XEOMIN®

What Is XEOMIN®?

XEOMIN® is a prescription botulinum neurotoxin type A developed by Merz Pharmaceuticals (Frankfurt, Germany). It acts at the neuromuscular junction by inhibiting acetylcholine release from the presynaptic terminal, which temporarily reduces contraction in the injected muscle. The active substance is a purified 150 kDa botulinum toxin type A, isolated from the accessory protein complex that surrounds it in the parent organism. Beyond the neurotoxin, the vial contains human serum albumin as a stabiliser and sucrose as an excipient. As a botulinum neurotoxin type A, XEOMIN® is prescription-only in every jurisdiction where it is licensed.

Each injection of XEOMIN® is reconstituted at the point of use from a lyophilised powder and delivered intramuscularly with product- and indication-specific dosing; the pharmacological effect develops over the following days as acetylcholine release is progressively suppressed.

What Is BOCOUTURE®?

BOCOUTURE® is the European aesthetic brand name used by Merz for incobotulinumtoxinA. Although the packaging and regulatory naming differ by market, the formulation supplied inside the vial remains the same as XEOMIN®. What differs is the commercial name attached to the carton and the regulatory dossier that name sits under in a given market. BOCOUTURE® is authorised across the EU and UK primarily for aesthetic indications through national medicines authorities. XEOMIN® is the wider international and US brand, and it carries the broader combined aesthetic-and-therapeutic label under the FDA. Practitioners who encounter both names on packaging should treat them as one product with two carton designs.

XEOMIN® in the Botulinum Toxin Category

XEOMIN® is one of several botulinum toxin type A formulations available to practitioners looking to buy botulinum toxins for aesthetic and therapeutic use.

Common examples include:

• BOTOX® – onabotulinumtoxinA
• DYSPORT® – abobotulinumtoxinA
• XEOMIN®/ BOCOUTURE® – incobotulinumtoxinA
• NABOTA®/JEUVEAU® – prabotulinumtoxinA
• BOTULAX® – Korean botulinum toxin type A product
• LETYBO® – letibotulinumtoxinA-wlbg in the US

“Botox” is often used informally to describe the entire category, but clinically these are separate pharmaceutical products. Their formulations, potency assays, approved indications, storage requirements and labeling are not identical.

Protein-Free Formulation – Clinical Significance

XEOMIN® is described as a “naked toxin” because Merz’s purification step removes the haemagglutinin and non-haemagglutinin accessory proteins that surround the 150 kDa neurotoxin in most other products. What remains is the pharmacologically active component alongside two inactive excipients.

The phrase “protein-free” needs a caveat. XEOMIN® is free from complexing bacterial proteins. The neurotoxin itself is a protein, and the finished formulation contains human albumin. That distinction matters most in the immunogenicity conversation.

Repeated exposure to any botulinum toxin can, in a small proportion of patients, be associated with the development of neutralising antibodies. Antibody formation may contribute to secondary treatment non-response, particularly in long-term therapeutic settings. Published systematic reviews across therapeutic indications have generally found low neutralising-antibody rates with modern formulations, and incobotulinumtoxinA has been repeatedly associated with the lowest rates in this class [2][3]. In our reading of the current evidence base at Doctor Medica, that reduced foreign-protein load is the practical reason clinicians favour XEOMIN® for patients expected to undergo repeated treatment over many years.

The clinical importance should not be overstated. Treatment interval, cumulative dose, indication, injection technique, and individual immune response all shape antibody development. Nor should the absence of complexing proteins be read as evidence that XEOMIN® reliably produces less clinical diffusion than another toxin. Injection volume, concentration, anatomy, and needle placement all affect local spread. Precision aesthetic work involving fine lines and wrinkles depends more on accurate anatomical placement than on formulation choice.

Room-Temperature Storage

Storage is a practical differentiator that separates XEOMIN® from every other product in the class. Current US prescribing information states that unreconstituted XEOMIN® should not be stored above 25°C (77°F) [1], which permits room-temperature storage before reconstitution and reduces the dependence on continuous refrigerated stock. Once reconstituted, XEOMIN® should be refrigerated at 2°C to 8°C and used within the period specified in the current label.

For clinics managing multiple botulinum toxin products, that flexibility can simplify inventory workflow and reduce cold-chain risk during receiving and shipping. Storage instructions should always be checked against the packaging and prescribing information supplied for the specific market of use.

FDA Approvals and Indications

XEOMIN® was first approved by the FDA in 2010 for two therapeutic indications and has since built one of the broadest labels in the botulinum toxin class. Current US prescribing information covers five adult indications plus a paediatric upper limb spasticity indication, with chronic sialorrhea approved for patients aged 2 and older [1]:

• Cervical dystonia in adults (2010)
• Blepharospasm in adults (2010)
• Moderate to severe glabellar lines (2011), expanded in July 2024 to moderate to severe upper facial lines (glabellar lines, horizontal forehead lines, and lateral canthal lines)
• Upper limb spasticity in adults (2015)
• Chronic sialorrhea in patients 2 years of age and older (2018)
• Upper limb spasticity in paediatric patients 2 to 17 years of age, excluding spasticity caused by cerebral palsy

On the aesthetic side, practitioners use XEOMIN® for upper facial line correction — approved doses of 20 U for glabellar lines, 20 U for horizontal forehead lines, and 24 U for lateral canthal lines. On the therapeutic side, XEOMIN® addresses conditions involving involuntary or excessive muscle activity as well as chronic drooling. Dosing, administration schedule, and reconstitution vary meaningfully by indication.

Full XEOMIN® Product Range

XEOMIN® is manufactured in three unit strengths. Availability varies between markets and suppliers.

XEOMIN® 50U — a smaller vial suited to lower-dose aesthetic areas or precision work where a full 100-unit vial would be excess.

XEOMIN® 100U — the standard presentation across aesthetic and therapeutic settings. Doctor Medica currently lists XEOMIN® 100U presentations, including market-specific packaging variants.

XEOMIN® 200U — a larger vial for therapeutic protocols requiring higher total labelled doses, such as multi-region cervical dystonia or upper limb spasticity sessions.

BOCOUTURE® 50U — Merz’s aesthetic-market carton of the same incobotulinumtoxinA molecule, currently listed in the Doctor Medica range for jurisdictions where BOCOUTURE® is the registered brand.

Current US prescribing information recognises all three XEOMIN® unit strengths [1].

Even clinics that routinely buy Korean botox for cost-sensitive protocols tend to hold at least one XEOMIN® presentation in stock for patients who specifically request a Merz-manufactured, protein-free alternative. Practitioners planning to buy XEOMIN® wholesale should confirm which vial sizes and market-specific packaging variants are currently available before ordering.

XEOMIN® Compared to Other Botulinum Toxin Products

Botulinum toxin potency units are product-specific. Formal prescribing information states that units from one botulinum toxin preparation cannot automatically be converted into units of another. Published clinical studies sometimes use defined dose ratios when comparing specific products, but those study ratios should not be treated as universal conversion rules.

XEOMIN® vs BOTOX®

The primary distinction between these two products is their formulation: XEOMIN® provides incobotulinumtoxinA without complexing proteins, while BOTOX® uses onabotulinumtoxinA in a protein-complex formulation. Both inhibit acetylcholine release at the neuromuscular junction, and both are FDA-approved and widely used across aesthetic and therapeutic settings.

Direct comparative work in glabellar lines has evaluated 20 units of incobotulinumtoxinA against 20 units of onabotulinumtoxinA and found comparable efficacy under the studied conditions [4], and a separate placebo-controlled Phase III study confirmed single-dose efficacy of a 20-unit incobotulinumtoxinA regimen in the same indication [5]. Together, those findings underlie the 1:1 dose relationship frequently discussed in the aesthetic literature. Official labelling nevertheless states that biological units are product-specific and should not be treated as universally interchangeable.

Storage is a second practical distinction, since unreconstituted XEOMIN® can sit at up to 25°C and BOTOX® has its own refrigeration requirement. Both develop effect over the first several days after injection, with the final response shaped by dose, treatment area, anatomy and technique. Looking at BOTOX and XEOMIN together in this way, the XEOMIN® and BOTOX® difference is best defined by formulation, labelling and storage rather than by onset claims.

XEOMIN® vs DYSPORT®

DYSPORT® contains abobotulinumtoxinA, and its Speywood potency units are not equivalent to BOTOX® or XEOMIN® units. Aesthetic literature frequently discusses approximate DYSPORT®-to-BOTOX®/XEOMIN® ratios in the region of 2.5:1 to 3:1 depending on indication and study design, but those published ratios do not override product labelling.

Formulation also differs: DYSPORT® contains complexing proteins, XEOMIN® does not. Claims that one product inherently spreads further than another should be interpreted cautiously because dose, concentration, injection volume and technique also affect distribution. AZZALURE® is the aesthetic-market brand associated with abobotulinumtoxinA in relevant European markets.

XEOMIN® vs BOTULAX®

BOTULAX® is a South Korean botulinum toxin type A product manufactured by Hugel. It shares its underlying letibotulinumtoxinA molecule with LETYBO®, the version Hugel supplies to the US and EU under a different brand. The BOTULAX® carton itself carries market-specific regulatory approvals in Korea and other countries; it should not be represented as holding US FDA status equivalent to XEOMIN®.

The clearest structural difference is formulation. XEOMIN® is manufactured without complexing proteins; BOTULAX® is a conventional botulinum toxin complex product. Direct unit equivalence should not be assumed without product-specific clinical guidance.

XEOMIN® vs NABOTA®

NABOTA® is manufactured by Daewoong Pharmaceutical in South Korea, and its US-market brand is Jeuveau®. Jeuveau® contains prabotulinumtoxinA-xvfs and received FDA approval for moderate to severe glabellar lines in adults. That approval gives NABOTA®/Jeuveau® a stronger US regulatory footing than several other Korean botulinum toxin products.

XEOMIN® nevertheless holds a substantially broader FDA-approved indication set, spanning aesthetic upper facial lines plus cervical dystonia, blepharospasm, upper limb spasticity, and chronic sialorrhea. NABOTA®/Jeuveau®’s US label is confined to glabellar lines. Formulation differs in the familiar way: XEOMIN® is manufactured without complexing proteins.

XEOMIN® vs LETYBO®

LETYBO® contains letibotulinumtoxinA-wlbg and is manufactured by Hugel. It received US FDA approval for the temporary improvement of moderate to severe glabellar lines in adults. LETYBO® should be distinguished from BOTULAX®, another Hugel-associated brand used outside the US that shares the same underlying molecule.

The principal contrasts with XEOMIN® are formulation, labelled storage requirements, US approval history, and indication breadth. XEOMIN® has held FDA approval since 2010 across therapeutic and aesthetic indications. LETYBO® entered the US market considerably later and currently carries a narrower single-indication label. As with the other products in this section, units should not be assumed to be directly interchangeable.

Safety and Possible XEOMIN® Side Effects

The reported XEOMIN® side effects profile varies by indication, injected area, and dose. For upper facial-line treatment, current US prescribing information identifies injection-site bruising among the most commonly reported adverse reactions [1]. Across therapeutic indications, reported events also include headache, dry mouth, eyelid ptosis, muscle weakness, injection-site pain, and dysphagia.

Like all products in this class, XEOMIN® carries a boxed warning concerning distant spread of toxin effect. Serious symptoms can include swallowing or breathing difficulties and generalised muscle weakness, and in severe cases these may be life threatening [1]. Serious hypersensitivity reactions are also possible; symptoms requiring urgent medical assessment include difficulty breathing, wheezing or asthma symptoms, swelling, severe allergic reaction, and dizziness or feeling faint. Anyone evaluating the broader safety profile should separate common local effects from these much rarer serious class-wide risks. XEOMIN® may cause serious side effects. Individual results may vary.

For pregnant patients, current US prescribing information states that XEOMIN® may cause fetal harm based on animal data. Human pregnancy data are insufficient to establish safety, and pregnancy is not listed as an absolute contraindication in the current US label. Treatment decisions in this context require individual medical assessment of potential benefit and fetal risk. XEOMIN® also contains human serum albumin as a stabiliser and cannot be characterised as a vegan pharmaceutical product.

Where to Buy XEOMIN® Online

XEOMIN® is a prescription pharmaceutical intended for professional use. Licensed practitioners weighing where to buy XEOMIN® online should first verify the regulatory status of the product in their jurisdiction and confirm that sourcing documentation is appropriate for professional medical procurement. Before arranging to order XEOMIN® online or purchase XEOMIN® from a distributor, practitioners typically confirm:

• supplier and distribution-channel verification
• original manufacturer packaging with intact seals
• LOT number documentation and certificates of authenticity
• correct market-specific labelling and vial strength
• expiration dates and shipping temperature records
• medical-license and jurisdictional requirements for the receiving clinic

Shipping conditions matter for this product class. Even though XEOMIN® holds a room-temperature storage allowance up to 25°C, temperature excursions during transit can still compromise stability in extreme cases, and controlled shipping records support any downstream investigation.

Licensed practitioners looking to buy XEOMIN® online or to buy XEOMIN® wholesale can contact Doctor Medica’s staff for guidance on available presentations, supporting documentation, and verified sourcing information. Availability varies by country and vial strength.

Frequently Asked Questions

What is XEOMIN®?

XEOMIN® is Merz Pharmaceuticals’ formulation of incobotulinumtoxinA, a botulinum toxin type A used in both aesthetic and therapeutic applications. Its purified neurotoxin is manufactured without complexing accessory proteins.

What is XEOMIN® used for?

Approved US indications include upper facial lines (glabellar, horizontal forehead, and lateral canthal lines), cervical dystonia, blepharospasm, upper limb spasticity, and chronic sialorrhea. Administration, dose and treatment interval vary meaningfully by indication.

How is XEOMIN® different from BOTOX®?

XEOMIN® and BOTOX® use different botulinum toxin type A molecules. XEOMIN® uses incobotulinumtoxinA without complexing proteins, while BOTOX® uses onabotulinumtoxinA with associated proteins. Their dosing units remain product-specific according to prescribing information.

Is XEOMIN® the same as BOCOUTURE®?

Both products contain the same incobotulinumtoxinA active substance from Merz. BOCOUTURE® is the aesthetic-market brand used across Europe and the UK; XEOMIN® is the international and US brand covering both aesthetic and therapeutic indications.

Is XEOMIN® FDA approved?

Yes. Initial US approval came in 2010 for cervical dystonia and blepharospasm, followed by glabellar lines (2011, expanded in July 2024 to full upper facial lines), upper limb spasticity (2015), and chronic sialorrhea (2018), with a paediatric upper limb spasticity indication for patients 2 to 17 years of age (excluding spasticity caused by cerebral palsy). Chronic sialorrhea covers patients aged 2 and older.

What are XEOMIN®’s side effects?

Reported adverse reactions vary by indication and can include injection-site bruising, headache, eyelid ptosis, dry mouth, muscle weakness, injection-site pain and dysphagia. Rare class-wide serious effects include distant spread of toxin effect [1].

Is XEOMIN® safe during pregnancy?

Human pregnancy data are insufficient to establish safety, and the current US label notes that XEOMIN® may cause fetal harm based on animal data. Pregnancy is not listed as an absolute contraindication, so individual benefit-risk assessment is required.

Is XEOMIN® vegan?

No. XEOMIN® contains human serum albumin as an excipient.

Where can practitioners find information on buying XEOMIN®?

Licensed practitioners can contact Doctor Medica’s staff for information about available presentations, product documentation, and verified sourcing channels.

Disclaimer

For licensed medical professionals only. This content is for informational purposes only and does not constitute medical advice. Product indications, dosing, storage requirements and regulatory status should always be checked against the current prescribing information for the relevant jurisdiction.

Citations

[1] U.S. Food and Drug Administration. XEOMIN® (incobotulinumtoxinA) Prescribing Information. U.S. Food and Drug Administration, revised 2026, www.accessdata.fda.gov/drugsatfda_docs/label/2026/125360s110lbl.pdf.

[2] Walter, Uwe et al. “Systematic Review and Meta-Analysis of Secondary Treatment Failure and Immunogenicity With Botulinum Neurotoxin A in Multiple Indications.” European journal of neurology vol. 32,8 (2025): e70289. doi:10.1111/ene.70289

[3] Rahman, Eqram et al. “Immunogenicity to Botulinum Toxin Type A: A Systematic Review With Meta-Analysis Across Therapeutic Indications.” Aesthetic surgery journal vol. 42,1 (2022): 106-120. doi:10.1093/asj/sjab058

[4] Kane, Michael A C et al. “A Randomized, Double-Blind Trial to Investigate the Equivalence of IncobotulinumtoxinA and OnabotulinumtoxinA for Glabellar Frown Lines.” Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] vol. 41,11 (2015): 1310-9. doi:10.1097/DSS.0000000000000531

[5] Carruthers, Alastair et al. “Multicenter, randomized, phase III study of a single dose of incobotulinumtoxinA, free from complexing proteins, in the treatment of glabellar frown lines.” Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] vol. 39,4 (2013): 551-8. doi:10.1111/dsu.12100

Written by Doctor Medica’s Editorial team

The content on this page has been written and fact-checked in accordance with our Editorial Policy. Clinical claims are sourced from peer-reviewed literature, regulatory documentation, and manufacturer specifications. Where citations are provided, it is always in accordance to our editorial standards.

Doctor Medica sources products exclusively through authorized distributors and established procurement channels. Products are verified as genuine, and supplied in the original packaging with their seal intact. Learn more about how we guarantee product authenticity, sourcing compliance, and traceable delivery to our clients.