Can ZYTAZE Enhance Botulinum Toxin Injections?

It has been noted by many medics over the years since we have been using botulinum toxin for both medical and cosmetic indications that some patients simply don’t achieve the responses to the drug that others can, leading to increased dose requirements and more frequent treatments, particularly in older patients. It was from this observation that researchers started to look at the zinc levels of patients and consider the concept of supplementation.

Each capsule of the patent pending ZYTAZE supplement contains 25mg of zinc citrate and 1500mg of phytase as the primary active ingredient. Phytase is an enzyme which effectively breaks down phytates which are a group of compounds found in certain foods such as whole grain bread, whole wheat cereals, beans, corns, nuts, rice and other foods such as peas and peanuts many of which are zinc-rich as well.  Phytates prevent zinc absorption by the body by tightly binding themselves with any zinc they find in the intestinal tract. By introducing an enzyme which destroys any phytates, it’s expected that zinc absorption would no longer be impaired and the maximum zinc levels could be achieved.

A recent, modified double-blind, randomised, placebo-controlled, crossover pilot study * of 44 patients (average age of 65 years, with 75% women) was conducted by researchers at The Methodist Hospital in Houston, Texas, lead by Oculoplastic Surgeon Dr. Charles Soparkar, used ZYTAZE to increase zinc levels for 4 days before botulinum toxin injections in the treatment of blepharospasm, hemifacial spasm (4 patients) and cosmetic procedures for wrinkles (10 patients).

2 patients were treated with Myobloc® (Neurobloc®) for blepharospasm, 3 were treated with Dysport® for cosmetic indications and the remaining 39 were treated with Botox® for various indications.

The patient-specific change in the duration of the botulinum toxin effect (irrespective of the individual brand used) was compared. When given ZYTAZE a 23.6% change in the duration of action was observed which surprised the researchers, who as yet are unsure of exactly the precise method of action of the zinc supplementation.

They concluded that this study suggests that using ZYTAZE may lead to fewer botulinum toxin injections at a lower dose and with less treatment-to-treatment variability in effect.

They presented the study at the American Society of Ophthalmic Plastic & Reconstructive Surgery’s 41st Annual Fall Scientific Symposium in October 2010 in Chicago.

 ZYTAZE became commercially available in the USA in November 2010 and is marketed as a prescription only treatment to eliminate the potential for patient abuse and resulting zinc toxicity. It is packaged in a blister pack of ten capsules (2 per day to give the 50mg zinc citrate/3,000mg phytase dose over 4 days prior to botulinum toxin treatment).

The study carried out by Dr. Soparkar is currently under review, pending publication in a medical journal but it certainly causing interest amongst physicians who view this as a very interesting finding. As Dr. Soparkar himself admits, larger, multi-centre studies will need to be carried out with more advanced protocols in order to truly assess the increased effect this supplement has on the effect and duration of botulinum toxin treatments for a variety of indications and whether it can indeed lead to lower doses and less frequent re-treatment.

*Effect of Dietary Zinc Supplementation on Botulinum Toxin Treatments Koshy JC, Sharabi SE, Feldman EM, Hollier LM, Hollier LH, Patrinely JR, Soparkar CNS. (Manuscript currently in review)