Expanded PBS Listing for IncobotulinumtoxinA

The Pharmaceutical Benefits Scheme (PBS) listing for incobotulinumtoxinA (Xeomin®) has expanded to include chronic sialorrhea.

Eligible patient groups include:

• Adults with Parkinson’s disease, atypical Parkinson’s, traumatic brain injury, or chronic sialorrhea following an acute event; and
• Children (2-17 years) with cerebral palsy, traumatic brain injury, or a developmental disorder.

Sialorrhea is commonly associated with neurological conditions and can cause social issues, skin irritation, and aspiration risk. Management typically requires a multi-modal approach. While anticholinergic medications may be effective in reducing saliva production, their use is often limited by adverse effects and drug interactions.

IncobotulinumtoxinA offers a targeted treatment option. When injected directly into the salivary glands, it reduces saliva production by inhibiting acetylcholine release from peripheral nerve endings. The onset of effect typically occurs within one week, with peak response at around four weeks. Dosing intervals are determined by individual clinical need but should not be more frequent than every 16 weeks.

IncobotulinumtoxinA has demonstrated efficacy in reducing unstimulated salivary flow rate. It is often better tolerated than systemic anticholinergics, particularly for patients with dementia or Parkinson’s disease who are sensitive to their effects on the central nervous system. Common adverse effects associated with incobotulinumtoxinA therapy include paraesthesia, dry mouth, and dysphagia. Severe and persistent dry mouth has been reported and may contribute to complications such as dysphagia or dental issues.