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Treatment for adults with Dupuytren’s
contracture with a palpable cord

XTRA TrainingProgram

Training program for hand surgeons by hand surgeons

Whether you are just getting started with XIAFLEX® or want to enhance your injection technique, access an assortment of exclusive resources

Training video and
enrollment forms

Real procedure videos
from our experts

Reimbursement forms and
information for office staff

What is your experience with XIAFLEX®?

Training Video

Watch the full training video prior to treating with XIAFLEX®

Only physicians who have completed the necessary training and enrollment can obtain and inject XIAFLEX®

Self Test




Where Innovation meets technique

Question 1 of 2


Before use, for how long should the vials containing XIAFLEX® and the diluent be left to stand at room temperature?

Question 2 of 2


Fill in the blanks: When reconstituting XIAFLEX®, use ____ mL of sterile diluent for an MP joint and _____ mL of sterile diluent for a PP joint.

Self Test


Injection Procedure


Where Innovation meets technique

Question 1 of 3


The proper site of injection for XIAFLEX® is:

Question 2 of 3


The amount of reconstituted XIAFLEX® that should be injected at each location along the cord is:

Question 3 of 3


When injecting XIAFLEX®, it is important to:

Self Test


Finger Extension Procedure


Where Innovation meets technique

Question 1 of 3


What is the maximum number of attempts that should be made to disrupt the cord during the follow-up visit?

Question 2 of 3


Injections and finger extension procedures may be administered up to ___ times per cord, at approximately 4-week intervals.

Question 3 of 3


What should patients be instructed to do following the finger extension procedure?

Download the Training Guide to reinforce your learnings from the training video.


Only enrolled HCPs and healthcare sites may receive XIAFLEX® orders

Only enrolled, trained physicians can administer XIAFLEX®


You must complete XIAFLEX® training in order to complete your enrollment

2Enroll yourself

Complete the HCP Enrollment Form to register and set up an account with the XTRA Managed Distribution Program

HCP Enrollment Form»

3Enroll your practice

Enroll healthcare sites as a ship-to location using the Pharmacy/Healthcare Setting Enrollment Form

  • All healthcare sites where XIAFLEX® will be shipped must be registered with the XIAFLEX® Managed Distribution Program

Setting Enrollment Form »

4Select preferred acquisition method

Please print the full Prescribing Information, including Medication Guide.

XTRA Videos

Help advance your technique

Watch your peers perform real patient procedures using XIAFLEX®

To become a trained injector, please refer to the Training Video

Please see full Prescribing Information, including Medication Guide.


Get answers to common questions about treating with XIAFLEX®

Facts about injection, finger extension, and more

To determine the proper site for injection,

locate the area where the contracting cord is maximally separated from the underlying flexor tendons, and where the skin is not intimately adhered to the cord.1

If injecting into a cord affecting the PIP joint of the fifth finger, care should be taken to inject as close to the palmar digital crease as possible (as far proximal to the digital PIP joint crease), and the needle insertion should not be more than 2 to 3 mm in depth. Tendon ruptures occurred after XIAFLEX® injections near the digital PIP joint crease.

For complete details on the appropriate injection procedure for XIAFLEX® watch the Training Video above.

Local anesthetic may be used for the finger extension procedure to help with patient comfort.1

However, it is not recommended prior to the injection procedure, as it may interfere with proper placement of the needle.1

To learn more about the appropriate administration of XIAFLEX®, visit the Procedure Overview page.

~24–72 hours after the injection of XIAFLEX®

the finger extension procedure may be performed if a contracture persists.1

Read more about performing the finger extension procedure on the Procedure Overview page.

Yes. In fact, XIAFLEX® demonstrated efficacy in patients with PIP contractures up to 80 degrees.2,3

Learn more about how XIAFLEX® helped correct contractures and increased range of motion on the PIP Joint Clinical Data page.

Please see full Prescribing Information, including Medication Guide.

PIP=proximal interphalangeal; MP=metacarpophalangeal.

View All

Important Safety Information
for Xiaflex

  • XIAFLEX is contraindicated in patients with a history of hypersensitivity to XIAFLEX or to collagenase used in any other therapeutic application or application method
  • In the controlled and uncontrolled portions of clinical trials in Dupuytren’s contracture, flexor tendon ruptures occurred after XIAFLEX injection. Injection of XIAFLEX into collagen-containing structures such as tendons or ligaments of the hand may result in damage to those structures and possible permanent injury such as tendon rupture or ligament damage. Therefore, XIAFLEX should be injected only into the collagen cord with a metacarpophalangeal (MP) or proximal interphalangeal (PIP) joint contracture, and care should be taken to avoid injecting into tendons, nerves, blood vessels, or other collagen-containing structures of the hand. When injecting a cord affecting a PIP joint of the fifth finger, the needle insertion should not be more than 2 to 3 mm in depth and avoid injecting more than 4 mm distal to the palmar digital crease
  • Other XIAFLEX-associated serious local adverse reactions in the controlled and uncontrolled portions of the clinical studies included pulley rupture, ligament injury, complex regional pain syndrome (CRPS), sensory abnormality of the hand, and skin laceration (tear). In a historically controlled post-marketing trial, the incidence of skin laceration (22%) was higher for subjects treated with two concurrent injections of XIAFLEX compared with subjects treated with up to three single injections in the placebo-controlled premarketing trials (9%). Post-marketing 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 have been reported. Signs or symptoms that may reflect serious injury to the injected finger/hand should be promptly evaluated because surgical intervention may be required
  • In the controlled portions of the clinical trials in Dupuytren’s contracture, a greater proportion of XIAFLEX-treated patients (15%) compared to placebo-treated patients (1%) had mild allergic reactions (pruritus) after up to 3 injections. The incidence of XIAFLEX-associated pruritus increased after more XIAFLEX injections in patients with Dupuytren’s contracture
  • Because XIAFLEX contains foreign proteins, severe allergic reactions to XIAFLEX can occur. Anaphylaxis was reported in a post-marketing clinical trial in one patient who had previous exposure to XIAFLEX for the treatment of Dupuytren’s contracture. Healthcare providers should be prepared to address severe allergic reactions following XIAFLEX injections
  • In the XIAFLEX trials in Dupuytren’s contracture, 70% and 38% of XIAFLEX-treated patients developed an ecchymosis/contusion or an injection site hemorrhage, respectively. Patients with abnormal coagulation (except for patients taking low-dose aspirin, eg, up to 150 mg per day) were excluded from participating in these studies. Therefore, the efficacy and safety of XIAFLEX in patients receiving anticoagulant medications (other than low-dose aspirin, eg, up to 150 mg per day) within 7 days prior to XIAFLEX administration is not known. In addition, it is recommended to avoid use of XIAFLEX in patients with coagulation disorders, including patients receiving concomitant anticoagulants (except for low-dose aspirin)
  • In the XIAFLEX clinical trials for Dupuytren’s contracture, the most common adverse reactions reported in ≥25% of patients treated with XIAFLEX and at an incidence greater than placebo were edema peripheral (eg, swelling of the injected hand), contusion, injection site hemorrhage, injection site reaction, and pain in the injected extremity. Post-marketing experience – Syncope and presyncope have been reported in patients treated with XIAFLEX for Dupuytren’s contracture. In some cases, pain from injection and pain during finger extension procedures were identified as potential triggers for syncopal events


XIAFLEX® is indicated for the treatment of adult patients with Dupuytren’s contracture with a palpable cord.

Click for full Prescribing Information and Medication Guide.

  1. References:
  2. 1. XIAFLEX® [package insert]. Malvern, PA: Endo Pharmaceuticals Inc.
  3. 2. Data on file. DOF-XDC-07. Endo Pharmaceuticals Inc; July 29, 2015.
  4. 3. Data on file. DOF-XDC-08. Endo Pharmaceuticals Inc; July 24, 2015.