Request a Merz Representative Please provide or update the following information to be connected with a Merz Representative: *Required FieldFirst Name*Last Name*Practice Name*AddressState*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingCityZIP*Email Address* Phone*SpecialtyProducts* Cellfina Radiesse, Belotero Balance, or XEOMIN (incobotulinumtoxinA) Ultherapy NEOCUTIS My Merz Select Loyalty Program Neurosciences Products Asclera® (polidocanol) Injection INDICATIONS AND USAGE XEOMIN® (incobotulinumtoxinA) for injection, for intramuscular use, is a prescription medication that is injected into facial muscles for the temporary improvement in the appearance of moderate to severe glabellar lines (frown lines) in adult patients. XEOMIN® should be administered no more frequently than every three months. IMPORTANT SAFETY INFORMATION WARNING: DISTANT SPREAD OF TOXIN EFFECT The effects of XEOMIN® (incobotulinumtoxinA) for injection, for intramuscular use, and all botulinum toxin products may spread from the area of injection and produce effects that include loss of strength, muscle weakness all over the body, double vision, blurred vision, drooping eyelids, trouble swallowing, hoarseness or change or loss of voice, trouble saying words clearly, loss of bladder control, and trouble breathing. These symptoms have been reported hours to weeks after injection. Swallowing and breathing difficulties can be life threatening and there have been reports of death. The risk of symptoms is probably greatest in children treated for spasticity but symptoms can also occur in adults, particularly in those patients who have underlying conditions that would predispose them to these symptoms. Cases in which the effect has spread have occurred both at the doses used for the treatment of neck spasticity and disorders of muscle tone and at lower doses. XEOMIN® may cause serious side effects that can be life threatening. Call your doctor or get medical help right away if you have any of these problems any time (hours to weeks) after treatment with XEOMIN®: Problems with swallowing, speaking, or breathing can happen after an injection of XEOMIN® if the muscles that you use to breathe and swallow become weak. If these problems are severe, you could die. People with certain breathing problems may need to use muscles in their neck to help them breathe and may be at greater risk for serious breathing problems with XEOMIN®. Swallowing problems may last for several months, and during that time you may need a feeding tube to receive food and water. If swallowing problems are severe, food or liquids may go into your lungs. People who already have swallowing or breathing problems before receiving XEOMIN® have the highest risk of getting these problems. Spread of toxin effects. In some cases, the effect of botulinum toxin may affect areas of the body away from the injection site and cause symptoms of a serious condition called botulism. The symptoms of botulism include: loss of strength and muscle weakness all over the body, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, loss of bladder control, trouble breathing, trouble swallowing. Do not take XEOMIN® if you: are allergic to XEOMIN® or any of the ingredients in XEOMIN®; had an allergic reaction to any other botulinum toxin product such as rimabotulinumtoxinB (Myobloc®), onabotulinumtoxinA (Botox®, Botox® Cosmetic), or abobotulinumtoxinA (Dysport®); have a skin infection at the planned injection site. Before you take XEOMIN®, tell your doctor about all your medical conditions, including if you have a disease that affects your muscles and nerves (such as amyotrophic lateral sclerosis [ALS or Lou Gehrig's disease], myasthenia gravis or Lambert-Eaton syndrome), as you may be at increased risk of serious side effects including difficulty swallowing or breathing. Tell your doctor if you have: had any side effect from any other botulinum toxin in the past; breathing problems such as asthma or emphysema; a history of swallowing problems or inhaling food or fluid into your lungs (aspiration); bleeding problems; drooping eyelids; plans to have surgery; had surgery on your face. Also tell your doctor if you are pregnant or plan to become pregnant (it is not known if XEOMIN® can harm your unborn baby); are breastfeeding or plan to breastfeed (it is not known if XEOMIN® passes into breast milk). Tell your doctor about all the medicines you take, including prescription and nonprescription medicines, vitamins and herbal products. Using XEOMIN® with certain other medicines may cause serious side effects. Do not start any new medicines until you have told your doctor that you have received XEOMIN® in the past. Especially tell your doctor if you have received any other botulinum toxin product in the last four months or in the past. Be sure your doctor knows exactly which product you received. The dose of XEOMIN® may be different from other botulinum toxin products that you have received. Tell your doctor if you: have recently received an antibiotic by injection; take muscle relaxants; take an allergy or cold medicine; take a sleep medicine; take a blood thinner medicine. XEOMIN® may cause loss of strength or general muscle weakness, blurred vision, or drooping eyelids within hours to weeks of taking XEOMIN®. If this happens, do not drive a car, operate machinery, or do other dangerous activities. XEOMIN® may cause other serious side effects including allergic reactions. Symptoms of an allergic reaction to XEOMIN® may include: itching, rash, redness, swelling, wheezing, asthma symptoms, or dizziness or feeling faint. Tell your doctor or get medical help right away if you get wheezing or asthma symptoms, or if you get dizzy or faint. Headache was the most common side effect of XEOMIN® for treatment of glabellar lines. Other side effects of XEOMIN® include: dry mouth, discomfort or pain at the injection site, tiredness, neck pain, muscle weakness, and eye problems, including double vision, blurred vision, drooping eyelids, swelling of your eyelids, and dry eyes. Reduced blinking can also occur. Tell your doctor or get medical help right away if you have eye pain or irritation following treatment. Tell your doctor if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of XEOMIN®. For more information, ask your doctor or pharmacist. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088. Please click here for XEOMIN® Full Prescribing Information and Medication Guide. BOTOX is a registered trademark of Allergan, Inc. Dysport is a registered trademark of Ipsen Biopharm Limited Company. MYOBLOC is a registered trademark of Solstice Neurosciences, Inc. NameThis field is for validation purposes and should be left unchanged.