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safety in pregnancy has not been established People with a neuromuscular condition such as myasthenia gravis, Lambert-Eaton syndrome, or ALS, who carry a higher risk of serious swallowing and breathing effects and should have clearance from their treating clinician first Anyone who has received a botulinum toxin injection within the previous 3 months Anyone under 18, since Letybo is approved for adults Tell Your Injector Before Treatment Any botulinum toxin treatment in roughly the past four months, including the product name and the dose Aminoglycoside antibiotics or other medicines that interfere with neuromuscular transmission, which can amplify the toxin’s effect Blood thinners or regular NSAID use, which raise the likelihood of bruising Any history of difficulty swallowing or breathing, or any previous reaction to a neurotoxin Safety Overview Letybo carries a boxed warning for distant spread of toxin effect, as every botulinum toxin product does

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One of the key proposed contributors to these conditions is oxidative stress, which is thought to impair energy production in muscles, leading to the characteristic fatigue observed in these patients