The Joint Council for Cosmetic Practitioners (JCCP) is advising all registrants who prescribe, administer or work with botulinum toxin products to review the latest Drug Safety Update (DSU) published by the Medicines and Healthcare products Regulatory Agency (MHRA).

The update follows the outbreak of iatrogenic botulism reported between June and August 2025 and introduces strengthened safety warnings for all botulinum toxin type A products. While botulinum toxin medicines continue to have a well-established safety profile when used appropriately, the MHRA is reminding practitioners that, in very rare cases, the toxin's effects may spread beyond the injection site, resulting in botulism—a serious and potentially life-threatening medical emergency.

Quote from Andrew Rankin, Acting Co-Chair, JCCP

“The JCCP welcomes the MHRA’s robust response to the outbreak of iatrogenic botulism last year. We endorse all the advice offered by the MHRA in the Drug Safety Update and we encourage its adoption in the strongest terms.

The events of last year were a serious challenge to public safety and they were avoidable. The JCCP expects to see the application of acceptable standards of sourcing, prescribing and administration of medicines under the forthcoming framework of licensing and its oversight and enforcement.”

Key actions for practitioners

All practitioners using botulinum toxin products should be familiar with this Drug Safety Update. We note in particular:

• check that the botulinum toxin product is authorised for use and follow the product specific guidance in the product information for administration, dose and indication
• prescribers should ensure that anyone they direct to administer the product, including practitioners who may use it for cosmetic purposes, follow the directions on the prescription and that they are familiar with this Drug Safety Update and the actions to be taken

Patients should also be advised to seek immediate medical attention if they develop symptoms such as difficulty swallowing, slurred speech, breathing difficulties or muscle weakness following treatment. These symptoms may occur within days or up to four weeks after treatment.

JCCP Recommendation

Given the proposal to update product information to include iatrogenic botulism warnings, the JCCP recommends that iatrogenic botulism is now included as part of the informed consent discussion and documented within the patient consent process.

The JCCP also takes this opportunity to remind you of our previous advice that all practitioners should report any adverse events to the MHRA using the Yellow Card Scheme and they should advise members of the public that they can do the same. 

The MHRA has also reiterated the importance of using only authorised botulinum toxin products obtained through regulated supply chains. Unlicensed or counterfeit products present significant risks to patient safety and do not meet UK safety and quality standards.

Patient safety remains the highest priority for the JCCP. We encourage all registrants to familiarise themselves with the MHRA Drug Safety Update, review their clinical protocols where appropriate, and ensure patients are fully informed of the risks, signs and symptoms associated with treatment.

Read the full MHRA Drug Safety Update here.