The short answer
Allergan's prescribing information says reconstituted BOTOX should be stored refrigerated at 2 to 8 degrees C and used within 24 hours. Peer-reviewed research tells a longer story: a multicenter double-blind study by Hexsel and colleagues, published in Dermatologic Surgery in 2003, found no difference in efficacy for toxin reconstituted up to six weeks before injection when properly refrigerated. Most practices land somewhere between those two numbers with a written policy set by their medical director.
The policy only protects anyone if every vial's clock is actually tracked. That is where practices fail. Not the science, the tracking.
What each label says
Windows below are the storage guidance for reconstituted product in the current US prescribing information. Always confirm against the package insert in your hand; labels change.
| Product | Reconstituted storage per label | Units per vial |
|---|---|---|
| Botox (onabotulinumtoxinA) | Refrigerated 2 to 8 degrees C, use within 24 hours | 50, 100, 200 |
| Dysport (abobotulinumtoxinA) | Refrigerated 2 to 8 degrees C, use within 24 hours | 300, 500 |
| Jeuveau (prabotulinumtoxinA) | Refrigerated 2 to 8 degrees C, use within 24 hours | 100 |
| Xeomin (incobotulinumtoxinA) | Refrigerated 2 to 8 degrees C, use within 24 hours | 50, 100, 200 |
| Daxxify (daxibotulinumtoxinA) | Refrigerated 2 to 8 degrees C, use within 72 hours | 50, 100 |
The units column matters more than it looks. It is the number that tells you when a vial is empty, which the last section of this article is about.
Fridge, room temperature, syringe, freezer
The questions that come up every week in a med room, answered from the label first and practice second.
| Situation | What the label says | What practices do |
|---|---|---|
| Reconstituted, in the fridge | 24 hours (Daxxify: 72 hours) | A written discard window set by the medical director, commonly 7 to 14 days, with the mix time recorded on every vial |
| Reconstituted, at room temperature | No room-temperature window is given | Pull the vial for the treatment, return it to the fridge between patients, never leave it on the counter |
| Drawn into a syringe | No syringe window is given | Draw at the time of treatment; a pre-drawn syringe inherits the vial's clock and most policies require same-day use |
| Unopened, before reconstitution | Botox: refrigerator or freezer per the label; others: refrigerate | Track the manufacturer expiration date on the box like any other lot |
| Reconstituted, frozen | Do not freeze reconstituted product | If it froze, it is waste; record it as waste so the loss is real instead of invisible |
What the label requires
Three facts from the prescribing information worth pinning to the med room wall:
- Reconstitute with sterile, preservative-free 0.9 percent sodium chloride.
- Store reconstituted vials at 2 to 8 degrees C, refrigerated, not frozen.
- The labeled window is 24 hours. Anything beyond that is a practice-level decision your medical director owns, documented in your policy.
Whatever window your practice sets, the operational question is identical: for any open vial in the fridge, can anyone on the team answer when it was mixed, from which lot, by whom, how much is left, and how long it has left?
Why the per-vial clock matters
Three reasons, in the order they cost you:
Waste. A 100 unit vial runs 500 to 600 dollars wholesale. A vial mixed Friday and found Monday with no mix date on it is a write-off by default, because nobody can prove it is inside the window. Practices that track mix times stop throwing away product on uncertainty.
Compliance. If your policy says 14 days, an inspector or an attorney will ask how you enforce 14 days. A handwritten date on tape enforces nothing. A per-vial record with a timestamp does.
Recalls. Manufacturer recalls name lot numbers. If the lot is recorded when the vial is mixed, answering which patients received a given lot takes seconds instead of a week of chart archaeology.
How to know when a vial is empty
A reconstituted vial has two clocks, and most practices only watch one. The first is time: mixed on Tuesday, discard by the policy date. The second is units: a 100 unit vial that has had 100 units drawn from it is empty no matter what the calendar says, and a vial with 60 units still in it on the discard date is 60 units of waste that should be counted.
The paper version cannot see the second clock at all. Tape on a vial records when it was mixed; it does not know that four patients drew 25 units each on Wednesday.
The system version tracks both. When a provider mixes a vial, the vial is recorded with its size, 100 or 200 or 300 units depending on the product. Every dose drawn afterward is logged in units with patient and provider initials, and counts against that vial. When the units drawn reach the vial's size, the vial closes itself: it leaves the open-vial list, and the record shows who drew the last unit. Nobody has to remember to clear it. If a vial reaches its discard date with units left, those units are recorded as waste and priced, so the write-off number at the end of the month is real.
That is how MedRestock does it, and the "closes itself" part shipped this month at the request of a clinic that was clearing finished vials by hand and could not keep up.
How practices track it
The paper version: write the date and time on tape, stick it on the vial, hope the tape survives the fridge. It fails quietly and constantly.
The system version: when a provider mixes a vial she taps Mix on that product, picks the lot from the ones on her shelf, adds her initials, and taps Start clock. The vial now has a live countdown visible to the whole team, its lot, its size, the name of who mixed it, and a running count of units used. Every dose drawn from it is logged with patient and provider initials. When the last unit goes, the vial closes on its own. If it has to be discarded with product left, the remaining units are recorded as waste and priced automatically.
One clinic running this flow logged eight treatments across six patients in a single day, with four vials mixed under two manufacturer lots, every dose attributed to a patient, a provider, and a lot. Their recall answer for either lot is a ten second search.
Does the same apply to Dysport, Jeuveau, Xeomin, and Daxxify?
The principle is identical, the numbers differ. Each product's prescribing information carries its own reconstitution and storage guidance (see the table above), and practices commonly run different discard windows for different toxins. In MedRestock the window is set per product, so Botox can run 14 days while Dysport runs 7, each vial counting down against its own product's rule and its own unit size.
The short version
The label says 24 hours, 72 for Daxxify. The literature supports longer under refrigeration. Your medical director sets the policy. And the policy is only as good as the clock on each vial: mix time, lot, initials, countdown, units remaining, and a waste record when a vial dies early. That is the whole discipline.
If your practice tracks this on tape and memory today, MedRestock's Clinical plan runs the clocks, the lots, the unit counts, and the dose log for you, with a 14 day free trial. For the wider picture of running injectable inventory, start with the Botox inventory management guide.