dosing (drooling). Multi-product per-gland dosing and injection-volume planning for the four marketed botulinum toxins. Units are product-specific and NOT interchangeable. Off-label except the incobotulinumtoxinA pediatric licence; no consensus protocol.

Pre-injection prep & screening sheet

Contraindication checklist, pediatric landmark adjustments, reconstitution & technique, plus the bilingual Drooling Impact Scale — one printable file.

Download prep sheet (.docx)

Product Population

Body weight (kg)

Dosing basis

Total dose

Gland set

Total dose · {{ subLabel }}

Per parotid gland ×2

{{ parotidVol }} per side

Per submandibular gland ×2

{{ submandVol }} per side

Concentration

Total volume injected

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Administer under ultrasound guidance. Volume per gland = dose ÷ concentration. Doses shown are per gland; the total reflects every selected gland (both sides).

Safety

Units are NOT interchangeable between products. BOTOX, Xeomin, Dysport and Myobloc/Neurobloc each have their own unit system — never substitute dose-for-dose.
Sialorrhea injection is off-label (except the incobotulinumtoxinA pediatric licence) and has no consensus protocol. Figures are licence schedules or literature ranges, not validated formulae.
Inject under ultrasound guidance; watch for dysphagia and other adverse effects after treatment.

Type B toxin (rimabotulinumtoxinB). Myobloc / Neurobloc is a different molecule with its own unit system — type A and type B units are NOT convertible. Doses (thousands of units) are far larger than type-A products by design. Double-check the product and the unit count.

Per-product literature ranges

Product	Pediatric	Adult
{{ row.product }} {{ row.generic }}	{{ row.pediatric }}	{{ row.adult }}

Type-A unit conversion. Approximate ratio (Yu 2022): BOTOX 1 : Xeomin 1 : Dysport 3. Type A and type B (Myobloc / Neurobloc) are NOT convertible.

Xeomin (incobotulinumtoxinA) pediatric weight table

FDA label schedule — chronic sialorrhea, patients ≥ 12 kg. 4-gland (asymmetric: parotid > submandibular). Volumes shown at 25 U/mL (100 U in 4 mL).

Body weight	Per parotid	Per submand.	Total
{{ row.range }}	{{ row.parotid }}	{{ row.submand }}	{{ row.total }}

Citations

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Disclaimer. For educational and reference use by qualified clinicians only. Verify dosing against current product labeling and institutional protocols. Units are product-specific and not interchangeable. Does not replace clinical judgment.

Ali Alshahrani

Otolaryngology

Clinical record
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shahrani.me

Sialorrhea Botulinum Toxin

Salivary BoNT Dose Plan

Total dose · {{ rPopulation }} {{ rTotal }}

Patient & plan

Patient / MRN	____________
Product	{{ rProduct }}
Population	{{ rPopulation }}
Body weight	{{ rWeight }}
Dosing basis	{{ rBasis }}
Product lot	____________

Dose plan

Per parotid ×2	{{ rParotid }}
Per submandibular ×2	{{ rSubmand }}
Concentration	{{ rConc }}
Total volume to draw	{{ rVol }}

Pre-injection screening — confirm before injecting

Absolute contraindications

Myasthenia gravis
Lambert-Eaton syndrome
Prior hypersensitivity to any botulinum product

Relative / caution

Aminoglycosides (gentamicin/tobramycin/amikacin/neomycin)
Neuromuscular blockers (rocuronium/vecuronium/succinylcholine)
Polymyxins / clindamycin / magnesium sulfate
Pregnancy / lactation
Active infection at injection site
Significant dysphagia / aspiration risk

Reminders

Onset 48–72 h, peak 1–2 wk, duration 3–9 mo
Aspirate before each injection (facial artery near submandibular gland)
Ultrasound guidance preferred in children; scale depth to gland
Record baseline drooling score

References

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Doses are product-specific and not interchangeable; verify against the current product label and local protocol. For educational and reference use by qualified clinicians — does not replace clinical judgment.

Clinician & signature

Date