A guide to dosing in the treatment of cervical dystonia and blepharospasm with Xeomin ®: A new botulinum neurotoxin A

Fernando L. Pagan, Andrew Harrison

Research output: Contribution to journalReview articlepeer-review

10 Scopus citations


Xeomin ® (incobotulinumtoxinA; Merz Pharmaceuticals, Frankfurt am Main, Germany) was first introduced in Germany for movement disorders in 2005. In 2010, it was approved for use in the United States by the FDA for the treatment of cervical dystonia (CD) and blepharospasm. It is a unique botulinum type A formulation free of any complexing proteins and contains only the pure 150 kD neurotoxin. Thus, the formation of neutralizing antibodies is not induced even after long-term treatment. The purpose of this report is to review the safety profile and dosing schedule for Xeomin for the treatment of CD and blepharospasm. The recommended dose for patients with CD is 120 U/treatment, with administration intervals normally between 3 and 6 months. However, clinical studies have found Xeomin to be safe and effective at doses up to 400 U in both previously treated and treatment-naïve patients. The recommended starting dose in patients with blepharospasm is 2.5-5.0 U/injection site. Patients can be switched using a 1:1 conversion ratio from Botox ® (onabotulinumtoxinA, Allergen Inc., Irvine, CA, USA) to Xeomin without any loss of efficacy or safety concerns. Xeomin does not differ from Botox in terms of its potency, onset, diffusion profile, or duration and waning of effect. It is the only botulinum treatment that is stable for up to 3 years at room temperature. Xeomin offers a new and important treatment option for movement disorders.

Original languageEnglish (US)
Pages (from-to)441-445
Number of pages5
JournalParkinsonism and Related Disorders
Issue number5
StatePublished - Jun 2012

Bibliographical note

Funding Information:
This project was supported, in part, by an unrestricted grant from Research to Prevent Blindness and the Lions of Minnesota . This project was also supported by Merz Pharmaceuticals . Editorial support was provided by The Curry Rockefeller Group, LLC, Tarrytown, NY, which was supported by Merz Pharmaceuticals. Dr Pagan has received research grants from Medtronic , Soltice Neuroscience , and Teva Neuroscience ; has been a consultant and/or speaker for Allergan, Boehringer Ingelheim, GlaxoSmithKlein, Ipsen, Medtronic, Novartis, Soltice Neuroscience, and Teva Neuroscience; and served on an advisory panel for Merz Pharmaceuticals. Dr Harrison is a paid consultant for Merz Pharmaceuticals.


  • Antibodies
  • Complexing proteins
  • Formulation
  • Hemagglutinins
  • Movement disorders
  • Safety


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