Xiaflex is a brand-name prescription medication. It’s FDA-approved to treat the following conditions in adults:

With Peyronie’s disease, plaques (fibrous scar tissue) develop under the skin of your penis. These plaques cause your penis to curve painfully, especially when erect. Xiaflex is approved to treat Peyronie’s disease in males* who have a plaque that can be felt. It also treats males that have a curve in the penis of 30 degrees or more when starting treatment.

Dupuytren’s contracture is a condition in which the connective tissue under the skin in your palms and fingers thickens and tightens. Over time, cords of connective tissue can develop that pull your finger in toward your palm and prevent you from straightening it. Xiaflex is approved to treat Dupuytren’s contracture where a cord can be felt.

* Sex and gender exist on spectrums. Use of the term “male” in this article refers to sex assigned at birth.

Drug details

Xiaflex contains the active drug collagenase clostridium histolyticum. The active drug is an enzyme called collagenase that’s extracted from Clostridium histolyticum bacteria. Collagenase breaks down collagen, which is the main protein that makes up connective tissue and scar tissue.

Xiaflex comes as a powder inside single-use vials. Your doctor will use the powder to make a liquid solution of Xiaflex that’s given by injection.

For Dupuytren’s contracture, your doctor will inject Xiaflex into the cord in your hand. For Peyronie’s disease, they’ll inject Xiaflex into the plaque in your penis.

Effectiveness

For information about the effectiveness of Xiaflex, see the “Xiaflex uses” section below.

Xiaflex is a brand-name biologic medication, which is also called a biologic. It’s not currently available in a generic or biosimilar form.

Biologic drugs are made from living cells. It’s not possible to copy these drugs exactly. A biologic medication is a drug that’s similar to a brand-name biologic drug (the parent drug) and is approved for the same use. A generic, on the other hand, refers to drugs made from chemicals. A generic is an exact copy of the active drug in a brand-name medication.

Biosimilars are considered to be just as safe and effective as their parent drug. And like generics, biosimilars tend to cost less than brand-name medications.

Another brand-name medication containing the same active drug as Xiaflex is available. This drug is called Qwo. But it’s not approved for the same uses as Xiaflex.

As with all medications, the cost of Xiaflex injections can vary. To find current prices for Xiaflex in your area, check out WellRx.com.

The cost you find on WellRx.com is what you may pay without insurance. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use. It will also depend on the cost of the visit to your healthcare professional to receive doses of Xiaflex.

Before approving coverage for Xiaflex, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide if the drug will be covered.

If you’re not sure if you’ll need to get prior authorization for Xiaflex, contact your insurance company.

Financial and insurance assistance

If you need financial support to pay for Xiaflex, or if you need help understanding your insurance coverage, help is available.

Xiaflex has a Copay Assistance Program. For more information and to find out if you’re eligible for support, call 877-XIAFLEX (877-942-3539). You can also visit the program website for the condition the drug is treating: Dupuytren’s contracture or Peyronie’s disease.

To learn more about saving money on prescriptions, see this article.

Biosimilar version

Xiaflex is a biologic medication, which is also called a biologic. It’s not currently available in a biosimilar form.

Biologic drugs are made from living cells. It’s not possible to copy these drugs exactly. A biosimilar medication is a drug that’s similar to a brand-name biologic drug (the parent drug) and is approved for the same use.

Biosimilars are considered just as safe and effective as their parent drug. And they tend to cost less than the parent brand-name medication.

Xiaflex can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Xiaflex. These lists do not include all possible side effects.

For more information about the possible side effects of Xiaflex, talk with your doctor or pharmacist. They can give you tips on how to manage any side effects that may be concerning or bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Xiaflex, you can do so through MedWatch.

Mild side effects

Mild side effects of Xiaflex can vary depending on the condition the drug is being used to treat. Most of these side effects may go away within a few days to a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

Mild side effects when used for Peyronie’s disease

Mild side effects* of Xiaflex can include:

  • hematoma (collection of blood under the skin) at the injection site
  • blisters or nodules (lumps) at the injection site
  • itching of your penis or scrotum
  • discoloration of the skin of your penis
  • painful erection
  • painful sex
  • erectile dysfunction
  • swelling or pain in your penis†
  • swelling or pain at the injection site†
  • bleeding or bruising at the injection site†

* This is a partial list of mild side effects from Xiaflex. To learn about other mild side effects, talk with your doctor or pharmacist, or view the Xiaflex prescribing information.
† For more information about this side effect, see “Side effect details” below.

Mild side effects when used for Dupuytren’s contracture

Mild side effects* of Xiaflex can include:

  • injection site reactions, such as swelling, redness, discoloration, warmth, itching, or pain
  • breaks in the skin of the injected hand
  • swelling of your lymph nodes, such as those in your armpit
  • pain in your armpit
  • swelling or pain in the injected hand†
  • bleeding or bruising at the injection site†

* This is a partial list of mild side effects from Xiaflex. To learn about other mild side effects, talk with your doctor or pharmacist, or view the Xiaflex prescribing information.
† For more information about this side effect, see “Side effect details” below.

Serious side effects

Serious side effects from Xiaflex aren’t common, but they can occur. Also, serious side effects can vary depending on which condition the drug is being used to treat. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects when used for Peyronie’s disease

Serious side effects and their symptoms can include:

  • Sudden brief back pain. Symptoms may include:
    • sudden severe low back pain that may move to your legs, arms, or chest
    • trouble walking
  • Fracture or other serious penis injury.*†
  • Allergic reaction.*

* For more information about this side effect, see “Side effect details” below.
Xiaflex has a boxed warning for this side effect. This is a serious warning from the FDA. To learn more, see the “Side effect details” section below.

Serious side effects when used for Dupuytren’s contracture

Serious side effects and their symptoms can include:

  • Tendon rupture or ligament damage. Symptoms can include:
    • trouble bending your treated finger toward your palm
    • weakness in your treated hand or finger
    • trouble using your hand after your follow-up visit
  • Nerve damage, skin lacerations, or other serious hand or finger injury. Symptoms can include:
    • numbness, tingling, or pain in your hand or fingers
    • splits or tears in your skin
  • Allergic reaction.*

* For more information about this side effect, see “Side effect details” below.

Side effect details

Here’s some detail on certain side effects this drug may cause. To find out how often side effects occurred in clinical trials, see the prescribing information for Xiaflex.

Fracture or other serious penis injury when used for Peyronie’s disease

Xiaflex has a boxed warning about the risk of penile fracture or other serious penis injury when used to treat Peyronie’s disease. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients to side effects that may be dangerous.

When used to treat Peyronie’s disease, Xiaflex is injected into the plaque (fibrous scar tissue) in your penis that’s making your penis bend. When injected in this way, Xiaflex may damage the tubes in your penis called the corpora. This could lead to corporal rupture (fracture of the penis) when you get an erection.

When injected into the plaque in your penis, Xiaflex may also cause other serious penis injuries. These include damage to the blood vessels in your penis. This could lead to penile hematoma (collection of blood under the skin of your penis). Severe penile hematoma could lead to death of skin cells and other soft tissue in your penis.

In clinical trials, penile fracture and other serious penis injuries were rare with Xiaflex. However, if these injuries occur, they may need to be treated with surgery, and the damage may not get better.

Symptoms of penile fracture or other serious penis injury may include:

Due to the risks of serious penis injury, Xiaflex is only available through a drug safety program when used for Peyronie’s disease. This is called the Xiaflex Risk Evaluation and Mitigation Strategy (REMS) program. As part of this program, only healthcare professionals who have received training in the correct administration of Xiaflex are certified to prescribe and administer the drug.

What you can do

To minimize your risk for serious penis injury, you should not have sex or other sexual activity at certain times during your treatment with Xiaflex. These are:

  • between the first and second injections in each of your treatment cycles
  • for at least 4 weeks after the second injection in each of your treatment cycles
  • if you have any pain or swelling in your penis

If you have symptoms of a penile fracture or other serious penis injury after receiving a Xiaflex injection, see your doctor right away.

Swelling

You may have swelling at the site where Xiaflex is injected, as well as in the surrounding tissue. If you are prescribed Xiaflex for Dupuytren’s contracture, your hand may swell. If you are receiving Xiaflex for Peyronie’s disease, your penis may swell. This swelling may be painful.

In clinical trials, swelling at the injection site or in the surrounding tissue was common with Xiaflex.

The swelling may last several days, but it should ease as you recover. Note that if you have swelling that’s getting worse, this could be a sign of infection. In this case you may also have other symptoms, such as increasing redness, fever, or chills.

What you can do

After receiving Xiaflex, it’s important to follow your doctor’s instructions to minimize any swelling you may have.

If you receive Xiaflex for Dupuytren’s contracture, your doctor will wrap your hand in a bandage after the injection. You should keep your hand elevated until bedtime (you may use a sling). It’s important to keep your treated finger as still as possible after your injection.

Do not remove the bandage or try to straighten or bend your finger until your doctor tells you to. Moving your finger could cause the medication to leak out of the cord, which could damage nearby tissues and increase swelling.

If you receive Xiaflex for Peyronie’s disease, your doctor will wrap your penis in a bandage after the injection. Do not remove this until your doctor tells you to. Do not engage in sexual activity for at least 4 weeks after your second injection in a treatment cycle. Also, avoid straining your abdominal muscles, for example, during a bowel movement.

If you have painful swelling, this can usually be relieved with over-the-counter pain relievers, such as acetaminophen (Tylenol) or ibuprofen (Advil). It may also help to apply an ice pack to your hand.

If you have swelling that’s severe, worsening, or doesn’t get better after a few days, see your doctor. Also, see your doctor if you have symptoms of infection.

Bleeding

You may have bleeding or bruising at the site where Xiaflex is injected. This is because the injection procedure, as well as the drug itself, could damage small blood vessels in the area. If you receive Xiaflex for Peyronie’s disease, you may also develop a hematoma (collection of blood under the skin) at the injection site.

In clinical trials, bleeding or bruising at the injection site was common with Xiaflex. When used for Peyronie’s disease, hematoma was also common. However, severe hematoma was rare.

If you develop a severe penile hematoma, this could lead to serious penis injuries, such as death of skin cells and other soft tissue in your penis. Xiaflex has a boxed warning about this side effect. See “Fracture or other serious penis injury when used for Peyronie’s disease” just above to learn more.

If you receive Xiaflex for Dupuytren’s contracture, your doctor may try to straighten your finger 1 to 3 days after your injection. This procedure can sometimes tear the skin, which could also cause bleeding.

If you have a blood clotting problem or take blood thinner medications, you may have a raised risk for bleeding or bruising with Xiaflex. Due to this risk, your doctor will likely not prescribe Xiaflex.

Bruising may last for several days after Xiaflex injection, but it should ease as you recover.

What you can do

After receiving Xiaflex, it’s important to follow your doctor’s instructions to minimize any bleeding or bruising you may have.

If you receive Xiaflex for Dupuytren’s contracture, your doctor will wrap your hand in a bandage after the injection. You should keep your hand elevated until bedtime (you may use a sling). It’s important to keep your treated finger as still as possible after your injection.

Do not remove the bandage or try to straighten or bend your finger until your doctor tells you to. Moving your finger could cause the medication to leak out of the cord, which could damage nearby tissues. It could also tear your skin.

If you receive Xiaflex for Peyronie’s disease, your doctor will wrap your penis in a bandage after the injection. Do not remove this until your doctor tells you to. Do not engage in sexual activity for at least 4 weeks after your second injection in a treatment cycle. Also, avoid abdominal straining, such as straining during a bowel movement.

See your doctor if you have bleeding that doesn’t stop, severe bruising, or bruising that lasts longer than a few days.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Xiaflex. This side effect was common in clinical trials of the drug.

Symptoms of a mild allergic reaction can include:

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing

Call your doctor right away if you have an allergic reaction to Xiaflex, as the reaction could become severe. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Other drugs are available that can treat your condition. Some may be a better fit for you than others. If you’re interested in finding an alternative to Xiaflex, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed here are used off-label to treat these specific conditions. Off-label drug use is when a drug that’s approved by the Food and Drug Administration (FDA) is prescribed for a purpose other than what it’s approved for.

Alternatives for Peyronie’s disease

Examples of other drugs your doctor may use to treat Peyronie’s disease include:

  • other drugs injected in the plaque(s) in the penis, such as:
    • interferon alfa-2b
  • oral drugs, such as:
    • colchicine
    • pentoxifylline
    • potassium aminobenzoate

Alternatives for Dupuytren’s contracture

Examples of other drugs your doctor may use to treat Dupuytren’s contracture include steroid injections, such as triamcinolone.

Other treatments for this condition may include:

The Food and Drug Administration (FDA) approves prescription drugs such as Xiaflex to treat certain conditions. Xiaflex may also be used off-label for other conditions. Off-label drug use is when an FDA-approved drug is prescribed for a purpose other than what it’s approved for.

Xiaflex for Peyronie’s disease

Xiaflex is FDA-approved to treat Peyronie’s disease in adult males.* It’s approved for use in males who have:

  • a plaque (fibrous scar tissue) in the penis that can be felt, and
  • a curve in the penis of 30 degrees or more when starting treatment

* Sex and gender exist on spectrums. Use of the term “male” in this article refers to sex assigned at birth.

Peyronie’s disease explained

Peyronie’s disease is a condition where flat plaques (fibrous scar tissue) develop under the skin of your penis. The plaques are made of a protein called collagen. You may have one or more plaques.

The plaques are hard and tight, and they pull on the surrounding tissues. They’re also unable to stretch. The plaques can cause your penis to curve, mainly when you get an erection. Your penis may bend upward, downward, or to the side, depending on where the plaques are. This can lead to sexual problems.

Symptoms of Peyronie’s disease may include:

  • hard, flattened lumps under the skin of the penis
  • curving of the penis, mainly with an erection
  • pain in the penis, especially with an erection
  • erectile dysfunction
  • trouble having sex due to the curve in your penis
  • anxiety or depression about your condition

Your doctor will inject Xiaflex directly into the plaque that’s causing the curve in your penis. The drug breaks down the plaque, which should reduce the curving of your penis.

Your doctor will also manually try to stretch the plaque and help straighten your penis. And you’ll need to do gentle penis stretching and straightening exercises as instructed by your doctor.

To learn more about your condition, visit Medical News Today’s hub for men’s health.

Effectiveness for Peyronie’s disease

Xiaflex is an effective treatment for Peyronie’s disease. To find out how the drug performed in clinical trials, see Xiaflex’s prescribing information.

The American Urological Association guidelines for Peyronie’s disease recommend Xiaflex as a treatment option.

Xiaflex for Dupuytren’s contracture

Xiaflex is FDA-approved to treat Dupuytren’s contracture in adults. It’s approved for use when a cord can be felt in the palm of your hand.

Dupuytren’s contracture explained

Dupuytren’s contracture is a condition that affects the connective tissue under the skin in the palms of your hands and fingers. This tissue is called fascia. It’s made of a protein called collagen.

With Dupuytren’s contracture, the fascia in your palms and fingers gets thicker and tighter. This causes lumps under the skin and pitting on the surface of the skin. Over time, the thickened fascia can form a tight cord between your palm and finger. This pulls your finger in toward your palm and prevents you from straightening it.

Dupuytren’s contracture usually affects your ring or pinkie finger, but other fingers and your thumb can also be involved. You may have one or more cords. The cords look like tendons, but in fact the tendons aren’t involved. The condition isn’t usually painful, but it can cause trouble with your daily activities.

Symptoms of Dupuytren’s contracture may include:

  • lumps in the palm of your hand
  • pitting of the skin on your palms
  • cords between your palm and one or more fingers
  • one or more fingers being bent in toward your palm
  • being unable to fully straighten one or more fingers
  • being unable to place your hand flat on a surface
  • trouble using your fingers and hand

Xiaflex is a treatment that your doctor will inject directly into the cord(s) in the palm of your hand. The drug breaks down the cord, which should allow you to straighten your finger. However, you should not try to bend or straighten your finger until your doctor tells you to.

You’ll usually see your doctor 1 to 3 days after the injection. If the cord hasn’t broken down, your doctor may try to slowly straighten your finger to help break the cord.

Effectiveness for Dupuytren’s contracture

Xiaflex is an effective treatment for Dupuytren’s contracture. To find out how the drug performed in clinical trials, see Xiaflex’s prescribing information.

Xiaflex and children

Xiaflex isn’t approved for use in children. The drug hasn’t been studied in children under age 18 years.

Here are answers to some frequently asked questions about Xiaflex.

Where can I find before-and-after photos of treatment with Xiaflex?

For Dupuytren’s contracture, you can find photos before and after Xiaflex treatment on the manufacturer’s website. For Peyronie’s disease, your doctor will likely have before-and-after photos.

Keep in mind that you may not have the same results as other people treated with Xiaflex. The effect of the drug, as well as the side effects it may cause, can vary between people. Talk with your doctor about your expectations of treatment with Xiaflex.

What’s the recovery time with Xiaflex?

The recovery time with Xiaflex may vary, depending on your condition and how your body responds to the treatment. However, swelling, pain, and bruising can last for several days after the injection.

For Dupuytren’s contracture, it may take about 2 to 4 weeks before you’re able to use your hand normally again. If your skin tears, it may take a bit longer. You might not be able to use your hand normally until the skin has healed. Always follow your doctor’s advice about when it’s safe to do certain activities, such as lifting, with your treated hand.

For Peyronie’s disease, it may take at least 4 weeks for the swelling and bruising in your penis to improve. You should not engage in sexual activity until this has happened.

Talk with your doctor to find out how long you can expect your recovery time to be.

How long should I abstain from sex after early injections of Xiaflex for Peyronie’s disease?

You should not have sex, or any other sexual activity, between the first and second injection of each treatment cycle with Xiaflex. After the second injection of each treatment cycle, you should wait at least 4 weeks before having sex or other sexual activity. Only engage in sexual activity if any pain or swelling in your penis has gone away.

Xiaflex is given in treatment cycles for Peyronie’s disease. For each treatment cycle, you’ll receive two injections 1 to 3 days apart. You may have up to four treatment cycles at 6-week intervals.

Note that you should not use vacuum erection devices during treatment with Xiaflex.

If you have questions about sexual activity with Xiaflex, talk with your doctor.

The following information describes dosages that are commonly used or recommended. However, your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Xiaflex comes as a powder inside single-use vials. Your doctor will use the powder to make a liquid solution of Xiaflex that’s given by injection. Your doctor will administer the injection in their office or clinic.

Each vial of Xiaflex contains 0.9 milligrams (mg) of the drug. Your doctor will use one 0.9 mg vial for each injection they give. They’ll withdraw the recommended dose from the vial and discard any medication that’s left in the vial.

Dosage for Peyronie’s disease

For Peyronie’s disease, your doctor will inject Xiaflex directly into the plaque (fibrous scar tissue) in your penis that’s causing it to bend. You may receive up to four cycles of treatment about 6 weeks apart.

For each cycle of treatment, you’ll receive two injections 1 to 3 days apart. The recommended dosage for each injection is 0.58 mg injected into the plaque. Then 1 to 3 days after your second injection you’ll see your doctor again. They’ll try to manually stretch the plaque and help straighten your penis.

If the angle of the curve in your penis reduces to less than 15 degrees after any treatment cycle, you won’t need further treatment cycles.

Dosage for Dupuytren’s contracture

For Dupuytren’s contracture, your doctor will inject Xiaflex directly into the cord in your hand that’s causing your finger to bend inward. The recommended dosage is one injection of 0.58 mg into the cord.

You may receive up to two injections in the same appointment. For example, if you have one cord that’s causing two joints in the same finger to bend, your doctor may give you two injections into different places in that cord. Or if you have two cords that are causing two separate fingers to bend, your doctor may give one injection into each cord.

You’ll usually see your doctor 1 to 3 days after your injection(s). If the cord hasn’t broken down, your doctor may try to slowly straighten your finger to help break the cord. This is typically done using local anesthetic.

If your finger is still unable to straighten, your doctor may reinject the cord after 4 weeks. One to 3 days later they’ll try to straighten your finger again. Each cord may be treated up to three times at 4-week intervals.

What if I miss an appointment for a dose?

If you miss an appointment to receive your Xiaflex injection, call your doctor’s office to reschedule.

To help make sure you don’t miss an appointment, be sure to put your appointment schedule on your calendar. You could also download a reminder app on your phone.

Will I need to use this drug long term?

No, Xiaflex is meant to be a short-term treatment for Dupuytren’s contracture and Peyronie’s disease.

Drinking alcohol isn’t known to affect Xiaflex. If you drink alcohol and you have questions about drinking it during your treatment with Xiaflex, talk with your doctor.

Xiaflex can interact with certain other medications. Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Xiaflex and other medications

Below is a list of medications that can interact with Xiaflex. This list does not contain all drugs that may interact with Xiaflex.

Before taking Xiaflex, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Types of drugs that can interact with Xiaflex include:

  • Blood thinners. Blood thinners are drugs used to prevent and treat blood clots. If you take blood thinners, you may have a raised risk for bleeding and bruising with Xiaflex injection. Due to this interaction, doctors will typically not prescribe Xiaflex if you take blood thinners. Examples of these drugs include:
    • dalteparin (Fragmin)
    • edoxaban (Savaysa)
    • enoxaparin (Lovenox)
    • fondaparinux (Arixtra)

Xiaflex and herbs and supplements

There aren’t any herbs or supplements that have been specifically reported to interact with Xiaflex. However, you should still check with your doctor or pharmacist before using any of these products while taking Xiaflex.

Xiaflex and foods

There aren’t any foods that have been specifically reported to interact with Xiaflex. If you have any questions about eating certain foods with Xiaflex, talk with your doctor.

Xiaflex is given by injection. Your doctor will give the injection in their office or clinic.

For Dupuytren’s contracture

Your doctor will inject Xiaflex directly into the cord in your hand that’s causing your finger to bend inward. You may receive up to two injections in the same appointment.

After you receive the injection, your doctor will wrap your hand with a bandage. It’s important to:

  • keep your treated finger as still as possible, do not try to straighten or bend it
  • keep your hand elevated until bedtime (you may use a sling)

You’ll usually see your doctor 1 to 3 days after your Xiaflex injection. If the cord hasn’t broken down, your doctor may try to slowly straighten your finger to help break the cord. You’ll typically receive a local anesthetic to numb your hand first.

If your finger is still unable to straighten, your doctor may reinject the cord after 4 weeks. One to 3 days later, they’ll try to straighten your finger again. Each cord may be treated up to three times at 4-week intervals.

If your finger straightens, your doctor will give you a splint to wear at bedtime for about 4 months. This can help keep your finger straight. Your doctor will also give you finger exercises to do. You should do these several times a day for several months. Talk with your doctor about when you can start to use your hand as you usually would.

For Peyronie’s disease

Your doctor will inject Xiaflex directly into the plaque (fibrous scar tissue) in your penis that’s causing it to bend. You may receive a local anesthetic to numb the area first. You may receive up to four cycles of treatment about 6 weeks apart.

For each cycle of treatment, you’ll receive two injections 1 to 3 days apart. Your doctor may wrap your penis with a bandage after each injection. Then 1 to 3 days after your second injection you’ll see your doctor again. They’ll try to stretch the plaque and help straighten your penis. You may receive a local anesthetic to numb your penis first.

After each treatment cycle with Xiaflex, you should gently stretch your penis three times a day for 6 weeks. Your doctor will show you how to do this. Also, your doctor will show you how to gently straighten your penis if you get an erection. But you should not engage in sexual activity for at least 4 weeks after each treatment cycle.

Xiaflex is a brand-name prescription medication. It’s FDA-approved to treat the following conditions in adults:

What happens with Dupuytren’s contracture

With Dupuytren’s contracture, the connective tissue under the skin in your palms and fingers thickens and tightens.

Over time, cords of connective tissue can develop between your palm and finger. These pull your finger in toward your palm and prevent you from straightening it.

The connective tissue and cords are made of a protein called collagen.

What happens with Peyronie’s disease

With Peyronie’s disease, plaques (fibrous scar tissue) develop under the skin of your penis. These plaques cause your penis to curve painfully, especially when erect.

The plaques of scar tissue are made of collagen.

What Xiaflex does

Xiaflex contains the active drug collagenase clostridium histolyticum, which is an enzyme that breaks down collagen.

For Dupuytren’s contracture, your doctor will inject Xiaflex into the cord in your hand that’s making your finger bend. For Peyronie’s disease, they’ll inject it into the plaque in your penis that’s making your penis curve.

Xiaflex works by breaking down the collagen in the Dupuytren’s cords and the Peyronie’s plaques. This dissolves the cords and plaques. With Dupuytren’s contracture, this allows you to straighten your finger(s). With Peyronie’s disease, this stops your penis from curving.

How long does it take to work?

Xiaflex starts dissolving the cords and plaques as soon as it’s injected.

For Dupuytren’s contracture, Xiaflex may dissolve the cord within 1 to 3 days. If the cord is still there, your doctor may slowly try to straighten your finger to break the cord. However, the first injection of Xiaflex may not work for everyone. If the first injection doesn’t work, your doctor may recommend a second injection 4 weeks later. You may receive up to three injections 4 weeks apart.

For Peyronie’s disease, Xiaflex may take a little longer to work and you’ll also need to do gentle penis stretching and straightening as instructed by your doctor. The plaque may dissolve with the first course of treatment (two injections given 1 to 3 days apart, followed by a penis straightening procedure 1 to 3 days later). But most people need four courses of treatment, given 6 weeks apart.

It’s not known if Xiaflex treatment is safe during pregnancy. The drug hasn’t been studied in people who are pregnant. In animal studies, Xiaflex didn’t cause fetal harm when given to pregnant females. But animal studies don’t always predict what will happen in humans.

If you’re pregnant or planning to become pregnant, talk with your doctor about the possible risks and benefits of Xiaflex.

It’s not known if Xiaflex is safe to use during pregnancy. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs during Xiaflex treatment.

For more information about Xiaflex treatment during pregnancy, see the “Xiaflex and pregnancy” section above.

It’s not known if Xiaflex can pass into breast milk or if it’s safe to receive while breastfeeding.

If you’re breastfeeding or plan to breastfeed, talk with your doctor about the best way to feed your child during Xiaflex treatment.

This drug comes with several precautions.

FDA warning: Penile fracture or other serious penis injury when used for Peyronie’s disease

This drug has a boxed warning. This is the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

When used to treat Peyronie’s disease, Xiaflex may damage the tubes in your penis called the corpora. This could lead to corporal rupture (fracture of the penis) during an erection.

Xiaflex may also cause other serious penis injuries when used for Peyronie’s disease. These include damage to the blood vessels in your penis. This could lead to penile hematoma (collection of blood under the skin of your penis). Severe penile hematoma could lead to death of skin cells and other soft tissue in your penis.

Penile fracture and other serious penis injuries may need to be treated with surgery, and the damage may not get better.

Due to these risks, Xiaflex is only available through a drug safety program called the Xiaflex Risk Evaluation and Mitigation Strategy (REMS) program. As part of this program, only healthcare professionals who have received training in the correct administration of Xiaflex are certified to prescribe and administer the drug.

To read more about these risks, see “Side effect details” in the “Xiaflex side effects” section above.

Other precautions

Before taking Xiaflex, talk with your doctor about your health history. Xiaflex may not be the right treatment for you if you have certain medical conditions or other factors affecting your health. These include:

  • Blood clotting problems. If you have blood clotting problems, you may have a raised risk for bleeding or bruising at the site where Xiaflex is injected. You may also have an increased risk for this side effect if you take blood thinner medications. See “Xiaflex interactions” above for examples of blood thinners. If you have blood clotting problems or take blood thinners, your doctor will likely not prescribe Xiaflex. Ask them about other treatments that may be better options for you.
  • Peyronie’s plaques involving the urethra. If you have Peyronie’s disease and the plaque that makes your penis curve involves your urethra (urine tube), your doctor will likely not prescribe Xiaflex. This is because Xiaflex could damage your urethra. Talk with your doctor about other treatments that may be better options for you.
  • Pregnancy. It’s not known if Xiaflex treatment is safe during pregnancy. For more information, see the “Xiaflex and pregnancy” section above.
  • Breastfeeding. It’s not known if Xiaflex treatment is safe while breastfeeding. For more information, see the “Xiaflex and breastfeeding” section above.
  • Allergic reaction. If you’ve had an allergic reaction to Xiaflex or any of its ingredients, your doctor will likely not prescribe Xiaflex. Ask them about other medications that may be better options for you.

Note: For more information about the potential negative effects of Xiaflex, see the “Xiaflex side effects” section above.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.