How do you reconstitute a bottle of Xeomin (IncobotulinumtoxinA) 100 units for the treatment of hyperhidrosis (excessive sweating) of the axillae (underarms)?

From the FDA Drug Label

To reconstitute XEOMIN, use sterile, preservative-free 0.9% Sodium Chloride Injection, USP. A 20-27 gauge short bevel needle is recommended for reconstitution. Draw up an appropriate amount of preservative-free 0.9% Sodium Chloride Injection, USP into a syringe (see Table 5). Clean the exposed portion of the rubber stopper of the vial with alcohol (70%) prior to insertion of the needle. After vertical insertion of the needle through the rubber stopper, the vacuum will draw the saline into the vial. Gently inject any remaining saline into the vial to avoid foam formation Remove the syringe from the vial and mix XEOMIN with the saline by carefully swirling and inverting/flipping the vial – do not shake vigorously.

To reconstitute a bottle of Xeomin 100 units for hyperhydrosis of the underarms, follow these steps:

• Use sterile, preservative-free 0.9% Sodium Chloride Injection, USP as the diluent.
• Choose a suitable volume of diluent from Table 5 based on the desired concentration of XEOMIN.
• For example, to achieve a concentration of 1 Unit per 0.1 mL, use 5 mL of diluent for a 100 Unit Vial.
• Use a 20-27 gauge short bevel needle for reconstitution.
• Clean the rubber stopper with alcohol (70%) before inserting the needle.
• Insert the needle vertically through the rubber stopper and allow the vacuum to draw the saline into the vial.
• Gently inject any remaining saline into the vial to avoid foam formation.
• Mix the XEOMIN with the saline by carefully swirling and inverting/flipping the vial – do not shake vigorously. 1

From the Research

To reconstitute Xeomin 100 units for hyperhidrosis treatment of the underarms, first gather sterile saline (0.9% sodium chloride) and the Xeomin vial, then draw up 2.5 mL of preservative-free saline into a syringe and slowly inject it into the Xeomin vial. The most recent and highest quality study on the management of hyperhidrosis is from 2018 2, which provides guidance on treatment options but does not specifically address the reconstitution of Xeomin. However, based on general principles of botulinum toxin reconstitution and the provided examples, the process involves using aseptic technique to draw up the saline and inject it into the vial, directing the stream against the glass wall rather than directly onto the powder.

• Gently rotate (don't shake) the vial to dissolve the powder completely, creating a clear, colorless solution with a concentration of 4 units per 0.1 mL.
• For axillary hyperhidrosis, typically 50 units are administered per underarm via multiple intradermal injections spaced about 1-2 cm apart across the area with excessive sweating.
• The reconstituted solution should be used immediately or stored refrigerated for up to 24 hours, as supported by the general principles of handling botulinum toxin products. This dilution allows for precise dosing while minimizing spread to surrounding tissues, which helps target the eccrine sweat glands effectively while reducing the risk of unwanted effects on nearby muscles, consistent with the goal of treating hyperhidrosis with minimal side effects 3.