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Xeomin

Last reviewed on RxList: 7/11/2018
Xeomin Side Effects Center

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 7/11/2018

Xeomin (incobotulinumtoxinA) is botulinum toxin type A used to treat cervical dystonia (severe spasms in the neck muscles), and also to treat certain eye muscle conditions caused by nerve disorders. This includes uncontrolled blinking or spasm of the eyelids, and a condition in which the eyes do not point in the same direction. Common side effects include:

  • neck pain
  • dry eyes
  • headache
  • tired feeling
  • diarrhea
  • eyelid swelling or bruising
  • blinking less than usual
  • pain, redness, or swelling where the injection was given

The recommended initial total dose of Xeomin for cervical dystonia is 120 Units. Xeomin may interact with cold or allergy medicines, muscle relaxers, sleeping pills, bronchodilators, bladder or urinary medicines, irritable bowel medicines, blood thinners, or injected antibiotics. Tell your doctor all medications and supplements you use. It is unknown if Xeomin will harm a fetus. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. It is unknown if this drug passes into breast milk or if it could harm a nursing baby. Consult your doctor before breastfeeding.

Our Xeomin (incobotulinumtoxinA) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Xeomin Consumer Information

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; feeling like you might pass out; swelling of your face, lips, tongue, or throat.

The botulinum toxin contained in this medication can spread to other body areas beyond where it was injected. This has caused serious life-threatening side effects in some people receiving botulinum toxin injections, even for cosmetic purposes.

Call your doctor at once if you have any of these side effects, some of which can occur up to several weeks after an injection:

  • trouble breathing, talking, or swallowing;
  • hoarse voice, drooping eyelids;
  • blurred vision, double vision;
  • unusual or severe muscle weakness (especially in a body area that was not injected with the medication);
  • loss of strength, loss of bladder control;
  • wheezing, tightness in your chest;
  • eye pain or irritation;
  • severe skin rash or itching; or
  • feeling like you might pass out.

Common side effects may include:

  • neck pain;
  • dry eyes;
  • headache, tired feeling;
  • diarrhea;
  • eyelid swelling or bruising, blinking less than usual; or
  • pain, redness, or swelling where the injection was given.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Read the entire detailed patient monograph for Xeomin (Incobotulinumtoxin A for Injection)

Xeomin Professional Information

SIDE EFFECTS

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

  • Spread of Effects from Toxin [see WARNINGS AND PRECAUTIONS]
  • Lack of Interchangeability between Botulinum Toxin Products [see WARNINGS AND PRECAUTIONS]
  • Dysphagia and Breathing Difficulties [see WARNINGS AND PRECAUTIONS]
  • Corneal Exposure, Corneal Ulceration, and Ectropion in Patients Treated with XEOMIN for Blepharospasm [see WARNINGS AND PRECAUTIONS]
  • Risk of Ptosis in Patients Treated for Glabellar Lines [see WARNINGS AND PRECAUTIONS]
  • Human Albumin and Transmission of Viral Diseases [see WARNINGS AND PRECAUTIONS]

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.

Chronic Sialorrhea

Table 4 lists the adverse reactions that occurred in ≥3% of XEOMIN-treated patients in the double-blind, placebo-controlled phase of the study in patients with chronic sialorrhea [see Clinical Studies]. The most common adverse reactions (≥4%) were tooth extraction, dry mouth, diarrhea, and hypertension. In the controlled portion of this study, 74 patients received 100 Units of XEOMIN and 36 patients received placebo. XEOMIN-treated patients were 21-80 years old (mean 65 years), and were predominantly male (71%) and white (99.5%).

Table 4: Adverse Reactions (≥3%) and Greater for XEOMIN than Placebo: Double-Blind Phase of the Placebo-Controlled Chronic Sialorrhea Study

Adverse Reaction XEOMIN 100 Units
(N = 74) (%)
Placebo
(N = 36) (%)
Tooth extraction 5 0
Dry mouth 4 0
Diarrhea 4 3
Hypertension 4 3
Fall 3 0
Bronchitis 3 0
Dysphonia 3 0
Back pain 3 0
Dry eye 3 0

Upper Limb Spasticity

Table 5 lists the most common (≥2%) adverse reactions following injection of XEOMIN in two placebo-controlled, Phase 3 studies in patients with upper limb spasticity. Study 1 and Study 2 were both double-blind, placebo-controlled studies, with an open-label extension [see Clinical Studies]. In the controlled portion of these studies, 283 patients received ≥120 Units to 400 Units, of which 217 patients received at least 400 units of XEOMIN, and 182 patients received placebo. XEOMIN-treated patients were 20-79 years old (mean 56 years), and were predominantly male (58%) and white (84%).

Table 5: Most Common Adverse Reactions (≥2%) and Greater for XEOMIN than Placebo: Double-Blind Phase of Placebo-Controlled Upper Limb Spasticity Study 1 and Study 2

Adverse Reaction XEOMIN 400 Units
(N = 217) (%)
Placebo
(N = 182) (%)
Seizure 3 0
Nasopharyngitis 2 0
Dry mouth 2 1
Upper respiratory tract infection 2 1

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 6: Most Common Adverse Reactions (≥5%) and Greater than Placebo: Double-Blind Phase of Cervical Dystonia Clinical Trial

Adverse Reaction XEOMIN 120 Units
(N=77) %
XEOMIN 240 Units
(N=82) %
Placebo
(N=74) %
Any Adverse Reactions 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 mediastinal disorders 13 10 3

Blepharospasm

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 7: Most Common Adverse Reactions (≥5%) and Greater than Placebo: Double-Blind Phase of Blepharospasm Clinical Trial

Adverse Reaction XEOMIN
(N=74) %
Placebo
(N=34) %
Subjects with Adverse Reactions 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
Diarrhea 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
Dyspnea 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 8: Adverse Reactions in Placebo-Controlled Glabellar Lines Trials

Adverse reactions XEOMIN
(N=535) (% )
Placebo
(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.

Immunogenicity

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 of 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 entire FDA prescribing information for Xeomin (Incobotulinumtoxin A for Injection)

Related Resources for Xeomin

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© Xeomin Patient Information is supplied by Cerner Multum, Inc. and Xeomin Consumer information is supplied by First Databank, Inc., used under license and subject to their respective copyrights.

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