How to Decide on What Muscle Relaxer Product to Use: Botox, Dysport or Xeomin? (Cont’d)

“What are the Differences Between Botox, Dysport and Xeomin?”

In last week’s blog, we discussed that the biggest difference between the brands was the size of the total proprietary botulinum toxin product – Botox was the biggest, Dysport was second and Xeomin was smallest.

The size of each “total” product was determined by adding the weight of the active botulinum toxin to the weight of its protective “envelope” of NAPs (neurotoxin associated proteins).

Since Botox is biggest, many felt that it had a higher chance of being “recognized” by the immune system. Some argued that, over time, the body could develop “resistance” to it. Over time, some felt its effects could be lessened when compared to its competitors that were smaller in size.

On the other hand, others argued that its large size was a good thing because it made it less likely to diffuse. In areas such as the lower forehead and the glabella/upper nose, there could be less chance of causing eyebrow or eyelid droop.
The trouble is, there was inconsistent data in the literature to support this. In fact, recently it was shown that when botulinum products are reconstituted with saline before they are injected, the NAPs actually fall off, and all 3 products are effectively naked/active neuropeptides!

“The next question, then, is why doesn’t 1 unit of Botox and Xeomin equal 1 unit of Dysport? ”

The answer is that the term “unit” is not universal among each product. Therefore, 1 unit of Botox likely has a different amount of active neurotoxin than 1 unit of Dysport. Even though the function/activity of both products are likely identical (or very close to it), the number of active molecules in a unit of Botox is different than that in a unit of Dysport.

In general, Xeomin and Botox are felt to have a close to 1:1 ratio of potency. The ratio of Botox to Dysport is debated but probably falls somewhere between 1:2 and 1:2.5.

There have been published studies comparing the products – especially comparing Botox to Dysport. Depending on the study, some claim that one may cause more/less diffusion, one may last longer, one may take effect quicker, etc. It is likely that the differences between the studies have little to do with the qualitative differences between products. Rather, the dose ratios between Botox and Dysport (eg 1:2 vs 1:4) that were used likely accounted for the majority of the differences between the products.

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