Botox, the brand name for onabotulinumtoxinA, is used to treat several medical conditions other than its popular use for smoothing facial wrinkles. Xeomin, the brand name for IncobotulinumtoxinA, is a newer product similar to Botox. Botox and Xeomin are basically neurotoxins, that work by affecting the nervous tissue; hence, they are said to work in a similar fashion. However, unlike other neurotoxins like Botox and Dysport, Xeomin contains no bounding albumin protein. This keeps its molecules pure, minimizing chances of allergic reactions. Moreover, Xeomin can be kept at room temperature before reconstitution; Botox needs to be kept either frozen or refrigerated.

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Botox versus Xeomin comparison chart
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Medicine Class Neurotoxin Neurotoxin
Other Name OnabotulinumtoxinA IncobotulinumtoxinA
Company Allergan Merz
Made from Toxin produced by bacterium Clostridium botulinum Botulinum toxin type A produced from fermentation of Hall strain Clostridium botulinum serotype A
Primary use Temporary smoothing of facial wrinkles Temporary smoothing of facial wrinkles
Other uses Treats severe underarm sweating, cervical dystonia (contraction of neck and shoulder muscles), blepharospasm (uncontrolled blinking), strabismus (misaligned eyes), chronic migraine, overactive bladder. Treats cervical dystonia (contraction of neck and shoulder muscles), blepharospasm (uncontrolled blinking), strabismus (misaligned eyes), chronic migraine.
Application Given as a number of tiny injections Given as an injection
How it Works Weakens or paralyzing certain muscles, blocks certain nerves. Relaxes muscle by blocking release of chemical called acetylcholine
Length of Effects 3 to 12 months, depending on what is being treated 3-6 months
Effective 4-7 days after injection 5-14 day after injection
Risks May spread from injection area and affect other muscles. May spread from injection area and affect other muscles.

What is Botox?

Botox or OnabotulinumtoxinA is made from the toxin produced by the bacterium Clostridium botulinum. This is the same toxin that causes a life-threatening type of food poisoning called botulism. Botox belongs to a class of drugs known as neurotoxins and is used to treat several medical conditions, but its most popular use is the temporary smoothing of facial wrinkles.

What is Xeomin?

Xeomin is the brand name for IncobotulinumtoxinA, a Botulinum toxin type A produced from fermentation of Hall strain Clostridium botulinum serotype A. Xeomin, also a neurotoxin, is a relatively newer product and like Botox or Dysport, is mainly used for the temporary smoothing of facial wrinkles.

How it Works

Both Botox and Xeomin are given as a number of tiny injections. Botox weakens or paralyzes muscles near the injection site by blocking certain nerves, while Xeomin relaxes muscles near the injection site by blocking the release of a chemical called acetylcholine. When the nerves command the muscle to contract, there is no muscle response. Wrinkles are basically a result of the contracting of muscle; injecting a neurotoxin relaxes the muscles, causing less wrinkles.

The effects of Botox last three to 12 months, depending on what is being treated. The effects of Xeomin last three to six months.

How the Toxins Exit the Body

Small amounts of neurotoxin products like Botox and Xeomin naturally degrade into the body with time. The body may make new collagen in the areas where the cosmetic dermal fillers begin to slowly break down and degrade. How Botox leaves the body is explained in this very brief video:

Which is Better?

Botox and Xeomin are very similar. However, Botox acts faster, taking between four to seven days, whereas Xeomin can take up to two weeks to take effect. Botox also lasts longer, up to a year. Xeomin lasts a maximum of six months. They exhibit the same diffusion pattern.

One key difference is that Botox mixes the Clostridium botulinum molecule with proteins, whereas Xeomin contains no bounding albumin protein, keeping the molecules pure. This results in fewer allergic reactions. Another advantage is that unlike Botox, Xeomin can be kept at room temperature before reconstitution. Dr. Michael Lesser speaks more on the difference between Botox and Xeomin.

Precautions

Patients considering Botox should give detailed medical history to their doctor. Muscle or nerve conditions such as amyotrophic lateral sclerosis -- ALS or Lou Gehrig’s disease -- myasthenia gravis or Lambert-Eaton syndrome should especially be maintained. Patients should also detail bleeding problems, history of seizures; hyperthyroidism -- a condition that occurs when the thyroid gland produces too much thyroid hormone -- lung or heart disease.

Patients considering Xeomin should especially mention bleeding problems, seizures, heart disease, dysphagia – trouble swallowing --and breathing problems such as asthma, emphysema or aspiration-type pneumonia. Doctors should also be told about muscle or nerve disorders such as Lou Gehrig's disease, Lambert-Eaton syndrome or myasthenia gravis and history of seizures.

Risks

Both Botox and Xeomin can diffuse from the injection site and affect muscles other than the ones targeted. The muscles that control breathing and swallowing can be affected. If this happens, patients may develop severe problems breathing or swallowing. These effects may last for several months or may cause death. Patients who have difficulty swallowing, may need to be fed through a feeding tube to avoid getting food or drink into the lungs.

Side Effects

Some common side effects of Botox may be pain, swelling, or bruising at the injection site; headache; dry mouth; neck, bone, or muscle pain; tiredness; nausea; constipation; anxiety; dry or irritated eyes; difficulty falling asleep or staying asleep. Rare but serious side effects may also be experienced. These are double, blurred, or decreased vision; eyelid swelling; difficulty moving the face; seizures; irregular heartbeat; inability to empty bladder; pain or burning when urinating or frequent urination.

Common side effects of Xeomin include pain or tenderness in injection site; headache; dry mouth; diarrhea; neck, bone, or muscle pain; tiredness; reduced blinking or effectiveness of blinking. Rare but serious side effects may be vision changes, eyelid swelling, eye pain or irritation, itching, neck pain, shortness of breath, fainting.

Allergic and Overdose Reactions

Patients may exhibit an allergic reaction to Botox. Symptoms include itching, rash, red itchy welts, wheezing, asthma symptoms, dizziness or feeling faint.

Symptoms of allergic reaction to Xeomin include dizziness, rash, hives, itching and swelling of the hands, feet, ankles, or lower legs.

The symptoms of overdose for both Botox and Xeomin are the same: serious muscle weakness, breathing problems and paralysis.

Drug Interactions

Botox may interact with the following drugs: certain antibiotics, such as aminoglycosides, gentamicin and polymyxin; anticoagulants such as warfarin; Alzheimer's disease drugs, such as donepezil, galantamine, rivastigmine and tacrine; myasthenia gravis drugs, such as ambenonium and pyridostigmine; and quinidine.

Xeomin interacts with certain antibiotics such as amikacin, clindamycin, colistimethat, gentamicin, kanamycin, lincomycin, neomycin, polymyxin, streptomycin, and tobramycin; anticoagulants; cholinesterase inhibitors such as ambenonium, donepezil, galantamine, neostigmine, physostigmine, pyridostigmine, rivastigmine, and tacrine; magnesium sulfate; medications for allergies, colds, or sleep; muscle relaxants; and quinidine.

Other Uses

Botox is also used to treat the following disorders: severe underarm sweating; cervical dystonia, a neurological disorder that causes severe neck and shoulder muscle contractions; blepharospasm, uncontrollable blinking; strabismus, misaligned eyes; chronic migraine and overactive bladder.

Xeomin is also used to treat the following disorders:; cervical dystonia, a neurological disorder that causes severe neck and shoulder muscle contractions; blepharospasm, uncontrollable blinking; strabismus, misaligned eyes and chronic migraines.

References

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