AdultPediatricDosage Forms & Strengths lyophilized powder for injection plus diluent 0.9mg/vial (Xiaflex) 0.92mg/vial (Qwo) 1.84mg/vial (Qwo) Dupuytren Contracture Xiaflex only Indicated for Dupuytren contracture with a palpable cord Inject 0.58 mg into palpable Dupuytren cord with a contracture of metacarpophalangeal (MP) joint or proximal interphalangeal (PIP) joint If contracture persists 24-72 hr following injection, perform finger extension procedure May repeat injection and finger extension procedures up to 3 times per cord at 4-week intervals Inject only 1 cord at a time; if other cords with contractures exist, inject each cord in sequential order Each vial of drug and sterile diluent should only be used for a single injection; if 2 joints on the same hand are to be treated during a treatment visit, separate vials and syringes should be used for each reconstitution and injection Approximately 24-72 hr after injection, perform a finger extension procedure if a contracture persists to facilitate cord disruption May reinject four weeks after the initial injection if MP or PIP contracture still present; may reinject with a single dose of collagenase C histolyticum 2 injections on same hand per treatment visit Perform up to 2 injections in the same hand during a treatment visit Two palpable cords affecting 2 joints may be injected or 1 palpable cord affecting 2 joints in the same finger may be injected at 2 locations during a treatment visit If a patient has other palpable cords with contractures of MP or PIP joints, these cords may be injected at other treatment visits ~4 wk apart Peyronie Disease Xiaflex only Available for treatment of Peyronie disease only through a restricted Risk Evaluation and Mitigation Strategy (REMS) program called the XIAFLEX REMS Program Indicated in men with a palpable plaque and curvature deformity of at least 30 degrees at the start of therapy Inject 0.58 mg into a Peyronie plaque; if >1 plaque present, inject into the plaque causing the curvature deformity Treatment course consists of a maximum of 4 treatment cycles; each treatment cycle consists of 2 injection procedures and 1 penile modeling procedure for a maximum of 8 injection procedures and 4 modeling procedures Perform 2nd injection procedure 1-3 days after the 1st Interval between treatment cycles is ~6 weeks Induce a penile erection; to achieve it, may use a single intracavernosal injection of 10 or 20 mcg of alprostadil With the penis in the erect state, identify and mark the target area in the Peyronie plaque to be injected The penis should be in flaccid state before injecting Inject 0.58 mg into target plaque once on each of 2 days, 1 to 3 days apart, according to injection procedure Perform a penile modeling procedure 1 to 3 days after second injection of each treatment cycle For each plaque causing the curvature deformity, may administer up to four treatment cycles; may repeat each treatment cycle at approximately six-week intervals; if curvature deformity is <15 degrees after 1st, 2nd, or 3rd treatment cycle, or if further treatment not clinically indicated, do not administer subsequent treatment cycles If curvature deformity is <15 degrees after 1st, 2nd, or 3rd treatment cycle, or if healthcare provider determines that further treatment not clinically indicated, then do not administer subsequent treatment cycles Cellulite Qwo only Up to twelve 0.07-mg (0.3-mL) SC injections totaling 0.84 mg per treatment area (ie, single buttock) Treatment visit may consist of up to 2 treatment areas Repeat q21Days for 3 treatment visitsSafety and efficacy not establishedInteraction CheckerEnter a drug name and collagenase clostridium histolyticumNo Results No Interactions Found Interactions FoundContraindicatedSerious - Use AlternativeSignificant - Monitor CloselyMinorAll Interactions Sort By: SeverityName Contraindicated (0)Serious - Use Alternative (0)Monitor Closely (13)antithrombin alfaantithrombin alfa increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).antithrombin IIIantithrombin III increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).argatrobanargatroban increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).aspirinaspirin increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).bivalirudinbivalirudin increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).dabigatrandabigatran increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).dalteparindalteparin increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).desirudindesirudin increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).enoxaparinenoxaparin increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).fondaparinuxfondaparinux increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).heparinheparin increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).protein C concentrateprotein C concentrate increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).rivaroxabanrivaroxaban increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).Minor (0)antithrombin alfaMonitor Closely (1)antithrombin alfa increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).antithrombin IIIMonitor Closely (1)antithrombin III increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).argatrobanMonitor Closely (1)argatroban increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).aspirinMonitor Closely (1)aspirin increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).bivalirudinMonitor Closely (1)bivalirudin increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).dabigatranMonitor Closely (1)dabigatran increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).dalteparinMonitor Closely (1)dalteparin increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).desirudinMonitor Closely (1)desirudin increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).enoxaparinMonitor Closely (1)enoxaparin increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).fondaparinuxMonitor Closely (1)fondaparinux increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).heparinMonitor Closely (1)heparin increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).protein C concentrateMonitor Closely (1)protein C concentrate increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).rivaroxabanMonitor Closely (1)rivaroxaban increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day). >10% Dupuytren contracture Peripheral edema (ie, swelling of injected hand) (73%) Contusion (70%) Injection site hemorrhage (38%) Injection site reaction (35%) Pain in injected extremity (35%) Tenderness (24%) Injection site swelling (24%) Pruritus (15%) Lymphadenopathy (13%) Peyronie Disease Penile hematoma (65.5%) Penile swelling (55%) Penile pain (45.4%) Penile ecchymoses (14.5%) Cellulite Bruising (84%) Pain (48%) Nodule (33%) Pruritus (15%) 1-10% Dupuytren contracture Skin laceration (9%) Lymph node pain (8%) Erythema (6%) Axillary pain (6%) Peyronie Disease Blood blister (4.5%) Penile blister (3.3%) Pruritus genital (3.1%) Painful erection (2.9%) Erectile dysfunction (1.8%) Procedural pain (1.6%) Injection site vesicles (1.3%) Localized edema (1.3%) Dyspareunia (1.1%) Injection site pruritus (1.1%) Nodule (1.1%) Suprapubic pain (1.1%) Cellulite Erythema (9%) Discoloration (8%) Swelling (8%) Warmth (3%) <1% Peyronie Disease Corporal rupture Postmarketing Reports Syncope and presyncope Back pain Localized skin and soft tissue necrosis, occurring as sequelae of penile hematoma Cellulite Immune system disorders: serious hypersensitivity reactions including anaphylaxis Black Box Warnings Peyronie disease Corporal rupture (penile fracture) was reported as adverse reaction in clinical trials Promptly evaluate signs or symptoms reflecting serious penile injury to assess for corporal rupture or severe penile hematoma which may require surgical intervention Because of risks of corporal rupture or other serious penile injury, available for the treatment of Peyronie’s disease only through the XIAFLEX REMS Program Contraindications Hypersensitivity Peyronie plaques that involve the penile urethra Cautions Do not substitute injectable collagenase products (ie, do not use Xiaflex for cellulite treatment of use Qwo for Dupuytren contracture or Peyronie disease) Serious hypersensitivity, including anaphylaxis, reported; if hypersensitivity occurs, discontinue and institute appropriate medical therapy Pruritus experienced especially after more injections Use with caution in patients with coagulation disorders, including in patients who have received anticoagulant medications other than low- dose aspirin within 7 days of the injection Administration in patients with abnormal coagulation may result in ecchymosis/contusion or an injection site hemorrhage Post-injection back pain Acute post-injection back pain reactions reported in postmarketing period in patients treated for Peyronie’s disease; these events typically have an onset immediately or within minutes of injection The acute lower back pain can be mild to severe in intensity and can radiate to the legs, arms and chest; other systemic symptoms, such as chest pain, headache, and dyspnea, reported along with back pain episodes None of the events were reported to occur after the patient’s first injection and a few were reported to occur during a second treatment course Reported events typically resolved within 15 minutes, but some lasted up to 30 minutes, and one event lasted 1.5 hours; reported events typically did not require intervention, but some required observation and treatment with analgesics Dupuytren contracture Tendon rupture of other serious injury to the injected extremity reported in clinical trials; avoid injecting into tendons, nerves, blood vessels, or other collagen-containing structure of the hand Healthcare providers should be prepared to address hypersensitivity reactions, including anaphylaxis, following injections Incidence of skin laceration (22%) was higher when treating 2 concurrent injections compared with up to 3 single injections in the placebo-controlled premarketing trials (9%) Postmarketing cases of skin laceration requiring skin graft after finger extension procedures and local skin and soft-tissue necrosis, some requiring skin grafting or, other surgical interventions including finger amputation reported; signs or