What is the proper administration technique for Xiaflex (collagenase clostridium histolyticum)?

Administration of Xiaflex (Collagenase Clostridium Histolyticum)

Xiaflex is administered as an intralesional injection directly into the palpable cord or plaque, followed by a standardized finger extension procedure (for Dupuytren's contracture) or penile modeling (for Peyronie's disease) performed 24-48 hours after injection. 1

Preparation and Injection Technique

For Dupuytren's Contracture

• Reconstitute the vial according to manufacturer specifications to achieve 0.58 mg per injection 2
• Identify the palpable cord causing the contracture in the affected finger 2
• Inject directly into the cord using proper sterile technique 1
• Maximum of 3 injections per cord may be administered during the treatment course 2
• Injections are typically spaced at 4-week intervals between doses 3

For Peyronie's Disease

• Administer under penile block using 10 mL of plain 1% lidocaine for patient comfort 3
• Inject 0.9 mg directly into the plaque causing penile curvature 3
• Standard protocol involves up to 8 injections over 24 weeks (4 treatment cycles of 2 injections each, separated by approximately 6 weeks) 4
• Modified shortened protocol uses 3 injections at 4-week intervals, which has shown comparable efficacy 3

Post-Injection Procedures

Finger Extension (Dupuytren's)

• Perform cord disruption 24 hours after injection using a standardized finger extension procedure 2
• Apply gentle manual pressure to attempt cord disruption 2
• Patients should perform home modeling and stretching exercises between treatment cycles 3

Penile Modeling (Peyronie's)

• Clinician performs modeling after each treatment cycle 4
• Patients must perform home modeling three times daily between treatment cycles 4
• Patients should attempt to straighten the penis without pain during spontaneous erections once daily 4
• Combination of home modeling, stretching, and vacuum device use on a daily basis enhances outcomes 3

Treatment Monitoring and Follow-up

• Assess treatment response 30 days after the last injection 2
• For Dupuytren's: Success is defined as reduction of contracture to 0-5 degrees of normal 2
• For Peyronie's: Measure penile curvature reduction and assess using validated questionnaires (IIEF, PDQ, GAPD) at week 12 3
• Terminate treatment when adequate correction is achieved or after maximum recommended injections 1

Critical Safety Considerations

Common Adverse Events

• Expect localized reactions including penile/hand hematoma (bruising), swelling, and pain in the majority of patients 5
• Most adverse events are mild to moderate and resolve without intervention 5, 2
• No tendon ruptures or systemic allergic reactions were reported in major trials 2

Serious Complications

• Corporal rupture risk exists with Peyronie's treatment—counsel all patients before initiating therapy 4
• One case of flexion pulley rupture occurred in Dupuytren's trials 2
• Monitor for signs of infection at injection sites 1

Contraindications and Precautions

• Do not inject near neurovascular structures to avoid injury 1
• Patients with baseline contracture ≥25 degrees have higher recurrence rates 6
• Recurrence rate is approximately 25% for Dupuytren's contracture during long-term follow-up 6

Practical Pitfalls to Avoid

• Avoid performing injections without proper training in identifying anatomical landmarks and palpable cords/plaques 1
• Do not skip the modeling/extension procedures—these are essential components that significantly enhance treatment efficacy 4, 3
• Do not use in acute inflammatory phase of Peyronie's disease; treatment is indicated for stable disease 4
• Ensure patients understand home exercise requirements—passive treatment without modeling yields suboptimal results 3