A Las Vegas physician is accusing sales representatives for Allergan Inc. of promoting unsafe injection practices by encouraging doctors to use single-use vials of the company's anti-wrinkle drug Botox on multiple patients.

Ivan Goldsmith, MD, states in a lawsuit filed in California last month that although Botox is sold in 50-unit or 100-unit vials marked as single-use, doctors cannot make a profit on the injections unless they reuse vials on multiple patients. That's because most patients don't need 50 or 100 units of Botox in a single treatment, and, once opened, the drug can't be saved for more than 4 hours for future use on the same patient.

A single Botox treatment may cost a patient about $500, but a 100-unit vial could cost the physician about $1,000, alleges Dr. Goldsmith. If you threw out the drug remaining in the vial instead of reusing it, "you were losing money that way, not making it," he told the Las Vegas Review-Journal. The newspaper quotes several other physicians and clinics who say they've been to seminars where Allergan representatives encouraged multiple patient use of Botox vials.

Allergan spokeswoman Caroline Van Hove has denied the lawsuit's claims, telling Courthouse News Service that Botox's prescribing label says it's for single use. "The complaint further recites alleged facts about Botox Cosmetic and its price and contains accusations concerning Allergan's promotional and educational practices that are demonstrably false," said Ms. Van Hove of the lawsuit.

Injection safety is one of several big issues being targeted in the Centers for Medicare and Medicaid Services' current round of ambulatory surgery center infection control surveys. CMS surveyors are instructed to cite facilities if they use single-use medication vials for more than 1 patient.

Irene Tsikitas