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The FDA is requiring safety label changes - including a boxed warning - and a risk evaluation and mitigation strategy for all botulinum toxin products. The agency said it took the action because of reports that the effects of the products may spread from an injection site to other parts of the body. This distant spread can cause symptoms such as muscle weakness, hoarseness or trouble talking, trouble speaking clearly, loss of bladder control, trouble breathing, trouble swallowing, double vision, blurred vision, and drooping eyelids. The agency urged physicians who provide botulinum toxins to follow these steps:

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