What Is Xiaflex? A Peyronie’s Disease Guide

Peyronie’s disease can bring up a lot of questions, especially when it comes to understanding treatment options and what they involve. If you’ve come across the name Xiaflex and want to know more, you’re not alone. In this guide, we’ll break down what Xiaflex is, why it’s often discussed in relation to Peyronie’s disease, and what to know if you’re exploring information about it.

What Is Peyronie’s Disease? 

Peyronie’s disease is a progressive, non-cancerous condition where the penis develops an abnormal bend or curve during an erection. This happens because scar tissue, also called fibrosis, forms inside the tunica albuginea, the firm outer layer that surrounds the erectile tissue.

When this scar tissue forms, that area becomes less flexible. During an erection, the rest of the penis expands normally, but the scarred area does not stretch the same way, which can lead to bending or deformity. The exact reason why this fibrotic scar tissue develops is still not fully understood.¹

Peyronie’s disease can be distressing for many people because it may affect the shape, appearance, and function of the penis. It is also linked with erectile dysfunction, which can add to the physical and emotional impact of the condition.¹

What Is Xiaflex?

Xiaflex® is the brand name for collagenase clostridium histolyticum (CCH), a treatment made from enzymes originally isolated and purified from the bacterium Clostridium histolyticum in 1953 by Mandl et al.²

CCH contains a heterogeneous group of seven different enzymes known for their ability to specifically break down parts of type I and type III collagen fibers under physiological conditions. These collagen types are important because they make up much of the plaque tissue seen in Peyronie’s disease (PD).²

How Does Xiaflex Work in Peyronie’s Disease? 

Commercially, Xiaflex is available as a combination of two collagenase groups:

- AUX-I collagenases, which cleave the N-terminal and C-terminal ends of triple-helical collagen

- AUX-II collagenases, which hydrolyze internal peptide domains and have a higher affinity than AUX-I

Because Peyronie’s disease is a fibroproliferative condition marked by penile plaques made largely of type I and type III collagen, the collagen-targeting action of Xiaflex makes it a relevant therapeutic option.²

Who May Be Eligible for Xiaflex? 

XIAFLEX is indicated for adult men with Peyronie’s disease who have a palpable plaque (a plaque that can be felt during examination) and a curvature deformity of at least 30 degrees at the start of therapy. In simple terms, this means treatment may be considered for adults whose penile plaque can be physically identified and whose bend measures 30 degrees or more before treatment begins.³

What Does the Xiaflex Treatment Process Look Like? 

XIAFLEX treatment for Peyronie’s disease is administered by a healthcare provider experienced in treating male urological diseases. Before use, the XIAFLEX lyophilized powder is reconstituted using only the supplied diluent.³

A treatment cycle includes two XIAFLEX injection procedures followed by a penile modeling procedure:³

- To begin, a penile erection is induced so the healthcare provider can clearly identify and mark the target area within the Peyronie’s plaque that needs treatment. For this purpose, a single intracavernosal injection of 10 or 20 micrograms of alprostadil may be used.

- Once the plaque has been identified, the penis should return to a flaccid state before treatment is given. The provider then injects 0.58 mg of XIAFLEX into the target plaque once on each of two treatment days, scheduled 1 to 3 days apart.

- After the second injection, a penile modeling procedure is performed 1 to 3 days later as part of the same treatment cycle.

- For each plaque causing curvature deformity, up to four treatment cycles may be given. These cycles can be repeated at approximately six-week intervals.

- However, if the curvature deformity becomes less than 15 degrees after the first, second, or third cycle, or if further treatment is not clinically indicated, additional cycles should not be administered.

What Are Penile Modelling Exercises and Why Do They Matter? 

Penile modelling exercises are techniques used to apply gentle, controlled stretching force to the penis as part of Peyronie’s disease (PD) management. They are commonly discussed alongside Penile Traction Therapy (PTT), where a penile traction device (PTD) is used to place steady tension on the tissue. The goal is to stretch the tunica albuginea and support tissue remodeling, which may help reduce penile curvature and improve other PD-related symptoms.⁴

The proposed science behind this is mechanotransduction, a process where cells sense mechanical force and respond by changing cellular behavior and tissue structure. In PD, this remodeling effect is believed to help areas affected by plaque-related changes.⁴

These exercises matter because they are considered a non-invasive, self-administered, and generally safe treatment approach. They may be used as a primary lengthening therapy with modest improvements, for curvature correction before surgery or to help avoid surgery, and as part of rehabilitation after surgical correction. One common challenge, however, is consistency, since traditional traction-based routines may require 2 to 9 hours per day of use.⁴

What Results Do Patients Expect From Xiaflex? 

Studies on CCH in Peyronie’s disease have shown improvements in penile curvature, deformity, and pain in many patients:

- In one early study of 31 patients with stable Peyronie’s disease, 20 patients (64.5%) had an objective improvement within 4 weeks of the first injection. Peyronie’s disease was eliminated in 4 patients, while 16 patients (51.6%) had a reduction in penile curvature ranging from 20% to 100%.²

- The same study also found that Xiaflex relieved penile deformity more effectively in patients who had a greater initial plaque burden. Among 14 patients who had penile pain at the start of treatment, 13 patients (92.9%) reported complete pain resolution within 4 weeks.²

- Later studies combined Xiaflex with penile modeling therapy, which involved gentle stretching of the flaccid penis in the opposite direction of the curve. In a phase IIb study involving 147 patients, the Xiaflex plus modeling group had a mean penile curvature reduction of −17.5° ±15.3°, equal to 32.4% improvement per patient. This was better than Xiaflex without modeling (−15.0° ±14.0° or 27.1%) and placebo with modeling (−5.4° ±13.8° or 11%; p<0.001).

- A larger trial also showed statistically significant results. Patients receiving Xiaflex had a mean curvature reduction of −17.0° ±14.8°, or 34%, compared with −9.3° ±13.6°, or 18.2%, in the placebo group.²

What Are the Important Risks and Side Effects? 

XIAFLEX has several important risks and side effects that should be understood before treatment. The most frequently reported side effects seen in 25% or more of patients, and more often than placebo, were penile hematoma (bruising), penile swelling, and penile pain.Other risks include:³

- One serious risk is corporal rupture (penile fracture) or other serious injury to the penis. Because of this, injections should avoid areas such as the urethra, nerves, blood vessels, corpora cavernosa, and other collagen-containing structures, as injury to these areas may lead to possible permanent damage.

- Another important risk is hypersensitivity reactions, including anaphylaxis, which is a severe allergic reaction.

- XIAFLEX should also be used with caution in patients with abnormal coagulation or those who have taken anticoagulant medications (other than low-dose aspirin) within 7 days of the injection, as this may increase bleeding-related concerns.

Why Is Xiaflex Given Only by a Trained Specialist? 

Xiaflex is given only by a trained specialist because the treatment involves a precise injection technique and condition-specific handling. Proper training helps ensure the medication is administered in the appropriate setting, with the right approach, and with guidance on what to expect before and after treatment to lower risks.³

Questions to Ask Your Urologist Before Starting Xiaflex 

Before starting Xiaflex, it can be helpful to have an open conversation with your urologist so you know what the treatment process may involve and what to expect:

- How does the treatment process usually work?
- How many appointments might be needed?
- What can I expect during each visit?
- Is there anything I should do before starting treatment?
- What should I expect after each session?
- Are there any activity restrictions during treatment?
- How long does the overall process usually take?
- How will progress typically be reviewed?
- Are there other treatment options I should know about?
- What factors help decide if Xiaflex is the right choice for me?
- What costs or insurance details should I check beforehand?
- When should I contact you if I have questions during treatment?

Xiaflex Access and Treatment Planning 

Getting started with Xiaflex often involves more than just the treatment itself, it can also include appointment scheduling, prescription coordination, insurance checks, and planning visits around your routine. Understanding these practical steps early can make the process feel smoother and less stressful.

It is available in India through specialized pharmaceutical importers and distributors, primarily for treating Dupuytren's contracture and Peyronie's disease. You can purchase it from specialized importers like Rx4u.

Conclusion 

In summary, Xiaflex is one of the treatment options that may be discussed for Peyronie’s disease, and the best next step is usually an informed conversation with a qualified urologist about whether it fits your needs, goals, and treatment plan.³ Access can also involve practical steps such as prescriptions, scheduling, and availability support. For patients in India exploring sourcing pathways, services like Rx4U may help simplify the process through specialized import assistance and coordination.

FAQs

1.What is Xiaflex used for in Peyronie’s disease?
Xiaflex is used in adult men with Peyronie’s disease who have a palpable plaque and curvature deformity of at least 30 degrees.³

2. How does Xiaflex work?
Xiaflex contains collagenase enzymes that break down type I and type III collagen found in Peyronie’s plaque tissue.²

3. Who gives Xiaflex treatment?
Xiaflex is administered by a healthcare provider experienced in treating male urological diseases.³

4. How many Xiaflex treatment cycles can be given?
For each plaque causing curvature deformity, up to four treatment cycles may be given at approximately six-week intervals.³

5. What are the common side effects of Xiaflex?
Commonly reported side effects include penile bruising, swelling, and pain.³

6. Can Xiaflex be combined with other approaches?
Studies have evaluated Xiaflex alongside penile modeling exercises to support curvature improvement.²

7. Is Xiaflex available in India?
Xiaflex may be accessed in India through specialized importers and distributors like RX4U.

8. Should I speak to a urologist before starting Xiaflex?
Yes, discussing suitability, expectations, and treatment planning with a qualified urologist is recommended.³

References

1. Sandean DP, Leslie SW, Lotfollahzadeh S. Peyronie Disease. [Updated 2024 Oct 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560628/

2. Gabrielson AT, Alzweri LM, Hellstrom WJ. Collagenase Clostridium Histolyticum in the Treatment of Peyronie's Disease: Review of a Minimally Invasive Treatment Option. World J Mens Health. 2017;35(3):134-145. doi:10.5534/wjmh.17033

3. XIAFLEX [prescribing information]. Endo Pharmaceuticals Inc.; n.d. Accessed April 23, 2026. file:///C:/Users/lp/Downloads/3.%20XIALEX%20PI.pdf

4. Almsaoud NA, Safar O, Alshahrani ST, et al. The effect of penile traction device in men with Peyronie's disease on penile curvature, penile length, and erectile dysfunction: a systematic review and meta-analysis. Transl Androl Urol. 2023;12(11):1673-1685. doi:10.21037/tau-23-310.

Note:

This information is provided for educational purposes only and is not a substitute for professional medical advice. Xiaflex should only be taken under the guidance of a qualified healthcare provider. Patients should always consult their doctor or pharmacist for advice on diagnosis, treatment, and medication use, and should not make changes to their prescribed therapy without medical supervision.

Disclaimer:

Rx4U procures prescribed medicines directly from manufacturers or authorized distributors. It does not claim ownership of any trademarks and complies with the provisions of the Trademark Act, 1999, particularly Sections 30 and 30(1) concerning ‘Fair Use’. It solely facilitates access to new launches through named patient import.