Contraindications for Xeomin (Botulinum Toxin)
Xeomin is absolutely contraindicated in individuals with known hypersensitivity to botulinum toxin preparations or to any components in the formulation, and in the presence of infection at the proposed injection site(s). 1
Primary Contraindications
- Known hypersensitivity to botulinum toxin: Any patient with a history of allergic reactions to botulinum toxin products should not receive Xeomin 1
- Infection at injection site: Active infection at the proposed injection site is a clear contraindication 1
Special Considerations and Relative Contraindications
Neuromuscular Disorders
- Patients with neuromuscular disorders (e.g., myasthenia gravis, Lambert-Eaton syndrome) may be at increased risk of clinically significant systemic effects including severe dysphagia and respiratory compromise
Risk of Toxin Spread
- Botulinum toxin effects may spread beyond the site of local injection, causing symptoms consistent with botulinum toxin effects 1
- These symptoms may include:
- Asthenia (weakness)
- Generalized muscle weakness
- Diplopia (double vision)
- Ptosis (drooping eyelid)
- Dysphagia (difficulty swallowing)
- Dysphonia (voice changes)
- Dysarthria (speech difficulties)
- Urinary incontinence
- Breathing difficulties
Pregnancy and Lactation
- Use during pregnancy only if the potential benefit justifies the potential risk to the fetus
- Exercise caution when administering to nursing women
Monitoring and Safety Considerations
Risk of Anaphylaxis
- Anaphylaxis risk is approximately 1-2% with botulinum toxin preparations 2
- Epinephrine and antihistamine treatments should be available for all patients receiving botulinum toxin 2
- Caregivers capable of identifying and responding to anaphylaxis should observe patients during administration 2
Post-Injection Precautions
- Patients should remain upright for 3-4 hours after treatment 3
- Avoid touching, rubbing, or massaging the treated areas 3
- Refrain from strenuous exercise for 24 hours 3
- Avoid alcohol consumption for 24 hours 3
- Maintain normal facial expressions but avoid excessive facial movements 3
Important Clinical Notes
- Skin testing before administration is no longer recommended as it requires specialized training, is time-consuming, and has low positive predictive value 2
- The critical period for potential toxin spread is within the first 24-48 hours after injection 3
- Botulinum toxin is not interchangeable between different commercial preparations - dosing is specific to each product 1
Serious Adverse Reactions
- Life-threatening swallowing and breathing difficulties have been reported with botulinum toxin products 1
- Patients or caregivers should seek immediate medical care if swallowing, speech, or respiratory difficulties occur 1
- Serious adverse reactions including excessive weakness, dysphagia, and aspiration pneumonia have been reported, some with fatal outcomes 1
By understanding these contraindications and taking appropriate precautions, clinicians can minimize risks associated with Xeomin administration while maximizing therapeutic benefits for appropriate patients.