Drug guidance
Botulinum toxin A for the management of focal spasticity of the lower limbs associated with stroke in adults
Condition
Musculoskeletal
16 September 2025
Published on 01 Jun 2023
Last Updated on 16 Sep 2025
Guidance Recommendations
The Ministry of Health's Drug Advisory Committee has recommended:
Clostridium botulinum toxin type A neurotoxin complex (Botox) 50 U and 100 U injection vials, and
Clostridium botulinum type A toxin-haemagglutinin complex (Dysport) 300 U and 500 U injection vials
for the management of focal spasticity of the lower limbs associated with stroke in adults who:
have a score of 3 or more on the Modified Ashworth Scale at the target muscle intended for botulinum toxin A treatment;
do not have the affected joint permanently fixed in position due to fibrotic shortening of the target muscle; and
are concurrently receiving physiotherapy.
Botulinum toxin A must be administered by either a neurologist trained in movement disorder or a rehabilitation physician who has undergone training to administer botulinum toxin A.
Funding status
Clostridium botulinum toxin type A neurotoxin complex (Botox) 50 U and 100 U injection vials are recommended for inclusion on the Medication Assistance Fund (MAF) for the abovementioned indication from 1 August 2023.
Clostridium botulinum type A toxin-haemagglutinin complex (Dysport) 300 U and 500 U injection vials are recommended for inclusion on the MAF for the abovementioned indication from 1 November 2025.
MAF assistance does not apply to Botox 200 U injection vial or other brands of botulinum toxin A.