Why Are More People Not Using Xeomin?

Question

Seems like a good alternative to Botox and the fact that it does not need to be refrigerated, seems more people would try it. Is there a downside?

James Bonaparte, MD, MSc, FRCSC · Answer

I've asked myself the same question. I am still not ready to recommend Xeomin use to my patients for a few reasons. I should also point out that I am in the process of completing a very large study comparing Botox, Dysport and Xeomin using only the highest quality research (a meta-analysis).

	Like all businesses, there is a lot of marketing. Xeomin's claims to fame are #1 you dont need to refrigerate it and #2 there is less risk of allergies. After reviewing over 20,000 patients in a number of randomized studies, there are no reports of allergies with botox. Yes, there are reports of this happening in other series but it is extremely rare thus I dont believe that Xeomin offers any advantage in this regard. At this point, there is absolutely no evidence one is better than the other. Its just marketing based on "theory." 

	Also, Botox is such a popular brand now, people ask for it by name. I think many people are nervous about trying a product that has been on the market for a few years versus one that has been around over 15 years. I tend to use Botox cause I know it works, its safe and people are happy with the results. 

	Also, there is evidence that Xeomin may not last as long as Botox. Now, this is controversial but hopefully the study I am doing will answer this question. At this  time, there is no reason to believe one lasts longer than the other, however....time will tell. 

	Finally, one of the "benefits" of Xeomin is that it is considered a more purified version of the active component of the toxin. Basically, botulinum toxin contains an active component (that results in the key effect) and some other proteins. Xeomin removed these proteins and thus the notion that there is less of a risk of allergy as some believe the allergy risk is associated with these proteins. However, there is another side to the story. Some people suggest that these proteins are important for making the medication work better, thus some believe this is the reason why Botox may last longer, it keeps some of these "extra" proteins that may have a role in improving its effect. Who knows, maby these proteins are required for things like, finding its way into the nerve it is going to effect. 

	Wheww...Long winded I know, but its a complicated topic and one I find interesting. 

	I think I'll end by saying, I dont know what the right answer is, it may turn out there is no difference between products. But as a physician, my goal is to treat people with a medication that I believe is the safest and most effective available. At this point, Botox is that product. Perhaps my opinion will change once more evidence is out there, but for now, I continue to recommend Botox.

Matthew Richardson, MD · Answer

Botox has excellent name recognition. Even people who don't understand what Botox is, how it works, or even really what it is used for ... still recognize the name Botox. Xeomin is a bit late to the game and that seems to be the biggest limiting factor in its popularity.All the best,

Larry S. Nichter, MD, MS, FACS · Answer

Xeomin, Dysport and Botox are all preparations of botulinum toxin A derived protein that works at the nerve-muscle interface to relax targeted muscles. Each preparation is slightly different, for example the protein size differs. Dysport and Xeomin have been around in Europe for a long time and more recently introduced in the USA. Note the dosage is not the same between the drugs though each works well in my experience.I think that because Xeomin is "the new kid on the block"in the USA, is not dramatically less expensive, and physicians are more comfortable with medications they are already using with good results - it just takes time for Xeomin to gain popularity.

Raffy Karamanoukian, MD, FACS · Answer

Xeomin is a very popular alternative to Botox injections and works well to reduce wrinkles and lines around the eyes and forehead, much like Botox.

Stephen Prendiville, MD · Answer

Your inclination is correct. In my experience, Xeomin is a very good product and is essentially equivalent to Botox in efficacy and duration of results. However, Allergan, the manufacturer of Botox has filed a legal injunction against Merz (the maker of Xeomin) for issues concerning intellectual property. This will prevent sale of Xeomin for aesthetic purposes for the better part of the next year. Although Xeomin can be purchased by practitioners for functional purposes, Merz cannot promote the sale or use of the product until the injunction is lifted. This has obviously affected sales of the product, but does not mean that Xeomin is inferior in quality. Both Botox and Xeomin are forms of Botulinum Toxin type A and work about the same for the majority of patients.

Lisa Gardner, DO · Answer

This comes down to name recognition only! We use Xeomin in our practice almost exclusively. Our patients love it. However, because of the name recognition that Botox possesses we use the name "Botox" in marketing. When patients come in we then explain the similarities and differences between the two. The vast majority choose Xeomin.

Anteneh Roba, MD · Answer

Xeomin needs to be refrigerated after its reconstituted, but not before. While Botox needs to be refrigerated before and after reconstitution.Otherwise except for some minor differences both Xeomin and Botox do the same thing. Most likely explanation is that Botox is a very well known product used in the US for many years, while Xeomin is a German product introduced fairly recently and is not a well known neurotoxin in the US.

Harry Goldin, MD · Answer

Xeomin is an FDA approved botulinum toxin similar to Botox. Its dilutions are the same as Botox and it lasts as long as Botox, but is much less expensive. We have replaced Botox for Xeomin for cosmetic injections. The results have been the same.Xeomin is the "new kid on the block"  and does not have the name recognition as Botox.  Merz may not be advertising as much as they might, and doctors and patients are comfortable with the "name brand."We try to deliver excellent service at the best price.  I have not seen any difference between Xeomin and Botox for cosmetic uses.  The price savings is significant.  I want to save my patients money when I can.  I have only injected Xeomin for cosmetic problems in the past year.

Thomas McFadden, MD · Answer

There is a good chance that more people are not using Xeomin simply because of brand recognition.  Do you buy facial tissue or Kleenex?

Kristin J. Tarbet, MD, FACS · Answer

I have patients that use both and alternate often. Both are great products and Xeomin sets in a bit faster then Botox.

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