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It can be further oxidized to N-methyl-2-pyridone-5-carboxamide (2PY) and N-methyl-4-pyridone-3-carboxamide (4PY) in vivo and is easily excreted in urine in the forms of MNA, 2PY, and 4PY (in humans, the major metabolite of MNA is 2PY, and in rodents, the major metabolite of MNA is 4PY) [6567]

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The most frequently reported adverse reactions following injection of BOTOX for upper limb spasticity include pain in extremity, muscular weakness, fatigue, nausea, and bronchitis