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Additional Information 

What is Xeomin?

Xeomin is a medication that contains botulinum toxin type A and is indicated for the treatment of blepharospasm (eyelid spasms), spasmodic torticollis (twisted neck), and upper limb spasticity. As an inhibitor of the neurotransmitter acetylcholine, this neurotoxin temporarily relaxes the muscles involved in neuromuscular disorders by preventing the muscle fibers from receiving nerve transmission. This injectable is clinically proven to be a safe, effective and durable treatment.

Patients who have a history of hypersensitivity to botulinum toxin or to any of the other components of Xeomin should not be treated with it. Do not inject it into infected skin and do not use this medication in nursing or pregnant women. The safety profile of this product has not yet been established in patients below 18 years of age.

How does Xeomin work?

Movement disorders arise as a result of neurological conditions that cause increased abnormal movement. These conditions are often painful and debilitating. The types of movement disorders Xeomin can treat include spasmodic torticollis, a condition involving spasms or contractions of the neck muscles that cause abnormal head movement; blepharospasm, a condition where there is involuntary contraction or twitching of the eyelid; and upper limb spasticity, which refers to muscle stiffness in various regions in the upper limb, such as flexed elbow or wrist, clenched fist, pronated forearm, thumb-in-palm, or rotated/adducted/extended, to name a few.

Intended for intramuscular injection only, Xeomin alleviates symptoms of these disorders by acting on the nerves of the muscles involved in the abnormal movement to temporarily cease muscle contractions underneath the treatment area. This product is made of a neurotoxin isolated from the bacterium clostridium botulinum that acts on nerve endings to prevent the release of acetylcholine, a neurotransmitter. This action effectively stops nerve signaling in the affected area, resulting in paralysis. This effect is temporary, and will gradually cease once signaling is re-established by the formation of new nerve endings.

Treatment details & dosing

Only an authorized medical practitioner with specialist knowledge of treatment with botulinum neurotoxin type A may administer this treatment.

Prior to treatment, fully inform your prospective patient on the associated indications, contraindications, precautions, and potential adverse events. Take down a complete medical history of the patient before proceeding.

Reconstitution

Xeomin must be reconstituted prior to intramuscular injection. Reconstitute Xeomin with 0.9% sodium chloride solution.

Dosing

The optimum dose, frequency, and number of injection sites in the treated muscle should be tailored to the individual patient. The results of initial treatment with Xeomin should be evaluated and dosage adjustment may be required to achieve the desired therapeutic effect.

Recommended starting doses for each indication are as follows:

• Twisted neck (spasmodic torticollis): Up to 50 units per injection site, up to a maximum dose of 200 units in the first treatment session. Doses of up to 300 units may be given in subsequent courses depending on response. Usually, the first onset of effect is observed within 7 days of injection.
• Spasticity of the upper limb: Up to 500 units per treatment session, with no more than 250 units administered to the shoulder muscles. Patients reported the onset of action as being 4 days after treatment. An improvement of muscle tone is usually perceived within 4 weeks.

How long does Xeomin last?

The duration of effect of Xeomin varies by indication:

• Blepharospasm: Up to 4 months. Treatment can be repeated if required.
• Spasmodic torticollis: Up to 4 months. Treatment intervals of less than 12 weeks are not recommended.
• Upper limb spasticity: Typically 12 weeks. The period between treatment sessions should be a minimum of 12 weeks.

Safety information: side effects and precautions

Xeomin is made via a state-of-the-art manufacturing process that minimizes the quantity of accessory or complexed proteins. As a result, this toxin is less prone to triggering immunogenic reactions in the patient, which in turn increases the success rate of repeat treatment.

As with all medications, injection with this product may cause unintended side effects. Advise your patient to seek medical attention immediately if he or she experiences an allergic reaction. Swallowing difficulties and excessive muscle weakness are other side effects that may occur when Xeomin acts to relax muscles in sites distal to the injection site. This is more likely to happen when using Xeomin to treat spasmodic torticollis.

The most common side effects observed with Xeomin treatment are mild inflammatory reactions at the site of injection, which may include:

• Redness
• Itching
• Edema
• Bruising at the site of injection

These reactions are typically not severe and will spontaneously resolve within a week.

Other side effects may be associated with a specific indication. Refer to the product pamphlet for a complete list of possible reactions.

Recovery time

There is no recovery time associated with botulinum toxin injections. Patients may resume their daily activities immediately following a treatment session.

Cost of Xeomin

In the United States, a Xeomin injection typically costs an average of $450. The price varies depending on the number of units administered.