Xiaflex: Dosage, Cost, Side Effects, Uses, and More

Xiaflex (collagenase clostridium histolyticum) is a prescription injection used for certain conditions caused by excess collagenbasically, when your body gets a little too enthusiastic with the “scar tissue and tightening” setting. It’s not a pill, not a cream, and definitely not a DIY weekend project. Xiaflex is administered by trained healthcare professionals in a clinic setting, and it comes with specific safety rules for each condition it treats.

This guide covers what Xiaflex is used for, how dosing typically works, what side effects to watch for, what it can cost, and the practical “what should I ask my doctor?” details people wish they had on day one.

What is Xiaflex?

Xiaflex is an injectable enzyme therapy that targets collagen. Collagen is the tough structural protein that helps hold tissues together. That’s great when you’re healing a cut. It’s less great when collagen builds up in the wrong place and starts pulling, bending, or curving body parts that would prefer to keep their original geometry.

Xiaflex contains collagenase, an enzyme that breaks down collagen strands. In plain English: it helps weaken and disrupt collagen-heavy cords or plaques so the tissue can loosen and movement/shape can improve.

How Xiaflex works (without the lab-coat headache)

Think of problematic collagen as a thick, over-tight zip tie made of biological rope. Xiaflex is designed to weaken that rope. Once the collagen structure is softened, a clinician may perform a controlled “release” or modeling procedure (depending on the condition) to help restore function or reduce deformity.

Important note: Xiaflex doesn’t “melt” everything in the area. It’s injected into a targeted collagen structure, and the goal is to reduce the abnormal collagen that’s causing a functional problem. That targeting is part of why training and technique matter so much.

Approved uses

1) Dupuytren’s contracture (hand)

Dupuytren’s contracture happens when thickened tissue in the palm forms a cord that gradually pulls one or more fingers toward the palm. Over time, straightening the finger becomes difficult. Xiaflex is indicated for adults with a palpable cord causing contracture.

Real-life example: Someone can place their hand flat on a table… except the ring finger won’t fully cooperate. The goal of treatment is to improve extension so daily taskstyping, gloves, handshakes, pocketsstop feeling like obstacle courses.

2) Peyronie’s disease (penile curvature)

Peyronie’s disease involves a palpable plaque that can cause curvature. Xiaflex is indicated for adult men who have a plaque that can be felt and a curvature deformity meeting the criteria in prescribing information. Treatment involves in-office injections and a structured follow-up plan.

Because this condition and its treatment involve sensitive anatomy and specific safety risks, Xiaflex for Peyronie’s disease is available only through a restricted safety program and must be administered by trained clinicians.

Off-label uses

You may see Xiaflex mentioned online for other “fibrous tissue” problems. Off-label use means a clinician is prescribing a medication for a condition that is not an FDA-approved indication. If you ever hear “off-label,” your next question should be: “What’s the evidence, what are the risks, and what are my alternatives?”

Dosage and administration: what “dose” means for an injection you don’t give yourself

With Xiaflex, dosing is less about “take 1 tablet twice a day” and more about clinic-based treatment sessions. The dose is measured in milligrams per injection, and the schedule depends on the condition being treated. Your clinician determines the exact plan based on anatomy, severity, response, and safety considerations.

Dosage for Dupuytren’s contracture

• Typical labeled dose per injection: 0.58 mg injected into a palpable cord.
• Follow-up visit: usually about 24–72 hours after the injection, a clinician may perform a finger extension procedure if the contracture persists.
• Repeat dosing: if contracture remains, the cord may be re-injected after about 4 weeks. Treatment may be repeated up to 3 times per cord (per labeling).
• More than one area: in some cases, up to two joints in the same hand may be treated during a treatment visit (with separate preparation as required by clinicians).

What it feels like, practically: People often plan for a few days where the treated hand is sore, swollen, bruised, and not thrilled about heavy use. Many are advised to avoid manipulating the treated cord themselves and to follow the clinic’s instructions for splinting and exercises after the clinician’s procedure.

Dosage for Peyronie’s disease

Peyronie’s dosing is organized into treatment cycles. A cycle typically includes two injections separated by 1 to 3 days, followed by a clinician-performed modeling procedure 1 to 3 days after the second injection. Multiple cycles may be used, separated by several weeks, up to the maximum described in prescribing information.

Patients are commonly instructed to follow clinician-guided at-home activities between visits, and there are specific restrictions on sexual activity during certain parts of the cycle. Your clinician will give individualized instructions that match your anatomy, response, and safety profile.

How soon does Xiaflex work, and what results can you expect?

Dupuytren’s contracture: Many people notice improvement after the injection plus the clinician’s extension procedure, often within days to a couple of weeks. However, complete correction isn’t guaranteed, and some contractures require repeat treatment or alternative procedures. Recurrence can happen over time with any treatment approach for Dupuytren’s, because the underlying condition can progress.

Peyronie’s disease: Improvements are usually measured over weeks to months across treatment cycles. Clinical trials and guideline discussions describe meaningful average improvements in curvature for many (not all) appropriately selected patients, with results depending on factors like baseline curvature, plaque characteristics, and adherence to clinician guidance.

Reality check (the helpful kind): Xiaflex is often best thought of as a non-surgical option that may reduce a problem rather than erase it completely. For the right patient, “less curve” or “more finger extension” can be life-changingeven if it’s not mathematically perfect.

Side effects

Side effects vary depending on where Xiaflex is injected. Many are local (at or near the injection site) and temporary. Some are serious and require urgent evaluation. Because Xiaflex is an enzyme and a biologic product, allergic reactions are also possible.

Common side effects (often expected, usually temporary)

Dupuytren’s contracture

• Swelling in the hand or at the injection site
• Bruising or bleeding at the injection site
• Pain or tenderness in the hand
• Itching, redness, warmth, or skin irritation
• Swollen lymph nodes near the elbow or armpit
• Skin breaks/tears (can occur during the extension procedure)

Peyronie’s disease

• Swelling, bruising, pain, or tenderness in the treated area
• Firmness or localized discomfort
• Temporary changes in sensation

Serious risks and warnings (the part you should not skim)

Boxed warning: serious penile injury (Peyronie’s disease)

Xiaflex carries a boxed warning for corporal rupture (penile fracture) or other serious penile injury when used for Peyronie’s disease. This is rare but urgent. Symptoms such as a sudden “popping” sensation/sound, sudden loss of erection, significant pain, or difficulty urinating require immediate medical attention.

Tendon rupture or ligament injury (Dupuytren’s contracture)

If Xiaflex is injected into the wrong structure (like a tendon or ligament), it can cause serious injury. This is why treatment is performed by trained clinicians using careful technique. Report severe pain, inability to bend/straighten a finger, numbness, or worsening function promptly.

Hypersensitivity reactions, including anaphylaxis

Severe allergic reactions can occur because Xiaflex contains foreign proteins. Hives, facial swelling, breathing trouble, chest pain, dizziness, or fainting after an injection should be treated as urgent symptoms.

Bleeding and bruising risk

Because injection can cause local bleeding, patients taking blood thinners or with bleeding disorders need special evaluation and planning. Always tell your clinician about anticoagulants, antiplatelet drugs, and supplements that can increase bleeding risk.

Who should not receive Xiaflex?

Eligibility depends on indication, anatomy, and safety factors. Some common reasons Xiaflex may not be appropriate include:

• Known allergy to collagenase clostridium histolyticum or ingredients in the product
• For Peyronie’s disease: plaques that involve the urethra (the urine channel), because injection could increase injury risk
• Situations where the clinician determines the anatomy or risk profile makes treatment unsafe

Also, Xiaflex isn’t approved for children, and its safety/effectiveness in pediatric populations isn’t established.

Cost: why Xiaflex can be expensive (and how people often lower out-of-pocket costs)

Xiaflex is commonly categorized as a specialty medication. The total cost isn’t just “the drug”:

• Medication cost (often high for specialty biologic products)
• Administration fees (office procedures, injections, supplies)
• Follow-up procedures (finger extension or penile modeling visits)
• Insurance rules (prior authorization, step therapy, coverage criteria)

Insurance coverage patterns

Because Xiaflex is administered in a clinic, it may be billed under a medical benefit rather than a standard retail pharmacy benefit. This can affect deductibles, coinsurance, and which “bucket” the costs land in.

Common ways people save

• Manufacturer copay programs (for eligible commercially insured patients)
• Patient assistance programs (often income- and insurance-status based)
• Foundation support for certain diagnoses (availability can change)
• Clinic support services that help with paperwork and prior authorization

Practical tip: When you call your insurer, ask two separate questions: “Is Xiaflex covered?” and “How is it billedmedical or pharmacy?” That second answer often explains the first surprise bill.

Questions to ask your clinician (because “sounds good” is not a plan)

• Am I a good candidate based on my anatomy and severity?
• What outcome is realistic for me: improvement, partial correction, or symptom relief?
• How many treatment visits should I expect?
• What restrictions should I follow after injections (work, lifting, sports, sexual activity if applicable)?
• What are the serious warning signs that should prompt urgent care?
• What are my alternatives (needle procedures, surgery, traction therapy, watchful waiting), and how do they compare?
• What will this cost me with my specific insurance, including office and procedure fees?

Alternatives to Xiaflex

Xiaflex isn’t the only option, and sometimes it isn’t the best one. Alternatives depend on the condition:

Dupuytren’s contracture alternatives

• Needle aponeurotomy (needle-based cord disruption)
• Surgical fasciectomy (removal of diseased tissue)
• Observation for mild cases not limiting function
• Hand therapy and splinting (often supportive rather than curative)

Peyronie’s disease alternatives

• Observation (especially early or mild cases, depending on stability)
• Traction devices (selected patients; clinician guidance matters)
• Other intralesional therapies (used by some specialists)
• Surgical options for severe or persistent cases

Choosing between options is usually about balancing: degree of deformity, functional impact, stability over time, risk tolerance, and desired speed of results.

Frequently asked questions

Is Xiaflex a steroid?

No. It’s an enzyme (collagenase) that breaks down collagen.

Can I inject Xiaflex at home?

No. Xiaflex is administered by trained healthcare professionals due to the risk of serious injury if injected incorrectly.

Does Xiaflex cure Dupuytren’s or Peyronie’s disease?

It treats the collagen structure causing a specific problem (contracture or curvature). It can improve function and reduce deformity, but recurrence or ongoing disease progression can still occur.

What’s the biggest safety takeaway?

Follow post-procedure restrictions and report urgent symptoms immediately. For Peyronie’s disease, serious injury is rare but time-sensitive. For Dupuytren’s, protecting tendons and nerves depends on proper injection technique and careful follow-up.

Patient experiences and “what it’s like” (extended, ~)

Note: The experiences below are common themes reported by patients and clinics and are presented as generalized, educational examplesnot as medical advice or guarantees of outcome. Your experience may differ based on anatomy, severity, and treatment technique.

Dupuytren’s contracture: the “my hand is mad at me” week

A lot of people describe the first couple of days after a Xiaflex injection as surprisingly… colorful. Swelling and bruising are common, and the hand can look like it lost an argument with a doorframe. The discomfort is usually localized, but it can be annoying in very practical ways: gripping a steering wheel, opening jars, typing for long stretches, or even pulling on socks can feel like a negotiation.

One theme that comes up often is timing: people who plan their injection around work deadlines, travel, or big events tend to feel calmer because they’re not trying to do everything one-handed. (If you’ve ever tried to button a shirt with your non-dominant hand, you know why patience becomes a personality trait.)

The follow-up visitwhen the clinician assesses the cord and may perform an extension procedurecan be emotionally loaded. Some patients feel anxious because they’re worried about pain or about whether the finger will straighten. Others feel oddly hopeful, like they’re about to watch a stuck zipper finally move. When improvement happens, people often describe a moment of surprise: “Wait… my finger is actually straighter.” Even partial gains can feel huge because daily activities become easier fast.

Afterward, routines matter. Patients who stick with their clinician’s aftercare instructionssplinting if prescribed, gentle exercises if recommended, and avoiding risky hand useoften feel more in control. The best mindset is usually: “I’m helping healing happen,” not “I’m going to test-drive this hand like it’s a new pickup truck.”

Peyronie’s disease: the “structured plan” that requires patience

For Peyronie’s disease, people frequently describe Xiaflex treatment as more of a process than an event. There are scheduled injections, follow-up visits, and clear rules about what not to do between appointments. The biggest emotional shift tends to happen when patients realize the plan is designed for safetynot to be controlling, but to lower the chance of serious injury and to support the intended remodeling effect.

Patients often report that the first couple of days after an injection can involve bruising and swelling that looks dramatic but resolves. Many also say the mental side is real: it can feel awkward to talk about symptoms, to schedule visits, and to follow restrictions that disrupt normal routines. People who bring a list of questions to appointmentsespecially about what symptoms are expected versus urgentoften feel less anxious. (Sometimes the best medicine is clarity, closely followed by an ice pack and a calendar reminder.)

In terms of results, experiences vary. Some patients notice steady improvement across cycles; others see smaller changes and decide, with their clinician, whether continuing makes sense. A common “win” is not just a number on a curvature measurement, but improved confidence, less bother, and a feeling of getting their body back on speaking terms.

The most consistent success stories share two ingredients: careful patient selection by an experienced clinician and strong follow-through on instructions. The most frustrating stories tend to involve mismatched expectationshoping for a perfect fix when the realistic goal is meaningful improvement. Setting a realistic target up front can turn “I wish it was flawless” into “Wow, this is actually usable again,” which is a far better ending.

Conclusion

Xiaflex is a specialized, clinic-administered injection that targets excess collagen. For Dupuytren’s contracture, it may help release a tightening cord so fingers can straighten more. For Peyronie’s disease, it can reduce curvature in appropriately selected adult men through a structured cycle-based approach. Like any powerful tool, it comes with tradeoffs: common short-term side effects like swelling and bruising, and rare but serious risks that make proper training and follow-up essential.

If you’re considering Xiaflex, focus on three things: candidacy (are you the right fit?), expectations (what’s realistic for you?), and cost clarity (how will your insurance bill it?). With the right plan and guidance, Xiaflex can be a meaningful non-surgical optionone that helps collagen stop acting like it owns the place.