"The US Food and Drug Administration (FDA) has approved diclofenac sodium injection (Dyloject, Hospira Inc), a proprietary nonsteroidal anti-inflammatory drug (NSAID) for the treatment of mild to moderate pain, and for the management of mod"...
XEOMIN (incobotulinumtoxinA) is indicated for the treatment of adults with cervical dystonia to decrease the severity of abnormal head position and neck pain in both botulinum toxin-na´ve and previously treated patients.
XEOMIN (incobotulinumtoxinA) is indicated for the treatment of adults with blepharospasm who were previously treated with onabotulinumtoxinA (Botox).
XEOMIN (incobotulinumtoxinA) is indicated for the temporary improvement in the appearance of moderate to severe glabellar lines associated with corrugator and/or procerus muscle activity in adult patients.
DOSAGE AND ADMINISTRATION
The potency Units of XEOMIN (incobotulinumtoxinA) for injection are specific to the preparation and assay method utilized. They are not interchangeable with other preparations of botulinum toxin products and, therefore, Units of biological activity of XEOMIN cannot be compared to or converted into Units of any other botulinum toxin products assessed with any other specific assay method [see WARNINGS AND PRECAUTIONS and DESCRIPTION].
The recommended initial total dose of XEOMIN for cervical dystonia is 120 Units. In a placebo-controlled trial utilizing initial XEOMIN doses of 120 Units and 240 Units, no meaningful difference in effectiveness was demonstrated between the doses [see Clinical Studies]. In previously treated patients, their past dose, response to treatment, duration of effect, and adverse event history should be taken into consideration when determining the XEOMIN dose.
In the treatment of cervical dystonia, XEOMIN is usually injected into the sternocleidomastoid, levator scapulae, splenius capitis, scalenus, and/or the trapezius muscle(s). This list is not exhaustive, as any of the muscles responsible for controlling head position may require treatment [see Clinical Studies]. The dose and number of injection sites in each treated muscle should be individualized based on the number and location of the muscle(s) to be treated, the degree of spasticity/dystonia, muscle mass, body weight, and response to any previous botulinum toxin injections.
The frequency of XEOMIN repeat treatments should be determined by clinical response, but should generally be no more frequent than every 12 weeks [see Clinical Studies].
The recommended initial total dose of XEOMIN should be the same dose as the patient's previous treatment of onabotulinumtoxinA (Botox), although responses to XEOMIN and onabotulinumtoxinA (Botox) may differ in individual patients. In a placebo-controlled trial in which patients were dosed with the same number of Units as they had received previously with onabotulinumtoxinA (Botox), the mean dose per eye was about 33 Units (range 10-50 Units), and the mean number of injections per eye was 6. The maximum dose per eye in the controlled trials was 50 Units, with a range of 10-50 Units. In the controlled trial, few patients received a total dose of greater than 75 Units.
If the previous dose of Botox is not known, the initial dose of XEOMIN should be between 1.25-2.5 Units/injection site.
The total initial dose of XEOMIN in both eyes should not exceed 70 Units (35 Units/eye).
The number and location of injection sites should be based on the severity of blepharospasm, and previous dose and response to onabotulinumtoxinA (Botox) injections. Subsequent dosing should be tailored to the individual patient, based on response, up to a maximum dose of 35 Units per eye [see Clinical Studies]. XEOMIN dosing has not been established in patients with blepharospasm who have not been previously treated with onabotulinumtoxinA (Botox).
The frequency of XEOMIN repeat treatments should be determined by clinical response but should generally be no more frequent than every 12 weeks [see Clinical Studies].
The total recommended XEOMIN dose is 20 Units per treatment session divided into five equal intramuscular injections of 4 Units each. The five injection sites are: two injections in each corrugator muscle and one injection in the procerus muscle.
Retreatment with XEOMIN should be administered no more frequently than every three months.
Figure 1: Injection Sites for Glabellar Lines
The safety and effectiveness of XEOMIN in the treatment of cervical dystonia, blepharospasm, and glabellar lines in patients below 18 years of age have not been assessed [see WARNINGS AND PRECAUTIONS].
Preparation and Reconstitution Technique
Prior to injection, reconstitute each vial of XEOMIN with sterile, preservative-free 0.9% Sodium Chloride Injection, USP. Draw up an appropriate amount of preservative-free 0.9% Sodium Chloride Injection, USP into a syringe (see Table 1). Clean the exposed portion of the rubber stopper of the vial with alcohol (70%) prior to insertion of the needle. Gently inject the saline solution into the vial. If the vacuum does not pull the solvent into the vial, then XEOMIN must be discarded. Gently mix XEOMIN with the saline by rotating the vial. Reconstituted XEOMIN is a clear, colorless solution free of particulate matter. XEOMIN should not be used if the reconstituted solution has a cloudy appearance or contains floccular or particulate matter.
Diluent volumes for reconstitution of XEOMIN are indicated in Table 1.
Table 1: Diluent Volumes for Reconstitution of XEOMIN
|Volume of Preservative-free 0.9% Sodium Chloride Injection, USP||50 Unit Vial:
Resulting dose in Units per 0.1 mL
|100 Unit Vial:
Resulting dose in Units per 0.1 mL
|0.25 mL||20 Units||-|
|0.5 mL||10 Units||20 Units|
|1 mL||5 Units||10 Units|
|1.25 mL||4 Units||8 Units|
|2 mL||2.5 Units||5 Units|
|2.5 mL||2 Units||4 Units|
|4 mL||1.25 Units||2.5 Units|
|5 mL||1 Unit||2 Units|
|8 mL||-||1.25 Units|
Reconstituted XEOMIN solution should be administered within 24 hours after dilution. During this time period, reconstituted XEOMIN should be stored in a refrigerator 2-8°C (36-46°F) [see Storage and Handling].
Reconstituted XEOMIN is intended for intramuscular injection only. After reconstitution, XEOMIN should be used for only one injection session and for only one patient.
If proposed injection sites are marked with a pen, the product must not be injected through the pen marks; otherwise a permanent tattooing effect may occur.
The number of injection sites is dependent upon the size of the muscle to be treated and the volume of reconstituted XEOMIN injected.
XEOMIN should be injected carefully when injected at sites close to sensitive structures, such as the carotid artery, lung apices and esophagus. Before administering XEOMIN, the physician should be familiar with the patient's anatomy and any anatomic alterations, e.g., due to prior surgical procedures.
A suitable sterile needle (e.g., 26-gauge (0.45 mm diameter), 37 mm length for superficial muscles; or 22-gauge (0.70 mm diameter), 75 mm length for injections into deeper muscles) should be used in the administration in the treatment of cervical dystonia.
Localization of the involved muscles with electromyographic guidance or nerve stimulation techniques may be useful.
A suitable sterile needle (e.g., 26-gauge (0.45 mm diameter), 37 mm length for superficial muscles; or 22-gauge (0.70 mm diameter), 75 mm length for injections into deeper muscles) should be used in the administration in the treatment of blepharospasm.
A suitable sterile needle 30-33 gauge (0.3-0.2 mm diameter), 13 mm length should be used in the administration in the treatment of glabellar lines.
Monitoring to Assess Effectiveness
The median first onset of XEOMIN effect occurs within seven days after injection. The typical duration of effect of each treatment is up to 3 months; however, the effect may last significantly longer, or shorter, in individual patients.
Dosage Forms And Strengths
Single-use, sterile 50 Units or 100 Units lyophilized powder for reconstitution only with sterile, preservative-free 0.9% Sodium Chloride Injection, USP, prior to injection.
Type 1 borosilicate glass single-use vials with latex-free bromobutyl rubber closures and tamper-proof aluminum seals in the following pack sizes:
Cervical Dystonia and Blepharospasm
|Package||XEOMIN 50 Units||XEOMIN 100 Units|
|single vial pack||NDC 0259-1605-01||NDC 0259-1610-01|
|Package||XEOMIN 50 Units||XEOMIN 100 Units|
|single vial pack||NDC 46783-161-01||NDC 46783-160-01|
Unopened vials of XEOMIN can be stored at room temperature 20 to 25°C (68 to 77° F), in a refrigerator at 2 to 8°C (36 to 46°F), or a freezer at -20 to -10°C (-4 to 14°F) for up to 36 months. Do not use after the expiration date on the vial. Reconstituted XEOMIN should be stored in a refrigerator at 2 to 8°C (36 to 46°F) and administered within 24 hours.
XEOMIN is reconstituted prior to use with sterile preservative-free 0.9% Sodium Chloride Injection, USP [see DOSAGE AND ADMINISTRATION].
XEOMIN should not be used if the reconstituted solution has a cloudy appearance or contains floccular or particulate matter.
Any reconstituted toxin solution for injection that has been stored for more than 24 hours, as well as any unused solution for injection, should be discarded.
Manufactured by: Merz Group Services GmbH Am Pharmapark 15 A, D-06861 Dessau-Rosslau, Germany. Distributed by: Merz Pharmaceuticals, LLC, 4215 Tudor Lane, Greensboro, NC 27410 and Merz Aesthetics, Inc. 4133 Courtney Road, Suite 10, Franksville, WI 53126. Revised: 07/2011
Last reviewed on RxList: 8/9/2011
This monograph has been modified to include the generic and brand name in many instances.
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