Names and pronunciation
(oh-mah-lye-zoo′mab) Xolair
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Drug reference
(oh-mah-lye-zoo′mab) Xolair
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Func. class.: Antiasthmatic
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Chem. class.: Monoclonal antibody
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ACTION: Recombinant DNA-derived humanized IgG murine monoclonal anti- body that selectively binds to IgE to limit the release of mediators in the allergic response
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USES: Moderate to severe persistent asthma, chronic idiopathic urticaria
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CONTRAINDICATIONS: Hyper- sensitivity to hamster protein
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Black Box Warning: Hypersensitivity to this product Precautions: Pregnancy, breastfeeding, children <12 yr, acute attacks of asthma, lymphoma, nephrotic disease, broncho- spasm, neoplastic disease, status asthmaticus Black Box Warning: Anaphylaxis, aller- gic reactions: rash, urticaria, inability to breathe, edema of throat; product should be discontinued; have emergency equip- ment available; observe for 2 hr; reaction can occur ≤24 hr • Pregnancy/breastfeeding: use only if clearly needed; pregnant patients should enroll in the EXPECT Pregnancy Registry, 1-866-496-5247; cautious use in breast- feeding, excretion unknown Black Box Warning: To report signs of allergic reaction immediately, can be life- threatening
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SIDE EFFECTS CV: Heart failure, cardiomyopathy, hypo- tension, MI, PE, thrombosis HEMA: Serious systemic eosinophilia INTEG: Pruritus, dermatitis, inj-site reac- tions, rash MISC: Earache, dizziness, fatigue, pain, malignancies, viral infections, anaphy- laxis, thrombocytopenia, headache MS: Arthralgia, fracture, leg, arm pain RESP: Sinusitis, upper respiratory infec- tions, pharyngitis, pulmonary hyperten- sion, bronchospasm
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INTERACTIONS Increase: toxicity—belimumab, loxapine (inhalation), avoid using together • Use cautiously with live virus vaccines Drug/Lab Test Increase: IgE
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DOSAGE AND ROUTES Moderate to severe asthma • Adult/child ≥16 yr: SUBCUT 75-375 mg × 2-4 wk; divide inj into 2 sites if dose >150 mg; dose is adjusted based on IgE levels, significant changes in body weight Chronic idiopathic urticaria • Adult/adolescent >12 yr: SUBCUT 150-300 mg q4wk
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Available forms: Powder for inj, lyoph- O ilized 202.5 mg (150 mg/1.2 mL after reconstitution); 75 mg/0.5 mL, 150 mg/ mL; prefilled syringe
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Administer: SUBCUT route • Reconstitute using 1.4 mL sterile water for inj (150 mg/1.2 mL or 125 mg/mL); gently swirl to dissolve; allow vial to stand and q5min gently swirl for 5-10 sec to dissolve; some vials may take ≥20 min; do not use if contents do not dissolve within 40 min; should be clear or slightly opalescent; use large-bore needle to withdraw medication; replace needle with small-bore needle • Given q2-4wk; product is viscous; if >150 mg is given, divide into 2 sites; inj may take 5-10 sec to administer
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Assess: • Asthma: respiratory rate, rhythm, depth; auscultate lung fields bilaterally; notify prescriber of abnormalities; monitor pulmonary function tests; serum IgE (may increase and continue for 1 yr) • Inj-site reactions: inflammation, edema, redness, warmth at site; may oc- cur within 60 min of inj; may decrease with repeated dosing
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Evaluate: • Therapeutic response: ability to breathe more easily
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That improvement will not be immediate • Not to stop taking or decrease current asthma medications unless instructed by prescriber • To avoid live virus vaccines while tak- ing this product
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PHARMACOKINETICS Slowly absorbed, peak 7-8 days, half-life 26 days, degradation by liver, excretion in bile
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• Adult/child ≥16 yr: SUBCUT 75-375 mg × 2-4 wk; divide inj into 2 sites if dose >150 mg; dose is adjusted based on IgE levels, significant changes in body weight Chronic idiopathic urticaria
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