Product Details
Xeomin 50
Clostridium Botulinum Neurotoxin Type A50 LD50 Units
Powder for Injection
Vial Pack
DIN/PIN/NPN
02371081
Manufacturer
Merz Pharmaceutical GmbH
Formulary Listing Date
2013-10-31
Unit Price
165.0000
Amount MOH Pays
165.0000
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
M03AX01
Interchangeable Products
NOLU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| Note: Xeomin should be administered personally by a neurologist or a physician with equivalent post-graduate training and experience with neuromuscular disorders. | ||
| 130 | 1 year | To reduce the subjective symptoms and objective signs of cervical dystonia (spasmodic torticollis) in adults |
| 412 | 1 year | For the management of focal spasticity, due to stroke or spinal cord injury in adults |
| 421 | 1 year | For the treatment of blepharospasm associated with dystonia, including benign essential blepharospasm or VII nerve disorders in adults. |