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Side Effects


The following adverse reactions to XEOMIN are discussed in greater detail in other sections of the labeling:

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug, and may not reflect the rates observed in practice.

Cervical Dystonia

The data described below reflect exposure to a single intramuscular dose of XEOMIN in a placebo-controlled, Phase 3 trial in patients with cervical dystonia [see Clinical Studies]. In this study, 159 patients received XEOMIN (78 were randomized to receive a total dose of 120 Units, and 81 were randomized to receive a total dose of 240 Units). XEOMIN-treated patients were 18 to 79 years old (mean 53 years), and were predominantly female (66%) and Caucasian (91%). At study baseline, approximately 25% had mild, 50% had moderate, and 25% had severe cervical dystonia. Approximately 61% of XEOMIN-treated patients had previously received another botulinum toxin type A product. Common adverse events ( ≥ 5% in any XEOMIN treatment group) observed in patients who received XEOMIN (120 Units or 240 Units) included dysphagia, neck pain, muscle weakness, injection site pain, and musculoskeletal pain.

Table 2: Most Common TEAEs ( ≥ 5%) and Greater than Placebo: Double-Blind Phase of Clinical Trial

System Organ ClassPreferred Term Double-Blind Phase
XEOMIN 120 Units
XEOMIN 240 Units
Any TEAEs 57% 55% 42%
Musculoskeletal and connective tissue disorders 23% 32% 11%
  Neck pain 7% 15% 4%
  Muscular weakness 7% 11% 1%
  Musculoskeletal pain 7% 4% 1%
Gastrointestinal disorders 18% 24% 4%
  Dysphagia 13% 18% 3%
Nervous system disorders 16% 17% 7%
General disorders and administration site conditions 16% 11% 11%
  Injection site pain 9% 4% 7%
Infections and infestations 14% 13% 11%
Respiratory, thoracic and 13% 10% 3%


In the placebo-controlled Phase 3 trial in patients with blepharospasm previously treated with onabotulinumtoxinA (Botox) [see Clinical Studies], 74 patients received XEOMIN at a mean dose of approximately 33 Units per eye (minimum 10 Units, maximum 50 Units). XEOMIN-treated patients were 22 to 79 years of age (mean 62 years), predominantly female (65%), Caucasian (79%), and had a mean time since diagnosis of approximately 5 years.

The adverse events occurring in ≥ 5% of XEOMIN-treated patients and greater than placebo in the Phase 3 study were eyelid ptosis, dry eye, dry mouth, diarrhea, headache, visual impairment, dyspnea, nasopharyngitis, and respiratory tract infection. No serious adverse events occurred in patients who received XEOMIN; one placebo-treated patient experienced a serious adverse event (dyspnea).

Table 3: Most Common TEAEs ( ≥ 5%) and Greater than Placebo: Double-Blind Phase of Clinical Trial

System Organ Class
Preferred Term
Double-Blind Phase
Subjects with TEAEs 70% 62%
Eye disorders 38% 21%
  Eyelid ptosis 19% 9%
  Dry eye 16% 12%
  Visual impairment* 12% 6%
Gastrointestinal disorders 30% 15%
  Dry mouth 16% 3%
  Diarrhoea 8% -
Infections and infestations 20% 15%
  Nasopharyngitis 5% 3%
  Respiratory tract infection 5% 3%
Nervous system disorders 14% 9%
  Headache 7% 3%
General disorders and administration site conditions 11% 9%
Respiratory, thoracic and mediastinal disorders 11% 3%
  Dyspnoea 5% 3%
*including vision blurred

Glabellar Lines

In three placebo-controlled trials in 803 subjects with glabellar lines, 535 subjects received a single dose of 20 Units XEOMIN and 268 subjects received placebo. XEOMIN treated subjects were 24 to 74 years old, and were predominantly female (88%). The most frequent adverse reactions in XEOMIN treated subjects were: headache 29 (5.4%), facial paresis 4 (0.7%), injection site hematoma 3 (0.6%) and eyelid edema 2 (0.4%). Four serious adverse events occurred in two placebo-treated subjects. Six XEOMIN treated subjects experienced six serious adverse events. All serious adverse events were assessed as unrelated to study drug.

The adverse reactions below reflect exposure to XEOMIN with glabellar lines in placebo-controlled studies. Adverse reactions are adverse events in which there is some basis to believe there is a causal relationship between the drug and the occurrence of the adverse event.

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

Table 4: Adverse Reactions in Placebo-Controlled Trials

Adverse reactions XEOMIN
(N=535) (%)
(N=268) (%)
Nervous system disorders 33 (6.1) 6 (2.2)
  Headache1 29 (5.4) 6 (2.2)
  Facial paresis (brow ptosis) 4 (0.7) 0
General disorders and administration site conditions 5 (0.9) 2 (0.7)
  Injection site hematoma 3 (0.6) 0
  Injection site pain 1 (0.2) 0
  Facial pain 1 (0.2) 0
  Injection site swelling 0 1 (0.4)
  Sensation of pressure 0 1 (0.4)
Eye disorders 5 (0.9) 0
  Eyelid edema 2(0.4) 0
  Blepharospasm 1 (0.2) 0
  Eye disorder 1(0.2) 0
  Eyelid ptosis 1(0.2) 0

In open label, multiple dose trials, adverse reactions were reported for 105 of the 800 subjects (13.1%). Headache was the most common adverse reaction, reported for 57 subjects (7.1%), followed by injection site hematoma in 8 subjects (1.0%). Adverse reactions reported in less than 1% of subjects were: facial paresis (brow ptosis), muscle disorder (elevation of eyebrow), injection site pain, and eyelid edema.


As with all therapeutic proteins, there is a potential for immunogenicity.

The incidence of antibody formation is highly dependent on the sensitivity and specificity of the assay. In addition, the observed incidence of antibody positivity in an assay may be influenced by several factors including assay methodology, sample handling, timing of sample collection, concomitant medications, and underlying disease. For these reasons, comparison of the incidence of antibodies across products in this class may be misleading.

Postmarketing Experience

The following adverse reactions have been reported during post-approval use with XEOMIN. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure: eye swelling, eyelid edema, dysphagia, nausea, flu-like symptoms, injection site pain, injection site reaction, allergic dermatitis, localized allergic reactions like swelling, edema, erythema, pruritus or rash, herpes zoster, muscular weakness, muscle spasm, dysarthria, myalgia and hypersensitivity.

Read the Xeomin (incobotulinumtoxin a for injection) Side Effects Center for a complete guide to possible side effects


No formal drug interaction studies have been conducted with XEOMIN.

Coadministration of XEOMIN and aminoglycoside antibiotics or other agents interfering with neuromuscular transmission, e.g., tubocurarine-type muscle relaxants, should only be performed with caution as these agents may potentiate the effect of the toxin.

Use of anticholinergic drugs after administration of XEOMIN may potentiate systemic anticholinergic effects.

The effect of administering different botulinum toxin products at the same time or within several months of each other is unknown. Excessive neuromuscular weakness may be exacerbated by administration of another botulinum toxin prior to the resolution of the effects of a previously administered botulinum toxin. Excessive weakness may also be exaggerated by administration of a muscle relaxant before or after administration of XEOMIN.

This monograph has been modified to include the generic and brand name in many instances.

Last reviewed on RxList: 12/14/2015

Side Effects

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