XEOMIN® Dose Calculator

Pediatric Chronic Sialorrhea Treatment Guide & Dosing Calculator

Botulinum Toxin Type A - Individualized Body Weight-Adapted Dosing

Indication

XEOMIN® (Botulinum Toxin Type A) is indicated for the symptomatic treatment in children and adolescents aged 2 to 17 years and weighing ≥ 12 kg of chronic sialorrhea due to neurological/neurodevelopmental disorders.

Total Dose Range

20 to 75 units

Distribution Ratio

3:2 (Parotid:Submandibular)

Treatment Effect

At least 16 weeks

Frequency

Up to 3 injections/year

Dose Calculator

Minimum weight: 12 kg

Complete Dosing Table

Body Weight (kg) Parotid Gland (Each Side) Submandibular Gland (Each Side) Total Dose
(Both Glands, Both Sides)
Dose per Gland (Units) Volume per Injection (ml) Dose per Gland (Units) Volume per Injection (ml)
≥ 12 to < 15 6 0.24 4 0.16 20 units
≥ 15 to < 19 9 0.36 6 0.24 30 units
≥ 19 to < 23 12 0.48 8 0.32 40 units
≥ 23 to < 27 15 0.60 10 0.40 50 units
≥ 27 to < 30 18 0.72 12 0.48 60 units
≥ 30 22.5 0.90 15 0.60 75 units

Note: Doses are calculated based on 3:2 ratio distribution to parotid and submandibular glands

Step-by-Step Injection Protocol

1

Pre-Procedure Assessment

  • Confirm diagnosis of chronic sialorrhea due to neurological/neurodevelopmental disorder
  • Verify patient age (2-17 years) and weight (≥12 kg)
  • Review medical history and current medications
  • Obtain informed consent from parent/guardian
  • Assess baseline drooling severity
2

Anesthesia Consideration

  • Options: Local anesthesia, sedation, or anesthesia in combination with sedation
  • Perform careful benefit-risk evaluation per local site practice
  • In SIPEXI study:
    • 64% received local anesthetic
    • 23% had general anesthetic
    • 25% received hypnotics/sedatives
3

Reconstitution

  • Use preservative-free 0.9% Sodium Chloride for injection
  • Standard dilution: 100 units in 4 ml (25 units/ml)
  • Draw up reconstitution solution with appropriate syringe
  • Slowly inject into XEOMIN vial
  • Gently swirl (do not shake) to dissolve
  • Inspect for particulate matter - should be clear and colorless
4

Dose Preparation

  • Calculate total dose based on patient weight (use calculator above)
  • Draw up appropriate volumes for each gland
  • Use separate syringes for each injection site
  • Label syringes clearly (Parotid L/R, Submandibular L/R)
5

Identify Injection Sites

  • Parotid Gland:
    • Located anterior and inferior to the ear
    • Palpate the gland between masseter muscle and mandible
    • Mark injection point in the center of the gland
  • Submandibular Gland:
    • Located below the mandible, medial to angle of jaw
    • Palpate gland in submandibular triangle
    • Mark injection point avoiding marginal mandibular nerve
  • Consider ultrasound guidance for accurate localization
6

Injection Technique

  • Clean injection sites with antiseptic
  • Use fine gauge needle (25-30G)
  • Injection sequence (bilateral):
    1. Right parotid gland
    2. Left parotid gland
    3. Right submandibular gland
    4. Left submandibular gland
  • Insert needle directly into salivary gland
  • Aspirate to ensure not in vessel
  • Inject slowly over 5-10 seconds
  • Apply gentle pressure post-injection (no massage)
7

Post-Procedure Care

  • Monitor patient for 15-30 minutes post-injection
  • Observe for immediate adverse reactions
  • Instruct to avoid rubbing/massaging injection sites
  • Keep head upright for 2-4 hours post-injection
  • Avoid strenuous activity for 24 hours
8

Follow-Up & Re-Treatment

  • Onset of effect: Typically within 1 week
  • Peak effect: 2-4 weeks post-injection
  • Duration: At least 16 weeks
  • Re-treatment: Up to 3 injections per year
  • Assess drooling severity at follow-up visits
  • Document treatment response and adverse events

Important Safety Information

Contraindications

  • Hypersensitivity to botulinum toxin type A or any excipients
  • Infection at proposed injection site(s)
  • Myasthenia gravis or Lambert-Eaton syndrome

Warnings & Precautions

  • Spread of toxin effects: Monitor for symptoms of systemic weakness, dysphagia, or respiratory compromise
  • Dysphagia: Risk of swallowing difficulties - assess swallowing function
  • Respiratory compromise: Use caution in patients with compromised respiratory function
  • Pre-existing neuromuscular disorders: Increased risk of severe adverse effects

Common Adverse Reactions

  • Dental caries (tooth decay)
  • Tooth disorder
  • Dry mouth
  • Dysphagia (swallowing difficulty)
  • Injection site pain

Clinical Tips & Best Practices

Ultrasound Guidance

Consider using ultrasound to accurately identify and target salivary glands, especially in patients with anatomical variations or obesity

Dilution Consistency

Use consistent dilution (25 units/ml) to maintain accuracy and reduce calculation errors

Patient Positioning

Position patient semi-reclined with head slightly extended for optimal gland access

Documentation

Record exact doses, volumes, and injection sites for each treatment session

Baseline Assessment

Use standardized drooling scales (e.g., Drooling Severity Scale) to track treatment efficacy

Timing

Schedule re-treatment when effect begins to wane, typically 16-20 weeks after previous injection

References

  1. XEOMIN® Summary of Product Characteristics. https://www.medicines.org.uk/emc/product/6202
  2. Data on file, REF-1362. Merz Pharmaceuticals. September 2021
  3. Berweck S, et al. Neurology. 2021;97(14):e1425-e1436. doi:10.1212/WNL.0000000000012567
  4. Merz Therapeutics is a business of Merz Pharmaceuticals GmbH. Prescribing information available at www.merztherapeutics.com

Disclaimer: This calculator is for educational purposes only. Always refer to the current prescribing information and local guidelines. Dosing should be individualized based on patient characteristics and clinical judgment. This tool does not replace professional medical advice.