Xeomin vs. Botox: Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Cosmetic medicine has popularized the use of injectables for promoting smoother, younger looking skin. Xeomin and Botox are two injectable treatments that are commonly used to reduce the appearance of fine lines and wrinkles.

Xeomin and Botox contain botulinum toxin type A, a neurotoxin produced by a bacterial species called Clostridium botulinum. This neurotoxin works by blocking neuromuscular signals to relax targeted muscles at the injection site. Despite the fact that these treatments contain the same active ingredient, they have some differences in how they are used and formulated.

What are the main differences between Xeomin and Botox?

The main difference between Xeomin and Botox is that Xeomin contains a “naked” form of botulinum toxin. Unlike Botox, which contains accessory proteins, Xeomin is designed to deliver the toxin without any protein additives. This purified structure may help prevent antibody resistance, a growing problem that has been seen with botulinum toxin injections administered over time.

Xeomin, which is manufactured by Merz Pharma, can be stored at room temperature or in a refrigerator before using it. Botox is manufactured by Allergan, and it needs to be stored in a refrigerator prior to use.

Main differences between Xeomin and Botox
	Xeomin	Botox
Drug class	Botulinum Toxin Type A Neuromodulators	Botulinum Toxin Type A Neuromodulators
Brand/generic status	Brand name only	Brand name only
What is the generic name?	IncobotulinumtoxinA	OnabotulinumtoxinA
What form(s) does the drug come in?	Injection powder for solution	Injection powder for solution
What is the standard dosage?	Lines and wrinkles: 20 units divided into vie sites (4 units per injection)	Lines and wrinkles: 20 units divided into five sites (4 units per injection)
How long is the typical treatment?	Treatment may need to be repeated every three to four months.	Treatment may need to be repeated every three to four months.
Who typically uses the medication?	Adults 18 years and older	Adults 18 years and older

Conditions treated by Xeomin and Botox

Xeomin was FDA-approved in 2010 to not only treat glabellar lines, or fine lines, but also a number of other conditions. As a cosmetic treatment, Xeomin can help temporarily get rid of frown lines, forehead lines, and crow’s feet around the eyes. Xeomin can also treat excessive drooling and salivation (chronic sialorrhea), as well as abnormal muscle contractions of the neck (cervical dystonia), eyelids (blepharospasm), or limbs (limb spasticity).

Botox was initially FDA approved in 1989. It can be used for cosmetic treatments as well as other conditions such as an overactive bladder, urinary incontinence, and excessive sweating. It is also approved to prevent migraines. Like Xeomin, Botox can treat muscle spasms and abnormal contractions of the limbs, neck, and eyelids.

Condition	Xeomin	Botox
Glabellar lines	Yes	Yes
Excessive drooling/salivation	Yes	Off-label
Abnormal muscle contractions of the neck muscles, eyelids, or limbs	Yes	Yes
Headaches and migraines	Off-label	Yes
Overactive bladder	Off-label	Yes
Urinary incontinence due to a neurological disorder	Off-label	Yes
Excessive sweating	Off-label	Yes

Is Xeomin or Botox more effective?

For cosmetic purposes, Xeomin and Botox are effective treatments. They are both relatively convenient treatments to administer compared to plastic surgery and other invasive procedures.

Both Xeomin and Botox start working once they’re injected into the muscle. For aesthetic purposes, their full effect may not be seen until seven to 14 days after injection or longer.

According to one randomized, double-blind study, Xeomin was found to work faster and last longer than Botox. The study, which assessed 180 people over six months, found that more women experienced greater effects compared to men. Dysport (abobotulinumtoxinA), another botulinum toxin injection, was also included in the study and fared on a similar level with Botox when compared to Xeomin. These 3 medications—Xeomin, Botox, and Dysport—all work in similar ways.  

The Journal of Dermatology Surgery published results from a double-blind clinical trial comparing the active ingredients of Xeomin and Botox. The trial included 250 women who either received 20 units of Xeomin or 20 units of Botox. According to this study, both toxin injections showed similar effectiveness after four months.

Aside from the fact that these injections work in identical ways, they must also be administered by a licensed provider or medical doctor, such as a board-certified dermatologist or plastic surgeon. Consult your provider to determine which option is better for you.

Coverage and cost comparison of Xeomin vs. Botox

Unfortunately, there are no generic versions of Xeomin or Botox available. These drugs are biologic drugs. A similar, less expensive alternative to a biologic drug is called a biosimilar. There are not any biosimilars available at this time for Xeomin or Botox. 

Although they may still be expensive, the good news is that Xeomin and Botox are relatively similar in price. The average retail cost of either drug can be $1,000 or more for a vial. However, since you would be getting treatment administered at a medspa or doctor’s office, your treatment session may be priced differently.

Medicare prescription plans and most insurance plans do not cover Xeomin or Botox. With a SingleCare discount card for Xeomin or Botox, the cash price can be lowered significantly. Depending on the pharmacy you use, Xeomin could cost less than $500 and Botox slightly more than $600.

	Xeomin	Botox
Typically covered by insurance?	No	No
Typically covered by Medicare?	No	No
Standard dosage	1 vial (100 units)	1 vial (100 units)
Typical Medicare copay	$1,109	$1,382
SingleCare cost	$496+	$634+

Common side effects of Xeomin vs. Botox

After receiving an injection, you may experience minor redness, pain, or swelling around the area. 

Side effects and the frequency at which they occur may vary depending on the indication for Xeomin or Botox use. 

In patients taking Xeomin for glabellar lines, the most common side effect is headache, which occurs in about 5% of people. 

In those taking Botox for glabellar lines, forehead lines, or crow’s feet, the most common side effects are headache (occurring in about 9% of people), drooping eyelids (3%), swollen eyelids (1%), and drooping eyebrows (2%).

More serious side effects may include hypersensitivity or allergic reactions. If you experience a rash, difficulty breathing, or swelling of the face, lips, tongue, or throat, seek medical attention immediately.

This is not a complete list of side effects and others may occur. Consult your doctor or pharmacist for more information about possible side effects.

Source: DailyMed (Xeomin), DailyMed (Botox)

Xeomin vs. Botox aftercare

After receiving an injection of Xeomin or Botox, you’ll want to follow some instructions. 

• Do not massage or rub the treated area for 6 to 8 hours after treatment. 
• Do not lie down for 6 hours after the procedure.
• Do not lean forward, shower, or cook over a hot stove for 6 hours after treatment.
• Keep your head in an upright position for at least 6 hours after treatment.
• Do not apply makeup for at least 12 hours after treatment. 
• For the first 24 hours after treatment, avoid exercise/yoga, saunas, facials, sun and heat, and alcohol. 
• Avoid driving until you know how the treatment affects you.
• Ask your healthcare provider about exercises you can do for your treated muscles, such as practicing facial expressions, frowning, or raising your eyebrows. 
• Headaches are a common side effect of botulinum toxin products. Avoid taking aspirin or medications that contain aspirin. Instead, use Tylenol and apply cool compresses. Consult your healthcare provider if headaches persist or worsen. 
• If you experience swelling or discomfort, you can take Tylenol and/or apply cool compresses to the area. 

Consult your healthcare provider for additional instructions and follow-up appointments. 

Drug interactions of Xeomin vs. Botox

Xeomin and Botox should be avoided with other medications that have similar effects. These medications include aminoglycosides, anticholinergics, and muscle relaxants. Taking these drugs while getting a Xeomin or Botox injection could lead to increased side effects.

Xeomin and Botox should also be avoided with other botulinum neurotoxin products. Receiving other toxin injections without a long enough interval between sessions can worsen side effects such as muscle weakness.

Drug	Drug Class	Interacts with Xeomin?	Interacts with Botox?
Gentamicin Tobramycin Streptomycin	Aminoglycosides	Yes	Yes
Atropine Benadryl (diphenhydramine) Benztropine	Anticholinergics	Yes	Yes
Cyclobenzaprine Tizanidine Methocarbamol Metaxalone Carisoprodol	Muscle relaxants	Yes	Yes

This may not be a complete list of all possible drug interactions. Consult a doctor with all the medications you may be taking.

Warnings of Xeomin and Botox

Both Xeomin and Botox have a black box warning, which is the strongest warning required by the FDA. Botulinum toxin has been known to spread from the injection area and cause adverse effects associated with the toxin. These effects include difficulty swallowing or breathing. In severe cases, botulinum toxin can cause paralysis, respiratory failure, and even death. 

These symptoms can occur several hours or even up to several weeks after injection. Get emergency medical help if you have any of the following symptoms:

• Difficulty breathing/shortness of breath
• Difficulty talking or swallowing
• Hoarse voice
• Sore throat, cough
• Chest tightness, pain, or pressure
• Irregular heartbeat
• Unusual or severe muscle weakness (especially in a part of the body that was not injected)
• Loss of bladder control, pain or burning when you urinate, difficulty emptying the bladder
• Drooping eyelids or eyebrows, swollen eyelids, eye crusting/drainage
• Changes in vision, eye pain, or very dry, irritated eyes

It is important to get Xeomin or Botox injected by a licensed professional. Because of the possibility of adverse effects, these medications need to be injected properly and in the correct dosage.

Frequently asked questions about Xeomin vs. Botox

What is Xeomin?

Xeomin is the brand name for incobotulinumtoxinA injections. Xeomin is often used to reduce fine lines and wrinkles. Injections should be given every three to four months for consistent results.

What is Botox?

Botox is a commonly used botulinum toxin injection for cosmetic purposes. Botox contains onabotulinumtoxinA and is injected every three to four months. It is also FDA-approved for the prevention of migraines as well as treatment of other conditions.

Are Xeomin and Botox the same?

Xeomin and Botox both contain botulinum toxin. But they are not the same drug. Unlike Botox, Xeomin contains a different form of botulinum toxin with no accessory proteins. Xeomin also has less storage restrictions, meaning it doesn’t have to be refrigerated before use.

Is Xeomin or Botox better?

Xeomin and Botox both work to smooth the skin and get rid of frown lines. While they are both comparable in effectiveness, some studies have shown that Xeomin has a quicker onset of action and a longer duration. The best treatment is the one that your practitioner recommends for your specific condition.

Can I use Xeomin or Botox while pregnant?

Since Xeomin and Botox are usually localized treatments, they have a low risk of getting into the bloodstream. That being said, there is still a risk of fetal harm, especially if large amounts are administered. Consult your healthcare provider if you are pregnant or planning to become pregnant and seek treatment with Xeomin or Botox.

Can I use Xeomin or Botox with alcohol?

Alcohol has blood-thinning properties, which may worsen the side effects of some drugs. It’s usually recommended to hold off on drinking alcohol for at least 24 hours after your Xeomin or Botox session. Otherwise, alcohol may increase the risk of bruising or swelling around the treatment area.

Which lasts longer: Xeomin vs. Botox?

Botulinum toxin injections usually last at least three months. Some people may experience effects that last up to four to five months or longer depending on the area treated and the dose injected. According to some studies, women who received Xeomin for glabellar lines reported longer-lasting effects compared to Botox.

Can Xeomin and Botox injections be repeated?

Yes. Either drug can be administered every 3 or 4 months, but not sooner than 3 months. Follow-up visits will depend on your condition(s) and response to treatment. Consult your healthcare provider for guidance on follow-up injections of Xeomin or Botox. 

Can you mix Botox and Xeomin?

No. These drugs are very similar. The effect of administering two different botulinum neurotoxin medications at the same time, or even within a few months of each other, is not known. However, it would be expected to cause excessive muscle weakness or other problems.

How many units of Xeomin is equal to Botox?

Botox and Xeomin are dosed in a similar way. Twenty units of Botox is equal to the strength of 20 units of Xeomin. 

What is the average cost of Xeomin?

The cost of Xeomin depends on where you purchase it from. If you are buying a vial from the pharmacy, the average retail price can be around $1,000. With a free SingleCare Xeomin discount card, the price can be lowered to under $300 for a 100-unit vial. You would, however, most likely receive Xeomin treatments from a medspa or dermatology clinic. Since insurance does not typically cover Xeomin injections, the price will vary based on where you go.

How fast does Xeomin work?

Xeomin starts working right after it’s injected into the targeted facial muscles. However, the visible effects of Xeomin treatments may not be seen for at least seven days after administration. It’s best to follow up with your provider seven to 14 days after your treatment to evaluate the results.