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What is Xeomin®

Xeomin is a Clostridium botulinum toxin type A powder that is indicated to relax muscle contractions, and is manufactured by Merz Pharma, an internationally renowned pharmaceutical company specializing in over-the-counter products and injectables. It is available in 50-, 100- or 200-unit vials. The toxin powder must be reconstituted with 9mg/ml (0.9%) sodium chloride solution into a transparent and colorless solution that is free from any foam or floccular or particulate matter. This neuromodulator is a white powder with human albumin and sucrose as excipients. Do not store the medicine above 25°C.


Who makes a good candidate?

This brand of botulinum toxin is suitable for patients without any hypersensitivity to the ingredients in the injectable; generalized disorders of muscle activity (e.g. myasthenia gravis, Lambert-Eaton syndrome, etc.); or infections or inflammation on proposed injection sites. This botulinum toxin should not be used in patients who are pregnant or nursing.


Treatment areas

This muscle relaxant is indicated for the treatment of the following conditions:

  • Eyelid spasms (blepharospasm);
  • Cervical dystonia (spasmodic torticollis);
  • Spasticity of upper limbs.


How does it work?

Clostridium botulinum is actually a type of gram-positive bacteria that is found abundantly in various environmental setting such as the soil and lakes. Extensive research discovered that the toxin is an effective muscle relaxant and is suitable for calming hyperactive muscles or painful muscle contractions. Today, this toxin is also developed for various medical conditions.

Unlike other brands of botulinum toxin, Xeomin has been purified extensively to be free from any complexing proteins. Once injected, the toxin inhibits the release of acetylcholine and prevents the cholinergic transmission at the neuromuscular junction. Nerve impulses are not generated, which results in temporary paralysis of muscle contractions. Over time, the activity of the toxin will be reduced, and muscle activity will resume as normal. Since Xeomin is free from any complexing proteins, neutralizing proteins will not be produced by the immune system.


Method of administration

Just like any other medical or aesthetic procedure, botulinum toxin injections must be started with a thorough medical checkup. Information about patients’ medical history (e.g. any underlying diseases present, previous history of botulinum toxin administration, medications or supplements taken, etc.) is vital to determine the best treatment plan. Some doctors may use this neuromodulating toxin is used to treat aesthetic imperfections.

The initial consultation session is also important for discussing about the possible side effects that your patients might experience. Once they are deemed suitable and ready, you may proceed to the treatment session. Prepare the injection solution by reconstituting the toxin powder with 9mg/mL (0.9%) sodium chloride solution. You may alter the volume of solvent to produce an injection solution of varying strengths. If the solution is not used immediately, it can only be kept up to 24 hours in the refrigerator at a temperature between 2°C to 8°C.

  • Blepharospasm: Inject the prepared toxin solution into the medial and lateral orbicularis oculi muscle of the upper lid and the lateral orbicularis oculi muscle of the lower lid. The initial recommended dose is 1.25 to 2.5 units per injection site, and the total dose should not exceed 25 units per eye.
  • Spasmodic torticollis: Inject the prepared toxin solution into levator scapulae, splenius capitis, sternocleidomastoid, scalenus, and/or the trapezius muscle(s). Do not exceed more than 50 units at any 1 injection site or a total dose of 300 units in a single session.
  • Spasticity of Upper Limbs: The affected muscle(s) can be isolated using ultrasound or electromyographic tests before being injected intramuscularly with the prepared toxin solution. Do not exceed more than 500 units of toxin per treatment session.

Unused vials or syringes must be autoclaved. Only certified medical practitioners who are experienced in preparing botulinum toxin should conduct the treatment session.


How long do the effects last?

Most patients will notice the desirable medical and/or aesthetic improvements within a week following the injection session. These effects should last from 3 to 6 months depending on the patient’s health status, age, lifestyle habits, and the amount of toxin injected. The activity and efficacy of Xeomin is almost comparable to Botox due to their similar onset and duration of action; however, the units are measured differently and cannot be used interchangeably.


Side effects

Xeomin has been processed thoroughly to contain only the therapeutic amount of the toxin. The muscle-relaxing injectable has been extensively purified to be free from any complexing proteins so as to reduce the production of neutralizing antibodies that could potentially affect the efficacy of the botulinum toxin injections. That being said, patients will still experience some common injection site reactions.

  • Pain
  • Swelling
  • Redness
  • Itchiness
  • Bruising
  • Bleeding

The above list is not all all-inclusive, please refer to the product information pamphlet for other possible side effects. Depending on the area being injected, the patient may experience adverse reactions specific to that area, such as mild eyelid ptosis when being treated for blepharospasm. Educate your patients on these side effects during the initial consultation session, so that they can quickly identify them and obtain medical attention if necessary.


Effects on lifestyle

There is no downtime required after the treatment. Patients must be educated on the proper aftercare methods.


Cost of Xeomin

The cost of this muscle relaxing medicine is estimated to be at $225 per treatment session or lower. The average cost is about $9 per unit. Ultimately, you can set the cost of this treatment based on the number of units being used.

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